The Kingdom is rife with infectious diseases, with statistics for all the major killers several times the regional average. But while Cambodia has long had to deal with tuberculosis and malaria, new deadly viruses, such as avian flu, EV71 and nipah, continue to make their debut. Even some of the old culprits, such as rabies, continue to kill as international donors put their cash elsewhere.
Although non-communicable diseases, such as cancer and diabetes, are beginning to take a larger toll as the country develops economically, Dr Vincent Deubel, director at Institut Pasteur of Cambodia, said that infectious diseases still kill more people overall.
“Infectious diseases remain the biggest cause of death in Cambodia,” said Dr Deubel, adding that he was not including death from traumatic injuries.
Infectious diseases in Cambodia made international headlines in summer 2012 when at least 64 children died from a mysterious hand, foot and mouth disease that turned out to involve EV71, though other illnesses, such as dengue fever and streptococcus suis, were also present in many patients. EV71 is normally a mild illness with cold-like symptoms, but serious cases in young children can cause encephalitis or meningitis.
Avian flu, which infected a record 22 people in Cambodia last year and has already infected at least nine this year, is also making itself known in the Kingdom. Similar to other influenza strains, complications sometimes result in death.
To boost regional research into infectious diseases, Institut Pasteur recently inaugurated a new 400 square metre research facility to host the Regional Platform of Research–Asia, which Dr Deubel said should be operational by the end of the year. The idea, he said, is to bring regional researchers together into a consolidated centre for research.
“The idea was to try to find a way to coordinate more, to bring people working together on infectious diseases, and to prevent redundancy, and to have more cooperation and trust,” said Dr Deubel, adding that colleagues in neighbouring countries sometimes had difficulty coordinating research.
The laboratory will accept applications from researchers who have already received grants. Pasteur will take 10 per cent of the researchers’ grant funds in exchange for using the space and its resources.
“We built it up as a classic laboratory for molecular biology, for cell culture, for virus culture. It is an open space where people can bring their equipment.”
The building also features a level two bio-safety lab, which accommodates moderately dangerous and contagious diseases such as influenza A, salmonella and measles. Pasteur already has a level three facility on site, while level four, the highest safety level, is only needed for one disease found in Cambodia: the nipah virus, a disease found in the country’s bats that has yet to infect a person in the Kingdom. A highly dangerous form of encephalitis with no known effective treatment, around half of all human patients have died.
It will be important, said Dr Deubel, for the researchers to work on projects concerning diseases other than the “big three”: tuberculosis, HIV/AIDS and malaria, which are all high on donors’ priority lists. “Neglected” diseases, such as rabies and dengue fever, must also receive attention, he said, explaining: “It’s not because they happen rarely, it’s because they don’t attract much funding.”
Although Dr Deubel said he plans to retire this year, he said he would also like to see the centre used for entomology, the study of insects, to further understand the spread of mosquito-borne diseases.
“This is a big gap. We have a very strong group working on malaria, but this group doesn’t have the capacity to work on mosquitoes themselves. This is very important so you can better handle the control of these mosquitoes.”
Gene analysis conducted last year, which was conducted by Pasteur’s Malaria Molecular Epidemiology Unit, pinpointed Western Cambodia as the world’s largest hot spot of mosquitos resistant to artemisinin, the frontline anti-malarial drug.
Dr Deubel said he would also be interested in conducting comparative studies with Pasteur’s African branches to determine geographical differences in the bacterial composition of the human digestive tract. By better understanding the differences in microbes that live in all human bodies, Dr Deubel said it can help improve fecal transplants, which involves taking bacteria from a healthy person’s stool and placing it into the patient.
“It is something that was known in China for many years. It was used arbitrarily before, but now people are looking at the genetics and the composition of the bacteria.”
For now, the hallways of the new research centre are empty and the labs have only the most basic equipment. But by the end of the year, Dr Deubel expects the lab to accommodate up to 50 researchers.
“If they are very good researchers with innovative ideas, who want to establish here, and [perform] work dedicated to infectious disease research, they will certainly be accepted on the capacity of their innovation.”
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