Re-emerging Disease Research Articles

Presence of a Sexual Population of Puccinia graminis f. sp. tritici in Georgia Provides a Hotspot for Genotypic and Phenotypic Diversity.

Wheat stem rust, caused by Puccinia graminis f. sp. tritici, is a re-emerging disease exemplified by recent epidemics caused by new virulent races. Understanding the sources and origins of genetic variations in the pathogen populations globally can facilitate the development of better strategies in disease management. We analyzed 68 wheat stem rust samples collected between 2013 and 2015 from Georgia where stem rust incidences are frequent and the alternate host, common barberry, is present. A total of 116 single-pustule isolates were derived and evaluated on stem rust differential lines to determine the virulence phenotypes and 23 races were identified, many of which were detected for the first time. Unique virulence combinations including, Sr22+Sr24 and Sr13b+Sr35+Sr37 were detected. These virulence combinations pose new challenges to breeding programs because many of these genes are used in breeding for resistance to the Ug99 race group. Sixty-one isolates were genotyped using a custom single-nucleotide polymorphism chip and 17 genotypes were identified. The 2013 isolates contained 11 multilocus genotypes compared with isolates of 2014 and 2015, with five and three genotypes, respectively. The higher levels of virulence and genotypic diversity observed in the 2013 samples strongly indicated that sexual recombination occurs in the Georgian P. graminis f. sp. tritici population, and that the Caucasus region of Eurasia may be an important source of new races.[Formula: see text] Copyright © 2019 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.

Validation study of the Parent Attitudes About Childhood Vaccines (PACV) questionnaire: the Malay version

ABSTRACT Vaccine hesitant parents are linked with re-emergence of vaccine preventable diseases, but evidence is scarce locally. The Parent Attitudes about Childhood Vaccines (PACV) questionnaire was validated and used in the USA to identify vaccine hesitant parents. This study aimed to adapt and translate the 15-item PACV questionnaire from English into the Malay language, and to examine its validity and reliability. The sample population was parents of children aged 0–24 months, recruited at an urban government health clinic between November 2016-June 2017. During content validation, two items from the “Behavior” subdomain were identified as items with formative scale and excluded from exploratory factor analysis (EFA) but retained as part of demography. A total of 151 parents completed the questionnaire with response rate of 93.3%. Test-retest reliability was tested in 25 respondents four weeks later and the intra-class correlation was between 0.53 and 1.00. EFA of the 13 items showed possibility of two to four factor domains, but three domains were most conceptually equivalent. Two of the domains were similar to the original and one factor was identified de novo. One item was deleted due to poor factor loading of < 0.3. Therefore, the validated final PACV-Malay consisted of 12 items framed within three-factor domains. The PACV-Malay was reliable with total Cronbach alpha of 0.77. In conclusion, the PACV-Malay is a valid and reliable tool which can be used to identify vaccine hesitant parents in Malaysia. Confirmatory factor analysis and predictive validity are recommended for future studies.

About unification of indices of the possibility of disease occurrence in risk assessment methodology and the determination of the probability of non-carcinogenic effects in toxicological-hygienic, clinical and epidemiological studies and according to data about health-seeking behavior

In the methodology for the assessment of the risk the possibility of the disease occurrence under the impact of carcinogenic and non-carcinogenic substances is measured by different indices. This leads to the fact that within the single methodology there are used various scores for such similar index as the risk of the disease occurrence, as a result carcinogens and systemic toxicants happen to be inconsistent from this point of view. At the same time, unlike carcinogens risk indices for systemic toxicants do not allow to evaluate the number of possible diseases in the population during the corresponding period of time, because they contain no information about their probability. Obviously, from this point of view, the characteristics of carcinogenic risk have certain advantages. Therefore, noncarcinogenic risk should be assessed by the similar indices as carcinogenic ones. However, an obstacle to this is the fact that in toxicological-hygienic, clinical and epidemiological studies, according to the results of which there is determined the risk for systemic toxicants, the impact of non-lethal levels of the exposure is established not in separate individuals, as for carcinogens, but according to mean-group values of indices of the state of the body as the identification of the nonspecific effect under relatively non high doses (concentrations) in the single person is fairly difficult. Such data do not allow to estimate the probability of the break of the effect. Also the data concerning seeking for the medical help, considering repeated medical resource utilization due to protract diseases or afflictions occurring repeatedly in a person several times for the considered period of time fail to be the estimation of the probability for the disease occurrence. For the obtaining of the possibility of unification of the carcinogenic and non-carcinogenic indices of risk in the paper there are presented methods for the determination of the probability of non-carcinogenic effects in toxicological-hygienic, clinical and epidemiological studies, as well as according to statistical data on the seeking for the medical help, taking into account the repeated appeals of the protract or re-emerging diseases.

