Vaccine Preventable Diseases in Australia, 2005 to 2007

Appendix 6.6 Case definitions of selected notifiable vaccine preventable diseases prior to 2004

Page last updated: 24 December 2010

In September 2003, new national case definitions for notifications reported to NNDSS were endorsed by the Communicable Diseases Network Australia,1 with nearly all jurisdictions implementing the new definitions in January 2004 (New South Wales commenced in August 2004). Prior to the adoption of the national definitions, some jurisdictions used the 1994 NHMRC case definitions2 (e.g. Tasmania and the Australian Capital Territory), some jurisdictions used modified definitions that were based on the NHMRC case definitions, and some others used definitions specific to the state (e.g. New South Wales) for some diseases.

This appendix highlights the 1994 NHMRC Surveillance Case Definitions2 in use for notifiable diseases data prior to 2004 for the vaccine preventable diseases covered in this report, with the exception of those that became notifiable after 1994 (influenza, invasive pneumococcal disease, rotavirus and varicella/zoster). An unpublished report that reviewed the national notifiable diseases case definitions, prepared by Dr Sue Skull for the Communicable Diseases Network Australia and New Zealand in January 2001, identified considerable discrepancies from the respective NHMRC case definitions being used by various jurisdictions then, for each of the diseases included in this appendix. The variations included the exclusion of one or more of the NHMRC criteria, addition of extra alternative or mandatory criteria, modification of some of the criteria, and inclusion of suspected or presumptive cases in addition to confirmed cases. Further details about definitions in use previously may be found in earlier reports in this series.3–5

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Diphtheria

Notifications prior to 2004

  • Isolation of toxigenic Corynebacterium diphtheriae and one of the following:
  • pharyngitis and/or laryngitis (with or without membrane), or toxic (cardiac or neurological) symptoms.

Haemophilus influenzae type b

Notifications prior to 2004

  1. An invasive clinically compatible illness (meningitis, epiglottitis, cellulitis, septic arthritis, osteomyelitis, pneumonia, pericarditis or septicaemia) and either:
    • the isolation of Haemophilus influenzae type b (Hib) from blood, or
    • detection of Hib antigen (in a clinically compatible case), or
    • detection of Gram-negative bacteria where the organism fails to grow in a clinical case

or

  1. A confident diagnosis of epiglottitis by direct vision, laryngoscopy or X-ray.

Note: In Victoria, from 2002, notifications only included cases where Hib was laboratory confirmed.6

Hepatitis A

Notifications prior to 2004

  1. Detection of anti-hepatitis A virus IgM antibody, in the absence of recent vaccination

or

  1. A clinical case of hepatitis (jaundice, with or without elevated aminotransferase levels, and without a non-infectious cause), and an epidemiological link to a serologically confirmed case.

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Hepatitis B

Notifications prior to 2004

People who have a positive hepatitis B surface antigen (HBsAg) and one of the following:

  1. hepatitis B core antibody (anti-HBc) IgM

or

  1. demonstration of a clinical illness consistent with acute viral hepatitis (jaundice, elevated aminotransferase).

Note: Prior to 2004, the variations in case definition criteria among jurisdictions included the exclusion of one or more of the NHMRC criteria (e.g. other causes of acute hepatitis), addition of extra alternative criteria (e.g. HbsAg positive with a previous negative test in the last 12 months), inclusion but differentiation of acute, unspecified infection and chronic carrier cases, and the inclusion of suspected and presumptive cases.

Influenza

Notifications prior to 2004

The 1994 NHMRC Surveillance Case Definitions did not include influenza. Laboratory-confirmed influenza became a notifiable disease in 2001 in all jurisdictions except for South Australia, where laboratory-confirmed influenza became notifiable in May 2008; nevertheless, cases reported in South Australia prior to May 2008 were included in the NNDSS dataset. The case definition criteria for laboratory-confirmed influenza remained unchanged from 2001 to 2004.

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Measles

Notifications prior to 2004

  1. An illness characterised by all of the following features:
    • a generalised maculopapular rash lasting 3 or more days, and
    • a fever (at least 38ºC if measured), and
    • cough or coryza or conjunctivitis or Koplik spots

or

  1. Demonstration of measles-specific IgM antibody

or

  1. A 4-fold or greater change in measles antibody titre between acute and convalescent phase sera obtained at least 2 weeks apart, with tests preferably conducted at the same laboratory

or

  1. Isolation of measles virus from a clinical specimen

or

  1. A clinically compatible case epidemiologically related to another case.

Meningococcal disease

Notifications prior to 2004

  1. Isolation of Neisseria meningitidis from a normally sterile site

or

  1. Detection of meningococcal antigen in joints, blood or cerebrospinal fluid (CSF)

or

  1. Detection of Gram negative intracellular diplococci in blood or CSF.

Note: The variations in case definition criteria among jurisdictions included the addition of extra alternative criteria (e.g. presence of clinical compatible illness in addition to laboratory criteria of diplococci isolated from skin and joints; culture from conjunctiva; positive nucleic acid test from cerebrospinal fluid, blood or normally sterile sites together with clinically compatible disease) and inclusion of suspected, presumptive and probable cases.

