̽��ֱ�� of Cambridge - Medical Research Council (MRC) Biostatistics Unit

Over 20,000 people join search for new dementia treatments

cjb250 — Tue, 14 May 2024 09:00:00 +0000

Using the resource, scientists have already been able to show for the first time that two important bodily mechanisms – inflammation and metabolism – play a role in the decline in brain function as we age.

By 2050, approximately 139 million people are expected to be living with dementia worldwide. In the UK, in 2022, UK Prime Minister launched the Dame Barbara Windsor Dementia Mission, part of the government’s commitment to double increase research funding for dementia.

Although there has been recent progress developing drugs that slow down progression of the disease, the two leading treatments only have a small effect, and the vast majority of new approaches that work in animal studies fail when it comes to patient clinical trials.

One explanation for these failures is that the drugs are tested in people who already have memory loss – and by this point, it may be too late to stop or reverse the disease. Hence, there is an urgent need to understand what is going on before people develop symptoms at the very early stages of disease, and to test new treatments before people come to their doctor with cognitive problems. This approach requires a large cohort of participants willing to be recalled for clinical and experimental studies of cognitive decline.

Today, writing in the journal Nature Medicine, scientists led by the ̽��ֱ�� of Cambridge in partnership with the Alzheimer’s Society report how they have recruited 21,000 people aged 17-85 to the Genes and Cognition Cohort within the National Institute for Health and Care Research (NIHR) BioResource.

̽��ֱ��NIHR BioResource was established in 2007 to recruit volunteers keen to engage in experimental medicine and clinical trials across the whole of medicine. Approximately half of its participants are recruited to disease specific cohorts, but the other half are from the general public, and detailed information about their genetics and their physical makeup has been collected. They have all given their consent to be contacted about future research studies.

For the Genes and Cognition Cohort, researchers used a combination of cognitive tests and genetic data, combined with other health data and demographic information, to enable the first at-scale study of cognitive changes. This will allow the team to recruit participants for studies of cognitive decline and new treatments for this.

For example, a pharmaceutical company with a promising new drug candidate to slow the cognitive decline could recruit people through the BioResource based on their profile and invite them to join in the clinical trial. Having a baseline measurement for their cognitive performance will allow scientists to observe whether the drug slows their expected cognitive decline.

Professor Patrick Chinnery from the Department of Clinical Neurosciences at the ̽��ֱ�� of Cambridge and co-Chair of the NIHR BioResource, who has led the project, said: “We’ve created a resource that is unmatched anywhere else in the world, recruiting people who are not showing any signs of dementia rather than people already having symptoms. It will allow us to match individuals to particular studies and speed up the development of much-needed new drugs to treat dementia.

“We know that over time our cognitive function decreases, so we’ve plotted out the expected trajectory of various different cognitive functions over our volunteers’ life course according to their genetic risk. We’ve also asked the question, ‘What are the genetic mechanisms that predispose you to slow or fast cognitive decline as you age?’.”

Using the research, the team have identified two mechanisms that appear to affect cognition as we age and could serve as potential targets to slow down cognitive decline and thereby delay the onset of dementia. ̽��ֱ��first of these is inflammation, with immune cells specific to the brain and central nervous system – known as microglia – causing gradual deterioration of the brain and hence its ability to perform key cognitive functions. ̽��ֱ��second mechanism relates to metabolism – in particular, how carbohydrates are broken down in the brain to release energy.

Professor Chinnery added: “Cognitive decline is a natural process, but when it drops below a particular threshold, that’s when there’s a problem – that is when we would diagnose dementia. Anything that slows that decline will delay when we drop below that threshold. If you could put off the onset of dementia from 65 to 75 or even 85, it would make a huge difference at an individual and at a population level.”

Dr Richard Oakley, Associate Director of Research and Innovation at Alzheimer’s Society, said: “This exciting study, funded by Alzheimer’s Society, is an important step in helping us to better understand how the diseases that cause dementia begin, and will aid in the development of new treatments that target the early stages of these diseases.

“ ̽��ֱ��data, from over 20,000 volunteers, helps us to better understand the connection between participants’ genes and cognitive decline and allows for further ground-breaking analysis in future.

“One in three people born in the UK today will go on to develop dementia in their lifetime but research will beat dementia. We need to make it a reality sooner through more funding, partnership working and people taking part in dementia research.”

