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ECOMORE 2 in few words  

5 partner countries: the Philippines will join Cambodia, Lao PDR, Myanmar and Vietnam to implement ECOMORE II project

Public Health oriented: all partners have identified a priority public health concern in line with the country health strategy before designing the study

Regional and transversal: all partners will work on correlated topics to stimulate a regional close collaboration

Knowledge Translation and sustainability: the KT initiated at the design stage of the project will be developed along project implementation to ensure integrating recommendations in Health Policies

Networking and scientific collaborations: to develop experience and knowledge sharing with other similar projects implemented in the region and to gain visibility and interest from policy makers

Common topic: water-borne and vector borne diseases related to change in land use and with extreme climatic events

Climate change: this transversal study will be implemented in the 5 partner countries to provide technical assistance for the formulation of risk and possible adaptation measures.




ECOMORE 2 in Cambodia   

Can the integrated vector control in schools mitigate the epidemic peaks and absenteeism and help to reduce overcrowding in hospitals during the epidemic season of dengue?

Schools, especially those in peri-urban areas with high density of population are certainly hot spots for transmission of dengue among children, knowing that these children contaminated at school will be a source of horizontal transmission of the virus at home and for the neighborhood. Targeting preferential areas for transmission, to organize an integrated vector control during the dengue season should be more cost effective in comparison of dispersal interventions in area after confirmation of dengue cases.

The ECOMORE II project aims at measuring whether the implementation of an integrated vector control strategy focusing schools and combined with an educational program can:

⦁Mitigate peak of dengue, dengue-like syndromes (leptospirosis, chikungunya, zika) or other vector-borne diseases

⦁Have a positive impact on the activities of health centers which are generally overcrowded during these transmission peaks




ECOMORE 2 in Lao  

Can an innovative program for the control of vectors borne diseases to reduce the risk of dengue, Chikungunya and Zika in urban and peri-urban areas?

The urbanization rate observed in Laos (16.85% in 1994 to 37.55% in 2014_WB data) is one of the highest in the ASEAN countries. The development of peri-urban areas, where high population density is combined with traditional rural activities, offers ideal ecosystem for the proliferation of Aedes, vectors of dengue virus, chikungunya and zika. Movement of populations from rural to urban areas observed in recent years and the increasing number of immigrants are factors that facilitate the circulation of dengue virus between the Laotian provinces but also between the countries of the sub-region.

It is demonstrated that the identification of the most likely sites of contamination can be improved by analyzing the dynamic mapping data of confirmed outbreaks, combined with the study of genomic similarity of viruses and a study of population movements. The goal of ECOMORE II project is to provide a dynamic mapping model to confirm or reverse that the contamination occurs outside or within the community and, so to identify "hotspots" of potential contamination to allow better targeting the vector control strategy.




ECOMORE 2 in Myanmar  

Can laboratory and hospital capacity building improve post-disaster management of emerging diseases?

Floods and extreme rainfall are regularly associated with leptospirosis outbreaks. It is critical to examine mechanisms by which climate change can affect ecosystems that are likely to drive an increase in the overall incidence of leptospirosis Today leptospirosis is well identified as a re-emerging worldwide disease by WHO.

Epidemics of infectious or parasitic diseases which can occur after natural disasters pose challenges in terms diagnosis in emergency situation and in the medium term. However, early diagnosis, clinical and / or laboratory-confirmed can minimize the number of severe cases because early treatment of some of these infections (e.g. leptospirosis) is crucial to decrease morbidity and mortality (20%). While the extreme weather events are a priori increasingly frequent in Myanmar, yet little is known about their health impacts and little research has been done to examine short-term and deferred health implications.




ECOMORE 2 in Philippines   

Can the vaccination campaign have a significant impact on dengue cases when it is combined with innovative vector-control strategy?

Dengue is an ongoing public health concern in the Philippines. According to the World Health Organization, the Philippines experienced the seventh highest number of dengue fever cases in the world between 2004 and 2010. In January 2016, the Philippines Department of Health announced that over 1 million nine-year old Filipinos enrolled in government schools would be the first to be vaccinated against dengue. This is the world’s first public dengue immunisation programme.

