MEMBERS NEWS. Keeping you updated! Issue 5. Contents 1/5

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1 Issue 5 MEMBERS NEWS Keeping you updated! Surveillance of fever among children from 2 to 59 months old in Madagascar Since October 2009, the Malagasy Ministry of Health has initiated an operational research project in close collaboration with the Fondation Mérieux, the Centre d Infectiologie Charles Mérieux, the Reggio Terzo Mondo (RTM) and the Fondation Médicale d Ampasimanjeva (FMA). The aim of this study is to identify fevers aetiologies among children from 2 to 59 months old, because it s estimated that 60% of feverish syndromes are not explained by malaria in Madagascar. This study, lasting a year, concerns a cohort of 2000 children living in Ampasimanjeva, a small village located in the south-east of Madagascar. All children with fever and negative for malaria by rapid diagnostic test (RDT) are referred by Community Agents to the FMA hospital. Medical staff determined if feverish syndrome is associated with respiratory troubles or digestive disorders and then performed specific samples (nasal swab or stool sample) sent to the Rodolphe Mérieux laboratory in Antananarivo. Specific molecular diagnostic tools will be used to identify virus and bacteria responsible for tract respiratory infections and diarrhoea (Fast-track Diagnostic). Contents Surveillance of fever among children from 2 to 59 months old in Madagascar New molecular test for pneumococcus serotype identification The study of emerging viruses at the Dr. Christophe Mérieux Laboratory The project CoPanFlu (Cohorts for Pandemic Influenza) in Laos The sanitary situation in Haiti Universal exposition in Shanghai, China In brief... Furthermore, sickle cell disease diagnostic is performed on each child included in the study. Recently this new blood spot diagnostic test has been set up in the Rodolphe Mérieux laboratory in Antananarivo. All molecular diagnostic results obtained will be correlated with other child data such as blood group, blood count, age and sex. The results of this study will enable to better document the fever symptoms in this area of Madagascar. The main objective is to set up an algorithm for patient management to tailor treatments and prevent abusive use of non adapted anti malarial drugs and antibiotics. Jonathan Hoffmann and Dr Bénédicte Contamin (Fondation Mérieux, Centre d Infectiologie Charles Mérieux of Madagascar), Dr Arsène Ratsimbasoa (Ministère de la Santé, Centre d Infectiologie Charles Mérieux of Madagascar) 1/5

2 New molecular test for pneumococcus serotype identification Community-acquired pneumonia is still today the main cause of mortality in children, especially among those under the age of 5 years. This is most significant in developing countries where incidence rates are 10 times higher than in developed countries. Streptococcus pneumoniae or pneumococcus is the main agent involved in the pneumonia. Pneumonia is a severe disease and happens when the pneumococcus, which is naturally in the upper respiratory tract, migrates to the lung. There are 90 different pneumococcus serotypes which are distributed differently according to the age and the geographic localization of the infected patients. The Prevnar vaccine (PCV-7) targets the main serotypes involved in invasive respiratory infections in children living in USA and Europe. The vaccine is responsible for the elimination of the pneumococcus serotypes targeted by the vaccine, but it is also responsible for the emergence of the serotypes not targeted by the vaccine. It is then crucial to be able to follow the worldwide evolution and circulation of the serotypes in order to develop more effective and adapted vaccines. We have developed at the Emerging Pathogens Laboratory in Lyon, a pneumococcus serotype identification assay based on the real-time multiplex PCR technology. This molecular biology assay, which enables the identification of the 29 main pneumococcus serotypes responsible for the pneumonia, has been validated on referenced pneumococcal strains provided by Sanofi Pasteur. The assay has then been evaluated on one hundred clinical samples (nasopharyngeal aspirates, pleural effusions, whole blood) from two cohorts formed of children hospitalized for severe pneumonia at the Hôpital Femme-Mère Enfant (Bron, France) and at the Oswaldo Cruz Foundation (Rio de Janeiro, Brésil). The results have been very encouraging. This molecular assay can now be transferred to the GABRIEL network laboratories for the worldwide molecular epidemiology of circulating pneumoccocus strains. Jean-Noël Telles, Elodie Paredes et Gláucia Paranhos-Baccalà (Fondation Mérieux, Emerging Pathogens Laboratory (EPL), France) The study of emerging viruses at the Dr. Christophe Mérieux Laboratory As a member of the GABRIEL network, one of the activities of the Dr. Christophe Mérieux Laboratory is to investigate the prevalence and molecular evolution of new emerging respiratory viruses. Dr. Christophe Mérieux Laboratory has carried out research studies on newly discovered viruses such as WU, KI polyomaviruses (PyVs) and Saffold cardiovirus (SAFV), on patients suffering from acute gastroenteritis or acute respiratory tract infection. In the study on polyomaviruses, WU and KI PyVs were detected in respiratory tract samples from children, but not from immunocompetent adults. The Dr. Christophe Mérieux Laboratory team was the first group to report the presence of WU PyV in fecal samples. The Dr. Christophe Mérieux Laboratory published the first report on the prevalence of SAFV-1 sublineage in China after a 20-year hiatus of the first idendification of SAFV-1 in United States. The group was also the first to report the co-circulation of SAFV-1, -2 and -3 sublineages in respiratory samples from Chinese patients. Further investigations on newly discovered viruses need to be conducted, such as sero-epidemiological analysis to clarify their pathogenicity pattern. 2/5

