- Email: [email protected]
MEEGID-V: Fifth international meeting on molecular epidemiology and evolutionary genetics in infectious diseases
Infection, Genetics and Evolution 1 (2001) 167–170
Conference report
MEEGID-V: Fifth international meeting on molecular epidemiology and evolutionary genetics in infectious diseases
MEEGID is an international forum that brings together molecular biologists, evolutionary geneticists, laboratory scientists, clinicians and epidemiologists on an annual basis to discuss and deliberate on issues of contemporary biomedical importance. Of late, MEEGID has been additionally attracting health care providers, public health professionals, program managers and providing them with an opportunity to discuss the use of genetic tools and methodologies needed to meet the challenges of diagnosis and management of emerging, re-emerging and endemic infectious diseases. Five hundred epidemiologists, microbiologists, evolutionary biologists, physicians, laboratory scientists, other medical professionals and biomedical scientists from 25 countries convened in Hyderabad, India on November 12–15, 2000 for the fifth MEEGID meeting. For the first time a MEEGID meeting was held in Asia and was jointly sponsored by the Center for Disease Control and Prevention (CDC, USA), the Institut de Recherche pour le Développement (IRD, France), the Center National de la Recherche Scientifique (CNRS, France), Indian Council of Medical Research (ICMR, India), Department of Biotechnology (DBT, India) and Center for DNA Fingerprinting and Diagnostics (CDFD, India). The goals of this conference, like those of its predecessors in 1996 (Atlanta, USA), 1997 (Montpellier, France), 1998 (Rio de Janeiro, Brazil) and 1999 (Dakar, Senegal) were: • To integrate epidemiologic, molecular biologic and evolutionary genetic approaches in areas of diagnosis, strain typing, species identification, pathogenesis, antigenic variation, drug and vaccine resistance, host (animal and human) susceptibility and vector specificity. • To foster interactions between epidemiologists and laboratory scientists working on hosts (animal and human), parasites, yeast, fungi, bacteria, viruses and vectors. • To provide health care providers, public health professionals, policy makers, epidemiologists, laboratory scientists and program managers an opportunity to discuss the use of the genetic tools and methodologies that are needed to meet the challenges of diagnosis and management of emerging, re-emerging and endemic infectious diseases.
More than 300 scientific papers, abstracts and lectures were presented in 26 plenary sessions, symposia, panels, slide presentations and poster sessions during the 4 days of the conference. The epidemiology, disease surveillance and prevention of antimicrobial-drug resistant infections were recurring topics as were new knowledge and current research on malaria, tuberculosis (TB), cholera, enteric pathogens, HIV, viral hepatitis, leishmaniasis and opportunistic infections. This time in MEEGID, new sessions on human genetic epidemiology and host factors, emerging molecular techniques and intellectual property issues associated with health care were organized. Areas of particular emphasis included disease surveillance, opportunistic infections in special populations including pediatric, geriatric and immunocompromised patients. The meeting was inaugurated by N. Chandrababu Naidu, Chief Minister of the state of Andhra Pradesh, India and was presided by Manju Sharma, Secretary, DBT, India. Addressing the inaugural session N.K. Ganguly, Director General, ICMR in his research highlighted various challenges in the diagnosis and identification of infectious agents rampant in India and the way they are being addressed with indigenous expertise in ICMR laboratories. He described one such problem related to a viral infection in vultures which was caused by an unknown agent and led to heavy mortality. When persuaded by the parsi community in India, the viral agent of mysterious vulture disease was investigated by the ICMR laboratories and the underlying virus was characterized. In his plenary lecture Steve Blount of the Office of Global Health, CDC, Atlanta addressed the overall challenge of emerging and re-emerging diseases in a global perspective. Throughout the 4 days of the conference several plenaries were delivered by Michel Tibayrenc (IRD, France), Howard Fields (CDC, USA), Bruce Levin (Emory University, USA), Tom Frieden (SEARO, India), Michael Gottlieb (NIH, USA), Douglas Berg (Washington University at St. Louis, USA), Altaf A. Lal (CDC, USA), G. Padmanaban (IISc, India), Dan Colley (CDC, USA), James Bradac (NIAID, USA), Stephen Ostroff (CDC, USA), John Kaplan (CDC, USA), J.V.R. Prasada Rao, National AIDS Control Organization (NACO, India) and many others (Figs. 1 and 2).
