What do we know about communicable diseases among Indigenous people?

What are communicable diseases?

Communicable diseases are diseases that are passed from person to person either by direct contact with an infected person or indirectly, such as through contaminated (dirty/unclean) food or water. Another example of indirect transmission is when the disease is spread through the air, such as when an infected person coughs or sneezes and another person breathes in the air that contains the germ. Communicable diseases can be caused by:

• bacteria (e.g. tuberculosis)
• viruses (e.g. HIV)
• fungi (e.g. tinea)
• parasites (e.g. malaria) [1].

Improvements to personal and environmental cleanliness, and the introduction of new immunisations (vaccines), have greatly reduced the number of people who catch some communicable diseases [2].

If a person contracts (catches/develops) certain communicable diseases (like tuberculosis), the disease must be ‘notified'; this means that the information is collected by health authorities. Unfortunately, Indigenous status is often not reported in notifications. Only WA, SA, and the NT reliably identify Indigenous status in the notification of communicable diseases [3].

What is known about communicable diseases in the Indigenous population?

The communicable diseases that are most important to the health of Indigenous people include:

• tuberculosis
• hepatitis (A, B, and C)
• sexually transmissible infections (e.g. chlamydia, gonorrhoea)
• HIV/AIDS
• Haemophilus influenzae type b (Hib)
• pneumococcal disease
• meningococcal disease
• skin infections and infestations [4][5].

Information about most of these communicable diseases, including how common they are in the Indigenous population, follows:

Tuberculosis

• a lung infection caused by a bacterium that can trigger a range of symptoms, such as coughing, weight loss, and fever [6]
• tuberculosis notifications were 11 times higher for Indigenous people than for non-Indigenous people in 2005-2009 (Derived from [7][8][9][10][11][12]).

Hepatitis

• inflammation (involving swelling and tenderness) of the liver caused by viral infections, alcohol or other drugs, toxins, or an attack by the body's immune system on itself [13]
• the most common types of hepatitis are hepatitis A, B, and C
• in 2009-2011:
  o notifications for hepatitis C were more than 3.5 times higher for Indigenous people than for non-Indigenous people
  o hepatitis B notifications were the same for Indigenous people than for non-Indigenous people
  o Notifications for hepatitis A were much lower for Indigenous people than for non-Indigenous people (Derived from [11][14][15][16][17]).
  

Chlamydia and gonorrhoea

• sexually transmissible infections that are caused by bacteria and can lead to a range of health conditions if left untreated, such as pelvic inflammatory disease (blocked tubes) in women [18][19]
• in 2008-2010, notifications for chlamydia were almost nine times higher, and notifications for gonorrhoea were around 50 times higher for Indigenous people than for non-Indigenous people (Derived from [11][15][20]).

HIV/AIDS

• human immunodeficiency virus (HIV) is an infection that destroys cells in the body's immune system [21]
• acquired immune deficiency syndrome (AIDS) is the late stage of HIV and is when the body's immune system is weakened, meaning that even a minor infection may cause death [22]
• the rate of HIV diagnosis was similar for Indigenous and non-Indigenous people in 2011 [23].

Haemophilus influenzae type B (Hib)

• a bacterium that can cause a range of illnesses, such as meningitis, septicaemia, and pneumonia [24]
• notifications for Hib were 20 times higher for Indigenous people than for non-Indigenous people in 2010 [25].

Invasive pneumococcal disease (IPD)

• caused by the bacterium Streptococcus pneumoniae, can lead to several major health conditions, such as pneumonia and meningitis [26]
• notifications for IPD were more than seven times higher for Indigenous people than for other Australians in 2006-2008 [27][28][29].

Meningococcal disease

• caused by the bacterium Neisseria meningitidis, can lead to meningitis, meningococcaemia without meningitis, and septic arthritis [30]
• notifications for Indigenous children aged 0-4 years were nearly five times higher than for non-Indigenous children in 2003-2006 [30].

Skin infections and infestations

• scabies is caused by the mite Sarcoptes scabiei, which results in itchy skin [31]; scratching the skin can result in secondary infection
• scabies is widespread in some remote central and northern Indigenous communities, with reports of up to 50% of children [32] and up to 25% of adults [33] being affected by this skin condition
• in 2006-2008, skin conditions accounted for around 3.9% of hospital admissions (excluding dialysis) for Indigenous people, 2.3 times the rate for other Australians [29].

