News

New analysis finds 15% fall in qualified FTE GPs across England

lshkb29 — Wed, 04 Sep 2024 09:54:32 +0000

New analysis finds 15% fall in qualified FTE GPs across England by lshkb29 Wed, 09/04/2024 - 10:54

Over the past decade, the number of NHS general practices in England has decreased by 20% with 15% fewer qualified full time equivalent (FTE) general practitioners (GPs) per 1000 patients, while the average practice patient list size has increased by 40%, according to an analysis published in BMJ Open.

The study, which combined data from NHS England, the Office for Health Improvement and Disparities, and the Care Quality Commission, was funded by the National Institute for Health and Care Research. It revealed significant structural changes in English NHS general practice between 2013 and 2023 and was led by researchers at the London School of Hygiene & Tropical Medicine (LSHTM) and University College London (UCL).

The findings showed that from 2013 to 2023, the number of people registered with an NHS general practice in England grew by 11%, with a temporary slowdown during the COVID-19 pandemic.

Over the same time period, the number of NHS general practices fell by 20%, while the average practice patient list increased by 40%. The proportion of practices with over 20,000 registered patients rose from 1% to 6%.

While the total number of qualified GPs working in NHS general practice in England rose from 34,474 to 36,492, after taking working hours into account, the full time equivalent (FTE number of qualified GPs fell from 27,948 to 27,321. Factoring in population growth, the average number of GPs fell from 0.53 to 0.45 for every 1000 patients, representing a fall of 15%. Nursing numbers remained stable.

The analysis showed a move towards practices having more administrative and multidisciplinary staff between 2015 and 2022, with the total FTE general practice and primary care network workforce per 1000 patients increasing by 20%.

The authors also found roles across general practice were predominantly filled by women and that around 1 in 4 GPs completed undergraduate training overseas, mostly in low- or middle-income countries.

The researchers warned that falling FTE GP numbers could lead to a tipping point where most general practice appointments are no longer delivered by GPs. They say that the impact of a shift towards larger practices and a diversified workforce on care quality and cost-effectiveness remains uncertain.

Dr Luisa Pettigrew, lead author of the study, a GP and NIHR Doctoral Research Fellow at LSHTM, said:

“Although GP trainee numbers are rising, the new government must also prioritise GP retention. While the headcount of GPs in NHS general practice has marginally increased, when you factor in reported working hours and the growing population the total number of full-time equivalent GPs per 1000 patients working in NHS general practice has fallen.

“Trends point to a changing role for the GP partner, from a self-managing owner of a small business to holding responsibility for the governance of a much larger organisation and multidisciplinary team.

“General practice in England appears to be in a period of transition, from the smaller partnership-based model of general practice to that of larger organisations with more administrative and multidisciplinary staff but fewer GPs. However, patients are struggling to get appointments; concerns have been raised regarding the safety of introducing new roles without adequate supervision; and we are now facing the lowest ever levels of public satisfaction with general practice recorded.”

Irene Petersen, Professor of Epidemiology and Health Informatics at UCL, said:

“Our study highlights the importance of integrating data from multiple sources to gain a comprehensive understanding of the situation in NHS general practice across England.”

Appointment data, available from 2018 onwards, does not capture activities such as reviewing routine correspondence, prescriptions or results, or other general practice work such as staff supervision, management and quality improvement work. Online consultations may also not have been consistently captured in the appointment data.

Publication

Pettigrew LM, Petersen I, Mays N, et al. The changing shape of English general practice: a retrospective longitudinal study using national datasets describing trends in organisational structure, workforce and recorded appointments. BMJ Open. doi: 10.1136/bmjopen-2023-081535

Image

Introduction

Study of general practice data over past decade suggests a shift towards larger multidisciplinary practices with fewer full time equivalent GPs, amid growing patient lists

£2.8m funding boost to investigate hidden malaria in India

lshpw5 — Tue, 27 Aug 2024 10:18:23 +0000

£2.8m funding boost to investigate hidden malaria in India by lshpw5 Tue, 08/27/2024 - 11:18

Researchers at the London School of Hygiene & Tropical Medicine (LSHTM) have been awarded £2.8m to study factors sustaining malaria transmission in an area of India where infections are evading detection.

The team will investigate malaria in the eastern tribal state of Odisha, where asymptomatic infections and those that cannot be spotted through microscopic examination help maintain a reservoir of this parasitic disease.

They will also evaluate biomarkers associated with malaria infections to inform the design and implementation of new interventions and diagnostic tools, furthering the goal of malaria elimination across India.

Malaria in India has been declining since the early 2000s. Cases have gone down from 20 million in 2000 to 5.6 million in 2019, according to the WHO World Malaria Report 2020. Despite this, the burden of malaria in Odisha has remained stubbornly high compared to other states in the country.

In collaboration with the Indian Council of Medical Research and the Community Welfare Society Hospital, LSHTM researchers and partners will carry out a community-based study of 3,000 people to investigate why malaria-causing Plasmodium infections persist across three districts of Odisha, each of which has a distinct ecology and malaria transmission settings.

The five-year project will focus on the prevalence and impact of submicroscopic and asymptomatic infections, understanding how infections are evading diagnosis, measuring human-to-mosquito transmission through antibody levels, monitoring non-Plasmodium falciparum species, and evaluating changes in mosquito vector dynamics and insecticide resistance.

