5 Monivong Boulevard, P.O Box. 983, Phnom Penh, Cambodia [email protected]

Respiratory diseases remain a major cause of death in Cambodia and countries of the Lower Mekong Region. Seasonal or pandemic respiratory pathogens can exact an high toll due to low levels of vaccination coverage (influenza), inappropriate treatment, individual (nutrition disorders) or environmental factors (indoor fires). Two projects on respiratory disease are under way, one clinical study and the other a broad effort to network and share respiratory data for evidence-based antibiotics guidelines.

Financial support

The IMMI influenza study is funded by by the Institut de Microbiologie et des Maladies Infectieuses (IMMI) while the CALIBAN network was funded bya grant from Agence Française de Développement.

Studies

CALIBAN

Community-acquired pneumonia (CAP) and other acute lower respiratory infections are the first cause of death in low income countries among both adults and children. In 2011, the Cambodian Ministry of health organized the first revision of the existing national therapeutic guidelines, including the medical management of CAP. It appeared of the utmost importance to guide this revision process with data on CAP epidemiology in Cambodia and neighboring countries. In 2012, thanks to a grant from AFD, epidemiologists at IPC helped create the Community-Acquired Lung Infections, Bacteria and Antibiotics Network (Caliban) of national and international stakeholders in Cambodia to provide health policymakers with evidence-based information on bacterial etiologies of community acquired pneumonia in Cambodia and antimicrobial resistance levels, using both published and unpublished data. Six stakeholders shared data about a total of 1432 patients with respiratory infections (various case definitions). Five of these stakeholders shared resistance data about a total of 148 S. pneumoniae strains, 195 H. influenzae strains, 62 K. pneumoniae strains, 68 B. pseudomallei strains. The conclusions of the working group will be delivered to the health authorities before end 2012. The process used to build a common corpus of scientific knowledge using referenced, grey and unpublished sources from various stakeholders will also be described and published, and proposed as a model for similar situations where epidemiological evidence is lacking in Cambodia.

IMMI influenza

With support from the Institut de Microbiologie et des Maladies Infectieuses (IMMI) a prospective case-control study is under way comparing influenza-like illness (ILI, outpatients) versus severe acute respiratory illness (SARI, inpatients). This study aims to identify the epidemiological, clinical, bacteriological, virological and immunological determinants of influenza severity including A (H1N1)pdm infection in a developing country. It is being conducted in Asia (Cambodia) and Africa (Cameroon, Madagascar, Senegal), comparing hospitalized patients to outpatients with lab–confirmed influenza. From September 2011 to 18 October 2012, 391patients have been screened (274 ILI + 117 SARI), of which 64 (16.4%; 47 ILI + 17 SARI) were confirmed by rapid test. Among these, 58 (90.6% ; 42 ILI + 16 SARI) have been confirmed by PCR, included and fully documented.