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The WHO South-East Asia Region (SEAR), with its high population density, is recognised by epidemiologists as a critical reservoir for the emergence and global dissemination of novel influenza strains, making it a potential epicentre for future influenza pandemics. Despite this significant risk, most SEAR countries lack comprehensive seasonal influenza vaccination policies, resulting in low vaccine uptake across the region. This review analysed the latest WHO National Influenza Programme factsheets from the 11 SEAR member states and supplemented this with extensive manual literature searches using electronic databases and government websites. As of October 2022, only three countries-India, Bhutan and Thailand-had established seasonal influenza vaccination policies. Among them, Bhutan and Thailand have policies that cover all five WHO-recommended high-risk groups. While national influenza surveillance systems are in place across SEAR, only India and the Democratic People's Republic of Korea claim full population coverage. Influenza vaccine production capacity is limited to Bangladesh, India and Indonesia. The region's varied climatic conditions and insufficient local data have further obscured the true burden of influenza. Thailand offers a successful model for other countries in the region, beginning with the most vulnerable groups and gradually expanding coverage. To effectively develop and implement national influenza vaccination policies, SEAR countries must close the evidence gap by strengthening surveillance systems to provide accurate, timely data and prioritise context-specific research, leverage existing vaccine infrastructure, enhance public education and finally engage with local and international stakeholders to establish strong international cooperation to support these efforts and improve pandemic preparedness., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Purpose: Plasmodium inui is a type of malaria that is endemic in simian populations in Southeast Asia, primarily infecting nonhuman primates, one of which is Macaca fascicularis, or the long-tailed macaque. Plasmodium inui, a malaria parasite endemic to simian populations in Southeast Asia, predominantly targets non-human primates. The escalating rates of deforestation and urban expansion, which facilitate increased interactions between humans and primates, have intensified concerns regarding its zoonotic potential. Despite receiving comparatively less scholarly attention than P. knowlesi, P. inui is distinguished by its substantial strain diversity and capacity to infect various macaque species. This review investigates the potential for crossspecies transmission of P. inui to humans, concentrating on the regions of Indonesia and Southeast Asia., Methods: We evaluate the ecological and epidemiological determinants influencing the distribution and transmission dynamics of P. inui among macaques while also considering the implications for human infection based on a literature review obtained from PubMed, Google Scholar, and Scopus., Results: Although no documented human cases have emerged in Indonesia, cases in humans have only been detected in Malaysia and Thailand, the review underscores the zoonotic risk associated with P. inui, drawing comparisons to other simian malaria species that have successfully infiltrated human populations. The lack of systematic surveillance and detailed molecular investigations concerning P. inui in these regions accentuates the imperative for further scholarly inquiry., Conclusion: This review emphasizes the need for ongoing monitoring and research to enhance the understanding of zoonotic threats associated with P. inui, and informs future public health initiatives in Southeast Asia through a comprehensive evaluation of the genetic diversity of the parasite and its potential implications for public health., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests. The authors declared that have no conflicts of interest with others. Ethical Approval: Not applicable., (© 2025. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Left main (LM) percutaneous coronary intervention (PCI) has expanded rapidly in the past decade, with up to fourfold increase annually. Recent trials found that intravascular imaging (IVI)-guided LM PCI resulted in lower risks of cardiac death and stent failure due to suboptimal PCI compared to angiography-guided PCI. IVI usage has increased in recent years; however, its utilization remains variable across regions and is still incredibly low in developing countries. Furthermore, to date, there is no data about LM size in the Southeast Asian population. This study aims to determine the mean external elastic membrane (EEM) diameter, cross-sectional area (CSA) of LM, and its predictor. This is a cross-sectional observational study on 100 patients with coronary artery disease (CAD) who underwent IVUS-guided PCI with a pullback to LM in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from January 2020 until December 2022. Linear regression was used to determine the predictors of LM size. There were 100 segments of LM. LM's mean EEM diameter and CSA were 5.02 ± 0.43 mm and 19.93 ± 3.48 mm 2 . Body surface area (BSA) is an independent predictor of EEM diameter and CSA with a positive linear relationship (p 0.001 and p 0.0001). Hypertension is an independent predictor of EEM diameter with a positive linear relationship (p 0.034). The linear equation to predict EEM diameter and CSA were (2.741 + 1.272BSA(m 2 ) + 0.165 hypertension (yes)) and (2.745 + 9.601BSA(m 2 )), respectively. The LM coronary artery size of the Southeast Asian population was comparable with the previous studies. BSA and hypertension are independent predictors of EEM diameter, with BSA being stronger than hypertension. Neither sex nor other cardiovascular risk factors affect the LM size. The knowledge of coronary artery size will help the clinician have a reference for intervention, especially when no intravascular imaging is available., Competing Interests: Declarations. Conflicts of interest: All authors declare no conflict of interest related to this study. Informed consent: Informed consent was obtained from each participant involved in this study. Research involving human and animal participants: This study was conducted under the 1964 Declaration of Helsinki and its subsequent amendments. We do not involve animals in our study., (© 2024. Springer Nature Japan KK, part of Springer Nature.)

Background/purpose(s): Dengue virus (DENV) is one of the most troublesome mosquito-borne infectious viruses in tropical and subtropical zones. People with secondary/multiple DENV infections are at an increased risk of developing severe dengue. Both monocytes and T cells are known to play important roles in the immune response against DENV. However, the function of monocytes and T cells in individuals with potentially multiple exposures to DENV is rarely reported., Method: In the present study, we performed a functional analysis of monocytes and T cells from people with previous DENV infection and DENV-naïve people that stimulated with DENV2 ex vivo., Results: Our preliminary analysis indicated that the response of monocytes and T cells to DENV2 restimulation was comparable between DENV-exposed and DENV-naïve individuals. Furthermore, the cytokine expression profiles in monocytes from both naïve individuals and previously DENV-exposed subjects were similar after DENV2 stimulation. In addition, it was observed that the function of T cells was also equivalent when monocytes were present as antigen-presenting cells for dengue antigen, NS3, in terms of cell proliferation, interferon-gamma (IFNγ) secretion, and memory response., Conclusions: Based on the results, it was observed that previously DENV-exposed monocytes and T cells seemed to be anergic during DENV reinfection. However, whether the impaired response of monocytes and T cells against DENV in people with a history of previous DENV infection leads to severe dengue upon secondary infection in endemic areas requires further investigation., Competing Interests: Declaration of competing interest The authors have declared no conflicts of interest in the article., (Copyright © 2024. Published by Elsevier B.V.)

Background: Respiratory syncytial virus (RSV) is an important cause of bronchiolitis and pneumonia in children globally. This study aimed to incorporate new data to update estimates of RSV burden in children through 5 years of age in Western Pacific and Southeast Asia Regions., Methods: A systematic review and meta-analysis were conducted to examine the proportion of RSV among cases of respiratory tract infection (RTI) in children in Western Pacific and Southeast Asia Regions using random effects models. Studies were eligible if they met the following inclusion criteria: (1) observational studies such as cohort and cross-sectional studies; (2) studies on humans; (3) studies on patients with RTI or influenza-like illness (ILI); (4) studies reporting incidence or proportion of RSV infection among respiratory related illness; and (5) studies on children aged 5 years or less., Findings: A total of 4403 studies were identified from an initial search. After screening titles, abstracts, and full-text review, a total of 173 studies that met predefined eligibility criteria were included in the analysis. The overall proportion of RSV infections among all ARTIs was 18.7% (95% CI: 16.0%-21.5%), whereas the proportion of RSV infections among LRTIs was 28.7% (95% CI: 2.6%-30.3%) in children in Western Pacific and Southeast Asia Regions between 1970 and 2020. The proportion of RSV infections peaked in the 1980s at 33.4% (95% CI: 19.8%-48.5%), having increased from 10.6% (95% CI: 2.9%-22.2%) in the 1970s. It then showed a decreasing trend, with 28.9% (95% CI: 18.8%-40.3%) in the 1990s, 24.5% (95% CI: 22.3%-26.8%) in the 2000s, and 20.1% (95% CI: 17.8%-22.5%) in the 2010s. By country, Myanmar (50.0%; 95% CI, 47.5%-52.4%) and New Zealand (45.3%; 95% CI, 37.1%-53.7%) had the highest proportion during the overall time period, followed by Bhutan (45.2%; 95% CI, 36.4%-54.3%), Lao PDR (41.0%; 95% CI, 36.2%-46.0%), and Vietnam (35.5%; 95% CI, 19.3%-53.6%)., Interpretation: Substantial RSV-associated disease burden occurs in children in Western Pacific and Southeast Asia Regions. Our findings provide new and important evidence of the need for RSV prevention in Western Pacific and Southeast Asia countries. They could inform future preventive policy., (© 2025 The Author(s). Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Dengue, a climate-sensitive mosquito-borne viral disease, is endemic in many tropical and subtropical areas, with Southeast Asia bearing the highest burden. In China, dengue epidemics are primarily influenced by imported cases from Southeast Asia. By integrating monthly maximum temperature and precipitation from Southeast Asia and local provinces in China, we aim to build models to predict dengue incidence in high-risk areas of China. From 2005-2023, a total of 117,839 dengue cases were reported, with Guangdong and Yunnan provinces accounting for 57.8 % and 26.2 % of cases, respectively. Large outbreaks occurred in 2014 (47,052 cases), 2019 (22,688 cases), and 2023 (19,936 cases), with peak incidence typically observed from August to October. The number of provinces reporting cases and outbreaks gradually linearly increased from 10 and 0 in 2005 to a peak of 30 and 11 in 2019, respectively, before declining in 2021 and 2022, then rebounding to 29 and 8 in 2023. Of the 13,927 imported cases, 91.3 % were from Southeast Asia, primarily from Myanmar (41.3 %) and Cambodia (27.3 %). Predictive models for dengue incidence in Guangdong Province showed high adjusted R 2 values (0.993-0.999) and deviance explained values (0.975-0.989). The models from Cambodia, Thailand, and the Philippines outperformed the other six models. In Yunnan, adjusted R 2 values and deviance explained values ranged from 0.81-0.84 and 0.90-0.92, respectively, with models from Laos, Myanmar and Cambodia achieving the best predictive performance. Incorporating meteorological data from Southeast Asia along with local data from China, we were able to develop accurate predictive models for dengue incidence in the high-risk areas of China., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

