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Asia-Pacific Health

Our research provides evidence for policy and clinical practice to improve child health outcomes in resource-poor settings in the Asia-Pacific setting. We partner with governments, local institutions and the World Health Organization (WHO) in the Asia-Pacific region to answer questions needed for policy decision making. Our research started with evaluating reduced dose pneumococcal conjugate vaccine (PCV) schedules and we are now evaluating the impact of PCV and rotavirus vaccines, and a single dose human papillomavirus (HPV) vaccine schedule in various Asia-Pacific countries; and developing approaches to describe and monitor equity and quality of care.

Our vision is to: 

  1. Undertake high priority, innovative, translational research to improve equitable health outcomes in low- and middle-income settings globally, with a particular focus in the Asia-Pacific region;
  2. Develop the next generation of local and regional global health research leaders and support in-country research capacity; and
  3. 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.

Uptake of PCV has been very slow in the Asia-Pacific region and there is a dearth of studies measuring vaccine impact. Measuring impact in low- and middle-income countries (LMICs) is challenging for many reasons so we have developed a number of innovative methods to measure the direct and indirect effects of PCV in LMICs in the Asia-Pacific region using novel methodological approaches using pneumococcal carriage (a precursor for disease) instead of disease, and an innovative single hospital-based approach to measure PCV effectiveness on hypoxic pneumonia, using a variant case-control test-negative design. As vaccines are not yet available for neonatal sepsis and meningitis, we have a clinical trial of azithromycin in labour to prevent maternal and infant infections in Fiji.

The pneumococcus is a bacteria which is often the cause of pneumonia, particularly in young children. Our research has contributed to global, regional, and country level decision making on the implementation of new vaccines and the pneumococcal research priorities, globally. Our pneumococcal research has informed the recommended PCV schedule as adopted by the 2012 WHO PCV Position Statement- this document provides guidelines for LMICs on PCV use. It provided much of the evidence to support a 2+1 PCV schedule, endorsed by WHO policy (2012). Our research on PCV has also led to a paradigm shift in the number and timing of infant doses. Our findings from Fiji were instrumental in setting the global PCV research agenda.

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 closely with WHO and local and regional governments to inform COVID-19 vaccine policies and decision-making. We are leading studies in the Asia-Pacific region to assess COVID-19 vaccines and publish weekly COVID-19 vaccine updates. We led the analysis of Victorian school outbreak data and the development of a plan for the safe re-opening of schools.

COVID-19 Weekly Vaccine Update

Weekly COVID-19 vaccine updates summarised by researchers at the Melbourne Children's Campus. This work is being led by Dr John Hart, Prof Fiona Russell, Prof Kim Mulholland, A/Prof Nigel Crawford, Prof Julie Bines and A/Prof Margie Danchin.

https://medicine.unimelb.edu.au/school-structure/paediatrics/news-and-ev...

COVID-19 in Victorian schools report

An analysis of COVID-19 in ECEC and schools and evidence-based recommendations for opening ECEC and schools & keeping them open.

PDF iconDownload report (PDF, 2.71 MB)
Group Leaders: 
Group Members: 
Dr Alicia Quach
Role: 
PhD Student / Paediatrician
Dr Cattram Nguyen
Role: 
Biostatistician / Research Fellow
Dr Claire von Mollendorf
Role: 
Senior Research Fellow / Medical Epidemiologist
Mr Darren Suryawijaya
Role: 
Research Assistant / Program Manager
Ms Eleanor Neal
Role: 
Research Assistant / PhD student / Epidemiologist / Data Manager
Ms Felisita Tupou Ratu
Role: 
Honorary Research Fellow / Fiji Site Coordinator
Ms Helen Thomson
Role: 
Research Manager
Ms Isatou Jagne
Role: 
MPhil student
Dr Jocelyn Chan
Role: 
Honorary Fellow
Dr John Hart
Role: 
Research Clinician / Medical Epidemiologist
Dr Kathleen Ryan
Role: 
Honorary Fellow
Ms Kathryn Bright
Role: 
Clinical Coordinator
Dr Maeve Hume-Nixon
Role: 
Project Coordinator / PhD student / Public Health Specialist Trainee
Dr Natalie Carvalho
Role: 
Honorary Fellow / Health Economist
Dr Nicole Wong
Role: 
Project Manager / Paediatric Trainee
Ms Rita Reyburn
Role: 
Epidemiologist / Honorary Research Assistant

