Human microbe interactions in health and disease, a genomic view
Speaker: Professor Gordon Dougan
Professor in the Department of Medicine, University of Cambridge
Throughout human evolution there has been a constant interplay between we humans as hosts and microbes. This interaction has shaped both communicable and non-communicable disease profiles. The relationship has been driven both by microbes with pathogenic potential and those that simply live on us as part of our microbiota (the microbial communities living on our bodies). However, this relationship has arguably changed significantly in the past century as human population size and global travel increase, and as we introduce therapies such as antibiotics that drive evolution in microbes. In this presentation I will describe how antibiotics are reshaping our relationships with these microbes, relating this to both communicable and non-communicable diseases. I will use my experience with genomics, alongside specific examples such as the evolution of antibiotic resistance and the impact of antibiotic treatment on the microbiota, to illustrate these points.
Gordon Dougan is a group leader at The Wellcome Trust Sanger Institute (WTSI) and a Professor in the Department of Medicine at Cambridge University. He also holds adjunct professorships at the Universities of Monash and Melbourne. His personal research team studies enteric pathogens with a strong emphasis on pathogenic mechanisms, genomics and immunology. He has a particular interest in using genomics to study the evolution of Salmonella enterica serovar Typhi, the cause of typhoid. Before moving to the WTSI he was the founding Director of the Centre for Molecular Microbiology and Infection at Imperial College London and a Professor of Biochemistry. He is a member of EMBO and a Fellow of the Royal Society. He received his B Sc and Ph.D. from the University of Sussex and conducted postdoctoral studies at the University of Washington (Seattle) in the laboratory of Stanley Falkow. He worked in industry developing novel vaccines at an internationally renowned multi-national company and is an expert in vaccinology.
HIV and Bone Health
Speaker: Dr Ann Prentice
Director and Head of Nutrition & Bone Health Research at MRC Elsie Widdowson Laboratory, University of Cambridge
Public health policy on food and nutrition is developed to ensure dietary adequacy for the general population. Nutritional recommendations, dietary reference values and food-based guidelines are designed for the general, healthy population. However, many individuals live with chronic conditions that may impact on their nutritional requirements to support general wellbeing, as opposed to treating the disease, but there is little evidence from robust research studies to inform policy. People living with HIV infection provide an important example. Since the advent of effective antiretroviral therapy (ART), the survival of people with HIV infection has increased dramatically. This brings concerns that vulnerability to non-communicable diseases, such as osteoporosis, may be greater than in the general population and may be related to nutritional inadequacies. HIV and ART have been associated with bone loss and poor vitamin D status, suggesting an increased requirement for vitamin D to maintain bone health. The evidence comes predominantly from observational studies, often in men. However, the burden of HIV-infection lies in Sub-Saharan African women, and may result in poor vitamin D status and accentuated bone loss during lactation and the menopause. Longitudinal studies by my research group among premenopausal and lactating women in Soweto, South Africa, and Kampala, Uganda, are addressing whether HIV-positive young women, with and without ART, have increased requirements for vitamin D and altered calcium and bone metabolism.
Ann Prentice Ph.D. is the Director and Head of Nutrition and Bone Health Research at MRC Elsie Widdowson Laboratory (formerly MRC Human Nutrition Research), Cambridge. Her research focuses on nutrient requirements for bone health, with a specific emphasis on calcium and vitamin D, and encompasses the nutritional problems of both affluent and resource-limited societies. She is involved in projects studying pregnant and lactating women, children, adolescents and older people in the UK, The Gambia, Uganda, China, Bangladesh and South Africa. Dr Prentice is Chair of the UK Scientific Advisory Committee on Nutrition and serves on a number of advisory committees. She is a Visiting Professor in Nutritional Science at the University of Southampton, an Honorary Doctor of the University of Surrey, and holds Honorary Professorships at the University of Witswatersrand, South Africa, and Shenyang Medical College, China. She was appointed OBE in the Birthday Honours List in 2006
HPV and human cancers: new challenges
Speaker: Professor Margaret Stanley
Director of Research, Department of Pathology, University of Cambridge
Benign and malignant disease caused by HPV (human papillomavirus) constitutes a global public health problem. Genital warts are the commonest viral sexually transmitted infection and 5% of all cancers are HPV associated. The unfolding of the HPV story started in the 1970’s with the recognition that HPVs were a large family of viruses that included types that caused cancer particularly cancer of the cervix, a disease that kills 250,000 women each year. It has resulted in the development of 3 prophylactic virus like particle (VLP) vaccines using sophisticated recombinant molecular techniques and protein expression. All the vaccines target infection by the oncogenic HPV’s 16 and 18 and two also target the low risk HPVs 6 and 11 that cause genital and laryngeal warts. These vaccines are now included in the national immunisation programmes in more than 62 countries and delivered in most settings to peripubertal girls. Population effectiveness in women is now being demonstrated in those countries with high vaccine coverage.
