Long term clinical, biomedical and public health activities related to healthy skin. The following themes form the “Filling the Gaps” (FTG) project, which builds on this solid background and expands on existing work, aiming to address several significant knowledge gaps that are potential barriers to the effectiveness and sustainability of community-based healthy skin interventions.

Theme (i)       Scabies resistance and the immunology of infection
Theme (ii)      Determinants of persistent/recurrent scabies
Theme (iii)     Treatment of skin sores and the role of antibiotic resistance
Theme (iv)     Epidemiology of GAS isolates in East Arnhem and Queensland

The emergence of antibiotic resistance among skin bacteria and drug resistance among scabies mites are two issues likely to be major obstacles to the sustainability of community-based programs. Also of serious concern is the emergence in Australia of community-acquired methicillin resistant Staphylococcus aureus (CAMRSA), which has increasingly been found to involve remote Indigenous communities. The FTG proposal will supplement activities aimed at ensuring effectiveness of a potential GAS vaccine that may eventually prevent skin disease from progressing to the more serious illnesses of rheumatic fever, rheumatic heart disease and streptococcal kidney disease.

The primary objectives of the FTG project are:

• Better understanding of the types of bacteria that cause skin infections in Aboriginal communities in the Northern Territory and Queensland and whether these will be preventable by a vaccine currently under development at Queensland Institute of Medical Research.
• Better understanding of how bacteria and scabies mites develop resistance to treatments and identification of alternative therapies.
• Consolidation of evidence about the causes and associated risk factors for persistent and recurrent scabies infestations.
• Identification of the mechanism of the allergic reaction responsible for many of the manifestations of scabies infestation.