In 2017, the Myanmar National Action Plan for Containment of Antimicrobial Resistance (AMR) (2017-2022) was endorsed by the Ministry of Health and Sports, Myanmar; one of its objectives was to increase public awareness of AMR to accelerate appropriate antibiotic use. This survey aimed to assess the public knowledge, practices and awareness concerning antibiotics and AMR awareness among adults in Myanmar. We conducted a nationwide cross-sectional mobile phone panel survey in January and February 2020. Participants were randomly selected from the mobile phone panel in each of three groups stratified by gender, age group, and residential area urbanity; they were interviewed using a structured questionnaire. Collected data were weighted based on the population of each stratum from the latest national census and analyzed using descriptive and inferential statistics. Two thousand and forty-five adults from 12 regions and states participated in this survey. Overall, 89.5% of participants had heard about antibiotics; however, only 0.9% provided correct answers to all five questions about antibiotics, whereas 9.7% provided all incorrect answers. More than half of participants (58.5%) purchased antibiotics without a prescription, mainly from medical stores or pharmacies (87.9%); this was more frequent in age group (18-29 years) and those in rural areas (p = 0.004 and p < 0.001, respectively). Only 56.3% were aware of antibiotic resistance and received their information from medical professionals (46.3%), family members or friends (38.9%), or the media (26.1%). Less than half (42.4%) knew that antibiotics were used in farm animals. Most did not know that using antibiotics in farm animals could develop resistance (73.2%) and is banned for the purposes of growth stimulation (64.1%). This survey identifies considerable gaps in the knowledge, practices, and awareness about antibiotics among the general population in Myanmar. Continuous public education and awareness campaigns must be urgently conducted to fulfill these gaps, which would aid in promoting antibiotic stewardship, leading to combating AMR in Myanmar.
Background. The spread of Enterobacteriaceae coproducing carbapenemases, 16S rRNA methylase and mobile colistin resistance proteins (MCRs) has become a serious public health problem worldwide. This study describes two clinical isolates of Klebsiella pneumoniae coharbouring blaIMP-1, armA and mcr-10.Methods. Two clinical isolates of K. pneumoniae resistant to carbapenems and aminoglycosides were obtained from two patients at a hospital in Myanmar. Their minimum inhibitory concentrations (MICs) were determined by broth microdilution methods. The whole-genome sequences were determined by MiSeq and MinION methods. Drug-resistant factors and their genomic environments were determined.Results. The two K. pneumoniae isolates showed MICs of ≥4 and ≥1024 µg ml-1 for carbapenems and aminoglycosides, respectively. Two K. pneumonaie harbouring mcr-10 were susceptible to colistin, with MICs of ≤0.015 µg ml-1 using cation-adjusted Mueller-Hinton broth, but those for colistin were significantly higher (0.5 and 4 µg ml-1) using brain heart infusion medium. Whole-genome analysis revealed that these isolates coharboured blaNDM-1, armA and mcr-10. These two isolates showed low MICs of 0.25 µg ml-1 for colistin. Genome analysis revealed that both blaNDM-1 and armA were located on IncFIIs plasmids of similar size (81 kb). The mcr-10 was located on IncM2 plasmids of sizes 220 or 313 kb in each isolate. These two isolates did not possess a qseBC gene encoding a two-component system, which is thought to regulate the expression of mcr genes.Conclusion. This is the first report of isolates of K. pneumoniae coharbouring blaNDM-1, armA and mcr-10 obtained in Myanmar.
