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NIID, Japan, Tokyo, 2011.11.24 Infectious Diseases Dynamics Infectious Diseases Dynamics in Mongolia in Mongolia Prof Prof. P . P.Nymad .Nymadawa wa, MD , MD, PhD , PhD, DSc( DSc(Med), Med), President, M President, Mongo ngolian

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NIID, Japan, Tokyo, 2011.11.24

Infectious Diseases Dynamics Infectious Diseases Dynamics in Mongolia in Mongolia

Prof

  • Prof. P

. P.Nymad .Nymadawa wa, MD , MD, PhD , PhD, DSc( DSc(Med), Med), President, M President, Mongo ngolian lian Academy of Academy of Medic Medical Sc al Sciences, iences, Vice-President, Vice-President, Mon Mongol golian ian Academy of Academy of Sciences, Sciences, Scientif Scientific D ic Director, rector, Nati Nationa

  • nal Influenza

Influenza Center, N Center, NCCD, CCD, Mon Mongol golia ia

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 2

Infectious Diseases Dynamics Infectious Diseases Dynamics in Mongolia in Mongolia

1.

  • 1. Introduction: country and scientific

Introduction: country and scientific research coordination research coordination 2.

  • 2. General dynamics of infectious diseases

General dynamics of infectious diseases 3.

  • 3. Surveillance of influenza and influenza

Surveillance of influenza and influenza-

  • like

like illnesses illnesses 4.

  • 4. Influenza research

Influenza research 5.

  • 5. Measles, Rubella, Mumps, Varicella

Measles, Rubella, Mumps, Varicella-

  • Zoster

Zoster 6.

  • 6. Areas to collaborate with NIID, Japan

Areas to collaborate with NIID, Japan

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 3

MONGOLIA HISTORICAL AND CONTEMPORARY MONGOLIA HISTORICAL AND CONTEMPORARY

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 4

GEOGRAPHICAL DIVERSITY AND GEOGRAPHICAL DIVERSITY AND ADMINISTRATIVE DIVISIONS OF MONGOLIA ADMINISTRATIVE DIVISIONS OF MONGOLIA

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 5

Altai Mountains

(over 5,000 meters above sea level), Bayan-Ulghei Aimak, West Mongolia

Mongolian Steppe

Dornod (East) Aimak (Province), Mongolia

GEOGRAPHICAL DIVERSITY OF MONGOLIA 1 GEOGRAPHICAL DIVERSITY OF MONGOLIA 1

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 6

Winter of Lake Khubsughul

North Mongolia

Gobi Desert

South Mongolia

GEOGRAPHICAL DIVERSITY OF MONGOLIA 2 GEOGRAPHICAL DIVERSITY OF MONGOLIA 2

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 7

WINTER (JANUARY) MEAN TEMPERATURE WINTER (JANUARY) MEAN TEMPERATURE DISTRIBUTION OVER MONGOLIA (IN DISTRIBUTION OVER MONGOLIA (IN ° °C) C)

National Meteorological Service, Ulaanbaatar, Mongolia, 2001

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 8

SUMMER (JULY) MEAN TEMPERATURE SUMMER (JULY) MEAN TEMPERATURE DISTRIBUTION OVER MONGOLIA (IN DISTRIBUTION OVER MONGOLIA (IN ° °C) C)

National Meteorological Service, Ulaanbaatar, Mongolia, 2001

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 9

DISTRIBUTION OF YEARLY DISTRIBUTION OF YEARLY MEAN PRECIPITATION OVER MONGOLIA MEAN PRECIPITATION OVER MONGOLIA

National Meteorological Service, Ulaanbaatar, Mongolia, 2001

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 10

1 dot = 500 people

POPULATION DENSITY IN MONGOLIA (2000) POPULATION DENSITY IN MONGOLIA (2000)

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 11

Mongolian Academy of Sciences (MAS): Mongolian Academy of Sciences (MAS):

Mission and Function

  • Mission:

to ensure scientific basis of the sustainable socio-economic development of the country

  • Function:
  • development science and technology policy,
  • advisory functions to the NCST and to the Government,
  • coordination of scientific research activities,
  • evaluation and assessment of scientific research results of the

Government-funded projects,

  • development of collaboration with scientific research institutions,
  • rganizations and communities at international and bi-laterial levels,
  • conducting scientific research on basic sciences and priority areas.

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 12

Mongolian Academy of Sciences (MAS): Mongolian Academy of Sciences (MAS):

Structure

General Assembly (MAS) NCST President /Presidium MoECS Subassembly of Physics, Chemistry and Mathematics Subassembly of Earth Sciences Subassembly of Biological Sciences Mongolian Academy of Medical Sciences Subassembly of Social and Humanitarian Sciences Subassembly of Engineering and Technology Mongolian Academy of Agricultural Sciences

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 13

Mongolian Academy of Medical Sciences (MAMS): Mongolian Academy of Medical Sciences (MAMS):

Mission and Function

  • Mission:

to ensure scientific basis of an evidence-based medical and health services to the entire population of the country

  • Function:
  • development science and technology policy of medical sciences and health

services,

  • advisory functions to the MoH and to the Government,
  • coordination of scientific research activities within the sector and with other

sectors of scientific activities,

  • evaluation and assessment of scientific research results of the Government-

funded projects,

  • development of collaboration with scientific research institutions,
  • rganizations and communities at international and bi-laterial levels,
  • conducting scientific research on basic sciences and priority areas.

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 14

Mongolian Academy of Medical Sciences (MAMS): Mongolian Academy of Medical Sciences (MAMS):

Structure

MAMS General Assembly MAS President /Presidium MoH Branch of Public Health Branch of Clinical Sciences Branch of Biomedical Sciences Branch of Traditional Medicine and Pharmacy

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 15

National Center of Communicable Diseases (NCCD): National Center of Communicable Diseases (NCCD): Structure Structure

Director General, NCCD MoH

Administration Council

Deputy Directors Scientific Council MoECS MAMS

  • Dept. Administration
  • Dept. Statistics and

EWAR NIC

  • Dept. Finance and Planing
  • Dept. General Supply
  • Dept. Drug Supply
  • Dept. Nursing
  • Dept. Health Education

Division of Epidemiological Surveilance Division of Out-patient Services Division of In-Patient Services Division of TB Division of Laboratory Services Division of HIV-AIDS/STD

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 16

Infectious Diseases Dynamics Infectious Diseases Dynamics in Mongolia in Mongolia

1.

