Abstract
Background: Globally, gastroenteritis (GE) significantly impacts children’s health and contributes to societal, economic, and health burdens. Previous studies reporting risk factors of GE in children in high-income settings mainly rely on outbreak investigations, which inherently capture only a fractional representation of the overall spectrum of GE occurrences. In addition, there is paucity of comprehensive information pertaining to modifiable risk factors of GE. This scoping review aims to synthesize existing evidence concerning modifiable and behavioural risk factors associated with GE among children in high-income countries.
Methods: PubMed, Embase, CINAHL, and Scopus were the databases from which articles were retrieved. A descriptive synthesis of the evidence was performed, following the Arksey and O’Malley scoping studies framework and enhanced by the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist (PRISMA-ScR).
Findings: The systematic search identified 13,395 journal articles, which were subsequently screened, and duplicates removed, resulting in 19 articles for inclusion in the review. The majority of these studies (63.2%) employed a case-control design and were predominantly conducted in community settings (68.4%). Factors such as parental literacy, contact with individuals exhibiting gastrointestinal symptoms, and nappy-wearing were identified as significantly associated with childhood GE within domestic environments. Childcare-related variables, including enrolment size, mixing of personnel between child groups, the presence of central cleaning stations, and the implementation of hygiene and disease prevention policies, showed significant association with GE. In addition, the presence of sand pits, paddling pools, and animals in childcare centers correlated with increased incidences of GE among attending children.
Conclusions: The scoping review reveals a complex and varied research landscape on factors influencing gastroenteritis (GE) for children in high-income countries. The findings suggest that while some variables are closely linked to specific pathogens, others may not be, highlighting variability across GE aetiology. The significant association between various household level and childcare-related factors and childhood GE points to a valuable direction for future research and public health intervention.

Background:
Pakistan persistently faces high maternal mortality (186 per 100,000 live births) and under-five child mortality (67 per 1,000 live births), emphasizing the need for improved healthcare delivery in underserved regions. Frontline Health Workers (FHWs) play a critical role in addressing these challenges but they often face significant physical and mental burdens at work, including long working hours, low compensation, disrespect from communities, and other adverse working conditions, leading to demotivation, burnout, decreased performance and diminished sense of purpose.

Objective:
This study evaluates the impact of strategies to empower FHWs sustainably, through a humanities-based training curriculum designed to strengthen their character virtues and sense of purpose.

Method:
We conducted a mixed-methods study design with both quantitative and qualitative components. A group of 112 FHWs, comprising Lady Health Workers and Vaccinators working in two high risk districts (Korangi and Badin) of Sindh, participated in the study. The quantitative data was collected by administering the Claremont Purpose Scale (CPS) pre- and post-intervention with FHWs. Whereas for the qualitative component, in-depth interviews were conducted with a group of randomly selected FHWs and their supervisors to gather insights into their experiences with the training 3 months post intervention. A thematic analysis of the IDIs was conducted using NVivo.

Results:
The training significantly improved participants' sense of purpose, meaningfulness, and goal orientation (CPS baseline 48; endline 53; p < 0.001), with sustained effects three months post-training. Qualitative feedback indicated increased resilience, emotional strength, and self-confidence, as well as improved work productivity and community engagement.

Conclusion:
This approach shows promise as a replicable model for fostering resilience and empowerment among FHWs, though further research is needed to test its scalability. This intervention significantly enhanced FHWs’ sense of purpose, potentially improving motivation and engagement in service delivery.

Keywords: Sense of purpose, transformative impact, humanities-based curriculum, Frontline Health Workers (FHWs)

Background
The birth of a baby can bring new parents so much joy, however in rare cases it may also bring forth a differing of opinion when it comes to following the recommended National Immunisation Program (NIP) and choosing to vaccinate the child. This dispute may lead to the child remaining unvaccinated. In the case where the parents of the child/children separate or divorce, the topic may be raised again, and a parent may choose to go through legal courts to enforce vaccination. The Royal Children’s Hospital (RCH), Immunisation Service is a referral point to counsel the parents on vaccination concerns with the aim of mutual agreement for catch up vaccination. The outcomes of these legal cases vary, with either full or partial vaccination going ahead after, in some cases, all legal avenues by the opposing parent have been exhausted. At times children coming for vaccination require sedation due to the impact of psychological trauma.

Aim
Examine cases of parental dispute where vaccination has been court ordered. Looking particularly at numbers of children, their ages, whether they received full or partial vaccination and if sedation was required to complete vaccination.

Method
Extract data from the electronic medical record (EMR) over a 10 year period January 2015 – January 2025, compare data to the Australian Immunisation Register (AIR) to examine vaccination outcomes.

Results
There were 17 children consulted at RCH for court ordered vaccination over a 10 year period, of these 10 children were siblings. Data extracted from the EMR will be analysed with challenges and vaccination outcomes reported.

Discussion
17 children over a 10 year period were referred to RCH for court ordered vaccination. Some cases were consulted more than once. Psychological trauma was noted in some children presenting for vaccination. A portion of children required sedation.

Abstract
Background
Geospatial mapping techniques can be creatively utilized to consolidate and describe events sequentially, especially in instances of epidemics like COVID-19. Saudi Arabia was seriously affected by this epidemic across its 13 administrative areas, beginning in March 2020 and ending in May 2023. This research, utilizing mapping as a tool, explores the spread of disease over the period, illustrating its locational spread, geographic variations, prevalence, and burden.
Methods
This research utilized daily reports published by the Ministry of Health, Saudi Arabia. Analyses were carried out by dividing the infections into three periods 2000-2021; 2021-2022; and 2022-2023 for exploratory purposes. Analyzed data were then transferred to maps for visual presentations. They are presented in six panels of varying interpretations.
Results
During this period, 205 locations in the country were affected, with fewer cases in the first year, a wider spread in the second year, and subsidence in the third year. Although this pattern holds for infections, fatality continued beyond the period, as an aftereffect.
Conclusions
Severe prolonged infections and fatalities were observed in smaller administrative areas, especially in the southwestern regions, comprising Jazan, Najran, Aseer, and Al-Baha. Analyzing data using mapping is crucial for understanding the real picture of the rise and fall of COVID-19 infections, which is instrumental in planning and implementing precautions and control measures in similar epidemic and disaster situations.

Background: Saudi Arabia crossed a crucial period of the COVID-19 epidemic that spread to 205 locations across 13 administrative areas. There were serious repercussions of mortality and morbidity during its three years of spread. With the hard efforts of all the sectors and agencies, this epidemic was successfully controlled in the country.
Aims and objectives: This analytical investigation of COVID-19 aims to pinpoint affected locations over the three years. It also investigates morbidity and mortality burden from the epidemic. Additionally, it identified locations, governorates, and administrative areas for the volume and severity of COVID-19 cases, year-wise.
Data and methods:
Daily reports of COVID-19 cases published by the Ministry of Health, Saudi Arabia from March 15, 2020, to April 30, 2023 analyzed in this research. Annual counts, estimates of crude infection rates, and case fatality rates with monthly averages were done for the entire country, its administrative areas, and 205 locations.
Results: Despite a progressive trend, the impact of second and third waves on morbidity and mortality varied across administrative areas, governorates, and locations. While major administrative areas of Al-Riyadh, Makkah Al-Mokarramah, Al-Madina Al-Monawarah, and the Eastern Region experienced significant consequences, others such as Al-Baha, Jazan, and Aseer have faced serious repercussions. Additionally, mortality was notable in Al-Jouf, Hail, Jazan, Aseer, Northern Borders, and Al-Baha – the smaller administrative areas. Besides, certain locations within the administrative areas, other than popular cities and administrative headquarters, emerged as COVID-19 hotspots, particularly of mortality.
Conclusions:
The morbidity and mortality of COVID-19 in Saudi Arabia exhibited a discernible pattern across the administrative areas, governorates, and locations, with numbers and infection rates fluctuating every month with increases and decreases. Although mortality rates were higher in the initial year, significant control measures were implemented. The fatality rate displayed notable variations across administrative areas. This analysis holds significance for the development of epidemic control systems, the implementation of resistance measures at the grassroots level, and the establishment of a surveillance system. Furthermore, it contributes to a clearer understanding of the situation that facilitates international comparisons and formation of collaborative networks.

Background
Travellers visiting friends and relatives (VFR) have been shown globally to have a higher risk of acquiring infectious diseases compared to other travellers. Overseas-acquired infections place a burden on the person and their family on return and risk onward transmission in the community. We aimed to describe the characteristics of VFR travellers in routine surveillance data for food and waterborne conditions commonly associated with overseas travel in NSW residents, to inform surveillance and prevention strategies.
Methods
We extracted demographic and epidemiological data recorded for overseas-acquired infections of included food and waterborne conditions notified in NSW residents in 2024. Reason for travel is not routinely collected from overseas-acquired cases in NSW. Therefore, a VFR traveller was defined as a case with country of birth matching the country where they acquired their infection. VFR and non-VFR travellers were described and compared by condition, age group, sex, region of acquisition, place of residence and season of acquisition.
Results
Overall, 22.0% of overseas-acquired cases of included food and waterborne conditions were VFR travellers. VFR travel was most common in hepatitis A (OR 6.03, 95% CI 3.19, 11.40) and typhoid (OR 4.86, 95% CI 2.80, 8.44) cases. We found that VFR travellers were more likely to be aged 20-39 years (OR 2.01, 95% CI 1.30, 3.12), have been born in Central and South Asia (OR 12.06, 95% CI 7.13, 20.37), and reside in Western Sydney (OR 3.83, 95% CI 2.40, 6.11).
Conclusion
Our analysis identified risk groups for overseas-acquired infections associated with VFR travel by NSW residents. This will inform work with multicultural health colleagues to develop prevention strategies for these groups, who may not resonate with ‘holiday traveller’ campaigns. Surveillance could be improved by increasing completion of country of birth in surveillance data and asking cases their reason for travel.

In anticipation of a future need for annual seasonal immunizations against both SARS-CoV-2 and influenza viruses, Novavax developed a COVID-19 Influenza Combination vaccine (CIC), comprising recombinant nanoparticle SARS-CoV-2 spike protein (rS), a trivalent nanoparticle influenza hemagglutinin vaccine (tNIV), and Matrix-M™ adjuvant. Here, we report on a randomized, observer-blinded trial (CIC-E-301) to evaluate the safety and immunogenicity of CIC and a standalone adjuvanted tNIV vaccine that is currently ongoing. The CIC vaccine formulation being evaluated was selected based on a formulation optimization trial (CIC-E-201): 60 µg HA (per strain), 35 µg rS, and 75 µg Matrix-M was chosen as the dose combination for CIC and 60 µg HA (per strain) and 75 µg Matrix-M was selected for tNIV. Safety and immunogenicity of CIC using this dose combination in older adult participants was comparable to Novavax’s standalone qNIV or SARS-CoV-2 rS vaccines, to Fluzone® High-Dose, and to Fluad®.

In CIC-E-301, the combination vaccine is compared to Novavax's authorized updated 2024-2025 COVID-19 Vaccine against JN.1 (NVX-CoV2705), Novavax’s standalone tNIV, and a licensed seasonal influenza vaccine comparator. A total of 1985 adult participants in Australia and New Zealand aged ≥65 years were randomized to receive either CIC, NVX-CoV2705 (JN.1), tNIV, or Fluzone® High-Dose in a 3:2:1:3 ratio, respectively. All participants received a single intramuscular injection of study vaccine on Day 0. Sera collected 28 days post vaccination were analyzed for influenza hemagglutination-inhibiting (HAI) and neutralizing antibody (Nab) responses to vaccine-homologous influenza A and B strains, and for SARS-CoV-2 NAb responses to the homologous SARS-CoV-2 rS strain. The tolerability and safety of CIC and tNIV were also assessed. Data were analyzed using descriptive statistical methods.

Data to date will be presented on the trial findings; safety and antibody persistence follow-up are ongoing.

Vaccines exert non-specific effects (NSEs) on the immune system, impacting immunity beyond targeted pathogens. These effects often exhibit sex-specific differences, with females frequently displaying more pronounced responses. While primarily studied in infants, NSEs likely influence vaccine impact across all ages, offering potential for modulating immune homeostasis and mitigating immunosenescence. This study investigates sex-specific NSEs of seasonal influenza vaccines in senior (>65) adults participating in the VITAL trial. RNA sequencing was performed on blood samples at baseline and 24 hours post-vaccination. Initial analysis of 90 VITAL older participants focused on the impact of Influenza vaccination (FluZone, FluAd or FluQuad) on gene expression. Using statistical modelling through Bioinformatics pipelines to understand sex differences emerging within the different influenza vaccine types, we investigated differentially expressed genes (DEGs) and their biological functions via pathway enrichment analysis (Panther, GSEA, KEGG, DAVID, REACTOME). Controlling for sex, no significant DEGs were associated with vaccine type. However, stratification by seasonal influenza vaccine revealed sex-specific DEGs in the FluAd, FluZone and FluQuad group (35 in males, 219 differentially expressed between sexes). Using a variety of readouts, initial data suggests important sex differential reactivity to the three different influenza vaccines. The results from this study may help inform vaccine policy and strategy for recommended vaccines in different age groups stratified by sex, particularly for older individuals.

Background
The "Be on the TEAM" study evaluated the impact of 4CMenB (Bexsero) and MenB-fHbp (Trumenba) on meningococcal carriage and their potential to provide indirect population protection. The indirect (herd) protective effects of the conjugate capsular meningococcal vaccines cannot be extrapolated to the subcapsular protein-based capsular group B vaccines.