The U.S. National Institute of Allergy and Infectious Diseases (NIAID) is funding the project as part of its International Centres of Excellence for Malaria Research (ICEMR) programme.

Dr Sam Wassmer, co-director of the Malaria Centre at LSHTM and co-director of the new India ICEMR programme, said: "Previous research as part of this programme has generated extensive data showing there is a considerable burden of infections that are not detectable by microscopy, or do not lead to symptoms in malaria-endemic regions in India. These hidden reservoirs perpetuate malaria parasite transmission locally.”

“In addition, research from our team has shown a high occurrence of diagnostic escape in the region, when using rapid diagnostic tests. Malaria parasites have evolved to stop shedding the protein used to detect them in the blood of patients, jeopardising their chance of being diagnosed accurately and treated.

“Deciphering the factors driving the maintenance of malaria infections and reservoirs is key for designing innovative strategies tailored to different transmission settings and supporting malaria elimination efforts locally.

“The particular convergence of threats to malaria elimination is unique to Odisha within India but is highly relevant to other endemic countries facing similar challenges.”

Dr Sanjib Mohanty, a senior physician based at the Community Welfare Society Hospital in Rourkela, and co-director of the programme, said: "This award will be crucial to better understanding how malaria parasites evade current elimination strategies in different settings in Odisha.

“Through our research projects and the training of a new generation of malaria scientists, the India ICEMR will support future steps in the fight against malaria in India.”

Read more about this programme research here (NIH award number 1U19AI181587-01).

Image

Introduction

NIAID grant will enable LSHTM researchers to examine why cases persist despite elimination efforts

Mpox: what our experts are saying

lshpw5 — Fri, 23 Aug 2024 13:35:35 +0000

Mpox: what our experts are saying by lshpw5 Fri, 08/23/2024 - 14:35

On 14 August 2024, the WHO Director-General declared that the upsurge of mpox in the Democratic Republic of the Congo (DRC), and a growing number of countries in Africa, constitutes a Public Health Emergency of International Concern (PHEIC).

Since the news broke, experts from the London School of Hygiene & Tropical Medicine (LSHTM) have been working with the global media to provide accurate, up-to-date information on what mpox is, why the current outbreak is of concern, and what steps could help to prevent the spread of infection.

Read our experts commenting on the WHO announcement.

So far, LSHTM experts have featured in over 2,200 items of media coverage about the mpox outbreak, including print, online, TV and radio, and podcasts.

Michael Marks, Professor of Medicine at LSHTM and Honorary Consultant in Infectious Diseases at the Hospital for Tropical Diseases, University College London Hospital, provided extensive comment and briefing for The Guardian’s First Edition newsletter.

Professor Marks told The Guardian that the current outbreak “is far and away the biggest outbreak of mpox ever, with quite a high fatality rate… It’s not likely to lead to a COVID-19 style pandemic. There will be concerns about its spread in countries with more resources, but it’s chiefly going to be a problem in the region.”

He highlighted the vital importance of getting vaccines to where they are needed on the frontline: “There hasn’t been a release of adequate funding or vaccination to control this in the most affected countries… The teams in DRC are very experienced, and with the right resources, they can handle it. But what’s required is vaccine access.”

Speaking on the Evening Standard’s Tech & Daily Podcast, Professor Marks directly addressed the concerns people in the UK might have, he said:

“The risk to listeners, I suspect, is very small, unless they’re planning to travel to an area where there is an outbreak. They may be able to access vaccination before they travel. Really because transmission is predominantly through direct skin to skin contact with individuals with the rash, it’s about avoiding that direct contact with those individuals.”

While in an interview for The Independent’s ‘Debunked’ podcast he commented on false claims attempting to link mpox to other vaccines, such as those for COVID-19, he said:

“The outcome of disinformation will be pretty minimal, probably, for the people spreading the disinformation but could be catastrophic for the populations most at risk, who stand most to benefit from vaccination.”

Professor Marks commented for numerous other media outlets including Mail Online, FT, LA Times, Fortune, The Hindu, BBC Africa, ABC News, Al Jazeera, Mirror, and The Metro.

Much of the media coverage sought to explain the differences between the two main ‘clades’, or variants of mpox, with clade II responsible for the previous 2022 outbreak, which began circulating in West Africa, and clade I behind the current outbreak in DRC.

In an interview with Sky News, Emma Thomson, Clinical Professor of Emerging Viruses at LSHTM and The University of Glasgow, said:

“In 2022, we saw mpox in the UK and that occurred largely as a result of sexual transmission and also direct contact transmission. There were more than 3,000 cases in the UK in 2022.

“This Clade I virus is more concerning because it has been expanding very rapidly, it appears to be more transmissible and it’s associated with a higher mortality rate.”

In a live interview with the BBC News channel, Emeritus Professor Jimmy Whitworth from LSHTM said:

“There is a great danger that this can spread widely throughout Africa… It does seem that it has been able to evolve so that it can transmit from person to person than previous forms of the mpox virus.

“In terms of what can be done on the ground at the moment, I think [we should be] engaging with the population so that they’re aware about this and what they can do in terms of reporting if they have any symptoms and avoiding unprotected sex, close contact with strangers and crowded places. It’s important that healthcare workers are also aware about what they need to provide good clinical care for people who are infected.”

