Khin Yi Oo

KU Leuven

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Reemerging of Japanese encephalitis in different regions of Myanmar.

Myanmar Health Sciences Research Journal (2013)

Khin Yi Oo Ommar Swe Tin Myint Thazin Aung Sanda Ko Khin Myat Nwe

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Ensuring accurate testing for human immunodeficiency virus in Myanmar

Bulletin of the World Health Organization (2014)

Latt Latt Kyaw Ikuma Nozaki Koji Wada Khin Yi Oo Htay Htay Tin

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.

10.2471/blt.14.138909

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Rare Influenza A (H3N2) Variants with Reduced Sensitivity to Antiviral Drugs

Emerging infectious diseases (2010)

Clyde Dapat Yasushi Suzuki Reiko Saito Yadanar Kyaw Yi Yi Myint

Abstract In 2007 and 2008 in Myanmar, we detected influenza viruses A (H3N2) that exhibited reduced sensitivity to both zanamivir and amantadine. These rare and naturally occurring viruses harbored a novel Q136K mutation in neuraminidase and S31N mutation in M2.

Zanamivir

Amantadine

Neuraminidase inhibitor

Oseltamivir

Rimantadine

10.3201/eid1603.091321

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Delayed emergence of oseltamivir‐resistant seasonal influenza A (H1N1) and pandemic influenza A(H1N1)pdm09 viruses in Myanmar

Influenza and Other Respiratory Viruses (2012)

Clyde Dapat Reiko Saito Yadanar Kyaw Yi Yi Myint Htun Naing Oo

The prevalence and timing of emergence of oseltamivir-resistant seasonal and pandemic influenza A (H1N1) viruses in Myanmar in 2008 and 2009 are described in this report. In 2008, the oseltamivir-resistant seasonal H1N1 virus was detected at a lower rate (6%) and emerged at least 2 months later when compared with neighboring countries. Similarly, the prevalence of pandemic H1N1 virus was low (3%) and the timing of emergence was late (August 2009) in Myanmar. Interestingly, we detected three isolates that were resistant to both amantadine and oseltamivir. Limited movement of people into the country is attributed to the delayed emergence of drug-resistant seasonal and pandemic A(H1N1) viruses.

Oseltamivir

Pandemic

Seasonal influenza

H1n1 pandemic

Amantadine

H5N1 genetic structure

10.1111/irv.12030

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Multisite Laboratory Evaluation of a Dual Human Immunodeficiency Virus (HIV)/Syphilis Point-of-Care Rapid Test for Simultaneous Detection of HIV and Syphilis Infection

Open Forum Infectious Diseases (2014)

Claire C. Bristow Yaw Adu‐Sarkodie Raphael Ondondo Elizabeth A. Bukusi Claver Anoumou Dagnra

Recently, test developers have created rapid point-of-care tests that can simultaneously detect multiple infections within the same specimen using a single device. The SD BIOLINE Duo HIV/Syphilis rapid point-of-care test uses a solid-phase immunochromatographic assay to detect immunoglobulin (Ig)G, IgM, and IgA antibodies to human immunodeficiency virus (HIV)-specific antigens (HIV-1 gp41, sub O, HIV-2 gp36) and recombinant Treponema pallidum antigen (17 kDa) in human serum. This study was a multisite laboratory-based evaluation of the performance of SD BIOLINE HIV/Syphilis Duo test using previously characterized sera in 6 countries.Laboratories in Ghana, Mexico, Laos, Togo, Kenya, and Myanmar participated in the evaluation during 2012-2013. Each site characterized sera using T pallidum particle agglutination assay or T pallidum hemagglutination assay and HIV enzyme immunoassay, Western blot, and/or HIV antibody rapid tests. Those gold standard test results were compared with SD BIOLINE Duo test results. We calculated the sensitivity and specificity of test performance and used the exact binomial method to calculate 95% confidence intervals (CIs).The sensitivity and specificity for the HIV antibody test component (n = 2336) were estimated at 99.91% (95% CI, 99.51% and 100%) and 99.67% (95% CI, 99.16% and 99.91%), respectively. For the T pallidum test component (n = 2059), the sensitivity and specificity were estimated at 99.67% (95% CI, 98.82% and 99.96%) and 99.72% (95% CI, 99.29% and 99.92%), respectively.The sensitivity and specificity of the SD BIOLINE HIV/Syphilis Duo test were consistently high across sera specimens from 6 countries around the world. Dual rapid tests should be considered for improved HIV and syphilis screening coverage.

