Category: Infection Control

Categories : Infection ControlTags :

Strep A Immunity Could Be Acquired via Asymptomatic Infection

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This illustration depicts a 3D computer-generated image of a group of Gram-positive, Streptococcus pneumoniae bacteria. The artistic recreation was based upon scanning electron microscopic (SEM) imagery. Credit: CDC on Unsplash

Exposure to a mild or symptom-free strain of Streptococcus pyogenes (Strep A) can trigger the body’s immune response and naturally build protection, potentially solving a nearly 100-year-old mystery of immunity.

New Griffith University research, with the help of clinical scientists from the Murdoch Children’s Research Institute (MCRI), investigated how immunity developed over time as infection rates declined with age, suggesting progressive immune protection.

Strep A is a common bug which can cause painful tonsillitis and school sores in young children and teenagers.

If untreated, it can lead to rheumatic fever, rheumatic heart disease and kidney disease, conditions for which First Nations peoples in Australia suffer some of the highest reported rates in the world.

It is estimated 10-20% of children across Australia develop Strep A tonsillitis each year, with some getting the disease multiple times and requiring surgical removal of the tonsils.

By adulthood, most people have developed immunity to Strep A even though most will have only had a few bouts of tonsillitis in their life.

Senior author Associate Professor Manisha Pandey from Griffith’s Institute for Biomedicine and Glycomics said: “How this might happen has never been adequately explained as there are more than 250 distinct strains of Strep A, and immunity to one strain does not provide protection against the others.”

“To address this question, the team investigated the development of immunity using samples collected through a controlled human infection study conducted by MCRI researchers who administered a dose of Strep A which was high enough to cause tonsillitis in most, but not all.

“All participants were treated with antibiotics, regardless.

“Surprisingly, antibodies from the asymptomatic participants not only bound strongly to the exposed strain of bacteria but were able to kill the Strep A germ in a murine model of tonsillitis.”

The findings demonstrated both symptomatic and asymptomatic participants developed robust immune responses to the Strep A strain they were exposed to.

Dr Ailin Lepletier, said it had been known for many years that multiple strains of Strep A were circulating in the community and up to 30% of people had Strep A in their throats without getting sick.

“But we didn’t know this may be providing immunity to these strains, causing silent infections so that by adulthood, we have accumulated antibodies to fight most strains,” she said.

“While a person may not feel sick, their body can still learn how to fight the bacteria and remember it from childhood into adulthood.”

Professor Michael Good AO, said this mechanism of natural immunity may also apply to other common infections.

“While highly intriguing for Strep A, it is unlikely to provide a strategy for a vaccine as it would be necessary to vaccinate against each of the 250 strains,” he said.

Dr Anna Calkin, National Manager of Research at the Heart Foundation, said the findings came from research made possible through approximately $2.79 million in Heart Foundation funding.

“The findings highlight the importance of investing in research that addresses conditions disproportionately affecting First Nations peoples,” Dr Calkin said.

“By improving our understanding of how natural immunity to Strep A develops, this work may contribute to future efforts to prevent rheumatic heart disease and close longstanding health gaps.”

The research team included Griffith University Professor Daniel Kolarich, plus MCRI researchers Associate Professor Joshua Osowicki and Professor Andrew Streer.

The paper ‘Subclinical exposure to Streptococcus pyogenes drives the development of long-lived homologous immunity’ has been published in Nature Communications.

Source: Griffith University

Categories : Hospitals Infection ControlTags :

Brushing Your Teeth in Hospital Could Reduce the Chance of Catching Pneumonia

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Photo by Stephen Andrews on Unsplash

Brett Mitchell, University of Newcastle; Allen Cheng, Monash University; Nicole White, Queensland University of Technology; Peta Ellen Tehan, Monash University, and Philip Russo, Monash University

You go to hospital for treatment and to get better. But sometimes, you get something much less welcome: an infection.

Pneumonia, an infection of the lungs, is one of the most common and deadly infections people develop in hospital. Around 50 000 patients contract pneumonia in Australian hospitals every year. Around 1900 of them die from it.

It’s rarely monitored and rarely reported. And to date, few studies have looked at how it can be prevented.

But our new trial, published today in The Lancet Infectious Diseases, shows a surprisingly simple action can make a major difference: brushing patients’ teeth.

We found this can reduce the chance of getting this type of pneumonia, called non-ventilator hospital-acquired pneumonia, by 60%.

What is this type of pneumonia?

Non-ventilator hospital-acquired pneumonia occurs in patients who aren’t on a ventilator, usually outside of intensive care settings.

Patients are infected when bacteria from the mouth or throat are breathed into the lungs.

