Head, Skin Health, Program Head of Vaccines and Infectious Diseases
BA MBBS DCH FRACP PhD
Areas of expertise: Skin infections, Streptococcus pyogenes, Staphylococcus aureus, Aboriginal children, COVID-19.
Associate Professor Asha Bowen is a clinician-researcher at Perth Children’s Hospital and Head of Skin Health at the Wesfarmers Centre of Vaccines and Infectious Diseases, based at Telethon Kids Institute. Recently appointed as the Institute's Program Head of Vaccines and Infectious Diseases, A/Prof Bowen is uniquely placed for rapid translation of results from bush to bench to bedside.
A/Prof Bowen received her Fellowship of the Royal Australasian College of Physicians (FRACP) as a paediatric infectious diseases specialist in 2009. Her NHMRC-funded PhD (2010–2014, Menzies School of Health Research), a randomised controlled trial of impetigo treatment in remote Aboriginal children, was published in The Lancet, with the results translated into national and international guidelines. She has >10 years’ experience leading infectious diseases research and investigator-initiated clinical trials focusing on issues significant to Aboriginal child health.
A/Prof Bowen is currently the lead investigator for the SToP Trial to “see, treat and prevent” skin infections, a large cluster randomised trial with a stepped wedge design recruiting from 2019-2021 throughout the Kimberley region in Western Australia. Community engagement over several years formed the foundation of the SToP Trial and ensured the study was guided by the Aboriginal co-investigators and community members.
In 2020, A/Prof Bowen pivoted into COVID-19 research to complement her other fields and is a lead investigator of the WA DETECT-Schools study and chair of the Australasian COVID-19 Trial (ASCOT) global steering committee.
A/Prof Bowen has received numerous awards in recognition of her outstanding research, including:
- 2020 3M Eureka Prize for Emerging Leader in Science
- 2020 NHMRC Investigator Award as an Emerging Leader (her third consecutive NHMRC people support award)
- 2019 WA Tall Poppy Science Award
- 2018 L’Oréal UNESCO Women in Science Fellowship – one of only 4 awarded nationally, and an Australian finalist for the International Rising Talents Award
- 2017 Woodside Early Career Scientist of the Year at the WA Premier's Science Awards
She is also the Chair of the Australian and New Zealand Paediatric Infectious Diseases committee and Deputy Chair of the Australasian Society of Infectious Diseases clinical research network.
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Projects
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Publications
March 2021
Modes of transmission and attack rates of group A Streptococcal infection: a protocol for a systematic review and meta-analysis
Group A Streptococcus (Strep A) is an important cause of mortality and morbidity globally. This bacterium is responsible for a range of different infections and post-infectious sequelae. Summarising the current knowledge of Strep A transmission to humans will address gaps in the evidence and inform prevention and control strategies. The objective of this study is to evaluate the modes of transmission and attack rates of group A streptococcal infection in human populations.
Published research Infectious Diseases Subsite: Wesfarmers Centre of Vaccines and Infectious Diseases Invasive Streptococcus A DiseaseMay 2021Increase in Body Mass Index in Children With HIV, Switched to Tenofovir Alafenamide Fumarate or Dolutegravir Containing Antiretroviral Regimens
Recent data indicate excessive weight gain in treatment-naive adults with HIV commenced on antiretroviral therapy (ART) regimens containing tenofovir alafenamide (TAF) or the integrase strand transfer inhibitors (INSTIs) dolutegravir (DTG) and bictegravir.
Published research Infectious Diseases Subsite: Wesfarmers Centre of Vaccines and Infectious DiseasesFebruary 2021Molecular diagnosis of scabies using a novel probe-based polymerase chain reaction assay targeting high-copy number repetitive sequences in the sarcoptes scabiei genome
The suboptimal sensitivity and specificity of available diagnostic methods for scabies hampers clinical management, trials of new therapies and epidemiologic studies. Additionally, parasitologic diagnosis by microscopic examination of skin scrapings requires sample collection with a sharp scalpel blade, causing discomfort to patients and difficulty in children. Polymerase chain reaction (PCR)-based diagnostic assays, combined with non-invasive sampling methods, represent an attractive approach.
