major dan burns infectious diseases registrar uk pi prevent …€¦ · epidemiology and etiology...
TRANSCRIPT
Major Dan Burns
Infectious Diseases Registrar
UK PI PREVENT TD Trial
Enteric Disease
HERRICK data
ndash 40 attack rate over 6 months
ndash 27 days off and 4 days underperforming per episode
ndash Total ndash 45000 man days lost on HERRICK 10 (or 2 companies at any one time)
ndash Risk to self while underperforming
Kenya data
ASKARI STORM 15 rate
ASKARI SERPENT 13 rate
Op TRENTON data
127 diarrhoeal episodes over 4months
6-7 times risk of IBS
Risk to self while underperforming
Connor P Hutley E et al Enteric disease on Operation HERRICK J 2013159229ndash236 doi101136jramc-2013-000084An outbreak inside an epidemic managing an infectious disease outbreak while treating Ebola Horne S Forbes K Burns D et al JRAMC20171637-12Epidemiology and etiology of diarrhea in UK military personnel serving on the United Nations Mission in South Sudan in 2017 A prospective cohort study Biswas JS et al TMID 2019 Mar - Apr2834-40 doi 101016jtmaid201812004 Epub 2018 Dec 12
0
3
6
9
12
15
13215 15215 17215 19215 21215
Nu
mb
er
of p
atie
nts
pre
se
nting
Date of Onset of Symptoms
Diarrhoeal Outbreak Op GRITROCK 13-21 Feb 2015 All patients with diarrhoea
Eden Park Benguema
The Problem
Current solutions
Solutions 1 Early treatment
Early treatment in practice
ASKARI STORM 2PARA 2018
bull Post CALFEX phasebull 35 cases over 12 hours within a FOBbull Severe stomach cramps diarrhoeabull Crowded camp (approx 1000) sub-
optimal latrines and intermittant waterbull Single dose abxbull Loperamide
bull 2987 man hours lostbull 1680 man hours saved (2 daysman)Demographics Age 245(19-35)
Gender 33Male2Female
Trade 31Inf3CMT1Log
Nationality 32British3US
Captain John ColvinCaptain Emily ReillyMajor Paddy Wilkinson
de Bruyn G Hahn S Borwick A Antibiotic treatment for travellers diarrhoea Cochrane Database of Systematic Reviews 2000 Issue 3 Art No CD002242 DOI 10100214651858CD002242
Solution 2 Antimicrobial prophylaxis
Prevent TD Trial
Research in practice
Results end of 2019Applications short term high risk overseas deployments on risk assessed basis
Research resilience
bull 12 Investigators trainedbull 4 GDMOsbull 4 nurse investigatorsbull 4 medicine trainees
bull Defence pathologybull 4 BMS deployedbull Research laboratory set upbull -80 freezer funded
bull Research monitor trainedbull Drug delivery amp storagebull Pharmacist amp pharmacy techbull Existing Caldicott compliant
record storage
Triservice multiple cadres (nursing MOs pharmacy BMS)Used existing research infrastructure amp created new
A Randomized Double-Blind Placebo-Controlled Trial Evaluating the Efficacy of Non-Antibiotic OTC Products for Travellersrsquo
Diarrhoea (TD) Prevention(P4TD)
Total Sample Size 1336
IDCRP Sites n=636 (47)
400 Travelers (30)
NMCSD 200
NMCP 200
200 deployed personnel (15)
NMCPNMCCL 50
NMCSD 50
TAMCMAMC 100
UK Military n=300 (22) NYC Travel Clinic n=400 (30)
Solution 3 Microbiome based prophylaxis
Primary objective
To evaluate the clinical efficacy of Travelanreg
Florastorreg and Bimunoreg vs placebo for prevention of
TD as measured by the incidence of TD or treatment for
TD focusing on a 14 day window of prophylaxis during
travelSample size 1336 subjects
Assumptions 35 protective efficacy 25 placebo TD attack
rate 15 loss to follow-up and 80 power to detect TD
protection when compared to placebo
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
HERRICK data
ndash 40 attack rate over 6 months
ndash 27 days off and 4 days underperforming per episode
ndash Total ndash 45000 man days lost on HERRICK 10 (or 2 companies at any one time)
