Background and Aim: Hepatitis A, an acute enteric illness of faecal-oral transmission, is not endemic to Australia and immunity levels to the virus are low in the general population. The Victorian protocol advises post-exposure prophylaxis (PEP) be administered to contacts within 14 days of last exposure to an infectious case. On 7 June 2025 Western Public Health Unit (WPHU) was notified of a case of hepatitis A in a 20-year-old male who had just arrived from overseas and was staying in a city hostel. WPHU led an incident response to manage the risk of spread.

Methods and Analysis: Case interview determined the case had been staying in the hostel for 23 days while infectious, including use of 23 shared unisex bathrooms and 1 kitchen. Of 652 residents or staff at the hostel during the infectious period, WPHU assessed 323 as household-like contacts with exposure within 14 days.


Outcomes: WPHU contacted all staff and residents of the hostel present during the infectious period to advise them of the exposure and provide information about Hepatitis A. Local Council supervised cleaning at the hostel, established a pop-up immunization clinic, providing free PEP at short notice to enable vaccination within 14 days of exposure. Twenty-one people received PEP at the council-led immunization pop-up clinic. A further three contacts are known to have received PEP organized by other public health units or general practice.

No additional cases were identified because of this exposure.

Conclusions and Future actions:  The response to this exposure highlighted the importance of rapid communications with stakeholders to facilitate an environmental assessment, provide appropriate advice and organize PEP in a timely manner. Established inter-agency relationships and preparedness were critical in enabling a coordinated and timely public health response.

Background and Aim
People experiencing homelessness experience a disproportionate burden of communicable diseases and face significant barriers to accessing primary care. Aboriginal and Torres Strait Islander peoples are disproportionately represented among people experiencing homelessness, compounding inequities in access to preventive healthcare. Within homelessness services, vaccination delivery is often opportunistic and clinician-dependent, resulting in missed opportunities for preventive immunisation. This abstract describes a quality-improvement initiative within a nurse-led primary care clinic embedded in a homelessness crisis accommodation setting in metropolitan Melbourne. The aim is to implement a structured vaccination assessment and catch-up process at intake, informed by baseline audit findings.

Methods and Analysis
The initiative is situated within an onsite, nurse-led primary care clinic operating a flexible appointment and walk-in model. A six-month baseline audit reviewed routine clinical documentation to assess vaccination status assessment practices, Australian Immunisation Register (AIR) verification, and identification of risk-based vaccine eligibility. The audit identified inconsistent assessment, infrequent AIR cross-checking, and variable identification of clients eligible for funded vaccinations. In response, a structured vaccination assessment and catch-up process was implemented from January 2026, incorporating AIR review, clinical history, risk-based eligibility, and individualised catch-up planning aligned with guidelines.

Outcomes
Baseline service activity data demonstrate substantial engagement with nurse-led primary care. Over the past seven months, the clinic delivered more than 1,500 client-facing interactions and conducted over 100 BBV and STI screens, identifying previously undiagnosed infections, including eight cases of hepatitis C. These outcomes demonstrate the reach of nurse-led models within highly marginalised populations, while reinforcing the need for systematic immunisation approaches beyond opportunistic delivery.

Conclusion and Future Actions
Audit-informed implementation of systematic vaccination assessment within the services represents a practical strategy to strengthen communicable disease prevention and immunisation equity. Post-implementation evaluation of vaccination uptake is planned to inform refinement and broader application of the model.

Background and Aim
Homelessness crisis accommodation services are at increased risk of communicable disease transmission due to shared living environments, high resident turnover, and a high prevalence of chronic illness and complex health needs among residents. Commonly encountered conditions include respiratory infections (such as influenza and COVID-19), gastroenteritis, and skin and soft tissue infections including staphylococcal and methicillin-resistant Staphylococcus aureus (MRSA), alongside blood-borne viruses (BBVs) and sexually transmissible infections requiring early identification, screening, and linkage to care. Embedded nurse-led primary care offers a practical approach to early identification and management of these risks. This abstract describes the role of an onsite, nurse-led primary care clinic in outbreak prevention and response within a metropolitan Melbourne homelessness crisis accommodation service.
Methods and Analysis
The initiative operates within an onsite, nurse-led primary care clinic using a flexible appointment and walk-in model. Nurses provide routine clinical surveillance, rapid symptom assessment, and risk stratification through screening and targeted health education, delivered in collaboration with case management and operations staff. Key activities include early identification of symptomatic residents, facilitation of testing and referral pathways, implementation of isolation strategies where indicated, liaison with public health units, and infection prevention and control measures tailored to the facility setting.
Outcomes
Over the past seven months, the nurse-led clinic delivered more than 1,500 client-facing interactions, supporting timely identification and management of communicable disease risks within a high-turnover accommodation environment. Nurse-led intervention facilitated appropriate testing and treatment, supported management of suspected outbreaks, reduced escalation to emergency and tertiary services. The model enabled context-specific responses not achievable through external, appointment-based services alone.
Conclusion and Future Actions
Embedded nurse-led primary care offers a practical approach to supporting early identification and management of communicable disease risks in this setting. This abstract describes the role of an onsite, nurse-led primary care clinic in outbreak prevention and response within a metropolitan Melbourne homelessness crisis accommodation service, with potential for further evaluation and implementation of targeted strategies in collaboration with the client group.

Background and Aim: Rotavirus remains a major cause of morbidity and mortality among children in low-income countries. Although vaccination is effective, dropout between the first and second dose persists in Ethiopia. Evidence combining geospatial analysis with multilevel modeling is limited. This study assessed rotavirus dose-2 dropout and its spatial and contextual determinants in Ethiopia.
Methods and Analysis: We conducted a secondary analysis of the 2019 Mini-Ethiopia Demographic and Health Survey including 1,376 weighted children aged 12–23 months. Spatial autocorrelation was assessed using Moran’s I, and hotspot areas were identified using Getis-Ord Gi*. A multilevel logistic regression model was fitted to identify individual- and community-level predictors of dropout. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported, and model fit was evaluated using log-likelihood and AIC.
Outcomes: The national prevalence of rotavirus dose-2 dropout was 8.8% (95% CI: 6.7–11.4) and showed significant spatial clustering (Moran’s I = 0.108, p = 0.01). Hotspot clusters were identified in Afar, Somali, and Harari regions. Higher odds of dropout were observed among children delivered at home (AOR = 1.85, 95% CI: 1.30–2.72), female children (AOR = 1.60, 95% CI: 1.16–2.16), children of mothers aged 20–34 years (AOR = 3.01, 95% CI: 1.31–7.01), those living in peripheral regions (AOR = 2.18, 95% CI: 1.01–3.19), and children without a health card (AOR = 2.66, 95% CI: 1.55–4.55).
Conclusion and Future actions: Rotavirus dose-2 dropout in Ethiopia remains substantial and geographically concentrated in pastoral and peripheral regions. Strengthening community-based health programs, promoting institutional delivery, and improving documentation through consistent health-card use may reduce dropout. Tailored interventions in identified hotspot regions are essential.
Keywords: rotavirus vaccine, immunization, dropout, spatial analysis, Ethiopia.

Background and Aim
Respiratory syncytial virus (RSV) is a highly infectious respiratory virus which causes significant morbidity and mortality. While RSV burden in infants is well documented, data describing adult RSV infection—particularly among Aboriginal and Torres Strait Islander people are limited. The Northern Territory (NT) of Australia has the highest proportion of Aboriginal people in Australia (31%), who generally have higher rates of comorbidities and poorer health outcomes than non-Aboriginal Australians.

Methods and Analysis
We conducted retrospective cohort study on all adult notifications of RSV in the NT from 1 July 2021 (when it became notifiable)to 30 June 2025. We defined severe infection as infection resulting in hospitalisation and/or death. We performed multivariate logistic regression analysis to identify risk factors for severe RSV infection.

Outcomes
Of 4,738 RSV notifications across all ages, 2,021 (43%) occurred in adults; 31% of were severe infection. Aboriginal adults were more likely to experience severe RSV infection compared with non-Aboriginal adults (adjusted OR 3.9, 95% CI 2.8–5.4, p value?). Older age (aor, 95% CI, p value) and remote residence (aOR, 95% ci, p value) were also independently associated with severe disease. RSV notifications occurred year-round with no consistent seasonal pattern.

Conclusion and Future actions
RSV causes substantial morbidity and mortality among adults in the NT, with disproportionate impact on Aboriginal people. We recommend adult RSV vaccination to reduce incidence and severe infection in the NT, particularly for Aboriginal people, older adults, and those living in remote areas.

Background and Aim: A national dengue outbreak was declared in Samoa in April 2025, triggering a major public health emergency. In response, four Australian Medical Assistance Team (AUSMAT) doctors were invited to embed in a New Zealand Medical Assistance Team (NZMAT) on deployment in August 2025. In preparation, the Public Health Directorate collaborated with the Disaster Preparedness and Response Directorate at the National Critical Care and Trauma Response Centre to rapidly develop evidence-informed recommendations to minimise dengue risk among AUSMAT members. Dengue virus is transmitted by the bite of an infected Aedes aegypti mosquito; therefore, prevention strategies focussed on reducing mosquito bites.

Methods and Analysis: A rapid review of national and international guidance on mosquito bite prevention was undertaken. Recommendations included: wearing full length clothing, which is tucked in and treated with insecticide, head nets, bug lights, insect screens, treated mosquito nets, electronic insecticide diffusers and using insect repellent containing 20-30% DEET, or Picaridin (10-20% strength) and Oil of Eucalyptus for anyone with allergies to DEET. Guidelines were developed and disseminated by Public Health on mosquito bite protection prior to deployment.

Outcomes: Pharmaceutical procurement enabled provision of three repellent options: DEET based, oil of eucalyptus and picaridin. Due to aviation restrictions, non- aerosol spray repellents were supplied. Interventions were well tolerated; one member reported contact dermatitis of the hands associated with DEET based use. Operational feedback identified the need for longer socks and alternative clothes to wear after work. Electronic insect repellent devices were also not utilised due to heat generation. No AUSMAT members contracted dengue during the deployment.

Conclusion and Future actions: A rapid inter-disciplinary approach to mosquito bite prevention was successful in mitigating dengue risk to deployed AUSMAT members. The public health advice created, and lessons learned will be applied to future deployments and internal guideline development at NCCTRC.

Introduction
Human Papillomavirus (HPV) is a risk factor for oropharyngeal cancers (OPC). The PROGRESS study evaluated oral HPV (oHPV) prevalence in adults in France, Germany, and Spain, while the PROGRESS-Plus study did the same in China. The BROADEN study assessed the HPV attributable fraction (AF) in OPC patients across all mentioned countries. Across these studies, we assessed the burden of HPV in the upper airway and explored a potential association between oHPV prevalence and HPV-AF in OPC.
Methods
Gargle samples and OPC paraffin samples were centrally tested by HPV-DNA PCR (SPF10/DEIA/LiPA25 assay). OPC samples were also tested by p16 INK4a immunohistochemistry and HPV E6*I mRNA, requiring at least 2 positive tests for HPV-attributability. oHPV prevalence (all, high-risk [HR] and HPV16 genotypes) and HPV-AF were described at country level to assess a descriptive association in overall population and stratified by males.
Results
In all countries, oHPV prevalence for all HPV genotypes was higher in males and HPV-AF on OPC patients increased between study periods, being HR and HPV16 the most frequent genotypes identified. Overall, in countries with lower prevalence of HR oHPV infection (Spain=1.2% and China=1.4%), the HPV-AF in OPC was lower (Spain=24.4% and China=21.9%); compared to countries with higher oHPV (France=2.8% and Germany=1.6%), which exhibited a higher HPV-AF (France=43.0% and Germany=48.1%). This association tended to be higher in males.
Conclusions
Results highlight the increasing burden of HPV in OPC. Countries with higher oHPV prevalence show a higher portion of HPV-driven OPCs more evident in males.


Funding: Funding for this study was provided by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.

Background and Aim

Childhood vaccination coverage has declined since the onset of the COVID‑19 pandemic. The rise of vaccine misinformation and disinformation, including in mainstream channels, poses a substantial threat to vaccine acceptance. This project aimed to address vaccine mis- and disinformation on social media, and counterbalance the spread of myths with reliable, clear information.

Recent changes to national vaccination recommendations in the United States prompted the Melbourne Vaccine Education Centre (MVEC) to develop information campaigns promoting accurate, evidence‑based vaccine information for Australian audiences.

Methods and Analysis

In 2025, MVEC used different science communication to share information on 2 topical vaccine subjects: 1) the safety of paracetamol to reduce the rate and intensity of post‑vaccination fever, and 2) hepatitis B vaccination.

6 Instagram posts addressed these subjects (2 on paracetamol, 4 on hepatitis B) using a variety of visual formats and employing different science communication models. There were 5 posts employing a contextual communication model (2 text‑only and 3 infographics) and one post using a lay‑expertise model (photograph with quote).

We descriptively analysed the efficacy of these methods by exploring average shares, average comment numbers and average views.

Outcomes

Text‑only posts had the highest average shares (text‑only = 12, infographic = 5.33, photograph = 1). Text‑only posts also had the highest average of total comments and shares (text‑only = 13.5, infographic = 7.67, photograph = 1). The infographic format had the highest average views (text‑only = 2017, infographic = 3461, photograph = 1975).

Conclusions and Future actions

Text‑only resources had more engagement but fewer views than infographics. Knowing MVEC’s audience is comprised of more healthcare professionals suggests that clear, evidence‑based information is popular among this cohort. Future social media messages can be tailored in a format to match their aim – more exposure with infographics or more engagement with text‑only.

Background and Aim
Engagement in hepatitis B care is below the national average in Barwon South West (BSW), Victoria. Recent local qualitative work identified enablers to providing hepatitis B care in general practice (GP) including a community of practice (CoP) for hepatitis B s100 prescribers and GP software audits to identify priority populations for hepatitis B testing and linkage to care. This study describes implementation of a hepatitis B CoP and GP software audits in BSW.

Methods and Analysis
To establish the CoP, a working party was convened with clinicians, Cultura (multicultural support agency) and Western Victoria Primary Health Network (WVPHN). The integrated hepatitis nurse recruited hepatitis B s100 prescribers to the CoP and created a WhatsApp group with local specialists. CoP participants were offered funded secondments to specialist viral hepatitis clinics and BSW Public Health Unit to fulfil s100 professional development requirements.

With the support of WVPHN and ASHM, GP practice audits are in progress. Researchers are identifying how available audit tools can be utilised according to GP practice software and resources.

Outcomes
Four of eight identified hepatitis B s100 prescribers have been recruited to the CoP and two have attended/are planned to attend funded secondments.

As a result of this pilot, a viral hepatitis auditing tool is now available to GP practices across the region through WVPHN’s practice intelligence tool POLAR and has been used by one participating practice. As a data extraction tool, its optimal use is limited by incomplete patient records, particularly where country of birth is not routinely recorded, but rather ethnicity, in keeping with Royal Australian College of General Practitioner standards.

Conclusion and Future actions
Early signs are promising for the role of a CoP in informing initiatives to improve hepatitis B care. Engagement with local organisations that have a broad mandate to deliver healthcare and other essential services and key elements of the CoP.

Background and Aim

Human resources for health are the main cost driver in primary health care programs. A well-trained workforce is critical to the delivery of immunisation services. In Fiji current capacity building does not reach all those in need. A training needs assessment was conducted in 2025 to assess immunisation provider competencies, enablers and barriers to learning and preferred learning formats to guide the development of country-owned and sustainable learning options.

Methods and Analysis
A mixed-methods approach was used with an online quantitative survey via REDCap completed by managers and frontline health workers (n=30). Qualitative data were collected through 12 focus group discussions and 20 semi-structured interviews with nursing and midwifery policy makers, managers and educators. Qualitative thematic analyses were conducted using an inductive approach. Quantitative analyses were conducted in STATA/MP 18.0. Means and standard deviations were reported for Likert scale items, and proportions for categorical variables. Training needs were calculated as the importance-performance gap.

Top training needs of frontline health workers were disease surveillance, computer literacy, vaccine immunology and strategic planning. Reported enablers to learning included access to learning materials, opportunities for mentoring and assistance in online learning. Preferred modalities included printed materials, YouTube videos and on-the-job quick reference aids.

Outcomes

An expanded national training package was developed building on immunisation essentials to include equity-focused microplanning, disease surveillance and life course immunisation. Case studies, videos and quizzes increase learner engagement. Delivery of the modular format will be through on-site training with hands-on practice. An e-learning is being developed to meet the need for self-paced digital resources.

Conclusion and Future actions

Immunisation providers in Fiji require a diverse range of learning options with expanded technical content and skills-building in computer literacy to avail digital content. Mentoring, coaching and use of peer learning will further reinforce knowledge, skills and confidence.

Background and Aim: Vietnam's immunisation program faces significant challenges, with a sharp decline in full immunisation coverage from 85.7% of districts (2020) to 24.2% (2023). While primary healthcare (PHC) providers are pivotal, there was insufficient understanding of their capacity strengthening needs. This study aimed to identify critical competency gaps and explore enablers and preferred modalities for developing effective educational solutions.

