Melbourne School of Population and Global Health - Research Publications
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ItemHealth services : knowledge, use and satisfaction of Afghan, Iranian and Iraqi settlers in Australia(Radcliffe Publishing, 2007)This paper reports the findings of a study examining the knowledge of, use of and satisfaction with local primary healthcare services reported by new arrivals to Australia from Iran, Iraq and Afghanistan. The study sample consisted of a purposive sample of 98 new settlers from the selected countries and used a semi-structured questionnaire and focus groups to attain information. Key findings were that friends and family were the greatest sources of health provider information and there was a lack of both more general health information and understanding of the health system. While study participants were able to access primary healthcare services and were generally satisfied, several major operational deficiencies were reported. General practitioners (GPs) were the major health providers for these groups. Health-seeking behaviours were strongly influenced by the country of birth in comparison with the other examined factors, and experiences of health service encounters also varied greatly between countries of birth. The facility’s proximity to the participant’s home was a strong influence in the selection of health services. The researchers recommend that a network of appropriately supported and staffed community health centres and/ or GP clinics is needed in areas where there are high concentrations of refugees and immigrants.
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ItemImmunogenicity of a locally produced hepatitis B vaccine with the birth dose stored outside the cold chain in rural Vietnam(AMER SOC TROP MED & HYGIENE, 2006-02)The heat stability of hepatitis B vaccine (HepB vaccine) should enable its storage outside the cold chain (OCC), increasing access to the birth dose in areas lacking refrigeration. We compared the immunogenicity of a locally produced vaccine among infants who received three doses stored within the cold chain (n = 358) or for whom the first dose was stored OCC for up to one month (n = 748). Serum was collected from these infants at age 9-18 months. The vaccine was protective in 80.3% of all infants. There were no differences in the prevalence of a protective level of antibody or antibody titer among groups of infants according to storage strategy. Differences in antibody titer between certain groups of infants could be explained by different vaccination schedules. Where birth dose coverage will be improved, HepB vaccine can be taken OCC for up to one month without affecting its immunogenicity.
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ItemNo Preview AvailableAssessment of susceptibility of Plasmodium falciparum to chloroquine, quinine, mefloquine, sulfadoxine-pyrimethamine and artemisinin in southern Viet Nam(ROYAL SOC TROPICAL MEDICINE, 2001)Resistance to antimalarial chemotherapy is a major concern for malaria control in Viet Nam. In this study undertaken in 1998, 65 patients with uncomplicated Plasmodium falciparum malaria were monitored for 28 days after completion of a 5-day treatment course with artemisinin. Overall 36.9% (24/65) of patients had recurrent parasitaemia during the surveillance period. P. falciparum isolates were tested for sensitivity in vitro to chloroquine, mefloquine, quinine, sulfadoxine-pyrimethamine and results were compared to those from a similar study in 1995. Increased parasite sensitivity to sulfadoxine-pyrimethamine, chloroquine and quinine was demonstrated, with significantly lower mean EC50 and EC99 values in 1998 compared to 1995. Parasite sensitivity to mefloquine did not differ significantly in the 2 surveys. Isolates were also tested for sensitivity in vitro to artemisinin in the 1998 survey. The mean EC50 was 0.03 mumol/L and the EC99 was 0.94 mumol/L. Parasite sensitivity to artemisinin will need to be monitored in view of its increasing use in Viet Nam.
