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Case-control study of use of personal protective measures and risk for severe acute respiratory syndrome coronavirus 2 infection, Thailand

MORU

Posted 22/09/2020. This case-control study, conducted by Direk Limmathurotsakul and colleagues in Thailand, shows that wearing masks all the time, maintaining >1 m distance, having close contact for <15 minutes, and frequent handwashing are independently associated with lower risk for SARS-CoV-2 infection (COVID-19)

Estimating the proportion of Plasmodium vivax recurrences caused by relapse

MORU

Posted 18/09/2020. New findings by Ric Price and colleagues highlight that a remarkably high number of P. vivax infections arise from relapses (reactivation of dormant liver stages). This has important implications since almost 85% of recurrent infections could be prevented if more patients were treated with primaquine. The study emphasises the important of work done by the VxWG (Vivax Working Group for the Asia Pacific Malaria Eliminiation Network) in promoting wider access to safe and effective radical cure.

Clinical, etiological and epidemiological investigations of hand, foot and mouth disease in southern Vietnam during 2015 – 2018

OUCRU

Posted 11/09/2020. Nineteen different enterovirus serotypes were detected in 1196 Vietnamese children presenting with hand foot and mouth disease during 2015-2018. Le Van Tan and colleagues show that EV-A71 was the major cause, especially in those with severe disease, followed by CV-A6, CV-A10 and CV-A16. Multivalent vaccines are urgently needed to control hand foot and mouth disease.

Development of locally relevant clinical guidelines for procedure-related neonatal analgesic practice in Kenya

@Oxford KWTRP

Posted 03/09/2020. Cian Wade, Mike English and colleagues brought together a large body of evidence to inform recommendations for Kenya on neonatal analgesic guidelines for routine procedures. They describe the process by which a group of local experts translated systematic review and meta-analysis findings into context-specific clinical guidelines. The work emphasises the value of breastfeeding or breast milk as an important and feasible therapeutic strategy for alleviating neonatal pain.

Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE): protocol for a multisite prospective observational study of the causes of fever in Africa and Asia

@Oxford LOMWRU MORU

Posted 01/09/2020. This paper provides an overview of FIEBRE’s activities. The study aims to identify infections that are treatable and/or preventable, to assess antimicrobial susceptibility of bacterial pathogens and to collect qualitative data on care-seeking and treatment behaviours. Paul Newton and colleagues detail clinical and laboratory assessments, data analysis plan, and outline the study’s strengths and limitations.

G6PD deficiency in malaria endemic areas of Nepal

MORU SMRU

Posted 27/08/2020. Germana Bancone and colleagues from EDCD (Nepal) and SMRU conducted this study in malaria endemic districts of Nepal, showing that G6PD deficiency is prevalent among most ethnic groups across the region. G6PD testing will be necessary for safe deployment of 8-aminoquinolines in order to eliminate Plasmodium vivax malaria in Nepal.

No evidence that chloroquine or hydroxychloroquine induce hemolysis in G6PD deficiency

MORU

Posted 25/08/2020. With renewed interest in chloroquine and hydroxychloroquine, much has recently been written and published about the risk of haemolysis in G6PD deficient individuals. William Schilling and colleagues believe many have overlooked the wealth of data which already exists about this very issue. Here presented is an overview of the long-accrued evidence (as well as that from recent COVID-19 publications) that chloroquine and hydroxychloroquine do not induce haemolysis in G6PD deficiency.

Integration of HIV services with primary care in Yangon, Myanmar

MOCRU MORU

Posted 21/08/2020. Frank Smithuis and colleagues did a retrospective cohort analysis looking at integration of HIV care with general health care clinics in Yangon, Myanmar. HIV patient survival was high at 0.95 at 1 year and 0.90 at 5 years. Integration is effective to attain early linkage to care but attention should be given to disengagement from care, in particular for pregnant women.

Initiating a network to support engagement between health researchers and schools: recommendations from an international meeting of schools engagement practitioners held in Kilifi, Kenya

KWTRP

Posted 18/08/2020. In November 2018 twenty-nine participants, representing 21 institutions from 11 countries, participated in a first international “school engagement” workshop hosted by the KEMRI-Wellcome Research Programme in Kilifi, Kenya. Alun Davies and colleagues report on the broad range of goals and approaches for engagement between health researchers and school students.

Burkholderia pseudomallei multi-centre study to establish EUCAST MIC and zone diameter distributions and epidemiological cut-off (ECOFF) values

LOMWRU MORU

Posted 14/08/2020. David Dance and colleagues describe a multi-centre study, co-ordinated by EUCAST, to establish interpretative criteria for Burkholderia pseudomallei disc diffusion tests. Three MORU network sites (Laos, Thailand and Cambodia) participated. The results, based on 361 isolates, will enable laboratories around the world to conduct quality-assured testing of B. pseudomallei susceptibility.

