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Gibbons R.V.,Armed Forces Research Institute of Medical science | Streitz M.,Uniformed Services University of the Health Sciences | Babina T.,Uniformed Services University of the Health Sciences | Fried J.R.,Mahidol Oxford Tropical Medicine Research Unit
Emerging Infectious Diseases | Year: 2012

Dengue is a major cause of illness among travelers and a threat to military troops operating in areas to which it is endemic. Before and during World War II, dengue frequently occurred in US military personnel in Asia and the South Pacific. From the 1960s into the 1990s, dengue often occurred in US troops in Vietnam, the Philippines, Somalia, and Haiti. We found attack rates as high as 80% and periods of convalescence up to 3-1/2 weeks beyond the acute illness. The increase in dengue throughout the world suggests that it will remain a problem for military personnel until an effective vaccine is licensed. Source

Taylor W.R.,Mahidol Oxford Tropical Medicine Research Unit
The Southeast Asian journal of tropical medicine and public health | Year: 2013

The Greater Mekong Subregion (GMS) has low transmission of Plasmodium falciparum and P. vivax and is a prime region for malaria elimination based on evidence. The extent of GMS based research is unknown. Pub Med-identified research articles from the GMS were selected based on defined criteria and classified into 24 research areas. A research questionnaire was sent to WHO country offices, national malaria control programs (NMCPs), national research institutes and non governmental organizations (NGOs). Two thousand eight hundred ninety of 3,319 identified publications were included, dating from 1933 to June 2012; 1,485 (51.8%) of 2,890 since 2000. Ten research areas accounted for 2,264 (78.3%) publications: drug resistance 12.8% (n=371), entomology 11.42% (n=330), clinical trials 10.45% (n=302), pathophysiology 9.34% (n=270), epidemiology 8.96% (n=259), pharmacology 6.06% (n=175), parasite biology 5.19% (n=150), malaria control 4.88% (n=141), diagnosis/diagnostics 4.6% (n=133) and clinical studies 4.6% (n=133). Thailand produced most publications, 1,684 (58.27%), followed by Viet Nam (365, 12.63%), Cambodia (139, 4.81%), Myanmar (132, 4.57%), Yunnan Province, China (124, 4.3%) and Lao PDR (79, 2.73%). Other publications were multicountry, including >or=1 GMS country (n=269), or reviews (n=98). Publication numbers increased significantly over time. Eleven questionnaires were received. Principal research areas were treatment seeking behavior, knowledge, attitude and practice surveys, bed net use, access to treatment by migrants, and malaria diagnostics. Research in GMS is broad. Biomedical research dominates peer reviewed publications. NMCP and NGOs focus more on downstream malaria implementation issues. The challenge is to engage GMS research capacity to build quality evidence for malaria elimination. Source

Deeny S.R.,Public Health England | Cooper B.S.,University of Oxford | Cookson B.,Public Health England | Hopkins S.,Public Health England | And 2 more authors.
Journal of Hospital Infection | Year: 2013

Background: The benefits of universal meticillin-resistant Staphylococcus aureus (MRSA) admission screening, compared with screening targeted patient groups and the additional impact of discharge screening, are uncertain. Aims: To quantify the impact of MRSA screening plus decolonization treatment on MRSA infection rates. To compare universal with targeted screening policies, and to evaluate the additional impact of screening and decolonization on discharge. Methods: A stochastic, individual-based model of MRSA transmission was developed that included patient movements between general medical and intensive care unit (ICU) wards, and between the hospital and community, informed by 18 months of individual patient data from a 900-bed tertiary care hospital. We simulated the impact of universal and targeted [for ICU, acute care of the elderly (ACE) or readmitted patients] MRSA screening and decolonization policies, both on admission and discharge. Findings: Universal admission screening plus decolonization resulted in 77% (95% confidence interval: 76-78) reduction in MRSA infections over 10 years. Screening only ACE specialty or ICU patients yielded 62% (61-63) and 66% (65-67) reductions, respectively. Targeted policies reduced the number of screens by up to 95% and courses of decolonization by 96%. In addition to screening on admission, screening on discharge had little impact, with a maximum 7% additional reduction in infection. Conclusions: Compared with universal screening, targeted screening substantially reduced the amount of screening and decolonization required to achieve only 12% lower reduction in infection. Targeted screening and decolonization could lower the risk of resistance emerging as well as offer a more efficient use of resources. © 2013. Source

Meeyai A.,Health Intervention and Technology Assessment Program | Meeyai A.,Mahidol University | Praditsitthikorn N.,Health Intervention and Technology Assessment Program | Kotirum S.,Health Intervention and Technology Assessment Program | And 5 more authors.
PLoS Medicine | Year: 2015

