International Congress for Tropical Medicine & Malaria

18-22 September 2016, Brisbane Australia

CONFERENCE REPORT

“Having Australia host this international conference on tropical medicine and malaria is testimony to the world class research undertaken here, and our

commitment to global health by understanding and addressing some of the world’s most devastating, but neglected tropical diseases.”

ASID President Professor Cheryl Jones The XIX International Congress for Tropical Medicine and Malaria (ICTMM 2016) was held at the Brisbane Exhibition and Convention Centre from 18-22 September, attracting over 1500 attendees, with invited speakers from 14 different countries. It was the first time for this event to be held in Australia. Topics included tropical medicine, malaria, parasitology, infectious diseases, zoonoses,

veterinary and one health, travel medicine and more. The Australasian Society for Infectious Diseases (ASID) co-hosted the Congress together with The Australian Society for Parasitology Inc (ASP). ASID’s biennial Zoonoses Conference and the inaugural Barrie Marmion Award for Research in Zoonoses were incorporated into the program.

TROPICAL MEDICINE HIGHLIGHTS: Malaria

The Congress opened with Professor John Reeder,

WHO, on the evolution of The Special Programme

for Research and Training in Tropical Diseases

(TDR), a global programme of scientific

collaboration that helps facilitate, support and

influence efforts to combat diseases of poverty.

He was followed by Dr BT Slingsby, CEO of Global

Health Innovative Technology Fund (GHIT), a

public-private partnership that leverages Japanese

innovation and leadership to advance R&D for

novel health technologies for the developing world. Innovative public-private partnerships to

stimulate R&D were a major theme of the Congress.

Read about GHIT’s new funding for a single dose antimalarial and vaccines for dengue + TB.

AUSTRALIAN MALARIA RESEARCH

From Australia, ASID’s Professor James McCarthy, QIMR, presented on the use of experimental

human malaria infection to improve the understanding of the pathogenesis of malaria and to

develop new diagnostics, drugs and vaccines. He was interviewed by Dr Norman Swan from ABC’s

Health Report in the lead up to the conference.

Listen to the Health Report interview or read the transcript

Read the study published in the MJA that suggests breath biomarkers could be exploited in a

simple, malaria breath diagnostic.

Read the study on induced blood-stage Plasmodium vivax infection in healthy volunteers.

MALARIA VACCINE WITHIN REACH

Dr Stephen Hoffman: Sanaria’s PfSPZ malaria vaccine has yielded ‘unprecedented protection in

clinical trials and is found to be safe, easily administered and protects for at least a year’. The vaccine

received FDA fast track designation during the conference. By March next year Sanaria hope to have

completed phase 2 trials to establish dosage regimen with a view to launching the vaccine in March

2019. Strategy involves pursuing 2 parallel tracks to licensure: a vaccine for use in endemic regions

and a vaccine for travellers, military and expat workers. Hoffman’s presentation focused on how to

overcome the challenges faced in using this for elimination campaigns.

Read Sanaria’s media releases on vaccine efficacy and on FDA fast track designation

Read the Nature study by pasting the link: http://dx.doi.org/10.1038/nm.4110

COLLABORATION PAVES THE WAY

Associate Professor Matthew Todd: A unique “open source” study has created a collaborative

patent-free environment that will accelerate the development of new malaria treatments, according

to lead researchers at the Univ. of Sydney. Read the media release or the research article in ACS

Dr Jorg Mohrle: A new potent antimalarial development candidate with potential for both treatment

and prevention of malaria has been identified by a collaboration between Medicines for Malaria

Venture (MMV) and an international network of partners. Read the media release.

TROPICAL MEDICINE HIGHLIGHTS: TB, HIV, Zika

Snapshot: TB Priorities for Australia

The soon-to-launched National Strategic Plan will inform

those involved in TB care but also other Commonwealth

and State and Territory Departments in areas where a

'Health in All Policies' approach is needed. The plan aligns

with WHO guidance on how to approach the elimination of

TB from the global health landscape.

