Institute Of Tropical Medicine Research Articles

Collaboration Spanning Two Continents: An Online Master’s Degree in Tropical Animal Health

A joint international program in Tropical Animal Health was launched in 2016 by the Institute of Tropical Medicine, Antwerp, Belgium, and the Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria. This program is flexible in time, place, and curriculum, allowing part-time students to apply the program's learning outcomes directly in their daily work environment. This article focuses on the major challenges and issues related to developing an international joint program in general and how these challenges were addressed. Challenges such as incompatibility of admission procedures, merging academic calendars, and quality assurance mechanisms were mitigated partly by the type of collaboration and partly by using a joint e-learning platform. The e-learning format proved to be a solution for particular challenges such as mobility issues, joint development of course material, and administrative processes. Furthermore, we present the results of a survey on the experiences of graduates and facilitators in this unique joint, web-based program.

Health economic assessment of a rabies pre-exposure prophylaxis program compared with post-exposure prophylaxis alone in high-risk age groups in the Philippines

ObjectivesOnce symptoms appear, rabies is almost always fatal and accounts for 200–300 deaths annually in the Philippines. Available rabies vaccines can be administered either in pre- exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP). After exposure, PrEP-immunized individuals require fewer doses of PEP and no rabies immunoglobulin. MethodsA static decision-tree model was developed to assess cost-effectiveness of a PrEP+PEP program vs PEP alone. Philippines-specific data for people seeking medical advice at the Research Institute for Tropical Medicine between July 2015 and June 2016 were used in the model, together with data from published literature. ResultsOver a 20-year period, in a cohort of 1 million 5-year-old children in the Philippines, PrEP+PEP was expected to prevent 297 deaths compared with PEP alone. From both payer and societal perspectives, the resulting incremental cost-effectiveness ratios were 36 035 (US$759; 2016 US$ conversion) and 18 663 (US$393) Philippine Pesos (PHP) — quality-adjusted life-years gained — respectively, which are both below the willingness-to-pay threshold of PHP140 255 (US$2 953). ConclusionThese data suggest that a universal PrEP program targeting 5-year-olds would be cost-effective in the Philippines.

TBE in Belgium

In 2018, the two first human tick-borne encephalitis (TBE) cases with possible/probable autochthonous infection were diagnosed at the National Reference Centre (NRC) of Arbovirus (The Institute of Tropical Medicine, Antwerp, Belgium). Every year, some imported cases of TBE are also detected, infected in other European countries such as Germany,1 Scandinavia, Austria, Kyrgyzstan or Slovenia2 and Russia between 2011 and 2019.

Should We Screen HIV-Positive Migrants for Strongyloidiasis?

Background: Strongyloides stercoralis, a nematode endemic in all (sub)tropical regions, can cause life-threatening disease, especially in immunosuppressed patients. Many countries with high HIV-prevalence rates are also highly S. stercoralis endemic, and co-infection may occur. Methods: Retrospective study based on serological testing for S. stercoralis in all HIV-infected migrants followed at the Institute of Tropical Medicine, Antwerp, Belgium. If untested, serologic testing was performed on stored samples, dating from the first HIV viral load determination. The epidemiological, clinical and laboratory features of patients with and without strongyloidiasis were retrieved from the electronic medical files. Results: Of the 2846 HIV patients in active follow-up, 723 (25.4%) had a migration background. Thirty-six patients (5.1%) were diagnosed with Strongyloides co-infection, including 29 during their medical evaluation and seven retrospectively. Patients had a median age of 35.3 years (IQR 30.3–44.4), 28 patients (78%) originated from Sub-Saharan Africa and median time in Belgium was 3.5 years (IQR 0.8–5.7). Symptoms compatible with strongyloidiasis were present in 17 (47%) patients, of whom two were diagnosed retrospectively. Eosinophilia (eosinophil cell count > 450/µL) was observed in 19 (53%) participants. Median CD4 level was 386 /µL (IQR 299–518) at diagnosis of co-infection. Of note, 8 (22%) patients with strongyloidiasis had no reported symptoms nor eosinophilia. None of the patients developed hyperinfection syndrome. There were no differences in age, gender, geographic origin, clinical presentation, CD4 level or viral load between patients with and without strongyloidiasis. Only eosinophilia was strongly correlated with the presence of Strongyloides in multivariate analysis (OR 10.74 (95% CI 5.19–22.25), p < 0.001); the positive likelihood ratio (LR+) of eosinophilia for strongyloidiasis was 5.38 (95% CI 3.66–7.91). Conclusion: Strongyloidiasis was diagnosed in 5.1% of HIV-infected migrants. Eosinophilia had good confirming power for the presence of the disease. However, a sizeable proportion (22%) of co-infected individuals were asymptomatic and had normal eosinophil count, supporting universal screening of all HIV-positive patients native to tropical countries.