HPV associated cancers are not confined to the cervix and HPV infection is implicated in the development of a proportion of vaginal, vulval, anal penile and head and neck cancers. Importantly the incidence of HPV related cancers in these sites, particularly anal carcinomas and tonsillar carcinomas is increasing. Almost all cervix cancers are caused by HPV. It is the 3rd commonest cancer in women worldwide but it is the developing world which bears 86% of the cervical cancer burden. Projections of population growth indicate that without effective intervention this disease burden inequality will increase in the coming 3-4 decades making intervention by vaccination a global public health priority.
Margaret Stanley is Emeritus Professor of Epithelial Biology, Director of Research in the Department of Pathology, University of Cambridge, Honorary Consultant Addenbrookes Hospital Cambridge and Fellow of Christs College. She attended the Universities of London, Bristol and Adelaide, is a Fellow of the Academy of Medical Sciences and Honorary Fellow of the UK Royal College of Obstetricians and Gynaecologists. She has a lifetime award from the American Society for Colposcopy and Cytopathology (ASCCP) and from the International Papillomavirus Society (IPVS). She was a member of the UK Biology and Biotechnology Science Research Council from 2000-2003 and a member of the Spongiform Encephalopathies Advisory Committee that advised the UK government on prion diseases from 2003-2010. In 2004 she was awarded the OBE for services to Virology. She attends the HPV sub committee of the JCVI (Joint Committee for Vaccines and Immunisation) as the HPV expert. Her research focuses on mechanisms of host defence in the ano-genital tract and the development of vaccines and immunotherapies against human papillomaviruses.
Non-communicable disease burden in a cohort of HIV positive Ugandan adults on long term anti-retroviral treatment
Speaker: Dr Rosalind Parkes-Ratanshi
Lecturer in Public Heath, Cambridge Institute of Public Health
People living with HIV (PLHIV) have an increased risk of cardiovascular risk (CVR) and disease (CVD), due to the direct effect of HIV, as well as side effects on long term anti-retroviral treatment (ART). This is increasingly well documented in resource risk settings, but there is limited data on CVR and CVD in HIV patients in sub-Saharan Africa. However, there is an increasing burden of CVD in sub-Saharan Africa due to improvements in nutrition, and lifestyle changes predisposing to CVR.
Between May 2014 and September 2015, we enrolled a prospective observational cohort of 1,000 patients who had received ART for 10 years. The first reported cohort of patients on long term ART in sub-Saharan Africa. Demographics, previous opportunistic infections and other medical conditions, HIV related indices and cardiovascular risk factor indices were measured at baseline and will continue to be measured at each annual follow up. Cardiovascular measurements include blood pressure, BMI, and lipids.
62% of the cohort are female, median age was 46. At baseline, the median BMI was 22.4 Kg/m2, 20% of the patients had a history hypertension at enrolment, 3% had a history of diabetes and 1% has been diagnosed with cardiovascular disease.
Patients will be followed for a further 10 years which will provide important information regarding CVR and CVD in this population.
