Liverpool School Of Tropical Medicine Research Articles

Fasciola gigantica, F. hepatica and Fasciola intermediate forms: geometric morphometrics and an artificial neural network to help morphological identification.

BackgroundFasciola hepatica and F. gigantica cause fascioliasis in both humans and livestock. Some adult specimens of Fasciola sp. referred to as “intermediate forms” based on their genetic traits, are also frequently reported. Simple morphological criteria are unreliable for their specific identification. In previous studies, promising phenotypic identification scores were obtained using morphometrics based on linear measurements (distances, angles, curves) between anatomical features. Such an approach is commonly termed “traditional” morphometrics, as opposed to “modern” morphometrics, which is based on the coordinates of anatomical points.MethodsHere, we explored the possible improvements that modern methods of morphometrics, including landmark-based and outline-based approaches, could bring to solving the problem of the non-molecular identification of these parasites. F. gigantica and Fasciola intermediate forms suitable for morphometric characterization were selected from Thai strains following their molecular identification. Specimens of F. hepatica were obtained from the Liverpool School of Tropical Medicine (UK). Using these three taxa, we tested the taxonomic signal embedded in traditional linear measurements versus the coordinates of anatomical points (landmark- and outline-based approaches). Various statistical techniques of validated reclassification were used, based on either the shortest Mahalanobis distance, the maximum likelihood, or the artificial neural network method.ResultsOur results revealed that both traditional and modern morphometric approaches can help in the morphological identification of Fasciola sp. We showed that the accuracy of the traditional approach could be improved by selecting a subset of characters among the most contributive ones. The influence of size on discrimination by shape was much more important in traditional than in modern analyses. In our study, the modern approach provided different results according to the type of data: satisfactory when using pseudolandmarks (outlines), less satisfactory when using landmarks. The different reclassification methods provided approximately similar scores, with a special mention to the neural network, which allowed improvements in accuracy by combining data from both morphometric approaches.ConclusionWe conclude that morphometrics, whether traditional or modern, represent a valuable tool to assist in Fasciola species recognition. The general level of accuracy is comparable among the various methods, but their demands on skills and time differ. Based on the outline method, our study could provide the first description of the shape differences between species, highlighting the more globular contours of the intermediate forms.

A pneumococcal controlled human infection model in Malawi: Transfer of an established pneumococcal carriage model from Liverpool, UK to Blantyre, Malawi – A feasibility study

Streptococcus pneumoniae is the leading cause of morbidity and mortality due to community acquired pneumonia, bacterial meningitis and bacteraemia worldwide. Pneumococcal conjugate vaccines protect against invasive disease, but are expensive to manufacture, limited in serotype coverage, associated with serotype replacement and demonstrate reduced effectiveness against mucosal colonisation. As asymptomatic colonisation of the human nasopharynx is a prerequisite for pneumococcal disease, this is proposed as a marker for novel vaccine efficacy. Our team established a safe and reproducible pneumococcal controlled human infection model at Liverpool School of Tropical Medicine (LSTM). This has been used to test vaccine induced protection against nasopharyngeal carriage for ten years in over 1000 participants. We will transfer established standardised operating procedures from LSTM to Malawi and test in up to 36 healthy participants. Primary endpoint: detection of the inoculated pneumococci by classical culture from nasal wash recovered from the participants after pneumococcal challenge. Secondary endpoints: confirmation of robust clinical and laboratory methods for sample capture and processing. Tertiary endpoints: participant acceptability of study and methods. We will test three doses of pneumococcal inoculation (20,000, 80,000 and 160,000 colony forming units [CFUs] per naris) using a parsimonious study design intended to reduce unnecessary exposure to participants. We hypothesise that 80,000 CFUs will induce nasal colonisation in approximately half of participants per established LSTM practice. The aims of the feasibility study are: 1) Establish Streptococcus pneumoniae experimental human pneumococcal carriage in Malawi; 2) Confirm optimal nasopharyngeal pneumococcal challenge dose; 3) Confirm safety and measure potential symptoms; 4) Confirm sampling protocols and laboratory assays; 5) Assess feasibility and acceptability of consent and study procedures. Confirmation of pneumococcal controlled human infection model feasibility in Malawi will enable us to target pneumococcal vaccine candidates for an at-risk population who stand the most to gain from new and improved vaccine strategies.

