Volume 92, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We performed a prospective multicenter study to address the lack of data on the etiology, clinical and demographic features of hospitalized pediatric diarrhea in Ho Chi Minh City (HCMC), Vietnam. Over 2,000 (1,419 symptomatic and 609 non-diarrheal control) children were enrolled in three hospitals over a 1-year period in 2009–2010. Aiming to detect a panel of pathogens, we identified a known diarrheal pathogen in stool samples from 1,067/1,419 (75.2%) children with diarrhea and from 81/609 (13.3%) children without diarrhea. Rotavirus predominated in the symptomatic children (664/1,419; 46.8%), followed by norovirus (293/1,419; 20.6%). The bacterial pathogens , , and were cumulatively isolated from 204/1,419 (14.4%) diarrheal children and exhibited extensive antimicrobial resistance, most notably to fluoroquinolones and third-generation cephalosporins. We suggest renewed efforts in generation and implementation of policies to control the sale and prescription of antimicrobials to curb bacterial resistance and advise consideration of a subsidized rotavirus vaccination policy to limit the morbidity due to diarrheal disease in Vietnam.


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  1. Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O'Brien KL, Campbell H, Black RE, , 2013. Global burden of childhood pneumonia and diarrhoea. Lancet 381: 14051416.[Crossref] [Google Scholar]
  2. Thapar N, Sanderson IR, , 2004. Diarrhoea in children: an interface between developing and developed countries. Lancet 363: 641653.[Crossref] [Google Scholar]
  3. Davidson G, Barnes G, Bass D, Cohen M, Fasano A, Fontaine O, Guandalini S, , 2002. Infectious diarrhea in children: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 35: S143S150.[Crossref] [Google Scholar]
  4. Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, Wu Y, Sow SO, Sur D, Breiman RF, Faruque ASGS, Zaidi AKM, Saha D, Alonso PL, Tamboura B, Sanogo D, Onwuchekwa U, Manna B, Ramamurthy T, Kanungo S, Ochieng JB, Omore R, Oundo JO, Hossain A, Das SK, Ahmed S, Qureshi S, Quadri F, Adegbola RA, Antonio M, Hossain MJ, Akinsola A, Mandomando I, Nhampossa T, Acácio S, Biswas K, O'Reilly CE, Mintz ED, Berkeley LY, Muhsen K, Sommerfelt H, Robins-Browne RM, Levine MM, , 2013. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet 382: 209222.[Crossref] [Google Scholar]
  5. Bhutta ZA, Das JK, Walker N, Rizvi A, Campbell H, Rudan I, Black RE, , 2013. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet 381: 14171429.[Crossref] [Google Scholar]
  6. Nguyen TA, Yagyu F, Okame M, Phan TG, Trinh QD, Yan H, Hoang KT, Thi A, Cao H, Le Hoang P, Okitsu S, Ushijima H, , 2007. Diversity of viruses associated with acute gastroenteritis in children hospitalized with diarrhea in Ho Chi Minh City, Vietnam. J Clin Microbiol 590: 582590. [Google Scholar]
  7. Vinh H, Nhu NTK, Nga TVT, Duy PT, Campbell JI, Hoang NVM, Boni MF, My PVT, Parry C, Nga TTT, Van Minh P, Thuy CT, Diep TS, Phuong LT, Chinh MT, Loan HT, Tham NTH, Lanh MN, Mong BL, Anh VTC, Bay PVB, Chau NVV, Farrar J, Baker S, , 2009. A changing picture of shigellosis in southern Vietnam: shifting species dominance, antimicrobial susceptibility and clinical presentation. BMC Infect Dis 9: 204216.[Crossref] [Google Scholar]
  8. 2012. Statistical Yearbook of Ho Chi Minh City 2011. Ho Chi Minh City, Vietnam: Ho Chi Minh City Statistical Office. [Google Scholar]
  9. Le TMV, Baker S, Le TPT, Le TPT, Cao TT, Tran TTN, Nguyen VMH, Campbell JI, Lam MY, Nguyen TH, Nguyen VVC, Farrar J, Schultsz C, , 2009. High prevalence of plasmid-mediated quinolone resistance determinants in commensal members of the Enterobacteriaceae in Ho Chi Minh City, Vietnam. J Med Microbiol 58: 15851592.[Crossref] [Google Scholar]
