Background and Aim:
Q fever, is a zoonotic disease caused by Coxiella burnetii, transmitted mainly via contaminated livestock aerosols. Gippsland, a rural dairy and agricultural region in Victoria, Australia, experiences high burden of disease. Notification data likely underestimate true burden due to variable clinical presentation, limited clinician awareness and reduced healthcare engagement among at risk populations. Vaccination is effective but underutilised. A subsidised Q Fever testing and vaccination initiative established by GippsDairy and Gippsland Region Public Health Unit enabled assessment of prior exposure within a high-risk workforce.
Methods and Analysis:
Dairy and livestock workers were recruited, with testing and vaccination delivered at four Gippsland primary care clinics. A retrospective serosurvey was conducted among adults (≥18 years) participating between January - October 2025 using de-identified serology and skin prick test results. Survey data assessed awareness and barriers to vaccination. Statistical analyses estimated prevalence of prior C. burnetii exposure and examined associations with demographic, occupational and geographic factors using chi-square/Fisher’s exact tests and unadjusted logistic regression (ORs, 95% CI).
Outcomes:
A total of 178 participants were included (median age 38 years; 55.1% male), of whom 52.2% were full time dairy farm workers. Evidence of prior C. burnetii exposure was identified in 22 participants (95% CI 7.9-18.1%), while 153 received vaccination. Prior exposure varied by age group (χ² p=0.0036), peaking among those aged 40–49 years (10/29, 34.5%). Key barriers to vaccination included time and work constraints, cost, limited local providers and low awareness of personal risk and vaccine effectiveness.
Conclusion and Future actions:
This study provides region-specific evidence of Q fever exposure among Gippsland agricultural workers. Seroprevalence suggests notification data underestimate true infection burden and may exceed previous Australian serosurvey estimates. Findings highlight the need for sustained, accessible and affordable vaccination pathways, supported by targeted prevention and education strategies in rural agricultural settings.

Background and Aim
Q fever notifications have been increasing in Australia since 2024. People working with animals and/or animal products are at increased risk, and are recommended to receive Q fever vaccination. In 2025, the Barwon South West Public Health Unit (BSWPHU) investigated two separate outbreaks of Q fever among sheep shearing contractors employed in Victoria but who spent their acquisition periods working in New South Wales. This resulted in cross-jurisdictional outbreak investigations.

Methods and Analysis
Confirmed and suspected outbreak cases were identified through routine laboratory and clinician notifications, and active surveillance of identified co-exposed individuals. Potential acquisition sources were identified through case interviews and epidemiological analyses. Outbreak investigation and management was conducted in collaboration with several regional public health units and jurisdictional health authorities. Advice was provided to employers and to co-exposed individuals about Q fever testing and vaccination, and other preventive measures such as use of personal protective equipment.

Outcomes
Ten cases (five confirmed by serology, one confirmed by PCR, and four suspected) were identified across the two outbreaks. The first outbreak, identified in March 2025, included six cases among 12 exposed individuals. The second outbreak, identified in October 2025, included four cases among 27 exposed individuals. Eight cases were unvaccinated against Q fever, while two reported receiving vaccination approximately 20 years ago. All cases reported direct contact with sheep or sheep products during their acquisition, across multiple premises. Other risk factors included contact with goats, feral pigs, and foxes.

Conclusion and Future Actions
These outbreaks highlight the risk for contracting shearing teams due to close contact with livestock and contaminated environments across multiple high-risk settings. Key learnings include the need for targeted Q fever vaccination and education strategies for contractors working in high-risk occupations, and the importance of interjurisdictional communication as part of outbreak management and response.

Background and Aim

Humans can be infected with Coxiella burnetii - the causative agent of Q fever - through direct contact with animal hosts, vector borne transmission from ticks, and indirect environmental exposure. We describe the epidemiology of notified cases to identify the potential drivers of increases in Q fever notifications in New South Wales.

Methods and Analysis

We compared the number and characteristics of NSW Q fever notifications from 2015–2023 to those in 2024–2025. The median number of weekly notifications between periods were compared using the Mann-Whitney U-Test. Exposure risks for Q fever and Q fever vaccination status were analysed with Pearson’s Chi Square tests. Distribution of animal contact type was described as a proportion of cases.

