Communicable Diseases Intelligence (CDI) is a peer-reviewed scientific journal published by the Australian Centre for Disease Control, an Australian government agency responsible for disease control and management of public health emergencies. The journal aims to disseminate information on the epidemiology, surveillance, prevention and control of communicable diseases of relevance to Australia and the near region.
Tuberculosis notifications in Australia, 2019–2020
In 2020, the National Notifiable Diseases Surveillance System received 1,618 tuberculosis (TB) notifications, representing a notification rate of 6.3 per 100,0000 population. In 2019, there were 1,505 TB notifications, with a rate of 5.9 per 100,000 population. Australia has achieved and maintained good TB control since the mid-1980s, sustaining a low annual TB incidence rate of approximately five to six cases per 100,000 population. The number of multi-drug-resistant TB (MDR-TB) cases notified in Australia is lower than global rates, with approximately 2% of TB notifications per year classified as MDR-TB. In Australia, overseas-born people represent the majority of TB cases, accounting for 92% and 90% of TB notifications in 2020 and 2019, respectively. In 2020 and 2019, Aboriginal and Torres Strait Islander people recorded TB rates approximately four times higher than the Australian-born non-Indigenous population. Whilst Australia has achieved and maintained excellent control of TB, sustained effort is required to reduce local rates further, especially among Aboriginal and Torres Strait Islander populations, and to contribute to the World Health Organization’s goal to end the global TB epidemic by 2035.
Copyright (c) 2026 Communicable Diseases Intelligence https://creativecommons.org/licenses/by-nc-nd/4.0
Australian Trachoma Surveillance Report 2024
Trachoma is the world’s leading infectious cause of preventable blindness and is linked to poor living conditions. In Australia, trachoma has remained a public health problem in remote Indigenous communities in northern, central, and western regions. To seek formal validation by the World Health Organization (WHO) of the elimination of trachoma as a public health problem, Australia has needed to maintain levels of overall trachoma prevalence below 5% in children for at least two years in each formerly endemic state or territory. Australia must also demonstrate that the prevalence of previously undiagnosed trachomatous trichiasis (TT), the severe advanced blinding stage caused by repeated infection, remains below 0.2% in people aged 15 years and over. Australia first reached elimination thresholds in 2022, with 2024 the final year of pre-validation monitoring. In 2024, screening staff assessed trachoma according to WHO grading criteria in 86 communities. Overall prevalence of trachoma was 2.1% in the Northern Territory; 0% in South Australia; and 1.3% in Western Australia. Only nine previously unknown TT cases were reported throughout the Northern Territory, Queensland, South Australia and Western Australia. Based on 2024 surveillance data, Australia is eligible to apply for validation of elimination as a public health problem. Maintaining this achievement will require ongoing improvements to remote housing and environmental conditions; supporting communities to manage remaining disease pockets or risk of resurgence; and continuing accessible TT diagnosis and surgery pathways to address long-term disease impacts. Indigenous leadership is critical to ensure local ownership and accountability to communities.
Creutzfeldt-Jakob disease surveillance in Australia: update to 31 December 2025
Nationwide surveillance of Creutzfeldt-Jakob disease (CJD) and other human prion diseases is performed by the Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR). National surveillance encompasses the period since 1 January 1970, with prospective surveillance occurring from 1 October 1993. Over this prospective surveillance period, considerable improvements have been developed in pre-mortem diagnostics in parallel with the delineation of new disease subtypes and heightened awareness of prion diseases in healthcare settings. Surveillance practices of the ANCJDR have evolved and adapted accordingly. This report summarises the activities of the ANCJDR during 2025. Since the ANCJDR began offering diagnostic cerebrospinal fluid (CSF) 14-3-3 protein testing in Australia in September 1997, the annual number of diagnostic test referrals has steadily increased. In 2025, there were 788 domestic CSF specimens referred for diagnostic testing; 92 persons with suspected human prion disease were formally added to the national register. As of 31 December 2025, more than half of the 84 initial case notifications for 2025 (44/84) remain classified as ‘incomplete’; 35 cases have been confirmed as ‘definite’ or ‘probable’ prion disease; five cases were excluded. In 2025, most suspected human-prion-disease-related deaths in Australia (56%) underwent neuropathological examination. No cases of variant or iatrogenic CJD were identified in Australia during 2025.
Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2025
For over 30 years, the Australian Paediatric Surveillance Unit (APSU) has conducted national prospective surveillance of rare conditions in children, including communicable diseases and complications, providing data that has informed changes to policy and clinical practice. In 2025, the APSU monitored seven rare communicable diseases and complications: acute flaccid paralysis (AFP); perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection; juvenile-onset recurrent respiratory papillomatosis (JoRRP); congenital rubella infection/syndrome; congenital varicella syndrome (CVS); and neonatal varicella infection (NVI). An average of 1,313 paediatricians and other relevant clinical specialists received a report card each month listing rare conditions under APSU surveillance (including the seven described in this report), and completed a case report form for any child(ren) seen with one or more of these conditions, detailing demographics, clinical features, treatment/management, risk factors and short-term outcomes. There were 134 notifications, of which 105 were confirmed as cases, after excluding duplicate reports or errors. The annual response rate to the report card was 78.4%. The non-polio AFP incidence of 1.58 per 100,000 children aged < 15 years exceeded the World Health Organization requirement to maintain Australia’s polio-free status. Incidence of perinatal exposure to HIV remained stable, but new paediatric HIV infections increased. While there were no cases of congenital rubella or CVS, three cases of NVI and one case of JoRRP were reported, indicating ongoing gaps in vaccination despite two decades of universal vaccination in Australia. Continued APSU surveillance remains essential to assess the prevention of disease occurrence and adverse outcomes.
Annual immunisation coverage report 2024
We analysed Australian Immunisation Register (AIR) data for children, adolescents and adults as at 2 February 2025, concentrating primarily on National Immunisation Program (NIP)–funded vaccines. Our focus was on the calendar year 2024 and trends from previous years. This report provides comprehensive analyses and interpretation of vaccination coverage data to inform immunisation policy and programs in Australia. Along with the results outlined below, the report also includes a range of other data for vaccines given across the lifespan, including data on timeliness and vaccination provider settings. Population overall Children Fully vaccinated coverage decreased between 2023 and 2024 at all three standard age milestones: 12 months (from 92.8% to 91.6%); 24 months (from 90.8% to 89.4%); and 60 months (from 93.3% to 92.7%). This follows the 1.2–2.0 percentage point decrease in vaccination coverage uptake at these three milestones between the 2020 and 2023 reports. A combination of acceptance and access factors have contributed to this ongoing decline. Adolescents Coverage of a dose of HPV vaccine by the fifteenth birthday decreased in 2024 to 81.1% in girls and 77.9% boys; these values were 3.1 and 3.9 percentage points lower, respectively, than in 2023 and 5.5 and 7.0 percentage points lower than in 2020. In girls and boys turning 15 years of age in 2024, respectively 83.4% and 80.9% had received an adolescent dose of diphtheria-tetanus-pertussis vaccine by 31 December 2024. Overall, 68.5% of girls and 64.4% of boys turning 16 years of age in 2024 had received an adolescent dose of meningococcal ACWY vaccine by 31 December 2024. Adults Zoster vaccination coverage (one dose of Zostavax or two doses of Shingrix given at least 4 weeks apart) was 45.9% for adults aged ≥ 65 years in 2024. Coverage of an adult dose of 13vPCV was 38.6% for adults turning 71 years of age in 2024, which was 1.0 percentage point higher than in 2023; and 41.5% for adults aged ≥ 70 years, which was 6.9 percentage points higher than in 2023. Influenza vaccination coverage decreased in 2024 across all adult age groups. Aboriginal and Torres Strait Islander peoples Children Fully vaccinated coverage for Aboriginal and Torres Strait Islander children decreased between 2023 and 2024 at all three age milestones: 12 months (from 89.7% to 89.2%), 24 months (from 87.8% to 86.7%) and 60 months (from 95.0% to 94.4%), following a 2.0–3.4 percentage point decrease between the 2020 and 2023 reports. However, coverage of meningococcal B vaccine, which was introduced onto the NIP for all Aboriginal and Torres Strait Islander children in July 2020, was higher in 2024 than 2023: namely, 83.0% versus 81.0% for the first dose; 80.9% versus 80.0% for the second dose; and 75.0% versus 71.7% for the third dose. Adolescents Coverage of a dose of HPV vaccine by the fifteenth birthday decreased in 2024 in Aboriginal and Torres Strait Islander adolescents to 76.7% for girls and 69.2% for boys; these values were 4.2 and 5.8 percentage points lower, respectively, than in 2023 and 11.1 and 13.8 percentage points lower than in 2020. In Aboriginal and Torres Strait Islander girls and boys turning 15 years of age in 2024, respectively 79.3% and 73.0% had received an adolescent dose of diphtheria-tetanus-pertussis vaccine by 31 December 2024. Coverage of an adolescent dose of meningococcal ACWY vaccine received by 31 December 2024 in Aboriginal and Torres Strait Islander adolescents turning 16 years of age in 2024 was 52.7% for girls and 47.1% for boys. Adults Zoster vaccination coverage (one dose of Zostavax or two doses of Shingrix given at least 4 weeks apart) was 42.2% for Aboriginal and Torres Strait Islander adults aged ≥ 65 years in 2024. Coverage of an adult dose of 13vPCV was 48.7% for Aboriginal and Torres Strait Islander adults turning 71 years of age in 2024, which was 5.7 percentage points higher than in 2023, and 47.8% for those aged ≥ 70 years, which was 8.1 percentage points higher than in 2023. However, it was only 23.2% for those aged 50–69 years. Influenza vaccination coverage decreased in 2024 across all Aboriginal and Torres Strait Islander adult age groups. Conclusions There have been concerning and persistent downward trends in childhood and adolescent vaccination coverage in Australia since 2020, with further declines in 2024. The picture for adult coverage is more mixed, but consistently suboptimal across all vaccines. National surveys of parents of young children and adults have identified a range of access and acceptance barriers that may be contributing to observed declines in coverage. More research is needed to delineate contributory factors, particularly among adolescents and Aboriginal and Torres Strait Islander peoples. This can then be used to inform evidence-based and culturally appropriate strategies to increase vaccine uptake and coverage equity. The National Immunisation Strategy for Australia 2025–2030 provides a comprehensive framework to guide such measures and improve coverage – and hence the protection provided by vaccine programs – against disease.