In comments that were reported across a range of media outlets, including Newsweek, Professor Whitworth said:

“These declarations amount to a call for action, and should lead to the prompt mobilisation of money and resources, and a coordinated international response to the epidemic.

"The amount of vaccine required has been estimated by Africa CDC to be 10 million doses. The cost and availability of vaccine is going to be a great challenge, but it is really important that, unlike in the COVID-19 pandemic, there is global solidarity, that the vaccine reaches the people who need it most and that it is not stockpiled by rich countries."

Professor Whitworth also did a series of live interviews for BBC radio and was quoted in outlets including The i and Evening Standard.

In comments provided ahead of the WHO declaration, David Heymann, Professor of Infectious Disease Epidemiology at LSHTM, told Mail Online:

“Person-to-person transmission is now occurring and if persons with infection travel to other countries, the same situation regarding smallpox vaccination exists... outbreaks of person-to-person transmission could occur.

“Though the world joined together for mpox outside Africa, the situation in Africa continues to be neglected at a risk to persons in DRC.”

In a further comment alluded to in the article he shared his concerns about what will happen next: “The question post smallpox eradication remains: will mpox fill the epidemiological niche left by the eradication of smallpox?”

Image

Introduction

LSHTM experts have been commenting in the media on the outbreak of a new strain of mpox. We highlight key points from the coverage.

Lack of climate action could see Europe’s heat-related deaths triple by 2100, study suggests

lshkb29 — Thu, 22 Aug 2024 08:42:56 +0000

Lack of climate action could see Europe’s heat-related deaths triple by 2100, study suggests by lshkb29 Thu, 08/22/2024 - 09:42

Deaths from extreme heat could triple in Europe by 2100 under current climate policies, mostly among people living in southern parts of the continent, according to a new study published in The Lancet Public Health.

The findings highlight the need to strengthen policies that limit global warming to protect vulnerable regions and communities from the effects of higher temperatures.

In recent years, Europe has experienced some of its hottest summers which have coincided with high mortality rates. Elderly people face a greater risk of death from extreme temperatures and the number of people reaching old age is projected to increase over time.

Previous studies predicting health risks of hot and cold temperatures in Europe have contained little local-level data and have largely focused on individual countries, predominantly in Western Europe. The study, led by researchers from the Joint Research Centre (JRC) at the European Commission in partnership with the London School of Hygiene & Tropical Medicine (LSHTM), provides the first in-depth analysis of the current and future health risks from hot and cold temperatures between regions within countries across Europe.

Data from 1,368 regions across 30 European countries were used to model the current differences in deaths from hot and cold temperatures. The researchers then modelled the mortality risk of different age groups (from 20 to over 85 years) and produced estimates of current and future temperature-related deaths for four levels of global warming (1.5°C, 2°C, 3°C and 4°C) to estimate how risks could change by 2100.

The analysis revealed that temperature-related deaths are projected to rise by 13.5% with 3°C global warming, leading to 55,000 more deaths each year, driven by an increase in deaths from heat. Most deaths will be among people aged over 85 years.

Overall, with 3°C global warming – an upper estimate based on current climate policies – the number of heat-related deaths in Europe could increase from 43,729 to 128,809 by the end of the century. In the same scenario, deaths attributed to cold – currently much higher than from heat – would remain high with a slight decrease from 363,809 to 333,703 by 2100.

Hotspots that will be particularly affected by greater warming and increasingly elderly populations include Spain, Italy, Greece and parts of France.

Dr Pierre Masselot, Assistant Professor in the Environment and Health Modelling Lab at LSHTM, and co-author of the study, said:

“After the heat-related death tolls of the last two years in Europe, this research shows that this trend will only continue to increase.

“It is clear that the Mediterranean area is particularly vulnerable and that, in a world that is now reaching a global warming of 1.5°C, radical climate mitigation policies that the EU can lead on are more urgent than ever, to reduce the burden on public health systems and protect populations at risk.”

Dr David García-León of the JRC at the European Commission and lead author of the study said:

“We find that deaths in Europe from hot and cold temperatures will rise substantially as many more heat-related deaths are expected to occur as the climate warms and populations age, while deaths from cold decline only slightly in comparison.

“Our study also identifies hotspots where the risk of death from high temperatures is set to drastically increase over the next decade. There is a critical need for the development of more targeted policies to protect these areas and members of society most at risk from temperature extremes.”

The results are based on data on people living in urban areas, who typically face higher levels of temperature stress so overall estimates may be lower. Further research is also needed to account for gender, ethnicity, or effects on other vulnerable groups such as infants. The authors hope the findings are used in combination with local indicators of vulnerability to improve climate adaptation policies in Europe and avoid further disparities in public health.

Publication

David García-León, Pierre Masselot, Malcolm N Mistry, Antonio Gasparrini, et al. Temperature-related mortality burden and projected change in 1368 European regions: a modelling study. The Lancet Public Health. https://doi.org/10.1016/S2468-2667(24)00179-8

This news story is based on an original Lancet Public Health press release.