  • 1. Introduction: country and scientific

Introduction: country and scientific research coordination research coordination 2.

  • 2. General dynamics of infectious diseases

General dynamics of infectious diseases 3.

  • 3. Surveillance of influenza and influenza

Surveillance of influenza and influenza-

  • like

like illnesses illnesses 4.

  • 4. Influenza research

Influenza research 5.

  • 5. Measles, Rubella, Mumps, Varicella

Measles, Rubella, Mumps, Varicella-

  • Zoster

Zoster 6.

  • 6. Areas to collaborate with NIID, Japan

Areas to collaborate with NIID, Japan

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 17

EPIDEMIOLOGICAL TRANSITION IN MONGOLIA EPIDEMIOLOGICAL TRANSITION IN MONGOLIA

(Percentage of disease groups in mortality causes)

10 20 30 40 50 60 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 %

Diseases of Respiratory System Diseases of Circulatory System Diseases of Digestive System Communicable Diseases Neoplasms Injury and Poisoning

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 18

INFECTIOUS DISEASES INCIDENCE AND CONTROL INFECTIOUS DISEASES INCIDENCE AND CONTROL IN MONGOLIA IN MONGOLIA

(incidence rate of total registered infectious per 10,000 population in 1952-2010)

100 200 300 400 500 600 700 800 1920 1923 1926 1929 1932 1935 1938 1941 1944 1947 1950 1953 1956 1959 1962 1965 1968 1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010

per 10 000 population

Smallpox vaccine (1923) Live plague vaccine in endemic sites (1944) BCG in Cities (1946) Polio vaccine (1962) DTP vaccine (1965) Measles vaccine (1974) BCG for all newborns (1987)

Hep B (1991) Penta- vaccine: HepB+Hib +DTP (2005) MMR (2009)

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 19

OFFICIALLY REGISTERABLE INFECTIOUS DISEASES OFFICIALLY REGISTERABLE INFECTIOUS DISEASES IN MONGOLIA IN MONGOLIA

(Year of beginning of official registration)

I.Respiratory infections: 1. Diphtheria (1955) 2. Erithema infectiosa (2005) 3. Measles (1958) 4. Meningococcal disease (1955) 5. Mumps (1958) 6. Pertussis (1958) 7. Rubella (1987) 8. SARS (2003) 9. Scarlet fever (1966)

  • 10. Tuberculosis (1962)
  • 11. Varicella (1955)
  • II. Enteric infections
  • 12. Diarrheal infection (2001)
  • 13. Food poisoning (1981)
  • 14. Hepatitis A (1978)
  • 15. Hepatitis, acute, unsp (1961)
  • 16. Poliomyelitis, paralytic (1962)
  • 17. Salmonellosis (1981)
  • 18. Shigellosis (1952)
  • 19. Typhoid fever (1952)
  • III. STD
  • 20. Gonococcal infection (1952)
  • 21. HIV/AIDS (1987)
  • 22. Syphilis (1952)
  • 23. Trichomoniasis (1998)
  • IV. Skin infections
  • 24. Erysepelas (1968)
  • 25. Gas gangrene (1952)
  • 26. Mycosis (2001)
  • 27. Scabies (1952)
  • 28. Tetanus (1952)
  • V. Zoonotic infections
  • 29. Anthrax (1964)
  • 30. Brucellosis (1958)
  • 31. Plague (1964)
  • 32. Rabies (1964)
  • 33. Tick-born borreliosis (2003)
  • 34. Tick-born encephalitis (2003)
  • 35. Tick-born rikketsiosis (2005
  • VII. Blood-born infections
  • 36. Hepatitis B (1978)
  • 37. Hepatitis C (1997)3
  • 38. Neonatal sepsis (2001)

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 20

PREVALENCE OF REGISTRABLE INFECTIOUS DISEASE GROUPS IN PREVALENCE OF REGISTRABLE INFECTIOUS DISEASE GROUPS IN MONGOLIA MONGOLIA (averages of 1996-2000 and 2001-2005)

1996-2000 respiratory enteric std skin zoonotic blood born 2001-2006 respiratory enteric std skin zoonotic blood born

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 21

Infectious Diseases Dynamics Infectious Diseases Dynamics in Mongolia in Mongolia

1.

  • 1. Introduction: country and scientific

Introduction: country and scientific research coordination research coordination 2.

  • 2. General dynamics of infectious diseases

General dynamics of infectious diseases 3.

  • 3. Surveillance of influenza and influenza

Surveillance of influenza and influenza-

  • like

like illnesses illnesses 4.

  • 4. Influenza research

Influenza research 5.

  • 5. Measles, Rubella, Mumps, Varicella

Measles, Rubella, Mumps, Varicella-

  • Zoster

Zoster 6.

  • 6. Areas to collaborate with NCCD, Japan

Areas to collaborate with NCCD, Japan

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 22

ILI Surveillance in Mongolia ILI Surveillance in Mongolia

ILI surveillance has started in Mongolia in 1974, and is coordinated by NIC, Mongolia. There are two tiers of ILI surveillance: 1. Epidemiological surveillance is based on collection of data

  • n clinical diagnosis of ILI/pneumonia in out- and inpatient

visits, 2. Virological surveillance is based on weekly collection of samples from ILI and pneumonia/sARI patients in ISSSs and detection/isolation and antigenical, genetical and anti- viral resistance analysis of influenza and other respiratory viruses NIC, Mongolia has joined WHO GISN in 1978

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  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 23

Influenza surveillance network in Mongolia: Influenza surveillance network in Mongolia: 1974 1974-

  • 2004

2004

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 24

Influenza surveillance network in Mongolia: Influenza surveillance network in Mongolia: 2004 2004-

  • 2009

2009

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 25

Influenza Surveillance network in Mongolia: Influenza Surveillance network in Mongolia: since September 2009 since September 2009

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 26
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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 27

Integrated Influenza Surveillance Structure and Function Integrated Influenza Surveillance Structure and Function

MoH

Outpatient ISSSs:(129) Ulaanbaatar – 23 Provinces - 106

21 provinces; 9 city districts’ and Ulaanbaatar City Health Departments

Specimen collection/sending Weekly ILI report

WHO Collaborating Centers: NIID Tokyo, Japan; CDC Atlanta USA Specimen

Report, feedback

NCCD, Virology Laboratory

NCCD, NIC

www.flu.mn Daily ILI report

Hospital-based ISSSs:(38) Reference Centers/Hospitals: (5) General Hospitals: 33

FluNet

Weekly pneumonia/sARI case/death report

Virus isolates, standard kits NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 28

