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Ho Chi Minh City, Vietnam

Addo-Yobo E.,University of Ghana | Anh D.D.,National Institute of Hygiene and Epidemiology | El-Sayed H.F.,Suez Canal University | Fox L.M.,Boston University | And 6 more authors.
Tropical Medicine and International Health

Objective A recent randomized clinical trial demonstrated home-based treatment of WHO-defined severe pneumonia with oral amoxicillin was equivalent to hospital-based therapy and parenteral antibiotics. We aimed to determine whether this finding is generalizable across four countries. Methods Multicentre observational study in Bangladesh, Egypt, Ghana and Vietnam between November 2005 and May 2008. Children aged 3-59months with WHO-defined severe pneumonia were enrolled at participating health centres and managed at home with oral amoxicillin (80-90mg/kg per day) for 5days. Children were followed up at home on days 1, 2, 3 and 6 and at a facility on day 14 to look for cumulative treatment failure through day 6 and relapse between days 6 and 14. Results Of 6582 children screened, 873 were included, of whom 823 had an outcome ascertained. There was substantial variation in presenting characteristics by site. Bangladesh and Ghana had fever (97%) as a more common symptom than Egypt (74%) and Vietnam (66%), while in Vietnam, audible wheeze was more common (49%) than at other sites (range 2-16%). Treatment failure by day 6 was 9.2% (95% CI: 7.3-11.2%) across all sites, varying from 6.4% (95% CI: 3.1-9.8%) in Ghana to 13.2% (95% CI: 8.4-18.0%) in Vietnam; 2.7% (95% CI: 1.5-3.9%) of the 733 children well on day 6 relapsed by day 14. The most common causes of treatment failure were persistence of lower chest wall indrawing (LCI) at day 6 (3.8%; 95% CI: 2.6-5.2%), abnormally sleepy or difficult to wake (1.3%; 95% CI: 0.7-2.3%) and central cyanosis (1.3%; 95% CI: 0.7-2.3%). All children survived and only one adverse drug reaction occurred. Treatment failure was more frequent in young infants and those presenting with rapid respiratory rates. Conclusions Clinical treatment failure and adverse event rates among children with severe pneumonia treated at home with oral amoxicillin did not substantially differ across geographic areas. Thus, home-based therapy of severe pneumonia can be applied to a wide variety of settings. © 2011 Blackwell Publishing Ltd. Source

Cheng H.-J.,National Cheng Kung University | Luo Y.-H.,National Cheng Kung University | Wan S.-W.,National Cheng Kung University | Lin C.-F.,Taipei Medical University | And 8 more authors.
American Journal of Tropical Medicine and Hygiene

We have previously shown that anti-dengue virus nonstructural protein 1 (anti-DENV NS1) antibodies cross-react with endothelial cells, and several autoantigens have been identified. This study shows that the antibody levels against these self-proteins are higher in sera from patients with dengue hemorrhagic fever (DHF) than those in control sera. Anti-protein disulfide isomerase (PDI) and anti-heat shock protein 60 (anti-HSP60) IgM levels correlated with both anti-endothelial cells and anti-DENV NS1 IgM titers. A cross-reactive epitope on the NS1 amino acid residues 311-330 (P311-330) had been predicted. We further found that there were higher IgM and IgG levels against P311-330 in DHF patients' sera than those in the control sera. In addition, correlations were observed between anti-PDI with anti-P311-330 IgM and IgG levels, respectively. Therefore, our results indicate that DENV NS1 P311-330 is a major epitope for cross-reactive antibodies to PDI on the endothelial cell surface, which may play an important role in DENV infection-induced autoimmunity. Copyright © 2015 by The American Society of Tropical Medicine and Hygiene. Source

