Since the beginning of 2018, Australia’s health authorities and experts have grappled with outbreaks of hepatitis A, measles and listeria.
The listeria outbreak identified in mid-February was linked to rockmelons. It affected 19 people and led to six deaths, three in each of NSW and Victoria.
All contaminated melons were quickly removed from supply. New crops of rockmelons are safe to eat.
Meanwhile, cases of hepatitis A continue to rise in Victoria, with 68 confirmed cases and one death in the past three months. Also in Victoria, there have been 14 confirmed cases of measles since early March.
More recently, Victorian researchers said they were concerned about the “worsening epidemic” of the flesh-eating Buruli ulcers across the state.
So how is Australia preparing for the next epidemic or pandemic? And are we ready?
Infectious disease expert Professor Allen Cheng said Australia had a strong public health system that could respond to all sorts of communicable diseases. But our federated system could hamper the country’s ability to respond quickly and effectively to national threats.
“It is the state health departments that do most of the on-the-ground work, and the Commonwealth takes more of a co-ordinating role. This works well in some infections, for example with Hendra virus, which is localised to NSW and Queensland,” he said.
“However, it works less well for national threats. An example would be antibiotic resistance, where our surveillance and response systems are very patchy.”
Professor Cheng, a Monash University epidemiologist and Australasian Society for Infectious Diseases council member, said the risk of ebola spreading to Australia when it broke out in West Africa in 2014-2015 exposed weaknesses in the system.
“ASID and many other organisations have long called for a national centre for disease control,” Professor Cheng said.
“We are the only OECD country that doesn’t have a central agency that co-ordinates surveillance and response for communicable diseases threats nationally.”
It just takes a subtle change in that virus and suddenly you’ve got a whole new ball game.
Professor Roy Hall, an infectious disease specialist at the University of Queensland, said health authorities have an extra focus on mosquito-borne viruses after being surprised by the 2015-16 Zika outbreak.
“We know these things can fly under the radar and then just hit. It can be a sweet spot of the virus having a little mutation, finding an appropriate host and then changing when it gets into the host, so it becomes more virulent for other species,” he said.
“Those little jumps it makes between species – it might find a better vector, a better tick or mosquito, and that change can make a huge difference.”
Recently, health experts and authorities were surprised by a tick-borne illness known as SFTS, or severe fever with thrombocytopenia syndrome.
A Japanese woman died from SFTS in July after being bitten by a stray cat. The case is believed to be the world’s first human infection of the illness without a direct bite from a tick.
Global health officials are also worried that another strain of avian influenza could make a jump into humans, just as H5N1 did in the late 1990s. It has since caused hundreds of deaths but has not acquired the ability to transmit easily from person to person.
“We know that with the pathogenic avian flu, it can be highly lethal in humans but it can’t transmit well,” Professor Hall said.
“If the virus were just to change a few of its amino acids, it could then bind well with our receptors. It just takes a subtle change in that virus and suddenly you’ve got a whole new ball game.”
Since 2016, Australia has had an emergency response plan for disease outbreaks of national significance, known as the CDINS. It incorporates lessons learnt from previous pandemics, such as the 2009 swine flu outbreak.
“For emerging threats, such as ebola, each state – and, in many cases, each hospital – came up with response plans that could have been better done if co-ordinated,” Professor Cheng said.
“OzFoodNet, the system that responds to food-borne outbreaks, such as listeria, is one of the better systems in Australia, and they are tested regularly.”
“That said, we have loose national systems that do provide some flexibility in responses. We now have a more flexible framework for responding to pandemics, and a ‘whole of government’ plan for other threats co-ordinated by the Australian Department of Health,” he said.