Bacterial communicable diseases

Introduction

This section highlights selected communicable diseases of public health concern focusing on infectious syphilis, acute rheumatic fever (ARF), rheumatic heart disease (RHD), and tuberculosis (TB). These conditions disproportionately affect vulnerable populations, including First Nations peoples. Data on ARF and RHD are reported for the period 2024–2023, encompassing individuals recorded in the registry during this time. Additional summary data related to ARF and RHD in 2024 are available on-line at Notifiable conditions annual reporting.

Early detection, effective treatment, and prevention strategies such as antibiotic therapy, health education, and improved healthcare access are available. Timely intervention can prevent the progression of syphilis to more severe stages, reduce the risk of ARF advancing to RHD, and improve TB prognosis.

Information in this section is presented as age-specific rates (ASpR) and age-standardised rates (ASRs or standardised rates) by sociodemographic characteristics including by remoteness¹ and the area-based index of relative socioeconomic advantage and disadvantage.² Further information, including weekly updates of all communicable disease conditions reported in Queensland, are available on the Queensland Health Surveillance reports. Information on ARF and RHD are available from the Queensland Health Acute rheumatic fever and rheumatic heart disease page. Figures in this report may differ from other reporting systems due to differences in data extractions dates and application of different methodology. Please see Section Technical notes below for more detail.

Health burden

Nationally, for the subset of conditions included in this section, the number and standardised rate for years of healthy life lost in 2024 were:

• syphilis: 101 years (standardised rate 0.003 per 1,000 persons)
• tuberculosis: 1,090 years (standardised rate 0.04 per 1,000 persons)
• rheumatic heart disease (including acute rheumatic fever): 5,783 years (standardised rate 0.2 per 1,000 persons).³

Corresponding national health expenditure information for 2022–23 was $17 million (syphilis), $36 million (tuberculosis), and $215 million (rheumatic heart disease).³

Infectious syphilis

Syphilis is a highly infectious sexually transmissible infection (STI) caused by the Treponema pallidum bacterium. The disease has four stages (primary, secondary, late latent and tertiary) with each having different signs and symptoms. Left untreated, syphilis can cause severe complications.

There were 1,448 infectious syphilis reported in 2024, with a standardised rate of 31.1 per 100,000 persons (Figure 1). The primary and secondary stages of syphilis are highly transmissible and can be passed to sexual partners for up to two years if left untreated. Without treatment, syphilis can cause severe complications, most notably affecting the brain and heart. Additionally, the infection can be transmitted from mother to child during pregnancy (congenital syphilis), leading to serious and potentially fatal health outcomes. This underscore the urgent need for critical public health interventions.

Sociodemographic differences

In 2024, Queensland standardised rates for infectious syphilis were (Figure 1):

• 2.6 times higher for males than females (45.4 compared to 17.3 per 100,000, respectively)
• 2.3 times higher for those in remote areas than for those in the major cities
• 2.2 times higher for those in the most disadvantaged areas than those in the most advantaged areas.

Adults 30 to 34 years had the highest rates for both males and females—having 6.7 times and 15.7 times higher rates than those 50 years and older for males and females, respectively.

Trends

From 2015 to 2024, standardised rates for infectious syphilis increased by 168.2% over the period. Males and females had similar increases over time but males had consistently higher rates. Trend methodology is available in About this report.

From 2015 to 2022, gay, bisexual and other men-who-have-sex-with-men (GBMSM) were the majority of syphilis cases. From 2023 to 2024, the proportion of syphilis cases resulting from exposures other than GBMSM have increased. In 2024, GBMSM represented less than half (44.9%) of notified syphilis cases.

Congenital syphilis

From 2013 to 2024, 33 babies were born with congenital syphilis, including 22 First Nations babies. Increasing rates of infectious syphilis in women 15 to 44 years, and increases in congenital syphilis in infants, have been reported nationally for the period 2011 to 2021.⁴

Figure 1: Queensland infectious syphilis rates and trends

Acute rheumatic fever

ARF is a serious inflammatory disease that can develop after a group A streptococcal throat infection. It primarily affects children and young adults, leading to damage in the heart, joints, brain, and skin. If untreated, ARF can progress to rheumatic heart disease, causing long-term disability or death. ARF disproportionately impacts First Nations peoples and disadvantaged communities due to household crowding and barriers in accessing timely healthcare and preventive measures. Public health efforts focus on early diagnosis, access to antibiotics, and improved living conditions to prevent ARF and its complications. Raising awareness of the issue is crucial to protect at-risk populations.