3 The project CoPanFlu (Cohorts for Pandemic Influenza) in Laos CoPanFlu Laos is a research project in collaboration with the Centre Christophe Mérieux of Laos, the French School of Public Health (EHESP) and the Fondation Mérieux. The aim of this study is to identify the epidemiologic and virologic determinants of risk of infection for A(H1N1) 2009 at the individual level. The project is conducted on a group of 807 households which represents 3,941 people living in Vientiane, Laos. The project is divided into 3 phases: the inclusion phase (from February to April 2010) consisted of a visit by investigation teams who collected the written consent forms, basic information and peformed the first blood samples in order to carry out serology analysis; then, the surveillance phase period when the virus is most prevalent (June-August 2010 ; December 2010 February 2011). During this phase, interviewers will perform weekly calls for every participating household in order to document the occurrence of ear/nose/throat (ENT) or infectious respiratory symptoms in one or more household members during the course of the past week. Upon any detection or symptom reported by the household, interviewers will pay a home visit to collect biological samples (nasal swab) and epidemiological and clinical data ; finally, the follow-up phase where all household members will undergo a post-seasonal check-up (October 2010 and May/June 2011). This will consist of the collection of a blood sample and update of clinical data. The Centre Christophe Mérieux of Laos, as the principal investigator of this project, is reponsible for the logistics of the project as well as the molecular detection tests of Flu A (typing for H1, H3, N1 ) and B. Anti-viral resistance mutation research and phylogenetic analysis (through the complet sequencing of the genome) will be also conducted to assess the viral diversity and the evolutionary mechanisms of the A(H1N1) 2009 virus. Data from previous studies suggest that influenza is prevalent in tropical areas and the disease have considerable impact on morbidity and mortality rates. The results of this study will be essential in the management of patients by clinicians. In addition, this multicentric project was initiated by the EHESP in France, Réunion, Djibouti, Senegal, Mali and Bolivia. CoPanFlu Team, Rodolphe Mérieux Laboratory in Laos 3/5

