Background:
Although uncommon, invasive meningococcal disease (IMD) results in death in 5-10% of cases in healthy children and adolescents. This study aimed to examine demographics, clinical presentation, treatment, and outcomes of Australian children hospitalised with IMD during meningococcal vaccine program introduction, overall and by serogroup/disease severity.

Methods:
This prospective, multicentre study was conducted through the Paediatric Active Enhanced Disease Surveillance (PAEDS) network across eight tertiary paediatric hospitals in Australia. Children aged 0-18 years with laboratory-confirmed IMD admitted between July 2016-June 2022 were included. Clinical data were collected using standardised protocols. Logistic, quantile, negative binomial regression and univariate comparisons were used to compare characteristics by serogroup and to investigate factors associated with disease severity.

Results:
Among 137 IMD cases included, 56% were male with a median age of 2 years, 37% were Aboriginal/Torres Strait Islander children, and over half resided in socioeconomically disadvantaged areas. MenB accounted for 55% of cases, followed by MenW (28%) and MenY (4%). The case fatality rate was 3%. Antibiotics were administered within one hour of presentation in 17% of cases. At discharge, 29% had ongoing sequelae, including scarring, arthritis, limb deformities, or amputation. Most MenB cases were unvaccinated against MenB (93%), and only one MenY case had prior quadrivalent polysaccharide vaccination.

Conclusions:
This study highlights the continued burden of MenB disease, particularly among socioeconomically disadvantaged and Aboriginal and Torres Strait Islander children, underscores the importance of earlier recognition and treatment to reduce morbidity and mortality, and emphasise the need for improving vaccine uptake and vaccine availability.

Background and Aim

In Australia, testing and diagnosis for hepatitis C (HCV) has improved, yet many people do not start treatment. Health systems must support diagnosis and notification of cases into timely access to care, highlighting a crucial but under-utilised role of notification systems. Engaging people with HCV and health providers is critical to ensure system improvements address gaps in the care cascade. Connect C aims to explore community-informed changes to surveillance, follow-up, and care pathways to strengthen treatment linkage and engagement.

Methods and Analysis

Between 2024 and 2026 Connect C engaged people with lived experience, health providers, policymakers, and community organisations through co-design workshops in the Northern Territory and Queensland. Participants explored how notification systems could facilitate linkage between diagnosis and treatment, mapped care pathways, and identified barriers, including legislative and data handling requirements.

Outcomes

In both jurisdictions, communities and stakeholders strongly endorsed the model. They agreed that with community support, barriers to using notifications data more effectively (to link people into care) can be overcome. Participants valued contributing to solutions and provided clear guidance on supports needed for engagement with follow-up and treatment. Co-designed solutions clarified roles, streamlined referral pathways and embedded peer-supported approaches. Insights were consolidated into consensus statements guiding regulatory and data recording reforms, enabling systematic follow-up and linkage to care.

Conclusion and Future Actions.

Centring community voices and lived experience enables meaningful reform of notifications and care systems. Embedding community health services and peer support into effective use of notifications data shifts health systems from passive reporting to actively support people into care, and for HCV, to cure. The Connect C model demonstrates how co-designed, consensus driven approaches have the potential to overcome barriers to notification data use, strengthen treatment linkage, and provide a transferrable framework for HCV elimination and other communicable diseases in Australia.

Background: Most typhoid and paratyphoid cases notified in Australia are acquired overseas, with limited local transmission. Despite low notification rates in Australia (1.2/100 000 typhoid and paratyphoid combined 2025), public health action is a high priority to reduce potential onward transmission. National guidelines require exclusion of cases and contacts in high-risk groups (food-handlers, healthcare workers, childcare workers and children under 5 years) from employment or childcare until stool samples are negative on culture. This creates a high burden on public health units and potential economic stress for cases and contacts.
Methods: We conducted a case series describing public health actions for typhoid and paratyphoid notifications in South Australia (2024-2025). We summarised the proportion of cases and contacts in high-risk settings for exclusion, clearance and screening by stool sample culture, and time taken to complete public health action.
Outcomes: There were 54 cases in the study period (39 typhoid, 15 paratyphoid). Twenty-three cases (43%) were in high-risk settings requiring clearance and exclusion. Sixty-seven contacts required screening, and 50 required exclusion from high-risk settings. The median time from case interview to completion of public health follow up for cases was 22 days (range 9 - 50 days) and 8 days for contacts (range 5 – 39 days). Five cases were cleared based on only one sample or two samples submitted less than 48 hours apart; one case aged less than 5 years, not in childcare, was lost to follow up. Seven contacts in high-risk groups were lost to follow up.
Conclusions and future actions: Using culture alone for high-risk cases and contacts prolongs the time taken for clearance. A trial to use nucleic acid testing, followed by culture, could shorten clearance time reducing use of public health resources and economic stress on cases and contacts.

