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IntroductionCOVID-19 vaccines are now being distributed to low- and middle-income countries (LMICs), with global urgency surrounding national vaccination plans. LMICs have significant experience implementing vaccination campaigns to respond to epidemic threats but are often hindered by chronic health system challenges. We sought to identify transferable lessons for COVID-19 vaccination from the rollout of three vaccines that targeted adult groups in Africa and South America: MenAfriVac (meningitis A); 17D (yellow fever) and rVSV-ZEBOV (Ebola virus disease).MethodsWe conducted a rapid literature review and 24 semi-structured interviews with technical experts who had direct implementation experience with the selected vaccines in Africa and South America. We identified barriers, enablers, and key lessons from the literature and from participants’ experiences. Interview data were analysed thematically according to seven implementation domains.ResultsParticipants highlighted multiple components of vaccination campaigns that are instrumental for achieving high coverage. Community engagement is an essential and effective tool, requiring dedicated time, funding and workforce. Involving local health workers is a key enabler, as is collaborating with community leaders to map social groups and tailor vaccination strategies to their needs. Vaccination team recruitment and training strategies need to be enhanced to support vaccination campaigns. Although recognised as challenging, integrating vaccination campaigns with other routine health services can be highly beneficial if well planned and coordinated across health programmes and with communities.ConclusionAs supplies of COVID-19 vaccines become available to LMICs, countries need to prepare to efficiently roll out the vaccine, encourage uptake among eligible groups and respond to potential community concerns. Lessons from the implementation of these three vaccines that targeted adults in LMICs can be used to inform best practice for COVID-19 and other epidemic vaccination campaigns.

Background The public health impact of Chikungunya virus (CHIKV) is often underestimated. Usually considered a mild condition of short duration, recent outbreaks have reported greater incidence of severe illness, fatality, and longer-term disability. In 2018/19, Eastern Sudan experienced the largest epidemic of CHIKV in Africa to date, affecting an estimated 487,600 people. Known locally as Kankasha, this study examines clinical characteristics, risk factors, and phylogenetics of the epidemic in Kassala City. Methodology/Principal findings A prospective cohort of 102 adults and 40 children presenting with chikungunya-like illness were enrolled at Kassala Teaching Hospital in October 2018. Clinical information, socio-demographic data, and sera samples were analysed to confirm diagnosis, characterise illness, and identify viral strain. CHIKV infection was confirmed by real-time reverse transcription-PCR in 84.5% (120/142) of participants. Nine (7.5%) CHIKV-positive participants had concurrent Dengue virus (DENV) infection; 34/118 participants (28.8%) had a positive Rapid Diagnostic Test for Plasmodium falciparum; six (5.0%) had haemorrhagic symptoms including two children with life-threatening bleeding. One CHIKV-positive participant died with acute renal injury. Age was not associated with severity of illness although CHIKV-infected participants were younger (p = 0.003). Two to four months post-illness, 63% of adults available for follow-up (30) were still experiencing arthralgia in one or more joints, and 11% remained moderately disabled on Rapid3 assessment. Phylogenetic analysis showed all CHIKV sequences from this study belonged to a single clade within the Indian Ocean Lineage (IOL) of the East/Central/South African (ECSA) genotype. History of contact with an infected person was the only factor associated with infection (p = 0.01), and likely related to being in the same vector environment. Conclusions/Significance Vulnerability to CHIKV remains in Kassala and elsewhere in Sudan due to widespread Aedes aegypti presence and mosquito-fostering household water storage methods. This study highlights the importance of increasing awareness of the severity and impact of CHIKV outbreaks, and the need for urgent actions to reduce transmission risk in households., Author summary Chikungunya is an arboviral disease transmitted to humans by infected mosquitoes and characterised by fever and arthralgia. Although it is generally considered a short self-limiting infection, long term sequelae and severe disease are increasingly recognised. In 2018/19, Eastern Sudan experienced the largest epidemic of Chikungunya in Africa to date, affecting approximately 500,000 people. We undertook a prospective hospital-based cohort study of patients presenting with undifferentiated febrile illness in Kassala city, Sudan, supported by next-generation sequencing. We confirmed that CHIKV was the dominant pathogen, with positive CHIKV RT-PCR in 85% of patients presenting during the 7-day study period. Dengue virus was also circulating with nine CHIKV RT-PCR-positive patients co-infected, and we identified high rates of Plasmodium falciparum infection and CHIKV/P.falciparum co-infection. Genetic sequencing confirmed Indian Ocean Lineage of the East/Central/South African CHIKV genotype. A quarter of participants available for follow-up (16/60, 26.6%) reported being admitted to hospital including two children with haemorrhage, reflecting the severe phenotype linked to this genotype. Increased understanding of the health and economic burden of Chikungunya is needed, and recognition that severe and occasionally fatal infection exists. With widespread presence of Ae. aegypti and household water storage practices that encourage mosquito breeding, timely actions will be essential to prevent further large outbreaks.

