This summary report on vaccine preventable diseases in Australia is the latest in a series of multi-year surveillance reports that bring together the three most important national sources of routinely-collected data on VPDs (notifications, hospitalisations and deaths) and serve as a resource to support surveillance and control of VPDs in Australia. This report focuses on the four-year period 1 January 2019 to 31 December 2022 with longer term trends also presented. Two VPDs are included for the first time: coronavirus disease 2019 (COVID-19) and Japanese encephalitis virus (JEV) infection.

This report describes influenza surveillance activities in Australia in 2022 to 2023. Data were extracted from several sources constituting the National Influenza Surveillance Scheme. Following the relaxation of public health and social measures which had been applied in Australia in response to the coronavirus disease 2019 (COVID-19) pandemic in 2020 and 2021, the influenza seasons in 2022 and 2023 were characterised by high activity overall, with 1.4 and 1.8 times the number of laboratory-confirmed influenza notifications than those of the 2015-2019 pre-pandemic five-year mean, respectively. There were differences in the timing of the 2022 and 2023 influenza seasons compared to most pre-pandemic years, with earlier season starts and earlier peaks (approximately six to eight weeks earlier than in pre-pandemic years). There was also considerable variation in the timing of peak influenza activity between the states and territories, particularly in 2023. Notification rates were highest in the 5-9 years age group, with rates in this age group about two and a half times as high in 2022 and three times as high in 2023 as the overall notification rate in the corresponding years. Influenza A(unsubtyped) comprised most notifications in 2022 and 2023. Of the remaining samples, influenza A(H3N2) was dominant in 2022; however, in 2023, there was substantial circulation of influenza B, which predominantly affected children and younger adults, and of A(H1N1). Sentinel surveillance supports the assessment that both the 2022 and 2023 influenza seasons were characterised by early, high activity. High notification rates were also reflected in increased sentinel hospital admissions with confirmed influenza in 2023, particularly among children. The burden placed on sentinel hospitals due to people admitted with influenza was moderate in 2022 but high in 2023. Severity, measured through the proportion of patients admitted to sentinel hospital intensive care units, was moderate in both years and consistent with historical estimates. Influenza was recorded as the underlying cause of death in 0.16% of all deaths that occurred in 2022, and 0.24% of all deaths in 2023. Overall, the 2022 influenza season had high activity with low-to-moderate severity, while 2023 had high activity with moderate severity.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exploits host cellular machinery to support its replication. Members of the host poly(ADP-ribose) polymerase (PARP) family regulate the DNA damage response and have been implicated in both antiviral and proviral processes. In this study, we investigated the potential role of PARP3 in SARS-CoV-2 replication in VeroE6/Rep3 cells. siRNA-mediated knockdown of PARP3 reduced viral subgenomic RNA (sgRNA) levels and reporter activity, whereas PARP3 overexpression enhanced these processes, suggesting that PARP3 promotes SARS-CoV-2 replication. In addition, PARP3 expression was increased in SARS-CoV-2-infected Calu-3 cells and in cells expressing SARS-CoV-2 nucleocapsid protein, suggesting that the nucleocapsid protein contributes to PARP3 upregulation during infection. Co-immunoprecipitation and immunofluorescence analyses revealed that PARP3 associates with the nucleocapsid protein and redistributes to the cytoplasm in nucleocapsid-expressing cells. Screening of a PARP inhibitor library identified venadaparib as a compound that reduced SARS-CoV-2 sgRNA levels and reporter activity in VeroE6/Rep3 cells with limited cytotoxicity under the condition tested. We further found that venadaparib reduced the interaction between PARP3 and the nucleocapsid protein. Molecular docking analysis further suggested that venadaparib can bind to the PARP3 catalytic domain. Collectively, these findings support a model in which PARP3 facilitates SARS-CoV-2 replication through its interaction with the viral nucleocapsid protein and suggest that venadaparib warrants further evaluation as a host-directed antiviral candidate.

An early adolescent with bilateral temporomandibular joint (TMJ) ankylosis presented with obstructive sleep apnoea (OSA), facial asymmetry and reduced mouth opening with an interincisal distance of 2 mm. Baseline polysomnography (PSG) revealed a critically elevated apnoea-hypopnoea index (AHI) of 90.3, consistent with extremely severe OSA. Due to high anaesthetic risk and compromised airway, a staged surgical approach was adopted. A planned tracheostomy was performed during the first-stage procedure to secure the airway with subsequent bilateral mandibular distraction osteogenesis leading to significant improvement in OSA symptoms, nutritional status and airway dimensions. Four months later, bilateral TMJ ankylosis release and interpositional gap arthroplasty using dermis fat were performed. Tracheostomy was maintained for approximately 175 days to ensure airway safety during the interval between staged procedures and because of the anticipated difficulty with reintubation for the subsequent surgery. Postoperatively, the unassisted interincisal opening improved to 35 mm. No postoperative device-related or neurological complications were reported. Decannulation was performed after confirmation of adequate airway patency. Repeat PSG performed at 1 year follow-up demonstrated an AHI of 0.6. This report illustrates the effectiveness of a staged approach in managing TMJ ankylosis complicated with severe OSA. In this case, airway management is a point of practical importance for surgical planning due to anticipated difficult intubation and intraoperative risk.

