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.
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.
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\u2019s dominant lineage likely emerged in 1970s, and predicted that resistance against first-line antimicrobials was rare.
Posted 13/01/2022. Associate Professor Tan and colleagues demonstrated that Oxford-AstraZeneca COVID-19 vaccine is immunogenic in Vietnamese health-care workers. Neutralizing antibodies were detectable in 98.1% and 94.7% of the study participants at 14 days and month 3 after vaccination, respectively. These data are critical to informing the deployment of the COVID-19 vaccine.
Posted 19/10/2021. The search for more effective and affordable treatments for cryptococcal meningitis must go on, as results of a trial repurposing tamoxifen, a drug developed for breast cancer, found it had no effect in a trial in Vietnam, by Nguyen Thi Thuy Ngan and Jeremy Day. Although tamoxifen shows activity against Cryptococcus neoformans in vitro, there was no evidence of benefit in patients. The OUCRU team will keep looking for better treatments for cryptococcosis.
Posted 15/10/2021. Tan Le Van and colleagues showed Delta variant breakthrough infections may cause asymptomatic or mild disease, but are associated with high viral loads and low levels of vaccine-induced neutralizing antibodies. The data suggested ongoing transmission had occurred between fully-vaccinated individuals. Social distancing measures remain critical to reduce the transmission of SARS-CoV-2.
Posted 02/09/2021. A cross-sectional survey of G6PD deficiency genotypes and phenotypes of nearly two thousand girls and women living on malarious Sumba island in eastern Indonesia assessed risk of hemolytic crisis with primaquine therapy against latent malaria with G6PD screening technologies. These findings by Kevin Baird and colleagues will help guide the selection of G6PD screening methodology and practice.
Posted 31/08/2021. Using a simple One Health survey design, this pilot study by Juan Carrique-Mas and colleagues measured AMU in the four commonly farmed animal species in the Mekong Delta (Vietnam) and compared it to human AMU using different metrics. Lessons from this study can be used in the formulation of One Health surveillance systems.
Posted 09/07/2021. Dr Tan and his colleagues showed that only subgenogroup B1a of coxsackievirus A16, a common cause of the ongoing Hand Foot and Mouth Disease epidemic in Asia was circulating in southern Vietnam between 2011-2017. Active surveillance for viral circulation is critical to informing outbreak response and vaccine development.
Posted 30/06/2021. In a cluster-randomised trial of mass microscopic diagnostic screening and treatment for malaria in eastern Indonesia, Kevin Baird and colleagues show that the intervention had no impact on the prevalence of carriage of gametocytes infectious to mosquitoes. The findings highlight the requirement for much greater sensitivity of diagnostics for this intervention to provide benefit to communities.
Posted 21/05/2021. Based on the analysis of a large volume of observational data on disease (diarrhea, nervous and respiratory signs, legs lesions) and antimicrobial usage (from 13 classes), Marc Choisy and colleagues highlight the absence or negative effects from prophylactic antimicrobial use in small-scale chicken farms in the Mekong Delta of Vietnam.
Posted 04/05/2021. This survey in Jakarta, Indonesia, led by Licia Limato & Raph Hamers, evaluated patterns and quality indicators of antibiotic prescribing in six public and private hospitals. The study reported a high rate of empirical use of broad-spectrum antibiotics, coupled with poor documentation and guideline adherence, suggesting important areas for antimicrobial stewardship interventions.
Posted 09/04/2021. Survivorship after an intensive care unit (ICU) stay is associated with long-term disability throughout the world. Nguyen Thi Kim Anh, Louise Thwaites and colleagues designed, implemented and evaluated the feasibility of a sustainable ICU rehabilitation programme in a resource-limited setting with the aim of improving the long-term outcome of critically ill patients.
Posted 23/03/2021. In tuberculous meningitis, raised intracranial pressure often results in irreversible neurological injury. In this study of 107 participants with tuberculous meningitis, Joseph Donovan and colleagues show how optic nerve sheath diameter ultrasound may provide a low-cost point-of-care option for the identification of individuals with raised intracranial pressure in tuberculous meningitis
Posted 12/03/2021. Henry Surendra, Raph Hamers and colleagues report a large retrospective study of patients hospitalised with COVID-19 in Jakarta, Indonesia. In-hospital mortality was lower than reported in high-income countries, likely explained by the younger population, fewer comorbidities and less severe disease. Nonetheless, this study affirmed the vulnerability of elderly and comorbid patients as well as children under 5 years in LMICs
Posted 02/02/2021. Indiscriminate antimicrobial use (AMU) in animal production is a driver of antimicrobial resistance globally. In this trial, Juan Carrique-Mas and colleague provided regular veterinary advice to chicken farmers in Vietnam aiming to reducing AMU. AMU was quantitatively reduced by 66% and flock mortality by 40%. This study demonstrates that reductions in AMU without compromising health and productivity can be achieved in LMICs.