Point-of-Care Testing

Point of care

10.1093/ofid/ofu015

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Full Genome Characterization of Human Influenza A/H3N2 Isolates from Asian Countries Reveals a Rare Amantadine Resistance-Conferring Mutation and Novel PB1-F2 Polymorphisms

Frontiers in Microbiology (2016)

Hassan Zaraket Hiroki Kondo Akinobu Hibino Ren Yagami Takashi Odagiri

Influenza A viruses evolve at a high rate requiring continuous monitoring to maintain the efficacy of vaccines and antiviral drugs. We performed next generation sequencing analysis of 100 influenza A/H3N2 isolates collected in four Asian countries (Japan, Lebanon, Myanmar, and Vietnam) during 2012-2015. Phylogenetic analysis revealed several reassortment events leading to the circulation of multiple clades within the same season. This was particularly evident during the 2013 and 2013/2014 seasons. Importantly, our data showed that certain lineages appeared to be fitter and were able to persist into the following season. The majority of A/H3N2 viruses continued to harbor the M2-S31N mutation conferring amantadine-resistance. In addition, an S31D mutation in the M2-protein, conferring a similar level of resistance as the S31N mutation, was detected in three isolates obtained in Japan during the 2014/2015 season. None of the isolates possessed the NA-H274Y mutation conferring oseltamivir-resistance, though a few isolates were found to contain mutations at the catalytic residue 151 (D151A/G/N or V) of the NA protein. These variations did not alter the susceptibility to neuraminidase inhibitors and were not detected in the original clinical specimens, suggesting that they had been acquired during their passage in MDCK cells. Novel polymorphisms were detected in the PB1-F2 open-reading frame resulting in truncations in the protein of 24-34 aminoacids in length. Thus, this study has demonstrated the utility of monitoring the full genome of influenza viruses to allow the detection of the potentially fittest lineages. This enhances our ability to predict the strain(s) most likely to persist into the following seasons and predict the potential degree of vaccine match or mismatch with the seasonal influenza season for that year. This will enable the public health and clinical teams to prepare for any related healthcare burden, depending on whether the vaccine match is predicted to be good or poor for that season.

Reassortment

Neuraminidase inhibitor

Oseltamivir

Amantadine

Resistance mutation

10.3389/fmicb.2016.00262

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Citations (18)

Influenza Vaccination Guidelines and Vaccine Sales in Southeast Asia: 2008–2011

PLoS ONE (2012)

Vinay Gupta Fatimah S. Dawood Charung Muangchana Phan Trong Lan Anonh Xeuatvongsa

Background Southeast Asia is a region with great potential for the emergence of a pandemic influenza virus. Global efforts to improve influenza surveillance in this region have documented the burden and seasonality of influenza viruses and have informed influenza prevention strategies, but little information exists about influenza vaccination guidelines and vaccine sales. Methods To ascertain the existence of influenza vaccine guidelines and define the scope of vaccine sales, we sent a standard three-page questionnaire to the ten member nations of the Association of Southeast Asian Nations. We also surveyed three multinational manufacturers who supply influenza vaccines in the region. Results Vaccine sales in the private sector were <1000 per 100,000 population in the 10 countries. Five countries reported purchasing vaccine for use in the public sector. In 2011, Thailand had the highest combined reported rate of vaccine sales (10,333 per 100,000). In the 10 countries combined, the rate of private sector sales during 2010–2011 (after the A(H1N1)2009pdm pandemic) exceeded 2008 pre-pandemic levels. Five countries (Indonesia, Malaysia, Singapore, Thailand and Vietnam) had guidelines for influenza vaccination but only two were consistent with global guidelines. Four recommended vaccination for health care workers, four for elderly persons, three for young children, three for persons with underlying disease, and two for pregnant women. Conclusions The rate of vaccine sales in Southeast Asia remains low, but there was a positive impact in sales after the A(H1N1)2009pdm pandemic. Low adherence to global vaccine guidelines suggests that more work is needed in the policy arena.