Methods and analysis: A mixed-methods study was conducted from April to July 2025. A national cross-sectional survey, adapted from the Hennessy-Hicks Training Needs Analysis tool, was completed by 447 PHC providers. To contextualize quantitative findings, 19 in-depth interviews with policymakers and 7 focus group discussions with diverse stakeholders were held. Quantitative data were analysed to determine competency gaps (importance vs. performance), while qualitative data underwent thematic analysis.
The most critical training gap was the management of anaphylaxis, with large effect sizes at both commune (Cohen’s d=1.19, 95% CI: 0.96–1.41) and district levels (Cohen’s d=1.48, 95% CI: 1.24–1.73). Commune-level providers prioritized equity-focused planning and communication to reach underserved populations, while district-level providers emphasized training organization and outbreak control. This reflects a significant "theory-practice gap" in pre-service training and a lack of standardized continuous medical education. Key learning enablers were professional certification and on-site support. Hybrid models combining in-person training with remote support via platforms like Zalo were preferred.

Outcomes: A hybrid training model was developed and piloted in two workshops. A calibrated, practice-oriented national immunisation handbook has been created for primary care and is being adapted into an interactive user-focused website.

Conclusion and future actions: Immunisation training needs in Vietnam require a shift from a one-size-fits-all approach to tailored, continuous strategies. Future actions will scale up the updated training models, integrating hands-on practical support with accessible online guidance and peer networks to improve both effectiveness and sustainability nationwide.

Background and Aim
Invasive bacterial diseases such invasive pneumococcal disease (IPD) and invasive group A streptococcal disease (iGAS) remain important causes of morbidity. Respiratory viruses, particularly influenza, may increase susceptibility to invasive bacterial infections, but detecting population-level temporal associations is challenging in small jurisdictions with pronounced seasonality. Recent iGAS increases have refocused attention on viral–bacterial interactions. Approaches leveraging surveillance data may provide situational awareness and early warning of increased invasive bacterial disease risk

Methods and Analysis
Confirmed case notifications of influenza, respiratory syncytial virus (RSV), iGAS, and IPD were extracted from the Tasmanian Notifiable Diseases Surveillance System, 1 January 2017–31 December 2025 (RSV and iGAS from 2022). Monthly notifications were converted to relative anomalies representing deviations from seasonal expectations. Temporal associations between influenza and RSV activity and IPD and iGAS were assessed using lagged correlation analyses and distributed lag regression models across a 0–3-month lag window. Cumulative relative risks (CRRs) were translated into absolute excess cases.

Outcomes
Influenza activity demonstrated a modest delayed association with IPD, peaking at 2–3 months. A 10% increase above expected monthly influenza activity was associated with a CRR of 1.04 over 3 months, rising to 1.07–1.10 at higher anomaly levels. A50% increase in influenza activity corresponded to ~2 excess IPD cases over the following 3 months, increasing to 4-5 cases at a 100% anomaly. RSV showed minimal associations with IPD. Influenza demonstrated a smaller short-delay association with iGAS (1-2 months), but cumulative effects did not translate into a meaningful excess burden. RSV showed no association with iGAS.

Conclusion and future actions
Anomaly-based influenza surveillance may complement routine respiratory disease monitoring in Tasmania, with sustained deviations above the expected seasonal levels serving as a signal for short-term increases in IPD risk over the subsequent 2-3 months. RSV provided limited predictive value for IPD or iGAS trends

Background and Aim
Understanding the real-world safety of COVID-19 vaccines booster doses across Asian populations is needed to inform national immunisation programs, but data are limited. This review evaluated the safety profile of mRNA-1273 (Moderna COVID-19 vaccine) using post-marketing observational data.

Methods and Analysis
A literature search was conducted in PubMed and EMBASE (search date: 10Dec2024). Studies were screened using predefined inclusion criteria: observational design, adverse event (AEs) reporting, mRNA-1273 boosters (third or subsequent dose), population data from sovereign states and territories within the WHO South-East Asia and Western Pacific Regions. Data were extracted on study characteristics, AE incidence, and severity. Council for International Organizations of Medical Sciences (CIOMS) terminology was used to describe frequency categories.

Outcomes
Of 822 records screened, 25 studies from Japan, South Korea, Singapore, Taiwan, Thailand, and Australia met inclusion criteria. Across studies, findings consistently demonstrated that mRNA-1273 boosters were well tolerated, with severe AEs occurring at a low frequency. In Japan, a mass vaccination site administering 221,716 third doses and 32,934 fourth doses showed acute AEs in 0.18% and 0.07% of recipients, respectively, with serious AEs (e.g., anaphylaxis) reported rarely. Korea’s national AE reporting system documented 156.4 non-serious AEs and 6.8 serious AEs per 100,000 third doses administered. Similarly, an analysis of 861,743 XBB.1.5-targeting boosters in Taiwan identified 24 serious AEs (1.5 cases per 100,000 doses). In Singapore, surveillance following 648,214 booster doses administered during the Omicron wave found no increase in all-cause mortality or cardiovascular events. Myocarditis incidence after booster doses remains very rare, declining over time.

Conclusion and Future actions
These real-world data support the favorable safety profile of mRNA-1273 boosters across diverse Asian populations. Continued monitoring of long-term safety will guide adaptive, evidence-based public health responses to evolving COVID-19 variants.

Background:
Vaccination is a highly effective tool in preventing infection and transmission of vaccine-preventable diseases (VPD) in vulnerable cohorts. In high-risk populations, such as immunocompromised patients, VPDs are associated with higher rates of adverse outcomes and substantial healthcare costs. This study aimed to assess vaccination coverage amongst high-risk patients.
Method:
This retrospective study assessed the immunisation status of high-risk patients at Northern Health (NH) in March 2025 (1st to 31st). High-risk groups included patients with malignancies, chronic respiratory conditions, HIV, those on haemodialysis, and geriatric inpatients. The study reviewed 100 oncology, haematology, and respiratory outpatients, 100 dialysis patients, all HIV patients under care at NH, and all geriatric inpatients admitted to a Geriatric Evaluation and Management unit in March. Vaccination records were obtained from electronic medical records and the Australian Immunisation Register. The primary outcome was up-to-date vaccination status based on Australian Technical Advisory Group on Immunisation (ATAGI) guidelines.
Results:
15.7% (n=94) of 599 patients across 7 high-risk patient groups were fully vaccinated per national guidelines. Completion of Covid-19 vaccination primary course was high (92%), however subsequent booster coverage was substantially lower (12.8%). Only 1 inpatient aged over 65 (n=50) was fully vaccinated in March, while admitted to geriatric inpatient ward at high-risk for nosocomial outbreaks. Amongst outpatients, the rates of complete vaccination coverage were lowest amongst the HIV (2%) cohort. Coverage was 8% amongst Oncology patients and 9% amongst those on dialysis, while higher amongst Haematology (17%), Respiratory (21%) and Antenatal patients (36%). Vaccination gaps were highest for Meningococcal B and ACWY (93.9%) and pneumococcal (83.6%) vaccines with the smallest being DTP (33%).
Conclusion:
The results reveal alarmingly low immunisation rates amongst vulnerable patients, highlighting the need for proactive and integrated vaccine delivery strategies. Addressing these gaps could reduce VPD-related morbidity and mortality, avoidable hospitalisations and hospital-associated outbreaks.

Background and Aim:
Streptococcus pneumoniae (Spn) continues to impose a substantial disease burden on older adults. Antibody-mediated protection targeting capsular polysaccharide underpins pneumococcal vaccine efficacy. Although polysaccharide (PPSV23) and conjugate vaccines (PCV7, PCV13) have reduced invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP), immunity wanes over time as antibody-producing plasma cells decline. Long-term immunogenicity data in older adults are limited, and serotype- or vaccine-specific differences complicate revaccination strategies. This study evaluated antibody waning after PPSV23 and PCV7/PCV13 in adults ≥65 years.
Methods and Analysis:
A Bayesian hierarchical piecewise multimodel framework was used to model antibody kinetics, incorporating an Exponential increase model for early rise and multiple decay models—including Exponential, Power-Law, Bi-phase Exponential, Linear and All-at-once phases—to capture waning patterns. This probabilistic approach incorporated prior knowledge and accounted for variability across studies. Posterior distributions estimated credible intervals for serotype-specific antibody persistence, enabling comparisons between PPSV23 and PCV7/PCV13.
Outcomes:
Preliminary analyses using exponential rise-and-decay model showed heterogeneous rise and waning across serotypes, with faster decline observed for serotype 3 and 8. PCV7/PCV13 induced faster and higher initial responses but also waned more rapidly, whereas PPV23 generated a slower rise with more gradual decay.
Conclusion and Future actions:
This study provides a comprehensive quantitative understanding of pneumococcal antibody waning in older adults to support evidence-based revaccination strategies and ensure sustained protection against Spn in aging populations.

Background and Aim:
Pertussis vaccination is recommended to be given in each pregnancy, with Adacel® and Boostrix® both considered safe and effective. However, composition differences may influence immunogenicity. This study compared pertussis antibody concentrations at 6 weeks of age in infants born to mothers who received either Boostrix® or Adacel® vaccine during pregnancy.

Methods and Analysis:
Infants were recruited at the Women’s and Children’s Hospital (South Australia) between April 2017 and March 2021 through the Antibiotics and Immune Responses study (ACTRN12617000856314). Infant blood samples were collected at 6 weeks of age. Pertussis antibody concentrations (IgG) were measured by multiplex immunoassay. Geometric mean concentrations (GMCs) and 95% confidence intervals (CIs) were calculated and compared using linear regression on log transformed IgG concentrations.

Outcomes:
Among 160 infants with pertussis serology and documented maternal vaccine history, 120 (75%) were born to Adacel® recipients and 40 (25%) to Boostrix® recipients. The median interval from vaccination to delivery was similar between groups (Adacel®: 69 days [IQR 53-80], Boostrix®: 70 days [IQR 59-81]). Pertussis toxin (PT) IgG GMCs at 6 weeks of age were higher for infants of Boostrix® recipients (25.6 IU/ml; 95% CI 17.9-36.6) compared with Adacel® recipients (10.2 IU/ml; 95% CI 8.3-12.5) (p<0.001). A higher percentage of infants born to recipients of Boostrix® had PT IgG concentrations >5 IU/ml compared with infants of Adacel recipients (39/40, 97.5% vs 89/120, 74.2%, p<0.001). As expected, given antigen composition, fimbrial (FIM) IgG GMC was substantially higher for infants at 6 weeks of age for Adacel® recipients (306 IU/ml; 95% CI 225-415) compared with Boostrix® recipients (22 IU/ml; 95% CI 7-71) (p<0.001).

Conclusion and Future actions:
Maternal pertussis vaccine brand was associated with antigen specific differences in infant antibody concentrations at 6 weeks of age. The clinical implications of these differences require further evaluation to inform vaccine policy.

Background
Australia experienced its first large outbreak of Japanese encephalitis virus (JEV) infection in 2021–22 leading to a national coordinated emergency response by animal and human health sectors. Now endemic to the mainland, JEV re-emerged across south-eastern Australia during 2024–25. Timely sharing of JEV surveillance data between sectors was identified as essential to understanding geographical and temporal distribution.

Context and Aim
JEV surveillance for human health and animal health historically has been conducted independently. Alone, each is insufficient to understand JEV circulation, risk and inform response measures. We aim to bring this surveillance together.

Methods
The JEV data sharing memorandum of understanding (MoU) formalises sharing of JEV surveillance data between health authorities, including standardised data requirements, timely reporting and outputs.

Outcomes
Outputs under development include collaborative surveillance reports and dashboards between animal and human health experts.

Conclusions and Future Actions
Uncertainty remains surrounding the ecology of JEV in Australia and potential future impact. Integrated animal and human surveillance data under a One Health approach strengthens monitoring and understanding of JEV transmission and may inform future human health control measures. The MoU represents a commitment for information sharing between sectors to respond to JEV and other zoonotic diseases in the future.  

Background and aim:
Most vaccines in Australia are funded by the National Immunisation Program (NIP), however there are several which are recommended by the Australian Immunisation Handbook (AIH) but not NIP-funded. With increasing demands for health funding, private vaccines represent a growing area of potential inequity, and there is limited literature describing their use in general practice. This study aimed to understand General Practitioners’ (GPs) attitudes to private vaccines, excluding travel vaccines.

Methods and analysis:
We conducted a two-part mixed methods study. Semi-structured interviews were conducted to explore GPs’ use of private vaccines. Transcripts were thematically analysed; themes informed the survey items. The survey was conducted during a HealthEd webinar in November 2025. Survey data are undergoing statistical analysis.

Outcomes:
Thirteen GPs were interviewed, achieving thematic saturation. Three themes were (1) ‘Structural barriers and enablers’; (2) ‘Social determinants and patient factors influencing uptake’, including vaccine hesitancy/fatigue and socioeconomic status; (3) ‘GPs value private vaccines but report difficulties in practice’.

972 GPs from all states and territories, MMM regions and IRSAD quintiles completed the survey. Preliminary analysis found that affordability was the most frequently selected barrier to private vaccine uptake; however, GPs are selective about discussing private vaccines based on perceived patient socioeconomic circumstances. Nevertheless, the most commonly reported reasons that patients decline private vaccines when offered included affordability, believing they are unnecessary, and safety concerns. Clinical resource use was surveyed and the most commonly-used resource was the AIH.

Conclusion and future actions:
This study identified barriers that can be addressed to improve private vaccine uptake, as well as enablers to be utilised. Data show that GPs, while diverse in their practice, are largely supportive of private vaccine use but require further resources and support to ensure equitable outcomes.

Background and Aim: V116 is an adult-specific, 21-valent pneumococcal conjugate vaccine (PCV) for prevention of invasive pneumococcal disease (IPD) and pneumonia. It includes serotypes responsible for the majority of adult IPD in countries with established pediatric vaccination programs. Safety of V116 in the phase 3 program involving healthy adults and adults with medical conditions that increase risk of pneumococcal disease was evaluated in the phase 3 program

Methods and Analysis: We evaluated the proportions of participants with solicited injection-site and systemic adverse events (AEs) through day 5 post-vaccination, and vaccine-related serious AEs through month 6. Data for this secondary analysis included healthy adults (Group 1, n=3,220) and adults with one or more risk-conferring medical conditions (Group 2, n=2,080).

Outcomes: Overall, 2,044 (63.5%) participants in Group 1 and 1,182 (56.8%) in Group 2 reported at least one solicited AE. The proportions of participants with solicited AEs were comparable between groups, with the exception of injection-site pain, which was numerically higher in participants from Group 1 (1,812; 56.3%) than in Group 2 (978; 47.0%). Most solicited AEs were mild to moderate in intensity and resolved within three days. Grade 4 events were rare in both groups. One participant in each group experienced a serious vaccine-related AE (injection-site cellulitis in Group 1; bronchospasm in Group 2). There were 7 total deaths, and none were considered vaccine related.

Conclusion and Future Actions: Across a large phase 3 program, V116 was well tolerated in adults with and without conditions that increase pneumococcal disease risk. Results support the use of V116 in adults.

Background and Aim: Clesrovimab is a long-acting monoclonal antibody approved to prevent respiratory syncytial virus (RSV) lower respiratory tract infection (LRI) in neonates and infants born during or entering their first RSV season. The phase 3 SMART (NCT04938830) trial enrolled infants at increased risk of severe RSV disease due to prematurity, chronic lung disease of prematurity, or hemodynamically significant congenital heart disease. This analysis evaluated safety pharmacokinetics, and RSV-associated disease incidence post-clesrovimab administration across two seasons.

Methods and Analysis: Participants were randomized 1:1 to receive clesrovimab (105mg on day 1, placebo on day 28) or monthly palivizumab in season 1; eligible participants received open-label clesrovimab 210mg in season 2. The primary endpoint was safety and tolerability in season 1. Secondary endpoints included safety of clesrovimab 210mg in season 2, pharmacokinetics, and incidence of RSV-associated medically attended LRI (MALRI) and hospitalization through day 150.

Outcomes: In season 1, 997 participants received clesrovimab or palivizumab, of whom 276 received clesrovimab in season 2. Baseline characteristics were balanced. Adverse events were comparable between groups; clesrovimab 210mg in season 2 was well-tolerated. RSV-associated MALRI and RSV-associated hospitalization through day 150 (season 1) were similar between clesrovimab (3.2% and 1.0%) and palivizumab (3.4% and 1.7%). Season 2 RSV-associated MALRI and hospitalization through day 180 were 7.3% and 3.0% (no comparator). Geometric mean serum concentration of clesrovimab at day 150 were 11.8μg/mL (105mg dose) and 14.4μg/mL (210mg dose), similar to the phase 2b/3 CLEVER study (10.2μg/mL).

Conclusions and Future Actions: Clesrovimab was well-tolerated in infants at increased risk for severe RSV disease through two RSV seasons. Season 1 RSV-associated disease incidence was comparable between clesrovimab and palivizumab; season 2 rates were reflective of higher burden years. Exposures after 210mg in season 2 were comparable to 105mg. Season 1 efficacy was established through PK bridging from CLEVER.

Background and Aim:

Timely clinician notification of urgent and high-risk conditions is crucial for rapid public health response, enabling early case management, post-exposure prophylaxis, and contact tracing. In Victoria, regional-level evidence describing how and when clinicians escalate urgent conditions remains limited. Understanding this is increasingly important as Local Public Health Units (LPHUs) assume greater responsibility for frontline communicable disease control.

