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Jung BK, Chang T, Ryoo S, Hong S, Lee J, Hong SJ, Sohn WM, Khieu V, Huy R, Chai JY. High Prevalence of Echinostoma mekongi Infection in Schoolchildren and Adults, Kandal Province, Cambodia. Emerg Infect Dis 2024; 30:572-576. [PMID: 38407225 PMCID: PMC10902544 DOI: 10.3201/eid3003.240001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
A high prevalence of Echinostoma mekongi infection (13.9%; 260/1,876) was found among schoolchildren and adults in Kandal Province, Cambodia, by fecal examination, worm expulsion, and molecular analysis of cox1 and nd1 genes. The source of infection was consumption of Pila sp. snails, a finding confirmed morphologically and molecularly.
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Sprecher VP, Hofmann D, Savathdy V, Xayavong P, Norkhankhame C, Huy R, Khieu V, Sayasone S, Hattendorf J, Keiser J. Efficacy and safety of moxidectin compared with ivermectin against Strongyloides stercoralis infection in adults in Laos and Cambodia: a randomised, double-blind, non-inferiority, phase 2b/3 trial. Lancet Infect Dis 2024; 24:196-205. [PMID: 37949090 DOI: 10.1016/s1473-3099(23)00507-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Infection with the soil-transmitted helminth Strongyloides stercoralis affects up to 600 million people globally, most of whom live in rural areas with poor sanitation. If untreated, infection leads to long-lasting morbidity and might even be life-threatening. Moxidectin might be a promising alternative to ivermectin, the only currently recommended single-dose treatment. We aimed to assess whether moxidectin is non-inferior in terms of efficacy and safety compared with ivermectin. METHODS In this randomised, double-blind, parallel-group, non-inferiority, phase 2b/3 trial in communities in Laos and Cambodia, adults aged 18-65 years were screened for the presence of S stercoralis larvae in their stool via sextuplicate quantitative Baermann assays. Using computer-generated group allocation (block randomisation stratified by infection intensity), parasitologically (two or more positive Baermann assays) and clinically eligible participants were randomly assigned (1:1) to receive single oral doses of either moxidectin (8 mg) and ivermectin-matched placebo, or ivermectin (200 μg/kg bodyweight) and moxidectin-matched placebo. The primary endpoint was cure rate assessed at 14-21 days after treatment, using the available-case population analysed according to intention-to-treat principles. Moxidectin was considered non-inferior to ivermectin if the lower limit of the two-sided 95% CI of the difference was greater than the non-inferiority margin of -10 percentage points. Safety endpoints were assessed before treatment, and at 2-3 h, 24 h, and 14-21 days after treatment. This trial is registered at ClinicalTrials.gov, NCT04056325 and NCT04848688. FINDINGS Between Dec 6, 2020, and May 21, 2022, 4291 participants were screened, 726 of whom were enrolled and randomly assigned to moxidectin (n=363) or ivermectin (n=363). For the participants with primary outcome data, we observed a cure rate of 93·6% (95% CI 90·5 to 96·0; 324 of 346 participants) in the moxidectin group and 95·7% (93·0 to 97·6; 335 of 350 participants) in the ivermectin group, resulting in a between-group difference of -2·1 percentage points (95% CI -5·5 to 1·3). The most common adverse events were abdominal pain (32 [9%] of 363 with moxidectin vs 34 [9%] of 363 with ivermectin) and headache (25 [7%] vs 30 [8%]), which were predominantly mild and transient. INTERPRETATION Moxidectin was non-inferior to ivermectin in terms of efficacy in the treatment of strongyloidiasis. Additionally, both drugs had a similar safety profile. The fixed dose and lower cost of moxidectin compared with ivermectin make it a valuable alternative for people with strongyloidiasis. FUNDING Swiss National Science Foundation.
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Affiliation(s)
- Viviane P Sprecher
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Daniela Hofmann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | | | - Rekol Huy
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | | | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
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Chea S, Willen L, Nhek S, Ly P, Tang K, Oristian J, Salas-Carrillo R, Ponce A, Leon PCV, Kong D, Ly S, Sath R, Lon C, Leang R, Huy R, Yek C, Valenzuela JG, Calvo E, Manning JE, Oliveira F. Antibodies to Aedes aegypti D7L salivary proteins as a new serological tool to estimate human exposure to Aedes mosquitoes. medRxiv 2023:2023.12.22.23300438. [PMID: 38318204 PMCID: PMC10843157 DOI: 10.1101/2023.12.22.23300438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Introduction Aedes spp. are the most prolific mosquito vectors in the world. Found on every continent, they can effectively transmit various arboviruses, including the dengue virus which continues to cause outbreaks worldwide and is spreading into previously non-endemic areas. The lack of widely available dengue vaccines accentuates the importance of targeted vector control strategies to reduce the dengue burden. High-throughput sensitive tools to estimate human-mosquito contact and evaluate vector control interventions are lacking. We propose a novel serological tool that allows rapid screening of large human cohorts for exposure to potentially infectious mosquitoes and effective targeting of vector control. Methods We tested 563 serum samples from a longitudinal pediatric cohort study previously conducted in Cambodia. Children enrolled in the study were dengue-naïve at baseline and were followed biannually for dengue incidence for two years. We used Western blotting and enzyme-linked immunosorbent assays to identify the most immunogenic Aedes aegypti salivary proteins and measure total anti- Ae. Aegypti IgG. Results We found a strong correlation (r s =0.86) between the combined IgG responses against AeD7L1 and AeD7L2 recombinant proteins and those to whole salivary gland homogenate. We observed seasonal fluctuations of AeD7L1+2 IgG responses, corresponding to Aedes spp. abundance in the region, and no cross-reactivity with Culex quinquefasciatus and Anopheles dirus mosquitoes. The baseline median AeD7L1+2 IgG responses for young children were higher in those who developed asymptomatic dengue versus those who developed symptomatic dengue. Conclusion The IgG response against AeD7L1+2 recombinant proteins is a highly sensitive and Aedes specific marker of human exposure to Aedes bites that can facilitate standardization of future serosurveys and epidemiological studies by its ability to provide a robust estimation of human-mosquito contact in a high-throughput fashion.
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Odio C, Yek C, Hasund CM, Man S, Ly P, Nhek S, Chea S, Lon C, Voirin C, Huy R, Leang R, Huch C, Oliveira LF, Manning JE, Katzelnick LC. Immunity to non-dengue flaviviruses impacts dengue virus IgG ELISA specificity in Cambodia. medRxiv 2023:2023.11.17.23298701. [PMID: 38076831 PMCID: PMC10705617 DOI: 10.1101/2023.11.17.23298701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Seroprevalence studies are the gold standard for disease surveillance, and serology was used to determine eligibility for the first licensed dengue vaccine. However, expanding flavivirus endemicity, co-circulation, and vaccination complicate serology results. Among 713 healthy Cambodian children, a commonly used indirect dengue virus IgG ELISA (PanBio) had a lower specificity than previously reported (94% vs. 100%). Of those with false positive PanBio results, 46% had detectable neutralizing antibodies against other flaviviruses, with the highest frequency against West Nile virus (WNV). Immunity to non-dengue flaviviruses can impact dengue surveillance and potentially pre-vaccine screening efforts.
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Affiliation(s)
- Camila Odio
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Christina Yek
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Chloe M. Hasund
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Somnang Man
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Piseth Ly
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Sreynik Nhek
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Sophana Chea
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Chanthap Lon
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Charlie Voirin
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rekol Huy
- National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rithea Leang
- National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Chea Huch
- National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - L. Fabiano Oliveira
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Jessica E. Manning
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Leah C. Katzelnick
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Yek C, Li Y, Pacheco AR, Lon C, Duong V, Dussart P, Young KI, Chea S, Lay S, Man S, Kimsan S, Huch C, Leang R, Huy R, Brook CE, Manning JE. National dengue surveillance, Cambodia 2002-2020. Bull World Health Organ 2023; 101:605-616. [PMID: 37638355 PMCID: PMC10452936 DOI: 10.2471/blt.23.289713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 08/29/2023] Open
Abstract
Global dengue incidence has increased dramatically over the past few decades from approximately 500 000 reported cases in 2000 to over 5 million in 2019. This trend has been attributed to population growth in endemic areas, rapid unplanned urbanization, increasing global connectivity, and climate change expanding the geographic range of the Aedes spp. mosquito, among other factors. Reporting dengue surveillance data is key to understanding the scale of the problem, identifying important changes in the landscape of disease, and developing policies for clinical management, vector control and vaccine rollout. However, surveillance practices are not standardized, and data may be difficult to interpret particularly in low- and middle-income countries with fragmented health-care systems. The latest national dengue surveillance data for Cambodia was published in 2010. Since its publication, the country experienced marked changes in health policies, population demographics, climate and urbanization. How these changes affected dengue control remains unknown. In this article, we summarize two decades of policy changes, published literature, country statistics, and dengue case data collected by the Cambodia National Dengue Control Programme to: (i) identify important changes in the disease landscape; and (ii) derive lessons to inform future surveillance and disease control strategies. We report that while dengue case morbidity and mortality rates in Cambodia fell between 2002 and 2020, dengue incidence doubled and age at infection increased. Future national surveillance, disease prevention and treatment, and vector control policies will have to account for these changes to optimize disease control.
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Affiliation(s)
- Christina Yek
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, 12735 Twinbrook Parkway, Rockville, MD20852, United States of America (USA)
| | - Yimei Li
- Department of Ecology and Evolution, University of Chicago, Chicago, USA
| | - Andrea R Pacheco
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Chanthap Lon
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Veasna Duong
- Biological Sciences Department, University of Texas at El Paso, El Paso, USA
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Katherine I Young
- Biological Sciences Department, University of Texas at El Paso, El Paso, USA
| | - Sophana Chea
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Sreyngim Lay
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Somnang Man
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Souv Kimsan
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Chea Huch
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rithea Leang
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Cara E Brook
- Department of Ecology and Evolution, University of Chicago, Chicago, USA
| | - Jessica E Manning
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, 12735 Twinbrook Parkway, Rockville, MD20852, United States of America (USA)
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Jung BK, Hong S, Chang T, Cho J, Ryoo S, Lee KH, Lee J, Sohn WM, Hong SJ, Khieu V, Huy R, Chai JY. High endemicity of Opisthorchis viverrini infection among people in northern Cambodia confirmed by adult worm expulsion. Sci Rep 2023; 13:9654. [PMID: 37316679 DOI: 10.1038/s41598-023-36544-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
Opisthorchis viverrini infection is an emerging disease in Cambodia, especially in central and southeastern areas. However, its status in northern areas bordering Lao PDR has been relatively unknown. The present study was performed to investigate the status of O. viverrini infection among people in Preah Vihear and Stung Treng provinces through fecal examination to detect eggs and recovery of adult flukes from some of the egg-positive cases. Fecal examinations were performed on a total of 1101 people from 10 villages in the 2 provinces using the Kato-Katz thick smear technique. For recovery of adult flukes and other helminth parasites 10 volunteers positive for eggs of Opisthorchis viverrini and/or minute intestinal flukes (Ov/MIF), in Kampong Sangkae village, Preah Vihear province, were administered a single oral dose of 40 mg/kg praziquantel plus 5-10 mg/kg of pyrantel pamoate and purged with 40-50 g magnesium salts. Adult trematodes, together with nematodes and cestodes expelled in diarrheic stools were collected under a stereomicroscope or with the naked eye. The proportion of egg-positive cases for overall liver and intestinal helminths was high but not notably different between the 2 provinces, 65.5% in Preah Vihear versus 64.7% in Stung Treng. The average proportion of Ov/MIF egg-positive cases was 59.8%. A total of 315 adult specimens of O. viverrini were recovered from the 10 volunteers (4-98 specimens per individual; mean, 32). A smaller number of Haplorchis taichui adults, an intestinal fluke, were found mixed-infected in 7 (103 specimens in total; 1-31 per individual; mean, 15) of the 10 volunteers. Adult specimens of hookworms, Enterobius vermicularis, Trichostrongylus sp., and a Taenia tapeworm strobila were recovered in some cases. Based on the results, it has been confirmed that the surveyed areas in Preah Vihear and Stung Treng provinces, Cambodia, are highly endemic areas of O. viverrini infection with a low-grade mixed infection with H. taichui.
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Affiliation(s)
- Bong-Kwang Jung
- MediCheck Research Institute, Korea Association of Health Promotion, Seoul, 07649, Republic of Korea.
| | - Sooji Hong
- MediCheck Research Institute, Korea Association of Health Promotion, Seoul, 07649, Republic of Korea
| | - Taehee Chang
- MediCheck Research Institute, Korea Association of Health Promotion, Seoul, 07649, Republic of Korea
| | - Jaeeun Cho
- MediCheck Research Institute, Korea Association of Health Promotion, Seoul, 07649, Republic of Korea
| | - Seungwan Ryoo
- MediCheck Research Institute, Korea Association of Health Promotion, Seoul, 07649, Republic of Korea
| | - Keon Hoon Lee
- MediCheck Research Institute, Korea Association of Health Promotion, Seoul, 07649, Republic of Korea
| | - Jeonggyu Lee
- MediCheck Research Institute, Korea Association of Health Promotion, Seoul, 07649, Republic of Korea
| | - Woon-Mok Sohn
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea
| | - Sung-Jong Hong
- Convergence Research Center for Insect Vectors, Incheon National University, Incheon, 22012, Republic of Korea
| | - Virak Khieu
- National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Jong-Yil Chai
- MediCheck Research Institute, Korea Association of Health Promotion, Seoul, 07649, Republic of Korea.
- Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
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Yek C, Li Y, Pacheco AR, Lon C, Duong V, Dussart P, Chea S, Lay S, Man S, Kimsan S, Huch C, Leang R, Huy R, Brook CE, Manning JE. Dengue in Cambodia 2002-2020: Cases, Characteristics and Capture by National Surveillance. medRxiv 2023:2023.04.27.23289207. [PMID: 37333247 PMCID: PMC10274987 DOI: 10.1101/2023.04.27.23289207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Objective Data from 19 years of national dengue surveillance in Cambodia (2002-2020) were analyzed to describe trends in dengue case characteristics and incidence. Methods Generalized additive models were fitted to dengue case incidence and characteristics (mean age, case phenotype, fatality) over time. Dengue incidence in a pediatric cohort study (2018-2020) was compared to national data during the same period to evaluate disease under-estimation by national surveillance. Findings During 2002-2020, there were 353,270 cases of dengue (average age-adjusted incidence 1.75 cases/1,000 persons/year) recorded in Cambodia, with an estimated 2.1-fold increase in case incidence between 2002 and 2020 (slope = 0.0058, SE = 0.0021, p = 0.006). Mean age of infected individuals increased from 5.8 years in 2002 to 9.1 years in 2020 (slope = 0.18, SE = 0.088, p <0.001); case fatality rates decreased from 1.77% in 2002 to 0.10% in 2020 (slope = -0.16, SE = 0.0050, p <0.001). When compared to cohort data, national data under-estimated clinically apparent dengue case incidence by 5.0-fold (95% CI 0.2 - 26.5), and overall dengue case incidence (both apparent and inapparent cases) by 33.6-fold (range: 18.7- 53.6). Conclusion Dengue incidence in Cambodia is increasing and disease is shifting to older pediatric populations. National surveillance continues to under-estimate case numbers. Future interventions should account for disease under-estimation and shifting demographics for scaling and to target appropriate age groups.
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Affiliation(s)
- Christina Yek
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Yimei Li
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA
| | - Andrea R Pacheco
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Chanthap Lon
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sophana Chea
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Sreyngim Lay
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Somnang Man
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Souv Kimsan
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Chea Huch
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rithea Leang
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Cara E Brook
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA
| | - Jessica E Manning
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
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Liu M, Liu Y, Po L, Xia S, Huy R, Zhou XN, Liu J. Assessing the spatiotemporal malaria transmission intensity with heterogeneous risk factors: A modeling study in Cambodia. Infect Dis Model 2023; 8:253-269. [PMID: 36844760 PMCID: PMC9944205 DOI: 10.1016/j.idm.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/08/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Malaria control can significantly benefit from a holistic and precise way of quantitatively measuring the transmission intensity, which needs to incorporate spatiotemporally varying risk factors. In this study, we conduct a systematic investigation to characterize malaria transmission intensity by taking a spatiotemporal network perspective, where nodes capture the local transmission intensities resulting from dominant vector species, the population density, and land cover, and edges describe the cross-region human mobility patterns. The inferred network enables us to accurately assess the transmission intensity over time and space from available empirical observations. Our study focuses on malaria-severe districts in Cambodia. The malaria transmission intensities determined using our transmission network reveal both qualitatively and quantitatively their seasonal and geographical characteristics: the risks increase in the rainy season and decrease in the dry season; remote and sparsely populated areas generally show higher transmission intensities than other areas. Our findings suggest that: the human mobility (e.g., in planting/harvest seasons), environment (e.g., temperature), and contact risk (coexistences of human and vector occurrence) contribute to malaria transmission in spatiotemporally varying degrees; quantitative relationships between these influential factors and the resulting malaria transmission risk can inform evidence-based tailor-made responses at the right locations and times.
