Global flu pandemic, we need to prepare with a model vaccine, WHO

The World Health Organisation says countries should urgently develop a vaccine to combat a possible global flu pandemic.
All it would take would be $13 million and good coordination, says WHO.

The outbreaks of SARS and Bird Flu have made preparedness imperative. A vaccine is the key to being prepared.

Over the last 100 years three pandemics have hit with such force that they spread around the whole planet before health
experts were even able to identify the virus strain. In order to get a vaccine ready, you need to identify the strain well
in advance.

With today’s technology we can get a vaccine ready before a pandemic hits.

Klaus Stohr, WHO Coordinator of the Influenza Program, said “It is not only possible, but also important, that influenza
pandemic vaccines be made available. There’s a shared responsibility needed to make that happen.”

50 scientists, regulators and vaccine manufacturers met at UN’s Health HQ, Geneva, Switzerland, precisely with this aim in
mind – getting ready for a possible global flu pandemic by creating a new vaccine.

Stohr said we have a huge window of opportunity now. “We could now get our groundwork done, our homework done, to ensure
that when it matters most for vaccine production, it can happen immediately. We don’t want to miss our chance.” he said.

Stohr said the main problem at the moment is money.

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Australia’s Defence Against Infectious Diseases Is At Risk

The nation’s public health response capacity is at serious risk because the Australian
Government has decided not to renew funding for an epidemiology program, according to an
article in the Medical Journal of Australia.

Emeritus Professor Robert Douglas, visiting fellow at the National Centre for Epidemiology
and Population Health at the Australian National University, and co-authors discuss the
importance of the Master of Applied Epidemiology (MAE) program and its role in preventing
the spread of epidemics.

Prof Douglas said that the Australian Government’s decision not to renew funding for the
MAE program was disappointing as the program had provided the investigative backbone to
Communicable Disease Network Australia for nearly 20 years.

“Although Australia is now one of the few industrialised nations that has no national centre
for disease control, the MAE program at least represented one of the essential elements that
such a national organisation would provide,” Prof Douglas said.

“The MAE program was born as a response to the urgent need, recognised during the early
years of the HIV epidemic, for Australia to upgrade its national disease intelligence capacity.

“Over two decades, 160 MAE trainees have played central roles in stemming the spread of
about 200 epidemics, including the severe acute respiratory syndrome (SARS) and the 2009
H1N1 influenza pandemic.

“Infections respect neither state nor national boundaries and, under Australia’s political
structure, their control can only be achieved through a consistent, coordinated effort by the
federal and jurisdictional governments.

“This will leave Australia vulnerable at a time when increasing population movements,
changing climate, and other pressures increase the likelihood that we will face new
pandemics and the re-emergence of old ones.

“The ongoing human resource represented by the MAE trainees is a highly cost-effective
insurance policy that we cannot risk losing in the challenging times ahead.”

The Medical Journal of Australia is a publication of the Australian Medical Association.


Medical Journal of Australia

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Viroblock SA Reports Positive Results Of Preclinical Studies In Antiviral Nasal Spray

Viroblock SA has announced that the first generation of VCCD Tech antiviral nasal spray formulation is active against human influenza. Viroblock’s patented Cholesterol Catalytic Depletion Technology (VCCD Tech) inactivates enveloped viruses during the extra-cellular phase, by altering and destabilizing cholesterol-rich viral envelopes.

The two pre-clinical studies exposed ferrets to Influenza A Wisconsin/67/2005 and influenza A Panama/2007/99 strains, and were conducted by Retroscreen Virology Ltd, a recognized leader in the research and testing of antiviral compounds and vaccines. Both the direct inoculation and the natural transmission protocols have confirmed the effectiveness and the value of the antiviral nasal spray.

These in-vivo campaigns confirm all in laboratory in-vitro studies to date and demonstrate that VCCD Tech represents a breakthrough for inactivating a number of enveloped viruses and their strains.

