Research
Diarrhoeal Diseases
I have investigated gastrointestinal infections at the University of Liverpool for 25 years. My major research interest is diarrhoeal disease in children, particularly that caused by rotavirus (the most important cause of severe diarrhoea in children worldwide). I have since 1996 conducted studies of rotavirus gastroenteritis in children in Blantyre, Malawi. I first established that rotavirus is an important cause of severe diarrhoea in Malawian children, and that a wide variety of rotavirus serotypes are responsible for this burden of disease including novel serotype G8 strains. In October 2006, as Chief Principal Investigator, I led a phase III, placebo- controlled clinical trial of monovalent oral rotavirus vaccine in Malawi, which represented the first study of a modern rotavirus vaccine in Africa. The vaccine was efficacious in reducing the incidence of severe rotavirus gastroenteritis, and the results were published in the New England Journal of Medicine. These data led in 2009 to a global recommendation of rotavirus vaccine use by WHO.
I then secured a 5-year Wellcome Trust Programme Grant to address the impact of rotavirus vaccine on disease burden and epidemiology among children in Malawi. Data demonstrating the effectiveness of rotavirus vaccine, the first from a low income country, were published in Lancet Infectious Diseases (2015). I led a large birth cohort study in Malawi, which demonstrated that rotavirus vaccine reduced diarrhoea deaths by a third, the first evidence from a low income country that rotavirus vaccine saves lives (Lancet Global Health, 2018). Ongoing rotavirus work in Malawi, funded by the Wellcome Trust and NIH, includes study of the impact of rotavirus vaccine on rotavirus transmission, examination of host factors affecting rotavirus vaccine immunogenicity and modelling the impact of rotavirus vaccination. Funding from the Bill and Melinda Gates Foundation has supported a clinical trial to examine the safety and immunogenicity of a neonatal rotavirus vaccine (RV3) in Malawi, and a Phase III, randomised trial of antibiotic treatment of severe diarrhoea in children in Malawi.
I demonstrated the impact of rotavirus vaccination in reducing diarrhoeal disease in Merseyside, UK, with greatest benefit in the most deprived areas. I demonstrated that the incidence of febrile convulsions has fallen in the UK as a result of rotavirus vaccination. I have led multiple Cochrane Reviews of rotavirus vaccine. From 2020, I am the Director of the NIHR Health Protection Research Unit in Gastrointestinal Infections at the University of Liverpool. My work was been recognised as one of the top 100 research achievements among UK Universities.
Research grants
Global Health Research Group in Gastrointestinal Infections: Facilitating the Introduction and Evaluation of Vaccines for Enteric Diseases in Children in Eastern and Southern sub-Saharan Africa
DEPARTMENT OF HEALTH & SOCIAL CARE (UK)
August 2022 - July 2025
Modelling next generation rotavirus vaccines
NATIONAL INSTITUTES OF HEALTH (USA)
September 2020 - August 2025
Enterics for Global Health – Shigella Surveillance in Malawi (Part B)
BILL & MELINDA GATES FOUNDATION (USA)
January 2021 - April 2025
NIHR Senior Investigator Award
DEPARTMENT OF HEALTH & SOCIAL CARE (UK)
April 2022 - March 2026
Epidemiology, Prevention, and Treatment of Influenza and Other Respiratory Infections in a Malaria-Endemic Area of Malawi with High HIV Prevalence. (Year 4)
CENTERS FOR DISEASE CONTROL AND PREVENTION (USA)
August 2017 - July 2018
Characterization of B-cell Subsets and Immunoglobulin Sequence Repertoires in Infants Immunised with Human Rotavirus Vaccine in Malawi
WELLCOME TRUST (UK)
January 2017 - June 2022
Molecular Diagnostics for Enteric Diseases Core Facility
BILL & MELINDA GATES FOUNDATION (USA)
January 2019 - June 2020
A Phase II randomised, parallel dose-ranging study of oral RV3-BB Rotavirus Vaccine in Malawi, administered at a titre of 1x 107, 3x 106 or 1x 106 as a 3 dose infant schedule or administered at a titre of 1x 107 as a 3-dose neonatal schedule.
BILL & MELINDA GATES FOUNDATION (USA)
July 2017 - June 2022
One Health Research Network for the Horn of Africa (HORN)
BIOTECHNOLOGY & BIOLOGICAL SCIENCE RESEARCH COUNCIL
October 2017 - March 2023
Epidemiology, Prevention, and Treatment of Influenza and Other Respiratory Infections in a Malaria-Endemic Area of Malawi with High HIV Prevalence. (Year 3)
CENTERS FOR DISEASE CONTROL AND PREVENTION (USA)
August 2016 - July 2020
Optimal use of antibiotics in facility based case management of diarrhea
BILL & MELINDA GATES FOUNDATION (USA)
July 2016 - December 2021
Model-guided assessment of rotavirus vaccine Impact in developing countries.
NATIONAL INSTITUTES OF HEALTH (USA)
February 2015 - January 2021
Impact of rotavirus vaccination on winter /spring pressures at a large paediatric hospital in the UK: an ecological study.
GLAXOSMITHKLINE (UK)
October 2015 - September 2018
New Childhood vaccines for Malawi: Impact of a national pneumococcal and rotavirus vaccine roll-out on disease burden, epidemiology, and circulating strains.
WELLCOME TRUST (UK)
February 2011 - January 2017
Impact of maternally derived antibodies and infant microbiota on the immunogenicity of rotavirus vaccines in African, Indian and European infants.
DEPARTMENT FOR BUSINESS, INNOVATION AND SKILLS (UK)
July 2015 - December 2018
Disease Burden of Norovirus in Children in Urban and Rural Malawi.
TAKEDA GLOBAL RESEARCH & DEVELOPMENT CENTRE, INC (USA)
September 2015 - June 2018
Estimating the economic burden of acute gastroenteritis in Malawian children
PATH(USA)
June 2012 - September 2014
Predictors of rotavirus vaccine virus replication, immune response and clinical protection following oral rotavirus vaccination in Malawian children.
WELLCOME TRUST (UK)
September 2014 - August 2017
Impact of national rotavirus vaccination on diarrhoea deaths among infants in rural Malawi
GLAXOSMITHKLINE BIOLOGICALS S.A. (BELGIUM)
May 2014 - December 2016
Effect of exposure to rotavirus vaccine on household rotavirus transmission in a semi-urban Malawian population.
WELLCOME TRUST (UK)
September 2014 - August 2017
Epidemiology, Prevention, and Treatment of Influenza and Other Respiratory Infections in a Malaria-Endemic Area of Malawi with High HIV Prevalence.
CENTERS FOR DISEASE CONTROL AND PREVENTION (USA)
August 2014 - July 2016
Research collaborations
Professor Osamu Nakagomi
Molecular epidemiology of rotaviruses
Nagasaki University
Characterisation of rotaviruses in Malawi and Nepal
Dr Umesh Parashar
Rotavirus gastroenteritis in Malawi
Centers for Disease Control and Prevention
Assessment of rotavirus vaccine roll-out in Malawi
Professor Gagandeep Kang
Rotavirus
Christian Medical College, Vellore, India
Understanding rotavirus vaccine performance in multiple settings
Dr Virginia Pitzer
Modelling rotavirus vaccine impact in developing countries
Yale University, USA
NIH-funded study of rotavirus vaccine impact
Dr Tom Snelling
Rotavirus
Telethon Kids Institute, Western Australia
Rotavirus vaccine scheduling