Hung N.T.,Childrens Hospital No. 1
Paediatrics and International Child Health

Dengue is a serious public health problem worldwide. Dengue shock syndrome (DSS), the severe form of dengue fever, can cause death within 12-24 hours if appropriate treatment is not promptly administered. For patients with DSS and the 30% of non-shocked dengue patients who require intravenous fluid therapy, a range of solutions is available for plasma volume support. Crystalloid solutions, such as normal 0.9% saline or Ringer's lactate, are the ones most commonly used. In severe cases, colloid solutions may be administered for their greater osmotic effect, although they carry a greater risk of adverse events. This paper summarises the key clinical data, comparing fluid regimens in children with severe dengue, and concludes that the majority of patients with DSS can be treated successfully with isotonic crystalloid solutions. If a colloid is thought necessary, a medium-molecular-weight preparation that combines good initial plasma volume support with good intravascular persistence and an acceptable side-effect profile is optimal. Further research should aim to determine whether there are benefits to early treatment with colloids, and which colloid solution is most effective for resuscitation of DSS patients. © W. S. Maney & Son Ltd 2012. Source

Tuan N.M.,Childrens Hospital No. 1 | Nhan H.T.,University of Oxford | Van Vinh Chau N.,Hospital for Tropical Diseases | Hung N.T.,Childrens Hospital No. 1 | And 12 more authors.
PLoS Neglected Tropical Diseases

Dengue is the commonest arboviral disease of humans. An early and accurate diagnosis of dengue can support clinical management, surveillance and disease control and is central to achieving the World Health Organisation target of a 50% reduction in dengue case mortality by 2020. 5729 children with fever of <72hrs duration were enrolled into this multicenter prospective study in southern Vietnam between 2010-2012. A composite of gold standard diagnostic tests identified 1692 dengue cases. Using statistical methods, a novel Early Dengue Classifier (EDC) was developed that used patient age, white blood cell count and platelet count to discriminate dengue cases from non-dengue cases. The EDC had a sensitivity of 74.8% (95%CI: 73.0-76.8%) and specificity of 76.3% (95%CI: 75.2-77.6%) for the diagnosis of dengue. As an adjunctive test alongside NS1 rapid testing, sensitivity of the composite test was 91.6% (95%CI: 90.4-92.9%). We demonstrate that the early diagnosis of dengue can be enhanced beyond the current standard of care using a simple evidence-based algorithm. The results should support patient management and clinical trials of specific therapies. © 2015 Tuan et al. Source

Anders K.L.,University of Oxford | Anders K.L.,Monash University | Thompson C.N.,University of Oxford | Thompson C.N.,London School of Hygiene and Tropical Medicine | And 15 more authors.
International Journal of Infectious Diseases

Objectives: Previous studies indicate a high burden of diarrhoeal disease in Vietnamese children, however longitudinal community-based data on burden and aetiology are limited. The findings from a large, prospective cohort study of diarrhoeal disease in infants in southern Vietnam are presented herein. Methods: Infants were enrolled at birth in urban Ho Chi Minh City and a semi-rural district in southern Vietnam, and followed for 12 months (. n=. 6706). Diarrhoeal illness episodes were identified through clinic-based passive surveillance, hospital admissions, and self-reports. Results: The minimum incidence of diarrhoeal illness in the first year of life was 271/1000 infant-years of observation for the whole cohort. Rotavirus was the most commonly detected pathogen (50% of positive samples), followed by norovirus (24%), Campylobacter (20%), Salmonella (18%), and Shigella (16%). Repeat infections were identified in 9% of infants infected with rotavirus, norovirus, Shigella, or Campylobacter, and 13% of those with Salmonella infections. Conclusions: The minimum incidence of diarrhoeal disease in infants in both urban and semi-rural settings in southern Vietnam was quantified prospectively. A large proportion of laboratory-diagnosed disease was caused by rotavirus and norovirus. These data highlight the unmet need for a rotavirus vaccine in Vietnam and provide evidence of the previously unrecognized burden of norovirus in infants. © 2015 The Authors. Source

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