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current treatments for HBV in adults are licensed for children, and

trials of treatment for children during HBV



commenced. Future challenges include improved screening and

prevention through immunisation.


Combatting Bacterial Resistance in Europe

in a public-private partnership

Ron De Winter, Miquel Ekkelenkamp.

European Projects, University

Medical Center Utrecht (UMCU)

As part of its Action Plan against the rising threats from Antimicrobial

Resistance, the European Commission initiated the New Drugs 4 Bad

Bugs (ND4BB) programme. ND4BB kicked off in January 2013 with the

COMBACTE-project, aimed at improving the efficiency of research and

development of new antibiotics through open sharing of knowledge

between pharma industry and academia, and addressing the barriers

to clinical development of antibiotics. Crucially, the COMBACTE will

generate innovative trial designs to facilitate the registration of novel

antibacterial agents. This collaboration is currently supporting over

fifteen international trials, involving both (registration) clinical trials

with drugs under development and investigator-initiated research.

One of the backbones of COMBACTE is CLIN-Net, which aims to

become a premier Europe-wide network of hospitals prepared for and

experienced in performing high-quality clinical studies. The ultimate

goal is to create a self-sustaining organization active in all European

countries. CLIN-Net has an up-to-date portfolio of clinical trial sites in

all European countries that maximizes efficiency of site selection and

study performance. Alongside, LAB-Net has been established: a pan-

European laboratory network to deliver epidemiological and microbial

surveillance data to guide the selection of clinical trial sites. To this

end, COMBACTE tries to collaborate as much as possible with already

existing (national) networks.


new therapies/trials, and the management of MDR

and XDR TB

Martin Dedicoat.

Infectious Diseases, Heart of England Foundation Trust

This session will discuss the basis for current X/MDRTB treatment

regimens. New drugs and repurposed drugs will be discussed. A brief

summary of ongoing trials and the TB drug pipeline will be outlined.

The main learning outcomes will be 1. How to design an X/MDRTB

regimen 2. Using genetic and phenotypic resistance data 3. The place

of the newX/MDRTB drugs in patient management 4. Future X/MDRTB

drug regimens.

Case 3: Faecal transplant

When the drugs don

t work

But canwe

set it up in our centre?

Rishi Dhillon.

Public Health Wales Microbiology, Cardiff

Faecal Microbiota Transplantation (FMT) is a widely recognised

and accepted treatment strategy for recurrent Clostridium difficile

infection. However there are still significant barriers to implement-

ing such a service. This talk will explore some of the practical

considerations required to be taken into account when setting up a

FMT service.

Typhoidal/non-typhoidal enteric fever in sub-Saharan Africa and

the recent typhoid outbreak in Blantyre Malawi

Nicholas Feasey.

Liverpool School of Tropical Medicine

Serovars of Salmonella enterica number amongst the most common

causes of bacterial bloodstream infection (BSI) in sub-Saharan Africa

(SSA). Nontyphoidal serovars have been identified as major causes of

BSI, or invasive Nontyphoidal Salmonella (iNTS) disease across SSA in

association with HIV, malaria and malnutrition, whilst there is

disagreement about the burden of Typhoid. Both Typhoid and iNTS

disease typically present with non-focal sepsis, therefore diagnostic

microbiological facilities, in short supply in SSA, are necessary for

identification. MLW has conducted longitudinal bacteraemia surveil-

lance in Blantyre, Malawi since 1998, enabling the identification

of three epidemics of multidrug resistant invasive Salmonella disease

and facilitating a number of major genomic studies of invasive

Salmonella disease, which have identified novel clades of

S. Typhimurium and S. Enteritidis. Recent studies from across SSA

have started to clarify the true burden of both iNTS disease and

Typhoid, revealing that the different serovars are in both geographical

and temporal flux. Mortality from iNTS disease was recently at

390,000/year in 2010. Many questions remain unanswered; there

have been no clinical endpoint studies of the management of iNTS

disease, and the precise role that vaccines, WASH strategies and

treatment play in the control of these conditions remains to be


Recent discoveries around a novel typhoid toxin

Malick Gibani.

Oxford Vaccine Group, University of Oxford

The typhoid-toxin is a recently identified exotoxin expressed by

Salmonella Typhi. Converging lines of evidence suggest that typhoid-

toxin may have a central role in the pathogenesis of typhoid fever and

could account for the host-restriction properties of typhoidal

Salmonella. In addition, typhoid-toxin is a strongly immunogenic

antigen following natural infection, raising the intriguing possibility

that typhoid-toxin could be a promising vaccine candidate for

Salmonella Typhi. The lack of a meaningful animal model has, to-

date, hampered the ability to explore this hypothesis in a biologically

relevant host. A human challenge model for typhoid fever has recently

been established by the Oxford Vaccine Group, providing a platform to

study host-pathogen interactions in a controlled setting. In this talk,

we will review evidence for the role of typhoid-toxin in the

pathogenesis of typhoid fever and will present data from the human

challenge model describing the host immune response to the typhoid-

toxin. We will describe how the human challenge model is being

applied to further investigate its role, by undertaking human challenge

with a typhoid-toxin deficient strain of Salmonella Typhi. In addition,

we will describe the regulatory requirements and processes involved

in establishing human challenge models using genetically modified

strains of bacteria.

Viral infections in neonates

Paul Heath.

Paediatric Infectious Diseases, St Georges University of


Although viral infections in the neonatal unit (NU) are likely to be

more common than currently recognised, especially as causes of

neonatal sepsis

, there are several that are of particular importance.

Neonatal HSV is a rare but increasing cause of disease and disability yet

there is uncertainty as to the optimal strategy for prevention.

Congenital CMV is also associated with controversy: who should be

treated? How can it be prevented? What about treatment of

postnatally acquired CMV? The evidence base on which to base

decisions is unfortunately poor. Respiratory virus outbreaks on NNUs

are well described with RSV, enterovirus and adenovirus most

common and influenza surprisingly rare. Prevention of virus infections

by intensifying hygiene measures and cohorting infected infants

should be a major goal for NUs, as well as more common use of virus

diagnostics. Healthcare-worker vaccination against influenza is essen-

tial and encouragement of vaccination of pregnant women with

influenza vaccine is important. A maternal RSV vaccine is currently in

phase III trials and offers promise in preventing the burden of this

disease in young infants.

The global challenges of typhoid and invasive non-typhoidal

salmonella disease in 2016

Robert Heyderman.

Infectious Diseases & International Health, Division

of Infection & Immunity, University College London

Salmonella enterica is a leading cause of invasive bacterial disease

among adults and children worldwide. However, although described

in the 1800s, invasive Salmonella infection (typhoid fever or invasive

Abstracts of FIS/HIS 2016

Invited Speaker Abstracts / Journal of Hospital Infection 94S1 (2016) S1