TDR clinical R&D Fellows' Conference report by Lyda Osorio
Conference: The Third International Conference on Dengue and Dengue Haemorrhagic Fever: Global Dengue Challenges and Promises. 21-23 October 2013. The Imperial Queen's Park Hotel, Bangkok, Thailand.
http://www.dengue2013bangkok.com/home/index/en
1. Objectives of attending this conference
By attending this conference I expected to: 1) improve my knowledge of dengue, 2) recognize the current global challenges for dengue research and development, and 3) interact with international researchers in a topic of the utmost important for Colombia, as one of the countries with the highest burden of Dengue in Latin America. As an active member of the Colombian network of dengue researchers, I should be able to share with my colleagues the benefits of my participation in the Conference and hence to improve the quality and contribution of our research. I will also share the information with my colleagues at Universidad del Valle and incorporate the acquired knowledge in the teaching courses I run for undergraduate and postgraduate students in Colombia.
2. Agenda of the conference The program was organized over 3 full days with the following structure:
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The basic science behind Dengue vaccine development Funding and research |
Plenary sessions |
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successful dengue vaccine in Thailand opportunities in Dengue |
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Symposia: |
Symposia: |
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Symposia: |
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1:Global Dengue Situation 10: Innovative Vector Control and Approaches 14: Vector Biology and Behavior 19: Vascular Biology of Viral Hemorrhagic Fevers 21: Pathogenesis 26, 29: Dengue Vaccine Under Clinical Trials I, II |
2: Research at Queen Sirikit National Institute of Child Health 4: Lessons learned from cohort studies 7, 11: Laboratory diagnosis I, II 17: Biology of Dengue Virus and Dengue Virus-Host Interaction 22: Vector and Vector Control 27: Tools for Vaccine Trial 30: Clinical aspects and treatments |
3: Emerging Flavivirus and Epidemiology of DENV 5: Health Economic Communication & Community Empowerment 8: Activation and Evasion of Innate Immunity by Dengue Virus 12: The Roles of Adaptive Immunity in Protection and Disease 15: Adaptive and Innate Immunity in Dengue 18: Integrated Vector Management (IVM) 23: Next Generation Dengue Vaccines 25: Vector and Vector Control 31: Anti-Dengue Virus Agents |
Generating Evidence for Decision Making regarding the Introduction of Dengue Vaccines 6: Epidemiology 9, 13: Vaccine I, II 16: Dengue Case Management: Points of Clinicians' Concern 20: Hematologic Changes in Dengue Illness 24: Clinical and Laboratory Diagnosis 28: Dengue Virus Evolution and Epidemiology 32: DENV Evolution and Vaccine |
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Lunch time seminars 1st day: The Growing Burden of Dengue: Southeast Asian and Global Perspectives 2nd day: Making diagnosis of Dengue in clinical practice 3rd day: New Approach to the diagnosis and quantification of dengue virus infection |
Poster session
Detailed program available at: http://www.dengue2013bangkok.com/scientific_program
3. Did attendance to this conference meet the needs you originally described? Please explain your answer in either way:
This conference was the largest scientific event in dengue research of the year and hence was the perfect opportunity for me to have a comprehensive view of the state of the art in dengue research and development. In addition, it was held in an endemic country located in a different geographical region where I conduct my research which was important to
get a more global picture of dengue. Finally, international leaders in dengue research gathered at the conference providing the opportunity to meet them and tell them about our work in Colombia and hence improve my networking skills.
I was able to get a better understanding of the basic science behind clinical and laboratory diagnosis of dengue as well as recognising the different scenarios (e.g. health care systems in different countries, intensity of transmission) in which these need to be applied. It also allowed me to think in the different ways research could help to improve dengue control. For example, how molecular epidemiology of dengue viruses in time and space could help to identify where pockets of viruses remain during inter epidemic periods and in this way helping to focus vector control interventions an potentially prevent or decrease epidemics. This is particularly relevant to my country where there is co-circulation of the 4 dengue serotypes and vector control is costly and difficult to sustain. There is progress in understanding worldwide dengue burden but still data is mainly provided by routine surveillance systems that are seldom evaluated. Seroprevalence seems still the best approach to estimate dengue burden and to try to define a classification for intensity of transmission. Nevertheless, laboratory methods for seroprevalence have several limitations. Dengue vaccine is one of the most discussed current topics but perhaps the best lecture was given by someone with expertise in vaccines rather than an expert in dengue. I say so because, he gave his advice for dengue vaccine development which seemed to me very public health sound as well as scientifically based. Finally, the current WHO classification of dengue is not yet used in all countries but progress was made towards understanding that the current classification has a specific objective of trying to identify those cases in whom interventions should be prioritized to prevent complications and mortality while the previous classification is more physiopathologically oriented. Studies to improve dengue classification are underway.
