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Journal articleCharnley G, Murray K, Gaythorpe K, et al., 2021,
Traits and risk factors of post-disaster infectious disease outbreaks: a systematic review
, Scientific Reports, Vol: 11, Pages: 1-14, ISSN: 2045-2322Infectious disease outbreaks are increasingly recognised as events that exacerbate impacts or prolong recovery following disasters. Yet, our understanding of the frequency, geography, characteristics and risk factors of post-disaster disease outbreaks globally is lacking. This limits the extent to which disease outbreak risks can be prepared for, monitored and responded to following disasters. Here, we conducted a global systematic review of post-disaster outbreaks and found that outbreaks linked to conflicts and hydrological events were most frequently reported, and most often caused by bacterial and water-borne agents. Lack of adequate WASH facilities and poor housing were commonly reported risk factors. Displacement, through infrastructure damage, can lead to risk cascades for disease outbreaks; however, displacement can also be an opportunity to remove people from danger and ultimately protect health. The results shed new light on post-disaster disease outbreaks and their risks. Understanding these risk factors and cascades, could help improve future region-specific disaster risk reduction.
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Journal articlePark SW, Pons-Salort M, Messacar K, et al., 2021,
Epidemiological dynamics of enterovirus D68 in the United States and implications for acute flaccid myelitis
, SCIENCE TRANSLATIONAL MEDICINE, Vol: 13, ISSN: 1946-6234- Cite
- Citations: 45
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Journal articleRicks S, Kendall EA, Dowdy DW, et al., 2021,
Quantifying the potential value of antigen-detection rapid diagnostic tests for COVID-19: a modelling analysis
, BMC Medicine, Vol: 19, Pages: 1-13, ISSN: 1741-7015BackgroundTesting plays a critical role in treatment and prevention responses to the COVID-19 pandemic. Compared to nucleic acid tests (NATs), antigen-detection rapid diagnostic tests (Ag-RDTs) can be more accessible, but typically have lower sensitivity and specificity. By quantifying these trade-offs, we aimed to inform decisions about when an Ag-RDT would offer greater public health value than reliance on NAT. MethodsFollowing an expert consultation, we selected two use cases for analysis: rapid identification of people with COVID-19 amongst patients admitted with respiratory symptoms in a ‘hospital’ setting; and early identification and isolation of people with mildly symptomatic COVID-19 in a ‘community’ setting. Using decision analysis, we evaluated the health system cost and health impact (deaths averted and infectious days isolated) of an Ag-RDT-led strategy, compared to a strategy based on NAT and clinical judgment. We adopted a broad range of values for ‘contextual’ parameters relevant to a range of settings, including the availability of NAT, the performance of clinical judgement, etc. We performed a multivariate sensitivity analysis to all of these parameters. ResultsIn a hospital setting, an Ag-RDT-led strategy would avert more deaths than a NAT-based strategy, and at lower cost per death averted, when the sensitivity of clinical judgement is less than 85%, and when NAT results are available in time to inform clinical decision-making for less than 90% of patients. The use of an Ag-RDT is robustly supported in community settings, where it would avert more transmission at lower cost than relying on NAT alone, under a wide range of assumptions. ConclusionsDespite their imperfect sensitivity and specificity, Ag-RDTs have the potential to be simultaneously more impactful, and have a lower cost per death and infectious person-days averted, than current approaches to COVID-19 diagnostic testing.
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Journal articleChallenger J, Olivera Mesa D, Da DF, et al., 2021,
Predicting the public health impact of a malaria transmission-blocking vaccine
, Nature Communications, Vol: 12, Pages: 1-12, ISSN: 2041-1723Transmission-blocking vaccines that interrupt malaria transmission from humans to mosquitoes are being tested in early clinical trials. The activity of such a vaccine is commonly evaluated using membrane-feeding assays. Understanding the field efficacy of such a vaccine requires knowledge of how heavily infected wild, naturally blood-fed mosquitoes are, as this indicates how difficult it will be to block transmission. Here we use data on naturally infected mosquitoes collected in Burkina Faso to translate the laboratory-estimated activity into an estimated activity in the field. A transmission dynamics model is then utilised to predict a transmission-blocking vaccine’s public health impact alongside existing interventions. The model suggests that school-aged children are an attractive population to target for vaccination. Benefits of vaccination are distributed across the population, averting the greatest number of cases in younger children. Utilising a transmission-blocking vaccine alongside existing interventions could have a substantial impact against malaria.
