Authors: Martha Powell, Future Science Group
Antimicrobial resistance continues to be a hot topic, with a report this year suggesting an increase in the number of deaths due to resistant infections in Europe, and a UK Government committee highlighting that resistance should be a ‘top five policy priority’. In our campaign for World Antibiotic Awareness Week (12–18 November), we looked at some key statistics surrounding resistance, and asked whether the awareness campaigns for antibiotic stewardship and sepsis have conflicting messages?
Current threats to global public health as a result of bioterrorism are not out of the realm of possibility. In February we took a closer look at biothreats with regards to technology and identification, data science and storytelling, as well as providing an overview of the field in our animated video.
Candida auris hasn’t ceased to be a big issue this year, with multi-use thermometers linked to a large UK outbreak. We spoke to Ana Litvinseva from the CDC (GA, USA) about this emerging infection and the research being carried out by the CDC. In addition, we highlighted both this pathogen and the burden of fungal infections more broadly in our #TalkFungi twitter chat in aid of Fungal Awareness Week (1–5 October).
In May the WHO published its first ever Essential Diagnostics List, a catalog of tests required to identify the most common conditions and a number of global priority diseases. The list will hopefully allow countries to update or develop their own list of essential diagnostics and will be constantly reviewed, with an updated version due in mid-2019.
The Democratic Republic of Congo has seen two Ebola outbreaks this year. The first outbreak in May was controlled swiftly; however, the second (ongoing) outbreak has faced challenges with the security and safety of healthcare workers owing to the instability of the area. In other news, a new species of Ebolavirus, termed the Bombali virus, was discovered in bats.
The UK experienced a bad flu season in 2018 with ‘Aussie flu’ (H3N2) causing bed shortages in many hospitals. However, it was an interesting year for flu research as scientists uncovered that previous influenza virus exposure could enhance susceptibility to subsequent infection, with individuals born during the 1957 H2N2 Asian flu pandemic having higher mortality risk during subsequent outbreaks. In addition, we looked into influenza in pregnancy and researchers working on universal flu protection had success using antibodies derived from llamas!
Rising levels of STIs have been a concerning trend of-late and gonorrhea has been no exception, with rising cases in the USA and the UK. Drug resistance presents an additional challenge; it was reported this year that Neisseria gonorrhoea continues to show high levels of azithromycin resistance across Europe. In addition, the first complete comparison of gonococcal gene expression and regulation in women and men revealed potential sex differences.
The HPV vaccine has been a huge success, with an 86% decrease in HPV infections in women aged 16–21 since its introduction in 2008. 2018 saw a recommended change in guidelines for HPV vaccines, with the Joint Committee on Vaccination and Immunisation (UK) arguing that a program to vaccinate school-age males would clearly provide direct protection against HPV infection and associated diseases.
Cutting inappropriate prescriptions is a huge part of antibiotic stewardship; however, there have been some concerning reports, with Public Health England (UK) estimating that 20% of antibiotic prescribing is inappropriate. Across the pond at IDWeek (3–7 October, CA, USA) it was reported that nearly half of outpatient antibiotic prescriptions were written without an infection-related diagnosis. But stewardship doesn’t just relate to healthcare providers, as a survey suggests that nearly three-quarters of parents who keep leftover antibiotics shared them with others, prompting calls for more patient education.
Julaca, the first two-drug regimen for the maintenance treatment of HIV-1 infection, gained its FDA approval in 2017, and 2018 saw increased evidence for the regimen as Phase III trials assessing the safety and efficacy of switching individuals from a three- or four-drug antiviral regimen onto Juluca presented positive results.
Organs from hepatitis-infected donors are often discarded; however, they could be a useful resource for those on the waiting list for transplants. This year, a study demonstrated that 20 patients who received hepatitis C-infected kidneys were all cured following antiviral treatment post-transplant. Moreover, the kidney function was similar to non-infected organs suggesting this as a valuable option in the future.
Despite control efforts, in September a new study reported that the incidence of visceral leishmaniasis in Brazil has risen 53% between 1990 and 2016, suggesting that region-specific control measures could be the way to tackle this neglected tropical disease.
2018 saw the first ever case of monkeypox diagnosed in the England, believed to have been contracted in Nigeria before travel the UK. This was not the only travel-related diagnosis this year, as a week earlier an individual in the UK was diagnosed with MERS, possibly picked up in the Middle East. These cases, and a MERS case in the United Arab Emirates, highlighted the challenges we face in an increasingly globalized world.
