Infection prevention


Looking ahead, we need to consider: how might the lessons learnt from the pandemic shape resilience and future risks? “There have been significant challenges


and changes in how we deliver care, and that is going to continue to evolve,” she continued. “IPC must fit in with those changes; it is about constant evolution and adaption. It is not about the rigour of black and white. There is also an opportunity to think differently – about some of the ways we have considered the transmission of infection, historically. I truly believe this is the biggest opportunity we’ve had for many years to encourage people into IPC; to succession plan and take the specialty forward into the next 10-20 years.” Rose Gallagher concluded by stating that


“every story matters”. She encouraged the audience to take part in a listening exercise, by sharing their stories directly with the Inquiry. (https://covid19.public-inquiry.uk/every-story- matters/)


Emerging threats to UK diagnostics In the wake of the COVID-19 pandemic, the IPC community is striving to identify the next potential threats on the horizon. Zoonotic overspill of rapidly mutating respiratory viruses are the likeliest candidates that pose a pandemic risk. However, these viruses also pose challenges for existing diagnostics, and this was the subject of discussion in a presentation by Dr. Lisa Stevens, Head of the Pathogen Diagnostics Assurance Group, and a Senior Scientific Advisor for the UK Health Security Agency (UKHSA). Dr. Stevens pointed out that diagnostics


are critical for the identification, infection management and containment of a pathogen, and play a particularly important role in the frontline defence against a pathogen with pandemic potential. These tests aid the identification of pathogen introduction into a country, identification of the first few cases and subsequent contract tracing, as well as ensuring patients receive appropriate treatments. Therefore, it is critical that our frontline diagnostics can detect pathogens of concern for effective management and containment of a pandemic threat.


The UKHSA has recently published the priority pathogen family tool which communicates the pandemic/epidemic risk potential and the gaps in diagnostic and countermeasure tools. Sixteen viral families were considered in the priority pathogen family R&D tool. Of these 16 viral families, 14 viral families have RNA genomes. That means that 87.5% of all viral families considered to pose pandemic/epidemic risk within the UKHSA priority pathogen family tool have an RNA genome. She explained that RNA viruses have the highest mutation rates. When mutations arise in diagnostic test


target regions, it can result in target failure or a reduction in sensitivity of a diagnostic test. This results in increases in false negative reporting, impacting patient safety, management and containment. This was evident during the recent COVID-19 pandemic. “This can mean hundreds of thousands of


tests per day are failing. But much more than that, you can have hundreds of thousands of people who are getting false negative test results,” she commented. “This can be absolutely catastrophic in a pandemic.” She went on to highlight some emerging


threats – we are currently seeing a rapid expansion of Influenza A H5N1 HPAI (highly pathogenic avian influenza), with global distribution. We are also seeing increases in spillover events observed in atypical species (cattle).


Human spillover cases are being observed in all but one of the major clades of H5N1. While there is no confirmed human-to-human transmission yet, repeated spillover is increasing the risk of adaptation to humans. Dr. Stevens explained that there have been


Aspergillus


increased incidents of human spillover events within H5N1 Clade 2.3.4.4b and we are seeing increasing incidents of human spillover events over time – including, a recent UK human spillover case. Evaluations of various diagnostic tests were carried out, by Dr. Stevens and her colleagues, and this research found that 16 out 18 frontline


Influenza A diagnostic tests, screened through computational analysis, were at risk due to the presence of mutations within primer/probe regions of circulating strains of H5N1. A further four Influenza sub-typing diagnostic


tests computationally screened were found to be at risk due to the presence of mutations within the primer/probe region of circulating strains of H5N1. Laboratory evaluation of 13 frontline Influenza A diagnostic tests identified that 8 of the 13 were found to have a decrease in sensitivity (1 to 3 logs) at the limit of detection (LoD). Laboratory evaluation of subtyping assays also found that one subtyping test led to misdiagnosis of H5N1 and three subtyping tests were found to have a decrease in sensitivity. In conclusion, Dr. Stevens warned that vigilance and effective proactive post-market surveillance is required for diagnostic tests detecting rapidly mutating pathogens, to ensure they are fit for purpose. “This is the responsibility not only of public health bodies, but also for manufacturers,” she commented. Ultimately, correct diagnosis is critical to


ensure identification of cases and effective containment of pathogens of concern, in order to prevent a pandemic. Therefore, tests need to be assessed at a frequency that is relevant for the pathogen, Dr. Stevens advised.


Killer fungal diseases: hiding in plain sight


Also high on the agenda at the IPC 2025 conference was the rising threat of resistant fungal infections. Professor David Denning, from the Manchester Fungal Infection Group, University of Manchester, highlighted the global incidence and mortality of severe fungal disease. He warned that a failure to suspect fungal infection, increasing Azole resistance and climate change are all key challenges that must be addressed. According to figures cited by Prof. Denning, the annual incidence of potentially lethal fungal infections is around 6.5 million cases, while deaths total around 3.8 million. He


August 2025 I www.clinicalservicesjournal.com 33


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