There were 1,538 diagnoses of ARF reported for the 10-year period 2014–2023, comprised of 58.8% definite diagnoses, 20.5% probable diagnoses, and 20.7% possible diagnoses, which were recorded among 1,371 people on the Queensland RHD Register. Of these, 83.0% cases were among First Nations peoples (1,277 diagnoses in 1,131 people), who generally exhibited a higher percentage of ARF recurrence compared to other Queenslanders (Figure 2).

Sociodemographic differences

In Queensland, standardised rates for ARF in 2023 were (Figure 2):

• 3.5 per 100,000 persons overall, with similar rates for males and females (3.4 and 3.5 per 100,000, respectively)
• 79.8 times higher among First Nations peoples than other Queenslanders.

Children 5 to 14 years had the highest rates for both males and females, with rates decreasing with age.

Trends

From 2014 to 2023, standardised rates varied over time but were broadly stable across the period overall and by sex. Trends in First Nations peoples also varied, especially in the most recent years. Additional data are required to determine longer term patterns.

First Nations peoples consistently exhibited higher standardised rates with the trend varying over time, while standardised rates in other Queenslanders were consistently low, indicating a stark disparity. First Nations peoples also had higher rates of ARF recurrence, with the gap between other Queenslanders narrowing in more recent years. The contrast between First Nations peoples and other Queenslanders underscores the disproportionate impact of ARF on First Nations peoples, driven by factors such as socioeconomic challenges, environmental and household exposure, and inequities in healthcare access.

Figure 2: Queensland acute rheumatic fever rates and trends

Rheumatic heart disease

RHD is a chronic condition caused by damage to the heart valves following inadequately treated or repeated episodes of ARF. RHD disproportionately affects vulnerable populations, particularly in low-resource settings and among Indigenous communities, where overcrowding and limited healthcare access exacerbates its impact. It can lead to severe complications, including heart failure, stroke, and premature death. Preventing RHD requires a strong public health focus on early diagnosis and treatment of ARF, improved living conditions, and access to healthcare services. Raising awareness of this issue is essential to saving lives.

There were 2,331 people living with RHD recorded on the Queensland RHD register (including 88.3% with definite and 11.7% with borderline diagnoses) during the 10-year period 2014–2023. Of these, 54.3% of diagnoses were among First Nations peoples (Figure 3).

Among people diagnosed with definite RHD over the 10-year period, 1-in-4 (24.3%; 501 out of 2,058) underwent surgery. The proportions of RHD patients undergoing surgery for other Queenslanders was 3.1 times higher than those for First Nations peoples (36.9%; 377 out of 1,021 compared to 12.0%; 124 out of 1,036, respectively).

Sociodemographic differences

In Queensland, the standardised rates for RHD in 2023 were (Figure 3):

• 2.7 per 100,000 overall, with female rates moderately higher than males (3.3 and 2.0 per 100,000, respectively)
• 55.4 times higher among First Nations peoples than other Queenslanders.

Age-specific rates for those 0 to 14 years were 3.0 times higher than in those 25 to 34 years.

Trends

From 2014 to 2023, standardised rates varied with a large increase from 2017 to 2019 followed by a declining trend to 2023 with consistently higher rates in females. Trends in First Nations peoples peaked in 2019 and 2021 followed by a decline to 2023. Similar to ARF, First Nations peoples consistently exhibited higher standardised rates driven by the same factors as ARF. Declines should be interpreted with caution as this period coincides with various pandemic disruptions in health care.

Figure 3: Queensland rheumatic heart disease rates and trends

Secondary prophylaxis

Individuals with ARF receive routine antibiotic treatment to prevent future infections caused by group A streptococcus (strep A). This approach, known as secondary prophylaxis, lowers the likelihood of recurring ARF and helps to prevent the onset or progression of RHD. The most effective antibiotic for this purpose is a penicillin intramuscular injection called benzathine benzylpenicillin G (BPG or Bicillin) every 3 to 4 weeks for many years. Adherence to the BPG prophylaxis regimen is paramount for its success. However, there are barriers which can impact adherence such as injection discomfort, lack of access to healthcare facilities, and socioeconomic challenges. Therefore, addressing these barriers through patient education, community health support, and improved healthcare delivery systems is essential to maximise the effectiveness of secondary prophylaxis and improve outcomes for individuals with ARF and/or RHD.

