Asia-UK Maternal-neonatal Infection and Immunity Network (AMMuNet)

About AMMuNet

The Asia-UK maternal-neonatal infection and iMMunity Network (AMMuNet) is a newly established network of academics in the United Kingdom and Nepal, with collaborators from the United States of America and India. This network is jointly led by the UK’s Centre for Neonatal and Paediatric Infection (CNPI) at the Institute of Infection and Immunity, City St. George’s, London, and Nepal’s Global Health Research and Medical Interventions Institute (GlohMed), Kathmandu.

Objectives

The network has five key objectives listed below:

  1. Bring together international expert groups to strengthen research on maternal and neonatal infections and immunity in Nepal and South Asia
  2. Strengthening the clinical and laboratory research capacities in Nepal to enable the country for large clinical trials
  3. Initiate collaboration for writing larger research grants on maternal and neonatal infection and immunity fostering Asia-UK academic partnership
  4. Support early career clinical researchers of Nepal and neighboring countries through longitudinal mentorship opportunities
  5. Aid to the country and regional initiatives towards meeting the United Nations Sustainable Development Goals, particularly SDG 3 – Good Health and Wellbeing

Activities

  • Collaborative research projects
  • Knowledge exchange and networking
  • Workshops, symposia and training programmes
  • Community and stakeholder engagement and involvement
  • Scientific publications and global dissemination
  • Policy briefs and advisory to national health sector programmes

Partners

  • National and subnational government units, non-government partners
  • Academic institutions
  • Research groups
  • Early career researchers

Co-Chairs

Portrait of Suraj Bhattarai
Dr. Suraj Bhattarai

Dr. Suraj Bhattarai is a clinician-scientist with interest in key global health issues that impact people's health in LMICs. Recently, the focus of his research has been maternal-newborn-child health: vaccine-preventable infections such as RSV, Group B Streptococcus, pneumonia and the diagnostics, emerging tropical infections (melioidosis), AMR and quality improvement. He is the Founding director and investigator of GlohMed, as well as a global health researcher (WISE fellow) at the London School of Hygiene & Tropical Medicine (LSHTM), United Kingdom.

Previously, he worked as a technical adviser for GIZ GmbH’s health project in Nepal. Following medical training from BPKIHS, Nepal, he undertook informal medical training in USA and graduate degree courses (Masters and PhD) at the LSHTM, UK. For nearly a decade, Dr. Bhattarai has served several high-level scientific committees for reputed academic organizations like Inter-Academy Partnership (IAP), International Science Council (ISC), International Society of Urban Health (ISUH), Acadmey of Medical Sciences, among others.

He is experienced in writing, reviewing and evaluating small to large-size research and project grants. Dr. Bhattarai is the first Nepali physician-scientist selected for highly competitive fellowships like IAP Young Physician Leaders Programme, Global Young Academy and Lindau Nobel Laureate Meetings. His research work has been featured in 50+ peer-reviewed publications and global reports.

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Prof. Paul Heath

Prof. Paul Heath is a Professor in Paediatric Infectious Diseases at City St George's, University of London, where he is the Director of the Vaccine Institute. His training in paediatrics and infectious diseases was at the Royal Children’s Hospital, Melbourne, Australia; the John Radcliffe Hospital, Oxford; and St George’s Hospital, London. His research interests are in the epidemiology of vaccine preventable diseases, in clinical vaccine trials, particularly in at-risk groups and in perinatal infections.

Prof. Heath coordinates a European neonatal infection surveillance network (neonIN) and the UK Paediatric Vaccine Group (UKPVG), is a member of the UK Joint Committee on Vaccination and Immunisation (JCVI), chairs the National Institute for Health Research (NIHR) Vaccine Innovation Pathway (VIP): Vaccine Research in Pregnant Participants Working Group, is co-Chair of the UK VIP Infectious Diseases Vaccine Research Forum and is a member of the WHO GBS and Klebsiella Working Groups.

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Prof. Kirsty Le Doare

Prof. Kirsty Le Doare is a Professor of Paediatric Infectious Diseases and Director of the Centre of Excellence in Maternal and Infant Immunisation in Uganda and the Centre for Neonatal and Paediatric Infection in the UK. With a medical degree from St George’s, University of London, and a PhD in Immunology from Imperial College London, her work focuses on Group B Streptococcus (GBS) vaccine development and implementation.

A central pillar of her research is defining correlates of protection to accelerate vaccine licensure and inform immunisation policy. She leads research on maternal immunisation strategies to prevent neonatal infections, particularly in low- and middle-income settings. A key advisor to the WHO, she collaborates with global organisations like CEPI and the Gates Foundation to advance equitable vaccine access for mothers and infants.

