Dr J Middleton FRGS @MedVetAcarology@qoto.org

My #introduction : Senior Research Fellow (Sussex Uni); Brighton and Sussex Medical School; Chair, WildHealth C.I.C.

Interests: #epidemiology, #ntds, #conservationbiology, #parasitology, #diseaseecology, #lymedisease, #scabies, #medicalanthropology, #planetaryhealth.

Folk have been making overblown medical claims for cold water for a long-time.

Turns out one of the first proposals for a controlled trial (on #scabies fwiw) was a C19th Irish Dr trolling a cold-water proponent.

Our new #OpenAccess #HistoryofMedicine paper: https://link.springer.com/article/10.1007/s11845-025-04027-x

#ColdWaterTherapy #RCTs #MedicalHistory #scabies #IrishMedicine

Photo: Man swims in cold water. Credit: Oleg Dubyna from Poltava, Ukraine. From Wikimedia, Creative Commons Attribution-Share Alike 2.0 Generic license, see https://commons.wikimedia.org/wiki/File:Man_swims_in_cold_water_(34807325734).jpg

Was on an EU programme panel last week interviewing #PapuaNewGuinea potential MPhil students for #biodiversity and #climate research, and we have now awarded 21 full scholarships. Most of the panel were #PNG academics (with a few of us from elsewhere too), and it was great to see these resources are going to flow through to PNG students and universities rather than those of the ex-colonial powers (as is too often the case with New Guinea related research).

The EU-FCCB Programme will be accepting applications for a further c20 MPhil scholarships in the next round, with applications deadlines expected towards the end of 2025. This is a rare funding opportunity for Papua New Guineans, so spread the word to anyone who may want to apply to keep an eye on the The EU-FCCB Programme scholarship pages: https://fccbpng.eu/scholarships-and-grants . I am sure other panel members would agree that we are really look forward to reading your proposals and meeting some of you at interview.

For background on why its important to decolonise research about New Guinea, see an article from last year co-written by staff from The University of Papua New Guinea, New Guinea Binatang Research Centre, University of Goroka, and Sussex Sustainability Research Programme (SSRP) + Brighton and Sussex Medical School (including Jessica A. Stockdale and myself): https://journals.lww.com/coas/fulltext/2024/22020/mobilising_papua_new_guinea_s_conservation.4.aspx

Paper by me (+ Cooper & Rott) on Tick hazard in the South Downs National Park (UK) + how to control without reducing ecosystem health. Free-to-read in @PeerJ at: https://peerj.com/articles/17483

Funders: @britishdeersoc , @BritishEcolSoc

ABSTRACT:
Background. #SouthDowns National Park (SDNP) is UK’s most visited #NationalPark, and a focus of tick-borne #Lymedisease. UK's first presumed locally acquired cases of #TBE and #babesiosis were recorded in 2019–20. The #SouthDownsNationalPark aims to conserve wildlife and encourage recreation, so interventions are needed that reduce hazard without negatively affecting ecosystem health. To be successful these require knowledge of site hazards.

Methods. British Deer Society members submitted ticks removed from deer. Key potential intervention sites were selected and six 50 m2 transects drag-sampled per site (mostly twice yearly for 2 years). #Ticks were identified in-lab (sex, life stage, species), hazard measured as tick presence, density of ticks (all life stages, DOT), and density of nymphs (DON). Sites and habitat types were analysed for association with hazard. Distribution was mapped by combining our results with records from five other sources.