For further information about how you can join the BioResource and contribute to studies like this one and many others, please visit bioresource.nihr.ac.uk.

̽��ֱ��research was carried out in collaboration with the Medical Research Council Biostatistics Unit and was supported by the Alzheimer’s Society and the NIHR BioResource. ̽��ֱ��researchers were also supported by Wellcome and the Medical Research Council.

Reference
Rahman, MS et al. Dynamics of cognitive variability with age and its genetic underpinning in NIHR BioResource Genes and Cognition Cohort participants. Nat Med; 14 May 2024; DOI: 10.1038/s41591-024-02960-5

More than 20,000 volunteers have been recruited to a resource aimed at speeding up the development of much-needed dementia drugs. ̽��ֱ��cohort will enable scientists in universities and industry to involve healthy individuals who may be at increased risk of dementia in clinical trials to test whether new drugs can slow the decline in various brain functions including memory and delay the onset of dementia.

We’ve created a resource that is unmatched anywhere else in the world, recruiting people who are not showing any signs of dementia rather than people already having symptoms

Patrick Chinnery

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Smiling elderly woman speaking to a healthcare worker

̽��ֱ��text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Prostate cancer risk prediction algorithm could help target testing at men at greatest risk

cjb250 — Fri, 09 Dec 2022 21:00:39 +0000

CanRisk-Prostate, developed by researchers at the ̽��ֱ�� of Cambridge and ̽��ֱ��Institute of Cancer Research, London, will be incorporated into the group’s CanRisk web tool, which has now recorded almost 1.2 million risk predictions. ̽��ֱ��free tool is already used by healthcare professionals worldwide to help predict the risk of developing breast and ovarian cancers.

Prostate cancer is the most common type of cancer in men. According to Cancer Research UK, over 52,000 men are diagnosed with the disease each year and there are more than 12,000 deaths. Over three-quarters (78%) of men diagnosed with prostate cancer survive for over 10 years, but this proportion has barely changed over the past decade in the UK.

Testing for prostate cancer involves a blood test that looks for a protein known as a prostate-specific antigen (PSA) that is made only by the prostate gland; however, it is not always accurate. According to the NHS website, around three in four men with a raised PSA level will not have cancer. Further tests, such as tissue biopsies or MRI scans, are therefore required to confirm a diagnosis.

Professor Antonis Antoniou from the Department of Public Health and Primary Care at the ̽��ֱ�� of Cambridge said: “Prostate cancer is the most common cancer in men in the UK, but population-wide screening based on PSA isn’t an option: these tests are often falsely positive, which means that many men would then be biopsied unnecessarily. Also, many prostate tumours identified by PSA tests are slow-growing and would not have been life-threatening. ̽��ֱ��treatment of these tumours may do more harm than good.

“What we need is a way of identifying those men who are at greatest risk, allowing us to target screening and diagnostic tests where they are most needed, while also reducing the harms for those men who have low risk of the disease. This is what CanRisk-Prostate aims to do. For the first time, it combines information on the genetic makeup and prostate cancer family history, the main risk factors for the disease, to provide personalised cancer risks.”

Prostate cancer is one of the most genetically determined of common cancers. Inherited faulty versions of the BRCA2, HOXB13 and possibly BRCA1 genes are associated with moderate-to-high risk of prostate cancer, though such faults are rare in the population. In addition, there are several hundred more common genetic variants that each confer a lower risk, but in aggregate they act like ‘volume control’ that moderate or increase the prostate cancer risk.

Writing in the Journal of Clinical Oncology, the researchers – supported by Cancer Research UK – describe the development of the first comprehensive prostate cancer model using genetic and cancer family history data from almost 17,000 families affected by prostate cancer. It uses data on rare genetic faults in moderate-to-high-risk genes and a risk score based on 268 common low-risk variants, together with detailed cancer family history, to predict the future risks.

One in six men (16%) will develop prostate cancer by the time they are 85 years old. Using the model, the team found that the predicted risk was higher for men who had a father diagnosed with prostate cancer – 27% if the father was diagnosed at an older age (80 years) but as high as 42% if the father was diagnosed at a young age (50 years).

̽��ֱ��risks were considerably higher for men with genetic faults. For example, 54% of men who carry an alteration in the BRCA2 gene would develop prostate cancer – however, among men with BRCA2 gene faults, the risks were substantially lower if they also had a small number of the low-risk variants, but much higher if they also had a large number of the low-risk variants.

