Although the mortality rate due to hepatocellular carcinoma (HCC) has been gradually decreasing in Japan, approximately 30 000 people died of HCC in 2016. In 2007, the dominant etiology was persistent hepatitis C virus (HCV) infection, which accounted for 65% of total HCC deaths, and 15% of cases were due to chronic hepatitis B virus (HBV) infection. In managing chronic HBV and HCV infection, it is critically important to know the exact number of infected individuals in a particular country, which then assists in evaluating medical and financial needs in the foreseeable future. Therefore, from an epidemiological perspective, we estimated the numbers of HBV and HCV carriers in four categories: (i) undiagnosed carriers; (ii) carriers who were already hospitalized as patients or were receiving outpatient medical attention; (iii) diagnosed carriers who had not consulted any medical facility, or had discontinued consultation; and (iv) newly infected carriers. From these estimates we determined the current HBV and HCV burden and then reviewed the existing countermeasures for their prevention and control in Japan. While continuing the surveillance on the dynamics of hepatitis virus infections linked with preventive measures against hepatitis virus infection, it is crucially important to promote appropriate measures for each of the four groups of hepatitis virus carriers in society.

Highlights This study proved of Cambodia achieving WHO 2017 target of <1% HBsAg prevalence. HBsAg prevalence in 5–7 years old children was 0.56% (95%CI: 0.32%–0.98%). HBsAg prevalence among the mothers was 4.39% (3.53%–5.45%). Among children with HBsAg-positive mother, prevalence was as high as 10.11%. 78.4% of children received HepB birth-dose and 58.7% were administered ≤24 h.

Background and objectives Myanmar adopted the World Health Organization (WHO) Package for Essential Non-Communicable Disease Interventions (PEN) in 20 pilot townships in 2017. This study was conducted to assess the implementation of PEN, its effectiveness and understand the facilitators and barriers in its implementation. Methods Mixed methods design involving a quantitative component (retrospective study analysing both aggregate and individual patient data from PEN project records; cross-sectional facility survey using a structured checklist) and a descriptive qualitative component. Results A total of 152,446 individuals were screened between May 2017-December 2018 comprising of current smokers (17.5%), tobacco chewers (26.3%), Body Mass Index �25 kg/m 2 (30.6%), raised blood pressure i.e. � 140/90 mmHg (35.2%) and raised blood sugar i.e. Random Blood Sugar >200 mg/dl, Fasting Blood Sugar >126 mg/dl (17.1%). Nearly 14.8% of those screened had Cardiovascular Disease (CVD) risk score �20%, 34.6% had CVD risk not recorded. Of 663 patients registered with diabetes and/or hypertension in 05 townships, 27 (4.1%) patients made three follow-up visits after the baseline visit, of whom, CVD risk assessment, systolic blood pressure and blood sugar measurement was done in all visits in 89.0%, 100.0% and 78.0% of cases respectively. Health facility assessment showed 64% of the sanctioned posts were filled; 90% of those appointed been trained in PEN; key

Although hepatitis B (HBV) and C (HCV) virus infections are still global health issues, measuring sero-markers by standard venipuncture is challenging in areas limited with the adequate human resources and basic infrastructure. This study aimed to inform the usefulness of dried blood spot (DBS) sampling technique for epidemiological study of HBV and HCV in the resources limited areas. We compared specimen recovery rate expressed as analytical sensitivity ratio of HBsAg, HBcAb and anti-HCV between serum specimens and DBS samples (HemaSpot vs Whatman903). Sensitivity ratio was calculated as the ratio of the measured value from DBS to the measured value from serum. Then both the qualitative and quantitative comparisons of HBsAg detection by DBS were done using Cambodian samples. HBsAg, HBcAb and anti-HCV sensitivity ratios for the highest sample dilution (8fold) were 31.2:1, 38.9:1 and 32.0:1 for Whatman903 card and 17.6:1, 23.5:1 and 26.3:1 for HemaSpot respectively. Detection efficacy of HemaSpot (80%) was not inferior to Whatman903 (60%) after 1 month storage, and no significant difference in any hepatitis virus sero-markers was observed in HemaSpot-spotted patient samples stored for 2 weeks at −25 °C and 29 °C. All reference HemaSpot-spotted 400 HBsAg sero-negative samples showed negative. Sensitivity and specificity of HBsAg in HemaSpot were 92.3% and 100%. The recovery expressed as analytical sensitivity ratio of HBsAg, HBcAb and anti-HCV of HemaSpot specimen were not inferior to Whatman903. Therefore, DBS with its usefulness proved as an acceptable tool for large epidemiological study of HBV and HCV in resources limited remote area. Hepatitis B virus (HBV) and hepatitis C virus (HCV) constitute a global health issue. Although there are the effective hepatitis B vaccine since 1982 1 and anti-viral drugs such as interferon alpha, lamivudine and others (tenofovir, adefovir, etc) 2,3 , WHO reported that approximately 257 million people have been infected with HBV and only 16.7% of the people diagnosed with hepatitis B were on anti-viral treatment as of 2016 4. Similarly, even there is no vaccine for HCV till now, the direct-acting antiviral drugs (DAAs) for the treatment of HCV were initially developed in 2011 5 and have since yielded high sustained virologic responses (SVRs) 6. But, WHO reported that 71 million people have been chronically infected with HCV and approximately 19% of global population (13.1 millions) knew their diagnosis and around 5 million only had treated with DAA at the end of 2017 7. Therefore, the World Health Organization (WHO) announced in 2016 a target to eliminate HBV as public health threats by 2030 by reducing the hepatitis B surface antigen (HBsAg) prevalence among children to ≤0.1% 8 and to eliminate HCV by 90% reduction in new diagnosis and 65% reduction in HCV related mortality by 2030 9. However, both

