Enterovirus D68 in Viet Nam (2009-2015)

Background: Since 1962, enterovirus D68 (EV-D68) has been implicated in multiple outbreaks and sporadic cases of respiratory infection worldwide, especially in the USA and Europe with an increasing frequency between 2010 and 2014. We describe the detection, associated clinical features and molecular characterization of EV-D68 in central and southern Viet Nam between 2009 and 2015. Methods: Enterovirus/rhinovirus PCR positive respiratory or CSF samples taken from children and adults with respiratory/central nervous system infections in Viet Nam were tested by an EV-D68 specific PCR. The included samples were derived from 3 different observational studies conducted at referral hospitals across central and southern Viet Nam 2009 2015. Whole-genome sequencing was carried out using a MiSeq based approach. Phylogenetic reconstruction and estimation of evolutionary rate and recombination were carried out in BEAST and Recombination Detection Program, respectively. Results: EV-D68 was detected in 21/625 (3.4%) enterovirus/rhinovirus PCR positive respiratory samples but in none of the 15 CSF. All the EV-D68 patients were young children (age range: 11.8 – 24.5 months) and had moderate respiratory infections. Phylogenetic analysis suggested that the Vietnamese sequences clustered with those from Asian countries, of which 9 fell in the B1 clade, and the remaining sequence was identified within the A2 clade. One intra sub-clade recombination event was detected, representing the second reported recombination within EV-D68. The evolutionary rate of EV-D68 was estimated to be 5.12E -3 substitutions/site/year. Phylogenetic analysis indicated that the virus was imported into Viet Nam in 2008. Conclusions: We have demonstrated for the first time EV-D68 has been circulating at low levels in Viet Nam since 2008, associated with moderate acute respiratory infection in children. EV-D68 in Viet Nam is most closely related to Asian viruses, and clusters separately from recent US and European viruses that were suggested to be associated with acute flaccid paralysis

Toxocara malaysiensis infection in domestic cats in Vietnam - An emerging zoonotic issue?

Toxocara canis of canids is a parasitic nematode (ascaridoid) that infects humans and other hosts, causing different forms of toxocariasis. This species of Toxocara appears to be the most important cause of human disease, likely followed by Toxocara cati from felids. Although some studies from Malaysia and China have shown that cats can harbor another congener, T. malaysiensis, no information is available about this parasite for other countries. Moreover, the zoonotic potential of this parasite is unknown at this point. In the present study, we conducted the first investigation of domestic dogs and cats for Toxocara in Vietnam using molecular tools. Toxocara malaysiensis was identified as a common ascaridoid of domestic cats (in the absence of T. cati), and T. canis was commonly found in dogs. Together with findings from previous studies, the present results emphasize the need to explore the significance and zoonotic potential of T. malaysiensis in Vietnam and other countries where this parasite is endemic and prevalent in cats

Molecular characterization of hepatitis B virus in Bangladesh reveals a highly recombinant population

The natural history and treatment outcome of hepatitis B viruses (HBV) infection is largely dependent on genotype, subgenotype, and the presence or absence of virulence associated mutations. We have studied the prevalence of genotype and subgenotype as well as virulence and drug resistance associated mutations and prevalence of recombinant among HBV from Bangladesh. A prospective cross-sectional study was conducted among treatment naïve chronic HBV patients attending at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh for HBV viral load assessment between June and August 2015.. Systematical selected 50% of HBV DNA positive patients (every second patient) were enrolled. Biochemical and serological markers for HBV infection and whole genome sequencing (WGS) was performed on virus positive sample. Genotype, subgenotype, virulence, nucleos(t)ide analogue (NA) resistance (NAr) mutations , and the prevalence of recombinant isolates were determined. Among 114 HBV DNA positive patients, 57 were enrolled in the study and 53 HBV WGS were generated for downstream analysis. Overall, 38% (22/57) and 62% (35/57) of patients had acute and chronic HBV infections, respectively. The prevalence of genotypes A, C, and D was 18.9% (10/53), 45.3% (24/53), and 35.8% (19/53), respectively. Among genotype A, C and D isolates subgenotype A1 (90%; 9/10), C1 (87.5%; 21/24) and D2 (78.9%; 15/19) predominates. The acute infection, virulence associated mutations, and viral load was higher in the genotype D isolates. Evidence of recombination was identified in 22.6% (12/53) of the HBV isolates including 20.0% (2/10), and 16.7% (4/24) and 31.6% (6/19) of genotype A, C and D isolates, respectively. The prevalence of recombination was higher in chronic HVB patients (32.2%; 10/31 versus 9.1%; 2/22); p<0.05. NAr mutations were identified in 47.2% (25/53) of the isolates including 33.9% novel mutations (18/53). HBV genotype C and D predominated in this population in Bangladesh; a comparatively high prevalence of recombinant HBV are circulating in this setting