Surveillance of 10 hospitals and a regional public health laboratory in Myanmar identified 31 isolates of carbapenem-resistant Enterobacter cloacae complex harboring blaNDM-type Of these isolates, 19 were highly resistant to aminoglycosides and harbored one or more genes encoding 16S rRNA methylases, including armA, rmtB, rmtC, and/or rmtE Of the 19 isolates, 16 were Enterobacter xiangfangensis ST200, with armA on the chromosome and a plasmid harboring blaNDM-1 and rmtC, indicating that these isolates were clonally disseminated nationwide in Myanmar.IMPORTANCE The emergence of multidrug-resistant E. cloacae complex has become a public health threat worldwide. E. xiangfangensis is a recently classified species belonging to E. cloacae complex. Here, we report a clonal dissemination of multidrug-resistant E. xiangfangensis ST200 producing two types of New Delhi metallo-β-lactamase (NDM-type MBL), NDM-1 and -4, and three types of 16S rRNA methylases, ArmA, RmtC, and RmtE, in hospitals in Myanmar. The observation of these multidrug-resistant E. xiangfangensis ST200 isolates stresses the urgency to continue molecular epidemiological surveillance of these pathogens in Myanmar and in South Asian countries.
Opisthorchis viverrini is endemic in the South East Asian region, especially in Cambodia, Lao People's Democratic Republic, Vietnam and Thailand, but there have been no previous records from Myanmar. During stool surveys of rural populations in three regions of Lower Myanmar, Opisthorchis-like eggs were found in 34 out of 364 (9.3%) participants by stool microscopy after using the modified formalin-ether concentration technique. DNA was extracted from these positive stool samples and a portion of the mitochondrial cytochrome c oxidase subunit I (cox1) gene was amplified using the polymerase chain reaction and then sequenced. DNA sequences, successfully obtained from 18 of 34 positive samples (Bago Region, n = 13; Mon State, n = 3; Yangon Region, n = 2), confirmed that the eggs were of O. viverrini. Sequences showed 99.7% identity with O. viverrini mitochondrial cox1 (GenBank accession no. JF739555) but 95%, 88.7%, 82.6% and 81.4% identities with those of Opisthorchis lobatus from Lao People's Democratic Republic (GenBank accession nos. HQ328539-HQ328541), Metorchis orientalis from China (KT239342), Clonorchis sinensis from China (JF729303) and Opisthorchis felineus from Russia (EU921260), respectively. When alignement with other Opisthorchiidae trematodes, 81% similarity with Metorchis bilis from Czech Republic (GenBank accession nos. KT740966, KT740969, KT740970) and Slovakia (GenBank accession nos. KT740971-KT740973), 84.6% similarity with Metorchis xanthosomus from Czech Republic (GenBank accession no. KT740974), 78.6% similarity with M. xanthosomus from Poland (GenBank accession no. KT740968) and 82.2% similarity with Euamphimerus pancreaticus from Czech Republic (GenBank accession no. KT740975) were revealed. This study demonstrated, for the first time, O. viverrini from rural people in Myanmar using molecular methods and is an urgent call for surveillance and control activities against opisthorchiasis in Myanmar.
Until 2005, the quality of rapid diagnostic human immunodeficiency virus (HIV) testing was not monitored and no regular technical support was provided to hospital laboratories in Myanmar.The national reference laboratory introduced a national external quality assessment scheme. The scheme involved (i) training laboratory technicians in HIV testing and in the requirements of the quality assessment system; (ii) implementing a biannual proficiency panel testing programme; (iii) on-site assessments of poorly-performing laboratories to improve testing procedures; and (iv) development of national guidelines.In 2011, a total of 422 public hospitals in Myanmar had laboratories providing HIV tests. In addition, private laboratories