JAPAN

India is the global TB epicentre - the country records 2.8 million new TB cases annually.

A vaccine which could "revolutionise" tuberculosis treatment has been unveiled by researchers.

It is hoped the vaccine will provide long-term protection against the disease, which kills 1.5 million people around the world each year.

The highly contagious disease is caused by bacteria, and the current vaccine, the BCG jab, is not very effective. However, while initial trials have proved successful, the vaccine is still a few years away from being licensed.

The team of researchers, who come from all over the world, revealed the vaccine, which is made up of proteins from bacteria which trigger an immune response, during a global summit on lung health in the southern Indian city of Hyderabad on Tuesday.

It has already cleared a critical phase of clinical trials and been tested on more than 3,500 adults in TB endemic regions of South Africa, Kenya and Zambia, researchers said.

Why is the vaccine "revolutionary"?

David Lewinsohn, a TB expert, told the BBC the potential vaccine was a "real game changer".

"What is really remarkable is that it was effective in adults who were already infected with Mycobacterium tuberculosis that is the causative agent of TB," he said.

"As most people who are infected with Mycobacterium tuberculosis do not get TB, we have believed that infection confers some degree of protection. As a result it is really exciting that a vaccine has been shown to improve on this natural immunity."

Dr Lewinsohn said the new vaccine had cleared a key "mid-phase development, and it is designed to test both safety and to provide an early indicator of efficacy".

"It is likely that the vaccine will need to be tested in additional populations, and possibly bigger trials before it will be licensed. Assuming the data holds up in the remaining trials, which seems likely, this vaccine has the potential to revolutionise TB treatment."

How long will it take for the vaccine to reach the market?

Dr Lewinsohn estimates that, if all goes well, the vaccine should reach people who most need it by about 2028.

Researchers say proving that the vaccine works often requires studies that are much larger than required for viral diseases such as measles. Drug firm GlaxoSmithKline (GSK) has been working on the TB vaccine for nearly 20 years.

To progress, a vaccine must show efficacy in animals, usually mice, but also guinea pigs and non-human primates.

One reason developing a TB vaccine is a challenge, say researchers, is that "animal models often do not reflect what we would like to see in an effective vaccine".

For example, in the mouse, TB tends to be an "indolent disease" and researchers might define success as a roughly 10-fold reduction in the number of bacteria in the lung.

This is encouraging, but a child with a tenth of the bacteria still has TB.

How serious is the current situation?

In 2018 an estimated 10 million people fell ill with TB, according to the World Health Organization (WHO).

Nearly a quarter of the world's population has latent TB infection. This means they carry the bacteria in an inactive form, are not ill and do not transmit the disease to others. People with latent TB have a 5 to 10% risk in their lifetimes of developing active TB.

Meanwhile, multi-drug resistant tuberculosis (MDR-TB) - a type of tuberculosis which is unresponsive or resistant to at least two of the first line of anti-TB drugs - continues to be a major public health threat. Drug-resistant TB is harder and more expensive to diagnose and treat.

The WHO aims to reduce the number of new TB cases by 90% and the number of TB deaths by 95% between 2015 and 2035.

Which countries are the worst affected?

Eight countries account for two thirds of global TB cases: India (27%), China (9%), Indonesia (8%), the Philippines (6%), Pakistan (6%), Nigeria (4%), Bangladesh (4%) and South Africa (3%).

With slightly more than one in four of all estimated global cases, India has the highest burden of TB cases in the world. The country records nearly three million new tuberculosis cases annually, of which more than 100,000 are multi-drug resistant, according to the WHO. The disease also kills 400,000 Indians annually, and costs the government around $24bn ($18.68bn) annually.

"We cannot eliminate TB globally unless we end it in India," said Jamhoih Tonsing, director of the International Union Against Tuberculosis and Lung Disease's office in Delhi.

The Union is convenor of the 50th Union World Conference on Lung Health being held in Hyderabad this week.

"The number of people with TB in India is falling and that is good news. But let´s be honest - TB is still not falling nearly fast enough in India, progress is still too slow to meet the targets. We need to step up the pace of treatment and prevention," she said.

