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Article ; Online: Changes in transmission of Enterovirus D68 (EV-D68) in England inferred from seroprevalence data

Margarita Pons-Salort / Ben Lambert / Everlyn Kamau / Richard Pebody / Heli Harvala / Peter Simmonds / Nicholas C Grassly

eLife, Vol

2023 Volume 12

Abstract: The factors leading to the global emergence of Enterovirus D68 (EV-D68) in 2014 as a cause of acute flaccid myelitis (AFM) in children are unknown. To investigate potential changes in virus transmissibility or population susceptibility, we measured the ... ...

Abstract	The factors leading to the global emergence of Enterovirus D68 (EV-D68) in 2014 as a cause of acute flaccid myelitis (AFM) in children are unknown. To investigate potential changes in virus transmissibility or population susceptibility, we measured the seroprevalence of EV-D68-specific neutralising antibodies in serum samples collected in England in 2006, 2011, and 2017. Using catalytic mathematical models, we estimate an approximately 50% increase in the annual probability of infection over the 10-year study period, coinciding with the emergence of clade B around 2009. Despite such increase in transmission, seroprevalence data suggest that the virus was already widely circulating before the AFM outbreaks and the increase of infections by age cannot explain the observed number of AFM cases. Therefore, the acquisition of or an increase in neuropathogenicity would be additionally required to explain the emergence of outbreaks of AFM. Our results provide evidence that changes in enterovirus phenotypes cause major changes in disease epidemiology.
Keywords	Enterovirus D68 ; seroepidemiology ; mathematical model ; Medicine ; R ; Science ; Q ; Biology (General) ; QH301-705.5
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	eLife Sciences Publications Ltd
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Protective Measures for Humans against Avian Influenza A(H5N8) Outbreaks in 22 European Union/European Economic Area Countries and Israel, 2016–17

Cornelia Adlhoch / Gavin Dabrera / Pasi Penttinen / Richard Pebody

Emerging Infectious Diseases, Vol 24, Iss 10, Pp 1-

2018 Volume 8

Abstract: We sought to better understand national approaches for managing potential human health risks during outbreaks of infection with avian influenza A(H5N8) virus during 2016–17. Twenty-three countries in the Union/European Economic Area and Israel ... ...

Abstract	We sought to better understand national approaches for managing potential human health risks during outbreaks of infection with avian influenza A(H5N8) virus during 2016–17. Twenty-three countries in the Union/European Economic Area and Israel participated in this study. Risk to the general public was assessed as low in 18 countries and medium in 1 country. Of 524 exposed persons identified, 274 were passively monitored and 250 were actively monitored. Of 29 persons tested, all were negative for H5N8 virus. Vaccination and antiviral drug recommendations varied across countries. A high level of personal protection was recommended although a low risk was assessed. No transmission of this virus to humans was identified.
Keywords	influenza ; avian influenza ; influenza virus ; viruses ; H5NS subtype ; respiratory infections ; Medicine ; R ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2018-10-01T00:00:00Z
Publisher	Centers for Disease Control and Prevention
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Optimising health and economic impacts of COVID-19 vaccine prioritisation strategies in the WHO European Region

Yang Liu / Frank G. Sandmann / Rosanna C. Barnard / Carl A.B. Pearson / Roberta Pastore / Richard Pebody / Stefan Flasche / Mark Jit

The Lancet Regional Health. Europe, Vol 12, Iss , Pp 100267- (2022)

a mathematical modelling study

2022

Abstract: Summary: Background: Countries in the World Health Organization (WHO) European Region differ in terms of the COVID-19 vaccine supply conditions. We evaluated the health and economic impact of different age-based vaccine prioritisation strategies across ... ...

