Mr. Thesis

မျောက်​ကျောက်​ရောဂါကာကွယ်​ဆေးထိုးနှံခြင်း
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​မျောက်ကျောက်​ရောဂါကာကွယ်​ဆေးထိုးနှံခြင်း
နဲ့ပတ်သက်ပြီး ကမ္ဘာ့ကျန်းမာ​ရေးအဖွဲ့က ၁၄-၆-၂၀၂၂ ရက်​နေ့မှာ ကနဦးလမ်းညွန်ချက်ကို ထုတ်ပြန်ခဲ့ပါတယ်။ ဒီထုတ်ပြန်ချက်မှာ အဓိကအချက် ၅ချက်ပါပါတယ်။

အဲဒီအချက်​တွေက​တော့
၁။ လက်ရှိအ​ခြေအ​နေမှာ လူအများအပြားကို ကာကွယ်​ဆေးထိုးဖို့ မလိုအပ်သလို၊ မတိုက်တွန်းကြောင်း၊

၂။ ​ရောဂါရှိသူနဲ့ ထိ​တွေ့ထားသူ​တွေအ​နေနဲ့ ထိ​တွေ့ပြီး ၄ရက်အတွင်း post-exposure prophylaxis (PEP) လို့​ခေါ်တဲ့ ထိ​တွေ့ပြီး​​နောက်ရောဂါဖြစ်ပွားမှုကိုကာကွယ်နိုင်ဖို့ ကမ္ဘာကျန်းမာ​ရေးအဖွဲ့ကအသိအမှတ်ပြုထားတဲ့ကာကွယ်​ဆေးကိုထိုးနှံဖို့ တိုက်တွန်း​ကြောင်း၊

၃။ အလားတူ ​ရောဂါကူးစက်နိုင်​ခြေများတဲ့ ကျန်းမာ​ရေးဝန်ထမ်း​တွေ၊ ဓါတ်ခွဲစမ်းသပ်ရောဂါရှာ​ဖွေသူ​တွေ၊ ဒါ့အပြင် နိုင်ငံအလိုက် ချမှတ်ထားတဲ့မူဝါဒအရ​ ရောဂါကူးစက်နိုင်​ခြေရှိသူ​တွေ အ​နေနဲ့လည်း post-exposure prophylaxis (PEP) ယူဖို့ တိုက်တွန်း​​ကြောင်း၊

၄။ ကာကွယ်​ဆေးထိုးစီမံချက်ကို အ​ကောင်အထည်မ​ဖော်ခင် ​ရောဂါရှာ​ဖွေစစ်​ဆေးမှု၊ ထိ​တွေ့လူနာရှာ​ဖွေ​ဖော်ထုတ်မှု၊ ကျန်းမာ​​ရေးအသိပညာ​ပေးမှု၊ ကာကွယ်​ဆေးရဲ့​ဘေးကင်းစိတ်ချရမှုနဲ့ အာနိသင်ရှိမှု​တွေကို စနစ်တကျသု​တေသနပြု​လေ့လာသုံးသပ်မှု ​ဆောင်ရွက်ဖို့ လိုအပ်​ကြောင်း၊

၅။ ကာကွယ်​ဆေးထိုးသင့်၊ မထိုးသင့် ဆုံးဖြတ်တဲ့​နေရာမှာ လူတစ်ဦးချင်းဆီအတွက် ​အကျိုး၊ အပြစ် ​သေချာစစ်​ဆေးတွက်ချက်ဖို့လိုအပ်​ကြောင်း၊ စတာ​တွေဖြစ်ပါတယ်။

အခုအချိန်အထိ မြန်မာနိုင်ငံမှာ ​မျောက်​ကျောက်​ရောဂါကူးစက်ခံရသူ တစ်ဦးတစ်​ယောက်မှမရှိ​သေး​ကြောင်း ကျန်းမာ​ရေးဝန်ကြီးဌာနကထုတ်ပြန်ထားပါတယ်။

​မေတ္တာဖြင့်
​ဒေါက်တာဇင်​ဇေယျာဝင်း
၁၅-၆-၂၀၂၂

Identification of a new HCV subtype 6xg among injection drug users in Kachin, Myanmar

Abstract
Characterizing HCV genetic diversity not only allows us to trace its origin and evolutionary history, but also provides valuable insights into diagnosis, prevention and therapy of HCV infection. Although eight HCV genotypes and 86 subtypes have been classified, there are still some HCV variants that need to be assigned. The genotype 6 is the most diverse HCV genotype and mainly prevalent in Southeast Asia. In this study, we identified a new HCV subtype 6xg from injection drug users (IDUs) in Kachin, Myanmar. A distinctive feature of 6xg from other subtypes of the genotype 6 was a Lys insertion in NS5A gene, which changes the RRKR/K motif into RRKKR/K. Bayesian analyses showed that HCV 6xg originated during 1984-1988, and experienced a rapid population expansion during 2005-2009. We characterized HCV subtype profile among IDUs in this region, and detected six HCV subtypes, including 1a (12%), 3a (12%), 3b (24%), 6n (16%), 6xa (20%), and 6xg (12%). Importantly, we found that HCV subtype distribution in Kachin was very similar to that in Dehong prefecture of Yunnan, but very distinct from those in other regions of Myanmar and Yunnan, indicating that the China-Myanmar border region shared a unique HCV subtype pattern. The appearance of 6xg and the unique HCV subtype profile among IDUs in the China-Myanmar border region have significant epidemiological and public health implications.

