รายงานประจำปี 2562 สถาบันวิทยาศาสตร์การแพทย์ทหาร

สถาบันวจิ ัยวิทยาศาสตรก์ ารแพทยท์ หาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

อตั ราการติดเชอ้ื ก่อโรคไขร้ ิคเคท็ เซีย และสครบั ไทฟสั ในหนู ไรออ่ น และสตั วข์ า
ข้อดูดเลือด ในพ้ืนท่ีปฏิบัติการทางทหารตามแนวชายแดนภาคตะวันตกของ
ประเทศไทย

กมลวรรณ ศิริวัฒนกุล นฤพน คุตตะสงิ คี ยทุ ธพงษ์ สดุ สวาท สุชชนา แทบประสิทธิ์
วฒุ ิกรณ์ รอดความทกุ ข์ และ จริยาณาฏ เกวี

สถาบนั วจิ ัยวิทยาศาสตรก์ ารแพทยท์ หาร

รายงานความก้าวหน้า

การศกึ ษาระบาดวทิ ยาของโรคตดิ เชอ้ื ในพนื้ ทปี่ ฏบิ ตั กิ ารทางทหาร โดยเฉพาะโรคไขน้ ำ� โดยพาหะ มคี วามสำ� คญั และ
จำ� เปน็ ทจี่ ะตอ้ งดำ� เนนิ การเปน็ มาใชว้ างแผนปอ้ งกนั โรคใหแ้ กก่ ำ� ลงั พลทปี่ ฏบิ ตั กิ ารในพน้ื ทนี่ นั้ สถาบนั วทิ ยาศาสตรก์ ารแพทยท์ หาร
จึงด�ำเนินการส�ำรวจพื้นที่ปฏิบัติการทางทหารตามแนวชายแดนฝั่งตะวันตกของประเทศไทย ครอบคลุม 4 จังหวัด คือ
จว.กาญจนบรุ ี จว.ราชบรุ ี จว.เพชรบรุ ี และ จว.ประจวบคริ ขี นั ธ์ เกบ็ ตวั อยา่ งสตั วฟ์ นั แทะทอี่ าจเปน็ แหลง่ รงั โรคโดยการวางกรงดกั
ได้ท้งั หมด 51 ตวั จำ� แนกได้ 8 สายพันธ์ุ คือ หนูพุกใหญ่ (Bandicota indica) ร้อยละ 21.6 (11/51) หนทู ้องขาว (Rattus
rattus) ร้อยละ 21.6 (11/51) หนจู ด๊ิ (Rattus exulans) รอ้ ยละ 15.7 (8/51) หนฟู านสนี �ำ้ ตาล (Rattus rajah) ร้อยละ 13.7
(7/51) กระแต (Tupaia glis) ร้อยละ 11.8 (6/51) หนูพุกเล็ก (Bandicota savilei) ร้อยละ 7.8 (4/51) หนหู วาย (Rattus sa-
banus) รอ้ ยละ 5.9 (3/51) และ กระรอกดินข้างลาย (Menetes berdmorei) รอ้ ยละ 1.9 (1/51) และเก็บตวั อยา่ งสตั วข์ าข้อดดู
เลอื ด เห็บ หมัด ไร เหา ท่ีอาจเปน็ พาหะนำ� โรค ได้ 47 กลมุ่ ตวั อยา่ ง เป็นเหบ็ 11 กล่มุ ตัวอย่าง 2 สายพนั ธ์ุ คอื เห็บสนุ ขั
สีน้ำ� ตาล (Rhipicephalus sanguineus) ร้อยละ 19.1 (9/47) และ เห็บป่า (Haemaphysalis spp.) รอ้ ยละ 4.3 (2/47) เป็นหมดั
18 กลุ่มตวั อย่าง 4 สายพันธ์ุ คือ หมดั แมว 2 สายพันธ์ุคอื Ctenocephalides felis orientis ร้อยละ 23.4 (11/47) และ Cteno-
cephalides felis felis ร้อยละ 2.1 (1/47) หมัดหนู (Xenopsylla cheopis) ร้อยละ 10.6 (5/47) หมัดไก่ (Echidnophaga
gallinacean) ร้อยละ 2.1 (1/47) ไร 16 กลุม่ ตวั อย่าง เปน็ ไรหนู (Echinolaelaps echininus) ทงั้ หมด ร้อยละ 34.1 (16/47)
และเหา 2 กลุม่ ตวั อยา่ ง คอื เหาไก่ (Lipeurus caponis) รอ้ ยละ 2.1 (1/47) และ เหาสนุ ัข (Heterodoxus spiniger) รอ้ ยละ
2.1 (1/47) ผลการตรวจดเี อน็ เอของเชอ้ื กอ่ โรคดว้ ยเทคนคิ Real-time PCR พบอตั ราการตดิ เชอื้ กอ่ โรคไขร้ คิ เคท็ เซยี (Rickettsia
spp.) ในตวั อยา่ งสตั วข์ าข้อดดู เลอื ด รอ้ ยละ 42.6 และเชอ้ื ก่อโรคสครับไทฟัส (Orientia tsutsugamushi) ในตัวอยา่ งสตั วฟ์ นั
แทะ ร้อยละ 2.0 แล้วน�ำข้อมูลผลการตรวจทางห้องปฏิบัติการมาวิเคราะห์ประมวลผลร่วมกันข้อมูลทางภูมิศาสตร์โดย
ใช้เทคโนโลยีภูมิสารสนเทศ สร้างเป็นแผนท่ีภูมิสารสนเทศแสดงพื้นที่เสี่ยงต่อการติดเช้ือโรคไข้น�ำโดยพาหะ เพื่อใช้เป็น
ขา่ วกรองทางการแพทย์ และเครอื่ งมอื แจง้ เตอื นภยั คกุ คามในพนื้ ท่ี เตรยี มความพรอ้ มใหก้ บั กำ� ลงั พลกอ่ นออกปฏบิ ตั กิ ารสนาม
ในพ้ืนที่เส่ียงดังกล่าวอย่างยิ่ง เพื่อให้ได้ข่าวกรองทางการแพทย์ในพ้ืนท่ีมาใช้วางแผนป้องกันโรคให้แก่ก�ำลังพลที่ปฏิบัติการ
ในพนื้ ท่ีน้นั

รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019 91

สถาบนั วจิ ัยวทิ ยาศาสตร์การแพทย์ทหาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Common Antibody Dependent Cell Mediated Cytotoxicity (ADCC)
Antibody Epitopes of HIV-1 CRF01_AE Env and Gag in Early
HIV-1 Infected Individuals

Soraya Sangjan1, Silawan Ampol1, Suchana Tabprasit2, Navin Horthongkham1, Thippawan Chuenchitra2, Pattama Ekpo1
and Wannee Kantakamalakul1
1Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2Armed Force Research Institute of Medical Sciences (AFRIMS), Ratchathewi, Bangkok 10400, Thailand

ABSTRACT

Background: There have been a few studies aimed at identifying epitopes of ADCC-inducing
antibodies when compared to those of neutralizing antibodies and cytotoxic T lymphocytes against
a variety of HIV-1 clades.
Objective: To map the common ADCC epitopes of HIV-1 CRF01_AE.
Methods: We screened 65 sera of confirmed early HIV-1 CRF01_AE infected individuals for
ADCC antibody against gp120 utilizing an EGFP-CEM-NKr flow cytometric assay. Sera with high
ADCC antibody were then examined against ADCC epitopes using the complete HIV-1 CRF01_AE
gp160- and subtype A Gag-overlapping peptide sets which were divided into 7 pools: E1-E7 and
5 pools: G1-G5, respectively. Each positive peptide pool was further investigated for fine ADCC
epitope mapping using matrix formats.
Results: Twenty, 25 and 20 sera demonstrated the high-, medium- and low-ADCC antibody activities
against gp120, respectively. Interestingly, 11 Env- and 6 Gag-peptides of pools E3, E4, E7 and
pools G1, G2, G4 with high ADCC responses were also responded by at least 20%, 12% and 5%,
10% of medium- and low-ADCC antibody sera, respectively. These eleven common Env ADCC
epitopes were localized at C2-V3-C3-V4 regions of gp120 and cytoplasmic tail of gp41 while six
common Gag ADCC epitopes were localized at p17-p24-p2 regions.
Conclusions: Although the degree of ADCC antibody responses to the gp120 protein varied from
high to low, there were certain consensus Env and Gag peptides that could induce the ADCC
antibody responses of 21.54-58.46% and 23.08-41.54%, respectively of the early infected individ-
uals. This epitope information should be useful as the new antibody-based vaccine immunogens.

Asian Pac J Allergy Immunol. 2019 Mar; 37(1):43-50. doi: 10.12932/AP-101017-0177

92 รายงานประจำ�ปี 2562 ANNUAL REPORT 2019

สถาบันวิจยั วทิ ยาศาสตร์การแพทย์ทหาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Comparison of Antibody-Dependent Cellular Cytotoxicity Activity
Elicited in Recent and Chronic HIV-1-Infected Thai Individuals

Nithinart Chaitaveep1, Piraporn Utachee2, Sutchana Tabprasit1, Thippawan Chuenchitra1 and Masanori Kameoka3
1Armed Force Research Institute of Medical Sciences (AFRIMS), Ratchathewi, Bangkok 10400, Thailand
2Bureau ofVector-Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
3Department of Public Health, Kobe University Graduate School of Health Science, Hyogo, Japan

ABSTRACT

Subsequent to the establishment of human immunodeficiency virus type 1 (HIV-1) infection,
host immune responses including humoral and cellular responses against HIV-1 are induced and
maintained throughout disease progression. Antibody-dependent cellular cytotoxicity (ADCC)
response plays a keyrole in protecting vaccinees from HIV-1 infection in the Thai RV144 vaccine
trial. In addition, anti-HIV-1 ADCC response is involved in controlling and slowing disease
progression. However, the level of ADCC response in the course of disease progression especially
in recent HIV-1- infection is poorly understood. The study compared levels of anti-HIV-1 ADCC
activities between serum samples derived from recent and chronic HIV-1-infected individuals in
Thailand using peripheral blood mononuclear cells as effector cells and HIV-1-infected CEM.NKR
CCR5+ cells as target cells. Distribution of ADCC activities do not differ significantly between
both groups. Anti-HIV-1 ADCC activity was induced in a limited number of recent and chronic
HIV-1-infected individuals. However, induction ratio of ADCC activity is not significantly related
to the course of disease progression. These results provide additional information on ADCC responses
during the course of HIV-1- infection, recent and chronic.

Keywords: antibody-dependent cellular cytotoxicity, chronic HIV-1- infection, recent HIV-1-
infection, Thailand

Southeast Asian J Trop Med Public Health Vol 50 No. 4 July 2019

รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019 93

สถาบนั วิจยั วทิ ยาศาสตร์การแพทยท์ หาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Degenerative Ultrastructural Changes of Infected Hamster
Gastrocnemius Muscle with Leptospira interrogans, Serovar
Pyrogenes

Kingkarnonk Ruxsanawet1, Kleophant Thakrerngpol2, Paisal Parichatikanond2, Duangporn Phulsuksombati3,
Noppadon Sangjun3, Chaiyaphruk Pilakasiri3, Wiphawi Hipkaeo4, Kasem Koedpuech1 and Kajee Pilakasiri1
1Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
2Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
3Armed Force Research Institute of Medical Sciences (AFRIMS), Ratchathewi, Bangkok 10400, Thailand
4Department of Anatomy, Faculty of Medicine Khon Kaen University, Khon Kaen 40002, Thailand

ABSTRACT
Objective: The purpose of this research is to investigate the degenerative ultrastructural changes
of the gastrocnemius muscle of hamsters infected with Leptospira interrogans serovar Pyrogenes
at different periods of infection.
Methods: Thirty adult female hamsters were included in the study. They were divided into control
group (six hamsters) and experimental infected groups (twenty four hamsters). Those of the control
group were injected intraperitoneal with 0.5 ml. PBS while those of infected group were injected
by the same procedure with 0.5 ml. PBS containing 1x108 of leptospires per milliliter. Each three
of infected animals were sacrificed respectively at 1 hour and 6 hours as well as 1, 2, 3, 4, 5 and
6 days after infection. The gastrocnemius muscles were processed for transmission electron
microscopy.
Results: The hamster gastrocnemius muscle of all infected groups showed many kinds of degenerative
ultrastructural changes, including myofibril, nucleus, lipid vacuole, mitochondria, sarcoplasmic
reticulum, capillary, hemorrhage, inflammation and leptospire presentation. These changes were
found as early as one hour after infection and progressive continuing until the last day of experiment.
Conclusion: The finding obtained should correspond to clinical manifestation of the calf muscle
of leptospirosis patients.

Keywords: Gastrocnemius muscle; leptospirosis; ultrastructure

Siriraj Med J. 2019. 71 (Suppl 1): S160-S169.

94 รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019

สถาบันวิจัยวิทยาศาสตร์การแพทยท์ หาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Development of Multiplex PCR for Neglected Infectious Diseases

Nutchanart Sea-liang1, Amornpun SereemaspunID1*, Kanitha Patarakul2, Jariyanart Gaywee3, Wuttikon Rodkvamtook3,
Nattachai Srisawat4, Supaporn Wacharaplusadee5 and Thiravat Hemachudha5
1Nanomedicine Research Unit, Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,
2Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,
3Armed Force Research Institute of Medical Science (AFRIMS), Ratchathewi, Bangkok 10400, Thailand
4Nephrology Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,
5Thai Red Cross Emerging Infectious Diseases-Health Science Centre, World Health Organization Collaborating Centre for Research and
Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
These authors contributed equally to this work. * [email protected]

ABSTRACT

Scrub typhus, murine typhus, and leptospirosis are widely neglected infectious diseases
caused by Orientia tsutsugamushi, Rickettsia typhi, and pathogenic Leptospira spp., respectively.
Patients usually present with non-specific symptoms and therefore are commonly diagnosed with
acute undifferentiated febrile illness. Consequently, patients face delayed treatment and increased
mortality. Antibody-based serological test currently used as gold standard has limitations due to
insufficient antibody titers, especially in the early phase of infection. In this study, we aimed to
develop multiplex PCR to combine 3 primer pairs that target specific genes encoding 56-kDa TSA
of O. tsutsugamushi, 17-kDa antigen of R. typhi, and LipL32 of L. Interrogans and evaluate its
performance in comparison to the standard serological tests. Using EDTA blood samples of known
patients, the sensitivity and specificity of our multiplex PCR was 100% and 70%, respectively.
In addition, the assay was able to diagnose the co-infection of scrub typhus and leptospirosis.
The assay may be useful in identifying causative agents during the early phase of these diseases,
enabling prompt and appropriate treatment.

PLOS Neglected Tropical Diseases | https://doi.org/10.1371/journal.pntd.0007440 July 8, 2019

รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019 95

สถาบันวจิ ยั วิทยาศาสตรก์ ารแพทยท์ หาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Mil-Mil Experience Sharing in Outbreak Investigation of Scrub
Typhus

Wuttikorn Rodkvamtook1, Han Tin Aung2, Yutthapong Sudsawat1, Titisak Nirattsai3, Weera Boonsome1,
Jariyanart Gaywee1, Tin Maung Hlaing2 and Pramote Imwattana1
1Armed Force Research Institute of Medical Science (AFRIMS), Ratchathewi, Bangkok 10400, Thailand
2Defense Services Medical Research Centre, Nay Pyi Taw, The Republic of the Union of Myanmar
3Royal Thai Army Medical Department, Bangkok, Thailand

ABSTRACT

Background: Evidences indicated the presence of rickettsiosis, the arthropod-borne febrile illnesses
along Thai-Myanmar border. These diseases are difficult to prevent and control due to variety
factors involving disease transmission. Information of arthropod vectors, reservoir hosts as well as
pathogenic rickettsia strains in particular area is crucial to establish effective disease prevention
and control strategy.
Objective: In response to this health threat, Thailand and Myanmar Medical Corps established
mil-mil collaboration to fight against rickettsiosis. A joint surveillance program aiming to gain
information of rickettisal pathogens spreading in the Republic of the Union of Myanmar and Thailand
and also the transmission cycles has been conducted.
Method: Scrub typhus outbreak investigation in Thailand and Myanmar febrile disease surveillance
were performed as Thailand-Myanmar jointed working during September-November 2018. Research
practice in field survey for reservoirs and vectors as well as laboratory evaluation for rickettsial
infection was carried out in manner of sharing and transferring.
Results: Outbreak investigation in Thailand showed 28% and 6% of captured rodents were positive
for scrub typhus and murine typhus agents, respectively. 53.3% (16/30) of blood sucking arthropods
(6 tick, 9 flea and 1 louse pools) were positive for rickettsiae by 17 kDa realtime PCR. Rickettsia
asembonensis, the causative agent of flea-borne spotted fever were identified in 9/16 of positive
arthropods. Of total 200 febrile patients recruited from military health facilities throughout the
Republic of the Union of Myanmar, 8% and 0.5% displayed seroconversion to scrub typhus and
murine typhus agents, respectively. A total of 62 blood sucking arthropod pools collected from
pets, poultry, livestock and rodents in Ywar Thit village around Tatkone region, Myanmar comprised
of 2 tick species (Rhipicephalus sanguineus and R. microplus), 2 flea species (Ctenocephalides
felis and C. canis) and 3 louse species (Haematopinus eurysternus, Heterodoxus spinigerum and
Liperus caponis). Rickettsial 17 kDa gene was detected in 35.5% of collected arthropods (6/30 tick,
13/23 flea and 3/8 louse pools). Species specific realtime PCR identified 17 of 22 rickettsia DNA
found were Rickettsia asembonensis. These mil-mil surveillance activities clearly demonstrated the
presence of rickettsia infection in this region.
Conclusions: Specific information regarding the causative agents and transmission of rickettsial
diseases is essential to establish an effective disease prevention and control program in this region.
Experience sharing during this mil-mil collaborative activity will also extend the capacity for outbreak
response as well as for active surveillance of theses endemic arthropod-borne febrile diseases among
ASEAN countries.

Podium presentation: The 26th Myanmar Military Medicine Conference, Yangon, Myanmar, 20-22
February 2019

96 รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019

สถาบนั วจิ ัยวทิ ยาศาสตร์การแพทย์ทหาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Molecular Survey for Arthropod Vectors of Rickettsiae in
The Republic of The Union of Myanmar

Han Tin Aung1, Kamonwan Siriwatthanakul2, Wuttikorn Rodkvamtook2, Myo Thant1, Kyaw Soe1, Min Kramyoo2,
Jariyanart Gaywee2 and Tin Maung Hlaing2
1Defense Services Medical Research Centre, Nay Pyi Taw, The Republic of the Union of Myanmar
2Armed Force Research Institute of Medical Science (AFRIMS), Ratchathewi, Bangkok 10400, Thailand

ABSTRACT

Background: Arthropod-borne diseases are difficult to prevent and control because of variety
factors involving disease transmission. Gaining insight of specific arthropod species harboring
specific strains of pathogens in particular area will allow public health stakeholders to adopt an
effective disease prevention and control. Several evidences continuously indicated the presence of
rickettsiosis, the arthropod-borne febrile illnesses along Thai-Myanmar border
Objective: In response to these health threat, we have initiated an active surveillance program
aiming to survey for these bacteria transmission cycles in the Republic of the Union of
Myanmar since September 2018
Method: Three rodents were captured and evaluated for rickettsia infection by serology as well as
molecular methods. No trace of rickettsia was found in rodents. A total of 62 blood sucking arthropod
pools were collected from pets, poultry, livestock and rodents in Ywar Thit village around Tatkone
region.
Results: Two species of ticks (Rhipicephalus sanguineus: Brown dog tick and R. microplus: Cow
tick), 2 species of fleas (Ctenocephalides felis: Cat flea and C. canis: Dog flea), 3 species of louse
(Haematopinus eurysternus: Short-nosed Louse, Heterodoxus spinigerum: Dog Louse, and Liperus
caponis: Poultry wing louse) and 1 species of mite (Dermanyssus gallinae) were identified. Using
real-time PCR, Rickettsial 17 kDa was detected in 35.5% (22/62) of collected arthropods composed
of 6/30 tick pools, 13/23 flea pools and 3/8 louse pools. Species specific realtime PCR identified
17 of 22 rickettsia DNA found were Rickettsia asembonensis, the causative agent of flea-borne
spotted fever. Confirmation by sequence analysis is ongoing.
Conclusions: The survey results were subsequently analyzed with geographical information to
generate risk area maps, a useful tool for epidemiology warning of arthropod borne diseases in
those areas.

