Search results (114)
« Back to Research HighlightsTracing epistemic injustice in global antimicrobial resistance research
Posted 14/03/2025. This commentary explores whether there is epistemic injustice in global antimicrobial resistance (AMR) research – who sets priorities, who produces knowledge, and which types of knowledge are valued. Prof Phaik Yeong Cheah and colleagues argue that epistemic injustice may have created blind spots in policy. Addressing this requires a commitment to diversity, equity, and inclusion.
Challenges associated with dapsone for leprosy treatment in Indonesia - urgent need for access to alternative antimicrobial drugs
Posted 05/03/2025. Marlous Grijsen and colleagues highlight the challenges associated with dapsone for leprosy treatment in Indonesia. Dapsone, a key drug in multi-drug therapy, can cause life-threatening adverse drug reactions, including dapsone hypersensitivity syndrome and hemolytic anemia. Routine screening could prevent these complications, but in many leprosy-endemic areas, testing and alternative regimens are inaccessible or unaffordable. We call for better diagnostics and alternative treatments to ensure safer care.
Rethinking neglected tropical diseases: A shift towards more inclusive and equitable terminology
Posted 05/02/2025. Neglected tropical diseases (NTD) affect >1 billion people, disproportionally affecting under-resourced communities. While the term ‘NTD’ has been instrumental in driving critical funding and policy initiatives, it may also carry unintended negative consequences. Marlous Grijsen and colleagues explore the term NTD to foster dialogue and advocate for more inclusive and equitable language.
Sustainable antimicrobial resistance surveillance: time for a global funding mechanism
Posted 07/01/2025. The continued costs of a standard national AMR surveillance system are predicted to account for over 5% of the total domestic general government health expenditure (GGHE-D) for 28 LMICs and more than 2% of GGHE-D for 46 LMICs. This high cost is not sustainable without a long-term global financing mechanism. By Liz Ashley
Leprosy
Posted 03/12/2024. This comprehensive review, co-authored by Marlous Grijsen and a multidisciplinary team of global experts from leprosy endemic and non-endemic countries, describes the epidemiology, pathophysiology, clinical manifestations and management of leprosy and the impact it has on quality of life. The paper addresses knowledge gaps and research priorities and offers an up-to-date perspective on leprosy.
Changing epidemiology and antimicrobial susceptibility of bloodstream infections at a Vietnamese infectious diseases hospital (2010–2020)
Posted 24/10/2024. Duy Pham’s lab performed comprehensive epidemiological analysis of bloodstream infections (BSI) in Vietnam (2010-2020), revealing an increasing trend of E. coli and K. pneumoniae as predominant pathogens. Both showed rising multidrug resistance, primarily affecting elderly individuals with comorbidities. Antibiotic prescriptions declined significantly following control policies. Their work highlights the needs for community surveillance and antimicrobial stewardship to manage BSIs in Vietnam.
A nationwide mixed methods study of gaps and barriers to implementation of antimicrobial stewardship programs in hospitals in Indonesia
Posted 23/10/2024. Robert Sinto, Raph Hamers and colleagues conducted a nationwide evaluation of antimicrobial stewardship programmes (ASP) in Indonesian public and private hospitals. They found that to date most hospitals only reached an inadequate or basic level of ASP implementation, and they identified several globally-relevant and context-specific barriers. The paper formulates actions recommended for sustainable improvement.
Genomic insights unveil the plasmid transfer mechanism and epidemiology of hypervirulent Klebsiella pneumoniae in Vietnam
Posted 22/10/2024. Duy Pham's lab investigated hypervirulent Klebsiella pneumoniae bloodstream infections in Vietnam, uncovering high strain diversity likely driven by horizontal transfer of non-self-transmissible virulence plasmids. Plasmid acquisitions led to the independent emergence of MDR hypervirulent strains. Significant gaps persist in understanding community transmission for targeted interventions, especially in Asia where new strains are emerging.