Current key programs

Vaccine schedules

  • Optimal timing and number of doses of pneumococcal conjugate vaccines (PCV)
  • Predicting the impact of changing from a 3 dose to 2 dose PCV schedule
  • Duration of protection from a single dose of human papillomavirus (HPV) vaccine

Measuring vaccine impact

  • With imperfect datasets and minimal disease surveillance
  • Herd protection
  • Defining the role of pneumococcal carriage

Health economics

  • Meningococcal C; simultaneous introduction of three new vaccines; 1+1 PCV schedule
  • Impact of severe health events 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

Pneumococcal conjugate vaccine (PCV)

Centre of Research Excellence for Pneumococcal Disease Control in the Asia-Pacific (2021-2025)
The CRE for Pneumococcal Disease Control in the Asia-Pacific (CRE-PDC) aims to address two outstanding research gaps for PCV use in the Asia-Pacific region:

  • Country decisions regarding reduced dose PCV schedules (1+1)
  • 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 of ten projects and is an international effort with collaborators from Fiji, Vietnam, Lao PDR, Mongolia, The Philippines, Thailand, Singapore, and the UK. This is funded by the NHMRC.

https://www.mcri.edu.au/research/centres/cre-pneumococcal-disease-control-asia-pacific ⠀

PCV effectiveness against antimicrobial resistance, Lao PDR (2020-2022)
For 5 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 will now be extending this surveillance for 2 more years to look at the impact of PCV on antimicrobial resistance (AMR). AMR is a huge problem in Asia. The study is funded by the Wellcome Trust.

Global pneumococcal carriage review (2019-2022)
The goal of this global pneumococcal carriage systematic review is to describe the impact of PCV programmes on serotype-specific carriage and compare our carriage results with invasive pneumococcal disease (IPD) in the post-PCV era. 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). This is funded by WHO.

COVID-19

COVID-19 vaccines in the Asia-Pacific region (2020-ongoing)
We work closely with WHO, DFAT and Ministries of Health to inform regional COVID-19 vaccine policies and decision-making. We have ongoing and planned studies in Fiji to assess COVID-19 vaccine effectiveness against infection, hospitalisation and death; kinetics of antibody persistence and immunity following vaccination; and population immunity seroprevalence surveys. The group also publishes weekly COVID-19 vaccine updates, summarising the most recent developments in this space.

COVID-19 in children and schools (2020-onging)
During 2020, enduring school closures resulted in remote learning and social isolation for many Victorian children, leading to numerous challenges for children, their families and teachers as well. In an effort to get kids back to school, MCRI was 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 members of the WHO COVID-19 Schools Research Technical Advisory Group.⠀

Other projects

Bulabula MaPei trial, Fiji (2019-2022)
Infections, including skin and soft tissue infections (SSTIs), are common causes of infant and maternal morbidity and a common cause of infant mortality. There are five bacteria that cause the majority of these infections, and for very young infants, are vertically- and horizontally-acquired. A simple, low-cost approach to preventing these infections is required in settings where access to health care is poor, and where developed country approaches are not suitable. Bulabula MaPei is a blinded placebo-controlled phase III RCT, to investigate whether a single-dose of oral azithromycin given to women in labour in Fiji reduces young infant SSTI rates and carriage of bacteria commonly causing maternal and infant infections. The results of this trial will be highly relevant to the Pacific region and for Indigenous Australians, where SSTIs cause a very large burden of disease, and where control of these infections is a public health priority. 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). This study is funded by the NHMRC.

