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Background. A large outbreak of hepatitis A affected individuals in several Australian states in 2009, resulting in a 2-fold increase in cases reported to state health departments compared with 2008. Two peaks of infection occurred (April-May and September-November), with surveillance data suggesting locally acquired infections from a widely distributed food product. Methods. Two case-control studies were completed. Intensive product trace-back and food sampling was undertaken. Genotyping was conducted on virus isolates from patient serum and food samples. Control measures included prophylaxis for close contacts, public health warnings, an order by the chief health officer under the Victorian Food Act 1984, and trade-level recalls on implicated batches of semidried tomatoes. Results. A multijurisdictional case-control study in April-May found an association between illness and consumption of semidried tomatoes (odds ratio [OR], 3.0; 95% CI 1.4-6.7). A second case-control study conducted in Victoria in October-November also implicated semidried tomatoes as being associated with illness (OR, 10.3; 95% CI, 4.7-22.7). Hepatitis A RNA was detected in 22 samples of semidried tomatoes. Hepatitis A virus genotype IB was identified in 144 of 153 (94%) patients tested from 2009, and partial sequence analysis showed complete identity with an isolate found in a sample of semidried tomatoes. Conclusions. The results of both case-control studies and food testing implicated the novel vehicle of semidried tomatoes as the cause of this hepatitis A outbreak. The outbreak was extensive and sustained despite public health interventions, the design and implementation of which were complicated by limitations in food testing capability and complex supply chains. [ABSTRACT FROM AUTHOR]

The authors reflect the preparedness of Zika virus infection in Australia. Topics discussed include an overview of the Zika virus infection, the cases associated with the infection, the programs designed to deal with the infection and enhance preparedness against it, and the robust systems of the country to communicable diseases.

We report on human illness due to histamine fish poisoning outbreaks in Australia from 2001 to 2013. Histamine fish poisoning results from the ingestion of histamine contained within the flesh of certain fish species that naturally contain histidine, which has been converted to histamine by spoilage bacteria following poor handling or temperature control after harvesting. While symptoms vary, allergic symptoms such as facial flushing, headaches and rashes are frequently reported. Using the OzFoodNet outbreak register, published case reports and surveillance reports, we found data on 57 outbreaks of histamine fish poisoning, which affected 187 people, of whom 14% were hospitalised. There were no deaths reported. Outbreaks were generally small in size, with a median of 2 cases per outbreak (range 1 to 22 people), with 88% of outbreaks comprising less than 5 people. Tuna (in the family Scombridae) was the most frequently reported food vehicle, while 18 outbreaks involved non-scombridae fish. Median incubation periods among the outbreaks were short; being less than 1 hour for 22 outbreaks. The most frequently reported symptoms were diarrhoea and rash. Symptoms of facial/body flushing were reported for at least one case in 19 outbreaks and tingling, burning or swelling of the skin, especially around the lips for at least 1 case in 13 outbreaks. In 3 outbreaks, one or more cases were reported to have had respiratory distress or difficulty breathing. While the condition is often mild, improved recognition and appropriate treatment is important, as it will reduce the possibility of any severe health effects resulting from this condition. Key features of histamine fish poisoning outbreaks are the high attack rate, rapid onset, the typical symptoms and their short duration., (This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or by email to copyright@health.gov.au.)

The National Notifiable Diseases Surveillance System received notifications for 7,875 cases of disease transmitted by mosquitoes during the 2011-12 season (1 July 2011 to 30 June 2012). The alphaviruses Barmah Forest virus and Ross River virus accounted for 6,036 (77%) of these. There were 18 notifications of dengue virus infection acquired in Australia and 1,390 cases that were acquired overseas, while for 38 cases, the place of acquisition was unknown. Imported cases of dengue in Australia were most frequently acquired in Indonesia. There were 20 imported cases of chikungunya virus. There were no notifications of locally-acquired malaria in Australia during the 2011-12 season. There were 314 notifications of overseas-acquired malaria and 41 notifications where the place of acquisition was unknown. Sentinel chicken, mosquito surveillance, viral detection in mosquitoes and climate modelling are used to provide early warning of arboviral disease activity in Australia. In 2011-12, sentinel chicken programs for the detection of flavivirus activity were conducted in most states with the risk of arboviral transmission. Other surveillance activities to detect the presence of arboviruses in mosquitoes or mosquito saliva or for surveying mosquito abundance included honey-baited trap surveillance, surveys of household containers that may provide suitable habitat for the dengue vector, Aedes aegypti, and carbon dioxide baited traps. Surveillance for exotic mosquitoes at the border continues to be a vital part of preventing the spread of mosquito-borne diseases to new areas of Australia., (This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or by email to copyright@health.gov.au.)

Background: Chikungunya virus (CHIKV) is a major threat to Australia given the distribution of competent vectors, and the large number of travellers returning from endemic regions. We describe current knowledge of CHIKV importations into Australia, and quantify reported viraemic cases, with the aim of facilitating the formulation of public health policy and ensuring maintenance of blood safety., Methods: Cases reported to the National Notifiable Disease Surveillance System (NNDSS) from 2002 to 2012 were analysed by place, month of acquisition, and place of residence. Rates of chikungunya importation were estimated based on reported cases and on the numbers of short-term movements., Results: Between 2002 and 2012, there were 168 cases of chikungunya virus (CHIKV) imported into Australia. Victoria and New South Wales had the largest number of notifications. The main sources were Indonesia, India and Malaysia. The number of cases increased from 2008 to reach a peak in 2010 (n=64; 40%). Although Indonesia accounted for the majority of CHIKV notifications in Australia, travel from India had the highest CHIKV importation rate (number of imported cases per 100,000 travellers)., Conclusions: The Australian population is increasingly at risk from CHIKV. Arrivals from endemic countries have increased concurrently with vector incursions via imported goods, as well as via local movement from the Torres Strait to North Queensland ports. An outbreak of CHIKV could have a significant impact on health, the safety of the blood supply and on tourism. Case and vector surveillance as well as population health responses are crucial for minimising any potential impact of CHIKV establishment in Australia., (This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca.)

