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The Global Dengue & Aedes-Transmitted Diseases Consortium (GDAC) convened a 2-day consultative meeting of the Americas Dengue Prevention Board on August 3-4, 2017 in São Paulo, Brazil.

The objective of this meeting was to define key issues and considerations in dengue prevention and control in the context of dengue and Zika co-circulation; and to provide recommendations for research and public health measures needed especially for the Americas region. The meeting was sponsored by Bill & Melinda Gates Foundation, Sanofi Pasteur, Takeda Pharmaceuticals International AG, and Standard Diagnostics, Inc. (SD).

Download the meeting report

The purpose of this workshop is to review novel technologies, to identify which characteristics should be prioritized, how to meet regulatory requirements, and how to move from innovation to market.

Despite advances in diagnostics for flaviviral infections, there is a critical need for more sensitive, specific, easy to use and affordable tests for point of care (POC) diagnosis, multiplex virologic and serologic assays to differentiate co-circulating viruses of public health significance, eg, dengue, Zika, yellow fever and chikungunya, and methods for viral quantification and genomic characterization. New diagnostic methods continue to be innovated, such as microfluidics, paper-based diagnostics, chip-based systems, micro- and nanofabrication technologies, deep sequencing, among others.

Towards the development of new technologies

The Partnership for Dengue Control (PDC) wishes to cast a wider net to facilitate and expedite the development of the most promising technologies that are urgently needed not only for pressing research questions but also to be rolled out in affected countries. The Flavivirus field can learn from cutting-edge technologies that have been developed for diseases such as HIV, malaria and Tuberculosis. Hence the workshop is organized around three questions:

• What is the current status of Zika and dengue diagnostics?
• What new technologies might be available in the near, intermediate and long-term future?
• What is needed to make these technologies available?

Chairs

• May Chu, Colorado School of Public Health, Clinical Professor
• Duane Gubler, Duke-NUS Medical School, Emeritus Professor
• Rosanna Peeling, London School of Hygiene and Tropical Medicine, Professor and Chair, Diagnostics Research
• Annelies Wilder-Smith, Foundation PDC, Director of the Partnership for Dengue Control and Professor of Infectious Diseases Research

Scientific Committee

• Arlene Chua, World Health Organization, Technical Consultant
• Duane Gubler, Duke-NUS Medical School, Emeritus Professor
• Eva Harris, University of California, Berkeley, Professor
• Aravinda de Silva, University of North Carolina School of Medicine, Professor
• Bernadette Murgue, WHO, R&D Blueprint manager
• Maurine Murtagh, The Murtagh Group, LLC Principal
• Rosanna Peeling, London School of Hygiene and Tropical Medicine, Professor and Chair, Diagnostics Research
• Annelies Wilder-Smith, Foundation PDC, Director of the Partnership for Dengue Control and Professor of Infectious Diseases Research

Organized by the Partnership for Dengue Control (PDC) and the Mérieux Foundation (France), with the support of the Bill & Melinda Gates Foundation, bioMérieux, Takeda and Sanofi Pasteur.

Download Program

Tuesday, May 2 – Day 1

Where are we now?

1.30pm – 3pm	Session 1 Chairs: Annelies Wilder-Smith, Duane Gubler Setting the objectives of the meeting – Annelies Wilder-Smith, PDC What are the necessary characteristics of diagnostic assays depending on the intended use: case management, surveillance, serosurveys, research studies, intervention trials – Duane Gubler, GDAC Review of Zika standard assays (CDC MAC, IgG and PRNT) – Aravinda de Silva for Amy Lambert, CDC Landscape analysis of the current status of Flavivirus diagnostics (dengue and Zika) – Maurine Murtagh, The Murtagh Group
Coffee break
3.30pm – 5pm	Session 2 Chairs: Francis Moussy, Amy Lambert Learning from successful novel technologies that made it to the market – Mark Miller, BioMerieux Demand forecasting and market considerations – Nagwa Hasanin, UNICEF Learning from past emergency authorizations – Elliot Cowan, Partners in Diagnostics
Networking session
6.00pm – 7.00pm	Evening Chair: May ChuTalk: Zika and dengue diagnostics from a strategic investor’s perspective – Julie Schäfer, BARDA
Cocktail Dinner

