The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birthdose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region. 168 www.thelancet.com/gastrohep Vol 5 February 2020The Lancet Gastroenterology & Hepatology Commission accounted for 108 276 (8·2%) of the total liver-related deaths in the region in 2015, compared with 929 (1·2%) of 72 437 in the USA and 4032 (0·3%) of 197 179 in Europe. Deaths in the Asia-Pacific region represented three-quarters of the global total number of deaths due to acute viral hepatitis. In 2015, the region accounted for three-quarters of the global total number of deaths related to acute HBV, almost two-thirds of those due to acute hepatitis A infection, and almost 80% of those due to acute hepatitis E infection. Of all deaths du...

Understanding the host immune response during Zika virus (ZIKV) infection will provide valuable insights into ZIKV immunopathogenesis. In this study, characterization of cellular changes and immune mediators of ZIKV-infected patients was performed, allowing for the identification of key infection-associated markers.

The increase in CS rate is attributed largely to the rising CS rate in Group 5, followed by Group 1. We propose that future efforts to reduce overall CS rate should be focused on increasing vaginal birth after cesarean and reduce CS rates in nulliparous women with singleton cephalic full-term pregnancy (Groups 1 and 2), which in turn will reduce the number of pregnant women with a previous CS.

Aim: An epidemic of hand, foot and mouth disease (HFMD) occurred in Singapore between September and November 2000. During the epidemic, there were four HFMD‐related deaths and after the epidemic, another three HFMD‐related deaths. This study sought to determine the risk factors predictive of death from HFMD disease. Methods: The risk factors for fatal HFMD were determined by comparing clinical and laboratory findings between fatal cases (n= 7) and non‐fatal controls (n= 131) admitted between September 2000 and April 2001. Enterovirus 71 positive fatal cases (n= 4) and non‐fatal controls (n= 63) were also compared. Results: In total, 138 HFMD cases with a mean age of 32 mo were studied. The majority of fatal cases died from interstitial pneumonitis, of whom three also had brainstem encephalitis. Of the 131 non‐fatal cases, 3 had concomitant infections (respiratory syncytial virus bronchiolitis, right‐sided pneumonia, Haemo‐philus influenzae type b meningitis), 2 had aseptic meningitis, and 1 each had transient drowsiness, intravenous immunoglobulin‐related complications and transverse myelitis. By multivariate logistic regression analysis, atypical physical findings (p= 0.0006), raised total white cell count (p= 0.0128), vomiting (p= 0.0116) and absence of mouth ulcers (p= 0.043) were predictive of a fatal course. Although previous epidemics have described neurogenic pulmonary oedema as the main cause of death, the fatal cases in this study died mainly from interstitial pneumonitis alone or with myocarditis or encephalitis. Conclusion: Although HFMD is generally a benign disease, risk factors such as vomiting, absence of mouth ulcers, atypical presentation and raised total white cell count should alert the physician of a fatal course of illness.