Smartphone tests for infections could be the next step in global fight against superbugs, top scientist says

Scientists are exploring a test involving smartphones to identify if users have a bacterial or viral infection, paving the way for more effective usage of antibiotics to fight the “global crisis” of superbugs, a leading microbiologist has said.

Canadian scientist Dr Rosanna Peeling Lee Wai-wai – who used to live in Hong Kong – spoke to the Post earlier this week while in the city to give two speeches on anti-microbial resistance and viral hepatitis at the Hospital Authority Convention 2018.

When she was research coordinator and head of diagnostics research at the World Health Organisation’s Special Programme for Research and Training in Tropical Diseases, Peeling coined the acronym “ASSURED”, which means “accessible, safe, sensitive, user-friendly, rapid and robust, equipment-free and deliverable” laboratory tests.

These tests can immediately identify infectious diseases such as dengue fever, HIV and syphilis.

Peeling, who studied at Diocesan Girls’ School in Hong Kong is currently professor and chair of diagnostics research at the London School of Hygiene and Tropical Medicine and director of its International Diagnostics Centre.

As a member of the advisory panel of the US$2 billion (US$15.7 billion) Global Antimicrobial Innovation Fund, Peeling said if the governments of each country “do their own thing, it is not going to work”. The fund drives reinvestment in research and development on antibiotics, and encourages further investment from governments and the private sector.

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Distinguishing between viruses and bacteria is important to stem the superbug tide. Antibiotics are prescribed for bacterial infections but these drugs do not work against viruses. Without proper identification, the overuse of antibiotics, such as in cases of viral infections, has led to increasingly drug-resistant microbes.

Instead of costly and difficult procedures which test for all possible causes of infections, Peeling said one of the possibilities would be using biomarkers.

“The test could be based on how the body reacts to a bacterial or viral infection. For bacterial infections, the white blood count goes up, but for viral infections, not so much. There are other inflammation markers that would kick in for bacterial infections but, again, not so much for viral infections,” she said.

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Over 100 biomarkers have been identified and pharmaceutical companies, including those in mainland China, are looking into how to incorporate them into a test, she said.

Asked if antimicrobial resistance was the biggest threat to man, Peeling said: “We are very close to a global crisis and people don’t realise it.

“In the old days [before antibiotics], people would die from childbirth or diseases such as typhoid and scarlet fever. Those are a thing of the past now that we have antibiotics. But we are heading back to the pre-antibiotics era.”

Peeling’s remarks came as a Department of Health study released last month found that the “top three classes of antibiotics” in terms of wholesale supply volume were used to treat “common bacterial infections in community and hospital settings”, implying a trend of overuse.

“They are usually prescribed as first-line treatment for suspected bacterial infections,” the department said. Most the drugs were supplied to the Hospital Authority and private hospitals. Private doctors, the authority and community pharmacies were the three industry sectors supplied with the highest volume of antibiotics.

“As private doctors and the Hospital Authority are the major health care providers in the community and hospital settings, this result is not unexpected. About 18 per cent of total antibiotics were supplied to community pharmacies and the department has been closely monitoring the situation,” the study said.

In the report, the department obtained data on citywide usage of antibiotics through annual local wholesale supply figures of all registered antibiotics classified under a WHO code.

Data from 2014 to 2016 was collated from questionnaires given to licensed drug wholesalers. These distributors supplied antibiotic stocks to eight sectors including the department, Hospital Authority, private hospitals and doctors, dentists, veterinary surgeons, as well as community pharmacies and farmers.

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A government spokesman said last year that the High Level Steering Committee on Antimicrobial Resistance, chaired by Secretary for Food and Health Sophia Chan Siu-chee, launched the Hong Kong Strategy and Action Plan on Antimicrobial Resistance (2017 – 2022) to combat superbugs.

Under the plan, the monitoring of antibiotics usage was set out as one of the strategic actions.

Peeling said one person would die of antimicrobial resistance every 45 seconds, citing a 2016 report by economist Jim O’Neill that 700,000 people were projected to die from superbug infections that year.

And if no action were taken, 10 million would die by 2050, and US$100 trillion would be lost in global productivity.

‘More powerful than Houston’s rocket computers’

Accurate, affordable and accessible tests for infectious diseases have been developed to help stem outbreaks in Africa through the use of smartphones.

“The smartphones that we have are in fact [more than just] a device for making calls and text messaging. They are even more powerful than the computers that Houston used to send a rocket to the moon. So we are underutilising the power of the phone,” Dr Rosanna Peeling said, referring to technology at the Texas launch site of US space agency Nasa.

“So now, many engineers are looking at how to utilise the phone not only to read a test result but also to power a diagnostic test.”

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For instance, she said, quick tests using smartphones to screen for antibodies produced by the body to fight infections from syphilis and HIV, have gone through clinical trials in Africa.

“You can run 80 reaction tests before you have to recharge your phone,” she said.

“That’s the beauty of it. It is taking lab testing out of the lab into communities and being able to send data to a central database.”

In the future, a person’s blood sample could even be put into a dongle that can be attached to a smartphone. A mobile app would then launch the diagnostics, Peeling said.

There are other applications being tested, such as a study in Tanzania using a tablet to train health care workers to ask questions based on information given by patients. She said: “It’s actually a machine that’s learning – with each input of information on the tablet, it can tell you what questions to ask next, and what tests should be done.

“A lot of this is now tied to platforms and tablets. It’s quite remarkable, the convergence of digital technology and diagnostics.”

Peeling will also present a paper to the African Union’s Centres for Disease Control in Addis Ababa, Ethiopia at the end of the month. The centre was set up following the worst Ebola outbreak on the continent in 2014.

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“I have a research fellow who was able to map out cell phone tower locations,” she said. Using the method superimposed on data such as population density and health facility locations, Peeling’s team found “gaps in communications” that could be closed to strengthen outbreak alerts and monitor disease trends.

She said: “If we have stewardship programmes and special interventions for superbugs, we would be able to monitor the effectiveness of these [schemes] through data analysis in real time.”