Rosalind Parkes-Ratanshi is clinical academic with a research interest in sustaining HIV and STI care using innovation in Africa. She trained as a Clinical Lecturer in Genito-urinary Medicine at St Mary’s Hospital, Imperial College, London and holds an Honorary Contract at Cambridge University Foundation Hospital. She has over 13 years experience working in Uganda and completed her PhD from the Liverpool School of Tropical Medicine in the prevention of cryptococcal disease in HIV positive Ugandan adults in 2009. In 2011 she joined the Infectious Diseases Institute, at Makerere University in Kampala, where she served as head of the clinical services. During this time she was responsible for introduction of new services such as a co-pay clinic, HIV-hepatitis services and elderly persons HIV clinic. She also headed a systems strengthening project for over 50,000 patients in care in government hospitals across Uganda. In 2015 she established the Ugandan Academy for Health Innovation and Impact (The Ugandan Academy) whose mission is ‘To improve health outcomes through innovations in clinical care, capacity building, systems strengthening and research which inform policy and practice with a strong emphasis on HIV and TB’. In 2015 she also returned to the University of Cambridge as Lecturer in CIPH, CIPH-PHE Liaison, whilst maintaining her work in Uganda as the Director of The Ugandan Academy. She has been Chairperson of the Board of Directors, Aga Khan Health Services, Uganda since 2009 and was the Uganda Country Ambassador for the Global Action Fund for Fungal Infections (GAFFI) 2014-15. She was elected a Fellow of the Faculty of Public Health in 2015.
Dementia and Infection: New possibilities for impact
Speaker: Dr Angelique Mavrodaris
Clinical Research Fellow and Consultant in Public Health Medicine, Cambridge Institute of Public Health
As populations age globally, dementia is emerging as one of the most important public health challenges, associated with major impacts on function, physical health and quality of life. At any one time, 1 in 4 people admitted in acute hospitals have dementia, with a large proportion estimated to be due to infection. There is growing interest in how infections interact, modify and potentially accelerate disease progression in dementia. Targeting infection may improve outcomes for people with dementia – preventing or slowing further decline and reducing hospital admissions. Currently however, the relationship between infection and dementia remains poorly understood. Exploring what we know and adding to what we don’t know will clarify how best to develop and apply public health interventions; with potential implications for cognitive ageing across the globe.
Angelique Mavrodaris is a Clinical Research Fellow and Consultant in Public Health Medicine based at the Cambridge Institute of Public Health. Her research is focused on exploring the interface between acute and chronic conditions, particularly the impact of infections on dementia progression and potential for prevention. Clinically, Angelique leads the design and development of the system-wide Cambridgeshire and Peterborough Ageing Well Programme. In her joint clinical-academic role she is working to ensure research evidence drives policy and service delivery in response to the needs of local populations.
Integrating mental health services in an HIV clinic
Speaker: Ms Farida Mayanja
Senior Clinic Manager, The Infectious Diseases Institute, Uganda
Background: Mental health problems in individuals with HIV are a common problem. Chronic illness, like HIV, that affect the brain as well as an individual’s way of life can result in mental illness. At the same time individuals with mental illness can be a risk for accruing HIV due to a misjudgement in behaviour as well as decision making. Unfortunately, in most of the centers these illnesses are not identified due to either lack of trained personnel for mental health or an ignorance of the presentation of these problems. It had been established that good drug adherence and clinical outcomes for patients with chronic illness is key in the delivery of a good clinical service.
Methods: The Infectious Diseases Institute (IDI) operates a large HIV clinic with approximately 8000 patients in Kampala, Uganda. The burden of mental health and psychosocial problems became apparent through the IDI counselling service where trained counsellors were not equipped to handle complex mental health conditions. Furthermore, for some patients, referral to other facilities for management of mental health conditions was unsuccessful as patients would not attend those clinics. To address these challenges, an integrated mental health clinic was established in 2013. The clinic is staffed by a medical officer and a visiting psychiatrist and the clinic operates once a week. Specialist medication including antipsychotics and antidepressants were procured and integrated into the clinic formulary.
Lessons learnt: The clinic caters for pre-existing and new onset psychiatric conditions. To date the clinic has registered 260 clients. Through the setup of this clinic we can now understand problems of mental health in our clinic setting in comparison to general population. Similar integrated approaches should be considered in other HIV programs.
