Progress in rubella control initiated through measles elimination strategies:the Malaysian experience

Objective:To analyse the laboratory surveillance data from 2004 till 2008 to examine the changing trend of rubella cases in Malaysia.Methods:Samples for this study were either received through the measles case based surveillance program or were hospital cases received for sero-diagnosis of congenital rubella syndrome(CRS). Specific rubella IgM antibody test was carried out on all samples that were negative for measles IgM antibody and for sero-diagnosis of CRS.Results:Through the surveillance program for measles,the samples received for rubella had increased five fold from 365 in 2004 to 1 522 in 2007.Positive rubella cases detected had also increased from 4.1%in 2004 to 33.2%in 2007.The age group 11 to 20 years accounted for 73.6%of rubella cases confirmed in 2008,with a higher incidence among males than females.Positive rubella IgM was detected in 25 CRS cases during the 6 year period between January 2003 and December 2008.Conclusion:The measles elimination program had contributed to significant progress in the control of rubella,with the majority of rubella cases detected through this strategy.Since rubella is not notifiable in Malaysia,this integrated measles and rubella surveillance should be continued.However,to enhance the progress,specific targets should also be established in the national program to eliminate rubella and CRS.

Prevalence and risk factors associated with tuberculosis mortality in Brunei Darussalam

Objective:To determine the prevalence and risk factors associated with tuberculosis mortality in Brunei Darussalam and to explore its underlying causes.Methods:A retrospective cohort study was conducted where data on socio-demographics,clinical characteristics and treatment outcomes of all tuberculosis patients registered at the National tuberculosis Coordinating Centre between 2013 and 2017 were collected.Overall tuberculosis mortality and the proportion of tuberculosis-related deaths were calculated.Logistic regression analysis was used to determine the risk factors of tuberculosis mortality when compared to those who are cured and/or completed tuberculosis treatment.Results:Of 1107 tuberculosis cases,99 died,giving an overall tuberculosis mortality rate of 8.9%(95%CI 7.4%-10.8%).Significant risk factors associated with tuberculosis mortality were age≥40 years(adjusted OR for 40-59 years was 3.89;95%CI 1.13-1.69;adjusted OR for≥60 years was 22.3;95%CI 7.27-91.9,using 20-39 years as reference),female sex(adjusted OR 1.74;95%CI 1.09-2.79),having renal disease(adjusted OR 25.7;95%CI 2.82-191.50)and having any cancers(adjusted OR 3.61;95%CI 1.26-10.00).The majority(75.8%)of the recorded deaths were not related to tuberculosis.Conclusions:Tuberculosis patients who were older than 40 years,female,and having renal disease and any cancer will need close monitoring in their management program to prevent tuberculosis mortality.Clinicians should also focus on other non-tuberculosis aspects of the patient’s medical history.

Knowledge, attitudes and practice survey on Zika virus infection among pregnant women in Brunei Darussalam

To assess the knowledge, attitudes, and practices(KAP) on Zika virus infection among pregnant women in Brunei Darussalam by a cross-sectional survey. Methods: Between February and June 2017, we recruited 234 pregnant women from all government healthcare centres at Brunei-Muara district, using a modified systematic sampling approach. A pre-tested and self-administered questionnaire was used and data analysis was conducted using descriptive statistics and multiple logistic regression analyses. Results: The study participants were mainly Malay(87.2%) and their mean age was 28.0 years. The median knowledge score was 13, out of a possible score of 28. Most participants(92.7%) knew that Zika virus was transmitted by mosquito bites whereas some(34.6%) knew that sexual transmission was also possible. Media(radio, television or newspapers) was the preferred source of updated information on Zika virus, followed by healthcare workers(44.0%), government announcements(43.2%), and social media(38.0%). Pregnant women who were 25 years old or older [Adj. OR=3.62(95% CI: 1.57, 9.51)], not Malays [Adj. OR=3.32(95% CI: 1.35, 8.55)], and had an average monthly household income of more than BND $3 000 [Adj. OR=4.06(95% CI: 1.81, 19.44)] were more likely to score higher for knowledge on Zika virus. The median prevention practice score was 23, out of a possible score of 36. Most participants reported wearing covering clothes(98.3%) and kept their living surroundings clean(99.6%). Most participants(88.0%) agreed that Zika is an important issue in their community. Conclusion: We found a lack of knowledge on Zika virus infection among pregnant women attending government maternal and child healthcare centres in Brunei Darussalam, in particular that Zika virus can be sexually transmitted. Such information could be well disseminated at the healthcare centre level. Health literacy studies should be conducted to understand the facilitators and barriers of KAP on Zika virus infection among pregnant women.

