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Bulletin references October 2025

You can read the October 2025 Bulletin here.

Prevention and screening

Harnessing the gut microbiome to combat antimicrobial resistance: Current strategies and future perspectives

  1. O'Neill J, Review on Antimicrobial Resistance. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Available at: wellcomecollection.org/works/rdpck35v
  2. WHO. Bacterial priority pathogens list, 2024: bacterial pathogens of public health importance, to guide research, development and strategies to prevent and control antimicrobial resistance. Available at: iris.who.int/handle/10665/376776
  3. Alevizakos M, Karanika S, Detsis M, Mylonakis E. Colonisation with extended-spectrum β-lactamase-producing Enterobacteriaceae and risk for infection among patients with solid or haematological malignancy: a systematic review and meta-analysis. Int J Antimicrob Agents 2016;48(6):647–654.
  4. McConville TH, Sullivan SB, Gomez-Simmonds A, Whittier S, Uhlemann AC. Carbapenem-resistant Enterobacteriaceae colonization (CRE) and subsequent risk of infection and 90-day mortality in critically ill patients, an observational study. PloS One 2017;12(10):e0186195.
  5. Tacconelli E, Mazzaferri F, de Smet AM, Bragantini D, Eggimann P, Huttner BD et al. ESCMID-EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers. Clin Microbiol Infect 2019;25(7):807–817.
  6. Sender R, Fuchs S, Milo R. Are we really vastly outnumbered? Revisiting the ratio of bacterial to host cells in humans. Cell 2016;164(3):337–340.
  7. Caballero-Flores G, Pickard JM, Núñez G. Microbiota-mediated colonization resistance: mechanisms and regulation. Nat Rev Microbiol 2023;21(6):347–360.
  8. Buffie CG, Pamer EG. Microbiota-mediated colonization resistance against intestinal pathogens. Nat Rev Immunol 2013;13(11):790–801.
  9. Davido B, Merrick B, Kuijper E, Benech N, Biehl LM, Corcione S. How can the gut microbiome be targeted to fight multidrug-resistant organisms? Lancet Microbe 2025;6:101063.
  10. den Besten G, van Eunen K, Groen AK, Venema K, Reijngoud DJ, Bakker BM. The role of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy metabolism. J Lipid Res 2013;54(9):2325–2340.
  11. Gensollen T, Iyer SS, Kasper DL, Blumberg RS. How colonization by microbiota in early life shapes the immune system. Science 2016;352(6285):539–544.
  12. Zhang T, Sasabe J, Hullahalli K, Sit B, Waldor MK. Increased Listeria monocytogenes dissemination and altered population dynamics in Muc2-deficient mice. Infect Immun 2021;89(4):e00667-20.
  13. Ma T, McAllister TA, Guan LL. A review of the resistome within the digestive tract of livestock. J Anim Sci Biotechnol 2021;12:121.
  14. Yip AYG, King OG, Omelchenko O, Kurkimat S, Horrocks V, Mostyn P et al. Antibiotics promote intestinal growth of carbapenem-resistant Enterobacteriaceae by enriching nutrients and depleting microbial metabolites. Nat Commun 2023;14(1):5094.
  15. Mullish BH, Merrick B, Quraishi MN, Bak A, Green CA, Moore DJ et al. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridioides difficile infection and other potential indications: second edition of joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines. J Hosp Infect 2024;148:189–219.
  16. Ghani R, Mullish BH, McDonald JAK, Ghazy A, Williams HRT, Brannigan ET et al. Disease prevention not decolonization: A model for fecal microbiota transplantation in patients colonized with multidrug-resistant organisms. Clin Infect Dis 2021;72(8):1444–1447.
  17. Battipaglia G, Malard F, Rubio MT, Ruggeri A, Mamez AC, Brissot E et al. Fecal microbiota transplantation before or after allogeneic hematopoietic transplantation in patients with hematologic malignancies carrying multidrug-resistance bacteria. Haematologica 2019;104(8):1682–1688.
  18. Bilinski J, Grzesiowski P, Sorensen N, Madry K, Muszynski J, Robak K et al. Fecal microbiota transplantation in patients with blood disorders inhibits gut colonization with antibiotic-resistant bacteria: Results of a prospective, single-center study. Clin Infect Dis 2017;65(3):364–370.
  19. Saïdani N, Lagier JC, Cassir N, Million M, Baron S, Dubourg G et al. Faecal microbiota transplantation shortens the colonisation period and allows re-entry of patients carrying carbapenamase-producing bacteria into medical care facilities. Int J Antimicrob Agents 2019;53(4):355–361.
  20. Shin J, Lee JH, Park SH, Cha B, Kwon KS, Kim H et al. Efficacy and safety of fecal microbiota transplantation for clearance of multidrug-resistant organisms under multiple comorbidities: A prospective comparative trial. Biomedicines 2022;10(10):2404.