This study aims to evaluate clinician escalation patterns for urgent and select high-risk notifiable conditions within the Loddon Mallee region of Victoria between January 2023 and January 2025, and to use this information to prioritise clinician engagement and education.

Methods and Analysis:

A retrospective audit of the Victorian Public Health Event Surveillance System data was conducted for all urgent notifiable conditions and conditions with actionable clinical presentations. A descriptive analysis examined notification pathways and patterns of timeliness.

Outcomes:

Across urgent notifiable conditions, laboratories accounted for most initial notifications (~80%), with clinician-initiated notifications occurring less frequently. Earlier clinician notification was more common for conditions with distinctive clinical features or epidemiological risk factors, for example measles and IMD. Most clinician notifications occurred within five days of specimen collection. Longer delays (weeks) were observed when community-based clinician follow-up was required after specimens were collected in hospital.

Findings will guide targeted clinician engagement and education in the region, reinforcing timely notification on suspicion for conditions with actionable clinical presentations.

Conclusion and Future Actions:

This audit highlights opportunities to improve clinician awareness of urgent notification requirements and streamline escalation pathways. Closer engagement with regional clinicians strengthens suspicion-based notification, particularly when prompt public health action is required. This is especially important in regional settings where laboratory confirmation can be delayed by specimen transport and processing. Earlier escalation strengthens early-warning capacity and reinforces shared accountability across clinicians, laboratories, and LPHUs.

Background and Aim
Online discussion about vaccine policy actions can shift rapidly and may include misinformation, creating uncertainty for health organisations, health care workers, immunisation advocates, and media about whether narratives are escalating, stabilising or already fading. We aim to describe how online conversation volume and misinformation rate accompany recent actions by the US expert vaccine advisory panel, Advisory Committee on Immunization Practices (ACIP), and what routinely collected misinformation data can reveal about timing, magnitude and duration of misinformation signals.

Methods and Analysis
Through VaxPulse, a real-time multilingual misinformation early-warning platform that uses validated automated classification methods (HREC/85026/RCHM-2022), we extracted event-focused datasets around ACIP-linked events: (1) ACIP thimerosal announcement (26 June 2025), (2) ACIP vote favouring separate MMR plus varicella (18 September 2025), and (3) recommendation for HPV single dose revision (5 January 2026). Posts were labelled as misinformation (YES/NO). We overlaid volume and misinformation rate around each event date to assess peak timing and co-movement.

Outcomes
Across events, attention and misinformation clustered around event windows, often peaking before the event date rather than rising uniformly afterwards. Thimerosal peaked sharply in the lead-in period then declined, with a fluctuating misinformation rate. MMR volume rose ahead of the event and stayed elevated, while misinformation rate fell as volume increased. For HPV, volume showed a major pre-event surge with smaller post-event aftershocks, and misinformation rate varied without a sustained step-up after the event date.

Conclusion and Future actions
Our results describe how dynamic the online attention and misinformation rate was around three ACIP-linked events, showing that online attention and misinformation do not follow a consistent post-announcement trajectory. However, the scope is limited to short event windows and does not yet assess longer-term persistence or whether public and professional messaging modified trajectories. Future work will extend follow-up and standardise event windows for comparability.

Background and Aim
In Australia and globally, vaccine misinformation and disinformation increasingly undermine confidence and uptake. Recent actions by the US Advisory Committee on Immunization Practices (ACIP), following completely new members being appointed, have raised concern about renewed misinformation and spillover. Yet health organisations, health care workers and immunisation advocates lack guidance on when to correct misinformation versus when commentary may amplify it. We used VaxPulse to quantify misinformation dynamics around ACIP-linked events to inform timely responses.

Methods and Analysis
Using VaxPulse, an AI-powered multilingual early-warning misinformation platform (HREC/85026/RCHM-2022), we extracted event-focused datasets around three ACIP-linked events: (1) ACIP thimerosal announcement (26 June 2025), (2) ACIP vote favouring separate MMR plus varicella (18 September 2025), and (3) recommendation for HPV single dose revision (5 January 2026). We applied an interrupted time series design using negative binomial regression. We modelled the daily misinformation rate (YES with offset for YES+NO) and compared no-change, temporary, and phased models (2-month durations) using information criteria and counterfactual predictions.

Outcomes
For MMR and thimerosal, effect direction depended on the assumed impact shape: temporary-change model suggested a decrease or minimal change in misinformation (IRR = 0.49 and 0.95, respectively); the phase-change model suggested increases (IRR = 4.94 and 1.59, respectively). HPV showed an immediate decrease in misinformation under both models (IRR = 0.55). Inspection of the time-series plots suggested a modest later rebound for HPV and continued decline for thimerosal. Overall, peaks often occurred in the lead-in period, thus underscoring the value of monitoring upward trajectory, with impact-model estimates used as supportive evidence.

Conclusion and Future actions
Infodemic risk after high-profile events is not uniform. Early-warning surveillance with pre-specified impact models can support proportionate action, reducing unnecessary amplification. Future work will extend follow-up and translate outputs into practical response thresholds for health services and primary care.

Background and Aim: Adults with certain chronic medical conditions are at increased risk for pneumococcal disease (PD). Strategies to achieve broad pneumococcal disease coverage in this population is critical. V116 is an adult-specific 21-valent pneumococcal conjugate vaccine designed to broaden protection against invasive PD and pneumonia in adults. This secondary analysis evaluated the safety and immunogenicity of adult-specific pneumococcal conjugate vaccine V116 in pneumococcal vaccine-naïve adults aged 18-64 years by subgroup.

Methods and Analysis: Participants with diabetes mellitus and/or chronic kidney, heart, liver and lung disease were randomized in a 3:1 ratio to receive either a single dose of V116 followed by placebo or a single dose of PCV15 followed by PPSV23 8 weeks later. Immune response for this subgroup analysis was evaluated by serotype-specific opsonophagocytic assay (OPA) geometric mean titers (GMTs). Safety was evaluated by the proportions of participants with adverse events. Primary study data are published (PMID 41208546).

Outcomes: V116 elicited an immune response to all vaccine serotypes by OPA reverse cumulative distribution curves at 30 days following vaccination, which were comparable to PCV15+PPSV23 for the 13 serotypes in common between the groups, and higher for the 8 serotypes unique to V116. This was consistent when evaluating immunogenicity by age (18-49 and 50+), sex, and chronic medical condition subgroups. The overall safety profile was comparable between groups.

Conclusions and Future Actions: In pneumococcal vaccine-naïve adults with chronic medical conditions, V116 was well tolerated and immunogenic compared to PCV15+PPSV23, regardless of the subgroup evaluated. V116 has the potential to broaden disease coverage in this vulnerable population.

Background and Aim: Despite ~94% pneumococcal conjugate vaccine coverage, invasive pneumococcal disease (IPD) has increased in Australian children <5 years. We describe temporal IPD trends and a 2024 snapshot of burden and serotype distribution in children <5 years.

Methods and Analysis: We analysed IPD notifications from the National Notifiable Diseases Surveillance System, 2002–2024, stratified by age (<1, 1-2, 2-4 years) and Indigenous status.

Outcomes: IPD incidence has increased in Australian children since 2022, especially infants <1 year and children 1-2 years, with a smaller rise at 2-4 years. Incidence rate ratios were higher in Indigenous vs non-Indigenous children (~1.5–4.3-fold). In infants <1 year, bacteraemia is most common (40%), then bacteraemic pneumonia (21%). Among older children, bacteraemic pneumonia predominates: 47% at 1-2 years and 58% at 2-4 years, driven chiefly by serotype 3 (ST3). Serotypes varied by age and Indigenous status. In infants <1 year, ST33F and 22F predominated in non-Indigenous and Indigenous children, respectively (17.0%, n=9/53 typed cases; 28.6%, n=2/7 typed cases). At 1-2 years, ST3 and ST33F predominated in non-Indigenous (21.8% each, n=12/55), while 19F and ST3 led in Indigenous children (36.4%, n=4/11; 27.3%, n=3/11, respectively). At 2–4 years, ST3 was the primary driver in non-Indigenous (36.1%, n=35/97) and Indigenous children (71.8%, n=5/7).

Conclusion and Future Actions: IPD incidence has increased in Australian children <5 years since 2022. Different patterns of disease presentation were observed, and serotype prevalence varied; most common serotypes were ST3, ST33F, ST22F, ST19A, ST19F. The 2024 snapshot underscores the need for ongoing surveillance and vaccines addressing current IPD burden.

Background and Aim

COVID-19 surveillance is undertaken for multiple purposes, such as to monitor trends and to estimate morbidity and mortality. However, surveillance data are incomplete, and representativeness is poorly understood. We examined the characteristics of people aged ≥70 years in Victoria who received COVID-19 oral antivirals from July 2022 to April 2023 with and without a notification of COVID-19.

Methods and Analysis

We linked the following data on Victorian residents aged ≥70 years: COVID-19 notifications, antiviral dispensing from the Pharmaceutical Benefits Scheme, the Australian 2021 Census, Australian Immunisation Register, and Medicare Benefits Scheme. Temporal trends, socio-demographic and clinical characteristics of people who received antivirals were compared according to their COVID-19 notification status.

Outcomes

Among 112,145 people who received an antiviral, 50,004 (45%) had a COVID-19 notification. The proportion of antiviral recipients without a notification increased over the study period from 34% (5387/15643) in July 2022 to 75% (6267/8342) in April 2023. Compared to those with a notification, people without were more likely to have income <$1000 per week (65% without vs 58% with respectively), lower education (61% vs 55%), speak a language other than English at home (22% vs 18%). They were less likely to live in a major city (68% vs 73%) or to be up to date with COVID-19 vaccine booster recommendations (6% vs 71%).

Conclusion and Future actions

Most people received antivirals without a COVID-19 notification, reinforcing that case ascertainment is incomplete. People without a COVID-19 notification were more likely to have characteristics of socio-economic disadvantage and lower vaccine uptake, which may be due to healthcare access barriers, or the acceptability of public health measures. To conduct robust studies of antiviral and vaccine effectiveness, representative surveillance systems with high case ascertainment, such as in sentinel populations or sites, are required. Use of linked data provides additional insights to strengthen surveillance of acute respiratory infections.

Background and Aim:

The inaugural Australian Vaccinology Course (AVC) was conducted in 2025 as a three-day face-to-face course aiming to build capacity in emerging and future leaders in immunisation. The course was developed in response to a perceived lack of advanced vaccinology courses within the Western Pacific region and is a member of the International Collaboration on Advanced Vaccinology Training. Well-trained leaders with advanced skills in vaccinology and immunisation system management are vital to address the many challenges facing vaccination globally

Methods and Analysis: Out of 100 applications, 67 participants were selected to attend the 2025 inaugural AVC, including supported positions for 3 attendees from Aboriginal Community Controlled Organisations and 2 attendees from low-middle income countries (LMICs). Participants attended from a range of locations across Australia, and the Asia-Pacific region (13%). Participant roles also varied including immunisation providers (55%), local, state and national government (21%), epidemiologists / researchers (12%) and pharmaceutical industry (12%).

The AVC is led by NCIRS, in partnership with Sydney Infectious Diseases Institute. The teaching faculty is comprised of 15 leading immunisation policy and program experts from around Australia and New Zealand (4 NCIRS, 11 other organisations).

Evaluative feedback was collected from ~50% of participants twice daily and at completion of course using online surveys, and from the teaching faculty through a mix of online survey and focused discussion.

Outcomes: Qualitative feedback about the course was very positive, with participants highlighting the high calibre and approachability of the expert faculty, breadth and depth of content, and networking opportunities with diverse attendees as most valuable. 91% of survey respondents reported that they were very likely to recommend the AVC to colleagues.

Conclusion and Future actions: Advanced vaccinology courses are a key component in developing immunisation workforce leaders. The AVC will run yearly, aiming to increase capacity and relationships between immunisation leaders in Australia and the Asia-Pacific region including a focus on priority populations and LMICs.

BACKGROUND AND AIM:
Local-level surveillance is critical to identify outbreaks by providing epidemiological intelligence to inform public health action. In Townsville Public Health Unit (PHU), epidemiological support is provided to three Hospital and Health Services: Townsville, North West and Mackay—each with unique populations and underlying contexts. Established methods were creatively utilised to signal notified case counts exceeding pre-defined thresholds rapidly identifying potential outbreaks.

METHODS AND ANALYSIS:
Three proportionality approaches were trialled on cases recorded in Queensland Health’s Notifiable Conditions System since 2011 using condition-specific data:
• Comparison ratio of counts to-date/past four weeks and five-year mean,
• CDC aberration detection¹ (including counts to-date),
• In-house approach (≥2 cases in past week/four weeks above the rolling six-week/six-month median).
Detailed epidemiological investigations were undertaken for conditions exceeding thresholds in at least two approaches. Signals and findings were flagged with PHU communicable disease control teams weekly for contextualised interpretation and consideration for public health action.

OUTCOMES:
In 2025, 59% (43/73) of conditions had signals detected across the three PHUs. Active monitoring was recommended for all but one condition, based on similarity of temporal trends, demographic factors and risk/exposure factors (where available) to historic data. Public health action was recommended for an increase in rotavirus cases where weekly and yearly counts exceeded the five-year mean by a factor of six (three-week duration) and factor of two respectively. The three methods offered sensitivity, adaptability to any software package, and increased detection specificity. However, single-case conditions could still be detected with the comparison ratio a frequent method to trigger an epidemiological investigation.

CONCLUSION AND FUTURE ACTIONS:
Implementing this process identified conditions for active monitoring, and based on the intelligence, timely public health action in a resource-restricted setting. With epidemiological support demand increasing, streamlined methods need to be considered to prevent new/emerging conditions from flying under the radar.


1. Stroup DF, Wharton M, Kafadar K, and Dean AG. Evaluation of a method for detecting aberrations in public health surveillance data. American Journal of Epidemiology, Vol 137 (3), 373-380, 1993.

Title: Predictive value positive of mpox notifications in southeast Melbourne, Australia, April-December 2024

Background and Aim
Mpox is a contagious viral disease declared notifiable in Australia in 2022 following its emergence in non-endemic countries. During a locally acquired outbreak in 2024, a broad suspected case definition was introduced to enhance case detection based on clinical and epidemiological evidence. We analysed the predictive value positive (PVP) of mpox notifications between April and December 2024, identified factors associated with rejected cases, and estimated the public health resources used to investigate these cases.

Methods and Analysis
The PVP was calculated as the proportion of notifications meeting the confirmed case definition. Demographic and clinical characteristics were compared between confirmed and rejected cases. Univariable and multivariable log-binomial regression analyses identified factors associated with a rejected case classification. Time spent investigating rejected cases was estimated using a stratified sample by notifier type.

Outcomes
Between April and December 2024, 247 mpox cases were notified in southeast Melbourne. Of which, 162 (65.6%) were confirmed and 85 (34.4%) rejected. Cases were predominantly male, aged >26-≤50 years, and notified due to clinical presentation. Multivariable analysis showed that rash or lesion reduced the risk of rejection (RR=0.21, 95% CI 0.14–0.32), whereas notifications from low caseload clinics or hospitals increased it (RR=2.39, 95% CI 1.59–3.58). Median investigation time per rejected case was 39 minutes, representing 8.6% of a full-time public health officer’s (PHO) workload, equivalent to 55 hours or 7.24 PHO days when extrapolated across all rejected cases.

Conclusion and Future Actions
About one-third of mpox cases were rejected, representing a PVP of 68%. Findings highlight variation in the PVP across notifier types and the operational burden of investigating rejected mpox cases. A review of the suspected case definition requiring a response to laboratory-confirmed cases only, except where suspected cases occur outside the gay, bisexual, and other men-who-have-sex-with-men cohort, may improve resource and surveillance efficiency in future outbreaks.

Background and Aim

Monash Health is Victoria’s largest maternity service delivering over 10,000 babies annually across its sites. Maternal immunisation is a vital public health intervention, protecting both mother and baby from vaccine preventable diseases. Three vaccines have been funded on the National Immunisation Program over the past 15 years- influenza, pertussis and respiratory syncytial virus (RSV). Australia has made substantial progress in the uptake of maternal vaccines, however coverage has fallen since the COVID-19 pandemic.

Methods and Analysis

Decisions to vaccinate during pregnancy are shaped by several factors including perception of risk, and practical and behavioural factors. Evidence consistently shows that a key driver and strong predictor of vaccine uptake among pregnant women is a healthcare provider’s recommendation. Practical factors are important. Pregnant women are typically in frequent contact with providers of antenatal care. Vaccine uptake increases when vaccines are offered at point of care and publicly funded.

Outcomes

Monash Health sites are supported by different models of care for administering immunisations. Monash Immunisation at Clayton has provided antenatal immunisations since 2012. In the middle of 2025, a business case was approved for a nurse immuniser to work at Pakenham (a Monash Health site) located 40km southeast of Clayton, facilitating local appointments and a drop-in service for pregnant women. In 2025 over 1030 patients were seen here by an immunisation nurse, which included 80% of all women attending in the month of November. This resulted in rates of pertussis and influenza vaccine uptake well exceeding national averages. 700 RSV vaccines were also administered in 2025.