A rare case of imported Strongyloides fuelleborni infection in a Belgian student

Abstract Background We report a rare case of imported and asymptomatic Strongyloides fuelleborni infection in a Belgian student, returning from the Democratic Republic of the Congo. Strongyloidiasis, one of the most neglected tropical diseases, is estimated to affect more than 100 million people worldwide. The exact number of cases attributable to Strongyloides fuelleborni is not known, as correct identification of this parasite can be difficult. S. fuelleborni is a parasitic helminth, known to infect both humans and non-human primates. S. fuelleborni eggs in the stools of infected patients may be mistaken for hookworm eggs. Correct identification of these eggs is essential, as the recommended treatment for hookworm infection is different. Case report A Belgian student, who had returned from the Democratic Republic of the Congo, was treated at the outpatient clinic of the Institute of Tropical Medicine in Antwerp, Belgium, because of an episode of fever, rash and diarrhea. Microscopic examination of a stool sample demonstrated Trichuris trichiura eggs and Strongyloides eggs, but no helminth larvae. A Strongyloides fuelleborni infection was suspected and subsequently confirmed using molecular techniques. The patient was treated with ivermectin and mebendazole. No helminth eggs could be detected in a follow-up stool sample. Conclusions Imported human Strongyloides fuelleborni infection is very rarely reported. When hookworm-like eggs are found during parasitological stool examination, Strongyloides spp. should be kept in mind as a possibility. Careful measurement of eggs, together with embryonation level and stool sample consistency, are important criteria to ensure correct initial identification, while molecular testing can be used for confirmation. This case should raise awareness about Strongyloides fuelleborni as a possible cause of infection in travelers returning from endemic regions, something which should be kept in mind in order to avoid erroneous treatment.

A Critical Effect of Pol Escape Mutations Associated with a Detrimental Allele HLA-C*15:05 on Clinical Outcome in HIV-1 Subtype A/E Infection

Background: The mechanism explaining the role of detrimental HLA alleles in HIV-1 infections has not been studied. We recently demonstrated that HLA-A*29:01-B*07:05-C*15:05 is a detrimental haplotype and that Pol mutations associated with this haplotype significantly correlated with poor clinical outcome in HIV-1 subtype A/E-infected individuals. To clarify the mechanism underlying this detrimental haplotype, we here investigated the effect of these Pol mutations on the ability of HIV-1-specific CD8+ T-cells to recognize HIV-1 and on the clinical outcome. Methods: To identify a T-cell epitope including Pol653/657 where this haplotype-associated mutations were found, we analyzed T-cell responses to overlapping or truncated peptides. The recognition of epitope-specific CD8+ T-cells were analyzed for target cells infected with the mutant virus. We further analyzed the existence of T-cells specific for this epitope and its mutant ones and their role in suppression of HIV-1 replication in the subtype A/E-infected HLA-C*15:05+ Vietnamese. Findings: We identified HLA-C*15:05-restricted T-cells specific for the Pol SL9 epitope and found that 3 mutants (Pol S653A/T/L) had escaped from the T-cells. HLA-C*15:05+ individuals infected with these mutants showed significantly lower CD4+ T-cell counts than those with the wild-type virus or Pol S653K/Q mutants, which are not associated with HLA-C*15:05. Interpretation: These findings indicate that the accumulation of Pol S653A/T/L mutants critically and negatively affected control of HIV-1 by SL9-specific T-cells in the subtype A/E-infected individuals having the HLA-C*15:05 detrimental allele. Funding Statement: This research was supported by a grant-in-aid (15fk0410019) for AIDS Research from AMED, a JSPS KAKENHI grant-in-aid for scientific research (A) (grant No. 15H02658), and by a Joint Research Grant with the Institute of Tropical Medicine, Nagasaki University. Declaration of Interests: The authors have no financial conflicts of interest. Ethics Approval Statement: This study was approved by the Ethical Committee of NHTD and Kumamoto University. Informed consent was obtained from all individuals according to the Declaration of Helsinki.

