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Interview with Xavier Rodó: "The Iberian Peninsula Is Particularly Vulnerable to Climate Change. We Are Not Tuvalu, but We Are Halfway There".

Xavier Rodó, head of the Climate and Health Research Group at ISGlobal, talks about the flooding in Valencia, climate change and the future of the Mediterranean.

21.11.2024
Interview with Xavier Rodó:

With people still missing and mud covering the villages affected by the October 29th floods in Valencia, we pause to reflect on what happened in the sky that fateful day, what lies ahead of us in this part of the Mediterranean and beyond due to global warming, and how science is advancing to provide us with the best tool for action: knowledge. We interviewed Xavier Rodó (Terrassa, 1965), ICREA Research Professor and Head of the Climate and Health Research Group at ISGlobal.

 

-As a climatologist, were you surprised by what happened in Valencia?

-It is difficult not to be surprised by such an event. You are surprised by the magnitude of its consequences, although relatively speaking, and it is hard to say, it is very small compared to, for example, tropical cyclone Nargis, which killed more than 100,000 people and destroyed entire communities in Myanmar in 2008, or the drought in the Horn of Africa in 2011, which claimed more than 250,000 lives, according to estimates by the World Weather Attribution (WWA) group. However, in what we might call the “first world”, it is an extreme and catastrophic event in terms of its consequences. In terms of the specific meteorological situation, although such events don’t occur often, they are not uncommon in this part of the western Mediterranean and has been well known for many years. What was initially unexpected was the energetic load associated with this particular event, which caused very heavy rainfall. However, the forecasts pointed in the right direction.

-So we will have more extreme events?

-Unfortunately, they will become more frequent. It is no longer science fiction, we must begin to understand that the predictions are coming true. From a social point of view it is a disaster, but from a scientific point of view it is a success. What is happening in the Mediterranean is going to get worse, because we have a very active cyclogenesis zone in the western part, which is going to get stronger as the sea continues to warm.

-Is the western Mediterranean considered a planetary hotspot?

-Yes. On the one hand, we see a progressive and steady increase in surface air temperatures and the warming of the Mediterranean Sea, accompanied by less rainfall during the two main rainy seasons, as a long-term trend. On the other hand, we are witnessing an intensification of extremes: the Spanish Levant region has a very active cyclogenesis zone, where autumn conditions lead to collisions between cold air masses and warm, moisture-laden air masses. These interactions fill the air column and, when released, trigger energetic discharges in the form of torrential rains. These heavy rains are expected to become more frequent. We could go from drought conditions to situations where it rains heavily but the reservoirs remain half empty. This reflects a dichotomy between decreasing water resources and increasing extreme weather events. We must begin to adapt to these increasingly variable and diminishing resources.

-What other factors are at play?

-Global warming, which raises air and water temperatures, also changes general atmospheric circulation patterns. For example, as in the case of an isolated high-altitude cold air mass, it can cause "bubbles," or masses of very cold air at high altitudes, to break away from the usual mid-latitude flow over Europe and move toward the Mediterranean. In addition, certain planetary-scale phenomena can amplify this process in certain years - for example, the strong El Niño that began last year and continued well into 2024. This phenomenon transfers a significant amount of energy through climate teleconnections to latitudes outside the tropics. It's like heating up a pressure cooker: the heat has to escape somehow. The excess energy finds regional outlets, many of which are well known, including the Mediterranean Sea, especially its western part. As a result, when a large amount of energy accumulates, it can lead to extreme rainfall events, such as the one in Valencia, where almost a year's worth of rain fell in just eight hours.

3 degrees of warming is a different world

-We already know that 2024 will be the hottest year on record and the first to exceed 1.5 degrees of warming above pre-industrial levels, the limit set by the Paris Agreement. How does this data make you feel?

-It's hard to say. As a scientist, there is a sense of satisfaction in seeing the work of so many years validated. But as a citizen, the disappointment is immense. Nevertheless, I believe that knowledge gives us tools for action, and that the generation of new scientific knowledge can somehow mobilize action in various fields. What worries me most is that at the current rate of emissions, we are heading for 2.7 to 3 degrees of warming by the end of the century. That would be a very different world.

-What will be the consequences if we reach 3 degrees of warming?

-The models may not be perfect - they are always approximate - but they clearly show that at 3 degrees of warming, the Atlantic thermohaline circulation would collapse. This is the system of ocean currents that circulates water in the Atlantic, moving warm water north and cold water south, and is crucial to maintaining Europe's temperate climate. Its collapse would trigger numerous cascading effects across the planet. Let's be clear: while we often talk about limiting warming to 1.5 degrees, the reality ahead is much more alarming. This naturally fuels pessimism, but I also want to change the narrative and focus on solutions.

-How can the message be turned around?

-From a scientific perspective, we are gaining an increasingly detailed understanding of how the planet and climate systems behave. While there have been surprises, particularly regarding the planet's high climate sensitivity as seen recently, this knowledge should strengthen our conviction as a society to pressure governments to change the system. We need to redefine our relationship with the environment. It's essential to move away from the historical mindset of humans as limitless resource extractors and understand that infinite growth is not possible. We've already reached planetary limits, and this requires a reorganization of the distribution of wealth. This doesn't mean going back to the way we lived 50 years ago - although in many ways life was better then - but rather managing our development based on the finite resources available rather than on unchecked demand. This change must occur at the local, regional, state, and national levels. It's time to change the way we organize ourselves as a society and ensure that intelligence and foresight are reflected in decision-making at the highest levels.

Summits to avoid decisions

-How do scientists in this field feel about the fact that climate change denial is gaining momentum?

-It is not a scientific problem; it is a sociological problem - a problem of human behavior. It goes beyond what we as scientists can directly address. A broad societal debate is needed to address this issue, and we are not the only ones who should decide how to proceed. Climate denial exists and will continue to exist, and it is gaining strength under the current global political conditions. It has become a widely used tool to justify inaction.

