FEDERATION OF
infection societies
CONFERENCE 2018

13th – 15th November 2018 | Sage Gateshead – Newcastle

FEDERATION OF
infection societies
CONFERENCE 2018

13th – 15th November 2018 | Sage Gateshead – Newcastle

FEDERATION OF
infection societies
CONFERENCE 2018

13th – 15th November 2018 | Sage Gateshead – Newcastle

Programme

Day 1: Tuesday 13th November

09:30 – 09:45

SAGE 1
Welcome Address and Introductions
Dr Albert Mifsud, BIA President & Dr Hiten Thaker, Chairman of Organising Committee

09:45 – 1130
Plenary Session: HIV Medicine 2018
Chairs: Professor Steve Green, Honorary Professor in Infection, Immunity and Cardiovascular Disease, University of Sheffield & Dr Ashley Price, Consultant in Infectious Diseases, Newcastle upon Tyne Hospitals

09:45
Pulmonary Opportunistic Infections

Professor David Dockrell, Professor of Infection Medicine, The University of Edinburgh

Abstract - Pulmonary Opportunistic Infections

The epidemiology of pulmonary disease in people living with HIV (PLWH) in the UK has changed significantly with the widespread use of combination antiretroviral therapy. As in other organs an increasing contribution of non-AIDS related conditions and a reappraisal of the nature of opportunistic infections has changed perspectives on the causes of lung disease. High rates of smoking compound the incidence of both infectious and non-infectious diseases in the lung. Recent evidence suggests that ongoing viral replication in the lung and persistent immune regulation, despite antiretroviral therapy contribute to lung pathology. In select groups of PLWH syndromes such as obliterative bronchiolitis have emerged as causes of disease. With respect to infections community-acquired pneumonia has emerged as the leading respiratory cause of infection. Pneumococcal disease has remained at increased levels in PLWH despite antiretroviral therapy and potential reasons for this include persistent alteration in alveolar macrophage killing of pneumococci. Haemophilus influenzae and Staphylococcus aureus have also become increasing causes of infection. In contrast opportunistic pathogens such as Pneumocystis jirovecii have declined but remain important due to late presentation. HIV health care providers are faced with increasing options for the diagnosis of Pneumocystis pneumonia. Other opportunistic infections encountered prior to the widespread use of antiretrovirals are now rare causes of disease, but must still be considered in patients with significant levels of immunosuppression. Travel-related infections are an increasing cause of lung infections, while influenza A virus remains an important vaccine-preventable cause of lung disease, necessitating access to vaccine programmes for PLWH.

10:15
Ageing and HIV

Dr Brendan Payne, Honorary Consultant & Wellcome Fellow, Infectious Diseases & Virology, Newcastle University

Abstract - HIV and Ageing

The age demographic of HIV cohorts is progressively shifting to the right, and many cohorts will soon have a mean age of over 50 years. Older people living with HIV (PLWH) are clearly a very diverse group and may experience the effects of the normal ageing process as well as the additional specific effects of HIV infection and anti-retroviral therapy. Many older PLWH are ‘long-term survivors’ who have lived with HIV for decades and have been exposed to periods of partially effective and toxic anti-retroviral therapy (ART). Conversely new infections in older persons are also increasingly common.

This talk will focus principally on understanding HIV and ageing from a ‘bottom up’ perspective, by considering the cellular and molecular changes of the ageing process, such as immune senescence and mitochondrial dysfunction (a biogerontological perspective). I will argue that we need to focus not only on lifespan but also on ‘healthspan’. I will explore these concepts through a series of questions. Can HIV and/or ART be considered to accelerate or augment biological ageing? What does this mean for the long-term health of PLWH as they grow older? Is it possible to define what ‘successful’ and ‘unsuccessful’ ageing look like in the context of HIV? How relevant are HIV-related factors (immunological parameters, duration of infection, treatment history etc.) in determining this? What is the residual biological effect of the ‘best case’ scenario of modern ART and full viral suppression? Is it feasible to think about interventions to target the ageing process itself in PLWH, and what might these look like?

