Gender and Ethnic Differences in Diabetes Self Care in Malaysia: An Individual Participant Meta-Analysis of Summary of Diabetes Self Care Activities Studies.

Background: Many published studies in Malaysia have examined and assessed self care among type 2 diabetes mellitus (T2DM) patients using the Summary of Diabetes Self Care Activities (SDSCA) scale. The current paper is a meta-analysis of related studies that also examines how gender and ethnicity influence and shape T2DM self care practices in Malaysia. Methods: We undertook a bibliographic search for studies conducted and published in Malaysia on T2DM adults using the SDSCA scale. This is a two-stage individual participant meta-analysis of SDSCA which synthesised the overall and subscale score based on gender and ethnic groups as well as the correlation between SDSCA and HbA1c. Results: We examined 11 studies that utilised SDSCA to analyse 3,720 T2DM patients. The overall SDSCA score was 33.46 (47.8% of the 7-day week). The subscale score for general diet, specific diet, exercise, blood glucose self-monitoring and foot care were 4.80, 4.09, 2.87, 1.80 and 3.21, respectively. A small but statistically significant better self care in some gender or ethnic groups was noted. The SDSCA diet subscale and HbA1c showed statistically significant correlation. Conclusion: The finding suggested Malaysian T2DM patients were deficient in exercise and blood glucose self-monitoring. In fact, overall self care among Malaysian adult T2DM patients appears to be suboptimal across gender and the three main ethnic groups. Greater efforts are therefore needed to educate Malaysian adult T2DM patients to improve their self care practices.

The Effects of Meteorological Factors on Dengue Cases in Malaysia.

Dengue is a vector-borne disease affected by meteorological factors and is commonly recorded from ground stations. Data from ground station have limited spatial representation and accuracy, which can be overcome using satellite-based Earth Observation (EO) recordings instead. EO-based meteorological recordings can help to provide a better understanding of the correlations between meteorological variables and dengue cases. This paper aimed to first validate the satellite-based (EO) data of temperature, wind speed, and rainfall using ground station data. Subsequently, we aimed to determine if the spatially matched EO data correlated with dengue fever cases from 2011 to 2019 in Malaysia. EO data were spatially matched with the data from four ground stations located at states and districts in the central (Selangor, Petaling) and east coast (Kelantan, Kota Baharu) geographical regions of Peninsular Malaysia. Spearman's rank-order correlation coefficient (ρ) was performed to examine the correlation between EO and ground station data. A cross-correlation analysis with an eight-week lag period was performed to examine the magnitude of correlation between EO data and dengue case across the three time periods (2011-2019, 2015-2019, 2011-2014). The highest correlation between the ground-based stations and corresponding EO data were reported for temperature (mean ρ = 0.779), followed by rainfall (mean ρ = 0.687) and wind speed (mean ρ = 0.639). Overall, positive correlations were observed between weekly dengue cases and rainfall for Selangor and Petaling across all time periods with significant correlations being observed for the period from 2011 to 2019 and 2015 to 2019. In addition, positive significant correlations were also observed between weekly dengue cases and temperature for Kelantan and Kota Baharu across all time periods, while negative significant correlations between weekly dengue cases and temperature were observed in Selangor and Petaling across all time periods. Overall negative correlations were observed between weekly dengue cases and wind speed in all areas from 2011 to 2019 and 2015 to 2019, with significant correlations being observed for the period from 2015 to 2019. EO-derived meteorological variables explained 48.2% of the variation in dengue cases in Selangor. Moderate to strong correlations were observed between meteorological variables recorded from EO data derived from satellites and ground stations, thereby justifying the use of EO data as a viable alternative to ground stations for recording meteorological variables. Both rainfall and temperature were found to be positively correlated with weekly dengue cases; however, wind speed was negatively correlated with dengue cases.

Plasmodium spp. in macaques, Macaca fascicularis, in Malaysia, and their potential role in zoonotic malaria transmission.

