Day 1 :
Nationwide Children’s Hospital, USA
Time : 10:00-10:40
Michael T Brady is an Emeritus Professor of Pediatrics at The Ohio State University. He is a Pediatric Infectious Diseases Clinician and Researcher. He is an Associate Editor of the 2015 and 2018 American Academy of Pediatrics Committee on Infectious Diseases Red Book. He has made presentations on Maternal Immunizations nationally and internationally
Many infectious diseases can adversely affect the health of pregnant women; adversely impact the fetus directly during gestation and cause infectious illnesses in newborn infants who are too young to receive benefit from available vaccines. Globally, 10-50% of still births are due to maternal/fetal infections; 600,000-800,000- neonatal deaths are due to infections. Maternal immunizations with vaccines targeting influenza, pertussis and tetanus have already provided improved maternal health during pregnancy, fewer adverse fatal fetal events and reduced illness in young infants. Infections in young infants frequently result in illness and the need for medical care; while some result in morbidity and even mortality. Some of these infections are due to vaccine-preventable conditions which are acquired at an age prior to completion of an effective vaccine series, e.g. influenza, meningococcal group B, pertussis. Other infections are caused by infections for which there is no currently available vaccine, e.g. group B streptococcus and respiratory syncytial virus (RSV). Utilizing vaccines more effectively during pregnancy could result in better health outcomes for the mother, her off-spring or both. Future candidates for maternal immunizations include: Group B streptococcus vaccine, respiratory syncytial virus vaccine, meningococcal group B vaccine, meningococcal conjugate vaccine (MenACWY) and pneumococcal conjugate vaccine. Considerations that will impact successful utilization of a maternal immunization strategy include: Vaccine safety during pregnancy: Mother and fetus, vaccine efficacy for mother, fetus and infant, increasing capacity and acceptance of vaccine administration by obstetric providers and cost.
- Omer SB (2017) Maternal Immunization. NEJM 2017. 374: 1256-67.
- Edwards KN (2017) Ensuring vaccine safety in pregnant women. NEJM 2017. 376: 1280-1282.
- Kourtis A P, Read J S, Jamieson D J (2014) Pregnancy and Infection. N Engl J Med 2014. 370: 2211-2218.
- Munoz FM, Bond NH, Maccato M, et al. (2014) Safety and immunogenicity of tetanus diphtheria and a cellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial. JAMA 2014. 311: 1760-1769.
- Tapia M D, Sow S O, Tamboura B, et al. (2016) Maternal immunization with trivalent inactivated influenza vaccine for prevention of influenza in infants in Mali: a prospective, active-controlled, observer-blind, randomised phase 4 trial. Lancet Infect Dis 2016. 16: 1026-1035.
Dutch Armed Forces / Royal Dutch Navy, Netherlands
Keynote: Cooperation in public health to fight infectious diseases in developing countries is good for the global economy
Time : 10:40-11:20
Stef Stienstra works internationally for several medical and biotech companies as Scientific Advisory Board Member and is also an active Reserve-Officer of the Royal Dutch Navy in his rank as Commander (OF4). For the Dutch Armed Forces, he is CBRNe Specialist with focus on (micro) biological and chemical threats and Medical- And Environmental Functional Specialist within the 1st CMI (Civil Military Interaction) Battalion of the Dutch Armed Forces. For Expertise France, he is now managing an EU CBRN CoE public health project in West Africa. In his civilian position, he is at this moment developing with MT-Derm in Berlin (Germany) a novel interdermal vaccination technology as well as a new therapy for cutaneous leishmaniasis for which he has won a Canadian Grand Challenge grant. With Hemanua in Dublin (Ireland), he has developed an innovative blood separation unit, which is also suitable to produce convalescent plasma for Ebola virus disease therapy. He has finished both his studies in Medicine and in Biochemistry in the Netherlands with a Doctorate and has extensive practical experience in cell biology, immuno-haematology, infectious diseases, biodefense and transfusion medicine.
