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Journal articleBarnsley G, Olivera Mesa D, Hogan A, et al., 2024,
Impact of the 100 days mission for vaccines on COVID-19: a mathematical modelling study
, The Lancet Global Health, Vol: 12, Pages: e1764-e1774, ISSN: 2214-109XBackgroundThe COVID-19 pandemic has underscored the beneficial impact of vaccines. It alsohighlighted the need for future investments to expedite an equitable vaccine distribution.The 100 Days Mission aims to develop and make available a new vaccine against a futurepathogen with pandemic potential within 100 days of that pathogen threat beingrecognised. We assessed the value of this mission by estimating the impact that it couldhave had on the COVID-19 pandemic.MethodsUsing a previously published model of SARS-CoV-2 transmission dynamics fit to excessmortality during the COVID-19 pandemic, we projected scenarios for three differentinvestment strategies: rapid development and manufacture of a vaccine, increasingmanufacturing capacity to eliminate supply constraints, and strengthening health systems toenable faster vaccine roll-outs and global equity. Each scenario was compared against theobserved COVID-19 pandemic to estimate the public health and health-economic impactsof each scenario.FindingsIf countries implemented non-pharmaceutical interventions (NPIs) as they did historically,the 100 Days Mission could have averted an estimated 8.33 million (95% credible interval7.70 – 8.68 million) deaths globally, mostly in low-middle income countries. Thiscorresponds to a monetary saving of $14.35 trillion (95% CrI $12.96 – $17.87) based on thevalue of statistical life years saved. Investment in manufacturing and health systems furtherincreases deaths averted to 11.01 million (95% CrI 10.60 – 11.49 million). Under analternative scenario whereby NPIs are lifted earlier based on vaccine coverage, the 100Days Mission alone could have reduced restrictions by 12,600 (95% CrI 12,300 – 13,100)days globally whilst still averting 5.76 million (95% CrI 4.91 – 6.81 million) deaths.InterpretationOur findings demonstrate the value of the 100 Days Mission and how these can beamplified through improvements in manufacturing and health systems equity. However,t
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Journal articlePates K, Shang Z, Jabbar R, et al., 2024,
The effects of COVID-19 on antifungal prescribing in the UK – lessons to learn
, Journal of Fungi, Vol: 10, ISSN: 2309-608XFungal infections are increasingly prevalent; however, antifungal stewardship attracts little funding or attention. Previous studies have shown that knowledge of guidelines and scientific evidence regarding antifungals is poor, leading to prescribing based on personal experiences and the inherent biases this entails. We carried out a retrospective study of inpatient antifungal usage at two major hospitals. We assessed the longitudinal trends in antifungal usage and the effect of COVID-19 on antifungal prescription, alongside levels of empirical and diagnostically targeted antifungal usage. Our results showed that the longitudinal patterns of total systemic antifungal usage within the trusts were similar to national prescribing trends; however, the composition of antifungals varied considerably, even when looking exclusively at the more homogenous group of COVID-19 patients. We showed a high level of empirical antifungal use in COVID-19 patients, with neither trust adhering to international recommendations and instead appearing to follow prior prescribing habits. This study highlights the significant challenges to optimise antifungal use with prescribing behaviour largely dictated by habit, a lack of adherence to guidelines, and high rates of empirical non-diagnostic-based prescribing. Further research and resources are required to understand the impact of antifungal stewardship on improving antifungal prescribing behaviours in this setting and the effects on outcome.