“Our depletion technology shows no toxicity at the dosage we tested thus far and allegedly limits the development of any viral resistance, and makes it effective on all families of enveloped viruses, such as human and avian influenzas, SARS, AIDS, Ebola and smallpox viruses.”

“This is an exciting development period for Viroblock and the most recent pre-clinical performance is a testament to our innovative and cutting-edge technology, the quality of our team, board of directors and investors.”

“We, at Viroblock, leverage all our technological assets for rapidly developing the next generation of antiviral nasal sprays; I am also confident that our technology will become an important element of pandemic influenza preparedness efforts”.

“Our ability to deliver tailored antiviral formulations, which can exist as colloidal suspensions, gels, creams, and aerosol sprays, opens promising business opportunities and a bright future for Viroblock.”, comments CEO Thierry Pelet.

About Viroblock SA

Viroblock SA is a Swiss start-up founded in 2005, which has become a pioneer and world leader in the blocking virus transmission technology.

Its patented VCCD technology allegedly inactivates all families and strains of enveloped viruses, like human and avian influenzas, RSV, SARS, AIDS, Ebola and smallpox viruses, and leverages a mechanism of action that limits the development of any viral resistance and toxicity. VCCD Tech products exist as colloidal suspensions, gels, creams, and aerosol sprays, having specific mechanical, physical and chemical properties

The W.A. De Vigier Foundation nominated Viroblock SA as one of the 10 best technology projects of the year 2006, and the Swiss Tech Tour 2007 Selection Committee has rated Viroblock SA as part of the top 50 technology companies in Switzerland.

Viroblock was founded by Dr. Donald F. H. Wallach who was a worldwide expert in artificial and bio-membranes, and non-phospholipid vesicles.

Viroblock SA

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Predator-Prey Interaction Recreated In A Petri Dish

The hunter-versus-hunted phenomenon exemplified by a pack of lionesses chasing down a lonely gazelle has been recreated in a Petri dish with lowly bacteria.

Working with colleagues at Caltech, Stanford and the Howard Hughes Medical Institute, a Duke University bioengineer has developed a living system using genetically altered bacteria that he believes can provide new insights into how the population levels of prey influence the levels of predators, and vice-versa.

The Duke experiment is an example of a synthetic gene circuit, where researchers load new “programming” into bacteria to make them perform new functions. Such re-programmed bacteria could see a wide variety of applications in medicine, environmental cleanup and biocomputing. In this particular Duke study, researchers rewrote the software of the common bacteria Escherichia coli (E. coli.) to form a mutually dependent living circuit of predator and prey.

The bacterial predators don’t actually eat the prey, however. The two populations control each others’ suicide rates.

“We created a synthetic ecosystem made up of two distinct populations of E. coli, each with its own specific set of programming and each with the ability to affect the existence of the other,” said Lingchong You, assistant professor of biomedical engineering at Duke’s Pratt School of Engineering and member of Duke’s Institute for Genome Sciences and Policy. “This ecosystem is quite similar to the traditional predator-prey relationship seen in nature and may allow us to explore the dynamics of interacting populations in a predictable manner.”

The results of You’s study appear April 15 in the journal Molecular Systems Biology. The research was supported by National Institutes of Health, the Defense Advanced Research Projects Agency, the Howard Hughes Medical Institute, and the David and Lucile Packard Foundation.

This field of study, known as synthetic biology, emerged on the scientific scene around 2000, and many of the systems created since have involved the reprogramming of single bacteria. The current circuit is unique in that two different populations of reprogrammed bacteria live in the same ecosystem and are dependent on each other for survival.

“The key to the success of this kind of circuit is the ability of the two populations to communicate with each other,” You said. “We created bacteria representing the predators and the prey, with each having the ability to secrete chemicals into their shared ecosystem that can protect or kill.”

Central to the operation of this circuit are the numbers of predator and prey cells relative to each other in their controlled environment. Variations in the number of cells of each type trigger the activation of the reprogrammed genes, stimulating the creation of different chemicals.