1567-1348/01/$ – see front matter © 2001 Elsevier Science B.V. All rights reserved. PII: S 1 5 6 7 - 1 3 4 8 ( 0 1 ) 0 0 0 2 0 - X
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Conference report / Infection, Genetics and Evolution 1 (2001) 167–170
Post-genomic revolution in molecular epidemiology, diagnostics and applied genomics of bacterial pathogens was the topic of much interest and was debated and discussed in many of the invited lectures and platform presentations. However, the hallmark of most of the presentations was the concern on the overall burden of various infectious diseases and the need for the evaluation of the respective impact of genetic diversity of hosts, pathogens and vectors on the transmission and pathogenicity of infectious diseases, as well as their co-evolutionary interactions. This concept was particularly highlighted by Michel Tibayrenc in his plenary lecture. He proposed a joint approach linking the genetics and epidemiology of hosts, parasites and vectors. He also highlighted the concept of integrated genetic epidemiology advocating the cause of the ‘European CDC’ (European Center for Infectious Diseases-ECID). Altaf A. Lal (CDC, USA) in his plenary address summarized various approaches to malaria vaccines and the status of the recombinant P. falciparum candidate vaccine antigen incorporating 21 different B- and T-cell epitopes, encoded by a synthetic gene. Doug Berg of the Washington University, School of Medicine (USA) in his presentation highlighted the problem of metronidazole resistance in Helicobacter pylori and the molecular mechanisms underlying the phenomenon. Referring to his studies involving transgenic and
knockout H. pylori strains, he explained the role of rdxA and frxA genes in metronidazole resistance and its impact on bacterial fitness in different world populations. During the important session of HIV/AIDS, eight experts in the field of infectious diseases, molecular biology, public health administration and vaccinology presented the respective updates on HIV/AIDS. The primary characteristic of the two symposia was the blend of different specialists speaking the global language of health. J.V.R. Prasada Rao, Director of NACO of the Ministry of Health, New Delhi stated that India had an estimated 2.8–3.5 million HIV-infected persons. This was based on expanded HIV surveillance established at 172 centers in the country, possibly the world’s largest HIV surveillance exercise. He disputed the UNAIDS estimate of 400,000 deaths each year. Feng Gao (University of Alabama, USA) reported that globally HIV-1 has been grouped into nine subtypes and five circulating recombinant forms (CRF). Some of these subtypes such as subtype HIV-1A which is prevalent in developed nations has evolved into a new subtype, namely A2. Robert Bollinger of Johns Hopkins University, USA reported that HIV-1 subtypes such as E, F, G and I prevalent in Thailand, Brazil and West/Central Africa are characterized by low transmissibility. On the other hand HIV-1 subtypes A, B, C, D, F, K, H and J prevalent in eastern and
Fig. 1. Opening ceremony of MEEGID-V. From left to right: Mr. N. Chandrababu Naidu, Chief Minister of the state of Andhra Pradesh, India; Prof. Seyed E. Hasnain; Dr. N.K. Ganguly, Director General, ICMR, India; Dr. Michel Tibayrenc, IRD, France; Dr. Manju Sharma, Secretary, DBT, India.
Conference report / Infection, Genetics and Evolution 1 (2001) 167–170
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Fig. 2. Opening ceremony of MEEGID-V. From left to right: Dr. Anupama Raina, staff CDFD, Hyderabad, India; Mr. N. Chandrababu Naidu; Dr. Altaf A. Lal, CDC, Atlanta; Dr. Stephen Blount, Director, Office of Global Health, CDC; Prof. Seyed E. Hasnain; Dr. Manju Sharma; Dr. Michel Tibayrenc.
