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. 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 Thach Hospital, HCMC, Vietnam 5. University of Otago, New Zealand.
Background
The prevalence of fungal infections in Vietnam is poorly
described, and there is no formal surveillance
Results
Total population
90,796,000
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
Methods
Estimates were based on current reports from Vietnam,
epidemiological studies from the local region and global
data
22.9%
Female >50
17.2%
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
2
3% of new AIDS diagnoses
Pneumocystis pneumonia
13% of new AIDS diagnoses
Penicilliosis
4% of new AIDS diagnoses
Candidaemia
5/100,000 general population: 1.5 in ICU patients, 3.5 in non-ICU patients
Oesophageal candidiasis
20% of HIV patients not on ARVs; 5% of those on ARVs
Invasive aspergillosis
3.9% severe COPD8; 10% AML; 10% non-AML haematological malignancy;
0.5% renal transplants; 6% heart transplants; 4% liver transplants 9,10
2.5% of adult asthmatics
COPD 6.7%
Allergic bronchopulmonary
aspergillosis (ABPA)
Severe asthma with fungal
sensitisation (SAFS)
Chronic pulmonary
aspergillosis (CPA)
Mucormycosis
Asthma 1.04%
Total
HIV+
Children
Total cases
Estimation Method
Cryptococcal meningitis
Pulmonary TB (incidence/yr)
130,000
9300
HIV/AIDS (est. current cases)
256,845
COPD/Asthma (prevalence)
Stem Cell Transplant
22.5/ year
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
Underlying conditions
associated with
fungal disease
Infection
140
0.15
608
0.67
206
0.23
4,540
5
33,107
36
14,523
15.99
23,607
26
31,161
34
55,509
61
1.2 cases per 1,000,000 population 12
109
0.12
Fungal keratitis
7 cases per 100,000 population 13
6,356
7
Recurrent vaginal
candidiasis >4/times/year
Tinea capitis
6% of women >50 yrs old 14
364,829
804
2% of children <14 yrs old
415,301
457
3
4
11
33% of the most severe 10% of adult asthmatics
130/ year
M
48.8%
F
51.2%
Critical Care Beds
11,325 nationally
5
6,7
11
22% of cases of cavitatory pulmonary TB; 2% of non-cavitatory cases
Estimated cases
Renal Transplant
Rate /100K
1
1,072,266
Conclusion
This is the first attempt to comprehensively describe invasive fungal infections in Vietnam and
suggests that the majority of severe disease is due to Aspergillus species, 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
Gender/Age Structure
Population density map courtesy of
Corinne Thompson, Epidemiologist,
OUCRU Vietnam
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
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. AIDS 23, 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 Penicillium marneffei 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. Care 16, 445–52 (2010). 6. Smith, E. & Orholm, M. Trends and patterns of opportunistic diseases in Danish AIDS patients 19801990. 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. Agents 36, 531–6 (2010). 11. Denning, D. W., Pleuvry, A. & Cole, D. C. Global burden of allergic bronchopulmonary aspergillosis 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