Aim This study aimed to survey the prevalence and incidence of hepatitis B (HBV) and hepatitis C virus (HCV) infection among elementary school students in Siem Reap province, Cambodia and to evaluate the effects of a national infant HBV vaccination program introduced in 2001. Methods Students in 3rd grade during the 2011, 2012, and 2013 academic years were enrolled in this study; at the time of the second examination, in the 2014–2015 academic year, the students were in 5th or 6th grade. The incidence and prevalence rates of HBV and HCV infection were estimated and full HBV sequences were analyzed. Results Among 248 students (107 male and 141 female) born between 1999 and 2005, five students were HBV surface antigen (HBs‐Ag) positive (2.02%), and all of them were infected with genotype C. Among them, subgenotype C1 was found in four students and, unexpectedly, complete genetic sequence identity of subgenotype C1 was found in two students from different families. The anti‐HBV core (HBc) and anti‐HBs prevalence rates were 10.89% and 16.13%, respectively. Twenty‐five students were positive for anti‐HBs and negative for both HBsAg and anti‐HBc (10.08%; estimated serological vaccination rate); this rate increased significantly with the birth year (P = 0.0229). Prevalence of anti‐HCV was 2.82%, and HCV RNA was not detected. The estimated incidence of HBV and HCV infection were both 0/1000 person‐years (PY) (95% confidence interval, 0–20.61/1000 PY and 0–14.50/1000 PY, respectively). Conclusion Hepatitis B virus full‐genome sequencing and serological analysis revealed the possibility of horizontal transmission of HBV among Cambodian schoolchildren. However, the anti‐HBc positivity rate decreased along with increasing age and estimated serological vaccination rates.

BackgroundHypertension is the leading risk factor for cardiovascular diseases, and little is known about trends in prevalence, awareness, treatment and the control of hypertension in Myanmar. This study aims at evaluating changes from 2004 to 2014 in the prevalence, awareness, treatment and control of hypertension in the Yangon Region, Myanmar, and to compare associations between hypertension and selected socio-demographic, behavioural- and metabolic risk factors in 2004 and 2014.MethodsIn 2004 and 2014, household-based cross-sectional studies were conducted in urban and rural areas of Yangon Region using the WHO STEPS protocol. Through a multi-stage cluster sampling method, a total of 4448 and 1486 participated in 2004 and 2014, respectively, with the response rates above 89%.ResultsFrom 2004 to 2014, there was a significant increase in the age-standardized prevalence of hypertension from 26.7% (95% CI:24.4-29.1) – 34.6% (32.2-37.1), as well as an awareness from 19.4% (17.2-21.9) to 27.8% (24.9-31.0), while treatment and control rates did not change. The age-standardized mean systolic blood pressure increased from 122.8 (SE) ± 0.82 mmHg in 2004 to 128.1 ± 0.53 mmHg in 2014, whereas diastolic blood pressure increased from 76.2 ± 0.35 mmHg to 80.9 ± 0.53 mmHg. In multivariate analyses, hypertension was significantly associated with age, alcohol consumption, overweight and diabetes in both 2004 and 2014, and additionally associated with low physical activity and hypercholesterolemia in 2004. Combining all data, a significant association between study-year and hypertension persisted in different models with an adjustment for socio-demographic variables and behavioural variables, but not when adjusting for a combination of socio-demographic variables, the metabolic variables, BMI and hypercholesterolemia.ConclusionThe prevalence of hypertension has risen from 2004 to 2014 in both urban and rural areas of the Yangon Region, while, the awareness, treatment and control rate of hypertension remains low in urban and rural areas among both males and females. It is likely that changes in the metabolic variables, BMI and hypercholesterolemia have contributed to an increase in the prevalence of hypertension from 2004 to 2014. Factors associated with hypertension in both study years were age, alcohol consumption, overweight and diabetes. A national hypertension control programme should be implemented in order to reduce premature deaths in Myanmar.Electronic supplementary materialThe online version of this article (10.1186/s12889-017-4870-y) contains supplementary material, which is available to authorized users.

