nihr health protection rhuitiei dresearch unit in emerging and...
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NIHR Health Protection R h U it i E i dResearch Unit in Emerging and Zoonotic InfectionsZoonotic Infections
Tom Solomon
3/10/2014
NIHR H lth P t ti R h U it iNIHR Health Protection Research Unit in Emerging and Zoonotic Infections g g
‐ a collaboration between Liverpool and Public Health England
Tom SolomonDirector, Institute of Infection and Global Health,
University of LiverpoolMiles Carrol
P bli H l h E l dPublic Health England
Liverpool Strengths in Emerging and Zoonotic InfectionsZoonotic Infections
• Medical School Veterinary School School of TropicalMedical School, Veterinary School, School of Tropical Medicine in one city
• Decades of Zoonosis Health Protection Research– North West Zoonosis Group – UoL Centre for Comparative Infectious Diseases (Est 1994) h l l dUoL Centre for Comparative Infectious Diseases (Est. 1994)– National Consortium for Zoonosis Research (Est. 2007)
Encephalitis in England Lancet ID 2010
• Collaboration with Public Health England– 100 joint UoL/PHE publications– £13.2M in joint UoL/PHE grant funding – 9 Joint PhD Studentships
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Aedes risk and European ClimateJ R Soc Interface 2012
Emerging and Zoonotic Infections in Liverpoolin Liverpool
• Liverpool School of Tropical MedicineRonald Ross Building (£40M)
– Largest vector‐borne diseases unit in world– Containment Level III Vector Biology Laboratories
g ( )
• Institute of Infection and Global Health (Est. 2010)– Targets Emerging and Zoonotic Infections
d d l– >250 Medics, Vets, Epidemiologists, Basic Scientists– £50M of new facilities
• 250 m2 Containment Level III in vitro and in vivo
UK mosquitoes transmittingJapanese encephalitis
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Strengths & Unique Selling PointsStrengths & Unique Selling Points
Medical Veterinary“O l h”“One Health”
Basic Science Clinical Populations
UK Global
One Health? World-class researchtargeting infectious disease
www.liverpool.ac.uk/infection-and-global-health
One Health? World-class researchtargeting infectious disease
• One Health recognizes that the health of humans, animals and ecosystems are interconnected. It involves applying a coordinated, collaborative, multidisciplinary and cross‐sectoral approach to address potential or existing risks that originate at the animal‐human‐ecosystems interface.p g g y
• Regardless of which of the many definitions of One Health is used, the common theme is collaboration across sectors. Collaborating across sectors that have a direct or indirect impact on health involves thinking and working across silos and optimizing resources and efforts while respecting the autonomy of the various sectors. To improve the effectiveness of the One Health
h th i d t t bli h b tt t l b l i ti dapproach, there is a need to establish a better sectoral balance among existing groups and networks, especially between veterinarians and physicians, and to increase the participation of environmental and wildlife health practitioners, as well as social scientists and development actors.
• In less than four years, One Health has gained significant momentum. It is now a movement and it is moving fast. The approach has been formally endorsed by the European Commission, the USis moving fast. The approach has been formally endorsed by the European Commission, the US Department of State, US Department of Agriculture, US Centers for Disease Control and Prevention (CDC), World Bank, World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE), United Nations System Influenza Coordination (UNSIC), various Universities, NGOs and many others.h l h d d l h d f ll• The current One Health movement is an unexpected positive development that emerged following the unprecedented Global Response to the Highly Pathogenic Avian Influenza. Since the end of 2005, there has been increasing interest in new international political and cross‐sectoralcollaborations on serious health risks. Numerous international meetings and symposia have been held, including major initiatives in Winnipeg (Manitoba, Canada, March 2009), Hanoi (Vietnam, , g j p g ( , , ), ( ,April 2010), and Stone Mountain (Georgia, US, May 2010), as well as the first international One Health scientific congress, which took place in Melbourne, Australia, in February of 2011.