There was a wide offer of topics and lectures and I had to prioritize what I wanted to attend. I tried to go to most of the symposia related to diagnosis and case management which is my current research topic but also was interested in other topics in which I had little knowledge. I was happy to see face to face the persons who wrote some of the papers I had read and to have the chance to ask questions at the end of the sessions or
request a meeting. In fact, I was pleased to have long discussions with Elizabeth Hurspenberg and Jorge Munoz-Jordan from CDC Puerto Rico who have developed a real time RTPCR kit for dengue diagnosis with “universal” probes. This is important, because as I learned, PCR-based techniques need to evolve to take into account the changing genetic profile of dengue viruses. Probes designed 30 years ago can miss dengue viruses in current circulation. I also met other researchers as well as product developers to discuss potential collaboration.
Personally, when I go to a conference I prefer to submit an abstract in advance for either oral or poster presentation because I think presenting one’s own work gives the chance to have feedback from others. I did this for this conference and was presenting the results of our clinical trial on dengue diagnostics which was accepted for poster presentation. During the poster sessions, I had the opportunity to interact with people interested in our work as well as visit other posters. The degree of interaction was less than what I anticipated perhaps because of the size of the conference. From the other posters, I learned of new techniques for screening of antidengue drugs which I knew little and was able to identify research groups which I was not aware of.
One of the intentions of attending the conference was to share the knowledge with my colleagues at my home institution, Universidad del Valle in Cali-Colombia. I achieved this by reporting to them via email some of the key learning experiences I had during each day and the results or actions of the meetings. I was surprised when they replied back with news they heard of a new dengue serotype mentioned at the conference which I did not know! This interaction was useful and productive as I was able to answer some of the questions others asked me at the conference for which I did not have the data but my colleagues provided via email and at the same time go and ask questions that my colleagues, who were not present, wanted to ask. Attending these conferences in countries far from ours is costly and certainly a privilege that I feel has to be share with those who are not able to attend. This, I will try to keep as a policy within our research group.
4. Please highlight what was the most important/useful information you learnt during the conference
Among all the useful information I learnt during the conference, I would highlight that dengue diagnostic tests are been used in different ways and that is not necessarily enough evidence to support many of the current uses. Talk to people who already had the experience of using them in routine care helps to anticipate some of the results in our own studies.
The new developments in dengue diagnostics involve technologies that are not currently available and that even reference or academic labs in our countries are not likely to implement in the near future. Hence, there is a role for research groups in endemic countries to adapt some of these technologies but also consider alternative approaches. Collaborations with groups who lead technology advances are the most likely way to expedite access to these methods. However, understanding the direct use of the results
and the key questions that are going to have a direct translation into dengue case management or control is very much our responsibility in endemic countries.
5. What ideas/recommendations did you bring back?
There are several ideas I brought back and was discussing already with my colleagues in Colombia:
a) There is a need to speed up the process to incorporate the new probes in our dengue real time RTPCR, and evaluate the feasibility to implement it routinely in sentinel hospitals.
b) To consider lot to lot variation of dengue RDTs
c) Circulate proposal with other researchers who are willing to help us in refining the diagnostic intervention for our clinical study planned to start next year.
d) Molecular epidemiology is an area for potential development in our group
e) Try that the member of our research group who attends a conference remains in contact with the group if feasible to share on time the experience and maximize the direct benefit to others.
6. How will you incorporate them in your research or training activities?
All these ideas could be directly incorporated in our research protocols and group activities.
To speed up the process of implementing real time RTPCR, I will request the new kit from CDC as instructed and discuss with my colleague at the virology lab the potential ways to make it as part of the routine in sentinel hospitals.
To consider lot to lot variation in rapid diagnostic tests in dengue, we had contacted the manufacturer who has offered training and supply of a different lot.
To circulate proposals with other researchers, I will prepare one slide detailing the proposed intervention and the key characteristics of the study design.
To consider further research in molecular epidemiology we need to follow on some contacts made during the meeting with groups who are already advance in this area and work together in a research proposal.
To try to maximize benefit of attending a conference need to discuss with the research group and gather more opinions in how people think that keeping in contact during the conference is desirable and the potential disadvantages.
7. How could others benefit from the conference?
As described above, one of my objectives was to share the knowledge gained during the conference with my colleagues in my home institution and I did this by reporting to them in a daily basis via email. I have the intention to do the same more often in the future, and promote it as a policy within our research group. Writing this report is also a way to share my experience with the CDF community and hence benefit others. Back at GSK where my placement is taken place, I am sharing also the knowledge and experience with colleagues at the office. In a different way, the conference is going to directly benefit the current research our dengue network in Colombia is doing and improve the design of our studies as well as open new opportunities for international collaboration.
8. Would you recommend other grantees attend this conference?
I chose this conference because my current research and the one I expect to do upon returning to my home institution is in dengue. It is a focused in a single disease which for me was advantageous as I am relatively new to dengue research, having done most of my previous work in malaria. If a grantee wants to improve knowledge and network in dengue I certainly recommend this conference.
Please view my poster presentation for this conference 'USE OF RAPID DENGUE DIAGNOSTIC TESTS IN THE ROUTINE CLINICAL SETTING' which is located at the top right corner of this screen.
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