Drones Optimized Therapy System (DrOTS): Use of Drones for Tuberculosis Diagnosis in Nepal

Over 50% of the total Nepalese population lives in hilly and mountainous areas with extremely poor transportation and access to health care facilities. With advanced health centers concentrated only in urban areas, and diagnostic laboratories not being present in most primary healthcare facilities, majority of people are forced to have to walk by foot, in an average 6-8 hours, to access proper healthcare facilities. Drone Optimized Therapy System, (DrOTS) aims to improve access to healthcare access in rural villages of Nepal. The pilot phase currently involved improving the accessibility of Tuberculosis diagnostic tests by linking communit y health workers (CHWs) with state-of-the-art diagnostic tools (GeneXpert) via drones in two municipalities of Pyuthan district, Nepal. The drones fly from central Hospitals to remote healthcare centers and bring back sputum samples for diagnosis. The purpose of this project is to assist the Ministry of Health and Population (MoHP) and National Tuberculosis Center (NTC) by generating the data necessary to assess the suitability of the drones-based services for nationwide expansion. The aerial distance between any two points being lesser than the actual road distance, drone technology has come out as a very popular tool in transporting medical samples/medicines between health centers. Drones can be used as crucial tools to connect primary healthcare facilities to hospitals by delivering patient information such as blood, urine, sputum, stool etc. samples required for diagnosis from primary facilities to hospitals, and medicines from hospitals to patients in nearby rural locations for treatment. The project team consists of multisector experts; Public Health- Birat Nepal Medical Trust (BNMT), Drones & Tech - WeRobotics, Nepal Flying Labs & DroNepal, Research: The Liverpool School of Tropical Medicine, Govt. stakeholders: MoHP Nepal, the National TB Center and the District Public Health Office (DPHO Pyuthan) is supported by Stony Brook University and the Simons Foundation.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 14

Characterisation of Anopheles strains used for laboratory screening of new vector control products

BackgroundInsecticides formulated into products that target Anopheles mosquitos have had an immense impact on reducing malaria cases in Africa. However, resistance to currently used insecticides is spreading rapidly and there is an urgent need for alternative public health insecticides. Potential new insecticides must be screened against a range of characterized mosquito strains to identify potential resistance liabilities. The Liverpool School of Tropical Medicine maintains three susceptible and four resistant Anopheles strains that are widely used for screening for new insecticides. The properties of these strains are described in this paper.MethodsWHO tube susceptibility bioassays were used for colony selection and to screen for resistance to the major classes of public health insecticides. Topical and tarsal contact bioassays were used to produce dose response curves to assess resistance intensity. Bioassays with the synergist piperonyl butoxide were also performed. Taqman™ assays were used to screen for known target site resistance alleles (kdr and ace-1). RT-qPCR was used to quantify expression of genes associated with pyrethroid resistance.ResultsPyrethroid selection pressure has maintained resistance to this class in all four resistant strains. Some carbamate and organophosphate resistance has been lost through lack of exposure to these insecticide classes. The Anopheles gambiae (sensu lato) strains, VK7 2014, Banfora M and Tiassalé 13 have higher levels of pyrethroid resistance than the An. funestus FUMOZ-R strain. Elevated expression of P450s is found in all four strains and the 1014F kdr mutation is present in all three An. gambiae strains at varying frequencies. Tarsal contact data and overexpression of CYP4G16 and SAP2 suggest penetration barriers and/or sequestration also confer resistance in Banfora M.ConclusionsContinual selection with deltamethrin has maintained a stable pyrethroid-resistant phenotype over many generations. In conjunction with a standardized rearing regime, this ensures quality control of strains over time allowing for robust product comparison and selection of optimal products for further development. The identification of multiple mechanisms underpinning insecticide resistance highlights the importance of screening new compounds against a range of mosquito strains.

