ESPID Reports And Reviews
32nd Annual Meeting of the European Society for Pediatric Infectious Diseases in Dublin, Ireland Karina Butler, MB, BCh, FRCPI
T
he 32nd European Society for Pediatric Infectious Diseases (ESPID) annual meeting was held in Dublin, Ireland, from May 6th to 10th, 2014. Since its founding in 1983, ESPID has grown to include almost 1200 members from Europe and, increasingly, from other continents. ESPID’s annual meeting provides an excellent forum for clinicians and scientists interested in the many aspects of infectious diseases including clinical practice, research, education and training and vaccinology to meet, network, learn and to enjoy the conviviality of the atmosphere. More than 2500 participants from 96 countries attended this year meeting, confirming ESPID’s position as a truly global pediatric infectious diseases meeting, the theme for which was “Pediatric Infection: The Global Challenge.” Through the work of the International Scientific Committee and the Local Organizing Committee, a program was developed that encompassed problems of the developed and the developing world, that broadened horizons through cuttingedge research presentations and, importantly, that informed daily clinical practice, thus striving to meet the ESPID goal “Excellence in Paediatric Infectious Disease.” ESPID aims to inspire, nurture, develop and educate the next generation of pediatric infectious disease investigators and clinicians. “Young ESPID” is a dynamic and important group within the ESPID membership who ensures that the voice of trainees and young investigators is well articulated and heard. The “Young ESPID” meeting took place just prior to the Educational Workshop and goals for 2015 and beyond were outlined. The very popular clinically oriented Walter Marget Educational Workshop, coordinated Accepted for publication August 11, 2014. From the Department of Infectious Diseases and Immunology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland. The author has no funding or conflicts of interest to disclose. Address for correspondence: Karina Butler, MB, BCh, FRCPI, Department of Infectious Diseases and Immunology, Our Lady's Children's Hospital Crumlin, Dublin 12, Ireland. E-mail: [email protected]. Copyright © 2014 by Lippincott Williams & Wilkins ISSN: 0891-3668/14/3311-1180 DOI: 10.1097/INF.0000000000000515
by Dr. Hermione Lyall (UK), brought together 12 experienced faculty members to provide an excellent educational day for trainees. On this occasion topics selected for in-depth discussion included central nervous system and respiratory infections, congenital and neonatal infections antibiotic resistance and difficultto-treat organisms. There was also great scope for young investigators to present original work in the daily short oral abstract presentations, poster walks and poster presentations. Support and development of the young investigators was also the focus of the 6th ESPID Research Masterclass, organized by Dr. Pierre Smeesters (BE), supported by a faculty of ESPID senior and junior researchers and held immediately following the meeting. It provides opportunities for young researchers to present their studies in a collegial forum for analysis and discussion. The premeeting industry sponsored satellite vaccinology symposia, and facilitated robust discussion on many of the issues confronting those tasked with the development and harmonization of immunization guidelines. Topics covered during the course of 7 symposia included optimizing protection against the common bacterial pathogens including pneumococcus, meningococcus and pertussis, improving implementation of vaccine programs for influenza and human papilloma virus and further unraveling of respiratory syncytial virus pathogenesis to inform preventive strategies. In opening the meeting, Prof. Ron de Groot (NL), President of ESPID, spoke of the important contribution of ESPID in advancing pediatric infectious disease knowledge, through educational programs, talks and presentations at the annual meeting, and the informal networking facilitated by meeting. With a few carefully learned and well-chosen Irish words, he wished delegates an enjoyable stay and a productive meeting. Prof. Karina Butler (IRL), Congerence Chair, thanked delegates for taking time from their busy schedules to attend ESPID, highlighted their importance in making it a successful event. Success would be achieved if, through the meeting, delegates increased their own knowledge and understanding and, in turn, shared that knowledge with others on their return home. Mr. Oisín
Quinn, Lord Mayor of Dublin, officially opened the meeting acknowledging the tremendous accomplishments in the field. He recognized the continuing challenges of emerging and re-emerging infections, the development of antimicrobial resistance and equity of access to care. He commended all those attending for their endeavors and concluded by warmly welcoming all to Dublin. An absolute highlight of the meeting was the opening session. Prof. Mike Ryan, the World Health Organization (WHO) Middle East Polio Response Coordinator and Adjunct Professor of International Health, University College Dublin, presented a compelling “Report from the Front—responding to infectious disease threat.” Prof. Ryan took us on a whirlwind tour, showing how microbes, the dominant life force on earth, have shaped our history. From plagues and pestilences of the middle ages through the 1918 influenza pandemic to current-day threats, he examined the drivers of pandemic infection from the emergent, often zoonotic outbreak, through epidemic amplification, fuelled by population density, displacement and poverty and ultimately disease propagation facilitated by rapid transit of people, animals and animal products, that can culminate in pandemic disease. He reviewed the lessons from severe acute respiratory syndrome (SARS), their application in the context of the emergence of the Middle East respiratory syndrome coronavirus and outlined the real challenges to containment presented by Ebola. The global challenge of infectious diseases has never been more apparent. From the global to the local, Prof. Fergus Shanahan, University College Cork, Ireland, dwelt on an entirely different side of the microbe–host interaction in his talk “The microbiome: controlling us or controlling them.” Links between gut microbiota, host metabolism, inflammation, chronic disease and obesity were explored. The tantalizing prospect that, through manipulation of gut microbiota, we might be able to control susceptibility to a wide array of inflammatory, metabolic and neoplastic disorders was discussed. This very exciting area of research is clearly ripe for translation to the clinical setting. Scheduling a biochemical talk for an early-morning session might seem foolhardy
The ESPID Reports and Reviews of Pediatric Infectious Diseases series topics, authors and contents are chosen and approved independently by the Editorial Board of ESPID.