Effect of a catastrophic health event on the household, Lao PDR (2020-2021)
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 hypothesize that the health and economic wellbeing of the poorest of families are the most effected by a catastrophic health event. We will describe the health and economic impact of a pneumonia health shock on the household. This is funded by MCRI and the NHMRC CRE.


Past projects

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’s VPD Section for surveillance, research and epidemiology; to generate evidence for policy makers on the vaccine impact on disease and circulating serogroups of Neisseria meningitidis post mass vaccination campaign;  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;  to provide policy makers with evidence on the cost-effectiveness of introducing the meningococcal vaccine into the routine infant immunisation schedule.⠀

PneuCAPTIVE, Lao PDR, Mongolia and Papua New Guinea (2014-2020)
The global PCV research agenda regarding schedules focusses on a 1+1 schedule for countries with a mature PCV program. 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 is a multi-country study to determine the PCV coverage required to show herd protection. Using carriage surveillance in children hospitalised with pneumonia we are modelling the effect estimate the PCV coverage required to show herd immunity effects. We collaborate with WHO Western Pacific Regional Office; WHO Lao PDR Office; Mongolian Ministry of Health; Lao PDR Ministry of Health; the MCRI New Vaccines and Translational Microbiology Groups; St George's, University of London, UK; LOMWRU; Papua New Guinea Institute of Medical Research; University of Western Australia; Telethon Kids Institute; The University of Health Sciences, Lao PDR. This study was funded by the Bill & Melinda Gates Foundation (BMGF).
 ⠀
Key publications:

  1. Chan J, et al. Indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with acute respiratory infection despite heterogeneous vaccine coverage: an observational study in Lao People’s Democratic Republic. BMJ Global Health. 2021 Jun 9; 6(6):e005187. https://doi.org/10.1136/bmjgh-2021-005187 
  2. Chan J, et al. Direct and indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with pneumonia from formal and informal settlements in Mongolia: an observational study. The Lancet Regional Health Western Pacific. 2021 Jul 12; 15:100231. https://doi.org/10.1016/j.lanwpc.2021.100231 

This was a multi-country study in Lao PDR, PNG and Mongolia. These papers describe novel methods to determine indirect effects of PCV in Lao PDR and Mongolia. Prof Fiona Russell was Principal Investigator of this project and primary supervisor for PhD Fox Fellow and Honorary Fellow Dr Jocelyn Chan.⠀⠀

New Vaccine Evaluation Project, Fiji (2012-2020)
This is a collaborative project with the Fiji Ministry of Health and Medical Services. The aims of this project are to improve surveillance at the Fiji government’s public health laboratory and evaluate the impact of PCV, rotavirus vaccine, and Human Papillomavirus vaccines which the government introduced in 2012/13. We evaluated the impact of PCV on carriage and disease, and with the MCRI Pneumococcal lab transferred technology from MCRI to the Fiji Ministry of Health to support meningitis surveillance. We measured the impact of rotavirus vaccine on diarrhoea; monitored for intussusception; and provided support for WHO IB-VPD and rotavirus surveillance. We evaluated reduced dose HPV schedules. This was funded by Australian Aid-funded Fiji Health Sector Support Program (FHSSP), DFAT; and BMGF.⠀

Key publications:

  1. Dunne EM, et al. Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumococcal carriage in Fiji: results from four annual cross-sectional carriage surveys. The Lancet Global Health. 2018 Dec; 6(12):e1375-e1385. https://doi.org/10.1016/s2214-109x(18)30383-8 
  2. Reyburn R, et al. Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumonia hospital admissions in Fiji: a time-series analysis. The Lancet Global Health. 2020 Nov 20; 9(1):e91-e98. https://doi.org/10.1016/s2214-109x(20)30421-6 

