The Lancet Regional Health: Western Pacific最新文献

{"title":"Climate change and antimicrobial resistance in the Western Pacific: a mixed-methods systematic analysis","authors":"Lianping Yang , Zishu Ma , Fanqian Meng , Ruonan Wang , Shanquan Chen , Chaojie Liu , Hung Chak Ho , Mingli Xu , Alvin Qijia Chua , Li Yang Hsu , Yanhui Jia , Yi Zhang , Cunrui Huang , John S. Ji","doi":"10.1016/j.lanwpc.2025.101772","DOIUrl":"10.1016/j.lanwpc.2025.101772","url":null,"abstract":"<div><h3>Background</h3><div>Climate change and antimicrobial resistance (AMR) are escalating public health threats globally. The Western Pacific Region faces unique climatic and socioeconomic vulnerabilities, but evidence on this climate-AMR intersection is limited. We aimed to systematically provide evidence on this critical issue.</div></div><div><h3>Methods</h3><div>We conducted a three-stage mixed-methods systematic analysis: (1) a narrative review mapping the regional AMR landscape and summarizing potential climate-driven mechanisms; (2) a systematic review (PubMed and Google Scholar, January 2000–March 2025) of regional quantitative studies; and (3) an empirical quantitative analysis using a longitudinal panel dataset. This analysis completes our systematic approach by visualizing AMR mortality trends (using data from the GRAM project) and applying regression analysis to model AMR-attributable death rates based on climatic and socioeconomic factors, providing quantitative evidence of the regional situation and its potential drivers.</div></div><div><h3>Findings</h3><div>Literature review evidence showed that increasing temperature caused by climate change directly accelerates bacterial growth and resistance mutation rates and indirectly affects healthcare disruptions and antibiotic misuse during extreme weather events. We included 18 quantitative studies synthesised using the SWiM framework, which provided more specific evidence that higher temperatures are associated with increased clinical resistance rates and enhanced environmental dissemination of antibiotic resistance genes (ARGs). Our quantitative analysis found that a 1 °C increase in mean ambient temperature was associated with higher AMR-attributable mortality from carbapenem-resistant <em>Acinetobacter baumannii</em> (CRAB; β = 0.652, 95% CI 0.579–0.724, p < 0.001) and carbapenem-resistant <em>Pseudomonas aeruginosa</em> (CRPA; β = 0.422, 95% CI 0.304–0.541, p < 0.001). It also revealed that socioeconomic factors have heterogeneous effects.</div></div><div><h3>Interpretation</h3><div>Climatic conditions and socioeconomic vulnerabilities jointly shape AMR risks in the Western Pacific Region. Projected increases in extreme weather events threaten to strain healthcare systems further and worsen antibiotic misuse. Strengthening climate-resilient health systems, improving multisectoral AMR governance, and establishing integrated AMR–climate surveillance networks are essential regional priorities.</div></div><div><h3>Funding</h3><div>This work is supported by <span>World Health Organization</span> (WPRO/2024-02/AGE-DHP/22552 4), <span>National Natural Science Foundation of China</span> (<span><span>82422064</span></span>, <span><span>82250610230</span></span>, <span><span>72374228</span></span>, <span><span>72074234</span></span>), <span>Natural Science Foundation of Beijing</span> (<span><span>IS23105</span></span>), <span>National Bureau for Disease Control and Prevention</span","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"67 ","pages":"Article 101772"},"PeriodicalIF":8.1,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145753863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pacific Way: advancing ethical research governance in the Pacific islands","authors":"Julienne Josephine O'Rourke ,&nbsp;Mengji Chen ,&nbsp;Natasha Cooke ,&nbsp;Andreas Alois Reis ,&nbsp;Nalei Taufa ,&nbsp;Judith McCool ,&nbsp;Collin Tukuitonga ,&nbsp;Si Thu Win Tin ,&nbsp;Kidong Park","doi":"10.1016/j.lanwpc.2025.101771","DOIUrl":"10.1016/j.lanwpc.2025.101771","url":null,"abstract":"<div><div>Ethical