In this system, low levels of prey in the environment cause the activation of a “suicide” gene in the predator, causing them to die. However, as the population of prey increases, it secretes into the environment a chemical that, when it achieves a high enough concentration, stimulates a gene in the predator to produce an “antidote” to the suicide gene. This leads to an increase in predators, which in turn causes the predator to produce another chemical which enters the prey cell and activates a “killer” gene, causing the prey to die.

“This system is much like the natural world, where one species – the prey – suffers from growth of another species – the predator,” You said. “Likewise, the predator benefits from the growth of the prey.”

This circuit is not an exact representation of the predator-prey relationship in nature because the prey stops the programmed suicide of predator instead of becoming food, and both populations compete for the same “food” in their world. Nevertheless, You believes that the circuit will become a useful tool for biologic researchers.

“This system provides clear mapping between genetics and the dynamics of population change, which will help in future studies of how molecular interactions can influence population changes, a central theme of ecology,” You said. “There are literally unlimited ways to change variables in this system to examine in detail the interplay between environment, gene regulation and population dynamics.

“With additional control over the mixing or segregating of different populations, we should be able to program bacteria to mimic the development and differentiation of more complex organisms,” he said.


The research is a collaboration between the You lab and the laboratories of Frances Arnold at Caltech and Stephen Quake at Stanford and the Howard Hughes Medical Institute. The first author of the study, Frederick Balagadde, is currently establishing a research program at the Lawrence Livermore National Lab. While working in the Quake lab, he developed the technology to enable high-resolution measurements of the circuit dynamics. Other study authors include Duke’s Hao Song and Jun Ozaki, as well as Cynthia Collins, Rensselear Polytechnic Institute and Mat Barnet, Caltech.

Source: Richard Merritt

Duke University

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Global Fund Board Selects New Executive Director

The board of the Global Fund To Fight AIDS, Tuberculosis and Malaria has selected Michel Kazatchkine — France’s global ambassador for HIV/AIDS and communicable diseases and a former Global Fund vice chair — to serve as the organization’s new executive director, spokesperson Jon Liden said on Thursday, the AP/International Herald Tribune reports (AP/International Herald Tribune, 2/8). The Global Fund in November 2006 called off plans to name a new executive director to succeed Richard Feachem — whose contract ends in March — and launched a new search. Board members at closed meetings in November 2006 were unable to agree on one of two finalists. At that time, the final two candidates were Kazatchkine and Michel Sidibe, director of UNAIDS’ country and regional support department, according to meeting participants. Sidibe withdrew his candidacy for the position. According to a previous report, a nomination committee in January named nine candidates for the executive direction position. Three final candidates were named last month (Kaiser Daily HIV/AIDS Report, 1/31). The board’s official vote tally is not immediately available, Liden said, adding that Kazatchkine received the two-third majority required for approval (AP/International Herald Tribune, 2/8). “I look forward to handing over a strong institution that is positively impacting tens of millions of lives in 136 countries,” Feachem said, adding, “Under Dr. Kazatchkine’s leadership, the Global Fund is in excellent hands and its life saving work will continue to expand.” Carol Jacobs, chair of the Global Fund board, said, “This is a new period in the life of the Global Fund and we are indeed fortunate to have Professor Kazatchkine lead the secretariat at the start of the fund’s second five-year cycle. He has a right blend of skills and experience needed to manage this unique financial institution” (Global Fund release, 2/8).

