NEWS
15 February 2015 
Objectives and outputs of the meeting are on FBLI website:
http://www.ecohealthasia.net/news/103
Collaboration between ECOMORE project and FBLI started more than one year ago when Dr Pham Duc Phuc, the Vietnam country team leader of FBLI project was contracted to assist ECOMORE project in Vietnam to set up the Knowledge Translation platform. The necessary close collaboration between ECOMORE and others One Health project in Vietnam was also regularly brought to discussion with Dr Hung, the Regional Programm Coordinator of FBLI especially to strengthen our message to the decision makers. This 3rd Annual FBLI Regional Meeting gave the opportunity to share experiences and to imagine a realistic manner to extend such collaboration at the regional level. The Power Point presentation “ECOMORE_FBLI meeting Bangkok 15 Feb 2016” is available in Publications & Communications.
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FBLI at the ECOMORE meeting in Hanoi on 22snd December 2015 |
25-29 January 2016 
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The ECOMORE team in Cambodia created a simple cheap and without-maintenance website for private MDs’ reporting. Now doctors can connect the website www.ecomore-surveillance.com and after login their Personal Identification Number they can enter their surveillance data on a weekly basis. The format of reporting is similar to the National Surveillance System managed by CDC. The data are collated for each province and each doctor can consult the website at anytime to see analysis graph in real time; the feedback is quite immediate. They can access data from other provinces as well. The procedure to fill the online form is absolutely simple because they already used this form in their agenda for one year; it is cheap: the internet domain costs only 60 USD/year and does not require maintenance. Actually after a short presentation of the tool, all MDs are capable to use it within few minutes. For Kratie, Kampong Speu and Kampong Chhnang cities, more than 90% of MDs have proper mobile phone and internet connection to access properly the website. |
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The next step will be to create a Feacebook group to allow discussion and sharing between private MDs. After developing a very simple and useful algorithm that can be easily used as Early Warning System (see News of 10 November 2015) to alert to dengue outbreak, ECOMORE team led by the epidemiologist J.Ledien, created a new simple and cheap tool to smooth reporting and to ensure automatic feedback.
Presentation of the website to MDs at the PHD |
MDs in Kampong Speu try to utilize the tool with assistance of ECOMORE team |
The ECOMORE team visit MDs to train them again |
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This countrywide mission offered the opportunity to Mr. Antony Cousien to observe the reality of health and surveillance system in Cambodia. He is a mathematical modeler who works on modeling time-space profiles of infectious processes associated to their environmental and socio-economic factors in order to better understand and predict vector-borne diseases transmission for ECOMORE project. |
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22 December 2015 
The first Working Group was organized at the end of May 2015 to present preliminary findings to the decision makers from Human Health, Animal Health and Environment side. Dr Phuc made a presentation to summarize and to remind topics discussed during this previous meeting. Six months later, the second cross-sectional study has been implemented and the one year longitudinal study is completed. NIHE made a significant progress in analysis of field and lab data; this Working Group was critical to inform participants on documented evaluation of risk when moving from traditional to more intensive farming practices and on potential recommendations see the presentation. Participants from IPSARD were very concerned in the discussions after presentations of study conducted by ECOMORE and FLBI - Field Building Leadership Initiative, implemented by the Center for Public Health and Ecosystem Research (CENPHER), under the Hanoi School of Public Health (HSPH); actually they are just starting a One Health project in line with ECOMORE.
Hence, this meeting focused as well on the importance and necessity of regular collaboration between the several “One Health” projects currently implemented in Vietnam. Of course ECOMORE project and NIHE are projected to act as a catalyst to bring together key persons involved in these projects.
03 December 2015 
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Philippe Lagier, supervisor of ECOMORE project at the headquarters of AFD (French Agency for Development) visited Kampong Chhnang city to meet several stakeholders in Provincial Health Department (PHD), in hospital and also private doctors who are involved in activities implemented in the framework of ECOMORE Cambodian component. Dr Sorya Chan, manager of ECOMORE project at AFD Cambodian branch accompanied the mission |
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23-27 November 2015 
The goal of ECOMORE Project in Myanmar is to reinforce the national capacity for diagnosis and surveillance of infectious diseases causing Severe Acute Respiratory Infections which are major causes of morbidity and mortality, particularly in children. Specifically, the Project aims to improve the diagnosis of viral and bacteriological pathogens of public health interest. A main concern is that the etiological profile of bacterial pathogens is changing in developing countries and bacteriological diagnosis in SARI patients requires high-quality sputum samples, sometimes completed by blood culture. The SISEA study results from Cambodia showed that sputum is extremely difficult to collect in children, especially < 10 years old, unless they are intubated. Additionally, it is difficult to determine causation of isolated pathogens in children, due to highly prevalent and intense asymptomatic carriage.
Another, ongoing ANRS 12229 - PAANTHER study in Cambodia shows that sputum is successfully collected in 0%, 19% and 43% of children aged 0-<4, 4-<10 and 10+ years, respectively.