Real Real-

  • time weekly on

time weekly on-

  • line reporting

line reporting in Mongolian and English since 2008: www.flu.mn in Mongolian and English since 2008: www.flu.mn

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 29

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 1.1. Country 1.1. Country-

  • wide: Registered morbidity/10,000

wide: Registered morbidity/10,000 population population

20 40 60 80 100 120 140 50 1 10 20 30 40 50 1 10 20 30 40 ILI morbidity per 10000 Lower tolerance limit (95%) Upper tolerance limit (95%) 2009/10-2010/11 2011/2012 2009 2010 2011

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 30

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 1.2. Country 1.2. Country-

  • wide: Detected pathogens

wide: Detected pathogens

5 10 15 20 50 1 10 20 30 40 50 1 10 20 30 40 25 50 75 100

B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Entero- Adeno- Corona- HBoV Micoplasma Number of specimens

2009 2010 Number of detected viruses Number of specimens 2011

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 31

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 1.3. Country 1.3. Country-

  • wide: geographical distribution

wide: geographical distribution

  • f the registered ILI morbidity/10,000 population
  • f the registered ILI morbidity/10,000 population

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 32

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 1.4. Country 1.4. Country-

  • wide: geographical distribution

wide: geographical distribution

  • f the registered ILI morbidity in percentages
  • f the registered ILI morbidity in percentages

among outpatient visits among outpatient visits

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 33

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 1.5. Country 1.5. Country-

  • wide: age distributions

wide: age distributions

  • f the registered ILI cases (%)
  • f the registered ILI cases (%)

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

w36 w37 w38 w39 w40 w41 w42 w43 w44 w45

0-11 months 1-4 yrs 5-9 yrs 10-15 yrs 16-24 yrs 25-44 yrs 45-64 yrs 65+

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 34

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 1.6. Country 1.6. Country-

  • wide: pneumonia hospitalizations and registered

wide: pneumonia hospitalizations and registered deaths due to pneumonia (data from 37 sentinel surveillance deaths due to pneumonia (data from 37 sentinel surveillance hospitals) hospitals)

0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 45 50 10 20 30 40 50 1 10 20 30 40 3 6 9 12 15 Deaths Percentage of patients w ith pneumonia among all hospitalized patients in average Percentage of patients w ith pneumonia among hospitalized 2009 Percentage Deaths 2011 2010

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 35

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 1.7. Country 1.7. Country-

  • wide: detected pathogens among hospitalized

wide: detected pathogens among hospitalized pneumonia patients (data from 37 sentinel surveillance pneumonia patients (data from 37 sentinel surveillance hospitals) hospitals)

5 10 15 20 40 50 1 10 20 30 40 20 40 60 80 100

B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Entero- Adeno- Corona- HBoV Micoplasma Number of specimens

2010 Number of detected viruses Number of specimens 2011 2009

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 36

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 2.1. In Ulaanbaatar: Registered morbidity/10,000 population 2.1. In Ulaanbaatar: Registered morbidity/10,000 population

50 100 150 200 250 50 10 20 30 40 50 10 20 30 40 ILI morbidity per 10000 Lower tolerance limit (95%) Upper tolerance limit (95%) 2009/10-2010/11 2011/2012 2009 2010 2011

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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 37

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 2.2. In Ulaanbaatar: Detected pathogens 2.2. In Ulaanbaatar: Detected pathogens

5 10 15 20 50 1 10 20 30 40 50 1 10 20 30 40 50 25 50 75 100

B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Entero- Adeno- Corona- HBoV Micoplasma Number of specimens

2009 2010 Number of detected viruses Number of specimens 2011

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 38

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 2.3. In Ulaanbaatar: geographical distribution 2.3. In Ulaanbaatar: geographical distribution

  • f the registered ILI morbidity/10,000 population
  • f the registered ILI morbidity/10,000 population
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NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 39

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 2.4. In Ulaanbaatar: geographical distribution 2.4. In Ulaanbaatar: geographical distribution

  • f the registered ILI morbidity in percentages
  • f the registered ILI morbidity in percentages

among outpatient visits among outpatient visits

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 40

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 2.5. In Ulaanbaatar: pneumonia hospitalizations and 2.5. In Ulaanbaatar: pneumonia hospitalizations and registered deaths due to pneumonia (data from 12 sentinel registered deaths due to pneumonia (data from 12 sentinel surveillance hospitals) surveillance hospitals)

0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 40 50 1 10 20 30 40 3 6 9 12 15 Deaths Percentage of patients w ith pneumonia among all hospitalized patients in average Percentage of patients w ith pneumonia among hospitalized 2010 Percentage Deaths 2011

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  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 41

Weekly influenza surveillance reporting: Weekly influenza surveillance reporting: 2.6. In Ulaanbaatar: detected pathogens among hospitalized 2.6. In Ulaanbaatar: detected pathogens among hospitalized pneumonia patients (data from 12 sentinel surveillance pneumonia patients (data from 12 sentinel surveillance hospitals) hospitals)

5 10 15 20 40 50 1 10 20 30 40 25 50 75 100 B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Entero- Adeno- Corona- HBoV Micoplasma Number of specimens 2010 2011 Number of detected viruses Number of specimens

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 42

Infectious Diseases Dynamics Infectious Diseases Dynamics in Mongolia in Mongolia

1.

  • 1. Introduction: country and scientific

Introduction: country and scientific research coordination research coordination 2.

  • 2. General dynamics of infectious diseases

General dynamics of infectious diseases 3.

  • 3. Surveillance of influenza and influenza

Surveillance of influenza and influenza-

  • like

like illnesses illnesses 4.

  • 4. Influenza research

Influenza research 5.

  • 5. Measles, Rubella, Mumps, Varicella

Measles, Rubella, Mumps, Varicella-

  • Zoster

Zoster 6.