Background Despite identification 50 years ago, the true burden of Lassa Fever (LF) across Africa remains undefined for reasons including research focus on hospitalised patients, lack of validated field-feasible tools which reliably identify past infection, and the fact that all assays require blood samples making large-scale surveys difficult. Designated a priority pathogen of epidemic potential requiring urgent research by the World Health Organisation, a better understanding of LF sero-epidemiology is essential to developing and evaluating new interventions including vaccines. We describe the first field testing of a novel species-neutral Double Antigen Binding Assay (DABA) designed to detect antibodies to LF in plasma and oral fluid. Methodology/Principal findings Paired plasma and oral fluid were collected in Sierra Leone from survivors discharged from Kenema Government Hospital Lassa Fever Unit between 1980 and 2018, and from controls recruited in Freetown in 2019. Epidemiological sensitivity and specificity of the DABA measured against historical diagnosis in survivors and self-declared non-exposed controls was 81.7% (95% CI 70.7%– 89.9%) and 83.3% (72.7%- 91.1%) respectively in plasma, and 71.8% (60.0%– 81.9%) and 83.3% (72.7%– 91.1%) respectively in oral fluid. Antibodies were identified in people infected up to 15 years and, in one case, 40 years previously. Participants found oral fluid collection easy and painless with 80% happy to give an oral fluid sample regularly. Conclusions/Significance Given the difficulties of assay validation in a resource-limited setting, including unexpected exposures and diagnostics of varying accuracy, the new assay performed well in both plasma and oral fluid. Sensitivity and specificity are expected to be higher when case/control ascertainment is more definitive and further work is planned to investigate this. Even at the performance levels achieved, the species-neutral DABA has the potential to facilitate the large-scale seroprevalence surveys needed to underpin essential developments in LF control, as well as support zoonotic investigations., Author summary Lassa Fever (LF) is a life-threatening rodent-borne viral haemorrhagic disease of epidemic potential particularly affecting some West African communities. Although it is estimated to cause 100,000–300,000 infections and 5,000 deaths annually, the true burden of the disease in the community is not well understood since research has largely focussed on hospitalised cases (thought to account for ~15% of infections) because of the difficulty of identifying mild or asymptomatic cases in the community. Gaining a better understanding of LF epidemiology, particularly the exposure and immunity status of populations in countries where the virus is endemic in the rodent hosts, is critical to developing control measures including vaccines which can protect against disease and/or reduce risk of epidemic transmission. A key step is to be able to identify who has been previously infected by virus, and therefore likely immune, and who remains susceptible by examining the prevalence of antibodies to the virus in the community. However, to date all tests require blood to be drawn which can be problematic for community participation as well as risky for collectors. This study reports on a project to develop and validate an antibody test that can be used with an easy-to-give oral fluid sample.

