The UK-PHRST, funded by UK aid from the Department of Health and Social Care, supports low- and middle-income countries in investigating and responding to disease outbreaks and conducts research to improve our response to future epidemics.
About the team
Through the UK Public Health Rapid Support Team (UK-PHRST), the UK has the capacity to respond rapidly to disease outbreaks in low- and middle-income countries around the world and conduct operational research into epidemic preparedness, playing an important role in global health security. The team also works to help countries to build their own capacity for an improved and rapid national response to outbreaks.
The UK-PHRST is funded by UK aid from the Department of Health and Social Care and is a partnership between the London School of Hygiene & Tropical Medicine (LSHTM) and Public Health England (PHE). University of Oxford and King’s College London (KCL) are academic partners. The team’s Director is Professor Daniel Bausch.
Tackling disease outbreaks at their source at the earliest possible stage helps prevent their spread, saves lives, and is the most effective way to protect the UK. As of July 2018, the team has taken part in nine deployments in six countries.
The UK-PHRST comprises of a core team of experts ready to deploy overseas within 48 hours to support countries in responding to disease outbreaks.
The deployable team includes experts in tracking the progress of an outbreak (epidemiologists); in diagnosing the cause of an outbreak (microbiologists); in advising on outbreak control measures (infection prevention and control) and community responses to outbreaks (social scientists); and in developing the best clinical response measures (clinical researchers). The full team comprises:
- Clinical researcher
- Social scientist
- Data scientist
- Infection prevention and control expert
Deployment of the UK-PHRST is at the invitation of the host government or in response to requests made by the World Health Organization (WHO) or by the Global Outbreak Alert and Response Network (GOARN).
In addition to the deployable team, the UK-PHRST will train a group of public health reservists to ensure the UK is able to scale up its response to any disease outbreak or health emergency. Information on how to join the public health reserve cadre will be posted as soon as it is available.
Background to the UK-PHRST
The Ebola crisis in West Africa in 2014/15 highlighted the need for the international community to develop a system to help countries respond to and control disease outbreaks that pose a threat to public health, before they develop into a global emergency.
The UK Public Health Rapid Support Team was developed as part of the UK contribution to global health security and to complement the World Health Organization’s work on the Global Health Emergency Workforce. The team is funded over five years by £20 million made available from the UK official development assistance budget. Former Public Health Minister Nicola Blackwood officially announced the launch of the team in November 2016.
The London School of Hygiene & Tropical Medicine was chosen to lead the UK-PHRST in partnership with Public Health England. LSHTM is a world authority in public and global health research. During the Ebola crisis, LSHTM staff advised governments, analysed data to assist in response planning, conducted clinical trials of vaccines and treatments, provided a free online course for healthcare professionals, developed culturally sensitive interventions to change behaviour in local communities, volunteered on the frontline in Ebola treatment centres, and carried out research to strengthen the global response to future infectious disease epidemics. LSHTM was also involved in the response to the Zika virus outbreak and ongoing related research.
Professor - (LSHTM)
Professor - (LSHTM)
Dr Olivier le Polain
Professor - (PHE)
Professor - (PHE)
Dr Isabel Oliver
Research microbiologist (LSHTM)
Olivier le Polain
Infection control nurse (PHE)
Clinical researcher (Oxford)
As of July 2018, the UK Public Health Rapid Support Team (UK-PHRST) has been involved in nine deployments to date. The requests for deployment have come through WHO-GOARN, direct requests from the government of the state affected by the epidemic, or through the UK Emergency Medical Team and DFID.
The first deployment of the UK-PHRST took place in April-May 2017, when two epidemiologists and one clinical researcher deployed through GOARN to the Somali Regional State of Ethiopia to support an escalating outbreak of acute watery diarrhoea.
This was followed in May-June 2017 by a deployment through GOARN to Nigeria when a team of two epidemiologists and one laboratory microbiologist assisted in the response to an outbreak of cerebral meningitis.
The UK-PHRST’s first bilateral deployment was to Sierra Leone (August-September 2017) when two epidemiologists, two microbiologists, one logistician, two Field Epidemiology Training Programme (FETP) fellows and the UK-PHRST Director were deployed. In this instance they assisted in the establishment of water-borne disease surveillance and assessment of diagnostic capacity at Connaught Hospital in Freetown in the wake of heavy rains, flooding and landslides in and around the capital.
In October – November 2017, two epidemiologists and one clinician were deployed to Madagascar though GOARN to support the response to an outbreak of pneumonic plague affecting primarily two large urban centres.