Global Fund Should Manage Administrative Expenses, Prioritize Governance, Editorial Says
“Almost nobody … said a bad word about” the Global Fund “until this week” when the Boston Globe reported on an internal inspector general investigation into the business expense practices of the Global Fund’s executive director, a Los Angeles Times editorial says. According to the Times, the Global Fund’s new executive director will “start the job under a cloud of suspicion.” That is a “pity because the allegations, at least so far, don’t seem all that serious,” the editorial adds. “Given the size of its operations,” the Global Fund’s “administrative expenses are relatively modest,” the editorial says, concluding that the Global Fund board should “get a handle on this controversy by making governance matters a priority. The Global Fund lives or dies on its reputation — and so do the millions of people in Africa and across the developing world who need its services” (Los Angeles Times, 2/8).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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HIVMA Calls On President-Elect Obama For Leadership, Realistic Funding For HIV/AIDS – World AIDS Day: Dec. 1, 2008

Statement of HIV Medicine Association (HIVMA) Chair Arlene Bardeguez, MD, MPH:

The majority of the one million-plus people in this country living with HIV are uninsured or rely on public programs for care. As the economy worsens, and the number of people diagnosed rises, the strain on publicly funded programs will only grow. In fact, one in five people with HIV do not yet know they are infected. Most won’t be diagnosed until the disease has progressed to full-blown AIDS.

As part of the coalition AIDS in America, we join with other HIV/AIDS organizations in calling for important changes in prevention, access to care, civil rights, and research within the first 100 days of the new administration. We need an increased federal investment in domestic HIV/AIDS programs, including research and prevention efforts at the Centers for Disease Control and Prevention and the National Institutes of Health, and care and services for those with HIV/AIDS through the Ryan White CARE Act. We also urge President-elect Obama to quickly begin working on a national HIV/AIDS strategy that finally deals realistically with the growing epidemic in the United States.

HIVMA and AIDS in America have high hopes that the new administration can provide renewed leadership and help build on the many positive things that occurred this year, which attest that together we can make a difference. Among the HIV-related triumphs this year are:

the finding that people with HIV who are on treatment have similar survival rates as those of non infected people;

the reality that newly approved treatment options allow for simpler regimens with a better safety profile; and

the fact that states are making progress in implementing routine HIV testing in health care settings.

Our nation has made a critical and unprecedented commitment to the HIV/AIDS crisis in the developing world. That investment must continue, but the crisis at home requires more attention. To that aim the community, health care providers, researchers and government officials at all levels must work collaboratively to bring changes in diagnosis, access to care and treatment, and a decrease in the number of new infections. We are hopeful that with the next Administration’s leadership and a bold new national strategy we can do just that.


HIVMA is the professional home for more than 3,600 physicians, scientists, and other health care professionals dedicated to the field of HIV/AIDS. Nested within the Infectious Diseases Society of America (IDSA), HIVMA promotes quality in HIV care and advocates policies that ensure a comprehensive and humane response to the AIDS pandemic informed by science and social justice. HIVMA is part of the umbrella group AIDS in America, whose funding recommendations and proposals for the new president’s first 100 days are available online at hivma.

Because of our commitment to global public health issues, HIVMA and IDSA have created the Infectious Diseases Center for Global Health Policy and Advocacy to support and promote U.S. efforts to combat HIV/AIDS and tuberculosis throughout the developing world. More information about the Center is available online.

Source: Steve Baragona

Infectious Diseases Society of America

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Conference On Nanomedicine, Geriatric Care, Brain Injury: Nobel Laureate Keynote Speaker

Sir Harold Kroto, Nobel Laureate, will be the keynote speaker at the Edward Via Virginia College of Osteopathic Medicine Third Annual Via Research Recognition Day and Geriatric Update for Continued Medical Education on Oct. 5-6, 2006.

Kroto, a professor in the School of Chemistry and Molecular Sciences at the University of Sussex, will speak on “Architecture in NanoSpace.” He received the Nobel in Chemistry in 1996 along with Robert F. Curl and Richard E. Smalley for the 1985 discovery of fullerenes (C60 Buckminsterfullerene), a new form of carbon in which the atoms are arranged in closed shells. Kroto’s research areas in addition to fullerenes are spectroscopy of unstable species and reaction intermediates, cluster science, including carbon and metal clusters, microparticles, and nanofibers, and astrophysics, specifically interstellar molecules and circumstellar dust.

The focus on Thursday, Oct. 5, will be nanomedicine and biomedical applications of nanoparticles. Virginia Tech President Charles Steger will provide an introduction to biomedical research at Virginia Tech, where many of VCOM’s faculty members are adjunct faculty.

