Mahidol Oxford Tropical Medicine Research Unit MORU

Bangkok, Thailand

Mahidol Oxford Tropical Medicine Research Unit MORU

Bangkok, Thailand
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PubMed | Office of Director General of Health Services, Ministry of Health, Intensive Care National Audit and Research Center, Royal London Hospital and 5 more.
Type: | Journal: Intensive & critical care nursing | Year: 2016

To deliver and evaluate a short critical care nurse training course whilst simultaneously building local training capacity.A multi-modal short course for critical care nursing skills was delivered in seven training blocks, from 06/2013-11/2014. Each training block included a Train the Trainer programme. The project was evaluated using Kirkpatricks Hierarchy of Learning. There was a graded hand over of responsibility for course delivery from overseas to local faculty between 2013 and 2014.Sri Lanka.Participant learning assessed through pre/post course Multi-Choice Questionnaires.A total of 584 nurses and 29 faculty were trained. Participant feedback was consistently positive and each course demonstrated a significant increase (p0.0001) in MCQ scores. There was no significant difference MCQ scores (p=0.186) between overseas faculty led and local faculty led courses.In a relatively short period, training with good educational outcomes was delivered to nearly 25% of the critical care nursing population in Sri Lanka whilst simultaneously building a local faculty of trainers. Through use of a structured Train the Trainer programme, course outcomes were maintained following the handover of training responsibility to Sri Lankan faculty. The focus on local capacity building increases the possibility of long term course sustainability.


Van Effelterre T.,GSK Biologicals | Moore M.R.,Centers for Disease Control and Prevention | Fierens F.,GSK Biologicals | Whitney C.G.,Centers for Disease Control and Prevention | And 3 more authors.
Vaccine | Year: 2010

Universal infant vaccination with the 7-valent pneumococcal conjugate vaccine (PCV7) has nearly eliminated PCV7-serotype invasive pneumococcal disease (IPD) in young U.S. children, but has been accompanied by increases in the incidence of serotype 19A IPD. Because antibiotic-non-susceptible 19A has increased more than antibiotic-susceptible 19A, antibiotic selection pressure could be contributing to this trend. We developed a dynamic compartmental transmission model of pneumococcus to better understand the causes of this rise and to estimate the impact of vaccines or changes in antibiotic use on future IPD incidence in the U.S. in <2 year-olds. The model predicted that with current practices, serotype 19A IPD incidence will plateau at about the 2007 level over the next few years. The model suggests that antibiotic usage played a major role in the rise in antibiotic-non-susceptible 19A IPD, with a lesser contribution from PCV7 vaccination. However, hypothetical large decreases in antibiotic use starting in 2008 are predicted to yield only gradual decreases in antibiotic-non-susceptible 19A IPD. On the other hand, vaccines with modest (20%) effectiveness against 19A (or 6A or PCV7-serotypes) carriage are predicted to substantially (by 80%) decrease the incidence of IPD caused by those serotypes within 10 years of implementation. Our findings highlight that vaccine effects on colonization are key to their overall benefits. In addition, serotype changes following vaccine introduction may have multifactorial origins, with antibiotic use an important factor for resistant strains such as 19A. © 2010 Elsevier Ltd. All rights reserved.


Fuller C.,University College London | Savage J.,University College London | Besser S.,King's College London | Hayward A.,University College London | And 3 more authors.
Infection Control and Hospital Epidemiology | Year: 2011

