Kinetics of Neutralizing Antibodies against Omicron Variant in Vietnamese Healthcare Workers after Primary Immunization with ChAdOx1-S and Booster Immunization with BNT162b2.

We studied the development and persistence of neutralizing antibodies against SARS-CoV-2 ancestral strain, and Delta and Omicron (BA.1 and BA.2) variants in Vietnamese healthcare workers (HCWs) up to 15 weeks after booster vaccination. We included 47 HCWs, including group 1 (G1, N = 21) and group 2 (G2; N = 26) without and with breakthrough Delta variant infection before booster immunization, respectively). The study participants had completed primary immunization with ChAdOx1-S and booster vaccination with BNT162b2. Neutralizing antibodies were measured using a surrogate virus neutralization assay. Of the 21 study participants in G1, neutralizing antibodies against ancestral strain, Delta variant, BA.1, and BA.2 were (almost) abolished at month 8 after the second dose, but all had detectable neutralizing antibodies to the study viruses at week 2 post booster dose. Of the 26 study participants in G2, neutralizing antibody levels to BA.1 and BA.2 were significantly higher than those to the corresponding viruses measured at week 2 post breakthrough infection and before the booster dose. At week 15 post booster vaccination, neutralizing antibodies to BA.1 and BA.2 dropped significantly, with more profound changes observed in those without breakthrough Delta variant infection. Booster vaccination enhanced neutralizing activities against ancestral strain and Delta variant compared with those induced by primary vaccination. These responses were maintained at high levels for at least 15 weeks. Our findings emphasize the importance of the first booster dose in producing cross-neutralizing antibodies against Omicron variant. A second booster to maintain long-term vaccine effectiveness against the currently circulating variants merits further research.

Wearable devices for remote monitoring of hospitalized patients with COVID-19 in Vietnam.

Patients with severe COVID-19 disease require monitoring with pulse oximetry as a minimal requirement. In many low- and middle- income countries, this has been challenging due to lack of staff and equipment. Wearable pulse oximeters potentially offer an attractive means to address this need, due to their low cost, battery operability and capacity for remote monitoring. Between July and October 2021, Ho Chi Minh City experienced its first major wave of SARS-CoV-2 infection, leading to an unprecedented demand for monitoring in hospitalized patients. We assess the feasibility of a continuous remote monitoring system for patients with COVID-19 under these circumstances as we implemented 2 different systems using wearable pulse oximeter devices in a stepwise manner across 4 departments.

An observational study of breakthrough SARS-CoV-2 Delta variant infections among vaccinated healthcare workers in Vietnam.

BACKGROUND: Data on breakthrough SARS-CoV-2 Delta variant infections in vaccinated individuals are limited. METHODS: We studied breakthrough infections among Oxford-AstraZeneca vaccinated healthcare workers in an infectious diseases hospital in Vietnam. We collected demographic and clinical data alongside serial PCR testing, measurement of SARS-CoV-2 antibodies, and viral whole-genome sequencing. FINDINGS: Between 11th-25th June 2021 (7-8 weeks after the second dose), 69 staff tested positive for SARS-CoV-2. 62 participated in the study. Most were asymptomatic or mildly symptomatic and all recovered. Twenty-two complete-genome sequences were obtained; all were Delta variant and were phylogenetically distinct from contemporary viruses obtained from the community or from hospital patients admitted prior to the outbreak. Viral loads inferred from Ct values were 251 times higher than in cases infected with the original strain in March/April 2020. Median time from diagnosis to negative PCR was 21 days (range 8-33). Neutralizing antibodies (expressed as percentage of inhibition) measured after the second vaccine dose, or at diagnosis, were lower in cases than in uninfected, fully vaccinated controls (median (IQR): 69.4 (50.7-89.1) vs. 91.3 (79.6-94.9), p=0.005 and 59.4 (32.5-73.1) vs. 91.1 (77.3-94.2), p=0.002). There was no correlation between vaccine-induced neutralizing antibody levels and peak viral loads or the development of symptoms. INTERPRETATION: Breakthrough Delta variant infections following Oxford-AstraZeneca vaccination may cause asymptomatic or mild disease, but are associated with high viral loads, prolonged PCR positivity and low levels of vaccine-induced neutralizing antibodies. Epidemiological and sequence data suggested ongoing transmission had occurred between fully vaccinated individuals. FUNDING: Wellcome and NIH/NIAID.

The direct-medical costs associated with interferon-based treatment for Hepatitis C in Vietnam.