Consequently it has been decided to perform Broncho-Alveolar-Lavage to obtain specimens of proper quality (Microbiological BAL diagnostics can confirm the cause in 50 to 85 % of cases). Pediatricians of YCH and YKCH participated in September 2015 in the training course on pediatric flexible bronchoscopy held in Paris by the European Respiratory Society; in November 2015 on site follow-up training was implemented by Dr Delaisi in Yangon. To maximize the quality of the procedure and to assure patient safety, pediatric flexible bronchoscopes and accessories have been provided to both hospitals.
24-25 November 2015 
The Steering Committee is organized annually to review activities implemented by each Work Package (WP) over the past year. Dr Myat Wonna Soe, Deputy Director General of the Department of Medical Service made the opening speech.
During the first session, project leaders had to explain actions taken to comply with recommendations issued during the previous Steering Committee held in 2014. After that, an hour interactive presentation is made by each team leader to show the progress of their component. So, participants could assess and discuss development of WP1 (Cambodia), WP2 (Lao PDR), WP3 (Vietnam), WP4 (Myanmar) and WP5&6 (communication and coordination) during 2015.
The project team leader presented the financial status of the project and underlined the importance of the next forecast because the project activities are planned to be completed in June 2016 and consequently expenses must closely fit with the remaining budget. The second session was dedicated to a preliminary discussion between partners to define guidelines for designing a likely second phase of the project. Participants debated as well on relevance of organization of a 3rd National Stakeholders meeting vs. a Regional Final Symposium to transfer the results and recommendations of the 4 components of the project.
Every year, invited external experts make presentations on cross-cutting topics of interest; this year, Dr Kaw Bing Chua (TEMASEK-Singapore) made a brilliant lecture on “scientific development of a candidate trivalent live attenuated vaccine to protect children against hand foot and mouth diseases due to EV71 and CA16 viruses”. The Steering Committee ended by a visit of the National Health Laboratory (NHL) in Yangon.
10 November 2015
More than 50 people directly involved in Dengue surveillance participated in this 4th Working Group.
Mr. Kim San, the data manager made a brilliant presentation with attractive and easily understandable graphs on the data collected during the last dengue season.
It is important to mention than now, due to experience gained during previous Working Groups, presentations are made in Khmer without translation to be smoother and less laborious; the attention of participants is significantly improved. Non-Khmer speakers receive the handouts of presentations in English and a translator is available for translation of discussions.
The Director of Kampong Chnnang Hospital and a private doctor established in Kampong Chhnang city made attention-grabbing presentations on the management of major outbreak that occurred in this province. It gave opportunity to show the approach from doctors who are directly involved in management of dengue outbreaks and not only the point of view of Laboratory technicians or from epidemiologists.
Dr A.Tarantola deciphered next activities while the project finishes in few months and explained the expected benefit of modeling surveillance data, entomological data, surveillance data from the private sector and data on population density, meteorological data…especially to better predict outbreaks.
On the other hand, Julia Ledien, epidemiologist, presented an automated algorithm that detects aberrations in the surveillance data and which can predict major outbreaks and then tests if the determined outbreak threshold has been crossed. The technique is simple, free and has proved a posteriori to be enough sensitive and specific to predict the outbreaks few weeks in advance.
Finally the participants acclaimed the prototype of the game to be displayed in waiting rooms in pediatric units of hospitals to demonstrate to young children, good practices to decrease the density and the risk of mosquitoes at household level. The suggestions of participants will be considered to finalize the game.
27 October 2015
Participation of Dr Kyaw Zin Thant, Director general of DMR, of Dr. Hlaing Myat Thu, Deputy Director General of DMR, of Mrs. Kaori Nakatani, Project Adviser at JICA, of Prof. Hisawsi Watanabe, research Professor at Niigata University, of Dr. Thar Tun Kyaw, Senior Medical Superindent of YKCH, of Dr. Su Su Dwe, Medical Superindent of YCH, of Dr. Dora Warren, Country Director of US-CDC…demonstrated the importance of this study for many people involved in public health in Yangon. More than 60 professionals attended the meeting.
After the welcome speeches, Dr P.Dussart made an overview of the progress of the project since the last National Stakeholders meeting held in January 2014. This presentation showed the huge work implemented in term of capacity building, supply of equipment and lab renovation. After that Mrs. May July, data manager for ECOMORE project, presented the different tools used to collect specimens and data (CRF, SOPs) and explained the fundamental of the design of the database. So, Pr Htay Htay Tin could present the preliminary results of the analyses conducted (on more than 250 patients) especially those obtained with the innovative technique using the kit PCR-FTD33.
The enthusiastic presentations of two pediatricians from Yangon Children Hospital and Yankin Children Hospital on the usefulness of the study for diagnosis and treatment of SARI in children showed that this new techniques become now essential.
04-06 October 2015
Dr Le Phuong Mai (NIHE_Vietnam) presented a poster on the study conducted in Vietnam on Impact of Livestock Intensification on Community Health and Ms. Julie-Anne Tangena (Institut Pasteur in Laos) gave an oral presentation on the survey implemented in LAO PDR on Risk of Mosquito-Borne Diseases in Relation to Rubber Plantation Development.
Both of them reported that it was very interesting to meet many people from different backgrounds: social sciences, physicists, governmental organizations from Europe, South America, North America, Asia, and Africa.