Image

Introduction

Researchers call for updated policies across Europe to protect the most vulnerable people and areas from the effects of extreme temperatures

Expanding use of pneumococcal conjugate vaccines could save 700,000 children

lshkb29 — Fri, 16 Aug 2024 13:25:09 +0000

Expanding use of pneumococcal conjugate vaccines could save 700,000 children by lshkb29 Fri, 08/16/2024 - 14:25

Utilising pneumococcal conjugate vaccines (PCVs) could save almost 700,000 children’s lives between the time of their introduction to the year 2030, according to a new modelling study. This would be equivalent to the average number of babies born in the UK each year.

The new study, by researchers from The London School of Hygiene & Tropical Medicine (LSHTM) and the National University of Singapore (NUS), suggests that by 2030, PCVs could have prevented around 5% of pneumococcal deaths since their introduction in 2000.

They also found that delays in vaccine roll-out, as well as low coverage achieved in some countries, have resulted in PCVs failing to achieve their full potential in preventing deaths. Increasing the vaccine coverage to levels seen with other vaccines such as the DTP vaccine against whooping cough, tetanus and diphtheria, could prevent an additional 146,000 deaths.

The findings are published in The Lancet Global Health.

PCVs protect children from the dangerous Streptococcus pneumoniae bacterium, which can lead to severe illnesses including pneumonia and meningitis.

The analysis modelled the impact of PCVs given to children aged 5 and under across 112 countries. It updates a previous analysis with new data from low- and middle-income countries that have recently introduced the vaccine, as well as updated vaccine coverage figures.

The research emphasises not only the potential health benefits of utilising the vaccine but also calculates their affordability.

The researchers found that saving a year of a child’s life by using a pneumococcal vaccine would only cost the same as $851USD worth of goods in 2015. This time-point was used to allow the team to compare figures with data published in their previous study in 2019.

Mark Jit, Professor of Vaccine Epidemiology at LSHTM and senior author for the paper, said:

“This study underscores the urgent need to ramp up vaccine coverage worldwide. By working together, we can ensure these lifesaving vaccines reach every child who needs them.”

Cynthia Chen Huijun, Assistant Professor at Saw Swee Hock School of Public Health and the first author on the paper, said:

“The substantial benefits of PCV, through prevention of disease and death, clearly outweigh the costs involved in providing vaccinations to those who need it.”

The study was conducted as part of the Vaccine Impact Modelling Consortium, an international community of modellers providing high-quality estimates of the public health impact of vaccination funded by the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

The modelling assumed level coverage across each country and further research is needed to collect figures on a more localised level, to help tailor potential interventions.

An earlier study by a group of investigators, including LSHTM, that was convened by the World Health Organization (WHO), found that WHO-recommended vaccines have provided the single greatest contribution to improved infant survival over the past 50 years.

Image

Introduction

New LSHTM modelling study estimates lifesaving potential of pneumococcal conjugate vaccines and supports calls for higher vaccine coverage

Expert Comment – WHO declares mpox outbreak a public health emergency

lshkb29 — Thu, 15 Aug 2024 13:17:58 +0000

Expert Comment – WHO declares mpox outbreak a public health emergency by lshkb29 Thu, 08/15/2024 - 14:17

The upsurge of mpox in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC), according to an announcement made by the World Health Organization (WHO).

Mpox is an infectious disease with similar but less severe symptoms to smallpox, including fever, swelling of the lymph nodes, pain and skin lesions. It is transmitted through lesion-to-skin contact, including contact during sexual activity and may be transmitted through respiratory droplets.

The new Clade I virus strain, referred to as Clade 1b, has been identified as having novel mutations and is estimated to have emerged around mid-September 2023. The virus has continued to circulate from human-to-human and more than 15,600 cases of infection have been reported since the beginning of 2024, including 537 deaths.

Reacting to the announcement, Michael Marks, Professor of Medicine at the London School of Hygiene & Tropical Medicine (LSHTM), said:

“Declaring a Public Health Emergency of International Concern (PHEIC) is used to highlight the critical importance of a response, to provide a mechanism for strategic co-ordination and to potentially unlock certain forms of funding which are only available in response to an ‘emergency’.

“It’s clear that this is the largest outbreak of mpox reported from the region. It’s also the largest of the Clade 1 mpox virus, which has traditionally been associated with a higher case fatality rate than Clade 2, which caused the large global outbreak in 2022.

“It’s generally felt that smallpox vaccination provides some protection against mpox. Smallpox vaccination stopped in DRC around the 1980s, so those who are around 40 years old and over may well have been vaccinated, providing them some protection. Children and younger adults would not have been vaccinated and are therefore at higher risk.

“The best available evidence supports a need for pre-exposure vaccination, where people at risk are vaccinated before they come into contact with a case. There is less strong evidence in support of post-exposure vaccination.

“We need a large supply of vaccine so that we can vaccinate those most at risk – in the current outbreak that might be sex workers, children and adults living in areas with many cases. If we want a long term solution, we need to consider broader vaccination of the entire population in areas where mpox outbreaks occur to avoid the risk of future outbreaks also getting so large.

“We also need to distinguish between known cases and all cases. We know that not all cases are being detected among adults and children. Children are likely at higher risk of getting sick or having a severe illness and it is therefore not implausible that most cases in children get detected but a larger proportion of cases in adults, where symptoms may be more mild, are missed. We can only find out if reported case numbers are truly representative through better surveillance.

