Recent progress in antiviral therapy discussed at the 4th Christophe Mérieux Trends in Virology conference
The 4th Christophe Mérieux Trends in Virology conference convened 67 experts from various disciplines (virologists, chemists, infectious disease specialists, epidemiologists and veterinarians) involved in the development and implementation of antiviral strategies. They met at the Fondation Mérieux Conference Centre, Les Pensières, from 27-29 January, to discuss recent developments in the field of antiviral therapy.
Viral infections remain a major public health threat worldwide. Significant progress achieved in the antiviral field during the last decades has improved or saved the lives of millions of patients, most notably those infected with HIV, hepatitis B and C viruses and herpes simplex viruses. Anti-flu molecules are the only solution for infected patients at the beginning of a severe flu pandemic. Prof. Michael Sofia from the company Oncor Biopharma presented the development story that led to the success of new treatments for hepatitis C. Several presentations concerned research on new molecules to fight against these infections, including those by Prof. Zoulim (Inserm, Lyon), Prof. Baumert (Inserm, Strasbourg) and Prof. Sarrazin (University of Frankfurt), which took into account, in particular, the issue of emerging resistance to current treatments.
Serious efforts are underway to develop drugs for the treatment of infections with respiratory syncytial virus or rhinoviruses, among others. Prof. Charles Penn of WHO provided a detailed description of the challenges of treating viral diseases. The development costs of drugs are very high and for many other, often life-threatening, viral infections, the development of antivirals is still desperately needed. This includes flaviviruses such as dengue, respiratory infections such as coronaviruses, rabies, and hemorrhagic fever viruses.
Several presentations covered recent advances in this area, in particular those by Prof. Sebastian Johnston, Imperial College of London, on rhinoviruses; Prof. Stephan Günther, Bernhard Nocht Institute of Hamburg, on the hemorrhagic fever viruses Lassa, Ebola and Marburg; Dr. James Whitehorn, Oxford University at Ho Chi Minh City, on dengue and Dr. Noël Tordo, Pasteur Institute of Paris, on rabies. Dr. Jean-Christophe Audonnet, from Merial, presented recent developments in the treatment of viral diseases affecting livestock.
Along with the development of new antiviral therapies, strong capacity-building of healthcare systems is also needed. The most vulnerable patients often live in remote places or have limited resources and access to healthcare infrastructures. Several presentations concerned simplified formulations for HIV treatments (Dr. Calvin Cohen, Community Research Initiative of New England, USA), the ’recycling’ of molecules for use in developing countries (Dr. Michael Holscher, University of Munich), the role of generic drugs (Dr. Yazdan Yazdanpanah, Inserm, Paris) or programs for treatment access in developing countries (Dr. Lilian Lou, Gilead, USA).
First National Workshop on blood culture in Cambodia
The first national workshop on blood culture was organized 21-22 February in Phnom Penh by the Cambodian Ministry of Health and the University of Health Sciences (UHS), in collaboration with the Sihanouk Hospital Centre of Hope (SHCH), the Institute of Tropical Medicine of Antwerp (ITM), the World Health Organization (WHO), the Diagnostic Microbiology Development Program (DMDP), the Naval Medical Research Program 2 (NAMRU2) and Fondation Mérieux.
Introducing an essential test in Cambodia
The workshop is part of a broader, national project to introduce the use of blood culture in Cambodian provincial laboratories. Blood culture is one of the most essential analyses performed by a microbiology laboratory. It is an important tool for the diagnosis of sepsis and the valuable information it provides to the medical team can improve patient prognosis. Blood culture also plays a role in disease surveillance and infection control at both hospital and national levels.
Learning good practices
The aim of this first national workshop was to introduce good practices for blood culture in six provincial hospitals of Cambodia (Battambang, Takeo, Svay Rieng, Kampong Cham, Kossamak and the National Pediatric Hospital). The hospitals are part of a national network of microbiology, created to enhance patient care in Cambodia by providing good quality health services and education about the most prevalent pathogens, their susceptibility to antibiotics and clinical presentation.
During plenary sessions, participants were given key information about:
the main pathogens (e.g., Escherichia coli, Salmonella spp., Burkholderia pseudomallei and Staphylococcus aureus)
the issue of antibiotic resistance and the need for guidelines for treatment and rational use of antibiotics
the importance of team work and close communication between the hospital ward and the laboratory.
Participants were also divided into groups (clinicians, nurses, laboratory staff), for some practical, interactive sessions, where they had the opportunity to exchange their experiences. Not only did the workshop foster knowledge-sharing between healthcare professionals from different hospitals nationwide, but also across borders; two representatives from Lao National Center for Laboratory and Epidemiology (NCLE) participated.
Commercial blood culture bottles are not affordable for Cambodian provincial laboratories. This initiative has been made possible thanks to the local production and distribution of blood culture bottles by the Central Media Making Laboratory at the UHS and the support of DMDP.
