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Streptococcus pneumoniae (the pneumococcus) is an important human pathogen, which is responsible for the deaths of millions of children each year in developing countries. The high morbidity and mortality associated with pneumococcal disease is also being exacerbated by the rate at which this organism is acquiring resistance to multiple antibiotics. Existing pneumococcal polysaccharide vaccines are poorly immunogenic in young children and only provide cover against a limited range of serotypes. S ....Streptococcus pneumoniae (the pneumococcus) is an important human pathogen, which is responsible for the deaths of millions of children each year in developing countries. The high morbidity and mortality associated with pneumococcal disease is also being exacerbated by the rate at which this organism is acquiring resistance to multiple antibiotics. Existing pneumococcal polysaccharide vaccines are poorly immunogenic in young children and only provide cover against a limited range of serotypes. Serotype coverage is even lower in the more immunogenic conjugate vaccines currently being developed; these will also be very expensive, thereby limiting their use in developing countries, where the need for effective paediatric vaccines is greatest. Pneumococci produce a variety of proteins which are important in causing disease, but the relative contribution of these factors at each stage of the infection process remain to be determined. Moreover, virtually nothing is known of the mechanism whereby these virulence factors are regulated in response to the external environment of the bacterium. In view of this, we are conducting a comprehensive examination of the mechanisms of pathogenesis of pneumococcal disease, with particular reference to the role of putative virulence proteins. This information is being used to develop cheap and effective vaccines based on pneumococcal protein antigens common to all serotypes.Read moreRead less
The Immunogenicity Of 7-valent Pneumococcal Conjugate Vaccine In Sick Elderly People For Whom Vaccine Is Not Registered
Funder
National Health and Medical Research Council
Funding Amount
$443,800.00
Summary
The bacteria pneumococcus (also known as streptococcus pneumoniae) is the most common cause of pneumonia in the community, and a major cause of illness and death in the elderly. Rates of antibiotic resistance are also increasing. The pneumococcus is a complex bacteria, with over 80 known serotypes. Most human disease in Australia is caused by 23 of these serotypes. Australia has an ageing population. The health and wellbeing of the elderly has been identified as a national priority. Vaccination ....The bacteria pneumococcus (also known as streptococcus pneumoniae) is the most common cause of pneumonia in the community, and a major cause of illness and death in the elderly. Rates of antibiotic resistance are also increasing. The pneumococcus is a complex bacteria, with over 80 known serotypes. Most human disease in Australia is caused by 23 of these serotypes. Australia has an ageing population. The health and wellbeing of the elderly has been identified as a national priority. Vaccination and prevention of serious infections, a common cause of illness in the elderly, is an achievable public health goal. The National Health and Medical Research Council (NHMRC) of Australia recommends that adults aged 65 years and over should be immunised with 23-valent polysaccharide pneumococcal vaccine (PPV). PPV has been available long term in Australia, but the dilemma associated with its use is that it is least effective in those at greatest risk of pneumococcal disease and its complications, the sick elderly population. A new 7-valent pneumococcal conjugate vaccine (PCV-7) has been available since the end of 2000, but is currently indicated only for children, because it has never been tested in adults. This vaccine uses different technology, and is conjugated to a protein to make it more effective. Clinicals trials of PCV7 have largely been limited to children aged 0-4 years, and have shown it protects 93.9% of children under 2 years of age against invasive pneumococcal disease (IPD). Our study aims to look at the efficacy of this new vaccine, currently only registered for children, in the sub-group of the population who are at highest risk for pneumococcal disease - hospitalised elderly. We will vaccinate hospitalised elderly people with PCV or PPV and compare their immune response to the two different vaccines. If PCV is more effective than PPV, this has implications for the development and use of conjuagated pneumococcal vaccines for adults.Read moreRead less
A Dual Antigen Synthetic Peptide Subunit Vaccine Approach To Prevent Streptococcal Associated Cardiovascular Disease
Funder
National Health and Medical Research Council
Funding Amount
$604,017.00
Summary
Infection with streptococcus is responsible for causing more than 500,000 deaths each year, the majority of which are due to rheumatic fever and rheumatic heart disease, which contributes to cardiovascular disease. Our research is aimed at the development of a vaccine to prevent heart disease and involves targeting multiple molecules present on the bacterial surface. We will use a novel vaccine delivery system developed in the laboratory, which will enable the vaccine to be delivered nasally.