Emerging Monkeypox Virus Sublineage C.1 Causing Community Transmission, Vietnam, 2023
Posted 02/10/2024. Le Van Tan and colleagues studied a community cluster of mpox in Vietnam caused by emerging MPXV sublineage C.1, imported into Vietnam through 2 independent events; 1 major cluster carried a novel APOBEC3-like mutation. Three patients died; all had advanced HIV co-infection. Viral evolution and its potential consequences should be closely monitored.
Hospital-acquired infections and unvaccinated children due to chronic diseases: an investigation of the 2017–2019 measles outbreak in the northern region of Vietnam
Posted 24/09/2024. Measles-infected children with chronic diseases had lower vaccination rates and a higher proportion of hospital-acquired infections during the 2017–2019 outbreak in northern Vietnam. Early nosocomial transmission was detected before community outbreaks in several provinces. Strengthening hospital infection control and raising awareness about the importance of vaccination for vulnerable groups is essential. By Thinh Ong Phuc
Towards a machine-learning assisted non-invasive classification of dengue severity using wearable PPG data: a prospective clinical study
Posted 05/07/2024. Early warnings of clinical deterioration through continuous non-invasive monitoring could benefit clinical care in dengue-endemic settings. Taking the approach of using low-cost wearables, Chanh Ho Quang and colleagues successfully demonstrate the ability to classify dengue patients with different severity and disease state. The implementation of these models could improve patient outcomes and resource allocation
Mitigating machine learning bias between high income and low–middle income countries for enhanced model fairness and generalizability
Posted 03/07/2024. Collaborative AI efforts between high-income countries (HICs) and low- to middle-income countries (LMICs) are essential for pooling resources and expertise. Jenny Yang, Louise Thwaites and colleagues show that AI approaches can lead to divergent outcomes across HIC and LMIC settings. Using COVID-19 screening data, we demonstrate that bias mitigation methods improve fairness and maintain diagnostic sensitivity.
Leprosy identified in Sumba Island, eastern Indonesia: elimination targets under threat
Posted 24/05/2024. Frontline healthcare workers detected 60 persons affected by leprosy in Sumba Island, Indonesia, through teledermatology, over a 3-year period. Marlous Grijsen and colleagues at the Sumba Foundation and Gadjah Mada University highlight the challenges of delivering leprosy care in remote areas, how these translate into population risks of ongoing transmission and disabilities, and how leprosy can re-emerge after reaching national elimination targets.
Feasibility of wearable monitors to detect heart rate variability in children with hand, foot and mouth disease
Posted 26/03/2024. Dr Le Nguyen Thanh Nhan and colleagues at the Oxford University Clinical Research Unit showed that wearable devices could be used to monitor heart activity in children with hand foot and mouth disease. This monitoring method was feasible even in young children, and the heart activity measured was linked with the virus causing the disease.
Emerging Enterovirus A71 Subgenogroup B5 Causing Severe Hand, Foot, and Mouth Disease, Vietnam, 2023
Posted 14/02/2024. Le Van Tan and colleagues describe a 2023 outbreak of severe hand, foot, and mouth disease in Vietnam caused by an emerging lineage of enterovirus A71 subgenogroup B5. Affected children were significantly older than those reported during previous outbreaks. The virus should be closely monitored to assess its potential for global dispersal.
Characteristics and clinical outcomes of patients with pre-delta, delta and omicron SARS-CoV-2 infection in Indonesia (2020–2023): a multicentre prospective cohort study
Posted 26/01/2024. A recent prospective study among Indonesian patients hospitalised with COVID-19, from 2020 to 2023, demonstrated that, despite lower disease severity than delta, the omicron variant still caused substantial patient burdens. Older and unvaccinated individuals remained at higher risk of adverse outcomes, warranting optimised treatment and vaccine booster strategies for this setting. By Raph Hamers
Teledermatology to Improve Access to and Quality of Skin Care in Eastern Indonesia
Posted 12/01/2024. Our recent study in Sumba, a remote island in eastern Indonesia, shows that teledermatology improves access to skin care. Using limited resources, this is a great way to empower frontline healthcare workers, build local capacity and support remote and medically underserved communities across the globe. The project is in collaboration with Sumba Foundation, Gadjah Mada University and OUCRU-Indonesia. From Marlous Grijsen
Use of antimicrobials during the COVID-19 pandemic: A qualitative study among stakeholders in Nepal
Posted 17/11/2023. Early critical phase of the COVID-19 pandemic added tremendous pressure to find curative therapies. A lot of empirical treatments, including antimicrobials, were recommended. Drawing on interviews with patients, clinicians and drug dispensers, Bipin Adhikari and colleagues explore how and why antimicrobials may have been used for the management of COVID-19 in Nepal.
