Public Health England

COVID-19 vaccine uptake varied across geographical areas and demographic groups in England, with significant disparities observed locally. Understanding the factors driving these disparities is crucial for improving public health interventions. Using a comprehensive dataset containing sociodemographic, economic, and health-related variables, this study identifies key predictors of COVID-19 vaccine uptake and dropout rates across Lower Tier Local Authorities (LTLAs) in England. Specific Index of Multiple Deprivation (IMD) variables, including crime and environment scores, were significant predictors of both vaccine uptake and vaccine dropout rates, indicating that these domains create barriers to vaccination. Socioeconomic deprivation, especially among ethnic minority groups such as Asian and Black/African/Caribbean populations, was linked to lower vaccine uptake and higher dropout rates. LTLAs with younger populations saw significantly higher rates of dropout between doses, and LTLAs with a greater proportion of the population over the age of 65 saw significantly lower rates of vaccination dropout, likely due to targeted public health messaging and prioritisation. These findings highlight the need for targeted public health strategies to address the barriers faced by underserved communities. By focusing on the identified predictors, future vaccination campaigns can be tailored to improve uptake and reduce health disparities, ultimately enhancing public health outcomes.

Bioaerosols are ubiquitous airborne microorganisms comprised of bacteria, fungi, pollen, virus and their constituents. Fungi have been associated with negative health effects ranging in severity from allergic reactions to asthma and serious infection, where susceptible individuals are at greater risk of life-threatening health outcomes resulting from exposure. While airborne fungi are abundant, they are poorly characterized due to the low temporal resolution of traditional offline sampling methods, limiting our understanding of key emission drivers in critical micro-environments and their impacts on air quality.There is a critical need to better characterize background fungal aerosol concentrations to build baselines to explore exposure assessment. Here we investigate the utility of emerging real-time detection methods in conjunction with offline sampling during a two-week pilot study to characterize the outdoor concentrations of key aeroallergenic fungi at high time resolution.A Multiparameter Bioaerosol Spectrometer (MBS) was deployed at UKHSA Chilton alongside a Burkard sampler during summer 2022, capturing the extreme European-wide heatwave which occurred 9-15th of August; The MBS is a biofluorescence spectrometer that classifies and quantifies bioaerosols on a single particle basis via their autofluorescent signatures, allowing for fungal aerosol concentrations to be derived at 5-minute time resolution; Next Generation Sequencing (NGS) was performed on daily integrated Burkard samples to provide broader fungal compositional context. Meteorological data was also recorded.Clear diurnal behaviour in Cladosporium- and Penicillium-like aerosol was observed with the MBS, with maximums occurring in the late afternoon and early morning respectively. These characteristic diurnal emission features would not be evident from sample integrations typical of offline sampling.Splitting the MBS real-time data into pre-heatwave and heatwave periods revealed that during heatwave conditions the environment was too hot and dry for the typical day time sporulation and emission of Cladosporium to occur, where the emission was delayed until the early morning when temperatures dropped and subsequently critical humidity levels had recovered; The typical early morning release of Penicillium was largely unaffected by the heatwave, however, daytime concentrations dropped to zero during the hottest and driest periods.Analysis of the daily NGS data showed that the abundance of key species such as Alternaria and Cladosporium were enhanced during the heatwave, while Aureobasidium and Epicoccum are suppressed by heatwave conditions in our observations.We demonstrate the utility of a complimentary real-time and offline NGS dual approach to gain deeper insights into fungal spore emissions. This allowed us for the first time to investigate the impacts of heatwave conditions on the emissions of key aeroallergenic species, providing insight into how diurnal emissions may be impacted by a warming climate. We also suggest that this approach shows promise for routine fungi monitoring to assess impacts on public health.