These papers provide the first evidence of PCV impact on carriage and pneumonia in a Pacific LMIC. It was the first study to show impact of PCV in the Asia-Pacific region. We used novel analytical methods to undertake the analysis. This was accompanied by an Editorial and Commentary, and an article by Prof Fiona Russell for the online University of Melbourne Pursuit magazine, which was republished by the BMGF’s The Optimist online magazine. We found direct and indirect effects in Fijian toddlers and their households, which will translate into reduced pneumococcal transmission and disease. Our Fijian Site Coordinator, Tupou Ratu, was featured on the front cover of The Lancet Regional Health Western Pacific.

PCV impact in Lao PDR (2013-2019)
We undertook a number of studies measuring PCV impact in Lao PDR: community carriage surveys, invasive pneumococcal disease and population-based pneumonia review. We demonstrated PCV impact in Lao PDR despite limited preceding baseline data. We developed of a novel case-control variant design using a single hospital-based approach to determine the vaccine effectiveness of PCV on hypoxic pneumonia. We collaborated with the WHO Western Pacific Regional Office; WHO Lao PDR Office; Lao PDR Ministry of Health; MCRI New Vaccines and Translational Microbiology Groups; St George's, University of London, UK; LOMWRU; The University of Health Sciences, Lao PDR. These studies were funded by Gavi and BMGF.⠀

Key publications:

  1. Weaver R, et al. 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. The Lancet Regional Health Western Pacific. 2020; 2:100014. https://doi.org/10.1016/j.lanwpc.2020.100014 
  2. von Mollendorf C, et al. Evaluation strategies for measuring pneumococcal conjugate vaccine impact in low-resource settings. Expert Review of Vaccines. 2021 Aug 19. https://doi.org/10.1080/14760584.2021.1965474

Weaver et al. described the first study to use the test-negative design to show the impact of PCV on pneumonia. We used novel methods to document effect of PCV on hypoxic pneumonia and provided compelling evidence to policymakers to support vaccine use. The results were presented to Lao PDR Ministry of Health, WHO and BMGF, and over 17 media mentions across the USA, Europe, Asia and Australia. A photo of our Lao team was featured on the front cover of The Lancet Regional Health Western Pacific.

von Mollendorf et al. described a variety of methods used to demonstrate that PCV13 had direct and indirect effects on pneumonia, and pneumococcal vaccine-type carriage and disease in Lao PDR. Combined, the results from the different studies provide sufficient evidence of the impact of PCV13 introduction in the context of limited baseline data. This evaluation approach could be used in similar settings to augment existing WHO PCV evaluation guidelines and document vaccine effects. 

Association between social contact, ethnicity and pneumococcal carriage, Fiji (2015-2016)
Little is known about pneumococcal transmission, particularly in the post-PCV era. 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 socio-economics, genetic predisposition and social contact patterns. This project measured the association between social behaviour, ethnicity and pneumococcal carriage. Our results will aid the development of pneumococcal disease transmission models to evaluate and predict PCV10 impact on pneumococcal disease, and therefore inform pneumococcal disease control strategies. We collaborated with the MCRI New Vaccines and Translational Microbiology Groups, and LSHTM. This was funded by BMGF.⠀

Key publications:

  1. Neal EFG, et al. Associations between ethnicity, social contact, and pneumococcal carriage three years post-PCV10 in Fiji. Vaccine. 2020 Jan 10; 38(2):202-211. https://doi.org/10.1016/j.vaccine.2019.10.030 
  2. Neal EFG, et al. A comparison of pneumococcal nasopharyngeal carriage in very young Fijian infants born by vaginal or Cesarean delivery. JAMA Network Open. 2019 Oct 2; 2(10):e1913650. https://doi.org/10.1001/jamanetworkopen.2019.13650 

The findings from this study have also been included in a meta-analysis of contact patterns which vary by setting and will be used to define mathematical models for COVID-19. The first paper showed that pneumococcal carriage was positively associated with the frequency of physical contact. Three years post-PCV10 introduction, contact with older children (7-14 years) was as important as contact with toddlers with regards to vaccine-type carriage. This novel finding has important public health implications with regards to ongoing pneumococcal disease control, as older, unvaccinated children, may become a reservoir for vaccine-type carriage following the introduction of PCV.

