Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2025.

For over 30 years, the Australian Paediatric Surveillance Unit (APSU) has conducted national prospective surveillance of rare conditions in children, including communicable diseases and complications, providing data that has informed changes to policy and clinical practice. In 2025, the APSU monitored seven rare communicable diseases and complications: acute flaccid paralysis (AFP); perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection; juvenile-onset recurrent respiratory papillomatosis (JoRRP); congenital rubella infection/syndrome; congenital varicella syndrome (CVS); and neonatal varicella infection (NVI). An average of 1,313 paediatricians and other relevant clinical specialists received a report card each month listing rare conditions under APSU surveillance (including the seven described in this report), and completed a case report form for any child(ren) seen with one or more of these conditions, detailing demographics, clinical features, treatment/management, risk factors and short-term outcomes. There were 134 notifications, of which 105 were confirmed as cases, after excluding duplicate reports or errors. The annual response rate to the report card was 78.4%. The non-polio AFP incidence of 1.58 per 100,000 children aged < 15 years exceeded the World Health Organization requirement to maintain Australia's polio-free status. Incidence of perinatal exposure to HIV remained stable, but new paediatric HIV infections increased. While there were no cases of congenital rubella or CVS, three cases of NVI and one case of JoRRP were reported, indicating ongoing gaps in vaccination despite two decades of universal vaccination in Australia. Continued APSU surveillance remains essential to assess the prevention of disease occurrence and adverse outcomes.