Patients who develop this type of pneumonia stay in hospital between ten and 48 days longer, and are around eight times more likely to die during their admission.

A simple intervention made a big difference

We studied 8,870 patients across three Australian hospitals to see whether improving oral care – which included tooth-brushing – could reduce this type of pneumonia.

Usually, when patients go to hospital, they don’t pack a toothbrush – especially in emergencies.

In busy hospital wards, oral care isn’t always given the attention it needs, nor are oral care products always readily available. Patients don’t always get reminders to brush their teeth and many patients need help with their oral care.

The intervention in our study was deliberately simple. We:

  • gave patients in hospital a toothbrush and toothpaste in a bag when they were admitted
  • educated patients and hospital staff about the importance of tooth-brushing. The toothbrush also had a written prompt on it – “Brush away pneumonia”
  • assisted patients who needed help with tooth-brushing
  • audited how oral care was being delivered and gave feedback to hospital wards.

We introduced the intervention into one ward at a time over 12 months at each hospital. This gradual roll-out is known as a stepped-wedge cluster randomised trial. It can test new health interventions when it’s too difficult to randomise individuals without revealing who is receiving the intervention and who isn’t.

We found that this relatively simple intervention increased the proportion of people who cleaned their teeth from 16% to 62%.

This increasing oral care led to a 60% reduction in the risk of acquiring pneumonia, from the equivalent of eight infections per month on a typical ward of 30 patients, to less than four infections per month.

This is the largest trial of its kind and the first completed across multiple hospitals.

Why does brushing teeth help?

The mouth is home to billions of bacteria. Oral hygiene often deteriorates when people are unwell, sedated, immobile, or taking certain medications.

When this happens, bacteria build up on the teeth, gums and tongue. If these bacteria are breathed in – even in tiny amounts – they can cause pneumonia.

Daily tooth-brushing reduces this bacteria. It’s a simple mechanical action with a powerful protective effect.

Yet in busy hospitals, oral care is often overlooked. Patients may not know just how important oral care is. Staff are often busy with competing priorities and oral care can be de-prioritised. There is also a general lack of understanding about the importance of oral care.

Patients can help protect themselves

One of the most important messages from our research is patients aren’t powerless. While health-care staff such as nurses play a crucial role, patients who are able to brush their own teeth can meaningfully reduce their own risk.

If you or a loved one is admitted to hospital, you can:

  • bring your own toothbrush and toothpaste
  • brush your teeth twice a day if you’re able
  • ask staff for help if you can’t
  • remind staff if oral care has been missed.

These small actions can reduce the risk of a serious, life-threatening infection.

What happens next?

Pneumonia is costly – in lives, hospital days and the financial cost of care. But because non-ventilator hospital-acquired pneumonia isn’t routinely reported, it’s often invisible.

Our research challenges the assumption that hospital-acquired pneumonia is an unavoidable complication when you go to hospital.

It also highlights the need for hospitals to monitor non-ventilator hospital-acquired infections, in the same way they monitor falls, pressure injuries and other preventable harms.

Finally, our study strengthens the case for including oral care in national infection-prevention guidelines and nursing practice.

Oral care isn’t glamorous, expensive or technologically advanced – but it works. Sometimes, the simplest interventions are the most powerful.

Brett Mitchell, Professor of Nursing and Health Services Research, University of Newcastle; Allen Cheng, Professor of Infectious Diseases, Monash University; Nicole White, Associate Professor of Statistics, Queensland University of Technology; Peta Ellen Tehan, Senior Lecturer, Monas University, Monash University, and Philip Russo, Professor, Director of Research, Nursing and Midwifery, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : Infection ControlTags :

Finding the Lock and Key for the Cryptosporidium Parasite and Its Host

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Cryptosporidium parasites. Credit: Cryptosporidiosis Laboratory. 

The Cryptosporidium parasite lives within cells that line the human intestine, but how does this pathogen find, recognise and then successfully invade these cells without triggering immunity? An international collaboration aims to find out. 

Parasites have lived on and within humans throughout history, co-evolving along with us to adjust to new climates and challenges. In some cases, this relationship has left significant genetic imprints. For example, the prevalence of sickle-cell disease in humans has been driven by selective pressure from the malaria parasite.

Cell biologist Adam Sateriale and his team at the Crick study a close relative of the malaria parasite, known as Cryptosporidium, which infects the intestinal tract of a wide range of animals, including humans. Most human infections are mild and asymptomatic, but Cryptosporidium can be deadly within immunocompromised people or very young children.  

“Certain species of the Cryptosporidium parasite are adapted to specifically invade and then live within the human intestinal lining, or epithelium,” Adam explains. “We’re interested to find out how the parasite recognises, and then successfully invades, these cells within the epithelium.”