Wednesday, May 3 – Day 2

Where do we go? Technological innovations in Flavivirus diagnostics

8.30am – 12.30pm	Session 3: Detecting acute infection Chairs: Maurine Murtagh, Arlene Chua Imminent technological innovations Cutting edge innovations for the intermediate and long-term future Discussion
8.30am – 10.00am	Near-care molecular testing for Dengue, Zika and related pathogens – Jesse Waggoner, Emory University Development of molecular tests for management of febrile illnesses and diagnosis of viral haemorrhagic fever – Kevin Arien, ITM Tetracore T-COR8 diagnostic system for the detection of Dengue and other arboviruses using real-time-rtPCR at the point-of-care – Bill Nelson, Tetracore Triplex PCR ZIKV/DENV/CHIKV assay and simple to operate real-time portable device – Craig Mosman, Kirkland Biosciences
Coffee break
10.30am – 12.30pm	Molecular test to detect dengue, Zika & Chikungunya and run on the QuRapID LV platform – Emily Adams, LSTM & David Edge, BioGene NS1 antigen capture assays for the specific detection of different dengue virus serotypes and other arboviruses – Katharina Roeltgen, Swiss TPH Application of a parsimonious targeted-enrichment methodology for full-genome sequencing of viral genomes directly from patient samples – October Sessions, Duke-NUS Multiplex Diagnosis kit for Zika, Dengue, Chikungunya and Japanese Encephalitis Viruses using Printed Array Strip based on Single-stranded Tag Hybridization method – Takahiro Haruyama, AVSS Multiplex magneto-optical detection technique – John Lewandowski, MIT Discussion
Lunch
2pm – 5.45pm	Session 4: Detecting past infections Chairs: Eva Harris, Aravinda de Silva
2pm – 3.40pm	Dx antigen discovery and imminent technological innovations New discoveries about the molecular specificity of the human antibody response to dengue and Zika viruses – Aravinda de Silva, UNC NS1 blockade-of-binding ELISA distinguishes between dengue and Zika virus antibodies – David Corti – Humabs BioMed SA In-country development and evaluation of new molecular and serological methods for Zika diagnosis and surveillance and their applications – Eva Harris, Berkeley University Structure based design of novel Zika virus antigens for serodiagnosis – Prem Lakshmanane, UNC-CH, North Carolina
Coffee Break
4.00pm – 5.00pm	Cutting Edge Innovations For The Intermediate And Long-Term Future VIDAS Zika and Dengue: Preliminary results on an automated immunoAssay platform – Nathalie Renard, Biomerieux VIRO-TRACK – A rapid, quantitative, and accurate dengue/zika diagnostics platform for point of care use in endemic regions – Filippo Giacomo Bosco, BluSense Diagnostics ApS A nanoscale plasmonic-gold platform for specific diagnosis of Zika and differentiation from other Flavivirus infections – Benjamin A. Pinsky, Stanford, CA
5.00pm – 5.45pm	Discussion
BBQ