Inhibition by Marine Algae of Chikungunya Virus Isolated From Patients in a Recent Disease Outbreak in Rio de Janeiro.

Chikungunya virus (CHIKV) infection is one of the most challenging re-emergent diseases caused by a virus, and with no specific antiviral treatment it has now become a major public health concern. In this investigation, 25 blood samples were collected from patients with characteristic CHIKV symptoms and submitted to a virus isolation protocol, which detected 3 CHIKV isolates. These samples were evaluated by sequencing for the characterization of the strains and any homology to viruses circulating in Brazil during a recent outbreak. These viruses were used for the development of antiviral assays. Subsequently, the inhibitory effects of seaweed extracts on CHIKV replication were studied. The marine species of algae tested were Bryothamnion triquetrum, Caulerpa racemosa, Laurencia dendroidea, Osmundaria obtusiloba, Ulva fasciata, and Kappaphycus alvarezii, all of which are found in different countries including Brazil. The results revealed high levels of CHIKV inhibition, including extracts of O. obtusiloba with inhibition values of 1.25 μg/mL and a selectivity index of 420. Viral inhibition was dependent on the time of addition of extract of O. obtusiloba to the infected cells, with the optimal inhibition occurring up to 16 h after infection. Neuron evaluations with O. obtusiloba were performed and demonstrated low toxicity, and in infected neurons we observed high inhibitory activity in a dose-dependent manner. These results indicate that the algal extracts may be promising novel candidates for the development of therapeutic agents against CHIKV infections.

Epidemiology, clinical profile and laboratory parameters of scrub typhus cases in West Bengal

Context: Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. It is a re-emerging rickettsial disease known to occur all over India. Also no data exists as to what proportion of fever cases are due to scrub typhus in West Bengal. Aims: This study was aimed at identifying the proportion of Orientia tsutsugamughi infection among the patients presenting with acute febrile illness and their epidemiological characteristics, clinical profile and laboratory parameters. Methods and Material: Blood samples of patients suffering from acute undifferentiated febrile illness for more than five days duration were collected from different hospitals of Kolkata and IgM capture Enzyme Linked Immuno-Sorbant Assay (ELISA) was performed at referral virology laboratory of School of Tropical Medicine, Kolkata over the period, April 2017 to March 2018. Results: 89 cases were found reactive for scrub typhus IgM out of 259 suspected cases (34.36%). Scrub typhus was mainly prevalent in children with slight male predilection. Most of the patients were from rural belt with a history of poor housing conditions. The common symptoms associated with fever were headache, nausea/vomiting, cough and skin rashes. Common signs were hepatomegaly, splenomegaly, followed by eschar and lymphadenopathy. Important laboratory findings were anaemia, leucocytosis, thrombocytopenia, and elevated liver enzymes whereas serum urea/creatinine level was almost within normal limits. There was no mortality. Conclusions: In this study 34.36% of febrile patients (duration of fever ? five days) were positive for scrub typhus. So it needs to be included in the differential diagnosis of febrile illness in West Bengal. Keywords: Acute febrile illness, Scrub typhus, West Bengal, Orientiatsutsugamushi.

Portable sequencer in the fight against infectious disease

Infectious disease is still a major threat in the world today. Five decades ago, it was considered soon to be eradicated, but the adaptation of pathogens to environmental pressure, such as antimicrobials, encouraged the emergence and reemergence of infectious disease. The fight with infectious disease starts with prevention, diagnosis, and treatment. Diagnosis can be upheld by observing the cause of disease under the microscope or detecting the presence of nucleic acid and proteins of the pathogens. The molecular techniques span from classical polymerase chain reaction (PCR) to sequencing the nucleic acid composition. Here, we are reviewing the works have been undertaken to utilize a portable sequencer, MinION, in various aspects of infectious disease management.

