EH 4_2015

EUROPEAN HOSPITAL  Vol 24 Issue 4/15 22 INFECTION CONTROL Technology against infectious diseases The multidisciplinary plan to tackle antibiotics resistance Developing vaccines and n Spain’s response to EU dire Mélisande Rouger reports on expert reviews of vaccines in the pipeline and the potential of nanomedicine given during the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) annual meeting in Seville. Vaccination remains one of the most efficient strategies against infectious diseases, often being the best pro- tection against infections such as hepatitis B, or influenza. Vaccine science has evolved great- ly over the past few years, according to Dr Carlos Martín from the Medical Faculty, University of Zaragoza: ‘There’s been a huge advance not only preventing infectious diseases but also chronic diseases such as cancer. The hepatitis B vaccine, for instance, has significantly lowered the incidence of liver carcinoma and, with the papilloma vaccine, we will see less and less cases of cervi- cal cancer in the coming years.’ Clinic trials Most commonly, new vaccines in development use viruses or new generation of adjuvants to improve immunisation. They can use ade- noviruses such as MVA, virus-like particles, purified proteins or nano- particles. It is essential to conduct efficacy clinical trials and new technolo- gies, such as transcriptomics, could be used as potential correlates of protection to accelerate the devel- opment of a new vaccine, Martín ‘The plan is a consequence of a directive of the European Union and is coordinated by every coun- try; in Spain, the Spanish FDA is responsible for its management,’ explains Jesús Rodriguez-Baño. ‘It follows the concept of one health and includes a multidisciplinary plan involving doctors and phar- maceuticals. The idea is to regroup all our actions because the prob- lem is multifactorial; therefore the solution must be factorial as well. ‘We aim to find a common solution to a global problem. ‘There are currently very impor- tant changes in our society. People travel more than any time of human history, not only for holidays or living, but also to receive health- care. These migrations increase the risk of spreading bacteria. ‘Of course, bacteria are present in our food. Antibiotics are used in animals to increase their weight and make them larger. This technique is banned, but it is hard to control. Antibiotics are also used as a pro- phylactic technique to make sure one sick animal doesn’t infect the others. Resistance develops here explained. ‘We usually have to wait 25 years for a vaccine to be devel- oped and bringing it to the market costs between 500 and 800 million euros. In the 80s, the discovery phase was extremely long and clini- cal trials lasted about five years,’ he said. ‘We should be able to reduce the time of clinical trials with new technologies.’ Combined vaccines reduce HIV HIV is an important but complex area of innovation. Researchers have worked for the past 20 years on a prevention cure for AIDS, first as well and the meat becomes con- taminated. Importing food from a country where resistance is strong can bring this problem to other countries. Bacteria are also present in the water, which can contaminate vegetable and plants. ‘Furthermore, the global popula- tion is growing older; people need more care and the number of nurs- ing homes is rising. These environ- with inactivated viruses, and then with vaccines trying to improve T-cell response by using Adenovirus and Poxvirus. According to Martín, recent studies have shown that com- bining those two vaccines reduced HIV infection by 30%. Over 100 of malaria vaccine can- didates, studied in animals, and doz- ens of clinical trials exist for malaria. Adjuvants are just as important in the equation. A study conducted in more than 15,000 infants and young children showed that malaria vaccine RTS S candidate reduced disease over four years of follow- up. Protection is low – only in ments are highly favourable to the spread of bacteria. ‘It’s no coinci- dence that resistance is coming now. It is a consequence of antibiotics use in humans and animals, the fast-paced development of many countries and ageing population. In a nutshell, it’s a consequence of globalisation. ‘We have to think of all these aspects and find new ways to address them. There’s no answer right now, we have to think outside the box.’ What measures will Spain take? ‘Surveillance will be central to the plan. Surveillance is a complex task because resistance is not homogene- ously spread. If you do something superficially, you will not realise that an outbreak is occurring some- where and you might not be able to contain it. We need to be able to detect outbreaks anywhere to pre- vent them from spreading. ‘We are working towards having reference labs in different areas of Spain so that every single lab can rapidly isolate the bacteria and send results to obtain an answer within 48 hours. In Andalusia, for example, about 30% of the vaccinated – and reduces within a year, but approval is under study. ‘That would be the first time that a protection vaccine against malaria would be brought to the market,’ he said. Due to the human challenge, the context of vaccine development for malaria has changed tremendously. TB: Respiratory transmission route Things are also changing for TB, a disease responsible for 1,000,000,000 deaths in the past two centuries, according to an article recently mentioned in Nature. one hospital receives alarms from everywhere else in the region and provides answers quickly to control transmission as early as possible. ‘As you know, Spain is very het- erogeneous and this is why har- monising surveillance is an impor- tant part of the plan. The problem The BCG candidate has been around for over 100 years and is used worldwide. The problem is that TB’s main route of transmis- sion is respiratory, which BCG does not cover. In 1993 a mycobacte- rium bovis triggered a very resistant TB epidemic in Spain. The strain showed an increased expression of the phoP gene. The unusual outbreak killed 114 individuals and was highly transmissible by aerosol route. This spurred the creation of the MTBVAC candidate, follow- ing recommendations by the 2005 Geneva consensus criteria that two stable independent mutations (phoP and fadD26) should be used for live vaccines. Some of the newest develop- ments include vaccines against cyto- megalovirus, dengue and Japanese encephalitis, RSV and, last but not least, Ebola. The latter actually serves as a model of accelerated vaccine development, according to Martín. ‘This epidemic caught us by surprised because of its scale. But there were already candidates in macaques, so things went quickly.’ The rVSV-ZEBOV – recombinant vesicular stomatitis virus and the ChAd3-ZEBOV – chimpanzee ade- novirus 3 had already been used in clinical trials in Switzerland, the USA and Germany before December 2014. There are now Vaccine Phase 3 efficacy trial designs in Liberia and Sierra Leone. ‘By comparison, we’ve been in the developing process of a malaria vaccine for over 25 years; and in Ebola we’ve shorten this period to one year!’ Martín said. with having different communities is that management differs from one region to another.’ Do you expect improvements after November’s general election? ‘We have a very interesting situ- ation right now in Spain. There Increasingly resistant bacteria are a global problem and require innovative action from all parties concerned, says Jesús Rodriguez-Baño, President of the Scientific Committee of the annual meeting of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), which unfolded last May in Seville. Mélisande Rouger asked him why the creation of a national plan has become necessary to tackle antibiotics resistance. Jesús Rodríguez-Baño, Head of the Infectious Diseases and Clinical Microbiology Interhospital Department at Hospital Universitario Virgen Macarena, Sevilla, Spain and SEIMC 2015 President. Copyright:Shutterstock/CopyrightShilovaEkaterina

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