Methods
A cluster RCT of UK adolescents 16-19 years-old in 155 schools across 16 sites assigned by study site to (i) 4CMenB vaccination (ii) MenB-fHbp vaccination or (iii) control (deferred vaccination). Oropharyngeal swab samples were taken at baseline and at 12-months in all groups. The primary outcome was carriage of genogroup B, C, W, X or Y meningococci at 12-months. Secondary outcomes included carriage of genogroup B, other genogroups, hyperinvasive strains, new acquisition and, analysis by MenDeVar Index. Carriage was identified by culture and characterised by WGS. A secondary carriage endpoint using PorA culture-amplified PCR was added. A sample size of 8000 per group was estimated to provide 80% power to detect a 30% reduction in carriage in each vaccine group. Group comparisons used a GEE model adjusted for school clustering, demographics, carriage risk factors and baseline carriage. EudraCT: 2017-004609-42

Results
24098 Participants were recruited between March 2018 and November 2019. The study was discontinued early due to Covid-19 restriction measures and the closure of UK schools in March 2020. Swabs were available from 11,427 participants (control n=3917, MenB-fHbp n=3870, 4CMenB n=3640) with completion of all laboratory processing and statistical analysis.

Conclusions
Final results for the primary outcome and all secondary outcomes for carriage assessed by conventional culture and culture-enhanced PCR will be presented.

Funding
This study is independent research funded by the National Institute for Health Research (NIHR) ( PR-R18-0117- 21001). The funders have no role in the study design, conduct, analysis or publications arising from this study.

Introduction

The introduction of SARS-CoV-2 in Australia resulted in the closure of international borders from March 2020, along with introduction of non-pharmaceutical interventions. Influenza virus circulation in Australia dropped dramatically, until international borders reopened from November 2021, and Western Australia (WA)’s border in March 2022.

Methods

Virological surveillance data and residual sera from two laboratories, in WA and Victoria, were used to examine influenza virus circulation and seropositivity over this time. Inter-seasonal periods examined were: pre-COVID–19 introduction (Dec 2019-Mar 2020); during COVID19 restrictions (Dec 2020-Mar 2021, Dec 2021-Mar 2022); and after international borders reopened (Dec 2022-Mar 2023). 200 sera from each site at each time period were tested by haemagglutinin inhibition assay (HI) for antibodies to influenza A and B viruses commonly circulating or used in vaccines across these periods.

Results

Overall, seropositivity (% with HI titre >40) to various H1N1pdm09 and H3N2 viruses was similar across the states, or slightly higher in WA. Seropositivity was higher in those aged 5-19y and 20-64y in WA for most H1N1pdm09 viruses. An increase in geometric mean titres (GMT) over time was seen for H1N1pdm09 in 5-19y in WA. Changes in seropositivity related to the strains included in the seasonal vaccine were not generally observed, although the H3N2 A/Darwin/6/2021 virus was included for the 2022 season, and seropositivity increased from 17% (2021-2022 period) to 42% (2022-2023) in Vic and 16% to 39% in WA. While B/Yamagata became globally extinct in April 2020, seropositivity averaged 60% across subsequent interseasonal periods.

Conclusion

Impacts of influenza infection or vaccination with different influenza virus strains were not always clear in this study, which may suggest that residual sera may not be a sensitive enough method to distinguish annual variation in influenza epidemics and current levels of vaccination, and more targeted or larger serosurveys may be required.

Background
Solomon Islands has a population of 297,000 women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 65 women are diagnosed with cervical cancer and 40 die from the disease in Honiara.
Gardasil HPV vaccine was introduced in 2019 and the coverage of 9 – 14 you girls that year was 52% (25,773/49,423). However, with the COVID-19 pandemic and subsequent lock down, school closures and staff diverted to Covid vaccination the HPV vaccine services were affected resulting in the coverage for 2021 and 2022 being 6.3% (3268/51540) and 6.5% (3413/52803) respectively.
Methods
A nationwide big catch-up (BCU) campaign for HPV vaccine for school girls 9-14 years with integrated community outreach is planned for April 2025. The Solomon Islands plans to conduct intensified outreach for a period of 3 weeks covering around 854 schools and selected communities. It is estimated that 30% of community outreach involves a team camping at the sites in the outer Islands. Provincial Teams mostly consist of 2 Health workers and a Community mobiliser.
Results
The target population for school girls 9-14 years of age in 2025 is 55,242 with approximately 27,000 unvaccinated for HPV who will be the target for this campaign. There are estimated to be 14,550 girls in the 9-14 year cohort out of school who need to be identified and vaccinated through local clinics. There will be an extensive health promotion campaign prior targeting teenage girls and their families, teachers and community leaders with HPV messaging and that vaccines are for all of the life course.
Conclusion
The coverage of the Solomon Islands Big Catch Up Campaign April 2025 will be reported with a focus on operational challenges.

Pneumococcal disease (PD) remains a major public health concern, with Streptococcus pneumoniae responsible for both invasive pneumococcal disease and community-acquired pneumonia. Over 100 distinct pneumococcal serotypes have been identified globally, and those associated with the highest disease burden have been included in pneumococcal conjugate vaccines (PCVs). The introduction of PCVs into paediatric and, subsequently, adult vaccination schedules has led to reductions in PD caused by vaccine serotypes. However, this has been accompanied by an increase in PD caused by non-vaccine serotypes, a phenomenon known as serotype replacement. To address this, higher-valency PCVs have been developed. Immunogenicity assessments of these new PCVs typically compare antibody responses to established vaccines, such as PCV13 in adults and PCV7 in children, where clinical efficacy has been demonstrated. However, the impact of vaccine products, dosing schedules, and regional factors on immunogenicity in paediatric populations remains incompletely understood. To address this gap, we conducted a systematic review and meta-analysis to quantify serotype-specific immunogenicity following pneumococcal vaccination in paediatric populations. We synthesised data on vaccine-induced immune responses across different vaccine products and schedules, estimating immunogenicity-based vaccine efficacy parameters for integration into disease transmission models. By identifying serotype-specific immune response variations, this study provides critical evidence to inform pneumococcal vaccine evaluation and future immunisation strategies.

Background
Multi-drug resistance (MDR) and extensive drug resistant (XDR) shigellosis has reportedly been increasing in Australia, with Shigella sonnei the most common species associated with MDR and XDR. In May 2024, an increase in MDR/XDR S. sonnei notifications prompted the WA Department of Health (DoH) to investigate.
Methods
Notifications of MDR/XDR S. sonnei are reported to the DoH by clinicians and laboratories under the Public Health Act, 2016. WA acquired MDR/XDR S. sonnei cases with illness onsets between May and October were interviewed with a semi-structured questionnaire on symptoms and possible risk factors. Data were analysed descriptively. Whole genome sequencing (WGS) was performed to ascertain genomic relatedness of cases.
Results
There were 35 cases (32 male, 3 female, median age 39 years) and most cases had illness onsets from May to July (71%). Ten (29%) cases were hospitalised and 14 (40%) reporting blood in their diarrhoea. Of the males, 27 reported being men who have sex with men (MSM). Nine of the MSM cases reported visiting the same sex-on-premises venue (SOPV) during their incubation period. In response to cases visiting a SOPV, prevention strategies included working with this and other SOPVs to develop online and venue-based communication material, and providing infection control advice and environmental monitoring as required. Individual cases were also adviced on helping to prevention transmission. Isolates from 28 cases underwent WGS and 26 were genomically similar (clustering within < 5 SNPs).
Conclusion
MSM exposure was the main risk factor for the acquisition of MDR Shigella sonnei in WA and a proportion of cases reported visiting a SOPV in common. A range of strategies at the individual, community and venue level were implemented to help prevent ongoing transmission in the MSM population. Since October 2024, notifications have decreased and no further cases have reported visiting a SOPV.

Background: Clesrovimab is an investigational, long-acting monoclonal antibody for the prevention of RSV lower respiratory tract infection (LRI) in infants, including those at high risk of severe RSV disease due to serious comorbidity or premature birth.

Methods: This is a planned interim analysis (IA) of a randomized, controlled, phase 3 trial in infants entering their first RSV season recommended to receive palivizumab due to prematurity, chronic lung disease of prematurity, or hemodynamically significant congenital heart disease. Participants (pts) were randomized 1:1 to receive clesrovimab (105 mg IM on day 1, placebo on day 28) or monthly palivizumab in season 1; eligible pts received clesrovimab (210 mg IM) in season 2. The primary endpoint was safety and tolerability of clesrovimab vs. palivizumab in season 1. Secondary endpoints included the incidence of RSV-associated medically attended LRI (MALRI) requiring ≥1 indicator of LRI or severity and of RSV-associated hospitalization through day 150.

Results: At this IA, 901 pts had been randomized into the trial. Baseline characteristics were well balanced. In season 1, the proportion of pts with AEs were comparable between arms; no pts in the clesrovimab arm had a drug-related serious AE. In the season 2 IA, proportions of pts with AEs were comparable between those who had received clesrovimab or palivizumab in season 1. There were 8 deaths (1.8%) in the clesrovimab and 4 (0.9%) in the palivizumab arm, all attributable to underlying comorbidities or causes unrelated to treatment. Incidence rates of RSV-associated MALRI and of RSV-associated hospitalization were comparable between clesrovimab (3.6% and 1.3%, respectively) and palivizumab (3.0% and 1.5%, respectively) through day 150.

Conclusions: In season 1, a single dose of clesrovimab had a safety profile and RSV disease incidence rates that were generally comparable to monthly palivizumab in infants at high risk for RSV disease.

Background
Confidence in vaccination is essential for high uptake and robust public health systems. A rapid drop in vaccine confidence is triggered by events such as controversies over vaccine safety, misinformation, and negative media coverage. The changes in confidence in institutions and vaccines have not been well-explored over time at the country level. We aimed to analyse trends in confidence in institutions and vaccines before and after the COVID-19 pandemic, as well as the correlation between these factors after the pandemic in three selected countries.
Methods
We analysed national-level data from India, Morocco, and the Netherlands, which were selected for their consistent public data in two databases before and after the COVID-19 pandemic. The data cover confidence in vaccines and institution confidence (government, media, UN agencies) from the Vaccine Confidence Project and the World Value Survey. Findings were presented through three case studies using an adapted social-ecological framework.
Results
Our findings revealed statistically significant change in confidence trends in the institutions, and vaccines before, during and after the COVID-19 pandemic across these countries. Public confidence in childhood vaccines and their perceived safety decreased significantly pre and post-COVID-19 pandemic; India saw a 16% decline, the Netherlands a 30.2% decline, and Morocco experienced a notable 68% increase in strong support for vaccines. Trust in governments declined in Morocco (26%) and the Netherlands but increased in India by 14.8%. Confidence in the press varied, with India showing an 8.1% rise in scepticism and Morocco a 25.8% decline, while the Netherlands showed no significant change. No correlation was found between confidence in the institutions and vaccine confidence at the country level in the post-pandemic context. A global study supports this finding, revealing that while trust in institutions generally positively correlated with vaccine confidence, this effect is less significant in countries with higher levels of religiosity, such as India and Morocco, or individualism, like the Netherlands.
Conclusions
We recommend strengthening the ongoing monitoring of public sentiment towards vaccination in each country to help timely detection of changes in public trust and guide strategies to improve vaccine confidence and its consequences.

This presentation describes innovative work done in collaboration between the Defence Science and Technology Group and university partners on EpiDefend, an electronic surveillance system designed to detect biological attacks and disease outbreaks.

Following the 2001 anthrax laced letter attacks in the US, significant efforts around the world were put into syndromic surveillance systems that monitor health data feeds for early signs of a biological attack. While these systems are capable of detecting a biological attack in syndromic data, in general they cannot do so in a timely fashion without increasing sensitivity to the point that such systems are swamped with false alarms.

Previous work on EpiDefend showed it could detect attacks in simulated medical data at a significantly lower false alarm rate than the best currently deployed system, ESSENCE. The authors improved upon this previous work by simulating in more detail Q-Fever, Tularaemia, Pneumonic Plague and Inhalational Anthrax aerosol dispersal attacks over Sydney, and then inserting the simulated events amongst real, NSW health data, in the PEARL database. PEARL is an anonymised, retrospective database of linked, line listed case data tracking ambulance and hospital data of respiratory patients over a 15 year period.

The previous generation of EpiDefend was modified significantly to meet the challenges presented by real health datasets. The result of the collaboration is an algorithm that in particular should be able to detect biological attacks using Q Fever and Tularaemia significantly before the hospital system could, at low false alarm rates.

The vaccine infodemic has emerged as a significant challenge in recent years, driven by increased online discussions about vaccines. In Indonesia, despite a robust history of vaccine development, the COVID-19 pandemic led to a decline in vaccination rates and public confidence, with unvaccinated infants rising to 26% in 2021 due to fears related to multiple immunisations and adverse events following immunisation (AEFI). Similarly, in the Philippines, misinformation about the dengue vaccine in 2017 caused a sharp drop in vaccine trust. To tackle this issue, VaxPulse—a regional platform for assessing and responding to vaccine-related infodemics—is being developed for East Asia.

VaxPulse uses the learning health system framework to generate Vaccine Infodemic Risk Assessment Lifecycle (VIRAL) by continuously monitoring and analysing multi-lingual content from social media, search engines, and news platforms. These insights are combined with expert input and established infodemic strategies to identify risks and develop targeted responses, which are evaluated in controlled settings. Feedback from these interventions is used to refine VIRAL and response strategies, completing the LHS cycle.

We are currently collaborating with institutions in Australia, Indonesia, the Philippines, Hong Kong SAR, Switzerland, and Canada. Machine learning models have been trained to detect social bots, adverse event mentions, and vaccine-related discussions in multiple languages (Filipino, Bangla, Spanish, Urdu, Farsi). Data is collected from platforms like X (Twitter), Facebook, Reddit, YouTube, and Google Trends. In Australia, VaxPulse has provided recommendations for improving vaccine safety communication on public websites and supported educational content creation for TikTok and Instagram.

VaxPulse’s real-time VIRAL insights can help governments and health organizations in East Asia address vaccine-related concerns swiftly, protecting immunisation programs. The platform’s machine learning models allow rapid adaptation to emerging threats, enhancing the resilience of vaccination efforts across diverse settings.