“Traditionally, outbreaks are viewed through the lens of global health security. If it isn’t impacting high income countries, even if an outbreak is very bad, there will likely be insufficient funding. If we looked at it through the perspective of health as a human right, we would already be providing vaccines and interventions to mpox-affected countries, not to prevent emergencies but because people deserve a right to healthcare.

“It’s clear current mpox control strategies aren’t working and there is an urgent need for more resources including people, money and vaccines.”

Dorien Braam, Assistant Professor in Social Science at LSHTM and member of the UK-Public Health Rapid Support Team (UK-PHRST), said:

“We don’t currently have enough data at community level to determine exact risks and vulnerabilities for transmission. However, we know that people with existing infections or underlying issues affecting the immune system are more vulnerable. Health inequalities through a lack of access to health services, medication or endemic diseases also make people vulnerable, including children, who constitute a majority of community-transmitted cases in some parts of DRC and Burundi.

“As one of the possible transmission routes is directly from animals to humans, we need to tackle this with a ‘One Health’ approach to monitor potential non-human animal hosts and reservoirs such as rodents and non-human primates. Collaboration across different sectors proved very effective during COVID-19, when veterinary services and laboratories supported surveillance and diagnostics. By engaging and supporting community animal health workers, who are embedded and closely connected in the communities they serve, gaps in surveillance and underreporting can be addressed.

“To be effective, any interventions and public health messaging must be introduced with community engagement firmly built in. More in-depth social science approaches would also address knowledge gaps through assessing contextual risks and vulnerabilities, and developing a more participatory engagement with communities, who can play an important role in surveillance and as first responders, provided they are supported to do so.

“Faced with a global shortage of mpox vaccines, international collaboration is also crucial, to address global health inequalities and promote the fair sharing of limited supplies.”

Jimmy Whitworth, Emeritus Professor of Epidemiology at LSHTM, said:

“The current epidemic of Clade 1b mpox in eastern Democratic Republic of Congo and neighbouring countries is very concerning, and it is to be welcomed that Africa Centres for Disease Control (Africa CDC) and the World Health Organization have declared this to be a public health emergency.

“These declarations amount to a call for action and should lead to the prompt mobilisation of money and resources, and a co-ordinated international response to the epidemic.

“The epicentre of the epidemic in South Kivu is undergoing a protracted humanitarian crisis and getting the necessary facilities in place for surveillance, diagnostic testing, contact tracing and case management, is going to be very challenging.

“The amount of vaccine required has been estimated by Africa CDC to be 10 million doses. The cost and availability of vaccine is going to be a great challenge but it is really important that, unlike in the COVID-19 pandemic, there is global solidarity, that the vaccine reaches the people who need it most and that it is not stockpiled by rich countries.

“This is a real challenge for the global health security community to demonstrate that they can work together for global public good and not for narrow national interests. Let us hope they take that opportunity, otherwise we risk this epidemic spreading across the African continent, and possibly beyond.”

Image

Introduction

LSHTM experts react to the World Health Organization’s highest level of alert for the ongoing mpox outbreak within parts of Africa

Expert Comment – Why open water swimming could leave you unwell

lshkb29 — Wed, 14 Aug 2024 08:07:53 +0000

Expert Comment – Why open water swimming could leave you unwell by lshkb29 Wed, 08/14/2024 - 09:07

Professional swimmers who compete in open water events, such as at the Paris 2024 Olympics, and those who swim for leisure in rivers, lakes and the sea, may be at risk of experiencing health issues.

While symptoms will generally be mild to moderate and resolve on their own, microorganisms found in open water can cause gastrointestinal illnesses or stomach bugs, as well as respiratory, skin, ear and eye infections. There is also a risk of more severe infections caused by organisms including drug-resistant strains of E. coli or other pathogens, which can be harder to treat.

During the Paris Olympics, water quality in the River Seine was a recurring issue as officials contended with heavy rainfall and had to closely monitor safety for triathlon competitors. An outbreak of Cryptosporidium also recently occurred in the UK, believed to have been caused by water system failures.

According to the UK Health and Security Agency (UKHSA), swimmers can take practical measures to reduce the risk of illness, including minimising how much water they swallow, showering soon after swimming and washing hands before eating.

Dr Jackie Knee, Assistant Professor of Environmental Health and Microbiology in the Department of Disease Control at the London School of Hygiene & Tropical Medicine (LSHTM), said:

“It’s important to understand that open water swimming or sports in rivers, lakes and the sea, particularly those subject to sewer overflows and pollution by untreated or partially-treated human or animal waste, carries additional health risks compared with using swimming pools that are properly treated and managed.

“Those that swim or bathe in untreated water are at risk of contact with untreated or partially treated sewage, which can lead to outbreaks of gastrointestinal illness. A large-scale example of this is the gastrointestinal illness experienced by hundreds of open-water swimmers at an event in the River Thames in October 2012.

“Contact with water contaminated with waste poses a risk as it can contain a range of enteric pathogens that can cause mild to severe illness. These include viruses such as norovirus, bacteria such as Salmonella and pathogenic strains of E. coli, and parasites such as Cryptosporidium.

“Some of these pathogens can also be resistant to common treatments including antibiotics, making infections harder to treat. While ingestion is of primary concern, some illnesses can even occur through skin or eye contact, or inhalation.