  21. Bar-Yoseph H, Carasso S, Shklar S, Korytny A, Even Dar R, Daoud H et al. Oral capsulized fecal microbiota transplantation for eradication of carbapenemase-producing Enterobacteriaceae colonization with a metagenomic perspective. Clin Infect Dis 2021;73(1):e166–175.
  22. Huttner BD, de Lastours V, Wassenberg M, Maharshak N, Mauris A, Galperine T et al. A 5-day course of oral antibiotics followed by faecal transplantation to eradicate carriage of multidrug-resistant Enterobacteriaceae: a randomized clinical trial. Clin Microbiol Infect 2019;25(7):830–838.
  23. Woodworth MH, Conrad RE, Haldopoulos M, Pouch SM, Babiker A, Mehta AK et al. Fecal microbiota transplantation promotes reduction of antimicrobial resistance by strain replacement. Sci Transl Med 2023;15(720):eabo2750.
  24. Merrick B, Prossomariti D, Allen E, Bisnauthsing K, Kertanegara M, Sergaki C et al. Faecal microbiota transplant to ERadicate gastrointestinal carriage of Antibiotic-Resistant Organisms (FERARO): A feasibility randomised controlled trial. J Infect 2025;91(1):106504
  25. Baunwall SMD, Terveer EM, Dahlerup JF, Erikstrup C, Arkkila P, Vehreschild MJ et al. The use of Faecal Microbiota Transplantation (FMT) in Europe: A Europe-wide survey. Lancet Reg Health Eur 2021;9:100181.
  26. Merrick B, Allen L, Masirah M Zain N, Forbes B, Shawcross DL, Goldenberg SD. Regulation, risk and safety of Faecal Microbiota Transplant. Infect Prev Pract 2020;2(3):100069.
  27. Rebyota. About Rebyota. Available at: www.rebyota.com/what-is-rebyota
  28. Vowst. Official Patient Website. Available at: www.vowst.com
  29. European Commission. New EU rules on substances of human origin. Available at: https://health.ec.europa.eu/blood-tissues-cells-and-organs/overview/new-eu-rules-substances-human-origin_en     
  30. Zmora N, Suez J, Elinav E. You are what you eat: diet, health and the gut microbiota. Nat Rev Gastroenterol Hepatol 2019;16(1):35–56.
  31. Oliver A, Xue Z, Villanueva YT, Durbin-Johnson B, Alkan Z, Taft DH et al. Association of diet and antimicrobial resistance in healthy U.S. adults. mBio 2022;13(3):e00101-22.
  32. David LA, Maurice CF, Carmody RN, Gootenberg DB, Button JE, Wolfe BE et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature 2014;505(7484):559–563.
  33. Mulder M, Kiefte-de Jong JC, Goessens WHF, de Visser H, Ikram MA, Verbon A et al. Diet as a risk factor for antimicrobial resistance in community-acquired urinary tract infections in a middle-aged and elderly population: a case-control study. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 2019;25(5):613–619.
  34. Morello E, Roversi S, Brambilla G, Signorini L, Lorenzoni M, Andreoli M et al. Nutritional strategies to improve VRE control. Transplant Cell Ther 2024;30(5):548.e1-548.e4.
  35. Roberfroid M, Gibson GR, Hoyles L, McCartney AL, Rastall R, Rowland I et al. Prebiotic effects: metabolic and health benefits. Br J Nutr 2010;104 Suppl 2:S1-63.
  36. Rahman MN, Barua N, Tin MCF, Dharmaratne P, Wong SH, Ip M. The use of probiotics and prebiotics in decolonizing pathogenic bacteria from the gut; a systematic review and meta-analysis of clinical outcomes. Gut Microbes 16(1):2356279.
  37. Medlock G, Felix C, Alsharif W, Cornacchione L, Schinn M, Watson A et al. 2521. VE707, a defined live biotherapeutic product for prevention of infection by multidrug-resistant gram-negative bacteria. Open Forum Infect Dis 2023;10(Suppl 2):ofad500.2139.
  38. Honda K, Furuichi M, Kawaguchi T, Pust MM, Yasuma-Mitobe K, Plichta D et al. Rationally-defined microbial consortia suppress multidrug-resistant proinflammatory Enterobacteriaceae via ecological control. Res Sq 2023;rs.3.rs-3462622.
  39. Osbelt L, Wende M, Almási É, Derksen E, Muthukumarasamy U, Lesker TR et al. Klebsiella oxytoca causes colonization resistance against multidrug-resistant K. pneumoniae in the gut via cooperative carbohydrate competition. Cell Host Microbe 2021;29(11):1663-1679.e7.
  40. Kuipers S, Ruth MM, Mientjes M, de Sévaux RGL, van Ingen J. A Dutch case report of successful treatment of chronic relapsing urinary tract infection with bacteriophages in a renal transplant patient. Antimicrob Agents Chemother 2019;64(1):e01281-19.
  41. Chemla Y, Sweeney CJ, Wozniak CA, Voigt CA. Design and regulation of engineered bacteria for environmental release. Nat Microbiol 2025;10(2):281–300.
  42. Mayorga-Ramos A, Zúñiga-Miranda J, Carrera-Pacheco SE, Barba-Ostria C, Guamán LP. CRISPR-Cas-based antimicrobials: Design, challenges, and bacterial mechanisms of resistance. ACS Infect Dis 2023;9(7):1283–1302.
  43. Li C, Liang Y, Qiao Y. Messengers from the gut: Gut microbiota-derived metabolites on host regulation. Front Microbiol 2022;13:863407.
  44. WHO. Antimicrobial resistance. Available at: www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