The study conducted in Vietnam really fits in perfectly in the One Health concept and people were very interested in how the ECOMORE project have been managed to integrate the authorities in the project from the beginning. Actually, this seems to be a problem for many One Health projects; where the results of the study do not manage to reach the important governmental parties and industries. In a similar vein, the presentation on ECOMORE Lao component was therefore mostly focused on how the Lao project has managed to integrate the Agricultural and Health ministries of Lao PDR in the project together with the different other stakeholders like the WHO. Apart mosquitoes data, J-A Tangena emphasized the importance of the Knowledge Transfer and Knowledge Translation implemented through international meetings (steering committee meetings), national meetings (national stakeholders meetings) and the local projects (Rapid Rural Appraisals, meetings with the villages, visiting the schools). Participants were clearly impressed in how the ECOMORE project has managed to integrate the important parties from the beginning and how we gave all stakeholders a sense of ownership.
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14-16 September 2015
Dr Phyu Tin Moe from Yangon Children Hospital (YCH) and Dr Myittar Khin fron Yankin Children Hospital (YKH) participated in a training conducted by the European Respiratory Society in Paris.
This training was aimed at pulmonologists and thoracic surgeons who want to train in diagnostic and therapeutic interventional pulmonology. The main part of the course was devoted to "hands-on" workshops giving opportunity to practice live bronchoscopy (using pigs and sheep). This training was critical in the framework of ECOMORE project because pediatricians need to practice the Broncho-Alveolar-Lavage technique to provide good quality specimens from young children with Severe Acute Respiratory Infections (SARI).
The pediatricians took the opportunity of this mission to meet Dr Delaisi at the Robert Debré pediatric hospital (Paris-France) to see organization of routine bronchoscopy at hospital level in particular management of disinfection of equipments. Dr Delaisi will assist on site the pediatricians of YCH and YKH to practice BAL when they receive the new equipment (PENTAX flexible pediatric bronchoscopes) from 23 to 27 November 2015.
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21 August 2015
The 2nd National Stakeholders meeting gave the opportunity to present preliminary findings of the study conducted in Lao PDR.
In addition to the participation of people from the MoH, Provincial Health authorities, Provincial Agriculture Office, NAFRI, AFD, French Embassy…we were very pleased to welcome our colleagues from Institut Pasteur de Côte d’Ivoire.
Firstly Julie-Anne Tangena and Phoutmany Thammavong made a presentation on “Risk of mosquito-borne diseases in rubber plantations of South- East Asia” to demonstrate the potential risk.
Later on they presented the “Risk of Vector-Borne Diseases In Relation To Rubber Plantations In Lao PDR” to show the key results of the field study and to demonstrate the likely impact of development of rubber plantation in Lao PDR on public health and so they paved the way to issue practical recommendations to decrease the risk of vector-borne diseases for workers and their families living in rubber plantation areas.
Key figures about ECOMORE project in Lao PDR:
A total of 3888 hours of data was collected in each habitat during the collection period of 2013-2014. |
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Several tens of villagers involved |
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A total of 24,920 female mosquitoes were collected |
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We identified a total of 123 different mosquito species |
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300 water bodies have been identified in the three study areas and more than 2000 mosquito larvae collected |
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3 years study and analysis of data |
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Budget 465,000€ |
17-28 August 2015
The overall objective is to monitor bacterial pathogens in the environment. However, pathogens such as Salmonella and Campylobacter may be at a very low concentration and patchy in distribution in water, soil and vegetables; consequently the fecal indicator E. coli appeared to be a relevant marker to trace the fecal contamination of the environment.
As E. coli is present in the intestinal tracts of both humans and warm blood animals, it cannot be used to distinguish contamination by human pollution from other sources of pollution such as pig manure. For this reason, alternative microbial indicators may be used besides E. coli to trace the fecal pollution in the different compartments of the village environment; there are:
Human specific marker: HF183 Bacteriodes 16S rRNA genetic marker
Pig specific markers: Pig-2-Bac, and Lactobacillus amylovorus
Poultry marker: Bifidobacterium saeculare
However, it is noteworthy that due to the high limit of detection of the qPCR, the markers could be only analysed when counts of E. coli >1000 CFU / 100 mL or 100g
Participants in the training will be capable to perform filtration for analyzing of Bacteroidales, Lactobacillus amylovorus and Bifidobacterium; they are also trained on NPP and TBX methods for E.Coli numeration. The second part of the training focuses on DNA extraction of Gram negative bacteria and PCR treatment.
14-16 July 2015
These 3-day discussions between NHL, pediatricians and IPC team allowed clarifying reading of the analysis results issued by NHL and demonstrated that proper interpretation can help pediatricians in diagnosis and treatment of children with SARI. The Working Group members agreed as well to amend the SOPs (Standard Operating Procedures) as below:
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Type of analysis |
Results of analysis |
Comments |
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Naso-pharyngeal swab
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All patients
2 swabs |
✓ FTD33
✓ Bacteriology |
• Viruses and bacteria present are identified. |
Infection or colonization?
• Must be linked with the clinical symptoms and response to treatment.
• Comparison of results of FTD33 and bacteriology can be decisive. |
| Throat swab |
ONLY patients with evident tonsillitis |
✓ Bacteriology |
• Bacteria (mainly Streptococcus) likely pathogen identified. |
• Important: not to miss diphtheria cases. |
| Sputum |
As often as possible |
✓ FTD33
✓ Bacteriology |
• Bacteria and viruses causing infection identified.
