Scientists investigate extent of severe respiratory infection in Malawi


Scientists at the University of Liverpool’s Institute of Infection and Global Health have been awarded more than £3 million to define the nature and extent of influenza-associated Severe Acute Respiratory Infection (SARI) amongst adults and children in Malawi. 

The research, supported by the Centers for Disease Control and Prevention (CDC) influenza division, will support the surveillance of patients admitted to urban and rural hospitals, as well as a vaccine trial in children aged six to 59 months. 

The results of the study will contribute to a broader understanding of influenza and its impact on the most vulnerable populations, as well as provide data to help policy makers decide on the best way to protect those most at risk. 

Influenza in Malawi is responsible for 10-20% of all SARI hospital admissions. It has had a considerable impact on the health systems in many parts of Africa. In Malawi, weakened immunity is common due to malaria, malnutrition or HIV and this may increase the severity of influenza. In the event of another influenza pandemic, Malawi’s already stretched health systems could potentially be overwhelmed. 

High risk groups

Dr Dean Everett said: “We are working with high risk groups in the region, such as children under the age of one, pregnant women, and adults with HIV to understand the impact of the virus on more vulnerable parts of society. These groups could potentially be the focus of future vaccine interventions and new health policies.”  

The team will also be carrying out a Phase IV Clinical Trial to determine if Inactivated Influenza Vaccination (IIV) provides a good immune response in children under five years old who live in malaria endemic areas.  

IIV has been in use for decades in industrialised countries, and is approximately 70% effective in preventing influenza in young children. There is, however, little data regarding the impact of malaria on the efficacy of IIV in children; malaria is known to be immunosuppressive and has been observed to reduce efficacy of other childhood vaccines.  

Vaccine acceptability

The trial will take place in 30 villages in rural Chikhwawa District and will compare immune response to IIV in children with and without malaria parasitaemia, Scientists believe that the data generated from this trial will assist decision makers in countries like Malawi regarding the introduction of influenza vaccine. 

In parallel to the vaccine trial, researchers are exploring vaccine acceptability and hesitancy in response to non-routinised vaccination in young children in Malawi.  The study aims to show that decisions on vaccine uptake are not always about having access to the right information and more information can in fact lead to greater hesitancy in vaccine acceptability. The team will investigate whether this is the case in African settings where people may have access to less medical information. 

As part of the five year study, the team will also look at the genetics associated with influenza susceptibility and severity by sequencing the human genome from severe influenza cases. This will help scientists to understand what makes some people become extremely sick, or die, from flu, and may help to design future treatments. 

The research is in collaboration with The CDC Influenza Division, The Liverpool School of Tropical Medicine; the Rosalin Institute; the University of Malawi, College of Medicine; and the Malawi-Liverpool-Wellcome Trust Clinical Research Programme.


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