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Affiliation(s)
- Mutong Liu
- Department of Computer Science, Hong Kong Baptist University, Hong Kong Special administrative region of China
- HKBU-CSD & NIPD Joint Research Laboratory for Intelligent Disease Surveillance and Control, China
| | - Yang Liu
- Department of Computer Science, Hong Kong Baptist University, Hong Kong Special administrative region of China
- HKBU-CSD & NIPD Joint Research Laboratory for Intelligent Disease Surveillance and Control, China
- Corresponding author. Department of Computer Science, Hong Kong Baptist University, Hong Kong Special administrative region of China.
| | - Ly Po
- National Center for Parasitology, Entomology & Malaria Control (CNM), Ministry of Health, Phnom Penh, Cambodia
| | - Shang Xia
- HKBU-CSD & NIPD Joint Research Laboratory for Intelligent Disease Surveillance and Control, China
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- Key Laboratory of Parasite and Vector Biology, National Health and Commission of the People's Republic of China, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Rekol Huy
- National Center for Parasitology, Entomology & Malaria Control (CNM), Ministry of Health, Phnom Penh, Cambodia
| | - Xiao-Nong Zhou
- HKBU-CSD & NIPD Joint Research Laboratory for Intelligent Disease Surveillance and Control, China
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- Key Laboratory of Parasite and Vector Biology, National Health and Commission of the People's Republic of China, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Jiming Liu
- Department of Computer Science, Hong Kong Baptist University, Hong Kong Special administrative region of China
- HKBU-CSD & NIPD Joint Research Laboratory for Intelligent Disease Surveillance and Control, China
- Corresponding author. Department of Computer Science, Hong Kong Baptist University, Hong Kong Special administrative region of China.
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Guerrero D, Vo HTM, Lon C, Bohl JA, Nhik S, Chea S, Man S, Sreng S, Pacheco AR, Ly S, Sath R, Lay S, Missé D, Huy R, Leang R, Kry H, Valenzuela JG, Oliveira F, Cantaert T, Manning JE. Evaluation of cutaneous immune response in a controlled human in vivo model of mosquito bites. Nat Commun 2022; 13:7036. [PMID: 36396947 PMCID: PMC9672097 DOI: 10.1038/s41467-022-34534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Abstract
Mosquito-borne viruses are a growing global threat. Initial viral inoculation occurs in the skin via the mosquito 'bite', eliciting immune responses that shape the establishment of infection and pathogenesis. Here we assess the cutaneous innate and adaptive immune responses to controlled Aedes aegypti feedings in humans living in Aedes-endemic areas. In this single-arm, cross-sectional interventional study (trial registration #NCT04350905), we enroll 30 healthy adult participants aged 18 to 45 years of age from Cambodia between October 2020 and January 2021. We perform 3-mm skin biopsies at baseline as well as 30 min, 4 h, and 48 h after a controlled feeding by uninfected Aedes aegypti mosquitos. The primary endpoints are measurement of changes in early and late innate responses in bitten vs unbitten skin by gene expression profiling, immunophenotyping, and cytokine profiling. The results reveal induction of neutrophil degranulation and recruitment of skin-resident dendritic cells and M2 macrophages. As the immune reaction progresses T cell priming and regulatory pathways are upregulated along with a shift to Th2-driven responses and CD8+ T cell activation. Stimulation of participants' bitten skin cells with Aedes aegypti salivary gland extract results in reduced pro-inflammatory cytokine production. These results identify key immune genes, cell types, and pathways in the human response to mosquito bites and can be leveraged to inform and develop novel therapeutics and vector-targeted vaccine candidates to interfere with vector-mediated disease.
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Affiliation(s)
- David Guerrero
- Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh, Cambodia
| | - Hoa Thi My Vo
- Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh, Cambodia
| | - Chanthap Lon
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Jennifer A Bohl
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Sreynik Nhik
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Sophana Chea
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Somnang Man
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia.,National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Sokunthea Sreng
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia.,National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Andrea R Pacheco
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Sokna Ly
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Rathanak Sath
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Sokchea Lay
- Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh, Cambodia
| | - Dorothée Missé
- MIVEGEC, Univ. Montpellier, IRD, CNRS, 34000, Montpellier, France
| | - Rekol Huy
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Rithea Leang
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Hok Kry
- Kampong Speu Provincial District, Ministry of Health, Phnom Penh, Cambodia
| | - Jesus G Valenzuela
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Fabiano Oliveira
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Tineke Cantaert
- Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh, Cambodia
| | - Jessica E Manning
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia. .,Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA.
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10
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Sovannaroth S, Ngor P, Khy V, Dunn JC, Burbach MK, Peng S, Mak S, Siv K, Manzoni G, Guintran JO, Tuseo L, Huy R. Accelerating malaria elimination in Cambodia: an intensified approach for targeting at-risk populations. Malar J 2022; 21:209. [PMID: 35780142 PMCID: PMC9250186 DOI: 10.1186/s12936-022-04234-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Malaria in Cambodia has decreased by 90.8% between 2010 and 2020, driven by the commitment of the National Center for Parasitology, Entomology and Malaria (CNM) and the achievements of the roll-out of a village malaria worker programme. However, in the first seven months of 2018, CNM identified a 207% increase (11,969 to 36,778) in confirmed malaria cases compared to the same months in the previous year. To address this increase, CNM developed the “Intensification Plan” (IP), implemented between October 2018 and December 2020. Methods The structure of the IP was summarized, including the selection of sites, the interventions implemented in the selected health facility catchment areas (HFCAs) and the monitoring and evaluation process. Data on IP interventions were collected by CNM and civil society organisations. Data on malaria cases and tests from all HFCAs in Cambodia from January 2018 to December 2020 were sourced from the Cambodia Malaria Information System (MIS) and WHO Malaria Elimination Database. Malaria data from IP HFCAs and non-IP HFCAs was analysed and compared to present the changes in malaria testing and confirmed cases before and during implementation of the IP. Results Between October 2018 and December 2020, through the IP 16,902 forest packs and 293,090 long-lasting insecticide treated nets were distributed. In the 45 HFCAs included in the IP, 431,143 malaria tests were performed and 29,819 malaria cases were diagnosed, 5364 (18%) of which were Plasmodium falciparum/mixed cases. During the intervention period, over all HFCAs included in IP, P. falciparum/mixed cases declined from 1029 to 39, a 96.2% decrease, and from 25.4 P. falciparum/mixed cases per HFCA to 0.9. HFCAs not included in IP declined from 468 to 43 cases, a 90.8% decrease, showing that routine malaria activities in Cambodia were also playing an important contribution to malaria control. Conclusions Over the course of IP implementation there was a substantial increase in malaria testing and both overall malaria cases and P. falciparum/mixed cases decreased month on month. The initiative yields lessons learned for Cambodia to reach the final stage of elimination as well as for other countries aiming to accelerate their malaria control programmes. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04234-2.
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Affiliation(s)
- Siv Sovannaroth
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Pengby Ngor
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Vichka Khy
- Clinton Health Access Initiative, Phnom Penh, Cambodia
| | - Julia C Dunn
- Clinton Health Access Initiative, Phnom Penh, Cambodia.
| | | | - Sovann Peng
- Catholic Relief Services, Phnom Penh, Cambodia
| | | | | | | | | | | | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
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11
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Yek C, Nam VS, Leang R, Parker DM, Heng S, Souv K, Sovannaroth S, Mayxay M, AbuBakar S, Sasmono RT, Tran ND, Le Nguyen HK, Lon C, Boonnak K, Huy R, Sovann L, Manning JE. The Pandemic Experience in Southeast Asia: Interface Between SARS-CoV-2, Malaria, and Dengue. Front Trop Dis 2021; 2:788590. [PMID: 35373190 PMCID: PMC8975143 DOI: 10.3389/fitd.2021.788590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Southeast Asia (SEA) emerged relatively unscathed from the first year of the global SARS-CoV-2 pandemic, but as of July 2021 the region is experiencing a surge in case numbers primarily driven by Alpha (B.1.1.7) and subsequently the more transmissible Delta (B.1.617.2) variants. While initial disease burden was mitigated by swift government responses, favorable cultural and societal factors, the more recent rise in cases suggests an under-appreciation of prior prevalence and over-appreciation of possible cross-protective immunity from exposure to endemic viruses, and highlights the effects of vaccine rollout at varying tempos and of variable efficacy. This burgeoning crisis is further complicated by co-existence of malaria and dengue in the region, with implications of serological cross-reactivity on interpretation of SARS-CoV-2 assays and competing resource demands impacting efforts to contain both endemic and pandemic disease.
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Affiliation(s)
- Christina Yek
- Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD, United States
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Vu Sinh Nam
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Daniel M. Parker
- Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, CA, United States
- Department of Epidemiology, University of California, Irvine, Irvine, CA, United States
| | - Seng Heng
- Ministry of Health, Phnom Penh, Cambodia
| | | | | | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sazaly AbuBakar
- WHO Collaborating Center for Arbovirus Reference and Research (Dengue) and Tropical Infectious Diseases Research and Education Center, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Nhu Duong Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Chanthap Lon
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Kobporn Boonnak
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rekol Huy
- Ministry of Health, Phnom Penh, Cambodia
| | - Ly Sovann
- Ministry of Health, Phnom Penh, Cambodia
| | - Jessica E. Manning
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
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12
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Colella V, Khieu V, Worsley A, Senevirathna D, Muth S, Huy R, Odermatt P, Traub RJ. Risk profiling and efficacy of albendazole against the hookworms Necator americanus and Ancylostoma ceylanicum in Cambodia to support control programs in Southeast Asia and the Western Pacific. Lancet Reg Health West Pac 2021; 16:100258. [PMID: 34590062 PMCID: PMC8403762 DOI: 10.1016/j.lanwpc.2021.100258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022]
Abstract
Background: Hookworm disease is endemic throughout many parts of the Asia Pacific, despite targeted control programs of at-risk populations. The success of these programs has been hindered by the limited efficacy of widely-used mebendazole, rapid re-infection rates linked to persistent reservoirs of untreated people and dogs, and the low sensitivity of conventional coprodiagnostic techniques employed. Methods: Here, we used standard faecal flotation (SFF) and a multiplex qPCR (mqPCR) assay to calculate and compare species-specific cure and egg reduction rates of single dose albendazole (400 mg) against hookworm infections at community level. Data from a cross-sectional survey in 1,232 people from Cambodia were used to inform a generalised linear mixed model to identify risk factors linked to hookworm infection(s) at baseline. Furthermore, we calculated risk factors associated to the probability of being cured after albendazole administration. Findings: Overall, 13·5% of all 1,232 people tested by SFF were positive for hookworm infection(s). Most (80·1%) infected people were >12 years of age, hence above the age targeted by the WHO control program. We estimate that as age increases, the odds of being infected increases at a faster rate for females than for males. We revealed a substantial difference in cure rate of hookworm infection(s) following albendazole treatment using the SFF (81·5%) and mqPCR (46·4%) assays, and provide the first data on the efficacy of this drug against the zoonotic hookworm Ancylostoma ceylanicum. We estimated that as age increases by one year, the odds of being cured decreases by 0·4%-3·7%. Similarly, the odds of being cured for people who boiled drinking water was estimated to be between 1·02 and 6·82. Interpretation: These findings show that the adoption of refined diagnostic techniques is central to monitoring hookworm infection(s) and the success of control strategies, which can ultimately aid in reducing associated morbidity in human populations. The approach taken is likely to be directly applicable to other parts of Southeast Asia and the Western Pacific, where specific epidemiological conditions might hamper the success of targeted treatment programs. Funding: Faculty of Veterinary and Agricultural Sciences Strategic Research Funds, The University of Melbourne.
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Affiliation(s)
- Vito Colella
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | | | - Dammika Senevirathna
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
| | - Sinuon Muth
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
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13
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Manning JE, Chea S, Parker DM, Bohl JA, Lay S, Mateja A, Man S, Nhek S, Ponce A, Sreng S, Kong D, Kimsan S, Meneses C, Fay MP, Suon S, Huy R, Lon C, Leang R, Oliveira F. Development of inapparent dengue associated with increased antibody levels to Aedes aegypti salivary proteins: a longitudinal dengue cohort in Cambodia. J Infect Dis 2021; 226:1327-1337. [PMID: 34718636 DOI: 10.1093/infdis/jiab541] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We established the first prospective cohort to understand how infection with dengue virus is influenced by vector-specific determinants like humoral immunity to Aedes aegypti salivary proteins. METHODS Children aged two to nine years old enrolled in the PAGODAS (Pediatric Assessment Group of Dengue and Aedes Saliva) cohort with informed consent by their guardians. Children were followed semi-annually for antibodies to dengue and to proteins in Ae. aegypti salivary gland homogenate using enzyme-linked immunosorbent assays and dengue-specific neutralization titers. Children presented with fever at any time for dengue testing. RESULTS From July 13 to August 30, 2018, we enrolled 771 children. At baseline, 22% (173/770) had evidence of neutralizing antibodies to one or more dengue serotypes. By April 2020, 51 children had symptomatic dengue while 148 dengue-naïve children had inapparent dengue defined by neutralization assays. In a multivariate model, individuals with higher antibodies to Ae. aegypti salivary proteins were 1.5x more likely to have dengue infection (HR 1.47 95% CI 1.05-2.06; p=0.02), particularly individuals with inapparent dengue (HR 1.64 95% CI 1.12-2.41; p=0.01). CONCLUSIONS High levels of seropositivity to Ae. aegypti salivary proteins are associated with future development of dengue infection, primarily inapparent, in dengue-naïve Cambodian children.
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Affiliation(s)
- Jessica E Manning
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.,International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Sophana Chea
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia.,National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh Cambodia
| | | | - Jennifer A Bohl
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sreyngim Lay
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia.,National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh Cambodia
| | - Allyson Mateja
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Somnang Man
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia.,National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh Cambodia
| | - Sreynik Nhek
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia.,National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh Cambodia
| | - Aiyana Ponce
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sokunthea Sreng
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia.,National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh Cambodia
| | - Dara Kong
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia.,National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh Cambodia
| | - Soun Kimsan
- National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh Cambodia.,National Dengue Control Program, Ministry of Health, Phnom Penh, Cambodia
| | - Claudio Meneses
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael P Fay
- Biostatistics Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Seila Suon
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia.,National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh Cambodia
| | - Chanthap Lon
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.,International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Rithea Leang
- National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh Cambodia.,National Dengue Control Program, Ministry of Health, Phnom Penh, Cambodia
| | - Fabiano Oliveira
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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14
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Chang T, Jung BK, Hong S, Shin H, Ryoo S, Lee J, Lee KH, Park H, Eom KS, Khieu V, Huy R, Sohn WM, Chai JY. Occurrence of a Hybrid Between Taenia saginata and Taenia asiatica Tapeworms in Cambodia. Korean J Parasitol 2021; 59:179-182. [PMID: 33951775 PMCID: PMC8106985 DOI: 10.3347/kjp.2021.59.2.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/17/2021] [Indexed: 11/23/2022]
Abstract
Human infection with Taenia asiatica or a hybrid between Taenia saginata and T. asiatica has not been reported in Cambodia. We detected for the first time a hybrid form between T. saginata and T. asiatica in Preah Vihear Province, Cambodia. An adult tapeworm specimen, i.e., 75 cm long strobila without scolex, was expelled from a 27-year-old man after praziquantel medication and purging. It was morphologically indistinguishable between T. saginata and T. asiatica. Several proglottids were molecularly analyzed to confirm the tapeworm species. The mitochondrial gene encoding cytochrome c oxidase subunit 1 (cox1) and nuclear genes encoding elongation factor-1α (ef1) and ezrin-radixin-moesin (ERM)-like protein (elp) were sequenced, and a single-allele analysis was performed to confirm the haploid genotype. The results revealed that our sample showed a discrepancy between the mitochondrial and 2 nuclear genes. It possessed homozygous sequences typical of T. saginata at cox1 and ef1 loci. However, it was heterozygous at the elp locus, with 1 allele in T. asiatica (elpA) and 1 in T. saginata (elpC), which indicates that it is a hybrid between T. saginata and T. asiatica. The present results confirmed the presence of a hybrid between T. saginata and T. asiatica in Cambodia and strongly suggest the existence of also ‘pure’ T. asiatica in Cambodia.
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Affiliation(s)
- Taehee Chang
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Bong-Kwang Jung
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Sooji Hong
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Hyejoo Shin
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Seungwan Ryoo
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Jeonggyu Lee
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Keon Hoon Lee
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Hansol Park
- Department of Parasitology and Medical Research Institute, Chungbuk National University College of Medicine, Cheongju 28644, Korea
| | - Keeseon S Eom
- Department of Parasitology and Medical Research Institute, Chungbuk National University College of Medicine, Cheongju 28644, Korea
| | - Virak Khieu
- National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Woon-Mok Sohn
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju 52727, Korea
| | - Jong-Yil Chai
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea.,Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080, Korea
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15
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Chai JY, Sohn WM, Cho J, Jung BK, Chang T, Lee KH, Khieu V, Huy R. Echinostoma mekongi: Discovery of Its Metacercarial Stage in Snails, Filopaludina martensi cambodjensis, in Pursat Province, Cambodia. Korean J Parasitol 2021; 59:47-53. [PMID: 33684986 PMCID: PMC7939970 DOI: 10.3347/kjp.2021.59.1.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/23/2022]
Abstract
Echinostoma mekongi was reported as a new species in 2020 based on specimens collected from humans in Kratie and Takeo Province, Cambodia. In the present study, its metacercarial stage has been discovered in Filopaludina martensi cambodjensis snails purchased from a local market nearby the Tonle Sap Lake, Pursat Province, Cambodia. The metacercariae were fed orally to an experimental hamster, and adult flukes were recovered at day 20 post-infection. They were morphologically examined using light and scanning electron microscopes and molecularly analyzed by sequencing of their mitochondrial cox1 and nad1 genes. A total of 115 metacercariae (1-8 per snail) were detected in 60 (60.0%) out of 100 Filopaludina snails examined. The metacercariae were round, 174 µm in average diameter (163-190 µm in range), having a thin cyst wall, a head collar armed with 37 collar spines, and characteristic excretory granules. The adult flukes were elongated, ventrally curved, 7.3 (6.4-8.2)×1.4 (1.1-1.7) mm in size, and equipped with 37 collar spines on the head collar (dorsal spines in 2 alternating rows), being consistent with E. mekongi. In phylogenetic analyses, the adult flukes showed 99.0-100% homology based on cox1 sequences and 98.9-99.7% homology based on nad1 sequences with E. mekongi. The results evidenced that F. martensi cambodjensis snails act as the second intermediate host of E. mekongi, and hamsters can be used as a suitable experimental definitive host. As local people favor to eat undercooked snails, these snails seem to be an important source of human infection with E. mekongi in Cambodia.