East, South, and Southeast Asia (together referred to as Southeastern Asia hereafter) have been recognized as critical areas fuelling the global circulation of seasonal influenza. However, the seasonal influenza migration network within Southeastern Asia remains unclear, including how pandemic-related disruptions altered this network. We leveraged genetic, epidemiological, and airline travel data between 2007-2023 to characterise the dispersal patterns of influenza A/H3N2 and B/Victoria viruses both out of and within Southeastern Asia, including during perturbations by the 2009 A/H1N1 and COVID-19 pandemics. During the COVID-19 pandemic, consistent autumn-winter movement waves from Southeastern Asia to temperate regions were interrupted for both subtype/lineages, however the A/H1N1 pandemic only disrupted A/H3N2 spread. We find a higher persistence of A/H3N2 than B/Victoria circulation in Southeastern Asia and identify distinct pandemic-related disruptions in A/H3N2 antigenic evolution between two pandemics, compared to interpandemic levels; similar patterns are observed in B/Victoria using genetic distance. The internal movement structure within Southeastern Asia markedly diverged during the COVID-19 pandemic season, and to a lesser extent, during the 2009 A/H1N1 pandemic season. Our findings provide insights into the heterogeneous impact of two distinct pandemic-related disruptions on influenza circulation, which can help anticipate the effects of future pandemics and potential mitigation strategies on influenza dynamics., Competing Interests: Competing interests: H.Y. received research funding from Sanofi Pasteur, GlaxoSmithKline, Yichang HEC Changjiang, Shanghai Roche Pharmaceutical Company, and SINOVAC Biotech Ltd. None of these funds are related to this work. All other authors declare no competing interests., (© 2025. The Author(s).)

Burkholderia pseudomallei (Bp), causing melioidosis, is becoming a major global public health concern. It is highly endemic in Southeast Asia (SEA) and Northern Australia and is persisting beyond the established areas of endemicity. This study aimed to determine the environmental variables that would predict the most suitable ecological niche for this pathogenic bacterium in SEA by maximum entropy (MaxEnt) modeling. Systematic review and meta-analysis of data for melioidosis were obtained from public databases such as PubMed, Harmonized World Soil (HWSD) and WorldClim. The potential map showing the environmental layers was processed by ArcGIS, and the prediction for the probability of habitat suitability using MaxEnt software (version 3·4·4) and ENMeval R-based modeling tools was utilized to generate the distribution map with the best-fit model. Both bioclimatic and edaphic predictors were found to be the most important niche-determining environmental variables affecting the geographical distribution of Bp. The highest probability of suitability was predicted in areas with mean temperature of the wettest quarter at ≥26°C, annual precipitation of <2300 mm and Acrisol soil type. Combining those significantly influential variables, our predictive modeling generated a potential distribution map showing the concentration of areas and its location names with high suitability for Bp presence. The predicted distribution of Bp is extensive in the mainland part of SEA. This can be used to draw appropriate measures to safeguard public health and address the true disease burden of melioidosis in the region under the current climate scenario., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Abrantes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Aims: To provide insight on targeted approach to mitigate diabetes burden, this research aims to analyze the trends of prevalence, mortality, and disability attributable to risk factors for type 2 diabetes mellitus (T2DM) from 1990 to 2019 in the Southeast Asia (SEA) region., Methods and Results: Age-standardized rates for prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) from 1990 to 2019 from the Global Burden of Disease Study were assessed. DALYs-related risk factors were estimated using multivariate regression analysis and estimated annual percentage change (EAPC) was calculated to quantify the temporal trends. Over 30 years, the SEA region experienced a 59.5 % rise in T2DM ASPR, 17.33 % in ASMR, and 26.97 % in DALYs. The T2DM DALYs rate per 100,000 population was 1002.91 (885.23-1132.40) in 1990 and 1273.42 (1103.92-1452.41) in 2019, increasing by 27 %. Cambodia and Indonesia had the highest worsening in three parameters, while most significant improvement in all parameters was observed in Singapore. The curvilinear association was demonstrated between ASMR and DALYs to Gross Domestic Product (GDP) per capita. Prominent risk factors affecting DALYs increase were high fasting plasma glucose (FPG) (p < 0.001), high body mass index (BMI) (p < 0.001), tobacco use (p = 0.012), and household pollution (p = 0.03). Men were more affected than women., Conclusion: The burden of T2DM in the SEA region has increased significantly during the 30-year period. Policymakers should address high BMI, high FPG, smoking, and air pollution to regulate T2DM burden in SEA., Competing Interests: Declaration of competing interest The authors declare none of completing interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Diabetes is one of the most pressing health issues in the Southeast Asian region, and hypertension has been commonly reported as a comorbidity in adults with diabetes. This systematic review aimed to synthesize evidence on the prevalence and management of hypertension in adults with diabetes in Southeast Asian countries. A literature search was conducted in Ovid MEDLINE and Embase Classic + Embase from database inception until March 15, 2024. Studies were included if (1) they were conducted in Southeast Asian countries, (2) the study populations were adults with diabetes, and (3) there was information related to hypertension or blood pressure (BP) in the study results. Of the 7486 abstracts found, 90 studies qualified for this review. Most studies reported a hypertension prevalence of 70% or higher (ranging from 29.4% to 93.4%). Despite this high prevalence, a substantial proportion of these populations did not receive adequate BP control, with most studies indicating a control rate of less than 40%. There was limited evidence on the prescription of antihypertensive therapies and medication adherence. There was a lack of studies from 4 of the 11 countries in the region. This review highlights that BP control in adults with diabetes remains a significant challenge in Southeast Asia. Given the ongoing epidemiological transition, and the increasing older population in this region who are likely to accumulate multiple chronic conditions complicating medication strategies, this review highlights the urgent need to improve BP management in those with diabetes., (© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

This narrative review describes pneumococcal serotype prevalence for invasive disease and carriage and antibiotic resistance among specimens collected from children in countries across South and Southeast Asia from 2012 to 2024. Literature search retrieved 326 articles; 96 were included. The prevalence of pneumococcal serotypes varied geographically and over time after introduction of pneumococcal conjugate vaccine. Serotypes common in both pneumococcal carriage and disease were 6A, 6B, 14, 15B/15C, 19F, and 23F; serotypes 1, 3, 5, 19A, 15A, 10A, and 35B were also common in disease. Most of these serotypes are included in the 13-valent and 10-valent PCV. Carriage and disease isolates remained generally highly susceptible to vancomycin (mostly 100%) and levofloxacin (mostly >97%). These findings indicate that vaccine-preventable serotypes contribute significantly to pneumococcal disease burden in children in South and Southeast Asia. Consistency of national immunization programs with World Health Organization recommendations may reduce rates of pneumococcal disease in this region.

