News & Events
10 October 2013
Paper entitled "Distribution of selected healthcare resources for influenza pandemic response in Cambodia", has been published in International Journal for Equity in Health
Sara U Schwanke Khilji, James W Rudge, Tom Drake, Irwin Chavez, Khieu Borin, Sok Touch and Richard Coker authored the paper entitled "Distribution of selected healthcare resources for influenza pandemic response in Cambodia", which has been published in International Journal for Equity in Health 2013, 12:82 doi:10.1186/1475-9276-12-82
Human influenza infection poses a serious public health threat in Cambodia, a country at risk for the emergence and spread of novel influenza viruses with pandemic potential. Prior pandemics demonstrated the adverse impact of influenza on poor communities in developing countries. Investigation of healthcare resource distribution can inform decisions regarding resource mobilization and investment for pandemic mitigation.
A health facility survey performed across Cambodia obtained data on availability of healthcare resources important for pandemic influenza response. Focusing on five key resources considered most necessary for treating severe influenza (inpatient beds, doctors, nurses, oseltamivir, and ventilators), resource distributions were analyzed at the Operational District (OD) and Province levels, refining data analysis from earlier studies. Resources were stratified by respondent type (hospital vs. District Health Office [DHO]). A summary index of distribution inequality was calculated using the Gini coefficient. Indices for local spatial autocorrelation were measured at the OD level using geographical information system (GIS) analysis. Finally, a potential link between socioeconomic status and resource distribution was explored by mapping resource densities against poverty rates.
Gini coefficient calculation revealed variable inequality in distribution of the five key resources at the Province an OD levels. A greater percentage of the population resides in areas of relative under-supply (28.5%) than over-supply (21.3%). Areas with more resources per capita showed significant clustering in central Cambodia while areas with fewer resources clustered in the northern and western provinces. Hospital-based inpatient beds, doctors, and nurses were most heavily concentrated in areas of the country with the lowest poverty rates; however, beds and nurses in Non-Hospital Medical Facilities (NHMF) showed increasing concentrations at higher levels of poverty.
There is considerable heterogeneity in healthcare resource distribution across Cambodia. Distribution mapping at the local level can inform policy decisions on where to stockpile resources in advance of and for reallocation in the event of a pandemic. These findings will be useful in determining future health resource investment, both for pandemic preparedness and for general health system strengthening, and provide a foundation for future analyses of equity in health services provision for pandemic mitigation planning in Cambodia.
The paper is available online here.
23 September 2013
Meeting : Collaborative meeting in Myanmar
HE Union Minister for Health Prof Pe Thet Khin, Deputy Minister for Health Dr.Than Aung, Director General, Department of Medical Science Dr. Than Zaw Myint, Deputy Director General (Medical Care), Department of Health Dr. Than Win, Rector, University of Public Health Prof. Nay Soe Maung and Head of CDPRG Prof. Richard Coker had a meeting in Nay Pyi Taw, Myanmar to discuss for future collaborations.
17 September 2013
CAP-TB launches new online Knowledge Gateway
CAP-TB has launched a new website that will serve as an information hub, library, and news center for the work of partners and other TB experts. If you work in global health, TB, or manage public health efforts in Asia, the site will be consistently useful to you.
Control and Prevention of Tuberculosis (CAP-TB) is a five-year project funded by the U.S. Agency for International Development (USAID) to help to reduce the incidence and mortality related to Multi-Drug Resistant TB (MDR-TB.) The project supports activities in partnership with the National TB Programs (NTPs) and local organizations in Myanmar, China, and Thailand.
The project, which runs from October 2011-October 2016, aims to reduce MDR-TB-related incidence and mortality in these three target countries.
Professor Richard Coker, a noted researcher from the London School of Hygiene and Tropical Medicine. As partners of the CAP-TB team, Professor Coker and his team will use macro-economic modeling to analyze different funding allocations and their impact on TB control. These analyses will help to ensure that project and national/provincial TB program efforts are directed toward maximul effect.
CAP-TB's Chief of Party, Dr.Anh Innes
Visit the site at: www.cap-tb.org.
7 August 2013
Editorial on "Human to human transmission of H7N9" has been published in BMJ
Dr.James Rudge and Prof.Richard Coker authored an editorial in the BMJ on evidence that the new bird flu visus, H7N9, has passed between humans. They conclude that, while the study "might not suggest that H7N9 is any closer to delivering the next pandemic, it does provide a timely reminder of the need to remain extremely vigilant". BMJ 2013;347 doi: http://dx.doi.org/10.1136/bmj.f4730
Please see the editorial here.
The original research article in BMJ by Qi and colleagues can be found here.
Dr.James Rudge also comments on the findings at BBC News Online here.
BMJ podcast about H7N9 by Dr.James Rudge can be found here.