Brief review about the life and contribution of the peruvian parasitologist Cesar Gabriel Naquira Velarde

Scientific institutions and their achievements are built on people and their stories. In this case, Dr. César Náquira Velarde constitutes a prominent figure in Peru's public health, to which he contributed until days before his departure at 85 years of age. Dr. Náquira actively participated in the founding of the Daniel A. Carrión Institute of Tropical Medicine of the National University of San Marcos from where - through re search and teaching - he has trained doctors and specialists in the field of parasitology and tropical medici ne. However, his greatest contribution was in the study of Chagas disease. He also served as a public official and decision maker, as he was head of the National Institute of Health of Peru and permanent technical advisor of the Ministry of Health of Peru, in the areas of his specialty. We highlight his role as a teacher for many generations of doctors and his authority as an expert in the field of medical parasitology.

Early Action, Applied Research & Collaboration to Combat COVID-19: María Guadalupe Guzmán MD PhD DSc.

Virologist Dr María Guadalupe Guzmán is recognized as a global leader in dengue research and heads the Pedro Kourí Tropical Medicine Institute's work as a WHO/PAHO Collaborating Center for the Study of Dengue and Its Vector. The Institute (IPK) was founded in 1937 and is now Cuba's national reference center for the diagnosis, treatment, control and prevention of communicable diseases. Dr Guzmán is also president of the Cuban Society of Microbiology and Parasitology and directs IPK's Scientifi c Council, which is responsible for setting the Institute's research priorities. A recent h-index analysis found that Dr Guzmán is among the most widelypublished and cited Cuban researchers.

An Epidemic of Dengue Virus Serotype-4 during the 2015 - 2017: the Emergence of a Novel Genotype IIa of DENV-4 in the Philippines.

Volume 72 no 6, p.413-419, 2019. Page 418, Acknowledgments "We would like to thank all staff and members of the Department of Virology, NEKKEN, Nagasaki University, Japan for providing technical support and advice. Our special thanks to the staff of the Pavilion II and the Central Laboratory of San Lazaro Hospital for their kind assistance during patient recruitment and data collection. We are also very grateful for the support of the Senior Vice President and Head of Research and Biotechnology (R&B) Group of St. Luke's Medical Center, Dr. Isaac David E. Ampil II. Finally, our sincere thanks to the members of R&B's dengue research group for kindly preparing the samples to be transported to NEKKEN." should read "This research was supported by grants from the Japan Agency for Medical Research and Development (AMED) under Grant Number JP18fm0108001, JP19fm0108001 (Japan Initiative for Global Research Network on Infectious Diseases (J-GRID)), AMED Research on Emerging and Re-emerging Infectious Diseases (19fk0108035j0003) and e-ASIA Joint Research Program and; Philippine Council for Health Research and Development (PCHRD) of the Department of Science and Technology (DOST), Philippines, with partial support from the Research and Biotechnology of St. Luke's Medical Center (R&B-SLMC), Philippines (Project No. 07-024). Funders have no role in the study design, data collection, and interpretation, or the decision to submit this work for publication. We would like to thank all staff and members of the Department of Virology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Japan, for providing technical support and advice. Our special thanks to the staff of the Pavilion II and the Central Laboratory of San Lazaro Hospital for their kind assistance during patient recruitment and data collection. We are also very grateful for the support of the Senior Vice President and Head of Research and Biotechnology (R&B) Group of St. Luke's Medical Center, Dr. Isaac David E. Ampil II. Finally, our sincere thanks to the members of R&B's Dengue Research Group for kindly preparing the samples to be transported to NEKKEN."

Cuba's Pedro Kourí Tropical Medicine Institute:Battling COVID-19 One Study, One Test, One Patient at a Time.

