nihr health protection rhuitiei dresearch unit in emerging and...

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


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.


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


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


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: 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


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


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


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.


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


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


HPRU In Emerging Infections: outbreak response teamoutbreak response team


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

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