Introduction: In response to a significant increase of measles cases and a high percentage of unvaccinated adolescents in New South Wales, Australia, a measles high school catch-up vaccination programme was implemented between August and December 2014. This study aimed to explore the factors affecting school-based supplementary immunization activities (SIAs) and to inform future SIA and routine school-based vaccination programme implementation and service provision. Methods: Focus group analysis was conducted among public health unit (PHU) staff responsible for implementing the SIA catch-up programme. Key areas discussed were pre-programme planning, implementation, resources, consent materials, media activity and future directions for school vaccination programme delivery. Sessions were audio recorded, transcribed verbatim and reviewed. Thematic analysis was conducted to identify the major themes. Results: Two independent focus groups with 32 participants were conducted in January 2015. Barriers to the SIA implementation included lead time, consent processes, interagency collaboration, access to the targeted cohort and the impact of introducing a SIA to an already demanding curriculum and school programme immunization schedule. A positive PHU school coordinator rapport and experience of PHU staff facilitated the implementation. Consideration of different approaches for pre-clinic vaccination status checks, student involvement in the vaccination decision, online consent, workforce sharing between health districts and effective programme planning time were identified for improving future SIA implementation. Conclusion: Although many barriers to school programme implementation have been identified in this study, with adequate resourcing and lead time, SIAs implemented via a routine school vaccination programme are an appropriate model to target adolescents.

Introduction：There are large Pacific island communities in western and south-western Sydney, New South Wales, Australia. In 2011 and 2012, measles outbreaks disproportionally affected children and youth within these communities. The objectives of this study were to explore barriers to immunization in a Pacific island community from the perspectives of community members and health professionals and to conduct a pilot programme whereby immunization catch-up clinics were held in a Samoan church in western Sydney.Methods：Interviews were conducted with Pacific island community members (n = 12) and health professionals connected with the Pacific island community (n = 7) in 2013. A partnership with a local Samoan church was established to provide an accessible venue for immunization catch-up clinics.Results：Among the community members there were high levels of belief in the importance of immunization and a positive view regarding the protection offered by immunization. A key barrier reported by community members was being busy and therefore having limited time to get children immunized. The important role of the church within the community was emphasized in the interviews, and as a result, two immunization catch-up clinics were held in a Samoan church in western Sydney. The age range of attendees was 7–33 years. A total of 31 measles, mumps and rubella doses and 19 meningococcal C doses were given during the two clinics.Discussion：The outcomes of the interviews and the subsequent clinics highlighted the potential of churches as a venue for providing public health interventions such as catch-up immunization.

Introduction: In countries where measles is rare, health-care-setting transmissions remain problematic. Australia experienced its largest measles outbreak in 15 years in 2012 with 199 cases reported nationally; 170 cases occurred in the state of New South Wales (NSW) with symptom onset between 7 April and 29 November 2012. Methods: A descriptive study was conducted using measles case data obtained from metropolitan Sydney local health districts in NSW in 2012. Characteristics of measles source and secondary cases were described. Details of health-care presentations resulting and not resulting in measles transmission were also analysed. Results: There were 168 confirmed and two probable cases resulting in 405 documented health-care presentations. Thirty-four secondary cases acquired in health-care settings were identified, including 29 cases resulting from 14 source cases and 5 cases whose source could not be identified. Health-care-acquired cases accounted for 20% of all cases in this outbreak. Source cases were more likely to be of Pacific Islander descent (p = 0.009) and to have had more presentations before diagnosis (p = 0.012) compared to other cases. The percentage of presentations to emergency departments was higher for presentations that resulted in transmission compared to those that did not (71.4% and 37.6%, respectively, p = 0.028). There were no significant differences between transmission and non-transmission presentations with respect to presence of rash and infection control measures (p = 0.762 and p = 0.221, respectively), although the power to detect these differences was limited. Rash was reported at 66% of the presentations. Conclusion: Development of and adherence to protocols for the management of patients presenting to hospitals with fever and rash will minimize secondary transmission of measles.