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Wits scientists pioneer vaccine to safeguard pregnant women against stillbirth and infant death

- Wits University

A global study of GBS, bacteria that cause stillbirth and infant death, shows that Africa has the highest incidence. Wits University is pioneering a vaccine.

Scientists at the Wits/Medical Research Council Respiratory and Meningeal Pathogens Research Unit (RMPRU) have contributed to the first comprehensive study of Group B Streptococcus (GBS), which are bacteria that infect pregnant women and cause stillbirths and severe invasive disease and death in infants.

Africa has the highest burden of GBS with 54% of estimated cases and 65% of stillbirths and infant deaths.

The GBS burden of disease analysis involved more than 100 researchers from around the world and the published supplement comprises 11 research papers. Conservative estimates show that GBS infection causes some 150,000 preventable stillbirths and infant deaths every year.

Professor of Vaccinology, Shabir Madhi, who is director of the RMPRU, the DST/NRF SARChI Chair in Vaccine Preventable Diseases, and Executive Director of the National Institute for Communicable Diseases, contributed to the study.

“This research is especially important for South Africa, where the highest incidence of invasive GBS in young infants globally has been reported for the past 20 years. Furthermore, we have shown recently that at least 1250 South African women will have a stillbirth due to GBS each year,” says Madhi.  

Professor Shabir Madhi

The GBS burden of disease analysis, funded by the Bill & Melinda Gates Foundation, includes data and estimates for the year 2015 from every country worldwide and includes outcomes for pregnant women, their babies and infants. Previous data on GBS burden focused on infant cases and high-income countries, but the impact of GBS disease worldwide, especially in Asia, was less clear. 

The new research found GBS colonise the rectum and vagina of pregnant women in all regions of the world, and an average of 18% of pregnant women worldwide carry (are colonised with) GBS, ranging from 11% in eastern Asia to 35% in the Caribbean, and totalling 21.7 million in 195 countries. 

Although several vaccines to prevent GBS are in development, none is currently available – this despite GBS accounting for more than the combined neonatal deaths from tetanus, pertussis, and respiratory syncytial virus, for which maternal vaccines are already in use or further advanced in development. 

The GBS burden of disease analysis shows for the first time that a maternal GBS vaccine, which was 80% effective and reached 90% of women, could potentially prevent 231,000 infant and maternal GBS cases. 

Madhi and his team at the Wits MRC Respiratory and Meningeal Pathogens Research Unit recently completed the first study of an investigational GBS vaccine in pregnant women, the results of which were published in the prestigious Lancet Infectious Diseases journal. The unit is also investigating the potential of other components of GBS as potential vaccine targets.

Dr Keith Klugman, Director of the Pneumonia Team at the Bill & Melinda Gates Foundation and Wits Medical School alumnus, says:  “The first few days and weeks of a baby's life are the most vulnerable by far. By filling in one of the great voids in public health data, this work provides crucial insight and shows the pressing unmet need for the development of an effective Group B Strep vaccine. Immunizing expectant mothers is a potentially ground-breaking approach that could dramatically reduce the number of maternal and child deaths.”

About Group B Streptococcus 

  • GBS is carried by up to a third of adults, usually with no symptoms.
  • In women, GBS can live harmlessly in the digestive system or lower vaginal tract, from where it can be passed to the unborn baby through the amniotic fluid or to newborns during labour.
  • Babies are more vulnerable to infection as their immature immune systems cannot fight off the multiplying bacteria.
  • If untreated, GBS can cause serious infections, such as meningitis and septicaemia, which may lead to stillbirths, and newborn and infant deaths. If they survive, babies can develop permanent problems including hearing or vision loss, or cerebral palsy.
  • Current GBS prevention focuses on giving antibiotics to women in labour to reduce disease in infants at delivery. At least 60 countries have a policy for antibiotic use in pregnancy to prevent newborn GBS disease. Of those, 35 have a policy to test all pregnant women to see if they carry GBS, and the remaining 25 countries identify women with clinical risk factors. However, implementation of these policies varies around the world.

World-renowned Wits vaccines prof to chair SA medicine regulatory board

- Wits University

The Minister of Health has appointed Wits Professor Helen Rees to chair the Board of the South African Health Products Authority.

