Australian National Disease Surveillance Plan for COVID-19



Australian National Disease Surveillance Plan for COVID-19May 2020BackgroundThe Australian National Disease Surveillance Plan for COVID-19 forms part of the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-2019). It is also a supporting plan to the Pandemic Health Intelligence Plan.The plan describes a national approach to disease surveillance for COVID-19, and the virus that causes it – severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Surveillance is the ongoing, systematic collection, analysis and interpretation of health-related data. Data collected through the plan inform public health measures for control of COVID-19 in Australia.Australia is currently pursuing a suppression response strategy. This is defined by the World Health Organization as “sustainable suppression of transmission at a low level while enabling the resumption of some parts of economic and social life, prioritised by carefully balancing socio-economic benefit and epidemiological risk”. Critically, the plan provides key epidemiological information to inform Australia’s need to adjust public health measures, and evaluate the impact of adjustments. COVID-19 surveillance supports public health measures through timely reporting and description of cases and clusters, testing patterns, and disease severity. ScopeDisease surveillance is a partnership between the Australian Government, state and territory governments, health research institutions, clinicians, public and private laboratories, and other health sector stakeholders. The plan recognises and builds on established systems for communicable disease surveillance in Australia.The indicators at the core of the plan are linked to specific surveillance goals, with the mechanisms to enable achievement of the indicators being provided through a variety of surveillance data sources. These are either generally collected nationally, or, if appropriate, from sentinel sites for selected populations.The plan also drives a series of content outputs and reports on health indicators that are made available to various stakeholders, including the general public. It therefore enables a coordinated and consistent national approach for COVID-19 surveillance, recognising that disease transmission and impact, and therefore surveillance requirements, may vary across the ernance and implementationThe Communicable Diseases Network Australia (CDNA) COVID-19 Working Group is responsible for the plan and monitors its implementation. Each new iteration of the plan is developed in conjunction with state and territory governments and endorsed by the CDNA COVID-19 Working Group.The plan is a living document that will be regularly updated as disease surveillance priorities and needs change. It will also be updated to support responses proportionate to the level of risk over time, geographic regions and for different population groups. In particular, there may be additional considerations for some subpopulations, particularly those at higher risk from morbidity and mortality and for more rapid spread of disease. As such, considerations for Aboriginal and Torres Strait Islander populations have been included, but will be further developed and incorporated into future versions of this document as required. Further surveillance and epidemiological considerations for Aboriginal and Torres Strait Islander populations can be found in other documents such as: the Management Plan for Aboriginal and Torres Strait Islander populations; the Remote framework – conditions for easing remote area travel restrictions; and the CDNA Interim National Guidance for remote Aboriginal and Torres Strait Islander communities for COVID-19.The plan will be responsive to the needs of the National Cabinet and the Australian Health Protection Principal Committee, at the same time as considering technical feasibility and sustainability of data gathering needed to report against the indicators. Principles underlying the development and implementation of the plan are at Appendix 1.Disease surveillance approaches adopted in the planCase-based reportingIn the National Notifiable Diseases Surveillance System (NNDSS), Australia has a well-established case-based surveillance system which relies on reporting from state and territory communicable disease control units. This in turn depend on reports from laboratories, health facilities and clinicians. This system is used to report nationally on all new diagnoses of infection with SARS-CoV-2. The NNDSS is responsive to changing requirements that may lead to modifications of the specific data elements recorded with each case. The case reporting mechanisms are supplemented by more specialised reporting in specific areas, including: the extent of testing for SARS-CoV-2 in the communitydeaths due to COVID-19outbreaks in particular settings, and outcomes of contact tracing procedures.Targeted active case findingThe ability to detect cases of SARS-CoV-2 infection is central to the strategies that can be employed in order to prevent transmission in Australia. A high rate of well-targeted testing is essential to provide confidence that cases will be detected as control measures evolve. The Testing Framework