Aetiology and Potential Animal Exposure in Central Nervous System Infections in Vietnam

An estimated 73% of emerging infections are zoonotic in origin, with animal contact and encroachment on their habitats increasing the risk of spill-over events. In Vietnam, close exposure to a wide range of animals and animal products can lead to acquisition of zoonotic pathogens, a number of which cause central nervous system (CNS) infections. However, studies show the aetiology of CNS infections remains unknown in around half of cases. We used samples and data from hospitalised patients with CNS infections, enrolled into the Vietnam Initiative on Zoonotic Infections multicentre study, to determine the association between aetiology and animal contact including those in whom the cause was unknown. Among 933 patients, a pathogen or an antibody response to it was identified in 291 (31.2%, 95% CI 28.3-34.3%). The most common pathogens were Streptococcus suis (n = 91 (9.8%, 8.0-11.9%)) and Japanese encephalitis virus (JEV) (n = 72 (7.7%, 6.1-9.7%)). Commonly reported animal contact included keeping, raising or handling (n = 364 (39.0%, 35.9-42.2%)) and handling, cooking or consuming raw meat, blood or viscera in the 2 weeks prior to symptom onset (n = 371 (39.8%, 36.6-43.0%)), with the latter most commonly from pigs (n = 343 (36.9%, 33.8-40.1%). There was no association between an unknown aetiology and exposure to animals in a multivariate logistic regression. Further testing for unknown or undetected pathogens may increase diagnostic yield, however, given the high proportion of zoonotic pathogens and the presence of risk factors, increasing public awareness about zoonoses and preventive measures can be considered.

Clinical and aetiological study of hand, foot and mouth disease in southern Vietnam, 2013-2015: Inpatients and outpatients

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Multiple serotypes of enterovirus A cause hand, foot and mouth disease in southern Vietnam.

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Clinical characteristics differed slightly between the different pathogen groups.

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CV-A6 and CV-A10 emerged in Vietnam in 2013–2015.

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An unexpected dominance of EV-A71 was found among both inpatients and outpatients.

Background

Hand, foot and mouth disease (HFMD) has been associated with large outbreaks among young children in the Asia-Pacific Region since 1997, including cases of severe illness and death. Severe illness is often associated with enterovirus A71 (EV-A71). Vietnam experienced a large sustained outbreak of 200 000 hospitalized cases and over 200 deaths in 2011–12, the large majority occurring in southern Vietnam.

Methods

A prospective observational study was conducted in the outpatient clinics, infectious diseases wards, and paediatric intensive care units of the three main referral centres for the treatment of HFMD in southern Vietnam. Demographic data, basic laboratory parameters, and clinical data were recorded, and molecular diagnostic tests were performed.

Results

Between July 2013 and July 2015, a total of 1547 children were enrolled. Four serotypes of enterovirus A (EV-A71, Coxsackievirus (CV) A6, A10, and A16) were responsible for 1005 of 1327 diagnosed cases (75.7%). An unexpected dominance of EV-A71 was found among both inpatients and outpatients, as well as a strong association with severe illness. CV-A6 and CV-A10 emerged in Vietnam during the study period and replaced CV-A16. CV-A10 was associated with different clinical and laboratory characteristics. During admission, 119 children developed a more severe illness. It was found that children with a skin rash showed less progression of severity, but when a rash was present, a macular rash was significantly associated with an increased risk of progression.

Conclusions

This study represents the most comprehensive descriptive HFMD study from Vietnam to date. Co-circulation and replacement of different serotypes has implications for vaccine development and implementation. These findings from a severely affected country add to our understanding of the presentation, progression, and aetiology of HFMD.

Manipulation of ultraviolet light affects immigration behavior of Ceratothripoides claratris (Thysanoptera: Thripidae)

Studies were conducted in tropical greenhouses to elucidate the role of UV light (UV) for the orientation and flight behavior of the thrips Ceratothripoides claratris (Shumsher) (Thysanoptera: Thripidae), an important pest on tomato (Lycopersicum spp.), in the hot and humid tropics of South-East Asia. Four greenhouse types characterized by different combinations of UV-absorbing or -transmitting plastic films and nets on the roof and sidewalls, respectively, were used in these studies. In choice experiments C. claratris always preferred the environment with higher UV intensity. Furthermore, natural thrips populations around the greenhouses were captured during the majority of control dates in lower numbers on sticky traps on the outer sidewalls of greenhouses clad with UV-absorbing materials compared with UV-transmitting materials. The immigration of thrips into the UV-absorbing greenhouses also was impeded, as measured by sticky traps on the inner side walls. UV-absorbing plastic roofs showed the most pronounced deterrent effect for thrips movement toward greenhouses, and the UV-absorbing net effectively reduced thrips numbers crossing the net barrier into the greenhouse. A simple extension of UV-absorbing plastic roof around conventional greenhouses clad with UV-transmitting plastic and net reduced thrips capture rates inside the greenhouse up to 77% when thrips was released at 1 m distance from the net walls. These results are discussed in the context of wavelength dependent insect vision and the dilemma of tropical greenhouse constructions, i.e., physical pest exclusion versus appropriate ventilation to ensure a conducive microclimate for plant growth.