SYMPOSIUMS

Symposium #A

Title: Vaccination in Special Groups

Date & Time: Tuesday 10 June, 11.00am to 12.30pm ACST

Organisation Name: Vaccine Special Interest Group (VACSIG) of Australasian Society for Infectious Diseases (ASID)

Hosted by: VACSIG

Facilitated by: Dr Nan Vasilunas and Dr Archana Koirala

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Symposium Summary:

We have 4 speakers on the following topics: 

1. Immunising children with behavioural issues/neurodiversity

2. How to better engage adolescents in immunisation 

3. Practical ways of improving vaccine uptake in people living with disabilities

4. Older adults- how do we do a better job? 

Speakers will talk for a maximum of 20 mins each to allow for discussion/questions.

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Abstracts:

• Dr Laura Burgoyne - Immunising children with behavioural issues/neurodiversity

Many clinicians involved in childhood vaccine administration encounter individuals who are difficult to manage due to psychological or behavioural issues. Anecdotal evidence would suggest that this population is rising, in line with the increasing number of children diagnosed with anxiety and autism spectrum disorder. Some clinicians, such as General Practitioners and Paediatricians provide simple oral sedation to manage such patients, but this is not always successful, available, or feasible.

The Paediatric Sedation Service at the Women’s and Children’s Hospital, Adelaide was created when the ad hoc efforts by the Anaesthetic and Allergy/Immunology Services to vaccinate psychologically and behaviourally challenging children were supercharged by the Covid 19 pandemic.

In this talk we will share our experience from a predominantly nurse-led service that is now sedating over 100 patients a year for vaccinations. It will focus on how we manage patient flow through the service and what we do when non-pharmacological measures fail.

• Ms Kathleen Prokopovich  - Increasing adolescent vaccination uptake through engagement

Post-COVID, routine adolescent vaccination coverage rates have been steadily declining- could this imply people are less engaged with adolescent immunisation services?

To answer this question, I will discuss how engagement with adolescent vaccination should not be seen as simply vaccine acceptance but as an active, two-way relationship between adolescents, families, and immunisation providers.

Drawing on research conducted by the National Centre for Immunisation Research and Surveillance (NCIRS) and the available literature, I will present evidence on what is (or isn’t) facilitating health user engagement with routine adolescent vaccination, and outline how we may need to re-think current approaches and embrace new strategies within the immunisation ecosystem.

With changes to adolescent vaccine schedules, re-engagement strategies are possible and have the potential to increase uptake in the long term. This type of change requires both systemic and community efforts though, especially to rebuild trust and develop authentic and long-term healthcare relationships with parents, carers and communities.

• Ms Deirdre Brogan - Practical ways of improving vaccine uptake in people living with disabilities

  • Background - Individuals with severe anxiety, disability and neurodiverse conditions may be difficult to vaccinate in the community. These individuals often have greater health needs, may have experienced multiple unsuccessful vaccination attempts resulting in missed or incomplete vaccines, with highly motivated families.

  • Approach - An increase request for assistance from families and immunisation providers, prompted the development of a tired structured approach.

    • Tier 1: vaccination in the community no additional support required

    • Tier 2 is stratified incorporating a combination of non-pharmacological (2a) and pharmacological (2b) interventions utilising simple procedural sedation

    • Tier 3: immunisation is clustered with other simple medical interventions (eg. blood collection) requiring procedural sedation in a tertiary setting.

    • Tier 4: substantial pharmacological support clustered medical interventions in a tertiary setting

    • An individualised plan with reasonable adjustments is devised following a pre assessment telehealth. Utilising resources like visual aids, sensory-friendly spaces, and flexible scheduling can make the experience more comfortable for children with disabilities, helping to ease any anxieties they may have.

  • Conclusion - Working together with families while creatively utilising available resources, is crucial in ensuring that children with disabilities are vaccinated. Collaborative efforts that incorporate both innovative strategies and compassionate care empower children with disabilities to access vital vaccinations, ensuring their health and well-being in a supportive and inclusive environment​

• Ms Luda Mochanoff - Older adults- how do we do a better job?: Improving vaccination of residents in aged care facilities across the six regional Local Health Networks in SA

The six regional LHNs are the largest aged care providers in regional SA. In the past, aged care facilities have relied heavily on primary care – GPs have been relied upon to administer NIP vaccines for aged care residents. Access to GPs in rural and remote communities has been limited due to demands on their service provision. This was recognised to be a barrier to achieving good vaccination coverage of residents in aged care facilities. Staff in aged care facilities were upskilled to administer vaccines. Staff completed immunisation training recognised under legislation. Staff were provided access to the Australian Immunisation Register (AIR) to record immunisations on the Register. Consent and declination information were recorded. Resources were developed to support staff to deliver the program. A central resource and contact point was provided for staff to access for timely and relevant information..

