Epidemics emergency: what role for research?

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1 Epidemics emergency: what role for research? Pr Jean François Delfraissy Dr Bernadette Murgue Institut of Microbiology & Infectious Diseases 1

2 The Heavy Burden of Infectious Diseases Infectious diseases account for 26% of all deaths worldwide Leading cause of mortality in ressources limited countries Two-thirds of worldwide deaths in children <5 years old 36% 18% 15% % of deaths Pneumonia Diarrhoea Other infections Non infectious 31% 2

3 Medical and Scientific challenges Emerging diseases; zoonosis, human ecology, biodiversity Transmission of infection (mechanisms, nosocomial ) Resistance : Tuberculosis, Bacteria, MDR Infectious agents and non infectious diseases: cancer, cardiovascular, obesity, allergy, inflammation, Vaccination: new vaccines, immunity, SHS The big 3 : HIV, Tuberculosis, Malaria

4 Emergence: a global threat Newly apparent in the human population e.g. AIDS, Ebola, SRAS, H5N1, H1N1 Rapidly increasing in incidence or geographic range e.g. dengue, chikungunya, West Nile Multiresistant pathogens e.g Tuberculosis NDM-1, E. Coli (O 104)

5 Emergence: importance of zoonosis Multidisciplinary approach Humans Vectors Hosts

6 New pathogens and diseases: Year Agent Disease 1983 HIV AIDS 1983 Helicobacter pylori Peptic ulcer disease 1985 Enterocytozoon bieneusi Microsporidiosis 1986 Cyclospora cayatenensis Cyclosporidiosis 1988 Human Herpes 6 Roseola infantum 1988 Hepatitis E virus Hepatitis E 1989 Ehrlichia chaffeensis Ehrlichiosis 1989 Hepatitis C virus Hepatitis C 1989 Guanarito virus Venezuelan hemorrhagic fever 1992 Bartonella henselae Cat scratch disease 1993 Sin nombre virus Hantavirus pulmonary syndrome Sabia virus Brazilian hemorrhagic fever 1995 Human herpesvirus 8 Kaposi sarcoma 1997 H5N1 Avian influenza 1999 Nipah virus Nipah virus disease 2003 SARS Coronavirus SARS 2009 A/H1N1v Influenza pandemic 2010 NDM-1 Multiresistant bacteria 2.??????

7 A B A: Pathogens from wild life B: Pathogens from non-wild life C: Drug resistant pathogens D: Vector-borne pathogens C D Relative risk of an emerging disease event Jones et al, Nature, 451, p990, 2008

8 Passengers (thousands) Epidemics/Pandemics: the main drivers Human ecology deforestation urbanization Human activities mobility, transportation technology, economic changes Pathogen changes mutation and adaptation inter-species transfer Air Passengers, US carriers Year 5-fold increase in passenger numbers in 40 years

9 Microbiology and Infectious Diseases Key points: France 2011 Major Institutions : Institut Pasteur, Inserm, CNRS, IRD Others : ANRS, CEA, CIRAD, INRA, INVS, Universities 12% of French research forces: 300 teams, 2000 Scientists & Technical staff 18% of French biomedical publications: 5000 publications per year Translationnal and clinical research: 35 clinical units involved, including HIV and hepatits Network of vaccine research centers Large research network in ressources limited countries

10 French International Research Network

11 IMMI: main objectives Improve organization and coordination Implement research orientations Strengthen specific fields, e.g. parasitology, mycology Develop and improve research with low and middle income countries Improve responsiveness to epidemic crises: e.g H1N1

12 Responsiveness to H1N1 pandemic in France 30 research projects - Cohorts: households, infected - Case-control studies - Serosurveys - Vaccine trials and observational studies - Severe disease: ARDS - Social and Human Sciences - Diagnostics - Basic research 13m Total funding Main funders: Public: Inserm, Ministries Research and Health, ANRS Private: Roche, GSK, Fondation Mérieux

13 Assessment: The strong points IMMI/AVIESAN, reactive, flexible and well recognized as chair and coordinator of scientific acitivities Interactions with Ministries (Research & Health) and Public Health Surveillance bodies Rapid implementation of multidisciplinary projects, including with ressources limited countries teams Effective and quick responses of the regulatory agencies Data quickly reported to the French health authorities More than forty international scientific publications

14 Assessment: The weak points Difficulties to implement and maintain the projects in the absence of proper funding Complexity of the financial process: several funders Few social and human scientific teams involved No access to biological collections, nor to dedicated paltforms Few European and International collaboration

15 Research: a key factor to be prepared to respond to an epidemic threat

16 How to implement research to respond to an epidemic threat? Set up an Organisation: Decision-making body: rapid mobilisation and effective response Linked to public health surveillance Dedicated and long-term funding Define a Strategy: Mock-up cohorts «Academic» Contract Research Organization Tools for detection and identification of new infectious agents

17 How to implement research to respond to an epidemic threat? Implement Research Programme: Transdisciplinary and International research programmes based on platforms and networks Partnership with southern countries Partnership with the private sector Improve Communication: Decision-making process: expertise and KABP studies In a European and International perspective

18 Discussion New emerging diseases to come Scientific approaches are essential to control them Challenges: integrating science and practice Dealing with the diseases we have the best preparation for diseases we await What next? New reassorted influenza viruses Further antibiotic resistant pathogens New hospital-acquired infections Something entirely new!

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