31 July 2013
Short Course - Vaccinology for Clinical and Public Health Practice
Jointly Organised by London School of Hygiene & Tropical Medicine & Saw Swee Hock School of Public Health
This course is designed to provide an understanding of the concepts used in the evaluation of vaccines, Participants will learn epidemiological and immunological principles relevant to public health evaluation of vaccines, conduct and interpretation of vaccine trials, post-marketing surveillance, and more advanced topics involved in decision-making and vaccine introduction, including herd immunity, the application of mathematical models to predict vaccine impact, and economic evaluation of vaccines. Participants will have the opportunity to apply these concepts in problem-solving exercises and through an expert panel discussion covering emerging issues related to vaccination.
This course is relevant to public health and medical professionals in both private and public sectors, and field researchers with a strong interest in vaccine efficacy, safety and impact. Participants will be expected to have a basic understanding of research methods relevant to public health. The course is intensive and a good command of the English language is essential. Basic knowledge of Microsoft Office Word and Excel is also essential.
For more information on the course, please see the course brochure here.
For registration, please register online here.
Closing date for Registration: 30 September 2013
For more information, please visit: http://www.sph.nus.edu.sg/index.php/education/short-courses
14 June 2013
Paper entitled "Health system strengthening in Myanmar during political reforms: perspectives from international agencies", has been published in Health Policy and Planning
Isabelle Risso-Gill, Martin McKee, Richard Coker, Peter Piot and Helena Legido-Quigley authored the paper entitled "Health system strengthening in Myanmar during political reforms: perspectives from international agencies", which has been published in Health Policy and Planning 2013 ; 1-9 doi:10.1093/heapol/czt037
Myanmar has undergone a remarkable political transformation in the last 2 years, with its leadership voluntarily transitioning from an isolated military regime to a quasi-civilian government intent on re-engaging with the international community. Decades of underinvestment have left the country underdeveloped with a fragile health system and poor health outcomes., International aid agencies have found engagement with the Myanmar government difficult but this is changing rapidly and it is opportune to consider how Myanmar can engage with the global health system strengthening (HSS) agenda. Nineteen semi-structured, face-to-face interviews were conducted with representatives from international agencies working in Myanmar to capture their perspectives on HSS following political reform. They explored their perceptions of HSS and the opportunities for implementation. Participants reported challenges in engaging with government, reflecting the disharmony between actors, economic sanctions and barriers to service delivery due to health system weaknesses and bureaucracy. Weaknesses included human resources, data and medical products/infrastructure and logistical challenges. Agencies had mixed views of health system finance and governance, identifying problems and also some positive aspects. There is little consensus on how HSS should be approached in Myanmar, but much interest in collaborating to achieve it. Despite myriad challenges and concerns, participants were generally positive about the recent political changes, and remain optimistic as they engage in HSS activities with the government.
The paper is available online here.
12 June 2013
Paper entitled "Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation", has been published in BMC Public Health
Wiku Adisasmito, Dewi Nur Aisyah, Tjandra Yoga Aditama, Rita Kusriastuti, Trihono, Agus Suwandono, Ondri Dwi Sampurno, Prasenohadi, Nurshanty A Sapada, MJN Mamahit, Anna Swenson, Nancy A Dreyer and Richard Coker authored the paper entitled "Human influenza A H5N1 in Indonesia", which has been published in BMC Public Health 2013,13:571 doi:10.1186/1471-2458-13-571
Indonesia has had more recorded human cases of influenza A H5N1 than any other country, with one of the world's highest case fatality rates. Understanding barriers to treatment may help ensure life-saving influenza-specific treatment is provided early enough to meaningfully improve clinical outcomes.
Data for this observational study of humans infected with influenza A H5N1 were obtained primarily from Ministry of Health, Provincial and District Health Office clinical records. Data included time from symptom onset to presentation for medical care, source of medical care provided, influenza virology, time to initiation of influenza-specific treatment with antiviral drugs, and survival.
Data on 124 human cases of virologically confirmed avian influenza were collected between September 2005 and December 2010, representing 73% of all reported Indonesia cases. The median time from health service presentation to antiviral drug initiation was 7.0 days. Time to viral testing was highly correlated with starting antiviral treatment (p < 0.0001). We found substantial variability in the time to viral testing (p = 0.04) by type of medical care provider. Antivirals were started promptly after diagnosis (median 0 days).
Delays in the delivery of appropriate care to human cases of avian influenza H5N1 in Indonesia appear related to delays in diagnosis rather than presentation to health care settings. Either cases are not suspected of being H5N1 cases until nearly one week after presenting for medical care, or viral testing and/or antiviral treatment is not available where patients are presenting for care. Health system delays have increased since 2007.
The paper is available online here.
10 June 2013
Paper entitled "Human H5N1 influenza infections in Cambodia 2005--2011: case series and cost-of-illness", has been published in BMC Public Health
Karen Humphries-Waa, Tom Drake, Anthony Huszar, Marco Liverani, Khien Borin, Sok Touch, Teng Srey and Richard Coker authored the paper entitled "Human H5N1 influenza infections in Cambodia 2005--2011: case series and cost-of-illness", which has been published in BMC Public Health 2013, 13:549 doi:10.1186/1471-2458-13-549
Southeast Asia has been identified as a potential epicentre of emerging diseases with pandemic capacity, including highly pathogenic influenza, Cambodia in particular has the potential for high rates of avoidable deaths from pandemic influenza due to large gaps in health system resources. This study seeks to better understand the course and cost-of-illness for cases of highly pathogenic avian influenza in Cambodia.
