7 Oct 2016

Athena Swan Silver Award for IGH

In the latest round of ECU Athena Swan Awards, the Institute of Infection and Global Health (IGH) was conferred with the Silver Athena SWAN Departmental Award – 1 of only 24 Silver awards announced for this round.

The Institute has been committed to advancing women’s careers in STEMM (science, technology, engineering, maths and medicine) since its inception in 2010 and this achievement is a mirror of IGH’s Athena SWAN team effort through the years.

Professor Mathew Baylis, IGH Research Strategy Lead and head of the current Athena Swan team, said about this award: “I am absolutely delighted that the changes being implemented in IGH to encourage, support and promote women scientists have been recognised in this Silver Award. I am grateful to the entire IGH Athena Swan team for their hard work”.

In recent years the Institute has employed a series of measures to ensure that women across the Institute are encouraged and supported in their career progression. At the time of application towards this Athena Swan Silver Award women constituted at least 50% of all Institute Committees, including its Management Team. Additionally, women at the institute have been successfully using initiatives such as a mentoring programme and leadership training which have led to an increase in the number of female academic postgraduate students and staff at all career progression levels. Ultimately, for all members of the Institute, it is clear that IGH foments a positive atmosphere for women. This is reflected in family-friendly policies, allowing staff to bring children to meetings when necessary and the implementation of the “Maternity Mentors” initiative to support staff and students planning or returning from maternity leave.

Professor Tom Solomon, Head of the Institute, added: "I would like to congratulate everyone who has worked so hard on this over several years, from Jane Hodgkinson who initiated our application, all the way through Matthew Baylis, Jo Parker and the current team. It is a well-deserved achievement that truly reflects our many activities to support our women in science."

The Institute continued efforts to champion women in STEMM will not stop here and more positive initiatives will be implemented in the coming period through their Silver Action Plan. One of the main focus of this being the ongoing support of women transitioning from post-doctoral researcher to lecturer through the FLIGHT (Fostering Liverpool Infection and Global Health Talent) programme and the continued investment in initiatives such as the Institute’s highly successful tenure-track programme.

5 Oct 2016

IGH Summer School class of 2016

In July 2016 we hosted the second edition of the IGH Summer School, after a very successful first installment last year.

The event took place between the 11th and 15th of July and 12 local students participated, ages ranging from 16 to 19. This project was supported by the Wellcome Trust's Institutional Strategic Support Fund. Once more, our aim was to provide STEM students with a week-long work experience placement. Through talks, meetings and even practical experiments, all participants were able to take part in ongoing studies which, for some of them, was their first contact with structured scientific research.

Below,  Hugh Takemoto from Barrow Hall college tells us about his experience:

"The whole week was thoroughly enjoyable. The staff from the Institute were all brilliant, I met a great group of students and had a lot of fun."

“For me, the most enjoyable and useful session was the lab session where we prepared serial dilutions of Streptococcus pneumoniae and examined the effects of the bacteria on horse blood. This was the first time I had conducted an experiment in aseptic conditions and I learned techniques to ensure reliable experiment results such as using a Bunsen burner to kill any bacteria in the immediate vicinity. I was also able to practice pipetting techniques, which was a useful skill.

I really enjoyed our visit to the Leahurst Animal Disease Investigation Unit too. The tour of the unit was very interesting and I was surprised to learn that pigs like to listen to Capital radio! During the visit, we helped filter vet reports on diseases in animals brought to the UK from the other European countries and entered the data in spreadsheets.  This showed me another side of biological research and the importance of maths and ICT in biology.”

We hope the week has been inspiring and motivating for all participants and wish them all the best in their future endeavors!

8 Jul 2016

Hospital life in Sierra Leone after Ebola

Tom Solomon, University of Liverpool
There are not many places in the world where you scrub your hands with alcohol getting off the plane before you enter the airport terminal; have a temperature gun held to your head every time you enter a hospital, and again every time you leave; where makeshift hand-washing facilities – large tubs with a tap and bucket – greet you seemingly at every corner. There are not many places in the world like Freetown, Sierra Leone in 2016. Ebola has gone, but its legacy lives on.
Large four-wheel drive vehicles continue to cruise the streets, logos slightly tatty but still legible: World Hope International, Save the Children, World Food Programme. The 2014 outbreak was declared over in January 2016, with no new cases for 42 days. However, we now know some people carry the virus for longer than previously thought, so there is always the chance they will pass it to somebody new: every few days a patient with a suspect fever needs investigating.
At the UK aid screening tent in Military Hospital 34 the Sierra Leonean nursing staff are relaxed. The last positive patient was months ago – and there is almost a party atmosphere as they joke and tease each other, a spirit that was captured in Bye Bye Ebola, a video that went viral after the country was declared free of Ebola.

