OUCRU Hanoi

The Oxford Clinical Research Unit, Hanoi (OUCRU Hanoi) was established in 2006 and is hosted by the National Hospital of Tropical Diseases (NHTD). NHTD is a tertiary level teaching hospital, receiving infection related referrals from northern Vietnam and has close ties to the Ministry of Health (MoH).

Through its partnership with NHTD, OUCRU Hanoi also works with other hospitals and institutes in the region, including the National Institute for Hygiene and Epidemiology, the Vietnam National Children Hospital, the National Lung Hospital, Bach Mai Hospital, National Center for Veterinary Diagnosis, and other regional hospitals and health stations. The research programme at OUCRU Hanoi focuses on influenza, hospital acquired infections, and a range of laboratory, clinical, community and policy aspects of antimicrobial resistance. Through NHTD, OUCRU Hanoi has also been involved in consultations with MoH on national quality standards, antibiotic treatment guidelines, management of avian influenza and Streptococcus suis, and other public health issues.

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The importance of OUCRU Hanoi in Vietnam

OUCRU Hanoi is close to all the key national institutes in Vietnam (see partners/collaborators) and the Ministry of Health. These relations ensure that OUCRU research findings also find their way into policies. Our research in the area of antibiotic resistance supported the development of a National Action Plan on Antibiotic Resistance that was signed by the Minister of Health in 2013.

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What we’re doing to improve outcomes for patients/communities and understand infectious diseases.

OUCRU Hanoi has led clinical trials to develop and evaluate interventions to improve outcomes for patients with septicaemia and for patients in critical care. We have participated in clinical trials to evaluate potential improvements in treatment of severe influenza, Cryptococcal meningitis and Talaromycosis.

In the community setting we recently completed a trial to address the overuse of antibiotics for acute respiratory infection by using a test at the point-of-care for a biomarker of bacterial infection (C-reactive protein, or CRP). We are developing further community-based interventions to tackle inappropriate antibiotic use, with the potential for national scale-up. These will tackle the supply of antibiotics through reducing prescriptions for antibiotics at primary or commune health care level, as well as he demand for antibiotic treatment by changing public expectations and self-medication behaviours. These are informed by a global and regional analysis of geographical and temporal trends in antibiotic use, and an exploration of associated risk factors and modifiable behaviours.

Our studies on Streptococcus suis have led to the formulation of national guidelines for this disease and a better understanding of its burden and sequelae. We have worked with the MoH, NHTD and other hospitals to develop national Quality Standards for the hospital management of community acquired pneumonia and exacerbations of COPD. Our work on influenza immunity in the Ha Nam cohort has led to better understanding of influenza transmission in Vietnam and novel approaches to vaccine design that will shortly be evaluated through clinical trials.

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Key milestones

OUCRU Hanoi was one of the leading partners in a national working group for AMR with the Global Antibiotic Resistance Partnership. The resulting situation analysis of antibiotic use and resistance in Vietnam was one of the main sources of information used for the Nation Action Plan for AMR that was developed by the Ministry of Health.

In 2013 a national programme (VINARES) to assess hospital acquired infections, antibiotic use and antibiotic resistance in 16 hospitals across Vietnam was completed. This network was maintained for collection of antibiotic resistance data as part of a Newton Fund grant to develop evidence based guidelines for treatment of infectious diseases. A Quality Standard was developed with the international branch of the National Institute for Health and Care Excellence (NICE UK) and was reviewed and approved by the Ministry of Health, professional organization and a committee with broad national representation of clinicians, microbiologists, pharmacists and others.

In 2015 OUCRU Hanoi, together with NHTD and Oxford University/Public Health England and supported by WHO and the Ministry of Health, was awarded pilot funding from the Fleming Fund to develop a national surveillance network for AMR and a reference laboratory for AMR. We continued working with the VINARES network for this purpose, which has now been officially recognized as the national surveillance network by the Ministry of Health

We are running one of the longest influenza household cohorts worldwide in Ha Nam, Vietnam. This cohort has been ongoing for over 10 years. Data from this cohort have led to new insights into influenza transmission and immunology. ‘Antibody landscapes’ derived from cohort residents, depicting the nature of an individual’s immune response to past and current influenza infections, may potentially lead to novel ways of vaccination in the near future. As current influenza vaccination is suboptimal, this may have important public health benefits.

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Our research locations

OUCRU Hanoi is based at the National Hospital of Tropical Diseases. We also have research offices and laboratory capacity at National Institute of Hygiene and Epidemiology (NIHE), and Hanoi Medical University (HMU). With NIHE we have been conducting influenza household transmission studies for over 10 years in Ha Nam Province. With HMU we conduct community based studies in Ba Vi.

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 The OUCRU Hanoi research team

  • Rogier van Doorn, Clinical Microbiologist. Rogier is the Unit Director and focuses on antibiotic resistance and influenza
  • Behzad Nadjm, Clinician. Baz heads the Clinical Trials Unit and clinical research
  • Sonia Lewycka, Epidemiologist. Sonia represents OUCRU Hanoi on the training committee and works on community aspects of antibiotic resistance
  • Marc Choisy, Mathematical modeller, works on influenza and dengue at the National Institute of Hygiene and Epidemiology
  • Le Viet Thanh, Computer Scientist / Bioinformatician. Thanh is responsible for the bioinformatics systems / pipelines in Hanoi and whole genome sequencing analysis
  • Do Thi Thuy Nga, Pharmacist. Nga works with Sonia on community aspects of antibiotic resistance and coordinates the Global Antibiotic Resistance Partnership working group
  • Vu Thi Lan Huong, Public Health. Huong works on the health economics of antimicrobial resistance in hospitals and coordinates an international study on supply and demand of antibiotics in the community
  • Bui Huyen Trang, Head of Admin. Chi Trang is the head of admin, finance and HR of OUCRU Hanoi

