Asia-Pacific Health
Improving the health of children and families in the Asia-Pacific.
Our research provides evidence for policy and clinical practice to improve child health outcomes in resource-poor settings in the Asia-Pacific region. We partner with governments, local institutions and the World Health Organization (WHO) to answer questions needed for policy decision-making.
Our research started with evaluating reduced-dose pneumococcal conjugate vaccine (PCV) schedules, which helped to set the global PCV research agenda.
We are now evaluating the impact of PCV, rotavirus and a single-dose human papillomavirus (HPV) vaccine schedule in various Asia-Pacific countries; evaluating the use of azithromycin in labour to prevent maternal and infant infections; and developing approaches to describe and monitor equity and quality of care.
Our vision
- Undertake high-priority, innovative, translational research to improve equitable health outcomes in low- and middle-income settings globally, with a particular focus on the Asia-Pacific region.
- Develop the next generation of local and regional global health research leaders and support in-country research capacity.
- Communicate our findings widely and ensure they are translated into local, regional and global policy and clinical practice by working in partnership with relevant stakeholders.
The emergence of COVID-19 has led us to rapidly utilise our expertise in vaccines, epidemiology and global child health to contribute to the pandemic response. Our group works with WHO, UNICEF, DFAT and local and regional governments to inform COVID-19 vaccine policies and decision-making.
Impact of Pneumococcal Vaccine in Laos
New Vaccine Evaluation Project - Fiji
More information
- COVID-19 Weekly Vaccine Updates, The University of Melbourne
- COVID-19 in Victorian Schools Report
- Research articles, Professor Fiona Russell - The University of Melbourne
- News articles, Professor Fiona Russell - The Conversation
- Research articles, Dr John Hart - The University of Melbourne
- News articles, Dr John Hart - The Conversation
Group Leaders
Group Members
Our programs
Vaccine schedules
- Optimal timing and number of doses of pneumococcal conjugate vaccine (PCV)
- Predicting the impact of changing from a 3 dose to 2 dose PCV schedule
- Duration of protection from a single dose of the human papillomavirus (HPV) vaccine
Measuring vaccine impact
- With imperfect datasets and minimal disease surveillance
- And herd protection
- Defining the role of pneumococcal carriage
Health economics
- Meningococcal C; simultaneous introduction of 3 new vaccines; 1+1 PCV schedule
- Impact of a severe health event in childhood on household health and wealth
Child health
- Antibiotics to prevent maternal and infant infections
- Indicators to monitor child health, equity and quality of care
Our projects
Centre of Research Excellence for Pneumococcal Disease Control in the Asia-Pacific (CRE-PDC)
The CRE-PDC aims to address two outstanding research gaps for PCV use in the Asia-Pacific region, namely country decisions regarding reduced dose PCV schedules (1+1 dose) and understanding serotype replacement following vaccine introduction. The program will generate new evidence to support decisions regarding the sustainability of national immunisation PCV programs and forge partnerships with key end-users to ensure research translation, establish new international linkages and develop the next generation of researchers. The CRE-PDC comprises ten projects and is an international effort with collaborators from Fiji, Vietnam, Lao PDR, Mongolia, The Philippines, Thailand, Singapore, and the UK. The National Health and Medical Research Council (NHMRC) funded this.
Effectiveness of PCV against antimicrobial resistance, Lao PDR
For eight years, we have been undertaking pneumococcal carriage and acute respiratory infection surveillance in children in collaboration with the Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), the Lao PDR University of Health Sciences and the MCRI New Vaccines and Translational Microbiology Groups. We are extending this surveillance to look at the impact of PCV on antimicrobial resistance (AMR), which is an immense problem in Asia. The Wellcome Trust funds the study.
Global review of pneumococcal carriage
This systematic review aims to describe the impact of PCV programmes on serotype-specific carriage and compare our carriage results with invasive pneumococcal disease (IPD) after the introduction of PCV. This will help define the role of carriage studies in measuring PCV impact and monitoring serotype replacement, and further, understand the value of carriage as a serotype monitoring tool. We are collaborating with the London School of Hygiene and Tropical Medicine (LSHTM). The World Health Organization (WHO) funded this study.
