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After 2015: Infectious diseases in a new era of health and development

The United Nations Millennium Development Goals (MDGs) have provided a framework for accelerating the decline of infectious diseases, backed by a massive injection of foreign investment in low-income countries. As the MDG era draws to a close in 2015, a new set of goals will focus on poverty reduction and sustainable development. In the area of health, these new goals will take on non-communicable diseases, nutritional disorders, mental health and injuries, and risks linked to environmental and climate change. There will be a marked shift in political support and funding as the prevention and control of infectious diseases is placed in a wider context. At this critical juncture, this themed issue of Philosophical Transactions of the Royal Society B explores the frontiers of infection biology at the level of individuals (molecular, cellular, genetic, immune) and populations (demography, ecology, epidemiology). It asks how efforts to investigate and control infections will fare in the era of sustainable development, and how science can help to meet the challenge.

“At a time when infectious diseases must compete for attention on a crowded international health agenda, this collection of papers shows that infection biology is as exciting and challenging as ever, and that the ensuing discoveries can be profoundly important for public health.” Organiser Christopher Dye, World Health Organisation.

This issue of Philosophical Transactions of the Royal Society B is accompanied by a podcast interview with Christopher Dye and Anne O’Garra.

Research includes: How we will tackle infectious diseases after 2015? 5 new areas in the fight against infection; what can we do whilst the onslaught of multidrug resistant bacteria grows and we are left with a deficit of antimicrobial drugs?; and controlling malaria as pyrethroid insecticide resistance spreads.

After 2015: infectious diseases in a new era of health and development

by Dye, Christopher

The paper spotlights five aspects of the fight against infection beyond 2015, when the MDGs will be replaced by a new set of goals for poverty reduction and sustainable development. These aspects are: exploiting the biological links between infectious and non-infectious diseases; controlling infections among the new urban majority; enhancing the response to international health threats; expanding childhood immunization programmes to prevent acute and chronic diseases in adults; and working towards universal health coverage. By scanning the wider horizon, infectious disease specialists have the chance to shape the post-2015 era of health and development.

The role of vector control in stopping the transmission of malaria: threats and opportunities


by Hemingway, Janet

Mosquitoes transmit several diseases including malaria. The major methods of malaria control are use of insecticide treated bednets, or indoor spraying of insecticide on walls. Scaling up of these interventions over the last decade has reduced malaria deaths by a third. This progress is now threatened by the rapid selection of intense pyrethroid insecticide resistance. A Public-Private Partnership is working with industry to develop the next generations of public health insecticides, but these will take at least 6 – 9 years to reach the market. Plans to manage this growing resistance issue need to be put in place in the interim using available mosquito control interventions.

Human genetics of tuberculosis: a long and winding road


by Abel, Laurent; El Baghdadi, Jamila; Bousfiha, Ahmed Aziz; Casanova, Jean-Laurent; Schurr, Erwin

Tuberculosis (TB) is not exclusively an infectious disease, as only a small fraction of those individuals exposed to Mycobacterium tuberculosis develop clinical disease. Evidence has accumulated that TB is also a genetic disease, and human genetic factors have been recently identified in resistance to TB infection, severe childhood TB, and, to a lesser extent, in pulmonary TB. Refined genetic studies are being conducted in these TB-related phenotypes, taking advantage of new genomic technologies. Identification of the human genetic variants controlling key steps of TB pathogenesis are expected to have major implications for TB control and the development of novel treatments.

Immune responses during spontaneous control of HIV and AIDS: what is the hope for a cure?

by Saez-Cirion, Asier; Jacquelin, Beatrice; Barré-Sinoussi, Francoise; Müller-Trutwin, Michaela

The “towards an HIV cure” initiative aims to eradicate HIV or at least bring about a lasting remission during which the host controls infection without treatment. Cases of spontaneous and treatment-induced control offer substantial hope. We discuss the immunological lessons learned by studying spontaneous control of viremia and/or disease progression in human HIV infection and animal models. We describe the impact of early virus-host interactions on the outcome of infection and explain why chronic inflammation, a hallmark of HIV infection, might be an obstacle for remission. Future therapeutic strategies might need to combine anti-viral and immunological approaches. Contact: Dr Michaela Müller-Trutwin, Institut Pasteur, [email protected]