ndash Risk to self while underperforming
Kenya data
ASKARI STORM 15 rate
ASKARI SERPENT 13 rate
Op TRENTON data
127 diarrhoeal episodes over 4months
6-7 times risk of IBS
Risk to self while underperforming
Connor P Hutley E et al Enteric disease on Operation HERRICK J 2013159229ndash236 doi101136jramc-2013-000084An outbreak inside an epidemic managing an infectious disease outbreak while treating Ebola Horne S Forbes K Burns D et al JRAMC20171637-12Epidemiology and etiology of diarrhea in UK military personnel serving on the United Nations Mission in South Sudan in 2017 A prospective cohort study Biswas JS et al TMID 2019 Mar - Apr2834-40 doi 101016jtmaid201812004 Epub 2018 Dec 12
0
3
6
9
12
15
13215 15215 17215 19215 21215
Nu
mb
er
of p
atie
nts
pre
se
nting
Date of Onset of Symptoms
Diarrhoeal Outbreak Op GRITROCK 13-21 Feb 2015 All patients with diarrhoea
Eden Park Benguema
The Problem
Current solutions
Solutions 1 Early treatment
Early treatment in practice
ASKARI STORM 2PARA 2018
bull Post CALFEX phasebull 35 cases over 12 hours within a FOBbull Severe stomach cramps diarrhoeabull Crowded camp (approx 1000) sub-
optimal latrines and intermittant waterbull Single dose abxbull Loperamide
bull 2987 man hours lostbull 1680 man hours saved (2 daysman)Demographics Age 245(19-35)
Gender 33Male2Female
Trade 31Inf3CMT1Log
Nationality 32British3US
Captain John ColvinCaptain Emily ReillyMajor Paddy Wilkinson
de Bruyn G Hahn S Borwick A Antibiotic treatment for travellers diarrhoea Cochrane Database of Systematic Reviews 2000 Issue 3 Art No CD002242 DOI 10100214651858CD002242
Solution 2 Antimicrobial prophylaxis
Prevent TD Trial
Research in practice
Results end of 2019Applications short term high risk overseas deployments on risk assessed basis
Research resilience
bull 12 Investigators trainedbull 4 GDMOsbull 4 nurse investigatorsbull 4 medicine trainees
bull Defence pathologybull 4 BMS deployedbull Research laboratory set upbull -80 freezer funded
bull Research monitor trainedbull Drug delivery amp storagebull Pharmacist amp pharmacy techbull Existing Caldicott compliant
record storage
Triservice multiple cadres (nursing MOs pharmacy BMS)Used existing research infrastructure amp created new
A Randomized Double-Blind Placebo-Controlled Trial Evaluating the Efficacy of Non-Antibiotic OTC Products for Travellersrsquo
Diarrhoea (TD) Prevention(P4TD)
Total Sample Size 1336
IDCRP Sites n=636 (47)
400 Travelers (30)
NMCSD 200
NMCP 200
200 deployed personnel (15)
NMCPNMCCL 50
NMCSD 50
TAMCMAMC 100
UK Military n=300 (22) NYC Travel Clinic n=400 (30)
Solution 3 Microbiome based prophylaxis
Primary objective
To evaluate the clinical efficacy of Travelanreg
Florastorreg and Bimunoreg vs placebo for prevention of
TD as measured by the incidence of TD or treatment for
TD focusing on a 14 day window of prophylaxis during
travelSample size 1336 subjects
Assumptions 35 protective efficacy 25 placebo TD attack
rate 15 loss to follow-up and 80 power to detect TD
protection when compared to placebo
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
Current solutions
Solutions 1 Early treatment
Early treatment in practice
ASKARI STORM 2PARA 2018
bull Post CALFEX phasebull 35 cases over 12 hours within a FOBbull Severe stomach cramps diarrhoeabull Crowded camp (approx 1000) sub-
optimal latrines and intermittant waterbull Single dose abxbull Loperamide
bull 2987 man hours lostbull 1680 man hours saved (2 daysman)Demographics Age 245(19-35)
Gender 33Male2Female
Trade 31Inf3CMT1Log
Nationality 32British3US
Captain John ColvinCaptain Emily ReillyMajor Paddy Wilkinson
