Vaccine Preventable Disease Update

Clinical Vaccinology Update

November 2019

Janet Strachan

Senior Epidemiologist (Vaccine Preventable Diseases)

Communicable Disease Epidemiology and Surveillance

Health Protection Branch

Regulation Health Protection and Emergency Management Division

Measles

Measles Incidence Rate per Million

(12 month period)

https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/

UK 2019

Lost WHO “measles-free status"

USA 2019

Most measles cases

in 25 years

New Zealand 2019

> 2000 measles cases

Samoa 2019

≈1,800 measles cases

22 deaths

21/22 < 5 yrs old

10/22 < 12 mths old

Measles

Victoria vs Rest of Australia

January 2009 – October 2019

0

50

100

150

200

250

300

350

400

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

VIC Rest of Australia

http://www9.health.gov.au/cda/source/cda-index.cfm

Measles immunisation

Pre-1970 most children infected by 5 years of age

1970-72 single measles vaccine dose added to schedule

1992-93 2nd dose added to schedule

…

2019 Australian-born ≈ 25 – 50 years

- received maybe one dose = “under immunised”

2019 Overseas-born – unknown vaccination status

Measles prodrome

Cough

Coryza

Conjunctivitis

Fever

Rash around Day 4

Maybe not all symptoms present

Measles Rash

Rash begins behind ears

Spreads to face and neck

Spreads to rest of body

Rash can be very faint

- Might be itchy

- May appear anywhere on the body

Public Health Management

“Immune”

A person can be considered to be immune if:

• Born pre-1966 (presumed natural immunity)

• Documented evidence of 2 doses of measles vaccine

• Documented evidence of immunity (IgG positive)

• Documented lab-confirmed prior measles

Measles

Source of Infection

Victoria January 2019 – October 2019

SOURCE Cases

IMPORTED

Thailand 5

New Zealand 4

Vietnam 3

Philippines 3

India 1

Myanmar 1

Lebanon 1

[ Indonesia (Bali) 0 ]

IMPORT-RELATED

Australia (contact with known imported case) 17

Australia (unknown source) 3

November 2019

4 imported cases from Samoa

+

2 secondary cases

Samoa

Recent cases include seasonal workers in regional areas

Background Issue in Samoa

July 2018

Incorrect diluent used to prepare MMR 2 child deaths

“chaos … mistrust”

MeaslesVIC: January – October 2019By age group and sex

+

Age (years)

Measles

VIC: January – October 2019

Cases aged ≤ 12 months old

All aged ≥ 6 months

Influenza

Influenza – notified cases

VIC: 1 January 2017 – 31 October 2019

Notified cases of laboratory-confirmed influenza

Age group, influenza type, and rate (per 100,000 pop)

Victoria 2019

0

500

1000

1500

2000

2500

3000

0

1,000

2,000

3,000

4,000

5,000

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Age group (years)

Type A Rate

0

500

1000

1500

2000

2500

3000

0

1,000

2,000

3,000

4,000

5,000

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Age group (years)

Type B Rate

Nu

mb

er

of

No

tifi

ed

Cases

An

nu

al ra

te p

er 1

00,0

00 p

op

ula

tion

Influenza – notified cases

VIC: 1 January 2017 – 31 October 2019

Disease notifications based on laboratory results

eg Influenza and “Influenza-like illness”

GPs Hospital

Factors affecting number of

influenza notifications

Health-seeking behaviour

- Severity of illness

Immunity (vaccinated or previous exposure)

- Need work certificate

- Availability of doctor

- Age

Doctor testing behaviour

Flu surveillance

Flutracking - self reported online

Nurse-on-call

GPs - people presenting with influenza-like illness

Ambulance

Hospitals - emergency department, admissions, ICU

Mortality - death notifications (BDM – Dept Justice)

- Proportion of patients presenting with influenza-like illness (ILI)

- Percentage of patients with ILI who have influenza

- Identification of other circulating viruses causing ILI

VicSPIN

Sentinel GP surveillance of influenza-like illness

https://www.vidrl.org.au/surveillance/influenza-surveillance/

VicSPIN – sentinel GP surveillance

Influenza-like illness consultation proportions

2009 – October 2019

ALERT

ABOVE

AVERAGE

AVERAGE

BASELINE

Source: Victorian Infectious Diseases Reference Laboratory

0

5

10

15

20

25

30

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

ILI p

ati

en

ts p

er

1,0

00

co

nsu

ltati

on

s

Year

How severe is the flu this year?

FluCAN

Sentinel Hospital Admissions

Victoria

Laboratory-confirmed influenza admissions from 1 April

2019 2018 2017

year-to-date ICU % year-to-date ICU % year-to-date ICU %

Adult # 969 6.9 185 9.7 1029 10.9

Paediatric # 700 10.1 127 7.1 -- --

https://monashhealth.org/services/services-f-n/monash-infectious-diseases/research4/influenza-research/flucan-influenza-surveillance-2/

Meningococcal

Infection

Meningococcal Infections

VIC: 1 January 2009 – 31 October 2019

B C W Y Not typed Probable case

MenACWY

15-19 yrs

Meningococcal age groups

Victoria: 1 January 2015 – 31 October 2019

B C W Y Not typed Probable case

Whooping

Cough

Pertussis (whooping cough) – notified cases

VIC: 1 January 2009 – 31 October 2019

Pertussis – notified cases

VIC: Age groups

January – October 2019

All

ages

Infants

< 12 months

Vaccination in Pregnancy

https://www.health.gov.au/news/influenza-and-pertussis-whooping-cough-vaccination-in-pregnancy

Invasive

Pneumococcal

Disease https://www.theage.com.au/sport/afl/football-and-family-the-rising-star-and-his-heroic-grandfather

-20190802-p52d9q.html

Invasive Pneumococcal Disease

VIC: January 2009 – September 2019

Invasive Pneumococcal Disease

Age groups and mortality rate

Victoria 2014 - 2018

4.2% 16.3%

Pneumococcal serotypes

VIC: January – September 2019

PCV13 type

PPV23 type

non vaccine type

typing pending

Cases < 5 years old

Cases ≥ 65 years old

Rotavirus

Rotavirus

Victoria

October 2018 – September 2019

Age < 6 months

All ages: N=209

Vaccine Preventable Diseases

Victoria

Measles

- atypical clinical presentation

- New Zealand and Samoa

Meningococcal Infection

Pertussis

Pneumococcal Disease

- increase in non-vaccine strains

Other Victorian Vaccine Preventable Diseases Data

on DHHS website

https://www2.health.vic.gov.au/public-health/infectious-diseases/infectious-diseases-surveillance/interactive-infectious-disease-reports/local-government-

areas-surveillance-report

Thank-you

Melbourne Vaccine Education Centre

Notifying laboratories and doctors

Reference Laboratories – MDU and VIDRL

Communicable Diseases Section DHHS

- Epidemiology and Surveillance

- Prevention and Control

- Immunisation