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prof. dr. dr. techn h.c. Marion Koopmans DVM

Researcher Marion KoopmansMarion Koopmans, head of the department of  Virology at the Erasmus MC, wants to shake off the 'rookiefootball' feel currently associated with research into emerging infections. We need to be prepared for future outbreaks and get ahead of the curve: from a reactive approach to a proactive one.

'Over the past century we've seen mortality rates from infectious disease gradually decline on a global level. We are getting healthier and we are living longer. However, this trend has slowed since the emergence of the HIV epidemic, which heralded the changing pattern of infectious diseases due to global changes over the past decades. Other examples are avian flu, SARS, MERS, Q fever, and most recently Ebola. Looking at the global scale, not a year goes by without an emerging disease outbreak of some kind.'

'Currently, a lot of our attention is focussed on Zika, a viral infection transmitted by mosquitoes. We've been aware of Zika for years. The viral infection was known as a cause of fever, some joint pain and rash, and not considered very serious. As a consequence, not much research has been done, despite a changing pattern of spread with the outbreaks in South East Asia since 2007, and in South America in 2014. Most recently, however, new reports from Brazil suggest a 20-fold increase of the number of newborns with microcephaly, a condition in which the baby's skull is too small and the development of the brain is impaired. The current suspicion is that this condition is related to exposure to Zika during pregnancy. With this new fact, there is a cry for information on disease causing mechanisms, diagnostics, treatments, etc. This is the pattern that I describe as " rooky football": a research response that is triggered after diseases emerge, us running after the ball.'

'These examples show that we need more forward-looking and planning of emerging disease preparedness research, play more strategically. Most new infectious diseases come from the animal world, including wildlife and livestock, and are called zoonotic diseases. So we need to gain knowledge about the complex ecosystem that connects humans, animals and the pathogens that they carry, what drives disease outbreaks, and what we can do to prevent or control them.'

'Outbreaks may seem unpredictable but there are certain patterns that should raise flags. For instance, looking at zoonotic pathogens, a warning signal is the occurrence of numerous local outbreaks, even if they die down by themselves or by basic control activities. A second warning sign is when such infections start to spread among humans. We have seen such outbreaks of Ebola for decades in small remote villages. The only difference with the recent huge outbreak was that now the virus reached urban areas and hospitals, where controlling spread was much more difficult. Warning signs are also seen for avian flu, MERS, Rift Valley Fever and the Nipah virus, all viruses causing rare but severe disease with occasional outbreaks. So we should learn from Ebola and start to tackle these problems now!'

'I would like to see the creation of a joint research program which focuses on such global challenges, by creating a joint research program which will look into how viruses and bacteria pass from animal to animal and to humans. Is it via manure, via food or via a number of different routes? What factors determine if an infection can spread from animals to humans? How are these transmission patterns and pathways influenced by interventions, for instance the way animals are housed and handled?'

'The Netherlands is an excellent region to do this type of research: lots of animals and lots of people live in close proximity, which is why we are considered as a hotspot for disease emergence.
Current research programs in One Health tend to focus on the veterinary sector. It is challenging to involve the medical sector and there are hardly any examples of structural research collaborations between medical and veterinary experts with ecological and agricultural researchers. If we can manage to get those parties together then we really will have something unique here in the Netherlands.'

This interview has been published in the One Health magazine of the Netherlands Centre for One Health. Want to know more about the NCOH? Go to www.ncoh.nl

Professor Marion Koopmans, DVM PhD focuses on global population level impact of rapidly spreading zoonotic virus infections, with special emphasis on foodborne transmission. Her research focuses on unravelling the modes of transmission of viruses among animals and between animals and humans, and the use of pathogenic genomic information to unravel these pathways and to signal changes in transmission or disease impact. As initiator of the global Noronet network (www.noronet.nl), she has developed a global network of scientists sharing information on disease outbreaks into a jointly owned database to study norovirus diversity related to human health impact. This work has led to the discovery of a wide range of norovirus genotypes that differ in their ability to spread and cause disease. Her team also was first to describe that norovirus epidemiology is shaped by rapid evolution through viral mutation and recombination, thus circumventing population immunity, and explaining why noroviruses rank among the top causes in the global burden of infectious disease estimates. Her research ranges "from barn to bedside", trying to understand the contribution of animal noroviruses to the genetic diversity of viruses impacting on humans on the one hand, and on the other hand studying how noroviruses evolve in patients that have difficulty clearing the infection. Her aim is to provide insights that can be translated into concrete public health interventions, and the outputs from her research have been used to develop guidelines for the food industry and for healthcare settings where noroviruses are a cause of frequent outbreaks.

