Annual Report 2003/2004 Menzies School of Health Research
Tabled paper 1523
Tabled Papers for 9th Assembly 2001 - 2005; Tabled papers for 9th Assembly 2001 - 2005; Tabled Papers; ParliamentNT
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8 | Infectious Diseases Division | Menzies School of Health Research 2003 Annual Report The Ear and Respiratory Health program is made up of researchers from a variety of backgrounds, including Aboriginal health workers, doctors, nurses, laboratory scientists, and postgraduate students committed to researching causes, methods of prevention and treatment of severe respiratory conditions, particularly middle ear infections and chronic lung disease. Middle ear infections (otitis media) are common among children in all populations. While the World Health Organization indicate that ear drum perforation greater than 4% represents a massive public health problem, the rate in most remote Aboriginal communities is dramatically higher. In these children middle ear infection follows nasopharyngeal colonisation and persists throughout childhood, often progressing to perforation of the ear drum. Up to 60% of Aboriginal babies have perforations in the first year of life. Research conducted in 2001 by our Ear Team, spanning 29 communities in the Northern Territory, revealed further alarming results in children aged six months to 2.5 years: 25% of these children presented with perforated eardrums, and only 7% of children were identified as having normal middle ear status. In 2003 that rate had only fallen to 21%, despite pneumococcal conjugate vaccination. It is not clear how many Aboriginal adults suffer significant hearing loss, (estimates range up to 40% in some communities), but childhood middle ear infections from pneumococcal bacteria are considered the main cause. Ongoing trials into the effectiveness of a new pneumococcal conjugate vaccine to prevent middle ear infection are currently an important focus of the Ear Teams work. Several research projects evaluating the impact of the vaccine Prevenar are continuing in Aboriginal communities from Central Australia to Katherine West, East Arnhem Land and the Tiwi Islands. Chronic obstructive pulmonary disease (COPD) affects nearly 15% of Aboriginal Australians living in remote communities. COPD (often used to describe chronic bronchitis and emphysema) is a progressive disease, with limited treatments available once lung damage becomes severe. Although smoking, overcrowding and growth in early life are recognised factors contributing to COPD, repeated bacterial respiratory infections may also be an important, preventable factor in the establishment and progress of COPD within Aboriginal communities. Ear & Respiratory Health A Territory-wide surveillance project has been established to monitor drug resistance to antibiotics traditionally used to treat pneumococcal infections. The study will also measure antibiotic prescription rates and pneumococcal conjugate vaccination uptake. Commenced a study to determine if antibiotic treatment or vaccine effectiveness is compromised by high levels of respiratory bacterial pathogens. The first phase of this project has confirmed important differences in the density (or concentration) and diversity of bacteria carried in the noses of children with severe ear disease. Successful randomisation of over 150 children in our first Territory wide controlled trial in a study evaluating the best treatment for Aboriginal children diagnosed with middle ear infection single dose Azithromycin versus seven days Amoxycillin. Completed our second Territory-wide survey of ear disease as part of our studies investigating the impact of the new 7-valent conjugate pneumococcal vaccine Prevenar. Completion of the first phase of an assessment of herd immunity following infant vaccination (pneumococcal vaccine Prevenar) on pneumococcal carriage within an entire Aboriginal community. Developed a Train the Trainer workshop for the Ear Video training package to assist Aboriginal communities in the diagnosis and management of middle ear infection. Instigated community consultation and preliminary research in an Arnhem Land community in a project to gain a local perspective of how to make tuberculosis (TB) control intervention programs more effective. The aim of the project is to reduce the incidence of TB infection in this community where periodic TB outbreaks still occur. It is also anticipated this project will help increase local capacity to deal with other public health problems in Aboriginal communities. Key achievements MSHR 2003 Research & Education Report provides detail on all research projects and is available online at www.menzies.edu.au ABOVE: Certainly not shy, young Marie Assumpta shows the Menzies PRIORiTI Ear Team how saliva swabs should be taken! (Photo courtesy PRIORiTI Project, MSHR)