Background Australia was declared malaria free in 1981. However, the proximity of Australia's Torres Strait region to malaria-endemic Papua New Guinea (PNG), and the presence of the Anopheles mosquito across Northern Australia, means there is an ongoing risk of malaria for many Australian residents. This paper describes the epidemiology of malaria in the Torres Strait region between 2000 and 2025 and reports the public health response to three malaria outbreaks between 2023 and 2025. Methods Case data from 1 January 2000 to 31 December 2025 were extracted from the Queensland Notifiable Conditions System to describe the epidemiology of malaria in the Torres Strait. The public health responses to each of the three recent outbreaks were reported against the Queensland Health Public Health Unit Guidelines for Malaria. Results During the period 2000-2013, there were 171 cases of malaria reported in the Torres Strait region. Of these, 89 (52%) were positive for Plasmodium falciparum and 82 (48%) for P. vivax. Of cases during this period, 130 (76%) were imported from PNG; 13 (8%) were acquired in Australia; and 28 (16%) had an unknown place of acquisition. After a nine-year period without any confirmed malaria cases in the region, eight cases were reported across three outbreaks between 2023 and 2025. In all six of the outbreak cases in which a species could be confirmed, P. vivax was identified. The three outbreaks were managed effectively in partnership with local leaders, and included active case finding and vector control activities. Discussion and conclusion The public health response successfully halted transmission of malaria during three separate outbreaks in the Torres Strait Islands. However, there is an ongoing local risk due to the high incidence of malaria in PNG and cross-border movement under the Torres Strait Treaty. Ongoing collaboration with PNG stakeholders and enhanced local surveillance are essential to minimise the future importation of malaria, and other potentially life-threatening pathogens, into mainland Australia.
The Australian Gonococcal Surveillance Programme (AGSP) has continuously monitored antimicrobial resistance in Neisseria gonorrhoeae (NG) for more than 45 years through the system of jurisdictional Neisseria reference laboratories, the National Neisseria Network (NNN). In 2025, a total of 10,204 isolates across Australia, from public and private sectors, were tested for in vitro antimicrobial susceptibility by standardised methods. In 2025, the AGSP captured antimicrobial susceptibility data for 23.9% of all gonococcal infection notifications nationally. The current treatment recommendation for gonorrhoea, for the majority of Australia, continues to be dual therapy with ceftriaxone and azithromycin. In 2025, of NG isolates tested, 0.73% (74/10,204) met the World Health Organization (WHO) criterion for decreased susceptibility (DS) to ceftriaxone, defined as a minimum inhibitory concentration (MIC) ≥ 0.125 mg/L. This proportion of isolates meeting the ceftriaxone DS criterion was greater than that reported in 2024 (0.51%), with the majority from New South Wales and Victoria. Genomic analysis indicated that 64.9% of these isolates (48/74) possessed the mosaic penA 60.001 allele, the key target associated with ceftriaxone resistance. Resistance to azithromycin was reported in 7.1% of NG isolates nationally, increasing from being proportionally stable (3.9% to 4.7%) since 2019. Of NG isolates tested, 0.20% (20/10,204) exhibited high-level resistance to azithromycin (MIC value ≥ 256 mg/L), with cases reported across Australia, predominantly in New South Wales, Victoria and non-remote Western Australia. There were ten isolates detected in 2025 that had an extensively drug-resistant (XDR) phenotype: i.e., displaying both high-level resistance to azithromycin and decreased susceptibility to ceftriaxone (MIC ≥ 0.125 mg/L). When added to the 14 XDR isolates reported during 2022-2024, this brings the total to 24 XDR NG isolates reported in Australia since 2022. Genomic analyses of the ten XDR isolates reported in 2025 indicated all harboured the mosaic penA 60.001 allele, with several differing sequence types (ST) identified. By contrast, during 2022 and 2024, XDR NG sequence types were limited to ST-16406, consistent with reports from Europe and England. Travel information, where available, indicates infections in 2025 were associated with travel to Southeast Asia but also arose where no travel was involved. In 2025, penicillin resistance was found in 23.4% of gonococcal isolates, and ciprofloxacin resistance in 59.3% of isolates where tested, although there was variation by jurisdiction particularly in remote settings, where acquisition of cultures for antimicrobial susceptibility testing is low. Tetracycline resistance has been included in surveillance in the AGSP in recent years, coincident with increasing use of doxycycline post-exposure prophylaxis for syphilis and chlamydia. Nationally 36.2% of NG isolates in 2025 were tetracycline resistant, with variation by jurisdiction. No isolates were resistant to spectinomycin; data for gentamicin, whilst no breakpoints are defined, are reported by the AGSP as these data are reportable to the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS). The emergence of antimicrobial resistant NG in Australia has largely occurred through importation, spread and local transmission. In 2025, in Australia and overseas, increased detection of drug-resistant NG isolates is of significant concern as the threat for the future of the current recommended therapeutic agents is increasingly evident, and no ideal alternate therapeutic agent has been identified. Disease prevention strategies under investigation for the future have included the MenB-4C vaccine, designed to protect against meningococcal disease. Despite early promise, recent results from a large Australian trial indicate the MenB-4C vaccine is not effective at preventing gonorrhoea in men who are at high risk of infection. The AGSP continues to monitor antimicrobial resistance and to identify emerging resistant clones by enhanced surveillance approaches, to inform strategies for disease management and treatment of gonorrhoea in Australia.