1180 | www.pidj.com
The Pediatric Infectious Disease Journal • Volume 33, Number 11, November 2014
The Pediatric Infectious Disease Journal • Volume 33, Number 11, November 2014
and guaranteed to send delegates back to sleep. Such was not the case as Prof. Luke O’Neill, Trinity College Dublin, Ireland, gave a riveting talk, which was appreciated even by the most biochemistry averse. In “Future Concepts in Microbial Defence,” Prof. O’Neill guided us through the unraveling of understanding of metabolic pathways important in the control of inflammation. Much of this science originated in Prof. O’Neill’s own laboratory, which as he cheerfully pointed out lay only a 5-minute walk from the podium. The audience were reintroduced to the Warburg effect, that is, the shift from oxidative phosphorylation to aerobic glycolysis. This shift, triggered by the interaction of bacterial lipopolysaccharide with TLR4, alters metabolite production to upregulate the inflammatory response. The system appears to be fairly tightly controlled by the dimeric enzyme PKM2, targeting of which could result in a shift from the proinflammatory to anti-inflammatory state. He continued with an animated presentation of the important role of the circadian rhythm and BMAL1, the master clock regulator protein, in the proinflammatory/anti-inflammatory balance and in determining responsiveness to bacterial lipopolysaccharide. Complex, though it undoubtedly is, understanding of such basic biochemistry and host metabolic response may be key, leading not only to better management of bacterial sepsis but also to control of the wider spectrum of inflammatory and autoinflammatory syndromes. Having drilled down to analyze drivers of the inflammatory response at the biochemical and molecular level, it was time to draw back and look at the macro picture. Prof. Zulfiqar A. Bhutta, Founding Director of the Center of Excellence in Women and Child Health at the Aga Khan University in Karachi, Pakistan, and the Robert Harding Inaugural Chair in Global Child Health at the Hospital for Sick Children in Toronto, Canada, spoke of the critical importance of maternal nutrition in child health. For many children there remain very basic simple unmet needs. Addressing food security and maternal nutrition would reap enormous dividends for child health and dramatically reduce morbidity and mortality rates associated with infectious diarrheal disease and pneumonia. Over the following 2 days delegates were confronted with many difficult choices. Fortunately for ESPID members many of the presentations are available on the ESPID e-learning site: espid.multilearning.com. Annual favorites at ESPID are the Literature Review and the Interactive Case Sessions. A multinational panel, Drs. Morven Edwards (US), Shai Ashkenazi (ISR), Saul Faust (UK), Gerben Ferwerda (NL) and Andrew Cant (UK), ensured that attendees were updated on all that is “hot” in the pediatric infectious diseases literature. Prof. Nigel Curtis (AUS) and Dr. Julia © 2014 Lippincott Williams & Wilkins
Bilicki (CH) challenged both the audience and the panelists with their case conundrums. The parallel sessions on pertussis and bacterial infection and on vaccinology incorporated state-of-the-art presentations as well as original abstract presentations. Prof. Jussi Mertsola (FIN) spoke of the clinical consequences of pertussis, Prof. Kingston Mills (IRL) reported on novel pertussis vaccine developments and Dr. C. Mary Healy (US) on the successes and failures of pertussis prevention strategies. Vaccination of women against pertussis, late in pregnancy, is safe and, when timed appropriately, can be effective in protecting vulnerable neonates from the most severe consequences of this infection. Challenges to optimizing vaccination in scheduling, use of additional vaccines and managing suspected, unexpected serious adverse reactions were explored in the “Hot Topics in Vaccinology” session by Prof. Adam Finn (UK) and Dr. Hanna Nohynek (FIN). A new introduction to ESPID this year was the Special Antimicrobial Session. Prof. Mike Sharland (UK), founder of the Antimicrobial Resistance and Prescribing in European Children project, has led the charge to generate solid pediatric data and to raise awareness in Europe. The project involved the development and implementation of novel neonatal and pediatric surveillance methods to monitor antimicrobial consumption and resistance in children’s hospitals and in primary care across Europe. ESPID provided an excellent forum for presentation of some of the outputs of this project. After individual presentations pertinent to the topic, Prof. Sharland was joined by Dr. Julia Bielicki (CH) of Young ESPID, Prof. Carol Baker (US), Dr. Rob Cunney (IRL) and Dr. Dominique Monnet (SWE) for round-table discussion on combating antimicrobial resistance in children. A complimentary session was the very practical special lecture devoted to the control of hospital-acquired infections, delivered by Prof. Simon Dobson (CA). At the 32nd ESPID in Dublin, broad arrays of topics were included with symposia and lectures relating to community-acquired and hospital-acquired infections, tuberculosis, fungal infections, tropical infections, HIV/ AIDS and Kawasaki syndrome. I urge ESPID members to take advantage of the availability of webcasts from the meeting. You can hear Prof. David Burgner (AUS) lecture on the epidemiology of Kawasaki syndrome, its increasing incidence in industrialized countries and association with urbanization. He explored the case for a likely infectious etiology, possibly requiring the “double hit” of infection with more than 1 agent and examined the potential roles of host susceptibility and environmental exposure. Prof. Mike Levin (UK) in a scholarly presentation on its management indicated that it is now time to reconsider the current treatment paradigm, with earlier intervention and
ESPID Reports and Reviews
