The incidence and notification of measles in Australia

Epidemics, Panic and Power: Representations of Measles and Measles Vaccines

In anglophone countries, there have been increasing efforts to vaccinate the total population. A number of strategies have been employed in order to achieve this goal, including compulsory vaccination before children can attend school (USA); financial incentives to general practitioners and other vaccinators to achieve vaccination targets (UK); and, in New Zealand, a system known as mandatory choice. The New Zealand system involves education centres being co-opted into the medical domain to encourage parents to vaccinate their children. In order to promulgate such strategies, ‘vaccinepreventable’ diseases, vaccines, parents of unvaccinated children, and the children themselves are represented in particular ways. This paper examines the last three ‘epidemics’ of measles in New Zealand and the way in which the campaigns to prevent these epidemics represented the disease and other agents. Drawing on Foucault’s concepts of governmentality and bio-power, the paper explores the linkages between disease representations and the state.

Physician privacy concerns when disclosing patient data for public health purposes during a pandemic influenza outbreak

Background

Privacy concerns by providers have been a barrier to disclosing patient information for public health purposes. This is the case even for mandated notifiable disease reporting. In the context of a pandemic it has been argued that the public good should supersede an individual's right to privacy. The precise nature of these provider privacy concerns, and whether they are diluted in the context of a pandemic are not known. Our objective was to understand the privacy barriers which could potentially influence family physicians' reporting of patient-level surveillance data to public health agencies during the Fall 2009 pandemic H1N1 influenza outbreak.

Methods

Thirty seven family doctors participated in a series of five focus groups between October 29-31 2009. They also completed a survey about the data they were willing to disclose to public health units. Descriptive statistics were used to summarize the amount of patient detail the participants were willing to disclose, factors that would facilitate data disclosure, and the consensus on those factors. The analysis of the qualitative data was based on grounded theory.

Results

The family doctors were reluctant to disclose patient data to public health units. This was due to concerns about the extent to which public health agencies are dependable to protect health information (trusting beliefs), and the possibility of loss due to disclosing health information (risk beliefs). We identified six specific actions that public health units can take which would affect these beliefs, and potentially increase the willingness to disclose patient information for public health purposes.

Conclusions

The uncertainty surrounding a pandemic of a new strain of influenza has not changed the privacy concerns of physicians about disclosing patient data. It is important to address these concerns to ensure reliable reporting during future outbreaks.

[Measles, pertussis, rubella and mumps completeness of reporting. Literature review of estimates for industrialized countries]

BACKGROUND

Surveillance data for infectious diseases in industrialized countries have been providing useful epidemiological information for several years. However, surveillance is complex and notifications underestimate the true disease incidence. The goal of this paper is to determine the completeness of reporting of measles, pertussis, rubella and mumps through notification in industrialized countries.

METHODS

A thorough literature review of papers published (in French or English) on surveillance data of measles, pertussis, rubella and mumps was undertaken with PUBMED. The review was limited to studies conducted in industrialized countries that quantitatively assessed the completeness of the reporting of these diseases.

RESULTS

Fourteen studies published from the 1920s met the inclusion criteria. For measles, the studies suggest that 64-85% of symptomatic patients sought medical care, 13-57% of those were diagnosed with measles and 22-81% of the diagnosed cases were reported for a completeness of reporting ranging from 7% to 63% between 1920 and 1980 and 3% to 41% in recent years. For pertussis, it was estimated that 49-59% of symptomatic patients sought medical care, 12% of those were diagnosed and 19-47% of the diagnosed cases were reported for a completeness of reporting ranging from 5% to 25% between 1920 and 1980 and from 3% to 12% in recent years. Very few studies on rubella and mumps were found and none allowed the determination of the global completeness of reporting.

CONCLUSION

Reporting has been found to be considerably incomplete. Continued efforts to improve the recognition and reporting of these diseases are needed.

Notification of infectious diseases by general practitioners: a quantitative and qualitative study

OBJECTIVE

To examine general practitioners' knowledge and practices concerning reporting of notifiable conditions, and to examine barriers to notification of infectious diseases by general practitioners and identify strategies for improving the notification process.

DESIGN AND SETTING

Audit of the 100 most recent notifications received by the South Eastern Sydney Public Health Unit of cases of each of hepatitis A, pertussis and measles; and focus groups with GPs practising in Sydney's eastern and southern suburbs, some of whom were selected on the basis of their notification practices.