For Australia this will mean targeting populations within our community that have higher rates of TB

and higher risk of developing TB. Many of these persons may not have yet arrived in Australia as

nearly 90 per cent of Australia's active TB cases were born overseas, usually in a country with high

TB incidence. TB usually takes months/years to develop after initial infection but can take decades.

Snapshot: HIV Professor Sharon Lewin updated the audience on the search

for an HIV cure. The world simply can’t afford to put

everyone with HIV on lifelong treatment, she said, and a

cure will be essential.

Today, achieving long-term remission of the virus is

considered a “functional cure” for HIV. However,

measurement of such remission needs to be standardized

across the industry to allow for better comparison of

research on this topic. Other cure studies presented include

“shock and kill” in various European countries, whereby the

virus is activated and then treated with a vaccine; and a

clinical trial of adults who initiated treatment early and then

stopped medications while being closely monitored. HIV

cure research can benefit from advances in cancer research,

as well, Lewin concluded.

Watch a video interview with Sharon Lewin

Snapshot: Zika Virus Zika Virus continued to peak interest, with Dr Federico Costa providing an update from Brazil. Their

current perspective is that ZIKV causes a congenital infection and syndrome distinct from other

causes of microcephaly. However, he raised caveats in attributing the entire burden of microcephaly

to congenital Zika syndrome. An effective response to this emergency will require systematic

investigation of pregnant women and newborns, a serologic test that detects exposure in utero and

stratifies risk among women of child bearing age, and a fundamental understanding of all modes of

ZIKV transmission in order to project future trends and risks.

Travel Medicine: A message for GPs Given the boom in travel, tropical medicine should not be considered an exotic field for GPs, writes ICTMM Presenter Dr Colleen Lau. Read her article in Medical Observer and ASID’s media release.

BURDEN OF DISEASE: Aboriginal Populations

Snapshot: Global burden of

neglected diseases

PLOS Neglected Tropical Diseases co-Editor-in-

Chief Dr Peter Hotez’ presentations brought into

sharp focus the changing health landscape, with

widespread poverty-related neglected diseases

occurring predominantly among the poor living in

wealthy G20 countries. Such findings represent a

significant departure for the way in which we usually think about global health and as a result have

important policy implications for the G20 leaders and governments. This concept - “Blue Marble

Health” - was first expressed in 2011 and is now in a new book with 38 new research papers.

Investigators are invited to continue contributing new papers to this collection. Read more in PLOS.

Indigenous Australia Dr Peter Hotez also focused on diseases of poverty in global Aboriginal populations, who account for

15 per cent of global poverty even though they comprise only 5 per cent of the global population.

In Australia, the greatest burden of neglected tropical diseases is in Indigenous populations in

remote and rural areas of the Northern Territory:

Strongyloidiasis: hyperendemic and often associated with (HTLV-1) co-infection

Hookworm: caused by Ancylostoma duodenale

Intestinal protozoan infections

Ectoparasitic scabies

Secondary group A streptococcal (GAS) infections & impetigo (extremely common)

Post-streptococcal sequelae: including glomerulonephritis and rheumatic heart disease. (In

some cases secondary staphylococcal infections occur.)

Trachoma: still common in remote rural areas, although recently the Australian government

committed to eliminating this disease.

Melioidosis (Burholderia pseudomallei' infection): also common during the wet season.

ASID Focus: Rheumatic Fever

ASID issued a media release from the Congress on Rheumatic Fever:

“Rheumatic Fever is a disease of poverty and neglect, normally associated with developing

countries. However, the highest rates of Rheumatic Fever in the world are actually found here, in

Australia’s Indigenous children.”

Professor Bart Currie, Director of RHD Australia and ASID Secretary.

The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease provides a clear opportunity to turn this around by identifying standards of care, introducing evidence based management strategies and ensuring high-risk populations receive the same standard of care as that available to other Australians. Read ASID’s media release.