This MEDICC Review roundtable brings you specialists from Havana's Pedro Kourí Tropical Medicine Institute (IPK), who are working directly with testing, research and patient care during the COVID-19 pandemic. Founded in 1937 by its namesake, the Institute has gained considerable worldwide prestige. Today, it is a PAHO-WHO Collaborating Center for the Study of Dengue and Its Vector, and for the Elimination of Tuberculosis. Its main role within Cuba's health system is as the national reference center for prevention, control, management and elimination of infectious diseases, including epidemics. Its 479 workers staff 32 departments, including laboratories, research and teach-ing facilities, a hospital and isolation center. The IPK's hospital treats later-stage AIDS patients, while the Institute is the nation-al reference center for attention to all HIV-positive patients and maintains the national HIV/AIDS registry, as well as registries for other infectious diseases. The institution was responsible for training the Cuban doctors who served in West Africa during the 2014-2016 Ebola outbreaks and for those going abroad to assist in the COVID-19 response today, and its professionals offer an internationally-recognized biennial course on dengue.

Clinical manifestations of primary and secondary dengue in Paraguay and its relation to virus serotype.

Dengue virus (DENV) infection is currently a major cause of morbidity in the world, and its incidence has mainly increased during the last years in Latin America, including Paraguay. The objective of this study was to compare the clinical and laboratory findings of dengue and assess whether the serotype is a risk factor for severity. We included patients ≤ 15 years old hospitalized with dengue at the Institute of Tropical Medicine, from Paraguay, from 2007 to 2018. Patients were classified according to the 2009 WHO dengue classification guidelines and were stratified by serotype into three groups according to the hospitalization period: the 2007 epidemic (DENV-3), the 2012-2013 epidemic (DENV-2) and the 2016-2018 epidemic (DENV-1). Of 784 children hospitalized for dengue, 50 cases (6.3%) were caused by DENV-3, 471 (60%) by DENV-2, and 263 (33.5%) by DENV-1. Myalgias and headache were associated with DENV-3 cases and abdominal pain was associated with DENV-2 cases. Bleeding was observed mainly in DENV-1 and 2 cases. Patients with DENV-2 infections experienced more severe disease, required fluid expansion more frequently, and exhibited more often shock and admission in the ICU. Secondary cases of dengue were more severe that primary cases. Patients with infection by DENV-2 had longer hospital stays (5.1 ± 2.8 days) when compared to DENV-3 o DENV-1 infection cases (2.9 ± 1.6 days and 4.36 ± 2.7 days, respectively) (p < 0.05). The DENV serotype has a profound impact on the clinical manifestations and severity of dengue. DENV-2 infections were associated more frequently to requirement of fluid expansion, shock, and longer hospital stay.

National Reference Laboratory Surge Capacity Response to a Massive Nationwide Measles Outbreak in 2013-2014

This management case documents the experience of the Research Institute for Tropical Medicine (RITM) National Reference Laboratory, when a massive nationwide outbreak of Measles occurred during the last quarter of 2013 to the whole of 2014. This was the largest infectious disease outbreak referred thus far to the Institute, with an unprecedented 40,000 blood specimens from all over the country received by the laboratory, overwhelming its testing capacity, and causing large backlogs. The incident revealed significant gaps in the laboratory’s preparedness to respond to a sudden large surge of specimens. The activation of a department-level Incident Command System was the most appropriate management approach to implement due to the urgency and scale of the surge of specimens. The response to the specimen surge was prioritized leading to temporary rearrangements in the organizational structure of the department in order to effectively and rapidly coordinate the staff and allocate resources.

Daily and event-driven pre-exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence.

IntroductionPre‐Exposure Prophylaxis (PrEP) is highly effective in reducing the risk for HIV infection among men who have sex with men (MSM) and may have an important impact in slowing down the HIV epidemic. Concerns remain however about low adherence, increased risk behaviour and reduced condom use when using PrEP. The aim of this study was to assess these factors prospectively among MSM using daily and event‐driven PrEP in Belgium.MethodsAn open‐label prospective cohort study was conducted from October 2017 to May 2018 at the Institute of Tropical Medicine, in Antwerp, Belgium. At enrolment, MSM at high risk for HIV chose between daily or event‐driven PrEP. They were allowed to switch regimens or stop taking PrEP at each of their tri‐monthly visits. Data were collected on an electronic case report form, web‐based diary and self‐administered questionnaire. Screening for HIV and other Sexually Transmitted Infections (STIs) was also performed.ResultsTwo hundred MSM were followed up for a total duration of 318 person‐years. At month 18, 75.4% of the participants were on daily and 24.6% were on event‐driven PrEP. The mean proportion of covered sex acts by PrEP for the complete follow‐up period was 91.5% for all participants, 96.5% for daily and 67.0% for event‐driven PrEP use. The number of casual and anonymous sex partners was significantly higher for daily users, as compared with event‐driven users, but did not change over time. In contrast, the mean proportion of condomless receptive anal intercourse with casual and anonymous partners increased significantly during follow‐up, for both daily and event‐driven use (p < 0.0001 for all 4 trends). No new HIV infection was diagnosed during follow‐up. The incidence of bacterial STIs was 75.4 per 100 person‐years (95% CI 63.8 to 89.1). We did not detect a significant change in N. gonorrhoeae/C. trachomatis incidence over time. The incidence of hepatitis C was 2.9 per 100 person‐years.ConclusionsPrEP is an effective and well adopted HIV prevention tool for MSM in Belgium. Participants adapted daily and event‐driven regimens to their own needs and were able to adapt their PrEP adherence to risk exposure.

