Global health improvement targets announced on World Aspergillosis Day

Aspergillosis, lung and sinus disease caused by the fungus Aspergillus, affects around 15 million people and kills over 1 million each year.  Announced today at the 8th biennial Advances against Aspergillosis international conference in Lisbon starting on February 1st (World Aspergillosis Day), are the 5 Aspirational targets for aspergillosis to be achieved by 2030:

  1. Survival in invasive aspergillosis increased to 90% (up from under 50%)
  2. New antifungal agents licensed for all major forms of pulmonary aspergillosis (invasive, chronic and allergic) and for all age groups (only 3 classes currently available)
  3. The biological, immunological and genetic basis of aspergillosis understood (major gaps in our understanding currently)
  4. Diagnostics (standardised and clinically validated) for disease widely available and simple screening tests developed (most countries, including all of Africa have no diagnostic capability at all)
  5. At least one vaccine against aspergillosis in clinical trials or approved (none currently).

At the conference opening session, Professor David Denning, President of the Global Action Fund for Fungal Diseases (GAFFI) and the University of Manchester spoke on behalf of patients, doctors, and researchers in calling for radical improvements. Because diagnostics are not available in so many countries and cities, hundreds of thousands of people unknowingly die or are disabled by aspergillosis, yet could be saved or cured. He said:

 

“I have been looking after patients with aspergillosis for over 35 years, and yet we still lose patients and see too many people severely affected by this common fungus. I contributed to many clinical studies bringing the first effective oral drugs to patients (itraconazole and voriconazole), and yet the burden and deaths remain huge. Nothing less than a concerted international effort is required to address huge disparities in aspergillosis frequency.”

 

2018 marks the 20th anniversary of The Aspergillus Website www.aspergillus.org..uk), which the Fungal Infection Trust has been supporting. It provides a truly encyclopedic resource (>100,000 pages)  and news feed to the world at no cost to the user, thanks to its many supporters over decades. Together with its sister Website for Patients (www.nacpatients.org.uk), they attract over 125,000 users per month, indicative of the need for information. In 2012, the Fungal Infection Trust launched a global educational website Life Worldwide (www.LIFE-Worldwide.org), in English and Spanish, which is also highly utilised.

The Advances in Aspergillosis conference series held alternate years, is the premier forum for detailed and dedicated discussion of all aspects of aspergillosis, attracting over 350 delegates from 35+ countries. Topical issues include: pan-azole and echinocandin resistance has emerged and requires unique approaches, new opportunities for both antifungal agents and immunotherapies in chronic and allergic aspergillosis, better molecular and low-cost strategies for diagnosis and publication of several recent clinical guidelines for clinicians offer detailed guidance.

Other major needs for health improvements in aspergillosis include:

  • Keeping homes free from excessive Aspergillus and other moulds, related to dampness, and therapy reduce asthma cases and severity
  • Hospital environments for vulnerable patients free of Aspergillus
  • Improvement in the public’s awareness of fungal diseases and specifically aspergillosis
  • Reduction in azole resistance with reduced use of azole fungicides in non-essential crops
  • Prevention of a new epidemic of resistance with any new classes of antifungal used for aspergillosis by not allowing such chemical class to be used as a fungicide
  • Need for better surveillance and detailed epidemiology data
  • Development of immunotherapies as well as vaccines

Patients’ Stories

Patients are often diagnosed with one of the several different types of aspergillosis after a considerable time spent being treated for different medical problems for example tuberculosis or asthma. Aspergillosis is often only considered when treatment for their pre-existing condition becomes ineffective, and by that time aspergillosis can be well established. There is a pressing need for tests that may diagnose aspergillosis in all its forms more quickly. As we discover more about the genetics of vulnerability to aspergillosis it may also be possible to start screening high-risk populations for early treatment.

Nasilele describes her experience of living with CPA after a prior diagnosis of Tuberculosis and then having a severe cough that did not respond to antibiotics.

This patient describes his experiences with childhood asthma and Allergic Bronchopulmonary Aspergillosis (ABPA). After persistent chest infections and continuous steroids and a bad productive cough, Aspergillus was cultured from his sputum in 2002. His difficulties with adverse effects caused by his antifungal treatment illustrate the need for new, alternative medication.

Resources mentioned

World Aspergillosis Day Feb 1st www.aspergillosisday.org

Advances Against Aspergillosis www.AAA2018.org

Fungal Infection Trust www.fungalinfectiontrust.org.uk

Aspergillus Website www.aspergillus.org.uk

Aspergillosis Patients website www.nacpatients.org.uk

LIFE-Worldwide (Fungal disease education & awareness) www.LIFE-Worldwide.org

World Aspergillosis Day is Feb 1st, click here for more detail

Editor-in-Chief , National Aspergillosis Centre
Editor-in-Chief, Research Associate for the National Aspergillosis Centre and PPI Lead for Respiratory Section of the Manchester Biomedical Research Centre