Jesús Oteo is the director of the National Microbiology Center (CNM) of the ISCIII since last September, a reference center for the National Health System (SNS) for the diagnosis and investigation of infectious diseases. The CNM works with surveillance programs, characterizes microorganisms, handles microbiological alerts and offers rapid response to possible outbreaks and threats to public health, in addition to training and dissemination.
Oteo is Doctor of Medicine from Complutense University of Madrid (UCM), specialist in Microbiology and Clinical Parasitology and he is responsible for the Reference and Research Laboratory in Antibiotic Resistance of the National Center for Microbiology. He is member of the Spanish Society of Infectious Diseases and Clinical Microbiology, expert of the National Plan against Antibiotic Resistance (PRAN) and partner of the European Center for Disease Prevention and Control (CDC).
He is the author of the popular book 'Antibiotic resistance: the threat of superbugs'. In addition to 'getting lost' among microorganisms, he likes to do it in nature, especially in the mountains. A conversation with Oteo is enough to see that he has an enormous facility to condense ideas and convey clear and simple messages.
QUESTION: CNM is a reference in the study of infectious diseases, is it a complex task?
ANSWER: Throughout history, infectious diseases have produced an enormous impact on human health, generating billions of deaths, great morbidity and even conditioning some of the historical processes that have shaped the moment we are living now. Introduction of antimicrobials and vaccination campaigns in clinical practice, as well as hygienic-sanitary improvements, have reduced the relative weight of infections with respect to tumor or cardiovascular diseases, especially in Western societies.
However, infectious diseases remain a major health issue. In fact, every human being suffers some infection throughout his life; infections such as tuberculosis, AIDS, malaria, among many others, generate major epidemics worldwide; the increase in antimicrobial resistance makes it difficult to treat infections that not long ago were easily cured; and the appearance of variants of known microorganisms causes some vaccine-preventable infections to reemerge.
QUESTION: What work does CNM do?
ANSWER: The work is based on four main pillars such as diagnosis of infectious diseases, their control and prevention, research, and referral and advice. The main task is to support the National Health System (SNS), and it can also be summarized in the following four main actions:
- To support health care work of the SNS through laboratory diagnosis of infections, especially those emerging or infrequent. The maximum exponent of this function is the participation in diagnosis of health alerts, for which we have a rapid response system.
- To act in the control of pathogens dissemination, through characterization of outbreaks by molecular techniques, and of possible ways of expansion of clones of especially dangerous microorganisms.
- To investigate, mainly supported by the new technologies that allow us, for example, to analyze and compare the complete genomes of a large number of microorganisms. The results of these investigations may allow us to detect new therapeutic and diagnostic targets as well as to develop new vaccines.
- To advise the SNS on emerging pathogens or new mechanisms for both antimicrobial resistance and virulence, and on the implementation of new protocols or laboratory techniques. Here we can also highlight the importance of the informative work and dissemination of information aimed at the population.
QUESTION: What kind of professionals work at CNM?
ANSWER: CNM staff consists of more than 190 workers, including: researchers specialized in the field of infectious diseases (mainly biologists, doctors, pharmacists and chemists), technical personnel highly qualified in phenotypic and molecular techniques, and other laboratory support staff.
QUESTION: How would you explain the main CNM work to someone who does not know about this center and who had limited knowledge about science, health research and the health system?
ANSWER: We have all suffered some kind of infection throughout our lives. We have relatives, friends, acquaintances who have had some infectious disease, mainly those more complicated or with greater severity. These infections are caused by microorganisms such as bacteria, viruses, fungi or parasites. All of them are living beings, and therefore, like everyone else, they evolve, adapt to the environment, reproduce, transmit ... and, in addition, they do so much faster than we do, the "more evolved" living beings. Detecting and knowing in detail all these behaviors and modifications of microorganisms help us to diagnose, treat and effectively prevent infections that may occur. That's what we do at the CNM.
QUESTION: What do you think are the most significant contributions of CNM during its years of life?
ANSWER: Since its creation in 1986, the CNM has served as a reference for diagnosis and investigation of infectious diseases, especially those difficult to address by hospitals of the SNS. At first CNM had its main contribution in viral infections, microorganisms whose isolation and management is more complex and needs cell cultures. Contributions to the study of HIV are a good example of this. Over the years, CNM quickly expanded its influence to other branches of infectious diseases. For example, it became a reference center for phylogenetic studies that allow characterizing outbreaks, defining the genetic similarity between different strains of microorganisms.
Many specific contributions could be highlighted, but some of the most significant are the approach to health alerts generated by viruses that cause hemorrhagic fevers, such as dengue or Ebola; the study of respiratory viral infections such as influenza; the implementation of advanced genomic sequencing techniques for the study of health alerts such as the recently produced by listeria; or the characterization of emerging bacterial strains with multi-resistance to antibiotics.
QUESTION: How does CNM collaborate with other centers and structures of the National Health System?