This study uses an adapted Multiple Streams Framework (MSF) to explore why COVID-19 vaccine mandates were applied at subnational levels in Vietnam while the central government declared that vaccination was voluntary. Document analysis reveals that COVID-19 vaccine mandates were adopted due to the effective coupling of the three streams: problem, policy, and politics. In the problem stream, insufficient community immunity, negative feedback from macro policies, and pressure from the central government were identified as key problems. Within the policy stream, vaccine mandates appeared to be a feasible and politically viable solution. The politics stream demonstrates the importance of political factors, including political leadership and determination, that supported mandates. The window of opportunity opened due to a strong decentralization approach in the pandemic context that granted substantial autonomy to subnational governments. The study proposes a flexible application of the MSF for authoritarian contexts, where divergence from the central government’s policy agenda is uncommon.

Conceptually, current definitions of vaccine mandates involve two key elements: the requirement to be vaccinated and the sanctions for non-compliance. However, during COVID-19, governments frequently introduced vaccine mandates in contexts where people were already denied access to work, travel, and social activities due to lockdowns and restrictions. This important context disrupts the standard operation of vaccine mandates. Accordingly, this study explores vaccine mandates in New South Wales (Australia), France, Malaysia, Israel, Singapore, and Vietnam, where mandates primarily served as incentives to restore basic rights, such as traveling, working, and accessing public spaces, that had been restricted during the pandemic. Through document analysis and key informant interviews, the study examines how governments employed this “removal and restoration” model and explores how mandates as incentives can be conceptually justified. It proposes a revised conception, modifying the existing 5S vaccine mandate framework by adding synergy and sustainment as categories. The study also provides the implications of this revised conception and framework for vaccine mandate policy research and design.

Background: In recent years, undernutrition has remained a significant public health issue in Tunisia, increasing the risk of illness and mortality in young children. Therefore, this study aims to analyse the prevalence and factors contributing to undernutrition among Tunisian children aged 0–23 months. Methods: The study included 3265 children aged 0–23 months from the 2011–2023 Tunisia Multiple Indicator Cluster Surveys (MICS). Trends and logistic regression analyses were used to determine the prevalence and predictors of undernutrition. Results: The prevalence of stunting, wasting, and underweight in infants and children aged 0–23 months has increased by 3.3%, 0.5%, and 2.1%, respectively. Stunting and underweight were more common among infants aged 0–5 months (11.8% for stunting, 8.9% for underweight, p < 0.01), and first-time mothers (8.3% for stunting, 4.1% for underweight, p < 0.01). In 2023, compared to 2011, the odds of stunting, wasting, and being underweight had increased by 22%, 16%, and 70%, respectively. Infants aged 0–5 months had higher odds of undernutrition in all three indices. Children of obese or overweight mothers, and those who started breastfeeding late, were more likely to be stunted. Boys had significantly higher odds of wasting and underweight. Children with low birth weight, and duration of breastfeeding > 12 months, had significantly higher odds of being underweight. Conclusions: This study shows that infants aged 0–5 months, first-time mothers, boys, and children from poor households in Tunisia are at a higher risk of undernutrition. To address the growing issue of undernutrition in Tunisian children, enhancing maternal and child health and nutrition services, improving parental education, and implementing community-based programs that provide breastfeeding and nutritional education to infants born to new mothers and mothers with high/low BMI is recommended.

Keywords: stunting, wasting, underweight, under 2 years, undernourished

Bordetella pertussis continues to circulate globally despite wide-spread vaccination, with an emergent international epidemic in 2024. The resurgence of disease is confounded by the emergence of pertactin-deficient, macrolide-resistant B. pertussis (MRBP) strains in Asia and Europe, which are under-recognised using traditional diagnostic and surveillance methods. This study addressed these gaps by applying a probe-capture hybridisation technique, which enables targeted culture-independent sequencing of genomes (tNGS) directly from respiratory specimens. Seven co-circulating lineages of B. pertussis were identified in Australia, including two associated with MRBP. Eight epidemiologically unrelated and geographically dispersed cases of MRBP in Australia with a A2037G mutation in all three copies of 23S rRNA were documented, three of which were confirmed by phenotypic testing and sequencing of corresponding isolates. The estimated rate of MRBP among B. pertussis PCR positive cases was 4.4%. This study demonstrated the value of tNGS based on target enrichment and probe capture sets designed for respiratory pathogens for public health laboratory surveillance of pertussis. This approach can improve the resolution and completeness of B. pertussis surveillance given the increasing diversity and vaccine evasion capability of this pathogen.

The Northern Sydney Public Health Unit in NSW investigated a mumps cluster at a high school in 2024, where all students had received at least one dose of the mumps, measles, and rubella (MMR) vaccine. Lasting just over four weeks, initial cases were acquired overseas, however local transmission did occur. Symptoms were mild, primarily unilateral swelling of the parotid glands, a common sign of mumps, and likely delayed recognition and diagnosis.
Once the cluster was recognised, infected individuals were isolated to prevent further transmission, and the situation was closely monitored. While the symptoms were generally mild and there were no reports of severe complications, the cluster raises concerns about the long-term effectiveness of the vaccine in some individuals, the potential for mumps to resurge in communities with low vaccine coverage, delayed immunity and the possibility of vaccine strain mismatch. Furthermore, delayed diagnosis and recognition of symptoms, was contributed to by factors including lack of utilisation of appropriate laboratory testing, such as PCR, and cost, as well as presumed complete immunity.
Most of the students had had their primary vaccination course on time in childhood with an average time between the students' vaccination and the onset of symptoms of around 11 years. Despite the widespread vaccination coverage, this cluster highlights the possibility of vaccine failure or waning immunity over time.
The cluster also underscores the importance of ongoing vigilance and the potential need to consider booster vaccinations to maintain immunity, especially as international travel increases the risk of imported infections and the disruption of vaccination programs internationally throughout the covid pandemic.

In September of 2024, the Northern Sydney Public Health Unit in NSW was alerted to a gastroenteritis outbreak in a boarding school. On the same day, we were also contacted by the One Health Branch and requested to investigate several food complaints that had been received by the NSW Food Authority.
Further investigation and interviews with complainants revealed a link between the public complaints and the boarding school. All complainants had eaten at one of two food outlets that were owned by the same company and served the same food type. The boarding school was located within easy distance of both outlets and was a preferred after-school and weekend hangout for students.
The NSW Food Authority was alerted to the outcomes of interviews and undertook investigation of the venues reviewing food safety practices, inspecting preparation areas and undertaking food testing. A second wave of complaints prompted further investigation and actions by the food authority, resulting in further reviews of food importation processes and potentially the prevention further cases.
Digital and social media-savvy individuals, particularly younger demographics, were most affected by the outbreak. Many complainants utilised social media platforms and online food reviews to share their symptoms, potentially amplifying the issue and raising public concern. Despite the increased awareness, few were willing to undergo testing, as many believed their symptoms were mild, self-limiting, or had already resolved by the time they made complaints. Additionally, the high level of gastro-like illness circulating in the community made it difficult to differentiate between unrelated cases and those tied to the outbreak. While social media and digital disease surveillance offer promise, they also raise ethical concerns. In this case, it’s unclear whether these online reviews increased noise in the investigation or improved reporting.

ASSESSMENT OF INFLUENZA VIRUS AND CO-INFECTION WITH SARS-COV-2 OR RESPIRATORY SYNCYTIAL VIRUS
Gebremariam1*, Dhekebo2, Ebren1, Binegde3, Tolossa1, Ali1
1PHEM and Research, Adama public health research referral laboratory center, Ethiopia, 2Meki district Hospital Laboratory
3Adama Comprehensive Specialized Hospital MedicalCollege
*Corresponding author E-mail: fikrumelaku@gmail.com
Abstract
Acute respiratory disease (ARD) accounts for large proportion of all acute morbidities and mortalities worldwide, among which acute viral respiratory tract infection is leading cause (appropriate 80%). Major Viral pathogens include influenza virus, respiratory syncytial virus (RSV), coronavirus,
adenovirus, and rhinovirus. The aim was to assess influenza virus and co-infection with SARS-CoV-2 or Respiratory syncytial virus among SARI patients at Oromia Region, Ethiopia. Facility based cross sectional study was conducted during study period July 1, 2022 through to April 30, 2023 on SARI sentinel surveillance based on WHO SARI case
definitions. The throat-swab specimens collected, extracted viral RNA and subjected to CDC Multiplex RT-PCR to determine the positive cases. We further subtyped Influenza A positive specimens. A total of 302 throat-swab specimens collected and tested, 39 (12.9%) were Influenza positive where 25 (89.3%) influenza A (H3N2), 3 (10.7%) Influenza A (H1N1) pdm2009 and 11 (28.2%) Influenza B. Influenza positivity rate among age categories of under 5, 5-14, 15-49, 50-64, and age greater or equal to 65 years, respectively, were 58.9%, 26.6%, 5.1%, 5.1%, and 5.1%. Of the total 22 (7.3%) and 11 (3.6%) found to be positive for SARS-CoV-2 and RSV viruses, respectively. Among positive SARS-CoV-2 cases 73.2%, 13.6% and 9% attributed to age under 5, 15-49 and greater 65 years, respectively. Among positive RSV viruses 91% attributed to less than 5 years. Finally, co-infection with SARS-COV-2 and RSV found on 5(12.8%) and 3(7.7%) children, respectively, during December, January and February. Influenza co-circulation and co-infection mostly in under five children: not vaccinated, highlights economic burden implying less monitoring of vaccine uptake. Therefore, healthcare system and public should implement vaccination, holistic approach IPC measures, surveillance scaling up to include all age, never over look co-infection, strengthen multiplex (rt-PCR), conducting research well addressing the co-infection using large sample and case control study.
Key Words: SARI, Influenza, SARS-CoV-2, RSV

Since 2013, the Pharmacy Board of Australia has considered the administration of vaccines within the scope of practice of suitably trained pharmacists¹.
Each Australian State and Territory has utilised various mechanisms within the architecture of their medicines and poisons legislation to facilitate pharmacists administering vaccines². Generally, these include an authority and list of vaccines pharmacists may administer in defined circumstances.
In South Australia, pharmacists were added to the Vaccine Administration Code (Code) in 2015. The Code is subordinate legislation under the Controlled Substances (Poisons) Regulations 2011 which was originally developed to facilitate registered nurses administering vaccines under programs delivered through local councils.
Over the past decade, pharmacists have played a significant role in providing easy accessibility for South Australian's seeking vaccines, including the seasonal influenza vaccine, COVID-19 vaccine and others under the National Immunisation Program Vaccinations In Pharmacy (NIPVIP). Community acceptance and demand for pharmacist-delivered vaccine services was reflected in ongoing updates to the Code allowing pharmacists to administer an expanding range of vaccines. Limitations of the Code, including the requirement that vaccines must be part of approved immunisation programs, proved problematic in allowing pharmacists to provide all vaccine services within their scope of practice.
With support from the Minister for Health and Wellbeing, a process was undertaken to make a new regulation under South Australian legislation to facilitate pharmacists administering vaccines. The regulation minimises regulatory barriers and empowers pharmacists to work to their individually defined scope of practice, allowing the pharmacist vaccinator workforce to realise its full potential. South Australia is unique as the first Australian jurisdiction to allow pharmacists to administer vaccines in line with individual practitioner’s scope of practice and the Australian Immunisation Handbook.


References:
1. Pharmacy Regulation at work in Australia 2013/14 AHPRA---Report---Pharmacy-Regulation-at-Work-in-Australia-2013-14.PDF
2. Pharmacist administered vaccinations Pharmacist administered vaccinations - Pharmaceutical Society of Australia (psa.org.au)

Introduction:
Botulism is a rare, potentially fatal illness resulting from intoxication with a botulinum neurotoxin. Outbreaks are reported worldwide in humans, animals, and the environment. With toxin identification reliant on traditional surveillance methods conducted in laboratories. Open-source epidemic intelligence (OSINT) provides an alternative disease surveillance method in which outbreaks are reported from open sources such as news media, websites, or social media.

Methods:
Using the AI-driven OSINT early warning system EPIWATCH, we extracted a dataset published between 31 December 2016 and 1 January 2025 and filtered by our search terms to identify botulism outbreaks. Data collected included country, event date, location, symptoms, outbreak type (human/animal), case numbers, hospitalisations, antitoxin treatment, deaths, source and origin of outbreaks, botulism type, toxin strain, and time from exposure to symptom onset. Analyses were conducted using STATA/BE 17.0 and hotspot mapping in ArcGIS Pro v.3.1.

Results:
We identified 296 botulism outbreaks, affecting 28,634 individuals, with 27,334 deaths. Human outbreaks (87.5%, n = 259) resulted in 1,097 cases and 47 deaths, while animal outbreaks (12.5%, n = 37) accounted for 27,537 cases and 27,287 deaths. The highest number of human outbreaks occurred in Ukraine (56.0%, n = 145), the Russian Federation (10.8%, n = 28), and the United States of America (7.0%, n = 18). Common symptoms included dysphagia (11.0%), nausea (9.0%), and generalised weakness (8.8%). The primary transmission routes were foodborne (79.5%), unknown (13.5%), and iatrogenic (3.1%). The most frequently implicated sources were dried fish (33.2%), unknown (15.4%), and canned fish (5.4%). Toxin strain was rarely reported (97.7%), with strain B (1.2%), strain E (0.8%), and strain A (0.4%) identified. Symptom onset most often occurred within one day (8.1%) or the same day (5.0%) after exposure.

Conclusions:
There is no global surveillance system for botulism. OSINT-based surveillance provides a unique way to understand the global epidemiology of outbreaks, especially for diseases for which global surveillance systems do not exist, and to guide outbreak response.

Influenza is a vaccine-preventable disease, with free National Immunisation Program (NIP) vaccines for at-risk groups. Children, are a priority group because they have the highest influenza rates and risk severe illness, driving healthcare costs and family strain. In 2024, only 25.8% of Australian children aged 6 months to under five years received an influenza vaccine, historically lower than other NIP vaccines. Global declines are also evident. Our hypothesis is outreach clinics at accessible times and locations can improve coverage.

The Australian Capital Territory Health Directorate and Canberra Health Services collaborated to deliver a two-year outreach vaccination pilot program from 2024-2025. The pilot program aimed to implement outreach clinics for 8 weeks each year from May-June, to align with the surge in seasonal influenza cases. The pilot program held outreach clinics during weekdays and weekends at accessible locations, such as community halls, scout halls and places of worship.

