We built PHN-Map, an open-data Web-based GIS with geo-linked 360° images to support 15 000 public health nurses (PHNs) during the 2024 Noto Peninsula earthquake and subsequent floods. The map improved pre-deployment triage, home-visit routing and training, logging >300 uses on launch day, proving GIS and 360° imagery useful for PHN disaster activities.

The World Health Organization requires States Parties to report significant public health events through National Focal Points (NFPs). However, the nature and adjudication of events reported to NFPs is not well known outside of government. We summarized a sample of Australian NFP event information during 2014–2023 by year, hazard, origin and whether other NFPs were notified.

Objective: This study aimed to demonstrate the benefits of using SaTScan (Boston, MA, USA), a cluster-detection software programme, and whole genome sequencing to investigate a suspected outbreak of Serratia marcescens infections in a tertiary government hospital in the southern Philippines. The hospital is part of the national Antimicrobial Resistance Surveillance Program’s network of sentinel sites. Methods: The investigation followed national outbreak investigation protocols. In May 2022, when evaluation of daily hospital laboratory census data revealed an increase in the number of Serratia species in the hospital, an alert was triggered. A concurrent, routine SaTScan analysis of the hospital’s surveillance data by the Antimicrobial Resistance Surveillance Reference Laboratory confirmed a cluster of cases. The Reference Laboratory requested isolates from clinical specimens from the hospital for confirmation of bacterial identification, antimicrobial susceptibility testing and whole genome sequencing. Results: Six isolates were submitted for genomic analysis, two of which were from the identified cluster. Although originally identified as S. marcescens, five of the isolates were subsequently confirmed as S. sarumanii. Phylogenetic analysis showed that the two isolates from the cluster were closely related and belonged to the same clade, which may suggest a common source. Three antimicrobial resistance genes were identified, but their phenotypic expression was limited, with one isolate exhibiting resistance mechanisms. Discussion: This study highlighted the utility of SaTScan for the early detection of potential disease outbreaks. The use of whole genome sequencing enhanced the investigation by enabling the analysis of potential transmission pathways at the genetic level, identification of the outbreak source and the detection of novel species.

Objective: On 27 June 2023, the Thailand Department of Disease Control was notified of an incident of carbon monoxide poisoning related to a Thai-style hotpot restaurant. An outbreak investigation was performed to describe the incident, confirm its cause and sources of exposure, and provide preventive measures. Methods: The restaurant owner, restaurant guests and waiting staff were interviewed, and the medical records of hospitalized cases were reviewed. In an environmental survey, air quality parameters were measured, including temperature, relative humidity, carbon dioxide and carbon monoxide. Additionally, a simulation of the incident was conducted, and data were reviewed from previous poisoning incidents in Thailand. Results: There were 11 cases, all of whom were guests who dined in the same private dining room. The median age of cases was 28 years (range 2–62 years). Three cases were hospitalized and received hyperbaric oxygen therapy. The air changes in the dining rooms were below the recommended level. The incomplete combustion of charcoal in a poorly ventilated room led to carbon monoxide build-up, which caused the incident. The simulation experiment showed a high concentration of carbon monoxide (mean 183.16 ± 55.15 parts per million), above the standard level. Ten similar poisoning incidents occurred between 2019 and June 2023, totalling 23 cases and 2 deaths; none occurred in a restaurant. Discussion: Charcoal use in poorly ventilated areas poses a health risk, especially for children. The use of charcoal stoves for hotpot cooking indoors is prohibited. Public health policy should mandate regular restaurant inspections to ensure compliance with occupational and environmental health standards.