In practice, say the researchers, clinicians will be able to use any combination of cancer family history, rare and common genetic variants to provide a personalised risk.

To validate their model, the team ran the risk model on an independent cohort of over 170,000 men recruited to UK Biobank, a biomedical database and research resource containing anonymised genetic, lifestyle and health information from half a million UK participants. All of these men were free from prostate cancer when they were recruited to the study, but more than 7,600 developed prostate cancer within the subsequent ten years.

When validating their model, the researchers found that 86% of the UK Biobank participants who developed cancer were in the half of men with the highest predicted risks, which suggests that it may be possible to target screening and diagnostic tests to the subgroup of the population at highest risk, among whom the majority of the cancers will occur.

Dr Tommy Nyberg from the MRC Biostatistics Unit at Cambridge said: “We’ve created the most comprehensive tool to date for predicting a man’s risk of developing prostate cancer. We hope this will help clinicians and genetic counsellors assess their clients’ risk and provide the appropriate follow-up.

“Over the next 12 months, we aim to build this tool into the widely used CanRisk tool, which will facilitate the risk-based clinical management of men seen in family cancer clinics and enable risk-adapted early detection approaches to the population at large.”

Professor Ros Eeles from ̽��ֱ��Institute of Cancer Research, London and co-author on the study said: “This is an important step forward as it will enable clinicians to have conversations with men about their individual risk of prostate cancer based on the most accurate computer model to date. This will help them in making decisions about screening.”

So far, the data used to develop CanRisk-Prostate has been from men of European ancestry. ̽��ֱ��team hope to be able to include data from men of other ethnicities as further research is undertaken.

̽��ֱ�� ̽��ֱ�� of Cambridge recently launched the Early Cancer Institute with the aim of detecting cancer early enough to cure it. It is the first physical institute in the UK dedicated to early cancer. A new Cambridge Cancer Research Hospital is also planned for the near future, bringing together clinical and research expertise in a new, world-class hospital, designed in partnership with patients.

There is also an Early Detection and Diagnosis centre at ̽��ֱ��Institute of Cancer Research and ̽��ֱ��Royal Marsden NHS Foundation Trust where a prostate risk clinic has been established to translate these findings into targeted screening programmes.

̽��ֱ��research was supported by the Cancer Research UK-funded CanRisk programme. Additional support for CanRisk-Prostate was provided by Prostate Cancer UK, ̽��ֱ��Institute of Cancer Research, Everyman Campaign, National Cancer Research Network UK, National Cancer Research Institute, NIHR Cambridge Biomedical Research Centre and the NIHR Biomedical Research Centre at ̽��ֱ��Institute of Cancer Research and ̽��ֱ��Royal Marsden NHS Foundation Trust.

Reference
Nyberg, T et al. CanRisk-Prostate: a comprehensive, externally validated risk model for the prediction of future prostate cancer. Journal of Clinical Oncology; 9 Dec 2022; DOI: 10.1200/JCO.22.01453

Cambridge scientists have created a comprehensive tool for predicting an individual’s risk of developing prostate cancer, which they say could help ensure that those men at greatest risk will receive the appropriate testing while reducing unnecessary – and potentially invasive – testing for those at very low risk.

What we need is a way of identifying those men who are at greatest risk, allowing us to target screening and diagnostic tests where they are most needed, while also reducing the harms for those men who have low risk of the disease. This is what CanRisk-Prostate aims to do

Antonis Antoniou

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Middle aged couple

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Vice-Chancellor’s Awards highlight research impact and engagement across Cambridge

zs332 — Thu, 07 Oct 2021 14:44:34 +0000

Academics from across the ̽��ֱ�� have been recognised in this year’s Vice-Chancellor’s Research Impact and Engagement Awards for their research into improving management of maternity emergencies during COVID-19, helping rural communities in India become agriculturally more sustainable and aiding the Government’s real-time COVID-19 monitoring.

Fewer than one in 20 people living with HIV in England expected to be unaware of status by 2025

cjb250 — Fri, 24 Sep 2021 07:49:11 +0000

In 2014, UNAIDS set an ambitious target of 90-90-90 by 2020 – that is, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression.

According to the Cambridge and PHE team, in 2019 there were an estimated 105,200 people living with HIV in the UK, of whom 94% were aware of their HIV status. In addition, 98% of those living with diagnosed HIV were on treatment, and 97% of these were virally suppressed. In other words, England had already reached the UNAIDS goals.