selective use of adjunctive steroid therapy for those at high risk of complications. Similarly the very popular presentations on tuberculosis diagnosis (Dr. Tom Connell AUS), treatment (Dr. James Seddon, UK), Bacillus CalmetteGuérin (BCG) vaccination and beyond (Prof. Nigel Curtis, AUS), invasive fungal infection (Prof. Emmanuel Roilides, GR), Aspergillus and mold infection (Dr. Andreas Groll, DE) and antifungal agents (Prof. Thomas Walsh, US) are now, or will soon be, available as webcasts or slide presentations. The global importance of tropical diseases was brought sharply into focus in Dublin with Prof. Peter Hotez (US) reminding us that this group of conditions— ancient diseases, endemic to the most poorly resourced areas of the world, often chronic and disabling, with higher morbidity than mortality and often stigmatizing and poverty promoting, the Neglected Tropical Diseases—affect at least one-sixth of the world’s population and account for 500,000 deaths per year. Remedies though often inexpensive are still not universally available. Systematic population-based programs, using combination pills to cover the most prevalent infections, can yield significant health dividends. Dr. Andrew Riordan’s (UK) “Tropical Diseases, Nontropical Locations,” Prof. Robert Sauerwein’s (DE) discussion on malaria and a symposium devoted to HIV/AIDS reflected the international focus of the meeting. ESPID is about building bridges, networking and information exchange. We were delighted to welcome our sister society, the Paediatric Infectious Diseases Society of America, who convened a special ESPID/Paediatric Infectious Diseases Society of America viral infection symposium. Drs. Shannon Ross (US) and David Kimberlin (US) covered the dynamic area of cytomegalovirus infection. Years after the sentinel study on ganciclovir as treatment for congenital cytomegalovirus, there remain uncertainties regarding which children to treat and for how long and temptation to treat all is strong. However, as ganciclovir is associated with the potential for serious toxicity, the importance of awaiting the outcome of well-designed, randomized controlled trials to correctly inform practice was stressed. Dr. Mark Denison (US) on emerging coronaviruses and Dr. Ravi Jhaveri (US) on Hepatitis C infection completed the session. The interest generated was reflected in the very active audience and panel discussion that ensued. Following on the success of the ESPID/WHO symposium in Milan 2013, ESPID 2014 hosted a WHO symposium convened by Dr. Robb Butler. Dr. Eli Somekh (ISR) discussed the re-emergence of Polio and roll-out of the vaccination campaign in his country. Dr. Noni MacDonald (CA) spoke of the key role of health care workers in tackling vaccine hesitancy. A theme echoed very www.pidj.com | 1181
ESPID Reports and Reviews
strongly in the Bill Marshall Lecture and again in the closing plenary. The Conference of Meningitis Organisations is an international member organization that brings together patient groups, health professionals and organizations and survivors and families, dedicated to the prevention of meningitis worldwide. The Conference of Meningitis Organisations symposium “The power of the patient voice: an essential ingredient to influence change” was a new engagement for ESPID. Allied to it was a very graphic portrayal of the effects of meningitis in a series of meningitis survivor portraits by renowned photographer Anne Geddes. This thought-provoking work served as a stimulus to all working to prevent these conditions. The final afternoon served as a memorable climax to the meeting. The “Best of ESPID” is always a highlight, wherein the present and future stars of the society can shine. This year a new award “The Education and Communication Award” reflecting the Society’s prioritization of efforts in this area found a just recipient in Prof. Mike Sharland, Professor of Pediatric Infectious Diseases at St. George’s Hospital in London (UK). Three ESPID fellowships were awarded: one to Dr. Aspasia Katragkou (GR) to undertake “A metabolomics-based investigation of antifungal therapy against Candida albicans” at the Weill Cornell Medical Center, NY, USA, and a second to Dr. Bridget Freyne (IRL) to pursue her research into the “Immunological basis of the heterologous effects of BCG immunisation in infants” in the laboratory of Prof. Nigel Curtis in Melbourne. Dr. Talia Costa (ES) received not only the third ESPID fellowship award to study “The effect of nutritional intervention on the intestinal microbiota, inflammation/immuneactivation and vaccine in vertically HIV-infected children” but also an ESPID Young Investigator award for her paper on cardiovascular risk in HIV-infected children and adolescents, “The CAROVIH study.” A second young investigator, Dr. Alexis de Rougmont (FR), was similarly honored for his work on “Qualitative and quantitative analysis of the binding of G11.4 Norovirus variants onto human blood group.” Those few delegates who had to depart prior to the final session will surely regret having missed what turned out to be a truly historic occasion. Prof. Pierre Van Damme of the University of Antwerp, Belgium, selected by the Society to deliver The Bill Marshall Lecture, the Society’s highest honor, set the scene with his most erudite talk “Education in Vaccinology Versus Vaccinology in Education.” He highlighted the reality that despite overwhelming evidence of vaccination benefit in improving public health, the cold fact remains that readily available vaccines are underutilized. While we continue to seek new vaccines, we are not yet reaping the full benefits of currently available, safe and effective vaccines. Even in
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The Pediatric Infectious Disease Journal • Volume 33, Number 11, November 2014