Advances in malaria prevention

  1. World Health Organization. World Malaria Report 2023. Geneva, Switzerland: World Health Organization, 2023.
  2. RTS,S Clinical Trials Partnership. Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. Lancet 2015;386:31–45
  3. Datoo MS, Dicko A, Tinto H, Ouédraogo J-B, Hamaluba M, Olotu A et al. Safety and efficacy of malaria vaccine candidate R21/Matrix-M in African children: a multicentre, double-blind, randomised, phase 3 trial. Lancet 2024;403:533–544.
  4. Chandramohan D, Zongo I, Sagara I, Cairns M, Yerbanga R-S, Diarra M et al. Seasonal malaria vaccination with or without seasonal malaria chemoprevention. N Engl J Med 2021;385:1005–1017.
  5. Silal SP. Seasonal targeting of the RTS,S/AS01 malaria vaccine: a complementary tool but sustained funding is required. Lancet Glob Health 2022;10:e1693–e1694.
  6. World Health Organization. Immunization dashboard. Available at: immunizationdata.who.int
  7. Williams BG, King LDW, Pulido D, Quinkert D, Lias AM, Silk SE et al. Development of an improved blood-stage malaria vaccine targeting the essential RH5-CyRPA-RIPR invasion complex. Nat Commun 2024;15:4857.
  8. Gamain B, Chêne A, Viebig NK, Tuikue Ndam N, Nielsen MA. Progress and insights toward an effective placental malaria vaccine. Front Immunol 2021;12:634508.
  9. Sagara I, Healy SA, Assadou MH, Kone M, Swihart BJ, Kwan JL et al. Malaria transmission-blocking vaccines Pfs230D1-EPA and Pfs25-EPA in Alhydrogel in healthy Malian adults; a phase 1, randomised, controlled trial. Lancet Infect Dis 2023;23:1266–1279.
  10. Probst AS, Paton DG, Appetecchia F, Bopp S, Adams KL, Rinvee TA et al. In vivo screen of Plasmodium targets for mosquito-based malaria control. Nature 2025; 643;1–9
  11. Balta VA, Stiffler D, Sayeed A, Tripathi AK, Elahi R, Mlambo G et al..Clinically relevant atovaquone-resistant human malaria parasites fail to transmit by mosquito. Nat Commun 2023;14:6415.
  12. Rosenthal PJ, Asua V, Bailey JA, Conrad MD, Ishengoma DS, Kamya MR et al. The emergence of artemisinin partial resistance in Africa: how do we respond? Lancet Infect Dis 2024;24:e591–e600.
  13. Koller R, Mombo-Ngoma G, Grobusch MP. The early preclinical and clinical development of ganaplacide (KAF156), a novel antimalarial compound. Expert Opin Investig Drugs 2018;27:803–810.
  14. Ogutu B, Yeka A, Kusemererwa S, Thompson R, Tinto H, Toure AO et al. Ganaplacide (KAF156) plus lumefantrine solid dispersion formulation combination for uncomplicated Plasmodium falciparum malaria: an open-label, multicentre, parallel-group, randomised, controlled, phase 2 trial. Lancet Infect Dis 2023;23:1051–1061.
  15. Schmitt EK, Ndayisaba G, Yeka A, Asante KP, Grobusch MP, Karita E et al. Efficacy of cipargamin (KAE609) in a randomized, phase II dose-escalation study in adults in Sub-Saharan Africa with uncomplicated plasmodium falciparum malaria. Clin Infect Dis 2022;74:1831–1839.
  16. Novartis Pharmaceuticals. An adaptive, randomized, active-controlled, open-label, sequential cohort, multicenter study to evaluate the efficacy, safety, tolerability and pharmacokinetics of intravenous cipargamin (KAE609) in adult and pediatric participants with severe plasmodium falciparum malaria (KARISMA - KAE609's role in severe malaria). 2025. Available at: www.novartis.com/clinicaltrials/study/nct04675931
  17. Cavalcanti DM, de Oliveira Ferreira de Sales L, da Silva AF, Basterra EL, Pena D, Monti C et al. Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis. Lancet 2025;406:283–294.

