New Zealand's hard-won Covid-19 lessons applied to RSV, flu

The two-year project, Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance V (SHIVERS-V), is led by the University of Auckland in collaboration with the Institute of Environmental Science and Research (ESR) and features genomic testing of viruses, the detective work which became routine during the Covid-19 pandemic.

Researchers will analyse thousands of swabs from patients with respiratory illnesses to discover how respiratory viruses enter and spread within Aotearoa. This will help scientists model outbreaks and, most importantly, help design strategies to prevent them.

New Zealand is uniquely suited to examine the re-introduction and transmission of respiratory viruses like influenza and RSV. The success of New Zealand’s Covid-19 measures has created a novel environment for this ambitious project, and its well-developed systems for tracking health data facilitate population-level research.

The current RSV epidemic is part of a respiratory-disease environment unlike any New Zealand has seen before. Sick children are filling hospital wards after Covid-19 social distancing and lockdown restrictions blocked the development of natural immunity to RSV. Scientists are also watching to see what happens next with influenza after Covid restrictions virtually eliminated the disease.

“As border restrictions are likely eased over the next two years, we will face a resurgence of respiratory viruses,” says Professor Nikki Turner, medical director of the University of Auckland’s Immunisation Advisory Centre (IMAC). “Understanding the viruses’ patterns will help us predict and mitigate outbreaks to help protect whānau and communities in this new post-Covid world.”

South Auckland is a focus of the research because of the social deprivation that exacerbates the spread of disease and the risk that the international airport will serve as a vector for disease transmission. Swabs of children at kohanga reo and early childhood learning centres will help to establish baseline rates of respiratory diseases.

Swab tests will also occur at doctors’ offices in Wellington and Auckland and the emergency department of Middlemore Hospital. People in managed isolation facilities will be tested for respiratory diseases additional to Covid-19.

Professor Turner and Professor Peter McIntyre, who is affiliated with both the Otago and Auckland universities, will helm the study. After leading previous SHIVERS projects starting in 2012 in Auckland and Wellington, Virologist Sue Huang of ESR will play a key role. “Expanding the SHIVERS programme with information from the impact of closed borders is an important next step in helping tackle the viruses in a post-Covid world,” says Dr Huang.

Epidemiologic, clinical, and genomic information will be combined in the same way ESR tracks Covid-19 outbreaks. The University of Auckland’s Professor Shaun Hendy, known for his Covid-19 modelling, will do similar work for this new project.

The SHIVERS-V research will cover:

• The impact of border closures and lockdowns on respiratory virus transmission
• The influence of travel on the spread of influenza, RSV, and other respiratory viruses
• The capability to forecast how respiratory viruses behave in future winter seasons
• How a year of minimal exposure to respiratory viruses affected subsequent transmission and disease among preschool children

University of Otago evolutionary virologist Dr Jemma Geoghegan and Dr Joep de Ligt of ESR will genetically type viruses. Associate Professor Cass Byrnes of the University of Auckland, and Dr Adrian Trenholme, a pediatrician at Middlemore Hospital, will track the severity of respiratory infections in young children.

“This is crucial work,” says Professor Turner. “The RSV epidemic is particularly concerning because of its impact on those who are most vulnerable: our tamariki, our elderly, those with significant medical problems, those in poor housing, and particularly for our Māori and Pacific communities.”

This project is funded by the U.S.-based Flu Lab, which envisions a world free from the dangers of influenza. To achieve this, Flu Lab seeks out high-impact opportunities and makes grants and investments to create actionable knowledge and advance solutions to pressing influenza challenges. It is funding the project through UniServices, a wholly-owned company of the University of Auckland focusing on knowledge transfer and research commercialisation. Previous SHIVERS work in New Zealand was funded by the U.S. government.