-Can COP29 do anything?

-Climate summits have become increasingly bureaucratic, making transformative decisions more difficult than ever. In fact, such decisions are simply not being made. It often feels like summits are designed to avoid making them. We've become too used to the ritual: late-night negotiations on the last day, as if the previous two or three weeks had been wasted on procedural formalities. ISGlobal is an accredited observer at COP29, and I see the same pattern emerging: endless debates over the wording of minor clauses in sub-paragraphs, while the most critical issues are completely sidelined. Enough is enough - we have already had 29 climate summits! This is a major problem. It's the same dynamic with biodiversity summits; we've had 16 of them now and little has changed. This is dangerous. We need to change the way we work - not only within the scientific community, but also with the general public. Most importantly, we need to put pressure on governments to act decisively.

-What are the issues that need to be addressed urgently?

-The COP has been dealing with the same issues for many years. One is the mechanism and the size of the Loss and Damage Fund—how to compensate the countries and regions that have been suffering the effects of climate change for years, and who is responsible for paying for it. On the other hand, there is no subsequent verification mechanism or agency to ensure that states comply with their commitments and pay this debt (which, in fact, we must consider as a debt already incurred by developed countries and both historical and current emitters). In the end, everything will be purely voluntary, and we will get nowhere.

-What can we do about this lack of action by the summits?

-We need to create a new mechanism that forces countries to compensate for the effects of their historical actions, which are already well-documented. What we need is both the political will and a new framework, because it is clear that the theory of the "common good" does not work for this type of global issue. But this seems difficult, as we can see that UN decisions are very weak in other areas, such as armed conflicts, where resolutions often go unenforced. So, how can we expect the resolutions of a subordinate organization, which depends on the UN, to be respected? In any case, despite the risk of sounding pessimistic, I always end up believing that the power of the people, which is starting to shift in many countries due to climate disasters, will eventually change the way many governments act.

We are not Tuvalu, but we are halfway there.

-Is there anything we can do at the individual level, or should we focus on demanding action from governments?

-You can help reduce your environmental impact, for example, by following the "three Rs" (reduce, reuse, and recycle). However, it must also be said that the aware citizen has been overly blamed, while large corporations and multinational companies have been insufficiently held accountable. The major oil lobbies and business groups coined the term "carbon footprint" to put the spotlight on individuals, and this term has been used ad nauseam, even by left-wing politicians. As citizens, we should follow the guidance of experts on what to do, but the solution to a problem of this magnitude goes far beyond individual actions, and in some cases, beyond what the state can address alone. The Spanish state, in particular, is starting to suffer more than other countries because we are warming much faster than the rest of Europe, and because mitigation and adaptation policies and plans have been entirely inadequate so far. We're not Tuvalu, but we're halfway there, and the solution needs to come not only from our state, but also from international agreements. On a global scale, however, one might argue that it’s not entirely bad that the effects of climate change are now reaching wealthy countries, because this could spur action.

-Do politicians and administrations consult you on these issues?

-In Catalonia and Spain, we still operate in an outdated manner, and I'm sorry to say it, but we need to speak out. Here, if a politician knows someone or has been told that a person is an expert, they pick up the phone and get an expert opinion right away. We should aim to work much more objectively, as is done in countries with a long tradition of climate research, which are much more advanced than we are—by using the best available information at any given time. We have excellent researchers and research groups that are underutilized by our political class. Politicians, and especially the public, deserve to have the best possible information, even if they have to seek it from outside the country, because, unfortunately, not enough has been invested in this field of knowledge here.

Intensity and forgetfulness

-Will anything change after what happened in Valencia? Can it be a turning point?

-I would like to say yes, but if I had to bet, I would definitely say no. All we have to do is look at the example of the COVID-19 pandemic, where, in theory, we were all supposed to learn a lot, but the truth is that very little has changed since then. For starters, we still do not have a national epidemiological agency or a pandemic forecasting system that fully utilizes the available tools, because the political class neither understands nor believes in them. If we were to face that situation again, we would encounter the same problems and shortcomings. An event like the floods in Valencia, like all extreme phenomena, has an intense psychological impact in the first few weeks or months, but then it is forgotten. In this sense, I would say that there will be no changes. On a broader level, beyond politicians, there is no perception of the magnitude or seriousness of these events, and unfortunately, we are learning this the hard way, through the experiences and suffering of many people.

Drawing the line

-Are we at a point of no return or can we still slow down climate change?
-From a scientific point of view, we have a better understanding of how the planet behaves. However, this also leads us to see that, throughout many crucial moments in Earth's history, climate has played a fundamental role. In a positive sense, because we know that 600,000 years ago, climate was the trigger for the emergence of multicellular life, thanks to the end of the Snowball Earth period, when the planet was no longer frozen, and also because of the climatic role during a major episode of global oxygenation. But also in a negative sense, less than 250,000 years ago, during the Permian-Triassic transition, we know that the magnitude and frequency of El Niño events in the tropical Pacific were so extreme that they led to a major extinction of species and a massive loss of terrestrial and marine biodiversity. And this occurred under conditions of CO₂ emissions ranging from 410 ppm to 860 ppm. Warning! These values are already included in the climate change scenarios projected for the coming decades! This should give us pause for thought.

-How can science help us?

-We are now able to design "safe" climate scenarios, where certain planetary variables must not be exceeded. These are called safe pathways. In other words, we are anticipating what politicians might ask us to do in the coming years, and there is a significant international research effort in this direction. What are the planetary emissions limits? If we stop emitting, will the planet return to previous conditions, or will there be hysteresis (the transition of the climate to a new state of equilibrium, driven by a forcing that causes an irreversible chang), leading to a different world, depending on where we are? What are the deforestation limits in certain parts of the world to prevent the collapse of biodiversity or the transition from forests to savannas? Is the sequestration of greenhouse gases possible as a planetary solution? What should we avoid doing or going beyond? We are generating immense knowledge that we didn't have before. Ten or twenty years ago, it would have been impossible to argue that this could be done - and now we are doing it. We can simulate a parallel planet and manipulate it to better understand how it behaves. So even if we as a society are in a boat approaching a waterfall, we now know exactly how much time we have to get out of the boat or what we need to do to steer it to safety. All we have to do is decide to take action.

