title: An outbreak of enterovirus 71 in metropolitan Sydney: enhanced surveillance and lessons learnt.
abstract: OBJECTIVE
  To report the findings of the enhanced surveillance set up in New South Wales in response to the recent outbreak of human enterovirus 71 (EV71) infection.
  
  
  METHODS
  A two-armed enhanced public health surveillance system including statewide emergency department surveillance and clinical surveillance at the Sydney Children's Hospitals Network.
  
  
  METHODS
  Children aged less than 10 years with suspected or confirmed enterovirus infection.
  
  
  METHODS
  Epidemiology of the outbreak, including weekly case counts, demographic information, geographic spread of the outbreak, and clinical presentation and progression.
  
  
  RESULTS
  Statewide weekly case counts indicate that an epidemic of EV71 infection occurred in NSW from December 2012 until May 2013. Around 119 children were reported with disease severe enough to warrant admission to a tertiary Sydney children's hospital. Cases were spread throughout the Sydney metropolitan area and there is some evidence of geographic migration of the outbreak. Presenting features included fever, lethargy, myoclonus and skin rash. Only 24% of cases presented with classical hand, foot and mouth disease.
  
  
  CONCLUSIONS
  EV71 infection is likely to continue to be a public health problem in Australia. Surveillance of routinely collected emergency department data can provide a useful indication of its activity in the community.
authors.affiliation: Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, NSW, Australia. setob@doh.health.nsw.gov.au.
authors.forename: Alexis
authors.initials: A
authors.lastname: Zander
authors.affiliation: Discipline of Paediatrics and Child Health. Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Britton
authors.affiliation: Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, NSW, Australia.
authors.forename: Tina
authors.initials: T
authors.lastname: Navin
authors.affiliation: Northern Beaches Health Service, Sydney, NSW, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Horsley
authors.affiliation: Health Protection NSW, Sydney, NSW, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Tobin
authors.affiliation: Health Protection NSW, Sydney, NSW, Australia.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: McAnulty
mesh_terms: D002648:Child; D002675:Child, Preschool; D002947:Cities / Q000453:epidemiology; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D018792:Encephalitis, Viral / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D029821:Enterovirus A, Human; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D011159:Population Surveillance