Background and Aim:
The First Few X (FFx) model is used internationally to understand early transmission of respiratory illnesses with pandemic potential, but it has not been assessed for cultural safety within First Nations communities. We explored whether FFx can be conducted in a culturally safe and acceptable way with Aboriginal families in Hunter New England (HNE). Early engagement with Aboriginal community members identified the need for transparent consent processes and a culturally safe data sharing agreement that reflects community control, clarity, and protection of cultural and intellectual property.
Methods and analysis:
A First Nations Community Panel process ensured decisions were led by Aboriginal community members and that governance structures aligned with cultural expectations. Panel recommendations informed redesign of consent materials and data governance pathways. Consultation occurred with HNE and NSW Health teams responsible for legal, governance, research, and information security considerations. An Indigenous law firm was engaged to ensure the Data Sharing Agreement aligned with Indigenous Data Sovereignty principles, community expectations, and ethical standards. The refined FFx model will be tested with Aboriginal families and households during the respiratory season to assess feasibility, cultural appropriateness and acceptability.
Outcomes:
The Community Panel identified three priority areas: Aboriginal leadership and governance; transparent and inclusive consent; and ongoing communication. In response, an Individual Data Consent Form and explanatory materials were co-designed. These included clear definitions of participant data, community-controlled governance arrangements, cultural restrictions, reciprocal data sharing, and participant control over data. These elements guide the structure and requirements of the Data Sharing Agreement, ensuring it reflects community expectations and culturally safe data pathways.
Conclusion and future actions:
The Data Sharing Agreement approach aims to formalise culturally safe data pathways and strengthen community-led disease surveillance. Next steps include finalising the agreement and applying these learnings to future FFx implementation and broader NSW Health data governance practice.

Background and aim:
The Incident Command System (ICS) is used to coordinate infectious disease emergencies. While ICS provides structured governance for public health emergencies, little is known about how Aboriginal leadership, cultural support and governance are embedded within local ICS models. This study aimed to explore ICS Team Leads perspective of embedding Aboriginal leadership and cultural support within a regional NSW public health unit during COVID-19.
Methods and analysis:
Semi-structured interviews were conducted with fifteen ICS Team Leads involved in the COVID-19 response. Interviews explored perspectives and experiences of embedding cultural support, Aboriginal leadership and governance within the ICS. The study was informed by Indigenous research methodologies and Indigenous Data Governance and Sovereignty, ensuring Aboriginal leadership and oversight throughout the design, analysis and interpretation. Interviews were audio-recorded, with notes taken and analysed using reflexive thematic analysis.
Outcomes:
Team Leads described strong commitment to culturally safe practice and reported positive experiences of embedding Aboriginal leadership and cultural support within the local ICS. In practice, Aboriginal leadership and a dedicated Aboriginal team were formally embedded into the ICS, guiding culturally informed communication, informing surveillance and decision-making, and strengthening trust with Aboriginal communities. Findings highlighted the need to adapt traditional Western command-and-control structures to incorporate cultural ways of working, centre Aboriginal leadership, formalise cultural support as core public health infrastructure, and address the cultural and colonial burden carried by Aboriginal staff. Elevated Aboriginal leadership, dedicated Aboriginal workforce capacity and trusted community relationships were pivotal to an effective response.
Conclusion and Future Actions:
Pandemic preparedness frameworks should formally embed Aboriginal cultural governance, with defined leadership roles and integrated Aboriginal public health workforce within ICS structures. Moving beyond informal and reactive cultural review and advice towards culturally informed and grounded practice will strengthen equitable Aboriginal health outcomes in future public health emergencies.

Background and Aim: The COVID-19 pandemic highlighted the significant challenges that residential aged care facilities (RACFs) face during pandemic events. These challenges are further amplified in regional areas of Australia. A research focus is required to address current and future threats of pandemics in these high-risk settings. The aim of this study was to therefore explore the capacity of RACFs in regional/remote Western Australia (WA) to prepare for and respond to respiratory outbreaks and pandemics.
Methods and Analysis: In-depth interviews were conducted between June 2024 – August 2025 with CEOs/Executive Managers of 11 Approved Providers operating one or more RACFs in regional/remote WA. Interviews explored: 1) challenges in preparing for and responding to respiratory outbreaks and pandemics; 2) decision-making pathways during outbreak events; 3) access to essential resources; 4) lessons learned from the COVID-19 pandemic. Data were thematically analysed in NVivo.
Outcomes: Providers noted improved capacity for outbreak preparedness compared to the pre-COVID period, citing the establishment of outbreak management teams to coordinate responses, clearer outbreak management procedures, trained infection prevention and control (IPC) leads, and implementation of mandatory staff IPC training. However, workforce shortages were identified as the most significant challenge related to outbreak preparedness, and compromised day-to-day delivery of aged care more generally. Providers highlighted the limited availability of suitably skilled staff, particularly registered nurses and personal care workers, leading to a reliance on agency staff and Commonwealth funded surge workforce during outbreak events. Lack of housing availability and affordability in regional areas also contributed to challenges in attracting and retaining staff to these areas.
Conclusion and Future Actions: Future outbreak and pandemic preparedness efforts in regional areas must prioritise solutions to improve workforce supply and address accommodation barriers. The Commonwealth could potentially extend the surge workforce program to support regional RACFs facing critical staff shortages during outbreaks.

