GSK_TACKLING_INFECTIOUS_DISEASES Tackling Infectious Diseases Across Prevention and Treatment: Highlights from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global Congress 2024

Open Meeting Summary

Why Your Influence Counts:Shaping Adult Vaccination Policies & Recommendations

Adult Vaccination Policies and Recommendations in Europe

Supranational Approach to Guidance and Recommendations for Vaccination in Europe

Optimising Immunisation Programmes for Healthy Longevity

The Role of Medical Societies in Vaccination Recommendations at National & European Levels

The Role and Importance of Surveillance

Healthcare Professional Involvement in the Development of Hospital Vaccination Guidelines

Adult Vaccination Policies and Recommendations in Europe

Conclusion

The highlights from ESCMID Global 2024 indicate that tackling infectious diseases across prevention and treatment is a robust approach to rewrite the infectious diseases narrative and to ‘overcome their burden’.

GSK Code: NX-GBL-HZU-WCNT-240002 - Date of Preparation: October 2024

References

Life-course immunisation extends the benefits of vaccination against infectious diseases from childhood throughout the entire lifespan.1 Vaccination beyond childhood is associated with substantial benefits at the individual, community, and socioeconomic levels.2 Adult vaccination policies are evolving slowly in Europe, with a few countries, such as Italy,3 having life-course immunisation programmes. However, this strategy is not well implemented in most European countries. See figure 1: Overlay

Half of participants were confident to answer questions about vaccines

However, the same proportion had received questions about vaccination in the last 3 months that they could not answer.30

One in five HCPs considered that they had acquired sufficient knowledge about vaccinations during their medical education and training, with most participants willing to follow extra courses to fill the knowledge gap.30

Survey ResultsA survey29 conducted in Europe of 3,298 healthcare professionals (HCP)30 showed that:

These data highlight the lack of HCP confidence in communicating about vaccinations, and the need for more comprehensive information on immunisation in medical education.

Click numbers to reveal the policies & recommendations

Childhood immunisation programmes are well-established throughout Europe;4 however, there are gaps in vaccination coverage in adult and elderly populations.5 Reasons for these gaps include limited access to these populations and lack of consistency in recommendations for vaccination (such as for herpes zoster),5 both within and between countries across the continent.1

National Immunisation Technical Advisory Groups (NITAG) are composed of national experts from different disciplines who provide evidence-based recommendations to policy makers and immunisation programme managers.6 Almost all Member States of the European Region have NITAGs in place, some of which have been active for more than 20 years, with others established for less than 10 years.6

Vaccination recommendations from NITAGs vary across Europe, with only some advisory groups taking into account economic evaluations. Furthermore, decentralised, or subnational, implementation of immunisation strategies creates complexity in many countries in the region. There is a clear lack of harmonisation surrounding immunisation in Europe.5

A pilot project organised by the European Centre for Disease Prevention and Control (ECDC) brings together NITAGs from different European countries with the aim of encouraging interaction and discussions between the advisory groups and driving standardisation of immunisation recommendations across Europe.11

This collaborative approach is likely to reduce duplication of work, such as literature reviews and creation of evidence-based recommendations, and provides a platform where countries can learn from each other about different methods of implementation.

Although all European countries have recommendations for adult immunisation, these recommendations vary within countries and between countries,5 and vaccination acceptance and coverage rates are low in adult populations.12,13 National immunisation programmes are needed to ensure that these recommendations are being implemented.

The expert panel proposed that a further goal to help improve adult vaccination strategies is better coordination between the Centers for Disease Control and Prevention (CDC) in the USA and the ECDC, which often diverge on vaccination recommendations

The expert panel considered that vaccination guidance and recommendations at a supranational level are potentially useful in Europe, but it is important to keep the national rights and mandates within each country to ensure that each country’s health authorities have the power to decide on vaccination schedules for their own country.

Audience poll results showed that 80% of the symposium audience considered that there is a need for supranational organisations in Europe focused on vaccination for adults.

In Europe, there are opportunities for countries to learn from each other about different immunisation programmes and vaccination policies.

Sharing evidence at a supranational level and tapping into the diversity surrounding vaccination recommendations across Europe would provide an opportunity to evaluate disease burden and the effect of vaccination across the continent, and may lead to implementation of more successful immunisation strategies in countries with low coverage rates. Streamlining the costly cohort studies and surveillance required to establish disease burden as well as vaccine efficacy and cost-effectiveness across Europe not only reduces research expense but will also accelerate progress towards widespread effective vaccination strategies and standardisation of European Union (EU) policy.