Another emerging infection, Nipah, hit the headlines in June this year when over ten individuals died from an outbreak in Kerala (India), including a nurse who was thought to have contracted the virus via human-to-human transmission. Fatality rates for Nipah have been reported as up to 70%, making the development of a vaccine a priority.
One of the most exciting developments in stem cell research in the past few years has been the development of organoid systems. This year, we looked at how organoids can be used as a model to study infectious diseases and spoke to Christina Faherty (Massachusetts General Hospital, MA, USA) about her research using organoids to elucidate the pathophysiology of enteric infections.
Plasmodium vivax has had an exciting year: for example, liver and bone marrow were uncovered as new reservoirs where the parasite might accumulate undetected, potentially leading to improved diagnostics. In addition, the US FDA approved the first drug for this parasite in 50 years when single-dose Krintafel (tafenoquine) was given the green light for the prevention of relapse in P. vivax infections.
2018 has seen two companies drop out of the infectious disease industry. In May, Allergan (Dublin, Ireland) announced plans to sell its infectious disease business to focus on four core areas. Following this, in July, Novartis (Basel, Switzerland), announced it will close its antibacterial and antiviral research activities in Emeryville (CA, USA), cutting approximately 140 jobs, and also narrowing its R&D focuses.
In the first 6 months of 2018, over 41, 000 children and adults in the WHO European Region were infected with measles – a record high as this number exceeds the 12-month totals for every other year this decade. This is a concerning trend, especially in light of research presented at ECCMID (21–24 April, Madrid, Spain), which suggested that measles remains a ‘serious threat’ for those under 2 years old.
Standard treatment of sepsis currently involves high doses of antibiotics to fight the infection; however, this year new evidence came to light that could lead to potential novel therapies. For example, in March it was reported that an IL-7 drug could be used in sepsis patients to boost their adaptive immunity, improving survival rates. In addition, researchers identified that exposing mice to particular microbes increased their blood levels of IgA antibodies, which protected them against polymicrobial sepsis.
New research has suggested 3D printing and related innovations could be used to help in antimicrobial resistance research, from new HP D300e Digital Dispenser BioPrinters for rapid susceptibility testing to a 3D printed box capable of analyzing more than 6000 samples of bacteria at a time.
2018 saw the first ever high-level political meeting on tuberculosis, which occurred at the UN’s General Assembly, and hoped to spark action on this disease. We highlighted some of the issues surrounding tuberculosis in March, via our #TalkTB Twitter chat. Moreover, we’ve covered cutting-edge research on this disease, including a novel non-antibiotic tested in animals and variations uncovered in tuberculosis care in India.
A report released in May this year has shown that infection rates of diseases transmitted via the bite of an infected mosquito, tick or flea have tripled in the USA since the year 2004. Following this, leading scientists from the National Institute of Allergy and Infectious Diseases (MD, USA) warned that tick-borne disease are a growing threat, highlighting the need for research developing diagnostics and vaccines.
Researchers reported the first citywide deployment of Wolbachia in August, demonstrating protection from Aedes-transmitted arboviruses – specifically dengue – as a result. Over 28 months the team reported that Wolbachia frequencies remained stable and that no local dengue transmission has been confirmed in the area.
With an urgent need for new therapies to treat drug-resistant infections, the year saw several promising studies for new strategies, such as CRISPR-based antimicrobials. For Gram-negative bacteria, optimized arylomycins were found to be potent, leading researchers to suggest they could be a new class of antibiotics. In addition, scientists found promise in immunotherapy, with small-molecule compounds designed to tag the cell surface of Gram-negative bacteria triggering the recruitment of endogenous antibodies. For Gram-positive bacteria, antivirulence inhibitors have shown potential, including molecules that block bacterial toxin formation.
2018 saw the launch of our new section dedicated to early career scientists, and we’ve had some great knowledge shared so far, from the one piece of advice to give an early career researcher to the ten things you learn during the first year of your PhD and the advice some scientists would give their younger selves!
Zika virus has shown a different side in the past year, transformed from enemy to ally in the field of cancer research, with promising results for treating glioblastoma with a Zika virus vaccine. However, the virus is still a public health problem in many countries, and new research continues to both answer and raise more questions: for example, could corneal transplantation be a potential method of transmission?