Europe, outbreaks of vaccine preventable diseases continue, the consequence of having a critical mass of unvaccinated susceptible individuals. Harmonization of vaccination strategies across health care providers and institutions could reduce the message dilution effect. Different messages lead to confusion. There is need for a simple, clear, uniform message as to the benefits and the necessity of vaccination. A vaccine recommended in one jurisdiction but not another can suggest that that vaccine is less important or perhaps less effective. There is an opportunity for international professional organizations, such as ESPID, to take the lead in this regard. The key role of the health care worker in determining vaccination uptake was also emphasized. The strong link between health care workers’ perception of vaccination and vaccination uptake is well evidenced. Addressing the pre-service vaccination training needs of medical students and health care workers could enable health care workers to confidently communicate about vaccine risks and benefits, increase their own confidence and security around vaccination and thus ultimately increase vaccine uptake. Vaccination education should not be confined to pre-service or in-service training of health care workers, but rather should reach out into our schools with age-appropriated educational programs for children, even at the primary school level. This talk was the perfect prelude to the concluding session. An historic triumvirate, Prof. Louis Cooper, Professor Emeritus of Pediatrics at the College of Physicians and Surgeon of Columbia University and Past President of the AAP, Prof. Samuel Katz, The Wilbur Cornell Davidson Professor and Chairman Emeritus of Pediatrics at Duke University and Prof. Stanley Plotkin, Emeritus Professor of Pediatrics at the University of Pennsylvania, joined forces on the podium to counter the real threat that, in the words of Santayana, “those who cannot remember the past are doomed to repeat it.” With success seeming just a hair breath away, a remarkable resurgence in the numbers of cases of measles, with >25 to 30,000 cases/year in Europe, has occurred. This compares with only very small numbers of cases in the Western Hemisphere, almost all of which are due to importation from other countries, including from Europe. Wars and strife, poverty and population displacement all increase the challenge facing us in the elimination of these infections but with 30,000 cases/year in Europe, efforts must focus on decreasing the susceptible population and increasing vaccine uptake. Who better than Prof. Katz, who worked with Nobel Laureate John Enders to develop the attenuated measles vaccine, Prof. Plotkin, with his pivotal role in the development of Rubella vaccine, and Prof. Cooper, who has worked tirelessly to end vaccine preventable disease, to remind us why eradication matters and to call for a redoubling of eradication
efforts. Prof. Sam Katz reviewed measles vaccine development and its impact with the successful elimination of endemic measles in the USA. Prof. Plotkin outlined why the congenital rubella syndrome (CRS) should be an easy target for elimination; the virus is restricted to the human host, the vaccine is cheap and effective and can be combined with measles vaccine for a joint eradication initiative. Prof. Cooper, in a historic review, presented the clinical face of CRS, its devastating impact on children and their families, recalling its severity and noting the underappreciation of the associated morbidity and mortality. There are >100,000 cases of CRS globally each year, some even in countries in the developed world. That these diseases, measles and rubella, can be eliminated has been demonstrated by the elimination of endemic disease in the Americas. It is an opportunity not to be missed. Thus, concluded the meeting with a real call to action, to embrace the strongly evidenced benefits of vaccination and to renew efforts towards the elimination of vaccine preventable disease starting with measles and congenital rubella syndrome. Delegates were challenged to expand their comfort zone and to engage with their local professional organizations and with ESPID in this task. The daily schedule was full with early-morning starts and late finishing. Time for less formal interactions is also important. Following the opening session ESPID hosted a welcome reception for all delegates, beginning with a most wonderful choral presentation by Anúna to an enraptured audience. This Irish choral crossover ensemble merged folklore, traditional and classical music, in a very unique way and served as a great welcome to Dublin. The celtic theme was much in evidence as the following evening speakers, faculty and invited guests were treated to a viewing of the Monastic Book of Kells and the Trinity College Library, as seen in the Harry Potter movies, thereafter to cross the cobbled courtyard to dinner in the College. On the final evening the Society Networking event took place in Dublin’s most visited tourist attraction —The Guinness Storehouse. Stress and tensions drained away as following the dinner many took to the dance floor with our very own version of an Irish Ceilí. With ESPID 2014 over, it now remains for me to thank everyone, the President and the Board for their support, the International Scientific and the Local Organizing Committee, the very excellent speakers, most importantly the delegates and of course the conference organizers Kenes. ESPID has grown as a society. The meeting now covers the full breath of pediatric infectious disease issues. I urge you to join us next year as Drs. Vokler Schuster and Michael Borte have already planned an exciting program for ESPID 2015 in Leipzig, Germany, May 12–15, 2015. I hope to see you there! © 2014 Lippincott Williams & Wilkins
32nd Annual Meeting of the European Society for Pediatric Infectious Diseases in Dublin, Ireland Karina Butler, MB, BCh, FRCPI
T