In a publication today in ̽��ֱ��Lancet Public Health, the researchers extended their analysis of evidence from multiple surveillance, demographic, and survey datasets relevant to HIV in England from estimating HIV prevalence in a single year to estimating the trends over time in HIV prevalence. Trends in the number of people living with HIV, the proportion of people unaware of their HIV infection, and the corresponding prevalence of undiagnosed HIV are reported.

According to their analysis, the estimated number of people in England living with HIV aged 15-74 years who were unaware of their infection halved from 11,600 in 2013 to 5,900 in 2019, with a corresponding fall in prevalence from 0.29 to 0.14 per 1,000 people.

At the same time, the increase in the number of people living with diagnosed HIV resulted in the total number of people living with HIV rising from 83,500 to 92,800 over the same period. ̽��ֱ��percentage of people living with HIV whose infection was diagnosed therefore steadily increased from 86% in 2013 to 94% in 2019, reaching the UNAIDS target in 2016 – and even earlier, in 2013, for Black African heterosexuals.

Professor Daniela De Angelis from the MRC Biostatistics Unit, the study’s senior author, said: “Overall, we see a positive picture for the HIV epidemic in England, with a dramatic fall in the number of people living with undiagnosed HIV. We estimate we are already several years ahead of the UNAIDS 2020 goals and are on target to reach 95% diagnosed by 2025 and to eliminate HIV infections by 2030.

Dr Anne Presanis from the MRC Biostatistics Unit added: “Examined more closely, the situation is not as positive for everyone. We estimate that areas of England outside London have not seen as steep a decrease in undiagnosed HIV prevalence as in London, and there is evidence of missed opportunities to diagnose HIV infections among some population subgroups.”

In England, gay, bisexual, and other men who have sex with men, and Black African heterosexuals remain disproportionately affected by HIV, with considerably higher undiagnosed HIV prevalence per population in 2019 than heterosexuals in other ethnic groups. However, undiagnosed HIV prevalence rates within these communities have seen dramatic falls: for gay, bisexual, and other men who have sex with men, prevalence fell from 13.9 to 5.4 per 1,000, and for Black African heterosexuals prevalence fell from 3.3 to 1.7 per 1,000 population.

London saw more dramatic falls in the prevalence of undiagnosed HIV during the study period than other regions of England, down from 0.74 to 0.31 per 1,000, compared to a decrease from 0.20 to 0.11 per 1,000 outside London.

Although sexual health clinics provide free and confidential HIV testing to all clinic attendees, the researchers estimated that among heterosexuals in an ethnic group other than Black African, undiagnosed prevalence in clinic attendees in 2019 was more than 30 times greater than in those who had not attended in the past year. This implies that sexual health clinics are missing opportunities for testing attendees. This is in line with findings from Public Health England that among individuals outside those subgroups at greatest risk of HIV infection, the proportion declining a HIV test had increased to more than one in four (27%) in 2016.

̽��ֱ��researchers say their estimates have important implications for efforts to eliminate HIV transmission in England and the UK.

Dr Valerie Delpech, head of the HIV Team at Public Health England said: “This research is good news and shows that combination prevention, and in particular HIV testing and early treatment, is working in England. ̽��ֱ��increasing use of pre-exposure prophylaxis among persons at higher risk of HIV has further amplified our response to end HIV transmission. Nevertheless, further reducing the number of people who remain undiagnosed with HIV infection will become very challenging in the coming years. This is particularly the case for heterosexuals who may not consider themselves at risk of HIV.

“ ̽��ֱ��priority must be to ensure that all sexual health clinic attendees are offered and encouraged to accept a HIV test, regardless of ethnicity, rather than the 73% that currently do test. If we can increase the number of clinic attendees unaware of their HIV status who get tested and diagnosed, as well as improve partner notification, the prospect of eliminating HIV transmission becomes increasingly likely.”

̽��ֱ��research was funded by the Medical Research Council and Public Health England.

Reference
Presanis AM, et al. Trends in undiagnosed HIV prevalence in England and implications for eliminating HIV transmission by 2030: an evidence synthesis model. Lancet Public Health; 23 Sept 2021; DOI: 10.1016/S2468-2667(21)0042-0

England is on track to have diagnosed 95% of people living with HIV by 2025, putting it in a strong position to eliminate HIV transmission by 2030, say researchers at the MRC Biostatistics Unit, ̽��ֱ�� of Cambridge, and Public Health England (PHE).

