Infectious Diseases

Infectious diseases are a global threat to human health as illustrated by the COVID-19 pandemic. To counter this threat further research efforts are needed to improve the ways we prevent, control and treat infectious diseases. Prevention is at the center of infectious diseases vaccine research. Control is achieved through work on infectious diseases diagnostic tests whereas infectious diseases drug discovery aims at improving our treatment options.

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Vaccine Development for Infectious Diseases

For emerging infectious diseases vaccine development is seen as a vital component of disease prevention. Often other medical options are unavailable or the disease results in rapid clinical deterioration that the effectiveness of drugs is limited.¹ The importance of vaccines in outbreak response is underlined by the foundation of the Coalition for Epidemic Preparedness Innovations (CEPI) 2017 in the wake of the Ebola epidemic 2014/2015.² The objective of CEPI is to ensure a coordinated effort in developing and deploying new vaccines to prevent future epidemics. During the COVID-19 pandemic CEPI is involved in numerous vaccine development projects.³

Key Vaccine Development Activities

Hatchett and Lurie point out key vaccine development activities that should be carried out both before and during the outbreak:²

• Sequence, serotype, and share outbreak strain
• Collect acute and convalescent blood samples and other body fluid specimens
• Accelerate development of diagnostic tests that can serve as endpoints for vaccine trials
• Conduct epidemiological studies essential for vaccine development
• Understand cultures and beliefs

Vaccine Development Platforms

An antigen delivery system which optimizes antigen presentation and induces broad protective immune responses is the center piece for the development of successful and effective vaccines. A number of different vaccine platforms have been established over the years:

• Viral Vector Technology
• Virus-like Particles
• Nucleic Acid Vaccines
• Synthetic Peptides
• Inactivated Viruses

For benefits and disadvantages of each approach see Afrough et al. (2019).¹

Diagnostic Test Development for Emerging Infectious Diseases

Diagnostic tests for Infectious Diseases can serve multiple purposes, i.e. surveillance, diagnosis, and support of clinical decision making. The purpose of these diagnostic tests is to accurately identify the infecting pathogen to enable healthcare professionals to initiate appropriate treatments and prevent further transmission of disease. Given the implications the test must have sufficient clinical sensitivity and specificity to be useful. Complications in diagnostic tests such as cross-reactivity with other pathogens poses additional challenges for developing diagnostic tests for emerging infectious diseases.⁴

To avoid false positive results cross reactivity needs to be evaluated by testing specimens containing antibodies to other microorganisms. Selection of the relevant mircoorganisms depends on prevalance and differential diagnosis for the disease in question. As an example: For SARS-CoV-2 ELISA tests the WHO recommends cross reactivity analysis for the following organisms: Other coronaviruses (e.g. Human coronavirus OC43), Adenovirus, Human Metapneumovirus (hMPV), Parainfluenza virus, Influenza A virus, Influenza B virus, Haemophilus influenzae, Rhinovirus, Respiratory syncytial virus, Epstein-Barrvirus.

Drug Discovery for Emerging Infectious Diseases

As was the case for COVID-19 typically neither drugs nor vaccines are available at the outset of an emerging infectious disease. Repurposing drugs that have been approved for other diseases is often the fastest way to arrive at a treatment option for such a disease - as underlined by the approval of Remdesivir for the treatment of COVID-19.⁵

References

• CEPI Website