Dr Aaron Motsoaledi appointed Professor Helen Rees, Executive Director of the Wits Reproductive Health and HIV Institute (Wits RHI) as Chair of the SAHPRA earlier this month.

SAHPRA, which replaces the Medicines Control Council (MCC), will ensure that the medicines in South Africa are safe, effective and of good quality.

Rees has extensive experience in the field of medicines regulation and on governance boards. She has served on many regulatory committees, including being the current and previous Chair of the MCC (1998-2002; 2014 to present). She is recognised by her peers to be an exceptional leader of the MCC.

Between 2011-2014, Rees chaired the SA Health Products Technical Task Team to advise the Director-General of Health and the Health Minister on the legal and operational transition from the MCC to SAHPRA, including prioritisation of the transformation agenda.

Her experience has given her extensive knowledge of medicines regulation, including as Chair of MCC’s Pharmacovigilance Committee (2001), Chair of MCC’s Clinical Trials Committee (1997-1998) and as a member of MCC’s Clinical Committee (1996-1998).

Telling Teeth

- Wits University

More accurate aging of teeth could hold the key to identifying health-compromised children in Africa.

Population-based data on human biological growth and development processes are fundamental for assessing the health status of a community. For many populations in rural Africa, birth registry and eliciting date of birth are still challenges. Data on uncompromised development and growth variation in most developing populations are surprisingly lacking, and researchers typically compare growth in the population of interest to standards that are formulated for European or US children.

Wits University anatomical science and community dentistry researchers, however, believe that more accurate aging of teeth could hold the key to identifying health-compromised children on the African continent. The researchers, who are investigating dental development as a more reliable gauge for assessing the age of children and juveniles in forensic and anthropological contexts, recently published a systematic review of dental development assessment methods to determine the best and most accurate means to estimate chronological age in different populations. 

One growth stage from the Dental Development Atlas formulated by Esan and Schepartz for South African black children shows dental development at age 6.5 years.©Esan and Schepartz March 2017

According to Professor Lynne A Schepartz, Associate Professor and Head of the Biological Anthropology Division at Wits and co-author of the paper, “It is important to accurately estimate chronological age from a sample of living children in the population of interest, because this information can then be used as a benchmark for evaluating the growth of health-compromised children. Our review illustrates that there is significant population-level variation in the tempo of dental development.”

Their review focused on studies investigating the predominant dental development assessment methods - the Demirjian and the Willems methods - in different populations with the aim of determining the more accurate method.  The findings conclude that the Willems method of dental age estimation provides a better and more accurate estimation of chronological age in different populations than the Demirjian method. Still, the ages of children in most populations are over-estimated using that method. 

The findings have implications for growth assessment in general, and the use of global standards that are largely untested in African populations. The research highlights the need for population-specific standards for age estimation, as their use extends beyond basic biological anthropology and health research.

The Wits researchers say the information from dental development may play a major role in determining many clinical decisions, including choices about treatment options and sequence of treatment in the future.

Wits leads innovative African laboratory network initiative

- Wits University

The Wits-led African Innovation Laboratory Network (iLEAD) launched today with a mission to integrate and optimise laboratory systems to improve patient care.

Wits School of Pathology researcher, Professor Wendy Stevens and her team lead the African Innovation Laboratory Network - iLEAD (Innovation: Laboratory Engineered Accelerated Diagnostics) - an initiative to advance innovation in medical pathology laboratory systems and diagnostics.

iLEAD aims to integrate laboratory systems and tackle obstacles to often-neglected laboratory space in Africa. iLEAD will stimulate new ideas and processes for diagnostics and laboratory systems specifically as well as innovate across the laboratory value chain generally. Wits is the SA and managing partner in iLEAD, an initiative that aims to integrate and advance laboratories across Africa“We hope that, in addition to diagnostic and pathology services, we can stimulate new approaches to unique patient identification, sample collection and logistics, as well as continuous quality monitoring and connectivity. We also intend to explore big data management and a variety of innovative pathology and molecular solutions,” says Stevens, who is an expert in laboratory medicine and a specialist in haematology and has driven multiple innovations in pathology services.