Published research Skin Infections Infectious Diseases Subsite: Wesfarmers Centre of Vaccines and Infectious DiseasesFebruary 2021DETECT Schools Study Protocol: A Prospective Observational Cohort Surveillance Study Investigating the Impact of COVID-19 in Western Australian Schools
Amidst the evolving COVID-19 pandemic, understanding the transmission dynamics of the SARS-CoV-2 virus is key to providing peace of mind for the community and informing policy-making decisions. While available data suggest that school-aged children are not significant spreaders of SARS-CoV-2, the possibility of transmission in schools remains an ongoing concern, especially among an aging teaching workforce. Even in low-prevalence settings, communities must balance the potential risk of transmission with the need for students' ongoing education.
Published research Academic Biostatistics Influenza Infectious Diseases Human Capability Subsite: Wesfarmers Centre of Vaccines and Infectious Diseases Child Physical Activity, Health and Development Social and Emotional Wellbeing of Aboriginal Young People Geospatial Health and DevelopmentMarch 2021COVID-19, children and schools: overlooked and at risk
We have closely followed the international literature about severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission dynamics in children (aged 0–18 years).2 Evidence‐informed discussion about school attendance in the context of COVID‐19 is a high priority and this complex subject requires weighted expert review of the literature to accurately inform policy. As paediatricians and infectious diseases specialists, we wish to highlight important considerations when interpreting the available data.
Published research Infectious Diseases Subsite: Wesfarmers Centre of Vaccines and Infectious DiseasesMarch 2021Meningococcal serotype W septic arthritis: Case series in children
The epidemiology of invasive meningococcal disease has changed over the last decade and there has been an increase in cases caused by serogroup W135, particularly in Indigenous children. Extra‐meningeal and atypical presentations are associated with serogroup W and may delay diagnosis and therefore appropriate treatment. Public and clinician awareness are essential in facilitating effective new vaccine schedule implementation.
Published research Immunisation Aboriginal Health Infectious Diseases Subsite: Wesfarmers Centre of Vaccines and Infectious DiseasesJanuary 2021Clinical experience with SUBA-itraconazole at a tertiary paediatric hospital
Itraconazole remains a first-line antifungal agent for certain fungal infections in children, including allergic bronchopulmonary aspergillosis (ABPA) and sporotrichosis, but poor attainment of therapeutic drug levels is frequently observed with available oral formulations. A formulation of 'SUper BioAvailability itraconazole' (SUBA-itraconazole; Lozanoc®) has been developed, with adult studies demonstrating rapid and reliable attainment of therapeutic levels, yet paediatric data are lacking.
Published research Skin Infections Subsite: Wesfarmers Centre of Vaccines and Infectious DiseasesDecember 2020Performance and Practicality of a Rapid Molecular Test for the Diagnosis of Strep A Pharyngitis in a Remote Australian Setting
Over 5 days, 120 schoolchildren from two schools in the remote Kimberley region of Australia were screened for Strep A pharyngitis. Molecular point-of-care testing identified Strep A pharyngitis in 13/18 (72.2%) symptomatic children. The portability and feasibility of molecular point-of-care testing was highly practical for remote settings.
Published research Subsite: Wesfarmers Centre of Vaccines and Infectious Diseases Invasive Streptococcus A DiseaseNovember 2020The incidence of sore throat and group A streptococcal pharyngitis in children at high risk of developing acute rheumatic fever: A systematic review and meta-analysis
Group A streptococcal (GAS) pharyngitis has traditionally been considered the sole precursor of acute rheumatic fever (ARF). Evidence from Australia, however, suggests that GAS skin infections may contribute to the pathogenesis of ARF.
Published research Infectious Diseases Subsite: Wesfarmers Centre of Vaccines and Infectious Diseases Invasive Streptococcus A DiseaseNovember 2020Ending rheumatic heart disease in Australia: the evidence for a new approach
The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world.
