School of Public Health and Community Medicine

image - Infectious Disease 2

Research Interests

Epidemic Response
Clinical research
Observational epidemiology and data linkage
Healthcare-associated infection epidemiology, prevention and control
Immunisation
Infectious disease and health economic modelling

Biosecurity

 

Social and behavioural research Traveller health research
Aboriginal and Torres Strait Islander research
Migrant and refugee health research
Frail elderly
International HIV Group


 

Epidemic Response

Professor Raina MacIntyre, Dr Alex Rosewell, A/Professor David Heslop, Dr Heather Gidding, Dr Rob Menzies, Dr Zoie-Wilkins Wong, Dr Abrar Chughtai, Dr Chau Bui

SPHCM is a member of the WHO’s Global Outbreak Alert Response Network, and a founding member of the ARM network, Australia’s own infectious diseases emergency response network.  The ARM Network for epidemic response is central to the CRE, with the co-founders all being part of the CRE. SPHCM has major strength in applied field epidemiology, with numerous staff involved in deployment to major epidemics around the world.   SPHCM is also home to a NHMRC Centre for Research Excellence in Epidemic Response (ISER) which is an international research initiative conducting applied systems research, enhancing collaboration and building capacity in health systems research for epidemic control. We bring together experts in field epidemiology and epidemic response, military experts, international law and risk science experts, and government and non-government agencies involved in epidemic response.  This Centre is international, with partners in Australia, New Zealand, USA, China, Malaysia and Indonesia who will work together to solve global problems in epidemic response.


 

Biosecurity

 
Professor Raina MacIntyre, A/Prof David Heslop, Dr Abrar Chugtai
 
We conduct research on personal protective equipment, epidemic pattern recognition, bioterrorism, epidemic control, biosecurity, CBRNE and military medicine.  Professor MacIntyre won the Sir Henry Wellcome Medal and Prize from the Association of Military Surgeons of the US for her work on risk prioritisation of bioterrorism, and has published extensively on biosecurity.  She has also done the largest body of clinical trials internationally on PPE to protect against infection for health care workers. She leads a NHMRC CRE in Epidemic Response within which the ISER Academy brings together stakeholders from all sectors of first responders in epidemics. 
A/Prof David Heslop is an active military medical practitioner, the Senior Medical Advisor CBRNE Medical to Special Operations Command (Res), and full time academic at UNSW. He has recently transitioned from Officer Commanding the ADFs only dedicated CBRNE capable medical incident response capability. He has ongoing ADF wide responsibilities for the provision CBRNE health capability advice, policy development, capability development and CBRNE operational health risk analysis.
 
 

Clinical research

Professor Raina MacIntyre, Dr Anita Heywood, Dr Holly Seale

We conduct investigator designed and driven clinical research on interventions to control infectious diseases in Australia and overseas. Many of our clinical trials are in the area of vaccines and respiratory pathogens, and on the prevention and transmission dynamics of these pathogens. We also conduct observational epidemiologic studies in the clinical setting such as case control and cohort studies. We have a large program of research including the use of face masks in the community and in health care workers, the relationship of infections to ischaemic vascular disease (see: http://heart.bmj.com/content/99/24/1843.full) and adult vaccine research, including studies in vulnerable populations such as immunosuppressed and the frail elderly. We have successfully obtained funding from key research funding bodies, such as the National Health and Medical Research Council (NHMRC) and the Australian Research Council (ARC) to conduct these studies. Specific disease areas include Influenza, HPV, TB, pneumococcal disease and other respiratory pathogens. Our research sites include Australia, India, China and Vietnam. Prof MacIntyre leads a NHMRC Centre for Research Excellence which also conducts clinical studies in vaccination of special risk groups.


 

Observational epidemiology and data linkage

Dr Heather Gidding, Dr Anita Heywood, A/Prof Anthony Newall, Dr Bette Liu, Professor Raina MacIntyre, Dr Rob Menzies, Dr Alex Rosewell, Dr Padmanesan Narasimhan

Infectious disease epidemiological research in the School aims to provide evidence for policy development and evaluation of disease control programs. We conduct research in the areas of infectious disease epidemiology (patterns of infectious diseases in the community) and the impact of disease prevention and control measures, such as immunisation, on the burden of disease. Diseases include vaccine preventable infections such as measles, pertussis, HPV, TB, pneumococcal disease and influenza. Primary sources of epidemiological data include routinely collected disease notification, hospitalisation and death records. Analysing linked records for people across multiple data sources brings together a wealth of information about each person and improves estimates of the burden and determinants of infectious diseases. Observational methods are also used to study the epidemiology of infectious diseases and the impact of control methods. For an example of a high impact PhD student publication on the link between human papillomavirus and oesophageal cancer, see: www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0069238.