Outcomes

From 2015–2023 to 2024–25 there was an increase in annual notification rate, from 2.74/100,000 to 3.82/100,000, and the median notifications per week from 4 to 6 (W = 14067, p <0.001). The most substantial change in geographic distribution was for Hunter New England Local Health District which accounted for 22% of cases in 2015–2023 and 33% in 2024–2025. Cases with no-high risk occupation increased from 27% to 36% (X2 = 44.64, p < 0.001). In both time periods the most frequently reported settings for contact were farms (53%), livestock (43%) and the most common occupation farmer/grazier (32%). The proportion of unvaccinated cases increased from 73% to 84% 2024-2025, likely due to the decrease in unknown vaccination status from 26% to 14% (p<0.001).

Conclusion and future actions

Q fever incidence has increased in NSW in recent years, the drivers of which are likely multifaceted. The increase in cases with no obvious risk factors and a geographic shift in distribution warrants further investigation and may necessitate an adjustment to public health awareness and control methods.

Background and Aim
Tuberculosis (TB) continues to disproportionately affect Aboriginal communities in South Australia, driven by structural inequities that increase exposure risk and hinder treatment completion. In 2024, a new statewide response model was proposed to reduce TB-related harm by improving access to culturally safe TB services for high-risk populations. In May 2025, NALHN Watto Purrunna Aboriginal Health established the Tuberculosis Outreach Team (TBOT) to adapt existing TB services and deliver accessible, culturally respectful, patient-centred care for Aboriginal communities.

Methods and Analysis
TBOT collaborated with SA TB Services to implement an outreach programme targeting high-risk populations. A service review of complex TB cases lost to follow-up (2022–2024) identified barriers, including housing instability, unemployment, and limited access to transport and communication. Findings informed a multidisciplinary outreach model addressing social determinants of health alongside clinical care.

Outcomes
Aligned with World Health Organization (2025) recommendations for community-based outreach and linkage services, TBOT implemented a multidisciplinary model involving TB specialist nurses, general practitioners, cultural support workers, and social and emotional wellbeing clinicians. The programme delivered face-to-face treatment support, screening, and culturally informed education through a co-design approach.

Within the first seven months (May–December 2025), TBOT supported 279 individuals for TB screening, re-engaged 200 individuals previously lost to follow-up, and delivered over 436 outreach activities. Among patients who received face-to-face treatment support (n=18), the treatment completion rate exceeded 85%. Provision of mobile phones as a targeted social support strategy strengthened patient-clinician communication and was associated with a 94% treatment completion rate among one DOT patient. Service-level feedback from patients and providers indicated increased trust, improved engagement, and reconnection with mainstream healthcare services.

Conclusion and Future Actions
Addressing TB among vulnerable populations requires models that respond to social, cultural, and economic barriers. Culturally safe TB outreach programme represents a sustainable approach to improving treatment adherence, advancing health equity, and strengthening TB prevention outcomes for Aboriginal communities.

Reference
World Health Organization. (2025). Tuberculosis among populations at high risk and people in vulnerable situations: Policy brief. https://doi.org/10.2471/B09350

Background and Aim
Melioidosis, caused by the soil-dwelling bacterium Burkholderia pseudomallei, is endemic in northern Australia. In early 2025, Queensland experienced an unprecedented surge in notifications. We conducted a descriptive epidemiological analysis of all melioidosis cases notified from 1 January to 30 June 2025 using Queensland Health's Notifiable Conditions System.

Methods and Analysis
Incidence, temporal, spatial, and person characteristics were compared with the 2020–2024 year-to-date average. Regression models (negative binomial and Poisson), adjusted for demographic confounders, were used to estimate notification rates and risks of ICU admission and death.