Poster presentation: The 2nd ASEAN Military Medicine Conference, Yangon, Myanmar,
17-21 February 2019,
Podium presentation: The 26th Myanmar Military Medicine Conference,Yangon, Myanmar,
20-22 February 2019

รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019 97

สถาบันวจิ ยั วิทยาศาสตรก์ ารแพทยท์ หาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Neutralization Activity Pattern of Recent HIV-1 Infection in Young
Thai Men, 1999-2013

Sutchana Tabprasit1,2, Thippawan Cheunchitra2, Navin Horthongkham1, Wannee Kantakamalakul1, Chitraporn Karnasuta1
and Ruengpung Sutthent1
1Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
2Armed Force Research Institute of Medical Sciences (AFRIMS), Ratchathewi, Bangkok 10400, Thailand

ABSTRACT

Strength and breadth of neutralizing antibodies of 133 HIV-1 infected young Thai men,
randomly selected from the annual serosurveillance, 1999-2013, were classified using a multiassay
algorithm (ELISA, IgG-Capture HIV-EIA and western blotting) into 38 sera in Fiebig stage V
(late acute infection phase), 71 in Fiebig stage VI (early chronic infection phase) and 24 in chronic
infection sample groups. TZM-bl neutralizing antibody (Nab) assay against five HIV pseudovi-
ruses, namely, MN subtype B/1990, CM235/CRF01_AE/1990, 0503M02138/ CRF01_AE/1996,
620354CRF01_AE/2005 and 427299.c12/CRF01_AE/2006, was employed to study neutralizing
activity, revealing neutralization strength of chronic infection group is significantly higher than
those of Fiebig stage V and VI groups. Of the five pseudoviruses, MN/B pseudovirus, a tier 1A
virus, was the most neutralizing sensitive, both in neutralization strength and breadth by all three
serum groups. Among CRF01_AE pseudoviruses, CM235/E was the most sensitive to the neutral-
izing ability of Fiebig stage VI and chronic serum groups. Neutralization frequency against each
pseudovirus increased from Fiebig stage V to Fiebig stage VI and then to chronic infection serum
groups, with the latter being highest against MN/B pseudovirus (92%). Neutralization ability of
Fiebig stage VI serum group (33.33%) from 1999-2005 is significantly broader than that (12.00%)
from 2006-2013 (p=0.008), but chronic infection serum group had the most neutralization breadth.
Neutralization frequency (29%) of Fiebig stage VI sera from 1999-2005 against 620354/E pseudo-
virus is significantly higher than that (8%) from 2006-2013 (p=0.018). Neutralization pattern of
recently HIV- infected Thai sera showed potency and breadth to neutralize tier 1 clade-mismatched
viruses and, thus, may be used for further vaccines against non-clade specific HIV.

Keywords: Fiebig staging, HIV-1 infection, neutralizing antibody, TZM-bl neutralization anti-
body assay

Southeast Asian J Trop Med Public Health Vol 49 No. 6 November 2018

98 รายงานประจำ�ปี 2562 ANNUAL REPORT 2019

สถาบนั วิจยั วิทยาศาสตร์การแพทยท์ หาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Reduced Renal Colonization and Enhanced Protection
by Leptospiral Factor H Binding Proteinsas a Multisubunit
Vaccine against Leptospirosis in Hamsters

Teerasit Techawiwattanaboon1,2, Christophe Barnier-Quer3, Tanapat Palaga4, Alain Jacquet2, Nicolas Collin3,
Noppadon Sangjun5, Pat Komanee5, Surapon Piboonpocanun6 and Kanitha Patarakul1,2
1Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok 10330, Thailand
2Chula Vaccine Research Center (Chula VRC), Center of Excellence in Vaccine Research and Development, Chulalongkorn University,
Pathumwan, Bangkok 10330, Thailand
3Vaccine Formulation Laboratory (VFL), University of Lausanne, 1066 Epalinges, Switzerland
4Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand
5Armed Force Research Institute of Medical Sciences (AFRIMS), Ratchathewi, Bangkok 10400, Thailand
6Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand

ABSTRACT

Subunit vaccines conferring complete protection against leptospirosis are not currently
available. The interactions of factor H binding proteins (FHBPs) on pathogenic leptospires and host
factor H are crucial for immune evasion by inhibition of complement-mediated killing. The inhibition
of these interactions may be a potential strategy to clear leptospires in the host. This study aimed
to evaluate a multisubunit vaccine composed of four known leptospiral FHBPs: LigA domain
7–13 (LigAc), LenA, LcpA, and Lsa23, for its protective efficacy in hamsters. The mono and
multisubunit vaccines formulated with LMQ adjuvant, a combination of neutral liposome,
monophosphoryl lipid A, and Quillaja saponaria fraction 21, induced high and comparable specific
antibody (IgG) production against individual antigens. Hamsters immunized with the multisubunit
vaccine showed 60% survival following the challenge by 20× LD50 of Leptospira interrogans
serovar Pomona. No significant difference in survival rate and pathological findings of target
organs was observed after vaccinations with multisubunit or mono-LigAc vaccines. However,
the multisubunit vaccine significantly reduced leptospiral burden in surviving hamsters in comparison
with the monosubunit vaccines. Therefore, the multisubunit vaccine conferred partial protection
and reduced renal colonization against virulence Leptospira infection in hamsters. Our multisubunit
formulation could represent a promising vaccine against leptospirosis.

Keywords: leptospirosis; Leptospira; factor H binding protein; multisubunit vaccine; neutral lipo-
some;MPL; QS21

Vaccines (2019) Aug 22;7(3)

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สถาบันวิจัยวทิ ยาศาสตรก์ ารแพทย์ทหาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Sero-Survey for Scrub Typhus Infection in Febrile Patients in The
Republic of The Union of Myanmar

Myo Thant1, Wuttikorn Rodkvamtook2, Kyaw Soe1, Han Tin Aung1, Maneerat Somsri2, Kiatisak Somsri2, Min Kramyoo2,
Jariyanart Gaywee2 and Tin Maung Hlaing2
1Defense Services Medical Research Centre, Nay Pyi Taw, The Republic of the Union of Myanmar
2Armed Force Research Institute of Medical Science (AFRIMS), Ratchathewi, Bangkok 10400, Thailand

ABSTRACT

Background: Rickettsioses are reported as one of the health problems spreading over Asia.
Evidences were also demonstrated number of rickettsial patients and the presence of vectors along
Thai-Myanmar border. In response to this concern, we have initiated a surveillance program aiming
to survey for pathogenic rickettsiae and to investigate of how these bacteria transmitted to human
in the Republic of the Union of Myanmar since September 2018.
Objective: To identify which rickettsia species causing illness and to locate the disease spreading
areas.
Method: During 2017-2018, the high incidence of scrub typhus was reported in Nakornrathchasima
Province, Northeastern Thailand. Survey of reservoir hosts and vectors were performed in outbreak
areas to investigate the disease transmission cycle during September 2018.
Results: 200 febrile patient serum specimens were recruited from military health facilities throughout
the country. Using Indirect Fluorescence Assay with whole cell antigens of Orientia tsutsugamushi,
Rickettsia typhi and Rickettsia honei, TT118, 16 serum specimens displayed immune response to
scrub typhus agent and one specimen demonstrated history of murine typhus infection
Conclusions: We have now obtained preliminary information indicated that rickettsial infection
presence in Myanmar. Future direction is to implement a surveillance program focusing survey
area for pathogenic rickettsiae and actively investigate the transmission cycle of these bacteria.
This information is essential for health authority to establish an effective prevention and control
strategy for the Republic of the Union of Myanmar.

Podium presentation: The 26th Myanmar Military Medicine Conference, Yangon, Myanmar, 20-22
February 2019

100 รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019

สถาบันวิจัยวทิ ยาศาสตรก์ ารแพทย์ทหาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Survey of Rickettsia spp. and Orientia tsutsugamushi Pathogens
Found in Animal Vectors (Ticks, Fleas, Chiggers) in Bangkaew
District, Phatthalung Province, Thailand

Amornrat Sanprick1, Thanapon Yooyen1,* and Wuttikon Rodkvamtook2
1Department of Biology, Faculty of Science, Thaksin University, Pa Phayom District, Phatthalung, 93210, Thailand
2Armed Forces Research Institute of Medical Science (AFRIMS), Royal Thai Army, Bangkok, 10400, Thailand

ABSTRACT

Rickettsial infections (Rickettsioses) are the causes of acute fever found in Thailand. It
is classified as acute febrile illnesses (AFI) transmitted by bloodsucking arthropod vectors (tick,
flea and chigger). This research investigated pathogens of scrub typhus in vectors from Bangkaew
district, Phatthalung province. A total of 303 pools of vector samples were ticks (Rhipicephalus
sanguineus, R. microplus and Haemaphysalis sp.), fleas (Ctenocephalides felis orientis, C. f. felis
and C.canis) and chiggers (Leptotrombidium deliense, Aschoschoengastia indica, Blankaartia
acuscutellaris and Walchia disparunguis pingue) collected from reservoir hosts (dogs and rodents).
The 17 and 56 kDa gene of Rickettsia causing scrub typhus were found in 29% of ticks and 98%
of flea. DNA sequence analysis reveeled the detected strains were R.asembonensis and
Rickettsia sp. cf 1 and 5. The chiggers, 1 %, were infected with strain TA763, a pathogen of
scrub typhus.

Korean J Parasitol Vol. 57, No. 2: 1-7, April 2019. https://doi.org/10.3347/kjp.2019.57.2.1

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สถาบันวจิ ยั วิทยาศาสตรก์ ารแพทยท์ หาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Thailand-Myanmar Medical Corps: Mil-Mil Close Partnership in
Fighting Against Rickettsia Diseases

Jariyanart Gaywee1, Han Tin Aung2, Wuttikon Rodkvamtook1, Myo Thant2, Yutthapong Sudsawat1, Kyaw Soe2,
Kamonwan Siriwatthanakul1, Weera Boonsome1, Min Kramyoo1, Titisak Nirattsai3, Tin Maung Hlaing2 and
Pramote Imwattana1
1Armed Force Research Institute of Medical Science (AFRIMS), Ratchathewi, Bangkok 10400, Thailand
2Defense Services Medical Research Centre, Nay Pyi Taw, The Republic of the Union of Myanmar
3Royal Thai Army Medical Department, Bangkok, Thailand

ABSTRACT

Background: Evidences indicated the presence of rickettsiosis, the arthropod-borne febrile illnesses
along Thai-Myanmar border. These diseases are difficult to prevent and control due to variety
factors involving disease transmission. Information of arthropod vectors, reservoir hosts as well as
pathogenic rickettsia strains in particular area is crucial to establish effective disease prevention
and control strategy.
Objective: In response to this health threat, Thailand and Myanmar Medical Corps established
mil-mil collaboration to fight against rickettsiosis. A joint surveillance program aiming to gain
information of rickettisal pathogens spreading in the Republic of the Union of Myanmar and Thai-
land and also the transmission cycles has been conducted.
Method: Scrub typhus outbreak investigation in Thailand and Myanmar febrile disease surveillance
were performed as Thailand-Myanmar jointed working during September-November 2018. Research
practice in field survey for reservoirs and vectors as well as laboratory evaluation for rickettsial
infection was carried out in manner of sharing and transferring.
Results: Outbreak investigation in Thailand showed 28% and 6% of captured rodents were positive
for scrub typhus and murine typhus agents, respectively. 53.3% (16/30) of blood sucking arthropods
(6 tick, 9 flea and 1 louse pools) were positive for rickettsiae by 17 kDa realtime PCR. Rickettsia
asembonensis, the causative agent of flea-borne spotted fever were identified in 9/16 of positive
arthropods. Of total 200 febrile patients recruited from military health facilities throughout the
Republic of the Union of Myanmar, 8% and 0.5% displayed seroconversion to scrub typhus and
murine typhus agents, respectively. A total of 62 blood sucking arthropod pools collected from
pets, poultry, livestock and rodents in Ywar Thit village around Tatkone region, Myanmar comprised
of 2 tick species (Rhipicephalus sanguineus and R. microplus), 2 flea species (Ctenocephalides
felis and C. canis) and 3 louse species (Haematopinus eurysternus, Heterodoxus spinigerum and
Liperus caponis). Rickettsial 17 kDa gene was detected in 35.5% of collected arthropods (6/30 tick,
13/23 flea and 3/8 louse pools). Species specific realtime PCR identified 17 of 22 rickettsia DNA
found were Rickettsia asembonensis. These mil-mil surveillance activities clearly demonstrated the
presence of rickettsia infection in this region.
Conclusions: Specific information regarding the causative agents and transmission of rickettsial
diseases is essential to establish an effective disease prevention and control program in this region.
Experience sharing during this mil-mil collaborative activity will also extend the capacity for
outbreak response as well as for active surveillance of theses endemic arthropod-borne febrile
diseases among ASEAN countries.

Poster presentation: The 2nd ASEAN Military Medicine Conference, Yangon, Myanmar, 17-21
February 2019

102 รายงานประจำ�ปี 2562 ANNUAL REPORT 2019

สถาบันวิจัยวิทยาศาสตรก์ ารแพทย์ทหาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

Thailand-Myanmar Mil-Mil Collaborative Surveillance Program
for Rickettsiosis

Jariyanart Gaywee1, Han Tin Aung2, Wuttikorn Rodkvamtook1, Myo Thant2, Kamonwan Siriwatthanakul1, Kyaw Soe2,
Maneerat Somsri1, Chanokaun Timhaiphon1, Yutthapong Sudsawat1, Kiatisak Somsri1, Weera Boonsome1,
Min Kramyoo1, Thitisak Niratsai3, Tin Maung Hlaing2 and Pramote Imwattana1
1Armed Forces Research Institute of Medical Science (AFRIMS), Ratchathewi, Bangkok 10400, Thailand.
2Defense Services Medical Research Centre, Nay Pyi Taw, Myanmar.
3Royal Thai Army Medical Department, Bangkok, Thailand

ABSTRACT

Thailand and Myanmar established a mil-mil surveillance program aiming to gain information
of rickettisal pathogens spreading in the Republic of the Union of Myanmar and Thailand as well
as to investigate transmission cycle. Scrub typhus outbreak investigation in Thailand and Myanmar
febrile disease surveillance were performed as jointed working during September- November 2018.
Captured rodents in Thailand outbreak areas showed 28% and 6% positive for scrub typhus and
murine typhus agents, respectively. 17 kDa rickettsia gene were detected in 53.3% (16/30) of
collected blood sucking arthropods (6 tick, 9 flea and 1 louse pools). Rickettsia asembonensis were
identified in 9/16 of positive arthropods. Of total 200 febrile patients recruited from military health
facilities throughout the Republic of the Union of Myanmar, 8% and 0.5% displayed seroconversion
to scrub typhus and murine typhus agents, respectively. A total of 62 blood sucking arthropod pools
were collected from pets, poultry, livestock and rodents in Ywar Thit village around Tatkone region,
Myanmar. Rickettsial 17 kDa gene was detected in 35.5% of collected arthropods (6/30 tick, 13/23
flea and 3/8 louse pools). R. asembonensis were identified in 17 of 22 rickettsia positive arthropod
pools. These mil-mil surveillance activities clearly demonstrated the presence of rickettsia infection
in this region. Specific information regarding the causative agents and transmission of rickettsial
diseases is essential to establish an effective disease prevention and control program. Experience
sharing during this mil-mil activities will also extend the capacity for outbreak response and active
surveillance of theses arthropod-borne febrile illnesses among ASEAN countries.

Poster presentation: The 30th Meeting of American Society for Rickettsiology, Santa Fe, New Mexico,
8-11 June 2019

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สถาบันวจิ ัยวทิ ยาศาสตร์การแพทย์ทหาร

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

104 รายงานประจำ�ปี 2562 ANNUAL REPORT 2019



รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019 U.S. ARMY MEDICAL DIRECTORATE สถาบันวจิ ัยวิทยาศาสตรก์ ารแพทยท์ หาร
ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES
ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES
Director

NCOIC

Executive Officer

Human Subjects Protection

Administration Departments Science Departments

Human Resources Health Security Cooperation Department of Bacterial and
Information Management (JUSMAG) Parasitic Diseases

Laboratory Operations - Defense Malaria Assistance Program
(DMAP)
Logistics Physical Security - Walter Reed/ AFRIMS Research Unit
Nepal (WARUN)
Occupational Health Research Support Services - Field Operations, Cambodia
Resource Management
Department of Entomology
107
Department of Retrovirology

Department of Veterinary Medicine

Department of Virology

- Kamphaeng Phet - AFRIMS Virology
Research Unit (KAVRU), Thailand

- Philippines - AFRIMS Virology
Research Unit (PAVRU )

As of 30 September 2019

สถาบันวจิ ัยวทิ ยาศาสตร์การแพทย์ทหารDirector
COL Eric D. Lombardini
ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES
Secretary Human Subjects Protection Office
108 รายงานประจำ�ปี 2562 ANNUAL REPORT 2019 Titikul Aramboonpong Director, HSPO

Bussara Sukpanichnant

Executive Officer
MAJ Brandon D. McCarter

Secretary Research Support
Marina Brook
Technology Transfer Specialist
Chief, Resources Management Chief, Human Resources Chief, Laboratory Operations Health Security Cooperation Officer Chief, Occupational Health Physician Suthicha Wuwongse
Mr. Ronald T. Goding Boodsaba Daechanaranon MAJ Persaud M. Vidhika to JUSMAGTHAI LTC Kevin M. Cron*
LTC Kevin M. Cron* Biostatistician
Supervisory Financial Management Analyst Human Resources Assistant Occupational Health Nurse/ CMA Somporn Krasaesub
Budget Analyst Pasana Chuanak Safety Manager and Radiation Medical Research Scientist Yinglak Fuangmarayat
Protection Officer (Senior Biosafety Specialist) Research Support Assistant
Chadchadaporn Phueakpipatana Human Resources Assistant Geerati Sornwattana Tippawan Tephassadin na Ayuthaya Anuch Apiradchajit
Financial Assistant Sasiprapa Pichitphan
Lantharima Ngernsiri Biosafety Officer Medical Research Scientist Research Support Administrator
Mail Clerk Amorn Upakaew (Inventory Control Manager) Siriporn Janariyawong
Financial Assistant Hasadee Vanasuntree
Sirin Limsurat Vacant Training Coordinator
CoAg Personnel - RTA Yok Rattanathan
Physical Security Specialist Kritika Singharaj
Mr. Frank DeSomer Quality Unit
Security Clerk
Phaiphet Longpadung Chief, Information Management Division Sr. Quality Assurance Specialist
Vacant Pornsuk Visudhiphan Grandin

Assistant Chief, IM Division/IT Specialist Quality Assurance Associate
Soukasame Inthavong Threechada Boonchan

Admin Assistant
Narumol Jongthaworn

Chief, Information Resources Center
Information Resources Specialist
Vacant

Computer Programmer System Administrator Specialist MAVS Library Language Instruction
Ganyakrit Kulsukthawee Vacant
Art and Graphics Assistant Technical Services Librarian English Language Instructor
Computer Technician, CoAg System Administrator Siripan Phatisawad Pattrapan Jullasing Eakkachai Trikomol
Rattanapol Charoenpol Thosapol Laosungnoen
Audio Visual Technician Reference Librarian Thai Language Instructor
Computer Technician, CoAg Computer Management Specialist Danuphol Junkaew Saowalak Booncharoenraksa Kaewkarn Noonpakdee
Songsak Panyawannarak Chalermkiat Wilairatanaporn
Photographer
Computer Technician Puwanai Sangsri Total Personnel = 45
Weerasak Yeephu Military = 4, GS = 3, FSN = 13, CoAg = 23, RTA = 1, NPSC = 1
Audio Visual Technologist
Anuwat Chamrat As of 30 September 2019
*Dual-hatted role

รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019 Chief, Department of Logistics
MAJ Anthony T. Shiepko, Jr.