Abstract Metabolic adaptation to nutrient stress is a key but poorly understood driver of fungal virulence. Here, we show that a dominant East Asian lineage of Cryptococcus neoformans (VNIa-5), which disproportionately infects immunocompetent hosts, has undergone lineage-specific rewiring of glucose-responsive stress pathways. Integrating population genomics, transcriptomics, and experimental infection models, we demonstrate that VNIa-5’s clinical dominance is not explained by environmental prevalence. Instead, selective activation of Snf1 signalling links glucose limitation to mitochondrial tubularisation, extracellular vesicle remodelling, and enhanced melanization. Under low-glucose conditions, VNIa-5 exhibits marked mitochondrial plasticity and extracellular vesicle compositional shifts resembling hypervirulent outbreak lineages of Cryptococcus gattii . Following experimental induction of dormancy, VNIa-5 shows significantly increased virulence in vivo compared with the closely related but clinically rare VNIa-31 subclade, with host survival tightly correlated with mitochondrial morphology. These findings identify metabolic stress integration as a central mechanism shaping cryptococcal virulence and disease in immunocompetent human hosts.

Artificial intelligence (AI) promises to enhance breast cancer screening. Here we evaluated Google's mammography AI system (version 1.2) across two phases: a retrospective study using 115,973 mammograms from five National Health Service screening services with 39-month follow-up and prospective noninterventional feasibility deployment at 12 sites (9,266 cases). The primary endpoint was AI sensitivity and specificity versus first reader using a 5% noninferiority margin. The secondary endpoints were performance versus second or consensus readers and breast-level analyses. Retrospectively, AI achieved superior sensitivity (0.541 versus 0.437 for first reader, P < 0.001) and noninferior specificity (0.943 versus 0.952, P < 0.001). Cancer detection rate increased from 7.54 to 9.33 per 1,000 women, with AI detecting 25.0% of interval cancers. Performance was particularly strong for first screens (39.3% fewer recalls, 8.8% higher detection) and invasive cancers. No systematic demographic disparities were observed. Simulated second-reader replacement reduced reading time by 32% while increasing detection by 17.7%. Prospective deployment confirmed technical feasibility but revealed a distribution shift requiring threshold recalibration. Implementation requires adaptive calibration and continuous monitoring to ensure safety and equity.

Whole bacterial genome sequence reconstruction using Oxford Nanopore Technologies ('Nanopore') long-read-only sequencing may offer a lower-cost, higher-throughput alternative for pathogen surveillance to 'hybrid' assembly with recent improvements in Nanopore sequencing accuracy. We evaluated the accuracy, including plasmid reconstruction, of Nanopore long-read-only genome assemblies of Enterobacterales. We sequenced 92 genomes from clinical Enterobacterales isolates, collected in England under a national surveillance programme, with long-read Nanopore (R10.4.1, Dorado v5.0.0 super-high-accuracy basecalled) and short-read Illumina (NovaSeq) sequencing approaches. Genomes were assembled using three long-read-only (Flye, Hybracter long and Autocycler) and three hybrid assemblers (Hybracter hybrid, Unicycler normal and bold). Three polishing modalities (Medaka v2 with subsampled or un-subsampled long-reads; Polypolish+Pypolca with short-reads) were investigated. Autocycler circularised the most chromosomes [87/92 (95%)]. Plasmid sequence reconstruction was comparable among all assemblers except Flye, all recovering 90-96% of plasmids, although the 'ground truth' was uncertain. Flye performed worse than other assemblers on almost all metrics. Autocycler+Medaka (un-subsampled long-reads) was the most accurate long-read-only assembler/polisher combination, comparable to hybrid assemblies [median 0 (IQR: 0-0) single nucleotide variants (SNVs) and 0 (IQR: 0-1) insertions/deletions (indels) per genome; median quality value/Q score 100 (IQR: 64-100)], with only 4/92 genome sequences having >10 SNVs/indels. Medaka polishing with un-subsampled long-reads resulted in small improvements in indels, but not SNVs for both Flye and Autocycler assemblies. Seven-locus multi-locus sequence type, antimicrobial resistance, virulence and stress gene annotation was equivalent across assembler/polisher combinations. Nanopore long-read-only bacterial genome assembly with Autocycler combined with Medaka polishing (using un-subsampled reads) is similarly accurate and possibly more complete than hybrid assemblies, representing a viable alternative for incorporating high-quality genomic data, including plasmids, into Enterobacterales surveillance.

