Group A Streptococcus

The Strep A Research Group is a multi-disciplinary research team with a focus on understanding and preventing infectious diseases that affect children and their families in disadvantaged communities. The group conducts research across three main areas:

  1. Prevention of Strep A infection, including vaccine development
  2. Control of scabies and other neglected tropical diseases
  3. Prevention and control of rheumatic heart disease

The group views collaboration as central to conducting impactful research, and is involved in a number of collaborative projects.

Group Leaders: 
Professor Pierre Smeesters
Role: 
Honorary senior Research Fellow
Dr Samantha Colquhoun
Role: 
Senior Research Officer
Dr Lucia Romani
Role: 
Honorary Research Fellow
Ciara Baker
Role: 
Microbiologist
Kristy Azzopardi
Role: 
Senior Research Assistant
Frances Oppedisano
Role: 
Laboratory Manager
Dr Trish Campbell
Role: 
Honorary Research Fellow (Modelling)
Dr Daniel Engelman
Role: 
Honorary Research Fellow / PhD Candidate
Myra Hardy
Role: 
PhD Candidate
Dr Joshua Osowicki
Role: 
PhD Candidate
Hannah Frost
Role: 
PhD Candidate
Michael Lydeamore
Role: 
PhD Candidate
Dr Jane Oliver
Role: 
Honorary Fellow
Sanjeewani Pathirage
Role: 
Research Administration Assistant

1. PREVENTION OF STREP A DISEASE, INCLUDING VACCINES

Strep A is a common bacterium that causes Strep throat (affecting approximately 600 million people every year) and skin sores (also called impetigo) that affect 160 million people at any one time.  Both these diseases are most common in children. The bacteria can also cause severe sepsis including streptococcal toxic shock syndrome. The greatest burden of severe disease caused by Strep A is rheumatic heart disease, a chronic disease of the valves of the heart that starts with a Strep A infection in childhood that causes rheumatic fever and subsequently rheumatic heart disease. This disease affects over 33 million people worldwide and leads to the premature death of over 300,000 deaths per year.

The Strep A Research Group aims to enhance collaboration and research capacity in the field of group A strep research, consolidating Australian leadership in this field and maximising the likelihood of early vaccine introduction for at-risk populations globally, and specifically Aboriginal Indigenous Australians.

Controlled Human Infection Model
To overcome challenges faced in the development of a Strep A vaccine, which include incomplete understanding of the immunobiology and the perceived financial risk of conducting large phase III trials, the group is developing a controlled human infection model of Strep A throat infection that will provide the platform and mechanism to appraise novel vaccines and other therapeutics, and allow detailed investigation of immunity following Strep A infection.

Invasive Strep A infection surveillance
Invasive Strep A infection is a medical emergency in children. More than a third of children with this disease require mechanical ventilation and inotropic support. Adding to this, invasive Strep A infection has comparable mortality ratios to Meningococcal disease prior to introduction of the meningococcus vaccine. The group, along with its partners, established paediatric surveillance for invasive Strep A infection at the Royal Children’s Hospital in 2014, and then expanded this surveillance to multiple paediatric centres across Australia in 2017. The group is driving forward efforts to create an invasive Strep A infection surveillance system for adults and children nationally. Surveillance and timely notification of invasive Strep A infection will establish a body of evidence to ensure the improved short and long-term outcomes for children presenting with invasive Strep A infection, and will also inform vaccine design and development.

2. CONTROL OF SCABIES AND OTHER NEGLECTED TROPICAL DISEASES

Scabies is a microscopic mite that burrows under the skin, and predisposes to Strep A skin infection. Scabies is a major cause of morbidity in many developing countries, leading to economic disadvantage and reduced quality of life for the individuals, families and communities of high prevalence areas. The group is meeting this challenge through innovative research projects in the Pacific, where prevalence of scabies exceeds 20%. These applied research studies aim to address the current challenges of scabies control in high prevalence countries, through the investigation of the efficacy and integration of mass drug administration (MDA) using an oral tablet called ivermectin. The aim is to substantially reduce the level of scabies infestation, and thus reducing secondary infection with Strep A.