This was followed by a deployment to Bangladesh (December - January 2017/18) when a team consisting of an epidemiologist, a FETP fellow and an Infection Prevention Control (IPC) specialist worked alongside the UK Emergency Medical Team and DFID in support of the international response to the outbreak of diphtheria in the displaced Rohingya population in refugee camps in Cox’s Bazar.
The second bilateral deployment came in February-March 2018 in Nigeria, when an epidemiologist, FETP fellow, case management specialist and a logistician supported the government in controlling a large outbreak of Lassa fever through field-level interventions, logistics, capital-level data analysis and intervention strategy.
During February – March 2018, two epidemiologists and one infection prevention and control specialist were deployed to Bangladesh once again to support the WHO response to surveillance and monitoring of infectious disease outbreaks in the Rohingya refugee camps in Cox’s Bazar. In July 2018 an IPC specialist was redeployed to Cox’s Bazar.
In May-June 2018 during the Ebola outbreak in DRC, UK-PHRST deployed two epidemiologists and a data scientist to support with strengthening the alert system, including case investigation, protocol development, epidemiological analysis and data management.
When not responding to disease outbreaks, the UK Public Health Rapid Support Team (UK-PHRST) conducts rigorous operational research to improve epidemic preparedness and enhance our understanding of how best to tackle these threats in the future.
The team’s work will help generate an evidence base for best practice in disease outbreak interventions.
At LSHTM there are academics from a range of disciplines who are involved in research related to the UK-PHRST. Their areas of expertise include epidemiology, mathematical modelling, anthropology, community engagement and trust, virology, bacteriology, mental health and clinical research.
- Epidemic Response Anthropology Platform
The UK-PHRST funds the Epidemic Response Anthropology Platform, which is a partnership between LSHTM and the Institute of Development Studies. The platform is a resource to support a humane and effective response to epidemics. It aims to promote evidence on the social dimensions of epidemics in different contexts and to improve the way this evidence is used in response planning. The platform builds networks of anthropologists and other social scientists with regional or subject expertise and connects them to policy makers, scientists and humanitarian response workers involved in responding to outbreaks.
- The contribution of social science research to outbreak response
This work was led by Shelley Lees and Karl Blanchett (LSHTM). The project had two components:
- Component one consisted of exploring the views and experiences of anthropologists and other social scientists, and key information from organisations involved in infectious disease responses on the role of social scientists.
- Component two consisted of conducting secondary data analysis of research concerning community views and experiences of the Ebola response during the 2014 to 2016 Ebola epidemic.
An oral presentation was delivered at the Quebec Outbreak Intervention Symposium 2017, with Shelley Lees being invited as a main speaker. Manuscripts describing the work are being finalised.
This project has raised the profile of the UK-PHRST within the social science community. A social science working group has been formed at LSHTM to support the research team, which will be sustained. The findings of this work helped define the profile of the social researcher to be recruited into the UK-PHRST and have also guided the social science working group when developing the social science research strategy. On a wider scale, these findings will inform contemporary debates about the role of social scientists and anthropologists in outbreaks, and on how to engage with affected communities.
- Effect of acute illness on contact patterns, Malawi
This work was led by Judith Glynn (LSHTM). Understanding population mixing patterns are vital for predicting how infectious diseases move through communities. This project aimed to assess how acute illness affects contact patterns in a rural African setting in northern Malawi. We recorded contacts over 48-hours following a clinic consultation for acute illness and again 2-3 weeks later for the recovered person and for their mother/carer, if a child.
We documented changes in contact patterns when ill and these findings will help to refine models of infection transmission, which are essential for understanding how infections spread, and for planning appropriate interventions. We are preparing a paper for publication.
- Study of the aetiology of severe undifferentiated febrile illness outbreaks in Sudan
The research aims to assist the FMoH of Sudan to identify the causative agent(s) of outbreaks of febrile illness associated with haemorrhagic symptoms that occur regularly in the country and to inform public health intervention and diagnostic capacity for them.
The study involves testing legacy samples from an outbreak in Dafur in 2015/16 (~500 case; 18% case fatality) at PHE Porton Down, and developing a prospective study with a FMoH and Karary University team to encourage more rapid identification and better description of the disease in future outbreaks.
To date, a set of stored outbreak samples have been prepared and transferred, with the collaboration of colleagues from the National Public Health Laboratory (NPHL) and FMoH agreement, to PHE Porton Down and tested on a bespoke panel of molecular and serological assays covering a broad range of likely pathogens. Results have been shared with the Ministry and will be published shortly. A prospective study protocol has been developed with ethical approval from LSHTM, Karary University and the FMoH Technical Review Board, and a seven-person team has been trained in study implementation, with basic logistics also in place for a rapid start if/when an outbreak occurs. If no outbreak of the syndrome occurs within the current grant period, the protocol will remain in place ready to be triggered by Sudanese colleagues and we anticipate a request for UK-PHRST support may be made at that time.