It is critical to document if the synergized strategy of vaccination (it has been found that the vaccine has significantly lower efficacy in protection against dengue-1 and 2 versus that of dengue-3 and 4) and vector control will reduce incidence from 32 cases/100,000 population to 20 cases/100,000 population and reduce the risk of human exposure to aedes bite by House index of <5 and Breteau index of 20




ECOMORE 2 in Vietnam   

Identifying the role of climatic factors in combination with agricultural practices can mitigate the incidence of water borne diseases (such as Leptospirosis)?

The Red River Delta is home for over 20% of the Vietnamese population with a density of more than 1,000 Hab./km2 in an area called "rural“. The ECOMORE study in Vietnam showed an unexpected stream of leptospirosis and hepatitis E among rural people caring for livestock or agriculture. Clinically, leptospirosis is difficult to differentiate from other infectious diseases and so is typically under-diagnosed; the estimated fatality rate of severe forms can reach 20% which can be significantly minimized by timely diagnosis and proper antibiotic treatment.

Identification of environmental and occupational risks associated with leptospirosis will result in development of a strategy to raise awareness of populations at risk, to strengthen local capacity for diagnosis and treatment of the disease and to support authorities to be prepared for the increased risk of leptospirosis due to climate change.





ECOMORE 2 and climate change   

This transversal component will include several studies which will link scientific and social data, to result in:

⦁  measurement of verifiable climate change over a period of 20 years after setting the point of reference in the study areas to be compared with the perception of the local population,
⦁  an inventory of local actions in place to mitigate the effects of climate change and assess whether they can be replicated on a larger scale,
⦁  assessment whether the recommended strategies are effective and can be integrated into an overall strategy adapted to local and national priorities in terms of risks and actions needed
⦁  description of the possible impacts of climate change on the environment and landscape to assess the risk of re-emergence of infectious diseases such as leptospirosis and dengue.





Vientiane 17 November 2016  

The final symposium has been combined with the JRDs (Journées de la Recherche et de l’Environnement/ the Research Week for Development) organized by the French embassy in Lao PDR jointly with the Ministry of Health.



The conference was opened by H.E. Ms Claudine Ledoux, French Ambassador to Lao PDR jointly with H.E. Dr. Phouang Parisack Pravongviengkham, Vice-Minister of Agriculture and Forestry. The participation of the former minister of Health, Dr. Ponmek Dalaloy of Prof. Ass. Dr. Somchith BOUPHA, President of the University of Health Sciences of Lao PDR, of Prof. Menorath Sing, Vice-rector, University of Health Sciences of Lao PDR and of Dr. Bansa Oupathana, Head of International Cooperation, and University of Health Sciences demonstrated the implication of the Ministry of Health in this event.



During this full morning session, ECOMORE had the opportunity to present the main results of the 3-year study conducted on the “Relationship between rubber plantation development and variation of mosquito population and its consequence on public healthread more...

…and to present the edited version of the Rubber Manual, prepared by the NAFRI (National Agriculture and Forestry Research Institute) and including recommendations on public health resulting of the project.


During this conference Dr Paul Brey made a presentation of the extension of the project in Cote d’Ivoire in Africa under Michelin Foundation funding and so demonstrated the sustainability of the project initiated in Lao PDR and the reality of a South-South cooperation.



In the context of Laos' ASEAN presidency it was critical to gather researchers from neighboring countries and entomologists from NIHE (Vietnam), NHL (Myanmar) and IPC (Cambodia) were invited by the ECOMORE project to participate in this Research Week for Development. The participation of the representative of AFD and FAO in Lao PDR, of the Regional Health Counselor of the French Embassy in Bangkok, of CNRS, CIRAD, IRD, GRET, Helvetas, the Comité de Coopération avec le Laos…showed the importance of the event and of the scope of the ECOMORE project. Many student of the IFMT (Institut Français de Médecine Tropicale) attended the meeting showing the concern of future medical doctors for research in public health. Aside the coverage by the national newspapers, Mr. Igor Strauss, reporter at RFI (Radio France Internationale) participated in the 3 day event and especially conducted interviews of key people who participated in ECOMORE project to propose a 40 minutes health radio program (Priorité Santé) which you can listen on http://www.rfi.fr/emission/20161215-dengue-laos







Yangon 21 November 2016   

The National Health Laboratory has organized the final symposium in an exceptional setting, along the Inya Lake.

The participation of Pr Pe Thet Khin, the former Minister of Health who initiated ECOMORE component in Myanmar showed his continuing involvement in the project.




