| Abstract |
Antimicrobial resistance (AMR) is now deemed to be the biggest global threat facing humanity in the 21C. AMR has taken center stage as a global health issue yet most non-specialists are unaware the impact AMR will have on global populations, and how AMR will effect international communities in 2020/2025. Recent announcements from Prime Minister David Cameron, the UK Chief Medical Officer (Professor Sally Davies), and the US president, Barak Obama, is clear evidence that this starting to attract UK and international scientific and political traction. Additionally the World Health Organization recently published a mapping exercise on regional capacity and SE Asia, including Viet Nam lacked many basic reporting structures on multiple drug resistance (MDR). Therefore in keeping with the general notion of "One World Health" there clearly needs to better alignment and engagement between the "developed world" and low-middle income countries. There have been ad-hoc studies on AMR in Viet Nam; however, the majority of these are small in number and importantly do not blend clinical and basic scientific data. Those studies that have been done tend to focus only on a resistance mechanisms such as, for example, the carbapenem (penicillin-like compounds used in last resort infections) - resistant mechanism called NDM-1. Despite the fact that NDM-1 is now present in Viet Nam and causing antibiotic failures and no doubt impacting on mortality we know very little of its true impact, or indeed any other type of AMR mechanism. Thus far studies in Viet Nam have been sporadic and lack meaningful clinical data to truly attribute risk factors such as AMR. This application addresses these knowledge gaps by undertaking the following: 1. Comprehensive approach to the problem of infection and AMR in Viet Nam. This application is unique in that it combines clinical epidemiology with molecular biology (whole genome sequencing) to assess the impact of AMR in patients in Viet Nam. We have selected four Vietnamese medical centres where we will employ and train staff to collect clinical data following ethical consent. The National Institute of Hygiene and Epidemiology will carry out antibiotic resistance testing and basic molecular biology. This comprehensive approach to studying infections is the first of its type in not only Vietnam but also SE Asia. 2. Provide meaningful infrastructure and sustainable research excellence in Viet Nam. The UK lab will purchase a sequencer and the Vietnamese research fellows will travel to the UK and train in sequencing and bioinformatics; at the end of the two-year period the sequencer will be installed in Viet Nam providing essential molecular infrastructure. The Vietnamese research fellows will be equipped to independently run genomic sequencing in Viet Nam. 3. Establish a Vietnamese national AMR surveillance network. This application also seeks to implement a national AMR network in accordance with the WHO "one world health" mantra. This comprehensive and unique approach will identify risk factors for infection and AMR, and allow identification of interventions positively impacting on mortality. 4. Improving patient welfare in Viet Nam. The data from this study will identify groups of patients most at risk from infections and AMR. These groups could be based on age (infant versus adult), socio-economic status (type of dwelling, level of sanitation), type of job (farmer, hospital worker etc.) etc. etc. but will provide meaningful data for identifying high-risk patient groups. By understanding these risk factors we will be able to implement interventions resulting in better patient care. In the UK we will very closely with our Vietnamese colleagues to ensure close communication and engagement through social media and web-based communication portals. We also will establish a Vietnamese public education program (written in Vietnamese and French) to reach local people unaware of AMR issues in Viet Nam. |