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Speakers:

1. Dr Laura Burgoyne - Clinical Lead, Paediatric Sedation Service, Women's and Children's Health Network, South Australia

2. Ms Kathleen Prokopovich - Senior Research Officer Social Science, National Centre for Immunisation Research and Surveillance

3. Ms Deirdre Brogan - National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, Australia

4. Ms Luda Mochanoff - Advanced Nurse Manager/Rural Support Service, Immunisation Clinical Lead, Rural Support Service, SA Health

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Symposium #B

What happens when government wipes its hands of vaccination?

Date & Time: Tuesday 10 June, 11.00am to 12.30pm ACST

Organisation Name: University of Western Australia

Hosted by: Profs Katie Attwell and Julie Leask

Facilitated by: Profs Katie Attwell and Julie Leask

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Symposium Summary:

Recent events in the US and elsewhere have heightened concerns about maintaining vaccine coverage. But how exactly do governments work on vaccination programs? What are the implications of a leadership that effectively undermines vaccination?

In this innovative symposium, two former Chairs of the Collaboration on Social Science (COSSI), Professor Katie Attwell and Professor Julie Leask AO, explore global examples of how governments build and maintain vaccination uptake. They walk through what is already occurring and likely to unfold in the United States and beyond. Bringing together concepts from public health and political science with examples from a range of countries, Professors Attwell and Leask provide a comprehensive "state of the nation" for immunisation uptake.

Following their discussion, they will be joined by panelists from government, research, and practice. The panel will discuss with the audience the implications of the US situation for policy and programs in Australia and elsewhere, and what is needed to shore up government support for vaccination.

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Abstracts:

• SESSION ONE ABSTRACT (45 MIN)​

  • INTRODUCTION: Frequently, public health discourse presents immunisation uptake as the collective but untethered responsibility of the "eclectic we".  Governments, health professionals, and civil society are all imagined to participate, but the roles of these actors and their mechanisms of action are often absent from analysis. To address this gap, this symposium unpacks the centrality of "the state" in coordinating these activities and providing funding and leadership.

  • METHODS: Professors Attwell and Leask bring insights and concepts from public health and political science to a 45-minute podcast style discussion with prepared talking points. They offer conceptual categories for thinking about the roles that the state can play. They seek to develop a shared vocabulary.​

  • IMPACT: This discussion will be of high interest to anybody who is interested in strategies to increase immunisation uptake or preparing for threats to programs from abroad. It will appeal to those keen to understand more about global and domestic politics. It will enhance knowledge about the levers that governments can pull to promote vaccine uptake and drive partnerships with community, civil society and the health and medical fields.

• SESSION TWO ABSTRACT (45 MINS)​

  • INTRODUCTION: Understanding the role of the state in supporting immunisation programs is crucial, especially as challenges to these programs have emerged globally in recent times. Rollback of investment and ideological support for immunisation is unprecedented in most countries. We need to be prepared for its implications in Australia and beyond. How are program and policy workers planning for this?​

  • METHODS: A panel of professionals forms the second half of the symposium. Leaders from research, policy, programs, and professional organisations including Professor Mark Jit (Chair of the Department of Global and Environmental Health, NYU), Ken Griffin (CEO, Australian Primary Health Care Nurses Association), and Professor Nicola Spurrier (South Australian Chief Public Health Officer) join Professors Attwell and Leask to share prepared talking points and take questions from the audience. Using examples from their work in diverse systems, the panel explores how all those involved in immunisation governance and programs can support immunisation in these challenging times.

  • IMPACT: The panel discussion translates the concepts and political insights of the “podcast” discussion to policy and practice.

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Speakers:

1. Professor Katie Attwell - University of Western Australia

2. Professor Julie Leask - University of Western Australia

3. Professor Mark Jit - Chair of the Department of Global and Environmental Health, NYU

4. Professor Nicola Spurrier - South Australian Chief Public Health Officer

5. Ken Griffin - CEO, Australian Primary Health Care Nurses Association

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Symposium #C

Title: Moving into the future: Pathogen discovery with metagenomics

Date & Time: Wednesday 11 June, 1.30pm to 3.00pm ACST

Organisation Name: Communicable Diseases Genomics Network (CDGN)

Hosted by: Communicable Diseases Genomics Network (CDGN)

Facilitated by: Public Health Laboratory Network (PHLN)

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Symposium Summary:

The advancement of next generation sequencing has allowed for the higher resolution analysis of the entire genetic content of a clinical or environmental sample. This technique, also known as metagenomic next generation sequencing (mNGS) has instigated a change of landscape of the infectious diseases and the surveillance of pathogens with public health interest. These include the application of mNGS in difficult-to-culture infectious diseases from clinical and environmental samples, including wastewater monitoring, and accurate diagnosis to the subtype/genotype levels. The deployment of these technologies in Australian microbiology laboratories have been gaining momentum but constant innovation is still required for a sustainable mNGS program to form part of a global surveillance network.  