Mapping the high burden areas of cholera in Nepal for potential use of oral cholera vaccine: An analysis of data from publications and routine surveillance systems

Objective:To assess the extent of existing published evidence on cholera and to characterize the epidemiologic data of cholera in Nepal.Methods:We conducted a literature scoping review by summarizing published literature reporting on cholera in Nepal from January 1946 to March 2019 in online databases:MEDLINE,Embase,Cochrane,and Global Health.Additionally,we reviewed national surveillance data on clinically diagnosed and laboratory confirmed cholera reported by the Ministry of Health and Population.Results:Most of the published studies were conducted predominantly in Kathmandu Valley during the rainy season;however,outbreaks have been reported in other parts of Nepal including Terai,Hilly and Mountain regions.Our literature review exhibited that all age groups were affected by cholera,but particularly children and young adults were at-risk age groups in Nepal.Vibrio cholerae serogroup O1,biotype El Tor,serotype Ogawa has been predominantly isolated with an emergence of resistant strains since 1996.Two mass vaccination campaigns using oral cholera vaccines were conducted:Rautahat district in 2014 and Banke district in 2017.Conclusions:Capacity building for a nation wide systematic cholera surveillance with rapid and reliable diagnosis is needed to better estimate the burden of cholera and identify geographically at-risk areas associated with the disease in Nepal.It is essential for developing an adequate policy on oral cholera vaccine introduction and effective water,sanitation and hygiene interventions.

Socio-Demographic and Behavioral Factors for Serious Injury among Adolescents in Malaysia

This study was to determine the prevalence and socio-demographic associated factors for serious injury among adolescents in Malaysia. The study used data from the Malaysian Global School-based Health Survey which was conducted in 2012. Logistic regression analysis was used to establish associations. Of the 25,507 respondents, 34.9% (42.1% males and 27.8% females) reported having been in a serious injury. Compared to participants who were not bullied, those who reported being bullied were more likely to have sustained serious injury (aOR = 2.2;95% CI [1.95 - 2.48]). Adolescents who were involved in physical fighting were 57.5% (aOR = 2.75;95% CI [2.53 - 2.99]) and more likely to have sustained serious injury compared to those who were not involved in the fighting. Meanwhile, adolescents who used substances were 52.3% (aOR = 1.68 [1.52 - 1.85]) and more likely to have sustained serious injury compared to those who did not use substances. Serious injury is frequent among adolescents in Malaysia. Based on studies by Harel, suggestion where reduction of substance use and bullying may be assessed if they have an impact in reducing serious injury among adolescents. Furthermore, educational programmes that focus on the underlying causes and determinants of injury provide an effective and efficient method of injury prevention.

