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Sanusi IA, Arisoyin AE, Aruoture S, Folorunsho IL, Okereke OP, Adeyemo DA, Salawu MA, Okobi OE, Gupta A, Akunne HS, Patel R, Emmanuel O, Ezeudemba NC. Exploring the Prevalence and Factors Influencing Clinical Trial Awareness in US Adults with Self-Reported Depression and Anxiety. Cureus 2023; 15:e40780. [PMID: 37485134 PMCID: PMC10362504 DOI: 10.7759/cureus.40780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE Lack of clinical trial awareness is a crucial barrier to clinical trial enrollment. The objective of this study was to examine the prevalence and factors associated with clinical trial awareness among US adults with self-reported depression and anxiety. METHODS Data were collected from 896 adults who self-reported depression and anxiety from the 2020 Health Information National Trends Survey. Multinomial logistic regression was utilized to assess predictors of clinical trial awareness, particularly socio-demographic, health-related, and technological variables. Odds ratios (OR) for the associations were reported. RESULTS About 60.4% of adults with self-reported depression or anxiety reported being aware of clinical trials. In the multivariable regression, education level, health-related social media use, and having access to a regular provider were all significantly associated with greater odds of clinical trial awareness among individuals with depression and/or anxiety. Specifically, individuals with at least some college education (OR 2.07, 95% confidence interval (CI); 1.28-3.34; p = 0.004) were more likely to report awareness of clinical trials than those with less than a college education. Similarly, compared to those without access to health providers, individuals with depression and/or anxiety who had a regular provider had greater odds of clinical trial awareness (OR 2.23, 95% CI; 1.16-4.31; p = 0.017). Additionally, those who reported two or more health-related uses of social media were significantly more likely to report clinical trial awareness than their counterparts who reported no health-related social media use (OR 3.17, 95% CI; 1.48-6.80; p = 0.004). CONCLUSION Our study shows that about six in 10 adults with depression and anxiety in the United States were aware of clinical trials. However, some sub-groups of patients, particularly those without access to a regular health provider, those with a lower education level, and those with limited use of social media for health purposes, remain inadequately informed and may lack awareness of available clinical trials. These findings are crucial and identify subgroups of people with mental disorders that may benefit from targeted interventions to improve clinical trial awareness.
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Affiliation(s)
| | | | - Shaw Aruoture
- Psychiatry, Behavioral Hospital Of Bellaire, Houston, USA
| | | | | | | | - Mujeeb A Salawu
- Medicine and Surgery, University of Ilorin College of Health Sciences, Ilorin, NGA
- Internal Medicine and Psychiatry, Houston Health Department, Houston, USA
| | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Akash Gupta
- Internal Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | | | - Radhey Patel
- Psychiatry and Behavioral Sciences, Avalon University School of Medicine, Willemstad, CUW
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Kumar G, Chaudhary P, Quinn A, Su D. Barriers for cancer clinical trial enrollment: A qualitative study of the perspectives of healthcare providers. Contemp Clin Trials Commun 2022; 28:100939. [PMID: 35707483 PMCID: PMC9189774 DOI: 10.1016/j.conctc.2022.100939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/14/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022] Open
Abstract
Background Barriers to clinical trial enrollment have been the subject of extensive research; however, the rate of clinical trial participation has not improved significantly over time. Studies often emphasize patient-related barriers, but institutional and organizational barriers in the health care system may have a more substantial impact on clinical trial participation. Objective To qualitatively identify perceived barriers to clinical trial participation based on perspectives from healthcare providers. Design Qualitative research design with a phenomenological approach was used. A purposive sample of 18 healthcare providers participated in an in-depth focus group session. Participants were involved in cancer care and clinical research from a large hospital in the United States Midwest region. Data were transcribed, coded, and systematically analyzed through thematic content analysis. Results The data revealed four levels of barriers to clinical trial enrollment, with emergent themes within each level: patient (beliefs or trust, distance to trial sites, health insurance coverage, language, and immigration status), provider (limited awareness of trial, time constraint, and non-cooperation from colleagues), clinical (eligibility criteria and clinical design), and institutional (policy and limited logistic support). Conclusion Healthcare providers face complex, multifaceted, and interrelated barriers to clinical trial enrollment. To overcome these barriers, health care organizations need to commit more human and financial resources, break down boundaries for more efficient inter-departmental cooperation, develop more coordinated efforts in promoting trial awareness and participation, and remove unnecessary regulatory barriers.