10:45
Non-Alcoholic Fatty Liver Disease (NAFLD) and HIV

Professor Edmund Ong, Consultant Physician & Honorary Professor, Infection & Tropical Medicine, Royal Victoria Infirmary, Newcastle

Abstract - Non-Alcoholic Fatty Liver Disease (NAFLD) and HIV

With the introduction of combination antiretroviral therapy, survival of individuals with HIV has improved substantially. Liver disease with hepatitis B and C which often co-exist have become treatable with directly acting antivirals. With such agents becoming widely used, the spectrum of liver disease is likely to change. With increasing survival and increasing age, more frequent onset of diabetes and dyslipidemia, metabolic causes of liver disease become much more likely to occur in this population. There have been increased reports on the development of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) in HIV co-infection which raise the question around prevalence, clinical manifestation, clinical outcome and future management.

11:15
Q & A
Supported by BHIVA

11:30 – 12:00
COFFEE, Exhibition & Poster Viewing
CONCOURSE

Parallel Sessions

State of the Art
SAGE 1

12:00 – 13:00

Chairs:
Professor Martin Wiselka, Professor of Infection & Tropical Medicine, University Hospitals of Leicester & Dr David Chadwick, Consultant & Clinical Director, Infectious Diseases, James Cook
University Hospital, Middlesborough

12:00
Management of HIV and new horizons

Professor Mark Nelson, Consultant in HIV & Sexual Health, Chelsea & Westminster
Hospital, London

12:30
Hepatitis C treatment and new horizons

Dr Peter Moss, Consultant in Infectious Diseases, Hull & East Yorkshire Hospitals

Abstract - Hepatitis C treatment and new horizons

Hepatitis C infection is a major cause of morbidity and mortality worldwide. The World Health Organisation (WHO) estimates that there are more than 70 million people chronically infected, although prevalence data are limited for many parts of the world. The WHO has announced an aim of eradicating hepatitis C infection as a significant public health problem by 2030, and National Health Service England has committed to trying to achieve this goal locally by 2025.

Simple, safe, well-tolerated oral direct acting antiviral drugs (DAA) are now available which will clear hepatitis C from the blood in more than 95% of patients. Public Health England estimates that there are still many patients with chronic hepatitis C infection who remain undiagnosed, and there has been major investment by NHSE to identify and treat these people.

Despite the availability of new drugs, and the endorsement of WHO, fundamental questions are still being asked about the management of chronic hepatitis C infection. The British Medical Journal (among others) has published articles questioning the efficacy of the oral antiviral drugs, and proposing that absence of virus from the blood 12 weeks after treatment (SVR12, the standard measure of ‘cure’) does not in fact equate to viral eradication. A recent Cochrane review of treatments for hepatitis C infection concluded that there was insufficient evidence to judge whether DAAs have overall beneficial or harmful effects on the outcome of patients with hepatitis C-induced liver damage, and the authors have called for a moratorium on treatment. There is evidence that the incidence of hepatocellular carcinoma in patients with hepatitis C-induced cirrhosis may actually increase following antiviral therapy. Moreover Hepatitis C Networks in England are finding it increasingly difficult to find new patients with chronic hepatitis C infection, and many are falling behind the NHSE targets for treatment rates. Concerns have been raised about viral resistance to DAAs, both intrinsic and treatment-induced.

This talk addresses these controversies, and summarises the evidence for using antiviral drugs in chronic hepatitis C infection, as well as considering the significance of drug resistance and the role of resistance testing in managing hepatitis C infection.

