カンボジア王国における小学生を対象とする健康診断システム構築に関するパイロット調査

広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

The Pilot Study for Health Check-Ups System at Elementary School in Cambodia

Background: In Cambodia, there is no national health check-ups system for the schoolchildren and the general population. This pilot study aimed to promote a school health check-ups system in collaboration with the government of Cambodia. Method: From 2016 to 2017, we conducted a survey in an elementary school in Siem Reap province, Cambodia. Two hundred and ninety-two students were eligible for data analysis. Physical examination, questionnaire and urinalysis were conducted using the Japanese school health check-ups model. Anthropometry was measured using the World Health Organization’s growth reference data for school-age children. Results: Among 292 schoolchildren, 88.7% were diagnosed as healthy. Based on the evaluation criteria of health examination in the study, two (0.7%) students with rale, one (0.3%) student with abnormal urinalysis, and another 27 students complaining of cardiopulmonary symptoms were recommended for further consultation at hospital. The prevalence of overweight (15.1%) was higher than that of underweight (8.6%). According to parents’ questionnaires responses, the coverage rate of the National Immunization Program varied from 41.8% to 79.8% depending on each particular vaccine. Conclusion: In this pilot study, we showed the prevalence of healthy among Cambodian schoolchildren and detected the students having possibility of health problem through this health check-ups and then recommended for further hospital visit. Based on the results, we assume that health check-ups system in elementary school as a whole Cambodia will be effective to assess the current health status in ordinary time and possibility of early detection of disease

Substitution of the CD81 Binding Site and β-Sandwich Area in E2 of HCV in Cambodia

The high genetic variability of hepatitis C virus (HCV) is the main obstacle to developing a vaccine. E2 has attracted attention for vaccine development because targeting this protein could potentially overcome issues related to the genetic diversity of HCV. In this study, we analyzed HCV genes in the general population of Cambodia and investigated the E2 locus as a candidate for vaccine development. HCV sero-epidemiological surveys were conducted between the period 2010 and 2014, with an HCV RNA–positive rate of 1.3% (11/868). Follow-up blood samples were collected from four anti-HCV– and HCV RNA– positive patients (genotype 1b: 2 cases, 6e: 1 case, 6r: 1 case) after 4.12 years. Analysis of HCV full-length nucleotide sequences in paired specimens revealed that the mutation rates of HCV genotypes 1b and 6e/6r were 1.61–2.03 × 10−3 and 2.52–2.74 × 10−3 substitutions/site/year, respectively. Non-synonymous substitutions were detected in HVR1, the front layer of the CD81 binding site, and the β-sandwich, but not in the N-terminal region or adjacent to the CD81 binding site. Therefore, we conclude that the CD81 binding site is a promising locus for HCV vaccine development

Phylogenetic tree constructed with sequences of HBV complete genome.

<p>HBV genotype FX75663 was used for outgroup. An arrow head is indicated for obtained residents isolate and an arrow for family member isolate. (A): Phylogenetic tree of full HBV genome of twenty-one isolates. Obtained all family members isolates were reconfirmed genotype B4 with whole HBV genome analysis. (B): Phylogenetic tree based on the core region sequences of twenty-one whole genome isolates, showed every genotype B4 isolate had a similarity as genotype C at the core region. Consequently, isolates were recombinants, genotype B4/C.</p

Demographic characteristics of residents and family members.

<p>Demographic characteristics of residents and family members.</p

Partial nucleotide sequences from nt1601 to nt1790 including core promoter of 48 obtained isolates.

<p>Each genotype is shown besides each isolates name. The upper line sequence is AB073835, genotype B4, as a standard. HBeAg and HBeAb status are described at the right side of figure. In forty-four genotype B4 isolates, mutation rate at nt1613 was 13.6%, at nt1753 was 4.5%, at nt1762/64 was 11.4%. Insertions were detected in three isolates with 24 base starting from nt1673, just middle in the promoter, in X region.</p

Phylogenetic tree of mitochondrial hyper variable region (HVR) sequences of family members.

<p>NJ method was used for construction of the phylogenetic tree, by bootstrap method with one thousand-time resampling. Outgroup is EF556173 (haplogroup L5). Every child was identified having the same sequence as his or her mother, meaning they are in a blood relation.</p