Paul R Hunter

Paul R Hunter
University of East Anglia | UEA · Norwich Medical School

MBA MD

About

551
Publications
153,972
Reads
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21,866
Citations
Citations since 2016
142 Research Items
11765 Citations
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Introduction
Research interests cover the epidemiology and microbiology of emerging infectious diseases of humans, especially food and waterborne disease. Also working on health impacts of climate change including risks from vector-borne disease such as dengue fever. Favourite pathogen is Cryptosporidium, especially cryptosporidiosis. Experience of systematic reviews, quantitative risk assessment, case-control and cohort studies, cross sectional surveys, quasi-experimental and randomized controlled trials.
Additional affiliations
September 2013 - present
Tshwane University of Technology
Position
  • Professor
August 2001 - November 2017
Norfolk and Norwich University Hospitals NHS Foundation Trust
Position
  • Consultant
July 2001 - present
University of East Anglia
Position
  • Professor
Education
September 1982 - June 1983
The University of Manchester
Field of study
  • Bacteriology
September 1974 - June 1979
The University of Manchester
Field of study
  • Medicine

Publications

Publications (551)
Article
Full-text available
A small island community in Malaysia uses gravity-fed drinking water, and rejected water treatment by the authorities. This study was conducted to evaluate the community's risk perception towards their untreated water supply by interviewing one adult per household in four out of eight villages on the island. The survey asked questions on risk perce...
Article
Full-text available
Background Face shields were widely used in 2020-2021 as facial personal protective equipment (PPE). Laboratory evidence about how protective face shields might be and whether real world user priorities and usage habits conflicted with best practice for maximum possible protection was lacking – especially in limited resource settings. Methods Rela...
Article
Full-text available
Context: COVID-19 is especially dangerous to older adults living in residential care.Objective: To evaluate the usefulness of a nurse-led Enhanced Care Home Team (ECHT) SARS-CoV-2 testing strategy to identify resident cases early, identify typical illness presentation residents, and correctly attribute cause of death in care home settings in Norfol...
Article
Full-text available
COVID-19 has had a severe impact on human health, as well as in social and economic terms, with implications for the management and governance of the water and sanitation sector. These implications are evident in Latin America and the Caribbean due to existing challenges the region faces in accessing water and sanitation services. In spite of signi...
Article
Full-text available
Understanding is still developing about spatial risk factors for COVID-19 infection or mortality. This is a secondary analysis of patient records in a confined area of eastern England, covering persons who tested positive for SARS-CoV-2 through end May 2020, including dates of death and residence area. We obtained residence area data on air quality...
Article
Full-text available
Introduction The current pandemic of coronavirus disease (COVID-19) is unparalleled in recent history as are the social distancing interventions that have led to a considerable halt on the economic and social life of so many countries. Aim We aimed to generate empirical evidence about which social distancing measures had the most impact in reducin...
Article
Full-text available
The COVID‐19 pandemic has disrupted economies and societies throughout the world since early 2020. Education is especially affected, with schools and universities widely closed for long periods. People under 25 years have the lowest risk of severe disease but their activities can be key to persistent ongoing community transmission. A challenge aros...
Preprint
Full-text available
A distinctive feature of the roll out of vaccination against SARS-CoV-2 virus in the UK was the decision to delay the timing of the second injection till 12 weeks after the first. The logic behind this is to protect more people sooner and so reduce the total number of severe infections, hospitalisations, and deaths. This decision caused criticism f...
Preprint
Full-text available
Objectives Is herd immunity to COVID-19 a realistic outcome of any immunisation programme with the two main vaccines currently licenced in the UK (Pfizer vaccine BNT162b2 and Astra Zeneca/Oxford vaccine ChAdOx1-S)? More formally, can these vaccines achieve a sufficient level of population immunity to reduce R, the reproduction number of the infecti...
