1st October 2018
Kong Meta | Publication date 01 October 2018 | 08:22 ICT
https://www.phnompenhpost.com/national/rabies-vaccine-now-available-in-battambang

The Health Ministry and the Pasteur Institute opened the first rabies prevention centre in Battambang on Thursday after observing a growing demand for vaccination in the province. Ministry spokeswoman Or Vandin said the Battambang centre’s opening will also be convenient for people living in neighbouring provinces.  “Now, those in Pursat, Battambang, Banteay Meanchey, Pailin and Kampong Chhnang provinces, can go to Battambang rather than travel to Phnom Penh,” she said.  Previously, patients who got rabies would travel to the capital for vaccination. The centre brings the service closer to the people in the province, she added. Vandin said 22,000 people took rabies vaccine last year.

Date: Thu 23 Aug 2018
Source: PLoS Neglected Tropical Diseases [edited]
<http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006644>

Citation
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Di Francesco J, Choeung R, Peng B, et al. Comparison of the dynamics of Japanese encephalitis virus circulation in sentinel pigs between a rural and a peri-urban setting in Cambodia. PLoS Negl Trop Dis. 2018 Aug 23;12(8):e0006644.

Abstract
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Japanese encephalitis is mainly considered a rural disease, but there is growing evidence of a peri-urban and urban transmission in several countries, including Cambodia. We, therefore, compared the epidemiologic dynamic of Japanese encephalitis between a rural and a peri-urban setting in Cambodia. We monitored 2 cohorts of 15 pigs and determined the force of infection - rate at which seronegative pigs become positive - in 2 study farms located in a peri-urban and rural area, respectively. We also studied the mosquito abundance and diversity in proximity of the pigs, as well as the host densities in both areas. All the pigs seroconverted before the age of 6 months. The force of infection was 0.061 per day (95 percent confidence interval = 0.034-0.098) in the peri-urban cohort and 0.069 per day (95 percent confidence interval = 0.047-0.099) in the rural cohort.

Several differences in the epidemiologic dynamic of Japanese encephalitis between both study sites were highlighted. The later virus amplification in the rural cohort may be linked to the later waning of maternal antibodies, but also to the higher pig density in direct proximity of the studied pigs, which could have led to a dilution of mosquito bites at the farm level. The force of infection was almost identical in both the peri-urban and the rural farms studied, which shifts the classic epidemiologic cycle of the virus. This study is a 1st step in improving our understanding of Japanese encephalitis virus ecology in different environments with distinct landscapes, human and animal densities.

Author summary
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The number of Japanese encephalitis cases has decreased substantially over the past decades with the implementation of childhood vaccination programs. Japanese encephalitis virus, however, remains the most important cause of acute viral encephalitis in Eastern and Southern Asia, with an estimated 68 000 cases reported annually worldwide. Our results demonstrate that Japanese encephalitis virus circulates intensely both in a rural and a peri-urban setting in Cambodia, which raises important public health concerns as peri-urban areas are densely populated. These results support the importance of changing vaccination recommendations for travelers and of not focusing national immunization programs against Japanese encephalitis solely on rural areas.
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[Although ProMED has posted relative few reports of Japanese encephalitis (JE) in Cambodia over the years, that country is within the JE virus endemic area. JE virus is the leading cause of vaccine-preventable encephalitis in Asia and the western Pacific. In Southeast Asia, JE virus is maintained in an enzootic cycle involving the _Culex tritaeniorhynchus_ group of mosquitoes and wild birds. Ardeid wading birds and pigs are amplifying vertebrate hosts. In endemic areas, incidence in humans is one-10 per 10 000 population. Children under 15 years of age are at greatest risk of encephalitis. For most travelers to Asia, the risk for JE is very low but varies based on destination, duration of travel, season, and activities.

Inactivated Vero cell culture-derived Japanese encephalitis (JE) vaccine (manufactured as IXIARO) is the only JE vaccine licensed and available in the United States. This vaccine was approved in March 2009 for use in people aged 17 years and older and in May 2013 for use in children 2 months through 16 years of age.

USA CDC JE Vaccine Recommendations:
- JE vaccine is recommended for travelers who plan to spend 1 month or more in endemic areas during the JE virus transmission season. This includes long-term travelers, recurrent travelers, or expatriates who will be based in urban areas but are likely to visit endemic rural or agricultural areas during a high-risk period of JE virus transmission.

- Vaccine should also be considered for the following:
1.- Short-term (less than1 month) travellers to endemic areas during the transmission season, if they plan to travel outside an urban area and their activities will increase the risk of JE virus exposure. Examples of higher-risk activities or itineraries include: 1) spending substantial time outdoors in rural or agricultural areas, especially during the evening or night; 2) participating in extensive outdoor activities (such as camping, hiking, trekking, biking, fishing, hunting, or farming); and 3) staying in accommodations without air conditioning, screens, or bed nets.
2.- Travellers to an area with an ongoing JE outbreak.
3.- Travellers to endemic areas who are uncertain of specific destinations, activities, or duration of travel.

JE vaccine is not recommended for short-term travelers whose visits will be restricted to urban areas or times outside a well-defined JE virus transmission season.

CDC summaries of JE virus, its epidemiology and available vaccines can be found on the US CDC website:
<https://www.cdc.gov/japaneseencephalitis/vaccine/index.html>.

