#Threats of #Zika virus #transmission for #Asia and its Hindu-Kush #Himalayan region (Infect Dis Poverty., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Infect Dis Poverty. 2018 May 15;7(1):40. doi: 10.1186/s40249-018-0426-3.

Threats of Zika virus transmission for Asia and its Hindu-Kush Himalayan region.

Dhimal M1,2, Dahal S3, Dhimal ML4,5, Mishra SR6, Karki KB3, Aryal KK3, Haque U7, Kabir MI8, Guin P9,10, Butt AM11, Harapan H12, Liu QY13, Chu C14, Montag D15, Groneberg DA4, Pandey BD16, Kuch U4, Müller R4.

Author information: 1 Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal. meghdhimal@gmail.com. 2 Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany. meghdhimal@gmail.com. 3 Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal. 4 Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany. 5 Faculty of Social Sciences, Goethe University, Frankfurt am Main, Germany. 6 The University of Queensland, Brisbane, Australia. 7 Department of Public Health, Baldwin Wallace University, Berea, Ohio, USA. 8 Department of Epidemiology, National Institute of Preventive and Social Medicine, Ministry of Health and Family Welfare, Dhaka, Bangladesh. 9 Public Health Foundation of India, Gurgaon, Haryana, India. 10 Centre for Environmental Health, Gurgaon, Haryana, India. 11 Translational Genomics Laboratory, Department of Biosciences, COMSATS Institute of Information Technology (CIIT), Islamabad, 45550, Pakistan. 12 Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia. 13 WHO Collaborating Centre for Vector Surveillance and Management, SKLID, CCID, ICDC, China CDC, Beijing, China. 14 Centre for Environment and Population Health, Griffith University, Nathan, Queensland, Australia. 15 Barts and the London School of Medicine, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK. 16 Department of Health Services, Ministry of Health, Government of Nepal, Kathmandu, Nepal.



Asia and its Hindu Kush Himalayan (HKH) region is particularly vulnerable to environmental change, especially climate and land use changes further influenced by rapid population growth, high level of poverty and unsustainable development. Asia has been a hotspot of dengue fever and chikungunya mainly due to its dense human population, unplanned urbanization and poverty. In an urban cycle, dengue virus (DENV) and chikungunya virus (CHIKV) are transmitted by Aedes aegypti and Ae. albopictus mosquitoes which are also competent vectors of Zika virus (ZIKV). Over the last decade, DENV and CHIKV transmissions by Ae. aegypti have extended to the Himalayan countries of Bhutan and Nepal and ZIKV could follow in the footsteps of these viruses in the HKH region. The already established distribution of human-biting Aedes mosquito vectors and a naïve population with lack of immunity against ZIKV places the HKH region at a higher risk of ZIKV. Some of the countries in the HKH region have already reported ZIKV cases. We have documented an increasing threat of ZIKV in Asia and its HKH region because of the high abundance and wide distribution of human-biting mosquito vectors, climate change, poverty, report of indigenous cases in the region, increasing numbers of imported cases and a naïve population with lack of immunity against ZIKV. An outbreak anywhere is potentially a threat everywhere. Therefore, in order to ensure international health security, all efforts to prevent, detect, and respond to ZIKV ought to be intensified now in Asia and its HKH region. To prepare for possible ZIKV outbreaks, Asia and the HKH region can also learn from the success stories and strategies adopted by other regions and countries in preventing ZIKV and associated complications. The future control strategies for DENV, CHIKV and ZIKV should be considered in tandem with the threat to human well-being that is posed by other emerging and re-emerging vector-borne and zoonotic diseases, and by the continuing urgent need to strengthen public primary healthcare systems in the region.

KEYWORDS: Aedes aegypti; Aedes albopictus; Chikungunya virus; Dengue virus; Hindu Kush Himalayas; Mountain; Poverty, Zika virus

PMID: 29759076 DOI: 10.1186/s40249-018-0426-3

Keywords: Arbovirus; Dengue Fever; Chikungunya Fever; Zika Virus; Mosquitoes; Asia Region; Aedes spp.



