Transcript 1. Cambodia

Characterization of human
influenza virus circulation in
Cambodia 2006-2010 and impact
for national public health policies.
Ly Sovann, MD, DTMH, MCTM
Philippe Buchy, MD, PhD
NIC Cambodia
ILI and ALRI sites in Cambodia
ILI sentinel sites
ALRI sentinel sites
2
Material and Method
• Naso-pharyngeal specimens obtained from 5-10 patients
fulfilling the ILI case definition, each week, from 8 sentinel
sites (5 IPC/MoH since 2006, 3 NIPH/US CDC/MoH since 2009)
+ 1 study site (AFRIMS since 2010)
• >4000 NP specimens obtained from patients hospitalized in
Takeo and Kampong Cham provincial hospitals with ALRI
symptoms between 2007-2010.
• Specimens tested by RT-PCR at IPC, NIPH/CDC, AFRIMS labs
• Results centralized and analyzed for epidemiological purposes
by MoH (CDC department) with support of WHO country office
and by IPC (for FluNet reporting)
• Antigenic tests, genomic analysis, phenotypic drug resistance
tests performed at IPC before selection of representative
strains shipped to WHOCC Melbourne (including NAMRU-2
influenza isolates detected during fever study)
3
Influenza circulation
Year
4
Type
No. of
No. of
Specimens positives Influenza A Influenza B
(%)
(%)
tested
(%)
2006
812
32
(3.9)
32
(100)
0
2007
1962
104
(5.3)
44
(41.7)
2008
2873
259
(9)
2009
4820
2010
3455
Subtype of influenza A
H1N1pdm
H1N1 H3N2 H5N1
09
(%) (%)
(%)
(%)
30
(100)
(93.4)
2
(6.6)
-
60
(58.3)
14
29
(32.5) (67.5)
1
(2.3)
-
171
(65.9)
88
(34.1)
31
139
(18.2) (81.8)
1
(0.5)
-
743
(15.4)
648
(87.2)
95
(12.8)
2
(0.3)
245
(37.8)
1
(0.15)
400
(61.8)
433
(12.5)
335
(77.4)
98
(22.6)
0
151
(45)
1
(0.3)
183
(54.7)
0
Influenza circulation (2006-2010)
250
1st H1N1pdm09
Case detected in the
community
A(H5N1)
200
A(H1N1)pdm
B
1st H1N1pdm 09
Case confirmed
(imported case)
150
A(H1N1)
A(H3N2)
100
50
Rainy season
2006
5
Rainy season
2007
Rainy season
2008
Rainy season
2009
Dec
Oct
Nov
Sep
Aug
Jun
July
Apr
May
Mar
Jan
Feb
Dec
Oct
Nov
Sep
Aug
Jun
July
Apr
May
Mar
Jan
Feb
Dec
Oct
Nov
Sep
Aug
Jun
July
Apr
May
Mar
Jan
Feb
Dec
Oct
Nov
Sep
Aug
Jun
July
Apr
May
Mar
Jan
Feb
Dec
Oct
Nov
Sep
Aug
0
Rainy season
2010
Susceptibility to drugs
Virus type and
subtype
Resistance to neuraminidase inhibitors
Zanamivir
Oseltamivir
6
Resistance to M2
inhibitors
# isolates
tested
Number of
resistant
(%)
# isolates
sequenced
Number of
resistant
(%)
0
54
0
51
43 (84.3)
10
1 (10)
7
0
18
12 (66.6)
B
90
0
38
0
NA
NA
A(H1N1)pdm09
62
0
62
0
34
34 (100)
A(H5N1)
10
0
5
0
5
5 (100)
# isolates
tested
Number of
resistant
(%)
A(H3N2)
123
A(H1N1)
Antigenic analysis
Season
A/H1N1
Vaccine
Strains
2006
(SH*)
A/New
Caledonia/
20/1999-like
2006-2007
(NH*)
A/New
Caledonia/
20/1999-like
2007
(SH*)
A/New
Caledonia/
20/1999-like
2007-2008
(NH*)
A/Solomon
Islands/3/
2006-like
2008
(SH*)
A/Solomon
Islands/3/
2006-like
2008-2009
(NH*)
A/Brisbane/59
/2007-like
2009
(SH*)
A/Brisbane/59
/2007-like
2009-2010
(NH*)
A/Brisbane/59
/2007-like
A/H3N2
Cambodian
Strains
Vaccine
Strain
Cambodian
Strains
Vaccine Strain
N/A
A/California/7/
2004-like
A/Wisconsin/6
7/2005-like
B/Malaysia/250
6/2004-like
A/New
Caledonia/
20/1999-like
A/Brisbane/59/
2007-like
N/A
2010-2011
(NH*)
7
A/Wisconsin/6
7/2005-like
B/Malaysia/250
6/2004-like
A/Wisconsin/6 A/Wisconsin/6
7/2005-like
7/2005-like
B/Malaysia/250
6/2004-like
A/Wisconsin/6
7/2005-like
B/Malaysia/250
6/2004-like
A/Brisbane/10 A/Brisbane/10/
/2007-like
2007-like
B/Florida/4/200
6-like
A/Brisbane/10
/2007-like
B/Florida/4/200
6-like
A/Brisbane/
10/2007-like
A/Perth/16/
2009-like
N/A
A/Brisbane/
10/2007-like
A/Brisbane/
10/2007
2010
(SH*)
N/A
Influenza B
B/Florida/4/200
6-like