The FIT trial: Fiji Integrated Therapy trial
Lymphatic filariasis is a parasitic infection transmitted by mosquitoes that leads to the disfiguring disease of elephantiasis. MDA of 2 drugs (usually albendazole and DEC) given to whole communities annually over 3 consecutive years is the central public health control strategy globally. However, this approach has not been as effective as hoped in some areas. The FIT study aims to prove that the inclusion of ivermectin to make a 3 drug MDA will improve treatment outcomes and be safe when compared to the current 2 drug approach. The Project is also looking at the effectiveness of ivermectin of this new drug combination on scabies and intestinal worms. This projects multi-faceted intervention will give clear evidence for the control and potential eradication of multiple Neglected Tropical Diseases (NTD). The outcomes will enable country health systems in developing nations to actively eradicate diseases related to poverty.

The BIG SHIFT trial: Big Skin Health Intervention Fiji Trial
Following on from the success of the SHIFT Project in Fiji, where it was shown that a single round of ivermectin-based MDA was able to reduce the prevalence of scabies by up to 94% after one year, the immediate move into a scaled-up project was envisaged and acted upon. “BIG SHIFT” will be implemented over the coming years across the broad area of northern Fiji to consolidate and strengthen research and programmatic outcomes to show that multi-drug therapy for the eradication of scabies at a national level is possible. The primary aims of the project is to evaluate the impact on ivermectin based MDA on admissions to hospital of people with skin and soft tissue infection and other serious complications of scabies (invasive Strep A infection, along with kidney and heart disease)

The RISE trial: Regimen Ivermectin Scabies Eradication
The RISE Project will be conducted in the Solomon Islands, where the burden of disease from scabies also impacts around 20% of the whole population and double that in young children. RISE will test whether a simplified regimen of 1 dose of ivermectin is as effective as the current standard regimen of 2 doses. The project will run over a number of years to understand how the two regimens reduces the burden of disease. If the outcome of the research shows equal effect, the costs and logistics affecting MDA can be effectively halved, thereby providing a more cost effective options for scabies control programs.

Development of International agreed diagnosis criteria for Scabies
There has been a recognised need for standardised diagnostic criteria for scabies. The group has led the development of consensus criteria using a Delphi process with an international expert panel. The diagnostic criteria will be able to be utilised in both developed and developing contexts. This will ensure not only accurate diagnosis but also help to gain a clearer picture of the extent of infestation and disease within communities. It will also strengthen research methodology by promoting  standardised comparison between studies.

International Alliance for the Control of Scabies (IACS)
The International Alliance for the Control of Scabies is a global network which brings together researchers, clinicians and public health experts whose aim is the control and eradication of scabies. The Alliance aims to achieve this by advocating through different national and international partners/organisations, developing and providing up-to-date evidence for the control and potential elimination of scabies.

3. PREVENTION AND CONTROL OF RHEUMATIC HEART DISEASE

Screening for Rheumatic Heart Disease
Detection of RHD during the early phase of the disease before patients develop symptoms may allow early institution of antibiotic preventative therapy, thereby halting the progression of the disease and avoiding serious complications. The group’s projects in this area have focussed on screening for rheumatic heart disease among children living in high-risk areas using ultrasound of the heart (echocardiography), including training of non-experts in the delivery of echocardiogram screening. It is hoped that the research in this field will inform public health approaches that will reduce serious complications and the need for cardiac surgery.

Fiji Islands Rheumatic Heart Disease Control and Prevention
In collaboration with Fiji Ministry of Health, Cure Kids New Zealand, Auckland District Health Board this project aims to facilitate the expansion and strengthening of the existing Fiji Rheumatic Heart Disease Control Program. The project aims to provide Fiji with evidence-based models of care and prevention for acute rheumatic fever and rheumatic heart disease. It aims to provide local health professionals and wider stakeholders with the strategies, expertise and tools needed to significantly reduce rheumatic heart disease morbidity and mortality.