Evaluating respiratory cryptosporidiosis in pediatric diarrheal disease: protocol for a prospective, observational study in Malawi

BackgroundCryptosporidium is among the most common causes of severe diarrhea in African children 0–23 months old. It is associated with excess mortality, stunting and malnutrition. The most common manifestation of cryptosporidium is intestinal diarrheal disease. However, respiratory cryptosporidiosis has been documented in up to a third of children presenting with diarrhea. It is unclear whether respiratory involvement is a transient phenomenon or a reservoir for gastrointestinal (GI) disease. This study aims to evaluate the role of respiratory cryptosporidiosis in pediatric diarrheal disease.MethodsThis is a prospective, observational study conducted at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Young children aged 2–24 months hospitalized with diarrhea will be enrolled. Enrolled children will have induced sputum, nasopharyngeal (NP) swab and stool samples collected. All participants positive for cryptosporidium on sputum/NP/stool PCR testing will be followed up fortnightly after discharge from the hospital up to 8 weeks post-discharge. Sputum/NP/stool sample collection will be done at each visit. The primary outcomes will be presence of Cryptosporidium spp. in sputum/NP/stool. The secondary outcome will be presence of respiratory and GI symptoms, mortality and stunting. Ethical approval was obtained from the University of Malawi College of Medicine Research Ethics Committee (COMREC) and the Liverpool School of Tropical Medicine (LSTM) research ethics committee.DiscussionThe study began recruitment activities at QECH in February 2019. The protocol allows for expansion of recruitment to secondary sites within Blantyre and Chikwawa districts in the event that targets are not met at QECH. Study recruitment is expected to continue until early 2020.

Advances in Antiwolbachial Drug Discovery for Treatment of Parasitic Filarial Worm Infections

The intracellular bacteria now known as Wolbachia were first described in filarial worms in the 1970s, but the idea of Wolbachia being used as a macrofilaricidal target did not gain wide attention until the early 2000s, with research in filariae suggesting the requirement of worms for the endosymbiont. This new-found interest prompted the eventual organization of the Anti-Wolbachia Consortium (A-WOL) at the Liverpool School of Tropical Medicine, who, among others have been active in the field of antiwolbachial drug discovery to treat filarial infections. Clinical proof of concept studies using doxycycline demonstrated the utility of the antiwolbachial therapy, but efficacious treatments were of long duration and not safe for all infected. With the advance of robotics, automation, and high-speed computing, the search for superior antiwolbachials shifted away from smaller studies with a select number of antibiotics to high-throughput screening approaches, centered largely around cell-based phenotypic screens due to the rather limited knowledge about, and tools available to manipulate, this bacterium. A concomitant effort was put towards developing validation approaches and in vivo models supporting drug discovery efforts. In this review, we summarize the strategies behind and outcomes of recent large phenotypic screens published within the last 5 years, hit compound validation approaches and promising candidates with profiles superior to doxycycline, including ones positioned to advance into clinical trials for treatment of filarial worm infections.

Development of a High-Throughput Cytometric Screen to Identify Anti-Wolbachia Compounds: The Power of Public–Private Partnership

The Anti-Wolbachia (A·WOL) consortium at the Liverpool School of Tropical Medicine (LSTM) has partnered with the Global High-Throughput Screening (HTS) Centre at AstraZeneca to create the first anthelmintic HTS for neglected tropical diseases (NTDs). The A·WOL consortium aims to identify novel macrofilaricidal drugs targeting the essential bacterial symbiont (Wolbachia) of the filarial nematodes causing onchocerciasis and lymphatic filariasis. Working in collaboration, we have validated a robust high-throughput assay capable of identifying compounds that selectively kill Wolbachia over the host insect cell. We describe the development and validation process of this complex, phenotypic high-throughput assay and provide an overview of the primary outputs from screening the AstraZeneca library of 1.3 million compounds.