“A common method used to monitor the quality of environmental and drinking water is to test for the presence of ‘faecal indicator bacteria’ like generic E. coli, a very common bacteria found in the gut of humans and mammals that typically causes little to no harm. Higher than normal levels of E. coli detected in natural waters, like rivers, may indicate a pollution event has occurred.

“To better understand the risks associated with open water swimming, sports or bathing, it would be necessary to measure levels of not only faecal indicator bacteria, like generic E. coli, but also the additional pathogens known to cause harm.

“Ultimately, what prevents illness from contaminated water is more effective monitoring, enforcement of safe swimming areas and investment in effective waste management and infrastructure, so that these overflows and contamination events occur far less frequently.”

Image

Introduction

LSHTM environmental health expert explains why some may experience illness after swimming in rivers, lakes and the sea

Expert Comment – Oropouche outbreak across South America

lshpf1 — Fri, 02 Aug 2024 15:50:00 +0000

Expert Comment – Oropouche outbreak across South America by lshpf1 Fri, 08/02/2024 - 16:50

Two people have died following an outbreak of Oropouche, and authorities are investigating concerns about potential harm to foetuses from the virus.

According to the Pan American Health Organization (PAHO), as of July 16, 2024, there have been 7,688 confirmed cases of Oropouche virus reported across five countries in the Americas: Bolivia, Brazil, Colombia, Cuba, and Peru. Brazil accounts for 90% of these cases.

The two reported deaths are the first to be attributed to Oropouche infection. Brazilian Public health authorities are also investigating whether nine cases of miscarriage, foetal deaths and congenital abnormalities are potentially related to the virus. Oropouche is an arbovirus, spread to people primarily through the bite of infected biting midges. Some mosquitoes have also been known to carry the virus. Other arboviruses include dengue, Zika and chikungunya.

Infected individuals will typically experience a fever illness three to eight days after infection. Common symptoms include a rash; headache; muscle or joint pain with weakness. In some cases, individuals may also experience gastrointestinal symptoms and sensitivity to light. Severe cases are rare but can lead to neurological symptoms, similarly to meningitis or meningoencephalitis.

Patients usually recover well, but muscle pain and weakness has been reported to last for up to one month for some individuals. Estimating the rate of asymptomatic infections is challenging but one study has reported that up to 63% of patients exhibit symptoms.

The Oropouche virus was first isolated in 1955 in Trinidad and has since been found circulating in the Amazonian region, causing sporadic cases and several outbreaks. While most outbreaks have occurred in Brazil, the virus has also been reported in Peru, Panama, and more recently in Ecuador, French Guiana and Colombia.

The pathogenesis of Oropouche infection, how it develops into the disease and severe cases, is poorly understood, and the morbidity and mortality associated with infection may be underestimated.

As of the second half of 2023, reports of infection in both human and non-human hosts suggest the virus is expanding geographically into new areas due to a range of possible factors including climate change.

Associate Professor Enny Paixao from the Centre for Epidemic Preparedness and Response at the London School of Hygiene & Tropical Medicine, said:

“There is much we still do not know about the Oropouche virus but one of the main concerns arising from the current outbreak is its potential harmful effects on unborn foetuses.

“In July 2024, the Pan American Health Organization (PAHO) issued an alert regarding the potential transmission of the Oropouche virus from mother to child in Brazil. Some very limited studies have suggested that antibodies against the virus have been found in children born with microencephaly and that there may be a link between infection, miscarriage, and foetal deaths, but further research is needed to investigate a potential causal link.

“The current outbreak does not yet show the same level of abnormalities in newborns as the Zika epidemic. However, the risks of Oropouche virus infection to foetal development remain uncertain and require closer scrutiny.

“Several factors may explain the recent outbreak, including enhanced surveillance, climate and environmental changes, and potential changes to the virus.

“Similarly to other vector-borne diseases such as dengue, climate change may also be impacting Oropouche virus expansion. Changes to temperature and precipitation can affect transmission, for example, rising temperatures can enhance the rate of development of Culicoides midges, one of the virus’ main transmission vectors alongside mosquitos.

“Previous studies have linked Oropouche outbreaks to increased agricultural activities, highway and road development and bridge construction. These activities disrupt ecosystems by causing population migration, vegetation loss (such as deforestation and illegal mining) and changes in agricultural practices. These changes can alter the distribution of wild animal reservoirs and vectors.

“A recent study also indicates that the main Oropouche virus circulating in 2023-2024 exhibits significantly higher replication in mammalian cells compared to older strains. While it remains unclear if this increased replication leads to greater transmissibility by its vectors, it could help explain the recent rise in cases.

“Surveillance for Oropouche infection is challenging, as there is overlap of symptoms with other co-circulating arboviruses like dengue, Zika and chikungunya. It’s also important to note that the reported figures are based on laboratory-confirmed cases and taking into account that some individuals will not experience symptoms or seek health care, it’s likely that the true number of infections is much higher.

“Therefore, it is plausible that the increased number of cases and enhanced surveillance are bringing rare events, including deaths, to light. The same principle applies to the potential harmful effects on unborn children.

“Although Oropouche virus is not new to Brazil, the factors driving the recent sharp increase—including reported deaths and potential foetal harm—highlight the need for further investigation. Until advancements are made in vaccine development or mosquito and midge control, or until natural immunity within the population increases, the challenge posed by this neglected tropical disease will persist.”