Choosing Wisely in Infection
NORTHERN ROCK

12:00 – 13:00

Chair:
Professor Martin Llewelyn, Professor of Infection Medicine, Brighton and Sussex Medical School

12:00
The principles of choosing wisely and future plans

Dame Professor Sue Bailey, Chair of Choosing Wisely

12:30
Choosing wisely in infection

Dr Gavin Barlow, Consultant in Infection, Hull & East Yorkshire Hospitals
Supported by “Choosing Wisely” run by the Royal Academy of Colleges

Abstract - Choosing wisely in infection
The principles of Choosing Wisely and antimicrobial stewardship, both global initiatives that predominantly aim to optimise medical investigation and intervention, have considerable resonance. In 2017/18, the British Society for Antimicrobial Chemotherapy (BSAC) developed five Choosing Wisely UK recommendations that focused on respiratory infections, bacteruria, intra-abdominal infection, antibiotics towards the end of life, and the prescribing of antibiotics for non-infection conditions. This talk will briefly review the development of these recommendations, present data from an ongoing synthesis of global Choosing Wisely infection recommendations and consider other examples of Choosing Wisely in infection using a shared patient-prescriber decision-making approach.

13:00 – 13:30
Keynote Lecture

Chair:
Dr Natasha Ratnaraja, Consultant, Microbiology & Infection, University Hospitals Coventry and Warwickshire

Tuberculosis in focus
Professor Francis Drobniewski, Professor of Global Health, Infectious Diseases and Immunity, Imperial College London

Abstract - Tuberculosis in Focus

Despite the existence of an inexpensive well-established evidence –based treatment for tuberculosis (TB), over 1.6 million people died of TB in 2017 including 300 000 individuals co-infected with HIV. It remains the top single infectious disease killer in the world, especially those with HIV with many deaths now occurring due to the development of antimicrobial drug resistance.

The World Health Organisation (WHO) estimates that over 10 million people have active TB but of these 3.6 million were either not diagnosed or formally reported. Half a million cases of multidrug resistant tuberculosis (MDRTB) are now recorded annually requiring prolonged, expensive and toxic therapy. Yet only a third of new TB cases are tested for rifampicin resistance (as a surrogate for MDRTB, ie resistance to rifampicin and isoniazid).

Currently the global effort is contained within the goals of the WHO End TB strategy with targets for 2035 of: 95% reduction in tuberculosis deaths (compared with 2015); 90% reduction in TB incidence rate (less than 10 tuberculosis cases per 100 000 population) and no affected families facing catastrophic costs due to TB.

Whilst there are many success stories globally there are countries with continuing high rates of TB, HIV, MDRTB (and XDRTB, further resistance to injectable agents and a fluroquinolone). There are cancers with better survival rates than patients with XDRTB and concurrent HIV infection.

During the last year the UN met and passed resolutions supporting EndTB and a rejuvenation of the global TB effort including addressing the consequences of drug resistant TB and HIV co-infection; there were important new studies utilising novel technology such as whole genome sequencing in mapping resistance, further development of near-patient diagnostic devices, initiatives re-defining critical concentrations of drugs tested for drug resistance, pharmacokinetic/pharmacodynamics assessments of drugs as part of a strategy to develop new regimens and re-define drug dosages of existing drugs. Some of these will be discussed in this talk.

13:30 – 14:30
LUNCH, Exhibition & Poster Viewing
CONCOURSE

13:30 – 14:30
Poster Walks
Level 1

13:30
Viral hepatitis & general virology

Professor Mark Nelson, London & Professor Edmund Ong, Newcastle

14:00
HIV
Professor David Dockrell, Edinburgh

13:30 – 14:30
Meet the Expert
SAGE 2

Advances in HIV therapy – a discussion

With
Dr Hiten Thaker
Consultant in Infectious Diseases, Hull & East Yorkshire Hospitals NHS Trust

Dr Andrew Ustianowski
Consultant in Infectious Diseases, North Manchester General Hospital

Dr Ashley Price
Consultant in Infectious Diseases, Newcastle upon Tyne Hospitals

Supported by Gilead

14:30 – 15:30

Barnett Christie Lecture
SAGE 1

Chairs:
Dr Farnaz Dave, ST5 in Infectious Diseases, North West ID Unit, Manchester
Professor Martin Llewelyn, Professor of Infection Medicine, Brighton and Sussex Medical School

Passengers and pathogens: how can bacterial genomes help us understand Staphylococcus aureus infections?
Dr Bernadette Young, Academic Clinical Lecturer, Infectious Diseases & Microbiology, University of Oxford and Oxford University Hospitals NHS Foundation Trust

Supported by BIA 

Abstract - Passengers and pathogens: How can bacterial genomes help us understand Staphylococcus aureus infections?

