Crimean-Congo hemorrhagic fever virus (CCHFV) is endemic in Asia, infecting many animal hosts, but CCHFV has not been reported in Myanmar. We conducted a seroepidemiologic survey of logging communities in Myanmar and found CCHFV exposure was common (9.8%) and exposure to wild animal blood and body fl uids was associated with seropositivity.
Dengue fever, caused by the mosquito-borne dengue virus (DENV), has been endemic in Myanmar since 1970 and it has become a significant public health burden. It is crucial that circulating DENV strains are identified and monitored, and that their transmission efficiency and association with disease severity is understood. In this study, we analyzed DENV-1, DENV-2, DENV-3, and DENV-4 serotypes in 1235 serum samples collected in Myanmar between 2017 and 2019. Whole-genome sequencing of DENV-1–4 demonstrated that most DENV-1–4 strains had been circulating in Myanmar for several years. We also identified the emergence of DENV-3 genotype-I in 2017 samples, which persisted through 2018 and 2019. The emergence of the strain coincided with a period of increased DENV-3 cases and marked changes in the serotype dynamics. Nevertheless, we detected no significant differences between serum viral loads, disease severity, and infection status of individuals infected with different DENV serotypes during the 3-year study. Our results not only identify the spread of a new DENV-3 genotype into Yangon, Myanmar, but also support the importance of DENV evolution in changing the epidemic dynamics in endemic regions.
Background
Rotavirus vaccine was planned to be introduced in the National Immunization Program of Myanmar in 2020. Reported potential association of a small increased risk of intussusception after rotavirus vaccination in some countries is a major safety concern and it is mandatory to collect baseline information before vaccine introduction.
Methods
Retrospective study reviewed medical records of intussusception cases for past 3 years (2015–2018) and prospective, active study was conducted from August 2018 to January 2020 at three tertiary children hospitals where pediatric surgical facility is present. Brighton Level 1 Criteria was used for confirmation of intussusception among children <2 years of age admitted to surgical wards. Demographic, clinical, diagnostic and treatment practices data were collected and descriptive data analysis was performed.
Results
A total of 697 (421 in retrospective and 276 in prospective) confirmed intussusception cases were identified. Majority of intussusception cases (550/697, 78.9%) were observed in the first year of life and most frequent between 5-7 months of age (292/697, 41.9%) with a peak at 6 months (114/697, 16.4%). The most common clinical presentations were vomiting and bloody diarrhea accounting 82.1% and 77.5% respectively. Regarding diagnosis and treatment, 458/697 (65.7%) required surgical intervention either manual reduction or intestinal resection and 34.4% by either air or barium enema. Overall mortality was 0.7% (5/697) and four out of five children died needed intestinal resection. Late arrival to hospital (>3days after onset) is significantly associated with requirement of surgery (61/85, 71.8%), which in turn is significantly associated with longer hospital stay (296/452, 65.5%) (p < 0.05).
Conclusions
Intussusception occurrence is most frequent between 5-7 months age group which is old enough to be vaccinated under the schedule that has now been introduced in Myanmar. More than half of the cases were treated by surgery and late arrival to hospital enhances requirement of surgery and poor outcome. Findings of this baseline surveillance provide important facts for public health officials in balancing risks and benefits of rotavirus vaccine introduction, defining targeted age and dosage scheduling and facilitate monitoring system in post-vaccination.
A hospital-based prospective active surveillance for rotavirus gastroenteritis (RVGE) was conducted among hospitalised acute gastroenteritis (AGE) patients to identify the infecting rotavirus strains and to provide epidemiological information on RVGE in Myanmar. Stool samples were collected from children less than 5 years old admitted to Yangon Children’s Hospital (YCH) for AGE during January 2015 to September 2017. Collected stool samples were screened for rotavirus antigen by ELISA and genotyped by reverse transcription polymerase chain reaction (RT-PCR). Overall, 48.8% (1,167/2,393) of samples were ELISA positive for rotavirus and the most affected were children aged 6-23 months, 81.9% (956/1,167). RVGE occurred in a seasonal cycle with peak detection in the cold and dry months (November to February). As compared with non-RVGE, RVGE cases had significant higher percentage of vomiting (84.5% versus 73.0%; P<0.05), fever (80.1% versus 71.8%; P<0.05) and severe clinical scoring (79.4% versus 67.5%; P<0.05). Genotyping revealed that G9P[8] was predominant in the year 2015 (53.3%) and 2016 (30.9%), but it was replaced in 2017 by G3P[8] (58.2%). Information from this surveillance not only highlights facts for consideration of rotavirus vaccine introduction plan in pre-vaccination era, but also provides vital baseline data for post-vaccination monitoring of vaccine impact and effectiveness.
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