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A Prospective Multi-Center Observational Study of Children Hospitalized with Diarrhea in Ho Chi Minh City, Vietnam

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  • The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam

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 Salmonella, Campylobacter, and Shigella 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.

Author Notes

* Address correspondence to Stephen Baker, Hospital for Tropical Disease/Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam. E-mail: sbaker@oucru.org† These authors contributed equally to this work.

Financial support: This work was funded by the Wellcome Trust (United Kingdom) (WT1093724), the Li Ka Shing Foundation (the People's Republic of China), and the Oak Foundation (United States). Stephen Baker is a Sir Henry Dale Fellow, jointly funded by the Wellcome Trust and the Royal Society (100087/Z/12/Z).

Authors' addresses: Corinne N. Thompson and Stephen Baker, The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom, and The London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mails: cthompson@oucru.org and sbaker@oucru.org. My V. T. Phan, The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom, E-mail: mp21@sanger.ac.uk. Nguyen Van Minh Hoang, Pham Van Minh, Nguyen Thanh Vinh, Cao Thu Thuy, Tran Thi Thu Nga, Pham Thanh Duy, Tran Thi Ngoc Dung, Voong Vinh Phat, Tran Vu Thieu Nga, Le Thi Phuong Tu, Ha Thanh Tuyen, The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, E-mails: hoangnvm@oucru.org, minhpv@oucru.org, vinhnt@oucru.org, caothanhthuy09@gmail.com, ngattt@oucru.org, duypt@oucru.org, dungttn@oucru.org, phatvv@oucru.org, ngatvt@oucru.org, tultp@oucru.org, and tuyenht@oucru.org. Maia A. Rabaa, The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom, E-mail: mrabaa@oucru.org. Keisuke Yoshihara, The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan, E-mail: pelopop7171new@outlook.com. Claire Jenkins, Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom, E-mail: Claire.Jenkins1@phe.gov.uk. Vu Thuy Duong, The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam, E-mail: duongvt@oucru.org. Hoang Le Phuc and Tang Chi Thuong, Children's Hospital 1, Ho Chi Minh City, Vietnam, E-mails: drphuc.ph1@gmail.com and drtcthuong@gmail.com. Pham Thi Ngoc Tuyet, Nguyen Minh Ngoc, and Ha Manh Tuan, Children's Hospital 2, Ho Chi Minh City, Vietnam, E-mails: tuyetpham57@yahoo.com, mngocnd2@yahoo.com, and manhtuanzu@yahoo.com. Tran Tinh Hien, James I. Campbell, and Guy Thwaites, The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, and the Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom, E-mails: hientt@oucru.org, jcampbell@oucru.org, and gthwaites@oucru.org. Ha Vinh, Nguyen Tran Chinh, and Nguyen Van Vinh Chau, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, E-mails: vinhh@oucru.org, chinhquan284@vnn.vn, and chaunvv@oucru.org.

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