Cryptosporidium and the malaria parasite, known as Plasmodium, diverged from one another nearly 500 million years ago, yet many of their features are conserved. Two organelles (or cellular compartments) can be found within both parasites: micronemes, which contain proteins that help parasites move, and rhoptries, which contain proteins that help parasites invade cells.

Micronemes of the malaria parasite are important vaccination targets, as proteins from these organelles are displayed on the surface of the parasite and are critical for infection. While Cryptosporidium has these invasion organelles, very little is known about their function and how they diverge from those of the malaria parasite.  

A recently awarded Wellcome Discovery grant has allowed Adam’s team to join forces with Gavin Wright’s team at the University of York and Amandine Guérin’s team at the University of Geneva to tackle these questions. Together, they will examine the function of micronemes and rhoptries and explore how Cryptosporidium specifically recognises and invades intestinal epithelial cells. To do that, they will harness the power of genetic editing.

“We’re going to use CRISPR gene editing to switch off, one by one, all the genes that code for the proteins in Cryptosporidium’s micronemes and rhoptries,” says Adam. “If the parasites can’t complete their normal functions without a particular protein, we’ll know that it’s a critical part of Cryptosporidium’s offensive strategy.”

Working together over the next five years, this multidisciplinary team are each bringing unique expertise: Adam’s team have developed CRISPR screening technology for the parasite, Amandine’s team work on Cryptosporidium invasion in detail and Gavin’s team specialise in identifying and studying cell surface protein interactions.

“Although there are many species of the Cryptosporidium parasite, some can only infect very specific hosts,” says Adam. “For instance, there are human species that can only invade and replicate within humans, suggesting a specific lock and key mechanism between the parasite and host. If we can find the essential parasite proteins that engage and unlock human cells for infection, we can then study these interactions and learn how to block them.”

He’s also excited about the impact this work could have, adding, “Ultimately this will lay the foundation for new treatments and preventions for children living in endemic areas.”

Source: Crick Institute

Categories : Infection ControlTags :

Africa CDC update on the Bundibugyo Virus Disease Outbreak

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The Bundibugyo ebolavirus outbreak is currently affecting 27 health zones in the Democratic Republic of the Congo and one district in Uganda. A cumulative total of 681 confirmed cases and 126 deaths among confirmed cases have been reported across the Democratic Republic of the Congo and Uganda, representing a case fatality ratio of 18.5%.

The Democratic Republic of the Congo remains the main focus of the outbreak, with 662 confirmed cases and 124 deaths reported to date. Ituri Province continues to account for the majority of reported cases. In the last 24 hours, 29 new confirmed cases and five deaths among confirmed cases were reported in Ituri Province. Seven additional confirmed cases from North Kivu were also reported as part of a backlog from 8 June.

Uganda has reported 19 confirmed cases and two deaths to date. No new confirmed cases, deaths, suspected cases or recoveries were reported in Uganda in the last 24 hours. Uganda has now reported no new confirmed cases or deaths for five consecutive days.

Across both countries, 25 recoveries have been reported, and 6,525 contacts have been listed for follow-up. Thirty-four healthcare workers have been infected, including 29 in the Democratic Republic of the Congo and five in Uganda.The outbreak is currently affecting 27 health zones in the Democratic Republic of the Congo and one district in Uganda.

Africa CDC continues to work closely with national authorities and partners to support surveillance, contact tracing, case management, infection prevention and control, risk communication and cross-border coordination.

Africa CDC and WHO continue to advise against unnecessary restrictions on travel and trade. Public health measures should remain evidence-based and aligned with the International Health Regulations.

Africa CDC urges communities in affected and at-risk areas to remain vigilant, follow guidance from health authorities, report symptoms early and cooperate with trained response teams.

Further updates will be shared as the situation evolves.

Distributed by APO Group on behalf of Africa Centres for Disease Control and World Health Organization

Categories : Antibiotics Infection ControlTags :

Shiga-producing E. coli Growing More Resistant to Antibiotics

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Photo by CDC on Unsplash

Resistance to antimicrobial agents is rising among human infections with Escherichia coli bacteria that produce the Shiga toxin, according to a study analysing data from nearly 2000 infections in the United States between 2010 and 2021.

The increase in resistance points to a need for antibiotic stewardship in the food production chain as well as in human health, says study leader Csaba Varga, a professor of pathobiology at the University of Illinois Urbana-Champaign.

“Shiga toxin–producing E. coli is a type of foodborne bacteria that can cause anything from mild diarrhoea to very serious illness. About 100 000 people in the U.S. get sick from this strain each year, and some end up in the hospital,” Varga said. “The biggest concern is for children under five years of age, who are more likely to develop serious complications, such as kidney failure.”