Published research Rheumatic Heart Disease Aboriginal Health Subsite: END RHDNovember 2020A model of population dynamics with complex household structure and mobility: implications for transmission and control of communicable diseases
Households are known to be high-risk locations for the transmission of communicable diseases. Numerous modelling studies have demonstrated the important role of households in sustaining both communicable diseases outbreaks and endemic transmission, and as the focus for control efforts. However, these studies typically assume that households are associated with a single dwelling and have static membership.
Published research Aboriginal Health Infectious Diseases Subsite: Wesfarmers Centre of Vaccines and Infectious DiseasesOctober 2020Planning and clinical role of acute medical home care services for COVID-19: consensus position statement by the Hospital-in-the-Home Society Australasia
During a pandemic when hospitals are stretched and patients need isolation, the role of hospital-in-the-home (HITH) providing acute medical care at home has never been more relevant. We aimed to define and address the challenges to acute home care services posed by the COVID-19 pandemic.
Published research Infectious Diseases Subsite: Wesfarmers Centre of Vaccines and Infectious Diseases Skin HealthJuly 2020Antimicrobial stewardship in remote primary healthcare across northern Australia
The high burden of infectious disease and associated antimicrobial use likely contribute to the emergence of antimicrobial resistance in remote Australian Aboriginal communities. We aimed to develop and apply context-specific tools to audit antimicrobial use in the remote primary healthcare setting.
Published research Skin Infections Aboriginal Health Skin HealthSeptember 2020Clinical Management of Staphylococcus aureus Bacteremia in Neonates, Children, and Adolescents
Staphylococcus aureus is a common cause of community and health care-associated bacteremia, with authors of recent studies estimating the incidence of S aureus bacteremia (SAB) in high-income countries between 8 and 26 per 100 000 children per year. Despite this, <300 children worldwide have ever been randomly assigned into clinical trials to assess the efficacy of treatment of SAB.
Published research Infectious Diseases Allergy & Infectious DiseasesJuly 2020Predicting the causative pathogen among children with osteomyelitis using Bayesian networks – improving antibiotic selection in clinical practice
We have demonstrated the potential use of Bayesian Networks in improving antibiotic selection for children with osteomyelitis
Published research Infectious Diseases Infectious Disease Implementation Research Infectious Diseases Epidemiology Skin HealthJune 2020Progress towards a coordinated, national paediatric antimicrobial resistance surveillance programme
These data support that children are not just 'little adults' in the AMR era, and analyses by age group are important to detect differences in antibiotic susceptibility
Published research Infectious Diseases Group A Streptococcal & Rheumatic Heart Disease Infectious Diseases Epidemiology Skin HealthJune 2020Complicated skin and soft tissue infections in remote indigenous communities
The burden and consequences of skin infections for remote living indigenous people are high
Published research Skin Infections Infectious Diseases Skin HealthMarch 2020Skin infections in Australian Aboriginal children: a narrative review
The Australian National Healthy Skin Guideline summarises evidence-based treatment of impetigo, scabies and fungal infections in high burden settings
Published research Skin Infections Skin HealthMarch 2020Spotting sporotrichosis skin infection: The first Australian paediatric case series
These data highlight the importance of recognising Sporotrichosis in children outside an outbreak setting
Published research Skin Infections Infectious Diseases Infectious Diseases Epidemiology Skin HealthJanuary 2020Barriers and enablers of health service utilisation for childhood skin infections in remote aboriginal communities of Western Australia
Health service utilisation in this setting may be enhanced by improving general awareness of the significance of childhood skin infections
Published research Skin Infections Group A Streptococcal & Rheumatic Heart Disease Skin HealthJanuary 2020Prevalence of Group A β-hemolytic Streptococcal Throat Carriage and Prospective Pilot Surveillance of Streptococcal Sore Throat in Ugandan School Children