de Bruyn G Hahn S Borwick A Antibiotic treatment for travellers diarrhoea Cochrane Database of Systematic Reviews 2000 Issue 3 Art No CD002242 DOI 10100214651858CD002242
Solution 2 Antimicrobial prophylaxis
Prevent TD Trial
Research in practice
Results end of 2019Applications short term high risk overseas deployments on risk assessed basis
Research resilience
bull 12 Investigators trainedbull 4 GDMOsbull 4 nurse investigatorsbull 4 medicine trainees
bull Defence pathologybull 4 BMS deployedbull Research laboratory set upbull -80 freezer funded
bull Research monitor trainedbull Drug delivery amp storagebull Pharmacist amp pharmacy techbull Existing Caldicott compliant
record storage
Triservice multiple cadres (nursing MOs pharmacy BMS)Used existing research infrastructure amp created new
A Randomized Double-Blind Placebo-Controlled Trial Evaluating the Efficacy of Non-Antibiotic OTC Products for Travellersrsquo
Diarrhoea (TD) Prevention(P4TD)
Total Sample Size 1336
IDCRP Sites n=636 (47)
400 Travelers (30)
NMCSD 200
NMCP 200
200 deployed personnel (15)
NMCPNMCCL 50
NMCSD 50
TAMCMAMC 100
UK Military n=300 (22) NYC Travel Clinic n=400 (30)
Solution 3 Microbiome based prophylaxis
Primary objective
To evaluate the clinical efficacy of Travelanreg
Florastorreg and Bimunoreg vs placebo for prevention of
TD as measured by the incidence of TD or treatment for
TD focusing on a 14 day window of prophylaxis during
travelSample size 1336 subjects
Assumptions 35 protective efficacy 25 placebo TD attack
rate 15 loss to follow-up and 80 power to detect TD
protection when compared to placebo
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
Solutions 1 Early treatment
Early treatment in practice
ASKARI STORM 2PARA 2018
bull Post CALFEX phasebull 35 cases over 12 hours within a FOBbull Severe stomach cramps diarrhoeabull Crowded camp (approx 1000) sub-
optimal latrines and intermittant waterbull Single dose abxbull Loperamide
bull 2987 man hours lostbull 1680 man hours saved (2 daysman)Demographics Age 245(19-35)
Gender 33Male2Female
Trade 31Inf3CMT1Log
Nationality 32British3US
Captain John ColvinCaptain Emily ReillyMajor Paddy Wilkinson
de Bruyn G Hahn S Borwick A Antibiotic treatment for travellers diarrhoea Cochrane Database of Systematic Reviews 2000 Issue 3 Art No CD002242 DOI 10100214651858CD002242
Solution 2 Antimicrobial prophylaxis
Prevent TD Trial
Research in practice
Results end of 2019Applications short term high risk overseas deployments on risk assessed basis
Research resilience
bull 12 Investigators trainedbull 4 GDMOsbull 4 nurse investigatorsbull 4 medicine trainees
bull Defence pathologybull 4 BMS deployedbull Research laboratory set upbull -80 freezer funded
bull Research monitor trainedbull Drug delivery amp storagebull Pharmacist amp pharmacy techbull Existing Caldicott compliant
record storage
Triservice multiple cadres (nursing MOs pharmacy BMS)Used existing research infrastructure amp created new
A Randomized Double-Blind Placebo-Controlled Trial Evaluating the Efficacy of Non-Antibiotic OTC Products for Travellersrsquo
Diarrhoea (TD) Prevention(P4TD)
Total Sample Size 1336
IDCRP Sites n=636 (47)
400 Travelers (30)
NMCSD 200
NMCP 200
200 deployed personnel (15)
NMCPNMCCL 50
NMCSD 50
TAMCMAMC 100
UK Military n=300 (22) NYC Travel Clinic n=400 (30)
Solution 3 Microbiome based prophylaxis
Primary objective
To evaluate the clinical efficacy of Travelanreg
Florastorreg and Bimunoreg vs placebo for prevention of
TD as measured by the incidence of TD or treatment for
TD focusing on a 14 day window of prophylaxis during
travelSample size 1336 subjects
Assumptions 35 protective efficacy 25 placebo TD attack
rate 15 loss to follow-up and 80 power to detect TD
