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Sustained research by the University of Oxford's Mahidol Oxford Tropical Medicine Research Unit in Thailand (MORU) has been the driving force behind the current World Health Organization recommendations for the management of acute and chronic infection in patients with melioidosis. This research has motivated improvements in treatments and provided new strategies to identify at-risk populations, enabling clinicians to make early diagnoses. Melioidosis is a major cause of severe illness in parts of Southeast Asia and there are increasing numbers of cases in India, China, and Brazil.
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.
The research reported here has influenced the Scottish Government's Hepatitis C Action Plans and led to changes in practice in services providing sterile injecting equipment to people who inject drugs (PWID) in Scotland and to reductions in risk behaviours for hepatitis C infection among this population. Specifically, there has been an increase in the availability and uptake of sterile equipment used to prepare and inject drugs and a reduction in sharing of such equipment by PWID. More recent research is beginning to indicate that the changes in Government policy and practice are helping to reduce recent (incident) hepatitis C infections among PWID.
Strathclyde research underpinned formation of the Scottish Chikhwawa Health Initiative (SCHI) in 2006, to deliver tangible health benefits by reducing major causes of disease and death in Chikhwawa, Malawi. Health impact occurred through training of government personnel and community volunteers, combined with increased infrastructure capacity, at health facilities and in the community, producing improvements in water quality, sanitation and communicable disease control. Within the first 2 years of implementation among a population of 5700 people, a 30% reduction in diarrhoeal disease was achieved, and access to safe water improved through increased water points and improved water storage [1]. Initial success saw expansion of the initiative to 150 communities covering a population of 110,000.
Our research identified an epidemic of Acanthamoeba infection amongst UK contact lens wearers, established the epidemiology of infection, introduced improved approaches to contact lens hygiene, developed the most sensitive test to make a diagnosis and discovered a new treatment for established infection. This has impacted on contact lens wearers around the world, forming the basis for guidelines and patient information leaflets, types of contact lens solutions, and treatments for this rare but devastating condition.
Bristol University's School of Veterinary Sciences, a global leader in feline medicine, was the first UK centre to develop and commercially offer polymerase chain reaction (PCR) and quantitative (q) PCR assays to detect a range of feline infectious and genetic diseases. Since 2008 there has been a dramatic increase in the number of qPCR tests performed, with over 35,000 tests carried out between 2008 and 2013. The results of genetic testing have informed breeding programmes and resulted in a reduced prevalence of genetic disorders such as polycystic kidney disease (PKD). The results of testing for infectious diseases have informed diagnosis and treatment modalities and, together with the genetic testing, have contributed to significant improvements in feline health and welfare. This work has also generated commercial income in excess of £1.7M, which has been used to further research into feline infectious and genetic diseases.
Research conducted at the University of Bristol between 2003 and 2012 on the ecology, epidemiology and control of parasitic flies and worms has improved animal health and welfare in the UK and is addressing a major constraint on global food production — animal disease, particularly in the context of climate change. These are some of the impacts:
Impact: Health and welfare; policy in the form of national and international guidelines; diagnostic service; engagement with patient groups.
Significance: UoE-formulated diagnostic criteria adopted by the World Health Organisation (WHO), the European Centre for Disease Prevention and Control (ECDC) and US Centers for Disease Control and Prevention (CDC), enable reliable case ascertainment and longitudinal study of disease trends. The UoE Creutzfeldt-Jacob Disease Unit acts as an international reference centre for diagnosis. Case ascertainment has improved.
Beneficiaries: Patients with prion disease and their families, policy-makers, the NHS, charities.
Attribution: The UoE CJD Unit led the work with international collaborators.
Reach: Worldwide; diagnostic criteria are WHO-endorsed and have been adopted worldwide. Pooling of data across Europe has enabled assessment of 11,000 cases of sporadic CJD.
Our biomarker research and underpinning technologies have commercially impacted upon the global R&D strategies of Unilever, Philips and Mars, realising new market areas for them, resulting in several million GBP invested in related R&D as well as "claim support" for products both in development and already available on shelves. Unilever have adopted biomarker outcomes as endpoints in clinical trials of new products, and Philips and Mars are developing with us saliva-based near-patient diagnostic tests for the human and small animal markets. We have also spun out two SME's: A) Oral Health Innovations (OHI) Ltd has developed online risk and disease analysis software for oral conditions, which was piloted, adopted and launched by Denplan, the UKs largest dental capitation plan operator (accessing 6500 dentists and 1.8 million patients), at the 2013 annual British Dental Association conference; and B) GFC Diagnostics makes SmokeScreen™ a non-invasive, sensitive and objective saliva test developed from our biomarker research at Birmingham University. Both technologies have already provided demonstrable social and commercial impact and given their uptake to date, will also deliver economic, environmental and health impacts.
Researchers from St Georges have evaluated and optimised anti-fungal therapy for cryptococcal meningitis, the commonest cause of adult meningitis in sub-Saharan Africa. They have developed a "screen-and-treat" strategy to prevent the development of clinical disease in HIV-positive patients, and with collaborators developed and tested a novel point-of-care diagnostic test. These advances have led to changes in and development of a series of international guidelines and application of these new strategies in parts of Africa. A case for reduced costs of amphotericin was advanced by the group who were instrumental in reducing these costs in South Africa, allowing wider drug provision.