A Clinically Oriented antimicrobial Resistance surveillance Network (ACORN): pilot implementation in three countries in Southeast Asia, 2019-2020
Posted 01/11/2023. ACORN (A Clinically Oriented Antimicrobial Resistance Surveillance network) is a WHO GLASS compatible case-based surveillance method for antimicrobial resistance that produces more meaningful and locally actionable data. Rogier van Doorn and colleagues publish the results of a pilot in three countries, showing proof of principle and valuable lessons to be learned going forward. More at: acornamr.net
Severe falciparum malaria in pregnancy in Southeast Asia: a multi-centre retrospective cohort study
Posted 30/08/2023. This study by Makoto Saito and colleagues analysing 213 severe malaria cases in pregnancy at SMRU, MORU and OUCRU showed vital organ dysfunction led to high maternal and fetal mortality. In contrast, severe anaemia or hyperparasitaemia alone did not. This marked difference may explain the variation of mortality reported in the literature. Early diagnosis and treatment of malaria and anaemia in antenatal care should be promoted.
Impact of the COVID-19 pandemic on tuberculosis control in Indonesia: a nationwide longitudinal analysis of programme data
Posted 29/08/2023. A large-scale study in Indonesia found devastating consequences on TB control during the COVID-19 pandemic, estimating declines of TB case notification by 26% and treatment coverage by 11%. Districts with high COVID-19 incidence and limited healthcare resources were most affected. Henry Surendra, Raph Hamers and colleagues emphasise the need for resilient health systems.
The spatio-temporal distribution of acute encephalitis syndrome and its association with climate and landcover in Vietnam
Posted 05/07/2023. The aetiology of acute encephalitis syndrome (AES) varies greatly in Vietnam and is unknown in many cases. Hannah Brindle, Marc Choisy and colleagues used national surveillance data to analyse the spatio-temporal distribution of cases of AES from 1998 until 2016, which showed differences by region. The number of cases of AES was also positively associated other syndromes and pathogens, climate, landcover and the number of pigs suggesting that many cases may be due to vector-borne pathogens, particularly Japanese encephalitis virus.
Global knowledge gaps on antimicrobial resistance in the human health sector: a scoping review
Posted 14/06/2023. This scoping review, led by Raph Hamers with WHO, aggregated knowledge gaps in antimicrobial resistance in bacteria, including TB, and fungi: 2340 knowledge gaps were consolidated into 177 thematic research questions across 14 AMR areas. The findings informed research priorities in the novel WHO AMR Global Research Agenda for human health.
FLASH-TB: an Application of Next-Generation CRISPR to Detect Drug Resistant Tuberculosis from Direct Sputum
Posted 25/04/2023. Providing tuberculosis patients with optimal and timely treatment depends on rapid drug resistance diagnosis. Nguyen Thuy Thuong Thuong and colleagues applied a genome editing method and successfully detected drug resistance directly from sputum with 93.7% concordance to the standard phenotypic drug test, which potentially speeds up drug resistance diagnosis in tuberculosis and other infectious diseases.
Which trial do we need? A global, adaptive, platform trial to reduce death and disability from tuberculous meningitis
Posted 21/04/2023. Tuberculous meningitis kills around 25% of sufferers. New antimicrobial and adjunctive anti-inflammatory agents offer an unparalleled opportunity to reduce mortality. But small trials, testing single interventions, are unlikely to transform outcomes. Guy Thwaites and colleagues therefore propose a global platform trial in adults and children with tuberculous meningitis that will investigate multiple interventions at scale and at speed.