  • 6. Areas to collaborate with NIID, Japan

Areas to collaborate with NIID, Japan

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SLIDE 22

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 43

A table of nucleotide sequences of genes of influenza virus A table of nucleotide sequences of genes of influenza virus strains isolated in Mongolia and released by GenBank strains isolated in Mongolia and released by GenBank

Genome segment No Genes Numbers of base-pairs All released sequences Submitted by VL, NCCD, Mongolia Persentage of NCCD, Mongolia, submission (%) 1 PB2 2341 4 4 100.0% 2 PB1 2341 4 4 100.0% 3 PA 2233 4 4 100.0% 4 HA 1778 55 23 48.8% 5 NP 1565 17 4 23.5% 6 NA 1413 23 6 26.0% 7 M 1027 16 16 100.0% 8 NS 890 10 10 100.0% Бүгд 133 71 53.4% NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 44

The list of hemagglutinin A(H1) genes of influenza virus strains The list of hemagglutinin A(H1) genes of influenza virus strains isolated in Mongolia and their GenBank accession numbers isolated in Mongolia and their GenBank accession numbers

GenBank Accession numbers strains

CAA91080 A/Mongolia/231/85(H1N1) CAA91081 A/Mongolia/153/88(H1N1) CAA91082 A/Mongolia/111/91 (H1N1) CAA91083 A/Mongolia/162/91(H1N1) ADB80153 A/Dornogobi/1726/2007(H1N1) ACE00254 A/Orkhon/1901/2007(H1N1) ACE00250 A/Sainshand/1142/2007(H1N2) ACE00248 A/Ulaanbaatar/1094/2007(H1N1) ACE00258 A/Ulaanbaatar/1809/2007(H1N1) ACE00252 A/Ulaanbaatar/1830/2007(H1N1) ADB54355 A/Bayanulgii/9912/2009(H1N1) ADC53558 A/Dundgobi/9746/2009(H1N1)) ADB65926 A/Ulaanbaatar/1627/2009(H1N1) ACZ18239 A/Ulaanbaatar/5882/2009(H1N1) ACZ18241 A/Ulaanbaatar/6133/2009(H1N1) ACZ18240 A/Ulaanbaatar/6266/2009(H1N1) ADJ56640 A/Ulaanbaatar/6525/2009(H1N1) ADJ56650 A/Ulgii/9911/2009(H1N1) ADB54352 A/Unmugobi/9586/2009(H1N1) ACZ95465 A/Zavkhan/8299/2009(H1N1) ADV58939 A/Ulaanbaatar/190/2011(H1N1)

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  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 45

The list of hemagglutinin A(H3) genes of influenza virus strains The list of hemagglutinin A(H3) genes of influenza virus strains isolated in Mongolia and their GenBank accession numbers isolated in Mongolia and their GenBank accession numbers

GenBank Accession numbers strains ACE00260 A/Arvaikheer/0510/2006(H3N2) ACC66827 A/Choibalsan/2083/2005(H3N2) ACE00237 A/Choibalsan/2083/2005(H3N2) ACC67166 A/Khovd/262/2006(H3N2) ACE00238 A/Khovd/0262/2006(H3N2) ACE00239 A/Khovd/0269/2006(H3N2) ACC67167 A/Khovd/0269/2006(H3N2) ACE00261 A/Mongolia/15/2003(H3N2) ACE00262 A/Mongolia/18/2003(H3N2) ACE00264 A/Mongolia/416/2003(H3N2) ACE00263 A/Mongolia/96/2003(H3N2) ACC66979 A/Suhbaatar/1568/2005(H3N2) GenBank Accession numbers strains ADR02757 A/Sainshand/0643/2008(H3N2) ACE00241 A/Sukhbaatar/1568/2005(H3N2) ACC67017 A/Ulaanbaatar/1599/2005(H3N2) ACC67018 A/Ulaanbaatar/1922/2005(H3N2) ACC67019 A/Ulaanbaatar/2164/2005(H3N2) ACE00242 A/Ulaanbaatar/0003/2006(H3N2) ACE00243 A/Ulaanbaatar/0006/2006(H3N2) ACE00256 A/Ulaanbaatar/1380/2007(H3N2) ACE00244 A/Ulaanbaatar/1599/2005(H3N2) ACE00246 A/Ulaanbaatar/1922/2005(H3N1) ACE00247 A/Ulaanbaatar/2164/2005(H3N2) ADU85827 A/Ulaanbaatar/3380/2010(H3N2)

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The list of hemagglutinin B genes of influenza virus strains The list of hemagglutinin B genes of influenza virus strains isolated in Mongolia and their GenBank accession numbers isolated in Mongolia and their GenBank accession numbers

GenBank Accession numbers strains ACE00265 B/Ulaanbaatar/2232/2007 ACE00266 B/Ulaanbaatar/2263/2007 ACE00267 B/Ulaanbaatar/1924/2007 ACE00268 B/Ulaanbaatar/2202/2007 ACE00269 B/Sukhbaatar/2488/2007 ACE00270 B/Ulaanbaatar/2373/2007 ACE00271 B/Arvaikheer/2476/2007 ACE00272 B/Orchon/2505/2007 ADR02754 B/Ulaanbaatar/2481/2008 ADD01312 B/Ulaanbaatar/289/2010

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SLIDE 24

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0.01 A/Weiss/43 A/Dundgobi/10320/2009 A/Orkhon/1779/2009 A/Chiobalsan/8524/2009 A/Ulaanbaatar/2212/2007 A/Albany/4836/1950__ A/Chile/1/1983_ A/Fort_Monmouth/1/1947 A/Mongolia/111/91 A/Memphis/6/1996_ A/Mongolia/231/85 A/Ulaanbaatar/1628/2009 A/New_Caledonia/20/1999 A/Solomom Islands/03/2006 A/Ulaanbaatar/116/2007 A/Mongolia/162/91 A/Ulaanbaatar/5882/2009 A/Memphis/39/1983 A/Arvaikheer/8802/2009 A/Bayern/7/95 A/New_York/653/1996 A/Brazil/11/78 A/Ulaanbaatar/190/2011 A/Mongolia/327/2004 A/Ulaanbaatar/1429/2005 A/Mongolia/JP5756/2009 A/Beijing/262/95 A/Sainshand/8886/2009 A/AA/Huston/1945_ A/Brevig Mission/1/1918 A/Puerto Rico/8/34 A/Memphis/3/1987 A/Ulgii/9911/2009 A/Ulaanbaatar/0607/2008 A/California/07/2009 A/Brisbane/59/2007_ A/New_South_Wales/24/1999 A/USSR/90/1977 A/Unmugobi/9586/2009 A/Karaj/5327/2010 A/Mongolia/754/2004 A/Ulaanbaatar/1599/2009 A/Ulaanbaatar/1341/2009 A/Ulaanbaatar/0957/2007 A/Malaysia/54__ A/Memphis/03/2008_ A/Roma/1949 A/Taiwan/01/1986 A/New_York/8/2006 A/Mongolia/153/88