The paper is available online here.
29 May 2013
Paper entitled "Pandemic influenza preparedness planning : lessons from Cambodia", has been published in the WHO South-East Asia Journal of Public Health
Anthony C. Huszar, Tom Drake, Teng Srey, Sok Touch and Richard Coker authored the paper entitled "Pandemic influenza preparedness planning : lessons from Cambodia", which has been published in the WHO South-East Asia Journal of Public Health ISSN 2224-3151 Volume 1, Issue 4, October-December 2012, P.369-373
Experts have estimated that a pandemic influenza outbreak could cost more than million lives worldwide. When considered in combination with recent research demonstrating human-to-human transmission potential of the highly pathogenic strain of avian influenza A(H5N1), this highlights the growing need for public health officials to review their pandemic influenza preparedness strategy. This is especially true for South-East Asia which is predicted to be the likely epicentre of future pandemics.
Following the 2009 H1N1 swine flu pandemic, many governments drew upon guidance from the World Health Organization (WHO) pandemic influenza preparedness framework to revise their national pandemic influenza plans. Cambodia was no different and the government updated its National Comprehensive Avian and Human Influenza Plan by producing three further pandemic influenza strategies.
The paper can be downloaded here. (Page 369-373)
2 May 2013
Meeting: 6th ASEAN Congress of Tropical Medicine and Parasitology (ACTMP) 2014
The Malaysian Society of Parasitology and Tropical Medicine (MSPTM) takes great pleasure to invite you to the Golden Jubilee of MSPTM and 6th ASEAN Congress of Tropical Medicine and Parasitology (ACTMP) which will be held in Kuala Lumpur, Malaysia from 5-7 March 2014. The theme for the congress is: GLOBAL CHALLENGES IN TROPICAL DISEASES: Bridging Gaps and Building Partnerships.
Please see the details for the meeting here.
25 April 2013
Paper entitled "Quantifying Effect of Geographic Location on Epidemiology of Plasmodium vivax Malaria", has been published in the Emerging Infectious Disease Journal
Andrew A. Lover and Richard Coker authored the paper entitled "Quantifying Effect of Geographic Location on Epidemiology of Plasmodium vivax Malaria", which has been published in the Emerging Infectious Disease Journal ISSN: 1080-6059. Volume 19, Number 7 - July 2013
Recent autochthonous transmission of Plasmodium vivax malaria in previously malaria-free temperate regions has generated renewed interest in the epidemiology of this disease. Accurate estimates of the incubation period and time to relapse are required for effective malaria surveillance; however, this information is currently lacking. By using historical data from experimental human infections with diverse P. vivax strains, survival analysis models were used to obtain quantitative estimates of the incubation period and time to first relapse for P. vivax malaria in broad geographic regions. Results show that Eurasian strains from temperate regions have longer incubation periods, and Western Hemisphere strains from tropical and temperate regions have longer times to relapse compared with Eastern Hemisphere strains. The diversity in these estimates of key epidemiologic parameters for P. vivax supports the need for elucidating local epidemiology to inform clinical follow-up and to build an evidence base toward global elimination of malaria.
The paper is available online here.
9 April 2013
Paper entitled “Priority setting in global health: Towards a minimum DALY value", has been published in Health Economics
Tom Drake authored the paper entitled "Priority setting in global health: Towards a minimum DALY value", which has been published in Health Economics. doi: 10.1002/hec.2925
Rational and analytic healthcare decision making employed by many national healthcare-funding bodies could also be expected from global health donors. Cost effectiveness analysis of healthcare investment options presents the effectiveness of a particular action in proportion to the resources required, and cost effectiveness thresholds, while somewhat arbitrary, define the level at which the investment can be considered value for money. Currently, cost effectiveness thresholds reflect the national budget context or willingness-to-pay, which is problematic when making cross-country comparisons. Defining a global minimum monetary value for the disability adjusted life year (DALY) would in effect set a global baseline cost effectiveness threshold. A global minimum DALY value would reflect a universal minimum value on human health, irrespective of a national provider's willingness or ability to pay. A minimum DALY value and associated threshold has both limitations and flaws but is justified on similar grounds to the Millennium Development Goals or the absolute poverty threshold and has the potential to radically improve transparency and efficiency of priority setting in global health.
The paper is available online here.
8 April 2013
Paper entitled “Trade years of life to make the whole world healthier”, has been published in New Scientist
Roman Carasco, Alex Cook and Richard Coker authored the paper entitled "Trade years of life to make the whole world healthier", which has been published in New Scientist, Magazine issue 2911.
To solve the tragedy of child mortality we need to set up an international market in ill health
ABOUT 6 million children under 5 die from infectious diseases each year. Most of those deaths occur in low-income countries as a result of diseases that can be prevented cheaply, such as diarrhoea, malaria or measles.
This tragedy is a result of two fundamental problems in global health: money and support from richer countries are insufficient; and the available funds are often not used efficiently.