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Journal articleKura K, Ayabina D, Toor J, et al., 2021,
Disruptions to schistosomiasis programmes due to COVID-19: an analysis of potential impact and mitigation strategies.
, Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol: 115, Pages: 236-244, ISSN: 0035-9203BACKGROUND: The 2030 goal for schistosomiasis is elimination as a public health problem (EPHP), with mass drug administration (MDA) of praziquantel to school-age children (SAC) as a central pillar of the strategy. However, due to coronavirus disease 2019, many mass treatment campaigns for schistosomiasis have been halted, with uncertain implications for the programmes. METHODS: We use mathematical modelling to explore how postponement of MDA and various mitigation strategies affect achievement of the EPHP goal for Schistosoma mansoni and S. haematobium. RESULTS: For both S. mansoni and S. haematobium in moderate- and some high-prevalence settings, the disruption may delay the goal by up to 2 y. In some high-prevalence settings, EPHP is not achievable with current strategies and so the disruption will not impact this. Here, increasing SAC coverage and treating adults can achieve the goal. The impact of MDA disruption and the appropriate mitigation strategy varies according to the baseline prevalence prior to treatment, the burden of infection in adults and the stage of the programme. CONCLUSIONS: Schistosomiasis MDA programmes in medium- and high-prevalence areas should restart as soon as is feasible and mitigation strategies may be required in some settings.
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Journal articleMalizia V, Giardina F, Vegvari C, et al., 2021,
Modelling the impact of COVID-19-related control programme interruptions on progress towards the WHO 2030 target for soil-transmitted helminths
, Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol: 115, Pages: 253-260, ISSN: 0035-9203BACKGROUND: On 1 April 2020, the WHO recommended an interruption of all activities for the control of neglected tropical diseases, including soil-transmitted helminths (STH), in response to the COVID-19 pandemic. This paper investigates the impact of this disruption on the progress towards the WHO 2030 target for STH. METHODS: We used two stochastic individual-based models to simulate the impact of missing one or more preventive chemotherapy (PC) rounds in different endemicity settings. We also investigated the extent to which this impact can be lessened by mitigation strategies, such as semiannual or community-wide PC. RESULTS: Both models show that without a mitigation strategy, control programmes will catch up by 2030, assuming that coverage is maintained. The catch-up time can be up to 4.5 y after the start of the interruption. Mitigation strategies may reduce this time by up to 2 y and increase the probability of achieving the 2030 target. CONCLUSIONS: Although a PC interruption will only temporarily impact the progress towards the WHO 2030 target, programmes are encouraged to restart as soon as possible to minimise the impact on morbidity. The implementation of suitable mitigation strategies can turn the interruption into an opportunity to accelerate progress towards reaching the target.
