IVI and Cambodia
Real-time tracking of Neglected Bacterial Diseases and Resistance Patterns in Asia (TuNDRA) and TuNDRA Plus
With funding from the German Federal Ministry of Health, IVI initiated the TuNDRA program In 2017. TuNDRA established a standardized, on-site means of pathogen surveillance which characterized phenotypical and genotypical resistance patterns and estimated the economic burden of hospitalized children in three Southeast Asian countries, including Cambodia.
In 2019, this AMR surveillance network was expanded through TuNDRA Plus, which investigated the bacterial and viral etiology of hospitalized children and identified a high proportion of viral respiratory infections. This indicated a need to implement viral PCR diagnostics that could prevent the overuse of antibiotics and spread of AMR. TuNDRA Plus also introduced whole genome sequencing (WGS) to sites in Cambodia to improve molecular diagnostics in future outbreak response efforts.
Vaccine Adverse Events Information Monitoring System (VAEIMS)
IVI created the software tool VAEIMS to transfer data surrounding the adverse events following immunization (AEFI) to central and global healthcare databases. With support from WHO, VAEIMS was deployed at the national level in Cambodia in 2017 to better inform decision making around vaccination.
Since 2004, nine individuals from Cambodia have participated in IVI’s International Vaccinology Course.
The Pediatric Dengue Vaccine Initiative (PDVI) and Dengue Vaccine Initiative (DVI)
IVI launched the PDVI in 2004 with a cost-of-illness study in Cambodia which aimed to assess the burden of Dengue and public willingness to pay for the vaccine. Specifically, this program sought out to analyze the potential of Dengue vaccines to become more prominent in national childhood immunization programs. With funding from the Heller School for Social Policy and Welfare at Brandeis University, IVI conducted facility-based studies to evaluate the social and economic cost of Dengue over the next several years.
By 2008, PDVI studies revealed that nationally reported Dengue cases severely underestimated the true burden of the disease in Cambodia. PDVI established the Dengue Prevention Boards in the Asia-Pacific and Americas Meetings, which convened in Cambodia in 2009 to discuss Dengue vaccine licensing, testing, surveillance and implementation at the national level.
In collaboration with the U.S. CDC, PDVI developed the user-friendly software DenguEcon in 2010. This free resource allows Cambodia and other affected countries to determine the health economic impact of Dengue.
In 2014, IVI expanded its Dengue vaccine efforts through the DVI and began preparation for the launch of new field sites in Cambodia and other target countries through the next year.
Respiratory Pathogen Vaccine Program
With funding from the U.S. CDC in 2007, IVI and the Pasteur institute conducted a two-year study to assess the severity and risk factors of influenza in Cambodian children being treated in clinic and hospital settings throughout the Kampong Cham province.
To differentiate Dengue from other common causes of fever such as Influenza, the U.S. CDC funded a separate collaborative effort between IVI and the Pasteur institute in 2007. Titled “Epidemiology of Influenza in Tropical and Developing Countries,” this project investigated the co-existence of seasonal influenza and dengue fever at the field site in Kampong Cham. Among patients who presented with fever to government clinics and hospitals, 251 cases of dengue and 63 cases of influenza were identified in 2009. This study provided a useful model for adapting disease surveillance platforms to test for multiple pathogens at once. The data was further analyzed to determine factors such as the dengue serotype, influenza strain, and prevalence of co-infection of dengue and influenza.
Rotavirus Diarrhea Vaccine Program
In 2003, Gavi, The Health Alliance approved the creation of the Accelerated Development and Introduction Plan (ADIP) for rotavirus vaccines to reduce the global burden of the rotavirus. This ADIP became the Rotavirus Vaccine Program (RVP). With funding from PATH and the RVP, IVI scientists worked to develop a protocol to conduct standardized hospital-based studies in Vientiane, Laos; Phnom Penh, Cambodia; Ulaanbaatar, Mongolia; and Colombo, Sri Lanka.
In 2005, pediatricians and public health agencies began enrolling children in these studies. In addition to enrolling suspected rotavirus cases into Cambodia’s hospital-based surveillance study, IVI scientists also supplied collaborators with the capacity to perform G and P typing for rotavirus strains and invited one local scientist to go through short term molecular virologic typing training at the University of Melbourne. By 2007, 1,920 children were enrolled in the Phnom Penh study, 833 of which were suffering from Rotavirus. After data collection was completed in 2007, it was discovered that 56% of diarrhea patients in Cambodia tested positive for rotavirus. After another two-year extension of the study, final results were used to help determine the national incidence of rotavirus diarrhea in Cambodia.