(Extracted from the BBC
www.bbc.com/news/world-asia-india-50205762
30 October 2019

The following members have now retired from the Education Committee having served their long terms: Dr David Lam, former chair of the Education Committee (for an extended term), Dr Haja Mydin Helmy, Dr Guy Marks and Dr Manil Peiris. On behalf of the Society, we thank them for their long time and outstanding contribution to the APSR and the Education Committee.

Retiring committee members

David Lam Committee member since 2012 & Committee Chair until 2018

Haja Mydin Helmy Committee member since 2016

Guy Marks Committee member since 2016

Manil Peiris Committee member since 2016

At the same time, we are delighted to have received from APSR en bloc societies excellent nominations for members to join the APSR Education Committee. The 15 nominees have been approved by Chair of the Education Committee, President and Secretary General, and will join the existing 10 members of the Committee.

We are also delighted to announce a new Deputy Chair, Dr Giap Vu Van, who has kindly agreed to take on the challenging role. Working together with the Chair, Dr Arata Azuma, the Committee is poised for great achievements.

The Education Committee now comprises:

Standing committee members

Arata Azuma Committee member since 2011 & Committee Chair since 2018

Sita Andarini Committee member since 2016

Fumihiro Asano Committee member since 2016

Shu Hashimoto Committee member since 2011

Meng-Chih Lin Committee member since 2016

Henry Marshall Committee member since 2016

Patrick Gerald Moral Committee member since 2016

Chau Ngo Quy Committee member since 2016

Chin Kook Rhee Committee member since 2016

Kazuhisa Takahashi Committee member since 2011

New committee members from 2019

Giap Vu Van Nominated by VNRS New Deputy Chair

Lenora Fernandez Nominated by PCCP

Jiro Fujita Nominated by JRS

Md Ali Hossain Nominated by BLF

Albert Lim Yick Hou Nominated by STS

Asiah Kassim Nominated by MTS

Le Thi Tuyet Lan Nominated by VNRS

Asif Mujtaba Mahmud Nominated by BLF

Yasuhiko Nishioka Nominated by JRS

Hye Yun Park Nominated by KATRD

Diahn-Warng Perng Nominated by TSPCCM

Jin-Yuan Shih Nominated by TSPCCM

Arif Santoso Nominated by ISR

Yuichi Tamura Nominated by JRS

Duminda Yasaratne Nominated by SLCP

The following members have kindly sent their donation towards the Society's goals, as outlined at apsresp.org/members/donors.php.

• Dr Umar Kaleem FAPSR
• Dr Bobby Singh FAPSR
• Dr Faisal Yunus

The APSR is profoundly grateful for their generosity.

Continuing this series, we are delighted to share a tribute to Prof. Chunxue Bai, prepared by Prof. Yuanlin Song.

This series complements our APSR Members' Honour Roll, on which as a member, you are welcome to add your appreciation of your mentor(s) at any time.

Prof. Bai

Dr Bai got his MD in 1982 and PhD in 1989. He went to UCSF for postdoctoral fellow in 1996 and became a Professor of Medicine in 1997.

His major interest focusses on early diagnosis and treatment of lung cancer. He leads the group for drafting and publishing an Asia-Pacific guideline for pulmonary nodule diagnosis and treatment. He has been also working on ARDS for more than 25 years with funding from the Natural National Science Foundation. He has published more than 500 papers with 200 in peer-reviewed English journals, as well as more than 20 books. His major contribution is the application of Medical Internet of Things and AI on the diagnosis of pulmonary nodules with patterned BAIDX system.

He has served as the Editor of the American Journal of Respiratory and Critical Care Medicine and CHEST, and Associate Editor of AJP-Lung. He is also the Chief Editor of e-Health.

He has been Vice President of the Chinese Thoracic Society and President of the Shanghai Respiratory Society. He is currently President of the Medical Internet of Things Society on non-public hospitals in China and the President of the International Society of Respiratory Disease. He is also President of the Chinese Alliance against Lung Cancer with affiliation of more than 700 hospitals in China.

