Tropical Medicine Research Articles

Dengue and its association with hepatic biomarkers: antiinflammatory action and utilization of paracetamol as a hepatotoxicity factor

Dengue fever is a tropical infectious pathology caused by an arbovirus from the Flaviviridae family, the dengue virus goes through an initial replication in striated and smooth muscle cells. The bioindicators of hepatic functions are enzymes that detect lesions in the hepatocytes. Thrombocytopenia is one of the bioindicators of the key clinical manifestations in dengue patients. Besides the natural process of the platelets in the anti-inflammatory activity, the used drugs act and the auto medication overcharges hepatic functions due to the hepatotoxicity of non-opioid analgesics. Usually, the most used analgesic is paracetamol. The present article aims to associate hepatic biomarkers with the dengue infection and the hepatotoxicity caused by the indiscriminate use of anti-inflammatory drugs like paracetamol. As a research method, the literature review was utilized, with the utilization of scientific articles related to the theme, taken from electronic databases such as Scielo and Google Scholar. Aiming to associate dengue with hepatic biomarkers such as thrombocytopenia and hepatotoxicity caused by the anti-inflammatory drug known as paracetamol. It is important to highlight the relation between thrombocytopenia and dengue´s hemorrhage episodes, besides the hepatic overload caused by the indiscriminate use of paracetamol.

Artificial intelligence facilitates tropical infectious disease control and research

Since the global pandemic of coronavirus disease 2019 (COVID-19) in late 2019, artificial intelligence technology has shown increasing values in the research and control of tropical infectious diseases. The introduction of artificial intelligence technology has shown remarkable effectiveness to reduce the diagnosis and treatment burdens, reduce missing diagnosis and misdiagnosis, improve the surveillance and forecast ability and enhance the medicine and vaccine development efficiency. This paper summarizes the current applications of artificial intelligence in tropical infectious disease control and research and discusses the important values of artificial intelligence in disease diagnosis and treatment, disease surveillance and forecast, vaccine and drug discovery, medical and public health services and global health governance. However, artificial intelligence technology suffers from problems of single and inaccurate diagnosis, poor disease surveillance and forecast ability in open environments, limited capability of intelligent system services, big data management and model interpretability. Hereby, we propose suggestions with aims to improve multimodal intelligent diagnosis of multiple tropical infectious diseases, emphasize intelligent surveillance and forecast of vectors and high-risk populations in open environments, accelerate the research and development of intelligent management system, strengthen ethical security, big data management and model interpretability.

Access to vaccines: how can we leverage technology innovations to achieve greater vaccine equity?

Fatema Kazi is an Immunologist working at the WHO’s R&D Blueprint Team–part of the Health Emergencies and Preparedness Response. Previously, she has worked at the Elizabeth Glaser Pediatric AIDS Foundation, GAVI, UNOPS, The Stop TB Partnership, and the Global TB Programme (WHO) focusing on research and development in innovative therapeutics, vaccines, and diagnostics. She has a PhD in Cellular Immunology and Infectious Diseases from the London School of Hygiene and Tropical Medicine, and pursued her postdoctoral career as a Senior Immunologist Research Fellow at Leiden University Medical Centre and the University of Oxford, as well as training as a molecular biologist for the Ministry of Defense, UK. In response to the pandemic, Fatema has been leading projects at WHO related to tracking, monitoring, and assessing the development of the COVID-19 vaccine candidates worldwide, conducting epidemiological reviews of vaccine effectiveness against variants of concern. She is now evaluating vaccines for Monkeypox, Lassa Fever and Sudan ebolavirus in response to the current outbreaks.Fatema Kazi works for the WHO, where she helps to assess the public health value of vaccine products and technologies in routine, campaign, and outbreak settings. We caught up with her to discuss how innovations in vaccine technology can help get vaccines to the people who need them.

The COVID-19 Schools Infection Survey in England: Protocol and Participation Profile for a Prospective Observational Cohort Study.

