Melbourne School of Population and Global Health - Theses

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Author: Marcato, Adrian John × End date: 2023 × Start date: 2020 × Subject: Public health ×

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    The development, implementation and evaluation of first few X household transmission studies in Australia
    Marcato, Adrian John ( 2023-04)
    New or re-emerging infectious diseases pose a serious threat to public health. First Few X (FFX) studies provide a platform for the rapid collection of detailed epidemiological data and specimens from cases and their close contacts to understand the potential impact of such diseases. When activated in the early epidemic stages, the data collected from FFX studies can be used to produce estimates of key transmissibility and severity parameters to inform public health and social measures. The Australian Government Department of Health recognise the value of FFX studies, however, detailed protocols in the Australian context were not finalised at the start of my doctoral research in 2019. This thesis documents my experience contributing to the development of a global FFX protocol for pandemic influenza in 2019, as part of my internship at the World Health Organization. The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the advent of the global coronavirus disease (COVID-19) pandemic during the first year of my studies rapidly pivoted my PhD focus from piloting a FFX study during the 2020-2021 influenza seasons to implementation in a global health emergency. As such, I detail my role coordinating the design and implementation of the Australian FFX Project for COVID-19 – a national study of confirmed cases of COVID-19 and household contacts conducted between April-October 2020. Using a contact-level mixed-effects logistic regression model, I estimated the household secondary attack rate to be 12% (95%CI 7–17%), which aligned with the estimate produced by my collaborators (15%, 95%CrI 8–25%) using a mathematical model. As this was the first project of its kind in Australia, there were many challenges encountered with respect to logistics, ethics, governance, and data management. I subsequently led a qualitative evaluation of stakeholders involved in the project to consolidate on lessons learnt to inform future FFX platform development in Australia. Four main recommendations were developed from the series of modified Delphi surveys and interviews with key stakeholders, including: forming strong partnerships between health departments and researchers; developing FFX protocols that can be easily adapted for different pathogen contexts; investing in data infrastructure, and; having broad ethical approvals in place before a study begins. The learnings presented in this thesis have significant implications for pandemic planning in Australia, by reinforcing the need for pre-determined and pandemic-ready FFX protocols. The development of a fit-for-purpose FFX protocol in Australia, in advance of the next infectious disease emergency, will enable better understanding of the epidemiology in the early and subsequent epidemic phases of a novel or re-emerging pathogen and help inform a proportionate public health response.