 

Healthcare-associated infection epidemiology, prevention and control

Professor Mary-Louise McLaws, Dr Holly Seale, Professor Raina MacIntyre

We do a range of research around reducing the risk of acquiring and transmitting infections in healthcare facilities, in both patients and healthcare workers. Our patient safety improvement research focuses on patients and healthcare workers in healthcare facility settings. We research changes in clinical practices to reduce the risk of transmission of healthcare associated infections and improve healthcare worker’s knowledge, attitude and beliefs associated with infection control practices.

Current collaborations include the Clinical Excellence Commission, the World Health Organization First Global Patient Safety Challenge, The Beijing Center for Disease Prevention and Control, Beijing, China, Imperial College and the London School of Hygiene and Tropical Medicine. Other patient safety collaborators include the Australian Group for Antimicrobial Resistance to statistical modelling of the resistant Staphylococcus aureus infection, Sigma Sustainability Institute using cybernetics to map and predict the transmission of infection within intensive care patients. Our World Health Organization First Global Patient Safety Challenge collaboration is examining the relationship between hand hygiene and infection rates in six test sites globally. For a key publication, see: www.ncbi.nlm.nih.gov/pmc/articles/PMC2661074.


 

Immunisation

Professor Raina MacIntyre, A/Prof Anthony Newall, A/Prof Bette Liu, Dr Holly Seale, Dr James Wood, Dr Heather Gidding, Dr Anita Heywood, Dr Rob Menzies, Ms Telphia Joseph, Dr Alex Rosewell

Vaccines are one of the greatest achievements in public health with dramatic reductions in morbidity and mortality from vaccine-preventable diseases. With the expansion of available vaccines and the cost and complexity of immunisation programs in Australia and internationally, there is a need for high quality, multi method research that informs vaccine policy and practice. Immunisation and vaccine-preventable diseases are a key focus of the research undertaken within the School and we have advanced expertise across a range of methodologies including clinical research, epidemiology, disease and economic modelling, data linkage and social research methods. We are currently involved in numerous research projects spanning from program evaluation, the impact of immunisation program schedule changes and predictors of behavioural factors associated with vaccine uptake in vulnerable and high risk populations. Specific vaccines and vaccine-preventable diseases of interest include influenza, pneumococcal disease, HPV, herpes zoster, measles, mumps, rubella, hepatitis A and travel vaccines.

We also have NHMRC Centre for Research Excellence in Population Health, led by Professor MacIntyre, in immunisation titled “Immunisation in under studied and special risk populations: closing the gap in knowledge through a multidisciplinary approach” (see creimmunisation.com.au). The CRE involves a multidisciplinary and collaborative team across UNSW, The National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, The Kirby Institute, Westmead Hospital, The University of Sydney and the University of Antwerp. The NHMRC Centre for Research Excellence in Immunisation has four streams of research on immunisation in: The frail elderly; maternal and neonatal; Aboriginal and Torres Strait Islanders; and traveller, migrant and refugee immunisation issues. 


 

Infectious disease and health economic modelling

Dr James Wood, A/Prof Anthony Newall, Dr Chau Bui, Dr Zoie Wilkins-Wong, A/Professor David Heslop, Professor Raina MacIntyre

We have a large program of research in mathematical modelling and economic evaluation of infectious disease prevention. Modelling has become an important tool to help inform our understanding of infectious disease epidemiology and control. Infectious disease models can be used to predict the impact of alternative control strategies and can be linked with economic models to estimate the cost-effectiveness of these programs. Together these factors can play a major role in policy and funding decisions. Infections of interest include vaccine preventable diseases, particularly influenza, rotavirus, varicella zoster virus, measles, mumps, rubella, tuberculosis, pertussis and pneumococcal disease, among others. We also have interests in more theoretical questions such as structural uncertainty in model outcomes and the impact of antibody decline on disease elimination. A/Prof Newall is a leader in vaccine health economics (see: link.springer.com/article/10.1007%2Fs40273-013-0060-7). Dr Wood is a leader in modelling of vaccine preventable diseases and part of PRISM, a NHMRC Centre for Research Excellence in modelling of infectious diseases. For a key publication which has informed national pandemic planning, see: aje.oxfordjournals.org/content/169/12/1517.full.


 

Social and behavioural research

Professor Juliet Richters, Professor Heather Worth, Dr Holly Seale, Dr Niamh Stephenson, Professor Nick Zwar, Professor Mary-Louise McLaws,

We have high level expertise in social research methods and sociology at SPHCM. Research in these areas includes sexual health, prison health, social aspects of global control of HIV, behaviour and attitudes of health care workers and how this impacts on infection control and connections between pandemic influenza science, policy and public understandings. The School is also involved in a number of HIV social and behavioural research projects being undertaken in Asia and the Pacific. For a key publication, see: www.sciencedirect.com/science/article/pii/S0277953613006345.


