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Research at LSHTM has been central to the introduction of the Hib vaccine in developing countries. School staff were involved in the 1990s Gambia Hib vaccine trial, which demonstrated the impact of Hib vaccine on pneumonia. Through their work on the subsequent Hib Initiative, their research was instrumental in speeding up evidence-based decision-making for Hib vaccine introduction in a number of countries, mainly in Asia and Africa. The project has been an outstanding success, with Hib vaccine now introduced into 71 of the 73 countries eligible for GAVI Alliance support.
A trial of a pneumococcal conjugate vaccine (PCV) coordinated by Greenwood (LSHTM) and conducted in Gambian infants, showed a significant reduction in invasive pneumococcal disease, severe pneumonia, hospital admissions and deaths in vaccinated children. These results played an important role in encouraging WHO to recommend the introduction of a PCV into the routine immunisation programme of all countries with a high child mortality. Fifty-one GAVI eligible countries have now introduced, or made a commitment to introduce, a PCV into their routine infant immunisation programme with the consequent saving of many young lives.
Research conducted by LSHTM has informed the delivery of a 30-year WHO strategy aimed at reducing the devastating burden of liver cancer in Africa and least developed countries in other regions. Studies evaluating the effectiveness of the Gambia Hepatitis Intervention Study (GHIS) - the only randomised trial of a hepatitis B vaccine with a disease endpoint in Africa - have shaped current WHO policy recommendations for vaccinations against the virus, enabling WHO to advise against the need for a booster programme, and protecting governments in the less developed world from significant additional expenditure.
Research by Professor Grassly and colleagues at Imperial College on the epidemiology of poliovirus and the efficacy of new vaccines has played a critical role in the thinking and strategy of the Global Polio Eradication Initiative (GPEI). This research has supported the introduction of new vaccines, guided the timing and location of vaccination campaigns and influenced polio `endgame' policy. This is documented in the GPEI Strategic Plan 2010-2012, where Imperial research informed 2 of the 4 `major lessons' concerning poliovirus epidemiology described in the executive summary that led to changes in the programme. The research has also informed our understanding of mucosal immunity induced by oral poliovirus vaccines, and led to two clinical trials of the potential role of inactivated vaccine to boost mucosal immunity. Results from one of these trials were used to support the recent World Health Organisations (WHO) recommendation for universal vaccination with inactivated vaccine following the switch to bivalent oral vaccine in routine programmes.
Research performed by the University of Oxford has led to increased protection against meningococcal meningitis, through childhood immunisation in the UK and internationally. Around 600,000 infants each year receive meningococcal vaccines, which prevent up to 1,000 cases of meningitis per annum. Research into the immune responses to polysaccharide conjugate vaccines has changed policy by leading to the introduction of new meningococcal C vaccines in early childhood and booster vaccination in adolescents. Oxford University research has also led to the planned use of vaccines against serogroup B meningococcal disease, which have been licensed and recommended for the prevention of disease in high-risk individuals, and broader use is under consideration.
Clinical Trials undertaken by the Oxford Vaccine Group led to the recommended immunisation of three million UK children during the 2009 H1N1 influenza pandemic. This research was also used to inform World Health Organization (WHO) global policy. The 2009 H1N1 influenza pandemic, or "Swine Flu", was first identified in April 2009 and declared a pandemic by the WHO in June 2009. After acquiring two novel flu vaccines for the 2009 H1N1 influenza virus, the UK government approached the Oxford Vaccine Group to provide paediatric data on the safety of each vaccine. Rapidly recruiting 943 children to the study, the Group delivered essential data to the Department of Health prior to the onset of the winter influenza season. In August 2010, the WHO declared the H1N1 pandemic over.
Research by G Favato of Kingston University established that it is cost-effective to vaccinate males against the HPV virus, overturning previous studies that had suggested such vaccination was not cost-effective.
This research was presented to the Italian Agency for Drug Approval (AIFA). As a result, AIFA changed its vaccination policy for HPV, removing its previous restriction of vaccination to females only and approving vaccination also for males.
The Italian regions of Emilia-Romagna and Sicily have now begun voluntary vaccination programmes for males under 26, with economic benefits amounting to €98.9 million. In addition, Emilia-Romagna has introduced a vaccination programme for HIV-infected males under 26, providing health benefits for a high-risk sub-population.
Rotavirus is the leading cause of acute gastroenteritis in infants and young children worldwide, causing 500,000 deaths annually. Prof Cunliffe at the University of Liverpool (UoL) has conducted rotavirus studies in Malawi since 1997, including descriptive epidemiology and the first clinical trial of a human rotavirus vaccine in Africa. Based upon the results of this clinical trial in Malawi, where vaccination was shown to reduce severe rotavirus disease caused by diverse strains by 50%, a global recommendation for rotavirus vaccine use was issued by WHO in 2009. African countries are now introducing rotavirus vaccines into their childhood immunization schedules with introduction in Malawi in 2012.
Research by the Institute of Aquaculture has made a significant contribution to the development of effective fish vaccines, some of which have been commercialised and are used widely within the aquaculture industry. The majority of farmed fish in the UK are vaccinated (44 million salmon and 7.5 million rainbow trout in 2012 alone) with vaccines developed at Stirling, resulting in vast improvements in survival and fish health, and a sustained minimal use in antibiotics through mass vaccination. Vaccines have been developed for all the major farmed species in Europe, and recently the first vaccine for Pangasius catfish in Vietnam (>2 million tonne).
A programme of work undertaken jointly between the UCL Institute of Child Health (ICH) Vaccine Evaluation Laboratory headed by Professor David Goldblatt and the Health Protection Agency (now Public Health England [PHE]) led by Professor Liz Miller, has led directly to the introduction of pneumococcal conjugate vaccines (PCV) into the UK infant immunisation schedule. These vaccines have reduced the burden of invasive disease in the UK saving many lives and reducing morbidity from these devastating infections. This work has also provided the evidence for other countries to introduce PCV with fewer than the originally recommended doses, thus improving cost effectiveness and hastening the implementation of these vaccines worldwide. Goldblatt has also contributed to a WHO programme to roll out PCV in developing countries; by July 2013 this programme had vaccinated around 10 million children.