Advisory Committee on Dangerous Pathogens (ACDP) Seminar on Microbiological Risk Assessment, 28 January 1997

Microbiological risk assessment is an area of growing importance and significant potential, where the underlying science, software systems and databases are developing to the point of real and useful application. It is also an area where the developing science is posing as many questions as it is presenting answers. Key issues emerging from the day included: the need for more sophisticated management of uncertainty, which is much more relevant to microbiological risk analysis than to other applications; the need for global surveillance systems with better compatibility and appropriate peer review; considered assessment of the impact of new molecular-based diagnostic and screening techniques; the explosion of relevant information available, particularly on the Internet, which makes computer literacy essential both to professionals and 'laymen'; and the appearance of software systems which are either tailored for microbiological application or have the potential for this use. The closely associated issues of risk communication and perception also emerged as being vital to the effective application of microbiological risk management to public health issues. Overall, the majority of participants considered the event to have been valuable and stimulating and thought that it would lead to improvements in the use of microbiological risk assessment. The Advisory Committee on Dangerous Pathogens is committed to taking this topic forward and will be both taking up the messages from this seminar and encouraging development of suitable databases and software systems.     

Accounting for multiplicity in the evaluation of "signals" obtained by data mining from spontaneous report adverse event databases

Surveillance of drug products in the marketplace continues after approval, to identify rare potential toxicities that are unlikely to have been observed in the clinical trials carried out before approval. This surveillance accumulates large numbers of spontaneous reports of adverse events along with other information in spontaneous report databases. Recently developed empirical Bayes and Bayes methods provide a way to summarize the data in these databases, including a quantitative measure of the strength of the reporting association between the drugs and the events. Determining which of the particular drug-event associations, of which there may be many tens of thousands, are real reporting associations and which random noise presents a substantial problem of multiplicity because the resources available for medical and epidemiologic followup are limited. The issues are similar to those encountered with the evaluation of microarrays, but there are important differences. This report compares the application of a standard empirical Bayes approach with micorarray-inspired methods for controlling the False Discovery Rate, and a new Bayesian method for the resolution of the multiplicity problem to a relatively small database containing about 48,000 reports. The Bayesian approach appears to have attractive diagnostic properties in addition to being easy to interpret and implement computationally.     

Different Occupations Associated with Amyotrophic Lateral Sclerosis: Is Diesel Exhaust the Link?

The cause of sporadic amyotrophic lateral sclerosis (SALS) remains unknown. We attempted to find out if occupational exposure to toxicants plays a part in the pathogenesis of this disease. In an Australia-wide case-control study we compared the lifetime occupations of 611 SALS and 775 control individuals. Occupations were coded using country-specific as well as international classifications. The risk of SALS for each occupation was calculated with odds ratios using logistic regression. In addition, the literature was searched for possible toxicant links between our findings and previously-reported occupational associations with SALS. Male occupations in our study that required lower skills and tasks tended to have increased risks of SALS, and conversely, those occupations that required higher skills and tasks had decreased risks of SALS. Of all the occupations, only truck drivers, where exposure to diesel exhaust is common, maintained an increased risk of SALS throughout all occupational groups. Another large case-control study has also found truck drivers to be at risk of SALS, and almost two-thirds of occupations, as well as military duties, that have previously been associated with SALS have potential exposure to diesel exhaust. In conclusion, two of the largest case-control studies of SALS have now found that truck drivers have an increased risk of SALS. Since exposure to diesel exhaust is common in truck drivers, as well as in other occupations that have been linked to SALS, exposure to this toxicant may underlie some of the occupations that are associated with SALS.     

Current situation and future usage of anticancer drug databases

Cancer is a deadly disease with increasing incidence and mortality rates and affects the life quality of millions of people per year. The past 15 years have witnessed the rapid development of targeted therapy for cancer treatment, with numerous anticancer drugs, drug targets and related gene mutations been identified. The demand for better anticancer drugs and the advances in database technologies have propelled the development of databases related to anticancer drugs. These databases provide systematic collections of integrative information either directly on anticancer drugs or on a specific type of anticancer drugs with their own emphases on different aspects, such as drug–target interactions, the relationship between mutations in drug targets and drug resistance/sensitivity, drug–drug interactions, natural products with anticancer activity, anticancer peptides, synthetic lethality pairs and histone deacetylase inhibitors. We focus on a holistic view of the current situation and future usage of databases related to anticancer drugs and further discuss their strengths and weaknesses, in the hope of facilitating the discovery of new anticancer drugs with better clinical outcomes.     