2024 Annual Australian Respiratory Surveillance Report
In 2024, coronavirus disease 2019 (COVID-19), influenza, and respiratory syncytial virus (RSV) were nationally notifiable in Australia. The states and territories reported 302,250 COVID-19, 365,589 influenza, and 175,918 RSV notifications to the National Notifiable Diseases Surveillance System. Influenza and RSV notifications increased between 2023 and 2024; however, COVID-19 notifications decreased. Trends in test positivity from sentinel laboratories were generally reflective of the trends in case notifications. The weekly proportion of new ‘fever and cough’ symptoms in the community remained stable between 2023 and 2024. In contrast, influenza-like-illness notification rates for consultations at sentinel general practice sites in 2024 were higher than in previous years, reflecting increased activity in case notifications. In 2024, there were fewer sentinel hospital admissions with COVID-19 or influenza than in 2023 or 2022, and the proportion of patients admitted directly to intensive care remained low and stable. In contrast, there were more sentinel intensive care admissions for severe acute respiratory infections overall in 2024 than in 2023; however, there were fewer intensive care admissions with COVID-19 than in previous years. In 2024, deaths involving influenza and RSV increased compared to 2023, whereas deaths involving COVID-19 decreased. However, COVID-19 remains the leading cause of acute respiratory infection mortality. All three acute respiratory infections are more likely to cause death in older age groups than in younger age groups. Overall, information from Australia’s national acute respiratory infection surveillance systems indicates there was high acute respiratory infection activity with moderate severity but a lower burden on health system utilisation in 2024.
Surveillance of adverse events following immunisation in Australia, 2023
This report summarises Australia’s spontaneous surveillance data for adverse events following immunisation (AEFI) for all vaccines administered in 2023, reported to the Therapeutic Goods Administration (TGA). This report combines coronavirus disease 2019 (COVID-19) and non-COVID-19 AEFI that were previously reported separately in 2022 and 2021. Overall, there were 5,534 AEFI reports for vaccines administered in 2023. This represents an annual AEFI reporting rate of 20.8 per 100,000 population, compared with 79.2 per 100,000 population in 2022. The sharp decrease in the AEFI reporting rate in 2023 was likely driven by a change in COVID-19 vaccination policy. This included limiting COVID-19 vaccine booster dose recommendation to high-risk populations rather than to the wider community, resulting in a steep decline in both the number of administered doses and the number of AEFIs reported. The most commonly reported adverse events were medication errors, injection site reaction, hypersensitivity, pyrexia, and gastrointestinal nonspecific symptoms. The most commonly reported adverse events for new vaccines introduced in 2023 were medication errors and headache for COVID-19 vaccines; hypersensitivity and pyrexia for DTPa-HepB-IPV-Hib vaccine (Vaxelis); and injection site reaction and hypersensitivity for recombinant zoster vaccine (Shingrix). There was reduction in deaths reported following vaccination in 2023 compared to 2022 and 2021. None of the 34 reported deaths in 2023 were determined to be causally related to the vaccine(s) received.
Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2024
Since 1993, the Australian Paediatric Surveillance Unit (APSU) has been conducting prospective national surveillance of rare conditions in Australian children, including communicable diseases and complications of communicable diseases. In 2024, fifteen communicable diseases and complications were under APSU surveillance: acute flaccid paralysis (AFP); congenital cytomegalovirus (cCMV) infection; dengue; severe acute hepatitis; neonatal/infant herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection, juvenile-onset recurrent respiratory papillomatosis (JoRRP); severe complications of influenza (Flu); Japanese encephalitis virus infection; paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS); Q fever; congenital rubella infection/syndrome; congenital varicella syndrome; and neonatal varicella infection. A total of 1,350 paediatricians and other child health specialists received the monthly APSU report card (97% electronically) in 2024. A total of 237 notifications were received, with 174 confirmed as incident cases after excluding duplicates, errors and prevalent (historic) cases not previously reported. The incident cases included: Flu (n = 34) – one child died and only two children had received influenza vaccination; JoRRP (n = 1); NVI (n = 1); cCMV (n = 26); HSV (n = 8) – neurological sequelae were common; perinatal exposure to HIV (n = 15) – no cases of mother-to-child transmission identified; and rare emerging diseases dengue (n = 4) and PIMS-TS (n = 2). The non-polio AFP rate of ≥ 1 case per 100,000 children aged < 15 years was again achieved. The APSU continues to be an important mechanism for obtaining enriched data on rare communicable diseases and their complications in Australian children, to better understand disease burden, and the effects of health interventions, over time.
