1/ FWO support boosts international reach
Six ITM researchers successfully gained regional support in 2018 from the Research Foundation – Flanders (Fonds voor Wetenschappelijk Onderzoek – Vlaanderen or FWO). FWO supports local researchers in order for them to advance in their independent, international research careers. ITM received three postdoctoral fellowships with Tom Decroo, Bart Cuypers and Thijs Reyniers (left to right above) successfully applying. Sofie Braet received a PhD fellowship with Bouke de Jong as ITM co-supervisor. Chris Kenyon was awarded an applied biomedical grant for a gonorrhea study. Leen Rigouts will contribute as ITM co-supervisor to a tuberculosis project with the University of Antwerp.
2/ New high-security laboratory opens
ITM inaugurated a new high-security laboratory in 2018, offering more capacity and flexibility to tackle new challenges. Funding for the expansion and upgrade of the lab facility came from the players of the Belgian National Lottery.
As an international player in tuberculosis (TB) diagnosis and research with a reference laboratory for the World Health Organization, “We urgently needed more space to carry out our reference tasks and to further strengthen our international reputation. The advance of multi-drug resistant TB also calls for increasingly stringent control measures to protect laboratory staff,” explains Dr Leen Rigouts, head of the TB laboratory.
The term ‘biosafety level’ (BSL) is used to identify the level of precautionary measures needed in a laboratory. BSL1 is the lowest and BSL4 the highest level of containment. A subsidy of €400,000 from the National Lottery allowed ITM to convert BSL2 premises into an additional BSL3 + laboratory. In previous years, the National Lottery also contributed substantially to building our BSL3 laboratories and other infrastructure projects, such as the conversion of a 17th-century monastery into an international campus.The new premises will also act as back-up allowing maintenance of present BSL3 laboratories and ensuring continuity for the analyses of bacteria, viruses and parasites. Flexibility in the laboratory capacity is also important for our recently formed outbreak research team.
3/ DRC gets first WHO collaborating centre
ITM’s longstanding partner ‘Institut National de Recherche Biomédicale’ (INRB) became the first World Health Organization (WHO) collaborating centre in the Democratic Republic of the Congo (DRC). The honour went to INRB’s National Reference Laboratory for human African trypanosomiasis, or sleeping sickness.
ITM has been working with the INRB laboratory since 1998 through its capacity-development programme funded by the Belgian Development Cooperation. Receiving the status of WHO collaborating centre is recognition for decades of hard work and the strengthening of skills.
“ITM has accompanied us in the creation and the functioning of the laboratory, as well as by training the majority of staff members, myself included,” said Prof Dieudonné Mumba Ngoyi who heads the laboratory. “To me, becoming a WHO collaborating centre is the crowning of a sincere long-term partnership.”
ITM is leading the international support to the DRC’s efforts to eliminate sleeping sickness, which is funded by Belgium and the Bill & Melinda Gates Foundation. Sleeping sickness is a deadly parasitic disease transmitted by tsetse flies. It currently affects 16 African countries with over 80% of new cases currently reported in DRC. In recent years, systematic screening and treating has reduced new cases to a mere few thousands, but the risk of a flare-up always looms.
As sleeping sickness becomes increasingly rare, it becomes more challenging to recognise the disease in its early stages. INRB’s position and skills as diagnostic reference centre are therefore essential in the elimination of sleeping sickness.
4/ Leprosy trial to involve 140,000 people
Teaming up with eight international partners including the Damien Foundation, ITM is gratified to be leading a new leprosy trial that will involve 140,000 people at high risk of acquiring the disease. Despite the World Health Organization’s (WHO) declared elimination of leprosy – with its target of less than 1 in 10,000 people reached across the world in 2000 – the disease continues to be endemic in some countries posing a serious public health threat. Known as the PEOPLE trial – Post-ExpOsure Prophylaxis in the Comoros and Madagascar – it looks into the optimal approach to preventing leprosy in endemic areas. This includes the Comoro islands and Madagascar, where in some areas the prevalence is 5-10 times the WHO elimination rate. The trial is generously funded by the European & Developing Countries Clinical Trials Partnership, which includes the support of the Leprosy Research Initiative.