There was strong community support, with the highest uptake observed during Saturday clinics. Parents also rated the service more accessible than existing childhood immunisation providers, such as General Practices and Early Childhood Immunisation clinics which are only open during business hours. Interim evaluation suggests that after-hours service is more important to parents than new locations.

Limitations of the pilot included the inability to address other barriers to immunisation, including negative attitudes and perceptions to the influenza vaccine and not catering to parents who are less supportive of childhood immunisations. It is recommended to address these while continuing to drive accessibility through outreach programs.

The current program model could be used to guide future afterhours immunisation investments for young children’s routine NIP vaccinations. Furthermore, this model could be adopted to immunise vulnerable groups and emerging threats such as mpox and avian influenza.

Objective: The Australian paediatric National Immunization Program (NIP) currently includes a 2+1 schedule of the 13-valent pneumococcal conjugate vaccine (PCV13). The 15- and 20-valent pneumococcal conjugate vaccines (PCV15 and PCV20, respectively) are available, but not yet NIP funded in Australia. This study investigated the cost-effectiveness of implementing PCV20 compared with PCV13 and PCV15 in the Australian paediatric NIP.

Methods: The analysis utilised a population-based multi-cohort model over a 10-year horizon with costs and benefits discounted at 5% annually. The model considered direct vaccine effects for vaccinated cohorts (aged <2 years) and indirect effects for unvaccinated cohorts (all ages). Epidemiological, cost, and utility input data were obtained from Australian-specific sources and literature, while vaccine effectiveness estimates were derived from PCV13 real-world data, 7-valent pneumococcal conjugate vaccine (PCV7) trial data, and PCV7/PCV13 impact data. Model outcomes included pneumococcal disease cases (invasive pneumococcal disease, pneumonia, and otitis media), deaths, costs, and quality-adjusted life years (QALY), which were used to calculate incremental cost-effectiveness ratios. Sensitivity analyses were conducted to examine model robustness.

Results: Over 10 years, PCV20 was estimated to prevent more disease cases and deaths than PCV13 (642,804 and 8,308, respectively) and PCV15 (290,943 and 3,730, respectively). These greater health benefits translated into substantial QALY gains of 117,417 and 55,279, and total cost-savings of AUD 668,174,379 and AUD 312,296,604 with PCV20 versus PCV13 and PCV15, respectively. Therefore, the model predicted that PCV20 would be the dominant vaccination strategy versus both comparators in the base case. PCV20 was also dominant versus PCV13 in 97.40% of probabilistic sensitivity analysis iterations and versus PCV15 in 85.70% of iterations, suggesting robust results.

Conclusions: This cost-effectiveness analysis estimated that paediatric vaccination with PCV20 would be the dominant strategy, outperforming both lower-valent options – PCV13 and PCV15 – in terms of health benefits and cost-savings among the Australian population.

Mpox, a viral disease with two clades (clade I and II) has re-emerged as global health emergency. This study describes the epidemiology of the mpox clade IIb outbreak in Australia and critically evaluates current surveillance systems and public health responses, highlighting the need for complementary surveillance strategies. Using a mixed-methods design, trends in national and state-level epidemiological data from 2022 to 2024 were analysed descriptively. A literature review was conducted, and the findings were summarised thematically.
Between 2022 and 2024, a total of 1,582 mpox cases clade IIb were reported in Australia through the NNDSS surveillance system: 144 in 2022, 26 in 2023, and 1,412 in 2024, representing an 881% increase between 2022 and 2024 and 5330% increase between 2023 and 2024. As of December 2024, NSW reported 798 cases, Victoria 575 cases, Queensland 135 cases and other states 74 cases. The incidence rate per 100,000 population was 9.9 in NSW, 8.8 in Victoria, 2.6 in Queensland and 1.3 in other states.99% of cases were male, with 60% aged 30–44 years and most reported male-to-male sexual exposure. In 2024, NSW accounted for 52% of all cases, marking a 1204% increase from 2022. Most (88%; 646/721) case in NSW reportedly acquired it locally, and only 39% having received two-doses of vaccine. Mpox surveillance relied on laboratory notifications, which depended on symptomatic cases presenting to clinics, followed by case interviews and contact tracing. The self-limiting nature of the illness also impacted case notification. A literature review indicated that individuals with mpox infection reportedly experienced stigma associated with the contact tracing process, as well as discrimination and fear of judgment.
There was a sharp increase in mpox cases in Australia between 2022 and 2024. In NSW, cases increased over 60-fold, with over three quarters acquired through local transmission. The sharp rise in mpox cases in 2024 could be attributed to, pre-symptomatic transmission, inadequate vaccine uptake, challenges in contact tracing, and the prevailing stigma and discrimination faced by GBMSM. Integrating environmental and wastewater surveillance which is independent to individual’s care seeking behaviour can enhance existing surveillance efforts.

Vaccine hesitancy is a serious threat to public health, leading to vaccine rejection or delayed vaccine coverage. Social media (SM), a quick information source, has been a source of vaccine misinformation, which negatively impacts global vaccination rates. It has become essential for identifying vaccine public sentiments, concerns, and topics of discussion. Moreover, the information on SM is not driven exclusively by genuine human-run accounts. The contribution of social bots in vaccine-related discussions complicates the reliability of social media data.
To address these challenges, we developed VaxPulse Query Corner (VaxPulse QC), a Retrieval Augmented Generation-based tool designed to enhance the reliability of social media analysis for vaccine-related discussions. This tool answers complex queries from public health administrators and other stakeholders, helping them understand public concerns regarding vaccines on various online platforms by bridging the knowledge gap.
While Large Language Models (LLMs) can answer queries, they lack real-time awareness of events and anxieties, and are prone to hallucination, a critical risk in public health messaging. Recognising these limitations, VaxPulse QC is a Retrieval Augmented Generation-based tool to overcome the challenges of traditional methods and LLMs.
The same tool could be used to segregate human and bot-generated SM comments to provide us with crucial insights into the spread of misinformation and genuine public concerns. For instance, conducting a temporal analysis could help us to understand the transfer of concerns from bots to humans. VaxPulse QC segregates bot and human concerns using our bot detection tool, followed by an iterative process: (a) extracting and ranking relevant comments, (b) compressing context, and (c) generating differentiated outputs. Analysing 7,847 Shingrix® zoster vaccine posts, it achieved 90% recall, with average answer faithfulness and relevancy scores of 0.96 and 0.94.

Vaccine hesitancy poses growing threats to public health across Australia, particularly for vulnerable populations such as pregnant women. Delayed or missed uptake of recommended vaccines during pregnancy can lead to serious health consequences for both mother and child, yet the factors driving vaccination behaviour in this population remains under investigated. This talk will present preliminary findings from the Emotional Mental Imagery in Vaccine Acceptance (EMIVA) study, a WA Child Research Fund funded project investigating modifiable psychological factors predicting vaccination behaviour during and after pregnancy. N = 411 pregnant women attending antenatal clinic at King Edward Memorial Hospital in Perth completed a baseline survey relating to disease and vaccine-related risks and anticipated emotions relating to Pertussis, Influenza, and Covid-19. Importantly, participants were asked to report the occurrence of spontaneous mental images relating to disease and vaccines whilst completing the survey. This talk will present preliminary findings concerning the role of emotional mental imagery as a predictor of maternal vaccine hesitancy and behaviour at baseline, as well as prospectively at the end of pregnancy.

Background
Newborns are at greatest risk of mortality at birth due to neonatal complications. To reduce maternal and neonatal complications, the World Health Organization recommends ≥4 antenatal care (ANC) visits. In Pakistan, only 51% of women receive ≥4 ANC visits, a rate lower than that of other middle-income countries. Limited research in Pakistan explores how ANC visit frequency affects newborn health and immunization.

Objective
To evaluate the impact of recommended ANC visits on newborn health outcomes and immunization coverage in Sindh, Pakistan

Methodology
Using a pregnant women birth registry program, we analyzed data of women visiting healthcare facilities between November 2020 and December 2021. Women were stratified into Group-1 (≥4 ANC visits) and Group-2 (<4 ANC visits). Two-sample proportion tests were applied to compare birth weight, gestational age, and full immunization coverage (FIC) between groups.

Results
Among 33,137 enrolled pregnant women, for all 15 sites, 75% received at least one ANC visit. The proportion of women receiving four or more ANC visits increased in all sites. Low birth weight was lower in Group-1 (0.57%) than in Group-2 (1.02%) (p<0.05), preterm birth was lower in Group-1 (0.80% vs.1.61%, p<0.001) FIC was higher in Group-1 (51.43%) compared to Group-2 (41.22%) (p<0.001). Antigen-wise coverage for Group-1 vs. Group-2 was: BCG (86.46% vs. 76.25%), OPV-0 (96.32% vs. 94.02%), HepB0 (18.31% vs. 16.42%), Penta-1 (77.27% vs. 68.65%), Penta-2 (70.10% vs. 60.95%), Penta-3 (65.65% vs. 56.78%), Measles-1 (65.17% vs. 56.01%), and Measles-2 (53.25% vs. 42.92%).

Conclusion
This study highlighted that utilization of ANC ≥4 visits has significantly lowered the rate of low birth weight, preterm birth and improved FIC coverage from 41% to 51%. Strengthening interventions to increase ANC visits may contribute to better newborn health outcomes and immunization coverage.

Keywords: Antenatal care, longitudinal study, Immunizations, Pregnant Women, Birth Registry

Background: Vaccination uptake in donors may differ from the general population. Understanding these differences is essential for accurately interpreting vaccine-preventable disease (VPD) serosurveillance data from donor samples.
Methods: We utilised data from the Sax Institute’s 45 and Up Study (baseline recruitment 2005-2009, n=267,357), linked to blood donation records, the Australian Immunisation Register, and Registry of Births, Deaths, and Marriages records. By 2020, 37,671 (14.1%) of 266,413 participants available for this analysis had donated blood at least once. A total of 35,432 donors and non-donors were included in this analysis after matching on age and sex. Participants were categorised as active donors, other donors, or non-donors for each analysis year (2021–2023). Annual/cumulative vaccination uptake differences for influenza, pertussis, herpes-zoster, pneumococcal, and COVID-19 vaccines were calculated. Regression models were used to assess the association between donor status and vaccination likelihood, adjusting for confounders. These analyses will be updated further using more recent deaths data.
Results: In the matched cohort, 56.9% were females, average age was 72.1 years (SD 7.4). The cumulative vaccination uptake differences between active donors and non-donors for herpes-zoster (70+years), pneumococcal (70+years), and pertussis (65+years) were 19.3%(16.9–21.7), 11.5%(8.8–14.1), and 5.8%(4.5–7.2), respectively. Average annual influenza uptake difference for 65+years was 9.2%(8.4–10.1), while the difference for at least two COVID-19 vaccine doses in 2021 was 6.7%(6.1–7.2). Adjusted relative risks of vaccination for active donors vs. non-donors remained higher: herpes-zoster: 1.22(95%CI 1.15–1.30), pertussis: 1.16(1.06–1.27), pneumococcal: 1.20(1.13–1.28), influenza: 1.09(1.07–1.11), and COVID-19: 1.04(1.03–1.05).
Conclusions: For this cohort, blood donors had relatively higher vaccination uptake than non-donors. These findings emphasise the need to account for vaccination differences when interpreting serosurveillance data from donor samples for accurate insights of VPDs. Further care should be taken while interpreting the results of this study as the 45 and Up study was not designed to be representative of the general population.
Footnote: We thank the Centre for Health Record Linkage (www.cherel.org.au) and Australian Institute of Health and Welfare for the provision of linked Registry of Births, Deaths, Marriages data, and Australian Immunisation Register data, respectively. Secure data access was provided through the Sax Institute’s Secure Unified Research Environment.

Introduction
Social media platforms generate real-time, valuable health data, offering insights into vaccine reactions crucial for monitoring vaccine safety and early intervention. However, the volume, diversity, and informal nature of this content pose significant challenges for automated detection. This study explored the use of large language models (LLMs) to identify personal health mentions (PHMs) related to vaccine reactions and assessed the role of LLMs in accelerating the development of lightweight, high-performance classifiers for scalable surveillance systems.
Methods
We evaluated different prompting strategies (zero-shot, few-shot, chain-of-thought) across two LLMs (GPT-3.5, GPT-4) using Reddit data focused on shingles vaccines. Additionally, we compared LLMs against a traditional fine-tuned transformer-based model for vaccine-related PHM detection. We also examined how LLMs can complement traditional models by identifying missed cases and generating high-quality synthetic training data, enabling rapid and resource-efficient classifier development.
Results
Chain-of-thought prompting significantly improved LLM performance, with GPT-4 achieving an F1-score of 0.90 using a few-shot approach. While the fine-tuned transformer-based model outperformed LLMs in classification accuracy, LLMs excelled at identifying previously missed cases (false negatives) and generating synthetic data, accelerating the development of more accurate, lightweight models with minimal labelled data.
Conclusion
This study highlighted the potential of LLMs in rapidly developing efficient, high-performing classifiers for vaccine safety surveillance. By leveraging LLM-generated training data, smaller and more precise models can be trained with minimal resources, making surveillance systems more scalable and accessible. This approach is particularly valuable for real-time adverse event detection in resource-limited settings. By improving vaccine safety monitoring, these advancements can strengthen public confidence in immunisation programs, ultimately supporting higher vaccine uptake and better communicable disease control.

