Countries: Australia

Name

Australian Paediatric Surveillance Unit (APSU)

Website

More information is available on the APSU website at www.apsu.org.au

Year established

May 1992 (Surveillance commenced May 1993)

Association

Royal Australasian College of Physicians, Division of Paediatrics

Population under 15 years

4.1 million

General information

The APSU commenced surveillance in May 1993. Currently approximately 1360 paediatricians and other child health clinicians report to the APSU on up to 16 conditions on a monthly basis.

The overall response rate was 94% in 2008. APSU introduced email reporting in 1997 with the proportion responding by e-mail reaching 80% in 2009. The average monthly response rate for the 16 years to the end of 2008 is 96%.

APSU has been evaluated twice (in 1999 and 2007) according to the Centres for Disease Control (CDC) criteria. In both evaluations APSU was found to fulfil its objectives and met key CDC criteria. Both evaluations also included direct feedback from paediatricians who participate in monthly surveillance, who perceived the APSU to be educationally useful particularly in the provision of diagnostic criteria for the rare conditions studied. It was perceived to be a simple and flexible scheme and acceptable in terms of workload. http://www3.interscience.wiley.com/journal/122569793/abstract

APSU collaborates closely with the New Zealand Paediatric Surveillance Unit, sharing study protocols where possible and appropriate, as well as having representation on each other's scientific review panels.

Highlights

1) The APSU celebrated 15 years of surveillance in 2008 with the publication of APSU: Celebrating 15 years of surveillance 1993-2007 and by presenting two dedicated sessions at the Annual Scientific Meeting of the Royal Australasian College of Physicians. Srikanthan S, Zurynski Y, Elliott E. Australian Paediatric Surveillance Unit: Celebrating 15 years of surveillance. Australian Paediatric Surveillance unit, Sydney 2008; ISBN: 978-0-646-49063-2

2) In 2008 Prof Elizabeth Elliott was awarded AM for service to paediatrics and child health as an academic, researcher and educator, and through establishing the APSU.

3) In 2007 the APSU demonstrated the feasibility of using its’ surveillance system to respond at short notice to monitor epidemiological emergencies by responding to a call from the Department of Health and Ageing for rapid response surveillance for severe complications of influenza, after several child deaths were reported. This surveillance was repeated during the 2008 influenza season and during the swine influenza pandemic H1N1 09.

4) In 2008 APSU convened a “National Taskforce for Rare Diseases”, consisting of a group of researchers, clinicians and parent support groups dedicated to developing a coordinated national plan on rare diseases. APSU joined the global effort to raise awareness of rare diseases on International Rare Diseases Day 28 th February 2009. http://www.smh.com.au/national/common-front-to-fight-rare-ailments-20090227-8K95.html

5) APSU has enhanced the national surveillance effort by contributing to the development and management of new innovative surveillance systems:

• PAEDS: Paediatric Active Enhanced Disease Surveillance system was piloted over 18 months from August 2007 in four tertiary paediatric hospitals (Children’s Hospital Westmead NSW, Royal Children’s Hospital Vic, Princess Margaret Hospital WA, Women’s and Children’s Hospital SA). This project was supported by the Department of Health and Ageing and the initial funding agreement has been extended to June 2010. http://www.apsu.org.au

• AMOSS- Australian Maternal Outcomes Surveillance System (AMOSS) aims to provide detailed, systematically collected data on serious but rare outcomes related to birth and pregnancy. AMOSS is based on the APSU surveillance mechanism and informed by a similar surveillance system operating in the UK, the UK Obstetric Surveillance System (UKOSS). http :// www.amoss.com.au

6) APSU continues to strengthen its links with policy makers and governments, by informing public health policy and clinical practice. Examples include monitoring the incidence of neonatal, congenital and severe complications of varicella after the introduction of the varicella vaccine; data collected on Fetal Alcohol Syndrome informed NH&MRC Australian Alcohol Guidelines, and data collected on seatbelt related injuries informed the 7 th Amendment to the Australian Road Rules.

7) APSU has addressed surveillance gaps among Indigenous children and refugees by mounting surveillance for conditions particularly relevant to these groups eg. Acute rheumatic fever in Indigenous children and vitamin D deficiency rickets in refugee children.

8) APSU is collaborating with the Telethon Institute for Child Health Research in the national Alcohol in Pregnancy Project, a highly productive program of research, education, advocacy and policy development relating to Fetal Alcohol Spectrum Disorders (FASD).

Conditions under surveillance

Current: Acute flaccid paralysis, acute rheumatic fever, congenital cytomegalovirus infection, congenital rubella, HIV/AIDS perinatal exposure to AIDS, intussusception neonatal herpes simplex virus infection, neuromuscular disorders, neonatal varicella, congenital varicella, Rett syndrome, severe complications of varicella infection, severe complications of influenza and vitamin K deficiency bleeding (includes haemorrhagic disease of the newborn).

New study: A study on Systemic Lupus Erythematosus commenced in October 2009 and will be led by Dr Fiona Mackie from Sydney Children’s Hospital.

Concluded study: Hepatitis C virus infection (HCV): Perinatal transmission is the main source of HCV infection in Australian children. Infants at risk were born to mothers who used IV drugs, had invasive procedures overseas or had tattoos. Most HCV infected children were clinically asymptomatic with mildly elevated liver function tests at diagnosis, however, HCV induced chronic liver disease and liver failure have been reported among older children. Given that 1-2% of Australian women of childbearing age are infected with HCV, the reported rate of infected children is lower than predicted. This may be due to the lack of a consistent approach to identifying children with HCV infection. HCV infected children were predominantly offspring of HCV-infected women. This identifies a need for education in regard to investigation, diagnosis and management of HCV infection in children.

Publications

To date, studies conducted through the APSU have given rise to the publication of more than 195 original articles and 230 scientific presentations that have informed the general public and the wider medical community.

Contact

Prof Elizabeth Elliott (Director) and Dr. Yvonne Zurynski (Deputy Director)

APSU
Level 2, Research Building
The Children's Hospital at Westmead
Locked Bag 4001
Westmead NSW 2145
Australia

Tel: 612-9845-3005 / 1202 Fax: 612-9845-3082
Email: apsu@chw.ed.au