Australian National Notifiable Diseases Surveillance System surveillance case definitions
Surveillance Case Definitions for the Australian National Notifiable
Diseases Surveillance System
1 January 2004 to 1 January 2016
Acquired immunodeficiency syndrome (AIDS) ................................................................................... 4
Anthrax ................................................................................................................................................. 5
Australian bat lyssavirus ....................................................................................................................... 6
Avian Influenza in humans ................................................................................................................... 7
Barmah Forest virus infection ............................................................................................................... 9
Botulism .............................................................................................................................................. 11
Brucellosis........................................................................................................................................... 12
Campylobacteriosis ............................................................................................................................. 13
Chikungunya virus infection ............................................................................................................... 14
Chlamydial infection (excluding eye infection).................................................................................. 15
Cholera ................................................................................................................................................ 16
Creutzfeldt–Jakob disease (CJD) ........................................................................................................ 17
Variant Creutzfeldt–Jakob disease (vCJD) ......................................................................................... 18
Cryptosporidiosis ................................................................................................................................ 20
Dengue fever infection ........................................................................................................................ 21
Diphtheria ........................................................................................................................................... 23
Donovanosis ........................................................................................................................................ 24
Flavivirus infection (unspecified) ....................................................................................................... 25
Gonococcal infection .......................................................................................................................... 27
Haemolytic uraemic syndrome (HUS) ................................................................................................ 28
Haemophilus influenzae serotype b (Hib) (invasive only) .................................................................. 29
Hepatitis A .......................................................................................................................................... 30
Hepatitis B – newly acquired .............................................................................................................. 32
Hepatitis B – unspecified .................................................................................................................... 33
Hepatitis C - newly acquired............................................................................................................... 34
Hepatitis C - unspecified ..................................................................................................................... 36
Hepatitis D .......................................................................................................................................... 37
Hepatitis E........................................................................................................................................... 38
Hepatitis (not elsewhere classified) .................................................................................................... 40
Human immunodeficiency virus (HIV) infection – individuals less than 18months of age ............... 41
Human immunodeficiency virus (HIV) – newly acquired .................................................................. 42
Human immunodeficiency virus (HIV) - unspecified individuals over 18 months of ages ................ 43
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Influenza (laboratory confirmed) ........................................................................................................ 44
Japanese encephalitis virus infection .................................................................................................. 45
Legionellosis ....................................................................................................................................... 47
Leprosy ............................................................................................................................................... 49
Leptospirosis ....................................................................................................................................... 51
Listeriosis ............................................................................................................................................ 52
Lyssavirus (not elsewhere classified) ................................................................................................. 53
Malaria ................................................................................................................................................ 54
Measles ............................................................................................................................................... 55
Meningococcal infection (Invasive).................................................................................................... 57
Mumps ................................................................................................................................................ 59
Murray Valley encephalitis virus infection ......................................................................................... 60
Ornithosis (psittacosis)........................................................................................................................ 62
Paratyphoid ......................................................................................................................................... 63
Pertussis .............................................................................................................................................. 64
Plague .................................................................................................................................................. 66
Pneumococcal disease (invasive) ........................................................................................................ 67
Poliovirus infection ............................................................................................................................. 68
Q fever ................................................................................................................................................ 73
Rabies.................................................................................................................................................. 74
Ross River virus infection ................................................................................................................... 75
Rubella ................................................................................................................................................ 77
Congenital Rubella Infection .............................................................................................................. 79
Salmonellosis ...................................................................................................................................... 81
Severe acute respiratory syndrome (SARS)........................................................................................ 82
Shiga toxin- and verocytotoxin-producing Escherichia coli (STEC/ VTEC) .................................... 84
Shigellosis ........................................................................................................................................... 85
Smallpox ............................................................................................................................................. 86
Syphilis - congenital ........................................................................................................................... 87
Infectious Syphilis – less than 2 years duration (includes primary, secondary and early latent) ....... 90
Syphilis - more than 2 years duration or unspecified duration ........................................................... 93
Tetanus ................................................................................................................................................ 95
Tuberculosis ........................................................................................................................................ 96
Tularaemia .......................................................................................................................................... 97
Typhoid ............................................................................................................................................... 98
Varicella zoster (chickenpox) ............................................................................................................. 99
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Varicella zoster (shingles)................................................................................................................. 101
Varicella zoster (unspecified) ........................................................................................................... 102
Viral haemorrhagic fevers (quarantinable) (Quarantinable – includes Ebola, Marburg, Lassa and
Crimean-Congo fevers) ..................................................................................................................... 103
West Nile /Kunjin virus infection ..................................................................................................... 105
Yellow fever...................................................................................................................................... 107
Appendix A: National notifiable diseases sorted according to disease type ..................................... 109
Notice regarding detection of IgGs ................................................................................................... 112
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Acquired immunodeficiency syndrome (AIDS)
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
Definitive diagnosis of HIV infection (see case definitions for human immunodeficiency virus).
Clinical evidence
A diagnosis of at least one of the following clinical conditions*:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Candidiasis of the bronchi, trachea or lungs – definitive diagnosis only
Oesophageal candidiasis – definitive or presumptive diagnosis
Invasive cervical cancer – definitive diagnosis
Coccidioidomycosis, disseminated or extrapulmonary – definitive diagnosis only
Cryptococcosis, extrapulmonary – definitive diagnosis only
Cryptosporidiosis of more than one month’s duration – definitive diagnosis only
Cytomegalovirus retinitis, with loss of vision – definitive or presumptive diagnosis
Encephalopathy, HIV related – definitive diagnosis only
Herpes simplex: chronic ulcer(s) of more than one month’s duration, bronchitis, pneumonitis or
oesophagitis – definitive diagnosis only
Histoplasmosis, disseminated or extrapulmonary – definitive diagnosis only
Isosporiasis, chronic intestinal, of more than one month’s duration – definitive diagnosis only
Kaposi’s sarcoma – definitive or presumptive diagnosis
Lymphoma, Burkitt’s – definitive diagnosis only
Lymphoma, immunoblastic – definitive diagnosis only
Lymphoma, primary, of brain – definitive diagnosis only
Mycobacterium tuberculosis complex, any site, pulmonary or extrapulmonary – definitive or
presumptive diagnosis
Non-tuberculous mycobacterial disease, disseminated or extrapulmonary – definitive or presumptive diagnosis
Pneumocystis carinii pneumonia – definitive or presumptive diagnosis
Pneumonia, recurrent bacterial – definitive or presumptive
Progressive multi-focal leukoencephalopathy – definitive diagnosis only
Salmonella septicaemia, recurrent – definitive diagnosis only
Toxoplasmosis – definitive or presumptive diagnosis
Wasting syndrome due to HIV infection – definitive diagnosis only
Bacterial infection affecting a child less than 13 year of age – definitive diagnosis only
Lymphoid interstitial pneumonia and/or pulmonary lymphoid hyperplasia affecting a child less
than 13 years of age – definitive or presumptive diagnosis.
*
Illnesses indicative of AIDS are defined in the Australian National Council on AIDS (ANCA) Bulletin 18:
Definition of HIV infection and AIDS-defining illnesses. ANCA. April 1994. Canberra.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Anthrax
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires either:
Laboratory definitive evidence
OR
Laboratory suggestive evidence AND clinical evidence.
Laboratory definitive evidence
Isolation of Bacillus anthracis-like organisms or spores confirmed by a reference laboratory.
Laboratory suggestive evidence
Detection of Bacillus anthracis by microscopic examination of stained smears
OR
Detection of Bacillus anthracis by nucleic acid testing.
Clinical evidence
Cutaneous: skin lesion evolving over 1-6 days from a papular through a vesicular stage, to a
depressed black eschar invariably accompanied by oedema that may be mild to extensive
OR
Gastrointestinal: abdominal distress characterised by nausea, vomiting, anorexia and followed by
fever
OR
Rapid onset of hypoxia, dyspnoea and high temperature, with radiological evidence of mediastinal
widening
OR
Meningeal: acute onset of high fever, convulsions, loss of consciousness and meningeal signs and
symptoms.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Australian bat lyssavirus
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of Australian bat lyssavirus confirmed by sequence analysis
OR
Detection of Australian bat lyssavirus by nucleic acid testing.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Avian Influenza in humans
Reporting
Both confirmed cases and probable cases should be notified. Suspected cases shouldn’t be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence
Laboratory definitive evidence
Isolation of an Avian Influenza (AI) virus
OR
Detection of AI by nucleic acid testing using two different targets, e.g. primers specific for influenza
A and AI haemagglutinin (genetic sequencing should be employed to confirm diagnosis);
OR
A fourfold or greater rise in antibody titre to the AI virus detected in the outbreak (or AI virus
suspected of causing the human infection), based on testing of an acute serum specimen (collected 7
days or less after symptom onset) and a convalescent serum specimen. The convalescent neutralizing
antibody titre must also be 80 or higher.
OR
An antibody titre to the AI virus detected in the outbreak (or AI virus suspected of causing the
human infection) of 80 or greater in a single serum specimen collected at day 14 or later after
symptom onset. The result should be confirmed in at least two different serological assays (i.e.
haemagglutinin-inhibition, microneutralisation, positive Western blot, etc).
Note: Tests must be conducted in a national, regional or international influenza laboratory whose
Avian Influenza in Humans (AIH) test results are accepted by WHO as confirmatory
Clinical evidence
An acute illness characterised by:
a. Fever (>38ºC ) or history of fever AND one or more of; cough OR rhinorrhoea OR myalgia OR
headache OR dyspnoea OR diarrhoea;
OR
b. Conjunctivitis
OR
c. infiltrates or evidence of an acute pneumonia on chest radiograph plus evidence of acute
respiratory insufficiency (hypoxaemia, severe tachypnoea).
Probable case
A probable case requires laboratory suggestive evidence AND clinical evidence AND
epidemiological evidence
Laboratory suggestive evidence
Confirmation of an influenza A infection but insufficient laboratory evidence for AIH infection.
Clinical evidence
As with confirmed case
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Epidemiological evidence
One or more of the following exposures in the 10 days prior to symptom onset:
a. Close contact (within 1 metre) with a person (e.g. caring for, speaking with, or touching) who is
a probable, or confirmed AIH case;
b. Exposure (e.g. handling, slaughtering, defeathering, butchering, preparation for consumption) to
poultry or wild birds or their remains or to environments contaminated by their faeces in an area
where AI infections in animals or humans have been suspected or confirmed in the last month;
c. Consumption of raw or undercooked poultry products in an area where AI infections in animals
or humans have been suspected or confirmed in the last month;
d. Close contact with a confirmed AI infected animal other than poultry or wild birds (e.g. cat or
pig);
e. Handling samples (animal or human) suspected of containing AI virus in a laboratory or other
setting.
Suspected case
A suspected case requires clinical evidence AND epidemiological evidence
Clinical evidence for suspected case
As with confirmed case
Epidemiological evidence
As with probable case
Note: For overseas exposures, an AI-affected area is defined as a region within a country with
confirmed outbreaks of AI strains in birds or detected in humans in the last month (seek advice from
the National Incident Room when in doubt). With respect to the H5N1 AI outbreak that commenced
in Asia in 2003, information regarding H5-affected countries is available at:
http://gamapserver.who.int/mapLibrary/. With respect to the H7N9 outbreak that commenced in
eastern China in 2013, information regarding H7-affected countries is available at:
http://www.who.int/influenza/human_animal_interface/influenza_h7n9/en/
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Barmah Forest virus infection
Version
Status
Last
reviewed
Endorseme
nt date
Implementation
date
1.2
New probable category
CDWG
September
2015
CDNA
October
2015
1 January 2016
CDNA
5 October
2012
1 January 2013
Laboratory definitive evidence now only
includes detection by PCR and
demonstrated seroconversions. A single
IgM will no longer be included in this
category.
Laboratory suggestive evidence will
require an IgM in the presence of IgG on
the same specimen.
Single IgM positive results will no
longer meet the confirmed or probable
case definition.
1.1
1. Members agreed to add to the end of CDWG
point 4 under Laboratory definitive
21 September
evidence 'in the absence of IgM to
2012
Ross River IgM, virus unless Barmah
Forest virus IgG is also detected'.
2. Members agreed to add to the end of
point 5 under Laboratory definitive
evidence 'Detection of Barmah Forest
virus IgM in the presence of Barmah
Forest virus IgG'.
1.0
Initial CDNA case definition (2004).
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Probable case
A probable case requires laboratory suggestive evidence only.
Laboratory definitive evidence
Isolation of Barmah Forest virus
OR
Detection of Barmah Forest virus by nucleic acid testing
OR
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
IgG seroconversion or a significant increase in IgG antibody level (e.g. fourfold or greater rise in
titre) to Barmah Forest virus.