Back ground and objective. Wearing of gloves reduces transmission of organisms by health care workers'hands but is not a substitute for hand hygiene. Results of previous studies have varied as to whether hand hygiene is worse when gloves are worn. Most studies have been small and used nonstandardized assessments of glove use and hand hygiene. We sought to observe whether gloves were worn when appropriate and whether hand hygiene compliance differed when gloves were worn. design. bservational study. participants and setting. Healthcare workers in 56 medical or care of the elderly wards and intensive care units in 15 hospitals across England and Wales. methods. Weobservedhandhygieneandgloveusage(7,578momentsforhandhygiene)during249one-hoursessions.Observersalso recorded whether gloves were or were not worn for individual contacts. results. Gloves were used in 1,983 (26.2%) of the 7,578 moments for hand hygiene and in 551 (16.7%) of 3,292 low-risk contacts; gloves were not used in 141 (21.1%) of 669 high-risk contacts. The rate of hand hygiene compliance with glove use was 41.4% (415 of 1,002 moments), and the rate without glove use was 50.0% (1,344 of 2,686 moments). After adjusting for ward, healthcare worker type, contact risk level, and whether the hand hygiene opportunity occurred before or after a patient contact, glove use was strongly associated with lower levels of hand hygiene (adjusted odds ratio, 0.65 [95% confidence interval, 0.54-0.79 P.0001). conclusion. Therateofgloveusageislowerthanpreviouslyreported.Glovesareoftenwornwhennotindicatedandviceversa.The rate of compliance with hand hygiene was significantly lower when gloves were worn. Hand hygiene campaigns should consider placing greater emphasis on the World Health Organization indications for gloving and associated hand hygiene. trial registration. National Research Register N0256159318. © 2011 by The Society for Healthcare Epidemiology of America.


PubMed | Institute Pasteur in Cambodia, FHI 360 Cambodia Office and 03, Bethesda University, Malaria Consortium and 5 more.
Type: Journal Article | Journal: BMC medicine | Year: 2016

In 2012, the World Health Organization recommended the addition of single low-dose primaquine (SLDPQ, 0.25mg base/kg body weight) to artemisinin combination therapies to block the transmission of Plasmodium falciparum without testing for glucose-6-phosphate dehydrogenase deficiency. The targeted group was non-pregnant patients aged1year (later changed to6months) with acute uncomplicated falciparum malaria, primarily in countries with artemisinin-resistant P. falciparum (ARPf). No dosing regimen was suggested, leaving malaria control programmes and clinicians in limbo. Therefore, we designed a user-friendly, age-based SLDPQ regimen for Cambodia, the country most affected by ARPf.By reviewing primaquines pharmacology, we defined a therapeutic dose range of 0.15-0.38mg base/kg (9-22.5mg in a 60-kg adult) for a therapeutic index of 2.5. Primaquine doses (1-20mg) were tested using a modelled, anthropometric database of 28,138 Cambodian individuals (22,772 healthy, 4119 with malaria and 1247 with other infections); age distributions were: 0.5-4 years (20.0%, n=5640), 5-12 years (9.1%, n=2559), 13-17 years (9.1%, n=2550), and18years (61.8%, n=17,389). Optimal age-dosing groups were selected according to calculated mg base/kg doses and proportions of individuals receiving a therapeutic dose.Four age-dosing bands were defined: (1) 0.5-4 years, (2) 5-9 years, (3) 10-14 years, and (4) 15years to receive 2.5, 5, 7.5, and 15mg of primaquine base, resulting in therapeutic doses in 97.4% (5494/5640), 90.5% (1511/1669), 97.7% (1473/1508), and 95.7% (18,489/19,321) of individuals, respectively. Corresponding median (1st-99th centiles) mg base/kg doses of primaquine were (1) 0.23 (0.15-0.38), (2) 0.29 (0.18-0.45), (3) 0.27 (0.15-0.39), and (4) 0.29 (0.20-0.42).This age-based SLDPQ regimen could contribute substantially to malaria elimination and requires urgent evaluation in Cambodia and other countries with similar anthropometric characteristics. It guides primaquine manufacturers on suitable tablet strengths and doses for paediatric-friendly formulations. Development of similar age-based dosing recommendations for Africa is needed.


PubMed | University of California at San Francisco and Mahidol Oxford Tropical Medicine Research Unit MORU
Type: Journal Article | Journal: PLoS medicine | Year: 2016

Roly Gosling and Lorenz von Seidlein consider a potential future development plan for the RTS,S/AS01 malaria vaccine.


