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      Development of sustainable research excellence with a global perspective on infectious diseases: Centre de Recherches Médicales de Lambaréné (CERMEL), Gabon

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          Summary

          Medical research in sub-Saharan Africa is of high priority for societies to respond adequately to local health needs. Often enough it remains a challenge to build up capacity in infrastructure and human resources to highest international standards and to sustain this over mid-term to long-term periods due to difficulties in obtaining long-term institutional core funding, attracting highly qualified scientists for medical research and coping with ever changing structural and political environments. The Centre de Recherches Médicales de Lambaréné (CERMEL) serves as model for how to overcome such challenges and to continuously increase its impact on medical care in Central Africa and beyond. Starting off as a research annex to the Albert Schweitzer Hospital in Lambaréné, Gabon, it has since then expanded its activities to academic and regulatory clinical trials for drugs, vaccines and diagnostics in the field of malaria, tuberculosis, and a wide range of poverty related and neglected tropical infectious diseases. Advancing bioethics in medical research in Africa and steadily improving its global networks and infrastructures, CERMEL serves as a reference centre for several international consortia. In close collaboration with national authorities, CERMEL has become one of the main training hubs for medical research in Central Africa. It is hoped that CERMEL and its leitmotiv “to improve medical care for local populations” will serve as an inspiration to other institutions in sub-Saharan Africa to further increase African capacity to advance medicine.

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          Most cited references98

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          Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial.

          (2015)
          The efficacy and safety of the RTS,S/AS01 candidate malaria vaccine during 18 months of follow-up have been published previously. Herein, we report the final results from the same trial, including the efficacy of a booster dose.
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            Decreased atopy in children infected with Schistosoma haematobium: a role for parasite-induced interleukin-10.

            Most of the effort directed at understanding the role infections have in preventing allergy has focused on bacteria and viruses and their ability to divert the immune system towards T-helper-1 responses and away from proallergic T-helper-2 responses. However, helminth infections, highly prevalent in large parts of the developing world, where allergy is uncommon, stimulate strong T-helper-2 responses. We investigated the influence of chronic helminth infections on the prevalence of atopy and aimed to understand the relation at a detailed immunological level. 520 Gabonese schoolchildren were tested for skin reaction to house-dust mite and other allergens, for Schistosoma haematobium eggs in urine, and for microfilariae in blood samples. Total and mite-specific IgE antibodies were measured. A subsample selected on the basis of their skin test to house-dust mite received detailed immunological investigations. Children with urinary schistosomiasis had a lower prevalence of a positive skin reaction to house-dust mite than those free of this infection (odds ratio 0.32 [95% CI 0.16-0.63]). The degree of sensitisation to house-dust mite could not explain this difference in skin-prick positivity. Schistosome-antigen-specific concentrations of interleukin-10 were significantly higher in infected children, and higher specific concentrations of this anti-inflammatory cytokine were negatively associated with the outcome of skin-test reactivity to mite (0.53 [0.30-0.96]). No association between polyclonal IgE antibodies and skin-test results was found. The anti-inflammatory cytokine, interleukin-10, induced in chronic schistosomiasis, appears central to suppressing atopy in African children.
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              Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials.

              Intermittent preventive treatment (IPT) is a promising strategy for malaria control in infants. We undertook a pooled analysis of the safety and efficacy of IPT in infants (IPTi) with sulfadoxine-pyrimethamine in Africa. We pooled data from six double-blind, randomised, placebo-controlled trials (undertaken one each in Tanzania, Mozambique, and Gabon, and three in Ghana) that assessed the efficacy of IPTi with sulfadoxine-pyrimethamine. In all trials, IPTi or placebo was given to infants at the time of routine vaccinations delivered by WHO's Expanded Program on Immunization. Data from the trials for incidence of clinical malaria, risk of anaemia (packed-cell volume <25% or haemoglobin <80 g/L), and incidence of hospital admissions and adverse events in infants up to 12 months of age were reanalysed by use of standard outcome definitions and time periods. Analysis was by modified intention to treat, including all infants who received at least one dose of IPTi or placebo. The six trials provided data for 7930 infants (IPTi, n=3958; placebo, n=3972). IPTi had a protective efficacy of 30.3% (95% CI 19.8-39.4, p<0.0001) against clinical malaria, 21.3% (8.2-32.5, p=0.002) against the risk of anaemia, 38.1% (12.5-56.2, p=0.007) against hospital admissions associated with malaria parasitaemia, and 22.9% (10.0-34.0, p=0.001) against all-cause hospital admissions. There were 56 deaths in the IPTi group compared with 53 in the placebo group (rate ratio 1.05, 95% CI 0.72-1.54, p=0.79). One death, judged as possibly related to IPTi because it occurred 19 days after a treatment dose, was subsequently attributed to probable sepsis. Four of 676 non-fatal hospital admissions in the IPTi group were deemed related to study treatment compared with five of 860 in the placebo group. None of three serious dermatological adverse events in the IPTi group were judged related to study treatment compared with one of 13 in the placebo group. IPTi with sulfadoxine-pyrimethamine was safe and efficacious across a range of malaria transmission settings, suggesting that this intervention is a useful contribution to malaria control. Bill & Melinda Gates Foundation.
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                Author and article information

                Contributors
                ramharter@bnitm.de
                Journal
                Wien Klin Wochenschr
                Wien Klin Wochenschr
                Wiener Klinische Wochenschrift
                Springer Vienna (Vienna )
                0043-5325
                1613-7671
                4 January 2021
                4 January 2021
                : 1-9
                Affiliations
                [1 ]GRID grid.424065.1, ISNI 0000 0001 0701 3136, Department of Tropical Medicine, , Bernhard Nocht Institute for Tropical Medicine & I. Dep. of Medicine University Medical Center Hamburg-Eppendorf, ; Hamburg, Germany
                [2 ]Centre de Recherches Médicale de Lambaréné, Lambaréné, Gabon
                [3 ]GRID grid.452463.2, German Center for Infection Research, ; Hamburg-Lübeck-Borstel-Riems, Germany
                [4 ]GRID grid.10392.39, ISNI 0000 0001 2190 1447, Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Clinics, , Eberhard Karls University Tübingen, ; Tübingen, Germany
                [5 ]GRID grid.452463.2, German Center for Infection Research, ; Tübingen, Germany
                [6 ]GRID grid.10419.3d, ISNI 0000000089452978, Department of Parasitology, , Leiden University Medical Center, ; Leiden, The Netherlands
                [7 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Medical University of Vienna, ; Vienna, Austria
                [8 ]Faculty of Medicine, University of Libreville, Libreville, Gabon
                [9 ]GRID grid.7177.6, ISNI 0000000084992262, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, , University of Amsterdam, ; Amsterdam, The Netherlands
                [10 ]GRID grid.16149.3b, ISNI 0000 0004 0551 4246, Institut für Medizinische Mikrobiologie, , Universitätsklinikum Münster, ; Münster, Germany
                Author information
                http://orcid.org/0000-0002-9259-1885
                Article
                1794
                10.1007/s00508-020-01794-8
                7781170
                33398458
                6e54db56-3e68-4159-a11f-233e73fecda3
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 20 October 2020
                : 30 November 2020
                Funding
                Funded by: Bernhard-Nocht-Institut für Tropenmedizin (3424)
                Categories
                Review Article

                Medicine
                medical research,sub-saharan africa,gabon,capacity development,neglected tropical diseases

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