Download BRIEFING PAPER Southern Hemisphere Influenza Vaccine


BRIEFING
PAPER
Southern
Hemisphere
Influenza
Vaccine
Effectiveness
Research
and
Surveillance
(SHIVERS)
DOCUMENT
EMBARGOED
UNTIL
5
OCTOBER
2011
INTRODUCTION:
In
December
2010,
the
Influenza
Division
of
the
National
Center
for
Immunization
and
Respiratory
Diseases
(NCIRD)
of
the
United
States
Centers
for
Disease
Control
and
Prevention
(CDC)
called
for
cooperative
applications
from
organisations
working
in
the
Southern
Hemisphere
to
provide
Southern
Hemisphere
Influenza
Vaccine
Effectiveness
Research
and
Surveilllance
(SHIVERS)
over
a
five
year
period.
An
application
was
made
by
ESR
working
with
a
team
of
collaborators
consisting
of
leading
influenza
researchers
in
New
Zealand
and
abroad
including
the
University
of
Otago,
The
University
of
Auckland,
the
Auckland
District
Health
Board
(ADHB)
and
the
WHO
Collaborating
Centre
at
St
Jude
Children’s
Hospital
in
the
USA.
ESR
has
received
formal
confirmation
from
CDC
that
the
application
for
the
five
year
multi‐
million
dollar
study
was
successful.
The
study
will
commence
end
of
September
2011
with
funding
allocated
on
an
annual
appropriation
basis
by
the
US
Department
of
Health
and
Human
Services.
The
Award
is
a
significant
achievement
for
ESR
and
their
collaborators
and
the
resulting
research
will
generate
new
knowledge
to
underpin
the
public
health
strategies
and
policies
needed
to
address
the
many
factors
influencing
the
impact
of
influenza
locally,
nationally,
and
globally.
Combating
seasonal
and
pandemic
influenza
and
other
respiratory
pathogens
relies
on
being
able
to
accurately
identify
the
disease
in
all
its
forms,
from
mild
infection
though
to
severe
disease
causing
hospitalisation
and
death.
We
also
need
to
understand
how
immune
systems
respond
to
this
virus,
monitor
the
effectiveness
of
influenza
vaccines,
and
know
how
disease
can
be
prevented
through
improvements
in
housing,
nutrition,
personal
behaviour
and
other
factors.
1
www.esr.cri.nz
The
SHIVERS
project
will
consider
all
of
these
questions
in
a
southern
hemisphere
setting,
New
Zealand,
which
has
high
quality
public
health
surveillance
systems
and
a
proven
track
record
in
early
detection
and
characterisation
of
pandemic
influenza
viruses.
The
SHIVERS
project
proposes
to
extend
New
Zealand’s
existing
influenza
surveillance
systems
by
establishing
two
(hospital‐based
and
community‐based)
enhanced
real‐time
surveillance
systems
in
the
Auckland
region.
The
Award
is
the
start
of
a
process
that
will
see
the
project
team
and
collaborators
consulting
widely
with
primary
and
secondary
care
networks
across
the
Auckland
region
about
how
to
collectively
work
together
to
achieve
the
study’s
objectives.
In
addition
to
the
benefits
envisaged
by
CDC
(in
provision
of
information
to
support
northern
hemisphere
influenza
planning),
the
SHIVERS
project
is
intended
to
provide
New
Zealand
with:
• Robust
information
for
national
influenza
response
planning;
• Development
and
integration
of
existing
surveillance
systems;
• Further
development
of
relationships
with
overseas
collaborators
and
funders;
• Models
for
organising
collaborative
activity
within
New
Zealand;
• An
innovative
model
for
surveillance
research
collaboration
within
New
Zealand;
and
• Establish
New
Zealand
as
a
centre
for
research
excellence
at
a
population
level;
and
• Position
New
Zealand‐based
collaborating
organisations
for
future
collaborative
overseas
bids
SHIVERS
OBJECTIVES
The
two
primary
research
objectives
of
SHIVERS,
commencing
in
the
first
year,
are:
Objective
1:
Estimate
the
incidence
rate,
prevalence,
clinical
spectrum,
pathogenesis
and
outcomes
of
severe
pneumonia
and
severe
acute
respiratory
infection
(SARI)
caused
by
influenza
and
other
respiratory
pathogens
in
population
and
subpopulations.