The trial examines the antibiotic Rifampicin as a post-exposure prophylaxis. Currently this method of treating those who have been exposed to other contagious people is seen as the most effective way to stop the chain of leprosy infection. ITM and its partners are trying to find out whether the effect of prophylaxis is confined to a person’s household or a broader social context.
This is in response to the WHO’s call for more research into systematically tracing household contacts and finding the optimal way to administer preventive treatment for cost effectiveness reasons for healthcare systems. Fieldwork for the PEOPLE study will start early 2019, with its results hopefully also helping people with leprosy in other endemic regions.
5/ Safe travels!
The Institute sustained its historic ‘raison-d’être’ of providing local travellers with state-of-the-art tropical medicine services in 2018. We remained vigilant in watching developments in travel health ensuring best preventative measures as well as treatment to 19,653 patients through our travel clinic doors.
A key highlight was in January where we took the lead organising the 12th Belgian Travel Medicines Seminar for 170 enthusiastic experts. The seminar produced the following important recommendations for Belgian travellers:
• As from May 2018, the (pre-exposure) vaccination against the rabies virus will consist of two injections in seven days instead of three spread over 28 days.
• The vaccination carnet will no longer contain the stamp ‘cholera vaccine not indicated’.
Also in 2018, our travel clinic advised people planning an active and outdoor stay in wooded areas in Central and Eastern Europe in spring, summer or autumn to consider vaccination for tick-borne encephalitis. Due to a noted increase in malaria cases at the ITM travel clinic, we continue to remind people to seek preventive treatment when travelling to tropical and sub-tropical regions.
6/ Improving life quality for vulnerable HIV patients
ITM received the generous contribution of €32,500 from ‘Antwerp Diner 2018’, a yearly HIV charity event. With it our researchers developed a psychosocial self-management tool for vulnerable people from Sub-Sahara Africa with an HIV diagnosis. It is based on four sessions that teach people with HIV healthy life practices. ITM will make the course available to all AIDS reference centres in Flanders, who can use at their discretion.
7/ Fighting antimicrobial resistance on all fronts
Antimicrobial resistance is one of the biggest challenges to public health globally. Rooted in the misuse of antibiotics in humans and animals, there is a growing list of common bacterial infections that are becoming hard, or even impossible, to treat as antibiotics become less effective. To add to this, low-income countries are disproportionally hit because of limited control measures, surveillance and laboratory support. Alongside our 2018 Colloquium on the topic, all three departments of ITM intensified their efforts in 2018 to address this growing challenge.
In Clinical Sciences, Dr Jan Jacobs has been implementing his world-leading expertise in starting up and maintaining clinical bacteriology laboratories in low-resource settings. Through ITM’s capacity building programmes he, his team and cherished ITM partners have setup antibiotic resistance surveillance programmes in Cambodia, Democratic Republic of the Congo, Benin and Mozambique, with the generous support of Belgian Development Cooperation and Flanders, respectively.
The interdepartmental Bacterial Infections in the Tropics or ‘BIT’-team, setup under the patronage of the Baillet-Latour Foundation, also focuses on antibiotic resistance. In 2018, they conducted pioneering research on multidrug resistance in Salmonella infections in sub-Saharan Africa – a severe bacterial infection that kills more children than malaria. On another front, our multidisciplinary Outbreak Research Team are complementing and bolstering ongoing efforts by studying the drivers of antibiotic resistance outbreaks.
8/ Arrivals & departures
ITM is in the middle of a generational shift as dedicated professors retire from our ranks leaving the next wave to pick up from their research with their own perspectives on tropical diseases in the world, as they know it.
