Imperial College London


Faculty of MedicineSchool of Public Health

Honorary Research Associate



h.mills Website




Norfolk PlaceSt Mary's Campus





Publication Type

8 results found

Garske T, Cori A, Ariyarajah A, Blake I, Dorigatti I, Eckmanns T, Fraser C, Hinsley W, Jombart T, Mills H, Nedjati-Gilani G, Newton E, Nouvellet P, Perkins D, Riley S, Schumacher D, Shah A, Van Kerkhove M, Dye C, Ferguson N, Donnelly Cet al., 2017, Heterogeneities in the case fatality ratio in the West African Ebola outbreak 2013 – 2016, Philosophical Transactions of the Royal Society B: Biological Sciences, Vol: 372, ISSN: 1471-2970

The 2013–2016 Ebola outbreak in West Africa is the largest on record with 28 616 confirmed, probable and suspected cases and 11 310 deaths officially recorded by 10 June 2016, the true burden probably considerably higher. The case fatality ratio (CFR: proportion of cases that are fatal) is a key indicator of disease severity useful for gauging the appropriate public health response and for evaluating treatment benefits, if estimated accurately. We analysed individual-level clinical outcome data from Guinea, Liberia and Sierra Leone officially reported to the World Health Organization. The overall mean CFR was 62.9% (95% CI: 61.9% to 64.0%) among confirmed cases with recorded clinical outcomes. Age was the most important modifier of survival probabilities, but country, stage of the epidemic and whether patients were hospitalized also played roles. We developed a statistical analysis to detect outliers in CFR between districts of residence and treatment centres (TCs), adjusting for known factors influencing survival and identified eight districts and three TCs with a CFR significantly different from the average. From the current dataset, we cannot determine whether the observed variation in CFR seen by district or treatment centre reflects real differences in survival, related to the quality of care or other factors or was caused by differences in reporting practices or case ascertainment.

Journal article

Cori A, Donnelly CA, dorigatti, ferguson NM, fraser, garske, jombart, Nedjati-Gilani G, Nouvellet, Riley, Van Kerkhove, Mills, Blake IMet al., 2017, Key data for outbreak evaluation: building on the Ebola experience, Philosophical Transactions of the Royal Society B: Biological Sciences, Vol: 372, ISSN: 1471-2970

Following the detection of an infectious disease outbreak, rapid epidemiological assessmentis critical to guidean effectivepublic health response. To understand the transmission dynamics and potential impact of an outbreak, several types of data are necessary. Here we build on experience gained inthe West AfricanEbolaepidemic and prior emerging infectious disease outbreaksto set out a checklist of data needed to: 1) quantify severity and transmissibility;2) characterise heterogeneities in transmission and their determinants;and 3) assess the effectiveness of different interventions.We differentiate data needs into individual-leveldata (e.g. a detailed list of reported cases), exposure data(e.g.identifying where / howcases may have been infected) and populationlevel data (e.g.size/demographicsof the population(s)affected andwhen/where interventions were implemented). A remarkable amount of individual-level and exposuredata was collected during the West African Ebola epidemic, which allowed the assessment of (1) and (2). However,gaps in population-level data (particularly around which interventions were applied whenand where)posed challenges to the assessment of (3).Herewehighlight recurrent data issues, give practical suggestions for addressingthese issues and discuss priorities for improvements in data collection in future outbreaks.

Journal article

Mills HL, White E, Colijn C, Vickerman P, Heimer Ret al., 2013, HIV transmission from drug injectors to partners who do not inject, and beyond: Modelling the potential for a generalized heterosexual epidemic in St. Petersburg, Russia, DRUG AND ALCOHOL DEPENDENCE, Vol: 133, Pages: 242-247, ISSN: 0376-8716

Journal article

Mills HL, Cohen T, Colijn C, 2013, Response to Comment on "Community-Wide Isoniazid Preventive Therapy Drives Drug-Resistant Tuberculosis: A Model-Based Analysis", SCIENCE TRANSLATIONAL MEDICINE, Vol: 5, ISSN: 1946-6234

Journal article

Mills HL, Cohen T, Colijn C, 2013, Community-Wide Isoniazid Preventive Therapy Drives Drug-Resistant Tuberculosis: A Model-Based Analysis, SCIENCE TRANSLATIONAL MEDICINE, Vol: 5, ISSN: 1946-6234

Journal article

Mills HL, Ganesh A, Colijn C, 2013, Pathogen spread on coupled networks: Effect of host and network properties on transmission thresholds, Journal of Theoretical Biology

Journal article

Mills HL, Colijn C, Vickerman P, Leslie D, Hope V, Hickman Met al., 2012, Respondent Driven Sampling and community structure in a population of injecting drug users in Bristol, UK, Drug and Alcohol Dependence, Vol: 126, Pages: 324-332

Journal article

Mills HL, Cohen T, Colijn C, 2011, Modelling the performance of isoniazid preventive therapy for reducing tuberculosis in HIV endemic settings: the effects of network structure, JOURNAL OF THE ROYAL SOCIETY INTERFACE, Vol: 8, Pages: 1510-1520, ISSN: 1742-5689

Journal article

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