WHO review of pneumonia guidelines
Members from the Murdoch Children's Asia-Pacific Health group and the University of Melbourne led the public health aspect of a major review into childhood pneumonia. These reviews were commissioned by the WHO to inform updated pneumonia guidelines that cover diagnosis, treatment and follow-up care in children. Members will participate in the development of the updated WHO guidelines to better monitor and manage this infection.
For more information:
COVID-19 vaccines in the Asia-Pacific region
We work closely with the WHO, UNICEF, Australian Department of Foreign Affairs and Trade (DFAT) and Ministries of Health to provide technical advice on COVID-19 vaccine, school mitigation measures and priority child health research. Our group also publishes weekly COVID-19 vaccine updates, summarising the most recent developments in this space.
COVID-19 and children surveillance
Our group publishes weekly updates on COVID-19 epidemiology in children from select regions and countries, summarising paediatric cases, hospitalisations, mortality and MIS-C/PIMS-TS.
COVID-19 and schools
In 2020, enduring school closures resulted in remote learning and social isolation for many Victorian children, leading to numerous challenges for children, their families and school staff. To get children back to school, we were tasked with preparing the COVID-19 in Victorian Schools Report at the request of the Victorian Department of Health and the Department of Education and Training. Our team analysed international evidence and Victorian school outbreak data with funding from the Victorian Government, which informed the return to school in Term 4, 2020. We are also working group members of the WHO COVID-19 Schools Research Technical Advisory Group and chair the WHO Health Emergencies Programme Ad-hoc COVID-19 Infection Prevention and Control Guideline Development Group for COVID-19 to review the current advice on mask use in children. We produced a directory of guidelines and resources from WHO and other UN agencies related to COVID-19 and educational institutions. The resources are summarised briefly and targeted to policymakers from the health and education sectors, educational staff, parents and students.
Bulabula MaPei Trial, Fiji
Infections, including skin and soft tissue infections (SSTIs), are common causes of infant and maternal morbidity and a common cause of infant mortality. A simple, low-cost approach to preventing these infections is required in settings where access to health care is limited. Our blinded, placebo-controlled phase III randomised controlled trial in Fiji is investigating whether a single dose of oral azithromycin given to women in labour reduces young infant SSTI rates and carriage of bacteria which commonly cause maternal and infant infections. We collaborate with the Fiji Ministry of Health and Medical Services, MCRI New Vaccines and Translational Microbiology Groups, the Doherty Institute and the South Australian Health and Medical Research Institute (SAHMRI). The NHMRC funded this study.
Effect of a catastrophic health event on the household, Lao PDR
High out-of-pocket payments for health can lead to catastrophic health expenditure, resulting in impoverishment for vulnerable groups. Oxygen supplementation, which is required for most serious health conditions in children, can be prohibitively expensive, with many families unable to afford treatment. We hypothesise that the health and economic wellbeing of the poorest of families are the most affected by a catastrophic health event. We will describe the health and economic impact of a pneumonia health shock on the household. Murdoch Children's Research Institute and the NHMRC CRE-PDC fund this.