A phylogenetic tree of hemagglutinin A(H1) gene A phylogenetic tree of hemagglutinin A(H1) gene

  • f influenza viruses isolated in Mongolia
  • f influenza viruses isolated in Mongolia

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A phylogenetic tree of hemagglutinin A(H3) gene A phylogenetic tree of hemagglutinin A(H3) gene

  • f influenza viruses isolated in Mongolia
  • f influenza viruses isolated in Mongolia

0.01 A/Ulaanbaatar/0598/08 A/Dornogobi/4067/2010 A/Ulaanbaatar/3920/2010 A/KHOVD/262/2006 A/Dornogobi/3875/2010 A/Ulaanbaatar/1600/2008 A/SUKHBAATAR/1568/2005 A/CHOIBALSAN/2083/2005 A/Ulaanbaatar/3805/2010 A/Uvurkhangai/3970/2010 A/Uvurkhagai/3970/2010 A/KHOVD/269/2006 A/ULAANBAATAR/1922/2005 A/PERTH/10/2010 A/New_York/55/2004 A/Ulaanbaatar/3380/2010 A/ULAANBAATAR/1599/2005 A/Ulaanbaatar/3893/2010 A/Ulaanbaatar/3849/2010 A/ULAANBAATAR/2164/2005 A/Dornogobi/4064/2010 A/Ulaanbaatar/4320/2010 A/Sainshand/0643/2008 A/Ulaanbaatar/3887/2010 A/Brisbane/10/2007 A/Perth/16/2009

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SLIDE 25

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A phylogenetic tree of hemagglutinin B gene A phylogenetic tree of hemagglutinin B gene

  • f influenza viruses isolated in Mongolia
  • f influenza viruses isolated in Mongolia

0.01 B/Yamagata/16/88 B/Ulaanbaatar/956/2010 B/Ulaanbaatar/0856/2008 B/ULAANBAATAR/2808/2008 B/Ulaanbaatar/2373/2007 B/Orchon/2505/2007 B/Ulaanbaatar/943/2010 B/Ulaanbaatar/1885/2007 B/Ulaanbaatar/2481/2008 B/Sukhbaatar/1733/2007 B/Ulaanbaatar/2202/2007 B/Brisbane/3/2007 B/Ulaanbaatar/935/2010 B/Ulaanbaatar/930/2010 B/Ulaanbaatar/905/2010 B/Ulaanbaatar/881/2010 B/Ulaanbaatar/1247/2008 B/Victoria/2/87 B/Brisbane/60/2008 B/Ulaanbaatar/2232/2007 B/Sainshand/917/2010 B/Ulaanbaatar/878/2010 B/Sukhbaatar/2488/2007 B/Orkhon/2536/2008 B/Arvaikheer/2476/2007 B/Ulaanbaatar/1924/2007 B/Ulaanbaatar/2263/2007 B/Ulaanbaatar/954/2010 B/Malaysia/2506/2004 B/Ulaanbaatar/289/2010

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Results of the screening on amantadine resistance Results of the screening on amantadine resistance

  • f influenza viruses isolated in Mongolia (1997
  • f influenza viruses isolated in Mongolia (1997-
  • 2011)

2011)

subtypes A(H1N1) A(H3N2) Pdm A(H1N1) years tested resistant to amantadine tested resistant to amantadine tested resistant to amantadine 1997 2 0(0%)

  • 1998

2 0(%)

  • 1999
  • 2000
  • 2001
  • 2002
  • 2003
  • 2004

8 0(%) 2 0(0%)

  • 2005

2 0(0%) 12 12(100%)

  • 2006

10 10(100%)

  • 2007

9 9(100%) 2 1(50%)

  • 2008
  • 2009
  • 7

7(100%) 2010

  • 2011
  • 1

1(100%)

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SLIDE 26

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Results of the screening on oseltamivir resistance Results of the screening on oseltamivir resistance

  • f influenza viruses isolated in Mongolia (2007
  • f influenza viruses isolated in Mongolia (2007-
  • 2011)

2011)

subtypes A(H1N1) A(H3N2) Pdm A(H1N1) B years tested resistant to

  • seltamivir

tested resistant to

  • seltamivir

tested resistant to

  • seltamivir

tested resistant to

  • seltamivir

2007 37 1(2.7%)

  • 2008
  • 2009
  • 228

0(0%) 18 0(0%) 2010

  • 34

1(2.94%)

  • 2011
  • 2

0(0%) 30 0(0%)

  • 262 strains of pdm A(H1N1) were tested by the One-Step RT-PCR method for detecting oseltamivir-resistant

mutations (developed Mina Hori, NIID, Tokyo, Japan) and obtained the same results with NAI tests results.

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Number of influenza Number of influenza-

  • like illness and influenza virus positive cases from

like illness and influenza virus positive cases from influenza surveillance data of Selenghe province (April 2009/Mar influenza surveillance data of Selenghe province (April 2009/March 2010): ch 2010): all influenza positive cases were pandemic (H1N1) 2009 all influenza positive cases were pandemic (H1N1) 2009

1st sample collection (Jun 2009) 2nd sample collection (Dec 2009)

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SLIDE 27

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Proportion of seroconversion (antibody titer increase by 4 fold Proportion of seroconversion (antibody titer increase by 4 fold or more)

  • r more)

by age groups against A/California/07/2009pdm before (June 2009) by age groups against A/California/07/2009pdm before (June 2009) and and after (November 2009) the first influenza A (H1N1) pandemic wave after (November 2009) the first influenza A (H1N1) pandemic wave in in Selenghe province, Mongolia Selenghe province, Mongolia

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Results of a sero Results of a sero-

  • surveillance in Ulaanbaatar City

surveillance in Ulaanbaatar City (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) for HI antibodies against A/Ulaangom/8148/09 (H1N1) pnd strain for HI antibodies against A/Ulaangom/8148/09 (H1N1) pnd strain

slide-28
SLIDE 28

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Results of a sero Results of a sero-