Laboratory suggestive evidence
Detection of Barmah Forest virus IgM AND Barmah Forest virus IgG EXCEPT if Barmah
Forest IgG is known to have been detected in a specimen collected greater than 3 months earlier.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Botulism
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
Isolation of Clostridium botulinum
OR
Detection of Clostridium botulinum toxin in blood or faeces.
Clinical evidence
A clinically compatible illness (e.g. diplopia, blurred vision, muscle weakness, paralysis, death).
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Brucellosis
Version
Status
Last reviewed
Endorsement
date
Implementation
date
1.1
1. Members agreed to add a definition
for probable case requiring laboratory
suggestive and clinical evidence:
CDWG 29 June
2010
CDNA 7 July
2010
1 July 2010
Probable case
A probable case requires laboratory
suggestive and clinical evidence.
Laboratory suggestive evidence
A single high Brucella agglutination
titre.
Clinical evidence
A clinically compatible illness.
2. The words “in parallel” were added
to point 2 under “Laboratory definitive
evidence”.
1.0
Initial CDNA case definition (2004).
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
1. Isolation of Brucella species
OR
2. IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre
in Brucella agglutination titres or complement fixation titres between acute and convalescent phase
serum samples (where possible both tests should be conducted in parallel at the same laboratory).
Probable case
A probable case requires laboratory suggestive and clinical evidence.
Laboratory suggestive evidence
A single high Brucella agglutination titre.
Clinical evidence
A clinically compatible illness.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Campylobacteriosis
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation or detection of Campylobacter species.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Chikungunya virus infection
Version
Status
Last reviewed
Endorsement
date
Implementation
date
1.0
Initial CDNA case definition.
CDWG
4November 2009
CDNA 12 May
2010
1 July 2010
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence.
Laboratory definitive evidence
1. Isolation of chikungunya virus
OR
2. Detection of chikungunya virus by nucleic acid testing
OR
3. Seroconversion or a significant rise in antibody level or a fourfold or greater rise in titre to
chikungunya virus, in the absence of a corresponding change in antibody levels to Ross River virus
and Barmah Forest virus
OR
4. Detection of chikungunya virus-specific IgM, in the absence of IgM to Ross River virus and
Barmah Forest virus.
Confirmation of laboratory results by a second arbovirus reference laboratory is required in the
absence of travel history to areas with known endemic or epidemic activity.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Chlamydial infection
(excluding eye infection)
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
Added “(Excluding Eye Infection)”
CDWG 3
April
2013
CDNA 24
May 2013
1 July 2013
1.0
Initial CDNA case definition (2004).
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of Chlamydia trachomatis
OR
Detection of Chlamydia trachomatis by nucleic acid testing
OR
Detection of Chlamydia trachomatis antigen.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Cholera
Version
Status
Last reviewed
Endorsement
Date
Implementation
date
1.1
No Change.
14 August 2008
14 August 2008
From 14 August
2008
1.0
Initial CDNA case definition
(2004).
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of toxigenic Vibrio cholerae O1 or O139.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Creutzfeldt–Jakob disease (CJD)
Version
Status
Last reviewed
Endorsement
date
Implementation
date
1.0
Initial CDNA case
definition.
CDWG November
2009
CDNA 16
December 2009
1 July 2010
Reporting
Both confirmed cases and probable cases should be notified. This includes sporadic, accidental and
familial cases (Note: a “confirmed” case is equivalent to the ANCJDR classification of “definite”).
Confirmed case
A confirmed case requires laboratory definitive evidence.
Laboratory definitive evidence
Neuropathological confirmation of CJD supplemented by immunochemical detection of proteaseresistant PrP by western blot OR immunocytochemistry.
Probable case
A probable case requires clinical evidence AND either electroencephalogram (EEG) or laboratory
suggestive evidence.
Laboratory suggestive evidence
Positive 14-3-3 protein CSF test.
Clinical evidence
Progressive dementia of less than two years duration;
AND
At least 2 of the following clinical features:




17
myoclonus
visual or cerebellar signs
pyramidal/extrapyramidal signs
akinetic mutism.
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Variant Creutzfeldt–Jakob disease (vCJD)
Version
Status
Last reviewed
Endorsement
date
Implementation
date
1.0
Initial CDNA case
definition.
CDWG
CDNA 16
December 2009
1 July 2010
November 2009
Reporting
Both confirmed cases and probable cases should be notified (Note: a “confirmed” case is
equivalent to the ANCJDR classification of “definite”).
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
Neuropathological confirmation of vCJD.
Clinical evidence
Progressive neuropsychiatric disorder.
Probable case
A probable case requires clinical definitive evidence
OR
Clinical suggestive evidence AND laboratory suggestive evidence.
Clinical definitive evidence
1. Progressive neuropsychiatric disorder AND duration of illness greater than six months AND
routine investigations do not suggest an alternative diagnosis AND no history of potential
iatrogenic exposure AND no evidence of a familial form of TSE.
AND
1. Four of the following symptoms:
a. Early psychiatric symptoms
b. Persistent painful sensory symptoms
c. Ataxia
d. Myoclonus or chorea or dystonia
e. Dementia
AND
2. Bilateral pulvinar high signals on magnetic resonance imaging (MRI) scans
AND
3. Electroencephalogram (EEG) which does not exhibit the typical appearance of classic CJD.
Clinical suggestive evidence
1. Progressive neuropsychiatric disorder AND duration of illness greater than six months AND
routine investigations do not suggest an alternative diagnosis AND no history of potential
18
Australian National Notifiable Diseases Surveillance System surveillance case definitions
iatrogenic exposure AND no evidence of a familial form of TSE.
Laboratory suggestive evidence
1. A PrPSC positive tonsil biopsy.
19
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Cryptosporidiosis
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Detection of Cryptosporidium.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Dengue fever infection
Version
Status
Last
reviewed
Endorsement
date
Implementati
on date
1.1
A probable case category was added.
CDWG
CDNA 5
21Septembe October 2012
r 2012
1 January 2013
IgM in blood was changed from definitive
to suggestive evidence requiring clinical
evidence and epidemiological evidence to
become a probable case. This is more
consistent with the PHLN case definition
and resolves the issue of false positive
serum IgM 'locally acquired' cases in
Queensland, both in north Queensland
when there is no known outbreak and in
other areas of Queensland where Aedes
aegypti is present.
New criterion added under definitive
evidence 'Detection of dengue nonstructural protein 1 (NS1) antigen in blood'
point 3.
Point 4 under laboratory definitive evidence
has been re-worded to 'IgG seroconversion
or a significant increase in antibody level or
a fourfold or greater rise in titre to dengue
virus, proven by neutralisation or another
specific test.'
Point 5 under laboratory definitive evidence
has been re-worded to 'Detection of dengue
virus-specific IgM in cerebrospinal fluid, in
the absence of IgM to Murray Valley
encephalitis, West Nile /Kunjin, or Japanese
encephalitis viruses'
Note requiring second reference laboratory
testing in area ‘without known previous
local transmission’ amended to make clear
that this relates to transmission since 1990.
Clinical evidence amended to be consistent
with the new WHO classification (p11).
http://whqlibdoc.who.int/publications/2009/
9789241547871_eng.pdf
Epidemiological evidence criterion added:
'A plausible explanation, e.g. travel to a
country with known dengue activity OR
exposure in Australia where local
transmission has been documented within
the previous month.'
1.0
21
Initial CDNA case definition (2004).
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
Isolation of dengue virus
OR
Detection of dengue virus by nucleic acid testing
OR
Detection of dengue non-structural protein 1 (NS1) antigen in blood
OR
IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to
dengue virus, proven by neutralisation or another specific test
OR
Detection of dengue virus-specific IgM in cerebrospinal fluid, in the absence of IgM to Murray
Valley encephalitis, West Nile virus / Kunjin, or Japanese encephalitis viruses
Confirmation of the laboratory result by a second arbovirus reference laboratory is required if the
infection was locally acquired and occurred in an area of Australia without known local transmission
of dengue fever since 1990 (i.e. anywhere outside north Queensland).
Clinical evidence
A clinically compatible illness (e.g. fever, headache, arthralgia, myalgia, rash, nausea, and vomiting,
with possible progression to severe plasma leakage, severe haemorrhage, or severe organ impairment
– CNS, liver, heart or other).
Probable case
A probable case requires laboratory suggestive evidence AND clinical evidence AND
epidemiological evidence.
Laboratory suggestive evidence
Detection of dengue virus-specific IgM in blood.
Clinical evidence
As for a confirmed case
Epidemiological evidence
A plausible explanation, e.g. travel to a country with known dengue activity OR exposure in
Australia where local transmission has been documented within the previous month.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Diphtheria
Version
Status
Last
reviewed
Endorsement
date
1.1
At the end of confirmed case, added
“AND clinical evidence”
CDWG
CDNA 24
3April 2013 May 2013
1.0
Initial CDNA case definition (2004).
Implementation
date
1 July 2013
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence and clinical evidence.
Laboratory definitive evidence
Isolation of toxigenic Corynebacterium diphtheriae or toxigenic C. ulcerans.
Probable case
A probable case requires:
Laboratory suggestive evidence AND clinical evidence
OR
Clinical evidence AND epidemiological evidence.
Laboratory suggestive evidence
Isolation of Corynebacterium diphtheriae or C. ulcerans (toxin production unknown).
Clinical evidence
At least one of the following:
Pharyngitis and/or laryngitis (with or without a membrane)
OR
Toxic (cardiac or neurological) symptoms.
Epidemiological evidence
An epidemiological link is established when there is:
Contact between two people involving a plausible mode of transmission at a time when:
a. one of them is likely to be infectious (usually 2 weeks or less and seldom more than 4
weeks after onset of symptoms)
AND
b. the other has an illness which starts within approximately 2-5 days after this contact
AND
At least one case in the chain of epidemiologically linked cases (which may involve many cases) is
laboratory confirmed.
23
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Donovanosis
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
Demonstration of intracellular Donovan bodies on smears or biopsy specimens taken from a lesion
OR
Detection of Calymmatobacterium granulomatis by nucleic acid testing of a specimen taken from a
lesion.
Clinical evidence
Clinically compatible illness involving genital ulceration.
Probable case
A probable case requires clinical evidence AND epidemiological evidence.
Clinical evidence
As with confirmed case.
Epidemiological evidence
A compatible sexual risk history in a person from an endemic area
OR
A compatible sexual risk history involving sexual contact with someone from an endemic area.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Flavivirus infection (unspecified)
Note
1.
It is recognised that some cases of human infection cannot be attributed to a single flavivirus.
This may either be because the serology shows specific antibody to more than one virus,
specific antibody cannot be assigned based on the tests available in Australian reference
laboratories, or a flavivirus is detected that cannot be identified
2. Confirmation by a second arbovirus reference laboratory is required if the case cannot be
attributed to know flaviviruses.
3. Occasional human infections occur due to other known flaviviruses, such as Kokobera, Alfuy,
Edge Hill and Stratford viruses.
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
Isolation of a flavivirus that cannot be identified in Australian reference laboratories or which is
identified as one of the flaviviruses not otherwise classified
OR
Detection of a flavivirus, by nucleic acid testing, that cannot be identified in Australian reference
laboratories or which is identified as one of the flaviviruses not otherwise classified
OR
IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre of
flavivirus specific IgG that cannot be identified or which is identified as being specific for one of the
flaviviruses not otherwise classified. There must be no history of recent Japanese encephalitis or
yellow fever vaccination
OR
Detection of flavivirus IgM in cerebrospinal fluid, with reactivity to more than one flavivirus antigen
(Murray Valley encephalitis, West Nile/Kunjin, Japanese Encephalitis and/or dengue) or with
reactivity only to one or more of the flaviviruses not otherwise classified
OR
Detection of flavivirus IgM in the serum, with reactivity to more than one flavivirus antigen (Murray
Valley encephalitis, West Nile/Kunjin, Japanese Encephalitis and/or dengue) or with reactivity only
to one or more of the flaviviruses not otherwise classified. This is only accepted as laboratory
evidence for encephalitic illnesses. There must be no history of recent Japanese encephalitis or
yellow fever vaccination.
Clinical evidence
Non-encephalitic disease: acute febrile illness with headache, myalgia and/or rash
OR
Encephalitic disease: acute febrile meningoencephalitis characterised by one or more of the
following:

25
focal neurological disease or clearly impaired level of consciousness
Australian National Notifiable Diseases Surveillance System surveillance case definitions


26
an abnormal computerised tomograph or magnetic resonance image or electrocardiograph
presence of pleocytosis in cerebrospinal fluid.
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Gonococcal infection
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of Neisseria gonorrhoeae
OR
Detection of Neisseria gonorrhoeae by nucleic acid testing
OR
Detection of typical Gram-negative intracellular diplococci in a smear from a genital tract specimen.
27
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Haemolytic uraemic syndrome (HUS)
Note: Where STEC/VTEC is isolated in the context of HUS, it should be notified as both
STEC/VTEC and HUS.