Background: Mental illnesses contribute to a significant burden of disease in low- and middle- income countries (LMICs). Understanding risk factors for poor mental health is essential to reducing the burden, and for preventative measures to be implemented. The role of socioeconomic position (SEP) in poorer mental health is well established in high income countries, but less is known in LMICs. This study aimed to identify and synthesise epidemiological evidence for the associations between SEP and depression and suicidal ideation in LMICs in Southeast Asia, and to describe the strength and direction of any associations identified., Methods: This systematic review identified evidence by searching four databases in February 2023 (Medline, Embase, PsycInfo and Web of Science), grey literature and reference searching of included papers. Papers were included if they were based in a Southeast Asian LMIC general or hospital populations (= 16 years of age) and explored at least one measure of SEP in association with depression or suicidal ideation. Study quality was assessed using the Joanna Briggs Institute tool. A meta-analysis and narrative synthesis were performed., Results: Fifty-nine papers from six out of nine Southeast Asian LMICs were identified, with education the most commonly examined measure of SEP. Several papers explored more than one measure of SEP. Around half of the papers were rated as higher quality. Meta-analyses of education (OR: 1.87, 95% CI: 1.49-2.35) and working status (OR: 1.30, 95% CI: 0.99-1.71) provided evidence of lower levels of education and not being employed being associated with higher odds of depression. Consistent associations between lower SEP and higher odds of depression were also found for financial difficulty and subjective economic status. Three papers used suicidal ideation as their outcome, and there was some evidence of an association with lower SEP and higher ideation., Conclusions: Evidence indicates that lower SEP is associated with higher likelihood of depression, whereas for suicidal ideation, the evidence available is insufficient to reach a conclusion. The lack of longitudinal studies prevents the temporal nature of these associations being established., Systematic Review Registration: PROSPERO: CRD42023410444., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Thalassemia, an inherited hemoglobin synthesis disorder, imposes a significant health burden in Asian regions with high prevalence. Detailed patterns and trends of the disease across countries and territories within these regions remain underexplored. Our study focuses on the disease burden indices of thalassemia within the four GBD-defined Asian regions and the twenty-five included countries and territories. It provides insights into the gender-age distribution, temporal changes, and economic aspects of the thalassemia burden., Methods: Data on thalassemia prevalence, incidence, mortality, and Disability-Adjusted Life Years (DALYs) were extracted from the Global Burden of Disease (GBD) 2021 study for South, East, Southeast, and high-income Asia regions, encompassing the relevant countries and territories from 1990 to 2021. The Average Annual Percent Change (AAPC) in age-standardized rates of thalassemia was determined to assess temporal trends. Age-gender cohort proportions were considered. The economic aspect of the disease burden and frontier analysis were evaluated using the GBD Socio-Demographic Index and Global Health Expenditure data., Results: Southeast Asia exhibited notably high age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate among the four studied Asian regions in 2021. The East Asia region had recorded the highest age-standardized incidence rate (ASIR). A general decline in disease burden indices across the four regions from 1990 to 2021 was evident, with the exception of ASIR in Southeast Asia. The ASMR was highest among pediatric population under five years old, with a significant male preponderance. An unusual increase in ASMR was detected among females of childbearing age and the elderly within the studied region. Further analysis had identified six high-burden countries and territories, particularly those with low-middle Socio-Demographic Index (SDI) rankings and limited health expenditure., Conclusion: Although the overall burden of thalassemia has decreased substantially, the disease burden was influenced by gender, age, geography, temporal trends, and economic factors in distinct manners. Based on the current SDI, many countries and regions still have greater improvement potential in the disease burden. There is a necessity for enhanced attention and resource allocation, particularly in low-middle and low SDI countries, with an emphasis on policies that promote early diagnosis and comprehensive care., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Nipah virus (NiV), a highly lethal virus in humans, circulates in Pteropus bats throughout South and Southeast Asia. Difficulty in obtaining viral genomes from bats means we have a poor understanding of NiV diversity., Methods: We develop phylogenetic approaches applied to the most comprehensive collection of genomes to date (N = 257, 175 from bats, 73 from humans) from 6 countries over 22 years (1999-2020). We divide the 4 major NiV sublineages into 15 genetic clusters. Using Approximate Bayesian Computation fit to a spatial signature of viral diversity, we estimate the presence and the average size of genetic clusters per area., Results: We find that, within any bat roost, there are an average of 2.4 co-circulating genetic clusters, rising to 5.5 clusters at areas of 1500-2000 km2. We estimate that each genetic cluster occupies an average area of 1.3 million km2 (95% confidence interval [CI], .6-2.3 million km2), with 14 clusters in an area of 100 000 km2 (95% CI, 6-24 km2). In the few sites in Bangladesh and Cambodia where genomic surveillance has been concentrated, we estimate that most clusters have been identified, but only approximately 15% of overall NiV diversity has been uncovered., Conclusions: Our findings are consistent with entrenched co-circulation of distinct lineages, even within roosts, coupled with slow migration over larger spatial scales., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: Multiple studies have reported the profound influence of various climate factors on dengue fever infection, while the effects of joint exposure to warm and wet environment, a condition favouring dengue vectors, on disease transmission were less evaluated. This study aims to investigate the impact of various compound temperature, rainfall, and relative humidity exposures on dengue fever infection in the South and Southeast Asia regions., Methods: Weekly dengue fever surveillance data from 2012 to 2020 were collected from 48 locations in four countries named Singapore (1 location), Sri Lanka (15 locations), Malaysia (9 locations), and Thailand (23 locations, with 11 locations having different study periods). The distributed lag non-linear models were built to assess the impacts of compound temperature, rainfall, and relative humidity exposures on dengue fever infection risks., Results: A total of 1,359,993 dengue fever cases were reported with 9.33%, 24.02%, 48.73%, and 17.91% cases contributed by Singapore, Sri Lanka, Malaysia, and Thailand, respectively. Compared to non-warm-non-wet, compound warm-wet was associated with an increased dengue risk (RR:1.32, 95% CI:1.21-1.44). Compared to moderate temperature-humidity, warm-wet environment was also associated with an increase in dengue risk (RR:1.37, 95% CI:1.22-1.55). In comparison to weeks with moderate temperature-rainfall, warm-wet weeks was linked to an elevated dengue risk (RR:1.39, 95% CI:1.27-1.52), whereas cold-dry weather would significantly reduce the infection risk (RR:0.70, 95% CI:0.62-0.80). Modification effects showed that the hot effect on dengue infection was more pronounced under higher humidity, while the impact of rainfall increased with warmer temperature., Conclusion: Warm-wet events were associated with an increased dengue fever risk, while the infection risk would decline in cold-dry environment, and modification effects exist among exposures. Findings from this study highlight the importance of considering joint temperature, humidity, and rainfall dependency of dengue fever infection in disease prevention and control., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Adults who are elderly or who have underlying health conditions are at particular risk of Streptococcus pneumoniae infections, and pneumococcal vaccines are available. Nonetheless, only national recommendations from countries of North America and Europe have been previously reviewed in the literature., Methods: Consequently, we aimed to collate national guidelines for adult pneumococcal immunization across the 161 countries within the World Health Organization (WHO) regions-the Americas (except Canada and the United States of America), Africa, Eastern Mediterranean, South East Asia, and Western Pacific-from country-level official websites and documents, from the WHO portal, and from direct contact with public health officials, pertinent governmental sources, or local vaccination experts., Results: For 40.4 % (65/161) of these countries, adult pneumococcal vaccination information was available. Among these 65 with available information, 63.1 % (41/65) include adult pneumococcal vaccination in the national vaccination schedule: 58.5 % (24/41) recommend vaccination both for older adults and for risk groups, while 9.8 % (4/41) recommend it only for older adults, and 31.7 % (13/41) only for risk groups. Of note, among the 13 national risk based-only recommendations, 30.8 % (4/13) are age-dependent and strictly reserved for older adults. The regions where age-based adult pneumococcal vaccination recommendations seem to predominate are South East Asia, Western Pacific, and the Americas. The threshold for age-based pneumococcal vaccination recommendations varies between 50 and 70 years of age. The Americas has the highest proportion of countries with risk-based recommendations. Three-quarters of these countries include PCV and PPV23 in the recommendations, most often given in sequence., Conclusions: Less than half of countries of the five WHO regions analyzed have accessible information on adult pneumococcal vaccination, and only 25.5 % (41/161) of all countries reviewed recommend adult pneumococcal immunization within the national vaccination schedule. Policymakers should consider extending pneumococcal vaccination guidelines-adapted to national priorities for adult healthcare-as based on local age demographics and risk factor predominance., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mark A Fletcher reports financial support was provided by Pfizer. Jelena Vojicic reports financial support was provided by Pfizer. Derek Daigle reports financial support was provided by Pfizer. Bulent Taysi reports financial support was provided by Pfizer. Hammam Haridy reports financial support was provided by Pfizer. Maria Gabriela Abalos reports financial support was provided by Pfizer. Graciela del Carmen Morales reports financial support was provided by Pfizer. Mark A Fletcher reports a relationship with Pfizer that includes: equity or stocks. Jelena Vojicic reports a relationship with Pfizer that includes: equity or stocks. Derek Daigle reports a relationship with Pfizer that includes: equity or stocks. Hammam Haridy reports a relationship with Pfizer that includes: equity or stocks. Maria Gabriela Abalos reports a relationship with Pfizer that includes: equity or stocks. Graciela del Carmen Morales reports a relationship with Pfizer that includes: equity or stocks. MAF, JV, DD, BT, HH, MGA, and GdCM are employees of Pfizer Inc. and may hold stock or stock options. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. MAF, JV, DD, BT, HH, MGA, and GdCM are employees of Pfizer Inc. and may hold stock or stock options., (Copyright © 2024 Pfizer, Inc. Published by Elsevier Ltd.. All rights reserved.)

