Dr Irani Thevarajan, an Infectious Diseases Physician with the Royal Melbourne Hospital’s Victorian Infectious Diseases Service, was having a coffee with former colleague, Professor Cameron Simmons, when the Zika virus was fast becoming an epidemic in South America in 2015.
“I said to him, it’s such a shame that we’re here at the Doherty Institute where we have access to all of these specialist departments, but if a Zika case presented in the hospital tomorrow, we can’t do any real-time research because we have to wait for ethics and protocols,” recalls Dr Thevarajan.
“He said, why don’t we establish a protocol now so when the next disease comes through the doors, we’re ready to go?”
And that they did. Dr Thevarajan is the Lead Investigator for SETREP-ID (Sentinel Travellers and Research Preparedness for Emerging Infectious Diseases), a platform that enables a broad range of biological sampling in returned travellers who might present with a new disease, whether it be a respiratory infection, an undifferentiated fever or encephalitis.
“The protocol has been approved at the Royal Melbourne Hospital for two years now at what we call a `low-disease transmission phase’, but it’s designed to upscale to `emerging infection phase’ if need be,” explains Dr Thevarajan.
“So if a patient with an unknown new infectious disease walks in the door tomorrow, we can upscale and do fairly intense sampling and convene a committee of experts from across the Institute and work out what research we need to do for the patient and community at large.”
A first for Australia, the framework is currently expanding to the Austin Hospital, with further plans to roll it out across other acute care hospitals in Victoria in the near future.
Dr Thevarajan says the relationships she and her fellow physicians have forged with scientists and researchers across the Doherty Institute have been extremely beneficial to clinical practice and for generating new research ventures.
“We’re constantly using the transit of knowledge between the two. Research becomes really important and might take us to another level,” she says.
In 2018, a returned traveller from Thailand presented to the emergency department at the Royal Melbourne Hospital with encephalitis symptoms, including a fever, reduced conscious state and seizures. Routine tests failed to provide the clinicians with an answer.
“The clinician managing the patient spoke to a scientist from the Doherty Institute about what other testing was available,” explains Dr Thevarajan.
“The scientist suggested taking a urine sample to test for Japanese Encephalitis (JE), but said it was a pretty new way of diagnosing JE. And sure enough, the urine test was positive for JE.”
There is currently no treatment for this mosquito-borne illness, which in the case of this patient proved fatal.
“JE is endemic in parts of Asia, but for Aussies going on short trips to Bali and Thailand, we used to think the risk was minimal. But this case proved us wrong” explains Dr Thevarajan.