Posted 22/01/2021. Raph Hamers and colleagues conducted a multi-country prospective study of Africans with HIV-1 on suppressive antiretroviral therapy. Plasma concentrations of sCD14 and CRP predicted subsequent poor CD4+ T-cell recovery, and CXCL10 and sCD163 predicted viral rebound. Further research is needed to increase our understanding of and to explore the potential for adjunctive therapeutic interventions targeting these pathways.
Posted 19/01/2021. Tan Le Van and colleagues show that metagenomics could detect enteroviruses (n=23), hepatitis B virus (3), HIV (2), molluscum contagiosum virus (1) and germycircularvirus (1) in 14.7% of 204 cerebrospinal fluid from Vietnamese patients presenting with central nervous system infections of unknown origin. It remains a challenge to identify a plausible cause in patients with brain infections.
Posted 12/01/2021. Azithromycin is effectively the last remaining oral antimicrobial to treat typhoid fever and is widely used for empirical therapy in South Asia. Although azithromycin resistance in Salmonella Typhi has rarely been reported, Abhilasha Karkey and colleagues show that an increasing reliance on this drug has led to the emergence of azithromycin resistant S. Typhi in the region.
Posted 20/11/2020. Providing compensation for participants in clinical research is well established but defining compensation in low-resource settings is challenging due to ethical concerns and the lack of appropriate frameworks. Evelyne Kestelyn and colleagues at OUCRU Vietnam developed a compensation and reimbursement framework, providing a consistent, fair and transparent decision-making process that will be implemented across all future clinical research.
Posted 17/11/20. Rogier van Doorn and colleagues show that antibiotics were prescribed to almost all 500 children with mild respiratory infection presenting to an outpatient clinic. They assessed prior antibiotic use by questionnaire and urine testing (HPLC), and reported overuse and overprescription of antibiotics when most respiratory infections are caused by viruses, and selection of resistant Enterobacteriaceae in gutflora with transmission potential.
Posted 20/10/2020. Buddha Basnyat and colleagues describe findings from NUFIT, the Nepal Undifferentiated Febrile Illness Trial, a randomized, double blind, placebo controlled trial. The trial revealed that 7 days of sulphamethoxazole-trimethoprim (Bactrim) is inferior to azithromycin in the treatment of undifferentiated febrile illness (fever without a focus) and enteric fever in Nepal and the wider region in South Asia.
Posted 11/09/2020. Nineteen different enterovirus serotypes were detected in 1196 Vietnamese children presenting with hand foot and mouth disease during 2015-2018. Le Van Tan and colleagues show that EV-A71 was the major cause, especially in those with severe disease, followed by CV-A6, CV-A10 and CV-A16. Multivalent vaccines are urgently needed to control hand foot and mouth disease.
Posted 06/08/2020. Cholesterol is required for efficient dengue virus (DENV) replication, however statin treatment did not show efficacy against dengue in clinical trials, and underscored the need for a more detailed understanding of the interaction between DENV and cellular cholesterol. In this paper, in collaboration with DUKE-NUS, Sophie Yacoub and colleagues demonstrate the pivotal role of PCSK9 in DENV infections.
Posted 24/07/2020. A team from OUCRU led by Le Van Tan, Hospital for Tropical Diseases, Vietnam, and the Target Discovery Institute at the University of Oxford showed that lipocalin 2 is a sensitive and specific biomarker for discriminating bacterial meningitis from a broad spectrum of other brain infections, and outperforms routine CSF markers such as leukocytes, glucose, protein and lactate.
Posted 09/06/2020. Dr Le Van Tan and colleagues from OUCRU, Vietnam, demonstrate that 43% of quarantined people who were RT-PCR positive for SARS-CoV-2 were asymptomatic, but potentially contagious. The results emphasize the importance of contact tracing, airport quarantine and RT-PCR screening for SARS-CoV-2 among isolated people in controlling the ongoing pandemic.