Other key participants were Prof.Dr. Nay Soe Maung, Rector of the University of Public Health, and Prof.Dr.Kyawt Sann Lwin who teaches as well at the UOHP, Dr Kyaw Zin Thant, Director General of DMR (Department of Medical Research), Dr. Tin Nyunt, Director of MMC (Myanmar Medical Council), Dr. Khin San Dar Aung, Deputy Director of the Department of Public Health.

Professors, senior medical superintendant, medical doctors, pathologists who collaborated in the study were all present and many students have joined the conference. A senior pathologist from NIHE, Dr Thi Thu Hong Tran participated in the meeting.


Pr Htay Htay Tin, Deputy Director General ( Laboratory )/Department of Medical Services, Dr Win Thein, Director of NHL, Dr San Mya and Dr Latt Latt Kyaw, Deputy Directors of NHL organized this final symposium to present major findings and recommendations as result of the study “Improvement of diagnosis, early detection and surveillance of severe respiratory diseases” conducted from 2013 to 2016 by the NHL in collaboration with Yangon Children Hospital and Yankin Children Hospital.

The Institut Pasteur in Cambodia was represented by Dr A. Delauzanne, epidemiologist and pediatrician and by Dr P. Piola, head of epidemiology unit at IPC; that demonstrated the importance of analysis of data for Public Health research to be capable to issue documented recommendations.



Presentations on bacteriological results, presented by Dr San Mya (NHL), on virological results, presented by Dr Latt Latt Kyaw, on data management, presented by Mrs. May July and on resistance to antibiotic and SARI presented by Dr Agathe Delauzanne, are available on the ECOMORE website. read more...
This important event has been covered by popular medias, news papers, Myanmar Times, Myanmar language and ENGlish version (series 41, No 803, (1-7/12/2016)) and by the TV (SkyNet Health Channel).









Hanoi 25 November 2016   

The Final Symposium to present the findings and recommendations of the Vietnamese component of ECOMORE project has been held in the conference room of NIHE which offers an ideal setting for important events; because many speakers of various organizations presented their work in the One Health area, it stressed clearly the leading role of NIHE for implementing such complex project combining Public Health and One Health.




This conference gave opportunity to everyone working in the area of One Health to present their ongoing projects, their results or their strategy; FAO/WHO, CENPHER, ILRI, CIRAD, USAID, AFD and One Health Partnership made very interesting presentation and demonstrated the importance of working in close collaboration to address complex One Health approach.


Students of 5 foreign countries trained at the National School of Public Health of Hanoi participated in the symposium and contributed keenly in discussions.


The core of the Vietnamese component of ECOMORE project was to study “Impacts of livestock intensification to community health” and so to issue practical recommendations to mitigate the risks. At NIHE, the Department of Community Health and Network Coordination was responsible of the implementation of the project and so made presentation of the detailed methodology of the field study and of the main findings after analysis of tens of thousands data. These presentations highlighted the need of extremely rigorous protocol associated with adapted database and models of analysis when managing One Health project. The Power Point presentations are available in “communications and publications” sub-menu. read more...


The media coverage included a Vietnamese Health magazine and an English daily newspaper; articles are available as below:

28 THÁNG 11, 2016

http://suckhoedoisong.vn/70-benh-truyen-nhiem-o-nguoi-co-nguon-goc-tu-dong-vat-n125285.html

November, 25/2016

http://vietnamnews.vn/society/346951/new-farms-see-more-health-risks-than-traditional-farms.html#Y49BEmCYluXVFY1h.99






Phnom Penh, 05 December 2016   

The Symposium has been held in the very nice setting of the Royal Raffle hotel and despite the considerable number of meetings organized at this period of the year, most of the people invited have attended this event. This showed that Dengue remains a major concern in the region and all organizations involved in the control of the disease are eager to share experiences and new findings. Didier Fontenille, the Director of Institut Pasteur du Cambodge, despite the moderate success of combating the disease at the global level, transmitted his enthusiasm to the audience during his opening speech.





The field phase of the project was completed in March 2016 and this Final Symposium allowed bringing together the team responsible of implementation of the Cambodian component of ECOMORE; Dr Arnaud Tarantola who is now the head of the epidemiology unit in Institut Pasteur de Nouvelle Calédonie, Mrs. Julia Ledien who is free lance statistical epidemiologist in France, Dr Peas Muslim who works for Médecins Sans Frontières and Mr. Doum Dyna who joined the team of Malaria Consortium, all were cheerful to meet again.