Do Rapid Detection & Isolation Of Colonised Patients Reduce MRSA Spread? An Epidemiological, Economic & Modelling Study
Funder
National Health and Medical Research Council
Funding Amount
$354,299.00
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) is the antibiotic resistant form of Golden Staph. It is one of the most common causes of hospital acquired infection. Despite the presence of MRSA for more than 40 years in our hospitals, the most efficient ways of controlling it are still debated. Some experts recommend swabbing all high risk patients for MRSA, isolating those found to be carriers it in single rooms or with other carriers and using special precautions, such as gowns and gloves, ....Methicillin-resistant Staphylococcus aureus (MRSA) is the antibiotic resistant form of Golden Staph. It is one of the most common causes of hospital acquired infection. Despite the presence of MRSA for more than 40 years in our hospitals, the most efficient ways of controlling it are still debated. Some experts recommend swabbing all high risk patients for MRSA, isolating those found to be carriers it in single rooms or with other carriers and using special precautions, such as gowns and gloves, when in contact with these patients. One of the problems with this approach is that it takes 2-3 days to detect MRSA from swabs using the usual culture methods in the microbiology laboratory. This means that there are delays in instituting control measures, which may reduce their effectiveness. We plan to test whether use of isolation and special precautions is better than our current practices in preventing the spread of MRSA from patient to patient in the Royal Melbourne Hospital intensive care unit. Patients will be swabbed several times during their admission to see if they are carrying MRSA. We will use new, rapid laboratory methods that can detect MRSA within hours from these patient specimens. This will mean that if patients are found to be carriers, isolation and special precautions can be implemented early. We will compare how many people get MRSA in the time when we are not using any special precautions with how many get it in the time when we are. We are also going to undertake an economic analysis to see whether, even if these new diagnostic methods are more expensive that standard methods, they may still be worth the cost if we can prevent infections in patients. This study will help infection control practitioners to decide whether patients should be isolated with special precautions if they are MRSA carriers. The results of this study will contribute to better patient outcomes, lower hospital costs and more efficient use of resources.Read moreRead less
Antibiotic resistance increases mortality and costs in the Intensive Care Unit (ICU), but the impact of antibiotic therapy has not been adequately studied. We propose to characterise the behaviour of key elements of the bacterial microflora (resistant bacteria and major resistance genes) in response to antibiotics. We have developed new rapid diagnostics to harness these data and this proposal has the potential to greatly improve diagnostic speed and accuracy and thus clinical outcomes.
Immunogenicity Of 23-valent Pneumococcal Polysaccharide Vaccination Among Indigenous Australian Adolescents And Adults
Funder
National Health and Medical Research Council
Funding Amount
$674,738.00
Summary
Multiple doses of pneumococcal vaccine are recommended for Indigenous Australians under a unique schedule aimed at reducing high rates of pneumococcal disease. However, disease rates have not reduced after several years of the program. This study examines a key, previously unstudied explanation for the lack of disease reduction in this population: that repeated vaccination could produce suboptimal protection against disease. It will provide evidence to underpin future vaccination policy.
Community-based Surveillance Of Bacterial Respiratory Pathogens In The NT And WA
Funder
National Health and Medical Research Council
Funding Amount
$782,905.00
Summary
This surveillance project is a continuation of previous work that describes the strains of respiratory bacterial pathogens in the various community groups - Indigenous and non-Indigenous - across the NT and in WA (urban and remote areas). New vaccines are complex and whilst overall benefits are considerable, there are potential influences on microbiology that may be unwanted. Detailed knowledge of these effects will assist in selection of the best vaccines for use in Australia.