One of the most debated questions in the COVID-19 pandemic has been the role of schools in SARS-CoV-2 transmission. The COVID-19 Schools Infection Survey (SIS) aims to provide much-needed evidence addressing this issue. We present the study protocol and participation profile for the SIS study, aimed at assessing the role of schools in SARS-CoV-2 infection and transmission within school settings, and investigating how transmission within and from schools could be mitigated through the implementation of school COVID-19 control measures. SIS was a multisite, prospective, observational cohort study conducted in a stratified random sample of primary and secondary schools in selected local authorities in England. A total of 6 biobehavioral surveys were planned among participating students and staff during the 2020-2021 academic year, between November 2020 and July 2021. Key measurements were SARS-CoV-2 virus prevalence, assessed by nasal swab polymerase chain reaction; anti-SARS-CoV-2 (nucleocapsid protein) antibody prevalence and conversion, assessed in finger-prick blood for staff and oral fluid for students; student and staff school attendance rates; feasibility and acceptability of school-level implementation of SARS-CoV-2 control measures; and investigation of selected school outbreaks. The study was approved by the United Kingdom Health Security Agency Research Support and Governance Office (NR0237) and London School of Hygiene & Tropical Medicine Ethics Review Committee (reference 22657). Data collection and laboratory analyses were completed by September 2021. A total of 22,585 individuals-1891 staff and 4654 students from 59 primary schools and 5852 staff and 10,188 students from 97 secondary schools-participated in at least one survey. Across all survey rounds, staff and student participation rates were 45.2% and 16.4%, respectively, in primary schools and 30% and 15.2%, respectively, in secondary schools. Although primary student participation increased over time, and secondary student participation remained reasonably consistent, staff participation declined across rounds, especially for secondary school staff (3165/7583, 41.7% in round 1 and 2290/10,374, 22.1% in round 6). Although staff participation overall was generally reflective of the eligible staff population, student participation was higher in schools with low absenteeism, a lower proportion of students eligible for free school meals, and from schools in the least deprived locations (in primary schools, 446/4654, 9.6% of participating students were from schools in the least deprived quintile compared with 1262/22,225, 5.7% of eligible students). We outline the study design, methods, and participation, and reflect on the strengths of the SIS study as well as the practical challenges encountered and the strategies implemented to address these challenges. The SIS study, by measuring current and incident infection over time, alongside the implementation of control measures in schools across a range of settings in England, aims to inform national guidance and public health policy for educational settings. RR1-10.2196/34075.

Publishing data to support the fight against human vector-borne diseases.

Vector-borne diseases are responsible for more than 17% of human cases of infectious diseases. In most situations, effective control of debilitating and deadly vector-bone diseases (VBDs), such as malaria, dengue, chikungunya, yellow fever, Zika and Chagas requires up-to-date, robust and comprehensive information on the presence, diversity, ecology, bionomics and geographic spread of the organisms that carry and transmit the infectious agents. Huge gaps exist in the information related to these vectors, creating an essential need for campaigns to mobilise and share data. The publication of data papers is an effective tool for overcoming this challenge. These peer-reviewed articles provide scholarly credit for researchers whose vital work of assembling and publishing well-described, properly-formatted datasets often fails to receive appropriate recognition. To address this, GigaScience's sister journal GigaByte partnered with the Global Biodiversity Information Facility (GBIF) to publish a series of data papers, with support from the Special Programme for Research and Training in Tropical Diseases (TDR), hosted by the World Health Organisation (WHO). Here we outline the initial results of this targeted approach to sharing data and describe its importance for controlling VBDs and improving public health.

Tropical Medicine & International Health November 2022

Tropical Medicine & International HealthVolume 27, Issue 11 p. 941-941 FEATURE PAGE Tropical Medicine & International Health November 2022 First published: 13 November 2022 https://doi.org/10.1111/tmi.13622Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume27, Issue11November 2022Pages 941-941 RelatedInformation

Implementation of adaptation to climate change in public health in Europe: qualitative thematic analysis

