The Ebola epidemic and public health response.

INTRODUCTION: An unprecedented global effort has been required to tackle the Ebola outbreak in West Africa. In this paper, we describe the contribution of Public Health England (PHE) in West Africa and the UK. SOURCES OF DATA: Public Health England AREAS OF AGREEMENT: The epidemic has been a humanitarian crisis for the three worst affected countries. PHE contributions have included expertise in outbreak control and microbiology services in West Africa, and UK preparedness for an imported case. AREAS OF CONTROVERSY: National and international systems require change to enhance the response to the next international public health crisis. GROWING POINTS: Legacy planning following the epidemic will be crucial, supporting the recovery of the health and public health systems in West Africa and ensuring that the knowledge gained during this outbreak is put to best use. AREAS TIMELY FOR DEVELOPING RESEARCH: Ongoing PHE-associated research includes efforts to understand the pathogenicity of Ebola virus disease, improve diagnostic capability, explore therapeutic options and develop new vaccines.

Programme to vaccinate poultry workers against seasonal influenza: options for delivery in the East of England.

Avian influenza A (H5N1) has spread to the UK causing outbreaks in commercial poultry. Vaccination of poultry workers with seasonal influenza has been advised to prevent a viral mutation that could facilitate human-to-human transmission, causing a new pandemic strain. This project aimed to determine delivery options and costs of a vaccination programme targeted at poultry workers. Data from the Great Britain Poultry Register were used to understand the distribution of the target population. A stakeholders group in the East of England (EoE) discussed delivery options. An options appraisal is used to prioritize these options. There are over 10,000 poultry workers distributed throughout the EoE. Five delivery options were considered (industry's occupational health services, via general practitioners as a Directed or Locally Enhanced Services, via other community healthcare providers and a commercial provider). Delivery is likely to cost between £35,414 and £182,899 (or £10.18-£48.93 per person vaccinated) in the EoE, depending on delivery mechanism, target threshold and level of uptake. Delivering through a commercial provider was the preferred option. Whichever way the programme is delivered it should be cost-neutral to the Primary Care Trust (PCT). Otherwise PCTs may see themselves having to prioritize between vaccinating poultry workers against other pressing programmes.

'Partners in clime': sustainable development and climate change--what can the National Health Service do?

Climate change is arguably the biggest threat to health in the medium and long term. Necessary responses to this threat include adaptation, i.e. preparing to respond to the consequences of climate change, of which there are many in respect of health; and mitigation, i.e. reducing the activities that lead to climate change and, in particular, reducing the levels of greenhouse gas emissions, the most significant of which is carbon.

Screening for abdominal aortic aneurysm.

BACKGROUND: Abdominal aortic aneurysm (AAA) is found in 5% to 10% of men aged 65 to 79 years. The major complication is rupture which presents as a surgical emergency. The mortality after rupture is high, 80% for patients reaching hospital and 50% for those undergoing surgery for emergency repair. Currently elective surgical repair is recommended for aneurysms discovered to be larger than 5.5 cm to prevent rupture. There is interest in population screening to detect, monitor and repair abdominal aortic aneurysms before rupture. OBJECTIVES: To determine the effects of screening asymptomatic individuals for AAA on mortality, subsequent treatment, quality of life and cost effectiveness of screening. SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group searched their Trials Register (last searched 26 January 2007) and CENTRAL (last searched Issue 1, 2007). SELECTION CRITERIA: Randomised controlled trials of population screening for AAA. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trials and extracted data. MAIN RESULTS: Four studies involving 127,891 men and 9,342 women were included in this review. Only one study included women. Results for men and women were analysed separately. Three to five years after screening there was no significant difference in all-cause mortality between screened and unscreened groups for men or women (men, odds ratio (OR) 0.95; 95% Confidence interval (CI) 0.85 to 1.07; for women OR 1.06; 95% CI 0.93 to 1.21). There was a significant decrease in mortality from AAA in men (OR 0.60; 95% CI 0.47 to 0.78), but not for women (OR 1.99; 95% CI 0.36 to 10.88). In this analysis mortality includes death from rupture and from emergency or elective surgery for aneurysm repair. There was also a decreased incidence of ruptured aneurysm in men (OR 0.45; 95% CI 0.21 to 0.99) but not in women (OR 1.49; 95% CI 0.25 to 8.94). There was a significant increase in surgery for AAA in men (OR 2.03; 95% CI 1.59 to 2.59). This was not reported in women. There were no data on life expectancy, complications of surgery or subjective quality of life. AUTHORS' CONCLUSIONS: There is evidence of a significant reduction in mortality from AAA in men aged 65 to 79 years who undergo ultrasound screening. There is insufficient evidence to demonstrate benefit in women. The cost effectiveness may be acceptable, but needs further expert analysis. These findings need careful consideration in judging whether a co-ordinated population-based screening programme should be introduced.

Travel times and radiotherapy uptake in two English counties.

OBJECTIVES: To examine whether longer travel times for radiotherapy are associated with reduced overall uptake of radiotherapy treatment, or with reduced uptake of palliative as opposed to radical radiotherapy. DESIGN: Correlations of weighted average travel times for radiotherapy with overall radiotherapy uptake, and of travel times to one cancer centre with the ratio of palliative to radical radiotherapy at that centre. SETTING: The fourteen local authority (county) Districts of Bedfordshire and Hertfordshire. SUBJECTS: Residents of Bedfordshire and Hertfordshire registered by the Cancer Registries as attending hospital with a diagnosis of cancer, and registered as receiving radiotherapy treatment. Residents recorded by single cancer centre as receiving radical or palliative radiotherapy at that centre. RESULTS: There was no significant correlation between travel times for treatment and overall radiotherapy uptake (r = 0.40, P = 0.18), or with the ratio of palliative to radical radiotherapy at a single centre (r = -0.29, P = 0.34). Both measures of uptake showed considerable variability. Longest travel times were about one hour. CONCLUSIONS: Travel times up to one hour do not appear to reduce radiotherapy uptake, and the variability observed is likely to be due to other factors. The recommendation of the Chief Medical Officer's expert advisory group on cancers, that radiotherapy should be provided in larger cancer centres, is unlikely to result in lower radiotherapy uptake with travel times of this order.

Growth of normal human T lymphocytes induced by monoclonal antibody to the T cell antigen receptor.

A monoclonal antibody (mAb) called 30-3D6 has been raised against the T cell antigen receptor analogue on a human T cell leukemia cell line HPB-ALL. This mAb comodulates the T3 molecule on HPB-ALL and precipitates the heterodimeric structure previously described as a T cell idiotypic receptor analogue on this cell line. 30-3D6 reacts with a variable percentage of normal T cells (up to 6%) depending on the donor and this number is stable on repeated sampling and is not affected by the temperature of the reaction. When normal T cells from a high frequency donor are stimulated with 30-3D6 and interleukin 2 in vitro the idiotype-positive (Id+) population can be expanded. Large numbers of greater than 90% Id+ T cells can be generated. Id cells are present in both the helper and cytotoxic suppressor subsets.