Paediatric Virology: A rapidly increasing educational challenge

The foundation of the Institute of Paediatric Virology on the island of Euboea, Greece (Review)

The Institute of Paediatric Virology, founded on October 2019 on the island of Euboea in Greece, introduces medical students, paediatric and neonatal trainees, postgraduate students, virologists, paediatric and allied health professionals to the bold, new, scientific field of paediatric virology. The institute is committed to medical education and is the sequel of the Paediatric Virology Study Group (PVSG), which was formed in 2007 in the United Kingdom by a group of young paediatric trainees and junior researchers. The main mission of the institute is to provide an educational e-platform on neonatal and paediatric viral infections, to facilitate scientific discussion between virologists and paediatric health professionals and to develop an international network aiming to the promotion of children's health by the prevention and treatment of viral infectious diseases. The foundation of the institute is dedicated to three children from a small fishing village at the south of the island of Euboea in Greece, who survived the 1918 Spanish flu pandemic.

The perspectives and the challenges of Paediatric Radiology: An interview with Dr Georgia Papaioannou, Head of the Paediatric Radiology Department at the 'Mitera' Children's Hospital in Athens, Greece

Dr Georgia Papaioannou, MD, PhD, Head of the Paediatric Radiology Department at ‘Mitera’ Children's Hospital in Athens (Greece), is one of the most talented Paediatric Radiologists in Greece. She graduated from the Medical School of Athens of the National and Kapodistrian University of Athens in 1996 and she was trained in Radiology at the 2nd Department of Radiology of the Medical School of Athens and in Paediatric Radiology in Great Ormond Street Hospital for Children (GOSH) in London (UK). Her special interests focus on foetal magnetic resonance imaging (MRI) and special applications of paediatric MRI, such as MR enterography and MR urography. According to Dr Papaioannou, medical education in Paediatric Radiology has to be of excellent quality, raising professional career and academic opportunities. Paediatric Radiology focuses on the diagnostic imaging of foetuses, neonates, infants, children and adolescents and represents the oldest subspecialty of Radiology. The advent in technology and computer science, which is strongly associated with Radiology, has launched a new era for Paediatric Radiology training and practice. Digital imaging and archiving, telemedicine, fused imaging, evolution of sonographic equipment, computed tomography (CT) and MRI scanners have opened new horizons to the understating of paediatric physiology and pathophysiology and have contributed significantly in precision Medicine and the implication of targeted therapies into clinical practice. Modern paediatric imaging focuses on radiation protection issues and launches faster sequences in all modalities, in order to reduce the number and duration of sedation. The diagnosis of neonatal and paediatric viral infections is routinely clinical and laboratory; however, Paediatric Radiology assists the diagnostic approach by excluding other entities, if that is required, i.e., in complex cases or hospitalized children, and mainly by revealing associated complications.

Paediatric Virology and innovation in medical education: An interview with Dr Ioannis N. Mammas, Consultant Paediatrician on the island of Euboea (Greece) and Coordinator of the Paediatric Virology Study Group

Born in Chalkida in Greece, Dr Ioannis N. Mammas, Consultant Paediatrician on the island of Euboea, studied Medicine at the University of Crete School of Medicine, where he received his MD in 2002 and his PhD in Clinical Virology in 2006. He was trained in Paediatrics and Neonatology in Merseyside (UK), attending the 'Alder Hey' Children's Hospital's specialty training (ST) rotation programme and in Athens (Greece) at the 'Penteli' Children's Hospital and the 'MAKKA' Paediatric Infectious Diseases (PID) Unit of the 'Aghia Sophia' Children's Hospital. On October 10th, 2015, he presented the Paediatric Virology subspecialty's proposal, which up-to-date has attracted the critical interest of several international experts in the scientific fields of Neonatology, Paediatrics, PID and Virology and has been evaluated as a unique project of innovation in medical education. According to Dr Mammas, Paediatrics is the specialty, which daily provides the opportunity to support with responsibility the children's smile, the hope of life and future. He highlights the significant role of the Paediatric Virology Study Group (PVSG), a paediatric think tank, which was established by a group of paediatric trainees and young paediatricians in 2007 and since then has been involved with enthusiasm in the perspectives of Paediatric Virology in medical education. Dr Mammas strongly believes that in the future, Paediatric Virology subspecialists will have a strategically principal role, both clinical and academic, at the fight against viral infections in childhood. This aim will be supported by the newly founded Institute of Paediatric Virology (IPV), the first scientific initiative in the world committed to medical education on neonatal and paediatric viral infections.