He has been working with the ASPR for many years. His current position is Treasurer and Chair of the Finance Committee and a member of the Central Congress Committee. He held the 16th Congress of the APSR in Shanghai, China in 2011 with more than 3,000 attendees as Congress President, leading to the great success of the congress. He has proposed and been keeping APSR-ISRD Joint Session at ATS International Conferences which has improved the influence of the APSR and provided opportunities for young clinicians and researchers particularly in the Asia-Pacific region for communication on an international platform.

Dr Song

Prepared by Professor Yuanlin Song, MD, Prof
Associate Editor, Respirology, official journal of the APSR
Associate Editor, Clinical Respiratory Journal
Chief, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China

My history with Dr Chunxue Bai started in 1994 when I came to the department for graduate study. He was one of my mentors for my research project and supported me to study acute lung injury in animal model using his funding. After graduation, Dr Bai recommended me to go to UCSF for postgraduate research study. In 2011 Dr Bai recruited me back to Zhongshan Hospital for clinical practice and research as a faculty. In 2011 I was appointed as Secretary General of the 16th Congress of the APSR in Shanghai and participated in the programme design and the speakers and attendees reception, which gave me an opportunity to learn about international conference preparation. Currently developing further activities as Head-Elect of the APSR Respiratory Infections (non-tuberculous) Assembly.

As announced in the October Bulletin, Professor J Patrick Barron died on 17 August 2019 at the age of 71, and the APSR / J Patrick Barron Medical Education Young Investigator Award was established in his honour.

An obituary by Dr Philip Thompson who worked closely with Prof Barron, can be read at onlinelibrary.wiley.com/doi/full/10.1111/resp.13721

Further obituaries will be published in the Bulletin soon.

I'm greatly honoured to have received the APSR Travel Award to attend the CHEST 2019 in New Orleans. I'd like to express my deep gratitude for the numerous supports from the APSR.

I was very pleased to have the opportunity to present our work entitled Association of Bystander-Initiated Conventional versus Compression-only CPR with Neurologic Outcome After Out-of-Hospital Cardiac Arrest due to Drowning in the Original Investigation Poster Discussion Session. In our presentation, we showed that the results of our nationwide population-based observational study of out-of-hospital cardiac arrest due to drowning from 2013 to 2016 indicated that there was no significant difference in outcomes after OHCA due to drowning between conventional (with rescue breathing) versus compression-only (without rescue breathing) CPR. Thanks to heated discussion and constructive comments, the session was very exciting and beneficial for me.

In several sessions, I got the latest updates on state-of-the-art Critical Care Medicine, and valuable take-home knowledge from cutting-edge presentations of original scientific research from all over the world.

I also attended a variety of events and exchanged scientific ideas with top clinicians and scientists from around the world. It also provided face-to-face networking opportunities with the most renowned leaders and influential critical care specialists from across the world.

Thank you again for the support from the APSR to attend the CHEST annual meeting.

It was an honor to receive such a prestigious award and to have the opportunity to participate at the CHEST annual meeting. It was my first time attending the meeting, so I was really looking forward to it.

On the first day, I had time to look around the conference center. When I first entered the New Orleans Convention Center on the 20th of October, I was overwhelmed by its size. It was much bigger than any conference center in Japan.

On the second day, I went to look at the various institutions' booths, and one of them caught my eye. That booth displayed new drainage kits which were much longer than the ones used in Japan. From the medical devices, I could see the difference between Japanese and American physiques. This was an interesting experience for me.

I acquired a lot of new knowledge and information about treatment methods by listening to others' presentations. One of the most memorable and enjoyable sessions was a luncheon seminar on severe asthma. We were put in a small group where we discussed the treatments we administered on a day-to-day basis. It was such a pleasure to talk with people from different countries and backgrounds.