Preprint
Full-text available
In the UK the epidemic of COVID-19 continues to pose a significant threat to public health. On the 14th October the English government introduced a tier system for control of the epidemic but just 3 weeks later a National lockdown across all areas of England was implemented. When English areas emerged from Lockdown many were placed in different tie...
Article
Background Residential care homes for the elderly are important settings for transmission of the SARS-CoV-2 virus that causes COVID-19 disease. Methods We undertook secondary analysis of 248 care homes in Norfolk, UK. The dataset counted nurses, care workers and non-care workers, their status (available, absent due to leave or sickness and extra s...
Preprint
Full-text available
The COVID-19 pandemic disrupted economies and societies throughout the world in 2020. Education was especially affected, with schools and universities widely closed for long periods. People under 25 years have the lowest risk of severe disease but their activities can be key to persistent ongoing community transmission. A challenge arose for how to...
Article
Background Evidence for face-mask wearing in the community to protect against respiratory disease is unclear. Aim To assess effectiveness of wearing face masks in the community to prevent respiratory disease, and recommend improvements to this evidence base. Methods We systematically searched Scopus, Embase and MEDLINE for studies evaluating resp...
Preprint
Full-text available
Understanding is still developing about risk factors for COVID-19 infection or mortality. This is especially true with respect to identifying spatial risk factors and therefore identifying which geographic areas have populations who are at greatest risk of acquiring severe disease. This is a secondary analysis of patient records in a confined area...
Article
Full-text available
A prior systematic review on the efficacy of halofuginone (HFG) treatment to prevent or treat cryptosporidiosis in bovine calves was inconclusive. We undertook an updated synthesis and meta-analyses on key outcomes for the treatment of calves with HFG. Evaluated outcomes were oocyst shedding, diarrhoea, mortality and weight gain. Experiments had to...
Article
Full-text available
Abstract Currently available evidence supports that the predominant route of human-to-human transmission of the SARS-CoV-2 is through respiratory droplets and/or contact routes. The report by the World Health Organization (WHO) Joint Mission on Coronavirus Disease 2019 (COVID-19) in China supports person-to-person droplet and fomite transmission du...
Preprint
Full-text available
Despite it being over 10 months since COVID-19 was first reported to the world and it having caused over 1.3 million deaths it is still uncertain how the virus can be controlled whilst minimising the negative impacts on society and the economy. On the 14 th October, England introduced a three-tier system of regional restrictions in an attempt to co...
Article
Full-text available
Objective: This study will analyse respiratory contacts to three healthcare services that capture more of the community disease burden than acute data sources, such as hospitalisations. The objective is to explore associations between contacts to these services and the patient’s age, gender and deprivation. Results will be compared between healthca...
Article
Full-text available
Cryptosporidiosis is common in young calves, causing diarrhoea, delayed growth, poor condition and excess mortality. No vaccine or cure exists, although symptomatic onset may be delayed with some chemoprophylactics. Other response and management strategies have focused on nutritional status, cleanliness and biosecurity. We undertook a systematic re...
Article
Full-text available
Shiga toxin (Stx), one of the most potent bacterial toxins known, can cause bloody diarrhea, hemolytic uremic syndrome, kidney failure and death. The aim of this pilot was to investigate the occurrence of Shiga toxin-encoding genes, stx (stx1 and stx2) from total coliform (TC) and E. coli positive samples from small community water systems. After a...
Article
Full-text available
Introduction Water fetching for household needs can cause injury, but documentation of the burden of harm globally has been limited. We described the frequency, characteristics and correlates of water-fetching injuries in 24 sites in 21 low-income and middle-income countries in Asia, Africa and Latin America and the Caribbean. Methods In a survey...
Preprint
Full-text available
Background COVID-19 has especially affected care home residents. Aim To evaluate a nurse-led Enhanced Care Home Team (ECHT) enhanced SARS-CoV-2 testing strategy. Design and setting Service evaluation in care homes in Norfolk UK. Method Residents and staff received nose and throat swab tests (7 April to 29 June 2020). Resident test results were link...
