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To assess concordance between self-reported amphetamine-type stimulant (ATS) use and toxicology results among young female sex workers (FSW) in Phnom Penh, Cambodia. Cross-sectional data from the Young Women's Health Study-2 (YWHS-2), a prospective study o

Background: Tracking the emergence, introduction and spread of SARS-CoV-2 variants of concern are essential for informing public health strategies. In 2021, Cambodia faced two major epidemic waves of SARS-CoV-2 triggered by the successive rise of the Alpha and Delta variants., Methods: Phylodynamic analysis of 1,163 complete SARS-CoV-2 genomes from Cambodia, along with global sequences, were conducted between February and September 2021 to infer viral introductions, molecular epidemiology and population dynamics. The relationship between epidemic trends and control strategies were evaluated. Bayesian phylogeographic reconstruction was employed to estimate and contrast the spatiotemporal dynamics of the Alpha and Delta variants over time., Results: Here we reveal that the Alpha variant displays rapid lineage diversification, accompanied by the acquisition of a spike E484K mutation that coincides with the national implementation of mass COVID-19 vaccination. Despite nationwide control strategies and increased vaccination coverage, the Alpha variant was quickly displaced by Delta variants that exhibits a higher effective reproductive number. Phylogeographic inference indicates that the Alpha variant was introduced through south-central region of Cambodia, with strong diffusion rates from the capital of Phnom Penh to other provinces, while the Delta variant likely entered the country via the northern border provinces., Conclusions: Continual genomic surveillance and sequencing efforts, in combination with public health strategies, play a vital role in effectively tracking and responding to the emergence, evolution and dissemination of future emerging variants., Competing Interests: Competing interests: Y.C.F.S. and G.J.D.S. report grants from National Institutes of Health. All other authors declare no competing interests., (© 2024. The Author(s).)

The global burden of dengue, an emerging and re-emerging mosquito-borne disease, increased during the 20-year period ending in 2019, with approximately 70% of cases estimated to have been in Asia. This report describes the epidemiology of dengue in the World Health Organization's Western Pacific Region during 2013-2019 using regional surveillance data reported from indicator-based surveillance systems from countries and areas in the Region, supplemented by publicly available dengue outbreak situation reports. The total reported annual number of dengue cases in the Region increased from 430 023 in 2013 to 1 050 285 in 2019, surpassing 1 million cases for the first time in 2019. The reported case-fatality ratio ranged from 0.19% (724/376 972 in 2014 and 2030/1 050 285 in 2019) to 0.30% (1380/458 843 in 2016). The introduction or reintroduction of serotypes to specific areas caused several outbreaks and rare occurrences of local transmission in places where dengue was not previously reported. This report reinforces the increased importance of dengue surveillance systems in monitoring dengue across the Region., Competing Interests: MC, LB, SO, CKL, RRA, SC and TM are associate editors and BO is executive editor of the Western Pacific Surveillance and Response journal. They were not involved in the editorial decision to publish the manuscript. All other authors have no conflicts of interest to declare., ((c) 2023 The authors; licensee World Health Organization.)

The first case of coronavirus disease 2019 (COVID-19) in Cambodia was confirmed on 27 January 2020 in a traveller from Wuhan. Cambodia subsequently implemented strict travel restrictions, and although intermittent cases were reported during the first year of the COVID-19 pandemic, no apparent widespread community transmission was detected. Investigating the routes of severe acute respiratory coronavirus 2 (SARS-CoV-2) introduction into the country was critical for evaluating the implementation of public health interventions and assessing the effectiveness of social control measures. Genomic sequencing technologies have enabled rapid detection and monitoring of emerging variants of SARS-CoV-2. Here, we detected 478 confirmed COVID-19 cases in Cambodia between 27 January 2020 and 14 February 2021, 81.3 per cent in imported cases. Among them, fifty-four SARS-CoV-2 genomes were sequenced and analysed along with representative global lineages. Despite the low number of confirmed cases, we found a high diversity of Cambodian viruses that belonged to at least seventeen distinct PANGO lineages. Phylogenetic inference of SARS-CoV-2 revealed that the genetic diversity of Cambodian viruses resulted from multiple independent introductions from diverse regions, predominantly, Eastern Asia, Europe, and Southeast Asia. Most cases were quickly isolated, limiting community spread, although there was an A.23.1 variant cluster in Phnom Penh in November 2020 that resulted in a small-scale local transmission. The overall low incidence of COVID-19 infections suggests that Cambodia's early containment strategies, including travel restrictions, aggressive testing and strict quarantine measures, were effective in preventing large community outbreaks of COVID-19., (© The Author(s) 2023. Published by Oxford University Press.)

Objective: To assess concordance between self-reported amphetamine-type stimulant (ATS) use and toxicology results among young female sex workers (FSW) in Phnom Penh, Cambodia., Methods: Cross-sectional data from the Young Women's Health Study-2 (YWHS-2), a prospective study of HIV and ATS use among young (15 to 29 years) FSW in Phnom Penh, Cambodia, was analyzed. The YWHS-2 assessed sociodemographic characteristics, HIV serology, HIV risk, and ATS use by self-report and urine toxicology testing at each quarterly visit, the second of which provided data for this assessment. Outcomes include sensitivity, specificity, positive- and negative predictive values (overall and stratified by age), sex-work setting, and HIV status., Results: Among 200 women, prevalence of positive toxicology screening for ATS use was 14% (95% confidence interval [CI], 9.2, 18.9%) and concurrent prevalence of self-reported ATS was 15.5% (95% CI, 10.4, 20.6%). The sensitivity and specificity of self-reported ATS use compared to positive toxicology test results was 89.3% (25/28), and 96.5% (166/172), respectively. The positive predictive value of self-reported ATS use was 80.6% (25/31); the negative predictive value was 98.2% (166/169). Some differences in concordance between self-report and urine toxicology results were noted in analyses stratified by age group and sex-work setting but not by HIV status., Conclusion: Results indicate a high prevalence of ATS use among FSW in Phnom Penh, Cambodia, and high concordance between self-reported and toxicology-test confirmed ATS use.

Objectives: To evaluate sleep in professional football players and describe clinical features of players at risk for sleep for sleep-disordered breathing (SDB)., Methods: The Multivariable Apnea Prediction (MAP) index was used to stratify players into high (MAP> or =0.5) and low (MAP<0.5) risk for SDB. Players from both risk groups were randomly selected for overnight polysomnography, with over-sampling from the High-risk group. Of 302 players from eight professional football teams; 52 underwent attended polysomnography. Anthropometrics including neck circumference, airway size (Mallampati score, maxillary overjet) and sleepiness measured by Epworth scores (ESS) were recorded. The primary outcome measures were ESS and an apnea-hypopnea index (AHI) > or =10., Results: Ninety-two percent of players were <30 years old (mean (SD) age: 25.5+/-2.7 years) with large necks (45.2+/-3.6 cm) and elevated BMI (31.5+/-4.6). More than 20% of players had an ESS>10 with ESS highest in habitual snorers. An AHI of > or =10 was found in 13 (34%, 95% confidence interval (CI) 21-50%) high-risk players but only one (7%, 95% CI 1-31%) of 14 low-risk players. Offensive (9) or defensive (3) linemen accounted for the majority of the positive cases. Based on our sample, we estimate the prevalence of SDB to be 14% (2-25%)., Conclusions: Excessive daytime sleepiness (EDS) is present in a large fraction of professional football players. Some but not all of this may be due to an increased prevalence of SDB. Further study is required to understand all of the factors responsible for EDS and to determine which of the biggest players will have SDB, which may impact not only performance and productivity but also future health.