The coronavirus disease 2019 pandemic highlighted the necessity and limitations of scientific collaboration and equitable and effective international research partnerships. The spread of mosquito-borne diseases (MBDs) presents severe public health challenges, particularly in Southeast Asia. Addressing these threats requires establishing regional priorities, bridging research gaps, and strengthening long-term international collaboration. We propose a practical approach to multifaceted perspectives to enhance collaboration across Asia. This study examines MBD-related scientific publications from nine Southeast Asian countries between January 2017 and June 2024, utilizing bibliometric analysis and data visualization to identify research trends, research capacities, key institutions, and international collaborative partners. Thailand and Singapore led the dengue research, followed by Malaysia and Indonesia. Vietnam and the Philippines demonstrated moderate research capabilities, whereas Cambodia, Laos, and Myanmar had lower capacities. Relationships with high-income countries drove international collaboration, whereas intra-regional collaboration in Southeast Asia increased. Furthermore, we identified directions for cooperative opportunities between South Korea and other Southeast Asian countries by analyzing their relative research capacities for infectious MBDs. We propose a practical approach to bridge research-capacity gaps and strengthen collaboration between low- and middle-income countries. These findings provide fundamental information for developing future infectious-disease-response strategies and international-collaboration research partnerships and facilitate the implementation of effective global public health preparedness policies and evidence-based decision-making, such as knowledge-transfer and resource-sharing., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Livestock is a strategic part of the small-farm economy in Southeast Asia's society, providing food income, clothing, fertilizer, and draught power. However, incidences or outbreaks of transboundary animal diseases (TADs) are due to converging factors such as the natural hazards' aftermath, climate change, deforestation, urban growth, changing production conditions, and market chains. Therefore, this affects productivity and impacts farmers' livelihoods with small holdings. The literature review was carried out to understand the current situation of TADs in Southeast Asia, identifying knowledge gaps to provide actions for disease control and prevention in the region. We have attempted to summarise the scientific literature in English on the prevalence data of TADs in Southeast Asia between 2011 and March 2022. Relatively few studies evaluated the distribution of TAD, where most of the studies focused on diseases that are important for international trade, such as avian influenza (AI), African swine fever (ASF), classical swine fever (CSF), foot-and-mouth disease (FMD) and Newcastle disease (ND). Traditional production systems have received little attention in such studies as they belonged to mainly smallholders. The outbreaks of ASF and lumpy skin disease (LSD) in 2019 resulted in increased research activity between 2019-2022, while the other TADs were ignored in this period. For new emerging TADs diseases such as ASF and LSD, there is only information about the first detection without prevalence information. Therefore, further epidemiological investigations are necessary to reduce the gaps in disease surveillance reporting systems and support the prevention and reduction of further outbreaks.

As COVID-19 has shown, pandemics and outbreaks of emerging infections such as Zika, Nipah, monkeypox and antimicrobial-resistant pathogens, especially emerging zoonotic diseases, continue to occur and may even be increasing in Southeast Asia. In addition, these infections often result from environmental changes and human behaviour. Overall, public health surveillance to identify gaps in the literature and early warning signs are essential in this region. A systematic review investigated the prevalence of emerging zoonotic diseases over 11 years from 2011 to 2022 in Southeast Asia to understand the status of emerging zoonotic diseases, as well as to provide necessary actions for disease control and prevention in the region. During the 2011-2022 period, studies on pigs, poultry, ruminants, companion animals and wildlife in Southeast Asia were reviewed thoroughly to assess the quality of reporting items for inclusion in the systematic review. The review was performed on 26 studies of pigs, 6 studies of poultry, 21 studies of ruminants, 28 studies of companion animals and 25 studies of wildlife in Southeast Asia, which provide a snapshot of the prevalence of the emerging zoonotic disease across the country. The findings from the review showed that emerging zoonotic diseases were prevalent across the region and identified a few zoonotic diseases associated with poultry, mainly stemming from Cambodia and Vietnam, as high priority in Southeast Asia. Clinical relevance : Appropriate prevention and control measures should be taken to mitigate the emerging zoonotic diseases in Southeast Asia.

In June 2020, Lumpy Skin Disease Virus (LSDV) was first discovered in Guangdong, China. Whole-genome sequencing and evolutionary analysis indicate that this strain represents a novel recombinant vaccine strain. Our investigation has identified regions affected by LSD outbreaks prior to 2024, revealing widespread prevalence of LSDV across East Asia and Southeast Asia. Subsequent analysis of the physical and chemical characteristics of the strain revealed LSDV's resilience to high temperatures, varying pH levels, humidity, UV radiation, and light exposure. Among the tested disinfectants, potassium persulfate, glutaraldehyde, and benzalkonium bromide have demonstrated the most potent virucidal efficacy against LSDV while maintaining high safety profiles. Utilizing the Syrian hamster model, infection with this strain has resulted in the formation of skin nodules and testicular damage, providing valuable insights into the pathogenesis of LSDV. In conclusion, the comprehensive experimental data presented herein serve as a cornerstone for advancing biosafety protocols, facilitating effective prevention and control strategies, and fostering the development of small animal model for LSDV., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

In the UK, multidisciplinary teamwork for patients with hip fracture has been shown to reduce mortality and improves health-related quality of life for patients, while also reducing hospital bed days and associated healthcare costs. However, despite rapidly increasing numbers of fragility fractures, multidisciplinary shared care is rare in low- and middle-income countries around the world. The HIPCARE trial will test the introduction of multidisciplinary care pathways in five low- and middle-income countries in South and Southeast Asia, with the aim to improve patients' quality of life and reduce healthcare costs., Competing Interests: M. L. Costa's employer, the University of Oxford, receives research grant funding from the National Institutes of Health and Care Research and the Wellcome Trust for research into musculoskeletal trauma. R. Ivers's institution received the NIHR award for research for the Research and Innovation for Global Health Transformation (RIGHT) Programme: NIHR203194 - HIPCARE: a cluster randomised controlled trial with embedded process evaluation. I. A. Tabu's institution received funding from the UK-NIHR Global Heath Research Fund. I. A. Tabu also received honoraria for presentations about osteoporosis and fragility fracture management from Zuellig-Amgen Philippines, unrelated to this article, and is the Regionalization Committee Chair of the Fragility Fracture Network and President of the Philippines Fragility Fracture Network., (© 2024 Tabu et al.)

Patients with diabetes are susceptible to acute kidney injury (AKI) as compared to counterparts without diabetes. However, data on the long-term clinical outcome of AKI specifically in people with diabetes are still scarce. We sought to study risk factors for and adverse cardio-renal outcomes of AKI in multi-ethnic Southeast Asian people with type 2 diabetes. 1684 participants with type 2 diabetes from a regional hospital were followed an average of 4.2 (SD 2.0) years. Risks for end stage kidney disease (ESKD), major adverse cardiovascular events (MACE) and all-cause death after AKI were assessed by survival analyses. 219 participants experienced at least one AKI episode. Age, cardiovascular disease history, minor ethnicity, diuretics usage, HbA1c, baseline eGFR and albuminuria independently predicted risk for AKI with good discrimination. Compared to those without AKI, participants with any AKI episode had a significantly high risk for ESKD, MACE and all-cause death after adjustment for multiple risk factors including baseline eGFR and albuminuria. Even AKI defined by a mild serum creatinine elevation (0.3 mg/dL) was independently associated with a significantly high risk for premature death. Therefore, individuals with diabetes and any episode of AKI deserve intensive surveillance for cardio-renal dysfunction., (© 2024. The Author(s).)

Visceral leishmaniasis (VL) caused by L. donovani in South-East Asian endemic countries including India, Nepal and Bangladesh has been the primary focus of the ongoing VL elimination program. With a major reduction in VL cases resulting from the elimination program during the last two decades, the efforts are now focused on the challenges posed by potential reservoirs within the asymptomatic cases, HIV-co-infection VL cases and Post Kala-azar Dermal Leishmaniasis (PKDL) cases that continue to sustain the parasite transmission cycle in known and newer endemic zones. This article brings attention to a new potential parasite reservoir in the form of atypical cutaneous leishmaniasis (ACL) cases caused by novel L. donovani genetic variants. L. donovani mediated ACL is an emerging phenomenon in recent endemic sites that now justify a need for implementing molecular surveillance tools to identify region-specific L. donovani variants with dermotropic capabilities and potential to revert to visceral disease. A timely detection of novel ACL causing L. donovani genetic lineages in South-East Asian endemic regions is necessary to halt the spread of ACL and is potentially crucial for the sustainability of the advances made by the VL elimination., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jain, Sangma, Parida, Negi, Negi, Matlashewski and Lypaczewski.)

Introduction: This study provides an epidemiological description of cancer in the lip, oral cavity, and oropharynx in the South and South-East Asia region., Methods: The number of new cases and deaths was extracted from the GLOBOCAN 2020 and the CI5 series. We present age-standardized incidence and mortality rates per 100,000 inhabitants. To assess temporal trends, we estimated the annual percent change., Results: The incidence rates (ASR) for lip and oral cavity cancer in South and South-East Asia were highest in Taiwan (30.2), Sri Lanka (16.5), India (14.8), and Pakistan (13.2) among males. For oropharyngeal cancer, the highest rates were found in Taiwan (4.7), Bangladesh, Sri Lanka, and India (4.3, 2.9, and 2.6, respectively). Incidence rates were consistently higher in males compared to females. Overall, trends in lip and oral cavity cancer incidence were either stable or decreasing in most of the populations evaluated. In India, an increase in rates among males contrasted with a decline among females over the study period., Conclusion: Incidence and mortality rates of oral cavity cancer in South and South-East Asia are among the highest globally. Our results suggest an optimistic trend of reduction in oral cavity rates in the region, despite an increase in rates among Indian males., (© 2024 Wiley Periodicals LLC.)

Introduction: Respiratory syncytial virus (RSV) is a common, highly contagious pathogen and a leading cause of serious illness among infants and older adults. While existing scientific evidence has predominantly focused on the epidemiology and disease burden of RSV in infants, data in older adults remain limited in some countries, including those in Southeast Asia (SEA) and the Middle East and North Africa (MENA) region. Here, we outline the key challenges for understanding the burden of RSV in older adults in SEA and the MENA region and we propose opportunities for improving understanding and eventually reducing the impact of RSV., Main Findings and Conclusions: A key challenge identified by the expert group, particularly in older adults, is a lack of awareness (among healthcare professionals, policy makers, and the public) of RSV burden and the associated risks for severe outcomes. This is often confounded by the complexities of underdiagnosis, surveillance limitations, and comorbidities. To address these issues, we suggest medical education initiatives for physicians in SEA and the MENA region to better understand the need to protect older adults from RSV, and encourage more widespread routine testing to better understand the burden of RSV. We also recommend surveillance studies in these regions to provide comprehensive and accurate epidemiological data on RSV in older adults. Finally, in the absence of current surveillance data in these regions, we propose extrapolating existing global data and local pediatric data to inform the likely burden of RSV in older adults. A graphical abstract is available with this article., (© 2024. GlaxoSmithKline Biologicals SA 2024.)