Macaques, Macaca fascicularis, are a known reservoir of Plasmodium knowlesi, the agent of simian malaria which is the predominant zoonotic species affecting humans in Malaysia and other Southeast Asian countries. Recently, a naturally acquired human infection of another simian malaria parasite, P. cynomolgi has been reported. Thus, it is crucial to study the distribution of simian Plasmodium infections with particular attention to the macaques. Four hundred and nineteen (419) long-tailed macaques (Macaca fascicularis) were trapped in selected areas where human cases of P. knowlesi and P. cynomolgi have been reported. Nested polymerase chain reaction (PCR) was conducted to identify the Plasmodium spp., and circumsporozoite protein (CSP) genes of P. knowlesi samples were sequenced. Plasmodium cynomolgi infection was shown to be the most prevalent among the macaque population (68.4%). Although 50.6% of analyzed samples contained single infections either with P. knowlesi, P. cynomolgi, P. inui, P. coatneyi, or P. fieldi, mixed infections with double, triple, quadruple, and all 5 species were also detected. Infection with P. cynomolgi and P. knowlesi were the highest among Malaysian macaques in areas where humans and macaques are in close contact. The risk of zoonotic infection in these areas needs to be addressed since the number of zoonotic malaria cases is on the rise. With the elimination of human malaria, the risk of humans being infected with simian malaria is very high and steps should be taken to mitigate this issue.

Title: Plasmodium spp. chez les macaques, Macaca fascicularis, en Malaisie, et leur rôle potentiel dans la transmission zoonotique du paludisme. Abstract: Les macaques, Macaca fascicularis, sont un réservoir connu de Plasmodium knowlesi, l'agent du paludisme simien qui est l'espèce zoonotique prédominante affectant les humains en Malaisie et dans d'autres pays d'Asie du Sud-Est. Récemment, une infection humaine acquise naturellement par un autre parasite du paludisme simien, P. cynomolgi, a été signalée. Ainsi, il est crucial d'étudier la distribution des infections simiennes à Plasmodium avec une attention particulière pour les macaques. Quatre cent dix-neuf (419) macaques à longue queue (Macaca fascicularis) ont été piégés dans des zones sélectionnées où des cas humains de P. knowlesi et P. cynomolgi avaient été signalés. La réaction en chaîne par polymérase (PCR) nichée a été menée pour identifier les Plasmodium spp. et les gènes de la protéine circumsporozoïte (CSP) des échantillons de P. knowlesi ont été séquencés. L'infection à P. cynomolgi s'est avérée la plus répandue parmi la population de macaques (68,4 %). Bien que 50,6 % des échantillons analysés montraient des infections simples avec soit P. knowlesi, P. cynomolgi, P. inui, P. coatneyi ou P. fieldi, des infections mixtes avec deux, trois, quatre ou même les cinq espèces ont également été détectées. L'infection par P. cynomolgi et P. knowlesi était la plus élevée parmi les macaques malais dans les zones où les humains et les macaques sont en contact étroit. Le risque d'infection zoonotique dans ces zones doit être pris en compte car le nombre de cas de paludisme zoonotique est en augmentation. Avec l'élimination du paludisme humain, le risque d'être infecté par le paludisme simien est très élevé et des mesures doivent être prises pour atténuer ce problème.

Exposure Assessment of methyl mercury from consumption of fish and seafood in Peninsular Malaysia.

The concentration of meHg in freshwater fish and seafood was investigated, as well as the consumption patterns of fish and seafood by different demographic groups (age, ethnicity, gender). A potential alarm for human health hazards was also assessed, and the results were compared to the provisional tolerable weekly intakes (PTWIs) and the hazard quotient parameter (HQ). The results showed that meHg levels of 67 species ranged from 0.013 to 0.252 mg/kg of wet weight (WW) with significant differences between different fish and seafood groups (χ2KW = 49.09; p < 0.001). Median concentrations of meHg in fish and seafood groups in descending orders are as follows: demersal fish (0.1006 mg/kg WW) > pelagic fish (0.0686 mg/kg WW) > freshwater fish 0.045 mg/kg WW) > cephalopods (0.0405 mg/kg WW) crustaceans (0.0356 mg/kg WW). The results revealed that older population (> 40 years old) consumed significantly (p = 0.000) more fish compared to younger generations and the elderly consumed the highest amounts of fish (104.0 ± 113.0 g/day). The adolescents (10-17 years old) consumed more than double of amount for both cephalopod and crustacean compared to the older populations (p < 0.05). Malay ethnic (96.1 ± 99.6 g/day) consumed significantly (p = 0.000) higher amounts of fish and seafood compared to other ethnicities, similar to male subjects (95.2 ± 102 g/day; p = 0.026) when compared to the female (86 ± 96.3 g/day). The estimated weekly intake (EWI) values showed results below 1.6 µg/kg BW/week, the tolerable levels recommended by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) for all different demographic factors except for higher consumers at 75th percentile and above. Consumption of marine fish contributed to a higher value of PTWI to all different demographic groups (the estimated weekly intake (EWI) range: 0.2988-0.6893 µg/kg BW/week) but for the adolescents, where from the consumption of crustaceans (0.3488 µg/kg BW/week or 21.8% of PTWI) and cephalopods (0.504 µg/kg BW/week or 31.5% of PTWI). The results from this study also revealed the HQ value for overall consumption of fish and seafood by the adolescents and elderly exceeded one. This was contributed from the consumption of demersal fish and cephalopods, thus indicating the nonacceptable level of noncarcinogenic adverse health effects.