Background: Injectable interferon-based therapies have been used to treat hepatitis C virus (HCV) infection since 1991. International guidelines have now moved away from interferon-based therapy towards direct-acting antiviral (DAA) tablet regimens, because of their superior efficacy, excellent side-effect profiles, and ease of administration. Initially DAA drugs were prohibitively expensive for most healthcare systems. Access is now improving through the procurement of low-cost, generic DAAs acquired through voluntary licenses. However, HCV treatment costs vary widely, and many countries are struggling with DAA treatment scale-up. This is not helped by the limited cost data and economic evaluations from low- and middle-income countries to support HCV policy decisions. We conducted a detailed analysis of the costs of treating chronic HCV infection with interferon-based therapy in Vietnam. Understanding these costs is important for performing necessary economic evaluations of novel treatment strategies. Methods: We conducted an analysis of the direct medical costs of treating HCV infection with interferon alpha (IFN) and pegylated-interferon alpha (Peg-IFN), in combination with ribavirin, from the health sector perspective at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, in 2017. Results: The total cost of the IFN treatment regimen was estimated to range between US$1,120 and US$1,962. The total cost of the Peg-IFN treatment regimen was between US$2,156 and US$5,887. Drug expenses were the biggest contributor to the total treatment cost (54-89%) and were much higher for the Peg-IFN regimen. Conclusions: We found that treating HCV with IFN or Peg-IFN resulted in significant direct medical costs. Of concern, we found that all patients incurred substantial out-of-pocket costs, including those receiving the maximum level of support from the national health insurance programme. This cost data highlights the potential savings and importance of increased access to generic DAAs in low- and middle-income countries and will be useful within future economic evaluations.

Variation in susceptibility of eight insecticides in the brown planthopper Nilaparvata lugens in three regions of Vietnam 2015-2017.

The brown planthopper (BPH), Nilaparvata lugens, is a serious threat to rice production in Vietnam and insecticides are widely used for its control. Migration of the BPH have one of its roots in tropical Vietnam in the Mekong River Delta and the insecticide resistance status of BPH populations from Vietnam is thus important for East Asia. In the present investigation, we evaluate the susceptibility of BPH populations from nine provinces from the Red River Delta, the Central Coastal region and the Mekong River Delta of eight insecticides during 2015-17. BPH field populations of Vietnam have developed a low to moderate level of resistance to the neonicotinoids dinotefuran, nitenpyram and imidacloprid, the pyrethroid etofenprox, the anticholinesterase fenobucarb, as well as fipronil and pymetrozine, and the growth regulator buprofezin. There was a correlation of in toxicology of fipronil, dinotefuran, etofenprox, buprofezin, which represents four different modes of action. The neonicotinoid nitenpyram, pymetrozine and fenobucarb did not show correlation in toxicology to any of the investigated insecticides. For most insecticides, a gradient of susceptibility was established from the Red River Delta in the north, through the Central Coastal region and to the Mekong River Delta in the south of Vietnam. The most susceptible populations were from the north. Insecticide resistance of the BPH populations in Vietnam is not at an alarming level and they are not the direct origin of high insecticide resistance found in East Asia. The cross-resistance pattern of BPH populations in Vietnam, where insecticides with different modes of action correlated, indicate that insecticides should be used with caution. There could be a buildup of a general metabolic resistance, which alone or in combination with the emergence of target-site resistance mutations will cause control problems. The results will be beneficial for development of resistance management strategies to prevent and delay development of insecticide resistance in BPH not only for Vietnam, but also for more northern Asian regions due the migration of BPH from tropical Vietnam.

Expression analysis of inhibitor of apoptosis and related caspases in the midgut and silk gland of the greater wax moth, Galleria mellonella, during metamorphosis and under starvation.

We cloned a cDNA encoding inhibitor of apoptosis (IAP) from the greater wax moth, Galleria mellonella. The deduced amino acid sequence showed that GmIAP contains two baculoviral IAP repeat (BIR) motifs, followed by a RING finger. The sequence comparison showed that GmIAP had high homology to lepidopteran IAPs and baculoviral IAPs, as well as dipteran IAPs. GmIAP transcript and its protein appeared in both the midgut and the silk gland during metamorphosis and starvation where cell death was detected by TUNEL test. IAP, and capases-1, -3, -4 and -6 appeared as at least two peaks in the midgut and silk gland during metamorphosis. Caspase-1 transcript appeared at the highest level among caspases, while caspase-3 and caspase-6 seemed to be the most relevant caspases to IAP during metamorphosis suggesting that IAP and caspases may be involved in a core apoptosis pathway in the wax moth as in flies and mosquitoes.

Large scale screening for haemoglobin disorders in southern Vietnam: implications for avoidance and management.

In order to obtain an approximate assessment of the public health burden that will be posed by the inherited disorders of haemoglobin in southern Vietnam, several thousand individuals were screened for these conditions. A smaller sample was screened for glucose-6-phosphate dehydrogenase (G6PD) deficiency. The important haemoglobin disorders identified were beta thalassaemia, haemoglobin E and a variety of different forms of alpha thalassaemia. There were sufficient G6PD-deficient individuals to materially affect malaria control programme design. The most remarkable finding was wide variation in the gene frequencies of these conditions among the ethnic groups sampled. The approximate number of babies expected to be born with clinically significant haemoglobin disorders in Vietnam was estimated from the gene-frequency data. This study emphasizes the importance of wide-scale population screening, including ethnic subgroups, to establish the requirements for inherited haemoglobin disorder programmes in resource-limited settings.