B/Brisbane/
60/2008-like
N/A
A/Perth/16/
2009-like
Cambodian
Strains
Vaccine Strain
Cambodian
Strains
N/A
N/A
N/A
N/A
B/Malaysia/250
6/2004-like
B/Brisbane/
60/2008-like
N/A
N/A
N/A
B/Florida/4/200
6-like
N/A
N/A
N/A
B/Brisbane/
60/2008-like
B/Brisbane/
60/2008-like
A/Perth/16/
2009-like
A/H1N1pdm09
A/California/7/2 A/California/7/2
009-like
009-like
A/California/7/2
009-like
B/Brisbane/
60/2008-like
B/Malaysia/250
6/2004-like
B/Florida/4/200
6-like
A/California/7/2
009-like
A/California/7/2
009-like
A/California/7/2
009-like
Antigenic analysis
Season
A/H1N1
Vaccine
Strains
2006
(SH*)
A/New
Caledonia/
20/1999-like
2006-2007
(NH*)
A/New
Caledonia/
20/1999-like
2007
(SH*)
A/New
Caledonia/
20/1999-like
2007-2008
(NH*)
A/Solomon
Islands/3/
2006-like
2008
(SH*)
A/Solomon
Islands/3/
2006-like
2008-2009
(NH*)
A/Brisbane/59
/2007-like
2009
(SH*)
A/Brisbane/59
/2007-like
2009-2010
(NH*)
A/Brisbane/59
/2007-like
A/H3N2
Cambodian
Strains
Vaccine
Strain
Cambodian
Strains
Vaccine Strain
N/A
A/California/7/
2004-like
A/Wisconsin/6
7/2005-like
B/Malaysia/250
6/2004-like
A/New
Caledonia/
20/1999-like
A/Brisbane/59/
2007-like
N/A
2010-2011
(NH*)
8
A/Wisconsin/6
7/2005-like
B/Malaysia/250
6/2004-like
A/Wisconsin/6 A/Wisconsin/6
7/2005-like
7/2005-like
B/Malaysia/250
6/2004-like
A/Wisconsin/6
7/2005-like
B/Malaysia/250
6/2004-like
A/Brisbane/10 A/Brisbane/10/
/2007-like
2007-like
B/Florida/4/200
6-like
A/Brisbane/10
/2007-like
B/Florida/4/200
6-like
A/Brisbane/
10/2007-like
A/Perth/16/
2009-like
N/A
A/Brisbane/
10/2007-like
A/Brisbane/
10/2007
2010
(SH*)
N/A
Influenza B
B/Florida/4/200
6-like
B/Brisbane/
60/2008-like
N/A
A/Perth/16/
2009-like
Cambodian
Strains
Vaccine Strain
Cambodian
Strains
N/A
N/A
N/A
N/A
B/Malaysia/250
6/2004-like
B/Brisbane/
60/2008-like
N/A
N/A
N/A
B/Florida/4/200
6-like
N/A
N/A
N/A
B/Brisbane/
60/2008-like
B/Brisbane/
60/2008-like
A/Perth/16/
2009-like
A/H1N1pdm09
A/California/7/2 A/California/7/2
009-like
009-like
A/California/7/2
009-like
B/Brisbane/
60/2008-like
B/Malaysia/250
6/2004-like
B/Florida/4/200
6-like
A/California/7/2
009-like
A/California/7/2
009-like
A/California/7/2
009-like
H3N2 phylogenetic analysis
2010
2009
2007-2008
2005-2006
9
H1N1pdm09 phylogenetic analysis
10
Influenza B phylogenetic analysis
2009
2010
Victoria/2/87
-like lineage
2007
2010
Yamagata/16/88
-like lineage
2008
11
Conclusions
• Although Cambodia is geographically located in the
Northern hemisphere, influenza circulation has a
Southern hemisphere pattern.
• Although the viruses circulating in Cambodia are not
always totally matching with those included in the
vaccine composition, the use of the Southern
hemisphere vaccine should be recommended
• Neuraminidase inhibitors would be the drug of choice
for influenza treatment and chemoprophylaxis in
Cambodia.
12
Aknowledgements
• Ministry of Health/CDC department
•
Dr. Sok Touch, Dr. Ly Sovann, Dr. Seng Heng, Mr. Ieng Vannra & coll.
• Institut Pasteur in Cambodia – Virology & Epi Units
•
Dr. Sek Mardy, Dr. Monica Naughtin, Dr. Sareth Rith, Dr. Sirenda Vong, Dr.
Sowath Ly, Dr. Arnaud Tarantola & coll.
• National Institute of Public Health
•
Dr. Ung Sam An, Dr. Buth Sokhal and coll.
• WHO Cambodia
•
Dr. Chea Nora, Dr. Nima Asgari and coll.
• Centres of Disease Control and Prevention USA & Cambodia
•
Dr. Paul Kitsutani, Dr. Borann Sar & coll.
• NAMRU2, Cambodia
•
Dr. William Rogers, Dr. Chadwick Yasuda
• WHOCC Melbourne, Australia
•
Prof. Anne Kelso, Dr. Ian Barr & coll.
• AFRIMS Bangkok & Cambodia
•
13
Dr. Ans Timmermans, Dr. Youry Se, Ms. Nou Samon, Dr. Chanthap Lon, Dr.
Stuart Tyner, Dr. David Saunders