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Kochar A, Summers MB, Benziger CP, Marquis-Gravel G, DeWalt DA, Pepine CJ, Gupta K, Bradley SM, Dodson JA, Lampert BC, Robertson H, Polonsky TS, Jones WS, Effron MB. Clinician engagement in the ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) trial. Clin Trials 2021; 18:449-456. [PMID: 33541120 DOI: 10.1177/1740774520988838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) is a pragmatic clinical trial examining high-dose versus low-dose aspirin among patients with cardiovascular disease. ADAPTABLE is leveraging novel approaches for clinical trial conduct to expedite study completion and reduce costs. One pivotal aspect of the trial conduct is maximizing clinician engagement. METHODS/RESULTS Clinician engagement can be diminished by barriers including time limitations, insufficient research infrastructure, lack of research training, inadequate compensation for research activities, and clinician beliefs. We used several key approaches to boost clinician engagement such as empowering clinician champions, including a variety of clinicians, nurses and advanced practice providers, periodic newsletters and coordinated team celebrations, and deploying novel technological solutions. Specifically, some centers generated electronic health records-based best practice advisories and research dashboards. Future large pragmatic trials will benefit from standardization of the various clinician engagement strategies especially studies leveraging electronic health records-based approaches like research dashboards. Financial or academic "credit" for clinician engagement in clinical research may boost participation rates in clinical studies. CONCLUSION Maximizing clinician engagement is important for the success of clinical trials; the strategies employed in the ADAPTABLE trial may serve as a template for future pragmatic studies.
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Affiliation(s)
- Ajar Kochar
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary B Summers
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Darren A DeWalt
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas Medical School, Kansas City, KS, USA
| | - Steven M Bradley
- Division of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - John A Dodson
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Brent C Lampert
- Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Holly Robertson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tamar S Polonsky
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - W Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Mark B Effron
- John Ochsner Heart and Vascular Institute, The University of Queensland Ochsner Clinical School, New Orleans, LA, USA
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Abstract
IMPORTANCE Effective, continuous improvement in patient engagement depends on an intimate understanding of public and patient perceptions and experiences in clinical research. OBJECTIVES To identify the views of clinical trial participants and nonparticipants and characterize trends in these views over time. DESIGN, SETTING, AND PARTICIPANTS In this survey study, a questionnaire was administered online from May 8 to July 24, 2017, by the Center for Information and Study on Clinical Research Participation (CISCRP), and findings were compared with previous studies conducted in 2013 and 2015. The 2017 sample included responses from 12 427 individuals from 68 countries and represents a 10% participation rate. Similar to international assessments conducted by the CISCRP and other organizations, this study drew responses from a convenience sample; any adult older than 18 years who received an email or had online access was eligible to participate. MAIN OUTCOMES AND MEASURES Significant changes were observed in the perceptions and clinical trial experiences of the public and study volunteers compared with past CISCRP studies. RESULTS A total of 12 427 individuals (mean [SD] age, 55 [15] years; 7355 [59.2%] female; 10 085 [81.2%] white), 2194 (17.7%) of whom had participated in previous clinical research studies, responded to the survey in 2017. Findings indicated a belief in the importance of clinical research, but limited understanding of the research process persists. In 2017, a total of 10 506 individuals (84.5%) perceived clinical research to be very important to the discovery and development of new medicines; however, 4079 of 6919 respondents (59.0%) were unable to name a place where studies were conducted. A total of 11 182 respondents (90.0%) believed that clinical research is generally safe; however, 5578 of 12 427 individuals (44.9%) reported that clinical trials are rarely considered as an option when discussing treatments or medications with their physician. Clinical trial participation was perceived as inconvenient and burdensome; in the latest survey, 1075 respondents (49.0%) expressed that their clinical trial participation disrupted their daily routine. CONCLUSIONS AND RELEVANCE The results of this study may provide a foundation from which to build meaningful and effective engagement with the public and patients and revealed roadblocks, including knowledge gaps among the public, limited physician involvement in discussing clinical trials as treatment options, and the inconveniences that patients encounter after they volunteer to participate. These findings may inform patient engagement strategies and tactics and ultimately help accelerate the drug-development process.