Adult Vaccination Policies and Recommendations in Europe

A supranational-level platform for the open and transparent exchange of information regarding adult immunisation programmes and vaccination policies would provide substantial real-world data on different vaccination schedules and co-administrations.

Finally, lack of harmonisation in adult vaccination recommendations across Europe, such as differences in starting age for vaccination in older adults, can lead to vaccine hesitancy.

Standardisation of vaccination recommendations among neighbouring countries, or at least explaining to patients why there are differences in recommendations between countries, might potentially reduce vaccine hesitancy.

Supranational Approach to Guidance and Recommendations for Vaccination in Europe

However, recommendations and reimbursement pathways for this intervention differ across Europe.

An example strategy that can contribute to healthy longevity in the ageing population is vaccination against HZ, a common condition in older adults that is characterised by unilateral, self-limited, dermatomal rash and debilitating pain.19

The AIB provides evidence-based guidance on key technical and strategic issues, shares information on adult immunisation with a broad array of stakeholders, and monitors the progress of adult immunisation programmes at regional, national, and European levels.

The objective of the AIB is to increase vaccination coverage in adults and the elderly throughout Europe through knowledge sharing and lessons learned, thereby helping to reduce the impact of vaccine-preventable infections and diseases, and contributing to healthy longevity in this growing population.16-18

By 2050, at least one in four citizens in Europe will be aged over 65 years,14,15 which has implications for population health as older populations are hard to access for vaccination, leaving them susceptible to infectious diseases.

In this context, the Adult Immunisation Board (AIB),16-18 a multidisciplinary board of European experts, was created to increase discussion of disease prevention programmes in adults and the elderly in Europe, and to establish a platform to provide guidelines for the implementation and optimisation of adult immunisation across the continent.16

Target audiences for the AIB include key opinion leaders, policy makers, researchers, public health experts, and healthcare professionals.16-18

Optimising Immunisation Programmes for Healthy Longevity

Also important is the involvement of patient organisations in vaccination recommendations through attendance at European scientific meetings and the AIB, as these organisations will have a key role in the dissemination of vaccination-related messages to patients.

These societies also support community engagement by providing education and training, and keeping their members up to date with current practices, thereby facilitating the implementation of recommendations.

The expert panel agreed with this opinion, indicating that medical societies amplify NITAG and European recommendations to their target audience, and have more ownership if they are involved in processes such as drafting recommendations.

The majority (76%) of the symposium audience considered that medical societies have a role in vaccination recommendations at both the national and European level.

In Denmark, several medical societies participate in the National Vaccination Council and provide valuable input into the development of national guidelines for pathogen testing. Such guidelines have been developed by medical societies for influenza, but not currently for RSV. Medical societies also have a key role in assessing the impact of vaccines and monitoring their effectiveness.

An example of the involvement of medical societies in vaccination recommendations is found in Germany. Shortly after two RSV vaccines were licenced in 2023, the German Society for Haematology and Medical Oncology (DGHO), along with the German Respiratory Society, recommended the use of these vaccines in specific populations, prior to any official recommendation from the national authority.20

• For example, the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI) collaborates with other scientific societies to publish guidelines to help improve adult and elderly vaccination coverage.21-23 • Similarly, in the USA, national, state, and local medical, scientific, and infectious diseases societies participate in discussions about vaccine policy recommendations.24

The importance of collaborating with scientific societies to deliver scientifically sound, simple, and consistent messaging about vaccination has been recognised in some countries.

The Role of Medical Societies in Vaccination Recommendations at National & European Levels

• For example, surveillance data from Germany showed that there were over 12,000 hospital admissions due to RSV infection in adults from November 2022–June 2023, with adults aged at least 60 years making up over 80% of RSV cases in intensive care units.26 The experts highlighted that such data should trigger action, which in this case would ideally be the introduction of preventive vaccination strategies.

The expert panel advocated that surveillance data should lead to change, where indicated.

The expert panel indicated that although Europe is ahead with many initiatives, the surveillance systems currently in place across the continent are far from ideal.

Robust surveillance strategies are vital to provide valid and harmonised data on disease burden before and after the introduction of vaccination programmes, to confirm the need for the vaccines for specific populations, to shape implementation strategies, and to evaluate the effectiveness of vaccination programmes.25

The Role and Importance of Surveillance

Effective communication about a vaccine starts with discussion of the nature, severity, and individual and societal burden of the relevant infectious disease. Providing this information sets the scene for more compelling and effective discussions about preventive interventions.