Outcomes
During the first six months of 2025, 234 cases were reported, including three cases with previous notifications (3, 4 and 7 years ago)—a threefold increase over the five-year average of 71. Most cases (89%) resided in Cairns or Townsville. Most were male (62%) and older (mean: 60 years; SD: 16 years). First Nations peoples accounted for 36% of cases. Case fatality exceeded the five-year average (15% vs. 7%). Since 2000, the incidence rate ratio (IRR) increased by 7% per year (IRR: 1.07; 95% CI: 1.06–1.09). While demographic factors did not associate with ICU admission, multivariable models linked death to age (IRR: 1.07 per year increase; 95% CI: 1.04–1.09) and First Nations status (IRR: 2.36; 95% CI: 1.27–4.38). The outbreak displayed a bimodal pattern aligned with heavy rainfall. Most (64%) exposure sources were unidentified or unrecorded, highlighting surveillance gaps that obscure preventable risk factors.

Conclusion and Future actions
The outbreak prompted immediate strengthening of melioidosis surveillance and the formation of a statewide working group to improve the case report form. These findings underscore the importance of a One Health-aligned risk reduction strategy for high-risk individuals. Such strategies emphasize staying sheltered during heavy rainfall, utilizing personal protective equipment during exposure-prone activities, and seeking medical evaluation immediately upon the development of symptoms.

Background and Aim
Participants in the Pacific Australia Labour Mobility (PALM) scheme make vital contributions to Australia’s economy. However, they face significant structural and social barriers to accessing healthcare while living and working in Australia. The research objectives were to identify opportunities to improve healthcare (particularly for blood-borne viruses (BBVs), including hepatitis B (HBV)) in the areas of public health policy, service delivery, and support for PALM participants in regional Queensland and, more broadly, Australia.
Methods and Analysis
A mixed-methods sequential research design incorporating qualitative and quantitative components to address research objectives, working with PALM participants, healthcare providers, and employer welfare officers.
The research adopted a health equity lens, underpinned by human rights principles.
Outcomes
An array of factors impacting healthcare access and navigation revealed systemic challenges beyond BBVs across several levels.
These included Medicare ineligibility, mandatory and restrictive private health insurance, and high out-of-pocket costs. Limited access to healthcare services in regional areas, a lack of culturally responsive and in-language care, and reactive responses resulted in fragmented care. At a micro level, there was reliance on goodwill and on the advocacy of health providers and employer welfare officers.
A cost-benefit analysis found that the costs of screening and treating PALM participants for HBV would be offset by costs avoided by delaying serious sequelae through early medical intervention.
Conclusions and Future Actions
Gaps identified in effective healthcare access call for considerable policy/funding shifts in order to provide respectful models of care for PALM seasonal workers, underpinned by better continuity of care. This includes a fundamental review of the health insurance system, improved paid sick leave entitlements, and innovative models such as outreach healthcare, as well as screening, vaccination and treatment for HBV in particular. Such models require strengthening cultural safety, guided by a co-designed approach.

Background and Aim
Highly Pathogenic Avian Influenza (HPAI) is an influenza A virus associated with severe disease in birds, posing a global zoonotic risk. HPAI has long been considered a pathogen of significant pandemic potential requiring risk mitigation to prevent spillovers into human populations.

Between February and March 2025, the Goulburn Valley Public Health Unit (GVPHU) responded to four interconnected HPAI outbreaks at poultry farms in regional Victoria. GVPHU responded to the outbreaks through rapid identification of people exposed to HPAI and subsequent implementation of control measures. The response placed strain on our internal processes and data capture methods. This work aimed to identify data collection challenges in large-scale outbreaks and develop more efficient approaches to data collection and screening.

Methods and Analysis
Identification of exposed people relied on lists of site attendees provided by workplace managers. Individuals were contacted by phone to assess exposure risk and provide public health advice. Data was recorded on Microsoft Word templates, then transcribed into an excel-based template and the Victorian notifiable disease surveillance system (PHESS). Under outbreak response conditions, several inefficiencies were identified, including inaccurate lists of potentially exposed persons, duplicated data entry, and delays in producing reportable metrics.

Outcomes
To address some of the learnings from this incident, a proof-of-concept REDCap-based triage questionnaire was developed to support future outbreak responses. The tool was designed to identify true exposed persons, stratify exposure risk, and streamline data capture at the point of entry. Utilising data collection in REDCap reduces transcription steps, improves data flow for surveillance reporting, and enables public health resources to be prioritised toward risk assessment and control measures.

Conclusion and Future actions
Large-scale outbreaks such as HPAI can overwhelm routine traditional workflows. Preparedness should include flexible, scalable data collection tools that minimise duplication and support timely reporting, enabling public health units to respond effectively during high-pressure outbreak events.