Schlackow I.,John Radcliffe Hospital | Stoesser N.,John Radcliffe Hospital | Stoesser N.,Mahidol Oxford Tropical Medicine Research Unit MORU | Walker A.S.,John Radcliffe Hospital | And 5 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2012

Objectives: To investigate trends in Escherichia coli resistance, bacteraemia rates and post-bacteraemia outcomes over time. Methods: Trends in E. coli bacteraemia incidence were monitored from January 1999 to June 2011 using an infection surveillance database including microbiological, clinical risk factor, infection severity and outcome data in Oxfordshire, UK, with imported temperature/rainfall data. Results: A total of 2240 E. coli (from 2080 patients) were studied, of which 1728 (77%) were susceptible to coamoxiclav, cefotaxime, ciprofloxacin and gentamicin. E. coli bacteraemia incidence increased from 3.4/10000 bedstays in 1999 to 5.7/10000 bedstays in 2011. The increase was fastest around 2006, and was essentially confined to organisms resistant to ciprofloxacin, co-amoxiclav, cefotaxime and/or aminoglycosides. Resistant E. coli isolation rates increased similarly in those with and without recent hospital contact. The sharp increase also occurred in urinary isolates, with similar timing. In addition to these long-term trends, increases in ambient temperature, but not rainfall, were associated with increased E. coli bacteraemia rates. It is unclear whether resistant E. coli bacteraemia rates are currently still increasing [incidence rate ratio=1.07 per annum (95% CI=0.99-1.16), P=0.07], whereas current susceptible E. coli bacteraemia rates are not changing significantly [incidence rate ratio=1.01 (95% CI=0.99-1.02)]. However, neither mortality nor biomarkers associated with mortality (blood creatinine, urea/albumin concentrations, neutrophil counts) changed during the study. Conclusions: E. coli bacteraemia rates have risen due to rising rates of resistant organisms; little change occurred in susceptible E. coli. Although the severity of resistant infections, and their outcome, appear similar to susceptible E. coli in the setting studied, the increasing burden of highly resistant organisms is alarming and merits on-going surveillance. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Rahimi B.A.,Mahidol University | Rahimi B.A.,Kandahar University | Thakkinstian A.,Mahidol University | White N.J.,Mahidol Oxford Tropical Medicine Research Unit MORU | And 5 more authors.
Malaria Journal | Year: 2014

Background: Malaria caused by Plasmodium vivax was long considered to have a low mortality, but recent reports from some geographical areas suggest that severe and complicated vivax malaria may be more common than previously thought. Methods: The primary objective of this systematic review and meta-analysis was to describe the reported clinical characteristics and the geographical variation in prevalence of reported severe vivax malaria and its change over time derived from English-language articles published since 1900. Medline and Scopus databases were searched for original papers on severe vivax malaria, using as inclusion criteria modified 2010 WHO criteria for the diagnosis of severe falciparum malaria. Articles before 1949 were identified through reference lists in journals, textbooks, and personal collections of colleagues. Results: A total of 77 studies with reported severe vivax malaria and 63 studies with no reported severe vivax malaria (totaling 46,411 and 6,753 vivax malaria patients, respectively) were included. The 77 studies with reported severe vivax malaria were mainly from India (n = 33), USA (n = 8), Indonesia (n = 6), and Pakistan (n = 6). Vivax endemic countries not reporting severe vivax malaria beyond individual case reports included: the Greater Mekong Sub-region, China, North Korea, Bangladesh, Afghanistan, Middle East (except Qatar), the horn of Africa, and Madagascar. Only 17/77 reports were from before 2000. Vivax mono-infection was confirmed by PCR in 14 studies and co-morbidities were ruled out in 23 studies. Among the 77 studies reporting severe vivax malaria, severe thrombocytopenia (<50,000/mm3) was the most common "severe" manifestation (888/45,775 with pooled prevalence of 8.6%). The case fatality was 0.3% (353/46,411). Severity syndromes varied widely between different geographical areas, with severe anaemia being most prominent in areas of high transmission and chloroquine resistance. Conclusion: Plasmodium vivax can cause severe and even fatal disease, but there is a recent increase in reports over the past 15 years with larger series restricted to a limited number of geographical areas. The biological basis of these variations is currently not known. More detailed epidemiological studies are needed which dissociate causation from association to refine the definition and estimate the prevalence of severe vivax malaria. © 2014 Rahimi et al.; licensee BioMed Central.