EMF exposure assessment in the Finnish garment industry: evaluation of proposed EMF exposure metrics

Recently published studies indicate that having worked in occupations that involve moderate to high electromagnetic field (EMF) exposure is a risk factor for neurodegenerative diseases, including Alzheimer's disease. In these studies, the occupational groups most over-represented for EMF exposure comprised seamstresses, dressmakers, and tailors. Future epidemiologic studies designed to evaluate the possibility of a causal relationship between exposure to EMF and a neuro degenerative disease endpoint such as incidence of Alzheimer's disease, will benefit from the measurement of electromagnetic field metrics with potential biological relevance. Data collection methodology in such studies would be highly dependent upon how the metrics are defined. In this research the authors developed and demonstrated (1) protocols for collecting EMF exposure data suitable for estimating a variety of exposure metrics that may have biological relevance, and (2) analytical methods for calculation of these metrics. The authors show how exposure might be estimated under each of the three prominent EMF health-effects mechanism theories and evaluate the assertion that relative exposure ranking is dependent on which mechanism is assumed. The authors also performed AC RMS magnetic flux density measurements, confirming previously reported findings. The results indicate that seamstresses, as an occupational group, should be considered for study of the possible health effects of long-term EMF exposure.     

Toxicogenomic approach for assessing toxicant-related disease

The problems of identifying environmental factors involved in the etiology of human disease and performing safety and risk assessments of drugs and chemicals have long been formidable issues. Three principal components for predicting potential human health risks are: (1) the diverse structure and properties of thousands of chemicals and other stressors in the environment; (2) the time and dose parameters that define the relationship between exposure and disease; and (3) the genetic diversity of organisms used as surrogates to determine adverse chemical effects. The global techniques evolving from successful genomics efforts are providing new exciting tools with which to address these intractable problems of environmental health and toxicology. In order to exploit the scientific opportunities, the National Institute of Environmental Health Sciences has created the National Center for Toxicogenomics (NCT). The primary mission of the NCT is to use gene expression technology, proteomics and metabolite profiling to create a reference knowledge base that will allow scientists to understand mechanisms of toxicity and to be able to predict the potential toxicity of new chemical entities and drugs. A principal scientific objective underpinning the use of microarray analysis of chemical exposures is to demonstrate the utility of signature profiling of the action of drugs or chemicals and to utilize microarray methodologies to determine biomarkers of exposure and potential adverse effects. The initial approach of the NCT is to utilize proof-of-principle experiments in an effort to "phenotypically anchor" the altered patterns of gene expression to conventional parameters of toxicity and to define dose and time relationships in which the expression of such signature genes may precede the development of overt toxicity. The microarray approach is used in conjunction with proteomic techniques to identify specific proteins that may serve as signature biomarkers. The longer-range goal of these efforts is to develop a reference relational database of chemical effects in biological systems (CEBS) that can be used to define common mechanisms of toxicity, chemical and drug actions, to define cellular pathways of response, injury and, ultimately, disease. In order to implement this strategy, the NCT has created a consortium of research organizations and private sector companies to actively collaborative in populating the database with high quality primary data. The evolution of discrete databases to a knowledge base of toxicogenomics will be accomplished through establishing relational interfaces with other sources of information on the structure and activity of chemicals such as that of the National Toxicology Program (NTP) and with databases annotating gene identity, sequence, and function.     

Occupational physical activity and risk of coronary heart disease among active and non-active working-women of North Dakota: a Go Red North Dakota Study

Currently less than half of the US adults meet physical activity (PA) recommendations, yet many more are sedentary in their occupations. Sedentary workers may therefore be at elevated risk for coronary heart disease (CHD). Therefore, the objective of the study is to examine the relationship of CHD risk with occupational PA (OCPA) and leisure time PA (LTPA) among working-women. The 10-year CHD risk and relative risk scores were calculated for 642 working-women. Self-report questionnaire determined levels of OCPA and LTPA. Biometric data were directly collected on all women. No direct relationship for OCPA and 'high risk' of CHD was determined. Insufficient LTPA was significantly associated with greater prevalence of 'high risk' of CHD. No dose response relationship was determined with PA and CHD risk. The odds of being 'high risk' were significantly greater for sedentary workers with insufficient LTPA compared to sufficient LTPA. The odds for being 'high risk' were similar among moderately active or heavy working women completing insufficient LTPA compared to women doing sufficient LTPA. For women with sedentary occupations, a sufficient amount of LTPA is essential to reduce CHD risk. Women in moderate to heavy working occupations may be acquiring adequate amounts of PA to minimize CHD risk.     