Biosecurity is inherently a cooperative issue: biothreats in the form of communicable diseases readily affect and spread between all communities. There are many interrelated axes of inequity including wealth disparity, racial inequalities, and gender discrimination. Heightened vulnerability to biosecurity risks within any community increases the risk for all communities. As a result, equity is a fundamental consideration for effective biosecurity investment.
We analyze inequity through the lenses of biosecurity resource allocation and participation. Through the analysis of case studies on interventions like the COVID-19 Vaccines Global Access (COVAX) vaccine initiative and a comprehensive data review of models about biothreats, it becomes evident that investments in cooperative technology and research yield significant benefits. Retrospective analyses of successful attempts to incorporate Indigenous engagement and peer-to-peer training programs demonstrate paths forward for equitable biosecurity participation.
To improve equity in biosecurity intervention resource distribution, we recommend that the World Health Organization (WHO) implement explicit compliance mechanisms to bolster technology sharing. In addition, we recommend that biosecurity funding entities create grants specific for research elucidating biothreat presentation and treatment in under researched populations. These recommendations are intended to increase the availability and effectiveness of treatments for vulnerable populations and additionally benefit non vulnerable populations through increased efficiency in resource use.
To improve equity in biosecurity participation, we recommend a new Biological Weapons Convention (BWC) Confidence Building Measure (CBM) promoting equity and urge the inclusion of equity commitments across international health and biosecurity organizations. These measures from large international biosecurity bodies would result in improved commitment and discussion surrounding the importance of equity. We additionally propose that the BWC expand upon its Sponsorship Program to include more financially excluded participants. Furthermore, we recommend the uptake of the Implementation tool of Practical Interventions and Measuring Progress by biosecurity organizations to improve equity practices across the professional sector.

Protecting the community against Q Fever: The Gippsland Q Fever Project

Background
Gippsland is a major agricultural region in Southeastern Victoria, where dairy farming and meat production are key industries. In 2024, following multiple outbreaks and a subsequent sharp rise in cases, Gippsland reported 45 per cent of all Q fever cases in Victoria. In response, the Gippsland Region Public Health Unit (GRPHU) launched a community engagement and media campaign. This response was amplified leveraging a partnership with the dairy industry body (GippsDairy), to increase reach and explore solutions to improve vaccine access and reduce costs.

Process
A steering committee was convened with membership from GRPHU, GippsDairy, WorkSafe, Agriculture Victoria and FarmSafe Australia. Three key interventions were identified as the focus for the Gippsland Q Fever project: subsidising testing and vaccination, improving access to vaccine providers; and increasing awareness within the healthcare and agriculture sectors. A serosurvey to capture levels of exposure within the community was also identified as a future lobbying tool for government funded vaccine. A successful grant received through the Victorian Livestock Biosecurity Fund (Agriculture Victoria) helped fund the project.

Results
Three primary health care clinics were engaged to offer subsidised Q fever testing and vaccinations to 200 dairy farm workers in 2025. A nationwide vaccination shortage slowed the process, however testing and vaccinations are underway. Twenty extra health care practitioners were selected via an expression of interest process to complete training in Q fever testing and vaccination via an online module as well as a practical component.

Outcomes
Greater ongoing investment in screening and vaccination services to increase Q Fever awareness and minimise cost and access barriers is essential. Exploring policy options to enhance preventive measures for high-risk occupations may be required to mitigate the rising number of cases nationwide. Ongoing engagement with agribusinesses is also needed to bolster Q fever awareness to reduce the disproportionate burden of Q fever in Gippsland.

Carbapenemase-producing organisms (CPOs) are a major threat to public health and patient safety, with carbapenemase-producing Enterobacterales notifiable in Victoria since 2016, and Acinetobacter and Pseudomonas species from 2019. Together with the Victorian Department of Health, local public health units, and health services, MDU PHL integrates prospective genomic and epidemiological investigation of CPO cases to detect local transmission. Here we report on the evolving epidemiology of CPOs in Victoria.

In 2024, 450 cases were notified (0.64 notifications per 100,000 population), the highest in nine years of surveillance and 30% more than 2023. About half (57%) of cases were likely acquired overseas; of the remainder, only one-third were attributable to a known local cluster or outbreak, and two-thirds were unknown source. Twenty-six transmission risk areas (TRAs) were declared across one regional and five metropolitan health services; 14 TRAs occurred in one health service with six distinct outbreaks. Most local outbreaks involved blaNDM (50%) and blaIMP (30%). Overall, blaNDM-5 has emerged as the most common carbapenemase gene, reported in one in three cases in 2022-2024, compared to fewer than one in five cases from 2016-2021. The prevalence of blaNDM-1 has also increased from just over 10% of cases before 2022 to 25% in 2024. Surveillance is also detecting novel carbapenemase genes, including blaOXA-1205 and blaOXA-1207.

The World Health Organization highlighted CPOs as the most critical bacterial priority pathogens in 2024. CPO epidemiology in Victoria has notably evolved, with increasing complex transmission patterns in recent years. Consistently high case numbers reflect increased importation of blaNDM-5 and multiple local outbreaks of blaNDM-1 transmission, likely via mobile genetic elements (MGEs). Comprehensive national surveillance and response is required to reduce impact of CPO importation. Current surveillance and response protocols do not account for MGE transmission; novel methods are essential to adequately respond to these outbreaks.

Australian First Nations children living in remote communities have among the highest reported rates of otitis media (OM). Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are major pathogens. The prevalence of chronic suppurative OM (CSOM) declined post 7-valent pneumococcal conjugate vaccine (PCV7), from 24% to 17%, but remains a major public health emergency (>>4%) post PCV13 (12%). Furthermore, the prevalence of bilateral healthy ears persists at only ~10%.
Surveillance during 2 years of government funded NTHi protein D-conjugated 10-valent PCV (PHiD-CV10) in the Northern Territory showed a decline in culture of NTHi from ear discharge and a decline in prevalence of AOM, compared to the PCV7 era.
In two randomised controlled trials of primary and booster dose mixed schedules (the PREVIX – PREVenar and SynflorIX trials) we found:
1. below threshold immunogenicity of first dose PCV13 compared to a strong first dose PHiD-CV10 response
2. a similar immune response following one versus three doses of PCV13
3. no difference in nasopharyngeal carriage or any type of OM at any timepoint for any schedule
4. significantly less hearing loss post-PCV13 booster versus post-PHiD-CV10 booster
These RCTs confirm first evidence and importance of data from mixed and novel PCV schedules. Lack of response to PCV13 at age 2 months suggests that for high-risk or naive populations, a 1+1 PCV13 schedule may increase risk compared to PHiD-CV10. The anticipated benefit for OM from PHiD-CV10 was not shown, whereas potential for PCV13 to impact hearing via unsubstantiated mechanisms, needs investigation.

Background
The human papillomavirus (HPV) vaccine was included in Australia's National Immunisation Program (NIP) school-based program for females in 2007 and males from 2013. Since then, the program has undergone several changes. Initially recommended as a 3-dose schedule using 4-valent HPV vaccine (Gardasil™), in 2018 the HPV vaccine moved to a 2-dose schedule, and replaced with the 9-valent vaccine (Gardasil®9). In February 2023, based on emerging evidence, the program moved to a single dose schedule for immunocompetent adolescents aged 12–13 years.

Methods
SAEFVIC is the reporting service in Victoria for Adverse Events Following Immunisation (AEFI) and integrated with clinical services. A search of the SAEFVIC database was undertaken for the period 2007 to 31 December 2024 for individuals aged 11-16 years following HPV vaccination.

Results
1,734 AEFI reports were identified, corresponding to 2,869 adverse events. 61% of reports were following dose 1 with median age 12 years old and 61% relating to females. 884 (51%) had a concomitant vaccination (i.e. Boostrix). The most frequently reported AEFI were urticaria/rash (14.7%) followed by vasovagal (syncope) (12.6%), injection site reaction (8.9%) and headache (7.7%). 438 (25%) of individuals were seen in a specialist Immunisation clinic (SIC) with main reason for consult being rash/urticaria and vasovagal episodes. Since moving to a single dose schedule, SAEFVIC has only received 75 reports following HPV vaccination and 7 individuals seen in a SIC.

Conclusion
As expected with the introduction of a new vaccine, AEFI reporting volume was high in 2007/2008 as demonstrated by the 26 cases of ‘mass psychogenic response’ reported at a Melbourne school shortly after the program commencement. Reporting increased again in 2013 with the introduction for males before stabilising in line with dosing schedule changes. Over the past 18 years, SAEFVIC has supported uptake of the 9-valent HPV vaccine through safety messaging for healthcare providers and consumers via phone counselling and specialist clinic referral where required.

Background
Influenza vaccine formulations change annually to capture new circulating virus strains demanding sensitive and responsive post-market surveillance systems to swiftly detect and investigate adverse events following immunisation (AEFI).

Process
Since 2023, the TGA has conducted monthly expanded safety surveillance for seasonal influenza vaccines reviewing AEFI reported to the TGA and adjusting for vaccine doses using data from the Australian Immunisation Register (AIR) during the influenza season. We examined the overall numbers, cumulative reporting rates, and the most frequently reported AEFI for all influenza vaccines, with subgroup analyses conducted by trade name. Reporting rate trends for adverse events of special interest (AESI) including pyrexia, febrile convulsions, seizures, Guillain Barre Syndrome (GBS), stroke, pericarditis and myocarditis were monitored. AESI reporting rates were compared against published background population rates. Disproportionality analysis reporting (DPAR) was conducted to identify potential safety signals. Active surveillance findings for seasonal influenza vaccines published in the National Center for Immunisation Research and Surveillance’s AusVaxSafety reports were also considered.

Analysis
From 1 March to 31 August 2024, 1,034 AEFIs following influenza vaccination were available for analysis. Cumulative rates of AEFI were considered rare across all influenza vaccine trade names. Seven of the ten most frequently reported AEFI were expected and listed within the vaccine product information. No potential safety signals were identified for the monitored AESI. Three unknown safety signals identified from DPAR were further investigated, each resulting in a recommendation to update the relevant product information.

Conclusions
The TGA’s expanded safety surveillance of influenza vaccines provides reassuring evidence of the safety profile of quadrivalent vaccines. The TGA will continue to use expanded safety surveillance methods to promptly identify, investigate, and action potential safety concerns with influenza vaccines, including for the new trivalent influenza vaccines to be phased in during 2025.

Background
The National Immunisation Program is constantly evolving. The introduction of Abrysvo (RSV vaccination) onto the schedule for pregnant people, prompted MVEC (Melbourne Vaccine Education Centre, mvec.mcri.edu.au) to analyse the utility of current methods for disseminating information to the immunisation workforce. Access to and engagement with reliable, useful and timely education for vaccine providers is crucial for supporting the success of program changes. It gives clinicians the confidence to discuss vaccine recommendations with patients and encourage acceptance and uptake.

Aim
To better understand immunisation providers’ preferences for vaccine education modalities in 2025.

Methods
In early 2025, we surveyed healthcare professionals on their perceived value of (5-point scale) and self-reported demand for (3-point scale) various vaccine education tools.

We collected information on frequency and motivations for seeking vaccine education, workplace support for education, their professional roles and geographic location.

Results
Of the 67 responses received from across Australia (as at 20 February 2025), interim findings indicate differences in the various tools: web-based resources (M(value)=4.71, M(demand)=1.92), eLearnings (4.46, 2.23), webinars (4.57, 2.14), face-to-face activities (4.11, 2.37), newsletters/alerts (4.62, 1.19), podcasts (3.69, 2.21), social media (3.45, 2.22) and direct contact with an immunisation authority (4.36, 2.22).

Further analysis showed that providers in regional areas (n=24) reported the lowest value in (M=4.19) and demand for (M=2.14) education overall compared with metropolitan respondents (M(value)=4.28, M(demand)=2.16). Across all locations, the education tool in highest demand by nurses was face-to-face activities (M=2.45), whereas doctors prefer education delivered via podcasts (M=2.60).

Conclusion
Understanding healthcare professionals’ needs and preferred method of information delivery, noting this may change over time, can lead to more targeted education and communication. Recognising and acting on barriers to engagement with education tools will further support successful program changes across both metropolitan and regional areas.

Background:
Shigellosis is transmitted via the faecal oral route with many cases acquired overseas due to poor food hygiene practices; however, local transmission is seen in Australia among men who have sex with men (MSM). This transmission is linked to oro-anal sexual practices with increased risk of transmission of other sexually transmissible infections (STIs). At the South East Public Health Unit (SEPHU) in Victoria shigellosis cases with MSM contact as an acquisition risk factor are asked if they have had recent testing for STIs. For cases who have not had recent STI testing we recommend they obtain appropriate screening.
 
Aim:
To determine whether shigellosis cases with MSM contact as a risk factor undertook subsequent STI screening upon the advice of the local public health unit.

Method:
Data on all shigellosis cases that were notified to SEPHU between 1 January 2023 and 31 December 2023 who identified MSM contact as a risk factor were extracted from the Victorian Public Health Events Surveillance System. Eligible cases were contacted by phone by the project lead, and those who consented to participate were asked standardised questions about their shigellosis knowledge and STI testing. Where the first call was not answered, a further two phone calls were made and one text message sent.
 
Findings:
55 notified cases were identified for the study period. Five cases were lost to follow up during initial management after shigellosis diagnosis. Of the remaining 50 cases, 20 either declined participation or could not be contacted, and interviews were successfully completed for all 30 remaining cases.

At the time of initial management after shigellosis diagnosis, 26 cases (87%) had reported a recent STI test. Twenty-nine cases (97%) reported at least one STI screen after initial follow-up and 80% reported routine STI testing every three months. Additionally, 3% were living with Human Immunodeficiency Virus, 73% were on Pre-Exposure Prophylaxis and 57% were vaccinated for Hepatitis A. Nearly all cases (93%) were not aware that shigellosis is sexually transmissible.
 
Conclusion:
While most people were routinely undergoing regular STI checks, there was limited awareness that shigellosis can be transmitted through sexual contact.