 

Traveller health research

Dr Anita Heywood, Professor Raina MacIntyre, Professor Nick Zwar, A/Professor Bette Liu, Dr Holly Seale

International travellers are important sources of infectious disease in countries with low disease incidence and strong national disease control systems, such as Australia. Current research in the School aims to control the importation of diseases into Australia by understanding traveller behaviour and travel patterns, including epidemiologic research on travel related infections, travel vaccine research and social and behavioural research. Our research identifies areas for national disease control policy development in the prevention of travel-related infectious diseases in travellers and their contacts and provides data for modelling the impact of global disease transmission and travel patterns on Australia’s national disease control. Important work on travel, border control and screening has directly informed Australia’s national pandemic response. Our research examining the knowledge, attitudes and behaviours of international travellers to infectious disease risks and preventative health practices has identified poor uptake of pre-travel health advice and vaccination in travellers, particularly migrant Australians who travel. The School is also involved in the promotion of health travel through representation on the Travel Health Advisory Group. For a key publication, see: www.biomedcentral.com/1471-2334/12/43.


 

Aboriginal and Torres Strait Islander research

Dr Robert Menzies, Ms Telphia Joseph, Dr Heather Gidding, A/Prof Bette Liu

SPHCM has several staff who work on Indigenous Immunisation, infectious diseases and data linkage studies. Ms Joseph is a Yamatji woman from Western Australia and has previously been the National Indigenous Immunisation Coordinator. Research includes immunisation activities in Aboriginal Medical Services and their reporting procedures to the Australian Childhood Immunisation Register. The team at UNSW specialise in vaccine preventable disease epidemiology, evaluation of immunisation programs, and applying vaccines to improve the health of Aboriginal and Torres Strait Islander people. Other research interests include improving immunisation program delivery for Indigenous communities, continuous quality improvement, and the use of large routine data collections including complex data linkage using Indigenous identifiers.


 

Migrant and refugee health research

Professor Raina MacIntyre, Professor Nick Zwar, Dr Anita Heywood, Dr Holly Seale, Dr Mohamud Sheikh, Dr Padmanesan Narasimhan

The potential impact of population mobility, particularly in complex humanitarian emergencies, on health care provision is significant. Research in the School aims to develop understanding of the trends and burden of infectious diseases in complex humanitarian situations and also on refugees and Internally Displaced Persons (IDPs) who resettle in Australia but become marginalised members of the community. The School is engaged in studies on the epidemiology of exotic infectious diseases of refugees and internally displaced persons, immunisation issues and access to diagnostic and therapeutic services upon resettlement. This research aims to inform planning and management of outbreaks of infectious diseases and the development of high level management guidelines to improve access to healthcare services of this cohort.  

Health inequity and provision of health care is a challenge identified in migrant communities worldwide. The influence of culture on health service utilisation and health outcome has been well documented. Migrant Australians from culturally and linguistically diverse populations more like to have a passive rather than active role in treatment with under-diagnosis of health problems a concerning issue. Migrants who return to their country of birth to visit friends and relatives (VFR travellers) are at increased risk of infectious diseases compared to other travellers. VFR travellers are a special category of migrants that deserve special attention in disease prevention and travel health. Current research seeks to identify practical opportunities for addressing the higher risks of infectious diseases through quantifying the burden of travel-associated disease in VFR travellers and identifying current practices and barriers to healthcare utilisation and areas of concern within health practitioners and community members.  For proceedings of a national stakeholder workshop on migrant and refugee health see: creimmunisation.com.au/sites/default/files/newsevents/events/Proceedings_CREMigrantRefugeeWorkshop.pdf.


 

Frail elderly

Professor Raina MacIntyre, Dr Bette Liu, A/Prof Tony Newall

The School has strengthened its focus on aged care research with the establishment in 2011 of the Hammond Chair of Positive Ageing and Care, in partnership with the Hammond Care group. Together with other key staff from the SPHCM, the nucleus for a new focus on aged care research within the School has been generated. The aged care research partnership between the SPHCM and Hammond Care has already delivered approximately $1.6 million dollars of funding from various Commonwealth government grants and other funding bodies. The School is involved in a number of research projects with frail older adults undertaken in hospital and aged care facility settings. Specific projects include investigating the burden of respiratory infections in older adults; investigating specific aspects of adult immunisation practices, beliefs regarding adult immunisation in hospitals and aged care facilities involving healthcare workers, inpatients and residents and long term immunity following vaccination in older adults. We also have an interest in equity and ethical aspects of vaccination in the elderly - see dx.doi.org/10.4236/health.2013.512A011.


 

International HIV Group

Professor Heather Worth, Dr Angela Kelly, Dr Patrick Rawstorne

Under the leadership of Professor Heather Worth and the International HIV Research Group, the School also has a large number of collaborative research projects in Asia and the Pacific. Specific projects include a large-scale qualitative project understanding sex work and HIV risk in a number of Pacific countries;  A study of the Fiji Crimes Decree 2009, which further criminalized sex work in Fiji and led to the detainment and ill-treatment of sex workers in that country; a longitudinal study of HIV, pregnancy and parenthood and other HIV research in PNG; HIV risk on the border of PNG and Indonesia in collaboration with the PNG National AIDS Council and the Papua Provincial AIDS Council; a study of older gay Chinese men in collaboration with Tsinghua University.  See: International HIV Research Group.