The above report indicates that visitors to peri-urban areas that have pig populations should also consider vaccination if they are going to be present during the JE virus transmission season. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Cambodia: <http://healthmap.org/promed/p/145>]
Date: Sat, 19 May 2018 04:55:27 +0200

Phnom Penh, May 19, 2018 (AFP) - Five people, including a four-year-old child, were killed instantly in a lightning strike in southwestern Cambodia, officials said Friday, as the onset of the rainy season draws near.   The group was sheltering from a downpour in a mountainous area of Koh Kong province's Thmar Baing district on Thursday, police chief for minor crimes Lay Meng Laing told AFP, adding that three victims were from the same family.   The tropical Southeast Asian country of winding rivers and lakes is prone to lightning storms, a problem that some believe is worsening with the ravages of climate change.

Keo Vy, a spokesman for Cambodia's National Committee for Disaster Management, said the number of lightning deaths has now reached 50 people since January, while 41 died last year in the same period.    He said the government had conducted education seminars to warn residents in rural areas about the threats, encouraging them to avoid taking shelter under a tree and not to stand in pools of water.    The strikes also hit livestock, killing 36 cows since January.
Date: Mon 7 May 2018
Source: Khmer Times [edited]
<https://www.khmertimeskh.com/50487017/eleven-dead-from-tainted-water-in-kratie/>

Kratie [Kracheh or Krahes] provincial authorities yesterday [Sun 6 May 2018] distributed clean water to villages where at least 11 people have died and more than 100 others have been hospitalised since [Thu 3 May 2018] after drinking tainted water from the Prek Ter canal and rice fields in Chetr Borei district's Kantuot commune.

Provincial Governor Va Thorn said yesterday [Sun 6 May 2018] so far 11 people have died and more than 120 others have been hospitalised after they drank water suspected of being contaminated with insecticides.

"Up to 11 people have died so far, of whom 4 are men, and 121 other people, including children and elderly people, are receiving treatment at the referral hospital and provincial hospital. About 8 who were in serious condition were sent to Calmette Hospital in Phnom Penh," he said.

"I just came back from the village. We sent health officials and armed forces to guard and help the people in the villages where many people are sick and have died."

Children in the village also got poisoned from drinking tainted water from a canal.

Mr Thorn said that he also ordered the delivery of 2 fire trucks of water and 2 trucks of fresh water to be distributed to villagers.

Police and local authorities have also used loudspeakers to inform villagers to stop using or drinking water that they took from the canal, he said.

"We banned them from using water from a canal in the village we preliminarily suspect was contaminated by insecticides which farmers used to kill weeds in their rice fields. It then flowed into the canal when it rained," he said.

Mr Thorn added that residents from 2 villages - [SN and A] - have used water from the canal for a long time, but have never experienced any serious problems.

An ambulance arrives in the village to transport sick residents. "We are waiting for the result from the laboratory in Phnom Penh where our health officials sent the sample," he said. "We stopped them from using the water in the canal for a while already and we may dig a pond for them instead of using water from the canal again."

Phon Phea, Kantuot commune police chief, said the situation had improved slightly as no new residents had fallen ill from yesterday [Sun 6 May 2018] morning until about 4pm.

"We are using loudspeakers to broadcast in the villages to inform villagers to stop using water from the canal and not to use the rest of the water that they took to use at home. We have clean and fresh water to distribute to our villagers to use instead," he said.

Mr Phea said the water could not have been poisoned by mining because there were no mining operations in the area.

"From what I know, there's a place where people are mining in another commune that is far from here, but the villagers there have not had any problems. So, I think it's not the reason why our people have died and are sick," he said.

The 1st person started to feel sick and died on the way to the health centre on Thursday and 4 more people fell ill and died the following day.

"They got sick and died too fast. Some of them just had a headache, felt dizzy, vomited and had difficulty breathing. Some people died on the way to hospital and some died at the hospital," Mr Phea said. "It is a strange disease we have never met before. They died so quickly."

Or Vandin, spokeswoman for the Health Ministry, said yesterday that the ministry's working group was investigating the case.

Kim Santepheap, spokesman for the Justice Ministry, also confirmed Kratie Provincial Court officials were investigating the case.
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[The article does not give us much to go on as far as clinical signs or symptoms. The article mentions possible insecticide poisoning from spraying of nearby fields. The following clinical signs were listed headache, felt dizzy, vomited and had difficulty breathing which could be from a large dose of organophosphate insecticide. Typically, organophosphate signs are associated with salivation, lacrimation, urination, diarrhea, and emesis (vomiting). Often the pupils of the eye may be small and pin point. However, there are other insecticides, not organophosphates, which may have been used and could produce the same or similar signs.

Without more information regarding clinical signs, it is difficult to speculate which specific type of insecticide it may have been. Because this was from a water source, which usually provides some dilution, it would have been a massive dose or the water was massively contaminated, such as a point source.

We certainly hope the source is found and the fresh water for the village eliminates the problems. Any pets or livestock should be provided fresh water, not from the canal.

A map of Cambodia: <http://healthmap.org/promed/p/145>. - ProMED Mod.TG]
Date: Mon, 7 May 2018 15:15:49 +0200

Phnom Penh, May 7, 2018 (AFP) - At least 13 people have died and nearly 150 have been hospitalised in central Cambodia after drinking contaminated liquid, health officials said Monday, blaming either home brewed rice wine or water.   The deaths began on May 3, rocking two villages in the poor, rural Chet Borey district of Kratie province.   "As of today (Monday) 13 people have died," Chheang Savutha, provincial health director, said.   "We don't know what cause is of the incident yet, we are working on that now," he added. 

The Ministry of Health said samples from local rice alcohol found high levels of methanol, which can be very toxic.   But officials were also awaiting test results from water samples.   The ministry warned villagers to stop drinking rice alcohol, and to take extra care over the hygiene of their food and water.   Cambodia is one of Asia's poorest countries and health and safety standards are virtually non-existent outside of the major cities.
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