for COVID-19 in Australia has been developed as a companion to this Disease Surveillance Plan (Appendix 2). It outlines the priority settings in which testing is currently being conducted or proposed to be conducted for COVID-19, and emphasises that the highest priority group for testing is people with symptoms. The Testing Framework will be responsive to changes in the pandemic, and so too is a living document, and will be compatible with the COVID-19 CDNA National Guidelines for Public Health Units. The plan aims to capture the extent and outcomes of targeted testing in a range of settings. These settings include clinics established for screening people with respiratory symptoms, and particular population groups in which any form of enhanced testing is taking place. Syndromic and sentinel surveillanceAustralia has a number of established surveillance systems originally set up to monitor influenza and influenza-like illnesses and their complications. These systems are:syndromic surveillance, where data are collected based on the clinical features of people without a diagnosis, and sentinel surveillance, involving selected health facilities that collect high-quality data that cannot be obtained through case-based reporting. There are also mechanisms for reporting on health service utilisation and outcomes for people admitted to tertiary care with COVID-19. The data collected will be used to signal trends and monitor the burden of disease in the community. Further consideration should be given to the representativeness of high risk populations in syndromic and sentinel surveillance systems.SerosurveillanceSerosurveillance complements the understanding of population transmission of SARS-CoV-2 obtained from case-based reporting. Case-based reporting may miss asymptomatic, mild or atypical cases and people who do not present to health care or are not tested when ill. It helps us understand at a population level how many people cumulatively have been infected. This information will support epidemic modelling and may in the future provide an indication of population protection.Molecular epidemiology While genomic data are not yet incorporated into routine surveillance activities they can provide a helpful adjunct to surveillance data. Viral genomic data can help to:clarify the source of infection in outbreak settings,assist in cases arising without a known source, support characterisation of clusters of diseases transmission,monitor SARS-CoV-2 evolution to identify if different virus variants are emerging over time, and help determine if there is any impact to the accuracy of diagnostic tests or change in pathogenicity, immunogenicity, or transmissibility. COVID-19 surveillance goals and indicatorsEach disease surveillance goal contributes information, via key indicators, that supports decision-making by national and jurisdictional governments and public health authorities. Indicators under Goals 1, 3, 5, 6 and 10 describe current patterns and time trends in SARS-CoV-2 infections, so that prevention and testing activities can be targeted and evaluated. Indicators under Goals 2 and 7 describe health impacts of SARS-CoV-2 infection. Indicators under Goals 4 and 8 report on health system capacity, in regard to contact tracing and tertiary care respectively. The Goal 9 indicator measures the level of spread of SARS-CoV-2 in the community to support modelling.Goal 1. Provide daily updates on the characteristics and time trends of COVID-19 cases to support planning and evaluation of prevention activities and testing services.IndicatorsDaily number, and weekly rate (per 100,000 population) of COVID-19 cases by age group and sex, nationally and by jurisdiction.Daily number of COVID-19 cases by source of infection (Overseas acquired|Acquired on a cruise ship|Locally acquired – known epidemiological link|Locally acquired – no known epidemiological link).Number of COVID-19 cases in populations of interest (Aboriginal and Torres Strait Islander people|Health care workers).Why is this important?Data collected on demographic and other characteristics, including Aboriginal and/or Torres Strait Islander status, for all laboratory confirmed cases of COVID-19 provide an understanding of the characteristics of the pandemic in Australia. Of crucial importance within this data set is the number of cases without a known link to other cases, provided in real time, as this demonstrates previously undetected community transmission. It is important to note jurisdictions with a large proportion of the population residing in remote areas (particularly when examining Aboriginal and Torres Strait Islander population data) may have limited laboratory testing capacity, which may affect interpretation of these data. Comparison of the testing and incidence rates between Aboriginal and Torres Strait Islander people and other Australians may help understand the impact of, and access to, health services.Goal 2. Provide daily updates on the characteristics of deaths due to COVID-19, as a key measure of the health impact of the disease in our community, at the upper extreme of severity.Indicators2.1 Daily number, and weekly rate (case fatality and per 100,000 population) of confirmed deaths in people due to COVID-19 