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In rural Viet Nam the relationships between farmers and their animals are close, with pigs and poultry often kept in vicinity of the houses. The recent history of serious zoonotic outbreaks of novel pathogens such as SARS, H5N1 and Nipah virus has raised awareness of the health risk of such close contact with animals.

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Health in the Backyard is an interactive media project using digital story telling methods to explore the attitudes and perceptions of risk of communities involved in animal husbandry. The Health in the Backyard project supports the activities of the OUCRU research project on zoonotic diseases (Vietnam Initiative on Zoonotic Infections or VIZIONS) by engaging with rural communities involved in animal farming practices, and to improve communication between stakeholders and scientists. Through this project we have partnered with Dong Thap Department for Animal Health and worked with small hold farmers, slaughterhouse workers and people involved with the rats for meat trade.

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Working with Fact and Fiction Films (FFF), community members were taught how to use simple digital cameras which they took home. Each created and narrated a short photo story of situations and events that pose a risk to the health of themselves, their families and their animals.

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The finished films were screened for group review sessions, allowing individuals to discuss and share concerns and good practice. The group identified key areas of interest which informed the curriculum of 2 one-day training workshops for provincial animal health officers and local farmers (about 65 participants in each workshop). Topics covered included:

• Vaccine schedule for pigs and poultry
• Transmission of diseases between humans and animals
• Good practices in farming (biogas, hygiene, home produced feed etc)
• Pig and poultry diseases
• Environmental issues in farming

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Speakers came from OUCRU; University of Agriculture and Forestry; Institute of Environment and Resources HCMC; Dong Thap Community College and the Department of Animal Health Dong Thap province.
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The films and views shared through the Health in the Backyard project are informing scientists and health workers of perceptions and practices of the people they work with, which scientific research doesn’t reveal. It is also informing the writing of non-technical educational material on veterinary diseases and zoonotic health risks to be distributed as part of the Public Engagement section of VIZIONS project.

Place of Change is a unique community-led media health project that encourages participants to consider key factors that affect their health and wellbeing on a personal level. OUCRU has partnered with Fact and Fiction Films (FFF) to equip communities with skills to generate their own film stories about their health experiences.
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The project had four workshops based around pertinent health issues: HIV positive intravenous drug users; professional sex workers with STIs; a community in the malaria endemic border province of Binh Phuoc and duck farmers in the Mekong delta. Between 5-12 individuals in each group worked with FFF and facilitators to film and narrate their personal stories.
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The community-authored stories have been reviewed with local government health workers and research groups to generate discussion and raise awareness of community perceptions, attitudes and knowledge. In an extension phase the short films will be shown at local screenings, facilitated to generate discussion and sharing of information. We believe the project empowers communities and helps improve the public understanding of health sciences, while increasing researchers and health worker’s engagement with their communities of study.

In northern Vietnam from April to September every year, children often have had a malignant syndrome called Acute Encephalitis Syndrome (AES). From 1965 to 1977, the total number of AES in children was 22,545 cases, from whom 4,774 died. Before 1964, the etiology of AES in northern Vietnam has not yet been identified; so the JE infection in our country is still a blank area on the World Map. In this study, we have to determine the etiology of the AES by carrying-out:
Virus isolation
From 1964 to 1976, we have isolated 22 JEV from different specimens including: 10 from AES children (1 from blood, 9 from brains), 1 from bird, 1 from swine blood, 10 from mosquitoes.
The positive diagnoses (HI test) using paired sera taken from AES children have been varied from 25.58% to 67.5%.
Investigate the JEV circulation through serological survey of healthy humans: During 1964-1978, we have tested 7,868 sera, from which the positive rate varied from 25% to 82.94%.
Vectors transmitting JEV
JEVs were isolated for the first time in 1971 from Culex tritaeniorhynchus. Then in 1975-1976, JEV were discovered from Culex gelidus, Aedes albopictus and Aedes (Sp) diemmaccus. To this time, Culex tritaeniorhynchus has been identified as the main vector transmitting JEV in northern Vietnam.
Explore the circulation of JEV in animals
– Birds: in 1964 we have isolated the strain LD-68 from bird Garrulax perspicillatus – Gmelin and have found 8/14 bird species carrying JE antibody; therefore wild birds have played the role as reservoir of JEV.
– Animals:
a/ Serological survey in swine: In 1970: 606 pig sera have been collected in several localities, from which 63.69% were positive to JEV with MAT: 1/619.76.
b/ Sero-survey in livestock: During 1972-1975, we have continued to investigate sera from other animal species. The results obtained demonstrated that swine was the most commonly infected with JEV to compare with other domestic animals.

Results
With the results obtained, we asserted that northern Vietnam was a natural focus of JEV. This virus virtually persisted everywhere, in wild birds, an arthropod transmitted this virus from bird to livestock; at first to a few pigs, Culex tritaeniorhynchus sucking blood from pigs in phase of viremia then widespreading this virus to other pigs, allowed herd of infected pigs increased rapidly and just to this phase, JE infections occur in humans with a small number of children suffered from AES.

