Oxford University Clinical Research Unit – Nepal Patan Academy of Health Sciences (PAHS), Kathmandu

The Unit in Kathmandu has recently been busy with an increase in clinical and research activities.  With the onset of the monsoon season there is a deluge of patients with unexplained fever. Laboratory renovations are ongoing, and we are hopeful that they will be completed by the first quarter of 2011.

We have three new medical officers in our team who are responsible for the enrollment and follow up of patients in the randomized control trial of gatifloxacin versus ofloxacin, in the Hepatitis E study, and in the PANI (Patan Adult Neurological Infections) study.

The current RCT which needs about forty more patients with culture confirmed enteric fever, will hopefully end by mid 2011. The RCT of chloramphenicol and gatifloxacin in the treatment of uncomplicated typhoid fever is almost ready for publication. The study shows that gatifloxacin, the newer and surprisingly cheaper antimicrobial, is as effective as chloramphenicol in the treatment of enteric fever.  Our geospatial mapping and environmental sampling is yielding fascinating results for a range of potential human enteric pathogens and we hope we will be able to present this in our next update.

Thankfully there have been very few pregnant women with Hepatitis E this year, but our initial study has completed recruitment and we are preparing the analysis now.  We are pleased that our letter regarding Hepatitis E in developing countries triggered an editorial in the Lancet. (Neglected hepatitis E and typhoid vaccines. Lancet 2010; 376(9744):869).
Our study of carriage of bacteria in the gall bladder study is ongoing and the Salmonella carriage rate in the gall bladders according to the study stands at around 3% for the moment.
We were happy to contribute to the study looking into antimicrobial susceptibility of Salmonella Typhi which has resulted in a paper publication. (online ahead of print on 13 September 2010 Antimicrob. Agents Chemother. doi:10.1128/AAC.00963-10)

Sample storage has been a huge problem, but with the arrival of two freezers (-80˚C) we along with our samples have all been able to heave a sigh of relief!!
Dr Basnyat continues to be involved with the RCTs in the prevention and treatment of high altitude ailments brought on by the hypoxia in the Himalayas.
We hope to meet our friends and colleagues at the Tropical Network Meeting in Laos in February 2011 and of course you are always welcome to come and visit us in Nepal.

Peter Horby, Annette Fox and the NIHE team

Preliminary results from the Ha Nam influenza cohort study

Influenza is one of the most important respiratory infections of humans, responsible for 250,000 to 500,000 deaths annually, and capable of causing global epidemics that are at best disruptive and at worst devastating. South East Asia is an area of special interest to influenza researchers for two main reasons. First, the presence of highly pathogenic avian influenza viruses such as H5N1 in domestic and wild birds and the extensive mixing of humans, swine and poultry increase the risk of new influenza viruses emerging in this region. Second, it has been postulated that South East Asia may be the source of some influenza strains that cause annual outbreaks in the Northern and Southern hemispheres. Despite the potential importance of influenza in South East Asia, the burden and epidemiology are poorly described. In partnership with the National Institute for Hygiene and Epidemiology and the Ha Ham Centre for Preventive Medicine, the Respiratory Infections Group of OUCRU set out to try to better understand the epidemiology of influenza in Vietnam.
In late 2007 a cohort of households was established to determine the true influenza infection and clinical attack rates in the community. 908 people from 269 randomly selected households have been followed since then with active surveillance to detect influenza-like-illness (ILI) and serology before and after each wave of infection. Figure 1 shows the proportion of the people seroconverting to various influenza A viruses by age group. Seroconversion rates for seasonal influenza infection ranged from 2-14%, and were highest for a drifted H3N2 strain that appeared in 2009. The pandemic H1N1 seroconversion rate was higher again, at 18%, but similar to rates reported for other parts of the world. The proportion of infections that presented as ILI (9-24%) was similar across strains and subtypes. Seroconversion rates decreased sharply with age for pandemic H1N1 and to a lesser extent for seasonal H1N1, but not for H3N2.

How common is influenza infection in VietnamFigure caption : The figure shows the proportion of people in the cohort by age group who seroconverted to different influenza A viruses. Seroconversion was defined as a four-fold or greater rise in antibody titre as measured by haemagglutination inhibition assay, with the convalescent titre being at least 1 in 40.

Professor Tran Tinh Hien, Director of Clinical Research at the Hospital for Tropical Diseases and the Wellcome Trust Major Overseas Programme - Oxford University Clinical Research Unit Viet Nam has been awarded the 2010 Mackay Medal by the Royal Society of Tropical Medicine and Hygiene (RSTMH) for his outstanding work in infectious diseases in Vietnam for over twenty years.

http://www.rstmh.org/awards/medals/medals-available-2010/donald-mackay-medal

Professor Tran Tinh Hien has made seminal contributions to Malaria, Typhoid, Diphtheria, Influenza, Fasciola, Tetanus and Plague and he has inspired generations of Vietnamese and international clinicians and scientists. Hien graduated from Saigon University in 1978. His brilliance as a clinician was recognised by Cho Quan Hospital and he was made Head of the Intensive Care Unit at 27 years of age and Vice-Director at 38. He has published more than 150 scientific articles in the international literature. Hien played a major role in dealing with malaria in Viet Nam between 1975 and 1990 and helped establish successful approaches to the control typhoid in rural Viet Nam. He has lead work on plague in the central highlands, fasciola on the coast, and tetanus and diphtheria in southern Viet Nam. Professor Hien has been a leading figure in the response to Bird Flu, Swine Flu and Dengue. Prof. Hien is the most inspirational leader and teacher and without doubt one of the most respected infectious disease clinicians in Viet Nam. He has played a leading role at the Hospital for Tropical Diseases since 1989 and officially retired from government work after 34 years.

The RSTMH Mackay Medal is awarded annually in alternating years by the Royal Society of Tropical Medicine and Hygiene and by the American Society of Tropical Medicine and Hygiene. The award is for outstanding work in tropical health, especially relating to improvements in the health of rural or urban workers in the tropics. The medals ceremony will be taking place in RSTMH meeting in Liverpool in September 2010.

Asked about this award, Professor Hien said he is extremely honoured to be awarded prestigious Medal in recognition of the contributions of all his colleagues in Hospital for Tropical Diseases as well as in all the Provincial Hospitals who he has worked with since his career began. Professor Jeremy Farrar, the director of OUCRU-VN, who recommended Professor Hien for the Mackay Medal, remarks “In the year he officially retires from government work after 34 years the award of the Donald MacKay Medal is the perfect tribute to his enormous and unparalleled contribution and to the legacy of Donald MacKay”.

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