Publications by authors named "Steer A"
Background: Healthy skin is important for maintaining overall physical and cultural health and wellbeing. However, remote-living Australian Aboriginal children contend with disproportionally high rates of (Strep A) infected impetigo. The SToP Trial was a large stepped-wedge cluster randomised trial of See, Treat, and Prevent (SToP) skin health activities implemented between 2019 and 2022 in the Kimberley region of Western Australia, during which a decrease in impetigo was observed.
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- Knowledge gaps in understanding human immunity to Streptococcus pyogenes have slowed vaccine development, prompting researchers to establish a human challenge model to study this infection.
- The study analyzed antibody responses in serum and saliva from participants, revealing that those who developed pharyngitis had strong serum IgG responses to vaccine antigens but weaker mucosal IgA responses.
- The findings indicate that past exposure to the bacteria affects immune responses, underscoring the need to consider these complexities when evaluating potential vaccines in future trials.
Scabies is the most common neglected tropical disease with cutaneous manifestations, disproportionately affecting socially disadvantaged populations living in overcrowded settings. Scabies infestation is characterised by a generalised intractable pruritus, and is often complicated by secondary bacterial infection, which can lead to a range of complications. Scabies is a clinical diagnosis and requires an adequate degree of suspicion.
View Article and Find Full Text PDFBackground: Scabies and impetigo cause direct health effects and contribute to severe infectious and immune-mediated complications. Ivermectin-based mass drug administration can reduce scabies and impetigo prevalence in island settings with high prevalence, but the effectiveness in moderate-prevalence settings is not known.
Methods: We conducted a single-arm, before-after community intervention trial.
Introduction: Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste.
Methods And Analysis: Echocardiograms will be obtained by trained local staff using hand-held echocardiographic devices employing the 'Single Parasternal Long Axis view with a Sweep of the Heart' (SPLASH) technique and interpreted by experts remote from the site of acquisition.
Article Synopsis
- The skin is the largest organ and skin infections can seriously affect health and self-image, which prompted a systematic review that updates treatment strategies for various skin infections prevalent in resource-limited settings.
- This review builds on a previous one from 2019 and incorporates new data on conditions like atopic dermatitis and head lice to revise the Australian National Healthy Skin guidelines.
- A thorough search of medical literature from 1960 to 2022 identified 68 studies focusing on the treatment of specific skin infections among Indigenous populations in lower-income areas, leading to key recommendations based on the evidence gathered.
Article Synopsis
- A study was conducted to evaluate the impact of a holistic skin control program, SToP, aimed at reducing impetigo among children in remote communities of the Kimberley, Western Australia.
- The trial involved skin checks, treatment training, and health promotion, targeting children aged 0-18 years in a stepped-wedge randomization process.
- Results showed a significant decline in impetigo cases, particularly noted during initial baseline skin checks prior to the official intervention, with 85% of consented children receiving at least one skin assessment.
Article Synopsis
- Scabies and related bacterial skin infections are common in tropical and low-income areas, significantly raising healthcare costs and straining health systems.
- The "Big SHIFT" trial in Fiji analyzed scabies and SSTIs from 2018 to 2019, aiming to estimate the healthcare costs associated with these conditions before a mass drug treatment campaign.
- The study found that healthcare costs for scabies and SSTIs in Fiji totaled approximately $3 million annually, with an estimated cost of $3.3 per person, highlighting the economic impact and the potential benefits of prevention efforts.
Objectives: The immune response in children elicited by SARS-CoV-2 Omicron infection alone or in combination with COVID-19 vaccination (hybrid immunity) is poorly understood. We examined the humoral and cellular immune response following SARS-CoV-2 Omicron infection in unvaccinated children and children who were previously vaccinated with COVID-19 mRNA vaccine.
Methods: Participants were recruited as part of a household cohort study conducted during the Omicron predominant wave (Jan to July 2022) in Victoria, Australia.
Article Synopsis
- Fiji has a high prevalence of scabies, and mass drug administration (MDA) is being considered as an effective control strategy, but its acceptability has not been fully explored.
- A qualitative study involved 44 community members and 12 key informants to identify barriers and facilitators of MDA acceptability, highlighting prior experiences, community attitudes, and leader endorsements as positive influences, while distrust and limited community outreach were significant barriers.
- This study is the first to qualitatively examine MDA acceptability for scabies globally, suggesting that future programs should include better community engagement, tailored approaches for different areas, and involve local communities in planning and implementation.
Chains of misery: surging invasive group A streptococcal disease.
Curr Opin Infect Dis
December 2024
Article Synopsis
- The recent rise in invasive group A streptococcal (GAS) disease globally has raised concerns, especially with the emergence of a hypervirulent strain called M1UK in high-income countries.
- After the COVID-19 pandemic, there has been a notable increase in iGAS cases, along with related infections like scarlet fever and viral co-infections.
- Current treatment options for iGAS lack strong clinical evidence, and while there are ongoing efforts for GAS vaccine development, most candidates are still in early stages.
