R E S P A R I - Research driven response to acute respiratory infections

National Institute of Hygiene and Epidemiology, IP-Ho Chi Minh City, IP-Nha Trang, IP-Cambodia, IP-New Caledonia, National Centre for Laboratory and Epidemiology

The backbone of WP1 is the study of community acquired acute pneumonia among hospitalized patients. Acute Lower Respiratory Infections (ALRI) are one of the main three causes of child death and loss of disability adjusted life years in children globally. They are one of the top ten individual causes of global burden of disease. ARI account for over two million deaths per year in <5 yo children, mostly in developing countries, and 30% of these deaths occur in South East Asia. The mortality burden is principally constituted by ALRI, primarily pneumonia.

The region of the world with the highest incidence of ALRI is South Asia and South East Asia with an estimated 55.2 million episodes occurring in <5 yo children. The main cause of ALRI in children less than five years of age is Streptococcus pneumoniae infection accounting for 30 to 60%. The remaining 40% is thought to be attributed to viral causes. However, the extent and the relative contribution of viral infections to severe pneumonia are unknown in many developing Asian countries. In addition, following the occurrence of SARS in 2003 and the threat of pandemic due to a potential human to human transmission of A/H5N1 influenza virus since end of 2003, the international community has emphasized the needs for studies on etiologies of severe respiratory infections in adults and children. Impetus gained by the threat of H5N1 pandemic potential has provided an opportunity to determine patterns and causes of severe pneumonia in a hospital setting. The participating centers of the Pasteur network in collaboration with 1 or 2 public hospitals will implement such studies and apply classical and rapid molecular diagnostic tools (e.g. multiplex PCR) for bacterial and viral infections. The genetic diversity of most respiratory viruses circulating in South-East Asia has not been comprehensively studied. Such information will also be essential in the frame of the development of new vaccines or new drugs.

Describe morbidity, mortality and patterns of community acquired acute pneumonia
Detect in a timely manner, unusually severe morbidity and mortality caused by unknown and known respiratory pathogens that have the potential for large scale epidemics or pandemics
Determine the extent of emerging and reemerging bacterial and viral infections and their risk factors through additional epidemiological investigations in the community.
Determine the extent of drug resistance (antibiotics and antiviral drugs) and virulence of the main respiratory pathogens in association with their related genetic diversity.

WP1 will provide the basis for added synergies as it will allow to share antimicrobial drug resistance data within the IP network. In addition, pathogens identified and their sequences could be of interest to Institutes involved in drug screening or immunological studies (i.e. IP Shanghai, IP Hong Kong, IP Korea).

Samples will be distributed for further development of new diagnostic tests that require clade- and lineage-specific validation in comparison with the gold standards (i.e. microneutralization test under BSL3 conditions for avian flu).