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Jo Middleton

Jo Middleton BSc MRes MRSB

Research Fellow
E: J.Middleton@bsms.ac.uk
T: +44 (0)1273 641025
Location: Department of Primary Care and Public Health Medicine; NIHR Global Health Unit on Neglected Tropical Diseases, Brighton and Sussex Medical School, Room 318a, Watson Building, Falmer BN1 9PH

Areas of expertise: Parasitology (particularly acarine: scabies. Lyme disease etc.); planetary health; sustainability; outbreak research; disease ecology; zoonotic diseases; Rapid anthropological Assessment Procedures for health; systematic reviews; remote pre-hospital care; Papua New Guinea.

Research areas: Infection and immunology; primary care and health services.

Other roles: BSMS institutional liaison with the Planetary Health Alliance

Biography

Jo Middleton is a disease ecologist  working across BSMS and its host institutions, with research in the Department of Primary Care and Public Health Medicine and the NIHR Global Health Unit on Neglected Tropical Diseases, as well as Life Sciences at University of Sussex, and Pharmacy and Biomolecular Sciences at University of Brighton. Much of Jo’s research and teaching involves interrelated work at two very different scales, that of microscopic parasites (specifically acarines) and that of Planetary Health, an emerging field which aims to safeguard both human health and the natural systems that underpin it.

Before joining BSMS Jo worked in the ambulance service and taught courses for Brighton and Sussex University Hospitals staff and those travelling to remote areas. They have a long term commitment to biodiversity conservation, with a particular focus on forest preservation and indigenous health in Oceania. 

Jo is a peer reviewer for the Department of Health (UK government), evidence mapping for policy and the Health Research Board (Irish government grant body), as well as the following journals: Epidemiology and Infection; BMJ Open; PLOS Neglected Tropical Diseases; British Journal of General Practice; P J Acarology, Planetary Health Alliance/The Lancet Planetary Health; Paediatrics and Child Health; Parisitology; Emerging Microbes & Infections.

Research

Jo provides an overview of their work in a filmed public lecture to Brighton and Sussex Medico-Chirurgical Society: ‘From parasites to planetary health: research and interventions bridging medical acarology, public health and conservation biology’ [https://vimeo.com/334889141].

2020-21 Epidemic modelling and statistical support for policy: sub-populations, forecasting, and long-term planning

Jo is a Co-Investigator on this project, which is reporting directly to SAGE (the UK government scientific group advising state policy on COVID-19). Epidemic dynamics, particularly in the presence of changing control policies, will shift the dominant modes of transmission and hence the distribution of disease. We are developing models to integrate the diverse but often noisy and incomplete datasets available, providing real-time policy support together with quantification of uncertainty. We are addressing three particular challenges. (1) Understanding spread in closely connected sub-populations in which there are close, repeated contacts capable of spreading disease such as households, hospitals, prisons, and care homes. Data from these contexts allow epidemiological parameters relating to infection risk conditional on contact to be identified in statistical work, and they are also important foci for policies. (2) Making short- and medium-term predictions of the epidemic trajectory and healthcare demand with appropriate uncertainty quantification. (3) Modelling long-term prospects for the epidemic, including the likelihood of eventual endemicity, the consequences of different virological assumptions about SARS-CoV-2, and how the different scenarios in this context will interact with long-term societal and health consequences of the pandemic. [Funder: UK Research and Innovation].

2019-22 Integrating conservation and health in Papua New Guinea’s vulnerable rainforests 

Jo is a Co-I and Research Fellow on this Darwin Initiative project which aims to protect highly diverse forests in Papua New Guinea (PNG) and improve their inhabitants’ quality of life. Using conservation interventions, research, and capacity building it is: (i) enabling expansion of indigenous rainforest conservation through community health provision (ii) spreading awareness of the benefits of intact forests (iii) researching both the relationships between forest integrity and health in PNG, and the efficacy of integration of health services into forest conservation across the tropics, and (iv) training students and staff in research and conservation. [Funder: Department for Environment Food & Rural Affairs].

2017-22 Surfaces: an interdisciplinary project to understand and enhance health in the vulnerable rainforests of Papua New Guinea (PNG) (UK; Papua New Guinea)

Jo is a Co-I and Research Fellow on Surfaces. PNG’s globally important rainforests are threatened by logging, and its health-related Sustainable Development Goal indicators are worse than all but two countries outside sub-Saharan Africa. Surfaces is mapping evidence on integrated health and conservation projects worldwide, and aims to provide a practical example in PNG’s rainforests, focusing first on neglected tropical skin diseases (specifically scabies and fungal diseases). [Funder: Sussex Sustainability Research Programme]. Read more > 

2014-21 Public Health England Scabies Research Project and NIHR Global Health Unit on Neglected Tropical Diseases (UK; Europe; Papua New Guinea; Ethiopia)

Jo came to BSMS in January 2014 to work on the Scabies Research Project, a collaboration between BSMS, London School of Hygiene & Tropical Medicine, and Public Health England (PHE). The project carried out the first UK study into scabies outbreaks in care homes for the elderly, which are a considerable public health burden and highly distressing for residents (see the cover story in Lancet Infectious Diseases). The team is now developing national outbreak guidelines. Scabies is also a WHO Neglected Tropical Disease and Jo is now engaged in international projects in Papua New Guinea and Ethiopia. They have also studied outbreaks in refugee/migrant camps across Europe. [Funders: Public Health England, British Skin Foundation, Economic Social Research Council, National Institute of Healthcare Research].