 

Interview by Yvette Moya-Angeler.

Research

The AEMPS Awards ISGlobal a Prize for its Study on Antibiotic Resistance in Water

The project, carried out in collaboration with Agbar, aims to provide scientific evidence for the selection of the most appropriate water treatment.

19.11.2024

ISGlobal has been recognised with the National Plan against Antibiotic Resistance (PRAN) 2024 prize by the Spanish Agency for Medicines and Health Products (AEMPS) for its contribution to the fight against antimicrobial resistance. The winning project, led by researcher Sara Soto and carried out in collaboration with Agbar, was awarded in the category of 'Best initiative against antimicrobial resistance in the environment'. Eight other projects were recognised in this fourth edition of the PRAN 2024 Awards, out of a total of 77 applications.

The ISGlobal project investigates the spread of resistant bacteria and resistance genes throughout the integral water cycle. “Our goal is to generate scientific evidence to guide the most appropriate water treatment methods for reducing bacteria and antibiotic resistance genes,” said Sara Soto, Director of ISGlobal's Bacterial and Viral Infections Programme.

This award highlights the importance of environmental research in the fight against antimicrobial resistance and reaffirms ISGlobal's commitment to protecting public health and sustainability.

Policy & Global Development, Research

Quique Bassat, New Board Member of the European Centre for Disease Prevention and Control

The epidemiologist and Director General of ISGlobal joins the EU agency that coordinates the response to health threats

20.11.2024

Quique Bassat, an epidemiologist and Director General of the Barcelona Institute for Global Health (ISGlobal), has been appointed to the Management Board of the European Centre for Disease Prevention and Control (ECDC) as a representative of the European Parliament. This appointment underlines his track record in infectious disease epidemiology and public health and strengthens the representation of Spanish experts in high-level European bodies. 

Coordinating the response to health threats

The ECDC, based in Stockholm, Sweden, is a European Union agency coordinating and strengthening the EU’s public health response to communicable disease threats. Its tasks include collecting and analysing public health data, supporting surveillance systems and issuing recommendations for preparedness and response to health emergencies. It works closely with other EU bodies and international agencies to ensure a coherent and effective health response. Its work has been particularly prominent during recent health crises, such as the COVID-19 pandemic and other infectious disease outbreaks, including Mpox.

Scientific leadership to strengthen the European response

Quique Bassat, a paediatrician and ICREA Research Professor, has combined clinical work with biomedical research on infectious diseases affecting the poorest and most vulnerable populations, with his two main areas of interest being childhood malaria and respiratory infections (bacterial or viral). With his appointment, ISGlobal's Director General will join a select group of experts charged with advising on the agency's strategies and policies, ensuring that its activities are relevant and aligned with the needs of member states. 

“It is a privilege to be part of such an important institution for the health of European citizens. In an increasingly interconnected world, the ability to respond to health threats in a coordinated and effective way is vital. I look forward to contributing my expertise in infectious diseases to the ECDC's mission of strengthening prevention and control capacities across Europe,” he said after his appointment was confirmed. 

Policy & Global Development

New ISGlobal channel on Tiktok

Under the slogan ‘global health in less than a minute’, the account will try to bring scientific concepts to a wider audience

10.10.2024
Fotogramas de distintos vídeos del canal de tiktok de ISGlobal.

The Barcelona Institute for Global Health (ISGlobal) has opened a new official communication channel, this time on the video platform Tiktok and under the username @isglobalorg. The institution's profile on this social network is available at https://www.tiktok.com/@isglobalorg.
 

@isglobalorg Su tamaño es micro, pero son un problema macro: los microplásticos #ciencia #medioambiente #microplasticos #contaminacionambiental #aprendeentiktok #aprendecontiktok #isglobal ♬ sonido original - ISGlobal

The aim of this new channel is to bring science and research to a younger and more diverse audience. Initially, the @isglobalorg profile will be devoted mainly to disseminating key concepts of ISGlobal's scientific agenda through short videos. Hence the slogan ‘global health in less than a minute’ has been chosen for the opening.
 

The first videos published, starring members of ISGlobal's Communication team, offer a sample of the diversity of the topics covered by the institute's scientific agenda, with pieces dedicated to the differences between eliminating and eradicating a disease, the exposome, malaria, the human papillomavirus (HPV), particulate matter and microplastics.

@isglobalorg 👋 Toc toc, ¿alguien en tiktok? #aprendeentitktok#ciencia #isglobal#aprendecontiktok #cienciaentiktok #epidemiologia #erradicar #erradicacion #eliminar #eliminacion ♬ sonido original - ISGlobal

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Research

Using Stool-Based Molecular Tests to Improve Tuberculosis Diagnosis in Children

A systematic review and meta-analysis shows that molecular testing of stool samples could significantly enhance TB diagnosis and treatment in children

12.11.2024
Photo: Murchana Roychoudhury / ISGlobal

A systematic review and meta-analysis by the Stool4TB partnership supports the use of the Xpert Ultra test on stool samples for diagnosing tuberculosis in children. The study, led by ISGlobal, an institution supported by “la Caixa” Foundation, has been published in The Lancet Microbe.

Tuberculosis (TB) is difficult to diagnose in children due to non-specific symptoms and the challenge of obtaining respiratory samples that contain enough bacteria for confirmation. This delay in diagnosis can lead to serious health problems and even death. In an effort to improve TB detection in young children, the scientific community is exploring the use of more accessible samples, such as stool, for molecular testing.