Implications Of Bacterial Load For Vaccine Efficacy And Antibiotic Treatment Outcomes In High-risk Populations
Funder
National Health and Medical Research Council
Funding Amount
$345,000.00
Summary
Otitis media (middle ear disease) is a common childhood infection, and a major concern in remote Aboriginal communities of the Northern Territory. For these children, otitis media commences within the first few weeks of life and progresses to perforation of the ear drum in 60% of children by 12 months of age. Few children in remote Aboriginal communities have normal ear status or normal hearing and many have conductive hearing loss, affecting language development and education. Otitis media in t ....Otitis media (middle ear disease) is a common childhood infection, and a major concern in remote Aboriginal communities of the Northern Territory. For these children, otitis media commences within the first few weeks of life and progresses to perforation of the ear drum in 60% of children by 12 months of age. Few children in remote Aboriginal communities have normal ear status or normal hearing and many have conductive hearing loss, affecting language development and education. Otitis media in these children results from infection with the bacteria Streptococcus pneumoniae, Haemophilus influenzae and-or Moraxella catarrhalis. Therefore the types of interventions we are using to combat the high prevalence of ear disease are antibiotic therapy, Streptococcus pneumoniae vaccination, and hygiene interventions. However we fear that the high load of bacteria carried by these children compromises the treatment and prevention strategies. The current proposal will test this hypothesis, and if found to be true, there will be implications for the management of otitis media. For example, dose, frequency and choice of antibiotic treatment, and vaccine schedule changes including an early dose or a booster dose.Read moreRead less
Immunising Aboriginal Mothers With Pneumococcal Polysaccharide Vaccine To Prevent Infant Ear Disease And Carriage
Funder
National Health and Medical Research Council
Funding Amount
$1,131,530.00
Summary
Aboriginal children experience the highest rates of acute and chronic ear infections in the world, with resultant permanent ear damage, hearing loss and educational disadvantage. These infections are mainly bacterial, and Streptococcus pneumoniae (pneumococcus) is the predominant pathogen. Pneumococcal colonisation and infection begins within days of birth, many months before any potential immunological protection from infant pneumococcal conjugate vaccine may be expected. New strategies are nee ....Aboriginal children experience the highest rates of acute and chronic ear infections in the world, with resultant permanent ear damage, hearing loss and educational disadvantage. These infections are mainly bacterial, and Streptococcus pneumoniae (pneumococcus) is the predominant pathogen. Pneumococcal colonisation and infection begins within days of birth, many months before any potential immunological protection from infant pneumococcal conjugate vaccine may be expected. New strategies are needed to eliminate, or at least delay, this early-onset pneumococcal colonisation. One such strategy is the administration to the mother of pneumococcal vaccine, which may protect the newborn infant by leading to higher titres of transplacental or breast milk pneumococcal antibodies and-or by reducing carriage (and transmission to the infant) of maternal pneumococci. Previous small studies using this strategy have been encouraging, but there have been no studies properly evaluating carriage or disease endpoints in infants. The polysaccharide pneumococcal vaccine is currently recommended for all Aboriginal and Torres Islander persons aged 15 years or more in the Northern Territory but uptake of the vaccine has been poor. We propose to conduct a pilot study to determine if maternal immunisation with this vaccine, either in the third trimester of pregancy of immediately following delivery, can reduce pneumococcal carriage and the prevalence of middle ear disease among Aboriginal infants at seven months of age. We aim to recruit 210 Aboriginal women who have uncomplicated pregnancies from Darwin and remote communities in the Top End of the Northern Territory. Each subject and their infant offspring will be followed-up after vaccination and at birth, one , two and seven months after birth.Read moreRead less
PneuMum: An RCT Of Maternal Pneumococcal Vaccination For Protection Of Indigenous Children From Ear Disease
Funder
National Health and Medical Research Council
Funding Amount
$591,291.00
Summary
Ear disease starts in the first few months of life for most Indigenous children. By school entry, 2 out of every 3 Indigenous children in the NT have hearing problems. This proposal is to renew funding of the PneuMum study, which aims to find out whether the protection that a mother gets when she receives a pneumococcal vaccine late in pregnancy or soon after delivery can help to protect her child from getting ear disease.