In 2018 we proudly welcomed two internationally trained and recognised scientists: German biologist Ruth Müller and Spanish epidemiologist José Peñalvo. Prof Müller is now Professor of Medical Entomology at ITM taking the lead of this existing department in the Department of Biomedical Sciences. Prof Peñalvo is setting up a new unit as ITM’s first Professor Non-Communicable Diseases in the Department of Public Health. Non-communicable diseases and their impact on health systems in low- and middle-income countries are increasingly topical issues.
With this welcome, we then extend our warm appreciation and thanks to the following retiring professors: Dirk Berkvens (Veterinary Epidemiology/Biomedical Sciences), Anne Buvé (HIV/Public Health), Marc Coosemans (Medical Entomology/Biomedical Sciences) and Vincent De Brouwere (Maternal Health/Public Health).
9/ HIV expert receives royal decoration
Professor Marie Laga has dedicated an entire career to improving care for people living with HIV. She was pleasantly surprised, and honoured, to be awarded the distinction of Commander in the Order of Leopold by the King of the Belgians. “This is a sign of appreciation of our HIV work and team, where we combine science and social engagement,” she said.
10/ Kind words
John Nkengasong has studied and worked at ITM. In 2017 he became the first director of the Africa Centres for Disease Control and Prevention (Africa CDC). Nkengasong, who was chief of the Virology Lab and the WHO collaborating Center for HIV Diagnostics at ITM from 1993-1995, is also member of the Institute’s Scientific Advisory Committee. As an alumnus and former employee he has an insider’s view. When asked about his perspective on ITM in an interview for our P3 magazine he said: “I appreciate ITM’s courage to face the issues head-on and take a mirror and look at itself and say ‘who are we and where are we going? …To me ITM’s future looks promising. You have so many assets in terms of strong partnerships, vast experience and a long history …You should look forward with confidence.”
11/ 59th ITM Colloquium – acting against antibiotic resistance
ITM’s annual scientific colloquium confronted one of the most pressing public health threats of our time – antibiotic resistance. 200 experts from around the world gathered in Phnom Penh, Cambodia where, together with our local partners, we offered a platform that incited thought and debate on multidisciplinary solutions that could be reflected into policy and worldwide action.
This 59th Colloquium was structured on the pillars for containment of antibiotic resistance outlined by the Word Health Organization. These pillars gave form to the various themes of the conference including microbiological surveillance, antibiotic stewardship and infection prevention and control in a ‘One Health’ approach. In particular this ‘One Health’ approach took centre stage highlighting the topic as a truly multisectoral challenge affecting human and animal health, agriculture and the environment. This was further demonstrated by the array of professions represented with participants ranging from health care and animal husbandry practitioners and researchers to policy makers. Running since 1959, the Colloquium is ITM’s yearly flagship scientific conference, funded by the Belgian Development Cooperation. The event alternates every year between Antwerp and an ITM partner country. With this, we heartily thank our Cambodian partners for a highly rated event of dynamic exchange in their beautiful bustling capital may it now bring action on this very real threat to medical practice globally.
12/ Focus on health care access for all
Too many people around the world are still without access to basic health care and this 40 years after the Alma Ata primary health care declaration. The Institute hosted international experts to take stock of progress on the issue in a symposium in preparation for the large WHO-UNICEF gathering in Astana, Kazakhstan, marking Alma Ata’s 40th anniversary.
13/ Outbreak Research Team up and running
ITM’s interdepartmental Outbreak Research Team (ORT), financed by the Flemish Ministry of Science, shaped up in 2018. This eight-strong multidisciplinary team aims at generating new insights on how best to prevent and combat outbreaks. The researchers are also investigating new innovative tools, methods and procedures for diagnosis, case management, prevention and control.
