Background Acute lower respiratory infection (ALRI) remains the leading cause of death in children worldwide, and viruses have been the major cause of ALRI. In Myanmar, ALRI is associated with high morbidity and mortality in children, and detailed information on ALRI is currently lacking. Methods This prospective study investigated the viral aetiologies, clinical manifestations, and outcomes of ALRI in hospitalised children aged 1 month to 12 years at the Yankin Children Hospital, Yangon, Myanmar from May 2017 to April 2019. The sample size was set to 300 patients for each year. Two nasopharyngeal swabs were obtained for the patients with suspected viral ALRI; one for rapid tests for influenza and respiratory syncytial virus (RSV), and the other for real-time PCR for the 16 ALRI-causing viruses. Pneumococcal colonization rates were also investigated using real-time PCR. Clinical information was extracted from the medical records, and enrolled patients were categorised by age and severity for comparison. Results Among the 5463 patients admitted with a diagnosis of ALRI, 570 (10.4%) were enrolled in this study. The median age of the patients was 8 months (interquartile range, 4–15 months). The most common symptoms were cough (93%) and difficulty in breathing (73%), while the most common signs of ALRI were tachypnoea (78%) and chest indrawing (67%). A total of 16 viruses were detected in 502 of 570 patients’ samples (88%), with RSV B (36%) and rhinovirus (28%) being the most commonly detected. Multiple viruses were detected in 221 of 570 samples (37%) collected from 570 patients. Severe ALRI was diagnosed in 107 of 570 patients (19%), and RSV B and human rhinovirus were commonly detected. The mortality rate was 5%; influenza virus A (29%) and RSV B (21%) were commonly detected, and stunting and lack of immunization were frequently observed in such cases. Additionally, 45% (259/570) of the patients had pneumococcal colonization. Conclusions Viral ALRI in hospitalised children with a median of 8 months has significant morbidity and mortality rates in Myanmar. RSV and rhinovirus were the most commonly detected from nasopharyngeal swabs, while influenza virus and RSV were the most frequently associated with fatal cases.

A community outbreak of human influenza A(H1N1)pdm09 virus strains was observed in Myanmar in 2017. We investigated the circulation patterns, antigenicity, and drug resistance of 2017 influenza A(H1N1)pdm09 viruses from Myanmar and characterized the full genome of influenza virus strains in Myanmar from in-patients and outpatients to assess the pathogenicity of the viruses. Nasopharyngeal swabs were collected from outpatients and inpatients with acute respiratory tract infections in Yangon and Pyinmana City in Myanmar during January-December 2017. A total of 215 outpatients and 18 in-patients infected with A(H1N1)pdm09 were detected by virus isolation and real-time RT-PCR. Among the positive patients, 90.6% were less than 14 years old. Hemagglutination inhibition (HI) antibody titers against A(H1N1)pdm09 viruses in Myanmar were similar to the recommended Japanese influenza vaccine strain for 2017-2018 seasons (A/Singapore/GP1908/2015) and WHO recommended 2017 southern hemisphere vaccine component (A/Michigan/45/2015). Phylogenetic analysis of the hemagglutinin sequence showed that the Myanmar strains belonged to the genetic subclade 6B.1, possessing mutations of S162N and S164T at potential antigenic sites. However, the amino acid mutation at position 222, which may

Glucose-6-phosphate dehydrogenase (G6PD) deficiency may affect the clinical presentation of dengue due to the altered redox state in immune cells. We aimed to determine the association between G6PD deficiency and severity of dengue infection in paediatric patients in Myanmar. A cross-sectional study was conducted among paediatric patients aged 2–13 years with dengue in Yankin Children Hospital, Myanmar. One hundred and ninety-six patients positive for dengue infection, as determined via PCR or ELISA, were enrolled. Dengue severity was determined according to the 2009 WHO classification guidelines. Spectrophotometric assays determined G6PD levels. The adjusted median G6PD value of males in the study population was used to define various cut-off points according to the WHO classification guidelines. G6PD genotyping for Mahidol, Kaiping and Mediterranean mutations was performed for 128 out of 196 samples by real-time multiplex PCR. 51 of 196 (26.0%) patients had severe dengue. The prevalence of G6PD phenotype deficiency (< 60% activity) in paediatric patients was 14.8% (29/196), specifically, 13.6% (14/103) in males and 16.2% (15/93) in females. Severe deficiency (< 10% activity) accounted for 7.1% (14/196) of our cohort, occurring 11.7% (12/103) in males and 2.2% (2/93) in females. Among 128 samples genotyped, the G6PD gene mutations were detected in 19.5% (25/128) of patients, with 20.3% (13/ 64) in males and 18.8% (12/64) in females. The G6PD Mahidol mutation was 96.0% (24/25) while the G6PD Kaiping mutation was 4.0% (1/25). Severe dengue was not associated with G6PD enzyme deficiency or presence of the G6PD gene mutation. Thus, no association between G6PD deficiency and dengue severity could be detected.Trial registration: The study was registered following the WHO International Clinical Trials Registry Platform (WHO-ICTRP) on Thai Clinical Trials Registry (TCTR) website, registration number # TCTR20180720001