Molecular characterization of hepatitis B virus in Bangladesh reveals a highly recombinant population

The natural history and treatment outcome of hepatitis B viruses (HBV) infection is largely dependent on genotype, subgenotype, and the presence or absence of virulence associated mutations. We have studied the prevalence of genotype and subgenotype as well as virulence and drug resistance associated mutations and prevalence of recombinant among HBV from Bangladesh. A prospective cross-sectional study was conducted among treatment naïve chronic HBV patients attending at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh for HBV viral load assessment between June and August 2015.. Systematical selected 50% of HBV DNA positive patients (every second patient) were enrolled. Biochemical and serological markers for HBV infection and whole genome sequencing (WGS) was performed on virus positive sample. Genotype, subgenotype, virulence, nucleos(t)ide analogue (NA) resistance (NAr) mutations , and the prevalence of recombinant isolates were determined. Among 114 HBV DNA positive patients, 57 were enrolled in the study and 53 HBV WGS were generated for downstream analysis. Overall, 38% (22/57) and 62% (35/57) of patients had acute and chronic HBV infections, respectively. The prevalence of genotypes A, C, and D was 18.9% (10/53), 45.3% (24/53), and 35.8% (19/53), respectively. Among genotype A, C and D isolates subgenotype A1 (90%; 9/10), C1 (87.5%; 21/24) and D2 (78.9%; 15/19) predominates. The acute infection, virulence associated mutations, and viral load was higher in the genotype D isolates. Evidence of recombination was identified in 22.6% (12/53) of the HBV isolates including 20.0% (2/10), and 16.7% (4/24) and 31.6% (6/19) of genotype A, C and D isolates, respectively. The prevalence of recombination was higher in chronic HVB patients (32.2%; 10/31 versus 9.1%; 2/22); p<0.05. NAr mutations were identified in 47.2% (25/53) of the isolates including 33.9% novel mutations (18/53). HBV genotype C and D predominated in this population in Bangladesh; a comparatively high prevalence of recombinant HBV are circulating in this setting

Baseline characteristics and treatment cost of hepatitis C at Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam in Direct-Acting Antiviral treatment era

Background: Direct-Acting Antivirals (DAAs) are recommended as first-line of drugs for the treatment of chronic hepatitis C virus (HCV) infection in Vietnam in 2016. Since then, Hospital for Tropical Diseases (HTD), Ho Chi Minh City, Vietnam introduced DAAs based treatment for all newly presented chronic HCV patients. Here, we report the sociodemographic, clinical, biochemical, and virologic characteristics of patients and the direct medical cost associated with DAAs treatment. Methods: We conducted a retrospective cross-sectional study among chronic HCV patients attended at HTD from March 2016 to October 2017 and treated with DAAs. We used an extract of the patient’s electronic medical record containing demographics, clinical presentations, laboratory results, drug prescription, and cost of treatment at the hospital for data analysis. Results: 2817 chronic HCV patient received DAAs treatment during the study period. The mean age was 55.0 years, and 54.9% (1546/2817) of the patients were female. HCV genotype 1, 2, 3 and 6 prevalence was 32.1% (904/2817), 12.7% (359/2817), 0.4% (10/2817), and 54.7% (1542/2817) respectively. The mean HCV viral load was 3.1 × 106 copies/ml, including 46.9% (1322/2817) had ≥106 copies/ml. 70.64% (1990/2817) and 16.15% (455/28817) of the patients received Sofosbuvir (SOF)/Ledipasvir (LDV) ± Ribavirin (RBV) and SOF/Daclatasvir (DCV) ± RBV therapy respectively. The average drug cost for a 12-week of SOF/LDV ± RBV and SOF/DCV ± RBV treatment was US$2068 - 2230 and US$2417 - 2472, respectively. Conclusion: Genotype 6 was the most predominant genotype in southern Vietnam. The preferred treatment for chronic HCV infection was SOF/LDV ± RBV for 12 weeks.</p