Posted 05/06/2020. Tan Le Van and colleagues showed that metagenomics can accurately detect a wide range of neurotropic viruses, especially vaccine-preventable-disease causing viruses such as mumps, in CSF of 66 consecutively treated adults with meningoencephalitis. Prospective study is needed to demonstrate the benefit metagenomics may add to the management of devastating diseases such as meningoencephalitis.
Posted 18/05/2020. The etiology of high altitude pulmonary edema (HAPE), a disease sometimes seen in sojourners to high altitude, is lack of adequate oxygen and not an inflammation provoked by an infectious agent like the novel coronavirus. Except for supplemental oxygen, Buddha Basnyat and colleagues strongly caution against managing COVID-19 lung injury with treatments that are used for HAPE.
Posted 15/05/2020. Tuberculous meningitis is the most severe form of tuberculosis. Here Joseph Donovan and colleagues review tuberculous meningitis research during the last 2 years, focusing on that considered to have a major impact in advancing understanding, diagnosis, treatment of this disease in children and adults
Posted 12/05/2020. Exposure to pigs may not be the only source of Streptococcus suis infection. In a study in Vietnam by Juan Carrique-Mas and colleagues, 33.9% healthy chickens investigated carried this organism. Sequencing data indicated that chicken S.suis were generally different from human/pig isolates, although 10% chicken S.suis were identical to pig isolates from the same area.
Posted 27/03/2020. Nguyen Thuy Thuong Thuong and colleagues in OUCRU, Vietnam, investigated the sources of multi-drug resistant TB in patients with undiagnosed isoniazid-resistant TB treated with first-line anti-TB therapy. They found that re-infection with a new multi-drug resistant TB strain was just as common as the emergence of rifampicin resistance.
Posted 11/02/2020. Hand, foot and mouth disease is an emerging infection with pandemic potential. To inform vaccine development, Tan Le Van and colleagues studied the antibody responses in 120 infected patients. Results support previous reports about the potential benefit of enterovirus-A71 vaccine, but emphasize the requirement for multivalent vaccines to control this emerging infection.
Posted 07/02/2020. Within the research community, it is generally accepted that consent processes for research should be culturally appropriate and tailored to the context, yet researchers continue to grapple with what valid consent means within specific stakeholder groups. Evelyne Kestelyn and colleagues explored the consent practices and attitudes within hospital-based trial communities from four referral hospitals in Vietnam.
Posted 24/01/2020. Tuberculous meningitis is the most severe form of tuberculosis. Late diagnosis leads to worse patient outcomes, however currently available diagnostic tests are insufficiently sensitive, and new tests are urgently needed. Joseph Donovan, Guy Thwaites, and colleagues present a randomised diagnostic accuracy study demonstrating that new GeneXpert Ultra is not superior to standard GeneXpert for the diagnosis of tuberculous meningitis in Vietnam.
Posted 14/01/2020. Vu Thi Ngoc Bich and colleagues analyse the antibiotic resistance gene profiles among humans, animals, and their food and water in a rural Vietnamese community. Colistin resistance genes are predominantly found in both human and animal faeces, and a higher positive proportion of carbapenemase is reported \u2013 encoding genes among water and food samples when compared to human and animal faeces. This work is a collaboration between OUCRU and Radboudumc, Maastricht University in the Netherlands and NIHE in Vietnam.
Posted 17/12/2019. Typhoid fever is rampant in South Asia. This new typhoid vaccine (studied in Kathmandu, Nepal, by Buddha Basnyat and colleagues) appears to be very effective in the prevention of typhoid. Administration of the new vaccine, especially in children, will revolutionize the prevention of this disease. And, crucially, help fight typhoid treatment resistance, a burgeoning problem.
Posted 12/11/2019. Juan Carrique-Mas and colleagues characterize the veterinary drug shop network in two rural districts in the Mekong Delta of Vietnam. This study also describes the linkages between poultry farmers and these drug shops that are the main source of supply of antimicrobials to farmers. Therefore, interventions aimed at reducing excessive antimicrobial usage should include this important stakeholder group.
Posted 12/07/2019. Sepsis is a devastating clinical condition. However, the etiology remains unknown in the majority of the patients. Herein, Dr Tan and colleagues set out to apply metagenomic next generation sequencing to look for viral contents in ~400 Vietnamese patients presenting with sepsis of unknown cause.
