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We report a new norovirus GII.4 variant, GII.4 Hong Kong, with low-level circulation in 4 Eurasia countries since mid-2017. Amino acid substitutions in key residues on the virus capsid associated with the emergence of pandemic noroviruses suggest that GII.4 Hong Kong has the potential to become the next pandemic variant.

Rotavirus (RV) is an important cause of diarrheal disease particularly in children aged under 5 years. Monovalent RV vaccine (RVV) was selectively introduced in 2012 in the Philippines and in July 2014 was introduced in the public health program of a province. Two RVV doses are recommended at 6 and 10 weeks of age. We conducted a test negative case-control evaluation to assess the effectiveness of RVV when given in a routine public health program in the Philippines. From September 2014 to August 2017, 967 children aged <5 years were hospitalized with diarrhea and of these, we enrolled 600 who were eligible to have received RVV and provided stool specimens for testing. Among children ≥8 months of age who were age-eligible to have received RVV, at least one dose of RVV had an adjusted vaccine effectiveness (VE) against RV hospitalization of 60% (95% confidence interval, CI: 24%, 79%), and against severe rotavirus diarrhea, VE was 64% (95% CI: 11%, 85%). These findings support the introduction of RVV into routine public health use in the Philippines. However, other factors such as costs, cost-effectiveness and operational issues must be considered prior to adoption of the vaccine into the countries’ public immunization program.

HighlightsStarting in 2012, RVV was introduced in public health clinics of Agusan del Sur province.Declines in diarrheal hospitalizations and consults were seen following RVV introduction.No declines in diarrheal admissions were observed in a province where RVV was not introduced.This is the first evidence of the public health impact of RVV in a middle income country Asia.

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Purpose: Pneumocystis jivoreci is an opportunistic pathogen which can lead to life threatening respiratory failure. It has a documented mortality of between 5-20%. Historically it was almost exclusive to HIV patients however; an increase in immunosuppressive therapies has led to a reciprocal increase in the prevalence of Pneumocystis pneumonia (PJP) in this non-HIV population.Despite clear guidelines for PJP prophylaxis in HIV, there is a haphazard approach in other immunosuppressed populations.A growing body of evidence suggests that immunosuppressed patients are at an increased risk of PJP, but to what extent, or to whom that risk is greatest is not certain.Given this uncertainty we felt it prudent to review regional rates of PJP to develop a clearer understanding of the potential at risk population.Methods & Materials: We audited a random cohort of 103 patients with Pneumocystis pneumonia over a 5 year period in a region in the United Kingdom. We collated information on potential risk factors, morbidity and mortality.Results: The highest proportion of patients were cancer patients, however the most at risk population were rheumatology patients, with a 73% mortality rate in those who tested positive for PCP.Admission to ICU was 38% and mortality was 32%. Mortality was highest when prescribed three modalities of immunosuppression in combination; however prednisolone alone carries a mortality rate of 62%. Conclusion:We feel that prophylaxis guidelines should be considered in these identified high risk groups, but much more study is required on the absolute risk, and on how prophylaxis should be approached.

To assess the prevalence of hepatitis B in the Philippines, we conducted a cross-sectional study among 5 to 6 year old children born in 2007–2008, when the birth dose started to be implemented in the country. The study was conducted from 25 July to 22 October 2013 in 24 provinces and used a 3-stage cluster design and probability-proportional to size sampling. Blood was obtained and sera were tested for hepatitis B surface antigen (HBsAg). The survey included 2,769 children, of whom 26% received a timely birth dose (within 24 hours of birth) and 89% received 3 doses of the hepatitis B vaccine. Due to problems in the initial testing algorithm, only 2,407 sera were available for HBsAg testing, 20 (weighted%, 0.86%) were HBsAg positive. By immunization card and recall, among HBsAg positive children, 2 (weighted%, 20%) received a timely birth dose while 17 (weighted%, 85%) received 3 doses of the hepatitis B vaccine. The seroprevalence of HBsAg that we detected was lower than expected. However, there were several limitations in the field and in the laboratory that may have affected the representativeness of the results. Follow up studies need to be conducted to validate these results.