Estimating The Burden Of Group A Streptococcal Diseases In Victoria
Funder
National Health and Medical Research Council
Funding Amount
$386,760.00
Summary
Despite the considerable advances in the diagnosis and treatment of group A streptococcal (GAS) diseases made during the last century, the impressive spectrum of infections caused by this organism continues to have a significant impact in developed countries. This spectrum includes diseases that are mild but common (e.g. sore throat, skin sores), rare but very severe (e.g. bloodstream infections, flesh-eating bacteria) and those that are more common in developing countries and the Aboriginal pop ....Despite the considerable advances in the diagnosis and treatment of group A streptococcal (GAS) diseases made during the last century, the impressive spectrum of infections caused by this organism continues to have a significant impact in developed countries. This spectrum includes diseases that are mild but common (e.g. sore throat, skin sores), rare but very severe (e.g. bloodstream infections, flesh-eating bacteria) and those that are more common in developing countries and the Aboriginal population (e.g. rheumatic fever, kidney disease). Streptococcal sore throat remains one of the most common childhood infections, and severe group A streptococcal diseases are thought to be increasing in incidence in Australia. Yet, there are no accurate data on the incidence and costs of these or other GAS diseases in non-Aboriginal Australians, or in most other populations around the world. It is becoming more urgent to collect this data as numerous vaccine candidates are entering human trials, new approaches to the treatment of sore throat are emerging, and new strategies to treat and control the spread of severe disease are being developed. We propose a comprehensive strategy to measure the incidence, prevalence and costs of each group of GAS diseases. We will follow a group of families for 12 months to detect cases of GAS sore throat and skin sores and measure the impact on the family. We will survey children in schools to estimate the prevalence of skin sores. We will check hospital records to calculate the number of cases of rheumatic fever and kidney disease. And we will maintain surveillance for severe diseases by checking hospital and laboratory records. We will also check to see if family members of people with severe disease have the GAS bacterium in their throats. We will then compile these data into a comprehensive estimate of the burden of disease in Victoria, and estimate the cost-effectiveness of different treatment and prevention strategies.Read moreRead less
A Randomised Placebo-controlled Trial Of Antibiotics To Prevent Urinary Tract Infection In Children
Funder
National Health and Medical Research Council
Funding Amount
$735,000.00
Summary
This study is needed to determine whether a common clinical practice long-term antibiotic treatment for children following urinary tract infection (UTI) - is safe and effective in preventing further UTI and if so, whether all appropriate children are being treated. UTI will affect about 10% of Australian children by high school age (88,000 children per year). Because UTI may damage the kidneys, the management priority for children with UTI has been prevention of further infection. Currently this ....This study is needed to determine whether a common clinical practice long-term antibiotic treatment for children following urinary tract infection (UTI) - is safe and effective in preventing further UTI and if so, whether all appropriate children are being treated. UTI will affect about 10% of Australian children by high school age (88,000 children per year). Because UTI may damage the kidneys, the management priority for children with UTI has been prevention of further infection. Currently this means the identification of children thought to be most at risk of recurrent UTI by renal tract imaging. Those found to have reflux of urine from the bladder to the kidney (present in about 30% of those with UTI) are then placed on antibiotics fro 2-5 years. Unfortunately there has never been a properly designed trial to test whether antibiotics do really prevent UTI and if so, whether children with reflux are the appropriate and only group requiring treatment. Long term antibiotics may in fact do more harm than good because of side effects like skin, bowel and blood problems and because resistant bacteria may develop. The design of this study involves the random allocation of placebo or antibiotic (cotrimoxazole, the usual antibiotic given in this case) to about 800 children after their first symptomatic UTI. These children are treated and followed for one year to determine the rate of futher UTI in both groups. Any difference in outcome between the two groups of children will be because of the antibiotic treatment. This study may prove long-term antibiotics are ineffective and therefore should not be routinely used. In this case investigation of children to detect vesicoureteric reflux would serve little purpose and should be abandoned. Alternatively antibiotic treatment may be shown as effective treatment for preventing further UTI and in this case the study will clearly identify those children who will benefit.Read moreRead less
A Study To Investigate Alternative Regimens For Pneumococcal Vaccination Of Infants In A Developing Country
Funder
National Health and Medical Research Council
Funding Amount
$1,622,210.00
Summary
Streptococcus pneumoniae (Pnc) is the leading vaccine preventable cause of serious infection in infants. The current Pnc conjugate vaccine is very expensive (approximately USD $200-infant) so it is unlikely to be affordable for most developing countries. Moreover, as health care access in developing countries may be episodic and unreliable, many children do not receive either complete or timely vaccine courses. Therefore, it is important to investigate affordable and flexible ways to deliver thi ....Streptococcus pneumoniae (Pnc) is the leading vaccine preventable cause of serious infection in infants. The current Pnc conjugate vaccine is very expensive (approximately USD $200-infant) so it is unlikely to be affordable for most developing countries. Moreover, as health care access in developing countries may be episodic and unreliable, many children do not receive either complete or timely vaccine courses. Therefore, it is important to investigate affordable and flexible ways to deliver this vaccine, which are safe and effective. A recent WHO-GAVI meeting to address impediments to the introduction of these vaccines in developing countries recognized the need to evaluate other regimens of Pnc conjugate vaccine as an important research priority. This study has been deliberately formulated with that need in mind. The site for this research is Fiji. Although health services are good, Pnc disease, particularly pneumonia, remains the commonest cause of childhood morbidity and mortality. Fiji has good vaccine coverage and was the first Pacific country to introduce Hib vaccine. The arrival of the new, expensive Pnc conjugate vaccine presents a dilemma for Fiji and many similar countries. The expense of this vaccine would consume a large portion of the health budget. This study has two components: 1. A Phase 2 immunogenicity study (involving 750 infants) to evaluate regimens using reduced numbers of doses of Pnc conjugate vaccine, and using timing of dosing and combinations with the Pnc polysaccharide (PS) vaccine that may be more suited to the epidemiology of Pnc disease in developing countries. 2. An epidemiological study will measure the burden of invasive Pnc disease and pneumonia in Fiji. This will be part of a global effort to address these issues, and will be used to develop rapid assessment tools for these diseases in developing countries. We will seek cofounding for this component.Read moreRead less
A Case-control Study Of Rotavirus Vaccine Effectiveness Against Gastroenteritis Hospitalisation Of Children In The NT
Funder
National Health and Medical Research Council
Funding Amount
$465,859.00
Summary
Almost 1 out of 5 children in remote Aboriginal communities are hospitalised with diarrhoea caused by rotavirus. This study will evaluate the impact of rotavirus vaccination in preventing these hospitalisations. In addition to making sure that vaccination works and that those at highest risk are receiving the benefits, it will assess the indirect impact against other causes of diarrhoea providing, critical information relevant to the vaccine's broader introduction in developing country settings.