BackgroundIncreasingly, climate change policies are emerging across Europe. Policies addressing adaptation (adjusting the effects of climate change on public health) are being implemented after the COVID-19 pandemic. This study aims to identify issues in climate adaptation implementation for public health and understand the health implications from responses after COVID-19. MethodsKey informant interviews were undertaken with decision makers in international, national, and local governments across 20 European countries (Norway, England, Cyprus, Spain, Ireland, Finland, Lithuania, Belgium, the Netherlands, Sweden, Latvia, Italy, Estonia, Austria, Croatia, France, Germany, Hungary, Denmark, and Scotland). A WHO stakeholder analytical framework was followed for developing the interview themes. Participants were recruited if based in European governments, working in public or environmental health, and involved in climate adaptation policy. Participants were recruited through known networks and geographical coverage was obtained (eight per European region). An interview schedule with key themes (barriers, public health agenda, levers, networks, evidence needs, and COVID-19 recovery) was used. Interviews were conducted online, recorded, transcribed, and analysed through Nvivo. Findings32 interviews were completed between June and October, 2021; four international stakeholders, five national-level decision makers, 23 city-level decision makers or network representatives. Most reported inadequate resources for health adaptation implementation (funding, training, and personnel) and the marginal role of health in climate adaptation policy. A key reported challenge was limited departmental cross-collaboration across governance levels, because city-level stakeholders were less aware of the public health role in climate change policy. COVID-19 recovery strategies were not perceived as opportunistic for future adaptation. However, several respondents identified benefits for health system resilience, for example improved emergency planning and disaster management. InterpretationAcross Europe, there is varied progress in the implementation of climate change and health adaptation. Providing appropriate resource, inter-departmental collaboration, knowledge mobilisation, and multi-level governance support will facilitate climate and health policy implementation. Overcoming these barriers and learning from COVID-19 through strengthened emergency planning and responses to climate events can strengthen UK public health system resilience and beyond. FundingThis project has received part-funding from the Enhancing Belmont Research Action to support EU policy making on climate change and health project, which is part of the EU's Horizon 2020 research and innovation programme (grant agreement number 101003966). The research was part-funded by the National Institute for Health Research Health Protection Research Unit in Environmental Change and Health at the London School of Hygiene and Tropical Medicine in partnership with Public Health England, the Met Office, and University College London (grant number PHSEZT6210). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or PHE.

Impact of a multifaceted intervention on physicians’ knowledge, attitudes and practices in relation to pharmaceutical incentivisation: protocol for a randomised control trial

IntroductionIn settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients’ well-being. In their interactions with pharmaceutical companies, private general practitioners...

Using drones to transport suspected COVID-19 samples; experiences from the second largest testing centre in Ghana, West Africa.

The declaration of COVID-19 as a pandemic on March 11 2020, by the World Health Organisation prompted the need for a sustained and a rapid international response. In a swift response, the Government of Ghana, in partnership with Zipline company, launched the use of Unmanned Automated Vehicles (UAV) to transport suspected samples from selected districts to two foremost testing centres in the country. Here, we present the experiences of employing this technology and its impact on the transport time to the second largest testing centre, the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR) in Kumasi, Ghana. Swab samples collected from suspected COVID-19 patients were transported to the Zipline office by health workers. Information on the samples were sent to laboratory personnel located at KCCR through a WhatsApp platform to get them ready to receive the suspected COVID-19 samples while Zipline repackaged samples and transported them via drone. Time of take-off was reported as well as time of drop-off. A total of 2537 COVID-19 suspected samples were received via drone transport from 10 districts between April 2020 to June 2021 in 440 deliveries. Ejura-Sekyedumase District Health Directorate delivered the highest number of samples (765; 30%). The farthest district to use the drone was Pru East, located 270 km away from KCCR in Kumasi and 173 km to the Zipline office in Mampong. Here, significantly, it took on the average 39 minutes for drones to deliver samples compared to 117 minutes spent in transporting samples by road (p<0.001). The use of drones for sample transport during the COVID-19 pandemic significantly reduced the travel time taken for samples to be transported by road to the testing site. This has enhanced innovative measures to fight the pandemic using technology.