Thursday, May 4 – Day 3

How do we make it happen? From idea to market

8.30am – 10am	Session 5: Preparing for the inevitable: open technology platforms for rapid outbreak response Chairs: Bill Rodriguez, Bernadette Murgue Preparing for the inevitable: open platform technologies for rapid outbreak response WHO call for open technology platforms to accelerate test development – Bernadette Murgue, WHO Blueprint Diagnostics preparedness platform – Thomas Ullrich, Alere Learning from influenza POCT – Julie Schäfer, BARDA Genetic analysis tool kit for rapid outbreak response – Michael Baffi, Thermo Fisher
Coffee break
10.30am – 12.30pm	Session 6: Critical steps to ensure quality products Chairs: Rosanna Peeling, Piero Olliaro Critical steps to ensure quality products – Bill Rodriguez Lessons learnt on bringing diagnostics to the market in low and middle income countries – Cassandra Kelly, FIND Two new WHO IVD initiatives: SAGE-IVD and EDL – Francis Moussy, WHO Blueprint Regional regulatory harmonization working parties – Rosanna Peeling, LSHTM Streamlining from bench-to-bedside – Piero Olliaro, WHO TDR Panel Discussion
Lunch
1.30pm – 3:30pm	Session 7: Identifying PDC’s roles to support innovative diagnostics Chairs: May Chu, Julie Schäfer Panel 1: Networks and alliances – Dhamari Naidoo, WHO; Maria Guzman, RELDA Cuba; Amadou Sall, Institute Pasteur Senegal; Francois Xavier Babin, Merieux (Networks of Laboratories); Annelies Wilder-Smith and In-Kyu Yoon, GDAC Panel 2: Accelerating from ideas to market – Jennifer Fluder, USAID; Rosanna Peeling, LSHTM; Thomas Ullrich, Alere Panel 3: Views from stakeholders and partners – Sumi Paranjape, Vulcan; Nagwa Hasanin, UNICEF; Julie Schäfer, BARDA Concluding Discussion: research agenda and roadmap for the next 12 months
3.30pm – 4pm	Summary and Recommendations – May Chu, Rosanna Peeling and Annelies Wilder-Smith
Coffee Break

PDC’s diagnostics workshop, to be held May 2-4 at Fondation Mérieux’s Les Pensières center in Annecy, will look at the current status of Zika and dengue diagnostics.
New technologies are needed to address urgent research needs and also to support longer term public health strategies to control outbreaks in the field.

The workshop will bring together scientists and experts from academia, public health, biotechnology companies and industry to review the new technologies and approaches that might be available in the near, intermediate and long-term future and determine what needs to be done to make these new diagnostics available.

View the program

Call for Abstracts

If you are interested in presenting a new or innovative dengue/Zika diagnostic assay at the PDC Diagnostics Workshop, please submit the attached form with your abstract (in 300 words) by February 10, 2017 to PDC Director, Prof Annelies Wilder-Smith.

A selection committee will then go through a formal process of evaluating and selecting the most appropriate abstracts for oral presentations.

Download the abstract form

PDC has created an interactive map to identify the main stakeholders working on dengue globally and regionally.

This interactive map makes it easy not only to locate the organizations (academic, industrial, governmental and NGOs) involved in combatting dengue but also to discover the specific domain in which they work (such as vaccines, vector control, diagnostics, treatment and therapeutics, epidemiological surveillance or integration).

Although it is not exhaustive, this mapping of multi-disciplinary stakeholders provides a practical tool to find the right contacts in the right domain across the globe.

For it to be useful, an interactive map must be kept up-to-date. Users are, therefore, warmly invited to send us any relevant updates or complementary information.

View Map

Today, four leading institutions at the forefront of dengue prevention and control—the International Vaccine Institute (IVI), the International Vaccine Access Center (IVAC) of the Johns Hopkins University, the Partnership for Dengue Control Foundation (PDC) and the Sabin Vaccine Institute—announced a new global alliance to integrate approaches to fight dengue and other Aedes-transmitted diseases under one strategic umbrella.

Named the Global Dengue and Aedes-transmitted Diseases Consortium (GDAC), this new partnership will expand its expertise in dengue to other Aedes-transmitted diseases including Zika, chikungunya and yellow fever, responding to the urgent need for coordination in the currently fragmented efforts to control the diseases transmitted by one of the world’s most dangerous animals—the Aedes mosquito.

“Dengue has emerged as one of the most important infectious diseases over the past 40 years, today infecting 400 million people worldwide each year in over 100 countries. Efforts to reverse this trend have fallen short for many reasons, but limited funding, lack of effective tools, and fragmented leadership have been among the most important” said Dr. In-Kyu Yoon, Deputy Director General of Science at the International Vaccine Institute and now Director of GDAC. “Other rapidly spreading Aedes-borne infections such as Zika and chikungunya remind us that Aedes-transmitted diseases will continue to spread as irreversible global trends such as population growth, urbanization and globalization continue to provide the ideal conditions to promote the spread of these diseases. We need a global, unified strategy to prevent and control known and as yet unknown Aedes-transmitted diseases.”