Medication and skilled work

There is increasing interest in the way in which drugs impair performance. This has arisen because some may impair day-to-day skills of those whose occupations demand vigilance and motor skill, and of those who are involved in decision making or where interpersonal relations are crucial. For many years the position was adopted, at least in certain occupations where impaired performance could be a danger to others, that the use of any drug should preclude employment. However, recent advances in therapeutics and a greater understanding of drug action in man has made this rather uncomplicated view of life less tenable, and there is now an increasing desire that advances in therapy should, if at all possible, be available to occupational groups, such as airline pilots. In this way the adverse effect which a drug may have on performance has become an important aspect of its clinical profile. Hypnotics appropriate for transient insomnia, which may arise from the irregularity of rest inherent in many occupations, need to be free of residual effects, antihistamines that are sedative must be avoided, and drugs used in the management of mild hypertension, often during the important years of middle life, must be as free as possible from central effects. And it must be emphasized that these drugs are often used by active, healthy or near healthy individuals. The issues involved in the safe use of a particular drug by a particular individual are complex, and as with all aspects of therapeutics it is sometimes necessary to balance efficacy and adverse effects.     

One Health and surveillance of zoonotic tuberculosis in selected low-income,middle-income and high-income countries: A systematic review

BackgroundLittle is known about zoonotic tuberculosis (zTB) due to Mycobacterium bovis burden across the globe. The aim of this study was to describe zTB surveillance programs in selected WHO signatory countries and to assess the relationship of the disease with the country’s income level and the risk of M. bovis transmission.MethodsWe searched the main articles databases and grey literature for guide documents published between 1980 and 2019. For inclusion, the articles and guide documents had to be in English, French, Portuguese, Spanish, or Italian. Only original articles and narrative and systematic reviews were accepted and the guide documents were required to be available on official websites. We excluded articles that did not focus on epidemiology, control and surveillance. We used bovine TB cases in livestock and wildlife populations as a proxy for the country’s risk of zTB using data from the World Organization for Animal Health (OIE) published from 2015 to 2018. Countries were classified according to income level (World Bank’s classification) and strength of zTB surveillance. The study was registered in PROSPERO under number CRD42018090603.FindingsWe included 13 articles and 208 guide documents including data from 119/194 countries (61.3%). We found a lack of surveillance data about zTB in over half (89.9%) of the 119 WHO signatory countries. Most surveillance systems perform passive surveillance and are not integrated into the One Health perspective, which was operating in 4/119 (3.4%) countries, all high-income. Many of these countries (71/119, 59.7%) have M. bovis circulating in their cattle herds, but only ~10% of them have implemented zTB surveillance activities.InterpretationOur findings highlight weaknesses in zTB surveillance worldwide, with a consequent lack of information that could support an adequate understanding of disease burden, especially in countries at major risk for M. bovis transmission. To meet this challenge, efforts will be needed to promote intersectoral policies, implementing the One Health strategy.     

Drug Repositioning for Diabetes Based on 'Omics' Data Mining

Drug repositioning has shorter developmental time, lower cost and less safety risk than traditional drug development process. The current study aims to repurpose marketed drugs and clinical candidates for new indications in diabetes treatment by mining clinical ‘omics’ data. We analyzed data from genome wide association studies (GWAS), proteomics and metabolomics studies and revealed a total of 992 proteins as potential anti-diabetic targets in human. Information on the drugs that target these 992 proteins was retrieved from the Therapeutic Target Database (TTD) and 108 of these proteins are drug targets with drug projects information. Research and preclinical drug targets were excluded and 35 of the 108 proteins were selected as druggable proteins. Among them, five proteins were known targets for treating diabetes. Based on the pathogenesis knowledge gathered from the OMIM and PubMed databases, 12 protein targets of 58 drugs were found to have a new indication for treating diabetes. CMap (connectivity map) was used to compare the gene expression patterns of cells treated by these 58 drugs and that of cells treated by known anti-diabetic drugs or diabetes risk causing compounds. As a result, 9 drugs were found to have the potential to treat diabetes. Among the 9 drugs, 4 drugs (diflunisal, nabumetone, niflumic acid and valdecoxib) targeting COX2 (prostaglandin G/H synthase 2) were repurposed for treating type 1 diabetes, and 2 drugs (phenoxybenzamine and idazoxan) targeting ADRA2A (Alpha-2A adrenergic receptor) had a new indication for treating type 2 diabetes. These findings indicated that ‘omics’ data mining based drug repositioning is a potentially powerful tool to discover novel anti-diabetic indications from marketed drugs and clinical candidates. Furthermore, the results of our study could be related to other disorders, such as Alzheimer’s disease.     