The Group A β-hemolytic Streptococcus pharyngeal carriage rates seen in Uganda (15.9%) are higher than the most recent pooled results globally, at 12%
Published research Infectious Diseases Group A Streptococcal & Rheumatic Heart Disease Skin HealthOctober 2019A Survey of Infectious Diseases and Microbiology Clinicians in Australia and New Zealand About the Management of Staphylococcus aureus Bacteremia
Significant variation in practice, particularly for patients with a severe disease phenotype and antibiotic-resistant profile
Published research Infectious Diseases Skin HealthSeptember 2019SToP (See, Treat, Prevent) skin sores and scabies trial: study protocol for a cluster randomised, stepped-wedge trial for skin disease control in remote Western Australia
Skin infection burden in remote Aboriginal communities can be reduced by the See, Treat, Prevent (SToP skin sores and scabies) trial
Published research Skin Infections Group A Streptococcal & Rheumatic Heart Disease Skin HealthSeptember 2019Talking skin: Attitudes and practices around skin infections, treatment options, and their clinical management in a remote region in Western Australia
Documenting carer, service provider and healthcare practitioner perspectives on skin infections provides more understanding of the context of treatment decisions
Published research Skin Infections Group A Streptococcal & Rheumatic Heart Disease Aboriginal Maternal Health & Child Development Skin HealthSeptember 2019Perinatal risk factors associated with skin infection hospitalisation in Western Australian Aboriginal and Non-Aboriginal children
We have quantified the relative influence of perinatal risk factors associated with skin infection hospitalisations in WA children
Published research Academic Biostatistics Skin Infections Aboriginal Health Group A Streptococcal & Rheumatic Heart Disease Infectious Diseases Epidemiology Skin HealthJuly 2019An urgent need for antimicrobial stewardship in Indigenous rural and remote primary health care
We write this perspective to raise awareness of antimicrobial resistance as an issue in Indigenous primary health care
Published research Infectious Diseases Skin HealthJuly 2019A population pharmacokinetic study of benzathine benzylpenicillin G administration in children and adolescents with rheumatic heart disease
Few children and adolescents receiving BPG as secondary prophylaxis will achieve concentrations >0.02 mg/L for the majority of the time between injections
Published research Rheumatic Heart Disease Group A Streptococcal & Rheumatic Heart Disease Skin HealthJune 2019Infectious diseases clinician's variation in the management of pediatric Staphylococcus aureus bacteraemia and equipoise for clinical trials
Large variation in antibiotic prescribing amongst clinicians is demonstrated and increased, corresponding with escalating case complexity and persisting MRSA bacteraemia
Published research Infectious Diseases Skin HealthJune 2019CASSETTE-clindamycin adjunctive therapy for severe Staphylococcus aureus treatment evaluation: Study protocol for a randomised controlled trial
This study will assess the effect of adjunctive clindamycin on patient-centred outcomes in severe, toxin-mediated S. aureus infections
Published research Infectious Diseases Skin HealthApril 2019Pre-exposure prophylaxis for HIV prevention during pregnancy and lactation: forget not the women and children
The framework for appropriately identifying and managing at-risk pregnant and lactating women requiring PrEP is poorly defined
Published research Skin HealthMarch 2019Treatment, prevention and public health management of impetigo, scabies, crusted scabies and fungal skin infections in endemic populations: a systematic review
Systematic review of the treatment, prevention and public health control of skin infections in resource-limited settings where skin infections are endemic
Published research Skin Infections Group A Streptococcal & Rheumatic Heart Disease Skin HealthMarch 2019Burden of skin disease in two remote primary healthcare centres in northern and central Australia
Skin infections are an under-appreciated and dominant reason for presentation to primary healthcare centres in these indigenous communities
Published research Skin Infections Skin HealthFebruary 2019Potential for molecular testing for group a streptococcus to improve diagnosis and management in a high-risk population: A prospective study
Implementation of molecular testing could improve antibiotic use in this high-burden setting
Published research Skin HealthJanuary 2019Adjunctive protein synthesis inhibitor antibiotics for toxin suppression in Staphylococcus aureus infections: a systematic appraisal
