Microbe Mail – Details, episodes & analysis

Vaccinations play an important role in both our individual and community health. They help to prevent serious and sometimes deadly diseases by strengthening our immune system. But in recent years this cost effective method of disease prevention has come under the spot light, drawing attention to some myths and misconceptions.

In this episode, Dr Anne von Gottberg dives into the importance of vaccinations, how to handle missed vaccines, vaccine dos and don'ts and recent changes in the Extended Programme onIimmunzation(EPI) in South Africa.

About our Guest:

Dr Anne von Gottberg is currently the laboratory lead at the Centre for Respiratory Diseases and Meningitis at the National Institute for Communicable Diseases, Johannesburg, South Africa; and Associate Professor within the School of Pathology, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg; and Honorary Professor, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town. She leads a laboratory team responsible for reference diagnostics for respiratory and meningitis pathogens nationally and regionally. The laboratory is the regional reference laboratory for the World Health Organization (WHO) Vaccine-preventable Invasive Bacterial Diseases (VP-IBD) Coordinated Global Surveillance Network for the southern African region; a National Influenza Centre (NIC); and a global WHO RSV and regional SARS-CoV-2 reference laboratory. She is currently a member of several committees and technical advisory groups for AFRO, Africa CDC and WHO. Her main interests include surveillance for meningitis and respiratory pathogens, assessing vaccine effectiveness where relevant. She has authored or co-authored more than 200 articles in peer-reviewed journals. In addition, she supervises a number of Masters and PhD students. Dr von Gottberg obtained her MBBCh and PhD at the University of the Witwatersrand, and trained for her specialisation in clinical microbiology (FC Path[SA] MICRO) at the National Health Laboratory Service (former South African Institute for Medical Research) and at the University of the Witwatersrand.

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This episode gives a nod to the show's history while also hinting at the variety of topics discussed. A Journey Through the Microscopic World – Highlights from some memorable episodes

Episodes featured in this recap:

• EP 49: No spleen, how mean! - Asplenia_ Antibiotic prophylaxis
• EP 59: What's all the buzz about_ Malaria diagnostics
• EP 33: Would you rather, the antibiotics version_ Empiric therapy for community acquired meningitis
• EP 50: HIV in the USA _ Diagnosing HIV in the USA
• EP 58: Findings from FIDSSA part 2_ Rabies update and outbreak response
• EP 44: Highlights from the PathRed Congress 2023 - Part 1_Emerging viral infections
• EP 62: Myco-moments: Interviews from the 4th AIDS-related Mycoses Workshop: The immunology of Oral candidiasis
• EP 61: "Prescription Ice cream" Book review and interview: Advice to young medical doctors and students
• EP 53 : Appropriate use of β-lactam - β-lactamase inhibitor combinations _ Rapid genetic testing, know your syndromic antibiograms, and diagnostic stewardship

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Earlier this year, some of the Microbe messengers attended the 10th FIDSSA Congress held in Johannesburg, South Africa. Besides being presenters themselves, they met and interviewed medical researchers in various infectious disease related fields.

This joint biennial congress hosted by the Federation of Infectious Diseases Societies of Southern Africa (FIDSSA) brings together healthcare professionals from its various societies, where members share research experiences and outcomes. Let's hope this acts as a catalyst for collaborative work, culminating in all-encompassing guidance in the management of infectious diseases.

To learn more about FIDSSA and its member societies visit: https://www.fidssa.co.za/

This episode includes discussions with:

• Dr Nicollete du Plessis
• Dr Jeremy Nel
• Professor James Seddon (@Jamesseddon10 on X)
• Dr Lyle Murray
• Professor Akebe Luther King Abia
• Dr Ribkha Berhanu

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It's that time of the year again, and most of us have already experience our fair share of the snuffles, so why not discuss it? In this episode Vin and Ruan speak to Associate Professor Diana Hardie about when respiratory infections go viral.... and not in a good way.

About our Guest:

Diana Hardie is a clinical virologist and head of the diagnostic virology laboratory at Groote Schuur Hospital. Her research interests center around viral infections in immuno-compromised patients and the immuno-pathogenesis of viral infections. She has also contributed to the development of various diagnostic assays for viral infections.

She has had many years of experience teaching medical virology and immunology to medical students, honours and post graduate students.

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Ever wondered what Microbiologists get up to in the laboratory? Is it all about waiting for organisms to grow, "doomsday prophecies" regarding antimicrobial resistance, and asking for a clinical correlation? The feild of Microbiology is vast, and Vin speaks to some well seasoned experts to get their take on a career in Microbiology.