After this symposium, attendees will have a better understanding on the concept and types of mNGS (ie. genomics, targeted metagenomics, and shotgun metagenomics). This symposium will also showcase the utility of mNGS deployed in Australian laboratories, along with the challenges and considerations of integration of these new technologies into the surveillance system.

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Abstracts:

• Abstract 1: The hard challenges of metagenomic study of complex microbial communities in wastewater

  • Introduction: Metagenomic sequencing offers the potential to explore the dynamics of complex microbial communities in wastewater systems for a wide variety of uses, including pathogen surveillance, monitoring the efficacy of the wastewater treatment chain in reducing risk of pathogen transmission, and exploring how toxic and nuisance microorganisms can interrupt wastewater treatment or the supply of recycled water products. However, the robust application of metagenomics in these complex and often poorly characterised communities presents technical and analytical challenges. Furthermore, translating metagenomic detection into a measure of public health or wastewater management risk is both essential and challenging.

  • Aims: We will discuss the experience and efforts in applying metagenomic sequencing and related methods to the surveillance of pathogens and other microorganisms in complex microbial communities, particularly in wastewater. These observations include insight into method sensitivity and specificity considerations, optimisation for use in complex samples, and a range of analytical considerations and quality control steps to support routine use and translation.

  • Methods: As a case example, we will present a metagenomic analysis examining seasonal and temporal changes in the composition of seasonal cyanobacterial blooms in wastewater treatment plants, as well as an analysis of how cyanobacterial blooms impact on the composition of markers of antimicrobial resistant pathogens. Additionally, we will draw on specific experiences and observations from our genomic surveillance for SARS-CoV-2 during the COVID-19 pandemic.

  • Outcomes: Our work highlights key optimisation steps in sample processing and sequencing that can significantly improve the sensitivity of environmental metagenomics or targeted genomic sequencing. We also identified important quality control thresholds to ensure high-quality data output. Finally, we identify critical points in analysing these data that can significantly impact the outcome.

• Abstract 2: Capturing the diversity of viral pathogens with targeted metagenomics

  • Introduction: Targeted metagenomic sequencing using multi-pathogen enrichment offers a robust and cost-effective approach with clearly defined limits of detection for a very wide range of pathogens, including both DNA and RNA viruses, bacteria, and host markers. The power of the technique lies in co-detection of multiple pathogens simultaneously with no need for additional assay optimisation. In recent years, several targeted protocols have been made available by manufacturers, which provide both pre-designed and custom enrichment panels for targeted metagenomic sequencing.

  • Aims: In this presentation, we discuss applications of targeted mNGS to a range of clinical specimens, focusing particularly on clinical respiratory swabs. We would also present unique challenges and opportunities for understanding the dynamics of co-infecting and co-circulating pathogens.

  • Methods: We will be using the targeted mNGS approaches on respiratory swabs containing very large range of bacterial and viral pathogens.

  • Results: Using two case studies, we compare the application of an off-the-shelf protocol for respiratory viral panel for sequencing seasonal influenza A, and the design and analysis of a custom, powerful multi-pathogen method to examine the impact of both viral and bacterial co-infections on the severity of respiratory symptoms in infants with RSV.

  • Outcomes: We will address some approaches for effective and robust design of custom enrichment panels and for analysis of targeted enrichment data.​

• Abstract 3: Metagenomic sequencing as a tool for AMR surveillance

  • Introduction: Neisseria gonorrhoeae (Ng) is concerning for sexual and public health professionals due to its systematic development of resistance to most classes of antibiotic. More information on the genomic epidemiology of Ng in Australia is vital in understanding how these drug-resistant strains are entering and circulating in the community. However, due to their high prevalence and culture availability, where only 20% of all Ng cases in Australia have a corresponding isolate, not all Ng cases can have antimicrobial susceptibility testing and whole genome sequencing performed. While PCR screening can be utilised, constant evolution of resistance mechanisms makes this difficult to implement and maintain for public health laboratories. It is possible that pathogen-agnostic metagenomics-based approaches might be able to address this surveillance gap in a cost-effective and efficient manner.