Outbreak of Human Metapneumovirus in Ibaraki, Japan and Its Descriptive Epidemiology

Introduction: The Infection Control Law in Japan does not cover monitoring of human metapneumovirus (HMPV). Therefore, its epidemiology is not well known. However, rapid diagnostic testing for this virus has been reimbursed by public health insurance in Japan since 2014. One case of acute encephalitis caused by HMPV was reported in April 2017 in Ibaraki. All schools in Ibaraki prefecture started to participate in the (Nursery) School Absenteeism Surveillance System ((N)SASSy) in 2009. All nursery schools started to use it in 2012. Methods: We specifically examine its seasonality and incidence by age. The study period extends from October 1, 2014 through May 31, 2017. Results: In total, (N)SASSy received 187 cases during the period. Spring and early summer were apparently the high season. The highest incidence was 36 cases in April 2015. The incidence among zero and one year olds was higher in 2017 than in the same season among 2014-2016. The necessary effort to download data from (N)SASSy, show these figures, and confirm the situation and background was a few minutes. Discussion: Rapid diagnostic testing for HMPV elucidated its epidemiology for the first time. Moreover, timely information sharing through (N)SASSy led the Ibaraki prefectural office to publish a reminder in July 2017 about the HMPV outbreak situation and to encourage precautions against it by nursery schools.

Descriptive Epidemiology for <i>Mycoplasma pneumoniae</i>Infection Using (Nursery) School Absenteeism Surveillance System, and Proposal for Countermeasures

Objective: We present descriptive epidemiology of Mycoplasma infection using the (Nursery) School Absenteeism Surveillance System ((N)SASSy) in addition to national official sentinel surveillance for infectious diseases (NOSSID). It is expected to be helpful for early detection and response to outbreak of Mycoplasma infection and also to be useful for antimicrobial resistance measures. Method: The study period was 2010-2014 seasons. The study area was the whole of Ibaraki prefecture, Japan. NOSSID reports the number of patients with Mycoplasma pneumonia from 13 sentinel hospitals. We compare the number of patients and the incidence rate of NOSSID with the same information in (N)SASSy. Result: In NOSSID, the largest number of patients by age was 27 patients of one year old in 2012. (N)SASSy showed that the incidence rate in the elementary schools is high in 2011 and 2012. Especially, the second grade students were the highest. Discussion: Even though Mycoplasma infection is well known as a pediatric disease, we showed that second grade was the highest in incidence at first. Because (N)SASSy is timely and real-time information collection, evaluation and sharing countermeasures with (nursery) schools, public health centers, and physicians are useful for students and nursery school children, and communities. Conclusion: Because mycoplasma infection is common pediatric infectious diseases and because some patients rarely develop severe infections, we must prevent larger outbreaks. (N)SASSy can provide timely intervention at the initial phase of outbreak by monitoring situations in (nursery) schools and comparing data to baseline information.

Ambient Air Pollution and Pulmonary Tuberculosis in Malaysia

Introduction: The possible impact of ambient air pollution exposure on the development of active tuberculosis (TB) remains obscure. This study investigated the potential role of ambient air pollution in activating pulmonary TB (PTB) compared to extrapulmonary TB (EPTB). Materials and Methods: Data on TB cases were obtained from national surveillance data in Malaysia during 2013 and air pollution data were obtained from 52 air-monitoring stations around the country for the 3-year period of 2011-2013. Analyses were performed to estimate the odds of PTB vs. EPTB with changes in the 3-year (2011-2013) average Air Pollutant Index (API) and specific ambient air pollutants. Results: Results showed that the 95th-percentile of API levels during 2011-2013 was moderate and it was not associated with PTB. However, the odds of active PTB compared to EPTB was significantly elevated with the 95th-percentile levels for particulate matter with an aerodynamic diameter of 10 μm or less (aOR = 1.006, 95% CI: 1.002, 1.011), p-value Conclusions: These results provide suggestive evidence of the effects of ambient air pollution on development of active pulmonary TB compared to extrapulmonary TB. Additional research on the impacts of ambient air pollution on TB is warranted.

The new WHO guideline for control and elimination of human schistosomiasis:implications for the Schistosomiasis Elimination Programme in Nigeria

Background With some 134,073,166 people living in endemic communities at risk of infection[1],Nigeria is the most endemic country in Africa and requires preventive chemotherapy(PC)for a total of 26.3 million persons[2].The National Schistosomiasis Elimination Programme(NSCHEP),with the support of international partners,has been implementing PC in Nigeria since 2009 and most recently will need to revise its current strategy(Additional file 1).For example,the new World Health Organization(WHO)guideline has six key recommendations that will dramatically change the implementation of schistosomiasis elimination in endemic countries[3].However,its impact and programmatic implications will vary from country to country,hence the need for a country-specific analysis.

