 My name is Tri Wang-Rang Simakul. I am an infectious diseases and microbiology doctor. I am based up in Chiang Rai in northern Thailand, up in most northern most province in Chiang Rai and I mainly research a disease called scrubtyphus. Scrubtyphus is an infectious disease caused by a bacteria called Orientius of Sugumushi and humans catch the disease through the bite of an infected chigamite, a very tiny insect that you can barely see with the naked eye and sometimes patients develop a skin lesion called an eschar similar to a cigarette burn at the site of the bite and it usually occurs in rural areas and agricultural workers are the ones at most risk. The disease is characterized by fever and patients can have an eschar or not and it's then patients also develop other non-specific symptoms such as rash, cough, swollen glands and or headache. The mortality of the disease ranges depending on where you are within the endemic area so in northern Thailand it can be as bad as 13% which is quite high. The northern region accounts for 50 to 60% of these cases despite only containing 20% of the population so it is a major problem in northern Thailand and scrubtyphus you don't develop natural immunity to it which is long-term so if you live in the endemic area and you have ongoing transmission risk such as in agricultural workers you can catch the disease year after year after year. We treat scrubtyphus normally with specific antibiotics mainly the main one being one called doxycycline which has been around for a few decades. The problem is it's none of these antibiotics are first-line antibiotics so if you or I develop a fever within the endemic area and go to the hospital most likely going to receive another class of antibiotics similar to penicillins and these antibiotics have no action against scrubtyphus. The most important lines of research in relation to scrubtyphus has been in epidemiology and diagnostics. Diagnostics of scrubtyphus is actually not that easy. The rapid tests are available have a range of accuracy and the current one we're using is probably one of the better ones that we have but it's just a screening test. What we need to do to diagnose scrubtyphus usually is to collect blood from the patient when they're sick followed by another blood sample, maybe a couple of weeks down the line when they're better and assess for the antibody levels in response to scrubtyphus infection and that remains the gold standard. It is a gold standard that's been in place for decades and we need to do better. One of the areas where we're looking to improve is to provide a low-cost accurate test for clinicians to use at the place where it's needed the most. In the district hospitals, in the clinics within this endemic area. We talked about the Tsutsugomushi triangle and it was such a surprise to hear reports of scrubtyphus being diagnosed firstly from the United Arab Emirates in the Middle East and even more of a shock to hear that cases were being diagnosed in Chile in South America and there's also been tentative cases diagnosed from Africa. So this has really opened up the span of scrubtyphus. It might be much more widespread than we originally thought. Scrubtyphus is a neglected tropical disease, so neglected in fact that the World Health Organization does not have scrubtyphus listed as one of the official diseases in the neglected tropical disease lists and is a disease that's been under research and underfunded for decades. We are light years away from being in the position of other major diseases such as HIV, TB and malaria and the fact that drug resistance has been reported and the fact that there are no effective vaccines currently available means that we need to progress with what we're doing and actually accelerate the amount of research we're doing in scrubtyphus. We have come a long way in developing new tests for scrubtyphus, particularly in the research setting where we need to be absolutely certain as much as possible that the patient has scrubtyphus or not. Unfortunately, a scrubtyphus vaccine that is effective and ready to roll out is still many years away. In Chiang Rai, the majority of our studies are clinically related studies aimed at either answering clinically related questions and how we can improve the management of patients or will end up with improvements in diagnostics and treatment. So we try to maximize the potential benefits of every study and we realize that we need to collaborate more and more, especially in an area which is underfunded.