Febrile illness and general infectious disease
- The Expanded Fever Surveillance (EFS) project is investigating the aetiology of fever in inpatients attending Xieng Khouang, Salavan and Luang Nam Tha Provincial Hospitals. These data will be useful for informing treatment algorithms. We have recently started the FIEBRE multicountry fever study in Vientiane Province.
- 1,354 patients have been diagnosed with culture-positive melioidosis since 1999 (120 in 2018) and we are concerned that there is substantial unrecognised but potentially treatable mortality due to Burkholderia pseudomallei elsewhere, especially in southern Laos. Analysis of the association between climatic factors and the occurrence of melioidosis in patients from Laos and Cambodia, suggested that humidity, low visibility and maximum wind speed were important in Laos, and humidity, rainy days and maximum wind speed in Cambodia.
- Through innovative collaboration with soil scientists and hydrologists from the Institut de recherche pour le développement and the International Water Management Institute, LOMWRU is expanding our understanding of the ecology of B. pseudomallei and the reasons for its distribution in different soil and water habitats.
- After PCV13 introduction in Laos there was a 23% relative reduction in PCV13-type carriage in children aged 12-23 months, and no significant change in non-PCV13 serotype carriage, suggesting that the reductions in PCV13 serotype carriage in vaccine-eligible children are likely to result in reductions in pneumococcal transmission and disease in Laos. We are working with Professor Fiona Russell and the Murdoch Children's Research Institute to monitor the longer term impact of PCV13 introduction in Laos, including prevalence of drug-resistant serotypes.
- We concluded that there are currently no anti-Leptospira spp. antibody detecting RDTs with good sensitivity and specificity for use in Laos. However, data suggest that PCR of urine and serum is a useful technique. We found no evidence of Leptospira spp. resistance to azithromycin, ceftriaxone, ciprofloxacin, doxycycline, gentamicin and penicillin G.
- We found evidence that Streptococcus agalactiae (Group B Streptococcus - GBS) in Laos is potentially a fish-borne pathogen; fish may represent an under-recognised source of GBS infection regionally.
- A novel mathematical model, incorporating a time-varying discovery rate, estimated that some further 10-11 species of human pathogens are currently waiting to be discovered in Laos.
- A study of the antibiotic susceptibility of Orientia tsutsugamushi (the agent of scrub typhus) did not support the current existence of doxycycline- and chloramphenicol-resistant scrub typhus in northern Thailand and Laos.
- With evidence of low herd immunity in Vientiane, Zika virus represents a risk for future largescale outbreaks in Laos
- The first whole genome sequencing was performed in Laos, at Mahosot Hospital in 2018, using the portable MinION next generation sequencing platform, for the whole genome of Rickettsia typhi, the agent of murine typhus.