Eisenmenger syndrome (ES) is a form of cyanotic congenital heart disease resulting in pulmonary hypertension and right-to-left shunting. End-stage ES often requires lung transplantation and patients may require extracorporeal membrane oxygenation (ECMO) as a bridge, though the optimal cannulation strategy is not standardized. A 49-year-old woman with ES due to unrepaired ostium secundum atrial septal defect presented with acute on chronic pulmonary embolism and refractory hypoxemia, ultimately requiring VA ECMO cannulation, which was complicated by venous cannula migration across the ASD and into the left atrium, requiring bedside repositioning under echocardiographic guidance. Differential hypoxemia was managed throughout her ECMO course and she was ultimately bridged to bilateral lung transplantation after three days. ECMO use in ES is complex and requires appreciation of the inherent limitations of each cannulation strategy. Peripheral VA ECMO can serve as a short-term strategy when emergent circulatory support is needed.

The Nursing Activities Score is a promising tool to calculate nursing workload in Intensive and Intermediate Care Units of different typologies.

To assess nursing workload in a Stroke Unit using the Portuguese version of the Nursing Activities Score.

Prospective observational study conducted with patients admitted to a Stroke Unit from November 2024 to February 2025. The study was approved by the Ethics Committee and was reported in accordance with the STROBE guidelines.

The study included 69 patients admitted to the Stroke Unit for more than 24 h. Each participant generated an average nursing workload of 45.30 ± 7.39 points/day. The Stroke Unit recorded a median nursing workload of 159.40 (IQR: 126.60-211.90) points/day and an average occupancy rate of 82.0%. The days of admission and discharge are periods that tend to generate greatest nursing workload. There were statistically significant differences between the first and the last nursing workload assessments. Altered state of consciousness and fibrinolysis in the Stroke Unit are associated with greater nursing workload on the admission day.

This study revealed the potential of the Nursing Activities Score as a tool to assess nursing workload in Intermediate Care Units, such as Stroke Units. The Nursing Activities Score showed an imbalance between nursing resources and reported care needs. The nursing workload was higher in the first assessment than in the last, reflecting the trend towards recovery of autonomy and improvement of the participants' clinical condition throughout the length of stay. There are demographic and clinical characteristics present at the time of admission that may be associated with a higher nursing workload.

Nursing workload assessment using the Nursing Activities Score enables identification of patients and periods with the greatest care needs, thereby supporting decision-making in complex environments such as Stroke Units.

Transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) anatomy remains challenging, with heterogeneous outcomes and no standardized sizing strategy. The LIRA (level of implantation at the raphe) method is a bicuspid-dedicated approach that complements standard annular sizing with a single perimeter measurement at the raphe level. A previous single-center experience suggested favorable results.

The aim of this study was to evaluate clinical performance and reproducibility of the LIRA method for TAVR sizing in a large BAV multicenter cohort.

A total of 215 BAV patients undergoing TAVR with the LIRA method at 6 centers were retrospectively analyzed. Procedural and clinical outcomes were adjudicated according to Valve Academic Research Consortium 3 criteria and assessed at 30 days and 1 year. Available full-cycle computed tomographic data sets from external centers were reanalyzed in a blinded centralized core laboratory to assess reproducibility of the LIRA method.

The application of the LIRA method led to prosthesis downsizing in 74.4% of cases. At 30 days, device success was 93%, and moderate or greater paravalvular leak had occurred in 4.6% of patients, new permanent pacemaker implantation in 10.7%, and stroke in 1.9%. At 1 year, all-cause mortality was 5.7%, and clinical efficacy was observed in 92.8% of patients. Clinical outcomes were consistent across centers. Prosthesis sizing agreement was excellent (κ = 0.85; 95% CI: 0.74-0.96), and perimeter concordance was good (intraclass correlation coefficient = 0.76; 95% CI: 0.63-0.85).

In this large multicenter cohort, the LIRA method demonstrated good reproducibility across centers and was associated with favorable procedural and clinical outcomes in BAV patients undergoing TAVR. These findings support its clinical applicability as a bicuspid-dedicated sizing strategy.

Extremely premature infants (<28 weeks' gestation) with hemodynamically significant patent ductus arteriosus (PDA) may require transcatheter PDA closure (TCPC) when medical therapy fails. Although TCPC is associated with improved respiratory outcomes over surgical ligation, its availability is limited because of the need to transport these critically ill infants to cardiac catheterization laboratories, delaying care and increasing risk.