Bacteria that are frequently found as commensals are also some of the most important bacterial pathogens. In humans Staphylococcus aureus is usually asymptomatically carried, but also causes invasive and life-threatening infection. The causes of such alteration in the host-pathogen balance have only partly been answered by candidate gene studies of virulence, and whole genome sequencing has promised to improve our understanding of natural variations in virulence. I will review our recent studies of Staphylococcus aureus virulence, using both within-host and population wide studies to identify bacterial genomic determinants of disease. 

15:30 – 16:10
Platinum Sponsored Satellite Symposium
SAGE 1

DTG▼-Based Regimens – another step in the 2DR era
Dr Bryn Jones, Regional Medical Lead Europe, ViiV Healthcare

Supported by ViiV Healthcare

COFFEE, Exhibition & Poster Viewing
CONCOURSE

16:10 – 16:30

 

Poster Walk
CONCOURSE

16:10 – 16:30

Clinical case reports
Dr Anne Tunbridge, Sheffield and Dr Penny Lewthwaite, Leeds

PARALLEL SESSIONS

16:30 – 18:30

Exotic Imported Infection: Identify, Treat and Prevent
SAGE 1

Chair:
Dr Nick Beeching, Consultant & Senior Lecturer in Infectious Diseases, Royal Liverpool University Hospital & Liverpool School of Tropical Medicine

16:30

Introduction
Dr Nick Beeching

16:35

Yellow fever: beyond supportive care
Sir Michael Jacobs, Clinical Director, Infectious Diseases, Royal Free London NHS Foundation Trust

Abstract - Yellow fever: beyond supportive care

This presentation will address the challenges of managing patients with yellow fever. 15-20% of individuals with symptomatic yellow fever virus infection develop severe disease, with a high case-fatality rate even with optimal supportive care. Better treatment strategies are needed, but none are imminent. This overview will outline the current understanding of yellow fever, progress towards improved treatment and key outstanding research questions to enable better outcomes.

16:55

Yellow fever vaccination recommendations and regulations
Mrs Hilary Simons, Senior Specialist Nurse, Travel Health, National Travel Health Network and Centre

Abstract - Yellow fever vaccination: recommendations and regulations

An effective and ‘safe’ vaccine for yellow fever has been available for over seventy years. Over the last decade or so, new knowledge about the potential for this vaccine to cause serious adverse events in some recipients has emerged, resulting in a more guarded approach to yellow fever vaccine administration. Nevertheless, vaccination should be recommended for personal protection if travelling to areas where yellow fever transmission occurs. In addition, to prevent international spread, yellow fever is only one of two diseases specified in the International Health Regulations (IHR); under IHR countries can require proof of vaccination from travellers as a condition of entry under certain circumstances.

This overview presents some challenges faced by health professionals who must, as part of a yellow fever vaccination service and individual traveller risk assessment, consider yellow fever vaccination recommendations and interpret country regulations. Factors that must be considered include the dynamic nature of yellow fever epidemiology, changes to certificate requirements and validity, hesitancy regarding vaccine use and most recently, an awareness of the unprecedented increase in numbers of cases of the disease in unvaccinated international travellers.

17:25

MERS-CoV and monkeypox in the UK
Dr Mike Beadsworth, Clinical Director, Tropical and Infectious Diseases, Royal Liverpool University Hospital

Abstract - MERS and Monkeypox

In August 2018 the airborne High Consequence Infectious Disease (HCID) network in the United Kingdom was tested for the first time since its inception.

