Treatment and outcomes of high-risk neuroblastoma in Southeast Asia: a single-institution experience and review of the literature

INTRODUCTION@#In Europe and North America, the majority of children with high-risk neuroblastoma survive the disease. Elsewhere, the treatment outcomes are poor.@*METHODS@#A retrospective review of children treated for high-risk neuroblastoma in a single institution in Singapore from 2007 to 2019 was carried out. Treatment consisted of intensive chemotherapy, surgery aimed at gross total resection of residual disease after chemotherapy, consolidation with high-dose therapy followed by autologous stem cell rescue, and radiotherapy to the primary and metastatic sites followed by maintenance treatment with either cis-retinoic acid or anti-disialoganglioside monoclonal antibody therapy. Survival data were examined on certain clinical and laboratory factors.@*RESULTS@#There were 57 children (32 male) treated for high-risk neuroblastoma. Their mean age was 3.9 (range 0.7-14.9) years. The median follow-up time was 5.5 (range 1.8-13.0) years for the surviving patients. There were 31 survivors, with 27 patients surviving in first remission, and the five-year overall survival and event-free survival rates were 52.5% and 47.4%, respectively. On log-rank testing, only the group of 17 patients who were exclusively treated at our centre had a survival advantage. Their five-year overall survival rate compared to patients whose initial chemotherapy was done elsewhere was 81.6% versus 41.1% (P = 0.011), and that of event-free survival was 69.7% versus 36.1% (P = 0.032). Published treatment results were obtained from four countries in Southeast Asia with five-year overall survival rates from 13.5% to 28.2%.@*CONCLUSION@#Intensified medical and surgical treatment for high-risk neuroblastoma proved to be effective, with superior survival rates compared to previous data from Southeast Asia.

Antimicrobial Activities of Mangrove Species in Southeast Asia: A Systematic Review (Aktiviti Antimikrob Spesies Bakau di Asia Tenggara: Tinjauan Sistematik) / Jurnal Sains Kesihatan Malaysia

@#Antimicrobial resistance in Southeast Asia is a macro-level health dilemma that may cause substantial casualties annually. Fortunately, Southeast Asian mangroves are potent reservoirs of bioactive compounds with antimicrobial properties in correlation to their traditional usage. Hence, this study aimed to systematically review studies concerning antimicrobial activities of mangroves in Southeast Asia as well as provide a technological overview of its prospective use in pharmaceutical industry applications through patents. Through the PRISMA protocol, the search for peerreviewed studies originated from Southeast Asia and published between 2010 to 2022 were conducted over databases such as CORE, Google Scholar, PubMed (MedLine), Science Direct, Semantic Scholar, Scopus, and Web of Science. Additionally, a patent search was also performed on the Espacenet Patent Search, Google Patents, National Institute of Industrial Property, and United States Patent and Trademark Office. The studies and patents were collated on Mendeley Reference Manager as well as tabulated and assessed on Microsoft Office Excel 2016. After the four-phase screening, 59 studies and one patent regarding antimicrobial activities of Southeast Asian mangroves passed the criteria for the systematic review. It was inferred that Southeast Asia constitutes potentially most species-diverse mangroves with highly varied antimicrobial properties and can form synergism with drugs. The existing studies and patents may provide enlightenment on the future path of studies and inventions which must be continually substantiated in animal and clinical experiments for prospective pharmaceutical industry use. In this way, mangroves can be conserved while antimicrobial resistance and anthropogenic activities can be lowered.

Review of recommended energy and nutrient intake values in Southeast Asian countries

@#This review summarises the officially published recommended energy and nutrient intake values in five Southeast Asia (SEA) countries namely Indonesia, Malaysia, Philippines, Thailand and Vietnam. The background information, general approaches and references used for setting up recommendations and the recommended intakes levels for energy, protein, fat and carbohydrate, dietary fibre, sugars,14 vitamins and 15 minerals of these countries were tabulated and compared. The recommended intake values show remarkable similarities in terms of approaches and principles taken, as well as references used as the basis for the recommendations development and the application of the recommendations in respective country. There are nevertheless some differences in age groupings, reference height and weight used, as well as the final recommendations of the intake levels for some nutrients, after adjustment to suit local situations. All five countries had provided recommendations in terms of recommended nutrient intakes (RNI) or recommended dietary allowance (RDA) for almost all the nutrients. Due to the limited availability of local data and resources, countries in the region have referred to several references, including those from Food and Agriculture Organization/World Health Organization (FAO/WHO) consultation report and recommendations from research organisations in United States and Europe and adapted the values for local uses. Opportunities should be created to enable closer dialogue and collaboration regarding future developments in nutrient recommendations for populations in the region. These could include consideration of establishing more appropriate nutrient recommendations and the call for setting up harmonised approaches to establishing recommended nutrient intake values for the region.