southern Africa, parts of Europe and parts of India are characterized by rapid transmissibility. This difference in subtypes may explain rapid spread of epidemic in some part of the world. Laurence Vergne (HIV laboratory, IRD, France), who worked on correlation of genetic diversity with treatment, found that consistent recognition of prevalent subtype in a country by the immune cells of the infected individuals will keep the viral load low in their body. Formation of recombinant forms is associated with lack of recognition of recombinant forms and therefore, lead to higher viral load and rapid disease progression. Subhash Hira of the University of Texas, USA presented the natural history of HIV in Mumbai. A group of 1077 HIV-infected persons were followed for 7 years at AIDS Research Center (ARCON) at J.J. Hospital in Mumbai. The duration of disease progression from HIV infection to AIDS was 6.2 years among patients in Mumbai which was twice as fast compared to patients in the US and Europe. There is evidence that around 4220 adults die in Mumbai each year due to AIDS. Hira said that the AIDS epidemic in India is fueling another dangerous epidemic, namely, TB. As a result, at least 15% new cases of TB occur in India due to AIDS, i.e. 240,000 new TB cases each year are added to the traditional load of 1.8 million cases of TB in India. AIDS patients with TB were dying faster due to severity of TB infection. In addition to TB, there is
new information emerging from studies in Mumbai that HIV-infected patients were severely debilitated when they contract falciparum malaria. Hira believes “there is an urgency to investigate the association between HIV and malaria”. Deepti Dongaonkar who started mother to child transmission studies several years ago in Mumbai found that transmission of HIV-1 from pregnant women to their unborn babies was 36% which is similar to transmission rates seen in Africa. While making a strong plea for providing AZT treatment and behavioral intervention to HIV-infected women she presented evidence of patients not taking full treatment course. According to her the issue of breast feeding was unresolved. Deepak Gadkare reported the prevalence of C- subtype of HIV in India. There was evidence of recombinant viral forms occurring as result of fast spreading of this infection in Pune. John Kaplan (CDC, USA) informed the meeting that since the start of the anti-retroviral therapy in the US, the number of AIDS deaths had declined by 80%. Due to immune reconstitution with anti-retroviral therapy, most medicines given for treatment of opportunistic infections were no longer required. This has lead to the improved survival and quality of life. The ARCON at J.J. Hospital is following over 400 patients who have opted for anti-retroviral therapy, many of the drugs are locally manufactured.
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Conference report / Infection, Genetics and Evolution 1 (2001) 167–170
James Bradac of NIH, USA presented a comprehensive presentation of anti HIV-1 vaccine including the 28 candidate vaccines in phase 1/2 fields trails at five sites in the US, one site in Brazil, one site in Uganda and one site in Thailand. Vaccine experts world over believe that while some specific questions about the subtype difference prevalent in various part of the world or emergence of new recombinant viruses pose a real challenge to the development of vaccine, the urgency of an epidemic should take precedence over theoretical questions thereby, iterating an urgent need for HIV vaccine field trials in more countries. The newly organized session on human genetic epidemiology was mostly centered around the human host factors and susceptibility to TB and other infectious diseases. R.M. Pitchappan (Madurai Kamaraj University, India) described the Indian caste system as a true Mendelian model for the study of genetic susceptibility to TB and leprosy. Further, BCG non-vaccination in non-DR2 individuals and IL-10 expresssion together predispose for adult pulmonary TB in Tamil Nadu. Genome scan studies in leprosy patients from Tamil Nadu has implicated five candidate regions of immunologic interest. He suggested that host immunogenetics, non-MHC and genes of immunologic interest, epidemiology and vaccination, all might determine susceptibility or resistance of an individual to a disease, in endemic countries like India. Eknath Naik (University of Florida) described most of his observations on susceptibility of HIV-infected caucasians to M. avium. He discussed the role of various candidate gene polymorphisms (HLA-DMA, DMB, DRB1 and DQB1) in this phenomenon. While Sarah Campbell from the Wellcome Trust Center for Human Genetics in Oxford highlighted the role of Xq-26–28 as a candidate region for susceptibility to TB in Gambian populations, Kerrie Tosh from the same laboratory described the association of macrophage mannose receptor gene polymorphisms with TB and leprosy. One study on malaria susceptibility of Kenyan populations was presented by Venkatachalam Udhayakumar (CDC). While testing the role of sickle cell trait in malaria mortality, he described his findings support the hypothesis that HbAS genotype confers significant survival advantage in areas with intense falciparum malaria transmission before the development of clinical immunity. MEEGID-V, like each of the earlier MEEGIDs documented remarkable scientific advances and achievements
