BackgroundSoutheast Asia is a region with great potential for the emergence of a pandemic influenza virus. Global efforts to improve influenza surveillance in this region have documented the burden and seasonality of influenza viruses and have informed influenza prevention strategies, but little information exists about influenza vaccination guidelines and vaccine sales.MethodsTo ascertain the existence of influenza vaccine guidelines and define the scope of vaccine sales, we sent a standard three-page questionnaire to the ten member nations of the Association of Southeast Asian Nations. We also surveyed three multinational manufacturers who supply influenza vaccines in the region.ResultsVaccine sales in the private sector were <1000 per 100,000 population in the 10 countries. Five countries reported purchasing vaccine for use in the public sector. In 2011, Thailand had the highest combined reported rate of vaccine sales (10,333 per 100,000). In the 10 countries combined, the rate of private sector sales during 2010–2011 (after the A(H1N1)2009pdm pandemic) exceeded 2008 pre-pandemic levels. Five countries (Indonesia, Malaysia, Singapore, Thailand and Vietnam) had guidelines for influenza vaccination but only two were consistent with global guidelines. Four recommended vaccination for health care workers, four for elderly persons, three for young children, three for persons with underlying disease, and two for pregnant women.ConclusionsThe rate of vaccine sales in Southeast Asia remains low, but there was a positive impact in sales after the A(H1N1)2009pdm pandemic. Low adherence to global vaccine guidelines suggests that more work is needed in the policy arena.

This study highlights a persistent transmission network of EV-A71, with specific Asian countries seeding other countries in the region and beyond, emphasizing the need for improved EV-A71 surveillance and detailed genetic and antigenic characterization.

BackgroundHo Chi Minh City and Bangkok are highly dengue endemic. The extent to which disease patterns are attributable to local versus regional dynamics remains unclear. To address this gap we compared key transmission parameters across the locations.Methods and Principal FindingsWe used 2003–2009 age-stratified case data to inform catalytic transmission models. Further, we compared the spatial clustering of serotypes within each city. We found that annual case numbers were highly consistent across the two cities (correlation of 0.77, 95% CI: 0.74–0.79) as was the annual force of infection (correlation of 0.57, 95% CI: 0.46–0.68). Serotypes were less similar with serotype-specific correlations ranging from 0.65 for DENV1 to -0.14 for DENV4. Significant spatial clustering of serotypes was observed in HCMC at distances <500m, similar to previous observations from Bangkok.DiscussionsDengue dynamics are comparable across these two hubs. Low correlation in serotype distribution suggests that similar built environments, vector populations and climate, rather than viral flow drives these observations.

HIV testing during pregnancy facilitates timely antiretroviral treatment for HIV-positive women. This study identifies reasons for late HIV testing among pregnant women delivering at a hospital in Ho Chi Minh City. We conducted a case-control study in which 160 cases were women who were tested for HIV late (i.e., at labor and delivery) and 160 controls were women who were tested during antenatal care (ANC). In multivariable logistic regression analysis, six variables were associated with late HIV testing: age less than 30 years, nine or fewer years of education, working as a homemaker or worker/farmer, living 20 km or more from the hospital, having received ANC at a private clinic/hospital only, and not believing that HIV testing is important during pregnancy. We recommend that national programs should provide additional effort for HIV testing during pregnancy to young women, less educated women, homemakers, and those receiving ANC at private clinics and hospitals.

DISCLAIMER This paper was submitted to the Bulletin of the World Health Organization and was posted to the COVID-19 open site, according to the protocol for public health emergencies for international concern as described in Vasee Moorthy et al. (http://dx.doi.org/10.2471/BLT.20.251561). The information herein is available for unrestricted use, distribution and reproduction in any medium, provided that the original work is properly cited as indicated by the Creative Commons Attribution 3.0 Intergovernmental Organizations licence (CC BY IGO 3.0).