Effect of Plasmodium falciparum sulfadoxine-pyrimethamine resistance on the effectiveness of intermittent preventive therapy for malaria in pregnancy in Africa: a systematic review and meta-analysis

Resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine threatens the antimalarial effectiveness of intermittent preventive treatment during pregnancy (IPTp) in sub-Saharan Africa. We aimed to assess the associations between markers of sulfadoxine-pyrimethamine resistance in P falciparum and the effectiveness of sulfadoxine-pyrimethamine IPTp for malaria-associated outcomes. For this systematic review and meta-analysis, we searched databases (from Jan 1, 1990 to March 1, 2018) for clinical studies (aggregated data) or surveys (individual participant data) that reported data on low birthweight (primary outcome) and malaria by sulfadoxine-pyrimethamine IPTp dose, and for studies that reported on molecular markers of sulfadoxine-pyrimethamine resistance. Studies that involved only HIV-infected women or combined interventions were excluded. We did a random-effects meta-analysis (clinical studies) or multivariate log-binomial regression (surveys) to obtain summarised dose-response data (relative risk reduction [RRR]) and multivariate meta-regression to explore the modifying effects of sulfadoxine-pyrimethamine resistance (as indicated by Ala437Gly, Lys540Glu, and Ala581Gly substitutions in the dhps gene). This study is registered with PROSPERO, number 42016035540. Of 1097 records screened, 57 studies were included in the aggregated-data meta-analysis (including 59 457 births). The RRR for low birthweight declined with increasing prevalence of dhps Lys540Glu (ptrend=0·0060) but not Ala437Gly (ptrend=0·35). The RRR was 7% (95% CI 0 to 13) in areas of high resistance to sulfadoxine-pyrimethamine (Lys540Glu ≥90% in east and southern Africa; n=11), 21% (14 to 29) in moderate-resistance areas (Ala437Gly ≥90% [central and west Africa], or Lys540Glu ≥30% to <90% [east and southern Africa]; n=16), and 27% (21 to 33) in low-resistance areas (Ala437Gly <90% [central and west Africa], or Lys540Glu <30% [east and southern Africa]; n=30; ptrend=0·0054 [univariate], I2=69·5%). The overall RRR in all resistance strata was 21% (17 to 25). In the analysis of individual participant data from 13 surveys (42 394 births), sulfadoxine-pyrimethamine IPTp was associated with reduced prevalence of low birthweight in areas with a Lys540Glu prevalence of more than 90% and Ala581Gly prevalence of less than 10% (RRR 10% [7 to 12]), but not in those with an Ala581Gly prevalence of 10% or higher (pooled Ala581Gly prevalence 37% [range 29 to 46]; RRR 0·5% [-16 to 14]; 2326 births). The effectiveness of sulfadoxine-pyrimethamine IPTp is reduced in areas with high resistance to sulfadoxine-pyrimethamine among P falciparum parasites, but remains associated with reductions in low birthweight even in areas where dhps Lys540Glu prevalence exceeds 90% but where the sextuple-mutant parasite (harbouring the additional dhps Ala581Gly mutation) is uncommon. Therapeutic alternatives to sulfadoxine-pyrimethamine IPTp are needed in areas where the prevalence of the sextuple-mutant parasite exceeds 37%. US Centers for Disease Control and Prevention, the Malaria in Pregnancy Consortium (funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine), Worldwide Antimalarial Resistance Network, European and Developing Countries Clinical Trials Partnership.