Multiyear prospective cohort study to evaluate the risk potential of MERS-CoV infection among Malaysian Hajj pilgrims (MERCURIAL): a study protocol.

INTRODUCTION: Middle East respiratory syndrome (MERS) is a viral respiratory infection caused by the MERS-CoV. MERS was first reported in the Kingdom of Saudi Arabia in 2012. Every year, the Hajj pilgrimage to Mecca attracts more than two million pilgrims from 184 countries, making it one of the largest annual religious mass gatherings (MGs) worldwide. MGs in confined areas with a high number of pilgrims' movements worldwide continues to elicit significant global public health concerns. MERCURIAL was designed by adopting a seroconversion surveillance approach to provide multiyear evidence of MG-associated MERS-CoV seroconversion among the Malaysian Hajj pilgrims. METHODS AND ANALYSIS: MERCURIAL is an ongoing multiyear prospective cohort study. Every year, for the next 5 years, a cohort of 1000 Hajj pilgrims was enrolled beginning in the 2016 Hajj pilgrimage season. Pre-Hajj and post-Hajj serum samples were obtained and serologically analysed for evidence of MERS-CoV seroconversion. Sociodemographic data, underlying medical conditions, symptoms experienced during Hajj pilgrimage, and exposure to camel and untreated camel products were recorded using structured pre-Hajj and post-Hajj questionnaires. The possible risk factors associated with the seroconversion data were analysed using univariate and multivariate logistic regression. The primary outcome of this study is to better enhance our understanding of the potential threat of MERS-CoV spreading through MG beyond the Middle East. ETHICS AND DISSEMINATION: This study has obtained ethical approval from the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia. Results from the study will be submitted for publication in peer-reviewed journals and presented in conferences and scientific meetings. TRIAL REGISTRATION NUMBER: NMRR-15-1640-25391.

Spatiotemporal spread of chikungunya virus in Sarawak, Malaysia.

BACKGROUND: We studied the spatiotemporal spread of a chikungunya virus (CHIKV) outbreak in Sarawak state, Malaysia, during 2009-2010. METHODS: The residential addresses of 3054 notified CHIKV cases in 2009-2010 were georeferenced onto a base map of Sarawak with spatial data of rivers and roads using R software. The spatiotemporal spread was determined and clusters were detected using the space-time scan statistic with SaTScan. RESULTS: Overall CHIKV incidence was 127 per 100 000 population (range, 0-1125 within districts). The average speed of spread was 70.1 km/wk, with a peak of 228 cases/wk and the basic reproduction number (R0) was 3.1. The highest age-specific incidence rate was 228 per 100 000 in adults aged 50-54 y. Significantly more cases (79.4%) lived in rural areas compared with the general population (46.2%, p<0.0001). Five CHIKV clusters were detected. Likely spread was mostly by road, but a fifth of rural cases were spread by river travel. CONCLUSIONS: CHIKV initially spread quickly in rural areas mainly via roads, with lesser involvement of urban areas. Delayed spread occurred via river networks to more isolated areas in the rural interior. Understanding the patterns and timings of arboviral outbreak spread may allow targeted vector control measures at key transport hubs or in large transport vehicles.

COVID-19 in adult patients with pre-existing chronic cardiac, respiratory and metabolic disease: a critical literature review with clinical recommendations.