Current Perspectives in Cancer Immunotherapy

Different immunotherapeutic approaches have proved to be of significant clinical value to many patients with different types of advanced cancer. However, we need more precise immunotherapies and predictive biomarkers to increase the successful response rates. The advent of next generation sequencing technologies and their applications in immuno-oncology has helped us tremendously towards this aim. We are now moving towards the realization of personalized medicine, thus, significantly increasing our expectations for a more successful management of the disease. Here, we discuss the current immunotherapeutic approaches against cancer, including immune checkpoint blockade with an emphasis on anti-PD-L1 and anti-CTLA-4 monoclonal antibodies. We also analyze a growing list of other co-inhibitory and co-stimulatory markers and emphasize the mechanism of action of the principal pathway for each of these, as well as on drugs that either have been FDA-approved or are under clinical investigation. We further discuss recent advances in other immunotherapies, including cytokine therapy, adoptive cell transfer therapy and therapeutic vaccines. We finally discuss the modulation of gut microbiota composition and response to immunotherapy, as well as how tumor-intrinsic factors and immunological processes influence the mutational and epigenetic landscape of progressing tumors and response to immunotherapy but also how immunotherapeutic intervention influences the landscape of cancer neoepitopes and tumor immunoediting.

Clinical Virology research and medical education in Greece: An interview with Demetrios A. Spandidos, Professor of Clinical Virology at the University of Crete in Greece

Professor Demetrios A. Spandidos, Professor Emeritus of Clinical Virology at the University of Crete School of Medicine in Crete, Greece, is a pioneer in world research in Virology, Oncology and medical education. He has been the first Professor of Clinical Virology at the University of Crete School of Medicine, the only School of Medicine with a separate Department of Clinical Virology in Greece. According to Professor Spandidos, the understanding of the interactions of viruses with human host cells is what enables the development of new vaccines and new therapies against a wide range of diseases in humans, including cancer. Over the past two decades, the expansion of new knowledge, treatments, prevention and management options and the emerging needs on neonatal and paediatric viral infections have made the role of future paediatric virologists more than necessary. For this reason, he strongly believes that Paediatric Virology should be recognized as a new paediatric subspecialty. Professor Spandidos declares that medical education is a continuous sequence from undergraduate to postgraduate/specialty/subspecialty medical training and continuing learning. He also supports the concept that the future of medical education represents the future of Medicine.

Paediatric virology and human papillomaviruses: An update

Almost 10 years ago, in October, 2008, the scientist who reported for the first time the association between human papillomaviruses (HPV) and cervical cancer, was awarded with the Nobel prize. In the years that followed, Professor Harald zur Hausen actively supported the value of the HPV vaccination in the prevention of different types of cancer and highlighted the necessity of its introduction in both girls and boys. However, to date, in the majority of countries, HPV vaccination among male adolescents has not been implemented into the national vaccination schemes, while in several countries, including Greece, the participation rate to HPV vaccination among female adolescents still remains low. Recent data indicate that catch-up HPV vaccination among young women has been extremely useful and has exhibited a significant effect in decreasing the prevalence of HPV. While the marketed current HPV vaccines prevent anogenital HPV infection, their impact on the natural history of oral HPV and their efficacy in preventing HPV-related head and neck carcinomas need to be further investigated. Juvenile onset recurrent respiratory papillomatosis, as well as HPV-associated conjunctival papillomas continue to be observed in childhood and their clinical management involves different therapeutic approaches with controversial outcomes. This review article provides an overview of recent views and advances on HPV infections and prevention in childhood that were presented at the '4th Workshop on Paediatric Virology' on Saturday September 22, 2018 in Athens, Greece.

The future of medical education in neonatology, paediatrics and paediatric virology: An interview with Professor Alan Michael Weindling, Professor of Perinatal Medicine at the University of Liverpool

Professor Alan Michael Weindling, Emeritus Professor of Perinatal Medicine at the University of Liverpool in the UK, is one of the pioneers of modern neonatal care worldwide with an enormous contribution to the care of premature babies in the city of Liverpool. During the last 3 decades, his contributions focused on the development of the clinical service, the training provided and the strong research achievements at Liverpool Women's Hospital NHS Trust, one of the most widely respected centres for neonatal medicine in western Europe. According to Professor Weindling, teaching a commitment to continuing lifelong learning as well as trying to make clinical care cost-effective is really important. He highlights the value of humility, holistic scientific approach, evidence-based medicine and multidisciplinary team working to neonatal and paediatric care. Looking back to neonatology as practiced in the 1990s, he accepts that since then, the overall standard of care has improved enormously. He supports that further neonatal care research is required for the prevention and treatment of acquired brain damage as well as on looking at ways of minimising stress for families, who have a child in an intensive care unit. He could see how for most trainees a module or series of lectures in paediatric infectious diseases would be helpful as part of their training and he estimates that in the future paediatric virology may become a specialist interest for a limited number of paediatric trainees. In the context of the ‘4th Workshop on Paediatric Virology’, which will be held in Athens, Greece, on September 22nd, 2018, Professor Weindling will receive the ‘2018 Paediatric Virology Award in Neonatology and Medical Education’.

