Tran Hien: Infectious diseases in the tropics
Although incidence of malaria has decreased in Vietnam, the burden of infectious diseases remains high and weighs heavily on the health care system. Clinical research aims to allow investments to go further: findings in the laboratory, tested in clinical trials and then applied to the community, help improve diagnosis and management.
I am Tran Tin Hien, I am a physician working with OUCRU in Ho Chi Minh City Vietnam. The first unit was established in Ho Chi Minh City in 1990, and ten years later we had a sub-unit in Hanoi.
Most diseases in the tropics are infectious diseases: malaria, dengue haemorrhagic fevers, encephalitis, avian flu; Ebola in other countries but not in Vietnam. In Vietnam, 20 years ago malaria was at the top with more than 1 million cases in the whole country, but now the incidence has decreased. But the incidence of dengue haemorrhagic fever is still high, with more than 100,000 cases in the whole country. I think to reduce the burden of disease in Vietnam we have to strengthen the health care network because if we have a good start with skills, physicians, nurses, and technicians with the right equipment we can make an early diagnosis and treatment, and in infectious diseases, early diagnosis and treatment help reduce the mortality and the morbidity.
With infectious diseases I think blood culture is crucial practice in laboratory to confirm diagnosis, but now we have all the molecular tools, like for example PCR, and all the machines to make automatic blood culture, so we can improve the quality of diagnosis.
Over the last 10 years, we have conducted the most important study in monitoring the resistance of the Plasmodium falciparum malaria parasite to the most powerful anti-malaria drug: artemisinin and artemisinin combination therapy. Now, in South East Asia the treatment failure to that drug artemisinin is high, yesterday I think it was 50%. That means that in two patients with malaria, in Vietnam, that you treat with artemisinin, one fails; you cannot cure the patient, you have to find another combination or a new drug to treat the patient.
Vietnam is a low and middle income country. Even in health care, despite lots of investment from the government we are still lacking money, that means lacking staff, lacking equipment, so the investment has to improve the health through clinical research. Because the burden of infectious diseases in Vietnam is still high with dengue haemorrhagic fever, with malaria, with hand-foot-mouth disease and all the viral infections, we have to invest money to improve good diagnosis and management.
From the beginning we have conducted studies to test what we knew in the laboratory, to apply in clinical trials and then apply to the community. That means three steps of translational medicine: bench side, bedside and then community, and all three steps fit into the translational medicine policy of the department.