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Mumps

Notifications prior to 2004

  1. Isolation of mumps virus from a clinical specimen

or

  1. Significant rise in mumps antibody level by any standard serological assay, except following vaccination

or

  1. A clinically compatible illness (unilateral or bilateral swelling of the parotid or other salivary glands lasting 2 days or more without other apparent cause).

Note: In Victoria, from July 2001, notifications based on a clinical case definition alone [(c)] were no longer notifiable. In New South Wales, only laboratory-confirmed cases [(a) or (b)] were notifiable. In Queensland, mumps was not notifiable between July 1999 and June 2001.

Pertussis

Notifications prior to 2004

  1. Isolation of Bordetella pertussis from a clinical specimen

or

  1. Elevated B. pertussis-specific IgA in serum or the detection of B. pertussis antigen in a nasopharyngeal specimen using immunofluorescence with history of a clinically compatible illness

or

  1. An illness lasting 2 weeks or more with one of the following: paroxysms of coughing, or inspiratory whoop without other apparent causes, or post-tussive vomiting

or

  1. An illness characterised by a cough lasting at least 2 weeks in a patient who is epidemiologically linked to a laboratory-confirmed case.

Invasive pneumococcal disease

Notifications prior to 2004

The 1994 NHMRC Surveillance Case Definitions did not include invasive pneumococcal disease. Invasive pneumococcal disease became a notifiable disease in 2001 in all jurisdictions, and the case definition criteria remained unchanged from 2001 to 2004.

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Poliomyelitis

Notifications prior to 2004

Acute-onset flaccid paralysis of one or more limbs with decreased or absent tendon reflexes in the affected limb(s) without apparent cause, and without sensory or cognitive loss.

Q fever

Notifications prior to 2004

  1. A 4-fold or greater change in serum (CF) antibody titre to Phase II antigen of Coxiella burnetii

or

  1. A 4-fold or greater change in enzyme-linked immunosorbent assay (ELISA) antibody titre to Phase I or Phase II antigens of C. burnetii

or

  1. An IgM fluorescent antibody titre of at least 1:160 during the convalescent phase of the illness (i.e. 10 days or more after onset)

or

  1. In chronic infections (e.g. endocarditis), elevated (CF) IgG or IgA titres to C. burnetii Phase I antigen

or

  1. Isolation of C. burnetii from a clinical specimen.

Rubella

Notifications prior to 2004

  1. A generalised maculopapular rash, fever, and one or more of arthralgia/arthritis or lymphadenopathy or conjunctivitis, and an epidemiological link to a confirmed case

or

  1. Demonstration of rubella-specific IgM antibody, except following vaccination

or

  1. A 4-fold or greater rise in rubella antibody titre between acute and convalescent phase sera obtained at least 2 weeks apart

or

  1. Isolation of rubella virus from a clinical specimen.

Note: From July 2001 to July 2002, enhanced rubella surveillance was undertaken in Victoria; this led to an increase in the specificity of notifications.7

Tetanus

Notifications prior to 2004

A clinically compatible illness without other apparent cause, with or without a history of injury, and with or without laboratory evidence of the organism or its toxin.

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References

1. Communicable Diseases Network Australia. Surveillance case definitions for the Australian National Notifiable Diseases Surveillance System. 2004. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-casedefinitions.htm Accessed on 24 August 2009.

2. Public Health Committee, National Health and Medical Research Council. Surveillance case definitions. Canberra: National Health and Medical Research Council, 1994.

3. McIntyre P, Amin J, Gidding H, Hull B, Torvaldsen S, Tucker A, et al. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 1993–1998. Commun Dis Intell 2000;24(Suppl):S1–S83.

4. McIntyre P, Gidding H, Gilmour R, Lawrence G, Hull B, Horby P, et al. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 1999 to 2000. Commun Dis Intell 2002;26(Suppl):S1–S111.

5. Brotherton J, McIntyre P, Puech M, Wang H, Gidding H, Hull B, et al. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 2001 to 2002. Commun Dis Intell 2004;28(Suppl 2):S1–S116.

6. Public Health Group. O’Grady KA, Counahan M, Birbilis E, Tallis G, eds. Surveillance of notifiable infectious diseases in Victoria, 2002. Melbourne: Communicable Diseases Section, Rural and Regional Health and Aged Care Services, Victorian Department of Human Services, 2003. Available from: http://www.health.vic.gov.au/__data/assets/pdf_file/0019/19810/snid2002_complete.pdf Accessed on 31 March 2010.

7. Guy RJ, Andrews RM, Kelly HA, Leydon JA, Riddell MA, Lambert SB, et al. Mumps and rubella: a year of enhanced surveillance and laboratory testing. Epidemiol Infect 2004;132(3):391–398.

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