Five Year Study of a Unique, Eco-friendly, Menstrual Cup, That Enhances the Quality of Women’s Lives During Menstruation

Menstrual cups are gaining more popularity among women, [1]. who prefer cups over pads and tampons. The innovative FemmyCycle (Figure 2) has several advantages over traditional menstrual cups, which has led to its increased popularity [2]. The objective of this study is to mitigate and correct the possible or potential side effects caused by traditional menstrual cups (Figure 3). The most common side effect among traditional cups is leakage. Despite the fact that 1.9 billion women globally are of menstruating age—spending on average 65 days a year dealing with menstrual blood flow, few good quality studies exist that compare sanitary products, says senior author Penelope Phillips-Howard, a public health epidemiologist from the Liverpool School of Tropical Medicine in the UK. [3]. We focused our study on all causes of leakage and other side effects caused by traditional menstrual cups. Methods of corrective and preventive actions included; the no-spill design, (Figure 4 & Figure 5), use of a removal ring instead of a rigid stem, the use of a flask shaped body rather than the conical shape of traditional menstrual cups, (Figure 2 & Figure 3), the elimination of suction holes and the need to manually open the cup. We analyzed 834 independent reviews by women who have had prior experience with traditional menstrual cups to obtain objective results. The implementation of these design changes and enhancing the written and video instructions produced measurable, objective, positive results in favor of the FemmyCycle. We analyzed all these reviews for FemmyCycle to measure the effects on leakage and other side effects. We selected the reviewers who volunteered to compare the FemmyCycle with their experience with traditional cone shaped menstrual cups. There were many reasons why women preferred FemmyCycle, but the most common by far was the prevention of leakage followed by the ease of insertion, ease of removal and comfort when inserted. The implementation of the design changes from a conical shaped cup with a removal stem to a flask shape cup with a removal ring, in addition to the added no-spill feature and enhanced instructional material, improved the acceptability of the FemmyCycle.

Delusional infestation managed in a combined tropical medicine and psychiatry clinic.

Delusional infestation (DI) is a well-recognised delusional disorder presenting as the persisting belief in the presence of parasitic or other infestations. Combined clinics have been run by dermatology and psychiatry in a small number of centres. Here we report the first few years of a unique combined clinic run with experts in infectious diseases/tropical medicine and psychiatric management of DI. We reviewed all patients seen at the combined assessment clinics run at the Liverpool School of Tropical Medicine between 19 December 2011 and 31 October 2016. Data were collected prospectively as part of clinical assessment. Descriptive analysis of these data was performed to examine clinical features at assessment, investigations performed and treatment outcomes. A total of 75 patients were assessed and 52 (69%) were given the formal diagnosis of DI. A history of travel was given by 64% of individuals but no significant tropical or infectious diagnosis was made. Of those who returned for follow-up, 61% reported improvement in symptoms. The Clinical Global Impressions Severity scale improvement was 1.36 for DI patients but only 0.63 for non-DI patients. DI patients were more impaired at baseline (5.0 vs 4.1). Health anxiety was the most common diagnosis seen in those not considered to have DI. Combined clinics to treat DI are effective in improving patient outcome. A significant minority of patients referred do not have a diagnosis of DI.

The Availability and Quality of Continuous Positive Airway Pressure (CPAP) for Neonatal Care in Public Health Facilities in India: A Cross- Sectional Cluster Survey