Deputy, Logistics Department สถาบันวจิ ัยวิทยาศาสตรก์ ารแพทยท์ หาร
Wisnee Panichphol
ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES
Procurement Supervisor Interim Facility Management Manager
Wisnee Panichphol SFC Justin D. Goforth

Procurement Agent Engineer
Ranida Peeramongkolchai Eakkapob Srichumnan

Santi Kaewkrai Facility Management Service
Parachanun Khurimon Narong Vitisin
Thanittha Mekmethaneedon
Engineer Technician
Logistics Support Admin Assistant Perapol Thuannok
Apinya Chueadee
Facility Management Assistant
Ruedee Arunkhajohnsak

Supply & Services NCOIC Medical Maintenance NCOIC TMO NCOIC Property Book Assistant
SSG Eddie Martinez SSG David A. Argaez SFC Matthew J. Howard Nawaporn Chantakulkij
Property Clerk
Shipment Clerk Glassware Technician Combined Maint Supervisor TMO Supervisor Suwanich Saleewan
Tidatip Inphet Orapan Prathomwongkul Manoon Bunya Orawan Thaveesuk
Total Personnel = 46
Store Keeper Usana Chuanak Medical Equipment Technician Mechanic Military = 5, FSN = 23, CoAg = 18
Supoj Kitsanguan Sombat Hongbucha Ratchada Thipwong Anek Piyamaporn
Perapong Manavet Surasak Thabtim As of 30 September 2019
Sipphaporn Sombatpiboon
Receiving Clerk Biohazardous Waste Nipat Promchart Chauffeur
Jakkaphong Maneerat Disposal Technician Thanaphon Prayoonyuang
Thongpian Sattayadit Tharanat Thanatepasansakun
Parnu Thongboonlua Somsak Sangsri
Thanadej Pitakraksa
TMDE Coordinator
Rattiya Cheejun Surapol Okpai
Siriphong Amnuaysuksiri
109 Phattanasyn Navaroljittharath

Sittikorn Boonnak
Sarayuth Chienrum

LN2
Nirutti Boonnak
Chatree Kumhom
Niphon Sawangsang

สถาบันวจิ ัยวทิ ยาศาสตร์การแพทย์ทหารProject ManagerProgram Manager-DMAPDepartment Chief, Bacterial and Parasitic Diseases
Krisada Jongsakul, MD CDR Nicholas J. Martin, PhD COL Norman Waters, PhD
ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCESDMAP AdministratorDeputy Program Manager-DMAP
Anan Wongpinyochit Assistant Chief
110 รายงานประจำ�ปี 2562 ANNUAL REPORT 2019LTC Kevin Cron, MD (Head of Research)
MAJ Samandra Demons, PhD
Assistant Chief
(Head of Clinical Operations) WARUN , NEPAL

LTC Mariusz Wojnarski, MD Director of WARUN
Sanjaya Shrestha, MD (CA)
Administrative Support

Senior Clinical Study Physician Medical Research Aide Laboratory Management Admin
Michele Spring, MD, MSPH Vacant Panita Gosi, PhD

Program Management Admin Financial Management Admin Boonchai Wongstitwilairoong WARUN Team
Vacant Kanit Teerathumaskul
Nucharee Thongsen - Nisha K.C. - Binob Shrestha
Sariya Chanyart Prapatsorn Ngaowichit
Field Operations, Thailand - Subhadra Shakya - Anandi Vaidya

- Chandra K. Gurung - Bina Sakha

- Shankar Khadka - Brajen Dev Shrestha

- Ram Sharan Magar - Bishnu Rayamajhi

- Rameshwor Als Magar - Jasmin Shrestha

Section Chief and Principal Investigator - Bharat Thapa - Samita Bajracharya
Phimphan Pisutsan, MD
Deputy Section Chief - Shiva Ali Magar - Pashupati Khanal
Ladaporn Bodhidatta, MD
- Rekesh Shakya - Ashish Shrestha

Total Personnel = 45 - Ghuran Rajdhami - Jid Chani Rana
Military = 4, GS = 3, FSN = 13, CoAg = 23, RTA = 1, NPSC = 1
- Ramila Gurung
As of 30 September 2019
- Pabitra Rayamajhi

- Bishnu Prasad

Clinical Field Team Laboratory Field Team *Dual-hatted role Chief, Laboratory Operations

• Nichapat U-Thaimongkol, RN • Worachet Kuntawunginn (Team Leader) CPT (P) Brian Vesely, PhD, MPH
• Nillawan Buathong, RN • Chadin Thongpiam
• Sabaithip Sriwichai, RN • Chaiyawat Mathavarat Bacteriology Pharmacology and Bioanalytical Molecular Biology
• Siriporn Sornsakarin, RN • Kamonporn Poramathikul Laboratory Laboratory Laboratory
• Umaporn Suksawad, RN • Kingkan Pidtana
• Vacant • Kittijarankon Phontham Section Chief Section Chief Section Chief
• Montri Arsanok Woradee Lurchachaiwong, PhD Pattaraporn Vanachayangkul, PhD (FSN) Paphavee Ketwalha, PhD
• Parat Boonyarangka
• Saowaluk Wongarunkochakorn Team Team Team
• Dutsadee Peerapongpaisarn • Chanikarn Kodchakorn (CA) • Chaiyaporn Chaisatit
Field Operations, Cambodia • Nantanat Wongpatcharamongkol • Winita Ta-aksorn (CA) • Nuanpan Khemnu
• Paksathorn Kietsiri • Panida Nobthai
National Malaria Center • Wilawan Oransathid Malaria Culture and In Vitro • Patcharawalai Wasanaroongroj
• Wirote Oransathid Drug Sensitivity Laboratory • Pimmada Sakpaisal
Section Chief and Principal Investigator • Piyaporn Sai-ngam
Immunology and Vaccinology Section Chief • SasikanyaThaloengsok
Chanthap Lon, MD, MCTM Laboratory Nonlawat Boonyalai, PhD (FSN) • Sasikorn Silapong
• Sirigade Ruekit
Deputy Section Chief Section Chief Team
Nattaya Ruamsap • Chantida Praditpol
Darapiseth Sea, MD, MPH • Chatchadaporn Thamnurak
Team • Kirakarn Kirativanich
Investigator Lab Technicians Clinical Research • Amporn Limsalakpetch • Watcharintorn Fagnark
Somethy Sok, MD Kheangheng Thay Coordinator • Dilara Islam, PhD
Chandara Sok • James Jones, PhD
Ponha Uk, MD Lychhea Huot Samon Nou • Kosol Yongvanichit
My Mok Sohei Hom • Patchariya Khantapura
Administrators Soklyda Chann • Sathit Pichyangkul, PhD
Roat Rangsey Mok Nareth Kong Sokna Ly • Siriphan Gonwong
Phyra Phon Pheaktra Oung • Utaiwan Srichairatanakul
Sinin Cheam Samel Buth
Sophea Yim Sarath Nuom
Thida San
Vandy Chheng Soch Va

Drivers Vannak Pheap Data and IT Team Total Personnel = 119
Chantha Keo Vy Dav Pheakdey Yan Military = 6, FSN = 26 , CoAg = 24, NPSC = 3, HJF = 1, Contractor =2
Samfanna Ton Yom You
Cambodia CoAg = 33, WARUN CoAg = 11, NPSC =13
Sea Em Somnang Iem As of 30 September 2019
Sokha Yos
*Note* Names listed in alphabetical order
Sokhanny Yos

รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019 Chief, Department of Entomology
MAJ Wesley McCardle

Deputy Department Chief สถาบันวจิ ัยวิทยาศาสตรก์ ารแพทยท์ หาร
MAJ Katie Poole-Smith
ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES
Admin Assistant Quality Administrator (QA)
Tanukorn Rumakom Nantavadee Suwanabun

Admin Assistant Secretary
Saruta Anukul Yanischa Ketmunin

Malaria Research, NRC Research Research Support
Kevin Kobylinski, PhD

Vector Biology and Control Diagnostic and Reemerging Diseases Malariology Insectary Mite and Rodent Support
Alongkot Ponlawat, PhD Ratree Takhampunya, PhD Ratawan Ubalee, PhD Siriporn Phasomkusolsil, PhD Surachai Leepitakrat

Medical Research Technologist Medical Research Technologist Medical Research Technologist Medical Research Technologist Medical Research Technologist
Thanyalak Fansiri, PhD Sawaanna, PhD Vichit Phunkitchar Kanchana Pantuwatana Taweesak Monkanna
Patcharee Khongtak Nitma Chanarat Amnart Kayha Orawan Thaveesuk Natthanun Auysawadi
Boonsong Jaichapor Jira Sakolvaree Waranya Buadok Tanaporn Kornkan
Arissara Pongsiri Suparat Chairuksa Insectary Technician
Wachiraphan Chittham Molecular Biologist Technician Opas Thachin
Nattaphol Pathawong Sommai Promstaporn Nattapat Rochanarutaiprida Yossasin Kertmanee
Preeraya Bousaraporn Tippayachai Supakit Wanasith
Jaruwan Tawong
Medical Research Technician Leptospirosis Model Jutarat Saengsuwan Nantaporn Monkanna
Udom Kijchalao Panadda Krairojananan, PhD Sakon Khaosanorh
Scrub Typhus Model
Somsak Tiangtrong Medical Research Technologist Piyada Charoensinphon, PhD
Kasima Wasuworawong
Medical Research Technologist
Sirima Wongwairot
Chawin Limsuwan

111 Total Personnel = 45

Military = 2, FSN = 13, CoAg = 29, NRC = 1
As of 30 September 2019

สถาบันวจิ ัยวทิ ยาศาสตร์การแพทย์ทหารQA SpecialistQA SectionChief, Department of RetrovirologyProgram Management Assistant
Benjapar Vesamavibool QA Supervisor COL Mark M. Fukuda Suda Wilairatanaporn
ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCESSopana Chatnilbandhu
QA Coordinator Assistant Department Chief Secretary
112 รายงานประจำ�ปี 2562 ANNUAL REPORT 2019Ajchariyarat Sangdara Dr. Siriwat Akapirat Jantana Uthesanan

Director, Research Division Program Manager Director, CAP Laboratory Non-Human Primate Laboratory Laboratory Director Department Science Manager
Suchai Kitsiripornchai, MD Research Support Section Head Dr. Siriwat Akapirat* (NHP), Head Department Safety Officer Alexandra Schuetz*, PhD

COG Senior Clinical Trials Robert A. Morgenthaler Denise Hsu, MD, PhD MAJ Thomas A. Musich*
Specialist
Program Coordinator NHP Laboratory Manager Humoral Immunology Laboratory Cellular Immunology Laboratory
Nampueng Churikanont Vivalya Khongkhakul Decha Silsorn (HI) Head (CI), Head
COG Clinical Trials Specialist
Administrative & NHP Medical Research MAJ Thomas A. Musich Alexandra Schuetz, PhD
Saowanit Getchalarat Logistics Coordinator Technologist
Nongluck Sangnoi HI, Medical Research CI, Laboratory
Nitit Isravudhakul Dutsadee Inthawong Technologist Supervisor
Jumpol Sopanaporn
Procurement Specialist Somsak Chantakulkij Yuwadee Phuang-Ngern
Rungnapa Muanyart Panupat Nadee Sirinan Madnote Weerawan Chuenarom

Logistics Specialist Jiraporn Puangkaew
Parnu Thongboonlua Surawach Rittiroongrad

IT Support Specimen Processing Laboratory (SPL) Laboratory Manager CI, Laboratory
Specialist and Archiving Manager Supervisor, CAP Lab Deputy Supervisor
Tossapol Ounhapattana Bessara Nuntapinit AFRIMS Retrovirology Clinical Laboratory Surat Jongrakthaitae

IT Support (ARCL/MOL) CI, Medical Research
Coordinator Rapee Trichavaroj Technologist
Nutthapol Pramual
SPL, Specimen Processing SPL, Specimen Archive CAP Lab Senior Medical Suchada Sukhumvittaya
Supervisor Data Manager Research Technologist Nipattra Tragonlugsana
Pornchanok Panjapornsuk
Phiromrat Rakyat Anant Phramtong Boot Keawboon
CAP Laboratory, Chayada Sajjaweerawan
SPL, Senior Laboratory SPL, Repository Technician Medical Research
Technician Kajornsak Chaiteamwong Putita Saetun
Nitipan Klamyusuk Technologist
Surasit Inprakong Anawat Phramtong Nantana Tantibul Total Personnel = 77
SPL Laboratory Technician Sarawoot Mongkolpun Bhubate Tongchanakarn Military = 2, FSN = 5, HMJF = 4, PRTR = 64
SPL, Data Entry Paramate Promnarate
Panjaree Ruangjan Pongstron Peachyai Vatcharain Assawadarachai As of 30 September 2019
Anake Nuchwong Karnjana Techwongtham *Dual-Hatted
Sukanya Lucksanawong
Pannadda Kruacharoen
Suwanee Techapitaksat
Worakarn Wongchankham
Witchuda Khamthai
Chaichana Chuendoung
SPL, Support Technician

Thiti In-ngarm

รายงานประจ�ำ ปี 2562 ANNUAL REPORT 2019 Chief, Department of Veterinary Medicine & Attending Veterinarian
LTC Luis A. Lugo

Deputy Department Chief & Chief, Divisions of Comparative Pathology & สถาบันวจิ ัยวิทยาศาสตรก์ ารแพทยท์ หาร
Chief, Research and Laboratory Animal Medicine Veterinary Medical Research
MAJ Matthew C. Reed ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES
Rawiwan Im-Erbsin, DVM

Clinical Veterinarian, Program Management
Supervisory
NCOIC/Program Manager Administrative Section QC, Training, GLP Medical Research
Kesara Chumpolkulwong, DVM SSG Carrie L. Josephson Admin Assistant Wallapa Thajeen Supervisor Scientist
IACUC/Secretary Angwara Arinhamapan Vacant
Clinical Veterinarian Piyanate Sunyakumthorn, PhD
Vacant, DVM
Administrative Associate Ganokwan Chaksurak Quality Control Assistant
Environmental Enrichment Launderer Boonhome Meepuak Surayuth Seegaewin
Coordinator Launderer Sunisa Kaewwaen

Siwakorn Sirisrisopa Medical Research Technologist
Manutsanun Inthawong
Environmental Enrichment
Coordinator Technician
Sakda Wongsawanonkul

Supervisor Supervisor Supervisor Supervisor Clinical Lab Supervisor
Vet Care Section Support Section Non-human Primate Section Small Animal Section Laksanee Inamnuay
Mana Saithasao Chardchai Burom
Natthasorn Komcharoen Anchalee Tungtaeng

Veterinary Technicians Support Technicians , Caretakers, Technologists, Technicians Medical Research
Alongkorn Hanrujirakomjorn Technologist
Support Section NHP Section Small Animal Section Noppon Popruk
Nuttawat Wongpim Sawaeng Sripakdee Chakkapat Detpattanan Dejmongkol Onchompoo Arasa Suttana
Khrongsak Saengpha Thanaphon Rattanathan
Siwadol Sammano Rachata Jecksaeng Medical Technologist
Phakorn Wilaisri Sakchai Lerdmontee Yongyut Kongkaew and Histotechnologist
Sonchai Jansuwan
Thanathorn Jirarot Sujitra Tayamun
Vacant Amnat Andang
Vacant Chaisit Pornkhunviwat Total Personnel = 46
Vacant Military = 3, FSN = 8 CoAg = 35
Manas Kaewsurind
Wuthichai Puenchompu As of 30 September 2019
Sitthidech Hanphongsak
113
Yosswat Kumhun
Kidanan Rungrueang

Paitoon Hintong
Sirachach Tangmaitrijit

สถาบันวจิ ัยวทิ ยาศาสตร์การแพทย์ทหารDirector, Laboratory Operations Chief, Department of Virology Out-going Chief
MAJ Anthony R. Jones, PhD LTC Stefan Fernandez, PhD COL Louis R. Macareo
ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES
Regional Clinical Investigator Molecular Administrative and Clinical Research Coordinator Kamphaeng Phet-AFRIMS
John Mark S. Velasco, MD114 รายงานประจำ�ปี 2562 ANNUAL REPORT 2019Chonticha Klungthong, PhD Logistics Support Thidarat Intararit Virology Research Unit

Clinical Investigator Kittinun Hussem Nualanong Akaraputtiporn Suttiman Wattanasrirote (KAVRU)
Kathryn B. Anderson, MD, PhD Piyawan Chinnawirotpisan, PhD Russama Jittawisutthikul Wanatsanan Sitkittitad Darunee Buddhari, MD
Prapanrat Kivwongngam
Virology/Serology Prinyada Rodpradit Yuwadee Sae-Yong Kanyakorn Rattanakorn Laboratory Section
Butsaya Thaisomboonsuk, PhD Thipwipha Phonpakobsin Apinop Surayan Benjawan Khuntirat, PhD
Wudtichai Manasatienkij Ubon Srangsrok
Viral Serology Yongyuth Poolpanichupatam Supaporn Sakaekhao Forradee Nuchsongsin Wallika Kulthongkam
Duangrat Mongkolsirichaikul Nednaris Seniwong Na Ayuthya Wichien Sa-Nguansuk
Taweewun Hunsawong, PhD Khajohn Joonlasak Philippines AFRIMS Kanyarat Phutthasophit
Prapapun Ong-Ajchaowlerd Tippa Wongstitwilairoong Virology Research Unit Quality Systems Unit Nantawan Kunchon
Rungarun Suthangkornkul Nawarat Charoensri
Project Management (PAVRU) Study Coordinators/Nurses
Kanittha Sirikajornpan Chitchai Hemachudha Maria Theresa P. Alera, MD Wipa Chawachalasai Rungkarn Hangsuwan
Kamonthip Rungrojcharoenkit Wiangchai Watcharanirun Chaleaw Saengchan
Information System Deputy Head Raveewan Siripokasupkul Dararat Kanjana
Kedsara Tayong Management Paula Corazon S. Diones, MD Chuthatip Mahayos
Yanin Kuncharin
Tipawan Thipwong Administrative Log Administrative Support/QC
Viral Culture Worrawut Leelanimit Support Data Management Rattiya Wannawong
Chuanpis Ajariyakhajorn, DVM Jittima Khiannukul Frances Dominique Y. Villano Rungkarn Kaenman
Wicha Panyalikhit
Thongchai Khiankaew Angkana Huang Margie Meca Parado Wanchai Inpho
Chutithorn Tawilert Alberto Amora Belleza
Winai Kaneechit Specimen Processing Pannarat Cheukanobon
Prachakkra Panthusiri Danny C. Obidas Noppol Sirichai
Jindarat Lohachanakul Nino J. Embalsado
Rewadee Klinmala Raymundo P. Sanchez Supaporn Kaewpongsri
URI Research Assistant Parinya Kruacharoen Nirun Khothasen
Methee Gomootsukavadee Edlyn A. Achay
Naphat Yimthin Jewernest C. Casquejo
Wipaporn Khanom Wonlana Theerapolumpun
Lab and Clinical
Wimonsri Tinrum Catherine B. Lago
Susie G. Leonardia
Maria Theresa G. Valderama Total Personnel = 98
Maria Teresa Despacio
Michael Ian T. Cuizon Military = 3, FSN = 19, CoAg = 70, Contract = 6
Maricar C. Vismanos As of 30 September 2019
Angeli Mae B. Reyes
Jaspher H. Baliguat
Jhufelyn Lou T. Inso
Josephine Bonete Gayrama
Maria Leanor Dizon Timbol
Maria Lourdes Cerdan Maghuyop

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ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES

USAMD-AFRIMS

Department of Administration

Resource Management Division

Mission:

The Resource Management Division is to ensure that the USAMD-AFRIMS Director and
departments, and other supported U.S. government agencies as directed, receive required fiscal
and budgetary guidance and education in an efficient and cost effective manner. This Resource
Management (RM) support extends to various field sites and laboratories located throughout the
Kingdom of Thailand, Nepal, the Philippines, Cambodia, Bhutan and in other countries in the
INDOPACOM area of responsibility as required.