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires clinical evidence only.
Clinical evidence
Acute microangiopathic anaemia on peripheral blood smear (schistocytes, burr cells or helmet cells)
AND AT LEAST ONE OF THE FOLLOWING:
Acute renal impairment (haematuria, proteinuria or elevated creatinine level)
OR
Thrombocytopaenia, particularly during the first seven days of illness.
28
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Haemophilus influenzae serotype b (Hib) (invasive only)
Version
Status
Last
reviewed
1.1
In Laboratory definitive evidence, after CDWG
“Isolation” ADD “or detection” and
27February
CHANGE “at an approved reference
2014
laboratory” to “at a jurisdictional or
regional reference laboratory”
Endorsement
date
Implementation
date
CDNA 13
March 2014
1 July 2014
DELETE “OR Detection of Hib
antigen in cerebrospinal fluid when
other laboratory parameters are
consistent with meningitis”.
1.0
Initial CDNA case definition (2004).
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation or detection of Haemophilus influenzae type b (Hib) from a normally sterile site where
typing has been confirmed at a jurisdictional or regional reference laboratory.
29
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Hepatitis A
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
Confirmed case
CDWG
13August
2012
CDNA
29August 2012
1 January 2013
Added 'either' and 'OR Laboratory
suggestive evidence AND clinical
evidence OR laboratory suggestive
evidence AND epidemiological
evidence.'
Laboratory definitive evidence
Removed 'Detection of anti-hepatitis A
IgM, in the absence of recent
vaccination.'
Laboratory definitive evidence
Added 'Detection of hepatitis A virus
by nucleic acid testing.'
Laboratory suggestive evidence
Added 'Detection of hepatitis Aspecific IgM, in the absence of recent
vaccination.'
Clinical evidence
Changed to Child less than 5 years of
age OR Acute illness with discrete
onset of at least two of the following
signs and symptoms: fever; malaise;
abdominal discomfort; loss of appetite;
nausea AND jaundice or dark urine or
abnormal liver function tests that
reflect viral hepatitis.
1.0
Initial CDNA case definition (2004).
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires either
Laboratory definitive evidence
OR
Laboratory suggestive evidence AND clinical evidence
OR
Laboratory suggestive evidence AND epidemiological evidence
30
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Probable case
A probable case requires clinical evidence AND epidemiological evidence.
Laboratory definitive evidence
Detection of hepatitis A virus by nucleic acid testing.
Laboratory suggestive evidence
Detection of hepatitis A-specific IgM, in the absence of recent vaccination.
Clinical evidence
Child less than 5 years of age
OR
Acute illness with discrete onset of at least two of the following signs and symptoms: fever; malaise;
abdominal discomfort; loss of appetite; nausea
AND
jaundice or dark urine or abnormal liver function tests that reflect viral hepatitis.
Epidemiological evidence
Contact between two people involving a plausible mode of transmission at a time when:
a.
one of them is likely to be infectious (from two weeks before the onset of jaundice to a week
after onset of jaundice)
AND
b. the other has an illness that starts within 15 to 50 (average 28 – 30) days after this contact
AND
At least one case in the chain of epidemiologically linked cases (which may involve many cases) is
laboratory confirmed.
31
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Hepatitis B – newly acquired
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
Laboratory Definitive Evidence
CDWG
February
2015
CDNA April
2015
1 July 2015
For clarity, remove “in the absence of
prior evidence of hepatitis B infection”
and insert “except where there is prior
evidence of hepatitis B infection”.
Note
To caution about the influence of
recent vaccination, add note:
“Transient HBsAg positivity can occur
in patients following HBV vaccination.
This occurs more commonly in dialysis
patients and is unlikely to persist
beyond 14 days post-vaccination”
1.0
Initial CDNA case definition (2004).
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Detection of hepatitis B surface antigen (HBsAg) in a patient shown to be negative within the last 24
months
OR
Detection of HBsAg and IgM to hepatitis B core antigen, except where there is prior evidence of
hepatitis B infection OR
Detection of hepatitis B virus by nucleic acid testing, and IgM to hepatitis B core antigen, except
where there is prior evidence of hepatitis B infection
Note:
Transient HBsAg positivity can occur in patients following HBV vaccination. This occurs more
commonly in dialysis patients and is unlikely to persist beyond 14 days post-vaccination.
32
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Hepatitis B – unspecified
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
Laboratory definitive evidence
CDWG
February
2015
CDNA April
2015
1 July 2015
For clarity, remove “in the absence of
prior evidence of hepatitis B infection”
and insert “except where there is prior
evidence of hepatitis B infection”.
Note
To caution about the influence of
recent vaccination, add note:
“Transient HBsAg positivity can occur
in patients following HBV vaccination.
This occurs more commonly in dialysis
patients and is unlikely to persist
beyond 14 days post-vaccination”
1.0
Initial CDNA case definition (2004).
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND that the case does not meet any of the
criteria for a newly acquired case.
Laboratory definitive evidence
Detection of hepatitis B surface antigen (HBsAg), or hepatitis B virus by nucleic acid testing, except
where there is prior evidence of hepatitis B infection.
Note:
Transient HBsAg positivity can occur in patients following HBV vaccination. This occurs more
commonly in dialysis patients and is unlikely to persist beyond 14 days post-vaccination.
33
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Hepatitis C - newly acquired
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
In ‘Laboratory definitive evidence’
change ‘Detection of hepatitis C virus
by nucleic acid testing in a child aged
28 days to 24 months’ TO ‘Detection
of hepatitis C virus by nucleic acid
testing in a child aged 3 months to 24
months’
July 2014
3 December
2014
1 January 2015
In ‘Laboratory suggestive evidence’
added ‘…in a patient with no prior
evidence of hepatitis C infection.’
In ‘Clinical evidence’ changed Alanine
transaminase (ALT) from seven to ten
times upper limit of normal.
1.0
Initial CDNA case definition (2004).
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires either:
Laboratory definitive evidence
OR
Laboratory suggestive evidence AND clinical evidence.
Laboratory definitive evidence
Detection of anti-hepatitis C antibody from a person who has had a negative anti-hepatitis C
antibody test recorded within the past 24 months
OR
Detection of hepatitis C virus by nucleic acid testing from a person who has a negative anti-hepatitis
C antibody test result currently, or has had, within the past 24 months
OR
Detection of anti-hepatitis C antibody from a child aged 18 months to 24 months
OR
Detection of hepatitis C virus by nucleic acid testing in a child aged 3 months to 24 months.
Laboratory suggestive evidence
Detection of anti-hepatitis C antibody, or hepatitis C virus by nucleic acid testing in a patient with no
prior evidence of hepatitis C infection.
Clinical evidence
Clinical hepatitis within the past 24 months (where other causes of acute hepatitis have been
excluded) defined as:
34
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Jaundice
OR
Bilirubin in urine
OR
Alanine transaminase (ALT) ten times the upper limit of normal.
35
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Hepatitis C - unspecified
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND that the case does not meet any of the
criteria for a newly acquired case AND is aged more than 24 months.
Laboratory definitive evidence
In a person with no prior evidence of hepatitis C virus infection:
Detection of anti-hepatitis C antibody
OR
Detection of hepatitis C virus by nucleic acid testing.
36
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Hepatitis D
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only, in a person known to be hepatitis B
surface antigen (HbsAg) positive.
Laboratory definitive evidence
Detection of IgM or IgG to hepatitis D virus
OR
Detection of hepatitis D virus on liver biopsy.
37
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Hepatitis E
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.2
Confirmed case
CDWG
March 2015
CDNA May
2015
1 July 2015
CDWG 3
April 2013
CDNA 24 May 1 July 2013
2013
Remove requirement for
epidemiological evidence so that a
positive IgM or IgG in combination
with clinical evidence can constitute a
confirmed case
Remove Epidemiological evidence
section
1.1
Confirmed case
Added “OR Laboratory suggestive
evidence AND clinical evidence AND
epidemiological evidence”
Laboratory definitive evidence
Replaced “Detection of IgM or IgG to
hepatitis E virus. If the person has not
travelled outside Australia in the
preceding 3 months, the antibody result
must be confirmed by specific
immunoblot” with “IgG
seroconversion or a significant increase
in antibody level or a fourfold or
greater rise in titre to hepatitis E virus”
Added Laboratory suggestive evidence,
Clinical evidence and Epidemiological
evidence and the following;
Laboratory suggestive evidence
Added “Detection of IgM or IgG to
hepatitis E virus”
Clinical evidence
Added “A clinically compatible illness
without other apparent cause”
Epidemiological evidence
Added “Travel to a country with
known hepatitis E activity between 15
– 64 days prior to onset OR
epidemiological link to a confirmed
case”
1.0
Initial CDNA case definition (2004).
Reporting
Only confirmed cases should be notified.
38
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Confirmed case
A confirmed case requires laboratory definitive evidence
OR
Laboratory suggestive evidence AND clinical evidence.
Laboratory definitive evidence
Detection of hepatitis E virus by nucleic acid testing
OR
Detection of hepatitis E virus in faeces by electron microscopy
OR
IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to
hepatitis E virus
Laboratory suggestive evidence
Detection of IgM or IgG to hepatitis E virus.
Clinical evidence
A clinically compatible illness without other apparent cause.
39
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Hepatitis (not elsewhere classified)
Reporting
Only confirmed cases should be notified.
Confirmed cases
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
Laboratory exclusion of hepatitis A, B, C, D and E and other clinically relevant infectious and noninfectious causes of hepatitis.
Clinical evidence
Clinical hepatitis, defined as:
Jaundice
OR
Bilirubin in urine
OR
Alanine transaminase (ALT) seven times the upper limit of normal.
40
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Human immunodeficiency virus (HIV) infection – individuals less than
18months of age
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Detection of HIV by at least two virologic assays (nucleic acid testing for proviral DNA; HIV p24
antigen, with neutralisation; virus isolation) on at least two separate blood samples (excluding cord
blood).
Probable case
A probable case requires laboratory suggestive evidence only.
Laboratory suggestive evidence
Detection of HIV by one of the following virologic assays (nucleic acid testing for proviral DNA;
HIV p24 antigen, with neutralisation; virus isolation) in one blood sample (excluding cord blood)
and no subsequent negative HIV virologic or antibody tests.
41
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Human immunodeficiency virus (HIV) – newly acquired
Newly acquired HIV infection may be diagnosed in individuals aged 18 months or older at the time
of blood sample collection. A diagnosis of newly acquired HIV infection excludes a diagnosis of
HIV infection (unspecified).
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Repeatedly reactive result on a screening test for HIV antibody followed by a positive result on a
western blot AND laboratory evidence of a negative or indeterminate HIV antibody result in the 12
months prior to blood sample collection
OR
A group IV indeterminate western blot AND detection of HIV by at least one of the following
virologic assays (nucleic acid testing for proviral DNA; HIV p24 antigen, with neutralisation; virus
isolation). A group IV indeterminate western blot is defined by the presence of a glycoprotein band
(gp41, gp120 or gp160) and one or two other HIV specific bands.
Probable case
A probable case requires laboratory suggestive evidence and clinical evidence.
Laboratory suggestive evidence
Detection of HIV by at least one of the following virologic assays (nucleic acid testing for proviral
DNA; HIV p24 antigen, with neutralisation; virus isolation)
OR
Repeatedly reactive result on a screening test for HIV antibody followed by a positive result on a
western blot.
Clinical evidence
HIV seroconversion illness within the 12 months prior to blood sample collection.
42
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Human immunodeficiency virus (HIV) - unspecified individuals over 18
months of ages
HIV infection (unspecified) is diagnosed in individuals aged 18 months or older at the time of blood
sample collection, who do not have evidence of HIV acquisition in the previous 12 months. A
diagnosis of HIV infection (unspecified) excludes a diagnosis of newly acquired HIV infection.
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only AND that the case does not meet any
of the criteria for a newly acquired case.
Laboratory definitive evidence
Repeatedly reactive result on a screening test for HIV antibody followed by a positive result on a
western blot. A positive result on a western blot is defined by the presence of a glycoprotein band
(gp41, gp120 or gp160) and at least three other HIV-specific bands
OR
Detection of HIV by at least two virologic assays (nucleic acid testing for proviral DNA; HIVp24
antigen, with neutralisation; virus isolation) performed on at least two separate blood samples.
Probable case
A probable case requires laboratory suggestive evidence only.
Laboratory suggestive evidence
Detection of HIV by at least one of the following virologic assays (nucleic acid testing for proviral
DNA; HIV p24 antigen, with neutralisation; virus isolation) in one blood sample.
43
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Influenza (laboratory confirmed)
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
In Laboratory definitive evidence
under point 3. add Laboratory in front
of “Detection of influenza …” to read
“Laboratory detection of influenza
…”.
14 August
2008
29 October 2008 From 29 October
2008
1.0
Initial case definition (2004).
