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Oxford Centre for Tropical Medicine and Global Health
Immunogenicity and safety of fractional doses of 17D-213 yellow fever vaccine in HIV-infected people in Kenya (YEFE): a randomised, double-blind, non-inferiority substudy of a phase 4 trial
Posted 10/05/2023. Although yellow fever vaccine provides a lifelong protection to most people, little research was done on HIV population. Josephine Bendera and colleagues evaluate the immunogenicity of fractional and standard doses of yellow fever vaccine on the HIV population. They demonstrate that fractional doses of vaccine are safe, effective and immunologically non inferior to standard doses in HIV-infected individuals.
Submicroscopic malaria in pregnancy and associated adverse pregnancy events: A case-cohort study of 4,352 women on the Thailand–Myanmar border
Posted 11/03/2025. Malaria is known to be dangerous for pregnant women and their developing babies. But how much malaria is too much malaria? Using an ultra-sensitive PCR method that detects one parasite per drop of blood, Mary Ellen Gilder and SMRU colleagues found that even infections with very few parasites are associated with adverse pregnancy outcomes.
A family cluster of cutaneous Leishmania major infection unresponsive to intralesional meglumine antimonial: Case reports
Posted 12/08/2022. This small series describes four family members who contracted cutaneous leishmaniasis due to Leishmania major that did not improve in two patients and worsened in the other two despite 4 weeks of intralesional meglumine antimoniate. All responded to a 4-week course of oral ketoconazole. The paper provides an interesting discussion, by Bob Taylor and colleagues
Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome
Posted 23/12/2021. Marcus Schultz and colleagues analysed 4 large prospective observational studies conducted in 534 ICUs in 54 countries. Patients in middle–income countries were younger, shorter with a slightly lower BMI, had more often diabetes and active cancer, but less often COPD and heart failure. Sequential organ failure assessment scores were similar. ICU mortality was higher in middle–income countries, and inversely associated with GDP.
Three phylogenetic groups have driven the recent population expansion of Cryptococcus neoformans
Posted 03/05/2019. Jeremy Day and colleagues sequenced the genomes of 699 Cryptococcus neoformans isolates from meningitis patients from southeast Asia and Africa. The phylogenetic structure demonstrates a recent, exponential, population expansion, driven almost entirely by three sub-clades (VNIa-4, VNIa-5 and VNIa-93). Mitochondrial recombination seen in VNIa-5 may be important in its ability to infect immunocompetent people. VNIa-93, previously associated with poorer outcomes, is in fact associated with a significantly reduced risk of death.
Distribution and origins of Mycobacterium tuberculosis L4 in Southeast Asia
Posted 12/04/2023. There are now 9 recognised lineages of Mycobacterium tuberculosis, with 1-4 being found most widely around the world. Lineage 4 is understood to have emerged in Europe and been introduced into Asia through trade and colonisation. Timothy Walker and colleagues have identified that relatively unique sub-lineages of lineage 4 have however been circulating between south-east Asian countries since being introduced, possibly with China serving as a conduit from Europe. This leads to the hypothesis that there may have been host population-specific evolution of lineage 4 in south-east Asia.
Estimation of incidence of typhoid and paratyphoid fever in Vientiane, Lao People’s Democratic Republic
Posted 10/03/2020. Incidence data about infectious diseases are needed to inform decisions about vaccine introduction. Using data from health-seeking behaviour survey for fever and data from hospital bloodstream infection, Mayfong Mayxay and colleagues estimated typhoid and paratyphoid fever incidence in Vientiane, the capital of Laos, and found that the incidence is low, with an annual incidence of 4.7 and 0.5 per 100,000 persons, for typhoid and paratyphoid fever, respectively.
Determinants of Implementation of a Critical Care Registry in Asia: Lessons From a Qualitative Study
Posted 10/03/2023. Timo Tolppa and CCAA colleagues conducted a qualitative study across 4 South Asian countries to understand the implementation of a critical care registry, which is used to enable quality improvement and research. Implementation was possible due to motivated champions, a supportive community of practice and efforts to fit the registry with existing practice.
Detection of low frequency artemisinin resistance mutations, C469Y, P553L and A675V, and fixed antifolate resistance mutations in asymptomatic primary school children in Kenya
Posted 31/01/2025. This is an important finding for Kenya, artemisinin resistance k13 mutations previously identified in Uganda (C469Y and A675V) and SE Asia (P553L) are described. Though at low frequencies, 4%, 1.7% and 1.2%, respectively, they sound the alarm for studies to determine their impact on the efficacy of artemisinin-based combination therapies. By Isabella Oyier
The wrongful indictment of pre-referral rectal artesunate further delays the roll-out of this lifesaving drug
Posted 22/12/2022. On Jan 27, 2022, WHO recommended a moratorium on the deployment of rectal artesunate suppositories for severe malaria and in doing so stopped the roll-out of a lifesaving intervention. The decision is based on data from a large demonstration project CARAMAL. Lorenz von Seidlein discusses the project and its consequences with two leaders of the project in a point- counterpoint published in the Lancet infectious Diseases.