Avian influenza and bird flu – prevention, control and elimination

  1. Alexander DJ. An overview of the epidemiology of avian influenza. Vaccine 2007;25:5637–5644.
  2. World Organisation for Animal Health. What is avian influenza? Available at: www.woah.org/en/disease/avian-influenza/#ui-id-1        
  3. Food and Agricultural Organization of the United Nations. Global avian influenza viruses with zoonotic potential situation update. Available at: www.fao.org/animal-health/situation-updates/global-aiv-with-zoonotic-potential/en      
  4. Food and Agricultural Organization of the United Nations, World Health Organization, World Organisation for Animal Health. Updated joint FAO/WHO/WOAH public health assessment of recent influenza A(H5) virus events in animals and people. Available at: www.woah.org/app/uploads/2024/12/cleared-2024-12-10-fao-woah-who-h5n1-assessment-woah-fao.pdf     
  5. UK Government. Influenza of avian origin confirmed in a sheep in Yorkshire. Available at: www.gov.uk/government/news/influenza-of-avian-origin-confirmed-in-a-sheep-in-yorkshire#:~:text=Influenza%20of%20avian%20origin%20(H5N1,mammal%20detected%20on%20the%20premises     
  6. Swayne DE. Avian influenza in poultry and wild birds. MSD Veterinary Manual.  Available at: www.msdvetmanual.com/poultry/avian-influenza-in-poultry-and-wild-birds/avian-influenza-in-poultry-and-wild-birds       
  7. Caserta LC, Frye EA, Butt SL, Laverack M, Nooruzzaman M, Covaleda LM et al. Spillover of highly pathogenic avian influenza H5N1 virus to dairy cattle. Nature 2024;634:669–676.
  8. World Organisation for Animal Health. High Pathogenicity Avian Influenza (HPAI) – Situation Report 69. Available at: www.woah.org/en/document/high-pathogenicity-avian-influenza-situation-report-69 
  9. World Organisation for Animal Health. High Pathogenicity Avian Influenza (HPAI) – Situation Report 70. Available at: www.woah.org/app/uploads/2025/05/hpai-report-70-1.pdf   
  10. The Royal Society for the Protection of Birds. Avian influenza: a major threat to our struggling seabirds. Available at: www.rspb.org.uk/birds-and-wildlife/seabird-surveys-project-report 
  11. Reid SM, Byrne AMP, Lean FZX, Ross CS, Pascu A, Hepple R et al. A multi-species, multi-pathogen avian viral disease outbreak event: Investigating potential for virus transmission at the wild bird - poultry interface. Emerg Microbes Infect 2024;13:2348521.
  12. Peacock TP, Moncla L, Dudas G, van Insberghe D, Sukhova K, Lloyd-Smith JO et al. The global H5N1 influenza panzootic in mammals. Nature 2025;637:304–313.
  13. Lean FZX, Vitores AG, Reid SM, Banyard AC, Brown IH, Nunez A et al. Gross pathology of high pathogenicity avian influenza virus H5N1 2021–2022 epizootic in naturally infected birds in the United Kingdom. One Health 2022;14:100392.
  14. Lean FZX, Nunez A, Banyard AC, Reid SM, Brown IH, Nansen RDE. Gross pathology associated with highly pathogenic avian influenza H5N8 and H5N1 in naturally infected birds in the UK (2020–2021) Vet Record 2021;190:e731.
  15. Seekings AH, Warren CJ, Thomas SS, Lean FZX, Selden D, Mollett BC et al. Different outcomes of chicken infection with UK-origin H5N1-2020 and H5N8-2020 high-pathogenicity avian influenza viruses (Clade 2.3.4.4b). Viruses 2023;15:1909.
  16. Bhat S, James J, Sadeyen J, Mahmood S, Everest HJ, Chang P et al. Coinfection of chickens with H9N2 and H7N9 avian influenza viruses leads to emergence of reassortant H9N9 virus with increased fitness for poultry and a zoonotic potential. J Virol 2022;96:e0185621.
  17. World Organisation for Animal Health. Avian influenza. Available at: www.woah.org/en/disease/avian-influenza/#ui-id-3        
  18. Department for Environment, Food & Rural Affairs, Animal and Plant Health Agency. Bird flu (avian influenza): how to prevent it and stop it spreading. Available at: www.gov.uk/guidance/bird-flu-avian-influenza-how-to-prevent-it-and-stop-it-spreading       
  19. World Organisation for Animal Health. Global Strategy for the Prevention and Control of High Pathogenicity Avian Influenza (2024–2033). Available at:  www.woah.org/en/document/global-strategy-for-the-prevention-and-control-of-high-pathogenicity-avian-influenza-2024-2033/  
  20. World Organisation for Animal Health. Avian influenza vaccination: why it should not be a barrier to safe trade. Available at: www.woah.org/en/document/avian-influenza-vaccination-why-it-should-not-be-a-barrier-to-safe-trade/

Men's Health Strategy for England call for evidence – A tale of histopathology input

  1. Professor Dan Berney. Improving Men’s Health in Prostate Cancer: A Histopathological Perspective. London, UK: The Royal College of Pathologists, 2025.
  2. Royal College of Pathologists. Workforce census. Available at: www.rcpath.org/profession/workforce-and-engagement/workforce-planning/workforce-census.html    
  3. Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R et al; PROMIS study group. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017;389(10071):815–822.
  4. Carmona Echeverria LM, Haider A, Freeman A, Stopka-Farooqui U, Rosenfeld A et al. A critical evaluation of visual proportion of Gleason 4 and maximum cancer core length quantified by histopathologists. Sci Rep 2020;10(1):17177.
  5. Stavrinides V, Norris JM, Karapanagiotis S, Giganti F, Grey A et al. Regional histopathology and prostate MRI positivity: A secondary analysis of the PROMIS trial. Radiology 2023;307(1):e220762.
  6. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018;378(19):1767–1777.
  7. Heavey S, Costa H, Pye H, Burt EC, Jenkinson S et al. PEOPLE: PatiEnt prOstate samPLes for rEsearch, a tissue collection pathway utilizing magnetic resonance imaging data to target tumor and benign tissue in fresh radical prostatectomy specimens. Prostate 2019;79(7):768–777.
  8. Dinneen E, Haider A, Allen C, Freeman A, Briggs T et al. NeuroSAFE robot-assisted laparoscopic prostatectomy versus standard robot-assisted laparoscopic prostatectomy for men with localised prostate cancer (NeuroSAFE PROOF): protocol for a randomised controlled feasibility study. BMJ Open 2019;9(6):e028132.
  9. Dinneen E, Almeida-Magana R, Al-Hammouri T, Pan S, Leurent B et al. Effect of NeuroSAFE-guided RARP versus standard RARP on erectile function and urinary continence in patients with localised prostate cancer (NeuroSAFE PROOF): a multicentre, patient-blinded, randomised, controlled phase 3 trial. Lancet Oncol 2025;26(4):447–458.
  10. Ng ABCD, Asif A, Agarwal R, Panebianco V, Girometti R, Ghai S et al. Biparametric vs multiparametric MRI for prostate cancer diagnosis: The PRIME diagnostic clinical trial. JAMA 2025:e2513722.

