Higher risk for international migrants of contracting HIV

A ground-breaking piece of research, which aims to quantify the risk of HIV in international migrants could play a major role in Australia’s efforts to eliminate the virus, according to researchers from the Melbourne Sexual Health Centre, part of Alfred Health.

Sexual health physician Associate Professor Jason Ong said this study provides evidence of international migrants were at a higher risk of contracting HIV.

Universal HBV screening in China is cost-effective, the earlier the better

A/Prof Lei Zhang is senior author on a paper modelling early
diagnostic screening for HBV infection in China

China has one of the largest disease burdens of hepatitis B virus (HBV) infections worldwide, accounting for one-third of the world's infected population. If uncontrolled, chronic HBV infection can lead to liver cirrhosis and liver cancer. 

However, estimated only 19% of chronic HBV-infected people are diagnosed in China, versus the 90% target set by the WHO for HBV elimination by 2030. A universal HBV screening program may improve diagnostic rates and aid China in reaching the WHO 2030 target. 

Elective surgery patients to be screened for COVID-19

Prof Paul Myles in theatre

by Tania Ewing

A Monash University researcher warns, in an editorial in The Lancet, that countries aiming to reintroduce elective surgery should be prepared to balance the need for surgery over the risk of a compromised patient developing COVID-19 and dying.

Professor Paul Myles, from the Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, has written the editorial to accompany a research paper from the University of Birmingham, which looked at more than 1100 patients across 24 countries who had surgery from the 1 January to 31 March this year. More that two thirds of these patients were diagnosed with coronavirus post-operatively. One in four of these patients were dead within 30 days of the surgery.

The Big Picture: Benefits of HIV self testing

Professor Christopher Fairley with a
colleague, Dr Eric Chow

by Anne Crawford

"The Big Picture" will be a series profiling multicentre and international studies in which Central Clinical School (CCS) researchers and affiliates play a part.

CCS and Melbourne Sexual Health Centre researchers Professor Kit Fairley and Dr Marcus Chen were part of a multi-centre Australian study investigating whether HIV self-testing would increase frequency of testing in high-risk gay and bisexual men, with a particular focus on men who delayed testing or had never been tested before.

Frequent testing of individuals at high risk of HIV is central to current prevention strategies.

Which type of polio vaccine is best?

By Dr Jodie Abramovitch

The current polio vaccine was developed by Albert Sabin in 1961 and is a live-attenuated, orally administered vaccine (OPV). Live-attenuated means that the polio virus is alive but unable to cause disease. In settings with high childhood mortality, the OPV is believed to have non-specific effects that allows for protection against other childhood infections such as paralytic poliomyelitis (also known as infantile paralysis caused by the polio virus), tuberculosis and measles. This non-specific protection is thought to be able to reduce mortality to infectious diseases, particularly in childhood, by up to 17%. The significance of this protection is controversial.

Professor Magda Plebanski

To reduce the incidence of poliomyelitis which is around 75 cases worldwide per year, the World Health Organisation (WHO) has recommended the OPV be replaced by an inactivated form (IPV) of the polio virus. Inactivated means the virus used in the vaccine is dead.

In a recent correspondence published in The Lancet, a group of physicians and scientists, including Professor Magdalena Plebanski from the Department of Immunology and Pathology, voiced their concern at a potential change to the form of the current polio vaccine from OPV to IPV. It was noted that previous evidence suggests that the IPV does not confer the same non-specific protection as the OPV. Therefore, the IPV may be associated with an increase in childhood mortality (caused by a range of different infectious diseases). The authors postulated that for every case of poliomyelitis that is reduced by the IPV about 4000 extra deaths due to other infectious diseases (resulting in 300 000 additional deaths each year) may occur that could have been prevented by the OPV.

The authors of this correspondence concluded by urging the WHO to conduct randomised trials of the two different forms of polio vaccine before phasing out the OPV. This would allow for a better understanding of the non-specific protection that each of the polio vaccines provides against other infectious diseases. The results of these trials would inform whether the IPV leads to a higher infectious disease mortality overall when compared to the OPV, as well as whether the OPV and IPV may be administered alongside one another in children to prevent poliomyelitis and keep infectious disease mortality low.

Reference: Fish EN, Flanagan KL, Furman D, Klein SL, Kollmann TR, Jeppesen DL, Levy O, Marchant A, Namachivayam S, Netea MG, Plebanski M,Rowland-Jones SL, Selin LK, Shann F, Whittle HC.  Changing oral vaccine to inactivated polio vaccine might increase mortality. Lancet. 2016 Mar; 387:1054-5.
doi: 10.1016/S0140-6736(16)00661-9.

Lancet letter by Young Physician Leaders Michelle Giles and Fabien Vincent

2013 YPL workshop

Associate Professor Michelle Giles (Department of Infectious Diseases and the Department of Obstetrics and Gynaecology) and Dr Fabien Vincent (Rheumatologist and PhD student, Department of Immunology) have published a Correspondence letter in The Lancet, entitled: "Leadership training by the InterAcademy Medical Panel: what has it achieved in three years of the Young Physician Leaders Programme?" Both early career researchers were among the 19 selected Young Physician Leaders (YPL) participants in the world to attend the IAMP YPL Programme, representing Monash at the World Health Summit in 2013 in Berlin. See article link.

Lancet review: The end of AIDS:HIV infection as a chronic disease

Professor Sharon Lewin

 HIV infection is now no longer a death sentence, as antiretroviral (ART) treatment will hold the disease in check. However, the disease is not cured. ART must be taken for life as HIV is latent and may 'awaken' any time without ART. HIV-infected individuals have a higher risk of developing non-AIDS disorders, including chronic cardiovascular, kidney, liver, cancer and some neurological illnesses. Profs Steven Deeks, Sharon Lewin (HOD Department of Infectious Diseases) and Diane Havlir outline the issues in their Lancet review article.

Lancet review article on bomb blast traumatic brain injury

Professor Jeffrey V. Rosenfeld AM, OBE, Head, Department of Surgery, Monash University, is lead author on a review article in The Lancet on bomb blast brain injury, published 22 July 2013. As a military surgeon he has seen injuries from war zones. In this video (www.youtube.com/watch?v=zADazb8GUWk), he describes what the article is about. Article link. See biography detail.