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PhD Students

  • Vu Tien Viet Dung – Dung has a scholarship from the French embassy and works on modeling and improving antibiotic resistance surveillance systems.
  • Vu Thi Ngoc Bich – Bich has a scholarship from the Radboud University, Nijmegen and works on the metagenomics of antimicrobial resistance
  • Vu Quoc Dat – Dr Dat, a critical care physician at NHTD, has a scholarship from OUCRU for his PhD on interventions to address antimicrobial resistance in hospitals

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Our collaborations/partnerships

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Publications

NV Kinh, Wertheim HFL, Thwaites GE, Khue LN, Thai CH, Khoa NT, Ha NTB, Trung NV, Crook D, van Doorn HR. Developing an antimicrobial resistance reference laboratory and surveillance programme in Viet Nam: A Fleming Fund pilot project. Lancet Global Health. 2017. 5(12):e1186. PMID: 29132611.

R Li, van Doorn HR, Wertheim HFL, Khue LN, Ha NTB, Dat VQ, Hanh CT, Nga DTT, Trang NNM, Nadjm B, Cluzeau F, Kinh NV, Trung NV, Huong NTL, Chao NQ, Huong LQ, Thao LTP, Hong LTA, Oanh TTM, Islam J, Roberts M. and Chalkidou K. Combating AMR: Quality Standards for Prescribing for Respiratory Infections in Vietnam. Lancet Global Health. 2016. 4(11):e789. PMID: 27765287.

DTT Nga, Ngan TTD, Ninh TTH, Hung TM, Bich VTN, Long HB, van Doorn HR, Dung VTV, Cals JWL, Chandna A., Lubell Y, Nadjm B, Thwaites GE, Wolbers M, Kinh NV and Wertheim HFL. Point-of-care C-reactive protein testing to reduce inappropriate use of antibiotics for non-severe acute respiratory infections in adults and children in the Vietnamese primary health care setting: a multi-centre randomised controlled trial. (NCT01918579) Lancet Glob Health. 2016. 4(9):e633–41. PMID: 27495137.

VD Phu, Nadjm B, Duy NHA, Co DX, Mai NTH, Trinh DT, Campbell JI, Khiem DP, Quang TN, Loan HT, Binh HS, Dinh Q-D, Thuy DB, Lan NPH, Ha NH, Bonell A, Larsson M, Hoan HM, Tuan DQ, Hanberger H, Hoang NVM, Yen LM, Hao NV, Binh NG, Chau NVV, Kinh NV, Thwaites GE, Wertheim HFL, van Doorn HR and Thwaites CL. Ventilator Associated Respiratory Infection in a Resource-Restricted Setting: Impact and Etiology. J Intensive Care. 2017. Accepted for publication.

VTL Huong, Long HB, Kinh NV, Ngan TTD, Dung VTV, Nadjm B, van Doorn HR, Hoa NT, Horby P and Wertheim HFL. Long-term outcomes of patients with Streptococcus suis infection in Viet Nam: a case-control study. J Infect. 2017. PMID: 28970042.

JM Fonville, Wilks SH, James SL, Fox A, Ventresca M, Aban M, Xue L, Jones TC, Hoa LNM, Thai PQ, Duong TN, Wong Y, Mosterin A, Katzelnick LC, Labonte D, Thanh LT, van der Net G, Skepner E, Russell CA, Kaplan TD, Rimmelzwaan GF, Masurel N, de Jong JC, Palache A, Beyer WE, Mai LTQ, Hien NT, Wertheim HF, Hurt AC, Osterhaus AD, Barr IG, Fouchier RA, Horby PW and Smith DJ. Antibody landscapes after influenza virus infection or vaccination. Science. 2014. 346(6212):996-1000. PMID: 25414313

NV Kinh, Nga DTT, Chandna A, Trung NV, Ca PH, Phuong DM, An NQ, Chuc NTK, Larsson M, Escalante S, Olowokure B, Laxminarayan R, Gelband H, Horby P, Ha NTB, Mai HT, Farrar J, Hien TT and Wertheim HF. Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam. BMC Public Health. 2013. 13:1158. PMID: 24325208.

HFL Wertheim, Chandna A, Phu VD, Ca PV, Phong NTD, Yen LM, Chau NVV, Larsson M, Rydell U, Nilsson LE, Farrar J, Kinh NV and Hanberger H. Providing impetus, tools, and guidance to strengthen national capacity for antimicrobial stewardship in Viet Nam. PLoS Med. 2013;10(5):e1001429. PMID: 23667342

P Horby, Mai LTQ, Fox A, Thai PQ, Yen NTT, Thanh LT, Hang NLK, Duong TN, Thoang DD, Farrar J, Wolbers M and Hien NT. The epidemiology of interpandemic and pandemic influenza in Vietnam, 2007-2010: The Ha Nam household cohort study I. Am J Epidemiol. 2012. 175(10):1062-74. PMID: 22411862

P Horby, Wertheim HFL, Ha NH, Trung NV, Trinh DT, Taylor W, Ha NM, Lien TTM, Farrar J and Kinh NV. Stimulating the development of national Streptococcus suis guidelines in Viet Nam through a strategic research partnership. Bull World Health Organ. 2010 Jun;88(6):458-61. PubMed PMID: 20539860