in contemporary medical research focusing on infections associated with health care. This conference has also provided a forum towards the emerging challenges in the areas of epidemiology and evolution of pathogens, the growing numbers of patients with increased susceptibility to infection, the rapidly increasing resistance to antimicrobials and the dramatic developments in the post-genomic scenario. Many speakers addressed topics that have evolved over three decades but continue to be vital areas of research and investigation, such as antimicrobial-drug resistance, opportunistic infections and disease surveillance. Also featured were presentations on subjects that have grown in prominence only in recent years: emerging molecular techniques such as the microarrays, new vaccine candidates, diagnostic markers, molecular surveillance databases, IPR related issues, etc. A roundtable discussion on clinical management of opportunistic infections was organized to invite opinions on infection control in pediatric, geriatric and HIV settings. Two wet workshops each on the clinical diagnosis of viral hepatitis and enteric pathogens were organized at the Deccan College of Medical Sciences, Hyderabad, India. The meeting ended with a concern that the problem of artificial compartmentalization of genetics of hosts, pathogens and vectors as three separate fields of research should be addressed in the light of our growing appreciation of the strong co-evolutionary interactions among hosts, pathogens and vectors. It was therefore, found to be highly desirable to develop a unified synthetic approach: the “Integrated Genetic Epidemiology of Infectious Diseases” (IGEID). This will involve evaluation of the respective impact of genetic diversity of hosts, pathogens and vectors on the transmission and severity of infectious diseases, as well as their co-evolutionary interactions. This meeting also provided a platform for the launch of the new Elsevier Press journal “Infection, Genetics and Evolution” and signaled the birth of the new scientific society “Molecular Epidemiology and Evolutionary Genetics of Infectious Diseases”.
Seyed E. Hasnain Center for DNA Fingerprinting and Diagnostics ECIL Road, Nacharam, Hyderabad, India Tel.: +91-40-715-1344; fax: +91-40-7155-610 E-mail address: [email protected]
Conference report
MEEGID-V: Fifth international meeting on molecular epidemiology and evolutionary genetics in infectious diseases
MEEGID is an international forum that brings together molecular biologists, evolutionary geneticists, laboratory scientists, clinicians and epidemiologists on an annual basis to discuss and deliberate on issues of contemporary biomedical importance. Of late, MEEGID has been additionally attracting health care providers, public health professionals, program managers and providing them with an opportunity to discuss the use of genetic tools and methodologies needed to meet the challenges of diagnosis and management of emerging, re-emerging and endemic infectious diseases. Five hundred epidemiologists, microbiologists, evolutionary biologists, physicians, laboratory scientists, other medical professionals and biomedical scientists from 25 countries convened in Hyderabad, India on November 12–15, 2000 for the fifth MEEGID meeting. For the first time a MEEGID meeting was held in Asia and was jointly sponsored by the Center for Disease Control and Prevention (CDC, USA), the Institut de Recherche pour le Développement (IRD, France), the Center National de la Recherche Scientifique (CNRS, France), Indian Council of Medical Research (ICMR, India), Department of Biotechnology (DBT, India) and Center for DNA Fingerprinting and Diagnostics (CDFD, India). The goals of this conference, like those of its predecessors in 1996 (Atlanta, USA), 1997 (Montpellier, France), 1998 (Rio de Janeiro, Brazil) and 1999 (Dakar, Senegal) were: • To integrate epidemiologic, molecular biologic and evolutionary genetic approaches in areas of diagnosis, strain typing, species identification, pathogenesis, antigenic variation, drug and vaccine resistance, host (animal and human) susceptibility and vector specificity. • To foster interactions between epidemiologists and laboratory scientists working on hosts (animal and human), parasites, yeast, fungi, bacteria, viruses and vectors. • To provide health care providers, public health professionals, policy makers, epidemiologists, laboratory scientists and program managers an opportunity to discuss the use of the genetic tools and methodologies that are needed to meet the challenges of diagnosis and management of emerging, re-emerging and endemic infectious diseases.