Molecular epidemiology of resistance to antimalarial drugs in the Greater Mekong subregion

MORU

Posted 11/08/2020. This very large molecular epidemiology study done over 12 years describes the evolution and spread of antimalarial drug resistance across the entire Greater Mekong subregion (GMS). Mallika Imwong and colleagues show no evidence of spread of artemisinin resistant parasite lineages from the eastern to the western GMS. There is also no evidence for piperaquine resistance in the western GMS.

Dengue virus induces PCSK9 expression to alter antiviral responses and disease outcomes

OUCRU

Posted 06/08/2020. Cholesterol is required for efficient dengue virus (DENV) replication, however statin treatment did not show efficacy against dengue in clinical trials, and underscored the need for a more detailed understanding of the interaction between DENV and cellular cholesterol. In this paper, in collaboration with DUKE-NUS, Sophie Yacoub and colleagues demonstrate the pivotal role of PCSK9 in DENV infections.

Addressing challenges for clinical research responses to emerging epidemics and pandemics

@Oxford

Posted 04/08/2020. Major infectious disease outbreaks are a constant threat to human health; clinical research responses generate evidence to improve outcomes and outbreak control. Experiences from previous epidemics have identified multiple challenges to undertaking timely clinical research responses to emergency epidemics. Louise Sigfrid and colleagues review those challenges and identify solutions to address them.

Evaluation of the forum theatre approach for public engagement around antibiotic use in Myanmar

MOCRU MORU

Posted 31/07/2020. Myo Maung Maung Swe and colleagues describe evaluation and experience of using the forum theatre technique, a novel form of public engagement. Our experience was fun, informative and encouraged widespread participation around the subject of antibiotic use. We believe that this technique will be of great interest to scientists who engage in activities using participatory techniques.

Screening of ectoparasites from domesticated dogs for bacterial pathogens in Vientiane, Lao PDR

LOMWRU MORU

Posted 28/07/2020. Ticks, fleas and lice from dogs in Vientiane (Lao PDR) were shown to carry a variety of zoonotic pathogens including R. felis (cat-flea typhus). Matthew Robinson and colleagues highlight the risk of these pathogens transmitted between dogs and humans within the city, as well as the role of pets in human diseases, and important public health considerations

Value of lipocalin 2 as a potential biomarker for bacterial meningitis

OUCRU

Posted 24/07/2020. A team from OUCRU led by Le Van Tan, Hospital for Tropical Diseases, Vietnam, and the Target Discovery Institute at the University of Oxford showed that lipocalin 2 is a sensitive and specific biomarker for discriminating bacterial meningitis from a broad spectrum of other brain infections, and outperforms routine CSF markers such as leukocytes, glucose, protein and lactate.

Respiratory support in COVID-19 patients, with a focus on resource-limited settings

MORU

Posted 21/07/2020. This article by Arjen Dondorp and colleagues provides guidance on respiratory support for patients with severe COVID-19 focusing on low- and middle-income countries, based on current evidence and experience. Rather than the usual focus on mechanical ventilation, it emphasizes the importance of having the right modalities for non-invasive oxygen therapy in place

Enhancing science preparedness for health emergencies in Africa through research capacity building

KWTRP

Posted 17/07/2020. In this editorial, Sam Kinyanjui and colleagues argue that establishing science preparedness, which is an integral component of emergency preparedness, should be embedded within long-term investment in research capacity. They illustrate how African-led research capacity building consortia including IDeAL have contributed to Africa’s preparedness for the COVID-19 pandemic.

Non-adherence in non-inferiority trials: pitfalls and recommendations

MORU

Posted 14/07/2020. Non-adherence in non-inferiority trials typically dilutes observed treatment effects, leading to a higher probability of claiming non-inferiority. Mo Yin and colleagues describe different patterns of non-adherence and the influence of the confounders on treatment effects. Causal inference methods that account for these confounders can minimise bias and risk of false non-inferiority claims.

The paediatrician workforce and its role in addressing neonatal, child and adolescent healthcare in Kenya

@Oxford KWTRP

Posted 07/07/2020. In a country with 25 million newborns, children and adolescents, how many paediatricians are there and where are they? This paper by Mike English and colleagues seeks to start a debate on how to deliver paediatric services in LMIC in the future.