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Affiliation(s)
- Jong-Yil Chai
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
- Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Woon-Mok Sohn
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju 52727, Korea
| | - Jaeeun Cho
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Bong-Kwang Jung
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Taehee Chang
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Keon Hoon Lee
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Virak Khieu
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
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16
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Chang T, Jung BK, Sohn WM, Hong S, Shin H, Ryoo S, Lee J, Lee KH, Khieu V, Huy R, Chai JY. Morphological and Molecular Diagnosis of Necator americanus and Ancylostoma ceylanicum Recovered from Villagers in Northern Cambodia. Korean J Parasitol 2020; 58:619-625. [PMID: 33412765 PMCID: PMC7806429 DOI: 10.3347/kjp.2020.58.6.619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/03/2020] [Indexed: 12/04/2022]
Abstract
Human hookworm infections caused by adult Ancylostoma spp. and Necator americanus are one of the most important tropical diseases. We performed a survey of intestinal helminths using the Kato-Katz fecal examination technique targeting 1,156 villagers residing in 2 northern provinces (Preah Vihear and Stung Treng) of Cambodia in 2018. The results revealed a high overall egg positive rate of intestinal helminths (61.9%), and the egg positive rate of hookworms was 11.6%. Nine of the hookworm egg positive cases in Preah Vihear Province were treated with 5–10 mg/kg pyrantel pamoate followed by purging with magnesium salts, and a total of 65 adult hookworms were expelled in diarrheic stools. The adult hookworms were analyzed morphologically and molecularly to confirm the species. The morphologies of the buccal cavity and dorsal rays on the costa were observed with a light microscope, and the nucleotide sequences of mitochondrial cytochrome c oxidase subunit 1 (cox1) gene were analyzed. The majority of the hookworm adults (90.7%) were N. americanus, whereas the remaining 9.3% were Ancylostoma ceylanicum, a rare hookworm species infecting humans. The results revealed a high prevalence of hookworm infections among people in a northern part of Cambodia, suggesting the necessity of a sustained survey combined with control measures against hookworm infections.
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Affiliation(s)
- Taehee Chang
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Bong-Kwang Jung
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Woon-Mok Sohn
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea
| | - Sooji Hong
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Hyejoo Shin
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Seungwan Ryoo
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Jeonggyu Lee
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Keon Hoon Lee
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Virak Khieu
- National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Jong-Yil Chai
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea.,Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080, Korea
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17
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Christofferson RC, Parker DM, Overgaard HJ, Hii J, Devine G, Wilcox BA, Nam VS, Abubakar S, Boyer S, Boonnak K, Whitehead SS, Huy R, Rithea L, Sochantha T, Wellems TE, Valenzuela JG, Manning JE. Current vector research challenges in the greater Mekong subregion for dengue, Malaria, and Other Vector-Borne Diseases: A report from a multisectoral workshop March 2019. PLoS Negl Trop Dis 2020; 14:e0008302. [PMID: 32730249 PMCID: PMC7392215 DOI: 10.1371/journal.pntd.0008302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rebecca C. Christofferson
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Daniel M. Parker
- University of California, Irvine, California, United States of America
| | | | | | - Gregor Devine
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Bruce A. Wilcox
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | - Vu Sinh Nam
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Sazaly Abubakar
- Tropical Infectious Diseases Research and Education Center, Kuala Lumpur, Malaysia
| | | | - Kobporn Boonnak
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Stephen S. Whitehead
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Rekol Huy
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Leang Rithea
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Tho Sochantha
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Thomas E. Wellems
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Jesus G. Valenzuela
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Jessica E. Manning
- US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
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18
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Ou TP, Yun C, Auerswald H, In S, Leang R, Huy R, Choeung R, Dussart P, Duong V. Improved detection of dengue and Zika viruses using multiplex RT-qPCR assays. J Virol Methods 2020; 282:113862. [PMID: 32417207 DOI: 10.1016/j.jviromet.2020.113862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/30/2022]
Abstract
Dengue virus (DENV) and Zika virus (ZIKV) are important viral pathogens, known to cause human infections with similar symptoms, are transmitted by common vectors and co-circulate in intertropical regions. Moreover, dengue fever results from infection with one of four different serotypes of dengue virus. Considering the recent ZIKV emergence, multiplex and up-to-date assays are more preferable for detection of both viruses in a single reaction. This study aimed to develop: (i) an one-step duplex real-time reverse transcription polymerase chain reaction (RT-qPCR) assay to efficiently and simultaneously detect and quantify DENV and ZIKV; (ii) a fourplex RT-qPCR to differentiate and quantify the four DENV serotypes. The detection limit of the duplex assay was 0.028 and 0.065 FFU (focus forming unit)/ml for DENV and ZIKV respectively. The lower limit of analytical sensitivity of fourplex assay was 0.01 FFU/ml for DENV-1 and 0.1 FFU/ml for DENV-2,-3 and -4. The assessment of specificity indicated both assays were highly specific to targeted viruses with negative results for other Flaviviridae such as Japanese encephalitis, West Nile, Yellow fever or Hepatitis C viruses. The newly developed RT-qPCRs were shown to be more sensitive than a previously described assay in detecting DENV in clinical samples and are suitable for the routine diagnosis.
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Affiliation(s)
- Tey Putita Ou
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia.
| | - Chanvannak Yun
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia.
| | - Heidi Auerswald
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia.
| | - Saraden In
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia.
| | - Rithea Leang
- National Center for Parasitology, Entomology & Malaria Control, Phnom Penh, Cambodia.
| | - Rekol Huy
- National Center for Parasitology, Entomology & Malaria Control, Phnom Penh, Cambodia.
| | - Rithy Choeung
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia.
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia.
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia.
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Chang T, Jung BK, Sohn WM, Hong S, Shin H, Ryoo S, Lee J, Lee KH, Khieu V, Huy R, Chai JY. Molecular Diagnosis of Taenia saginata Tapeworms from Two Residents of Northern Cambodia. Korean J Parasitol 2020; 58:201-204. [PMID: 32418391 PMCID: PMC7231828 DOI: 10.3347/kjp.2020.58.2.201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022]
Abstract
Taenia saginata infection has seldom been reported in Cambodia. In this study, we performed a survey of intestinal parasites in 1,156 residents of Preah Vihear and Stung Treng Provinces in 2018. The results revealed that 26 (2.4%) cases were positive for Taenia spp. eggs. In order to obtain the strobilae of the tapeworms, 2 patients in Preah Vihear were treated with praziquantel and purged with magnesium salts. The proglottids expelled after the medication were morphologically and molecularly analyzed to determine the species. The main uterine lateral braches in gravid proglottids were >15 in number suggesting that they are either T. saginata or Taenia asiatica. The sequences of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene and 2 nuclear loci, elongation factor-1 alpha (ef1) and ezrin-radixin-moesin-like protein (elp), were identical to the sequences of T. saginata available in GenBank but distant from Taenia solium, T. asiatica, and T. saginata-T. asiatica hybrid. This is the first report of the presence of T. saginata in the northern part of Cambodia bordering Lao PDR based on a molecular confirmation.
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Affiliation(s)
- Taehee Chang
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Bong-Kwang Jung
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Woon-Mok Sohn
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju 52727, Korea
| | - Sooji Hong
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Hyejoo Shin
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Seungwan Ryoo
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Jeonggyu Lee
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Keon Hoon Lee
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Virak Khieu
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Jong-Yil Chai
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea.,Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080, Korea
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20
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van der Pluijm RW, Tripura R, Hoglund RM, Pyae Phyo A, Lek D, Ul Islam A, Anvikar AR, Satpathi P, Satpathi S, Behera PK, Tripura A, Baidya S, Onyamboko M, Chau NH, Sovann Y, Suon S, Sreng S, Mao S, Oun S, Yen S, Amaratunga C, Chutasmit K, Saelow C, Runcharern R, Kaewmok W, Hoa NT, Thanh NV, Hanboonkunupakarn B, Callery JJ, Mohanty AK, Heaton J, Thant M, Gantait K, Ghosh T, Amato R, Pearson RD, Jacob CG, Gonçalves S, Mukaka M, Waithira N, Woodrow CJ, Grobusch MP, van Vugt M, Fairhurst RM, Cheah PY, Peto TJ, von Seidlein L, Dhorda M, Maude RJ, Winterberg M, Thuy-Nhien NT, Kwiatkowski DP, Imwong M, Jittamala P, Lin K, Hlaing TM, Chotivanich K, Huy R, Fanello C, Ashley E, Mayxay M, Newton PN, Hien TT, Valecha N, Smithuis F, Pukrittayakamee S, Faiz A, Miotto O, Tarning J, Day NPJ, White NJ, Dondorp AM. Triple artemisinin-based combination therapies versus artemisinin-based combination therapies for uncomplicated Plasmodium falciparum malaria: a multicentre, open-label, randomised clinical trial. Lancet 2020; 395:1345-1360. [PMID: 32171078 PMCID: PMC8204272 DOI: 10.1016/s0140-6736(20)30552-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/20/2020] [Accepted: 03/02/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Artemisinin and partner-drug resistance in Plasmodium falciparum are major threats to malaria control and elimination. Triple artemisinin-based combination therapies (TACTs), which combine existing co-formulated ACTs with a second partner drug that is slowly eliminated, might provide effective treatment and delay emergence of antimalarial drug resistance. METHODS In this multicentre, open-label, randomised trial, we recruited patients with uncomplicated P falciparum malaria at 18 hospitals and health clinics in eight countries. Eligible patients were aged 2-65 years, with acute, uncomplicated P falciparum malaria alone or mixed with non-falciparum species, and a temperature of 37·5°C or higher, or a history of fever in the past 24 h. Patients were randomly assigned (1:1) to one of two treatments using block randomisation, depending on their location: in Thailand, Cambodia, Vietnam, and Myanmar patients were assigned to either dihydroartemisinin-piperaquine or dihydroartemisinin-piperaquine plus mefloquine; at three sites in Cambodia they were assigned to either artesunate-mefloquine or dihydroartemisinin-piperaquine plus mefloquine; and in Laos, Myanmar, Bangladesh, India, and the Democratic Republic of the Congo they were assigned to either artemether-lumefantrine or artemether-lumefantrine plus amodiaquine. All drugs were administered orally and doses varied by drug combination and site. Patients were followed-up weekly for 42 days. The primary endpoint was efficacy, defined by 42-day PCR-corrected adequate clinical and parasitological response. Primary analysis was by intention to treat. A detailed assessment of safety and tolerability of the study drugs was done in all patients randomly assigned to treatment. This study is registered at ClinicalTrials.gov, NCT02453308, and is complete. FINDINGS Between Aug 7, 2015, and Feb 8, 2018, 1100 patients were given either dihydroartemisinin-piperaquine (183 [17%]), dihydroartemisinin-piperaquine plus mefloquine (269 [24%]), artesunate-mefloquine (73 [7%]), artemether-lumefantrine (289 [26%]), or artemether-lumefantrine plus amodiaquine (286 [26%]). The median age was 23 years (IQR 13 to 34) and 854 (78%) of 1100 patients were male. In Cambodia, Thailand, and Vietnam the 42-day PCR-corrected efficacy after dihydroartemisinin-piperaquine plus mefloquine was 98% (149 of 152; 95% CI 94 to 100) and after dihydroartemisinin-piperaquine was 48% (67 of 141; 95% CI 39 to 56; risk difference 51%, 95% CI 42 to 59; p<0·0001). Efficacy of dihydroartemisinin-piperaquine plus mefloquine in the three sites in Myanmar was 91% (42 of 46; 95% CI 79 to 98) versus 100% (42 of 42; 95% CI 92 to 100) after dihydroartemisinin-piperaquine (risk difference 9%, 95% CI 1 to 17; p=0·12). The 42-day PCR corrected efficacy of dihydroartemisinin-piperaquine plus mefloquine (96% [68 of 71; 95% CI 88 to 99]) was non-inferior to that of artesunate-mefloquine (95% [69 of 73; 95% CI 87 to 99]) in three sites in Cambodia (risk difference 1%; 95% CI -6 to 8; p=1·00). The overall 42-day PCR-corrected efficacy of artemether-lumefantrine plus amodiaquine (98% [281 of 286; 95% CI 97 to 99]) was similar to that of artemether-lumefantrine (97% [279 of 289; 95% CI 94 to 98]; risk difference 2%, 95% CI -1 to 4; p=0·30). Both TACTs were well tolerated, although early vomiting (within 1 h) was more frequent after dihydroartemisinin-piperaquine plus mefloquine (30 [3·8%] of 794) than after dihydroartemisinin-piperaquine (eight [1·5%] of 543; p=0·012). Vomiting after artemether-lumefantrine plus amodiaquine (22 [1·3%] of 1703) and artemether-lumefantrine (11 [0·6%] of 1721) was infrequent. Adding amodiaquine to artemether-lumefantrine extended the electrocardiogram corrected QT interval (mean increase at 52 h compared with baseline of 8·8 ms [SD 18·6] vs 0·9 ms [16·1]; p<0·01) but adding mefloquine to dihydroartemisinin-piperaquine did not (mean increase of 22·1 ms [SD 19·2] for dihydroartemisinin-piperaquine vs 20·8 ms [SD 17·8] for dihydroartemisinin-piperaquine plus mefloquine; p=0·50). INTERPRETATION Dihydroartemisinin-piperaquine plus mefloquine and artemether-lumefantrine plus amodiaquine TACTs are efficacious, well tolerated, and safe treatments of uncomplicated P falciparum malaria, including in areas with artemisinin and ACT partner-drug resistance. FUNDING UK Department for International Development, Wellcome Trust, Bill & Melinda Gates Foundation, UK Medical Research Council, and US National Institutes of Health.
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Affiliation(s)
- Rob W van der Pluijm
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Richard M Hoglund
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Dysoley Lek
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia; School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Anupkumar R Anvikar
- National Institute of Malaria Research, Indian Council of Medical Research, New Delhi, India
| | | | | | | | | | | | - Marie Onyamboko
- Kinshasa Mahidol Oxford Research Unit (KIMORU), Kinshasa, Democratic Republic of the Congo; Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Nguyen Hoang Chau
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Yok Sovann
- Pailin Provincial Health Department, Pailin, Cambodia
| | - Seila Suon
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Sokunthea Sreng
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Sivanna Mao
- Sampov Meas Referral Hospital, Pursat, Cambodia
| | - Savuth Oun
- Ratanakiri Referral Hospital, Ratanakiri, Cambodia
| | | | - Chanaki Amaratunga
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | | | | | | | | | - Nhu Thi Hoa
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ngo Viet Thanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - James J Callery
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Akshaya Kumar Mohanty
- Infectious Disease Biology Unit, IGH, Rourkela Research Unit of ILS, Bhubeneswar, DBT, Rourkela, India
| | - James Heaton
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar
| | - Myo Thant
- Defence Services Medical Research Centre, Yangon, Myanmar
| | | | | | - Roberto Amato
- Nuffield Department of Medicine and MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK; Wellcome Sanger Institute, Hinxton, UK
| | - Richard D Pearson
- Nuffield Department of Medicine and MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK; Wellcome Sanger Institute, Hinxton, UK
| | | | | | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Naomi Waithira
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Charles J Woodrow
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Michele van Vugt
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Rick M Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA; AstraZeneca, Gaithersburg, MD, USA
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Thomas J Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Mehul Dhorda
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; WorldWide Antimalarial Resistance Network - Asia Regional Centre, Bangkok, Thailand
| | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; The Open University, Milton Keynes, UK; Harvard T H Chan School of Public Health, Harvard University, Boston, MA USA
| | - Markus Winterberg
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nguyen Thanh Thuy-Nhien
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Dominic P Kwiatkowski
- Nuffield Department of Medicine and MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK; Wellcome Sanger Institute, Hinxton, UK
| | - Mallika Imwong
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Podjanee Jittamala
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Khin Lin
- Department of Medical Research, Pyin Oo Lwin, Myanmar
| | | | - Kesinee Chotivanich
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rekol Huy
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Caterina Fanello
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Kinshasa Mahidol Oxford Research Unit (KIMORU), Kinshasa, Democratic Republic of the Congo
| | - Elizabeth Ashley
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit (LOMWRU), Vientiane, Laos
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit (LOMWRU), Vientiane, Laos; Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Laos
| | - Paul N Newton
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit (LOMWRU), Vientiane, Laos
| | - Tran Tinh Hien
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Neena Valecha
- National Institute of Malaria Research, Indian Council of Medical Research, New Delhi, India
| | - Frank Smithuis
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar
| | - Sasithon Pukrittayakamee
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; The Royal Society of Thailand, Dusit, Bangkok, Thailand
| | - Abul Faiz
- Malaria Research Group and Dev Care Foundation, Dhaka, Bangladesh
| | - Olivo Miotto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Nuffield Department of Medicine and MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK; Wellcome Sanger Institute, Hinxton, UK
| | - Joel Tarning
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
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21
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Cousien A, Ledien J, Souv K, Leang R, Huy R, Fontenille D, Ly S, Duong V, Dussart P, Piola P, Cauchemez S, Tarantola A. Predicting Dengue Outbreaks in Cambodia. Emerg Infect Dis 2020; 25:2281-2283. [PMID: 31742509 PMCID: PMC6874239 DOI: 10.3201/eid2512.181193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In Cambodia, dengue outbreaks occur each rainy season (May–October) but vary in magnitude. Using national surveillance data, we designed a tool that can predict 90% of the variance in peak magnitude by April, when typically <10% of dengue cases have been reported. This prediction may help hospitals anticipate excess patients.