• Antibiotic sensitivity tested. |
• Quality of sputum checked at hospital lab.
• Sputum is difficult to collect in children under 10: training by physio-therapist and on performing Induced Sputum will be provided. |
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BAL |
ICU patients |
✓ FTD33
✓ Bacteriology |
• Bacteria and viruses causing infection identified.• Antibiotic sensitivity tested. |
• Important to evaluate when BAL is beneficial for the child health in comparison with the risk of the bronchoscopy. |
| Pleural fluid |
Patients with pleural effusion |
✓ FTD33
✓ Bacteriology
✓ BINAX: detection of antigen for Strep. pneumonia |
• Bacteria and viruses causing infection identified.
• Antibiotic sensitivity tested.
• Positive Strep. pneumoniae Ag in pleural fluid reflects infection for sure. |
• BINAX is labeled for urine and LCR but can be used on pleural effusion fluid.
• The fluid is centrifuged if too viscous. |
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Blood culture |
As often as possible |
✓ Bacteriology |
• Bacteria causing septicemia identified.
• When positive it is a critical indicator for treatment.
• Antibiotic sensitivity tested. |
• Disinfection of collection site is crucial
• Better to collect specimen before any antibiotic treatment
• Low quantity of blood impairs result |
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Urine |
All patients |
✓ BINAX: detection of antigen for Strep. pneumonia |
• Positive S. pneumoniae Ag in urine may reflect either colonization or infection. |
• If negative, S. pneumoniae is not responsible for SARI.
• If positive in children between 1 and 6 years old, it may only reflect colonization. |
08 July 2015
After opening remarks made by Pr Dang Duc Anh, director of NIHE the program of presentation started:
- Overview about One Health approach and ECOMORE study in Hanam Province presented by Pr Nguyen Tran Hien , former Director of NIHE
- Database: collection of data, questionnaires design and control, presented by Dr Nuyen Thi Phuong Lien _NIHE
- Preliminary findings from the field study, presented by Dr Lep Phuong Mai_NIHE
This meeting gave opportunity to discover other projects conducted in Hanoi region in the One Health area:
- Mrs. Nguyen Mai Huong from RUDEC/IPSARD presented the REVALTER project
- Dr Pham Duc Phuc from CENPHER showed a presentation on the “Health risks related to biogas waste –water in Hanam province.
The presentations were followed by a discussion session chaired by Pr Nguyen Tran Hien; many participants were able to share their comments and the chairman emphasized the importance of exchanging experiences with all stakeholders.
05 to 17 June 2015
Julia Ledien and Peas Muslim conducted an evaluation mission in Kampong Chhnang, Kratie and Kampong Speu cities after 6 monts of participation of private doctors in the National Surveillance System (CAmEwarn); the objective of the mission was:
- to know the point of view of Authorities (PHD) on the likely improvement of including the private sector in the surveillance system
- to initiate a broad debate between private doctors and PHD on their potential role in the surveillance system
- to assess opinion and expectation of private doctors on their participation in the CamEwarn surveillance system trough individual interview; questionnaires will be analyzed to issue a possible and sustainable strategy
29May 2015
The Knowledge Translation is a critical part of ECOMORE project that is more imagined as a dynamic set of approaches to build trust and dialogue to connect research and policy processes. Three hours of intense discussions have been chaired by Pr Hien (NIHE); the main topic was to debate on the manner to produce recommendations which will match with the strategy on livestock production.
The number of participants was limited to facilitate fruitful discussions:
- Manager of the project "Enhance One Health coordination mechanisms in Vietnam" Manager of the Secretariat Office of The Partnership on Avian and Human Influenza (PAHI)
- Deputy Director of the Center for Public Health and Ecosystem Research (CENPHER) Hanoi School of Public Health ,Coordinator of the Vietnam One Health University Network (VOHUN)
- Vice-Director of National Institute of Veterinary Research (NIVR)
- Researcher at Institute of Policy and Strategy for Agriculture and Rural Development -(IPSARD)-MARD
- Head of Department of Economics and Farming Systems at National Institute of Animal Sciences (NIAS) - MARD
- Senior Officer at Department Of Livestock Production (DLP) - (MARD)
- Deputy head of Community Environmental Health Division, The Health Environment Management Agency, MOH of Vietnam (VIHEMA)
- Professor at Institute for Preventive Medicine & Public Health
- Vice Director of CECT at Vietnam Environment Agency, MONRE
- Head of Dept. of rural production system and services at Rural Development Center; Institute of Policy and Strategy for Agriculture and Rural Development
- Head of food poisoning control department at Vietnam Food Safety Administration
- Policy & Communication Coordinator at Wildlife Conservation Society (WCS)
22 May 2015
The 2nd National Stakeholders meeting gave opportunity to show several presentations:
- Presentation on the surveillance system improvements realized thank to the partnership between ECOMORE project and CNM (Mr. Kim San_IPC/CNM)
- Presentation of the surveillance system results of 2014 (Dr Chim Vun _CNM)
- Presentation on the private sector surveillance system (Dr A.Tarantola_IPC)
- Presentation of the results of the entomological study (Mr. Prasetyo Didot_Namru2)
- Review of the lab good practices at hospital level (DR Ong Sivuth_IPC)
The Working Group organized the same day in the afternoon focused on:
- Drafting of a realistic preparedness plan at PHD and hospital level when a reliable Early Warning System allow to predict a dengue peak
- Design of an educational game to be displayed in the waiting area of pediatric wards to explain to children the risk vs. good practices for dengue transmission at the village level
18-23 May 2015
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2 virologists and 2 bacteriologists from NHL (Myanmar) arrived at IPC to be trained to perform DNA/RNA extraction, to manage the CFX96 (Bio-Rad) Real‐Time PCR machine and to properly use the FTD33 respiratory pathogens kit. At the same time a maintenance engineer from NHL is trained on maintenance of bio-safety cabinets and especially will receive a preliminary training on maintenance of BSL3 facilities. |
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30 April 2015
List of websites linked to ECOMORE:
30 January 2015
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Pr Htay Htay Tin reminded the potential benefit from the project for the clinicians and for the children as this ECOMORE project is clearly Public Health oriented and not a research study.