Bibliometric Analysis of Research on Boesenbergia rotunda, Pinostrobin, and Their Derivatives: Dominance of Southeast Asian Researchers

Pinostrobin, marker compounds from Boesenbergia rotunda with various pharmacological activities, have been studied extensively, including synthesizing its derivatives, which have potent pharmacological activities. This study aims to describe research related to B. rotunda, pinostrobin, and their derivatives. Metadata information was collected from Scopus in August 2022, with three keywords searched for article titles, abstracts, and keywords. Analysis and research mapping were carried out with VOSviewer. The most widely used synonym for the plant name was "Boesenbergia rotunda", in which Norzulaani Khalid from the University of Malaya, Malaysia, mostly reported research with the keywords "Boesenbergia rotunda", "pinostrobin", and "derivative". The majority of researchers come from institutions in Southeast Asia, such as Malaysia, Thailand, and Indonesia. Interestingly, no Chinese researchers have reported studies on this topic. The journals and publishers that publish the most articles with these three keywords are Bioorganic and Medicinal Chemistry Letters and Elsevier, respectively. This information will make it easier for researchers on this topic to find partners for collaboration and determine journals to publish their research results.

La pinostrobina, compuesto de marcadores de Boesenbergia rotunda con diversas actividades farmacológicas, se ha estudiado ampliamente, incluida la síntesis de sus derivados que tienen potentes actividades farmacológicas. Este estudio tuvo como objetivo describir investigaciones relacionadas con B. rotunda, pinostrobina y sus derivados. La información de metadatos se recopiló de Scopus en agosto de 2022, con tres palabras clave buscadas para títulos de artículos, resúmenes y palabras clave. El análisis y el mapeo de la investigación se realizaron con VOSviewer. El sinónimo más utilizado para el nombre de la planta fue "Boesenbergia rotunda", en el que Norzulaani Khalid de la Universidad de Malaya, Malasia, informó principalmente sobre investigaciones con las palabras clave "Boesenbergia rotunda", "pinostrobina" y "derivado". La mayoría de los investigadores provienen de instituciones del sudeste asiático como Malasia, Tailandia e Indonesia. Curiosamente, ningún investigador chino ha informado de estudios sobre este tema. Las revistas y editoriales que más artículos publican con estas tres palabras clave son Bioorganic and Medicinal Chemistry Letters y Elsevier. Esta información facilitará a los investigadores sobre este tema encontrar colaboraciones y determinar las revistas para publicar los resultados de sus investigaciones.

Effectiveness of the Otago Exercise Programme in falls reduction among community-dwelling older people in Southeast Asia: a systematic review

@#BACKGROUND: Falls are common in older people and a leading cause of injury. Exercise programmes are available for falls prevention, including the Otago Exercise Programme (OEP). The Southeast Asia region has a rapidly ageing population with unique aspects to consider in falls prevention. This systematic review aims to explore the effectiveness of OEP in Southeast Asia for falls prevention. METHODS: A literature search conducted in April 2020 of PubMed and Google Scholar databases was performed to identify randomised controlled trials on OEP in Southeast Asia. RESULTS: Three studies met inclusion criteria for the systematic review. The studies in Malaysia and Thailand did not identify any differences in the rate of falls with the modified OEP intervention compared to conventional treatment. The study from Indonesia inferred a reduced fall risk with improved Timed Up and Go with the intervention, but did not quantify fall rates. CONCLUSION: The three studies identified used a modified OEP, with limited evidence of efficacy or reduction in fall rates. Further research is required, particularly randomized controlled trials to evaluate OEP for falls prevention in Southeast Asia.

