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On June 4, 2016, the Prey Veng Provincial Health Department reported a total of 107 patients with influenza-like illness (ILI) from Chakhlanh village to the Cambodian Ministry of Health. To confirm the outbreak and evaluate its clinical and epidemiological characteristics, the investigation team visited the village and reviewed the case-based surveillance (CBS) data on severe respiratory infection (SRI) and patients’ records in health facilities. The team interviewed all households in the village from May 1 to June 5, 2016 and obtained the following data: age, medical history, date of onset, treatment, symptoms, and history of contact with patients or dead poultry. Nasal swab samples were collected from suspected ILI cases to test for influenza virus by RT-PCR. The investigation detected 498 suspected ILI cases, including 288 females. Although the incidence of suspected ILI cases who visited health centers was 63.0 per 1,000 persons per month, the attack rate was 27.1 per 100 population. The major age group was 5–14 years followed by 0–4 years. Major symptoms were cough, fever, runny nose, and headache. Six of seven nasal swab samples were positive for influenza A/H1N1 pdm09 virus. Most children with flu symptoms had contact with previous cases. This study showed that the ILI outbreak might be caused by seasonal influenza A/H1N1 pdm09 spread from person to person. Poor living conditions and poor hygiene and sanitation practices were environmental factors that caused the outbreak. As the CBS system was unable to identify this epidemic, it needs to be improved.

Enteric fever is a systemic bacterial infection in humans that is endemic in Cambodia and for which antibiotic resistance is increasingly reported. To guide public health programs, this qualitative study sought to explore community perceptions on transmission and treatment. Participant observation was carried out in hospital settings, pharmacies, and at a community level in Phnom Penh. In-depth interviews 39 and one focus group discussion were carried out with blood culture-confirmed enteric fever patients and purposively selected key informants. Informants were theoretically sampled based on initial themes identified using abductive analysis. Nvivo 11 was used for thematic coding. An urgent need to address health literacy concerning the transmission of enteric fever was identified, as lay informants did not link the disease and its symptoms to bacterial contamination of foods and drinks but rather to foods considered "bad" following humoral illness interpretations. As a result, lay informants considered recurrence of enteric fever preventable with appropriate dietary restrictions and Khmer traditional medicines. This study also reveals pluralistic health-care-seeking behavior. For initial and mild symptoms, patients preferred home treatment or traditional healing practices; limited household finances delayed treatment seeking. When symptoms persisted, patients first visited drug outlets or private practitioners, where they received a mix of nonessential medicines and one or more antibiotics often without prescription or confirmation of diagnosis. Inappropriate use of antibiotics was common and was related to diagnostic uncertainty and limited finances, factors which should be addressed during future efforts to improve the uptake of appropriate diagnostics and treatment of enteric fever. ispartof: AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE vol:99 issue:6 pages:1369-1377 ispartof: location:United States status: published

Background: Simplifying hepatitis C virus (HCV) screening is a key step in achieving the elimination of HCV as a global public health threat by 2030. Objectives: The objective of this study was to demonstrate the agreement of capillary blood and venipuncture specimens when using SD Bioline© HCV, a low-cost rapid diagnostic test (RDT), prequalified by WHO in 2016 on venous blood samples. Study design: Recruitment was conducted prospectively among adult patients presenting for HCV testing at the Medecins Sans Frontieres (MSF) clinic of Preah Kossamak Hospital (Phnom Penh, Cambodia) between October and November 2017. Capillary and venous blood samples were collected from consenting patients and tested with SD Bioline© HCV. Two independent, blinded readers, and in the case of disagreement, a third reader, interpreted the results of each blood sample. Concordance between results was compared using Cohen's Kappa interrater reliability statistic. Discrepant sample pairs were tested with an enzyme immunoassay, the reference standard, at the Institute Pasteur of Cambodia. Results: Among 421 pairs of samples collected, reader disagreement occurred for 0.7% (n = 3) of the participants. Sixty-four percent of capillary and venous blood sample pairs tested positive for HCV, with a Kappa statistic of 0.985 between the two methods. Three participants with discrepant sample pair results tested positive with EIA. Conclusions: Capillary and venous blood samples were concordant when tested with HCV SD Bioline© in a clinical context. This simplified testing approach is essential to the scale-up of HCV screening and useful in resource-limited settings or among populations for whom venipuncture is problematic.

Simplifying hepatitis C virus (HCV) screening is a key step in achieving the elimination of HCV as a global public health threat by 2030.The objective of this study was to demonstrate the agreement of capillary blood and venipuncture specimens when using SD BiolineRecruitment was conducted prospectively among adult patients presenting for HCV testing at the Médecins Sans Frontières (MSF) clinic of Preah Kossamak Hospital (Phnom Penh, Cambodia) between October and November 2017. Capillary and venous blood samples were collected from consenting patients and tested with SD BiolineAmong 421 pairs of samples collected, reader disagreement occurred for 0.7% (n = 3) of the participants. Sixty-four percent of capillary and venous blood sample pairs tested positive for HCV, with a Kappa statistic of 0.985 between the two methods. Three participants with discrepant sample pair results tested positive with EIA.Capillary and venous blood samples were concordant when tested with HCV SD Bioline

