Uncoupling vaccination from politics: a call to action

Political polarisation in the USA is impeding vaccination of the population against SARS-CoV-2. Today, the lowest COVID-19 vaccination rates in the USA are overwhelmingly in Republican-leaning states and counties. At a time when the delta variant is spreading, these are also the areas experiencing surges in admissions to hospital and intensive care.1 If political divides on COVID-19 vaccination become ingrained, the consequences could include greater resistance to all vaccination and outbreaks of other vaccine-preventable diseases. Understanding and countering this trend are urgent public health priorities

Policy lessons from quantitative modeling of leprosy

Recent mathematical and statistical modeling of leprosy incidence data provides estimates of the current undiagnosed population and projections of diagnosed cases, as well as ongoing transmission. Furthermore, modeling studies have been used to evaluate the effectiveness of proposed intervention strategies, such as postleprosy exposure prophylaxis and novel diagnostics, relative to current approaches. Such modeling studies have revealed both a slow decline of new cases and a substantial pool of undiagnosed infections. These findings highlight the need for active case detection, particularly targeting leprosy foci, as well as for continued research into innovative accurate, rapid, and cost-effective diagnostics. As leprosy incidence continues to decline, targeted active case detection primarily in foci and connected areas will likely become increasingly important

Quantitative analyses and modelling to support achievement of the 2020 goals for nine neglected tropical diseases

Quantitative analysis and mathematical models are useful tools in informing strategies to control or eliminate disease. Currently, there is an urgent need to develop these tools to inform policy to achieve the 2020 goals for neglected tropical diseases (NTDs). In this paper we give an overview of a collection of novel model-based analyses which aim to address key questions on the dynamics of transmission and control of nine NTDs: Chagas disease, visceral leishmaniasis, human African trypanosomiasis, leprosy, soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis and trachoma. Several common themes resonate throughout these analyses, including: the importance of epidemiological setting on the success of interventions; targeting groups who are at highest risk of infection or re-infection; and reaching populations who are not accessing interventions and may act as a reservoir for infection,. The results also highlight the challenge of maintaining elimination 'as a public health problem' when true elimination is not reached. The models elucidate the factors that may be contributing most to persistence of disease and discuss the requirements for eventually achieving true elimination, if that is possible. Overall this collection presents new analyses to inform current control initiatives. These papers form a base from which further development of the models and more rigorous validation against a variety of datasets can help to give more detailed advice. At the moment, the models' predictions are being considered as the world prepares for a final push towards control or elimination of neglected tropical diseases by 2020

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Structure-function relationships of the components of the membrane attack complex of complement

SIGLEAvailable from British Library Document Supply Centre- DSC:D60759 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Sediment Transfer and Geomorphological Evolution in River Systems & Coastal Zones in Italy, Romania and Greece

This work deals with with the comparative account and evaluation of the impact to the environment and especially the changes to the sediments transfer and geomorphological evolution in river systems and coastal zones in Italy, Romania, and Greece

Cost-effectiveness of canine vaccination to prevent human rabies in rural tanzania

Background: The annual mortality rate of human rabies in rural Africa is 3.6 deaths per 100 000 persons. Rabies can be prevented with prompt postexposure prophylaxis, but this is costly and often inaccessible in rural Africa. Because 99% of human exposures occur through rabid dogs, canine vaccination also prevents transmission of rabies to humans.&lt;p&gt;&lt;/p&gt; Objective: To evaluate the cost-effectiveness of rabies control through annual canine vaccination campaigns in rural sub-Saharan Africa.&lt;p&gt;&lt;/p&gt; Design: We model transmission dynamics in dogs and wildlife and assess empirical uncertainty in the biological variables to make probability-based evaluations of cost-effectiveness.&lt;p&gt;&lt;/p&gt; Data Sources: Epidemiologic variables from a contact-tracing study and literature and cost data from ongoing vaccination campaigns.&lt;p&gt;&lt;/p&gt; Target Population: Two districts of rural Tanzania: Ngorongoro and Serengeti.&lt;p&gt;&lt;/p&gt; Time Horizon: 10 years.&lt;p&gt;&lt;/p&gt; Perspective: Health policymaker.&lt;p&gt;&lt;/p&gt; Intervention: Vaccination coverage ranging from 0% to 95% in increments of 5%.&lt;p&gt;&lt;/p&gt; Outcome Measures: Life-years for health outcomes and 2010 U.S. dollars for economic outcomes.&lt;p&gt;&lt;/p&gt; Results of Base-Case Analysis: Annual canine vaccination campaigns were very cost-effective in both districts compared with no canine vaccination. In Serengeti, annual campaigns with as much as 70% coverage were cost-saving.&lt;p&gt;&lt;/p&gt; Results of Sensitivity Analysis: Across a wide range of variable assumptions and levels of societal willingness to pay for life-years, the optimal vaccination coverage for Serengeti was 70%. In Ngorongoro, although optimal coverage depended on willingness to pay, vaccination campaigns were always cost-effective and life-saving and therefore preferred.&lt;p&gt;&lt;/p&gt; Limitation: Canine vaccination was very cost-effective in both districts, but there was greater uncertainty about the optimal coverage in Ngorongoro.&lt;p&gt;&lt;/p&gt; Conclusion: Annual canine rabies vaccination campaigns conferred extraordinary value and dramatically reduced the health burden of rabies.&lt;p&gt;&lt;/p&gt