Background and Aim: Acute Rheumatic Fever (ARF) is an inflammatory disease caused by recurrent infection with Group A Streptococcus bacterium (GAS). GAS infections are closely linked to skin sores caused by scabies mites. Untreated ARF can lead to irreversible damage to the heart valves resulting in Rheumatic Heart Disease (RHD). ARF and RHD are determined by social and economic disadvantage – rather than biomedical risk - driven by lack of access to adequate healthcare, housing, washing facilities, water and power. Despite being entirely preventable, within Australia the burden of ARF is almost exclusively witnessed in the Aboriginal and Torres Strait Islander population, accounting for 94% of diagnoses, particularly in the 5-14 years age group.
Aboriginal Investment Group (AIG) launched the Remote Laundries Project in 2019 as a community-identified solution to the lack of adequate washing facilities in remote Aboriginal communities. Seven. This study aimed to measure the impact of this community-led primordial prevention activity on health, social and economic outcomes, and enablers and barriers to implementation, scaling and sustainment in remote Indigenous communities across Northern Australia.

Methods and Analysis: A co-designed mixed-methods impact and implementation evaluation protocol was co-developed with AIG based upon implementation science and impact assessments. The Social Impact Framework (Canuto et al., 2023), previously co-designed by Flinders University with AIG and the National Heart Foundation, guided the evaluation framework.
Data were collected using qualitative interview and ethnographic observations, and quantitative data related to laundry operation. Deductive thematic analysis was undertaken using the Indigenous and non-Indigenous implementation frameworks.
The collaborative research approach with AIG ensured that all research activity was approved by the Indigenous Board of Directors for conducting the research with their communities. AIG staff also travelled with researchers to Laundry sites and introduced researchers to community members and organisations to facilitate relationship building for recruitment and informed consent of community-based participants. CSIRO researchers independently conducted all data collection, analysis and writing of the research, early findings were presented to AIG to confirm contextual details and ensure cultural sensitivities were communicated effectively.

Outcomes: Findings from this Indigenous led and community co-designed mixed-methods evaluation protocol established the Remote Laundries Project as a legitimate and scalable primordial and primary prevention intervention to advance health, social and economic outcomes within remote Indigenous communities, including the prevention and treatment of scabies infections. Core components to implementation success included embedded Indigenous governance and workforce, flexible design and delivery suitable to remote contexts, and investment in strong partnerships. The greatest barrier to continued implementation and scale is access to funding. These findings have been shared with AIG to inform continued enhancement and subsequent scaling of the intervention across Northern Australia as well as pathways to optimise access to further funding opportunities.

Conclusion and Future Direction: With adequate financial investment, the Remote Laundries Project is positioned for scaling across Northern Australia to respond to community identified health, social and economic priorities to advance equitable outcomes for remote Indigenous peoples. Further research embedding more community member perspectives, and epidemiological health research to produce data on the associations between laundry interventions and GAS and ARF prevalence are encouraged.

Background and Aim
In 2024, the Western NSW Local Health District Public Health Unit (PHU) identified an unexpected increase in invasive pneumococcal disease (IPD), with over half of cases occurring in adults aged 50-69 years. Although overall case numbers were low compared with metropolitan centres, this pattern suggested potential gaps in vaccine access and funding. To determine the significance of this emerging trend, an epidemiological analysis of PHU notifications from 2010 to 2024 was conducted.
Methods and Analysis
A descriptive analysis was undertaken of cases for the reporting period, examining age, gender, serotype, vaccination status, outcomes (hospitalisation and mortality) and local government area (LGA), to characterise the regional disease profile. Incidence rate ratios (IRRs) were estimated using Poisson regression, comparing 2024 with the 2010-2023 reference period to determine whether the observed increase in 2024 was statistically significant. Age-specific trends were further contextualised against national patterns.
Outcomes
In 2024, IPD incidence was 1.81 times that of the 2010–2023 reference period (IRR 1.81, 95% CI 1.23-2.75), largely due to a rise in cases aged 50–69 years. For 2010-2024, the highest case proportions occurred in adults aged 50–69 years (34%) and ≥70 years (27%), with elevated rates in rural-remote LGAs. Overall, 94% of cases were hospitalised, 13% died, and 30% had documented prior vaccination. Vaccination coverage was highest among children <10 years and adults ≥70 years. Among vaccinated cases, serotypes 3, 8, 19A and 22F predominated.
Conclusion and Future Actions
The disproportionate burden of IPD among adults aged 50-69 years and rural-remote residents highlights important prevention gaps. Targeted public health strategies are needed to improve adult vaccine access and uptake. These findings have informed a PHU-led Priority Populations Immunisation Program focussed on addressing access barriers and strengthening equitable adult vaccination.

