Proteomic and immunomic analysis of Schistosoma mekongi egg proteins.

Schistosomiasis remains a global health problem. In the Mekong river basin, approximately 80,000 people are at risk of infection by Schistosoma mekongi. The parasite's eggs become entrapped in the host's organs and induce massive inflammation, contributing to the pathogenesis of schistosomiasis. In addition, egg antigens are important in circumoval precipitin tests (COPTs) and other diagnostic techniques. Little is known regarding the egg proteins of S. mekongi, and so we applied immunoblotting and mass spectrometry-based proteomic approaches to study these proteins and their antigenicity. A total of 360 unique proteins were identified in S. mekongi eggs using proteomic analyses. The major protein components of S. mekongi eggs were classified into several groups by functions, including proteins of unknown function, structural proteins, and regulators of transcription and translation. The most abundant proteins in S. mekongi eggs were antioxidant proteins, potentially reflecting the need to neutralize reactive oxidative species released from host immune cells. Immunomic analyses revealed that only DNA replication factor Cdt1 and heat shock protein 70 overlap between the proteins recognized by sera of infected mice and humans, illustrating the challenges of knowledge transfer from animal models to human patients. Forty-one immunoreactive protein bands were recognized by either mouse or patient sera. Phosphoglycerate kinase, fructose-1,6-bisphosphate aldolase and elongation factor 1 appeared to be interesting immunogens of S. mekongi eggs as these proteins were recognized by polyclonal IgMs and IgGs in patient sera. Our findings provide new information on the protein composition of S. mekongi eggs as well as the beginnings of a S. mekongi immunogen dataset. These data may help us better understand the pathology of schistosomiasis as well as natural antibody responses against S. mekongi egg proteins, both of which may be useful in including S. mekongi to other schistosoma diagnostic, vaccine and immunotherapy development.

What do the occurrences of migratory fishes in the Upper Mekong mean?

This paper examines the recent appearance of four migratory species in the Upper Mekong: Dasyatis laosensis, Anguilla bicolor, Anguilla marmorata, and Chitala ornata. Since 2006 these species have been continually sampled in an area below Jinghong Dam in Xishuangbanna, China. This region is far beyond their historical upstream distribution, and the reasons for these appearances and their subsequent impact on river ecosystem are considered.

The flood pulse as the underlying driver of vegetation in the largest wetland and fishery of the Mekong Basin.

The Tonle Sap is the largest wetland in Southeast Asia and one of the world's most productive inland fisheries. The Mekong River inundates the Tonle Sap every year, shaping a mosaic of natural and agricultural habitats. Ongoing hydropower development, however, will dampen the flood pulse that maintains the Tonle Sap. This study established the current underlying relationship among hydrology, vegetation, and human use. We found that vegetation is strongly influenced by flood duration; however, this relationship was heavily distorted by fire, grazing, and rice cultivation. The expected flood pulse alteration will result in higher water levels during the dry season, permanently inundating existing forests. The reduction of the maximum flood extent will facilitate agricultural expansion into natural habitats. This study is the most comprehensive field survey of the Tonle Sap to date, and it provides fundamental knowledge needed to understand the underlying processes that maintain this important wetland.

Determinants affecting the well-being of people in the Greater Mekong Subregion countries.

The aim of this research was to examine the determinants/factors affecting the well-being of the Thai and Lao people, and the factors that predict the well-being of those respective peoples. Eight hundred and sixty participants were recruited from three major regions of Thailand and Laos and were selected using multistage random sampling. A self-reported well-being questionnaire was developed using the theoretical framework of Maslow's hierarchy of needs, and a questionnaire assessing their perceptions/attitudes concerning the factors affecting their well-being was administered. The major findings were the following: (i) the factors affecting the well-being and the self-reported well-being of Thais and Laotians were significantly different; and (ii) the factors predicting the well-being of Thais included the living and working environment and the availability of medical information and technology at their hospitals. On the other hand, one of the factors predicting the well-being of Laotians was their attitudes toward their society and its cultural values. A comprehensive and system-wide review of mental-health policy planning to improve the well-being of people in Thailand and Laos in accordance with those predicted factors is recommended.

Absence of knockdown resistance suggests metabolic resistance in the main malaria vectors of the Mekong region.

