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  Director : FONTANET Arnaud (fontanet@pasteur.fr)


  abstract

 

The Emerging Diseases Epidemiology Unit was founded on 1 July 2001. The main research topics of the unit are 1) transmission modes of and means of prevention against emerging diseases agents and 2) clinical research, and in particular natural history cohorts and clinical trials. Most research projects take place in developing countries, preferably in collaboration with institutes from the International Network of Pasteur Institutes, and deal with the epidemiology of HIV and hepatitis C virus (HCV).



  report

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Introduction

The Emerging Diseases Epidemiology Unit was founded on 1 July 2001. Activities started in early 2002 with the arrival of first unit members.

The main research topics of the unit are 1) the transmission modes of and means of prevention against emerging diseases agents and 2) clinical research, and particularly natural history cohorts and clinical trials of treatments against the human immunodeficiency virus (HIV) and hepatitis C virus (HCV). "Emerging diseases agents" are agents recently spread via epidemics in human population (e.g., HIV), agents recently identified (e.g., HCV), and re-emerging agents (e.g., P.falciparum and M.tuberculosis).

Expertise activities of the unit consist in contributions to the strategic thinking of the Institute in areas where epidemiology takes a leading role, in provision of epidemiological and biostatistical assistance to other research units of the Institute, and in participation in the teaching activities in epidemiology locally and in the international network. In this context, special effort has been dedicated to the preparation of the epidemiology and biostatistics curriculum for the future school of public health, and to the initiation of a training scheme in clinical research for institutes of the network.

Most research projects of the unit take place in developing countries, preferably in collaboration with institutes of the international Network of Pasteur Institutes.

On-going projects

1) Epidemiology and treatment of HCV infection in Egypt (A. Fontanet and C. Rekacewicz).

Egypt is the country with the highest HCV prevalence in the wold, reaching 45% among adults older than 40 in rural areas. The number of people infected with HCV was estimated around 8 million in 1999 by the Egyptian Ministry of Health and Population. The origin of such epidemic has been attributed to mass treatment by intravenous injections for bilharziosis in the years 1960-1982.

This project, headed by A. Fontanet and M.K. Mohamed, is funded by the European Commission (2001-2005) and by the French National Agency for Research on AIDS (ANRS) (2002-2004 with possibilities for extension). The project has several components: 1) the establishment of a cohort study on HCV incidence and infection progression in a rural population (n=4000); 2) the validation of blood donors as a sentinel population to monitor HCV trends in the general population; 3) the identification of risk factors for HCV infection in urban areas through a case-control study comparing exposures in patients with acute hepatitis C with those of controls; 4) a study of the efficacy of pegylated interferon and ribavirin in the treatment of chronic hepatitis C in Egypt (genotype 4); 5) a study of the efficacy of pegylated interferon in the treatment of acute hepatitis C. Our partners in this project are the unit INSERM U444 (Director: AJ Valleron) which coordinated the European part of the project (B Larouzé) and the mixed unit Pasteur/INSERM U370 of C Bréchot for its expertise in the virological and clinical aspects of HCV. Egyptian partners of this project are Ain Shams University n cairo (Mostafa K Mohamed) and the Egyptian Ministry of Health (Saeed Aoun).

2) Management of infectious lung disease among adults with HIV/AIDS in Africa (Dakar, Bangui) and South-East Asia (Phnom Penh, Ho Chi Minh) (Principal Investigators: Y Germani and P Lehr) (C Rekacewicz, M Vray, A Fontanet).

This project aims to identify infectious etiologies of lung disease among hospitalised HIV-infected patients. Broncho-fibroscopy will be used in non-tuberculous patients depending on radiological aspects and response to conventional antibiotic treatment. Study sites are Dakar (Senegal), Bangui (Centrafrican epublic), Phnom Penh (Cambodia) and Ho Chi Minh (Vietnam). Institutes from the International Network are fully involved in this study coordinated y Y Germani (Bangui) and P Lehr (Paris) and funded by ANRS.

3) HIV epidemiology in Ethiopia (A Fontanet).