ISGlobal PhD student Lucía Carratalà and an international team of experts from the EDCTP-funded Stool4TB project, conducted a systematic review and meta-analysis to examine the effectiveness of stool-based molecular tests and processing methods for TB diagnosis in children. The analysis included data from 35 studies (a total of 6,562 children) published from 2000 to 2023. The authors compared the detection of Mycobaterium tuberculosis DNA in stool with traditional microbiological tests on other samples or clinical diagnosis.

“This is the most up-to-date systematic review on this topic, with a large number of studies using Xpert Ultra, which is the frontline test for TB diagnosis in most high-burden countries,” says Alberto García-Basteiro, ISGlobal researcher, associate physician in the Department of Preventive Medicine and Epidemiology of the Hospital Clínic Barcelona and coordinator of the Stool4TB consortium.

A simpler and effective way to confirm TB

The results show that the molecular tests Xpert MTB/RIF and Xpert Ultra had promising results when used on stool samples. In particular, stool Xpert Ultra, identified about 73% of the children who were bacteriologically confirmed via respiratory samples. When respiratory-based tests were negative, adding this test increased the overall bacteriological confirmation of TB by 39%.

In addition, simplified methods for processing stool samples without the need for a centrifuge did not affect - and often improved - the performance of the molecular tests. These results show that stool Xpert Ultra provides an easier and effective way to confirm TB in children, especially when respiratory samples are difficult to obtain.

“The WHO guidelines have recently included stool-based molecular testing as a valid tool for diagnosing TB in children. Our study further supports this approach by providing new evidence on the diagnostic accuracy of Xpert Ultra in stool samples,” says Carratalà, who received a grant from the European Society of Pediatric Infectious Diseases to carry out this work. Furthermore, the adoption of this test by several African and Asian countries supports its feasibility and acceptability in high-burden countries. 

The authors conclude that the use of Ultra on stool samples has great potential for routine TB testing in children and could significantly improve early diagnosis and treatment, potentially saving many young lives.

 

Reference

Carratalà L, Munguambe S, Saavedra-Cervera B et al. Use of stool-based molecular tests for pediatric tuberculosis diagnosis: a systematic review and meta-analysis. Lancet Microbe. 2024. Doi: 10.1016/j.lanmic.2024.100963

Research

Meningitis Has a Much Greater Impact on Child Mortality than Previously Thought

New study by the CHAMPS network reveals high rates of antibiotic-resistant bacteria in hospital-associated cases of meningitis in children under five years of age

19.11.2024
Meningitis
Photo: Murchana Roychoudhury / ISGlobal

Meningitis contributes to higher child mortality rates than estimated by the WHO, according to a new study by the CHAMPS network and led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by “la Caixa” Foundation. The study, published in Journal of Infection, reveals a high prevalence of drug-resistant bacteria in hospital cases, highlighting the need for earlier suspicion and faster diagnosis and appropriate treatment to reduce mortality.

Meningitis remains a serious condition, especially for young children, with high death rates and lasting neurological effects in survivors. Vaccines can protect against the most common types of meningitis-causing bacteria, such as Haemophilus influenzae type B (Hib), Streptococcus pneumoniae, and Neisseria meningitidis. Yet, reaching the World Health Organization’s (WHO) goal to eliminate meningitis by 2030 requires a clearer understanding of the global impact of this disease and the specific pathogens involved.

“Meningitis poses a diagnostic challenge due to its non-specific symptoms, which often resemble those of other serious illnesses,” explains senior author Quique Bassat, ICREA researcher and General Director at ISGlobal. “Identifying the specific pathogens behind meningitis cases would allow us to make a better use of resources and guide the development of new highly-awaited vaccines,” he adds.

The study draws on data from the CHAMPS network, which is conducting an in-depth investigation into causes of childhood deaths in seven countries: Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. Using a technique called MITS (minimally invasive tissue sampling), researchers perform biopsies to obtain samples of key organs or fluids, including cerebrospinal fluid, followed by histopathological examination, molecular testing for 126 pathogens, and microbiological cultures.

A significant contributor to death

The study found that meningitis was a contributing factor in 7% of the 3,857 deaths analysed. The highest proportions of child deaths due to meningitis were observed in South Africa (16.6%) and Ethiopia (15.6%), followed by Mali and Sierra Leone. Most of these deaths (66%) occurred in newborns, with the remaining cases diagnosed in older infants and young children. “The higher incidence among newborns may be due to the vertical transmission of pathogens infecting their mothers, and the lack of specific strategies to protect them during delivery. Additionally, their underdeveloped immune systems also confer a higher vulnerability,” says Sara Ajanovic, ISGlobal researcher and co-author of the study.

A shift towards antibiotic-resistant bacteria

The prevalence of pathogens associated with meningitis deaths in the hospital and in the community varied between regions. However, the most common pathogens were Acinetobacter baumannii and Klebsiella pneumoniae, particularly in deaths occurring in healthcare settings. These multi-drug resistant bacteria are often acquired in the hospital, which means that improving infection prevention practices in hospitals is essential for reducing meningitis cases. Worryingly, it also means that without the appropriate antibiotics, the risk of dying from meningitis remains high. 

Almost half of meningitis deaths occurred at the community, likely due to limited access to healthcare. While vaccines have significantly reduced cases of Streptococcus pneumoniae, this bacterium still caused many of the community-acquired cases of meningitis.

These findings indicate a shift in the landscape of pathogens associated with meningitis, with an increase of pathogens like K. pneumoniae and A. baumannii, alongside a decline in S. pneumoniae and Hib due to vaccination efforts. This shift, the authors point out, “challenges the foundations of current empirical antibiotic guidelines.”

Implications for public health

CHAMPS' findings suggest that meningitis contributes to higher child mortality rates (7%) than the WHO’s estimate of 5.1%. Critically, many of these cases had not been recognized as meningitis before death, highlighting the need for faster diagnosis and treatment to prevent fatalities. “Less than a quarter of all confirmed meningitis cases had undergone a lumbar puncture -the gold standard technique for diagnosing meningitis - prior to death, highlighting the urgent need to deploy more actively this diagnostic approach to avoid missing cases of this life-threatening infection,” says Bassat.