Paediatric virology as a candidate of paediatric subspecialisation: An interview with Assistant Professor of Molecular Microbiology-Virology Angeliki Melidou

According to Professor Angeliki Melidou, Assistant Professor of Molecular Microbiology-Virology at the School of Medicine of the Aristotle University of Thessaloniki in Greece, recent advances in modern virology have important implications in the successful clinical management of neonatal and paediatric viral infections. On the other hand, preventive measures for infectious diseases and their complications, including vaccinations, proper regular examinations and early diagnosis, are equally crucial. Molecular genetics reveals a new era both in the detection of viral infections and in following up the infection and treatment, as well as identifying genetic predisposition that would affect disease course and outcome. Professor Melidou supports that paediatric virology as a candidate of paediatric subspecialisation would definitely play an important role in preparing specialised medical scientists. These scientists would be properly educated for the management of emerging and re-emerging viral infections, treatment options and schemes according to children's special needs, available prevention strategies and diagnostic capacities. In the context of the ‘4th Workshop on Paediatric Virology’, Professor Melidou's lecture will focus on the epidemiology of influenza virus types and subtypes in childhood.

Neonatology, paediatrics and paediatric virology on a British island: An interview with neonatologist Dr Prakash Thiagarajan (Isle of Man)

Dr Prakash Thiagarajan, consultant neonatologist and clinical director at Women's and Children's Division at Noble's Hospital on the Isle of Man, is one of the most talented neonatologists in the UK with a great experience in newer modes of infant ventilation and the application of technology in neonatal medicine and paediatrics. Under his leadership, the new neonatal intensive care unit (NICU) at Noble's Hospital is a state-of-the-art neonatal unit offering the very highest standards of care for critically ill babies on the island. Dr Thiagarajan highlights the re-emergence of continuous positive airway pressure (CPAP) as a key mode of ventilatory support for preterm infants and describes the current practice relating to the transport of the critically ill newborn and paediatric population. He reports the main milestones of the Isle of Man preparedness plan for influenza during the 2009 A/H1N1 influenza pandemic and he emphasises the role of immunisations and high level infection control measures in preventing future outbreaks of viral illnesses in children. He accepts that paediatric virology is an extremely important, yet underserved area of paediatrics and as with any clinical specialty, it is very important for effective two-way communications between frontline clinicians and academic researchers. He sums up suggesting the formation of the ‘European Society for Paediatric Virology’ in order to propagate knowledge and training in paediatric virology to health professionals, set standards in training, promote research and development and also raise public awareness. In the context of the ‘4th Workshop on Paediatric Virology’, which will be held in Athens, Greece, on September 22nd, 2018, Dr Thiagarajan's plenary lecture will focus on antiviral drugs in the clinical management of children with influenza.

Paediatric Virology and its interaction between basic science and clinical practice (Review)

The 3rd Workshop on Paediatric Virology, which took place on October 7th, 2017 in Athens, Greece, highlighted the role of breast feeding in the prevention of viral infections during the first years of life. Moreover, it focused on the long-term outcomes of respiratory syncytial virus and rhinovirus infections in prematurely born infants and emphasised the necessity for the development of relevant preventative strategies. Other topics that were covered included the vaccination policy in relation to the migration crisis, mother‑to‑child transmission of hepatitis B and C viruses, vaccination against human papilloma viruses in boys and advances on intranasal live‑attenuated vaccination against influenza. Emphasis was also given to the role of probiotics in the management of viral infections in childhood, the potential association between viral infections and the pathogenesis of asthma, fetal and neonatal brain imaging and the paediatric intensive care of children with central nervous system viral infections. Moreover, an interesting overview of the viral causes of perinatal mortality in ancient Greece was given, where recent archaeological findings from the Athenian Agora's bone well were presented. Finally, different continuing medical educational options in Paediatric Virology were analysed and evaluated. The present review provides an update of the key topics discussed during the workshop.