Obesity and the labor market: A fresh look at the weight penalty

This paper applies semiparametric regression models to shed light on the relationship between body weight and labor market outcomes in Germany. We find conclusive evidence that these relationships are poorly described by linear or quadratic OLS specifications. Women's wages and employment probabilities do not follow a linear relationship and are highest at a body weight far below the clinical threshold of obesity. This indicates that looks, rather than health, is the driving force behind the adverse labor market outcomes to which overweight women are subject. Further support is lent to this notion by the fact that wage penalties for overweight and obese women are only observable in white-collar occupations. On the other hand, bigger appears to be better in the case of men, for whom employment prospects increase with weight, albeit with diminishing returns. However, underweight men in blue-collar jobs earn lower wages because they lack the muscular strength required in such occupations.     

Congenital malaria with atypical presentation: A case report from low transmission area in India

Drug resistant malaria was a major factor contributing to the failure of a worldwide campaign to eradicate malaria in the last century, and now threatens the large investment being made by the global community in the rollout of effective new drug combinations to replace failed drugs. Four related papers in this issue of Malaria Journal make the case for creating the World Antimalarial Resistance Network (WARN), which will consist of four linked open-access global databases containing clinical, in vitro, molecular and pharmacological data, and networks of reference laboratories that will support these databases and related surveillance activities. WARN will serve as a public resource to guide antimalarial drug treatment and prevention policies and to help confirm and characterize the new emergence of new resistance to antimalarial drugs and to contain its spread.     

Environmental DNA/RNA for pathogen and parasite detection,surveillance, and ecology

Detection of pathogens, parasites, and other symbionts in environmental samples via eDNA/eRNA (collectively eNA) is an increasingly important source of information about their occurrence and activity. There is great potential for using such detections as a proxy for infection of host organisms in connected habitats, for pathogen monitoring and surveillance, and for early warning systems for disease. However, many factors require consideration, and appropriate methods developed and verified, in order that eNA detections can be reliably interpreted and adopted for surveillance and assessment of disease risk, and potentially inclusion in international standards, such as the World Organisation for Animal Health guidelines. Disease manifestation results from host–symbiont–environment interactions between hosts, demanding a multifactorial approach to interpretation of eNA signals.     

Biosecurity surveillance design: detecting non-indigenous vertebrate introductions using risk and power

Ecosystems can be severely damaged by the introduction, establishment and spread of non-indigenous species (NIS) including vertebrates, invertebrates and plants. Development and use of natural areas poses a biosecurity risk regarding the introduction of increase NIS invasion risks, so biosecurity systems including prevention and detection measures are required. Even with the most rigorous biosecurity efforts, there is potential for NIS to evade quarantine and go on to establish and spread. The cost of such an event can be great, both environmentally and financially (e.g. containment/ management or eradication). We have developed a surveillance design methodology, for an application where increased use of a natural area may result in NIS incursions, even with extensive biosecurity systems. The surveillance design methodology acknowledges heterogeneity of risk in the study area and stratifies the area to optimise surveillance deployment, achieving great efficiencies and improvement in statistical power of detection. Many of the risk decisions require lack data and so the system incorporates expert opinion with available data. The design covers the broad range of potential NIS that may be introduced by using exemplar species and a variety of surveillance system components (SSCs) (such as a combination of formal scientific surveys, trapping methods, and casual observation) distributed optimally over time and space. The mix of SSCs can be manipulated to take into account such factors as their relative financial costs and demands on expertise. The methodology has the flexibility to be applied to various groups of potential NIS (e.g. vertebrates, invertebrates and plants), and the design can evolve as data are collected (adaptive management). Overall, the surveillance design methodology allows for an efficient use of resources, providing sufficient power to detect incursions, resulting in reduced environmental and financial costs from NIS incursions.     