"The changing landscape of the pathogens causing lethal meningitis in children in these settings underscores the positive effect of vaccine campaigns conducted in the last decades, which must be continued,” adds Ajanovic. However, the findings highlight an urgent need for developing new vaccines against emerging pathogens such as K. pneumoniae, and for updating clinical guidelines. This includes testing for these pathogens and their resistance patterns, as well as adjusting antibiotic regimens to ensure an effective treatment.

CHAMPS work recognised in Catalonia

On 26 October, the Catalan Society of Clinical Microbiology and Infectious Diseases awarded the Josep Barrio Infectious Diseases Prize to Quique Bassat for the best scientific paper published in 2023 by a member of the society. The paper was a study by the CHAMPS network showing that infectious diseases continue to cause most deaths in infants and children, often in conjunction with malnutrition.

 

Reference

Mahtab S, Madewell ZJ, Baillie V et al. Etiologies and Comorbidities of Meningitis Deaths in Chilren Under 5 Years in High-Mortality Settings: Insights from the CHAMPS Network in the Post-Pneumococcal Vaccine Era. J Infection10.1016/j.jinf.2024.106341

Research, Chagas

Lipid Biomarkers May Improve Management of Chagas Disease

Study identifies lipid molecules that distinguish symptomatic from asymptomatic individuals with chronic T. cruzi infection and could be used to closely monitor treatment response

11.11.2024

Certain lipids are altered in people infected with the parasite T. cruzi, and return to normal after treatment, shows a study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation. The findings highlight the role of lipid metabolism in the progression of Chagas disease, and suggest that these molecules could be used as biomarkers for the timely assessment of anti-parasitic treatment response in chronically infected individuals.

Chagas disease, caused by the parasite Trypanosoma cruzi, is a neglected tropical disease affecting an estimated seven million people worldwide. Most infections go undetected for years, but around 30% of chronically infected people eventually develop digestive and heart disorders, which can be fatal. 

One of the biggest challenges in managing the disease is the difficulty in diagnosing it early and evaluating how well treatments are working. “Chagas disease is treatable, but the treatment is long and little progress has been made in identifying biomarkers that tell us if a patient is responding well to the treatment,” says ISGlobal researcher Julio Alonso-Padilla. Currently, the criterion for determining whether a person is cured is when antibodies against the parasite are no longer detectable in blood. But this ‘seronegativisation’ process can take up to 30 years.

Changes in lipid abundance

In this study, the research team led by Alonso-Padilla analysed blood samples from 28 patients enrolled at the Hospital Clinic (8 with symptoms and 20 without), before and after anti-parasitic treatment with benznidazole, in order to detect any changes. Fifteen healthy people served as controls. A large number of molecules related to the metabolism, including fats, or lipids, were measured using liquid chromatography and mass spectrometry.

The researchers identified three types of lipids, that helped distinguish between people who had symptoms and those who didn’t. Specifically, two types of phosphatidylethanolamine (PE) were more abundant in symptomatic patients, while levels of 10-hydroxydecanoic acid were reduced. PEs are an important component of the cell membrane and have been shown to increase in patients with heart failure and cardiovascular damage.

Remarkably, the analyses also revealed a number of molecules in the blood of treated patients that returned to levels similar to those in healthy people, including five types of sphingolipids. These molecules are known to modulate immune responses and are involved in the progression of several infectious diseases.

Implications

“Our results reinforce the idea that altered lipid metabolism plays an important role in the progression of Chagas disease, and that certain lipids could be used to monitor the progression and response of patients to treatment” says Juan Carlos Gabaldón, ISGlobal researcher and first author of the study. “The lipid signatures we identified may reflect damage to tissues infected by the parasite”, he adds.

The authors caution that the findings will need to be validated in other patient cohorts, and more research is required to understand the underlying mechanisms. Also, the technology to measure these molecules in blood must be simplified to make it accessible in low-resource settings, where Chagas disease is most prevalent.

Despite these challenges, the molecules identified in this study show potential as valuable tools to monitor Chagas disease progression and evaluate the effectiveness of both existing and new treatments.

 

Reference

Gabaldón-Figueira JC, Ros-Lucas A, Martínez-Peinado N et al. Changes in lipid abundance are associated with disease progression and treatment response in chronic Trypanosoma cruzi infection. Parasites and Vectors. 2024. https://doi.org/10.1186/s13071-024-06548-3

Research

An integrated forecasting system allows for real-time El Niño-Southern Oscillation predictions more than a year in advance

Researchers call for official long-lead forecasting of the ENSO phenomenon

15.11.2024

The El Niño-Southern Oscillation (ENSO) is one of the phenomena with the greatest capacity to alter the Earth's climatic conditions. The official forecasting system currently used to issue warnings related to this phenomenon is limited, as it only anticipates ENSO by 6 to 8 months. Now, a study led by climate researchers from the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation, has unveiled a methodology that makes it possible to predict El Niño in real time up to 19 months in advance.

ENSO typically produces changes in global circulation patterns often linked to extreme weather events. Although it is popularly known as El Niño, this name refers only to its oceanic component, while the nomenclature Southern Oscillation refers to the associated atmospheric disruptions. “Given the large impact this phenomenon has on much of the planet, early anticipation through operational long-lead forecasts could have huge economic, societal and health benefits”, says Desislava Petrova, ISGlobal researcher and first author of the study showing the effectiveness of the new methodology in the Bulletin of the American Meteorological Society.

Over more than seven years of work, the team led by Petrova has developed, tested and improved an El Niño-Southern Oscillation statistical prediction model that incorporates carefully selected predictor variables such as subsurface and surface ocean temperature and zonal wind stress, along with additional dynamic components that account for the quasi-cyclical ENSO physics. 

