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Journal articleRitchie AJ, Meeyai A, Trotter C, et al., 2025,
Routine childhood rabies pre-exposure prophylaxis can be cost effective in low- and middle-income countries.
, Vaccine, Vol: 47BACKGROUND: Pre-exposure prophylactic rabies vaccination (PrEP) is advised for travellers to countries with high rabies incidence, but rarely available for local residents. Some studies suggest poor cost-effectiveness of PrEP in such settings, but have generally focused upon post-exposure prophylaxis (PEP) cost savings as the main benefit of PrEP, without considering lives saved by PrEP efficacy. METHODS: We compared incremental cost-effectiveness ratios (ICERs) of use of rabies PrEP, against an alternative of using only PEP, by adapting a decision-tree model previously used to inform Gavi's investment in rabies PEP. We consider scenarios including: a range of PrEP efficacies in individuals unable to access PEP; PrEP costs significantly below current prices (through single-dose approaches, inclusion in childhood vaccination schedules, increased manufacturing volume and/or new low-cost products); and variable rabies exposure risk and PEP access. We also present results from a simplified model, designed for ease of understanding. RESULTS: Modelled ICERs were <1000 USD per quality adjusted life year (QALY) across a range of plausible combinations of rabies exposure risk, PEP access, PrEP cost and PrEP efficacy. If PrEP efficacy exceeds 50 % over 15 years, we estimate ICERs <500 USD/QALY where rabies incidence ≥3 per 100,000 per year and cost of vaccination is ≤5 USD/child. Under scenarios with lower rabies incidence of around 0.3 per 100,000 per year, due either to more limited exposure or greater access to PEP, ICERs <3000 USD may still be achieved even if PrEP efficacy is as low as 30 %. CONCLUSIONS: Routine childhood PrEP may be cost-effective in settings with modest willingness-to-pay, and rabies exposure risks plausible across much of Africa and South Asia. Cost-effectiveness requires low-cost PrEP regimes and some efficacy of PrEP in individuals unable to access PEP. Under such conditions, PrEP may be an attractive additional to
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Journal articleWan Y, Pike R, Harley A, et al., 2025,
Complete genome assemblies and antibiograms of 22 Staphylococcus capitis isolates
, BMC Genomic Data, Vol: 26, ISSN: 2730-6844Objective:Staphylococcus capitis is part of the human microbiome and an opportunistic pathogen known to cause catheter-associated bacteraemia, prosthetic joint infections, skin and wound infections, among others. Detection of S. capitis in normally sterile body sites saw an increase over the last decade in England, where a multidrug-resistant clone, NRCS-A, was widely identified in blood samples from infants in neonatal intensive care units. To address a lack of complete genomes and antibiograms of S. capitis in public databases, we performed long- and short-read whole-genome sequencing, hybrid genome assembly, and antimicrobial susceptibility testing of 22 diverse isolates.Data description:We present complete genome assemblies of two S. capitis type strains (subspecies capitis: DSM 20326; subspecies urealyticus: DSM 6717) and 20 clinical isolates (NRCS-A: 10) from England. Each genome is accompanied by minimum inhibitory concentrations of 13 antimicrobials including vancomycin, teicoplanin, daptomycin, linezolid, and clindamycin. These 22 genomes were 2.4–2.7 Mbp in length and had a GC content of 33%. Plasmids were identified in 20 isolates. Resistance to teicoplanin, daptomycin, gentamicin, fusidic acid, rifampicin, ciprofloxacin, clindamycin, and erythromycin was seen in 1–10 isolates. Our data are a resource for future studies on genomics, evolution, and antimicrobial resistance of S. capitis.
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Journal articleLiyew EF, Tollera G, Mengistu B, et al., 2025,
Small bowel obstruction due to ascariasis in a child from southern Ethiopia: a case report.
, J Med Case Rep, Vol: 19BACKGROUND: Ascariasis, caused by the parasitic nematode Ascaris lumbricoides, is estimated to affect just under 900 million people globally, the majority of whom are children. Infections are most common in impoverished regions with poor water, sanitation, and hygiene, as transmission is reliant upon the ingestion of eggs excreted in feces found in contaminated soil. CASE PRESENTATION: An 8-year-old Black African boy from the Sidama region, southern Ethiopia, presented at Adare General Hospital with a 3-day history of vomiting, abdominal pain, distension, and inability to pass stool or gas. Ultrasound confirmed a small bowel obstruction caused by a bolus of A. lumbricoides, which was successfully removed by surgical intervention via laparotomy and enterotomy. Postoperative treatment included the administration of anthelmintics and antibiotics, which led to stable recovery, with normal bowel function observed 1 month after surgery. The child's socioeconomic status, environmental conditions, and lack of knowledge about ascariasis transmission likely contributed to this severe infection, leading to the occurrence of the small bowel obstruction. Critically, his family lacked sanitation facilities, practiced open defecation, and consumed untreated surface water. The family did not participate in recent mass drug administration campaigns and had poor awareness of hygiene practices, highlighting gaps in the current national neglected tropical disease control program and deficiencies in public health education. CONCLUSION: Despite Ethiopia's national deworming program being in existence since 2015, the lack of adequate water, sanitation, and hygiene infrastructure and awareness of risk-reducing behaviors, including participation in mass drug administration campaigns, has culminated in the continuation of A. lumbricoides transmission in many communities in Ethiopia. Enhanced mass drug administration coverage and robust water, sanitation, and hygiene interventions are the maj
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Journal articleVaraden D, Barratt B, Dallman MJ, et al., 2025,
West London Healthy Home and Environment (WellHome) Study: Protocol for a Community-Based Study Investigating Exposures Across the Indoor-Outdoor Air Pollution Continuum in Urban Communities.