Other speakers on nanomedicine will be Roop Mahajan, director of the Institute for Critical Technology and Applied Science at Virginia Tech, on “Nanotechnology and Modern Medical Science: Challenges and Opportunities”; Harry C. Dorn, professor of chemistry at Virginia Tech, on “New Nanoscale Multi-Modal Diagnostic and Therapeutic Approaches in Biomedicine”; and Ishwar Puri, professor and head of engineering science and mechanics at Virginia Tech, speaking about “Biomedical Applications of Superparamagnetic Nanoparticles in Microfluidic Systems.”

Mahajan comes to Virginia Tech from the University of Colorado at Boulder and is the founder and co-director of MicroElectronic Devices in Cardiovascular Applications (MEDICA).

Dorn has invented a new family of filled fullerenes with many applications, including as a diagnostic and therapeutic agent that boosts the sensitivity of MRI techniques and improves the diagnosis and treatment of brain tumors. Based on findings with animal models, Dorn and colleagues at Virginia Commonwealth University and Virginia Tech have funding from the National Institutes of Health’s National Cancer Institute to further develop, produce, and test nanoparticles that can identify brain tumor cells and selectively target them for radiation therapy.

On Friday, Oct. 6, topics will be anti-aging medicine, geriatric care, and osteopathic medicine in the genomic era, image-guided therapy, and depression in older adults.

Traumatic Brain Injury will be addressed both days by such speakers as Ross D. Zafonte, DO, professor and chair of the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh Medical School, speaking on clinical trials in traumatic brain injury; Katherine H. Taber of the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center in Salisbury, N.C., on the neurobiology of traumatic brain injury; and Robin A. Hurley, MD, of the Hefner Veteran Affairs Medical Center in Salisbury, on the neuropsychiatry of traumatic brain injury.

Attendance at the conference is limited to approximately 600 participants. Registration is free for those who apply before Sept. 11, 2006. Registration includes admission to all sessions, continental breakfast, beverages, and lunch. To register, contact Kelly Varelos at On-site registration will be $50 per person and depends on availability of space.

The meeting site will be the Edward Via Virginia College of Osteopathic Medicine (VCOM), 2265 Kraft Drive, Blacksburg, VA. For additional information about the conference, contact Hara Misra at

* Continued Medical Education (CME) Credits – DO’s: VCOM is accredited by the American Osteopathic Association (AOA). The college anticipates being approved for 12 AOA Category 1-A credits pending approval by the AOA CCME. Each physician should claim only the hours of credit that he/she actually spent in the educational activity.

CME Credits – MD’s: This activity has been planned and implemented in accordance with the Essentials and Standards of the Medical Society of Virginia through joint sponsorship of Lewis Gale CME Organization, the Montgomery Regional Hospital, and the Edward Via Virginia College of Osteopathic Medicine. It is anticipated that the Lewis Gale CME Organization will designate this educational activity for a maximum of 12 credits AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in this activity.


VCOM’s research facility is located in the Virginia Tech Corporate Research Center in Blacksburg, Virginia. Learn more about the Edward Via Virginia College of Osteopathic Medicine at
The Edward Via Virginia College of Osteopathic Medicine is a professional graduate college offering the degree of Doctor of Osteopathic Medicine (D.O.) The college operates with a collaborative agreement with Virginia Tech for research and for student activities.

Contact: Hara Misra

Virginia Tech

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Scientists Discover Crucial Trigger For Tumour Protein

Scientists have discovered an essential protein that controls inflammation induced by ‘tumour necrosis factor’ (TNF) – an important part of the body’s defences against infection and a driver of cancer-associated inflammation, according to research published in Nature.

The study – led by Cancer Research UK-funded scientists based at Imperial College London in close collaboration with scientists at La Trobe University in Melbourne* – may also shed light on the causes of certain autoimmune diseases, such as rheumatoid arthritis and psoriasis.

