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Title: Clinical characteristics, virology and host genetic markers of Hand, Foot and Mouth Disease in Southern Vietnam
Author: Van, Hoang Minh Tu
ISNI:       0000 0004 7232 8531
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2018
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Hand, foot and mouth disease (HFMD) has been associated with large outbreaks among young children, including severe illness and fatality, in the Asia-Pacific Region since 1997. Severe illness is most often associated with enterovirus A71 (EVA71). Vietnam experienced a large sustained outbreak of almost 200.000 hospitalised cases and over 200 deaths in 2011-12, the large majority occurring in southern Vietnam. Retrospective data from 2009 to 2015 showed that Vietnam experienced 3 phases of HFMD outbreak time: before the outbreak (2009-2010), during the outbreak (2011-2012) and after the outbreak (2013-2015). Clinical features were slightly different between phases, partly reflected the effect of national intervention strategies. Between July 2013 and July 2015 1547 children were enrolled. Four serotypes of EV-A71, Coxsackie virus (CV) A6, A10 and A16 were responsible for 1005/1327 (75.7%) of diagnosed cases. We found an unexpected dominance of EV-A71 among both in- and outpatients, and a strong association with severe illness. CV-A6 and A10 emerged in Vietnam during our study period and replaced CV-A16. CV-A10 was associated with different clinical and laboratory characteristics. The relative genetic diversity of subgenogroup B5 increased sharply in 2012, leading to subgenogroup switch from C4 to B5 and then remained stable from 2013 to 2015. Subgenogroup B5 dominantly circulated in Vietnam during the study time and might import to Vietnam from two independent sources. Three potential single nucleotide polymorphism (SNPs), rs10235866 represents gene NPTX2/TMEM130, rs817854 and rs10739235 represent gene RAD23B (RAD23 homolog B), were detected to be associated with severe disease. Results from my study, covering demography, clinical features, virology and host genetic factors, provides a full view of HFMD in Southern Vietnam and therefore may have great impact for disease management and control.
Supervisor: van Doorn, H. Rogier ; Thwaites, Louise ; Le Van Tan Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available