Background: Continuous Positive Airway Pressure (CPAP) is increasingly used in low- and middle-income setting to manage respiratory distress in neonates. Methods: National cross-sectional cluster survey of neonatal care units (SNCU) in 79 medical colleges (MC) and 63 district hospitals (DH) to assess availability, use, and, outcomes of CPAP. Findings: 68·3% of MC and 36·6% of DH used CPAP. Basic infrastructure was widely available. Air-oxygen blenders were available in 50·7% (95%CI 41·4,60·9) of hospitals. Equipment needed for monitoring and/or the detection and management of complications was not always in place; screening for retinopathy in 89·9%(77·2,95·9) MC and 60·3%(44·0,75·6) DH, treatment for retinopathy in 44·3%(30·9,58·5) MC and 7·9%(2·9,20·0) DH, screening for bronchopulmonary dysplasia in 62·0%(49·0,73·5) MC and 22·2%(12·5,36·3) DH, management of pneumothorax in 63·3%(49·8,74·9) of MC and 20·6%(9·8,38·3) of DH. Medical staff trained in the use of CPAP was available in 56·0%(45·8,65·8) of hospitals. The nurse:patient ratio was 7·3(95% CI 6·4-8·5) in MC and 6·6 (5·5-8·3) in DH. 72% MC and 59·3% DH used an upper oxygen saturation limit of above 94%. Respiratory circuits were reused in 52·8% of hospitals. Case Fatality Rates for neonates admitted to a SNCU were 11·5%(9·7,13·3) [13·2%(10·7,15·7) at MC and 7·4%(5·7,9·1) at DC] and 21·4%(16·6,26·2) for neonates receiving CPAP [19·8%(14·6,24·9) MC; 26·3%(15·7,37·0) DH]. Complication rates ranged from 27·9%(21·2,34·5) for rescue mechanical ventilation and 0·7%(0·2,1·2) for pneumothorax. Interpretation: Further support to infrastructure, training, and revision of current guidelines is urgently needed to improve the quality of care and ensure successful scale up of CPAP. Funding Statement: World Health Organization (Reference:2016/613341-0) Declaration of Interests: The authors have no competing interests to declare. Ethics Approval Statement: The study was approved by the Ministry of Health and Family Welfare of India (Child Health Division) and by the Liverpool School of Tropical Medicine’s Research and Ethics Committee (Research protocol 15·032).

Equity and efficiency in the scaled-up implementation of integrated neglected tropical disease control: the health economics protocol of the COUNTDOWN multicountry observational study in Ghana, Cameroon and Liberia

IntroductionWorldwide, millions of individuals are affected by neglected tropical diseases (NTDs). They are frequently the poorest and most marginalised members of society. Their living conditions, among other things, make them...

NEW WORLD LEISHMANIOSIS IN RUSSIAN TOURISTS WHO VISITED SOUTH AMERICAN COUNTRIES AND THE FIRST EXPERIENCE OF THE TREATMENT WITH PERU BALSAM

Two cases of New World cutaneous leishmaniasis acquired by Russian tourists in Peru and possibly in Bolivia are presented. L. viannia ( L.braziliensis complex) was identified in Liverpool School of Tropical medicine in the patient travelled to Bolivia. The present study aimed to investigate Balsamum peruvianum one of the product of folk medicine of Indians of Amazon region against local species of Leishmania resulted in healing the ulcers. Leishmaniasis is a major public health problem, and the alarming spread of parasite resistance has increased the importance of discovering new therapeutic products.

Fangblenny venom drops blood pressure, ignites inflammation

If a predator fish tries to swallow a tiny fangblenny, the hunter receives such a compelling dose of venom from its prospective lunch that the larger fish quivers and opens its mouth, letting the fangblenny escape unharmed. When Nicholas R. Casewell of the Liverpool School of Tropical Medicine, Bryan G. Fry of the University of Queensland, and colleagues took a close look at venomous fangblennies of the Meiacanthus genus, they discovered that the fish’s propensity to deliver toxic deterrents has some peculiar attributes (Curr. Biol. 2017, DOI: 10.1016/j.cub.2017.02.067). For example, many fish that use venom for defense rely on sharp spines to deliver their cargo; the fangblenny uses fangs. Furthermore, venomous fangblennies evolved their fangs before they evolved the biochemical ability to produce venom. Initially, the fish may have used the fangs to scoop out the flesh of competitors or to give predators a sharp poke. The team also discovered

Net Loss? Agrochemicals and Insecticide Resistance in the Fight against Malaria.

Net Loss? Agrochemicals and Insecticide Resistance in the Fight against Malaria.

A bibliometric analysis of literature on malaria vector resistance: (1996 - 2015).