TROPICAL MEDICINE HIGHLIGHTS: Paediatrics and Mycology

ASID Focus: PAM

Research presented at the Congress and then published in the Medical Journal of Australia (MJA)

drew attention to a very rare but fatal brain infection mostly affecting children. Primary Amoebic

Meningoencephalitis (PAM) is caused by amoeba such as Naegleria fowleri and is typically found in

warm fresh water, such as ponds, lakes, rivers, hot springs and poorly maintained municipal water

supplies. Rural and remote communities are particularly at risk, where hot bore water and long

surface pipelines promote the growth of large concentrations of the disease-causing amoeba. ASID

President Professor Cheryl Jones warned health professionals and communities to be on alert to

PAM with summer approaching, and respond immediately to any suspected infections by alerting

their laboratories to look for amoebae.

Read the ASID media release on PAM

Read the study in MJA

Related coverage: MJA Insight; Medical Observer

TROPICAL MEDICINE HIGHLIGHTS: Mycology

The ASID-run Tropical Mycology session at the ICTMM included presentations by Ed Zulstra, Wieland

Meyer and Isabella Gremiao.

Fungal Diagnostics in Resource Poor Settings

Wieland Meyer and Debbie Marriott

The global burden of fungal disease is difficult to assess but likely to be significantly under-estimated due to inadequate surveillance, lack of recognition of fungal infection and poor diagnostic tests.

However, it is likely that fungal infections add a substantial burden to health care making rapid, accurate and affordable diagnosis essential.

Diagnostic modalities include direct microscopy, histopathology, culture, antigen testing, molecular techniques.

This presentation discussed the pros and cons of each. Read a news article in the Lancet: “Bringing fungal infections in from the cold”

IN THE NEWS

Data from Labceutics’ Infectious Disease Lap Mapping Program Marketwired Laboratory Testing Data From More Than 19 Tropical and Developing Countries Provides Unique Insight Into Potential for Outbreak and Resistance Tracking Using Molecular Diagnostics.

Rat lungworm study sheds light on disease Hawaii Tribune Herald East Hawaii Island is the epicenter for rat lungworm infections, said ... part of the International Congress for Tropical Medicine and Malaria.

SNAPSHOT: PUBLIC HEALTH IN THE PACIFIC

ASID Focus: Antimicrobial Resistance Nicola Townell

Pacific Island countries are developing and implementing national AMS programs.

They face significant challenges: lab detection of resistant organisms + surveillance, lack of

antimicrobial guidelines, poor awareness and understanding of AMR and infection control

practices, lack of local leadership and external support.

Discussion of case study: Solomon Islands

Success of SI program dependent on multi-disciplinary educational approach w local HCW taking

ownership whilst collaborating with international supporting partners.

Labs’ ability to perform susceptibility testing and clinicians’ level of knowledge and understanding

in respect to diagnosis, management and prevention of infection requires further attention.

Read the WHO report on tackling AMR in the Solomon Islands

ASID Focus: Newly Recognised Cause of Chronic Skin Ulceration

Sally Roberts

Haemophilus ducreyi is the causative agent of chancroid, a genital ulcer disease common in developing countries.

There is increasing evidence to support its previously unrecognised role as a causative agent of

chronic skin ulceration in children in South Pacific Island Countries and Territories (PICT).

2 recent studies in PNG and SI have demonstrated high rates of H. ducreyi in skin lesions.

Additional work is needed to better understand the role of H. ducreyi in chronic skin ulceration.

Read a study by Sally Roberts in PLOS Neglected Tropical Diseases

Role of Tropical Islands in Globalising of Emerging Arboviruses Van-Mai Cao Lormeau Zika virus (ZIKV) appeared for the first time in the Pacific in 2007, expanded regionally and, in 2015,

emerged in Brazil. This study found that remote islands, with small populations mostly

immunologically naïve for new emerging arboviruses, combined with an environment highly suitable

for mosquito-borne diseases, should be considered as ideal hubs for virgin soil outbreaks of such

viruses, and subsequent geographic expansion through international travel. In addition, if remote

tropical islands experience outbreaks before more populated continental countries, such areas could

serve as sentinel sites.