Background In response to the COVID-19 pandemic, governments have implemented a range of non-pharmaceutical interventions (NPIs) and pharmaceutical interventions (PIs) to reduce transmission and minimise morbidity and mortality, whilst maintaining social and economic activities. The perceptions of public health workers (PHWs) and healthcare workers (HCWs) are essential to inform future COVID-19 strategies as they are viewed as trusted sources and are at the forefront of COVID-19 response. The objectives of this study were to 1) describe the practicality of implementing NPIs and PIs and 2) identify potential barriers to implementation, as perceived by HCWs and PHWs. Methods We conducted a cross-sectional study of PHWs and HCWs perceptions of the implementation, practicality of, and barriers to implementation of NPIs and PIs using an online survey (28/9/2020-1/11/2020) available in English, French and Portuguese. We used descriptive statistics and thematic analysis to analyse quantitative and qualitative responses. Results In total, 226 respondents (67 HCWs and 159 PHWs) from 52 countries completed the survey and 222 were included in the final analysis. Participants from low and middle-income countries (LMICs) accounted for 63% of HCWs and 67% of PHWs, with the remaining from high-income (HICs). There was little difference between the perceptions of PHWs and HCWs in HICs and LMICs, with the majority regarding a number of common NPIs as difficult to implement. However, PHWs in HICs perceived restrictions on schools and educational institutions to be more difficult to implement, with a lack of childcare support identified as the main barrier. Additionally, most contact tracing methods were perceived to be more difficult to implement in HICs than LMICs, with a range of barriers reported. A lack of public support was the most commonly reported barrier to NPIs overall across both country income and professional groups. Similarly, public fear of vaccine safety and lack of vaccine supply were the main reported barriers to implementing a COVID-19 vaccine. However, PHWs and HCWs in LMICs perceived a lack of financial support and the vaccine being manufactured in another country as additional barriers. Conclusion This snapshot provides insight into the difficulty of implementing interventions as perceived by PHWs and HCWs. There is no one-size-fits-all solution to implementing interventions, and barriers in different contexts do vary. Barriers to implementing a vaccine programme expressed here by HCWs and PHCWs have subsequently come to the fore internationally.

Summary Background Collecting credible data on violence against health services, health workers, and patients in war zones is a massive challenge, but crucial to understanding the extent to which international humanitarian law is being breached. We describe a new system used mainly in areas of Syria with a substantial presence of armed opposition groups since November, 2015, to detect and verify attacks on health-care services and describe their effect. Methods All Turkey health cluster organisations with a physical presence in Syria, either through deployed and locally employed staff, were asked to participate in the Monitoring Violence against Health Care (MVH) alert network. The Turkey hub of the health cluster, a UN-activated humanitarian health coordination body, received alerts from health cluster partners via WhatsApp and an anonymised online data-entry tool. Field staff were asked to seek further information by interviewing victims and other witnesses when possible. The MVH data team triangulated alerts to identify individual events and distributed a preliminary flash update of key information (location, type of service, modality of attack, deaths, and casualties) to partners, WHO, United Nations Office for the Coordination of Humanitarian Affairs, and donors. The team also received and entered alerts from several large non-health cluster organisations (known as external partners, who do their own information-gathering and verification processes before sharing their information). Each incident was then assessed in a stringent process of information-matching. Attacks were deemed to be verified if they were reported by a minimum of one health cluster partner and one external partner, and the majority of the key datapoints matched. Alerts that did not meet this standard were deemed to be unverified. Results were tabulated to describe attack occurrence and impact, disaggregated where possible by age, sex, and location. Findings Between early November, 2015, and Dec 31 2016, 938 people were directly harmed in 402 incidents of violence against health care: 677 (72%) were wounded and 261 (28%) were killed. Most of the dead were adult males (68%), but the highest case fatality (39%) was seen in children aged younger than 5 years. 24% of attack victims were health workers. Around 44% of hospitals and 5% of all primary care clinics in mainly areas with a substantial presence of armed opposition groups experienced attacks. Aerial bombardment was the main form of attack. A third of health-care services were hit more than once. Services providing trauma care were attacked more than other services. Interpretation The data system used in this study addressed double-counting, reduced the effect of potentially biased self-reports, and produced credible data from anonymous information. The MVH tool could be feasibly deployed in many conflict areas. Reliable data are essential to show how far warring parties have strayed from international law protecting health care in conflict and to effectively harness legal mechanisms to discourage future perpetrators. Funding None.