Spatiotemporal Evolution of SARS-CoV-2 Alpha and Delta Variants during Large Nationwide Outbreak of COVID-19, Vietnam, 2021
Posted 18/04/23. Dr Anh and colleagues investigated the evolution of SARS-CoV-2 in Vietnam, 2021. The Alpha and Delta variants were the responsible viruses. The Delta variant was confined to AY.57 lineage, likely via a single introduction, causing over 1.7 million infections and more than 32,000 deaths. Viral transmission was strongly affected by non-pharmaceutical interventions.
Distribution and origins of Mycobacterium tuberculosis L4 in Southeast Asia
Posted 12/04/2023. There are now 9 recognised lineages of Mycobacterium tuberculosis, with 1-4 being found most widely around the world. Lineage 4 is understood to have emerged in Europe and been introduced into Asia through trade and colonisation. Timothy Walker and colleagues have identified that relatively unique sub-lineages of lineage 4 have however been circulating between south-east Asian countries since being introduced, possibly with China serving as a conduit from Europe. This leads to the hypothesis that there may have been host population-specific evolution of lineage 4 in south-east Asia.
Early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America (IDAMS study): a multicentre, prospective, observational study
Posted 28/02/2023. Researchers from Heidelberg and Oxford worked with partners from eight countries across Asia and Latin America to develop an algorithm to improve early diagnosis of dengue; simple clinical and laboratory variables were collected daily from 5189 patients presenting with undifferentiated fever, among whom 2694 were subsequently confirmed to have dengue. Results will help to improve case management and use of limited resources in dengue-endemic areas. By Ronald Geskus
Awareness of Antibiotics and Antibiotic Resistance in a Rural District of Ha Nam Province, Vietnam: A Cross-Sectional Survey
Posted 17/02/2023. Low awareness of antibiotics and antibiotic resistance may lead to inappropriate antibiotic use and contribute to the problem of antibiotic resistance. Sonia Lewycka and colleagues found that most people in a rural community in northern Vietnam had heard of antibiotics, but practical knowledge about antibiotics and antibiotic resistance was limited. Type of health facility, distance from health facility, media use, and health information sources were associated with knowledge.
Outpatient antibiotic prescribing for acute respiratory infections in Vietnamese primary care settings by the WHO AWaRe (Access, Watch and Reserve) classification: an analysis using routinely collected electronic prescription data
Posted 10/02/2023. Over 97% of primary care patients with acute respiratory infections are prescribed antibiotics, and children under 5-years old are more likely to be prescribed antibiotics with higher resistance potential. This study in northern Vietnam by Nam Nguyen Vinh, Sonia Lewycka and colleagues highlights the urgent need for antimicrobial stewardship interventions in primary care settings.
Monkeypox Virus Infection in 2 Female Travelers Returning to Vietnam from Dubai, United Arab Emirates, 2022
Posted 08/02/2023. Dr Anh used metagenomics to whole-genome sequence monkeypox virus in 2 women with mpox returning to Vietnam from the United Arab Emirates. The viruses belonged to an emerging sublineage, A.2.1, distinct from B.1 which is responsible for the ongoing multicountry outbreak. Enhanced genomic surveillance is needed to clarify pathogen evolution.
Flexible resources and experiences of racism among a multi-ethnic adolescent population in Aotearoa, New Zealand: an intersectional analysis of health and socioeconomic inequities using survey data
Posted 03/02/2023. As societies become increasingly diverse, understanding the complex nature of racism for multiple ethnic, social, and economic identities is required. Sonia Lewycka and colleagues in New Zealand showed that indigenous and minority experiences of racism are heterogeneous, and flexible resources such as wealth and perceived whiteness can mitigate against some forms of systemic and interpersonal racism.