We reviewed and analyzed the existing data on vibriosis in Southeast Asia to better understand its burden and prevalent causal agents. We searched PubMed, Web of Science, and EMBASE for studies published between January 2000 and April 2024. A random-effects meta-analysis was used to estimate the pooled isolation rate of non-cholera Vibrio species. Among the 1385 retrieved studies, 22 met the inclusion criteria for the systematic review and 11 were included in the meta-analysis. The pooled isolation rate of non-cholera Vibrio species among diarrheal patients was 5.0 %. Most species that caused vibriosis included V. parahaemolyticus, V. mimicus, V. vulnificus, non-O1/non-O139 V. cholerae, V. fluvialis, and V. alginolyticus. Pooled isolation rate of V. parahaemolyticus and non-O1 V. cholerae were 7.0, and 4.0, respectively. The prevalence of vibriosis in Southeast Asia is non-negligible. Public health strategies should prioritize enhanced surveillance, and clinicians should consider vibriosis in diarrheal patients with seafood consumption history., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Predictions on the future prevalence of myopia suggest one of the Global Burden of Disease regions will develop an epidemic like in East Asia and Singapore in Southeast Asia. This paper analyses the available evidence on prevalence of myopia in this region, concluding that the bulk of the evidence suggests that the prevalence of myopia at the end of schooling is still modest, although two papers suggest that in young adults in Thailand and Indonesia, the prevalence of myopia may be approaching levels typical of the epidemic of myopia. It also analyses an indicator of expected years of education at school entry, as well as current educational levels of adults, using data from the calculation of the UN Human Development Index. It then analyses the results obtained by the countries of the Southeast Asian region in the PISA international surveys of student achievement. Neither of these educational indicators suggests an impending epidemic of myopia. There is a need for more data to clarify this uncertainty. It is suggested that future collection of data concentrate on determining the prevalence of myopia in young adults finishing their schooling. Even methodology as simple as determining levels of lowered visual acuity in senior school students should be sufficient to resolve the uncertainty. This group provides a sound basis for the prediction of future levels of myopia in the adult population, and avoids the impact of the high levels of myopia and high myopia associated with cataract development that occur in much of Southeast Asia., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Stunting or growth failure is a health problem faced by the world today, especially in developing countries, including Southeast Asia. The Southeast Asian region accounts for more than a quarter of the number of children experiencing stunting worldwide. In addition to impacting children's growth and development, mortality and morbidity rates will also affect the economies and productivity of countries in the future., Research Objectives: This scoping review aimed to systematically map the research that has been conducted in this area and identify existing gaps in knowledge related to risk factors for stunting in the Southeast Asian region., Methode: A scoping review was conducted using three databases: Scopus, PubMed, Embase, and one academic publisher, Taylor & Francis. The keywords used were "Children," "Risk Factors," "Stunting.". The inclusion criteria were as follows: (1) studies with a population of children under five years of age, (2) studies addressing risk factors for stunting, (3) studies conducted in countries in the Southeast Asian region, (4) studies of all research types, and (5) articles published in English. Of the 2252 articles, 54 met the inclusion criteria., Result: In this review, the risk factors associated with stunting in children under five years of age in Southeast Asia were categorized into direct, underlying, and basic factors. Direct factors include parental and child characteristics, food intake, and health. Underlying factors include the practice of providing food and access to health services and care. The basic factors causing stunting are environmental, household health, and socioeconomic factors., Conclusions: This scoping review determined the risk factors for childhood stunting in Southeast Asia, such as attributes of the child, traits of the parent, the amount of food the child consumes, the health of the child, feeding habits, access to health services, household and environmental health, and socioeconomic status. These factors are interrelated and affect each other. Therefore, it is necessary to pay attention to these factors to reduce the risk of stunting among underfives in Southeast Asia., (© 2024. The Author(s).)

Background: Dental caries is a common chronic oral disease, posing a serious public health issue. By analyzing large datasets, machine learning shows potential in addressing this problem. This study employs bibliometric analysis to explore emerging topics, collaborations, key authors, and research trends in Southeast Asia related to the application of machine learning in dental caries management., Methods: A comprehensive selection using the Scopus database to obtain relevant research, covering publications from inception to July 2024 was done. We employed the Bibliometric approaches, including co-authorship networks, yearly publishing trends, institutional and national partnerships, keyword co-occurrence analysis, and citation analysis, for the collected data. To explore the visualization and network analysis, we employed the tools such as VOSviewer and Bibliometrix in R package., Results: The final bibliometric analysis included 246 papers. We found that Malaysia became the top contributor with 59 publications, followed by Indonesia (37) and Thailand (29). Malaysia had the highest Multiple Country Publications (MCP) ratio at 0.407. Top institutions including the Universiti Sains Malaysia led with 39 articles, followed by Chiang Mai University (36) and the National University of Singapore (30) became the leader. Co-authorship analysis using VOSviewer revealed six distinct clusters. A total of 1220 scholars contributed to these publications. The top 10 keywords, including 'human' and 'dental caries,' indicated research hotspots., Conclusion: We found growing evidence of machine learning applications to address dental caries in Southeast Asia. The bibliometric analysis highlights key authors, collaborative networks, and emerging topics, revealing research trends since 2014. This study underscores the importance of bibliometric analysis in tackling this public health issue., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Hasan F et al.)

Introduction: The South and Southeast Asia region has the second-highest number of people living with HIV globally. Despite progress in reducing HIV incidence and AIDS-related deaths, the region still has a long way to go in achieving the Joint United Nations Programme on HIV and AIDS (UNAIDS) 95-95-95 HIV testing, treatment and viral suppression targets. HIV self-testing (HIVST) is recommended by the World Health Organization as an additional approach to HIV testing. This paper provides a commentary on the implementation status, benefits, barriers and recommendations for HIVST implementation in South and Southeast Asia. Additionally, it presents perspectives from HIV testing service experts from 11 countries in the region to put forth recommendations to accelerate the implementation of HIVST in South and Southeast Asia., Discussion: There is uneven progress in national HIVST policy development and implementation across the region. HIVST, as an additional testing approach, can help to enhance testing coverage, frequency and demand for follow-up HIV services among key populations. Key factors influencing the implementation and scale-up of HIVST include the degree of awareness of HIVST among general and key populations, the development and implementation of supportive national HIVST policies and the availability of public funding for HIVST. To address barriers and leverage enablers to HIVST implementation, generating evidence on cost-effectiveness and budget impact, developing multisectoral partnerships for market shaping, promoting differentiated and decentralized delivery models, and optimizing linkage to further testing and care are recommended., Conclusions: It is crucial to accelerate the implementation and scale-up of HIVST to differentiate and decentralize the delivery of HIV testing services in South and Southeast Asian countries. Sharing experiences among country experts is vital to foster the adoption of best practices and facilitate the trial-and-error process of HIVST implementation. Such collaborative approaches can help South and Southeast Asian countries attain the UNAIDS 95-95-95 targets, especially the first 95 on HIV diagnosis, and play a significant role in ending the global AIDS epidemic., (© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)

Lumpy skin disease (LSD) poses a significant threat to animal welfare and leads to economic losses in affected countries. LSD outbreaks may also impact trade and regional relationships. South and Southeast Asia, with its dense livestock population and intricate trade networks, are susceptible to LSD outbreaks. Indonesia confirmed its first LSD cases in March 2022, leading to substantial livestock losses by August 2023. Australia, an important player in the global beef industry, faced trade disruptions due to LSD concerns raised by Indonesia and Malaysia, claims that were refuted by Australian authorities. The dispute highlights the need for good surveillance. EPIWATCH®, employing artificial intelligence, provides real-time outbreak signals, and spatial analysis can identify LSD hotspots, leading to timely interventions. This study uses data collected by the EPIWATCH® open-source disease surveillance system at the University of New South Wales in 2022 and 2023 and compares it for timeliness and completeness with data available on the World Animal Health Information System (WAHIS). We found more timely reports of LSD outbreaks in EPIWATCH® compared to WAHIS. In conclusion, open-source surveillance tools like EPIWATCH® can provide timely alerts of disease emergence, such as LSD outbreaks in South and Southeast Asia, which can supplement formal reporting systems., (© 2024 The Author(s). Australian Veterinary Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Veterinary Association.)

