- The Peter Doherty Institute for Infection and Immunity
|Professor Tim Stinearemail@example.com||+61383445693|
A new project seeks to understand the Buruli ulcer epidemic in the Mornington Peninsula and disrupt disease transmission for the first time
Buruli ulcer (or ‘Bairnsdale ulcer’) is an invasive soft tissue infection caused by Mycobacterium ulcerans. It can cause lasting cosmetic and functional damage. The infection usually responds to oral antibiotics, however surgery is sometimes necessary. West and Central African countries are inequitably affected. In Australia, Buruli ulcer was first noted in the Bairnsdale area (East Gippsland) in the 1930s. An outbreak occurred on Philip Island in the 1990s, followed by an epidemic on the Bellarine Peninsula. From 2015, the annual number of cases notified to the Victorian Department of Health and Human Services (DHHS) increased 3.2–fold, to 340 cases in 2018, with most cases being residents of the Mornington Peninsula.
How people become infected with M. ulcerans is not fully understood. Some native Australian animals, including possums (which are ubiquitous on the Mornington Peninsula) can develop Buruli ulcer and excrete the pathogen live in their faeces. M. ulcerans has also been detected in biting aquatic insects and adult mosquitoes. Person-to-person transmission is rare. Being bitten by mosquitoes, and gardening, increases the risk of developing Buruli ulcer. Insect repellent appears to be protective. Possibly, the Mornington Peninsula epidemic is mediated by people being exposed to infected possum faeces through breaks in their skin, or from receiving bites from mosquitoes (which are contaminated with M. ulcerans; perhaps through exposure to possum faeces or by blood-feeding on infected possums).
An ambitious new study which aims to determine how Buruli ulcer is transmitted, and how to prevent it, is underway. The Beating Buruli in Victoria study is supported by a substantial National Health and Medical Research grant. This is a collaborative partnership between the Victorian Government Department of Health and Human Services, the Doherty Institute, Barwon Health, Austin Health, CSIRO, Agriculture Victoria, the University of Melbourne and Mornington Peninsula Shire. The study will run for two years.
There are two major components. The first is a case-control study. Here people with Buruli ulcer (cases) and people who live nearby, but do not have it, (the 'controls') complete a short questionnaire. Field surveys to test for M. ulcerans at participants’ residences are also conducted. Cases and controls are then compared to see what exposures are associated with developing Buruli ulcer.
The second component, the Mosquito Control Study, seeks to disrupt disease transmission. This involves a cluster randomised control trial, where small residential areas are identified and randomly assigned to either 'intervention' or 'control' status. All residents of the study area will receive information about how to reduce their risk of mosquito bites. Mosquito surveillance will be performed. ‘Intervention’ areas will also receive a comprehensive mosquito control program, which uses intensive pesticide administration and mosquito trapping. Finally, rates of Buruli ulcer among residents of control and intervention areas will be compared to see if the mosquito control program was effective in preventing new cases.
The Beating Buruli in Victoria study findings are likely to be of significant importance for preventing and controlling epidemics, both in Australia and overseas.
- Dr Jane Oliver. Research Fellow
- Dr Ee Laine Tay, Epidemiologist
- Rebecca Feldman, Medical Entomologist
- Dr Katherine Gibney, Research Fellow
- Dr David Price, Research Fellow
- Dr Simon Crouch, Public Health Physician
- Prof. Paul Johnson, Infectious Disease Physician
- Prof Tim Stinear, Chief Investigator
- Victorian Department of Health and Human Services,
- University of Melbourne,
- Austin Health,
- Barwon Health,
- Mornington Peninsula Shire.
Loftus MJ, Tay EL, Globan M, Lavender CJ, Crouch SR, Johnson PDR, Fyfe JAM. Epidemiology of Buruli Ulcer Infections, Victoria, Australia, 2011-2016. Emerg Infect Dis 2018;24(11):1988-1997.
Yerramilli A, Tay EL, Stewardson AJ, Fyfe J, O'Brien DP, Johnson PDR. The association of rainfall and Buruli ulcer in southeastern Australia. PLoS Negl Trop Dis 2018;12(9):e0006757.