4 The sanitary situation in Haiti The sanitary situation in Haiti still under close surveillance, 5 months after the earthquake. "Hydric diseases" (including typhoid) are particularly under surveillance, several outbreaks have been observed but were contained so far. The rainy season also facilitates the resurgence of malaria and dengue. Tuberculosis (TB) is also under high surveillance. More than 950 camps remain on Port-au-Prince. The high concentration of population associated with the camps aids the spread of TB, increasing its prevalence (402 case / before the earthquake, the highest in the Americas), as well as multidrug-resistant tuberculosis (MDR TB, 3 % of the TB hospital in IMIS/GHESKIO cases of primary infections). Clinical suspicion rate increase significantly, especially in pediatrics. More than 100 patients were already hospitalized at the hospital TB under tents in IMIS / GHESKIO site since last February, including patients co-infected with MDR TB, HIV-TB, TB patients injuried by the earthquake requiring hospitalization and TB patients living in camps, to limit transmission. IMIS and GHESKIO s laboratories carry out smear stains on sputums for patients from GHESKIO and IMIS, Haitian State Hospital University, the National Penitentiary, the HIV-Centre of the ex-sanatorium of Sigueneau and several refugee camps. Around 2,000 tests are performed monthly, and screening tests number should continue to increase rapidly. TB cultures, as well as the TB drug susceptibility testing, will resume as soon as the laboratory of biosafety level 3 will be operational, since technical problems occurred during recent months delaying the actual implementation. Marie Gauthier, Rodolphe Merieux Laboratory, GHESKIO Centres, Haiti Universal exposition in Shanghai, China The Rhône-Alpes region, in collaboration with Lyon biopole, has organized a week devoted to health from the the 2 to 5 June 2010 in the Rhône-Alpes pavilion of the Universal Exposition in Shanghai, China. The Rhône-Alpes region has had a long standing partnership (22 years) with Shanghai. During this week, 4 major themes were developed by academics and industrialists from the Rhône-Alpes region and China in the following fields: vaccination, therapeutic monoclonal antibodies, cancer and epidemiology. I had the opportunity to coordinate the epidemiology section which developed viral epidemiology aspects of children and adults. The epidemiological section was opened by the Professor Yu Wang, Managing Director of the Chinese Centre for Disease Control and Prevention (China, CDC) and China s Minister of Health, who made a presentation on Epidemiology of respiratory viral infections in infants. Several presentations were followed: Epidemiology of children and adults viral infections Gláucia Paranhos-Baccalà, Research Director, Emerging Pathogens Laboratory in Lyon and Christophe Mérieux Laboratory in Beijing, Fondation Mérieux; 4/5

5 Epidemiology of respiratory viral infections in infants Daniel Floret, Professor of Pediatrics, Claude Bernard Lyon 1 University, Director of the Pediatric Emergency Department CHU, Lyon Pediatric Hospital; Survey of Children's respiratory infections Yuan QIAN, Chief and Professor of the Laboratory of Virology, Capital Institute of Pediatrics, Beijing, Vice Chief of the Beijing Municipal Laboratory of Infection and Immunity, Chief of the Beijing Network Laboratory for Surveillance of SARS and Influenza virus; The potential cost-effectiveness of rotavirus immunization program in rural China Xuan Yi WANG, Research Scientist, Institute of Biomedical Sciences, Fudan University; New pathogens discovery in China Jianguo XU, Director in General, State Key Laboratory for Infectious Diseases Prevention and Control (China Center for Diseases Control and Prevention). Director in General, National Institute of Communicable Diseases Control and Prevention, China Center for Diseases Control and Prevention; Emerging and re-emerging viruses in China: Research-driven solutions for novel diagnostics and vaccines Ralf ALTEMEYER, Director, Institut Pasteur of Shanghai; JianWei Wang, Deputy Director of Institute of Pathogen Biology, Chinese Academy of Medical Sciences; Respiratory virus infections in Adults: A five-year study Director of Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux; Organisation of infectious diseases in France and Rhône-Alpes Region Guy VERNET, Scientific Director, Fondation Mérieux Gláucia Paranhos-Baccalà (Fondation Mérieux, Emerging Pathogens Laboratory (EPL), France) IN BRIEF Jonathan Hoffmann (Rodolphe Mérieux Laboratory in Madagascar), received the Grand Prize for the International Volunteers in Enterprise (VIE) organized by the Advisors of the External Commerce of France (CCEF), Ubifrance and the Economic Mission of the French Embassy. In June and July 2010, Alexandra Déroncelay (GHESKIO Centres, Haiti) had received a bacteriology training of 1 month at the training centre of biomérieux and at the bacteriology laboratory of Pr Flandrois (CHU Lyon Sud). The public and the private areas of the GABRIEL website ( is under evaluation by different members from the network: Patricia Costa Barras (Brazil), Rita Beyrouthy (Lebanon), Thomas Dugue (Haiti), Richard Gonzalez (China), Carlos Henrique de Azeredo Lima (Brazil), Jonathan Hoffmann (Madagascar), Nicolas Steenkeste (Cambodia), Jean-Noel Telles (France) and Fatou Traore Fayé (Mali). Their comments and advices will contribute to improve our GABRIEL website. 5/5