BACKGROUND: As insecticide resistance may jeopardize the successful malaria control programmes in the Mekong region, a large investigation was previously conducted in the Mekong countries to assess the susceptibility of the main malaria vectors against DDT and pyrethroid insecticides. It showed that the main vector, Anopheles epiroticus, was highly pyrethroid-resistant in the Mekong delta, whereas Anopheles minimus sensu lato was pyrethroid-resistant in northern Vietnam. Anopheles dirus sensu stricto showed possible resistance to type II pyrethroids in central Vietnam. Anopheles subpictus was DDT- and pyrethroid-resistant in the Mekong Delta. The present study intends to explore the resistance mechanisms involved. METHODS: By use of molecular assays and biochemical assays the presence of the two major insecticide resistance mechanisms, knockdown and metabolic resistance, were assessed in the main malaria vectors of the Mekong region. RESULTS: Two FRET/MCA assays and one PCR-RFLP were developed to screen a large number of Anopheles populations from the Mekong region for the presence of knockdown resistance (kdr), but no kdr mutation was observed in any of the study species. Biochemical assays suggest an esterase mediated pyrethroid detoxification in An. epiroticus and An. subpictus of the Mekong delta. The DDT resistance in An. subpictus might be conferred to a high GST activity. The pyrethroid resistance in An. minimus s.l. is possibly associated with increased detoxification by esterases and P450 monooxygenases. CONCLUSION: As different metabolic enzyme systems might be responsible for the pyrethroid and DDT resistance in the main vectors, each species may have a different response to alternative insecticides, which might complicate the malaria vector control in the Mekong region.

Let's 'cut to the chase' on malaria elimination in the Greater Mekong Subregion.

The Greater Mekong Subregion has made remarkable progress towards eliminating malaria in recent years, but efforts are now faltering in some areas. The development of tools to control forest-based transmission is taking too long and efforts to control malaria among high-risk mobile people are failing. If countries are to meet their elimination targets and prevent the spread of multidrug-resistant falciparum malaria, urgent and radical changes will be required. This commentary proposes changes in the approach to the development and roll-out of new tools as well as changes to the management of elimination efforts targeting transmission in forests and forest-farms.

The insecticide resistance status of malaria vectors in the Mekong region.

BACKGROUND: Knowledge on insecticide resistance in target species is a basic requirement to guide insecticide use in malaria control programmes. Malaria transmission in the Mekong region is mainly concentrated in forested areas along the country borders, so that decisions on insecticide use should ideally be made at regional level. Consequently, cross-country monitoring of insecticide resistance is indispensable to acquire comparable baseline data on insecticide resistance. METHODS: A network for the monitoring of insecticide resistance, MALVECASIA, was set up in the Mekong region in order to assess the insecticide resistance status of the major malaria vectors in Cambodia, Laos, Thailand, and Vietnam. From 2003 till 2005, bioassays were performed on adult mosquitoes using the standard WHO susceptibility test with diagnostic concentrations of permethrin 0.75% and DDT 4%. Additional tests were done with pyrethroid insecticides applied by the different national malaria control programmes. RESULTS: Anopheles dirus s.s., the main vector in forested malaria foci, was susceptible to permethrin. However, in central Vietnam, it showed possible resistance to type II pyrethroids. In the Mekong delta, Anopheles epiroticus was highly resistant to all pyrethroid insecticides tested. It was susceptible to DDT, except near Ho Chi Minh City where it showed possible DDT resistance. In Vietnam, pyrethroid susceptible and tolerant Anopheles minimus s.l. populations were found, whereas An. minimus s.l. from Cambodia, Laos and Thailand were susceptible. Only two An. minimus s.l. populations showed DDT tolerance. Anopheles vagus was found resistant to DDT and to several pyrethroids in Vietnam and Cambodia. CONCLUSION: This is the first large scale, cross-country survey of insecticide resistance in Anopheles species in the Mekong Region. A unique baseline data on insecticide resistance for the Mekong region is now available, which enables the follow-up of trends in susceptibility status in the region and which will serve as the basis for further resistance management. Large differences in insecticide resistance status were observed among species and countries. In Vietnam, insecticide resistance was mainly observed in low or transmission-free areas, hence an immediate change of malaria vector control strategy is not required. Though, resistance management is important because the risk of migration of mosquitoes carrying resistance genes from non-endemic to endemic areas. Moreover, trends in resistance status should be carefully monitored and the impact of existing vector control tools on resistant populations should be assessed.

The Access to Antenatal and Postpartum Care Services of Migrant Workers in the Greater Mekong Subregion: The Role of Acculturative Stress and Social Support.

The objective of this paper is to determine whether social support and acculturative stress were related to obtaining antenatal and postpartum care for pregnant female migrants, as well as access to health care for migrant children. The study utilized data of 987 migrant workers in Thailand who originated from hill tribes and mountain communities in Myanmar and Cambodia. Regression analysis showed that the language barrier, a crucial factor behind acculturative stress, adversely influenced access to maternal care. Social support reduced the impact of acculturative stress. Migrants with support are more likely to access health care. Based on the Multidimensional Scale of Perceived Social Support, more sources of support either from friends, family members, or other supporters who are significant could increase health care access. Besides friends and family, the support from the Migrant Health Worker Program and Migrant Health Volunteer Program allowed the formal health sector to utilize the informal social networks to improve care for migrants.

