Asian Pacific Journal of Tropical Medicine

333-334

Authors: James Ngamije, Callixte Yadufashije

None.

350-357

Authors: Fauze Mahmud, Ping Chin Lee, Habibah A Wahab, Khairul Mohd Fadzli Mustaffa, Chiuan Herng Leow, Azhar Rasul, Ngit Shin Lai

Malaria is one of the most devastating infectious diseases that caused millions of clinical cases annually despite decades of prevention efforts. Recent cases of Plasmodium falciparum resistance against the only remaining class of effective antimalarial (artemisinin) in South East Asia may soon pose a significant threat. Hence, the identification of new antimalarial compounds with a novel mode of action is necessary to curb this problem. Protein kinase has been implicated as a valid target for drug development in diseases such as cancer and diabetes in humans. A similar approach is now recognized for the treatment of protozoan-related disease including malaria. Few Plasmodium protein kinases that are not only crucial for their survival but also have unique structural features have been identified as a potential target for drug development. In this review, studies on antimalarial drug development exploiting the size of Plasmodium protein kinase ATP gatekeeper over the past 15 years are mainly discussed. The ATP-binding site of Plasmodium protein kinases such as Pf CDPK1, Pf CDPK4, Pf PKG, Pf PK7, and Pf PI4K showed great potential for selective and multi-target inhibitions owing to their smaller or unique ATP-gatekeeper amino acid subunits compared to that of human protein kinase. Hence it is a feasible solution to identify a new class of active antimalarial agents with a novel mode of action and longer clinical life-span.

366-374

Authors: Mila Nu Nu Htay, Ian M Hastings, Eva Maria Hodel, Katherine Kay

Objective: To explore the efficacy of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine and pyrimethamine (SP) against sensitive parasites. Methods: A pharmacological model was used to investigate the effectiveness of the previous recommended at least two-dose regimen, currently recommended three-dose regimen and 4, 6, 8-weekly regimens with specific focus on the impact of various non-adherence patterns in multiple transmission settings. Results: The effectiveness of the recommended three-dose regimen is high in all the transmission intensities, i.e. >99%, 98% and 92% in low, moderate and high transmission intensities respectively. The simulated 4 and 6 weekly IPTp-SP regimens were able to prevent new infections with sensitive parasites in almost all women (>99%) regardless of transmission intensity. However, 8 weekly interval dose schedules were found to have 71% and 86% protective efficacies in high and moderate transmission areas, respectively. It highlights that patients are particularly vulnerable to acquiring new infections if IPTp-SP doses are missed. Conclusions: The pharmacological model predicts that full adherence to the currently recommended three-dose regimen should provide almost complete protection from malaria infection in moderate and high transmission regions. However, it also highlights that patients are particularly vulnerable to acquiring new infections if IPTp doses are spaced too widely or if doses are missed. Adherence to the recommended IPTp-SP schedules is recommended.

378-380

Authors: Kia Jahanbin,Vahid Rahmanian

None.

285-287

Authors: Terkuma Chia, Oluwatosin Imoleayo Oyeniran

None.

295-300

Authors: Giao Huynh, Quang Vinh Bui, Ngoc Lan Nguyen, Le An Pham

Objective: To assess levels of HBsAb amongst infants who received hepatitis B vaccine in the Expanded Program on Immunization in Vietnam. Methods: A cross-sectional study was carried out at 16 community health centers from February 2016 to July 2017. Eligible infants were tested for HBsAb and HBsAg. Structured questionnaires were used to collect relevant information about the demographics of the parents/caregivers and their infants after physical examination. Results: A total of 199 eligible infants were selected with a mean age of (17.3±4.5) months. Protective antibody levels with HBsAb ≥10 mIU/mL were detected in 68.3% of infants. Of these, antibody levels from 10 to 99 mIU/ mL were 48.5% of those tested and antibody levels ≥100 mlU/mL were recorded as 51.5%. No cases were recorded of being infected with hepatitis B virus. The rate of positive HBsAb level in those who were not wasting and ≥18 months old was less than that among those who were <18 months old (OR 0.49, 95% CI: 0.26-0.92, P<0.05) while the infants with wasting and <18 months were less likely to be positive HBsAb than those who were not wasting and of the same age group (OR 0.15, 95% CI: 0.04-0.55, P<0.05). Conclusions: Seroprotection against hepatitis B virus was low in the infants tested (at 68.3%), which suggests that the hepatitis B vaccine should be administered with one additional dose for infants between 12 and 24 months of age, particularly those with wasting.