Expected
outcomes:
- Guide
improved
methods
for
disease
surveillance
- Assist
early
detection
and
prediction
- Optimise
clinical
case
management
- Optimise
laboratory
diagnosis
2
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Objective
2:
Assess
the
annual
effectiveness
and/or
efficacy
of
influenza
vaccines
in
preventing
laboratory‐confirmed
influenza
in
population
and
subpopulations.
Expected
outcomes:
- Guide
better
vaccine
design
- Guide
targeted
vaccination
strategies
for
population
and
subgroups
- Understand
host
immune
response
- Identify
better
immune
diagnostic
markers
- Optimise
laboratory
diagnosis
In
addition
to
the
above
primary
objectives,
additional
studies
are
to
be
conducted
on
interaction
between
influenza
infection
and
other
infections,
aetiologies
and
causes
of
respiratory
mortality,
non‐severe
illness
due
to
influenza
and
other
respiratory
pathogens,
serological
studies
of
annual
infection
risk,
impact
of
various
risk
factors
for
influenza
infection
or
severe
disease,
immune
response
to
influenza,
healthcare
and
societal
economic
burden
of
influenza
disease,
and
assessment
of
cost‐effectiveness
of
influenza
vaccination.
These
additional
studies
are
provided
for
in
the
additional
objectives
below,
which
will
be
conducted
in
the
second
to
fifth
years
of
the
project:
Objective
3
Investigate
the
interaction
between
influenza
and
other
respiratory/non‐
respiratory
infections
Objective
4
Understand
aetiologies
and
causes
of
respiratory
mortality
Objective
5
Estimate
annual
incidence
and
attack
rates
of
non‐severe
illness
due
to
influenza
and
other
respiratory
pathogens
in
population
and
subpopulations
Objective
6
Estimate
annual
risk
of
infection
with
influenza
among
population
subgroups
using
serologic
methods
Objective
7
Identify
and
quantify
the
impact
of
various
risk
factors
for
influenza
infection
or
severe
disease
Objective
8
Describe
immune
response
to
influenza
infection
/vaccination
and
compare
the
level,
duration
and
cross‐reactivity
of
immune
response
in
subgroups
with
risk
factors
for
influenza
disease.
Objective
9
Estimate
healthcare
and
societal
economic
burden
of
influenza
and
other
respiratory
pathogens
and
cost‐effectiveness
of
influenza
vaccination
among
different
subpopulations
3
www.esr.cri.nz
WHY
NEW
ZEALAND?
A
number
of
powerful
factors
combined
to
give
the
ESR‐led
research
team
the
competitive
advantage
to
win
the
CDC
tender
against
tough
international
competition,
these
include:
(1) New
Zealand’s
Location
New
Zealand
is
a
temperate
southern
hemisphere
country
that
lies
entirely
below
the
Tropic
of
Capricorn.
Its
influenza
season
occurs
predominantly
during
the
northern
hemisphere
summer
(June
to
September)
and
what
is
observed
in
New
Zealand
often
predicts
the
subsequent
northern
hemisphere
experience.
(2) New
Zealand’s
Unique
Healthcare
System
• A
number
of
critical
logistical
factors
combine
to
make
New
Zealand
a
unique
location
for
ground‐breaking,
population‐based
research,
including
its
predominantly
publicly
funded
healthcare
system
and
associated
health
information
systems:
o All
New
Zealanders
have
a
unique
identifier
‐
the
National
Health
Index
number
‐
that
allows
tracking
of
individual
healthcare
utilisation
over
time
and
linkage
to
multiple
data
sources
(e.g.
notifiable
diseases,
primary
care,
hospitalisation,
mortality,
pharmaceuticals
and
geographically
referenced
data).
o Additionally,
patients
are
registered
with
primary
care
providers
who
maintain
highly
computerised
records
with
detailed
demographic,
risk
factor
and
immunisation
status
information.
o The
NZ
population
is
extremely
well
characterised
according
to
demographic
structure,
particularly
by
ethnicity
and
socioeconomic
group.
Indigenous
Maori
and
Pacific
immigrant
populations
(collectively
20%
of
the
population)
are
vulnerable
to
influenza
and
other
respiratory
infections
and
will
be
of
particular
interest
in
this
proposed
research.