Objective: To investigate COVID-19 mortality in Philippine provinces from 2020 to 2023. Methods: Crude mortality rate (CMR), age-standardized mortality rate (ASMR) and age-specific mortality rate were computed for 84 areas (82 provinces and 2 cities) using COVID-19 surveillance data from the Philippine Department of Health, which captured data about confirmed deaths occurring between 20 January 2020 and 9 May 2023. Provinces were ranked by their ASMR. A correlation analysis was conducted to identify possible predictors of COVID-19 mortality. Among the factors investigated were the incidence of poverty, population density, proportion of the population considered elderly (aged >=65 years), hospital bed density and COVID-19 testing rates. Results: Eight of the 10 provinces that had the highest COVID-19 ASMRs were located in the Luzon island group. The province with the highest ASMR was Benguet in Northern Luzon (207.83 deaths/100 000 population), and the lowest rate was in Tawi-Tawi in Southwestern Mindanao (2.22 deaths/100 000 population). The incidence of poverty was negatively correlated with COVID-19 mortality, while hospital bed density and COVID-19 testing rates were positively correlated with CMRs and ASMRs. Discussion: This analysis provides a starting point for investigating COVID-19 mortality in Philippine provinces. The ranking of provinces by their ASMR is useful for directing future epidemiological investigations and, coupled with the results of the correlation analysis, provides insight into the factors that may have impacted COVID-19 mortality in the Philippines. Our analysis suggests that COVID-19 mortality patterns can partly be explained by the streetlight effect and factors linked to the availability of and access to health care.

Objective: To determine the causative agent, clinical manifestations and risk factors for infection during a September 2023 outbreak of acute haemorrhagic conjunctivitis (AHC) in Pak Touch village, Ratanakiri province, Cambodia. Methods: A retrospective case-control study was conducted. Cases were age-matched to controls (1:1), who were randomly selected from the village population. Twenty-one conjunctival samples were analysed using real-time reverse transcription–polymerase chain reaction (RT–PCR). RNA sequencing was additionally performed to identify the causative agent of the outbreak. Logistic regression models were used to identify significant risk factors. Results: A total of 73 cases and 73 controls were included in the analysis. Cases had a median age of 20 years (range: 1–70, mean and standard deviation: 27.7 ± 20.0), and 46.6% (34/73) were male. The overall attack rate was 12.3% (73 cases/594 residents). Clinical presentations included conjunctival hyperaemia (100%), subconjunctival haemorrhage (82.2%, 60), pain and discharge (64.4%, 47 each), eyelid swelling (57.5%, 42) and tearing (54.8%, 40). RT–PCR identified enterovirus in 52.4% (11/21) of conjunctival swabs, with RNA sequencing confirming the coxsackievirus A24 variant as the causative agent in five swabs. Statistical analysis identified significant risk factors, including physical contact with patients with acute haemorrhagic conjunctivitis (adjusted odds ratio [aOR]: 4.42, 95% confidence interval [CI]: 1.90–10.10), frequent eye rubbing (aOR: 4.56, 95% CI: 2.00–10.37) and poor hand hygiene (aOR: 3.70, 95% CI: 1.64–8.43). Discussion: The outbreak of acute haemorrhagic conjunctivitis in Pak Touch village was primarily caused by coxsackievirus A24. Significant risk factors included physical contact with infected individuals, frequent eye rubbing and poor hand hygiene. Effective hygiene measures are crucial to prevent the spread of AHC.

Many countries record high rates of fireworks-related injuries, especially during national celebrations. In the Philippines, increases in the number of injuries reported around the New Year period in recent years have highlighted the importance of continued strengthening of national fireworks-related injury surveillance. The Philippines’ regional epidemiology and surveillance units play a significant role in surveillance by linking its key stakeholders, the sentinel hospitals and the Department of Health’s Central Office. More specifically, these units promote compliance with reporting standards among sentinel hospitals and support case data validation. Approximately half of the sentinel hospitals that contribute data to the surveillance system are in the nation’s capital, Metro Manila. This concentrated coverage prompted the Regional Epidemiology and Surveillance Unit staff in Metro Manila to implement low-cost, digital strategies to improve the quality and timeliness of fireworks-related injury reporting. During the 2023–2024 surveillance period (21 December to 5 January), the use of virtual coordination spaces and data dashboards contributed to reducing turnaround times for generating surveillance reports from 31 minutes to 8 minutes. Moreover, at least 80% of sentinel hospitals provided timely reports on 11 of the 16 days of the surveillance period. Staff commitment was a major contributing factor in overcoming the time and human resource constraints encountered during implementation of these strategies. However, it is important to recognize that beyond these digital innovations, policy reforms that increase funding are needed to enhance fireworks-related injury surveillance and secure its long-term sustainability and scalability in the Philippines.