  • Aims: To develop a cost-effective method that would enable large-scale sequencing of Ng isolates and potentially nucleic acid positive clinical specimens in order to collect AMR gene and typing information.

  • Methods: We utilised targeted mNGS (amplicon and bait-based sequencing techniques) developed by our laboratory to perform epidemiological typing of Queensland Ng samples. These methods were used to examine population genetics such as long-term epidemiology (MLST), mid-term epidemiology (NG-MAST) and resistance typing (NG-STAR).

  • Outcomes: The ability to perform large scale sequence-based analysis on Ng isolates and clinical specimens from across Queensland allowed the identification of specific clones circulating in the community and was able to provide important information on AMR resistance genes present. This approach has the potential to expand the molecular tools available for public health laboratories to manage AMR surveillance, potentially across the majority of cases regardless of diagnostic approach.​

• Abstract 4: An open discussion on the challenges and evolution of metagenomics

  • Introduction: Metagenomics is a rapidly evolving innovation with the need for continuous discussion around new techniques, best practice methods and future applications. To keep up with the dynamic and differing nature of this work, open discussions and building an understanding of jurisdictional methods are imperative to the long-term use of metagenomics.

  • Aims: To understand the different methods and challenges faced by laboratories across Australia, as well as the opportunities in metagenomics.

  • Methods: A panel discussion consisting of key stakeholders with expertise in bacterial, viral and environmental metagenomics will explore several topics: 1. The various techniques and methods used by different labs and their set-up; 2. How to navigate short falls and incidental findings from these technologies; 3. The utility of mNGS in the state-level or national level, and a foreseeable impact to the integration of mNGS into surveillance system. The panel will be interactive, with opportunities for the audience to engage with, and provide feedback to the panel to support an active discussion.

  • Outcomes: At the conclusion of this session, the audience will have developed a better understanding of the capability and application of metagenomic sequencing for public health purposes, and its caveats.

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Speakers:

1. Abstract 1: Dr Aaron Jex - WEHI

2. Abstract 2: Assoc/Prof. Tanya Golubchik - University of Sydney.

3. Abstract 3: Dr Rikki Graham - QLD Public and Environmental Health Reference Laboratory (QH PEHRL)

4. Abstract 4: Assoc/Prof. Amy Jennison (QH PEHRL), Dr Lex Leong (SA Pathology), Dr Aaron Jex, Assoc/Prof. Tanya Golubchik and Dr Rikki Graham

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Symposium #D

Title: Immunization Information Management and Innovation in the Digital Era: Insights and Prospects from China and Australia

Date & Time: Wednesday 11 June, 1.30pm to 3.00pm ACST

Organisation Name: Chinese Preventive Medicine Association

Hosted by: Chinese Preventive Medicine Association and Australia National Centre for Immunisation Research and Surveillance

Facilitated by: Prof. Kristine Macartey, Director, Australia National Centre for Immunisation Research and Surveillance

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Symposium Summary:

This symposium will focus on advancing immunization informatization and sharing practical experiences and innovative achievements from China and Australia. It will also address challenges faced by both countries and the global community. Key topics include developing immunization information management systems, managing immunization data (including collection, sharing, storage, analysis, etc.), and applying innovative technologies to improve immunization coverage and operational efficiency. Through fostering the exchange of experiences and knowledge, the symposium seeks to strengthen collaboration and mutual learning among Chinese, Australian, and international stakeholders. Ultimately, the event aims to promote the sustainable development of immunization informatization, contributing to enhanced national, regional and global public health outcomes. By serving as a platform for cooperation, the symposium will uncover best practices and drive the development of innovative solutions, such as AI-driven data analytics and digital health tools.

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Abstracts:

Symposium Chair: Prof. Kristine Macartey, Director, Australia National Centre for Immunisation Research and Surveillance

• Opening Remarks by Prof. Bin Li, President, Chinese Preventive Medicine Association (5 minutes):

  • Briefly introduce  the goals and vision of this syposium, call on Chinese, Australian, and international colleagues to learn from each other's experiences, promote information sharing, strengthen international cooperation, and jointly enhance global immunization information management level.