How to do no harm: empowering local leaders to make care safer in low-resource settings
Posted 31/03/2021. Patient safety is a key goal of WHO but identifying harms and developing strategies to deliver safe care has been given little attention. Mike English and colleague describe a ‘portfolio’ approach to safety improvement in four broad categories: prioritising critical processes, improving the organisation of care, control of risks and enhancing responses to hazardous situations that we believe is relevant to low resource settings. We focus attention on the possible roles of practitioner groups and professional associations as key to advancing patient safety through collaboration and skill development in this field
COVID-19 and risks to the supply and quality of tests, drugs, and vaccines
Posted 14/04/2020. Enormous emergency efforts are underway to find optimal medical products, to prevent, diagnose, and treat COVID-19, that 7.8 billion people will depend on. With dire disruption of pharmaceutical production and supply and increasing falsified and substandard products, we need strategic planning now to ensure global access to quality-assured medical products and monitoring of supply chains
Immunogenicity and safety of fractional doses of yellow fever vaccines
Posted 15/01/2021. Yellow Fever is a re-emerging disease whose incidence has increased globally in the last three decades. Although very successful, the stocks of the YF vaccine are often insufficient. Derick Kimathi, George Warimwe and colleagues assessed the immunogenicity and safety of fractional (1/5th) doses. Our results support fractional dosing of all four WHO-prequalified YF vaccines in general adult population as a dose-sparing strategy.
Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia
Posted 15/12/2020. A recent study co-led by Paul Turner and colleagues at COMRU identified extremely high prevalence of antimicrobial resistant (AMR) bacterial carriage in households from Siem Reap, Cambodia. Extended-spectrum beta-lactamase producing Escherichia coli were detected in stool samples from >90% of participants. The results highlight the challenges to AMR control in locations where antibiotic overuse is common.
Guidelines should not pool evidence from uncomplicated and severe COVID-19
Posted 15/04/2021. Philippe Guérin co-authored a letter published in The Lancet drawing attention of the risk of pooling data from uncomplicated illness and more severe ill hospitalised patients in the development of COVID-19 treatment guidelines. Although SARS-CoV-2 is one virus, the COVID-19 disease has a complex and evolving physiopathology pathway and requires different therapeutic approaches depending of the stage of the disease. In low-resource settings, the prevention of hospital admission is the therapeutic priority.
No clinical benefit of empirical antimicrobial therapy for pediatric diarrhea
Posted 25/10/2017. Professor Stephen Baker recruited more than 3,000 children with severe diarrhoea in high usage, high resistance settings in Ho Chi Minh City, Vietnam. He found that antimicrobial usage did not result in reducing the time of symptoms, and actually prolonged it in most cases.
Effect of transmission intensity on hotspots and micro-epidemiology of malaria in sub-Saharan Africa
Posted 18/08/2017. Malaria transmission is patchy at local levels, and when a group of houses is located in a high transmission patch this is labelled a "hotspot". Looking at 19 studies in 7 African Countries, we see that hotspots are the norm, and especially prominent when malaria transmission falls.
Arterolane–piperaquine–mefloquine versus arterolane–piperaquine and artemether–lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Kenyan children
Posted 16/06/2021. The progress made in treatment of malaria is threatened by the emergence of resistance to current first line treatments artemisinin-based combination therapies (ACTs). There are currently no good alternatives for the treatment of uncomplicated malaria in the African setting in the event of resistance emerging to antimalarials that are in the ACTs. Mainga Hamaluba, Rob van der Pluijm and colleagues demonstrate that triple artemisinin combination therapies (TACTs) can potentially be used safely to prevent, delay or manage uncomplicated malaria in our setting.
Mapping genetic markers of artemisinin resistance in Plasmodium falciparum malaria in Asia: a systematic review and spatiotemporal analysis
Posted 04/02/2022. Current knowledge of P. falciparum artemisinin resistance evolution in Asia is as old as 4yrs ago. For swift policy decisions, rapid sharing of data collected over extended periods in the same areas is highly needed. Frank Kagoro and colleagues found a steady increase in geographic locations and the proportion of artemisinin resistance from 2002 to 2018. Using the latest WHO classification, the authors map all published K13 markers in Asia by province and district.
The emergence of azithromycin-resistant Salmonella Typhi in Nepal
Posted 12/01/2021. Azithromycin is effectively the last remaining oral antimicrobial to treat typhoid fever and is widely used for empirical therapy in South Asia. Although azithromycin resistance in Salmonella Typhi has rarely been reported, Abhilasha Karkey and colleagues show that an increasing reliance on this drug has led to the emergence of azithromycin resistant S. Typhi in the region.