About our Guests:

• Crystal Viljoen, B.Tech Biomedical Technology: Crystal has more than 20 years of laboratory experience, and is currently working as the laboratory manager at the Infection Control Laboratory Services in Johannesburg. She is also an executive member of Legionella Action Group (LAG); and has a wealth of experience with quality management systems, including proficiency testing schemes, laboratory safety procedures and the process of laboratory accreditation, gained at the National Institute of Communicable Diseases (NICD)



• Andrea Prinzi, Ph.D., MPH, SM(ASCP): Dr Andrea Prinzi is currently a field medical director of US medical affairs at BioMérieux (pronounced bee oh merry you). Prior to her work in industry, Andrea was a clinical microbiologist with over 12 years of hands-on bench experience in a pediatric hospital laboratory. In 2014, she obtained her master’s in public health from the Colorado School of public health with a focus in epidemiology. In 2021, she completed a PhD in clinical and translational science from the University of Colorado. As a PhD in Clinical and Translational science, her interests include antimicrobial and diagnostic stewardship (with an emphasis on pneumonia diagnostics and management), development of effective teaching methods for clinicians and the fusion of public health, clinical science and medicine to improve patient outcomes, quality improvement, infectious disease epidemiology, science communication, and implementation science. Dr. Prinzi’s PhD work was clinical and translational, and focused on bridging the gap between the clinical microbiology laboratory and clinical practice. She combined clinical diagnostics, public health, clinical research and science communication to improve the way we think about and use diagnostic tests and antimicrobials. Dr. Prinzi is the clinical and public health community leader for the American Society for Microbiology’s Council on Microbial sciences, as well as a regular blog writer for ASM. She is a reviewing editor for the ASM journal Spectrum, as well as an editorial advisory board member for Open Forum Infectious Diseases. She also enjoys volunteering time to help co-host the Let’s Talk Micro antimicrobial resistance sub-series with her friend, Luis Plaza.

• Dr Keeren Lutchminarain: Dr Keeren Lutchminarain is a clinical microbiologist based at Inkosi Albert Luthuli Central Hospital. Her primary role in the NHLS is to oversee the KZN reference Tb laboratory where she is involved in interpreting routine diagnostic tests; verification of new instruments; teaching and training within the province and TB related research.

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We're back with another game of 'Would you rather?' Where we pose a scenario, and our guests give us their views. This episode really challenges the basis of some of the beliefs and practices regarding antimicrobials. Some of the questions are so tricky, who knows if there even is a correct answer. What we do know is... it depends.

About our Guest:

Prof. Andrew Whitelaw worked as a consultant pathologist in clinical microbiology at Groote Schuur Hospital from 2003 – 2012. In December 2012 took up the post of Head of Department of Medical Microbiology at the University of Stellenbosch / Tygerberg Hospital. His early research revolved around molecular characterization of ESBLs in members of the Enterobacteriaceae, and he has been involved in a number of studies and activities related to antimicrobial resistance (AMR) and infection control over the last decade, both for community as well as hospital acquired pathogens. Most relevant among these would be his involvement in the South African Antibiotic Stewardship Programme (SAASP), The Infection Control Society of Southern Africa, and the SA Ministerial Advisory Committee on AMR. 

Ongoing research interests focus on antimicrobial resistance in Enterobacteriaceae and Staphylococcus aureus, including molecular epidemiology and mechanisms of resistance as well as clinical impact and control of AMR. He is also involved in studies describing the human microbiota and in particular the effect of antimicrobials on the microbiota.

Resources from this episode:

SASCM C. difficile infection guidelines

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Don't forget to also have a listen to these featured episodes:

Episode 43: Communicating antimicrobial therapy to patients

Episode 38: Would you rather?: The mycology version

Episode 35: Would you rather?: The virology version

Episode 33: Would you rather?:The Bacterial version

The rampant emergence of antimicrobial resistance, particularly amongst Gram negative organisms, has called for both the discovery of novel agents but also for a review of therapeutics thought to have been long lost in this battle. Enter, the "BLBLIs or BLICs'. In this episode Vin and Ruan speak with the 1st author of the publication "Appropriate use of the new β-lactam - β-lactamase inhibitor combination agents: Ceftazidime-avibactam and Ceftolozane-tazobactam in South Africa", Professor Adrian Brink, and receive a welcomed masterclass on this interesting group of antimicrobials.

About our Guest:

Professor Adrian Brink is Head of the Division: Medical Microbiology, and member of the Institute of Infectious Disease & Molecular Medicine,  Faculty of Health Sciences, University of Cape Town and the National Health Laboratory Services, Groote Schuur hospital, Cape Town, South Africa. 

Prof Brink was founding President of the Federation of Infectious Diseases Societies of Southern Africa and is the founder and currently co-chairs the South African Antibiotic Stewardship Program (SAASP). Prof Brink currently serves on the South African Minister of Health’s Ministerial Advisory Committee (MAC) on Antimicrobial Resistance and representing Africa, is a member of the European Society of Clinical Microbiology and Infectious Diseases International Affairs Subcommittee.

His is main research interests are the clinical and molecular epidemiology of antibiotic-resistant infections, the mechanisms of resistance as a confounder in antibiotic stewardship, the design and implementation of large-scale antibiotic stewardship, diagnostic stewardship and infection prevention and control interventions in low- and middle-income countries. His interests also include the protective, metabolic and immune functions of the gastrointestinal and vaginal biome including the resistome and metabolome. 