Pandemic

10.1371/journal.pone.0052842

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Ensuring accurate testing for human immunodeficiency virus in

Myanmar Latt Kyaw Ikuma Nozaki Koji Wada Khin Yi Oo Htay Htay Tin

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Genetic and Serologic Characterization of HIV Type 1 Prevailing in Myanmar (Burma)*

AIDS Research and Human Retroviruses (1998)

Shigeru Kusagawa Hironori Sato Seishiro Watanabe Kyoko Nohtomi Kayoko Kato

To study the molecular epidemiology of HIV-1 spread in Myanmar and the interplay with the epidemic in surrounding Southeast Asian countries, we determined the HIV-1 subtypes prevailing in Myanmar. Thirty HIV-positive blood specimens were sampled in the capital city, Yangon, and an additional 459 sera were collected nationwide in 1995. Genetic subtyping based on the env C2/V3 sequence and serologic data, using a V3 peptide enzyme immunoassay (PEIA), revealed three patterns of HIV spread in different geographic regions in Myanmar: (1) in the capital city, Yangon, HIV-1 subtype B′ ("Thai-B" cluster within subtype B) predominated both in IDUs and heterosexuals; (2) in the cities near the border with Thailand, including Tachelaik and Kawthaung, where heterosexual transmission is a major pathway of HIV-1 spread, HIV-1 subtype E was predominantly distributed among the commercial sex workers and heterosexuals; (3) in central and northeast Myanmar, both HIV-1 subtypes B′ and E occurred in a mixed distribution, without showing any significant segregation by risk group. In addition, the PEIA data implied the occurrence of other subtype(s) in these areas. The interperson nucleotide sequence variations in env C2/V3 regions of B′ and E, prevailing in Yangon, were 6.7 ± 2.1 and 7.1 ± 0.7%, respectively. They were similar to those levels observed in Thailand. These findings are consistent with the view that HIV spread in Myanmar might have taken place at about the same time as that in Thailand, and that multiple entries and exchanges of HIV-1 with neighboring countries are important factors contributing to the current distribution of subtypes in Myanmar.

10.1089/aid.1998.14.1379

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Emergence of New Forms of Human Immunodeficiency Virus Type 1 Intersubtype Recombinants in Central Myanmar

AIDS Research and Human Retroviruses (2000)

Kazushi Motomura Shigeru Kusagawa Kayoko Kato Kyoko Nohtomi Hla Htut Lwin

We have previously shown that HIV-1 env subtypes B′ (a Thai-B cluster within subtype B) and E (CRF01_AE) are distributed in Yangon, the capital city of Myanmar. However, HIV strains from the rest of country have not yet been genetically characterized. In the present study, we determined env (C2/V3) and gag (p17) subtypes of 25 specimens from central Myanmar (Mandalay). Phylogenetic analyses identified 5 subtype C (20%), in addition to 10 CRF01_AE (40%) and 4 subtype B′ (16%). Interestingly, the remaining six specimens (24%) showed discordance between gag and env subtypes; three gag subtype B′/env subtype C, one gag subtype B′/env subtype E, one gag subtype C/env subtype B′, and one gag subtype C/env subtype E. These discordant specimens were found frequently among injecting drug users (4 of 12, 33%) and female commercial sex workers (2 of 8, 25%) engaging in high-risk behaviors. The recombinant nature of these HIV-1 strains was verified in three specimens, indicating the presence of new forms of HIV-1 intersubtype C/B′ and C/B′/E recombinants with different recombination breakpoints. The data suggest that multiple subtypes of B′, C, and CRF01_AE are cocirculating in central Myanmar, leading to the evolution of new forms of intersubtype recombinants among the risk populations exhibiting one of the highest HIV infection rates in the region.

Group-specific antigen

Molecular Epidemiology

10.1089/08892220050195793

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Citations (67)