Data such as these are important for informing policy makers and healthcare providers about the burden of disease, and to support decision making and enable prioritisation of preventive interventions based on disease burden.27

When these data are lacking, the burden of disease in adults might be underestimated,27 and vaccination may be limited to at-risk groups rather than being offered to the entire adult and elderly population.

Comprehensive surveillance data are essential to show the true burden of disease in adult and elderly populations.27

• An algorithm was developed in Italy for implementation of adult vaccination recommendations, including delivery of vaccination at local level, and two options for delivery in hospital (Giovanni Gabutti, personal data).

Hospital vaccination is further complicated by the varying rules and regulations in different hospitals.

• Establishing routine vaccinations in hospitals would increase access for adult and elderly patients, which may improve coverage rates in this population; however, this would create competition between private and public healthcare systems, with hospitals potentially channelling revenue away from general practitioners.

In Germany, vaccinations are typically administered by general practitioners rather than in hospitals28 (except during the COVID-19 pandemic), due to a lack of trained staff and funding.

A total of 76% of the audience considered it very, or quite, challenging to be involved in the development of hospital vaccination guidelines.

The current lack of reimbursement for vaccinations in hospitals in Europe should also be addressed as part of the substantial change required to implement vaccinations in hospitals.

Approaches to intra-hospital vaccination included administration of vaccines by specialists within their own department or operative unit, or development of a dedicated vaccination centre within the hospital. In these intra-hospital schemes, issues such as training, vaccine supply, and vaccination registry need to be resolved, and systems put in place to enable successful implementation.

Healthcare Professional Involvement in the Development of Hospital Vaccination Guidelines

Shining a spotlight on infectious diseases

Schrödinger’s Cat - Rewriting the Infectious Disease Narrative

A Spotlight on Shingles

Burden of Respiratory Syncytial Virus in Adults

Embracing Schrödinger’s Cat in the Rewriting of the Infectious Diseases Narrative

Emerging infectious disease events around the world over the past 25 years have become increasingly frequent, larger, and more disruptive.97,98 In addition, a vast demographic shift is occurring towards substantially larger older populations, with their associated higher risk of infectious diseases and increased comorbidity.99 Furthermore, AMR is a serious and continuous threat to global health and the world economy.100

In the context of the infectious diseases narrative, the metaphorical box contains known threats, including AMR, and potential threats, such as emerging infectious diseases. It is essential to open the box and initiate discussions on these topics to understand the threats and to learn how to prepare for the future.96

Schrödinger’s cat is a quantum thought experiment about a box in which there is a cat, a radioactive atom, and a vial of poison.95 The combination of the radioactive atom and the poison could kill the cat. It is not known whether the cat is alive; therefore, it may be considered to be simultaneously both ‘dead and alive’. Only by opening the box can the status of the cat be confirmed.

AMR and infectious disease threats are a problem for the whole of society.106 To get ahead of these threats requires empowering and encouraging collaboration between diverse audiences, including healthcare consumers, healthcare providers, pharmaceutical and life sciences companies, and the general public.

Moreover, in developing countries specifically, there is a shortage of drugs (with poor-quality generic drugs), as well as a lack of proper infection control in hospitals, little attention to antibiotic use in agriculture and animal feeds, and physicians who are unwilling to change habits.102 However, technology is driving AMS through rapid diagnostics, machine learning, electronic medical records, vaccination, clinical decision support systems, and telemedicine.103-105

Perceived barriers to AMS implementation include a lack of infectious diseases and microbiological services, enforcement, willingness to change, high-level transient staff, senior clinical support, processes for post-prescription review, training and education, leadership, pharmacy resources, and financial support.102

Addressing AMR requires collaboration and preparedness on a local, national, and global scale. This preparedness necessitates a range of tools such as vaccines, as well as machine learning and AI to supplement human capabilities. AMR control strategies include antimicrobial stewardship (AMS); perception, awareness, and educational campaigns; diagnostic and laboratory surveillance; and vaccinations.101

Complications of HZ include postherpetic neuralgia, a chronic, often debilitating pain condition, and eye involvement, which can lead to loss of vision.107

HZ occurs most frequently in older adults and immunocompromised individuals,107 with immunosuppression known to increase the incidence of HZ complications and disease severity.108

HZ is a localised, painful, cutaneous eruption caused by the reactivation of latent varicella zoster virus (VZV) decades after initial VZV infection is established.107

A Spotlight on Shingles

RSV is an important respiratory infection in adults, but is under-researched in this population.109

