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current treatments for HBV in adults are licensed for children, and
trials of treatment for children during HBV
‘
immunotolerance
’
have
commenced. Future challenges include improved screening and
prevention through immunisation.
EU COMBACTE Group
–
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.
Tuberculosis
–
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
determined.
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
London
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
–
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