References

1. Australian Institute of Health and Welfare (2004) Australia's health 2004: the ninth biennial health report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
2. Australian Institute of Health and Welfare (2010) Australia's health 2010: the twelfth biennial report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
3. Australian Bureau of Statistics, Australian Institute of Health and Welfare (2008) The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare
4. Burns J, Burrow S, Genovese E, Pumphrey M, Sims E, Thomson N (2003) Other communicable diseases. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press: 397-441
5. McIntyre P (2003) Pneumococcal disease. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press: 384-396
6. National Institute of Allergy and Infectious Diseases (2009) Tuberculosis (TB): detailed explanation of TB. Retrieved 6 March 2009 from http://www.niaid.nih.gov/topics/tuberculosis/Understanding/WhatIsTB/Pages/detailed.aspx
7. Roche P, Bastian I, Krause V (2007) Tuberculosis notifications in Australia, 2005. Communicable Diseases Intelligence; 31(1): 71-80
8. Roche PW, Krause V, Konstantinos A, Bastian I, Antic R, Brown L, Christensen A, Gebbie S, Hurwitz M, Misrachi A, Waring J (2008) Tuberculosis notifications in Australia, 2006. Communicable Diseases Intelligence; 32(1): 1-11
9. Barry C, Konstantinos A, National Tuberculosis Advisory Committee (2009) Tuberculosis notifications in Australia, 2007. Communicable Diseases Intelligence; 33(3): 1-12
10. Barry C, Waring J, Stapledon R, Konstantinos A (2012) Tuberculosis notifications in Australia, 2008 and 2009. Communicable Diseases Intelligence; 36(1): 82-94
11. Australian Bureau of Statistics (2009) Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians: Projected population, Aboriginal and Torres Strait Islander Australians, Australia, states and territories, 2006-2021 series [data cube]. Retrieved 8 September 2009 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&32380ds002_2006.srd&3238.0&Data%20Cubes&E79A5308D989173FCA25762A001CE1C3&0&1991%20to%202021&08.09.2009&Latest
12. Australian Bureau of Statistics (2007) Australian demographic statistics, June quarter 2007. Canberra: Australian Bureau of Statistics
13. Hepatitis Australia (2010) About hepatitis. Retrieved 18 November 2011 from http://www.hepatitisaustralia.com/about-hepatitis
14. The Kirby Institute (2012) HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2012. Sydney: University of New South Wales
15. The Kirby Institute (2011) HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2011. Sydney: University of New South Wales
16. National Centre in HIV Epidemiology & Clinical Research (2010) HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2010. Sydney, NSW: National Centre in HIV Epidemiology & Clinical Research, University of New South Wales
17. Australian Bureau of Statistics (2011) Australian demographic statistics, March quarter 2011. Canberra: Australian Bureau of Statistics
18. Gonorrhoea (2006) Family Planning Association of WA
19. Bowden FJ, Tabrizi SN, Garland SM, Fairley CK (2002) Sexually transmitted infections: new diagnostic approaches and treatments. Medical Journal of Australia; 176(11): 551-557
20. Australian Bureau of Statistics (2010) Australian demographic statistics: September quarter 2009. Canberra: Australian Bureau of Statistics
21. HIV & AIDS (2012) Western Australia Communicable Disease Control
22. The Kirby Institute (2011) Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: surveillance and evaluation report 2011. Sydney: University of New South Wales
23. The Kirby Institute (2012) Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: surveillance and evaluation report 2012. Sydney: University of New South Wales
24. Horby P, Gilmour R, Wang H, McIntyre P (2003) Progress towards eliminating Hib in Australia: an evaluation of Haemophilus influenzae type b prevention in Australia, 1 July 1993 to 30 June 2000. Communicable Diseases Intelligence; 27(3): 324-341
25. NNDSS Annual Report Writing Group (2012) Australia's notifiable diseases status, 2010: annual report of the National Notifiable Diseases Surveillance System. Communicable Diseases Intelligence; 36(1): 1-69
26. Chiu C, Dey A, Wang H, Menzies R, Deeks S, Mahajan D, Macartney K, Brotherton J, Jardine A, Quinn H, Jelfs J, Booy R, Lawrence G, Jayasinghe S, Roberts A, Senanayake S, Wood N, McIntyre P (2010) Vaccine preventable diseases in Australia, 2005 to 2007. Canberra: Australian Department of Health and Ageing
27. Barry C, Krause VL, Cook HM, Menzies RI (2012) Invasive pneumococcal disease in Australia 2007 and 2008. Communicable Diseases Intelligence; 36(2): E151-E165
28. Massey PD, Kerry T, Osbourn M, Taylor K, Durrheim DN (2011) Invasive pneumococcal disease in New South Wales, Australia: reporting Aboriginal and Torres Strait Islander status improves epidemiology: surveillance report. Western Pacific Surveillance and Response; 2(3): 1-4
29. Australian Institute of Health and Welfare (2011) Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses. Canberra: Australian Institute of Health and Welfare
30. Menzies R, Turnour C, Chiu C, McIntyre P (2008) Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia, 2003 to 2006. Canberra: Department of Health and Ageing
31. Walton SF, DBeroukas D, Roberts-Thomson P, Currie BJ (2008) New insights into disease pathogenesis in crusted (Norwegian) scabies: the skin immune response in crusted scabies. British Journal of Dermatology; 158(6): 1247-1255
32. Hengge UR, Currie BJ, Jäger G, Lupi O, Schwartz RA (2006) Scabies: a ubiquitous neglected skin disease. The Lancet Infectious Diseases; 6(12): 769-779
33. Carapetis JR, Connors C, Yarmirr D, Krause V, Currie BJ (1997) Success of a scabies control program in an Australian Aboriginal community. Pediatric Infectious Disease Journal; 16(5): 494-499

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