308-313

Authors: Atefeh Tavan, Fattaneh Mikaeili, Seyed Mahmoud Sadjjadi, Sara Bajelan, Hossein Mahmoudvand, Meysam Sharifdini

Objective: To study the prevalence and genotype of Enterobius (E.) vermicularis from adhesive tape samples in the cities of Shiraz and Khorramabad, Iran. Methods: A total of 1 000 adhesive tape samples from kindergartens in Shiraz (500 samples) and Khorramabad (500 samples) were collected and tested using a microscope to find E. vermicularis egg/s. A questionnaire was filled out for each sample. In order to characterize the genotype of E. vermicularis, the PCR-sequencing method of the mitochondrial cytochrome C oxidase subunit 1 (cox1) gene was used. Genomic DNA was extracted from the positive scotch tape samples of E. vermicularis. The cox1 gene was amplified by the polymerase chain reaction and sequenced. The sequence data were aligned using the BioEdit software and compared with the published sequences in GenBank. Phylogenetic analysis was performed using the maximum likelihood method. Results: The parasitological method showed that 15 out of the 500 samples from Shiraz (3.00%) and 12 out of the 500 samples from Khorramabad (2.40%) were infected with E. vermicularis eggs. BLAST analysis indicated that the sequenced isolates belonged to E. vermicularis genotype B while three different haplotypes were also identified. Conclusions: This is the first study on genotyping E. vermicularis in the cities of Shiraz and Khorramabad. Considering the public health importance of the disease, further studies are necessary to characterize the genotype of E. vermicularis in human populations from other regions of Iran.

322-327

Authors: Elfadil Abass

Objective: To compare diagnostic accuracy and agreement between direct agglutination test and rK39 rapid tests for diagnosis of visceral leishmaniasis in an endemic area, the Doka area in Eastern Sudan. Methods: Stored sera of confirmed visceral leishmaniasis cases, unconfirmed visceral leishmaniasis-suspects and negative controls were tested by direct agglutination test and rK39 rapid test. The sera were collected from the Doka area in Eastern Sudan. Diagnostic accuracy of direct agglutination test and rK39 rapid test was assessed in terms of sensitivity, specificity, positive predictive value and negative predictive value, estimated at 95% confidence interval (CI). Agreement between the two tests was determined by the kappa (κ) value. Results: Taking lymph node aspiration of Leishmania as a gold standard, direct agglutination test showed 91.0% sensitivity, 99.3% specificity, resulting in a positive and negative predictive value of 99.3% and 91.0%, respectively. In contrast, the sensitivity of rK39 rapid test was 85.2% and specificity 98.6%, resulting in a positive and negative predictive value of 98.5% and 85.9%, respectively. Most (81.3%) of the confirmed visceral leishmaniasis sera revealed strong antibody titers (≥1:6 400). Some sera (n=5) that were positively tested with rK39 rapid test were negative in direct agglutination test (≤1:800); in contrast, direct agglutination test was positive in 12 confirmed visceral leishmaniasis sera that were negatively tested with rK39 rapid test. There was moderate to good agreement between direct agglutination test and rK39 rapid test for confirmed visceral leishmaniasis patients (κ=0.42, 95% CI=0.21- 0.63) and control sera (κ=0.80, 95% CI=0.41-1.00). Conclusions: Both direct agglutination test and rK39 rapid test are satisfactory test systems for visceral leishmaniasis diagnosis in East Sudan. Their simplicity makes them ideal for first healthcare in rural areas. These data are relevant also for other East African endemic countries because of the geographical and overlapping distribution of the Leishmania parasite.

331-332

Authors: Natcha C. Jitsuk, Pikkanet Suttirat, Charin Modchang

None.

239-241

Authors: Sidgi S. Hasson, Ali A. Al-Jabri

None.