Our project has created a new and strong collaboration with the FMoH and the NPHL, and provided a good example of UK research collaboration and support to improve outbreak investigation and control in Sudan. As health scientists in Sudan emerge from the period of sanctions, we hope these relationships with key outbreak-related departments of the FMoH will create further opportunities to assist outbreak response and International Health Regulation capacities in the country.
- Establishing real-time evaluations of WASH on disease outbreaks in emergency settings
This work was led by Oliver Cumming and Lauren D’Mello-Guyett (LSHTM). The project aimed to combine the academic experience of LSHTM and the operational experience of Médecins Sans Frontières (MSF) to strengthen the evidence base for Water, Sanitation and Hygiene (WASH) interventions used in disease outbreaks in emergency settings in low and middle-income countries (LMICs).
The role of WASH interventions as a means to both preventing and controlling infectious disease outbreaks is well established. However, at a practice and policy level, there have been calls to address the evidence gap as to how WASH interventions can be best mobilized to support during outbreak responses. We therefore developed approaches for evaluating the WASH component of MSF outbreak responses with a particular focus on study designs and methods that are appropriate for cholera outbreaks during complex emergencies.
Using these approaches to more rigorously evaluate WASH interventions will help strengthen the effectiveness of routinely delivered interventions for cholera control and improve access and outcome among vulnerable populations in low income settings.
Three summary reports are available from our field site visits to MSF projects in Nigeria and South Sudan, evaluating the ability, risks, and ethical considerations to be able to conduct operational research in such a setting. These are supplemented by a desk-based study including interviews with MSF staff in Central African Republic and Democratic Republic of Congo (DRC).
Three “sleeper protocols” that could be adapted for urban or rural contexts and/or closed or open settings within DRC have been developed. Ethical approval has been granted on the basis that an update will be submitted when an appropriate study site has been identified at the start of a conducive cholera outbreak. The collaboration has continued with MSF with plans to implement the protocols in DRC during the next cholera outbreak. Copies of the reports and protocols can be obtained on request from email@example.com.
- Building readiness for real-time pathogen sequencing for surveillance and control of infectious disease outbreaks
This work was performed by teams from PHE and LSHTM. The aim of the study was to take advantage of new technologies for near-real time genome sequencing in the field. We aimed to develop specific genome sequencing primers for selected viruses capable of causing outbreaks, validate sequencing methods and primers using UK returning traveller clinical samples and evaluate MinION sequences in relation to MiSeq,
Equipment is now in place within UK PHRST for amplicon-based viral whole-genome-sequencing on the MinION, primer sets have been designed and provisioned for 4 dengue virus serotypes, 3 chikungunya lineages, and 5 Lassa virus lineages. The UK PHRST lead microbiologist has been trained in the use of the MinION and the primer sets, a bioinformatic pathway has been developed in-house at LSHTM. Testing shows DENV-1,2,3 and CHIKV Asia and ECSA schemes are fully effective at detecting viruses with good genome coverage.
However, the schemes were less effective for DENV-4, CHIKV West Africa and Lassa; most likely due to lack of a relevant reference genome and future work could be done to establish this. A strategy for amplicon-based Crimean Congo Haemorrhagic Fever (CCHF) virus genome sequencing has also been developed by PHE using a separate funding source. The primers and protocol are also available to the UK PHRST. All established protocols could now be field tested for further integration into the PHRST.
We aim to transfer technology to laboratories in West Africa and evaluate performance in an LMIC setting, and utilize sequence clustering and other bioinformatics tools to determine the performance of sequence results in identifying transmission.
University of Oxford
The Epidemic Diseases Research Group Oxford (ERGO) delivers on the clinical operational research theme and contributes to the core deployable team and the training and capacity building in low and middle income countries. ERGO is led by Professor Peter Horby and the group aims to reduce the health and socioeconomic impact of emerging and epidemic infections by conducting and enabling clinical research in this area.
Since the launch of the UK-PHRST, members of the Oxford team have worked in Ethiopia, Nigeria, Madagascar, Sierra Leone, Nigeria, China and Cambodia, either as part of deployments or on research projects with local staff.