Objective: The objective of this systematic review is to synthesize studies on the economic burden and economic impact of non-communicable diseases in the World Health Organization South-East Asia Region (WHO SEAR) countries., Introduction: WHO SEAR countries represent 8.6% of the world's population, and 75% of all deaths in this region are attributable to non-communicable diseases. In addition, there is a pattern of low government spending on health in SEAR countries, leading to a high proportion of health financing by patients, risking impoverishment for households., Inclusion Criteria: We will consider observational (cross-sectional, cohort, and case-control) and interventional (either single arm or comparative) studies that report the economic burden (direct and indirect costs, out-of-pocket expenditure) and economic impact (catastrophic health expenditure, hardship financing, impoverishment, and gross domestic product impact) at the individual, household, and/or country levels. This includes government surveys, surveillance, and secondary data analyses for one or more non-communicable diseases prevalent in the WHO SEAR., Methods: We will conduct a comprehensive search for relevant studies in databases, including MEDLINE (PubMed), Embase (Ovid), Scopus, Web of Science, Google Scholar, and gray literature, with no date limits. Two reviewers will independently screen titles and abstracts, followed by full-text screening. Included studies will be critically appraised for quality. Data will be extracted accordingly and, if possible, random effects meta-analyses will be conducted on the pooled data for resource utilization and costs (including burden and impact), presenting the degree of variation between studies. The characteristics and results of the included studies will be narratively summarized with accompanying tables., Review Registration: PROSPERO CRD42023421302., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 JBI.)

Competing Interests: We declare no competing interests. SW is the Regional Director for the WHO South-East Asia Regional Office. ID is Regional Advisor, Human Resources for Health, for the WHO South-East Asia Regional Office.

The Monocled Cobra (Naja kaouthia), a category one medically significant snake from the Elapidae family, inflicts severe envenomation in South and Southeast Asian countries. N. kaouthia is distributed throughout the eastern and northeastern parts of India, Nepal, Bangladesh, Myanmar, Thailand, Vietnam, Malaysia, and southwestern China. Envenomation by N. kaouthia is a medical emergency, and the primary clinical symptoms are neurotoxicity and localized tissue destruction. Unfortunately, data on the actual magnitude of N. kaouthia envenomation is scarce due to poor record keeping, lack of diagnostic kits, and region-wise well-coordinated epidemiological surveys. The present review highlights the diversity in the composition of N. Kaouthia venom (NKV) across various geographical regions, as revealed through biochemical and proteomic analyses. The qualitative and quantitative differences in the toxin isoforms result in differences in lethality and pathophysiological manifestation that may limit the effectiveness of antivenom therapy. Studies on commercial polyvalent antivenom (PAV) effectiveness against distinct NKV samples have revealed varying toxicity and enzymatic activity neutralization. Additionally, the identification of snake venom's poorly immunogenic toxins by mass spectrometry, quantification of venom-specific antibodies, and implications for antivenom therapy against snakebites are highlighted. Future directions involve clinical studies on NK envenomation where the snake is frequently encountered and the correlation of this data with NKV composition in that region. For more efficient and superior hospital management of NK envenomation, research should enhance the current immunization procedure to boost the development of antibodies against less immunogenic venom components of this snake., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Hirakjyoti Kakati reports financial support was provided by Indian Council of Medical Research. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Cardiovascular disease (CVD) risk factors tend to cluster and interact multiplicatively and have been incorporated into risk equations such as the Framingham risk score, which can reasonably predict CVD over short- and long-term periods. Beyond risk factor levels at a single time point, recent evidence demonstrated that risk trajectories are differentially related to CVD risk. However, factors associated with suboptimal control or unstable CVD risk trajectories are not yet established., Objective: This study aims to examine factors associated with CVD risk trajectories in a semirural, multiethnic community-dwelling population., Methods: Data on demographic, socioeconomic, lifestyle, mental health, and cardiovascular factors were measured at baseline (2013) and during follow-up (2018) of the South East Asia Community Observatory cohort. The 10-year CVD risk change transition was computed. The trajectory patterns identified were improved; remained unchanged in low, moderate, or high CVD risk clusters; and worsened CVD risk trajectories. Multivariable regression analyses were used to examine the association between risk factors and changes in Framingham risk score and predicted CVD risk trajectory patterns with adjustments for concurrent risk factors., Results: Of the 6599 multiethnic community-dwelling individuals (n=3954, 59.92% female participants and n=2645, 40.08% male participants; mean age 55.3, SD 10.6 years), CVD risk increased over time in 33.37% (n=2202) of the sample population, while 24.38% (n=1609 remained in the high-risk trajectory pattern, which was reflected by the increased prevalence of all major CVD risk factors over the 5-year follow-up. Meanwhile, sex-specific prevalence data indicate that 21.44% (n=567) of male and 41.35% (n=1635) of female participants experienced an increase in CVD risk. However, a stark sex difference was observed in those remaining in the high CVD risk cluster, with 45.1% (n=1193) male participants and 10.52% (n=416) female participants. Regarding specific CVD risk factors, male participants exhibited a higher percentage increase in the prevalence of hypertension, antihypertensive medication use, smoking, and obesity, while female participants showed a higher prevalence of diabetes. Further regression analyses identified that Malay compared to Chinese (P<.001) and Indian (P=.04) ethnicity, nonmarried status (P<.001), full-time employment (P<.001), and depressive symptoms (P=.04) were all significantly associated with increased CVD risk scores. In addition, lower educational levels and frequently having meals from outside were significantly associated to higher odds of both worsening and remaining in high CVD risk trajectories., Conclusions: Sociodemographics and mental health were found to be differently associated with CVD risk trajectories, warranting future research to disentangle the role of psychosocial disparities in CVD. Our findings carry public health implications, suggesting that the rise in major risk factors along with psychosocial disparities could potentially elevate CVD risk among individuals in underserved settings. More prevention efforts that continuously monitor CVD risk and consider changes in risk factors among vulnerable populations should be emphasized., (©Hamimatunnisa Johar, Chiew Way Ang, Roshidi Ismail, Zaid Kassim, Tin Tin Su. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 26.09.2024.)

The incidence of inflammatory bowel disease (IBD) has been increasing in Southeast Asia (SEA) in tandem with its economic growth and urbanization over the past 2 decades. Specific characteristics of IBD in SEA are similar to East Asia and the West, such as the declining ratio of ulcerative colitis to Crohn's disease. However, exceptionally low familial aggregation is seen. Smoking is also not a common risk factor in patients with Crohn's disease. The incidence of perianal disease is higher in SEA than in Australia and is comparable to the West. In a multiracial population, such as Singapore and Malaysia, Indians have the highest incidence and prevalence rates, which are likely to be due to important putative mutations. For instance, a higher frequency of the NOD2 predisposing mutation SNP5 and IBD risk allele IGR2198a and IGR2092a were found in Indians. Although differences in the genetic constitution play an important role in the epidemiology and prognosis of IBD in SEA, the emergence of this disease offers a unique opportunity to identify potential exposomes that contribute to its pathogenesis., (© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: Chronic kidney disease (CKD) etiology varies greatly between developed and developing countries. In addition, differences in underlying pathogenesis and therapeutic options affect the progression towards advanced-CKD. This meta-analysis aims to identify the etiology of advanced-CKD in Southeast Asia., Methods: A systematic search in four electronic-databases and complementary search on national kidney registries and repository libraries was conducted until July 20, 2023. The risk of bias was assessed using Newcastle-Ottawa Scale for observational studies and Version-2 of Cochrane for intervention studies. A random-effects model was used to estimate pooled prevalence. The protocol is registered in the International Prospective Register of Systematic Reviews PROSPERO; Registration ID:CRD42022300786., Results: We analyzed 81 studies involving 32,834 subjects. The pooled prevalence of advanced-CKD etiologies are diabetic kidney disease (DKD) 29.2% (95%CI 23.88-34.78), glomerulonephritis 20.0% (95%CI 16.84-23.38), hypertension 16.8% (95%CI 14.05-19.70), other 8.6% (95%CI 6.97-10.47), unknown 7.5% (95%CI 4.32-11.50), and polycystic kidney disease 0.7% (95%CI 0.40-1.16). We found a significant increase in DKD prevalence from 21% (9.2%, 95%CI 0.00-33.01) to 30% (95%CI 24.59-35.97) before and after the year 2000. Among upper-middle-income and high-income countries, DKD is the most prevalent (26.8%, 95%CI 21.42-32.60 and 38.9%, 95%CI 29.33-48.79, respectively), while glomerulonephritis is common in lower-middle-income countries (33.8%, 95%CI 15.62-54.81)., Conclusion: The leading cause of advanced-CKD in Southeast Asia is DKD, with a substantial proportion of glomerulonephritis. An efficient screening program targeting high-risk populations (diabetes mellitus and glomerulonephritis) is needed, with the aim to delay CKD progression., (© 2024. The Author(s).)