  • surveillance in Ulaanbaatar City

surveillance in Ulaanbaatar City (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) for HI antibodies against A/California/07/2009 (H1N1) pnd strain for HI antibodies against A/California/07/2009 (H1N1) pnd strain

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Results of a sero Results of a sero-

  • surveillance in Ulaanbaatar City

surveillance in Ulaanbaatar City (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) for HI antibodies against A/Ulaanbaatar/1242/09(H1N1) seasonal for HI antibodies against A/Ulaanbaatar/1242/09(H1N1) seasonal strain strain

slide-29
SLIDE 29

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Results of a sero Results of a sero-

  • surveillance in Ulaanbaatar City

surveillance in Ulaanbaatar City (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) for HI antibodies against A/Brisbane/59/07(H1N1) strain for HI antibodies against A/Brisbane/59/07(H1N1) strain

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Results of a sero Results of a sero-

  • surveillance in Ulaanbaatar City

surveillance in Ulaanbaatar City (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) for HI antibodies against A/Ulaanbaatar/1600/08(H3N2) strain for HI antibodies against A/Ulaanbaatar/1600/08(H3N2) strain

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SLIDE 30

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Results of a sero Results of a sero-

  • surveillance in Ulaanbaatar City

surveillance in Ulaanbaatar City (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) for HI antibodies against A/Brisbane/10/07(H3N2) strain for HI antibodies against A/Brisbane/10/07(H3N2) strain

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Results of a sero Results of a sero-

  • surveillance in Ulaanbaatar City

surveillance in Ulaanbaatar City (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) for HI antibodies against, BY/Huibeiwujiagang/158/09 strain for HI antibodies against, BY/Huibeiwujiagang/158/09 strain

slide-31
SLIDE 31

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Results of a sero Results of a sero-

  • surveillance in Ulaanbaatar City

surveillance in Ulaanbaatar City (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) for HI antibodies against B/Florida/4/06 strain for HI antibodies against B/Florida/4/06 strain

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Results of a sero Results of a sero-

  • surveillance in Ulaanbaatar City

surveillance in Ulaanbaatar City (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) (June 2009 [I] , Nov 2009 [II] and June 2010 [III]) for HI antibodies against BV/Heilongjianghulan/116/2010 strain for HI antibodies against BV/Heilongjianghulan/116/2010 strain

slide-32
SLIDE 32

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Results of a sero Results of a sero-

  • surveillance in Ulaanbaatar City

surveillance in Ulaanbaatar City (June 2009 [I], Nov 2009 [II] and June 2010 [III]) (June 2009 [I], Nov 2009 [II] and June 2010 [III]) for HI antibodies against, BV/Brisbane/60/08 strain for HI antibodies against, BV/Brisbane/60/08 strain

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Infectious Diseases Dynamics Infectious Diseases Dynamics in Mongolia in Mongolia

1.

  • 1. Introduction: country and scientific

Introduction: country and scientific research coordination research coordination 2.

  • 2. General dynamics of infectious diseases

General dynamics of infectious diseases 3.

  • 3. Surveillance of influenza and influenza

Surveillance of influenza and influenza-

  • like

like illnesses illnesses 4.

  • 4. Influenza research

Influenza research 5.

  • 5. Measles, Rubella, Mumps, Varicella

Measles, Rubella, Mumps, Varicella-

  • Zoster

Zoster 6.

  • 6. Areas to collaborate with NIID, Japan

Areas to collaborate with NIID, Japan

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SLIDE 33

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MMR (2009)

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MMR vaccination in Mongolia MMR vaccination in Mongolia

  • From September 2009 started MMR

vaccination.

  • Current schedule for MMR is: 9 months and

2 years olds

  • MMR1- 97% and MMR2 - 95% in 2010
slide-34
SLIDE 34

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National Measles Laboratory, Mongolia (NML) National Measles Laboratory, Mongolia (NML) testing results for 2009 testing results for 2009-

  • 2011

2011 Years Tested rash and fever cases Measles positive (Ig M ELISA) Rubella positive (IgM ELISA) 2009 177 3 3 2010 156 8 Jan-Oct, 2011 159 15

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NML NML data for other viruses (2009

data for other viruses (2009-

  • 2011)

2011)

Years Parvovirus B19 Mumps Tested cases positive Tested cases positive

2009

  • 217

180 2010

  • 69

16 Jan-Oct, 2011 2 2 89 45

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SLIDE 35

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Genotyping results of measles , rubella and Genotyping results of measles , rubella and mumps viruses detected in Mongolia mumps viruses detected in Mongolia

Years Measles Rubella Mumps 2006 D6

  • 2007
  • 2008

H1

  • 2009

H1

  • 2010
  • 1E
  • 2011
  • H3, F

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MVs/Logrono.SPA/02.06/1 (EU086735) MVi/Riga.LVA/16.06 (AM849085) MVs/Vladimir.RUS/40.05 (EU117227) MVs/Tallinn.EST/12.06 (AM849084) MVs/Kyiv.UKR/03.06/1 (EU105462) MVs/Perm.RUS/15.06/1 (HM802119) MVi/Smorgon.BLR/36.06/2 (HM802072) MVs/StefanVoda.MDA/6.07/1 (GU371646) MVs/Plovdiv.BGR/28.06 (AM849069) MVs/Baku.AZE/07.06/1 (EU105460) MVs/Dormagen.GER/15.06/4 (HM802086) 167/2006-MOG 175/2006-MOG 179/2006-MOG NewJersey.USA/94/1 (L46750) [D6] Bristol.UNK/74 (D01005) [D1] Victoria.AUS/16.85 (AF243450) [D7] Illinois.USA/50.99 (AY037020) [D7] Manchester.UNK/30.94 (AF280803) [D8] Illinois.USA/89/1 (U01977) [D3] Montreal.CAN/89 (U01976) [D4] Victoria.AUS/12.99 (AF481485) [D9] Palau.BLA/93 (L46758) [D5] Bangkok.THA/93/1 (AF079555) [D5] Johannesburg.SOA/88/1 (U64582) [D2] Kampala.UGA/51.00/1 (AY923185) [D10] NewYork.USA/94 (L46753) [B3] Ibadan.NIE/97/1 (AJ232203) [B3] Yaounde.CAE/12.83 (U01998) [B1] Libreville.GAB/84 (U01994) [B2] Edmonston-wt.USA/54 (U01987) [A] Goettingen.DEU/71 (X84879) [E] MVs/Madrid.SPA/94 (X84865) [F] Tokyo.JPN/84/K (AY043459) [C1] Maryland.USA/77 (M89921) [C2] Erlangen.DEU/90 (X84872) [C2] Hunan.CHN/93/7 (AF045212) [H1] Beijing.CHN/94/1 (AF045217) [H2] Berkeley.USA/83 (U01974) [G1] Amsterdam.NET/49.97 (AF171232) [G2] Gresik.INO/17.02 (AY184217) [G3]