(3) World
class
National
Influenza
Surveillance
system
New
Zealand
operates
a
number
of
surveillance
systems
which
will
be
employed
to
provide
real‐time
strategic
information
to
New
Zealand
and
to
northern
hemisphere
countries
during
inter‐pandemic
and
pandemic
periods.
4
www.esr.cri.nz
•
•
Inter‐pandemic
period
- Sentinel
GP‐based
surveillance
- Virological
surveillance
of
outpatients
and
inpatients
- ICD
code‐based
morbidity
and
mortality
surveillance
Pandemic
period
- National
notification
- Border‐related
public
health
surveillance
- ICU
utilisation
- Pandemic
sero‐survey
- Transmission
dynamic
study
Over
21
papers
on
pandemic
influenza
(2009‐11)
•
The
programme
will
expand
New
Zealand’s
existing
influenza
surveillance
systems
by
establishing
two
surveillance
systems
in
Auckland
‐
hospital‐based
and
community‐based.
(4) Collaboration
of
World
Leading
Influenza
Researchers
on
a
single
national
application
New
Zealand
gained
a
‘best
in
class’
international
reputation
for
its
response
to
the
pandemic
influenza
A(H1N1)09,
and
this
credibility
was
further
extended
as
a
result
of
a
subsequent
seroprevalence
study
and
over
20
related
publications.
For
the
SHIVERS
application,
as
for
the
earlier
seroprevalence
study,
ESR
assembled
a
multi‐
disciplinary,
multi‐centre
team
consisting
of
leading
influenza
researchers
in
New
Zealand
and
abroad.
This
type
of
productive
collaboration
also
led
to
the
success
of
this
CDC
award.
To
undertake
the
proposed
research
and
surveillance
programme
ESR’s
science
staff
from
its
WHO
National
Influenza
Centre
based
at
the
Wallaceville
National
centre
for
Biosecurity
and
Infectious
Disease
(NCBID)
and
its
Health
Intelligence
Team
(led
by
Dr
Sue
Huang
and
Dr
Graham
Mackereth)
will
collaborate
with
numerous
researchers
and
clinicians
including:
• Dr
Michael
Baker,
University
of
Otago
• Dr
Nikki
Turner,
The
University
of
Auckland
• Dr
Sally
Roberts,
Auckland
District
Health
Board
(ADHB)
• Dr
Colin
McArthur,
Auckland
City
Hospital
• Dr
Cameron
Grant,
Starship
Children’s
Hospital
• Dr
Richard
Webby,
Collaborating
Centre
at
St
Jude
Children’s
hospital
in
the
USA.
5
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ABOUT
CDC
The
Centers
for
Disease
Control
and
Prevention
(CDC)
collaborate
to
create
the
expertise,
information
and
tools
that
people
and
communities
need
to
protect
their
health
through:
• Health
promotion;
• Prevention
of
disease;
• Injury
and
disability;
and
• Preparedness
for
new
health
treatments
CDC
seeks
to
accomplish
its
mission
by
working
with
partners
throughout
the
US
and
the
world
to:
• Monitor
health;
• Detect
and
investigate
health
problems;
• Conduct
research
to
enhance
prevention;
• Develop
and
advocate
sound
public
health
policies;
• Implement
prevention
strategies;
• Promote
healthy
behaviours;
• Foster
safe
and
healthful
environments;
and
• Provide
leadership
and
training.
THE
RESEARCH
TEAM
&
COLLABORATORS
The
SHIVERS
research
team
has
been
carefully
selected
to
have
the
skills,
knowledge
and
experience
to
address
the
objectives,
meet
the
scientific
and
design
criteria,
and
deliver
results
that
will
make
a
difference
to
the
way
influenza
is
managed
in
the
future
in
New
Zealand
and
globally.
Most
importantly,
the
research
team
has
successfully
collaborated
on
influenza‐related
research
for
several
years
and
has
published
numerous
joint
papers
and
reports
on
both
seasonal
and
pandemic
influenza.
ESR
ESR
is
the
host
institute
for
the
SHIVERS
project
and
one
of
eight
Crown
Research
Institutes
owned
by
the
government
on
behalf
of
the
people
of
New
Zealand.