Why does this happen? One important cause is that global health is a public good, and like many other public goods it suffers from the tragedy of the commons. The benefits of contributing – reduced risk of new emerging diseases, for example – are shared by free riders as well as contributors. You don't have to pay into the system to reap the rewards.
At present, global health investment is voluntary and few countries make sizeable donations. Since the start of the global financial crisis, investment has stagnated.
Is there a way to improve the situation? We think so. Although the world does not have a lot of experience in managing global commons, there is an example we can learn from: carbon trading.
The paper is available online here.
25 March 2013
Paper entitled "Analysis of 2009 pandemic influenza A/H1N1 outcomes in 19 European countries: association with completeness of national strategic plans", has been published in BMJ Open
Aronrag Meeyai, Ben Cooper and Richard Coker authored the paper entitled "Analysis of 2009 pandemic influenza A/H1N1 outcomes in 19 European countries: association with completeness of national strategic plans", which has been published in BMJ Open. 2013;3:e002253 doi:10.1136/bmjoopen-2012-002253
Objective: To describe changes in reported influenza activity associated with the 2009 H1N1 pandemic in European countries and determine whether there is a correlation between these changes and completeness of national strategic pandemic preparedness.
Design: A retrospective correlational study.
Setting: Countries were included if their national strategic plans had previously been analysed and if weekly influenza-like illness (ILI) data from sentinel networks between week 21, 2006 and week 20, 2010 were more than 50% complete.
Outcome measures: For each country we calculated three outcomes: the percentage change in ILI peak height during the pandemic relative to the prepandemic mean; the timing of the ILI peak and the percentage change in total cases relative to the prepandemic mean. Correlations between these outcomes and completeness of a country's national strategic pandemic preparedness plan were assessed using the Pearson product–moment correlation coefficient.
Results: Nineteen countries were included. The ILI peak occurred earlier than the mean seasonal peak in 17 countries. In 14 countries the pandemic peak was higher than the seasonal peak, though the difference was large only in Norway, the UK and Greece. Nine countries experienced more total ILI cases during the pandemic compared with the mean for prepandemic years. Five countries experienced two distinct pandemic peaks. There was no clear pattern of correlation between overall completeness of national strategic plans and pandemic influenza outcome measures and no evidence of association between these outcomes and components of pandemic plans that might plausibly affect influenza outcomes (public health interventions, vaccination, antiviral use, public communication). Amongst the 17 countries with a clear pandemic peak, only the correlation between planning for essential services and change in total ILI cases significantly differed from zero: correlation coefficient (95% CI) 0.50 (0.02, 0.79).
Conclusions: The diversity of pandemic influenza outcomes across Europe is not explained by the marked variation in the completeness of pandemic plans.
The paper is available online here.
22 March 2013
Meeting - Surges in demand for health services: Health system impacts and capacity to respond in Indonesia
A meeting to disseminate results from the "Health System Surge Capacity in Indonesia" project was held in Jakarta, Indonesia on 14th March 2013. The project's co-principle investigators are Prof Richard Coker, Prof Wiku Adisasmito and Dr James Rudge. The research has been led by Dr.Samantha Watson. The briefing note from the meeting can be downloaded here.
21 March 2013
Paper entitled "Health Systems' "Surge Capacity": State of the art and priorities for future research", has been published in the Milbank Quarterly
Samantha K. Watson, James W. Rudge and Richard Coker authored the paper entitled "Health Systems' "Surge Capacity": State of the art and priorities for future research", which has been published in the Milbank Quarterly. Volume 91, Issue 1 (pages 78-122) doi: 10.1111/milq.12003
Context: Over the past decade, a number of high-impact natural hazard events, together with the increased recognition of pandemic risks, have intensified interest in health systems' ability to prepare for, and cope with, "surges" (sudden large-scale escalations) in treatment needs. In this article, we identify key concepts and components associated with this emerging research theme. We consider the requirements for a standardized conceptual framework for future research capable of informing policy to reduce the morbidity and mortality impacts of such incidents. Here our objective is to appraise the consistency and utility of existing conceptualizations of health systems' surge capacity and their components, with a view to standardizing concepts and measurements to enable future research to generate a cumulative knowledge base for policy and practice.
Methods: A systematic review of the literature on concepts of health systems' surge capacity, with a narrative summary of key concepts relevant to public health.
Findings: The academic literature on surge capacity demonstrates considerable variation in its conceptualization, terms, definitions, and applications. This, together with an absence of detailed and comparable data, has hampered efforts to develop standardized conceptual models, measurements, and metrics. Some degree of consensus is evident for the components of surge capacity, but more work is needed to integrate them. The overwhelming concentration in the United States complicates the generalizability of existing approaches and findings.
Conclusions: The concept of surge capacity is a useful addition to the study of health systems' disaster and/or pandemic planning, mitigation, and response, and it has far-reaching policy implications. Even though research in this area has grown quickly, it has yet to fulfill its potential to generate knowledge to inform policy. Work is needed to generate robust conceptual and analytical frameworks, along with innovations in data collection and methodological approaches that enhance health systems' readiness for, and response to, unpredictable high-consequence surges in demand.
