Health Protection and Influenza Research

Research Projects

Current /ongoing research

Pandemic preparedness


PhD students are in the process of working with WHO performing funded projects to look at pandemic preparedness across Europe and Asia as well as reasons for acceptance and refusal of flu virus vaccine.


A WHO report is available


Pandemic influenza surveillance research


A detailed investigation of patients hospitalised with pandemic influenza, working with the Flu-Clinical Information Network (FLU-CIN).


Two reports are now available in Thorax:

  • Predictors of clinical outcome in a national hospitalised cohort across both waves of the influenza A/H1N1 pandemic 2009–2010 in the UK.  Thorax doi:10.1136/thoraxjnl-2011-200266 
  • Risk factors for hospitalisation and poor outcome with pandemic A/H1N1 influenza: United Kingdom first wave (May–September 2009). Thorax 2010;65:645-651 doi:10.1136/thx.2010.135210

Subsequently, the group has built up a portfolio of research focusing on the 2009 A/H1N1 influenza pandemic.  Published studies include:

  • Nosocomial pandemic (H1N1) 2009, United Kingdom, 2009–2010.Emerg Infect Dis. 2011 Apr. doi: 10.3201/eid1704.101679
  • Pre-Admission Statin Use and In-Hospital Severity of 2009 Pandemic Influenza A(H1N1) Disease. PLoS ONE 6(4): e18120. doi:10.1371/journal.pone.0018120
  • Clinical and laboratory features distinguishing pandemic H1N1 influenza-related pneumonia from interpandemic community-acquired pneumonia in adults. Thorax 2011;66:247-252 doi: 10.1136/thx.2010.151522 
  • The Comparative Clinical Course of Pregnant and Non-Pregnant Women Hospitalised with Influenza A(H1N1)pdm09 Infection.PLoS ONE (8):e41638.doi:10.1371/journal.pone.0041638 
  • Comparison of CATs, CURB-65 and PMEWS as Triage Tools in Pandemic Influenza Admissions to UK Hospitals: Case Control Analysis Using Retrospective Data PLoS One. 2012; 7(4): e34428. doi: 10.1371/journal.pone.0034428 
  • Appendix A for the article 'Effectiveness of travel restrictions in the rapid containment of human influenza: a systematic review'.

Ongoing work includes: an investigation of clinical triage tools in pandemic situations; the impact of antivirals on influenza outcomes and a comparison of treatment and outcomes by ethnicity.


PRIDE (Post-pandemic Review of anti-Influenza Drug Effectiveness) study



The Post-pandemic Review of anti-Influenza Drug Effectiveness (PRIDE) study is an individual patient-level (IPD) global meta-analysis on the effectiveness of antiviral use on outcomes of public health importance during the 2009/10 A(H1N1)pdm09 pandemic. 


The aim of this study is to inform future public health policy for pandemic deployment of antivirals and elucidate the advantages gained during 2009-10.

We have conducted a systematic review of published studies on this topic which has been published in the Journal of Infectious Diseases. Our key finding was that early antiviral use was associated with a significant reduction in mortality compared to late or no antiviral use.

We have also established a collaboration of 81 research and surveillance groups across 38 countries to create a pooled dataset for the individual patient data (IPD) meta-analysis. We have so far completed and published the IPD meta-analyses investigating the association between neuraminidase inhibitor antivirals and A(H1N1)pdm09-related mortality (published in The Lancet Respiratory Medicine), and A(H1N1)pdm09-related pneumonia (published in Influenza and Other Respiratory Viruses)

Visit the PRIDE website for more information on this study.


EMIT (Evaluating Modes of Influenza Transmission) study


The HPIRG is strategically focused on influenza transmission and leads and coordinates the multi-disciplinary EMIT consortium with partners from the UK, USA, Australia and Canada.

The EMIT consortium was awarded major grant funding in October 2011 from the US Centers for Disease prevention and Control (CDC) to further develop quarantine-based human influenza challenge-transmission studies, which will disentangle the relative contribution of droplet nuclei (aerosols), large droplet and contact transmission of influenza in humans. 

Publications and media


FLU-CAT study - Evaluation and refinement of pandemic influenza community assessment tools


The aim of this study is the real time refinement and validation of criteria and tools used in primary care to aid hospital referral decisions for patients of all ages in the event of surge during an influenza pandemic.

This study is being carried out in partnership with Dr. M.G. Semple from the University of Liverpool and has been funded under an NIHR Pandemic themed research call.


Visit the FLU-CATS website for more information on this study.


Benzodiazepines and respiratory illnesses


The aim of this study is to investigate the association between benzodiazepines and the occurrence of and mortality from influenza, exacerbations of asthma and chronic obstructive pulmonary disease.


Benzodiazepines (e.g. valium [diazepam]) are widely prescribed drugs and on the World Health Organization list of essential drugs. Despite the longevity of clinical use, we know little about their effects on the immune system. Laboratory studies suggest that use of these drugs may increase the frequency of infections and death from these infections.

Here we wish to find further evidence for this by interrogating a large database based on General Practitioner records. If established in humans it will then be possible to (i) devise appropriate care pathways for patients taking these drugs and (ii) devise safer therapeutic alternatives.

