My names is Dr Charles Agoti, I work in the Programme as a molecular epidemiologist
and my focus has mainly been viruses and especially rotavirus.
So my job really is to use
molecular tools and bioinformatics tools to understand various pathogens.
So I work on rotavirus and as you know rotavirus is the leading cause of diarrhoea globally.
Up to about a hundred thousand children die every year, and we do have vaccines actually
against rotavirus, the disappointing bit though is that they are not working
optimally in populations that need it the most and that's the low and middle income settings.
My interest is why this vaccine is not working optimally, so I'm using
a variety of tools including genomics, molecular diagnostics
and epidemiology to understand why these rotavirus vaccines are not working optimally in our setting.
Diarrhoea is a really important public health problem in the tropics,
and my research focusing on a viral infection that we have a vaccine on
but not working optimally, is contributing to fighting illnesses in the tropics.
In particular I'm interested to know where the strains, for instance which
are circulating in the post-vaccine era, are originating from, and I'm using tools which
are now readily available including genomics to answer such a very important question.
The other thing which we know about pathogens which we are fighting at the moment and especially
viruses: they change rapidly, and once you have a vaccine in place, there is potential
that the virus will evolve and have another type that is not included in the vaccine.
So what you are doing is characterising these strains and trying to look at the vaccine
strain to understand whether there is vaccine escape, and that is going to point towards
do we need to re-think about the vaccine strains including the vaccine for instance.
So that's how I'm trying to provide information
from the best science I'm doing, such that it can go to the vaccine developers for instance.
The other thing which I might want to add on: the diagnostics are really important.
Diarrhoea is caused by a variety of pathogens, in particular we have up to 30 agents
and by involving my work which looks at how molecular tools can address that,
I'm able to tell you whether an infection is not from rotavirus, and that can stop for instance
giving unnecessary antibiotics, or if an infection is from a parasite, so it helps the clinician
know when a child is coming in with an infection, whether they need to give them a set of treatments
or preventative measures, and that's all important in addressing problems at the tropics.
Some very important lines of research have developed actually in the
last couple of years, for instance understanding how co-infections influence vaccine immunity.
When a child receives that vaccine, what other infections they have in the gut,
and how that influences how they are going to respond to the vaccine.
When you're seeing a child at the hospital you're finding them with rotavirus, what other infections
they have? It could be actually rota, it's just a bystander in such a child.
So things to do with reinfections: there are children who get repeatedly infected with this
virus for instance, so that's really important to understand.
Genomics is another area which has developed in the last couple of years - how can we utilise and
stop what's coming through genomics to understand infections in the tropics and we are trying to
understand genomic variation to help us understand vaccine escaping mutants to help us develop
diagnostics, so those are some of the new lines of research which are now developing and emerging.
It's really important for us to invest in understanding,
for instance, why vaccines are sub-optimal in populations that need them the most,
especially in the low and middle income countries,
because for every improvement of vaccine effectiveness you increase, you are saving lives.
My research fits into translational medicine indirectly; as I started from the beginning,
I'm more of at the basic science level, but this is part of the continuum of how
you get the understanding of a pathogen in the lab to how you develop a product in the end,
and by understanding what characteristics we have of the viruses we see in children who come to
the hospital, that's going to inform how we're going to constitute the vaccine for instance.
By understanding which strains are still in circulation and understanding where they are
coming from, even when you're vaccinating, it's going to help us point where we need to focus our
intervention mechanisms for instance, so we are producing information at the best
level for instance of how much co-infections are occurring and that's going to help for instance
public health experts know what else they need to do at the community to prevent children
from carrying these infections that we find as co-infections in the real cases at the hospital.