Malaria infection, disease and mortality among children and adults on the coast of Kenya

KWTRP

Posted 03/06/2020. Under declining malaria transmission on the Kenyan coast Kilifi, Alice Kamau, Bob Snow and colleagues show that children continue to bear the brunt of mild and severe disease. There was no significant malaria disease or mortality burden in adults. This is contrary to current modelled approaches to malaria disease burden among African adults.

Interferon-gamma polymorphisms and risk of iron deficiency and anaemia in Gambian children

KWTRP

Posted 30/06/2020. Interferon-gamma (IFN-g) is upregulated during malaria infection and influences erythropoiesis and iron status. Kelvin Mokaya, Sarah Atkinson and colleagues found that children carrying the IFNG+2200C allele, a variant previously associated with higher IFN-g levels, had a modestly increased risk of anaemia and iron deficiency after the malaria season. Larger studies are needed to validate this finding.

Quantifying antibiotic impact on within-patient dynamics of extended-spectrum beta-lactamase resistance

@Oxford

Posted 25/06/2020. Antibiotic-resistant bacteria are a growing global health crisis. In order to develop a quantitative understanding of how antibiotics affect drug-resistant bacteria within the human gut, Ben Cooper and colleagues developed a data-driven model of the within-host dynamics of blaCTX-M, one of the most important gene families for antibiotic resistance.

An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries

KWTRP

Posted 23/06/2020. As the COVID-19 global pandemic escalates in low-income and middle-income countries (LMICs), locally tailored responses addressing socio-economic and health inequities are essential. Edwine Barasa, Sassy Molyneux and colleagues offer five key considerations grounded in principles of social justice to inform decision making, and call for countries to act together, in cooperation, to build resilience.

Routine data for malaria morbidity estimation in Africa: challenges and prospects

KWTRP

Posted 19/06/2020. The true burden of malaria in sub-Saharan Africa remains challenging to measure. In Africa, there is increasing use of routine surveillance data to define national strategic targets, estimate malaria case burdens and measure control progress to identify financing priorities. Victor Alegana and colleagues address some of the challenges and prospects related to using routine data which equally apply to other disease surveillance.

Iron deficiency is associated with reduced levels of Plasmodium falciparum-specific antibodies in African children

KWTRP

Posted 15/06/2020. Iron deficiency and malaria are common among African children and studies suggest that iron may be critical for the development of humoral immunity. Sarah Atkinson and colleagues found that in 1,794 community-based children in Kenya and Uganda, iron-deficiency was associated with lower levels of P. falciparum-specific antibodies even after adjusting for malaria exposure.

Pregnancy outcomes and risk of placental malaria after artemisinin-based and quinine-based treatment for uncomplicated falciparum malaria in pregnancy

@Oxford MORU

Posted 12/06/2020. Safety of drugs is important, particularly during pregnancy. Makoto Saito and colleagues have pooled the data of 4503 women who had malaria in pregnancy and found that the currently used artemisinin-based combination therapies are equally safe for fetus. This study also highlights that risk of small-for-gestational-age (SGA) is high after malaria in pregnancy even treated with highly efficacious drugs, suggesting that prevention is important for reducing SGA in malaria endemic areas.

The natural history and transmission potential of asymptomatic SARS-CoV-2 infection

OUCRU

Posted 09/06/2020. Dr Le Van Tan and colleagues from OUCRU, Vietnam, demonstrate that 43% of quarantined people who were RT-PCR positive for SARS-CoV-2 were asymptomatic, but potentially contagious. The results emphasize the importance of contact tracing, airport quarantine and RT-PCR screening for SARS-CoV-2 among isolated people in controlling the ongoing pandemic.

Quantification of glucose-6-phosphate dehydrogenase activity by spectrophotometry

MORU

Posted 08/06/2020. Safe and effective radical cure of malaria will require better ways of testing for G6PD deficiency. In a large collaborative study a paper in PLoS Medicine, Daniel Pfeffer, Ric Price and colleagues highlight substantial variation between research laboratories using the current gold standard method (spectrophotometry). The study highlights challenges but also opportunities for new point of care tests.

Performance of metagenomic next-generation sequencing for the diagnosis of viral meningoencephalitis in a resource-limited setting

OUCRU

Posted 05/06/2020. Tan Le Van and colleagues showed that metagenomics can accurately detect a wide range of neurotropic viruses, especially vaccine-preventable-disease causing viruses such as mumps, in CSF of 66 consecutively treated adults with meningoencephalitis. Prospective study is needed to demonstrate the benefit metagenomics may add to the management of devastating diseases such as meningoencephalitis.

Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens

MORU

Posted 02/06/2020. Thomas Althaus and colleagues identified Influenza and dengue viruses as key pathogens in febrile children and adults attending primary care in Thailand and Myanmar. CRP performance for distinguishing bacterial from viral pathogens was average while patients recovered regardless of antibiotic prescription. This suggests that most primary care infections do not require an antibiotic.

