Matthew N. Berger

Microarray patches (MAPs) demonstrate potential to improve pandemic preparedness by supporting rapid and large-scale vaccine distribution and administration, particularly in settings with limited cold-chain capacity or health workforce resources. This narrative review synthesises preclinical and clinical MAP vaccine research alongside literature on product development, manufacturing, regulation, implementation, acceptability, and equitable access, and reports encouraging early-phase tolerability and immunogenicity findings for influenza, Japanese encephalitis, measles–rubella, and SARS-CoV-2 MAP vaccines. Notable advantages include improved thermostability, antigen dose sparing, simplified application, the possibility of self- or layperson administration, reduced reliance on trained vaccinators, and suitability for outreach and low-resource settings. Advancing MAP technology requires selection of target vaccines, development of stable, antigen-specific formulations, confirmation of dose delivery, completion of phased clinical trials and regulatory assessments, establishment of scalable, quality-controlled manufacturing systems, and integration into immunization programmes. Challenges involve antigen compatibility, dose consistency, formulation stability, manufacturing scale-up, regulatory requirements, uncertain costs and commercial incentives, public acceptance, and equitable access. Following licensure, Phase IV surveillance and effectiveness studies will be needed to evaluate real-world safety and performance. Investment across research, manufacturing, regulation, and delivery is essential to position MAPs as complementary tools to conventional vaccines, thus broadening the speed, reach, and flexibility of pandemic immunization responses.

Syphilis remains a major public health concern globally, with rising incidence contributing to preventable complications, including congenital syphilis. As such, the Western Sydney Local Health District implemented a direct syphilis referral pathway between the public health unit and sexual health services. This study aimed to explore healthcare professionals’ experiences of this direct referral pathway and its perceived impact on clinical outcomes and care coordination. A qualitative study was conducted as part of a quality improvement initiative. Semi-structured interviews were undertaken with clinicians from public health and sexual health services involved in the referral pathway. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive and deductive thematic analysis. Fourteen clinicians participated, including medical practitioners and registered nurses. Two overarching themes were identified: (1) proactive case follow-up as a safeguard against preventable consequences of syphilis and (2) infrastructure and interprofessional relationships as enablers of sustained coordination. Participants reported that the pathway enabled proactive engagement of high-risk populations (i.e., pregnant women), resulting in faster treatment and reduced loss to follow-up. Improved interprofessional communication, clearer roles, and access to digital tools (e.g., shared referral forms and electronic medical records) enhanced coordination. Persistent challenges included stigma, unstable housing, and difficulties engaging some patients despite repeated outreach. Clinicians perceived the direct syphilis referral pathway as improving timeliness, coordination, and equity of care for high-risk patients. Strengthened collaboration between public health and sexual health services supported integrated management, although ongoing social and structural barriers highlight the need for complementary supportive interventions.

Microarray patches (MAPs) are an emerging, needle-free vaccination technology with potential to improve vaccine uptake and acceptability. A cross-sectional online survey was conducted to assess parents' perceptions of MAP safety, usability, and acceptability for themselves and their children. Participants were parents of children aged ≤18 y residing in Australia, Canada, the United Kingdom, or New Zealand. Responses were recorded on a 7-point Likert scale. Descriptive statistics and paired t-tests were used for analysis. A total of 102 parents participated (mean age = 40.7 y, SD = 10.6), predominantly from Canada (59.8%) and Australia (35.3%). Parents rated MAP vaccination as safe and effective (mean = 5.13; 95% CI: 4.83-5.43), easy to use (mean = 5.51; 95% CI: 5.26-5.77), and acceptable (mean = 5.43; 95% CI: 5.18-5.68). Respondents preferred MAPs over traditional needle and syringe (N&S) methods for themselves and their children, particularly citing benefits for those with needle-related anxiety. Parents expressed stronger preferences for healthcare provider administration for children compared to themselves. MAP self-administration was also viewed positively. Participants indicated greater willingness to pay more for their child to receive the MAP vaccination compared to themselves. Findings suggest that parents perceive MAPs as a safe, usable, and acceptable alternative to N&S vaccination for themselves and their children.

Introduction: Mpox emerged as a multi-country outbreak in 2022 and disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma is known to exacerbate health crises by discouraging testing, treatment, and vaccination. This review aimed to explore stigma associated with Mpox among GBMSM from July 2022, when mpox was declared a public health emergency of international concern. Methods: The PICO framework guided this narrative review. A search was conducted across the following databases from inception to June 2025: PubMed/MEDLINE, Embase, CINAHL, and Web of Science. The literature had to be empirical, peer-reviewed research that focused on mpox-related stigma in GBMSM. Results: Forty-seven studies were included in this review. The following themes were derived: (1) healthcare experiences, (2) media influence, (3) internalised and anticipated stigma, (4) public health messaging, (5) community responses, and (6) psychosocial impact. Healthcare experiences were marked by anticipated discrimination; many GBMSM delayed testing or vaccination for fear of being disclosed or labelled promiscuous. This was especially apparent in contexts where same-sex relationships are criminalised, leading some men to self-medicate or seek clandestine services. Media analyses revealed that social and traditional platforms often amplified blame and homophobia, though community-led counter-messaging helped shift narratives. Internalised and anticipated stigma resulted in shame, concealment of symptoms, avoidance of care, and heightened anxiety. Public health messaging that framed mpox as a behaviour-linked rather than identity-linked risk was more acceptable, and flexible vaccination strategies (e.g., offering less conspicuous injection sites) increased uptake. Stigma contributed to psychosocial distress and may have impeded outbreak control. Conclusions: Mpox-related stigma among GBMSM operates at individual, community, and structural levels, echoing patterns from the HIV era. Effective mitigation requires rights-based, destigmatising communication, culturally competent care, and collaboration. Addressing stigma is vital to controlling future outbreaks and ensuring equitable healthcare access.