Article Synopsis
- - The study aimed to understand the transmission of Streptococcus A (Strep A) in a controlled environment through the Controlled Human Infection with Penicillin for (CHIPS) trial, where participants were intentionally infected with the emm75 strain.
- - Researchers used three methods to investigate transmission: agar settle plates for droplet or airborne spread, measuring how far droplets travel during conversation, and swabbing high-contact surfaces for the presence of Strep A.
- - Out of 60 participants in the CHIPS trial, only one instance of droplet transmission was detected, with no evidence of airborne spread or contamination on surfaces, suggesting minimal transmission in this controlled setting but highlighting the need for further research in real-world conditions.
Background: In Victoria, Australia, children with Pacific Islander ('Pacific') ethnicities are overrepresented in acute rheumatic fever (ARF) and rheumatic heart disease (RHD). In June 2023, ARF and RHD became notifiable in Victoria. To inform public health and clinical practice, we described young Pacific patients' and their caregivers' understandings and experiences of ARF/RHD, and identified possible ways to improve the delivery of clinical care.
View Article and Find Full Text PDFBackground: Ivermectin, an effective treatment for scabies, is not licensed for children weighing <15 kg. Pharmacokinetic modelling has shown a 3 mg dose in young children (2-4 years, weighing 10-14 kg) achieves comparable drug exposure to a 200 μg/kg dose in children aged ≥5 years. This trial evaluated a 3 mg dose in young children.
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- - Pleural empyema in children complicates pneumonia treatment; traditional bacterial cultures often fail to identify pathogens, leading to ineffective antibiotic use.
- - A new multiplex-quantitative PCR (molecular assay) was developed to improve detection of common bacteria and showed high sensitivity (99.1%) and specificity (100%) in testing.
- - In a study with 100 children, the multiplex-qPCR identified pathogens in 90% of cases, significantly outperforming bacterial cultures (24%), and could potentially reduce unnecessary antibiotic treatment duration by 20 days on average.
Background: Rheumatic Heart Disease (RHD) persists as a major cardiovascular driver of mortality and morbidity among young people in low-and middle-income countries. Secondary antibiotic prophylaxis (SAP) with penicillin remains the cornerstone of RHD control, however, suboptimal treatment adherence undermines most secondary prevention programs. Many of the barriers to optimal SAP adherence are specific to the intramuscular form of penicillin and may potentially be overcome by use of oral penicillin.
View Article and Find Full Text PDFStreptococcus pyogenes (Group A Streptococcus; GAS) is a Gram-positive bacterium responsible for substantial human mortality and morbidity. Conventional diagnosis of GAS pharyngitis relies on throat swab culture, a low-throughput, slow, and relatively invasive 'gold standard'. While molecular approaches are becoming increasingly utilized, the potential of saliva as a diagnostic fluid for GAS infection remains largely unexplored.
View Article and Find Full Text PDFObjectives: To test the prevailing dogma that Streptococcus pyogenes emm-types that cause pharyngitis are the same as those associated with the carriage, using a global dataset.
Methods: Drawing on our systematic review of the global distribution of S. pyogenes emm-types and emm-clusters from 1990 to 2023, we compared the distribution and diversity of strains associated with pharyngitis and pharyngeal carriage, in the context of local United Nations Development Programme Human Development Index (HDI) values.
Article Synopsis
- Reducing antibiotic use in Australia requires various strategies, including better vaccines against bacteria like Streptococcus pyogenes, which commonly causes sore throats, to combat antimicrobial resistance.
- An analysis of general practice data from 2013-2017 revealed that 5.7% of visits were for upper respiratory tract infections (URTIs), with 66.1% of sore throat visits leading to antibiotic prescriptions, often not following guidelines.
- The study suggests that sustained interventions, including effective vaccines for S. pyogenes, are needed to lower unnecessary antibiotic prescribing and align with Australian therapeutic guidelines.
Streptococcus dysgalactiae subsp. equisimilis (SDSE) is an emerging cause of human infection with invasive disease incidence and clinical manifestations comparable to the closely related species, Streptococcus pyogenes. Through systematic genomic analyses of 501 disseminated SDSE strains, we demonstrate extensive overlap between the genomes of SDSE and S.
View Article and Find Full Text PDFUnlabelled: Streptococcus pyogenes (S. pyogenes) is a Gram-positive bacteria which causes a spectrum of diseases ranging from asymptomatic infection to life-threatening sepsis. Studies report up to 2000 times greater risk of invasive S.
View Article and Find Full Text PDFBackground: Ivermectin mass drug administration (MDA) is effective for controlling onchocerciasis and scabies, with evidence supporting its role in some species of soil-transmitted helminth (STH) infections. In the context of RISE, a cluster-randomised trial for scabies, this study evaluated the effectiveness of ivermectin MDA in reducing STH burden in the Western Province of Solomon Islands.
Methods: Twenty villages were randomised 1:1 to receive ivermectin MDA as one dose (IVM-1) or two doses (IVM-2) for scabies.