Over the coming months, participating laboratories will monitor blood culture quality indicators. A second workshop will be organized, during which each laboratory will present the results of this monitoring (total number of blood cultures, % of contamination, % of clinically significant pathogens, blood sample volume,…) and any corrective actions will be determined to ensure optimal use of this important diagnostic tool.
4th Charles Mérieux Conference: cancer and infectious disease agents in the Mekong Basin
The 4th Charles Mérieux Conference was held at the Charles Mérieux Infectiology Centre in Vientiane, 14-15 March, as part of the 25th Jacques Cartier Meetings. Organised in partnership with the Francophone Institute of Tropical Medicine (IFMT), the Francophone University Agency (AUF) and Fondation Mérieux, the conference focused on the theme ’Cancer and Infectious Disease Pathogens in the Mekong Basin: What are the Best Strategies for Intervention and Training?’
Prof. Bounkong Syhavong, Deputy Minister, Health Ministry of Laos, opened the conference with Mr. Alain Bideau, Director of the Jacques Cartier Centre, Dr. Phimpha Paboriboune, Scientific Director of the Christophe Mérieux Centre for Infectiology and Prof. Dominique Peyramond, head of the Infectious Disease Department at the Croix-Rousse Hospital (Lyon, France). They conference’s central themes were: What are the most challenging cancers for public health in the Mekong basin? What needs to be developed in terms of training, prevention, patient care and treatment?
Some 20 international experts from Asia, Africa, North America and Europe shared their experience with healthcare professionals during the two days. They discussed the initiatives that have been implemented in different countries and examined infectious diseases by pathology (hepatitis, patients with HIV, cervical cancer,…) and by type of approach: vaccines or genetics.
An overview of the recommendations for training and effective actions to be implemented is in preparation.
Pasteur-Mérieux – IFMT course on infectious agents and tumors
The infectious agents and tumors course was held in Vientiane in Laos from 18-29 March at three sites: the Pasteur Institute of Laos (IPL), the Christophe Mérieux Infectiology Centre of Laos (CICML) and the Institut de la Francophonie pour la Médecine Tropicale (IFMT). Organized in collaboration with the Pasteur Institute of Paris and Fondation Mérieux, the course is part of a regional project, ’Cancer and Infectious Agents in Southeast Asia’, initiated by the Agence Universitaire de la Francophonie.
Fifteen participants from Laos, Vietnam, Cambodia and China took the course, which is designed especially for doctors, pharmacists or scientists who are young graduates of health science universities in Southeast Asia.
The course taught students the epidemiological and clinical relationships between infections and cancers, the role of bacterial, viral and parasitic pathogens involved in the process of oncogenesis and the laboratory diagnostic techniques for infectious agents. The students were also given the foundations for developing strategies for the screening and prevention of cancer caused by infectious agents. This addresses a need for strengthening capacity in the region for screening and preventing this type of cancer.
Local and French experts from major hospital and university centers and research institutes were among the speakers at this course, which lasted two weeks, representing 60 hours of training. The program included theoretical studies, clinical case studies, analysis of articles and practical laboratory work sessions.
A second edition of the course in two years is being considered, following the positive evaluations from the students.
Reprogramming the immune system through novel therapeutic vaccines
The meeting, Therapeutic vaccines: reprogramming immunity in infectious diseases, allergy and cancer, brought together 50 participants from seven countries at Fondation Mérieux’s Les Pensières conference centre from 25–27 March.
Vaccine producers, including Sanofi, GSK, Crucell, Transgène, and Genzyme, met with research institutions such as Inserm, the Emory Vaccine Centre, the National Cancer Institute, and University College London to:
discuss the underlying cellular and molecular mechanisms that allow the immune system to respond to the diverse challenges posed by infectious disease, allergy and cancer while still remaining agile and adaptable
determine what factors play a key role in the failure of the immune system to control these health issues under specific circumstances.
The meeting featured presentations on the biology and virulence mechanisms of a panel of pathogens associated with chronic infection (tuberculosis, chlamydia, Cytomegalovirus, herpes simplex virus, etc.), or at the interface between cancer and infection (human papillomavirus, Epstein-Barr virus, etc.). The group looked at how host factors specific to the individual patient can drive different responses to the same infection (e.g. herpes simplex virus).
The latest developments in therapeutic vaccines against cancer were discussed to see how the immune system can be re-programmed to target different antigens or stimulate a broader set of mechanisms in order to work more effectively against the proliferation of cancer cells. The participants also examined the opposite end of the spectrum, allergy, where an overly active immune response causes unintended damage to the host. They discussed how therapeutic vaccines can be used to re-educate or thwart the immune response to prevent or limit allergic reaction.
By looking at these diverse situations as part of a continuum, the meeting’s goal was to build a transversal understanding of the common drivers and underpinning mechanisms that can serve as a basis for the development of novel therapeutic vaccines against infectious diseases, allergy and cancer.