Annual Immunisation Coverage Report 2023
We analysed Australian Immunisation Register (AIR) data, predominantly for National Immunisation Program (NIP) funded vaccines, as at 4 February 2024 for children, adolescents and adults, focusing on the calendar year 2023 and trends from previous years. This report aims to provide comprehensive analysis and interpretation of vaccination coverage data to inform immunisation policy and programs. Children Fully vaccinated coverage in Australian children in 2023 was lower than in 2022 at the 12-month (92.8%, down from 93.3%), 24-month (90.8%, down from 91.0%) and 60-month (93.3%, down from 93.4%) age assessment milestones. This follows the 1.1–1.5 percentage point decrease at these three milestones between the 2020 and 2022 reports, which came after eight years of generally increasing coverage. Fully vaccinated coverage in Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) children was also slightly lower in 2023 than in 2022 at the 12-month (89.7%, down from 90.0%), 24-month (87.8%, down from 87.9%) and 60-month (95.0%, down from 95.1%) milestones, following a 1.9–3.3 percentage point decrease between the 2020 and 2022 reports. Due to the lag time involved in assessment, fully vaccinated coverage figures for 2023 predominantly reflect vaccinations due in 2022, when COVID-19 pandemic-related restrictions had largely been removed. Factors contributing to this ongoing decline in coverage in children include a combination of acceptance and access issues. Adolescents Among adolescents turning 15 years in 2023, 84.2% of girls and 81.8% of boys (80.9% and 75.0% of Indigenous girls and boys) had received at least one dose of human papillomavirus (HPV) vaccine by their fifteenth birthday, 1.1 and 1.3 percentage points lower than in 2022, respectively (2.1–3.1 percentage points lower for Indigenous adolescents). Coverage of an adolescent dose of meningococcal ACWY vaccine in adolescents turning 17 years in 2023 was 72.8% overall and 62.3% in Indigenous adolescents, 3.1 and 3.3 percentage points lower than in 2022, respectively. These decreases reflect impacts of the pandemic on school-based programs in 2020–2021. To provide an early insight into any immediate impacts on coverage of moving to the NIP single-dose HPV vaccine schedule in 2023 (offered in Year 7 in all jurisdictions), we calculated coverage of at least one dose of HPV vaccine by 31 December in adolescents turning 13 years, with South Australia excluded due to change of delivery from Year 8 in 2022, and found it to be around 3 percentage points lower in 2023 than 2022, and 6 percentage points lower in Indigenous girls, with patterns of diphtheria-tetanus-pertussis vaccination (also single-dose at this age) and HPV vaccination coverage broadly similar. This decrease in vaccinations due in school programs after pandemic restrictions had been removed could be due to impacts of the single-dose HPV transition (i.e. if fewer opportunities for vaccination are provided due to fewer school visits) or may be due to other factors that have changed or disrupted previous school immunisation program operations or reduced parental confidence in vaccination. It is important to promote catch-up vaccination and to monitor renewed efforts to ensure equitable coverage is achieved, particularly given HPV vaccine coverage by 15 years of age in 2023 was 4–8 percentage points lower in adolescents residing in socio-economically disadvantaged and remote areas. Adults Zoster vaccination coverage in adults turning 71 years was 41.0% overall in 2023, down from 41.3% in 2022, and 36.1% in Indigenous adults, down from 36.5%. However, the availability of the new (non-live) protein-based herpes zoster vaccine (Shingrix) from 1 November 2023 has resulted in increased uptake for the larger eligible cohort. Coverage of 13-valent pneumococcal conjugate vaccine (13vPCV) in adults turning 71 years was 37.6% in 2023, up from 33.8% in 2022, and 43.0% in Indigenous adults, up from 37.7%. Coverage of 13vPCV was lower among Indigenous adults turning 50–59 years (17.5%) and 60–69 years (23.4%) in 2023, despite this vaccine being funded under the NIP. Influenza vaccination coverage decreased across all adult age groups in 2023, both overall and in Indigenous adults, with decreases ranging from 5–11 percentage points. Conclusions There have continued to be modest but concerning declines in vaccination coverage in children and adolescents relative to pre-pandemic peaks, with decreases greater in Indigenous children and adolescents. Evidence suggests that the factors contributing to these ongoing declines are complex and variable but include both vaccine acceptance and access issues. The picture for adult coverage is more mixed, with coverage increasing for 13vPCV, stable for zoster and decreasing for influenza vaccination, though consistently suboptimal across all vaccines. Ongoing monitoring of vaccination coverage, and further exploration of the reasons underpinning these decreases and suboptimal coverage, are needed to inform approaches to address barriers effectively and to increase vaccine uptake and equity of coverage.
Australian Trachoma Surveillance Report 2023
Trachoma is the world’s leading infectious cause of preventable blindness and is linked to poor living conditions. Australia has remained the only high-income country where trachoma is endemic, primarily in remote Indigenous communities in the Northern Territory, South Australia and Western Australia. The Australian Government funds the National Trachoma Surveillance and Reporting Unit to analyse surveillance data annually to assess progress against World Health Organization (WHO) criteria for the elimination of trachoma as a public health problem. These criteria include (i) prevalence of trachomatous inflammation–follicular less than 5% in children aged 1–9 years; and (ii) prevalence of trachomatous trichiasis ‘unknown to the health system’ of less than 0.2% in persons aged 15 years and above. Australia first reached these thresholds in 2022 and must maintain these levels in each formerly endemic jurisdiction (state/territory) for a further two years before being eligible to apply to the WHO for validation of elimination of trachoma as a public health problem. In 2023, screening staff used WHO grading criteria to assess trachoma in 67 at-risk communities. Overall prevalence, which includes estimates from all communities ever considered at risk, remained below 5% in 2023 at 2.3% in the Northern Territory; 0% in South Australia; and 1.6% in Western Australia. The proportion of new trachomatous trichiasis cases was 0.01% in the Northern Territory; 0% in South Australia; and 0.2% in Western Australia. Australia is on track to eliminate trachoma as a public health problem; however, the disease remains a health issue in some remote Indigenous communities.
Report on influenza viruses received and tested by the Melbourne WHO Collaborating Centre for Reference and Research on Influenza during 2024
As part of its role in the World Health Organization (WHO) Global Influenza Surveillance and Response System (GISRS), the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne received 12,180 human influenza-positive samples during 2024. Viruses were analysed for their antigenic, genetic, and antiviral susceptibility properties. Selected viruses were propagated in qualified cells or embryonated hens’ eggs for potential use in seasonal influenza virus vaccines. During 2024, influenza A(H1N1)pdm09 and A(H3N2) viruses predominated, accounting for 33% and 42%, respectively, of all viruses received, compared to 5% for influenza B/Victoria. Of note, one influenza A(H5N1) virus was also received in 2024. The majority of A(H1N1)pdm09 (98%), A(H3N2) (88%) and influenza B (100%) viruses analysed at the Centre were found to be antigenically and genetically similar to the respective WHO recommended vaccine strains for the Southern Hemisphere in 2024. Of 4,007 samples tested for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir, twelve A(H1N1)pdm09 viruses and one B/Victoria virus showed highly reduced inhibition against oseltamivir or zanamivir. Of 3,294 total samples sequenced for baloxavir susceptibility, 18 of the 1,825 A(H3N2) samples were identified with genetic evidence of reduced susceptibility to baloxavir marboxil in the PA gene.
SAEFVIC: Surveillance of adverse events following immunisation (AEFI) in Victoria, Australia, 2019–2020
Background Adverse event following immunisation (AEFI) surveillance in Victoria is conducted through Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), an enhanced surveillance system integrated with clinical services for vaccinees experiencing an AEFI. This report summarises SAEFVIC’s surveillance and vaccine pharmacovigilance activities in 2019 and 2020. Methods A retrospective cohort study approach was used to analyse AEFI reports submitted in 2019 and 2020, compared to those since 2015. Data were categorised by vaccinee demographics (age; sex; pregnancy; and Indigenous status), vaccines administered and reported AEFI. Age cohorts were defined as best fit to the National Immunisation Program age groups. Proportional reporting ratio was determined for perceived signals being investigated. Clinical services and educational activities were described. Results There were 3,828 AEFI reports received in 2019 and 2020 (28.8 per 100,000 population), with 7.6% defined as serious; 52% of all reports were female vaccinees; 56 of 464 reports among adult females (12.1%) were pregnant vaccinees; and 29 reports (0.9%) were Indigenous Australians. Reporting trends by age group were similar across all cohorts. No vaccine safety signals were confirmed. Telehealth consultations at Specialist Immunisation Clinics increased in 2020 in-line with Medicare eligibility criteria changes. Educational resources on various vaccine safety topics were published, particularly the anticipated coronavirus disease 2019 (COVID-19) vaccination program. Conclusion AEFI surveillance in Victoria continues to be robust through the SAEFVIC model and provides confidence in informing the safety profile of vaccines administered in Australia. These data provide a baseline for AEFI surveillance for comparison to the COVID-19 vaccination program commenced in 2021.
ATAGI Targeted Review 2024: Immunisation strategies for prevention and control of respiratory syncytial virus disease in Australia
[Please note: This article was corrected on 27 May 2026. In an earlier published version, the 'Western Australia' study site column in Table 1 (Summary of estimates of age-specific annual respiratory syncytial virus (RSV) hospitalisation rates in Australia from various studies) incorrectly cited reference 11 as the primary source for derived details within that column. This has now been corrected, in both the PDF and DOCX version of the article, to identify reference 5 as the source of this information.] Respiratory syncytial virus (RSV) causes lower respiratory tract infection and severe disease, particularly in infants, and is increasingly recognised as a cause of major morbidity and mortality in the elderly. Several new vaccines aim to address the disease burden at both extremes of the age spectrum. Immunisation using a long-acting monoclonal antibody is also available for infants and young children. In 2025, a comprehensive RSV maternal and infant protection program commenced with a nationally coordinated maternal RSV vaccination in pregnancy on the National Immunisation Program and long-acting monoclonal antibody for infants and children funded by states and territories. This targeted review outlines the Australian Technical Advisory Group on Immunisation’s considerations and the evidence informing policy decisions on an RSV prevention strategy for Australia. Review of the burden of RSV disease in Australia indicates specific populations which would derive the most benefit from effective immunisation, including the very young; the elderly; First Nations people; and those with underlying medical risk factors. However, some data gaps exist in our understanding of RSV disease, particularly non-hospitalised disease and disease in adult age groups. The available evidence points to promising efficacy, against severe RSV disease, of three RSV vaccines in older adults, as well as the single available vaccine for use in pregnancy for protecting infants in the first six months of life. A long-acting RSV-specific monoclonal antibody, nirsevimab, has been highly effective in young infants in early assessments; however, there is a need to accumulate more information as these products expand in use. For RSV vaccines, there is a need to monitor duration of protection and safety, to inform the need for repeat vaccine doses in older adults and in subsequent pregnancies. As RSV immunisation involves new vaccines and monoclonal antibodies, it is important that a robust program monitoring and evaluation plan is put in place, to optimise assessment of vaccine uptake, patient acceptance and the impact of the interventions on RSV disease, with appropriate safety monitoring to facilitate public confidence in the immunisation program.
