By Ian Gust and Margery Kennett
June 15, 2020 — 1.31pm
Noreen Lehmann 1932-2020
Noreen Lehmann, the most senior of a group of talented women who made the Fairfield Hospital virus laboratory a powerhouse in the 1970s and 1980s, has died in Ballarat. Her lifetime and career spanned modern clinical virology from the isolation of the influenza virus to the current pandemic.
The second of four daughters from a wheat farming family in the Wimmera, Noreen was schooled in Horsham and, after completing year 12, worked as a technician in the pathology department of the Wimmera Base Hospital, where her supervisor, recognising her talent, suggested she go to university, which she did.
After graduating in science from the University of Melbourne in 1957 she was recruited by Allan Ferris, head of the pathology laboratory at Fairfield Infectious Diseases Hospital, to join Fred Lewis and Merren Nelson in the epidemiological research unit, which had been recently established to study the role of virus infections in the community.
Although infections were common and the wards of the hospital contained many patients with these diseases, the techniques for establishing a diagnosis were slow and while the data generated was of interest to epidemiologists and public health workers, it was rarely of help to the patient or their physician.
As there was no commercial incentive for industry, in the 1960s and 1970s much of the equipment and most of the reagents used in virology laboratories was fabricated or developed in house.
Infections were confirmed by obtaining a throat swab or sample of cerebrospinal fluid or faeces from the patient and isolating the causative agent in cell culture or embryonated eggs or demonstrating a rising titre of antibodies in serum samples collected 10-14 days apart.
Preparing and maintaining cell cultures from the kidneys of monkeys which had been used by CSL for production and testing of the Salk polio vaccine, human kidneys removed during surgery or amniotic cells from discarded placentas and maintaining their viability for weeks, in media containing foetal calf serum collected from local abattoirs was not for the squeamish and was part science and part art. It favoured those with green fingers of which Noreen was one. Her skills in inoculating the amniotic and allantoic cavities or chorioallantoic membrane of embryonated eggs, establishing various cell types in culture and coaxing difficult viruses to grown, were legendary.
In the 1960s together with Fred Lewis and Margery Kennett, she was responsible for isolating a wide range of respiratory and enteric viruses as well as the viruses responsible for many of the infectious rashes of childhood and studying their relevance both in hospitalised patients and children in the community followed prospectively.
She was the first person in Australia to isolate rubella virus in cell culture and to establish a sensitive assay for antibodies. Because of the serious effects that rubella infection could have on the unborn foetus, this assay became widely used for screening pregnant women and for diagnosing suspicious rashes, creating a new market for industry.
As the number of suppliers proliferated and the tests begun to be performed in general laboratories, sometimes by people without specialist training, concerns arose about the reliability of the results being generated.
With the help of Joc Forsyth, of the microbiological diagnostic unit at the University of Melbourne, Noreen assembled a panel of sera which was distributed, under code, to every laboratory in Victoria performing the test.
When the results were analysed they showed a wide discrepancy in the sensitivity and specificity of the assays being employed and considerable variations in the results being reported by different laboratories. This led to certain assays being preferred and a demand for regular quality assurance panels, which Noreen’s laboratory provided for many years.
In 1974 when a severe outbreak of Murray Valley encephalitis occurred in northern Victoria, killing several people and leaving many others severely damaged, Noreen was able to confirm the diagnosis by isolating the virus in embryonated eggs.
Despite these achievements Noreen’s most important contribution was probably in the field of viral hepatitis. In the early 1970s when Ron Lucas, Ian Gust and Jacov Kaldor began their studies of the epidemiology and natural history of these diseases using sera collected from the hundreds of patients admitted to Fairfield every year, the techniques available for detecting viral antigens and antibodies were relatively crude and insensitive.
Impressed by the impact that radioimmunoassays were having in the management of patients with endocrinological disease, with the help of Colin Johnson’s team at Prince Henry’s Hospital, Noreen developed a radio immunoprecipitation assay for hepatitis B antibodies which enabled the group to study the epidemiology, mode of spread and natural history of this infection in Australia, South-East Asia and the western Pacific. Later, the same approach was used for detection of total and class specific antibodies to hepatitis A with similar outcomes.
Perhaps her most lasting achievement came about by coincidence. When Ian Gust undertook a sabbatical year at the National Institutes of Health in 1976 he asked Noreen to select faecal samples from patients with community acquired HA that could be used to infect marmosets to determine whether there were any differences in Australian and American strains of the virus.
Noreen chose samples from a family outbreak in an unsewered outer suburb. By chance one of these contained a high titre of virus which enabled the NIH team to isolate the virus in cell culture, attenuate it by repeated passage and characterise the molecular basis for the attenuation. After demonstrating that the attenuated virus could protect marmosets and chimpanzees against challenge with wild HAV, NIH licensed the strain to Glaxo Smith Kline where it became the basis of the world’s first licensed hepatitis A vaccine, which has been now administered to hundreds of millions of people with dramatic effect.
Although often prickly, Noreen was a generous mentor to two generations of scientists and physicians, who both respected and were terrified of her. Known as Auntie Nor and having no family of her own, Noreen was particularly generous to young colleagues especially those coming from overseas or interstate for whom she supplied encouragement, the use of her home in Reservoir and later Research, sometimes supporting them financially until they found their feet.
Noreen was a woman of considerable presence; tall, strongly built with a farmer’s hands, a no-nonsense attitude and a formidable temper when aroused. She lived through an exciting period, which saw her clinical virology evolve from a cottage industry to a mainstream discipline and many of diseases which were scourges in her youth, brought under control, leading eventually to the closure of the institution in which she spent her entire career.
She saw the tiny group that she joined in 1958 become a major enterprise, spawn not only the virology section of the Victorian Infectious Diseases Reference Laboratory, several WHO collaborating centres, the Burnet Institute and the National Aids Reference Laboratory.
After her retirement she returned to the Wimmera, where she continued to pursue her passions for gardening and handicrafts.
Her passing marks the end of an era. We will not see her like again.
Ian Gust and Margery Kennett were friends and colleagues.
Disclosure: Smita Nair Jain has nothing to disclose. She doesn’t own stock in any publicly traded companies and does not hold investments in the technology companies. She has equivalent of the American 401(k) plan in India that is automatically managed. (Updated: July 13, 2020)
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