A summary of the literature regarding the use of adjunctive protein synthesis inhibitors for toxin suppression in the setting of S. aureus infections is presented
Published research Infectious Diseases Skin HealthJanuary 2019The fall and rise of Group A Streptococcus diseases
We overview the changing epidemiology of Group A Streptococcus infections and the genetic alterations that accompany the emergence of Group A Streptococcus strains
Published research Group A Streptococcal & Rheumatic Heart Disease Skin HealthSeptember 2018Ascertaining infectious disease burden through primary care clinic attendance among young Aboriginal children living in four remote communities in Western Australia
Improved public health measures targeting bacterial skin infections are needed to reduce this high burden of skin infections in Western Australia
Published research Skin Infections Infectious Diseases Infectious Disease Implementation Research Group A Streptococcal & Rheumatic Heart Disease Aboriginal Maternal Health & Child DevelopmentSeptember 2018Investigation of trimethoprim/sulfamethoxazole resistance in an emerging sequence type 5 methicillin-resistant Staphylococcus aureus clone reveals discrepant resistance reporting
Our findings are crucial in demonstrating that the Northern Territory STS clone is not STX resistant
Published researchAugust 2018Infection characteristics and treatment of Staphylococcus aureus bacteraemia at a tertiary children's hospital
There is a wide spectrum of disease severity in paediatric Staphylococcus aureus bacteraemia
Published research Infectious Diseases Vaccine Trials Group Skin HealthMay 2018Scabies and impetigo in Timor-Leste: A school screening study in two districts
Scabies and impetigo are common in Timor-Leste, with very high prevalence of scabies in the rural district of Ermera
Published research Skin Infections Group A Streptococcal & Rheumatic Heart Disease Skin HealthFebruary 2018Dedicated paediatric Outpatient Parenteral Antimicrobial Therapy medical support: a pre-post observational study
We examined the impact of introducing a dedicated team to OPAT, to define the role of increased medical oversight in improving patient outcomes in this cohort.
Published research Group A Streptococcal & Rheumatic Heart Disease Skin HealthNovember 2017Hospital admissions for skin infections among Western Australian children and adolescents from 1996 to 2012
Skin infections are a significant cause of severe disease, requiring hospitalization in Western Australian children, particularly with Aboriginal children
Published research Skin Infections Group A Streptococcal & Rheumatic Heart Disease Infectious Diseases Epidemiology Aboriginal Maternal Health & Child Development Skin HealthNovember 2017Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess
We conducted a systematic review of clinical trials and observational studies that address the utility of SXT for SSTI treatment, caused by either GAS or MRSA
Published research Skin Infections Group A Streptococcal & Rheumatic Heart Disease Skin HealthNovember 2017Hospital admissions for skin infections among Western Australian children and adolescents from 1996 to 2012
The objective of this study was to describe the occurrence of skin infection associated hospitalizations in children born in Western Australia (WA).
Published research Group A Streptococcal & Rheumatic Heart Disease Infectious Diseases Epidemiology Vaccine Trials Group Aboriginal Maternal Health & Child Development Skin HealthOctober 2017A 15-Year Old Burmese Girl With Hemoptysis: A Case Report
A 15 year old girl, born in Hakha, Myanmar, presented with 2 months of intermittent hemoptysis 3 years after immigrating to Australia, via Malaysia.
Published research Infectious Disease Implementation Research Group A Streptococcal & Rheumatic Heart Disease Skin HealthSeptember 2017Immuno-nephelometric determination of group streptococcal anti-streptolysin O titres (ASOT) from dried blood spots: Method for validating a new assay
This study was designed to determine the sensitivity and reproducibility of recovering anti-streptolysin O titres (ASOT) from dried blood spot (DBS) samples
Published research Rheumatic Heart Disease Group A Streptococcal & Rheumatic Heart Disease Skin HealthAugust 2017Dedicated paediatric Outpatient Parenteral Antimicrobial Therapy medical support: a pre-post observational study
The introduction of a formal medical team to Hospital in the Home (HiTH) demonstrated a positive clinical impact on Parenteral Antimicrobial Therapy (OPAT) patients' outcomes.