ANSWER: CNM maintains a close collaboration with the National Center for Epidemiology (CNE), which also belongs to ISCIII, for control and prevention of infectious diseases. The complexity in the management of large epidemics or health alerts due to pathogenic microorganisms makes the multidisciplinary and coordinated approach indispensable if efficacy needs to be achieved. From this point of view, it is necessary to promote joint work of microbiologists, clinicians and epidemiologists, among other health professionals.
The development of National Plans to fight against specific health problems of infectious origin, in which professionals from both CNM and CNE actively collaborate, is an example of the promotion of this work. In addition, the reference and research work of CNM is based on the great work of Scientific-Technical Central Units of the ISCIII, such as Veterinary, Bioinformatics, Electronic and Confocal Microscopy, Flow Cytometry and Genomics.
QUESTION: The National Center of Microbiology is known, among other tasks, for its technical support work in the management of health alerts, such as those experienced with influenza A, the Ebola virus, the disease known as the 'crazy cows' or the most recent listeriosis outbreak. How does the center's reference work contribute and why is it so relevant?
ANSWER: CNM has a Rapid Response System of 365 days a year that allows responding to health alerts that require it. In infectious diseases, early diagnosis is a key for both, at the patient level, to establish an early and effective treatment, and at the population level, to implement the necessary measures that minimize its dissemination. At present, the structure of CNM is based on existence of Reference and Research Laboratories that address large areas of interest in Infectious Diseases.
A Reference Laboratory provides the SNS with different techniques and methodologies for primary diagnosis or confirmation, and also for the characterization of microorganisms that, due to their complexity, infrequency or recent appearance, are not usually carried out in the SNS service portfolio. This characterization includes phenotypic studies (such as resistance or sensitivity to antibiotic treatment), genetic analysis of individual strains (presence of resistance genes of greater or lesser virulence), and phylogenetic studies that allow comparing different strains to see if they are part of the same outbreak.
In addition, the work of a Reference Laboratory includes the scientific-technical advice to the health system, and the maintenance of the material that guarantees the quality to attend to those centers that request it.
QUESTION: What are the main challenges and objectives of the CNM in the coming years??
ANSWER: The microorganisms that cause infectious diseases have the ability to evolve very quickly, which forces them to be in continuous adaptation to be able to face them in optimal conditions. Therefore, one of the main challenges of the center, and in general of clinical microbiology, is to be constantly prepared to respond to threats that the emergence of new microorganisms, or the variation of those already known (new variants, new resistance mechanisms, new virulence mechanisms ...) can generate. The rapid development of new technologies, and their application in the health field, is another great challenge.
The ability to sequence the entire genomes of pathogenic microorganisms generates a large amount of information for which at the moment, we only take advantage of a small part. The ability to jointly analyze huge amounts of data, both microbiological and genomic and clinical, through "big data" techniques, allows us to develop algorithms that can become very useful in the management of certain infections, for example by improving their prognosis. It would be important to promote the development of large clinical-microbiological databases that would allow us to move towards a personalized medicine for infectious diseases.
I also believe it is important to mention the paradigm change that is taking place in the surveillance of infectious diseases with the development of National Plans against certain infectious health problems. CNM will have to adapt to vertebrate and coordinate new pyramidal surveillance structures with the participation of multiple hospitals and centers organized by different reference levels.
QUESTION: What message would you send to society about the importance of managing public health alerts?
ANSWER: The early detection and characterization of the microorganisms causing health alerts is key to establish an effective treatment and to limit the risk of transmission. Proper management of public health alerts requires a multidisciplinary approach and adequate coordination between professionals from different fields and between institutions. Without forgetting the importance of information towards society: clear and easily understandable data must be transmitted, trying to minimize contradictory messages and avoiding unnecessary alarms.
QUESTION: What are the global challenges of microbiology research today?
ANSWER: Beyond those mentioned previously, I would like to highlight that the progression of the so-called public health microbiology, in which the activity of CNM is fully accommodated, and requires a greater coordination. Multiple national and international initiatives to address common issues do not always come together properly. The only way to succeed in this field is to act in coordination beyond geographical, professional or institutional barriers. Microorganisms know no borders, and with current means of transport they can cross the world in just 24 hours. The coordination of initiatives is key in research, both in the search for synergies and in the improvement of the use of resources. The creation of national and international research networks are a good example of this.
QUESTION: How do you think communication and dissemination of science and health can be promoted and improved?
ANSWER: The dissemination of knowledge, science and research is simply vital, what is not known is almost as if it did not exist. The idea that science and research must be in a "superior" status than the rest of society, not to mix with it, because neither society is able to properly understand scientific concepts, nor science should be influenced by the society. It is simply false and anachronistic. Science is part of society, and must be primarily aimed at improving its conditions. The needs of society should largely guide the objectives of the research.
To enhance this interrelation, society must understand the advances of knowledge, and know what is being done and for what. Adapting the language and scientific concepts for dissemination to non-experts is a subject which can sometimes cost, but of course it is possible, advisable and rewarding. Everyone must be able to participate in science. All this, which is of general applicability, is especially true and transcendent in the field of health, with which all people are especially sensitized. Among many other advantages, the generalization of adequate health information helps to manage and optimize health resources in a consistent way.