Conclusion

Integrating an immunisation nurse into routine antenatal care increases the opportunities to recommend and administer funded antenatal vaccines. This is achieved through providing timely advice and information to pregnant women regarding the safety and benefits of vaccines that is consistent with national recommendations.

Background and aim
Infectious syphilis notifications in Victoria have increased by 20% in the past decade. Understanding the context of new cases is essential for targeted interventions and public health responses. In 2021, Victoria became the first Australian jurisdiction to introduce a social vulnerability question into its syphilis enhanced surveillance form, capturing factors such as alcohol and/or other drugs, family violence, homelessness, mental health, and ‘other’ vulnerabilities.
Aim
We describe the prevalence and distribution of reported social vulnerabilities in Victorians diagnosed with infectious syphilis, comparing differences across key subpopulations.
Methods and analysis
All Infectious syphilis notifications from 2022 to 2025 were included. We calculated question completion rate and prevalence of reported social vulnerabilities among females, pregnant individuals, gay, bisexual men (GBMSM), other men who have sex with men (non-GBMSM), and Aboriginal and/or Torres Strait Islander people.
Outcomes
During the study period, 41.9% of cases had the social vulnerability question completed; 58.1% were missing or unknown. Completion was highest among pregnant individuals (66.7%), non-GBMSM (58.2%) and Aboriginal and/or Torres Strait Islander people (58.1%), and lowest among GBMSM (45.8%), likely reflecting differences in follow-up. Alcohol and/or other drug use was the most common vulnerability (8.0% overall), especially among Aboriginal and/or Torres Strait Islander people (31.1%), females (19.9%) and non-GBMSM (16.8%), but less common among GBMSM (3.9%). Homelessness and family violence were more frequent in pregnant individuals (17.6% and 13.0%) and Aboriginal and/or Torres Strait Islander people (12.2% and 9.2%) than in GBMSM (1.0%, 0.2%) or non-GBMSM (3.0%, 1.4%). Notably, 36.7% of cases with vulnerabilities reported multiple concurrent issues.
Conclusion and future actions
Victoria’s enhanced syphilis surveillance provides important epidemiological insight into social factors driving syphilis transmission. However, substantial data gaps highlight the need to improve data collection and support clinician education to better understand and address underlying causes and strengthen prevention.

Background and Aim
Over the past three decades, the global public health community has faced complex challenges in detecting and managing emerging infectious disease outbreaks. Of the 30 new pathogens identified during this period, 75% are zoonotic in origin. Yet our understanding of the spillover of zoonotic pathogens to humans remains limited. Traditional outbreak response efforts typically focus on patients and their contacts, and on symptom screening to detect threats. Lessons learned during COVID-19 revealed that such reductionist perspectives often overlook the socio-ecological determinants underpinning disease emergence, transmission, and the formulation of preventive strategies, which affected the public health response. This paper examined the contributions of social science intelligence to outbreak investigations.

Methods and Analysis
We conducted an informed synthesis and appraisal of the current state of knowledge and evidence regarding the need for and value of social science intelligence in outbreak preparedness and response. These were organised into thematic sections under outbreak intelligence and management: threat assessment, navigating pandemic threats, risk perception, outbreak hypothesis generation, risk communication, understanding pathways of disease transmission, community engagement, behaviour change communication, infection prevention and control, contact tracing and tracking misinformation.

Outcomes
The analysis demonstrates that social science intelligence strengthens outbreak response by capturing community perceptions, identifying socio-cultural determinants of transmission, informing hypotheses on outbreak causation, recognizing trusted community leaders, addressing mistrust, and guiding culturally appropriate interventions. It also plays a critical role in countering misinformation and improving risk communication. However, despite substantial evidence supporting its value, social science intelligence remains inconsistently integrated into routine public health practice.

Conclusions and future actions
Systematic integration of social science intelligence into epidemic and pandemic preparedness, response, and recovery efforts is essential. Embedding social science perspectives within outbreak investigations can enhance risk assessment, improve community engagement, and strengthen the effectiveness and sustainability of public health interventions.

Background and Aim:
Wastewater surveillance (WS) provides non-intrusive, cost-effective population-level insights on priority pathogen trends and early signals of outbreaks in near real-time, independent of an individual’s symptoms, uptake of, or access to health services. During the COVID-19 pandemic, Australian jurisdictions initiated independent WS programs which provided valuable insights informing local public health action; however, variation in data limited comparability and opportunity for integration with other disease surveillance data. In line with COVID-19 Inquiry recommendations and emerging global best practices, the Australian Centre for Disease Control (CDC) is leading the establishment of a National Wastewater Surveillance Program to strengthen Australia’s multimodal surveillance systems, delivered in partnership with Promoting Health4All.

Methods and Analysis:
The three-year program, commencing in early 2026, focuses on sentinel surveillance of priority respiratory pathogens and polio, preparedness for future pathogenic threats and agile WS in response to emerging pathogenic threats. Building on previous and current WS programs and capabilities, the design of the National Program is, and will continue to be, informed by engagement and consultation with i) public health and communicable disease epidemiology expertise in jurisdictional health departments, ii) water sector specialists, including environmental engineering, microbiologists and researchers, and iii) data analytics and modelling experts. Other key inputs include the Australian CDC’s Wastewater Surveillance Project for Emerging Pathogen Preparedness (WS-PEPP) WS trials and scenario planning workshop held following CDIC 2025, and the NextWater 2025 workshop on partnership with the water sector.

Outcomes:
Alongside national WS capacity building, the program will provide public health agencies and the public with a unique and complementary source of population-level surveillance data to support decision-making.

Conclusions and Future actions:
Ongoing analyses and evaluation will inform the future of the program, including expansion to emerging and re-emerging pathogens to support national preparedness and resilience.

Background and Aims
Non-typhoidal Salmonella (NTS) serovars usually cause self-limiting gastrointestinal illness but can also affect normally sterile body sites and result in invasive non-typhoidal Salmonella disease (iNTS), which may result in severe illness and complications. In Victoria, medical practitioners and pathology services must notify cases of salmonellosis. Cases meeting local follow up criteria are investigated and managed to collect additional demographic, risk factor and clinical information and control transmission. This study aimed to characterise salmonellosis epidemiology in Victoria using public health notification data, with a focus on determining factors associated with invasiveness, to identify trends and at-risk populations.

Methods and Analysis
Salmonellosis notification data from 1 January 2015 to 31 December 2024 were extracted from the Public Health Event Surveillance System and analysed using Microsoft Excel 2024 and R Version 4.3.0 via descriptive and statistical analyses. Invasiveness of serovars and demographic variables were analysed using multivariate logistic regression model. Cases with unknown age, sex or place of residence data or who resided outside of Victoria were excluded.

Outcomes
Notification rate was highest in 2016, in young children under 5 years and during summer. Most isolates were non-invasive and detected in faecal specimens. Salmonella Typhimurium and Enteritidis were the most common serovars. Among serovars, those most strongly associated with iNTS were Salmonella Panama (aOR:20.52, 95% CI:6.96–54.49; p<0.01) and Dublin (aOR:17.57, 95%CI: 7.66-39.98; p<0.01). Males, older adults aged ≥60 years and cases notified between 2020 and 2024 (excluding 2023) were also more likely to be associated with iNTS.

Conclusion and Future Actions
Findings around trends, at-risk groups and serovars more strongly associated with iNTS were consistent with known epidemiology and research literature. Ongoing monitoring of demographics and serovars associated with iNTS and further analyses on potential impacts of environmental factors may refine future public health response priorities for salmonellosis in Victoria.

Background and Aim
In recent years, the Malaysian government announced several initiatives to mandate childhood vaccinations, yet these policies were never implemented. This study aims to examine why the government proposed but ultimately did not implement childhood vaccine mandates.

Method and Analysis
Semi-structured interviews were conducted between November 2024 and January 2025 in person and online. The interviews involved 17 key informants knowledgeable about or with relevant experience in Malaysia’s childhood vaccination policy. A hybrid approach combining deductive and inductive coding was used to develop themes in the data analysis.

Outcomes
During the policy formulation phase, the World Health Organization, advising as an external expert body, highlighted the need to critically reassess the underlying causes of Malaysia’s suboptimal immunisation coverage, which had prompted the mandate proposal. Notably, cost posed an important barrier to immunisation for some of the population. Non-citizens were charged for each clinic visit and vaccine dose in public government health facilities. Urban poor families faced difficulty in accessing immunisation services stemming from constraints, including multiple jobs and limited time to visit clinics. Hence, these access issues further undermined overall coverage. This prompted policymakers to reflect that the problem of under-vaccination was not (only) deriving from parents refusing to immunise their children. There were also access barriers to vaccination that lay within the government’s remit to address. Moreover, policymakers’ new analysis identified that introducing mandates could exacerbate existing inequalities.

Conclusion and Future Actions
Importantly, different problems require different solutions. This research offers important insight into how Malaysia’s childhood vaccination policies can be improved, such as by reviewing the financing of vaccinations and collaborating closely with other sectors to achieve vaccine coverage.

Background and Aim: Measles is an exceedingly contagious virus requiring high levels of population immunity to limit its community transmission, and has been of specific importance in the Lower Mekong region. Seroprevalence studies offer direct evidence of population immunity. We aimed to review seroprevalence studies from the Lower Mekong region to establish regional immunity gaps.
Methods and analysis: Studies providing primary measles antibody seroprevalence data for people living in Cambodia, Thailand, Viet Nem, Lao PDR and Myanmar were included. The databases Ovid MEDLINE, Ovid EMBASE and Ovid Global Health, SCOPUS and Global Index Medicus were systematically searched on 24 September 2025. The search was date limited from 1 January 2012. This was supplemented by a search of grey literature sources. Critical appraisal was assessed with the adapted Joanna Briggs Institute tool. Findings were synthesised with structured descriptive analysis and narrative review.
Outcomes: From 565 records identified, 24 full texts were included with 32,518 participants. Thailand was the country most represented, with 11 included studies, and the median female proportion was 56.1% (IQR 50.0%, 78.3%). The weighted mean seroprevalence was 82.3%. The country with highest seroprevalence was Cambodia (95.9%), and lowest Myanmar (61%). The seroprevalence of those aged <5 years was 45.4%, and those ≥ 5 years was 84.4%.
Conclusion and future actions: The risk of bias was rated low in a majority of the studies, however a common source of bias was response rate. Heterogeneity of outcomes and inconsistent reporting of data limited the findings of the review. These findings indicate sub-elimination immunity overall and age- and geography-specific gaps.

Background and Aim
Rabies is a severe viral disease affecting the central nervous system and is almost invariably fatal once symptoms develop. Post-exposure prophylaxis (PEP), comprising vaccination and, in some cases, rabies human immunoglobulin (RHIG), is highly effective at preventing disease following potential exposures. Despite the availability of effective prophylaxis, gaps in knowledge and practices among health care providers can hinder timely and appropriate treatment.
This study aims to undertake an audit of rabies at risk notifications within South East Public Health Unit (SEPHU) catchment between February 2023-July 2025 to:
1. identify the number of GP clinics that have contacted SEPHU directly for PEP advice
2. identify the total number of vaccine orders submitted to the DH Immunisation Unit, within the SEPHU catchment requiring clarification of the schedule or further advice
3. identify whether HRIG is given in accordance with Australian Immunisation Handbook (AIH) recommendations
4. identify the number of orders from hospitals, and whether the schedules are in accordance with AIH recommendations
5. describe demographic and exposure risk factors associated with at risk notifications

Methods and Analysis
A retrospective audit of at risk notifications received between 13 February 2023 to 31 July 2025 will be undertaken (n=212). De-identified data relating to demographics, exposure history, PEP schedule, and contact with treating clinicians will be obtained. Quantitative data will be descriptively analysed.

Outcomes
Outcomes will be reported upon the completion of the audit.

Conclusion and Future actions
It is anticipated that the findings will inform the development of education for clinicians working in hospital emergency departments and general practices to improve rabies PEP delivery to at risk patients.
These may be in the form of engagement with health services, educational sessions or promotion of awareness through newsletters.

Winter Respiratory Campaign

Background and aim
Seasonal increases in influenza, COVID 19 and respiratory syncytial virus (RSV) cause morbidity and mortality and place pressure on the New South Wales health system. These surges highlight the need for public health campaigns to improve vaccination uptake. The 2025 campaign aimed to strengthen community preparedness and increase confidence in influenza vaccination.

Methods and Analysis
Campaign development drew on behavioural insights, stakeholder feedback and vaccination data. Early, pre-season vaccination messaging primed the community ahead of winter, supported by clear communication on vaccine safety and effectiveness. Resources for healthcare providers, parents and community organisations were expanded, and pharmacies were promoted as vaccination sites. Social media messaging, health professional prompt packs and webinars supported the awareness phase, followed by influenza specific messaging for high-risk groups that are eligible for free flu vaccination under the National Immunisation Program (NIP). Collaboration with aged care, education and Aboriginal stakeholders enabled a wide community approach. The campaign evaluation included online community surveys to measure recognition, recall and message take out and digital analytics to assess campaign effectiveness and resource usage.

Outcomes
Despite campaign efforts, influenza coverage rates did not improve and dropped slightly, despite above norm campaign recognition and recall. The top barrier was a belief the influenza vaccine is unnecessary, followed by inconvenience and concerns about side effects. Among older adults, views on the seriousness of influenza varied, and many who did not get vaccinated were influenced by a low sense of personal risk or importance.

Conclusion and Future Actions
Future campaigns should directly address these barriers via early plain English messaging on personal risk of influenza, foreground vaccine safety and side effect expectations, increase convenience through pharmacy access and booking nudges, increasing aged care promotion and ongoing transparent respiratory surveillance.

Background and Aim

People in residential aged care homes are at higher risk of a range of negative health outcomes, including from infectious diseases. During the pandemic, a suite of resources for residential aged care homes (RACHs) was developed, focusing on COVID-19 and the rapidly evolving needs of providers. As the pandemic response matured, this remit expanded to incorporate other acute respiratory viruses and health risks, reflecting the increasing need for integrated disease prevention and control guidance.

Methods and Analysis

NSW Health maintains a range of advice about respiratory illness and other vaccine preventable diseases, including the Public health advice to RACHs and Guidelines on management of acute respiratory infections. Seasonal advice over the festive period is also routinely developed, combining a range of public health areas including food and vector borne diseases and environmental health.

At the end of 2025, a debrief survey was distributed to aged care providers to evaluate use of these resources and gather feedback on how best to further support aged care providers moving forward.

Outcomes

The debrief survey showed high uptake and ongoing use of aged care resources. 95% of respondents reported they review NSW’s public health advice to RACHs. 86% reported using the NSW Respiratory surveillance report guidance, and all respondents noted it was useful to support undertaking internal risk assessments to inform measures. Feedback from providers during the policy consultation process has also been positive.

Conclusion and Future actions

Providing targeted and holistic public health advice is becoming more crucial to reduce confusion and misinformation, particularly to protect those at higher risk of severe illness. Collaboration between health disciplines to provide setting-based information supports availability of trusted advice to minimise the incidence of negative health outcomes.

Background and Aim
In recent years, there has been an increase in Q fever outbreaks in Victoria. Despite national guidelines, Q fever vaccination uptake is low among high-risk occupations due to a range of barriers including, high cost, low perceived susceptibility and poor accessibility - particularly for migrant and temporary workers.

This project aimed to increase Q fever vaccination rates and awareness among high-risk occupations in the Loddon Mallee region through shared knowledge and relationship building.

Methods and Analysis
We partnered with a local medical clinic, pathology provider, local council, and the Bendigo Livestock Exchange (a major livestock hub in the region) to provide pre-vaccination screening and a vaccination clinic. This streamlined access and allowed coordination with CSL to secure vaccine supply.

We ran screening sessions for 25 workers. Screening was crucial to prevent adverse reactions in those already immune. All eligible participants were invited to return and received their vaccinations at the clinic seven days after screening.

Outcomes
The results were highly encouraging, with 100% of participants receiving the vaccine. Workers gained a better understanding of Q fever risks, prevention, and the role of the public health unit. We not only achieved protection for those vaccinated but also strengthened community trust and awareness. This project reinforced the importance of building trust with communities, meeting workers at their place of work, and reducing barriers.

Conclusion and Future actions
Although Q fever remains a challenge in occupational settings, this intervention demonstrated that placed-based Q fever vaccination clinics work. Using local infrastructure makes uptake easier. Tailoring the project to local needs reduces costs and logistical barriers, therefore, collaboration between health services, councils and industry is key.

Looking ahead, an increased number of vaccination clinics could help mitigate future public health risk, increase capacity building efforts and address cost and time-related barriers.

References:
Department of Health. (2025). Increase in Q fever cases. Vic.gov.au. https://www.health.vic.gov.au/healthadvisories/increase-in-q-fever-cases

Mathews, K. O., Norris, J. M., Phalen, D., Malikides, N., Savage, C., Sheehy, P. A., & Bosward, K. L. (2023). Factors associated with Q fever vaccination in Australian wildlife rehabilitators. Vaccine, 41(1), 201–210.

Background and Aim:
The Australian CDC was established on 1 January 2026. As a new Australian Government entity, it is critical to position the CDC and the advice it provides is trusted by the broader community.