Background and Aim:
Japanese encephalitis serocomplex flaviviruses are emerging public health threats in Australia. Clinical cases are rare and geographically dispersed, limiting inference about areas of increased risk. We aimed to identify spatial clustering of human flavivirus exposure and assess concordance with environmental flavivirus activity using mosquito surveillance.

Methods and Analysis:
We pooled two cross sectional seroprevalence surveys from northern Victoria (n=1,247; 83 seropositive, 1,164 seronegative) using defined epitope blocking ELISA for total antibodies to Japanese encephalitis virus, Murray Valley encephalitis virus, and Kunjin virus. Mosquito surveillance comprised routine flavivirus testing performed during seasonal surveillance from 2019 to 2024.

We applied two complementary scan statistic approaches; Kulldorff spatial scan statistics were performed on point locations for serology (participant residence) and mosquito detections (trap location) using the Bernoulli model. Flexible scan statistics were performed on aggregated data within H3 hexagons, a standardised hierarchical geospatial grid system, to define contiguity and allow detection of irregular cluster shapes. For reporting and visualisation, serology and mosquito indicators were displayed in aggregated H3 hexagons as proportions to remove location identifiability. Serology results from enhanced surveillance will be incorporated when available using the same analytical and reporting framework.

Outcomes:
The spatial scan statistic outputs highlighted candidate areas of increased seropositivity and mosquito flavivirus positivity. Geographic overlap was observed, although cluster boundaries varied across methods and were sensitive to low counts and parameter choices.

Conclusion:
Integrating pooled human seroprevalence with mosquito surveillance, and comparing patterns across scan statistic methods, can help delineate areas of increased flavivirus activity that are not readily identifiable when clinical cases are sparse. This approach supports targeted surveillance and geographically focused public health decision making. Future studies may benefit from sampling designs that improve the geographic distribution of sampling effort to reduce spatial gaps and strengthen inference on cluster location and extent.

Background and aim:
State funded Japanese encephalitis (JE) vaccines are available from general practitioners or pharmacies for New South Wales (NSW) residents who live or work in Local Government Areas (LGAs) at high risk of JE.

Methods and analysis:
We conducted a survey of community pharmacies within LGAs at high risk of JE within Murrumbidgee, Southern NSW, and Western NSW Local Health Districts. The aim was to identify barriers and opportunities for pharmacy administration of JE vaccines to inform communication strategies for the community. Eligible pharmacies were selected from those registered with the NSW Vaccine Centre with a Vaccine Account Number in the selected LGAs. At least one pharmacy per LGA was contacted, and all pharmacies operating as the sole pharmacy eligible to administer vaccines in their LGA were included. Phone interviews were conducted from 2 October to 6 November 2025.

Outcomes:
Of 116 pharmacies in the LGAs of interest, 66 were called for interview, and 53 pharmacists (80%) completed surveys. The survey found 34 (64%) of respondent pharmacies administered the JE vaccine. The most frequently reported barrier to JE vaccine uptake reported by pharmacies administering the vaccine was a lack of customer interest and community awareness of JE and the vaccine (24 of 34 pharmacies, 71%). Of the 19 pharmacies not administering the vaccine, 10 (53%) were unsure of training requirements required to administer JE vaccines, and 8 (42%) were unaware of JE vaccine eligibility in their LGA.

Conclusion and future actions:
The survey findings highlighted several opportunities to strengthen local engagement with pharmacies. In response, the public health unit provided targeted resources for in-store awareness, and information for pharmacists about community JE vaccine eligibility, and pharmacist immuniser training.