The UK-South East Asia Expert Meeting on the Effects of Climate Change and Urbanisation on Infectious Diseases was held on 29th June 2010 in Pham Ngoc Thach University, Ho Chi Minh City, Vietnam.

The primary objective of the workshop was to bring together scientific experts from across Asia and Europe to identify opportunities for future collaboration in this critical area.

More than 100 multidisciplinary scientists met in Ho Chi Minh City to examine how trends in urbanization and the potential effects of environment and climate change may interact to influence future patterns of infectious diseases in South East Asia and the resilience of communities and health systems to respond to these new patterns.

The workshop was organized into four sections and presented by 12 international multi-disciplinary experts. The symposium was followed by a round table discussion organised at the Wellcome Trust Major Overseas Programme & OUCRU-VN. This was an opportunity for people from very different scientific backgrounds, different countries and cultures to discuss future collaborations and to brain storm ideas on these.

The workshop was sponsored by the UK-South East Asia Partners in Science and Program and the British High Commission in Singapore, and supported by the Pham Ngoc Thach University, Hospital for Tropical Diseases and the Wellcome Trust Major Overseas Programme & OUCRU-VN Ho Chi Minh City, Vietnam.

Agenda:

Tuesday, 29th June 2010 - Identifying opportunities for Collaboration

Wednesday, 30th June 2010 - Round Table: Future Collaborations and Brain Storming Ideas

On 17 June 2010, the Department of Health of HCM City (DoH) inaugurated a completely refurbished suite of offices dedicated to the support of Health Research in Ho Chi Minh City and in doing so opened up a new era in the collaboration between DoH & OUCRU-VN and Wellcome Trust Major Overseas Programme in Viet Nam. The new Office for Health Research DoH includes a large training and meeting room (80m2) and an office (60m2) with an integrated electronic library available for anyone in the health sector in HCMC to use. The funding for this renovation was approximately 50,000 USD and has been supported by the Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme. The DoH and OUCRU-VN & WT have worked together for 18 years but this represents a major new programme of collaborative work named “Strengthening the capacity of management and development of research activities of HCMC health sector”.

Professor Jeremy Farrar Director of OUCRU-VN, said: ‘The new Office for Health Research is a symbol and a strong foundation for our collaborative clinical and scientific research programme. In the future, we hope this collaboration will develop further with DoH and the hospitals and health sector of HCMC. In the future the health sector in HCM City will inevitably face new challenges. Viet Nam has made great advances in the control of malaria and typhoid, but now we are faced with problems from dengue fever, influenza, emerging infections, TB, drug resistance and increasingly in areas such as cardio-vascular diseases, stroke and mental health. We are delighted that this new Office of Health Research, an idea suggested from the DoH, will work to coordinate and develop a research strategy for HCMC in the years ahead and we look forward to working closely with the DoH and all partners.
The project will be conducted over a three - year period (2009-2012) in which the main objectives are establishment of the Office of Health Research at DoH, the setting up an Ethics Council for Biomedical Research at DoH; training on research methodology and skills for healthcare staff of HCMC health sector; sharing expertise, knowledge and skills in research between DoH and OUCRU-VN and the WT; cooperating in implementation of applied research topics; transferring technology and applying research achievements in disease prevention and taking care of patients as well as in the community.

Chau Nguyen Van, Director of DoH, said: ‘We are very glad to see the results of the collaboration between DoH and OUCRU-VN supported by Wellcome Trust and the South East Asia Clinical Infectious Disease Research Network (SEAICRN). The professional development in the health sector of HCM City has benefitted hugely from the work of OUCRU-VN and the Wellcome Trust, especially in tropical and infectious diseases field. I would like our cooperation will strengthen further in the future, particularly in clinical research and public health.

The respiratory infections group analysed the early progression of the epidemic of 2009 pandemic influenza (2009 H1N1) in Ho Chi Minh City, Vietnam from 26 May 2009 until the establishment of community transmission in the second half of July 2009

Data sources included all available health reports from the Ministry of Health and relevant health authorities as well as clinical and laboratory data from the first confirmed cases isolated at the Hospital for Tropical Diseases in Ho Chi Minh City. Extensive molecular diagnostics (RT-PCR) on serial samples, viral culture, susceptibility testing, and sequencing were performed on a subset of confirmed cases. Virological and epidemiological data were combined to reconstruct the initial outbreak. From 27 April to 24 July 2009, approximately 760,000 passengers who entered Ho Chi Minh City on international flights were screened at the airport by a body temperature scan and symptom questionnaire. Approximately 0.15% of incoming passengers were intercepted, 200 of whom tested positive for
2009 H1N1. An additional 121 out of 169 nontravelers tested positive after self-reporting or contact tracing. These 321 patients spent 79% of their PCR-positive days in isolation; 60% of PCR-positive days were spent treated and in isolation. Influenza-like illness was noted in 61% of patients and no patients experienced pneumonia or severe outcomes. Viral clearance times were similar among patient groups with differing time intervals from illness onset to treatment, with estimated median clearance times between 2.6 and 2.8 d post-treatment for illness-to-treatment intervals of 1–4 d, and 2.0 d (95% confidence interval 1.5–2.5) when treatment was started on the first day of illness.

The patients described here represent a cross-section of infected individuals that were identified by at the airport, as well as mildly symptomatic to moderately ill patients who self-reported to hospitals.
Data are observational and, although they are suggestive, it is not possible to be certain whether the containment efforts delayed community transmission in Vietnam. Viral clearance data showed a rapid therapeutic response to oseltamivir when given in the first four days of illness. (PLoS Med 7(5): e1000277.
doi:10.1371/journal.pmed.1000277)

Figure caption: 321 PCR-confirmed 2009 H1N1 cases and 298 PCR-negative suspected 2009 H1N1 cases admitted to hospitals in HCMC between early May 2009 and 20 July 2009. All 619 individuals are classified either as travelers (those who recently entered HCMC on a commercial flight from a foreign country) or residents; travelers are shown above the axis and residents below the axis. Graph is organized in a stacked fashion, so that the height of each colored area corresponds to the number of patients of a particular status (e.g., circulating, isolated) on a particular day. Graph is cut off on 20 July 2009 as the data were more sparse after this date.

Written by Rogier van Doorn