To cite: Zheng YT, Ye M, Chen X, Wang Y, Duo L, Zhang C. Identification of a new HCV subtype 6xg among injection drug users in Kachin, Myanmar. Frontiers in Microbiology. 2019;10:814.

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Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow

Abstract

Background
Plasmodium vivax malaria remains a major public health burden in Myanmar. Resistance to chloroquine (CQ), the first-line treatment for P. vivax, has been reported in the country and has potential to undermine local control efforts.
Methods
Patients over 6 years of age with uncomplicated P. vivax mono-infection were enrolled into clinical efficacy studies in Myawaddy in 2014 and Kawthoung in 2012. Study participants received a standard dose of CQ (25 mg/kg over 3 days) followed by weekly review until day 28. Pvmdr1 copy number (CN) and microsatellite diversity were assessed on samples from the patients enrolled in the clinical study and additional cross-sectional surveys undertaken in Myawaddy and Shwegyin in 2012.
Results
A total of 85 patients were enrolled in the CQ clinical studies, 25 in Myawaddy and 60 in Kawthoung. One patient in Myawaddy (1.2%) had an early treatment failure and two patients (2.3%) in Kawthoung presented with late treatment failures on day 28. The day 28 efficacy was 92.0% (95% CI 71.6–97.9) in Myawaddy and 98.3% (95% CI 88.7–99.8) in Kawthoung. By day 2, 92.2% (23/25) in Myawaddy and 85.0% (51/60) in Kawthoung were aparasitaemic. Genotyping and pvmdr1 CN assessment was undertaken on 43, 52 and 46 clinical isolates from Myawaddy, Kawthoung and Shwegyin respectively. Pvmdr1 amplification was observed in 3.2% (1/31) of isolates in Myawaddy, 0% (0/49) in Kawthoung and 2.5% (1/40) in Shwegyin. Diversity was high in all sites (H E 0.855–0.876), with low inter-population differentiation (F ST 0.016–0.026, P < 0.05).
Conclusions
Treatment failures after chloroquine were observed following chloroquine monotherapy, with pvmdr1 amplification present in both Myawaddy and Shwegyin. The results emphasize the importance of ongoing P. vivax drug resistance surveillance in Myanmar, particularly given the potential connectivity between parasite population at different sites.

To cite: Htun MW, Mon NC, Aye KM, Hlaing CM, Kyaw MP, Handayuni I, Trimarsanto H, Bustos D, Ringwald P, Price RN, Auburn S. Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow. Malaria journal. 2017 Dec;16(1):281.

Malaria epidemiology in central Myanmar: identification of a multi-species asymptomatic reservoir of infection
Abstract

Background
The spread of artemisinin-resistant Plasmodium falciparum is a global health concern. Myanmar stands at the frontier of artemisinin-resistant P. falciparum. Myanmar also has the highest reported malaria burden in Southeast Asia; it is integral in the World Health Organization’s plan to eliminate malaria in Southeast Asia, yet few epidemiological data exist for the general population in Myanmar.
Methods
This cross-sectional, probability household survey was conducted in Phyu township, Bago Region (central Myanmar), during the wet season of 2013. Interviewers collected clinical and behavioural data, recorded tympanic temperature and obtained dried blood spots for malaria PCR and serology. Plasmodium falciparum positive samples were tested for genetic mutations in the K13 region that may confer artemisinin resistance. Estimated type-specific malaria PCR prevalence and seroprevalence were calculated, with regression analysis to identify risk factors for seropositivity to P. falciparum. Data were weighted to account for unequal selection probabilities.
Results
1638 participants were sampled (500 households). Weighted PCR prevalence was low (n = 41, 2.5%) and most cases were afebrile (93%). Plasmodium falciparum was the most common species (n = 19. 1.1%) and five (26%) P. falciparum samples harboured K13 mutations. Plasmodium knowlesi was detected in 1.0% (n = 16) and Plasmodium vivax was detected in 0.4% (n = 7). Seroprevalence was 9.4% for P. falciparum and 3.1% for P. vivax. Seroconversion to P. falciparum was 0.003/year in the whole population, but 16-fold higher in men over 23 years old (LR test p = 0.016).
Discussion
This is the first population-based seroprevalence study from central Myanmar. Low overall prevalence was discovered. However, these data suggest endemic transmission continues, probably associated with behavioural risk factors amongst working-age men. Genetic mutations associated with P. falciparum artemisinin resistance, the presence of P. knowlesi and discrete demographic risk groups present opportunities and challenges for malaria control. Responses targeted to working-age men, capable of detecting sub-clinical infections, and considering all species will facilitate malaria elimination in this setting.

To cite
Ghinai I, Cook J, Hla TT, Htet HM, Hall T, Lubis IN, Ghinai R, Hesketh T, Naung Y, Lwin MM, Latt TS. Malaria epidemiology in central Myanmar: identification of a multi-species asymptomatic reservoir of infection. Malaria journal. 2017 Jan 5;16(1):16.