In the adjacent tent is a survivors’ clinic – 4,051 patients have survived Ebola virus disease and been discharged, declares the Ministry of Health and Sanitation’s website, but that does not mean their difficulties have ended. Work led by my colleagues at the University of Liverpool, and others, has shown that Ebola survivors can be left with a whole series of problems, from joint aches and depression to blindness and deafness. I have come to help assess their neurological sequelae – the problems left over after their previous infection – working alongside the country’s only neurologist, Durodamil Lisk.
I meet Amadu who is running a survivor clinic run by one of the non-governmental organisations: “First I examine the Ebola survivor certificate to check it is not fake,” he declares. “Then I ask for additional photo identification to be sure they are who they say they are.”
It seems bizarre that anyone would falsely claim to be an Ebola survivor, especially given the stigma, but Amadu explains: “We provide all sorts of services that people want – medical checks, support, counselling. But it is only for the Ebola survivors.”
What if you didn’t have Ebola, but all your family died from it and you need help?, I ask. Does that not make you a survivor? He starts to shake his head. “We bend the rules where we can,” interrupts the clinic supervisor, a Brazilian woman with years of experience, “but where do you draw the line?”

Prayers for an Ebola victim at Owen street, Freetown, in October 2014. EPA

Focused on just this one group of patients, the clinic has a calm and gentle feel. On the other side of town, at Connaught, the national referral and university hospital for adults, it is a different story. Built by the British in 1817, Connaught is a hustling bustling general hospital with patients and their families in every nook and cranny. This is the Africa I am used to. At the back, tucked away behind the medical ward I find a small office cramped with British medical volunteers from the King’s Sierra Leone Partnership, established in 2011 by King’s Health Partners, an academic health sciences centre in London.
“King’s were here before the Ebola epidemic; when many other NGOs left we stayed to help run Ebola isolation and treatment services across Freetown, and now we are part of the rebuilding process”, explains Paddy Howlett, a junior doctor from London who has taken two years out of his training in Britain. “The country has been devastated by the Ebola outbreak, but of course the roots of the epidemic are in poor health infrastructure, inadequate resources and a lack of trained staff; none of these has improved enough since the time of the civil war.” His voice trails off thoughtfully. “Even before Ebola, being born in Sierra Leone your life expectancy was 45.”
Howlett was in Sierra Leone as a medical student with Medicine Sans Frontiers almost a decade ago. Like many similar organisations their remit is emergency relief, not long-term development, and so they left soon after the war ended in 2002.
“Most people agree that the Ebola situation got so bad because of the poor medical infrastructure after the war,” he says. “You can’t help wondering how different Ebola would have been if all those emergency organisations had stayed to help build up the national health system.” Once again, now that the crisis is over, many are leaving and the funding has dried except for a few specific areas. “It is the same everywhere,” I tell him. “But imagine if these short-term relief organisations agreed to always reserve a small amount of funding for longer-term support – say 10% for ten years”. Yes, wouldn’t that be something!
I meet other doctors and nurses in the team. They are young and, although they all look thin and exhausted, their enthusiasm and passion beams from their faces. I have worked in some tough environments over the years, but Sierra Leone must be one of the most challenging. Even in the most deprived countries there is usually some kind of basic health provision for the poorest people; but here no money means no healthcare. “Even for those with money there are only a handful of investigations available,” explains Fennella Benyon, an infectious diseases clinician, “and only a few drugs”.
On the ward round we therefore resort to our basic clinical skills, taking a really thorough history and examining the patients very carefully. This is a million miles from the Walton Centre in Liverpool, where I usually work. At the Walton we have four MRI scanners. There is not a single one in the whole of Sierra Leone. Even CT scans are hard to get – and for each patient we weigh up carefully whether the additional cost is worth it. Many of the hospital staff are unpaid and the little equipment that is donated does not last because of power surges. It feels desperate, but the King’s team remain cheery and focus on what they can do to help. Ruth Tighe, a critical care doctor from Brighton, proudly shows off the “oxygen factory” she has set up with the engineers. “It’s not what I was trained to do, but it’s making a difference.“ Piping oxygen to the intensive care unit, full of critically ill patients struggling to breath, has brought the mortality rate down by 20%.