Rethinking the Burden of Respiratory Syncytial Virus in Adults

Risk factors for RSV-related complications include advanced age, chemotherapy, underlying conditions (e.g., acute respiratory failure, congestive heart failure, chronic obstructive pulmonary disease [COPD], diabetes), disability, and stem cell transplant.112 Patients with a previous diagnosis of RSV-related complications are more likely to have an RSV-related complication.112 Underlying conditions are common in patients hospitalised for RSV, but the prevalence of underlying conditions in these populations differs between countries.113,114

Lower respiratory tract infections were the fourth highest cause of death globally in 2019, with approximately 2.6 million deaths, behind ischaemic heart disease, stroke, and COPD (approximately 9, 6.2, and 3.2 million deaths, respectively).115

In the 28 current and former member states of the EU (EU-28), there were an estimated 158,229 hospitalisations per annum in adults (pre-COVID-19), with 92% occurring in adults aged over 65 years.110 However, PCR testing may lead to under-detection of RSV in adults.111

RSV affects people of all ages, with symptoms ranging from mild upper respiratory tract involvement, such as cold-like symptoms, to more severe conditions. RSV bronchiolitis and post-bronchiolitic wheeze are more common in infants and toddlers, while exacerbations of chronic conditions predominantly affect older children and adults. In older adults, RSV often presents as a more insidious respiratory illness. Infection or reinfection can lead to a wide spectrum of respiratory issues across all age groups.116

Rethinking the Burden of Respiratory Syncytial Virus in Adults

Global disease burden of RSV-associated acute respiratory infection (RSV-ARI) in adults aged ≥65 years is substantial.118 In 2015 in this population, there were an estimated 1.5 million episodes of RSV-ARI in industrialised countries, of which approximately 14.5% resulted in hospitalisation. In addition, there were approximately 14,000 in-hospital deaths globally.118

In a US prospective observational study, RSV was identified in approximately 10% of all evaluated cases of respiratory disease in patients hospitalised with acute cardiopulmonary conditions (102/1,388).117 In the hospitalised cohort, RSV infection and influenza A resulted in similar lengths of stay, rates of use of intensive care, and mortality.117

A retrospective cohort study in Ontario, Canada showed that older adults make up a disproportionate number of RSV-attributed deaths.119 Only 22% of RSV-attributed hospitalisations were in the ≥65-years population, yet 85% of RSV-related deaths were in this age group.119 Overall, around one in nine of those hospitalised in the ≥65-years age group died (30-day all-cause mortality) compared with one in 1,000 in the <5-years age group.119

Uncomplicated Urinary Tract Infections Across a Lifetime

Incidence, Risk Factors, & Symptoms

Diagnosis

Treatment

Impact

Incidence & recurrence

Challenges

Improvements

• Although labelled as uncomplicated, uUTIs are associated with psychological and social issues,35 and recurrence is common (20–40%),36,37 with relapse or treatment failure occurring in more than one in 10 women.38 These factors impact the quality of life of patients with uUTIs,35 and add complexity to decisions about their treatment.

• Around 40% of women have a uUTI at some point during their lives,32,33 and disability and mortality associated with UTI increases with age.34

Figure 2: Incidence of emergency department presentation for urinary tract infection per 100,000.31 ED: emergency department; UTI: urinary tract infection.

• The incidence of first UTI is highest in women aged in their 20s, and the incidence of UTIs varies throughout life (Figure 2).31

Incidence, Risk Factors, and Symptoms of Uncomplicated Urinary Tract Infection

3. Symptoms

2. Risk Factors

1.Incidence

Risk factors for recurrent uUTI include maternal or childhood history of UTI, treatment failure, sexual intercourse, use of spermicides, uropathogenic Escherichia coli within the bladder and vagina, and asymptomatic bacteriuria (ASB) treatment.39,40 Older age,41 recent antimicrobial use,41 poor adherence to antimicrobial therapy,42 antimicrobial resistance (AMR),43 and microbiological persistence44 are also important factors that increase the risk of relapse.