Screening for monkeypox virus infections in men who have sex with men in a sexual health clinic in Hanoi, Viet Nam
Posted 11/01/2023. A collaborative work between the Hanoi Medical University, UCLA, and OUCRU, showed no evidence of circulation of monkeypox virus among men who have sex with men attending a sexual health clinic in Hanoi, Vietnam in 2022. So far, the single case of monkeypox described in Vietnam was imported. By Thomas Kesteman
Kinetics of Neutralizing Antibodies against Omicron Variant in Vietnamese Healthcare Workers after Primary Immunization with ChAdOx1-S and Booster Immunization with BNT162b2
Posted 20/12/2022. Tan and colleagues showed that booster vaccination by BNT162b2 induced cross-neutralizing activities against Omicron variant sub-lineages BA.1 and BA.2 in Vietnamese health care workers completing primary immunization with ChAdOx1-S. These responses however significantly reduced at month 3 post booster doses. The need for a second booster merits further research.
Genomic epidemiology, antimicrobial resistance and virulence factors of Enterobacter cloacae complex causing potential community-onset bloodstream infections in a tertiary care hospital of Nepal
Posted 09/12/2022. Community-onset bloodstream infections caused by multidrug resistant Enterobacter cloacae complex (ECC) species are increasing, underscoring their potential emerging role. This study by Abhilasha Karkey and colleagues elucidated detailed genomic epidemiology of ECC isolates showing complex transmission dynamics within the community. Genomic evidence of resistance to several major antimicrobial classes including carbapenems was detected.
Antibody Responses and Reactogenicity of a Heterologous, Full-Dose Messenger RNA-1273 Booster in Heavily SARS-CoV-2–Exposed CoronaVac-Vaccinated Health-Care Workers in Indonesia: A Real-World Observational Study
Posted 07/12/2022. In this real-world cohort study in Indonesia, Raph Hamers and colleagues found high antibody responses and good tolerability of a heterologous, full-dose mRNA-1273 (Moderna) booster after two doses of inactivated vaccine (CoronaVac) in healthcare workers in Indonesia, with and without previous SARS-CoV-2 infection, including in those who had very low antibody levels.
Moderate and transient impact of antibiotic use on the gut microbiota in a rural Vietnamese cohort
Posted 02/12/22. PhD research from Vu Thi Ngoc Bich at OUCRU Hanoi (with NIHE, Radboud and Maastricht University) on samples from our longitudinal community cohort in Ha Nam, Vietnam, shows that frequent antibiotic exposure may push microbiota to different steady state that is less diverse but more resilient to disruption by subsequent antibiotic use.
Balancing uncertainty and proactivity in care seeking for hepatitis C: qualitative research with participants enrolled in a treatment trial in Ho Chi Minh City, Vietnam
Posted 16/11/2022. In this qualitative study, Jennifer Van Nuil and colleagues explored care seeking and treatment experiences for participants enrolled in hepatitis C clinical trials in Ho Chi Minh City, Vietnam. They found that experiences included the following themes: navigating uncertainty, proactivity in the face of challenges, living in fear with faith, and dynamic support systems.
A modified Sequential Organ Failure Assessment score for dengue: development, evaluation and proposal for use in clinical trials
Posted 27/09/2022. In this study, Sophie Yacoub and colleagues at OUCRU evaluated whether using a dynamic delta modified SOFA score might be a feasible endpoint for future therapeutic trials in dengue. They found that the delta mSOFA performed well, and was associated with requirement for organ support, duration of treatment and mortality.
African Plasmodium vivax malaria improbably rare or benign
Posted 08/07/2022. We have long believed most of sub-Saharan Africa to be free of Plasmodium vivax malaria due to the dominance of Duffy blood factor negativity. Recent work nonetheless reveals stable P. vivax transmission across Duffy-negative Africa, very probably causing an infection of deep organs responsible for harm of unrecognized origin. Review by Kevin Baird
Tackling typhoid fever burden in south Asia
Posted 28/06/2022. South Asia is a hub for typhoid fever, a biblical disease in the West. The new conjugate vaccine, which we studied and now implemented by the Nepali government, is very important for the control of typhoid fever. But well-done treatment trials with adequate sample size are also of paramount importance. By Buddha Basnyat
Perceptions, views and practices regarding antibiotic prescribing and stewardship among hospital physicians in Jakarta, Indonesia: a questionnaire-based survey
Posted 07/06/2022. This survey among over 1000 hospital physicians found that antimicrobial stewardship (AMS) implementation in Indonesian hospitals is challenged by institutional, contextual and diagnostic vulnerabilities. Appropriate recognition of the contextual determinants of antibiotic prescribing decision making will be critical to change physicians’ attitudes and develop context-specific AMS interventions. By Ralalicia Limato, Raph Hamers and colleagues.