Abstract	Summary: Background: Countries in the World Health Organization (WHO) European Region differ in terms of the COVID-19 vaccine supply conditions. We evaluated the health and economic impact of different age-based vaccine prioritisation strategies across this demographically and socio-economically diverse region. Methods: We fitted age-specific compartmental models to the reported daily COVID-19 mortality in 2020 to inform the immunity level before vaccine roll-out. Models capture country-specific differences in population structures, contact patterns, epidemic history, life expectancy, and GDP per capita.We examined four strategies that prioritise: all adults (V+), younger (20-59 year-olds) followed by older adults (60+) (V20), older followed by younger adults (V60), and the oldest adults (75+) (V75) followed by incrementally younger age groups. We explored four roll-out scenarios (R1-4) — the slowest scenario (R1) reached 30% coverage by December 2022 and the fastest (R4) 80% by December 2021. Five decision-making metrics were summarised over 2021-22: mortality, morbidity, and losses in comorbidity-adjusted life expectancy, comorbidity- and quality-adjusted life years, and human capital. Six vaccine profiles were tested — the highest performing vaccine has 95% efficacy against both infection and disease, and the lowest 50% against diseases and 0% against infection. Findings: Of the 20 decision-making metrics and roll-out scenario combinations, the same optimal strategy applied to all countries in only one combination; V60 was more or similarly desirable than V75 in 19 combinations. Of the 38 countries with fitted models, 11-37 countries had variable optimal strategies by decision-making metrics or roll-out scenarios. There are greater benefits in prioritising older adults when roll-out is slow and when vaccine profiles are less favourable. Interpretation: The optimal age-based vaccine prioritisation strategies were sensitive to country characteristics, decision-making metrics, and roll-out speeds. A prioritisation strategy involving more age-based stages (V75) does not necessarily lead to better health and economic outcomes than targeting broad age groups (V60). Countries expecting a slow vaccine roll-out may particularly benefit from prioritising older adults. Funding: World Health Organization, Bill and Melinda Gates Foundation, the Medical Research Council (United Kingdom), the National Institute of Health Research (United Kingdom), the European Commission, the Foreign, Commonwealth and Development Office (United Kingdom), Wellcome Trust
Keywords	Vaccine policy ; Health economics ; Policy evaluation ; COVID-19 ; Europe ; Mathematical modelling ; Public aspects of medicine ; RA1-1270
Subject code	320
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluating the next generation of RSV intervention strategies

David Hodgson / Richard Pebody / Jasmina Panovska-Griffiths / Marc Baguelin / Katherine E. Atkins

BMC Medicine, Vol 18, Iss 1, Pp 1-

a mathematical modelling study and cost-effectiveness analysis

2020 Volume 14

Abstract: Abstract Background With a suite of promising new RSV prophylactics on the horizon, including long-acting monoclonal antibodies and new vaccines, it is likely that one or more of these will replace the current monoclonal Palivizumab programme. However, ... ...

Abstract	Abstract Background With a suite of promising new RSV prophylactics on the horizon, including long-acting monoclonal antibodies and new vaccines, it is likely that one or more of these will replace the current monoclonal Palivizumab programme. However, choosing the optimal intervention programme will require balancing the costs of the programmes with the health benefits accrued. Methods To compare the next generation of RSV prophylactics, we integrated a novel transmission model with an economic analysis. We estimated key epidemiological parameters by calibrating the model to 7 years of historical epidemiological data using a Bayesian approach. We determined the cost-effective and affordable maximum purchase price for a comprehensive suite of intervention programmes. Findings Our transmission model suggests that maternal protection of infants is seasonal, with 38–62% of infants born with protection against RSV. Our economic analysis found that to cost-effectively and affordably replace the current monoclonal antibody Palivizumab programme with long-acting monoclonal antibodies, the purchase price per dose would have to be less than around £4350 but dropping to £200 for vaccinated heightened risk infants or £90 for all infants. A seasonal maternal vaccine would have to be priced less than £85 to be cost-effective and affordable. While vaccinating pre-school and school-age children is likely not cost-effective relative to elderly vaccination programmes, vaccinating the elderly is not likely to be affordable. Conversely, vaccinating infants at 2 months seasonally would be cost-effective and affordable if priced less than £80. Conclusions In a setting with seasonal RSV epidemiology, maternal protection conferred to newborns is also seasonal, an assumption not previously incorporated in transmission models of RSV. For a country with seasonal RSV dynamics like England, seasonal programmes rather than year-round intervention programmes are always optimal.
Keywords	Respiratory syncytial virus ; Transmission model ; Maternal vaccination ; Monoclonal antibodies ; Medicine ; R
Subject code	360
Language	English
Publishing date	2020-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Systematic review of seroprevalence of SARS-CoV-2 antibodies and appraisal of evidence, prior to the widespread introduction of vaccine programmes in the WHO European Region, January–December 2020