• Presentation 1 (20 minutes) - Title: Practice and prospect of immunization program information system in China

  • Presenter: Dr. Zundong Yin, Director, National Immunization Program, Chinese Center for Disease Control and Prevention 

  • Introduction: China's Immunization Information System (CIIS) has been progressively improved to take advantage of advances in information technology to meet an increasing demand for refined management of vaccination services, and established a comprehensive electronic traceability system for vaccines. The scope of this reconstruction project includes the National IIS and provincial-level integrated health information platform immunization information systems. The system integrates data from vaccination service points, including vaccination clinics, hospitals, and community health centers, and provides comprehensive information on vaccine inventory, vaccination activities, and adverse events following immunization (AEFI) monitoring reports.

  • Methods: By exchanging vaccination data with vaccine-preventable disease surveillance data, real-world vaccine effectiveness evaluations can be conducted. Through informatization methods, a combination of various approaches such as precise vaccination appointment scheduling, vaccination reminders, electronic health inquiries, electronic informed consent, electronic signatures, and QR code scanning for vaccination can be achieved.

  • Results: Although the construction of China's immunization information system has achieved remarkable results, in the face of emerging and sudden infectious disease challenges, it is still necessary to continuously strengthen the construction and application in areas such as system function improvement and expansion, data interoperability, data quality enhancement, management standardization, service diversification, and technological innovation. 

• Presentation 2 (20 minutes) - Title: Progress, functionality and application of Australia's Immunisation Register

  • Presenter: Prof. Kristine Macartney, Director, Australia National Centre for Immunisation Research and Surveillance

  • Introduction: The Australian Immunisation Register (AIR), established in 1996 to capture childhood vaccinations, was one of the first complete purpose-built national electronic childhood immunisation registers in the world.  Since then, the AIR has expanded to include all ages and been updated with new functionalities to respond to immunisation program evolution. 

  • Methods and results: The AIR is a key  source for monitoring and evaluation of immunisation programs and informing program planning and delivery and for promoting equity; key examples of how it has been used will be presented.  However, opportunities to better leverage to utility of the AIR to provide greater insights to strengthen evidence-based policy and practice. For example, use of the AIR for vaccine product tracking, linked AEFI reporting, or direct messaging (eg. pre-call/reminders for immunisation) to consumers using digital means will be explored. A user-friendly, tailored to context, digital dashboard reporting all vaccine coverage data to all immunisation stakeholders is also long-awaited.  Better understanding of vaccine impact in key populations, such those as residential aged care, with disability, who are culturally diverse, pregnant or have underlying medical risk conditions is needed and can be garnered through a comprehensive and well supported strategic approach to leveraging AIR linkages with key evolving data assests, such as the Person Level Integrated Data Asset (PLIDA), managed by the Australian Bureau of Statistics, the Australian Institute of Health and Welfare (AIHW) National Health Data Hub, and state/territory linked data assets.

• Panel Discussion (45 minutes) - Topic: How to leverage big data and digital technologies to improve vaccine access, coverage and inform policy?

  • Introduction: Achieving high and equitable vaccine coverage is a core objective of global immunization programs, but they face numerous challenges. Key insights are also needed to inform and prioritise new vaccine introductions and optimise immunisation program delivery and impacts. Big data and digital technologies offer new opportunities in this regard.

  • Methods: The panel will discuss approaches to optimizing vaccine coverage and insights  through big data analysis, streamline vaccination processes using digital tools, and model and evaluate program impact. Discussion will focus on relevance for all countries and settings. Interactive audience participation, citing other country examples, stakeholders key needs and experience sharing will be incorporated across the symposium.

  • Results: Big data and digital technologies hold great promise to improve global vaccine coverage and accessibility, benefiting low- and middle-income, as well as high-income countries. The symposium attendees will participate in a thought provoking and engaging dialogue to explore how such innovate is and can better be used to in vaccine preventable disease control.

  • Moderator: Dr.Melinda Chen, Senior Research Officer, Australia National Centre for Immunisation Research and Survelliance​

  • Panelists:

    • Prof. Mark Jit (TBC), Professor and Chair of the Department, Global and Environmental Health at New York University

    • Prof. Kristine Macartney, Director of Australia National Centre for Immunisation Research and Survelliance

    • Prof. Zijian Feng, Professor of Southern University of Science and Technology; Vice President, Chinese Preventive Medicine Association

    • Dr. Zundong Yin, Director of National Immunization Program, Chinese Center for Disease Control and Prevention

    • Prof. Shenglan Tang, Co-Director and Professor of Global Health of the Global Health Research Center, Duke Kunshan University, China

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Speakers:

1. Prof. Bin Li, President, Chinese Preventive Medicine Association

2. Dr. Zundong Yin, Director of National Immunization Program, Chinese Center for Disease Control and Prevention

3. Prof. Kristine Macartey, Director, Australia National Centre for Immunisation Research and Surveillance

4. Panel members listed above