Building from the norovirus work and molecular epidemiological expertise, she has expanded her research into emerging viral diseases that are recognized with increasing frequency. As head of the virology reference laboratory of the Netherlands National Institute for Public Health and the Environment, a position she held from 2001 to 2014, she has been responsible for emerging disease preparedness, and coordination of the national laboratory response to such disease outbreaks, including SARS, pandemic influenza H1N1 2009, avian influenza and MERS. Building from those experiences, she developed an academic emerging disease preparedness research agenda at Erasmus MC as head of the Department of Viroscience. This research agenda combines basic laboratory science and tools with epidemiology to both unravel causes, pathogenesis, sources and transmission routes of emerging viral diseases at the human-animal interface as well as to translate these into diagnostics, and tools for tracking of infection and early warning. This work amongst others led to the discovery that avian influenza viruses may evolve into lineages with different potential human health impact during the course of a single outbreak, that dromedary camels are the reservoir for MERS-CoV infections of humans, and that camel markets and racing events are crucial in the epidemiology of these viruses and could be targeted by interventions.

Professor Koopmans has been active as coordinator of a European foodborne virus network, the global NoroNet collaboration, national contact for the European Centre for Disease Control, advisor for the World Health Organisation on foodborne diseases and emerging disease outbreaks, has served as member of the WHO emergency committee on MERS, which advises the Director General on public health emergencies, and the Food and Agricultural Organisation committees on MERS and Ebola. She is member of the Scientific Advisory Group of the WHO initiative that develops a new global strategy and preparedness plan to ensure that targeted R&D can strengthen the emergency response by bringing medical technologies to patients during epidemics (WHO Research and Development). She is director of a WHO collaborating centre for emerging viral diseases, and head of the designated National Reference Laboratory for high threat viral pathogens for the European Commission, a network that aims to provide a common, coordinated and effective response to infectious disease outbreaks at EU level and abroad (www.emerge.rki.eu). As member of the scientific advisory board of the Guangdong Provincial Center for Disease Control and Prevention, China CDC she has advised on the building of the laboratory capacity for emerging infectious disease detection in this region and she has ongoing research collaborations trying to unravel emergence and spread of viruses through the animal production chain in this region. During the recent Ebola outbreak she led the deployment of three mobile laboratories in Sierra Leone and Liberia, in which essential minimal local laboratory capacity was provided, and volunteers were trained to operate these laboratories at the highest standards, contributing to the local emergency response to Ebola. She is member of the standing committee on public health of the Health Council of The Netherlands, that reviews all advise relevant to public health directed to the Dutch Ministry of Health from the different advisory committees of the Health Council of The Netherlands; the Council of Animal Affairs, that has a similar role for advise to the Ministry of Economic Affairs on issues related to animal health and welfare; she is chair of the scientific advisory board of GLOPID-R, a global consortium of funding agencies that aims to coordinate rapid mobilisation of funds in the face of epidemics (www.glopid-r.org).

She has obtained funding for the research activities, both academic and in a public health setting, from various sources including European FP6, FP7 and H2020 programs, US CDC, WHO, Welcome trust, NWO and ZONMW, the latter with funding specifically to develop insights into EID detection through the use of novel technologies that also will be central to this grant application. She is scientific coordinator of COMPARE, a large H2020 funded project (20 MEuro), exploring the potential uses of next generation sequencing techniques for outbreak detection and tracking (www.compare-europe.eu), and co-PI in the FP7 funded PREPARE project (www.prepare-europe.eu ) aimed at building a pan-European operational network for rapid and large-scale European clinical research in response to infectious disease outbreaks with epidemic potential. She is director of the WHO collaborating centre for emerging infectious diseases at Erasmus, and Scientific Director "Emerging infectious diseases" of the Netherlands Centre for One Health (www.ncoh.nl). She has received the Infectious disease award of the Dutch Association for Infectious Diseases. She has co-authored >300 papers that have been cited > 20.000 times. (citation score).

Koopmans received the award from Anders Bjarklev, President of the DTU. In the accompanying speech, Koopmans was labeled and honored as visionary and role model because of its stimulating influence on international cooperation. Koopmans was praised for her involvement in the fight against endangered viral diseases. During the outbreak of the Ebola epidemic in 2014, she was responsible for the deployment of mobile laboratories in Sierra Leone and Liberia (West Africa). Early intervention then prevented a worldwide spread of the disease. Her drive for research into (new) viruses and distribution through animals and food was also celebrated.
At the ceremony there were about four thousand guests, including Crown Prince Frederik and Soren Pind, the Danish Minister of Higher Education and Science.

12 September 2018, Marion has recieved the Simon Stevin prize, the highest award in Dutch science.

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