In 2018, research missions were deployed to a multitude of outbreaks. The ORT supported the Global Outbreak Alert and Response Network of the World Health Organization (WHO) with epidemiological research during a cholera outbreak in the Democratic Republic of the Congo (DRC). Several other missions to the DRC took place in the context of two subsequent Ebola outbreaks. They also supported Congolese partner ‘Institut National de Recherche Biomédicale’ (INRB) on diagnostics; were deployed to North-Kivu to support humanitarian NGO ALIMA with epidemiological work; and collaborated with the WHO in the implementation of a large four-arm trial evaluating novel Ebola therapeutics.
The ORT line-up has eight senior researchers including an epidemiologist, an entomologist, a clinical researcher, a laboratory expert, a one-health expert, a sociologist, a health systems expert and a molecular biologist specialised in next-generation sequencing; the team is completed by an operational coordinator to facilitate rapid deployment. The outbreak researchers focus on three types of outbreaks: viral infections transmitted by mosquitoes (e.g. dengue); infectious disease outbreaks that occur frequently in emergency situations (such as cholera) or in the context of elimination programmes (malaria, for example); and antibiotic resistance. These types of outbreaks are representative of the scale of potential infectious disease outbreaks the team will tackle and fall within the specific research niches of our Institute.
14/ Rabies Vaccination, a belgian success story
Rabies is an almost forgotten disease that is responsible for 60,000 victims around the world annually. Collaboration between the Belgian Ministry of Defence and ITM ensured a significant improvement in the prevention of rabies in 2018. Years of research among Belgian soldiers have resulted in a shorter vaccination schedule that is even being promoted by the World Health Organization.
Building up protection against rabies took quite some effort until recently: exactly three vaccinations before departure, on three different days (day 1, day 7 and day 28). The medical practitioner Lieutenant-Colonel Dr Patrick Soentjens, also head of ITM’s travel clinic, and his research team, spent years researching shorter and better vaccination schedules for Belgian soldiers. In Spring 2018, his work resulted in a revision of the WHO recommendations for travel doctors around the world: two vaccinations over seven days, instead of three injections over 28 days. Belgium, Denmark and the Netherlands have already adjusted their vaccination schedules and other countries are expected to follow suit.
The results of the study among 500 soldiers were also published in the journal Clinical Infectious Diseases. It showed the shorter vaccination schedule provides just as adequate antibody levels as the old schedule. The researchers are convinced that more travellers will get vaccinated given the easier arrangement and hope that more vulnerable children in Africa and Asia can be vaccinated.
A second clinical trial, evaluating a single visit schedule before departure in 300 participants, was recently published in the same journal, showing adequate immune responses after booster doses. Although this single visit schedule is not recommended by the WHO as first-line regimen at this stage, it is included in their new guideline as an option for last-minute travelers.
15/ Bringing DNA analysis to low-resource settings
Viral, bacterial, fungal, and protozoan infections are common in many developing countries with poor living conditions and weak health infrastructures. Analysing the genetic material of these pathogens can tell us a lot about how they are transmitted and spread in human and livestock populations. For instance, these techniques allowed for the tracing of the course of the recent Ebola epidemic in West Africa. However, using DNA analysis is a daunting task in low-resource settings where harmful microorganisms are most prevalent.
In recognition of this challenge, our Institute organized the interactive Molecular Data for Infectious Diseases (MID) course for the first time in 2018. The course capitalises on ITM’s long-stand¬ing expertise in tropical infectious diseases in endemic areas. Fourteen students from Africa, South America, and Asia were trained to implement genetic techniques in challenging environments with limited resources. They worked in multidisciplinary teams to develop their own project proposals.
Graduates of the first edition were unanimously positive: “The course was beyond expectations, I gained valuable knowledge on how to make a good research proposal in a specific setting in three weeks,” commented Tina Kusumaningrum from Jakarta, Indonesia, who was first of her class.
