BMC Medicine

BackgroundThis study evaluates the cost-effectiveness of extending the Dutch influenza vaccination programme for elderly and clinical risk groups to include paediatric influenza vaccination, taking indirect protection into account. MethodsAn age-structured dynamic transmission model was used that was calibrated to influenza-associated GP visits over four seasons (2010/11 to 2013/14). The clinical and economic impact of different paediatric vaccination strategies were compared over 20 years, var...

BackgroundNational immunisation programmes globally are at risk of suspension due to the severe health system constraints and physical distancing measures in place to mitigate the ongoing COVID-19 pandemic. Our aim is to compare the health benefits of sustaining routine childhood immunisation in Africa against the risk of acquiring SARS-CoV-2 infections through visiting routine vaccination service delivery points. MethodsWe used two scenarios to approximate the child deaths that may be caused b...

For infectious disease prevention, policy-makers are typically required to base policy decisions in light of operational and monetary restrictions, prohibiting implementation of all candidate interventions. To inform the evidence-base underpinning policy decision making, mathematical and health economic modelling can be a valuable constituent. Applied to England, this study aims to identify the optimal target age groups when extending a seasonal influenza vaccination programme of at-risk individ...

BackgroundThe Measles-Mumps-Rubella vaccine is given as a two-dose course in childhood, but the schedule of the second dose varies between countries. England recommended bringing forward the second dose from three years and four months to 18 months by 2025. We aim to quantify how changing the vaccine schedule could impact measles transmission dynamics. MethodsWe used a mathematical model stratified by age group and region to generate stochastic outbreaks with different vaccine schedules. We use...

BackgroundTwo RSV immunisations products: a maternal vaccine, Abrysvo, and a long-acting monoclonal antibody, nirsevimab, both designed to prevent RSV illness in infants, have recently become available. Modelling evidence is required to inform how to optimally use these products in immunisation programs to reduce the burden of RSV in young children. MethodsWe extend a dynamic transmission model calibrated to RSV-hospitalisation data of children aged < 5 years in temperate Western Australia (WA)...

BackgroundWith a suite of promising new RSV prophylactics on the horizon, including long-acting monoclonal antibodies and new vaccines, it is likely that one or more of these will replace the current monoclonal Palivizumab programme. However, choosing the optimal intervention programme will require balancing the costs of the programmes with the health benefits accrued. MethodsTo compare the next generation of RSV prophylactics, we integrated a novel transmission model with an economic analysis....

ObjectiveTo evaluate the association between ultra-processed food (UPF) consumption and colorectal cancer (CRC) risk and to assess whether inflammatory bowel disease (IBD) mediates this relationship using a two-stage mediation meta-analysis. DesignWe conducted a systematic review and meta-analysis of cohort studies on (i) UPF intake and CRC, (ii) UPF intake and IBD, and (iii) IBD and CRC. Two reviewers independently screened records, extracted hazard ratios (HRs) or relative risks, and assessed...

BackgroundThe COVID-19 vaccine supply shortage in 2021 constrained rollout efforts in Africa while populations experienced waves of epidemics. As supply picks up, a key question becomes if vaccination remains an impactful and cost-effective strategy given changes in the timing of implementation. MethodsWe assessed the impact of timing using an epidemiological and economic model. We fitted our mathematical epidemiological model to reported COVID-19 deaths in 27 African countries to estimate the ...

BackgroundIn response to the coronavirus disease 2019 (COVID-19), the UK adopted mandatory physical distancing measures in March 2020. Vaccines against the newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may become available as early as late 2020. We explored the health and economic value of introducing SARS-CoV-2 immunisation alongside physical distancing scenarios in the UK. MethodsWe used an age-structured dynamic-transmission and economic model to explore differen...

BackgroundTraditional influenza vaccination programs focus on preventing severe illness through the vaccines direct effect. However, vaccinating children may substantially reduce overall burden by lowering transmission, especially in high infection settings and when effective transmission reducing vaccines become available. MethodsTo evaluate the impact of a transmission-reducing vaccination campaign, we developed a Susceptible-Latent-Infectious-Recovered (SLIR) compartmental transmission model...