Today we are entering a new era in the fight against dengue and other Aedes-transmitted diseases, with the recent licensure of the first dengue vaccine and recent innovations in mosquito control and diagnostics. Many of these new technologies will become available for use in the next three to five years, but when used alone none will be as effective as when they are used in combination. GDAC proposes the use of these methods in combination to substantially decrease transmission and prevention of major epidemics of dengue and other Aedes-transmitted viruses.

Working closely with the World Health Organization (WHO), GDAC will provide scientific evidence to facilitate comprehensive Aedes-transmitted disease control, incorporating research and public health projects, technical meetings and consultancies, regulatory and policy support, financing frameworks and communications and advocacy. GDAC’s key objectives are to accelerate innovation and application of vaccines, vector control, antivirals, clinical management, therapeutics, diagnostics and surveillance, and licensure and post-marketing oversight of vaccines. GDAC will also focus on strengthening social mobilization, advocacy and capacity building. It will continue its members’ work with vaccine early adopter countries to develop integrated control strategies specific to those countries. GDAC will work with all stakeholders to develop strategies designed to prevent outbreaks caused by other viruses transmitted by Aedes mosquitoes.

“We propose to provide the leadership for integrated program implementation under one umbrella, working closely with the WHO and international funders, to reverse the trend of expanding epidemic dengue and other Aedes-transmitted viruses as public health problems” said Prof. Duane J Gubler, Chairperson of GDAC and Prof. Emeritus of the Program in Emerging Infectious Diseases, Duke-NUS Medical School. While much has been achieved in the past decade in developing new tools, it is unlikely that any of these new tools will be successful in controlling these diseases when used alone. Success will largely depend on integration of tools, effective partnerships, and coordinated leadership in program implementation. Our collective efforts are essential to eliminating the Aedes-mosquito as a public health threat worldwide.”

GDAC brings together the Dengue Vaccine Initiative (DVI) and the Partnership for Dengue Control (PDC). Established in 2011 by IVI, IVAC, Sabin and the WHO, DVI focused on accelerating the development and introduction of safe and protective dengue vaccines into public-sector programs, especially for the poor, stimulating the development of safe and effective dengue vaccines. PDC was created in 2013 by a group of international dengue and public health experts to build synergies among exciting new tools in the development pipeline. Hosted by Fondation Mérieux, its mission is to promote development and implementation of innovative integrated approaches for the prevention and control of dengue.

Now as GDAC, the four partners will combine their expertise across major spheres within global health, including epidemiology, health economics, advocacy and communication and surveillance. With a global presence, spanning Asia, America and Europe, they will build a common agenda to lead the new era for Aedes-transmitted diseases prevention and control.

About the International Vaccine Institute

The International Vaccine Institute (IVI) is an international organization devoted to developing and introducing new and improved vaccines to protect the world’s poorest people, especially children in developing countries. Established in 1997, IVI operates as an independent international organization under a treaty signed by 35 countries and the World Health Organization. The Institute conducts activities in more than 20 countries of Asia, Africa and Latin America on vaccines against a variety of diseases, and develops new and improved vaccines at its headquarters in Seoul, Republic of Korea. For more information, please visit http://www.ivi.int.

About the International Vaccine Access Center

The International Vaccine Access Center (IVAC) aims to accelerate equitable and sustainable access to vaccines through the generation, synthesis, and use of evidence to inform decision making and action. IVAC accomplishes this by drawing upon expertise from the Johns Hopkins Bloomberg School of Public Health faculty and partners. IVAC works to build knowledge about the value of vaccines to help support strong immunization programs through targeted, policy-focused research and practice in areas such as disease burden, cost-effectiveness, vaccine policy, financing, demand forecasting and disease epidemiology. For more information, please visit www.jhsph.edu/ivac.

