Emma Best

Objective: To describe the epidemiology, clinical features, microbiology and outcomes of paediatric Streptococcus pneumoniae haemolytic uraemic syndrome (SpHUS) in Aotearoa New Zealand across changing pneumococcal conjugate vaccine (PCV) eras. Design: Retrospective case series. Setting: National paediatric tertiary referral centre, New Zealand. Patients: Children aged 0–15 years with SpHUS between 2008 and 2024. Main outcome measures: Clinical presentation, microbiology and serotype distribution, acute severity and long-term renal outcomes. Results: 39 cases were identified; 26/39 (67%) occurred between 2020 and 2024. Median age was 18 months, with 26/39 (67%) aged <2 years. Māori and Pacific children comprised 24/39 (62%) of cases. Complicated pneumonia was the predominant presentation (36/39, 92%). Among 32 cases with serotype data, 27/32 (84%) were serotype 19A, including 21/21 cases from 2020 to 2024. Most children were PCV-immunised (31/39, 79%), with 6/32 (19%) infected with vaccine-covered serotypes. Disease severity was high: 35/39 (90%) required intensive care and 31/39 (79%) required kidney replacement therapy (median 13 days). Mortality was 2/39 (5%) and 2/39 (5%) required kidney transplantation. Among survivors with follow-up, 13/30 (43%) had chronic kidney disease. Conclusions: SpHUS in New Zealand has increased since 2020, during a period of rising invasive pneumococcal disease, predominantly involving serotype 19A, with high acute severity and substantial long-term kidney morbidity. The burden is disproportionately borne by Māori and Pacific children, highlighting the need for ongoing surveillance and vaccine strategies responsive to local epidemiology.

Background: Childhood immunisation coverage in Aotearoa New Zealand (ANZ) is below national targets, with persistent and widening inequities particularly for Māori and Pacific peoples’ children. Understanding the social, cultural, behavioural, and structural drivers of low vaccination uptake requires a validated, contextually grounded assessment tool. This study reports phase two of the adaptation of an internationally validated Vaccine Barriers Assessment Tool (VBAT) for use in ANZ and addresses local inequities.Methods: Items from the Australian VBAT were reviewed and adapted through expert input, equity frameworks, and cognitive testing. A large cross-sectional survey of ANZ caregivers using the new tailored items was conducted. Exploratory factor analysis, alongside considerations of cultural and practical relevance, informed domain structure and item refinement. Internal consistency for each domain was assessed using Cronbach’s alpha.Results: Seven domains comprising 45 items were identified for the ANZ VBAT. The ANZ and Australian versions contained seven domains but notable differences emerged in domain composition and conceptualisation, reflecting contextual nuanced differences in vaccination. The ANZ tool did not retain a standalone knowledge domain and placed greater emphasis on confidence in safety and effectiveness, relationship with provider, and social influence. Demographic analyses showed that being female, lower educational attainment or household income, and lacking confidence in completing medical forms were associated with higher concern scores.Conclusions: Phase two of tool development produced a robust, equity focused set of domains and items tailored to ANZ’s immunisation context. Prominent barriers included affordability, appointment accessibility, needle fear, and vaccine safety misconceptions. All domains demonstrated acceptable to excellent internal consistency.

BackgroundThere is need for international tools to measure and monitor childhood immunisation programme uptake, validated specifically for local country context. Childhood vaccine coverage has declined in Aotearoa New Zealand (ANZ) since 2016, especially for Māori and Pacific Peoples.ObjectivesTo adapt the Australian Vaccine Barriers Assessment Tool (VBAT) for ANZ context, to support improvement of vaccination coverage, particularly for Māori and Pacific Peoples children.MethodsThe NZ VBAT was developed and validated in three stages: (1) Literature review and cognitive theory, refined through cognitive testing in ANZ. (2) Surveys assessing reliability of potential items and selection of items via expert consensus. (3) Surveys assessing predictive validity of future immunisation, with responses linked to vaccination records. Confirmatory Composite Analysis (CCA) assessed fit of the final preferred models.ResultsStage 1 identified 80 items, refined to 45 through cognitive testing. In stage 2, 467 surveys assessed item reliability. In stage 3, 314 out of 492 (64%) carers/parents (82% Māori and Pacific Peoples) completed the final 35 item survey, with 176 responses linked to immunisation records. Logistic regression showed strong associations between access and acceptance barriers and vaccine uptake. The final 6-item short survey had five domains encompassing safety, access, effectiveness, intention and influence; whilst the 14 -item long survey incorporated two additional domains: social responsibility and relationship with provider. Both surveys outperformed the US Parent Attitudes Childhood Vaccines (PACV) Survey, explaining 13% and 14% of uptake variation compared to PACV’s 10%.ConclusionThe NZ Vaccine Barriers Assessment tools (NZ VBAT) is a culturally appropriate tool to identify the social and behavioural drivers of suboptimal vaccination in children <5 years in NZ. It will support development of targeted interventions to achieve optimal immunisation coverage and reduce equity gaps.

Purpose: In New Zealand after multiple changes to the immunization program, PCV13 was re-introduced in 2022, replacing PCV10. We investigate the resultant epidemiology of this change. Methods: Using invasive pneumococcal disease (IPD) surveillance data, we compared incidence rates in different PCV eras and predicted the number of pediatric cases we would have expected, assuming PCV10 was still part of the immunization program. Results: IPD incidence among children has decreased. Without a vaccine change, incidence was predicted to continue increasing, driven by serotype 19A. Conclusions: The timely change in pneumococcal vaccine and subsequent incidence decreases underscores the importance of epidemiology-driven decisions.

Background: There are increasing reports of outbreaks of measles in countries that achieved measles elimination using two doses of measles-mumps-rubella (MMR) vaccine, particularly in health care settings. While responses to a third dose of MMR in two-dose recipients have been examined, these studies have all administered MMR by the standard (intramuscular or subcutaneous) route, and data on the duration of antibody are limited. We have developed a protocol for an open-label parallel-arm randomized-controlled trial to compare measles antibody responses and safety after intradermal and aerosol administration of MMR with intramuscular, the usual mode of administration in Aotearoa (New Zealand). Methods: Eligible participants are aged ≥ 18 years who have previously received two doses of the MMR vaccine and based on levels of IgG antibody to measles or mumps below the threshold for seropositivity in commercially available screening tests are required to receive the MMR vaccine prior to entering health professional training programs at Aotearoa universities. The participants will be randomized to three routes of administration (1:1:1) to receive the MMR vaccine by the intradermal (via microneedle), intrapulmonary (via vibrating mesh nebulizer), or intramuscular routes. The primary objective is to determine the proportion of participants who attain levels of measles IgG antibody above the seroprotective threshold using a multiplex bead-based immunoassay, with those in the lowest quartile validated by plaque neutralization assay, at days 6–8, 13–15, 28–42, and at 12–18 months post-vaccination. Secondary objectives include a fold increase in the geometric mean concentration of IgG antibody from baseline, and systemic and local reactions following delivery of MMR by each method. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR; https://www.anzctr.org.au/Default.aspx; trial registration no. ACTRN12623000130662).