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Targeted Call for Research - public call for research priorities in Aboriginal and Torres Strait Islander health

ID: 
45
Personal Details
First Name: 
Sharron
Last Name: 
Hall
Specific Questions
1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum): 
Ear infections in children can impair hearing, speech development, educational and social skills and impose a significant burden on medical resources; it is a major priority for Closing the Gap (resource sheet 35, Nov. 2014, AHMAC 2012). Over the past 10 years, we studied Indigenous and non-Indigenous children experiencing chronic ear infections to assess which bacteria caused long-term infections. The results were unexpected and indicated a major paradigm shift to assessment of chronic infections. The usual ear infection bacteria were detected in only a minority of samples. Our study identified, from nearly half the children, a slowly-growing species, named Alloiococcus otitidis (AO). Its DNA has since been identified worldwide in children with acute or chronic disease. In our model system, AO induced inflammatory responses greater than or equal to those associated with ear infections caused by pneumococcus, a well-documented cause of bacterial ear infections. There is a need to assess the role of this organism in chronic infections and to determine, by advanced microbiome studies, if other species not readily identified by conventional pathology methods are involved. The role of risk factors requires investigation to determine how they increase bacterial infections and influence inflammatory responses that damage the middle ear. Closing the Gap Clearinghouse (AIHW & AIFS), 2014. Ear disease in Aboriginal and Torres Strait Islander children. Resource sheet no. 35. Produced by the Closing the Gap Clearinghouse. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. Australian Health Ministers’ Advisory Council, 2012. Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report, AHMAC, Canberra
2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum): 
The National Aboriginal and Torres Strait Islander Health Plan 2013 -2023 (NATSIHP) stipulates the goal: “Health policies and programs are clearly evidence-based and informed by robust health research and data systems” (p.18). Our research project has clearly demonstrated a significant gap in knowledge about the causes of chronic ear infections in Aboriginal children living in coastal and rural areas of regional NSW. The identification of differences between the micro-organisms associated with glue ear in children receiving grommets in NSW and those documented in the medical literature has been achieved through the development of cutting edge pathology research tools, which are translatable to other national and international regions for advanced research investigations. This has resulted in a unique collection of a previously little known bacterial species, A.otitidis, now detected in a majority of Aboriginal and non-Aboriginal participants. An additional priority nominated in the NATSIHP is that Aboriginal and Torres Strait Islander children meet “key childhood developmental milestones” and that environmental health programs be designed to prevent a range of issues, which includes ear health problems, demonstrating its acknowledged prevalence among Aboriginal and Torres Strait Islander children and its significance in child development (p.32). Australian Government, 2013. National Aboriginal and Torres Strait Islander Health Plan 2013–2023. Available: http://www.health.gov.au/internet/main/publishing.nsf/content/B92E980680486C3BCA257BF0001BAF01/$File/health-plan.pdf. Last accessed 02.09.16. .
3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum): 
A TCR in this area would lead to an in-depth examination of the role of A. otitidis and the assessment of samples from our studies on the microbiome of the middle ear for additional “covert pathogens” not identified by routine pathology methods. In addition, the environmental factors identified with increased risk of ear infections (e.g., virus infection, exposure to cigarette smoke) will be examined in the context of their effects on bacterial infections and also on the child’s strong inflammatory responses to these new micro-organisms. The latter is of particular importance as these responses are the basis of the discomfort suffered by the children and also tissue damage leading to hearing loss. The results would provide information on accurate diagnosis of organism(s) causing chronic infection, information to guide antibiotic therapy, potential vaccine components to prevent or reduce children’s strong inflammatory responses to these infections. This investigative approach provides an opportunity to advance the quality of Australian ear research methodology to a similar level of depth as has become normal for other well researched diseases, such as childhood asthma and cancer, illnesses which are studied widely at the molecular level (Kumar and Ghosh, 2009,.Pritchard-Jones et al, 2013) Kumar, A. and Ghosh, B., 2009. Genetics of asthma: a molecular biologist perspective. Clinical and molecular allergy, Vol 7(1), p.1. Pritchard-Jones, K. et al., 2013. Sustaining innovation and improvement in the treatment of childhood cancer: lessons from high-income countries. The Lancet Oncology , Vol 14 , No. 3, e95 - e103
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
In Australia, the number of cases of otitis media (OM) in 2008 were between 992,000 and 2.43 million with an estimated cost of AU$100-400 million, with additional costs of lost wellbeing, due to OM, estimated at AU$1-2.6 billion (Kong and Coates, 2009). Acknowledging that current pathology techniques cannot address needs for better understanding of bacterial infections and antibiotic resistance patterns, there is a world-wide push to rapidly advance the knowledge about microbes and their influence upon health and disease in humans. The recent availability of new DNA sequencing technologies created a new field of research, known as metagenomics, which has become a research target for the National Institute of Health in the USA, resulting in the establishment of the Human Microbiome Project. This is expected to greatly increase the understanding of the way in which major organ systems are affected by their microbial environments (NIH, 2016). The human ear is just beginning to undergo such studies and our Newcastle ear research team is poised to make a significant contribution to this field, with staff highly trained in molecular technologies and an experienced multi-disciplinary research team able to grow the field very quickly. This is the group hosting the national otitis media meeting, OMOZ 2016. Kong, K and Coates, H. 2009. Natural history, definitions, risk factors and burden of otitis media. Medical Journal of Australia. 191 (9), 39-43. National Institutes of Health, 2016. Human Microbiome Project. Available: https://commonfund.nih.gov/hmp/overview. Last accessed 03.09.16.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
In two surveys among children with otitis media with effusion (OME), the major bacteria associated with ear infections were NOT frequently isolated from middle ear fluid (Ashhurst-Smith et al., 2007; 2012) The major isolate was A. otitidis. Subsequent unpublished studies confirmed initial findings. Although usually detected only by molecular methods, our modification of routine pathology procedures resulted in detection of A. otitidis from 46% of children., findings confirmed by detecting A. otitidis DNA in middle ear fluid of 80% of children in the study. This collection of A. otitidis clinical isolates, the largest in Australia and possibly worldwide, enabled us to study bacterial characteristics, effectiveness of antibiotics used for ear infections, and currently by molecular screening, for potential severity of infection factors. What we don’t know - Ear disease in Aboriginal and Torres Strait Islander children (Resource sheet no. 35). “Why some of the ear disease in Indigenous children is not amenable to treatment and management, in contrast to its transitory nature in non-Indigenous children”. Our findings indicate resistance to an important group of antibiotics, known as macrolides, among half the bacterial strains from children in our studies. Possibly, the slow growth of the organism might reduce the effectiveness of penicillins when they are prescribed. Ashhurst-Smith, C., Hall, S.T., Walker, P., Stuart, J., Hansbro, P.M. and Blackwell, C.C., 2007. Isolation of Alloiococcus otitidis from Indigenous and non-Indigenous Australian children with chronic otitis media with effusion.FEMS Immunology & Medical Microbiology, 51(1), pp.163-170. Ashhurst-Smith, C., Hall, S.T., Stuart, J., Burns, C.J., Liet, E., Walker, P.J., Dorrington, R., Eisenberg, R., Robilliard, M. and Blackwell, C.C., 2012. Alloiococcus otitidis: an emerging pathogen in otitis media. Journal of Infection, 64(2), pp.233-235.

Page reviewed: 30 August, 2018