The paper is available online here.
4 March 2013
Meeting: Towards Cost-Effective Pandemic Influenza Mitigation in Cambodia
A meeting to disseminate results from the CamFlu project was held in Phnom Penh, Cambodia on 20th February 2013. The meeting was opened by H.E. Prof Eng Huot, Secretary of State for Health in Cambodia. The project investigators are Prof Richard Coker, Dr Sok Touch and Dr Khieu Borin. The lead researcher is Tom Drake. The briefing note from the meeting can be downloaded here.
22 February 2013
Paper entitled "Who Should Pay for Global Health , and How Much?", has been published in PLOS Medicine
Luis R. Carrasco, Richard Coker and Alex R. Cook authored the paper entitled "Who Should Pay for Global Health, and How Much?", which has been published in PLOS Medicine 10(2): e1001392. doi:10.1371/journal.pmed.1001392
The paper is available online here.
14 December 2012
The paper entitled "An analysis of health system resources in relation to pandemic response capacity in the Greater Mekong Subregion" resulting from the work of the AsiaFluCap project has been published in the International Journal of Health Geographics
Richard Coker, James Rudge and colleagues authored a paper entitled "An analysis of health system resources in relation to pandemic response capacity in the Greater Mekong Subregion", published in the International Journal of Health Geographics 2012, 11:53 doi:10.1186/1476-072X-11-53
resource sharing and mobilisation.
pandemic scenario could be crucial for more effective and equitable use of the resources that are available in the GMS.
The paper is available online here.
Improving health in Southeast Asia
The rapidly developing countries of Southeast Asia are on the front line of health challenges, including pandemic influenza, evolving drug-resistance, natural disasters and the growing threat of non-communicable diseases. The London School works with many partners across the region on collaborative research, you can read about some of these projects and partnerships in a new publication on Southeast Asia - the first of a series about how we are working to improve health worldwide.
Video interviews about improving health in SEA.
Singapore and London researchers collaborate on public health
The Saw wee hock School of Public Health in Singapore is an important strategic partner, and in this short video, its Dean, Professor Chia Kee Seng, and Professor Richard Coker discuss how we are working together to make research that leads to better public health policy in the region.
Investigating drug resistant malaria in Cambodia
Dr. Shunmay Yeung talks about the importance of documenting the rise of drug-resistant malaria - not only for the benefit of Cambodians, but for the good of other countries facing similar threats.
Research in Cambodia and Indonesia protects the world from disease threats
The School's Dr. James Rudge and his colleagues are investigating the complex interaction between humans and farm animals to understand how the virus spreads and evolves.
Influenza: Preparing for the next pandemic
Tom Drake and Professor Richard Coker discuss anti-flu measures as they affect Southeast Asia, considered by many to be the front line of any future battle against the disease.
Paper entitled "Cost–effectiveness analysis of pandemic influenza preparedness: what’s missing?" has been published in the Bulletin of the World Health Organization
4 December 2012
Tom Drake (CDPRG, LSHTM), Zaid Chalabi and Richard Coker (CDPRG, LSHTM), authored a paper entitled "Cost–effectiveness analysis of pandemic influenza preparedness: what’s missing?", published in the Bulletin of the WHO.
This paper was produced as part of the CamFlu project, an economic evaluation of pandemic influenza mitigation investment options for Cambodia, funded by Gesellschaft für Internationale Zusammenarbeit (GIZ).The paper is available online here.
1st Singapore International Public Health Conference: Translating Public Health Research into Practice
1 – 2 October 2012
The Saw Swee Hock School of Public Health and the Chapter of Public Health and Occupational Physicians with the Academy of Medicine Singapore organized the 1st Singapore International Public Health Conference: Translating Research into Practice, which took place on 1st-2nd October, 2012, in conjunction with the 7th Singapore Public Health & Occupational Medicine Conference.
The Conference brought together academics, researchers, practitioners, and policy makers from around the world to share innovative solutions to the address most pressing public health challenges of the 21st Century. The Conference programme included lectures, symposiums, research presentations, as well as pre-conference workshops and post-conference special interest group sessions.
The London School of Hygiene and Tropical Medicine (LSHTM) has recently formed a strategic partnership with the Saw Swee Hock School of Public Health. Professor Peter Piot (LSHTM Director) delivered a keynote speech on ”Science, Policy and Practice: lost in translation or synergy?” and many LSHTM staff members attended to highlight the school’s work and explore opportunities for future collaboration.
Richard Coker’s move to Singapore
After LSHTM signed a strategic MoU with the NUS Saw Swee Hock School Of Public Health to establish a regional hub for Public Health Research, Education and Innovation, on 1st June 2012 Richard Coker became the head the new infectious diseases programme at SSHSPH and continues to facilitate research and teaching links between LSHTM and Singapore.
Paper entitled "Avian and pandemic human influenza policy in South-East Asia: the interface between economic and public health imperatives" has been published in the Health Policy and Planning Journal
Richard Coker, Head of CDPRG LSHTM, and colleagues, authored a paper entitled "Avian and pandemic human influenza policy in South-East Asia: the interface between economic and public health imperatives", published in the Health Policy and Planning Journal.