Varga and graduate student Tarjani Bhatt used data reported by the U.S. Centers for Disease Control and Prevention, which collects the information through a national surveillance system. They focused on the E. coli strain O157, which produces the Shiga toxin responsible for the majority of severe illnesses. They looked at 1995 samples collected between 2010 and 2021 to see whether there was any change in antimicrobial resistance rates over time, and whether there were any patterns in age or geography.

“Most of the previous studies have looked at snapshots in time, not how resistance changes year by year. We didn’t have a clear picture of long-term trends, whether resistance was increasing, decreasing or staying the same,” Varga said. “Resistance doesn’t stay in one place; it moves through people, animals and the environment. Our study helps fill those gaps by looking at when, where and in whom resistance is emerging over time.”

The group found that, while overall resistance remains low, it has steadily increased over time – especially for the common antibiotics tetracycline and sulfisoxazole. They also found that resistance varied by geographical region and by age group, with younger adults in their 20s and 30s most likely to have infections resistant to some antibiotics.

The most mystifying aspect of the findings is that antibiotics are not typically recommended for Shiga-producing E. coli infections, Varga said. Though the treatment kills the bacteria, that action triggers the release of more Shiga toxin, making the illness more dangerous and increasing the risk for serious complications. Antibiotics are avoided unless the patient has another severe infection at the same time.  

“Even though we don’t usually treat this infection with antibiotics, we’re still seeing resistance emerging and spreading, which tells us these bacteria are being exposed to antibiotics somewhere along the way,” Varga said.

The researchers propose a “One Health” approach to the issue, taking into account not only human health and antibiotic use, but animals and environment as well, particularly because the illness is foodborne.

“Better antibiotic stewardship in agriculture, along with food safety and environmental controls, will be key to slowing this trend. What happens on farms, in food production and in the environment can directly impact human health. Prevention has to happen from farm to fork,” Varga said.

Source: University of Illinois at Urbana-Champaign

Categories : Infection ControlTags :

Africa CDC and WHO Launch Joint Continental Ebola Response Plan

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The plan complements national response plans launched by the Governments of the Democratic Republic of the Congo and Uganda

The Africa Centres for Disease Control and Prevention (Africa CDC) (www.AfricaCDC.org) and the World Health Organization (WHO) today launched a joint continental preparedness and response plan on the ongoing Ebola outbreak caused by the Bundibugyo virus. The plan aims to raise US$ 518 million to support African countries together with partners to prepare for, rapidly detect and respond to the outbreak.

The six-month plan, covering June to November 2026, brings together governments, partners and communities under a unified ‘One Response’ approach to strengthen outbreak response measures, including emergency coordination, disease surveillance, laboratory testing, infection prevention and control, clinical care, community engagement, research, logistics and support for essential health services.

The plan complements national response plans launched by the Governments of the Democratic Republic of the Congo and Uganda.

“Ebola moves fast. Africa must move faster. This joint plan gives the continent a clear path to act with speed and unity: to save lives, support the affected countries and protect neighbouring communities, said Africa CDC Director-General Dr Jean Kaseya. “With Member States, WHO and partners, Africa CDC is turning commitment into action and resources into response for the communities at risk.”

WHO Director-General Dr Tedros Adhanom Ghebreyesus said: “The only way to beat this outbreak is through close partnership, working together under the leadership of the affected countries in one coordinated effort, guided by a simple principle: one plan, one budget, one team.”

He added: “Containing Ebola depends on political commitment, sustained financing, and the trust and engagement of communities. This plan places communities at the centre, because without their participation, contact tracing falters, safe care is delayed, and transmission continues.”

The plan also focuses on protecting vulnerable populations, strengthening cross-border collaboration, and supporting countries to respond quickly to new cases. At a time when there are no licensed vaccines or therapeutics specifically approved for the Bundibugyo species of Ebola, the plan aims to strengthen health systems to ensure resilience even as countries respond to acute health emergencies.

Implementation of preparedness and response activities is already underway across affected and at-risk countries. Furthermore, in 10 priority countries critical measures are being strengthened to enhance public health emergency preparedness and ensure early detection and swift response

.The plan emphasizes the need to maintain support for other ongoing health emergencies, including mpox, cholera and measles, to prevent disruptions to critical response efforts and safeguard progress towards stronger, more resilient health systems.

This coordinated effort comes as response operations accelerate in the Democratic Republic of the Congo, where authorities, with support from Africa CDC, WHO and partners, are ramping up efforts to curb the spread of the virus and end the outbreak.