research governance across Pacific island countries and areas (PICs) faces challenges from limited local capacity and disproportionate external influences. However, a shared commitment to advance and strengthen ethical oversight is increasingly emerging. In May 2025, WHO, the Pacific Community, and the Pacific Academy of Sciences convened a workshop with PIC representatives to review existing health research ethics ecosystems and define priorities for improvement. Mapping efforts revealed wide disparities: some countries have formal legal frameworks and established ethics committees, while others rely on informal processes or external approvals. Concerns were expressed about externally driven research, limited local control, inconsistent consent practices, and weak mechanisms to ensure communities benefit from research. Key priorities included developing national policies that clarify governance roles and standards, creating Pacific-wide ethical research guidelines that reflect regional values, and embedding long-term capacity building and fair benefit-sharing into research partnerships. The workshop highlighted that ethical research governance is not only a technical necessity but also central to self-determination, cultural integrity, and equity. Moving forward, progress will require sustained investment, regional collaboration, and global partners to support research led by the Pacific, for the benefit of Pacific communities.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101771"},"PeriodicalIF":8.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium infections in children in the Oceania region: review of the epidemiology, antimicrobial availability, treatment, clinical trial and pharmacokinetic data and key evidence gaps","authors":"Amanda Gwee ,&nbsp;Sarah Bannister ,&nbsp;Emma Best ,&nbsp;Jeremy Carr ,&nbsp;Kiera Harwood ,&nbsp;Tony Lai ,&nbsp;Alice Lei ,&nbsp;Flora Lutui ,&nbsp;Brendan McMullan ,&nbsp;Mona Mostaghim ,&nbsp;Lesley Voss ,&nbsp;Heather Weerdenburg ,&nbsp;Phoebe Williams ,&nbsp;Amanda Wilkins ,&nbsp;Daniel Yeoh ,&nbsp;KIDS DOSE group","doi":"10.1016/j.lanwpc.2025.101754","DOIUrl":"10.1016/j.lanwpc.2025.101754","url":null,"abstract":"<div><div>Antimicrobial resistance poses a significant threat to children's health, with up to 20% of 1.27 million deaths attributable to bacterial AMR annually, occurring in children &lt;5 years. The WHO 2024 Bacterial Priority Pathogens List identifies methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) and vancomycin-resistant <em>Enterococcus faecium</em> (VRE) as critical pathogens. This review examines the epidemiology, treatment recommendations, dosing strategies, efficacy, and safety data for antibiotics targeting MRSA and VRE infections in children in Oceania. Paediatric MRSA infections are prevalent (13–43%) across Oceania, while VRE infections remain uncommon (3–5%). Disparate access to recommended treatments, particularly in Pacific Island Countries and Territories, highlights the need for paediatric licensing. Paediatric trials primarily assess safety, with efficacy data limited to vancomycin, teicoplanin, and daptomycin. Pharmacokinetic/pharmacodynamic studies show standard dosing in children under 12 years often fails to achieve therapeutic targets, highlighting the need for dedicated dosing studies. Addressing these gaps is essential to advancing paediatric access to optimal treatment for drug-resistant infections in the region.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101754"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes care performance in Indonesia: a serial cross-sectional analysis of behavioral, clinical, and laboratory outcomes from 2013 to 2023","authors":"Farizal Rizky Muharram ,&nbsp;Julian Benedict Swannjo ,&nbsp;Dicky Lavenus Tahapary ,&nbsp;Sally Aman Nasution ,&nbsp;Delvac Oceandy","doi":"10.1016/j.lanwpc.2025.101759","DOIUrl":"10.1016/j.lanwpc.2025.101759","url":null,"abstract":"<div><h3>Background</h3><div>The growing diabetes burden in Indonesia necessitates a comprehensive understanding of national diabetes care performance, which remains inadequately characterized. Evaluating care quality across domains is essential to inform chronic disease policy and improve health outcomes. This study assesses trends in behavioral, clinical, and laboratory outcomes of diabetes care in Indonesia from 2013 to 2023.