, Int J Environ Res Public Health, Vol: 22The relationship between indoor air quality and public health remains under-researched. WellHome is a transdisciplinary community-based study that will engage with residents to co-design feasible and acceptable research to quantify air pollution exposure in 100 homes in West London and examine its potential to exacerbate asthma symptoms in children. Sampling strategies such as using air quality monitors and passive samplers placed in kitchens, children's bedrooms, and living rooms, will be developed in collaboration with local ambassadors and participating households to measure multiple physical, chemical, microplastic, and biological contaminants. This will provide a comprehensive understanding of indoor air quality across the city's socio-economic gradient. Other data collected will include housing types and tenure, ventilation practices, occupant behaviours, time-activity, and airway symptoms. Epidemiological analysis will examine air pollution exposure impacts on children's respiratory health. The particulate mixture's relative hazard will be evaluated in toxicity studies based on source profiles and activity patterns of participants, focusing on asthma exacerbation related pathways. The study's findings will be communicated to participants through co-designed reports and inform evidence-based recommendations for reducing indoor air pollution in London and urban areas worldwide. By raising awareness and providing actionable insights, WellHome seeks to contribute to global efforts to improve the health and well-being of vulnerable communities.
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Journal articleAnderson P, Aranas E, Assaf Y, et al., 2025,
Project Silica: Towards Sustainable Cloud Archival Storage in Glass
, ACM Transactions on Storage, Vol: 21, ISSN: 1553-3077Sustainable and cost-effective long-term storage remains an unsolved problem. The most widely used storage technologies today are magnetic (hard disk drives and tape). They use media that degrades over time and has a limited lifetime, which leads to inefficient, wasteful, and costly solutions for long-lived data. This article presents Silica: the first cloud storage system for archival data underpinned by quartz glass, an extremely resilient media that allows data to be left in situ indefinitely. The hardware and software of Silica have been co-designed and co-optimized from the media up to the service level with sustainability as a primary objective. The design follows a cloud-first, data-driven methodology underpinned by principles derived from analyzing the archival workload of a large public cloud service. Silica can support a wide range of archival storage workloads and ushers in a new era of sustainable, cost-effective storage.
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Journal articleOkumu F, Moore SJ, Selvaraj P, et al., 2025,
Elevating larval source management as a key strategy for controlling malaria and other vector-borne diseases in Africa.
, Parasit Vectors, Vol: 18Larval source management (LSM) has a long history of advocacy and successes but is rarely adopted where funds are limited. The World Health Organization (WHO) guidelines on malaria prevention recommend the use of LSM as a supplementary intervention to the core vector control methods (insecticide-treated nets and indoor residual spraying), arguing that its feasibility in many settings can be limited by larval habitats being numerous, transient, and difficult to find or treat. Another key argument is that there is insufficient high-quality evidence for its effectiveness to support wide-scale implementation. However, the stagnation of progress towards malaria elimination demands that we consider additional options to the current emphasis on insecticidal commodities targeting adult mosquitoes inside homes. This letter is the result of a global, crossdisciplinary collaboration comprising: (a) detailed online expert discussions, (b) a narrative review of countries that have eliminated local malaria transmission, and (c) a mathematical modeling exercise using two different approaches. Together, these efforts culminated in seven key recommendations for elevating larval source management as a strategy for controlling malaria and other mosquito-borne diseases in Africa (Box 1). LSM encompasses the use of larvicide (a commodity) as well as various environmental sanitation measures. Together, these efforts lead to the long-term reduction of mosquito populations, which benefits the entire community by controlling both disease vector and nuisance mosquitoes. In this paper, we argue that the heavy reliance on large-scale cluster-randomized controlled trials (CRTs) to generate evidence on epidemiological endpoints restricts the recommendation of approaches to only those interventions that can be measured by functional units and deliver relatively uniform impact and, therefore, are more likely to receive financial support for conducting these trials. The explicit impacts of LSM
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Journal articleGeng L, Whittles LK, Dickens BL, et al., 2025,
Potential public health impacts of gonorrhea vaccination programmes under declining incidences: a modeling study