Overall, we see a positive picture for the HIV epidemic in England, with a dramatic fall in the number of people living with undiagnosed HIV

Daniela De Angelis

Andy McCarthy

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Patients with SARS-CoV-2 Delta variant were more likely to be admitted to hospital compared to patients with Alpha variant

sc604 — Tue, 31 Aug 2021 09:29:45 +0000

In a new study published in ̽��ֱ��Lancet Infectious Diseases, researchers at Public Health England and the MRC Biostatistics Unit, ̽��ֱ�� of Cambridge, found that the estimated risk of hospital admission was two times higher for individuals diagnosed with the Delta variant of the SARS-CoV-2 virus, compared to those with the Alpha variant, after adjusting for differences in age, sex, ethnicity, deprivation, region of residence, date of positive test and vaccination status. When broadening the scope to look at the risk of either hospital admission or emergency care attendance, the risk was 1.45 times higher for Delta than Alpha.

This is the largest study to date to report on the risk of hospitalisation outcomes for cases with the Delta compared to the Alpha variant, using 43,338 Alpha and Delta cases confirmed through whole-genome sequencing who tested positive for COVID-19 between 29th March and 23rd May 2021. It is crucial to note that most of the Alpha and Delta cases in the study were unvaccinated or only partially vaccinated: 74% were unvaccinated, 24% were partially vaccinated, and only 2% were fully vaccinated. ̽��ֱ��results from this study therefore primarily tell us about the risk of hospital admission for those who are unvaccinated or partially vaccinated. Given the small number of hospitalised vaccinated cases, it has not been possible to estimate reliably if the hospitalisation risk differed between Delta and Alpha cases who had been fully vaccinated.

̽��ֱ��Delta variant is now the most common SARS-CoV-2 lineage in several higher-income and lower-income countries on all continents, currently accounting for more than 99% of new cases in England [2]. ̽��ֱ��evidence provided in this study therefore has implications for healthcare practice, planning and response in countries with ongoing or future Delta variant outbreaks, particularly in unvaccinated or partially vaccinated populations. As previous studies have shown Delta and Alpha spread more rapidly than previous variants [2–4], the combination of faster transmission and the current study’s finding of higher risk of severe disease requiring hospital admission in unvaccinated populations implies a more severe burden on healthcare of Delta outbreaks than of Alpha epidemics.

Previous studies have shown the available COVID-19 vaccines are highly effective against symptomatic infections with the Alpha variant [5], and are effective against symptomatic infections with the Delta variant, particularly after a full vaccination cycle with two doses [6,7]. For those who despite vaccination become infected, the vaccination protects against admission to hospital [8].

Dr Anne Presanis, Senior Statistician at the MRC Biostatistics Unit said:

"Our analysis highlights that in the absence of vaccination, any Delta outbreaks will impose a greater burden on healthcare than an Alpha epidemic. Getting fully vaccinated is crucial for reducing an individual’s risk of symptomatic infection with Delta in the first place, and, importantly, of reducing a Delta patient’s risk of severe illness and hospital admission.”

Dr Gavin Dabrera, Consultant Epidemiologist at Public Health England, said:

“This study confirms previous findings that people infected with Delta are significantly more likely to require hospitalisation than those with Alpha, although most cases included in the analysis were unvaccinated.

We already know that vaccination offers excellent protection against Delta and as this variant accounts for over 99% of COVID-19 cases in the UK, it is vital that those who have not received two doses of vaccine do so as soon as possible.

It is still important that if you have COVID-19 symptoms, stay home and get a PCR test as soon as possible.”

Reference:
Katherine A Twohig et al. 'Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study.' ̽��ֱ��Lancet Infectious Diseases (2021). DOI: 10.1016/S1473-3099(21)00475-8

Largest study to date analysing more than 40,000 COVID-19 cases finds a two-fold increased risk of hospitalisation from delta versus alpha variant infections.