Despite the various advantages of online surveys, such as their cost-effectiveness and broad reach, the infiltration of bots can result in data distortion, eroding trust and hindering effective decision-making. Identifying bot responses within survey data is paramount, and epidemiologic and public health researchers can utilise various tactics such as email authentication and scrutiny of response times, to detect fraudulent responses. This paper discusses the authors’ experience of bot spamming in an online survey, which skewed our findings. We discuss the actions taken to detect and invalidate bot responses within survey data and discuss potential forms of bot prevention. To detect fraudulent responses, the authors investigated the time taken to complete the survey, recruitment rates, invalid email addresses, and invalid free-format responses. Supplementary strategies, such as data validation methods and monitoring tools, can complement reCAPTCHA systems to alleviate the adverse effects of bot activity on survey data accuracy. However, employing other methods that require challenges, or additional questions may reduce the recruitment rate and deter potential participants. Given the advancing sophistication of bots, ongoing innovation in authentication techniques is imperative to protect the dependability and accuracy of survey data in the future.

Background: Vaccination is a fundamental tenet of public and population health. Several barriers to vaccine uptake exist, exacerbated post-COVID-19, including misconceptions about vaccine efficacy and safety, vaccine hesitancy, vaccine inequity, costs, religious beliefs, and insufficient education and guidance for healthcare professionals. Vaccine uptake may be aided using microarray patches (MAPs) due to reduced pain, no hypodermic needle, enhanced thermostability, and potential for self and lay administration. Objectives: This protocol outlines the development of a scale that aims to accurately measure the perceived safety, usability, and acceptability of MAPs for vaccination among laypeople, MAP recipients, clinicians, and parents or guardians of children. Methods and analysis: This study will follow three phases of scale development and validation, including (1) item development, (2) scale development, and (3) scale evaluation. Inductive (interviews) and deductive methods (literature searches) will be used to develop scale items, which experts from target populations will assess through an online survey. Cognitive interviews will be conducted to observe their processes of answering the draft survey. Thematic analysis will be conducted to analyse qualitative data. Lastly, four surveys will be administered online to our target populations over two time points to determine their repeatability. Exploratory and confirmatory factor analyses, Cronbach’s alpha, and construct validity will be performed. Ethics: This study was approved by Metro South Health (HREC/2021/QMS/81653) and Western Sydney Local Health District (2023/ETH00705) Human Research Ethics Committees. Discussion: The scale will support a standardised approach to assessing the social and behavioural aspects of MAP vaccines, enabling comparison of outcomes across studies. Once validated, this scale will assist vaccination programmes in developing effective strategies for integrating MAPs and overcoming barriers to vaccination. This includes improving vaccine equity and accessibility, especially in lower- and middle-income countries and rural or remote locations.

Background Microarray patches (MAPs) deliver vaccines to the epidermis and the upper dermis, where abundant immune cells reside. There are several potential benefits to using MAPs, including reduced sharps risk, thermostability, no need for reconstitution, tolerability and self-administration. We aimed to explore and evaluate the immunogenicity, safety, usability and acceptability of MAPs for vaccination. Methods We searched CINAHL, Cochrane Library, Ovid Embase, Ovid MEDLINE and Web of Science from inception to January 2023. Eligibility criteria included all research studies in any language, which examined microarrays or microneedles intended or used for vaccination and explored immunogenicity, safety, usability or acceptability in their findings. Two reviewers conducted title and abstract screening, full-text reviewing and data extraction. Results Twenty-two studies were included (quantitative=15, qualitative=2 and mixed methods=5). The risk of bias was mostly low, with two studies at high risk of bias. Four clinical trials were included, three using influenza antigens and one with Japanese encephalitis delivered by MAP. A meta-analysis indicated similar or higher immunogenicity in influenza MAPs compared with needle and syringe (N&S) (standardised mean difference=10.80, 95% CI: 3.51 to 18.08, pConclusion MAPs for vaccination were safe and well tolerated and evoked similar or enhanced immunogenicity than N&S, but further research is needed. Vaccine uptake may be increased using MAPs due to less pain, enhanced thermostability, layperson and self-administration. MAPs could benefit at-risk groups and low and middle-income countries. PROSPERO registration number CRD42022323026.