ESR’s
work
underpins
the
health
and
justice
systems
in
New
Zealand
through
the
provision
of
science
services
and
research,
primarily
to
government
clients.
6
www.esr.cri.nz
The
Health
Programme
in
ESR
includes
the
public
health
reference
laboratory,
disease
surveillance
and
the
National
Influenza
Centre
(NIC).
The
NIC
was
recognised
by
the
WHO
in
1954
and
serves
as
the
key
point
of
contact
for
both
the
WHO
and
the
New
Zealand
Ministry
of
Health
for
the
virology
and
epidemiologic
surveillance
of
influenza.
The
NIC
provides
influenza
virus
isolates
to
the
WHO
Global
Influenza
Surveillance
Network
on
a
regular
basis.
ESR
has
made
a
recent
and
very
significant
investment
in
infrastructure
that
will
support
this
research,
in
particular
the
newly
built
and
refurbished
laboratories,
a
new
laboratory
information
management
system
(StarLIMS),
a
platform
for
web‐based
surveillance
of
notifiable
infectious
diseases,
and
other
information
management
and
surveillance
tools
and
systems.
The
NIC
is
situated
at
a
newly
purpose‐built
PC2
facility
attached
to
a
PC3+
facility
and
is
fully
equipped
to
conduct
the
proposed
laboratory
testing.
ESR
is
also
linked
to
the
Kiwi
Advanced
Research
and
Education
Network
(KAREN)
enabling
the
transfer
of
large
datasets
between
research
and
education
organisations
involved
in
this
study.
ESR
is
committed
to
ethical
research
and
the
research
team
has
considerable
experience
with
ethics
and
privacy
issues,
processes
and
compliance.
All
ESR
laboratories
are
IANZ
accredited
to
the
ISO
15189
quality
standard.
Health
and
safety
are
organisational
priorities.
ESR
operations
have
not
been
halted
by
the
recent
Christchurch
earthquake
and
the
research
forming
this
proposal
will
be
unaffected.
Programme
Leader
‐
Dr
Virginia
Hope
Dr
Hope
joined
ESR
in
2006
to
lead
the
development
of
its
National
Centre
for
Biosecurity
and
Infectious
Disease
(ESR
NCBID)
Programme.
She
has
subsequently
merged
this
with
the
Communicable
Diseases
and
Population
and
Environmental
Health
Programmes
to
form
the
current
Health
Programme.
Dr
Hope
is
a
specialist
in
both
public
health
medicine
and
in
medical
administration.
She
was
formerly
a
Medical
Officer
of
Health
in
Auckland
and
a
lecturer
in
Environmental
Health
at
the
School
of
Population
Health
in
Auckland.
Dr
Hope
has
been
involved
in
research
on
the
epidemiology
of
infectious
disease,
the
transmission
of
water‐borne
disease,
and
biosecurity,
and
has
been
involved
in
numerous
emergency
responses
to
food
or
water‐borne
pathogens
and
environmental
hazards.
7
www.esr.cri.nz
She
was
previously
a
member
of
the
Biosecurity
Ministerial
Advisory
Committee
and
Deputy
Chair
of
the
National
Health
Board
and
currently
serves
on
the
Capital
and
Coast
and
Hutt
Valley
District
Boards
as
Chair.
Principal
Investigator
–
Dr
Sue
Huang
The
Principal
Investigator
for
the
study
is
Dr
Sue
Huang
from
the
Institute
of
Environmental
Science
and
Research
(ESR),
which
is
based
in
a
new
purpose
‐built
facility
at
the
National
Centre
for
Biosecurity
and
Infectious
Disease
(NCBID)
in
Upper
Hutt,
Wellington.
Dr
Huang
is
a
virologist
and
WHO
National
Influenza
Centre
(NIC)
Director.
As
the
principal
investigator
of
the
SHIVERS
project,
Dr
Huang
is
responsible
for
scientific
oversight
of
the
project
including
active
leadership
and
involvement
in
several
objectives.
As
the
Director
of
the
WHO
National
Influenza
Center
(NIC),
Dr
Huang
is
responsible
for
the
virological
surveillance
of
influenza,
providing
reference
services
for
hospital
laboratories
within
the
New
Zealand
Virus
Laboratory
Network
and
some
Pacific
Island
countries,
as
well
as
providing
primary
diagnostic
services
for
some
sentinel
general
practitioners
(GPs).