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Dr. Gaurav Kwatra

Dr. Gaurav Kwatra is a distinguished researcher in the field of vaccinology and immunology, currently affiliated with Cincinnati Children's Hospital Medical Center and the University of Cincinnati in the United States. His academic journey has been marked by significant contributions to public health, particularly in the context of infectious diseases and vaccine development. Previously, Dr. Kwatra held various positions at the University of the Witwatersrand and the South African Medical Research Council.

His research has been pivotal in addressing critical health challenges in Africa, including group B streptococcal disease and COVID-19. In addition to his research endeavors, Dr. Kwatra has collaborated with prestigious organizations such as the Bill and Melinda Gates Foundation and the National Institutes of Health, further emphasizing his commitment to improving global health outcomes. His recent publications reflect a strong focus on maternal vaccination strategies and the durability of vaccine-induced immunity, underscoring his role as a leading voice in the field of vaccinology.

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Dr. Kalpana Subedi

Dr. Kalpana Subedi is a Consultant Paediatrician and a professor of paediatrics. She is a neonatology specialist with over 25 years of clinical, academic, and programmatic experience in Neonatology and Child health. She is also a member of Nepal’s National Immunization Advisory Committee.

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Dr. Balaji Veeraraghavan

Balaji Veeraraghavan is a Professor of Microbiology at Christian Medical College, Vellore, a position he has held since 2008. His research focuses on antimicrobial resistance, which includes molecular resistance surveillance, evaluation of newer agents and epidemiology of drug-resistant pathogens. He leads a research group with a multifaceted approach to studying and understanding the epidemiology and genomics of pathogens, which helped to put antimicrobial resistance on the map as a major public health concern. Balaji served as a temporary scientific advisory board member for several WHO Committees, including emerging bacterial infectious disease and antimicrobial resistance surveillance.

Balaji is a recipient of the Charles C. Shepard science award for scientific excellence and a member of several organizations, including the global genomic consortium for Klebsiella pneumoniae and Salmonella Typhi/Paratyphi, the Indian Network for Surveillance of Antimicrobial Resistance (INSAR) under the auspices of WHO–SEARO from its inception, and a steering committee member of AMS Hamied Foundation UK-India AMR Scientific group. He also has a wealth of experience leading the Indian Association of Medical Microbiology, an External Quality Assurance Scheme (IAMM EQAS) for more than 1000 laboratories across India.

He obtained his PhD in basic science from the Christian Medical College, India and a post-doctoral fellowship at Tufts Medical School, Boston, United States. He is a fellow of the Royal Society of the Academy of Medical Sciences. He has published over 410 articles and has an H-index of 37.

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Dr. Kiran Tiwari

Dr. Kiran Tiwari is a general pediatrician with a special interest in neonatal and adolescent health. He obtained his MBBS (2012) and MD in Pediatrics (2018) from the Institute of Medicine, Tribhuvan University. He currently serves as Consultant Pediatrician and Medical Superintendent at Dhaulagiri Provincial Hospital, Baglung. Dr. Tiwari has been actively involved in providing clinical care and training programs for health workers, including SBAs and medical officers, with a focus on reducing neonatal and child mortality in rural areas. He is a member of the NEPAS and NMA. His research interests include neonatal and child mortality risk factors, preventive interventions and strategies to strengthen child health services in Nepal. He has been a co-investigator in research conducted by GlohMed on patterns of ANC visits in different hospital of Nepal. He has been awarded visiting fellowship from RCPCH, UK in 2024.

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Dr. Suraj Bhattarai

Clinician Scientist and Director, GlohMed, Nepal/ IMPRINT Network & LSHTM, UK

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Prof. Paul Heath

Professor of Paediatric Infectious Diseases, Director of the Institute  of Infection & Immunity / Centre for Neonatal and Paediatric  Infection (CNPI), City St. George’s, London, UK

Advisers

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Prof. Kirsty Le Doare

Professor of Vaccinology and Immunity, Centre for Neonatal and Paediatric Infection (CNPI), Maternal and Neonatal Vaccinology Research Group, City St. George’s, London, UK

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Dr. Gaurav Kwatra

Director, Laboratory for Specialized Clinical Studies, Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH, USA/ Adjunct Faculty (Prof), Department of Clinical Microbiology, CMC, Vellore, India

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Dr. Kalpana Subedi

Neonatologist, Paropakar Maternity & Women’s Hospital/ Member, Perinatal Society of Nepal/ Member, National Immunization Advisory Committee