Nurse Hedda Nyhus working with Sierra Leonean colleagues (L-R) Bintu Sesay, Felicia Bangura and Cecilia Kamara. Nurses in Sierra Leone must work voluntarily for two years to qualify. DfID, CC BY

In the Emergency Department we meet Sister Cecilia. She has bright blue scrubs on and hair pulled back in a tight bun. “This is where we screened the Ebola patients during the epidemic. Hundreds of patients passed through here every week. Afterwards there was lots of money so we used it to refit the whole unit. Look, now we even have monitors,” she laughs. We bump into Richard Lowsby, an emergency medic from Merseyside, who is looking for beds. “This is not like at home, where looking for beds means asking the nurses for empty beds that new patients can go into,” he explains. “The surgical side of the emergency department is opening next week, so I am literally searching the hospital for any old unused beds to go in it.” It is a hands-on approach to help the hospital make sustainable and steady improvements.
We wish him luck as he heads off down the corridor. Around the hospital “obituary” posters of doctors who died in 2014 are pasted on the walls. They are faded and peeling now, but I recognise some of the names from the Ebola Doctors Memorial outside the health ministry.
The Connaught internal medicine department, led by the charismatic Gibrilla Deen, has set up extra neurology and psychiatric services for Ebola survivors, to complement the clinics they offer other patients. Anna Walder, a psychiatrist from London, talks with us about the depression and anxiety she has seen in the survivors. “But the amazing thing is how well people are coping,” she exclaims jumping up. “Just compare it with what you might expect for a disaster like this in the UK.“ Howlett agrees: "Sierra Leoneans have an incredible resilience and positive outlook on life. It’s admirable and maybe a consequence of all they have been through.”
I join Lisk, the neurologist, who is assessing survivors for long-term damage. He trained in the UK and we find we have many neurology friends in common. “The problem now is our doctors go overseas for training, but then they don’t come back,” he sighs. “And who can blame them?” A notice on his desk reads: “Imagine this hospital with all the medical and surgical specialties; an intensive care with ventilation and haemodialysis. This is not Connaught Hospital in five years’ time. This was the hospital 20 years ago.” “The war set us so far back,” he explains.

Sierra Leonean junior doctor, Marina Kamara, at the Connaught Hospital, Freetown. DfID, CC BY

We start the clinic. The survivors are greeted by the nurses like old friends, with hugs and laughter. Lisk looks midly uncomfortable as he dons his gown and gloves to examine them. “I don’t feel good about it,” he says to me apologetically, “but there is still so much we are learning about this virus.” Given what we are now discovering about long-term carriage of the virus I have some sympathy with his predicament.
Like many Sierra Leonean women, our first patient Patricia looks magnificent in her glittering yellow clothes. But she is downcast and avoids eye contact as I introduce myself. However, once I ask her about where she is from, and we talk about this beautiful country, she brightens up. She caught Ebola from her husband, she explains, a policeman who died of the disease. None of her three children were affected but they are now living in an orphanage. With no job, and shunned by family and friends she has no means of supporting them. “They are better off there,” she says. Although she tries to sound positive, her smile cannot hide the sadness in her eyes. Our next patient, Fatu, stayed behind on the Ebola treatment unit after she had recovered to help look after children affected by the disease. Her ongoing headaches and memory problems are slowly improving.
After my brief visit there is much to think about. I continue to be amazed by the dignity of the survivors, and the heroic efforts of some of the local and expatriate staff, as well as the patients. I don’t think I have ever washed my hands so many times in my life, or had my temperature taken so often. The final check is just before I board the plane home – 36.3°C is scrawled onto my boarding pass and I am good to go.
Some of the names in this article have been changed.
The Conversation
Tom Solomon, Director of the Institute of Infection and Global Health, and NIHR Health Protection Research Unit, and Professor of Neurology, University of Liverpool
This article was originally published on The Conversation. Read the original article.

9 May 2016

Viral Meningitis - What is it?

You have probably heard of meningitis and you might even have a clear idea of what it is but did you know that there are many types of meningitis? Bacterial Meningitis is often the most talked about as it is quite dangerous. Viral Meningitis is the most common strain in the UK, thankfully it is generally not as severe as its bacterial cousin, but it can still leave patients feeling very unwell and perhaps cause symptoms after recovery. Dr Fiona McGill is a researcher in the Institute of infection and Global Health and works to further research in to all types of meningitis. Here Fiona talks about Viral meningitis and the challenges that face doctors everyday in diagnosing and treating the infection.

This post was originally created for Meningitis Now as part of Viral Meningitis week 2nd - 8th May 2016. To read the full article, click here

Viral meningitis is the most common type of meningitis in the United Kingdom but it is often not talked about as much as, thankfully, it doesn’t kill people or harm people in the same way as bacterial meningitis.
Because of this it has often, in the past, also not been the subject of as much research as bacterial meningitis. Therefore, there is still a lot about viral meningitis we don’t really know.
Some of the big questions that need to be answered are:

