Conclusion

1. Estimating the burden of fungal disease in Vietnam J. Beardsley1, D.W. Denning2, N.V. Chau3, N.T.B. Yen4, J.A. Crump5, J.N. Day1 1. Denning, D. W., Pleuvry, A. & Cole, D. C. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull. World Health Organ.89, 864–72 (2011). 2. Park, B. J. et al. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS23, 525–30 (2009). 3. Kaplan, E. et al. Preventing opportunistic infections in human immunodeficiency virus-infected persons: implications for the developing world. 55, 1–11 (1996). 4. Le, T. et al. Epidemiology, seasonality, and predictors of outcome of AIDS-associated Penicilliummarneffei infection in Ho Chi Minh City, Viet Nam. Clin. Infect. Dis.52, 945–52 (2011). 5. Arendrup, M. C. Epidemiology of invasive candidiasis. Curr. Opin. Crit. Care16, 445–52 (2010). 6. Smith, E. & Orholm, M. Trends and patterns of opportunistic diseases in Danish AIDS patients 1980-1990. Scand. J. Infect. Dis.22, 665–72 (1990). 7. Matee, M. I., Scheutz, F. & Moshy, J. Occurrence of oral lesions in relation to clinical and immunological status among HIV-infected adult Tanzanians. Oral Dis.6, 106–11 (2000). 8. Xu, H. et al. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case control study from China. Clin. Microbiol. Infect.18, 403–8 (2012). 9. Lortholary, O. et al. Epidemiological trends in invasive aspergillosis in France : the SAIF. (2011). 10. Perkhofer, S. et al. The Nationwide Austrian Aspergillus Registry: a prospective data collection on epidemiology, therapy and outcome of invasive mould infections in immunocompromised and/or immunosuppressed patients. Int. J. Antimicrob. Agents36, 531–6 (2010). 11. Denning, D. W., Pleuvry, A. & Cole, D. C. Global burden of allergic bronchopulmonaryaspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med. Mycol.51, 361–70 (2013). 12. Bitar, D. et al. Increasing incidence of zygomycosis (mucormycosis), France, 1997-2006. Emerg. Infect. Dis.15, 1395–401 (2009). 13. Hong Nhung, P. Epidemiology of Fungal Keratitis in North Vietnam. J. Clin. Exp. Ophthalmol.03, (2012). 14. Foxman, B., Muraglia, R., Dietz, J.-P., Sobel, J. D. & Wagner, J. Prevalence of recurrent vulvovaginal candidiasis in 5 European countries and the United States: results from an internet panel survey. J. Low. Genit. Tract Dis.17, 340–5 (2013). FULL REFERENCES ON REQUEST Oxford University Clinical Research Unit, Vietnam (jbeardsley@oucru.org). 2. The National Aspergillosis Centre in association with the LIFE program www.LIFE-Worldwide.org, University Hospital of South Manchester and The University of Manchester, UK. 3. Hospital for Tropical Diseases, HCMC, Vietnam. 4. Pham Ngoc ThachHospital, HCMC, Vietnam 5. University of Otago, New Zealand. The prevalence of fungal infections in Vietnam is poorly described, and there is no formal surveillance Fungal infections are of increasing clinical and economic importance world wide, with mortality ranging from 15-50% We estimated the incidence and prevalence of fungal diseases in Vietnam, using a validated actuarial approach Underlying conditions associated with fungal disease Pulmonary TB (incidence/yr) Total 130,000 HIV+ 9300 HIV/AIDS(est. current cases) 256,845 COPD/Asthma(prevalence) COPD 6.7% Asthma 1.04% Total population 90,796,000 Background Results Children 22.9% Female >50 17.2% • Estimates were based on current reports from Vietnam, epidemiological studies from the local region and global data • Population data were sourced from the General Statistics Office of Vietnam and the WHO World Health Statistics Report • HIV/AIDS related data were sourced from UNAIDS and the Vietnamese Ministry of Health • Prevalence of asthma, Chronic Obstructive Pulmonary Disease (COPD), Tuberculosis (TB), cancer, transplant and intensive care were derived from local and regional data sources, and personal communications • The actuarial approach used was previously described by Denning1 Stem Cell Transplant 22.5/ year Renal Transplant 130/ year Critical Care Beds 11,325 nationally • This is the first attempt to comprehensively describe invasive fungal infections in Vietnam and suggests that the majority of severe disease is due to Aspergillusspecies, driven by the high incidence of pulmonary TB • The AIDS epidemic highlights opportunistic infections, such as penicilliosis and cryptococcosis. Penicilliosis is a problem unique to South and South East Asia. As the availability of transplants and other immune-modulating therapies increase, the epidemiology of fungal infection is likely to change • These data should be verified by further epidemiological approaches – but in the absence of formal surveillance, they provide a useful baseline indication of disease prevalence to inform future research and resource allocation M 48.8% F 51.2% Gender/Age Structure Population density map courtesy of Corinne Thompson, Epidemiologist, OUCRU Vietnam Methods Conclusion