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Journal articleTrickey A, Ambia J, Glaubius R, et al., 2024,
Excess mortality attributable to AIDS among people living with HIV in high‐income countries: a systematic review and meta‐analysis
, Journal of the International AIDS Society, Vol: 27, ISSN: 1758-2652IntroductionIdentifying strategies to further reduce AIDS-related mortality requires accurate estimates of the extent to which mortality among people living with HIV (PLHIV) is due to AIDS-related or non-AIDS-related causes. Existing approaches to estimating AIDS-related mortality have quantified AIDS-related mortality as total mortality among PLHIV in excess of age- and sex-matched mortality in populations without HIV. However, recent evidence suggests that, with high antiretroviral therapy (ART) coverage, a growing proportion of excess mortality among PLHIV is non-AIDS-related.MethodsWe searched Embase on 22/09/2023 for English language studies that contained data on AIDS-related mortality rates among adult PLHIV and age-matched comparator all-cause mortality rates among people without HIV. We extracted data on the number and rates of all-cause and AIDS-related deaths, demographics, ART use and AIDS-related mortality definitions. We calculated the proportion of excess mortality among PLHIV that is AIDS-related. The proportion of excess mortality due to AIDS was pooled using random-effects meta-analysis.ResultsOf 4485 studies identified by the initial search, eight were eligible, all from high-income settings: five from Europe, one from Canada, one from Japan and one from South Korea. No studies reported on mortality among only untreated PLHIV. One study included only PLHIV on ART. In all studies, most PLHIV were on ART by the end of follow-up. Overall, 1,331,742 person-years and 17,471 deaths were included from PLHIV, a mortality rate of 13.1 per 1000 person-years. Of these deaths, 7721 (44%) were AIDS-related, an overall AIDS-related mortality rate of 5.8 per 1000 person-years. The mean overall mortality rate among the general population was 2.8 (95% CI: 1.8–4.0) per 1000 person-years. The meta-analysed percentage of excess mortality that was AIDS-related was 53% (95% CI: 45–61%); 52% (43–60%) in Western and Central Europe and North America, and
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Journal articleBajaj S, Chen S, Creswell R, et al., 2024,
COVID-19 testing and reporting behaviours in England across different sociodemographic groups: a population- based study using testing data and data from community prevalence surveillance surveys
, LANCET DIGITAL HEALTH, Vol: 6, Pages: e778-e790 -
Journal articleJaggi TK, Agarwal R, Tiew PY, et al., 2024,
Fungal lung disease.
, Eur Respir J, Vol: 64Fungal lung disease encompasses a wide spectrum of organisms and associated clinical conditions, presenting a significant global health challenge. The type and severity of disease are determined by underlying host immunity and infecting fungal strain. The most common group of diseases are associated with the filamentous fungus Aspergillus species and include allergic bronchopulmonary aspergillosis, sensitisation, aspergilloma and chronic and invasive pulmonary aspergillosis. Fungal lung disease remains epidemiologically heterogenous and is influenced by geography, environment and host comorbidities. Diagnostic modalities continue to evolve and now include novel molecular assays and biomarkers; however, persisting challenges include achieving rapid and accurate diagnosis, particularly in resource-limited settings, and in differentiating fungal infection from other pulmonary conditions. Treatment strategies for fungal lung diseases rely mainly on antifungal agents but the emergence of drug-resistant strains poses a substantial global threat and adds complexity to existing therapeutic challenges. Emerging antifungal agents and increasing insight into the lung mycobiome may offer fresh and personalised approaches to diagnosis and treatment. Innovative methodologies are required to mitigate drug resistance and the adverse effects of treatment. This state-of-the-art review describes the current landscape of fungal lung disease, highlighting key clinical insights, current challenges and emerging approaches for its diagnosis and treatment.