When Both Markets and Governments Fail Health

This paper presents the rationale and motivation for countries and the global development community to tackle a critical set of functions in the health sector that appear to be under-prioritized and underfunded. The recent eruptions of Ebola outbreaks in Africa and other communicable diseases like Zika and SARS elsewhere led scientific and medical commissions to call for global action. The calls for action motivated the World Health Organization (WHO) to respond by defining a new construct within the health sector: Common Good for Health (CGH). While the starting point for developing the CGH construct was the re-emergence of communicable diseases, it extends to additional outcomes resulting from failures to act and finance within and outside the health sector. This paper summarizes global evidence on failures to address CGHs effectively, identifies potential reasons for the public and private sectors’ failures to respond, and lays out the first phase of the WHO program as represented by the papers in this special issue of Health Systems & Reform.

Neuroimaging of Emergent and Reemergent Infections.

Infectious diseases emerge and reemerge over the years, and many of them can cause neurologic disease. Several factors contribute to the emergence and reemergence of these conditions, including human population growth, an increase in international travel, the geographic expansion of recognized pathogens to areas where they were previously nonendemic, and greater contact with wild animal reservoirs. The antivaccination social movement has played an important role in the reemergence of infectious diseases, especially some viral conditions. The authors review different viral (arboviruses such as dengue, chikungunya, and Zika virus; enterovirus 71; measles; and influenza), bacterial (syphilis, Lyme disease, and listeriosis), and parasitic (Chagas disease) diseases, focusing primarily on their neurologic complications. Although there are several additional infectious diseases with central nervous system manifestations that could be classified as emergent or reemergent, those listed here are the most relevant from an epidemiologic standpoint and are representative of important public health issues on all continents. The infections caused by these pathogens often show a variety of neuroimaging patterns that can be identified at CT and MRI, and radiology is central to the diagnosis and follow-up of such conditions. Given the increasing relevance of emerging and reemerging infections in clinical practice and public health scenarios, radiologists should be familiar with these infections. Online supplemental material is available for this article. ©RSNA, 2019.

H5N1 (Avian Influenza) Virus Case In 2014 Central Java Wonogiri District, What Is A Re-Emerging Disease?

H5N1 (Avian Influenza) Virus Case In 2014 Central Java Wonogiri District, What Is A Re-Emerging Disease?

Zoonotic Trypanosomes in Rats and Fleas of Venezuelan Slums.

Rattus spp. are reservoirs of many human zoonoses, but their role in domestic transmission cycles of human trypanosomiasis is underestimated. In this study, we report trypanosome-infected Rattus norvegicus and Rattus rattus in human dwellings in slums neighboring Maracay, a large city near Caracas, the capital of Venezuela. Blood samples of R. norvegicus and R. rattus examined by PCR and FFLB (fluorescent fragment length barcoding) revealed a prevalence of 6.3% / 31.1% for Trypanosoma lewisi (agent of rat- and flea-borne human emergent zoonosis), and 10.5% / 24.6% for Trypanosoma cruzi (agent of Chagas disease). Detection in flea guts of T. lewisi (76%) and, unexpectedly, T. cruzi (21.3%) highlighted the role of fleas as carriers and vectors of these trypanosomes. A high prevalence of rats infected with T. lewisi and T. cruzi and respective flea and triatomine vectors poses a serious risk of human trypanosomiasis in Venezuelan slums. Anthropogenic activities responsible for growing rat and triatomine populations within human dwellings drastically increased human exposure to trypanosomes. This scenario has allowed for the reemergence of Chagas disease as an urban zoonosis in Venezuela and can propitiate the emergence of atypical T. lewisi infection in humans.

From Surveillance To Control: Evaluation of A Larvicide Intervention Against Aedes aegypti In Brownsville, Texas.