Results. A total of 87 Ixodes ricinus (all but one adults, 82% F) were removed from 14 deer (10 Dama dama; three Capreolus capreolus; one not recorded; tick burden, 1–35) at 12 locations (commonly woodland). Five key potential intervention sites were identified and drag-sampled 2015–16, collecting 623 ticks (238 on-transects): 53.8% nymphs, 42.5% larvae, 3.7% adults (13 M, 10 F). Ticks were present on-transects at all sites: I. ricinus at three (The Mens (TM); Queen Elizabeth Country Park (QECP); Cowdray Estate (CE)), Haemaphysalis punctata at two (Seven Sisters Country Park (SSCP); Ditchling Beacon Nature Reserve (DBNR)). TM had the highest DOT at 30/300 m2 (DON = 30/300 m2), followed by QECP 22/300 m2 (12/300 m2), CE 8/300 m2 (6/300 m2), and SSCP 1/300 m2 (1/300 m2). For I. ricinus, nymphs predominated in spring, larvae in the second half of summer and early autumn. The overall ranking of site hazard held for DON and DOT from both seasonal sampling periods. DBNR was sampled 2016 only (one adult H. punctata collected). Woodland had significantly greater hazard than downland, but ticks were present at all downland sites. I. ricinus has been identified in 33/37 of SDNPs 10 km2 grid squares, Ixodes hexagonus 10/37, H. punctata 7/37, Dermacentor reticulatus 1/37.

Conclusions. Mapping shows tick hazard broadly distributed across SDNP. I. ricinus was most common, but H. punctata’s seeming range expansion is concerning. Recommendations: management of small heavily visited high hazard plots (QECP); post-visit precaution signage (all sites); repellent impregnated clothing for deerstalkers; flock trials to control H. punctata (SSCP, DBNR). Further research at TM may contribute to knowledge on ecological dynamics underlying infection density and predator re-introduction/protection as public health interventions. #EcologicalResearch on H. punctata would aid control. SDNP Authority is ideally placed to link and champion policies to reduce hazard, whilst avoiding or reducing conflict between public health and ecosystem health.

#OneHealth #PlanetaryHealth #TickAware #DiseaseEcology #ConservationBiology #Acarology #MedicalEntomology #parasites #parasitology #lymedisease

I'm quoted in a great WIRED article on surging #scabies cases in Britain (particularly in care homes & universities), & my research on the need to up supply of oral #ivermectin for outbreak control & sexual health clinics. https://www.wired.com/story/scabies-outbreak-uk-europe-treatment-shortages-drug-resistance-permethrin-ivermectin/

#scabies #publichealth #parasitology #outbreakcontrol #medicine #dermatology

I was quoted in The Mail on Sunday yesterday after they interviewed me about the ongoing UK scabies surge & need to up #ivermectin supplies for it (not COVID19!): https://dailymail.co.uk/health/article-12959997/NHS-horse-dewormer-Scabies-ivermectin.html. My related @TheLancet piece: https://thelancet.com/journals/lancet/article/PIIS0140-6736(19)32619-4/fulltext

#scabies #publichealth #parasitology #outbreakcontrol #medicine

This afternoon I shared with local authority public health leads and practioners across Kent, Surrey & Sussex *UK) the outputs & recommendations from our
#scabies work. Looking forward to working with them on next steps. Recent outputs:

Middleton, Cassell, Walker. 2023. Scabies Management in Institutions. In Fischer & Chosidow (eds.) Scabies. Berlin: Springer Nature. ISBN 978-3-031-26069-8. https://link.springer.com/chapter/10.1007/978-3-031-26070-4_29

Richardson… Middleton. 2023. Scabies outbreak management in refugee/migrant camps across Europe 2014-17: a retrospective qualitative interview study of healthcare staff experiences and perspectives. BMJ Open. https://bmjopen.bmj.com/content/13/11/e075103

Great to see Brighton & Sussex Medical School website highlight #scabies work by myself & friends. Our work to control scabies
in institutions spans #refugee camps to #carehomes. To learn more about this & other impact case studies & emerging impact see: https://bsms.ac.uk/research/impact-case-studies-2021.aspx

#publichealth #parasites #microbiology #outbreakcontrol #epidemiology #dermatology

📕 Chuffed to pick up hardcopy of new @springernature Scabies book. Includes my chapter on managing institutional #scabies outbreaks from care homes to refugee camps: https://link.springer.com/chapter/10.1007/978-3-031-26070-4_29. Abstract + more info➡️