An outbreak of measles linked to healthcare services in Far North Queensland, 2025
In September 2025, Cairns experienced its largest measles outbreak since 1997. An imported case from Indonesia subsequently transmitted to 11 secondary cases, including four hospital staff. No further transmission was identified despite identification of nearly 1,500 contacts. Most of the cases (11/12; 91.6%) reported or demonstrated prior vaccination or immunity. This outbreak demonstrates the continued potential for re-emergence of measles in a setting with validated elimination status; the outbreak resulted in disruption to healthcare staff and services. Australian healthcare services should consider use of measles serology and booster vaccination doses among susceptible healthcare workers to reduce the risk of future similar outbreaks.
An outbreak of Salmonella Waycross related to sandpit contamination in a Gold Coast childcare centre, Queensland, Australia, 2024
Salmonella Waycross is a serovar with limited published literature on its reservoirs and epidemiology. In April 2024, the Gold Coast Public Health Unit (GCPHU) identified an outbreak of S. Waycross at a childcare centre in Queensland, Australia, following notifications of acute enterocolitis in children under five years of age. Whole-genome sequencing linked two confirmed cases to environmental contamination in the centre’s sandpit. The multi-disciplinary investigation highlights the potential for non-foodborne transmission of Salmonella in childcare settings, emphasising the importance of environmental surveillance in enteric outbreaks. The outbreak response led to the removal of contaminated sand and implementation of enhanced infection control measures in line with national guidelines. These findings contribute to the understanding of S. Waycross epidemiology and illustrate the potential for persistence and transmission of the contaminant in outdoor play environments. More broadly, the investigation adds to growing evidence that sandpits can act as transmission pathways for enteric infections. It reinforces the importance of basic prevention practices, such as hand hygiene after sandpit use, and supports the need to consider additional evidence-based strategies to reduce the risk of sandpit-related illness in children.
Presymptomatic transmission, vaccine breakthrough and anonymous contacts: a cluster of mpox in Canberra, Australian Capital Territory, 2024
This report outlines a localised cluster of mpox detected in July 2024, in Canberra, Australian Capital Territory. Investigation identified nine cases, including likely presymptomatic transmission by a vaccinated primary case with a high-contact profile. Five of the nine cluster cases had breakthrough infections and had received two mpox vaccinations more than 18 months earlier. The public health response involved targeted community engagement and a pop-up vaccination clinic, although a high proportion of anonymous sexual partners made contact tracing challenging. These findings underscore the potential for presymptomatic transmission and the importance of ongoing preventive measures, even with vaccination, in high-contact environments.
Investigation of a norovirus outbreak at a catered social event, Australian Capital Territory, 2024
Background An outbreak of gastrointestinal illness was notified, affecting attendees at a private function in the Australian Capital Territory (ACT) in 2024. Investigations were conducted to determine the infectious agent, source of illness and mode of transmission, as well as to determine any public health actions required to prevent further illness. Methods Function attendees were surveyed using a modified standard gastroenteritis questionnaire. A confirmed outbreak case was defined as an individual who was unwell after attending the event and had a norovirus-positive clinical sample; a probable outbreak case was defined as an individual who was unwell with clinically compatible symptoms after attending the event. A case-control study was conducted to identify food items associated with illness. Food safety inspections were performed, and food samples were tested at the ACT Government Analytical Laboratory. Clinical samples were collected from unwell attendees and from an asymptomatic food handler. Results There were approximately 250–500 attendees at the function; 224 attendees completed the questionnaire and there were 65 cases (5 confirmed and 60 probable). A food handler who had previously been unwell, and who prepared fruit and meat platters for the function more than 96 hours after their symptoms had resolved, subsequently tested positive for norovirus. Environmental Health investigations showed the venue had good food practices and handwashing; the investigation identified no ongoing risks to the public. Testing of food samples did not detect any bacterial foodborne pathogens. Epidemiological investigations identified consumption of fresh fruit (odds ratio [OR]: 5.3; 95% confidence interval [95% CI]: 2.4–12.6; p < 0.001) and cured meat (OR: 2.7; 95% CI: 1.2–6.2; p = 0.02) as significantly associated with disease. Conclusion Epidemiological and clinical evidence indicates that norovirus was transmitted via contaminated fresh fruit and cured meat platters. Despite the venue having good food handling and handwashing practices, it was likely due to a food handler who had been unwell in the week prior to the function and prepared the implicated foods more than 96 hours after their symptoms resolved. This outbreak investigation shows that safe food practices and exclusion periods reduce but do not eliminate risk completely. Our findings highlight the need for continued education on effective hand hygiene in food preparation settings, especially following gastrointestinal illness.
Identifying missing links – an ongoing outbreak of a novel tuberculosis strain in regional Queensland
Background Tuberculosis (TB) is a global public health problem, and community outbreaks occur. We report an outbreak of TB with an unusual MPT64 negative status, first detected in North Queensland, Australia, in 2017–2018. Methods A retrospective epidemiological and laboratory investigation into potentially linked cases was undertaken. Whole genome sequencing (WGS) phylogenetic and cluster analysis was performed. A confirmed outbreak case was defined as genomically closely related and a probable case as epidemiologically linked to a confirmed case, in the absence of WGS. Demographic characteristics and risk factors of outbreak cases were compared to other Australian-born cases in Queensland using univariate analysis. The aim of this study was to describe the outbreak, identify any associated risk factors and compare the epidemiological and genomic links between cases. Results Between 2002–2023, a total of 47 outbreak cases were identified: 44 (94%) were genomically linked and three (6%) were epidemiologically linked. Cases were all adults; 29 (64%) were male; 40 (89%) had pulmonary TB, of whom 30 (75%) were sputum smear positive. Compared to other Australian born cases, outbreak cases were more likely to be aged 25–44 years; to be Aboriginal and Torres Strait Islander peoples (First Nations peoples); to be residents of Central and Northern Queensland; and to experience a less successful TB treatment outcome (p < 0.05). Homelessness, previous incarceration, and substance use were significantly associated with being an outbreak case (p < 0.01). WGS analysis provided links for ten cases (24%) where no epidemiological links were identified. Conclusion Ongoing local transmission of a unique TB strain has persisted in Queensland’s First Nations communities and presents an opportunity to reconfigure TB prevention and care efforts in partnership with local communities. This study demonstrates the importance of integrating genomic data with traditional case investigation and contact tracing information, enhancing public health surveillance and targeted interventions to optimise TB management in high-risk populations.
Restaurant-associated campylobacteriosis outbreak likely linked to duck liver pâté
An outbreak of Campylobacter jejuni gastroenteritis was reported to the Hunter New England Public Health Unit in July 2025. Seven cases were identified from 26 people who had attended an event held at a local restaurant. Investigation included case interviews; a site visit to the restaurant in conjunction with local council; and an online survey administered to attendees. Observation of the pâté making process revealed the potential for both undercooking of the raw pâté product and for raw pâté product to be re-introduced to cooked product. New South Wales Food Authority issued a prohibition order requiring the restaurant to remove the item from the menu. Following this action, no further cases of campylobacteriosis associated with the premises have been reported.
Meningococcal Surveillance Australia: Reporting period 1 July to 30 September 2025
The reference laboratories of the Australian Meningococcal Surveillance Programme (AMSP) report data on the number of cases of invasive meningococcal disease (IMD) confirmed by laboratory testing using culture and molecular based techniques. Data contained in quarterly reports are restricted to a description of case numbers of IMD by jurisdiction and serogroup, where known and expanded in 2024 to include antimicrobial resistance data for ceftriaxone, penicillin, ciprofloxacin and rifampicin. A full analysis of laboratory confirmations of IMD in each calendar year are contained in the AMSP annual reports.