Discuss Significant Activities Related to Organizational Mission:

During FY19, RMD with 1 U.S. Department of the Army general schedule (GS) employee
and 3 Foreign Service Nationals provided financial oversight of AFRIMS’s overall $19.3M
operating budget. This included an Army/DoD Research, Development, Test and Evaluation
(RDT&E) program of $3.2 million; Defense Health Program (DHP), including O&M and RDT&E
of $14.5 million. The reimbursable program totaled $1.34 million.

Constraints/Problems Encountered:

Historically, USAMD-AFRIMS does not receive current year allotments when missions
are required. Global Emerging Infections Surveillance (GEIS) funds (O&M 1-yr funds) do not
get allotted to AFRIMS until late 2nd QTR of the fiscal year. FY19 DOD funding was fully funded
by Congress prior to the fiscal year start. USAMD AFRIMS had yet to receive any GEIS funding
as of 20 February 2019. To address this, departments are able to delay some projects in relation
to funds arriving late. In some cases, funds from other projects must be used to maintain mission
readiness and accomplishment.

USAMD-AFRIMS is authorized a sub-cashier from the U.S. Embassy Bangkok. In late
CY19, the US Embassy Bangkok instituted policy that all reimbursements must be transacted
through the E2 travel system under local travel. This will reduce the total amount of cash
transaction reimbursements from the sub-cashier.

Solutions Devised:

Any transaction that is executed through the U.S. Embassy, Bangkok will have a time
delay in the disbursement. These transactions consist of all Foreign Service National salary, TDYs
that are within the U.S. State Department travel system (E2) and all procurement items submitted
through the U.S. Embassy, Bangkok, Manila, and Kathmandu General Service Office offices.
USAMD-AFRIMS must input a manual obligation in GFEBS for all of these transactions. U.S.
Embassy will submit reimbursement voucher through the Global Financial Services to the Defense
Finance and Accounting offices. The DFAS offices will send these unmatched disbursements to
WRAIR RM to match against the manual obligations. This cycle takes a minimum of 4 months to
complete to show a disbursement in GFEBS. USAMD-AFRIMS Logistics has been able to reduce
the amount of transactions through the GSO offices by utilizing government purchase cards and
blanket purchase agreements through United States Army Medical Research Acquisition Agency.

New Missions Added: None

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Old Missions Discontinued: None

Outcomes:

USAMD-AFRIMS RM was able to close out all expiring funding in accordance with
fiscal laws.

Human Subjects Protection Office (HSPO)

Mission:

The mission of the Human Subjects Protection Office is to support the USAMD-AFRIMS
research departments on research activities and to ensure that USAMD-AFRIMS research activities
comply with U.S., DOD and local regulations and WRAIR policies.

Discuss significant Activities Related to Organizational Mission:

The major activities of the HSPO are to interpret and apply regulations, policies, and
guidelines; develop SOPs and policies; perform protocol/report pre-review to ensure compliance
with WRAIR/AFRIMS submission and WRAIR requirements; and provide review and
determination for NHSR/exempted protocols.

Constraints/Problems Encountered:

 Conflicts of U.S. and local regulations/requirement on human subject protection.
 Lack of coordination between the HSPO and the Research Support Administrators to
create visibility on publication review and submission to ensure all publication are from
approved research activities.
 Unable to access WRAIR website reduces awareness of the RSS personnel to updates
to WRIAR SOPs and policies.
 AFRIMS cannot submit protocol package through eIRB system.
 Lack of personnel to support the Director, Human Subjects Protection Office in the
scope of human protection activities when on TDY and leave.

Solutions Devised:

 Participate in local conferences and research for local regulations/requirements in order
to identify the conflicts, ensure local authorities aware of U.S. requirements and work with them
to ensure compliance with U.S. requirements.

 Appropriate visibility in publication review and submission.
 Ask WRAIR POC for regular updates on new/revised SOP and policies.
 Submit protocol package through email.

New Mission Added:

 Update the Thai and Khmer CITI training modules to reflect the revised Common Rule.
 Plan for an accessor hiring with at least 1 year overlap (The Director’s retirement is in
March 2022)

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Old Mission Discontinued:

 AFRIMS-wide HSP SOP and HSP policy training is planned for AFRIMS staff in
outlying sites for 2020.

 Revise AFRIMS SOPs and policies to comply with the new Common Rules (45 CFR
46) effective 21 January 2019, DOD regulation and WRAIR SOPs and policies.

 Enhance local authorities’ awareness of the new requirement per 45 CFR 46.

Outcomes:

 AFRIMS-wide SOP and policy training was provided to all oversea site staff in 2019.
 The WRAIR HSPB and AFRIMS HSPO have conducted monthly TCON to update
policies and SOPs.
 The AFRIMS HSPO are working closely with WRAIR HSPB on work assignment and
preparing for the changes due to the new 45 CFR 46.

Department of Logistics

Mission:

The mission of the Department of Logistics is to ensure that the USAMD-AFRIMS
research departments, and other supported US Government agencies, as directed, receive required
general and laboratory supplies, equipment, biomedical maintenance, facilities maintenance,
transportation, glassware, shipping, property accountability and lifecycle management services in
an efficient and cost effective manner. This logistics support extends to various field sites and
laboratories located throughout the Kingdom of Thailand, Nepal, the Philippines, Cambodia,
Bhutan and in other countries in the INDOPACOM area of responsibility (AOR) as required.

Discuss Significant Activities Related to Organizational Mission: NSTR

Constraints/Problems Encountered:

 USAMD-AFRIMS continues to shift programmatic procurement support requirements
to DOD supporting elements IAW MOU-DoD & STATE CABLE 00030953, ISSUED 4 April
2011 and 18 August 2015 SAV the GSO conducted for the Office of the Procurement Executive.

Solutions Devised:

 The department strengthened partnerships and information sharing amongst DOD
enablers thought the Pacific AOR such as: U.S. Indo-Pacific Command (USINDOPACOM);
U.S. Army Pacific (USARPAC); Theater Lead Agent for Medical Materiel-Pacific (TLAMM-P);
Defense Logistics Agency Pacific (DLA); U.S. Army Medical Materiel Center-Korea
(USAMMC-K) and the 6th Medical Logistics Management Center (6th MLMC).

 Additionally the logistics department formed a relationship with Joint United States
Military Advisory Group Thailand (JUSMAGTHAI) for regional contracting support and blanket
purchase agreement (BPA) support. United States Army Materials Research Agency (USAMRA)
assisted AFRIMS procurement with the establishment of BPAs with three local vendors for
$11.5M ensuring 315 high demand line items will be available for AFRIMS.

 Continuity of logistical operations is paramount with six logistics departments
supporting various research missions thought the region. The Chief of logistics along with the

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AFRIMS director and XO, conducted an analysis on what position within the department of
logistics was best situated to serve as the deputy of logistics. It was determined that the
supervisor of the procurement section had the best visibility of all AFRIMS missions and
operations. The procurements supervisor’s position was amended to include the duties and
responsibilities of deputy of logistics and the position was reclassified.

 With the support of Naval Facilities Engineering Command (NAVFAC) AFRIMS
executed $1.7M in facility projects.

New Missions Added: No significant new mission were added.

Old Missions Discontinued: No old missions discontinued

Outcomes:

 As AFRIMS continues to foster streamlining of requirements and develop a joint,
interagency, intergovernmental, and multinational concept of logistics support, the department
anticipates a more responsive supply chain.

Department of Bacterial and Parasitic Diseases

Mission:

The mission of the Department of Bacterial and Parasitic Diseases is to support medical
product development to protect the warfighter from bacterial and parasitic diseases, and conduct
infectious disease surveillance for Force Health Protection and Global Public Health. Malaria and
diarrheal diseases are ranked in the top 5 on the DOD Threat Prioritization List of 2019.
Departmental efforts are focused on evolving antimicrobial and malaria resistant organism
threats in the INDOPACOM AOR.

Discuss Significant Activities Related to Organizational Mission: NSTR

Constraints/Problems Encountered:

 AFRIMS has a diverse workforce comprised of U.S. military, U.S. contractors, Foreign
Service Nationals and foreign contractors. Funding sources are restricted in certain staff categories,
even though staff are contributing members to funding agency projects creating workforce
management challenges.

 The clinical trial execution at multiple field sites requires coordination with multiple
stakeholders and travel across international borders. The requirement for processing TDYs at
least 45 days in advance remains challenging in this fast pace environment, when we need to
coordinate the TDYs with our partners who may not be able to confirm meeting dates this far in
advance. When the TDYs are submitted in access of 45 days as required by our policies, this
often requires amendments to our travel plans due to changes in mission requirements, and
invariable places additional administrative work on our staff.

Solutions Devised:

 To address this, careful planning is required to ensure that funding diversity matches
employee-type diversity.

 We are working with our partners to inform them about our requirement for travel and
the lead times needed to get approvals. We always try to anticipate the field requirements as
much as possible. We are trying to build capacity of our local staff to be able to attend to most
issues that require TDYs on short notice.

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New Missions Added:

 Studies to evaluate and select optimal drugs for chemoprophylaxis in the areas of
multi-drug resistance are in currently in development.

 New projects will improve pharmacovigilance of antimalarials and provide better
information on drug safety in this region.

 New antimalarial drug combinations are being investigated to provide interim solutions
for drug resistant malaria in this region. It was demonstrated that FDA approved drugs may lack
required efficacy against resistant strains of malaria from Southeast Asia. These efforts are aimed
to address the current treatment challenges.

 The rise of vivax cases in malaria endemic areas, in comparison to the steady decline
of falciparum cases allows us to address the current knowledge gaps in P.vivax diagnosis and
case management.

 BPD has become a leader in Southeast Asia for training staff on G6PD diagnostic tests,
helping facilitate access to radical cure interventions for this region. The projected work will
provide additional information on the safe use of Tafenoquine, which is the latest FDA-approved
antimalarial.

 With the recognition that currently available point-of care malaria diagnostics are
unable to diagnose vast majority of early infections, AFRIMS entered into a new agreement with
Hemex Health to evaluate a new promising malaria diagnostic test, that can be used at the point-of-
care. It overcomes the limitations of available RDTs, which cannot diagnose even the most severe
forms of malaria if the parasites have HRP2/3 deletions. Our clinical team also supported the
assessment of Biofire new diagnostic test, in collaboration with Virology Department. The new
platform can be used for screening of patients presenting with fever, to aid in the diagnosis. Both
diagnostic products will likely seek the FDA approval and have a potential to be significant
improvement to what is currently available for malaria diagnosis.

 New study on surveillance and molecular characterization of multidrug resistant (MDR)
pathogens at Battambang Referral hospital, Cambodia (WR2636). This project recently opened
for enrollment and already received MDROs isolates for analysis.

 Surveillance for antimicrobial susceptibility of Gonorrhoeae in Thailand (WR2600).
N. gonorrhoeae isolates will be obtained from three high risk populations, performance of drug
susceptibility testing and characterization of antibiotic resistance genes will be conducted.

 New field sites were established to support GEIS work in the area of antimalarial drug
susceptibility and enteric pathogens responsible for diarrheal illness. The new sites will include
both military and civilian populations and provide much wider geographical coverage.

 BPD department was selected as the reference laboratory for samples collected under
Phase II randomized, observer-blind, placebo-controlled study, to assess efficacy of meningococcal
Group B vaccine rMenB+OMV NZ (Bexsero) in preventing gonococcal infection. This will be
FDA regulated study, protocol is under development.

 Initiated a study on wound infections, evaluating microbial flora in patients from a
Philippine military hospital, enrollment started 13 May 2019. Discussions with the Armed Forces
of the Philippines co-investigators provided protocol specific guidelines for collection of wound
debridement.

 Initiated a collaborative project with PanTheryx, Ltd. to evaluate colostrum-egg product
against AFRIMS’ gastro intestinal pathogen library. PanTheryx is the premier supplier of bovine
colostrum globally, which has extensive applications in health and wellness, including GI health.

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 Collaborative project with the University of Maryland Baltimore (UMB) and funded
by UMB, Center for Vaccine Development and Global Health, USA. The UMB has established
functional assays to measure Shigella serum bactericidal (SBA), opsonophagocytic killing
antibody (OPKA) activity, microarray technology to determine Ab repertoire to Shigella antigens,
and flow cytometric assays. These new capabilities will become available at AFRIMS.

Old Missions Discontinued:

 Determining the prevalence of Cryptosporidium spp., Entamoeba histolytica and
Giardia lamblia in diarrheal stool samples of travelers and U.S. Military deployed to Southeast
Asia (SEA)

 Diarrheal Disease Surveillance for Cobra Gold; it was replaced with microbiome study
to address the more pressing questions today.

 Surveillance of Tropheryma whipplei and Escherichia albertii in Acute Diarrhea Cases
and Controls Using Molecular Methods. A total of 300 pathogen-negative samples (cases and
controls) from travelers and children diarrhea surveillance studies from Nepal, Thailand, and
Cambodia were evaluated for these pathogens.

 Collection, Enrichment, and Biostabilization of Mosquito-borne Zika Virus and
Plasmodium falciparum from Baited Substrate. This study was the initial phase of a DHP project to
laboratory validate a Zika virus Collection, Enrichment, and Biostabilization System (ZV-CEBS).
Aedes aegypti mosquitoes inoculated with 2.5x10^7 PFU/ml Zika virus were evaluated in an
infected mosquito feeding experiment. Mosquitoes were fed on attractive sugar baited (ASB) and
attractive toxic sugar baited (ATSB) cards after a 14 day extrinsic incubation period. Achieved
100% virus detection efficiency via PCR from cards exposed to infected mosquito feeding.
Achieved exceptional NS1 ELISA detection results from infected mosquitoes feeding on cards.
Produced a fully optimized system for detection of Zika virus infected mosquitoes via feeding
and/or excreta deposition on ASB and ATSB cards. Completed engineering of ASB/ATSB card
holding technology to maximize ASB and ATSB card surface area availability for mosquito
feeding and to provide a secure platform for field deployment of ASB/ATSB cards.

Outcomes:

 Cambodia is considered an epicenter of drug resistance. BPD analyzed previously
collected field samples against commonly used antimalarials which allowed us to characterize
recent changes in drug resistance. Information collected included drug resistance data on the
drugs that are FDA approved and available in the USA as well as local first line treatments. Due
to changes in drug resistance observed for this region, it was observed that limited treatment
options exist for P.falciparum malaria as the FDA approved treatments are losing efficacy or are
no longer effective. Ongoing malaria surveillance and characterization of drug resistance remain
as critical components of our mission.

 APACT Trial: Multicenter Therapeutic Efficacy Assessment of Pyronaridine-Artesunate
(Pyramax®) and new drug combinations with Atovaquone-Proguanil for the treatment of
uncomplicated P. falciparum malaria in Cambodia was launched in response to the growing threat
that malaria may become untreatable by available drug combinations. Based on the preliminary
data we presented at the international malaria meeting (ASTMH, 2019), the combinations under
study are well tolerated, with no added risk to cardiotoxicity or liver injury. Additional data on
efficacy is expected in 2020. The results from this study will be important to shaping the policy
on drug combinations for this region where single agent ACTs are less effective. It is important
to note that the addition of atovaquone-proguanil to the ACTs did not result in new safety signals.
This is important to the DoD given the reliance on atovaquone-proguanil for chemoprophylaxis
and treatment of multi-drug resistant malaria. The information on the safety and drug tolerability

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of the increasingly more complex drug regimens is providing us with much needed information
in the event that the currently available drugs stop working. Most volunteers (86%) reported that
taking the drug combinations was acceptable, which is important to national malaria programs.
The preliminary results from this study were presented to the Bill and Melinda Gates Foundation
and the World Health Organization.

 Selected as an awardee for Global Fund malaria study through UNOPS, which allowed
the department to diversify its typical sources of funding.

 Scientists from BPD were selected as members of the Provepharm Life Solutions
Consortium to help advance another antimalarial for FDA approval.

 Expanded malaria resistance surveillance study to Yala Province in Thailand, through
new collaborations with RTA and MoPH staff. This allowed sample collection in a region of
instability which is typically not accessible for malaria surveillance work. These partnerships
provided valuable information regarding border malaria in that region.

 Demonstrated that Travelan® can prevent development of Shigellosis in 75% of NHPs
receiving therapy. This can lead to new preventative tools for the US DoD. Additional work in
this area is planned for 2020.

 We entered into agreements with Shin Poong Pharmaceutical Company Ltd (SPP) to
collect additional safety and efficacy data for Artesuante-Pyronaridine, the latest ACT approved
by EMA. Future work may facilitate FDA approval and make this drug available to the DoD.

 New field sites were established in Kratie, Cambodia able to support clinical trials of
antimalarials, as well as drugs from other therapeutic areas. It is strategically co-located with the
emergency department, which will allow Phase 1-4 execution at that site.