About the Sabin Vaccine Institute

The Sabin Vaccine Institute (Sabin) is a non-profit, 501(c)(3) organization of scientists, researchers and advocates dedicated to reducing needless human suffering from vaccine-preventable and neglected tropical diseases (NTDs). Since its founding in 1993 in honor of Dr. Albert B. Sabin, the developer of the oral polio vaccine, Sabin has been at the forefront of global efforts to eliminate, prevent and cure infectious and neglected diseases. Sabin develops new vaccines, advocates for increased use of existing vaccines and promotes expanded access to affordable medical treatments in collaboration with governments, academic institutions, scientists, medical professionals and other non-profit organizations. For more information, please visit www.sabin.org.

About the Partnership for Dengue Control Foundation

The Partnership for Dengue Control (PDC) was created in 2013 to spearhead an integrated approach to sustainably control and prevent dengue. As a non-profit foundation, it brings together leading experts in the dengue-prevention community from different fields to address key issues, with an emphasis on combining vector control and vaccination strategies. PDC seeks to build synergies among the many new and innovative tools in the development pipeline. Its unique approach is developed through workshops, multidisciplinary task forces, research agenda, advocacy and other initiatives. Hosted by Fondation Mérieux, PDC is led by an independent board with Prof. Thomas W. Scott as chairman and Prof. Annelies Wilder-Smith as director. They replace PDC’s founding chairman, Prof. Duane Gubler, and founding director, Dr. Rémy Teyssou, who both continue on the PDC Foundation board. For more information, please visit: www.gdac-dengue.org.

Media Contact

Rebecca Van Roy
Program Officer, Vaccine Advocacy and Education
Sabin Vaccine Institute
Email: rebecca.vanroy@sabin.org
Tel: +1 (202) 683-1880

In their weekly epidemiological record published on July 29th 2016, the World Health Organization published its first position paper on a Dengue Vaccine. The report is based on available evidence concerning CYD-TDV or Dengvaxia®, the only dengue vaccine to have been registered to date by National Regulatory Authorities (NRA).

Currently, Dengvaxia® is approved by the NRA in 6 countries: Brazil, Costa Rica, El Salvador, Mexico, Paraguay and the Philippines. The WHO recommendation is that the vaccine should be introduced only in ‘geographic settings (national or subnational) where epidemiological data indicate a high burden of the disease’.

Until the introduction of this vaccine, the only way to control or prevent the transmission of the dengue virus was through vector control. Indeed, the paper goes on to underline that the introduction of this vaccine should form part of a comprehensive dengue control strategy. It states that this should include ‘well-executed and sustained vector control, evidence-based best practices for clinical care and strong dengue surveillance’.

The paper highlights the need for a targeted communication strategy at the time of vaccine introduction and a dengue surveillance system to detect and report hospitalized and severe dengue cases. On the latter point, it states: ‘Dengue surveillance should be strengthened, particularly in the context of emerging infections with clinical similarities to dengue and in areas of the world for which data are scarce or absent. Use of standardized case definitions is encouraged to enhance data sharing and comparability across regions.’

It is believed that dengue is substantially under-reported both within health systems and to WHO. The number of cases reported has increased from 0.4 to 1.3 million between 1996 and 2005. However, the global annual incidence, based on mathematical modelling, has been estimated at between 50 and 100 million symptomatic cases over the past few years mainly in Asia, followed by Latin America and Africa.

WHO Position Papers undergo review by WHO staff and are reviewed and endorsed by the WHO Strategic Advisory Group of Experts on Immunization (SAGE). They provide information for, and are intended to be used by, national public health officials, managers of immunization programs and national dengue control programs.

Read the WHO Dengue vaccine position paper
Read the updated WHO fact sheet on dengue and severe dengue

Scientists from the Institut Pasteur and the CNRS in Paris, in collaboration with Imperial College, London and the University of Vienna have identified antibodies that are effective in neutralizing both the Dengue virus and the Zika virus. The results of their research were published in the journal Nature on June 23rd 2016.

In an earlier study, the scientists had identified antibodies that are effective against the four types of Dengue. These new findings increase the possibility of producing a vaccine to act against two types of virus at once.