he 32nd European Society for Pediatric Infectious Diseases (ESPID) annual meeting was held in Dublin, Ireland, from May 6th to 10th, 2014. Since its founding in 1983, ESPID has grown to include almost 1200 members from Europe and, increasingly, from other continents. ESPID’s annual meeting provides an excellent forum for clinicians and scientists interested in the many aspects of infectious diseases including clinical practice, research, education and training and vaccinology to meet, network, learn and to enjoy the conviviality of the atmosphere. More than 2500 participants from 96 countries attended this year meeting, confirming ESPID’s position as a truly global pediatric infectious diseases meeting, the theme for which was “Pediatric Infection: The Global Challenge.” Through the work of the International Scientific Committee and the Local Organizing Committee, a program was developed that encompassed problems of the developed and the developing world, that broadened horizons through cuttingedge research presentations and, importantly, that informed daily clinical practice, thus striving to meet the ESPID goal “Excellence in Paediatric Infectious Disease.” ESPID aims to inspire, nurture, develop and educate the next generation of pediatric infectious disease investigators and clinicians. “Young ESPID” is a dynamic and important group within the ESPID membership who ensures that the voice of trainees and young investigators is well articulated and heard. The “Young ESPID” meeting took place just prior to the Educational Workshop and goals for 2015 and beyond were outlined. The very popular clinically oriented Walter Marget Educational Workshop, coordinated Accepted for publication August 11, 2014. From the Department of Infectious Diseases and Immunology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland. The author has no funding or conflicts of interest to disclose. Address for correspondence: Karina Butler, MB, BCh, FRCPI, Department of Infectious Diseases and Immunology, Our Lady's Children's Hospital Crumlin, Dublin 12, Ireland. E-mail: [email protected]. Copyright © 2014 by Lippincott Williams & Wilkins ISSN: 0891-3668/14/3311-1180 DOI: 10.1097/INF.0000000000000515
by Dr. Hermione Lyall (UK), brought together 12 experienced faculty members to provide an excellent educational day for trainees. On this occasion topics selected for in-depth discussion included central nervous system and respiratory infections, congenital and neonatal infections antibiotic resistance and difficultto-treat organisms. There was also great scope for young investigators to present original work in the daily short oral abstract presentations, poster walks and poster presentations. Support and development of the young investigators was also the focus of the 6th ESPID Research Masterclass, organized by Dr. Pierre Smeesters (BE), supported by a faculty of ESPID senior and junior researchers and held immediately following the meeting. It provides opportunities for young researchers to present their studies in a collegial forum for analysis and discussion. The premeeting industry sponsored satellite vaccinology symposia, and facilitated robust discussion on many of the issues confronting those tasked with the development and harmonization of immunization guidelines. Topics covered during the course of 7 symposia included optimizing protection against the common bacterial pathogens including pneumococcus, meningococcus and pertussis, improving implementation of vaccine programs for influenza and human papilloma virus and further unraveling of respiratory syncytial virus pathogenesis to inform preventive strategies. In opening the meeting, Prof. Ron de Groot (NL), President of ESPID, spoke of the important contribution of ESPID in advancing pediatric infectious disease knowledge, through educational programs, talks and presentations at the annual meeting, and the informal networking facilitated by meeting. With a few carefully learned and well-chosen Irish words, he wished delegates an enjoyable stay and a productive meeting. Prof. Karina Butler (IRL), Congerence Chair, thanked delegates for taking time from their busy schedules to attend ESPID, highlighted their importance in making it a successful event. Success would be achieved if, through the meeting, delegates increased their own knowledge and understanding and, in turn, shared that knowledge with others on their return home. Mr. Oisín
Quinn, Lord Mayor of Dublin, officially opened the meeting acknowledging the tremendous accomplishments in the field. He recognized the continuing challenges of emerging and re-emerging infections, the development of antimicrobial resistance and equity of access to care. He commended all those attending for their endeavors and concluded by warmly welcoming all to Dublin. An absolute highlight of the meeting was the opening session. Prof. Mike Ryan, the World Health Organization (WHO) Middle East Polio Response Coordinator and Adjunct Professor of International Health, University College Dublin, presented a compelling “Report from the Front—responding to infectious disease threat.” Prof. Ryan took us on a whirlwind tour, showing how microbes, the dominant life force on earth, have shaped our history. From plagues and pestilences of the middle ages through the 1918 influenza pandemic to current-day threats, he examined the drivers of pandemic infection from the emergent, often zoonotic outbreak, through epidemic amplification, fuelled by population density, displacement and poverty and ultimately disease propagation facilitated by rapid transit of people, animals and animal products, that can culminate in pandemic disease. He reviewed the lessons from severe acute respiratory syndrome (SARS), their application in the context of the emergence of the Middle East respiratory syndrome coronavirus and outlined the real challenges to containment presented by Ebola. The global challenge of infectious diseases has never been more apparent. From the global to the local, Prof. Fergus Shanahan, University College Cork, Ireland, dwelt on an entirely different side of the microbe–host interaction in his talk “The microbiome: controlling us or controlling them.” Links between gut microbiota, host metabolism, inflammation, chronic disease and obesity were explored. The tantalizing prospect that, through manipulation of gut microbiota, we might be able to control susceptibility to a wide array of inflammatory, metabolic and neoplastic disorders was discussed. This very exciting area of research is clearly ripe for translation to the clinical setting. Scheduling a biochemical talk for an early-morning session might seem foolhardy
The ESPID Reports and Reviews of Pediatric Infectious Diseases series topics, authors and contents are chosen and approved independently by the Editorial Board of ESPID.
