Managing Potential Australian Bat Lyssavirus (ABLV) Exposure in Regional Queensland: A Mixed-Methods Investigation of Epidemiology and Operational Challenges

Background/Objectives: Australian bat lyssavirus (ABLV) is a rare but fatal zoonotic infection transmitted from infected bats. In Queensland, Australia, all potential human exposures should be reported to local public health units for assessment and post-exposure prophylaxis (PEP). Following a marked increase in notifications in 2025, the Darling Downs Public Health Unit (DDPHU), serving the Darling Downs and South West regions of Queensland, evaluated the epidemiology and operational challenges using a retrospective mixed-methods design. Methods: Data of all potential ABLV exposure notifications within the DDPHU catchment between 2011 and 2025 were collected from existing databases to describe demographic, temporal, spatial, and case management outcomes. Staff meeting records were analysed using framework analysis to identify operational challenges. Results: There were 237 potential exposure notifications, with annual counts fluctuating and peaks noted in 2013 and 2025. Notifications showed a seasonal pattern, peaking in spring and summer. Demographic characteristics of cases remained similar over time. Exposures were concentrated in the eastern part of the catchment, with no significant spatio-temporal clustering. Intentional contact with bats remained the leading cause of exposure. Over the study period, the proportion with documented PEP completion increased, as did timeliness of notification and PEP initiation. However, staff management time per case increased. Key operational challenges included the time-critical nature of case management, atypical exposure scenarios, and logistical complexity in arranging PEP across multiple providers. Availability of pre-positioned PEP at selected hospitals was perceived by staff to reduce workload. Conclusions: Although potential exposures aligned with known bat distribution and seasonal activity, the 2025 surge resulted in greater workload. Measures, including improved public health messaging, expanded pre-positioned PEP, and local protocols for atypical scenarios, may optimise case management and support workforce sustainability. These findings also highlighted the importance of accessible PEP and effective service coordination for timely management of potential lyssavirus exposures in non-urban settings.