A review of national plans of action for nutrition in Southeast Asian countries

@#This review describes national plans of action for nutrition (NPANs) in six Southeast Asia countries (Indonesia, Malaysia, Myanmar, Philippines, Thailand and Vietnam) in order to provide an understanding of the approach and framework undertaken by these countries in the formulation and implementation of NPANs, as well as the similarities and differences in various NPAN components. The six countries recognised the persistent undernutrition and escalating rates of obesity and other diet-related chronic diseases as the key drivers for nutrition action plan implementation. The prioritisation of nutrition interventions outlined in these NPANs are based on respective country context and needs. Although differing in strategies and targets set, these countries show similarities in several components including objectives, stakeholder involvement, nutritional issues to be addressed, implementation, monitoring and evaluation mechanism, programme/ activities identified and challenges in implementing NPANs. Countries have recognised that effective implementation, monitoring and evaluation are essential to successfully address both extremes of the challenging nutrition situation. Several important similarities in the NPANs studied suggest that closer collaboration among countries and stakeholders on NPANs would be beneficial. Opportunities should be created for periodic exchanges to enable sharing of experiences in the development and implementation of NPANs among the countries. Recommendations and conclusions drawn from this review could serve as useful reference for nutrition policy and planning in the future.

Epilepsy in Southeast Asia, how much have we closed the management gap in past two decades?

@#The last review on epilepsy in Southeast Asian (SEA) countries was reported in 1997. This review aimed to update the understanding of epilepsy management in this region over the past 23 years. There has been significant increase in the epidemiological studies which reported a prevalence of 4.3-7.7 per 1,000 populations in this region. Reversible aetiologies of epilepsy such as head injury, birth trauma, cerebrovascular disease, and intracranial infections (neurocysticercosis or meningoencephalitis) are still prevalent, with a surge in autoimmune encephalitis. There was a surge in genetic studies which suggest ethnic variation. Treatment gap is still high especially in the rural and less developed areas, and the availability and affordability of newer anti-epileptic drugs (AEDs) is still a major challenge in SEA. Alternative medicine is a common practice but varies among different ethnic groups. AEDs hypersensitivity especially on the association between HLA-B*1502 and carbamazepine-related severe cutaneous reaction had been extensively studied and proven in nearly all SEA countries. However, HLA-B*1502 screening is not widely available in SEA and the cost-effectiveness of the screening is questionable. Stigma and its psychosocial consequences are still a major concern despite enormous efforts to study the public attitudes towards epilepsy and change of epilepsy naming in a few countries. The number and complexity of epilepsy surgery are progressing, but it is still under-utilized in many SEA countries, related to cost, cultural perception and lack of facilities. More resources should also be channelled in training adequate number of epileptologists who can spearhead epilepsy care around the region, as well as public education and research in epilepsy. In conclusion, there is an increase in epilepsy research in this region, gradual increase in trained neurologists and facilities, and efforts to reduce the knowledge and treatment gap, but the epilepsy management gap is still a battle to fight.

Acanthamoeba in Southeast Asia – Overview and Challenges

Acanthamoeba, one of free-living amoebae (FLA), remains a high risk of direct contact with this protozoan parasite which is ubiquitous in nature and man-made environment. This pathogenic FLA can cause sight-threatening amoebic keratitis (AK) and fatal granulomatous amoebic encephalitis (GAE) though these cases may not commonly be reported in our clinical settings. Acanthamoeba has been detected from different environmental sources namely; soil, water, hot-spring, swimming pool, air-conditioner, or contact lens storage cases. The identification of Acanthamoeba is based on morphological appearance and molecular techniques using PCR and DNA sequencing for clinico-epidemiological purposes. Recent treatments have long been ineffective against Acanthamoeba cyst, novel anti-Acanthamoeba agents have therefore been extensively investigated. There are efforts to utilize synthetic chemicals, lead compounds from medicinal plant extracts, and animal products to combat Acanthamoeba infection. Applied nanotechnology, an advanced technology, has shown to enhance the anti-Acanthamoeba activity in the encapsulated nanoparticles leading to new therapeutic options. This review attempts to provide an overview of the available data and studies on the occurrence of pathogenic Acanthamoeba among the Association of Southeast Asian Nations (ASEAN) members with the aim of identifying some potential contributing factors such as distribution, demographic profile of the patients, possible source of the parasite, mode of transmission and treatment. Further, this review attempts to provide future direction for prevention and control of the Acanthamoeba infection.