Faridah Mayanja is a female Senior Clinic Manager based at the Infectious Diseases Institute in Uganda. Shedecided to embark in a career in nursing at an early age, due to her interest in serving the community, she specialized in Psychiatric nursing and obtained a Diploma in Registered Nursing (Mental Health). After completing training she was retained as a Teaching Assistant in the school of Psychiatric Nursing where she worked for two years. She later acquired a Diploma in Registered Midwifery form Mulago Nurses and Midwives Training School. She thentrained as an HIV Counselor at The AIDS Support Organization (TASO) where she worked for 3 years. She also received training in Health Services Management from the School of Public Health, Makerere University, and Health Management Information Systems from the Ministry of Health. In 2004, Faridah obtained a First Class Degree in Bachelors of Community Psychology. She is currently pursuing a Master of Science in Clinical Psychology at Makerere University. She also holds a Postgraduate Diploma in Project Planning Management awarded by Uganda Management Institute (UMI).
Faridah joined the Infectious Diseases Institute as a Clinic Manager in October, 2003. Since then, she has taken on a number of different leadership roles and responsibilities. She is currently the Senior Clinic Manager and was instrumental in the creation of a mental health clinic integrated in the HIV clinic. She is directly responsible for the nursing, counselling and medical record teams. She has also been able to oversee the smooth running of clinic activities and serves the IDI Training department as a psychosocial expert.
Infectious links between social factors and chronic disease
Speaker: Dr Jennifer Dowd
Senior Lecturer in the Department of Global Health and Social Medicine, King’s College London
Persistent infections such as cytomegalovirus (CMV) have been linked to chronic diseases of aging including CVD, cognitive decline, and immunosenescence. There are also large differentials in health and life expectancy by social factors that are not biologically understood. This talk will describe research linking infectious and chronic diseases and how microbial environments including latent infections may contribute to social differentials in health across the population, leading to novel targets for improvements in population health and health inequalities.
Jennifer Dowd is currently a Senior Lecturer in the Department of Global Health and Social Medicine, King’s College London. Her research focuses on the interaction of social and biological process over the life course and the mechanisms through which social factors “get under the skin” to impact health. In particular, she has examined the role of stress and immune function in explaining health inequalities by socioeconomic factors, as well as how persistent infections such as cytomegalovirus contribute to chronic diseases of aging. Ongoing projects include examining stress and telomere length in the U.K Whitehall II study, social variation in the microbiome at the population level, trends in the education-mortality gradient over time, and the impact of long-term obesity on population aging and longevity. Jennifer received her Ph.D. from Princeton University with a focus on Economics and Demography. From 2006-2008, she was a Robert Wood Johnson Health & Society Scholar in the Center for Social Epidemiology and Population Health at the University of Michigan. From 2008-2016 she was an Associate Professor of Epidemiology and Biostatistics, CUNY School of Public Health, City University of New York, where she maintains a research affiliation.
Translating knowledge across transmissible and non-transmissible diseases: tackling zoonotic diseases at the animal human interface
Speaker: Professor James Wood
Head of Department of Veterinary Medicine and Alborada Professor of Equine and Farm Animal Science Disease Dynamics Unit, University of Cambridge
There is a major but neglected global burden of zoonotic diseases, much of it in the developing world and in the tropics. When disease is in domestic animals, the burden is doubled through the impact on human health combined with the production or economic impact of many of these diseases.
In this talk, I will describe various integrated ‘One-Health’ approaches to zoonotic diseases in Africa. The diseases will include bovine tuberculosis in Ethiopia and bat-borne viruses such as Ebola in Ghana.
James Wood is Alborada Professor of Equine and Farm Animal Science and Head of the Department of Veterinary Medicine in Cambridge. He is an infectious disease epidemiologist, who works on a number of zoonotic diseases. He sits on the Public Health@ Cambridge steering committee and chairs the University’s Interdisciplinary Research Centre in Infectious Disease (http://www.infectiousdisease.cam.ac.uk/) and is one of the academic champions of the Cambridge Africa Programme (http://www.cambridge-africa.cam.ac.uk/).
Selective pressure from both infections and reproduction drive evolution of human immune system genes
Speaker: Professor Ashley Moffett
Improved diagnosis of infection to inform public health action
Speaker: Dr Nicholas Brown
Consultant Medical Microbiologist at Addenbrooke’s Hospital, Cambridge
Compared to other pathology specialties, microbiology has always been regarded as labour intensive (because of limited use of automation), slow (because an overnight incubation is the main unit of time) and relatively insensitive. However, increasing use of molecular diagnosis, sequencing technology and automation has changed this. The recently published Antimicrobial Resistance (AMR) Review chaired by Lord O’Neill stated that the development of new rapid point-of-care diagnostic tests was a key intervention that would change how we manage people with infection. The Holy Grail might not have been found yet, but a change in direction from specific individual tests to a more general syndromic approach is already producing interesting results.