Purpose: Visceral leishmaniasis (VL) is caused by an intracellular parasite that is transmitted to humans by sandfly bites. It is prevalent throughout Asia, Africa, the Americas, and the Mediterranean area, where 147 million people are at risk of contracting the illness. The manifestation of heterotrophic illness relies on both Leishmania implicated and the host's immunological response, ranging from asymptomatic to severe leishmaniasis with potentially lethal effects., Method: We reviewed the literature (published till 31st December 2023) on the worldwide situation of leishmaniasis, standard and novel detection techniques, and traditional and modern treatment strategies and endeavors to eliminate VL. Moreover, epidemiological data was collected from the World Health Organization's publicly available databases. GraphPad Prism Version 8 was used to analyze and produce figures based on the epidemiological data., Results: Diagnosis of parasites in tissues or serology is commonly employed. Diagnosis by identifying parasite DNA using molecular techniques is becoming more popular. Despite recent findings of L. donovani resistance to pentavalent antimoniate medications, it continues to be the cornerstone in the medical management of VL. Amphotericin B and its lipid formulations, injectable paromomycin, and oral miltefosine are among the new therapy options being researched. The number of reported VL cases has reduced remarkably over the last decade due to human interventions made to eliminate VL. Particularly countries from the South East Asian region have experienced momentous progress in reducing VL cases and eliminating this disease from this region. Owing to the robust elimination programs, countries such as Bangladesh has eliminated VL as a public health concern. India and Nepal are on the verge of its elimination., Conclusion: Rapid diagnosis, effective and inexpensive treatment, simple access to newly discovered medications, appropriate vector control, and a well-designed vaccine are all required for the elimination of this disease burden in impoverished areas of the globe., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Malaria continues to be a global public health problem although it has been eliminated from many countries. Sri Lanka and China are two countries that recently achieved malaria elimination status, and many countries in Southeast Asia are currently in the pipeline for achieving the same goal by 2030. However, Plasmodium knowlesi, a non-human primate malaria parasite continues to pose a threat to public health in this region, infecting many humans in all countries in Southeast Asia except for Timor-Leste. Besides, other non-human primate malaria parasite such as Plasmodium cynomolgi and Plasmodium inui are infecting humans in the region. The non-human primates, the long-tailed and pig-tailed macaques which harbour these parasites are now increasingly prevalent in farms and forest fringes close by to the villages. Additionally, the Anopheles mosquitoes belonging to the Lecuosphyrus Group are also present in these areas which makes them ideal for transmitting the non-human primate malaria parasites. With changing landscape and deforestation, non-human primate malaria parasites will affect more humans in the coming years with the elimination of human malaria. Perhaps due to loss of immunity, more humans will be infected as currently being demonstrated in Malaysia. Thus, control measures need to be instituted rapidly to achieve the malaria elimination status by 2030. However, the zoonotic origin of the parasite and the changes of the vectors behaviour to early biting seems to be the stumbling block to the malaria elimination efforts in this region. In this review, we discuss the challenges faced in malaria elimination due to deforestation and the serious threat posed by non-human primate malaria parasites., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Breast cancer progression varies across molecular subtypes, and treatment options for human epidermal growth factor receptor 2 (HER2)-low expression tumors are limited compared with those of HER2 overexpression tumors. Comprehensive information regarding the epidemiology and clinical outcomes of metastatic HER2-low expression breast cancer in a Southeast Asian population is lacking., Methods: This retrospective cohort study was performed to analyze data from patients with de novo advanced breast cancer, including HER2 expression, tumor stage, and metastatic pattern. Statistical analyses, including chi-square tests and survival analyses, were used to compare HER2-low expression and HER2-negative groups., Results: Of the 491 patients, 21.2% had HER2-low expression, 30% had HER2 overexpression, and 50% had HER2-negative expression. Among the hormone receptor (HR)-positive patients, 34% had HER2-low expression; in the triple-negative patients, the HER2-low incidence was 20.6%. No significant differences in clinical characteristics between HER2-low and HER2-negative groups were observed, except for more HR-positive patients in the HER2-low group. HER2-low patients had a longer overall survival (OS) than HER2-negative patients (43 v 23 months; hazard ratio, 0.7; P < .001), especially in HR-positive patients. After adjusting for HR status, HER2-low patients maintained improved outcomes. HR-positive HER2-low patients showed nonsignificant OS gains compared with HR-positive HER2-negative patients, regardless of first-line chemotherapy or endocrine therapy., Conclusion: This study revealed the incidence and clinical outcomes of HER2-low expression in de novo advanced breast cancer, suggesting favorable outcomes, particularly in HR-positive breast cancer. These findings may inform personalized treatment strategies. Further research into the mechanisms and implications of HER2-low expression in breast cancer is required.

Vaccination is one of the most successful and cost-effective interventions designed by science which has helped in preventing millions of deaths, especially in children. The Expanded Programme on Immunization (EPI) was established by World Health Organization (WHO) in 1974 to develop immunization programmes throughout the world with polio, measles, diphtheria, tetanus, tuberculosis and whooping cough. The WHO South-East Asia Region (SEAR) has a disproportionately high burden of infectious diseases and has greatly benefitted from the EPI as compared to other regions with more than 90 per cent of the population having access to vaccines. The story of vaccines in South-East Asia is a testament to scientific progress, global collaboration, and unwavering commitment to public health. This article aims to discuss the journey of EPI in the WHO SEAR.

Accurate diagnosis of strongyloidiasis is crucial for effective treatment and prevention of complications. We reviewed the current landscape of diagnostic assays used in detecting Strongyloides infection in Southeast Asia. A literature search was performed using Scopus, PubMed, and Web of Science databases spanning the last three decades. Based on the exclusion and inclusion criteria, 52 papers were included in this review. We outlined the diagnostic methods used and their advantages and drawbacks. Insensitive parasitological methods were commonly used, thus underscoring the underestimation of Strongyloides infection rates in Southeast Asia. A combination of diagnostic methods (i.e., microscopy, molecular techniques, and serology) is preferred because it leads to more effective detection and higher prevalence rates. New approaches have been developed, including urine ELISAs and rapid lateral flow tests. Improving and standardizing diagnostics and making them more accessible can improve Strongyloides prevalence estimates and facilitate control efforts.

Objective: The COVID-19 pandemic challenged the Global Outbreak Alert and Response Network's (GOARN) mechanism used to rapidly deploy technical support for international responses and highlighted areas that require strengthened capacity within the Network. GOARN's partners in the World Health Organization's (WHO) South-East Asia and Western Pacific regions were engaged to explore their levels of preparedness, readiness and ability to respond to international public health emergencies., Methods: Consultative discussions were held and a survey was conducted with GOARN's partners from the two WHO regions. Discussion topics included partners' capacity to support and participate in a GOARN deployment, training, research and collaboration. Descriptive and content analyses were conducted., Results: Barriers to engaging in GOARN's international outbreak response efforts included limited numbers of personnel trained to respond to outbreaks; institutional, financial and administrative hurdles; and limited collaboration opportunities. Partners identified innovative solutions that could strengthen their engagement with deployment, such as financial subsidies, mentorship for less experienced staff, and the ability to provide remote support., Discussion: GOARN plays an important role in enabling WHO to fulfil its international alert and response duties during disease outbreaks and humanitarian crises that have the potential to spark disease outbreaks. Yet without systematic improvement to strengthen national outbreak capacity and regional connectedness, support for international outbreak responses may remain limited. Thus, it is necessary to integrate novel approaches to support international deployments, as identified in this study., Competing Interests: AEP and SS are associate editors of the Western Pacific Surveillance and Response journal. They had no role in the decision to publish this manuscript. The other authors have no conflicts of interest to declare., ((c) 2024 The authors; licensee World Health Organization.)

Background: South-East Asia is a densely populated region with a considerable, however, under-prioritized mental health burden. Little is known about the mental health burden and services status in the prisons of the region., Objectives: We aimed to investigate the individual country-wise prison mental health status in South-East Asian region., Methods: We performed a narrative review based on the evidence available in PubMed, Scopus, PsycINFO, Google, and Google Scholar considering the review objectives. We highlighted country perspectives on total population, prison numbers, prisoner numbers, the prevalence of psychiatric disorders and suicide among prisoners, prison mental health services, current challenges, and ways ahead., Results: We discussed the prison mental health of five countries (Bangladesh, India, Indonesia, Nepal, and Sri Lanka). We found overcrowding (131.4%-215.6%) in the prisons, a high prevalence of psychiatric disorders in the prisons (40%-100%), negligible prison mental health services, and a lack of data on prison suicide with some variations among the five countries. Among the countries, Bangladesh has the highest prevalence (66.4%-100%) of psychiatric morbidity with an absence of a mental health system., Conclusions: Prison mental health in tSouth-East Asia is a neglected domain and warrants attention regarding ensuring adequate mental health services to the prisoners as there are high unmet mental health needs and an absence of poorly supported mental health needs., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Objectives: South Asia (SA) and Southeast Asia (SEA) are geographically close; however, discrepancies in oral cancer (OC) epidemiology exist between the two regions. Socioeconomic disparities may influence the OC burden. The aim of this study was to assess the epidemiology of OC and its relationship with the Inequality Adjusted Human Development Index (IHDI) and its components in SA and SEA., Methods: Cancer data for this ecological study was obtained from GLOBOCAN 2020, while the IHDI was obtained from the Human Development Report 2020. Based on data availability, 14 SA and SEA countries were chosen. Poisson log-weighted regression models were employed to examine IHDI and its components in relation to incidence and mortality. Univariate linear regression models were utilized to determine the association between the mortality-to-incidence ratio (MIR) and the IHDI., Results: Mortality and MIR of OC were negatively correlated with all sub-indices of the IHDI, including education, health and income. However, incidence and mortality of OC were influenced by region and sex., Conclusions: Higher IHDI countries tended to have lower MIR. SA and males showed higher incidence and mortality. Reducing intra-country inequalities in development may be a pragmatic approach to enhancing the OC burden and prognosis., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Tuberculosis (TB) remains a leading cause of mortality worldwide. We conducted this systematic review to understand the distribution of bovine and zoonotic tuberculosis in the World Health Organization (WHO)'s Southeast Asia Region (SEAR) and Western Pacific Region (WPR) to inform our understanding of the risk posed by this disease., Methods: A two-pronged strategy was used by evaluating data from peer-reviewed literature and official reports. A systematic search was conducted using a structured query in four databases (Web of Science, Scopus, Medline, and PubMed) to identify any reports of the occurrence of zoonotic TB. No language and time constraints were used during the search, but non-English language articles were later excluded. The official data were sourced from the World Organization for Animal Health's (WOAH) World Animal Health Information System (WAHIS) and WHO's global TB database., Results: The retrieved records from SEAR and WPR ( n  = 113) were screened for eligibility, and data about disease occurrence were extracted and tabulated. In SEAR, all of the five studies that conducted Mycobacterium speciation (5/6) in humans were from India, and the reported Mycobacterium species included M. tuberculosis , M. bovis , M. scrofulacium , M. kansasii , M. phlei , M. smegmatis and M. orygis . In WPR, Mycobacterium speciation investigations in humans were conducted in Australia (8), China (2), Japan (2), NewZealand (2) and Malaysia (1), and the reported Mycobacterium species included M. bovis , M. africanum and M. tuberculosis . Seven countries in WHO's SEAR have officially reported the occurrence of Mycobacterium bovis in their animals: Bangladesh, India, Indonesia, Myanmar, Nepal, Sri Lanka and Thailand. In WPR, the WAHIS information system includes reports of the identification of M. bovis from 11 countries - China, Fiji, Japan, Malaysia, Mongolia, New Zealand, the Philippines, the Republic of Korea, Singapore, Tonga and Viet Nam. In contrast, human zoonotic TB cases in the WHO database were only listed from Australia, Brunei Darussalam and Palau countries., Discussion: The available data suggests under-reporting of zoonotic TB in the regions. Efforts are required to strengthen zoonotic TB surveillance systems from both animal and human health sides to better understand the impact of zoonotic TB in order to take appropriate action to achieve the goal of ending the TB epidemic., Competing Interests: ND was employed by the company One Health Epi Consulting. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Singh, Dhand, Cadmus, Dean and Merle.)