Hand hygiene initiative in Laos
Thanks to funding from Fondation Mérieux, an initiative to reinforce hand hygiene in Laotian hospitals was deployed during the month of March. A prevalence survey ’on a given day’ of healthcare-associated infections in healthcare centers in four Laotian provinces, representative of the whole country, was conducted by students at the Institut de la Francophonie pour la Médecine Tropicale (IFMT). In the Luang-Prabang and Sekong province hospitals, training on hand hygiene was also organized for medical personnel to raise awareness about this essential step.
Addressing a major public health issue
Healthcare-associated infections affect hundreds of millions of patients in the world each year. These infections can cause serious illness, increased hospital stays, long-term disability and additional costs for patients and healthcare systems.
In this context, rubbing hands with hydro-alcoholic gel has become systematic in hospitals and clinics in developed countries. Due to their bactericidal, virucidal and fungicidal properties, hydro-alcoholic solution enables rapid and efficient hand hygiene. However, in developing countries, due to the lack of resources to purchase industrially produced gels, hand cleaning is often done with just soap and water, thereby limiting its practice between patients.
Local production of hydro-alcoholic gel
This initiative made it possible to establish hydro-alcoholic gel production units in the Luang-Prabang and Sekong province hospitals. Each hospital designated an area for preparation and a manager trained in producing and distributing the product. The solution uses a formula based on the one recommended by WHO (1), which comprises products that are available locally: ethanol, hydrogen peroxide, glycerin and water. Local reagents were supplied to start the production and hospitals are responsible for buying reagent stocks for future production to ensure its sustainability.
The development of these production units was based on the experiment carried out in 2011 by Caroline Leyer (International Volunteer at Fondation Merieux, 2011-2012) who created a production unit for hydro-alcoholic solution at the Thakhek hospital laboratory.
A WHO Project
By launching a first global challenge for patient safety called ’Clean Care is Safer Care’, WHO is asking all countries to increase hand hygiene awareness and understanding.(2)
(1) WHO 2009: Guidelines on Hand Hygiene in Health Care
(2) WHO 2010 : Overview of WHO Guidelines for Hand Hygiene in Health Care
A successful South-South collaboration between Madagascar and Mali
A pilot training program for laboratory technicians was organized at the Charles Mérieux Infectiology Centre (CICM) of Madagascar. Part of the Madagascan Minister of Health’s programme to reinforce the country’s network of laboratories, the programme was supported by the Agence Française de Développement (AFD).
Fourteen laboratory technicians from seven regional hospitals took part in the training, which covered immunology and bacteriology for the surveillance of diseases with the potential to become epidemic.
he courses were taught by three trainers who contribute to Fondation Mérieux programs at the CICM of Mali : Prof. Mahamadou Diakité, professor of immunology at the Bamako Malaria Research and Training Center and Dr. Seydou Diarra, Head of Bacteriology at the National Public Health Research Institute. They were supported by Aimé Césaire Kalambry, a monitor of laboratory work and a graduate from the first class of the BAMS* program at the CICM of Mali.
Dr. Seydou Diarra, who has contributed to networking programs in Mali (Action Biomali) and in West Africa (RESAOLAB) since 2005, was also able to visit laboratories and share his experience with his Madagascan colleagues.
Following this first success, the initiative will be continued, taking advantage of the expertise of West African partners, thanks to funding for strengthening the laboratory sector, in partnership with Fondation Mérieux.
*Bachelor of Science in Biological and Applied Medical Sciences (BAMS)
14th ADVAC Advanced Vaccinology Course Goes Green
80,000 pages of printed material were replaced by digital versions and each participant was provided with a personal tablet for the duration of the course that could also be used for note-taking. This pilot initiative was well-received and should be implemented more widely at future meetings at Les Pensières.
For Paul-Henri Lambert, ADVAC Course Director, University of Geneva: "ADVAC has entered in a new era through this move to digital technology. This will not only save trees and considerably reduce the extra weight all participants have to carry back at the end of the course, but it will also show the way for future international conferences."
Held annually at Les Pensières for the past 13 years, ADVAC brings together 65 participants and as many international speakers for 11 days of knowledge-sharing. The course is organized by Fondation Mérieux and the University of Geneva with the co-sponsorship of the European Commission (ADITEC project) and the World Health Organization.
ADVAC was designed for public and private sector scientists and decision-makers involved in vaccine development, in the elaboration of new vaccination strategies or in policy decisions, at national and international levels. Every year participants come from every continent and the Bill & Melinda Gates Foundation offers fellowships for those attending from developing countries.
Leading figures in the field of vaccines lecture on subjects ranging from organizing clinical trials and introducing new vaccines into vaccination programs, to vaccine safety and ethical issues. This very comprehensive overview of the field is intended to facilitate critical decision-making in vaccinology.
ADVAC participants receive a diploma and the course has been awarded 60 CME credits by the European Board for the Accreditation of CME in Infectious Diseases (EBAID) and by the European Union of Medical Specialists (UEMS).