by demographic characteristics, nationally and by jurisdiction.Why is this important?The number and rate of COVID-19 related deaths is an indication of the scale and severity of the epidemic. Demographic data tell us which parts of the community are being most affected. Mortality data integrate the impact of incidence and case fatality rates, so provide an overall summary to inform public health actions, as well as providing insight into the functioning of the health care system.Goal 3. To provide regular (at least weekly) updates on testing counts for SARS-CoV-2 and to provide a denominator to track how effectively testing is being utilised and for an indication of the positivity yield.IndicatorsDaily number of diagnostic tests conducted and the proportion that are positive, nationally and by jurisdiction (and weekly by demographic characteristics, geographical distribution, and test type). Weekly rate of testing (per 100,000 population), nationally and by jurisdiction.Why is this important?The daily number of tests for SARS-CoV-2 and the proportion that are positive are metrics used to better interpret case-based data. These data describe the uptake of testing across the community, and can be used to assess future need for testing related equipment, consumables and staff resources. Data on testing are an important measure to indicate that the key disease control strategies of case isolation and contact quarantine are effective. Weekly reports by demographic status (including where available, Aboriginal and/or Torres Strait Islander status) help to determine whether any groups are not adequately represented in testing data, and therefore whether further efforts are required to ensure equitable access to testing for all population groups. This goal and its indicators are supported by the Testing Framework for COVID-19 in Australia (Appendix 2). Goal 4. Report weekly on processes associated with contact tracing IndicatorsNumber of days from symptom onset to the date the PCR test was taken among symptomatic cases (Median, 75th and 90th percentile).Number of days from date test was taken to the time of notification to the jurisdictional health department (Median, 75th and 90th percentile).Number of days from notification to isolation among symptomatic cases (Median, 75th and 90th percentile).Number of contacts identified through traditional contact tracing methods per case stratified by household vs non-household contacts (Median, 75th and 90th percentile).Number of additional close contacts identified per case by the COVIDSafe app (Median, 75th and 90th percentile).Number and proportion of cases that were previously identified as contacts of a case and were in quarantine at the time of symptom onset (excluding overseas acquired cases).Number of days between the date of contacts’ earliest possible exposure and the date of their quarantine stratified by household, non-household and app-only contacts (Median, 75th and 90th percentile).Why is this important?People in close contact with an infectious confirmed or probable case of COVID-19 are at higher risk of contracting a SARS-CoV-2 infection. Rapid identification of and quarantining these close contacts of cases through contact tracing is a key strategy for control of COVID-19 as it helps break chains of transmission by ensuring that infected contacts do not transmit the virus to any other people. Contact tracing indicators can provide early warning of expanding transmission in the community. For cases with no known source of transmission, contact tracing back through the time that the case would have acquired their infection (i.e. the exposure period) may also lead to previously undiagnosed cases. Contact tracing data can also contribute to an understanding of transmission dynamics for SARS-CoV-2. In addition, these data support planning by providing a measure of the required public health effectiveness in undertaking contact tracing in a timely way. Adaptation of these indicators may be required for remote settings.Goal 5. Characterise clusters and secondary cases to facilitate management within and across jurisdictions.IndicatorsWeekly report of new clusters and clusters under investigation.Weekly summary of all clusters and outbreaks of COVID-19 specifying number of cases and contacts, along with the setting, detail of transmission, management and associated outcome data.Longer term summaries of cluster outcomes.Why is this important?For effective suppression of COVID-19, it is important to identify and control clusters rapidly, particularly in high risk settings such as remote and rural Aboriginal and Torres Strait Islander communities, residential care, healthcare facilities and other workplaces. Characterisation of clusters and secondary cases can inform targeted strategies to prevent similar outbreaks in these settings. Goal 6. Monitor community trends in ‘fever/acute respiratory illness (ARI)’ and the proportion tested and attributable to SARS-CoV-2 to assess the extent of community transmission and the effectiveness of public health measures aimed at both prevention and case detection.IndicatorsWeekly proportion of ‘fever/ARI’ testing positive for SARS-CoV-2 through systematic and/or targeted sampling, by demographic