Risk groups
Aboriginal and Torres Strait Islander People vaccination
Program leads: Ms Telphia Joseph and Dr Rob Menzies
A/Prof Heather Gidding, A/Prof Bette Liu , Elizabeth Kpozehouen
Students: Ms Amalie Dyda
Aboriginal and Torres Strait Islander people have substantially poorer health and shorter life expectancy than the rest of the Australian population. Vaccine programs have been successful in reducing disparities between Indigenous and non-Indigenous people for specific vaccine-preventable diseases, despite persistent adverse social and environmental conditions.
For vaccines included in the National Immunisation Program (NIP), coverage is comparable in Indigenous and non-Indigenous populations. While significant reductions in vaccine-preventable disease burden have been seen in both, persistent delays in vaccination among Aboriginal and Torres Strait Islander children continue to place them at increased risk of disease in early life. Australia has had a number of vaccine programs included on the NIP only for Indigenous people, and coverage for these programs is substantially lower than for universal NIP vaccines, largely related to poor identification of Indigenous status among health service providers and cultural and practical barriers to health service access.
Poor quality data on disease and health service delivery has limited the ability to monitor program effectiveness among Aboriginal and Torres Strait Islander people. The VIRL team has extensive experience in Indigenous vaccinology research and has developing methods to extend the use of administrative datasets. Research in this theme focuses on methods to improve Indigenous identifiers, means to monitor program effectiveness, methods to better target vaccination programs and models of delivering immunisation programs to Aboriginal and Torres Strait Islander people, and research into improving vaccine delivery, coverage and timeliness.
Travel, migrant and refugee immunization
Program lead: Dr Anita Heywood
Dr Holly Seale, Prof Raina MacIntyre, Dr Surendra Karki, Dr Alex Rosewell , Elizabeth Kpozehouen
Students: Dr Abela Mahimbo
VIRL conducts a range of social, epidemiologic and clinical studies to inform vaccination needs in migrants, refugees and travellers.
The traveller visiting friends and relatives is a special category of migrants that deserve special attention in vaccine-preventable diseases. The changing nature of organisms with their potential for mutation and crossing species, plus the impact of international travel and trade means that infectious diseases pose a continuing and evolving world-wide threat.
All entrants and re-entrants to Australia have the potential to import disease. For instance, virtually all measles clusters in Australia begin with an imported case and recent large outbreaks of dengue usually reflect virus importation from other countries via an infected index case. Travellers to some countries have considerable risk of infection, which they may bring back to Australia. Diarrhoeal and respiratory infections are common in travellers, both in the country of travel and on return. During the SARS (severe acute respiratory syndrome) epidemic, travel was a major mode of spread of the infection globally, causing WHO warnings about SARS-affected countries. These events highlight the fact that travellers are exposed to a range of infection risks, and may return carrying a pathogen. Indeed, the nature of contemporary travel means that individuals may be still within the incubation period when they arrive in their destination country.
Health inequity and provision of health care to resettled refugees and new migrants are complex and critical issues worldwide. Access to care before, during and after movement is a challenge identified in migrant and refugee groups, as well specific pre-embarkation and post migration challenges. The influence of culture on health service utilisation and health outcome has been well documented.
These groups often have higher rates of vaccine preventable diseases, combined with lower access to care and preventive services. Two decades ago, the most important of these groups were from South East Asia, but a shift in global conflict and migration patterns over this time means that our newest refugees and migrants are from Africa and the Middle East.
The specific issues facing these ethnic groups are different from the previous wave of migration. It is reported that immigrants from the horn of Asia, Middle East and Africa have an unmet health needs, with 17% having yet to access health care at all. Resettled refugees have not only faced the challenges of accessing health care services, but have been overwhelmed by other demanding resettlement issues such as poor housing, unemployment, poverty, acculturation, language, and social service needs among others. The research in this theme focuses on interventions to reach hard-to-reach migrant and refugee groups, and on comparing disease risks and immunisation strategies in older and newer migrant and refugee groups.
Occupational and medical at-risk groups
Program lead: Dr Holly Seale
A/Prof David Heslop, Prof Raina MacIntyre, Dr Abrar Chughtai
Students: Ms Sonya Nicholl
There are many adult populations that are at increased risk of contracting vaccine-preventable diseases. These include, but are not limited to, occupational, behavioural and medical risk groups.
