Ly Sovann, MD, DTMH, MCTM Philippe Buchy, MD, PhD NIC Cambodia
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Characterization of human influenza virus circulation in
Cambodia 2006-2010 and impact for national public health policies.
Ly Sovann, MD, DTMH, MCTM
Philippe Buchy, MD, PhD
NIC Cambodia
2
ILI and ALRI sites in Cambodia
ILI sentinel sites
ALRI sentinel sites
3
Material and Method
• Naso-pharyngeal specimens obtained from 5-10 patients fulfilling the ILI case definition, each week, from 8 sentinel sites (5 IPC/MoH since 2006, 3 NIPH/US CDC/MoH since 2009) + 1 study site (AFRIMS since 2010)
• >4000 NP specimens obtained from patients hospitalized in Takeo and Kampong Cham provincial hospitals with ALRI symptoms between 2007-2010.
• Specimens tested by RT-PCR at IPC, NIPH/CDC, AFRIMS labs
• Results centralized and analyzed for epidemiological purposes by MoH (CDC department) with support of WHO country office and by IPC (for FluNet reporting)
• Antigenic tests, genomic analysis, phenotypic drug resistance tests performed at IPC before selection of representative strains shipped to WHOCC Melbourne (including NAMRU-2 influenza isolates detected during fever study)
4
Influenza circulation
Year
No. of Specimens
tested
No. of positives
(%)
Type Subtype of influenza A
Influenza A(%)
Influenza B(%)
H1N1(%)
H3N2(%)
H5N1(%)
H1N1pdm09
(%)
2006 81232
(3.9)32
(100)0 0
30(100)
2(6.6)
-
2007 1962104(5.3)
44(41.7)
60(58.3)
14(32.5)
29(67.5)
1(2.3)
-
2008 2873259(9)
171(65.9)
88(34.1)
31(18.2)
139(81.8)
1(0.5)
-
2009 4820743
(15.4)648
(87.2)95
(12.8)2
(0.3)245
(37.8)1
(0.15)400
(61.8)
2010 3455433
(12.5)335
(77.4)98
(22.6)0
151 (45)
1(0.3)
183(54.7)
(93.4)
5
Influenza circulation (2006-2010)
0
50
100
150
200
250
Au
g
Se
p
Oc
t
No
v
De
c
Ja
n
Fe
b
Ma
r
Ap
r
Ma
y
Ju
n
Ju
ly
Au
g
Se
p
Oc
t
No
v
De
c
Ja
n
Fe
b
Ma
r
Ap
r
Ma
y
Ju
n
Ju
ly
Au
g
Se
p
Oc
t
No
v
De
c
Ja
n
Fe
b
Ma
r
Ap
r
Ma
y
Ju
n
Ju
ly
Au
g
Se
p
Oc
t
No
v
De
c
Ja
n
Fe
b
Ma
r
Ap
r
Ma
y
Ju
n
Ju
ly
Au
g
Se
p
Oc
t
No
v
De
c
A(H5N1)
A(H1N1)pdm
B
A(H1N1)
A(H3N2)
1st H1N1pdm 09Case confirmed(imported case)
1st H1N1pdm09 Case detected in the
community
Rainy season Rainy seasonRainy season Rainy seasonRainy season2006 2007 2008 2009 2010
6
Susceptibility to drugs
Virus type and subtype Resistance to neuraminidase inhibitors
Resistance to M2inhibitors
Oseltamivir Zanamivir
# isolatessequenced
Number of resistant
(%)# isolates
tested
Number of resistant
(%)
# isolatestested
Number of resistant
(%)
A(H3N2) 123 0 54 0 51 43 (84.3)
A(H1N1) 10 1 (10) 7 0 18 12 (66.6)
B 90 0 38 0 NA NA
A(H1N1)pdm09 62 0 62 0 34 34 (100)
A(H5N1) 10 0 5 0 5 5 (100)
7
Antigenic analysis
Season A/H1N1 A/H3N2 Influenza B A/H1N1pdm09Vaccine Strains
Cambodian Strains
Vaccine Strain
Cambodian Strains
Vaccine Strain Cambodian Strains
Vaccine Strain Cambodian Strains
2006(SH*)
A/New Caledonia/20/1999-like
N/AA/California/7/2004-like
A/Wisconsin/67/2005-like
B/Malaysia/2506/2004-like N/A N/A N/A
2006-2007(NH*)
A/New Caledonia/20/1999-like
A/Wisconsin/67/2005-like
B/Malaysia/2506/2004-like
N/A
2007(SH*)
A/New Caledonia/20/1999-like
A/New Caledonia/20/1999-like
A/Wisconsin/67/2005-like
A/Wisconsin/67/2005-like
B/Malaysia/2506/2004-like
B/Malaysia/2506/2004-like N/A N/A
2007-2008(NH*)
A/Solomon Islands/3/2006-like
A/Wisconsin/67/2005-like
B/Malaysia/2506/2004-like N/A
2008(SH*)
A/Solomon Islands/3/2006-like
A/Brisbane/59/2007-like
A/Brisbane/10/2007-like
A/Brisbane/10/2007-like
B/Florida/4/2006-like
B/Florida/4/2006-like N/A N/A
2008-2009(NH*)
A/Brisbane/59/2007-like
A/Brisbane/10/2007-like
B/Florida/4/2006-like
N/A
2009(SH*)
A/Brisbane/59/2007-like