The authors describe the successful transition of TCPC from the catheterization laboratory to the neonatal intensive care unit (NICU) bedside, emphasizing feasibility, safety, and early outcomes.

The authors conducted a retrospective review of infants at <28 weeks' gestation weighing <2 kg who underwent TCPC between July 2012 and December 2024. The program evolved in 3 phases: traditional laboratory-based TCPC (2012-2021), laboratory-based TCPC using transthoracic echocardiographic guidance only (July to December 2021), and bedside TCPC in the NICU (2022-2024).

Of 500 infants, 176 underwent bedside TCPC. These infants were younger (median 20 days vs 29 days) and smaller (820 g vs 1,010 g) than laboratory-treated infants. Bedside procedures were shorter (18 minutes vs 32 minutes) and had reduced radiation exposure (0.019 Gy × cm² vs 0.068 Gy × cm²; P < 0.001). Procedural success was 100% across all settings. Major complication rates were low (1.7%) and similar across settings. Follow-up (median 6.8 years) showed an 89% survival rate, no residual PDAs, and minimal late complications.

Bedside TCPC is a feasible, safe, and effective approach for managing PDA in extremely premature infants. It eliminates the need for interhospital transport, supports earlier intervention, and may improve outcomes. With appropriate training and experience, bedside TCPC has the potential to become the standard of care across NICUs.

The MITRA-PRO registry revealed residual mitral regurgitation (MR) as an important predictor of 1-year and 3-year mortality following mitral transcatheter edge-to-edge repair (M-TEER).

The 5-year follow-up of the MITRA-PRO registry (N = 1,491) aimed to assess the impact of residual MR on 5-year mortality. Furthermore, time-dependent predictors of mortality after M-TEER should be assessed.

Patients with a MitraScore of ≤3 were classified as patients with mild residual MR after M-TEER, while a MitraScore of ≥4 was defined as relevant residual MR. Adjusted HRs were calculated for multivariate analysis of time-dependent predictors.

Five-year mortality was significantly lower in patients with mild or less residual MR compared with patients with more than mild residual MR (MitraScore ≤3 group: 55.1% vs MitraScore ≥4 group: 67.7%). The relationship between intraprocedural MitraScore after M-TEER and mortality was almost linear. In patients with degenerative MR, 5-year mortality was 53.1% in the MitraScore ≤3 group and 73.2% in the MitraScore ≥4 group. Regarding functional MR, the corresponding 5-year mortality rates were 55.0% and 64.6%. Mortality predictors after M-TEER were time dependent: Early risk was driven by advanced disease and procedural factors, whereas residual MR became prognostic after 30 days and remained associated with excess long-term mortality.

Residual MR assessed by intraprocedural MitraScore after M-TEER independently predicts 5-year mortality. This finding underscores the importance of achieving optimal MR reduction during M-TEER and supports quantitative multimodal intraprocedural assessment to guide strategy and improve long-term outcomes.

Optimal stenting for true coronary bifurcation lesions is widely debated, with few studies using predefined intracoronary imaging.

The aim of this study was to assess predictors and outcomes associated with a 1 vs a 2-stent technique and whether optical coherence tomographic (OCT) guidance modified the association with clinical outcomes.

This OCTOBER (European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction; NCT03171311) post hoc analysis included 1,201 patients with true coronary bifurcation treated with percutaneous coronary intervention (PCI). Clinical outcomes were analyzed using multivariable Cox regression. Multivariable logistic regression identified predictors of a 2-stent technique.

Clinical indication, left main coronary artery (LMCA) bifurcation, and side branch (SB) lesion severity were the strongest predictors of 2-stent use (acute clinical presentation: adjusted OR: 1.73 [95% CI: 1.33-2.25]; LMCA: adjusted OR: 2.04 [95% CI: 1.38-3.03]; SB lesion length: adjusted OR: 1.06 per mm [95% CI: 1.03-1.09]; SB diameter stenosis: adjusted OR: 1.04 per 1% [95% CI: 1.03-1.05]). In as-treated analysis, a 1-stent technique was associated with a lower 2-year rate of major adverse cardiac events (MACE) than a 2-stent technique (9.0% vs 13.9%; adjusted HR: 1.53; 95% CI: 1.04-2.27), with no interaction with OCT (P for interaction = 0.24). Planned-strategy analyses showed no significant difference in MACE. Among patients treated with a double kissing (DK)-crush technique, angiography-guided DK crush was associated with higher MACE rates compared with OCT-guided DK-crush (HR: 2.42; 95% CI: 1.12-5.24).

Clinical indication, LMCA bifurcation, and SB disease severity predicted 2-stent PCI. MACE did not differ according to planned strategy, whereas actual 2-stent PCI had higher MACE rates, likely reflecting a higher burden of complexity. The lowest event rates were observed with OCT-guided 1-stent PCI.