and geographic variables.Proportion of ‘fever/ARI’ in the community tested for COVID-19.Number of ‘fever/ARI’ presentations and/or rate of ‘fever/ARI’ in the community by demographic characteristics and geographic distribution.Why is this important?Our current understanding of COVID-19 is that approximately 80% of infections result in mild disease and that the most common symptoms are consistent with those of other acute respiratory illnesses (ARI). A key surveillance indicator, derived from general practice, clinics and self-reported surveys, is the proportion of such syndromes that are being tested for SARS-CoV-2 and the proportion that are being found positive. Any indication, whether nationally or more locally, of a change in proportion or people tested or the proportion of people positive that suggests increased transmission should lead to a rapid public response. In addition, understanding the proportion of people overall and within specific population subgroups with ‘fever/ARI’ who present to health care for testing provides an indication of the effectiveness of public health messaging. Goal 7. Describe the clinical severity of COVID-19 cases to allow prediction of health resource use and to standardise models of care, as well as characterise risk factors for serious infection to allow for targeted public health strategies.IndicatorsProportion of COVID-19 cases who are hospitalised, by comorbidity and demographic characteristics, including Aboriginal and/or Torres Strait Islander status.Proportion of hospitalised COVID-19 cases who are admitted to Intensive Care Units (ICU), by comorbidity and demographic characteristics.Proportion of COVID-19 cases in ICU who receive who ventilation or extracorporeal membrane oxygenation (ECMO), by comorbidity and demographic characteristics.Proportion of hospitalised COVID-19 cases who die, by comorbidity and demographic characteristics.Proportion of COVID-19 cases in ICU who die, by comorbidity and demographic characteristics.Duration of ICU stay for COVID-19 cases (median, range), by comorbidity and demographic characteristics.Why is this important?Describing the characteristics and outcomes of hospitalised COVID-19 cases shows what is happening with people affected at the severe end of the disease spectrum in need of high-level care. These indicators also help to identify at risk groups for severe disease and poor outcomes, to inform the targeting of public health measures to populations most at risk. Collection of Aboriginal and/or Torres Strait Islander status is particularly important to determine whether this is an independent risk factor for severe disease. These data also inform resourcing to ensure the delivery of safe, timely and quality health care. Goal 8. Measure impacts on the tertiary health care system to contribute to forecasts of capacity requirements to redirect resources as required.IndicatorsCOVID-19 patient occupancy of hospitals, as count and proportion of total hospital capacity; reported daily, aggregated nationally and by jurisdiction.COVID-19 patient occupancy of ICUs, as count and proportion of total ICU capacity; reported daily, aggregated nationally and by jurisdiction.COVID-19 patients in ICU receiving ventilation/ECMO as count and proportion of total ventilation capacity; reported daily, aggregated nationally and by jurisdiction.COVID-19 presentations to emergency departments (suspected and confirmed), as a count and proportion of total emergency department presentations; reported daily, aggregated nationally and by jurisdiction.Duration of hospital stay for COVID-19 patients (median, range); reported weekly, nationally.Duration of ICU stay for COVID-19 patients (median, range); reported weekly, nationally.Duration of ventilation for COVID-19 patients (median, range); reported weekly, nationally.Why is this important?Hospital capacity and activity data indicate the impact COVID-19 is placing on the hospital system. When collected over time, these data can be used to assess and plan resourcing to ensure delivery of safe, timely and quality health care.Goal 9. Determine seroprevalence rates of SARS-CoV-2 by population group and geographic location to complement our understanding of population transmission of SARS-CoV-2 from other surveillance data.IndicatorsAntibody prevalence to SARS-CoV-2 by age group, sex, geographic area, risk group (e.g. by age, health care workers, Aboriginal and Torres Strait Islander people) and over time (before, during and after epidemic peaks).Why is this important?Infection with SARS-CoV-2 can result in mild, asymptomatic or atypical disease which may not be detected by standard disease surveillance systems. Serological testing for surveillance can indicate how widely SARS-CoV-2 infection has spread across the general population and within specific groups. It should be noted that antibody prevalence is not currently a measure of population protection as we do not yet know whether or for how long antibodies protect people against re-infection. A summary of the Australian COVID-19 Serosurveillance Strategy is at Appendix 3.Goal 10. Undertake strategically targeted asymptomatic screening of special occupational groups or populations.IndicatorsNumber and proportion