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Dr. Balaji Veeraraghavan

Professor of Microbiology, Christian Medical College, Vellore, India/ Member, Indian Network for Surveillance of Antimicrobial Resistance (INSAR)

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Dr. Kiran Tiwari

Consultant Paediatrician & Medical Superintendent, Dhaulagiri Hospital, Gandaki Province

Overview of Maternal-neonatal health

The health of women during pregnancy, delivery and postpartum period is referred to as maternal health. Direct causes like excessive bleeding, infections, high blood pressure, unsafe abortion, obstructed labor and indirect causes like malaria, anemia and heart diseases are the most common cause of maternal mortality. Timely management by skilled health workers can prevent the maternal deaths. [1] Neonate is a baby within the first 28 days of life. During this period neonate are at highest risk of morbidity and mortality. Preterm birth, birth asphyxia, infections and congenital abnormalities are the major causes of neonatal death. [2]

Maternal and neonatal mortality

Maternal mortality: In 2023, globally, more than 700 women died each day from pregnancy and childbirth related causes that could have been prevented. On average, a maternal death was recorded nearly every two-minute throughout the year. About 260,000 women died during and following pregnancy and childbirth in that year. About 92% of all maternal deaths happened in low and lower middle-income countries (LMICs). [3] In Nepal 190 maternal deaths were reported in fiscal year 2080/2081 B.S. (2023/24). [4] Neonatal mortality: In 2022, globally, around 2.3 million infants died worldwide within first 28 days of life. The highest neonatal mortality rate was reported in Sub Saharan Africa (22 deaths per 1000 live births) in 2022, followed by Central and Southern Asia (21 deaths per 1000 live births).[5] Over 550,000 newborn deaths occur each year because of neonatal infections.[6] In Nepal, out of 1,907 perinatal deaths in fiscal year 2080/2081 B.S (2023/24), 58% were antepartum still births.[7]

Perinatal infections and immunity:

During pregnancy, a woman goes through various physiological and immunological changes that supports healthy pregnancy. Sometimes these changes may make women more sensitive to infections. Bacterial, viral, parasitic or fungal maternal infections can occur at any stage of pregnancy. TORCH pathogens: Toxoplasma gondii; others (syphilis, varicella zoster, parvovirus b19), Rubella, cytomegalovirus, Herpes simplex virus) causes congenital infections.[8] On the other hand, infants and neonates are known to have underdeveloped and ineffective immune system. They are more susceptible to particular pathogens that leads to infection. [9] Risk of infection is increased due to both genetic and environmental factors. Neonatal infections are the most common cause of mortality. [10] In utero infection includes spontaneous abortion, intra-uterine growth retardation (IUGR), preterm birth, still birth, congenital infections (Rubella) and symptomatic(toxoplasmosis). During intra-partum period, infection is transmitted to fetus in utero as in cases of pre-labor rupture of membrane. Postpartum infections include TB (infected maternal tissue and body fluids) and acquired through breastfeeding (HIV, CMV). [11]

Vaccine preventable maternal and neonatal infections

Maternal immunization prevents perinatal infections and, thus, decreases morbidity and mortality in neonates. [12] Among the routine vaccines: COVID-19 vaccine is recommended during pregnancy; Hepatitis A is recommended if the pregnant woman is at risk; Hepatitis B is recommended if not already vaccinated; Influenza (inactivated) is recommended seasonally, while the live nasal spray form (LAIV) is contraindicated. TDaP is recommended during each pregnancy, ideally between 27–36 weeks; alternatively, TD should be used if otherwise indicated; RSV (Pfizer Abrysvo) is recommended between 32–36 weeks. While MMR and Varicella are contraindicated during pregnancy, Mpox, polio (IPV) and meningococcal B vaccines should be considered only if the benefit outweighs the risk (Meningococcal ACWY may be used if indicated). There is no recommendation for HPV, Hib, pneumococcal conjugate (PCV), pneumococcal polysaccharide (PPSV23), or the zoster (RZV) vaccine (consider delaying RZV until after pregnancy).[13] Hepatitis B vaccine, BCG (Bacille Calmette-Guérin) and polio vaccine are recommended for neonates to reduce the risk of infection and promote wellbeing. [14] According to Nepal Government guidelines, a child is considered fully immunized if they receive all vaccines as outlined in the National immunization schedule. Full immunization rate reached 96% in FY 2080/81 B.S. (2023/24). [15]

References :

Events: AMMUNet 1st International Symposium 2025

Network secretariat:
GlohMed Office,
Shree Marg, Pulchowk, Lalitpur 447700, Bagmati Province, Nepal

Email: ammunet@glohmed.org

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