Attitudes on vaccination among Portuguese travelers and Brazilian migrans: A pilot study in Portugal

Introduction: Anti-vaccination movements exist in Europe and it may reduce adherence to international vaccination.Objectives:To evaluate attitudes on vaccination among Portuguese travelers and Brazilian migrants in Portugal.Material and Methods:Between May and June 2019 a cross-sectional survey was carried out in the Travel Clinic of the Institute of Hygiene and Tropical Medicine of Lisbon. A self-administered questionnaire was applied after medical consultation. Travelers were asked about their attitudes to vaccines. An anonymous web-based survey was sent to Brazilian migrants living in Portugal for at least 6 months.Results: 55 Portuguese (P) travelers and 22 Brazilian (B) migrants answered the questionnaire. 47.3% of Portuguese travelers were male; the mean age was 33 years; reason for travel: tourism (43.6%) or business (30.9%). 31.8% of Brazilian migrants were male and the mean age was 44 years; 71.4% were living in Portugal for ≤ 2 years. Attitudes towards vaccines: 64.8% P and 68.2% B prefer to vaccine even when the risk of acquire a disease is low; 64.1% P and 95.5% B consider that the resistance acquired by disease is better than resistance acquired by vaccine; 75.5% P and 77.3% B prefer to vaccine even when diseases are not severe; 5.6% P and 13.6% B don’t take vaccines because they are afraid of side effects.About the reasons to accept a vaccine, travelers/migrants consider very important to trust in the doctor (100% P, 95.4% B), and the excellent protective effect of a vaccine (98.1% P, 90.9% B).Conclusions: Portuguese travelers and Brazilian migrants in Portugal seem to have a favorable attitude towards vaccination, despite the anti-vaccination movements in Europe. They believe that trust in the doctor and excellent protection of the vaccines are reasons to accept it. The quality of traveler's advice may maintain/increase adherence to vaccination.

Time of administration of rabies immunoglobulins and adequacy of antibody response upon post-exposure prophylaxis: a descriptive retrospective study in Belgium

ABSTRACT Background: Data on rabies post-exposure prophylaxis (PEP) and the use of human rabies immunoglobulins (HRIG) in Belgium are scarce. The main objective of this study was to evaluate the timely administration of HRIG after rabies exposure. The secondary objective was to evaluate the adequate antibody response following PEP. Methods: We reviewed all medical records from July 2017 to June 2018 of patients seeking care at, or referred to, the Institute of Tropical Medicine and the University Hospital, Antwerp for the administration of human rabies immunoglobulins following potential rabies exposure abroad or in Belgium. A timely response was defined as starting HRIG with a delay of ≤48 h and rabies vaccination in the first 7 days after exposure. Adequate antibody response was defined as a titer of >5.0 IU/mL in case of bat-related exposure and >3.0 IU/mL in case of exposure to other animals. Titers were measured 10 days after the last PEP vaccine dose, using the rapid fluorescent focus inhibition test (RFFIT). Results: Of the 92 cases treated with HRIG, 75 were evaluated. The majority of injuries were acquired in Asia (n = 26,34%) and in Western Europe (n = 18, 24%), of which 17 in Belgium. The five most frequently recorded countries overseas were Indonesia (n = 13), Thailand (n = 7), Morocco (n = 4), Peru (n = 3) and Costa Rica (n = 3). Administration of immunoglobulins was related to injuries by dogs (36%), monkeys (25%) or bats (22%). A timely response was observed in 16 (21,33%) and in 55 (73,33%) of subjects receiving HRIG (≤48 h) or rabies vaccine (<7days) respectively. The mean time between exposure and the first administered dose of rabies vaccine and HRIG was 7.7 and 8.7 days, respectively. The mean delay for HRIG administration was 9.6 days and 6 days for abroad and inland risks, respectively. In 15 of 16 (94%) bat-related cases the antibody titer after full PEP was >5.0 IU/ml. In 38 of 47 (81%) cases related to other animals the RFFIT titer was >3.0 IU/ml. All low-responders received additional rabies injections. Conclusion: This study showed a substantial time delay between the animal-related risk and the administration of HRIG, in particular when the injury occurred abroad. More targeted communication about the risks of rabies and preventable measures may reduce this delay. Furthermore, the antibody response was inadequate in some cases following full PEP administration according to the Belgian recommendation.