Background: Biosafety laboratories, including those found in vaccine-producing companies, are vital in producing vaccines to control and eliminate infectious diseases. However, they can be a source of unnatural outbreaks through accidental or incidental escapes of pathogens handled in these facilities. One of the largest laboratory leak-related brucellosis outbreaks occurred in 2019 from the Lanzhou Biopharmaceutical Plant, which produced animal brucellosis vaccine using live attenuated brucella bacteria. This laboratory leak has sickened over 10,000 people, including the laboratory workers and the community.1 Detecting such laboratory leaks is vital yet highly challenging. Given the endemicity of brucellosis in China, with known laboratory accident-related outbreaks, this study focuses on China’s brucellosis accident to examine geospatial techniques' capability to red-flag laboratory accidents early.
Aims: This study aimed to examine the capability of geospatial analysis of open-source intelligence data from EPIWATCH@ to detect laboratory acquired infections early.
Methods: We retrieved data on brucellosis outbreak signals collected in EPIWATCH@ from 2016 to 2024. EPIWATCH@ is an artificial intelligence based system that monitors global infectious disease outbreaks using open source data worldwide. To examine the capability of geospatial analysis of open-source intelligence data to early detect brucellosis leak in China, we identified and flagged brucellosis outbreak signals proximal to the Lanzhou Biopharmaceutical Plant, which caused the 2019 brucellosis outbreak.
Preliminary result: Open-source intelligence brucellosis outbreak signals data were available earlier than the government reported. We detected signals within 10 kilometres of the Lanzhou Biopharmaceutical Plant, and a nearby Lanzhou Animal Research Institute. This indicates that geospatial analysis of open-source intelligence data can enhance the early detection of laboratory-acquired infections that cause community outbreaks. Further advanced geospatial analysis will be implemented.
Conclusion: Geospatial analysis of open-source intelligence data can be used to red flag laboratory accidents/incidents earlier than the usual traditional surveillance.

Background. A prior Phase 3 study (V89_18) evaluated the immunogenicity and safety of an MF59-adjuvanted, cell-based H5N1 pandemic vaccine (aH5N1c) in healthy adults. Subjects were asked to participate in an extension study (V89_18E1) to evaluate the safety of two aH5N1c priming doses followed by booster vaccinations with aH5N6c 3 weeks apart. Immunogenicity results have been reported separately.

Methods. 258 subjects were evaluated. Primed subjects, who had received 2 aH5N1c doses were randomized 1:1 to receive aH5N6c Day 1 and aH5N6c or saline placebo on Day 22. H5 naïve subjects received two aH5N6c vaccinations, 3 weeks apart. Adverse event (AE) observation extended from first vaccination until study completion. AEs were collected as either unsolicited or solicited AEs (reactogenicity) collected for 7 consecutive days following vaccination.

Results. Reactogenicity within 7 days after any vaccination was similar across treatment groups. Injection site pain was the most frequently reported solicited local AE. The most frequently reported solicited systemic AEs were fatigue, headache and malaise. Most solicited AEs were mild/moderate in intensity, with onset close to vaccination, and resolved within 3 days. Rates of solicited AEs were lower after the second vaccination than the first vaccination. Receipt of a third or fourth dose of MF59-adjuvanted H5 vaccine in primed subjects did not result in increased reactogenicity. From Day 1 through Day 43, the proportion of subjects reporting at least 1 unsolicited AE was similar across treatment groups. The majority of unsolicited AEs were mild. The overall incidence of SAEs was low and none were considered related to the study vaccine.

Conclusions. Vaccinations with aH5N6c were well tolerated and no safety concerns were identified. Repeated dosing with an MF59-adjuvanted H5 vaccine did not result in increased reactogenicity. The safety profile observed in this trial was consistent with that of other MF59-adjuvanted monovalent cell-based influenza vaccines.

Background

Spleen Australia supports individuals with asplenia and hyposplenism, who are at lifelong risk of severe infections. The program provides vaccination guidance, education, and long-term support, with registration linked to a 69% reduction in serious infections. Funded by Queensland, Victoria, and Tasmania, Western Australia (WA) joined most recently. This study evaluates WA’s enrolment and barriers to participation.

Methods

The Spleen Australia registry (12,541 active patients) was reviewed to analyse enrolment trends. Eligible individuals were estimated using a prevalence of 0.2% of the population. A qualitative evaluation was conducted with WA health stakeholders to assess implementation challenges.

Results

Since WA began registering patients in April 2023, 380 of an estimated 6,000 (6%) have enrolled, compared to 57% in Victoria (8,039/14,000), 31% in Queensland (3,418/11,000), and 57% in Tasmania (633/1,100).
WA’s indications for splenectomy were comparable to other states, except for a higher proportion of cancer-related cases and fewer trauma-related splenectomies (13% vs. 28%, P<0.001). Targeted follow-up with trauma surveillance systems and key stakeholders are needed to identify these patients. Strengthening engagement with general surgeons, haematologists, GPs, and immunisation nurses will be essential for improving registration.

Conclusion

WA is in the early stages of Spleen Australia’s implementation, focusing on building awareness, increasing registrations, and partnerships. Limited awareness and engagement have been addressed through collaborations and educational outreach to medical specialists, general practitioners, clinic nurses and immunisation providers. Future efforts will prioritise identifying historical splenectomies, especially trauma cases—and strengthening outreach to healthcare providers to improve registration and long-term program impact.

Tuberculosis is one of the biggest health burdens worldwide with 10.6 million people infected in 2022 – 1.3 million of these children. It is curable and preventive according to the WHO 2022 but sequalae can be insidious and deadly, especially if the person is young or has other comorbidities such as HIV.
Having given over 12,000 BCG vaccines since its inception 13 years ago, Monash Immunisation, Monash Health’s specialist immunisation service, is one of the largest Medicare covered providers of BCG to our small people under 5 years of age in Australia. With a usual waitlist of around 6 months. and running clinics servicing 100-110 patients a month, we have become experts in BCG consultation, TST and BCG intradermal techniques and discussing the practicalities of the BCG vaccine site and its side effects with patients and their families.
This poster will cover the patients we have seen and continue to see – where they travel to, which communities they come from and our move to telehealth and coordination of visits during the covid19 pandemic shutdowns in Melbourne. Discussion and implementation of other NIP vaccines such as early MMR and influenza and learnings from these experiences will be considered and the further work we need to look at - the communities that we are missing at Monash Health and ideas that we can use to engage them as well as the outlook for BCG as a preventative vaccine going forward.

Background: Despite evidence that influenza and COVID-19 vaccines are safe and effective, uptake remains suboptimal. To expand community access to vaccines, in 2024 a National Immunisation Program for Vaccination in Pharmacy was implemented. We examined characteristics of adults receiving vaccinations in different provider settings.
Methods: Influenza and COVID-19 vaccinations given to adults (aged ≥ 20 years) between 1/1/2023 and 31/12/2024 and reported in the Australian Immunisation Register were linked to demographic information including the 2021 Census data through the Person Level Integrated Data Asset.
Results: In 2023, 61% of 7.49 million reported influenza vaccinations and 54% of 4.09 million reported COVID-19 vaccinations were provided in general practice whilst 24% of influenza and 44% of COVID-19 vaccinations were provided in pharmacies. In 2024 the number of reported doses of both vaccines declined (influenza: 7.01 million; COVID-19: 2.48 million) however, there was a small increase in the proportion (27%) and number of influenza vaccinations (1.87 million) given in pharmacy. The proportion of COVID-19 vaccinations given in general practice increased (62%) but the total number decreased substantially (1.42 million).
In 2023 and 2024, for both vaccines, a lower proportion of vaccinations were given in pharmacy among adults: aged ≥65 years (vs. <65 years); from culturally and linguistically diverse (CALD) backgrounds (vs. non-CALD backgrounds); with lower incomes (vs. higher incomes); with lower employment (unemployed vs. employed); with lower education (high school certificate vs. undergraduate degree or higher).
Conclusion: Overall general practice continues to be the most common setting for both influenza and COVID-19 vaccination. Groups known historically to have lower vaccine uptake also had low uptake of vaccination in pharmacy. Expanding vaccination provider types, including to pharmacy may help encourage uptake, but examining how this impacts population coverage in undervaccinated populations is needed to inform future setting-specific interventions aimed at improving vaccine uptake.

The Tasmanian State Government, Public Health Units and Local Governments across Australia are using Vitavo to evolve their School Immunisation Programs.

Vitavo is a fully digital end-to-end immunisation management platform which showcases how technology is enabling:
• an increase in both response and coverage rates for routine vaccinations by up to 23%
• the expansion of school programs beyond national or state funded vaccines to include parent paid influenza and meningococcal B vaccinations
• automated communications to promote school immunisation programs to parents and legal guardians to improve response and consent rates
• and more…

This presentation will share:
• the latest practical technology examples from immunisation providers across Victoria, Queensland, Tasmania and South Australia
• additional opportunities for expansion of school programs to improve community health
• insights into future technology developments to improve access and uptake of school vaccinations and service delivery

The adoption of automated communication tools in immunisation services presents a transformative opportunity to overcome known barriers to vaccination.

This presentation addresses how automated communication tools can effectively address known barriers to immunisation in Australia, as identified by the National Centre for Immunisation Research and Surveillance (NCIRS):
1. Access barriers:
a. Appointment accessibility: Automated communication can enhance appointment accessibility by providing flexible scheduling options, sending timely reminders, and notifying individuals about upcoming or overdue vaccinations.
b. Language barriers: By offering digital communication content, automated systems ensure that non-English speakers can utilise available translation technology to support interpretation
2. Acceptance barriers:
a. Misinformation: Automated communication can disseminate accurate, evidence-based information, countering myths and misconceptions that may deter individuals from vaccinating. Providing information about the benefits of vaccines and potential side-effects can alleviate parental anxiety and distress.

Immunisation providers face additional barriers to service delivery which can also be addressed with automated communication:
1. Administrative burdens: Automating appointment reminders, recalls, and follow-ups alleviates the workload on healthcare providers, allowing them to redirect capacity toward program expansion and targeted campaigns.
2. Data completeness: Automated reporting enhances the accuracy and completeness of immunisation data, addressing issues like missing Indigenous status or medical information on health records

Vitavo is a fully digital immunisation management platform that highlights the impact of automated communication. Qualitative surveys which polled end-users from Victorian LGAs using Vitavo demonstrate this impact:
• 56% of responders weren’t aware of vaccines they were eligible for: 96% of these people found this information helpful when displayed to them
• 95% of responders perceived email and SMS appointment reminders to be helpful
• 95% of responders were very satisfied with the information provided to them pre-vaccination

The integration of automated communication tools in immunisation services presents a significant opportunity to address both access and acceptance barriers to vaccination.

Background
In 2024, the Australian Government launched the National Immunisation Program Vaccinations in Pharmacy (NIPVIP) Program, enabling eligible people to access free National Immunisation Program (NIP) vaccines in community pharmacies. The state Department of Health, in collaboration with Hospital and Health Service Public Health Units (PHUs), provides governance and clinical support to ensure safe, effective, and timely immunisation services in primary care settings.

Objective
The 2023-2024 Pharmacy Vaccination Service Provider (VSP) Quality Improvement Initiative aimed to provide direct support to registered community pharmacies in delivering safe, effective, and timely NIP immunisation services, in partnership with peak pharmacy professional associations.

Methods
The Department collaborated with PHUs and pharmacy peak bodies to engage community pharmacies to undertake a quality assurance process, including development of a Vaccine Management Protocol and a detailed cold chain management plan. A non-recurrent state immunisation program investment enabled PHUs to enhance their capacity to support pharmacies during the process of NIP expansion planning and readiness.

Results
By 1 January 2024, over 300 community pharmacies had undertaken this process and were registered with the state’s immunisation program. This number increased significantly in the 6-month period to 30 June 2024, with more than 760 community pharmacies registered.

Discussion
The initiative demonstrated successful collaboration between government, the pharmacy peak bodies and the pharmacy sector in expanding NIP vaccination services. The rapid increase in pharmacies registered suggests effective implementation of the program, improving vaccine accessibility and choice of provider for the public. Future evaluations should assess the impact on vaccination rates, consumer satisfaction, and the overall impact on the healthcare system.

Context
The Griffith Local Government Area, New South Wales is a rural town, comprising approximately 27,000 people (1). Around 30% of residents were born overseas (1) and 14% live in highly disadvantaged areas (2).
The aim of the study was to understand knowledge held by overseas-born populations in the Griffith area about acute rhematic fever (ARF), Japanese encephalitis virus (JEV), tuberculosis (TB) and syphilis, to support developing targeted health promotion and education strategies. Diseases were selected based on their relatively high prevalence in certain birth countries, rarity in Australia and potentially severe outcomes.
Process
We undertook purposive sampling of recognised community leaders of different nationality groups in the Griffith area. For consenting leaders, semi-structured interviews using open-ended questionnaires were conducted via telephone. Interviews captured information on the level of knowledge about the cause, symptoms, transmission, prevention, treatment associated with TB, ARF, syphilis and JEV. Assessments of participant knowledge for each characteristic was categorised on a scale from excellent (thorough understanding of all) to limited (little or no working knowledge about all).
Analysis
Twelve community representatives from seven nationalities were interviewed (Egypt, Fiji, India, Indonesia, The Cook Islands, Tonga, Malaysia). Participant ages ranged from 27 to 77 years, seven were women.
One participant had excellent (TB, syphilis, JEV) or good knowledge (ARF). Among remaining participants, knowledge was best for TB but limited for ARF (55%) and syphilis (70%). JEV knowledge was largely fair (82%).
Outcomes
Responses were assessed using the COM-B model for behaviour change framework which generated ideas on key messages and possible communication channels for increasing awareness and health seeking behaviour in each nationality group.


1. Australian Bureau of Statistics 2021 Griffith Census Community Profiles. https://www.abs.gov.au/census/find-census-data/community-profiles/2021/LGA13450, accessed 22 November 2023.
2. Murrumbidgee Local Health District (2023) Murrumbidgee LHD Areas of Disadvantage. https://www.nsw.gov.au/sites/default/files/2023-10/Murrumbidgee-socioeconomic-disadvantage-indicators-SEIFA-2021.pdf, accessed 14 October 2023.