The educational challenge of Paediatric Virology: An interview with Professor of Neonatology Anne Greenough

According to Professor Anne Greenough, Professor of Neonatology and Clinical Respiratory Physiology at the King's College London (London, UK), Paediatric Virology is indeed a rapidly increasing educational challenge. Professor Greenough, who in 1992 wrote her book on congenital, perinatal and neonatal infections, believes that during the past 3 decades, paediatric health professionals are becoming increasingly involved in specialised care and follow-up of paediatric patients with viral diseases, who require advanced medical care and innovative technological services. Moreover, she highlights the expected role of new vaccines and antiviral agents that are currently under investigation, as well as the impact of emerging viral diseases that require novel prevention strategies and therapeutic protocols. However, she notes that the number of Paediatric Virologists in any one country is likely to be small; hence, a separate paediatric subspecialty needs to be considered carefully. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens, Greece, on October 7th, 2017, Professor Greenough will give her plenary lecture on the impact of viral infections on the long term outcomes of prematurely born infants.

Paediatric Virology as a new educational initiative: An interview with Nobelist Professor of Virology Harald zur Hausen

Born in Gelsenkirchen-Buer in Germany on March 11th, 1936, Professor Harald zur Hausen, Emeritus Professor of Virology at the University of Freiburg and 2008 Nobel Prize Laureate in Physiology or Medicine for his discovery of human papillomavirus (HPV), which causes cervical cancer, believes that good knowledge of virological methods and diagnostic possibilities are an asset for all young paediatricians. Professor zur Hausen considers that the creation of an educational platform on Paediatric Virology is definitely very beneficial for young paediatricians, as this will greatly enhance their knowledge in the field of Virology. He very actively advocates the vaccination of boys for the eradication of HPV infection and emphasises that male HPV vaccination should be included into the current vaccination programmes. He would have certainly considered Dr George N. Papanicolaou (Kyme, Island of Euboea, Greece, 1883 - Miami, Florida, USA, 1962) as an excellent candidate for the Nobel Prize, stating that the contribution of Dr Papanicolaou did not find sufficient recognition in the past. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens, Greece, on October 7th, 2017, Professor zur Hausen will give his plenary lecture on 'Paediatric Virology and Oncology: Virus persistence and the important first years of life'.

The innovation of the subspecialty of Paediatric Virology: An interview with Research Professor of Molecular Virology Anna Kramvis

Professor Anna Kramvis, Research Professor of Molecular Virology at the University of the Witwatersrand in Johannesburg, South Africa, talks about direct-acting antiviral treatments against hepatitis C virus (HCV), as well as the perspective of the development of an effective vaccine against HCV. She emphasises the necessity of vaccination against hepatitis B virus (HBV), highlighting that it is very important that vaccination should be administered at birth in order to prevent mother-to-child transmission (MTCT) of HBV. Professor Kramvis states that vaccination against HBV is safe and that HBV and HCV infections are not contraindications for breastfeeding. Regarding the challenge of Paediatric Virology, she believes that it is a field that during the last years is increasing exponentially, while she concurs that Paediatric Virology subspecialty will be a popular choice for infectious diseases subspecialists. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens on October 7th, 2017, Professor Kramvis will give her key lecture on MTCT of HBV and HCV.

The proposal of Paediatric Virology and its perspectives: An interview with Professor of Paediatrics Maria Theodoridou

Professor Maria Theodoridou, Emeritus Professor of Paediatrics at the University of Athens, is one of the few paediatricians in Greece, who have experienced almost all the infectious diseases of the second half of the 20th century and their severe consequences, prior to the widespread adoption of immunisations. A milestone during her career was the establishment of a specialised National Reference Unit for the care of paediatric patients with acquired immune deficiency syndrome (AIDS) at the 'Aghia Sophia' Children's Hospital in Athens, Greece. According to Professor Theodoridou, training on the prevention, management and treatment of neonatal and paediatric viral infections represents a new educational challenge for both community as well as hospital-based paediatric health professionals. The debate of the potential strategically principal role of Paediatric Virology subspecialists in the primary, secondary and tertiary clinical practice is definitely necessary and needs further discussion and evaluation, she adds. She describes the difficulties that Greece, a country under a long-standing financial crisis, faces for the hospital-based management of paediatric viral infections and refers to the future advances, which are expected in the field of diagnosis and treatment of viral infections in neonates and children. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens on October 7th, 2017, Professor Theodoridou will focus on the immigration crisis and vaccination policy.