#Origins of the current #outbreak of #MDR #malaria in southeast #Asia: a retrospective genetic study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Origins of the current outbreak of multidrug-resistant malaria in southeast Asia: a retrospective genetic study

Roberto Amato, PhD, Richard D Pearson, PhD, Jacob Almagro-Garcia, PhD, Chanaki Amaratunga, PhD, Pharath Lim, MD, Seila Suon, MD, Sokunthea Sreng, Eleanor Drury, Sc, Jim Stalker, MA, Olivo Miotto, PhD, Rick M Fairhurst, MD, Prof Dominic P Kwiatkowski, FRCP

Published: 01 February 2018 / Open Access / DOI: https://doi.org/10.1016/S1473-3099(18)30068-9

© 2018 The Author(s). Published by Elsevier Ltd.




Antimalarial resistance is rapidly spreading across parts of southeast Asia where dihydroartemisinin–piperaquine is used as first-line treatment for Plasmodium falciparum malaria. The first published reports about resistance to antimalarial drugs came from western Cambodia in 2013. Here, we analyse genetic changes in the P falciparum population of western Cambodia in the 6 years before those reports.


We analysed genome sequence data on 1492 P falciparum samples from 11 locations across southeast Asia, including 464 samples collected in western Cambodia between 2007 and 2013. Different epidemiological origins of resistance were identified by haplotypic analysis of the kelch13artemisinin resistance locus and the plasmepsin 2–3 piperaquine resistance locus.


We identified more than 30 independent origins of artemisinin resistance, of which the KEL1 lineage accounted for 140 (91%) of 154 parasites resistant to dihydroartemisinin–piperaquine. In 2008, KEL1 combined with PLA1, the major lineage associated with piperaquine resistance. By 2013, the KEL1/PLA1 co-lineage had reached a frequency of 63% (24/38) in western Cambodia and had spread to northern Cambodia.


The KEL1/PLA1 co-lineage emerged in the same year that dihydroartemisinin–piperaquine became the first-line antimalarial drug in western Cambodia and spread rapidly thereafter, displacing other artemisinin-resistant parasite lineages. These findings have important implications for management of the global health risk associated with the current outbreak of multidrug-resistant malaria in southeast Asia.


Wellcome Trust, Bill & Melinda Gates Foundation, Medical Research Council, UK Department for International Development, and the Intramural Research Program of the National Institute of Allergy and Infectious Diseases.

Keywords: Malaria; Asia Region; Antibiotics; Drugs Resistance; Artemisin; Piperaquine.


#Azithromycin #resistance in #Shigella spp. in Southeast #Asia (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Azithromycin resistance in Shigella spp. in Southeast Asia

Thomas C Darton1,2,  Ha Thanh Tuyen1,  Hao Chung The1,  Paul N Newton3,4, David A. B. Dance3,4,5,  Rattanaphone Phetsouvanh3,  Viengmon Davong3, James I Campbell1,  Nguyen Van Minh Hoang1,  Guy E Thwaites1,4, Christopher M Parry6,7,  Duy Pham Thanh1 and  Stephen Baker1,4,8*

Author Affiliations: 1 The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; 2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom; 3 Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos; 4 Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom; 5 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; 6 Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; 7 School of Tropical Medicine and Global Health, Nagasaki University, Japan; 8 The Department of Medicine, The University of Cambridge, Cambridge, United Kingdom



