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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 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 HPV vaccine schedule in various Asia-Pacific countries; and developing approaches to describe and monitor equity and quality of care.

Uptake of PCV has been very slow in the Asia-Pacific region and there is a dearth of studies measuring impact. Measuring impact in LMICs is challenging for many reasons. We now lead a number of studies to develop innovative methods to measure the direct and indirect effects of PCV in LMICs in the Asia-Pacific region using novel methodological approaches using carriage instead of disease, and an innovative single hospital-based approach to measure PCV effectiveness on hypoxic pneumonia, using a variant case-control 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 low- and middle-income countries (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.

COVID-19 Weekly Vaccine Update

Weekly COVID-19 vaccine updates summarised by researchers at the Melbourne Children's Campus, in affiliation with the World Health Organization. This work is being led by Prof Fiona Russell, Prof Kim Mulholland, Dr John Hart, 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.

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Group Leaders: 
Group Members: 
Dr Alicia Quach
Role: 
PhD student
Dr Cattram Nguyen
Role: 
Biostatistician / Research Fellow
Dr Claire von Mollendorf
Role: 
Senior Research Fellow
Mr Darren Suryawijaya
Role: 
Research Assistant / Program Manager
Ms Eleanor Neal
Role: 
Research Assistant / PhD student
Ms Emma Watts
Role: 
Project Manager / PhD student
Ms Felisita Tupou Ratu
Role: 
Honorary Research Fellow
Ms Helen Thomson
Role: 
Research Manager
Ms Isatou Jagne
Role: 
MPhil student
Dr Jocelyn Chan
Role: 
PhD student
Dr John Hart
Role: 
Research Clinician
Dr Kathleen Ryan
Role: 
Honorary Fellow
Ms Kathryn Bright
Role: 
Clinical Coordinator
Dr Maeve Hume-Nixon
Role: 
Project Coordinator / PhD student
Dr Natalie Carvalho
Role: 
Honorary Fellow
Dr Nicole Wong
Role: 
Project Manager
Ms Rita Reyburn
Role: 
Epidemiologist / Honorary Research Assistant
Dr Ruth Lim
Role: 
Research Assistant

Bulabula MaPei, Fiji (2019-2021)

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 Pneumococcal lab, Doherty Institute and SAMRI. This study is funded by NHMRC.

PneuCAPTIVE, Laos, 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 Laos Office, Mongolian Ministry of Health, Laos Ministry of Health, the MCRI Pneumococcal lab, St George's, University of London UK, Laos Oxford Mahosot Hospital Wellcome Trust Research Unit, PNG Institute of Medical Research, University of Western Australia, Telethon Kids; The University of Health Sciences, Laos. This study is funded by the Bill & Melinda Gates Foundation.

PCV effectiveness against AMR, Laos (2020-2022)

For 5 years, we have been undertaking pneumococcal carriage and acute respiratory infection surveillance in children in collaboration with the Laos-Oxford Mahosot Wellcome Research Unit, the University of Health Sciences and the MCRI Pneumococcal lab. 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 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 LSHTM. This is funded by WHO.

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 is funded by Australian Aid funded Fiji Health Sector Support Program, DFAT; and the Bill & Melinda Gates Foundation. Meningococcal & Surveillance Support Project, Fiji (2019-2020)

A meningococcal outbreak in Fiji was confirmed to be due to meningococcal C by the IB-VPD surveillance. This project aims 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 MDU Melbourne;  to provide policy makers with evidence on the cost-effectiveness of introducing the meningococcal vaccine into the routine infant immunisation schedule.

Effect of a catastrophic health event on the household, Laos (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.

COVID-19 in Victorian ECEC and Schools (2020-2021)

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 (DH) and the Department of Education and Training (DET). Our team analysed international evidence and Victorian school outbreak data, which informed the return to school in Term 4, 2020. We continue to work with DH and DET to keep schools open safely and inform how best to manage and monitor future outbreaks using enhanced surveillance.

Past

PCV impact in Laos (2013-2019)

We undertook a number of studies measuring PCV impact in Laos: community carriage surveys, invasive pneumococcal disease and population-based pneumonia review. We demonstrated PCV impact in Laos 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 Laos Office, Laos Ministry of Health, MCRI Pneumococcal lab, St George's, University of London UK, Laos Oxford Mahosot Hospital Wellcome Trust Research Unit, The University of Health Sciences, Laos. These studies were funded by Gavi and the Bill & Melinda Gates Foundation.

Association between social contact, ethnicity and pneumococcal carriage, Fiji (add years)

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 Pneumococcal lab and LSHTM. This was funded by the Bill & Melinda Gates Foundation.

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 SAGE and are cited in 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 12m 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 12m 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 Strategic Advisory Group of Experts on Immunization 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 restuls of which are cited in the 2019 WHO PCV Position Statement.  This study was funded by funded by US NIAID and NHMRC.

Funding: 
  • The Bill and Melinda Gates Foundation, USA
  • National Health and Medical Research Council, Australia
  • Wellcome Trust, UK
  • Department of Foreign Affairs and Trade (DFAT), Australia
  • WHO
  • Victorian Department of Health (DH)
Collaborations: 
  • WHO Western Pacific Regional Office
  • WHO Laos Office
  • Laos Ministry of Health
  • St George's, University of London UK
  • Laos Oxford Mahosot Hospital Wellcome Trust Research Unit
  • The University of Health Sciences, Laos
  • The Mongolian Ministry of Health
  • The Fiji Ministry of Health and Medical Services
  • PNG Institute of Medical Research
  • University of Western Australia
  • Telethon Kids
  • The South Australian Health and Medical Research Institute (SAHMRI)
  • Doherty Institute, Melbourne

COVID-19 in the Pacific

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COVID-19 in Schools

The Conversation articles

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Pursuit - Articles by Prof Fiona Russell

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New Vaccine Evaluation Project, Fiji

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Other news