No abstract

Thalassemias are inherited blood disorders that are found in high prevalences in the Mediterranean, Southeast Asia and the Pacific. These diseases provide varying levels of resistance to malaria and are proposed to have emerged as an adaptive response to malaria in these regions. The transition to agriculture in the Holocene has been suggested to have influenced the selection for thalassemia in the Mediterranean as land clearance for farming encouraged interaction between Anopheles mosquitos, the vectors for malaria, and human groups. Here we document macroscopic and microscopic skeletal evidence for the presence of thalassemia in both hunter-gatherer (Con Co Ngua) and early agricultural (Man Bac) populations in northern Vietnam. Firstly, our findings demonstrate that thalassemia emerged prior to the transition to agriculture in Mainland Southeast Asia, from at least the early seventh millennium BP, contradicting a long-held assumption that agriculture was the main driver for an increase in malaria in Southeast Asia. Secondly, we describe evidence for significant malarial burden in the region during early agriculture. We argue that the introduction of farming into the region was not the initial driver of the selection for thalassemia, as it may have been in other regions of the world.

Skeletal evidence of two probable cases of treponematosis, caused by infection with the bacterium Treponema pallidum, from the northern Vietnamese early Neolithic site of Man Bac (1906–1523 cal B.C.) is described. The presence of nodes of subperiosteal new bone directly associated with superficial focal cavitations in a young adult male and a seven-year- old child are strongly diagnostic for treponemal disease. Climatic and epidemiological contexts suggest yaws (Treponema pallidum pertenue) as the most likely causative treponeme. This evidence is the oldest discovered in the Asia-Pacific region and is the first well-established pre-Columbian example in this region in terms of diagnosis and secure dating. The coastal ecology, sedentary settlement, and high fertility at the site of Man Bac all provided a biosocial context conducive to the spread of treponemal disease among inhabitants of the site. Co-morbidity with scurvy in both individuals demonstrates that malnutrition during the agricultural transition may have exacerbated the expression of treponematosis in this community. Man Bac is a site of great regional importance owing to its role during the Neolithic transition of Mainland Southeast Asia. During this transition, approximately 4,000 years ago, farmers migrating from southern China into Southeast Asia influenced a number of changes in subsistence and demography and potentially introduced new infectious diseases such as treponematosis to indigenous forager communities. The findings presented here may encourage reevaluation of existing Southeast Asian skeletal samples and demonstrate the importance of using weighted diagnostic criteria for future reporting of treponematosis cases. Hai trường hợp nhiều khả năng mắc bệnh ghẻ cóc do nhiễm vi khuẩn Treponema pallidum, thuộc di chỉ Mán Bạc sơ kì đá mới Việt Nam (cal 1906–1523 B.C.) được mô tả trên bằng chứng di cốt. Sự có mặt của các hạt xương mới dưới màng xương trực tiếp liên quan đến các lỗ ổ bề mặt ở một nam trẻ tuổi trưởng thành và một trẻ em 7 tuổi là chẩn đoán nhiều khả năng cho bệnh này. Bối cảnh khí hậu và dịch tễ học cho thấy bệnh ghẻ cóc do nhiễm xoắn khuẩn Treponema pallidum pertenue là nguyên nhân phổ biến nhất. Bằng chứng trên được phát hiện muộn nhất ở khu vực Châu Á-Thái Bình Dương và là một ví dụ điển hình đầu tiên giai đoạn tiền Columbia trong khu vực này dựa vào chẩn đoán và định niên đại chính xác. Sinh thái biển, lối sống ít di động, và tỷ lệ sinh sản cao ở di chỉ Mán Bạc, tất cả đã tạo ra sự tương tác giữa các yếu tố sinh học và xã hội thuận lợi cho việc lây lan bệnh ghẻ cóc giữa các cư dân thuộc di chỉ này. Cùng với đó là sự mắc bệnh thiếu vitamin C (scurvy) ở cả hai cá thể trên chỉ ra rằng sự suy dinh dưỡng trong suốt quá trình chuyển tiếp nông nghiệp có thể trầm trọng hơn và biểu hiện bệnh ghẻ cóc ở cộng đồng này. Mán Bạc là một di chỉ vùng quan trọng bởi vì nó nằm trong ranh giới giai đoạn chuyển tiếp Đá Mới của Đông Nam Á lục địa. Trong suốt bước chuyển này, khoảng 4000 năm cách đây, các cư dân nông nghiệp di cư từ miền nam Trung Quốc vào Đông Nam Á đã ảnh hưởng nhiều thay đổi trong phương thức sinh kế, dân số, và mang theo bệnh nhiễm trùng mới tiềm ẩn như là bệnh ghẻ cóc vào các cộng đồng nông nghiệp bản địa . Các phát hiện trình bày trên đây hi vọng sẽ là khởi đầu đánh giá lại về sự tồn tại các di cốt Đông Nam Á và minh họa tầm quan trọng của việc sử dụng tiêu chí chẩn đoán tin cậy về các trường hợp bệnh ghẻ cóc cho nghiên cứu tiếp theo.