BackgroundConventional observational studies have identified several potential therapeutic agents that may lower risk of colorectal cancer development. However, these studies are susceptible to unmeasured and residual confounding and reverse causation, undermining robust causal inference. MethodsWe used Mendelian randomization (MR), a genetic epidemiological method that can strengthen causal inference, to evaluate the effect of previously reported therapeutic agents on colorectal cancer risk, i...

ObjectiveTo evaluate whether early life adiposity has an independent effect on later life disease risk or whether its influence is mediated by adulthood body mass index (BMI). DesignTwo-sample univariable and multivariable Mendelian randomization. SettingThe UK Biobank (UKB) prospective cohort study and four large-scale genome-wide association study (GWAS) consortia. Participants453,169 participants enrolled in the UKB and a combined total of over 700,000 individuals from different GWAS conso...

BackgroundAutoimmune conditions are common in women of reproductive age. They are associated with increased risk of adverse pregnancy outcomes; whether this is causal is unclear. Our aim was to explore the effects of autoimmune condition liability on pregnancy outcomes. MethodsWe conducted two-sample Mendelian randomization (MR) to estimate effects of liability to ten autoimmune conditions on nine primary and seven secondary pregnancy outcomes. We used data from the MR-PREG collaboration includ...

BackgroundRespiratory syncytial virus (RSV) is a leading cause of respiratory illness and hospitalisation in infants and young children. New pharmaceutical interventions for preventing severe RSV in early life, namely a maternal vaccine and a long-acting monoclonal antibody, have recently been approved and are now available for use. Over the past decade, mathematical models of RSV transmission have been used to predict the impact of novel pharmaceutical interventions, in anticipation of future p...

With a sizable fraction of primary care antibiotics prescribing attributable to RSV, the promising suite of prophylactic pharmaceuticals against could reduce the need for antibiotics in addition to controlling respiratory disease. To assess the potential impact of RSV vaccines on the reduction in primary care antibiotic prescribing in England, we integrate results from a dynamic transmission model of RSV and a statistical attribution framework. Under base case assumptions, targeting children age...

BackgroundThere is convincing evidence that overall adiposity (as measured by body mass index) increases the risks of several cancers. Whether there are similar relationships between these cancers and the distribution of adiposity is unclear. MethodsIn the absence of well-powered individual studies we utilised two-sample Mendelian randomization (MR) to examine causal relationships of five adiposity distribution traits (abdominal subcutaneous adipose tissue; ASAT, visceral adipose tissue; VAT an...

BackgroundPrevious epidemiological studies of the associations between polyunsaturated fatty acids (PUFAs) and cancer incidence have been inconsistent. We investigated the associations of plasma omega-3 and omega-6 PUFAs with the incidence of overall and 19 site-specific cancers in a large prospective cohort. Methods253,138 eligible UK Biobank participants were included in our study. With a mean follow-up of 12.9 years, 29,838 participants were diagnosed with cancer. The plasma levels of omega-...

BackgroundMany unvaccinated children were naturally immunised through infection during the last national measles epidemic in the Netherlands (2013/14). Over time susceptibility amongst school aged children in key under-vaccinated populations is likely to increase and warrants investigation. MethodsWe constructed a network to reflect the risk of transmission within and between schools in the Netherlands. Estimating school-level susceptibility rates using historical estimates and vaccine uptake. ...

BackgroundThe COVID-19 pandemic has disrupted routine measles immunisation and supplementary immunisation activities (SIAs) in most countries including Kenya. We assessed the risk of measles outbreaks during the pandemic in Kenya as a case study for the African Region. MethodsCombining measles serological data, local contact patterns, and vaccination coverage into a cohort model, we predicted the age-adjusted population immunity in Kenya and estimated the probability of outbreaks when contact-r...

ImportanceEvidence on adiposity altering colorectal cancer (CRC) risk differently among men and women, and on metabolic alterations mediating effects of adiposity on CRC, is unclear. ObjectiveTo examine sex- and site-specific associations of adiposity with CRC risk, and whether adiposity-associated metabolites explain associations of adiposity with CRC. DesignTwo-sample Mendelian randomization (MR) study. SettingGenetic variants from expanded genome-wide association studies of body mass index...