The complete mitochondrial DNA sequence of the Mekong giant catfish (Pangasianodon gigas), and the phylogenetic relationships among Siluriformes.

The Mekong giant catfish (Pangasianodon gigas) is the largest scale-less freshwater fish of the world, and a critically endangered species. We determined the complete nucleotide sequence (16,533 bp) of the mitochondrial genome of the Mekong giant catfish, and conducted phylogenetic analyses based on mitochondrial protein (the combined amino acid sequences of all 13 mitochondrial protein coding genes) and rRNA (the combined nucleotide sequences of mitochondrial 12S and 16S rRNA genes) data sets in order to further clarify the relative phylogenetic position of P. gigas, and to recover phylogenetic relationships among 15 out of the 33 families of Siluriformes. Phylogenetic analyses (maximum parsimony, minimum evolution, maximum likelihood, Bayesian inference) of the protein data set were congruent with a basal split of the order into Loricarioidei and Siluroidei, and supported a closer relationship of the Mekong giant catfish (family Pangasiidae) to Siluridae than to Bagridae. The rRNA-based Bayesian phylogeny recovered Callichthyidae as the sister group of all other analyzed non-diplomystid catfish families, rendering Loricarioidei paraphyletic. In addition, Loricariidae were recovered as paraphyletic due to the inclusion of Astroblepidae. However, none of the two relationships received bootstrap support in the maximum parsimony, minimum evolution, and maximum likelihood analyses, and should be interpreted with caution. The derived position of Cetopsidae within Siluroidei, the sister group relationship of Pseudopimelodidae and Pimelodidae, and a close relationship of Doradidae and Auchenipteridae to the exclusion of Mochokidae were strongly supported. Pangasiidae was placed as a single lineage without clear affinities.

Program issues in delivering targeted STI services through the public sector in the Greater Mekong region.

This review discusses the delivery of targeted STI services for both female sex workers (FSWs) and other high-risk groups through the public sector in the Greater Mekong region. Vaginal discharge algorithms for the general population are also discussed. High STI rates that justify targeted interventions have been reported recently amongst FSW in Cambodia, Lao PDR and Vietnam. Such interventions need to take into account the different patterns of sex work in the three countries. In Cambodia, there are large numbers of brothel-based FSWs although this pattern is changing as more brothels are closed by the authorities. In Lao PDR, services targeted towards reducing the burden of HIV/STI in FSW/service women are probably best delivered through NGO-led clinics. In Vietnam, commune based district health centers appear to offer better services for FSW than STI clinics. Male clients of FSW are an important group to target, but reaching such a heterogeneous population is difficult. Provision of quality STI drugs to those places where men present with STI symptoms should be a priority. The optimal way to manage STIs in FSWs is still unclear in this region. Clinical and laboratory specialists are keen to promote laboratory tests for STIs but there is an over reliance on direct staining techniques. In areas with high STI prevalences, periodic presumptive treatment could offer an effective option to reduce STI levels in high-risk groups until syndromic management algorithms are evaluated for local use. Social patterns of sex work are changing continually and require close monitoring in the future so that services can be adapted to these changes.

Designing river flows to improve food security futures in the Lower Mekong Basin.

Rivers provide unrivaled opportunity for clean energy via hydropower, but little is known about the potential impact of dam-building on the food security these rivers provide. In tropical rivers, rainfall drives a periodic flood pulse fueling fish production and delivering nutrition to more than 150 million people worldwide. Hydropower will modulate this flood pulse, thereby threatening food security. We identified variance components of the Mekong River flood pulse that predict yield in one of the largest freshwater fisheries in the world. We used these variance components to design an algorithm for a managed hydrograph to explore future yields. This algorithm mimics attributes of discharge variance that drive fishery yield: prolonged low flows followed by a short flood pulse. Designed flows increased yield by a factor of 3.7 relative to historical hydrology. Managing desired components of discharge variance will lead to greater efficiency in the Lower Mekong Basin food system.

The role of domestic dogs in the transmission of zoonotic helminthes in a rural area of Mekong river basin.