Overall, 49.8% of ARF/RHD patients on the registry received less than 50% of the prescribed BPG doses in 2023. However, an even greater proportion of other Queenslanders fell below this 50% threshold (Figure 4). Of those that received at least 80% of prescribed doses, 24.0% of First Nations peoples met this criterion compared to 17.5% of other Queenslanders. These figures should be interpreted with caution due to the low numbers of other Queenslanders.

BPG delivery for ARF-only patients was similar to RHD patients with just over half receiving less than 50% of prescribed doses (54.5% for ARF only and 47.7% for RHD patients). However, an even larger proportion of other Queenslanders with either ARF-only or RHD did not meet this 50% threshold. Similarly, the proportion receiving 80% or more BPG doses was higher in First Nations peoples in both groups (21.9% in ARF only and 24.9% in RHD patients) than in other Queenslanders (14.7% in ARF only and 18.7% in RHD patients). Again, caution should be used when interpreting these figures.

Figure 4: BPG delivery level for Queensland residents in 2023

Tuberculosis

Tuberculosis (TB) is caused by the Mycobacterium tuberculosis bacterium and it can affect various parts of the body, with the lungs being the most common site—referred to as pulmonary tuberculosis. While the risk of developing TB remains low and is well managed in Queensland, the disease can be serious if left undiagnosed or untreated. However, with proper medical treatment, TB is completely curable.

There were 233 TB cases reported in 2024, with a standardised rate of 4.4 per 100,000 persons (Figure 5). While TB remains relatively uncommon in Queensland, sustained case numbers highlight the importance of early diagnosis, effective treatment, and continued surveillance.

Sociodemographic differences

In Queensland, standardised rates for TB in 2024 were (Figure 5):

• similar for males and females (4.3 and 4.5 per 100,000, respectively)
• 2.2 times higher for those in major cities than for those in inner regional areas
• 94.1% higher for those in the most disadvantaged areas than those in more advantaged areas (quintile 4).

Adults 30 to 44 years had the highest rates for both males and females—10.6 times and 9.6 times higher rates than those 0 to 14 years for males and females, respectively.

Some populations are known to have higher rates of TB, such as First Nations peoples and people from countries with a high burden of TB.

Trends

From 2010 to 2024, there have been 2,503 identified cases of TB in Queensland as of 06 March 2025. Notably, there were sharp increases in 2023 and 2024, which were preceeded by reduced rates in 2021 and 2022 coinciding with efforts to interrupt COVID-19 transmission during the pandemic. The recent uptrend highlights the need to maintain focus on TB control measures, including enhanced surveillance, targeted public health interventions, and ensuring timely treatment adherence to prevent further escalation. Strengthening community awareness and improving access to healthcare services will be essential in addressing this resurgence and sustaining long term TB control efforts.

Figure 5: Queensland tuberculosis, rates and trends

Additional information

Data and statistics

• Queensland Health Communicable disease Notifiable conditions reports
• Australian Institute of Health and Welfare Infectious and communicable diseases

Strategies and general information

More information about communicable diseases can be found from:

• Department of Health and Aged Care Communicable diseases
• Queensland Health Communicable disease control guidance
• Queensland Health Queensland Sexual Health Framework

Section technical notes

• ARF/RHD results may vary from AIHW results due to differing methodology regarding the death of patients in the most recent reporting year. This report retains those individuals and calculates treatment adherence based on the proportion of the year that they were still receiving care. Further, AIHW undertakes reapportionment of interstate patients that may receive care in other jurisdictions while the analyses in this report includes those on the Queensland RDH registry as of June 2024.
• While data were from the Queensland RHD registry, the data extraction occurred prior to the transition to the re-developed registry released in October 2024.
• Notifications under-represent the incidence of communicable diseases because notifications depend on:
  • individuals presenting with the disease
  • appropriate tests having been undertaken to confirm a diagnosis
  • results being reported to Queensland Health.
• Laboratories, the source of most notifications, may not record First Nations status, causing under-reporting in First Nations peoples.
• Regional comparisons are based on area-based remoteness categories and the socioeconomic index of relative socioeconomic advantage and disadvantage.