Infection by Shigella spp. is a common cause of dysentery in Southeast Asia. Antimicrobials are thought to be beneficial for treatment, however antimicrobial resistance in Shigella spp. is becoming widespread. We aimed to assess the frequency and mechanisms associated with decreased susceptibility to azithromycin in Southeast Asian Shigella isolates and use these data to assess appropriate susceptibility breakpoints. Shigella isolated in Vietnam and Laos were screened for susceptibility against azithromycin (15μg) by disc diffusion and minimum inhibitory concentration (MIC). Phenotypic resistance was confirmed by PCR amplification of macrolide resistance loci. We compared the genetic relationships and plasmid contents of azithromycin resistant S. sonnei using whole genome sequences. From 475 available Shigella spp. isolated in Vietnam and Laos between 1994 and 2012, 6/181 S. flexneri (3.3%, MIC≥16g/L) and 16/294 S. sonnei (5.4%, MIC≥32g/L) were phenotypically resistant to azithromycin. PCR amplification confirmed a resistance mechanism in 22/475 (4.6%) isolates (19 mphA and 3 ermB). Susceptibility data demonstrated the acceptability of S. flexneri(MIC≥16g/L, zone≤15mm) and S. sonnei (MIC≥32g/L, zone≤11mm) breakpoints with <3% discrepancy. Phylogenetic analysis demonstrated that decreased susceptibility has arisen sporadically in Vietnamese S. sonnei on at least seven occasions between 2000 and 2009, but failed to become established. While the proposed susceptibility breakpoints may allow better recognition of resistant isolates, additional studies are required to assess the impact on clinical outcome. The potential emergence of azithromycin resistance highlights the need for alternative management options for Shigella infections in endemic countries.



*Corresponding author: Professor Stephen Baker, the Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. Tel: +84 89241761 Fax: +84 89238904 sbaker@oucru.org

Copyright © 2018 Darton et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

Keywords: Antibiotics; Drugs Resistance; Shigella spp.; Azithromycin; Asian Region.


Neutralizing #Antibody Correlates Analysis of Tetravalent #Dengue #Vaccine Efficacy Trials in #Asia and Latin America (J Infect Dis., abstract)

[Source: The Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Neutralizing Antibody Correlates Analysis of Tetravalent Dengue Vaccine Efficacy Trials in Asia and Latin America 

Zoe Moodie, Ph.D. Michal Juraska, Ph.D. Ying Huang, Ph.D. Yingying Zhuang, M.S. Youyi Fong, Ph.D. Lindsay N Carpp, Ph.D. Steven G Self, Ph.D. Laurent Chambonneau, M.Sc. Robert Small, Ph.D. Nicholas Jackson, Ph.D. Fernando Noriega, M.D. Peter B Gilbert, Ph.D.

The Journal of Infectious Diseases, jix609, https://doi.org/10.1093/infdis/jix609

Published: 29 November 2017




In the CYD14 and CYD15 Phase 3 trials of the CYD-TDV dengue vaccine, estimated vaccine efficacy (VE) against symptomatic, virologically-confirmed dengue (VCD) occurring between Months 13 and 25 was 56.5% and 60.8%, respectively.


Neutralizing antibody titers to the four dengue serotypes in the CYD-TDV vaccine insert were measured at Month 13 in a randomly sampled immunogenicity sub-cohort and in all VCD cases through Month 25 (2848 vaccine, 1574 placebo) and studied for their association with VCD and with the level of VE to prevent VCD.


For each trial and serotype, vaccinees with higher Month 13 titer to the serotype had significantly lower risk of VCD with that serotype (hazard ratios 0.19−0.43 per 10-fold increase). Moreover, for each trial vaccinees with higher Month 13 average titer to the four serotypes had significantly higher VE against VCD of any serotype (P values < 0.001).


Neutralizing antibody titers post-dose three correlate with CYD-TDV VE to prevent dengue. High titers associate with high VE for all serotypes, baseline serostatus groups, age groups, and both trials. However, lowest titers do not fully correspond to zero VE, indicating that other factors influence VE.

Issue Section: Major Article

© The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Keywords: Dengue Fever; Vaccines; Asia Region; Africa Region.