protection when compared to placebo
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
Early treatment in practice
ASKARI STORM 2PARA 2018
bull Post CALFEX phasebull 35 cases over 12 hours within a FOBbull Severe stomach cramps diarrhoeabull Crowded camp (approx 1000) sub-
optimal latrines and intermittant waterbull Single dose abxbull Loperamide
bull 2987 man hours lostbull 1680 man hours saved (2 daysman)Demographics Age 245(19-35)
Gender 33Male2Female
Trade 31Inf3CMT1Log
Nationality 32British3US
Captain John ColvinCaptain Emily ReillyMajor Paddy Wilkinson
de Bruyn G Hahn S Borwick A Antibiotic treatment for travellers diarrhoea Cochrane Database of Systematic Reviews 2000 Issue 3 Art No CD002242 DOI 10100214651858CD002242
Solution 2 Antimicrobial prophylaxis
Prevent TD Trial
Research in practice
Results end of 2019Applications short term high risk overseas deployments on risk assessed basis
Research resilience
bull 12 Investigators trainedbull 4 GDMOsbull 4 nurse investigatorsbull 4 medicine trainees
bull Defence pathologybull 4 BMS deployedbull Research laboratory set upbull -80 freezer funded
bull Research monitor trainedbull Drug delivery amp storagebull Pharmacist amp pharmacy techbull Existing Caldicott compliant
record storage
Triservice multiple cadres (nursing MOs pharmacy BMS)Used existing research infrastructure amp created new
A Randomized Double-Blind Placebo-Controlled Trial Evaluating the Efficacy of Non-Antibiotic OTC Products for Travellersrsquo
Diarrhoea (TD) Prevention(P4TD)
Total Sample Size 1336
IDCRP Sites n=636 (47)
400 Travelers (30)
NMCSD 200
NMCP 200
200 deployed personnel (15)
NMCPNMCCL 50
NMCSD 50
TAMCMAMC 100
UK Military n=300 (22) NYC Travel Clinic n=400 (30)
Solution 3 Microbiome based prophylaxis
Primary objective
To evaluate the clinical efficacy of Travelanreg
Florastorreg and Bimunoreg vs placebo for prevention of
TD as measured by the incidence of TD or treatment for
TD focusing on a 14 day window of prophylaxis during
travelSample size 1336 subjects
Assumptions 35 protective efficacy 25 placebo TD attack
rate 15 loss to follow-up and 80 power to detect TD
protection when compared to placebo
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
Solution 2 Antimicrobial prophylaxis
Prevent TD Trial
Research in practice
Results end of 2019Applications short term high risk overseas deployments on risk assessed basis
Research resilience
bull 12 Investigators trainedbull 4 GDMOsbull 4 nurse investigatorsbull 4 medicine trainees
bull Defence pathologybull 4 BMS deployedbull Research laboratory set upbull -80 freezer funded
bull Research monitor trainedbull Drug delivery amp storagebull Pharmacist amp pharmacy techbull Existing Caldicott compliant
record storage
Triservice multiple cadres (nursing MOs pharmacy BMS)Used existing research infrastructure amp created new
A Randomized Double-Blind Placebo-Controlled Trial Evaluating the Efficacy of Non-Antibiotic OTC Products for Travellersrsquo
Diarrhoea (TD) Prevention(P4TD)
Total Sample Size 1336
IDCRP Sites n=636 (47)
400 Travelers (30)
NMCSD 200
NMCP 200
200 deployed personnel (15)
NMCPNMCCL 50
NMCSD 50
TAMCMAMC 100
UK Military n=300 (22) NYC Travel Clinic n=400 (30)
Solution 3 Microbiome based prophylaxis
Primary objective
To evaluate the clinical efficacy of Travelanreg
Florastorreg and Bimunoreg vs placebo for prevention of
TD as measured by the incidence of TD or treatment for
TD focusing on a 14 day window of prophylaxis during
travelSample size 1336 subjects
Assumptions 35 protective efficacy 25 placebo TD attack
rate 15 loss to follow-up and 80 power to detect TD
protection when compared to placebo