Australian Gonococcal Surveillance Program, 1 October to 31 December 2025
The Australian National Neisseria Network (NNN) comprises reference laboratories in each state and territory that report data on antimicrobial susceptibility testing to an agreed group of antimicrobial agents for the Australian Gonococcal Surveillance Programme (AGSP). The AGSP data are presented quarterly in tabulated form, as well as in the AGSP annual report. This report presents national gonococcal antimicrobial resistance surveillance data from 1 October to 31 December 2025.
Meningococcal Surveillance Australia: Reporting period 1 October to 31 December 2025
Meningococcal Surveillance Australia: Reporting period 1 April to 30 June 2025
The reference laboratories of the Australian National Neisseria Network report data on invasive meningococcal disease (IMD) confirmed by culture and/or molecular techniques for the Australian Meningococcal Surveillance Programme (AMSP). Culture-positive cases and molecular-based diagnoses are defined as IMD by the Communicable Diseases Network Australia National Guidelines for Public Health Units.1 Data contained in the quarterly reports are restricted to a description of the number of cases by jurisdiction and serogroup, when known. The content of the quarterly reports was expanded in 2024 to include antimicrobial resistance (AMR) data for ceftriaxone, penicillin, ciprofloxacin and rifampicin. IMD AMR data was previously only reported annually in the AMSP Annual Report. The AMSP has a programme-specific quality assurance process. Some minor corrections to data in Table 1 may be made in subsequent reports if additional data are received. IMD notifications in Australia for the first six months of 2025 were consistent with the corresponding period of 2024 (Table 1),2 but lower than the 85 IMD notifications reported at quarter two year-to-date (ytd) in 2019 (prior to the SARS-CoV-2 pandemic).3 In quarter two 2025 ytd, there were 59 notifications of IMD nationally, of which 55/59 (93%) had the serogroup determined at the time of reporting. Notably, the predominance of N. meningitidis serogroup B (MenB) IMD continued in 2025, accounting for 82% of notifications (45/55) ytd, higher than reported in quarter 1 2025 (72%). In contrast, between 2019 and 2021, the proportion of IMD attributable to MenB was 50–62%.4 The number of notifications of IMD attributed to MenW and MenY remain small, and no further MenA or MenC IMD cases were reported in Australia in quarter two of 2025 (Table 1). Antimicrobial susceptibility testing data, on the 39 IMD diagnosed by culture ytd, detected two penicillin-resistant isolates, one from Western Australia (quarter one) and one from Victoria (quarter 2), both identified as MenB IMD. All 39 IMD isolates were susceptible to ceftriaxone and there was no resistance detected to ciprofloxacin and rifampicin. A full analysis of laboratory-confirmed cases of IMD in each calendar year is contained in the AMSP annual report published in Communicable Diseases Intelligence.
Australian Gonococcal Surveillance Program, 1 April to 30 June 2025
The National Neisseria Network (NNN), Australia, established in 1979, comprises reference laboratories in each state and territory. Since 1981, the NNN has reported data for the Australian Gonococcal Surveillance Programme (AGSP), on antimicrobial susceptibility profiles for Neisseria gonorrhoeae isolated from each jurisdiction for an agreed group of agents. The antibiotics reported represent current or potential agents used for the treatment of gonorrhoea, and include ceftriaxone, azithromycin, ciprofloxacin and penicillin. More recently, gentamicin and tetracycline are included in the AGSP Annual Report. Ceftriaxone, combined with azithromycin, is the recommended treatment regimen for gonorrhoea in Australia. Historically, there were substantial geographic differences in susceptibility patterns across the country, with certain remote regions of the Northern Territory and Western Australia having low gonococcal antimicrobial resistance rates. In these regions, an oral treatment regimen comprising amoxycillin, probenecid, and azithromycin was recommended. However, since January 2023, increasing reports of penicillin-resistant N. gonorrhoeae in the Northern Territory have changed treatment recommendations to align with the majority of Australia.1 Additional data on other antibiotics are reported in the AGSP Annual Report. The AGSP has a programme-specific quality assurance process.
Australian Gonococcal Surveillance Program, 1 July to 30 September 2025
The National Neisseria Network (NNN), Australia, established in 1979, comprises reference laboratories in each state and territory. Since 1981, the NNN has reported data for the Australian Gonococcal Surveillance Programme (AGSP), on antimicrobial susceptibility profiles for Neisseria gonorrhoeae isolated from each jurisdiction for an agreed group of agents. The antibiotics reported represent current or potential agents used for the treatment of gonorrhoea, and include ceftriaxone, azithromycin, ciprofloxacin and penicillin. More recently, gentamicin and tetracycline are included in the AGSP Annual Report. Ceftriaxone, combined with azithromycin, is the recommended treatment regimen for gonorrhoea in Australia. Historically, there were substantial geographic differences in susceptibility patterns across the country, with certain remote regions of the Northern Territory and Western Australia having low gonococcal antimicrobial resistance rates. In these regions, an oral treatment regimen comprising amoxycillin, probenecid, and azithromycin was recommended. However, since January 2023, increasing reports of penicillin-resistant N. gonorrhoeae in the Northern Territory have changed treatment recommendations to align with the majority of Australia.1 Additional data on other antibiotics are reported in the AGSP Annual Report. The AGSP is supported by a programme-specific quality assurance process.
An atlas of common Salmonella serotypes from routinely notified human cases in the Northern Territory of Australia, 2005–2024
Salmonella infections cost Australian society an estimated 140 million Australian Dollars (AUD) per year circa 2019. Salmonellosis is caused by Salmonella enterica, with over 2,500 serotypes of S. enterica identified. Knowledge of the epidemiology of Salmonella serotypes may facilitate traceback from strains detected in human cases to identify the cause of local and multijurisdictional outbreaks and to implement control measures. We analysed cases of human salmonellosis notified in the Northern Territory (NT), Australia, between 1 January 2005 and 31 December 2024. We calculated the incidence of salmonellosis for all locally acquired infections according to the NT location where the infection was most likely acquired. We mapped the geographical distribution of the 25 most frequently notified Salmonella serotypes to Statistical Areas Level 2. There were 8,706 salmonellosis cases acquired in the NT: Salmonella Saintpaul (1,047 notifications) was the most frequently notified serotype, followed by S. Virchow (948 notifications); S. Typhimurium (822 notifications); S. Ball (578 notifications); and S. Lansing (460 notifications). While S. Typhimurium was ubiquitous in the NT, S. Saintpaul, S. Virchow and S. Hvittingfoss showed distinct geographic patterns. Our atlas makes key epidemiological information about common NT Salmonella serotypes readily available, which may be useful for developing hypotheses during outbreak investigations; for facilitating traceback of suspected food vehicles; and for implementing control strategies more rapidly.
Infant respiratory syncytial virus (RSV) immunisation coverage in an Australian regional area, 1 May 2024 – 31 October 2025
The recent introduction in Australia of respiratory syncytial virus (RSV) immunisations — nirsevimab (neonatal) and Abrysvo (antenatal) — offers potential to reduce the RSV burden in infants. A retrospective cohort study included all infants born at Sunshine Coast University Hospital between 1 May 2024 and 31 October 2025. Of 5,116 infants, 71.7% (3,669/5,116) received valid RSV immunisation: 45.2% through nirsevimab only and 26.4% through antenatal Abrysvo only. During May–December 2024, RSV coverage was achieved exclusively through neonatal nirsevimab. Following Abrysvo's introduction in January 2025, a progressive shift in immunisation composition occurred: among RSV-vaccinated infants, the proportion protected through nirsevimab alone fell from 100% in December 2024 to 13.5% by October 2025, while those protected by Abrysvo alone rose correspondingly from 0% to > 85.0%. Overall RSV coverage remained stable throughout the study period (66.2–77.9%) and throughout the transition period January–October 2025 (66.2–74.9%). Coverage was comparable to Australian and United States estimates but lagged European benchmarks. Abrysvo's introduction maintained rather than improved population-level protection. These findings highlight the need to investigate barriers to RSV immunisation uptake to optimise infant protection.
Measles epidemiology in Australia: 2014 to 2024
This article, as originally published, contained a mis-compiled tabulation of the notified measles clusters within Australia for the period 2014–2024, inadvertently misrepresenting the distribution of measles clusters across the country during this period. The revised text passages and the revised table presented on the following pages correct these errors. Australia has maintained endemic measles elimination since verification was first achieved in 2014. To support sustained elimination, and strengthen national preparedness, we conducted a ten-year review of measles epidemiology from 1 January 2014 to 31 December 2024. Measles notifications to the National Notifiable Disease Surveillance System were analysed by sex, age, seasonality, state/territory, country of acquisition, vaccination status, genotype, and cluster characteristics.