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Affiliation(s)
- Annick Anderson
- The Center for Information and Study on Clinical Research Participation, Boston, Massachusetts
| | - Deborah Borfitz
- The Center for Information and Study on Clinical Research Participation, Boston, Massachusetts
| | - Kenneth Getz
- The Center for Information and Study on Clinical Research Participation, Boston, Massachusetts
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, Boston, Massachusetts
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de Graaf H, Sukhtankar P, Arch B, Ahmad N, Lees A, Bennett A, Spowart C, Hickey H, Jeanes A, Armon K, Riordan A, Herberg J, Hackett S, Gamble C, Shingadia D, Pallett A, Clarke SC, Henman P, Emonts M, Sharland M, Finn A, Pollard AJ, Powell C, Marsh P, Ballinger C, Williamson PR, Clarke NM, Faust SN. Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study. Health Technol Assess 2018; 21:1-164. [PMID: 28862129 DOI: 10.3310/hta21480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is little current consensus regarding the route or duration of antibiotic treatment for acute osteomyelitis (OM) and septic arthritis (SA) in children. OBJECTIVE To assess the overall feasibility and inform the design of a future randomised controlled trial (RCT) to reduce the duration of intravenous (i.v.) antibiotic use in paediatric OM and SA. DESIGN (1) A prospective service evaluation (cohort study) to determine the current disease spectrum and UK clinical practice in paediatric OM/SA; (2) a prospective cohort substudy to assess the use of targeted polymerase chain reaction (PCR) in diagnosing paediatric OM/SA; (3) a qualitative study to explore families' views and experiences of OM/SA; and (4) the development of a core outcome set via a systematic review of literature, Delphi clinician survey and stakeholder consensus meeting. SETTING Forty-four UK secondary and tertiary UK centres (service evaluation). PARTICIPANTS Children with OM/SA. INTERVENTIONS PCR diagnostics were compared with culture as standard of care. Semistructured interviews were used in the qualitative study. RESULTS Data were obtained on 313 cases of OM/SA, of which 218 (61.2%) were defined as simple disease and 95 (26.7%) were defined as complex disease. The epidemiology of paediatric OM/SA in this study was consistent with existing European data. Children who met oral switch criteria less than 7 days from starting i.v. antibiotics were less likely to experience treatment failure (9.6%) than children who met oral switch criteria after 7 days of i.v. therapy (16.1% when switch was between 1 and 2 weeks; 18.2% when switch was > 2 weeks). In 24 out of 32 simple cases (75%) and 8 out of 12 complex cases (67%) in which the targeted PCR was used, a pathogen was detected. The qualitative study demonstrated the importance to parents and children of consideration of short- and long-term outcomes meaningful to families themselves. The consensus meeting agreed on the following outcomes: rehospitalisation or recurrence of symptoms while on oral antibiotics, recurrence of infection, disability at follow-up, symptom free at 1 year, limb shortening or deformity, chronic OM or arthritis, amputation or fasciotomy, death, need for paediatric intensive care, and line infection. Oral switch criteria were identified, including resolution of fever for ≥ 48 hours, tolerating oral food and medicines, and pain improvement. LIMITATIONS Data were collected in a 6-month period, which might not have been representative, and follow-up data for long-term complications are limited. CONCLUSIONS A future RCT would need to recruit from all tertiary and most secondary UK hospitals. Clinicians have implemented early oral switch for selected patients with simple disease without formal clinical trial evidence of safety. However, the current criteria by which decisions to make the oral switch are made are not clearly established or evidence based. FUTURE WORK A RCT in simple OM and SA comparing shorter- or longer-course i.v. therapy is feasible in children randomised after oral switch criteria are met after 7 days of i.v. therapy, excluding children meeting oral switch criteria in the first week of i.v. therapy. This study design meets clinician preferences and addresses parental concerns not to randomise prior to oral switch criteria being met. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Hans de Graaf
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Priya Sukhtankar
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Barbara Arch
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Nusreen Ahmad
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Public Health England, Southampton, UK
| | - Amanda Lees
- Health and Wellbeing Research and Development Group, University of Winchester, Winchester, UK
| | - Abigail Bennett
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Catherine Spowart
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Helen Hickey
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Annmarie Jeanes
- Radiology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate Armon
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Andrew Riordan
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jethro Herberg
- Section of Paediatrics, Imperial College London, St Mary's Campus, London, UK
| | - Scott Hackett
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carrol Gamble
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Delane Shingadia
- Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Ann Pallett
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stuart C Clarke
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Philip Henman
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Marieke Emonts
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Mike Sharland
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Adam Finn
- Bristol Children's Vaccine Centre, School of Clinical Sciences, University of Bristol, Bristol, UK.,Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, UK
| | - Andrew J Pollard
- Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Colin Powell
- School of Medicine, University of Cardiff, Cardiff, UK.,Department of Paediatrics, University Hospital of Wales, Cardiff, UK
| | - Peter Marsh
- Public Health England, South East Public Health England Regional Laboratory, Southampton, UK
| | - Claire Ballinger
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Paula R Williamson
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Nicholas Mp Clarke
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Paediatric Orthopaedics, University of Southampton, Southampton, UK
| | - Saul N Faust
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
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McQuaid F, Jones C, Stevens Z, Meddaugh G, O'Sullivan C, Donaldson B, Hughes R, Ford C, Finn A, Faust SN, Gbesemete D, Bedford H, Hughes S, Varghese AS, Heath PT, Snape MD. Antenatal vaccination against Group B streptococcus: attitudes of pregnant women and healthcare professionals in the UK towards participation in clinical trials and routine implementation. Acta Obstet Gynecol Scand 2018; 97:330-340. [PMID: 29292509 DOI: 10.1111/aogs.13288] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Maternal vaccination is increasingly part of antenatal care in the UK and worldwide. Trials of Group B streptococcus vaccines are ongoing. This study investigated the attitudes of pregnant women and healthcare professionals towards antenatal vaccination, both in routine care and a clinical trial setting. MATERIAL AND METHODS Survey of 269 pregnant women, 273 midwives/obstetricians and 97 neonatal doctors across seven sites in the UK assessing attitudes towards antenatal vaccinations, knowledge of Group B streptococcus, a hypothetical Group B streptococcus vaccine, and participation in clinical vaccine trials. RESULTS 68% of pregnant women intended to receive a vaccine during their current pregnancy (183/269) and 43% (of all respondents, 115/269) reported they would be very/fairly likely to accept a vaccine against Group B streptococcus despite only 29% (55/269) knowing what Group B streptococcus was. This increased to 69% after additional information about Group B streptococcus was provided. Twenty-four percent of pregnant women reported they would be likely to take part in a clinical trial of an unlicensed Group B streptococcus vaccine. Fifty-nine percent of maternity professionals and 74% of neonatologists would be likely to recommend participation in a Group B streptococcus vaccine trial to women, with the vast majority (>99%) willing to be involved in such a study. Incentives to take part cited by pregnant women included extra antenatal scans and the opportunity to be tested for Group B streptococcus. CONCLUSION Pregnant women and healthcare professionals were open to the idea of an antenatal Group B streptococcus vaccine and involvement in clinical trials of such a vaccine. Education and support from midwives would be key to successful implementation.
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Affiliation(s)
- Fiona McQuaid
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, UK
| | - Christine Jones
- Pediatric Infectious Diseases Research Group & Vaccine Institute, Institute for Infection and Immunity, St Georges, University of London & St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Zoe Stevens
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, UK
| | - Gretchen Meddaugh
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, UK
| | - Catherine O'Sullivan
- Pediatric Infectious Diseases Research Group & Vaccine Institute, Institute for Infection and Immunity, St Georges, University of London & St Georges University Hospitals NHS Foundation Trust, London, UK
| | | | - Rhona Hughes
- Simpson Center for Reproductive Health, Royal Infirmary, Edinburgh, UK
| | - Carolyn Ford
- Simpson Center for Reproductive Health, Royal Infirmary, Edinburgh, UK
| | - Adam Finn
- Bristol Children's Vaccine Center, University Hospitals Bristol NHS Foundation Trust & University of Bristol, Bristol, UK
| | - Saul N Faust
- Southampton NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust & Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Diane Gbesemete
- Southampton NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust & Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Helen Bedford
- Population, Policy and Practice Program, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Stephen Hughes
- Department of Pediatric Allergy and Immunology, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | - Anu S Varghese
- Department of Pediatric Allergy and Immunology, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | - Paul T Heath
- Pediatric Infectious Diseases Research Group & Vaccine Institute, Institute for Infection and Immunity, St Georges, University of London & St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, UK
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