In occupational immunisations, working in some jobs increases exposure to some vaccine-preventable diseases. For example, for adults working with vulnerable people, such as in health care, laboratories, aged care or childcare, they may be exposed to and infect others with disease. Other groups may be vulnerable because they are immunosuppressed or have medical conditions such as heart disease, lung disease or diabetes, that place them at risk of infections.
UNSW VIRL aims to address the gaps in at-risk vaccination groups to identify strategies to best protect those at increased risk.
Vaccines for armed forces
Program lead: A/Prof David Heslop
Prof Raina MacIntyre
Armed forces personnel are at increased risk of contracting vaccine-preventable diseases, largely due to increased likelihood of exposure and location of operations. Infectious diseases can result in suspended or cancelled military operations and have had major impacts throughout history on the course and outcomes of conflict. Vaccination for infectious diseases is an important component of both general health care, and also of safeguarding and sustaining military capabilities prepared for and conducting operations.
The Australian Defence Force’s (ADF) vaccination policy aims to protect the health and enhance the effectiveness of service personnel. Vaccination is a cornerstone of force health protection measures and essential to safeguarding Australia's expeditionary and domestic military capabilities. Australia's ongoing involvement in actions across the spectrum of military and non-combatant operations highlights an additional potential need to be ready to provide medical support and advice to regional and allied military partners in operations. Often medical support is the most important aspect of support provided, particularly in humanitarian assistance and disaster relief operations.
UNSW VIRL aims to support the development and review of national and international military policies and evidence that will underpin the vaccination components of force protection. This will extend across better understanding the risks of endemic vaccine preventable diseases in domestic and international theatres, but also optimisation of the clinical and operational doctrine and evidence supporting vaccination protections associated with chemical, biological, radiological, nuclear, and explosives (CBRNE) medical risk management measures.
Vaccines for international health and outbreaks
Program lead: Dr Alex Rosewell
Dr Anita Heywood, Dr Holly Seale, Dr Rob Menzies, Dr David Muscatello, Dr Abrar Chugtai, Prof Raina MacIntyre
Students: Dr Amit Saha
An outbreak occurs when a disease arises in greater numbers than expected in a community or region or during a season. An outbreak may occur in one community or even extend to several countries, lasting from days to years. An epidemic occurs when an infectious disease spreads rapidly to many people. For example, Ebola virus epidemic in West Africa as recent as 2016. A pandemic is a global disease outbreak. For example, there have been a number of influenza pandemics, including Spanish influenza (1918), Hong Kong influenza (1968) and H1N1 (2009).
UNSW VIRL has great strength in international outbreak response, and is a member of WHO's Global Outbreak Alert and Response Network. Many of our staff and students work extensively internationally and deploy to international epidemics. Vaccines are a key strategy in epidemic control, and can be used acutely in many epidemics such as measles, hepatitis A and varicella.
We are also part of a NHMRC Centre for Research Excellence in Epidemic Control, ISER, which conducts research on epidemic control and response. UNSW is also a founding member of the ARM network, a national network for epidemic response. UNSW VIRL supports vaccination research that aims to curb the burden of such international health outbreaks.
Vaccines for older adults
Program lead: Prof Raina MacIntyre
Dr Abrar Chughtai, A/Prof Anthony Newall, A/Prof James Wood, A/Prof Bette Liu , Elizabeth Kpozehouen
Students: Dr Aye Moa, Ms Amalie Dyda
Older adults have a higher incidence and greater severity of vaccine-preventable diseases, due to both immune senescence and multiple co-morbidities.
The VIRL team has a track record of novel research in older populations, which will be used to build on research capacity in these important but understudied areas. Continuing improvements in health care, nutrition and disease prevention have led to dramatic increases in the proportion of the population that is elderly, which are set to continue.
This shift in population age structure is accompanied by an increase in the number of older adults who require greater levels of acute and chronic health care. Despite this, older adults are still under-vaccinated compared to younger populations.
We build on our track record of clinical research in the prevention of influenza and pneumococcal disease in frail, hospitalised or institutionalised elderly. We also examine other under-studied vaccine-preventable diseases in this group, such as pertussis and herpes zoster.