Thinking about my presentation, I had butterflies in my stomach from day one. I knew the presentation would be a major event and wanted to make sure not to make any mistakes. I also wanted to mentally organize everything that I wanted to present. Furthermore, I was not familiar with e-poster presentation formats, so I was extremely nervous. But once my turn came, surprisingly I managed to control my nerves and became calmer. The presentation was very interactive, and I got several questions; fortunately, I also had time to share my opinions with the other attendees. It was an unforgettable moment for me when one of the facilitators approached me and praised my study. He said "It's a very interesting theme. It's good data showing the usefulness of forced oscillation technique." When I heard this from him, I was relieved. This was the moment when all the hard work and effort I had put into this study paid off. At the same time, it motivated me to continue my clinical studies and research.

Finally, I would like to express my deep gratitude for this opportunity. I will apply the knowledge acquired from this experience to my practice. I would also like to share it with my colleagues.

When I presented the results of my meta-analysis (a rather very controversial topic on electronic cigarettes), I was really nervous that I will be thrown with many criticisms because I touched a topic which was very dangerous, yet timely.

My paper demonstrated that e-cigarettes were effective smoking cessation tools as compared to placebo or nicotine replacement therapy: however, due to heavy safety concerns, it cannot be recommended as of this time for that particular indication.

The chair of my session had commented that "although the paper has demonstrated efficacy, the effects are modest compared to the huge safety risks and definitely cannot be recommended". This comment hit me greatly and had me thinking about the recommendations regarding my study. I will definitely look into my study deeper and consider recommendations given by the audience and the chairman of the sessions. Definitely, the end does not always justify the means.

Over-all, being an attendee of various respiratory congresses worldwide, the European Respiratory Society Congress has always been the most respected and groundbreaking of all congresses.

Breakthrough management of asthma, tuberculosis and other important lung diseases were presented in this event.

The ERS Congress is very different from the rest because it boasts papers from all over the world, not just limited to a certain geographic region, and definitely papers presented here are of great importance. To be accepted to present my paper in this event is indeed a great esteem.

It is my second time being awarded by the APSR its most coveted Young Investigator Awardee (the first time was for the Japanese Respiratory Society Convention), and it is always a great honour and gratitude to be given this award.

To top it all off, being listened to by no less than the APSR President, Dr Kwun Fong, during the presentation is both nerve-wracking and also very inspiring. And to get a comment that the presentation was "great and concise" just brings me joy.

Thank you to the APSR and ERS. I will definitely echo the learnings that I have gained during the last ERS to our colleagues in the Philippines and try to improve healthcare decisions in my country.

Muchas Gracias!

Dear APSR Pulmonary Circulation Assembly members, colleagues and friends,

Recently I performed a literature search for drugs approved for treating pulmonary arterial hypertension (PAH) in APSR countries as a consequence of marketing from pharmaceutical companies.

Although the ESC/ERS guidelines and summary of the NICE conference recommended upfront combination therapies for PAH, in 45% of countries even sequential combination therapies are not yet available. The best treatment of PAH, intravenous epoprostenol, is approved in only six countries. There are no approved drugs in 29% of APSR countries, and the treatment in these countries is similar to that in Western countries in the 1990s.

Many PAH patients need PAH drugs to survive and therefore we need to work with government and pharmaceutical companies to achieve approval of these drugs at a low price.

The results of my literature search were presented at symposium 35 (Pulmonary Circulation) on Sunday morning at the 24th APSR meeting in Hanoi. We also discussed the problems that may occur during treatment of pulmonary hypertension and also the cooperation in our group for management of pulmonary hypertension in the assembly meeting.

Sincerely yours,
Pulmonary Circulation Assembly Troika

The following news summaries have been collected from recent publications by the Interstitial Lung Disease Assembly Deputy Head Dr Moo Suk Park.

A warm welcome to the following members who have recently joined APSR assemblies. They will undoubtedly enjoy working with and networking with their assembly colleagues.

Congratulations to the following members who have recently become Fellows of the APSR:

• Dr Umar Kaleem FAPSR
• Dr Nishith Kumar FAPSR
• Dr Prashant Kumar FAPSR
• Dr Bobby Singh FAPSR

If you have news of interest to APSR members, please send details to one of the Bulletin Coordinators; Prof. A Azuma (a-azuma@nms.ac.jp) or Prof. C K Rhee chinkook77@gmail.com).