Cervical cancer and HPV screening in the UK: A cytopathology and histopathology perspective

  1. Office for Health Improvement & Disparities (OHID) Cervical Screening Awareness Campaign 2022. Accessed September 2025. Available at: campaignresources.dhsc.gov.uk/campaigns/help-us-help-you-cancer/cervical-screening/
  2. Cancer Research UK. Cervical cancer mortality statistics. Accessed September 2025. Available at: www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer/mortality#heading-Zero)
  3. Pesola F, Sasieni P. Impact of screening on cervical cancer incidence in England: A time trend analysis. BMJ Open 2019;doi: 10.1136/bmjopen-2018-026292.
  4. UK National Screening Committee. Cervical cancer. Accessed September 2025. Available at: view-health-screening-recommendations.service.gov.uk/cervical-cancer/.
  5. UK Government. Cervical screening care pathway. Accessed September 2025. Available at: www.gov.uk/government/publications/cervical-screening-care-pathway/cervical-screening-care-pathway
  6. Okunade KS. Human papillomavirus and cervical cancer. J Obstet Gynaecol 2020 40602–608.
  7. Williams VM, Filippova M, Soto U, Duerksen-Hughes PJ. HPV-DNA integration and carcinogenesis: Putative roles for inflammation and oxidative stress. Future Virol 2011;6:45–57.
  8. Koliopoulos G, Nyaga VN, Santesso N, Bryant A, Martin-Hirsch PPL, Mustafa RA, Schünemann H et al. Cytology versus HPV testing for cervical cancer screening in the general population.e2017.8.
  9. Falcaro M, Castañon A, Ndlela B, Checci M, Soldan K et al.The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet 2021; 398:2084–2092.
  10. NHS England. Cervical cancer elimination by 2040 – plan for England. Published 28 March 2025. Available at: www.england.nhs.uk/long-read/cervical-cancer-elimination-by-2040-plan-for-england
  11. Burdier FR, Waheed DE, Nedjai B, Steenbergen RDM, Poljak M, Baay M et al. DNA methylation as a triage tool for cervical cancer screening - A meeting report. Prev Med Rep2024; doi: 10.1016/j.pmedr.2024.102678.

Preventing further deaths from fatal anaphylaxis

  1. UK Government. Coroners and Justice Act 2009. Available at: www.legislation.gov.uk/ukpga/2009/25/contents   
  2. National Health Service. Fit for the Future: 10 Year Health Plan for England. 2025. Available at: assets.publishing.service.gov.uk/media/6888a0b1a11f859994409147/fit-for-the-future-10-year-health-plan-for-england.pdf
  3. Daniels L, Barker S, Chang Y, Chikovani T, DunnGalvin A et al. Harmonizing allergy care–integrated care pathways and multidisciplinary approaches. World Allergy Organ J 2021 Sep 25;14(10):100584.
  4. Irvine G. Samantha Singh: Prevention of future deaths report. Ref: 2021-0225. 2021. Available at: www.judiciary.uk/prevention-of-future-death-reports/samantha-singh/
  5. Hassell M. Shanté Turay-Thomas: Prevention of future deaths report. Ref: 2020-0124. 2020. Available at: www.judiciary.uk/prevention-of-future-death-reports/shante-turay-thomas/
  6. Dilks K. James Atkinson: Prevention of future deaths report. Ref: 2024-0043. Available at: www.judiciary.uk/prevention-of-future-death-reports/james-atkinson-prevention-of-future-deaths-report/       
  7. Angier E, Choudhury D, Luyt D, Baker S, Warner A et al. Adrenaline auto-injector prescription for patients at risk of anaphylaxis: BSACI guidance for primary care. Clin Exper Allergy 2023;53(9):893–977.
  8. Radcliffe S. Hannah Jacobs: Prevention of future deaths report. Ref: 2024-0464. 2024. Available at: www.judiciary.uk/prevention-of-future-death-reports/hannah-jacobs-prevention-of-future-deaths-report-1      
  9. Wang J, Young MC, Nowak-Węgrzyn A. International survey of knowledge of food-induced anaphylaxis. Ped Allergy Immunol 2014;25(7):644–650.
  10. Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernández-Rivas M et al. World Allergy Organization Anaphylaxis Guidance 2020. World Allergy Organ J 2020;13(10):100472.
  11. British Society for Allergy and Clinical Immunology. UK Fatal Anaphylaxis Registry. 2025. Available at: www.bsaci.org/workforce/bsaci-registries/ukfar 
  12. Stoinanova S, Williams T, Odd D, Sleap V, Fraser J et al. Child deaths due to asthma or anaphylaxis: National Child Mortality Database Programme thematic report – data from April 2019 to March 2023. 2024. Available at: www.ncmd.info/wp-content/uploads/2024/12/Asthma-and-anaphylaxis.pdf   
  13. Connor H. Alexandra Briess: Prevention of future deaths report. 2023. Available at: www.judiciary.uk/prevention-of-future-death-reports/alexandra-briess-prevention-of-future-deaths-report      
  14. Dodd A, Turner PJ, Soar J, Savic L, the UK Perioperative Allergy Network. Emergency treatment of peri-operative anaphylaxis: Resuscitation Council UK algorithm for anaesthetists. Anaesthesia 2024;79(5):535–541.

Human papillomavirus and cervical cancer – is elimination on the horizon?

