DenominatorsProjectJohnKaldor,StephenLambert,RossAndrews,RebeccaGuy,SophiePhelan

Background• Accesstocomprehensivesurveillancedataisvitalforinterpretingdiseasetrendsandforguidingpublichealthcontrolmeasures.• Theuseofdifferentdenominatorsinthecalculationofdiseaseratesmayleadtodifferentinterpretationsoftheprevalence/incidenceofadisease

Forexample…Iftheprevalencerateofadiseaseiscalculatedusingthetotalpopulationasthedenominatorandtheprevalenceisfoundtobehigherthanusual,thedatacouldbeinterpretedasanoutbreak.However,iftheprevalencerateofthesamediseaseisrecalculatedusingtestingdataasthedenominator,thedatamayshowthattheincreasedprevalenceisactuallyaresultofincreasedtesting.

Advantage:obtainedfromroutinesurveillancedata.Disadvantage:theinterpretationofdiseasetrendsmaybebiased(noinfoontestingpatterns).

#Positivelaboratoryresults

Per100,000population

Currentsituation:

Rate=

Advantage:Accurateestimateofprevalencewithinthepopulation.Disadvantage:Expensive,resourceintense,pronetosamplingerrors.

#Positivelaboratoryresults

Per100,000peoplefrom

thetestedpopulation

*Ideal*solution:populationprevalencesurvey

Rate=

Advantage:asignificantandattainableimprovementfromcurrentmethods.Disadvantage:Maybeinfluencedbytestingpatterns.

#Positivelaboratoryresults

Total#oftestsperformed

Realisticsolution:useoftestingdata

Rate=

Influenzatestingbylaboratory,2004-2008.Source:Lambertetal,MJA,2010.

Proportionofinfluenza-positiverespiratorytestsbymonth,2012

Source:Dawsonetal,PublicHealthResPract,2016.

Chlamydianotificationsandtesting,Australia

-10%0%

10%20%30%40%50%60%70%80%90%

100%110%120%

2006 2007 2008 2009 2010

Perc

enta

ge c

hang

e

Year

Medicare testing rate (per 100,000 population) *

National notification rate (per 100,000 population)

43.3%

111.5%

*2005testingratehasbeenusedasthestartingpointas2006and2007dataismissing

Source:Ali,Hetal,SexTransm Infec,2011.

Source:Cretikos etal,WPSAR,2014.

Associationsbetweenage-specifictestingandchlamydianotificationratesbysex,NewSouthWales,Australia,2000to2010(Male)

Associationsbetweenage-specifictestingandchlamydianotificationratesbysex,NewSouthWales,Australia,2000to2010(Female)Source:Cretikos etal,WPSAR,2014.

Howcanwemakediagnostictestingdatamoreaccessibleandusefulfortheinterpretationoftimetrendsandotherpatternsofdisease?

TheDenominatorsProject

Aim: todescribeandunderstandwaysdenominatordataforchlamydiaandinfluenzahavebeenaccessed,interpretedandusedinAustralia.

Whychlamydiaandinfluenza?- Anumberofpapersonthecollectionoftestingdataforchlamydiaandinfluenzaexistalready

- Publichealthimportance:bothdiseasesconsistentlyrankinthetop5notifiablecommunicablediseasesinAustralia.

Output: Systematicreview

1. Constructsearchstrategy(keywords/MeSH headings/past10years)2. Peer-reviewedliteraturesearchinOvidMedline/Embase

• 251papers3. Titleandabstractscreening

• 29forfullreview.• Influenza:17papers• Chlamydia:12papers

4. Fullreviewofpapers5. SearchreferencelistsofrelevantpapersfromStep46. SearchSCOPUSforpapersthathavecitedrelevantpapersfromStep47. ReviewextraarticlesfoundinStep5and68. Greyliteratureandgovernmentreportsearch(eg WAHealth,NSWHealth,

Flutracking).

Sofar…

Dataextraction

• Howthetestingdatawereaccessed• Sourceofinformation• Populationcoverageachieved

• Howthetestingdatawereinterpreted• Whatkindofcomparisonsweredone?• Eg positivenotifications/testingdata,comparedtopositivenotifications/population?