South Texas is recognized as a potential area for the emergence and re-emergence of mosquito-borne diseases due to recent circulation of Zika, chikungunya, and dengue viruses. During 2017, high Aedes aegypti abundance found in the city of Brownsville, TX, in combination with the previous year's local transmission of Zika virus, triggered the activation of the Texas Department of State Health Services Emergency Mosquito Control Contingency Contract. A contract with the Clarke Environmental and Mosquito Control was a response to control Ae. aegypti, using a ground-based wide-area larvicide spray (WALS™) containing Bacillus thuringiensis israelensis. The WALS application was evaluated through a field-based bioassay and by comparing surveillance data pre- and post-WALS application. The WALS application bioassay demonstrated that the larvicide was effective up to 60 m into the target properties. Additionally, the number of Ae. aegypti captured in traps decreased in the WALS intervention areas compared with the untreated control areas, with an estimated 29% control.

PKB XXVII Ilmu Penyakit Dalam: Comprehensive Management in Internal Medicine

ForewordInternal Medicine is quickly developing in all lines, from basic theories, pathophysiology, diagnostic procedures and therapy. The challenges of new cases and the re-emergence of re-emerging diseases in the era of globalization, modernization and industrialization require clinicians to constantly renew their knowledge and expertise and possess global standard quality to improve medical services. Information on medical science and technology is now easily accessible to anyone, produce an increasingly critical society and bring up challenges for clinicians.The advancement of Indonesian doctors must be supported by access to regional, national and international scientific communication in the form of scientific forums that present the latest research information and results, as well as a forum for discussion with experts in addition to establishing family bond for doctors.Pendidikan Kedokteran Berkelanjutan (PKB) Internal Medicine Department, Faculty of Medicine of Udayana University / Sanglah Hospital 2019 is a scientific activity in Internal Medicine topics held annually. In the series of activities of PKB XXVII in Internal Medicine Faculty of Medicine Universitas Udayana / Sanglah Hospital 2019, the update in the field of Internal Medicine will be presented in the form of training (workshops), symposiums, and expert discussions hence the opportunities for interaction between participants and experts are optimal. Development in the field of research is also a concern and we give appreciation in the form of opportunities to compete in oral papers and posters.  Dr. I Wayan Losen Adnyana, SpPD-KHOM ChairmanÂ

Immunization coverage under universal immunization programme in Kozhikode district, Kerala

Background: Immunization is an important cost effective tool for preventing the morbidities and mortalities caused by vaccine preventable diseases. The objectives of this study were to assess the universal immunization programme coverage of children of 12–23 months of age in Kozhikode district and to study the factors associated with immunization coverage.Methods: A cross sectional study was conducted in 30 randomly selected electoral wards of Kozhikode district which were selected using multi stage cluster sampling technique during April 2013 to May 2014.Results: 469 children were studied from 30 clusters. 75.5% was fully immunized while 1.5% was unimmunized. Dropout rate for DPT 3 to Measles was the highest accounting to 20.2%. Most common reason for failure of immunization among unimmunized was that the parents didn’t feel the need (57.1%) and for partially immunized was the illness of the child (27.8%) followed by lack of awareness of the time of immunization (22.2%). Religion, early age of the mother at marriage and first delivery and high birth order were significantly associated with a higher proportion of partially immunized while higher education of the parents (&gt;12th standard), health worker’s home visit in the first year of the child and presence of immunization card were significantly associated with a high full immunization coverage (p&lt;0.05).Conclusions: Immunization coverage of 75.5% is far behind the target to be achieved. 1.5% of the children didn’t get any of the vaccinations. It is very important to increases the coverage to prevent the re-emergence of vaccine preventable diseases.

Development of Multispecies Recombinant Nucleoprotein-Based Indirect ELISA for High-Throughput Screening of Crimean-Congo Hemorrhagic Fever Virus-Specific Antibodies.