1180 | www.pidj.com
The Pediatric Infectious Disease Journal • Volume 33, Number 11, November 2014
The Pediatric Infectious Disease Journal • Volume 33, Number 11, November 2014
and guaranteed to send delegates back to sleep. Such was not the case as Prof. Luke O’Neill, Trinity College Dublin, Ireland, gave a riveting talk, which was appreciated even by the most biochemistry averse. In “Future Concepts in Microbial Defence,” Prof. O’Neill guided us through the unraveling of understanding of metabolic pathways important in the control of inflammation. Much of this science originated in Prof. O’Neill’s own laboratory, which as he cheerfully pointed out lay only a 5-minute walk from the podium. The audience were reintroduced to the Warburg effect, that is, the shift from oxidative phosphorylation to aerobic glycolysis. This shift, triggered by the interaction of bacterial lipopolysaccharide with TLR4, alters metabolite production to upregulate the inflammatory response. The system appears to be fairly tightly controlled by the dimeric enzyme PKM2, targeting of which could result in a shift from the proinflammatory to anti-inflammatory state. He continued with an animated presentation of the important role of the circadian rhythm and BMAL1, the master clock regulator protein, in the proinflammatory/anti-inflammatory balance and in determining responsiveness to bacterial lipopolysaccharide. Complex, though it undoubtedly is, understanding of such basic biochemistry and host metabolic response may be key, leading not only to better management of bacterial sepsis but also to control of the wider spectrum of inflammatory and autoinflammatory syndromes. Having drilled down to analyze drivers of the inflammatory response at the biochemical and molecular level, it was time to draw back and look at the macro picture. Prof. Zulfiqar A. Bhutta, Founding Director of the Center of Excellence in Women and Child Health at the Aga Khan University in Karachi, Pakistan, and the Robert Harding Inaugural Chair in Global Child Health at the Hospital for Sick Children in Toronto, Canada, spoke of the critical importance of maternal nutrition in child health. For many children there remain very basic simple unmet needs. Addressing food security and maternal nutrition would reap enormous dividends for child health and dramatically reduce morbidity and mortality rates associated with infectious diarrheal disease and pneumonia. Over the following 2 days delegates were confronted with many difficult choices. Fortunately for ESPID members many of the presentations are available on the ESPID e-learning site: espid.multilearning.com. Annual favorites at ESPID are the Literature Review and the Interactive Case Sessions. A multinational panel, Drs. Morven Edwards (US), Shai Ashkenazi (ISR), Saul Faust (UK), Gerben Ferwerda (NL) and Andrew Cant (UK), ensured that attendees were updated on all that is “hot” in the pediatric infectious diseases literature. Prof. Nigel Curtis (AUS) and Dr. Julia © 2014 Lippincott Williams & Wilkins
Bilicki (CH) challenged both the audience and the panelists with their case conundrums. The parallel sessions on pertussis and bacterial infection and on vaccinology incorporated state-of-the-art presentations as well as original abstract presentations. Prof. Jussi Mertsola (FIN) spoke of the clinical consequences of pertussis, Prof. Kingston Mills (IRL) reported on novel pertussis vaccine developments and Dr. C. Mary Healy (US) on the successes and failures of pertussis prevention strategies. Vaccination of women against pertussis, late in pregnancy, is safe and, when timed appropriately, can be effective in protecting vulnerable neonates from the most severe consequences of this infection. Challenges to optimizing vaccination in scheduling, use of additional vaccines and managing suspected, unexpected serious adverse reactions were explored in the “Hot Topics in Vaccinology” session by Prof. Adam Finn (UK) and Dr. Hanna Nohynek (FIN). A new introduction to ESPID this year was the Special Antimicrobial Session. Prof. Mike Sharland (UK), founder of the Antimicrobial Resistance and Prescribing in European Children project, has led the charge to generate solid pediatric data and to raise awareness in Europe. The project involved the development and implementation of novel neonatal and pediatric surveillance methods to monitor antimicrobial consumption and resistance in children’s hospitals and in primary care across Europe. ESPID provided an excellent forum for presentation of some of the outputs of this project. After individual presentations pertinent to the topic, Prof. Sharland was joined by Dr. Julia Bielicki (CH) of Young ESPID, Prof. Carol Baker (US), Dr. Rob Cunney (IRL) and Dr. Dominique Monnet (SWE) for round-table discussion on combating antimicrobial resistance in children. A complimentary session was the very practical special lecture devoted to the control of hospital-acquired infections, delivered by Prof. Simon Dobson (CA). At the 32nd ESPID in Dublin, broad arrays of topics were included with symposia and lectures relating to community-acquired and hospital-acquired infections, tuberculosis, fungal infections, tropical infections, HIV/ AIDS and Kawasaki syndrome. I urge ESPID members to take advantage of the availability of webcasts from the meeting. You can hear Prof. David Burgner (AUS) lecture on the epidemiology of Kawasaki syndrome, its increasing incidence in industrialized countries and association with urbanization. He explored the case for a likely infectious etiology, possibly requiring the “double hit” of infection with more than 1 agent and examined the potential roles of host susceptibility and environmental exposure. Prof. Mike Levin (UK) in a scholarly presentation on its management indicated that it is now time to reconsider the current treatment paradigm, with earlier intervention and