Reporting
Only confirmed cases should be notified.
Confirmed cases
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
1.
Isolation of influenza virus by culture from appropriate respiratory tract specimen
OR
2.
Detection of influenza virus by nucleic acid testing from appropriate respiratory tract
specimen
OR
3.
Laboratory detection of influenza virus antigen from appropriate respiratory tract specimen
OR
4.
IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in
titre to influenza virus
OR
5.
44
Single high titre by CFT or HAI to influenza virus.
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Japanese encephalitis virus infection
Version
Status
Last
reviewed
Endorsement
date
1.1
Change all references to Kunjin to West Nile
virus/Kunjin.
CDWG 4
Nov 2009
CDNA 12 May 1 July 2010
2010
Remove the two references to yellow fever
vaccination in laboratory definitive evidence
lines.
Under “Laboratory definitive evidence”
replace the reference to “in Australia” with
“in mainland Australia”.
Under Clinical evidence:
A clinically compatible febrile illness of
variable severity associated with neurological
symptoms ranging from headache to
meningitis or encephalitis. The encephalitis
cannot be distinguished clinically from other
central nervous system infections.
Symptoms may include headache or fever.
Clinical signs may include meningeal signs,
stupor, disorientation, coma, tremors,
generalised paresis, hypertonia, and loss of
coordination.
Replace it with the same text from clinical
evidence in West Nile virus/ Kunjin and
Murray Valley encephalitis virus case
definitions:
1. Non-encephalitic disease: acute febrile
illness with headache, myalgia and/or rash
OR
2. Encephalitic disease: acute febrile
meningoencephalitis characterised by one or
more of the following:
focal neurological disease or clearly impaired
level of consciousness
an abnormal computerised tomogram or
magnetic resonance image or
electroencephalogram
presence of pleocytosis in cerebrospinal fluid
OR
3. Asymptomatic disease: case detected as
part of a serosurvey should not be notified.
1.0
45
Initial case definition (2004).
Implementation
date
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
1. Isolation of Japanese encephalitis virus
OR
2. Detection of Japanese encephalitis virus by nucleic acid testing
OR
3. IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre
of Japanese encephalitis virus-specific IgG proven by neutralisation or another specific test, with no
history of recent Japanese encephalitis vaccination
OR
4. Detection of Japanese encephalitis virus-specific IgM in cerebrospinal fluid, in the absence of IgM
to Murray Valley encephalitis, West Nile/Kunjin and dengue viruses
OR
5. Detection of Japanese encephalitis virus-specific IgM in serum in the absence of IgM to Murray
Valley encephalitis, West Nile/Kunjin and dengue viruses, with no history of recent Japanese
encephalitis vaccination.
Confirmation of laboratory result by a second arbovirus reference laboratory is required if the case
appears to have been acquired in mainland Australia.
Clinical evidence
1. Non-encephalitic disease: acute febrile illness with headache, myalgia and/or rash
OR
2. Encephalitic disease: acute febrile meningoencephalitis characterised by one or more of the
following:



focal neurological disease or clearly impaired level of consciousness
an abnormal computerised tomogram or magnetic resonance image or electroencephalogram
presence of pleocytosis in cerebrospinal fluid
OR
3. Asymptomatic disease: case detected as part of a serosurvey should not be notified.
46
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Legionellosis
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
Confirmed case
CDWG 13
August 2012
CDNA 29
August 2012
1 January 2013
Under Laboratory definitive evidence,
Point 12, 'Presence of Legionella
urinary antigen' has changed to
'Detection of Legionella urinary
antigen'.
Probable case
Under Clinical evidence for probable
cases, ‘Fever OR Cough OR
Pneumonia’ has changed to ‘Fever
AND Cough OR Pneumonia.’
1.0
Initial CDNA case definition (2004).
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
Isolation of Legionella
OR
Presence of Legionella urinary antigen
OR
Seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to
Legionella.
Clinical evidence
Fever
OR
Cough
OR
Pneumonia.
Probable case
A probable case requires laboratory suggestive evidence AND clinical evidence.
Laboratory suggestive evidence
Single high antibody titre to Legionella
OR
47
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Detection of Legionella by nucleic acid testing
OR
Detection of Legionella by direct fluorescence assay.
Clinical evidence for probable cases
Fever AND Cough
OR
Pneumonia
48
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Leprosy
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
In Reporting, changed ‘only’
confirmed cases to 'a' confirmed case.
CDWG
22June
2012
CDNA 20 July
2012
1 January 2013
Changed Confirmed case to 'either
laboratory definitive evidence OR
laboratory suggestive evidence AND
clinical evidence'.
Changed 'Laboratory definitive
evidence to Laboratory suggestive
evidence'.
Redefined 'Laboratory definitive
evidence – Detection of
Mycobacterium leprae by nucleic acid
testing from the ear lobe or other
relevant specimens'.
1.0
Initial CDNA case definition (2004).
Reporting
Only a confirmed case should be notified.
Confirmed case
A confirmed case requires either laboratory definitive evidence
OR
Laboratory suggestive evidence AND clinical evidence.
Laboratory definitive evidence
Detection of Mycobacterium leprae by nucleic acid testing from the ear lobe or other relevant
specimens
Laboratory suggestive evidence
Demonstration of characteristic acid fast bacilli in slit skin smears and biopsies prepared from the
ear lobe or other relevant sites
OR
Histopathological report from skin or nerve biopsy compatible with leprosy (Hansen’s disease)
examined by an anatomical pathologist or specialist microbiologist experienced in leprosy diagnosis.
Clinical evidence
Compatible nerve conduction studies
OR
Peripheral nerve enlargement
OR
Loss of neurological function not attributable to trauma or other disease process
49
Australian National Notifiable Diseases Surveillance System surveillance case definitions
OR
Hypopigmented or reddish skin lesions with definite loss of sensation.
Note
International reporting to the World Health Organization (WHO) is based on the WHO working
definition: A person showing one or more of the following features, and who as yet has to complete
a full course of treatment:



hypopigmented or reddish skin lesions with definite loss of sensation
involvement of the peripheral nerves, as demonstrated by definite thickening with loss of
sensation
skin smear positive for acid-fast bacilli definition.
The difference in surveillance case definitions should be noted when reporting to the WHO.
50
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Leptospirosis
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of pathogenic Leptospira species
OR
A fourfold or greater rise in Leptospira agglutination titre between acute and convalescent phase sera
obtained at least two weeks apart and preferably conducted at the same laboratory
OR
A single Leptospira micro agglutination titre greater than or equal to 400 supported by a positive
enzyme-linked immunosorbent assay IgM result.
51
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Listeriosis
Reporting
Only confirmed cases should be notified. Where a mother and foetus/neonate are both confirmed,
both cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation or detection of Listeria monocytogenes from a site that is normally sterile, including foetal
gastrointestinal contents.
52
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Lyssavirus (not elsewhere classified)
Reporting
Only confirmed cases should be notified AND only where there is insufficient evidence to meet a
case definition for Australian bat lyssavirus or rabies.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
Positive fluorescent antibody test result for lyssaviral antigen on fresh brain smears
OR
Specific immunostaining for lyssaviral antigen on formalin fixed paraffin sections of central nervous
system tissue
OR
Presence of antibody to serotype 1 lyssavirus in the cerebrospinal fluid
OR
Detection of lyssavirus-specific RNA (other than to ABL or rabies).
Clinical evidence
Acute encephalomyelitis with or without altered sensorium or focal neurological signs.
53
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Malaria
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory evidence
Detection and specific identification of malaria parasites by microscopy on blood films with
confirmation of species in a laboratory with appropriate expertise
OR
Detection of Plasmodium species by nucleic acid testing.
54
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Measles
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires either:
Laboratory definitive evidence
OR
Clinical evidence AND epidemiological evidence.
Laboratory definitive evidence
At least one of the following:
Isolation of measles virus
OR
Detection of measles virus by nucleic acid testing
OR
Detection of measles virus antigen
OR
IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to
measles virus EXCEPT if the case has received a measles-containing vaccine eight days to eight
weeks before testing (Note: paired sera must be tested in parallel)
OR
Detection of measles virus-specific IgM antibody confirmed in an approved reference laboratory
EXCEPT if the case has received a measles-containing vaccine eight days to eight weeks before
testing.
Clinical evidence
An illness characterised by all of the following:
A generalised maculopapular rash lasting three or more days
AND
Fever (at least 38°C if measured) at the time of rash onset
AND
Cough OR coryza OR conjunctivitis OR Koplik spots.
Epidemiological evidence
An epidemiological link is established when there is:
1.
Contact between two people involving a plausible mode of transmission at a time when:
a. one of them is likely to be infectious (approximately five days before to four days after rash onset)
AND
b. the other has an illness that starts within seven to 18 (usually 10) days after this contact
AND
55
Australian National Notifiable Diseases Surveillance System surveillance case definitions
2.
At least one case in the chain of epidemiologically linked cases (which may involve many
cases) is laboratory confirmed.
Probable case
A probable case requires laboratory suggestive evidence AND clinical evidence.
Laboratory suggestive evidence
Detection of measles specific IgM antibody other than by an approved reference laboratory EXCEPT
if the case has received a measles-containing vaccine eight days to eight weeks before testing.
Clinical evidence
As with confirmed case.
56
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Meningococcal infection (Invasive)
Version
Status
Last reviewed Endorsement
date
Implementation
date
1.4
Re-examined differences
between Meningococcal
Guidelines October 2007 case
definition and the surveillance
case definition and adopted the
Guidelines version.
CDNA 30
September
2009
CDNA 30
September 2009
1 July 2010
1.3
No Change.
CDWG 14
August 2008
CDWG 14 August
2008
1.2
Under Laboratory suggestive
evidence delete following text
“Positive polysaccharide antigen
test in cerebrospinal fluid with
other laboratory parameters
consistent with meningitis.”
April 2007
October 2007
June 2005
April 2007
Under Laboratory definitive
evidence, add text in bold and
italics “Detection of specific
meningococcal DNA sequences
in a specimen from a normally
sterile site by nucleic acid
amplification testing.”
Move ‘detection of
meningococcus in a specimen
from a normally sterile site by
nucleic acid testing’ from
laboratory suggestive evidence to
laboratory definitive evidence.
1.1
Inclusion of PCR testing in
laboratory definitive evidence.
1.0
Initial CDNA case definition
(2004).
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires either:
1.
Laboratory definitive evidence
OR
2.
57
Laboratory suggestive evidence AND clinical evidence.
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Laboratory definitive evidence
1. Isolation of Neisseria meningitidis from a normally sterile site
OR
2. Detection of specific meningococcal DNA sequences in a specimen from a normally sterile
site by nucleic acid amplification testing.
Laboratory suggestive evidence

Detection of Gram-negative diplococci in Gram stain of specimen from a normally sterile
site or from a suspicious skin lesion

High titre IgM or significant rise in IgM or IgG titres to outer membrane protein antigens of
N. meningitides.
OR
Clinical evidence (for a confirmed case)
Disease which in the opinion of the treating clinician is compatible with invasive meningococcal
disease.
Probable case
A probable case requires clinical evidence only.
Clinical evidence (for a probable case)
A probable case requires:
1.
The absence of evidence for other causes of clinical symptoms
AND EITHER
2.
Clinically compatible disease including haemorrhagic rash
OR
3.
Clinically compatible disease AND close contact with a confirmed case within the previous 60
days.
58
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Mumps
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires either:
Laboratory definitive evidence
OR
Laboratory suggestive evidence AND clinical evidence
OR
Clinical evidence AND epidemiological evidence.
Laboratory definitive evidence
Isolation of mumps virus
OR
Detection of mumps virus by nucleic acid testing
OR
IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to
mumps virus EXCEPT when there has been recent mumps-containing immunisation.
Laboratory suggestive evidence
Detection of mumps-specific IgM antibody (in the absence of recent mumps vaccination).
Clinical evidence
A clinically compatible illness characterised by swelling of the parotid or other salivary glands
lasting two days or more without other apparent cause.
Epidemiological evidence
An epidemiological link is established when there is:
1. Contact between two people involving a plausible mode of transmission at a time when:
a. one of them is likely to be infectious (6-7 days before onset of overt parotitis to nine days
after)
AND
b. the other has an illness that starts within approximately 12 to 25 days after this contact
AND
2. At least one case in the chain of epidemiologically linked cases (which may involve many cases)
is laboratory confirmed.
59
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Murray Valley encephalitis virus infection
Version
Status
Last reviewed
Endorsement
date
1.1
Change all references to Kunjin on CDWG 4
CDNA 12 May
lines 15 and 18 to West Nile
November 2009 2010
virus/Kunjin.
Implementation
date
1 July 2010
Change the numbering under
clinical evidence, number 2. is to
be replaced with a number 3.
1.0
Initial case definition (2004).
