The Wish List in Travel Medicine

Transcription

1 The Wish List in Travel Medicine Patricia Schlagenhauf-Lawlor University of Zürich Centre for Travel Medicine North Atlantic Fish Roe from Time and Place, NOMA Page 1

2 Malaria Wishes o The malaria vaccine. o The perfect prophylaxis o A non-invasive test o Perfect treatment University of Zurich, New Zealand_Pre history to future, Patricia Schlagenhauf Seite 2

3 Malaria Vaccine Road Map CSP, RTS,S Adjuvants s naturally acquired semi-immunity Nussenzweig 1960 s immunity using irradiated sporozoites 1973 Clyde et al. immunization using irradiated mosquitoes 1990 s SPf66 (Cochrane review) 2009 RTS,S Adjuvants AS01, ASO2, ISA70 et al. 30 candidates in clinical trials 2015 Target for the malaria road map: a partially effective anti-disease vaccine (50% efficacy lasting 2 years) Page Seite 3

4 Progress in development of a series of malaria vaccines RTS,S/ASO1 -> 50% efficacy set in the Malaria Road Map Additional components needed -> 80% efficacy in 2025 The next five years will see trials of well designed vaccines D.G Heppner. Travel Med Infect Dis 2013

5 Wishing for the Perfect Prophylaxis? New restrictions 2014 Priority Antimalarial for chloroquine resistant Pf (CRPF) Mefloquine* 250mg WEEKLY Atovaquone/proguanil* 250mg/100mg daily Doxycycline* 100mg daily Mefloquine restricted use Checklist, Patient Card Restrictions apply to all EU countries Will there be a gap?

6 Protective efficacy of tafenoquine 200mg daily for three days followed by 200mg weekly is similar to that of weekly mefloquine 250mg G6PD Test!

7 University of Zurich, Dublin_NECTM_Baile Átha Cliath, Patricia Schlagenhauf Seite 7

8 Wish for a non-invasive malaria test Project is based on the use of a cellphone and red laser pointer to non-invasively obtain finger blood perfusion images...and detect malaria pigment NECTM Bergen, Patricia Schlagenhauf Page 8

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10 Wish for the perfect malaria treatment Are we there yet? MEDICATION Arthemether/Lumefantrine (20mg/120mg) Riamet * ADULT DOSE 24 Tablets over 3 days Atovaquone/Proguanil (250mg/100mg) Malarone * 12 Tablets over 3 days Dihydroartemisinin/piperaquine (40mg/320mg) Eurartesim 9 Tablets over 3 days * In use effective well tolerated EMA approved NECTM Bergen Patricia Schlagenhauf

11 Travellers Diarrhoea Wishes o Forget Cook it boil it, peel it o A (patch) vaccine o Effective antibiotics NECTM, Bergen Patricia Schlagenhauf 11

12 Have you heard about NOMA? University of Zurich, Sex and gender issues in travel medicine, Patricia Schlagenhauf Page 12

13 University of Zurich, Sex and gender issues in travel medicine, Patricia Schlagenhauf

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16 Prospects for a (patch) vaccine or an effective antibiotic for travellers diarrhea? Loperamide, rifaximin, oral Cholera vaccine Dukoral, patch vaccin containing E. Coli LT toxin*, ciprofloxacin. Azithromycin *Behrens et al. Lancet Infect Dis 2014 The greatest risk of hubris to human health comes in the form of antibiotic resistant bacteria, Sally Davies WEF University of Zurich, Sex and gender issues in travel medicine, Patricia Schlagenhauf Page 16

17 A wish for more harmonisation of European travel medicine guidelines? P.Schlagenhauf/

18 Europe is worldwide leader in outbound travel circa 475 million Europeans travel annually Germany - most travel related spending 59 billion Euros Travel WITHIN Europe (402 million per annum) Other: Americas 24., Asia 21., Africa million ARRIVALS in Europe- 53% leisure, 17% business and 30% VFR

19 Challenges and Opportunities Europe is a polyglot community > 65 different languages Heterogenous practice, legal stipulations and culturally diverse neighbour states Well established institutions, great potential for networking, for collaborative research, for establishing databases The issue of standards in travel medicine? NECTM Bergen 19

20 Harmonisation of malaria guidelines...a wish becoming reality? P: Chemoprophylaxis T: Stand-by treatment CT: Stand-by treatment chloroquine NECTM BergenPatricia Schlagenhauf Page 20

21 A WISH TO KNOW THAT PRE-TRAVEL ADVICE WORKS!

22 VACCINE WISHES? YELLOW WISHES Harmonisation of WHO and IHR dogmas. Exemptions? Transit? Is one dose really enough? An urgent wish for an end to yellow fever vaccine shortages! 22

23 Human/Vet Disease and travel Travel health warnings Quarantine, border control Page 23

24 Emerging and re-emerging zoonotic infections and their impact

25 FDA have mandated new regulations on the provision and use of preventive antibiotics In animal food production...

26 Plasmodium knowlesi monkey malaria JTM 2014 Bronner et al, Sweden 2006, Kantele et al. Finland 2007 Netherlands: van Hellmond et al 2009, Link et al Germany: Ehrhardt et al. 2013, Orth et al Page Seite 26

27 Wishing for Personalized Vaccinology* based on being male and female The sex of an individual can predict susceptibility to disease AND protective immune response to vaccines More sex-based research (adequately powered) needed to identify differences in disease prevalence and response to vaccines Timing! f *Klein SL, Vaccine 2013

28 1977 FDA prohibits female participation in Phase 1 and 2 trials 1986 NIH mandatory inclusion of women in trials 2010 IOM wished that sex specific analyses should be mandatory for publication Most study results are not stratified for sex and age. The assumption is that one shoe fits all when separate is more equal Adler NE, JAMA University of Zurich, Sex and gender issues in travel medicine, Patricia Schlagenhauf 28

29 SEX BIAS Tolerability by sex Gender issues Behaviour The hormonal household Relevant for travel medicine Interventions and vaccines

30 A wish for personalised travel medicine in terms of co-morbidities and comedication PS/BUD-SYMP/

31 Co-morbidities and Co-medications A JAMA US study of adults aged 57 to 85 showed that 81% are taking at least one prescription drug, 42% at least one OTC drug and 49% are using dietary supplements. One in 25 individuals at risk for a major drug-drug interaction. 31

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33 The Wish List, Patricia Schlagenhauf