247-251

Authors: Minh Van Hoang, Phuong Thi Ngoc Nguyen, Thao Thi Phuong Tran, Long Quynh Khuong, An Thi Minh Dao, Huy Van Nguyen, Riyanti Djalante, Hanh Thi Tuyet Tran

Objective: To provide preliminary descriptions of the spread, burden and related medical capacity characteristics of the ASEAN countries. Methods: We utilized the data from four main official databases, including WHO reports, the Statistics and Research of the Coronavirus Disease, and the Southeast Asia Program of the Center for Strategic and International Study. The spread of the COVID- 19 pandemic, current burden and the COVID-19 medical response capacities were extracted before April 11, 2020. Results: As of April 13, 2020, the ASEAN countries reported 19 547 COVID-19 positive cases with 817 deaths (case-facility rate of 4.2%). Thailand was the first country in the region that reported having the COVID-19 cases, while Laos was the last to report confirmed COVID-19 cases. Durations for the number of deaths to double were between 8-12 days. For the testing and treatment capacities, the number of PCR tests provided to the populations was the highest in Vietnam, followed by Singapore, Malaysia, and Thailand. Meanwhile, the percentage of the population being tested was the highest in Brunei (2.31%), followed by Singapore (1.30%). Conclusions: A wide range of interventions were taken into practice in response to the outbreak with an effort of curbing the rise of this pandemic. However, special care should not be overlooked as the pandemic is placing a huge impact on the population and becomes increasingly unpredictable. To tackle the spread of the pandemic in the region, the ASEAN countries should work together as one community to provide better responses to future pandemics and other transboundary public health challenges.

260-265

Authors: Huynh Giao, Nguyen Thi Ngoc Han, Tran Van Khanh, Vo Kim Ngan, Vo Van Tam, Pham Le An

Objective: To assess the knowledge and attitude toward coronavirus disease-2019 (COVID-19) among healthcare workers at District 2 Hospital in Ho Chi Minh City (HCMC). Methods: A cross-sectional study was performed between January 2020 and February 2020 at District 2 Hospital. A systematic random sampling strategy was carried out and the data was collected through a self-administered questionnaire of the knowledge and attitude of healthcare workers regarding COVID-19. Descriptive analysis was reported to describe the demographic, mean knowledge and attitude score of healthcare workers. Inferential statistics including t-test, ANOVA and Spearman’s correlation were used to evaluate the relationship between study variables. Results: A total of 327 eligible healthcare workers had a mean score of knowledge and attitude of 8.17±1.3 (range 4-10) and 1.86±0.43 (range 1-5), respectively. They showed good knowledge and a positive attitude. However, approximately two thirds of the participants knew the mode of transmission, the isolation period and treatment (67.0%, 65.8%, and 58.4%, respectively), and 82.3% and 79.8%, respectively, held positive attitude regarding the risk of personal and family members getting illness. There was a negative correlation between knowledge scores and attitude scores (r=-0.21, P<0.001). Additionally, healthcare workerspredominately used social media to inform themselves about COVID-19 (91.1%). Conclusions: The majority of healthcare workers had good knowledge and positive attitude toward COVID-19. However, the level of some knowledge and attitude lower than that expected for their position level towards the virus. Additional education interventions and campaigns are required for healthcare workers.

272-277

Authors: Vahid Rahmanian, Saied Bokaie, Karamatollah Rahmanian, Saeed Hosseini, Aliakbar Taj Firouzeh

Objective: To determine the temporal patterns of cumulative incidence of brucellosis using autoregressive integrated moving average models. Methods: This cross-sectional study employed yearly and monthly data of 1 117 laboratory-confirmed human brucellosis cases from January 2013 to December 2018 using the Yazd brucellosis national surveillance system. The monthly incidences constructed a timeseries model. The trend of cumulative incidence was perceived by tracing a line plot, which displayed a seasonal trend with periodicity. Thus, the ARIMA models were selected. Thereafter, Akaike information criteria (AIC) and Bayesian information criterion (BIC) values among different models indicated a preferable model from models which were expanded by diverse lags [(3, 0, 3), (2, 0, 3), (3, 0, 2), (4, 0, 3) and (3, 0, 4)]. Then, the achieved ARIMA model was applied to the forecasting cumulative incidence of monthly brucellosis incidences. All analyses were performed using Stata, version 11.2. Results: For the ARIMA (3, 0, 4) model, MAPE value was 56.20% with standard error 0.009–0.016, and white noise diagnostic check (Q=19.79, P=0.975) for the residuals of the selected model showed that the data were completely modelled. The monthly incidences that were fitted by the ARIMA (3, 0, 4) model, with AIC (25.7) and BIC (43.35) with a similar pattern of actual cases from 2013 to 2018 and forecasting incidences from January 2019 to December 2019 were, respectively, 0.50, 0.44, 0.45, 0.49, 0.55, 0.58, 0.56, 0.51, 0.46, 0.44, 0.45 and 0.49 per 100 000 people. Conclusions: In summary, the study showed that the ARIMA (3, 0, 4) model can be applied to forecast human brucellosis patterns in Yazd province, supplementing present surveillance systems, and may be better for health policy-makers and planners.