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
1. Isolation of Murray Valley encephalitis virus
OR
2. Detection of Murray Valley encephalitis virus by nucleic acid testing
OR
3. IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre
to Murray Valley encephalitis virus
OR
4. Detection of Murray Valley encephalitis virus-specific IgM in cerebrospinal fluid in the absence
of IgM to West Nile/Kunjin, Japanese encephalitis and dengue viruses
OR
5. Detection of Murray Valley encephalitis virus-specific IgM in serum in the absence of IgM to
West Nile/Kunjin, Japanese encephalitis and dengue viruses. This is only accepted as laboratory
evidence for encephalitic illnesses.
Confirmation of laboratory result by a second arbovirus reference laboratory is required if the case
occurs in areas of Australia not known to have established enzootic/endemic activity or regular
epidemic activity.
Clinical evidence
1. Non-encephalitic disease: acute febrile illness with headache, myalgia and/or rash
OR
2. Encephalitic disease: acute febrile meningoencephalitis characterised by one or more of the
following:



OR
60
focal neurological disease or clearly impaired level of consciousness
an abnormal computerised tomogram or magnetic resonance image or electroencephalogram
presence of pleocytosis in cerebrospinal fluid
Australian National Notifiable Diseases Surveillance System surveillance case definitions
3. Asymptomatic disease: case detected as part of a serosurvey should not be notified.
61
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Ornithosis (psittacosis)
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence AND
epidemiological evidence.
Laboratory definitive evidence
A fourfold rise or greater in antibody titre against Chlamydia psittaci as demonstrated by
microimmunofluorescence (MIF) on acute and convalescent sera (collected at least two weeks later)
tested in parallel
OR
Detection of C. psittaci by nucleic acid testing or culture.
Clinical evidence
Pneumonia
OR
AT LEAST TWO of the following:






fever,
headache,
myalgia,
rigors,
dry cough or
dyspnoea.
Epidemiological evidence
Exposure to birds or bird products, or proximity to an outbreak of psittacosis.
Probable case
A probable case requires laboratory suggestive evidence AND clinical evidence AND
epidemiological evidence.
Laboratory suggestive evidence
A single high total antibody level or detection of IgM antibody to C. psittaci by MIF
OR
A single high total antibody titre to Chlamydia species demonstrated by complement fixation (CF) in
at least one sample obtained at least two weeks after onset of symptoms
OR
A fourfold or greater rise in antibody titre against Chlamydia species as demonstrated by CF.
Clinical evidence
As with confirmed case.
Epidemiological evidence
As with confirmed case.
62
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Paratyphoid
Version
Status
1.0
Initial case definition (2015).
Last reviewed
Endorsement
date
Implementation
date
CDNA October
2015
1 January 2016
Reporting
Only confirmed cases should be notified
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation or detection of Salmonella Paratyphi A or S. Paratyphi B (excluding S. Paratyphi B biovar
Java) or S. Paratyphi C.
63
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Pertussis
Version
Status
Last
reviewed
1.1
Confirmed case
CDWG 12 CDNA 29
December January 2013
2012
Removed “Clinical evidence AND
epidemiological evidence”
Probable case
Added “AND epidemiological evidence”
Laboratory definitive evidence
Added “OR Seroconversion in paired sera for
B. pertussis using whole cell or specific
B. pertussis antigen(s) in the absence of
recent pertussis vaccination.
Added footnote “In the absence of recent
vaccination”.
Laboratory suggestive evidence
Changed to “In the absence of recent
vaccination Significant change (increase or
decrease) in antibody level (IgG, IgA) to
B. pertussis whole cell or B. pertussis specific
antigen(s) OR Single high IgG and or IgA
titre to Pertussis Toxin (PT) Single high IgA
titre to Whole Cell B. pertussis antigen.
Added footnote “In the absence of recent
vaccination”.
To “A probable case requires clinical
evidence only” added “ AND epidemiological
evidence”
Removed Clinical evidence for probable
cases.
Moved Clinical evidence and
Epidemiological evidence to Probable Case.
1.0
Initial case definition (2004).
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires either:
Laboratory definitive evidence
OR
Laboratory suggestive evidence AND clinical evidence
64
Endorsement
date
Implementation
date
1 July 2013
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Probable case
A probable case requires clinical evidence AND epidemiological evidence
Laboratory definitive evidence
Isolation of Bordetella pertussis
OR
Detection of B. pertussis by nucleic acid testing
OR
Seroconversion in paired sera for B. pertussis using whole cell or specific B. pertussis antigen(s) in
the absence of recent pertussis vaccination
Laboratory suggestive evidence
In the absence of recent vaccination
Significant change (increase or decrease) in antibody level (IgG, IgA) to B. pertussis whole cell or
B. pertussis specific antigen(s)
OR
Single high IgG and/or IgA titre to Pertussis Toxin (PT)
OR
Single high IgA titre to Whole Cell B. pertussis antigen.
Clinical evidence
A coughing illness lasting two or more weeks
OR
Paroxysms of coughing OR inspiratory whoop OR post-tussive vomiting.
Epidemiological evidence
An epidemiological link is established when there is:
Contact between two people involving a plausible mode of transmission at a time when:
a. one of them is likely to be infectious (from the catarrhal stage, approximately one week
before, to three weeks after onset of cough)
AND
b. the other has an illness which starts within 6 to 20 days after this contact
AND
At least one case in the chain of epidemiologically linked cases (which may involve many cases) is a
confirmed case with either laboratory definitive or laboratory suggestive evidence.
65
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Plague
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of Yersinia pestis.
66
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Pneumococcal disease (invasive)
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of Streptococcus pneumoniae from a normally sterile site by culture
OR
Detection of Streptococcus pneumoniae from a normally sterile site by nucleic acid testing.
67
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Poliovirus infection
Version Status
1.5
Change of disease name. Changed from
‘poliomyelitis’ to ‘poliovirus infection’
to more accurately reflect both the
notifiable paralytic and non-paralytic
infections.
1.4
Corrections to Poliomyelitis paralytic
infection. Changed National Poliovirus
Reference Laboratory to National
Enterovirus Reference Laboratory; and
changed Polio Expert Committee to
Polio Expert Panel.
Last
reviewed
Endorsement
date
Implementation
date
CDWG 2
October
2013
CDNA 14
October 2013
1 January 2014
CDWG 2
October
2013
CDNA 14
October 2013
1 January 2014
In Poliomyelitis paralytic infection
case definition, spelt AFP in full; and
corrected the title of WHO publication.
1.3
Changes to Non-paralytic
Laboratory definitive evidence
Changed National Poliovirus Reference
Laboratory to National Enterovirus
Reference Laboratory.
Sabin-like poliovirus infection
Added “except where there has been
vaccination with Sabin oral polio
vaccine in the six weeks* prior to the
date of specimen collection.”
Added * Note: This period may be
longer for immunocompromised
individuals.
68
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Version Status
Last
reviewed
Endorsement
date
Implementation
date
1.2
CDWG 1
December
2010
CDNA 30
June 2011
1 July 2011
69
In line with the recent WHO changes to
the case definition, the following text
under Vaccine derived poliovirus
(VDPV) infection
1. Isolation of poliovirus (confirmed in
the National Poliovirus Reference
Laboratory) OR detection of poliovirus
by nucleic acid testing (confirmed in the
National Poliovirus Reference
Laboratory)
AND
2. Detection of a vaccine derived
poliovirus according to the current
definition of the World Health
Organization (reported by the National
Poliovirus Reference Laboratory).
Has been changed to:
Isolation of poliovirus (confirmed in the
National Poliovirus Reference
Laboratory) OR detection of poliovirus
by nucleic acid testing (confirmed in the
National Poliovirus Reference
Laboratory), characterised as a vaccine
derived poliovirus according to the
current definition of the World Health
Organization (reported by the National
Poliovirus Reference Laboratory).
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Version Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
CDWG 29
June 2010
CDNA 29
September
2010
1 January 2011
The case definition has been split into
two parts – ‘Poliomyelitis (paralytic
infection)’ and ‘poliovirus (nonparalytic) infection.
Isolation of viruses and detection by
nucleic acid testing under laboratory
definitive evidence for both
'Poliomyelitis (paralytic infection)' and
'Poliovirus (non-paralytic) infection' to
be confirmed by the National Poliovirus
Reference Laboratory instead of the
WHO Western Pacific Regional
Poliovirus Reference Laboratory.
Under laboratory definitive evidence for
'Poliomyelitis (paralytic infection)' a
third category of "vaccine derived
poliovirus (VDPV) infection" has been
added to the existing "wild type" and
“vaccine associated" infection
categories.
Under clinical evidence for
'Poliomyelitis (paralytic infection)' the
World Health Organization (WHO)
clinical case definition ("Any child
under 15 years of age with acute flaccid
paralysis (including Guillain-Barré
syndrome) or any person of any age with
paralytic illness if polio is suspected")
was adopted on the advice of the Polio
Expert Committee (PEC).
Under clinical evidence for
'Poliomyelitis (paralytic infection)' a
footnote was added providing the WHO
definition of acute flaccid paralysis as
recommended by PEC.
Under clinical evidence for
'Poliomyelitis (paralytic infection)' the
wording " For a case to be classified as
VAPP the determination must be made
by the Polio Expert Committee" was
added.
1.0
70
Initial case definition (2004).
Australian National Notifiable Diseases Surveillance System surveillance case definitions
1. Poliomyelitis (paralytic infection)
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
Wild poliovirus infection
Isolation of wild poliovirus (confirmed in the National Enterovirus Reference Laboratory) OR
detection of wild poliovirus by nucleic acid testing (confirmed in the National Enterovirus Reference
Laboratory).
Vaccine-associated paralytic poliomyelitis (VAPP)
Isolation of Sabin-like poliovirus (confirmed in the National Enterovirus Reference Laboratory) OR
detection of Sabin-like poliovirus by nucleic acid testing (confirmed in the National Enterovirus
Reference Laboratory).
Vaccine derived poliovirus (VDPV) infection
Isolation of poliovirus (confirmed in the National Enterovirus Reference Laboratory) OR detection
of poliovirus by nucleic acid testing (confirmed in the National Enterovirus Reference Laboratory),
characterised as a vaccine derived poliovirus according to the current definition of the World Health
Organization (reported by the National Enterovirus Reference Laboratory).
Clinical evidence
Any child under 15 years of age with acute flaccid paralysis* (including Guillain-Barré syndrome)
or any person of any age with paralytic illness if polio is suspected.
For a case to be classified as VAPP the determination must be made by the Polio Expert Panel.
Probable case
A probable case of poliomyelitis (paralytic infection) requires clinical evidence AND the case not
discarded as non-polio paralytic illness by the Polio Expert Panel.
Clinical evidence
As with confirmed case.
* Acute flaccid paralysis syndrome is characterised by rapid onset of weakness of an individual’s extremities, often
including weakness of the muscles of respiration and swallowing, progressing to maximum severity within 1-10
days. The term “flaccid” indicates the absence of spasticity or other signs of disordered central nervous system
(CNS) motor tracts such as hyperflexia, clonus, or extensor plantar responses. (Excerpt from Acute onset flaccid
paralysis; World Health Organization 1993; WHO/MNH/EPI/93.3. Geneva)
2. Poliovirus (non-paralytic) infection
Reporting
Isolation or detection of poliovirus from clinical specimens with laboratory definitive evidence
should be notified.
This case definition should be used for asymptomatic patients or patients with illness not consistent
with acute flaccid paralysis.
71
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Laboratory definitive evidence
Wild poliovirus infection
Isolation of wild poliovirus (confirmed in the National Enterovirus Reference Laboratory) OR
detection of wild poliovirus by nucleic acid testing (confirmed in the National Enterovirus Reference
Laboratory).
Sabin-like poliovirus infection
Isolation of Sabin-like poliovirus (confirmed in the National Enterovirus Reference Laboratory) OR
detection of Sabin-like poliovirus by nucleic acid testing (confirmed in the
National Enterovirus Reference Laboratory) except where there has been vaccination with Sabin oral
polio vaccine in the six weeks# prior to the date of specimen collection.
# Note: This period may be longer for immunocompromised individuals
Vaccine derived poliovirus (VDPV) infection
Isolation of poliovirus (confirmed in the National Enterovirus Reference Laboratory) OR detection
of poliovirus by nucleic acid testing (confirmed in the National Enterovirus Reference Laboratory),
characterised as a vaccine derived poliovirus according to the current definition of the World Health
Organization (reported by the National Enterovirus Reference Laboratory).
72
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Q fever
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires either:
Laboratory definitive evidence
OR
Laboratory suggestive evidence AND clinical evidence.
Laboratory definitive evidence
Detection of Coxiella burnetii by nucleic acid testing
OR
Seroconversion or significant increase in antibody level to Phase II antigen in paired sera tested in
parallel in absence of recent Q fever vaccination
OR
Detection of C. burnetii by culture (Note: this practice should be strongly discouraged except where
appropriate facilities and training exist).