supported by nongovernmental organizations (NGOs) conducted HIV testing.The scheme was started in 65 public laboratories in 2005. In 2012, it had expanded nationwide to 347 laboratories, including 33 NGO laboratories. During the expansion of the scheme, laboratory response rates were greater than 90% and the proportion of laboratories reporting at least one aberrant result improved from 9.2% (6/65) in 2005 to 5.4% (17/316) in 2012.National testing guidelines and a reference laboratory are needed to successfully implement quality assurance of HIV testing services. On-site assessments are crucial for all participating laboratories and the only source for insight on the causes of aberrant results; lessons that the reference laboratory can share nationally. Proficiency testing helps laboratory technicians to maintain HIV testing skills by ensuring that they regularly encountered HIV-positive samples.Jusqu'à 2005, la qualité du dépistage du virus de l'immunodéficience humaine (VIH) à diagnostic rapide n'était pas surveillée, et aucune assistance technique régulière n'était fournie aux laboratoires hospitaliers du Myanmar.Le laboratoire national de référence a mis en place un système national d'évaluation de la qualité externe. Le système impliquait (i) la formation des techniciens de laboratoire au dépistage du VIH et aux exigences du système d'évaluation de la qualité; (ii) la mise en place d'un programme de contrôle des compétences deux fois par an; (iii) l'évaluation sur site des laboratoires à performance médiocre pour améliorer les procédures de dépistage; et (iv) l'élaboration de directives nationales.En 2011, un total de 422 hôpitaux publics au Myanmar disposaient de laboratoires réalisant des dépistages du VIH. En outre, des laboratoires privés soutenus par des organisations non gouvernementales (ONG) ont également effectué des dépistages du VIH.Le système a été lancé dans 65 laboratoires publics en 2005. En 2012, il a été étendu à l'échelle du pays dans 347 laboratoires, y compris 33 laboratoires gérés par des ONG. Pendant le développement du système, les taux de réponse des laboratoires étaient supérieurs à 90%, et le pourcentage de laboratoire ayant signalé au moins un résultat aberrant s'est amélioré, passant de 9,2% (6/65) en 2005 à 5,4% (17/316) en 2012.Des directives nationales en matière de dépistage et un laboratoire de référence sont nécessaires pour réussir la mise en œuvre de l'assurance qualité des services de dépistage du VIH. Les évaluations sur site sont essentielles pour tous les laboratoires participants et la seule source pour connaître les causes des résultats aberrants. Ce sont des leçons que le laboratoire de référence peut diffuser à l'échelle nationale. Les contrôles de compétence peuvent aider les techniciens de laboratoire à maintenir à niveau leurs compétences en matière de dépistage du VIH en s'assurant qu'ils rencontrent régulièrement des échantillons de VIH séropositifs.Hasta 2005, no se había controlado la calidad de las pruebas de diagnóstico rápido del virus de inmunodeficiencia humana (VIH) ni se había proporcionado asistencia técnica constante a los laboratorios de los hospitales en Myanmar.El laboratorio nacional de referencia introdujo un sistema nacional de evaluación externa de la calidad. El plan incluía (i) la capacitación de técnicos de laboratorio en las pruebas del VIH y en los requisitos del sistema de evaluación de la calidad; (ii) la aplicación de un programa bianual de un cuadro de análisis de la competencia; (iii) evaluaciones in situ de los laboratorios con un rendimiento bajo para mejorar los procedimientos de prueba; y (iv) el desarrollo de directrices nacionales.En 2011, un total de 422 hospitales públicos en Myanmar contaban con laboratorios que ofrecían pruebas del VIH. Además, laboratorios privados apoyados por organizaciones no gubernamentales (ONG) también realizaban