Anthony Nardone / Richard Pebody / Lorenzo Subissi / Isabel Bergeri / Aisling Vaughan / Erika Duffell / Gudrun S Freidl / Diogo Simão Lemos / M Valenciano / Eeva K Broberg / Pasi Penttinen / Maria Keramarou

BMJ Open, Vol 13, Iss

2023 Volume 11

Abstract: Objectives Systematic review of SARS-CoV-2 seroprevalence studies undertaken in the WHO European Region to measure pre-existing and cumulative seropositivity prior to the roll out of vaccination programmes.Design A systematic review of the literature ... ...

Abstract	Objectives Systematic review of SARS-CoV-2 seroprevalence studies undertaken in the WHO European Region to measure pre-existing and cumulative seropositivity prior to the roll out of vaccination programmes.Design A systematic review of the literature.Data sources We searched MEDLINE, EMBASE and the preprint servers MedRxiv and BioRxiv in the WHO ‘COVID-19 Global literature on coronavirus disease’ database using a predefined search strategy. Articles were supplemented with unpublished WHO-supported Unity-aligned seroprevalence studies and other studies reported directly to WHO Regional Office for Europe and European Centre for Disease Prevention and Control.Eligibility criteria Studies published before the widespread implementation of COVID-19 vaccination programmes in January 2021 among the general population and blood donors, at national and regional levels.Data extraction and synthesis At least two independent researchers extracted the eligible studies; a third researcher resolved any disagreements. Study risk of bias was assessed using a quality scoring system based on sample size, sampling and testing methodologies.Results In total, 111 studies from 26 countries published or conducted between 1 January 2020 and 31 December 2020 across the WHO European Region were included. A significant heterogeneity in implementation was noted across the studies, with a paucity of studies from the east of the Region. Sixty-four (58%) studies were assessed to be of medium to high risk of bias. Overall, SARS-CoV-2 seropositivity prior to widespread community circulation was very low. National seroprevalence estimates after circulation started ranged from 0% to 51.3% (median 2.2% (IQR 0.7–5.2%); n=124), while subnational estimates ranged from 0% to 52% (median 5.8% (IQR 2.3%–12%); n=101), with the highest estimates in areas following widespread local transmission.Conclusions The low levels of SARS-CoV-2 antibody in most populations prior to the start of vaccine programmes underlines the critical importance of targeted ...
Keywords	Medicine ; R
Subject code	306
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The added value of online user-generated content in traditional methods for influenza surveillance

Moritz Wagner / Vasileios Lampos / Ingemar J. Cox / Richard Pebody

Scientific Reports, Vol 8, Iss 1, Pp 1-

2018 Volume 9

Abstract: Abstract There has been considerable work in evaluating the efficacy of using online data for health surveillance. Often comparisons with baseline data involve various squared error and correlation metrics. While useful, these overlook a variety of other ...

Abstract	Abstract There has been considerable work in evaluating the efficacy of using online data for health surveillance. Often comparisons with baseline data involve various squared error and correlation metrics. While useful, these overlook a variety of other factors important to public health bodies considering the adoption of such methods. In this paper, a proposed surveillance system that incorporates models based on recent research efforts is evaluated in terms of its added value for influenza surveillance at Public Health England. The system comprises of two supervised learning approaches trained on influenza-like illness (ILI) rates provided by the Royal College of General Practitioners (RCGP) and produces ILI estimates using Twitter posts or Google search queries. RCGP ILI rates for different age groups and laboratory confirmed cases by influenza type are used to evaluate the models with a particular focus on predicting the onset, overall intensity, peak activity and duration of the 2015/16 influenza season. We show that the Twitter-based models perform poorly and hypothesise that this is mostly due to the sparsity of the data available and a limited training period. Conversely, the Google-based model provides accurate estimates with timeliness of approximately one week and has the potential to complement current surveillance systems.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2018-09-01T00:00:00Z
Publisher	Nature Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Health Information Systems in the COVID-19 Pandemic

