The challenge of communicable diseases in the WHO South-East Asia Region

Wastewater based environmental surveillance of toxigenic Vibrio cholerae in Pakistan

BACKGROUND

Pakistan has been experiencing intervals of sporadic cases and localized outbreaks in the last two decades. No proper study has been carried out in order to find out the environmental burden of toxigenic V. cholerae as well as how temporal and environmental factors associated in driving cholera across the country.

METHODS

We tested waste water samples from designated national environment surveillance sites in Pakistan with RT-PCR assay. Multistage sampling technique were utilized for samples collection and for effective sample processing Bag-Mediated Filtration system, were employed. Results were analysed by district and month wise to understand the geographic distribution and identify the seasonal pattern of V. cholera detection in Pakistan.

RESULTS

Between May 2019, and February 2020, we obtained and screened 160 samples in 12 districts across Pakistan. Out of 16 sentinel environmental surveillance sites, 15 sites showed positive results against cholera toxigenic gene with mostly lower CT value (mean, 34±2) and have significant difference (p < 0.05). The highest number of positive samples were collected from Sindh in month of November, then in June it is circulating in different districts of Pakistan including four Provinces respectively.

CONCLUSION

V. cholera detection do not follow a clear seasonal pattern. However, the poor sanitation problems or temperature and rainfall may potentially influence the frequency and duration of cholera across the country. Occurrence of toxigenic V. cholerae in the environment samples showed that cholera is endemic, which is an alarming for a potential future cholera outbreaks in the country.

The impact of crisis and disasters risk management in COVID-19 times: Insights and lessons learned from Saudi Arabia

Background

All countries all over the world strive to fight the outbreak of COVID-19 pandemic and their governments are facing unprecedented strains and challenges. Since COVID-19 has engendered socioeconomic recession and the deterioration of health systems, Insights and lessons from some countries can illustrate various approaches designing their people-centric health and socioeconomic policies. The kingdom of Saudi Arabia has implemented various measures and strategies to mitigate the spread of pandemic and to save the lives of people. Therefore, we investigate the role of the Saudi disaster risk reduction system (DRRS) to fight the virus outbreak and provide a safe environment for the well-being of its inhabitants.

Methodology

We use a qualitative case study methodology to document and analyze the crisis and disasters risk management framework within the hazard management process. The case study methodology is suitable in investigating a phenomenon in its real-life settings and contexts. Thus, we outline lessons learned from Saudi disaster risk management experience in combating COVID-19 pandemic.

Results

During COVID-19 disaster, we found that the Saudi disaster risk reduction system (DRRS) is structured into three main levels: strategic, operational and tactical. The strategic level represents the strategic planning division and runs audit and monitoring of overall decentralized units of crisis management at operational and tactical levels. The findings show that there are three policy implications: keep vigilance at the public national level, remaining flexible in a national management structure and good governance at local administration level.

Conclusion

The application of disaster risk reduction framework in COVID-19 times requires the use of multi-level strategies to protect vulnerable peoples during the four stages of mitigation (readiness), preparedness, response (implementation) and recovery (post-COVID).

Helicobacter pylori Infection and Related Gastrointestinal Diseases in Southeast Asian Countries: An Expert Opinion Survey

Background:

Helicobacter pylori (H. pylori) infection is currently considered as an infectious disease irrespective of symptoms and stage of disease. This study aimed to survey the impact of H. pylori infection and the current management approaches in Southeast Asian countries.

Materials and methods:

This is a survey among 26 experts from 9 Southeast Asian countries (Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam), who attended a meeting to develop the ASEAN consensus on H. pylori management in November 2015.

Results:

The prevalence of H. pylori varied significantly from 20% to 69% among countries, highest in Myanmar and lowest in Malaysia. The rate of H. pylori infection in patients with gastritis, peptic ulcer disease and gastric cancer (GC) also varied significantly, not only among countries but also among regions within the same country. The most common method for H. pylori diagnosis before treatment was rapid urease test, followed by urea breath test. In multi-ethnic countries, some ethnic groups including Chinese, Batak and Minahasanese were considered as having higher risk of GC. There have been no national screening programs for GC in all countries, and a majority of patients with GC were diagnosed in advanced stages with very poor 5-year survival.

Conclusions:

The prevalence of H. pylori infection and its infection rates in related gastrointestinal diseases were significantly different among Southeast Asian countries. The prognosis of patients with GC in the region was very poor. The result of this survey is a platform for future international and regional research collaboration.