Associations between residential greenspace exposure and premature mortality in London, UK: a data-linkage study

BackgroundUrban greenspaces might reduce non-communicable disease risk. The links between greenspaces and mortality related to non-communicable disease remain unclear. We estimated the associations between residential greenspace quantity and access with all-cause, cardiovascular disease, cancer, respiratory, and type 2 diabetes mortality. MethodsWe linked 2011 UK Census data of London-dwelling adults (aged ≥18 years) to data from the UK death registry and the Greenspace Information for Greater London resource (N=4 645 581). We calculated percent greenspace area, access point density (access points per km2), and distance (metres) to the nearest access point for each respondent's residential neighbourhood (defined as 1000-m street network buffers) for greenspaces overall and by park type using a geographic information system. We estimated associations using Cox proportional hazards models, adjusted for a range of confounders. Ethics approval was granted by the London School of Hygiene and Tropical Medicine's Observational/Interventions Research Ethics Committee. FindingsRespondents were followed for 8·4 years (SD 1·4). A one percentage point increase in pocket park area was associated with a 6% decrease in all-cause mortality risk (hazard ratio [HR] 0·94 [95% CI 0·92–0·97]) and an increase of ten pocket park access points per km2 was associated with an 8% decreased respiratory mortality risk (0·92 [0·85–0·99]). Other associations were observed but the estimated effects were 3% or less. For example, all-cause mortality risk for increases of one percentage point in regional park area (0·99 [0·99–1·00]) and increases of ten small open space access points per km2 (1·03 [1·02–1·03]). InterpretationIncreasing pocket park quantity and access might mitigate premature mortality risk. More research is needed to elucidate the mechanisms that could explain these associations. FundingHealth Data Research UK.

ICOPA 2022: living with parasites, collaborating globally, and breaking a glass ceiling

ICOPA 2022: living with parasites, collaborating globally, and breaking a glass ceiling

Experiences on the path to achieving SIDCER recognition of an Ethics Committee

Ethics Committees (ECs) are endowed with the responsibility of ensuring ethical conduct of biomedical research and human research participants’ protection. Although mandating its registration with central regulatory agency/agencies like Department of Health Research or Central Drugs Standard Control Organisation helps to improve its quality of functioning, further progress in achieving highest standards of ethical review is facilitated by undergoing various recognition/accreditation programs. One such is the Strategic Initiative for Developing Capacity in Ethical Review (SIDCER) recognition program, which was established under the World Health Organization–Tropical Disease Research (WHO-TDR) as a public-private partnership project in the year 2005. An EC is recognized by SIDCER after assessing five standards namely its structure and composition; adherence to specific policies; completeness of its review process; after review process; and documentation and archiving. This review describes the experiences of an EC of Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), on the path to receiving SIDCER recognition and way beyond.

Outcomes of a community-based antiretroviral therapy programme for key populations living with HIV in Benue State, Nigeria: protocol for a realist evaluation

IntroductionKey populations (KP) living with HIV are underserved and often face social and health system barriers to HIV care. To optimise access to quality HIV services among KP, the WHO...

Chung Un Lee: The trailblazer of tropical medicine in China

Abstract Chung Un Lee, (李宗恩, 1894–1962) was a pioneer of tropical medicine research in China, serving as the president of Guiyang Medical College, the dean of Peking Union Medical College, the vice president of the Chinese Medical Association, a member of the British Medical Association and the Far Eastern Tropical Medical Association (Fig. 1) (Lu, 1992). Chung Un Lee spent his life in medical education and scientific research, with outstanding achievements in research on filariasis, schistosomiasis, malaria, and kala-azar, confirming the reservoir of filariasis in China, innovating the application of plasmochin to combat malaria, proving that sandflies and dogs are sources of infection in human kala-azar, and making a clinical diagnosis of the early manifestations of kala-azar in China. Chung Un Lee is a distinguished medical scientist and medical educator, one of the founders of Chinese Tropical Medicine, who fought for forty years for the prevention and treatment of tropical diseases in China and conducted pioneering research in Chinese Tropical Medicine.

