1. Characterization of human influenza virus circulation in Cambodia 2006-2010 and impact for national public health policies. Ly Sovann, MD, DTMH, MCTM Philippe Buchy, MD, PhD NIC Cambodia

2. 2 ILI and ALRI sites in Cambodia ILI sentinel sites ALRI sentinel sites

3. 3 Material and Method Naso-pharyngeal specimens obtained from 5-10 patients fulfilling the ILI case definition, each week, from 8 sentinel sites (5 IPC/MoH since 2006, 3 NIPH/US CDC/MoH since 2009) + 1 study site (AFRIMS since 2010) >4000 NP specimens obtained from patients hospitalized in Takeo and Kampong Cham provincial hospitals with ALRI symptoms between 2007-2010. Specimens tested by RT-PCR at IPC, NIPH/CDC, AFRIMS labs Results centralized and analyzed for epidemiological purposes by MoH (CDC department) with support of WHO country office and by IPC (for FluNet reporting) Antigenic tests, genomic analysis, phenotypic drug resistance tests performed at IPC before selection of representative strains shipped to WHOCC Melbourne (including NAMRU-2 influenza isolates detected during fever study)

4. 4 Influenza circulation (93.4)

5. 5 Influenza circulation (2006-2010) 1st H1N1pdm 09 Case confirmed (imported case) Rainy season 2006 2007 2008 2009 2010

6. 6 Susceptibility to drugs

7. 7 Antigenic analysis

8. 8

9. 9 H3N2 phylogenetic analysis 2010 2009 2007-2008 2005-2006

10. 10 H1N1pdm09 phylogenetic analysis

11. 11 Influenza B phylogenetic analysis 2007 2010 2009 2008 2010

12. 12 Conclusions Although Cambodia is geographically located in the Northern hemisphere, influenza circulation has a Southern hemisphere pattern. Although the viruses circulating in Cambodia are not always totally matching with those included in the vaccine composition, the use of the Southern hemisphere vaccine should be recommended Neuraminidase inhibitors would be the drug of choice for influenza treatment and chemoprophylaxis in Cambodia.

13. 13 Aknowledgements Ministry of Health/CDC department Dr. Sok Touch, Dr. Ly Sovann, Dr. Seng Heng, Mr. Ieng Vannra & coll. Institut Pasteur in Cambodia – Virology & Epi Units Dr. Sek Mardy, Dr. Monica Naughtin, Dr. Sareth Rith, Dr. Sirenda Vong, Dr. Sowath Ly, Dr. Arnaud Tarantola & coll. National Institute of Public Health Dr. Ung Sam An, Dr. Buth Sokhal and coll. WHO Cambodia Dr. Chea Nora, Dr. Nima Asgari and coll. Centres of Disease Control and Prevention USA & Cambodia Dr. Paul Kitsutani, Dr. Borann Sar & coll. NAMRU2, Cambodia Dr. William Rogers, Dr. Chadwick Yasuda WHOCC Melbourne, Australia Prof. Anne Kelso, Dr. Ian Barr & coll. AFRIMS Bangkok & Cambodia Dr. Ans Timmermans, Dr. Youry Se, Ms. Nou Samon, Dr. Chanthap Lon, Dr. Stuart Tyner, Dr. David Saunders