This study is being undertaken by Georgina Nakafero as part of her PhD under the supervision of Prof. Jonathan Van-Tam and Dr. Puja Myles.


Nosocomial RSV systematic review


HPIRG is working with collaborators from Public Health England on a systematic review to describe the epidemiology of nosocomial respiratory syncytial virus (RSV) transmission events and the effectiveness of infection control measures to minimise further RSV transmission.

This review is currently underway and is expected to report findings in 2013.


Hepatitis B vaccination in prisons


We conducted a retrospective ecological study of hepatitis B vaccination in England and Wales over 2003-2010. Our results confirmed the significant progress made to extend the vaccination programme and improve overall median coverage. We identified statistically significant variation in coverage and uptake by geographical region and prison category.

We advocate further research activities to confirm and investigate potential explanations for our results.


  • Beck CR, Cloke R, O’Moore E, Puleston R. Hepatitis B vaccination coverage and uptake in prisons across England and Wales 2003-2010: a retrospective ecological study. Vaccine 2012; 30: 1965-71.  

RSV-EuroFlu study


The aim of this study is to describe the epidemiology of RSV and conduct a time series analysis to investigate the burden of this infection in Member States across the WHO/Europe region.

Sixteen Member States are collaborating with HPIRG to undertake this study, which is due to report in 2013.


Statins and perioperative mortality


This study has been funded by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) to investigate the association between statin use and perioperative mortality in both cardiac and non-cardiac surgery patients.


This is an observational study using anonymised data from the Clinical Research Practice Datalink (CPRD). This study is being led by Dr Myles in collaboration with Dr Robert Sanders form Imperial College, London. Drs George Okoli and Sudhir Venkatesan are working on this project as Research Associates.


Blood pressure thresholds and perioperative mortality


This study has been funded by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) to investigate the impact of blood pressure thresholds on perioperative mortality in non-cardiac surgery using anonymised data from the Clinical Research Practice Datalink (CPRD).


This study is being led by Dr Myles in collaboration with Dr Robert Sanders form Imperial College, London. Drs George Okoli and Sudhir Venkatesan are working on this project as Research Associates.


Malaria and pneumonia study: assessment of accuracy of various diagnostic approaches


This study, using both quantitative and qualitative research methods, aims to compare different early diagnostic approaches (for e.g. the WHO Integrated Management of Childhood Illness (IMCI) guidelines; the gold standard diagnostic tests comprising microscopy in malaria and chest radiography in pneumonia) for malaria and pneumonia in children under the age of five years in Benin City, Nigeria.

This study is currently ongoing and is expected to report findings as from 2017.






Evidence reviews

Numerous evidence reviews have been undertaken for national and international public health agencies including the UK Department of Health and World Health Organization on influenza and other related topic areas of public health importance.

Read further details of our evidence reviews



Past/completed research

Mummy Flu


A large study of whether pregnant women vaccinated with pandemic vaccine have transmitted immunity to their babies via placenta. The report of this study is now published in the Health Technology Assessment Journal.


Influenza virus viability


A recently completed study investigates how long influenza virus survives on household surfaces, as well as whether normal cleaning products manage to inactivate the virus.


Cleaners tested include a wet rag with washing up liquid, warm water with vinegar, branded household disinfectant wipes and baby wipes.

As part of our strategic targeting of research on influenza transmission, we have been working with partners at the Health Protection Agency in Cambridge (Addenbrookes) and Cambridge University to determine the survival of influenza when applied to materials commonly found and frequently touched in home, school and hospital environments, e.g. fabrics, light switches, telephones and computers, work surfaces etc.

Our results reveal that live virus can be recovered from most surfaces 4 hours after application; but by 9 hours only from certain non-porous surfaces.

These survival periods are consistent with transmission by indirect contact, especially when surfaces are frequently touched and infrequently cleaned. However, it seems most likely that surfaces in schools and workplaces that are left untouched overnight (for 9 hours or longer) probably harbour few viable viruses by the morning.



Influenza transmission


A challenge study in a quarantine setting in order to study influenza transmission. This is a world first, where volunteers are given the influenza virus then placed in a simulated household with other volunteers who haven’t been given the virus.

A series of major studies to continue this work are currently being planned.


  • Killingly et al (2011) Potential role of human challenge studies for investigation of influenza transmission. The Lancet Infectious Diseases, Volume 11, Issue 11, Pages 879 - 886.  doi:10.1016/S1473-3099(11)70142-6

"On the buses" study


A study into whether people are more likely to get a respiratory infection after using bus or tram in the previous few days. 

Results show that people are more prone to respiratory infection after short-term exposure to public transport but long-term use of buses and trams increases protection against respiratory infection.



Other outputs

Textbook on Pandemic Influenza


The second edition of the very successful textbook "Introduction to Pandemic Influenza" edited by Professor Van-Tam has recently been published by CAB International.

  • Introduction to Pandemic Influenza, Edited by J Van-Tam, Professor of Health Protection, City Hospital, Nottingham, UK, C Sellwood, Pandemic Flu Lead, NHS (National Health Service), London, UK







Health Protection and Influenza Research

Division of Epidemiology and Public Health
Nottingham City Hospital
The University of Nottingham
Hucknall Road, Nottingham, NG5 1PB

telephone: +44 (0)115 823 0276