Background and Aim
In Australia rotavirus vaccination is recommended for all infants younger than six months of age. Following vaccination, the vaccine-strain is shed in stool and current diagnostic polymerase chain reaction detection assays cannot distinguish between vaccine and wild-type viruses. This may lead to rotavirus vaccine-like strains contributing to notifications in infants.

Methods and Analysis
We sought to estimate a plausible range of Australian rotavirus case notifications in infants with acute gastroenteritis (AGE) who have laboratory-confirmed rotavirus potentially related to vaccine shedding. Between 2018 and 2022, we applied the proportion of genotyped rotavirus specimens from infants identified as vaccine-like virus from the Australian Rotavirus Surveillance Program to Australian rotavirus case notifications (excluding ACT and Vic) by week of age. Ninety-five percent uncertainty intervals (95% UI) were calculated using Monte Carlo simulation.

Outcomes
The estimated proportion of notified rotavirus cases due to infants with AGE who have laboratory identified rotavirus potentially related to vaccine shedding increased from 0% (95% UI: 0–14%) at five weeks of age to 87% (95% UI: 78–94%) at six weeks of age (timing of recommended first vaccine dose). The peak proportion of 96% (87–99%) occurred at ten weeks of age then declined to 0% (95% UI: 0–44%) by 27 weeks of age and remained low for the rest of infancy. Using data from 2018 to 2022, this may have resulted in 66% (3,348/5,079) of rotavirus notifications in infants being due to vaccine-like rotavirus detection.

Conclusion and Future actions
A substantial portion of notified infant rotavirus cases in Australia between 2018 and 2022 may be due to detection of vaccine-strain virus following vaccination. To overcome this issue, routine targeted discriminatory testing in infant specimens positive for rotavirus should be considered. A rotavirus-positive result in an infant younger than eight months of age must be interpreted with caution.

Background: Despite widespread adoption of rotavirus (RV) vaccines (including monovalent Rotarix (RV1), and pentavalent RotaTeq (RV5)) since 2016, RV remains a leading cause of diarrheal-related mortality in low- and middle-income countries. Although reduced effectiveness of RV1 and RV5 has been reported in certain populations and countries, broader age-and region-specific effectiveness remains unclear. This study aimed to assess RV vaccine effectiveness (VE) across different vaccine types, age-groups, and global regions.
Method: A systematic search of PubMed, Web of Science, Scopus, Embase, Cochrane, China National Knowledge Infrastructure and WANFANG identified studies reporting RV VE (INPLASY202530055). VE was meta-analysed using the inverse-variance heterogeneity model by age-group (< 6 months, 6- 23 months, 2- 5 years, >5 years), region (Africa, Americas, Eastern Mediterranean, Europe, South-East Asia, Western Pacific), and vaccine type (RV1, RV5, Lanzhou lamb vaccine, Rotavac).
Results: Of 7049 records retrieved and screened, 95 met the inclusion criteria. Overall combined VE was 63.6% [95%CI: 43.3%, 76.6%] compared with unvaccinated or rotavirus-negative controls. VE for mixed RV1 & RV5 was 84.4% [64.3%, 93.1%], compared with VE RV1 alone (60.6% [26.9%, 78.8%]) and RV5 alone (61.7% [12.9%, 83.1%]). VE for Lanzhou Lamb vaccine was 62.0% [50.1%, 71.0%], and significantly higher for Rotavac (94%, [84.8%, 97.6%]). Studies in the Americas had the highest VE (81.30% [77.6%, 84.4%]), while South-East Asia had the lowest (45.0% [-21.5%, 75.1%]). VE varied by age, ranging from a low of 52.40% [-17.3%, 80.7%] in 6- 23 month age-group to 80.30% [74.5%, 84.8%] in those aged >5 years.
Conclusions: RV vaccines provide moderate to high protection under real world conditions, with effectiveness varying by vaccine type, age-group, and region. Lower VE in certain populations highlights the need for optimised vaccination strategies, targeted immunisation of high-risk infants, and strengthened surveillance to maximise global impact.