100 96 93 96 95 92 99 95 0.01

450bp

Philogenetic tree of measles viruses (N gene) Philogenetic tree of measles viruses (N gene)

MVi/Henan.PRC/14.99/3 (DQ356781) MVi/Liaoning.PRC/17.01/18 (DQ356801) MVi/MOG/26.02 (DQ398076) 103/2009-MOG MVi/Sichuan.PRC/13.07/1 (GU237474) MVi/Tianjing.PRC/16.05/1 (FJ602666) MVi/Tianjin.PRC/11.06/1 (GU237316) MVi/Tianjin.CHN/15.02/1 (DQ356866) MVi/Shandong.PRC/14.06/2 (GU237290) MVs/HongKong.CHN/29.07/1 (EU368825) MVi/Umea.SWE/10.05 (AM849066) MVi/Shanxi.PRC/25.04/2 (EU557226) MVs/NewYork.USA/29.06 (DQ888763) MVi/Taoyuan.TWN/20.03 (AY738085) MVs/Taipei.TWN/39.06 (EU914235) MVi/Jiangsu.PRC/23.05/3 (FJ602609) MVs/Ibaraki.JPN/20.10/1 (AB573183) MVs/TWN/18.92/1 (AY737397) MVi/Sichuan.PRC/28.04/1 (EU557230) MVs/Tainan.TWN/33.07 (EU914238) MVi/Jilin.PRC/23.01/4 (DQ356796) 102/2009-MOG MVi/Sichuan.PRC/15.07/2 (GU237476) 300/2008-MOG MVs/HongKong.CHN/19.06/3 MVs/Pingtung.TWN/33.02 (AY737422) MVs/HongKong.CHN/24.07/2 MVi/Tianjin.PRC/8.03/1 (DQ356729) MVs/Taipei.TWN/27.02 (AY737421) CHN/93/2 (AF045205) [H1a] Hunan.CHN/93/7 (AF045212) [H1/H1b] CHN/94/7 (AF045216) [H1c] Beijing.CHN/94/1 (AF045217) [H2] Berkeley.USA/83 (U01974) [G1] Amsterdam.NET/49.97 (AF171232) [G2] Gresik.INO/17.02 (AY184217) [G3] Bristol.UNK/74 (D01005) [D1] NewJersey.USA/94/1 (L46750) [D6] Johannesburg.SOA/88/1 (U64582) [D2] Kampala.UGA/51.00/1 (AY923185) [D10] Manchester.UNK/30.94 (AF280803) [D8] Victoria.AUS/16.85 (AF243450) [D7] Illinois.USA/50.99 (AY037020) [D7] Montreal.CAN/89 (U01976) [D4] Victoria.AUS/12.99 (AF481485) [D9] Illinois.USA/89/1 (U01977) [D3] Palau.BLA/93 (L46758) [D5] Bangkok.THA/93/1 (AF079555) [D5] NewYork.USA/94 (L46753) [B3] Ibadan.NIE/97/1 (AJ232203) [B3] Yaounde.CAE/12.83 (U01998) [B1] Libreville.GAB/84 (U01994) [B2] Edmonston-wt.USA/54 (U01987) [A] MVs/Madrid.SPA/94 (X84865) [F] Goettingen.DEU/71 (X84879) [E] Tokyo.JPN/84/K (AY043459) [C1] Maryland.USA/77 (M89921) [C2] Erlangen.DEU/90 (X84872) [C2]

100 92 83 85 80 92 96 93 99 86 0.01

444bp

slide-36
SLIDE 36

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Philogenetic tree of mumps viruses isolated Philogenetic tree of mumps viruses isolated from Umnugobi province, 2011 from Umnugobi province, 2011

20/2011-MOG 50/2011-MOG 8/2011-MOG 11/2011-MOG V11-2227359 90255/09 V10-2277040 15968/09 MuVs-CHN04-4B050505 (EU780217) V10-2290739 Z77158 [F] 6787/09 AY380065 [F] AY380068 [F] Z77160 [F] 517-93 D90236 [B] 90-534 2836988/09 D90233 [B] D90234 [B] AB003414 [B] AF142766 [D1] AF142769 [D1] Ge9/Gem77 [D] Y08212 [D] AJ272363 [N] AY380079 [K] EU069922 [M] EU082459 [M] AY380064 [H1] AF142771 [H2] Be1/UK88 [H] 6957/08 AB105483 [L] AB105480 [L] X63710 [E] X63711 [E] X63709 [C] AY380062 [C] AY380063 [C] 12-8-05 21-11-84 Bm1/UK90 [C] Y08214 [C] D86174 [I] AF180374 [I] 15-3-84 20-01-83 AY380077 [o] AY380075 [G1] AF280799 [G1] AY380069 [G2] AY380070 [G2] 2850105/09 AF142776 [G2] AY380071 [G4] AY380066 [G3] AY380067 [G3] EU370207 [G5] 32630/09 AY380073 [G5] AY380074 [G6] AY380076 [G6] AY380078 [G7] AY380072 [G7] AF142770 [J] AB003417 [J] EU597479 [J] D90232 [A] D00663 [A] D90231 [A]

86 99 99 99 98 99 96 80 84 99 99 99 92 92 99 90 99 98 97 91 88 93 88 97 81 0.02

SH gene (316nt)

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Philogenetic tree of mumps viruses isolated from Philogenetic tree of mumps viruses isolated from Ulaanbaatar, 2011 Ulaanbaatar, 2011

slide-37
SLIDE 37

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Philogenetic tree of rubella virus Philogenetic tree of rubella virus