lower, than in the ] ng/ml (p>0.05); ] pg/ml and 8.5 [3.3-46.0] pg/ml respectively (p<0.05); ] pg/ml and 26.5 [11.2-79.2] pg/ml respectively (p<0.001). In women with obesity, 45 (83.3%) children were mature, 9 (16.7%)premature. Mean gestational age of mature newborns -38.4±0.2 weeks, premature -33.8±0.6 weeks (p<0.001). Body weight of mature children was 3,680.0 [2,958.0-4,040.0] grams, premature -2,000.0 [1525-2065] grams (p<0.001). Median level of 25(OH)D in mature newborns -8.8 [4.0-14.6] ng/ml, in premature -4.0 [3.9-4.5] ng/ml (p<0.01); IL-1b -20.4 [11.2-34.0] pg/ml and 38.1 [32.0-93.8] pg/ml respectively (p<0.01); IL-6 -84.6 [56.6-166.8] pg/ml, versus 64.6 [32.0-161.6] pg/ml (p>0.05). In mothers with obesity, 14 (25.9%) newborns had intrauterine infection, calcidiol level was 6.4 [4.0-13.4] ng/ml; IL-1b -17.4 [9.2-23.9] pg/ml; IL -6 -92.8 [45.6-190.6] pg/ml, which is 3.5 times higher, than in the CG (p<0.01).Conclusions The vast majority of newborns, born by mothers with obesity, had hypovitaminosis D, these children also had conclusively high level of IL-1b and IL-6. In newborns with intrauterine infection, IL-1b and IL-6 content reaches the highest level versus the CG.

Background Acute lower respiratory infection (ALRI) remains the leading cause of death in children worldwide, and viruses have been the major causative factors of ALRI after the introduction of bacterial conjugate vaccines. In Myanmar, ALRI is associated with high morbidity and mortality in children. However, detailed information on ALRI is currently lacking. Methods We conducted a prospective study to investigate the viral aetiologies, clinical manifestations, and outcomes of ALRI in hospitalised children at the Yankin Children Hospital, Yangon, Myanmar from May 2017 to April 2019. The World Health Organization’s definitions of ALRI and severe ALRI were used with minor modifications. For the patients with suspected viral ALRI, a nasopharyngeal swab was obtained, and rapid tests for influenza and respiratory syncytial virus (RSV) were performed, followed by real-time PCR for the 16 respiratory viruses causing ALRI. Clinical information was extracted from the medical records. Results Among the 5463 patients admitted with a diagnosis of ALRI, 570 (10.4%) were randomly enrolled in the study. The median age of the patients was 8 months (interquartile range, 4–15 months). The most common symptoms were cough (93%) and difficulty of breathing (73%), while the most common signs were tachypnoea (78%) and chest indrawing (67%). Sixteen potentially causative viruses were detected in 502 (88%) patients, with RSV B (36%) and rhinovirus (28%) being the most commonly detected. Multiple viruses were detected simultaneously in 221 patients (37%). Severe ALRI was diagnosed in 107 patients (19%). The mortality rate was 5%; influenza virus A (29%) and RSV B (21%) were commonly detected in such cases. Conclusions Viral ALRI in children has significant morbidity and mortality rates in Myanmar. RSV and rhinovirus were the most commonly detected, while influenza virus and RSV were the most common causes of mortality.