Preprint
Full-text available
Cryptosporidiosis is a common illness in young cattle that causes high morbidity and some mortality. A common prophylactic treatment are halofuginone products but it seems likely disease could be reduced by other other pharmacological products or some management strategies. We undertook a systematic review and meta-analyses on key outcomes for trea...
Preprint
Full-text available
BACKGROUND: Residential care homes for the elderly have been important settings for transmission of the SARS-CoV-2 virus that causes COVID-19 disease. METHODS: We undertook a secondary analysis of a dataset about 248 care homes in the county of Norfolk, eastern England. The dataset recorded categories of staff (nurses, care workers and non-care wor...
Preprint
Full-text available
The current epidemic of COVID-19 is unparalleled in recent history as are the social distancing interventions that have led to a significant halt on the economic and social life of so many countries. However, there is very little empirical evidence about which social distancing measures have the most impact. We report a quasi-experimental study of...
Article
Shiga toxin‐producing E. coli is carried in the intestine of ruminant animals, and outbreaks have occurred after contact with ruminant animals or their environment. The presence of STEC virulence genes in the environment was investigated along recreational walking paths in the North West and East Anglia regions of England. 720 boot sock samples fro...
Preprint
Full-text available
The current pandemic of COVID-19 has lead to conflicting opinions on whether wearing facemasks outside of health care facilities protects against the infection. To better understand the value of wearing facemasks we undertook a rapid systematic review of existing scientific evidence about development of respiratory illness, linked to use of facemas...
Article
The UK Government asserts that its response to the coronavirus disease 2019 (COVID-19) pandemic is based on evidence and expert modelling. However, different scientists can reach different conclusions based on the same evidence, and small differences in assumptions can lead to large differences in model predictions. Our country's response to COVID-...
Article
Background: Concern about health misinformation is longstanding, especially on the Internet. Methods: Using agent-based models, we considered the effects of such misinformation on a norovirus outbreak, and some methods for countering the possible impacts of "good" and "bad" health advice. The work explicitly models spread of physical disease and...
Article
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Cholera is a severe diarrhoeal disease affecting vulnerable communities. A long-term solution to cholera transmission is improved access to and uptake of water, sanitation and hygiene (WASH). Climate change threatens WASH. A systematic review and meta-analysis determined five overarching WASH factors incorporating 17 specific WASH factors associate...
Article
Full-text available
Background: Three large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations' Sustainable Development Goals, and the bol...
Article
Background: Infectious intestinal disease affects 25% of the UK population annually; 1 in 50 affected people consult health professionals about their illness. Aims: We tested if anticipated treatment-seeking decisions for suspected infectious intestinal disease could be related to emotional response, tolerance of symptoms, or beliefs about the c...
Article
Full-text available
Health misinformation can exacerbate infectious disease outbreaks. Especially pernicious advice could be classified as “fake news”: manufactured with no respect for accuracy and often integrated with emotive or conspiracy-framed narratives. We built an agent-based model that simulated separate but linked circulating contagious disease and sharing o...
Article
Shiga toxin–producing Escherichia coli (STEC) outbreaks involving ready-to-eat salad products have been described in the scientific literature since 1995. These products typically do not undergo a definitive control step such as cooking to eliminate pathogens. To reduce the number of STEC infections from salad products, efforts will need to focus o...
Article
Background: Millions of people carry water home from off-plot sources each day and lack improved sanitation. Research on the health outcomes associated with water fetching is limited, and with usage of improved sanitation is inconclusive. Objectives: To analyse the association of water fetching, unimproved water supplies, and usage of improved s...
Article
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Introduction Healthcare-associated infections (HCAIs) are the most frequent adverse event compromising patient safety globally. Patients in healthcare facilities (HCFs) in low-income and middle-income countries (LMICs) are most at risk. Although water, sanitation and hygiene (WASH) interventions are likely important for the prevention of HCAIs, the...