Introduction Australia’s adult respiratory vaccination coverage is suboptimal. There are different challenges in adult vaccination compared to child and adolescent programs. Limited public messaging about adult vaccination and complex and changing recommendations are key issues. To provide timely information on adult vaccination, Lung Foundation Australia conducted a survey with its lung disease client cohort and the general public. The analysis presented here is on vaccination barriers and preferences.
Method: Data were collected in mid-2024 (n=3,352). Demographics obtained were age, gender, state and territory residence, geographic location, and Aboriginal and Torres Strait Islander identification. Age was collected against seven brackets. For analysis, groups were condensed to 18-49 (n=855), 50-64 (n=965), and 65 and over (n=1,532). Health characteristics obtained were type of lung conditions for the lung disease cohort (40% of respondents) and presence of other chronic conditions for all participants. Data were analysed descriptively.
Results:
Barriers and preferences examined against demographics and health characteristics showed greatest variation by age. Barriers to vaccination (including out-of-pocket costs and not knowing which vaccines to get or when) decreased progressively with age. For vaccine administration, general practice and pharmacy were the most preferred settings. However, younger adults showed a greater preference for community clinics and workplace vaccination. Nearly half (46%) of 18–49-year-olds indicated they would be more likely to receive the influenza vaccine if it were always free. This contrasted with 50–64-year-olds, where 25% indicated this, and 36% indicated they would get the vaccine regardless of cost.
Conclusion:
Australia’s adult vaccine program primarily targets those aged 65+ and those medically at-risk. While recommended to receive influenza vaccination and consider yearly COVID-19 vaccination, younger adult coverage rates are low. Despite survey findings suggesting that expanding free vaccination across multiple settings could improve uptake, the real-world impact of this strategy requires further investigation.

Residential Aged Care Facilities (RACFs) house elderly individuals at increased risk of severe disease from gastroenteritis infections. Understanding how enteric pathogens enter these semi-restricted environments and the associated impact on outbreak magnitude can inform targeted prevention strategies.

The South East Public Health Unit (SEPHU) conducted a retrospective cohort study to investigate the association between the role of the outbreak primary case, defined as the case with the earliest symptom onset, and the size and duration of gastroenteritis outbreaks in RACFs.

66 RACF gastroenteritis outbreaks managed by SEPHU between November 2023 and December 2024 were included in the study. For each outbreak, the role of the primary case, either resident or staff, was identified from case line lists provided by RACFs as part of routine outbreak management. Outbreak size, defined as the total number of cases, and outbreak duration, measured by the number of days between symptom onset of the first and last cases, were obtained from Victoria’s Public Health Event Surveillance System (PHESS).
Residents were the primary case in 86% of RACF outbreaks. Outbreaks where the primary case was a staff member (n=9) were, on average, larger in size (mean difference = 11.9 cases, t=1.3, p=0.19) and slightly shorter in duration (mean difference = 0.98 days, t=0.32, p=0.75) than outbreaks with a resident primary case (n=57), though these findings were not statistically significant. However, the number of staff cases was significantly higher where a staff member was the primary case (mean difference = 6.42, t = 3.75, p = 0.0004).

These findings identify residents as the primary case for most RACF outbreaks, highlighting a need for strengthening infection prevention for residents. Additionally, the greater number of staff cases infected when a staff member is the primary case underscores the importance of staff exclusions while infectious to protect the RACF workforce.

Background:
Streptococcus pneumoniae (S. pneumoniae) is a leading cause of bacterial pneumonia, meningitis, sepsis, and other severe infections in young children, and is associated with high rates of morbidity and mortality. While pneumococcal conjugate vaccines (PCVs) have significantly reduced pneumococcal disease globally, Vietnam has yet to introduce PCV into its national immunization program (NIP). Additionally, data on invasive pneumococcal disease (IPD)-causing serotypes in Vietnam remain limited.

Objectives:
The primary aim of this systematic review and meta-analysis was to assess the overall prevalence and serotype distribution of nasopharyngeal carriage of S. pneumoniae among children in Vietnam. The secondary aim of this review was to describe antimicrobial resistance patterns of the included S. pneumoniae isolates.

Methods:
We conducted a systematic search across multiple databases, including Ovid MEDLINE, Ovid EMBASE, Ovid Global Health, Scopus, Web of Science, Global Index Medicus, and the Cochrane Library. Additionally, key Vietnamese journals were handsearched to identify published articles not indexed in biomedical databases. Tailored search strategies were developed, tested, and applied by an experienced information specialist for each database to ensure comprehensive retrieval of relevant literature. No language or publication date restrictions were applied. The entire systematic review process was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. A detailed description of the study methods is available in the PROSPERO registry (Registration ID: CRD42024612665).

Results:
This systematic review included fifteen studies. The pooled prevalence of S. pneumoniae nasopharyngeal carriage was 33% (95% CI: 28%–39%). The most common serotypes—6A, 19F, 6B, 23F, and 14—aligned with those frequently identified in invasive pneumococcal diseases in Vietnam. Additionally, we summarised the antimicrobial resistance patterns for penicillin, macrolides, sulfamethoxazole–trimethoprim, third-generation cephalosporins, tetracycline, and other antibiotics.

Hepatitis A is not endemic in Australia. Most cases occur in travellers returning from high-incidence countries. (1)

On 13 November 2024, Western Public Health Unit (WPHU) was notified of a case of hepatitis A in an adult individual. Of four household contacts, one school-aged child reported symptoms. Both this child and an asymptomatic sibling attending childcare returned positive hepatitis A IgM and PCR test results. No case reported consumption of high-risk foods, contact with a known case or overseas travel.

Genomic testing identified all three cases were infected with identical strains that had no links to other Victorian cases. WPHU and the Department of Health assessed that food testing was not indicated.

In response, WPHU arranged post-exposure prophylaxis (PEP) of childcare contacts through a council-run immunisation clinic. Of 139 childcare attendees, 32 (23%) received PEP with logistical challenges arranging the clinic potentially affecting uptake. Information sheets distributed to all school and childcare contacts encouraged testing and exclusion should symptoms occur. No subsequent cases were identified following one incubation period.

This isolated, locally acquired, genomically distinct cluster likely indicates spread from an undiagnosed overseas-acquired case. The region has a growing South Asian population with a frequent incidence of overseas-acquired hepatitis A cases. Undetected infection in travellers returning from hepatitis A endemic regions is possible, particularly amongst young children who often remain asymptomatic.

Where local acquisition without a source is identified, asymptomatic infection in young children should be considered. Established processes between public health and local government would help facilitate greater ability to deliver PEP and increase vaccination uptake during outbreaks.


(1) Australian Immunisation Handbook. Hepatitis A. 9 October 2024. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/hepatitis-a#epidemiology

Background: Seasonal influenza and SARS-CoV-2–associated diseases cause substantial burden in adults. We report 6-month post-vaccination immunogenicity and safety from two studies evaluating mRNA-based standalone vaccination against seasonal influenza or multicomponent vaccination against seasonal influenza+COVID-19.

Methods: Two phase 3, randomised, observer-blind trials evaluated immunogenicity and safety of mRNA-1010 (seasonal influenza) or mRNA-1083 (seasonal influenza+COVID-19) versus licensed comparators in adults. Study 1 (NCT05827978) was a 3-part trial where participants were randomly assigned (1:1) to receive mRNA-1010 or an age-appropriate licensed quadrivalent vaccine: standard-dose (SD-IIV4) for Parts A (≥18 years) and B (18-64 years) and high-dose (HD-IIV4) for Part C (≥65 years). Study 2 (NCT06097273) evaluated mRNA-1083 in participants (Cohort A: ≥65 years; Cohort B; 50-64 years) randomly assigned (1:1) to receive mRNA-1083+placebo or co-administered licensed COVID-19+HD-IIV4 (≥65 years) or COVID-19+SD-IIV4 (50-64 years) vaccines. Immune responses were assessed by haemagglutination inhibition assay (HAI [influenza]) and pseudovirus neutralisation assay (PsVNA [SARS-CoV-2 XBB.1.5]) for up to 6 months after vaccination.

Results: In Study 1, mRNA-1010 elicited HAI titres at Day 29 that were higher than licensed SD-IIV4 or HD-IIV4 comparators for all vaccine-matched influenza strains. Titres remained above baseline 6 months post-vaccination (Day 181), and were numerically similar to or higher than comparators for all age groups. In Study 2, mRNA-1083 elicited robust antibody responses at Day 29 that were higher than or similar to co-administered licensed comparators for all vaccine-matched influenza and SARS-CoV-2 strains. HAI and PsVNA responses to mRNA-1083 remained similar to or higher than co-administered comparators for both age cohorts 6 months post-vaccination. In both trials, no safety concerns were identified through Day 181 for either mRNA-1010 or mRNA-1083 vaccines.

Conclusions: mRNA-1010 and mRNA-1083 elicited robust humoral immune responses that persisted through 6 months post-vaccination, remaining comparable to or higher than licensed comparators. Both vaccines demonstrated acceptable tolerability and safety profiles over the 6-month period.

Introduction

Shoulder Injury Related to Vaccine Administration (SIRVA) is an adverse event following immunisation that can lead to long-lasting shoulder dysfunction. SIRVA has gained global attention and interest over the past few years, particularly since the rollout of COVID-19 vaccination programs. Current inconsistencies in SIRVA terminology, without a global standardised case definition make accurate diagnosis and patient care, accurate reporting, and improvements in vaccine safety challenging. To inform the development of an international Brighton Collaboration standardised case definition, we conducted a systematic review and compiled relevant published evidence of shoulder injury related to vaccine administration.

Methods

A comprehensive search of four databases (MEDLINE, PubMed, Embase, Web of Science) was conducted from inception to 6 October 2024, with no restrictions on date, language, geographical region or study design. Published observational epidemiological studies on any isolated ipsilateral shoulder injury presentations after vaccine administration with no prior or concomitant origin other than recent immunisation, were eligible for inclusion. This systematic review used narrative synthesis by mapping reported signs and symptoms to each potential SIRVA case. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO: CRD42024552827.

Results

Of 3,288 references identified, 157 studies met the inclusion criteria after the screening process. Shoulder pain and restricted range of motion were the most common symptoms, followed by neurological signs such as loss of sensitivity, muscle weakness and paraesthesia. Less common were infection-associated symptoms such as abscesses and septic arthritis. Time of onset predominantly fell within 0 to 7 days after immunisation, with symptoms lasting more than 6 weeks.

Conclusion

Our systematic review addressed the issue of highly heterogeneous terminology used to define SIRVA. It has shown consistent findings to provide a clearer framework for developing a global case definition. By summarising key reaction descriptions, our review ensures all cases can be counted, enabling timely and effective interventions. Establishing a standardised case definition will enhance diagnostic accuracy, improve patient outcomes, and strengthen vaccine safety monitoring worldwide.

Background
Clostridioides difficile infections (CDI) have been traditionally considered as hospital associated infections. However, recent Australian data shows an increase in community onset cases (>80%)(1).
Methods
In this retrospective study, information on potential risk factors was collected from 88 patient records with CDI diagnosis. These patients were admitted to a regional public hospital in the Goulburn Valley region, Victoria from 01/01/2022 to 31/12/2023.
Results
Mean age of the study population was 72 years. Majority were aged ≥65 years (73.8%). Males had higher incidence (56%) and 81.8% were born in Australia.
According to the timing of symptoms(2), cases included healthcare associated healthcare facility onset CDI (n=35, 39.8%), healthcare associated community onset CDI (n=23, 26.1%), community associated CDI (n=23, 26.1%), and indeterminate onset CDI (n=7, 8.0%). Community onset cases (CCDI) (n=53, 60.2%) included healthcare associated community onset CDI, community associated CDI, and indeterminate onset CDI.
Healthcare onset cases (HCDI) were more common among those >=65 years of age (89%) compared to CCDI (66%) (P<0.05). Higher number of HCDI had recent surgery (34%) compared to CCDI (11%) (P<0.05). Hypoalbuminaemia was more common among HCDI (75%) than CCDI (45.6%) (P<0.05).
Antibiotics were used prior to admission in 28(53%) of CCDI and in 11(31%) of HCDI (P=0.05). Prescriptions by general practitioners contributed to 28.9% of antibiotic usage prior to admission and hospital prescriptions during/after past hospital stays contributed to 60.5%.
Higher number of CDI occurred in November and December.
Conclusions
Preliminary data from this study highlighted a higher number of CCDI than HCDI. Older age, hypoalbuminaemia and recent surgery were associated with HCDI. Further study is being conducted on seasonality and association of other risk factors.
References
1. ACSQHC. Clostridioides difficile infection Data snapshot report: 2020 and 2021. Sydney(AU). ACSQHC; 2023
2. ACSQHC. Implementation Guide for the Surveillance of Clostridioides difficile Infection. Sydney(AU). ACSQHC; 2023

Introduction: The Surveillance and Monitoring to Eliminate Lymphatic Filariasis and Scabies from Samoa (SaMELFS) project, is an ongoing operational research program to monitor and evaluate the effectiveness of triple-drug mass drug administration (MDA) on lymphatic filariasis (LF) transmission using a household-based questionnaire to collect data on demographics, and household and environmental characteristics. Misinterpretations can arise from direct translations and culturally inappropriate terminology, emphasizing the need for consumer engagement before, during, and after a survey. This survey aimed to identify challenges and issues raised when conducting questionnaire interviews with community members, and to clarify terminology.

Methods: In August 2024, the SaMELFS questionnaire was conducted by volunteers from the Samoan Red Cross. Based on individual experiences, they were invited to participate in an online survey, via Qualtrics. The survey focused primarily on clarifying challenges and issues involved with delivering the SaMELFS questionnaire and further clarification was also sought regarding terminology used and ways to improve this for the local Samoan context.

Preliminary Results: We received 26 unique responses from Samoan Red Cross volunteers. Most (73.1%) were directly involved in delivering the questionnaire to households. Interestingly, most (42.3%) participants thought the questionnaire was an appropriate length, however one participant felt this was too short, and six (23.1%) participants thought it was too long. When poised with the option of splitting the questionnaire into two components, most (53.8%) thought this would complicate delivery while some (30.7%) thought this would simplify delivery.

Conclusion: Our results underscore the need for continuous consumer engagement to ensure the appropriateness of data collection tools. The insights gained from this survey will inform future iterations of the SaMELFS questionnaire, improving data quality and enhancing relevance for the local Samoan context. Furthermore, there is potential for adaptability to other similar contexts, such as other pacific island countries and territories.