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22
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Wojnarski B, Lon C, Sea D, Sok S, Sriwichai S, Chann S, Hom S, Boonchan T, Ly S, Sok C, Nou S, Oung P, Kong N, Pheap V, Thay K, Dao V, Kuntawunginn W, Feldman M, Gosi P, Buathong N, Ittiverakul M, Uthaimongkol N, Huy R, Spring M, Lek D, Smith P, Fukuda MM, Wojnarski M. Evaluation of the CareStart™ glucose-6-phosphate dehydrogenase (G6PD) rapid diagnostic test in the field settings and assessment of perceived risk from primaquine at the community level in Cambodia. PLoS One 2020; 15:e0228207. [PMID: 32004348 PMCID: PMC6994100 DOI: 10.1371/journal.pone.0228207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 01/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Primaquine is an approved radical cure treatment for Plasmodium vivax malaria but treatment can result in life-threatening hemolysis if given to a glucose-6-phosphate dehydrogenase deficient (G6PDd) patient. There is a need for reliable point-of-care G6PD diagnostic tests. Objectives To evaluate the performance of the CareStart™ rapid diagnostic test (RDT) in the hands of healthcare workers (HCWs) and village malaria workers (VMWs) in field settings, and to better understand user perceptions about the risks and benefits of PQ treatment guided by RDT results. Methods This study enrolled 105 HCWs and VMWs, herein referred to as trainees, who tested 1,543 healthy adult male volunteers from 84 villages in Cambodia. The trainees were instructed on G6PD screening, primaquine case management, and completed pre and post-training questionnaires. Each trainee tested up to 16 volunteers in the field under observation by the study staff. Results Out of 1,542 evaluable G6PD volunteers, 251 (16.28%) had quantitative enzymatic activity less than 30% of an adjusted male median (8.30 U/g Hb). There was no significant difference in test sensitivity in detecting G6PDd between trainees (97.21%), expert study staff in the field (98.01%), and in a laboratory setting (95.62%) (p = 0.229); however, test specificity was different for trainees (96.62%), expert study staff in the field (98.14%), and experts in the laboratory (98.99%) (p < 0.001). Negative predictive values were not statistically different for trainees, expert staff, and laboratory testing: 99.44%, 99.61%, and 99.15%, respectively. Knowledge scores increased significantly post-training, with 98.7% willing to prescribe primaquine for P.vivax malaria, an improvement from 40.6% pre-training (p < 0.001). Conclusion This study demonstrated ability of medical staff with different background to accurately use CareStart™ RDT to identify G6PDd in male patients, which may enable safer prescribing of primaquine; however, pharmacovigilance is required to address possible G6PDd misclassifications.
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Affiliation(s)
- Bertha Wojnarski
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- The George Washington University, School of Nursing, Washington, DC, United States of America
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Darapiseth Sea
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Somethy Sok
- Ministry of National Defense, Department of Health, Phnom Penh, Cambodia
| | | | | | - Sohei Hom
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Sokna Ly
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Chandara Sok
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Samon Nou
- Chenda Polyclinic (CPC), Phnom Penh, Cambodia
| | - Pheaktra Oung
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Nareth Kong
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Vannak Pheap
- Ministry of National Defense, Department of Health, Phnom Penh, Cambodia
| | - Khengheang Thay
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Vy Dao
- Ministry of National Defense, Department of Health, Phnom Penh, Cambodia
| | | | - Mitra Feldman
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Panita Gosi
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nillawan Buathong
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mali Ittiverakul
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Michele Spring
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Dysoley Lek
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Philip Smith
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mark M. Fukuda
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mariusz Wojnarski
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- * E-mail:
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23
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Tripura R, Peto TJ, Chea N, Chan D, Mukaka M, Sirithiranont P, Dhorda M, Promnarate C, Imwong M, von Seidlein L, Duanguppama J, Patumrat K, Huy R, Grobusch MP, Day NPJ, White NJ, Dondorp AM. A Controlled Trial of Mass Drug Administration to Interrupt Transmission of Multidrug-Resistant Falciparum Malaria in Cambodian Villages. Clin Infect Dis 2019. [PMID: 29522113 PMCID: PMC6117448 DOI: 10.1093/cid/ciy196] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The increase in multidrug-resistant Plasmodium falciparum in Southeast Asia suggests a need for acceleration of malaria elimination. We evaluated the effectiveness and safety of mass drug administration (MDA) to interrupt malaria transmission. Methods Four malaria-endemic villages in western Cambodia were randomized to 3 rounds of MDA (a 3-day course of dihydroartemisinin with piperaquine-phosphate), administered either early in or at the end of the study period. Comprehensive malaria treatment records were collected during 2014-2017. Subclinical parasite prevalence was estimated by ultrasensitive quantitative polymerase chain reaction quarterly over 12 months. Results MDA coverage with at least 1 complete round was 88% (1999/2268), ≥2 rounds 73% (1645/2268), and all 3 rounds 58% (1310/2268). Plasmodium falciparum incidence in intervention and control villages was similar over the 12 months prior to the study: 39 per 1000 person-years (PY) vs 45 per 1000 PY (P = .50). The primary outcome, P. falciparum incidence in the 12 months after MDA, was lower in intervention villages (1.5/1000 PY vs 37.1/1000 PY; incidence rate ratio, 24.5 [95% confidence interval], 3.4-177; P = .002). Following MDA in 2016, there were no clinical falciparum malaria cases over 12 months (0/2044 PY) in all 4 villages. Plasmodium vivax prevalence decreased markedly in intervention villages following MDA but returned to approximately half the baseline prevalence by 12 months. No severe adverse events were attributed to treatment. Conclusions Mass drug administrations achieved high coverage, were safe, and associated with the absence of clinical P. falciparum cases for at least 1 year. Clinical Trials Registration NCT01872702.
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Affiliation(s)
- Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Thomas J Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Nguon Chea
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh
| | | | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Pasathorn Sirithiranont
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mehul Dhorda
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.,World-Wide Antimalarial Resistance Network, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Cholrawee Promnarate
- World-Wide Antimalarial Resistance Network, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mallika Imwong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Jureeporn Duanguppama
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Krittaya Patumrat
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Nicholas P J Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
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24
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Lin JT, Patel JC, Levitz L, Wojnarski M, Chaorattanakawee S, Gosi P, Buathong N, Chann S, Huy R, Thay K, Sea D, Samon N, Takala-Harrison S, Fukuda M, Smith P, Spring M, Saunders D, Lon C. Gametocyte Carriage, Antimalarial Use, and Drug Resistance in Cambodia, 2008-2014. Am J Trop Med Hyg 2019; 99:1145-1149. [PMID: 30226145 DOI: 10.4269/ajtmh.18-0509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Gametocytes are the malaria parasite stages responsible for transmission from humans to mosquitoes. Gametocytemia often follows drug treatment, especially as therapies start to fail. We examined Plasmodium falciparum gametocyte carriage and drug resistance profiles among 824 persons with uncomplicated malaria in Cambodia to determine whether prevalent drug resistance and antimalarial use has led to a concentration of drug-resistant parasites among gametocyte carriers. Although report of prior antimalarial use increased from 2008 to 2014, the prevalence of study participants presenting with microscopic gametocyte carriage declined. Gametocytemia was more common in those reporting antimalarial use within the past year, and prior antimalarial use was correlated with higher IC50s to piperaquine and mefloquine, as well as to increased pfmdr1 copy number. However, there was no association between microscopic gametocyte carriage and parasite drug resistance. Thus, we found no evidence that the infectious reservoir, marked by those carrying gametocytes, is enriched with drug-resistant parasites.
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Affiliation(s)
- Jessica T Lin
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jaymin C Patel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Lauren Levitz
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Mariusz Wojnarski
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Suwanna Chaorattanakawee
- Department of Parasitology and Entomology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Panita Gosi
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nillawan Buathong
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Soklyda Chann
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Khengheng Thay
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Darapiseth Sea
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Nou Samon
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Shannon Takala-Harrison
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mark Fukuda
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Philip Smith
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Michele Spring
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - David Saunders
- U.S. Army Medical Materiel Development Activity, Fort Detrick, Maryland
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
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25
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Hamilton WL, Amato R, van der Pluijm RW, Jacob CG, Quang HH, Thuy-Nhien NT, Hien TT, Hongvanthong B, Chindavongsa K, Mayxay M, Huy R, Leang R, Huch C, Dysoley L, Amaratunga C, Suon S, Fairhurst RM, Tripura R, Peto TJ, Sovann Y, Jittamala P, Hanboonkunupakarn B, Pukrittayakamee S, Chau NH, Imwong M, Dhorda M, Vongpromek R, Chan XHS, Maude RJ, Pearson RD, Nguyen T, Rockett K, Drury E, Gonçalves S, White NJ, Day NP, Kwiatkowski DP, Dondorp AM, Miotto O. Evolution and expansion of multidrug-resistant malaria in southeast Asia: a genomic epidemiology study. Lancet Infect Dis 2019; 19:943-951. [PMID: 31345709 PMCID: PMC6715858 DOI: 10.1016/s1473-3099(19)30392-5] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND A multidrug-resistant co-lineage of Plasmodium falciparum malaria, named KEL1/PLA1, spread across Cambodia in 2008-13, causing high rates of treatment failure with the frontline combination therapy dihydroartemisinin-piperaquine. Here, we report on the evolution and spread of KEL1/PLA1 in subsequent years. METHODS For this genomic epidemiology study, we analysed whole genome sequencing data from P falciparum clinical samples collected from patients with malaria between 2007 and 2018 from Cambodia, Laos, northeastern Thailand, and Vietnam, through the MalariaGEN P falciparum Community Project. Previously unpublished samples were provided by two large-scale multisite projects: the Tracking Artemisinin Resistance Collaboration II (TRAC2) and the Genetic Reconnaissance in the Greater Mekong Subregion (GenRe-Mekong) project. By investigating genome-wide relatedness between parasites, we inferred patterns of shared ancestry in the KEL1/PLA1 population. FINDINGS We analysed 1673 whole genome sequences that passed quality filters, and determined KEL1/PLA1 status in 1615. Before 2009, KEL1/PLA1 was only found in western Cambodia; by 2016-17 its prevalence had risen to higher than 50% in all of the surveyed countries except for Laos. In northeastern Thailand and Vietnam, KEL1/PLA1 exceeded 80% of the most recent P falciparum parasites. KEL1/PLA1 parasites maintained high genetic relatedness and low diversity, reflecting a recent common origin. Several subgroups of highly related parasites have recently emerged within this co-lineage, with diverse geographical distributions. The three largest of these subgroups (n=84, n=79, and n=47) mostly emerged since 2016 and were all present in Cambodia, Laos, and Vietnam. These expanding subgroups carried new mutations in the crt gene, which arose on a specific genetic background comprising multiple genomic regions. Four newly emerging crt mutations were rare in the early period and became more prevalent by 2016-17 (Thr93Ser, rising to 19·8%; His97Tyr to 11·2%; Phe145Ile to 5·5%; and Ile218Phe to 11·1%). INTERPRETATION After emerging and circulating for several years within Cambodia, the P falciparum KEL1/PLA1 co-lineage diversified into multiple subgroups and acquired new genetic features, including novel crt mutations. These subgroups have rapidly spread into neighbouring countries, suggesting enhanced fitness. These findings highlight the urgent need for elimination of this increasingly drug-resistant parasite co-lineage, and the importance of genetic surveillance in accelerating malaria elimination efforts. FUNDING Wellcome Trust, Bill & Melinda Gates Foundation, UK Medical Research Council, and UK Department for International Development.
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Affiliation(s)
- William L Hamilton
- Wellcome Sanger Institute, Hinxton, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Roberto Amato
- Wellcome Sanger Institute, Hinxton, UK; MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Rob W van der Pluijm
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Huynh Hong Quang
- Institute of Malariology, Parasitology and Entomology, Quy Nhon, Vietnam
| | | | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Mayfong Mayxay
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Laos; Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit (LOMWRU), Vientiane, Laos
| | - Rekol Huy
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Rithea Leang
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Cheah Huch
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Lek Dysoley
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Chanaki Amaratunga
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Seila Suon
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Rick M Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas J Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Yok Sovann
- Provincial Health Department, Pailin, Cambodia
| | | | | | - Sasithon Pukrittayakamee
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; The Royal Society of Thailand, Bangkok, Thailand
| | | | - Mallika Imwong
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mehul Dhorda
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Worldwide Antimalarial Resistance Network (WWARN), Asia Regional Centre, Bangkok, Thailand
| | - Ranitha Vongpromek
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Worldwide Antimalarial Resistance Network (WWARN), Asia Regional Centre, Bangkok, Thailand
| | - Xin Hui S Chan
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Richard D Pearson
- Wellcome Sanger Institute, Hinxton, UK; MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK
| | - T Nguyen
- Wellcome Sanger Institute, Hinxton, UK
| | - Kirk Rockett
- Wellcome Sanger Institute, Hinxton, UK; Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | | | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas P Day
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dominic P Kwiatkowski
- Wellcome Sanger Institute, Hinxton, UK; MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK.
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Olivo Miotto
- Wellcome Sanger Institute, Hinxton, UK; MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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26
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van der Pluijm RW, Imwong M, Chau NH, Hoa NT, Thuy-Nhien NT, Thanh NV, Jittamala P, Hanboonkunupakarn B, Chutasmit K, Saelow C, Runjarern R, Kaewmok W, Tripura R, Peto TJ, Yok S, Suon S, Sreng S, Mao S, Oun S, Yen S, Amaratunga C, Lek D, Huy R, Dhorda M, Chotivanich K, Ashley EA, Mukaka M, Waithira N, Cheah PY, Maude RJ, Amato R, Pearson RD, Gonçalves S, Jacob CG, Hamilton WL, Fairhurst RM, Tarning J, Winterberg M, Kwiatkowski DP, Pukrittayakamee S, Hien TT, Day NP, Miotto O, White NJ, Dondorp AM. Determinants of dihydroartemisinin-piperaquine treatment failure in Plasmodium falciparum malaria in Cambodia, Thailand, and Vietnam: a prospective clinical, pharmacological, and genetic study. Lancet Infect Dis 2019; 19:952-961. [PMID: 31345710 PMCID: PMC6715822 DOI: 10.1016/s1473-3099(19)30391-3] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The emergence and spread of resistance in Plasmodium falciparum malaria to artemisinin combination therapies in the Greater Mekong subregion poses a major threat to malaria control and elimination. The current study is part of a multi-country, open-label, randomised clinical trial (TRACII, 2015-18) evaluating the efficacy, safety, and tolerability of triple artemisinin combination therapies. A very high rate of treatment failure after treatment with dihydroartemisinin-piperaquine was observed in Thailand, Cambodia, and Vietnam. The immediate public health importance of our findings prompted us to report the efficacy data on dihydroartemisinin-piperaquine and its determinants ahead of the results of the overall trial, which will be published later this year. METHODS Patients aged between 2 and 65 years presenting with uncomplicated P falciparum or mixed species malaria at seven sites in Thailand, Cambodia, and Vietnam were randomly assigned to receive dihydroartemisinin-piperaquine with or without mefloquine, as part of the TRACII trial. The primary outcome was the PCR-corrected efficacy at day 42. Next-generation sequencing was used to assess the prevalence of molecular markers associated with artemisinin resistance (kelch13 mutations, in particular Cys580Tyr) and piperaquine resistance (plasmepsin-2 and plasmepsin-3 amplifications and crt mutations). This study is registered with ClinicalTrials.gov, number NCT02453308. FINDINGS Between Sept 28, 2015, and Jan 18, 2018, 539 patients with acute P falciparum malaria were screened for eligibility, 292 were enrolled, and 140 received dihydroartemisinin-piperaquine. The overall Kaplan-Meier estimate of PCR-corrected efficacy of dihydroartemisinin-piperaquine at day 42 was 50·0% (95% CI 41·1-58·3). PCR-corrected efficacies for individual sites were 12·7% (2·2-33·0) in northeastern Thailand, 38·2% (15·9-60·5) in western Cambodia, 73·4% (57·0-84·3) in Ratanakiri (northeastern Cambodia), and 47·1% (33·5-59·6) in Binh Phuoc (southwestern Vietnam). Treatment failure was associated independently with plasmepsin2/3 amplification status and four mutations in the crt gene (Thr93Ser, His97Tyr, Phe145Ile, and Ile218Phe). Compared with the results of our previous TRACI trial in 2011-13, the prevalence of molecular markers of artemisinin resistance (kelch13 Cys580Tyr mutations) and piperaquine resistance (plasmepsin2/3 amplifications and crt mutations) has increased substantially in the Greater Mekong subregion in the past decade. INTERPRETATION Dihydroartemisinin-piperaquine is not treating malaria effectively across the eastern Greater Mekong subregion. A highly drug-resistant P falciparum co-lineage is evolving, acquiring new resistance mechanisms, and spreading. Accelerated elimination of P falciparum malaria in this region is needed urgently, to prevent further spread and avoid a potential global health emergency. FUNDING UK Department for International Development, Wellcome Trust, Bill & Melinda Gates Foundation, Medical Research Council, and National Institutes of Health.
