NNT 650. Given base rate even a perfect intervention would have NNT 500. UK we treat "high risk and/or symptomatic household contacts"

I doubt you get much C.diff from use of PenV or Azi though.

Other cohorts similar I think & Belgium long term follow-up study didn't show persistent shedding www.thelancet.com/journals/lan...

We aren't routinely measuring in our current cohort studies in Africa as value seems too marginal.

Seems quite different than Lassa/Ebola etc?

We found extremely low levels in semen in our cohort study during the 2022 pandemic & (caveat emptor) always below the level at which we could culture it (see also Table S3 in the Supplementary).

www.thelancet.com/journals/lan...

Presumably been discussed with us? We have TDM now for Albendazole I believe which has helped with a number of cases management.

I don't fully understand the underlying issues but I believe the USA has never ratified the UN Convention of Biodiversity because it can't pass the Senate. And as such it can't/won't take part in other sub-components like Nagoya.

That's not to say of course that there aren't US biorepositories following the type of best practice Nagoya aims to support but always makes me cautious when the high income country isn't a signatory to rules designed to protect rights of low income settings where many research samples come from.

Don't worry I think your position is common (especially in USA). Nagoya is a globally agreed set of rules about ensuring protection of rights related to genetic/biological resources. The USA is not a signatory unlike nearly all European, African, Asian and South American governments (see map).

The US was never a good option for this because USA is not a signatory to the Nagoya protocol which most countries are.

According to this ranking tool I predominantly study rheumatology. Which is news to me.

History of flu interventions doesn't give me much optimism they will be well trialled. Have had widespread use ~20 years & only now are we finally doing trials in hospitalised patients. And the history of the community studies and pharma suppressing the negative trials is well known.

In our trials, would say No1. reason for non-participation is a strong preference for a 'one-and-done' treatment over a multi-day oral therapy even though BPG is obviously painful.

Laurens Manning group has done great work on administering BPG sub-cut which seems better tolerated & with great PK:

Several RCTs completing soon inc BD dosing Linezolid and Cefixime.

Japanese published on Amoxicillin as they dont use BPG - seems to work just a long course.

Ongoing studies on alternative penicillin strategies & planned Doxy neurosyphilis RCT.

TBH all will be back-up drugs as BPG so effective.