ASTMH 2023
Authors: Rebecca Barksby
Journal: The Lancet Microbe (2023)

Between Oct 18 and Oct 22, 2023, the American Society of Tropical Medicine & Hygiene (ASTMH) held their 72nd Annual Meeting in Chicago, IL, USA. Preparing for disease X was, as expected, a prevalent topic. Maïna L’Azou Jackson (Coalition for Epidemic Preparedness Innovations [CEPI]) presented the “100 Days mission”, the focus of CEPI’s US$3·5 billion pandemic preparedness plan that aims to authorise and manufacture vaccines within 100 days of pathogen identification. To meet this ambitious aim, CEPI has created and will update a library of prototype vaccines that are based on computationally designed immunogens and, if needed, will be tested by ready-to-go clinical trial groups. Based on spillover risk data, CEPI has prioritised two virus families for the vaccine library: Arenaviridae (eg, Lassa and Machupo virus) and Paramyxoviridae (eg, measles and mumps). One paramyxoviruses, Nipah virus, was the subject of a series of presentations by a group affiliated with the International Center for Diarrheal Disease Research, Bangladesh (Dhaka, Bangladesh). Nipah virus can spill over from bats and has caused seasonal outbreaks in Bangladesh since 2001 with a high case fatality rate of around 70%. Jonathan Epstein (EcoHealth Alliance, New York, NY, USA) presented the investigation into five Nipah virus outbreaks in Bangladesh in 2021–22. The group sampled bats and bat urine samples from habitats close to the reported index cases, finding that seroprevelance in the bats was around 15% and two novel paramyoxyviruses were also detected. A concurrent behavioural investigation found that most people in the study area reported regularly drinking raw date palm sap, which is also consumed by bats, and all patients reported drinking the sap within 2 weeks before symptom onset. In a virology latebreakers session, Anna Durbin (Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA) presented the development of the first controlled human infection model for Zika virus. Healthy women aged 18–40 years who were not pregnant or lactating and on highly effective birth control were enrolled in a randomised, placebo-controlled, double-blind trial. Participants received 100 plaque-forming units of Zika virus and researchers investigated the tolerability and shedding of two Zika strains. Both strains were well tolerated and shedding was found to be highest in serum and whole blood; it is hoped that the development of this infection model will inform future Zika vaccine development. All 20 neglected tropical diseases (NTDs) featured in some capacity at the meeting. Three symposiums focused on schistosomiasis, one specifically on schistosomiasis in women. Olimpia Lamberti (London School of Hygiene & Tropical Medicine, London, UK) presented preliminary results of Schista!, a 3-year longitudinal cohort study that integrates female genital schistosomiasis into health screening in Zambia by distributing and analysing multi-pathogen self-testing kits. Initial cross-sectional results suggest that female genital schistosomiasis increases the odds of high-risk human papillomavirus, which is associated with cervical cancer, and Trichomonas vaginalis, a parasite known to increase the risk of HIV acquisition. Data collection on the immunological interactions occurring in these coinfections and linkage to cervical cancer care are ongoing. Richard Philips (Kwame Nkrumah University of Science and Technology, Kumasi, Ghana) gave updates in the diagnosis and treatment of Buruli ulcer, a necrotising skin NTD caused by Mycobacterium ulcerans that primarily affects children in west Africa. Research into portable point-of-care tests, particularly a dried reagent-based PCR assay that uses handheld DNA amplification and produces mobile phone readouts, have shown promise and are currently being evaluated in a multicentre study endorsed by WHO. There are also three ongoing clinical trials that could change treatment regimens for Buruli ulcer. Currently, treatment is 8-weeks of oral rifampicin and clarithromycin but WHO has advocated for this duration to be shortened in regions where Buruli ulcer is endemic. BuruliNOX (Ghana) is investigating adding a nitric oxide-releasing dressing to wounds, BuruliRIFDACC (Ghana) is investigating using high-dose rifampicin, and BLMS4BU (Benin, Côte d’Ivoire, Ghana, and Togo) is investigating the addition of amoxicillin and clavulanate. In an emotionally charged panel titled “Science under assault” Daniel Bausch, Peter Daszak, Peter Hotez, and Carol Schadelbauer shared their experiences in being targeted by sceptics of scientific research. These public health leaders urged researchers to engage in communications training to facilitate productive engagement with media and politicians. The panel was a stark contrast to the concluding session of the meeting: a plenary of the achievements of The Carter Center in advocating for global health, namely reducing dracunculiasis cases from 3·5 million in the 1980s to just 13 in 2022. Skilled diplomacy, compassion, and appreciation for scientific research by President Jimmy Carter and Rosalynn Carter were key to this success, emphasising the interconnectedness of health and politics in today’s society.