positive for SARS-CoV-2 of asymptomatic cases in structured, systematically reported studies of populations at high risk, and/or settings in which repeatable cross-sectional sampling is feasible. Why is this important?Asymptomatic testing is an active surveillance measure that seeks to uncover undetected infection in outbreak situations or high risk settings. This indicator contributes to the broader knowledge base on virus characteristics and also provides a greater understanding of the extent of virus circulation. A summary of the role of asymptomatic testing is described in the Testing Framework for COVID-19 in Australia (Appendix 2).Appendix 1: Principles underlying the National Surveillance PlanThe plan provides a national framework for reporting on health and health service-related aspects of infection with SARS-CoV-2, and the disease that it causes – COVID-19. The plan drives a series of outputs which will be targeted to a range of stakeholders, including the general public.The plan is a living document that responds to immediate priorities for indicators as determined by the National Cabinet and AHPPC, at the same time as considering technical feasibility and sustainability of the mechanisms needed to report the indicators. As Australia moves through the phases of the response plan, this surveillance plan will evolve. The plan will align with standard CDNA data request processes for data sharing. As each new iteration of the plan is produced, it will be presented to the CDNA COVID-19 Working Group, with an indication of what has been proposed for change, and decisions that are required by CDNA, and recommendations that will require implementation at a national or jurisdictional level. Once CDNA has endorsed the new iteration, it will be forwarded to AHPPC. The COVID-19 Surveillance Working Party will track implementation of new recommendations and feedback any issues to the CDNA COVID-19 Working Group that require resolution. A monitoring and evaluation framework for the plan will be developed in parallel to the plan, for this purpose. The core of the plan will be a series of indicators, generally collected nationally or, if appropriate, from sentinel sites for select populations.Each indicator under the plan will be linked to specific surveillance goals, and accompanied by an explicit description of the mechanism by which the indicator is reported, and a list of issues that require action for full implementation of the indicator.The plan will incorporate considerations for Aboriginal and Torres Strait Islander populations as required.Surveillance and testing data for Aboriginal and Torres Strait Islander populations should be informed, guided and determined by Aboriginal and Torres Strait Islander knowledges and voice, in data collection, analysis, use and reporting processes. All information and data collected and accessed about Aboriginal and Torres Strait Islander people will be treated, like all data, as de-identified.Non-standard surveillance data sources that may help in gaining a more comprehensive view of COVID-19 in Australia will be considered throughout the development of the plan, including novel data streams, emerging technologies and novel approaches to surveillance. Overall coordination of information collection and dissemination under the plan will be the responsibility of the CDNA COVID-19 Working Group.Appendix 2: Testing Framework for COVID-19 in AustraliaAustralia has managed to suppress the transmission of SARS-CoV-2, the virus that causes COVID-19, across our community so that we are currently only seeing very low levels of transmission.The ability to rapidly detect and isolate cases of COVID-19 and quarantine their close contacts is central to the suite of strategies the Australian governments can employ in order to prevent ongoing community transmission in Australia. A high testing rate across the population, and particularly in populations that are more likely to have infection, is essential to provide confidence that cases will be detected as control measures are adjusted. This framework for testing for COVID-19 in Australia supports the Australian National Disease Surveillance Plan for COVID-19, which includes the monitoring of testing rates among its key components. It outlines the range of surveillance activities that monitor routine testing, or introduce additional testing for surveillance of COVID-19.It is important that surveillance and testing are prioritised to meet the key public health objective of minimising transmission. The primary approach for identifying people with an active SARS-CoV-2 infection is based on testing people with characteristic clinical symptoms, followed by people with atypical symptoms and then groups that are more likely to reveal the presence of undetected community transmission. The rationale is that people with symptoms consistent with COVID-19 have a much higher probability of testing positive for SARS-CoV-2 than people without such symptoms, and also present a higher risk of transmission to others. Consistent with the Pandemic Health Intelligence Plan, the following groups are prioritised for testing: All people presenting with fever or acute respiratory illness (ARI). This represents the most important