Meningococcal & Surveillance Support Project, Fiji (2019-2020)
A meningococcal outbreak in Fiji was confirmed to be due to meningococcal C by the WHO Global Invasive Bacterial Vaccine Preventable Diseases (IB-VPD) surveillance. This project aimed to build capacity within the Fiji Ministry of Health and Medical Service’s VPD Section for surveillance, research and epidemiology; to generate evidence for policymakers on the vaccine impact on disease and circulating serogroups of Neisseria meningitidis after mass vaccination campaigns; strengthen clinical laboratory services to detect bacterial pathogens and provide evidence to guide treatment and prophylaxis choice in partnership with the Microbiological Diagnostic Unit (MDU), Melbourne; and to provide policymakers with evidence on the cost-effectiveness of introducing the meningococcal vaccine into the routine infant immunisation schedule.⠀
PneuCAPTIVE Study, Lao PDR, Mongolia and Papua New Guinea (2014-2020)
The global PCV research agenda regarding schedules focuses on a reduced 1+1 schedule for countries with a mature PCV program. The success of a 1+1 schedule relies on the PCV schedule controlling vaccine-type carriage and therefore maintaining indirect protection. It is unknown what PCV coverage results in indirect protection. In the absence of quality pneumococcal disease surveillance, countries require a method to evaluate direct and indirect effects. PneuCAPTIVE was a multi-country study to determine the PCV coverage required to show herd protection. Using carriage surveillance in children hospitalised with pneumonia we modelled the effect estimate of PCV coverage required to show herd immunity effects. This was a collaboration between multiple WHO regional offices, Ministries of Health and medical research institutes. This study was funded by the Bill & Melinda Gates Foundation (BMGF).
- Vaccine reduces likelihood of severe pneumonia
- Vaccine proves effective against the most severe type of pneumonia
- Fiji’s vaccine program reduces childhood death and illness
- Risk factors for carrying pneumonia causing bacteria revealed
New Vaccine Evaluation Project, Fiji (2012-2020)
This project aimed to improve surveillance at the Fiji Government’s public health laboratory and evaluated the impact of PCV, rotavirus and HPV vaccines following their introduction in 2012/13. We evaluated the impact of PCV on carriage and disease, and with the MCRI Pneumococcal Laboratory transferred technology from MCRI to the Fiji Ministry of Health and Medical Services to support meningitis surveillance. We measured the impact of the rotavirus vaccine on diarrhoea, monitored for intussusception and provided support for WHO IB-VPD and rotavirus surveillance. We also evaluated reduced-dose HPV schedules. We collaborated with the Fiji Ministry of Health and Medical Services. This project was funded by the Australian Aid-funded Fiji Health Sector Support Program (FHSSP), DFAT and BMGF.
Impact of PCV in Lao PDR (2013-2019)
We undertook several studies measuring PCV impact in Lao PDR: community carriage surveys, invasive pneumococcal disease and population-based pneumonia review. We showed PCV impact in Lao PDR despite limited preceding baseline data and developed a novel case-control variant design using a single hospital-based approach to determine the vaccine effectiveness of PCV on hypoxic pneumonia. This was a collaboration between the Lao PDR Ministry of Health and multiple WHO regional offices and medical research institutes. Gavi and BMGF funded these studies.
Association between social contact, ethnicity and pneumococcal carriage, Fiji (2015-2016)
Pneumococcal carriage is a precursor for pneumococcal disease and pneumococcal carriage rates vary by geography, ethnicity and age. The reasons for differences in carriage rates are unknown but may include factors related to socioeconomics, genetic predisposition and social contact patterns. This project measured the association between social behaviour, ethnicity and pneumococcal carriage. Our findings are aiding the development of pneumococcal disease transmission models to evaluate and predict the impact of PCV10 on pneumococcal disease and therefore inform pneumococcal disease control strategies. We collaborated with the MCRI New Vaccines and Translational Microbiology Groups, and LSHTM. This study was funded by BMGF.
Global age distribution of pneumococcal disease (2011)
In 2011, WHO undertook an update of its PCV Position Paper. Our group was commissioned by WHO to lead a global review to describe the age distribution of pneumococcal disease to aid country-specific decisions on the timing of PCV doses. The findings of this review were presented to the WHO Strategic Advisory Group of Experts on Immunisation (SAGE) and are cited in 2012 WHO PCV Position Paper.
