Initial Trials With Susceptibility-Based and Empiric Anti-H. pylori Therapies in Mongolia

Background: Mongolia has a high prevalence of Helicobacter pylori infection and gastric cancer. We conducted a prospective, randomized, single-blind study to evaluate the efficacy of common regimens in Mongolia and to obtain specimens for susceptibility testing. Methods: Empiric treatments: 270 patients with confirmed H. pylori infection were randomized to receive 10 days clarithromycin-triple therapy (Clari-TT) (n = 90), modified bismuth quadruple therapy (M-BQT) (n = 90), or sequential therapy (ST) (n = 90). A second group of 46 patients received susceptibility-based Clari-TT. H. pylori was cultured from 131 patients and susceptibility testing was performed. H. pylori eradication was confirmed by stool antigen 4 weeks after the therapy. Results: Intention-to-treat (ITT) analysis cure rates were 71.1% (95% CI = 61.7-80.5%) for Clari-TT, 87.8% (95% CI = 81-94.6%) for M-BQT, 67.8% (95% CI = 58.1-77.5%) for ST vs. 89.1% (95% CI = 86-98.2%) for susceptibility-based Clari-TT. Per-protocol (PP) analysis results for these therapies were 72.7% (63.4-82%), 89.8% (83.5-96.1%), 68.5% (58.8-78.2%), and 97.6% (89.5-99.8%), respectively. Among 131 cultured H. pylori, resistance rates to amoxicillin, clarithromycin, and metronidazole were 8.4, 37.4, and 74%, respectively. Conclusion: In Mongolia, the prevalence of H. pylori resistance is high requiring bismuth quadruple therapy or susceptibility-based therapy to obtain acceptable cure rates.

Seroconversion to Causes of Febrile Illness in Mongolian Peacekeepers Deployed to South Sudan

Immediately before deployment (Fall 2012) and after deployment (Spring 2013) in support of United Nations peacekeeping operations, Mongolian Armed Forces medical personnel obtained serum samples from the first contingent of Mongolian peacekeepers deploying to South Sudan to monitor serologic evidence of exposure to diseases that cause acute febrile illness. A total of 632 paired samples were tested for IgG antibody for the following (number of seroconversions in parentheses): Rickettsia (spotted fever and typhus groups) (25), West Nile fever virus (WNV) (23), Coxiella burnetii (causative agent of Q fever) (12), dengue virus (8), leptospirosis (6), chikungunya virus (0), Congo-Crimean hemorrhagic fever virus (0), Japanese encephalitis virus (0), and Rift Valley fever virus (0). There was also evidence of exposure to WNV, C. burnetii, leptospirosis, and Rickettsia before deployment.