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
Research in practice
Results end of 2019Applications short term high risk overseas deployments on risk assessed basis
Research resilience
bull 12 Investigators trainedbull 4 GDMOsbull 4 nurse investigatorsbull 4 medicine trainees
bull Defence pathologybull 4 BMS deployedbull Research laboratory set upbull -80 freezer funded
bull Research monitor trainedbull Drug delivery amp storagebull Pharmacist amp pharmacy techbull Existing Caldicott compliant
record storage
Triservice multiple cadres (nursing MOs pharmacy BMS)Used existing research infrastructure amp created new
A Randomized Double-Blind Placebo-Controlled Trial Evaluating the Efficacy of Non-Antibiotic OTC Products for Travellersrsquo
Diarrhoea (TD) Prevention(P4TD)
Total Sample Size 1336
IDCRP Sites n=636 (47)
400 Travelers (30)
NMCSD 200
NMCP 200
200 deployed personnel (15)
NMCPNMCCL 50
NMCSD 50
TAMCMAMC 100
UK Military n=300 (22) NYC Travel Clinic n=400 (30)
Solution 3 Microbiome based prophylaxis
Primary objective
To evaluate the clinical efficacy of Travelanreg
Florastorreg and Bimunoreg vs placebo for prevention of
TD as measured by the incidence of TD or treatment for
TD focusing on a 14 day window of prophylaxis during
travelSample size 1336 subjects
Assumptions 35 protective efficacy 25 placebo TD attack
rate 15 loss to follow-up and 80 power to detect TD
protection when compared to placebo
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
Results end of 2019Applications short term high risk overseas deployments on risk assessed basis
Research resilience
bull 12 Investigators trainedbull 4 GDMOsbull 4 nurse investigatorsbull 4 medicine trainees
bull Defence pathologybull 4 BMS deployedbull Research laboratory set upbull -80 freezer funded
bull Research monitor trainedbull Drug delivery amp storagebull Pharmacist amp pharmacy techbull Existing Caldicott compliant
record storage
Triservice multiple cadres (nursing MOs pharmacy BMS)Used existing research infrastructure amp created new
A Randomized Double-Blind Placebo-Controlled Trial Evaluating the Efficacy of Non-Antibiotic OTC Products for Travellersrsquo
Diarrhoea (TD) Prevention(P4TD)
Total Sample Size 1336
IDCRP Sites n=636 (47)
400 Travelers (30)
NMCSD 200
NMCP 200
200 deployed personnel (15)
NMCPNMCCL 50
NMCSD 50
TAMCMAMC 100
UK Military n=300 (22) NYC Travel Clinic n=400 (30)
Solution 3 Microbiome based prophylaxis
Primary objective
To evaluate the clinical efficacy of Travelanreg
Florastorreg and Bimunoreg vs placebo for prevention of
TD as measured by the incidence of TD or treatment for
TD focusing on a 14 day window of prophylaxis during
travelSample size 1336 subjects
Assumptions 35 protective efficacy 25 placebo TD attack
rate 15 loss to follow-up and 80 power to detect TD
protection when compared to placebo
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
Research resilience
bull 12 Investigators trainedbull 4 GDMOsbull 4 nurse investigatorsbull 4 medicine trainees
bull Defence pathologybull 4 BMS deployedbull Research laboratory set upbull -80 freezer funded
bull Research monitor trainedbull Drug delivery amp storagebull Pharmacist amp pharmacy techbull Existing Caldicott compliant
record storage
Triservice multiple cadres (nursing MOs pharmacy BMS)Used existing research infrastructure amp created new
A Randomized Double-Blind Placebo-Controlled Trial Evaluating the Efficacy of Non-Antibiotic OTC Products for Travellersrsquo
Diarrhoea (TD) Prevention(P4TD)
Total Sample Size 1336
IDCRP Sites n=636 (47)
400 Travelers (30)
NMCSD 200
NMCP 200
200 deployed personnel (15)
NMCPNMCCL 50
NMCSD 50
TAMCMAMC 100