Optimizing antibiotic use in Indonesia: A systematic review and evidence synthesis to inform opportunities for intervention
Posted 01/06/2022. This review represents a first attempt at systematically assessing human antibiotic use in Indonesia in the past 20 years. Ralalicia Limato, Raph Hamers and colleagues identified critical evidence gaps in the private health care sector, and what are the health system drivers of antibiotic use. Optimisation of antimicrobial use should be a priority of the national agenda for universal health coverage.
Zoonotic pathogens and diseases detected in Vietnam, 2020–2021
Posted 31/05/2022. Via online-survey with 332 clinical- and laboratory- based respondents in human and animal sectors across 61 of 63 provinces, followed by face-to-face interviews and review of 10-year-literature, Ngo Thi Hoa and colleagues identified 24 reported circulating-zoonotic diseases in Vietnam. With additional One-Health surveillance on these diseases, we will understand their animal reservoir and impact on human- and animal-health.
Human versus equine intramuscular antitoxin, with or without human intrathecal antitoxin, for the treatment of adults with tetanus: a 2 × 2 factorial randomised controlled trial
Posted 27/05/2022. This randomised controlled trial by Louise Thwaites and colleagues examined two different treatments for adults with tetanus. The first was spinal (intrathecal) injection of antitoxin compared to a sham (dummy) procedure (in addition to normal intramuscular injection) and showed no overall benefit. The second, comparing two types of intramuscular antitoxin (equine and human) also showed no difference between treatments
Mycobacterium tuberculosis transmission in Birmingham, UK, 2009–19: An observational study
Posted 20/04/2022. Although seasonality in tuberculosis is seen on all continents, explanations have remained elusive. In a 10-year population study of TB transmission in Birmingham, UK, Timothy Walker and colleagues see seasonality only among patients linked by recent transmission, with diagnoses peaking in spring time. TB’s incubation period may thus be even shorter than hitherto understood.
Mapping for engagement: setting up a community based participatory research project to reach underserved communities at risk for hepatitis C in Ho Chi Minh City, Vietnam
Posted 19/04/2022. Jennifer Van Nuil and colleagues used a community-based participatory research approach to engage in dialogues with underserved groups at risk for hepatitis C in Ho Chi Minh City, Vietnam. We present findings from stakeholder mapping meetings held with representatives from local organizations, including the challenges and dynamics of the communities.
Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review
Posted 18/02/2022. Integrating digital health innovations to the public hospital system in Vietnam requires understanding of the local technical and regulation landscape to avoid abandonment and ensure sustainability. Duc Minh Tran and colleagues mapped the relevant policy and academic publications, providing a big picture to inform the adoption of hospital-based digital health systems in Vietnam.
Genomic insights unveil the plasmid transfer mechanism and epidemiology of hypervirulent Klebsiella pneumoniae in Vietnam
Posted 01/02/2022. Pham Thanh Duy and colleagues at OUCRU have revealed the endemic circulation of fluoroquinolone-resistant extra-intestinal pathogenic Escherichia coli ST1193 in Vietnam, driven by multiple strain importations and sustained transmissions between humans. These organisms have developed resistance to multiple drugs of choice and are major causes of sepsis in neonates and bloodstream infections in adults in this setting.
The evolutionary history of Shigella flexneri serotype 6 in Asia
Posted 26/01/2022. Though Shigella flexneri serotype 6 has been proposed as a target for vaccine development against shigellosis, it is currently understudied. Hao Chung The and colleagues analyzed the genomes of 96 bacteria isolated from Asia, and showed that this pathogen’s dominant lineage likely emerged in 1970s, and predicted that resistance against first-line antimicrobials was rare.