The public health impact and cost-effectiveness of the R21/Matrix-M malaria vaccine: a mathematical modelling study

Background The R21/Matrix-M vaccine has demonstrated high efficacy against Plasmodium falciparum clinical malaria in children in sub-Saharan Africa. Using trial data, we aimed to estimate the public health impact and cost-effectiveness of vaccine introduction across sub-Saharan Africa. Methods We fitted a semi-mechanistic model of the relationship between anti-circumsporozoite protein antibody titres and vaccine efficacy to data from 3 years of follow-up in the phase 2b trial of R21/Matrix-M in Nanoro, Burkina Faso. We validated the model by comparing predicted vaccine efficacy to that observed over 12–18 months in the phase 3 trial. Integrating this framework within a mathematical transmission model, we estimated the cases, malaria deaths, and disability-adjusted life-years (DALYs) averted and cost-effectiveness over a 15-year time horizon across a range of transmission settings in sub-Saharan Africa. Cost-effectiveness was estimated incorporating the cost of vaccine introduction (dose, consumables, and delivery) relative to existing interventions at baseline. We report estimates at a median of 20% parasite prevalence in children aged 2–10 years (PfPR2–10) and ranges from 3% to 65% PfPR2–10. Findings Anti-circumsporozoite protein antibody titres were found to satisfy the criteria for a surrogate of protection for vaccine efficacy against clinical malaria. Age-based implementation of a four-dose regimen of R21/Matrix-M vaccine was estimated to avert 181 825 (range 38 815–333 491) clinical cases per 100 000 fully vaccinated children in perennial settings and 202 017 (29 868–405 702) clinical cases per 100 000 fully vaccinated children in seasonal settings. Similar estimates were obtained for seasonal or hybrid implementation. Under an assumed vaccine dose price of USD 3, the incremental cost per clinical case averted was USD 7 (range 4–48) in perennial settings and USD 6 (3–63) in seasonal settings and the incremental cost per DALY averted was USD 34 (29–139) in perennial settings and USD 30 (22–172) in seasonal settings, with lower cost-effectiveness ratios in settings with higher PfPR2–10. Interpretation Introduction of the R21/Matrix-M malaria vaccine could have a substantial public health benefit across sub-Saharan Africa. Funding The Wellcome Trust, the Bill & Melinda Gates Foundation, the UK Medical Research Council, the European and Developing Countries Clinical Trials Partnership 2 and 3, the NIHR Oxford Biomedical Research Centre, and the Serum Institute of India, Open Philanthropy

Wild Felids as Hosts for Human Plague, Western United States

Plague seroprevalence was estimated in populations of pumas and bobcats in the western United States. High levels of exposure in plague-endemic regions indicate the need to consider the ecology and pathobiology of plague in nondomestic felid hosts to better understand the role of these species in disease persistence and transmission

