Center for
Global Health

1: This study is one aspect of a fruitful collaboration on dengue with the colleagues from universities in Malaysia:

Background: Dengue, a major global public health concern, is growing more prevalent. Extensive measures have been undertaken to prevent and control dengue transmission in Malaysia including understanding and modifying human behaviour. This study was designed to assist in planning an effective health intervention for dengue by measuring residents’ knowledge, attitudes, and practice (KAP) in hotspot areas of Sabah, East Malaysia. Methods: A community-based and cross-sectional study was conducted at a known dengue hotspot in Sabah involving 463 residents aged 18 years and above. Information on the socio-demographic characteristics of the residents and their KAP towards dengue was collected using a structured pre-validated questionnaire developed by the researchers. In addition, residents were invited to participate in a dengue seroprevalence study using a dengue immunoglobulin (Ig)M and IgG ELISA kit. Results: Most of the residents correctly identified common signs and symptoms of dengue such as fever (84.4%), chills (70.7%), and nausea or vomiting (56.0%). Approximately half of the residents (51.3%) had good knowledge, 66.0% had a positive attitude, and 63.7% described their positive practice for dengue prevention and control, respectively. The dengue seroprevalence study included 200 of the 463 residents; IgG and IgM seropositivity was 74.1% (n = 63) and 7.1% (n = 6), respectively. Based on logistic regression analysis, locals and migrants differed considerably in terms of their knowledge and attitude towards dengue prevention and control, while gender and level of education were predictive of practice level (p < 0.05) among all sociodemographic variables examined. Knowledge was strongly correlated with attitude (p < 0.0001) and practice (p < 0.0014). Discussion: In order to effectively control dengue epidemics in Sabah, a proactive attitude and behavioural changes by community residents are both required. In order to effectively prevent and manage dengue transmission in this hotspot area, a coordinated collaborative effort between government and private sectors, housing residential committees and individual residents is essential.

2: This study is one aspect of an ongoing collaboration on antibiotic-resistant typhoid with colleagues from universities in Pakistan and Australia:

Background: Increasing antibiotic resistance by pathogenic bacteria is observed in poor sanitary conditions. The peak incidence of typhoid occurs between 5–15 years of age. This is the most common bacteremic illness of children in Pakistan. The aim of this study was to investigate the frequency of drug-resistant Salmonella Typhi and S. Paratyphi A in children hospitalized or treated as outpatients at a tertiary care centre that serves Gadap Town, an extensive slum district of Karachi. Methods: A total of 275 peripheral blood samples were collected from children up to 14 years old who presented with clinical features of typhoid to Fatima Hospital, Baqai Medical University, over a two-year period. Samples were cultured for growth of aerobic and facultative anaerobic bacteria, identified by biochemical reactions. Antimicrobial susceptibility was tested by Kirby-Bauer disc diffusion using eight different antibiotics. Results: Among all samples, 30 (10.9%) were positive for S. Typhi by blood culture. The rate of positivity was 23 (76.7%) cases for ages 5–14 years, three (10.0%) in each of age groups 2.0–2.9 and 4.0–4.9 years, and one patient (3.3%) aged 3.0–3.9 years. The majority of S. Typhi isolates were resistant to co-trimoxazole (66.7%), ampicillin (63.3%), nalidixic acid (60.0%), chloramphenicol (50.0%) and aztreonam (50.0%). However, most isolates were susceptible to ceftriaxone (76.7%) and ciprofloxacin (66.7%). There were 15 multidrug-resistant isolates but no typhoid-related deaths. Conclusion: Our findings show evidence of antimicrobial resistance by S. Typhi isolated from Karachiite children living in a poverty-stricken setting where water quality and sanitation are both unsatisfactory. Currently, Pakistan’s most populated city is recognized as a focus of typhoid cases. Therefore, this first report of the emergence of confirmed cases of multidrug-resistant S. Typhi from the only public hospital in its largest neighbourhood identifies a grave public health concern.

3. This study on pathogen early detection in Hanoi wastewater forms the start of a new collaboration on infectious disease surveillance in Vietnam with colleagues in the USA:

Background: Monitoring the advent and prevalence of SARS-CoV-2 variants of concern and variants of interest in a community could help local health authorities to make informed decisions in the best interests of the population’s health. Methods: Since the onset of COVID-19, pre-sewage treatment wastewater sampling has been harnessed as a non-evasive large-scale pathogen surveillance tool. Wastewater surveillance complements clinical diagnosis because between 7–14 days’ early warning detection of transmission by asymptomatic infected individuals is achieved without excessive resources and labor required for frequent human testing by an approved diagnostic microbiology laboratory. Results: The level of sensitivity of SARS-CoV-2 detection in sewage currently approximates to one in 2,000 people, thereby being sufficiently accurate to identify the location of an urban outbreak to a close geographical proximity or large building occupancy. Discussion: The establishment of infrastructure for wastewater-based SARS-CoV-2 surveillance serves as an entry point for monitoring other pathogenic infectious agents (of viral, bacterial, fungal, and parasite origin) in resource-limited settings. Conclusion: This approach provides a more rapid and accurate early warning system for the outbreak of notifiable infectious diseases than more traditional public health surveillance systems. Furthermore, this technology should enable medical researchers to investigate horizontal transfer among enteric bacterial isolates of antimicrobial resistance (AMR) genes, and even to detect chemicals or biomarkers that humans excrete during the course of infectious or metabolic diseases.