ESPID Reports and Reviews
selective use of adjunctive steroid therapy for those at high risk of complications. Similarly the very popular presentations on tuberculosis diagnosis (Dr. Tom Connell AUS), treatment (Dr. James Seddon, UK), Bacillus CalmetteGuérin (BCG) vaccination and beyond (Prof. Nigel Curtis, AUS), invasive fungal infection (Prof. Emmanuel Roilides, GR), Aspergillus and mold infection (Dr. Andreas Groll, DE) and antifungal agents (Prof. Thomas Walsh, US) are now, or will soon be, available as webcasts or slide presentations. The global importance of tropical diseases was brought sharply into focus in Dublin with Prof. Peter Hotez (US) reminding us that this group of conditions— ancient diseases, endemic to the most poorly resourced areas of the world, often chronic and disabling, with higher morbidity than mortality and often stigmatizing and poverty promoting, the Neglected Tropical Diseases—affect at least one-sixth of the world’s population and account for 500,000 deaths per year. Remedies though often inexpensive are still not universally available. Systematic population-based programs, using combination pills to cover the most prevalent infections, can yield significant health dividends. Dr. Andrew Riordan’s (UK) “Tropical Diseases, Nontropical Locations,” Prof. Robert Sauerwein’s (DE) discussion on malaria and a symposium devoted to HIV/AIDS reflected the international focus of the meeting. ESPID is about building bridges, networking and information exchange. We were delighted to welcome our sister society, the Paediatric Infectious Diseases Society of America, who convened a special ESPID/Paediatric Infectious Diseases Society of America viral infection symposium. Drs. Shannon Ross (US) and David Kimberlin (US) covered the dynamic area of cytomegalovirus infection. Years after the sentinel study on ganciclovir as treatment for congenital cytomegalovirus, there remain uncertainties regarding which children to treat and for how long and temptation to treat all is strong. However, as ganciclovir is associated with the potential for serious toxicity, the importance of awaiting the outcome of well-designed, randomized controlled trials to correctly inform practice was stressed. Dr. Mark Denison (US) on emerging coronaviruses and Dr. Ravi Jhaveri (US) on Hepatitis C infection completed the session. The interest generated was reflected in the very active audience and panel discussion that ensued. Following on the success of the ESPID/WHO symposium in Milan 2013, ESPID 2014 hosted a WHO symposium convened by Dr. Robb Butler. Dr. Eli Somekh (ISR) discussed the re-emergence of Polio and roll-out of the vaccination campaign in his country. Dr. Noni MacDonald (CA) spoke of the key role of health care workers in tackling vaccine hesitancy. A theme echoed very www.pidj.com | 1181
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strongly in the Bill Marshall Lecture and again in the closing plenary. The Conference of Meningitis Organisations is an international member organization that brings together patient groups, health professionals and organizations and survivors and families, dedicated to the prevention of meningitis worldwide. The Conference of Meningitis Organisations symposium “The power of the patient voice: an essential ingredient to influence change” was a new engagement for ESPID. Allied to it was a very graphic portrayal of the effects of meningitis in a series of meningitis survivor portraits by renowned photographer Anne Geddes. This thought-provoking work served as a stimulus to all working to prevent these conditions. The final afternoon served as a memorable climax to the meeting. The “Best of ESPID” is always a highlight, wherein the present and future stars of the society can shine. This year a new award “The Education and Communication Award” reflecting the Society’s prioritization of efforts in this area found a just recipient in Prof. Mike Sharland, Professor of Pediatric Infectious Diseases at St. George’s Hospital in London (UK). Three ESPID fellowships were awarded: one to Dr. Aspasia Katragkou (GR) to undertake “A metabolomics-based investigation of antifungal therapy against Candida albicans” at the Weill Cornell Medical Center, NY, USA, and a second to Dr. Bridget Freyne (IRL) to pursue her research into the “Immunological basis of the heterologous effects of BCG immunisation in infants” in the laboratory of Prof. Nigel Curtis in Melbourne. Dr. Talia Costa (ES) received not only the third ESPID fellowship award to study “The effect of nutritional intervention on the intestinal microbiota, inflammation/immuneactivation and vaccine in vertically HIV-infected children” but also an ESPID Young Investigator award for her paper on cardiovascular risk in HIV-infected children and adolescents, “The CAROVIH study.” A second young investigator, Dr. Alexis de Rougmont (FR), was similarly honored for his work on “Qualitative and quantitative analysis of the binding of G11.4 Norovirus variants onto human blood group.” Those few delegates who had to depart prior to the final session will surely regret having missed what turned out to be a truly historic occasion. Prof. Pierre Van Damme of the University of Antwerp, Belgium, selected by the Society to deliver The Bill Marshall Lecture, the Society’s highest honor, set the scene with his most erudite talk “Education in Vaccinology Versus Vaccinology in Education.” He highlighted the reality that despite overwhelming evidence of vaccination benefit in improving public health, the cold fact remains that readily available vaccines are underutilized. While we continue to seek new vaccines, we are not yet reaping the full benefits of currently available, safe and effective vaccines. Even in