Resources from this episode

Best practices: Appropriate use of Beta-lactam/Beta-lactamase inhibitor combinations Ceftazidime-Avibactam and Ceftolozane-Tazobactam)

WHO Priority Pathogens List

Table 1: Data on inhibitor classes, inhibitory mechanisms, and current clinical trial status, Kar D et al., 2023.

Table 6: β-lactam/β-lactamase inhibitor (BL/BLI) combinations in clinical trials or submitted for regulatory approval, Butler et al., 2023

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Professor Francois Venter is back in Part 3 of our HIV series in which he continues to address South Africa's battles against HIV. Here he discusses his experience on how and when to initiate antiretroviral therapy, prophylaxis against opportunistic infection, routine monitoring and what the future of HIV management looks like in South Africa.

About our Guest:

Professor WD Francois Venter, MD, FCP, PhD is Executive Director of Wits Ezintsha at the University of the Witwatersrand, Johannesburg, where he received most of his training. His work involves health systems research and clinical trials, most recently involving the antiretrovirals dolutegravir, tenofovir alafenamide, cabotegravir, and doravirine. He leads multiple antiretroviral treatment optimisation studies and is currently working on new access programmes through private pharmacies within South Africa, patient linkage-to-care interventions, self-testing projects, as well as most recently on new large-scale primary care delivery platforms addressing hypertension, diabetes, obesity, hyperlipidaemia and HIV. He has led large PEPFAR-funded HIV programmes in South Africa, focusing on men, women, children, young people, truckers, sex workers, and LGBTI communities. For over 20 years he has been an advisor to bodies such as the South African government, UNAIDS, and WHO, contributing to international, regional, and national HIV guidelines, and recently served as a member of the Ministerial Advisory Committee for COVID-19. He has an active interest in medical ethics and has been involved in several HIV-related human rights cases within the southern African region. He supervises Masters and PhD students and has over 200 publications, including first-author articles in major journals.

Resources:

SA HIV Clinicians society

ADVANCE STUDY

Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults:2023 update

Liverpool HIV Drug Interactions Checker

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Part 2 of our HIV series addresses South Africa's battles against HIV as we get an account of the complexities of diagnosis, prophylaxis, and managing opportunistic infections from a celebrated HIV clinician, Professor Francois Venter.

About our Guest:

Professor WD Francois Venter, MD, FCP, PhD is Executive Director of Wits Ezintsha at the University of the Witwatersrand, Johannesburg, where he received most of his training. His work involves health systems research and clinical trials, most recently involving the antiretrovirals dolutegravir, tenofovir alafenamide, cabotegravir, and doravirine. He leads multiple antiretroviral treatment optimisation studies and is currently working on new access programmes through private pharmacies within South Africa, patient linkage-to-care interventions, self-testing projects, as well as most recently on new large-scale primary care delivery platforms addressing hypertension, diabetes, obesity, hyperlipidaemia and HIV. He has led large PEPFAR-funded HIV programmes in South Africa, focusing on men, women, children, young people, truckers, sex workers, and LGBTI communities. For over 20 years he has been an advisor to bodies such as the South African government, UNAIDS, and WHO, contributing to international, regional, and national HIV guidelines, and recently served as a member of the Ministerial Advisory Committee for COVID-19. He has an active interest in medical ethics and has been involved in several HIV-related human rights cases within the southern African region. He supervises Masters and PhD students and has over 200 publications, including first-author articles in major journals.

Resources:

SA HIV Clinicians society website

PrEP guidelines

PEP guidelines

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Here we discuss how HIV is diagnosed and managed in the USA.

About our Guest:

Dr Ankita Kadakia, M.D. serves as the Deputy Public Health Officer for the County of San Diego.  Prior to her current role she served as the Chief and Medical Director for the County’s Tuberculosis Control and Refugee Health Branch and is the President of the California Tuberculosis Controller’s Association. Dr. Kadakia is a board-certified Internal Medicine and Infectious Disease specialist.  She has served in leading, coordinating, supervising, and managing operations for Covid-19 as well as coordinating the County Public Health Service’s Tuberculosis Elimination Initiative. Throughout the COVID-19 pandemic, she has played a critical role as a medical subject matter expert and Tri-Chair of the County COVID-19 Vaccine Clinical Advisory Group.

Prior to joining the County, Dr. Kadakia worked at the University of California, San Diego (UCSD) as an Assistant Professor of Medicine with a focus on HIV/AIDS and LGBTQ healthcare while practicing HIV medicine at UCSD Owen Clinic.  While at UCSD, Dr. Kadakia created the first Transgender HealthCare Symposium and became a co- principal investigator for the San Diego Pacific AIDS Education and Training Center. 

Dr. Kadakia’s passion, for serving underserved patients and preventing and treating Tuberculosis, STDs and HIV/AIDS, transcends borders. She has spent time in Uganda serving rural areas, partnering with Ugandans, to build and support schools for AIDS orphans and impoverished children. When she is not working, she immensely enjoys spending time with her two young children and practicing and teaching Kelee meditation.

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