The core of the Symposium was to present the modeling of the progression of dengue in relation to population movement and density and to show correlation of data with such external factors as road development, and meteorological data together with the variation of the biomass of vectors before and during dengue season; at present an automated algorithm that detects aberrations in the surveillance, simple and free has proved a posteriori to be enough sensitive and specific to predict the outbreaks few weeks in advance. More complex mathematical models which combine dengue progression with movement of population traced with mobile phone data is still under development, and preliminary results were presented by Julia Ledien and Anthony Cousien.

read more...




The CNM/MoH, WHO, NAMRU/CDC, MC (Malaria Consortium) contributed to the conference by providing very interesting presentations on surveillance, on strategy to fight dengue and on innovative technique for vector control. It is important to mention that the FAO, the Royal University of Agriculture and Vétérinaires Sans Frontières were represented, showing that dengue concern is global. In each partner country, the AFD representative made a review of health projects funded by AFD in the region and explained the strategy of the Agency for the Health Sector in the region; Dr Philippe Steinmetz, Director of AFD in Cambodia did an attention-grabbing presentation. Mr. Alla Arrato from Health Magazine of DKSH , Mr. Andrew Nachenson from The Phnom Penh Post and Mr. Chhim Sao Pheara from Health.com.kh attended the meeting the whole day and participated actively in the discussions.


Dr Arnaud Tarantola made brilliant presentations and wished to remind the strong support of the regretted director of CNM, Pr Ngan Chanta who initiated the ECOMORE project in Cambodia






17 November to 05 December 2016  

The Institut Pasteur in Laos will present the results of the study on “Changing patterns of forestry in Lao PDR, dynamics of vector-borne diseases, and risk assessment in rubber plantations and the surrounding area”. The meeting to be held on 17 November 2016 will be combined with Les Journées de la Recherche pour le Développement /Research week for Development in Vientiane (16-18 November 2016).
The NHL in Myanmar will show the results of the study on “Improvement of diagnosis, early detection and surveillance of severe respiratory diseases”. The meeting will be organized on 21 November 2016 in Yangon and will involve lab experts and practitioners of both hospitals which participated in the study.
The NIHE invite all stakeholders in the One Health area and decision makers involved in the Knowledge Translation platform to attend the final symposium on the “Impacts of livestock intensification on community health” that will be held on 25 November 2016 in Hanoi. Presentation of the study results will be gathered with presentations on other One Health projects in the North Vietnam, actions of International Agencies and strategies of donors. The last symposium will be organized in Cambodia on 05 December 2016, to document if “Improving the monitoring of disease emergence and progression related to changes in human demographics and transportation” can result in new Early Warning tools which can be used routinely by health authorities to better predict outbreaks (dengue was used as proxy) .




04-05 August 2016  

The Asian Development Bank (ADB) and Nordic Development Fund support a regional capacity development technical assistance (TA) for Strengthening Resilience to Climate Change in the Health Sector in the Greater Mekong Sub-region (GMS), with the aim to reduce vulnerability to climate-induced health risks, especially for vulnerable populations, including the poor, migrants, and ethnic minority groups in Cambodia, Lao PDR and Viet Nam.
The outcome of the project will be enhanced capacity of participating countries and health agencies in climate change adaptation and is to be achieved through three outputs: (i) improvement of knowledge and understanding of the relationship between climate change and human health; (ii) strengthening of human resource skills in coping with climate change adaptation in the health sector; and (iii) sharing of knowledge products and promotion of advocacy.
The project will be implemented over a period of three years and the first activities commenced with the inception phase in early March 2016: data collection and analysis, national consultations, coordination with technical partners.
During this Regional Workshop (RWS), a brief overview about the project objectives and originally proposed activities timeline as well as the approach of the TA team were presented to set the scene for the consultation with all participants, including those from ministerial departments of the three countries and other national as well as regional institutions and organizations. This was followed by a presentation of the various main work streams of the project, to describe their aims and purposes and to help understanding how the various tasks and activities of the work plan would help to achieve those goals, produce the relevant deliverables and how they would be connected with each other over time.