Diseases caused by the pneumococcus represent the largest cause of vaccine preventable death in the world today, mainly pneumonia and meningitis. In 2011, 16 developing countries will introduce pneumococcal conjugate vaccines, none in east Asia. Lack of research has been a major barrier to their use in the region. We have established an international centre of excellence in the field and we seek support to extend the capacity of this group and to transfer the technology to Vietnam.
Impact Of DTP Schedules On The Immunogenicity Of 2 Doses Of 13v-PCV Followed By An Early Booster
Funder
National Health and Medical Research Council
Funding Amount
$2,651,687.00
Summary
This project aims to come up with a vaccination schedule to make pneumococcal vaccines more effective and affordable for Fiji and other developing countries. We will evaluate schedules involving a 2 dose primary series in early infancy with a booster at 9 months of age. We will compare the immune responses to 3 different primary series and 2 booster options. The results of this project will be used to provide advice, at global and country levels, regarding introduction of pneumococcal vaccines.
Bringing back Australia's lost woodland biodiversity: towards strategic multi-species reintroductions. Australia has the highest rate of mammal extinction of any continent on the planet. This has reduced biodiversity and compromised many important ecological processes. What is the best way to re-build depauperate mammal communities with multi-species reintroductions? What effects do multi-species reintroductions have on recipient ecosystems? This project aims to explore these questions by reintr ....Bringing back Australia's lost woodland biodiversity: towards strategic multi-species reintroductions. Australia has the highest rate of mammal extinction of any continent on the planet. This has reduced biodiversity and compromised many important ecological processes. What is the best way to re-build depauperate mammal communities with multi-species reintroductions? What effects do multi-species reintroductions have on recipient ecosystems? This project aims to explore these questions by reintroducing three mammal species to a critically endangered temperate woodland: a carnivore (the eastern quoll), an insectivore (yellow-footed antechinus), and a herbivore (the eastern chestnut mouse). Results from this sequenced multi-species reintroduction experiment will have broad applicability to ecosystem restoration in Australia and overseas.Read moreRead less
Integrating fire and predator management to conserve threatened species. This project aims to empower land managers to better conserve Australia’s threatened native animals by developing decision-support approaches that facilitate integrated management of threatening processes. The project will use a combination of novel predictive models, field experiments and data syntheses to assist land managers to better conserve Australia’s threatened native fauna. This project will benefit biodiversity co ....Integrating fire and predator management to conserve threatened species. This project aims to empower land managers to better conserve Australia’s threatened native animals by developing decision-support approaches that facilitate integrated management of threatening processes. The project will use a combination of novel predictive models, field experiments and data syntheses to assist land managers to better conserve Australia’s threatened native fauna. This project will benefit biodiversity conservation by enabling more effective allocation of limited conservation resources.Read moreRead less
Improving the Governance of Species Lists. The aim of this project is to develop a system of governance for the creation of taxonomic lists. This project expects to apply knowledge of how other science organizations govern themselves to the governance of taxonomic lists, estimate the costs of current inefficiencies and identify impediments to improvement. Expected outcomes of this project include a process for validating global lists of species. This should provide significant benefits, such as ....Improving the Governance of Species Lists. The aim of this project is to develop a system of governance for the creation of taxonomic lists. This project expects to apply knowledge of how other science organizations govern themselves to the governance of taxonomic lists, estimate the costs of current inefficiencies and identify impediments to improvement. Expected outcomes of this project include a process for validating global lists of species. This should provide significant benefits, such as single lists of species that can be adopted at any scale and are readily comparable across countries and applications. A single list will ensure threatened species and those of quarantine or health concern don’t fall through the cracks and cause problems.Read moreRead less
A landscape-scale experimental test of factors driving mammal declines in northern Australia. Australia has suffered the highest rate of modern mammal extinctions in the world. Foxes have been largely responsible for this extinction in southern Australia and probably also Central Australia. However the decline in mammals in northern Australia has occurred later than that in the south, and in the absence of foxes. We will adopt an experimental approach to determine the mechanisms driving mammal d ....A landscape-scale experimental test of factors driving mammal declines in northern Australia. Australia has suffered the highest rate of modern mammal extinctions in the world. Foxes have been largely responsible for this extinction in southern Australia and probably also Central Australia. However the decline in mammals in northern Australia has occurred later than that in the south, and in the absence of foxes. We will adopt an experimental approach to determine the mechanisms driving mammal declines and extinctions in northern Australia. Populations of brush-tail tree rats (Conilurus penicillatus) will be translocated to suitable habitat on mainland sites that experience different fire regimes and predation pressures.Read moreRead less