Epidemiology in protection and prevention against environmental mutagens/carcinogens Examples from occupational medicine

Subjects occupationally exposed to potential mutagens/carcinogens represent the most suitable groups for epidemiological studies aimed at assessing the risk for the individual or the offspring. Several cancer risks to humans have been detected by epidemiological studies performed in occupational settings. Cancer epidemiology studies have been able (a) to identify specific occupations or agents associated with the risk; (b) to verify the results of experimental studies; (c) to test the effectiveness of changes in production or preventive measures in decreasing risks. Reproductive epidemiology has suggested a risk of spontaneous abortions or of malformation in the offspring of workers exposed to some chemicals or occupations, but data are often conflicting due to methodological problems. With the aim of early assessment of risk in mind, the epidemiological use of indicators of exposure or of the early effect of exposure to genotoxic agents is increasingly applied to occupational groups. Cytological monitoring of subjects at risk of occupational cancer of lung or bladder is carried out mainly to diagnose precancerous lesions of target tissues. Cytogenetic methods (chromosome aberrations, SCE, micronuclei) in somatic cells provide a means for detecting early effects of occupational exposure to known or potential mutagens/carcinogens in selected groups of individuals, but their significance is widely debated. Monitoring of urinary mutagenicity, as applied in nurses handling cytostatic drugs, is an example of how an indicator of exposure to genotoxins can be used to evaluate the impact of preventive measures. Among the perspectives, biochemical epidemiology seems to be promising in detecting individuals genetically susceptible to cancer.     

Risk of acute myocardial infarction with nonselective non-steroidal anti-inflammatory drugs: a meta-analysis

The use of cyclo-oxygenase 2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased risk of acute myocardial infarction (AMI). The association between the risks of AMI with nonselective NSAIDs is less clear. We reviewed the published evidence and assessed the risk of AMI with nonselective NSAIDs. We performed a meta-analysis of all studies containing data from population databases that compared the risk of AMI in NSAID users with that in non-users or remote NSAID users. The primary outcome was objectively confirmed AMI. Fourteen studies met predefined criteria for inclusion in the meta-analysis. Nonselective NSAIDs as a class was associated with increased AMI risk (relative AMI risk 1.19, 95% confidence interval [CI] 1.08 to 1.31). Similar findings were found with diclofenac (relative AMI risk 1.38, 95% CI 1.22–1.57) and ibuprofen (relative AMI risk 1.11, 95% CI 1.06 to 1.17). However, this effect was not observed with naproxen (relative AMI risk 0.99, 95% CI 0.88–1.11). In conclusion, based on current evidence, there is a general direction of effect, which suggests that at least some nonselective NSAIDs increase AMI risk. Analysis based on the limited data available for individual NSAIDs, including diclofenac and ibuprofen, supported this finding; however, this was not the case for naproxen. Nonselective NSAIDs are frequently prescribed, and so further investigation into the risk of AMI is warranted because the potential for harm can be substantial.     

Improved surveillance for early detection of a potential invasive species: the alien Rose-ringed parakeet <Emphasis Type="Italic">Psittacula krameri</Emphasis> in Australia

The Rose-ringed parakeet Psittacula krameri is the most widely introduced parrot in the world, and is an important agricultural pest and competitor with native wildlife. In Australia, it is classified as an ‘extreme threat’, yet captive individuals frequently escape into the wild. The distribution and frequency of incursions are currently unknown, as are the potential impacts of the species in Australia. This lack of critical ecological information greatly limits effective biosecurity surveillance and decision-making efforts. We compiled a unique dataset, which combined passive surveillance sources from government and online resources, for all available information on parakeet detections at-large in Australia. We investigated whether geographic variables successfully predicted parakeet incursions, and used species distribution models to assess the potential distribution and economic impacts on agricultural assets. We recorded 864 incursions for the period 1999–2013; mostly escaped birds reported to missing animal websites. Escapes were reported most frequently within, or around, large cities. Incursions were best predicted by factors related to human presence and activity, such as global human footprint and intensive land uses. We recommend surveillance of high (predicted) establishment areas adjacent to cities where a feral parakeet population could most affect horticultural production. Novel passive surveillance datasets combined with species distribution models can be used to identify the regions where potential invasive species are most likely to establish. Subsequently, active surveillance can be targeted to the areas of highest predicted potential risk. We recommend an integrated approach that includes outreach programs involving local communities, as well as traditional biosecurity surveillance, for detecting new incursions.     