pruebas del VIH.El plan se inició en 65 laboratorios públicos en 2005. En 2012, se amplió a nivel nacional a 347 laboratorios, de los cuales, 33 eran laboratorios de ONG. Durante la ampliación del plan, las tasas de respuesta de laboratorio fueron superiores al 90% y la proporción de laboratorios que notificaban al menos un resultado aberrante mejoró del 9,2% (6/65) en 2005 al 5,4% (17/316) en 2012.Se necesitan directrices nacionales para la realización de pruebas y un laboratorio de referencia para aplicar con éxito el control de calidad de los servicios de pruebas del VIH. Las evaluaciones in situ son fundamentales para todos los laboratorios participantes y la única fuente para comprender las causas de los resultados anómalos. El laboratorio de referencia puede compartir estas lecciones a nivel nacional. La evaluación de la competencia ayuda a los técnicos de laboratorio a mantener las aptitudes para la realización de las pruebas del VIH, ya que les garantiza encontrar muestras seropositivas.حتى عام 2005، لم يكن هناك رصد لجودة اختبارات فيروس العوز المناعي البشري التشخيصية السريعة ولم يتم تقديم دعم تقني إلى مختبرات المستشفيات في ميانمار.عرض المختبر المرجعي الوطني مخططاً لتقييم الجودة الخارجية على الصعيد الوطني. وتضمن المخطط (1) تدريب فنيي المختبرات على اختبارات فيروس العوز المناعي البشري وعلى متطلبات نظام تقييم الجودة؛ (2) تنفيذ برنامج نصف سنوي لاختبار مستلزمات الكفاءة؛ (3) تقييمات تنفذ في مواقع المختبرات ذات الأداء الضعيف بغية تحسين إجراءات الاختبار؛ (4) وضع دلائل إرشادية وطنية.في عام 2011، كان ما مجموعه 422 مستشفى عمومياً في ميانمار تحتوي على مختبرات تقدم اختبارات فيروس العوز المناعي البشري. بالإضافة إلى ذلك، أجرت مختبرات خاصة تدعمها منظمات غير حكومية اختبارات فيروس العوز المناعي البشري.تم بدء المخطط في 65 مختبراً عمومياً في عام 2005. وفي عام 2012، شهد المخطط توسعاً على الصعيد الوطني ليشمل 347 مختبراً، بما في ذلك مختبرات المنظمات غير الحكومية. وخلال التوسع الذي شهده المخطط، ازدادت معدلات الاستجابة المختبرية عن 90 % وتحسنت نسبة المختبرات التي أبلغت عن نتيجة زائغة واحدة على الأقل من 9.2 % (6/65) في عام 2005 إلى 5.4 % (17/316) في عام 2012.يتعين وجود دلائل إرشادية وطنية لإجراء الاختبارات ومختبر مرجعي بغية تنفيذ ضمان الجودة لخدمات اختبارات فيروس العوز المناعي البشري بشكل ناجح. وتعد التقييمات التي تنفذ في المواقع ذات أهمية حاسمة لدى جميع المختبرات المشاركة وهي المصدر الوحيد للرؤى بشأن أسباب النتائج الزائغة؛ والدروس التي يمكن للمختبر المرجعي تبادلها على الصعيد الوطني. ويساعد اختبار الكفاءة فنيي المختبرات على الاحتفاظ بمهارات اختبارات فيروس العوز المناعي البشري عن طريق ضمان تصديهم للعينات الإيجابية لفيروس العوز المناعي البشري بشكل منتظم.在2005年之前，缅甸快速诊断性艾滋病病毒（HIV）检测质量都未得到监控，医院实验室也没有获得定期技术支持。国家参考实验室引入了国家外部质量评估方案。方案涉及(i) 对实验室技术员进行艾滋病毒检测和质量评估系统要求的培训；(ii) 实施一年两次的熟练度专家组检测计划；(iii) 现场评估绩效不良的实验室以改善检测程序；(iv) 制定全国家导方针。在2011年，缅甸总共有422家公共医院设有提供HIV检测的实验室。此外，非政府组织（NGO）支持的私人实验室也执行HIV检测。2005年，该方案在65个公共实验室启动。在2012年，全国已经有347个实验室实施该方案，包括33个NGO实验室。在方案扩大期间，实验室响应率大于90%，实验室报告至少一例异常结果的比例从2005年的9.2%（6/65）降低至2012年的5.4%（17/316）。成功实施艾滋病毒检测服务的质量保证需要国家检测指导方针和参考实验室。对所有参与实验室提供现场评估至关重要，这也是洞察异常结果原因的唯一措施；参考实验室的经验教训可以在全国分享。熟练度检测有助于实验室技术员通过确保经常接触艾滋病毒阳性样本来保持艾滋病毒检测的技能。До 2005 года в Мьянме не осуществлялся контроль за качеством быстрой диагностики вируса иммунодефицита человека (ВИЧ), а лабораториям больниц не оказывалась регулярная техническая поддержка.Национальная справочная лаборатория внедрила национальную программу внешней оценки качества. Эта программа включала (i) обучение лаборантов тестированию на ВИЧ и требованиям системы оценки качества, (ii) реализацию полугодичной программы проверки квалификации, (iii) оценку на месте неудовлетворительно работающих лабораторий с целью совершенствования процедур тестирования и (iv) разработку национальных руководств.В 2011 году в общей сложности 422 государственные больницы в Мьянме располагали лабораториями, выполняющими тестирование на ВИЧ. Кроме того, тестирование на ВИЧ выполняли частные лаборатории, поддерживаемые неправительственными организациями (НПО).