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Europe, outbreaks of vaccine preventable diseases continue, the consequence of having a critical mass of unvaccinated susceptible individuals. Harmonization of vaccination strategies across health care providers and institutions could reduce the message dilution effect. Different messages lead to confusion. There is need for a simple, clear, uniform message as to the benefits and the necessity of vaccination. A vaccine recommended in one jurisdiction but not another can suggest that that vaccine is less important or perhaps less effective. There is an opportunity for international professional organizations, such as ESPID, to take the lead in this regard. The key role of the health care worker in determining vaccination uptake was also emphasized. The strong link between health care workers’ perception of vaccination and vaccination uptake is well evidenced. Addressing the pre-service vaccination training needs of medical students and health care workers could enable health care workers to confidently communicate about vaccine risks and benefits, increase their own confidence and security around vaccination and thus ultimately increase vaccine uptake. Vaccination education should not be confined to pre-service or in-service training of health care workers, but rather should reach out into our schools with age-appropriated educational programs for children, even at the primary school level. This talk was the perfect prelude to the concluding session. An historic triumvirate, Prof. Louis Cooper, Professor Emeritus of Pediatrics at the College of Physicians and Surgeon of Columbia University and Past President of the AAP, Prof. Samuel Katz, The Wilbur Cornell Davidson Professor and Chairman Emeritus of Pediatrics at Duke University and Prof. Stanley Plotkin, Emeritus Professor of Pediatrics at the University of Pennsylvania, joined forces on the podium to counter the real threat that, in the words of Santayana, “those who cannot remember the past are doomed to repeat it.” With success seeming just a hair breath away, a remarkable resurgence in the numbers of cases of measles, with >25 to 30,000 cases/year in Europe, has occurred. This compares with only very small numbers of cases in the Western Hemisphere, almost all of which are due to importation from other countries, including from Europe. Wars and strife, poverty and population displacement all increase the challenge facing us in the elimination of these infections but with 30,000 cases/year in Europe, efforts must focus on decreasing the susceptible population and increasing vaccine uptake. Who better than Prof. Katz, who worked with Nobel Laureate John Enders to develop the attenuated measles vaccine, Prof. Plotkin, with his pivotal role in the development of Rubella vaccine, and Prof. Cooper, who has worked tirelessly to end vaccine preventable disease, to remind us why eradication matters and to call for a redoubling of eradication
efforts. Prof. Sam Katz reviewed measles vaccine development and its impact with the successful elimination of endemic measles in the USA. Prof. Plotkin outlined why the congenital rubella syndrome (CRS) should be an easy target for elimination; the virus is restricted to the human host, the vaccine is cheap and effective and can be combined with measles vaccine for a joint eradication initiative. Prof. Cooper, in a historic review, presented the clinical face of CRS, its devastating impact on children and their families, recalling its severity and noting the underappreciation of the associated morbidity and mortality. There are >100,000 cases of CRS globally each year, some even in countries in the developed world. That these diseases, measles and rubella, can be eliminated has been demonstrated by the elimination of endemic disease in the Americas. It is an opportunity not to be missed. Thus, concluded the meeting with a real call to action, to embrace the strongly evidenced benefits of vaccination and to renew efforts towards the elimination of vaccine preventable disease starting with measles and congenital rubella syndrome. Delegates were challenged to expand their comfort zone and to engage with their local professional organizations and with ESPID in this task. The daily schedule was full with early-morning starts and late finishing. Time for less formal interactions is also important. Following the opening session ESPID hosted a welcome reception for all delegates, beginning with a most wonderful choral presentation by Anúna to an enraptured audience. This Irish choral crossover ensemble merged folklore, traditional and classical music, in a very unique way and served as a great welcome to Dublin. The celtic theme was much in evidence as the following evening speakers, faculty and invited guests were treated to a viewing of the Monastic Book of Kells and the Trinity College Library, as seen in the Harry Potter movies, thereafter to cross the cobbled courtyard to dinner in the College. On the final evening the Society Networking event took place in Dublin’s most visited tourist attraction —The Guinness Storehouse. Stress and tensions drained away as following the dinner many took to the dance floor with our very own version of an Irish Ceilí. With ESPID 2014 over, it now remains for me to thank everyone, the President and the Board for their support, the International Scientific and the Local Organizing Committee, the very excellent speakers, most importantly the delegates and of course the conference organizers Kenes. ESPID has grown as a society. The meeting now covers the full breath of pediatric infectious disease issues. I urge you to join us next year as Drs. Vokler Schuster and Michael Borte have already planned an exciting program for ESPID 2015 in Leipzig, Germany, May 12–15, 2015. I hope to see you there! © 2014 Lippincott Williams & Wilkins