Dogs have been bred since ancient times for companionship, hunting, protection, shepherding and other human activities. Some canine helminth parasites can cause significant clinical diseases in humans as Opisthorchis viverrini causing cholangiocarcinoma in Southeast Asian Countries. In this study, socio-cultural questionnaire, canine parasitological analysis, necropsy, parasite molecular confirmation and dog roaming data were evaluated in Savannakhet, Lao-PDR, a typical Mekong Basin area. Dog owners comprised 48.8% of the studied population, with 61.2% owning one dog, 25.1% 2 dogs, 8.5% 3 dogs and 1.8% owning more than 4 dogs. Data from GPS logger attached to dogs showed they walked from 1.4 to 13.3 km per day, covering an area of 3356.38m2 average, with a routine of accessing water sources. Thirteen zoonotic helminth species were observed. Causative agents of visceral and cutaneous larva migrans occurred in 44.1% and 70% of the samples respectively. Spirometra erinaceieuropaei was detected in 44.1% of samples. Importantly, O. viverrini was found in 8.8% of samples. Besides the known importance of dogs in the transmission of Ancylostoma spp., Toxocara spp. and S. erinaceieuropaei, the observed roaming pattern of dogs confirmed it as an important host perpetuating O. viverrini in endemic areas; their routine access to waterbodies may spread O. viverrini eggs in a favorable environment for the fluke development, facilitating the infection of fishes, and consequently infecting humans living in the same ecosystem. Therefore, parasitic NTDs control programs in humans should be done in parallel with parasite control in animals, especially dogs, in the Mekong River basin area.

Schistosomiasis in the Mekong region: epidemiology and phylogeography.

An account is given of progress made over the last 20 years in the study of Mekong schistosomiasis, causative agent Schistosoma mekongi (Trematoda: Digenea). Emphasis is given to the discussion of work concerning the origin and subsequent dispersal of S. mekongi and related taxa, including relevant snails. The role of such phylogeographical data in schistosomiasis control and the prediction of areas at risk is examined. New palaeogeographical models are reviewed in relation to traditional explanations for the biogeographic deployment of Southeast Asian Schistosoma and their intermediate hosts. The demographics and molecular ecology of Neotricula aperta (Gastropoda: Pomatiopsidae), the snail host of S. mekongi, are reviewed with particular reference to new models for the life cycle of this species and their importance in snail control. The use of population genetic data in the limitation of N. aperta populations is evaluated and strategies suggested for schistosomiasis control efforts directed against the intermediate host. Developments in the taxonomy of N. aperta, and related taxa, and changes in nomenclature are covered. The direction of future investigations into the problem of Mekong schistosomiasis is also discussed.

International population movements and public health in the Mekong region: an overview of some issues concerning mapping.

Geographical Information Systems (GIS) have many important applications in local, regional and global situation analysis, especially in relation to planning and implementation thereof. The complex issues involved in population movement between neighboring countries offer a good example of the assistance that GIS applications can provide to transborder public health planning. The Greater Mekong Subregion (GMS) involves 6 countries, among which greatly increased population movement is occurring for a variety of reasons. This movement carries with it high risks of disease dispersal and thus presents a major challenge to disease control. This paper addresses the questions of sources, access and presentation of a wide variety of data that is needed by planners to develop more appropriate cooperative approaches to public health management in the GMS, with the main focus on contributions from mapping.

Mekong Basin Disease Surveillance (MBDS): a trust-based network.

The Mekong Basin Disease Surveillance (MBDS) network was formally established in 2001 through a Memorandum of Understanding signed by six Ministers of Health of the countries in the Greater Mekong sub-region: Cambodia, China (Yunnan and Guangxi), Lao PDR, Myanmar, Thailand and Vietnam. The main areas of focus of the network are to: i) improve cross-border infectious disease outbreak investigation and response by sharing surveillance data and best practices in disease recognition and reporting, and by jointly responding to outbreaks; ii) develop expertise in epidemiological surveillance across the countries; and iii) enhance communication between the countries. Comprised of senior health officials, epidemiologists, health practitioners, and other professionals, the MBDS has grown and matured over the years into an entity based on mutual trust that can be sustained into the future. Other regions have started emulating the network's pioneering work. In this paper, we describe the development of MBDS, the way in which it operates today, and some of its achievements. We present key challenges the network has faced and lessons its members have learned about how to develop sufficient trust for health and other professionals to alert each other to disease threats across national borders and thereby more effectively combat these threats.

A one health perspective on HPAI H5N1 in the Greater Mekong sub-region.

Highly pathogenic avian influenza H5N1 has been a global concern for almost 10 years since its epidemic emergence in South-east Asia in 2003/2004. Despite large investment of resources into the region, the infection has not been eradicated and continues to result in outbreaks in poultry and a small number of human fatalities. This review synthesizes the knowledge base generated by a vast number of research activities conducted in the region and beyond, and adopts an interdisciplinary perspective consistent with the one health paradigm towards analysing the problem and formulating possible policy solutions. A key outcome of the work has been the need to integrate socio-economic and anthropological dimensions with any disease control and prevention activities traditionally informed by primarily epidemiological, virological and pathological attributes of the infection in poultry and wild waterbirds. Recommendations at a broad conceptual level are presented that acknowledge the diversity in the region with respect to livestock production, as well as the changing nature of the risk landscape as a consequence of the rapid economic development which some of the countries in the Greater Mekong sub-region are currently undergoing, as well as their strong trade links with China as the major economic power in East Asia.