She
is
also
responsible
for
the
national
sentinel
GP
surveillance
for
influenza,
overseeing
the
operation
of
the
system,
providing
detailed
analysis
of
influenza
epidemiological
and
virological
data
for
New
Zealand.
As
a
member
of
the
Australia
Influenza
Vaccine
Committee,
Dr
Huang
works
with
other
international
leading
experts
to
provide
the
annual
recommendation
for
influenza
vaccine
composition
for
New
Zealand,
Australia
and
South
Africa.
In
addition
to
routine
virological
and
epidemiological
surveillance,
Dr
Huang
has
published
extensively
on
influenza
virology
and
epidemiology
and
has
successfully
attracted
multi‐million
dollar
research
funding
for
previous
studies.
Dr
Graham
Mackereth
is
a
veterinary
epidemiologist
with
ESR
and
NCBID
and
will
be
the
Project
Manager
of
this
research.
During
the
A(H1N1)
2009
pandemic
Dr
Mackereth
worked
as
an
epidemiologist
in
the
response
centre
for
the
New
Zealand
Ministry
of
Health.
His
responsibility
during
the
response
was
to
work
on
improving
and
collating
surveillance
information
and
designed
a
serological
study
to
assess
the
level
of
population
exposure
to
the
pandemic
virus.
8
www.esr.cri.nz
Dr
Mackereth
now
manages
the
Health
Intelligence
Team
for
ESR.
The
Team
manages
the
public
health
informatics
associated
with
influenza
sentinel
surveillance
and
notifiable
diseases.
Co‐Principal
Investigator
Dr
Don
Bandaranayake
is
a
Public
Health
Physician
at
ESR.
He
was
a
principal
investigator
for
the
NZ
pandemic
Influenza
sero‐prevalence
study
and
has
published
widely
on
communicable
disease
and
public
health
issues
in
international
journals.
Since
coming
back
to
NZ
after
eight
years
with
the
WHO,
Dr
Bandaranayake
worked
as
a
senior
advisor
at
the
Ministry
of
Health
before
joining
ESR
two
years
ago.
He
will
co‐lead
the
serology
component
of
the
project
with
Dr
Sue
Huang. Dr
Richard
Hall
is
a
Molecular
Virologist
with
ESR
at
NCBID.
Universities
of
Otago
and
Auckland
The
University
of
Otago
and
University
of
Auckland
host
New
Zealand’s
two
medical
schools
and
New
Zealand’s
leading
research
universities
(ranked
first
and
second
for
research
excellence
in
the
last
New
Zealand
review).
Contributors
from
the
University
of
Otago
are
based
in
the
Department
of
Public
Health
at
the
University’s
clinical
school
in
Wellington.
Contributors
from
the
University
of
Auckland
are
based
in
the
University’s
Immunisation
Advisory
Centre
and
Department
of
Pediatrics:
Child
and
Youth
Health.
Co‐Principal
Investigator
Dr
Michael
Baker
is
an
epidemiologist
and
Associate
Professor
at
the
University
of
Otago,
Wellington.
As
most
of
the
goals
of
the
proposed
research
are
concerned
with
aspects
of
the
epidemiology
of
influenza,
notably
its
incidence,
distribution,
impact,
risk
factors,
and
prevention
(through
vaccination),
Dr
Baker
will
co‐lead
the
project
with
Dr
Sue
Huang.
He
will
also
lead
specific
components
concerned
with
how
influenza
interacts
to
cause
other
illnesses
and
to
identify
risk
factors
for
this
infection,
particularly
the
role
of
household
crowding.
Through
Dr
Baker’s
involvement
as
the
Co‐director
of
the
Housing
and
Health
Research
Programme
at
the
University
of
Otago,
he
has
researched
factors
associated
with
transmission
of
infectious
diseases
in
the
domestic
environment.
Dr
Baker
has
researched
and
published
extensively
on
the
epidemiology
of
influenza,
and
infectious
diseases
more
generally.
He
is
currently
the
principal
investigator
on
a
Health
Research
Council
funded
project
investigating
causes
for
ethnic
and
socioeconomic
inequalities
in
pandemic
influenza
infection
rates
in
New
Zealand.
