Applied Epidemiology of Communicable Disease at a National Level

Abstract

The Vaccine Preventable Diseases Surveillance section of the Australian Government Department of Health uses national data to monitor, analyse and report on a number of communicable diseases. Functions of the section include providing advice to inform policy, developing national pandemic plans, and providing epidemiological information to national and international stakeholders, including the Communicable Diseases Network Australia (CDNA). In this thesis, four epidemiological projects are described that utilize national data and state- and territory- specific data shared with the Commonwealth through professional networks. These projects identify populations at risk for certain communicable disease, identify gaps in national surveillance and make recommendations to improve the utility of surveillance data to better inform policy and public health interventions. Chapter Two describes an epidemiological analysis of national notifications of infectious and congenital syphilis over the period 2006 to 2015. Trends in rates over time are compared between Aboriginal and Torres Strait Islander people and non-Indigenous people and the analysis determines the impact that an ongoing multijurisdictional outbreak of infectious syphilis affecting Aboriginal and Torres Strait Islander people in the northern parts of Australia has on state-specific and national rates. Information gaps in national surveillance data are identified, particularly for cases of congenital syphilis and a proposal for the inclusion of additional fields to better understand risk factors for congenital syphilis infections is developed. Chapter Three describes the evaluation of the Australian Sentinel Practice Research Network (ASPREN); a national network of primary care practitioners that report on influenza-like illness. System data and the opinions of key stakeholders are used to evaluate whether ASPREN is achieving the objectives set for the system by the funding body, the Australian Government Department of Health. Recommendations are made to improve the representativeness, simplicity, sensitivity, and usefulness of ASPREN syndromic and virological data. Representativeness of syndromic surveillance sites is identified as necessary for the collection of meaningful data but is often challenging to achieve. Chapter Four describes an epidemiological analysis of notifications of community-associated Staphylococcus aureus (CA-MRSA) infections in the Kimberley, Western Australia; an emerging public health issue in this region. The analysis utilizes a dataset that links individuals with a positive isolate to hospital and emergency department records over the period 2003 to 2015. The burden of CA-MRSA infections on the health care system is described and the analysis shows the very high rates of notifications for Aboriginal and Torres Strait Islander persons.

Chapter Five describes an investigation into an outbreak of acute gastroenteritis at a catered lunch event in the Australian Capital Territory. Although this cohort study does not identify the cause of the outbreak, key learnings from the experience are reflected upon. Chapter Six describes my experience conducting event-based surveillance at the World Health Organization’s Western Pacific Regional Office in Manila. Additionally, this thesis includes examples of where epidemiological information is presented as part of teaching exercises to colleagues (Chapter Seven) as well as to national and international stakeholders, including CDNA and at national and international conferences. Show more