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Affiliation(s)
- Rob W van der Pluijm
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mallika Imwong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nguyen Hoang Chau
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nhu Thi Hoa
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Thanh Thuy-Nhien
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ngo Viet Thanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Podjanee Jittamala
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | | | | | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Thomas J Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sovann Yok
- Pailin Provincial Health Department, Pailin, Cambodia
| | - Seila Suon
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Sokunthea Sreng
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Sivanna Mao
- Sampov Meas Referral Hospital, Pursat, Cambodia
| | - Savuth Oun
- Ratanakiri Referral Hospital, Ratanakiri, Cambodia
| | | | - Chanaki Amaratunga
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Dysoley Lek
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia; School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Mehul Dhorda
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; WorldWide Antimalarial Resistance Network Asia Regional Centre, Bangkok, Thailand
| | - Kesinee Chotivanich
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Elizabeth A Ashley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Vientiane, Laos
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Naomi Waithira
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Richard J Maude
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Richard D Pearson
- Wellcome Sanger Institute, Hinxton, United Kingdom; MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK
| | | | | | | | - Rick M Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Markus Winterberg
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Dominic P Kwiatkowski
- Wellcome Sanger Institute, Hinxton, United Kingdom; MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Sasithon Pukrittayakamee
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; The Royal Society of Thailand, Dusit, Bangkok, Thailand
| | - Tran Tinh Hien
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nicholas Pj Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Olivo Miotto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Wellcome Sanger Institute, Hinxton, United Kingdom; MRC Centre for Genomics and Global Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
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27
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Ly S, Fortas C, Duong V, Benmarhnia T, Sakuntabhai A, Paul R, Huy R, Sorn S, Nguon K, Chan S, Kimsan S, Ong S, Kim KS, Buoy S, Voeung L, Dussart P, Buchy P, Tarantola A. Asymptomatic Dengue Virus Infections, Cambodia, 2012-2013. Emerg Infect Dis 2019; 25:1354-1362. [PMID: 31211672 PMCID: PMC6590774 DOI: 10.3201/eid2507.181794] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We investigated dengue virus (DENV) and asymptomatic DENV infections in rural villages of Kampong Cham Province, Cambodia, during 2012 and 2013. We conducted perifocal investigations in and around households for 149 DENV index cases identified through hospital and village surveillance. We tested participants 0.5-30 years of age by using nonstructural 1 rapid tests and confirmed DENV infections using quantitative reverse transcription PCR or nonstructural 1-capture ELISA. We used multivariable Poisson regressions to explore links between participants' DENV infection status and household characteristics. Of 7,960 study participants, 346 (4.4%) were infected with DENV, among whom 302 (87.3%) were <15 years of age and 225 (65.0%) were <9 years of age. We identified 26 (7.5%) participants with strictly asymptomatic DENV infection at diagnosis and during follow-up. We linked symptomatic DENV infection status to familial relationships with index cases. During the 2-year study, we saw fewer asymptomatic DENV infections than expected based on the literature.
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Affiliation(s)
| | | | - Veasna Duong
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Tarik Benmarhnia
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Anavaj Sakuntabhai
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Richard Paul
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Rekol Huy
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Sopheak Sorn
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Kunthy Nguon
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Siam Chan
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Souv Kimsan
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Sivuth Ong
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Kim Srorn Kim
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Sowathy Buoy
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Lim Voeung
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Philippe Dussart
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
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Abstract
Opisthorchis viverrini infection is widely prevalent in Southeast Asia. In Cambodia information on this helminth infection is scare. Recent reports suggest that O. viverrini is an emerging public health problem. We aimed to synthesize all information in relation to the infection, epidemiology, and morbidity of O. viverrini in Cambodia; from published as well as thus far unpublished sources. First reports on O. viverrini date back to 1995. In 2006 an O. viverrini initiative was launched by the national helminth control program. Since then O. viverrini has been reported in all - except two - provinces. Villages with high prevalences (>20%) were found in provinces from Preah Vihear to Takeo. The infection has a highly focal distribution. In many villages no infections were detected. O. viverrini infection was also reported in cats, dogs and intermediate hosts. No report on morbidity associated with O. viverrini was found. The current evidence suggests that O. viverrini infection remains underreported in Cambodia. It is likely that the transmission will further increase in the future with potentially serious consequences for human health.
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Affiliation(s)
- Virak Khieu
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Thomas Fürst
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; School of Public Health, Imperial College London, London, United Kingdom
| | - Kazuko Miyamoto
- School of Nursing, Faculty of Medicine & Center for International Education and Exchange, Yamanashi University, Yamanashi, Japan
| | - Tai-Soon Yong
- Department of Environmental Biology, Institute of Tropical Medicine, and Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Yil Chai
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul, Republic of Korea; Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Sinuon Muth
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
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29
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Ledien J, Souv K, Leang R, Huy R, Cousien A, Peas M, Froehlich Y, Duboz R, Ong S, Duong V, Buchy P, Dussart P, Tarantola A. An algorithm applied to national surveillance data for the early detection of major dengue outbreaks in Cambodia. PLoS One 2019; 14:e0212003. [PMID: 30730979 PMCID: PMC6366704 DOI: 10.1371/journal.pone.0212003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 12/08/2018] [Indexed: 01/21/2023] Open
Abstract
Dengue is a national priority disease in Cambodia. The Cambodian National Dengue Surveillance System is based on passive surveillance of dengue-like inpatients reported by public hospitals and on a sentinel, pediatric hospital-based active surveillance system. This system works well to assess trends but the sensitivity of the early warning and time-lag to usefully inform hospitals can be improved. During The ECOnomic development, ECOsystem MOdifications, and emerging infectious diseases Risk Evaluation (ECOMORE) project's knowledge translation platforms, Cambodian hospital staff requested an early warning tool to prepare for major outbreaks. Our objective was therefore to find adapted tools to improve the early warning system and preparedness. Dengue data was provided by the National Dengue Control Program (NDCP) and are routinely obtained through passive surveillance. The data were analyzed at the provincial level for eight Cambodian provinces during 2008-2015. The R surveillance package was used for the analysis. We evaluated the effectiveness of Bayesian algorithms to detect outbreaks using count data series, comparing the current count to an expected distribution obtained from observations of past years. The analyses bore on 78,759 patients with dengue-like syndromes. The algorithm maximizing sensitivity and specificity for the detection of major dengue outbreaks was selected in each province. The overall sensitivity and specificity were 73% and 97%, respectively, for the detection of significant outbreaks during 2008-2015. Depending on the province, sensitivity and specificity ranged from 50% to 100% and 75% to 100%, respectively. The final algorithm meets clinicians' and decisionmakers' needs, is cost-free and is easy to implement at the provincial level.
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Affiliation(s)
- Julia Ledien
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Kimsan Souv
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Centre National de Malariologie (CNM), Phnom Penh, Cambodia
| | - Rithea Leang
- Centre National de Malariologie (CNM), Phnom Penh, Cambodia
| | - Rekol Huy
- Centre National de Malariologie (CNM), Phnom Penh, Cambodia
| | - Anthony Cousien
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Mathematical Modelling of Infectious Diseases Laboratory, Institut Pasteur, Paris, France
| | - Muslim Peas
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Yves Froehlich
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Raphaël Duboz
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- UMR ASTRE CIRAD INRA, Montpellier, France
| | - Sivuth Ong
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Arnaud Tarantola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Epidemiology unit, Institut Pasteur de Nouvelle-Calédonie, Nouméa, New Caledonia
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30
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Manning JE, Oliveira F, Parker DM, Amaratunga C, Kong D, Man S, Sreng S, Lay S, Nang K, Kimsan S, Sokha L, Kamhawi S, Fay MP, Suon S, Ruhl P, Ackerman H, Huy R, Wellems TE, Valenzuela JG, Leang R. The PAGODAS protocol: pediatric assessment group of dengue and Aedes saliva protocol to investigate vector-borne determinants of Aedes-transmitted arboviral infections in Cambodia. Parasit Vectors 2018; 11:664. [PMID: 30572920 PMCID: PMC6300895 DOI: 10.1186/s13071-018-3224-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/20/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mosquito-borne arboviruses, like dengue virus, continue to cause significant global morbidity and mortality, particularly in Southeast Asia. When the infectious mosquitoes probe into human skin for a blood meal, they deposit saliva containing a myriad of pharmacologically active compounds, some of which alter the immune response and influence host receptivity to infection, and consequently, the establishment of the virus. Previous reports have highlighted the complexity of mosquito vector-derived factors and immunity in the success of infection. Cumulative evidence from animal models and limited data from humans have identified various vector-derived components, including salivary components, that are co-delivered with the pathogen and play an important role in the dissemination of infection. Much about the roles and effects of these vector-derived factors remain to be discovered. METHODS/DESIGN We describe a longitudinal, pagoda (community)-based pediatric cohort study to evaluate the burden of dengue virus infection and document the immune responses to salivary proteins of Aedes aegypti, the mosquito vector of dengue, Zika, and chikungunya viruses. The study includes community-based seroprevalence assessments in the peri-urban town of Chbar Mon in Kampong Speu Province, Cambodia. The study aims to recruit 771 children between the ages of 2 and 9 years for a three year period of longitudinal follow-up, including twice per year (rainy and dry season) serosurveillance for dengue seroconversion and Ae. aegypti salivary gland homogenate antibody intensity determinations by ELISA assays. Diagnostic tests for acute dengue, Zika and chikungunya viral infections will be performed by RT-PCR. DISCUSSION This study will serve as a foundation for further understanding of mosquito saliva immunity and its impact on Aedes-transmitted arboviral diseases endemic to Cambodia. TRIAL REGISTRATION NCT03534245 registered on 23 May 2018.
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Affiliation(s)
- Jessica E. Manning
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland USA
| | - Fabiano Oliveira
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland USA
| | - Daniel M. Parker
- Department of Population Health and Disease Prevention, University of California, Irvine, California, USA
| | - Chanaki Amaratunga
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland USA
| | - Dara Kong
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Somnang Man
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Sokunthea Sreng
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Sreyngim Lay
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Kimsour Nang
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Soun Kimsan
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Ly Sokha
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Shaden Kamhawi
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland USA
| | - Michael P. Fay
- Biostatistics Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland USA
| | - Seila Suon
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Parker Ruhl
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland USA
| | - Hans Ackerman
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland USA
| | - Rekol Huy
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Thomas E. Wellems
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland USA
| | - Jesus G. Valenzuela
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland USA
| | - Rithea Leang
- National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
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Kitchakarn S, Lek D, Thol S, Hok C, Saejeng A, Huy R, Chinanonwait N, Thimasarn K, Wongsrichanalai C. Implementation of G6PD testing and primaquine for P. vivax radical cure: Operational perspectives from Thailand and Cambodia. WHO South East Asia J Public Health 2018; 6:60-68. [PMID: 28857064 DOI: 10.4103/2224-3151.213793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Following progressive success in reducing the burden of malaria over the past two decades, countries of the Asia Pacific are now aiming for elimination of malaria by 2030. Plasmodium falciparum and Plasmodium vivax are the two main malaria species that are endemic in the region. P. vivax is generally perceived to be less severe but will be harder to eliminate, owing partly to its dormant liver stage (known as a hypnozoite) that can cause multiple relapses following an initial clinical episode caused by a mosquito-borne infection. Primaquine is the only anti-hypnozoite drug against P. vivax relapse currently available, with tafenoquine in the pipeline. However, both drugs may cause severe haemolysis in individuals with deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD), a hereditary defect. The overall incidence of malaria has significantly declined in both Thailand and Cambodia over the last 15 years. However, P. vivax has replaced P. falciparum as the dominant species in large parts of both countries. This paper presents the experience of the national malaria control programmes of the two countries, in their efforts to implement safe primaquine therapy for the radical cure, i.e. relapse prevention, of P. vivax malaria by introducing a rapid, point-of-care test to screen for G6PD deficiency.
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Affiliation(s)
- Suravadee Kitchakarn
- Bureau of Vector Borne Diseases, Ministry of Public Health, Nonthaburi, Thailand
| | - Dysoley Lek
- National Centre for Parasitology, Entomology and Malaria Control; School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia, Thailand
| | - Sea Thol
- Cambodian Pharmacovigilance Centre, Department of Drugs and Food, Ministry of Health, Phnom Penh, Cambodia
| | - Chantheasy Hok
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Aungkana Saejeng
- Office of Disease Prevention and Control No. 10, Chiang Mai, Thailand
| | - Rekol Huy
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Nipon Chinanonwait
- Bureau of Vector Borne Diseases, Ministry of Public Health, Nonthaburi, Thailand
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Khieu V, Or V, Tep C, Odermatt P, Tsuyuoka R, Char MC, Brady MA, Sidwell J, Yajima A, Huy R, Ramaiah KD, Muth S. How elimination of lymphatic filariasis as a public health problem in the Kingdom of Cambodia was achieved. Infect Dis Poverty 2018; 7:15. [PMID: 29463307 PMCID: PMC5819284 DOI: 10.1186/s40249-018-0394-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/04/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Endemicity of lymphatic filariasis (LF) in Cambodia was proven in 1956 when microfilariae were detected in mosquitos in the Kratié province. In 2001, an extensive study confirmed the presence of both Brugia malayi and Wuchereria bancrofti microfilariae. In 2003, the Ministry of Health established a national task force to develop policies and strategies for controlling and eliminating neglected tropical diseases (NTDs), with the goal of eliminating LF by 2015. This article summarizes the work accomplished to eliminate LF as a public health problem in Cambodia. METHODS The National Program to Eliminate Lymphatic Filariasis made excellent progress in the goal towards elimination due to strong collaboration between ministries, intensive supervision by national staff, and advocacy for mobilization of internal and external resources. Mass drug administration (MDA) with diethylcarbamazine citrate and albendazole was conducted in six implementation units, achieving > 70% epidemiological coverage for five consecutive rounds, from 2005 to 2009. In 2006, in 14 provinces, healthcare workers developed a line list of lymphedema and hydrocele patients, many of whom were > 40 years old and had been affected by LF for many years. The national program also trained healthcare workers and provincial and district staff in morbidity management and disability prevention, and designated health centers to provide care for lymphedema and acute attack. Two reference hospitals were designated to administer hydrocele surgery. RESULTS Effectiveness of MDA was proven with transmission assessment surveys. These found that less than 1% of school children had antigenemia in 2010, which fell to 0% in both 2013 and 2015. A separate survey in one province in 2015 using Brugia Rapid tests to test for LF antibody found one child positive among 1677 children. The list of chronic LF patients was most recently updated and confirmed in 2011-2012, with 32 lymphoedema patients and 17 hydrocele patients listed. All lymphedema patients had been trained on self-management and all hydrocele patients had been offered free surgery. CONCLUSIONS Due to the success of the MDA and the development of health center capacity for patient care, along with benefits gained from socioeconomic improvements and other interventions against vector-borne diseases and NTDs, Cambodia was validated by the World Health Organization as achieving LF elimination as a public health problem in 2016.