A34 Molecular characterization of Zika virus in Cuba

Until now, three genotypes of Zika virus (ZIKV) have been detected (two African lineages and one Asian lineage). After the declaration of Public Health Emergency of International Concern issued by The Pan American Health Organization and the World Health Organization authors from some Latin American countries have identified the Asian genotype as the lineage responsible for the Zika epidemic in the western hemisphere. However, data from the Caribbean are sparse, and there is no published data regarding the genotypes that produced isolated outbreaks in Cuba. Aiming to realize the molecular characterization of ZIKV in Cuba, we will sequence by next-generation sequencing the full genome of the ZIKV identified in samples from Cuban patients of different provinces in which ZIKV produced outbreaks. All samples required for this study have been collected during the molecular surveillance of Arboviral diseases conducted at the National Reference Laboratory at Pedro Kourí Tropical Medicine Institute. Viral RNA will be purified from urine and serum samples collected from patients with confirmed ZIKV infection by real time PCR. Using evolutionary dynamics studies, we will map the spread of a virus or of particular variants in time and space in order to understand how frequently ZIKV has been introduced into Cuba. Moreover, we will evaluate the amino acid diversity of each ZIKV proteins. Further, we will evaluate the population dynamics of ZIKV in samples from patients with varying clinical outcomes. The results will allow us to characterize the ZIKV genome and its evolution into the Cuban population that would also have impact for vaccine development, diagnosis, and pathogenesis studies.

Passive Screening and Diagnosis of Sleeping Sickness with New Tools in Primary Health Services: An Operational Research.

IntroductionThe integration of human African trypanosomiasis (HAT) activities into primary health services is gaining importance as a result of the decreasing incidence of HAT and the ongoing developments of new screening and diagnostic tools. In the Democratic Republic of Congo, this integration process faces multiple challenges. We initiated an operational research project to document drivers and bottlenecks of the process.MethodsThree health districts piloted the integration of HAT screening and diagnosis into primary health services. We analysed the outcome indicators of this intervention and conducted in-depth interviews with health care providers, seropositives, community health workers and HD management team members. Our thematic interview guide focused on factors facilitating and impeding the integration of HAT screening.ResultsThe study showed a HAT-RDT-positive rate of 2.2% in Yasa Bonga, 2.9% in Kongolo and 3% in Bibanga, while the proportion of reported seropositives that received confirmatory examinations was 76%, 45.6% and 68%, respectively. Qualitative analyses indicated that some seropositives were unable to access the confirmation facility. The main reasons that were given included distance, RDT rupture, lack of basic screening equipment and financial barriers (additional hospital fees not included in free treatment course), fear of lumbar puncture and the perception of HAT as a disease of supernatural origin.ConclusionPassive screening using HAT RDTs in primary health services inevitably has some limitations. However, regarding the epidemiological context and some obstacles to integrated implementation, this cannot on its own be a relevant alternative to the elimination of HAT by 2020.FundingWe acknowledge the agency that provided financial support for this study, the Belgian Development Cooperation. The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Philippe Mulenga received financial support thanks to a doctoral grant from the Belgian Development Cooperation under the FA4 agreement. Funding for the study and Rapid Service Fees was provided by the Epidemiology and Tropical Diseases Unit of the Institute of Tropical Medicine, Antwerp.