Introduction: Air pollution is the causative factor for considerable morbidity and premature death worldwide. This review critiques the WHO's Air Pollution Harm Reduction Strategy in Dhaka, Bangladesh, through the lens of the HBM by analysing its effectiveness and ethical implications. Materials and Methods: This critical review synthesises findings from WHO publications, peer-reviewed journals, and public health data on Dhaka's air quality management. The approach involves thematic analysis of health promotion strategies and behavioural change interventions. Discussion: The findings highlight that while the WHO strategy is successful in raising awareness and providing a policy direction, it continues to be hampered by economic barriers, weak enforcement, and absence of local engagement. HBM explains personal motivation toward cleaner practices but falls short on systemic inequities and gendered exposures. Conclusion: A multi-sectoral policy enforcement, equity-focused planning, and culturally sensitive communication are some of the basic tenets for structuring Dhaka's air pollution strategy toward sustainable impact. Strengthening community ownership and data-driven governance bridges the gap between global frameworks and local realities. Medicine Today 2026, Vol.38 (1): 137-141

Conflicting evidence exists on whether blue or red light modulates nitric oxide (NO) release within skin cells. Using environmentally relevant doses, irradiances and spectral distribution akin to low-level sunlight, we provide evidence that broad-spectrum blue or red (including infrared) light fails to significantly increase NO release in skin cell monolayers compared to unexposed controls for each individual timepoint assessed. We discuss observed discrepancies between our work and recent photobiomodulation (PBM)-based studies presenting measurable upregulation, noting that significant NO induction typically requires high-powered light-emitting diodes (LEDs) or lasers used in clinical settings within a specific narrow spectral band. Thus, while our findings show no significant effect, they provide an important counterpoint for public health discussions on visible light exposure at terrestrial levels, particularly low-level exposures, between 15 and 30 min midday UK visible light exposure.

To estimate the extent of potential research waste in the production of evidence-synthesis products for health screening, providing an initial assessment of its magnitude. Evidence-synthesis products supporting screening recommendations for adult populations, published by the UK National Screening Committee (UK NSC) and the US Preventive Services Task Force (USPSTF) between 2014 and 2024, were identified as anchor reviews. For each anchor review, Embase, Medline, and national and international organization websites were searched for overlapping evidence reviews on the same topic, defined as addressing the same research questions with at least partial overlap in the population, interventions, comparisons, and outcomes. A total of 48 anchor reviews (covering 33 conditions) were identified from the UK NSC and USPSTF. Overlapping evidence reviews were identified for 92% (44/48) of these, with a median of 4 additional reviews per anchor review (range: 0-60; interquartile range [IQR]: 2-15). Of the overlapping reviews, 11% showed overlap with partial use of prior work, explicitly updating or building upon prior external work, but with new elements and scope differences that maintained their classification as overlapping. Focusing on a core subset of conditions of shared interest to both organizations, the median overlap increased to 13 (range: 2-47; IQR: 4-17), indicating substantial duplication in priority areas. Seventy percent of all reviews in the evidence base were conducted in North America (28%) and Western Europe (42%), with limited representation from low- and middle-income countries. The results of this review highlight potential research waste due to duplication in evidence synthesis efforts. Coordinated action among organizations advising policymakers, such as NSCs, public health agencies, and evidence review bodies may help establish more efficient, collaborative approaches that enable reuse and adaptation across contexts. Such action could include real-time sharing of ongoing reviews, multiregion comprehensive reviews, and the use of stratified analyses to tailor findings to country-specific needs. These strategies should be explored to determine whether organizations can reduce unnecessary duplication, enhance equity, improve the timeliness and relevance of guidance, and redirect resources toward unmet research priorities and other pressing public health challenges.