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.
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.
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.
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.
- 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
- Victorian Department of Health (DH)
- 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
- Genotype Diversity before and after the Introduction of A Rotavirus Vaccine into the National Immunisation Program in Fiji 2021
- A single dose of quadrivalent human papillomavirus (HPV) vaccine is immunogenic and reduces HPV detection rates in young women in Mongolia, six years after vaccination. 2020
- Anthropometric measures that identify premature and low birth weight newborns in Ethiopia: a cross-sectional study with community follow-up. 2020
- Associations between ethnicity, social contact, and pneumococcal carriage three years post-PCV10 in Fiji. 2020
- Direct and indirect effects of rotavirus vaccine on diarrhoea, five years following national introduction in Fiji 2020
- Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumonia hospital admissions in Fiji: a time-series analysis. 2020
- Factors associated with pneumococcal carriage and density in children and adults in Fiji, using four cross-sectional surveys. 2020
- Measurement of Human Papillomavirus-Specific Antibodies Using a Pseudovirion-Based ELISA Method. 2020
- Predictors of antibody persistence to the 7-valent pneumococcal conjugate vaccine in healthy Fijian infants at 12 months of age. 2020
- Progress and Pitfalls in the Quest for Effective SARS-CoV-2 (COVID-19) Vaccines. 2020
- Temporal decline in diarrhea episodes and mortality in Kiribati children two years following rotavirus vaccine introduction, despite high malnutrition rates: a retrospective review. 2020
- 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 2020
- Who should be prioritised for COVID-19 vaccination? 2020
- A Comparison of Pneumococcal Nasopharyngeal Carriage in Very Young Fijian Infants Born by Vaginal or Cesarean Delivery. 2019
- Evaluation of a phased pneumococcal conjugate vaccine introduction in Mongolia using enhanced pneumonia surveillance and community carriage surveys: a study protocol for a prospective observational study and lessons learned. 2019
- Factors associated with pneumococcal carriage and density in infants and young children in Laos PDR. 2019
- Impact of the change in WHO's severe pneumonia case definition on hospitalized pneumonia epidemiology: case studies from six countries. 2019
- Nasal or throat sampling is adequate for the detection of the human respiratory syncytial virus in children with acute respiratory infections. 2019
- Pneumococcal carriage in vaccine-eligible children and unvaccinated infants in Lao PDR two years following the introduction of the 13-valent pneumococcal conjugate vaccine. 2019
- Pneumococcal vaccines in Nepal. 2019
- Prevalence of Low Birth Weight and Prematurity and Associated Factors in Neonates in Ethiopia: Results from a Hospital-based Observational Study. 2019
- Recombinant human papillomavirus nonavalent vaccine in the prevention of cancers caused by human papillomavirus. 2019
- Selective Persistence of HPV Cross-Neutralising Antibodies following Reduced-Dose HPV Vaccine Schedules. 2019
- Using pneumococcal carriage studies to monitor vaccine impact in low- and middle-income countries. 2019
- WASH: a basic human right and essential intervention for child health and development. 2019
- Carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in Indonesian children: A cross-sectional study. 2018
- Cellular Immune Responses 6 Years Following 1, 2, or 3 Doses of Quadrivalent HPV Vaccine in Fijian Girls and Subsequent Responses to a Dose of Bivalent HPV Vaccine. 2018
- Determining the pneumococcal conjugate vaccine coverage required for indirect protection against vaccine-type pneumococcal carriage in low and middle-income countries: a protocol for a prospective observational study. 2018
- Discovery of a Streptococcus pneumoniae serotype 33F capsular polysaccharide locus that lacks wcjE and contains a wcyO pseudogene. 2018
- Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumococcal carriage in Fiji: results from four annual cross-sectional carriage surveys. 2018
- Epidemiology of intussusception before and after rotavirus vaccine introduction in Fiji. 2018
- The Epidemiology of Cholera in Zanzibar: Implications for the Zanzibar Comprehensive Cholera Elimination Plan. 2018
- Vaccine-preventable child deaths in New South Wales from 2005 to 2014: How much is preventable? 2018
COVID-19 in the Pacific
- Contain This: The Latest in Global Health Security, March 2021: "Prof Fiona Russell and Dr Rachel Devi on COVID-19 vaccines in the Pacific"
- The Wire interview, January 2021: "COVID vaccine roll out in the Pacific could be delayed"
- South China Morning Post, December 2020: "Pacific Islands look to US, Australia, New Zealand for help with COVID-19 vaccines"
- ABC Pacific Beat interview, July 2020: COVID-19 vaccines for Pacific Island countries (starts at ~20:30)
COVID-19 in Schools
The Conversation articles
- March 2021: "We can't close schools every time there's a COVID outbreak. Our traffic light system shows what to do instead"
- January 2021: "Coronavirus: is it safe for kids to go back to school? And what about the new mutant strain?"
- September 2020: "Behind Victoria's decision to open primary schools to all students: report shows COVID transmission is rare"
- July 2020: "Will school temperature checks curb the spread of coronavirus?"
- National Geographic, December 2020: "Exclusive: Kids catch and spread coronavirus half as much as adults, Iceland study confirms"
- Nature Communications, October 2020: "Why schools probably aren't COVID hotspots"
Pursuit - Articles by Prof Fiona Russell
- February 2021: "Learning as we go during vaccine rollout"
- December 2020: "Should schools close during the COVID-19 pandemic?"
- November 2019: "Immunising kids against pneumonia"
- November 2018: "The vaccine saving the lives of Pacific children"
New Vaccine Evaluation Project, Fiji
- ABC Pacific Beat interview, April 2020: "Fiji: New study identifies risk factors for pneumonia-causing bacteria"
- ABC Pacific Beat interview, May 2018: "Fiji meningococcal vaccination campaign could take up to six months: WHO"
- ABC Pacific Beat interview, October 2016: “New study shows remarkable result of pneumonia and rotavirus vaccines in Fiji”
- ABC Pacific Beat interview, September 2016: “Fiji’s vaccination program a model for reducing Pacific child mortality”
- ABC Pacific Beat interview, August 2016: “Study: Fiji HPV vaccination program shows lower doses can be just as effective”
- ABC Pacific Beat interview, July 2016: “HPV vaccine protecting women from cervical cancer in Fiji”
- InSight, February 2021: "Diversity and COVID-19 vaccine rollout: we can't fix what we can't see"
- The Age, January 2021: "Health watchdog probes thermometers amid inaccuracy concerns"