She emphasized as well that new capacity of the NHL staff and the innovative close collaboration with YKCH and YCH will ensure sustainability of the project and so NHL will provide on a long term a practical tool to clinicians to better diagnose and treat SARI. The discussions mainly focused on:
- The case definition which determines inclusion of patients
- The limitation of use of Broncho-Alveolar-Lavage in the ICU due to the necessity to perform a strict monitoring of the patient. |
An acute respiratory illness with onset during the previous 7 days requiring overnight hospitalization that includes:
• History of fever or measured fever of 38oC or above 38oC
• Cough, AND
• Shortness of breath or difficulty breathing
- The requirement of “overnight hospitalization” is meant to imply that the patient has an illness that is severe enough to require inpatient medical care
- “Shortness of breath or difficulty breathing” is intended to capture dyspnea or air hunger with faster breathing rate + chest indrawing.
- “History of fever” does not require history of documented fever and may include a patient subjective report of having a fever or feeling feverish. |
13 January 2015
In addition to the longitudinal cohort study, since some livestock-related diseases do not display symptoms, a serology and bacteriology surveys is conducted in both animal and human to capture history of pathogen exposure. As the purpose of this study branch is to investigate the linkage between human and animal pathogens, the survey protocol is conducted in a similar manner for animal and human. Blood and stool specimens or manure in animals are collected to survey Salmonella spp, Campylobacter thermotolerant, Leptospira, Hepatitis and Japanese encephalitis. At the same time an environmental investigation is carried out to trace the fecal contamination in the environment which can be due to animals (pigs and or poultry) or humans (villagers). A direct approach would be to monitor bacterial pathogens in the environment; however, pathogens such as Salmonella and Campylobacter may be at a very low concentration and irregular in distribution in water, soil and vegetables. So the fecal indicator E. coli appeared to be a relevant marker to trace this fecal contamination. NIHE will also perform an innovative technique using biological markers to identify whether the origin of the contamination is from pigs or poultry or humans. This cross-sectional study will last 2 weeks and a second survey will be organized six months later.
02-04 December 2014
The Steering Committee is the highest level of decision-making within the Project. This committee represents the interests of the Consortium. Its role is particularly to monitor the progress of the Project towards the objectives, targeted results and identified milestones / indicators and to decide on adjustments or corrective actions on the methodology, if necessary. This 2nd Steering Committee was held in Hanoi on 02 and 03 December and was followed by a visit to the villages where the study was conducted on 04 December 2014. Participants were also invited to visit NIHE laboratories on the 03rd. Each partner and the coordination team made a detailed presentation on activities that have been implemented in the past year; participants were impressed by the huge work done during this time. Finally the Committee and invited experts issued some recommendations to guide the implementation of the project in 2015. Public Health orientation and effective Knowledge Translation were important concerns.
17-21 November 2014
The specific operational objectives of this proof-of concept network for Severe Acute Respiratory Infections surveillance will be to document viral and bacterial pathogens causing Severe Acute Respiratory Infections in two paediatric hospitals in Yangon and to allow (if any) detecting emerging/new pathogens or significant outbreaks.
In this sense, NHL will perform a set of analysis like blood culture using the BacT/Alert system, classical bacteriology and testing of antibiotic sensitivity on sputum (or BAL fluid), detection of Legionella and Streptococcus pneumoniae in urine antigen with BINAX kit. Performing PCR on naso-pharyngeal swabs and throat swabs using the kit FTD33 was the main purpose of this technical training organized by the lab manager of ECOMORE assisted by Mr. Gorman and Mrs. Kim Lay from IPC.
This innovative kit allows to detect 33 patogens: influenza A, influenza B, rhinovirus, coronavirus NL63, 229E, OC43, HKU1, parainfluenza 1, 2, 3, 4, human metapneumovirus A/B, bocavirus, Mycoplasma pneumoniae , respiratory syncytial virus A/B, adenovirus, enterovirus, parechovirus, Chlamydia pneumoniae , Staphylococcus aureus , Streptococcus pneumoniae , Haemophilus influenzae , cytomegalovirus, influenza C, Pneumocystis jirovecii , Haemophilus influenzae type B, Bordetella spp. (except Bordetella parapertussis ), Moraxella catarrhalis , Klebsiella pneumoniae , Legionella spp., Salmonella spp. and internal control.