01 June 2016  

The study at YCH and YKCH has been completed in April with inclusion of more 500 children with SARI. The objective of this Working Group was to present to the participants a comprehensive analysis of data collected to get a better picture of respiratory pathogens circulating in Yangon and to show the result of testing antibiotic sensitivity to better manage treatment of the patients. A critical part of the Working Group was the exchange with a French pediatrician and a specialist of infectious diseases from Sweden on linking a complete set of analysis with the clinical signs; for some cases, interpretation of analysis results is a complex issue and so requires a collegial discussion.
Finally the group has to imagine the way to promote the result of this study to other MDs and so to ensure sustainability of the service provided by NHL after the end of the project. Suggestions of participants will be presented during the next Working Group in September 2016 before organization of the final symposium in Yangon.





02-12 May 2016  

The participants in the Working Group Organized in November 2015 in Phnom Penh designed a game to be displayed in pediatric waiting rooms of sentinel hospitals; this game shows to the young children good practices to control Aedes density at home and to decrease biting. During one week, the epidemiologist of ECOMORE team, visited again all sentinel sites (8) to present and distribute the final version of the game and she can see the high interest of the youngest…for playing. It is expected that this educational and recreational tool can raise some awareness among children and their parents when the nurse takes short time to demonstrate how to use the game.




28-30 May 2016  

The Lao PDR component of the ECOMORE project aimed to assess the dynamics and distribution of the different species of mosquito between stages of development of rubber forest, surveying interactions between humans, vectors and environment when ecosystems change as well as assessing the vector-borne disease risk. Two of the critical objectives were:


To better understand the vector ecology in rubber plantations to minimize vector-borne disease incidence in the current situation and in the future with the changing dynamics


To release public health recommendations for protecting forest workers and neighbouring populations against vector borne diseases risk

Dr Pouthmany could explain with very simple words the risk, summarizing complex statistical analysis in understandable tables:




18-22 April 2016  

The team of NIHE is now analyzing data produced by the one year longitudinal study and two cross-sectional surveys conducted in human, in animal and in environment. Dr Bich-Tram Huynh expert in statistical analysis and interpretation of survey on infectious diseases at Institut Pasteur, participated in one week exchange of experience (18-22 April 2016) with NIHE to design a documented plan of analysis. Actually NIHE collaborated with many international experts throughout the project and so, strengthen its leadership position to conduct complex One Health project.




25 March 2016  

24 key persons who are influencing policy makers in Lao participated in a Working Group for discussing a reviewed version of the famous Rubber Manual. This manual has been updated by the NAFRI in the difficult context of surplus and prices falling steadily. This edited Manual will include a chapter on health and especially on the potential risk of vector-borne diseases for workers/tappers and nearby villagers. Recommendations result from the 3 year study conducted by the Institut Pasteur du Laos in the framework of ECOMORE project, on change of the vectors’ dynamic in mature and immature rubber plantations. This work should ensure that findings from research can be put into practice as a result of an effective Knowledge Translation process.




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.


ECOMORE at the FBLI meeting in Bangkok on 15th February 2016

FBLI at the ECOMORE meeting in Hanoi on 22snd December 2015




25-29 January 2016   

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.

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


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.





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  


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




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.





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.






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.

Several tens of villagers involved

A total of 24,920 female mosquitoes were collected

We identified a total of 123 different mosquito species

300 water bodies have been identified in the three study areas and more than 2000 mosquito larvae collected

3 years study and analysis of data

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:


Patient

Type of analysis

Results of analysis

Comments

Naso-pharyngeal swab

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.

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.

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

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   


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.




30 April 2015   


List of websites linked to ECOMORE:

http://ipmph.edu.vn/
http://cenpher.hsph.edu.vn/
http://vohun.org/
http://onehealth.org.vn/
http://vihema.gov.vn/
http://vcn.vnn.vn/

Already available

http://www.nihe.org.vn
http://vncdc.gov.vn
http://vfa.gov.vn
http://www.cucthuy.gov.vn
http://cucchannuoi.gov.vn
http://ipsard.gov.vn
http://www.rudec.gov.vn
http://www.ecohealthasia.net
http://vienthuy.gov.vn
http://www.cirad.fr
http://www.grease-network.org

In the course of being finalized.





30 January 2015   


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.





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.




01 August 2014   


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.




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  


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





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.