BIOTOPE samples being taken in Mzuzu

Over the past twelve months researchers from the gHealth Research group based in UCD and Queens University Belfast have been working with colleagues in Malawi to collect these samples.   The BIOTOPE (BIOmarkers TO diagnose PnEumonia) project is an innovative project which received funding from the Gates Foundation Grand Challenges Exploration Fund to investigate new ways to diagnose bacterial and severe pneumonia in the community.  It was one of 59 proposals from 1800 applications internationally selected from a variety of disease areas for pilot funding. 506 children have participated in the research and as part of this blood and urine samples have been collected and are now being shipped to Ireland for detailed analysis in University College Dublin and Queens University Belfast along with novel data from sensors and mobile phone applications monitoring the children’s health.  With this approach new ways to help stop the million children dying each year from pneumonia are being developed along with approaches that will help reduce antibiotic resistance both in Africa and internationally.

Pneumonia continues to be the number one infectious killer of children under the age of 5 years worldwide – more than HIV, TB, Zika, Ebola and malaria combined

People of any age in any country are at risk of contracting pneumonia but the bast majority (>90%) of childhood deaths from pneumonia occur in poor countries.

Antibiotic resistance is present in every country in the world and as recently as the 21st September 2016 the UN held a general assembly on antibiotic resistance.  This was only the fourth such General Assembly high-level event in the history of the UN to focus on a health issue highlighting the serious nature of this problem.

Background

Each year it is estimated that 5.9 million deaths occur in children aged less than 5 years of age.  Pneumonia is one of the major causes accounting for approximately 16% of these deaths – that is one child dying every twenty seconds from pneumonia.  Pneumonia occurs when the lungs become infected – usually with bacteria or viruses.  It made headlines recently when Hilary Clinton developed it during her campaign for US president.  Although often easily treated in developed countries difficulties in accessing healthcare, diagnostics and treatment mean that many children die from pneumonia each year in poorer countries.

Current guidelines in Africa suggest that all children with pneumonia should be treated with antibiotics. Antibiotics improve outcomes in children with pneumonia caused by bacteria.  However only approximately 20% of children with pneumonia have a bacterial infection. Since it is still impossible to clinically differentiate viral from bacterial pneumonia, prompt treatment of pneumonia with antibiotics remains a priority due to the high mortality rates. Concern now arises regarding the widespread use of antibiotics in those with viral infections leading to increased antibiotic resistance. Better use of antibiotics targeted at those with bacterial infections will help reduce antibiotic resistance.

A biomarker is a naturally occurring molecule, gene, or characteristic by which a particular disease can be identified.

An ideal biomarker for pneumonia would allow an early diagnosis of the condition and its severity and identify whether it is caused by bacteria or viruses. BIOTOPE is looking at the response of the body’s immune system to infection to help identify bacterial and severe pneumonia.  Using the samples shipped back to Ireland Dr Chris Watson and his team will screen them for thousands of proteins and genetic material which will identify which children would benefit from antibiotics.   Dr Joe Gallagher will use the clinical data collected on the symptom and examination findings to find ways to identify the most severely ill children.  Combining these datasets will allow the creation of new tools that can be deployed on mobile phones in Africa to help diagnose childhood pneumonia and reduce antibiotic resistance. The researchers hope to develop similar studies in Europe to help children here also.  Researchers in Children’s University Hospital, Temple Street and the National Virus Reference Laboratory are helping to identify the cause of pneumonia in these children.

These tools will aid clinicians working in Malawi and in other developing countries but also have the potential to be of relevance in high income countries where antibiotic resistance is a growing problem. Antibiotic resistance is present in every country in the world and as recently as the 21st September 2016 the UN held a general assembly on antibiotic resistance.  This was only the fourth such General Assembly high-level event in the history of the UN to focus on a health issue highlighting the serious nature of this problem.  By allowing clinicians in the community to identify pneumonia earlier and, in particular, to identify bacterial pneumonia, it will allow rational use of antibiotics and thereby reduce antibiotic resistance.

World Pneumonia Day

World pneumonia day is marked on the 12th November each year .  The goal is to raise awareness about pneumonia, promote prevention and treatment and generate action to fight the illness.