Establishment of Registers for Acute Rheumatic Fever and Rheumatic Heart Disease in Victoria
This project aims to establish a register within Victoria that will provide health professionals within the state with up-to-date models of care and prevention for acute rheumatic fever and rheumatic heart disease. Registers in other states have already shown their value by supporting health professionals in providing essential preventative actions and regular follow-up to patients as well as helping family members in the treatment of their children. The register will draw on years of lessons learnt from other jurisdictions to ensure the final product available to Victorian health professionals is the Gold Standard in Australia.

COLLABORATIVE PROJECTS

The GOAL trial, Uganda
There is an evidence gap to provide guidance on how to manage children detected with mild heart valve changes. Some experts recommend commencement of antibiotic preventative treatment, while others do not. The GOAL trial, led by researchers in Washington DC (Dr Andrea Beaton) and in Uganda, in collaboration with our group, is a randomised controlled trial of benzathine penicillin for the prevention of progression of rheumatic heart disease in Uganda.

The STOP trial
Led by researchers at the Telethon Kids Institute (Dr Asha Bowen), in collaboration with our group, the See-Treat-Prevent trial is a step-wedge trial of treatment as prevention for scabies and impetigo in the Kimberly region of Australia.

The Pre-YIAL trial
Led by researchers In the Pneumococcal Group at MCRI (A/Prof Fiona Russell), in collaboration wth our group, the “Preventing Young Infant Infections using Azithromycin in Labour” trial is a blinded placebo-controlled trial of azithromycin in pregnant mothers in Fiji to prevent serious bacterial infections in their babies.

The END RHD Centre for Research Excellence
Led by researchers at the Telethon Kids Institute (Prof Jonathan Carapetis), in collaboration with our group, the End Rheumatic Heart Disease Centre for Research Excellence aims to develop a endgame plan for rheumatic heart disease in Australia

Collaborations: 

University of Melbourne Centre for International Child Health CICH

Fiji Islands Rheumatic Heart Disease Control and Prevention Fiji Ministry of Health

  • CureKids New Zealand
  • Fiji Ministry of Health
  • Auckland District Health Board

MDA for scabies and impetigo Fiji

  • Fiji Ministry of Health
  • University of New South Wales (UNSW)
  • Kirby Institute

Evaluating the genetic contribution to RHD in ATSI communities

  • Telethon Kids Institute
  • Menzies School of Health Research

Immune correlates of protein and cross protection for GAS vaccine

  • University of Wollongong (UOW)
  • University of Tennessee (UTK)

Genetic susceptibility of rheumatic heart disease in Fiji and New Caledonia

  • Government of New Caledonia
  • Fiji Ministry of Health
  • University of Oxford
  • Jenner Institute
  • French Institute of Health and Medical Research INSERM France

Economic evaluation of RHD in Fiji

  • Fiji Ministry of Health
  • Harvard School of Public Health

Molecular and clinical epidemiology of GAS disease in Pacific, Asia and local areas

Screening for rheumatic heart disease

  • Fiji Ministry of Health
  • CureKids New Zealand
  • Makere University, Uganda
  • Children’s National Medical Centre, Washington DC, USA

GAS Group Affiliates at Murdoch Children's

  • Dr Margie Danchin – Senior Research Fellow
  • Dr Eileen Dunne - Postdoctoral Scientist
  • Dr Tom Parks - Research Fellow / PhD student
  • Dr Joseph Kado - Consultant Paediatrician
  • Ms Lucia Romani - Research Coordinator / PhD student
  • Mr Amini Koroi - Study Coordinator
  • Ms Laisiana Matatolu – Study Coordinator
  • Ms Frances Matanatabu – Research Nurse
  • Ms Maureen AhKee – Research Assistant