Context: Carbapenemase-producing Enterobacterales (CPE) are a critical antimicrobial resistance (AMR) threat, causing infections with high morbidity and mortality. CPE is monitored through the National Alert System for Critical Antimicrobial Resistance (CARAlert). In 2024, the CARAlert annual report noted an increase in CPE cases of 26.8% in 2023 compared to the previous year. Without collecting personal level data CARAlert cannot inform case follow-up without reliance on other local systems. CARAlert was evaluated as not collecting the information required to support clinicians, systems managers and policy makers, including insufficient epidemiological, clinical or identifying data to inform immediate public health action or early outbreak detection. CPE is currently notifiable in Victoria, New South Wales, South Australia, Western Australia, and Tasmania.
Aim: Rising CPE cases and limitations in current surveillance prompted the Communicable Diseases Network Australia (CDNA) to recommend adding CPE to the National Notifiable Disease List (NNDL). National notification aims to enable comprehensive data collection, improve outbreak detection, and support coordinated responses to emerging AMR threats.
Methods, analysis and outcomes: The process for nominating a disease for inclusion on the NNDL in Australia involves forming an assessment and seeking approvals from Principal committees and Health Ministers before legislation is tabled in parliament. The assessment was completed by a panel including experts on AMR, environmental health, infectious diseases and public health. CPE was ranked against 12 criteria that assess public health priority and feasibility of collection. The score for CPE was 28 to 36 out of 48, thus meeting the threshold for recommendation for national notification of 28.
Future actions: Should the recommendation be accepted and passes legislation in parliament, consultation with expert stakeholders will commence to inform implementation activities required to address the systematic and policy gaps for national surveillance of CPE.

Background and Aim

Since 2015, the Department of Health, Victoria, and Microbiological Diagnostic Unit Public Health Laboratory (MDU) have been running statewide epidemiological and genomic surveillance of carbapenemase-producing Enterobacterales (CPE), expanded to Pseudomonas and Acinetobacter (CPOs) in 2019. Globally, increasing CPO incidence and changes in circulating strains are reported; and locally, CPOs are soon to be made nationally notifiable. Here, we review 10 years of Victorian CPO surveillance data to examine local trends in cases, resistance genes and risk-factors.

Methods and Analysis

Whole genome sequence and risk factor data, including healthcare exposure and overseas travel, for confirmed CPO cases identified in Victoria between 2016-2025 were analysed descriptively.

Outcomes

Overall, 2,473 confirmed CPO cases were notified. Case numbers increased dramatically in recent years, with the 1455 cases observed between 2022-2025, exceeding the combined seven years prior (n=1018).
Changes in dominant carbapenemase genes were also noted. Between 2016-2020, 38% (n=340/882) of cases harboured IMP genes, including in 73% (214/291) with local acquisition. NDM genes prevelaence was similar (33% cases, 2016-2020), but predominantly associated with travel (commonly India, Greece and Thailand), and only infrequently implicated in local transmission (11%, n=33/291). Since 2021, NDM has become the most common carbapenamase gene (57%, n=907/1591), and alarmingly now responsible for 41%(117/286) of locally acquired cases.
Simultaneously, the complexity of analyses and investigations has surged, with MDU confirming several plasmid outbreaks since 2021, and increasingly detecting local outbreaks with no known epidemiological links.

Conclusions and future actions

The shift in carbapenemase genes, and associated risk factors has implications for patients and healthcare systems, potentially changing or limiting treatment options. Monitoring and understanding these changes will be critical for CPO control. However, increasing cases, local transmission, and the increased recognition of plasmid outbreaks pose significant challenges for surveillance, analysis and containment, and may require changes to current systems.