Risk of Water and Food-Borne Communicable Diseases in Travelers Entering Korea

OBJECTIVES: It was supposed to analyze status and affecting factors in water and food-borne communicable disease by screening entrants with diarrhea symptom at the point of entry in Korea METHODS: Symptomatic travelers with water and food-borne communicable diseases who entered Korea were diagnosed by a health declaration and detection of causative agents in water and food using laboratory tests. Among those entered in 2017, the affecting factors in the incidence of communicable diseases among those who had diarrhea at the entry into Korea, were analyzed, with frequency and chi-square test. RESULTS: The number of travel entrants with gastrointestinal communicable diseases increased by 40.19% from 2013 to 2017. The percentage of causative agents of water and food-borne communicable diseases was the highest at 69.2% from July to September. The rate of detection of causative agents of communicable disease pathogens in travelers from Southeast Asia entering Korea was 70.2%, which was higher than people arriving from East Asia and Central Asia (57.5%; p < 0.001). CONCLUSION: The positive ratio of causative agents of water and food-borne communicable diseases was high among travelers that had entered Korea from July to September, with a high number among entrants from Southeast Asia. Based on the positive detection of causative agents, the entry period and countries visited were statistically significant affecting factors (p < 0.001).

Epilepsy research output in Southeast Asian countries: A systematic review

@#Objective: Epilepsy is understudied in Southeast Asian (SEA) countries. This systematic review aimed to determine the number of epilepsy publications performed in SEA and identify factors associated with research output in this region. Methods: Existing academic journal article searches were performed using PubMed, Scopus, Medline and Web of Science till 1st March 2018. Openness is determined by the use of English in medical school and overseas epilepsy fellowship. Results: A total of 702 epilepsy articles have been published in the last 50 years in the SEA region, with an exponential increase of publications after the year 1997, with the cumulative number doubled every 5 years. Only half (54%) were published in the journals with impact factor (IF) ≥1. Majority of the publications (48.2%) employed cross sectional design, followed by animal or laboratory studies (21.1%), with few randomized controlled trials and systematic review/meta-analysis studies (1.7% and 2.3%, respectively). Half (52.9%) of the publications were clinical studies. The number of papers with IF≥1 correlated positively with openness to international standard (R=0.720, p<0.05), and knowledge-based economy (p=0.01). Conclusion: Epilepsy research output in SEA is low in quantity and quality. The output is mainly related to the type of economy (knowledge-based or non-knowledge-based) and openness to international ideas and standard.

Smokeless tobacco control: Litigation & judicial measures from Southeast Asia

Recourse to litigation and positive judicial interventions is one of the most effective tools to meet public health objectives. The present review envisions compiling litigation and judicial measures in Southeast Asia Region (SEAR) while assessing their role in advancing smokeless tobacco (SLT) control, and equally highlighting, how tobacco industry has used litigation to undermine tobacco control efforts in the Region. The litigation, especially from the SEAR, up to 2017, that have facilitated SLT control or have been used by the tobacco industry to challenge an SLT control policy decision were reviewed. Most of the litigation related to SLT control from the Region are on pictorial health warnings. Bhutan has imposed a complete prohibition on sale, manufacture and import of all kinds of tobacco products and the litigation there relates to the prosecution of offenders for violating the ban. Judiciary in the Region is well informed about the ill-effects of tobacco use and remains positive to tobacco control initiatives in the interest of public health. In India, several SLT-specific litigation helped in better regulation of SLT products in the country. Litigation has compelled governments for effective enforcement of the domestic tobacco control laws and the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). Parties to the WHO FCTC must now use Treaty Article 19 to strengthen their legal procedures and make the tobacco industry liable, for both criminal and civil wrongs.

