Case report: Managing multisystem inflammatory syndrome in children (MIS-C) in Lao People's Democratic Republic, a success story.

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is believed to be one of the most important life-threatening complications of COVID-19 infection among children. In any setting, early recognition, investigations, and management of MIS-C is crucial, but it is particularly difficult in resource-limited settings (RLS). This is the first case report of MIS-C in Lao People's Democratic Republic (Lao PDR) that was promptly recognized, treated, and resulted in full recovery with no known complications despite the resource limitations. Case presentation: A healthy 9-year-old boy presented to a central teaching hospital fulfilling the World Health's Organization's MIS-C criteria. The patient had never received a COVID-19 vaccine and had a history of COVID-19 contact. The diagnosis was based upon the history, changes in the patient's clinical status, and response to treatment and negative testing and response to treatment for alternative diagnoses. Despite management challenges relating to limited access to an intensive care bed and the high cost of IVIG; the patient received a full course of treatment and appropriate follow-up cares post discharge. There were several aspects to this case that may not hold true for other children in Lao PDR. First, the family lived in the capital city, close to the central hospitals. Second, the family was able to afford repeated visits to private clinics, and the cost of IVIG, and other treatments. Third, the physicians involved in his care promptly recognized a new diagnosis. Conclusions: MIS-C is a rare but life-threatening complication of COVID-19 infection among children. The management of MIS-C requires early recognition, investigations, and interventions which may be difficult to access, cost-prohibitive, and further increase demand on healthcare services that are already limited in RLS. Nevertheless, clinicians must consider means for improving access, determine which tests and interventions are worth the cost, and establishing local clinical guidelines for working within resource constraints while awaiting additional assistance from local and international public health systems. Additionally, using COVID-19 vaccination to prevent MIS-C and its complication for children may be cost-effective.

Factors contributing to a measles outbreak in a hard-to-reach rural village in Xaisomboun Province, Lao People's Democratic Republic.

Objective: An increase in measles cases was reported in the north-western of the Lao People's Democratic Republic beginning in January 2019, with outbreaks quickly spreading throughout the country. Following identification of two laboratory-confirmed cases in Xaisomboun Province, we conducted an outbreak investigation to identify factors contributing to the measles outbreak in hard-to-reach Village X. Methods: Active case-finding was undertaken at the provincial hospital and primary health care centre via a retrospective search through admission logbooks and house-to-house surveys in Village X and surrounding villages. Clinical samples were collected from suspected cases, and data were collected using a standard case investigation form. Vaccine coverage data were reviewed. Results: Of the 40 suspected measles cases with rash onset during 12 February-27 April 2019, 83% (33/40) resided in Village X and 98% (39/40) were of Hmong-Lu Mien ethnicity. Ages ranged from 22 days to 5 years, with 70% (28) aged < 24 months. Almost half of cases aged 9 to < 18 months (5/11) and 67% (8/12) of cases aged 324 months had received a measles-containing vaccine (MCV). Reported MCV coverage in Xaisomboun for children aged < 1 year in 2017-2018 was < 50%. In 55% (22/40) of cases, case notification was delayed by 36 days. The final case classification comprised 10% laboratory-confirmed, 20% clinically compatible, 60% epidemiologically linked and 10% non-cases. Discussion: This measles outbreak was likely associated with low immunization coverage, compounded by delays in reporting. Effective strategies are needed to address beliefs about and health literacy barriers to immunization and measles awareness. Such strategies may improve MCV coverage and early diagnosis, enabling timely public health interventions and reducing mortality and morbidity.

Rotavirus diarrhoea among children aged less than 5 years at Mahosot Hospital, Vientiane, Lao PDR.

Rotavirus is one of the most common causes of severe life-threatening diarrhoea in children leading to hospitalization especially in developing countries. At Mahosot Hospital in Vientiane, Lao PDR, children with diarrhoea underwent standard clinical evaluation and faecal specimen collection to estimate the burden of rotavirus hospitalizations and to determine rotavirus strain patterns among children aged less than 5 years old. From March 2005 to February 2007, a total of 1158 stool specimens were collected from children aged less than 5 years old hospitalized with acute diarrhoea. Rotavirus was identified in 624 (54%) of these patients. The G1P[8] strain was the most common genotype (35%), followed by G9P[8] (25%). These surveillance data suggest that improved prevention and control programs for rotavirus as well as other causes of diarrhoea are needed in Lao PDR.