www.liverpool.ac.uk/infection-and-global-health
World-class researchtargeting infectious disease
One HealthOne Health
The health of humans animal andThe health of humans, animal and the environment are linked, and ,need to be understood together
www.liverpool.ac.uk/infection-and-global-health
Arthropod‐borne viruses
Many (70%) emerging infections are zoonotic, arthropod‐borne, or both
www.earthintransition.org/
HPRU in EZI Overarching aim: to support and strengthen PHE in its role of protecting England from emerging & zoonotic infections & threatsof protecting England from emerging & zoonotic infections & threats
Novel infectious agents; inadequate diagnostics Enhance Pathogen Detection & Characterisation
Clinical presentations poorly defined Improve Clinical Surveillance methods
Limitations to pathogen detection and clinical surveillance Optimise Epidemiological Approachesp p g pp
To identify agents most likely to emerge St th Ri k A t f E i & Z ti Th t Strengthen Risk Assessment of Emerging & Zoonotic Threats
For mosquito‐ & tick‐borne pathogens Better Understanding of Vector Biology & Climate Modelling
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
HPRU: Overarching aim: to support and strengthen PHE in its role of i E l d f i d i i f i d hprotecting England from emerging and zoonotic infections and threats
Novel infectious agents; inadequate diagnostics Enhance Pathogen Detection & Characterisation
Clinical presentations poorly defined Improve Clinical Surveillance methods
Limitations to pathogen detection and clinical surveillance Optimise Epidemiological Approachesp p g pp
To identify agents most likely to emerge St th Ri k A t f E i & Z ti Th t Strengthen Risk Assessment of Emerging & Zoonotic Threats
For mosquito‐ & tick‐borne pathogens Better Understanding of Vector Biology & Climate Modelling
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Liverpool HPRU: Overarching aim: to support and strengthen PHE in its role of protecting England from emerging and zoonotic infections and threats
Pathogen Detection &Vector Biology & Detection &
CharacterisationClimate Modelling
Clinical Surveillance
Risk Assessment of Emerging &
HPRU
SurveillanceZoonotic Threats
Epidemiological Approaches
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Emerging Hantavirus Diseasek d f l d
Analysing Hantavirus Evolution
Hantavirus in UK kidney failure patients and rats‐ Euro Surveill 2012; Lancet 2013
Pathogen Detection & Vector Biology &
Climate Modelling
Evolution
CharacterisationClimate Modelling
Acute Renal Failure
Clinical Surveillance
Risk Assessment of Emerging &
Z ti Th t
HPRU
SurveillanceZoonotic Threats
Investigations of Patient CohortsSampling of
Rattus norvegicus
Epidemiological Approaches
Patient Cohortsp gRodents
Seoul hantavirus
Studying Rat Handlers
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Theme 1: Risk Assessment of Emerging ThreatsL d M l l B t (U L) Dil M (PHE)Leads: Malcolm Bennet (UoL), Dilys Morgan (PHE)
• Project One: The zoonotic potential of j pnovel pathogens – Exploitation of animal disease databases
• Enhanced Infectious Disease (EID2) database• SAVSNET
– Structured literature mining
• Project Two: Environmental (Animal) Risks – Zoonotic pathogens in peridomestic rodents– Zoonotic pathogens in peridomestic bats
• Project Three: Risks, burden and socio‐bi l f h i i E i f ibiology of hepatitis E infection– contribution of food sources, through sampling– case control study in asymptomatic and– case‐control study in asymptomatic and
symptomatic HEV‐infected peopleLiverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Theme 2: Epidemiological Approaches L d S h O’B i (U L) R b Vi (PHE)Leads: Sarah O’Brien (UoL), Roberto Vivancos (PHE)
• Project One: Real time surveillance and response – Integrated syndromic surveillance and molecular
diagnostic systemsdiagnostic systems• Project Two: Sources of newly‐emerged
and zoonotic infections in the UK – Importation of newly‐emerged zoonotic
pathogens into the UK • Using publically available passenger travel, shipping and
product importation datasets (e.g. TravelPac, Sea‐web, UK‐trade‐info and other Office for National Statistics data)
– Identifying populations at exposure risk toIdentifying populations at exposure risk to zoonoses
• Project Three: Social and behavioural f EID daspects of EID and zoonoses
– Risky behaviours, exposure to riskLiverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Theme 3: Clinical SurveillanceL d Ni k B hi (LSTM) Ti B k (PHE) T S l (U L)Leads: Nick Beeching (LSTM), Tim Brooks (PHE), Tom Solomon (UoL)
• Project One: Improved surveillance and diagnosis of hantavirusesdiagnosis of hantaviruses– examine the relationship and link between
hantavirus and acute kidney disease• a cohort study of patients acute kidney disease of unknowna cohort study of patients acute kidney disease of unknown
origin• prospective case‐control study to examine risk factors
• Project Two: Improved diagnosis of CNS i f tiinfections– integrated molecular approach to detecting
pathogensi h t i t i t i– examine host response genes using transcriptomic
approaches• Project Three: Improving diagnosis and clinical
management of Lyme borreliosis in the UKmanagement of Lyme borreliosis in the UK. – a clinical study investigating link between
symptoms, and results of pathogen specific diagnostic testsg
– protein arrays for correlation between disease symptoms and antibody and T‐cell assays
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Theme 4: Pathogen Detection &CharacterisationLeads: Neil Hall (UoL) Roger Hewson (PHE) Jonathon Wastling (UoL) Miles Carroll (PHE)Leads: Neil Hall (UoL), Roger Hewson (PHE) Jonathon Wastling,(UoL) Miles Carroll (PHE)
• Project One: Optimising the use of ‘Omic technologies for the d t ti h t i ti d ill f ldetection, characterisation and surveillance of novel pathogens
– Humans, e.g. Hantavirus, CNS infections, CCHFReservoirs e g rodents bats– Reservoirs, e.g. rodents, bats
• Project Two: Predicting pathogen evolution and disease risk and burden
– quasispecies examination of emerging viral infections– quasispecies examination of emerging viral infections including Hepatitis E virus and Hantavirus
• Project Three: : Determining the molecular changes in tissues from individuals infected with viral hemorrhagic feverg
– increase our knowledge of virus/host cell interactions– use RNAseq &deep discovery proteomics to map changes in global
cellular and viral mRNA and protein levels in CCHFV and Ebola virus
j i i h f i k• Project Four: Determining the vector competence of ticks to support and spread CCHFV
– use high throughput transcriptomics and label‐free quantitative proteomics to identify key molecules that arequantitative proteomics to identify key molecules that are differentially expressed in different Hyalomma species infected with CCHFV.
