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Tropical Infectious Diseases
Tropical Infectious Diseases
It was meant to be a routine boat trip to a remote Fijian island. But two hours in, the engine cut out and stubbornly refused to restart. The radio, of course, didn’t work. The wind whipped up the waves, rocking the stranded vessel. A member of Andrew Steer’s research team heaved over the side of the boat while one person with the tiniest amount of phone reception called for help.
Luckily for this professor, the story didn’t turn out like Gilligan’s Island and the group was rescued by another boat.
It was just one of many unusual occurrences Andrew has encountered while working in the Pacific region on a range of neglected common tropical diseases, including scabies, rheumatic heart disease, and rheumatic fever.
In this case, he was running a scabies treatment program comparing three different treatments in three remote Fijian island communities.
Scabies research “is not particularly sexy,” Andrew admits, “but it’s really important.”
It’s also an insidious disease which torments those it infects in developing countries – something Andrew knows all too well.
“Scabies causes great misery,” he says. “I’ve had it. It’s horrible. You scratch, you can’t sleep, you can’t think.”
The disease is caused by a microscopic mite that burrows into the skin, sparking extreme itchiness affecting sleep, work and study. The skin can become infected with the Streptococcus A bacteria which can be fatal if it enters the blood stream but also causes potentially deadly diseases including rheumatic fever, rheumatic heart disease and kidney problems.
About half a million people every year die prematurely from these diseases in developing countries worldwide, including those in Australia’s indigenous community.
Andrew believes conditions like scabies can be eradicated. And his research in the Fijian islands has shown it is possible.
Scabies was virtually eliminated when an entire community in the 2015 trial was given an oral drug called ivermectin. One year after the mass administration, the prevalence of scabies declined by 94 per cent.
A standard cream treatment and mass administration of the same cream, permethrin, was tested in the other two remote island communities. Scabies declined by 64 per cent in the mass cream group and 49 per cent in the standard-care group, showing that ivermectin was really the way to go to eradicate scabies completely.
“The problem with the cream is that you treat individuals who go home to their families and friends who have all got it and they just get it back again,” Andrew says. “That’s the idea behind ivermectin – you treat everyone at the one time and you just knock it out. And it works.”
The potential to rid communities of infectious diseases – illnesses he first observed as a medical student – is an exciting culmination of his dedication and hard work. An uncertainty about practising adult medicine prompted him to take a year off medical school and work in Samoa, where he developed a love of paediatrics.
It was here he observed the prevalence of rheumatic heart disease and helped diagnose it in children. He fondly remembers being welcomed into schools where a lavish lunch would be laid on, attended by the whole community. Visiting guests would be sent home with a pig.
Andrew later spent three years living in Fiji, moving there when his firstborn was just six months old, to complete his doctorate on Group A Strep infections. This involved screening children for rheumatic heart disease using echocardiograms. In Fiji, this disease is the second most common cause of death in people aged five to 29. More than 10,000 Fijian children have now been screened and the New Zealand government has devoted $3 million towards continuing the program.
While Andrew spends a great deal of time in the Pacific islands, the father-of-two continues to see patients in Melbourne where he practices as a paediatrician specialising in infectious diseases. Here, he sees rheumatic heart disease in patients with Pacific Islander and Aboriginal backgrounds. To understand why these groups are contracting the disease, he co-leads the world’s largest international study investigating genetic susceptibility to the disease.
There is now a groundswell of interest globally in the mass administration of drugs to beat widespread tropical diseases. While much of Andrew’s work on these diseases has been beyond the nation’s borders, the results will reverberate in Australia – with our own indigenous communities likely to benefit.