281-282

Authors: Shahrzad Soltani, Masoud Foroutan, Aliasghar Valipour, Zolfaghar Sabati, Fatemeh Hallajian

None.

189-192

Authors: Massimo Giangaspero, Pasquale Turno

None.

197-198

Authors: Jelili Olaide Mustapha, Kamoru Ademola Adedokun, Idris Abdullahi Nasir

None.

204-213

Authors: Oluwaseyitan A. Adesegun, Oluwafunmilola O. Adeyemi, Osaze Ehioghae, David F. Rabor3, Tolulope O. Binuyo, Bisola A. Alafin, Onyedikachi B. Nnagha, Akolade O. Idowu, Ayokunle Osonuga

Enteric fever remains a tropical disease of public health significance in Africa, due to its high endemicity and transmission rates, more in sub-Saharan Africa with 7.2 million cases of typhoid fever annually and incidence rate of 762 per 100 000 person-years when compared with Northern Africa with a reported incidence rate of 557 per 100 000 person-years and lower. Recent studies show that almost all regions of sub-Saharan Africa are tending towards high incidence rates, especially Central and Western Africa. Though clinically indistinguishable from paratyphoid fever, typhoid fever causes more morbidity and mortality than paratyphoid fever, with a greater threat to children. Risk factors include consumption of contaminated water, patronizing food vendors and a history of contact with a case or a chronic carrier, amongst others. Environmental factors such as the rainy season, open sewers, contaminated water bodies and areas of low elevation have been implicated. Diagnosis in Africa is challenging due to resource constraints, as many centres still depend on clinical diagnosis and serodiagnosis using Widal test, in an era where more sensitive and specific tests exist. The polymerase chain reaction is one of the most sensitive diagnostic methods, while culture (particularly bone marrow) is considered to be one of the most specific. Quinolones (ciprofloxacin) and third-generation cephalosporins, amongst others, remain potent in the management of enteric fever, with resistance to quinolones gradually on the rise. Poor diagnostics, poor antibiotic stewardship and lack of drug (antibiotic) regulation are contributors to the problem of antibiotic resistance in Africa. Prevention of typhoid fever through vaccination, especially in children is still under investigation, with steady progress being documented. Overall, long term prevention strategies for typhoid fever should be based on improved sources of drinking water, good sanitation and hygiene, food safety and poverty alleviation.

221-226

Authors: Mahadevan Ganesan, Robert Sudha, Murugesan Amudhan, Ganesan Sucila Thangam

Objective: To determine the proportion of dengue non-structural protein 1 (NS1) positives among laboratory confirmed dengue IgM negative patients. Methods: Data for 1 732 samples received from January to October 2017 at the Virus Research and Diagnostic Laboratory (VRDL) for dengue diagnosis were downloaded from the National Institute of Epidemiology server. Samples that were previously reported as IgM negative for dengue diagnosis were identified and their NS1 status was determined using ELISA. Thus, ‘missed out’ NS1 positives were correlated with the duration of illness. Furthermore, an epidemic curve for the study period was constructed. The increase in positivity rate within and between the months was compared by McNemar’s and Pearson’s chi-square test, respectively. Results: The reported IgM-negatives were 813, of which, 22.5% (183) were retrospectively positive for NS1 antigen. The addition of NS1 positives revealed by this study has raised the reported positivity across the months that ranged from 8.1% to 29.6%. By analyzing the dengue positives per month and the epidemic curve, the period between January and September, 2017 was identified as non-epidemic while the epidemic started from the month of October, 2017. Conclusions: Acute dengue infection is widely confirmed by detecting NS1 antigen in serum. Missing out of NS1 positives happen due to shortened window period and such cases act as reservoir for further viral transmission. Hence, this study highly emphasizes performing all three tests for dengue diagnosis that warrants the accurate dengue proportion in India.

