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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.
In 2012, around 19,500 kidney transplant operations were performed in the UK and USA. The greatest infection risk to transplant recipients is from cytomegalovirus (CMV), the standard 2-4 week treatment for which involves an average of 5 days as an inpatient, which can cost up to £13,000. University of Glasgow research has led to revised standards of care for the prevention and treatment of CMV disease in kidney transplant recipients (KTRs). First, that antiviral treatment with oral valganciclovir for 200 days can be used to prevent CMV disease in postoperative KTRs and is twice as effective as treatment for 100 days. Secondly, the team found that the use of oral valganciclovir was a practical and cost-effective alternative to intravenous ganciclovir for treatment of mild CMV disease in solid-organ transplant recipients. Since 2009, the use of these therapies has been recommended in key national and international guidelines for the care of KTRs. The research also provided the evidence base that was used for evaluating, and subsequently amending, the marketing authorisation of oral valganciclovir for use in preventative treatment of CMV disease in KTRs in the UK and USA.
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.
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.
COPD affects up to 3.5 million people in the UK and costs the NHS £700m pa. Over the last 15 years, research by Professor Calverley and colleagues at the University of Liverpool (UoL) has impacted significantly on the care of COPD patients. Specifically, this group showed that routine testing of COPD patients for the presence of bronchodilator reversibility was unreliable and did not predict clinical outcomes. This changed international guideline recommendations in 2007 and the Quality Outcomes Framework payments to GPs in 2009. They showed that oral corticosteroids accelerated recovery from exacerbations and that anti-inflammatory drugs, whether inhaled corticosteroids or PDEIV inhibitors, reduced exacerbations by 25% with a subsequent fall in the number and length of hospitalisations. This led to changed NICE guidance for corticosteroids in 2010 and drug registration with EMA and FDA for the PDEIV inhibitor treatment in 2011. Treatment in UK and Western Europe has changed as a result of this research.
Basic and translational research undertaken since 1993 by UCL Virology has defined the natural history and pathogenesis of cytomegalovirus (CMV) infection and disease. As a consequence of our work, rapid diagnosis and pre-emptive therapy are now available worldwide for this important infection. We have provided a national reference service for strains of CMV resistant to current antiviral drugs and for diagnosis of congenital CMV infection.
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.
Research at the University of Liverpool (UoL) has demonstrated the importance of intestinal tapeworm infection as an important and hitherto unrecognised risk factor for a major life-threatening acute intestinal disease (colic) in the horse. A novel serological test for exposure to the tapeworm infection was developed at UoL to provide a diagnostic tool for research and clinical applications. As a result, "best practice" equine preventive healthcare programmes now include anti-helminth and tapeworm control protocols and anti-tapeworm anthelmintics are licensed for use in the horse and marketed throughout the world. This research has had a major impact on equine health resulting in welfare and economic benefits for horses, their owners, veterinary practices and industry.
Impact: Health and welfare and public healthcare policy; demonstrating that community-directed treatment of onchocerciasis with doxycycline is effective where ivermectin is contra-indicated.
Significance: 12,936 onchocerciasis patients were treated safely and protected for at least 4 years. The treatment regime has been adopted by the US Centers for Disease Control and Prevention, the World Health Organization and governments.
Beneficiaries: Patients with onchocerciasis; governments and policy-makers.
Attribution: Studies performed by a long-standing African-European partnership formed and led by Taylor (UoE).
Reach: International; up to 8 million people in the Congo basin; onchocerciasis patients in Africa where ivermectin is not appropriate plus those in South America participating in focal eradication campaigns.
Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness. Research by Professors David Mabey and Robin Bailey, LSHTM, has shown that a single oral dose of azithromycin is an effective, feasible mass treatment and could eliminate trachoma from affected communities. As a result, the manufacturer Pfizer agreed to donate azithromycin to trachoma control programmes for as long as necessary and WHO established an Alliance for the Global Elimination of Blinding Trachoma by 2020. Since 2008, 205m azithromycin doses have been donated, and WHO elimination targets have been achieved in nine countries.