Selected research projects completed by ERGO:
- Rapid needs appraisal to inform clinical research priorities in response to (re-) emerging outbreaks
The evidence base for the response to epidemics of (re-)emerging pathogens is limited. Research is rarely an early priority, there are many challenges at the outset of an epidemic, and there is a limited window of opportunity to implement research.
This means it is important that the priorities for research are rapidly, but rigorously defined during the earliest stages of an epidemic, while considering ethical aspects and ensuring the potential for a direct clinical and public health impact.
A methodology for rapidly (≤5 days), systematically and transparently identifying key knowledge gaps to inform research priorities during emergency outbreaks was developed in collaboration with Evidence-Aid and Cochrane response.
The intention is that the outcome from the rapid research needs appraisal will be used to inform clinical research prioritisations.
The methodology was piloted in July 2017 using a Lassa fever outbreak scenario and the results compared with expert opinions collected from Lassa fever experts to inform the final version of the protocol.
The methodology was presented at the Global Evidence Summit in South Africa in September 2017.
- Patient data quality improvement in epidemics: An audit of West African Ebola data
This work was led by Amanda Rojek, Alex Salam, Peter Horby and the Infectious Diseases Data Observator.
Good medical record keeping is a challenge, particularly in humanitarian public health emergencies, and this is likely to impact clinical care for patients.
The overall aim of this project was to evaluate the quality of clinical data from patient records from the West African Ebola outbreak (2014/15).
The project was divided into 3 sub-projects:
- A systematic review and metaanalysis of published clinical data from the West African Ebola outbreak
- A questionnaire for healthcare workers, investigating their perceptions of the quality of clinical record keeping whilst working in West African Ebola Treatment Centres
- An audit of clinical data from 5,000 Ebola virus disease clinical case records from West Africa
This project will help generate an evidence base for best practice for medical record keeping in disease outbreaks and humanitarian emergencies in developing countries.
- An evaluation of syndromic surveillance and clinical characterisation of EEID syndromes in refugee camps
This work was led by Amanda Rojek together with Karl Blanchet (LSHTM) and Peter Horby.
There is an unprecedented global forced migration, with the UN Refugee Agency (UNHCR) estimating that more than 65 million people are in need of protection. At least 12 million of these are living in refugee camps, which are a high risk environment for disease outbreaks.
This work aimed to improve the provision of accurate and comprehensive clinical information that verifies an outbreak, characterises the likely cause and severity of illness, and identifies populations at risk.
The team collected prospective data from thirteen refugee camps across Greece, where research nurses observed clinical consultations with recently arrived refugees presenting with syndromes consistent with outbreak prone infectious diseases.
The data were collected to find out the extent to which the risks for infection, severity of infection and clinical manifestations of infection were assessed and recorded.
The study findings were published in BMC Medicine.
ERGO have several research projects currently underway. These include: Rapid identification and characterisation of avian influenza viruses by direct Nanopore sequencing in collaboration with Institut Pasteur du Cambodge; ongoing cohort study: clinical characterisation and microbiological diagnosis of patients with suspected pneumonic plague in collaboration with Institut Pasteur de Madagascar; an adaptive study of the pharmacokinetics of Favipiravir in patients with severe influenza in collaboration with the Ministry of Science and Technology of the People’s Republic of China and the China-Japan Friendship Hospital in Beijing; Lassa fever cohort study based in Sierra Leone in collaboration with Kennema Hospital.
In collaboration with the WHO/Tropical Diseases Research (TDR) programme, ERGO developed and ran a training curriculum on generating clinical evidence during outbreaks in lower and middle income countries (the Clinical Research During Outbreaks Course - CREDO). The delivery of the curriculum will build capacity overseas for an improved and rapid national research response to disease outbreaks. CREDO received accreditation for the African Academy of Sciences in 2017. The work was presented in October 2017 as a poster at the 10th European Congress on Tropical Medicine and International Health, Antwerp, Belgium.
King’s College London
Research into the mental health aspects of infectious disease outbreaks is led by a joint team from the NIHR Health Protection Research Unit in Emergency Preparedness and Response at King’s College London and the South London and Maudsley NHS Foundation Trust.
Projects already completed by the team as part of their UK-PHRST work include studies to understand the feasibility and effectiveness of small group therapy for staff in Sierra Leone who worked in Ebola treatment centres, the preliminary results of which are available in the International Journal of Social Psychiatry.
Ongoing work involves assessing whether it is possible to ‘screen’ people who wish to work on future infectious disease outbreaks, to identify and support people at risk of experiencing distress as a result of this work. For further information, please contact Dr James Rubin at KCL.