The first external quality #assessment of #isolation and #identification of #influenza viruses in #cell culture in the #Asia #Pacific region, 2016 (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

The first external quality assessment of isolation and identification of influenza viruses in cell culture in the Asia Pacific region, 2016

Patrick C. Reading, Vivian K. Leung, Iwona Buettner, Leah Gillespie, Yi-Mo Deng, Robert Shaw, Natalie Spirason, Angela Todd, Kanta Subbarao, Aparna Singh Shah, Frank Konings, Ian G. Barr

DOI: http://dx.doi.org/10.1016/j.jcv.2017.10.018

Article Info: Publication History: Published online: November 01, 2017 – Accepted: October 31, 2017 – Received in revised form: October 27, 2017 – Received: August 1, 2017



  • An external quality assessment (EQA) was developed for influenza virus isolation.
  • National Influenza Centres (NICs) in the Asia Pacific Region performed the EQA.
  • NICs used a variety of techniques to confirm and identify influenza virus isolates.
  • The EQA revealed good proficiency and highlighted the need to improve sensitivity.




The isolation and propagation of influenza viruses from clinical specimens are essential tools for comprehensive virologic surveillance. Influenza viruses must be amplified in cell culture for detailed antigenic analysis and for phenotypic assays assessing susceptibility to antiviral drugs or for other assays.


To conduct an external quality assessment (EQA) of proficiency for isolation and identification of influenza viruses using cell culture techniques among National Influenza Centres (NICs) in the World Health Organisation (WHO) South East Asia and Western Pacific Regions.

Study design

Twenty-one NICs performed routine influenza virus isolation and identification techniques on a proficiency testing panel comprising 16 samples, containing influenza A or B viruses and negative control samples. One sample was used exclusively to determine their capacity to measure hemagglutination titer and the other 15 samples were used for virus isolation and identification.


All NICs performed influenza virus isolation using Madin Darby canine kidney (MDCK) or MDCK-SIAT-1 cells. If virus growth was detected, the type, subtype and/or lineage of virus present in isolates was determined using immunofluorescence, RT-PCR and/or hemagglutination inhibition (HI) assays. Most participating laboratories could detect influenza virus growth and could identify virus amplified from EQA samples. However, some laboratories failed to isolate and identify viruses from EQA samples that contained lower titres of virus, highlighting issues regarding the sensitivity of influenza virus isolation methods between laboratories.


This first round of EQA was successfully conducted by NICs in the Asia Pacific Region, revealing good proficiency in influenza virus isolation and identification.

Abbreviations: CC (Collaborating Centre), EQA (external quality assessment), GISRS (Global Influenza Surveillance and Response System), WPR (WHO Western Pacific Region), SEAR (WHO South East Asia Region), NIC (National Influenza Centre), MDCK (Madin Darby canine kidney), HA (hemagglutination), HI (hemagglutination inhibition), IF (immunofluorescence)

Keywords: influenza, virus isolation, external quality assessment

© 2017 Published by Elsevier B.V.

Keywords: Influenza A; Influenza B; Diagnostic Tests; Asia Region.


#Evolution and spatio-temporal #dynamics of #Enterovirus A71 subgenogroups in #Vietnam (J Infect Dis., abstract)

[Source: The Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Evolution and spatio-temporal dynamics of Enterovirus A71 subgenogroups in Vietnam

Nguyen Thi Thanh, Celeste Donato, Vu Thi Huyen Trang, Nguyen Trung Kien, Phạm Mai Thuy Trang, Tran Quoc Khanh, Dang Thi Nguyet, Hoang Quoc Cuong, Phan Trong Lan, Vu Thi Que Huong, H Rogier van Doorn, Vijaykrishna Dhanasekaran

#Corresponding author: Vijaykrishna Dhanasekaran vijay.dhanasekaran@monash.edu Department of Microbiology 19 Innovation Drive Monash University Clayton 3800 Phone: +613 9905 5415 Fax: +613 9902 9222

The Journal of Infectious Diseases, jix500, https://doi.org/10.1093/infdis/jix500