He
was
the
principal
investigator
for
a
previous
(2006‐09)
CDC
funded
research
project
which
investigated
how
influenza
crosses
borders
and
how
such
spread
might
be
contained.
9
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Dr
Heath
Kelly
is
an
Australian
epidemiologist
and
adjunct
Associate
Professor
at
the
University
of
Otago
whose
interests
and
outputs
are
well
aligned
with
the
projects
aim
of
assessing
the
burden
of
influenza
in
a
southern
hemisphere
country
and
estimating
influenza
vaccine
effectiveness
in
community
and
hospital
settings.
For
more
than
a
decade
Dr
Kelly
has
had
responsibility
for
laboratory‐supported
surveillance
of
influenza‐like
illness
(ILI)
in
sentinel
general
practices
in
the
Australian
state
of
Victoria.
In
addition
to
reporting
surveillance
findings
on
an
annual
basis,
the
surveillance
scheme
has
been
used
to
explore
seasonal
thresholds
for
influenza,
the
adequacy
of
the
ILI
case
definition
and
the
optimal
distribution
and
number
of
sentinel
general
practice
sites.
More
recently
the
Victorian
sentinel
surveillance
network
has
been
used
to
estimate
influenza
vaccine
effectiveness
(VE)
using
the
relatively
novel
approach
of
the
test‐negative
design,
where
cases
are
sentinel
patients
with
ILI
who
test
positive
for
influenza
by
RT‐PCR
and
controls
are
sentinel
patients
who
test
negative.
Des
O’Dea
is
an
Economist
at
the
University
of
Otago
and
will
lead
Objective
9.
Co‐Principal
Investigator
Dr
Nikki
Turner
is
a
General
Practitioner
and
Director
of
the
Immunisation
Advisory
Centre
(IMAC)
and
a
Senior
Lecturer
at
The
University
of
Auckland.
She
will
also
co‐lead
the
project
with
Dr
Huang
and
lead
specific
components
concerned
with
vaccine
effectiveness.
IMAC
is
a
national
service
delivery
organisation
that
focuses
on
immunisation
coverage,
communication
and
coordination,
which
includes
an
active
research
division
that
utilises
effective
service
delivery
networks
to
translational
research.
Dr
Turner’s
areas
of
interest
academically
are
in
general
practice
and
child
health,
with
a
major
specialty
interest
in
immunisation
and
she
runs
a
research
unit
within
the
Immunisation
Advisory
Centre.
This
unit
is
focused
on
translational
research
around
all
aspects
of
improving
immunisation
uptake
in
New
Zealand,
vaccine
delivery
quality
issues,
matching
coverage
to
disease
surveillance
and
adverse
events
following
immunisation,
and
overall
reducing
the
impact
of
vaccine
preventable
diseases.
10
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Auckland
District
Health
Board
(ADHB)
Auckland
District
Health
Board
(ADHB)
operates
NZ’s
largest
public
hospital
with
almost
two
million
patient
contacts,
serving
more
than
449,440
people.
ADHB
provides
a
tertiary
and
quaternary
referral
service
for
the
rest
of
NZ
and
for
other
pacific
nations.
There
are
over
10,000
staff
or
approximately
7,750
full‐time
equivalent
positions
including
bureau
staff.
The
clinical
staff
is
fully
committed
to
ethical
research
when
collecting
respiratory
and
blood
specimens.
LabPLUS
is
the
IANZ
accredited
(ISO
15189)
medical
laboratory
of
ADHB.
The
Clinical
Microbiology
and
Virology
Laboratories
provides
a
wide
range
of
services
and
are
well
supplied
with
modern
processing
equipment,
work
practices
and
test
systems
and
supported
by
highly
qualified
and
experienced
clinical
and
technical
staff.
Co‐Principal
Investigator
Dr
Sally
Roberts
is
a
Clinical
Microbiologist
and
Infectious
Diseases
physician
and
she
is
the
Clinical
Head
of
Microbiology
at
Auckland
City
Hospital.
Co‐Principal
Investigator
Dr
Colin
McArthur
is
an
Intensivist
and
Clinical
Director
of
Critical
Care
Medicine
at
Auckland
City
Hospital.