UK Military n=300 (22) NYC Travel Clinic n=400 (30)
Solution 3 Microbiome based prophylaxis
Primary objective
To evaluate the clinical efficacy of Travelanreg
Florastorreg and Bimunoreg vs placebo for prevention of
TD as measured by the incidence of TD or treatment for
TD focusing on a 14 day window of prophylaxis during
travelSample size 1336 subjects
Assumptions 35 protective efficacy 25 placebo TD attack
rate 15 loss to follow-up and 80 power to detect TD
protection when compared to placebo
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
A Randomized Double-Blind Placebo-Controlled Trial Evaluating the Efficacy of Non-Antibiotic OTC Products for Travellersrsquo
Diarrhoea (TD) Prevention(P4TD)
Total Sample Size 1336
IDCRP Sites n=636 (47)
400 Travelers (30)
NMCSD 200
NMCP 200
200 deployed personnel (15)
NMCPNMCCL 50
NMCSD 50
TAMCMAMC 100
UK Military n=300 (22) NYC Travel Clinic n=400 (30)
Solution 3 Microbiome based prophylaxis
Primary objective
To evaluate the clinical efficacy of Travelanreg
Florastorreg and Bimunoreg vs placebo for prevention of
TD as measured by the incidence of TD or treatment for
TD focusing on a 14 day window of prophylaxis during
travelSample size 1336 subjects
Assumptions 35 protective efficacy 25 placebo TD attack
rate 15 loss to follow-up and 80 power to detect TD
protection when compared to placebo
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
TravelanregImmuron Ltd
(passive immunoprophylaxis)
FlorastorregBiocodex Inc
(probiotic)
BimunoregClasado
(prebiotic)
Active ingredient anti-ETEC HBC Saccharomyces boulardii β-Galacto-Oligosaccharide
[B-GOS]
Dose used in prior
studies showing efficacy
400 mg tid with ETEC challenge
200 mg tid with ETEC challenge
500 mgd and 1000 mgd
starting 5 days before travel
276g B-GOS once daily
Commercially available
formulation
Manufacturers
recommended dose
200 mg caplet
1 caplet tid with meals
250 mg capsule
500 mg sachet
2 capsules 1-2 times daily
1 sachet 1-2 times daily
365g sachet
276g pastille
Travelaid 276gpastille
3 pastilles once daily starting
7 days before travel
Available Form
Cost
Pack - 30 caplets
$2557 (085pill)
pound1977 (066pill)
Bottle ndash 100 capsules
$5509 (055pill)
pound4250 (043pill)
Packet ndash 30 sachets
$1215 (041sachet)
pound936 (031sachet)
API Dose selected for
P4TD (start 3 days
before and continue for
14 days during travel)
AM DOSE 400 mg
PM DOSE 400 mg
AM DOSE 500 mg
PM DOSE 500 mg
Option 1AM DOSE 276 g
PM DOSEPlacebo
Cheap safe physiologicaldosed in rations
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
Summary
bull Military diarrhoea remains a threatbull Degrades individual amp collective
performance and combat powerbull Limitations of existing tools require
innovative solutionsbull Early treatment reduces burdenbull Rifaximin prophylaxis may be a
new toolbull Microbiome focused solutions
likely to be cheaper and easier to dose
bull Successful enteric research programme develops research capacity and resilience across cadres and build US-UK relationship
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb
Thanks
bull Lt Cols Fitchett amp Hutleybull BMS
ndash LMT Adeyeyendash Cpl Evansndash Cpl Melinandash Cpl Miller
bull BATUK amp CTGbull 2PARAbull 2RIFLESbull 1LANCSbull 1IGbull US NMRC (Capt Gutierrez and team)bull IDCRP (Denise BennettDavid Tribble)bull Associate Investigators
ndash Major Hughesndash Sgt Youngndash Cpl Haffenden amp Millsndash Majors OrsquoSullivan amp Tom Trothndash Sqn Leaders Nevin amp Evesonndash Capt Reilly Colvin Geddes amp Matthews
bull Research monitor ndash Sqn Leader Mulvanneybull Pharmacy team
bull Cols Woods Connor amp Wilson amp Gp Captain Lamb