Prevalence Of Strongyloidiasis in Southeast Asia: A Systematic Review

@#Strongyloides stercoralis is an intestinal helminth that infects humans through contact with soil containing the larvae. Methods A systematic search was performed for relevant titles, abstract and keywords in database from Cochrane Library, PLOS One, PubMed and several other sources in October 2017 based on PICO strategy. Out of 511 papers that were evaluated for possible inclusion, final assessment for eligibility has yielded a total of 17 papers to be included which were found suitable for analysis covering period from 2012 till 2016. Results A major challenge of giving an overview of prevalence data for S. stercoralis lies in the low sensitivity of diagnostic method used which resulted in very low prevalence in certain countries. Cambodia and Laos presented with high prevalence ranging from 17.4% to 45.9% by using high sensitivity of diagnostic methods. The current prevalence situation of S. stercoralis in Southeast Asia still have wide gaps remains due to several reasons. Conclusions The information we have today only scratches the surface which cannot truly reflect the true burden of S. stercoralis in Southeast Asia The main risk factor is personal hygiene practices especially amongst males.

Polymorphism analysis of microsatellite marker loci of Plasmodium falciparum from different geographical origins / 中国血吸虫病防治杂志

Objective To compare the genetic diversity of imported Plasmodium falciparum by Polyα and TAA87 microsatellite markers in Southeast Asian and African geographical isolates. Methods Ninety-two and 126 filter paper samples from patients infected with P. falciparum from Southeast Asia (Myanmar) and Africa (Ghana) were collected, respectively. Two neutral microsatellite loci, Polyα and TAA87 were amplified by PCR. The length of PCR fragments was detected by capillary electrophoresis. The allele frequency and expected heterozygosity (He) were calculated by Excel 2010 and GenALEx 6.0 software. Results A total of 146 P. falciparum samples were analyzed as single infection samples with a total of 26 alleles in locus Polyα and 12 alleles in locus TAA87. The mean He value of the two loci was 0.86 ± 0.02. Ten alleles in locus Polyα and 8 alleles in locus TAA87 were distributed in Myanmar isolates, with the He values of 0.86 and 0.81 respectively. Fifteen alleles in locus Polyα and 11 in locus TAA87 were detected in Ghana isolates, with the He values of 0.91 and 0.86 respectively. In addition, the haplotype of 174 bp (Polyα) and 113 bp (TAA87) were only detected in Myanmar isolates with more than 17% gene frequency, whereas they were absent in Ghana isolates. Conclusions The two different geographical sources of imported P. falciparum strains have different allele frequencies and haplotypes at the two neutral microsatellite markers, Polyα and TAA87. Therefore, these two microsatellite loci may be considered as the potential molecular marker candidates for identifying P. falciparum strains with different geographical sources.

Polymorphism analysis of microsatellite marker loci of Plasmodium falciparum from different geographical origins / 中国血吸虫病防治杂志

Objective To compare the genetic diversity of imported Plasmodium falciparum by Polyα and TAA87 microsatellite markers in Southeast Asian and African geographical isolates. Methods Ninety-two and 126 filter paper samples from patients infected with P. falciparum from Southeast Asia (Myanmar) and Africa (Ghana) were collected, respectively. Two neutral microsatellite loci, Polyα and TAA87 were amplified by PCR. The length of PCR fragments was detected by capillary electrophoresis. The allele frequency and expected heterozygosity (He) were calculated by Excel 2010 and GenALEx 6.0 software. Results A total of 146 P. falciparum samples were analyzed as single infection samples with a total of 26 alleles in locus Polyα and 12 alleles in locus TAA87. The mean He value of the two loci was 0.86 ± 0.02. Ten alleles in locus Polyα and 8 alleles in locus TAA87 were distributed in Myanmar isolates, with the He values of 0.86 and 0.81 respectively. Fifteen alleles in locus Polyα and 11 in locus TAA87 were detected in Ghana isolates, with the He values of 0.91 and 0.86 respectively. In addition, the haplotype of 174 bp (Polyα) and 113 bp (TAA87) were only detected in Myanmar isolates with more than 17% gene frequency, whereas they were absent in Ghana isolates. Conclusions The two different geographical sources of imported P. falciparum strains have different allele frequencies and haplotypes at the two neutral microsatellite markers, Polyα and TAA87. Therefore, these two microsatellite loci may be considered as the potential molecular marker candidates for identifying P. falciparum strains with different geographical sources.