Incidence, Risk Factors, and Symptoms of Uncomplicated Urinary Tract Infection

3. Symptoms

2. Risk Factors

1.Incidence

A uUTI is defined in the 2024 European Association of Urology (EAU) Guidelines on Urological Infections as an acute, sporadic, or recurrent cystitis in non-pregnant women with no known relevant anatomical and functional abnormalities within the urinary tract, or comorbidities.45 Similarly, the definition in the Infectious Diseases Society of America (IDSA) guidelines (2011) is cystitis in pre-menopausal, non-pregnant women with no known urological abnormalities or comorbidities, without fever, flank pain, or other suspicion for pyelonephritis.46 uUTI is characterised by specific symptoms, including dysuria (the most common symptom),47 urgency, frequency, suprapubic pain, and haematuria.48,49 Offensive smell and nocturia are also observed.49 Symptoms are typically severe, with a rapid onset.48 The presence of vaginal discharge is not typical.50

Incidence, Risk Factors, and Symptoms of Uncomplicated Urinary Tract Infection

3. Symptoms

2. Risk Factors

1. Incidence

Dipsticks are a useful and immediate tool for the diagnosis of UTIs,45,51,52,53 but are not correlated with specific symptoms, and produce high false-negative rates.45 Urine culture does not provide a definitive diagnosis of uUTI, as many females have symptoms at low bacterial counts, and substantial bacterial growth may not indicate active infection.52 Recognition and monitoring of symptoms is paramount, particularly in younger females. The use of urine culture is recommended only in females with suspected acute pyelonephritis, symptoms not resolving or recurring within 4 weeks, atypical symptoms, suspicion of AMR, or in women who are pregnant.45 The Acute Cystitis Symptom Score (ACSS) is a validated measure for daily clinical practice, providing high sensitivity and specificity for uUTIs, including recurrent infections.54

Diagnosis of Uncomplicated Urinary Tract Infections

Part 1

Part 2

Although antibiotic treatment for 3 days is recommended in the guidelines,45,46 median symptom duration was 4.0 days with antibiotic treatment and 6.5 days without antibiotics in a study of 192 patients with uUTI.55 uUTI symptoms have been reported to resolve without antimicrobial treatment in up to 51% of cases.56,57 It is difficult for clinicians to differentiate between those patients with a uUTI that is likely to self-resolve within 4–6 days (with or without antimicrobial treatment) and those among the 1–2% who will progress to pyelonephritis.58 Further research and development of diagnostics is needed in this area.

Are Uncomplicated Urinary Tract Infections Self-Limiting?

• Alternative medicines, such as acupuncture, naturopathy, and Chinese medicine, may also help to alleviate symptoms.62 • There is a strong recommendation in the EAU Guidelines45 for topical or intravaginal oestrogen,62,67,68 methenamine hippurate,62,69 and immunoactive prophylaxis.62 These strategies form part of a stepwise, non-antibiotic prophylaxis approach for recurrent uUTIs.

At least half of women with recurrent uUTIs report using non-antibiotic self-management options,59,60 which is important in the context of increasing antimicrobial resistance. Strategies include: • Increased fluid intake,45,60,61 vitamin C,60 cranberry products,36,45,60,62,63 D-mannose,45,62,64 alkalising agents,65 and probiotics.45,62,66

Non-antimicrobial Options for Uncomplicated Urinary Tract Infection

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Part 2

Symptoms of uUTI affect all areas of patients’ lives. As well as physical symptoms, such as pain and discomfort, recurrent uUTIs impact patient quality of life through disruption of daily activities and work, social isolation, avoidance of sexual activity, and healthcare costs.70,71 In a study of 375 females, commonly reported impaired activities were sexual intercourse (66.9%), sleep (60.8%), exercise (52.3%), housework/chores (51.5%), and social activities (46.9%).72 Factors that increase the risk of uUTI include sexual activity (such as frequent or high-risk sexual intercourse and use of condoms with spermicide or diaphragms),45,61,73,74 history of UTI,45,61 constipation, diabetes, and vaginal douching.61,75

Impact of Symptoms of Uncomplicated Urinary Tract Infection

Personal or family history of UTIs and frequency of sexual activity remain important risk factors for females as they reach menopause; however, the menopause transition is associated with physiological changes that further increase the risk of uUTI, such as decreased levels of protective vaginal Lactobacillus.76 The impact of comorbidities, including diabetes, on uUTI risk may also be greater in menopausal versus younger females. Specific factors that increase the risk of recurrent uUTI in menopausal females include atrophic vaginitis secondary to oestrogen deficiency, cystocele, increased post-void urine volume, and functional status deterioration.39 The vaginal microbiota of the oestrogen-rich, pre-menopausal state, where glycogen deposits lead to a protective, Lactobacillus-predominant, low pH environment, is well understood.77 Less is known about the post-menopausal vaginal microbiota.78,79 • A low-oestrogen environment is thought to lead to fewer glycogen deposits80 and increased bacterial diversity,79 including Enterobacterales, which can cause UTI and recurrent UTI.81

Factors Influencing the Incidence and Recurrence of Uncomplicated Urinary Tract Infections in Menopausal Females

Part 1

Part 2

Presentation of uUTI-like symptoms is common in menopausal females and is often overlooked.82 There is overlap between the genitourinary syndrome of menopause and uUTI (Figure 3), which complicates the clinical diagnosis of uUTI.83 Differentiation between these conditions requires physical examination of the vagina, urinalysis, and a detailed sexual history.