More than 300 scientific papers, abstracts and lectures were presented in 26 plenary sessions, symposia, panels, slide presentations and poster sessions during the 4 days of the conference. The epidemiology, disease surveillance and prevention of antimicrobial-drug resistant infections were recurring topics as were new knowledge and current research on malaria, tuberculosis (TB), cholera, enteric pathogens, HIV, viral hepatitis, leishmaniasis and opportunistic infections. This time in MEEGID, new sessions on human genetic epidemiology and host factors, emerging molecular techniques and intellectual property issues associated with health care were organized. Areas of particular emphasis included disease surveillance, opportunistic infections in special populations including pediatric, geriatric and immunocompromised patients. The meeting was inaugurated by N. Chandrababu Naidu, Chief Minister of the state of Andhra Pradesh, India and was presided by Manju Sharma, Secretary, DBT, India. Addressing the inaugural session N.K. Ganguly, Director General, ICMR in his research highlighted various challenges in the diagnosis and identification of infectious agents rampant in India and the way they are being addressed with indigenous expertise in ICMR laboratories. He described one such problem related to a viral infection in vultures which was caused by an unknown agent and led to heavy mortality. When persuaded by the parsi community in India, the viral agent of mysterious vulture disease was investigated by the ICMR laboratories and the underlying virus was characterized. In his plenary lecture Steve Blount of the Office of Global Health, CDC, Atlanta addressed the overall challenge of emerging and re-emerging diseases in a global perspective. Throughout the 4 days of the conference several plenaries were delivered by Michel Tibayrenc (IRD, France), Howard Fields (CDC, USA), Bruce Levin (Emory University, USA), Tom Frieden (SEARO, India), Michael Gottlieb (NIH, USA), Douglas Berg (Washington University at St. Louis, USA), Altaf A. Lal (CDC, USA), G. Padmanaban (IISc, India), Dan Colley (CDC, USA), James Bradac (NIAID, USA), Stephen Ostroff (CDC, USA), John Kaplan (CDC, USA), J.V.R. Prasada Rao, National AIDS Control Organization (NACO, India) and many others (Figs. 1 and 2).
1567-1348/01/$ – see front matter © 2001 Elsevier Science B.V. All rights reserved. PII: S 1 5 6 7 - 1 3 4 8 ( 0 1 ) 0 0 0 2 0 - X
168
Conference report / Infection, Genetics and Evolution 1 (2001) 167–170
Post-genomic revolution in molecular epidemiology, diagnostics and applied genomics of bacterial pathogens was the topic of much interest and was debated and discussed in many of the invited lectures and platform presentations. However, the hallmark of most of the presentations was the concern on the overall burden of various infectious diseases and the need for the evaluation of the respective impact of genetic diversity of hosts, pathogens and vectors on the transmission and pathogenicity of infectious diseases, as well as their co-evolutionary interactions. This concept was particularly highlighted by Michel Tibayrenc in his plenary lecture. He proposed a joint approach linking the genetics and epidemiology of hosts, parasites and vectors. He also highlighted the concept of integrated genetic epidemiology advocating the cause of the ‘European CDC’ (European Center for Infectious Diseases-ECID). Altaf A. Lal (CDC, USA) in his plenary address summarized various approaches to malaria vaccines and the status of the recombinant P. falciparum candidate vaccine antigen incorporating 21 different B- and T-cell epitopes, encoded by a synthetic gene. Doug Berg of the Washington University, School of Medicine (USA) in his presentation highlighted the problem of metronidazole resistance in Helicobacter pylori and the molecular mechanisms underlying the phenomenon. Referring to his studies involving transgenic and
knockout H. pylori strains, he explained the role of rdxA and frxA genes in metronidazole resistance and its impact on bacterial fitness in different world populations. During the important session of HIV/AIDS, eight experts in the field of infectious diseases, molecular biology, public health administration and vaccinology presented the respective updates on HIV/AIDS. The primary characteristic of the two symposia was the blend of different specialists speaking the global language of health. J.V.R. Prasada Rao, Director of NACO of the Ministry of Health, New Delhi stated that India had an estimated 2.8–3.5 million HIV-infected persons. This was based on expanded HIV surveillance established at 172 centers in the country, possibly the world’s largest HIV surveillance exercise. He disputed the UNAIDS estimate of 400,000 deaths each year. Feng Gao (University of Alabama, USA) reported that globally HIV-1 has been grouped into nine subtypes and five circulating recombinant forms (CRF). Some of these subtypes such as subtype HIV-1A which is prevalent in developed nations has evolved into a new subtype, namely A2. Robert Bollinger of Johns Hopkins University, USA reported that HIV-1 subtypes such as E, F, G and I prevalent in Thailand, Brazil and West/Central Africa are characterized by low transmissibility. On the other hand HIV-1 subtypes A, B, C, D, F, K, H and J prevalent in eastern and
Fig. 1. Opening ceremony of MEEGID-V. From left to right: Mr. N. Chandrababu Naidu, Chief Minister of the state of Andhra Pradesh, India; Prof. Seyed E. Hasnain; Dr. N.K. Ganguly, Director General, ICMR, India; Dr. Michel Tibayrenc, IRD, France; Dr. Manju Sharma, Secretary, DBT, India.