Africa CDC and WHO urge Member States to strengthen screening and public health measures at points of entry and enhance cross-border coordination and solidarity to support a timely, effective and evidence-based response to the outbreak.

Through the joint preparedness and response plan, the continent is mobilising its collective expertise and resources to reinforce response measures, acting as one to control the outbreak and protect communities across the region. Its successful implementation will require strong political commitment, sustained investment and close collaboration among governments, health workers, communities and partners.

Drawing on lessons learned from previous Ebola outbreaks and recent public health emergencies, the plan also provides a pathway to broadly strengthen Africa’s capacity to prevent, detect and respond to future health threats while protecting lives and livelihoods.

DOWNLOAD | JOINT CONTINENTAL EBOLA RESPONSE PLAN: https://apo-opa.co/49KMxG2

Categories : Infection Control Neurology PaediatricsTags :

New Treatment Aims to Prevent Meningitis Without Antibiotics

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Photo by Christian Bowen on Unsplash

Meningitis is rare in newborns but often life-threatening and can cause serious and lasting damage, including developmental problems. Now, researchers from ETH Zurich and the University of Basel have developed an approach that seeks to prevent transmission to newborns. The research is published in Nature Communications.

Although meningitis is thankfully rare in newborns as a whole, it is more common in premature babies, affecting one in every 500 such infants in industrialised economies and likely more in developing countries. One of the leading pathogens responsible for these meningitis cases is the K1 form of the E. coli bacterium. In the adult intestine: in one in three healthy adults, E. coli K1 is part of the intestinal flora. As a silent cohabitant, the bacterium causes no problems in this environment. It is kept in check by other bacteria and a functioning immune system.

However, if the pathogen is carried by an expectant mother, it can be transmitted to the child during birth and enter its intestine. In premature babies whose immune systems are still weak, the pathogen can enter the bloodstream and migrate to the brain, where it causes severe inflammation.

First weaken the pathogen, then fight it

Researchers led by Emma Slack, Professor of Mucosal Immunology at ETH Zurich, and Médéric Diard, Professor of Infection Biology at the Biozentrum of the University of Basel, want to stop transmission from happening in the first place. Their idea is to eliminate the pathogen in pregnant women who carry it in their intestine – but that’s easier said than done.

A year ago, the two researchers from Zurich and Basel had already jointly developed a concept for eradicating other pathogens living in the intestine (as ETH News reported). Back then, they used a combination therapy with two components: an oral vaccination that weakens the pathogenic bacterium, followed by a dose of harmless microbes that compete with the weakened pathogen for food, starve it out, and ultimately supersede it. In experiments on mice, the researchers demonstrated that this approach can eliminate certain salmonellas and E. coli strains in the intestine.  

So tough that three components are needed

However, the K1 form of E. coli is a formidable opponent: unlike other E. coli bacteria, it is protected by a slippery outer layer. This prevents the antibodies generated by the oral vaccination from attacking the bacterium.

The team of researchers led by Slack and Diard therefore extended its previous two-pronged approach with a third component known as bacteriophages (or simply phages). These are viruses that specifically infect and kill bacteria.

However, the bacteria can make changes to themselves in order to evade the danger posed by these viruses. The phages attack the bacteria by docking to the protective layer, and the bacteria seek to prevent this by undergoing a sort of rapid evolution in which this layer is disposed of. Rapid in this case means that, since the bacteria are so numerous and multiply so quickly, they need fewer than 24 hours to adapt. 

“This is essentially a resistance mechanism that the bacteria deploy against the phages,” says Slack. “We use this mechanism to our advantage: the antibodies formed by the oral vaccination are effective against K1 bacteria that no longer have their protective coating.”

Most young animals protected

The project involved searching for effective strains of phages. Scientists generally find phages in places that are home to lots of bacteria: nutrient-rich bodies of water, the intestinal flora or, very often, waste water and waste water treatment plants. When it comes to the phages used in this study, the researchers from the Biozentrum in Basel found what they were looking for in waste water samples from the treatment plant of the Lucerne conurbation. From such a sample, their lab work successfully isolated several phages that are particularly effective at attacking the bacterium E. coli K1.

In experiments with pregnant mice, which the researchers had previously infected with pathogenic E. coli K1, they were able to demonstrate the effectiveness of their triple-pronged treatment. The researchers first gave the mice phages that forced the bacteria to cast off their protective shell. Second, they administered an oral vaccination that produced antibodies in the intestine in order to weaken the bacteria. Third, they gave them a harmless probiotic bacterium that could compete against the weakened bacteria and occupy their ecological niche in the intestine.

