SummaryBackgroundBecause of reductions in the incidence of Plasmodium falciparum malaria in Laos, identification of the causes of fever in people without malaria, and discussion of the best empirical treatment options, are urgently needed. We aimed to identify the causes of non-malarial acute fever in patients in rural Laos.MethodsFor this prospective study, we recruited 1938 febrile patients, between May, 2008, and December, 2010, at Luang Namtha provincial hospital in northwest Laos (n=1390), and between September, 2008, and December, 2010, at Salavan provincial hospital in southern Laos (n=548). Eligible participants were aged 5–49 years with fever (≥38°C) lasting 8 days or less and were eligible for malaria testing by national guidelines.FindingsWith conservative definitions of cause, we assigned 799 (41%) patients a diagnosis. With exclusion of influenza, the top five diagnoses when only one aetiological agent per patient was identified were dengue (156 [8%] of 1927 patients), scrub typhus (122 [7%] of 1871), Japanese encephalitis virus (112 [6%] of 1924), leptospirosis (109 [6%] of 1934), and bacteraemia (43 [2%] of 1938). 115 (32%) of 358 patients at Luang Namtha hospital tested influenza PCR-positive between June and December, 2010, of which influenza B was the most frequently detected strain (n=121 [87%]). Disease frequency differed significantly between the two sites: Japanese encephalitis virus infection (p=0·04), typhoid (p=0·006), and leptospirosis (p=0·001) were more common at Luang Namtha, whereas dengue and malaria were more common at Salavan (all p<0·0001). With use of evidence from southeast Asia when possible, we estimated that azithromycin, doxycycline, ceftriaxone, and ofloxacin would have had significant efficacy for 258 (13%), 240 (12%), 154 (8%), and 41 (2%) of patients, respectively.InterpretationOur findings suggest that a wide range of treatable or preventable pathogens are implicated in non-malarial febrile illness in Laos. Empirical treatment with doxycycline for patients with undifferentiated fever and negative rapid diagnostic tests for malaria and dengue could be an appropriate strategy for rural health workers in Laos.FundingWellcome Trust, WHO–Western Pacific Region, Foundation for Innovative New Diagnostics, US Centers for Disease Control and Prevention.

Background  Information on influenza virology and epidemiology from Lao PDR is limited and the seasonal patterns of influenza have not been previously described. Objectives  To describe epidemiological and virologic characteristics of influenza in Lao PDR to recommend public health interventions, including improvements in surveillance and response. Patients/Methods  We performed a descriptive analysis of samples taken from patients with influenza‐like‐illness (ILI) (fever >38°C with cough and/or sore throat) presenting at seven sentinel hospitals in three regions of Lao PDR, January 2008–December 2010. A nasopharyngeal (NP) swab or combined nasal with oropharyngeal swab was collected from patients with ILI. Samples were tested for influenza by either Luminex RVP, conventional reverse transcriptase PCR (RT‐PCR) (January 2008–2009), or by real‐time PCR (rRT‐PCR) using US CDC reagents (February 2009 onward). Results  Of 2346 samples tested from patients with ILI, 523 (22%) were positive for influenza. The median age of those positive was 12 years (range, <1–60 year). The percentage of samples that were influenza positive was similar over the 3 years (20–23%). Each year 3–4 types/subtypes cocirculated with differing predominant type/subtype. Influenza was detected year‐round with the highest proportion of positive specimens in the 3rd and 4th quarter. Conclusions  Similar to other countries in the region, we found that influenza is present year‐round and has a peak activity from July to December. Dominant types or subtypes vary by year. A large proportion of patients with ILI are not influenza positive. ILI surveillance is critical for weighing disease burden, both morbidity and mortality, against the costs of advancing influenza vaccine delivery strategy.

In May 2012, the first authenticated cases of active chikungunya virus infection were detected in Champasak Province, Southern Laos. Analysis of series of human samples and mosquito specimens collected during the outbreak and over the year that followed the emergence enabled the drawing up of a map of the progression of CHIKV and the establishment of a full genetic characterization of the virus.

Despite high sexually transmitted infection (STI) prevalence in the Pacific, there are limited data on STIs and risk among men who have sex with men (MSM) and transgender people (TG). In 2011, an Integrated Bio-Behavioural Survey recruited self-identified MSM and TG in Port Vila, Vanuatu. Descriptive findings were stratified by sexuality. Among 28 (55%) MSM and 23 (45%) TG, recent anal sex with male partners was more common among MSM (94% vs 71%; P < 0.1), including with casual (47% vs 35%), regular (59% vs 29%) and paying partners (28% vs 12%). MSM more commonly reported lifetime (P < 0.01) and recent sex with female partners (P < 0.01). Reported condom use with any partner type was low. More MSM (35%) than TG (24%) were diagnosed with an STI; previous treatment-seeking behaviour when symptomatic was lower among TG (P < 0.1). Tailored strategies acknowledging differences between MSM and TG are required to reduce STI vulnerability in Vanuatu.

The Lao People's Democratic Republic (PDR) committed to pandemic detection and response preparations when faced with the threat of avian influenza. Since 2006, the National Center for Laboratory and Epidemiology of Lao PDR has developed credible laboratory, surveillance, and epidemiological (human) capacity and as a result was designated a World Health Organization National Influenza Center in 2010. The Lao PDR experience in building influenza capacities provides a case study of the considerable crossover effect of such investments to augment the capacity to combat emerging and re-emerging diseases other than influenza.