How common is viral meningitis? Viral meningitis is probably about five times as common as bacterial meningitis in adults. In very young babies it is much commoner and can cause a very severe illness. Research being carried out at the University of Liverpool aims to determine exactly how common viral meningitis in adults is. This will allow us to work out where further research needs to be targeted
What viruses exactly cause it? Many cases of viral meningitis are caused by a virus that normally causes mild illness in children – the enterovirus. The family of herpes viruses (like the viruses that cause chickenpox or genital herpes) can also cause meningitis. Many cases never have a specific virus found. There is a need to improve the diagnostic tests for viral meningitis
What treatments might work for viral meningitis? There are no treatments for enteroviruses. Some enteroviruses in parts of the world can cause devastating illness including paralysis and death. In view of the number of patients suffering viral meningitis and the severity of illness it can cause in a few there is a need to develop a treatment. There is treatment available for herpes infections, however, no-one has ever done a study to see if it works in meningitis. As a result some patients get treated and others don’t. There is a need to find out once and for all if the drug works in herpes meningitis or not. There is a need to develop and test drugs for viral meningitis
What are the after effects of viral meningitis? This is a big question and many patients who suffer viral meningitis will describe all sorts of symptoms afterwards including tiredness, headaches and difficulty concentrating. There are a few small studies suggesting that viral meningitis may have longer lasting effects than we sometimes think, but the studies are often not big enough to come to any definitive conclusions. There is a need to properly assess the longer term effects of viral meningitis
There is so much we still need to know about viral meningitis so that we can better identify and treat it. Through research like mine and through charities such as Meningitis Now we can start to identify the problems and attempt to find solutions.
If you have any further questions about viral meningitis, feel free to leave questions in the comment section below. For a comprehensive resource we recommend www.meningitisnow.org

Dr Fiona McGillDr Fiona McGill is a Clinical Research Fellow in the Brain Infections Group specialising in meningitis diagnosis.

27 Apr 2016

The Global Burden of Norovirus & Prospects for Vaccine Development

As Part of our World Immunisation Week Series, you can watch a web chat between the Institute of Infection and Global Health's very own Prof. Miren Iturriza-Gomara and representatives from the Centre for Disease Control (CDC) and The Bill and Melinda Gates Foundation. The discussion is hosted by the Public Library of Science (PLOS) and is based upon a collection of work released this week about the Burden of Norovirus.

Norovirus is a virus that causes Gastroenteritis (diarrhea and vomiting), it is very common and for the majority of people it will only affect them for around 48hours. However, for those that are more vulnerable, for example, young children and the elderly, it can become more severe. The PLOS Burden of Norovirus Collection looks at three main areas;
  • Challenges of measuring the burden of noroviruses - finding out the scale of the problem. Not everyone who has Norovirus necessarily demostrates symptoms.
  • Biological challenges in vaccine development - Identifying a way to create an effective vaccine which works in the correct way (especially in the gut) and is effective in vulnerable and non-vulnerable people
  • Challenges in Implementation - considering the cost and availability of the vaccine from the manufacturer.

Prof. Miren Iturriza-Gomara is a professor in Clinical Infection Microbiology and Immunology. She works in the Gastrointestinal Infections Group and is a a virologist with a particular interest in enteric virus infections, virus evolution and the use of molecular tools for diagnosing, monitoring and tracking infections

25 Apr 2016

World Immunisation Week

This week is World Immunisation Week (24th -30th April 2016) it is organised by the World Health Organisation to promote the importance of vaccines for immunisation at all stages of life. This is a cause that's very important to us at the Institute of Infection and Global Health.

We've asked Dr Naor Bar-Zeev to give us a run down of why vaccines are so important and the Liverpool Malawi Vaccine Initiative.

Vaccines have been the greatest of all medical interventions. They have literally changed the world. Eradicating diseases and relegating previously common condition to what are today considered rare events.Vaccines have been instrumental to reducing child mortality globally. In developing countries where infectious diseases are still the primary cause of child and adult mortality, vaccines are really vital. 

Thankfully the University of Liverpool has been right at the forefront of vaccine development and evaluation for over 2 decades. In Malawi researchers from the Institute of Infection and Global Health (IGH) continuously track infectious diseases and together with the Malawi Ministry of Health ensure the best vaccines are trialled and introduced. 

IGH research has evaluated measles, rotavirus and pneumococcal vaccines and trials are soon concluding of an important vaccine against malaria in newborns.  Data collected by at the Malawi-Liverpool-Clinical Reserch Programme led by IGH  helped Malawi introduce pneumococcal conjugate vaccines and rotavirus vaccines earlier than other African sites. 

The benefits of these vaccines to disease and child mortality and to economic growth have been shown by our research. Our field workers and epidemiologists continuously work towards optimising the best use of vaccines to achieve the greatest benefit. While our microbiologists and molecular biologists are on the hunt for germs that mutate to escape the effect of vaccines, and are on a constant search for new vaccine candidates. Together with Malawian clinicans and scientists, these efforts ensure ongoing improvements in the health of children in Malawi, and a productive and impactful scientific process that maximises public health.

Join us throughout the week to find out more about our in vaccines. You can follow information from other organisations on Twitter using #VaccinesWork 

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