TNF plays a pivotal role in protecting the body against infection by bacteria, viruses and other pathogens. It does this by directing the immune system to spot rogue pathogens and then destroy them.

As the name suggests, when TNF was first discovered scientists thought its main role in the body was to help kill cancer cells. But later research showed that in many types of cancer TNF instead serves to promote cancer growth.

So rather than destroying cancer cells, it encourages them to grow and spread by triggering inflammation in the surrounding tissues.

Short-term inflammation is used by the body to increase blood flow to an injury or infection, helping it heal faster. But scientists believe prolonged inflammation may be exploited by some cancers to help fuel the growth and spread of the disease.

The researchers discovered how a protein called ‘Sharpin’ prevents TNF from inducing inflammation, providing potential new insights into the link between inflammation and cancer.

Study leader Professor Henning Walczak, based at Imperial College London, said: “Together with our collaborators at La Trobe University in Melbourne, we discovered that the inflammatory skin problems triggered in mice lacking Sharpin could be completely resolved by switching off TNF. This was a striking result, not least because TNF-controlled inflammation is central to a wide variety of different diseases from autoimmune diseases – like rheumatoid arthritis and psoriasis – to cancer.

“Understanding how inflammation is controlled in the body on a molecular level could one day open the door to completely new approaches for treating both cancer and autoimmune disease.”

Dr Lesley Walker, director of cancer information at Cancer Research UK, said: “This important discovery is the culmination of six years work and demonstrates how basic research into the fundamental mechanisms of inflammation may lead to exciting new insights into its links with cancer. Although still at an early stage, we hope this will open up new avenues of research for developing treatments that target cancer-related inflammation in the future.”


Gerlach B. et al, Linear ubiquitination prevents inflammation and regulates immune signalling (2011), Nature, DOI: 10.1038/nature09816.


* Additional collaborators were from the University of Melbourne, German Cancer Research Centre (DKFZ) in Heidelberg and the Mediterranean Institute of Oncology in Viagrande, Italy. Research in the Walczak lab is supported by grants from Cancer Research UK, AICR, BBSRC, Ovarian Cancer Action and the EU Marie Cure Research Training Network ApopTRAIN.


Cancer Research UK

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Insight Into HIV Immunity May Lead To Vaccine

Latest insights into immunity to HIV could help to develop a vaccine to build antibodies’ defences against the disease, a University of Melbourne study has found.

By investigating the action of the human antibodies called ADCC, in people with HIV, researchers were able to identify that the virus evolves to evade or ‘escape’ the antibodies.

Professor Stephen Kent of the University of Melbourne and one of the senior authors on the paper said ADCC antibodies have been strongly implicated in protection from HIV in several vaccine trials but their action was poorly understood.

“These results show what a slippery customer the HIV virus is, but also shows that these ADCC antibodies are really forcing the virus into changing, in ways that cause it to be weaker,” he said.

“It also implies that if good ADCC antibodies were available prior to infection, via a vaccine, we might be able to stop the virus taking hold. This is the holy grail.”

The group at the University of Melbourne’s Department of Microbiology and Immunology analysed blood samples of people with HIV and found their virus had evolved to evade or ‘escape’ the ADCC antibodies against HIV they are making to try to control their virus.

The team led by Dr Ivan Stratov and Professor Kent employed a novel technology developed in their laboratory to find where ADCC antibodies were attacking the virus. They then looked at how the sequence of the virus had mutated over time to avoid the immune response.

“There is an urgent need to identify effective immunity to HIV and our studies suggest ADCC responses supply significant immune pressure on the virus,” Dr Ivan Stratov, a clinician and researcher said.

The group is now working on designing HIV vaccines to induce ADCC antibodies that make it more difficult for the virus to escape.

The work was published in the prestigious international journal PNAS.

Rebecca Scott

University of Melbourne

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International Travel Increasing Spread Of New Drug-Resistant Bacteria: Is This The End Of Antibiotics?

