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Research undertaken at UCL's Centre for Infectious Disease Epidemiology has provided evidence about vaccination of different groups against influenza which have influenced policy and practice. In particular, our work underpins the government's ongoing policy on vaccination of healthcare workers, and is cited every year in the Chief Medical Officer's letter to healthcare workers as well as international recommendations on influenza vaccination of healthcare workers, including widespread mandatory vaccination programmes in North America. Research on influenza and acute cardiovascular events has informed US recommendations for prevention of stroke through vaccination. Recent work also informed the decision in the UK to extend regular influenza vaccination to children.
Research carried out by the Health Protection and Influenza Research Group (HPIRG), Division of Epidemiology and Public Health, impacted directly on the UK Government's response to the 2009 influenza pandemic, feeding directly into policy-making decisions. The group was appointed as an official WHO Collaborating Centre for pandemic influenza in 2010 and through its related research has "reduced the economic impact on Member States for pandemic preparedness" (quote from reference 7, section 5). In 2011, it secured £7M funding from the US Centers for Disease Control and Prevention (CDC) to lead `once only' work to determine the modes of influenza transmission using a human challenge model.
The work of Professor Ferguson and colleagues at Imperial College on modelling the effect of different intervention measures on the spread and health impact of a new influenza pandemic has substantially shaped UK and international public policy-making over the last 7 years. Prior to 2009, this work shaped UK policy on antiviral and pre-pandemic vaccine stockpiling and use, and on the potential use of school closure and border restrictions during a pandemic. During the 2009 H1N1 pandemic, real-time research provided the first estimates of key epidemiological parameters of the new pandemic virus, demonstrating the low-to-moderate severity and lower than typical transmissibility. In the UK, US and other countries, these data informed public policy decisions to pull back from use of economically costly interventions (such as reactive school closure or antiviral prophylaxis) and focus on targeted use of vaccination as the principal pandemic mitigation measure.
Research conducted by LSHTM into how governments and international organisations are preparing for an influenza pandemic has made an important contribution towards efforts to avoid the risks of up to 150m deaths anticipated by WHO in the event of such a pandemic. Governments, including the UK, and global institutions, have made policy changes and resource allocation decisions directly as a result of this research and technical advice.
Research from the University of Oxford has played a major role in the development of effective vaccines to combat the urgent worldwide problem of influenza. This methodology, licensed to AstraZeneca, has been used to prepare the currently licensed live attenuated influenza vaccine FluMist. Since its introduction in 2006 it is estimated that FluMist or other vaccines produced using reverse genetics have saved the lives of thousands of people worldwide who would otherwise have died from flu and its complications. FluMist has generated close to $1 billion income for the manufacturers (MedImmune, owned by AstraZeneca).
Atrial fibrillation (AF) is the commonest heart rhythm abnormality, affecting around 8.8 million people in the European Union, and confers a substantial risk of stroke and death. It accounts for one third of hospital admissions for cardiac rhythm disturbances, and the rate of AF-related admissions has continued to rise in recent years. The work of Prof Gregory Lip and Dr Deirdre Lane has made Birmingham an internationally-respected centre of excellence for research in AF, delivering crucial impacts in international clinical practice guidelines and improvements in patient care within three main areas: treatment decisions related to stroke and bleeding risk, screening practice in primary care, and stroke and bleeding risk assessment, ultimately reducing morbidity and mortality for a significant proportion of the population, particularly among the elderly.
Researchers in the University of Cambridge's Department of Zoology have developed a new methodology to analyse pathogen evolution. This `antigenic cartography' has led to the group becoming integrally involved in the World Health Organisation (WHO) influenza vaccine strain selection process, and has directly contributed to more accurate and appropriate flu vaccine design, with associated international impacts on disease prevention and public health (the flu vaccine is given to ~350 million people annually). The research has directly affected how public health professionals conduct disease surveillance and sampling.
Research in Oxford by Rothwell and colleagues since 2000 has radically changed how minor strokes and transient ischaemic attacks (TIAs) are managed. First, the risk of a major stroke in days after a minor stroke/TIA was found to be much higher than thought. In consequence, these `warning' events were rebranded as a medical emergency in clinical guidelines. Second, Rothwell showed that a delay in treating individuals at high risk of major stroke substantially reduced the benefits. Third, the Rothwell group developed a simple risk score (`ABCD system') to triage high-risk individuals, showing that more urgent treatment reduced the 90-day risk of major stroke by 80%. This strategy has been implemented in the National Stroke Strategy and NICE and international guidelines. In the UK it is estimated to prevent 10,000 strokes per year, and to save the NHS £200 million in acute care costs alone.
Pioneering interdisciplinary research at the Royal Veterinary College (RVC) has enabled governments internationally and global health authorities to respond swiftly to the outbreak of a disease that causes huge economic losses, threatens the livelihoods of vulnerable populations in the developing world and endangers human lives. Supported by proactive dissemination, it has shaped the control policies and risk management strategies of the United Nations and governments across Asia, Africa and Europe, as well as a national contingency plan for the UK. And it has demonstrated that costly vaccination campaigns and mass culling programmes can be avoided in efforts to bring the disease under control.
Researchers in the Epidemiology Group at the University of Warwick have an international reputation for high-quality mathematical modelling of human infectious diseases, with particular emphasis on population heterogeneity and variability. Such formulations and insights are an important component of predictive modelling performed by Public Health England (PHE), and are helping to shape national policy for a range of vaccine-preventable infections.
The Warwick group was instrumental in providing a range of real-time analyses and advice to UK authorities during the 2009 H1N1 (swine-flu) pandemic, acknowledged by the Department of Health (DoH) to be "fundamental to the construction of the UK's pandemic response" and making an important contribution to the overall programme which "led to the saving of many hundreds of millions of pounds of taxpayers money, while greatly increasing the health of the Nation". Modelling and analysis carried out at Warwick continue to provide insight into the control and containment of future pandemics and are considered "essential in determining UK pandemic policy".