He
co‐ordinated
the
national
intensive
care
response
to
pandemic
influenza
in
2009
and
has
been
the
New
Zealand
intensive
care
representative
for
several
international
severe
influenza
research
projects.
Co‐Principal
Investigator Dr
Cameron
Grant
is
a
paediatrician
at
Starship
Children’s
Hospital,
Associate
Professor
at
the
University
of
Auckland,
and
Associate
Director
of
Growing
Up
in
New
Zealand.
His
research
is
focused
on
child
health
problems
that
are
common,
affect
New
Zealand
children
disproportionately,
and
are
preventable
either
by
immunisation
or
improved
nutrition.
They
will
also
co‐lead
the
project
with
Dr
Huang
and
lead
specific
components
on
hospital
based
surveillance.
Dr
Mark
O’Carroll
is
a
Respiratory
Disease
Specialist
at
Auckland
City
Hospital.
Dr
Craig
Thornley
is
a
Public
Health
Physician
with
Auckland
District
Health
Board.
11
www.esr.cri.nz
WHO
Collaborating
Centre
at
St
Jude’s
Children’s
hospital
in
the
USA
St.
Jude
Children’s
Research
Hospital
is
a
premier
research
center
that
has
112
faculty‐level
basic
science
investigators
and
165
postdoctoral
research
associates.
Faculty
has
appointments
and
direct
graduate
students
at
the
University
of
Tennessee,
Memphis,
Colleges
of
Medicine
and
Pharmacy.
Each
area
of
research
has
fully
equipped,
state‐of‐the‐art
laboratories,
with
additional
common
areas
allocated
for
tissue
culture,
cold
room
storage,
ultracentrifuges,
and
other
shared
equipment.
Shared
resources
in
bioinformatics
and
biotechnology,
biostatistics,
central
data
management,
molecular
resources,
and
others
are
available
to
all
investigators.
Dr
Richard
Webby
is
a
virologist
and
Immunologist,
and
WHO
Collaborating
Center
(WHOCC)
Director
at
St.
Jude
Children’s
Research
Hospital,
USA.
His
role
in
the
SHIVERS
project
is
to
describe
components
of
the
immune
response
to
influenza
infection
and/or
influenza
vaccination
and
compare
the
level,
duration
and
cross‐reactivity
of
immune
response
in
subgroups
with
risk
factors
for
influenza
disease.
Over
the
past
11
years
Dr
Webby
has
been
involved
in
laboratory
and
clinical
research
on
influenza
pathogenesis
and
vaccinology,
all
of
which
will
provide
the
reagents
and
expertise
needed
for
this
study.
Other
SHIVERS
collaborators
The
SHIVERS
project
will
be
undertaken
in
the
Auckland
region
with
extensive
engagement
with
Auckland
based
DHBs
and
Primary
Health
Organisations
(PHOs).
THE
INFLUENZA
VIRUS
Influenza
is
a
significant
public
health
issue
worldwide
with
tens
of
thousands
infected,
many
thousands
every
year
die
from
influenza
or
seasonal
flu‐related
deaths,
and
billions
of
dollars
are
spent
on
vaccine
preventative
measures.
In
New
Zealand,
each
year
it
has
a
large
impact
on
our
community,
with
approximately
10‐20%
of
New
Zealanders
infected.
Some
of
these
people
become
so
ill
they
need
hospital
care,
and
a
small
number
die.
It
also
has
a
financial
impact,
particularly
in
workplaces,
and
can
potentially
overwhelm
both
primary
care
and
hospital
services
during
winter
epidemics.
The
Ministry
of
12
www.esr.cri.nz
Health
undertakes
a
“Don’t
let
the
flu
get
you”
vaccination
awareness
programme
and
funds
free
vaccinations
for
higher
risk
groups.
Influenza
viruses
frequently
undergo
antigenic
changes,
thus
evading
the
host
immune
response.
This
poses
a
real
challenge
in
the
prevention
and
control
of
influenza.
Infection
with
the
influenza
virus
can
be
asymptomatic,
mild,
severe
or
fatal,
and
can
pave
the
way
for
severe
secondary
bacterial
infections.
The
recent
pandemic
A(H1N1)
2009
fortunately
caused
generally
mild
disease
compared
with
previous
pandemics
but
it
showed
very
clearly
that
we
do
not
know
enough
about
this
virus,
its
interactions
with
the
host
or
ways
to
minimise
its
health,
social
and
economic
impacts.