Article
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Background: Communicable diseases pose a significant risk in humanitarian emergencies. This paper reports on the development and validation of a rapid risk assessment tool for communicable diseases in humanitarian emergencies. Methods: We developed a tool assessing the 20 most critical risk factors for disease outbreaks in humanitarian emergencies....
Article
Norovirus (NoV) is the most commonly recognized cause of acute gastroenteritis, with over a million cases globally per year. While usually self-limiting, NoV poses a substantial economic burden because it is highly contagious and there are multiple transmission routes. Infection occurs through inhalation of vomitus; faecal-oral spread; and food, wa...
Article
Full-text available
Human cryptosporidiosis is the leading protozoan cause of diarrhoeal mortality worldwide, and a preponderance of infections is caused by Cryptosporidium hominis and C. parvum. Both species consist of several subtypes with distinct geographical distributions and host preferences (that is, generalist zoonotic and specialist anthroponotic subtypes). T...
Article
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Aims: It is unclear how economic factors impact on the epidemiology of infectious disease. We evaluated the relationship between incidence of selected infectious diseases and economic factors, including economic downturn, in 13 European countries between 1970 and 2010. Methods: Data were obtained from national communicable disease surveillance cent...
Article
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Background: To develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and m...
Article
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Vulnerability has become a key concept in emergency response research and is being critically discussed across several disciplines. While the concept has been adopted into global health, its conceptualisation and especially its role in the conceptualisation of risk and therefore in risk assessments is still lacking. This paper uses the risk concept...
Article
Microbiological contamination of drinking water supplies is an ever-present concern for water utility managers. Most such threats are routine, well-recognised and described. Therefore, they can usually be prevented using standard protection measures. Incidents involving emerging pathogens and malicious attacks are inherently less predictable. In a...
Article
Full-text available
Background: Humanitarian emergencies including disasters associated with natural hazards, conflict, complex emergencies and famines can pose significant risks to public health, especially when they lead to population displacement into inadequate conditions. To reduce the risk of communicable disease outbreaks in such situations it is necessary to k...
Article
Full-text available
Background With over 800 million cases globally, campylobacteriosis is a major cause of food borne disease. In temperate climates incidence is highly seasonal but the underlying mechanisms are poorly understood, making human disease control difficult. We hypothesised that observed disease patterns reflect complex interactions between weather, patte...
Article
Full-text available
Background Globally cryptosporidiosis is one of the commonest causes of mortality in children under 24 months old and may be associated with important longterm health effects. Whilst most strains of Cryptosporidium parvum are zoonotic, C. parvum IIc is almost certainly anthroponotic. The global distribution of this potentially important emerging in...
Article
Full-text available
Objectives: The impact on diarrhoea of sanitation interventions has been heterogeneous. We hypothesize that this is due to the level of prevailing faecal environmental contamination and propose a Faecal Contamination Index (FAECI) of selected WASH indicators (objective 1). Additionally, we provide estimates of the proportion of the population livi...
Article
Full-text available
During 2011 a large outbreak of typhoid fever affected an estimated 1430 people in Kikwit, Democratic Republic of Congo. The outbreak started in military camps in the city but then spread to the general population. This paper reports the results of an ecological analysis and a case-control study undertaken to examine water and other possible transm...
Data
Typhoid fever risk factors. (DOC)
Data
Survey data and derived variables. (XLSX)
Data
Results of water quality tests. (XLSX)
Data
Sanitation engineers. (PDF)
Data
Typhoid fever spatial analysis. (DOC)
Article
Full-text available
Background Communicable diseases are a major concern during complex humanitarian emergencies (CHEs). Descriptions of risk factors for outbreaks are often non-specific and not easily generalisable to similar situations. This review attempts to capture relevant evidence and explore whether it is possible to better generalise the role of risk factors...