Emerging organisms in a tertiary healthcare set up

BACKGROUND

One-tenth of all infectious diseases are attributable to emerging organisms. As emerging organisms sporadically affect a relatively small percentage of population they are not studied at large. This study was aimed at studying the characteristics of emerging organisms encountered from various clinical samples in an apex tertiary care multispeciality teaching and research hospital.

METHODS

16,918 positive isolates obtained from 66,323 culture samples processed in the clinical microbiology lab of an apex multispeciality hospital during 2011-2012 were included after a pilot study. Both manual and automated systems were used for identification and antimicrobial susceptibility. The frequency of isolation, sources, referring centers, resistance and susceptibility profiles, phenotypic characteristics and number of reports in PubMed were studied.

RESULTS

Out of 16,918 isolates, 13,498 (79.78%) were Gram negative bacteria, 3254 (19.23%) were Gram positive bacteria and 166 (0.98%) were yeasts. A total of 483 (2.85%, 95% CI 2.6%-3.1%) emerging organisms including 116 (0.69%, 95% CI 0.57%-0.81%) emerging species were identified comprising 54 genera.

CONCLUSION

Emerging organisms are likely to evade routine identification or be disregarded as non-contributory. Astute efforts directed at identification of emerging isolates, decisions by clinical microbiologists and treating physicians and containment of infection are required.

A qualitative exploration of social contact patterns relevant to airborne infectious diseases in northwest Bangladesh

In South Asia, the burden of infectious diseases is high. Socioeconomically and culturally-defined social interaction patterns are considered to be an important determinant in the spread of diseases that are transmitted through person-to-person contact. Understanding of the contact patterns in this region can be helpful to develop more effective control measures. Focus group discussions were used in exploring social contact patterns in northwest Bangladesh. The patterns were assessed for perceived relevance to the spread of airborne infectious diseases, with special focus on diseases, like leprosy and tuberculosis, in which the role of social determinants is well-recognized. Highly-relevant social contact patterns inside the home and the neighbourhood, across age and sex groups, were reported in all group discussions. Outside the home, women and girls reported relevant contacts limited to the close neighbourhood while men mentioned high relevant contacts beyond. This implies that, in theory, infectious diseases can easily be transmitted across age and sex groups in and around the home. Adult men might play a role in the transmission of airborne infectious diseases from outside this confined area since only this group reported highly-relevant social contacts beyond the home. This concept needs further exploration but control programmes in the South Asian region could benefit from considering differences in social contact patterns by gender for risk assessments and planning of preventive interventions.

Communicable diseases and governance: a tale of two regions

Regional policies and programmes on communicable disease prevention and control are becoming an important component of global public health. In a comparative fashion, we examined the situation in the European and Southeast Asian contexts, with a focus on the underlying institutional and political backgrounds underpinning the regionalisation of planning and interventions. Our findings document the emergence of two distinctive models of regional integration. While in Europe there is a process of institutionalisation and centralisation, in Southeast Asia the landscape of regional cooperation is characterised by the proliferation of many provisional projects, based on loose agreements and a decentralised structure that emphasises the initiative and sense of ownership of member countries. These two approaches, we conclude, reflect wider differences of political culture between supranational integration in Europe and intergovernmental agreements in Southeast Asia.

Emerging infectious diseases in southeast Asia: regional challenges to control

Southeast Asia is a hotspot for emerging infectious diseases, including those with pandemic potential. Emerging infectious diseases have exacted heavy public health and economic tolls. Severe acute respiratory syndrome rapidly decimated the region's tourist industry. Influenza A H5N1 has had a profound effect on the poultry industry. The reasons why southeast Asia is at risk from emerging infectious diseases are complex. The region is home to dynamic systems in which biological, social, ecological, and technological processes interconnect in ways that enable microbes to exploit new ecological niches. These processes include population growth and movement, urbanisation, changes in food production, agriculture and land use, water and sanitation, and the effect of health systems through generation of drug resistance. Southeast Asia is home to about 600 million people residing in countries as diverse as Singapore, a city state with a gross domestic product (GDP) of US$37,500 per head, and Laos, until recently an overwhelmingly rural economy, with a GDP of US$890 per head. The regional challenges in control of emerging infectious diseases are formidable and range from influencing the factors that drive disease emergence, to making surveillance systems fit for purpose, and ensuring that regional governance mechanisms work effectively to improve control interventions.