Getting fully vaccinated is crucial for reducing an individual’s risk of symptomatic infection with Delta in the first place, and, importantly, of reducing a Delta patient’s risk of severe illness and hospital admission

Anne Presanis

Steven Cornfield via Unsplash

Patient receives Covid-19 vaccine

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Upgrading PPE for staff working on COVID-19 wards cut hospital-acquired infections dramatically

cjb250 — Tue, 29 Jun 2021 07:20:09 +0000

̽��ֱ��findings are reported by a team at the ̽��ֱ�� of Cambridge and Cambridge ̽��ֱ�� Hospitals (CUH) NHS Foundation Trust. ̽��ֱ��research has not yet been peer-reviewed, but is being released early because of the urgent need to share information relating to the pandemic.

Until recently UK Infection Protection Control guidance recommended that healthcare workers caring for patients with COVID-19 should use fluid resistant surgical masks type IIR (FRSMs) as respiratory protective equipment; if aerosol-generating procedures were being carried out (for example inserting a breathing tube into the patient’s windpipe), then the guidance recommended the use of an FFP3 respirator. ̽��ֱ��guidance has recently been updated to oblige NHS organisations to assess the risk that COVID-19 poses to staff and provide FFP3 respirators where appropriate.

Since the start of the pandemic, CUH has been screening its healthcare workers regularly for SARS-CoV-2, even where they show no symptoms. They found that healthcare workers caring for patients with COVID-19 were at a greater risk of infection than staff on non-COVID-19 wards, even when using the recommended respiratory protective equipment. As a result, its infection control committee implemented a change in respiratory protective equipment for staff on COVID-19 wards, from FRSMs to FFP3 respirators.

Prior to the change in respiratory protective equipment, cases were higher on COVID-19 wards compared with non-COVID-19 wards in seven out of the eight weeks analysed by the team. Following the change in protective equipment, the incidence of infection on the two types of ward was similar.

̽��ֱ��results suggest that almost all cases among healthcare workers on non-COVID-19 wards were caused by community-acquired infection, whereas cases among healthcare workers on COVID-19 wards were caused by both community-acquired infection and direct, ward-based infection from patients with COVID-19 – but that these direct infections were effectively mitigated by the use of FFP3 respirators.

To calculate the risk of infection for healthcare workers working on COVID-19 and non-COVID-19 wards, the researchers developed a simple mathematical model.

Dr Mark Ferris from the ̽��ֱ�� of Cambridge’s Occupational Health Service, one of the study’s authors, said: “Healthcare workers – particularly those working on COVID-19 wards – are much more likely to be exposed to coronavirus, so it’s important we understand the best ways of keeping them safe.

“Based on data collected during the second wave of the SARS-CoV-2 pandemic in the UK, we developed a mathematical model to look at the risks faced by those staff dealing with COVID-19 patients on a day to day basis. This showed us the huge effect that using better PPE could have in reducing the risk to healthcare workers.”

According to their model, the risk of direct infection from working on a non-COVID-19 ward was low throughout the study period, and consistently lower than the risk of community-based exposure.

By contrast, the risk of direct infection from working on a COVID-19 ward before the change in respiratory protective equipment was considerably higher than the risk of community-based exposure: staff on COVID-19 wards were at 47 times greater risk of acquiring infection while on the ward than staff working on a non-COVID-19 ward.

Crucially, however, the model showed that the introduction of FFP3 respirators provided up to 100% protection against direct, ward-based COVID-19 infection.

Dr Chris Illingworth from the MRC Biostatistics Unit at the ̽��ֱ�� of Cambridge, said: “Before the face masks were upgraded, the majority of infections among healthcare workers on the COVID-19 wards were likely due to direct exposure to patients with COVID-19.

“Once FFP3 respirators were introduced, the number of cases attributed to exposure on COVID-19 wards dropped dramatically – in fact, our model suggests that FFP3 respirators may have cut ward-based infection to zero.”

Dr Nicholas Matheson from the Department of Medicine at the ̽��ֱ�� of Cambridge, said: “Although more research will be needed to confirm our findings, we recommend that, in accordance with the precautionary principle, guidelines for respiratory protective equipment are further revised until more definitive information is available.”

Dr Michael Weekes from the Department of Medicine at the ̽��ֱ�� of Cambridge, added: “Our data suggest there’s an urgent need to look at the PPE offered to healthcare workers on the frontline. Upgrading the equipment so that FFP3 masks are offered to all healthcare workers caring for patients with COVID-19 could reduce the number of infections, keep more hospital staff safe and remove some of the burden on already stretched healthcare services caused by absence of key staff due to illness. Vaccination is clearly also an absolute priority for anyone who hasn’t yet taken up their offer.”