The contribution of vaccination to global health: past, present and future

by Greenwood, Brian

Vaccination has made a major contribution to global health since the discovery of smallpox vaccine by Edward Jenner in 1796. Smallpox and rinderpest, an important disease of cattle, have been eradicated and large reductions have been achieved in the incidence of many serious childhood infections such as measles. Developing vaccines against more complex organisms, such as the malaria parasite, has proved challenging but steady progress is being made and an increasing number of sophisticated technologies are being applied to vaccine development. In the future, vaccines are likely to be used in preventing some non-infectious as well as infectious diseases. Contact: Prof. Brian Greenwood, London School of Hygiene and Tropical Medicine, [email protected]

The contribution of mass drug administration to global health: past, present and future

by Webster, Joanne; Molyneux, David; Hotez, Peter; Fenwick, Alan

Mass Drug Administration (MDA) is a means of delivering safe and inexpensive essential medicines to treat people at risk from highly debilitating Neglected Tropical Diseases (NTDs). The combined cost of treating an individual for seven of these NTDS is 25-pence per person per year. More than 700 million people now receive treatment annually and activities have recently been expanded. MDA helps reduce the burden of disease, and hence poverty, amongst the poorest sector. It has made significant improvements to global health and productivity, and has the potential for further successes, particularly where incorporated into sanitation and education programmes.

The on-going challenge of latent tuberculosis


by Esmail, Hanif; Barry 3rd, Clifton; Young, Douglas; Wilkinson, Robert

In order to make progress towards eliminating tuberculosis as a public health problem we need to focus greater attention on the reservoir from where tuberculosis arises, healthy people with latent tuberculosis infection. We urgently need improved diagnostic tests that are better able to predict who will progress to developing infectious active tuberculosis and more effective drugs or new vaccines that can prevent this from occurring. This article outlines some of the ways in which we can make progress towards this goal.

The application of transcriptional blood signatures to enhance our understanding of the host response to infection: the example of tuberculosis


by Blankley, Simon; Berry, Matthew; Graham, Christine; Bloom, Chloe; Lipman, Marc; O’Garra, Anne

New approaches to define factors underlying the immune response to infectious diseases such as tuberculosis are needed to develop new diagnostics and treatments. Comparing the blood response using microarray technology to show changes in expression of genes during infectious diseases is helping to advance knowledge of disease pathways and help distinguish diseases with similar clinical presentations. This will help in development of future treatments, diagnosis and improve the management of clinical infectious diseases.

The coverage and frequency of mass drug administration required to eliminate persistent transmission of soil-transmitted helminths


by Anderson, Roy; Truscott, James; Hollingsworth, Deirdre

New analyses are presented to examine whether mass drug administration (MDA) alone can eliminate the transmission of soil-transmitted helminths (STHs), one of the major neglected tropical diseases afflicting poor communities in developing countries. The research suggests that in all but low transmission settings, the treatment of pre-school (pre-SAC) and school (SAC)-aged children is unlikely to drive transmission to a level where the parasites cannot persist. High levels of coverage are required in pre-SAC, SAC and adults, if MDA is to drive the parasite below the breakpoint under which transmission is eliminated. Long-term solutions to controlling helminth infections lie in concomitantly improving the quality of the water supply, sanitation and hygiene (WASH).

Heritable strategies for controlling insect vectors of disease


by Burt, Austin

Mosquito-borne diseases are causing a substantial burden of mortality, morbidity, and economic loss in many parts of the world, despite current control efforts, and new complementary approaches to controlling these diseases are needed. One promising class of new interventions under development involves the heritable modification of the mosquito, including the insertion of Wolbachia endosymbionts into the cytoplasm or novel genes into the nucleus. Once released into a target population, these modifications can act to reduce one or more components of the mosquito population’s vectorial capacity (e.g., the number of female mosquitoes, their longevity, or their ability to support development and transmission of the pathogen). Some of the modifications under development are designed to be self-limiting, in that they will tend to disappear over time in the absence of recurrent releases (and hence are similar to the sterile insect technique [SIT]), whereas other modifications are designed to be self-sustaining, spreading through populations even after releases stop (and hence are similar to traditional biological control). Several successful field trials have now been performed with Aedes mosquitoes, and such trials are helping to define the appropriate developmental pathway for this new class of intervention.

Edited and compiled by: Christopher Dye and Anne O’Garra


Please note that both the media summaries and the journal issue itself represent the views of the authors and not the position of the Royal Society.

Philosophical Transactions of the Royal Society B