Making blind spots visible: the lack of race-conscious research and data in public and global health

Abstract In Continental Europe, race-conscious research and data (RCRD) is not adequately deployed in support of policy-making and social change to tackle health disparities. One reason is a lack of national data systems based on race in many countries, another is that researchers or policymakers are unaccustomed to taking them into account. One consequence of this for public and global health is the adoption and implementation of policies that are ostensibly race-neutral but which in fact reproduce “methodological whiteness” (Bhambra, 2017) and create or exacerbate racial health inequities. Calls to decolonise public health recognize the importance of RCRD, yet race or ethnicity as a variable in research continues to be seen as a contentious issue for a number of reasons. First, while some researchers see it as a valuable tool for addressing health inequalities or the impact of institutionalized and systemic racism on racialized/ethnic minority groups, others oppose its use on the ground that it can lead to stigmatization or racial stereotyping. Second, RCRD is often seen as too difficult to implement in practice, due to challenges of finding appropriate approaches to conceptualisation, operationalisation, data (non)collection, and interpretation. Third, many researchers fear that the use of race and ethnicity in research may be instrumentalized against minorities in ways that are sometimes difficult to anticipate. This project aims to contribute to addressing this, by building expertise for RCRD and creating a knowledge network and community of practice for researchers working in Public and Global Health in Continental Europe. The project begins by examining how RCRD is used at the Institute of Tropical Medicine Antwerp, which is located in Belgium, Europe but has research collaborations on other continents. It then continues with a scoping review on the use of RCRD to address racial and ethnic health disparities more generally across Europe. Key messages • Race-conscious research and data are lacking in public and global health research and policy-making, leading to racial health disparities. • Need to develop expertise and a network of researchers in race-conscious research and data in Europe.

Monkeypox and HIV in the Canary Islands: A Different Pattern in a Mobile Population.

Background. The clinical and epidemiological data of the recent outbreak of monkeypox (MPX) differ from previous reports. One difference is the epidemiological profile; the disease mainly affects a subgroup of MSM (men who have sex with men) with high-risk sexual behaviors, frequently persons living with human immunodeficiency virus (PLHIV). Methods. In this observational analysis, all patients with PCR (polymerase chain reaction)-confirmed MPX attending an Infectious Diseases and Tropical Medicine Unit in Gran Canaria (Spain) between May and July 2022 were considered. Results. In total, 42 men were included; 88% were identified as MSM, with a median age of 40 years. Only 43% were born in Spain. All the patients had systemic symptoms and skin lesions. The distribution of lesions was more frequent in the genital/anal region, and the involvement of hands and feet was less common. Fever and lymphadenopathies were less frequent than in other series. Other unusual manifestations were proctitis, pharyngitis and penile–scrotal edema. Half of the patients had other associated infections (mainly STIs, sexually transmitted infections), and 60% of the monkeypox patients had PLHIV (People Living with HIV). When comparing the clinical characteristics between HIV-positive and -negative patients, we found three main differences: (i) a higher frequency of perioral lesions, (ii) a higher frequency of pharyngitis and (iii) a higher number of sexually transmitted infections in HIV-positive patients. Conclusions. The clinical findings in this outbreak of MPX had great variability in presentation. Several clinical differences were found in PLHIV-coinfected patients.

International Research and Philanthropy

International Research and Philanthropy

Optimiertes Delirmanagement im psychiatrischen Konsiliardienst im Versorgungskrankenhaus

Im Vergleich zu überwiegend somatischen Fällen beschreibt die Literatur einen deutlich negativen Effekt bei somatisch-psychiatrischer Komorbidität. Betroffen sind die Verweildauer, die Wiederaufnahmewahrscheinlichkeit, die Mortalität und die Pflegebedürftigkeit. Untersucht wurde, ob durch den standardisierten Einsatz psychiatrischer Interventionen eine Verbesserung des psychischen Zustands und des somatischen Krankheitsverlaufs erreicht werden kann.Zusammengearbeitet wurde dafür mit der infektiologischen Intensivstation (ICU, C11) der 4. medizinischen Abteilung mit Infektions- und Tropenmedizin der Klinik Favoriten (Wiener Gesundheitsverbund). Im Rahmen der Akutphase der Behandlung einer COVID-19-Pneumonie und des damit verbundenen internistischen Managements war ein kritischer Punkt das Auftreten eines Delirs. Mithilfe eines psychiatrischen Interventionsprotokolls mit dem Ziel des gezielten Erkennens eines Delirs und spezifisch festgelegter Reaktionen sollte diese kritische Phase schnell und erfolgreich begleitet werden.Im Ergebnis kam es zu einer Qualitätsverbesserung in Bezug auf das Delirmanagement, die Schweregrade der beobachteten Delirien konnten vermindert und eine annehmbarere Gestaltung des Delirsyndroms für die Betroffenen erreicht werden. Die regelhaft angewandten Maßnahmen des Protokolls führten zu einer Effizienzsteigerung. Diese äußerte sich auch in einer Abnahme der Frequenz psychiatrischer Konsile. Die frei werdenden Zeiten konnten zur Bedarfsdeckung an anderen Abteilungen genutzt werden, ohne neue Personalressourcen zur Verfügung stellen zu müssen.

