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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.
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 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.
A comprehensive body of research into the effectiveness, cost and distribution of long-lasting insecticidal nets (LLINs) by LSHTM has made a major contribution to the reduction of malaria-related mortality between 2008 and 2013, especially among children in Africa. The research formed the basis of a radically altered strategic approach to combating malaria by WHO and other agencies, and led to the roll-out of malaria campaigns based around LLINs in several African countries. LSHTM research into the technology of LLINs, which also contributed to these developments, is described in a separate case study.
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.
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 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.
Twenty years of comprehensive research into long-lasting insecticidal nets (LLINs) by LSHTM have contributed substantially to the prevention of around 1m deaths from malaria between 2008 and 2013. The research made a direct impact on guidelines and strategies issued by WHO as well as driving new technologies for insecticide-treated nets (ITNs), with downstream commercial benefits. Without the evolution of LLIN technology driven by LSHTM research, the large-scale roll-out of the new generation of nets (described in more detail in the other LSHTM impact case study on this body of research) would not have been possible.
LSHTM researchers carried out the initial trials of intermittent preventive treatment in infants (IPTi), a strategy to improve malaria control in very young children. LSHTM staff were active in setting up and running a dedicated research consortium which developed and executed a research agenda to provide data to inform policy. School staff presented evidence to a series of WHO policy-making meetings which in 2009 recommended that IPTi should be included as part of routine malaria control. This policy, which has been adopted in one country and discussed by eight others, has the potential to benefit hundreds of millions of lives.
Research by LSHTM has put handwashing with soap (HWWS) at the heart of international efforts towards diarrhoeal disease prevention, changing the way good hygiene practices are communicated globally. The research led to the global Public-Private Partnership for Handwashing with Soap (PPPHW), a coalition of stakeholders interested in child health and handwashing, and a billion people have been reached through initiatives such as Global Handwashing Day (GHD). Millions more have benefited from the research through hygiene programmes set up by industry. The risk of death from diarrhoeal disease for those reached by these campaigns has been substantially reduced.