Crimean-Congo hemorrhagic fever (CCHF) is a re-emerging zoonotic viral disease prevalent in many parts of Asia, Europe, and Africa. The causative agent, Crimean-Congo hemorrhagic fever orthonairovirus (CCHFV), is transmitted through hard ticks. Tick vectors especially belonging to the Hyalomma species serve as the reservoir and amplifying host. The vertebrate animals including sheep, goat, and bovine act as a short-lasting bridge linking the virus and ticks. CCHFV causes fatal hemorrhagic fever in humans. Humans are usually infected with CCHFV either through the bite of infected ticks or by close contact with infected animals. Immunological assays, primarily enzyme-linked immunosorbent assay (ELISA) using whole viral antigen, are widely used for serosurveillance in animals. However, the whole virus antigen poses a high biohazard risk and can only be produced in biosafety level 4 laboratories. The present study focuses on the development and evaluation of safe, sensitive, and specific IgG indirect enzyme-linked immunosorbent assay (iELISA) using recombinant nucleoprotein (NP) of CCHF virus as an antigen. The codon-optimized NP gene sequence was synthesized, cloned, and expressed in pET28a+ vector. The recombinant NP was purified to homogeneity by affinity chromatography and characterized through Western blot and MALDI-TOF/MS analysis. The characterized protein was used to develop an indirect IgG microplate ELISA using a panel of animal sera. The in-house ELISA was comparatively evaluated vis-à-vis a commercially available ELISA kit (Vector-Best, Russia) with 76 suspected samples that revealed a concordance of 90% with a sensitivity and specificity of 79.4 and 100%, respectively. The precision analysis revealed that the assay is robust and reproducible in different sets of conditions. Further, the assay was used for serosurveillance in ruminants from different regions of India that revealed 18% seropositivity in ruminants, indicating continued circulation of virus in the region. The findings suggest that the developed IgG iELISA employing recombinant NP is a safe and valuable tool for scalable high-throughput screening of CCHFV-specific antibodies in multiple species.

Leptospirosis Occurrence in Agricultural Communities in Setiu, Terengganu

Leptospirosis is a re-emerging infectious disease of public health importance. Infection can occur through occupational and environmental exposure of the causative agent through contaminated water in the agricultural field. In this study, soil and water samples were screened for the presence of Leptospira sp. In addition, the study aimed to explore the knowledge, attitudes and practice (KAP) on leptospirosis among agricultural communities in Setiu, Terengganu. A total of 40 environmental samples were randomly collected from rice fields, rubber plantation and oil palm plantation. All samples were examined for the presence of Leptospira sp by quantitative Real Time Polymerase Chain Reaction (qPCR) assay. KAP survey was carried out among 248 respondents using standardized modified translated questionnaires. Findings from this study revealed that only 5% of water collected from rice field area showed the presence of Leptospira sp. Similarly, only 5% of soil collected from oil palm plantation showed the presence of Leptospira sp DNA. Majority of respondents (52.58%) had moderate knowledge and unsatisfactory practice score (72.51%) but showed 75.21% of satisfactory attitude score. The findings also showed there is a significant difference in knowledge with regards to the signs and symptoms of leptospirosis (0.004). Furthermore, the practice score on rat control measures estimated 0.011 between three groups of respondents. The presence of Leptospira sp in the agricultural area and medium knowledge and practice among agricultural communities possesses environmental risks of contracting to leptospirosis. Hence, necessary interventions should be implemented by relevant authorities to prevent future transmission of leptospirosis in agricultural areas

Aggravation of Human Diseases and Climate Change Nexus.

For decades, researchers have debated whether climate change has an adverse impact on diseases, especially infectious diseases. They have identified a strong relationship between climate variables and vector’s growth, mortality rate, reproduction, and spatiotemporal distribution. Epidemiological data further indicates the emergence and re-emergence of infectious diseases post every single extreme weather event. Based on studies conducted mostly between 1990-2018, three aspects that resemble the impact of climate change impact on diseases are: (a) emergence and re-emergence of vector-borne diseases, (b) impact of extreme weather events, and (c) social upliftment with education and adaptation. This review mainly examines and discusses the impact of climate change based on scientific evidences in published literature. Humans are highly vulnerable to diseases and other post-catastrophic effects of extreme events, as evidenced in literature. It is high time that human beings understand the adverse impacts of climate change and take proper and sustainable control measures. There is also the important requirement for allocation of effective technologies, maintenance of healthy lifestyles, and public education.

Development of a Supervised Learning Algorithm for Detection of Potential Disease Reemergence: A Proof of Concept.

