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The Kids Research Institute: Perth team leading the world in vaccine for lethal Strep A infection

When Professor Jonathan Carapetis says Strep A is the “nastiest bug you’ve never heard of”, he’s not kidding. It’s the fifth most lethal pathogen in the world and causes a mild sore throat for most people — but for others the consequences can be life-altering, even fatal. “People don’t know it because it causes such a broad range of disease,” Professor Carapetis said. “We’re trying to get people to focus on the bug ‘Strep A’, because up until now we’ve talked about rheumatic heart disease, we’ve talked about sepsis, we’ve talked about sore throat. “It’s hard for people to recognise this is all one big thing. It’s all caused by the strep. “If we can get a vaccine . . . it’s going to have so many benefits in all these different areas.” What people also don’t know, is that Perth is leading the world in developing such a vaccine at The Kids Research Institute Australia. And they are as few as five years from achieving it, with the first clinical trials slated for June. Officially known as Group A Streptococcus or Streptococcus pyogenes, the microscopic bacterium with more than 200 strains causes sore throat or school sores. It’s easily spread — especially between kids — through contact with an infected person, usually droplets from coughing or sneezing, or touching contaminated surfaces and then touching the mouth or nose. What makes Strep A so dangerous is when it breaks through the body’s defences. “It can break through the defences locally and cause infection of the skin called cellulitis . . . it’s one of the main reasons for adults to present to the emergency department,” Professor Carapetis said. “But then it can break through even further and get into your bloodstream, and that’s where it can cause the really nasty infections.” It can trigger a harmful, flesh-eating disease or turn into sepsis. One of the best-known cases of sepsis in Perth is the preventable death of seven-year-old Aishwarya Aswath in 2021, but few know it was triggered by Strep A. The bug can also release toxins, causing Scarlet Fever or toxic shock syndrome, which damages the organs and can cause death within hours. “Scarlet Fever, which we all know from the Dickensian era — it’s still out there. It’s back. It’s actually going through a resurgence over the last couple of years, and that’s caused by strep throat releasing toxins,” Professor Carapetis said. But this nasty bug can be troublesome long-term, too. Strep A can cause the body’s immune system to mistakenly attack itself, like the heart, leading to acute rheumatic fever and eventually rheumatic heart disease, an autoimmune disease. It’s an issue that disproportionately affects Aboriginal and Torres Strait Islander children, who remain 55 times more likely to die from RHD than other Australian children. But it wasn’t long ago Australia was dealing with a nationwide rheumatic fever problem. Former Prime Minister Kevin Rudd rocks an artificial heart valve after contracting rheumatic fever as a child. He was later diagnosed with RHD, prompting an aortic valve replacement in 1993 and again in 2011 when he was foreign affairs minister in the Gillard government. Vaccine development has largely been hindered by technical difficulty, but also one controversial trial in the United States that saw the Food and Drug Administration slap a ban on Strep A vaccines in 1979, which wasn’t lifted until 2005. The legacy of that ban has proven a major barrier to investment, so Professor Carapetis and his colleagues at The Kids Research Institute Australia and the Murdoch Children’s Research Institute in Melbourne sought to “de-risk” early development. Enter the Australian Strep A Vaccine Initiative, or ASAVI. “What we are doing is working on all the vaccines that have been developed around the world. We’ve gone and checked them all out, we’ve talked to them, we’ve looked at their data,” Professor Carapetis said. “We’ve got a group of international experts advising us, and we’ve identified three leading vaccine candidates.” ASAVI is also guided by the expertise of its Indigenous advisory board, co-led by National Aboriginal Community Controlled Health Organisation chief executive Pat Turner and The Kids’ Professor of Indigenous Genomics Alex Brown. Working closely with vaccine developers, commercial and academic partners, Aboriginal community-controlled organisations, public health organisations and other global stakeholders, ASAVI is leading global efforts to fast-track a Strep A vaccine to first-stage trials. “We are on the verge of signing contracts, and expect that the first two vaccines will commence clinical trials in Australia in the next few months — the first time these vaccines have been given to people,” Professor Carapetis said. Those trials are slated for June and August, in Perth and Melbourne, for testing on adult volunteers. Trials of the third vaccine are earmarked for 2026. “We’ve developed the reference laboratory here at The Kids. We’ve got the gold standard laboratory to test the blood to look for the immune response,” Professor Carapetis said. “I’ve often said, the vaccine’s five to 10 years away. And I’ve been saying that for 30 years.” But his main concern isn’t whether ASAVI can develop a safe vaccine or attract the money to fund it. “I think our big challenge now is for people to care, to be aware of it,” he said. Suzanne and James Stuart care about Strep A more than they ever thought they would after their daughter Meredith ended up in intensive care in June 2024. What started as a mild fever resulted in a week at Perth Children’s Hospital and the terrifying prospect their little girl might not make it. Aged just five, Meredith had been struck down with invasive Strep A. James had taken Meredith to PCH ED when her fever wouldn’t go down and her eyes became puffy. She was admitted for monitoring overnight when her throat swab confirmed Strep A. “She seemed like she was getting a lot better,” James said. But her recovery took a nosedive when she had a seizure and became unconscious. “Suddenly the room was full of doctors and nurses and it was extremely stressful,” James said. “Talking to the doctor afterwards, I was like, is she going to live? Is she going to have brain damage? And his answer to both questions was ‘honestly, I don’t know.’” Meredith was transferred to intensive care, her parents besides themselves with worry and fear. “I spent most of that night huddled over her, begging her to wake up,” James said. “One of the really scary things about this whole event was she had seemed like she was getting better, and then she’d go significantly downhill, then she’d stabilise and she seemed like she might be starting to get better, and then she’d go downhill.” An infectious disease specialist was called in, who reviewed Meredith’s case, changed her antibiotics and sent her for a CT scan. Doctors told her anxious parents she needed surgery because the strep had gotten into her sinuses — and her bloodstream. Meredith had sepsis. “When you hear that word — that’s when there was a high degree of panic,” Suzanne said. “Then they put her in surgery that afternoon, and it was all very fast.” Post-sinus surgery with new antibiotics on board, Meredith began to improve rapidly. After two nights in ICU, she was transferred to a ward where she stayed another four days before being discharged. “It was amazing, she was so sick and she just bounced back. I was the one that was not okay,” Suzanne said. “If she hadn’t got the puffy eye, I probably would have put her into bed. And I don’t know if she’d had that seizure in the bed, would I have noticed? I would have woken up to an unresponsive child.” James said the ordeal had “scarred” them. “From the point she had the seizure to the point she had the sinus surgery, we barely slept. It was so scary,” he said. “We were struggling to comprehend what was going on.” Suzanne said a vaccine would go a long way toward eliminating that fear of recurrence. “We’re different people now,” Suzanne said. “But hopefully if (Meredith) ever has kids, there’ll be a vaccine for that.” The team at ASAVI is striving towards a future without Strep A, a future where little girls like Meredith will be protected from traumatic, near-death experiences. “Our aim is in 10 to 20 years’ time, people don’t have to worry about strep,” Professor Carapetis said. “And there are bugs out there that people don’t have to worry about anymore because we’ve really developed vaccines, we’ve got comprehensive approaches to them. “I want strep to be in that category.”

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The Kids Research Institute: Perth team leading the world in vaccine for lethal Strep A infection

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The Kids Research Institute: Perth team leading the world in vaccine for lethal Strep A infection