The 2013–16 epidemic of Ebola virus disease underscored the shortcomings of the international community to both respond to outbreaks and conduct critical research in complex humanitarian crises. To address these concerns, the UK Government has formed the UK Public Health Rapid Support Team (UK- PHRST). The UK-PHRST is a collaboration between Public Health England and the London School of Hygiene and Tropical Medicine with the University of Oxford and Kings College London as academic partners. The UK-PHRST has a novel triple mandate to work in low- and middle-income countries (LMICs) to: Respond to outbreaks Conduct innovative operational research during and between outbreaks to generate evidence on best practices Build LMIC and regional capacity for outbreak response

We report the case of an Ebola virus (EBOV) RNA-negative pregnant woman who delivered an EBOV RNA-positive stillborn infant at a community health center in rural Sierra Leone, 1 month after the mother's last possible exposure. The mother was later found to be immunoglobulins M and G positive indicating previous infection. The apparent absence of Ebola symptoms and not recognizing that the woman had previous contact with an Ebola patient led health workers performing the delivery to wear only minimal personal protection, potentially exposing them to a high risk of EBOV infection. This case emphasizes the importance of screening for epidemiological risk factors as well as classic and atypical symptoms of Ebola when caring for pregnant women, even once they have passed the typical time frame for exposure and incubation expected in nonpregnant adults. It also illustrates the need for health-care workers to use appropriate personal protection equipment when caring for pregnant women in an Ebola setting.

In a study of 94 Ebola-affected households, intrahousehold transmission was very variable, with more transmission from those with more severe disease and from older cases. The household secondary attack rate was 18%., Transmission between family members accounts for most Ebola virus transmission, but little is known about determinants of intrahousehold spread. From detailed exposure histories, intrahousehold transmission chains were created for 94 households of Ebola survivors in Sierra Leone: 109 (co-)primary cases gave rise to 317 subsequent cases (0–100% of those exposed). Larger households were more likely to have subsequent cases, and the proportion of household members affected depended on individual and household-level factors. More transmissions occurred from older than from younger cases, and from those with more severe disease. The estimated household secondary attack rate was 18%.

Background: \ud The frequency of asymptomatic infection with Ebola virus is unclear: previous estimates vary and there is no standard test. Asymptomatic infection with Ebola virus could contribute to population immunity, reducing spread. If people with asymptomatic infection are infectious it could explain re-emergences of Ebola virus disease (EVD) without known contact.\ud \ud Methods: \ud We validated a new oral fluid anti-glycoprotein IgG capture assay among survivors from Kerry Town Ebola Treatment Centre and controls from communities unaffected by EVD in Sierra Leone. We then assessed the seroprevalence of antibodies to Ebola virus in a cross-sectional study of household contacts of the survivors. All household members were interviewed. Two reactive tests were required for a positive result, with a third test to resolve any discrepancies.\ud \ud Findings: \ud The assay had a specificity of 100% (95% CI 98·9–100; 339 of 339 controls tested negative) and sensitivity of 95·9% (89·8–98·9; 93 of 97 PCR-confirmed survivors tested positive). Of household contacts not diagnosed with EVD, 47·6% (229 of 481) had high level exposure (direct contact with a corpse, body fluids, or a case with diarrhoea, vomiting, or bleeding). Among the contacts, 12·0% (95% CI 6·1–20·4; 11 of 92) with symptoms at the time other household members had EVD, and 2·6% (1·2–4·7; 10 of 388) with no symptoms tested positive. Among asymptomatic contacts, seropositivity was weakly correlated with exposure level.\ud \ud Interpretation: \ud This new highly specific and sensitive assay showed asymptomatic infection with Ebola virus was uncommon despite high exposure. The low prevalence suggests asymptomatic infection contributes little to herd immunity in Ebola, and even if infectious, would account for few transmissions.\ud \ud Funding: \ud Wellcome Trust ERAES Programme, Save the Children.