Реализация программы была начата в 65 государственных лабораториях в 2005 году. В 2012 году программа была распространена на всю страну и охватила 347 лабораторий, в том числе 33 лаборатории НПО. Во время расширения программы уровень участия лабораторий превышал 90%, а доля лабораторий, сообщивших по крайней мере об одном аберрантном результате, уменьшилась с 9,2% (6/65) в 2005 году до 5,4% (17/316) в 2012 году.Для успешного обеспечения качества услуг тестирования на ВИЧ требуются национальные рекомендации и наличие справочной лаборатории. Проведение оценок на месте имеет решающее значение для всех участвующих лабораторий и является единственным источником для понимания причин аберрантных результатов. Этими выводами справочная лаборатория может поделиться на национальном уровне. Профессиональное тестирование поможет лаборантам поддерживать свои навыки тестирования на ВИЧ на должном уровне путем регулярного выявления ВИЧ-позитивных образцов.
Background The majority of HIV infection among children occurs through mother-to-child transmission. HIV exposed infants are recommended to have virological testing at birth or 4–6 weeks of age but challenges with centralized laboratory-based testing in Myanmar result in low testing rates and delays in result communication and treatment initiation. Decentralized point-of-care (POC) testing when integrated in prevention of mother-to-child transmission of HIV (PMTCT) services, can be an alternative to increase coverage of early infant diagnosis (EID) and timely engagement in HIV treatment and care. Aim This paper aims to explore experiences of caregivers of HIV-exposed infants enrolled in the PMTCT program in Myanmar and the perceived acceptability of point-of-care EID testing compared to conventional centralised laboratory-based testing. Methods This is a sub-study of the cluster randomised controlled stepped-wedge trial (Trial registration number: ACTRN12616000734460) that assessed the impact of near POC EID testing using Xpert HIV-1 Qual assay in four public hospitals in Myanmar. Caregivers of infants who were enrolled in the intervention phase of the main study, had been tested with both Xpert and standard of care tests and had received the results were eligible for this qualitative study. Semi-structured interviews were conducted with 23 caregivers. Interviews were audio recorded, transcribed verbatim and translated into English. Thematic data analysis was undertaken using NVivo 12 Software (QSR International). Results The majority of caregivers were satisfied with the quality of care provided by PMTCT services. However, they encountered social and financial access barriers to attend the PMTCT clinic regularly. Mothers had concerns about community stigma from the disclosure of their HIV status and the potential consequences for their infants. While medical care at the PMTCT clinics was free, caregivers sometimes experienced financial difficulties associated with out-of-pocket expenses for childbirth and transportation. Some caregivers had to choose not to attend work (impacting their income) or the adult antiretroviral clinic in order to attend the paediatric PMTCT clinic appointment. The acceptability of the Xpert testing process was high among the caregiver participants and more than half received the Xpert result on the same day as testing. Short turnaround time of the near POC EID testing enabled the caregivers to find out their infants' HIV status quicker, thereby shortening the stressful waiting time for results. Conclusion Our study identified important access challenges facing caregivers of HIV exposed infants and high acceptability of near POC EID testing. Improving the retention rate in the PMTCT and EID programs necessitates careful attention of program managers and policy makers to these challenges, and POC EID represents a potential solution.
