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Nigel Curtis always imagined himself working as a doctor in Africa or Asia. The infectious diseases expert worked for short periods in The Solomon Islands, Gambia, Zimbabwe and South Africa early in his career to try the dream on for size.
But he realised that path wasn’t going to have the impact he wanted.
“The way to reduce child mortality is to make better vaccines, diagnostic tools and treatments that affect lots of people,” says Nigel. “And we can best do that on a large scale by using the resources we have in wealthy countries.”
The British-born paediatrician landed permanently in Australia in 1998 with his wife, their three-year-old daughter and a six- week-old son after an intrepid journey from the UK, via a Fellowship in Canada. He set up the infectious diseases unit at RCH, a department he continues to lead while also juggling projects investigating better diagnostic tests and preventative measures for tuberculosis.
His research into tuberculosis – a disease that kills half a million children worldwide every year despite the availability of a vaccine (called BCG) – unexpectedly led to a new study asking an intriguing question: is it possible the vaccine invented for tuberculosis could prevent infections and also allergies in Australian children?
His question led to the establishment of MISBAIR, the Melbourne Infant Study: BCG for Allergy and Infection Reduction. It involves more than 1400 babies, with half of those to be given the tuberculosis BCG vaccine. The babies will be followed for five years to determine whether the vaccine reduces infections in general as well as food allergy, eczema and asthma. Meanwhile, further research will investigate how BCG boosts the immune system, because that is, surprisingly, what it does.
Studies have shown babies given the vaccine have half the mortality rate of infants who don’t get it. “What it seems to do is protect against the infections – like sepsis and pneumonia – that normally kill babies in countries with high infant mortality,” says Nigel.
“This vaccine is made from bacteria that turns out to be very good at providing a kick-start to the developing immune system very early in life.”
The immune system is also important for allergy, Nigel explains. If it is not busy fighting infection it can turn on itself. Several small studies suggest the vaccine might prevent allergy in babies so the Institute decided to test this on a large scale and launched MISBAIR.
The BCG vaccine has been around since 1921 and is given shortly after birth in most countries, except in places where the disease has almost been eradicated like Australia, New Zealand, North America and some western European nations.
The vaccine is imperfect as it does not always prevent the disease. Tuberculosis is also particularly difficult to diagnose in children and is becoming increasingly resistant to drugs.
Nigel recently treated a patient with a strain of tuberculosis resistant to multiple drugs – eight or nine different antibiotics were tried. The child’s treatment will take two years and costs tens of thousands of dollars. A country like Australia can afford it, but the same situation in a third world country would be a death sentence.
Treating children on the wards with incredibly rare and unusual infections seems worlds away from his research sometimes, says the father-of-three children, now aged 20, 17 and 15. Occasionally, it does hit close to home. “I remember a patient who died of meningococcal disease who was born the same month as my daughter. That hit me really hard. It’s times like these that really puts things into perspective.”