  1. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;189(1):12–19.
  2. Wei F, Georges D, Man I, Baussano I, Clifford GM. Causal attribution of human papillomavirus genotypes to invasive cervical cancer worldwide: a systematic analysis of the global literature. Lancet 2024;404(10451):435–444.
  3. Kitchener HC, Almonte M, Wheeler P, Desai M, Gilham C et al. HPV testing in routine cervical screening: cross sectional data from the ARTISTIC trial. Br J Cancer 2006;95(1):56–61.
  4. Schlecht NF, Kulaga S, Robitaille J, Ferreira S, Santos M et al. Persistent human papillomavirus infection as a predictor of cervical intraepithelial neoplasia. JAMA 2001;286(24):3106–3114.
  5. Perkins RB, Wentzensen N, Guido RS, Schiffman M. Cervical cancer screening: A review. JAMA 2023;330(6):547–558.
  6. Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet 2007;370(9590):890–907.
  7. NHS England. NHS sets ambition to eliminate cervical cancer by 2040. Available at: www.england.nhs.uk/2023/11/nhs-sets-ambition-to-eliminate-cervical-cancer-by-2040/
  8. WHO. Cervical cancer elimination initiative 2020. Available at: www.who.int/initiatives/cervical-cancer-elimination-initiative
  9. Ferlay J  EM, Lam F (eds). Global Cancer Observatory: Cancer Today (Version 1.0). Lyon, France: International Agency for Research on Cancer. Available at: gco.iarc.who.int/today.
  10. Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ 1999;318(7188):904–908.
  11. Patnick J. Has screening for cervical cancer been successful? Br J Obstet Gynaecol 1997;104(8):876–878.
  12. Peto J, Gilham C, Fletcher O, Matthews FE. The cervical cancer epidemic that screening has prevented in the UK. Lancet 2004;364(9430):249–256.
  13. NHS England. Cervical screening pathway requirements 2025. Available at: www.gov.uk/government/publications/cervical-screening-pathway-requirements-specification/cervical-screening-pathway-requirements-specification.
  14. Public Health England. HPValidate: clinical validation of hrHPV test system using self-collected vaginal samples in NHS England commissioned laboratories providing cervical screening services 2024. Available at: www.qmul.ac.uk/fmd/media/smd/documents/research/hpv-self-collection-test-accuracy-report-hpvalidate-lot1.pdf.
  15. Lim AWW, Deats K, Gambell J, Lawrence A, Lei J et al. Opportunistic offering of self-sampling to non-attenders within the English cervical screening programme: a pragmatic, multicentre, implementation feasibility trial with randomly allocated cluster intervention start dates (YouScreen). EClinicalMedicine 2024;73:102672.
  16. Chorley AJ, Marlow LA, Forster AS, Haddrell JB, Waller J. Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis. Psychooncology. 2017;26(2):161–172.
  17. Loopik DL, Melchers W, Vedder J, van den Brule A, Massuger L, Bekkers R et al. Reflex cytology for triage of high-risk human papillomavirus positive self-sampled material in cervical cancer screening: a prospective cohort study. BJOG. 2020;127(13):1656–1663.
  18. Sundqvist A, Hellsten C, Strander B, Lindh M, Borgfeldt C. Self-collected vaginal HPV samples for long-term non-attendees in the Swedish organized cervical cancer screening program. Acta Obstet Gynecol Scand 2025;104(6):1181–1189.
  19. Cadman L, Reuter C, Jitlal M, Kleeman M, Austin J et al. A randomized comparison of different vaginal self-sampling devices and urine for human papillomavirus testing-predictors 5.1. Cancer Epidemiol Biomarkers Prev 2021;30(4):661–668.
  20. Pils S, Mlakar J, Poljak M, Domjanic GG, Kaufmann U et al. HPV screening in the urine of transpeople – A prevalence study. EClinicalMedicine 2022;54:101702.
  21. UK Health Security Agency. HPV vaccination programme: changes from September 2023 letter. Available at: www.gov.uk/government/publications/hpv-vaccination-programme-changes-from-september-2023-letter
  22. UK Health Security Agency. Human papillomavirus (HPV) vaccination coverage in adolescents in England: 2023 to 2024. Available at: www.gov.uk/government/statistics/human-papillomavirus-hpv-vaccine-coverage-estimates-in-england-2023-to-2024/human-papillomavirus-hpv-vaccination-coverage-in-adolescents-in-england-2023-to-2024.
  23. NHS England. Confirmation of national humanpapillomavirus (HPV) vaccination and immunisation catch-up campaign for 2025/26. Available at: www.england.nhs.uk/long-read/confirmation-of-national-human-papillomavirus-hpv-vaccination-and-immunisation-catch-up-campaign-for-2025-26/
  24. UK Health Security Agency. Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010. Availableat : assets.publishing.service.gov.uk/media/5a7ccab2e5274a2c9a484249/dh_123826.pdf.
  25. Rebolj M, Pesola F, Mathews C, Mesher D, Soldan K, Kitchener H. The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes: an observational study from the English HPV primary screening pilot. Br J Cancer 2022;127(2):278–287.
  26. Falcaro M, Soldan K, Ndlela B, Sasieni P. Effect of the HPV vaccination programme on incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia by socioeconomic deprivation in England: population based observational study. BMJ. 2024;385:e077341.
  27. Palmer TJ, Kavanagh K, Cuschieri K, Cameron R, Graham C et al. Invasive cervical cancer incidence following bivalent human papillomavirus vaccination: a population-based observational study of age at immunization, dose, and deprivation. J Natl Cancer Inst 2024;116(6):857–865.
  28. Cameron RL, Palmer TJ, Cuschieri K, Kavanagh K, Roy K. Assessing real world vaccine effectiveness: A review of Scotland's approach to monitoring human papillomavirus (HPV) vaccine impact on HPV infection and cervical disease. Vaccine 2024;42(21):126177.
  29. Gilham C, Peto J. Is elimination of cervical cancer in sight in England? Prev Med 2025;191:108218.
  30. Mesher D, Cuschieri K, Hibbitts S, Jamison J, Sargent A et al. Type-specific HPV prevalence in invasive cervical cancer in the UK prior to national HPV immunisation programme: baseline for monitoring the effects of immunisation. J Clin Pathol 2015;68(2):135–140.
  31. Landy R, Windridge P, Gillman MS, Sasieni PD. What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study. Int J Cancer 2018;142(4):709–718.