Wynne JW, Stinear TP, Athan E, Michalski WP, O'Brien DP. Low incidence of recurrent Buruli ulcers in treated Australian patients living in an endemic region. PLoS Negl Trop Dis 2018;12(8):e0006724.
Loftus MJ, Trubiano JA, Tay EL, Lavender CJ, Globan M, Fyfe JAM, Johnson PDR. The incubation period of Buruli ulcer (Mycobacterium ulcerans infection) in Victoria, Australia - Remains similar despite changing geographic distribution of disease. PLoS Negl Trop Dis 2018;12(3):e0006323.
Buultjens AH, Vandelannoote K, Meehan CJ, Eddyani M, de Jong BC, Fyfe JAM, Globan M, Tobias NJ, Porter JL, Tomita T, Tay EL, Seemann T, Howden BP, Johnson PDR, Stinear TP. Comparative Genomics Shows That Mycobacterium ulcerans Migration and Expansion Preceded the Rise of Buruli Ulcer in Southeastern Australia. Appl Environ Microbiol 2018;84(8):
Yerramilli A, Tay EL, Stewardson AJ, Kelley PG, Bishop E, Jenkin GA, Starr M, Trevillyan J, Hughes A, Friedman ND, O'Brien DP, Johnson PDR. The location of Australian Buruli ulcer lesions-Implications for unravelling disease transmission. PLoS Negl Trop Dis 2017;11(8):e0005800.
O'Brien DP, Wynne JW, Buultjens AH, Michalski WP, Stinear TP, Friedman ND, Hughes A, Athan E. Exposure Risk for Infection and Lack of Human-to-Human Transmission of Mycobacterium ulcerans Disease, Australia. Emerg Infect Dis 2017;23(5):837-840.
Wallace JR, Mangas KM, Porter JL, Marcsisin R, Pidot SJ, Howden B, Omansen TF, Zeng W, Axford JK, Johnson PDR, Stinear TP. Mycobacterium ulcerans low infectious dose and mechanical transmission support insect bites and puncturing injuries in the spread of Buruli ulcer. PLoS Negl Trop Dis 2017;11(4):e0005553.
Sarfo FS, Lavender CJ, Fyfe JA, Johnson PD, Stinear TP, Phillips RO. Mycobacterium ulcerans DNA not detected in faecal samples from Buruli ulcer patients: results of a pilot study. PLoS ONE 2011;6(5):e19611.
Fyfe JA, Lavender CJ, Handasyde KA, Legione AR, O'Brien CR, Stinear TP, Pidot SJ, Seemann T, Benbow ME, Wallace JR, McCowan C, Johnson PD. A major role for mammals in the ecology of Mycobacterium ulcerans. PLoS Negl Trop Dis 2010;4(8):e791.
Stinear T, Johnson PD. First isolation of Mycobacterium ulcerans from an aquatic environment: the end of a 60-year search?. PLoS Negl Trop Dis 2008;2(3):e216.
Johnson PD, Azuolas J, Lavender CJ, Wishart E, Stinear TP, Hayman JA, Brown L, Jenkin GA, Fyfe JA. Mycobacterium ulcerans in mosquitoes captured during outbreak of Buruli ulcer, southeastern Australia. Emerg Infect Dis 2007;13(11):1653-60.
Fyfe JA, Lavender CJ, Johnson PD, Globan M, Sievers A, Azuolas J, Stinear TP. Development and application of two multiplex real-time PCR assays for the detection of Mycobacterium ulcerans in clinical and environmental samples. Appl Environ Microbiol 2007;73(15):4733-40.
Johnson PD, Stinear T, Small PL, Pluschke G, Merritt RW, Portaels F, Huygen K, Hayman JA, Asiedu K. Buruli ulcer (M. ulcerans infection): new insights, new hope for disease control. PLoS Med 2005;2(4):e108.
Johnson PD, Stinear TP, Hayman JA. Mycobacterium ulcerans--a mini-review. J Med Microbiol 1999;48(6):511-3.
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