The aim of this study was to analyse the contemporary policies regarding avian and human pandemic influenza control in three South-East Asia countries: Thailand, Indonesia and Vietnam. An analysis of poultry vaccination policy was used to explore the broader policy of influenza A H5N1 control in the region. The policy of antiviral stockpiling with oseltamivir, a scarce regional resource, was used to explore human pandemic influenza preparedness policy. Several policy analysis theories were applied to analyse the debate on the use of vaccination for poultry and stockpiling of antiviral drugs in each country case study. We conducted a comparative analysis across emergent themes.
The study found that whilst Indonesia and Vietnam introduced poultry vaccination programmes, Thailand rejected this policy approach. By contrast, all three countries adopted similar strategic policies for antiviral stockpiling in preparation. In relation to highly pathogenic avian influenza, economic imperatives are of critical importance. Whilst Thailand's poultry industry is large and principally an export economy, Vietnam's and Indonesia's are for domestic consumption. The introduction of a poultry vaccination policy in Thailand would have threatened its potential to trade and had a major impact on its economy. Powerful domestic stakeholders in Vietnam and Indonesia, by contrast, were concerned less about international trade and more about maintaining a healthy domestic poultry population. Evidence on vaccination was drawn upon differently depending upon strategic economic positioning either to support or oppose the policy.
With influenza A H5N1 endemic in some countries of the region, these policy differences raise questions around regional coherence of policies and the pursuit of an agreed overarching goal, be that eradication or mitigation. Moreover, whilst economic imperatives have been critically important in guiding policy formulation in the agriculture sector, questions arise regarding whether agriculture sectoral policy is coherent with public health sectoral policy across the region.
The paper is available online here.
Paper entitled "Pandemic influenza H1N1 2009 in Thailand" has been published in the WHO South-East Asia Journal of Public Health
Aronrag Meeyai and Richard Coker from the CDPRG, LSHTM (www.cdprg.org) authored the paper entitled "Pandemic influenza H1N1 2009 in Thailand", published in the WHO South-East Asia Journal of Public Health, Vol. 1 No. 1, January – March, 2012.
a quantitative understanding of pandemic influenza dynamics in
Southeast Asia is important for informing future pandemic planning.
Hence, transmission dynamics of influenza A/H1N1 were determined across space and time in Thailand.
Methods: Dates of symptom onset were obtained for all daily laboratory-confirmed cases of influenza A/H1N1pdm in Thailand from 3 May 2009 to 26 December 2010 for four different geographic regions (Central, North, North-East, and South). These data were analysed using a probabilistic epidemic reconstruction, and estimates of the effective reproduction number, R(t), were derived by region and over time.
Results: Estimated R(t) values for the first wave peaked at 1.54 (95% CI: 1.42-1.71) in the Central region and 1.64 (95% CI: 1.38-1.92) in the North, whilst the corresponding values in the North-East and the South were 1.30 (95% CI: 1.17-1.46) and 1.39 (95% CI: 1.32-1.45) respectively. As the R(t) in the Central region fell below one, the value of R(t) in the rest of Thailand increased above one. R(t) was above one for 30 days continuously through the first wave in all regions of Thailand. During the second wave R(t) was only marginally above one in all regions except the South.
Conclusions: In Thailand, the value of R(t) varied by region in the two pandemic waves. Higher R(t) estimates were found in Central and Northern regions in the first wave. Knowledge of regional variation in transmission potential is needed for predicting the course of future pandemics and for analysing the potential impact of control measures
The paper is available online here.
Oral presentation by James Rudge at the International Congress on Infectious Diseases (ICID), June 13-16 2012, Bangkok
James Rudge gave an oral presentation on the paper entitled "Surveillance and characterisation of influenza among patients with influenza-like illness in Bali, Indonesia" at the International Congress on Infectious Diseases (ICID) in Bangkok.
James W. Rudge on behalf of the BaliMEI Project consortium: Nyoman Sri Budayanti, Wiku Adisasmito, Gavin J. Smith, Lidya Handayani, Made Prashinta, Dewi Nur Aisyah, I. Ketut Subrata, I. Nyoman Sutedja, Richard Coker
Background: Indonesia is of key strategic importance for influenza surveillance and research, as it continues to report the majority of highly pathogenic avian influenza (H5N1) outbreaks worldwide. However, research on the ecology and evolution of influenza viruses in Indonesia has been severely limited. Within Indonesia, the island province of Bali might be a particular hotspot for mixing of influenza viruses from different geographic regions and host species, due to high densities and close proximity of humans, poultry and pigs, along with its status a popular tourist destination.
Methods: The Molecular Epidemiology of Influenza A in Bali project (“BaliMEI”) aims to conduct five years of active surveillance and characterisation of influenza viruses among patients presenting with influenza-like illness at health facilities across Bali. Nasopharyngeal swabs are screened for Influenza A and B, and Influenza A-positive samples are subtyped and tested for genetic markers of resistance to oseltamivir, using PCR based assays. Sequencing and phylogenetic analysis of samples is planned to take place at a later stage.
