Investigating the epidemiology of trypanosomiasis in domestic livestock at the micro-scale in Busia, Kenya

Trypanosomiasis in Kenya is no longer viewed as a public health issue, as only sporadic sleeping sickness cases are reported from historic foci such as Busia. Trypanosomiasis is thus mainly perceived as a constraint on livestock production. The responsibility for tsetse and trypanosomiasis control in Kenya has therefore increasingly shifted from the state to individual livestock owners; this drastically reduced the scale of control approaches. This thesis examines the epidemiology of both animal infective and zoonotic trypanosome species in a range of domestic livestock at the micro-scale, in Busia, Kenya. The work is based on a unique crosssectional census data set of the entire livestock population in two study sites in Busia, employing sensitive molecular tools (PCR) to detect trypanosome infections.Cattle were the largest reservoir of trypanosomes with an infection prevalence of 20.1%, followed by pigs (11.5%). A low prevalence of infection was detected in small ruminants (3.3%). Human infective trypanosomes (71 b. rhodesiense) were detected at a low prevalence in cattle (1.5%) and pigs (2.9%). Key clinical signs for trypanosomiasis infection (anaemia & poor body condition) were only observed in a minority of infected cattle (<20%). Confinement of livestock to the homesteads, instead of grazing in communal grounds and watering at the river did not provide protection from trypanosome infections. An investigation of the micro-geographic variation in the distribution of trypanosome infections over the study population, revealed significant clustering in one of the two study sites. However, there was no significant effect of distance to water features on trypanosomiasis risk at the herd level. A convenience sampling protocol was shown to give a good estimate of overall trypanosomiasis in cattle, but failed to detect the low prevalence of T. b. rhodesiense.The sustainability of small-scale trypanosomiasis control based on trypanocide treatment of visibly diseased cattle is appraised and the feasibility of additional vector control is discussed. Furthermore, the potential human health implications of a livestock reservoir of T. b. rhodesiense to the local population are examined

Moving epidemic method (MEM) applied to virology data as a novel real time tool to predict peak in seasonal influenza healthcare utilisation. The Scottish experience of the 2017/18 season to date

Scotland observed an unusual influenza A(H3N2)- dominated 2017/18 influenza season with healthcare services under significant pressure. We report the application of the moving epidemic method (MEM) to virology data as a tool to predict the influenza peak activity period and peak week of swab positivity in the current season. This novel MEM application has been successful locally and is believed to be of potential use to other countries for healthcare planning and building wider community resilience

Fluch oder Segen? – Zum Umgang mit Konflikten in Software-Implementierungsprozessen

Aus der EINLEITUNG: Nicht immer sind organisationale Veränderungsprozesse von Erfolg gekrönt – wie bei 1000 befragten Unternehmen die vergleichsweise hohe Quote von 38 % an Prozessen belegt, die als gescheitert betrachtet werden [18]. Als häufigste Ursache werden dabei „Widerstände der Mitarbeiter“ genannt. Auch die Implementierung einer neuen Technologie in einer Organisation stellt einen derartig verändernden Eingriff dar, dessen Gelingen nicht zuletzt auch an die Nutzung der neuen Technologie geknüpft ist [10]. Um diesem Ziel gerecht zu werden, existieren in der Informatik zahlreiche Ansätze, die Schnittstellen zwischen Mensch und Technik anwenderfreundlich zu gestalten. Dabei ist insbesondere die Akzeptanz der (neuen) Technologie seitens der Nutzer von zentraler Bedeutung [5]. Denn wenn sich beispielsweise bei der Einführung eines ERP-Systems zur integrierten IT-Portfolio-Planung die Mitarbeiter überwacht und kontrolliert fühlen und aus diesen Motiven heraus Vorwände und Ausreden finden, das System nicht zu nutzen, können sie die Implementierung massiv beeinträchtigen und verzögern, was sich in erhöhtem Aufwand und höheren Kosten niederschlägt. [...

Reply to Kloepfer and Gern: Independent studies suggest an arms race between influenza and rhinovirus: what next?

No abstract available

Virus-virus interactions impact the population dynamics of influenza and the common cold

The human respiratory tract hosts a diverse community of cocirculating viruses that are responsible for acute respiratory infections. This shared niche provides the opportunity for virus–virus interactions which have the potential to affect individual infection risks and in turn influence dynamics of infection at population scales. However, quantitative evidence for interactions has lacked suitable data and appropriate analytical tools. Here, we expose and quantify interactions among respiratory viruses using bespoke analyses of infection time series at the population scale and coinfections at the individual host scale. We analyzed diagnostic data from 44,230 cases of respiratory illness that were tested for 11 taxonomically broad groups of respiratory viruses over 9 y. Key to our analyses was accounting for alternative drivers of correlated infection frequency, such as age and seasonal dependencies in infection risk, allowing us to obtain strong support for the existence of negative interactions between influenza and noninfluenza viruses and positive interactions among noninfluenza viruses. In mathematical simulations that mimic 2-pathogen dynamics, we show that transient immune-mediated interference can cause a relatively ubiquitous common cold-like virus to diminish during peak activity of a seasonal virus, supporting the potential role of innate immunity in driving the asynchronous circulation of influenza A and rhinovirus. These findings have important implications for understanding the linked epidemiological dynamics of viral respiratory infections, an important step towards improved accuracy of disease forecasting models and evaluation of disease control interventions