Posted 07/06/2019. Juan Carrique-Mas and colleagues quantified the retail prices of the most common antimicrobials used in chicken farms in Vietnam. By comparing these costs with antibiotics for human use, they conclude that extreme low prices of antimicrobials for animal production may be a major factor driving excessive use. The authors advocate for a taxing system that restricts the use of critically important antimicrobials in agriculture.
Posted 28/05/2019. Kevin Baird calls attention to the importance of local expertise in anopheline mosquito ecology as an essential weapon in striving to eliminate malaria. Slight but very specific modifications to environments that disfavour those mosquitoes achieved very significant gains before the advent of DDT insecticide and synthetic antimalarial commodities in the middle of the 20th century. Loss of those commodities, and a lack of alternative strategies, led to the great malaria resurgence of the latter 20th century.
Posted 15/05/2019. Tetanus antitoxin is a vital component of tetanus treatment. In this clinical trial currently running at OUCRU Ho Chi Minh City, Louise Thwaites and colleagues test whether, in addition to standard intramuscular injection of antitoxin, antitoxin given directly into the central nervous system is beneficial in adult patients with tetanus.
Posted 10/05/2019. Previously, Ronald Geskus and colleagues developed a model based on information at diagnosis that provides mortality risk prediction for patients with tuberculosis meningitis. Prediction improves when we use time-updated Glasgow coma score and plasma sodium collected during the disease course. Our model and accompanying app help define patients with poor prognosis.
Posted 03/05/2019. Jeremy Day and colleagues sequenced the genomes of 699 Cryptococcus neoformans isolates from meningitis patients from southeast Asia and Africa. The phylogenetic structure demonstrates a recent, exponential, population expansion, driven almost entirely by three sub-clades (VNIa-4, VNIa-5 and VNIa-93). Mitochondrial recombination seen in VNIa-5 may be important in its ability to infect immunocompetent people. VNIa-93, previously associated with poorer outcomes, is in fact associated with a significantly reduced risk of death.
Posted 30/04/2019. The Oxford University Clinical Research Unit in Ho Chi Minh City investigated gender-related issues associated with career progression within a LMIC. Ngo Thi Hoa, Louise Thwaites and colleagues surveyed 120 scientists, the majority Vietnamese. They describe barriers to female career progressions such as caring duties and home environments, as well as the specific initiatives launched to increases female leadership.
Posted 12/04/2019. Tetanus continues to be a significant problem in many countries. This seminar, written by OUCRU researchers Lam Minh Yen and Louise Thwaites describes the evidence base for tetanus treatment, current vaccination challenges and research questions for the future.
Posted 02/04/2019: Underdiagnosed in South Asia, melioidosis is caused by a bacterium called Burkholderia pseudomallei which is often referred to as a remarkable imitator. Pulmonary involvement including infections mimicking tuberculosis is a common form of presentation. In this case report, Buddha Basnyat and colleagues show that if a South Asian patient does not respond to anti tuberculosis treatment, melioidosis should be considered.
Posted 08/02/2019. Dengue has been estimated to cause a substantial health and economic burden globally. However, the specific estimates from different studies vary significantly. This review by Dr Hugo Turner and colleagues provides an overview of the different dengue burden estimates, using Vietnam as a case study. Understanding the methodology behind these calculations is vital when interpreting economic evaluations of novel dengue interventions.
Posted 21/12/18. A photo from Pearl Gan, Photographer In Residence for OUCRU, was selected for The Lancet Highlights 2018. The picture shows Senior Nurse Shikh Rema changing the dressing for Jabeda Begom, a 65-year-old woman with leprosy, at the Jalchatra Hospital in Bangladesh. Treatment of leprosy is a lengthy process, but thanks to dedicated staff, patients are given the care and attention they need.
Posted 27/11/2018. Since January 2018 there has been a significant increase in hospital admissions due to hand, foot and mouth disease across Vietnam. In collaboration with Children\u2019s Hospital 1 in Ho Chi Minh City, Dr Tan and colleagues set out to describe the etiology, clinical characteristics and demographics of the affected patients.
Posted 16/10/18. Clinical research is a crucial component of outbreak response as it provides evidence to improve the prevention and treatment of diseases with epidemic potential. However, disease epidemics are unpredictable and often short-lived, and this adds many challenges to the conduct of clinical research. Professor Peter Horby and colleagues have evaluated some commonly used clinical trial designs in order to determine the optimal design for this context.
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