Background: Southeast Asia is undergoing an epidemiological transition with non-communicable illnesses becoming increasingly important, yet infectious diseases (tuberculosis, HIV, hepatitis B, malaria) remain widely prevalent in some populations, while emerging and zoonotic diseases threaten. There are also limited population-level estimates of many important heath conditions. This restricts evidence-based decision-making for disease control and prevention priorities. Cross-sectional surveys can be efficient epidemiological tools to measure the prevalence of a wide range of diseases, but no systematic assessment of their coverage of different health conditions has been produced for the region., Methods: We conducted a systematic search in Medline, Embase, Global Health, CINAHL, Scopus, Web of Science Core Collection, and Global Index Medicus, and additionally Google Scholar. Our inclusion criteria were cross-sectional surveys conducted with community-based recruitment, in Bangladesh, Cambodia, Laos, Myanmar, and Thailand, published between January 1, 2010 and January 27, 2021, and reporting the prevalence of any health condition., Results: 542 publications from 337 surveys were included. Non-communicable conditions (n = 205) were reported by more surveys than infectious conditions (n = 124). Disability (n = 49), self-report history of any disease or symptoms (n = 35), and self-perceived health status (n = 34), which reflect a holistic picture of health, were studied by many fewer surveys. In addition, 45 surveys studied symptomatic conditions which overlap between non-communicable and infectious conditions. The most surveyed conditions were undernutrition, obesity, hypertension, diabetes, intestinal parasites, malaria, anemia, diarrhea, fever, and acute respiratory infections. These conditions overlap with the most important causes of death and disability in the Global Burden of Disease study. However, other high-burden conditions (e.g. hearing loss, headache disorder, low back pain, chronic liver and kidney diseases, and cancers) were rarely studied., Conclusion: There were relatively few recent surveys from which to estimate representative prevalences and trends of health conditions beyond those known to be high burden. Expanding the spectrum of health conditions in cross-sectional surveys could improve understanding of evolving disease patterns in the region., (© 2024. The Author(s).)

Background: Most publications on invasive pneumococcal disease (IPD) serotype distribution are from about 20 countries (Australia, Canada, China, European Union members, Japan, New Zealand, South Korea, and USA). Here, we reviewed the literature among underrepresented countries in the Americas (AMRO), Africa (AFRO), Eastern Mediterranean (EMRO), South-East Asia (SEARO), and Western Pacific (WPRO) WHO regions., Methods: We performed a systematic review of the most recent IPD serotype surveillance publications (from 01/01/2010 to 31/12/2021, Medline/Embase) in those WHO regions. Selection criteria were delineated by contemporality, within-country geographical scope, and number of samples. Reported serotype distributions for each country were stratified by age group, pneumococcal conjugate vaccine (PCV) serotype category (considering undifferentiated serotypes), and PCV program period (pre-PCV, intermediate, or PCVhv [higher valency PCV formulation]). Pre-PCV period pooled data estimated PCV serotype category distribution by age group across WHO regions, while for the PCVhv period, country-level dataset tables were prepared., Results: Of 2,793 publications screened, 107 were included (58 pediatric, 11 adult, 37 all ages, and one comprising every age group). One-third of eligible countries (51/135) published serotype distribution, ranging from 30 to 43% by WHO region. Considering number of samples per WHO region, a few countries prevailed: AMRO (Brazil), AFRO (South Africa, Malawi, and Burkina Faso), and WPRO (Taiwan). In the pre-PCV period, PCV13 formulation serotypes predominated: ranging from 74 to 85% in children and 58-86% in adults in the different WHO regions. The PCVhv period represented half of the most recent IPD surveillance by countries (26/51). Undifferentiated serotypes represented >20% of IPD from most countries (34/51)., Conclusion: Ubiquity of undifferentiated serotypes among the publications could constrain estimates of PCV program impact and of serotype coverage for newer PCVhv formulations; consequently, we recommend that countries favor techniques that identify serotypes specifically and, rather than reporting PCV formulation serotype distributions, provide serotype results individually., Systematic Review Registration: The protocol has been prospectively registered at PROSPERO, identifier: CRD42021278501. https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=278501., Competing Interests: MAF, DD, and GC are employees of Pfizer and may hold stock or stock options. MS, MB, and GH are employees of P95, which received funding from Pfizer in connection with the development of this manuscript. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Fletcher, Daigle, Siapka, Baay, Hanquet and del Carmen Morales.)

Background: Ticks, as critical vectors of a variety of pathogens, pose a significant public health challenge globally. In Southeast Asia (SEA), ticks are responsible for transmitting a diverse array of pathogens affecting humans and animals. The geographical and ecological diversity of SEA provides a unique environment that supports a wide range of tick species, which complicates the management and study of tick-borne diseases (TBDs)., Methodology/principal Findings: This article synthesizes findings from the first international symposium on ticks and TBDs in Southeast Asia, held in Phnom Penh on June 22 and 23, 2023. It highlights regional efforts to understand tick ecology and pathogen transmission. This paper proposes to present a summary of the various presentations given during the symposium following 3 main parts. The first one is devoted to the state of knowledge regarding ticks and TBDs in SEA countries, with presentations from 6 different countries, namely Cambodia, Indonesia, Laos, Malaysia, Thailand, and Vietnam. The second part focuses on the development of new research approaches on tick-borne pathogens (TBPs) and TBDs. The last part is a summary of the round table discussion held on the final day, with the aim of defining the most important challenges and recommendations for researches on TBP and TBD in the SEA region., Conclusions/significance: Key topics discussed include advancements in diagnostic tools, such as MALDI-TOF MS and proteomics, and the development of sustainable strategies for tick management and disease prevention. The symposium facilitated the exchange of knowledge and collaborative networks among experts from various disciplines, promoting a unified approach to tackling TBDs in the region. The symposium underscored the need for enhanced surveillance, diagnostics, and inter-regional cooperation to manage the threat of TBDs effectively. Recommendations include the establishment of a regional database for tick identification and the expansion of vector competence studies. These initiatives are crucial for developing targeted interventions and understanding the broader implications of climate change and urbanization on the prevalence of TBDs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yean et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: In addition to harms caused to individuals who smoke, second-hand smoke (SHS or passive smoke) is an important public health issue. We aim to estimate the extent of preventable deaths due to tobacco and SHS exposure in Southeast Asia., Methods: Data were from the Global Burden of Disease Study 2019. We analysed data from Southeast Asia, including Cambodia, Indonesia, Laos, Malaysia, Maldives, Mauritius, Myanmar, Philippines, Seychelles, Sri Lanka, Thailand, Timor-Leste, and Vietnam., Results: In 2019, there were 728,500 deaths attributable to tobacco in Southeast Asia, with 128,200 deaths attributed to SHS exposure. The leading causes of preventable deaths were ischemic heart disease, stroke, diabetes mellitus, lower respiratory infections, chronic obstructive pulmonary disease, tracheal, bronchus, and lung cancer. Among deaths attributable to tobacco, females had higher proportions of deaths attributable to SHS exposure than males in Southeast Asia., Conclusion: The burden of preventable deaths in a year due to SHS exposure in Southeast Asia is substantial. The implementation and enforcement of smoke-free policies should be prioritized to reduce the disease burden attributed to passive smoking in Southeast Asia., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Leung, Lim, Sun, Vu, McClure-Thomas, Bao, Tran, Santo, Fausiah, Farassania, Chan and Sebayang.)