Australia’s superbug watchdog A senior University of Adelaide researcher has played a leading role in the Australian Government’s national response to antimicrobial resistance. In 2014, Professor John Turnidge was appointed to lead the Antimicrobial Use Resistance in Australia (AURA) program’s National Surveillance System. The system tracks antimicrobial resistance (AMR) and antibiotic usage throughout the country and informs a range of AMR-containment strategies. In 2016, Turnidge also led the establishment of AURA’s National Alert System for Critical Antimicrobial Resistances (CARAlert), which collects surveillance data on priority organisms resistant to last-line antimicrobials. The system proved its value in mid-2017, when an outbreak of OXA-48 producing E. coli ST38 was detected in Queensland. Although 80 cases were reported, the outbreak was largely confined to a single facility and controlled within two months. CARAlert also plays a valuable role informing national health policy. Its data is regularly subjected to epidemiological analysis, and will increasingly be used to model temporal and spatial trends as data volumes rise.
Harnessing herd immunity A critical component of public health, of course, is prevention, with vaccination playing a significant role. The widespread adoption of immunisation programs in recent decades has had a profound impact worldwide, famously eliminating smallpox and drastically reducing the incidence of conditions like polio, meningitis and measles. Experts agree, however, that eliminating disease through vaccination more quickly and reliably requires another big step forward. We must harness the additional indirect benefits known as “herd immunity” by understanding what proportion of a community and what age groups need to be immunised to improve whole-community protection. This is vaccination’s ultimate goal—and the University of Adelaide is conducting the world’s largest study on it. In 2017, the University’s B Part of It program provided 35,000 adolescents across South Australia with free vaccines for meningococcal B, a highly preventable disease that can cause meningitis and sepsis, and still proves fatal in five to 10 per cent of cases. The Adelaide team has since been evaluating the level of protection this afforded both vaccinated and unvaccinated individuals, with full results expected to be released in late 2018.* According to principal investigator Professor Helen Marshall, the preliminary data are encouraging. “We were very pleased to see all adolescents enrolled in the study in 2017 and 2018 were protected against meningococcal disease, with a reduction in the number of cases in this age group in South Australia,” she says. “There have only been five cases of meningococcal disease in individuals aged 16 to 19 in 2017-18 to date, compared to 17 in 2015-16. This in itself is a great success.
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“ We have direct evidence that meningococcal B vaccination has protected South Australian adolescents against meningococcal disease; and we’re continuing our analysis to determine whether it has an impact on carriage.” Marshall’s team is also designing and evaluating interventions to increase uptake of recommended influenza and whooping cough vaccines among women during pregnancy. The work builds on insights she gained as Australia’s sole representative on a recent 26-person World Health Organisation international taskforce that evaluated maternal influenza immunisations’ health and economic impacts, particularly in lowsocioeconomic communities. “We’ve found the best way to increase uptake is to actually make immunisation an integral part of antenatal care,” she says. “If we can create systems that normalise immunisation as part of pregnancy care – like other important pregnancyrelated procedures – achieving over 90 per cent uptake, as we see for childhood vaccinations, is a realistic possibility. That would significantly reduce health risks for newborns and mothers alike.” *Correct at time of printing. Check adelaide.edu.au for updated information.