Scope, quality, and inclusivity of clinical guidelines produced early in the covid-19 pandemic: rapid review

@Oxford

Posted 29/05/2020. In an emergency, we all look for guidance, be that from experts, trusted authorities or professional bodies. The COVID-19 has been the most significant health care emergency for a generation. And yet the very characteristics of an emergency - uncertainty, time pressure - challenge the ability of experts to respond with the rigour that caused us to turn to them in the first place. In this rapid review, Andrew Dagens, Louise Sigfrid, Peter Horby and colleagues took clinical guidelines published in the early COVID-19 and appraised them. They highlight how international organizations can better produce guidelines for future emergencies.

HIV-1 transmission patterns within and between risk groups in coastal Kenya

KWTRP

Posted 21/05/2020. HIV-1 transmission patterns within and between risk groups (men who have sex with men, injecting drug users, female sex workers, and heterosexuals) in Kenya are not well understood. Based on 658 HIV-1 pol sequences, George Makau, Eduard Sanders and colleagues showed that 85% of transmission clusters was within risk groups, whereas 15% was shared between risk groups.

COVID-19 lung injury is different from high altitude pulmonary edema

OUCRU OUCRU-Nepal

Posted 18/05/2020. The etiology of high altitude pulmonary edema (HAPE), a disease sometimes seen in sojourners to high altitude, is lack of adequate oxygen and not an inflammation provoked by an infectious agent like the novel coronavirus. Except for supplemental oxygen, Buddha Basnyat and colleagues strongly caution against managing COVID-19 lung injury with treatments that are used for HAPE.

Tuberculous meningitis: where to from here?

OUCRU

Posted 15/05/2020. Tuberculous meningitis is the most severe form of tuberculosis. Here Joseph Donovan and colleagues review tuberculous meningitis research during the last 2 years, focusing on that considered to have a major impact in advancing understanding, diagnosis, treatment of this disease in children and adults

Carriage of the zoonotic organism Streptococcus suis in chicken flocks in Vietnam

OUCRU

Posted 12/05/2020. Exposure to pigs may not be the only source of Streptococcus suis infection. In a study in Vietnam by Juan Carrique-Mas and colleagues, 33.9% healthy chickens investigated carried this organism. Sequencing data indicated that chicken S.suis were generally different from human/pig isolates, although 10% chicken S.suis were identical to pig isolates from the same area.

A systematic review of changing malaria disease burden in sub-Saharan Africa since 2000

KWTRP

Posted 07/05/2020. Information on malaria burden should progressively be based on empirical data rather than models. Alice Kamau and colleagues show that although, in many locations, both local surveillance data and modelled estimates showed declines in malaria burden, there was weak association where stalling in progress or resurgence of malaria burden was observed empirically.

Barriers and facilitators to healthcare workers’ adherence with infection prevention and control guidelines for respiratory infectious diseases

MORU

Posted 05/05/2020. In this Cochrane qualitative review to inform the 2020 COVID19 pandemic, Xin Hui Chan and colleagues identify key barriers and facilitators to healthcare workers’ adherence to infection prevention and control (IPC) guidelines for respiratory infectious diseases to support policymakers and healthcare leaders in designing and implementing IPC guidelines. These include organisational factors (safety climate, design & communication of consistent PPE guidelines, availability of training programmes), physical environment (space, facility design, administrative controls, personal protective equipment availability), and individual factors (knowledge, beliefs, attitudes).

Efficacy and tolerability of artemisinin-based and quinine-based treatments for uncomplicated falciparum malaria in pregnancy

@Oxford

Posted 01/05/2020. Although effective treatment for malaria in pregnancy is needed for preventing adverse impact on both mother and fetus, quinine is still widely used in pregnancy. Makoto Saito and 41 other collaborators worldwide put their individual patient data together to summarise the currently available evidence showing that quinine is inferior to ACT and further research on dose optimization of ACT is warranted.

Plasmodium falciparum ATP4 inhibitors to treat malaria: worthy successors to artemisinin?

MORU

Posted 28/04/2020. In this comment Elizabeth Ashley and Aung Pyae Phyo discuss two recent studies of SJ733, a PFATP4 inhibitor. Compounds from this promising novel class of antimalarials kill parasites rapidly, a property previously unique to the artemisinin derivatives among antimalarials in use, and one that underpins their enormous success.