</div></div><div><h3>Methods</h3><div>We conducted a serial cross-sectional analysis of pooled data from the 2013, 2018, and 2023 Indonesian national health surveys (N = 42,224 for behavioral-clinical and N = 2957 for laboratory outcomes). Diabetes care performance was assessed across behavioral (treatment, smoking, diet, activity), clinical (blood pressure, BMI, waist length), and laboratory (glucose, lipids, renal function) domains. Composite scores and multilevel models were used to identify geographic and sociodemographic disparities.</div></div><div><h3>Findings</h3><div>Although linkage to diabetes care significantly improved from 68% to 92% between 2013 and 2023, performance in most other indicators remained stagnant or declined. In 2023, only 2.9% (95% CI 2.5–3.3%) met dietary fiber intake targets, 62.4% (95% CI 61.2–63.6%) achieved physical activity goals, and 83.9% (95% CI 82.9–84.8%) abstained from smoking. Clinical control was suboptimal, with 43.5% (95% CI 42.3–44.8%) meeting blood pressure targets and only 26.7% (95% CI 25.6–27.9%) and 33.1% (95% CI 32.0–34.3%) achieving BMI and waist circumference goals, respectively. Laboratory control was limited: only 25.2% (21.6–28.8%) achieved fasting glucose targets, 32.0% (95% CI 27.6–36.3%) had HbA1c &lt;7%, and only 22.6% (95% CI 19.1–26.2%) met LDL-C goals. Fewer than 5% of participants met all behavioral-clinical or laboratory composite targets. Composite performance declined in nearly all provinces, with disparities linked to older age, male sex, lower education, and rural residence.</div></div><div><h3>Interpretation</h3><div>Despite expanded healthcare coverage, Indonesia's diabetes care performance remains critically inadequate, particularly for achieving multiple targets. Strengthening national guidelines, embedding structured chronic care, and addressing social determinants are essential to improving diabetes outcomes.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101759"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical decision rules for diagnosis of Streptococcus pyogenes sore throat in Fiji: a prospective diagnostic accuracy study","authors":"John D. Hart ,&nbsp;Jimaima Kailawadoko ,&nbsp;Tria Williams ,&nbsp;Jyotishna Mani ,&nbsp;Ilikena Malo ,&nbsp;Tuliana Cua ,&nbsp;Natalie Caltabiano ,&nbsp;Jasmyn Voss ,&nbsp;Kristy Azzopardi ,&nbsp;Matthew G. Parnaby ,&nbsp;Sanjeshni Autar ,&nbsp;Komal Chand ,&nbsp;Lavenia Lagilagi ,&nbsp;Jessica Paka ,&nbsp;Eric Rafai ,&nbsp;Joseph Kado ,&nbsp;Hannah Frost ,&nbsp;Andrew C. Steer","doi":"10.1016/j.lanwpc.2025.101763","DOIUrl":"10.1016/j.lanwpc.2025.101763","url":null,"abstract":"<div><h3>Background</h3><div>Acute rheumatic fever is an immune-mediated condition triggered by <em>Streptococcus pyogenes</em> sore throat and possibly skin infection, with a substantial burden in resource-limited settings. Clinical decision rules (CDRs) are commonly used to guide antibiotic treatment of sore throat based on signs and symptoms, but their diagnostic accuracy varies by study and setting. This work aimed to assess the accuracy of multiple CDRs in Fiji to diagnose <em>S. pyogenes</em> sore throat.</div></div><div><h3>Methods</h3><div>We conducted a prospective diagnostic accuracy study at two primary healthcare centres in Suva, Fiji, enrolling children aged 5–15 years presenting with sore throat. Clinical features were assessed, and two throat swabs were collected from each participant for <em>S. pyogenes</em> detection using culture and a point-of-care nucleic acid amplification test (NAAT). Six CDRs were evaluated against NAAT and culture as reference standards.