235-236

Authors: Aroonkumar Beesham

None.

141-142

Authors: Saurabh Bhargava, Kiran Kumari, R.K. Sarin, Rajvinder Singh

After a prolonged debate and discussion, the World Health Organization (WHO) relisted ‘snakebite’ under Category ‘A’ of ‘Neglected Tropical Diseases’ (NTDs) in June 2017 hoping to diminish its burden on people. Earlier, in March 2009, WHO added snakebite to its official list of NTDs but later downgraded to ‘Other Neglected Conditions’, a list reduced in importance[1,2]. Obviously, the recent inclusion of snakebite in NTDs was due to the estimation of huge toll of deaths due to snake envenomation in tropical countries as supported by the multiple reports. This inclusion will expedite the process of developing better management protocols and infusing funds for such affected countries. However, a significant question here is whether the estimation of snakebite cases is accurate enough to publicise the authentic figures. Snakebite is a problem of resource poor tropical countries which usually lacks a solid central registry system of record keeping. Even when such record keeping is in place, yet people out there may not be aware enough for such measures and they don’t bother to register such cases. Snakebite incidences in such circumstances could definitely affect the national statistical figures of snakebite in any country. Many scientific reports and WHO reports have suggested that India leads the chart of mortality and morbidity caused by snakebites and envenomations contributing almost 50% of world’s burden by snakebites[3,4]. However, true figures remained elusive and the estimates range from 10 000 to 50 000 annual deaths in India. These estimates are usually based on extrapolation of smaller and regional studies. Nationally representative “Million Death Study” conducted by the Registrar General of India projected 45 900 annual deaths in India due to snake envenomation on the basis of statistical data generated from randomly selected 6 671 areas from 28 states and 7 Union territories of India between 2001 and 2003[5]. The WHO in 2005 has quoted similar figures about snake envenomations in India[3]. In 2008, an international study funded by the WHO estimated the global burden of snakebites to be around 1 841 000 snakebite incidences with around 94 000 annual deaths across the world[4]. They reported around 81 000 envenoming and nearly 11 000 annual deaths due to snakebite in India. On the other hand, the National Health Profile (NHP) maintained by the Central Bureau of Health Intelligence, Government of India reported average annual snakebite mortality of just 1 215 across India from 2010 to 2016[6]. This is the data that is quoted by the government for various purposes including policy making. The National Crime Records Bureau (NCRB) working under the Ministry of Home Affairs of Government of India reported an average 8 507 annual deaths due to snake envenomation across India during 2010-2016[7]. Data published by both, NHP and NCRB depict a huge difference in official figures of snakebites and is quite underreported than other scientific epidemiological studies. However, a well designed field survey conducted in Tamil Nadu in India suggested that even 50 000 snake envenomed mortality is underreported, and the actual burden of snake envenomation could be even more. This extensive field survey of 28 494 people from thirty villages in state of Tamil Nadu suggested around 10 000 annual deaths from snake envenomation[8] and it was in contrast with around 3 100 snakebite deaths suggested by nationally representative “Million Death Study” conducted by the Registrar General of India, average 44 annual deaths by NHP reports during 2010-2017, and average 638 annual deaths by NCRB from 2011 to 2015. Similarly, NCRB reported 368 deaths due to snake envenomation during 2011-2015 in the state of Haryana, whereas NHP reported only 32 deaths over same period in same region. However, another independently conducted government hospital based epidemiological profiling of the same region reported at least 130 deaths due snake envenomation in Haryana during 2011-2015[9]. Similar disparity between government records of snakebite and independently conducted surveys have been reported by researchers from West Bengal[10].

