Diphtheria in Lao PDR: Insufficient Coverage or Ineffective Vaccine?

Background

During late 2012 and early 2013 several outbreaks of diphthe-ria were notified in the North of the Lao People’s Democratic Republic. The aim of this study was to determine whether the re-emergence of this vaccine-preventable disease was due to insufficient vaccination coverage or reduction of vaccine effectiveness within the affected regions.

Methods

A serosurvey was conducted in the Huaphan Province on a cluster sampling of 132 children aged 12–59 months. Serum samples, socio-demographic data, nutri-tional status and vaccination history were collected when available. Anti-diphtheria and anti-tetanus IgG antibody levels were measured by ELISA.

Results

Overall, 63.6% of participants had detectable diphtheria antibodies and 71.2% tetanus antibodies. Factors independently associated with non-vaccination against diphtheria were the distance from the health centre (OR: 6.35 [95% CI: 1.4–28.8], p = 0.01), the Lao Theung ethnicity (OR: 12.2 [95% CI:1,74–85, 4], p = 0.01) and the lack of advice on vac-cination given at birth (OR: 9.8 [95% CI: 1.5–63.8], (p = 0.01) while the level of maternal edu-cation was a protective factor (OR: 0.08 [95% CI: 0.008–0.81], p = 0.03). Most respondents claimed financial difficulties as the main reason for non-vaccination. Out of 55 children whose vaccination certificates stated that they were given all 3 doses of diphtheria-containing vaccine, 83.6% had diphtheria antibodies and 92.7% had tetanus antibodies. Furthermore, despite a high prevalence of stunted and underweight children (53% and 25.8%, respectively), the low levels of anti-diphtheria antibodies were not correlated to the nutritional status.

Conclusions

Our data highlight a significant deficit in both the vaccination coverage and diphtheria vaccine effectiveness within the Huaphan Province. Technical defi-ciencies in the methods of storage and distribution of vaccines as well as unreliability of vac-cination cards are discussed. Several hypotheses are advanced to explain such a decline in immunity against diphtheria and recommendations are provided to prevent future outbreaks.     

Growth and morphological development of laboratory-reared larval and juvenile three-spot gourami <Emphasis Type="Italic">Trichogaster trichopterus</Emphasis>

Morphological development, including the body proportions, fins, pigmentation and labyrinth organ, in laboratory-hatched larval and juvenile three-spot gourami Trichogaster trichopterus was described. In addition, some wild larval and juvenile specimens were observed for comparison. Body lengths of larvae and juveniles were 2.5 ± 0.1 mm just after hatching (day 0) and 9.2 ± 1.4 mm on day 22, reaching 20.4 ± 5.0 mm on day 40. Aggregate fin ray numbers attained their full complements in juveniles >11.9 mm BL. Preflexion larvae started feeding on day 3 following upper and lower jaw formation, the yolk being completely absorbed by day 11. Subsequently, oblong conical teeth appeared in postflexion larvae >6.4 mm BL (day 13). Melanophores on the body increased with growth, and a large spot started forming at the caudal margin of the body in flexion postlarvae >6.7 mm BL, followed by a second large spot positioned posteriorly on the midline in postflexion larvae >8.6 mm BL. The labyrinth organ differentiated in postflexion larvae >7.9 mm BL (day 19). For eye diameter and the first soft fin ray of pelvic fin length, the proportions in laboratory-reared specimens were smaller than those in wild specimens in 18.5–24.5 mm BL. The pigmentation pattern of laboratory-reared fish did not distinctively differ from that in the wild ones. Comparisons with larval and juvenile morphology of a congener T. pectoralis revealed several distinct differences, particularly in the numbers of myomeres, pigmentations and the proportional length of the first soft fin ray of the pelvic fin.     

Rapamycin attenuates the paraquat-induced pulmonary fibrosis through activating Nrf2 pathway

Oxidative stress is a key regulator of idiopathic pulmonary fibrosis. Paraquat (PQ)-induced pulmonary fibrosis seriously endangers people's health. Rapamycin has been reported to alleviate PQ-induced pulmonary fibrosis, but its underlying mechanism is unclear. The nuclear factor E2-related factor 2 (Nrf2) plays an important regulatory role in the antioxidant therapy of PQ-induced pulmonary fibrosis. In this study, we tried to confirm that rapamycin attenuates PQ-induced pulmonary fibrosis by regulating Nrf2 pathway. In vivo, we proved that rapamycin could inhibit the degree of PQ-induced oxidant stress as well as enhanced the expression of Nrf2. In vitro, rapamycin decreased the upregulated effects of cell death and apoptosis, fibrosis-related factors expression and fibroblast-to-myofibroblast transformation by PQ treatment. In vivo, rapamycin treatment reduced fibrosis degree and the expression of fibrosis-related factors in lung tissues of rat treated PQ. Furthermore, we also found that Nrf2 knockdown reduced the inhibitory effect of rapamycin on PQ-induced pulmonary fibrosis, as well as decreased Nrf2 transfer from the cytoplasm into the nucleus. Our findings demonstrated that the protective effect of rapamycin is associated with the activation of the Nrf2 pathway in pulmonary fibrosis induced by PQ poisoning.     

Serosurveillance of Vaccine Preventable Diseases and Hepatitis C in Healthcare Workers from Lao PDR

Background and Aims

Healthcare workers (HCW) have an increased risk of exposure to infectious diseases and are a potential source of infections for their patients. The Lao People’s Democratic Republic (Lao PDR) has no national policy regarding HCW vaccinations and routine vaccination coverage is low within the general population. This cross-sectional serostudy determines the level of exposure and risk of infection in Lao HCW against 6 vaccine preventable diseases and hepatitis C.

Methods

1128 HCW were recruited from 3 central, 2 provincial and 8 district hospitals. Sera were tested by ELISA for the presence of antibodies and antigens to hepatitis B, hepatitis C, measles, rubella, varicella zoster, tetanus and diphtheria.

Results

Only 53.1% of the HCW had protective anti-hepatitis B surface antigen antibodies (anti-HBs) with 48.8% having anti-hepatitis B core antibodies (anti-HBc), indicating previous exposure and 8.0% were hepatitis B surface antigen carriers. 3.9% were hepatitis C seropositive. Measles and rubella antibodies were detected in 95.4% and 86.2% of the HCW, with 11.9% of females being unprotected against rubella. Antibodies against varicella zoster, tetanus and diphtheria were detected in 95%, 78.8% and 55.3%, respectively. Seroprevalence varied according to age, gender and number of children.

Conclusion

An unacceptably high proportion of Lao HCW remain susceptible to infection with hepatitis B, diphtheria, tetanus and rubella. Furthermore, a high number of healthcare workers are chronically infected with hepatitis B and C viruses. These data emphasize the need for a robust HCW vaccination policy in addition to increased awareness within this subpopulation.     

Developmental morphology and growth in early stages of laboratory-reared Cirrhinus molitorella and C. microlepis (Cypriniformes: Cyprinidae)

Ichthyological Research - The morphological developments in laboratory-reared larval and juvenile Cirrhinus molitorella and larval C. microlepis were described, and ontogenies (including yolk sizes...