80 Years of the Medicine and Tropical Hygiene Center in Gdynia (1937-2017): The Pioneer Pre-War Years 1937-1939.

The present Interdepartmental Institute of Maritime and Tropical Medicine in Gdynia of the Medical University of Gdańsk was formally established in 1939 by the Order of June 5, 1939, of the Minister of Social Welfare, Marian Zyndram-Kościałkowski. However, the Branch of the National Institute of Hygiene in Gdynia was founded 2 years earlier, in 1937 (the first head was Dr. Med. Jerzy Jakóbkiewicz [1892–1953]), and its fruitful activity was ennobled 2 years later by increasing its rank and adding the name “Marine and Tropical Hygiene Institute”. These facts are very little known, and therefore worth presenting in the jubilee years of the 80th anniversary of the institution.

Low adherence with national travel medicine recommendations in Belgian expatriate children: A retrospective analysis.

Expatriates (expats) from European countries regularly migrate to low-income countries where infectious diseases are more prevalent. Little evidence exists however on pediatric expatriates' compliance with preventive measures related to infectious diseases. This study aims to evaluate compliance in Belgian expat-children. Data of 135 Belgian expat-children, visiting the Institute of Tropical Medicine (Antwerp, Belgium), were collected from clinical notes, laboratory results and from a web-based immunization-register. Information on routine vaccinations, yellow fever, hepatitis A, rabies, typhoid fever, meningococcal ACW135Y, Japanese encephalitis, BCG vaccine and anti-malaria chemoprophylaxis was collected. Overall, 87% of expat-children were up-to-date with their routine vaccinations. Although all children were eligible for hepatitis A, typhoid and rabies vaccination, only 8-21% were fully vaccinated. Only 29 and 61% of eligible children were vaccinated against meningococcal (ACW135Y) or yellow fever respectively. Finally, only 10% of children who lived in malaria-endemic-areas, reported chemoprophylaxis-use. Although routine vaccination coverage in expat-children seems adequate, additional preventive measures are often needed. Whether this is due to lack of high-quality health care-access, fear of side-effects or insufficient knowledge about the risks/available preventive measures, remains elusive. Nevertheless, expats seem to constitute a separate risk-group for infectious diseases and destination-related health issues.

Ivermectin for Causal Malaria Prophylaxis: A Randomized Controlled Human Infection Trial

Background: Ivermectin is safe and widely used for treating helminth infections. It also kills arthropods feeding on treated subjects, including malaria vectors. Thus, ivermectin mass drug administration as an additional tool for malaria control is being evaluated by the World Health Organization: As in vitro data, animal experiments and epidemiological observations suggest that ivermectin has a direct effect on the liver stages of the malaria parasite, this study was designed to assess the prophylactic effect of ivermectin on Plasmodium falciparum controlled human malaria infection. Methods: 4 volunteers were randomized to placebo, and 8 volunteers were randomized to receive ivermectin 0,4 mg/kg, orally, once 2 hours before being experimentally infected intravenously with 3200 P. falciparum sporozoites. The primary endpoint was time to parasitaemia detected by positive thick blood smear; RT-qPCR was performed in parallel. Results: All but one volunteers became thick blood smear positive between day 11 and day 12 after infection and there was no significant effect of ivermectin on parasitaemia. Conclusions: Ivermectin - at the dose used - has no clinically relevant activity against the preerythrocytic stages of P. falciparum. Clinical Trial Registration Number: The study was registered with the European Clinical Trials Register (EudraCT-Nr. 2017-002723-16). Funding Statement: This study was carried out at the clinical trial platform at the Institute of Tropical Medicine at the University of Tubingen, Germany, and was partly funded by the Else Kroner-Fresenius-Stiftung/Bad Homburg, Germany. Declaration of Interests: Dr. Metzger has nothing to disclose. All other authors have nothing to disclose. Ethics Approval Statement: The study complied with the International Council for Harmonisation Good Clinical Practice guidelines and the German Medicines Law and was approved by the ethics committee of the Eberhard Karls Universitat and the Universitatsklinikum Tubingen and the competent regulatory authority Bundesinstitut fur Arzneimittel und Medizinprodukte and the Regierungsprasidium Tubingen. A Safety Monitoring Committee reviewed the study to evaluate the safety of individual volunteers.