16/ Keeping Belgians safe from insect intruders
Our entomologists have long researched the presence of disease bearing insects in Belgium, ones that bring such infections as dengue fever, Zika or encephalitis. 2018 was no exception as our team searched throughout Belgium for the possible entry of tiger mosquitoes (Aedes albopictus) and, due to two exceptional Belgian cases of tick-borne encephalitis, ticks.
The small but fierce tiger mosquitoes transmit diseases such as dengue fever, chikungunya and Zika. Due to international transport of goods, global warming and the mosquitoes’ own excellent adaptability, these insects have lived in Southern Europe for several years now, and are heading northbound. In order to prevent the creatures from becoming regulars in Belgium, Belgian government agencies have established the Monitoring of Exotic Mosquitoes in Belgium (MEMO) project.
Running until the end of 2019 the project is funded by the Flemish, Wallonian and Brussels-based authorities and the Health, Food Chain Safety and Environment Federal Public Service as part of the national collaboration agreement in the Environment and Health policy fields (NEHAP). ITM is carrying out the project in association with the Royal Belgian Institute of Natural Sciences (KBIN) and Barcoding of Organisms and Tissues of Policy Concern (BopCo).
Similarly ITM researchers can be seen foraging in Belgian wooded areas seeking hard evidence of ticks carrying tick-borne encephalitis, a viral illness that can cause serious neurological problems. Imported cases are no exception, but in 2018 two cases most likely acquired in Belgium were reported for the first time.
17/ Master in Public Health evolves
Our Master of Public Health (MPH) underwent major reform of its orientations in 2018, ready for the class of 2019-2020. This evolution is to fit the growing demand of MPH students for greater flexibility and freedom of choice as their ITM master education equips them to address health challenges and strengthen health systems for vulnerable groups, nationally and internationally, in resource-constrained settings.
By merging two of the three previous orientations ‘Disease Control’ and ‘Health Systems Management & Policy’ we are leveraging over 50 years of experience to provide a new and improved orientation known as ‘Health Systems & Disease Control’ (MPH-HSDC). It better meets the evolving needs of today’s health professionals as it allows them to address the inherent interconnectivity between meeting health challenges and strengthening health systems – an interdisciplinary approach that ITM fosters in its vision of public health education and practice.
The second orientation is now ‘Tropical Medicine & International Health’ (MPH-TMIH). This takes over from its predecessor orientation ‘International Health’ and will build again on our strong track record in offering this master’s programme at ITM, while increasing the focus on clinical or biomedical research and laboratory perspectives of important international and national health challenges. This orientation now pays increased attention to clinical decision-making and current diagnostic and therapeutic challenges in tropical medicine.
Along with these orientation reforms, MPH students are invited to choose advanced courses in line with their interests, learning needs and career aspirations. With these new orientations, added flexibility and, for some, the possibility to spread studies over more time, ITM is also addressing a larger variety of students.
18/ SORT IT – fighting neglected tropical diseases
Ethiopia has the third highest burden of neglected tropical diseases (NTDs) in Africa. As an answer to a call from an Ethiopian NTD taskforce and other experts, ITM and the University of Gondar successfully launched the Structured Operational Research and Training Initiative (SORT IT) in NTDs in Ethiopia in 2018. The initiative is organised under the aegis of the Special Programme for Research and Training in Tropical Diseases (TDR) of the World Health Organization.
Using a bottom-up approach, the project is strengthening research and knowledge management capacities to foster evidence-based improvements in NTD interventions and act as a catalyst for programme expansion into other NTD affected countries. On a global scale it will contribute to the World Health Organization (WHO) NTD Road map for elimination by 2020.
The Institute ran the first edition of the SORT IT on NTDs workshop in September 2018 in Gondar, with 12 participants. The training taught all levels of Ethiopian health ministry staff and local NGOs the practical skills for conducting and publishing research while cultivating evidence-informed decision-making. Participants also worked on 14 different study protocols for their next workshop in Gondar in March 2019.