Seasonal influenza is a major cause of mortality worldwide. Routine immunization of children has the potential to reduce this mortality through both direct and indirect protection, but has not been adopted by any low- or middle-income countries. We developed a framework to evaluate the cost-effectiveness of influenza vaccination policies in developing countries and used it to consider annual vaccination of school- and preschool-aged children with either trivalent inactivated influenza vaccine (TIV) or trivalent live-attenuated influenza vaccine (LAIV) in Thailand. We also compared these approaches with a policy of expanding TIV coverage in the elderly. We developed an age-structured model to evaluate the cost-effectiveness of eight vaccination policies parameterized using country-level data from Thailand. For policies using LAIV, we considered five different age groups of children to vaccinate. We adopted a Bayesian evidence-synthesis framework, expressing uncertainty in parameters through probability distributions derived by fitting the model to prospectively collected laboratory-confirmed influenza data from 2005-2009, by meta-analysis of clinical trial data, and by using prior probability distributions derived from literature review and elicitation of expert opinion. We performed sensitivity analyses using alternative assumptions about prior immunity, contact patterns between age groups, the proportion of infections that are symptomatic, cost per unit vaccine, and vaccine effectiveness. Vaccination of children with LAIV was found to be highly cost-effective, with incremental cost-effectiveness ratios between about 2,000 and 5,000 international dollars per disability-adjusted life year averted, and was consistently preferred to TIV-based policies. These findings were robust to extensive sensitivity analyses. The optimal age group to vaccinate with LAIV, however, was sensitive both to the willingness to pay for health benefits and to assumptions about contact patterns between age groups. Vaccinating school-aged children with LAIV is likely to be cost-effective in Thailand in the short term, though the long-term consequences of such a policy cannot be reliably predicted given current knowledge of influenza epidemiology and immunology. Our work provides a coherent framework that can be used for similar analyses in other low- and middle-income countries. © 2015 Meeyai et al. Source

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Melioidosis, a difficult to diagnose deadly bacterial disease, is likely to be present in many more countries than previously thought, reports a paper published online in the journal Nature Microbiology. The study predicts that melioidosis is present in 79 countries, including 34 that have never reported the disease. It recommends that health workers and policy makers give melioidosis a higher priority, and expects the number of melioidosis cases to rise as diabetes increases across the tropics, especially among the poor, and international travel increases the risk of introducing the pathogen to new areas. 'Although melioidosis has been recognised for more than 100 years, awareness of it is still low, even among medical and laboratory staff in cionfirmed endemic areas,' said study co-author Dr. Direk Limmathurotsakul, Head of Microbiology at MORU and Assistant Professor at Mahidol University (Thailand). 'We predict that the burden of this disease us likely to increase in the future because the incidence of diabetes mellitus is increasing and the movements of people and animals could lead to the establishment of new endemic areas.' The study is the first to provide an evidence-based estimate of the global extent of melioidosis, which is caused by Burkholderia pseudomallei, a highly pathogenic bacterium commonly found in soil and water in South and Southeast Asia and northern Australia. Led by researchers at Oxford University, the Mahidol Oxford Tropical Medicine Research Unit in Bangkok, Thailand, the University of Washington in Seattle and Mahidol University in Thailand, among others, the study is funded by the Wellcome Trust. The highest melioidosis risk zones are in South Asia, East Asia and the Pacific including all countries in Southeast Asia and tropical Australia, Sub-Saharan Africa and South America, with risk zones of varying sizes in Central America, Southern Africa and the Middle East. Contracted through the skin, lungs or by drinking contaminated water, melioidosis can be difficult to diagnose as it mimics other diseases. The bacterium is resistant to a wide range of antimicrobials, and inadequate treatment may result in fatality rates exceeding 70 percent. 'Melioidosis is a great mimicker of other diseases and you need a good microbiology laboratory for bacterial culture and identification to make an accurate diagnosis. It especially affects the rural poor in the tropics who often do not have access to microbiology labs, which means that it has been greatly under estimated as an important public health problem across the world,' said Dr. Limmathurotsakul. 'Our study predicts high infection rates in countries like India and Vietnam, where the disease is gradually being recognised more frequently.' The study estimates that melioidosis killed 89,000 of the 165,000 people who got it in 2015 – nearly as many as the annual global mortality from measles (95,000 deaths per year) and greater than deaths from leptospirosis (50,000 per year) or dengue (12,500 per year), two current health priorities for many international health organizations. High-risk melioidosis groups include patients with diabetes mellitus, chronic kidney disease or excessive alcohol intake. The authors mapped documented hu8man and animal melioidosis cases and environmental reports of B. pseudomallei published between 1910 and 2014. They combined these in a formal model that suggests that melioidosis is severely under-reported in most of the 45 countries where it is known to be endemic, and that it is probably endemic in another 34 countries that have never reported the disease. The authors suggest these results highlight the need for this diseases to be given a higher priority by health workers, international health organisation and policy makers. 'We hope that this paper will help to raise awareness of the disease among all healthcare workers in endemic areas, as the disease can be treated if it is caught early enough,' said Oxford researcher Dr. David Dance, one of the contributors to the report, who first highlighted the under-recognition of melioidosis 25 years ago and now studies infectious diseases including melioidosis at the Laos-Oxford-Mahosot-Wellcome Research Unit (LOMWRU) in Vientiane, Lao PDR.

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