Public health systems are not always prepared for outbreaks of infectious diseases. Although in the past several public health institutes, like the French ‘Institut Pasteur’ and the Dutch ‘Tropeninstituut‘, were prominent surveyors of infectious diseases, the investments in worldwide public health have decreased. Now more attention is given to curative healthcare compared to preventive healthcare. The recent Ebola Virus Disease outbreak in West Africa initiated a new wave of interest to invest in Worldwide Public Health to prevent outbreaks of highly contagious diseases. Zoonotic diseases are threatening as the population does not have natural nor artificial (from vaccination) immune response to new diseases like in the Ebola Virus Disease outbreak in 2014. The new strain of the Ebola Virus in West Africa was slightly less lethal, compared to other Ebola Virus strains, but the threat of spreading was far bigger as it had a longer incubation time. Most public health systems are not trained well enough to mitigate highly infectious and deadly disease outbreaks. NGO’s helping to fight the outbreak are often better trained in curative treatments and have less experience with biological (bioweapon) threats for which the military are trained for. The UNMEER mission was unique in this. It was a setting in which military and civilian actors cooperate in fighting a biological threat. Protection is essential for health workers. Smart systems have to be developed to prevent further spreading of the disease, but it is not only the biosafety, which has to be considered, but also the biosecurity, as misuse of extremely dangerous strains of microorganisms cannot be excluded. Several zoonotic infectious diseases, like anthrax, smallpox and haemorrhagic fevers are listed as potential bioweapons. Therefor both biosafety and biosecurity have to be implemented in all measures to fight outbreaks of highly infectious diseases.
- Moon S et al (2015) Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. Lancet. 386: 2204-21.
- Kamradt-Scott A et al (2015) WHO must remain a strong global health leader post Ebola. Lancet. 385: 111.
- Kieny MP, Dovlo D (2015) Beyond Ebola: a new agenda for resilient health systems. Lancet 385: 92
- Cenciarelli O et al (2015) Viral bioterrorism: Learning the lesson of Ebola virus in West Africa 2013-2015. Virus Research 210: 318-326
- Abramowitz SA et al (2015) Social science intelligence in the global Ebola response. Lancet. 385: 330
Paris University, Bichat Claude-Bernard- Hospital, France
Time : 11:40- 12:20
Eugénie Bergogne-Bérézin is Professor of Clinical Microbiology at the University Paris 7. She is Doctor in Medicine (MD and PhD), specialized in Microbiology-Infectious Diseases. She has developed.several fields of Research: 1-Acinetobacter spp as a nosocomial pathogen (epidemiology, resistance, infections); 2-Pharmacology of antibiotics tissue and body fluid distribution Pharmacodynamics of Antibiotics -3 Intestinal microbial Ecology, jejunal flora, bacterial adhesion to intestinal mucosa, impact of antibiotic therapy on intestinal flora. .She has published ~200 International Articles, 6 Medical Books, she contributed to Chapters in recent International Books of Infectious Diseases (Mosby), Pneumology (Respiratory Infection, James Pennington Ed, Raven Press), Antimicrobial Therapy (Victor Yu). She continues to work on Acinetobacter at an International level.
Human digestive tract (DT) is one of the most vulnerable organs to microbial aggressions. A natural bacterial flora in the DT is a source of maturation of immune systems: Lactobacilli, Bifidobacterium lactis contribute to children growth. Normal adult intestinal flora includes Enterobacteriaceae, Escherichia coli, Proteus spp., and anaerobes, as contributors to digestive tract functions. In adults who suffered of recurrent gastric pain, the discovery of Helicobacter pylori, Gram negative micro-aerophilic, helix-shaped organism, has been shown as responsible for gastric ulcer, Malt lymphoma, adeno-carcinoma: living in acidic areas, (upper digestive tract, 50% of elderly), treatment omeprazole+ clarithromycin has proven efficacy. Lower intestinal tract can be invaded by species responsible for diarrhea, contagious, of variable severity: Shigella, Salmonella spp, Vibrio cholerae: in countries with poor hygiene, cholera epidemics often occur. Yersinia enterocolitica, Y.pseudotuberculosis carried by pigs and contaminant to humans, determine sporadic acute gastro-enteritis, (contact with animals, contaminated food). Intestinal infections should not be treated with antibiotics systematically, as in some cases they result in aggravation, emergence of Clostridium difficile. The presence in intestinal flora of Escherichia coli resistant to β-lactams is a threat for treatment failure. E.coli resistant to β-lactams and carriage of genes of resistance became international problems. In ICU patients, disorganized flora occurs whatever treatment used: pathogenic MDR are often isolated. To re-establish equilibrium with a “normal “flora”, the development of “Fecal Microbiota Transplant” becomes extensively used ( in pills or tablets). Another option has been successful using living organisms (“probiotics”) such as fungi (Saccharomyces spp., S.boulardii sp.) can control ICU diarrhea.