BackgroundEmergence of insecticide resistance in malaria vectors is a real threat to future goals of elimination and control of malaria. Therefore, the objective of this study was to assess research trend on insecticide resistance of Anopheles mosquito. In specific, number of publications, countries, institutions, and authors’ research profile, citation analysis, international collaborations, and impact of journals publishing documents on insecticide resistance will be presented. It was conducted via Scopus search engine which was used to retrieve relevant data. Keywords used were based on literature available on this topic. The duration of study was set from 1996–2015.ResultsA total of 616 documents, mainly as original research articles (n = 569; 92.37%) were retrieved. The average number of citations per article was 26.36. Poisson log-linear regression analysis indicated that there was a 6.00% increase in the number of publications for each extra article on pyrethroid resistance. A total of 82 different countries and 1922 authors participated in publishing retrieved articles. The United Kingdom (UK) ranked first in number of publications followed by the United States of America (USA) and France. The top ten productive countries included seven African countries. The UK had collaborations mostly with Benin (relative link strength = 46). A total of 1817 institution/ organizations participated in the publication of retrieved articles. The most active institution/ organization was Liverpool School of Tropical Medicine. Retrieved articles were published in 134 different scientific peer reviewed journals. The journal that published most on this topic was Malaria Journal (n = 101; 16.4%). Four of the top active authors were from South Africa and two were from the UK. Three of the top ten cited articles were published in Insect Molecular Biology journal. Six articles were about pyrethroid resistance and at least two were about DDT resistance.ConclusionPublications on insecticide resistance in malaria vector has gained momentum in the past decade. International collaborations enhanced the knowledge about the situation of vector resistance in countries with endemic malaria. Molecular biology of insecticide resistance is the key issue in understanding and overcoming this emerging problems.

Medical Entomology for Students: Fifth Edition

Medical Entomology for Students: Fifth Edition Mike Service Cambridge University Press, Cambridge, UK 303 pages ISBN: 078-1-107-66818-8 Price: $50 (softcover) ![Graphic][1] Medical Entomology for Students has been an invaluable resource for physicians, nurses, health officers, and entomology students since the first edition appeared in 1996. The author, Mike Service, Emeritus Professor at the Liverpool School of Tropical Medicine, is an internationally recognized authority on medical entomology. Currently in its fifth edition and extensively revised with new information (particularly on control strategies), Service's book provides an overview of the identification, life cycles, ecology, classification, medical importance, disease transmission, and control of key vector species. As the title suggests and as the author cautioned in the first edition, this is not … gaugler{at}rci.rutgers.edu [1]: /embed/inline-graphic-1.gif

Profile: Liverpool School of Tropical Medicine, UK.

Profile: Liverpool School of Tropical Medicine, UK.

Fit for purpose: do we have the right tools to sustain NTD elimination?

Priorities for NTD control programmes will shift over the next 10-20 years as the elimination phase reaches the ‘end game’ for some NTDs, and the recognition that the control of other NTDs is much more problematic. The current goal of scaling up programmes based on preventive chemotherapy (PCT) will alter to sustaining NTD prevention, through sensitive surveillance and rapid response to resurgence. A new suite of tools and approaches will be required for both PCT and Intensive Disease Management (IDM) diseases in this timeframe to enable disease endemic countries to:1. Sensitively and sustainably survey NTD transmission and prevalence in order to identify and respond quickly to resurgence.2. Set relevant control targets based not only on epidemiological indicators but also entomological and ecological metrics and use decision support technology to help meet those targets.3. Implement verified and cost-effective tools to prevent transmission throughout the elimination phase.Liverpool School of Tropical Medicine (LSTM) and partners propose to evaluate and implement existing tools from other disease systems as well as new tools in the pipeline in order to support endemic country ownership in NTD decision-making during the elimination phase and beyond.

Moffat Nyirenda: investigating diabetes and other NCDs in Malawi

Moffat Nyirenda: investigating diabetes and other NCDs in Malawi