Sophie Yacoub: Dengue research in Vietnam

I'm Dr Sophie Yacoub, I lead the dengue research group at OUCRU Ho Chi Minh City. My work is centred all around dengue which is a globally relevant virus. It's a major cause of admission for many hospitals in Vietnam, especially in the rainy season. Globally there are around 100 million cases of dengue every year, and this is increasing due to many reasons, including urbanisation but also in response to climate change and human mobility.

To address some of the major issues around dengue and also presenting some of the expertise we have in our group, we have four major themes for the dengue group. One is to try and improve how we monitor patients, to see if we can innovate in understanding which patients will go on to get more severe forms of the disease. We're doing this by using various different modalities including wearable devices, also using point-of-care ultrasounds and echocardiography, and also clinical decision support systems to help manage patients who come in. One major issue for hospitals in endemic countries like Vietnam is this sudden surge of patients that come in with dengue, then to identify who actually needs to be in hospital and who can be safely discharged is really important, and we're trying to help understand which patients will go on to get more severe disease and which patients can be safely sent home.

Apart from improving clinical monitoring, we're also running clinical trials to improve the outcome of patients. Currently there are no therapeutics to treat patients with dengue, there's only supportive care. What we're trying to understand is to look at the underlying mechanism to see which patients would benefit from a therapeutic. We're looking at host-directed therapies for patients who are already in hospital, but also looking earlier on in the disease with antiviral medications to improve clinical outcomes.

A third theme for the group is looking at the impact of climate change on the dengue epidemiology. We're working more with climate scientists both within Vietnam and also in the UK in Oxford, and we're developing a prediction tool. It's called DART - Dengue Advanced Readiness Tools - to allow hospitals and public health officers to prepare in advance for that sudden surge of cases that we see as the dengue season starts. This is a multi-disciplinary project involving modelers, clinicians, climate scientists, virologists. The overall aim is to see if we can predict smaller and flexible spatial scale, where there will be a dengue outbreak, particularly in cities like Ho Chi Minh City and Hanoi, but we're hoping to expand this work regionally, particularly as dengue is now spreading up altitudinally, so we're seeing major outbreaks now in Nepal and higher up in other cities, in the Himalayas. That's a new area of interest for us, that intersection between climate and infectious diseases.

And the fourth related theme, because in all of our clinical trials we always try and investigate the underlying mechanism of the pathophysiology of the diseases, we're also investigating the immune pathogenesis of specific high-risk groups that we know are at higher risk of developing complications. Those include things like co-morbidities, diabetes, obesity, cardiovascular disease, but also in the elderly population, we know that these groups of people do worse, and we're trying to understand why and if we can impact any of the clinical outcomes for these patients as well.

Dengue is a neglected disease; even in this day and age we have nothing to offer a patient that comes in, except supportive care. What we're hoping is not only we will, in the future, we'll be able to predict where the cases will occur so we can intervene with prophylaxis or vector control, but also when patients do present, we will be able to offer a particular therapeutic whether that's an early antiviral or a later host-directed therapy. We're also hoping to be able to monitor patients better by using wearable devices. This will help healthcare staff who are really overburdened in hospitals during peak season, but also to safely monitor patients out of hospital, using remote monitoring and wearable devices, so overall trying to impact health systems but also individual patient care.

This interview was recorded in January 2024.