group on which to focus and increase testing. Contacts of cases.Asymptomatic testing in outbreak settings.There may be other circumstances where clinical and public health judgment lead to a decision to conduct asymptomatic testing. These groups include:People at risk of exposure who present with atypical symptoms.At risk populations and settings where time limited testing is used to provide an upper estimate of transmission in these groups or settings. Enhanced testing of symptomatic peopleTo increase testing coverage, CDNA has provided enhanced testing recommendations from 24 April 2020 to anyone with ARI (e.g. cough, shortness of breath, sore throat) or fever and without the need for an epidemiological link.To be confident there is high case ascertainment, the amount of testing should reflect the prevalence of ARI in the community. This can only be achieved by effective communication to the public, and removal of barriers to testing to ensure all symptomatic people present and are tested, including marginalised populations, people with limited access to health care and people who may have a disincentive to be tested. This alone would greatly increase the number of tests conducted in Australia and reduce the chance of missing infections. Testing of contacts of casesThe COVID-19 CDNA National Guidelines for Public Health Units recommends that close downstream contacts of a case should be monitored for the development of symptoms for 14 days after the last exposure to the infectious case, where feasible to do so.Upstream contact tracing of cases without an epidemiological link in their exposure period (to find the index case), including the testing of people who are currently asymptomatic, is important in identifying and managing unrecognised chains of transmission. Both PCR-based testing, to identify current infection, and serology, to identify past infection, may be of value in this context. The use of viral genomics, which can demonstrate links between cases, may also be effective.Asymptomatic testing in outbreak settingsIn addition to testing all symptomatic people, under the COVID-19 CDNA National Guidelines for Public Health Units, testing of asymptomatic people should be considered for public health management in high risk settings where a single case or outbreak is identified, such as in health care settings, residential care settings, remote Aboriginal and Torres Strait Islander communities, and workers in critical infrastructure. This may include the testing of all people in the relevant setting, including people who are asymptomatic, or presymptomatic to potentially provide early detection of cases and mitigate further transmission. Testing of people at risk of exposure who present with atypical symptomsPeople in specific occupational groups have the potential for greater exposure to SARS-CoV-2 due to more frequent contacts with others. Some categories of health care workers and residential aged care workers meet this criterion. Given that other atypical presentations of COVID-19 have been documented, testing of these at risk populations has been supported by CDNA NOTEREF _Ref40568795 \h \* MERGEFORMAT 5 based on clinical and public health judgment.Testing of asymptomatic people in at risk populations and high risk settingsThere may be situations in which repeatable cross-sectional surveys of asymptomatic people may be of value, for instance to provide an upper estimate of transmission in these groups or settings. These time-limited surveys would be targeted to high risk settings or occupations such as health care workers and aged care workers, remote Aboriginal and Torres Strait Islander communities and other communities who may have barriers to access timely testing.Role of large-scale, non-targeted asymptomatic testingWhilst asymptomatic infections at the time of testing have been reported in many settings, many of these cases develop some symptoms at a later stage of infection (i.e. they were tested while pre-symptomatic). The proportion of cases that are truly asymptomatic throughout the course of their infection is not yet fully understood. However, the risk of transmission from symptomatic cases is considered to be higher.At present CDNA and the Australian Health Protection Principal Committee do not recommend large-scale testing for SARS-CoV-2 in asymptomatic people for case finding purposes on epidemiological and cost-benefit grounds. Mathematical modelling shows that testing of unselected asymptomatic individuals is not an effective way of detecting community transmission compared with enhanced testing in symptomatic cases, and contacts of cases. Such testing would use significant testing resources and the effect of potential false positive results needs to be considered. A false positive result can have significant negative impacts for both individuals and their communities, as well as affecting confidence in SARS-CoV-2 testing more broadly.Data collection requirementsFor all surveillance and testing plans, the central collection of the patient data and the test results is critical to ensure effective assessment of risk in the settings tested. This is often difficult but should be a key consideration in determining testing arrangements and where