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Theme 5: Vector Biology & Climate ModellingLeads Matthe Ba lis (UoL) Dr Jol on Medlock (PHE) Stephen Torr (LSTM)Leads: Matthew Baylis (UoL), Dr Jolyon Medlock (PHE), Stephen Torr (LSTM)
• Project One: Strategy for development of tick‐b i i f iarbovirus infection system
– establish colonies of UK indigenous ticks that may be important disease vectors for CCHF, TBE
P j T S f i k b b li i• Project Two: Strategy for tick‐borne borreliosis– tick spatial distribution modelled using historic and
contemporary climate data. d l li t d i f ti t f th– develop a climate‐driven forecasting system for the activity of Ixodes ricinus and Lyme borreliosis risk
• Project Three: Strategy for development of mosquito borne arbovirus infection systemsmosquito‐borne arbovirus infection systems– Build on CL3 JEV system to develop DENV, and CHIK
mosquito systems• Project Four: Study of the feeding preferences• Project Four: Study of the feeding preferences
of UK mosquitoes– quantify the behaviour of vectors
nationwide mosquito sampling network– nationwide mosquito sampling network– identify factors that make important contributions to
biting risk.Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Opportunities for Collaborations with other HPRUSHPRUS
• Zoonoses– Healthcare Associated Infections &
Antimicrobial resistanceAntimicrobial resistance– Gastrointestinal– Respiratory– Blood‐borne
• Modelling Methodology• Evaluation on Interventions• Emergency Preparedness and Response
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Training in Emerging and Zoonotic Infections
• Masters /Short Courses for PHE staff• PhD Studentships (22 studentships)• PhD Studentships (22 studentships)
– Including UoL funded– MRES / PhDs– Integration with International PhD Schemes
• A*STAR Singapore• Hong Kong University• NIMHANS, Bangalore India• College of Medicine, Malawi
• Academic Clinical Fellowships– Medical and Veterinary
I l di U L f d d– Including UoL funded
• Lectureships– Clinical and Non‐Clinical– UoL funded
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
HPRU In Emerging Infections: outbreak response teamoutbreak response team
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats
Current Ebolavirus outbreak
March 2014: WHO notified of an outbreak in West Africa south‐east of the Guineain West Africa, south‐east of the Guinea
• Communicable disease • Fever • Severe diarrhoea • Vomiting Hi h f t lit t• High‐fatality rate
MSF and Guinean health ministry send a team in GuéckédouFirst set of blood samples sent to Lyon BSL4 laboratory • Sample received – March 20 (13:00)
• Filovirus detected March 20th• Filovirus detected - March 20th
• Communication to WHO and MSF - March 20th
• Ebola confirmed – March 21• Sequence indicates EBOV Z – March 22WHO request to deploy EM Lab March 21
EBOV 2014
• Viral isolation in BSL4 – March 24
95Working with HG4 viruses in the field –Isolation ward – samples – mobile lab (Inactivation)....
Contribution to Ebola Response Efforts
ProgressProgressP t• Posts– Manager Appointed– PhD StudentshipsPhD Studentships– Post Docs
• Research– Ebola– Other
• Scientific Advisory Board – David Heymann, ChairW b it• Website
• Inaugural Meeting11th November Liverpool– 11th November, Liverpool
Liverpool HPRU in Emerging & Zoonotic Infections and Biological Threats