At present the lab technicians of NHL are fully capable to perform the technique.
14 November 2014
Working Groups involving key people who work on the frontline of dengue surveillance are part of the Knowledge Translation platform for the Cambodian component of ECOMORE project. The role of these meetings is to give detailed and clear feedback on the activities in which these people participated; this time it was critical to present the results of data analysis that has been collected during the last 6 months (dengue season). Julia Ledien, an epidemiologist of the project prepared an innovative and demonstrative slide show (see home page) to present the evolution of dengue cases in each province in comparison with 2012 and 2013. Dr Peas Muslim presented the results of a questionnaire completed by the PHD directors, MDs and data managers. The aim of this was to assess their opinion on the improvements of the surveillance of dengue as a result of ECOMORE implementation.
A large part of this meeting was dedicated to the presentation of the entomological tool that was set up to evaluate the variation of vector biomass in the villages. Dr. Didot Prasetyo, entomology supervisor at NAMRU and Doum Dyna, research assistant, showed the results of their work on trapping and vector inventory. During the last session, participants split into 3 groups to discuss the format/content of a poster, drafted by ECOMORE team, which will be used as a reminder in the hospitals on the best manner of how to control vectors at the hospital level and consequent risk of contamination of children by dengue, malaria and JE.
31 October 2014
Setting up an effective Knowledge Transfer and Knowledge Translation platform is a main concern for ECOMORE project. The studies conducted in the field will produce knowledge and it is essential that knowledge can be put into action. It is proved now that simply receiving knowledge does not necessary lead to using it and reading educational materials or attending meeting does not mean that audience change practices. KT is a multi-directional flow of information; it is more properly imagined as a dynamic approach connecting research and policy processes throughout the study as opposed to deliver a finalized analysis of the study. The Director of the NAFRI expressed his willingness to publish an updated version of the Rubber Technical Manual. This manual presents agricultural and processing techniques on rubber production and all related data available. It is planned to update information provided by the manual and to add a section on health, showing the potential risk assessed during ECOMORE study, from vector-borne diseases, such as malaria, dengue and chikungunya for the rubber workers and villagers living in the surrounding areas. This process of review led by NAFRI will be done in collaboration with key people from MoH, MAF, MoNRE and implicated OI. Review of the manual has to be completed over a one year period. As a next step ECOMORE project intends to support printing of an adequate amount of copies of the manual; actually, the first edition 2011 (only 500 books) has been distributed in priority to policy-makers, to local authorities but many owners of rubber plantations expressed their interest.
13-15 October 2014
One Health is a multidisciplinary approach to achieve optimal health for people, animals and the environment through local, regional and global research collaboration. Particularly in Southeast Asia, One Health has gained much more focus due to the rise of cross-species epidemics such as SARS, avian influenza, Nipah virus, Japanese Encephalitis... With 70% of emerging diseases being of animal origins, this has become a crucial issue especially for the region, due to the frenzied urbanization and significant development of livestock production to match the increasing local demand of meat. In the past 10 years numerous position papers and workshops have proposed framework and guidance on practical implementation of the One Health concept to improve health management in the field. However a limited number of initiatives and projects have been implemented so far with limited results and limited visibility of the results. The core of ECOMORE project is to better understand anthropogenic ecological changes responsible for the emergence of infectious diseases and to measure the health risks for local communities as a result of improvement of surveillance systems and strengthening of national and regional cooperation. However, understanding how people and their health are related to ecosystems changes is a tough puzzle. A basic obstacle to the assessment of the human health status in relation to ecosystem changes relies on the absence of direct, strong, connective mechanisms, and scientific uncertainty. ECOMORE project in Vietnam aims at measuring and demonstrating effects of moving from traditional to more intensive livestock production on human health, animal health, and environment through a documented protocol validated by international experts.
October 13, 2014
Dr Khin Yi Oo, Deputy Director of NHL, Dr San Mya, Chief of Bacteriology unit, Dr Latt Latt Kyaw, Head of Virology Unit and Dr Artem Metlin, Lab Manager at IPC organized the second session of the Knowledge Translation Platform with participation of medical doctors and nurses of Yangon Children Hospital; the first session has been held in June with participation of key people of Yankin Children Hospital and a team of 6 experts of the Institut Pasteur du Cambodge. The objective was especially to initiate close teamwork between NHL and pediatric hospitals. Firstly the lecturers made presentations on the method to conduct clinical research on SARI with reference to similar projects conducted by Institut Pasteur like SISEA project. Furthermore, the discussion allowed to understand constrains at pediatric ward and at NHL level. Particular attention was given to the problem of collecting good quality sputum in young children to allow bacteriological analysis and testing of antibiotic sensitivity to result in more appropriate treatment of the patients. The next step will be to issue the SOPs for sample collection and handling in collaboration with Yangon Children Hospital, Yankin Children Hospital and the NHL.