Needs of exploring the burden of recent onset seizures due to neurocysticercosis and challenges in southeast Asia focusing on scenario in Malaysia

Seizures due to neurocysticercosis (NCC) is a neglected human-to-human transmitted disorder and an emerging problem worldwide. A substantial portion of recent onset seizures is known to be attributed to NCC in Taenia solium (T. solium) endemic areas where populations which neither raise pigs nor eat pig meat are also at risk. High prevalence of NCC causing epilepsy has been reported in the underdeveloped areas of Southeast Asia (SEA) however, only fragmentary information on its incidence is available in countries like Malaysia. In Malaysia T. solium infection was previously thought to be infrequent due to Muslim population majority and the religious prohibition of consuming pork, but it is not totally absent. There is an evident lack of knowledge and awareness of the actual burden, routes of transmission, and the impact of NCC in this region. The problem is assumed to be more prevalent particularly in cities because of the frequent inflow of possibly T. solium infected individuals or carriers among those who migrate from neighboring endemic countries to Malaysia. The issue of imported cases that are likely to be emerging in Malaysia is highlighted here. An accurate quantification of regional burdens of epilepsy due to NCC in Malaysia is warranted considering the disease emergence in its neighboring countries. It is suggested that the importance of NCC be recognized through quantification of its burden, and also to collect epidemiological data for its subsequent elimination in line of World Health Organization's mission for control of cysticercosis as a neglected tropical disease. In this review the need as well as a strategy for neuro-care center screening of epilepsy cases, and various issues with possible explanations are discussed. It is also proposed that NCC be declared as a reportable disease which is one of the eradicable public health problems in SEA.

Needs of exploring the burden of recent onset seizures due to neurocysticercosis and challenges in southeast Asia focusing on scenario in Malaysia

Seizures due to neurocysticercosis (NCC) is a neglected human-to-human transmitted disorder and an emerging problem worldwide. A substantial portion of recent onset seizures is known to be attributed to NCC in Taenia solium (T. solium) endemic areas where populations which neither raise pigs nor eat pig meat are also at risk. High prevalence of NCC causing epilepsy has been reported in the underdeveloped areas of Southeast Asia (SEA) however, only fragmentary information on its incidence is available in countries like Malaysia. In Malaysia T. solium infection was previously thought to be infrequent due to Muslim population majority and the religious prohibition of consuming pork, but it is not totally absent. There is an evident lack of knowledge and awareness of the actual burden, routes of transmission, and the impact of NCC in this region. The problem is assumed to be more prevalent particularly in cities because of the frequent inflow of possibly T. solium infected individuals or carriers among those who migrate from neighboring endemic countries to Malaysia. The issue of imported cases that are likely to be emerging in Malaysia is highlighted here. An accurate quantification of regional burdens of epilepsy due to NCC in Malaysia is warranted considering the disease emergence in its neighboring countries. It is suggested that the importance of NCC be recognized through quantification of its burden, and also to collect epidemiological data for its subsequent elimination in line of World Health Organization's mission for control of cysticercosis as a neglected tropical disease. In this review the need as well as a strategy for neuro-care center screening of epilepsy cases, and various issues with possible explanations are discussed. It is also proposed that NCC be declared as a reportable disease which is one of the eradicable public health problems in SEA.

For effective training program on nursing education system in Southeast Asia: Lessons learnt from the training evaluation / 国際保健医療

<p><b>Purpose</b></p><p>  The training for “Strengthening Human Resource Development for Nursing and Midwifery in Southeast Asia” was implemented in order to strengthen the nursing education system in Cambodia, Laos, Myanmar and Vietnam. The purpose of this study was to evaluate the training using the training evaluation guide suggested by WHO; and to explore factors for training program to be effective, issues, and lessons.</p><p><b>Methods</b></p><p>  The WHO training evaluation guide which has five evaluation levels was modified as a tool to evaluate the training. Data were collected from training evaluations questionnaire, meeting records during training, and records of interviews conducted during follow-up visits. The factors for training to be effective, issues, and lessons were inductively identified by methodological triangulation from the results of training evaluations, the summary of training feedback from participants and the results of action plan progress. </p><p><b>Results and Discussion</b></p><p>  The training was evaluated as effective that not only achieved “Level 1: Reaction and Satisfaction” and “Level 2: Learning”, but also “Level 3: Behavior”. The factors for training to be effective were (1) practical content through sharing experiences amongmulti-country participants in neighboring countries, (2) selection of suitable trainees by setting the training language as the native language of each participating country, (3)lecture documents in native language facilitated sharing of the learning with relevant people in one’s own country, (4) maintain trainees’ motivation to implement action plans following an agreement with trainees during the training to confirm action plan progress through follow-up visits, and (5) pre-visitingeach participating country to explain the training outline makes relevant people’s much understanding of the training and interest in the action plan. Lessons learned were the importance of the definitions of technical terminology in each country’s native language and the efficacy of follow-up visits. Future issues are: “Level 4: Results”, support for each participant’s needs and “Level 5: Impact”, the development of mechanisms for continued sharing of experiences.</p><p><b>Conclusions</b></p><p>  Our evaluation confirmed the effective factors　for training, issues, and lessons. These are needed to be considered for the future training.</p>