̽��ֱ��research was funded by Wellcome, the Addenbrooke’s Charitable Trust, UK Research and Innovations, and the NIHR Cambridge Biomedical Research Centre.

Reference
Ferris, M, Ferris, R et al. FFP3 respirators protect healthcare workers against infection with SARS-CoV-2. DOI: 10.22541/au.162454911.17263721/v1

When Addenbrooke’s Hospital in Cambridge upgraded its face masks for staff working on COVID-19 wards to filtering face piece 3 (FFP3) respirators, it saw a dramatic fall – up to 100% – in hospital-acquired SARS-CoV-2 infections among these staff.

Healthcare workers – particularly those working on COVID-19 wards – are much more likely to be exposed to coronavirus, so it’s important we understand the best ways of keeping them safe

Mark Ferris

Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust

Healthcare worker wearing FFP3 mask

Yes

England on track to achieve elimination of HIV transmission by 2030 as model shows sharp decrease in HIV incidence

Anonymous — Thu, 10 Jun 2021 08:20:10 +0000

To manage the HIV epidemic among men who have sex with men (MSM) in England, enhanced testing and earlier treatment strategies were scaled-up between 2011 and 2015 and supplemented from 2015 by pre-exposure prophylaxis (PrEP). ̽��ֱ��researchers examined the effect of these interventions on the number of new infections and investigated whether the United Nations (UN) targets for HIV control and elimination of HIV transmission by 2030 might be within reach among MSM in England.

A complexity in this assessment is that HIV infections are not observed. Routine surveillance collects data on new HIV diagnoses, but trends in new diagnoses alone can be misleading as they can represent infections that occurred many years previously and depend on the testing behaviour of infected individuals.

To estimate new HIV infections among adult MSM (age 15 years and above) over a 10-year period between 2009 and 2018, the researchers used a novel statistical model that used data on HIV and AIDS diagnoses routinely collected via the national HIV and AIDS Reporting System in England, and knowledge on the progression of HIV. Estimated trends in new infections were then extrapolated to understand the likelihood of achieving the UN elimination target defined as less than one newly acquired infection per 10,000 MSM per year, by 2030.

̽��ֱ��peak in the number of new HIV infections in MSM in England is estimated to have occurred between 2012 and 2013, followed by a steep decrease from 2,770 new infections in 2013 to 1,740 in 2015, and a further steadier decrease from 2016, down to 854. ̽��ֱ��decline was consistent across all age groups but was particularly marked in MSM aged 25–34 years, and slowest in those aged 45 years or older. Importantly, this decrease began before the widespread roll-out of PrEP in 2016, indicating the success of testing and treatment as infection prevention measures among MSM in England.

Through extrapolation, the researchers calculated a 40% likelihood of England reaching the UN elimination target by 2030 and identified relevant age-specific targeting of further prevention efforts (i.e., to MSM aged ≥45 years) to increase this likelihood.

Senior author, Professor Daniela De Angelis, Deputy Director of the MRC Biostatistics Unit, ̽��ֱ�� of Cambridge, said: “This is very good news and suggests that prevention measures adopted in England from 2011 have been effective. With the rollout of PrEP, England looks on course to meet the goal of zero transmissions by 2030. Our study also shows the value of regular estimation of HIV incidence to recognise and respond appropriately to changes in the current downward trend. ̽��ֱ��challenge now is to achieve these reductions in all groups at risk for HIV acquisition.”

Valerie Delpech, Head of National HIV Surveillance at Public Health England, said: “We have made good progress towards ending HIV transmission by 2030 in England. Frequent HIV testing and the use of PrEP amongst people most at risk of HIV, together with prompt treatment among those diagnosed, are key to ending HIV transmission by 2030.

“You can benefit from life-saving HIV treatments if you are diagnosed with HIV and it also means you cannot pass the virus on.

“HIV and STI tests are still available through sexual health clinics during the COVID pandemic. Many clinics offer online testing throughout the year – people can order tests on clinic websites, take them in the privacy of their own home, return by post and receive results via text, phone call or post.”

This research is funded by the UK Medical Research Council, UK National Institute of Health Research Health Protection Unit in Behavioural Science and Evaluation, and Public Health England.