Objective Scurvy in non‐adults was assessed at the Pre‐Neolithic site of Con Co Ngua and the Neolithic site of Man Bac in northern Vietnam to investigate nutritional stress during the agricultural transition in Mainland Southeast Asia (MSEA). Materials One hundred and four human skeletons under the age of 20 years old were assessed. Methods Lesions were recorded macroscopically and radiographically. Differential diagnosis using prior established paleopathological diagnostic criteria for scurvy was conducted. Results There was no clear evidence for scurvy at Con Co Ngua and a high burden of scurvy was present at Man Bac (>79% diagnosed with probable scurvy). Scurvy levels were high across all non‐adult ages at Man Bac indicating significant burden throughout childhood and adolescence. Conclusions No scurvy at Con Co Ngua is consistent with widely available food sources at the peak of the Holocene thermal maximum. High levels of scurvy at Man Bac corresponds with decreased dietary diversity, high pathogen load, and increased population stress with the transition to agriculture around the time of the 4.2 ka desertification event. Significance This is the first systematic population‐level non‐adult investigation of specific nutritional disease in MSEA and demonstrates an increase in nutritional stress during the Neolithic transition in northern Vietnam. Limitations Subperiosteal new bone deposits can be due to normal growth in infants and young children, therefore, identification of scurvy in children under the age of 4 years needs to be considered critically. Suggestions for Further Research Further work in diagnosing specific nutritional disease in other non‐adult cohorts throughout MSEA is required.

Objectives: Con Co Ngua is a complex, sedentary forager site from northern Vietnam dating to the early seventh millennium BP. Prior research identified a calcified Echinococcus granulosis cyst, which causes hydatid disease. Osteolytic lesions consistent with hydatid disease were also present in this individual and others. Hydatid disease is observed in high frequencies in pastoralists, and its presence in a hunter-gatherer community raises questions regarding human-animal interaction prior to farming. The objective of this article is to identify and describe the epidemiology of hydatid disease in the human skeletal assemblage at Con Co Ngua.Materials and methods: One hundred and fifty-five individuals were macroscopically assessed for lesions. Of these, eight individuals were radiographed. Hydatid disease was diagnosed using a new threshold criteria protocol derived from clinical literature, which prioritizes lesions specific to the parasite.Results: Twenty-two individuals (14.2%) presented with osteolytic lesions consistent with hydatid disease, affecting the distal humerus, proximal femur and forearm, and pelvis. Seven individuals radiographed (4.5%) had multilocular cystic lesions strongly diagnostic for hydatid disease. All probable cases had lesions of the distal humerus.The remaining lesions were macroscopically identical to those radiographed and were considered possible cases.Discussion: While hydatid disease has previously been found in pre-agricultural communities, the high prevalence at Con Co Ngua is non-incidental. We propose that the presence of wild canids and management of wild buffalo and deer increased the risk of disease transmission. These findings further reveal subsistence complexity among hunter-gatherers living millennia prior to the adoption of farming in Southeast Asia.