Gram-negative marine bacterium Vibrio parahaemolyticus is an important aquatic pathogen and has been demonstrated to be the causative agent of acute hepatopancreatic necrotic disease (AHPND) in shrimp aquaculture. The AHPND-causing V. parahaemolyticus strains contain a pVA1 plasmid encoding the binary PirA VP and PirB VP toxins, are the primary virulence factor that mediates AHPND and mortality in shrimp. Since PirAB VP toxins are secreted extracellularly, one can hypothesize that PirAB VP toxins would aggravate vibriosis in the aquatic environment. To address this, in vivo and in vitro experiments were conducted. Germ-free Artemia franciscana were co-challenged with PirAB VP toxins and 10 Vibrio spp. The in vivo results showed that PirAB VP toxin interact synergistically with MM30 (a quorum sensing AI-2 deficient mutant) and V. alginolyticus AQ13-91, aggravating vibriosis. However, co-challenge by PirAB VP toxins and V. campbellii LMG21363, V. parahaemolyticus CAIM170, V. proteolyticus LMG10942, and V. anguillarum NB10 worked antagonistically, increasing the survival of Artemia larvae. The in vitro results showed that the addition of PirAB VP toxins significantly modulated the production of the virulence factors of studied Vibrio spp. Yet these in vitro results did not help to explain the in vivo results. Hence it appears that PirAB VP toxins can aggravate vibriosis. However, the dynamics of interaction is strain dependent.
In our interconnected world, health-care professionals are the first line of defence to identify emerging diseases and public health events for rapid response. In Vietnam, event-based surveillance (EBS), critical for the early detection of emerging disease outbreaks and acute public health events, has been limited to media-based EBS until recently. In 2017-2018, the Ministry of Health of Vietnam, in collaboration with the World Health Organisation and the US Centres for Disease Control and Prevention, designed, implemented, and evaluated a hospital EBS demonstration pilot in six hospitals in two provinces in Vietnam. After the 9-month implementation period, we conducted a logbook review, eight interviews, and six focus group discussions with hospital and preventive medicine staff, and conducted thematic and descriptive analysis. During the implementation period, 11 signals were reported and confirmed as true events. Of the 11 signals, majority (N = 8, 72.7%) were detected in ICU, followed by the outpatient department (N = 2, 18.2%). The most common signal were clusters of food poisoning (N = 4, 36.4%). All (100%) signals were reported, risk-assessed, and responded to within 24 hours of signal detection. The hospital and preventive medicine staff reported that one of the main benefits of the pilot was their improved mutual relationship. This pilot formalised hospital event-based surveillance through a legal framework, standard operating procedures, a formal feedback mechanism to hospitals to facilitate a two-way conversation, and providing additional training and continued sensitisation. Most importantly, it fostered a trusting relationship between the curative medicine and public health sectors, marking an important step towards advancing the national event-based surveillance system in Vietnam.
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