On the agenda

A new patient co-chair for the National Blood Transfusion Committee in England

  1. Serious Hazards of Transfusion. SHOT UK. Available at: www.shotuk.org   
  2. Allard S, Cort J, Sherliker S, Miflin G, Toh CH. Transfusion 2024: A 5-year plan for clinical and laboratory transfusion in England. Trans Med 2021;31:400–408.
  3. Infected Blood Inquiry. Infected Blood Inquiry. Available at: www.infectedbloodinquiry.org.uk

Direct-to-consumer testing – to benefit safety and cost, can we share good practice from point-of-care testing?

  1. Shih P, Sandberg S, Balla J, Basok BI, Brady JJ, Croal B et al. Direct-to-consumer testing as consumer initiated testing: compromises to the testing process and opportunities for quality improvement: An opinion paper from the EFLM DTCT-Taskforce. Clin Chem Lab Med 2025:63(2);262–269.
  2. Thomas A. Quality assurance principles in point-of-care testing – a pragmatic perspective. Bulletin of the Royal College of Pathologists. Available at: www.rcpath.org/resource-report/quality-assurance-principles-in-point-of-care-testing-a-pragmatic-perspective.html      
  3. Coombes R, Boytchev H, Iacobucci G. How safe are health tests on UK supermarket shelves? BMJ 2025;390:r1503.
  4. The Royal College of Pathologists. Workforce census spotlight 2: morale and wellbeing. Available at: www.rcpath.org/static/5e502327-b26e-452c-b20dd4bfa0f43cb6/RCPath-workforce-census-spotlight-2.pdf
  5. Hillier B, Deeks JJ, Alderman J, Kale AU, Macdonald T, Baldwin SW et al. Direct-to-consumer self-tests sold in the UK in 2023: cross sectional review of regulation and evidence of performance. BMJ 2025;390:e085547.
  6. Davenport C, Richter A, Hillier B, Scandrett K, Agarwal R, Baldwin SW et al. Direct-to-consumer self-tests sold in the UK in 2023: cross sectional review of information on intended use, instructions for use, and post-test decision making. BMJ 2025;390:e085546.
  7. Watson J, McCartney M. Tests should be clinically useful and part of an evidence based pathway. BMJ 2025;390:r1476.

Sharing our subject

What 2 days can do: An aspiring medic’s reflections on pathology

The Sutton Trust. Unequal Treatment? Access to medicine for socio-economically disadvantaged students. Available at: https://www.suttontrust.com/wp-content/uploads/2025/02/Unequal-Treatment.pdf