Social Licence establishes how much the public trusts what an organisation does with data. Social Licence is a key determinant for establishing the CDC as a trusted entity.

The aim of the project is to implement data practices to ensure the CDC remains transparent about data use, ensure the commitments the CDC will uphold, and establish the foundation for the CDC Data Strategy.

Methods and Analysis:
In order to establish the baseline level of trust the community has in government organisations, we conducted the following consultation activities:
- National Survey: to gain a nationally representative sample.
- National Online Submission Portal: we encouraged all members of the public to make a submission.
- Stakeholder Interviews: Interviews were conducted with a role in data, privacy and health advocacy.
- Targeted consultations: Interviews were held with stakeholders who identified as being part of a priority population.

Outcomes:
Through the consultation process, we gained a better understanding of what the public expects of the CDC when it comes to the use of their data. We grouped these findings into 5 key outcomes which included:
1. Communicate clearly - the public expects the CDC to be transparent about how data is accessed, used and shared.
2. Use robust governance - Apply strong governance, security protocols, and safeguards.
3. Protect privacy - Ensure privacy is central to the management of CDC data assets.
4. Embed Health Equity - Address gaps in data quality and representation; avoid contributing to stigma for any population.
5. Improve outcomes - Use data ethically to inform government advice aimed at reducing health inequalities.

Conclusion and Future Actions:
1. Clear communication:
The CDC must be transparent about data use and management across the whole data lifecycle, and this is central to maintaining trust. The CDC will ensure information is accessible to all Australians and caters to a wide range of accessibility needs.

2. Meaningful engagement:
Australians expect meaningful involvement of communities and organisations across the whole data lifecycle. Data is used and managed in a way that reflects their experience, views, values and concerns.

3. Risk management:
Australians expect that the CDC has made every effort to avoid things going wrong with people’s data. The CDC will proactively manage risk and if something goes wrong, we acknowledge and learn from it.

What this means for the public:
The CDC will have access to timely data, which is comprehensive and relevant to communicable disease risk. This will allow for the development of public health advice which is more accurate, as it is informed by real-time data about the risks and trends of emerging diseases.

Background and aim:
National Centre for Immunisation Research and Surveillance (NCIRS) designed Sharing Knowledge About Immunisation (SKAI) Adolescent to support effective immunisation conversations. Many parents and carers of adolescents seek and share health information on social media. To drive engagement with the SKAI Adolescent website, NCIRS developed a social media toolkit with members of the NCIRS Consumer Advisory Group (Consumer Researchers) to ensure it effectively met end-user needs. The 4 Consumer Researchers are co-authors of this abstract.

Methods and analysis:
NCIRS conducted a needs assessment survey with the Consumer Researchers, each with diverse community networks. Findings informed a co-design workshop with Consumer Researchers to collect feedback on toolkit content, tone, preferred language and formats, and potential challenges with posting about vaccination. Insights were recorded and reviewed by NCIRS co-authors. Following the workshop, Consumer Researchers piloted example posts on their preferred social media platforms and provided structured feedback on the clarity of visuals, effectiveness of key messages, ease of sharing, and overall posting experience through a separate follow-up survey.

Outcomes:
Insights from Consumer Researchers shaped NCIRS decisions about the toolkit’s purpose and positioning, emphasising the importance of creating a trusted consumer-facing resource with:

• platform-specific guidance
• ready-to-use content
• clear calls to action
• moderation support for Facebook and Instagram.

Consumer Researchers stressed the importance of adaptable social media resources that support parents and carers to confidently share vaccine information quickly, and with low risk of negative responses. Priorities included clear and concise messaging, culturally neutral and accessible language and visuals, and guidance on comment moderation.

Conclusion and future actions:
Incorporating real-world insights from Consumer Researchers in early toolkit stages ensures relevance to end-user needs. Future toolkit versions are anticipated to increase parent and carer engagement with SKAI Adolescent via social media and help improve adolescent vaccination coverage in Australia.

Background
Large linked administrative health datasets are increasingly central to population-level research and public health surveillance. Victoria’s Vaccine Safety Health Link (VSHL) links near real-time records from Australian Immunisation Register with statewide hospital, emergency, notifiable disease, perinatal, birth and death datasets. Monthly linkage by the Centre for Victorian Data Linkage provides de-identified extracts for secure analysis, enabling population-wide real-world vaccine safety monitoring. Despite strengths of this comprehensive linkage, pitfalls can trip up novice & experienced analysts alike.

Aim
To share practical challenges working with large, linked health data.

Methods and Analysis
Four years of vaccine safety analyses within VSHL, defining denominator and numerator populations and assessing exposure–outcome associations using methods such as self-controlled case series, have highlighted challenges that can impact linked-spine administrative data systems. Differences in coding completeness, update cycles and temporal alignment across sources can subtly shift case ascertainment. At population scale, even small linkage error rates may create meaningful analytic distortion, including missed links, false matches or implausible records (e.g. multiple maternal links or improbable clusters of vaccinations [>50 in one individual] on a single day). Population continuity presents another critical fault line; when deaths or migration occur outside jurisdictional capture, individuals may persist analytically (like “immortals”) within the cohort, skewing denominators and risk estimates, particularly in older populations. Although near real-time linkage enables rapid surveillance, delays in source data availability (e.g. complete admission record coding) and limited clinical granularity can temper immediate signal interpretation.

Outcome
Large-scale administrative data linkage offers powerful opportunities for near real-time safety surveillance, but careful analytical interpretation and appropriate ways of adapting to available data are essential.

Conclusion
Linked administrative data brings great richness and representativeness but necessitates considerations when being operationalised. Sharing experience and expertise is can lift capability in linked data use and strengthen Australia’s public health intelligence.

BACKGROUND & AIM: The National Critical Care and Trauma Response Centre (NCCTRC) trains members of the Australian Medical Assistant Teams (AUSMAT) for international and domestic deployment to areas affected by disaster or health emergencies. All members must undertake AUSMAT Team Member training and regular refresher courses. Public Health-related elements were integrated into AUSMAT training in 2023, after being recognised as an integral part of emergency response. Whilst AUSMAT training is regularly evaluated, this project aimed to specifically evaluate the Public Health (PH) components of courses delivered in 2025 to inform future Public Health education.
METHODS & ANALYSIS: In 2025, an AUSMAT Team Member course was delivered in June and an AUSMAT Team Member Refresher course in August. The PH component of the course consisted of a half-day with three, team-based simulation exercises including: Undertaking a health needs assessment of a disaster affected community, interpreting infectious disease surveillance and forming a response, and discussing key principles of environmental health including sanitation. An electronic survey consisting of thirteen questions with a mix of Likert scale and open-ended questions and using Microsoft Teams was completed by course participants for the evaluation of the PH simulations.
OUTCOMES: In total, 83% of the 2025 course participants completed the survey, with all (100%) responders being very content with the design, content, and delivery mode of the PH components. 87% found pre-course reading materials sufficient, 93% deemed the exercises effective and relevant, and 93% highlighted consolidation of their PH learning. In contrast, 14% reported experiencing time constraints and 13% expressed the need for more pre-course learning.
CONCLUSION & FUTURE ACTIONS: Overall, the AUSMAT course PH modules were well received by most participants who rated highly the content, delivery mode, and relevance in an emergency response context. Evaluation findings will inform future AUSMAT training courses, contributing to continuous quality improvement in PH education at the NCCTRC.

Aim: In September 2025 Cairns experienced an outbreak of 12 cases of measles which impacted healthcare staff and services. The outbreak demonstrates the continued potential for re-emergence of measles in an elimination context and the resultant disruption to healthcare staff and services. This report identifies key concerns and options to mitigate the impact of future measles outbreaks.

Analysis: The index measles case transmitted to 11 more people at their hostel accommodation or the hospital emergency department. No subsequent onward transmission was identified from the secondary cases. Most of the cases (11/12) had prior immunisation or immunity, indicating likely vaccination failure. Seven of the secondary cases were exposed at a healthcare facility and four of them were staff. Extensive contact tracing of staff and patients was undertaken. Susceptible people were recommended to receive timely interventions with measles-containing vaccine or NHIG if exposed, or excluded according to current guidelines.

Outcome: Health care workers are at increased risk of exposure to measles cases and subsequent infection than the general population. Breakthrough infections can make up a higher percentage of cases in contexts of high vaccine coverage and potential waning immunity. This situation is reflected in similar settings where elimination of endemic measles circulation is achieved. Strategies to mitigate the burden of measles outbreaks in healthcare settings include reducing exposure risk, addressing waning immunity and modifying the public health response in the event of breakthrough infection.

Conclusion: Australian healthcare services should consider strategies to reduce the impact of measles outbreaks amongst staff going forwards.

Background and aim
Coverage of National Immunisation Program (NIP) vaccines is monitored closely, however less is known about uptake of non-scheduled and additional vaccines. Like NIP vaccines, non-scheduled and additional vaccines are important for disease prevention yet, uptake relies heavily on healthcare provider knowledge, understanding of benefit, and subsequent recommendation. Understanding provider confidence, attitudes and clinical practices can reveal knowledge gaps and barriers for recommendation and ultimately inform future education measures to support vaccine uptake.

Methods and analysis
The Melbourne Vaccine Education Centre (MVEC) invited healthcare providers involved in immunisation delivery to participate in a survey relating to their clinical experience and practices.
Between 17 October and 30 December 2025, 135 responses were received. Data on geographic location, profession, workplace, clinical experience and practices was collected.
Council nurses (n=47) and GP clinic nurses (n=53) were the highest represented professions. Analysis showed the most recommended non-scheduled or additional vaccines were meningococcal B (n=115), influenza (n=108) and pertussis (n=92). Cost to the patient (n=94), lack of patient interest or acceptance (n=48), and lack of time during consult (n=35) were reported as the strongest barriers to recommend or administer. Council nurses were less familiar with vaccines not on the NIP than GP nurses.

Outcomes
Survey findings identified gaps in practice and barriers to recommend and administer non-scheduled and additional vaccines. Further stratifying results by demographic group will inform targeted education for providers. Barriers like lack of time during consult and cost to patient would require more intervention than education alone.

Conclusion and future actions
Deeper analysis could produce greater insight into the recommendation and administration of non-scheduled and additional vaccines. MVEC’s next steps are to develop specified education programs for providers to support their practice and promote vaccine uptake. Action from stakeholders is needed to overcome some barriers.

Background and aim 

Protecting the older population against vaccine-preventable diseases is complicated by many factors: the prevalence of chronic disease and additional risk factors, increasing use of immunosuppressive treatments and the decline of vaccine response due to immunosenescence. Yet despite increasing vulnerability, vaccine coverage for older adults is low. The Melbourne Vaccine Education Centre (MVEC) and City of Melbourne Immunisation team (CoM) seek to increase vaccination rates and strengthen understanding of poor uptake. 

Methods and analysis 

This co-designed project will be implemented at the Ageing Well Expo (ageingwellexpo.com.au) in March 2026, a public event, providing education and awareness to Victorians on how to live a healthy lifestyle as they age. Over 2-days, MVEC/CoM will engage with visitors to address common questions and concerns about vaccines, share custom-made written resources, bust myths and misconceptions, and provide on-the-spot National Immunisation Program (NIP) vaccines to those who are due or overdue. Visitors’ overall attitudes to vaccination, specific barriers to uptake, and motivating factors for immunisation will be assessed through an anonymous survey.  

Outcomes 

Survey results, combined with the common questions, concerns and myths revealed through discussions with visitors, will be collated and analysed at the conclusion of the event. These insights are pending but will inform future education, resource development and other strategies that will support vaccine uptake in the older population. The number and type of vaccines provided by the onsite clinic will also demonstrate the impact of pop-up clinics in increasing access and uptake of vaccines.  

Conclusion and future actions 

The information obtained through exhibiting at the Ageing Well Expo will reveal the barriers and motivations to vaccinate felt by older people and their carers. This will inform future education and engagement opportunities, resource development, and guide clinical service delivery to be more suited to the needs of the older population. 

Authors:
Michael Muleme 1, Desmond Gul 2, Bridgette McNamara 1, Tiffany Pe 1, Dana Thomson 2, Mohammad Akhtar Hussain 1, Jennifer Dittmer 3, Alexander Fidao 4, Annaliese Van Diemen 2, Eugene Athan 1

Primary/main affiliation:
1Barwon South West Public Health Unit, Barwon Health, Geelong
2North Eastern Public Health Unit, Austin Health, Melbourne
3Loddon Mallee Public Health Unit, Bendigo Health, Bendigo
4Victorian Department of Health, Melbourne

Background:
Following the easing of international travel restrictions after the COVID-19 pandemic, Victoria has experienced a marked increase in notifications of overseas-acquired vector-borne diseases. Dengue virus infection represents the largest proportion of these cases, with notification rates in 2024 exceeding pre-pandemic levels. This study aims to characterise travel behaviours, exposure risks, and preventive practices among dengue cases to inform targeted pre-travel health messaging.

Methods:
A cross-sectional survey targeting 54 cases is being conducted among adult cases with laboratory-confirmed dengue virus infection notified to the North Eastern, Barwon South West, and Loddon Mallee Public Health Units in Victoria. Participants are recruited during routine public health follow-up, with consent obtained by treating clinicians where required. The structured questionnaire collects data on travel history, environmental and behavioural exposure risks, use of personal protective measures, and knowledge, attitudes, and practices related to mosquitoes and dengue transmission.

Results:
As of 3 February 2026, 38 responses have been received, representing 24.5% of all dengue notifications during the study period. Respondents were predominantly female (71%) and Australian-born (92%). Most reported short-term travel (median duration 10 days; IQR 7–16 days) to Asian destinations, primarily urban areas in Indonesia (61%), for holiday purposes. The majority reported observing potential mosquito breeding sites near accommodation, including uncovered sewers (84%), water storage containers (66%), and stagnant water (55%). While most respondents reported using basic personal protective measures, principally insect repellents, approximately half had not sought pre-travel health advice; only 26% consulted a health professional. Those who did not seek pre-travel information (42%) cited previous uneventful travel as the main reason. A total of 39% of respondents reported increased adoption of preventive behaviours after accessing pre-travel advice. General awareness of mosquito presence and breeding sites was high; however, knowledge of the daytime biting behaviour of dengue vectors was limited.

Conclusion:
Preliminary findings indicate important gaps in risk perception and uptake of pre-travel health advice, particularly among repeat travellers, underscoring the need for more targeted and behaviourally informed prevention strategies.

Background: Measles and rubella remain significant causes of morbidity and mortality among children in developing countries despite the availability of safe and effective vaccines. Nigeria plans to introduce the combined Measles–Rubella (MR) vaccine into its national immunization schedule. Understanding caregivers’ awareness and acceptance is crucial to ensure successful rollout and sustained coverage.
Methods: A descriptive cross-sectional study was conducted among 414 parents and caregivers of children aged 9–59 months across eight Local Government Areas of Plateau State, Nigeria. Data were collected using a structured, interviewer-administered questionnaire via KoboCollect and analyzed with SPSS version 25. Descriptive statistics summarized socio-demographic characteristics, awareness, and acceptance levels, while Chi-square and logistic regression were used to assess factors influencing vaccine acceptance at a significance level of p < 0.05.
Results: The study revealed that 79.5% of respondents were aware of the MR vaccine, while 96.6% expressed willingness to allow their children to be vaccinated. Key predictors of vaccine acceptance included awareness (OR = 3.62; 95% CI: 1.25–10.49; p = 0.018), trust in health workers (OR = 4.21; 95% CI: 1.11–15.88; p = 0.034), and educational level (OR = 2.86; 95% CI: 1.09–7.52; p = 0.033). Most caregivers (54.8%) lived within 30 minutes of a health facility, indicating good geographical access.
Conclusion: Awareness and acceptance of the Measles–Rubella vaccine among caregivers in Plateau State are high, suggesting strong readiness for vaccine introduction. Trust in health workers and educational attainment significantly influence vaccine acceptance. Sustained public enlightenment, community engagement, and the involvement of religious and traditional leaders are essential to address residual hesitancy and achieve optimal coverage.
Keywords: Measles-Rubella vaccine, Awareness, Acceptance, Caregivers, Plateau State, Nigeria, Vaccine Hesitancy, Immunization.

Background:
Community-Based Surveillance (CBS) plays a critical role in the early detection and reporting of communicable and vaccine-preventable diseases, especially in resource-limited settings. However, limited community awareness and training often hinder effective participation. This study evaluates the impact of CBS training on disease detection knowledge and reporting practices among community members in Kwali and Abaji, Federal Capital Territory (FCT), Nigeria.

Methods:
A quasi-experimental pre- and post-intervention design was employed involving 264 purposively selected community stakeholders (Kwali: n=144; Abaji: n=120). Participants included religious leaders, traditional rulers, health workers, and volunteers. A structured questionnaire assessing knowledge of CBS principles, disease symptoms, and outbreak reporting procedures was administered before and after the training. Data were analyzed using descriptive statistics and McNemar’s test to determine statistically significant changes in knowledge.