A new online resource which aims to strengthen the control response to disease outbreaks has been developed by the London School of Hygiene & Tropical Medicine (LSHTM) and the Institute of Development Studies. The Epidemic Response Anthropology Platform is funded by the UK-PHRST and will work with, and build, networks of anthropologists and other social scientists with regional or subject expertise, and connect them to policymakers, scientists and humanitarian response workers involved in responding to epidemics.
On 8 May 2018, the Democratic Republic of Congo (DRC) Government declared a new outbreak of Ebola Virus Disease (EVD)—the country’s ninth outbreak. The UK-PHRST is deploying to the Democratic Republic of Congo to help control the outbreak. The three UK-PHRST team members deploying include two experts in tracking outbreaks, LSHTM’s Hilary Bower and Olivier le Polain from Public Health England, and data scientist Patrick Keating from LSHTM.
The team is expected to remain in the DRC for around six weeks, during which time they will help track the spread of the outbreak, and will also support in establishing robust data systems that will help align crucial information gathering. The UK-PHRST also has expertise in various other key areas for Ebola response, such as laboratory diagnostics, that can be deployed should they be needed.
Q&A with team Director, Prof Dan Bausch.
In April 2017, Professor Daniel Bausch was appointed Director of the UK-PHRST. Prof Bausch is a specialist in emerging infectious diseases trained in internal medicine, infectious diseases, tropical medicine, and public health. He has extensive experience in sub-Saharan Africa, Latin America, and Asia combatting deadly global health threats such as Ebola virus, hantavirus, and SARS coronavirus.
A year on from the team's first deployment, Prof Bausch tells us more about the team and how they work to assist in managing disease outbreaks.
The UK Public Health Rapid Support Team (UK-PHRST) is deploying to Sierra Leone to help reduce the risk of a disease outbreak following the deadly landslides in Freetown.
Following natural disasters, outbreaks of water-borne diseases such as cholera can occur, particularly where there is a lack of access to clean water and sanitation. Given the scale of the disaster in Freetown, the local capacity to detect and control a disease outbreak is limited and the Government of Sierra Leone has requested international support.
The UK-PHRST team deployed to Sierra Leone includes experts in tracking the progress of an outbreak and diagnosing its cause, as well as a logistician. It will be working alongside Sierra Leone health system professionals and other experts in disaster relief to support the Sierra Leone Government’s response. As the UK-PHRST’s deployment progresses, it will continue to provide support and share expertise with our partners in Sierra Leone to strengthen the health system beyond the immediate response.
Professor Daniel Bausch has been appointed Director of the new UK Public Health Rapid Support Team (UK-PHRST).
Prof Daniel Bausch, a specialist in emerging infectious diseases trained in internal medicine, infectious diseases, tropical medicine, and public health, will take up the position of Director of the UK-PHRST in April. He has extensive experience in sub-Saharan Africa, Latin America, and Asia combatting deadly global health threats such as Ebola virus, hantavirus, and SARS coronavirus.
His most recent role was as the Technical Lead for the Epidemic Clinical Management Unit in the World Health Organization's (WHO) Pandemic and Epidemic Diseases Department. He is a tenured Professor at the Tulane University Health Sciences Center in the United States and has served as a regular consultant for the WHO, the United Nations and the US National Institutes of Health. In addition to his expertise in the sciences, Prof Bausch places a strong emphasis on capacity building in all his projects and also has a keen interest in the role of the scientist in promoting health and human rights.
The UK Public Health Rapid Support Team (UK-PHRST) has deployed to Nigeria to help control an unusually large outbreak of Lassa fever, a viral haemorrhagic illness that can cause severe symptoms and sometimes death.
Lassa fever outbreaks occur in most years in Nigeria but on a lower scale. Given the size of the current outbreak and the risk of further spread locally, the Government of Nigeria has requested support from the UK-PHRST.
The London School of Hygiene & Tropical Medicine has been chosen to jointly run the newly established UK Public Health Rapid Support Team in partnership with Public Health England. Public Health Minister Nicola Blackwood announced the £20m initiative, to help prevent global health emergencies on behalf of the UK Government. It means the UK has a fully operational specialist team that is ready to be deployed anywhere in the world within 48 hours to tackle disease outbreaks which have the potential to develop into major health emergencies.
It will continually monitor infectious disease outbreaks around the world, identifying situations where the deployment of specialist expertise could help mitigate threats. When not responding to a disease outbreak, the team will research how best to deal with different types of outbreak scenario as well as training a group of public health reservists so the UK maintains the capability to rapidly scale up responses to outbreaks.