  10. Vinh H, Baker S, Campbell J, Hoang NVM, Loan HT, Chinh MT, Anh VTC, Diep TS, Phuong LT, Schultsz C, Farrar J, , 2009. Rapid emergence of third generation cephalosporin resistant Shigella spp. in southern Vietnam. J Med Microbiol 58: 281283.[Crossref] [Google Scholar]
  11. World Health Organization, 2005. Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers. Geneva, Switzerland: World Health Organization. [Google Scholar]
  12. My PVT, Thompson C, Le Phuc H, Tuyet PTN, Vinh H, Hoang NVM, Van Minh P, Vinh NT, Thuy CT, Nga TTT, Hau NTT, Campbell J, Chinh NT, Thuong TC, Tuan HM, Farrar J, Baker S, , 2013. Endemic norovirus infections in children, Ho Chi Minh City, Vietnam, 2009–2010. Emerg Infect Dis 19: 2932.[Crossref] [Google Scholar]
  13. Clinical and Laboratory Standards Institute, 2012. Performance Standards for Antimicrobials Disk Susceptibility Test. Wayne, PA: Clinical and Laboratory Standards Institute. [Google Scholar]
  14. Bradford PA, , 2001. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 14: 933951.[Crossref] [Google Scholar]
  15. Tra My PV, Rabaa MA, Vinh H, Holmes EC, Hoang NVM, Vinh NT, Phuong LT, Tham NT, Bay PVB, Campbell JI, Farrar J, Baker S, , 2011. The emergence of rotavirus G12 and the prevalence of enteric viruses in hospitalized pediatric diarrheal patients in southern Vietnam. Am J Trop Med Hyg 85: 768775.[Crossref] [Google Scholar]
  16. Gomara MI, Cubitt D, Desselberger U, Gray J, , 2001. Amino acid substitution within the VP7 protein of G2 rotavirus strains associated with failure to serotype. J Clin Microbiol 39: 37963798.[Crossref] [Google Scholar]
  17. Yan H, Yagyu F, Okitsu S, Nishio O, Ushijima H, , 2003. Detection of norovirus (GI, GII), sapovirus and astrovirus in fecal samples using reverse transcription single-round multiplex PCR. J Virol Methods 114: 3744.[Crossref] [Google Scholar]
  18. Jenkins C, Lawson AJ, Cheasty T, Willshaw GA, , 2012. Assessment of a real-time PCR for the detection and characterization of verocytotoxigenic Escherichia coli . J Med Microbiol 61: 10821085.[Crossref] [Google Scholar]
  19. Olive DM, , 1989. Detection of enterotoxigenic Escherichia coli after polymerase chain reaction amplification with a thermostable DNA polymerase. J Clin Microbiol 27: 261265. [Google Scholar]
  20. Stacy-Phipps S, Mecca JJ, Weiss JB, , 1995. Multiplex PCR assay and simple preparation method for stool specimens detect enterotoxigenic Escherichia coli DNA during course of infection. J Clin Microbiol 33: 10541059. [Google Scholar]
  21. World Health Organization, 2006. WHO Child Growth Standards: Methods and development. Geneva, Switzerland: World Health Organization. [Google Scholar]
  22. Dewan N, Faruque AS, Fuchs GJ, , 1998. Nutritional status and diarrhoeal pathogen in hospitalized children in Bangladesh. Acta Paediatr 87: 627630.[Crossref] [Google Scholar]
  23. Vu Nguyen T, Le Van P, Le Huy C, Nguyen Gia K, Weintraub A, , 2006. Etiology and epidemiology of diarrhea in children in Hanoi, Vietnam. Int J Infect Dis 10: 298308.[Crossref] [Google Scholar]
  24. Wardlaw T, Salama P, Brocklehurst C, Chopra M, Mason E, , 2010. Diarrhoea: why children are still dying and what can be done. Lancet 375: 870872.[Crossref] [Google Scholar]
  25. Podewils LJ, Mintz ED, Nataro JP, Parashar UD, , 2004. Acute, infectious diarrhea among children in developing countries. Semin Pediatr Infect Dis 15: 155168.[Crossref] [Google Scholar]
  26. Vesikari T, , 2012. Rotavirus vaccination: a concise review. Clin Microbiol Infect 18 (Suppl 5): 5763.[Crossref] [Google Scholar]
  27. Dang DA, Nguyen VT, Vu DT, Nguyen THA, Nguyen DMDH, Yuhuan W, Baoming J, Le TL, Duc D, Van Trang N, Dinh V, Thi NAH, Wang Y, Jiang B, Luan LT, , 2012. A dose-escalation safety and immunogenicity study of a new live attenuated human rotavirus vaccine (Rotavin-M1) in Vietnamese children. Vaccine 30 (Suppl 1): 114121. [Google Scholar]