Results: To date, we have tested 772 patients (mean age = 11y, range= <1 to 79y) across all nine districts of Bali who presented with influenza-like illness between July 2010 and December 2011. Of these, 142 (18.4%) tested positive for Influenza A, and 28 (3.6%) tested positive for Influenza B. Findings show strong temporal patterns in circulation of seasonal and pandemic influenza viruses, with influenza B dominating from July to September 2010, pandemic A/H1N1 in December 2010 to April 2011, and seasonal A/H3N2 in July-October 2011. Two human cases of highly pathogenic avian influenza H5N1 were also identified within Bali during the study period, both of which were fatal.
Conclusion: With the continued incidence and high fatality rate of H5N1 among humans in Indonesia, ongoing surveillance is of critical importance. Further details on the methodologies, lessons learned, and results from the first two years of this study will be discussed.
The paper is available online here.
The AsiaFluCap Simulator
As part of the international AsiaFluCap project, led by Richard Coker, the team developed a simulation tool for assessing health system capacity for responding to various pandemic influenza scenarios. The AsiaFluCap Simulator was developed for policy makers, advisors and stakeholders involved in pandemic preparedness. Designed as a tool for evidence-based resource allocation, this unique simulator is able to estimate and display the availability, needs and gaps of 28 key health care resources (e.g. materials, equipment and personnel) for a selected pandemic scenario in a country, province or region. The AsiaFluCap Simulator was built in Microsoft Excel making the simulator easily accessible. Jame W. Rudge on behalf
What is AsiaFluCap Simulator designed for?
The AsiaFluCap Simulator can be used for:
For further information about the AsiaFluCap Simulator please visit http://www.cdprg.org/asiaflucap-simulator.php
An increasing amount of influenza research is being done in low and middle-income countries since the H1N1 influenza pandemic of 2009, according to a special theme issue of the Bulletin of the World Health Organization, published this month.
This issue includes the following articles on the topic:- Influenza still vexing scientists
- Timely interventions could lessen severity of future influenza pandemics
- Medium is the message for influenza communication
- Obstacles to effective influenza surveillance in Peru
- What are the next steps for pandemic preparedness?
In the news article entitled "The influenza enigma" reported by Patrick Adams, Richard Coker gave comments about animal influenza and the risk of a new pandemic due to increasing intensification of Southeast Asia's agriculture and farming sectors, both of which have experienced enormous growth in recent decades. (download full article)
Further information please visit http://www.who.int/bulletin/en/
Meeting on Emerging Infectious Diseases: understanding genetics, immunology and new control strategies
The meeting on ‘Emerging infectious diseases: understanding genetics, immunology, and new control strategies’, held in Bangkok on 19-20 March 2012, was organised by the British High Commission in Singapore as part of a wider set of initiatives aiming to strengthen scientific collaborations between the UK and Southeast Asia.
The meeting convened several experts working in the UK and/or Southeast Asia to explore scientific issues in emerging infectious diseases from an inter-disciplinary collaborative perspective.
Following the opening address by Ben Raby, Deputy Director for Trade and Investment at the British Embassy, and the welcome address by Phitaya Charupoonphol, Dean of the Faculty of Public Health at Mahidol University, the head of the LSHTM Communicable Diseases Policy Research Group at Mahidol University, Richard Coker, presented the aims and focus of the meeting.
The meeting report (download)
Job opportunity: Overseas Lecturer in Health Systems Analysis
(Closing date: Wednesday 18 April 2012)
We are seeking an enthusiastic Lecturer to join the Communicable Diseases Policy Research Group, Department of Global Health and Development, based in Thailand. The primary role for this post will be to work with the team to develop a research programme in health systems in SE Asia; in addition the post holder will support two GIZ funded projects undertaking health systems analyses in Cambodia and Indonesia.
We are looking for an applicant, to start as soon as possible, with a background in health systems and policy analysis, health economics, or related discipline, with experience in primarily quantitative research. As the GIZ projects involve development and simulation of healthcare “surge” scenarios, experience with mathematical modelling and/or programming is also desirable (but not essential).
The successful applicant will be based in Bangkok for the duration of the post, but will need to be able to travel between research partners and other collaborators in other SE Asian countries.
Salary will be on the Lecturer scale (£38,140-£44,165 per annum inclusive plus displacement allowance if applicable). The post will be subject to the LSHTM overseas terms and conditions of service, including membership of the Universities Superannuation Scheme. The post is full time for one year in the first instance.
Applications should be made on-line via our website at http://jobs.lshtm.ac.uk.The reference for this post is RC09.
Applications should also include a CV and the names of two referees, one of whom should be the most recent employer and may be approached immediately if shortlisted, should also be included with the on-line application. Any queries regarding the application process may be addressed to firstname.lastname@example.org.
The London School of Hygiene & Tropical Medicine is committed to being an equal opportunities employer
15 March 2012
Paper entitled "H5N1 Avian Influenza in Children" has been published in Clinical Infectious Diseases
Richard Coker and colleagues authored a paper entitled "H5N1 Avian Influenza in Children", published in the Clinical Infectious Diseases journal and is available online here.
