Belgian experts visiting the research laboratories at the Institute.

Ghent University and the Institute of Tropical Medicine (ITM), Antwerp, both in Belgium, have a long standing collaboration with Vietnamese partners of different research institutes in various fields of parasitology and zoonosis research. They are also involved in regional and international collaborations and meetings o­n these issues, such as o­ngoing anthelmintic efficacy studies in Vietnam (in collaboration with NIMPE, Hanoi), WHO expert consultation o­n food-borne trematodes and cysticercosis (Lao PDR, October 2009), an international workshop o­n "Emerging parasitic zoonoses: epidemiology, diagnosis and prevention in Asian countries", organised at Institute of Biotechnology (June 2012).

In November 2009 and August 2010, Prof P. Dorny from Ghent University (Belgium) visited the laboratories and hospital of IMPE QN where he discussed with the director and staff the situation and needs of this regional institute with regard to diagnosis of parasitic infections. Presently, they would like to cooperate with the IMPE-Quy Nhon in a research project o­n zoonotic Fasciola. The project proposal has been submitted to VLIR, a Belgian sponsor for research projects in developing countries and selected by the South Initiatives (SI) selection commission for funding in the framework of the South Initiatives (SI) Programme 2013. Funding through this budget line is meant to facilitate and organise new partnerships and new, innovative forms of cooperation. Within the new country strategy approach, South Initiatives are particularly relevant to identify new partners, to bring innovation in the country portfolio and to join forces around nationally relevant topics through selected pilot initiatives.

The project titled "The diagnosis of zoonotic and soil-transmitted helminth infections in Central Vietnam" has the duration of 2 years (2013-2015). The general objective of this project is to improve the health of the local population through improved diagnosis of helminth infections. An improved diagnosis will result in a better understanding of the importance and epidemiology, finally resulting in a improved control of ZHI and STH in Vietnam and improved health of the rural population at risk. The specific objective is to improve the diagnostic capacity and capability of IMPE QN. This will be done through: training, improvement of laboratory facilities, technology transfer and national and regional collaborations. Thus, this project aims at strengthening research, science and technology (including transfer), which is in alignment with the Vietnamese national and regional policies. A long-term goal is to help developing leading scientists who meet international standards, can receive and apply advanced technologies to solve practical problems in Vietnam. Research outputs are essential for both Vietnamese and Flemish partners.

The Methodology is as follows:

1. To set up a Parasitology Laboratory for stool examination and serological analysis that is working under a Quality System.

2. To organise training courses (in Vietnam, with collaboration of other Vietnamese and regional partners) and exchange visits (Vietnam, SE Asian region, Belgium) allowing the local researchers to perform the diagnostic tests.

3. To transfer and locally validate parasitological (e.g. mini-FLOTAC and McMaster egg counting methods) and serological methods (e.g. coproantigen test and antibody ELISA for diagnosis of Fasciola, and B158/B60 ELISA for cysticercosis).

4. To conduct a pilot community based study o­n parasitic infections with the aim to collect baseline data, to train the local staff o­n field-based research and to collect information o­n KAP (knowledge, attitudes and practices).

5. To establish a national and regional network o­n helminth diagnosis, NIMPE, Hanoi Medical University, IBT and Khon Kaen university (Thailand) and the Asian Liver Fluke Network will be instrumental.

Due to the humid tropical climate, culinary traditions, and widespread faecal contamination, helminth infections remain endemic in various countries in South-East Asia. In Vietnam the major genera of helminths important for public health are the zoonotic helminth infections (ZHI) (i) the trematodes Fasciola, Paragonimus, Opisthorchis and Chlonorchis, and the tapeworms Taenia spp. and (ii) the soil-transmitted helminths (STH), Ascaris, Trichuris and hookworms. The situation in Central Vietnam is particularly alarming. In the last decade this region has seen a spectacular increase in morbidity and mortality rates caused by these helminth infections. For example (i) opisthorchiasis is currently considered a major cause of cholangiocarcinoma; (ii) fascioliasis, rather sporadic in most of the country, has emerged to an epidemic situation in Central Vietnam, with thousands of cases each year; and (iii) Central Vietnam is among the regions with the highest prevalence of STH. It is clear that these helminthiases contribute to poverty, especially in the most exposed rural populations. The reasons why these helminth infections are emerging in Central Vietnam are not yet known, and this has primarily two causes. First, there is a lack of diagnostic facilities that is essential to tackle these problems. The leading partner institute, IMPE QN has an outpatient clinic and basic laboratories for parasitological, haematological and serological analyses. But these analyses are poorly validated and lack quality assessment. Second, most studies conducted in Central Vietnam were hospital-based and addressed mainly clinical issues. A lack of insights into the prevalence, disease burden and local epidemiology impedes the development of appropriate control programmes.

With the London Declaration o­n Neglected Tropical Diseases (January, 2012) there is an international awareness and commitment to combat neglected tropical diseases (NTD), which has resulted in worldwide increased pledges of drug donations to control and/or to eliminate these diseases by 2020. Among important NTD in Asian countries are: (i) the zoonotic helminth infections (ZHI) caused by the trematodes Fasciola, Paragonimus, Opisthorchis and Chlonorchis, and the tapeworms Taenia spp., and (ii) the cluster of soil-transmitted helminths (STH), Ascaris lumbricoides, Trichuris trichiura and hookworms. Each of these helminthiases are associated with high morbidity and for some also high mortality rates. Human liver trematode infection, mainly caused by Opisthorchis viverrini is an important cause of cholangiocarcinoma and Taenia solium cysticercosis is the most important cause of acquired epilepsy. STH are considered as o­ne of the most important NTD. Their disease burden is comparable of that of malaria and tuberculosis, with children and pregnant women being at the highest risk.

Belgian experts visiting the research laboratories at the Institute

In Vietnam ZHI and STH are highly prevalent and this can be explained by the presence of various factors contributing to the transmission of these disease, including high prevalence of infected animals, use of human/animal stool as fertilizer, use of wastewater for irrigation, culinary habit of eating raw vegetables/meat/fish and open defecation. The situation of ZHI and STH infections is particularly alarming in Central Vietnam. Recently, a 70% increase of fascioliasis cases has been recorded in the Central Vietnamese province of Binh Dinh. The region is also considered as a potential overlapping geographical zone for small liver trematodes, i.e. Clonorchis sinensis and O. viverrini, and as a hot spot for STH infections. Up to date, the reasons for this increased transmission of both ZHI and STH in Central Vietnam remains unsolved and hinders an efficient implementation of control programs. The main reasons for this lack in epidemiological data in Central Vietnam are the poor diagnostic capacity and the lack of field-based studies.

The region of Central Vietnam as well as the topics addressed in this project touching the aspects of food safety and health of the rural population are in line with the country strategy agreed between Vietnam and VLIR UOS. IMPE QN is in the epicentre of the zoonotic parasitic diseases and is highly endemic for STHs. It can therefore be assumed that samples from patients infected with the various parasites will be readily available for reference and validation. Rooms, basic facilities and lab equipment are available and during the visits of Prof. Pierre Dorny to IMPE QN the interest of the staff to collaborate o­n this kind of joint project was highlighted. There have already been exchanges between the leading Vietnamese partner and the other Institutes/Universities, and the Belgian promoters have o­ngoing collaborations or contacts with all these partners. For the fieldwork, care will be taken to thoroughly inform the local populations of different ethnic origins (applies especially to the mountainous provinces with ethnic minorities) o­n the objectives of the project. The centrally organised health system of the country makes it very important to follow the hierarchical procedure to reach the rural communities.

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