Reference
Brizzi, F et al. Tracking elimination of HIV transmission in men who have sex with men in England: a modelling study. Lancet HIV, 10 June 2021; DOI: 10.1016/ S2352-3018(21)00044-8

̽��ֱ��annual number of new HIV infections among men who have sex with men in England is likely to have fallen dramatically, from 2,770 in 2013 to 854 in 2018, showing elimination of HIV transmission by 2030 to be within reach – suggests work by researchers from the MRC Biostatistics Unit at the ̽��ֱ�� of Cambridge and Public Health England, published in ̽��ֱ��Lancet HIV.

This is very good news and suggests that prevention measures adopted in England from 2011 have been effective

Daniela De Angelis

Jason

#FreedomTo Know my HIV Status

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Tackling COVID-19: Professor Daniela De Angelis

jg533 — Thu, 20 Aug 2020 07:00:00 +0000

This article is part of a series in which we speak to some of the many Cambridge researchers tackling COVID-19. For other articles about our latest COVID-19-related research, click here.

I work for the Medical Research Council (MRC) Biostatistics Unit (BSU), a department in the ̽��ֱ��’s School of Clinical Medicine. I am a Programme Leader and Deputy Director of the Unit. ̽��ֱ��Unit is physically based at the Cambridge Institute of Public Health on the Cambridge Biomedical Campus. However since lockdown, all members of the Unit - including myself - have been working from home.

My research focuses on developing and applying statistical methods to characterise epidemics, using information on different aspects of the disease. This includes estimating transmission, severity (eg. the proportion of infected individuals who die), and reconstructing and predicting epidemics’ evolution. ̽��ֱ��goal is to provide accurate and timely quantitative support to the implementation and evaluation of public health policies. Historically we have worked on HIV, hepatitis and influenza, but since January this year our expertise has been used to understand the COVID-19 pandemic.

One of the most critical aspects of our COVID-19 work is to provide regular ‘now-casts’ and ‘forecasts’. ‘Now-casts’ refer to estimates of the current level of key epidemiological quantities, in our case, estimates of ongoing transmission and the number of new infections. ‘Forecasts’ mean estimates of future levels, in this instance, of the future number of deaths. Our results feed directly to the Scientific Pandemic Influenza sub-group on Modelling (SPI-M), a SAGE sub-group, and to regional Public Health England (PHE) teams.

I build models that allow us to reconstruct the pandemic and predict its future course. Our work on nowcasting and forecasting uses a model of disease transmission, data on daily COVID-19 deaths of infected individuals (by NHS region and age group), published information on the risk of dying and the time from infection to death, and data on antibodies levels in the population. This allows us to reconstruct the number of new COVID-19 infections and estimate changes in transmission (the famous reproduction number R) over time; and predict the number of COVID-19 deaths in different NHS regions and age groups.

I think the biggest challenge in dealing with COVID-19 is to understand what drives transmission of infection, and how to best use this knowledge to keep the pandemic under control - including when to introduce social restrictions and when to lift them. It is also important to use communication effectively, to build public understanding and trust so that people can react responsibly to the advice and recommendations given by the government and the scientific community.

There has been an enormous effort from the whole scientific community to contribute to the understanding of this pandemic. However, often these efforts have not been well coordinated and there are still lots of aspects of the SARS-CoV-2 infection that are not understood. We need to develop a more collaborative approach to working, building multidisciplinary teams where expertise is shared for a faster advancement of science.

I would like to see the creation of infrastructures that enable effective sharing of sensitive data. So much time has been spent in this pandemic waiting for authorised access to information that in an emergency situation should be available to any group with relevant expertise. It’s an important lesson to have learned, and we need to be better prepared for similar challenges in the future.

This has been one of the most challenging and exciting times to be in scientific research. I am glad to be playing a role in understanding this pandemic and making a difference to public health. Tracking COVID-19 will continue to be a major priority for my team at the BSU. ̽��ֱ��many important questions that still remain will keep us busy for years.

When the pandemic is over I’m looking forward to a nice holiday, and going back to normal life to enjoy the company of family and friends!

Professor Daniela De Angelis is Deputy Director of the MRC Biostatistics Unit. Read more about the Unit’s Nowcasting and Forecasting of COVID-19 here.

How you can support Cambridge’s COVID-19 research

Since January this year, Daniela De Angelis and her team have been informing the UK Government’s response to the COVID-19 pandemic. Their real-time model of transmission of the virus is helping to track and predict its course as information accumulates over time.

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