Objective: The objectives of this study were to describe the characteristics of Thailand’s first reported outbreak of herpes gladiatorum in Thai-boxing gyms and to provide recommendations for reducing the risk of transmission. Methods: Hospital reports of atypical rashes appearing among Thai-boxing trainees triggered investigations at three gyms in Phuket during May–August 2022. Semistructured questionnaires were used to collect data from gym owners, trainers and trainees. Skin and blood specimens were collected for reverse transcription–polymerase chain reaction testing for herpes simplex virus type 1 (HSV-1), antibodies to HSV-1 and other pathogens; genomic sequencing was performed on culturable samples. The environmental investigation included walk-through surveys, a review of each gym’s web site, and testing of surfaces and water specimens. Results: Nine cases of herpes gladiatorum were confirmed and one was suspected, all in non-Thai trainees. Attack rates in Gyms I, II and III were 21.4%, 11.5% and 2.6%, respectively. Risk behaviours included sparring with partners who had a rash, sharing equipment and neglecting to shower before training. HSV-1 was detected on gym equipment and surfaces, and cultures from skin lesions and blood samples revealed a genomic linkage between two cases in Gym II, identified as belonging to the East Asian Clade II strain. Disinfection of equipment reduced exposure to HSV-1. Discussion: The first outbreak of herpes gladiatorum in Thailand was confirmed in 2022. Genomic sequencing suggested local transmission within Thailand, with the virus introduced independently into each gym. Skin-to-skin contact was likely the main mode of transmission; environmental findings indicated a lower risk of transmission via gym surfaces. Recommendations to prevent future outbreaks include stricter regulations for pre-fight screening and improved gym cleaning and hygiene among trainers and trainees.

Objective: In 2022, the New South Wales TB Program was notified of genomically clustered Mycobacterium tuberculosis isolates from two smear-positive tuberculosis (TB) patients diagnosed 3 months apart. Secondary investigations found they resided in the same Sydney boarding house. The objective of this study was to investigate this cluster and conduct active case finding among contacts. Methods: We conducted a site visit to understand transmission risk, reviewed patient histories, performed a risk assessment and conducted on-site TB contact screening, including interferon-gamma release assay testing. Long-term residents were also screened via chest X-ray. Past residents were referred to local TB services. Results: Four residents with TB disease were identified, three of whom were genomically linked to the cluster. The exposure period in the boarding house was determined to be from January 2021 to September 2022. All residents and staff were considered contacts requiring screening. Of the 91 contacts identified, 37 (41%) completed screening, including 20 (22%) who attended the on-site clinic. Among those screened, one resident with TB disease (patient 4) and three residents and one staff member with TB infection were identified. Discussion: This cluster highlights the role of genomic sequencing in detecting TB transmission. The first three patients were infectious for prolonged periods before diagnosis, likely facilitating transmission in communal areas. In multidwelling buildings with TB exposures, contact screening of all residents may be required when prolonged exposures are found. Strategies to increase screening completion should be further explored.

Objective: Noncommunicable diseases impose a significant and growing burden in Pacific island countries and territories, prompting health authorities to implement media-driven communication campaigns as part of their broader strategies to address these diseases and promote health. This analysis was undertaken to assess the strengths and limitations of these campaigns and identify areas for improvement. Methods: A semi-structured online survey, conducted between August and October 2023, and a visual content analysis were used to examine noncommunicable disease-related communication in Pacific island countries and territories. Distributed through the Pacific Community’s Public Health Division focal-point network, the survey was designed to gather qualitative insights on campaign development, evaluation, audience targeting, challenges and success factors. Public health posters from the Pacific Community’s archives were analysed using a semiological approach to categorize their enunciative functions. Results: Thirty-four survey responses from 12 Pacific island countries and territories were received. Tobacco was the top campaign issue, followed by nutrition, physical activity and cancer awareness; social media was the primary communication channel. Most respondents (80%) rated their campaigns as only moderately successful. Actions needed to enhance the impact of communications included better planning, more preliminary research, sustainable funding, skilled staff and greater cross-sector collaboration. Most noncommunicable disease-related posters (70%) served a representational function by portraying reality as designed by public health authorities. While most posters incorporated local cultural elements and vernacular languages, they were predominantly authoritative (46%) or neutral (44%) in tone. Furthermore, 73% were not tailored to specific target groups. Discussion: Enhancing communication requires greater resourcing, transdisciplinary approaches and stronger audience engagement. More research-informed strategies that integrate behavioural science could improve interventions that promote healthier choices. Achieving this necessitates closer collaboration across disciplines, and stronger partnerships and engagement with communities.