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Journal articleBaggaley RF, Vegvari C, Dimala CA, et al., 2021,
Health economic analyses of latent tuberculosis infection screening and preventive treatment among people living with HIV in lower tuberculosis incidence settings: a systematic review
, Wellcome Open Research, Vol: 6, Pages: 51-51<ns4:p> <ns4:bold>Introduction:</ns4:bold> In lower tuberculosis (TB) incidence countries (<100 cases/100,000/year), screening and preventive treatment (PT) for latent TB infection (LTBI) among people living with HIV (PLWH) is often recommended, yet guidelines advising which groups to prioritise for screening can be contradictory and implementation patchy. Evidence of LTBI screening cost-effectiveness may improve uptake and health outcomes at reasonable cost. </ns4:p> <ns4:p> <ns4:bold>Methods:</ns4:bold> Our systematic review assessed cost-effectiveness estimates of LTBI screening/PT strategies among PLWH in lower TB incidence countries to identify model-driving inputs and methodological differences. Databases were searched 1980-2020. Studies including health economic evaluation of LTBI screening of PLWH in lower TB incidence countries (<100 cases/100,000/year) were included. Study quality was assessed using the CHEERS checklist. </ns4:p> <ns4:p> <ns4:bold>Results:</ns4:bold> Of 2,644 articles screened, nine studies were included. Cost-effectiveness estimates of LTBI screening/PT for PLWH varied widely, with universal screening/PT found highly cost-effective by some studies, while only targeting to high-risk groups (such as those from mid/high TB incidence countries) deemed cost-effective by others. Cost-effectiveness of strategies screening all PLWH from studies published in the past five years varied from US$2828 to US$144,929/quality-adjusted life-year gained (2018 prices). Study quality varied, with inconsistent reporting of methods and results limiting comparability of studies. Cost-effectiveness varied markedly by screening guideline, with British HIV Association guidelines more cost-effective than NIC
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Journal articleAguas R, Mahdi A, Shretta R, et al., 2021,
Potential health and economic impacts of dexamethasone treatment for patients with COVID-19 (vol 12, 915, 2021)
, NATURE COMMUNICATIONS, Vol: 12 -
Journal articleEilerts H, Prieto JR, Eaton J, et al., 2021,
Age patterns of under-five mortality in sub-Saharan Africa during 1990-2018: a comparison of estimates from demographic surveillance with full birth histories and the historic record
, Demographic Research, Vol: 44, Pages: 415-442, ISSN: 1435-9871BACKGROUND: In Sub-Saharan African countries which often lack high-quality vital registration data, estimates of under-five mortality (U5M) rely heavily on full birth histories (FBHs) collected in surveys and model age patterns of mortality calibrated against vital statistics from other populations. Health and Demographic Surveillance Systems (HDSS) are al-ternate sources of population-based data in much of sub-Saharan Africa, which are less formally utilized in estimation. OBJECTIVE: The objective of this study is to compare the age pattern of U5M in African HDSS with FBHs from the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), the Human Mortality Database (HMD), and model age patterns.METHODS: We examined the relative levels of neonatal, post neonatal, infant, and child mortality across data sources. We directly compared estimates for DHS and MICS subnational regions with HDSS, and used OLS regression to identify data attributes that correlated with the disparity between estimates. RESULTSH: DSS and FBH data suggests that African populations have higher levels of child mortality and lower infant mortality than the historic record. This age pattern is most explicit for Western African populations, but also characterizes data for other sub regions. The comparison between HDSS and FBH suggests that FBH child mortality is biased downward. The comparison is less conclusive for neonatal and infant mortality. CONTRIBUTION: This study questions the practice of using model age patterns derived from largely high-income settings for inferring or correcting U5M estimates for African populations. It also highlights the considerable uncertainty around the consistency of HDSS and FBH estimates of U5M.
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Journal articlede Souza Santos AA, Candido DDS, de Souza WM, et al., 2021,
Dataset on SARS-CoV-2 non-pharmaceutical interventions in Brazilian municipalities
, Scientific Data, Vol: 8, ISSN: 2052-4463Brazil has one of the fastest-growing COVID-19 epidemics worldwide. Non-pharmaceutical interventions (NPIs) have been adopted at the municipal level with asynchronous actions taken across 5,568 municipalities and the Federal District. This paper systematises the fragmented information on NPIs reporting on a novel dataset with survey responses from 4,027 mayors, covering 72.3% of all municipalities in the country. This dataset responds to the urgency to track and share findings on fragmented policies during the COVID-19 pandemic. Quantifying NPIs can help to assess the role of interventions in reducing transmission. We offer spatial and temporal details for a range of measures aimed at implementing social distancing and the dates when these measures were relaxed by local governments.
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