02-03 October 2014
The ECOMORE project in Vietnam is a real “One Health” approach to measure changes when moving to a more intensive livestock system. The field study will produce plenty of data on human health, animal health and environment. A total of 15 questionnaires will be used to collect data during the longitudinal and cross-sectional study and thousands of specimens will be collected. Inputting, storing, retrieving and managing these large quantities of information require setting up an adequate database. Firstly, the group issued a complete coding system to ensure proper identification of persons, animals and sample included in the field study. Therefore, they discussed the conceptual data model that will reflect the structure of the information to be held in the database. Finally the team of the Hanoi School of Public Health will develop the database by using Open Data Kit (www.enketo.org), a web-based solution. The participants in this working group will continue to cooperate during the creation of the database and to set up the comparison system using STATA. The participation of a representative of the Epidemiology unit at IP Cambodia was important to better embark on future “One Health” projects.
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September 17, 2014
Signature of this Memorandum of Understanding between the Ministry of Health of the Republic of the Union of Myanmar and the Institut Pasteur is a natural outcome of a rich history. The Eastern Daily Mail dated 07 October 1907 reported establishment of a Pasteur Institute in Rangoon, especially to fight rabies. More recently, in the framework of the ECOMORE project several missions and exchanges with the Ministry of Health and key people of the health sector resulted in a Technical Cooperation Agreement signed with the NHL on 20th January 2014 to implement the Myanmar component of ECOMORE project. Signature on 17th September 2014 of a supplementary TCA with the NHL to implement SEA encephalitis project shows that partnership between, the Ministry of Health, the NHL and Institut Pasteur is developing actively; much other collaboration is expected in a near future.
27-30 August 2014 
This international conference gave the opportunity for researchers, scientists, policy makers and other stakeholders involved in the rubber industry to meet and exchange their experiences. The conference focused on 4 dimensions of the rubber sector: Biology and Agronomy of rubber production, Social and economic issues related to natural rubber production, Rubber Technology and processing and on the Impact of rubber production on the environment and health. Presentations scrutinizing the impact of the development of rubber plantations on soils and environment, on wildlife and on public health have been particularly well attended by a large audience of students.
In her presentation, Julie-Anne Tangena explained that canopy coverage, humidity, temperature and abundant breeding locations can provide a good habitat for mosquito vectors. She showed interesting data on species collected among 25,000 mosquitoes and different trends in the exposure of people to mosquitoes in different habitats and consequently exposure intensity for rubber workers. Julie-Anne also pointed out that monitoring these areas for human migration intensity, disease incidence and vector population should be prioritized in order to understand if they are a driving factor for the increase in vector-borne diseases in SEA.
August 15, 2014 
In Myanmar the SARI study focuses on children in 2 Pediatric Hospitals and includes testing of several types of specimens in order to improve the identification of pathogens and consequently improve treatment.
Clinicians face difficulties in getting proper specimens to isolate pathogen bacteria because young children cannot produce sputum and the yield of blood to perform blood culture is often insufficient. This meeting initiated a debate between Hem Sopheak, Pharmacist Biologist at the microbiology unit of Institut Pasteur and the two specialists of DMDP, (www.dmdp.org) on how to determine the best technique and set of materials in order to perform blood culture when the volume of blood collected is much less than 5 ml. In particular, the discussion focused on using Isolator 1.5ml. In conclusion the experts stated that the BacT/Alert system is more pertinent for the study on SARI in Myanmar.
Mrs. Laurence Borand and Mrs. Sophie Goyet from ANRS participated in the discussion; they work in the framework of CHARLI project on Children's Antibiotic Resistant infections
29 July to 13 August 2014
The sentinel surveillance system was established in 2001 in Cambodia. The objective of this system is to collect high quality data from a small number of facilities in order to monitor trends to rapidly detect dengue and broad-scale epidemics. This monitoring is combined with serologic surveillance in some hospitals located in high-risk dengue areas in order to determine the sensitivity of the clinical case definition and to describe the circulation of serotypes overtime. The ECOMORE project aims at evaluating the role of the rapid development of transportation means in the progression of Dengue. To better assess this link, the project has reinforced and extended the system of surveillance in particular by adding three locations along the main roads: Kampong Speu, Kampong Chhnang and Kratie.
Pr Chantha, Director of CNM in Cambodia, Dr Sivuth, Chief of laboratory in virology unit at IPC and Dr. Mueslim field implementation project leader for ECOMORE organized training sessions on dengue case definition, on data management and especially on sample collection and handling in these 3 additional sites. The project provided a laptop, a refrigerator and a liquid nitrogen container to each new site to match with the standards of other sentinel sites.
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01 August 2014
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Mrs. Goyet, KT consultant, has been hired by the project to set up a Knowledge Translation Platform tailored for the ECOMORE component in Vietnam. This Knowledge Translation is a critical part of this One Health project to ensure that knowledge produced by the study will be put into practice. The principle is to organize a multi-directional flow of information and a dynamic set of approaches between researchers and policy-makers in the area of human health, animal health and environment.
This working group resulted in a year-action plan listing detailed activities to be implemented, key messages and a schedule for the communication strategy. |
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July 31st 2014 
Launch of the website ECOMORE
To finalize the layout of the website, the project hired Mr. Oeng Rotana, website developer. He will be responsible as well of updating the website on a weekly basis with news and document provided by partners and the coordination team.
July 7th 2014
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AFD has transferred management of ECOMORE project to AFD in Cambodia but the progress of the project is still supervised by P. Lagier, Project Manager at the Health and Social Protection Division at AFD.