BACKGROUND: A high burden of severe disease and death from the coronavirus disease 2019 (COVID-19) has been consistently observed in older patients, especially those with pre-existing medical co-morbidities. The global pandemic lockdown has isolated many patients with chronic illnesses from their routine medical care. This narrative review article analyses the multitude of issues faced by individuals with underlying medical conditions during the COVID-19 pandemic. METHODS: Sources for this publication were identified through searches of PubMed for articles published between 31st December 2019 and 4th June 2020, using combinations of search terms. Guidelines and updates from reputable agencies were also consulted. Only articles published in the English language were included. RESULTS: The volume of literature on COVID-19 continues to expand, with 17,845 articles indexed on PubMed by 4th June 2020, 130 of which were deemed particularly relevant to the subject matter of this review. Older patients are more likely to progress to severe COVID-19 disease requiring intensive care unit (ICU) admission. Patients with pre-existing cardiovascular disease, especially hypertension and coronary heart disease, are at greatly increased risk of developing severe and fatal COVID-19 disease. A controversial aspect of the management of COVID-19 disease has been the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Obese COVID-19 patients are more likely to require complex ICU management. Putative mechanisms of increased COVID-19 disease severity in diabetes include hyperglycaemia, altered immune function, sub-optimal glycaemic control during hospitalisation, a pro-thrombotic and pro-inflammatory state. Patients with mental health disorders are particularly vulnerable to social isolation, and this has been compounded by the suspension of non-emergency care in hospitals around the world, making it difficult for patients with chronic mental illness to attend outpatient appointments. CONCLUSIONS: The global pandemic of COVID-19 disease has had a disproportionately negative impact on patients living with chronic medical illness. Future research should be directed at efforts to protect vulnerable patients from possible further waves of COVID-19 and minimising the negative impact of pandemic mitigation strategies on these individuals.

Travellers with type 1 diabetes: questionnaire development and descriptive analysis of knowledge and practices.

BACKGROUND: Little is known about the awareness of travellers with diabetes about the health effects of international travel. This study aimed to design and validate a questionnaire to examine the travel health knowledge, attitudes and practices of people living with type 1 diabetes. METHODS: A set of 74 items based on a conceptual framework analysis underwent revision and its content validity was established. Items were grouped into three domains. A development study was conducted to establish evidence regarding their factorial structure. A construct validation study was then conducted in which the retained items were tested in an independent sample using confirmatory factor analysis (CFA). RESULTS: Four factors emerged from our development study and were labelled as pre-travel preparation-insect bites, pre-travel preparation-consultation, insulin and glycaemic control and travel risk behaviour. A CFA confirmed the factorial structure identified in the development study in an independent sample. Each factor loading had a significant (P < 0.001) loading of at least 0.4. The factor correlations ranged between 0.1 and 0.6, indicating good discriminant validity. The highest mean domain score in our sample of 268 participants related to insulin and glycaemic control (6.45), followed by travel risk behaviour (5.21) and pre-travel preparation (4.15). CONCLUSIONS: This valid questionnaire for measuring the degree of preparedness of travellers with type 1 diabetes may prove a useful tool in studies involving travellers with type1 diabetes. Our results suggest that improvements are needed in relation to timely pre-travel consultation and screening for diabetic complications.

Sylvatic dengue virus type 4 in Aedes aegypti and Aedes albopictus mosquitoes in an urban setting in Peninsular Malaysia.

Dengue fever is endemic in Malaysia, contributing to significant economic and health burden in the country. Aedes aegypti and Ae. albopictus are the main vectors of the dengue virus (DENV), which circulates in sylvatic and human transmission cycles and has been present in Malaysia for decades. The study investigated the presence and distribution of DENV in urban localities in the Klang Valley, Peninsular Malaysia. A total of 364 Ae. aegypti and 1,025 Ae. albopictus larvae, and 10 Ae. aegypti and 42 Ae. albopictus adult mosquitoes were screened for the presence of DENV. In total, 31 (2.2%) samples were positive, of which 2 Ae. albopictus larvae were co-infected with two serotypes, one with DENV-2 and DENV-3 and the other with DENV-3 and DENV-4. Phylogenetic analysis determined that the isolates belonged to DENV-1 genotype I (1 Ae. aegypti adult), DENV-2 (1 Ae. albopictus larva), DENV-3 genotype V (3 Ae. aegypti larvae and 10 Ae. albopictus larvae) and DENV-4 genotype IV (6 Ae. aegypti larvae and 12 Ae. albopictus larvae), a sylvatic strain of DENV-4 which was most closely related with sylvatic strains isolated from arboreal mosquitoes and sentinel monkeys in Peninsular Malaysia in the 1970s. All four DENV serotypes were co-circulating throughout the study period. The detection of a sylvatic strain of DENV-4 in Ae. aegypti and Ae. albopictus mosquitoes in urban areas in Peninsular Malaysia highlights the susceptibility of these vectors to infection with sylvatic DENV. The infectivity and vector competence of these urban mosquitoes to this strain of the virus needs further investigation, as well as the possibility of the emergence of sylvatic virus into the human transmission cycle.

Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme.

BACKGROUND: In 2006, 4 years of planning was started by the Ministry of Health, Malaysia (MOH), to implement the HPV (human papillomavirus) vaccination programme. An inter-agency and multi-sectoral collaborations were developed for Malaysia's HPV school-based immunisation programme. It was approved for nationwide school base implementation for 13-year-old girls or first year secondary students in 2010. This paper examines how the various strategies used in the implementation over the last 7 years (2010-2016) that unique to Malaysia were successful in achieving optimal coverage of the target population. METHODS: Free vaccination was offered to school girls in secondary school (year seven) in Malaysia, which is usually at the age of 13 in the index year. All recipients of the HPV vaccine were identified through school enrolments obtained from education departments from each district in Malaysia. A total of 242,638 girls aged between 12 to 13 years studying in year seven were approached during the launch of the program in 2010. Approximately 230,000 girls in secondary schools were offered HPV vaccine per year by 646 school health teams throughout the country from 2010 to 2016. RESULTS: Parental consent for their daughters to receive HPV vaccination at school was very high at 96-98% per year of the programme. Of those who provided consent, over 99% received the first dose each year and 98-99% completed the course per year. Estimated population coverage for the full vaccine course, considering also those not in school, is estimated at 83 to 91% per year. Rates of adverse events reports following HPV vaccination were low at around 2 per 100,000 and the majority was injection site reactions. CONCLUSION: A multisectoral and integrated collaborative structure and process ensured that the Malaysia school-based HPV immunisation programme was successful and sustained through the programme design, planning, implementation and monitoring and evaluation. This is a critical factor contributing to the success and sustainability of the school-based HPV immunisation programme with very high coverage.

Fish consumption pattern among adults of different ethnics in Peninsular Malaysia.

BACKGROUND: Understanding different patterns of fish consumption is an important component for risk assessment of contaminants in fish. A few studies on food consumption had been conducted in Malaysia, but none of them focused specifically on fish consumption. The objectives of this study were to document the meal pattern among three major ethnics in Malaysia with respect to fish/seafood consumption, identify most frequently consumed fish and cooking method, and examine the influence of demographic factors on pattern of fish consumption among study subjects. METHODS: A cross-sectional survey was conducted between February 2008 and May 2009 to investigate patterns of fish consumption among Malaysian adults in Peninsular Malaysia. Adults aged 18 years and above were randomly selected and fish consumption data were collected using a 3-day prospective food diary. RESULTS: A total of 2,675 subjects, comprising male (44.2%) and female (55.7%) participants from major ethnics (Malays, 76.9%; Chinese, 14.7%; Indians, 8.3%) with a mean age of 43.4±16.2 years, were involved in this study. The results revealed 10 most frequently consumed marine fish in descending order: Indian mackerel, anchovy, yellowtail and yellow-stripe scads, tuna, sardines, torpedo scad, Indian and short-fin scads, pomfret, red snapper, and king mackerel. Prawn and squid were also among the most preferred seafood by study subjects. The most frequently consumed freshwater fish were freshwater catfish and snakehead. The most preferred cooking style by Malaysians was deep-fried fish, followed by fish cooked in thick and/or thin chili gravy, fish curry, and fish cooked with coconut milk mixed with other spices and flavorings. Overall, Malaysians consumed 168 g/day fish, with Malay ethnics' (175±143 g/day) consumption of fish significantly (p<0.001) higher compared with the other two ethnic groups (Chinese=152±133 g/day, Indians=136±141 g/day). CONCLUSION: Fish consumption was significantly associated with ethnicity, age, marital status, residential area, and years of education of adults in Peninsular Malaysia, and the data collected are beneficial for the purpose of health risk assessment on the intake of contaminants through fish/seafood consumption.