In a control experiment in which the researchers did not treat the mothers, E. coli K1 was transmitted to 83% of young animals at birth. By contrast, the triple-pronged treatment significantly reduced the level of E. coli K1 in the mothers’ intestines, such that the pathogen was only transmitted to 23% of the young animals. The remaining offspring were protected.

Works even when antibiotics fail

The researchers are now keen to continue with their approach in order to develop a treatment for humans. In a world in which effective antibiotics are becoming increasingly scarce, we need new therapeutic approaches, says Slack. “Bacteria such as E. coli K1 are difficult to tackle. Our approach is potentially the only one that can be used to fight this pathogen and others without antibiotics.”

Not only can E. coli K1 cause cases of meningitis in newborns, which today must be treated with antibiotics in a race against time. It is also one of the most frequent causes of cystitis and pyelitis – infections that can also lead to serious cases of sepsis. 

The ETH professor doesn’t perceive any major obstacles to developing an effective treatment for humans: “Oral vaccinations, probiotics and even phages are all already used in medicine,” she says. It will also be possible, she adds, to pack all three components into a single capsule that people can simply swallow.

Moreover, the scientists are planning projects in which they want to use the same approach to tackle bacteria other than E. coli K1, including multi-resistant pathogens, against which many antibiotics are no longer effective.

Source: ETH Zurich

Categories : Infection ControlTags :

Hepatologist Hails Results of Groundbreaking Hepatitis B Treatment Trial

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Hepatitis C virus. The hepatitis B virus has significant differences compared to the C virus, including differences in the protein envelope and DNA versus hep C’s RNA genome. Credit: Scientific Animations CC4.0

In an editorial published in the New England Journal of Medicine, University of Michigan Health hepatologist Anna S. Lok, MD, hails newly announced results of the B-Well clinical trials as “a major step toward a functional cure for hepatitis B virus infection.”

The results, published concurrently in NEJM, report that 20% and 19% of patients in two duplicate clinical trials achieved a functional cure for their chronic hepatitis B infections following 24 weeks of bepirovirsen (versus 0% of the placebo groups).

The lead and corresponding author of the trial results is Jinlin Hou, M.D., Chairman and Professor of the Hepatology Unit and Department of Infectious Diseases, Southern Medical University in Guangzhou, China.

The University of Michigan Health did not participate in these clinical trials.

The most common treatment for chronic hepatitis B infection, nucleoside or nucleotide analogue (NA) therapy, can successfully suppress hepatitis B virus replication – reducing the risk of cirrhosis and cancer – but is rarely curative, and most patients will relapse if treatment is discontinued before hepatitis B surface antigen loss.

In 2016, Lok led the first meeting among the US Food and Drug Administration, European Medicine Agency, American Association for the Study of Liver Diseases, European Association for the Study of the Liver, and experts in academia and industry to discuss definition and paths towards a cure for hepatitis B.

This group of experts recommended that functional cure of hepatitis B should be defined as undetectable hepatitis B surface antigen and hepatitis B virus DNA at least 24 weeks after completing a finite course of treatment. During the past 10 years, many clinical trials testing different combinations of antiviral and immunomodulatory agents have been evaluated but only one phase 3 trial has been completed so far.  

In these latest phase 3 clinical trials, 24% of the patients taking bepirovirsen were able to discontinue NA therapy, compared to zero patients in the placebo groups, and none of the patients who discontinued NA therapy including a few who failed to achieve functional cure had clinical relapse.

Although these trials were conducted in highly selected patients and the results may not be generalizable to other patients with chronic hepatitis B — and side effects were more common among the patients who received bepirovirsen — they are encouraging and represent a major step towards a cure for hepatitis B. Lok hopes the results of these trials will encourage testing of other combinations that are safe and can lead to higher rates of functional cure in broader patient populations.

A renowned researcher into the natural history and treatment of hepatitis B, Lok co-authored every edition of the American Association for the Study of the Liver Diseases Guidelines on hepatitis B since 2001 and the first World Health Organization guideline on the condition in 2015.

Earlier this month, she was the senior author on a review of the current state of global hepatitis B virus prevention and treatment, published in JAMA.

Source: EurekAlert!

Categories : Infection ControlTags :

Why Africa – and the World – Remain Dangerously Unprepared for the Next Pandemic

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Oyewale Tomori, Nigerian Academy of Science

As the news spread about the outbreak of Ebola in mid-May 2026, the World Health Organization (WHO) released a report about pandemics. The title was: A World on the Edge: Priorities for a Pandemic-Resilient Future.

The document was prepared by the WHO’s Global Preparedness Monitoring Board. It sets out why the world isn’t better prepared for pandemics a decade after Ebola exposed dangerous gaps. And six years after COVID-19 turned those gaps into a global catastrophe.