Vaccine effectiveness of live attenuated and trivalent inactivated influenza vaccination in 2010/11 to 2015/16:the SIVE II record linkage study

Background: There is good evidence of vaccine effectiveness in healthy individuals but less robust evidence for vaccine effectiveness in the populations targeted for influenza vaccination. The live attenuated influenza vaccine (LAIV) has recently been recommended for children in the UK. The trivalent influenza vaccine (TIV) is recommended for all people aged≥65 years and for those aged<65 years who are at an increased risk of complications from influenza infection (e.g. people with asthma). Objective: To examine the vaccine effectiveness of LAIV and TIV. Design: Cohort study and test-negative designs to estimate vaccine effectiveness. A self-case series study to ascertain adverse events associated with vaccination. Setting: A national linkage of patient-level general practice (GP) data from 230 Scottish GPs to the Scottish Immunisation & Recall Service, Health Protection Scotland virology database, admissions to Scottish hospitals and the Scottish death register. Participants: A total of 1,250,000 people. Interventions: LAIV for 2- to 11-year-olds and TIV for older people (aged≥65 years) and those aged<65 years who are at risk of diseases, from 2010/11 to 2015/16. Main outcome measures: The main outcome measures include vaccine effectiveness against laboratory-confirmed influenza using real-time reverse-transcription polymerase chain reaction (RT-PCR), influenza-related morbidity and mortality, and adverse events associated with vaccination. Results: Two-fifths (40%) of preschool-aged children and three-fifths (60%) of primary school-aged children registered in study practices were vaccinated. Uptake varied among groups [e.g. most affluent vs. most deprived in 2- to 4-year-olds, odds ratio 1.76, 95% confidence interval (CI) 1.70 to 1.82]. LAIV-adjusted vaccine effectiveness among children (aged 2-11 years) for preventing RT-PCR laboratoryconfirmed influenza was 21% (95% CI -19% to 47%) in 2014/15 and 58% (95% CI 39% to 71%) in 2015/16. No significant adverse events were associated with LAIV. Among at-risk 18- to 64-year-olds, significant trivalent influenza vaccine effectiveness was found for four of the six seasons, with the highest vaccine effectiveness in 2010/11 (53%, 95% CI 21% to 72%). The seasons with non-significant vaccine effectiveness had low levels of circulating influenza virus (2011/12, 5%; 2013/14, 9%). Among those people aged≥65 years, TIV effectiveness was positive in all six seasons, but in only one of the six seasons (2013/14) was significance achieved (57%, 95% CI 20% to 76%). Conclusions: The study found that LAIV was safe and effective in decreasing RT-PCR-confirmed influenza in children. TIV was safe and significantly effective in most seasons for 18- to 64-year-olds, with positive vaccine effectiveness in most seasons for those people aged≥65 years (although this was significant in only one season). Future work: The UK Joint Committee on Vaccination and Immunisation has recommended the use of adjuvanted injectable vaccine for those people aged≥65 years from season 2018/19 onwards. A future study will be required to evaluate this vaccine. Trial registration: Current Controlled Trials ISRCTN88072400

Seasonal influenza vaccine effectiveness in people with asthma: a national test-negative design case-control study

Financial support. The work was funded by the Chief Scientist Office of the Scottish Government under the grant (AUKCAR/14/03) and the NIHR–Health Technology Assessment (HTA) Programme (13/34/14) for the Seasonal Influenza Vaccination Effectiveness II (SIVE II) study. As principal investigator, C. R. S. received a grant for the SIVE-II project from the NIHR HTA. This work was carried out with the support of the Asthma UK Centre for Applied Research (AUK-AC-2012-01), the Farr Institute (MR/M501633/2), Health Data Research UK (an initiative funded by UK Research and Innovation, Department of Health and Social Care England and the devolved administrations and leading medical research charities), the European Union’s Horizon 2020 research and innovation programme (under grant agreement No 634446) and European Centre for Disease Prevention and Control (Influenza-Monitoring Vaccine Effectiveness). Acknowledgments. The authors thank and acknowledge all colleagues at the Asthma UK Centre for Applied Research for their support in this study. Disclaimer. The funding bodies had no role in the design of the study, review process, analysis, interpretation, or reporting of data. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Health Technology Assessment Programme, National Institute for Health Research (NIHR), National Health Service, or the Department of Health. Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.Peer reviewedPublisher PDFPublisher PD