Elsa Negro-Calduch / Natasha Azzopardi-Muscat / Dorit Nitzan / Richard Pebody / Pernille Jorgensen / David Novillo-Ortiz

Frontiers in Public Health, Vol

A Short Survey of Experiences and Lessons Learned From the European Region

2021 Volume 9

Abstract: Introduction: The COVID-19 crisis provides an opportunity to reflect on what worked during the pandemic, what could have been done differently, and what innovations should become part of an enhanced health information system in the future.Methods: An ... ...

Abstract	Introduction: The COVID-19 crisis provides an opportunity to reflect on what worked during the pandemic, what could have been done differently, and what innovations should become part of an enhanced health information system in the future.Methods: An online qualitative survey was designed and administered online in November 2020 to all the 37 Member States that are part of the WHO European Health Information Initiative and the WHO Central Asian Republics Information Network.Results: Nineteen countries responded to the survey (Austria, Belgium, Croatia, Czech Republic, Finland, Greece, Iceland, Ireland, Israel, Italy, Kazakhstan, Latvia, Lithuania, Romania, Russian Federation, Sweden, Turkey, United Kingdom, and Uzbekistan). The COVID-19 pandemic required health information systems (HIS) to rapidly adapt to identify, collect, store, manage, and transmit accurate and timely COVID-19 related data. HIS stakeholders have been put to the test, and valuable experience has been gained. Despite critical gaps such as under-resourced public health services, obsolete health information technologies, and lack of interoperability, most countries believed that their information systems had worked reasonably well in addressing the needs arising during the COVID-19 pandemic.Conclusion: Strong enabling environments and advanced and digitized health information systems are vital to controlling epidemics. Sustainable finance and government support are required for the continued implementation and enhancement of HIS. It is important to promote digital solutions beyond the COVID-19 pandemic. Now is the time to discuss potential solutions to obtain timely, accurate, and reliable health information and steer policy-making while protecting privacy rights and meeting the highest ethical standards.
Keywords	data ; health information system ; COVID – 19 ; lessons learned ; health data ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Increase in Enterovirus D68 Infections in Young Children, United Kingdom, 2006–2016

Everlyn Kamau / Heli Harvala / Soile Blomqvist / Dung Nguyen / Peter Horby / Richard Pebody / Peter Simmonds

Emerging Infectious Diseases, Vol 25, Iss 6, Pp 1200-

2019 Volume 1203

Abstract: We determined the change in seroprevalence of enterovirus D68 (EV-D68) in the United Kingdom in age-stratified cohorts from 2006 to 2016, the period during which EV-D68 emerged as a cause of severe respiratory disease occasionally leading to paralysis. ... ...

Abstract	We determined the change in seroprevalence of enterovirus D68 (EV-D68) in the United Kingdom in age-stratified cohorts from 2006 to 2016, the period during which EV-D68 emerged as a cause of severe respiratory disease occasionally leading to paralysis. Infections were acquired primarily in infants and young children, and incidence was markedly higher in 2016.
Keywords	viruses ; epidemiology ; respiratory infection ; neutralization ; seroprevalence ; enterovirus ; Medicine ; R ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2019-06-01T00:00:00Z
Publisher	Centers for Disease Control and Prevention
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Sociodemographic and Occupational Factors Associated with Low Early Uptake of COVID-19 Vaccine in Hospital-Based Healthcare Workers, Georgia, March–July 2021

Héloïse Lucaccioni / Giorgi Chakhunashvili / Carl Jason McKnight / Tamila Zardiashvili / Pernille Jorgensen / Richard Pebody / Esther Kissling / Mark A. Katz / Lia Sanodze

Vaccines, Vol 10, Iss 1197, p

2022 Volume 1197

Abstract: In Georgia, an upper-middle income European country, the COVID-19 vaccine rollout began on 15 March 2021 with health workers (HWs), a priority group for vaccination. We assessed the factors associated with COVID-19 vaccination among HWs at six large ... ...