Published research Infectious Diseases Group A Streptococcal & Rheumatic Heart Disease Vaccine Trials Group Skin HealthJuly 2017Are scabies and impetigo “normalised”? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition
Scabies and impetigo infections are under-recognised and hence under-treated by clinicians
Published research Skin Infections Group A Streptococcal & Rheumatic Heart Disease Skin HealthOctober 2016Epidemiology and mortality of staphylococcus aureus Bacteremia in Australian and New Zealand children
Describe the epidemiology of Staphylococcus aureus bacteremia in children and adolescents younger than 18 years from Australia and New Zealand
Published research Infectious Diseases Group A Streptococcal & Rheumatic Heart Disease Vaccine Trials GroupAugust 2016Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines
Systematic review of antibiotic duration and timing of intravenous to oral switch for paediatric infectious diseases and evidence-graded recommendations
Published research Infectious Diseases Group A Streptococcal & Rheumatic Heart Disease Vaccine Trials GroupJuly 2016Impetigo and scabies - Disease burden and modern treatment strategies
Recent data on the epidemiology of impetigo and scabies and describe the current evidence around approaches to individual and community based treatment
Published research Skin Infections Group A Streptococcal & Rheumatic Heart DiseaseApril 2016The Importance of Scabies Co-Infection in the Treatment Considerations for Impetigo
Treatment success for scabies co-infection was lower than for impetigo overall, with a higher success seen in the co-trimoxazole group than benzylpenicillin
Published research Aboriginal Health Group A Streptococcal & Rheumatic Heart DiseaseFebruary 2016A Retrospective case-series of children with bone and joint infection from northern Australia
We report osteomyelitis incidence in indigenous children of northern Australia is amongst the highest reported in the world
Published research Infectious Diseases Group A Streptococcal & Rheumatic Heart DiseaseFebruary 2016Whole genome sequencing reveals extensive community-level transmission of group A Streptococcus in remote communities
There was evidence of extensive transmission of group A Streptococcus both within households and across the community
Published research Infectious Diseases Group A Streptococcal & Rheumatic Heart DiseaseJanuary 2016The inequitable burden of group A streptococcal diseases in Indigenous Australians
Given the ongoing mortality and morbidity from GAS infections, we must address more effectively the treatment and prevention of GAS impetigo and pharyngitis
Published research Skin Infections Group A Streptococcal & Rheumatic Heart DiseaseDecember 2014The microbiology of impetigo in Indigenous children
Prevalence and antimicrobial resistance of impetigo pathogens in a randomised, controlled trial of impetigo treatment conducted in remote Indigenous communities
Published research Skin Infections Infectious Diseases Group A Streptococcal & Rheumatic Heart DiseaseNovember 2014Standardising and assessing digital images for use in clinical trials: A practical, reproducible method that blinds the assessor to treatment allocation
We describe the development and evaluation of a protocol for digital image collection by the non-professional photographer in a remote setting research trial
Published research Group A Streptococcal & Rheumatic Heart DiseaseAugust 2014Short-course oral co-trimoxazole versus intramuscular benzathine benzylpenicillin for impetigo in a highly endemic region
The major burden of disease is in developing and tropical settings where topical antibiotics are impractical and lead to rapid emergence of antimicrobial...
Published research Aboriginal Health Group A Streptococcal & Rheumatic Heart DiseaseJune 2014Nitazoxanide for the treatment of infectious diarrhoea in the Northern Territory, Australia 2007-2012
This paper examines the use of a new antibiotic to treat diarrhoea cause by Cryptosporidium infection in Australian Indigenous children.
Published research Aboriginal Health Infectious Disease Implementation Research Group A Streptococcal & Rheumatic Heart DiseaseApril 2013Comparison of three methods for the recovery of skin pathogens from impetigo swabs collected in a remote community of Northern Territory, Australia
Immediate plating of impetigo swabs is the gold standard for bacterial recovery but is rarely feasible in remote regions.
Published research Infectious Diseases Group A Streptococcal & Rheumatic Heart Disease