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Monitoring for viruses, fungi and bacteria can prevent future pandemics

Publicado em 27 setembro 2021

To prevent further disease outbreaks or predict future epidemics, the Covid-19 pandemic shed light on the importance of so-called sentinel systems, ie constant monitoring of disease agents such as fungi, bacteria and viruses – including SARS-CoV-2 – that do not yet have effective treatments and can spread. “It is very important to have sentinel systems that allow a pandemic, at the beginning of its outbreak, to be quickly detected and fought. But all of this requires interaction, cooperation, which are not always natural”, said Luiz Eugênio Mello, FAPESP’s scientific director, during the opening of the 4th FAPESP 60 Years Conference, held on Wednesday, 22.

Under the theme “Challenges to Global Health”, the event alerted to the fact that, historically, it is not only viruses that cause pandemics, but also bacteria. “Since the 1960s, few new antibiotics have been discovered and today there is a group of bacteria known for their great ability to escape existing treatments,” warned Andrea Dessen, a researcher at the Center National de la Recherche Scientifique (CNRS) in France. “The United Nations estimates that today there are 700,000 dead a year due to antibiotic resistance, but if we don’t do anything, in 2050 it will be 10 million a year,” added the researcher, who coordinates a project supported by FAPESP at National Center for Research in Energy and Materials (CNPEM), under the São Paulo Excellence Chair Program (SPEC).

The researcher also recalled that there are six reasons indicated by the World Health Organization (WHO) for antibiotic resistance: over-prescription, unfinished treatments, excessive use in livestock (which consumes 80% of the world’s volume of these drugs), insufficient control of infections in hospital environments, lack of hygiene and sanitation and lack of antibiotics on the market.

One of the institutions that carry out this sentinel work is the Joint Brazil-UK Center for Arbovirus Discovery, Diagnosis, Genomics and Epidemiology (CADDE), created to monitor new arboviruses – pathogens transmitted by arthropods. But the urgency of Covid-19 increased this scope and the project also started to involve the monitoring of blood banks to verify the presence of viruses and, in the case of SARS-CoV-2, population antibody rates and sequencing of the virus isolated from people who sought health services. The objective was to verify the occurrence of certain variants, such as Delta, which is highly contagious.

“We expected a dengue epidemic last year and it didn’t come. Dengue is perhaps a mobility-sensitive disease. We observed a drop in cases when mobility dropped due to [das restrições impostas para conter] to Covid-19. But this year the most worrying thing is chikungunya, which may come when the movement of people returns”, said Ester Sabino, professor at the Faculty of Medicine of the University of São Paulo (FM-USP), researcher at the Institute of Tropical Medicine (IMT- USP) and coordinator of CADDE. “We need the SUS [Sistema Único de Saúde], universities and public authorities understanding what is being said in order to better define policies. And this has to be done before epidemics happen so that we can do something in time to improve our response”, he added.

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Fungi are also a big problem to watch out for. According to Arnaldo Colombo, Professor at EPM-Unifesp, the impact of fungal infections is a silent crisis in biodiversity, food security and human health. “It is essential to discuss economic models that are more compatible with planetary health, such as sustainable development. We are late in containing the global warming, which has led pathogens to acclimate to a temperature of 37º C and, therefore, infect us”, pointed out the researcher.

Agricultural activity, for example, is one of the main causes since field workers have direct contact with the soil, where numerous species of fungi live, relevant agents for these diseases, but little diagnosed. An estimate shown by the researcher showed that 1.2 million people with fungal pneumonia are treated as tuberculosis. Even so, fungal pathogens are little known and even ignored by doctors. A survey carried out in 129 medical centers in Latin America indicated that only 9% of them have diagnostic training for fungal infections. “There is a need to invest in global health centers that work on the concept of unique health to understand the natural history of the pathogen before it reaches humans,” said Colombo.

Not to mention those that threaten wild species such as amphibians and represent 30% of agents that emerge as pathogens in plants, including grains, being capable of compromising about 20% of what is harvested in different regions of the world. Colombo defends that fungicides can be replaced by other pest control strategies, in order to avoid the appearance of resistant fungi. According to the researcher, investment in the development of diagnostic platforms, in addition to drugs, is essential. “We need to learn to manipulate the human microbiome more effectively in order to contain dysbiosis [morte de microrganismos, muitas vezes benéficos, que vivem no corpo humano] induced by the use of antibiotics and, without a doubt, there is room to improve programs for the rational use of antimicrobials in the hospital environment and in the community”, he concluded.


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