 BPD participated in Subject Matter Exchanges in Cambodia, where we presented results
from our clinical trials that demonstrated benefit to the military from monthly chemoprophylaxis.
Based on the results from our studies (supported by other published data), now chemoprophylaxis
is being studied for high risk forest goers, and is considered as a possible solution to eliminate
malaria along the country borders. In addition to the reductions in malaria observed with
chemoprophylaxis, demonstrated incremental benefit of vector control measures, such as insecticide
treated uniforms, were recognized as major accomplishments and are now being considered as
adjuncts to current interventions. BPD was able to confirm that drug resistance is similar between
civilian and military populations, helping to guide malaria treatment recommendations for RCAF.

 The studies executed by BPD demonstrated that elimination of P.v malaria will require
new set of tools and additional research in this area is required. We have also demonstrated that
DHA-PIP which was recommended by other research groups as the preferred ACT for
chemoprophylaxis may not be effective in Cambodia due to high risk of breakthrough infections
while on chemoprophylaxis.

 Malaria Culture and In vitro Drug Sensitivity section supported WRAIR Experimental
Therapeutics by evaluating 4 Triazine compounds for ex vivo antimalarial drug susceptibility
against 100 field isolates of Plasmodium falciparum and Plasmodium vivax, which were collected
from field sites in Cambodia and Thailand as a part of an IND submission for the FDA.

 BPD provided data to Next-Generation Malaria Drug IPT resulting in down-selection
of a drug candidate, averting unnecessary spending of limited resources.

 Pharmacology and Analytical section supported AFRIMS Department of Veterinary
Medicine and WRAIR Experimental Therapeutics with 2 experiments (10 new antimalarial
candidates) in a P. cynomolgi infected rhesus monkey model. Of particular importance,
combination of tafenoquine, a recently approved drug for chemoprophylaxis and treatment of
relapsing malaria, and lead antimalarial compounds (Triazine, WR909390) demonstrated drug-
drug interactions, which was a key finding for DoD malaria drug development program.

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 A new malaria clinical study titled “Identification of hypnozoite biomarkers and
relapse patterns of Plasmodium vivax” was initiated in Khun Han District, Sisaket Province,
Thailand. This is a two-arm, open-label treatment study of Thai adults with acute, uncomplicated
P. vivax mono-infection malaria, designed to capture biomarkers of the dormant liver stage of
hypnozoites and determine 6-month efficacy of primaquine. The findings from this study may
contribute to identification of biomarkers of latent liver stage infections that can be used for
identifying those patients who require treatment with PQ/TQ post exposure before symptom
development.

 Thousands (6,627) of serum samples collected from Royal Thai Army recruits in 2012
from 77 provinces in Thailand tested positive for exposure to the following pathogens: Coxiella
burnetti (124, 2%); scrub typhus (2,105, 32%); Leptospira spp (1,176, 18%); Spotted Fever
group Rickettsia (296, 4.5%) and Rickettsia typhi (murine typhus) (339, 5.1%). These results will
be published in 2020.

 Survey of diarrheal illness in Cambodia provided new information on the etiology of
acute diarrhea and latest information on the antimicrobial drug resistance. A diagnostic platform
was developed and novel pathogen testing occurred on nonpathogenic E. coli isolates.

 1,630 samples from volunteers suspected of having influenza were collected in
Thailand (with 570 samples being processed in 2019). Similar studies are being conducted in
other neighboring countries, providing wide geographical coverage for influenza like illness.
The samples collected under these studies, in collaboration with Virology Department in
Thailand, and the Institute of Pasteur in Cambodia, allowed for characterization of antiviral drug
susceptibility, for outbreak preparedness. Indirectly, the samples are also being utilized for
generating influenza vaccines.

 Conducted surveillance for MDRO from wounds, hospital-acquired infections (HAIs),
and community-acquired infections at Queen Sirikit Naval Hospital, Sattahip, Thailand.
Characterization and identification of existing and novel antibiotic resistance genes from 715
MDROs using molecular techniques and whole genome sequencing was performed. In 2019,
over 715 MDROs isolates were obtained from the Naval Hospital.

 Over 98 MRDO isolates were obtained from the Philippines and the most consequential
finding was the 2662-18 isolate which confirmed presence of mcr-1. Manuscript Comparison of
Carbapenem-resistant Microbial Pathogens in Combat and Non-combat Wounds of Military and
Civilian Patients from Tertiary Military Hospital, Philippines (2013-2017) was accepted for
publication and is with the editor for the final edits prior to publication in Military Medicine.

 Discovered new insights into the immune protection mechanisms against primary
infection and relapse malaria in P. cynomolgi rhesus model.

Department of Entomology

Mission:

The mission of the Department of Entomology is to (1) develop and evaluate interventions
and vector control products to mitigate vector-borne diseases, (2) provide entomological support
for drug and vaccine studies, and (3) conduct comprehensive surveillance for vectors and
pathogens of military importance

Discuss Significant Activities Related to Organizational Mission: None

Constraints/Problems Encountered: None

Solutions Devised: None

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New Missions Added: None

Old Missions Discontinued: None

Outcomes:

 The Entomology Department maintained an ongoing collaboration with the National
Center of Zoonotic Diseases (NCZD), Mongolia to assess the potential vector threat of tick-borne
infections in Mongolia to better inform INDOPACOM force health protection decision makers.
This activity helps address the knowledge gap in tick-biology, identification, and distribution in
Mongolia, conduct molecular biology detection studies on the viral, bacterial, and associated
pathogens of collected specimen, and provides DOD access to reference specimens for future
outbreak response or training scenarios.

 The Department of Entomology Diagnostics and Re-emerging Disease section
identified B. miyamotoi in rodents and Ixodes tick a metagenomic approach to analyze bacterial
communities from diverse populations (humans, animals, and vectors) to investigate the role of
these microorganisms as causative agents of disease in human and animal populations in Nan
Province, Thailand. This bacteria species is known to cause “hard tick relapsing fever”, a form
of tick-borne relapsing fever.

 The Department of Entomology Insectary successfully colonized a local genus of
Sergentomyia sand flies. The original wild caught sand flies were originally collected from
Chantaburi province in Eastern Thailand. Currently, we are into the F3 generation in the lab.

 The Entomology Department continues to support Orientia tsutsugamushi research
through training (one Ph.D. student from University of Liverpool, United Kingdom, on detection
and genetic characterization of O. tsutsugamushi in Leptotrombidium chiggers) (vector of scrub
typhus) and providing Leptotrombidium mites to support the mite cell biobank project: a global
resource for in vitro research on mites and the pathogens they transmit. Entomology has also
entered into an agreement with Instituto de Ciencias e Inovacion en Medicina, Chile to establish
a colony of newly discovered Chilean chigger mites to facilitate the study of scrub typhus in
South America. This leverages AFRIMS Entomology’s unique experience in culturing chigger
mites. We continue to support global military engagements, including rodent and chigger
surveillance for scrub typhus and rickettsia risk assessment in areas used for the 2019 Cobra
Gold military training exercise in Thailand, with results published in U.S. Army Medical
Department Journal 2019 Jan-Jun; (1-18):29-39. Our researches were also invited to present as
Subject Matter Experts (SME) at the 2nd Military Medical Epidemiology for Emergency
Response among Military Medical Services of ASEAN Member States plus 8, where they
presented scientific findings about scrub typhus in Asia focused on military history and the
importance of vector identification due to recent changes in disease ecology.

 AFRIMS Entomology continues to support research into mosquito-borne disease
outbreaks, disease prevention, and vector control. Entomology assisted the Chiang Rai Provincial
Health Center, Ministry of Health to collect Aedes mosquitoes and screen for dengue, Chikungunya
and Zika virus during the dengue outbreak from May- August 2019. In a separate study, we
performed vector sampling to determine the incidence of dengue virus (DENV) infection in a
prospective cohort of family units and to estimate the risk of DENV transmission between
mosquitoes and different family members with diverse pre-exposure histories. Total of 148
mosquitoes were captured, 61 (41 %) of which were Ae. aegypti females, of which two were
positive for dengue (one DENV-1 and one DENV-4). Entomology continued our efforts in
maintaining Soldier lethality by assessing the field efficacy of uniforms treated with different
permethrin products against Ae. aegypti and An. minimus to determine the long lasting efficacy
of treated uniform under field conditions, and evaluate the repellency and lethal effects of treated
uniform against mosquito vectors. Four commercially insect repellent products were evaluated in

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this study and the results were will be presented at the Society for Vector Ecology in 2020. We
also field tested the effect of transfluthrin, a spatial repellent, applied to military netting materials
on reducing exposure to sand fly populations in rubber tree plantations in Chanthaburi province,
Thailand. Our findings demonstrate that spatial repellent treatments of military materials could
potentially serve as an effective tool to mitigate the risks associated with these biting flies.
Findings from this study were presented at the 10th International Symposium on Phlebotomine
Sandflies (ISOPS). Entomology also investigated efficacy of light traps (CDC light traps and
Laika trap 3.0) equipped with different baits (CO2, BG-lure) and to evaluate the impact of
colored lights (different wavelengths) on sand fly collection in order to improve sand fly trap. A
total of 25,327 sand flies including 14,614 females (58%) and 10,713 males (42%) were
collected from a total of 312 trap nights. Findings from this study will be presented at the AMCA
conference in March 2020. We performed significant surveillance activities in 2019, including
the surveillance of mosquito vectors that transmit malaria parasites, dengue, Chikungunya, and
Zika viruses at 6 sites across Thailand. For example, over 3,000 female Aedes aegypti, commonly
known as the yellow fever mosquito, were collected inside houses of dengue and zika infected
patients at Kamphaeng Phet province and analyzed for pathogen presence. This became part of our
monthly GEIS reporting. In addition to mosquito surveillance, leishmaniasis vector surveillance
was performed from 4 sites in Thailand in 2019. Collected sand flies were morphologically
identified and tested for pathogens.

 The Department of Entomology supported collaborations with the AFRIMS
Department of Veterinary Medicine, WRAIR Experimental Therapeutics and our industry
partner, Novartis with over 30 shipments of P. cynomolgi infected mosquitoes and over 50
million sporozoites to screen novel compounds using the AFRIMS Rhesus Macaque model.

Department of Retrovirology

Mission:

The mission of the Department of Retrovirology is to support the mission of the Military
HIV Research Program (MHRP) to protect the U.S. Military from HIV and improve global
health by conducting research to develop an HIV vaccine, reduce new infections and find a cure.

Discuss Significant Activities Related to Organizational Mission:

 Identify and characterize cohorts of volunteers at high risk of HIV for future clinical
research studies in Thailand, principally through a study called RV348, at four sites in Thailand

 Conduct acute HIV infection studies as a platform for laboratory research to better
understand infection, as well as a platform for cure research clinical trials

 Conduct HIV cure studies evaluating novel approaches including a therapeutic vaccine
and a monoclonal antibody after two different durations of time in volunteers found to be acutely
infected with HIV

 Evaluate novel approaches to cure HIV-like viruses in non-human primate models to
understand HIV-related biology and model potential therapeutic interventions or vaccines

 Established new assays to be able to assess functions of granulocytes, and antibody-
mediated immune cell functions and assessment of mucosal cell functions that we could not
previously assess in our vaccine, cure, or non-human primate studies

o Granulocyte isolation and functional characterization are now capabilities used in
support of ongoing studies.

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o Antibody-dependent complement-mediated lysis is being developed for use by
MHRP to further characterize non-neutralizing antibodies and their contribution to the immune
response in our vaccine and cure studies.

 Selected as site and initiated protocol development to perform RV564, a Phase II
randomized, observer-blind, placebo-controlled study, to assess efficacy of meningococcal Group B
vaccine rMenB+OMV NZ (Bexsero) in preventing gonococcal infection. Study will be a cross-
departmental collaboration with Department of Bacteria Disease.

Constraints/Problems Encountered:

 IRB delays: Delays in IRB continuing review approval resulting in a delay of study
continuing laboratory analysis phase.

 Departmental budget reductions signal need for diversification of traditional portfolio
beyond HIV and into other DoD relevant infectious diseases

Solutions Devised:

 IRB delays: Coordinating with the MHRP team, Principal Investigator and IRBs for a
resolution.

 Expansion of existing departmental capabilities into conduct of non-HIV trials (i.e.
Bexsero phase 2b trial above)

New Missions Added: No new missions added

Old Missions Discontinued: No old missions discontinued

Outcomes:

 The Department of Retrovirology’s ability to conduct clinical trials that meet local and
international regulatory standards is supported by its exemplary College of American Pathologists
(CAP)-accredited AFRIMS Retrovirology Clinical Laboratory (ARCL), specimen processing and
archiving laboratory and its basic science research program. The laboratory is also certified by
both Department of Defense Clinical Laboratory Improvement Program (DoD CLIP) and the
Division of AIDS, National Institute of Allergy and Infectious Diseases (DAIDS/NIAID). CAP
re-accreditation and CLIP certification are valid through September 2020.

o HIV cohort studies

 On-schedule enrollment and successful completion of clinical activities of RV348,
a high-risk HIV incidence cohort independently assessing four locations for inclusion as future
vaccine efficacy trial sites.

 RV348B (Bangkok), a total of 1,017 participants were enrolled in Bangkok (502
participants at Vaccine Trial Centre (VTC), Faculty of Tropical Medicine, Mahidol University,
Bangkok, Thailand, and 515 at Royal Thai Army Clinical Research Center (RTA CRC), AFRIMS).
Clinical activity was completed in April 2019 with 53 incident case identified (3.73%). Study
database has been cleaned and locked. One abstract namely “High HIV Incidence and Volunteer
Retention in a Bangkok Based Cohort of MSM and TGW” by Dr. Tanyaporn Wansom has
presented at the Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7,
2019, Seattle, WA.

 RV348M (MoPH): a total of 1,003 participants were enrolled (503 participants at
Potharam, Ratchaburi and 500 participants at Nakorn Ratchasima). Clinical activity was completed
in December 2019 with 20 incident cases identified. Study data is now in the final monitoring
and cleaning phase.

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 RV254 is a prospective cohort study designed to follow individuals with Fiebig I
to IV acute HIV infection. Study participants are identified and followed for at least 2 years and a
maximum of 15 years. They are monitored clinically and with CD4, HIV RNA, and safety
laboratory tests. Archiving of peripheral blood mononuclear cells (PBMCs) and plasma is
performed. This protocol allows co-enrollment in other treatment protocols and nearly all
participants have opted to join a trial providing access to immediate suppressive antiretroviral
therapy. Currently 612 participants are enrolled in this study.

 RV304 is a study that was established to allow the comparison of findings from
immunophenotyping and immunochemistry in the gut mucosa, spinal fluid, lymph node, and
blood of participants that are HIV negative, as well as HIV-infected adults to the findings from
participants with acute HIV infection from the RV254 study. Currently 154 participants are
enrolled in this study.

 RV217 (Early Capture acute HIV Cohort): For Thailand site, a total of 1,413
potential volunteers were screened and 947 participants (67%) enrolled the study; 71 incident
cases were identified. Laboratory and data analysis are ongoing.

 In support of acute HIV infection and HIV cohort studies, the department has
specimen processing and archiving, and developed two molecular assays in collaboration with
MHRP, the Multi-Region Subtype Specific PCR (MSSP) assay to characterize HIV-1 subtypes
and their recombinant viruses circulating in Thai HIV-infected participants and the total HIV
DNA assay to quantify all forms of HIV DNA in Thai HIV-infected participants.

o Post RV144 HIV Vaccine Trials

 RV305 (Phase 2 late boost follow-on study to RV144): A total of 164 participants
were enrolled, completed all study vaccination and clinical activities. Data showed that late
boosting is beneficial. Additional laboratory and data analysis are ongoing.

 RV306 (Phase 2 evaluation of various one-year boosts following the RV144
regimen in previously unvaccinated volunteers): 367 volunteers were enrolled, and all study
visits were completed. Late boosting preferentially improved plasma IgG over IgA responses and
neutralization activity as well as cellular immune functions. Laboratory and data analysis are
ongoing.

 RV328 (Evaluating the protein boost used in RV144 and a previous efficacy trial
in injecting drug users called Vax003): A total of 40 participants completed all vaccinations and
clinical activities. The study is now at laboratory analysis phase.

 RV417, a multicenter, randomized, parallel group, placebo-controlled, double-
blind clinical study in healthy HIV-uninfected adult. Subjects will be enrolled regardless of their
baseline Ad26 seropositivity, as data from Study IPCAVD003 suggest that there is little impact
of baseline Ad26 neutralizing antibodies (nAbs) on the immunogenicity of this Ad26 vaccine
vector, at the titers observed in that study, however regional differences are known to occur.
Currently 59 participants have been enrolled in Thailand and 12 participants are in the follow-up
long term extension phase.

o HIV Remission Trials

 RV397 (the administration of VRC01 monoclonal antibody to participants who
initiated ART during acute HIV infection): Total of 23 participants were enrolled, 18 participants
underwent treatment interruption and received study infusions according to study protocol. Only
one participant achieved the primary endpoint of HIV viral load (VL) <50 copies/mL at 24 weeks
after treatment interruption. Median time to VL rebound above 20 copies/mL was 29 days (range
9- 296) for the VRC01 arm and 14 days (range 14-29) for the placebo arm (p=0.051 for Kaplan-
Meier test). All participants achieved VL < 20 copies/mL within 5 weeks after ART resumption.
Completion of clinical activity and continue laboratory and data analysis phase.

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 RV398, conducted in collaboration with the NIH Vaccine Research Center and
the U.S. Military HIV Research Program (MHRP) designed to investigate whether a broadly
neutralizing antibody product given to acute HIV-infected volunteers either before or with the
initiation of antiretroviral treatment will benefit the volunteers, including limiting the amount of
virus in their bodies and possibly cure, has enrolled the majority of volunteers in this multicenter
study. Currently, 9 participants are eligible and recruited in this study.

 RV405 (HIV therapeutic vaccines for HIV infected participants who initiated
ART during acute HIV infection): 27 participants enrolled in this study and in follow up phase.
The vaccine was safe and generated robust immune responses, but delayed time to viral rebound
compared to that in placebo recipients by only several days and did not lead to viremic control
after treatment interruption.

 RV411, an exploratory study of analytical treatment interruption (ATI).
8 volunteers were enrolled in step I. Clinical activity were completed since June 2016. All
8 participants experienced rapid viral load rebound following analytical treatment interruption,
indicating that additional strategies are required to control or eradicate HIV.

 RV412, a clinical follow on study for participants who completed clinical
activities from HIV Remission Trials. Total 50 participants transferred from RV411, RV397 and
RV405 have followed for safety and virologic outcomes. This study is ongoing.