N/AA/Brisbane/10/2007-like
A/Brisbane/10/2007-like
B/Florida/4/2006-like
B/Brisbane/60/2008-like
A/California/7/2009-like
A/California/7/2009-like
2009-2010(NH*)
A/Brisbane/59/2007-like
A/Brisbane/10/2007
B/Brisbane/60/2008-like
A/California/7/2009-like
2010(SH*)
N/A N/A
A/Perth/16/2009-like
A/Perth/16/2009-like
B/Brisbane/60/2008-like
B/Brisbane/60/2008-likeB/Malaysia/2506/2004-likeB/Florida/4/2006-like
A/California/7/2009-like
A/California/7/2009-like
2010-2011(NH*)
N/AA/Perth/16/2009-like
B/Brisbane/60/2008-like
A/California/7/2009-like
8
Antigenic analysis
Season A/H1N1 A/H3N2 Influenza B A/H1N1pdm09Vaccine Strains
Cambodian Strains
Vaccine Strain
Cambodian Strains
Vaccine Strain Cambodian Strains
Vaccine Strain Cambodian Strains
2006(SH*)
A/New Caledonia/20/1999-like
N/AA/California/7/2004-like
A/Wisconsin/67/2005-like
B/Malaysia/2506/2004-like N/A N/A N/A
2006-2007(NH*)
A/New Caledonia/20/1999-like
A/Wisconsin/67/2005-like
B/Malaysia/2506/2004-like
N/A
2007(SH*)
A/New Caledonia/20/1999-like
A/New Caledonia/20/1999-like
A/Wisconsin/67/2005-like
A/Wisconsin/67/2005-like
B/Malaysia/2506/2004-like
B/Malaysia/2506/2004-like N/A N/A
2007-2008(NH*)
A/Solomon Islands/3/2006-like
A/Wisconsin/67/2005-like
B/Malaysia/2506/2004-like N/A
2008(SH*)
A/Solomon Islands/3/2006-like
A/Brisbane/59/2007-like
A/Brisbane/10/2007-like
A/Brisbane/10/2007-like
B/Florida/4/2006-like
B/Florida/4/2006-like N/A N/A
2008-2009(NH*)
A/Brisbane/59/2007-like
A/Brisbane/10/2007-like
B/Florida/4/2006-like
N/A
2009(SH*)
A/Brisbane/59/2007-like
N/AA/Brisbane/10/2007-like
A/Brisbane/10/2007-like
B/Florida/4/2006-like
B/Brisbane/60/2008-like
A/California/7/2009-like
A/California/7/2009-like
2009-2010(NH*)
A/Brisbane/59/2007-like
A/Brisbane/10/2007
B/Brisbane/60/2008-like
A/California/7/2009-like
2010(SH*)
N/A N/A
A/Perth/16/2009-like
A/Perth/16/2009-like
B/Brisbane/60/2008-like
B/Brisbane/60/2008-likeB/Malaysia/2506/2004-likeB/Florida/4/2006-like
A/California/7/2009-like
A/California/7/2009-like
2010-2011(NH*)
N/AA/Perth/16/2009-like
B/Brisbane/60/2008-like
A/California/7/2009-like
9
H3N2 phylogenetic analysis
2010
2009
2007-2008
2005-2006
10
H1N1pdm09 phylogenetic analysis
11
Influenza B phylogenetic analysis
Victoria/2/87-like lineage
Yamagata/16/88-like lineage
2007
2010
2009
2008
2010
12
Conclusions
• Although Cambodia is geographically located in the Northern hemisphere, influenza circulation has a Southern hemisphere pattern.
• Although the viruses circulating in Cambodia are not always totally matching with those included in the vaccine composition, the use of the Southern hemisphere vaccine should be recommended
• Neuraminidase inhibitors would be the drug of choice for influenza treatment and chemoprophylaxis in Cambodia.
13
Aknowledgements
• Ministry of Health/CDC department
• Dr. Sok Touch, Dr. Ly Sovann, Dr. Seng Heng, Mr. Ieng Vannra & coll.
• Institut Pasteur in Cambodia – Virology & Epi Units
• Dr. Sek Mardy, Dr. Monica Naughtin, Dr. Sareth Rith, Dr. Sirenda Vong, Dr. Sowath Ly, Dr. Arnaud Tarantola & coll.
• National Institute of Public Health
• Dr. Ung Sam An, Dr. Buth Sokhal and coll.
• WHO Cambodia
• Dr. Chea Nora, Dr. Nima Asgari and coll.
• Centres of Disease Control and Prevention USA & Cambodia
• Dr. Paul Kitsutani, Dr. Borann Sar & coll.
• NAMRU2, Cambodia
• Dr. William Rogers, Dr. Chadwick Yasuda
• WHOCC Melbourne, Australia
• Prof. Anne Kelso, Dr. Ian Barr & coll.
• AFRIMS Bangkok & Cambodia
• Dr. Ans Timmermans, Dr. Youry Se, Ms. Nou Samon, Dr. Chanthap Lon, Dr. Stuart Tyner, Dr. David Saunders
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