Nick Brown has been a Consultant Medical Microbiologist at Addenbrooke’s Hospital in Cambridge since 1996. He is also an Associate Lecturer in the Department of Pathology at the University of Cambridge. He is employed by Public Health England (PHE) and is currently interim Lead Public Health Microbiologist for the East of England.
Nick has a career-long interest in the use of antibiotics and antibiotic resistance. He is the immediate past-President of the British Society for Antimicrobial Chemotherapy (BSAC). In this role he works with various national and international groups on the implementation of strategies to combat antibiotic resistance.
Evidence synthesis to inform public health policies on infectious
Speaker: Dr Daniela De Angelis
Programme Leader, the Medical Research Council Biostatistics Unit, University of Cambridge
Public health decision making in the area of infectious diseases relies on knowledge on key aspects of epidemics, such as current disease prevalence, severity, incidence and transmission. These cannot be observed and can only be estimated through statistical models that use data from a multiplicity of sources. This talk gives examples of our work in this area and its implications on population health.
Daniela De Angelis is programme leader at the Medical Research Council Biostatistics Unit in Cambridge, leading research in “Statistical Methods in Epidemic Modelling” and coordinating the “Evidence Synthesis for Health” theme.
She has a degree in Statistical Science from “la Sapienza” (Rome) and a PhD in Medical Statistics from Cambridge University. Since the 1990s, she has worked at the interface between statistics and epidemiology, devising and applying methods to estimate natural history, burden and temporal evolution for a range of infectious diseases. Current research focuses on the statistical challenges posed by the need to synthesise information from multiple sources.
She has co-authored over 100 publications, which have impacted on statistical and epidemiological literature and provided the quantitative basis for the Department of Health’s policies on HIV and Hepatitis C.
Daniela has a strong track record of memberships of advisory groups and of scientific collaborations with academics and health agencies, nationally and internationally.
The (In)Discipline of Public Health
Speaker: Professor Dame Sally Davies
Chief Medical Officer for England
In this lecture, Professor Dame Sally Davies, Chief Medical Officer, will offer her reflections on the development of public health research. She will argue that public health must be ‘in-disciplined’, that is, it must seek to look beyond disciplinary and institutional boundaries if we are to find solutions to the public health challenges of today, and offer some guiding principles for how we might effectively do so.
Dame Sally became Chief Medical Officer (CMO) for England in March 2011, having held the post on an interim basis since June 2010. Previously Dame Sally held responsibility for Research and Development, she was the Chief Scientific Adviser (CSA) for the Department of Health from 2004-2016.
Dame Sally is independent advisor to the Government on medical matters, with particular responsibilities regarding Public Health. She provides professional leadership for Directors of Public Health. Sally was actively involved in NHS R&D from its establishment and founded the National Institute for Health Research (NIHR).
Sally sits on the WHO Executive Board and has led delegations to WHO summits and forums since 2004. She advises many governments on health and policy, holding positions on a number of Boards and Groups, including the Singapore A Star International Advisory Group and University of Washington Institute for Health Metrics and Evaluation Board.
As CMO, Dame Sally publishes independent annual reports. In March 2013, Dame Sally published her 2011 annual report on infectious diseases. The report focused on and brought to light the increasing threat of antimicrobial resistance, calling for national and international action to address the key areas of stewardship, monitoring and surveillance and antibiotic development. Since this publication, Dame Sally continues to advocate globally on AMR. She has spoken on AMR at numerous events, including in 2013, the World Health Assembly side event in May, the G8 Science Ministers’ meeting in June, the Global Health Security Initiative in Rome and she was an invited technical expert at meetings organised by WHO. She was chair of the 2013 AMR forum at the World Innovation Summit for Health (WISH) in Qatar and is chair of the Strategic and Technical Advisory Group on AMR to the WHO. She has also raised public awareness of the issue through publication of a Penguin book and a TED talk.
In 2014 Dame Sally was elected Fellow of the Royal Society and in 2015 a member of the National Academy of Medicine, USA.