“Avian flu viruses are a cause for concern, but so are sexually transmitted infections. We have many fronts open”

The mission of Isabel Jadoin front of the National Center for Microbiology (CNM)an organisation dependent on the Carlos III Health Institute (ISCIII), is to support the National Health System in the diagnosis and control of infectious diseases. From here, the different teams it coordinates act as a Reference Laboratory for activities focused on the early diagnosis of human infections and the maintenance of Surveillance programmes.

During Covid and before his appointment, Jado led a Rapid Response PCR group, he is now the visible face of a center with 13 Reference and Research Laboratories where 264 people work.

When the pandemic broke out, she worked “like a beastlike all the professionals of this center, with incredible camaraderie and unity”, leading a Rapid Response PCR group. He has participated in the resolution of the main threats to Public Health that our country has had: suspicion of bioterrorism with spores of Bacillus anthracisin 2001; SARS-CoV-1, in 2003; Influenza A, in 2009; Ebola virus, in 2014; description of the first autochthonous cases of Crimean-Congo Hemorrhagic Fever (CCHF), in 2016; SARS-CoV-2, in 2020; and MonkeyPoxin 2022, among the most notable.

However, this scientist who has always been at the forefront, in alerts and emergencies, describes the pandemic as “a before and after”. “In 2014, in Spain, we witnessed the first description of a patient positive for Ebola disease outside an endemic area. This fact was very shocking, but Covid-19 was another leap. On January 11, 2020, our laboratories had the complete sequence of SARS-CoV-2, because it was released by China.

Would we be ready for a second pandemic of this magnitude? He snorts and takes a breath. “It would be hard!” But it does not take long, nor does it hesitate, to list the key steps to follow. «I would work as I did then but, from my current perspective, I think that, first of all, in the event of any indication of suspicion of the beginning of a pandemic, I would meet with the CNM laboratory involved to assess how prepared you are“Adequate and effective preparation and response to any public health threat is essential.”

Jado then puts on the table the creation of a Contingency Planthe ministerial coordination (“with Health, Science, Innovation and Universities, Foreign Health and other possible organizations involved, Environment and Agriculture”) together with the International connection with WHO and ECDC; and does not forget any possible actor, “I would try a collaboration or some type of agreement with private entitiespharmaceutical companies or laboratories of essential material to be provided with all the resources”.

The CNM, which has always been in the background, little known, “has been always resolving important health situations of our country in the field of infectious diseases.”

And remember that when we started talking about the Chinese cases, “at the CNM we were already testing how it could work because we had SARS-CoV-1 from 2003. In fact, on January 31, 2020, our center confirmed the patient 1 from Spain, in La Gomera. A center like this has been preparing for potential emergencies for a long time, but we were unaware of this avalanche. Before the country was closed, at the CNM, the Respiratory Laboratory and the Rapid Response group were already there. done, outside working hours, more than 1,000 PCR tests for all suspicions“.

IMPACT ON DECISION-MAKING

From that he takes the positive side: the Visibility of Microbiology and the role it plays in Medicine. “The laboratory information, the characterization of the pathogenic agents, are essential for all the decisions that will be made later, including the consequences of prevention in Public Health measures.”

Because he insists that “Outbreaks of microorganisms do not stop; Problems are continually emerging and we must be prepared.” And he highlights that it is very important “to continue supporting the National Health System in resistance, in fungi, in parasites… We must not forget that in 2022 MonkeyPoxlast summer botulism…”. For this reason, she is a firm defender of all the previous processes that they carry out before a specific outbreak. “Although we work in situ, there are previous years of research and preparation. Otherwise, it would be impossible to give answers.”

An example? “When it appeared MonkeyPoxin less than a week we had the complete sequencing of several patients and we knew that the lineage that was circulating was the least pathogenic. We were the third country in Europe, after the United Kingdom and Portugal, to sound the alert about what MonkeyPox was expanding.”

But in addition to these viruses, the CNM also has as targets other pathogens“Right now, there is some concern about whooping cough, because there are many outbreaks. There is also meningococcal meningitis, multi-resistant tuberculosis, as well as other multi-resistant bacteria, which are very worrying in the case of nosocomial infections, and more recently, hepatitis A.”

The enumeration of Threats seem endless. “Avian flu viruses are worrying, the emergence of a new flu requires attention, but sexually transmitted infections (STIs) are also growing. We have many fronts open.”

All of this makes the WHO insist on preparing now for the arrival of a new pandemic. The key is when it will arrive. How are they prepared at the CNM? Its director points out that in influenza, for example, the Respiratory Laboratory is a reference collaborating centre, together with the one in Valladolid, of the WHO. And in Europe, thanks to a series of ECDC grants, from October “we will be one of the five European reference laboratories in validation of diagnostic devices in vitro for blood-borne agents.”

New horizons for improvement at the CNM

There is also a large project to install a Laboratory of Biosafety Containment Level 4 (BSL4)the highest level of biosecurity, “and one of the few that will exist in Spain, where we will be able to cultivate level 4 pathogens, such as Crimean-Congo, for example. All suspected cases of viral hemorrhagic fever can be studied here and we will be able to conduct research.”

Without a doubt, the ‘expertise’ of CNM professionals is an undoubted fact that, however, has been reinforced by the support of technological innovation and which, according to Jado, is essential to continue advancing. “For example, the massive sequencing of complete genomes, although it was already carried out and reported to the ECDC, is being implanting and expanding to many other groups of pathogens“It is the way to carry out a complete characterization and to know if an agent is increasing its pathogenicity, if it is changing, if a new strain has been introduced from other geographic areas, both through the passage of migratory birds and by people, and produce small outbreaks of diseases that were not in our country.”

And he does not hesitate, therefore, to point out that “excellent microbiological surveillance involves the massive sequencing of complete genomes. More and more laboratories are signing up for this technology that not only provides information, but also It is essential to seek treatmentsto provide more information for vaccines. The technique opens up a whole range of possibilities.”

As the ‘visible head’ of almost 300 professionals, he believes that there are margins for improvement. “I think that we scientists would like to have more resources, especially support from laboratory technicians because we lack hands. The laboratory technicians They are the ones with the greatest needs because they are burdened with a heavy workload, yet their professional careers are more inflexible.”

The Science Law indicates that it is something that must be developed, “but it is still in a very incipient way. I would focus the effort on giving them more opportunities for training, developing their professional careers and also growing their salaries. In definitively, that they had a greater perspective for the future”.