The PICOBOO study aims to evaluate the safety and effectiveness of COVID-19 vaccine strategies in the Australian context. Under its adaptive trial design, existing participants were offered the opportunity to re-enrol at set time points, to receive a randomised COVID-19 booster vaccination, thereby ‘starting again’ on the visit schedule of activities. The PICOBOO study is being conducted across multiple Australian sites. We present recruitment and retention of adult participants at The Kid’s Research Institute Australia. The research clinics are located within Perth Children’s Hospital.
Re-enrolment was offered at our site during two periods, January-August 2023 and January-September 2024. Following the 2023 enrolment period, 49.1% (121/246) of eligible participants opted to re-enrol and were re-randomised to a COVID-19 vaccine booster. This re-enrolment increased to 54% (161/298) by the end of the 2024 period.
Participants were not limited in how many times they could receive a booster within the study, if they met eligibility criteria. Of those participants who re-enrolled, 28.6% (46/161) did so only once, 45.3% (73/161) re-enrolled twice, and 26.1% (42/161) re-enrolled three times.
In preparation for the next round of re-randomisation being offered mid-2025, a reflection of strengths and challenges is valuable to optimise recruitment efforts and minimise retention barriers. Areas identified include participant engagement, understanding of research result timelines, the inconveniences of hospital-based visits, personal motivations, the impact of changing attitudes towards COVID-19 in the broader community, and responding to the evolving recommendations during the pandemic.
Assessing the impact of these factors at various stages of re-enrolment will provide valuable insight into recruitment and retention for similar adaptive trials, providing a framework for long-term participant engagement and satisfaction.

Background: A self-amplifying mRNA (sa-mRNA) vaccine against COVID-19 (ARCT-154) was evaluated for immunogenicity in three clinical studies with four booster scenarios: first homologous booster, first heterologous booster, second heterologous booster, and a two-dose series in previously infected participants.

Methods: Neutralizing antibody responses were measured four weeks after vaccination using pseudovirus microneutralization assays against the Wuhan-Hu-1 and SARS-CoV-2 variants.

Results: ARCT-154, administered as a homologous booster, resulted in a geometric mean fold-rise (GMFR) of 6.5 (95% confidence interval, 5.6–7.5) and seroconversion rate (SCR) of 77% (69.8–83.2), compared with 1.4 (0.9–2.2) and 17.3% (8.2–30.3) with placebo. A first heterologous booster of ARCT-154 achieved a GMFR of 36.7 (17.4–77.5) and SCR of 91.7% (61.5–99.8) against Wuhan-Hu-1, with GMFRs ranging from 20.0 to 29.4 for Beta, Delta, and Omicron BA.1 variants. When comparing ARCT-154 and BNT162b2 mRNA vaccine as a second booster dose, GMFRs against Wuhan-Hu-1 were 6.8 (6.0–7.6) and 4.4 (4.0–4.8), and SCRs were 66.1% (61.1–70.9) and 51.2% (46.0–56.4), respectively. Similar inter-group differences were shown for the Omicron BA.4/5 and persisted for ≥12 months. Following natural infection, one dose and two doses of ARCT-154 resulted in GMFR of 4.4 (2.2–7.0) and 6.2 (3.8–10.0), and SCR of 58.8% (32.9–81.6) and 79.3% (44.9–92.2) against Wuhan-Hu-1, respectively. Neutralizing antibodies remained elevated for at least 6 months.

Conclusions: These results confirm that ARCT-154, administered as a homologous or heterologous booster after previous COVID-19 vaccination or natural exposure, provides robust, broad, and durable immune responses against SARS-CoV-2 viruses.

Background: Older adults living in aged care are at risk of poor health outcomes due to influenza, pneumococcal disease and herpes zoster infections. Despite these
conditions being vaccine-preventable, little is known about vaccine uptake rates in the residential aged care setting in Australia.

Methods: This was a retrospective cohort study examining the medical records of residents of 31 aged care homes in Australia (n=1,108). Data were extracted from
medical records for the period March 2023 to September 2023. The proportion of residents vaccinated against influenza, pneumococcal and herpes zoster was
calculated. Univariate and multivariate logistic regression was used to identify possible demographic and other characteristics associated with vaccination uptake.
Results: 1,108 residents were included in the study. Two-thirds (68%) were female, median age was 87 years. All residents had one or more comorbidity. Most (92.6%)
had received an influenza vaccine within the prior two years, but only 38.3% had received a pneumococcal vaccine and 16.8% had received herpes zoster vaccination.
In all models, receipt of the other vaccines was a significant predictor for vaccine uptake. The other factor associated with influenza vaccination was abstinence from
alcohol; and younger age for herpes zoster vaccination.

Conclusions: While there is high uptake of influenza vaccines, there is a low uptake of both pneumococcal and herpes zoster vaccine in residents of aged care facilities. Further research into the barriers and enablers of vaccine uptake should be
undertaken, with the goal of increasing vaccination uptake in this vulnerable population.

Background:
The bivalent RSVpreF vaccine has been approved in multiple countries to prevent RSV-related lower respiratory tract disease among older adults. We estimated the number needed to vaccinate (NNV) to prevent medically attended RSV-related outcomes in high-income countries to assess the public health utility of an RSVpreF vaccination program.

Methods:
NNV was estimated using vaccine efficacy data from the RENOIR Phase III trial, RSV burden data from Li et al’s systematic review/meta-analysis and US risk factor prevalence. NNV for the 2-year and 4-year time horizons were computed with a 2-year observed vaccine efficacy projected over 4 years assuming a linear decay. NNV was estimated by care setting, age group, and risk status.

Results:
To prevent one hospitalization over a 4-year horizon, NNVs were 1,229 for adults aged 18-49 years, 256 for 50-64 years, and 115 for ≥65 years. To prevent one physician office (PO)/ hospital outpatient (HO) visit over a 4-year horizon, NNVs were 28 for adults aged 18-49 years, 20 for 50-64 years, 16 for ≥65 years. NNVs declined with increasing age and longer time horizon and were lower for adults with underlying medical conditions, especially for hospitalization or death. ED and PO/HO were less influenced by age and time horizon. NNV to prevent RSV-related hospitalization was similar for adults ≥65 years (115) and adults 50-64 years with comorbidities (90), and NNV to prevent RSV-related death in adults ≥65 years (1,891) was comparable to that in adults 18-49 years with comorbidities (1,741) over a 4-year horizon.

Conclusion:
The NNV for RSV vaccine largely depends on RSV disease incidence rate, vaccine efficacy and durability, outcome severity, and patient risk factors for severe RSV disease. Public health programs should consider RSV vaccination for younger adults with underlying conditions as the NNV approaches values for that of adults ≥65 years.
Disclosure: This study was sponsored by Pfizer.

Background
There are over 200 residential aged care facilities (RACH) in metropolitan Perth who are required to report COVID-19 and influenza outbreaks to Boorloo (Perth) Public Health Unit (Boorloo PHU). While a key priority area when COVID-19 transmission commenced in WA, COVID-19 outbreaks in RACH are now managed alongside business-as-usual processes in PHU’s. We aimed to describe the epidemiology of RACH outbreaks reported to Boorloo PHU since this transition has occurred, to inform future public health management and support.

Methods
We extracted outbreak data from the Boorloo PHU COVID-19 and influenza outbreaks REDCap database between 01/04/2023 and 31/12/2024 and descriptively analysed these data using R and R Studio.

Results
A total of 830 COVID-19 (94.9%) and 45 (5.1%) influenza RACH outbreaks were reported in the 21-month period 01/04/2023 to 31/12/2024 (mean 41.5 outbreaks/month). The median duration of outbreaks was 17 days (range 7-96). For COVID-19 outbreaks, the median number of resident cases was 9 (range 2-78) and median attack rate was 11.7% (range 0.5-93.7%), with ≥1 hospitalisation and ≥1 death being reported in 28.8% and 19.5% of outbreaks respectively. For influenza outbreaks, the median number of resident cases was 4 (range 2-17), and median attack rate was 6.4% (range 1.0-26.6%) with ≥1 hospitalisation and ≥1 death being reported in 51.1% and 20.0% of outbreaks respectively. Data presented at the conference will include a 24-month period from 01/04/2023 to 31/03/2025.

Conclusion
COVID-19 outbreaks in RACH are common and have significant impact on residents, staff, and visitors. Due to the high volume of outbreaks being reported and limited resources, PHU support for RACH is less than previously offered during the pandemic years. These data will inform a more detailed evaluation to better understand the impact of COVID-19 outbreaks on RACH and how we can optimise public health support provided.

Government agencies, academic researchers, and varied teams and individuals participate in producing forecasts and scenario projections for viral respiratory infections. The Australian Consortium of Epidemic Forecasting and Analytics created a forecasting hub to streamline input data and short-term forecast outputs. In a given respiratory infection season, multiple epidemics may be spreading concurrently. Different data sources and modelling approaches impact modelled outcomes, so a collaborative, hub based approach is useful to best guide decision makers to make rapid risk assessments regarding concurrent epidemics. Technical infrastructure and best practices have been developed within the consortium to improve the quality of both individual and ensemble forecasts. In this presentation, we will introduce the pipelines and tools designed to distribute streamlined data to modelling teams and integrate model outputs. The tools described tie in with a wider global effort to build collaborative forecasting platforms borne out of the COVID-19 experience.

Salmonella Montevideo is a relatively rare serovar that has been associated with foodborne outbreaks resulting from contamination of a range of food products including fruits, vegetables, meat, eggs, seeds and spices. On 11 February 2025, the Central Coast Public Health Unit (CCPHU) was notified of three cases that clustered in time and space within 5.3 kilometers and occurring from December 2024 to January 2025. To contextualise this, only a total of seven cases of Salmonella Montevideo have been identified on the Central Coast in the past five years. We present the preliminary findings of our investigation into this unusual cluster which will advance our understanding of the causes.

A detailed investigation was performed using the Salmonella Hypothesis Generating Questionnaire (SHGQ) and electronic medical records. Cases were contacted via phone to complete the SHGQ and supplementary information was obtained via text messages, email and further phone calls.

On 21 February 2025, whole genome sequencing revealed two of the three cases were genomically linked to another Central Coast case with symptom onset in March 2024 as well as a Southwest Sydney (SWS) case whose symptom onset was in November 2024. During this period, a fifth Central Coast case was notified and subsequently found to be genomically linked, bringing the total cluster case number up to five. The four Central Coast cases were female, and the one SWS case was male. No travel between the two locations was identified.

Case information was shared between CCPHU and SWSPHU, however, no obvious exposure source was identified. Currently, electronic food purchase records have been requested to identify commonalities, cases have been re-contacted regarding potential environmental exposures and CCPHU has commenced enhanced routine surveillance to identify further Salmonella Montevideo cases. The cluster investigation is ongoing and further results regarding possible point sources will be presented once available.

Background: Tuberculosis (TB) is a leading cause of morbidity globally. Since the outbreak of the Syrian war in 2011, millions of Syrian refugees (SRs) have been predisposed to the transmission of TB and development of resistant strains along the entire migration pathway. Countries that host SRs, including those in the neighbouring region, Europe and Australia, carry the high TB case burden.
Aim: To explore and analyse health policy of Syria’s neighbouring countries, Europe, and Australia in addressing TB control in SRs.
Methods: An in-depth web search of the literature (PubMed, Scopus), government and non-government health organisations, and news outlets was conducted into the global response towards TB in SRs from 2011 to present.
Results: Jordan and Lebanon’s National TB Programs (NTPs) increased TB screening, diagnosis, and treatment in SRs, while providing education and addressing TB stigma among SRs and healthcare workers. Their NTPs, respectively, exceeded (91%) and approached, WHO’s End TB Goal of 90% TB treatment success. However, Türkiye’s NTP only achieved 63% TB treatment success due to high mobility between and within provinces, loss to follow-up and lower directly-observed-therapy rates. There is very limited information available regarding TB health policy in Europe and Australia among SRs.
Conclusion: The global community must mobilise and advocate for the SR TB crisis. High-income countries should invest time and funds into TB programs and research to further understand the challenges of TB control. With a highly mobile cohort, additional support must be provided for diagnosis, follow-up and uninterrupted treatment to avoid disease spread and resistance. Strategies to address this include cross-border communication, ‘runaway bags’ and employing laypeople for directly-observed-therapy. TB care needs to be culturally sensitive and individualised, adopting a culture akin to HIV programs that promote community empowerment, patient education, voluntary and consensual testing, confidentiality and treatment adherence counselling.

The burden of influenza is high in children <5 years and vaccination is one of the most successful public health interventions to prevent disease. The clinical benefit of a cell-based inactivated influenza vaccine (QIVc) was evaluated in young children in a Phase 3 randomized, observer-blinded, controlled trial. Children aged 6-47 months were randomly assigned QIVc or meningococcal group C polysaccharide conjugate vaccine (Comparator) and monitored weekly for Influenza-like Illness and specific symptoms during influenza season. Nasopharyngeal swabs were collected for each ILI episode and tested for influenza by RT-PCR. Positive isolates were cultured to determine if they matched seasonal vaccine strains. The primary objective was to demonstrate absolute vaccine efficacy (aVE) of QIVc vs Comparator to prevent RT-PCR confirmed influenza or culture-confirmed illness from influenza strains antigenically matched to vaccine. Safety assessment included reporting of solicited and unsolicited adverse events. A total of 5723 subjects from 15 countries were enrolled over 5 influenza seasons, Southern Hemisphere (SH) 2019, Northern Hemisphere (NH) 2019/2020, NH2020/2021, NH2022/2023, SH2023; 5697 received at least 1 dose of study vaccine and 5691 were evaluated for efficacy. The aVE for RT-PCR confirmed and culture-confirmed influenza from any Type A and/or B strain was 41.26% (97.98% CI: 21.55, 56.02) and 50.67% (95% CI: 32.83, 63.77), respectively. The aVE for culture-confirmed influenza antigenically matched to vaccine strains was 46.90% (97.5% CI: 19.19, 65.11). Percentages of subjects reporting any solicited (55.8%; 60.8%), unsolicited (57.4%; 60.0%) and serious (2.2%; 3.0%) adverse events were similar between QIVc and Comparator groups, respectively. No serious adverse events were related to QIVc. This phase 3 study demonstrated that QIVc is effective in preventing influenza in children 6 months through 47 months of age with a clinically acceptable safety profile.