Seminar #22

Diagnostic challenges of acute febrile illness


Invitations necessary; TBD

Monday, 5 December
CTICC room location: 1.61-1.62

Medical technicians, scientists, Ministry of Health officials, programme managers, implementing partners, funding agencies


There are an estimated 655 million annual cases of acute fever in African children alone; though only one quarter of them will present to health facilities, this amounts to 275,000 children seeking diagnosis and treatment for fever in Africa every day. These fevers are symptomatic of a wide range of bacterial, viral, parasitic and other infections, some self-limiting and others severe and potentially fatal. Most of these fevers in children go undiagnosed, and adult fever incidence is poorly documented. Until recently, fevers were often treated presumptively as malaria, but the past decade has seen fever case management evolve to include the widespread use of malaria rapid diagnostic tests (RDTs). The increased use of these RDTs has revealed that, in fact, less than half of fevers are due to malaria.

In the absence of adequate diagnostic tests for use at or near the point of care, or of new protocols and diagnostic algorithms for improved management of non-malarial fevers, studies are showing an increase in the prescription of antibiotics when malaria RDT results are negative. In this context, the risks are that serious infections are not appropriately diagnosed and treated, surveillance of and laboratory preparedness for infectious diseases with outbreak potential are limited, and the inappropriate use of antibiotics is contributing to the global rise in antimicrobial resistance.

Given the importance of malaria RDTs in diagnostic algorithms for febrile illness, quality assurance remains paramount. The 10-year-old WHO-FIND lot quality assurance programme for malaria RDTs is transitioning to a sustainable, decentralized programme by the end of 2017 with oversight by WHO. Learn more about the knowledge transfer underway in the reference laboratories of the first nine African countries to provide regional lot testing capacity.

And if it’s not malaria, what is it? This seminar will also examine some of the diagnostic challenges related to acute febrile illness and recent developments in the field, including: an assessment of the challenges of managing non-malarial febrile illness in the absence of adequate diagnostics; efforts underway to drive the development of new diagnostics that can distinguish between bacterial and non-bacterial infections; the scale of antimicrobial resistance in Africa; and the urgent need to increase laboratory readiness for infectious disease outbreaks.


  • Understand the plans underway to transition to sustainable lot quality testing for malaria RDTs in regions of use by the end of 2017, and identify ongoing opportunities for reference laboratory capacity building for lot quality testing, already accomplished in 9 countries in sub-Saharan Africa
  • Be able to describe the diagnostic challenges of acute non-malarial febrile illness, including the consequences of a lack of appropriate diagnostic tools
  • Learn about recent efforts to drive the development of new tests to distinguish bacterial from non-bacterial infections
  • Be able to provide an overview of antimicrobial resistance in Africa, based on a newly concluded systematic review
  • Be able to describe diagnostic and laboratory preparedness needs in the context of infectious disease outbreak readiness


Dr Bill Rodriguez, FIND, Welcome & introduction – Febrile illness: Evolving from presumptive malaria diagnoses to pathogen identification and tackling the threat of antimicrobial resistance
Dr Bill Rodriguez is Chief Medical Officer at FIND. He is the co-founder and former CEO of Daktari Diagnostics, Inc., a company devoted to bringing medical diagnostics to the world’s poorest people. Bill is a graduate of Brown University and the Yale University School of Medicine. He trained in infectious disease medicine at the Brigham & Women’s Hospital in Boston, where he served as chief medical resident. While at Harvard, he established a research program on the use of appropriate diagnostics in global health.

Speaker TBC, Lot quality assurance of malaria rapid diagnostic tests: Moving from centralized lot testing to sustainable national capacity by the end of 2017

Speaker TBC, If it’s not malaria, what is it? The diagnostic challenges of acute febrile illness

Dr Sabine Dittrich, FIND, Developing new tests for fever management: Biomarkers to distinguish bacterial from non-bacterial infections
Dr Sabine Dittrich is a Senior Scientific Officer at FIND. She started working in the field of malaria and tropical disease diagnostics in 2002 at the Institute of Tropical Medicine in Berlin, Germany, focusing on the diagnosis of parasitic infections in returning travelers as well as research on molecular markers of malaria resistance. Subsequently, she completed her PhD in Biomolecular Science in 2008 at the University of Manchester (UK), studying the folate pathway of the malaria parasite P. falciparum.

Following her PhD, Sabine did a fellowship in Public Health Microbiology, centering around outbreak response and preparedness with the European CDC (EPIET/EUPHEM), where she become interested in “fever” in the wider sense. To continue work on tropical fevers, and particularly to understand the causative agents and diagnostic needs for fevers in South East Asia, she joined Oxford University in 2011 as a molecular microbiologist based at the Lao-Oxford-Mahosot-Wellcome Trust Research Unit in Vientiane, Laos. Her work in Laos focused mainly, but not exclusively, on vector-borne or zoonotic bacterial infections like Rickettsia spp., Orientia tsutsugamushi and Leptospira spp., their diagnosis and prevalence, particularly among CNS patients.

In December 2015, Sabine joined the FIND malaria team in support of its work on acute febrile syndrome.

Dr Birkneh Tadesse, Hawasse University, Ethiopia, The scale of antimicrobial resistance in Africa: Results of a systematic review
Dr Birkneh Tilahun Tadesse is a pediatrician by training and holds the position of Assistant Professor of Pediatrics at Hawassa University, Ethiopia. During a year spent at FIND as a WHO/TDR Fellow in Clinical Research and Development, he conducted a systematic review of antimicrobial resistance in Africa, concluded in September 2016.

Dr Petrus Jansen van Vuren (TBC), Center for Emerging & Zoonotic Diseases, National Institute for Communicable Diseases, South Africa, Are we ready for the next outbreak? Applying lessons learned from Ebola for diagnostic preparedness
Dr Petrus Jansen van Vuren is a Medical Scientist and the head of the Arbovirus Reference Laboratory at the Centre for Emerging & Zoonotic Diseases of South Africa’s National Institute for Communicable Diseases, which established an Ebola Mobile Laboratory in Sierra Leone in August 2014 in response to the Ebola outbreak in West Africa.