Using historical data sets provided by the equatorial ocean observing system, the team tested the model to prove that it was indeed able to predict major El Niño events since the 1970s, sometimes even more than two years in advance. Then they went on to forecast in real time the development of El Niño in the equatorial areas of the Pacific in the winter of 2023/2024. The forecasting system was able to predict this moderate-to-strong warm event up to 14 months in advance, while a borderline El Niño was foreseen 19 months in advance.

Having demonstrated the operational forecasting potential of their model, and considering results from other recent ENSO prediction studies, the scientific team calls on the authorities to incorporate these early forecasting systems and increase the official lead time of operational ENSO forecasting. “It is vital to take advantage of the tremendous potential that this model has in fields as diverse as health impact studies, the epidemiology of vector-borne diseases such as dengue or malaria, or energy production systems”, says Ivana Cvijanovic, researcher at ISGlobal and the French National Research Institute for Sustainable Development (IRD) and last author of the study. 

Reference

Petrova, D., X. Rodó, S. J. Koopman, V. Tzanov, and I. Cvijanovic, 2024: The 2023/24 El Niño and the Feasibility of Long-Lead ENSO Forecasting. Bull. Amer. Meteor. Soc., 105, E1915–E1928, https://doi.org/10.1175/BAMS-D-23-0158.1.

Research

Worm Infections in Travelers and Migrants May be Overlooked

New study identifies symptoms that should alert physicians to possible helminthiasis in people with a recent travel history

14.11.2024

Malaise, fatigue and cutaneous symptoms are good predictors of helminthiasis in people returning from tropical regions with high levels of eosinophils - a type of white blood cell - according to a study conducted at Karolinska University Hospital and led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by ”la Caixa” Foundation. The findings underscore the need for healthcare providers to test more widely for helminth infections in people with eosinophilia who have recently travelled to or migrated from endemic areas.

Helminth infections, known as helminthiases, are very common, affecting over a billion people worldwide. Common helminth infections include soil-transmitted diseases caused by parasites such as Ascaris, Trichuris, Strongyloides, as well as schistosomiasis, which is particularly prevalent in sub-Saharan Africa.

As global travel and migration increase, healthcare providers in non-endemic regions are likely to encounter more cases of helminthiasis. Eosinophilia (high counts of eosinophils in blood) is a telltale sign of helminthiasis, but can also be caused by other conditions such as allergies and autoimmune diseases. “It would therefore be very useful to have tailored protocols to detect helminthiasis in travellers and migrants,” says senior author Ana Requena, researcher at ISGlobal and the Karolinska Institute.

In this study, Requena and her team retrospectively examined data from more than 23,000 patients with eosinophilia (who visited the hospital between 2011 and 2021), of whom more than 5,000 had been in a region known for helminth infections. Surprisingly, only about 20% of those patients were tested for helminthiasis. Among those tested, 219 people were diagnosed with infections, with schistosomiasis and strongyloidiasis being the most common.

Three key predictors of helminth infections

The researchers identified three key predictors of helminthiasis in patients who were tested: i) a stay in an endemic region, particularly sub-Saharan Africa; ii) high-grade eosinophilia; and iii) symptoms of fatigue and general malaise. In addition, itching was strongly associated with strongyloidiasis.

These predictors were useful in the four weeks before and after eosinophilia, as most associations receded with time, and were particularly true in adults. In children, no region was specifically associated with helminthiasis and cutaneous symptoms were the only clinical predictors.

“It is remarkable that for the majority of persons presenting with eosinophilia after travel to endemic regions, no parasitological test was requested by health professionals,” says Requena.

This study underscores the need for healthcare providers to test more widely for helminth infections in individuals with eosinophilia who arrive from tropical areas. Doing so could help detect these infections earlier, preventing complications and promoting better health outcomes for this growing population.

Reference

van Waasdijk M, van der Werff SD, Sjöholm D et al. Prediction of helminthiases in travellers and migrants with eosinophilia: a cohort study. CMI. 2024. DOI: 10.1016/j.cmi.2024.10.009

Research, Urban Planning, Environment and Health

ICUH 2024

20th Annual International Conference on Urban Health

18.11.2024
Date
18/11/2024 - 21/11/2024
Place
Marrakesh, Morocco

Join us at the 20th International Conference on Urban Health (ICUH), organized by the International Society for Urban Health (ISUH), with ISGlobal as the academic partner. The conference, taking place in Marrakech, Morocco, from November 18-21, is the premier global gathering for interdisciplinary professionals, researchers, policymakers, and community advocates committed to improving urban health worldwide.

This year's theme, "A Healthier Horizon: Activating Urban Health Strategies for a Climate Resilient Tomorrow," could not be more critical for the future of urban health in Africa and across the world. Engage with world-leading experts as we explore innovative models of city policy, development and design that foster holistic health, wellbeing and equity for all.

At ICUH 2024, you will:

  • Connect with a unique, global network of leaders striving to make cities healthier, more equitable, and environmentally sustainable.
  • Uncover transformative, evidence-based solutions for pressing urban challenges, from mental health to climate change justice
  • Learn how to bridge the gaps between research, policy, and practice, mobilizing resources to shape cities that support health and equity today and for future generations.