The Strategic Plan for Tuberculosis Elimination and Equity in Australia 2026–2030
The Strategic Plan for Tuberculosis Elimination and Equity in Australia, 2026-2030 provides the framework for Australia’s tuberculosis (TB) programmatic response over the next five years. The Strategic Plan upholds a focus on achieving TB elimination, and equitable outcomes for all people affected by TB.
National Tuberculosis Advisory Committee
ATAGI 2025 Annual Statement on Immunisation
The Australian Technical Advisory Group on Immunisation (ATAGI) 2025 Annual Statement on Immunisation is the fifth publication in this series. It highlights the key successes, trends and challenges in the use of vaccines and control of vaccine preventable diseases (VPDs) in Australia in 2024. It also signals ATAGI’s priority advice on actions to address key issues for 2025 and beyond.
ATAGI 2024 Annual Statement on Immunisation
The Australian Technical Advisory Group on Immunisation (ATAGI) 2024 Annual Statement on Immunisation is the fourth publication in this series. It highlights the key successes, trends and challenges in the use of vaccines and control of vaccine preventable diseases (VPDs) in Australia in 2023. It also signals ATAGI’s priority actions for addressing key issues for 2024 and beyond.
Enhanced surveillance for hepatitis B and C: insights into clinical care after diagnosis
Background There are known gaps in care uptake for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and public health surveillance represents an opportunity to support health service engagement for cases; however, specific data are lacking regarding follow-up after diagnosis. We assessed outcomes of a Victorian initiative to enhance data availability and to support linkage to care. Methods Notified cases of HBV and HCV within Victoria during 2023–2024 were analysed to determine post-diagnosis follow-up, including variation by demographics and setting, and reported reasons for lack of linkage to care. Results Information was available for two-thirds of cases. For HBV, 37.7% reported current treatment or management, while 53.6% reported referral or assessment in progress; for HCV, these proportions were 33.3% and 54.7%. Reasons for gaps included loss to follow-up, cost barriers, and misapplication of HBV treatment criteria. Discussion Cascade of care information can be effectively collected via public health surveillance, and these systems represent an opportunity to support prioritisation of public health follow-up.
Neisseria gonorrhoeae notifications, resistance and management in the Pilbara Region, Western Australia, July 2023 – June 2024
Background In October 2024, Pilbara treatment guidance for uncomplicated urogenital gonorrhoea shifted from routine ZAP pack (amoxicillin 3 g and probenecid 1 g and azithromycin 1 g oral as a single treatment) to ceftriaxone-based LAC pack (ceftriaxone 500 mg in 2 mL 1% lignocaine intramuscularly and azithromycin 1 g oral, as a single treatment) in response to rising penicillinase-producing N. gonorrhoeae (PPNG) and the threat of imported ciprofloxacin resistance. Design A retrospective clinical audit to describe demographics, compare treatment and resistance data collected for N. gonorrhoeae notifications for Pilbara health region residents meeting the surveillance case definitions in the Western Australian Notifiable Infectious Diseases Database (WANIDD) against clinical guidelines. Setting All Pilbara health region resident N. gonorrhoeae notifications in the Western Australian Notifiable Infectious Diseases Database (WANIDD) from 1 July 2023 to 30 June 2024. Main outcome measures The proportion of notifications that reported treatment with a ZAP pack or LAC pack as per Western Australian and national clinical guidelines. Secondary outcomes included the proportion of notifications undertaken by the WA Country Health Service that reported test of cure at 1–2 weeks; the proportion that reported rescreening at 3 months post notification; and the proportion of notifications that reported PPNG and ciprofloxacin resistance. Results A total of 188 N. gonorrhoeae notifications were received over the audit time frame. One hundred and twenty-seven notifications of a total of 156 N. gonorrhoeae notifications (81%) reported receiving treatment consistent with WA and National STI treatment guidelines, i.e. ZAP or LAC pack. Fifteen notifications of a total of 188 notifications (8%) reported detection of PPNG and 20 notifications of a total of 188 notifications (11%) reported ciprofloxacin resistance. For WA Country Health service notifications, 9 of 27 (33%) reported re-testing at 1–2 weeks or 3 months. Conclusions The majority of notifications (81%) reported N. gonorrhoeae treatment consistent with guidelines. A significant proportion of notifications (8%) indicated likely penicillin resistance due to the detection of PPNG. Reinforcing treatment consistent with the updated treatment guidelines of October 2024 for the Pilbara region will reduce the risk of ineffective treatment. Improving the rate of test of cure and test for reinfection (33%) would improve the likelihood of detecting treatment failure and detecting resistance.
Ratting out leptospirosis: investigation of a revealing urban case associated with socioeconomic disadvantage in Sydney, Australia
Classically reported in Australia in association with travel or occupational exposures, leptospirosis in the urban setting is a disease of lower socioeconomic status with the risk of rat exposure inversely proportional to conditions of living. Whilst this has been widely reported elsewhere in the world, urban-acquired cases of leptospirosis are rare in Australia. Here we report on the fifth locally acquired case in Sydney, Australia, during the period 2003–2024. This case coincided with a severe rat infestation in the case’s social housing block. A collaborative environmental health investigation followed, involving members of the Public Health Unit and Department of Primary Industries and Regional Development. Twelve rats captured within a 1.5 km radius of the case’s residence underwent polymerase chain reaction testing for leptospirosis and were all negative. This prompted consideration of other potential reservoirs, including native species. This case demonstrates persisting social inequities in metropolitan Sydney, and the consequences for health.
Epidemiology of Staphylococcus aureus infections in Timor-Leste, January–July 2020
Background The nation of Timor-Leste has a significant burden of infectious disease but has historically had limited diagnostic capacity and limited availability of microbiology data on human health. Recent developments in the diagnosis and reporting of key pathogens including Staphylococcus aureus have allowed better understanding of the burden of key infectious diseases and their impact on the population of Timor-Leste. Methods A prospective observational study was performed on clinical isolates of S. aureus received at Laboratório da Saúde in Dili, Timor-Leste between January 2020 and July 2020. Clinical samples were obtained from patients living in 11 of the 13 municipalities in Timor-Leste. Standard microbiology culture, identification, and antimicrobial susceptibility testing were performed, and clinical and demographic data were collected on laboratory-confirmed S. aureus isolates. Results A total of 59 clinical isolates of S. aureus were identified. Most patients in our study were found to have community-acquired S. aureus (75%), whilst the remaining 25% were hospital-associated infections. Of S. aureus isolates, 25% were found to be methicillin-resistant. Conclusion This is the first description of S. aureus infections in Timor-Leste. The high MRSA rates identified in this study can be used to better inform guidelines for the empirical treatment of S. aureus infection. Continuous investment in detecting clinically important pathogens and understanding their susceptibility profiles is critical for the development of treatment guidelines and antibiotic stewardship activities.
Effectiveness of COVID-19 vaccine booster doses in adults aged 50 years and over during the Omicron period in Victoria, Australia
Background Country-specific estimates of coronavirus disease 2019 (COVID-19) vaccine effectiveness (VE) are important for policy making, but analyses of COVID-19 VE in Australia have been limited to date. Methods We used a modified Cox regression model to estimate, through the linkage of national and state-wide health and administrative datasets, the adjusted relative VE of three vs. two and four vs. three COVID-19 vaccine doses against hospitalisation and death due to COVID-19 among Victorians aged ≥ 50 years after the emergence of the Omicron SARS-CoV-2 variant. Analyses were conducted in two periods: 1 December 2021 to 19 June 2022 (Omicron BA.1/2 period; analyses of three vs. two doses); and 20 June 2022 to 7 November 2022 (Omicron BA.4/5 period; analyses of four vs. three doses). Results Approximately 1.8 million people were included in analyses of three vs. two doses and approximately 1.2 million people were included in analyses of four vs. three doses. Adjusted relative VE against death 28 days after boosting with a third dose (compared to two doses) in individuals aged ≥ 65 years in the Omicron BA.1/2-dominant period reached 81.2% (95% confidence interval [95% CI]: 76.9–84.6%). There was also evidence for a relative benefit of a third dose in the Omicron BA.1/2 period against hospitalisation (adjusted relative VE 63.6% [95% CI: 60.1–66.8%] 28 days post-boosting) and for a fourth dose in the Omicron BA.4/5 period against hospitalisation and death in this age group. In contrast, estimates of relative VE in the 50–64 year age group were highly imprecise (for example, 52.4% [95% CI: -16.6–80.6%] against death 28 days after receipt of a third dose in the Omicron BA.1/2-dominant period). Conclusions These results confirm the benefits of vaccine boosters in the Omicron era for those aged ≥ 65 years, with the most notable gains evident from a third dose in late 2021 to mid-2022.