Conference report / Infection, Genetics and Evolution 1 (2001) 167–170
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Fig. 2. Opening ceremony of MEEGID-V. From left to right: Dr. Anupama Raina, staff CDFD, Hyderabad, India; Mr. N. Chandrababu Naidu; Dr. Altaf A. Lal, CDC, Atlanta; Dr. Stephen Blount, Director, Office of Global Health, CDC; Prof. Seyed E. Hasnain; Dr. Manju Sharma; Dr. Michel Tibayrenc.
southern Africa, parts of Europe and parts of India are characterized by rapid transmissibility. This difference in subtypes may explain rapid spread of epidemic in some part of the world. Laurence Vergne (HIV laboratory, IRD, France), who worked on correlation of genetic diversity with treatment, found that consistent recognition of prevalent subtype in a country by the immune cells of the infected individuals will keep the viral load low in their body. Formation of recombinant forms is associated with lack of recognition of recombinant forms and therefore, lead to higher viral load and rapid disease progression. Subhash Hira of the University of Texas, USA presented the natural history of HIV in Mumbai. A group of 1077 HIV-infected persons were followed for 7 years at AIDS Research Center (ARCON) at J.J. Hospital in Mumbai. The duration of disease progression from HIV infection to AIDS was 6.2 years among patients in Mumbai which was twice as fast compared to patients in the US and Europe. There is evidence that around 4220 adults die in Mumbai each year due to AIDS. Hira said that the AIDS epidemic in India is fueling another dangerous epidemic, namely, TB. As a result, at least 15% new cases of TB occur in India due to AIDS, i.e. 240,000 new TB cases each year are added to the traditional load of 1.8 million cases of TB in India. AIDS patients with TB were dying faster due to severity of TB infection. In addition to TB, there is
new information emerging from studies in Mumbai that HIV-infected patients were severely debilitated when they contract falciparum malaria. Hira believes “there is an urgency to investigate the association between HIV and malaria”. Deepti Dongaonkar who started mother to child transmission studies several years ago in Mumbai found that transmission of HIV-1 from pregnant women to their unborn babies was 36% which is similar to transmission rates seen in Africa. While making a strong plea for providing AZT treatment and behavioral intervention to HIV-infected women she presented evidence of patients not taking full treatment course. According to her the issue of breast feeding was unresolved. Deepak Gadkare reported the prevalence of C- subtype of HIV in India. There was evidence of recombinant viral forms occurring as result of fast spreading of this infection in Pune. John Kaplan (CDC, USA) informed the meeting that since the start of the anti-retroviral therapy in the US, the number of AIDS deaths had declined by 80%. Due to immune reconstitution with anti-retroviral therapy, most medicines given for treatment of opportunistic infections were no longer required. This has lead to the improved survival and quality of life. The ARCON at J.J. Hospital is following over 400 patients who have opted for anti-retroviral therapy, many of the drugs are locally manufactured.