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Affiliation(s)
- Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, 477 Betong Street (Corner St.92), Village Trapangsvay, Sanakat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
| | - Vandine Or
- Directorate General for Health, Ministry of Health, 80, Samdech Penn Nouth Blvd. (289), Sangkat Boeungkak 2, Tuol Kork District, Phnom Penh, Cambodia
| | - Chhakda Tep
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, 477 Betong Street (Corner St.92), Village Trapangsvay, Sanakat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
| | - Peter Odermatt
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Meng Chuor Char
- Ministry of Health, 80, Samdech Penn Nouth Blvd. (289), Sangkat Boeungkak 2, Tuol Kork District, Phnom Penh, Cambodia
| | - Molly A. Brady
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | - Joshua Sidwell
- RTI International, East Cornwallis Road, PO Box 12194, Research Triangle Park, NC USA
| | - Aya Yajima
- World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Rekol Huy
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, 477 Betong Street (Corner St.92), Village Trapangsvay, Sanakat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
| | - Kapa D. Ramaiah
- Consultant on lymphatic filariasis, Tagore Nagar, Pondicherry, India
| | - Sinuon Muth
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, 477 Betong Street (Corner St.92), Village Trapangsvay, Sanakat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
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Chaorattanakawee S, Lon C, Chann S, Thay KH, Kong N, You Y, Sundrakes S, Thamnurak C, Chattrakarn S, Praditpol C, Yingyuen K, Wojnarski M, Huy R, Spring MD, Walsh DS, Patel JC, Lin J, Juliano JJ, Lanteri CA, Saunders DL. Measuring ex vivo drug susceptibility in Plasmodium vivax isolates from Cambodia. Malar J 2017; 16:392. [PMID: 28964258 PMCID: PMC5622433 DOI: 10.1186/s12936-017-2034-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/19/2017] [Indexed: 12/24/2022] Open
Abstract
Background While intensive Plasmodium falciparum multidrug resistance surveillance continues in Cambodia, relatively little is known about Plasmodium vivax drug resistance in Cambodia or elsewhere. To investigate P. vivax anti-malarial susceptibility in Cambodia, 76 fresh P. vivax isolates collected from Oddar Meanchey (northern Cambodia) in 2013–2015 were assessed for ex vivo drug susceptibility using the microscopy-based schizont maturation test (SMT) and a Plasmodium pan-species lactate dehydrogenase (pLDH) ELISA. P. vivax multidrug resistance gene 1 (pvmdr1) mutations, and copy number were analysed in a subset of isolates. Results Ex vivo testing was interpretable in 80% of isolates using the pLDH-ELISA, but only 25% with the SMT. Plasmodium vivax drug susceptibility by pLDH-ELISA was directly compared with 58 P. falciparum isolates collected from the same locations in 2013–4, tested by histidine-rich protein-2 ELISA. Median pLDH-ELISA IC50 of P. vivax isolates was significantly lower for dihydroartemisinin (3.4 vs 6.3 nM), artesunate (3.2 vs 5.7 nM), and chloroquine (22.1 vs 103.8 nM) than P. falciparum but higher for mefloquine (92 vs 66 nM). There were not significant differences for lumefantrine or doxycycline. Both P. vivax and P. falciparum had comparable median piperaquine IC50 (106.5 vs 123.8 nM), but some P. falciparum isolates were able to grow in much higher concentrations above the normal standard range used, attaining up to 100-fold greater IC50s than P. vivax. A high percentage of P. vivax isolates had pvmdr1 Y976F (78%) and F1076L (83%) mutations but none had pvmdr1 amplification. Conclusion The findings of high P. vivax IC50 to mefloquine and piperaquine, but not chloroquine, suggest significant drug pressure from drugs used to treat multidrug resistant P. falciparum in Cambodia. Plasmodium vivax isolates are frequently exposed to mefloquine and piperaquine due to mixed infections and the long elimination half-life of these drugs. Difficulty distinguishing infection due to relapsing hypnozoites versus blood-stage recrudescence complicates clinical detection of P. vivax resistance, while well-validated molecular markers of chloroquine resistance remain elusive. The pLDH assay may be a useful adjunctive tool for monitoring for emerging drug resistance, though more thorough validation is needed. Given high grade clinical chloroquine resistance observed recently in neighbouring countries, low chloroquine IC50 values seen here should not be interpreted as susceptibility in the absence of clinical data. Incorporating pLDH monitoring with therapeutic efficacy studies for individuals with P. vivax will help to further validate this field-expedient method. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-2034-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suwanna Chaorattanakawee
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand. .,Department of Parasitology and Entomology, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
| | - Chanthap Lon
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Soklyda Chann
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Kheang Heng Thay
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Nareth Kong
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Yom You
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Siratchana Sundrakes
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Chatchadaporn Thamnurak
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Sorayut Chattrakarn
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Chantida Praditpol
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Kritsanai Yingyuen
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Mariusz Wojnarski
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Michele D Spring
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Douglas S Walsh
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Jaymin C Patel
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica Lin
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jonathan J Juliano
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Charlotte A Lanteri
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - David L Saunders
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.,US Army Medical Materiel Development Activity, Fort Detrick, Frederick, MD, USA
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Agrawal S, Moser KA, Morton L, Cummings MP, Parihar A, Dwivedi A, Shetty AC, Drabek EF, Jacob CG, Henrich PP, Parobek CM, Jongsakul K, Huy R, Spring MD, Lanteri CA, Chaorattanakawee S, Lon C, Fukuda MM, Saunders DL, Fidock DA, Lin JT, Juliano JJ, Plowe CV, Silva JC, Takala-Harrison S. Association of a Novel Mutation in the Plasmodium falciparum Chloroquine Resistance Transporter With Decreased Piperaquine Sensitivity. J Infect Dis 2017; 216:468-476. [PMID: 28931241 DOI: 10.1093/infdis/jix334] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/12/2017] [Indexed: 12/30/2022] Open
Abstract
Background Amplified copy number in the plasmepsin II/III genes within Plasmodium falciparum has been associated with decreased sensitivity to piperaquine. To examine this association and test whether additional loci might also contribute, we performed a genome-wide association study of ex vivo P. falciparum susceptibility to piperaquine. Methods Plasmodium falciparum DNA from 183 samples collected primarily from Cambodia was genotyped at 33716 genome-wide single nucleotide polymorphisms (SNPs). Linear mixed models and random forests were used to estimate associations between parasite genotypes and piperaquine susceptibility. Candidate polymorphisms were evaluated for their association with dihydroartemisinin-piperaquine treatment outcomes in an independent dataset. Results Single nucleotide polymorphisms on multiple chromosomes were associated with piperaquine 90% inhibitory concentrations (IC90) in a genome-wide analysis. Fine-mapping of genomic regions implicated in genome-wide analyses identified multiple SNPs in linkage disequilibrium with each other that were significantly associated with piperaquine IC90, including a novel mutation within the gene encoding the P. falciparum chloroquine resistance transporter, PfCRT. This mutation (F145I) was associated with dihydroartemisinin-piperaquine treatment failure after adjusting for the presence of amplified plasmepsin II/III, which was also associated with decreased piperaquine sensitivity. Conclusions Our data suggest that, in addition to plasmepsin II/III copy number, other loci, including pfcrt, may also be involved in piperaquine resistance.
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Affiliation(s)
- Sonia Agrawal
- Division of Malaria Research, Institute for Global Health
| | - Kara A Moser
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore
| | - Lindsay Morton
- Division of Malaria Research, Institute for Global Health
| | - Michael P Cummings
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park
| | - Ankita Parihar
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore
| | - Ankit Dwivedi
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore
| | - Amol C Shetty
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore
| | - Elliott F Drabek
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore
| | | | | | - Christian M Parobek
- Division of Infectious Diseases, University of North Carolina at Chapel Hill
| | - Krisada Jongsakul
- Armed Forces Research Institute of Medical Sciences, Department of Immunology and Medicine
| | - Rekol Huy
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Michele D Spring
- Armed Forces Research Institute of Medical Sciences, Department of Immunology and Medicine
| | - Charlotte A Lanteri
- Armed Forces Research Institute of Medical Sciences, Department of Immunology and Medicine
| | - Suwanna Chaorattanakawee
- Armed Forces Research Institute of Medical Sciences, Department of Immunology and Medicine.,Department of Parasitology and Entomology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences.,Armed Forces Research Institute of Medical Sciences, Department of Immunology and Medicine
| | - Mark M Fukuda
- Armed Forces Research Institute of Medical Sciences, Department of Immunology and Medicine
| | - David L Saunders
- Armed Forces Research Institute of Medical Sciences, Department of Immunology and Medicine
| | - David A Fidock
- Department of Microbiology and Immunology.,Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York
| | - Jessica T Lin
- Division of Infectious Diseases, University of North Carolina at Chapel Hill
| | - Jonathan J Juliano
- Division of Infectious Diseases, University of North Carolina at Chapel Hill
| | | | - Joana C Silva
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore
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Ledien J, Sorn S, Hem S, Huy R, Buchy P, Tarantola A, Cappelle J. Assessing the performance of remotely-sensed flooding indicators and their potential contribution to early warning for leptospirosis in Cambodia. PLoS One 2017; 12:e0181044. [PMID: 28704461 PMCID: PMC5509259 DOI: 10.1371/journal.pone.0181044] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/26/2017] [Indexed: 12/27/2022] Open
Abstract
Remote sensing can contribute to early warning for diseases with environmental drivers, such as flooding for leptospirosis. In this study we assessed whether and which remotely-sensed flooding indicator could be used in Cambodia to study any disease for which flooding has already been identified as an important driver, using leptospirosis as a case study. The performance of six potential flooding indicators was assessed by ground truthing. The Modified Normalized Difference Water Index (MNDWI) was used to estimate the Risk Ratio (RR) of being infected by leptospirosis when exposed to floods it detected, in particular during the rainy season. Chi-square tests were also calculated. Another variable—the time elapsed since the first flooding of the year—was created using MNDWI values and was also included as explanatory variable in a generalized linear model (GLM) and in a boosted regression tree model (BRT) of leptospirosis infections, along with other explanatory variables. Interestingly, MNDWI thresholds for both detecting water and predicting the risk of leptospirosis seroconversion were independently evaluated at -0.3. Value of MNDWI greater than -0.3 was significantly related to leptospirosis infection (RR = 1.61 [1.10–1.52]; χ2 = 5.64, p-value = 0.02, especially during the rainy season (RR = 2.03 [1.25–3.28]; χ2 = 8.15, p-value = 0.004). Time since the first flooding of the year was a significant risk factor in our GLM model (p-value = 0.042). These results suggest that MNDWI may be useful as a risk indicator in an early warning remote sensing tool for flood-driven diseases like leptospirosis in South East Asia.
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Affiliation(s)
- Julia Ledien
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- * E-mail:
| | - Sopheak Sorn
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sopheak Hem
- Medical Biology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Rekol Huy
- Centre National de Malariologie (CNM), Phnom Penh, Cambodia
| | | | - Arnaud Tarantola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Epidemiology unit, Institut Pasteur de Nouvelle-Calédonie, 11 rue Paul Doumer, Nouméa, New Caledonia
| | - Julien Cappelle
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- CIRAD-ES, UPR AGIRs, Montpellier, France
- UMR EPIA, INRA, VetAgro Sup, Univ Lyon, Marcy-l'étoile, France
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Verschuere J, Decroo T, Lim D, Kindermans JM, Nguon C, Huy R, Alkourdi Y, Peeters Grietens K, Gryseels C. Local constraints to access appropriate malaria treatment in the context of parasite resistance in Cambodia: a qualitative study. Malar J 2017; 16:81. [PMID: 28212641 PMCID: PMC5316167 DOI: 10.1186/s12936-017-1732-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/09/2017] [Indexed: 12/02/2022] Open
Abstract
Background Despite emerging drug resistance in Cambodia, artemisinin-based combination therapy (ACT) is still the most efficacious therapy. ACT is available free of charge in the Cambodian public sector and at a subsidized rate in the private sector. However, un- and mistreated cases in combination with population movements may lead to the further spread of resistant parasites, stressing the importance of understanding how the perceived aetiology of malaria and associated health-seeking behaviour may delay access to appropriate treatment. A qualitative study explored these factors after an epidemiological survey confirmed parasite resistance in Preah Vihear province. Results In Cambodian cosmology, illnesses can be inflicted by supernatural beings or originate from ‘natural’ causes because of disorder in the social, domestic or outdoor environment. Initial treatment options consist of cheap and accessible home-based care (manual therapy, herbs and biomedical medication) targeting single symptoms. If there is no steady recovery or if the condition quickly aggravates, care will be sought from ‘village doctors’, public health facilities, private pharmacies or, in case of suspicion of a supernatural cause, from a specialized indigenous healer. The choice of provider is mostly based on the family’s financial situation, access to and trust in the provider, and the congruence between the suspected aetiology of the illness and the treatment offered by the provider. Different treatment options are often combined during the same illness episode through a serial process of trial and error guided by the observable improvements in the patient’s condition. Conclusions Cambodian perceptions of illness that focus on single symptoms and their perceived severity may lead to the identification of one or multiple illnesses at the same time, rarely suspecting malaria from the start and implying different patterns of health seeking behaviour and treatment choice. However, decisions to self-diagnose and treat at home are also pragmatic and must be understood in the context of poverty, a major barrier to seeking prompt and appropriate care for malaria in an area characterized by parasite resistance.
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Affiliation(s)
- Jesse Verschuere
- Médecins Sans Frontières, Operational Centre Brussels, Phnom Penh, Cambodia
| | - Tom Decroo
- Médecins Sans Frontières, Operational Centre Brussels, Medical Department, Brussels, Belgium
| | - Dara Lim
- Médecins Sans Frontières, Operational Centre Brussels, Phnom Penh, Cambodia
| | - Jean-Marie Kindermans
- Médecins Sans Frontières, Operational Centre Brussels, Medical Department, Brussels, Belgium
| | - Chea Nguon
- Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Rekol Huy
- Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Yasmine Alkourdi
- Médecins Sans Frontières, Operational Centre Brussels, Medical Department, Brussels, Belgium
| | - Koen Peeters Grietens
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Charlotte Gryseels
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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Duong V, Ong S, Leang R, Huy R, Ly S, Mounier U, Ou T, In S, Peng B, Ken S, Buchy P, Tarantola A, Horwood PF, Dussart P. Low Circulation of Zika Virus, Cambodia, 2007-2016. Emerg Infect Dis 2017; 23:296-299. [PMID: 27875110 PMCID: PMC5324809 DOI: 10.3201/eid2302.161432] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We describe a retrospective study on circulation of Zika virus in Cambodia during 2007–2016 among patients with dengue-like symptoms and Aedes aegypti mosquitoes. Our findings suggest that Zika virus in Cambodia belongs to the Asia genotype, is endemic, has low prevalence, and has had low-level impact on public health.
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38
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Witkowski B, Duru V, Khim N, Ross LS, Saintpierre B, Beghain J, Chy S, Kim S, Ke S, Kloeung N, Eam R, Khean C, Ken M, Loch K, Bouillon A, Domergue A, Ma L, Bouchier C, Leang R, Huy R, Nuel G, Barale JC, Legrand E, Ringwald P, Fidock DA, Mercereau-Puijalon O, Ariey F, Ménard D. A surrogate marker of piperaquine-resistant Plasmodium falciparum malaria: a phenotype-genotype association study. Lancet Infect Dis 2016; 17:174-183. [PMID: 27818097 PMCID: PMC5266792 DOI: 10.1016/s1473-3099(16)30415-7] [Citation(s) in RCA: 239] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
Abstract
Background Western Cambodia is the epicentre of Plasmodium falciparum multidrug resistance and is facing high rates of dihydroartemisinin–piperaquine treatment failures. Genetic tools to detect the multidrug-resistant parasites are needed. Artemisinin resistance can be tracked using the K13 molecular marker, but no marker exists for piperaquine resistance. We aimed to identify genetic markers of piperaquine resistance and study their association with dihydroartemisinin–piperaquine treatment failures. Methods We obtained blood samples from Cambodian patients infected with P falciparum and treated with dihydroartemisinin–piperaquine. Patients were followed up for 42 days during the years 2009–15. We established in-vitro and ex-vivo susceptibility profiles for a subset using piperaquine survival assays. We determined whole-genome sequences by Illumina paired-reads sequencing, copy number variations by qPCR, RNA concentrations by qRT-PCR, and protein concentrations by immunoblotting. Fisher’s exact and non-parametric Wilcoxon rank-sum tests were used to identify significant differences in single-nucleotide polymorphisms or copy number variants, respectively, for differential distribution between piperaquine-resistant and piperaquine-sensitive parasite lines. Findings Whole-genome exon sequence analysis of 31 culture-adapted parasite lines associated amplification of the plasmepsin 2–plasmepsin 3 gene cluster with in-vitro piperaquine resistance. Ex-vivo piperaquine survival assay profiles of 134 isolates correlated with plasmepsin 2 gene copy number. In 725 patients treated with dihydroartemisinin–piperaquine, multicopy plasmepsin 2 in the sample collected before treatment was associated with an adjusted hazard ratio (aHR) for treatment failure of 20·4 (95% CI 9·1–45·5, p<0·0001). Multicopy plasmepsin 2 predicted dihydroartemisinin–piperaquine failures with 0·94 (95% CI 0·88–0·98) sensitivity and 0·77 (0·74–0·81) specificity. Analysis of samples collected across the country from 2002 to 2015 showed that the geographical and temporal increase of the proportion of multicopy plasmepsin 2 parasites was highly correlated with increasing dihydroartemisinin–piperaquine treatment failure rates (r=0·89 [95% CI 0·77–0·95], p<0·0001, Spearman’s coefficient of rank correlation). Dihydroartemisinin–piperaquine efficacy at day 42 fell below 90% when the proportion of multicopy plasmepsin 2 parasites exceeded 22%. Interpretation Piperaquine resistance in Cambodia is strongly associated with amplification of plasmepsin 2–3, encoding haemoglobin-digesting proteases, regardless of the location. Multicopy plasmepsin 2 constitutes a surrogate molecular marker to track piperaquine resistance. A molecular toolkit combining plasmepsin 2 with K13 and mdr1 monitoring should provide timely information for antimalarial treatment and containment policies. Funding Institut Pasteur in Cambodia, Institut Pasteur Paris, National Institutes of Health, WHO, Agence Nationale de la Recherche, Investissement d’Avenir programme, Laboratoire d’Excellence Integrative “Biology of Emerging Infectious Diseases”.