ISGlobal Sessions

November 18

9.00-17.00 h — Pre-Conference Intensive Course: Urban Health in Practice, Shaping the Changemakers of Tomorrow. Speaker: Carolyn Daher. + info

November 19

10.30-11.30 h — Urban Regeneration: Inclusive Participatory Approaches for Healthy Cities in the Face of Climate Change. Speaker: Carolyn Daher. + info

10:30-11:30 h — Breakout Session 1 - Oral Abstract Presentations (15' each presentation) + info

  • Empowerment through measurement: an innovative citizen measurement protocol of NO2 in school environment. Speaker: Inés Valls
  • From Classroom to Community: Citizen Science and Social Innovation in Investigating Tyre Wear Particles. Speaker: Celia Santos-Tapia
  • Schoolchildren as citizen scientist: how to improve indoor air quality and health impacts in urban primary schools? Speaker: Mònica Ubalde
  • Incorporating a health perspective into transformation of vulnerable neighborhoods: tools and pilot experiences in three municipalities. Speaker: Carlota Sáenz de Tejada + info 

12.00-13.00 h — From epidemiological evidence to policy action: the role of health impact assessment (HIA) in urban health initiatives. Speakers: Sasha Khomenko, Tamara Iungman, Natalie Mueller, Carolyn Daher + info

15.30-17.00 h — Workshop Urban planning and resilience: from evidence to action. Speakers: Carlota Sáenz de Tejada, Carolyn Daher + info

November 20

9.00-10.00 h — Healthy by Design: Creating Climate-Resilient Urban Environments. Speaker: Cathryn Tonne + info

10.30-11.30 h — Urban Health Citizen Laboratory at Mohammed IV University of Sciences and Health: Exploring Challenges and Future Opportunities. Speaker: Celia Santos-Tapia + info

15.30-17.00 h — Measuring Health Impacts in Public Space: Policies and Interventions. Speaker: Carolyn Daher, Celia Santos-Tapia, Mònica Ubalde + info

15.30-17.00 h — Atlanta to Beijing: Measuring the Effectiveness or Air Quality Actions in a Changing Urban Transportation Landscape. Speaker: Cathryn Tonne + info

16:00-16:30 h — Breakout Session 7 - Oral Abstract Presentations (15' each presentation) + info

  • Urban Burden of Disease Estimation for Policy Making: Health impact assessment of environmental stressors. Speaker: Georgia Dyer
  • Indoor Environmental Quality (IEQ) in dense urban areas: key findings from households in Barcelona (Spain). Speaker: Carlota Sáenz de Tejada

17:45-18:00 h — Breakout Session 8 - Oral Abstract Presentations (15' each presentation) + info

  • Urban neighborhood accessibility, mobility behaviors, environmental exposure levels and health impacts in 5 Spanish cities: results of the ECOMOV and UBDPolicy projects. Speaker: Natalie Mueller

November 21

10:30-11:15 h — Breakout Session 9 - Oral Abstract Presentations (15' each presentation) + info

  • An Innovative Geospatial Monitoring and Health Impact Assessment Tool for Sustainable and Healthy City Planning. Speaker: Federica Montana
  • Feasibility and Potential of Replacing Short Car Trips in European Countries: Insights from the CATALYSE Project. Speaker: Daniel Velázquez
  • Health impact assessment of port-sourced air pollution in Barcelona. Speaker: Natalie Mueller

14:30-14:45 h — Breakout Session 11 - Oral Abstract Presentations (15' each presentation) + info

  • Protocol To Support Co-Creation of Nature-Based Social Prescription Menus in Local Urban Contexts. Speaker: Laura Hidalgo

Posters 

  • From urban health research to policy-making: insights from stakeholder consultations in four European cities. Author: Sasha Khomenko
  • Health burden and inequities of urban environmental stressors in Sofia, Bulgaria. Author: Sasha Khomenko
  • Co-benefits of nature-based solutions: a health impact assessment of the Barcelona Green Corridor (Eixos Verds) Plan. Author: Tamara Iungman
  • Poster Presentations Healthy Urban Design Index (HUDI): How to promote health and environmental quality in European Cities. Author: Federica Montana

 

Global Think-Tank on Steatotic Liver Disease: Priorities for 2025 and Beyond

Prevention of liver disease in people living with obesity and/or diabetes

26.11.2024
Global think-tank on steatotic liver disease: prioridades para 2025 y más allá
Date
26/11/2024
Hour
17:30 -18:15 CET
Place
Virtual
Speakers
Jeffrey V Lazarus, Kenneth Cusi, Nuria Alonso, Didac Mauricio, Maru Rinella

On 26 November 2024, an online webinar in Spanish will bring together a panel of experts from Spain and the USA to discuss the key takeaways from the May event. It will include a lively discussion on the priorities for 2025, with a focus on prevention of liver diseases in people living with obesity and/or diabetes, as well as how to address the MASLD/MASH public health threat.

This is a great opportunity for healthcare professionals, patients and researchers alike to get updated on the latest in early detection, prevention, treatment and care of SLD.

Key topics to be addressed:

 

  1. Bridging the diagnostic gap: Addressing the disconnect between the rising prevalence of SLD and the low rates of diagnosis, discussing non-invasive testing, ensuring more patients receive timely diagnosis, education and care.
  2. Prevention as key: Effective preventive strategies aimed at reducing MASLD/MASH, emphasising the roles of diet, exercise, and environmental pollutants.
  3. The Future of Treatments: The vision for the recently US FDA-approved MASH treatment
  4. The Multidisciplinary Approach: The importance of involving all stakeholders, not least endocrinologists.

 

TO REGISTER, CLICK HERE: https://docs.google.com/forms/d/e/1FAIpQLSemn-PVYnXttOMbaqTKZ1rphlhYgGt-0T9xTu9DY7BuAKNgsg/viewform

Speakers:

  • Jeffrey V Lazarus, Head of Public Health Liver Group, ISGlobal (Spain)
  • Kenneth Cusi, Professor of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Florida, USA
  • Nuria Alonso, Director of the Department of Endocrinology and Nutrition, Germans Trias i Pujol Hospital, Spain
  • Didac Mauricio, Director of the Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau Ciberdem, Spain
  • Maru Rinella, Gastroenterologist, Director of the Department of Metabolic and Fatty Liver Diseases, University of Chicago, USA
Policy & Global Development

Premiere of the series 'Global Immunity. The Transformative Power of Vaccines'

In five short, informative episodes, the documentary series provides the keys to understanding the impact of vaccines on global health.