We aimed to analyze the situation of the first two epidemic waves in Myanmar using the publicly available daily situation of COVID-19 and whole-genome sequencing data of SARS-CoV-2. From March 23 to December 31, 2020, there were 33,917 confirmed cases and 741 deaths in Myanmar (case fatality rate of 2.18%). The first wave in Myanmar from March to July was linked to overseas travel, and then a second wave started from Rakhine State, a western border state, leading to the second wave spreading countrywide in Myanmar from August to December 2020. The estimated effective reproductive number (Rt) nationwide reached 6-8 at the beginning of each wave and gradually decreased as the epidemic spread to the community. The whole-genome analysis of 10 Myanmar SARS-CoV-2 strains together with 31 previously registered strains showed that the first wave was caused by GISAID clade O or PANGOLIN lineage B.6 and the second wave was changed to clade GH or lineage B.1.36.16 with a close genetic relationship with other South Asian strains. Constant monitoring of epidemiological situations combined with SARS-CoV-2 genome analysis is important for adjusting public health measures to mitigate the community transmissions of COVID-19.
We investigated the circulation patterns of human influenza A and B viruses in Myanmar between 2010 and 2015 by analyzing full HA genes. Upper respiratory tract specimens were collected from patients with symptoms of influenza-like illness. A total of 2,860 respiratory samples were screened by influenza rapid diagnostic test, of which 1,577 (55.1%) and 810 (28.3%) were positive for influenza A and B, respectively. Of the 1,010 specimens that were positive for virus isolation, 370 (36.6%) were A(H1N1)pdm09, 327 (32.4%) were A(H3N2), 130 (12.9%) B(Victoria), and 183 (18.1%) were B(Yamagata) viruses. Our data showed that influenza epidemics mainly occurred during the rainy season in Myanmar. Our three study sites, Yangon, Pyinmana, and Pyin Oo Lwin had similar seasonality and circulating type and subtype of influenza in a given year. Moreover, viruses circulating in Myanmar during the study period were closely related genetically to those detected in Thailand, India, and China. Phylogeographic analysis showed that A(H1N1)pdm09 viruses in Myanmar originated from Europe and migrated to other countries via Japan. Similarly, A(H3N2) viruses in Myanmar originated from Europe, and disseminated to the various countries via Australia. In addition, Myanmar plays a key role in reseeding of influenza B viruses to Southeast Asia and East Asia as well as Europe and Africa. Thus, we concluded that influenza virus in Myanmar has a strong link to neighboring Asian countries, Europe and Oceania.
An influenza circulation was observed in Myanmar between October and November in 2021. Patients with symptoms of influenza-like illness were screened using rapid diagnostic test (RDT) kits, and 147/414 (35.5%) upper respiratory tract specimens presented positive results. All RDT-positive samples were screened by a commercial multiplex real-time polymerase chain reaction (RT-PCR) assay, and 30 samples positive for influenza A(H3N2) or B underwent further typing/subtyping for cycle threshold (Ct) value determination based on cycling probe RT-PCR. The majority of subtyped samples (n = 13) were influenza A(H3N2), while only three were B/Victoria. Clinical samples with low Ct values obtained by RT-PCR were used for whole-genome sequencing via next-generation sequencing technology. All collected viruses were distinct from the Southern Hemisphere vaccine strains of the corresponding season but matched with vaccines of the following season. Influenza A(H3N2) strains from Myanmar belonged to clade 2a.3 and shared the highest genetic proximity with Bahraini strains. B/Victoria viruses belonged to clade V1A.3a.2 and were genetically similar to Bangladeshi strains. This study highlights the importance of performing influenza virus surveillance with genetic characterization of the influenza virus in Myanmar, to contribute to global influenza surveillance during the COVID-19 pandemic.
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