We describe the first case of Middle Eastern Respiratory Syndrome (MERS) in the United Kingdom since 2013, followed by the first confirmed cases of Monkeypox virus infection, including the infection of a healthcare worker.

Furthermore, we will describe the mechanisms of HCID activation, including the involvement of PHE and NHSE, and the process of management using enhanced personal protective equipment (ePPE) when required for prolonged periods.

17:55

Panel discussion
Sir Michael Jacobs, Mrs Hilary Simons, Dr Mike Beadsworth

Dr Matthias Schmid, Consultant in Infection & Tropical Medicine, Royal Victoria Infirmary, Newcastle

Dr Dipti Patel, Director, National Travel Health Network and Centre (NaTHNaC)

Supported by NaTHNaC


16:30 – 18:30

Vaccines
NORTHERN ROCK

Chairs:
Dr Rajeka Lazarus, Consultant in Microbiology & Infectious Diseases, University Hospital Bristol &

Dr Anna Goodman, Consultant in Infectious Diseases, Guy’s & St Thomas’ Hospital

16:30
Current issues in adult vaccines in the UK

Dr Shamez Ladhani, Consultant in Paediatric Infectious Diseases, Public Health England

16:50
Gonococcal vaccines
Dr Darryl Hill, Senior Lecturer, Cellular & Molecular Medicine, University of Bristol

Abstract - Gonoccocal Vaccines

Gonorrhoea is caused by infection with the human restricted Gram-negative bacterium Neisseria gonorrhea. In 2012 according to the World Health Organisation (WHO), an estimated 78 million cases of urogenital cases of gonorrhea occurred globally. Many countries, including the UK have seen case numbers increase significantly since that WHO report was published. Infection can often be asymptomatic and therefore, be passed unknowingly from person to person. Besides the urogenital tract, gonococcal infection can occur at diverse mucosal sites including rectal, pharyngeal and ocular surfaces. Whilst primarily associated with focal infections, N. gonorrhoeae can also disseminate from mucosal surfaces to infect the joints, and in rare cases, cause sepsis and meningitis.

The only other pathogenic species within the neisserial genus, N. meningitidis has seen great progress in the development of vaccines to prevent infection. Unlike N. meningitidis, N. gonorrhoeae lacks the expression of a polysaccharide capsule. Thus, N. gonorrhoeae presents a similar challenge to Group B meningococcal strains for which the capsule is unsuitable for use as a vaccine antigen due to its similarity to human moieties. The development of a gonococcal vaccine is further hindered by the hypervariable nature of the gonococcus compared to the meningococcus. However, lessons may be learned from the development and introduction of the Men B vaccine into the UK childhood vaccine schedule and associated studies. Important considerations for the development and implementation of any future gonococcal vaccine include choosing suitable combinations of antigens, identifying appropriate correlates of protection, using relevant models of infection to assess suitability and choosing which individuals to vaccinate.

Given the substantive decrease in susceptibility to many antibiotics, there is an as yet unmet and urgent need to find new ways to combat infections caused by this highly specialised pathogen.

17:10
RSV vaccines for the elderly
Dr Christopher Green, Consultant in Infectious Diseases, University of Oxford

17:30
Human challenge models in accelerating vaccine development
Dr Angela Minassian, Chief Investigator, Clinical Vaccine Trials, University of Oxford

Abstract - Human challenge models in accelerating vaccine development

Human challenge trials, in which healthy volunteers are experimentally infected with a pathogen under controlled conditions, are currently accelerating the development of new drugs and vaccines for infectious diseases of global importance. The number of models is continuing to increase year on year, as their use is seeing a resurgence of interest. Coupled with dramatic advances in immuno-monitoring, -omic and sequencing technologies, these clinical trials are now generating unprecedented scientific insights into microbe biology, host-pathogen interactions and human immunity. However, these exciting clinical advances need to be coupled with critical ethical review according to established frameworks; because of their invasive nature, these studies require careful assessment of all aspects related to volunteer safety. Moreover, new models require thorough consideration for how to produce a new challenge inoculum to meet an acceptable quality standard – this can be hard to define given the nature of the product and lack of regulatory experience related to production of live pathogens intended for human challenge.