 ACTG studies- In collaboration with the Thai Red Cross AIDS Research Centre
(TRCARC) and the AIDS Clinical Trial Group (ACTG) NIAID/NIH, Department of Retrovirology
performs PBMC preparation from blood and leukapheresis specimens, plasma storage, isolation
of mucosal mononuclear cells (MMCs) from gut biopsy samples and analysis of biological samples
for 3 ACTG studies; A5354 Early ART to Limit Infection and Establishment of Reservoir, A5345
and A5347s HIV rebound & control biomarkers. The percent viability and viable recovery of
cryopreserve PBMCs obtained from a leukapheresis and/or whole blood provided by the Specimen
Processing Laboratory, Department of Retrovirology have been deemed satisfactory and acceptable
by the ACTG laboratory science group since May 2017.

o Non-Human Primate Studies

 In support of cure research, the department successfully conducted a SHIV cure
study in non-human primates: PN17-01, Efficacy of latency reversing agent TLR7 agonist GS-986
and HIV-Specific Broadly Neutralizing Antibodies N6-LS and PGT121 to Achieve Virologic
Remission in SHIV-Infected Rhesus Macaques (Macaca mulatta) that Initiated Antiretroviral
Therapy during Acute Infection”. This study investigated whether a combination of two
investigational therapies can cure or otherwise improve the health of monkeys infected with a
virus very similar to HIV, hopefully paving the way for the ability of HIV-infected Service
Members to remain clinically stable without the daily burden and lifetime cost of antiretroviral
therapy. This study was completed in Q2 of 2019. Administration of GS-986 and dual broadly
neutralizing antibodies (bNAbs) was associated with activation of NK cells and soluble biomarkers
of immune activation, a reduction in total HIV DNA in PBMCs, and a modest delay in viral
rebound. Additional laboratory analyses are currently being completed.

 The department has implemented Cambridge Neuropsychological Test Automated
Battery (CANTAB), a neurobehavioral testing platform in rhesus macaques in collaboration with
the Department of Veterinary Medicine. This platform will be used to correlate neurocognitive
changes with neuropathologies in rhesus macaques. The team has successfully completed
training of 6 healthy rhesus macaques to perform the “Motor Screening Task” (MOT) and the
“Self-Ordered Spatial Search (SOSS) Task in Q3 of 2019. Data analysis on the learning curves
for both assessments are currently on-going.

 PN19-05 “Evaluating the impact of Zika virus on neurocognition in adult infection
and neuroprotective effects of the Army Zika purified inactivated virus vaccine (ZPIV) in rhesus

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macaques”. The aims of this study are to investigate if 1) ZIKV infection in adult animals is
associated with cognitive deficits and 2) whether ZPIV can reduce the cognitive changes seen
after high-dose ZIKV challenge. In FY20 Q1, the study team has completed on screening of
animals for eligibility for the study including the absence of pre-existing antibodies against
flavivirus, collected biosampling, specimen processing, and cryopreservation and eight animals
in the control group commenced CANTAB training and assessment and placebo administration.

Future Plans:

 Among ongoing studies, RV254, RV304, RV398 and ACTG studies are continuing for
enrollment. The laboratory and data analysis for all studies are ongoing. In addition, we have
expanded our collaboration with the external collaborators worldwide.

 New protocols:

o RV490, a phase I, randomized, double-blind, controlled trial to investigate the
safety, tolerability and immunogenicity of conserved Human immunodeficiency virus (HIV)-1
peptide-pulsed, autologous α1-dendritic cell (DC) immunotherapy and its effect on virologic
control after analytic treatment interruption in 30 adults who initiated ART during Fiebig stage
I & II acute HIV infection and have viral suppression for ≥48 weeks. Protocol is now in
regulatory review phase.

o RV534, a phase I Prime-boost HIV vaccines with or without Toll-like Receptor 4
Agonist in perinatally HIV infected Children and Youth. Study will be conducted in Thailand,
Italy and South Africa. Protocol is now in regulatory review phase.

o RV550, a phase I, randomized, unblinded, controlled trial of 12 weeks duration to
investigate safety, tolerability and immunomodulation effect of combining Interleukin-15 (IL-15)
Receptor Super-agonist (Nant-803) with ART during AHI. Protocol is now in regulatory review
phase.

o RV546, a phase 1 evaluation of late boost strategies with IHV01 (FLSC in aluminum
phosphate) and A244 with or without ALFQ for HIV-uninfected Participants in the HIV Vaccine
Trial RV306. Protocol is now in regulatory review phase.

o RV564, a Phase II randomized, observer-blind, placebo-controlled study, to assess
efficacy of meningococcal Group B vaccine rMenB+OMV NZ (Bexsero) in preventing gonococcal
infection. This study is sponsored by Division of Microbiology and Infectious Diseases, NIAID,
NIH, DHHS. The study will be conducted in US and Thailand sites (RTA CRC and TRCARC).
Department of Retrovirology and Department of Bacteria and Parasitic (BPD) laboratories will
performed laboratory activities for the study. The protocol is currently being developed.

Department of Veterinary Medicine

Mission:

The mission of the Department of Veterinary Medicine (DVM) is to protect military
personnel and their families against tropical disease threats through pre-clinical product development
of new prophylactic and therapeutic drugs and new or improved vaccines. To fulfill this mission,
DVM conducts biomedical research in animal models and zoonotic disease surveillance; provides
veterinary training and expertise in the areas of animal research, laboratory animal care, animal
pathology and Institutional Animal Care and Use Committee engagement to students, faculty and
potential collaborators; maintains research animals that are free of potential confounding diseases
and ensures that all animals receive humane, proper and safe care and that the USAMD-AFRIMS's
Animal Care and Use program complies with appropriate laws, regulations and guidelines.

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Discuss Significant Activities Related to Organizational Mission: NSTR

Constraints/Problems Encountered:

 The procurement process is slow and complicated causing delays in ordering supplies
(animal feed, bedding, enrichment items such as fresh fruits and vegetables, etc.) and laboratory
equipment. These delays have a negative impact on the animal colony maintenance and research
study time plan.

 Facilities management is a major concern. Animal Biological Safety Level-3 containment,
Building 5 cannot be used due to the ventilation system failure. BioBubble technology installed
in room A6 cannot be utilized as commissioning is ongoing. Additionally, there is no elevator to
the clinical pathology laboratory or the laundry room on 2nd floor creating significant difficult in
move freezers, big equipment and heavy items. Often this has resulted in damaged equipment
and facilities in addition to risks to personnel carrying the equipment; no solution is available to
address the lack of elevator. The clinical pathology laboratory and animal vivarium are extremely
limited in space to store and maintain tissue blocks, documents, supplies, equipment, animal
cages and accessories; no solution is available to address this concern.

 Staff-power shortages have resulted in heavy workload in each section and threatens
mission fulfillment. The prolonged hiring process, in-processing and clearance of new personnel
has, in some circumstances, negatively impacted our ability to fill these personnel gaps. This
concern remains unresolved.

 Animal facility renovations and nonhuman primate cage modification projects have
been prolonged due problems with contractors finishing the projects on schedule, negatively
impacting animal colony management and research activities. No solution exists for this problem
at this moment; professional and reliable contractors will be sought for future renovations or
modifications.

 The current pest control program does not effectively control all pests that have been
found within the animal facility. Additionally, the lack of airlocks at animal facility access
points (i.e. loading dock corridors 9 and B12) complicates the problem. DVM is working with
facilities to address this issue.

Solutions Devised:

 Logistics has been working hard to ensure expedited procurement process including
using JUSMAG. We have been able to proceed with majority of requirements but not a 100%
solution.

 BioBubble Gap Analysis conducted. Awaiting funding to ensure renovation/certification.

New Missions Added:

 Comparative pathology has recently established new capacities for tissue and cell
culture. The CO2 incubator and upright microscope were purchased for both cell culture and
immunology assay (ELISpot).

Old Missions Discontinued: None

Outcomes:

 DVM has completed the first evaluation of 56kDa scrub typhus using rhesus scrub
typhus model that has been established here at AFRIMS. DVM has continued to use Rhesus
scrub typhus model for scrub typhus vaccine development and vaccine evaluation with Seoul

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National University, South Korea. In addition, DVM is currently expanding laboratory
capabilities and bring more collaborators who interested in tropical diseases and infectious
diseases.

 In 2019, DVM medical research staff presented research studies in three international
meetings.

 Forty one baby rhesus monkeys (Macaca mulatta) and 2476 ICR mice (Mus musculus)
were produced in 2019.

 ICR mice (1033) were used for eight active protocols, 109 mice were used as a blood
source to maintain mosquito and sand fly colonies, 450 mice were used to maintain the chigger
mite colony, 180 mice were used to produce dengue virus antigens, 90 mice were used to
investigate a single O. tsutsugamushi genotype among multiple genotypes within a single
L. deliense Ld-1 chigger could compete the other genotypes and survive alone within the scrub
typhus infected ICR mouse. 66 mice were used to evaluate the immunogenicity of the novel
m-RNA malarial vaccine.

 Forty seven mice and 32 monkeys were utilized this year to provide blood, blood
products or other biological samples (including urine, cervical vaginal mucosal samples, semen
and anal mucosal samples) from normal, healthy animals to investigators, veterinarians and
diagnostic laboratories supported by AFRIMS and other DOD institutes.

 Continue using 4 rhesus monkeys that were all successfully inoculated with SHIV and
tested for antiretroviral therapy efficacy: latency reversing agent TLR7 agonist GS-986 and HIV-
specific broadly neutralizing antibodies N6-LS and PGT121 to achieve virologic remission.
8 rhesus monkeys were trained for using the Cambridge Neuropsychological Test Automated
Battery (CANTAB) to assess the impact of ZIKV on neurocognition. 74 monkeys were used in
efficacy studies conducted on WRAIR-Experimental Therapeutics’s behalf for triazine and
8-aminoquinalone compounds utilizing the P. cynomolgi malaria models. 18 rhesus monkeys
were utilized for testing a novel vaccine for scrub typhus based on TSA56 and ScaA proteins.
23 monkeys were utilized for testing the novel compound (anti-von Willebrand factor aptamer)
for the treatment of severe malaria P. coatneyi model. 15 splenectomized rhesus monkeys were
used as donor monkeys to develop P. cynomolgi sporozoites. 6 monkeys were utilized for
characterizing the clinical course and immune response of Orientia tsutsugamushi Boryong
strain.

Department of Virology

Mission:

The mission of the department is to develop solutions to Military Medical Gaps in the
form of viral vaccines, therapeutics and diagnostic devices and actionable knowledge products
like disease epidemiology and timely viral surveillance data in SE Asia.

Discuss Significant Activities Related to Organizational Mission:

Our activities revolve around several pillars:

 Conduct advanced phase clinical trials to evaluate vaccine and therapeutic products

 Evaluate and validate diagnostic devices and kits

 Conduct expansive regional surveillance in order to both determine where to conduct
clinical trials and to determine evolving pathogen threats of importance to INDOPACOM.

 Assay development in the laboratory to better identify pathogens identified in or
studied in surveillance studies, clinical trials and diagnostic device evaluation

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Constraints/Problems Encountered:

 Cebu Facilities – PAVRU Cebu City facilities exploring new location. There was a
previous plan to have the department’s Cebu laboratory occupy space on the grounds of a large
local public hospital. This proved unworkable and over the last several years the department has
been renting commercial space, a lease managed by the US Army Corps of Engineers. PAVRU
present location is not sustainable due to the uncertainties of future lease agreements and the
physical distance from medical care organizations that rationally serve as source of study subjects.

 Maintain Sufficient Military Personnel – Since 2019, the department lacks a Military
infectious diseases clinician, a requirement given the number of human studies taking place now.
This is the first time this has occurred since the department inception, which has been traditionally
staffed with two physicians. The excess administrative, clinical, regulatory and other activities
are being shared by the rest of the Military staff, all of whom have full time obligations.

 Timely Receipt of Awarded Funds – A large portion of the department’s annual
operative budget comes from GEIS and MIDRP and their arrival to the department are
consistently and increasingly delayed, often arriving late 2Q or 3Q of FY. No explanation is
offered. Nonetheless, these delays are a significant obstacle to projects execution, forcing the
department to risk late or no completions of projects slated to begin in 01 October of each FY.

 Increasing Difficulties in Sending Specimens Outside Our Partner Countries – There
has been an increasing and spreading move towards our partner countries more highly regulating
the sending of specimens to laboratories outside of the country of origin of the specimens. The
move is driven to ensure greater control over indigenous specimens and to encourage capacity
building within countries.

Solutions Devised:

 PAVRU Cebu Facilities – The department in currently engaged in an exploratory
effort of potential hospitals and medical schools in Cebu City, which have expressed a desire to
host PAVRU within their footprint. We expect a firm solution in FY21.

 Maintain Sufficient Military Personnel – The department chief and AFRIMS Director
have worked aggressively to locate appropriate staff to at least maintain current staffing and the
WRAIR Commander and AFRIMS Director have acquired a status of tier one for our staffing
needs.

 Timely Receipt of Awarded Funds – The department works to utilize existing multi-
year funds in order to meet short-term needs pending receipt of the targeted funds, but the
solution is suboptimal and risks underfunding other significant efforts.

 Increasing Difficult in Sending Specimens Outside Our Partner Countries – The
department is actively seeking to push higher level of technology downwards to our local
laboratories and to our partners in order to allow more to be done locally, decreasing the impact
of this issue on the mission.

New Missions Added:

Engagement in India – We have initiated this year a new relationship with a partner in
India, THSTI (Translational Health Science and Technology Institute) of the Indian Ministry of
Health as a gateway to explore future and expanding collaborative projects consistent with
INDOPACOM goals.

Old Missions Discontinued: None

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Outcomes:
 We have neared the end of a large phase III dengue vaccine trial with a product

manufactured by Sanofi. This vaccine has proven effective in reducing severe diseases and
hospitalization in patients with pre-existing exposure to dengue and also offers moderate protection
against infection. However, it may increase severity of disease in those not previously infected
who become infected a year after completing the vaccination series and is poorly protective
against infection as well in such populations. Dengvaxia is no longer an Army Advance
Development candidate vaccine.

 We have achieved the primary endpoint in another phase III dengue vaccine study with
a product manufactured by Takeda pharmaceuticals Inc. This product showed broad protection
against dengue infection during the first year following vaccination. It remains to be seen what
the protection or risk assessment is in the following years.

 We completed a phase II study with the National Institute of Health dengue vaccine.
Detailed results are still pending, but it appears that this vaccine may have the most robust
immunological response of the three vaccines assessed by the department.

 We have continued to identify shifting trends in both arboviral and upper respiratory
viruses circulating in the region and provided this information to the COCOMs and to DoD
authorities that communicate with the CDC.

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AFRIMS Publications and Presentations

FY19 (October 2018 – September 2019)

Publications

1. Aldersley A; Pongsiri A; Bunmee K; Kijchalao U; Chittham W; Fansiri T; Pathawong N;
Qureshi A; Harrington LC; Ponlawat A; Cator LJ. Too "sexy" for the field? Paired
measures of laboratory and semi-field performance highlight variability in the apparent mating
fitness of Aedes aegypti transgenic strains. Parasit Vectors 2019 Jul; 12(1):357.

2. Alrubayyi A; Schuetz A; Lal KG; Jongrakthaitae S; Paolino KM; Ake JA; Robb ML; de
Souza MS; Michael NL; Paquin-Proulx D; Eller MA. A flow cytometry based assay that
simultaneously measures cytotoxicity and monocyte mediated antibody dependent effector
activity. J Immunol Methods 2018 Nov; 462:74-82.

3. Amoah S; Mishina M; Praphasiri P; Cao W; Kim JH; Liepkalns JS; Guo Z; Carney PJ;
Chang JC; Fernandez S; Garg S; Beacham L; Holtz TH; Curlin ME; Dawood F; Olsen
SJ; Gangappa S; Stevens J; Sambhara S. Standard-dose intradermal influenza vaccine elicits
cellular immune responses similar to those of intramuscular vaccine in men with and those
without HIV infection. J Infect Dis 2019 Jul; 31(220):743-51.

4. Banlunara W; Techangamsuwan S; Pirarat N; Kaewamatawong T; Piewbang C;
Kesdangsakonwut S; Haetrakul T; Singkhum N; Chansue N; Miller M; Lombardini E.
Epizootic of multi-centric, squamous cell carcinomas in populations of Indo-Pacific
humpbacked dolphins Sousa chinensis in Thai waters. Dis Aquat Organ 2019 May;
134(2):99-106.

5. Benante JP; Fox J; Lawrence K; Fansiri T; Pongsiri A; Ponlawat A; Chaskopoulou A. A
comparative study of mosquito and sand fly (Diptera: Psychodidae: Phlebotominae) sampling
using dry ice and chemically generated carbon dioxide from three different prototype CO2
generators. J Econ Entomol 2019 Feb; 112(1):494-8.

6. Bodhidatta L; Anuras S; Sornsakrin S; Suksawad U; Serichantalergs O; Srijan A;
Sethabutr O; Mason CJ. Epidemiology and etiology of traveler's diarrhea in Bangkok,
Thailand, a case-control study. Trop Dis Travel Med Vaccines 2019 Jun; 5:9.

7. Burns RJL; Douangngeun B; Theppangna W; Mukaka M; Wegner MD; Windsor PA;
Blacksell SD. Peste des Petits Ruminants (PPR) virus serological surveillance in goats in Lao
PDR: Issues for disease eradication in a low-resource disease-free setting. Transbound Emerg
Dis 2019 Mar; 66(2):939-47.

8. Chang D; Sanders-Buell E; Bose M; O'Sullivan AM; Pham P; Kroon E; Colby DJ;
Sirijatuphat R; Billings E; Pinyakorn S; Chomchey N; Rutvisuttinunt W; Kijak G; de
Souza M; Excler JL; Phanuphak P; Phanuphak N; O'Connell RJ; Kim JH; Robb ML;
Michael NL; Ananworanich J; Tovanabutra S; on behalf of the RV254/SEARCH 010
Study Group. Molecular epidemiology of a primarily MSM acute HIV-1 cohort in Bangkok,
Thailand and connections within networks of transmission in Asia. J Int AIDS Soc 2018 Nov;
21(11):e25204.

9. Chua ACY; Ananthanarayanan A; Ong JJY; Wong JY; Yip A; Singh NH; Qu Y;
Dembele L; McMillian M; Ubalee R; Davidson S; Tungtaeng A; Imerbsin R; Gupta K;
Andolina C; Lee F; Tan T; Nosten F; Russell B; Lange A; Diagana TT; Renia L; Yeung
BKS; Yu H; Bifani P. Hepatic spheroids used as an in vitro model to study malaria relapse.
Biomaterials 2019 Sep; 216:119221.

10. Crawford MA; Margulieux KR; Singh A; Nakamoto RK; Hughes MA. Mechanistic
insights and therapeutic opportunities of antimicrobial chemokines. Semin Cell Dev Biol 2019
Apr; 88:119-28.

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11. Crowell TA; Colby DJ; Pinyakorn S; Sacdalan C; Pagliuzza A; Intasan J; Benjapornpong
K; Tangnaree K; Chomchey N; Kroon E; de Souza MS; Tovanabutra S; Rolland M; Eller
MA; Paquin-Proulx D; Bolton DL; Tokarev A; Thomas R; Takata H; Trautmann L;
Krebs SJ; Modjarrad K; McDermott AB; Bailer RT; Doria-Rose N; Patel B; Gorelick RJ;
Fullmer BA; Schuetz A; Grandin PV; O'Connell RJ; Ledgerwood JE; Graham BS;
Tressler R; Mascola JR; Chomont N; Michael NL; Robb ML; Phanuphak N;
Ananworanich J; RV397 Study Group. Safety and efficacy of VRC01 broadly neutralising
antibodies in adults with acutely treated HIV (RV397): a phase 2, randomised, double-blind,
placebo-controlled trial. Lancet HIV 2019 May; 6(5):e297-e306.