Mr. André Pouilles-Duplex is the Director of AFD agency in Phnom Penh but Dr Chan Sorya will be particularly dedicated to ECOMORE project |
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June 25th to 27th 2014
Visit of NHL leaders at IPC; Pr Htay Htay Tin, Dr Win Thein, Dr San Mya and Dr Latt Latt Kyaw from National Health Laboratory in Yangon made a 3-day visit at Institut Pasteur du Cambodge.
Better diagnosis of SARI in children in 2 main pediatric hospitals is the core of the research study in Yangon; the group visited Kantha Bopha Hospital in Phnom Penh (1,000 to 1,500 out-patient/days) to exchange with Dr Beat Richner the founder. The project aims especially at capacitating the virology and the bacteriology unit of the NHL; it was important to show the lab facilities at IPC, to explain functioning and ongoing study research. This visit gave opportunity to show results obtained with the kit FTD 33 and usage of isolator for blood culture.
The group expressed special interest for rabies center and epidemiologic studies and for outstanding work of the malaria unit.
June 20th 2014
Presentation of the dossiers to CoRC (Comité de Recherche Clinique – Committee for Clinical Research) for Lao and Vietnamese components to be examined on 08 July 2014
The CoRC is an ethic committee for clinical research under guidance of Institut Pasteur; it is accredited by the Institutional Review Board (IRB) in USA. CoRC principles match with the Declaration of Helsinki developed by the World Medical Association (WMA) as a statement of ethical principles for medical research involving human subjects, including research on identifiable human material and data: while the primary purpose of medical research is to generate new knowledge, this goal can never take precedence over the rights and interests of individual research subjects.
June 18th 2014
Signature of the Partnership Part B of the Vietnamese component of the project by Pr C.Bréchot
ECOMORE project in Vietnam has been split in two parts namely Part A and Part B. This component is a real “One Health” concept linking human health, animal health and environment; NIHE needed some support to develop the specific protocol of the study concerning animal health and environment sections. So, the Part A was dedicated to issue a complete and relevant protocol with assistance of external experts. The Part B corresponds to the implementation of the field study and analysis of data.
June, 17th to 20th 2014
Technical mission of IPC experts in Yangon to assist NHL to issue the SOPs
New equipment and materials to be provided to NHL will be delivered mid-August 2014; installation, setting up, additional training and the pilot phase will be completed within one month. So it is estimated to start the study at the end of September 2014. Before this date it is critical to finalize writing of the SOPs to ensure quality of specimens collected from patient to NHL laboratory.
A pluri-technical group of experts of IPC met their counterparts at NHL and at Yankin Children Hospitals to better understand the context of ECOMORE project in Myanmar and to share their experience (especially got during SISEA project) to develop consistent SOPs.
- To ensure the quality of specimens from collection to analysis
- To finalize writing of SOPs
- To get approval of the National Ethic Committee and of the CoRC
Mrs. Hem Sopheak (bacteriology), Mrs. Kerleguer Alexandra (medical biology), Mr. Rith Sareth (virology), Mr. Crabol Yohan (clinician), Mr. Ly Sowath (epidemiologist) and Mrs. Goyet Sophie (Knowledge translation specialist) participated in this mission.
May 27th to June 3rd 2014
The protocol of the study in Cambodia includes an entomological component; it is planned to set up a simple, safe and inexpensive system of trapping in villages to estimate variation of vector density. Experience got during the first trapping season in Laos for ECOMORE project showed clearly that double net technique is the most effective method in comparison with CDC-light trap, BGS trap or Suna trap.
The implementing team of WP Laos trained the research assistant of the WP Cambodia for one week to be familiar with this double net trapping technique.
May 23rd 2014
The 1st National Stakeholders has been organized in Vientiane to give a clear overview of the project ECOMORE at regional level, to better explain global objectives and to decipher the protocol of the field study of the Lao component.
Participation of Dr Som Ock Kingsadamd, Deputy Minister (MoH), of Dr Simone Mambanya, Deputy Director of Centre for Malaria Parasitology and Entomology (CMPE) and of Dr Thavone Inthavong , Director of National Agriculture and Forestry Research Institute (NAFRI) demonstrated the interest attached to ECOMORE project.
Dr Thavone favored the establishment of a “Rubber Board” which could gather owner of rubber plantations, policymakers at MoH and Ministry of Environment and representatives of tappers community and villagers. Dr Paul Brey suggested that ECOMORE should support such initiative within the framework of the Knowledge Translation Platform.
April 08th 2014
Organization of a Knowledge Translation workshop in Phnom Penh with participation of people from 8 selected hospitals to implement the dengue surveillance under ECOMORE project. Participants were clinicians, nurses and data managers. The message during this workshop has been adapted to this medical audience. The main objectives of this workshop were:
- To disseminate the findings of the first assessment of the surveillance system in the eight selected hospitals.
- To present the Standard Operation Procedures of the NDSS to the audience.
- To organize participatory discussion groups to develop tools to improve surveillance of dengue. Posters on dengue case definition and dengue data management drafted by the project have been submitted to the groups to be improved and perfectly mach with their needs. The groups suggested and voted as well to develop additional tools.