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Title: Diarrhoeal disease in children under the age of five in Ho Chi Minh City, Vietnam
Author: My, Phan Vu Tra
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2013
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The focus of the global diarrhoeal disease burden is in low and middle-income countries, where the disease epidemiology and aetiology is highly variable and not well characterised. The aim of this thesis was to challenge the knowledge gaps regard ing diarrhoeal disease in children under the age of five in Ho Chi Minh City (HCMC), Vietnam. Firstly, a pilot surveillance in southern Vietnam demonstrated a preponderance of enteric viruses in hospitalised diarrhoeal children and reported the first rotav irus GI2 in Vietnam; despite being geographically disproportional distributed, rotav irus (RoV) predom inated fo llowed by norovirus (NoV). On the basis of these data, a prospective multi-centre hospita lbased surveil!ance was conducted in HeMe to study diarrhoeal disease in detail and \ investigate the extent and the ep idemiology of the hypothes ized NoV emergence. Faecal , specimens from diarrhoea patients and diarrhoea-free chi ldren were screened for a panel of pathogens; RoV was again identified as the predominant agent, fo llowed by NoV. Enteric bacteria were found at smaller proportions, and exhibited excessive antim icrobial res istance. As NoV was found to be highly endemic and a major cause of hospita lisation, a risk factor analysis for NoV infections was performed. Ri sk facto rs in cluded young age, residential crowding and contact with symptomatic individ uals. Additional analys is on the phylogenetic structure of NoV stra ins demonstrated diverse genotypes circulating, most commonly belonging to the GIIA lineage. A spatioremporal analysis of 0 11.4 variants, GI1.4-2006b (Minerva) and the novel emergent GIL4-20 10 (New Orleans), suggested a strain replacement phenomenon and detected a cluster of 0 11.4-201 0 in the northeastern part of the city. These studies indicate prominent di sease dynam ics involved rapid evolution of vi ruses, necessitate studies on strain distribution and genomic analyses and potenti al source additi onally f contributing to genetic variations (animal reservoirs), and suggest considerable impact of RoV and NoV immunisation in Vietnam.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available