As of 13 July 2016, 13 countries have reported fetal Zika virus (ZIKV) infection. Here we report a case of fetal ZIKV infection that resulted from an infection originating in Vietnam. Funding StatementThe author(s) received no specific funding for this work. ReportOn March 30, 2016, a woman at eight weeks of pregnancy presented with one day of rash, conjunctivitis, and fatigue to a hospital in Ho Chi Minh City, Vietnam. Blood samples were collected and tested for ZIKV using primers and probes as previously described 1 . Real-time RT-PCR was positive for ZIKV and negative for rubella virus. Two days after the initial blood draw, a repeat blood sample and a urine sample were collected. The urine sample tested positive for ZIKV by RT-PCR, but the later blood sample was negative. Viral RNA isolated from the urine sample was amplified using previously defined primers ZIKVENVF and ZIKVENVR and sequenced 2 . Sequence results indicate that the strain isolated from this patient is most closely related to those isolated previously in Malaysia (2012) and French Polynesia (2013).The patient reported no recent travel. Her husband had been working in Malaysia, returning to visit Vietnam from March 16th to 19th. He reported no symptoms in the month prior to his visit to Vietnam, and no cases of Zika had been reported in the area where he worked. The patient denied any sexual contact 12 days prior to the onset of symptoms, the assumed longest incubation period for Zika 5 . The patient's two-year old daughter experienced similar symptoms three days before her mother, however samples were only collected after the resolution of symptoms and were negative by RT-PCR.Seven days after her onset of symptoms the patient was seen in a prenatal clinic for counseling regarding ZIKV infection during pregnancy. A 8-week ultrasound performed the week before had shown a viable fetus, however at the visit, a repeat ultrasound was performed that indicated fetal demise. The following day a suction aspiration abortion was performed, during which samples were taken from both the placenta and fetus. Both the fetal and placental samples were positive by ZIKV RT-PCR, while negative for rubella.The previous lack of reported microcephaly in Asia and Africa had led to speculation regarding ZIKV strain differences in relation to teratogenicity. This case indicates that the viral strain present in Asia also has the ability to cause infection in utero. It is possible fetal infection was not previously noted in Asia due to limited surveillance systems for birth defects, or to early in life infection that provides immunity at child bearing age, or possibly, due to a more gradual spread of the disease.This report is one of the first documented cases of ZIKV infection in Vietnam, however it is likely that infection has been occurring for many years without detection or diagnosis. Since the increased awareness of the risk of ZIKV infection, three tourists have been identified who were infected while traveling in Veitnam and two local cases have been conf...

Background. There is a shortage of chemical reagents for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis and a surge of SARS-CoV-2 cases, especially in limited-resource settings. Therefore, the combination of an optimal assay kit is necessary. Methods. We compared the ability to screen SARS-CoV-2 among three primer-probe sets in two different master mixes, Invitrogen™ SuperScript™ III One-Step RT-PCR and LightCycler Multiplex RNA Virus Master. Results. The assay with TIB-Molbiol, IDT, and Phu Sa sets for LightCycler Multiplex RNA Virus Master or Invitrogen™ SuperScript™ III One-Step RT-PCR showed positive results from a single reaction of triplicate in the three days of 4.8 copies per reaction. R squared and amplification efficiency were 0.97 and ranged from 107 to 108%, respectively. Conclusions. Our findings indicated that TIB-Molbiol, IDT, and Phu Sa primer-probe sets could be beneficial for the laboratory screening of SARS-CoV-2 by RT-qPCR assay of E gene. There is a need to consider the combination of these reagent sets as a new strategy to increase the testing capacity of screening programs for COVID-19.

Cholera remains a major public health problem in many countries. Poor sanitation and inappropriate clean water supply, insufficient health literacy and community mobilization, absence of national plans and cross-border collaborations are major factors impeding optimal control of cholera in endemic countries.In March 2017, a group of experts from 10 Asian cholera-prone countries that belong to the Initiative against Diarrheal and Enteric Diseases in Africa and Asia (IDEA), together with representatives from the World Health Organization, the US National Institutes of Health, International Vaccine Institute, Agence de médecine préventive, NGOs (Save the Children) and UNICEF, met in Hanoi (Vietnam) to share progress in terms of prevention and control interventions on water, sanitation and hygiene (WASH), surveillance and oral cholera vaccine use.This paper reports on the country situation, gaps identified in terms of cholera prevention and control and strategic interventions to bridge these gaps.