152-161

Authors: Banghan Ding, Bangjiang Fang, Jun Li, Qingquan Liu, Chuanzhu Lv, Xuezhong Yu, Xiaodong Zhao

Xiyanping injection, a traditional Chinese medicine injection made of andrographolide sulfonate, consisting of well-defined ingredients with antiviral, antibacterial, anti-inflammatory and antipyretic efficacy, has been widely used for treating infectious diseases of respiratory and digestive systems. However, its wide applications may easily lead to unreasonable clinical medication. In order to guide the precise clinical application and rational use of Xiyanping injection, experts in related fields conducted systematically literature review, evaluated and deliberated the application of Xiyanping injection in treating acute infectious diseases using evidence-based medicine method, and jointly drafted the consensus to summarize types of acute infectious diseases in children and adults that can be treated with Xiyanping injection, and recommend the intervention time, usage and dosage, course of treatment and combined medication of the injection. Besides, the consensus elucidates the safety, precautions and contraindications of the injection, so as to provide guidance for clinical use.

169-175

Authors: Afshar Etemadi, Rezvan Moniri, Mahmood Saffari, Hossein Akbari, Saeed Alamian, Ali Mohammad Behrozikhah

Objective: To determine epidemiological, molecular characterization, and potential risk factors of human brucellosis. Methods: This descriptive study was carried out in the clinical setting in Iran between 2017 and 2018. A total of 297 participants enrolled in the study. The sample size was calculated based on the occurrence rate of brucellosis in different areas. Patients were assessed using serological tests and conventional culture methods. Phage and multiplex PCR methods typed all of Brucella isolates. Potential risk factors of disease were determined. Results: A total of 141 of 297 (47.5%) Brucella strains were isolated and all of them were detected as Brucella melitensis biovar 1. Based on serologic titers, high culture positivity was recorded at 1/640 titer (P<0.006). The risk factors for brucellosis were patients older than 40 years (OR=2.23, 95%CI: 1.4-3.55, P=0.001), animal keeper (OR=7, 95%CI: 1.51-32.41, P=0.005), housewife (OR=8.76, 95%CI: 1.85-41.37, P=0.002), farmer (OR=6.42, 95%CI: 1.21-33.97, P=0.019), and contact with animal (OR=1.31, 95%CI: 0.60-2.85, P=0.005). Conclusions: To the best of our knowledge, this is the first comprehensive report from Iran presenting the detection of Brucella species by the multiplex PCR. Brucella melitensis biovar 1 is still the dominant causative agent in Iran. The consumption of unpasteurized dairy products, living in rural areas, and animal contact were risk factors of brucellosis.

185-186

Authors: Hamid Reza Niazkar, Majid Niazkar

COVID-19 due to infections with the 2019 novel coronavirus (SARS-CoV-2) was first reported in Wuhan, Hubei Province, China in December 2019. Up to 2 March 2020, it has already spread to more than 55 countries, infected more than 85 000 individuals, and yielded to about 3 000 death cases[1]. Due to the vigorous outbreak of COVID-19, it has become a global concern. Further management and controlling of this worldwide threat inevitably relies on the preparedness and precise risk assessment of the future, particularly in countries that new cases have been observed. In this regard, estimation of new probable confirmed and death cases in the near future is crucial to health care systems of each country. As a result, some researches have been conducted to address this new concern[2-4]. In one of the most recent studies focusing on the first month of COVID-19 outbreak in Thailand, Sookaromdee and Wiwanitkit[2] proposed a second-order polynomial function, which relates imported infected cases (I) with time (t). The relation is given as I=2AT2+AT+C, where A is the acceleration rate of disease spreading and C is a constant. This relation was derived by integrating V=AT, where V is the average velocity of the spreading disease[2]. The authors sincerely appreciate Sookaromdee and Wiwanitkit for their valuable contribution. However, several issues are presented in accordance with their mathematical model: First of all, COVID-19 is highly contagious, and infected individuals can spread the disease during the incubation period, which is estimated to be about 2-14 days[5]. Due to the incubation period of COVID-19, imported infected cases may underestimate the outbreak, and may not be a suitable index for prediction purposes. In contrast, a forecasting model based on either total confirmed or death cases may give more accurate estimations. In the suggested model by Sookaromdee and Wiwanitkit[2], it was basically assumed that the spreading acceleration rate of COVID-19 outbreak is constant in respect with time. This assumption may not be compatible with the natural course of the outbreak. According to COVID-19 outbreak reported from 20 January to 24 February 2020 in Thailand[1], the accumulative number of confirmed cases not only has a highly nonlinear relationship with time but also demonstrates a repetitive pattern comprising of a steep rise followed by a plateau, as shown in Figure 1.