2025 Hugh Platt Foundation Essay Prize winning essay

  1. NHS England. NHS England strikes deal for ground breaking cancer treatment in a new European first. 2018. Available at: www.england.nhs.uk/2018/10/nhs-england-strikes-deal-for-ground-breaking-cancer-treatment-in-a-new-european-first/
  2. Haslauer T, Greil R, Zaborsky N, Geisberger R. CAR T-cell therapy in hematological malignancies. Int J Mol Sci 2021;22:8996.  
  3. Cancer Research UK. CAR T-cell therapy. 2024. Available at: www.cancerresearchuk.org/about-cancer/treatment/targeted-cancer-drugs-immunotherapy/car-t-cell-therapy
  4. Blood Cancer UK. What is CAR T-cell therapy? 2025. Available at: bloodcancer.org.uk/understanding-blood-cancer/treatment/treatment-planning-ty pes/car-t-cell-therapy/what-is-car-t-cell-therapy/#how-is-car-t-cell-therapy-given
  5. Velasco R, Mussetti A, Villagrán-García M, Sureda A. CAR T-cell-associated neurotoxicity in central nervous system hematologic disease: Is it still a concern? Front Neurol 2023;14:1144414.
  6. Grigor EJM, Fergusson D, Kekre N, Montroy J, Atkins H, Seftel MD et al. Risks and benefits of chimeric antigen receptor T-cell (CAR-T) therapy in cancer: A systematic review and meta-analysis. Transfus Med Rev 2019;33:98–110.
  7. Laetsch TW, Myers GD, Baruchel A, Dietz AC, Pulsipher MA, Bittencourt H et al. Patient-reported quality of life after tisagenlecleucel infusion in children and young adults with relapsed or refractory B-cell acute lymphoblastic leukaemia: A global, single-arm, phase 2 trial. Lancet Oncol 2019;20:1710–1718.
  8. Sidana S, Thanarajasingam G, Griffin J, Thompson CA, Burtis M, Warsame R et al. Patient experience of chimeric antigen receptor (CAR)-T cell therapy vs. stem cell transplant: Longitudinal patient reported adverse events, cognition and quality of life. Blood 2019;134:794–794.  
  9. Del Bufalo F, De Angelis B, Caruana I, Del Baldo G, De Ioris MA, Serra A et al. GD2-CART01 for relapsed or refractory high-risk neuroblastoma’. N Engl J Med 2023;388:1284–1295.
  10. Marofi F, Motavalli R, Safonov VA, Thangavelu L, Yumashev AV, Alexander M et al. CAR T cells in solid tumors: Challenges and opportunities’. Stem Cell Res Ther 2021;12:81.  
  11. Zhang Y, Qin D, Shou AC, Liu Y, Wang U, Zhou L. Exploring CAR-T cell therapy side effects: mechanisms and management strategies. J Clin Med 2023;12:6124.
  12. Holtzman NG, Xie H, Bentzen S, Kesari V, Bukhari A, El Chaer F et al. Immune effector cell–associated neurotoxicity syndrome after chimeric antigen receptor T-cell therapy for lymphoma: predictive biomarkers and clinical outcomes’. Neuro-Oncol 2021;23:112–121.
  13. Azoulay E, Castro P, Maamar A, Metaxa V, De Moraes AG, Voigt L et al. Outcomes in patients treated with chimeric antigen receptor T-cell therapy who were admitted to intensive care (CARTTAS): An international, multicentre, observational cohort study. Lancet Haem 2021;8:e355–364.
  14. NHS England. NHS England CAR-T therapy. 2018. Available at: hwww.england.nhs.uk/commissioning/spec-services/advanced-therapy-medicinalproducts/car-t-therapy/#:~:text=NHS%20Foundation%20Trust-,The%20following%20centres%20will%20be%20able%20to%20provide%20CAR%2DT,Iperial%20College% 20Healthcare%20NHS%20Trust.
  15. Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN et al. ASTCT consensus grading for cytokine release syndrome and neurologic toxicity associated with immune effector cells. Biol Blood Marrow Transplant 2019;25:625–638.
  16. National Institute for Health and Care Excellence. Axicabtagene ciloleucel for treating diffuse large B-cell lymphoma and primary mediastinal large B-cell lymphoma after 2 or more systemic therapies technology appraisal guidance. 2023. Available at: www.nice.org.uk/guidance/ta872/chapter/2-Information-about-axicabtagene-cilol-eucel.
  17. National Institute for Health and Care Excellence. Tisagenlecleucel for treating relapsed or refractory B-cell acute lymphoblastic leukaemia in people 25 years and under. 2024. Available at: www.nice.org.uk/guidance/ta975/chapter/2-Information-about-tisagenlecleucel
  18. Jørgensen J, Hanna E, Kefalas P. Outcomes-based reimbursement for gene therapies in practice: The experience of recently launched CAR-T cell therapies in major European countries. J Market Access Health Policy 2020;8:1715536.  
  19. Hansen DK, Liu YH, Ranjan S, Bhandari H, Potluri R, McFarland L et al. The impact of outpatient versus inpatient administration of CAR-T therapies on clinical, economic, and humanistic outcomes in patients with hematological cancer: a systematic literature review. Cancers 2023;15:5746.

Paola Domizio Undergraduate Essay Prize winner: Liquid biopsy: The future of cancer screening

  1. Staff G. GEN Roundup: Liquid Biopsies Remain Wait and See for Some Clinicians. Available at: www.genengnews.com/topics/translational-medicine/gen-roundup-liquid-biopsies-remain-wait-and-see-for-some-clinicians  
  2. Wan JCM, Massie C, Garcia-Corbacho J, Mouliere F, Brenton JD, Caldas C et al. Liquid biopsies come of age: towards implementation of circulating tumour DNA. Nature Rev Cancer 2017;17:223–238.
  3. Bettegowda C, Sausen M, Leary RJ, Kinde I, Wang Y, Agrawal N et al. Detection of circulating tumor DNA in early- and late-stage human malignancies. Science Translat Med 2014;6:224ra24.
  4. Cohen JD, Li L, Wang Y, Thoburn C, Afsari B, Danilova L et al. Detection and localization of surgically resectable cancers with a multi-analyte blood test. Science 2018;359:926–930.
  5. Chung DC, Gray DM, Singh H, Issaka RB, Raymond VM, Eagle C et al. A cell-free DNA blood-based test for colorectal cancer screening. New Engl J Med 2024;390:973–983.
  6. Liu MC, Oxnard GR, Klein EA, Swanton C, Seiden MV, Cummings SR et al. Sensitive and specific multi-cancer detection and localization using methylation signatures in cell-free DNA. Ann Oncol 2020;31:745–759.
  7. NHS England. (2024). An update on the ongoing NHS-Galleri trial. Available at: www.england.nhs.uk/blog/an-update-on-the-ongoing-nhs-galleri-trial    
  8. Tie J, Wang Y, Tomasetti C, Li L, Springer S, Kinde I et al. Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer. Sci Translat Med 2016;8:346ra92–346ra92.
  9. Xu J, Gao H, Guan X, Meng J, Ding S, Long Q et al. Circulating tumor DNA: from discovery to clinical application in breast cancer. Front Immunol 2024;15:1355887.
  10. Razavi P, Li BT, Brown DN, Jung B, Hubbell E, Shen R et al. High-intensity sequencing reveals the sources of plasma circulating cell-free DNA variants. Nat Med 2019;25:1928–1937.