Cancer health disparities in racial/ethnic minorities in the United States

There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA—African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.Fil: Zavala, Valentina A.. University of California; Estados UnidosFil: Bracci, Paige M.. University of California; Estados UnidosFil: Carethers, John M.. University of Michigan; Estados UnidosFil: Carvajal Carmona, Luis. University of California at Davis; Estados UnidosFil: Coggins, Nicole B.. University of California at Davis; Estados UnidosFil: Cruz Correa, Marcia R.. Universidad de Puerto Rico; Puerto RicoFil: Davis, Melissa. No especifíca;Fil: de Smith, Adam J.. University of California; Estados UnidosFil: Dutil, Julie. Ponce Research Institute; Puerto RicoFil: Figueiredo, Jane C.. Cedars Sinai Medical Center; Estados UnidosFil: Fox, Rena. University of California; Estados UnidosFil: Graves, Kristi D.. University Of Georgetown; Estados UnidosFil: Gomez, Scarlett Lin. University of California; Estados UnidosFil: Llera, Andrea Sabina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquímicas de Buenos Aires. Fundación Instituto Leloir. Instituto de Investigaciones Bioquímicas de Buenos Aires; ArgentinaFil: Neuhausen, Susan L.. No especifíca;Fil: Newman, Lisa. No especifíca;Fil: Nguyen, Tung. University of California; Estados UnidosFil: Palmer, Julie R.. National Institutes of Health; Estados UnidosFil: Palmer, Nynikka R.. University of California; Estados UnidosFil: Pérez Stable, Eliseo J.. National Institutes of Health; Estados UnidosFil: Piawah, Sorbarikor. University of California; Estados UnidosFil: Rodriquez, Erik J.. National Institutes of Health; Estados UnidosFil: Sanabria Salas, María Carolina. Instituto Nacional de Cancerología; ColombiaFil: Schmit, Stephanie L.. University of Southern California; Estados UnidosFil: Serrano Gomez, Silvia J.. Instituto Nacional de Cancerología; ColombiaFil: Stern, Mariana Carla. University of Southern California; Estados UnidosFil: Weitzel, Jeffrey. No especifíca;Fil: Yang, Jun J.. St. Jude Children’s Research Hospital; Estados UnidosFil: Zabaleta, Jovanny. No especifíca;Fil: Ziv, Elad. University of California; Estados UnidosFil: Fejerman, Laura. University of California; Estados Unido

Shared heritability and functional enrichment across six solid cancers

Correction: Nature Communications 10 (2019): art. 4386 DOI: 10.1038/s41467-019-12095-8Quantifying the genetic correlation between cancers can provide important insights into the mechanisms driving cancer etiology. Using genome-wide association study summary statistics across six cancer types based on a total of 296,215 cases and 301,319 controls of European ancestry, here we estimate the pair-wise genetic correlations between breast, colorectal, head/neck, lung, ovary and prostate cancer, and between cancers and 38 other diseases. We observed statistically significant genetic correlations between lung and head/neck cancer (r(g) = 0.57, p = 4.6 x 10(-8)), breast and ovarian cancer (r(g) = 0.24, p = 7 x 10(-5)), breast and lung cancer (r(g) = 0.18, p = 1.5 x 10(-6)) and breast and colorectal cancer (r(g) = 0.15, p = 1.1 x 10(-4)). We also found that multiple cancers are genetically correlated with non-cancer traits including smoking, psychiatric diseases and metabolic characteristics. Functional enrichment analysis revealed a significant excess contribution of conserved and regulatory regions to cancer heritability. Our comprehensive analysis of cross-cancer heritability suggests that solid tumors arising across tissues share in part a common germline genetic basis.Peer reviewe

Shared heritability and functional enrichment across six solid cancers

Quantifying the genetic correlation between cancers can provide important insights into the mechanisms driving cancer etiology. Using genome-wide association study summary statistics across six cancer types based on a total of 296,215 cases and 301,319 controls of European ancestry, here we estimate the pair-wise genetic correlations between breast, colorectal, head/neck, lung, ovary and prostate cancer, and between cancers and 38 other diseases. We observed statistically significant genetic correlations between lung and head/neck cancer (r(g) = 0.57, p = 4.6 x 10(-8)), breast and ovarian cancer (r(g) = 0.24, p = 7 x 10(-5)), breast and lung cancer (r(g) = 0.18, p = 1.5 x 10(-6)) and breast and colorectal cancer (r(g) = 0.15, p = 1.1 x 10(-4)). We also found that multiple cancers are genetically correlated with non-cancer traits including smoking, psychiatric diseases and metabolic characteristics. Functional enrichment analysis revealed a significant excess contribution of conserved and regulatory regions to cancer heritability. Our comprehensive analysis of cross-cancer heritability suggests that solid tumors arising across tissues share in part a common germline genetic basis

The nature of the electoral connection: An analysis of defense awards and electoral outcomes.