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Journal articleHay JA, Zhu H, Jiang CQ, et al., 2024,
Reconstructed influenza A/H3N2 infection histories reveal variation in incidence and antibody dynamics over the life course
, PLOS BIOLOGY, Vol: 22, ISSN: 1544-9173 -
Journal articleSovi A, Adoha CJ, Yovogan B, et al., 2024,
The effect of next-generation, dual-active-ingredient, long-lasting insecticidal net deployment on insecticide resistance in malaria vectors in Benin: results of a 3-year, three-arm, cluster-randomised, controlled trial
, The Lancet Planetary Health, Vol: 8, Pages: e894-e905, ISSN: 2542-5196BackgroundInsecticide resistance among malaria vector species now occurs in 84 malaria-endemic countries and territories worldwide. Novel vector-control interventions, including long-lasting insecticidal nets (LLINs) that incorporate new active ingredients with distinct modes of action, are urgently needed to delay the evolution and spread of resistance and to alleviate reversals in malaria-control gains. We aimed to assess the longitudinal effect of two dual-active-ingredient LLINs on insecticide resistance during a cluster-randomised, controlled trial in Benin.MethodsThis 3-year, three-arm, cluster-randomised, controlled trial was conducted between Oct 17, 2019, and Oct 24, 2022, in three districts in southern Benin, to compare the effects of LLINs containing chlorfenapyr–pyrethroid or pyriproxyfen–pyrethroid with LLINs containing pyrethroid only. In 19 292 mosquitoes (Anopheles gambiae sensu lato) collected over 36 months—3 months of baseline followed by 3 years post-intervention—we measured longitudinal phenotypic insecticide resistance profiles using bioassays and genotypic resistance profiles using quantitative, real-time, reverse transcriptase PCR of metabolic resistance genes in two clusters per trial group. The trial was registered with ClinicalTrials.gov, NCT03931473.FindingsIn all three trial groups, a significant effect of LLINs on insecticide resistance selection was evident, with the median lethal dose (LD50) of α-cypermethrin approximately halving between baseline and 12 months post-LLIN distribution (pyrethroid-only LLIN cluster 21: LD50 78·78 μg/ml [95% CI 65·75–94·48] vs 35·93 [29·41–43.86] and cluster 31: 79·26 [65·40–96·44] vs 38·71 [30·88–48·53]; chlorfenapyr–pyrethroid LLIN cluster 43: 104·30 [82·97–133·58] vs 43·99 [35·30–54·86]; and pyriproxyfen–
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Journal articleCharniga K, Park SW, Akhmetzhanov AR, et al., 2024,
Best practices for estimating and reporting epidemiological delay distributions of infectious diseases
, PLoS Computational Biology, Vol: 20, ISSN: 1553-734XEpidemiological delays are key quantities that inform public health policy and clinical practice. They are used as inputs for mathematical and statistical models, which in turn can guide control strategies. In recent work, we found that censoring, right truncation, and dynamical bias were rarely addressed correctly when estimating delays and that these biases were large enough to have knock-on impacts across a large number of use cases. Here, we formulate a checklist of best practices for estimating and reporting epidemiological delays. We also provide a flowchart to guide practitioners based on their data. Our examples are focused on the incubation period and serial interval due to their importance in outbreak response and modeling, but our recommendations are applicable to other delays. The recommendations, which are based on the literature and our experience estimating epidemiological delay distributions during outbreak responses, can help improve the robustness and utility of reported estimates and provide guidance for the evaluation of estimates for downstream use in transmission models or other analyses.
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Journal articleBouverat C, Badjie J, Samateh T, et al., 2024,
Integrating observational and modelled data to advance the understanding of heat stress effects on pregnant subsistence farmers in the gambia.
, Sci Rep, Vol: 14Studies on the effect of heat stress on pregnant women are scarce, particularly in highly vulnerable populations. To support the risk assessment of pregnant subsistence farmers in the West Kiang district, The Gambia we conducted a study on the pathophysiological effects of extreme heat stress and assessed the applicability of heat stress indices. From ERA5 climate reanalysis we added location-specific modelled solar radiation to datasets of a previous observational cohort study involving on-site measurements of 92 women working in the heat. Associations between physiological and environmental variables were assessed through Pearson correlation coefficient analysis, mixed effect linear models with random intercepts per participant and confirmatory composite analysis. We found Pearson correlations between r-values of 0 and 0.54, as well as independent effects of environmental variables on skin- and tympanic temperature, but not on heart rate, within a confidence interval of 98%. Pregnant women experienced stronger pathophysiological effects from heat stress in their third rather than in their second trimester. Environmental heat stress significantly altered maternal heat strain, particularly under humid conditions above a 50% relative humidity threshold, demonstrating interactive effects. Based on our results, we recommend including heat stress indices (e.g. UTCI or WBGT) in local heat-health warning systems.
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OtherDelgado Vela J, Philo SE, Brown J, et al., 2024,
Moving beyond Wastewater: Perspectives on Environmental Surveillance of Infectious Diseases for Public Health Action in Low-Resource Settings.
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