Relative Risk of Involuntary Injuries Among Currently Employed Adults in the U.S.

It can be very informative to compare the risk of injury for different occupations, places where accidents happen, demographic variables, and other characteristics. However, most epidemiologic literature shows that multiple logistic regression or odds ratio were commonly used to compare the relationship between the variables on two or more levels. A multiple logistic regression could be used for multiple comparisons assuming that the model correctly reflects the situation at hand. But it might not be a true assumption. Assuming no model, we defined the relative risk to compare risks of injury for different occupations, and applied this method to the data collected by the National Center for Health Statistics (NCHS) National Health Interview Survey (NHIS). This application showed that the relative risk of injury varied by occupation and by place of accident, sex, race, and age.     

Health Behaviors: Is There Any Distinction for Teachers? A Cross-Sectional Nationwide Study

Background

Health behaviors, as important modifiable determinants of health, are consistently targeted by prevention messages. Teachers, as educators and role models, may play a key-role in bringing such messages to children and adolescents. It is not clear which areas of prevention could be improved in collaboration with teachers to promote healthy behaviors at the population level through health education in schools.

Methods

to evaluate teacher’s health awareness, we compared their health/risk behaviors to those of non-teachers, taking into account demographic and socioeconomic factors that could confound crude differences. We used data from the 2010 Health Barometer, a cross-sectional nationally-representative French survey conducted by telephone among 27,653 persons aged 15–85. Adjusting sequentially for potential confounders, we compared six indicators of lifestyle and risky conducts (at-risk drinking, current smoking, cannabis use, gambling, corpulence, sleep duration) between teachers (n = 725) and two comparison groups: other occupations (n = 12,483) on the one hand, and other intermediate and managerial/professional occupations (n = 6,026) on the other.

Results

In the fully-adjusted models, teachers were less likely than other occupations to smoke, to have used cannabis in the last 12 months, to gamble regularly and to be overweight or obese. When restricting the comparison group to other occupations belonging to the same socio-professional category, differences were attenuated, but remain highly significant for tobacco, cannabis and gambling. No significant differences were observed between teachers and non-teachers regarding alcohol use and sleep duration, once important confounders had been adjusted for.

Conclusions

Our results suggest that teachers behave on the whole more healthily than other adults with a similar demographic and socioeconomic profile. The absence of a teacher distinction toward at-risk drinking needs to be examined in more detail.     

A research agenda for helminth diseases of humans: modelling for control and elimination

Mathematical modelling of helminth infections has the potential to inform policy and guide research for the control and elimination of human helminthiases. However, this potential, unlike in other parasitic and infectious diseases, has yet to be realised. To place contemporary efforts in a historical context, a summary of the development of mathematical models for helminthiases is presented. These efforts are discussed according to the role that models can play in furthering our understanding of parasite population biology and transmission dynamics, and the effect on such dynamics of control interventions, as well as in enabling estimation of directly unobservable parameters, exploration of transmission breakpoints, and investigation of evolutionary outcomes of control. The Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to review helminthiases research and identify research priorities and gaps. A research and development agenda for helminthiasis modelling is proposed based on identified gaps that need to be addressed for models to become useful decision tools that can support research and control operations effectively. This agenda includes the use of models to estimate the impact of large-scale interventions on infection incidence; the design of sampling protocols for the monitoring and evaluation of integrated control programmes; the modelling of co-infections; the investigation of the dynamical relationship between infection and morbidity indicators; the improvement of analytical methods for the quantification of anthelmintic efficacy and resistance; the determination of programme endpoints; the linking of dynamical helminth models with helminth geostatistical mapping; and the investigation of the impact of climate change on human helminthiases. It is concluded that modelling should be embedded in helminth research, and in the planning, evaluation, and surveillance of interventions from the outset. Modellers should be essential members of interdisciplinary teams, propitiating a continuous dialogue with end users and stakeholders to reflect public health needs in the terrain, discuss the scope and limitations of models, and update biological assumptions and model outputs regularly. It is highlighted that to reach these goals, a collaborative framework must be developed for the collation, annotation, and sharing of databases from large-scale anthelmintic control programmes, and that helminth modellers should join efforts to tackle key questions in helminth epidemiology and control through the sharing of such databases, and by using diverse, yet complementary, modelling approaches.