Background Undifferentiated febrile illness (UFI) is one of the most common reasons for people seeking healthcare in low-income countries. While illness and death due to specific infections such as malaria are often well-quantified, others are frequently uncounted and their impact underappreciated. A number of high consequence infectious diseases, including Ebola virus, are endemic or epidemic in the Federal Republic of Sudan which has experienced at least 12 UFI outbreaks, frequently associated with haemorrhage and high case fatality rates (CFR), since 2012. One of these occurred in Darfur in 2015/2016 with 594 cases and 108 deaths (CFR 18.2%). The aetiology of these outbreaks remains unknown. Methodology/Principal findings We report a retrospective cohort study of the 2015/2016 Darfur outbreak, using a subset of 65 of 263 outbreak samples received by the National Public Health Laboratory which met selection criteria of sufficient sample volume and epidemiological data. Clinical features included fever (95.8%), bleeding (95.7%), headache (51.6%) and arthralgia (42.2%). No epidemiological patterns indicative of person-to-person transmission or health-worker cases were reported. Samples were tested at the Public Health England Rare and Imported Pathogens Laboratory using a bespoke panel of likely pathogens including haemorrhagic fever viruses, arboviruses and Rickettsia, Leptospira and Borrelia spp. Seven (11%) were positive for Crimean-Congo haemorrhagic fever virus (CCHFV) by real-time reverse transcription PCR. The remaining samples tested negative on all assays. Conclusions/Significance CCHFV is an important cause of fever and haemorrhage in Darfur, but not the sole major source of UFI outbreaks in Sudan. Prospective studies are needed to explore other aetiologies, including novel pathogens. The presence of CCHFV has critical infection, prevention and control as well as clinical implications for future response. Our study reinforces the need to boost surveillance, lab and investigative capacity to underpin effective response, and for local and international health security., Author summary The Federal Republic of Sudan has had at least 12 outbreaks of febrile illness of unknown cause associated with symptoms of haemorrhage and high case fatality rates since 2012. Outbreaks without clear diagnosis are concerning, particularly in countries such as Sudan where a range of high consequence diseases, including viral haemorrhagic fevers, are endemic or epidemic, and local laboratory capacity is limited. We transferred historical samples stored in the National Public Health Authority from one of these outbreaks that occurred in Darfur 2015–2016 to the Public Health England Laboratory at Porton, UK, and tested them against a wide range of infectious diseases to try to identify the cause, and to help the Sudanese Federal Ministry of Health to develop and target their limited laboratory capacity. We found that Crimean-Congo Haemorrhagic Fever was an important cause but not the only source of cases in this outbreak. This has implications for prevention and control as well as for treating cases. Our study also highlighted the need for future studies to explore other possible causes, including new pathogens, and reinforced the need to boost surveillance, lab and investigative capacity for more timely and complete outbreak response.

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT). Methods: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake. Results: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners. Conclusions: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice.

Risk for disease correlated with level of exposure and was lowest for children 5–19 years of age., Using histories of household members of Ebola virus disease (EVD) survivors in Sierra Leone, we calculated risk of EVD by age and exposure level, adjusting for confounding and clustering, and estimated relative risks. Of 937 household members in 94 households, 448 (48%) had had EVD. Highly correlated with exposure, EVD risk ranged from 83% for touching a corpse to 8% for minimal contact and varied by age group: 43% for children 60% for adults >30 years of age. Compared with risk for persons 20–29 years of age, exposure-adjusted relative risks were lower for those 5–9 (0.70), 10–14 (0.64), and 15–19 (0.71) years of age but not for children

The international president of Medecins Sans Frontieres, Doris Schopper , tells Hilary Bower that she wants her organisation to have a louder voice in humanitarian issues. She hopes to do this without losing the spontaneity, individual commitment, and creativity of MSF Doris Schopper knows voluntary organisations need to change MSF Non-governmental health organisations (NGOs) have burgeoned in recent years and none more so than Medecins Sans Frontieres (MSF). From a single French branch with a handful of people in 1971, MSF now has branches in 19 countries and sends 2400 people on operations each year to work with 15000 local staff. But the challenges that Doris Schopper, the organisation's international president, foresees are not restricted to questions of size and logistics. Along with those running other NGOs, she faces the pressing task of redefining the role of voluntary organisations in a rapidly changing political and social environment. One of the most frightening changes is the increasing climate of insecurity in which volunteers work. This loss of respect for the neutrality of humanitarian work is due partly to the disappearance of the division between East …

Publication of the complete genome sequence of the gut pathogen Helicobacter pylori will radically change research approaches and pave the way for completely new methods of treatment, say molecular experts. Scientists from the Institute for Genome Research in Rockville, Maryland, United States, have described how H pylori has a circular genome consisting of 1667867 base pairs ( Nature 1997;388:539-47). The sequencing offers important clues about how the bacterium, which is the main non-pharmaceutical cause of ulcers, manages to survive and thrive in the hostile acidic environment of the human stomach. H pylori is only the seventh bacterium to be completely sequenced. Publication of the sequence places the information in the public domain and ends the simmering …