</div></div><div><h3>Findings</h3><div>Of 250 participants, <em>S. pyogenes</em> was detected among 31.7% (95% CI: 26.0–37.9) by NAAT and 10.4% (95% CI: 7.6–15.8) by culture. The Fiji CDR demonstrated high sensitivity (98.7%, 95% CI: 93.1–100 vs. NAAT; 100%, 95% CI: 86.8–100 vs. culture) but very low specificity (4.7% (95% CI: 2.1–9.1) vs. NAAT; 4.0% (95% CI: 1.9–7.5) vs. culture). All CDRs had poor discriminatory power (area under receiver operating characteristic curve: 0.48–0.55).</div></div><div><h3>Interpretation</h3><div>CDRs cannot accurately diagnose <em>S. pyogenes</em> sore throat in this tropical setting where rheumatic fever is common. There appears to be a high burden of <em>S. pyogenes</em> sore throat in Fiji, apparently underestimated when traditional culture-based methods are used. Although NAAT testing offers higher sensitivity than culture, the costs remain high. There is an urgent need for accurate, affordable diagnostics to guide sore throat management in resource-limited settings.</div></div><div><h3>Funding</h3><div>This project was funded by a <span>New Zealand Aid Programme grant</span>, awarded to <span>Cure Kids</span> (NZ research charity). Funds covered all costs pertaining to the study, including research personnel, data collection, patient recruitment and analysis.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101763"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening ASEAN's preparedness architecture: from fragmented efforts to a regional evidence and Policy Hub","authors":"Elil Renganathan ,&nbsp;Vinod R.M.T. Balasubramaniam ,&nbsp;Faith McLellan ,&nbsp;Aaron Koay ,&nbsp;Elisha Ab Rashid ,&nbsp;Mohammad Arshil Moideen","doi":"10.1016/j.lanwpc.2025.101773","DOIUrl":"10.1016/j.lanwpc.2025.101773","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101773"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building AI readiness for health in Southeast Asia","authors":"Mengji Chen ,&nbsp;Clive Tan ,&nbsp;Muhamad Noor Alfarizal Kamarudin ,&nbsp;Vivek Jason Jayaraj ,&nbsp;Premikha M ,&nbsp;Muhammad Taufeeq Wahab ,&nbsp;Anthony Li ,&nbsp;Kidong Park","doi":"10.1016/j.lanwpc.2025.101762","DOIUrl":"10.1016/j.lanwpc.2025.101762","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101762"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early performance of a decentralised, primary-care hepatitis C programme in Cambodia: a retrospective programme evaluation, 2024","authors":"Chansovannara Soputhy ,&nbsp;Florian Girond ,&nbsp;Samley Keo ,&nbsp;Kolveasna Kim ,&nbsp;Luis Sagaon-Teyssier ,&nbsp;Capucine Penicaud ,&nbsp;Sovann Ly ,&nbsp;Emilie Mosnier","doi":"10.1016/j.lanwpc.2025.101758","DOIUrl":"10.1016/j.lanwpc.2025.101758","url":null,"abstract":"<div><h3>Background</h3><div>Real-world evidence on decentralised, primary-care delivery for hepatitis C virus (HCV) in the Western Pacific is limited. We evaluated Cambodia's national, primary care–led HCV programme in 2024.</div></div><div><h3>Methods</h3><div>We analysed facility-level data from 256 health facilities in 15 operational districts to assess six HCV cascade steps: screening, anti-HCV positivity, RNA testing, viraemia, treatment initiation, and treatment completion. Design-based survey estimators were used to estimate proportions with 95% confidence intervals (CIs). To account for multi-stage design (clustering within operational districts), design-based generalised linear models were utilised to assess the factors associated with viraemia, treatment initiation and completion.</div></div><div><h3>Findings</h3><div>HCV testing coverage among adults (≥18 years; denominator 2,196,351) was 3·5% (95% CI 2·5–4·4). Of 76,512 adults tested, 3213 (4·2%; 95% CI 3·1–5·6) were anti-HCV-positive; 2628/3213 (81·8%) received RNA testing, and 1446/2628 (55·0%; 95% CI 49·5–60·3) were viraemic (1·9% of all tested). Among RNA-positive individuals, 1345/1446 (93·0%) initiated direct-acting antivirals and 1289/1345 (95·8%) completed treatment. Viraemia was higher among men (adjusted odds ratio [aOR] 1·40; 95% CI 1·05–1·86), varied by province (Takeo aOR 2·79, Kampong Cham aOR 2·11 versus Battambang), and elevated in October–December (Q4; aOR 1·79) versus January–March. Treatment initiation and completion surpassed 90% across facilities. The principal gap was confirmatory testing (18·2% of anti-HCV-positive individuals lacked RNA testing).