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5. Phillips EJ, Keystone JS, Kain KC. Failure by early 2006, only sporadic cases obtained from the health and market of combined chloroquine and high-dose were found. In July 2006, an outbreak authorities. Oral consent for interview primaquine therapy for Plasmodium vivax malaria acquired in Guyana, South Amer- of HPAI was confi rmed on 2 chicken was obtained from participants.
ica. Clin Infect Dis. 1996;23:1171–3.
6. Ruebush TK II, Zegarra J., Cairo EM, Lao PDR (1,3). Most of Laos’ ≈20 interviewed (Table). Differences in Chloroquine-resistant Plasmodium vivax malaria in Peru. Am J Trop Med Hyg. owned backyard farms; 3.2 million ated with different study areas. Differ-2003;69:548–52.
are on commercial farms (4). This ences in participant sex and age were 7. Alecrim MGC. Estudo clínico, resistência production meets 80% of Lao poultry also noted because, in the rural areas, e polimorfi smo parasitário na malária pelo (chicken, duck, goose, quail) needs; interviews took place in the home. A Plasmodium vivax, Manaus – AM. Brasí-lia: UNB, 2000. PhD Thesis, Faculdade de imports from neighboring countries, total of 583 (69.3%) participants were Medicina, Núcleo de Medicina Tropical, either through legal trade or cross- border smuggling, account for the rest and 150 (79.3%), in urban, semiur- 8. Baird JK, Leksana B, Masbar S, Fryauff (3). Common poultry diseases occur ban, and rural areas, respectively; p = DJ, Sutanihardja MA, Suradi FS, et al. Diagnosis of resistance to chloroquine by frequently during the cold season, and 0.002, 95% confi dence interval 66–72. Plasmodium vivax: timing of recurrence lack of reporting of poultry deaths is Mean ages for participants in these ar-and whole blood levels. Am J Trop Med Until February 2007, no human 32–36), and 38 (range 37–41) years, 9. Pan-American Health Organization. Gener- ic protocol for antimalarial drug-effi cacy cases of infl uenza A (H5N1) had been respectively; p<0.001. Animal breed- studies in the Américas. Effi cacy of chlo- reported in Lao PDR. To learn more ing was conducted by 50% of fami- roquine for the treatment of Plasmodium about Laotians’ knowledge of HPAI lies. Daily close exposure to poultry vivax malaria. 2004. [cited 2007 May 15]. Available from 10. Yonemitsu K, Koreeda A, Kibayashi K, In March–April 2006, participants dling of poultry was reported. Rates of Ng’walali P, Mbonde M, Kitinya J, et in 3 settings (Vientiane, urban; Oudo- al. HPLC analysis of anti-malaria agent, mxay, semiurban; Attapeu Province poultry diseases were higher in urban chloroquine in blood and tissue from fo-rensic autopsy cases in Tanzania. Leg Med and Hinheub District, both rural) were and semiurban areas; veterinary sur- interviewed in the Lao language by veillance was low (10.2%).
means of a standardized 33-question Address for correspondence: Franklin Simoes survey. We recorded information about already heard of HPAI, mainly through de Santana Filho, The Foundation for Tropical behavior, poultry handling and keeping television. Urban residents ranked it Medicine of Amazonas, Av Pedro Teixeira 25 practices, and poultry deaths. We used as the most well-known poultry dis-Planalto, Manaus, Amazonas 69040000, Brazil; multivariate analysis (Stata, version 8; ease, but rural residents ranked it fi fth. Stata Corporation, College Station, TX, Less than half of the respondents had USA) to analyze the factors associated some knowledge of the disease signs with behavior changes.
Using a random sampling list of try; 28.4% could describe 1 symptom. visitors and vendors, we interviewed Half of the respondents believed that 461 respondents in 4 Vientiane city they were not at risk for human avian markets (Vientiane has 114,793 infl uenza or that their poultry were not households and 3,700 registered poul- at risk for it. Respondents in urban and try farms) (5). Semiurban respondents semiurban areas knew more about avi-were recruited in Oudomxay (40,987 an infl uenza than those in rural areas.