2015-20 Ecology of Lyme disease (South Downs National Park)

Jo is investigating ecological determinants of Lyme disease hazard in the South Downs National Park and potential One Health based interventions. This involves field collection of ticks, acarine taxonomy, real-time PCR pathogen identification, and a systematic review to determine if interventions that aim to decrease Lyme disease hazard at non-domestic sites can be effective without negatively affecting ecosystem health. [Funders: British Ecological Society, Royal Society of Biology, British Deer Society, Nineveh Charitable Trust].

2016-17 Novel tests for infectious diseases to reduce hospital admissions (UK)

On behalf of i-sense Jo explored health and social care worker’s views on novel point-of-care diagnostics. The capability to detect infections and wirelessly connect results to healthcare systems may help patients gain faster access to treatment, and support public health efforts to map indicators of emerging infections in real-time. [Funder: Engineering and Physical Sciences Research Council].

Teaching

Jo teaches at BSMS and the School of Life Sciences at University of Sussex, primarily on topics related to parasites, planetary health, and disease ecology. They contribute to the following degree courses:

  • Bachelor Medicine Bachelor of Surgery (BSMS)
  • BSc Ecology and Conservation (University of Sussex)
  • MPH Public Health (BSMS)
  • MSc Conservation Biology (University of Sussex)

Jo supervises 4th year medical student Independent Research Projects, and is a PhD supervisor for a BSMS doctoral student (Robel Belachew. From quantification to control: a population based study to determine the magnitude of scabies and evaluate the disease surveillance system in Ethiopia). As part of their Darwin Initiative funded project Jo supervises a New Guinea based MPhil student investigating relationships between forest integrity and health.

Jo is the lead within the Planetary Health Alliance of an international working group developing curriculum across member medical and nursing schools, from Sydney to Yale.

Selected publications

Article

Middleton J, Cassell JA, Colthart G, et al. (2020) Rationale, experience and ethical considerations underpinning integrated actions to further global goals for health and land biodiversity in Papua New Guinea. Sustainability Science. https://link.springer.com/article/10.1007/s11625-020-00805-x

Middleton J, Walker SL, House T, Head MG and Cassel JA (2019) Ivermectin for the control of scabies outbreaks in the UK.
[http://sro.sussex.ac.uk/id/eprint/85729/] The Lancet, 394 (10214). pp. 2068-2069. ISSN 0140-6736

Middleton J (2018) A conversation with… Jo Middleton. Pulse (8). pp. 12-13. 

Middleton J, Cassell JA, Jones C, Lanza S, Head MG and Walker SL (2018) Scabies control: the forgotten role of personal hygiene- Authors reply. [http://sro.sussex.ac.uk/78707/] The Lancet Infectious Diseases, 18 (10). pp. 1068-1069. ISSN 1473-3099 

Cassell JA, Middleton J, Nalabanda A, Lanza S, Head MG, Bostock, J, Hewitt K, Jones C, Darley C, Karir S and Walker SL. (2018) Scabies outbreaks in ten care homes for the elderly: a prospective study of clinical features, epidemiology, and treatment outcomes. [http://sro.sussex.ac.uk/75896/] The Lancet Infectious Diseases. ISSN 1473-3099

Kinyanjui T, Middleton J, Güttel S, Cassell JA, Ross J and House T (2018) Scabies in residential care homes: modelling, inference and interventions for well-connected population sub-units. [http://sro.sussex.ac.uk/73765/] PLOS Computational Biology, 14 (3). e1006046. ISSN 1553-7358 

Middleton J, Cooper I, Rott AS (2016) Can interventions that aim to decrease Lyme disease hazard at non-domestic sites be effective without negatively affecting ecosystem health? A systematic review protocol. Environmental Evidence, 5 (23). ISSN 2047-2382  

Conferences or workshop item

Middleton J (2019) Scabies outbreaks in residential care homes for the elderly in Britain. In: International Alliance for Control of Scabies Annual Meeting, 20 November 2019, MGM National Harbor, Washington DC, USA.

Middleton J, Cassell JA, Novotny V, Colthart G, Peck M, Fairhead J, Walker SL, Head MG, Macgregor H, Inacio J and Stewart A (2017) Surfaces: An interdisciplinary project to understand and enhance health in the vulnerable rainforests of Papua New Guinea. Inaugural Planetary Health / GeoHealth Annual Meeting, 28-30 April 2017, Harvard Medical School, Boston, USA. 

Middleton J, Head MG and Cassell JA (2017) Scabies: diagnostic challenges of neglected tropical skin disease, existing tools, future developments. Diagnostics and the Developing World Conference 2017, 24 Jan 2017, Brunel University, London. 

Read more >