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Globally the most important cause of encephalitis (inflammation and swelling of the brain) is the mosquito-borne Japanese encephalitis virus (JEV), which causes an estimated 70,000 cases annually across Asia. Although vaccines were developed years ago, their uptake in Asian countries has been hampered through lack of disease burden data, a consequence of poor surveillance, complicated diagnostics, and insufficient knowledge about disease outcomes. Research at the University of Liverpool has addressed each of these areas in turn, to overcome the roadblocks in vaccine implementation. The University of Liverpool (UoL), through its leading role on all the relevant WHO committees groups and meetings, has ensured that its research findings are translated through to impact by supporting new vaccination programmes across Asia. By 2013 vaccination had begun in 11 new countries, and the vaccine had reached more than 200 million people. The public health benefits, estimated from a health economic modelling study, are 854,000 cases and 214,000 deaths avoided, with an associated saving across Asia of US$ 1.024 billion.
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 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).
Professor Rima's research on measles and mumps viruses over 4 decades at Queen's University allowed him to play an important role in re-establishing public confidence in the safety of the measles-mumps-rubella (MMR) vaccine. Claims that MMR vaccine could cause autism in 1998 undermined the vaccine uptake but Rima's expert testimony and that of others established in court that these claims were unfounded. This re-assurance and subsequent promotion of MMR vaccination reduced measles cases in the UK. In the USA, it also reduced the real risk that the Vaccine Court Fund, which compensates vaccinees for genuine vaccine related adverse events, would be bankrupted by over 50,000 claims amounting to between $30-50 Billion.
Viral infections pose a significant risk of long-term disease and death to cats. In Europe alone, over 30 million domestic cats are vaccinated each year against three core pathogenic viruses. Research performed at the University of Glasgow has systematically supported the development of key technologies against major feline viral diseases. This work has delivered incremental but wide-reaching benefits to veterinary healthcare and animal welfare by providing: (i) reagents used in the diagnostic industry; (ii) viral screening services for big cat conservation programmes; (iii) developmental input into the creation of one of the most efficacious and widely used vaccines against feline leukaemia virus; (iv) testing of feline vaccines for efficacy and safety; and (v) development of best practice guidelines and training for veterinary practitioners on feline viruses.
Postweaning multisystemic wasting syndrome (PMWS) had a huge global impact on the swine industry with estimated losses of €5-6 billion/year globally. Allan's team discovered and characterised the agent responsible for clinical development of PMWS (porcine circovirus 2 [PCV2]) and used these discoveries to drive vaccine development. The resultant PCV2 vaccines are the most successful ever produced for veterinary medicine and have: dramatically reduced global losses associated with PCV2 and other infections; improved pig health and welfare; and, reduced antibiotic usage. These vaccines are sold globally under licence and generate ~$600 million/year with 1.5% royalty income to QUB (2004-2018, ~$90 million).
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.
Meningococcal disease (MCD) is a major cause of morbidity and mortality worldwide. Underpinning research by Dr Carrol and colleagues at the University of Liverpool (1997-1999), has led to improved diagnosis and case confirmation, establishing Polymerase Chain Reaction (PCR) of meningococcal DNA as a gold standard test for diagnosis. The result is better management and therefore, impact on health and welfare of patients, and on practitioners. The work was conducted in collaboration with the Meningococcal Reference Unit, which provides a national diagnosis and surveillance service. The test was recommended in NICE guidelines in 2010, thereby impacting public policy.
Recent outbreaks across Europe of Bluetongue, a viral disease particularly affecting sheep, have driven research at LSHTM by Professor Polly Roy and her team, resulting in the Bluetongue virus (BTV) becoming one of the best understood viruses at the structural and molecular levels. The research has ultimately enabled the creation of several promising new vaccines. In addition the Roy group has contributed towards exploiting virus-like particles (VLPs) as a method to produce safe vaccines against human and animal viral pathogen. The most advanced example is a BTV vaccine for livestock, which is manufactured by Boehringer Ingelheim (BI).
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.