INFLUENZA
AND
OTHER
RESPIRATORY
DISEASES
IN
THE
SOUTHERN
HEMISPHERE
(NEW
ZEALAND)
New
Zealand
has
a
well‐established
national
influenza
surveillance
system,
comprising
four
information
sources:
1) a
national
sentinel
general
practitioner
(GP)
virology
and
epidemiologic
surveillance
component
2) virology
surveillance
of
outpatients
and
hospital
inpatients
3) international
classification
of
diseases
(ICD)
coded
data
for
influenza
hospitalization
and
mortality;
and
4) an
estimate
of
immunisation
coverage
based
on
medical
practitioners’
reimbursement
claims
for
immunisations.
During
the
recent
pandemic
A(H1N1)
2009
it
was
necessary
to
establish
other
surveillance
tools
such
as
border‐related
public
health
surveillance,
notifiable
disease
surveillance,
intensive
care
unit
(ICU)
utilisation
reporting
and
the
Pandemic
Influenza
Mortality
and
Morbidity
Review
Group.
These
initiatives
helped
contain
the
spread
of
the
disease
and
manage
the
pandemic
response.
The
influenza
season
in
New
Zealand
occurs
during
the
northern
hemisphere
summer,
and
can
therefore
provide
critical
information
on
the
epidemiology,
burden,
strains
and
effectiveness
of
prevention
measures
of
influenza
and
other
respiratory
pathogens
at
a
time
when
study
sites
in
the
northern
hemisphere
cannot.
In
addition,
understanding
the
epidemiology
of
influenza
and
the
effectiveness
of
annual
vaccines
in
the
southern
hemisphere
will
provide
needed
data
for
influenza
control
strategies
in
other
parts
of
the
world.
13
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PUBLIC
HEALTH
IMPACTS
OF
THE
SHIVERS
PROJECT
The
SHIVERS
research
will
provide
an
extended
evidence
base
for
future
health
investment
and
policy
development
relevant
to
New
Zealand
and
globally
and
will
answer
many
unresolved
questions
regarding
the
epidemiology
of
influenza.
These
include
but
are
not
limited
to:
• understanding
the
‘true’
contribution
of
influenza
to
serious
disease
• understanding
the
independent
contributions
of
chronic
diseases,
raised
BMI,
ethnicity
and
socioeconomic
deprivation
to
disease
risk;
• measuring
vaccine
effectiveness
(VE)
in
population
and
subgroups
in
relation
to
vaccine
formulation
and
variations
in
the
virus
over
time.
• assisting
the
timely
identification
of
known
and
unknown
etiological
organisms
causing
respiratory
diseases.
• assessing
influenza‐specific
humoral
and
cellular
immune
response
among
well
characterised
individuals
with
varying
disease
spectrum.
The
research
will
also
deliver
a
tested
model
for
efficient,
sustainable
surveillance
that
could
be
applied
in
multiple
settings
to
assist
early
detection
of
influenza
epidemics
and
pandemics,
and
respiratory
illness
more
generally.
Studies
on
the
epidemiology
and
aetiology
of
respiratory
illness
will
guide
improved
methods
for
laboratory
diagnosis
and
clinical
case
management.
Studies
on
VE
in
the
population
and
subgroups
with
various
risk
factors
will
inform
population‐
wide
and
subgroup‐targeted
vaccine
strategies.
Understanding
of
host
immune
responses
will
guide
better
vaccine
design
and
immune
diagnostic
markers.
Finally,
studies
on
risk
factors
will
guide
non‐pharmaceutical
interventions
and
preventive
measures.
ESR
believes
that
in
addition
to
providing
an
extended
evidence
base
and
providing
further
answers
on
the
epidemiology
of
influenza,
the
SHIVERS
research
will
improve
the
health
of
New
Zealanders
by
informing:
• the
development
of
health
policy
in
New
Zealand
and
elsewhere;
• public
health
initiatives;
• strategies
(diagnostic
and
treatment)
to
manage
patients
admitted
with
Severe
Community‐Acquired
Pneumonia
(severe
CAP)
;
and
• influenza
response
planning
within
New
Zealand.
14
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