Audrey Dubot-Peres: Viral infections in Laos
Infections such as dengue and Japanese encephalitis are important problems in Laos but confirmed data are lacking, particularly from outside the capital Vientiane. Rapid diagnostic tests that can be kept at tropical room temperature help better diagnosis and treatment, and also inform policy to implement vaccination programmes.
I’m Audrey Dubot-Pérès, I’m a virologist from IRD (Institut de Recherche pour le Développement) and I am based in Marseille at the Unit of Emerging Viruses at the Faculty of Medicine, and I am supervising the virology activity in LOMWUR in Laos.
Dengue virus infection is an important problem in Laos, with infections all year round and epidemics during the rainy season. The most serious epidemic was in 2013 with more than 40,000 reported cases and 95 deaths. These are not only in urban areas but there is also evidence of dengue infections in rural areas. Few data are available; some investigation are developing and we hope that we can provide more data in the future, especially from provinces.
The lack of confirmed data is a problem, we need to have accurate data based on confirmed laboratory testing. It’s a problem because the facilities are only in the Vientiane capital, so we have most of the data coming from the capital. There is a lack of data especially from the rural areas and the provinces. We don’t have a whole picture of what’s happening in the country and it’s really limited to the capital with some data from some provinces.
In Marseille we have a diagnosis platform where we develop and validate the molecular testing, like real time PCR. We developed a format, which is a freeze-dried format that we can send at room temperature to Laos. All the different testing for the different viruses are in the same format, so this is really easy to use for the team in Laos. We also provide some quality control so we can control the results in Laos.
We are involved in viruses that are important problems in Laos, which include dengue virus and also the viruses that cause central nervous system infections. We did a long term study on this and we set up diagnosis services at Mahosot Hospital. We provide support for diagnosis on central nervous system infections and arboviruses. The main arboviruses causes encephalitis – the Japanese encephalitis virus – and our studies provided the first data on the incidence of Japanese encephalitis in Laos. This was key information for the implementation of vaccination in Laos.
For me the most significant advances in our research was the development of new innovative technology for pathogen detection and characterisation, for example RDTs (Rapid Diagnostic Tests) that are easy to use and don’t require laboratory facilities. They are of important added value because they can be used in the community, in rural areas. However, they need to be validated in the environmental and epidemiological context they will be used. This is what we did for dengue RDT and we showed that it remains efficient even after long term storage at tropical temperature.
I think that our research matters because we are studying infectious diseases that can be fatal; some are preventable and our work in fact could save lives. I will give an example: in the framework of this study we set up a cerebrospinal diagnosis service at Mahosot Hospital; we did the first diagnosis of herpes simplex encephalitis on a young kid who could receive the appropriate treatment and survived. I would say that our research is in fact driven by translational medicine because we are studying the causes of infectious diseases in Laos, to adapt diagnosis and treatment, and to inform policy in Laos to decrease infectious diseases burden. The Japanese encephalitis data that we provided were key information to implement vaccination. Many other things need to be discovered in Laos and we know only a small part of the picture and there is plenty of research that needs to be done in Laos and not only in Vientiane capital.
Audrey is affiliated with IRD (Institut de Recherche pour le Développement), Unité des Virus Émergents (UVE: Aix-Marseille Univ – IRD 190 – Inserm 1207 – IHU Méditerranée Infection), Marseille, France.