12. Crowell TA; Pinyakorn S; Sacdalan C; Kroon E; Colby DJ; Puttamaswin S; Ubolyam S;
Trichavaroj R; Butterworth O; Turk E; McCullough C; Chomont N; de Souza M; Robb
ML; Phanuphak N; Ananworanich J; RV254/SEARCH010 Study Group. Viral blips after
treatment initiation during acute HIV infection. Clin Infect Dis 2019 Sep; [Epub ahead of
print]:ciz936.

13. Friberg H; Beaumier CM; Park S; Pazoles P; Endy TP; Mathew A; Currier JR; Jarman
RG; Anderson KB; Hatch S; Thomas SJ; Rothman AL. Protective versus pathologic pre-
exposure cytokine profiles in dengue virus infection. PLoS Negl Trop Dis 2018 Dec;
12(12):e0006975.

14. Fukuda MM; Wojnarski M; Martin N; Zottig V; Waters NC. Malaria in the Korean
peninsula: Risk factors, latent infections, and the possible role of tafenoquine, a new
antimalarial weapon [Editorial]. MSMR 2018 Nov; 25(11):2-3.

15. Goh OQ; Colby DJ; Pinyakorn S; Sacdalan C; Kroon E; Chan P; Chomchey N;
Kanaprach R; Prueksakaew P; Suttichom D; Trichavaroj R; Spudich S; Robb ML;
Phanuphak P; Phanuphak N; Ananworanich J; RV254/SEARCH 010 Study Group.
Switch to dolutegravir is well tolerated in Thais with HIV infection. J Int AIDS Soc 2019 Jul;
22(7):e25324.

16. Haltaufderhyde K; Srikiatkhachorn A; Green S; Macareo L; Park S; Kalayanarooj S;
Rothman AL; Mathew A. Activation of peripheral T follicular helper cells during acute
dengue virus infection. J Infect Dis 2018 Oct; 218(10):1675-85.

17. Horwood PF; Karlsson EA; Horm SV; Ly S; Heng S; Chin S; Darapheak C; Saunders D;
Chanthap L; Rith S; Y P; Chea KL; Sar B; Parry A; Ieng V; Tsuyouka R; Deng YM;
Hurt AC; Barr IG; Komadina N; Buchy P; Dussart P. Circulation and characterization of
seasonal influenza viruses in Cambodia, 2012-2015. Influenza Other Respir Viruses 2019
Sep; 13(5):465-76.

18. Hsu DC; Mellors JW. Longitudinal changes in HIV DNA in HIV controllers: what do they
mean?. J Int AIDS Soc 2019 Feb; 22(2):e25254.

19. Keasey SL; Smith JL; Fernandez S; Durbin AP; Zhao BM; Ulrich RG. Impact of dengue
virus serotype 2 strain diversity on serological immune responses to dengue. ACS Infect Dis
2018 Dec; 4(12):1705-17.

20. Korpe PS; Valencia C; Haque R; Mahfuz M; McGrath M; Houpt E; Kosek M;
McCormick BJJ; Penataro Yori P; Babji S; Kang G; Lang D; Gottlieb M; Samie A;
Bessong P; Faruque ASG; Mduma E; Nshama R; Havt A; Lima IFN; Lima AAM;
Bodhidatta L; Shreshtha A; Petri WA Jr; Ahmed T; Duggal P. Epidemiology and risk
factors for cryptosporidiosis in children from eight low-income sites: results from the MAL-ED
study. Clin Infect Dis 2018 Nov; 67(11):1660-9.

21. Kroon E; Pham PT; Sirivichayakul S; Trichavaroj R; Colby DJ; Pinyakorn S;
Phanuphak N; Sanders-Buell E; Van Griensven F; Kijak GH; Kim JH; Michael NL;
Robb ML; Ananworanich J; De Souza MS; Tovanabutra S; RV254/SEARCH 010 Study
Group. Transmission dynamics among participants initiating anti-retroviral therapy upon
diagnosis of early acute HIV-1 infection in Thailand. AIDS 2018 Oct; 32(16):2373-81.

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22. Lacerda MVG; Llanos-Cuentas A; Krudsood S; Lon C; Saunders DL; Mohammed R;
Yilma D; Batista Pereira D; Espino FEJ; Mia RZ; Chuquiyauri R; Val F; Casapia M;
Monteiro WM; Brito MAM; Costa MRF; Buathong N; Noedl H; Diro E; Getie S; Wubie
KM; Abdissa A; Zeynudin A; Abebe C; Tada MS; Brand F; Beck HP; Angus B; Duparc
S; Kleim JP; Kellam LM; Rousell VM; Jones SW; Hardaker E; Mohamed K; Clover DD;
Fletcher K; Breton JJ; Ugwuegbulam CO; Green JA; Koh GCKW. Single-dose
tafenoquine to prevent relapse of Plasmodium vivax malaria. N Engl J Med 2019 Jan;
380(3):215-28.

23. Lin JT; Patel JC; Levitz L; Wojnarski M; Chaorattanakawee S; Gosi P; Buathong N;
Chann S; Huy R; Thay K; Sea D; Samon N; Takala-Harrison S; Fukuda M; Smith P;
Spring M; Saunders D; Lon C. Gametocyte carriage, antimalarial use, and drug resistance in
Cambodia, 2008-2014. Am J Trop Med Hyg 2018 Nov; 99(5):1145-9.

24. Lombardini E; Haetrakul T; Kuit SH; Chansue N. Gastric Braunina cordiformis and a
review of helminth parasitism in the finless porpoise (Neophocaena phocaenoides). Braz J Vet
Pathol 2019 Mar; 12(1):24-6.

25. Lurchachaiwong W; Ruksasiri S; Wassanarungroj P; Serichantalergs O; Bodhidatta L;
Crawford J; Shrestha SK; Pandey P. Determination of azithromycin heteroresistant
Campylobacter jejuni in traveler's diarrhea. Gut Pathog 2019 May; 11:19.

26. Manak MM; Jagodzinski LL; Shutt A; Malia JA; Leos M; Ouellette J; Akapirat S; Colby
DL; Phanuphak N; Eller LA; Robb ML; de Souza M; Ananworanich J; Peel SA;
RV254/SEARCH010 and the RV217 Study Teams. Decreased seroreactivity in individuals
initiating antiretroviral therapy during acute HIV infection. J Clin Microbiol 2019 Sep;
57(10):e00757-19.

27. Manasatienkij W; Chinnawirotpaisan P; Kittichotirat W; Macareo LR; Ellison DW;
Cheevadhanarak S; Chotpitayasunondh T; Suntarattiwong P; Fernandez S; Yoon IK;
Olsen SJ; Kittikraisak W; Anderson KB; Rutvisuttinunt W; Klungthong C. Genetic
characterization of influenza A(H3N2) viruses from vaccinated and unvaccinated children
during Thailand 2013 and 2014 influenza seasons. Southeast Asian J Trop Med Public
Health 2019 Jan; 50(1):101-19.

28. Manning J; Lon C; Spring M; Wojnarski M; Somethy S; Chann S; Gosi P; Soveasna K;
Sriwichai S; Kuntawunginn W; Fukuda MM; Smith PL; Rekol H; Sinoun M; So M; Lin
J; Satharath P; Saunders D. Cluster-randomized trial of monthly malaria prophylaxis versus
focused screening and treatment: a study protocol to define malaria elimination strategies in
Cambodia. Trials 2018 Oct; 19(1):558.

29. Masakhwe C; Linsuwanon P; Kimita G; Mutai B; Leepitakrat S; Yalwala S; Abuom D;
Auysawasi N; Gilbreath T; Wanja E; Waitumbi J. Identification and Characterization of
Orientia chuto in Trombiculid Chigger Mites Collected from Wild Rodents in Kenya. J Clin
Microbiol 2018 Dec; 56(12):e01124-18.

30. Matthews BJ; Dudchenko O; Kingan SB; Koren S; Antoshechkin I; Crawford JE;
Glassford WJ; Herre M; Redmond SN; Rose NH; Weedall GD; Wu Y; Batra SS; Brito-
Sierra CA; Buckingham SD; Campbell CL; Chan S; Cox E; Evans BR; Fansiri T;
Filipovic I; Fontaine A; Gloria-Soria A; Hall R; Joardar VS; Jones AK; Kay RGG;
Kodali VK; Lee J; Lycett GJ; Mitchell SN; Muehling J; Murphy MR; Omer AD;
Partridge FA; Peluso P; Aiden AP; Ramasamy V; Rasi? G; Roy S; Saavedra-Rodriguez
K; Sharan S; Sharma A; Smith ML; Turner J; Weakley AM; Zhao Z; Akbari OS; Black
IV WC; Cao H; Darby AC; Hill CA; Spencer J; Murphy TD; Raikhe AS; Sattelle DB;
Sharakhov IV; White BJ; Zhao L; Aiden EL; S R; Lambrechts L; Powell JR; Sharakhova
MV; Tu Z; Robertson HM; McBride CS; Hastie AR; Korlach J; Neafsey DE; Phillippy
AM; Vosshall LB. Improved reference genome of Aedes aegypti informs arbovirus vector
control. Nature 2018 Nov; 563(7732):501-7.

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31. McCormick BJJ; Richard SA; Caulfield LE; Pendergast LL; Seidman JC; Koshy B;
Roshan R; Shrestha R; Svensen E; Blacy L; Rasmussen Z; Maphula A; Scharf R; Nahar
B; Haque S; Rasheed M; Oria R; Rogawski ET; Murray-Kolb LE; MAL-ED Network
Investigators . Early life child micronutrient status, maternal reasoning, and a nurturing
household environment have persistent influences on child cognitive development at age 5
years: results from MAL-ED. J Nutr 2019 Aug; 149(8):1460-1469.

32. Morseth MS; Strand TA; Torheim LE; Chandyo RK; Ulak M; Shrestha SK; Shrestha B;
Henjum S. Nutrient intake and environmental enteric dysfunction among Nepalese children 9-
24 months old-the MAL-ED birth cohort study. Pediatr Res 2018 Oct; 84(4):509-15.

33. Pan WK; Seidman JC; Ali A; Hoest C; Mason C; Mondal D; Knobler SL; Bessong P;
MAL-ED Network Investigators. Oral polio vaccine response in the MAL-ED birth cohort
study: considerations for polio eradication strategies. Vaccine 2019 Jan; 37(2):352-65.

34. Park S; Srikiatkhachorn A; Kalayanarooj S; Macareo L; Green S; Friedman JF;
Rothman AL. Use of structural equation models to predict dengue illness phenotype. PLoS
Negl Trop Dis 2018 Oct; 12(10):e0006799.

35. Phasomkusolsil S; Tawong J; Khaosanorh S; Wanja EW; Kim HC; Klein TA; Davidson
SA. Colonization and maintenance of Anopheles belenrae and Anopheles pullus from the
Republic of Korea. J Am Mosq Control Assoc 2018 Dec; 34(4):260-4.

36. Phuentshok Y; Dorji K; Zangpo T; Davidson SA; Takhampunya R; Tenzinla T; Dorjee
C; Morris RS; Jolly PD; Dorjee S; McKenzie JS. Survey and phylogenetic analysis of
rodents and important rodent-borne aoonotic pathogens in Gedu, Bhutan. Korean J Parasitol
2018 Oct; 56(5):521-5.

37. Pissani F; Schulte B; Eller MA; Schultz BT; Ratto-Kim S; Marovich M; Thongcharoen P;
Sriplienchan S; Rerks-Ngarm S; Pitisuttithum P; Esser S; Alter G; Robb ML; Kim JH;
Michael NL; Streeck H. Modulation of vaccine-induced CD4 T cell functional profiles by
changes in components of HIV vaccine regimens in humans. J Virol 2018 Dec; 92(23):e01143-18.

38. Platts-Mills JA; Liu J; Rogawski ET; Kabir F; Lertsethtakarn P; Siguas M; Khan SS;
Praharaj I; Murei A; Nshama R; Mujaga B; Havt A; Maciel IA; McMurry TL; Operario
DJ; Taniuchi M; Gratz J; Stroup SE; Roberts JH; Kalam A; Aziz F; Qureshi S; Ohedul
M; Sakpaisal P; Silapong S; Yori PP; Rajendiran R; Benny B; McGrath M; McCormick
BJ; Seidman JC; Lang D; Gottlieb M; Guerrant RL; Lima AA; Leite JP; Samie A;
Bessong PO; Page N; Bodhidatta L; Mason C; Shrestha S; Kiwelu I; Mduma ER; Iqbal
NT; Bhutta ZA; Ahmed T; Haque R; Kang G; Kosek MN; Houpt ER; The MAL-ED
Network Investigators. Use of quantitative molecular diagnostic methods to assess the
aetiology, burden, and clinical characteristics of diarrhoea in children in low-resource settings: a
reanalysis of the MAL-ED cohort study. Lancet Glob Health 2018 Dec; 6(12):e1309-18.

39. Ponnusamy L; Willcox AC; Roe RM; Davidson SA; Linsuwanon P; Schuster AL;
Richards AL; Meshnick SR; Apperson CS. Bacterial microbiome of the chigger mite
Leptotrombidium imphalum varies by life stage and infection with the scrub typhus pathogen
Orientia tsutsugamushi. PLoS One 2018 Dec; 13(12):e0208327.

40. Pusnik J; Eller MA; Tassaneetrithep B; Schultz BT; Eller LA; Nitayaphan S; Kosgei J;
Maganga L; Kibuuka H; Alter G; Michael NL; Robb ML; Streeck H. Expansion of stem-
cell-like CD4(+) memory T cells during acute HIV-1 infection is linked to rapid disease
progression. J Virol 2019 May; 93(14):e00377-19.

41. Qureshi A; Aldersley A; Hollis B; Ponlawat A; Cator LJ. Male competition and the
evolution of mating and life-history traits in experimental populations of Aedes aegypti. Proc
Biol Sci 2019 Jun; 286(1904):20190591.

42. Richard SA; McCormick BJJ; Murray-Kolb LE; Lee GO; Seidman JC; Mahfuz M;
Ahmed T; Guerrant RL; Petri WA; Rogawski ET; Houpt E; Kang G; Mduma E; Kosek
MN; Lima AAM; Shrestha SK; Chandyo RK; Bhutta Z; Bessong P; Caulfield LE; MAL-
ED Network Investigators. Enteric dysfunction and other factors associated with attained size
at 5 years: MAL-ED birth cohort study findings. Am J Clin Nutr 2019 Jul; 110(1):131-138.

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43. Rogawski ET; Liu J; Platts-Mills JA; Kabir F; Lertsethtakarn P; Siguas M; Khan SS;
Praharaj I; Murei A; Nshama R; Mujaga B; Havt A; Maciel IA; Operario DJ; Taniuchi
M; Gratz J; Stroup SE; Roberts JH; Kalam A; Aziz F; Qureshi S; Islam MO; Sakpaisal
P; Silapong S; Yori PP; Rajendiran R; Benny B; McGrath M; Seidman JC; Lang D;
Gottlieb M; Guerrant RL; Lima AA; Leite JP; Samie A; Bessong PO; Page N; Bodhidatta
L; Mason C; Shrestha S; Kiwelu I; Mduma ER; Iqbal NT; Bhutta ZA; Ahmed T; Haque
R; Kang G; Kosek MN; Houpt ER; The MAL-ED Network Investigators. Use of
quantitative molecular diagnostic methods to investigate the effect of enteropathogen infections
on linear growth in children in low-resource settings: longitudinal analysis of results from the
MAL-ED cohort study. Lancet Glob Health 2018 Dec; 6(12):e1319-28.

44. Ruang-areerate T; Piyaraj P; Ponlawat A; Mungthin M; Leelayoova S. Distribution and
predicting environmental suitability of Sergentomyia gemmea and Sergentomyia barraudi
(Diptera: Psychodidae) in Thailand. Southeast Asian J Trop Med Public Health 2019 Jan;
50(1):64-78.

45. Sakpaisal P; Silapong S; Yowang A; Boonyasakyothin G; Yuttayong B; Suksawad U;
Sornsakrin S; Lertsethtakarn P; Bodhidatta L; Crawford JM; Mason CJ. Prevalence and
genotypic distribution of rotavirus in Thailand: a multicenter study. Am J Trop Med Hyg 2019
May; 100(5):1258-65.

46. Sanchez-Vargas LA; Kounlavouth S; Smith ML; Anderson KB; Srikiatkhachorn A;
Ellison DW; Currier JR; Endy TP; Mathew A; Rothman AL. Longitudinal analysis of
memory B and T cell responses to dengue virus in a 5-year prospective cohort study in
Thailand. Front Immunol 2019 Jun; 10:1359.

47. Shetty AC; Jacob CG; Huang F; Li Y; Agrawal S; Saunders DL; Lon C; Fukuda MM;
Ringwald P; Ashley EA; Han KT; Hlaing TM; Nyunt MM; Silva JC; Stewart KE; Plowe
CV; O'Connor TD; Takala-Harrison S; Artemisinin Resistance Confirmation,
Characterization, and Containment (ARC3)Artemisinin Resistance Containment and
Elimination (ARCE)Tracking Resistance to Artemisinin Collaboration (TRAC). Genomic
structure and diversity of Plasmodium falciparum in Southeast Asia reveal recent parasite
migration patterns. Nat Commun 2019 Jun; 10(1):2665.

48. Shrestha R; McKenzie JS; Gautam M; Adhikary R; Pandey K; Koirala P; Bc GB; Miller
LC; Collins-Emerson J; Craig SB; Shrestha S; Heuer C. Determinants of clinical
leptospirosis in Nepal. Zoonoses Public Health 2018 Dec; 65(8):972-83.

49. Sortino O; Phanuphak N; Schuetz A; Ortiz AM; Chomchey N; Belkaid Y; Davis J;
Mystakelis HA; Quinones M; Deleage C; Ingram B; Rerknimitr R; Pinyakorn S; Rupert A;
Robb ML; Ananworanich J; Brenchley J; Sereti I; on behalf of the RV254/SEARCH010
Study Group. Impact of acute HIV infection and early antiretroviral therapy on the human gut
microbiome. Open Forum Infect Dis 2019 Aug:ofz367.

50. Takhampunya R; Korkusol A; Pongpichit C; Yodin K; Rungrojn A; Chanarat N;
Promsathaporn S; Monkanna T; Thaloengsok S; Tippayachai B; Kumfao N; Richards
AL; Davidson SA. Metagenomic Approach to Characterizing Disease Epidemiology in a
Disease-Endemic Environment in Northern Thailand. Front Microbiol 2019 Feb; 10:319.

51. Tam CC; Anderson KB; Offeddu V; Weg A; Macareo LR; Ellison DW; Rangsin R;
Fernandez S; Gibbons RV; Yoon IK; Simasathien S. Epidemiology and transmission of
respiratory infections in Thai Army recruits: a prospective cohort study. Am J Trop Med Hyg
2018 Oct; 99(4):1089-95.

52. Tisdale MD; Tribble DR; Telu K; Fraser JA; Connor P; Philip C; Odundo E; Reyes F;
Simons MP; Swierczewski B; Lizewski S; Liu J; Houpt E; Riddle MS; Lalani T. A
comparison of stool enteropathogen detection by semiquantitative PCR in adults with acute
travelers' diarrhea before and 3 weeks after successful antibiotic treatment. Open Forum Infect
Dis 2019 May; 6(5):ofz187.

