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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.
LSHTM researchers have developed four computer models to help decision-makers make evidence-based choices about new vaccines and vaccine schedules. These models analyse the public health impact and cost-effectiveness of different options under different assumptions and scenarios on a country-by-country basis. They are used by national immunisation managers and key decision-makers, international committees and partner organisations (e.g. the Global Alliance for Vaccines and Immunisation and the Bill & Melinda Gates Foundation). LSHTM's researchers have built on this research for WHO, informing global recommendations on vaccine timing and schedules.
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.
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.
Doses of cytotoxic drugs for chemotherapy need to be determined on an individual basis for each patient and are generally calculated using Body Surface Area (BSA). Traditionally, this meant that doses of cytotoxic drugs needed to be prepared at `the bedside', resulting in safety issues, significant wastage and placed an enormous burden on the time of healthcare workers. `Dose-banding' is a system whereby chemotherapy doses, calculated using BSA or other means, are then fitted to pre-defined dose ranges, or `bands'. This system allows for `standard' syringes or infusions to be batch-prepared by the hospital pharmacy, or even pre-prepared and purchased from an external commercial source.
Research at the University of Bath, conducted between 2000 and 2007, pioneered the establishment of dose-banding as a practice and, through its spin-out commercialisation vehicle, Bath Aseptic Services Unit, Ltd. (Bath ASU), demonstrated that the batch production of cytotoxic drugs according to dose-banding is a viable commercial proposition.
Today, dose-banding is accepted around the world as a valid method of dosing cytotoxic therapies and, since 2008, has had a profound economic and social impact on the healthcare sector through improved patient care, changes to purchasing policy and improved health outcomes. In fact, the impact of dose-banding is so significant in the UK that NHS cancer trusts now recommend that dose-banding should be implemented to manage capacity before investing in staff and facilities.
Bath ASU now supplies over 150 NHS hospitals and pharmacies with upwards of 500,000 doses of injectable `specials' per year (supplying around 30% of the entire UK commercial compounding market), employing over 70 full-time staff and currently generating revenues of over £20M per year.
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.
This case study summarises the research undertaken by Professor Sewell at Plymouth University in defining and developing the understanding of dose banding, a method for pre-defining standard dose ranges for Chemotherapy. The introduction of dose banding has improved care for patients by reducing the time patients wait for their chemotherapy infusions, enabling prospective quality control of infusions, optimising the infusion preparation process, and reducing wastage resulting in a more efficient, patient focused service for patients. Dose banding is now part of the professional guidelines produced by regional cancer Networks, and is being used in UK hospitals and increasingly across Europe.