Results:
Post-training scores significantly improved across both locations. In Kwali, correct response rates increased from an average of 42.3% pre-test to 72.8% post-test. Abaji showed similar improvement, with scores rising from 40.5% to 74.1%. McNemar’s test revealed statistically significant knowledge gains (p < 0.05) in 90% of the questions in Kwali and 100% in Abaji. Areas with the most improvement included vaccine- preventable diseases, surveillance components, and symptom recognition. A few knowledge areas, such as cholera and monkeypox symptoms, showed limited gains in Kwali.

Conclusion:
CBS training significantly enhanced community members’ knowledge and preparedness for disease surveillance in both Kwali and Abaji. The findings underscore the effectiveness of structured community education in strengthening grassroots public health systems. Continued investment in regular training, follow-up assessments, and behavior-oriented evaluations is recommended to sustain and deepen these gains.

Keywords:
Community-Based Surveillance, Vaccine-Preventable Diseases, Disease Detection, Public Health Training, Outbreak Reporting.

Background and Aim

Nakaseomyces glabrata (formerly Candida glabrata) is a commensal yeast that is a leading cause of candidiasis and a World Health Organization priority fungal pathogen. In May 2025, the public pathology provider servicing hospitals and clinics in the Australian Capital Territory (ACT) identified a cluster of N. glabrata cases from July-August 2024. This study investigated the source and factors contributing to development of this cluster.

Methods and Analysis

Cases were individuals with laboratory confirmed N. glabrata from 1 July-31 August 2024. Univariable analyses of routinely collected Digital Health Record data examined variables measuring potential environmental exposure (hospital and clinic visits and admissions, surgical and invasive procedures received, and invasive device use) and individual risk (comorbidities, antibiotic and antifungal use) between cases and controls matched by age and sex.

Outcomes

51 outbreak cases were identified. Of all cases, 48/51 (94%) received an inpatient procedure, 43/51 (82%) had at least one hospital admission, and 42/51 (82%) used at least one invasive device. Preliminary findings revealed higher odds of case status upon presentation to one ACT hospital site (univariable OR 4.10, 95% CI 1.59-10.51). Updated findings and investigation outcomes will be presented.

Conclusion and Future Actions

A case-control approach allowed for retrospective screening of environmental risk factors for a pathogen with no clear incubation period or transmission pathway. Preliminary findings suggest nosocomial transmission linked to one ACT hospital site. This study is expected to provide insight into environmental sources of infection in clinical care areas and inform future improvements to timely surveillance and reporting strategies for non-notifiable fungal pathogens.

Background and aim
This population-based record linkage study aimed to estimate the accuracy of hospital emergency department (ED) and admission diagnoses of COVID-19 recorded in administrative hospital databases in New South Wales (NSW) during the COVID-19 pandemic.
Methods
ED presentations and inpatient admissions from the PEARL probabilistic record linkage database of emergency department, infection notification, hospitalisation and death records were used. All patients with an acute respiratory infection-like diagnosis presenting to an emergency department (ED) participating in the NSW Emergency Department Data Collection, 1 January 2020 – 28 February 2023, were included.
Assuming all persons with COVID-19 infections presenting to NSW hospitals during the pandemic were detected and notified and there were no false positive test results, I calculated sensitivity, specificity, and positive and negative predictive value (PPV, NPV) of ED and inpatient diagnoses. Confidence intervals were not needed due to the large sample size.
Results
There were 1,053,694 patients included, presenting to 174 hospitals, of which 203,571 (19.3%) received a principal ED diagnosis of COVID-19 or coronavirus infection and 97,608 (9.3%) linked to a COVID-19 notification. The ED diagnosis sensitivity, specificity, PPV and NPV were: 73.4%, 86.2%, 35.2%, and 96.9%.
Of the 1,053,694 presentations, 304,395 (28.9%) were admitted. Of the inpatients, 5,009 (1.6%) had COVID-19 or coronavirus as a principal diagnosis, while 47,684 (15.7%) had it as any diagnosis. Among the same inpatients, 36,496 (12.0%) had a linked COVID-19 notification. For the principal inpatient diagnosis, the sensitivity, specificity, PPV and NPV were: 11.2%, 99.7%, 81.6%, and 89.2%. For any inpatient diagnosis, they were, respectively: 92.8%, 94.8%, 71.0% and 99.0%.
Conclusions
Research or surveillance of COVID-19 relying on emergency department diagnoses should consider their moderate under-ascertainment and high false positive rate. If using admission diagnoses, all available diagnoses should be used, which offers high ascertainment but moderate false positive rates.

Background and Aim: Spatial models are useful tools for predicting dengue transmission to inform dengue prevention and control. However, these models have rarely been applied to practical routines. This review aims to examine the features of spatial models and relevant risk factors and explore their limitations to help understand the challenges of development and application of the models in the local surveillance systems.
Methods and Analysis: A scoping review following PRISMA-ScR guidelines was conducted. The data were searched from four databases, including PubMed, Web of Science, Embase, and Scopus from March to December 2025. Studies were included based on eligibility criteria: spatial models predicting dengue hotspots or risk, endemic countries, peer-reviewed, and English language. After screening, relevant data were extracted thematically in Microsoft Excel form.
Outcomes: 15 studies were finally included in the review. Bayesian frameworks and machine learning approaches have been frequently applied over the past decade, using diverse accuracy metrics (AUC, DIC, WAIC, RMSE, Theil’s coefficient), and focused on small spatial scales. Most spatial models incorporated climate and sociodemographic factors. A short data timespan (<4 years) and no evaluation using predictive values (NPV, PPV) limited the predictive models at the finer spatial scales. Data availability and timeliness were still challenging for development.
Conclusions and Future Actions: Models developed at finer spatial scales for dengue prediction have been developed to support public health decisions and optimize cost-effectiveness. Future models should integrate predictive performance metrics and prospective evaluations to provide evidence robust enough for translation into practice. Local surveillance systems should strengthen data collection processes to ensure long-term, timely, and sustainable data to support proactive interventions.

Background and Aim:
Pertussis remains a significant public health threat despite routine immunisation, with a marked resurgence in Queensland in 2024 (over 15,000 notified cases). Emergency departments (EDs) frequently administer adult diphtheria–tetanus (ADT/dT) vaccine for tetanus-prone wounds, but ADT does not protect against pertussis. Substituting diphtheria–tetanus–acellular pertussis (dTpa) for ADT/dT offers equivalent tetanus and diphtheria protection, while providing additional pertussis protection for several years. This change creates an opportunity for pragmatic, opportunistic adult boosting against pertussis within existing ED workflows. We aimed to evaluate the clinical impact and cost-effectiveness of replacing ADT/dT with dTpa for adult tetanus prophylaxis in Queensland ED wound management.
Methods and Analysis:
This is a modelling study integrating routinely collected clinical, immunisation, and surveillance data with transmission-dynamic and health economic methods. A deterministic, age-structured compartmental model will simulate pertussis transmission under two scenarios: continuation of ADT/dT versus substitution with dTpa in ED wound care, across varying uptake thresholds. Outcomes will include pertussis cases averted, hospitalisations avoided, and quality-adjusted life years (QALYs) gained. A cost-utility analysis will be conducted from the Queensland health system perspective over a 1-year horizon (5% discounting), reporting incremental cost-effectiveness ratios and net monetary benefit. A complementary budget impact analysis will estimate 5-year financial implications under staged substitution scenarios.
Outcomes:
The analyses will generate policy-relevant thresholds for when ED substitution becomes cost-effective and budget-affordable, and quantify expected health gains and downstream cost offsets from reduced pertussis morbidity.
Conclusion and Future Actions:
If favourable, results will support updating ED wound management protocols to preferentially use dTpa, guide implementation targets (uptake/incidence thresholds), and inform broader immunisation strategy during periods of heightened pertussis activity.

Background and Aim
Australia is establishing a National Wastewater Surveillance Program (NWSP) to strengthen communicable disease intelligence. For emerging and re-emerging threats—often arising at the human–animal interface—public health action is limited without pre-agreed laboratory capability, governance and escalation pathways, and mechanisms to interpret and integrate wastewater signals with other surveillance. The Wastewater Surveillance – Preparedness for Emerging Priority Pathogens Project, delivered with the (then Interim) Australian Centre for Disease Control (iCDC), aimed to operationalise end-to-end wastewater surveillance for emerging pathogen scenarios and identify practical preparedness priorities to inform the NWSP.

Methods and Analysis
WS-PEPP combined time-limited, multi-jurisdictional wastewater surveillance pilots with a structured scenario planning workshop. MPXV surveillance was implemented across five jurisdictions (27 sites) and JEV/arbovirus surveillance across three jurisdictions (16 sites), using composite, grab and passive sampling methods selected with health authorities, water utilities and participating laboratories. The project strengthened laboratory capability and harmonised reporting protocols, including approaches for monkeypox clade differentiation, JEV integration with other arbovirus assays, as well as methods for measles, B. pertussis and other emerging pathogens. Results were provided to jurisdictions and iCDC for contextual interpretation alongside case and other surveillance information. A national scenario planning workshop convened multidisciplinary stakeholders to assess feasibility, governance, escalation triggers, ethical considerations and end-user decision-support needs.

Outcomes
The applied project demonstrated the feasibility of rapid activation and adaptation of wastewater surveillance for emerging pathogens within weeks through coordinated multisectoral partnerships. It strengthened laboratory readiness and identified critical enablers for fit-for-context interpretation and integration within multimodal surveillance systems.

Conclusion and Future actions
Preparedness for agile WS requires sustained partnerships across health, laboratories and the water sector; inter-laboratory quality assurance; harmonised reporting; clear governance and escalation pathways; and codesign with end users and affected communities. WS-PEPP provides implementation evidence to inform the preparedness and agile response components of Australia’s NWSP.

Background

Group A Streptococcus (GAS) infections have a range of clinical manifestations from superficial infections (pharyngitis and impetigo) to invasive GAS (iGAS), acute rheumatic fever (ARF), and acute post-streptococcal glomerulonephritis (APSGN). Public health and clinical guidelines for GAS infections often include advice on environmental control measures focusing on prevention. Variation in this advice may cause confusion and unintended burdens, particularly for individuals and communities in resource-constrained settings. This review identifies variation in environmental control recommendations in GAS-related guidelines in Australia and internationally.


Methods and Analysis

A structured search was conducted to identify clinical and public health guidelines, as well as infection, prevention and control (IPC) protocols addressing GAS, iGAS, sore throat, ARF, and APSGN. The search focused primarily on Australia but included documents from Canada, the United States of America and the United Kingdom given their mature public health systems, and use of English-language guidelines. IPC and environmental control recommendations were extracted and categorised. These were compared across jurisdictions to identify gaps, commonalities, and discrepancies.


Outcomes

IPC and environmental control recommendations for the prevention of GAS vary substantially between jurisdictions in Australia and internationally. Differences were identified in the advice on personal hygiene, sleeping arrangements, laundering, health hardware, and environmental decontamination. Some subnational documents recommended actions well beyond those of national best-practice guidelines without mention of the underpinning rationale or evidence. These escalations in practice may represent undue resource burdens for, and cause moral injury in, individuals and communities in resource-constrained settings.


Conclusions and Future Actions

Environmental control advice for the prevention of GAS that is inconsistent or potentially excessive, can affect adherence and worsen health inequities. In the absence of clear evidence to support variation in practice, guidance should be harmonised across the country. Future research should synthesise the available evidence, and develop feasible, proportionate, and nationally consistent recommendations.

Background and Aim
Japanese encephalitis virus (JEV), a vaccine-preventable mosquito-borne flavivirus, re-emerged on mainland Australia in 2021–2022 with locally acquired human cases and fatalities in regions previously considered non-endemic. This marked a significant shift in the national epidemiology of JEV and challenged long-held assumptions that the disease posed a risk primarily to northern Australia. At the same time, climate change is increasingly recognised as a critical driver of emerging and re-emerging infectious diseases, particularly vector-borne diseases. Rising temperatures, altered rainfall patterns, flooding events and extended warm seasons are reshaping mosquito ecology, increasing vector abundance, expanding geographic ranges and prolonging transmission seasons. These environmental changes are occurring alongside complex interactions with animal reservoirs, agricultural practices and human settlement patterns. This abstract explores the intersection of climate change and the re-emergence of JEV in Australia, with a focus on the implications for disease surveillance, immunisation strategies and public health preparedness.

Methods and Analysis
This work synthesises contemporary Australian and international evidence across three domains: climate-informed disease risk, vector and transmission dynamics, and public health system readiness. Evidence relating to projected climate scenarios and mosquito habitat suitability was examined to understand how future environmental conditions may influence JEV transmission risk beyond historically recognised regions. Entomological surveillance findings and experimental studies were reviewed to assess the capacity of mosquito species present in Australia, including those from previously non-endemic areas, to support JEV transmission. In parallel, public health and nursing literature was examined to consider the implications of climate-sensitive disease emergence for surveillance systems, immunisation policy, workforce capability and community engagement. Together, this synthesis provides a systems-level perspective on how climate change is reshaping JEV risk and how current communicable disease and immunisation frameworks may need to adapt.

Outcomes
The analysis indicates that climate change is likely to increase the geographic spread, seasonal duration and outbreak potential of JEV in Australia. Areas previously considered low risk may experience conditions increasingly suitable for sustained mosquito populations and virus transmission, particularly during summer and shoulder seasons. The emergence of JEV in these settings challenges existing approaches to risk-based surveillance, vaccination eligibility and outbreak preparedness, which have largely been informed by historical disease distribution. The findings also highlight the growing importance of integrating environmental intelligence into communicable disease systems, as well as the need to consider workforce readiness in regions without prior experience managing JEV. Nurses, immunisers and community health practitioners are likely to play an increasingly central role in responding to emerging vector-borne disease threats through surveillance, vaccination delivery, risk communication and community education.

Conclusion and Future Actions
The re-emergence of JEV in Australia illustrates how climate change is altering the landscape of communicable disease risk and exposing vulnerabilities in existing public health systems. Addressing this challenge requires a proactive, climate-informed and One Health approach that integrates environmental data into surveillance and decision-making, supports flexible and responsive immunisation strategies, and strengthens workforce capacity across urban, rural and regional settings. Future actions should include closer alignment between climate science and public health planning, ongoing review of immunisation policy in light of emerging risks, and targeted investment in education and training for nurses and immunisers as leaders in adaptive public health responses. Preparing for climate-sensitive vector-borne diseases such as JEV is essential to protecting population health in an increasingly unpredictable environment.

Background and Aim
Historically, measles exposure sites in Victoria were communicated primarily through Chief Health Officer (CHO) alerts. During periods of increased activity, this approach required frequent re-issuance, was resource-intensive, risked public messaging fatigue, and could delay timely access to updated exposure information. To improve efficiency, timeliness, and clarity of public health communication, the Victorian Department of Health (the department) transitioned exposure site listings to a dedicated webpage.

Methods and Analysis
In response to increasing measles notifications, the department implemented a standalone measles public exposure sites webpage in June 2025. This strategy separated high-level public health risk communication (via CHO alerts) from detailed, rapidly changing exposure information. Updated in near real time, the webpage provides site details, exposure dates and times, and guidance for symptom monitoring and health-seeking behaviour. It enhances usability and is more accessible for search engines, increasing communication reach. The webpage was developed in close collaboration with communication and system specialists, who guided improvements to layout, clarity and user navigation.

Outcomes
Since launch, the webpage has become the primary source of up-to-date measles exposure information. It enables rapid updates, reduces CHO alert re-issuance, streamlines processes, and improves clarity for the public. Early metrics indicate strong community engagement, with high page views and overwhelmingly positive feedback through the ‘Was this page helpful?’ feature. During periods of increased measles activity, the webpage supports near real-time updates, promotes public awareness, self-monitoring, and appropriate health-seeking behaviour, strengthening outbreak response.

Conclusion and Further actions
Dedicated exposure site webpages offer an effective and scalable approach to communicating dynamic public health information during communicable disease incidents. Future actions include ongoing monitoring of user engagement and exploring enhancements such as searchable tables and interactive mapping to improve usability, accessibility and reach. This model may also be adaptable for other notifiable diseases or public health incidents.

Background and Aim
The proportion of measles cases that were fully vaccinated in Australia increased in 2025 compared with earlier periods. Breakthrough measles infections in fully vaccinated individuals are usually mild with fewer complications, and less infectious than unvaccinated cases. This case report describes an outbreak of three confirmed measles cases in Tasmania in 2025, all with classical clinical presentation irrespective of vaccination status. We reflect on learnings from this outbreak arising from a fully vaccinated index case.

Methods and Analysis:
Vaccination status was confirmed through case interview and record review. Probable acquisition source was obtained through case interview. We conducted a descriptive epidemiological analysis of clinical and exposure details recorded in the Tasmanian Notifiable Diseases Surveillance System, stratified by vaccination status.

Outcomes:
The index case was a 25-year-old, fully vaccinated foreign national with a classical measles presentation, complicated by acute kidney injury. Case 2 was an unvaccinated adolescent with symptom onset 11 days after attending a public exposure site associated with Case 1. Visit times for the two cases overlapped by 15 minutes. Case 3 was an unvaccinated contact of Case 2 and under active monitoring when diagnosed. All cases were measles genotype D8.