Diagnostic Accuracy of Red Cell Distribution Width to Platelet Ratio for Detection of Liver Fibrosis Compared with Fibroscan in Chronic Hepatitis B Egyptian patients

Background and Aims: The decision to treat chronic hepatitis B Virus infection (CHB) may necessitate an assessment of the degree of liver fibrosis. Guidelines recommend Fibroscan examination in such cases. However, it is costly and not widely available. Red cell distribution width (RDW) and platelet count are simple parameters obtained from the blood pictures; and their ratio RDW to platelet ratio (RPR) was claimed to correlate with liver fibrosis. We aimed to assess the ability of RPR to replace the costly fibroscan in the detection of significant fibrosis in chronic hepatitis B patients. Patients and Methods: This cross-sectional study was conducted in the Tropical medicine department, Tanta University, Egypt, between December 2018 and September 2019. One hundred and twenty-five patients with CHB were included and divided according to the fibroscan examination into: Group I: patients with no significant fibrosis (n=66), Group II: patients with significant (≥ F2) fibrosis (n=59). RPR was calculated for all patients and tested against Fibroscan results. Results: Both groups were matched in regards to age, sex, viral load, and steatosis. There was a significant positive correlation between the degree of stiffness measured by FibroScan in patients with a significant degree of fibrosis and serum bilirubin, a quantitative polymerase chain reaction of hepatitis B virus DNA (HBV DNA PCR), and fibrosis-4 score (FIB-4 score) (P value= 0.020, 0.049, and 0.0402, respectively). However, RPR was not correlated to the degree of fibrosis in fibroscan examination. Conclusions: The accuracy of RDW to platelet ratio (RPR) for the detection of fibrosis in CHB patients is questionable. FIB-4 is correlated with liver stiffness measurement (LSM) in patients with significant fibrosis (F2 or more). Neither RPR, AST to Platelet Ratio Index (APRI) or FIB4 can replace fibroscan for grading of fibrosis in CHB patients for evaluation to start therapy.

Swiss-Chinese Cooperation in Tropical Medicine: The Role of Professor Marcel Tanner.

This paper is in honour of Professor Marcel Tanner, President of the Swiss Academies of Arts and Sciences, and former Director of the Swiss Tropical and Public Health Institute (Swiss TPH), in Basel, Switzerland. In the 30 plus years since his first visit to China in 1989, Professor Tanner has tirelessly promoted research collaboration between Switzerland and China on health and tropical diseases through international meetings, scholar exchange, and training of young scientists. As a contribution to Professor Tanner's life's work of collaboration with Chinese scientists, we summarize here ideas conceived, work initiated and major outcomes. His approach, embodied in his flowery expression: "Alps and Himalayas never meet, but Swiss and Chinese can", marked the occasion in 2013 when Xinhua Co., Ltd., a pharmaceutical company in Shandong of China, agreed to produce tribendimidine, a new remedy for tropical helminth infections, that was the fruit of long-term research by scientists at the Swiss TPH in Basel, and National Institute of Parasitic Diseases (NIPD) in Shanghai. This was neither the first nor the last of Professor Tanner's forceful, yet diplomatic influence, and we follow in his footprints when continuing in Swiss-Chinese cooperation in tropical medicine.