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Affiliation(s)
- Benoit Witkowski
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia; Malaria Translational Research Unit, Institut Pasteur, Paris, France; Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Valentine Duru
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Nimol Khim
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia; Malaria Translational Research Unit, Institut Pasteur, Paris, France; Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Leila S Ross
- Department of Microbiology and Immunology and Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Johann Beghain
- Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Sophy Chy
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Saorin Kim
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Sopheakvatey Ke
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Nimol Kloeung
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Rotha Eam
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Chanra Khean
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Malen Ken
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Kaknika Loch
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Anthony Bouillon
- Malaria Translational Research Unit, Institut Pasteur, Paris, France; Institut Pasteur in Cambodia, Phnom Penh, Cambodia; Structural Microbiology Unit, Biology of Malaria Targets Group, Department of Structural Biology and Chemistry and CNRS, UMR3528, Institut Pasteur, Paris, France
| | - Anais Domergue
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Laurence Ma
- Plate-forme Génomique, Département Génomes et Génétique, Institut Pasteur, Paris, France
| | - Christiane Bouchier
- Plate-forme Génomique, Département Génomes et Génétique, Institut Pasteur, Paris, France
| | - Rithea Leang
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Grégory Nuel
- Laboratoire de Mathématiques Appliquées (MAP5) UMR CNRS 8145, Université Paris Descartes, Paris, France
| | - Jean-Christophe Barale
- Malaria Translational Research Unit, Institut Pasteur, Paris, France; Institut Pasteur in Cambodia, Phnom Penh, Cambodia; Structural Microbiology Unit, Biology of Malaria Targets Group, Department of Structural Biology and Chemistry and CNRS, UMR3528, Institut Pasteur, Paris, France
| | - Eric Legrand
- Malaria Translational Research Unit, Institut Pasteur, Paris, France; Institut Pasteur in Cambodia, Phnom Penh, Cambodia; Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Pascal Ringwald
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - David A Fidock
- Department of Microbiology and Immunology and Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Frédéric Ariey
- Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France; Institut Cochin Inserm U1016, Université Paris-Descartes, Sorbonne Paris Cité, and Laboratoire de Parasitologie-Mycologie, Hôpital Cochin, Paris, France
| | - Didier Ménard
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia; Malaria Translational Research Unit, Institut Pasteur, Paris, France; Institut Pasteur in Cambodia, Phnom Penh, Cambodia.
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Chaorattanakawee S, Lon C, Jongsakul K, Gawee J, Sok S, Sundrakes S, Kong N, Thamnurak C, Chann S, Chattrakarn S, Praditpol C, Buathong N, Uthaimongkol N, Smith P, Sirisopana N, Huy R, Prom S, Fukuda MM, Bethell D, Walsh DS, Lanteri C, Saunders D. Ex vivo piperaquine resistance developed rapidly in Plasmodium falciparum isolates in northern Cambodia compared to Thailand. Malar J 2016; 15:519. [PMID: 27769299 PMCID: PMC5075182 DOI: 10.1186/s12936-016-1569-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/07/2016] [Indexed: 12/29/2022] Open
Abstract
Background The recent dramatic decline in dihydroartemisinin-piperaquine (DHA-PPQ) efficacy in northwestern Cambodia has raised concerns about the rapid spread of piperaquine resistance just as DHA-PPQ is being introduced as first-line therapy in neighbouring countries. Methods Ex vivo parasite susceptibilities were tracked to determine the rate of progression of DHA, PPQ and mefloquine (MQ) resistance from sentinel sites on the Thai–Cambodian and Thai–Myanmar borders from 2010 to 2015. Immediate ex vivo (IEV) histidine-rich protein 2 (HRP-2) assays were used on fresh patient Plasmodium falciparum isolates to determine drug susceptibility profiles. Results IEV HRP-2 assays detected the precipitous emergence of PPQ resistance in Cambodia beginning in 2013 when 40 % of isolates had an IC90 greater than the upper limit of prior years, and this rate doubled to 80 % by 2015. In contrast, Thai–Myanmar isolates from 2013 to 14 remained PPQ-sensitive, while northeastern Thai isolates appeared to have an intermediate resistance profile. The opposite trend was observed for MQ where Cambodian isolates appeared to have a modest increase in overall sensitivity during the same period, with IC50 declining to median levels comparable to those found in Thailand. A significant association between increased PPQ IC50 and IC90 among Cambodian isolates with DHA-PPQ treatment failure was observed. Nearly all Cambodian and Thai isolates were deemed artemisinin resistant with a >1 % survival rate for DHA in the ring-stage assay (RSA), though there was no correlation among isolates to indicate cross-resistance between PPQ and artemisinins. Conclusions Clinical DHA-PPQ failures appear to be associated with declines in the long-acting partner drug PPQ, though sensitivity appears to remain largely intact for now in western Thailand. Rapid progression of PPQ resistance associated with DHA-PPQ treatment failures in northern Cambodia limits drugs of choice in this region, and urgently requires alternative therapy. The temporary re-introduction of artesunate AS-MQ is the current response to PPQ resistance in this area, due to inverse MQ and PPQ resistance patterns. This will require careful monitoring for re-emergence of MQ resistance, and possible simultaneous resistance to all three drugs (AS, MQ and PPQ). Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1569-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suwanna Chaorattanakawee
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand.,Department of Parasitology and Entomology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Chanthap Lon
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand. .,USAMC-AFRIMS, Phnom Penh, Cambodia.
| | - Krisada Jongsakul
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | | | - Somethy Sok
- Royal Cambodian Armed Forces, Phnom Penh, Cambodia
| | - Siratchana Sundrakes
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | - Nareth Kong
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Chatchadaporn Thamnurak
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | | | - Sorayut Chattrakarn
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | - Chantida Praditpol
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | - Nillawan Buathong
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | - Nichapat Uthaimongkol
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | - Philip Smith
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | | | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Mark M Fukuda
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | - Delia Bethell
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | - Douglas S Walsh
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
| | - Charlotte Lanteri
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand.,Department of Pathology and Area Laboratory Services, Microbiology Section, Brooke Army Medical Center, San Antonio, TX, USA
| | - David Saunders
- US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
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40
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Siv S, Roca-Feltrer A, Vinjamuri SB, Bouth DM, Lek D, Rashid MA, By NP, Popovici J, Huy R, Menard D. Plasmodium vivax Malaria in Cambodia. Am J Trop Med Hyg 2016; 95:97-107. [PMID: 27708187 PMCID: PMC5201228 DOI: 10.4269/ajtmh.16-0208] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022] Open
Abstract
The Cambodian National Strategic Plan for Elimination of Malaria aims to move step by step toward elimination of malaria across Cambodia with an initial focus on Plasmodium falciparum malaria before achieving elimination of all forms of malaria, including Plasmodium vivax in 2025. The emergence of artemisinin-resistant P. falciparum in western Cambodia over the last decade has drawn global attention to support the ultimate goal of P. falciparum elimination, whereas the control of P. vivax lags much behind, making the 2025 target gradually less achievable unless greater attention is given to P. vivax elimination in the country. The following review presents in detail the past and current situation regarding P. vivax malaria, activities of the National Malaria Control Program, and interventional measures applied. Constraints and obstacles that can jeopardize our efforts to eliminate this parasite species are discussed.
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Affiliation(s)
- Sovannaroth Siv
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | | | - Seshu Babu Vinjamuri
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Denis Mey Bouth
- World Health Organization, Country Office, Phnom Penh, Cambodia
| | - Dysoley Lek
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | | | - Ngau Peng By
- Malaria Consortium Cambodia, Phnom Penh, Cambodia
| | - Jean Popovici
- Institute Pasteur in Cambodia (IPC), Phnom Penh, Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Didier Menard
- Institute Pasteur in Cambodia (IPC), Phnom Penh, Cambodia
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41
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Cavailler P, Tarantola A, Leo YS, Lover AA, Rachline A, Duch M, Huy R, Quake AL, Kdan Y, Duong V, Brett JL, Buchy P. Early diagnosis of dengue disease severity in a resource-limited Asian country. BMC Infect Dis 2016; 16:512. [PMID: 27670906 PMCID: PMC5036306 DOI: 10.1186/s12879-016-1849-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 09/17/2016] [Indexed: 12/03/2022] Open
Abstract
Background Dengue is endemic throughout Cambodia, a country faced with significant health and economic challenges. We undertook a clinical study at the National Paediatric Hospital in Phnom Penh to evaluate clinical diagnostic parameters for dengue and predictors of disease outcome. Methods Between September 2011 and January 2013, all consecutive inpatients aged between 1 and 15 years and presenting with suspected dengue were enrolled. They were clinically assessed using both the 1997 and 2009 WHO dengue classifications. Specimens were collected upon admission and discharge and tested for dengue at Institut Pasteur in Cambodia. Results A total of 701 patients were screened. Of these, 79 % were dengue-confirmed by laboratory testing, and 21 % tested dengue-negative. A positive tourniquet test, absence of upper respiratory symptoms, leukopenia, thrombocytopenia, and elevated liver transaminases were independent predictors for laboratory-confirmed dengue among the children. The presence of several warning signs on hospital admission was associated with a concurrent laboratory-confirmed diagnosis of severe disease outcome. Conclusions The presence of two or more warning signs was associated with a concurrent laboratory-confirmed diagnosis of severe dengue at hospital admission. Thus, a cumulative score combining simple clinical parameters and first-line laboratory findings could be used to accurately predict dengue virus infection in pediatric populations, optimizing triage in settings with limited laboratory resources. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1849-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philippe Cavailler
- Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. .,Current address: Agence de Médecine Préventive, 13 Chemin du Levant, Ferney-Voltaire, 01210, France.
| | - Arnaud Tarantola
- Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Yee Sin Leo
- Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Andrew A Lover
- Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Current address: Global Health Group, University of California, San Francisco, USA
| | - Anne Rachline
- Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Rekol Huy
- National Dengue Control Program (NDCP), National Center for Parasitological, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Ai Li Quake
- Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yuvatha Kdan
- National Paediatric Hospital, Phnom Penh, Cambodia
| | - Veasna Duong
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Jeremy L Brett
- Medical Affairs Department, Sanofi Pasteur, Singapore, Singapore.,Current address: Takeda Vaccines Pte Ltd., Singapore, Singapore
| | - Philippe Buchy
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia.,Current address: GlaxoSmithKline vaccines, 150 Beach road, Singapore, Singapore
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Hem S, Ly S, Votsi I, Vogt F, Asgari N, Buchy P, Heng S, Picardeau M, Sok T, Ly S, Huy R, Guillard B, Cauchemez S, Tarantola A. Estimating the Burden of Leptospirosis among Febrile Subjects Aged below 20 Years in Kampong Cham Communities, Cambodia, 2007-2009. PLoS One 2016; 11:e0151555. [PMID: 27043016 PMCID: PMC4820258 DOI: 10.1371/journal.pone.0151555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 03/01/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Leptospirosis is an emerging but neglected public health challenge in the Asia/Pacific Region with an annual incidence estimated at 10-100 per 100,000 population. No accurate data, however, are available for at-risk rural Cambodian communities. METHOD We conducted anonymous, unlinked testing for IgM antibodies to Leptospira spp. on paired sera of Cambodian patients <20 years of age between 2007-2009 collected through active, community-based surveillance for febrile illnesses in a convenience sample of 27 rural and semi-rural villages in four districts of Kampong Cham province, Cambodia. Leptospirosis testing was done on paired serological samples negative for Dengue, Japanese encephalitis and Chikungunya viruses after random selection. Convalescent samples found positive while initial samples were negative were considered as proof of acute infection. We then applied a mathematical model to estimate the risk of fever caused by leptospirosis, dengue or other causes in rural Cambodia. RESULTS A total of 630 samples are coming from a randomly selected subset of 2358 samples. IgM positive were found on the convalescent serum sample, among which 100 (15.8%) samples were IgM negative on an earlier sample. Seventeen of these 100 seroconversions were confirmed using a Microagglutination Test. We estimated the probability of having a fever due to leptospirosis at 1. 03% (95% Credible Interval CI: 0. 95%-1. 22%) per semester. In comparison, this probability was 2. 61% (95% CI: 2. 55%, 2. 83%) for dengue and 17. 65% (95% CI: 17. 49%, 18. 08%) for other causes. CONCLUSION Our data from febrile cases aged below 20 years suggest that the burden of leptospirosis is high in rural Cambodian communities. This is especially true during the rainy season, even in the absence of identified epidemics.
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Affiliation(s)
- Sopheak Hem
- Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Sowath Ly
- Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Irene Votsi
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Florian Vogt
- Masters of Science in Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nima Asgari
- World Health Organization, Phnom Penh, Cambodia
| | | | - Seiha Heng
- Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Mathieu Picardeau
- Institut Pasteur, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Touch Sok
- Communicable Diseases Control Department of the Ministry of Health, Phnom Penh, Cambodia
| | - Sovann Ly
- Communicable Diseases Control Department of the Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Dengue Control Program, National Center for Entomology, Parasitology, and Malaria Control, Phnom Penh, Cambodia
| | | | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
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Choi Y, Tang CS, McIver L, Hashizume M, Chan V, Abeyasinghe RR, Iddings S, Huy R. Effects of weather factors on dengue fever incidence and implications for interventions in Cambodia. BMC Public Health 2016; 16:241. [PMID: 26955944 PMCID: PMC4784273 DOI: 10.1186/s12889-016-2923-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background Dengue viruses and their mosquito vectors are sensitive to their environment. Temperature, rainfall and humidity have well-defined roles in the transmission cycle. Therefore changes in these conditions may contribute to increasing incidence. The aim of this study was to examine the relationship between weather factors and dengue incidence in three provinces in Cambodia, in order to strengthen the evidence basis of dengue control strategies in this high-burden country. Methods We developed negative binomial models using monthly average maximum, minimum, mean temperatures and monthly cumulative rainfall over the period from January 1998 to December 2012. We adopted piecewise linear functions to estimate the incidence rate ratio (IRR) between dengue incidence and weather factors for simplicity in interpreting the coefficients. We estimated the values of parameters below cut-points defined in terms of the results of sensitivity tests over a 0-3 month lagged period. Results Mean temperature was significantly associated with dengue incidence in all three provinces, but incidence did not correlate well with maximum temperature in Banteay Meanchey, nor with minimum temperature in Kampong Thom at a lag of three months in the negative binomial model. The monthly cumulative rainfall influence on the dengue incidence was significant in all three provinces, but not consistently over a 0-3 month lagged period. Rainfall significantly affected the dengue incidence at a lag of 0 to 3 months in Siem Reap, but it did not have an impact at a lag of 2 to 3 months in Banteay Meanchey, nor at a lag of 2 months in Kampong Thom. Conclusions The association between dengue incidence and weather factors also apparently varies by locality, suggesting that a prospective dengue early warning system would likely be best implemented at a local or regional scale, rather than nation-wide in Cambodia. Such spatial down-scaling would also enable dengue control measures to be better targeted, timed and implemented. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2923-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Youngjo Choi
- World Health Organization, Phnom Penh, Cambodia.
| | | | | | | | - Vibol Chan
- World Health Organization, Phnom Penh, Cambodia
| | | | | | - Rekol Huy
- National Center for Parasitology, Entomology & Malaria Control, Phnom Penh, Cambodia
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Canavati SE, Lawford HLS, Fatunmbi BS, Lek D, Top-Samphor N, Leang R, Dondorp AM, Huy R, Kazadi WM. Establishing research priorities for malaria elimination in the context of the emergency response to artemisinin resistance framework-the Cambodian approach. Malar J 2016; 15:120. [PMID: 26916933 PMCID: PMC4766599 DOI: 10.1186/s12936-016-1117-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Countries of the greater Mekong subregion have made a transition from malaria control to an aim for falciparum and vivax malaria elimination. The elimination of falciparum malaria will have to be achieved against a background of increasing artemisinin and multi-drug resistance. This ambitious goal requires an operational research (OR) agenda that addresses the dynamic challenges encountered on the path to elimination, which will need to be flexible and developed in close relation with the cambodian national programme for parasitology, entomology and malaria control (CNM). In Cambodia, a number of meetings with stakeholders were convened by the CNM and emergency response to artemisinin resistance (ERAR) hub, producing an initial list of priority OR topics. The process and outcome of these meetings are described, which could serve as a template for other countries in the region. Methods A landscaping exercise was conducted to gather all past, on-going and planned malaria focussed OR activities conducted by the cambodian research consortium in Cambodia and categorized according to research theme. The six themes included (1) malaria epidemiology, surveillance and response, (2) malaria case management, (3) malaria vector control, (4) malaria behavioural issues, (5) malaria clinical studies, and (6) other vector-borne diseases (dengue, neglected tropical diseases, soil-transmitted helminths). The different themes were discussed in small focus groups, which made an initial prioritization list which was then presented to a plenary group for further discussion. This produced a list of research questions ranked according to priority. Results OR priorities produced by the thematic groups were discussed in the plenary meeting and given a priority score by group voting. A list of 17 OR questions were developed, finalized and listed, which included questions on surveillance, active case detection and treatment efficacy. Conclusion This paper describes ERAR’s work on supporting Cambodia’s transition to malaria elimination by identifying national operational research priorities. ERAR has initiated and currently plays a critical role in the development of country specific research agendas for malaria elimination. The first example of this has been the described exercise in Cambodia, which could serve a template for setting OR priorities in the wider region.
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Affiliation(s)
- Sara E Canavati
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Rajthevee, Bangkok, Thailand.
| | - Harriet L S Lawford
- The National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
| | - Bayo S Fatunmbi
- Emergency Response to Artemisinin Resistance, WHO Representative Office in Cambodia, Penh Phnom Penh, Cambodia.
| | - Dysoley Lek
- The National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
| | - Narann Top-Samphor
- Emergency Response to Artemisinin Resistance, WHO Representative Office in Cambodia, Penh Phnom Penh, Cambodia.
| | - Rithea Leang
- The National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Rekol Huy
- The National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
| | - Walter M Kazadi
- Emergency Response to Artemisinin Resistance, WHO Representative Office in Cambodia, Penh Phnom Penh, Cambodia.