Background: Avian influenza continues to pose a threat to humans and maintains the potential for greater transmissibility. Understanding the clinical presentation and prognosis in children will help guide effective diagnosis and treatment.
Methods: A global patient registry was created to enable systematic collection of clinical, exposure, treatment and outcomes data on confirmed cases of H5N1. Bivariate and multivariate statistical tools were used to describe clinical presentation and evaluate factors prognostic of survival.
Results: Data were available from 13 countries on 193 cases <18 years who were confirmed as having been infected with H5N1; 35.2% of cases were from Egypt. The case fatality rate (CFR) for children was 48.7%, with Egypt having very low pediatric CFR. Overall, children aged ≤5 years had the lowest CFR and were brought to hospital more quickly and treated sooner than older children. Pediatric cases who presented for medical care with a complaint of rhinorrhea had a 76% reduction in the likelihood of death compared with those who presented without rhinorrhea, even after statistical adjustment for age, having been infected in Egypt, and oseltamivir treatment (P=0.02). Delayed initiation of treatment with oseltamivir increases the likelihood of death, with an overall 75% increase in the adjusted odds ratio for death for each day of delay.
Conclusions: The presence of rhinorrhea appears to indicate a better prognosis for children with H5N1, with most cases surviving regardless of age, country, or treatment. For cases treated with oseltamivir, early initiation of treatment substantially enhances the chance of survival.
9 March 2012
Report from the Wilton Park/ADPC meeting on Disaster Risk Reduction in Asia
The Disaster Risk Reduction in Asia meeting was organised by Wilton Park, UK and the Asian Disaster Preparedness Centre. This took place in December 2011, having been postponed because of the flooding in Thailand. The floods and their impact provided an important focus for the discussion, while a number of excellent examples of DRR practices across Asia were presented.
Key points discussed
Significant strides have been made in Asia to reduce the impact of disasters, particularly reducing deaths caused by floods and earthquakes. However, given Asia’s continued rapid economic growth and urbanisation greater efforts are needed to reduce the economic and social impacts. Asian cities need to become more resilient to both current and future risks. Asia constitutes 30% of the global land mass yet 60% of the world’s population. Increased population pressures and urbanisation alongside a changing climate will put increasing strains on the natural and built environments. Additionally, weather related disasters will challenge governments resources and the ability to respond to natural disasters. In the future, as existing risk patterns intensify and effects are felt across borders and regions, it will be economically prudent and more efficient for countries to cooperate on disaster mitigation.
For further details please visit the website: http://www.wiltonpark.org.uk/en/reports/?view=Report&id=739089482
2 March 2012
Paper entitled "Health System Resource Gaps and Associated Mortality from Pandemic Influenza Across Six Asian Territories" has been published by PLOS ONE
The paper "Health System Resource Gaps and Associated Mortality from Pandemic Influenza Across Six Asian Territories" resulting from the work of the AsiaFluCap project has been published by PLOS ONE and is available online here.
Background: Southeast Asia has been the focus of considerable investment in pandemic influenza preparedness. Given the wide variation in socio-economic conditions, health system capacity across the region is likely to impact to varying degrees on pandemic mitigation operations. We aimed to estimate and compare the resource gaps, and potential mortalities associated with those gaps, for responding to pandemic influenza within and between six territories in Asia.
Methods and Findings: We collected health system resource data from Cambodia, Indonesia (Jakarta and Bali), Lao PDR, Taiwan, Thailand and Vietnam. We applied a mathematical transmission model to simulate a “mild-to-moderate” pandemic influenza scenario to estimate resource needs, gaps, and attributable mortalities at province level within each territory. The results show that wide variations exist in resource capacities between and within the six territories, with substantial mortalities predicted as a result of resource gaps (referred to here as “avoidable” mortalities), particularly in poorer areas. Severe nationwide shortages of mechanical ventilators were estimated to be a major cause of avoidable mortalities in all territories except Taiwan. Other resources (oseltamivir, hospital beds and human resources) are inequitably distributed within countries. Estimates of resource gaps and avoidable mortalities were highly sensitive to model parameters defining the transmissibility and clinical severity of the pandemic scenario. However, geographic patterns observed within and across territories remained similar for the range of parameter values explored.
Conclusions: The findings have important implications for where (both geographically and in terms of which resource types) investment is most needed, and the potential impact of resource mobilization for mitigating the disease burden of an influenza pandemic. Effective mobilization of resources across administrative boundaries could go some way towards minimizing avoidable deaths.
25 January 2012
LSHTM Bangkok Office Opening
Assoc Prof Phitaya Charupoonh, Dean of Mahidol University's Faculty of Public Health, and Prof Richard Coker, Head of LSHTM's Communicable Disease Policy Research Group, welcomed Vice Director of LSHTM Prof Anne Mills and Head of LSHTM's Faculty of Public Health and Policy Prof Richard Smith, to the opening event for the LSHTM Bangkok office at Mahidol University's Faculty of Public Health.