^partial sequence

20/2010-MOG^ 40/2010-MOG^ RVs/HongKong.CHN/29.10/3^ RVi/Huzhu.Qinghai.CHN/16.07/5 (FJ875064) RVi/Zhejiang.CHN/22.08 (GQ374571)^ RVi/Pullman.WA.USA/30.08 (GU353078) RVs/HongKong.CHN/27.08 (FJ436377) RVi/Yinchuan.Ningxia.CHN/14.06/1 (FJ875061) RVi/Shenyang.Liaoning.CHN/14.07/2 (FJ875071) RVi/Jinan.Shandong.CHN/10.06 (FJ875033) RVi/Yubei.Chongqing.CHN/25.05/1 (FJ875051) RVs/HongKong.CHN/16.10 (HM211178)^ RVi/Jiangbei.Chongqing.CHN/27.03/1 (FJ875049) RVi/Xingyang.Henan.CHN/42.01/1 (FJ875044) RVi/Dezhou.CHN/02 (AY968210) [1E] RVi/MYS/01 (AY968221) [1E] RVi/Tokyo.JPN/90 (AY968214) [1D] RVi/Saitama.JPN/94 (AY968216) [1D] RVi/Tochigi.JPN/04 (AB238919) [1j] RVi/Dangshan.CHN/00 (AY968215) [1F] RVi/Linqing.CHN/00 (AY968213) [1F] RVi/Anhui.CHN/99 (AY326350) [1F] RVi/PA.USA/64 (L78917) [1a] RVi/Jerusalem.ISR/75 (AY968207) [1B] RVi/Tiberias.ISR/88 (AY968209) [1B] RVi/BeneBerak.ISR/79 (AY968208) [1B] RVi/Milan.ITA/46.92 (AY161360) [1i] RVi/Pavia.ITA/21.91 (AY161352) [1i] RVi/Minsk.BLR/28.05/2 (AM258953) [1h] RVi/Tomsk.RUS/05 (DQ454161) [1h] RVi/UGA/20.01 (EF588978) [1G] RVi/Ontario.CAN/27.05 (EF588970) [1G] RVi/Minsk.BLR/29.04 (AM258945) [1G] RVi/PAN/99 (AY968217) [1C] RVi/LosAngeles.USA/91 (AY968212) [1C] RVi/SLV/02 (AY968211) [1C] RVi/Toyama.JPN/67 (AB047330) [1a] RVi/BEL/63 (AF188704) [1a] RVi/NJ.USA/61 (M30776) [1a] RVi/Moscow.RUS/67 (DQ388279) [2C] RVi/Moscow.RUS/97 (DQ085340) [2C] RVi/Beijing.CHN/79 (AY258322) [2A] RVi/Beijing.CHN/80 (AY258323) [2A] RVi/TelAviv.ISR/68 (AY968219) [2B] RVi/Seattle.USA/16.00 (AY968220) [2B] RVi/Anqing.CHN/00/2 (AY968218) [2B]

100 99 100 84 94 90 99 99 99 96 90 92 88 100 90 94 0.01

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 74

Phylogenetic tree of some VZV strains, Phylogenetic tree of some VZV strains, detected in Mongolia detected in Mongolia

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SLIDE 38

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 75

Infectious Diseases Dynamics Infectious Diseases Dynamics in Mongolia in Mongolia

1.

  • 1. Introduction: country and scientific

Introduction: country and scientific research coordination research coordination 2.

  • 2. General dynamics of infectious diseases

General dynamics of infectious diseases 3.

  • 3. Surveillance of influenza and influenza

Surveillance of influenza and influenza-

  • like

like illnesses illnesses 4.

  • 4. Influenza research

Influenza research 5.

  • 5. Measles, Rubella, Mumps, Varicella

Measles, Rubella, Mumps, Varicella-

  • Zoster

Zoster 6.

  • 6. Areas to collaborate with NIID, Japan

Areas to collaborate with NIID, Japan

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 76

Areas to collaborate with NIID, Japan: I Areas to collaborate with NIID, Japan: I Influenza viruses Influenza viruses

1. Improvement of influenza virus surveillance in human and animal populations; 2. Antigenic and genotypic characterization of surface protein spikes of the circulating influenza viruses; 3. Study of evolution of internal genes of influenza virus to find out their roles in infectivity and virulence of influenza virus strains; 4. Surveillance antiviral resistance of the circulating influenza viruses; 5. Search for new compounds with capacity to inhibit influenza virus replication in vitro and in vivo; 6. Improvement of vaccine virus selection procedures to improve effectiveness of influenza vaccines for the local population, or population strata; 7. Development of rapid and sensitive methods detection and identification of influenza viruses suitable for field use; 8. Development of reliable and accurate methods for the measurement of immnity against influenza viruses;

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SLIDE 39

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 77

Areas to collaborate with NIID, Japan: II Areas to collaborate with NIID, Japan: II Influenza and ILI epidemiology Influenza and ILI epidemiology

1. Improvement of influenza and ILI epidemiological surveillance; 2. Improvement of the presentation of spatial and time-series spread of influenza and ILI events; 3. Development of modeling tools for influenza and ILI, especially real- time modeling to predict impact of the beginning outbreaks and epidemics; 4. Studies on disease burden of influenza and ILI events; 5. Efficacy and efficiency of influenza vaccines in different groups of population;

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 78

Areas to collaborate with NIID, Japan: III Areas to collaborate with NIID, Japan: III Other infectious diseases Other infectious diseases

1. Non-influenza respiratory viruses, especially rhinovirus, adenovirus, RS-virus, and human meta-pneumoniavirus: identification and genotyping, epidemiology and clinical manifestations; 2. Measles, rubella: virus identification and genotyping, epidemiology, vaccine efficacy; 3. Mumps: virus identification and genotyping, epidemiology, vaccine efficacy; 4. Human herpesviruses, especially, HSV and VZV: virus identification and genotyping, epidemiology; 5. Humn papillomaviruses: identification and genotyping, and epidemiology; 6. Viral hepatitis: virus identification, genotyping, antiviral resistance, epidemiology, and improvement of treatment outcomes; 7. Zoonotoc infectious diseases: identification of causative agents and genotyping, and epidemiology; 8. Diarrhial diseases: identification of causative agents and genotyping, and epidemiology;

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SLIDE 40

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  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 79

Acknowledgements Acknowledgements

NIID, Japan, Tokyo, 2011.11.24

  • Prof. P.Nymadawa, MD, PhD, DSc(Med), MAMS, Mongolia 80

Thank you Thank you for your kind attention for your kind attention

National Influenza Center, Mongolia, National Center of Communicable Diseases, Nam Yan Ju street-1, Bayanzurkh District, Ulaanbaatar-13335, Mongolia http://www.flu.mn;