31.10.2024

ISGlobal and streaming platform CaixaForum+ present the documentary series Global Immunity. The Transformative Power of Vaccines. Through interviews with scientists and health professionals, the five 8-minute episodes explore the importance of vaccines worldwide and provide a comprehensive view of how they have shaped and continue to shape global health. 

The series begins with the history of early vaccines and their evolution, from the eradication of smallpox to modern breakthroughs against diseases such as malaria, tuberculosis and COVID-19. It also highlights the positive impact of global immunisation campaigns, which have saved millions of lives, particularly in vulnerable communities.

Global Immunity underscores the importance of international collaboration between scientists, governments and NGOs to develop, produce and distribute vaccines equitably. It also examines the logistical, economic and political challenges facing global immunisation efforts and some of the strategies to overcome them. In addition, the series reflects on the importance of education and public awareness in promoting vaccine uptake

 

Watch the five episodes here.

Research

Maternal Antibodies Interfere with Malaria Vaccine Responses

First study to examine the combined effect of age, individual past exposure and baseline levels of vaccine-specific antibodies, whether passively transferred from mother to baby or actively acquired

24.10.2024
Photo: ISGlobal

Maternal antibodies passed across the placenta can interfere with the response to the malaria vaccine, which would explain its lower efficacy in infants under five months of age, according to research led by the Barcelona Institute for Global Health (ISGlobal), in collaboration with seven African centers (CISM-Mozambique, IHI-Tanzania, CRUN-Burkina Faso, KHRC-Ghana, NNIMR-Ghana, CERMEL-Gabon, KEMRI-Kenya). The findings, published in Lancet Infectious Diseases, suggest that children younger than currently recommended by the WHO may benefit from the RTS,S and R21 malaria vaccines if they live in areas with low malaria transmission, where mothers have less antibodies to the parasite.

The world has reached an incredible milestone: the deployment of the first two malaria vaccines -RTS,S/AS01E and the more recent R21/Matrix-M- to protect African children against malaria caused by Plasmodium falciparum. Both vaccines target a portion of the parasite protein called circumsporozoite (CSP) and are recommended for children aged 5 months or more at the moment of the first dose.

“We know that the RTS,S/AS01E malaria vaccine is less effective in infants under five months of age, but the reason for this difference is still debated,” says Carlota Dobaño, who leads the Malaria Immunology group at ISGlobal, a centre supported by “la Caixa” Foundation. 

To investigate this, Dobaño and her team analysed blood samples from more than 600 children (age 5-17 months) and infants (age 6-12 weeks) who participated in the phase 3 clinical trial of RTS,S/AS01E. Using protein microarrays, they measured antibodies against 1,000 P. falciparum antigens before vaccination to determine if and how malaria exposure and age affected IgG antibody responses to the malaria vaccine.

“This microarray approach allowed us to accurately measure malaria exposure at the individual level, including maternal exposure for infants and past infections for older children,” says Didac Maciá, ISGlobal researcher and first author of the study. 

The role of maternal antibodies

The analysis of antibodies to P. falciparum in children who had received a control vaccine instead of RTS,S/AS01E revealed a typical “exposure” signature, with high levels in the first three months of life due to the passive transfer of maternal antibodies through the placenta, a decline during the first year of life, and then a gradual increase as a result of naturally acquired infections.

In children vaccinated with RTS,S/AS01E, antibodies induced by natural infections did not affect the vaccine response. However, in infants, high levels of antibodies to P. falciparum, presumably passed from their mothers during pregnancy, correlated with reduced vaccine responses. This effect was particularly strong for maternal anti-CSP antibodies targeting the central region of the protein. Conversely, infants with very low or undetectable maternal anti-CSP IgGs exhibited similar vaccine responses as those observed in children.

The molecular mechanisms underlying this interference by maternal antibodies are not fully understood, but the same phenomenon has been observed with other vaccines such as measles. 

Overall, these findings confirm something that was already suspected but not clearly demonstrated: despite their protective function, maternal anti-CSP antibodies, which decline within the first three to six months of life, may interfere with vaccine effectiveness. The higher the level of malaria transmission, the more maternal antibodies are transmitted to the baby, resulting in lower vaccine effectiveness. These findings further suggest that infants below five months of age may benefit from RTS,S or R21 vaccination in low malaria transmission settings, during outbreaks in malaria-free regions, or in populations migrating from low to high transmission settings.

“Our study highlights the need to consider timing and maternal malaria antibody levels to improve vaccine efficacy for the youngest and most vulnerable infants,” says Gemma Moncunill, ISGlobal researcher and co-senior author of the study, together with Dobaño.

This study was supported by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health through grants R01AI095789 and U01AI165745.

 

Reference

Macia D, Campo JJ, Chenjerai J et al. The effect of Plasmodium falciparum exposure and maternal anti-circumsporozoite protein antibodies on responses to RTS,S/AS01E vaccination in infants and children: an ancillary observational immunological study to a phase 3, randomised clinical trial. Lancet Inf Dis. 2024. https://doi.org/10.1016/S1473-3099(24)00527-9

Institutional

ISGlobal, with those affected by the floods

03.11.2024

The members of the Barcelona Institute for Global Health would like to express our deepest condolences to the families of the victims of the floods in the province of Valencia and other parts of Spain, and our solidarity with all those affected.

This disaster has claimed lives and devastated communities. The priority now must be to find the missing, to support the bereaved and to restore the mental and physical health of those who have survived, while at the same time working on clean-up and reconstruction. In the first days after the tragedy, basic public health measures need to be ensured to prevent possible gastrointestinal problems and outbreaks of infectious diseases. 

Unfortunately, as science predicts, extreme weather events are becoming more likely. In this context, we want to express our commitment to continue generating scientific knowledge to help us understand, mitigate and adapt to changes in our climate, and to communicate scientific knowledge to society. 

ISGlobal will also contribute to the aid to the most affected areas through a donation of material, which will be complemented by contributions from staff who wish to do so.