Ethiopia has been lately but severely affected by the HIV epidemic. HIV prevalence in urban adult populations reaches 10-15%. Since 1994, a research programme in epidemiology, virology and immunology of HIV was set up at the Ethiopian Health and Nutrition Research Institute in Addis Ababa. This program is funded by the Ethiopian and Netherlands governments. The research work focuses on three populations: 1) a cohort study of factory workers since February 1997 (n=1600 among which 150 are HIV-infected); 2) a cohort of patients with tuberculosis and recruited in an urban health center (n=250) ; 3) a sentinel surveillance system of HIV prevalence and genotype distribution among women seen for antenatal care in Addis Ababa (n=1200 women / year).

4) Protection mechanisms against HIV-1 among exposed but non-infected individuals in Vietnam and in Cambodia (ENIASIA) (Principal Investigators: G Pancino and L Truong Thi Xuan) (A Fontanet and C Rekacewicz).

This study aims at identifying genetic and immunovirological factors responsible for protection against HIV-1 in exposed and non-infected individuals (ENI). ENI are intravenous drug users in Vietnam and sexual partners of HIV-infected individuals in Cambodia. Our role in this study is to provide assistance in the epidemiological and statistical aspects of the study.

5) Study of the influence of sexual hormones on immunity and susceptibility to infectious diseases (M Garenne).

Sexual hormones interfere with the immune system, and these interferences have an effect on diseases course. Females tend to favour Th2 responses, whereas males tend to favour Th1 responses. Diseases for which strong Th2 responses would have a deleterious effect would be more lethal to women, whereas diseases for which strong Th1 responses would have a deleterious effect would tend to be more lethal to males. This project aims at validate this theory by first studying morbidity and mortality statistics available at the National Reference Centers at of Pasteur Institute and other sentinel sites.

6) Study on the influence of intestinal helminthiases on malaria during pregnancy (M Nacher).

Cohort study of pregnant women on the border between Thailand and Myanmar. Main study variables are malaria incidence, hematocrit, parasitemia, malaria access severity, body mass index, pregnancy complications, and child weight according to helmintiases diagnosed with the mother during the first antenatal screening visit.

Projects under development

1) Randomised trial of efficacy and tolerance comparing two anti-retroviral therapies among HIV-infected patients in Senegal (Principal Investigators: R Landman and S Sow) (M Vray and A Fontanet).

This trial follows two one-arm open trial with anti-retroviral drugs carried out in Senegal which demonstrated the feasibility and efficacy of such treatments in an African context. The aim of this study is to compare the efficacy and tolerance of two anti-retroviral treatments. The Principal Investigator is R Landmann (IMEA, Bichat Hospital, Paris). Our unit, through Muriel Vray, is in charge of the methodological aspects and of the coordination of the clinical trial. This project will be submitted for funding in March 2003.

2) HCV epidemiology in Cambodia (Principal Investigators: A Sall et A Fontanet).

This project aims at improving assays used for the diagnosis of HCV infection and at better characterizing the molecular epidemiology of HCV in South-East Asia. The scientific coordinators of the project are A Sall, virologist at the Pasteur Institute in Dakar and for two years at the Pasteur Institute in Cambodia and A Fontanet. Our unit is responsible for the epidemiological and statistical aspects of the study. The project will be submitted for funding in early 2003.

Keywords: epidemiology, clinical research, drug trials, developing countries, HIV, HCV



  publications

puce Publications of the unit on Pasteur's references database


  personnel

  Office staff Researchers Scientific trainees Other personnel
  Thépaut Sylvana, sthepaut@pasteur.fr Fontanet Arnaud, IP, Head of the Unit fontanet@pasteur.fr

Baril Laurence, IP, baril@pasteur.fr (from March 2003 on)

Garenne Michel, IRD, mgarenne@pasteur.fr
Nacher Mathieu, post-doctoral fellow (posted in Thailand)

Micol Romain, public health resident, micol@pasteur.fr

Grahek Shannon, MPH, (posted in Egypt)

Françoise Colombani, MPH student (posted in Egypt)

Vray Muriel, INSERM, project manager, vray@pasteur.fr

Rekacewicz Claire, IP, project manager, reka@pasteur.fr

Chartier Loïc ; IP, data manager, chartier@pasteur.fr


Activity Reports 2002 - Institut Pasteur
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