Abstract	In Georgia, an upper-middle income European country, the COVID-19 vaccine rollout began on 15 March 2021 with health workers (HWs), a priority group for vaccination. We assessed the factors associated with COVID-19 vaccination among HWs at six large hospitals in the early stages of the vaccine rollout (March–July 2021). Among 1533 HWs, 274 (17.9%) had received one dose of the COVID-19 vaccine. Strong independent predictors of early vaccine uptake were age > 40 years, especially 50–59 years old (aOR 2.40, 95% CI 1.50–3.88), considering the vaccine as “somewhat effective” or “very effective” rather than “not effective” (aOR 6.33, 95% CI 2.29–26.3 and aOR 10.9, 95% CI 3.88–45.70, respectively), and previous vaccination against seasonal influenza (aOR 2.98, 95% CI 2.19–4.08). Previous SARS-CoV-2 infection was negatively associated with receiving the vaccine (aOR 0.6, 95% CI 0.40–0.80). Compared to physicians, nurses/midwives (aOR 0.22, 95% CI 0.15–0.32), administrative staff (aOR 0.36, 95% CI 0.22–0.56), and ancillary staff (aOR 0.07, 95% CI 0.04–0.15) were less likely to have received the COVID-19 vaccine. Tailoring the COVID-19 vaccine communications campaign to younger and non-physician HWs, and emphasizing the benefits of the COVID-19 vaccine, could help further increase vaccine coverage among HWs in Georgia.
Keywords	COVID-19 ; vaccine ; health workers ; hesitancy ; Republic of Georgia ; public health promotion ; Medicine ; R
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Household presentation of influenza and acute respiratory illnesses to a primary care sentinel network

Simon de Lusignan / Julian Sherlock / Oluwafunmi Akinyemi / Richard Pebody / Alex Elliot / Rachel Byford / Ivelina Yonova / Maria Zambon / Mark Joy

BMC Public Health, Vol 20, Iss 1, Pp 1-

retrospective database studies (2013–2018)

2020 Volume 11

Abstract: Abstract Background Direct observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models. The study aims to determine household incidence of influenza-like illness (ILI), ... ...

Abstract	Abstract Background Direct observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models. The study aims to determine household incidence of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections within a primary care routine data and identify factors associated with the diseases’ incidence. Methods We conducted two five-year retrospective analyses of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections using the England Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care sentinel network database; a cross-sectional study reporting incident rate ratio (IRR) from a negative binomial model and a retrospective cohort study, using a shared gamma frailty survival model, reporting hazard ratios (HR). We reported the following household characteristics: children < 5 years old, each extra household member, gender, ethnicity (reference white), chronic disease, pregnancy, and rurality. Results The IRR where there was a child < 5 years were 1·62 (1·38–1·89, p < 0·0001), 2·40 (2.04–2.83, p < 0·0001) and 4·46 (3.79–5.255, p < 0·0001) for ILI, LRTI and URTI respectively. IRR also increased with household size, rurality and presentations and by female gender, compared to male. Household incidence of URTI and LRTI changed little between years whereas influenza did and were greater in years with lower vaccine effectiveness. The HR where there was a child < 5 years were 2·34 (95%CI 1·88–2·90, p < 0·0001), 2·97 (95%CI 2·76–3·2, p < 0·0001) and 10·32 (95%CI 10.04–10.62, p < 0·0001) for ILI, LRTI and URTI respectively. HR were increased with female gender, rurality, and increasing household size. Conclusions Patterns of household incidence can be measured from routine data and may provide insights for the modelling of disease transmission and public health policy.
Keywords	Disease incidence ; Infectious ; Family characteristics ; Population characteristics ; Medical record systems ; Computerized ; Public aspects of medicine ; RA1-1270
Subject code	336
Language	English
Publishing date	2020-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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