Dr Paixao works closely with partners in Brazil on her research including researchers from the Centro de Integração de Dados e Conhecimento para a Saúde (CIDACS) at the Gonçalo Moniz Institute, Fundação Oswaldo Cruz; and the Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil.

Image

Introduction

LSHTM expert explains what scientists know so far about the virus following the World Health Organization’s outbreak alert across South America

Scent research inspires bed bug trap

lshpf1 — Wed, 31 Jul 2024 08:14:04 +0000

Scent research inspires bed bug trap by lshpf1 Wed, 07/31/2024 - 09:14

Scientists at London School of Hygiene & Tropical Medicine (LSHTM) spinout Arctech Innovation have used their in-depth knowledge of insects, chemistry and odour to develop a new trap for bed bugs.

The BugScents™ Sentry device is the culmination of over a decade of collaborative research and development led by company co-founders Professor James Logan and Professor Mary Cameron. They set up the enterprise while working together at LSHTM as medical entomologists focused on tackling vector-borne disease.

Bed bug bites can cause reactions ranging from minor irritation to severe allergic hypersensitivity. They are a pest of significant public health importance and a growing global economic problem, infesting homes, hotels and transport.

During hundreds of experiments in the labs at LSHTM and Arctech Innovation’s ‘Pest Pod’ testing facility, the team studied bed bug behaviour and the chemicals in their scent to create new solutions for pest control and public health.

The work on bed bugs was a catalyst to developing an odour discovery platform, Semeion IQ®, which now uses artificial intelligence (AI), combined with analytical chemistry and insect olfaction (sense of smell), to speed up their ability to detect and decode scent patterns. This is enabling them to adapt the technology to sniff out other pests beyond bed bugs, or smell changes in human body odour which may indicate they have a disease, like malaria.

Professor Logan, CEO of Arctech Innovation, said: “For every one of us, there are almost a billion insects that transmit more than 17% of infectious diseases. Many insects, such as bed bugs and mosquitoes are increasing and spreading their range because of climate change and resistance. So that means that we’re living in their world. We’ll never get rid of every pest and we’ll never get rid of every disease. We need to live smarter in a bug’s world.”

The BugScents™ Sentry trap works by luring bed bugs with the scent in the chemical substance, known as an aggregation pheromone, which they release naturally to signal to other bed bugs to gather together. A professional version of the trap, BugScents™ Sentry Pro, has also been launched for pest controllers, designed for year-long use as a monitoring solution.

The reusable trap is slimline so it can be placed under a mattress, with specially-designed channels which act like corridors to take advantage of the fact bed bugs are thigmotactic (they like to follow an edge). Once encouraged inside, they stick to the sticky roof. The trap allows individuals or businesses, such as hotels, to check if they have an infestation and need to call in pest control professionals, or to give peace of mind.

BugScents™ Sentry bed bug trap. Credit: Arctech Innovation

It all began around 2010, when Professor Logan and Professor Cameron teamed up with colleagues to solve a bed bug mystery – what caused them to gather together in groups?

Professor Cameron, Professor of Medical Entomology at LSHTM, said: “The hypothesis was that bed bugs produce a pheromone and attract each other. What you tend to find in infestations in houses or hotel rooms is that bed bugs aggregate – you get clumps of them together – so that implies there’s a mechanism which causes that. In the insect world usually it’s down to a pheromone. So that gave us a clue that a pheromone was likely to be involved in the aggregation, but it hadn’t been identified.”

Professor Mary Cameron in lab. Credit: Christian Sinibaldi

Rothamsted Research-based colleague Emma Weeks was awarded funding to study a PhD at LSHTM to find out. She discovered – after multiple experiments involving fitting microelectrodes to the bed bugs’ antennae and measuring their responses – that the answer was a pheromone in their poo.

With this breakthrough, Professors Logan and Cameron realised the potential for working with industry to develop ideas for translating this knowledge into commercial products, for example to lure bed bugs into a trap.

Thanks to financial support including a catalyst grant from LSHTM, the researchers did market research to assess if it was commercially viable, and employed an early career researcher for scientific work to reduce the number of compounds down from the 15 or so found in the relevant attractant pheromone to just two.

Pheromones are volatile, so in order for their new lure extract to work for a trap, the team needed to make sure it released just the right amount of chemical odour and would last long enough. Their solution was to develop a unique formulation and put it into tiny beads. They filed a patent on the two chemicals in a specific ratio that make up the key part of the pheromone.

This was the moment when Professor Logan and Professor Cameron spun out the project as Vecotech to develop it commercially. In 2021, Vecotech merged with ARCTEC, another LSHTM spinout, to form Arctech Innovation.

While happy with their lure recipe, Professor Logan said the team discovered there were problems with some of the existing bed bug traps as it was a challenge to get the insects to go inside.

So the next step was to develop a new trap design, exploiting everything they had discovered about bed bug biology and odour technology.

Professor James Logan filming with bed bugs in lab

Explaining the research and development behind the BugScents™ Sentry trap, Professor Logan said: “Bed bugs like to follow an edge – they are thigmotactic. They feel safe when they’re against an edge. So they follow the seam of a mattress or the edge of a skirting board.