</div></div><div><h3>Interpretation</h3><div>A decentralised, primary-care model achieved high linkage and treatment completion in the first year. Closing the confirmatory testing gap (reflex RNA/core antigen from same encounter), prioritising low-coverage/high-burden districts, and establishing patient-level linkage to capture sustained virologic response at week 12 are priorities to accelerate elimination.</div></div><div><h3>Funding</h3><div><span>ANRS MIE</span> (<span><span>ANRS0689b</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101758"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging managed access with life-cycle reassessment in Asia-Pacific: advancing the learning of health system matters for innovative medicines in oncology","authors":"Yuanshi Jiao ,&nbsp;Zonglin Dai ,&nbsp;Jiangnan Zhu ,&nbsp;Manuel A. Espinoza ,&nbsp;Xue Li","doi":"10.1016/j.lanwpc.2025.101769","DOIUrl":"10.1016/j.lanwpc.2025.101769","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101769"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socio-economic inequality underpins inequity in influenza vaccination uptake between public and private secondary schools: an Australian population-based study","authors":"Huong Le ,&nbsp;Christopher C. Blyth ,&nbsp;Clement Schlegel ,&nbsp;Jo-Anne Morgan ,&nbsp;Francis Mitrou ,&nbsp;Ha Nguyen ,&nbsp;Rachel Foong ,&nbsp;Samantha Carlson ,&nbsp;Catherine Hughes ,&nbsp;Bette Liu ,&nbsp;Hannah C. Moore","doi":"10.1016/j.lanwpc.2025.101761","DOIUrl":"10.1016/j.lanwpc.2025.101761","url":null,"abstract":"<div><h3>Background</h3><div>Socio-economic inequality and vaccination inequity have long been critical issues. However, no studies have explored the gap in influenza vaccination uptake between public and private schools. Importantly, the extent to which socio-economic inequality translates into vaccination uptake inequity has not been quantified. We investigate influenza vaccination uptake among school-aged Australian children in 2023, compare uptake between public and private schools, and assess the role of socio-economic inequality in vaccination uptake inequity.</div></div><div><h3>Methods</h3><div>We analysed whole-of-population linked immunisation, census, and administrative data. Multivariable logistic regression was used to identify key uptake predictors, and the Oaxaca-Blinder decomposition was used to identify factors driving uptake inequity between public and private schools.</div></div><div><h3>Findings</h3><div>Of 9.5 million influenza vaccination doses administered, only 0.7 million (7%) were given to school-aged children (5–&lt;18 years), who represent 16% of the population. Coverage among school-aged children was low. Secondary school-aged children had the lowest uptake, with a significant gap between public and private schools. Children in private secondary schools, who demonstrate greater socio-economic advantage, had higher uptake than their public peers (unadjusted OR = 1.47; 95% CI: 1.45–1.57). Two-thirds of the uptake gap is driven by differences in cultural, linguistic, and socio-economic characteristics, with parental education, parental income, and socio-economic characteristics of residential area being the strongest contributors.</div></div><div><h3>Interpretation</h3><div>Addressing socio-economic inequality among parents could reduce vaccination uptake inequity for children. Future influenza vaccination campaigns should consider tailored strategies for specific cultural, linguistic, and socio-economic groups.</div></div><div><h3>Funding</h3><div><span>Wesfarmers Centre of Vaccines and Infectious Diseases</span>; <span>Western Australian’s Future Health Research and Innovation Fund</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101761"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}