Potential Health Impacts of Bauxite Mining in Kuantan.

Bauxite mining is not known to most Malaysian except recently due to environmental pollution issues in Kuantan, Pahang. Potential impacts are expected to go beyond physical environment and physical illness if the situation is not controlled. Loss of economic potentials, and the presence of unpleasant red dust causing mental distress, anger and community outrage. More studies are needed to associate it with chronic physical illness. While evidences are vital for action, merely waiting for a disease to occur is a sign of failure in prevention. All responsible agencies should focus on a wider aspect of health determinants rather than merely on the occurrence of diseases to act and the need to emphasize on sustainable mining to ensure health of people is not compromised.

Investigation of hepatitis A outbreak in district of Manjung, Perak, Malaysia, October 2012.

BACKGROUND: In September 2012, 10 cases suspected to be hepatitis A were notified to the Manjung District Health Department. An investigation was conducted to identify the possible mode of transmission, source of the outbreak and to recommend prevention and control measures. METHODS: A case was a person with acute illness with discrete onset of symptoms and jaundice or elevated serum aminotransferase levels in September 2012 in the Manjung District. We conducted a case-control study and environmental assessments of processing plants and food premises. RESULTS: There were 78 confirmed cases of hepatitis A; an attack rate of 3.1 per 10,000 population. Multiple logistic regression showed that being male (odds ratio [OR]: 18.4 [5.13-65.9]; P < 0.001) and drinking toddy at processing place A (Adjusted OR: 2.70 [1.17-6.25]; P < 0.05) were associated with being a case. Environmental investigations of this and one other processing place found them to be unhygienic, and the pH of the toddy was at levels that encouraged growth of hepatitis A virus. CONCLUSION: Toddy was possibly the primary source of this outbreak based on both epidemiological and environmental results. Both toddy preparation places and several food premises were closed as a result of this investigation.

Bacterial constituents of indoor air in a high throughput building in the tropics.

Airborne bacteria are significant biotic constituents of bioaerosol. Bacteria at high concentrations in the air can compromise indoor air quality (IAQ) and result in many diseases. In tropical environments like Malaysia that extensively utilize air-conditioning systems, this is particularly significant due to continuous recirculation of indoor air and the potential implications for human health. Currently, there is a lack of knowledge regarding the impact of airborne bacteria on IAQ in Malaysia. This study was prompted by a need for reliable baseline data on airborne bacteria in the indoor environment of tropical equatorial Malaysia, that may be used as a reference for further investigations on the potential role played by airborne bacteria as an agent of disease in this region. It was further necessitated due to the threat of bioterrorism with the potentiality of release of exotic pathogenic microorganisms into indoor or outdoor air. Before scientists can detect the latter, a gauge of the common microorganisms in indoor (as well as outdoor) air needs to be ascertained, hence the expediency of this study. Bacterial counts from the broad-based and targeted study were generally in the order of 10(2) colony-forming units (CFU) per m(3) of air. The most prevalent airborne bacteria found in the broad-based study that encompassed all five levels of the building were Gram-positive cocci (67.73%), followed by Gram-positive rods (24.26%) and Gram-negative rods (7.10%). Gram-negative cocci were rarely detected (0.71%). Amongst the genera identified, Kytococcus sp., Micrococcus sp., Staphylococcus sp., Leifsonia sp., Bacillus sp. and Corynebacterium sp. predominated in indoor air. The most dominant bacterial species were Kytococcus sedentarius, Staphylococcus epidermidis and Micrococcus luteus. The opportunistic and nosocomial pathogen, Stenotrophomonas maltophilia was also discovered at a high percentage in the cafeteria. The bacteria isolated in this study have been increasingly documented to cause opportunistic infections in immuno-compromised patients, sometimes with fatal outcomes. Furthermore, some of them are becoming increasingly resistant to antibiotics. Hence, we propose that indoor reservoirs of these bacteria and their associated clinical and more subtle health effects, if any, be investigated further.

