I C G -- International Collaboration on Gonococci

International Collaboration on Gonococci (ICG) Workshop in conjunction with the 16th International Pathogenic Neisseria Conference 2008, Rotterdam, the Netherlands September 7-12, 2008

Monday 8 September 2008, 17:30-20:30

John Tapsall and Magnus Unemo chaired the meeting. Approximately 40 people from various countries attended the workshop, including J.R. Dillon, C. Ison, E. Yee, D. Trees, D. Lewis, R. Nicholas, F. Sparling, W. Shafer, and Francis Ndowa (Coordinator for control of STIs at WHO, Geneva, Switzerland).

The meeting was well attended with a focus on antimicrobial resistance (AMR) issues; extension of WHO/ICG liaison in the area of AMR surveillance; the 'problem' of multi-drug-resistant N. gonorrhoeae (MDR-NG) including that of reduced susceptibility to later generation cephalosporins; and the need for a formal structure for the ICG.

Outcomes for short term follow up:
(i)  Closer WHO/ICG liaison in the area of AMR surveillance to be facilitated by the ICG co-ordinator's (John Tapsall) presence at WHO, Geneva for 3 months (September-December 2008);
(ii)  Formation of an ICG AMR surveillance data review panel, defining criteria for validation of AMR data, and international harmonisation of the definitions regarding multi-drug resistant N. gonorrhoeae, etc;
(iii)  Formation of an ICG working group to consider various aspects of the emerging problem of recognition of reduced susceptibility to later generation cephalosporins;
(iv)  Preparation for consideration of a formal structure for the ICG;
(v)  Promotion and implementation of the new ICG/WHO control panel for AMR testing.
Participants were reminded of the background of the ICG, including its focus on laboratory contributions to gonorrhoea control, namely, areas of laboratory diagnosis, strain typing and antimicrobial resistance (AMR) determination.
In regard to AMR issues:
There is to be closer liaison between the ICG and WHO. Internationally there are increasing anxieties about multi-drug resistant N. gonorrhoeae (MDR-NG). Opportunities exist for collaboration between WHO and the ICG to obtain additional and better quality data on AMR and to share resources and expertise (see below).

One example of this is the launch of a new ICG/WHO control panel for AMR testing, at the IPNC meeting immediately prior to the ICG session. Magnus Unemo presented data on the full molecular analysis of some of these panel strains.
The scientific presentations also included data on global surveillance of antimicrobial resistance (AMR) in gonococci (GC) in WPRO and SEARO (PDF view, J. Tapsall), monitoring emerging resistance in GC in USA (PDF view, E. Yee, CDC), AMR of GC in Africa (D. Lewis), AMR within the European Union (C. Ison) and AMR in Eastern Europe (M. Unemo). It was noted that there were significant gaps in available AMR data. 
The molecular mechanisms of 3rd generation cephalosporin resistance and the differential effects of different genetic changes on the oral (cefixime) and injectable (ceftriaxone) members of this group were elegantly set out (R. Nicholas) and updates of the in vitro potential for cephalosporin resistance development in gonococci (D. Trees).
Discussion on ICG prospects hosted by J. Tapsall :
The ICG will continue to focus its work on AMR, typing of GC and diagnosis of gonorrhoea, with a close liaison with the WHO in regard to AMR - see above.
In regard to AMR surveillance, it was agreed the best structure would be one that is regionally based (using the WHO regions as a template and with close liaison with WHO regional advisers in STI as well as perhaps IUSTI members). There may be more than one grouping within a region.
The overall co-ordinating centre function for global AMR surveillance would reside within the ICG (to evaluate data suitability and validity) and the membership of this coordinating centre would comprise the wider group within the ICG responsible for regional affairs in regard to AMR.
In order to obtain, validate and distribute AMR data as widely as possible, several mechanisms were proposed. In essence additional sources of published and unpublished material have been identified (and some data from these sources were presented earlier in the meeting) and as a means of 'validating' these data, an ICG AMR surveillance review panel, using criteria to be defined soon, will be formed.  Once 'validated', selected data excerpts will be displayed on the WHO mapping facility. The possibility of the ICG (after formalisation of its structure - see below), establishing an on-line publishing facility for AMR data was raised and will be actively explored. In the meantime, ICG members are encouraged to store susceptibility testing data in the database of the ICG website (www.icgngo.org) if copyright requirements can be met.
It was agreed that the new QC control panel (Presentation by J Tapsall-An expanded WHO control panel), launched at the IPNC session preceding the ICG meeting, was urgently needed in the current era of antimicrobial resistance of GC. It was also agreed that additional and immediate attention should be paid to better describing and establishing clinical/laboratory correlations (treatment outcomes and in vitro sensitivity data) with the extended spectrum cephalosporins. The new control strains provided some basis for assessing cephalosporin resistance, but it was agreed that an ICG working group would be formed to address this topic as a matter of urgency.
A review paper on GC typing and molecular epidemiology is being written by ICG members to provide guidelines for appropriate selection and standardisation of typing methods, used for different purposes.
ICG structure :
There was an extensive discussion on the form and organisation of the ICG. It was commonly agreed that ICG should be formally constituted, rather than continue to exist as a grouping of professionals with common interests. A number of concrete advantages would ensue, including a smoother path to more formal recognition by a number of groups including funding agencies. There are precedents for other similar groupings following this path and their experience in this exercise will be sought. This formation of a formal organization structure is a priority for the ICG in coming months. 
Next Meeting:
The organisers of the IPNC meeting were formally thanked for the provision of meeting facilities for the ICG. It was noted however that time constraints prevented full discussion of many topics and others were unable to be discussed at all.
The next ICG workshop will be in conjunction with 18th International Society for STD Research (ISSTDR), London, UK, 28 June – 1 July 2009. The possibility of a full day meeting after the ISSTDR meeting proper will be explored.
By John Tapsall, Mingmin Liao, Magnus Unemo