  28. Le LT, Nguyen TV, Nguyen PM, Huong NT, Huong NT, Huong NTM, Hanh TB, Ha DN, Anh DD, Gentsch JR, Wang Y, Esona MD, Glass RI, Steele AD, Kilgore PE, Man NV, Jiang B, Hien ND, , 2009. Development and characterization of candidate rotavirus vaccine strains derived from children with diarrhoea in Vietnam. Vaccine 27S: F130F138.[Crossref] [Google Scholar]
  29. Ochoa TJ, Ecker L, Barletta F, Mispireta ML, Gil AI, Contreras C, Molina M, Amemiya I, Verastegui H, Hall ER, Cleary TG, Lanata CF, , 2010. Age-related susceptibility to infection with diarrheagenic E. coli in infants from peri-urban areas of Lima, Peru. Clin Infect Dis 49: 16941702.[Crossref] [Google Scholar]
  30. Abba K, Sinfield R, Hart CA, Garner P, , 2009. Pathogens associated with persistent diarrhoea in children in low and middle income countries: systematic review. BMC Infect Dis 9: 88.[Crossref] [Google Scholar]
  31. Qadri F, Svennerholm AM, Faruque AS, Sack RB, , 2005. Enterotoxigenic Escherichia coli in developing countries: epidemiology, microbiology, clinical features, treatment, and prevention. Clin Microbiol Rev 18: 465483.[Crossref] [Google Scholar]
  32. Bodhidatta L, McDaniel P, Sornsakrin S, Srijan A, Serichantalergs O, Mason CJ, , 2010. Case-control study of diarrheal disease etiology in a remote rural area in western Thailand. Am J Trop Med Hyg 83: 11061109.[Crossref] [Google Scholar]
  33. Meng CY, Smith BL, Bodhidatta L, Richard SA, Vansith K, Thy B, Srijan A, Serichantalergs O, Mason CJ, , 2011. Etiology of diarrhea in young children and patterns of antibiotic resistance in Cambodia. Pediatr Infect Dis J 30: 331335.[Crossref] [Google Scholar]
  34. Jean S-S, Hsueh P-R, , 2011. High burden of antimicrobial resistance in Asia. Int J Antimicrob Agents 37: 291295.[Crossref] [Google Scholar]
  35. Jain D, Sinha S, Prasad KN, Pandey CM, , 2005. Campylobacter species and drug resistance in a north Indian rural community. Trans R Soc Trop Med Hyg 99: 207214.[Crossref] [Google Scholar]
  36. Zhang M, Gu Y, He L, Ran L, Xia S, Han X, Li H, Zhou H, Cui Z, Zhang J, , 2010. Molecular typing and antimicrobial susceptibility profiles of Campylobacter jejuni isolates from north China. J Med Microbiol 59: 11711177.[Crossref] [Google Scholar]
  37. World Health Organization, 2005. Guidelines for the Control of Shigellosis, Including Epidemics due to Shigella dysenteriae Type 1. Geneva, Switzerland: World Health Organization. [Google Scholar]
  38. Carrique-Mas JJ, Bryant JE, Cuong NV, Hoang NVM, Campbell J, Hoang NV, Dung TTN, Duy DT, Hoa NT, Thompson C, Hien VV, Phat VV, Farrar J, Baker S, , 2013. An epidemiological investigation of Campylobacter in pig and poultry farms in the Mekong delta of Vietnam. Epidemiol Infect 142: 112. [Google Scholar]
  39. Howard SJ, Catchpole M, Watson J, Davies SC, , 2013. Antibiotic resistance: global response needed. Lancet Infect Dis 13: 10011003.[Crossref] [Google Scholar]
  40. Laxminarayan R, Duse A, Wattal C, Zaidi AKM, Wertheim HFL, Sumpradit N, Vlieghe E, Hara GL, Gould IM, Goossens H, Greko C, So AD, Bigdeli M, Tomson G, Woodhouse W, Ombaka E, Peralta AQ, Qamar FN, Mir F, Kariuki S, Bhutta ZA, Coates A, Bergstrom R, Wright GD, Brown ED, Cars O, , 2013. Antibiotic resistance—the need for global solutions. Lancet Infect Dis 13: 10571098.[Crossref] [Google Scholar]
  41. Chalmers RM, Campbell BM, Crouch N, Charlett A, Davies AP, , 2011. Comparison of diagnostic sensitivity and specificity of seven Cryptosporidium assays used in the UK. J Med Microbiol 60: 15981604.[Crossref] [Google Scholar]

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  • Received : 19 Oct 2014
  • Accepted : 28 Jan 2015
  • Published online : 06 May 2015

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