It adds that investment in pandemic preparedness has not kept pace with the rising risk of pandemics.

The Global Preparedness Monitoring Board is an independent monitoring and accountability body established in 2018 by the WHO and the World Bank. The aim was to strengthen preparedness for global health crises. It is composed of political leaders, agency principals and world-class experts. Its task is to provide assessments of global progress in building and sustaining the capacity to prevent, detect and respond to health emergencies.

The report was released during another Ebola epidemic. This time starting in the Democratic Republic of Congo. On 17 May the WHO declared the outbreak a public health emergency of international concern. This means that it is a risk to many countries through international spread and hence requires global coordinated efforts.

As a virologist and former global health administrator, I believe the monitoring board’s diagnosis and recommendations are vitally important for managing pandemics.

My first observation about the report is that its recommendations remain largely unimplemented by many countries. This is particularly true in Africa, where pandemics thrive and disease epidemics rage and ravage.

Africa needs to specially build trust in its own ability to prepare for and prevent disease outbreaks, and control them when they do occur.

To achieve this, and in line with the recommendations, Africa must sustain:

  • independent pandemic risk monitoring
  • health workforce capability and retention
  • equitable access to countermeasures such as vaccines
  • financing
  • political attention.

Independent pandemic risk monitoring

Using local resources and financing, African countries must own the solution to health through establishing data systems that uphold health sovereignty.

They must also ensure that data derived from surveillance, research and pathogen processing are securely managed and accountable to African institutions rather than foreign entities. Recent agreements with the US have brought this issue to the fore. Some were asking African countries to sign away their health data or prodigally release their precious pathogens in a barter exchange for donor funding.

But health data are an invaluable asset for public health, clinical management and research. They help countries identify diseases and develop vaccines and treatments.

What African countries should be doing instead is mobilising locally sourced counterpart funds. These should be used to create the local environment to support and enhance the capacity of indigenous scientists and researchers to develop innovations from national/natural pathogens for global benefits.

Two African health institutions should be at the centre of these endeavours: the WHO-Africa Region and the Africa Centers for Disease Control, an agency of the African Union. They must not compete, but collaborate and spearhead these efforts through centralised disease control and tracking scorecards.

Health workers

Fostering the well-being of health workforce results in growth, higher productivity, national pride and loyalty.

It also helps in long-term retention of health workers.

African countries need to prioritise capacity retention over capacity building. They must build and sustain a conducive work environment which involves physical workspace and psychological safety.

Availability of adequate resources is needed to function effectively and productively. This includes materials, laboratory facilities, supplies, reagents and consumables for a trained African health workforce and researchers.

Under such enabling conditions, the health workforce can focus on relevant and local health issues and find appropriate solutions to them.

Equitable access to countermeasures

Africa must not compromise on the ratification of international health pacts that guarantee fair technology transfer, intellectual property waivers, and robust regional manufacturing.

Countries must equally expand local production of laboratory diagnostic kits, vaccines and medical supplies as well as non-medical products. Such include gloves, personal protective equipment and masks.

This will reduce reliance on external donation and supply chains in and out of global crises.

Sustainable financing

The greater challenge for many African countries is the waste of available resources and spending on misplaced priorities.

To address this, governments must commit to sustained domestic investment in healthcare. At the same time they must use blended financing (involving both the public and private sectors) to close remaining gaps. Initiatives such as the African Epidemic Fund offer a practical model for building financial reserves for rapid, locally led responses. The fund, launched in 2025, is designed to mobilise funding to support preparedness and response efforts to combat public health threats on the continent. The African Epidemic Fund, though relatively new, must operate at the highest level of accountability. It must provide regular updates on contributions, projects supported and their impact on disease preparedness, prevention and control in Africa.

Sustained political attention

African leaders must keep pandemic preparedness high on the political agenda to ensure continuous resource allocation and accountability. The advocacy for preparedness must go beyond political campaign slogans. It must be driven by regional bodies like the African Union. Countries must then translate commitments into tangible national policies.

There can be no recess or holiday from pandemic preparedness.

African political leaders and elites, at the continental, national and sub-national levels, have crucial roles to play in achieving trusted community engagement and involvement for successful and reliable pandemic preparedness. Above all, there must be active community engagement and involvement.

Oyewale Tomori, Fellow, Nigerian Academy of Science

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What a List of Black Death Survivors Reveals About the Way People Recovered from Plague

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The Dance of Death by John of Kastav (1490). National Gallery of Slovenia

Alex Brown, Durham University and Grace Owen, Durham University

In our research in the British Library’s medieval collections, we have identified a previously unnoticed document that provides fresh insights into the survivors of the outbreak of plague known as the Black Death (1346–53).