Cervical Cancer Prevention in Emerging Nations Ian Frazer

The HPV vaccine has been successfully delivered to preteen girls in Bhutan and Vanuatu, but

sustaining the programs has proven challenging despite donated vaccine, and government and

community support. Different modes of cervical screening have been trialled in Vanuatu, and the

best combination of sensitivity and specificity was obtained with HPV testing amongst over 30 year

olds. The CareHPV test has been successfully delivered under tropical conditions, but central

laboratory facilities are necessary for reagent storage. Provision of QA and QC, and assuring

compliance with follow up from positive screening tests remains a challenge.

Read about in Ian Frazer in Vanuatu

BARRIE MARMION ZOONOSES AWARD “The Barrie Marmion Zoonoses Award gives us the opportunity to further shine the spotlight on our

achievements, by highlighting the best zoonoses-related research being presented here. We are thrilled to offer this award to Dr Stephen Graves, for his invaluable contribution to Q Fever research.”

Professor Cheryl Jones, ASID President

ASID’s Barrie Marmion Zoonoses Award was presented at the Congress to Professor Stephen Graves,

Director of the Australian Rickettsial Reference Laboratory, for his work on Q Fever.

Read ASID’s media release about the Barrie Marmion Zoonoses Award and find out how

you can apply for 2017.

Q Fever Fatigue Syndrome

Professor Graves provided an update on Q Fever Fatigue Syndrome, emphasising the challenges of

diagnosis and likelihood of misdiagnosis. He recommended vaccinating all Australian teenagers in

rural areas in their last year of school. “Q Fever is a preventable disease that can have disastrous

consequences,” he said.

View Professor Graves slides on what you need to know about Q Fever.

Read ‘The natural history of acute Q fever: a prospective Australian cohort’

Q Fever in Children

Associate Professor Clare Nourse presented on chronic recurrent multifocal Q fever osteomyelitis

in children. This rare manifestation of chronic Q fever infection is poorly understood, and effective

treatment options have not been established, leading the presenter to refer to it as ‘one of the most

significant clinical conundrums of today’.

Read new research by Clare Nourse and others is The Paediatric Infectious Disease Journal.

Q Fever in Companion Animals

Dr Amada Shapiro from UNSW presented on Q Fever in companion animals in Australia, reinforcing the need for vaccination in cat breeders, highlighting low awareness and touching on potential novel sources of infection requiring further study. Read ASID’s media release.

Read the article in Medical Observer

ICTMM 2016 IN PICTURES

Left: Over 1500 people attended

ICTMM 2016 from all around the

world.

Right: Conference Convenor

Professor David Looke gives his

opening address.

Below: The social program

provided multiple networking

opportunities, including a

fantastic Congress dinner at the

beautiful Lone Pine Koala

Sanctuary, which was fully

booked. Attendees enjoyed a

traditional Australian BBQ in

the world’s first and largest

koala sanctuary.

Below:

The packed Exhibition Hall had

over 18 booths and provided

excellent opportunities to

network in a favourable

environment that provided a

meeting place for all

participants.

.

Above: Malcolm Jones,

Convenor for the Australian

Society of Parasitology, receives

Honorary Life Membership of

ASID for his work in bringing the

Congress to Australia and

involving ASID as co-hosting

Society.

Right: an Early Career

Researchers Breakfast, hosted

by ASP and ASID for over 160

attendees, was very well

received and might be

replicated at other ASID

meetings and conferences.

Other events associated with

the Congress were 8

workshops, which ran

throughout the Congress, and a

Technical Tour of a Phase I

Clinical Trial facility. The

Congress was highly successful

and has significantly increased

ASID’s international profile.

We would like to say a special thank you to our Congress Sponsors

and Program Supporters.

ASID thanks all sponsors and supporters, including ASHM and its Chief

Executive Officer Levinia Crooks, for organising sponsorship of the HIV

stream, and the Marie Bashir Institute