Laboratory suggestive evidence
Detection of specific IgM in the absence of recent Q fever vaccination.
Clinical evidence
A clinically compatible disease.
73
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Rabies
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of rabies virus confirmed by sequence analysis
OR
Detection of rabies virus by nucleic acid testing.
74
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Ross River virus infection
Version
Status
Last
reviewed
Endorsement
date
1.2
New probable category
CDWG
September
2015
CDNA October 1 January 2016
2015
Laboratory definitive evidence now only
includes detection by PCR and
demonstrated seroconversions. A single
IgM will no longer be included in this
category.
Implementation
date
Laboratory suggestive evidence will
require an IgM in the presence of IgG on
the same specimen.
Single IgM positive results will no
longer meet the confirmed or probable
case definition.
1.1
An assessment of notifications of Ross
CDWG 21
River virus and Barmah Forest virus
September
infection found significant numbers of
2012
dual notifications in both jurisdictional
and national data sets. It was agreed that
the case definitions for Ross River virus
and Barmah Forest virus infection should
be made more specific.
Add to the end of point 4 under
Laboratory definitive evidence 'in the
absence of Barmah Forest virus IgM,
unless Ross River virus IgG is also
detected'.
Add point 5, 'Detection of Ross River
virus-specific IgM in the presence of
Ross River virus IgG'.
Classifying cases with IgM to both RRV
and BFV but IgG to neither as RRV
cases was considered, as the crossreactivity problem is thought to be
mainly due to false positive BFV IgM in
patients with genuine RRV IgM, rather
than vice versa. However it was decided
that this would complicate the case
definitions too much for little gain as
there are likely to be relatively few such
situations.
1.0
75
Initial CDNA case definition (2004).
CDNA 5
October 2012
1 January 2013
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Probable case
A probable case requires laboratory suggestive evidence only.
Laboratory definitive evidence
Isolation of Ross River virus
OR
Detection of Ross River virus by nucleic acid testing
OR
IgG seroconversion or a significant increase in IgG antibody level (e.g. fourfold or greater rise in
titre) to Ross River virus.
Laboratory suggestive evidence
Detection of Ross River virus IgM AND Ross River virus IgG EXCEPT if Ross River IgG is known
to have been detected in a specimen collected greater than 3 months earlier.
76
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Rubella
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of rubella virus
OR
Detection of rubella virus by nucleic acid testing
OR
IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to
rubella virus in the absence of recent rubella vaccination. The results must be established by the
testing of paired sera in parallel
OR
Detection of rubella-specific IgM, in the absence of recent rubella vaccination. (Note: that in
pregnant women, the result needs to be confirmed in a reference laboratory).
Probable case
A probable case requires:
Clinical evidence
AND
Laboratory suggestive evidence OR epidemiological evidence.
Laboratory suggestive evidence
In a pregnant patient, detection of rubella-specific IgM that has not been confirmed in a reference
laboratory, in the absence of recent rubella vaccination.
Clinical evidence
A generalised maculopapular rash
AND
fever
AND
arthralgia/arthritis OR lymphadenopathy OR conjunctivitis.
Epidemiological evidence
An epidemiological link is established when there is:
Contact between two people involving a plausible mode of transmission at a time when:
a. one of them is likely to be infectious (about one week before to at least four days after
appearance of rash)
AND
b. the other has an illness which starts within 14 and 23 days after this contact
77
Australian National Notifiable Diseases Surveillance System surveillance case definitions
AND
At least one case in the chain of epidemiologically linked cases (which may involve many cases) is
laboratory confirmed.
78
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Congenital Rubella Infection
Version
Status
Last
reviewed
Endorsement
date
1.1
Case definition has been renamed
‘Congenital Rubella Infection’, with a
subcategory of ‘Congenital Rubella
Syndrome’.
CDWG
CDNA July
June 2015 2015
Implementation
date
1 January 2016
Laboratory definitive evidence
separated into fetal and infant.
Laboratory suggestive evidence
(maternal) reframed as epidemiological
evidence and separated into 1st
trimester versus 2nd/3rd trimester.
Laboratory evidence criteria
throughout amended to be consistent
with PHLN case definition.
1.0
Initial CDNA case definition (2004)
Congenital rubella infection is reported based on relevant evidence from a live or stillborn infant,
miscarriage or pregnancy termination. Congenital rubella syndrome is reported as a subset of
congenital rubella infection.
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence (fetal)
OR
Laboratory definitive evidence (infant) AND epidemiological evidence
Laboratory definitive evidence
Fetal
Isolation or detection of rubella virus from an appropriate clinical sample (i.e. fetal blood or tissue,
amniotic fluid, chorionic villus sample) by culture or nucleic acid testing
Infant
Isolation or detection of rubella virus from an appropriate clinical sample in an infant, by culture or
nucleic acid testing.
OR
Detection of rubella-specific IgM antibody in the serum of the infant.
79
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Epidemiological evidence
The mother has confirmed rubella infection during pregnancy (see definition for Rubella – noncongenital).
Probable case
A probable case requires
Epidemiological evidence (1st trimester infection)
OR
Epidemiological evidence (2nd and 3rd trimester infection) AND laboratory suggestive evidence
(infant)
Laboratory suggestive evidence
Infant
High / rising rubella-specific IgG level in first year of life
Congenital Rubella Syndrome
Reporting
Both confirmed cases and probable cases should be reported.
Confirmed case
A confirmed case requires laboratory definitive evidence (fetal or infant), as described above AND
clinical evidence
Clinical evidence
A live or stillborn infant with ANY of the following compatible defects: cataract, congenital
glaucoma, congenital heart disease, hearing defect, microcephaly, pigmentary retinopathy,
developmental delay, purpura, hepatosplenomegaly, meningoencephalitis, radiolucent bone disease
or other defect not better explained by an alternative diagnosis.
Probable case
A probable case requires laboratory suggestive evidence (infant) OR epidemiological evidence, as
described above
AND clinical evidence
Clinical evidence
(as for confirmed CRS case)
80
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Salmonellosis
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
Revised to reflect the creation of a
separate case definition for
paratyphoid.
CDWG
August
2015
CDNA October
2015
1 January 2016
1.0
Initial CDNA case definition (2004)
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation or detection of Salmonella species (excluding serotypes captured under the case definitions
for typhoid and paratyphoid)
81
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Severe acute respiratory syndrome (SARS)
Reporting
Only confirmed cases should be notified. (Note: A surveillance case definition for probable cases is
currently in preparation).
Confirmed case
A confirmed case requires laboratory definitive evidence and clinical evidence.
Laboratory definitive evidence
Detection of severe acute respiratory syndrome-coronavirus (SARS-CoV) by nucleic acid testing
using a validated method from at least two different clinical specimens (e.g. nasopharyngeal and
stool) OR the same clinical specimen collected on two or more occasions during the course of the
illness (e.g. sequential nasopharyngeal aspirates) OR two different assays or repeat PCR using a new
RNA extract from the original clinical sample on each occasion of testing
OR
Seroconversion or significant increase in antibody level or fourfold or greater rise in titre to SARSCoV tested in parallel by enzyme-linked immunosorbent assay or immunofluorescent assay
OR
Isolation of SARS-CoV AND detection of SARS-CoV by nucleic acid testing using a validated
method.
Clinical evidence
A person with a history of:
Fever (≥ 38°C)
AND
One or more symptoms of lower respiratory tract illness (cough, difficulty breathing)
AND
Radiographic evidence of lung infiltrates consistent with pneumonia or Acute Respiratory Distress
Syndrome (ARDS) OR autopsy findings consistent with the pathology of pneumonia or ARDS.
Note:
The NNDSS definition is based on that provided by WHO for use in the inter-outbreak period. It
should be recognised that the case definition provided by WHO may be modified in the event of a
second global alert. Until the epidemiology of SARS has been further defined, “alert cases” (see
below) should be reported to State and Territory Health Departments, and informally reported to the
Australian Government Department of Health and Ageing. The aim of the alert cases is to provide
early warning of the potential recurrence of SARS to:



rapidly implement appropriate infection control measures
expedite diagnosis
activate the public health response.
Alert case
In the absence of an alternate diagnosis:
Two or more health care workers in the same health care unit fulfilling the clinical case definition of
SARS and with onset of illness in the same 10-day period
OR
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Hospital acquired illness in three or more persons (health care workers and/or other hospital staff
and/or patients and/or visitors) in the same health care unit fulfilling the clinical case definition of
SARS and with onset of illness in the same 10-day period.
83
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Shiga toxin- and verocytotoxin-producing Escherichia coli (STEC/ VTEC)
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of shigatoxigenic/verotoxigenic Escherichia coli from faeces
OR
Isolation of Shiga toxin or vero toxin from a clinical isolate of E. coli
OR
Identification of the gene associated with the production of Shiga toxin or vero toxin in E. coli by
nucleic acid testing on isolate or raw bloody diarrhoea.
Note: Where STEC/VTEC is isolated in the context of Haemolytic Uraemic Syndrome (HUS), it
should be notified as STEC/VTEC and HUS.
84
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Shigellosis
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation or detection of Shigella species.
85
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Smallpox
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of variola virus, confirmed at the Victorian Infectious Diseases Reference Laboratory
OR
Detection of variola virus by nucleic acid testing, confirmed at the Victorian Infectious Diseases
Reference Laboratory.
Probable case
A probable case requires either:
Clinical evidence AND laboratory suggestive evidence
OR
Clinical evidence AND epidemiological evidence.
Laboratory suggestive evidence
Detection of a poxvirus resembling variola virus by electron microscopy
OR
Isolation of variola virus pending confirmation
OR
Detection of variola virus by nucleic acid testing pending confirmation.
Clinical evidence
Credible clinical smallpox as judged by an expert physician.
Epidemiological evidence
An epidemiological link to a confirmed case.
Note:
The “Guidelines for Smallpox Outbreak, Preparedness, Response and Management” include
separate case definitions for smallpox surveillance both preceding and during an outbreak. The
Guidelines define confirmed, probable, suspected and possible cases for the purposes of public
health response. The definitions are at some variance with the case definitions for reporting to the
National Notifiable Diseases Surveillance System. Suspected cases and possible cases should also be
reported to the State/Territory Health Department.
86
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Syphilis - congenital
Version Status
Last reviewed Endorsement Implementation
date
date
1.2
CDWG May
2015
Reporting
Inclusion of a syphilis-related
stillbirth where this was previously a
note for the ‘Laboratory definitive
evidence’ section.
CDNA June
2015
1 July 2015
Laboratory Definitive Evidence
Inclusion of detection of Treponema
pallidum specific IgM in the child.
Inclusion of a nucleic acid
amplification (NAA) test as a means
of direct demonstration of Treponema
pallidum .
Notes
Removal of the serological criterion
for proof of treatment in point 4. This
is also reflected in the last sentence of
the ‘Clinical evidence’ section.
1.1
Confirmed Case: ‘Laboratory
Suggestive and Clinical evidence’
moved to define a Probable Case.
Probable Case: Structure and content
of ‘Probable Case’ section amended to
be consistent with Case Definition
style guide and comprise Laboratory
Suggestive and Clinical evidence.
Lab Definitive evidence: Extensive
rework of section including: removal
of specific reference to treponemal
IgM assays; inclusion of requirement
that NAT and other tests be
corroborated; broadening of the
specimen sites which might get tested;
adding criteria allowing for the
persistence of antibody in infants to
count as definitive.
Lab Suggestive evidence: Reworking
of section including: removal of
specific reference to IgM assays;
removing NAT from a non-sterile site
(now definitive evidence if
corroborated); adding seropositivity in
either child or mother.
Clinical Evidence: Structure and
87
CDWG O-O-S CDNA
January 2010
29 September
2010
1 January 2011
Australian National Notifiable Diseases Surveillance System surveillance case definitions
content of ‘Clinical Evidence’ section
amended to be consistent with Case
Definition style guide. ‘Asymptomatic
infection’, ‘Foetal death in utero’ and
‘Stillbirth in a foetus greater than 20
weeks gestation’ removed from
criteria, but accounted for in the notes;
details of clinical evidence also
removed; rewording of the clause
defining inadequate maternal
treatment; moving laboratory
evidence into appropriate sections.
1.0
Initial case definition (2004).
Reporting
Both confirmed cases and probable cases should be notified, including syphilis-related stiilbirth.1
Confirmed case
A confirmed case requires laboratory definitive evidence.
Laboratory definitive evidence
Mother and child both seropositive by a treponemal specific test2
AND
One or more of the following:
Direct demonstration of Treponema pallidum by any of the following: nucleic acid amplification
(NAA) test, dark field microscopy, fluorescent antibody or silver stain - in specimens from lesions,
nasal discharge, placenta, umbilical cord, cerebrospinal fluid (CSF), amniotic fluid or autopsy
material
OR
Detection of Treponema pallidum specific IgM in the child
OR
The child’s serum non-treponemal3 serology titre at birth is at least fourfold greater than the mother's
titre.