Fiji Pneumococcal Project (2003-2008)
This trial documented the safety, immunogenicity and impact on the carriage of reduced dose PCV7 in infancy combined with the 23-valent polysaccharide vaccine at 12 months of age. Our findings provided the first evidence base for defining both the optimal pneumococcal primary series and the value of a subsequent dose of polysaccharide vaccine in a resource-limited setting. Our findings were included in the review on the immunogenicity of reduced dose schedules, which subsequently changed WHO’s PCV policy and were cited in 2019 WHO PCV Position Paper. We collaborated with the Fiji Ministry of Health and Medical Services. The US National Institute of Allergy and Infectious Diseases (NIAID) and NHMRC funded this study.
Funding
- Australian Department of Foreign Affairs and Trade
- Australian National Health and Medical Research Council
- MCRI
- The Bill and Melinda Gates Foundation
- Victorian Department of Health
- Thrasher Research Fund
- Wellcome Trust
- World Health Organization
- Gavi, the Vaccine Alliance
Collaborations
- Burnet Institute
- Duke-National University of Singapore
- Fiji National University
- Fiji Ministry of Health and Medical Services
- Lao PDR Ministry of Health
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Lao PDR
- London School of Hygiene and Tropical Medicine (LSHTM), UK
- Mahidol University, Thailand
- Mongolian Ministry of Health
- Papua New Guinea Institute of Medical Research (PNGIMR)
- Pasteur Institute, Vietnam
- South Australian Health and Medical Research Institute (SAHMRI)
- St George's, University of London, UK
- Telethon Kids Institute
- The Peter Doherty Institute for Infection and Immunity
- University of Health Sciences, Lao PDR
- University of Sydney
- University of the Philippines
- University of Western Australia
- Wellcome Sanger Institute, UK
- WHO Lao PDR Office
- WHO Western Pacific Regional Office
- World Health Organization (WHO)
Featured publications
- The effectiveness of the 13-valent pneumococcal conjugate vaccine against hypoxic pneumonia in children in Lao People’s Democratic Republic: An observational hospital-based test-negative study.
Weaver R, Nguyen CD, Chan J, Vilivong K, Lai JYR, Lim R, Satzke C, Vongsakid M, Newton PN, Mulholland EK, Gray A, Dubot-Peres A, Dance DAB, Russell FM. Lancet Regional Health Western Pacific. 2020 Sep 20;2:100018. doi: 10.1016/j.lanwpc.2020.100014. - Levels of pneumococcal conjugate vaccine coverage and indirect protection against invasive pneumococcal disease and pneumonia hospitalisations in Australia: An observational study.
Chan J, Gidding HF, Blyth CC, Fathima P, Jayasinghe S, McIntyre PB, Moore HC, Mulholland EK, Nguyen CD, Andrews R, Russell FM. PLOS Medicine. 2021 Aug 3; 18(8):e1003733. doi: 10.1371/journal.pmed.1003733. - Associations between ethnicity, social contact, and pneumococcal carriage three years post-PCV10 in Fiji.
Neal EFG, Flasche S, Nguyen CD, Ratu FT, Dunne EM, Koyamaibole L, Reyburn R, Rafai E, Kama M, Ortika BD, Boelsen LK, Kado J, Tikoduadua L, Devi R, Tuivaga E, Satzke C, Mulholland EK, Edmunds WJ, Russell FM. Vaccine. 2020 Jan 10;38(2):202-211. doi: 10.1016/j.vaccine.2019.10.030. - Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumonia hospital admissions in Fiji: a time-series analysis.
Reyburn R, Tuivaga E, Nguyen CD, Ratu FT, Nand D, Kado J, Tikoduadua L, Jenkins K, de Campo M, Kama M, Devi R, Rafai E, Weinberger DM, Mulholland EK, Russell FM. Lancet Glob Health. 2020 Nov 20;S2214-109X(20)30421-6. doi: 10.1016/S2214-109X(20)30421-6. - SARS-CoV-2 infections and public health responses in schools and early childhood education and care centres in Victoria, Australia: an observational study.
Ryan K, Snow K, Danchin M, Mulholland K, Goldfeld S, Russell F. Lancet Regional Health Western Pacific. 2021 Feb 1;19:100369. doi: 10.1016/j.lanwpc.2021.100369