Her team of researchers established the first HIV laboratory in the National Health Laboratory Services (NHLS). Most recently the team implemented the WHO-endorsed TB diagnostic test, Gene Xpert, at scale across  64 centres, making this the leading global programme for molecular implementation of gene Xpert testing globally. 

The iLEAD network comprises three collaborating centres in South Africa, Mozambique and Senegal respectively.  Professor Souleymane Mboup will lead the centre in Senegal and Dr Ilesh Jani, Mozambique. Stevens, who is head of Molecular Medicine and Haematology at Wits, head of the National Priority Programme of the National Health Laboratory Services (NHLS), is responsible for the South Africa centre and for the overall project. These researchers are familiar with the unique implementation and maintenance of laboratory services required in Africa at scale.Professor Wendy Stevens is head of Molecular Medicine & Haematology at WitsiLEAD’s network merges expertise within the fields of basic science, research and development, clinical research, implementation and translational science, marketing and business development, to accelerate the introduction of novel solutions for African and global health security. iLEAD, which was established with seed funding from the Bill & Melinda Gates Foundation, will leverage public-private partnerships to help drive tailored innovations towards these goals. 

iLEAD will establish an Innovation Pipeline to help innovators develop products from ’concept and design’ through ’clinical validation for launch readiness’. As successful innovations exit the pipeline, they will be introduced to iLEAD’s network of implementing partners to drive real-world impact on patients.

New Centre of Centre of Excellence to focus on early human behaviour

- Wits University

Collaboration between Wits and the new CoE at University of Bergen is essential to answer some of the most fundamental questions about our ancestry.

A new Centre of Excellence in early human behaviour at the University of Bergen in Norway will aim to address unanswered questions about our species.

Professor Christ Henshilwood at the opening of the new SapienCEHeaded by Wits Professor, Christopher Henshilwood, the Centre for Early Sapiens Behaviour (SapienCE), was officially launched at the Bergen University’s Department of History, Archaeology, Cultural and Religious Studies recently.

“The Centre will directly address unanswered, first order questions about Homo sapiens, such as what defines the switch to ‘modern behaviour’, how exactly should this term be defined and why and how did this switch occur,” says Henshilwood.

“One of the other questions that we aim to answer is ‘were there changes in the human brain at that time that accelerated behavioural variability and how can these be measured now?’.” 

Henshilwood holds the South African NRF SARChI Chair in Modern Human Origins, which was recently renewed. The new CoE programme is operated by the Research Council of Norway, which finances  the activities of Norway’s foremost scientific environments in centres to achieve ambitious scientific objectives through collaboration and long-term basic funding. It has close links to Wits, with several staff members having links with Wits, including Professor Bruce Rubidge, who serves on the SapienCE board.

“The establishment of the SapienCE in Norway is a huge achievement for Professor Chris Henshilwood. As Director of the Centre of Excellence in Palaeosciences in South Africa I am excited about the close collaboration between these two centres of excellence. This will bring a great deal of local and international research attention to the remarkable Middle Stone Age sites of the Southwestern Cape which are providing ground breaking new understanding of early human behaviour,” says Rubidge.

Henshilwood believes his work in Blombos Cave and Klipdrift Shelter in the southern Cape has laid the foundation for the need to establish a Centre of Excellence in human origins research.

“Over the past 20 years, archaeological evidence from the Middle Stone Age in Africa has rapidly changed perceptions of the behavioural variability and adaptive strategies of these early humans,” says Henshilwood. “Our research in the southern Cape, since 1991, has uncovered unprecedented new evidence for the evolution of early Homo sapiens in southern Africa.”

Some of these major discoveries related to the advanced technology that early humans developed. It also included the earliest evidence for the making of a pigmented compound, as well as the first known use of a combination of heating and pressure flaking to create finely-crafted stone tools.

There are a lot of questions about our early development to still be answered by the SapienCE, says Henshilwood. The centre will focus on seven different research questions in the next 10 years.

“The starting point is simple. We all come from Africa. I am certain that in the next five or 10 years, we will have a completely new understanding of human behaviour.

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