In Cambodia, the true burden of viral hepatitis has not been revealed, but many surveys were carried out focusing on specific population or on small scales. Different markers of viral hepatitis were found between 27 and 97% in children and almost 100% in adults. Viral hepatitis B in children was 3.5% in 2006 and dropped in 2011; and in adults, it ranged from 4.5 to 10.8%. Viral hepatitis C was between 0.87 and 14.7%. No data are available for hepatitis D in the country. Viral hepatitis E (anti-HEV IgG) went from 7.2 to 12.7%. The complications due to viral hepatitis including chronic liver diseases and hepatocellular carcinoma were reported in the health information system. Around 79% of the patients with high transaminase had at least one viral marker and about 45% of the adults with chronic hepatitis and liver cirrhosis were positive for Hepatitis B surface antigen (HBsAg). Hepatocellular carcinoma accounted for 19.1% of all reported cancer cases. Hepatitis B surface antigen was found in between 55 and 90% in adults with hepatocellular carcinoma and anti-HCV in one-fourth. The only intervention implemented in Cambodia is vaccination against viral hepatitis B (HepB vaccine). How to cite this article Sreng B, Kimcheng HOK, Sovann LY, Huot ENG. Epidemiology of Viral Hepatitis and Liver Diseases in Cambodia. Euroasian J Hepato-Gastroenterol 2015;5(1):30-33.

Cross-border disease transmission is a key challenge for prevention and control of outbreaks. Variation in surveillance structure and national guidelines used in different countries can affect their data quality and the timeliness of outbreak reports. This study aimed to evaluate timeliness and data quality of national outbreak reporting for four countries in the Mekong Basin Disease Surveillance network (MBDS). Data on disease outbreaks occurring from 2010 to 2015 were obtained from the national disease surveillance reports of Cambodia, Lao PDR, Myanmar, and Vietnam. Data included total cases, geographical information, and dates at different timeline milestones in the outbreak detection process. Nine diseases or syndromes with public health importance were selected for the analysis including: dengue, food poisoning & diarrhea, severe diarrhea, diphtheria, measles, H5N1 influenza, H1N1 influenza, rabies, and pertussis. Overall, 2,087 outbreaks were reported from the four countries. The number of outbreaks and number of cases per outbreak varied across countries and diseases, depending in part on the outbreak definition used in each country. Dates on index onset, report, and response were >95% complete in all countries, while laboratory confirmation dates were 10%-100% incomplete in most countries. Inconsistent and out of range date data were observed in 1%-5% of records. The overall timeliness of outbreak report, response, and public communication was within 1–15 days, depending on countries and diseases. Diarrhea and severe diarrhea outbreaks showed the most rapid time to report and response, whereas diseases such as rabies, pertussis and diphtheria required a longer time to report and respond. The hierarchical structure of the reporting system, data collection method, and country’s resources could affect the data quality and timeliness of the national outbreak reporting system. Differences in data quality and timeliness of outbreak reporting system among member countries should be considered when planning data sharing strategies within a regional network., Author summary The rapid growth in cross-border trade and transportation networks has led to massive population movements across borders, which increase the risk of disease spread across countries. A regional surveillance network, where disease outbreak data of each member country are shared through the network, plays an important role in prevention and control of cross-border outbreaks. However, variation in national outbreak reporting systems and guidelines used for outbreak detection and response in different countries can pose a challenge to cross-border communication for outbreak investigation. In this study, we evaluated outbreak data reported from four countries, including Cambodia, Lao PDR, Myanmar, and Vietnam, in the Mekong Basin Disease Surveillance network (MBDS). We found that the definition of outbreak varied across countries. Vietnam reported severe diarrhea outbreaks when only 1–2 cases were detected, whereas severe diarrhea outbreak reported in Myanmar consisted of more than 20 cases per outbreak. Overall, the outbreak was reported and responded within 1–15 days after the first case was detected, depending on country and how fast each disease requires public health response. Understanding outbreak reporting data would help not only to improve disease reporting systems in each country, but also improve communication and response to cross-border outbreaks among neighboring countries.

An account of immunization against hepatitis B virus in Cambodia is given. How to cite this article Sreng B, Vichit O, Vuthikol Y, Aun C, Samnang C. Immunization against Viral Hepatitis B: Lessons Learnt from Kingdom of Cambodia. Euroasian J Hepato-Gastroenterol 2017;7(1):43-47.

The prevalence of viral hepatitis represents Cambodia as 1 of the highest endemic countries in the world. But the prevalence of viral hepatitis B among 5-year-olds is on a decreasing trend due to the effect of nationwide vaccination against hepatitis B. There are key interventions to address viral hepatitis by the Cambodian Ministry of Health. There are so far no comprehensive national guidelines for the prevention, care, and treatment of viral hepatitis. In 2014, the coverage of hepatitis B vaccine at birth and HepB3 vaccine was very high, at 87 and 97% respectively. Other interventions include the screening of viral hepatitis B and C among blood donors; the enhancement of infection prevention and control at health facilities; the program for People Who Use Drugs (PWUDs) and People Who Inject Drugs (PWIDs); control and prevention of HIV/AIDS and sexually transmitted diseases (STDs); and improved sanitation, clean water, and food safety. The diagnosis of viral hepatitis B and C could be made only at the national and provincial referral hospitals and there are no specific antiviral therapies for people who are infected with hepatitis B and C. How to cite this article Sreng B, Sophal C, Srun S, Samnang C, Huot E. Viral Hepatitis in Cambodia: Past, Present, and Future. Euroasian J Hepato-Gastroenterol 2016;6(1):45-48.