“We exploited that in the trap by creating channels all around the edge of the base so as soon as the bed bug gets there it feels the edge and follows it inside. There’s a slight ramp up into the middle so the roof narrows above them. Instead of putting glue on the bottom which means the bed bugs are likely to turn back as soon as they feel it on their feet, our trap has a sticky ceiling so the bed bugs get their backs stuck there and can’t escape.”

Through the opportunities offered by commercialisation, the scientists have also been able to dramatically speed up the process of detecting and decoding scents by developing an odour discovery platform called Semeion IQ®.

Professor Logan said: “Our first product came from academic research. That allowed us to develop Semeion IQ® which allows us to identify odour signatures really quickly.

“We can now do in a matter of weeks what we were doing in a couple of years before. We combine the analytical chemistry with the insects as biosensors and then we use AI as the insect’s brain to help us decode what’s going on.

“We’ve built a digital odour library so we now know the odour associated with other pests such as cockroaches, silverfish, clothes moths, carpet beetles, and many others, as well as bed bugs.

“With this process we can not only decode the odour, we can also build sensors that detect that odour - tiny gas sensors that can sniff out pretty much anything in the air with algorithms powered by AI.

“We’re essentially building machines that do the job of the insect’s nose. Over the coming months we’ll be putting sensors inside the trap that smell if a bed bug or another pest is present, and send an alert to a phone or computer to tell you there’s an infestation alert and where it is. For example, in a hotel with 500 bedrooms you’ll know where is infested as soon as it happens, so it can be dealt with rapidly.”

Arctech Innovation is now using the same odour-based technology to develop a handheld device for the detection of diseases such as malaria and dengue through changes in human body scent. Proof of concept trials suggest the device can detect malaria with accuracy above 95% and the product is now advancing to validation.

Professor Logan said: “We started with the humble bed bug. But that’s led us to develop and explore a range of other solutions.

“It could be world-changing technology, and it was inspired by nature, inspired by bed bugs and based on the work we’ve done in academic research and through commercialisation.

“Investing in innovation has not only led to useful products on the market but all these other applications which could be life changing.

“There were lots of challenges along the way. As well as having to raise money, we also had to build a supply chain, logistics, sales teams. But I never doubted the science and feasibility; I’ve always believed in it.”

Image

Introduction

LSHTM spinout team combining artificial intelligence with insect biology to develop pioneering technology for pest control and disease diagnostics

Expert Comment – Dengue season in Europe

lshkb29 — Mon, 29 Jul 2024 10:15:10 +0000

Expert Comment – Dengue season in Europe by lshkb29 Mon, 07/29/2024 - 11:15

The ‘tiger mosquito’, Aedes albopictus, is spreading further north, east and west in Europe, according to the European Centre for Disease Prevention and Control (ECDC).

Aedes albopictus carries a number of viruses that can infect humans, including dengue.

While most cases of dengue in Europe are 'imported’, brought in by travellers from dengue-affected regions, there has been a notable increase in locally-transmitted cases, which occur when mosquito colonies become established in European countries.

Concerns have been raised that large scale events, such as the Paris 2024 Olympics, may inadvertently lead to an increase in cases.

Since 2010, when the first outbreak was reported in Croatia, 48 outbreaks have occurred in Europe. A peak in 2023 included eight outbreaks in France, four in Italy and two in Spain.

A second mosquito species, Aedes aegypti, the main carrier of dengue in the Americas, has also become established in Cyprus.

Most people infected with the dengue virus will have no symptoms. Those that do will commonly experience high fever, severe headache, muscle and joint pain, and a rash, which typically subside in 1-2 weeks. There are currently no treatments for dengue infection.

Explaining why cases may be increasing and how we can reduce our risk, Professor Rachel Lowe, a Royal Society Dorothy Hodgkin Fellow at the London School of Hygiene & Tropical Medicine (LSHTM), said:

"There has been a considerable increase in the spread of Aedes albopictus across the globe and into Europe since the late 1990s, mainly through international trade and transportation of goods. Used tyres and bamboo plants, for example, can provide ideal breeding sites for mosquitoes.

"Increased international travel between Europe and areas of the globe where these diseases are endemic may also be playing a role. Climate change is leading to warmer temperatures for longer periods of the year, creating more favourable conditions for the mosquito’s survival and reproduction.

"The European Centre for Disease Prevention and Control coordinates surveillance efforts across Europe, providing risk assessments, guidelines, and support in managing mosquito-borne disease threats. Data from the UK is fed in from the UK Health Security Agency (UKHSA), which conducts active mosquito surveillance particularly at points of entry like ports and airports.

"In the case of outbreaks, rapid response teams will contain and manage cases by eliminating mosquito breeding sites in surrounding areas.

"To minimise their own risk of dengue infection, travellers should try to avoid mosquito bites by wearing long sleeves and trousers, using repellent and ensuring windows and doors have screens. It’s also important to check and eliminate standing water where mosquitoes can breed, such as in plant pots, buckets, and clogged gutters.

"If travellers return from holiday with symptoms such as a fever, rash, join pain or red eyes after being bitten by a mosquito, they should seek medical attention promptly and inform their healthcare provider about their travel history."

Image

Introduction

LSHTM expert explains why dengue cases are expected to rise in Europe, and how monitoring systems and taking precautions while travelling may minimise the risk of infection