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

Hepatitis E Virus in Cambodia: Prevalence among the General Population and Complete Genome Sequence of Genotype 4

<div><p>Hepatitis E virus (HEV) is a growing public health problem in many countries. In this study, we investigated HEV seroprevalence among the general population in the Siem Reap province, Cambodia, and performed HEV genetic analysis with the aim to develop an HEV prevention strategy. This seroepidemiological cross-sectional study conducted from 2010 to 2014 included 868 participants from four different locations in Siem Reap province, Cambodia. They answered questionnaires and provided blood samples for the analysis of hepatitis virus infections. Among the participants (360 men and 508 women; age range, 7–90 years), the prevalence of anti-HEV IgG was 18.4% (95% confidence interval: 15.9–21.0); HEV RNA was detected in two participants (0.23%) and was classified as genotype 3 and 4. Full-length genome of the genotype 4 isolate, CVS-Sie10, was sequenced; it contained 7,222 nucleotides and three ORFs and demonstrated high sequence identity with the swine China isolates swGX40 (95.57%), SS19 (94.37%), and swDQ (91.94%). Multivariate logistic regression analysis revealed that men, elderly people, and house workers were risk groups significantly associated with the positivity for anti-HEV IgG. This is the first report on the detection of HEV genotype 4 in humans in Cambodia and on the complete genome sequence of HEV genotype 4 from this country. Our study demonstrates that new HEV infection cases occur frequently among the general population in Cambodia, and effective preventive measures are required.</p></div

Phylogenetic tree constructed based on HEV full-length genomes using the neighbor-joining method.

<p>Each of HEV genotypes 1, 2, 3, and 5 is represented by a single isolate, while for genotype 4, all the isolates with reported complete or near-complete genome sequence are presented. GenBank accession numbers are shown in parentheses; scale bar indicates nucleotide substitutions per site.</p

HEV RNA positives among the general population in Cambodia.

<p>M: Male, F: Female, NT: Not tested, COI: Cut off index</p><p>^a at survey</p><p>HEV RNA positives among the general population in Cambodia.</p