Background Myanmar, a low-income Southeast Asia country with an estimated population of 53.9 million, is currently facing an increasing burden of noncommunicable diseases. Research that systematically measures and reports the national prevalence of diabetes and prediabetes within Myanmar represents a gap in the literature. This study, a national survey, was conducted with the objectives of 1) measuring diabetic population, 2) measuring the prediabetic population, and 3) finding out the risk factors leading to diabetes and prediabetes in Myanmar. Method Multistage sampling was applied in proportional cluster approach to recruit a nationally representative sample of 8,575 participants from 52 townships selected to represent 332 townships across the country. The Ethical Committee of the Department of Medical Research (Lower Myanmar) approved the current study. Fasting plasma glucose and the level of glucose 2 hours after 75 g glucose load were applied, to screen for diabetes and prediabetes. Interviewer-administered questionnaires were carried out to investigate demographic and lifestyle behaviors. Stadiometer, weighing scale, measuring tape, and Omron blood pressure monitor measuring devices were used for the anthropometric measurements. Survey data analysis used STATA version 13 and application of descriptive statistics with multinomial logistic regression. Result Prevalence of diabetes in Myanmar was 10.8%: 11.5% in males and 9.2% in females. Overall prevalence of prediabetes was 19.7%: 16.5% in males and 23% in females. Increasing age, urban residence, big waist circumference, and high triglyceride level were significant factors associated with diabetes and prediabetes. Many people with diabetes were found to lack knowledge and awareness of diabetes. Conclusion Diabetes prevalence in Myanmar is high, and relatively higher than that reported in many Association of Southeast Asian Nations countries. The study findings call for urgent nationwide public health action in Myanmar such as screening people at risk of diabetes and prevention of the disease. The findings can also assist the health authority in Myanmar with the preparation and allocation of resources for diabetes prevention.

Background In this study, we performed molecular characterization of SARS-CoV-2 strains in Hiroshima and its mutation pattern between the first and second waves of the outbreak. Method A total of 55 nasal swab samples from the first wave in Hiroshima and 13 from the second wave were examined quantitatively by RT-qPCR and qualitatively by nested PCR using specific primers. Four samples from each wave underwent next-generation sequencing and phylogenetic tree analysis including controls and all sequences retrieved in Japan from GISAID and GenBank. Subsequently, mutations were examined. Results Viral load ranged 7.85 × 101−1.42 × 108 copies/ml. Of 68 samples, one was Asian type-O, 65 were European type-GR, and 2 were undetectable. Phylogenetic tree analysis indicated that Japan was infected with various Asian strains (L, S, V, O) from January through April. By second week of March, European strains (G, GH, GR) had appeared, and GR strains became predominant after mid-March. The first case in Hiroshima was classified as Asian strain O, and the rest were GR strains. Then, second wave of GR strains appeared independently with 11–15 base mutations. Comparing the first- and second-wave GR strains, mutation rate was 1.17–1.36 × 10−3 base substitutions per site per year; in addition, amino acid changes occurred at S1361P and P3371S in ORF1a, A314V in ORF1b, and P151L in N. All seven GR strains were D614G variants with R202K and G203R mutations in N. A single-nucleotide insertion in ORF8 that causes a defect in ORF8 protein was found in one isolate (S66) from the second wave. Conclusion Our findings reveal the evolutionary hierarchy of SARS-CoV-2 in Japan. The predominant D614G variants and a new form of ORF8 deletion in Hiroshima provide the clue for role of viral factor in local outbreaks of SARS-CoV-2.