• Howthetestingdatawereused• Notedifferencesbetween:disease,jurisdiction,andstudytype

Discussion• ReasonsthattestingdataarenotnotifiableinAustralia• Limitationstointerpretation(ascitedbyauthorsinincludedstudies)• Identifydiseasesforwhichthecollectionofdenominatordatawouldbebeneficial• Considerothervariablestobecollectedinadditiontonegativetestresults(sex,ageatonset,onsetdate,labmethod,etc)• Approvalandfundingprocessesforaccessingdenominatordata

Nextsteps…• DirectionsfordenominatordatauseinAustralia

PresentationReferences

• Ali,Hetal.UnderstandingtrendsinChlamydiatrachomatiscanbenefitfromenhancedsurveillance:findingsfromAustralia.SexTransm Infect doi:10.1136/sextrans-2011-050423

• ChenMY,FairleyCK,DonovanB.2005.Nowherenearthepointofdiminishingreturns:correlationsbetweenchlamydiatestingandnotificationratesinNewSouthWales.AustNZJPublicHealth.29(3):249-53

• Cretikos M,MayneD,ReynoldsR,SpokesP,Madeddu D.2014.Testing-adjustedchlamydianotificationtrendsinNewSouthWales,Australia,2000to2010.WPSAR5(3)doi 10.5365/wpsar.2014.5.1.009

• DawsonG,GilmourR,TobinS,Travaglia J.2016.Strengtheningpublichealthsystems:assessingtheattributesoftheNSWinfluenzasurveillancesystem.PublicHealthResPract.26(2):e2621621

• LambertSB,FauxCE,GrantKA,WilliamsSH,Bletchly C,CattonMG,SmithDW,KellyHA.2010.InfluenzasurveillanceinAustralia:weneedtodomorethancount.MJA193:43-45

Reviewreferencessofar(chlamydia)1. AliH,CameronE,Drovandi CC,McCawJM,GuyRJ,MiddletonM,El-HayekC,HockingJS,KaldorJM,DonovanB,WilsonDP.2015.

Anewapproachtoestimatingtrendsinchlamydiaincidence.SexuallyTransmittedInfections91(7):513-519.2. AliH,GuyRJ,FairleyCK,WantH,ChenMY,DicksonB,O’ConnorCC,MarshallL,Grulich AE,KaldorJM,Hellard ME,DonovanB.

2012.UnderstandingtrendsingenitalChlamydiatrachomatiscanbenefitfromenhancedsurveillance:FindingsfromAustralia.SexuallyTransmittedInfections88(7):552-557.

3. BowringAL,Goller JL,Gouillou M,HarveyC,BatesonD,McNameeK,ReadC,BoyleD,JordanL,WardleR,StephensA,DonovanB,GuyR,Hellard M.2013.ChlamydiatestingandretestingpatternsatfamilyplanningclinicsinAustralia.SexualHealth10(1):74-81.

4. Cretikos M,MayneD,ReynoldsR,SpokesP,Madeddu D.2014.Testing-adjustedchlamydianotificationtrendsinNewSouthWales,Australia,2000to2010.WesternPacificSurveillanceResponseJournal5(3):7-17.

5. Dimech W,LimMS,VanGemert C,GuyR,BoyleD,DonovanB,Hellard M,Accesscollaboration.2014.AnalysisoflaboratorytestingresultscollectedinanenhancedchlamydiasurveillancesysteminAustralia,2008-2010.BMCInfectiousDiseases14:325.

6. ForrestG,Boonwaat L,DouglasJ,Aowfeso N.2009.EnhancedchlamydiasurveillanceinNewSouthWales(Australia)prisons,2005-2007.Internationaljournalofprisonhealth5(4):233-40.

7. FranklinN,O’ConnorCC,ShawM,GuyR,Grulick A,FairleyCK,ChenMY,Hellard M,DicksonB,MarshallL,DonovanB,AccessCollaboration.2010.ChlamydiaataninnermetropolitansexualhealthserviceinSydney,NSW:AustralianCollaborationforChlamydiaEnhancedSentinelSurveillance(ACCESS)Project.SexualHealth7(4):478-83.

8. Goller JL,WardJ,SaundersM,Couzos S,KaldorJ,Hellard MA,AustralianCollaborationforChlamydiaEnhancedSentinelSurveillanceSystem.2012.ChlamydiasentinelsurveillanceinAboriginalCommunityControlledHealthServicesfindshighertestingandpositivityratesamongyoungerpeople.Australian&NewZealandJournalofPublicHealth36(6):577-81.

9. GuyRJ,WantH,FranklinN,FairleyCK,ChenMY,O’ConnorCC,MarshallL,Grulich AE,KaldorJM,Hellard ME,DonovanB,AccessCollaboration.2011.ChlamydiatrendsinmenwhohavesexwithmenattendingsexualhealthservicesinAustralia,2004-2008.SexuallyTransmittedDiseases38(4):339-46.

10. KongFYS,GuyR,BergerI,BoyleDJ,HockingJS,MerrittT,BrittH,LauP,Pirotta MV,HealC,BrettT,KaldorJ,DonovanB,Hellard ME.2009.ChlamydiatestingratesingeneralpracticesacrossAustralia:TheAustraliancollaborationforchlamydiaenhancedsentinelsurveillance(ACCESS).SexualHealth6(4):367.

11. O’RourkeKM,FairleyCK,Smaranayake A,Collignon P,HockingJS.2009.TrendsinChlamydiapositivityovertimeamongwomeninMelbourneAustralia,2003to2007.SexuallyTransmittedDiseases36*12):763-7.