Background and Aim
Residents of aged care homes (RACH) are at high risk of severe disease and complications including hospitalisation and death from respiratory infections. National Australian data suggests vaccine uptake is inadequate and inconsistent across RACHs. Sociodemographic factors impact uptake however are under-analysed in Australian contexts. We aimed to determine coverage and predictors of influenza, COVID-19 and pneumococcal vaccination in RACHs participating in the START Trial (ClinicalTrials.gov NCT03941509).
Methods and Analysis
Post-hoc analysis was conducted using prospectively collected data nested in the START trial conducted in 12 Victorian RACHs from 1/1/2021 - 30/4/2022. Predictors of vaccination were determined using univariate and multivariable logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CI). Among 1409 residents, vaccination coverage for influenza, COVID-19 and pneumococcal was 73.24%, 86.24% and 10.93% respectively. In multivariable regression, years of residence (1-5yrs OR 16.94 [95% CI10.51-27.29], ≥5yrs OR 30.59 [95% CI 12.91-72.46]) and advanced care planning (OR 1.71 [95% CI 1.22-2.40]) predicted influenza vaccination. Having one comorbidity or hospitalisation within 3 months of enrolment was negatively associated. Living in large (>101 beds) RACHs predicted COVID-19 vaccination (OR 1.42 [95% CI 1.02-1.99]). Living in a regional facility predicted pneumococcal vaccination (OR 2.46 [95% CI 1.17-5.20]) whereas low weight and longer duration of residence (≥5yrs) were negatively associated.
Outcomes
Implications for practice include a need to revisit design and implementation of vaccine delivery to aged care residents.
Conclusion and Future actions
Interventions with robust evaluation are needed to improve vaccination uptake, particularly among people with predictors of lower vaccination. Further analysis would be valuable to determine if trends are consistent across Australian facilities, outside the pandemic context. A significant proportion of residents at high-risk remain under-vaccinated despite recommendations. Focusing on vaccination upon entry into RACHs could encourage uptake and should be explored in future projects.

Background and aim: Understanding the behavioural and social drivers of vaccination is essential for identifying modifiable barriers and developing targeted interventions. This study examined priority indicators from the Behavioural and Social Drivers of COVID-19 Vaccination guidelines among elderly adults in Aceh Timur and Aceh Besar Regencies, Aceh Province, Indonesia.
Methods and analysis: A cross-sectional survey was conducted in October to November 2024 among 452 respondents aged sixty years and older. Indicators assessed included confidence in vaccine importance, intention to vaccinate, family support, affordability, practical access, and vaccination uptake. Descriptive statistics and chi-square tests were used to compare differences between regencies.
Outcomes: Overall, 52.4% of respondents had received a COVID-19 vaccine, with higher uptake in Aceh Timur (59.5%) compared with 46.8% in Aceh Besar (p = 0.007). Intention to vaccinate was low at 25.4% overall but was significantly higher in Aceh Timur. Confidence in the importance of COVID-19 vaccination was modest at 38.1%, and family support for vaccination was reported by 42.7%, with both factors showing no meaningful differences between regencies. Affordability and practical access challenges were evident. Only 2.0% reported that vaccination was easy to pay for, and just 1.8% knew where to get vaccinated at the time of the survey. In contrast, 73.2% reported knowing where to obtain vaccination during the pandemic period, with significantly higher awareness in Aceh Timur (80.0%) than in Aceh Besar (67.9%, p = 0.004).
Conclusion and future actions: These findings highlight low COVID-19 vaccination coverage, declining intention in the endemic period, and reduced awareness of service locations. Strengthening communication on vaccine benefits, improving affordability and service visibility, and directing support to lower-performing areas are important strategies for increasing vaccination uptake among older adults.

Introduction and Aim
Children with Down syndrome are at increased risk of severe respiratory infections and healthcare utilisation compared to children without. However, contemporary Australian data describing pathogen-specific burden and impact of vaccine-preventable infections are limited. We aimed to characterise respiratory infection-related hospitalisations and quantify the vaccine-preventable burden in a contemporary cohort of children with Down syndrome.