The malaria field has some of the most long-standing experience in this arena, currently utilising various different “controlled human malaria infection” (CHMI) protocols (mosquito-bite, purified sporozoite or direct blood inoculation) for at least two different parasite species – Plasmodium falciparum and P. vivax. Recently, these CHMI models have expanded to include genetically attenuated parasite strains, as well as CHMI studies in malaria-endemic areas which is now enabling vaccine and drug efficacy testing in malaria-endemic populations. This talk will cover these recent advances.

17:50
Prevention of invasive Staphylococcus aureus infections: assessment of vaccines
Professor Richard Proctor, Professor Emeritus of Medicine, Medical Microbiology & Immunology, University of Wisconsin-Madison, USA

Abstract - Prevention of invasive Staphylococcus aureus infections: assessment of vaccines

After clean water, vaccines have had the greatest impact on lowering mortality due to infectious diseases. Therefore, it is not surprising that the development of a vaccine to prevent S. aureus infections has been a goal to prevent a leading cause of morbidity and mortality worldwide. Unfortunately, multiple vaccine trials have failed. Worse, one vaccine was associated with increased mortality in vaccine recipients who had unrecognized and underlying immune dysfunction. This lecture will review of the failed vaccines and vaccines that are still be tested. The potential reasons why these failures will be discussed. Clearly, vaccines can be developed most rationally when the mechanism(s) of immune protection are understood. This lack of information on the protective human immune response to S. aureus has hampered the development of making a successful vaccine. Of note, animal models have been exceptionally poor at predicting efficacy in humans. Nevertheless, recent investigations into the protective human immune response to S. aureus are providing insights into human staphylococcal immunity and immunopathogenesis of S. aureus infections. Significantly, interactions of S. aureus with the host may be far less benign than previously thought as immune dysregulation is frequently found in patients that succum to invasive S. aureus infections. Our new information may help in the development of vaccines that reduce morbidity and mortality, rather than prevent infections. Indeed, in the near future, prevention of infection may best achieved via decolonization.

18:10
Panel Discussion

Supported by BIA


16:30 – 17:45

Challenging Cases in Mycology
SAGE 2

Chair:
Dr Matthijs Backx, Consultant in Infectious Diseases and Medical Microbiology,
University Hospital of Wales

Abstract - Session Overview

This session will explore diagnostic and therapeutic challenges in medical mycology as illustrated by four interactive case presentations.

16:30
Sick post flu on ITU

Dr Ian Blyth, Consultant in Infectious Diseases & Microbiology, University Hospital
of Wales

16:45
Urine trouble now

Dr Matthijs Backx, Consultant in Infectious Diseases and Medical Microbiology,
University Hospital of Wales

17:00
Lines, damn lines and thoracics

Dr Irasha Hettiarachchi, Consultant Medical Microbiologist, University Hospitals
Bristol

17:15
Holy water, no darling

Dr Rebecca Gorton, Senior Clinical Scientist, Mycology, Health Services Laboratories,
London
Dr Emmanuel Way, Consultant in Infection, Royal Free Hospital NHS Foundation
Trust, London

17:30
Questions

Supported by BSMM / WMA

18:30 – 19:30
WELCOME RECEPTION, Exhibition & Poster Viewing
CONCOURSE

19:00 – 20:00
UK Vaccine Network Inaugural Meeting
NORTHERN ROCK

Chair:
Dr Rajeka Lazarus, Consultant in Microbiology and Infectious Diseases,
University Hospital Bristol
The UK clinical vaccine network is a newly formed network which aims to bring updates in
vaccinology to clinicians and offer opportunities for clinicians to get involved in vaccine
development.

The network is open to anyone who is interested in clinical vaccinology.

Please contact Dr Rajeka Lazarus for more information: Rajeka.lazarus@uhbristol.nhs.uk

Major Sponsors