12. Reekie J,DonovanB,BuyR,HockingJS,KaldorJM,Mak DB,PearsonS,PreenD,WantH,WardJ,LiuB.2017.TrendsinchlamydiaandgonorrhoeatestingandpositivityinWesternAustralianAboriginalandnon-Aboriginalwomen2001-2013:apopulation-basedcohortstudy.SexualHealth26:26.

Reviewreferencessofar(influenza)

1. Ballestas T,McEvoySP,DoyleJ.2009.Co-ordinatedapproachtohealthcareworkerinfluenzavaccinationinanareahealthservice.JournalofHospitalInfection73(3):203-209.

2. CarlsonSJ,DaltonCB,Durrheim DN,Fejsa J.2010.OnlineFlutracking surveyofinfluenza-likeillnessduringpandemic(H1N1)2009,Australia.EmergingInfectiousDiseases16(12):1960-2.

3. CarlsonSJ,DaltonCB,Tuyl FA,Durrheim DN,Fejsa J,Muscatello DJ,FrancisJL,d’Espaignet ET.2009.Flutracking surveillance:comparing2007NewSouthWalesresultswithlaboratoryconfirmedinfluenzanotifications.CommunicableDiseasesIntelligenceQuarterlyReport33(3):323-7.

4. CarlsonSJ,Durrheim DN,DaltonCB.2010.Flutracking providesameasureoffieldinfluenzavaccineeffectiveness,Australia,2007-2009.Vaccine28(42):6809-10

5. CattonM,Druce J,Papadakis G,TranT,BirchC.2011.Realitycheckoflaboratoryserviceeffectivenessduringpandemic(H1N1)2009,Victoria,Australia.EmergingInfectiousDiseases17(6):963-8.

6. ChurchesT,Conaty SJ,GilmourRE,Muscatello DJ.2010.Reflectionsonpublichealthsurveillanceofpandemic(H1N1)2009influenzainNSW.NewSouthWalesPublicHealthBulletin21(1-2):19-25.

7. CoghlanB,KellyHA,CarlsonSJ,GrantKA,Leder K,DaltonCB,ChengAC.2016.EstimatesofinfluenzavaccinecoveragefromVictoriansurveillancesystemsbasedinthecommunity,primarycareandhospitals.CommunicableDiseasesIntelligenceQuarterlyReport40(2):E204-6.

8. CowieGA,CowieBC,FieldingJE.2017.InfluenzatestingtrendsinsentinelsurveillancegeneralpracticesinVictoria2007to2014.CommunicableDiseasesIntelligenceQuarterlyReport41(1):E4-E9.

9. DawoodFS,HopeKG,Durrheim DN,Givney R,FryAM,DaltonCB.2010.Estimatingthediseaseburdenofpandemic(H1N1)2009virusinfectioninHunterNewEngland,NorthernNewSouthWales,Australia,2009PLoS ONE5(3):e9880.

10. DawsonG,GilmourR,TobinS,Travaglia J.2016.Strengtheningpublichealthsystems:assessingtheattributesoftheNSWinfluenzasurveillancesystem.PublicHealthResearchandPractice26(2):15.

11. FieldingJ,GrantK,FranklinL,SullivanS,Papadakis G,KellyH,ChengA.2013.Epidemiologyofthe2012influenzaseasoninVictoria,Australia.WesternPacificSurveillanceResponseJournal4(3):42-50.

12. FieldingJE,GrantKA,Papadakis G,KellyHA.2011.EstimationoftypeandsubtypespecificinfluenzavaccineeffectivenessinVictoria,Australiausingatestnegativecasecontrolmethod,2007-2008.BMCInfectiousDiseases11:170.

13. FieldingJE,ReganAK,DaltonCB,Chilver MB,SullivanSG.2016.Howseverewasthe2015influenzaseasoninAustralia?MedicalJournalofAustralia204(2)60-1.

14. KellyG,CarvilleK,GrantK,JacobyP,TranT,BarrI.2009.Estimationofinfluenzavaccineeffectivenessfromroutinesurveillancedata.PLoS ONE4(3):e5079.

15. KellyH,GrantK.2009.Interimanalysisofpandemicinfluenza(H1N1)2009inAustralia:surveillancetrends,ageofinfectionandeffectivenessofseasonalvaccination14(31):06.

16. KellyHA,GrantKA,TayEL,FranklinL,HurtAC.2013.Thesignificanceofincreasedinfluenzanotificationsduringspringandsummerof2010-11inAustralia.InfluenzaandOtherRespiratoryViruses7(6):1136-41.

17. LambertSB,FauxCE,GrantKA,WilliamsSH,Bletchly C,CattonMG,SmithDW,KellyHA.2010.InfluenzasurveillanceinAustralia:weneedtodomorethancount.MedicalJournalofAustralia193(1):43-5.