Von Seidlein L.,Mahidol Oxford Tropical Medicine Research Unit MORU | Dondorp A.,Mahidol University | Dondorp A.,University of Oxford
Expert Review of Anti-Infective Therapy | Year: 2015

The emergence and spread of antimalarial resistance has been a major liability for malaria control. The spread of chloroquine-resistant Plasmodium falciparum strains had catastrophic consequences for people in malaria-endemic regions, particularly in sub-Saharan Africa. The recent emergence of artemisinin-resistant P. falciparum strains is of highest concern. Current efforts to contain artemisinin resistance have yet to show success. In the absence of more promising plans, it has been suggested to eliminate falciparum malaria from foci of artemisinin resistance using a multipronged approach, including mass drug administrations. The use of mass drug administrations is controversial as it increases drug pressure. Based on current knowledge it is difficult to conceptualize how targeted malaria elimination could contribute to artemisinin resistance, provided a full treatment course is ensured. © 2015 Informa UK, Ltd.


Cooper B.S.,Mahidol Oxford Tropical Medicine Research Unit MORU | Cooper B.S.,University of Oxford | Boni M.F.,University of Oxford | Pan-ngum W.,Mahidol University | And 11 more authors.
PLoS Medicine | Year: 2015

Experimental treatments for Ebola virus disease (EVD) might reduce EVD mortality. There is uncertainty about the ability of different clinical trial designs to identify effective treatments, and about the feasibility of implementing individually randomised controlled trials during an Ebola epidemic.A treatment evaluation programme for use in EVD was devised using a multi-stage approach (MSA) with two or three stages, including both non-randomised and randomised elements. The probabilities of rightly or wrongly recommending the experimental treatment, the required sample size, and the consequences for epidemic outcomes over 100 d under two epidemic scenarios were compared for the MSA, a sequential randomised controlled trial (SRCT) with up to 20 interim analyses, and, as a reference case, a conventional randomised controlled trial (RCT) without interim analyses.Assuming 50% 14-d survival in the population treated with the current standard of supportive care, all designs had similar probabilities of identifying effective treatments correctly, while the MSA was less likely to recommend treatments that were ineffective. The MSA led to a smaller number of cases receiving ineffective treatments and faster roll-out of highly effective treatments. For less effective treatments, the MSA had a high probability of including an RCT component, leading to a somewhat longer time to roll-out or rejection. Assuming 100 new EVD cases per day, the MSA led to between 6% and 15% greater reductions in epidemic mortality over the first 100 d for highly effective treatments compared to the SRCT. Both the MSA and SRCT led to substantially fewer deaths than a conventional RCT if the tested interventions were either highly effective or harmful. In the proposed MSA, the major threat to the validity of the results of the non-randomised components is that referral patterns, standard of care, or the virus itself may change during the study period in ways that affect mortality. Adverse events are also harder to quantify without a concurrent control group.The MSA discards ineffective treatments quickly, while reliably providing evidence concerning effective treatments. The MSA is appropriate for the clinical evaluation of EVD treatments. © 2015 Cooper et al.


PubMed | Martin Luther University of Halle Wittenberg, Mahidol Oxford Tropical Medicine Research Unit MORU and Bill and Melinda Gates Foundation
Type: Journal Article | Journal: PLoS medicine | Year: 2017

In a Perspective accompanying Abad-Franch and colleagues, Lorenz von Seidlein, Alexander Kekul, and Daniel Strickman discuss the importance of developing effective strategies to minimize mosquito-borne transmission of human diseases.

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