Blog

In the first half of this two part blog about the Oxford University Clinical Research Unit (OUCRU), we heard from Katrina Lawson, who discussed in detail the work at OUCRU and its vision for health research on infectious diseases.

In this second part, we now hear from Le Van Tan, an advisor on the gateway and a Wellcome international intermediate fellow based in Vietnam, about his research and the benefit of publishing it via an open and transparent peer review model.

Helping the fight against novel and emerging viruses

Pathogen genetics is an important discipline of infectious diseases, which tells us how the pathogens under investigation may have been transmitted within and/or between geographic locations over time. It can also inform us about how such genetic changes may influence the capacity of pathogens to cause even more severe disease in their respective hosts, especially humans, and/or make the pathogen resistant to currently used drugs/vaccines.

Collectively, knowledge of pathogen genetics will enable us to develop appropriate diagnostic approaches and intervention strategies, to improve clinical outcomes. Infectious diseases have always been a global public health challenge, but are particularly prevalent in developing countries like Vietnam.

To make my contribution in the battle against infectious diseases, I am focusing on the genetics to help fight against novel and/or merging viruses and drug resistant microorganisms.

Viral pathogens

Over the years, my research interest has always been on emerging viruses in Vietnam, and the surrounding regions, that have the potential of causing pandemics. These are viruses of the family Picornaviridae (e.g. enterovirus A71 and enterovirus D68). The former causes some two million hospitalizations, especially young children, due to the outbreak of Hand Foot and Mouth Disease across Asia in recent years, while no vaccines or antivirals are currently available.

I am also interested in the discovery of new viruses. This is driven by the fact that around 40-60% of patients with severe infections, like brain infections, have as of yet, no determined cause. Seeing as Asia is a hotspot of emerging infections, including those caused by novel viral pathogens, named Disease X by the World Health Organization I am keen to analyze human samples to investigate novel viruses and assess their potential threat to public health to inform local public health authorities in Vietnam in order to prevent future emerging infections.

Genome sequencing

Enteroviruses causing hand, foot and mouth disease, and enterovirus D68, have become important public health issues globally. We currently have no antiviral available to offer affected patients.

Understanding the genetic evolution of these pathogens will help us to better understand the epidemiology of these emerging infections and inform vaccine development. Advancing our knowledge of the transmission dynamics, which can be unraveled through sequence analysis, is critical to predicting the rate with which the pathogens will move through a population and the number of new infections they will cause; which is crucial information for disease control.

Novel diagnostics

As part of my fellowship with Wellcome Trust, I aim to show that new diagnostic approaches can improve upon methods commonly used in hospitals in Vietnam, by using novel technologies based on mass spectrometry and next generation sequencing targeted at proteins found in the brain fluid of patients and the genetic material of infectious agents. I will also determine if the genetic code can rapidly predict antibiotic resistance and guide effective treatment.

How can this improve public health in Vietnam? 

Vietnam and Asia are hotspots of emerging infections, as illustrated by the emergence of Nipah virus, SARS-CoV, H5N1, enterovirus A71, and most recently Zika virus. Also, on a daily basis, there are many hospitalised patients whose severe illnesses result in brain infections that are left undiagnosed. I am trying to develop local capacity here in Vietnam, so that ongoing and future emerging infections can be addressed from within the affected local areas.

Active surveillance for novel pathogens and better understanding of the evolutionary aspects of clinically important viruses should strengthen the local capacity here in Vietnam, a relatively resource limited setting, and in turn enable us to rapidly respond to future infectious disease outbreaks.

Improving patient diagnostics so that doctors can quickly determine the cause of brain infections and decide which drugs will be effective will help patients with these devastating clinical entities worldwide.

Enterovirus D68

Enterovirus D68 is a virus of the family Picornaviridae, which also contains poliovirus. Enterovirus D68 was first discovered in 1962 in the U.S. from patients suffering from respiratory infection. Since then, it has been circulating in human population, but usually only causes mild respiratory infection.

Since 2014, enterovirus D68 has caused several outbreaks of severe respiratory illness worldwide, especially in the U.S. and Europe, where the virus has been linked with acute flaccid paralysis (inflammation of the spinal cord). Because of the potential clinical significance of enterovirus D68, better understanding of its geographic distribution; how the viral strains found in different localities are genetically linked together; and the level of severities of the diseases it causes, will enable us to accurately estimate the burden posed by enterovirus D68. Such knowledge is essential for policy makers in prioritizing the resources for the development of intervention strategies to reduce this burden.

The value of open access

I was born and grew up in Vietnam, a low-middle income country where, for many reasons, research is perceived as a tough career. For me, one of the most important issues is access to the most recently advanced scientific knowledge. I highly appreciate the value of open access.

I really like the novelty of the Wellcome Open Research platform, which has a very supportive Editorial team, who always offer enthusiastic support so that newly submitted manuscripts are made available online within a few days after submission. To the best of my knowledge few platforms offer such rapid communication process.

Last but not least, as an author, transparency has always been a desirable aspect of the publication process, and Wellcome Open Research provides that service with their transparent peer-review process.