The United Nations Mission in Kosovo laid out an ambitious blueprint for rebuilding and modernising health services in Kosovo this week, to address not only the recent destruction of the war but 10 years of political turmoil and neglect. According to Dr Hannu Vuori, the mission's commissioner for health and social services, the interim health policy guidelines and six month action plan launched on Monday provide a framework for the emergency relief effort, to guide the 300 or so international agencies and non-governmental organisations that have descended on the province. But, crucially, it should also help Kosovo's health professionals to take advantage of the opportunities for long term development that exist as a result of the influx of …

A leading virologist is calling on the scientific community to spend no more time investigatingalleged links between the MMR (measles, mumps, and rubella) vaccine, inflammatory bowel disease, and autism after the publication last week of two further studies, which seemed to demolish the theory that vaccination increased the risk of the conditions. The studies—one published in the Lancet by a team from the Royal Free Hospital Medical School, London, the second in Current Problems in Pharmacovigilance from a specially convened …

This paper discusses the benefits of training local people to become community health workers in south Sudan. Joyce Kiden relates her experiences as a health worker and gives a detailed account on the benefits of the work as well as the fulfillment of helping others. Despite some challenges and difficulties the training that was organized by WHO has made considerable impact on the improvement of primary health care services at the community level. Many agencies realize importance of community health workers training. These training enhances the basic skills of people and hopefully encourage international donors to support not just the international organizations that are vital but also the local people who will make improving health a sustainable possibility.

Negotiating protection against poliomyelitis has been a very difficult issue in Somalia particularly in the conflict zone of Mogadishu where most of the remaining reservoirs of wild polio are found. This article focuses on the polio eradication campaign conducted by the WHO in the danger zones of Somalia. The importance of such a campaign is accounted for in the fact that since January there have been 14 confirmed cases of wild polio with 32 more cases under investigation. Hence the international staff aimed to surpass challenges which include noncooperation of rival clans in order to carry out the campaign. Their success is attributable to reports that the first round of the campaign in Mogadishu achieved average coverage rates of 95% on the north side of the Green Line and 130% on the south side. If these results will continue for the rest of the scheduled national immunizations WHO estimates that Somalia could be free of polio within 24 months.

In response to the need of a health policy in Kosovo the UN Mission in Kosovo produced their blueprint for a new health system--the Interim Health Policy Guidelines and Six-Month Action Plan. The document seeks not only to provide a framework for emergency work but also to bring about sustained reform in the current health care system. It also aimed to shift the focus of the whole health care system around giving primary care to Kosovars. Targeted areas are antenatal care and childrens and mental health care which are currently falling well below European standards. Although a shift in the system will have huge effects on the health of Kosovars a problem of changing the attitudes of doctors and of patients to accept general practice as real medicine is seen. However without a policy framework emergency activities can skew services dramatically. It can offer unsustainable levels of care and bring in uneven donations to different regions which would encourage movement in the population.

Anonymous allegations of abnormally high child death rates have prompted an independent inquiry into standards of surgery at one of Britain's leading cardiac hospitals. The investigation, which came to light earlier this week, was set up by the Royal Brompton and Harefield NHS Trust last month after an unsigned letter containing death rate statistics was sent to Brian Langstaff, QC, the lead solicitor in the inquiry into child deaths at the Bristol Royal Infirmary. The Royal College of …

New UK research has prompted calls for hernia surgery to return to the domain of general surgeons and the use of open repair rather than laparoscopic procedures. The findings come from a 26 centre, randomised trial by the Medical Research Council Laparoscopic Hernia Group, which compared laparoscopic surgery for hernia with open procedures in more …

The decision by the British research charity the Wellcome Trust to give its 270 senior researchers a 30%pay rise has put pressure on the UK government to follow suit with its academic researchers; the move is unlikely, however, to provoke a compensatory windfall for researchers in competing US and European institutions. Urgent action is needed to keep Britain's …

Dramatic cuts in staff reporting to the chief medical officer (CMO) for England over the past decade have undermined the role to such an extent that effective action in a health crisis--such as occurred over bovine spongiform encephalopathy (BSE)--would now be almost impossible, a senior health administrator said last week. The warning came just before the announcement that Professor Liam Donaldson is to be the next CMO for England (see p 233). Presenting evidence to the BSE inquiry, Dr Hilary Pickles, who was lead principal medical officer on BSE from 1988 to 1990, said that the past 10 years had seen senior and middle ranking medical staff dramatically reduced, promotion prospects for senior staff disappear, …