Conclusion and Future Actions:
Clinical presentation of measles infection in a fully vaccinated individual can be classical and may be highly infectious. Public health risk assessments and responses should recognise the infectious potential of symptomatic, vaccinated cases. Understanding relative transmission risk by vaccination status with a larger sample may inform prioritisation of public health responses. Determining transmission risk associated with public exposures is challenging given the nature of high-mobility public encounters and variable environmental conditions.

Background and Aim
Crusted scabies is a highly contagious, severe skin disease caused by hyperinfestation of the Sarcoptes scabiei mite. Transmission occurs through close skin contact with an infested person. Individuals develop thick plaques and hyperkeratosis with complications including secondary bacterial infections, typically with Streptococcus pyogenes and Staphylococcus aureus. Crusted scabies has been a notifiable condition in the Northern Territory (NT) since 2016.

Methods and Analysis
We reviewed all crusted scabies notifications in the NT from 2016 to 2025 as per NT surveillance case definitions which required microbiological confirmation for the presence of S. scabiei mites from skin scrapings and clinical evidence including visible skin abnormalities. Severity of disease was assessed using the Royal Darwin Hospital grading scale (Grade 1,2,3 in increasing severity). Variables included age, sex, Indigenous status, location, grading and hospitalisation status.

Outcomes
There were 679 notifications from 485 individuals. The median age was 50 years (range 0-90 years) with 423 (62.3%) females. Most notifications were in the Darwin region (297, 44%), followed by East Arnhem (162, 24%) and Alice Springs (89, 13%). Aboriginal people account for 650 (96%) of the 679 notifications. Most cases were Grade 1 (286, 42%) followed by, Grade 2 (243, 36%), and then Grade 3 (97, 14%); 53 (7.8%) were of unknown grading. The majority (611, 90%) were hospitalised with a median length of stay of 12 days (range 1-203 days).
There were 66 notifications (9.7%) aged under 18 years (45 individuals), with 8 individuals (17.8%) having two or more notifications. The proportion of paediatric notifications increased from 3.2% in 2016 (1/31 notifications) to 20% in 2025 (19/94 notifications).

Conclusion and Future Actions
Crusted scabies is a significant cause of admissions and readmissions straining overburdened health services and compromising the lives of those affected. More targeted approaches are required to improve living conditions and scabies free environments in the NT.

Background and Aim: Incidence of invasive pneumococcal disease (IPD) was substantially reduced following nationwide introduction of pneumococcal conjugate vaccines (PCVs), like PCV7 in 2003, and PCV13 in 2011, in Australia. However, persistence of several vaccine-type (VT) and emergence of non-vaccine-type (NVT) pneumococcal serotypes (STs) causing IPD have been reported in the post-PCV period. In-depth understanding of the circulation patterns of these IPD-causing STs in countries with widespread PCV programs remains critical in development of next-generation vaccines.

Methods and Analysis: All IPD cases with reported STs among children (<5 years) and adults (≥65 years) between 2003 and 2024 were selected from the Australian National Notifiable Diseases Surveillance System dataset. The annual ST-specific IPD incidence rate (IR) was estimated per 100,000 person-years for each age-group. The relative risk (RR) for IPD attributable to PCV13/non-PCV7 VT-STs before and after PCV13 introduction was determined by negative binomial models.

Outcomes: In the post-PCV period, PCV7 and PCV13/non-PCV7 VT-ST-specific IPD incidence gradually decreased. Since 2020, most VT-STs have shown low IR (<0.6), except for ST-3, which exhibited an increasing trend. The NVT-STs with increasing IR trends post-PCV13 introduction were: 9N, 22F, 33F for both age-group; 15B for children; 23A and 23B for adults. The RR for PCV-13/non-PCV7 VT-STs-attributable IPD incidence ranged from 0.01–0.68 for all VT-STs, except ST-3 (children: 2.5; adults: 1.4).

Conclusions and Future actions: In Australia, ST-3 remains a major challenge among VT-STs alongside several emerging NVT-STs causing IPD in the post-PCV period. Next-generation vaccines offering enhanced ST-3 protection and broader ST coverage are needed to reduce disease burden.

Encore from 14th International Society of Pneumonia and Pneumococcal Disease (ISPPD) Symposium, 17–21 May 2026, Copenhagen, Denmark

Background and Aim
Vaccine effectiveness (VE) can diminish when vaccine antigens are poorly aligned with circulating variants – a phenomenon described as variant-vaccine mismatch (VVM). As COVID-19 viral evolution continues to present new public health risks, the need for ongoing vaccine adaptation is debated. This study estimated VE of the BNT162b2 XBB.1.5- and JN.1-adapted vaccines against COVID-19 hospitalisation in older Australians to determine the clinical relevance of updated formulations in a shifting variant landscape.

Methods and Analysis
The cohort was built using laboratory-confirmed COVID-19 cases recorded in Queensland’s Notifiable Conditions System (NoCS) between 23 December 2023 and 7 December 2025. A total of 34,940 individuals aged 65 years or older were included in the study. XBB- and JN.1-adapted vaccine eras were defined according to vaccine release in Queensland. VE was estimated for vaccine eras using logistic regression models adjusting for age, sex, previous laboratory-confirmed COVID-19 diagnosis (within 12 months), and calendar time using natural cubic splines to capture temporal trends.

Outcomes
XBB-adapted VE was 14.8% (95% CI: 5.5, 23.3) against hospitalisation while JN.1, KP.3, and XEC were the dominant circulating variants. JN.1-adapted VE was 58.5% (95% CI: 50.2–65.6) against hospitalisation while XEC and NB.1.8.1 were the dominant circulating variants. The JN.1-adapted vaccine provided greater protection than the XBB-adapted vaccine, which may reflect a closer antigenic match with circulating variants. These findings suggest that variant-adapted vaccines remain a highly effective tool for reducing burden on the tertiary healthcare system.

Conclusion and Future Actions
Ongoing vaccine adaptation and evaluation is a critical solution to the challenge of VVM. Maintaining robust genomic surveillance will ensure future adapted vaccines remain closely aligned with circulating variants, in turn maximising the benefits of vaccination. This strategy can help to safeguard public health and mitigate the consequences of VVM.

Background and Aim:
Adult vaccination coverage in Australia is suboptimal, with substantial health and economic consequences. In 2023–24, vaccine-preventable pneumonia and influenza hospitalisations in adults cost $726 million. Adult vaccination faces distinct challenges compared with child, adolescent, and maternal programs, including limited public awareness and insufficient strategic focus. As immunisation is a shared responsibility between the Commonwealth and state and territory governments, strong state-level leadership is essential. We aimed to draw the attention of state politicians and bureaucrats to low adult vaccination rates in their jurisdictions, highlight the impact on healthcare systems, and propose recommendations to improve coverage.
Methods and Analysis:
Lung Foundation Australia often use professionally designed documents to support government engagement. We developed tailored, double-sided infographics for each of the six Australian states, combining publicly available vaccination data with state-specific findings from our national Adult Vaccination Survey (n=3,352). Survey insights informed our five recommendations for governments: implement adult vaccination targets; recognise people with lung disease as a vaccination priority population; invest in public awareness and education; strengthen support for primary care providers to deliver adult vaccination; and fund clinically recommended adult vaccines.
Outcomes: The infographics will be distributed to state health ministers and shared during meetings with politicians, advisors, and health departments. This presentation will summarise feedback on the tool received to date and outline early progress in advancing adult vaccination policy at the sub-national level.
Conclusion and Future Actions: We will continue advocating for state-led strategies to increase adult vaccination coverage. Under the National Immunisation Strategy 2025–2030 Implementation Plan, states must develop action plans reflecting local priorities, service delivery contexts, and population needs. Embedding a specific and sustained focus on adult vaccination within these plans will be critical to reducing preventable disease and associated healthcare costs.

Background and Aim:

Organisms with antimicrobial resistance (AMR) are a growing public health concern and residential care facility (RCF) residents are especially vulnerable. In Victoria, the communication of AMR colonisation status between acute and community-based services relies on discharge documentation or patient self-reporting. We describe an instance of an RCF being unaware a resident was colonised with Candida auris and carbapenemase producing Enterobacterales (CPE), resulting in Victoria’s first mass screening for C. auris in an RCF.

Methods and Analysis:

The North Eastern Public Health Unit (NEPHU) identified during routine follow up of a CPE notification that the same resident was also colonised with C. auris. The case had resided in an RCF for six months; the RCF was unaware of prior AMR diagnoses. A risk assessment was conducted, and exposures and contacts identified. An infection prevention and control assessment found that environmental and shared resident equipment disinfection was not sufficiently effective for C. auris. The situation was discussed at the state-wide AMR-IMT (Incident Management Team) which recommended CPE and C. auris screening be offered to all RCF contacts.

Outcomes:

Contacts included selected residents, but not staff or visitors. Screening involved a rectal swab (CPE) and a groin/axilla swab (C. auris). Resources were developed for residents to support screening. Collection instructions were provided to RCF staff, and treating clinicians were informed. Eleven of 17 contacts were tested, all of which returned negative results.

Limited AMR knowledge among RCF staff and the community was observed. To address this, a working group of Victorian local public health units was convened to develop educational resources for RCF staff, clinicians, and residents.

Conclusion and Future Actions:

This case highlighted critical gaps in the management of patients with AMR in RCFs. Work is underway to improve knowledge, communication and management of AMR within the RCF sector.

Background and Aim

Dengue remains a major communicable disease threatening Southeast Asia and poses a critical public health challenge in Vietnam. The burden on the Vietnamese health system is substantial, and official numbers are often underestimated due to many cases being asymptomatic. The Mekong Delta Region (MDR) experiences a disproportionately high share of the country's cases due to favourable climate conditions for sustained transmission.

Methods and Analysis

This study collected 2025 baseline data from 13 MDR provinces in Vietnam. Sixteen standardized indicators recorded dengue cases, communities implementing prevention campaigns, households covered by proactive chemical spraying and individuals trained in prevention and control methods. Descriptive analysis will characterize prevention and control methods across provinces and over time. Additionally, this study will describe associations between dengue prevention and control activities and observed case trends to understand how implementation patterns align with case numbers.

Outcomes

The primary outcome of this baseline analysis is to describe dengue prevention and control activities implemented under Vietnam’s National Dengue Control Programme across the 13 participating provinces. This study will provide a systematic overview of current prevention and control methods and analyze variation in implementation across the MDR. Additionally, this study will examine the geographic distribution of dengue cases to identify heterogeneity in disease burden. This baseline establishes a comprehensive pre-intervention picture prior to implementation of the E-Dengue early warning system. This will serve as a critical reference point for interpreting the impact of the intervention during the subsequent trial period.

Conclusion and Further Actions

This baseline analysis will provide an understanding of how dengue prevention and control methods are implemented across the MDR. By analyzing and documenting variations in prevention strategies and dengue cases prior to the implementation of the E-Dengue early warning system, we will create a reference point to evaluate the impact of the intervention.

Background and Aim  

Viral haemorrhagic fevers (VHFs) including Ebola and Marburg virus disease, Lassa fever and Crimean Congo haemorrhagic fever are a low incidence, high consequence risk to Victorian health services. In Victoria, ongoing clinical care of VHF cases is the responsibility of two designated health services. The Victorian Department of Health identified the need for practical, accessible, and scalable guidance to enable early recognition and coordinated responses to suspected and confirmed VHF cases, particularly for non-designated health services and primary care settings.   

Methods and Analysis  

A multidisciplinary working group was formed comprising the Victorian Department of Health, regional and metropolitan health services, Primary Health Networks, Local Public Health Units (LPHUs), Ambulance Victoria, Victorian Infectious Diseases Reference Laboratory and the Environment Protection Authority Victoria. The group undertook a structured review of national and international VHF protocols, analysed operational readiness challenges, and examined frontline experience from clinical, laboratory, and public health staff. Iterative drafting incorporated sector feedback collected through broad cross-sector consultation. Consolidated insights were integrated into a state-wide guideline tailored to the Victorian operational context including resource variability, Personal Protective Equipment (PPE) availability, waste management logistics and escalation pathways.  

Outcomes  

The resulting Victorian VHF Health Services Guide provides clear, actionable procedures for early case identification, isolation, PPE requirements, specimen handling and communication pathways. It equips non-designated health services to safely manage suspected VHF cases while awaiting transfer advice, supported by decision trees and risk-based PPE recommendations. Development of the guideline strengthened cross-agency co-ordination and statewide preparedness, driving improvements to clinical resources, public health protocols and scenario-based training proposals.  

Conclusion and Future Actions  

Future VHF preparedness work should focus on exercising cross-agency scenario-based training, strengthening waste management solutions, and embedding VHF readiness within broader public health emergency frameworks. The success of this approach provides a blueprint for enhancing preparedness across other infectious diseases and emergency contexts.  

 

Background and Aim:
Pertussis is commonly perceived as a childhood illness; however, waning immunity, incomplete booster coverage, comorbidities, and communal living have resulted in ongoing transmission among older adults, increasing risk in residential aged care settings. The epidemiological and clinical features of disease in this population remain incompletely understood. In May 2025, the first pertussis outbreak in an aged care facility since the South East Public Health Unit’s inception was reported in metropolitan south-east Victoria. This study aimed to describe the outbreak dynamics, identify risk factors for transmission, and evaluate the effectiveness of public health control measures.

Methods and Analysis:
Cases were identified through surveillance and outbreak investigation activities. Descriptive epidemiological analysis was performed and a cohort study was undertaken to assess risk of infection. Public health interventions included case isolation, antibiotic treatment and prophylaxis, vaccination, and enhanced infection prevention and control measures.

Outcomes:
Attack rate among residents was 16.7% (12/72) with no staff cases. Residents aged ≥86 years and those with severe cognitive impairment were at higher risk of infection (RR 3.18(CI: 0.75- 13.46) and 1.91(CI: 0.57- 6.4) respectively). No cases had evidence of pertussis vaccination. Almost all cases had cough only and there were no hospitalisations. Two cases received incorrect antibiotics and were therefore in incorrect isolation protocol, which may have contributed to further transmission

Conclusion and Future actions:
Pertussis is not confined to paediatric populations and poses a public health risk in aged care settings, although symptoms appear to be mild in this cohort. It reinforces the importance of timely diagnosis, appropriate treatment, and vaccination review in aged care settings. Strengthening surveillance, staff awareness, and immunisation strategies may reduce future outbreaks.

Background and Aim
In NSW, adult blood lead levels (BLLs) ≥5 µg/dL are notifiable to Public Health Units (PHUs). Mining is a major local industry and employer in mineral-rich regional NSW. The Western and Far West NSW PHU region encompasses many of NSW’s mining operations, where industrial and residential areas intersect, creating complex occupational and environmental lead exposure risks. Although workers in lead-risk roles undergo mandatory health monitoring, workplace regulation sits outside the health system and PHUs investigate elevated BLLs alongside external regulators. Routine notifications often lacked sufficient detail to fully assess exposure pathways, identify vulnerable household members, or support regulatory liaison.
This project aimed to strengthen adult BLL surveillance and enhance cross-agency coordination by implementing a structured investigation tool embedded into routine PHU practice.
Methods
In consultation with mining and regulatory stakeholders, and local doctors, the PHU developed a new protocol incorporating a REDCap-based survey tool to deliver case investigation questionnaires. Using SMS, adults aged ≥15 years were sent links to lead-health information and invited to complete the survey. A locally designed risk-scoring framework was embedded to identify occupational and environmental exposures, generating automated prompts tailored to exposure context and guide health advice, referral pathways, and regulatory engagement.
Outcomes
The tool standardised collection of key information, including employment type, work areas aligned with regulatory lead risk categories, environmental exposures, and vulnerable household contacts.
Implementation generated strong engagement with 42% response rate. Improved data granularity strengthened exposure assessment, prioritisation for PHU action, documentation, and proactive engagement with regulators and workplaces.
Conclusion and Future Actions
Structured surveillance supported clearer identification of exposure sources, stronger interagency coordination, and more consistent adult BLL investigations. Ongoing stakeholder engagement is strengthening coordinated follow-up across agencies, with formal evaluation planned to refine and validate the tool.

Background
Vaccine coverage of 2 year olds in Cairns is low.
Calculation of the vaccine coverage is done using
- children aged 2 years to 2 years and 3 months of age
- who have received a full set of vaccine antigens per recommendations
- with a residential address in Cairns per AIR
83.6% of 697 children (aged 24 to 27 months old in Q4 2022) were reported with full vaccination coverage

Methods and Analysis
- We retrospectively reviewed the coverage of a cohort of children from 24 - 27 months to 60 - 63 months of age
- We analysed the cohort for differences at individual antigen level coverage

Outcomes
- The vaccine coverage increased from 83.6% to 89.7% by the time the cohort was 5 years old
- The coverage of individual antigens was approximately 5% higher than the overall coverage
- 24/697 (3.4%) of the cohort were missing only one dose of vaccine to be counted as fully vaccinated
- A core group remain completely unvaccinated
28/697 (4.0%) of cohort had no recorded vaccinations, with a further 8 (1.1%) having below half the required number of doses and not meeting criteria for any antigens.


Conclusions and Future actions
- Low vaccine coverage due to incomplete vaccination is frequently from missing just one of the full complement of vaccines
- Partially completed vaccinations tend to be caught up between 2 and 5 years old
o Calculating individual vaccine coverage may reveal better levels of protection than implied from overall coverage
o Low coverage is partly contributed to by delays in vaccination rather than anti vaccination sentiment
- Completion of scheduled vaccinations for partially vaccinated children should achieve adequate vaccine coverage.

