Unit: Epidemiology of Emerging Diseases
Director: FONTANET Arnaud
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 disease agents; and 2) clinical research, 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, hepatitis C virus (HCV), and the SARS coronavirus.
The Emerging Diseases Epidemiology Unit was founded on 1 July, 2001. Activities started in early 2002 with the arrival of first unit members, A. Fontanet (Unit Head) at the Pasteur Institute on 1 December, 2001, followed by C. Rekacewicz (medical epidemiologist) on 1 January, 2002.
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 disease agents" are agents recently spread via epidemics in human populations (e.g., HIV), agents recently identified (e.g., HCV), and re-emerging agents (e.g., P.falciparum and M.tuberculosis).
Areas of expertise in the Unit include: contributing to the strategic thinking of the Institute in areas where epidemiology takes a leading role; providing epidemiological and biostatistical assistance to other research units of the Institute; and in participating in the teaching activities in epidemiology locally and as part of the international network. In this context, special effort has been dedicated to the preparation of 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 of the Unit's research projects take place in developing countries, preferably in collaboration with institutes of the international Network of Pasteur Institutes.
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 world, reaching 45% among adults older than 40 years of age in rural areas. The number of people infected with HCV was estimated at around 8 million in 1999 by the Egyptian Ministry of Health and Population. The origin of this epidemic has been attributed to mass treatment campaigns of intravenous injections for bilharziosis from 1960 to1982.
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 possibility 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 for monitoring 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); and 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 in Cairo (Mostafa K. Mohamed) and the Egyptian Ministry of Health (Saeed Aoun).
2) Epidemiology of the SARS coronavirus (Coordination: A. Fontanet and L. Baril)
Following the SARS outbreak in China, a project funded by the European Commission, the French Ministry of Foreign Affairs and the Chinese Ministry of Science and Technology has been initiated to study the epidemiology of the SARS coronavirus. The main objectives of the project include: 1) the search for an animal reservoir for the SARS-like coronavirus; 2) the study of long-term clinical complications and humoral immunity in Chinese convalescent patients and; 3) the factors associated with the spread of the epidemic in Beijing in March-June 2003.
3) 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-tubercular patients depending on radiological aspects and response to conventional antibiotic treatment. Study sites are Dakar (Senegal), Bangui (Central African Republic), Phnom Penh (Cambodia) and Ho Chi Minh (Vietnam). Institutes from the International Network are fully involved in this multicentric study coordinated by Y. Germani (Bangui) and P. Lehr (Paris) and funded by ANRS.
4) HIV epidemiology in Ethiopia (A Fontanet)
Ethiopia is one of the countries in East Africa relatively recently affected by the HIV epidemic, but also one of the countries most severely affected. 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 governments of Ethiopia and The Netherlands. The research focuses on three populations: 1) a cohort study of factory workers (n=1600 among which 150 are HIV-infected) followed since February 1997; 2) a cohort of tubercular patients recruited in an urban health center (n=250); and 3) a sentinel surveillance system of HIV prevalence and genotype distribution among women attending antenatal care visits in Addis Ababa (n=1200 women / year).
5) 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 to identify 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 collaboration is to provide assistance in the epidemiological aspects and statistical analysis of the results.
6) 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 men. This project aims to validate this theory by studying morbidity and mortality statistics available at the National Reference Centers of the Pasteur Institute and other sentinel sites.
7) Factors associated with gametocyte production in patients infected with P. vivax in Thailand (M. Nacher)
This study examines Thai patients infected with P. vivax and treated by chloroquine, sulfadoxine-pyrimethamin and artesunate. Gametocyte production before and during the treatment programme and associated risk factors are modelled.
8) HCV epidemiology in Cambodia (Principal Investigators: A Sall et A Fontanet).
This project aims to improve assays used for the diagnosis of HCV infection and to better characterize 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 with two years of experience at the Pasteur Institute in Cambodia and A. Fontanet. Our Unit is responsible for the epidemiological and biostatistical aspects of the study. This project is part of an ACIP and a PTR coordinated by Penelope Mavromara (IP in Greece).
Keywords: epidemiology, clinical research, developing countries, HIV, HCV, SARS