The National Notifiable Diseases Surveillance System (NNDSS) received notification of 9,291 cases of disease transmitted by mosquitoes during the 2010-11 season (1 July 2010 to 30 June 2011). The alphaviruses Barmah Forest virus and Ross River virus accounted for 7,515 (81%) of these. There were 133 notifications of dengue virus infection acquired in Australia and 1,133 cases that were acquired overseas, while for 10 cases, the place of acquisition was unknown. The number of overseas acquired cases of dengue continues to rise each year, and these are most frequently acquired in Indonesia. Sentinel chicken, mosquito surveillance, viral detection in mosquitoes and climate modelling are used to provide early warning of arboviral disease activity in Australia. In early 2011, sentinel chickens in south eastern Australia widely seroconverted to flaviviruses. In 2010-11, there were 16 confirmed human cases of Murray Valley encephalitis acquired in Australia. There was one human case of Kunjin virus infection. There were 7 notifications of locally-acquired malaria in Australia and 407 notifications of overseas-acquired malaria during the 2010-11 season.

In 2010, 65 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 209,079 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, a decrease of 12% on the number of notifications in 2009. This decrease was largely due to a reduction of influenza compared with the influenza A(H1N1) pandemic 2009. In 2010, the most frequently notified diseases were sexually transmissible infections (86,620 notifications, 41.4% of total notifications), vaccine preventable diseases (61,964 notifications, 29.6% of total notifications), and gastrointestinal diseases (31,548 notifications, 15.1% of total notifications). There were 18,302 notifications of bloodborne diseases; 8,244 notifications of vectorborne diseases; 1,866 notifications of other bacterial infections; 532 notifications of zoonoses and 3 notifications of quarantinable diseases., (This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca.)

Background: Shiga toxin-producing Escherichia coli (STEC) are an important cause of gastroenteritis in Australia and worldwide and can also result in serious sequelae such as haemolytic uraemic syndrome (HUS). In this paper we describe the epidemiology of STEC in Australia using the latest available data., Methods: National and state notifications data, as well as data on serotypes, hospitalizations, mortality and outbreaks were examined., Results: For the 11 year period 2000 to 2010, the overall annual Australian rate of all notified STEC illness was 0.4 cases per 100,000 per year. In total, there were 822 STEC infections notified in Australia over this period, with a low of 1 notification in the Australian Capital Territory (corresponding to a rate of 0.03 cases per 100,000/year) and a high of 413 notifications in South Australia (corresponding to a rate of 2.4 cases per 100,000/year), the state with the most comprehensive surveillance for STEC infection in the country. Nationally, 71.2% (504/708) of STEC infections underwent serotype testing between 2001 and 2009, and of these, 58.0% (225/388) were found to be O157 strains, with O111 (13.7%) and O26 (11.1%) strains also commonly associated with STEC infections. The notification rate for STEC O157 infections Australia wide between 2001-2009 was 0.12 cases per 100,000 per year. Over the same 9 year period there were 11 outbreaks caused by STEC, with these outbreaks generally being small in size and caused by a variety of serogroups. The overall annual rate of notified HUS in Australia between 2000 and 2010 was 0.07 cases per 100,000 per year. Both STEC infections and HUS cases showed a similar seasonal distribution, with a larger proportion of reported cases occurring in the summer months of December to February., Conclusions: STEC infections in Australia have remained fairly steady over the past 11 years. Overall, the incidence and burden of disease due to STEC and HUS in Australia appears comparable or lower than similar developed countries.

In 2009, 65 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 236,291 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 48% on the number of notifications in 2008. This increase was largely due to cases of influenza A(H1N1) pandemic 2009. In 2009, the most frequently notified diseases were vaccine preventable diseases (101,627 notifications, 43% of total notifications), sexually transmissible infections (73,399 notifications, 31% of total notifications), and gastrointestinal diseases (31,697 notifications, 13% of total notifications). There were 18,861 notifications of bloodborne diseases; 8,232 notifications of vectorborne diseases; 1,919 notifications of other bacterial infections; 552 notifications of zoonoses and 4 notifications of quarantinable diseases.

In 2008, 65 communicable diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 160,508 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 9% on the number of notifications in 2007. In 2008, the most frequently notified diseases were sexually transmissible infections (69,459 notifications, 43% of total notifications), vaccine preventable diseases (34,225 notifications, 21% of total notifications) and gastrointestinal diseases (27,308 notifications, 17% of total notifications). There were 18,207 notifications of bloodborne diseases; 8,876 notifications of vectorborne diseases; 1,796 notifications of other bacterial infections; 633 notifications of zoonoses and 4 notifications of quarantinable diseases.

In 2007, 69 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 146,991 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 5% on the number of notifications in 2006. In 2007, the most frequently notified diseases were sexually transmissible infections (62,474 notifications, 43% of total notifications), gastrointestinal diseases (30,325 notifications, 21% of total notifications) and vaccine preventable diseases (25,347 notifications, 17% of total notifications). There were 19,570 notifications of bloodborne diseases; 6,823 notifications of vectorborne diseases; 1,762 notifications of other bacterial infections; 687 notifications of zoonoses and 3 notifications of quarantinable diseases.