Factors Influencing the Incidence and Recurrence of Uncomplicated Urinary Tract Infections in Menopausal Females

Part 1

Part 2

Genital signs & symtoms1 • Vaginal dryness • Irritation / burning / itching • Leuorrhea • Thinning / greying pubic hair • Vaginal / pelvic pain & pressure • Vaginal vault prolaps

Sexual signs & symptoms • Sexual dyspareunia • Reduced lubrication • Decreased orgasm & desire • Loss of libido • Dysorgasmia

Figure 3: Genitourinary syndrome of menopause and uncomplicated urinary tract infection.83,49 GSM: genitourinary syndrome of menopause; uUTI: uncomplicated urinary tract infection.

There are no validated diagnostic criteria for uUTI in elderly females. Challenges of uUTI diagnosis in this population include polypharmacy,84 atypical symptoms,85 chronic urinary symptoms related to UTI,86 and a high incidence of non-clinically relevant ASB.87 The incidence of ASB increases with age and dependency, with high rates of ASB in elderly females in long-term care facilities (25–50%) and in the community (>15%).87,88 Risk factors for ASB include urinary incontinence and dementia,88 and over 90% of older females with ASB also have pyuria.89 It is essential to differentiate between ASB and UTI to prevent overdiagnosis of UTI and overtreatment.45,89 • In females with bacteria ≥105 CFU/mL in midstream urine but no UTI clinical symptoms, no treatment is required for UTI;45 however, females with typical UTI clinical symptoms45 and bacteriuria (even as low as 102 CFU/mL)52 should be treated for UTI.

Challenges of Uncomplicated Urinary Tract Infection Diagnosis and Treatment in Elderly Females

Part 1

Part 2

In a retrospective cohort study of females aged ≥65 years undergoing evaluation for an incident uUTI, the 60-day risk of urosepsis was reported to be significantly higher in females aged >84 years and 75–84 years versus those aged 65–74 years (both p<0.0001).90 In contrast, the 60-day risk of pyelonephritis was not higher in the two older age groups relative to the 65–74 years group (75–84 years, p=0.24; >84 years, p=0.72).90 Patient-related factors that impact antibiotic treatment in older females include renal or hepatic impairment, altered pharmacokinetics, poor treatment adherence, and drug–drug interactions.91 Multidrug resistance is also important in this population.92,93

Challenges of Uncomplicated Urinary Tract Infection Diagnosis and Treatment in Elderly Females

Part 1

Part 2

There are numerous unmet needs associated with recurrent uUTIs, with patients describing feelings of frustration, helplessness, and loss of control, as well as not being listened to or taken seriously.70,71,94 Difficulty in accessing primary healthcare, lack of empathy and support from healthcare providers,70,71,94 and fear of repeated antibiotic courses61 are also reported. Better communication between HCPs and patients, acknowledgement by HCPs of the impact of uUTIs on patients’ lives, and advice and information for patients about recurrent uUTIs would improve the healthcare experience of patients.

Improving the Healthcare Experience for Females with Recurrent Uncomplicated Urinary Tract Infections

Across Prevention & Treatment:

Tackling Infectious Diseases

Microbiology & Infectious Diseases

Highlights from the European Society of Clinical Microbiology & Infectious Diseases (ESCMID) Global Congress 2024