Our previous global review found that young infants have the highest burden of pneumococcal disease in low- and middle-income countries (LMICs). The second paper described our findings that pneumococcal nasopharyngeal carriage and density were higher in very young infants born by vaginal delivery compared with infants born by Caesarean section; that infants born by vaginal delivery carried a greater number of unique serotypes compared with infants born by Caesarean section; and that vaginal delivery was positively associated with pneumococcal carriage. Important public health and clinical implications, especially for LMICs, as pneumococcal carriage rates are higher in young infants in LMICs than in high-income countries, rates of neonatal sepsis due to pneumococcus may be considerable, and IPD should be considered in cases of neonatal sepsis in LMICs, as herd protection in infants too young to be vaccinated cannot be assumed.

Global age distribution of pneumococcal disease (2011)
In 2011, WHO was updating the PCV Position Statement.  We led a WHO global review to describe the age distribution of disease so countries could decide based on the epidemiology in their countries, the timing of the doses of PCV.  The findings of this review were presented to the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and are cited in the 2012 WHO PCV Position Paper.⠀

Fiji Pneumococcal Project (2003-2008)
Our trial in collaboration with the Fiji Ministry of Health documented the safety, immunogenicity and impact on carriage of reduced dose PCV7 in infancy combined with the 23-valent polysaccharide vaccine at 12 months of age to broaden the serotype coverage. To address the theoretical concerns of hyporesponsiveness to the polysaccharide vaccine, the responses at 17 months of age to a small challenge dose of 20% of the polysaccharide vaccine in children who had or had not received the polysaccharide at 12 months was undertaken. Our results 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. Data from this study supported the introduction of a more affordable 2 dose primary series, and suggested one dose primes better than 2 or 3 doses. In 2011, the WHO SAGE asked for a number of reviews to be undertaken to update the WHO PCV Position Paper. The findings from our study were one of five studies included in the review on the immunogenicity of reduced dose schedules. The results changed WHO policy. We also documented pneumococcal epidemiology. The results of which are cited in the 2019 WHO PCV Position Statement.  This study was funded by funded by US NIAID and NHMRC.

Image credits: The Lancet Regional Health Western Pacific

Funding: 
  • Department of Foreign Affairs and Trade (DFAT), Australia
  • MCRI
  • National Health and Medical Research Council, Australia
  • The Bill and Melinda Gates Foundation, USA
  • Victorian Department of Health (DH)Thrasher Research Fund, USA
  • Wellcome Trust, UK
  • WHO
Collaborations: 
  • Burnet Institute
  • Colonial War Memorial Hospital, Fiji
  • The Peter Doherty Institute for Infection and Immunity, Melbourne
  • Duke-National University of Singapore
  • Fiji National University
  • Lao PDRs 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
  • Papua New Guinea Institute of Medical Research
  • Pasteur Institute, Vietnam
  • St George's, University of London, UK
  • Telethon Kids Institute
  • The Fiji Ministry of Health and Medical Services
  • The Mongolian Ministry of Health
  • The South Australian Health and Medical Research Institute (SAHMRI)
  • The 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

‎‎‎COVID-19 in Schools

‎‎COVID-19 Vaccines

COVID-19 in the Pacific

New Vaccine Evaluation Project, Fiji

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Other news

‎‎‎‎‎‎Pursuit - Articles by Prof Fiona Russell, Articles by Dr John Hart

The Conversation - Articles by Prof Fiona Russell, Articles by Dr John Hart