Investigation and response to an outbreak of mpox cases linked to a high-risk group event in Southeast Queensland in May 2024
Objective The primary aim of this paper is to describe the outbreak investigation and public health response to a cluster of mpox cases that occurred in Southeast Queensland; and to investigate transmission dynamics to inform contact management. Background The transmission of mpox in Australia has continued to circulate among the men who have sex with men community, since the declaration of the global outbreak of clade IIb in 2022. In May 2024, an outbreak investigation was carried out following the admission of an mpox case to a Queensland hospital, which precipitated a response coordinated by two metropolitan public health units (Metro North and Metro South) in Brisbane. Methods A prospective cohort study was conducted to follow up attendees of an intimate group event over a 21-day period. From 21 event attendees, 16 were able to be contacted by public health clinicians, and were included in the cohort. Case histories and their respective contacts were identified and classified as high, medium or low risk. Descriptive statistics were conducted, and relative risk was determined for developing infection after attendance at the group event, when accounting for the level of vaccination against mpox. Whole genome sequencing was performed on collected pathology specimens, and phylogenetic analysis was conducted to support epidemiological investigations. Findings A total of ten cases of mpox were detected, among a cohort of 16 males with differing levels of vaccination. Transmission of mpox occurred exclusively among high-risk contacts; no transmission was observed to medium- or low-risk contacts. Laboratory investigations revealed that all cases were of human MPXV clade IIb. Complete vaccination was a protective factor against development of mpox (relative risk = 0.33; 95% confidence interval: 0.06–1.88), compared with partial or no vaccination, after attendance at the high-risk exposure event. This outbreak resulted in 34 contacts, of which one high-risk contact became a secondary case. Findings from this investigation suggest there is less urgency for follow-up of household contacts and other medium- and low-risk contacts of mpox, compared with high-risk contacts. Fostering a rapport during telephone interviews with cases and contacts was found to be crucial to the overall attainment of accurate case histories, highlighting the need for the development of trust when interacting with members of priority groups. This outbreak investigation describes a comprehensive public health response attributed to the coordination of a range of public health workers in the Southeast Queensland area.
Background Endemic measles was verified as eliminated in Australia in 2014. We describe Australian measles epidemiology, 2014–2024. Methods National measles notification data were analysed by age; sex; state/territory of residence; genotype; place of acquisition (overseas/Australia); vaccination status (number of doses); and outbreak reference ID (for clusters). Results Between 2014 and 2024, there were 1,095 measles notifications (average annual notification rate 0.4 per 100,000 population per year). The highest annual notification rates were recorded in 2014 (1.4 per 100,000 per year) and 2019 (1.1 per 100,000 per year), when rates in the Northern Territory were 21.4 and 12.6 per 100,000 population per year, respectively. Although notification rates were highest among infants < 1 year of age (average 3.8 notifications per 100,000 population per year), people aged 20–49 accounted for 57.2% of total notifications (n = 626). Of cases with a known immunisation status (n = 766), there were 513 cases (66.9%) who reported being unvaccinated; 20.1% (n = 154) reported having received one dose of MMR vaccine prior to infection; and 12.1% (n = 93) reported two or more doses. For notifications where country of acquisition was available (n =1,077), just over half of cases (55.1%) were acquired in Australia. Where measles was acquired overseas (n = 493), the most common countries of acquisition were Indonesia (n = 99; 20.1%), the Philippines (n = 82; 16.6%) and India (n = 52; 10.5%). There were 47 clusters during the reporting period, of which the largest involved 74 linked cases in 2019. Of recorded clusters, 44 (93.6%) had a source country outside of Australia. Notifications tended to peak each year in the months coinciding with the end of Australian school holiday periods. Conclusion Australia has sustained measles elimination since 2014; this review of measles epidemiology, demonstrating a predominance of unvaccinated returning international travellers 20–49 years of age, provides strong motivation for maintaining high routine two-dose coverage and promoting measles vaccination to adults travelling internationally.
Temporal analysis of respiratory virus epidemics in Victoria over winter 2024
During winter months of temperate regions, concurrent epidemics of multiple respiratory pathogens can occur, causing periods of increased clinical burden. Case time series, which are predominantly used to monitor infection levels, can exhibit substantial noise and day-of-the-week effects, limiting the visual interpretation of trends in raw data. However, statistical methods can infer smoothed trends within case time series by quantifying and accounting for different sources of noise. Here we apply statistical models to estimate the epidemic dynamics of SARS-CoV-2, respiratory syncytial virus (RSV), and influenza subtypes (influenza A H3N2, influenza A H1N1, and influenza B) in Victoria, Australia, over the 2024 winter season. We model trends in daily reported cases and the daily growth rate over time for all pathogens/subtypes. We present: (1) retrospective analyses using the final dataset up to 10 September 2024 and (2) weekly real-time analyses from 19 March 2024 to 10 September 2024 using data up to each timepoint, including a retrospective performance evaluation. We estimated similar peak timing of SARS-CoV-2 and RSV epidemics in late May, followed by a H3N2-dominant influenza epidemic, which peaked in early July. Transient increases in SARS-CoV-2 activity coincided with the emergence of new variants and transient decreases in influenza activity corresponded to the timing of school holidays. Real-time estimates demonstrated good agreement with those produced at the end of the season, with significant overlap of the 95% credible intervals. Our findings demonstrate how statistical methods can be implemented in real time to synthesise noisy case time-series data into interpretable trends (including uncertainty), enabling quantification of the strength of evidence for whether epidemic activity is increasing, stable or declining. Our real-time outputs were reported weekly to the Department of Health, Victoria during June–September 2024, complementing other routine surveillance indicators.
Report of the National Influenza Surveillance Scheme, 2019
This report describes influenza surveillance activities in Australia in 2019. Data were extracted from several sources constituting the National Influenza Surveillance Scheme. The 2019 influenza season in Australia was characterised by high activity overall, with 2.8 times as many laboratory-confirmed influenza notifications as the five-year mean value. There were an unusually high number of notifications reported in the 2018–2019 interseasonal period; an earlier peak in influenza notifications; and prolonged activity after the peak of the season compared to previous years. There was considerable variation in the timing of peak influenza activity between states and territories; however, this was not unexpected given climatic differences. Notification rates were highest in the 0–4 and 5–9 year age groups, and about 2.1 times higher in these age groups than the overall notification rate. The age-specific notification rates of influenza A were higher than the corresponding rates of influenza B in all age groups in 2019; however, the age-specific notification rate of influenza B was considerably higher among those aged 0–15 years compared to other age groups. In 2019, of laboratory-confirmed influenza notifications, 76.6% were influenza A (71.6% influenza A(unsubtyped), 3.9% A(H3N2) and 1.1% A(H1N1)pdm09) and 23.2% were influenza B. Similar trends were observed across many sentinel surveillance systems for influenza, with each sentinel system showing increased activity during the interseasonal period and earlier peak activity in 2019. High notification rates were reflected in an increase in sentinel hospital admissions with confirmed influenza. The burden placed on hospitals due to people admitted with influenza was high; however, severity (measured through the proportion of patients admitted directly to intensive care units) was moderate. Influenza was recorded as the underlying cause of death for fewer than 1% of all deaths that occurred in 2019.
Report of the National Influenza Surveillance Scheme, 2020–2021
This report describes influenza surveillance activities in Australia in 2020 to 2021 and the impact which coronavirus disease 2019 (COVID-19) related public health and social measures (PHSMs) had on influenza notifications. Data were extracted from several sources constituting the National Influenza Surveillance Scheme. In 2020 and 2021, a range of PHSMs were instituted across Australia to reduce the spread of COVID-19. These measures had a substantial impact on influenza circulation during this time. Laboratory-confirmed influenza notifications in these years were the lowest reported to the National Notifiable Diseases Surveillance System (NNDSS) since influenza became nationally notifiable in 2001. Laboratory-confirmed influenza notification rates varied greatly between states and territories in the two-year reporting period, likely influenced by differences in the PHSMs instituted across the country. Higher influenza notification rates were observed in the 0–4 and 5–9 year age groups in 2020, while the notification rates in 2021 were very low across all age groups. In 2020, eighty-seven percent of laboratory-confirmed influenza notifications were influenza A (91.1% influenza A(unsubtyped); 7.7% A(H1N1)pdm09; 1.2% A(H3N2)) and 12.6% were influenza B. In 2021, seventy-two percent of laboratory-confirmed influenza notifications were influenza A (91.1% influenza A(unsubtyped); 8.3% A(H3N2); 1.3% A(H1N1)pdm09) and 17.3% were influenza B. Very low influenza activity was also observed in community sentinel surveillance systems. However, slight increases in influenza-like illness, still at very low rates compared to previous years, were reported by sentinel general practices, with rises observed in mid-June in both 2020 and 2021. Very few laboratory-confirmed influenza sentinel hospital admissions and deaths were reported in 2020 and 2021.
