75th stories: Helen McShane and a new vaccine for tuberculosis

Dr Helen McShane is talking about the PhD students and postdocs she's supervised in her lab when she breaks off, mid-sentence. "An email has just pinged in," she says. "It reads: 'We have just vaccinated baby number 2784. That's it: we have completed enrolment.' That's really exciting!" The delight is clear in her voice. The study she's referring to is the largest infant trial of a tuberculosis vaccine to date, what's known as a phase IIb efficacy trial, being run in South Africa. The vaccine under investigation, MVA85A, is the most clinically advanced tuberculosis (TB) vaccine candidate for decades.

There is already a vaccine approved for TB, which has been in use since 1921, but it's not enough. Across the world, 5000 people die every day from TB. Every second, someone else becomes infected with the bacterium that causes the disease. Why has it taken 90 years to get this far with a new candidate vaccine and what role has McShane - a Wellcome Trust Senior Clinical Fellow and Reader in Vaccinology at the Nuffield Department of Clinical Medicine at the University of Oxford - played in the process?

It was 1992 when McShane, a newly qualified junior doctor, stepped on to ward 6 in Hove General Hospital, Brighton. This ward was for people diagnosed with an emerging infection that was sweeping through the gay population - human immunodeficiency virus (HIV). She describes a ward of very sick patients who died soon after admission. "When one patient died, another who was just as ill arrived to take their place," she said. "At that time, the only treatment for HIV/AIDS was treatment of infections and palliative care."

This stark introduction into the world of infectious diseases had a career-changing impact on the young medic, who - for reasons that with hindsight, she says, aren't completely clear - had always thought she'd be a GP.

A year in Oxford as a registrar in infectious diseases followed her time in Brighton, after which she "toyed with the idea of research" but decided that she wasn't ready. Her next job, as a registrar in HIV and genito-urinary medicine in London, gave her hands-on experience working with TB, as she learned how to use an endoscope to examine the upper airways and lungs of people who were HIV-positive and also had TB. People with HIV are over 20 times more likely to develop TB if infected with the bacterium responsible than people without HIV. The combination is lethal: TB is the biggest cause of death of people with HIV.

Australian immunisation history simple? Perhaps not… | Mum's gone ...

Last year Mum wrote about adding our children to the immunisation register in Australia , and completing their immunisation history forms. We said it was a straight forward process which was a relief when we first arrived and had so much else to do.

Until now we were unaware that there were problems with our the records. We have recently been informed that our sons immunisations aren’t up to date.

Chicken Pox

One of the differences we quickly discovered between the UK and Australian immunisation schedule is that in Australia they immunise against chicken pox. When we arrived we were encouraged to give our boys the jab straight away, and we did.

Hepatitis B

Another standard immunisation provided in Australia, that children aren’t given in the UK, is Hepatitis B. Our children had a dose of this before coming to Aus, because they travelled in Asia and it’s a recommended travel vaccine, but we recently learnt that they haven’t had enough Hep B doses to be up to date in Australia.

In Australia a Hepatitis B immunisation is given to children as soon as possible after birth, followed by three doses at either 2 months, 4 months, and 6 months; or 2 months, 4 months and 12 months.

Mum’s going to write about Family Assistance in Australia, and the Childcare Rebate , at a later date. It’s a pretty complex topic that parents moving to Aus need to know about, but because we haven’t made it through our claim yet we’re waiting until we can share details of the whole process.

Because we’ve lodged an application for the childcare rebate, Family Assiatnce checked our children’s immunisation records and wrote to us to say they weren’t up to date, and the childcare rebate claim doesn’t get processed until they are (or until you send a letter from your doctor explaining why they’re exempt).

Having received immunisation history forms from the Australian immunisation register telling us everything was in order, it was something of a surprise to be told they needed more jabs. The injections our children were missing were two doses of Hepatitis B. Both our boys had one jab in the UK, but for their ages, they should have had more.

Immunisation against infectious disease

Clin. Methods in Ped.

History of Vaccine Development

Paediatrics

Vaccine, the controversial story of medicine's greatest lifesaver