Tackling Infectious Diseases Across Prevention and Treatment: Highlights from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global Congress 2024 Chairperson: Dan Barouch,1 José Molina Gil-Bermejo,2 Alan Caplan3 Speakers: Giovanni Gabutti,4 Thea Kølsen Fischer,5 Tino Schwarz,6 Pierre Van Damme,7 Annie Joseph,8 Jennifer Kranz,9 Pamela Kushner,10 Kamran Khan,11,12 Souha S. Kanj,13 Bakr Ahmed,14 Raunak Parikh,14 Peter Openshaw,15 Caterina Rizzo,16 Iván Sanz Muñoz17 1. Beth Israel Deaconess Medical Center, Havard Medical School, Boston, Massachusetts, USA 2. Virgen del Rocío University Hospital, Seville, Spain 3. Family Physician Airways Group of Canada, Ontario, Canada 4. Italian Scientific Society of Hygiene, Preventive Medicine and Public Health, Torino, Italy 5. Department of Public Health, University of Copenhagen, Denmark 6. Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Germany 7. Centre for the Evaluation of Vaccination, University of Antwerp, Belgium 8. Nottingham University Hospitals NHS Trust, UK 9. Medical Faculty of RWTH, Aachen, Germany 10. University of California, Irvine Medical Center, Orange, California, USA 11. Dalla Lana School of Public Health, University of Toronto, Canada 12. Li Ka Shing Knowledge Institute, Toronto, Canada 13. American University of Beirut, Lebanon and Duke University Medical Center, Durham, North Carolina, USA 14. GlaxoSmithKline (GSK), UK 15. UK National Heart and Lung Institute, Imperial College London, UK 16. University of Pisa, Italy 17. National Influenza Centre, University of Valladolid, Spain Disclosure: Gabutti has received honoraria for participation in advisory boards from Seqirus, MSD, Sanofi, Moderna, Emergent Biosolutions and GSK, and speaker fees for CME lectures from Seqirus, Sanofi, Pfizer, Novavax, Moderna, Emergent Biosolutions, MSD and GSK. Prof. G. Gabutti has participated in lectures held by Sanofi, GSK, Seqirus, Pfizer, Novavax, Emergent Biosolutions, MSD and Moderna. Kølsen Fischer has received honoraria for participation in advisory boards from MSD, Sanofi, Pfizer and GSK and speaker fees from Pfizer, and has contributed to registry studies sponsored by MSD and clinical trials sponsored by Pfizer. Schwarz has received honoraria for participation in advisory boards from, and has participated in lectures for AstraZeneca, Bavarian Nordic, Biogen, Biontech, CSL Seqirus, CSL Vifor, GSK, Janssen-Cilag, Merck-Serono, Moderna, Novavax, MSD, Pfizer, Roche, Sanofi-Aventis, Synlab and Takeda. He has received funding for clinical trials from GSK. Van Damme has been Principal Investigator for a large number of vaccine trials, for which the University obtained grants from vaccine manufacturers, and international institutions (eg CEPI, BMGF) and governments. His speaker’s fees are paid to his university. No personal remuneration received. Joseph Received payment for advisory boards for GSK, Pfizer and Advanz Pharma, sponsorship for conference attendance from Eumedica, for consultancy from Global Access Diagnostics (GADx) and speaker fees from Biomerieux. Kranz Received payment for scientific lectures from Apogepha Arzneimittel GmbH, Bionorica, GSK, Medac, MSD, and JanssenCilag GmbH, for advisory boards from Apogepha Arzneimittel GmbH, Bionorica, GSK, and Shionogi, sponsorship for conference attendance from Apogepha Arzneimittel GmbH, Medac, and Janssen-Cilag GmbH, honoraria for consultancy services from Repha-GmbH, and research funding from LEO Pharma. Kushner: Received payment as a speaker from Janssen, Boehringer Ingelheim/Lilly, AstraZeneca, Bayer, GSK, Phathom, Astellas, and Novo Nordisk, as a consultant from Haleon, Boehringer Ingelheim/Lilly, AstraZeneca, GSK, Novo Nordisk, and Abbott, and as an advisor from Salix and Corcept. Acknowledgements: This article is based on presentations at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global Congress 2024. Medical writing assistance provided by Brigitte Scott, MarYas Editorial Services, Cowlinge, UK. Disclaimer For healthcare professionals only. This article, as well as the featured scientific symposia, were funded and organised by GSK. NX-GBLHZU-BRF-240006. Date of preparation: July 2024. GlaxoSmithKline Biologicals S.A. Rixensart, Belgium. Keywords: Adult immunisation, herpes zoster (HZ), infectious diseases, prevention, recombinant zoster vaccine, respiratory syncytial virus (RSV), shingles, uncomplicated urinary tract infection (uUTI). Citation: EMJ Microbiol Infect Dis. 2024;5[Suppl 1]:1-16. https://doi.org/10.33590/emjmicrobiolinfectdis/QKUA8689.  Support: These symposia and innovation theatre sessions, and the publication of this article, were organised and funded by GSK.