A new gene (New Delhi metallo-beta-lactamase [NDM] 1) that enables bacteria to be highly resistant to almost all antibiotics is widespread in Enterobacteriaceae* taken from patients in India and Pakistan, and has also been found in UK patients who travelled to India for elective surgery, according to an Article published Online First and in the September edition of The Lancet Infectious Diseases. The rapid emergence of these multi-drug resistant NDM-1 producing bacteria and their potential worldwide spread could herald a period in which antibiotics become redundant and demands very close international monitoring and surveillance.

In 2009, Timothy Walsh from Cardiff University in the UK and international colleagues first identified the NDM-1 gene in Klebsiella pneumonia and Escherichia coli bacteria taken from a Swedish patient admitted to hospital in India. Worryingly, NDM-1-producing bacteria are resistant to many antibiotics including carbapenems, a group of antibiotics generally reserved for use in emergencies and the treatment of infections caused by multi-resistant bacteria.

In this study, the authors investigated how common the NDM-1 producing antibiotic resistant bacteria are in Bangladesh, India, and Pakistan and the importation of these bacteria into the UK via patients returning from these countries.

The researchers collected bacteria samples from patients presenting with various hospital and community-associated infections in Chennai and Haryana in India, and from patients referred to the UK’s national reference laboratory between 2007 and 2009. Samples were tested for antibiotic susceptibility and the presence of the NDM-1 gene using polymerase chain reaction (PCR) and sequencing.

They identified 44 (1.5%) NDM-1-positive bacteria in Chennai, 26 (8%) in Haryana, 37 in the UK, and 73 in other sites in Bangladesh, India, and Pakistan. NDM-1 was mostly found in E coli (36), the most common cause of community-associated urinary tract infections, and K pneumoniae (111). The NDM-1-producing bacteria were highly resistant to all antibiotics except tigecycline and colistin. In some cases, isolates were resistant to all antibiotics.

Importantly, the NDM-1 gene was found to be present on plasmids, DNA structures that can be easily copied and transferred between different bacteria, suggesting: “an alarming potential to spread and diversify among bacterial populations”.

The authors say that the emergence of NDM-1 positive bacteria is potentially a serious global public health problem as there are few new anti-Gram-negative antibiotics in development and none that are effective against NDM-1. Consequently, we are facing a period in which antibiotics become redundant. They go on: “Even more disturbing is that most of the India isolates from Chennai and Haryana were from community-acquired infections, suggesting that NDM-1 is widespread in the environment.”

They conclude by pointing out that several of the UK NDM-1 positive patients had travelled to India or Pakistan for surgical procedures (including cosmetic) within the past year: “India also provides cosmetic surgery for other Europeans and Americans, and it is likely NDM-1 will spread worldwide.”

In a Comment, Johann Pitout from the University of Calgary in Canada warns that patients who have medical procedures in India should be screened for multiresistant bacteria before they receive care in their home country: “If this emerging public health threat is ignored, sooner or later the medical community could be confronted with carbapenem-resistant Enterobacteriaceae that cause common infections, resulting in treatment failures with substantial increases in health-care costs.”

“Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study”
Karthikeyan K Kumarasamy, Mark A Toleman, Timothy R Walsh, Jay Bagaria, Fafhana Butt, Ravikumar Balakrishnan, Uma Chaudhary, Michel Doumith, Christian G Giske, Seema Irfan, Padma Krishnan, Anil V Kumar, Sunil Maharjan, Shazad Mushtaq, Tabassum Noorie, David L Paterson, Andrew Pearson, Claire Perry, Rachel Pike, Bhargavi Rao, Ujjwayini Ray, Jayanta B Sarma, Madhu Sharma, Elizabeth Sheridan, Mandayam A Thirunarayan, Jane Turton, Supriya Upadhyay, Marina Warner, William Welfare, David M Livermore, Neil Woodford
The Lancet Infectious Diseases August 11, 2010. DOI:10.1016/S1473-3099(10)70143-2

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