There is an ongoing outbreak of infectious syphilis affecting young Aboriginal and Torres Strait Islander people, predominately aged between 15 and 29 years, living in northern Australia.
The outbreak began in northern Queensland in January 2011, extended to the Northern Territory in July 2013, and then onto the Kimberley region of Western Australia in June 2014. In March 2017, South Australia declared an outbreak in the Western, Eyre and Far North regions from November 2016.
Current outbreak data to 31 October 2018 are attached in the surveillance report below. For historical data, please refer to the Reports section below.
The Australian Health Protection Principal Committee (AHPPC) Governance Group has developed a National strategic approach for an enhanced response to the disproportionately high rates of STI and BBV in Aboriginal and Torres Strait Islander people (Strategic Approach).
This will address the disproportionately high rates of syphilis and other Blood-Borne Viruses (BBV) and Sexually Transmissible Infections (STI) in regional and remote Indigenous communities.
The Strategic Approach was endorsed by the Australian Health Ministers’ Advisory (AHMAC) Council on 8 December 2017.
Supporting the Strategic Approach is an Action Plan, which is the Enhanced response to addressing STI (and BBV) in Indigenous populations.
The Action Plan will outline activities that are or will be undertaken to respond to the syphilis outbreak. The Action Plan was also endorsed by AHMAC on 8 December 2017.
The Australian Government has committed $8.8m in funding to support the enhanced response in line with the AHMAC endorsed Strategic Approach and Action Plan and delivered through Aboriginal Community Controlled Health Services (ACCHS) in the outbreak regions.
A test and treat model was endorsed by the AHPPC, commencing from June 2018 at ACCHS in Townsville and Cairns (Queensland) and Darwin (Northern Territory).
These sites were chosen in consultation with the jurisdictions and the National Aboriginal Community Controlled Health Organisation (NACCHO) because of the high and emerging number of syphilis cases in these regions and the capacity of the services to help develop, implement and trial the first phase of the rollout.
The Australian Government Department of Health is currently working to identify and plan the next phase of sites which will include Western Australia and other regions in the Northern Territory, with further sites in South Australia and Queensland being considered.
Affected jurisdictions are also responding to the outbreak in accordance with the recently updated 2018 National Guidelines for Syphilis.
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The disease control interventions that are being implemented or enhanced include:
- opportunistic and community screening/testing, particularly among young sexually active people aged less than 29 years;
- immediate treatment of people who are symptomatic (e.g. genital ulceration), have tested positive for syphilis or are sexual contacts of cases;
- reinforcement and focus on antenatal screening for syphilis, with particular attention paid to recommended guidelines for the ‘at risk’ population;
- public health alerts, health protection education and campaigns; and
- active follow up of cases.
Multi-jurisdictional Syphilis Outbreak Working Group (MJSO)
In April 2015, a Multijurisdictional Syphilis Outbreak Working Group (MJSO) of the Communicable Diseases Network Australia (CDNA) was formed in response to this on-going outbreak among young Aboriginal and Torres Strait Islander people living in remote areas of northern Australia.
The MJSO, with representatives from affected jurisdictions, sexual health physicians, experts in Aboriginal and Torres Strait Islander sexual health and the Australian Government Department of Health, meets regularly with the objective of advising governments on co-ordinating the public health response for outbreak control and preventing transmission of syphilis from infected women to their babies, through rigorous antenatal testing and care.
Syphilis Enhanced Response Governance Group
The Governance Group was established by AHPPC in September 2017 to oversee the enhanced response, including short term actions to address immediate priorities. The Governance Group will also take into consideration a long term approach to a sustainable response to STI and BBV.
The Chair of the Governance Group is the Commonwealth Chief Medical Officer (First Assistant Secretary Office of Health Protection (FAS OHP) (proxy)) and members include:
- Chair MJSO Working Group;
- Representative from the National Aboriginal Community Controlled Health Organisation (NACCHO);
- Representative from the South Australian Health and Medical Research Institute (SAHMRI);
- Representative from CRANAplus; and
- Chief Health Officers or senior decision makers from Queensland, Northern Territory, Western Australia, and South Australia.
The Governance Group is supported as needed by the various areas within the Commonwealth (including Department of Health and the Department of Prime Minister and Cabinet), as well as the AHPPC sub-committees and technical working groups, as outlined below:
- Communicable Diseases Network Australia: national public health coordination and leadership, including through the Series of National Guidelines (SoNGs);
- MJSO: surveillance, reporting, workforce issues related to the outbreak and guidance on antenatal care;
- Public Health Laboratory Network: advice and expertise on pathology and laboratory services, including Point of Care Testing (PoCT) and improved access to laboratory data; and
- Blood Borne Viruses and Sexually Transmissible Infections Standing Committee: advisory body on strategic policy, programs, social policy activities relating to BBV and STI, including education and awareness.
The Governance Group will also request advice and support as needed from key non-Government agencies, including: NACCHO, SAHMRI, Kirby Institute; Royal Australian College of General Practitioners, CRANAplus, Royal Australian College of Physicians; and Rural Doctors Association of Australia.
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Enhanced Response Unit
A dedicated unit, the STI Enhanced Response Unit (ERU) has been established in the Australian Government Department of Health within the Office of Health Protection to coordinate and progress the Commonwealth’s enhanced response to the syphilis outbreak.
Community Engagement and Health Resources
The Australian Government is funding SAHMRI to deliver a multi-strategy Aboriginal and Torres Strait Islander community awareness, education and testing campaign for syphilis and other STI.
The SAHMRI campaign will assist in:
- targeting Aboriginal and Torres Strait Islander people aged 15–29 years living in regional and remote Aboriginal communities of Queensland, Northern Territory, Western Australia and South Australia; and
- promotion, through television and radio advertising, engaging with local community groups, social media and the Young Deadly Free website.
The Young Deadly Free website offers a range of resources for young people in remote Aboriginal communities, as well as resources for Elders, parents, youth workers and other community leaders – with tips on how the whole community can work with young people to encourage STI and BBV testing, and knockout STIs and BBVs.
The website also offers resources for clinicians working in remote communities, providing links to testing and treatment guidelines and practical tips on engaging with young people on difficult topics such as sex, sexuality, and drug and alcohol use.
A full report titled Infectious and congenital syphilis notifications associated with an ongoing outbreak in northern Australia was published in the March 2016 edition (Volume 40 Number 1) of the Communicable Diseases Intelligence.
MJSO Surveillance Reports
The MJSO Surveillance Reports, formerly the MJSO Communique, summarise the epidemiological data from the outbreak for the period. For historical epidemiological data and MJSO activities refer to the MJSO Communiques.
2018 Surveillance Reports
The MJSO meeting Communiques summarise the epidemiological data from the outbreak and the activities of the group for the period. For the latest epidemiological data refer to the MJSO Surveillance Reports.
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