Meeting Summary This article summarises key discussions from GSK sponsored symposia that took place during the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global Congress 2024, held from 27–30th April 2024 in Barcelona, Spain. The sessions highlighted key challenges and advances in the prevention and management of infectious diseases. A panel discussion on adult vaccination policies explored the evolving landscape of recommendations in Europe, the importance of harmonised guidance, and the role of medical societies in shaping vaccination strategies. Participants also emphasised the value of surveillance and the critical role healthcare professionals play in developing effective hospital vaccination guidelines. The discussion also emphasised the importance of surveillance and the role of healthcare professionals in developing effective hospital vaccination strategies. In a symposium on uncomplicated urinary tract infections (uUTI) across a lifetime, discussions centered on the challenges of diagnosing, treating, and managing uUTIs across different age groups. Particular attention was given to factors influencing recurrence in menopausal and elderly females, along with strategies to improve care for women experiencing recurrent infections. Two innovation theatre sessions offered fresh perspectives on infectious disease management. One session focused on reshaping the overall infectious diseases narrative, while the other delved into the significant burden of shingles. The article concludes with key takeaways from a final symposium on respiratory syncytial virus (RSV) in adults, reexamining the impact of the virus on older populations. In sum, the ESCMID Global 2024 discussions underscore the importance of comprehensive approaches to both the prevention and treatment of infectious diseases through continued innovation and collaboration.

Incidence, Risk Factors, & Symptoms

Diagnosis

Treatment

Impact

Incidence & recurrence

Challenges

Improvements

The life-course immunisation approach in Italy was introduced in 2012, when the first edition of the vaccine Calendar for Life (Calendario per la Vita) was published.7-10 All vaccinations in the current calendar (Figure 1) are actively offered free of charge; however, good coverage rates have not yet been achieved in adult and elderly populations, and considerable effort is needed to improve coverage.3

Figure 1: Calendar for Life, Italy.3

Tackling Infectious DiseasesAcross Prevention andTreatment: Highlights fromthe European Society ofClinical Microbiology andInfectious Diseases (ESCMID)Global Congress 2024

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References

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(IRAs) y en Hospitales (IRAG): Gripe, COVID-19 y VRS. 2024. Available at: https://docsivira.isciii.es/Informe_semanal_SiVIRA_202408_n171.html. Last accessed: 5 June 2024.115. World Health Organization (WHO). The top 10 causes of death. 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Last accessed: 3 June 2024.116. Openshaw PJM et al. Protective and harmful immunity to RSV infection. Annu Rev Immunol. 2017;35:501-32.117. Falsey AR et al. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005;352(17):1749-59.118. Shi T et al. Global disease burden estimates of respiratory syncytial virus-associated acute respiratory infection in older adults in 2015: a systematic review and meta-analysis. J Infect Dis. 2020;222(Suppl 7):S577-83.119. Hamilton MA et al. Predictors of all-cause mortality among patients hospitalized with influenza, respiratory syncytial virus, or SARS-CoV-2. Influenza Other Respir Viruses. 2022;16:1072-81. The symposium sessions covered in this article are available on the ESCMID Global 2024 (formerly known as ECCMID) Online Platform until 30 October 2024. Available at: https://2024.eccmid.org/online-platform. Last accessed: 17 October 2024.

References cont...

HZ is a localised, painful, cutaneous eruption caused by the reactivation of latent varicella zoster virus (VZV) decades after initial VZV infection is established.107 HZ occurs most frequently in older adults and immunocompromised individuals,107 with immunosuppression known to increase the incidence of HZ complications and disease severity.108

3. Symptoms

2. Risk Factors

1.Incidence

3. Symptoms

2. Risk Factors

1.Incidence

• A low-oestrogen environment is thought to lead to fewer glycogen deposits80 and increased bacterial diversity,79 including Enterobacterales, which can cause UTI and recurrent UTI.81

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Part 2

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Part 2

Part 1

Part 2

Adult Vaccination Policies and Recommendations in Europe

Supranational Approach to Guidance and Recommendations for Vaccination in Europe

Optimising Immunisation Programmes for Healthy Longevity

The Role of Medical Societies in Vaccination Recommendations at National & European Levels

The Role and Importance of Surveillance

Healthcare Professional Involvement in the Development of Hospital Vaccination Guidelines

dTaP: diphtheria, tetanus, and acellular pertussis vaccine; DTaP/IPV or dTaP/IPV: diphtheria, tetanus, and acellular pertussis/inactivated polio vaccine; DTaP/IPV/Hib/HepB: diphtheria, tetanus, acellular pertussis/inactivated polio vaccine/Haemophilus influenzae type b/hepatitis B vaccine; HPV: human papillomavirus; HZ: herpes zoster; MenACWY: meningococcal serogroups A,C,W,Y; MenB: meningococcal serogroup B; MMRV: measles, mumps, rubella, and varicella; PCV: pneumococcal conjugate vaccine; RV: rotavirus.