Risk Perceptions, households, 715 poultry farms), an ac- der. Rural respondents were recruited er) and south than in Vientiane. The To the Editor: After the 2004 from Hinheup District and in Attapeu poultry mortality rate during the cold
outbreak of highly pathogenic avian (19,050 households, 360 poultry season was similar to that of Cambo-infl uenza (HPAI) in poultry in Lao farms), near the Vietnam border. dia (6). Behavior regarding poultry People’s Democratic Republic (PDR), Twenty villages were randomly se- the Ministry of Health implemented lected, and 10 participants per village a high rate of poultry deaths, none of extensive virologic surveillance (1,2). were randomly selected for interview. the interviewees had notifi ed authori-Surveillance began in July 2005, and Approval for the investigation was ties. Since hearing about HPAI, 67.1% Emerging Infectious Diseases • • Vol. 13, No. 7, July 2007 Table. Avian influenza knowledge, risk perception, and poultry-keeping behavior, Lao People’s Democratic Republic* Response to dead poultry (n = 399)‡ Bury dead chickens Perceive risk for avian influenza In Laos *CI, confidence interval; NA, not applicable. †Mean nos. of poultry deaths were 15 (range 10–19), 27 (range 22–32), and 15 (range 13–18) for urban, semiurban, and rural areas, respectively. Total mean = 19.3; p<0.0001; 95% CI, 17.0–18.4.
‡95% CIs were 89–94, 62–76, and 1–7 for urban, semiurban, and rural areas, respectively. This study had limitations but ban (91.8%) than in rural sites (3.8%, provides new insights on Laotians’ p<0.001), higher than changes made havior regarding poultry. Multivariate knowledge and poultry practices with by their counterparts in Thailand (7), analysis showed the following factors regard to HPAI. Despite a high level and confi rmed by reports after the to be associated with behavior change: of awareness, populations underesti- 2004 outbreaks (8,9). These differ- level of education (p = 0.002), urban mated the risk, particularly those in ences between urban and rural areas living (p<0.001), knowledge of avian rural areas. Most respondents were might be explained not only by par-infl uenza risk (p<0.001) and disease unaware of appropriate poultry-han- (p<0.001), owning poultry (p<0.001), dling measures to reduce risk (6). The lower extent of the awareness cam-and being a government worker claimed changes were higher (more paign in rural areas.
Emerging Infectious Diseases • • Vol. 13, No. 7, July 2007 Failure to report poultry deaths 3. World Health Organization. Avian infl u- enza update no. 56: 15 August 2006. [cited 2007 Apr 18]. Available from http://www. absence of an offi cial compensation 4. Food and Agriculture Organization. Epi-statement, farmers may fear income demiology of H5N1 infl uenza in Asia and implications for regional control. [cited To the Editor: Viral gastroen-
2007 Apr 18]. Available from http://www.
teritis affects millions of people of all 5. National Statistical Centre. Lao statisti- rences (13). During early 2006 in increase in outbreaks of gastroenteritis cus also needs to be placed on building 6. Vong S, Coghlan B, Mardy S, Holl D, occurred (Figure): 155 outbreaks were capacity in the veterinary system ( sion, southern Cambodia, 2005. Emerg pared with 88 outbreaks during 2005. Control and Pandemic Preparedness 7. Takeuchi MT. Avian infl uenza risk com- munication, Thailand. Emerg Infect Dis. 2006;12:1172–3.
8. Food and Agriculture Organization. Live- Acknowledgments
stock report 2006. Rome, 2006. [cited in norovirus in stool samples, detected 2007 Apr 18]. Available from http://www.
of the Institut Francophone pour la Méde- 9. US Department of Agriculture. Laos poul- try and products: avian infl uenza 2005. Lao Health Authorities. We thank Evelyne and Louise Pelletier for advice and docu- 10. World Organization for Animal Health. creased successively: 0/47 (0%), 1/73 Laos 2002, veterinarians and technical (1.4%), 5/169 (3.0%), 8/106 (7.5%), personnel. [cited 2007 Apr 18]. Available from
Tropical Medicine training program of Address for correspondence: Hubert Barennes, of norovirus detection (22.5%) was the Institut Francophone pour la Médecine Institut Francophone pour la Médecine signifi cantly greater than that of any Tropicale, Vientiane, Lao PDR, granted by Tropicale, BP 9516 Vientiane, Lao PDR; email: Agence Universitaire de la Francophonie.
p<0.0001), including intestinal para-sites, foodborne bacterial pathogens Hubert Barennes,*
(Salmonella, Shigella, and Camplylo- Bertrand Martinez-Aussel,*
bacter), and enteric viruses (rotavirus, Phengta Vongphrachanh,*†
and Michel Strobel*
Tropicale, Vientiane, Lao PDR; and †Minis- References
within 4 weeks of the original article’s publication. Letters reporting cases, 1. Boltz DA, Douangngneun B, Sinthasack al. H5N1 infl uenza viruses in Lao People’s Democratic Republic. Emerg Infect Dis. 2. Witt CJ, Malone JL. A veterinarian’s ex- perience of the spring 2004 avian infl u- enza outbreak in Laos. Lancet Infect Dis. CM) (4). Information collected came Emerging Infectious Diseases • • Vol. 13, No. 7, July 2007


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