Method and Analysis
We conducted a retrospective cohort study using data form the electronic medical records from the Royal Children’s Hospital, Melbourne. All children aged <18 years on January 1, 2023, with a Down syndrome diagnosis who attended between January 2023 and December 2024 were included. Respiratory infection-related admissions were analysed for demographic, comorbidities, clinical severity, pathogen profile and hospital bed-day distributions.

Results
Among 843 children, respiratory infections accounted for 9.6% (114/1189) of overall admissions. Affected children were younger (median 2.5 years) and more likely to have haemodynamically significant congenital heart disease (31.6%). Respiratory admissions had longer length of stay; and 32.5% required respiratory support. Pathogen testing (40.4% of respiratory admissions) identified high numbers of both, respiratory syncytial virus (RSV) and human metapneumovirus. Testing was strongly associated with markers of severity. Importantly, 20% of tested admissions were attributable to potentially vaccine-preventable pathogens (RSV, influenza, SARS-CoV-2), accounting for 15% of associated hospital bed-days.

Conclusion and Future Actions
Respiratory infections cause a significant burden on children with Down syndrome, especially affecting younger children with comorbidities. The substantial burden from RSV, influenza and SARS-CoV-2 underscores the need for targeted immunisation strategies to reduce potentially preventable burden in this special risk group.

Background and Aim
Listeriosis is a rare, serious disease in pregnant, immunocompromised, and older people. In NSW, annual listeriosis cases have fluctuated between 17 to 39 cases over 2010 to 2025 with no clear rise or decline over time. Proliferation of health messages and online misinformation makes delivery of prevention information challenging. NSW Health and NSW Food Authority are analysing surveillance data to inform the development of targeted education.

Methods and Analysis
Listeriosis cases notified to NSW Health between 1 January 2010 and 31 December 2025 were extracted from the NSW Notifiable Conditions Information Management System. Risk groups were defined and proportions calculated for responses to the standard question “before this illness, did a healthcare worker tell you to avoid certain foods to prevent listeriosis?”. A web search was conducted to identify Australian public-facing food safety resources relevant to listeriosis prevention.

Outcomes
In the analysis period, 408 listeriosis cases were notified; of these 296 (73%) were immunocompromised, 269 (66%) were aged 65 and older, and 31 (8%) were pregnant.
Prevention knowledge varied by risk-group; 18 (72%) pregnant cases reported being advised to avoid high-risk foods compared to 25 (12%) immunocompromised and 12 (7%) cases aged 65+. In each group, knowledge was lower among those born in a non-English speaking country or who spoke a language other than English at home.
Of 40 online resources identified, 19 were targeted at pregnant people, 4 at immunocompromised groups, and none specifically at older people or non-English speakers.

Conclusion and Future Actions
Listeriosis surveillance data should be analysed to inform prevention strategies. There is a gap in listeriosis prevention resources for immunocompromised and older people, including non-English speakers. Simple and targeted messaging will assist in providing long-lasting knowledge change.

Background and Aim: Ethiopia has eliminated wild poliovirus (WPV), yet outbreaks of circulating vaccine derived poliovirus (cVDPV) continue to threaten progress. Transmission risk is intensified by mobile pastoralist populations, conflict-affected areas, and cross-border movement. Vaccine hesitancy influenced by misinformation, mistrust of external interventions, and religious beliefs framing illness as fate also contributes to refusal and missed children. This study examines barriers to vaccination in high-risk Ethiopian communities and proposes practical, community focused strategies to strengthen prevention and response to future polio outbreaks.

Methods and Analysis: We conducted a mixed-method assessment in selected high-risk districts. Quantitative data were drawn from reports on immunization coverage, acute flaccid paralysis (AFP) surveillance, and environmental monitoring to assess program performance and identify gaps. We also conducted semi structured interviews with 100 participants, including caregivers, religious leaders, and health extension workers, focusing on perceptions of polio, attitudes toward vaccination, and reasons for refusal. We used thematic analysis to identify recurring barriers and compared qualitative findings with surveillance indicators to develop practical recommendations.

Outcomes: Quantitative findings showed substantial variation in coverage and surveillance indicators among mobile and conflict-affected communities. Qualitative analysis identified three recurring drivers of hesitancy: (i) infertility-related fears attributed to vaccination, (ii) distrust rooted in political instability and perceptions of external agendas, and (iii) religious interpretations that view disease as predetermined. Based on these findings, we proposed context-specific measures including structured engagement with religious leaders and trusted local influencers (to improve communication), mobile vaccination teams aligned with migration routes, stronger cross-border coordination for synchronized campaigns and tracking missed children, expanded environmental surveillance in high-risk areas, and locally adapted risk-communication materials.