, PLoS Medicine, Vol: 22, ISSN: 1549-1277Background:Gonorrhea is the second most common sexually transmitted disease notified in Singapore in 2023. Evidence suggests that the 4CMenB vaccine designed to protect against Neisseria meningitidis infection may offer partial cross-protection against gonorrhea. This generated interest in using 4CMenB for the purpose of staving gonorrhea transmission. We explored the efficacy of potential gonorrhea vaccination strategies in the context of historically declining gonorrhea incidence.Methods and findings:We employed an integrated transmission-dynamic model, calibrated using Bayesian methods to local surveillance data to understand the potential public health impact of 4CMenB in reducing gonorrhea acquisition and transmission in men who have sex with men (MSM) in Singapore. We explored the efficacy of implementing six vaccination programmes: (1) offering vaccination to all male adolescents in schools (vaccination before entry [VbE]), (2) offering vaccination to individuals attending sexual health clinics for testing (vaccination on attendance [VoA]), (3) offering vaccination to individuals attending sexual health clinics and who were diagnosed with gonorrhea (vaccination on diagnosis [VoD]), or (4) vaccination according to risk (VaR), by offering vaccination to patients who were diagnosed with gonorrhea plus individuals who tested negative, but report having more than five sexual partners per year. We further examined how altering (5) VoA and (6) VoD strategies changed if the strategies only targeted high risk groups (VoA(H),VoD(H)). We assessed efficacy by examining vaccination impact relative to no vaccination and when behavioral parameters were held constant. We further ascertained the effects of varying vaccine uptake (10%, 33%, 100%), vaccine efficacy (22%, 31%, 47%), and duration of protection (1.5, 4, 7.5 years) on the effectiveness of each vaccination strategy.For a hypothetical 10-year vaccination programme, VbE had 14.18% of MSM gonorrhea cases averted over t
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Journal articleHozé N, Pons-Salort M, Metcalf CJE, et al., 2025,
RSero: a user-friendly R package to reconstruct pathogen circulation history from seroprevalence studies
, PLoS Computational Biology, Vol: 21, ISSN: 1553-734XPopulation-based serological surveys are a key tool in epidemiology to characterize the level of population immunity and reconstruct the past circulation of pathogens. A variety of serocatalytic models have been developed to estimate the force of infection (FOI) (i.e., the rate at which susceptible individuals become infected) from age-stratified seroprevalence data. However, few tool currently exists to easily implement, combine, and compare these models. Here, we introduce an R package, Rsero, that implements a series of serocatalytic models and estimates the FOI from age-stratified seroprevalence data using Bayesian methods. The package also contains a series of features to perform model comparison and visualise model fit. We introduce new serocatalytic models of successive outbreaks and extend existing models of seroreversion to any transmission model. The different features of the package are illustrated with simulated and real-life data. We show we can identify the correct epidemiological scenario and recover model parameters in different epidemiological settings. We also show how the package can support serosurvey study design in a variety of epidemic situations. This package provides a standard framework to epidemiologists and modellers to study the dynamics of past pathogen circulation from cross-sectional serological survey data.
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Thesis dissertationCharles G, 2025,
Neural network based surrogates for scalable Bayesian inference on a complex malaria model
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Journal articleVillaveces A, Chen Y, Tucker S, et al., 2025,
Orphanhood and caregiver death among children in the United States by all-cause mortality, 2000-2021
, Nature Medicine, Vol: 31, Pages: 672-683, ISSN: 1078-8956Deaths of parents and grandparent caregivers threaten child well-being owing to losses of care, financial support, safety and family stability, but are relatively unrecognized as a public health crisis. Here we used cause-specific vital statistics death registrations in a modeling approach to estimate the full magnitude of orphanhood incidence and prevalence among US children aged 0–17 years between 2000 and 2021 by cause, child age, race and ethnicity, sex of deceased parent and state, and also accounted for grandparent caregiver loss using population survey data. In 2021, we estimate that 2.91 million children (4.2% of children) had in their lifetime experienced prevalent orphanhood and caregiver death combined, with incidence increasing by 49.5% and prevalence by 7.9% since 2000. Populations disproportionately affected by orphanhood included 5.2% of all adolescents; 6.4% and 4.7%, respectively, of non-Hispanic American Indian or Alaska Native, and non-Hispanic Black children; and children in southern and eastern states. In 2021, drug overdose was the leading cause of orphanhood among non-Hispanic white children, but not among minoritized subgroups. Effective policies and programs to support nearly three million bereaved children are needed to reduce the acute and long-term negative effects of orphanhood.
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