Nirsevimab, a long-acting monoclonal antibody with activity against respiratory syncytial virus (RSV), was introduced into the Queensland paediatric RSV prevention program in 2024. Using Queensland Notifiable Conditions Register (NoCS) data, we found that the infant cohort eligible for the nirsevimab program had lower RSV hospitalisation rates than comparable pre-program cohorts. The population-level impact of nirsevimab was greatest during the first month of life (incidence rate ratio [IRR]: 0.22; 95% confidence interval [95% CI]: 0.16-0.31; representing a 78% reduction in hospitalisation rate), with its magnitude gradually declining thereafter until nine months of age (IRR: 0.77; 95% CI: 0.62-0.96; a 23% reduction), following which the impact of nirsevimab on hospitalisation rate, with increasing age of the infant or child, was no longer statistically significant. An interrupted time-series analysis demonstrated an immediate 63% reduction in RSV hospitalisations following nirsevimab's introduction (IRR: 0.37; 95% CI: 0.23-0.60), showing a substantial population-level impact of the program in Queensland, Australia.
Background In the wake of the coronavirus disease 2019 (COVID-19) pandemic, there have been dramatic changes in the testing protocols for respiratory illness. Laboratory identification of respiratory pathogens causing clinical symptoms has become more important in the post-COVID-19 era, both for epidemiological and clinical reasons. This is particularly the case for respiratory syncytial virus (RSV) where a number of preventatives are at the point of clinical translation. The laboratory diagnosis is one of the critical elements in understanding the disease burden of respiratory pathogens and the effectiveness of preventatives. The aims of this study were to understand current laboratory testing and reporting practices across Australia. Methods We undertook a cross-sectional survey of Australian NATA (National Association of Testing Authorities) accredited laboratories to collect data on patterns of laboratory testing, the methods used and their reporting processes. The survey asked participants to report on testing of respiratory samples for 2022 as well as current respiratory multiplex testing in 2023. Outcomes In total, 45 out of 193 eligible laboratories (23%) completed the online survey. The majority of laboratories were from Victoria and New South Wales (31% and 27%, respectively) and most were hospital-based clinical diagnostic laboratories. Overall, 40% of responding laboratories (18/44) reported that > 80% of all tests in the molecular laboratory in 2023 were respiratory multiplex. Influenza viruses, RSV and SARS-CoV-2 were tested most frequently on respiratory multiplex PCR panels. RSV typing (RSV A or RSV B) was included in under a quarter of panels (9/43; 21%), compared to almost two-thirds for influenza typing (influenza A or influenza B: 29/44; 66%). There was considerable variability in testing platforms used, with thirty-seven laboratories using 87 different platforms (18 unique platforms). GeneXpert® (Cepheid) was the most commonly used platform; with a higher concentration of this instrument in laboratories from the eastern states (New South Wales, Queensland, Victoria). Forty percent of laboratories reported changes to respiratory testing procedures/panels in 2023 compared to the previous year. Laboratories were most likely to report results directly to the referring doctor (96-100%) followed by notifying their jurisdictional Department of Health.
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 January to 31 March 2026.