The document – a scrap of parchment inserted into an account of the Ramsey Abbey manor of Warboys in Huntingdonshire – records how much time peasants were absent from work when struck down by the plague. It also reveals the names of those who survived and how long their employers believed recovery could take.

In our recent paper with Barney Sloane we shed new light on a group of 22 tenants who probably contracted plague, languished on their sickbeds for several weeks, and then recovered.

As one of the deadliest pandemics in recorded history, it has been estimated that between a third and two-thirds of the population of medieval Europe died during the Black Death.

Painting of a grim landscape destroyed by plague
The Triumph of Death by Pieter Bruegel the Elder (1562) shows the social upheaval that followed the plague. Museo del Prado

Given the sheer scale, many historians have focused on discovering details about those who died. Yet this has left the histories of those who contracted plague and recovered largely untold.

Despite the deadliness of the disease, it was possible to recover from plague, and medieval chroniclers mention the possibility – however unlikely – of survival. For example, Geoffrey le Baker, a clerk of Swinbrook in Oxfordshire, wrote in the following decade that he thought recovery depended on people’s symptoms:

People who one day had been full of happiness, on the next were found dead. Some were tormented by boils which broke out suddenly in various parts of the body, and were so hard and dry that when they were lanced hardly any liquid flowed out. Many of these people escaped, by lancing the boils or by long suffering. Other victims had little black pustules scattered over the skin of the whole body. Of these people very few, indeed hardly any, recovered life and health.

But who recovered? Why did so many succumb to the disease when others survived? And just how long was this “long suffering”? Unfortunately, there is remarkably little documentary evidence because most medieval sources record information about mortality rather than ill health.

Unique list of plague survivors

A unique inclusion in the account of the manor of Warboys details a group of people who fell ill between the end of April and the start of August 1349. The monks of Ramsey Abbey wrote a list of their tenants who had fallen sufficiently sick that they could not work on the lord’s lands and detailed the length of time that they were absent.

People were clearly affected differently by their experience of plague.

The quickest recovery was that of Henry Broun who missed just a single week of work. By contrast, John Derworth and Agnes Mold had much more protracted illnesses and were both absent for nine weeks.

The average length of illness was between three and four weeks, with three-quarters of people returning to work in under a month. The speed of their recoveries is all the more surprising given that they were entitled to up to a year and a day of sick leave from work.

This list of survivors includes a preponderance of tenants who occupied larger holdings on the manor. It has long been debated by historians and archaeologists whether the plague killed indiscriminately, with no regard to status, sex or age, or whether the poor and elderly were more vulnerable.

The survival of so many wealthier tenants could indicate that their higher living standards enabled them to recover more readily than their poorer neighbours, perhaps because they were able to stave off secondary infections and complications. We should not read any significance into the fact that 19 out of the 22 people were men: this reflects the gender bias of manorial landholding rather than any sex-selectivity of plague.

Although 22 people may not seem like many, in a regular year during the 1340s, only two or three absences were recorded during the summer months. It, therefore, represents a tenfold increase in regular illnesses on the manor. Put another way, these sick tenants were absent for 91 weeks’ worth of labour services during just a 13-week period.

Medieval drawing of men harvesting wheat
Medieval peasants at work harvesting wheat (circa 1310). Queen Mary’s Psalter (Ms. Royal 2. B. VII)

Our understanding of the impact of the Black Death has been influenced by the appalling scale of death. Yet it is only when we add those who fell ill and recovered back into the picture that we can truly understand the seismic shock the pandemic had on society. The dead, dying and sick must have considerably outnumbered the living in villages and cities across Europe.

The consequences of this can be seen in medieval accounts and chronicles, one of which records that “there was so great a shortage of servants and labourers that there was no one who knew what needed to be done”. As a result of this combination of high mortality, unprecedented illness and abysmal weather, the two harvests of 1349 and 1350 have been described as the worst experienced in medieval England, worse even than those that caused the great famine of 1315-17.

This archival discovery allows us to write the history of sickness and recovery back into the Black Death, demonstrating that recovery was possible even during one of the worst pandemics in recorded history.

This new evidence reveals the remarkable resilience of medieval peasants. Many of them lay languishing on their sickbeds, exhibiting buboes (the painful, swollen and inflamed lymph nodes on the groin and neck that were typical of the Black Death), vomiting blood and wracked by fevers and not only survived but returned to work in just a few short weeks.

Alex Brown, Associate Professor of Medieval History, Durham University and Grace Owen, Postdoctoral Research Associate (Late Medieval History), Durham University

This article is republished from The Conversation under a Creative Commons license. Read the original article.