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53. Warrasak S; Euswas A; Fukuda MM; Ittiverakul M; Miller RS; Krudsood S; Ohrt C.
Comparative ophthalmic assessment of patients receiving tafenoquine or chloroquine/primaquine
in a randomized clinical trial for Plasmodium vivax malaria radical cure. Int Ophthalmol 2019
Aug; 39(8):1767-82.

54. Wojnarski M; Lon C; Vanachayangkul P; Gosi P; Sok S; Rachmat A; Harrison D;
Berjohn CM; Spring M; Chaoratanakawee S; Ittiverakul M; Buathong N; Chann S;
Wongarunkochakorn S; Waltmann A; Kuntawunginn W; Fukuda MM; Burkly H; Heang
V; Heng TK; Kong N; Boonchan T; Chum B; Smith P; Vaughn A; Prom S; Lin J; Lek D;
Saunders D. Atovaquone-proguanil in combination with artesunate to treat multidrug-resistant
P. falciparum malaria in Cambodia: an open-label randomized trial. Open Forum Infect Dis
2019 Sep; 6(9):ofz314.

55. Wojnarski M; Mouri O; Chambrion C; Roussel C; Chartrel N; Smith B; Smith P;
Thellier M; Buffet P; Ndour PA. Plasmodium falciparum clearance is pitting-dependent with
artemisinin-based drugs but pitting-independent with atovaquone-proguanil or mefloquine.
J Infect Dis 2019 Aug; 220(3):535-9.

56. WWARN K13 Genotype-Phenotype Study Group. Association of mutations in the
Plasmodium falciparum Kelch13 gene (Pf3D7_1343700) with parasite clearance rates after
artemisinin-based treatments-a WWARN individual patient data meta-analysis. BMC Med
2019 Jan; 17(1):1.

Conference Papers

1. Akapirat S; Phanuphak N; Pitisuttithum P; Kroon E; Nitayaphan S; Chariyalertsak S;
Phogat S; Sinangil F; Michael NL; Excler JL; Robb ML; Kim JH; Karasavvas N; Vasan
S; O'Connell RJ. ALVAC-HIV priming improves the magnitude and durability of plasma IgG
responses to AIDSVAXrB/E. Poster. Keystone Symposia Global Health: HIV Vaccines (X7).
Whistler, British Columbia, Canada. 24-28 March 2019.

2. Akapirat S; Rerks-Ngarm S; Pitisutthithum P; Nitayaphan S; Chariyalertsak S; Phogat
S; Sinangil F; Excler J; Robb ML; Michael NL; Kim JH; Karasavvas N; Vasan S;
O'Connell RJ; for the RV305 and RV306 Study Groups. Long boost intervals of ALVAC-
HIV/AIDSVAX B/E increased genital HIV Env IgG responses. Poster. Conference on
Retroviruses and Opportunistic Infections. Seattle, U.S.A. 4-7 March 2019. Top Antivir Med
2019; 27(suppl1):106s-107s. (Abstract no. 293; Poster P-D1 Preclinical and Clinical Vaccine
Trials).

3. Akapirat S; Rittiroongrad S; Rerks-Ngarm S; Pitisuttithum P; Madnote S; Puangkaew J;
Chantakulkij S; Phogat S; Sinangil F; Excler J; Robb ML; Michael NL; Kim JH;
Karasavvas N; Vasan S; O'Connell RJ; on behalf of the RV 305 Study Group. An
additional late boost of AIDSVAX B/E in RV144 participants induced plasma HIV envspecific
IgG4 and IgG1 with enhanced durability. Poster. HIV Research for Prevention 2018 "AIDS
Vaccine, Microbicide and ARV-based Prevention Science". Madrid, Spain. 21-25 October
2018. (Abstract no. P20.01; Poster Abstract Topic 20: Passive Immunization).

4. Anderson K. Finding the signal in the noise: 20 years of cohort studies in Thailand aiming to
disentangle the complexities of dengue disease and transmission. American Society of Tropical
Medicine and Hygiene 67th Annual Meeting. New Orleans, LA, U.S.A. 28 October-1
November 2018. (Session 138 - Insights From Prospective Cohort Studies to Understand the
Epidemiology of Severe Dengue and Inform Dengue Vaccine Evaluations).

5. Anderson K; Klungthong C; Wongstitwilairoong T; Suwanpakdee D; Watanaveeradej V;
Rangsin R; Kerdpanich P; Buddhari D; Yingyong T; Alera M; Velasco J; Wangchuck S;
Shrestha S; Weg A; Macareo L; Jarman R; Fernandez S. Seasonality of influenza viruses in
South and Southeast Asia: implications for the timing of seasonal vaccines. Poster. Options X
for the Control of Influenza. Suntec, Singapore. 28 August - 1 September 2019. (Abstract no.
11148; Topic: Public Health: Epidemiology Transmission).

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6. Aubry F; Martynow D; Baidaliuk A; Merkling SH; Dickson LB; Romero-Vivas CM;
Vega-Rúa A; Dusfour I; Jiolle D; Paupy C; Mayanja MN; Lutwama JJ; Kohl A; Duong
V; Ponlawat A; Cao-Lormeau V; Jarman RG; Diagne CT; Faye O; Faye O; Sall AA;
Lambrechts L. A worldwide survey of Aedes aegypti susceptibility to Zika virus sheds light on
the African exception to Zika emergence. Poster. American Society of Tropical Medicine and
Hygiene 67th Annual Meeting. New Orleans, LA, U.S.A. 28 October-1 November 2018. Am J
Trop Med Hyg 2018 Oct; 99(4 suppl):72. (Abstract no. 231; Session 22 - Poster Session A:
Presentations and Light Lunch).

7. Auysawasdi N; Linsuwanon P; Wanja E; Wongwairot S; Leepitakrat S; Limsuwan C;
Monkanna T; Richards A; Davidson S. Spatial-temporal trend and climatic and other
geospatial risk factors for scrub typhus in Thailand. Poster. American Society of Tropical
Medicine and Hygiene 67th Annual Meeting. New Orleans, LA, U.S.A. 28 October-1
November 2018. (Abstract no. LB-5275; Session 133 - Poster Session C: Presentations and
Light Lunch).

8. Aylor S; Roth A; Ubalee R; Davidson S; Waters N; Kreishman-Deitrick M; Black C; Lee
J; Adams J; Vesely B. Incorporating an innovative in vitro Plasmodium cynomolgi assay into
the Experimental Therapeutics' drug screening paradigm for the discovery of novel compounds
against Plasmodium hypnozoites. Poster. American Society of Tropical Medicine and Hygiene
67th Annual Meeting. New Orleans, LA, U.S.A. 28 October-1 November 2018. Am J Trop
Med Hyg 2018 Oct; 99(4 suppl):96. (Abstract no. 310; Session 22 - Poster Session A:
Presentations and Light Lunch).

9. Berry IM; Klungthong C; Rutvisuttinunt W; Chinnawirotpisan P; Ellison DW;
Thaisomboonsuk B; Ong-ajchaowlerd P; Theresa M; Srikiatkhachorn A; Chusri S; Yoon
I; Jarman RG; Macareo LR. A brief history of time and origin of chikungunya virus spread in
Thailand and Philippines. American Society of Tropical Medicine and Hygiene 67th Annual
Meeting. New Orleans, LA, U.S.A. 28 October-1 November 2018. Am J Trop Med Hyg 2018
Oct; 99(4 suppl):204. (Abstract no. 652; Session 29 - Chikungunya and Other Alphaviruses).

10. Boonyalai N. Plasmodium parasite resistance in Thailand and Cambodia. Fourth Annual Magill
Malaria Forum "Overcoming Challenges at the Front Lines of Malaria". Silver Spring, MD,
U.S.A. 26 April 2019.

11. Britch SC; Linthicum KJ; Ponlawat A; Kline DL; Helmey WL; Pongsiri A; Aldridge RL;
Golden FV. Transfluthrin on US military materials reduces mosquito populations in a hot
humid tropical environment in eastern Thailand. AMCA2019: 85th Annual Meeting. Orlando,
Florida, U.S.A. 25 February-1 March 2019. (Abstract no. 3; Session: Adult Control I).

12. Buadok W. Investigation of potential causes of febrile illness in Khon Kaen Province, Thailand
with focus on scrub typhus, rickettsioses, malaria infection and dengue virus infection. Poster.
American Society of Tropical Medicine and Hygiene 67th Annual Meeting. New Orleans, LA,
U.S.A. 28 October-1 November 2018. (Abstract no. LB-5002; Session 22 - Poster Session A:
Presentations and Light Lunch).

13. Buddhari D; Anderson KB; Gromowski G; Jarman RG; Iamsirithaworn S;
Srikiatkhachorn A; Rothman AL; Weg AL; Ellison DW; Macareo LR; Thomas SJ; Endy
TP. A novel prospective family cohort study of dengue virus transmission in Kamphaeng Phet,
Thailand baseline immunological and subclinical seroconversions from the first year. Poster.
American Society of Tropical Medicine and Hygiene 67th Annual Meeting. New Orleans, LA,
U.S.A. 28 October-1 November 2018. Am J Trop Med Hyg 2018 Oct; 99(4 suppl):286-287.
(Abstract no. 911; Session 77 - Poster Session B: Presentations and Light Lunch).

14. Buddhari D; Kankawinpong O; lamsirithaworn S; Anderson K; Hussem K; Klungthong
C; Weg A; Macareo L; Fernandez S. Performance of QuickVue influenza A+B rapid test to
detect influenza infection during year 2012-2019 in Kamphaeng Phet, Thailand. Poster. Options
X for the Control of Influenza. Suntec, Singapore. 28 August - 1 September 2019. (Abstract no.
11763; Topic: Clinical Sciences: Diagnostics and Disease Markers).

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15. Buranapraditkun S; Takata H; Kroon E; Chottanapund S; Sacdalan C; Tipsuk S;
Benjapornpong K; Nuntapinit B; Schacker T; Chomont N; Robb ML; Ananworanich J;
Spudich SS; Trautmann L; for the on behalf of the SEARCH018/RV408 Study group.
Effect of telmisartan given at ART initiation in AHI on immune cells in lymph nodes. Poster.
Conference on Retroviruses and Opportunistic Infections. Seattle, U.S.A. 4-7 March 2019. Top
Antivir Med 2019; 27(suppl1):108s-109s. (Abstract no. 300; Poster P-D2 Novel Therapeutic
Interventions Including Early ART).

16. Buranapraditkun S; Takata H; Schuetz A; Sacdalan C; Ratnaratorn N; Kroon E;
Rerknimitr R; Chottanapund S; Wansom T; O'Connell R; Michael N; Robb M;
Ananworanich J; Trautmann L; Vasan S; RV 304 Study Group. Altered CD4+ CCR5+
expression and cellular activation in mucosal and lymphoid tissues of transgender women.
Poster. HIV Research for Prevention 2018 "AIDS Vaccine, Microbicide and ARV-based
Prevention Science". Madrid, Spain. 21-25 October 2018. (Abstract no. P18.08; Poster Abstract
Topic 18: Mucosal Immunology).

17. Chinnawirotpisan P; Manasatienkij W; Joonlasak K; Klunhthong C; Huang A; Maljkovic
I; Rutvisuttinunt W; Morton L; Bishop-Lilly KA; Wiley M; Palacios G; Hamilton T;
Forshey B; Jarman RG; Macareo LR; Weg AL; Ellison DW. Evaluation of next generation
sequencing and bioinformatics pipeline for pathogen identification used at the Department of
Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand.
Poster. American Society of Tropical Medicine and Hygiene 67th Annual Meeting. New
Orleans, LA, U.S.A. 28 October-1 November 2018. Am J Trop Med Hyg 2018 Oct; 99
(4 suppl):281. (Abstract no. 893; Session 77 - Poster Session B: Presentations and Light
Lunch).

18. Chinnawirotpisan P; Manasatienkij W; Phonprakobsin T; Fernandez S; Thaisomboonsuk
B; Macareo LR; Buddhari D; Simasathien S; Suwanpakdee D; Watanaveeradej V;
Chusri S; Klungthong C. Molecular characterization and phylogenetic analysis of influenza
viruses circulating in Thailand between 2009 and 2018. Poster. Options X for the Control of
Influenza. Suntec, Singapore. 28 August - 1 September 2019. (Abstract no. 10897; Topic:
Virology and Pathogenesis: Cellular Molecular Virology).

19. Chuenklin S; Chaemchuen S; Wongsantichon J; Batty E; Sunyakumthorn P; Salje J.
The effect of extended laboratory propagation on the genome and virulence of Orientia
tsutsugamushi. Poster. 30th Meeting of the American Society for Rickettsiology: Rickettsial
Diseases at the Vector-Pathogen Interface. Santa Fe, New Mexico. 8-11 June 2019. (Abstract
no. 67).

20. Colby DJ; Sarnecki M; Barouch D; Tipsuk S; Stieh DJ; Kroon E; Schuetz A; Chomont N;
Pau MG; Phanuphak N; Michael N; Robb M; Tomaka F; Ananworanich J; the
HTX1001/RV405 Study team. AD26 MVA vaccines in acutely treated HIV: safety,
immunogenicity and viral rebound. Keystone Symposia Global Health: HIV Vaccines (X7) and
Functional Cures and the Eradication of HIV (X8). Whistler, British Columbia, Canada. 24-28
March 2019.

21. Colby DJ; Trichavaroj R; Pinyakorn S; Akapirat S; Crowell TA; Kroon E;
Benjapornpong K; Tipsuk S; Sacdalan C; Phanunphak P; Robb ML; Phanuphak N; de
Souza M; Ananworanich J; for the RV254/ SEARCH010 Study Team. Anogenital HIV
detected during analytic treatment interruption in remission trials. Poster. Conference on
Retroviruses and Opportunistic Infections. Seattle, U.S.A. 4-7 March 2019. Top Antivir Med
2019; 27(suppl1):144s-145s. (Abstract no. 402; Poster P-E11 Human Studies of Curative
Strategies and ATI).

22. Colby D; Pondet C; Pankam T; Plodkratok P; Trichavaroj R; Sacdalan C; Chomchey N;
Kroon E; Akapirat S; de Souza M; Phanuphak P; Ananworanich J; Phanuphak N.
Starting PrEP during acute HIV infection: what is the risk for antiretroviral drug resistance?. 4th
Asia Pacific AIDS Co-infections Conference: Translating Science into Clinical Practice. Hong
Kong. 27-29 June 2019. (Abstract no. 3).

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23. Costanzo MC; Schuetz A; Kim D; Anenia H; Barrera M; Boeckelman J; Thapa P;
Pitisutthithum P; Phanuphak N; Nitayaphan S; Chariyalertsak S; Kroon E; Pegu P;
Jongrakthaitae S; Phogat S; Sinangil F; Kim JH; Robb ML; Michael NL; O'Connell RJ;
Eller MA; Vasan S; for the RV306 and RV328 Study Groups. ALVAC-HIV is required for
effective priming of HIV-specific CD4+ T-cell responses with AIDSVAXrB/E vaccine. Poster.
Keystone Symposia Global Health: HIV Vaccines (X7). Whistler, British Columbia, Canada.
24-28 March 2019.

24. Crowell TA; Pinyakorn S; Sacdalan C; Kroon E; Colby DJ; Pattamasavin S; Ubolyam S;
Trichavaroj R; Butterworth O; Turk E; McCullough C; de Souza M; Phanuphak N;
Ananworanich J; for the RV254/SEARCH010 Study Group. Viral blips after treatment
initiation during acute HIV infection. Poster. Conference on Retroviruses and Opportunistic
Infections. Seattle, U.S.A. 4-7 March 2019. Top Antivir Med 2019; 27(suppl1):195s.
(Abstract no. 522; Poster P-H7 Acute Infection and HIV Transmission).

25. Dumre SP; Bhandari R; Chinnawirotpisan P; Klungthong C; Shakya G; Marasini B;
Shrestha S; Ghimire P; Karbwang J; Na-Bangchang K; Fernandez S; Hirayama K.
Molecular epidemiological investigation revealed serotype switching during major dengue
outbreaks in Nepal. Poster. Joint International Tropical Medicine Meeting 2018 "Innovation,
Translation, and Impact in Tropical Medicine". Amari Watergate Bangkok, Thailand. 12-14
December 2018:198. (Abstract no. ABS0001229; Poster No. 24).

26. Ellison DW; Klungthong C; Chinnawirotpisan P; Manasatienkij W; Poolpanichupatam
Y; Hussem K; Thaisomboonsuk B; Lohachanakul J; Nisalak A; Buddhari D; Khuntirat
B; Suntarattiwong P; Watanaveeradej V; Suwanpakdee D; Simasathien S; Chuenchitra
T; Chusri S; Buathong R; Weg AL; Anderson K; Macareo LR. Detection and molecular
characterization of Zika virus in specimens collected during 1998 to 2017 from Thailand. Poster.
American Society of Tropical Medicine and Hygiene 67th Annual Meeting. New Orleans, LA,
U.S.A. 28 October-1 November 2018. Am J Trop Med Hyg 2018 Oct; 99(4 suppl):293-294.
(Abstract no. 934; Session 77 - Poster Session B: Presentations and Light Lunch).

27. Fansiri T; Pongsiri A; Nitatsukprasert C; Khongtak P; Jaichapor B; Chittham W;
Khaengluecha A; Davidson SA; Ponlawat A. Evaluations of oviposition cues against Aedes
mosquitoes under different conditions in Thailand. AMCA2019: 85th Annual Meeting. Orlando,
Florida, U.S.A. 25 February-1 March 2019. (Abstract no. 238; Session: Biology/Behavior I).

28. Friberg H; Mathew A; Anderson KB; Ellison D; Macareo LR; Endy T; Jarman RG;
Rothman AL; Currier JR. Pre-existing T cell subsets and their association with subsequent
subclinical versus symptomatic dengue infection. Poster. American Society of Tropical
Medicine and Hygiene 67th Annual Meeting. New Orleans, LA, U.S.A. 28 October-
1 November 2018. Am J Trop Med Hyg 2018 Oct; 99(4 suppl):507. (Abstract no. 1610;
Session 77 - Session 133 - Poster Session C: Presentations and Light Lunch).

29. Gonwong S. Nationwide seroprevalence and geographic distribution of murine typhus in
Thailand. Poster. American Society of Tropical Medicine and Hygiene 67th Annual Meeting.
New Orleans, LA, U.S.A. 28 October-1 November 2018. Am J Trop Med Hyg 2018 Oct; 99
(4 suppl):182-183. (Abstract no. 582; Session 22 - Poster Session A: Presentations and Light
Lunch).

30. Gonwong S; Tabprasit S; Chuenchitra T; Ruamsap N; Islam D; Khantapura P;
Bodhidatta L. Human papillomavirus seroprevalence in young Thai men. Poster. ASM
Microbe 2019. San Francisco, CA, U.S.A. 20-24 June 2019. (Poster no. CIV-189; Session P408 -
CIV03 - Global Health: Viral Epidemiology).

31. Han WM; Apornpong T; Kerr SJ; Ubolyam S; Gatechompol S; Wansom T; Matthews G;
Tangkijvanich P; Ruxrungtham K; Phanunphak P; Avihingsanon A. Surge in hepatitis C
incidence associated with syphilis infection among Thai MSM. Poster. Conference on
Retroviruses and Opportunistic Infections. Seattle, U.S.A. 4-7 March 2019. Top Antivir Med
2019; 27(suppl1):226s. (Abstract no. 599; Poster P-K3 HCV Transmisson: the (Molecular)
Webs We Weave).

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