Probable case
A probable case requires laboratory suggestive evidence AND clinical evidence.
Laboratory suggestive evidence
Direct demonstration of Treponema pallidum as described under laboratory definitive evidence
(above), but without serological confirmation in the child.
OR
Child seropositive on non-treponemal testing in the absence of IgM testing
OR
A reactive CSF non-treponemal test (VDRL or RPR) in a child.
OR
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
A child who remains seropositive by a treponemal specific test at 15 months of age, which is
confirmed either by another, different reactive treponemal specific test or a reactive non-treponemal
test, in the absence of post-natal exposure to Treponema pallidum , including the non-venereal
subspecies Treponema pallidum subsp. pertenue (Yaws) or subsp. endemicum (Bejel, endemic
syphilis).
Clinical evidence
1. Any evidence of congenital syphilis on physical examination
OR
2. Any evidence of congenital syphilis on radiographs of long bones
OR
3. An elevated CSF cell count or protein (without other cause)
OR
4. The mother is seropositive in the perinatal period AND has no documented evidence of adequate
treatment4.
Notes:
1
A stillbirth where the foetal death has occurred after a 20 week gestation or in a foetus which
weighs greater than 500g should be counted as clinical evidence towards a case where laboratory
suggestive or definitive evidence exists.
2
Treponemal specific tests are:
Treponema pallidum immunoassays, Treponema pallidum haemagglutination assay (TPHA),
Treponema pallidum particle agglutination assay (TPPA), Fluorescent Treponemal Antibody
Absorption (FTA-Abs) and various IgM assays including 19S-IgM antibody test, or IgM
immunoassay. IgM assays should not be used for screening purposes.
Treponema pallidum-specific rapid immunochromatography (ICT) assays for use as point-of-care
tests are now becoming available, but their performance has not yet been fully established. Positive
ICT results should be confirmed with a second treponemal specific assay.
3
Non-treponemal tests are the agglutination assays Rapid Plasma Reagin (RPR) and Venereal
Disease Research Laboratory (VDRL). Any positive sera should be tested by serial dilution to
provide an end-titre. Non-treponemal tests may be used to monitor efficacy of treatment. Mother and
child sera should be collected contemporaneously and tested in parallel and cord blood should not be
used for the investigation of congenital syphilis.
4
Treatment is considered adequate if



a stage-appropriate penicillin-containing regimen was used 30 days or more prior to delivery
AND
all antenatal and delivery pathology investigations were performed and results verified AND
there is no evidence of reinfection.
4.1 Treatment with macrolides alone during pregnancy in penicillin-allergic women is no longer
regarded as adequate therapy as resistance to macrolides in T. pallidum is increasingly common and
may arise during therapy.
4.2 Although the risk of congenital syphilis is much higher in early-stage disease, in the presence of
untreated syphilis the birth of an unaffected child does not guarantee that subsequent children will
not be affected.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Infectious Syphilis – less than 2 years duration (includes primary,
secondary and early latent)
Version
Status
Last reviewed Endorsement
date
Implementation
date
Change name from ‘Syphilis – less than 2
years duration (infectious - primary,
secondary and early latent)’ to ‘Infectious
Syphilis – less than two years duration
(includes primary, secondary and early
latent)’
May 2014
1 July 2015
January 2015
Include new case definition for infectious
syphilis, probable case.
Reporting
Both confirmed and probable cases should
be notified.
Laboratory definitive evidence
Move details regarding treponemal tests to
notes section.
1.1
Lab Definitive evidence: Point 1: “… and
the latest result is confirmed by either a
reactive non-specific treponemal test or a
different specific treponemal test result.”
Added.
Lab Suggestive Evidence: Point 1:
“microscopy” added to the “direct
fluorescent antibody [microscopy]”
Significant rework of the remainder of this
section including addition of:
“A reactive specific treponemal test (e.g.
IgG enzyme immunoassay, Treponema
pallidum haemagglutination assay,
Treponema pallidum particle agglutination,
Treponema pallidum immobilisation assay,
or fluorescent treponemal antibody
absorption), confirmed either by a different
specific test or a non-specific treponemal
test; OR A reactive non-specific treponemal
test (e.g. Venereal Diseases Research
Laboratory, Rapid Plasma Reagin)
confirmed by a specific treponemal test (e.g.
IgG enzyme immunoassay, Treponema
pallidum haemagglutination assay,
Treponema pallidum particle agglutination,
Treponema pallidum immobilisation assay,
or fluorescent treponemal antibody
absorption).”
1.0
90
Initial case definition (2004).
CDWG O-O-S CDNA 29
January 2010 September
2010
1 January 2011
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Reporting
Confirmed and probable cases should be notified.
Confirmed case
A confirmed case requires either:
1. Laboratory definitive evidence
OR
2. Laboratory suggestive evidence AND clinical evidence.
Laboratory definitive evidence
1. Seroconversion in past two years: treponemal specific test a reactive when previous
treponemal specific test non-reactive within past two years and the latest result is confirmed
by either a reactive non-treponemal testb or a different reactive treponemal specific test
OR
2. A fourfold or greater rise in non-treponemal antibody titre compared with the titre within
past two years, and a reactive treponemal specific test
Laboratory suggestive evidence
1. Demonstration of Treponema pallidum by darkfield microscopy (not oral lesions), direct
fluorescent antibody microscopy (direct antigen test), equivalent microscopic methods (e.g.
silver stains), or DNA methods (e.g. nucleic acid testing)
OR
2. A reactive treponemal specific test confirmed by either a reactive non-treponemal test or a
different reactive treponemal specific test
OR
3. A reactive non- treponemal test confirmed by a treponemal specific test
Clinical evidence
1. Presence of a primary chancre (or ulcer)
OR
2. Clinical signs of secondary syphilis.
Probable case
A probable case requires that case does not meet the criteria for a confirmed case AND
Either:
a. In a person with no known previous reactive serology: no history of adequate treatment of
syphilis, or endemic treponemal disease, and
1. Contact with an infectious case AND laboratory suggestive evidence.
OR
2. Laboratory suggestive evidence AND RPR ≥16.
OR
3. Positive syphilis IgM AND laboratory suggestive evidence.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
OR
b. In a person with previous reactive serology: a fourfold or greater rise in non- treponemal
antibody titre when the previous serology was done more than two years ago.
AND
1. Contact with an infectious case
OR
2. Positive syphilis IgM
Notes:
a. Treponemal specific tests are: IgG immunoassay, Treponema pallidum haemagglutination assay,
Treponema pallidum particle agglutination assay, Fluorescent Treponemal Antibody Absorption,
19S-IgM antibody test, or IgM immunoassay
b. Non-treponemal tests are; Rapid Plasma Reagin (RPR), Venereal Disease Research Laboratory
(VDRL)
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Syphilis - more than 2 years duration or unspecified duration
Version
Status
Last reviewed Endorsement
date
Implementation
date
1.1
Lab Definitive evidence: Point 1:
deletion of “ .. if the non-specific
treponemal test is non-reactive”
CDWG O-OS January
2010
1 January 2011
CDNA 29
September
2010
Point 2: Restructured to “In a person
with no known previous reactive
serology: no history of adequate
treatment of syphilis, or endemic
treponemal disease (e.g. Yaws). OR
b) In a person with previously
reactive serology: a fourfold or
greater rise in non-specific
treponemal antibody titre when the
previous serology was done more
than two years ago.”
Lab Suggestive evidence: “…direct
fluorescent antibody tests..” amended
to “…direct antigen detection tests”.
Clinical evidence: description
expanded upon.
1.0
Initial case definition (2004).
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires that the case does not meet the criteria for a case of infectious syphilis
less than 2 years duration AND either:
1.
Laboratory definitive evidence
OR
2.
Laboratory suggestive evidence AND clinical evidence.
Laboratory definitive evidence
1. A reactive specific treponemal test (e.g. IgG enzyme immunoassay, Treponema pallidum
haemagglutination assay, Treponema pallidum particle agglutination, Treponema pallidum
immobilisation assay, or fluorescent treponemal antibody absorption) which is confirmed either by a
reactive non-specific treponemal test (e.g. Venereal Diseases Research Laboratory, Rapid Plasma
Reagin) or a different specific treponemal test
AND
2.
a) In a person with no known previous reactive serology: no history of adequate treatment of
syphilis, or endemic treponemal disease (e.g. Yaws)
OR
b) In a person with previously reactive serology: a fourfold or greater rise in non-specific treponemal
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
antibody titre when the previous serology was done more than two years ago.
Note: In a high prevalence area, only one reactive specific treponemal test result is necessary.
Laboratory suggestive evidence
Demonstration of Treponema pallidum by darkfield microscopy (not oral lesions), direct antigen
detection tests, equivalent microscopic methods (e.g. silver stains), or DNA methods (e.g. nucleic
acid testing).
Clinical evidence
Clinical, radiological or echocardiographic signs of tertiary syphilis.
94
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Tetanus
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires either:
Laboratory definitive evidence
OR
Clinical evidence.
Laboratory definitive evidence
Isolation of Clostridium tetani from a wound in a compatible clinical setting and prevention of
positive tetanospasm in mouse test from such an isolate using specific tetanus antitoxin.
Clinical evidence
A clinically compatible illness without other apparent cause.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Tuberculosis
Version Status
1.1
Last
reviewed
Point 1, under Laboratory definitive
CDWG 7
evidence was rewritten to include April 2010
excluding Mycobacterium bovis variant
BCG from notification:
Endorsement
date
Implementation
date
CDNA 29
September
2010
1 January 2011
“1. Isolation of Mycobacterium
tuberculosis complex (M. tuberculosis,
M. Bovis or M. africanum, excluding
M. bovis var BCG) by culture”
1.0
Initial case definition (2004).
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires a diagnosis accepted by the Director of Tuberculosis Control (or
equivalent) in the relevant jurisdiction, based on either:
Laboratory definitive evidence
OR
Clinical evidence.
Laboratory definitive evidence
Isolation of Mycobacterium tuberculosis complex (M. tuberculosis, M. bovis or M. africanum,
excluding M. bovis var BCG) by culture
OR
Detection of M. tuberculosis complex by nucleic acid testing EXCEPT where this is likely to be due
to previously treated or inactive disease.
Clinical evidence
A clinician experienced in tuberculosis makes a clinical diagnosis of tuberculosis, including clinical
follow-up assessment to ensure a consistent clinical course.
96
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Tularaemia
Version
Status
Last reviewed
Endorsement
date
Implementation
date
1.1
1. Change ‘rods’ to ‘bacilli’.
14 August 2008
29 October 2008
From 29 October
2008
2. ‘Laboratory Suggestive
Evidence’ includes the
following:

1.0
Immunofluorescence and
Immunohistochemistry
techniques.
Initial CDNA case definition
(2004).
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation of Francisella tularensis.
Probable case
A probable case requires laboratory suggestive evidence AND clinical evidence.
Laboratory suggestive evidence
1. Isolation of Gram negative bacilli suggestive of F. tularensis where the organism identity
and pathogenicity have not yet been confirmed by a reference laboratory
OR
2. Detection of F. tularensis by nucleic acid testing
OR
3. Detection of Gram-negative bacilli suggestive of F. tularensis, confirmed by a reference
laboratory
OR
4. Detection of F. tularensis by direct immunofluorescence antigen detection testing
OR
5. Detection of F. tularensis by immunohistochemical stains.
Clinical evidence
A clinically compatible illness.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Typhoid
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Isolation or detection of Salmonella typhi.
98
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Varicella zoster (chickenpox)
Version
Status
Last reviewed
Endorsement
date
Implementation
date
1.1
No Change.
14 August 2008
14 August 2008
From 14 August
2008
1.0
Initial case definition (2006).
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires either:
1. Laboratory definitive evidence AND clinical evidence
OR
2. Clinical evidence AND epidemiological evidence.
Laboratory definitive evidence
1. Isolation of varicella-zoster virus from a skin or lesion swab. If the case received varicella vaccine
between five and 42 days prior to the onset of rash the virus must be confirmed to be a wild type
strain
OR
2. Detection of varicella-zoster virus from a skin or lesion swab by nucleic acid testing from a skin
or lesion swab. If the case received varicella vaccine between five and 42 days prior to the onset of
rash the virus must be confirmed to be a wild type strain
OR
3. Detection of varicella-zoster virus antigen from a skin or lesion swab by direct fluorescent
antibody from a skin or lesion swab. If the case received varicella vaccine between five and 42 days
prior to the onset of rash the virus must be confirmed to be a wild type strain
OR
4. Detection of varicella-zoster virus-specific IgM in an unvaccinated person.
Clinical evidence
Acute onset of a diffuse maculopapular rash developing into vesicles within 24–48 hours and
forming crusts (or crusting over) within 5 days.