Infectious disease reemergence is an important yet ambiguous concept that lacks a quantitative definition. Currently, reemergence is identified without specific criteria describing what constitutes a reemergent event. This practice affects reproducible assessments of high-consequence public health events and disease response prioritization. This in turn can lead to misallocation of resources. More important, early recognition of reemergence facilitates effective mitigation. We used a supervised machine learning approach to detect potential disease reemergence. We demonstrate the feasibility of applying a machine learning classifier to identify reemergence events in a systematic way for 4 different infectious diseases. The algorithm is applicable to temporal trends of disease incidence and includes disease-specific features to identify potential reemergence. Through this study, we offer a structured means of identifying potential reemergence using a data-driven approach.

Research on Babesia: A bibliometric assessment of a neglected tick-borne parasite.

Given the emergence and reemergence of tick-borne diseases, here we assessed the publishing patterns of research focused on Babesia. We also discuss the implications for the articles published in the last decade, and how more clinical and epidemiological information concerning Babesia is still required. The findings of this article would be useful to define research priorities about Babesia and diagnose the important of scientific production on this pathogen.

Evaluation of Burkholderia mallei ΔtonB Δhcp1 (CLH001) as a live attenuated vaccine in murine models of glanders and melioidosis

BackgroundGlanders caused by Burkholderia mallei is a re-emerging zoonotic disease affecting solipeds and humans. Furthermore, B. mallei is genetically related to B. pseudomallei, which is the causative agent of melioidosis. Both facultative intracellular bacteria are classified as tier 1 select biothreat agents. Our previous study with a B. mallei ΔtonB Δhcp1 (CLH001) live-attenuated vaccine demonstrated that it is attenuated, safe and protective against B. mallei wild-type strains in the susceptible BALB/c mouse model.Methodology/Principal findingIn our current work, we evaluated the protective efficacy of CLH001 against glanders and melioidosis in the more disease-resistant C57BL/6 mouse strain. The humoral as well as cellular immune responses were also examined. We found that CLH001-immunized mice showed 100% survival against intranasal and aerosol challenge with B. mallei ATCC 23344. Moreover, this vaccine also afforded significant cross-protection against B. pseudomallei K96243, with low level bacterial burden detected in organs. Immunization with a prime and boost regimen of CLH001 induced significantly greater levels of total and subclasses of IgG, and generated antigen-specific splenocyte production of IFN-γ and IL-17A. Interestingly, protection induced by CLH001 is primarily dependent on humoral immunity, while CD4+ and CD8+ T cells played a less critical protective role.Conclusions/SignificanceOur data indicate that CLH001 serves as an effective live attenuated vaccine to prevent glanders and melioidosis. The quantity and quality of antibody responses as well as improving cell-mediated immune responses following vaccination need to be further investigated prior to advancement to preclinical studies.

Genotype diversity and distribution of Mycobacterium bovis from livestock in a small, high-risk area in northeastern Sicily, Italy.

Bovine tuberculosis (bTB) caused by Mycobacterium bovis is an important re-emerging disease affecting livestock, wildlife and humans. Epidemiological studies are crucial to identifying the source of bTB infection, and its transmission dynamics and host preference, and thus to the implementation of effective strategies to contain it. In this study, we typed M. bovis isolates from livestock, and investigated their genetic diversity and distribution. A total of 204 M. bovis isolates were collected from cattle (n = 164) and Sicilian black pigs (n = 40) reared in a limited area of the province of Messina, northeastern Sicily, an area that had previously been identified as having the highest incidence of bTB in livestock on the island. All M. bovis isolates were typed by both spoligotyping and 12-loci MIRU-VNTR analysis. Results from both methods were then combined in order to improve the discriminatory power of M. bovis typing. We identified 73 combined genetic profiles. Thirty-five point six percent of the profiles were common to at least two animals, whereas 64.4% of profiles occurred in only one animal. A number of genetic profiles were predominant in either cattle or black pigs. We identified common genetic patterns in M. bovis isolates originating not only from neighboring districts, but also from non-neighboring districts. Our findings suggest that bTB is widespread in our setting, and is caused by a large number of genetically diverse M. bovis strains. The ecology and farming practices characteristic of the area may explain the substantial M. bovis heterogeneity observed, and could represent obstacles to bTB eradication.