Monitoring the emergence of infectious diseases

were able to trace this infection back to her cutting herself when butchering a buffalo in her family house during New Year celebrations – this was the first reported human case of T. evansi in Southeast Asia. Our ability to interact with animal health authorities permitted access to sampling bovines in the proximity of the patient’s house. We found a very high prevalence of the parasite in the blood of cattle and buffalo close to where the woman lived, highlighting a new zoonotic infection in the region and likely a sustained risk.

Diagnostic information has also been vital in data we published detailing an outbreak of fluoroquinolone-resistant Shigella sonnei. The reason we found this organism was that one of my clinical colleagues was culturing organisms from children with severe diarrheal disease, and realized that these samples had come from children who had been admitted to hospital with a more persistent form of the infection, and several appeared to relapse with the same syndrome. When we investigated the antimicrobial susceptibility profile of the isolated Shigella, we observed that the bacteria were highly resistant to fluoroquinolones – the antimicrobials that are used routinely to treat this infection in Vietnam (and indeed globally). We then conducted more clinical and laboratory investigations and found more cases in Vietnam and further afield. Through genome sequencing and a group of international collaborators, we could accurately piece together the emergence of this novel strain into Vietnam, other parts of Asia, Europe and Australia.

These finding were largely serendipitous, but if you are not looking then you cannot find. Unfortunately, this approach is not a long-term strategy for monitoring and preventing the emergence of such pathogens. Sadly, the infrastructure improvements and long-term health studies that are needed to achieve a more sustainable model in lower income countries are an expensive undertaking, but without them healthcare improvements and changes to infectious disease policy will be difficult to achieve.

Bakers says that Vietnam has changed beyond recognition since his arrival in 2007. Huge economic investment and political stability has had positive effects on healthcare in the country, and across the region. However, many challenges remain; a growing population, increasing demands for animal protein, and the looming cloud of antimicrobial resistance in everyday pathogens suggest that Southeast Asia will continue to be a key region in driving global health security.

— Read more in Stephen Baker, “Emerging infectious diseases in Asia,” Microbiology Today (February 2017)