RESULTS

Although these diseases are notifiable on clinical suspicion, only about 40% of the hepatitis A and pertussis cases and 80% of measles cases (54% overall) had been notified by GPs. Delays between doctor and laboratory notifications were an average of seven days for hepatitis A, 19 days for pertussis and seven days for measles. Focus groups showed that at least some GPs have poor understanding of the process of notification, most felt uncomfortable notifying an unconfirmed case, many preferred to leave notification to the laboratory because of concerns about damaging the doctor-patient relationship, and that there is need for financial or other incentives.

CONCLUSIONS

There are deficiencies in the completeness and timeliness of notification by GPs which may adversely affect the timing of prophylaxis and outbreak control. Notification by GPs may be improved by such strategies as better notification forms and better feedback to doctors on the outcomes.

Reporting efficiency during a measles outbreak in New York City, 1991

OBJECTIVES

During an epidemic of measles among preschool children in New York City, an investigation was conducted in 12 city hospitals to estimate reporting efficiency of measles to the New York City Department of Health.

METHODS

Measles cases were identified by review of hospital emergency room and infection control logs and health department surveillance records. The Chandra Sekar Deming method was used (1) to estimate the total number of measles cases in persons less than 19 years old who presented to the 12 hospitals from January through March 1991 and (2) to estimate reporting efficiency. Information on mechanisms for reporting measles cases was collected from hospital infection control coordinators.

RESULTS

The Chandra Sekar Deming method estimated that 1487 persons with measles presented to the 12 hospitals during the study period. The overall reporting efficiency was 45% (range = 19% to 83%). All 12 hospitals had passive surveillance for measles; 2 also had an active component. These 2 hospitals had the first and third highest measles reporting efficiencies.

CONCLUSIONS

The reporting efficiency of measles cases by New York City hospitals to the health department was low, indicating that the magnitude of the outbreak was substantially greater than suggested by the number of reported cases.

An outbreak of measles in the Hunter area of New South Wales

An outbreak of measles occurred in 1990 in the Port Stephens Shire of New South Wales. The incidence of confirmed cases of measles and associated histories of immunisation are detailed by age for the period 24 June 1990 to 31 December 1990. Data were obtained from health and education professionals and from interviews with parents. Among the 158 cases were 116 school pupils, 82 of whom attended two large primary schools which had attack rates of 9.4 per cent and 4.1 per cent. The cases also included 29 persons who had been appropriately immunised. Inadequate immunisation coverage was seen as the principal cause of the outbreak in the Port Stephens Shire. Observance of institutional protocol was regarded as a principal impediment to disease counter-measures in a neighbouring measles-affected area. Regulated immunisation of young children and cooperative interaction among service providers could ultimately lead to the control of this serious disease in New South Wales.

Improving surveillance of infectious diseases in New South Wales

OBJECTIVE

To determine the feasibility of laboratory reporting of infectious diseases and to compare the value of this system with the existing medical practitioner notification system.

DESIGN

A sample of notifications was selected from medical practitioner notifications and was compared for both completeness and timeliness of notification with a sample of notifications obtained through the Laboratory Infectious Diseases Surveillance Project.

SETTING

The New South Wales Health Department and the Public Health Unit of the Eastern Sydney Area Health Service.

PARTICIPANTS

Medical practitioners forwarding notifications of infectious diseases to the New South Wales Health Department and laboratories participating in the Laboratory Infectious Diseases Surveillance Project.

MAIN OUTCOME MEASURES

We counted the number of infectious diseases reported by medical practitioners and participating laboratories and estimated the proportion of these diseases which were common to both sources of data. We also estimated the time taken between the diagnosis of a notifiable infectious disease and the receipt of the notification by the Medical Officer of Health.

RESULTS

There was substantial underreporting of notifiable infectious diseases by medical practitioners. During the study there were 461 cases of a notifiable disease reported by either medical practitioners or by participating laboratories. Of these cases, 75% were reported only by laboratory staff, 20.2% were reported by medical practitioners alone and 4.8% of cases were reported by both laboratory staff and medical practitioners. The Medical Officer of Health received the reports from the participating laboratories within a significantly shorter time than the notifications from medical practitioners.

CONCLUSION

The use of infectious disease notifications by laboratories can substantially improve the surveillance of infectious diseases.