Clinical study of distribution and drug resistance of pathogens in patients with severe acute pancreatitis

Background Previous researches about necrotic pancreatic tissue infections are numerous, but the study on systemic infection related to the severe acute pancreatitis （SAP） treatment period is limited. This study aimed to investigate the distribution and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP during the past three years. Methods A retrospective study was conducted on the distribution, category and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP from 2008 to 2011. Results A total of 594 pathogenic bacteria samples were isolated. Among them 418 isolates （70.4%） were Gram bacteria negative, 142 isolates （23.9%） were Gram bacteria positive, and 34 isolates （5.7%） were found fungi. The most common Gram negative bacteria were Escherichia coli （19.8%）, and the dominant Gram positive pathogenic bacteria were Enterococcus faecium. The distribution of SAP-related infectious pathogens was mainly in peritoneal drainage fluid, sputum, bile, and wound secretions. Almost all the Gram negative pathogenic bacteria were sensitive to carbapenum. Extended-spectrum I]-Iactamases （ESBLs） producing strains were more resistant to penicillins and cephalosprins than the ESBLs non-producing strains. Staphylococcus was sensitive to vancomycin and linezolid. The drug resistance of meticillin-resistant staphylococcus （MRS） to commonly used antibiotics was higher than meticillin-sensitive streptococcus （MSS）. Enterococcus sp. exhibited lower drug-resistance rates to vancomycin and linezolid. Conclusions Gram negative bacteria were the dominant SAP-related infection after hepatobiliary surgery. A high number of fungal infections were reported. Drug resistant rates were high. Rational use of antibiotics according to the site of infection, bacterial species and drug sensitivity, correctly executing the course of treatment and enhancing hand washing will contribute to therapy and prevention of SAP-related infection and decrease its mortality.

The practicality of Malaysia dengue outbreak forecasting model as an early warning system

Dengue is a harmful tropical disease that causes death to many people.Currently,the dengue vaccine development is still at an early stage,and only intervention methods exist after dengue cases increase.Thus,previously,two scientific experimental field studies were conducted in producing a dengue outbreak forecasting model as an early warning system.Successfully,an Autoregressive Distributed Lag(ADL)Model was developed using three factors:the epidemiological,entomological,and environmental with an accuracy of 85%;but a higher percentage is required in minimizing the error for the model to be useful.Hence,this study aimed to develop a practical and cost-effective dengue outbreak forecasting model with at least 90%accuracy to be embedded in an early warning computer system using the Internet of Things(IoT)approach.Eighty-one weeks of time series data of the three factors were used in six forecasting models,which were Autoregressive Distributed Lag(ADL),Hierarchical Forecasting(Bottom-up and Optimal combination)and three Machine Learning methods:(Artificial Neural Network(ANN),Support Vector Machine(SVM)and Random Forest).Five error measures were used to evaluate the consistency performance of the models in order to ensure model performance.The findings indicated Random Forest outperformed the other models with an accuracy of 95%when including all three factors.But practically,collecting mosquito related data(the entomological factor)was very costly and time consuming.Thus,it was removed from the model,and the accuracy dropped to 92%but still high enough to be of practical use,i.e.,beyond 90%.However,the practical ground operationalization of the early warning system also requires several rain gauges to be located at the dengue hot spots due to localized rainfall.Hence,further analysis was conducted in determining the location of the rain gauges.This has led to the recommendation that the rain gauges should be located about 3e4 km apart at the dengue hot spots to ensure the accuracy of the rainfall data to be included in the dengue outbreak forecasting model so that it can be embedded in the early warning system.Therefore,this early warning system can save lives,and prevention is better than cure.