The double standards that exist in judging orthodox and alternative medicine should be challenged, and reliable tools that can validate both approaches need to be found. The call came last week in London at a conference on integrated medicine which was organised by the Prince of Wales. Dr Iain Chalmers, the director of the UK Cochrane Centre and a vociferous proponent of systematic reviews, told delegates: “Critics of complementary medicine …

Research suggesting that genetic susceptibility raises the risk of developing cervical cancer could help increase the effectiveness of cytology screening programmes. An international collaboration group of British, Italian, and Canadian scientists has discovered that women who carry a particular variation of the tumour suppressor gene p53 are seven times more likely to develop cervical cancer than those who do not ( Nature 1998; 393:229-33). Research leader, Dr Alan Storey from the skin tumour laboratory of the Imperial Cancer Research Fund in London, …

Results from the largest ever collection of randomised data on a cancer drug suggest tamoxifen should be given to all patients with breast cancer who have had surgery for hormone dependent tumours, regardless of age. The new data decisively overturns accepted wisdom that tamoxifen has no benefit for younger women or those with breast only tumours. It also indicates that the drug has a substantial benefit on top of chemotherapy. Coordinators of the Early Breast Cancer Trialists' Collaborative Group based at Oxford University's Clinical Trial Service Unit say that acting on these results will prevent around 20000 more deaths from breast cancer a year worldwide, including …

A third of Nicaragua's state employed doctors have been fired and grants to trainee doctors removed in a government attempt to reduce state involvement in health. Over 400 specialists and 800 GPs have been dismissed while 600 student interns attached to the medical school of the National Autonomous University of Nicaragua in Leon have had their contracts cancelled. Coming on top of a seven year pay freeze at breadline wages, the move has triggered a strike that is devastating health services. Ninety five …

An expert group has backed vaccination with the combined measles, mumps, and rubella (MMR) vaccine after a day long examination of controversial evidence claiming that vaccination is linked with bowel disease and autism. Professor John Pattison, chairman of the expert group, said: “There is no evidence whatsoever that would lead anyone to suggest a change in the current vaccination policy in the UK.” The 37 …

Three new studies have found that aspirin is of no benefit in preventing pre-eclampsia or in reducing the effects of pre-eclampsia in newborns. But despite the growing body of evidence many doctors continue to use the treatment routinely. Reporting a randomised trial of 2539 women at high risk of pre-eclampsia, researchers from the National Institute of Child Health and Human Development in the United States said that the findings showed categorically that preventive treatment with aspirin does not work. No significant differences from placebo were found in the women, recruited …

Doctors at the Royal Free Hospital in London believe they have uncovered a new bowel disease in children that may be linked to autism and triggered by the measles, mumps, and rubella vaccine (MMR). The claim follows controversial work from the same team suggesting a causal link between measles vaccination and inflammatory bowel disease. The report stems from the investigation of 12 children aged between 3 and 10 years who were consecutively referred to the department of paediatric gastroenterology at the Royal Free Hospital ( Lancet 1998;351:637-41). After a period of apparently normal development, the children had lost acquired skills, including language, and had developed gastrointestinal symptoms such as diarrhoea, abdominal pain, and bloating. All 12 were found to have lumpy swellings of the lymph nodes and patchy recurring inflammation in the intestine. In nine of the children autism had also been diagnosed, and in eight children the parents or the …

German doctors have grown new blood vessels in human hearts using genetically engineered human growth factor. This is a clinical first that could transform treatment for ischaemic heart disease. In a randomised controlled trial, researchers from the Fulda medical centre in Germany injected human growth factor FGF-I into the heart muscle of 20 patients undergoing bypass surgery for three vessel coronary artery disease ( Circulation 1998;97:645-50). All participants also had stenoses in peripheral …

Deteriorating rehabilitation services in Britain over the past decade are causing unnecessary dependence and misery, particularly among older people, say healthcare analysts. In a joint report, the King's Fund and the government's watchdog, the Audit Commission, say that services promoting rehabilitation have been squeezed out due to lack of investment, leaving people with few alternatives …