Background and Aim
Children and adolescents have the highest influenza notification rates of any age group, with most influenza-related hospitalisations in Australia occuring in children under five years. Despite national antimicrobial guideline recommendations, antiviral therapy has historically been underutilised. We aimed to characterise paediatric influenza management and neuraminidase inhibitor (NAI) prescribing practices among infectious diseases clinicians in Australia and New Zealand.

Methods and Analysis
A cross-sectional survey was emailed to members of the Australia and New Zealand Paediatric Infectious Diseases (ANZPID) Network in 2020 and 2025. The survey included 12 clinical scenarios reflecting common paediatric influenza presentations, varying by season, illness severity, risk profile, and age group (<5 years versus >5 years). Participants were asked to indicate their approach to influenza testing and NAI use in each scenario. Additional questions explored clinicians’ perceptions of the benefits of NAI and symptom duration for treatment.

Outcomes
32 clinicians responded in 2020 and 16 in 2025. Most were paediatric infectious diseases physicians (83%; 88%) working in tertiary paediatric hospitals (84%; 75%). In both surveys, more clinicians opted to prescribe NAI during influenza season for children admitted to intensive care (24/32 in 2020; 8/16 in 2025) or with high-risk conditions (17/32; 15/16). Age did not influence decision to treat or test. No treatment was recommended if the child was being discharged, within 1-3 days of symptoms if admitted to ward, and any duration if admitted to intensive care. Most clinicians perceived the benefit of NAI as shortened symptom duration (18/32 in 2020; 11/16 in 2025), followed by reduced progression of disease (11/32; 14/16).

Conclusion and Future Actions
Influenza remains a significant cause of hospitalisaton and morbidity in Australian children. Clinicians across Australia and New Zealand show broad consensus in prescribing NAI during influenza season for children with high-risk conditions or severe illness requiring hospitalisation.

Background:
Elevated blood lead levels are harmful to human health; damaging organs, impairing cognition and at high levels causing death, and is a public health concern as these consequences of lead exposure are entirely preventable. Exposures are often through environmental or occupational routes, but an increasing number of notifications are associated with the use of unregistered supplements.

Methods and Analysis:
In September 2025, the public health unit received a notification of elevated blood lead levels (23.8 ug/dL) in a male who been tested through a holistic healthcare provider.

The public health unit initiated a response to assess occupational or environmental exposures. While no clear source of lead exposure was identified, the case reported consumption of Ayurvedic supplements purchased through an Ayurvedic practitioner within the Western Sydney Local Health District (WSLHD).

Outcomes:
The public health investigation involved collection of remaining Ayurvedic supplements for testing. Trace amounts of lead were detected in all samples, ranging from 0.23 – 0.76mg/kg. One additional supplement contained markedly elevated concentrations of lead at 10, 069 mg/kg.

The WSLHD Public Health Unit conducted a site inspection of the Ayurvedic practitioner where the case reported purchasing the supplements. While cooperative, the practitioner denied supplying the supplement with the highest lead concentration. Upon further questioning, the case admitted purchase of the product from an Ayurvedic practitioner in India.

Conclusion and Future Actions:
This case highlights the potential adverse health effects such as heavy metal toxicity associated with unregulated alternative medicines and the consequences of non-evidence-based health interventions. This underscores broader public health challenges in responding to the use of unregulated supplements among the “worried well”.

Background
Invasive Group A Streptococcal (iGAS) infection became a notifiable condition in New South Wales in September 2022. Group A streptococcal infections can range from mild disease such as sore throats to more severe invasive disease such as necrotising fasciitis, sepsis and meningitis. Outbreaks of iGAS have been documented in residential aged care homes (RACH), hospitals, and childcare centres. The public health response to iGAS aims to prevent secondary cases by identifying individuals at increased risk of invasive disease.

Methods and Analysis
In October 2024, a single case of iGAS was reported in a RACH resident in Murrumbidgee Local Health District. An initial assessment did not identify any high-risk contacts at the facility due to low mobility of the case. Low-risk contacts, defined as those with <24hrs contact with case during infectious period, were provided with information. Active surveillance was conducted for a 30-day period at the RACH. In December 2024, a second case of iGAS was reported in a resident of the same facility.

Active surveillance continued at the RACH for a further 3 months for any wound or respiratory infections. Whole genome sequencing results for the two cases became available in January 2025, which identified closely related specimens.

Outcome
The risk assessment, following the second case, did not identify any further high-risk contacts. Risk versus benefit discussions resulted in no resident or staff receiving chemoprophylaxis and the public health response continued placing emphasis on infection control and early detection. No further cases of invasive GAS were detected during the extended active surveillance period.

Conclusion and Future actions
The Public health management of iGAS contacts can be complex. Different approaches to the provision of chemoprophylaxis in RACH outbreaks should be considered together with current evidence to guide further development of Public Health Control Guidelines and inform a standardised approach across the country.

Background and Aim
Improving vaccination uptake is key to mitigating the impact of influenza and similar respiratory viruses, but increasing vaccine-sceptical beliefs since the Covid-19 pandemic has made vaccine conversations between health practitioners and patients more challenging. Practical guidance on effective communication in these contexts is typically decontextualised and/or based on invented conversational ‘scripts’, rather than on robust evidence of how such conversations actually work in real life.
A US study of infant and HPV vaccination talk found presumptive formats (e.g. “we’ll do three shots”) correlated with greater vaccination uptake than participatory approaches (e.g. “are we going to do shots today?”). However, in a recent Dutch study, parental vaccination intent was routinely elicited with open-ended questions (e.g. “have you thought about vaccination?”), which was an effective strategy for engaging parents in constructive discussion.
As yet there is no observational research on how health professionals initiate vaccine discussions related to influenza and other ILIs in NZ. This study aimed to address this gap.
Methods and Analysis
This paper presents an analysis of how New Zealand health professionals introduce the topic of influenza or Covid-19 vaccination in a sample of 28 video-recordings of routine healthcare consultations archived in the ARCH Corpus of Health Interactions (www.otago.ac.nz/wellington/research/groups/arch/corpus). Conversation analysis was used to classify the linguistic format of initiations and to closely examine how the subsequent sequences of talk unfolded.
Outcomes
Open-ended initiations that are neither presumptive nor participatory can be an effective and patient-centred way to start a conversation about vaccination, gain genuine patient participation in decision making and potentially gain alignment with an implicit or explicit recommendation to be vaccinated.
Conclusion and Future actions
Health professionals need evidence-based guidelines on effective communicative strategies for discussing vaccination that take due account of the complex, dynamic and situated nature of interactions in real-life healthcare encounters.

Background and aim:
Seasonal influenza remains a significant public health challenge, with refugee and culturally and racially marginalised(CARM) communities experiencing barriers to accessing accurate, trusted health information due to language barriers, lower health literacy and unfamiliarity with the Australian health system1,2. The Loddon Mallee region has substantial linguistic and cultural diversity, including communities whose languages and communication preferences are not consistently addressed through state-wide resources3.
During stakeholder engagement for the Loddon Mallee Public Health Unit(LMPHU) Seasonal Winter Action Plan, opportunities were identified to build on existing influenza campaigns by extending language availability and culturally tailoring resources.

Methods and analysis
A needs assessment was undertaken in partnership with Bendigo Community Health Services(BCHS) through consultation with community representatives and review of current influenza vaccination materials, including the Victorian Department of Health and Health Translations platforms(ref). While the Victorian 2025 Don’t Risk the Flu campaign4 provided a strong foundation offering translated materials, these did not necessarily meet the specific language and cultural needs of the Loddon Mallee catchment. Eleven priority languages were identified. Resources were collaboratively co-designed, translated and reviewed by NAATI-accredited interpreters and community champions, and disseminated via LMPHU, BCHS and Health Translations platforms.

Outcomes
Outputs included one influenza vaccination factsheet translated into eleven languages and one core video with Karen and Dari voiceovers. Content aligned with Victorian Health Department influenza messaging while adapting formats and language coverage to local needs.
Resources were distributed through LMPHU digital platforms, newsletters to regional health services, BCHS community champions, and the Victorian Health Translations website, enabling access beyond the Loddon Mallee region. Materials reached approximately 50 community members directly through community champions, with broader reach via LMPHU communications(newsletter reach: 5,024; campaign webpages: 512 views). Hosting resources on Health Translations reduced duplication and supported potential reuse by other Local Public Health Units and health services.

Conclusions and future actions
This project demonstrates that co-designed, translated resources can strengthen public health communication and preparedness for culturally diverse communities. LMPHU leadership enabled coordination, and region-wide dissemination, translating community insights into sustainable public health action. Future work will embed translation and co-design into seasonal campaigns

Background and Aim

High-quality, timely access to clinical data is essential for public health surveillance, service planning, and policy evaluation. However, routinely collected electronic medical record (EMR) data remain difficult to analyse at scale due to heterogeneity, local terminologies, governance constraints, and limited reproducibility.

Australia is responding through the Australian Health Data Evidence Network (AHDEN), which seeks to standardise hospital EMR data using the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) to enable interoperable analytics while preserving local governance. The Centre for Health Analytics (CHA) at Royal Children’s Hospital, Melbourne, serves as the Victorian node of AHDEN, a national collaboration led by the University of Adelaide funded by the Australia Research Data Commons.

Methods and Analysis

In line with this emerging national framework, CHA has implemented OMOP CDM in a tertiary paediatric health system to demonstrate feasibility and cross-site harmonisation. Clinical data captured during routine care in the Epic EMR are de-identified and transformed through an automated pipeline into OMOP CDM. Thousands of EMR source fields were mapped using automated extraction, transformation logic, and clinical review. Terminology mapping leveraged standard vocabularies and tools such as Usagi to align local terms to standard concepts while preserving traceability, with subject matter experts validating clinically nuanced domains.

Outcomes

The resulting research-ready datasets span demographics, encounters, diagnoses, procedures, medications, and measurements, enabling granular patient level analyses under secure, role-based governance supported by version-controlled transformation code. Operating within AHDEN’s federated model, identical code queries at each site can be executed behind institutional firewalls, with only aggregate results shared for meta-analyses.

Conclusion and Future actions

As linkage capabilities expand, including Australian Immunisation Register integration, this approach is positioned to strengthen vaccine safety surveillance and adverse events phenotyping, improve confidence in ICD-10-coding, and support scalable, trustworthy public health analytics within a national learning health system.

Background/ Aim
Sixty per cent of emerging infectious diseases come from wildlife. Feral animals such as feral pigs, cats and foxes are known to transmit communicable disease pathogens that pose public health risks.
Methods and Analysis
A purposive sample survey was undertaken with individuals from state/territory governments, Indigenous land management groups, not-for-profit organisations, industry, and feral animal management consultants. The aim of the survey is to improve understanding of who is involved in feral animal disease surveillance, and which diseases carried by feral animals are under surveillance and/or driving management action. Data was analysed using descriptive methods with frequency distributions and percentages.
Outcomes
The survey received 43 responses. Results show that the most common feral animals surveyed or managed are feral pigs, cats, wild dogs, horses, and rabbits. Over 50% of respondents reported undertaking some form of disease surveillance. This includes surveillance for zoonotic disease such as Japanese Encephalitis, Q fever, Leptospirosis, Buruli ulcer, Brucellosis, toxoplasmosis, salmonella and avian influenza. The results suggest that while there are strategies in place for feral animal disease surveillance, it can be inconsistent and piecemeal. Barriers to undertaking disease surveillance include lack of funding, training, geographical and landscape complexity and the lack of a One Health approach.
Conclusion and Future actions
Feral animal populations are increasing, aided by changes to Australia’s landscapes and climate, the lack of predators, and their ability to adapt to new environments. This increases the risk of human exposure to feral animals and the diseases they carry. Undermonitoring and a lack of a One Health approach increases the risk further. Feral animal disease surveillance, as an important communicable disease prevention strategy, is a topic that needs elevating in public health discourse.

Background
Prior to SCIIP, the Sunshine Coast Hospital and Health Service (SCHHS) recorded fewer than 50–100 childhood vaccinations per month. Pandemic-related disruption, workforce constraints and increasing vaccine hesitancy had reduced childhood immunisation coverage across the HHS including priority SA3 regions, while reliance on GP-only access created structural barriers to vaccination. SCIIP was established by the SCHHS Public Health Unit in partnership with Child Health to strengthen coverage and transition the health service from reactive to preventative care.
Aim
To implement and evaluate a structured immunisation service integration model within regional Child Health services using the RE-AIM framework.
Methods
Weekly immunisation clinics were established across six Child Health locations. Australian Immunisation Register (AIR) data monitored coverage trends and service activity. Immunisation was embedded within SCHHS Child Health delivery through education, mentoring and clinical governance, supported by Queensland Health Immunisation Program (QHIP) funding. Workflow redesign improved throughput and ongoing performance review informed transition to operational funding.
Outcomes
Monthly encounters grew from a mean of 235 in Q1 2024 to 921 in Q1 2025, a four-fold increase within 12 months. The service exceeded 1,000 encounters per month from mid-2025, peaking at 1,336 in July 2025. Total encounters for January–November 2025 reached 12,027, compared with 5,380 over the same period in 2024 (124% increase). Infants aged 0–6 months accounted for approximately 49% of encounters, consistent with primary schedule delivery. Sustained demand resulted in 4–6 week waiting times at some sites.
Conclusion and Future Actions
SCIIP demonstrates that a hospital and health service with negligible prior vaccination activity can become an active contributor to preventative care. This cultural shift, enabled by QHIP investment and local leadership, resulted in a sustained four-fold increase in vaccination encounters.

Background and Aim:
Boorloo (Perth) Public Health Unit (Boorloo PHU) supports provision of rabies post-exposure prophylaxis (PEP) to people with rabies exposure in metropolitan Perth, in collaboration with the Western Australian (WA) Department of Health. Boorloo PHU has seen a significant increase in people presenting with rabies exposures over recent years. We undertook a review of rabies exposures and PEP requests in 2025 to better understand exposure patterns and the public health burden.

Methods and Analysis:
Exposure data for PEP requests in 2025 were extracted from our REDCap database and analysed using R Studio. Overall, 410 exposure requests were managed in 2025, resulting in 380 PEP orders, a 40% increase from 2024. Patients were aged between 0 and 85 years of age (median age 28 years [IQR 22 to 41 years]). Exposures occurred in 23 countries, with the most common location being Bali, Indonesia (n=181; 44.1%). Thailand (n=62;15.1%) and the Philippines (n=50; 12.2%) were the next most common exposure countries. Exposures occurred most commonly from dogs (n=197; 48.0%), with cats (n=87; 21.2%) and monkeys (n=80; 19.7%) being the next most common. Only 10 (2.4%) exposures occurred from bats in Australia. 28 people (6.8%) reported being vaccinated against rabies prior to exposure. A high proportion (77.1%) had started PEP management overseas.

Outcomes:
Perth travellers potentially exposed to rabies and requiring PEP are increasing over time, putting significant pressure on the healthcare system.

Conclusion and Future Actions
Boorloo PHU and the WA Department of Health are exploring options to meet the increased demand for rabies PEP, with the aim of improving accessibility and ensuring providers are familiar with the PEP process. Providing education to travellers and promoting pre-travel rabies vaccination may also reduce the risk of rabies in the Perth population.

Background and aim:
Paediatric pneumonia with pleural empyema is a major cause of morbidity in children worldwide. Surveillance studies indicate that prevalence is increasing. The aim of this single centre paediatric study was to describe the prevalence, clinical characteristics and outcomes of children hospitalised with pleural empyema.

Methods and Analysis: The COUCHE study is a retrospective chart review of all children hospitalised at the Royal Children’s Hospital, Melbourne Australia with pleural empyema from 2016 to 2024. Comprehensive data on clinical, laboratory and radiological features, surgical interventions and outcomes are described.

Results:
In total, 297 children were included, 46.3% females, median age 3.8 year (IQR 2.08–6.27). First Nations children were over-represented (4.3%) compared to background prevalence in Victoria (1-1.5%). The most common surgical intervention was video-assisted thorascopic surgery (VATS) with chest tube insertion (71.4% of cohort). Almost two-thirds (185/297; 62.2%) of the cohort had necrotic lung disease. Those with necrotic lung disease were significantly more likely to have a CT chest compared with those without (14.1% vs 4.5%, p=0.015) and length of hospital stay was significantly longer [10 days (IQR 7-15) versus 7 days (IQR 5-9); p-value <0.001)].
S pneumoniae was the predominant bacterial species identified on PCR of pleural fluid.
Amongst those with S pneumoniae who had serotyping, serotype 3 was the predominant serotype detected in 43/58 (74%) samples and this was strongly associated with presence of necrotic lung disease (p<0.001).

Conclusion and Future actions:
In this large cohort of Australian children hospitalised with pleural empyema, necrotic lung disease was common and associated with longer hospital stay. S pneumoniae was the predominant bacterial pathogen with serotype 3 strongly associated with necrotic lung disease (p<0.001). Surveillance of paediatric empyema and associated S. pneumonia serotypes is critical to guide vaccine strategies.