Epidemiological evidence
An epidemiological link is established when there is:
1. Contact between two people involving a plausible mode of transmission at a time when:
a.
one of them is likely to be infectious
AND
b.
the other has illness 10 to 21 days after contact
AND
2. At least one case in the chain of epidemiologically-linked cases is laboratory confirmed.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Probable case
A probable case requires clinical evidence only.
Note: Laboratory confirmation should be strongly encouraged for vaccinated cases. If positive,
samples should be referred for identification as a vaccine or wild type strain.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Varicella zoster (shingles)
Version
Status
Last reviewed
Implementation
date
1.1
No Change.
14 August 2008 14 August 2008
1.0
Initial case definition (2006).
Implementation
date
From 14 August
2008
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
1. Isolation of varicella-zoster virus from a skin or lesion swab
OR
2. Detection of varicella-zoster virus from a skin or lesion swab by nucleic acid testing from a skin
or lesion swab
OR
3. Detection of varicella-zoster virus antigen from a skin or lesion swab by direct fluorescent
antibody from a skin or lesion swab.
Clinical evidence
A vesicular skin rash with a dermatomal distribution that may be associated with pain in skin areas
supplied by sensory nerves of the dorsal root ganglia.
Probable case
A probable case requires clinical evidence only.
Note: Laboratory confirmation should be strongly encouraged for vaccinated cases. If positive,
samples should be referred for identification as a vaccine or wild type strain.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Varicella zoster (unspecified)
Version
Status
Last reviewed
Implementation
date
1.1
No change.
14 August 2008 14 August 2008
1.0
Initial case definition (2006).
Implementation
date
From 14 August
2008
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence in the absence of clinical information.
Laboratory definitive evidence
1. Isolation of varicella-zoster virus from a skin or lesion swab
OR
2. Detection of varicella-zoster virus from a skin or lesion swab by nucleic acid testing from a skin
or lesion swab
OR
3. Detection of varicella-zoster virus antigen from a skin or lesion swab by direct fluorescent
antibody from a skin or lesion swab
OR
4. Detection of varicella-zoster virus-specific IgM in an unvaccinated person.
102
Australian National Notifiable Diseases Surveillance System surveillance case definitions
Viral haemorrhagic fevers (quarantinable)
(Quarantinable – includes Ebola, Marburg, Lassa and Crimean-Congo
fevers)
Version
Status
1.2
Include the Victorian Infectious
CDWG - 31 CDNA - 5
6 November
Diseases Reference Laboratory
October 2014 November 2014 2014
(VIDRL) as an additional laboratory
where laboratory definitive evidence
can be confirmed. Include footnote that
the first case in Australia in any given
outbreak will also be confirmed by
CDC or NIV.
1.1
Laboratory definitive evidence
Added “or the Special Pathogens
Laboratory, National Institute of
Virology (NIV), Johannesburg”.
Last
reviewed
CDWG - 12
June 2013
Endorsement
date
CDNA August 2014
Implementation
date
1 January 2014
Removed “viral haemorrhagic fever”
virus.
Added “specific” virus.
Added “or” antigen detection assay.
Removed “or electron microscopy”
1.0
Initial CDNA case definition (2004).
Reporting
Both confirmed cases and probable cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence only.
Laboratory definitive evidence
Laboratory definitive evidence requires confirmation by the Victorian Infectious Diseases Reference
Laboratory (VIDRL), Melbourne*, or the Special Pathogens Laboratory, CDC, Atlanta, or the
Special Pathogens Laboratory, National Institute of Virology (NIV), Johannesburg
Isolation of a specific virus
OR
Detection of specific virus by nucleic acid testing or antigen detection assay
OR
IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to
specific virus.
Probable case
A probable case requires laboratory suggestive evidence AND clinical evidence AND
epidemiological evidence.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Laboratory suggestive evidence
Isolation of virus pending confirmation by VIDRL, Melbourne, or CDC, Atlanta or NIV,
Johannesburg
OR
Detection of specific virus by nucleic acid testing, pending confirmation by VIDRL, Melbourne, or
CDC, Atlanta or NIV, Johannesburg
OR
IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to
specific virus pending confirmation by VIDRL, Melbourne, or CDC, Atlanta or NIV, Johannesburg
OR
Detection of IgM to a specific virus.
Clinical evidence
A compatible clinical illness as determined by an infectious disease physician. Common presenting
complaints are fever myalgia, and prostration, with headache, pharyngitis, conjunctival injection,
flushing, gastrointestinal symptoms. This may be complicated by spontaneous bleeding, petechiae,
hypotension and perhaps shock, oedema and neurologic involvement.
Epidemiological evidence
History of travel to an endemic/epidemic area within 9 days (Marburg), 13 days (Crimean Congo) or
21 days (Lassa, Ebola) of illness onset. Filoviruses are endemic in Sub-Saharan Africa, Lassa in
Western Africa, Crimean Congo in Africa and the Middle East to West China;
OR
Contact with a confirmed case,
OR
Exposure to viral haemorrhagic fever (VHF)-infected blood or tissues.
* The first case in any outbreak in Australia will also be confirmed by CDC, Atlanta or NIV, Johannesburg.
END
104
Australian National Notifiable Diseases Surveillance System surveillance case definitions
West Nile /Kunjin virus infection
Version
Status
Last reviewed
Endorsement
date
Implementation
date
1.1
Change all references to
“Kunjin” to “West Nile
virus/Kunjin”.
CDWG 4
November 2009
CDNA 12 May
2010
1 July 2010
Remove the words “of
Australia” from under
“Laboratory definitive
evidence” after “Confirmation
of laboratory results by a
second arbovirus reference
laboratory is required if the
case occurs in an area of …”.
Change the numbering under
clinical evidence number 1. is
to be replaced with a number
3.
1.0
Initial case definition (2004).
Reporting
Only confirmed cases should be notified.
Confirmed case
A confirmed case requires laboratory definitive evidence AND clinical evidence.
Laboratory definitive evidence
1. Isolation of West Nile virus/Kunjin virus
OR
2. Detection of West Nile virus/Kunjin virus by nucleic acid testing
OR
3. IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre
to West Nile virus/Kunjin virus
OR
4. Detection of West Nile virus/Kunjin virus-specific IgM in cerebrospinal fluid in the absence of
IgM to Murray Valley encephalitis, Japanese encephalitis and dengue viruses
OR
5. Detection of West Nile virus/Kunjin virus-specific IgM in serum in the absence of IgM to Murray
Valley encephalitis, Japanese encephalitis and dengue viruses. This is only accepted as laboratory
evidence for encephalitic illnesses.
Confirmation of laboratory result by a second arbovirus reference laboratory is required if the case
occurs in areas not known to have established enzootic/endemic activity or regular epidemic activity.
Clinical evidence
1. Non-encephalitic disease: acute febrile illness with headache, myalgia and/or rash
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
OR
2. Encephalitic disease: acute febrile meningoencephalitis characterised by one or more of the
following:



focal neurological disease or clearly impaired level of consciousness
an abnormal computerised tomogram or magnetic resonance image or electroencephalogram
presence of pleocytosis in cerebrospinal fluid
OR
1. Asymptomatic disease: case detected as part of a serosurvey should not be notified.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Yellow fever
Version
Status
Last
reviewed
Endorsement
date
Implementation
date
1.1
The yellow fever case definition was
changed to exclude vaccine-related
cases from being reported.
CDWG
21 Septemb
er 2012
CDNA
5 October
2012
1 January 2013
At the end of laboratory definitive
evidence, point 3 'in the absence of
vaccination in the preceding 3 weeks'
was added.
At the end of laboratory suggestive
evidence 'in the absence of vaccination
in the preceding 3 months' was added.
A note 'Confirmation of laboratory
results by a second arbovirus reference
laboratory is required in the absence of
travel history to areas with known
endemic or epidemic activity' was also
added.
1.0
Initial CDNA case definition (2004).
Reporting
Only a confirmed case should be notified.
Confirmed case
A confirmed case requires either:
1. Laboratory definitive evidence AND clinical evidence
OR
2. Laboratory suggestive evidence AND clinical evidence AND epidemiological evidence.
Laboratory definitive evidence
Isolation of yellow fever virus
OR
Detection of yellow fever virus by nucleic acid testing
OR
Seroconversion or a four-fold or greater rise in yellow fever virus-specific serum IgM or IgG levels
between acute and convalescent serum samples in the absence of vaccination in the preceding 3
weeks
OR
Detection of yellow fever virus antigen in tissues by immunohistochemistry.
Laboratory suggestive evidence
Yellow fever virus-specific IgM detected in the absence of IgM to other relevant flaviviruses, in the
absence of vaccination in the preceding 3 months.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Confirmation of laboratory results by a second arbovirus reference laboratory is required in the
absence of travel history to areas with known endemic or epidemic activity.
Clinical evidence
A clinically compatible illness.
Epidemiological evidence
History of travel to a yellow fever endemic country in the week preceding onset of illness.
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Appendix A: National notifiable diseases sorted according to disease type
Disease group
Disease
Bloodborne diseases
Acquired immunodeficiency syndrome (AIDS)
Hepatitis B – newly acquired
Hepatitis B – unspecified
Hepatitis C – newly acquired
Hepatitis C – unspecified
Hepatitis D
Hepatitis – (not elsewhere specified)
Human immunodeficiency virus (HIV) infection - individuals less
than 18 months of age
Human immunodeficiency virus (HIV) – newly acquired
Human immunodeficiency virus (HIV) – unspecified over 18 months
of age
Gastrointestinal diseases
Botulism
Campylobacteriosis
Cryptosporidiosis
Haemolytic uraemic syndrome
Hepatitis A
Hepatitis E
Listeriosis
Salmonellosis
Shiga toxin- and /verocytotoxin-producing Escherichia coli
(STEC/VTEC)
Shigellosis
Typhoid
Quarantinable diseases
Cholera
Avian influenza in humans
Middle East respiratory Syndrome Coronavirus (otherwise known as
MERS-CoV)
Plague
Rabies
Severe acute respiratory syndrome (SARS)
Smallpox
Viral haemorrhagic fevers (quarantinable)
Yellow fever
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Disease group
Disease
Sexually transmitted
infection
Chlamydia
Donovanosis
Gonococcal infection
Syphilis congenital
Infectious syphilis – less than 2 years duration (includes primary,
secondary and early latent),
Syphilis – more than 2 years duration or unspecified duration
Vaccine preventable
diseases
Diphtheria
Haemophilus influenzae serotype b (HIB) infection – ( invasive only)
Influenza (laboratory confirmed)
Measles
Mumps
Pertussis
Pneumococcal disease – invasive
Poliovirus infection
Rubella
Rubella (congenital)
Tetanus
Varicella zoster (chickenpox)
Varicella zoster (shingles)
Varicella zoster (unspecified)
Vectorborne diseases
Barmah Forest virus infection
Chikungunya virus infection
Dengue virus infection
Flavivirus infection – unspecified
Japanese encephalitis virus infection
West Nile/Kunjin virus infection
Malaria
Murray Valley encephalitis virus infection
Ross River virus infection
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Disease group
Disease
Zoonoses
Anthrax
Australian bat lyssavirus
Brucellosis
Leptospirosis
Lysssavirus (not elsewhere classified)
Ornithosis (Psittacosis)
Q fever
Tularaemia
Other bacterial infections
Creutzfeldt-Jakob disease (CJD)
Legionellosis
Leprosy
Meningococcal infection (invasive)
Tuberculosis
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Australian National Notifiable Diseases Surveillance System surveillance case definitions
Notice regarding detection of IgGs
Wherever possible when a serological diagnosis is made, recent infection should be shown to have
occurred by demonstrating a significant change in IgG between acute and convalescent sera. It is
particularly important for infections which either fail to produce a measureable IgM response (e.g.
influenza), where the IgM response persists for extended periods (e.g. flavivirus infections), or
where false positive or cross-reacting IgM is a known problem. Usually an interval of 10-14 days is
sufficient though for some infection (e.g. legionellosis) the antibody may rise may take up to 4-6
weeks. Significant changes in IgG may be shown by either:


112
Seroconversion: Change from IgG negative to IgG positive between acute and convalescent
samples. This may be used for confirming recent infection using tests that do not quantify
the antibody levels. That includes most enzyme-linked immunosorbent assays, particle
agglutination, immunofluorescent antibody and latex agglutination tests as performed
routinely.
Significant increase in antibody level or titre: This is generally confined to tests which use
titrations in two-fold dilutions, in which a four-fold increase is regarded as significant. For
some enzyme immunoassays that are not titred, it may be possible to establish changes in
absorbence that may be regarded as significant. That should only be done for properly
validated methods.