Responding to the Potential of Ebola Virus Disease (EVD) Importation into Malaysia.

The current Ebola outbreak, which is the first to affect West African countries, has been declared to have met the conditions for a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO). Thus, the Ministry of Health (MOH) of Malaysia has taken steps to strengthen and enhanced the five core components of preparedness and response to mitigate the outbreak. The National Crisis Preparedness and Response Centre (CPRC) commands, controls and coordinates the preparedness and response plans for disasters, outbreaks, crises and emergencies (DOCE) related to health in a centralised way. Through standardised case definition and mandatory notification of Ebola by public and private practitioners, surveillance of Ebola is made possible. Government hospitals and laboratories have been identified to manage and diagnose Ebola virus infections, and medical staff members have been trained to handle an Ebola outbreak, with emphasis on strict infection prevention and control practices. Monitoring of the points of entry, focusing on travellers and students visiting or coming from West African countries is made possible by interagency collaborations. To alleviate the public's anxiety, effective risk communications are being delivered through various channels. With experience in past outbreak control, the MOH's preparedness and response plans are in place to abate an Ebola outbreak.

High prevalence of mutation in the Plasmodium falciparum dhfr and dhps genes in field isolates from Sabah, Northern Borneo.

BACKGROUND: Sulphadoxine-pyrimethamine (SP) has been in use for the treatment of uncomplicated falciparum malaria in Malaysia since the 1970s and is still widely employed in spite of widespread clinical resistance. Resistance to SP is known to be mediated by mutations in the pfdhfr and pfdhps genes. The aim of the present study was to investigate the distribution of pfdhfr and pfdhps gene polymorphism in Plasmodium falciparum field isolates from Kalabakan, Sabah, in northern Borneo. METHODS: A total number of 619 individuals were screened from 23 study sites of which 31 were positive for P. falciparum. Analysis of restriction fragment length polymorphisms (RFLP) was used to identify polymorphism in the pfdhfr and pfdhps genes at positions 16, 51, 59, 108, 164 and 437, 540, 581, respectively. RESULTS: All samples had at least one mutation in each of the genes associated with drug resistance. The prevalence of pfdhfr 59arg, 164leu and 108asn were 100%, 80.65% and 58.06%, respectively. Pfdhps mutants 437gly and 581gly accounted for 100% and 74.19% respectively. In pfdhfr, the most common mutant genotypes were combination 59arg + 164leu (22.58%) and 59arg + 108asn + 164leu (51.61%). In pfdhps the most common genotype was 437gly + 581gly (74.19%). One individual (3.22%) harboured parasites with four pfdhfr (16 val + 59arg + 108asn + 164leu) and two pfdhps (437gly + 581gly) mutations. The highest quintuple pfdhfr/pfdhps (41.94%) was three pfdhfr (59arg + 108asn + 164gly) and two pfdhps (437gly + 581gly). CONCLUSION: The data suggest a high prevalence of genetic variations conferring resistance to SP which can predict treatment failure before becoming clinically evident. In areas like this, the use of SP may no longer be indicated.

High prevalence of pfcrt K76t mutants among Plasmodium falciparum isolates from Sabah, Malaysia.

Chloroquine (CQ) remains the first line drug for the prevention and treatment of malaria in Malaysia in spite of the fact that resistance to CQ has been observed in Malaysia since the 1960s. CQ-resistance is associated with various mutations in pfcrt, which encodes a putative transporter located in the digestive vacuolar membrane of P. falciparum. Substitution of lysine (K) to threonine (T) at amino acid 76 (K76T) in pfcrt is the primary genetic marker conferring resistance to CQ. To determine the presence of T76 mutation in pfcrt from selected areas of Kalabakan, Malaysia 619 blood samples were screened for P. falciparum, out of which 31 were positive. Blood samples were collected on 3 MM Whatman filter papers and DNA was extracted using QIAmp DNA mini kit. RFLP-PCR for the detection of the CQ-resistant T76 and sensitive K76 genotype was carried out. Twenty-five samples were shown to have the point mutation in pfcrt whereas the remaining samples were classified as CQ-sensitive (wild-type). In view of the fact that CQ is the first line anti-malarial drug in Malaysia, this finding could be an important indication that treatment with CQ may no longer be effective in the future.