The detection of a new and unexpected Japanese encephalitis virus (JEV) outbreak in March 2022 in Australia, where JEV is not endemic, demanded the rapid development of a robust diagnostic framework to facilitate the testing of suspected patients across the state of New South Wales (NSW). This nascent but comprehensive JEV diagnostic service encompassed serological, molecular and metagenomics testing within a centralised reference laboratory. Over the first three months of the outbreak (4 March 2022 to 31 May 2022), 1,061 prospective samples were received from 878 NSW residents for JEV testing. Twelve confirmed cases of Japanese encephalitis (JE) were identified, including ten cases diagnosed by serology alone, one case by metagenomic next generation sequencing and real-time polymerase chain reaction (RT-PCR) of brain tissue and serology, and one case by RT-PCR of cerebrospinal fluid, providing an incidence of JE over this period of 0.15/100,000 persons in NSW. As encephalitis manifests in <1% of cases of JEV infection, the population-wide prevalence of JEV infection is likely to be substantially higher. Close collaboration with referring laboratories and clinicians was pivotal to establishing successful JEV case ascertainment for this new outbreak. Sustained and coordinated animal, human and environmental surveillance within a OneHealth framework is critical to monitor the evolution of the current outbreak, understand its origins and optimise preparedness for future JEV and arbovirus outbreaks.

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Bacillus cereus is a common laboratory and environmental contaminant. Reports of severe infections are mainly limited to immunocompromised individuals. In reported cases, the time interval between bacteraemia and neuro-invasion appears to be very short, highlighting the importance of rapid and definitive identification and susceptibility testing of invasive B. cereus . We report a case of a neonatal B. cereus bacteraemia complicated by a brain abscess from a neonatal intensive care unit. The neonate presented with bradycardia and desaturations with increased oxygen requirements. Initial blood culture detected B. cereus but was considered a contaminant. Repeated culturing of the Gram-positive rod was subsequently considered to be significant. Initial ultrasound head scans revealed echogenicity in the right posterior deep white matter. A large central cavity (5 mm diameter) could eventually be observed. The brain abscess resolved after surgical drainage and an extensive 6 weeks of antimicrobial therapy. This case study describes a rare event that illustrates the importance of rapid identification and susceptibility testing of invasive B. cereus isolates from immunocompromised patients.