appropriate, included in testing contracts. Testing strategies should be developed in consultation with relevant national and jurisdiction public health authorities to ensure the most appropriate and effective approaches are employed.Appendix 3: Australian COVID-19 Serosurveillance Strategy – Summary (related to Goal #9 of the Plan)Purpose: This strategy forms part of the Australian National Disease Surveillance Plan for COVID-19 developed by the Communicable Diseases Network Australia (CDNA). It provides overall guidance on the use of serological surveys (serosurveillance) to track the spread of SARS-CoV-2 infection in the population. Serosurveys measure the prevalence of antibodies to SARS-CoV-2, which in most people appear by around 12–14 days after initial infection, whether or not the person had symptoms of disease, and may remain detectable for several months or longer. Serosurveillance complements epidemiological data collected using case reporting based on detection of the virus, which is likely to miss infections that are asymptomatic, mild or atypical or are not tested during the acute phase of their illness. Serosurveys provide a better understanding at the community level of how many people have been infected with the virus, and are considered an essential piece of pandemic intelligence. However, currently serosurveillance cannot be used to give an indication of population immunity, the extent to which antibodies can protect against reinfection is not known. Governance: This strategy has been developed by CDNA for the Australian Health Protection Principal Committee (AHPPC) and will be updated to reflect new knowledge or changes to the Australian situation. Specific activities carried out under this strategy will have well-defined governance structures that correspond with their locations, institutional partnerships and funding. Objective 1: Monitor national SARS-CoV-2 seroprevalence by geographic area and age groupLarge-scale serosurveys over time help to track the level of infection within the Australian population, can be used to assess the effectiveness of and guide public health measures, and to inform future plans. These surveys can be designed to examine variation in seroprevalence over time, and by geographic location, age group or sex, and factors that may impact on the risk of disease. The preferred approach for monitoring seroprevalence in Australia is through testing of anonymised residual blood specimens routinely collected for other purposes for the presence of SARS-CoV-2 antibodies. Using this approach, samples are selected using repeatable methodologies, to broadly reflect the desired population distribution. Analyses of these samples can be assumed to be reflective of time trends and geographic patterns in SARS-CoV-2 infection rates in the underlying communities from which they are drawn.Objective 2: Monitor SARS-CoV-2 seroprevalence in populations of importance in public health strategies Targeted serosurveillance supplements data from residual specimen collections described under Objective 1, but also addresses specific questions around infection, disease risk and outcomes (for example, if paired with clinical data) among specific and key populations of interest. These surveys involve active blood specimen collection to estimate the level of infection in specific populations of importance in the response to COVID-19. These include children and adolescents who have less routine blood testing, as well as at risk populations such as the elderly and health care workers. Serosurveillance in younger age groups can be undertaken through active recruitment of consenting participants in settings such as hospital emergency departments or schools. Surveys among health care workers and the elderly can be conducted in institutions including hospitals and aged care facilities. Serosurveys among potentially at risk or isolated populations such as Aboriginal and Torres Strait Islander people, the homeless or others might be considered, provided they are designed in consultation with local community, and conducted without substantial intrusion or additional burden on resources. Key considerations in the design of serological surveysSpecific activities carried out under this strategy should be based on comprehensive protocols, appropriate governance and relevant ethical and administrative approvals. Protocol/s need to provide detailed specification and justification including around: timing and location of surveys; sample size at each repetition; specimen type and collection logistics; serological test to be used (noting need for high specificity and sensitivity, suitability for this purpose, and ideally consistent across time and place); appropriate testing platforms; and data analysis and reporting. Survey frequency and scope should be adapted in response to intelligence needs and epidemic trends.Proposed outputs indicators Prevalence rates of infection (antibodies to SARS-CoV-2) by geographic area, age group, time, and in key populations, reported to CDNA, AHPPC, public health authorities, and made available to mathematical modellers and others researcher under standard access conditions. ................
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