Associate Professor Asha Bowen

Clinical 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.

DETECT 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.

Molecular 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.

Meningococcal 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.

COVID-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.

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.

Primary prevention of acute rheumatic fever

Acute rheumatic fever (ARF) is an abnormal immune reaction following Streptococcus pyogenes (Strep A) infection of the throat, and likely the skin. Primary prevention is the prompt and appropriate antibiotic treatment of Strep A infection, and it can reduce the risk of developing ARF and subsequent rheumatic heart disease.

Increase 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.

Lessons learnt during the COVID-19 pandemic: Why Australian schools should be prioritised to stay open

In 2020, school and early childhood educational centre (ECEC) closures affected over 1.5 billion school-aged children globally as part of the COVID-19 pandemic response. Attendance at school and access to ECEC is critical to a child's learning, well-being and health. School closures increase inequities by disproportionately affecting vulnerable children. Here, we summarise the role of children and adolescents in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission and that of schools and ECECs in community transmission and describe the Australian experience.

An update on the burden of group A streptococcal diseases in Australia and vaccine development

Australia needs a prioritised national research strategy for clinical trials in a pandemic: lessons learned from COVID-19

The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), sparking a global pandemic, has driven an imperative to quickly design and conduct treatment studies. We strongly propose a national, coordinated approach for randomised controlled trials (RCTs) for coronavirus disease 2019 (COVID-19), future pandemics and inter-pandemic periods in Australia.

A Meta-analysis on the Role of Children in Severe Acute Respiratory Syndrome Coronavirus 2 in Household Transmission Clusters

The role of children in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains highly controversial. To address this issue, we performed a meta-analysis of the published literature on household SARS-CoV-2 transmission clusters (n = 213 from 12 countries). Only 8 (3.8%) transmission clusters were identified as having a pediatric index case.

Cellulitis in children: A retrospective single centre study from Australia

To characterise the epidemiology, clinical features and treatment of paediatric cellulitis. Methods A retrospective study of children presenting to a paediatric tertiary hospital in Western Australia, Australia in 2018.

The role of Kingella kingae in pre-school aged children with bone and joint infections

The Pre-school Osteoarticular Infection (POI) study aimed to describe the burden of disease, epidemiology, microbiology and treatment of acute osteoarticular infections (OAI) and the role of Kingella kingae in these infections.

Viridans Group Streptococci in Pediatric Leukemia and Stem Cell Transplant: Review of a Risk-stratified Guideline for Empiric Vancomycin in Febrile Neutropenia

Viridans group streptococci (VGS) are an important cause of sepsis in immunosuppressed children. We reviewed the effectiveness of risk-stratified addition of vancomycin to empiric febrile neutropenia therapy among 107 children with leukemia or undergoing an allogeneic transplant.

Incidence of acute rheumatic fever in northern and western Uganda: a prospective, population-based study

Acute rheumatic fever is infrequently diagnosed in sub-Saharan African countries despite the high prevalence of rheumatic heart disease. We aimed to determine the incidence of acute rheumatic fever in northern and western Uganda.

COVID-19 in children: I. Epidemiology, prevention and indirect impacts

Children globally have been profoundly impacted by the coronavirus disease 2019 (COVID-19) pandemic. This review explores the direct and indirect public health impacts of COVID-19 on children. We discuss in detail the transmission dynamics, vaccination strategies and, importantly, the ‘shadow pandemic’, encompassing underappreciated indirect impacts of the pandemic on children.

COVID-19 in children. II: Pathogenesis, disease spectrum and management

The global disruption of the COVID-19 pandemic has impacted the life of every child either directly or indirectly. This review explores the pathophysiology, immune response, clinical presentation and treatment of COVID-19 in children, summarising the most up-to-date data including recent developments regarding variants of concern.

Clinical care of children and adolescents with COVID-19: recommendations from the National COVID-19 Clinical Evidence Taskforce

The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID-19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome.

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials

Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19.

Performance 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.

A 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.

Ending 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.

The 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.

Planning 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.

Clinical 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.

Predicting 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

Antimicrobial 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.

Progress 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

Complicated skin and soft tissue infections in remote indigenous communities

The burden and consequences of skin infections for remote living indigenous people are high

Skin 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

Spotting sporotrichosis skin infection: The first Australian paediatric case series

These data highlight the importance of recognising Sporotrichosis in children outside an outbreak setting

Barriers 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

Prevalence 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%

Adjunctive 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

The 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

Potential 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

Treatment, 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

Burden 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

Pre-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

Infectious 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

CASSETTE-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

An 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

A 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

SToP (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

Talking 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

Perinatal 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

A 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

Investigation 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

Ascertaining 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

Infection 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

Scabies 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

Dedicated 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.

Are 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

Dedicated 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.

Immuno-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

A 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.

Hospital 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

Sulfamethoxazole-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

Hospital 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).

Epidemiology 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

Antibiotic 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

Impetigo 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

The 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

A 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

Whole 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

The 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

The 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

Standardising 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

Short-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...

Nitazoxanide 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.

Comparison 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.

Re-examining Hepatitis B Postexposure Prophylaxis Following Pediatric Community-acquired Needle-stick Injury in an Era of a National Immunization Registry

Long-term hepatitis B immunity has been demonstrated following the completion of the primary vaccination series in childhood. Some guidelines recommend a hepatitis B surface antibody (anti-HBs) directed approach following community-acquired needle-stick injury (CANSI) to inform hepatitis B postexposure prophylaxis (PEP) management.