170
Conference report / Infection, Genetics and Evolution 1 (2001) 167–170
James Bradac of NIH, USA presented a comprehensive presentation of anti HIV-1 vaccine including the 28 candidate vaccines in phase 1/2 fields trails at five sites in the US, one site in Brazil, one site in Uganda and one site in Thailand. Vaccine experts world over believe that while some specific questions about the subtype difference prevalent in various part of the world or emergence of new recombinant viruses pose a real challenge to the development of vaccine, the urgency of an epidemic should take precedence over theoretical questions thereby, iterating an urgent need for HIV vaccine field trials in more countries. The newly organized session on human genetic epidemiology was mostly centered around the human host factors and susceptibility to TB and other infectious diseases. R.M. Pitchappan (Madurai Kamaraj University, India) described the Indian caste system as a true Mendelian model for the study of genetic susceptibility to TB and leprosy. Further, BCG non-vaccination in non-DR2 individuals and IL-10 expresssion together predispose for adult pulmonary TB in Tamil Nadu. Genome scan studies in leprosy patients from Tamil Nadu has implicated five candidate regions of immunologic interest. He suggested that host immunogenetics, non-MHC and genes of immunologic interest, epidemiology and vaccination, all might determine susceptibility or resistance of an individual to a disease, in endemic countries like India. Eknath Naik (University of Florida) described most of his observations on susceptibility of HIV-infected caucasians to M. avium. He discussed the role of various candidate gene polymorphisms (HLA-DMA, DMB, DRB1 and DQB1) in this phenomenon. While Sarah Campbell from the Wellcome Trust Center for Human Genetics in Oxford highlighted the role of Xq-26–28 as a candidate region for susceptibility to TB in Gambian populations, Kerrie Tosh from the same laboratory described the association of macrophage mannose receptor gene polymorphisms with TB and leprosy. One study on malaria susceptibility of Kenyan populations was presented by Venkatachalam Udhayakumar (CDC). While testing the role of sickle cell trait in malaria mortality, he described his findings support the hypothesis that HbAS genotype confers significant survival advantage in areas with intense falciparum malaria transmission before the development of clinical immunity. MEEGID-V, like each of the earlier MEEGIDs documented remarkable scientific advances and achievements
in contemporary medical research focusing on infections associated with health care. This conference has also provided a forum towards the emerging challenges in the areas of epidemiology and evolution of pathogens, the growing numbers of patients with increased susceptibility to infection, the rapidly increasing resistance to antimicrobials and the dramatic developments in the post-genomic scenario. Many speakers addressed topics that have evolved over three decades but continue to be vital areas of research and investigation, such as antimicrobial-drug resistance, opportunistic infections and disease surveillance. Also featured were presentations on subjects that have grown in prominence only in recent years: emerging molecular techniques such as the microarrays, new vaccine candidates, diagnostic markers, molecular surveillance databases, IPR related issues, etc. A roundtable discussion on clinical management of opportunistic infections was organized to invite opinions on infection control in pediatric, geriatric and HIV settings. Two wet workshops each on the clinical diagnosis of viral hepatitis and enteric pathogens were organized at the Deccan College of Medical Sciences, Hyderabad, India. The meeting ended with a concern that the problem of artificial compartmentalization of genetics of hosts, pathogens and vectors as three separate fields of research should be addressed in the light of our growing appreciation of the strong co-evolutionary interactions among hosts, pathogens and vectors. It was therefore, found to be highly desirable to develop a unified synthetic approach: the “Integrated Genetic Epidemiology of Infectious Diseases” (IGEID). This will involve evaluation of the respective impact of genetic diversity of hosts, pathogens and vectors on the transmission and severity of infectious diseases, as well as their co-evolutionary interactions. This meeting also provided a platform for the launch of the new Elsevier Press journal “Infection, Genetics and Evolution” and signaled the birth of the new scientific society “Molecular Epidemiology and Evolutionary Genetics of Infectious Diseases”.
Seyed E. Hasnain Center for DNA Fingerprinting and Diagnostics ECIL Road, Nacharam, Hyderabad, India Tel.: +91-40-715-1344; fax: +91-40-7155-610 E-mail address: [email protected]