The estimated burden of scrub typhus in Thailand from national surveillance data (2003-2018)

MORU

Posted 24/04/2020. Scrub typhus is a major cause of fever in the tropics. Tri Wangrangsimakul and colleagues estimated the disease burden in Thailand and showed that the number of cases rose significantly over the last two decades. Age, sex and occupation along with meteorological and geographical factors may be important determinants of disease incidence.

Longevity of the insecticidal effect of three pyrethroid formulations applied to outdoor vegetation on a laboratory-adapted colony of the Southeast Asian malaria vector Anopheles dirus

MORU

Posted 21/04/2020. This study by Victor Chaumeau and colleagues was carried out in order to assess the longevity of insecticide mists applied to outdoor vegetation. Insecticidal effect of sprayed plant material against malaria mosquitoes lasted for several weeks. These results provide a strong rationale for using outdoor residual spraying against the mosquito vectors that rest outside premises.

COVID-19 and risks to the supply and quality of tests, drugs, and vaccines

@Oxford MORU

Posted 14/04/2020. Enormous emergency efforts are underway to find optimal medical products, to prevent, diagnose, and treat COVID-19, that 7.8 billion people will depend on. With dire disruption of pharmaceutical production and supply and increasing falsified and substandard products, we need strategic planning now to ensure global access to quality-assured medical products and monitoring of supply chains

Data for tracking SDGs: challenges in capturing neonatal data from hospitals in Kenya

@Oxford

Posted 07/04/2020. Data are needed to track progress towards the target to end preventable deaths of newborns in LMICs. Christiane Hagel and colleagues report on the challenges of neonatal data capture and the wider health information system in LMICs. With use cases from Kenyan hospitals and visualisations of neonatal information flow they show the complex people- and paper-based subsystem of the District Health Information Software, version 2 (DHIS2) - a widely used data platform which forms part of the health information system in LMICs

Sources of multi-drug resistance in patients with previous isoniazid resistant tuberculosis identified using whole genome sequencing

OUCRU

Posted 27/03/2020. Nguyen Thuy Thuong Thuong and colleagues in OUCRU, Vietnam, investigated the sources of multi-drug resistant TB in patients with undiagnosed isoniazid-resistant TB treated with first-line anti-TB therapy. They found that re-infection with a new multi-drug resistant TB strain was just as common as the emergence of rifampicin resistance.

Examining which clinicians provide admission hospital care in a high mortality setting and their adherence to guidelines

KWTRP

Posted 24/03/2020. This study by Morris Ogero and colleagues was based on over 50,000 patients from 13 referral hospitals in Kenya. Results suggest that >85% of admissions are conducted by pre-registration clinicians who are under experiential training. Although clinical assessment was according to guidelines, there was a major challenge in classification of illness severity leading to overuse of treatment.

A trial of lopinavir–ritonavir in adults hospitalized with severe covid-19

@Oxford

Posted 20/03/2020. 199 patients received standard care, of which 99 received lopinavir-ritonavir for 14 days. Lopinavir-ritonavir didn’t induce significant clinical improvement, and mortality was similar in both groups. However, patients treated with lopinavir-ritonavir spent less time in hospital and in intensive care. The trial enrolled severely ill patients and was not big enough to detect modest benefits. Much larger studies are warranted to confirm or exclude if lopinavir-ritonavir treatment can help.

Parenting interventions to prevent violence against children in low- and middle-income countries in East and Southeast Asia

MORU

Posted 17/03/2020. This systematic review and meta-analysis by Amalee McCoy and colleagues synthesizes available evidence on the effectiveness of parenting interventions in preventing violence against children in the East and Southeast Asian region. The results suggest that parenting interventions can reduce rates of particular forms of violence against children, as well as promote positive parent-child interactions.

Mapping the travel patterns of people with malaria in Bangladesh

MORU

Posted 13/03/2020. New research by Ipsita Sinha and colleagues provides a framework for identifying key traveler groups and their origins and destinations of travel combination with knowledge of local epidemiology to inform malaria control and elimination efforts. This publication is based on travel information collected from over 2000 patients from 57 study sites in South-East Bangladesh, in collaboration with the National Malaria Elimination Control programme of Bangladesh.

Estimation of incidence of typhoid and paratyphoid fever in Vientiane, Lao People’s Democratic Republic

LOMWRU MORU

Posted 10/03/2020. Incidence data about infectious diseases are needed to inform decisions about vaccine introduction. Using data from health-seeking behaviour survey for fever and data from hospital bloodstream infection, Mayfong Mayxay and colleagues estimated typhoid and paratyphoid fever incidence in Vientiane, the capital of Laos, and found that the incidence is low, with an annual incidence of 4.7 and 0.5 per 100,000 persons, for typhoid and paratyphoid fever, respectively.

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