Published: 23 September 2017 – Received: 28 February 2017

Citation: Nguyen Thi Thanh Thao, Celeste Donato, Vu Thi Huyen Trang, Nguyen Trung Kien, Phạm Mai Thuy Trang, Tran Quoc Khanh, Dang Thi Nguyet, October Sessions, Hoang Quoc Cuong, Phan Trong Lan, Vu Thi Que Huong, H Rogier van Doorn, Vijaykrishna Dhanasekaran; Evolution and spatio-temporal dynamics of Enterovirus A71 subgenogroups in Vietnam, The Journal of Infectious Diseases, , jix500, https://doi.org/10.1093/infdis/jix500

© 2017 Oxford University Press




Enterovirus A71 (EV-A71) is the major cause of severe hand, foot and mouth disease and viral encephalitis in children across the Asia-Pacific region, including in Vietnam which has experienced a high burden of disease in recent years. Multiple subgenogroups (C1, C4, C5 and B5) concurrently circulate in the region with a large variation in epidemic severity. The relative differences in their evolution and epidemiology were examined within Vietnam and globally.


A total of 752 VP1 gene sequences were analysed (413 generated in this study combined with 339 obtained from GenBank), collected from patients in 36 provinces in Vietnam during 2003–2013 along with epidemiological metadata. Globally representative VP1 gene datasets of subgenogroups were used to co-estimate time-resolved phylogenies and relative genetic diversity to infer virus origins and regional transmission network.


Despite frequent virus migration between countries, the highest genetic diversity of individual subgenogroups was maintained independently for several years in specific Asian countries representing genogroup-specific sources of EV-A71 diversity.


This study highlights a persistent transmission network of EV-A71, with specific Asian countries seeding other countries in the region and beyond, emphasising the need for improved EV-A71 surveillance and detailed genetic and antigenic characterisation.

Enterovirus A71, Vietnam, Hand Foot and Mouth Disease, Phylogenetics

Topic: metadata – enterovirus – epidemiology – hand-foot-and-mouth disease – asia – child – cost of illness – viral encephalitis – genes – phylogeny – vietnam – genetics – viruses – persistence – epidemic – surveillance, medical – asian – absolute risk reduction – genbank – datasets

Issue Section: Major Article

© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Keywords: EV-71; HFMD; Asian Region; Vietnam.


A #clinical approach to the #threat of emerging #influenza viruses in the #Asia-Pacific region (Respirology, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Respirology. 2017 Jul 5. doi: 10.1111/resp.13114. [Epub ahead of print]

A clinical approach to the threat of emerging influenza viruses in the Asia-Pacific region.

Hui DSC1,2, Lee N1,2, Chan PKS2,3.

Author information: 1 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong. 2 Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong. 3 Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong.



Seasonal influenza epidemics and periodic pandemics are important causes of morbidity and mortality. Patients with chronic co-morbid illness, those at the extremes of age and pregnant women are at higher risks of complications requiring hospitalization, whereas young adults and obese individuals were also at increased risk during the A(H1N1) pandemic in 2009. Avian influenza A(H5N1) and A(H7N9) viruses have continued to circulate widely in some poultry populations and infect humans sporadically since 1997 and 2013, respectively. The recent upsurge in human cases of A(H7N9) infections in Mainland China is of great concern. Sporadic human cases of avian A(H5N6), A(H10N8) and A(H6N1) have also emerged in recent years while there are also widespread poultry outbreaks due to A(H5N8) in many countries. Observational studies have shown that treatment with a neuraminidase inhibitor (NAI) for adults hospitalized with severe influenza is associated with lower mortality and better clinical outcomes, especially when administered early in the course of illness. Whether higher than standard doses of NAI would provide greater antiviral effects in such patients will require further investigation. High-dose systemic corticosteroids were associated with worse outcomes in patients with severe influenza. There is an urgent need for developing more effective antiviral therapies for treatment of influenza infections.

© 2017 Asian Pacific Society of Respirology.

KEYWORDS: avian influenza; respiratory tract infections; seasonal; treatment; viral

PMID: 28677861 DOI: 10.1111/resp.13114

Keywords: Avian Influenza; H7N9; H5N1; H5N6; H10N8; H6N1; Human; Asian Region.