Gonorrhea, one of the most common sexually transmitted infections worldwide, can lead to serious sequelae, including infertility and increased HIV transmission. Recently, untreatable, multidrug-resistant Neisseria gonorrhoeae strains have been reported. In the absence of new antibiotics, and given the speed with which resistance has emerged to all previously used antibiotics, development of a vaccine would be the ideal solution to this public health emergency. Understanding the desired characteristics, target population, and expected impact of an anti-gonococcal vaccine is essential to facilitate vaccine design, assessment and implementation. The modeling presented herein aims to fill these conceptual gaps, and inform future gonococcal vaccine development. Using an individual-based, epidemiological simulation model, gonococcal prevalence was simulated in a heterosexual population of 100,000 individuals after the introduction of vaccines with varied efficacy (10–100%) and duration of protection (2.5–20 years). Model simulations predict that gonococcal prevalence could be reduced by at least 90% after 20 years, if all 13-year-olds were given a non-waning vaccine with 50% efficacy, or a vaccine with 100% efficacy that wanes after 7.5 years. A 40% reduction in prevalence is achievable with a non-waning vaccine of only 20% efficacy. We conclude that a vaccine of moderate efficacy and duration could have a substantive impact on gonococcal prevalence, and disease sequelae, if coverage is high and protection lasts over the highest risk period (i.e., most sexual partner change) among young people.

Wheat rust diseases pose one of the greatest threats to global food security, including subsistence farmers in Ethiopia. The fungal spores transmitting wheat rust are dispersed by wind and can remain infectious after dispersal over long distances. The emergence of new strains of wheat rust has exacerbated the risks of severe crop loss. We describe the construction and deployment of a near realtime early warning system (EWS) for two major wind-dispersed diseases of wheat crops in Ethiopia that combines existing environmental research infrastructures, newly developed tools and scientific expertise across multiple organisations in Ethiopia and the UK. The EWS encompasses a sophisticated framework that integrates field and mobile phone surveillance data, spore dispersal and disease environmental suitability forecasting, as well as communication to policy-makers, advisors and smallholder farmers. The system involves daily automated data flow between two continents during the wheat season in Ethiopia. The framework utilises expertise and environmental research infrastructures from within the cross-disciplinary spectrum of biology, agronomy, meteorology, computer science and telecommunications. The EWS successfully provided timely information to assist policy makers formulate decisions about allocation of limited stock of fungicide during the 2017 and 2018 wheat seasons. Wheat rust alerts and advisories were sent by short message service and reports to 10 000 development agents and approximately 275 000 smallholder farmers in Ethiopia who rely on wheat for subsistence and livelihood security. The framework represents one of the first advanced crop disease EWSs implemented in a developing country. It provides policy-makers, extension agents and farmers with timely, actionable information on priority diseases affecting a staple food crop. The framework together with the underpinning technologies are transferable to forecast wheat rusts in other regions and can be readily adapted for other wind-dispersed pests and disease of major agricultural crops.

BackgroundSingle-dose azithromycin is recommended over multi-dose doxycycline as treatment for chlamydial infection. However, even with imperfect adherence, doxycycline is more effective in treating genital and rectal infection. Recently, it has been suggested that autoinoculation from the rectum to the genitals may be a source of persistent chlamydial infection in women. We estimated the impact autoinoculation may have on azithromycin and doxycycline effectiveness.MethodsWe estimate treatment effectiveness using a simple mathematical model, incorporating data on azithromycin and doxycycline efficacy from recent meta-analyses, and data on prevalence of rectal infection in women with genital chlamydial infection.ResultsWhen the possibility of autoinoculation is taken into account, we calculate that doxycycline effectiveness may be 97% compared to just 82% for azithromycin.ConclusionsConsideration should be given to re-evaluating azithromycin as the standard treatment for genital chlamydia in women.

In managing plant diseases, there is often tension between a regulator seeking to destroy infected plants to prevent further infection on a national scale and growers seeking to retain infected plants to continue obtaining yield. A high‐profile example is Huanglongbing (HLB) or citrus greening, a bacterial disease that threatens Brazil's citrus industry. To prevent the spread of HLB, especially from abandoned infected groves, the government regulated that if 28% of a plantation unit (grove) is found to be symptomatic, then the whole plantation unit must be destroyed. This decision used the best evidence available in 2008, which suggested that a 28% detectable prevalence corresponded with 100% actual prevalence, the disparity being due to asymptomatic infected trees and imperfect detection methods. Using a mathematical model with parameters estimated from field data, we evaluate the assumptions underlying the 28% threshold. We investigate the effects of spraying insecticide and removing diseased plants on the infectious pressure and potential loss of yield from an infected grove. We find that the relationship between detectable and actual prevalence is much wider than allowed for in the regulations. There is a high probability that groves with detectable levels of symptomatic plants substantially below 28% have a >90% prevalence of infected plants. Paradoxically, in a well‐managed orchard, the threshold of 28% may not be reached at 100% prevalence. Infectious pressure from an infected grove is substantially reduced when growers control disease. Individual growers failing to manage disease, therefore, threaten the wider grower community. Control is likely to increase yield and prolong grove productivity, but in some groves may reduce yield. Policy implications. Current disease thresholds aimed at restricting the spread of the citrus disease, Huanglongbing (HLB), in Brazil allow heavily infected groves to remain in the landscape, but lower thresholds would disadvantage growers who are already controlling disease. There is probably no threshold that is optimal for individual growers and regulators but roguing and spraying is beneficial to both parties. Regulations should focus less on prevalence thresholds, and instead encourage early detection and co‐ordinated spraying among growers to control Huanglongbing on a regional level.

SummaryThis advice considers the conservation status of the koala Phascolarctos cinereus at two levels -across its entire range, and for the Queensland-New South Wales-Australian Capital Territory portion of its range. This advice revises that previously given by this Committee in September 2010, through the consideration of new information mostly arising from the Senate Inquiry (Senate Environment and Communications References Committee 2011).

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IntroductionIt is increasingly important to prioritize the most cost-effective HIV interventions. We sought to summarize the evidence on which types of interventions provide the best value for money in regions with concentrated HIV epidemics.MethodsWe conducted a systematic review of peer-reviewed and grey literature reporting measurements of cost-effectiveness or cost-benefit for HIV/AIDS interventions in Asia and Eastern Europe. We also collated HIV/AIDS spending assessment data from case-study countries in the region.ResultsWe identified 91 studies for inclusion, 47 of which were from peer-reviewed journals. Generally, in concentrated settings, prevention of mother-to-child transmission programmes and prevention programmes targeting people who inject drugs and sex workers had lower incremental cost-effectiveness ratios than programmes aimed at the general population. The few studies evaluating programmes targeting men who have sex with men indicate moderate cost-effectiveness. Collation of prevention programme spending data from 12 countries in the region (none of which had generalized epidemics) indicated that resources for the general population/non-targeted was greater than 30% for eight countries and greater than 50% for five countries.ConclusionsThere is a misalignment between national spending on HIV/AIDS responses and the most affected populations across the region. In concentrated epidemics, scarce funding should be directed more towards most-at-risk populations. Reaching consensus on general principles of cost-effectiveness of programmes by epidemic settings is difficult due to inconsistent evaluation approaches. Adopting a standard costing, impact evaluation, benefits calculation, analysis and reporting framework would enable cross comparisons and improve HIV resource prioritization and allocation.

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