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ItemNo Preview AvailableSchistosomiasis in Australian travellers to Africa(AUSTRALASIAN MED PUBL CO LTD, 1998-01-05)
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ItemNo Preview AvailableSchistosomiasis in Australian travellers to Africa(WILEY, 1997-03-17)OBJECTIVE: To determine the proportion of Australian travellers to Africa at risk of Schistosoma infection, and the proportion of those infected. DESIGN AND PARTICIPANTS: Retrospective postal survey of 360 patients who had attended Fairfield Hospital travel clinic in 1994 and stated an intention to travel to Malawi, Zimbabwe or Botswana. MAIN OUTCOME MEASURES: Self-reported risk status for Schistosoma infection. For those at risk, results of an indirect haemagglutination assay (IHA). For those with IHA titres > or = 1:32, results of enzyme-linked immunosorbent assay, urine microscopy and eosinophil count. RESULTS: 360 letters were sent; 35 were returned to sender. Of the 325 remaining, 250 (77%) either responded or had an IHA test; 19 of these were still overseas or did not travel. 117/231 (51%) returned travellers considered themselves at risk of infection. Significantly fewer older patients reported exposure (chi 2 = 66.6; P < 0.001). 109/117 (93%) of those at risk had IHA tests and 18 had titres > or = 1:32. Subsequent testing indicated infection in 10/117 travellers (8.5%; 95% CI, 4.2%-15.2%). CONCLUSION: Our findings indicate that a considerable number of Australian travellers to Africa are at risk of schistosomiasis, and some are infected. As complications can be serious, screening is recommended for individuals with any risk of infection, and treatment should be offered to those infected.
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ItemNo Preview AvailableChemoprophylaxis and treatment of malaria.( 1994-09)Prevention of malaria morbidity relies on the use of personal protection from mosquito bites, appropriate chemoprophylactic drugs, and early investigation of symptoms in returning travellers. Malaria chemoprophylaxis must be tailored to the individual patient's travel and personal needs, and no chemoprophylaxis is completely effective. Chloroquine alone is adequate for those areas with P vivax, or sensitive P falciparum but in most circumstances the choice will be between mefloquine and doxycycline. The specific area visited, the time spent there and the individual's medical history will help determine the final choice.
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ItemNo Preview AvailableAGE AND STRAIN TRANSCENDING IMMUNITY TO PLASMODIUM-FALCIPARUM - REPLY(ELSEVIER SCI LTD, 1994-08)
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ItemNo Preview AvailableCLINICAL IMMUNITY TO PLASMODIUM-FALCIPARUM - REPLY(ELSEVIER SCI LTD, 1994-02)
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ItemNo Preview AvailablePROTECTION, PATHOGENESIS AND PHENOTYPIC PLASTICITY IN PLASMODIUM-FALCIPARUM MALARIA(ELSEVIER SCI LTD, 1993-08)Why does Plasmodium falciparum cause severe illness in some but not all infections? How is clinical immunity acquired? These questions have intrigued investigators since the clinical epidemiology of malaria was first described. The search for answers to both questions has highlighted the changes that take place at the surface of infected red blood cells during the last half of the erythrocytic cycle. These changes specify the antigenic and adhesive or cytoadherence phenotypes for the infected cell. Now the antigenic and adhesive phenotypes appear to be linked and together undergo clonal variation. In this article David Roberts, Beverley-Ann Biggs, Graham Brown and Christopher Newbold explain how clonal phenotypic variation and the linkage between adhesive and antigenic types contribute to our understanding of naturally acquired immunity and of pathogenesis of severe malaria.
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ItemNo Preview AvailableADHERENCE OF INFECTED ERYTHROCYTES TO VENULAR ENDOTHELIUM SELECTS FOR ANTIGENIC VARIANTS OF PLASMODIUM-FALCIPARUM(AMER ASSOC IMMUNOLOGISTS, 1992-09-15)Erythrocytes (E) infected with asexual forms of malaria parasites exhibit surface antigenic variation. In Plasmodium falciparum infections, the variant Ag is the P. falciparum E membrane protein 1 (PfEMP1). This molecule may also mediate the adherence of infected E to host venular endothelium. We show here that parasite lines selected for increased adherence to endothelial cells have undergone antigenic variation. Three adherent lines selected from the same P. falciparum clone reacted with the same agglutinating antiserum that failed to agglutinate the parental clone. Immunoprecipitation experiments with the agglutinating anti-serum demonstrated that the selected lines expressed cross-reactive forms of PfEMP1 that were of higher m.w. and antigenically distinct from PfEMP1 of the parental clone. When one of the adherent lines was cloned in the absence of selection, a range of variant antigenic types emerged with differing cytoadherence phenotypes. These findings show that selection for cytoadherence in vitro favors the emergence of antigenic variants of P. falciparum and suggest that the requirement for cytoadherence in vivo may restrict the range of antigenic variants of P. falciparum in natural infections.