The nature of the electoral connection: An analysis of defense awards and electoral outcomes

Sovereign Investment: Concerns and Policy Reactions

Sovereign Investment: Concerns and Policy Reactions provides the first major holistic examination and interdisciplinary analysis of sovereign wealth funds. Sovereign wealth funds currently hold three trillion dollars\u27 worth of investments, almost twice the amount in all the hedge funds worldwide, and are predicted to hold nine trillion more by 2015. This relatively new and rapidly expanding phenomenon remains relatively unregulated, but the International Monetary Fund and the G7 aim to establish temporary and voluntary rules to introduce transparency and uniformity until more permanent regulatory structures are instituted. What permanent rules and procedures should govern sovereign wealth funds? What bodies should enforce them? Do the current provisional rules answer the national security concerns of host countries? Editors Karl P. Sauvant, Lisa Sachs, and Wouter P.F. Schmit Jongbloed address these questions in a collection of essays by leading authorities from the IMF, academic institutions, law firms, multi-national corporations, and think tanks. Together, these authors analyze how sovereign wealth funds have helped to limit the effects of the current global economic crisis, and what rules can govern their operation in the future.https://scholarship.law.columbia.edu/sustainable_investment_books/1002/thumbnail.jp

Sovereign Investment: Concerns and Policy Reactions

Sovereign Investment: Concerns and Policy Reactions provides the first major holistic examination and interdisciplinary analysis of sovereign wealth funds. Sovereign wealth funds currently hold three trillion dollars\u27 worth of investments, almost twice the amount in all the hedge funds worldwide, and are predicted to hold nine trillion more by 2015. This relatively new and rapidly expanding phenomenon remains relatively unregulated, but the International Monetary Fund and the G7 aim to establish temporary and voluntary rules to introduce transparency and uniformity until more permanent regulatory structures are instituted. What permanent rules and procedures should govern sovereign wealth funds? What bodies should enforce them? Do the current provisional rules answer the national security concerns of host countries? Editors Karl P. Sauvant, Lisa Sachs, and Wouter P.F. Schmit Jongbloed address these questions in a collection of essays by leading authorities from the IMF, academic institutions, law firms, multi-national corporations, and think tanks. Together, these authors analyze how sovereign wealth funds have helped to limit the effects of the current global economic crisis, and what rules can govern their operation in the future.https://scholarship.law.columbia.edu/sustainable_investment_books/1002/thumbnail.jp

Verifying Experimental Wet Bulb Globe Temperature Hindcasts Across the United States

Hot and humid heat exposures challenge the health of outdoor workers engaged in occupations such as construction, agriculture, first response, manufacturing, military, or resource extraction. Therefore, government institutes developed guidelines to prevent heat-related illnesses and death during high heat exposures. The guidelines use Wet Bulb Globe Temperature (WBGT), which integrates temperature, humidity, solar radiation, and wind speed. However, occupational heat exposure guidelines cannot be readily applied to outdoor work places due to limited WBGT validation studies. In recent years, institutions have started providing experimental WBGT forecasts. These experimental products are continually being refined and have been minimally validated with ground-based observations. This study evaluated a modified WBGT hindcast using the historical National Digital Forecast Database and the European Centre for Medium-Range Weather Forecasts Reanalysis v5. We verified the hindcasts with hourly WBGT estimated from ground-based weather observations. After controlling for geographic attributes and temporal trends, the average difference between the hindcast and in situ data varied from −0.64°C to 1.46°C for different Köppen-Geiger climate regions, and the average differences are reliable for decision making. However, the results showed statistically significant variances according to geographical features such as aspect, coastal proximity, land use, topographic position index, and Köppen-Geiger climate categories. The largest absolute difference was observed in the arid desert climates (1.46: 95% CI: 1.45, 1.47), including some parts of Nevada, Arizona, Colorado, and New Mexico. This research investigates geographic factors associated with systematic WBGT differences and points toward ways future forecasts may be statistically adjusted to improve accuracy