Conclusion and Future actions: Polio persistence in Ethiopia reflects intersecting challenges of mobility, insecurity, and culturally grounded beliefs. Progress will depend on sustained community dialogue, institutionalized partnerships with religious leaders, adaptive service delivery for mobile populations, integrated surveillance systems, and resilient cold-chain and logistics capacity in insecure settings. These strategies can improve acceptance, reduce missed children, and strengthen preparedness for future cVDPV outbreaks.

Background and Aim
Severe acute malnutrition (SAM) remains a major contributor to childhood morbidity and mortality in low-income and fragile settings. In Timor-Leste, undernutrition occurs within a context of socioeconomic disadvantage, constrained caregiving capacity, recurrent infectious exposures, and unsafe food and water environments. However, evidence integrating these interacting drivers of infection and nutritional vulnerability for action remains limited. This study aimed to identify factors associated with hospitalisation due to SAM among children aged under five years in Timor-Leste.
Methods and Analysis
We conducted an age-, and community-matched case–control study between June 2024 and August 2025. Cases were children aged 1–59 months hospitalised with SAM at the national referral hospital in Dili, with two community controls per case. Data were collected through anthropometry, household questionnaires, vaccination records, and biological sampling from children, animals, water, and domestic environments. Exposures spanning socioeconomic, caregiving, environmental, immunisation, and infectious pathways were analysed using conditional logistic regression.
Outcomes
Seventy-eight cases and 156 matched controls were included. SAM hospitalisation was independently associated with lower maternal education (aOR 2.8), recent household food insecurity (aOR 5.9), unimproved drinking water (aOR 5.1), and never breastfeeding (aOR 4.0). Short birth intervals (<12 months) were also linked to higher odds. Age-adjusted analysis showed children who missed measles–rubella vaccination had increased odds of SAM hospitalisation (aOR 2.8). Findings demonstrate how infection risk, immunisation gaps, and environmental exposures interact with socioeconomic vulnerability to drive preventable hospital demand.
Conclusion and Future Actions
Hospitalisation for SAM in Timor-Leste reflects modifiable caregiving, food security, hygiene, and immunisation factors operating within broader socioeconomic constraints. Reducing this burden requires coordinated action across health, nutrition, WASH, and immunisation systems rather than siloed interventions. One Health–orientated strategies integrating maternal education, birth spacing, household food access, vaccination coverage, and safe food and water hygiene—alongside nutrition-specific care—should be prioritised to reduce preventable hospitalisations in fragile and regional health security contexts.

Background and aim
Campylobacter spp. is a leading bacterial cause of diarrheal disease globally and associated with child malnutrition and growth impairment. In Timor-Leste, childhood malnutrition and diarrheal diseases remains a major health problem, yet data on Campylobacter epidemiology are limited. Information on circulating species and potential zoonotic transmission pathways is limited. This study aimed to investigate the molecular detection, species distribution, and exposure pathways of campylobacteriosis among children in Timor-Leste.
Methods and analysis
A case–control study was conducted using stool samples collected from children, aged 1-59 months enrolled in a nutrition study in Timor-Leste. Samples were obtained from children with malnutrition and age-matched community controls. Detection of Campylobacter was performed using a multiplex Real time Polymerase Chain Reaction (RT-PCR); culture was attempted for a subset of PCR-positive samples to assess bacterial viability and support further characterisation. Additionally, viable Campylobacter were isolated from animal and environmental swabs to explore potential exposure pathways.
Outcomes
Of 236 stools analysed, 47 (20%) were positive for Campylobacter, including 32 (68%) Campylobacter jejuni and 15 (32%) Campylobacter coli. Positives were identified in both malnourished children (10/47; 21.3%) and controls (37/47; 79%), indicating community-wide prevalence. Of the samples positive for Campylobacter by PCR, culture was also positive in 17 samples, including 9 Campylobacter jejuni, 7 Campylobacter coli, and 1 Campylobacter hyointestinalis. Of 120 animal swabs collected, 46 (38%) were culture-positive, including 24 (52%) Campylobacter jejuni, 21 (46%) Campylobacter coli, and 1 (2%) Campylobacter lanienae.
Conclusion and future actions
This study provides the first molecular evidence of campylobacteriosis among children in Timor-Leste. We show the feasibility and utility of PCR-based diagnostics for enteric disease surveillance where culture-based methods are challenging. Incorporating molecular detection of Campylobacter into routine communicable disease surveillance may improve understanding of enteric pathogen exposure in children and inform future One Health interventions.