The current status of Zika virus in Southeast Asia / 한국역학회지

OBJECTIVES: Zika virus currently poses a global threat and is a major public health issue throughout Latin America and the Caribbean. However, Zika virus infections in humans have also been observed in other regions, including Southeast Asia, where arboviral diseases are very common. In this study, we summarize the current status of Zika virus in Southeast Asia. This review aims to provide an overview of the current situation and also to suggest ways of adequately managing the emergence of Zika virus in Southeast Asia. METHODS: The literature searching for the reports on Zika virus in Southeast Asia was done using standard database PubMed and the re-analysis and summarization on the reports was done. RESULTS: A limited number of reports have addressed Zika virus disease in Southeast Asia, but it is has been confirmed that a problem already exists. Individual case reports and outbreaks of Zika virus have been confirmed in Southeast Asia. Several reports have also described patients becoming infected after visiting Southeast Asia. In addition, the concurrent circulation of Zika virus with other arboviruses has been confirmed. CONCLUSIONS: As a tropical region with a high prevalence of arboviral diseases, the emergence of Zika virus in Southeast Asia is a major concern. It is essential for local medical personnel to recognize this disease. Given the status of Southeast Asia as a globally important tourist destination, continuous updates on the status of Zika virus in Southeast Asia are required and should be incorporated into global health advisories regarding travel.

Comparative genome analysis between Southeast Asian and South American Zika viruses

OBJECTIVE@#To understand the cause for the differences between potentially mild Southeast Asian and the more pathogenic ZIKV in South America.@*METHODS@#A comparative genomic analysis was performed to determine putative causations stemming from ZIKV.@*RESULTS@#Phylogenetic analyses integrating geographical and time factors revealed that Southeast Asian ZIKV might not be the direct source of South American outbreaks as previously speculated. Amino acid residues unique to South American ZIKV isolates at the envelope, pr and NS1 proteins are listed and shown in the structural context. These unique residues on external viral proteins are not found in Southeast Asian ZIKV and could be responsible for the ongoing outbreak either via an intrinsic property of the virus or interactions with human immunity. Only a selected few primer/probe sets currently in clinical use were identified of being capable of detecting ZIKV strains worldwide. The envelope proteins of dengue virus (DENV) and ZIKV also showed a remarkable degree of similarity especially at the surface residues.@*CONCLUSIONS@#These findings may help explain the cross-reactivity of DENV antibodies to ZIKV. Thus, major caveats must be exercised in using existing diagnostic tools for ZIKV.

Comparative genome analysis between Southeast Asian and South American Zika viruses

Objective To understand the cause for the differences between potentially mild Southeast Asian and the more pathogenic ZIKV in South America. Methods A comparative genomic analysis was performed to determine putative causations stemming from ZIKV. Results Phylogenetic analyses integrating geographical and time factors revealed that Southeast Asian ZIKV might not be the direct source of South American outbreaks as previously speculated. Amino acid residues unique to South American ZIKV isolates at the envelope, pr and NS1 proteins are listed and shown in the structural context. These unique residues on external viral proteins are not found in Southeast Asian ZIKV and could be responsible for the ongoing outbreak either via an intrinsic property of the virus or interactions with human immunity. Only a selected few primer/probe sets currently in clinical use were identified of being capable of detecting ZIKV strains worldwide. The envelope proteins of dengue virus (DENV) and ZIKV also showed a remarkable degree of similarity especially at the surface residues. Conclusions These findings may help explain the cross-reactivity of DENV antibodies to ZIKV. Thus, major caveats must be exercised in using existing diagnostic tools for ZIKV.