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Canavati SE, Lawford HLS, Fatunmbi BS, Lek D, Leang R, Top Samphor N, Dondorp AM, Huy R, Kazadi WM. The Cambodia Research Consortium: expediting research for malaria elimination with the emergency response to artemisinin resistance framework. Malar J 2016; 15:5. [PMID: 26727996 PMCID: PMC4700627 DOI: 10.1186/s12936-015-1062-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 12/19/2015] [Indexed: 11/10/2022] Open
Abstract
This commentary offers insight into how to best address barriers that may hinder the translation of malaria research findings into policy. It also proposes viable methods of implementing these policies in Cambodia. Currently, a wide range of malaria research is being conducted by in-country stakeholders, including Cambodia's National Programme for Parasitology, Entomology and Malaria Control's (CNM), non-governmental organizations, and academic institutions. Coordinating research amongst these partners, as well as within the Ministry of Health, is a challenge. Results are rarely disseminated widely and seldom inform programme and policy decisions. CNM and its research partners have severely limited access to each other's databases. This lack of accessibility, timeliness, engagement and cooperation between CNM and its partners greatly impacts overall research efficiency in this field, and is stifling innovation both within and beyond CNM. Cambodia has set a goal to eradicate all forms of malaria by 2030. As countries approach the elimination phase, there is a greater need for sharing research-generated evidence amongst partners, in order to ensure that appropriate and impactful activities are conducted. The Cambodian Research Consortium was established to serve as a framework for partners, stakeholders and researchers to share research projects, information and results, and to promote the goals of CNM. The sharing of malaria research results will help to inform prevention, control and elimination activities in the country. It will also determine and address the country's operational research needs, and could potentially become a framework model to be used in other countries aiming to transition from malaria control to elimination.
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Affiliation(s)
- Sara E Canavati
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Harriet L S Lawford
- The National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
| | - Bayo S Fatunmbi
- Emergency Response to Artemisinin Resistance, WHO Representative Office in Cambodia, Phnom Penh, Cambodia.
| | - Dysoley Lek
- The National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
| | - Rithea Leang
- The National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
| | - Narann Top Samphor
- Emergency Response to Artemisinin Resistance, WHO Representative Office in Cambodia, Phnom Penh, Cambodia.
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Rekol Huy
- The National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
| | - Walter M Kazadi
- Emergency Response to Artemisinin Resistance, WHO Representative Office in Cambodia, Phnom Penh, Cambodia.
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Duru V, Khim N, Leang R, Kim S, Domergue A, Kloeung N, Ke S, Chy S, Eam R, Khean C, Loch K, Ken M, Lek D, Beghain J, Ariey F, Guerin PJ, Huy R, Mercereau-Puijalon O, Witkowski B, Menard D. Plasmodium falciparum dihydroartemisinin-piperaquine failures in Cambodia are associated with mutant K13 parasites presenting high survival rates in novel piperaquine in vitro assays: retrospective and prospective investigations. BMC Med 2015; 13:305. [PMID: 26695060 PMCID: PMC4688949 DOI: 10.1186/s12916-015-0539-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The declining efficacy of dihydroartemisinin-piperaquine against Plasmodium falciparum in Cambodia, along with increasing numbers of recrudescent cases, suggests resistance to both artemisinin and piperaquine. Available in vitro piperaquine susceptibility assays do not correlate with treatment outcome. A novel assay using a pharmacologically relevant piperaquine dose/time exposure was designed and its relevance explored in retrospective and prospective studies. METHODS The piperaquine survival assay (PSA) exposed parasites to 200 nM piperaquine for 48 hours and monitored survival 24 hours later. The retrospective study tested 32 culture-adapted, C580Y-K13 mutant parasites collected at enrolment from patients treated with a 3-day course of dihydroartemisinin-piperaquine and having presented or not with a recrudescence at day 42 (registered ACTRN12615000793516). The prospective study assessed ex vivo PSA survival rate alongside K13 polymorphism of isolates collected from patients enrolled in an open-label study with dihydroartemisinin-piperaquine for uncomplicated P. falciparum malaria in Cambodia (registered ACTRN12615000696594). RESULTS All parasites from recrudescent cases had in vitro or ex vivo PSA survival rates ≥10%, a relevant cut-off value for piperaquine-resistance. Ex vivo PSA survival rates were higher for recrudescent than non-recrudescent cases (39.2% vs. 0.17%, P <1 × 10(-7)). Artemisinin-resistant K13 mutants with ex vivo PSA survival rates ≥10% were associated with 32-fold higher risk of recrudescence (95% CI, 4.5-224; P = 0.0005). CONCLUSION PSA adequately captures the piperaquine resistance/recrudescence phenotype, a mainstay to identify molecular marker(s) and evaluate efficacy of alternative drugs. Combined ex vivo PSA and K13 genotyping provides a convenient monitor for both artemisinin and piperaquine resistance where dihydroartemisinin-piperaquine is used.
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Affiliation(s)
- Valentine Duru
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Nimol Khim
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Rithea Leang
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
| | - Saorin Kim
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Anais Domergue
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Nimol Kloeung
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Sopheakvatey Ke
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Sophy Chy
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Rotha Eam
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Chanra Khean
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Kaknika Loch
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Malen Ken
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Dysoley Lek
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
| | - Johann Beghain
- Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France.
| | - Frédéric Ariey
- Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France.
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network, Oxford, UK. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK.
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
| | | | - Benoit Witkowski
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
| | - Didier Menard
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Boulevard Monivong, BP 983, Phnom Penh, Cambodia.
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Andries AC, Duong V, Ly S, Cappelle J, Kim KS, Lorn Try P, Ros S, Ong S, Huy R, Horwood P, Flamand M, Sakuntabhai A, Tarantola A, Buchy P. Value of Routine Dengue Diagnostic Tests in Urine and Saliva Specimens. PLoS Negl Trop Dis 2015; 9:e0004100. [PMID: 26406240 PMCID: PMC4583371 DOI: 10.1371/journal.pntd.0004100] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 08/31/2015] [Indexed: 11/23/2022] Open
Abstract
Background Dengue laboratory diagnosis is essentially based on detection of the virus, its components or antibodies directed against the virus in blood samples. Blood, however, may be difficult to draw in some patients, especially in children, and sampling during outbreak investigations or epidemiological studies may face logistical challenges or limited compliance to invasive procedures from subjects. The aim of this study was to assess the possibility of using saliva and urine samples instead of blood for dengue diagnosis. Methodology/Principal Findings Serial plasma, urine and saliva samples were collected at several time-points between the day of admission to hospital until three months after the onset of fever in children with confirmed dengue disease. Quantitative RT-PCR, NS1 antigen capture and ELISA serology for anti-DENV antibody (IgG, IgM and IgA) detection were performed in parallel on the three body fluids. RT-PCR and NS1 tests demonstrated an overall sensitivity of 85.4%/63.4%, 41.6%/14.5% and 39%/28.3%, in plasma, urine and saliva specimens, respectively. When urine and saliva samples were collected at the same time-points and tested concurrently, the diagnostic sensitivity of RNA and NS1 detection assays was 69.1% and 34.4%, respectively. IgG/IgA detection assays had an overall sensitivity of 54.4%/37.4%, 38.5%/26.8% and 52.9%/28.6% in plasma, urine and saliva specimens, respectively. IgM were detected in 38.1% and 36% of the plasma and saliva samples but never in urine. Conclusions Although the performances of the different diagnostic methods were not as good in saliva and urine as in plasma specimens, the results obtained by qRT-PCR and by anti-DENV antibody ELISA could well justify the use of these two body fluids to detect dengue infection in situations when the collection of blood specimens is not possible. Dengue is the most important arthropod-borne disease affecting humans and represents a huge public health burden in affected countries. Symptoms are often non-specific hence the need for an early, sensitive and specific diagnosis of dengue for appropriate management as well as for early epidemic detection. Currently, almost all laboratory diagnostic methods require a blood specimen that may be sometimes be difficult or inconvenient to obtain. In this study, we assessed the possibility to use saliva and urine samples as alternatives to blood specimens in dengue diagnosis. We demonstrated that the performances of the different diagnostic methods (RT-PCR, NS1 antigen detection and anti-DENV IgM/IgG/IgA ELISAs) were in general not as good in saliva and urine as in plasma, but that the use of these body fluids obtained by non-invasive methods could be of value in certain circumstances such as outbreak investigations or in young children (once they are old enough to comply to instructions), in addition to the situations when blood cannot be easily collected (e.g., lack of phlebotomist, refusal of the procedure, etc.).
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Affiliation(s)
| | - Veasna Duong
- Institut Pasteur in Cambodia, Virology Unit, Phnom Penh, Cambodia
| | - Sowath Ly
- Institut Pasteur in Cambodia, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Julien Cappelle
- Institut Pasteur in Cambodia, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
- Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), Unité AGIRs, Montpellier, France
| | - Kim Srorn Kim
- Kampong Cham Provincial Hospital, Pediatric Department, Kampong Cham, Cambodia
| | - Patrich Lorn Try
- Kampong Cham Provincial Hospital, Pediatric Department, Kampong Cham, Cambodia
| | - Sopheaktra Ros
- Institut Pasteur in Cambodia, Virology Unit, Phnom Penh, Cambodia
| | - Sivuth Ong
- Institut Pasteur in Cambodia, Virology Unit, Phnom Penh, Cambodia
| | - Rekol Huy
- Ministry of Health, Centre National de Malariologie, Phnom Penh, Cambodia
| | - Paul Horwood
- Institut Pasteur in Cambodia, Virology Unit, Phnom Penh, Cambodia
| | - Marie Flamand
- Institut Pasteur, Structural Virology Unit & CNRS UMR 3569, Paris, France
| | - Anavaj Sakuntabhai
- Institut Pasteur, Functional Genetics of Infectious Diseases Unit, Paris, France
- Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, Paris, France
| | - Arnaud Tarantola
- Institut Pasteur in Cambodia, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Philippe Buchy
- Institut Pasteur in Cambodia, Virology Unit, Phnom Penh, Cambodia
- GlaxoSmithKline Vaccines, Vaccine Value and Health Sciences, Singapore, Singapore
- * E-mail:
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Lover AA, Buchy P, Rachline A, Moniboth D, Huy R, Meng CY, Leo YS, Yuvatha K, Sophal U, Chantha N, Y B, Duong V, Goyet S, Brett JL, Tarantola A, Cavailler P. Spatial epidemiology and climatic predictors of paediatric dengue infections captured via sentinel site surveillance, Phnom Penh Cambodia 2011-2012. BMC Public Health 2014; 14:658. [PMID: 24972712 PMCID: PMC4085229 DOI: 10.1186/1471-2458-14-658] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 06/20/2014] [Indexed: 12/03/2022] Open
Abstract
Background Dengue is a major contributor to morbidity in children aged twelve and below throughout Cambodia; the 2012 epidemic season was the most severe in the country since 2007, with more than 42,000 reported (suspect or confirmed) cases. Methods We report basic epidemiological characteristics in a series of 701 patients at the National Paediatric Hospital in Cambodia, recruited during a prospective clinical study (2011–2012). To more fully explore this cohort, we examined climatic factors using multivariate negative binomial models and spatial clustering of cases using spatial scan statistics to place the clinical study within a larger epidemiological framework. Results We identify statistically significant spatial clusters at the urban village scale, and find that the key climatic predictors of increasing cases are weekly minimum temperature, median relative humidity, but find a negative association with rainfall maximum, all at lag times of 1–6 weeks, with significant effects extending to 10 weeks. Conclusions Our results identify clustering of infections at the neighbourhood scale, suggesting points for targeted interventions, and we find that the complex interactions of vectors and climatic conditions in this setting may be best captured by rising minimum temperature, and median (as opposed to mean) relative humidity, with complex and limited effects from rainfall. These results suggest that real-time cluster detection during epidemics should be considered in Cambodia, and that improvements in weather data reporting could benefit national control programs by allow greater prioritization of limited health resources to both vulnerable populations and time periods of greatest risk. Finally, these results add to the increasing body of knowledge suggesting complex interactions between climate and dengue cases that require further targeted research.
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Affiliation(s)
- Andrew A Lover
- Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore.
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Duong V, Andries AC, Ngan C, Sok T, Richner B, Asgari-Jirhandeh N, Bjorge S, Huy R, Ly S, Laurent D, Hok B, Roces MC, Ong S, Char MC, Deubel V, Tarantola A, Buchy P. Reemergence of Chikungunya virus in Cambodia. Emerg Infect Dis 2013; 18:2066-9. [PMID: 23171736 PMCID: PMC3557864 DOI: 10.3201/eid1812.120471] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chikungunya virus (CHIKV), probably Asian genotype, was first detected in Cambodia in 1961. Despite no evidence of acute or recent CHIKV infections since 2000, real-time reverse transcription PCR of serum collected in 2011 detected CHIKV, East Central South African genotype. Spatiotemporal patterns and phylogenetic clustering indicate that the virus probably originated in Thailand.
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Affiliation(s)
- Veasna Duong
- Institut Pasteur in Cambodia, Phnom Penh, Cambodia
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50
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Andries AC, Duong V, Ngan C, Ong S, Huy R, Sroin KK, Te V, Y B, Try PL, Buchy P. Field evaluation and impact on clinical management of a rapid diagnostic kit that detects dengue NS1, IgM and IgG. PLoS Negl Trop Dis 2012; 6:e1993. [PMID: 23301110 PMCID: PMC3531494 DOI: 10.1371/journal.pntd.0001993] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 11/16/2012] [Indexed: 12/04/2022] Open
Abstract
Background Dengue diagnosis is complex and until recently only specialized laboratories were able to definitively confirm dengue infection. Rapid tests are now available commercially making biological diagnosis possible in the field. The aim of this study was to evaluate a combined dengue rapid test for the detection of NS1 and IgM/IgG antibodies. The evaluation was made prospectively in the field conditions and included the study of the impact of its use as a point-of-care test for case management as well as retrospectively against a panel of well-characterized samples in a reference laboratory. Methodology/Principal Findings During the prospective study, 157 patients hospitalized for a suspicion of dengue were enrolled. In the hospital laboratories, the overall sensitivity, specificity, PPV and NPV of the NS1/IgM/IgG combination tests were 85.7%, 83.9%, 95.6% and 59.1% respectively, whereas they were 94,4%, 90.0%, 97.5% and 77.1% respectively in the national reference laboratory at Institut Pasteur in Cambodia. These results demonstrate that optimal performances require adequate training and quality assurance. The retrospective study showed that the sensitivity of the combined kit did not vary significantly between the serotypes and was not affected by the immune status or by the interval of time between onset of fever and sample collection. The analysis of the medical records indicates that the physicians did not take into consideration the results obtained with the rapid test including for care management and use of antibiotic therapy. Conclusions In the context of our prospective field study, we demonstrated that if the SD Bioline Dengue Duo kit is correctly used, a positive result highly suggests a dengue case but a negative result doesn't rule out a dengue infection. Nevertheless, Cambodian pediatricians in their daily practice relied on their clinical diagnosis and thus the false negative results obtained did not directly impact on the clinical management. Dengue is a potentially life-threatening viral disease. Symptoms are often not specific hence the importance to confirm the diagnosis during the early stage of the disease. Nevertheless, until recently only specialized laboratories were able to confirm dengue diagnosis. The discovery of the NS1 protein as a marker of infection has allowed the development of point-of-care tests for a rapid diagnosis confirmation. These tests have previously been evaluated by laboratories, but their performances have never been assessed in field conditions. In this study we evaluated the performance of SD Bioline Dengue Duo kit when tests were performed by hospital laboratories staff in a dengue hyper-endemic country. We also assessed the impact of the test results on the clinical management decision. The combination of NS1 test with antibodies detection improved the performance, though discordances on IgM and IgG results were observed between the hospitals and the national reference laboratories. Physicians treated patients according to their clinical diagnosis and did not take negative results into consideration.
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Affiliation(s)
- Anne-Claire Andries
- Institut Pasteur du Cambodge, Réseau international des Instituts Pasteur, Phnom Penh, Cambodia
| | - Veasna Duong
- Institut Pasteur du Cambodge, Réseau international des Instituts Pasteur, Phnom Penh, Cambodia
| | - Chantha Ngan
- National Dengue Control Program, National Center of Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Sivuth Ong
- Institut Pasteur du Cambodge, Réseau international des Instituts Pasteur, Phnom Penh, Cambodia
| | - Rekol Huy
- National Dengue Control Program, National Center of Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Kim Kim Sroin
- Kampong Cham Provincial Hospital, Pediatric Department, Kampong Cham, Cambodia
| | - Vantha Te
- Takeo Provincial Hospital, Pediatric Department, Takeo, Cambodia
| | - Bunthin Y
- Institut Pasteur du Cambodge, Réseau international des Instituts Pasteur, Phnom Penh, Cambodia
| | - Patrich Lorn Try
- Kampong Cham Provincial Hospital, Pediatric Department, Kampong Cham, Cambodia
| | - Philippe Buchy
- Institut Pasteur du Cambodge, Réseau international des Instituts Pasteur, Phnom Penh, Cambodia
- * E-mail:
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