Click here to download full text PDF : Historical overview of studies on Japanese Encephalitis Virus in northern Vietnam, 1964 – 1978

By Do Quang Ha

Giving double doses of the antiviral drug oseltamivir, or Tamiflu, offers no clinical or virological advantages over a standard dose for patients admitted to hospital with severe influenza infection, according to a randomised trial published today and funded by the Wellcome Trust, the US National Institute of Allergy and Infectious Diseases, and the Singapore National Medical Research Council.

This is the first study to look at the effectiveness of higher doses of oseltamivir in cases of severe flu infection and has implications for global guidelines on clinical management and stockpiling drugs for pandemic preparedness, including the current outbreak of the H7N9 virus.

Most people who are infected with flu will recover within two weeks, but some people will develop complications (such as difficulty breathing) that can result in hospital admission and can be life-threatening.

Studies have shown that early treatment with oseltamivir is beneficial for patients with uncomplicated flu infection and improves survival in hospitalised patients with severe infection. This has led some authorities to recommend double doses of oseltamivir for the treatment of patients with severe flu infections.

The study, conducted by researchers from the South East Asia Infectious Diseases Clinical Research Network, involved 326 patients with severe flu infection at 13 hospitals in Indonesia, Singapore, Thailand and Vietnam. Most of the patients were children under the age of 15.

Patients were given either a standard dose or a double dose of oseltamivir for five days. Their virus levels were monitored for the duration of the treatment, along with other outcomes such as admission to intensive care, the need for mechanical ventilation to assist with breathing, and death.

The findings, published online today in the ‘British Medical Journal’, reveal no difference in virus levels at day five between the treatment groups. There were also no clinical differences in the outcome of patients including need for ventilation, time in hospital, rate of death, or rates of adverse events between the different doses.

Professor Jeremy Farrar, Director of the South East Asia Infectious Disease Clinical Research Network, said: “The recommendation to give higher doses of oseltamivir to severe cases of flu infection has major implications for clinical management, public health and planning for antiviral stockpiles but has not been grounded in evidence. Our findings do not support routine use of double doses to treat severe flu infections, which could help to conserve drug stocks in the event of a pandemic.”

Researchers have identified the dose of Dengue virus in human blood that is required to infect mosquitoes when they bite. Mosquitoes are essential for transmitting the virus between people so the findings have important implications for understanding how to slow the spread of the disease.

By defining the threshold of the amount of virus needed for transmission, the research also provides a target that experimental dengue vaccines and drugs must prevent the virus from reaching, in order to be successful at preventing the spread of disease during natural infection.

Dengue, also known as ‘breakbone fever’, is a viral infection that is transmitted between humans by mosquitoes. In most people it causes flu-like symptoms but in a small proportion of cases the disease can become life-threatening. Recent estimates indicate that there are 390 million infections of dengue across the globe each year and with no vaccine or specific treatment available, current measures to prevent the spread of disease are focused on controlling the mosquito vector.

In research funded by the Wellcome Trust, scientists and doctors at the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Vietnam studied the factors that influence the transmission of dengue viruses from dengue patients to the mosquitoes that feed on them. Their findings reveal that mosquitoes that feed on dengue patients with very high levels of virus in their blood are more likely to be infectious to other humans two weeks later.

“Our findings suggest that focused public health intervention strategies to prevent transmission from these “high risk” spreaders of the virus could have a major impact in slowing the spread of disease,” explains Professor Cameron Simmons, a Wellcome Trust Senior Fellow at the Oxford University Clinical Research Unit in Vietnam.

Although the levels of virus in patients who had been hospitalized by the disease were much higher, the majority of patients with mild symptoms who were treated at outpatient centres also had enough virus in their blood to support transmission.

“At the moment, dengue surveillance systems typically only count hospitalized patients but our findings confirm that less serious cases represent an equally important source of virus infection. Since these cases often remain in the community for the duration of their illness, it’s important that we explore ways to prevent such patients from providing a source of further virus transmission,” added Professor Simmons.

The researchers hope that understanding the level of virus needed for transmission of infection will provide a useful reference point for the development of experimental drugs and vaccines and could be used to inform the endpoints for clinical trials evaluating such interventions.

The study is published online today in the journal Proceedings of the National Academy of Sciences.

What happens when a philosopher interviews a scientist about their work? On November 22nd, our Director, Jeremy Farrar found out he was interviewed by philosopher AC Grayling and a public audience about our work in a medical research unit in Southeast Asia.

Jeremy talked about the Hospital and Unit’s groundbreaking work on a number of emerging infection

s including Avian influenza and more recently the Influenza pandemic of 2009 and the value of working together with a centre of gravity based firmly in Viet Nam.

The interview was part of the Exchanges at the Frontier Series a partnership between the Wellcome Collection the BBC World Service.

An edited recording of this event will be broadcast in early 2013 on the BBC World Service to a global audience of 40 million people. We will put a link to the show here on our website after it has been broadcast, so you can tune in at home.