Early use of genomics to guide acquisition investigation of Salmonella Typhi
Background As most Salmonella Typhi (S. Typhi) cases notified to public health units in Australia are acquired overseas, a case without recent travel raises concerns of local transmission. We describe a case of S. Typhi in a hospital inpatient without recent travel, where early use of genomic sequencing suggested remote acquisition from Chile in the 1980s, with chronic asymptomatic carriage. This facilitated the stand-down of a complex acquisition investigation. Case A notification of S. Typhi on stool culture was received for a female aged over 90 years living in Melbourne, Australia in October 2023. She had been hospitalised for three weeks (unrelated illness) and transferred into a residential aged care facility (RACF) six days prior to the result being known. She was asymptomatic and the sample was collected due to a recent ward gastroenteritis outbreak. Investigation Epidemiological investigation identified the case had emigrated to Australia in 1981 from Chile. Recent typhoid-like illness, overseas travel or contact with travellers from endemic areas were excluded. Subsequent genomic sequencing identified the isolate was multilocus sequence type 2 and did not cluster with any strains isolated in Victorian or international databases, most closely clustering with historical South American strains, with potential in-host changes over time. Management The case was presumed infectious throughout their hospital stay, with chronic carriage. There were 18 contacts, of whom 14 provided screening samples and were negative. Antibiotic case clearance was not recommended by the treating clinician due to patient comorbidity, treatment toxicity risks and unlikely treatment success without gallbladder removal. Enhanced infection control measures were instituted in the RACF (e.g. private bathroom, contact precautions for personal care, no food preparation). No additional cases were reported after two incubation periods (60 days). Conclusion Early genomic sequencing enhanced the efficiency of the public health investigation by rapidly confirming overseas acquisition and chronic carriage, obviating the need for extensive local upstream investigation.
Report on influenza viruses received and tested by the Melbourne WHO Collaborating Centre for Reference and Research on Influenza during 2025
As part of its role in the World Health Organization (WHO) Global Influenza Surveillance and Response System (GISRS), the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne (the Centre) received 13,817 human influenza-positive samples during 2025. Viruses were analysed for their antigenic, genetic, and antiviral susceptibility properties. Selected viruses were propagated in qualified cells or embryonated hens’ eggs for potential use in seasonal influenza virus vaccines. Of the 13,817 samples received or processed, influenza A(H1N1)pdm09 viruses predominated, accounting for 46.1% of samples, compared to 21.2% for A(H3N2) viruses and 19.5% for influenza B viruses; one influenza C virus was received. Among viruses analysed at the Centre, the majority of A(H1N1)pdm09 (> 99%) and influenza B (98%) viruses were antigenically similar to their respective WHO recommended vaccine strains for the Southern Hemisphere in 2025. In contrast, only 43% of A(H3N2) viruses were antigenically similar to their respective WHO recommended vaccine strains. Of 3,307 samples tested for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir, 37 A(H1N1)pdm09 viruses showed highly reduced inhibition by oseltamivir and no influenza viruses tested showed highly reduced inhibition by zanamivir. Of 5,080 samples with sequencing of the polymerase acidic (PA) gene, no genetic markers associated with highly reduced susceptibility to baloxavir marboxil were identified.
Meningococcal Surveillance Australia: Reporting period 1 January to 31 March 2026
ATAGI targeted review 2025: Immunisation considerations for immunocompromised people in Australia
Vaccination plays a pivotal role in protecting people who are immunocompromised, and who may therefore be at increased risk of infectious diseases, including vaccine preventable diseases (VPDs). However, there are special challenges in clinical practice and the development of immunisation policies to accurately address the vaccination needs of this heterogeneous population. This review aims to highlight the immunisation needs and challenges of immunocompromised populations, and to summarise the rationale behind the immunisation recommendations for these populations in Australia. The chapter Vaccination for people who are immunocompromised, in the Australian Immunisation Handbook, was recently updated by the Australian Technical Advisory Group on Immunisation (ATAGI). The updated chapter introduces new categorisation and risk classification for various types of immunocompromise, alongside the principles of immunisation. When planning immunisation for immunocompromised people, it is crucial to consider their underlying diagnoses, exposure to immunosuppressive therapies, susceptibility to VPDs, and their immune response to vaccination. Strategies to improve protection for immunocompromised persons include booster doses or altered schedules of routine vaccines; additional vaccines to prevent specific VPDs; and complete revaccination following immune reconstitution. Several national and jurisdictional vaccination programs have been implemented for immunocompromised populations (alongside other priority populations); however, monitoring vaccine coverage in these groups is challenging, and strategies to improve coverage are needed. There are significant evidence gaps in vaccine research for immunocompromised people, particularly regarding the optimal timing and scheduling of vaccinations to ensure maximum efficacy and safety. Future research should prioritise the inclusion of immunocompromised people in clinical trials and should integrate evidence from post-licensure use through data linkage. Emerging vaccine technologies may enable the development of more immunogenic vaccines or may offer more effective vaccination strategies for better protection against VPDs in immunocompromised people.
The first high pathogenicity avian influenza A(H5N1) clade 2.3.4.4b incursions in the Hunter New England region, New South Wales, Australia, June–July 2026
Two incursions of high pathogenicity avian influenza (HPAI) A(H5N1) clade 2.3.4.4b in vagrant birds were identified in the Hunter New England region of New South Wales, Australia on 28 June 2026 and 10 July 2026. These were the first detections of the virus in New South Wales and occurred shortly after the first Australian detection in June 2026. The Hunter New England Population Health Unit managed human contacts of the infected birds using a contact management system designed and purpose-built by the Unit. We report on the public health response and opportunities for improvement.
Transport time, not transport method, predicts Neisseria gonorrhoeae culture yield in an urban setting
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae poses a pressing public health threat. Current surveillance programs via antimicrobial susceptibility testing (AST) depend on successfully cultivating the organism via bacterial culture. However, AST is more challenging in extragenital sites and in remote clinical settings where there is a delay between sample collection and testing. This study evaluated whether an enhanced specimen transport system involving direct plating of samples onto selective agar with carbon dioxide enrichment (Bio-BagTM Type C, Becton Dickinson) improved N. gonorrhoeae recoverability compared to the standard method of rayon swabs in Amies gel (TransystemTM, Copan Diagnostics). Men with urethral or rectal gonorrhoea confirmed by nucleic acid amplification testing were consecutively recruited from an urban Sydney clinic. Among 33 rectal samples, enhanced transport yielded a slightly higher culture positivity rate (72.7%) than the standard method (69.7%), though this difference was not statistically significant (p = 0.790). Notably, rectal specimens arriving at the laboratory within five hours had significantly higher culture yields (100%) than those with longer transport times (61.5%; p = 0.049). Future studies of the impact of enhanced transport in rural and remote settings are critical to enhance AMR surveillance.
Maternal vaginal colonisation with Neisseria meningitidis serogroup B and late onset neonatal invasive meningococcal disease
Here we report a case of late onset neonatal invasive meningococcal disease that was vertically transmitted, with maternal vaginal swab at the time of delivery and neonatal cerebrospinal fluid culture positive for Neisseria meningitidis. Whole genome sequencing of meningococcal isolates in the neonatal cerebrospinal fluid and maternal vaginal found both Men-B ST-2506 (clonal complex 32) and identical (1 SNP difference on split kmer analysis).
Investment in cross-jurisdictional relationships results in a streamlined and efficient response by public health units to an imported case of measles in Far North Queensland and the Northern Territory, Australia, 2025
We describe the multi-jurisdictional collaborative approach employed in response to an imported case of measles in August 2025. This report highlights the importance of a rapid, coordinated response to measles across borders.
Shigellosis: antibiotics should be strictly reserved for severe disease and cases at very high risk of onward transmission
Increasing rates of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Shigella have been detected worldwide. This retrospective review of shigellosis notifications in Southeast Queensland found that XDR Shigella accounted for 48% of notifications. Antimicrobial treatment should be reserved for individuals with severe disease, immunocompromise or high risk of onward transmission.