Middleton et al. Scabies Management in Institutions

Abstract
Scabies is a particular problem in semi-closed institutions such as residential settings for elderly people, children and those with learning disabilities; refugee camps and other settings for displaced persons; prisons; schools; hospitals and hostels. What many of these diverse places have in common is a range of transmission drivers which enable scabies to reach very high prevalence including: high densities of potential hosts, social behaviours involving prolonged contact, bed and clothes sharing, manual handling, reduced access to laundry facilities and immunocompromise. We describe the epidemiology of institutional scabies outbreaks across settings, and based primarily on recent and longstanding evidence from adult health care, we draw out general strategic priorities for case management and outbreak control. The tools and information necessary to carry out an epidemiological assessment of an institutional scabies outbreak are provided, along with guidance on control measures. A summary checklist of the key steps to take in responding to an institutional outbreak concludes the chapter.

Thank you to @nihrresearch for funding support.

This is part of the first comprehensive book on scabies, written by experts from across the world. You can order the full 31 chapter ebook and hardback for your uni/clinical library here: https://link.springer.com/book/10.1007/978-3-031-26070-4

#NTDs #Scabies #Refugeehealth #carehomes #outbreakcontrol #epidemiology #publichealth #medicalacarology #acarology #prisonhealth #parisitology #globalhealth #parasites

In #PapuaNewGuinea's #rainforest we co-planned & established health services with an #indigenous people protecting their #forest home. In my new @bmj_company Open paper my friends & I at Brighton and Sussex Medical & beyond report how we did it + what we learned.
https://bmjopen.bmj.com/content/13/10/e075946

#planetaryhealth #biodiversity #conservation #publichealth #NTDs #medicine #science #nature #dermatology #malaria #fungal #oceania #newguinea #anthropology #health

Presented at Royal Sussex County Hospital on my (Brighton and Sussex Medical School) work with forest communities in #papuanewguinea co-planning & introducing health services into indigenous-led conservation collaborations: https://link.springer.com/article/10.1007/s11625-020-00805-x. The tool-kit we developed for combined clinical and rapid anthropological assessments with parallel treatment of urgent cases is available free for wider use ( https://bmjopen.bmj.com/content/10/10/e041784) & I am always happy to chat with people who may find the methodologies we developed helpful in their own work.

Thanks go out to my amazing group of interdisciplinary co-investigators from institutions in the UK, PNG, & Czech Republic: Jackie Cassell, Gavin Colthart, Francesca Dem, James Fairhead, Michael Head, Dr Moses Laman, Hayley MacGregor, Vojtech Novotny, Mika Peck, Willie Pomuat, João Inácio, Steve Walker, & Alan J Stewart.

#epidemiology #planetaryhealth #remotemedicine #biodiversityconservation #globalhealth #primarycare #tropicalmedicine #rainforests #indigenoushealth #medicalanthropology

Our research poster from Harvard Medical School last month (PDF: https://drive.google.com/file/d/1z3ehnrVvfZG5e_uu8i0Y4HS86Tw_vI8Q/view?usp=sharing) with key findings about 43 projects that have integrated #medical provision & #biodiversity #conservation. #planetaryhealth mapping.

#Planetaryhealth approaches that integrate #medicine & #conservation can improve #health outcomes and protection of #biodiversity, and such projects are more widespread than literature suggests. 5min summary of my talk at @harvardmed earlier this month (funder Darwin DEFRA). #onehealth

https://youtu.be/99Pjye1hYnw

Delighted earlier this week to do joint Q&A following screening of experimental #scabies documentaries (including an #opera) at Towner Art Gallery in #Eastbourne with #Sussex Uni and Brighton and Sussex Medical School colleagues from UK & #Ethiopia. Local newspaper report: https://www.sussexexpress.co.uk/news/people/a-neglected-infectious-disease-that-still-affects-our-town-eastbourne-film-event-3914316 #ntds #dermatology #skindisease