Antibiotic Resistance Genes and crAssphage in Hospital Wastewater and a canal receiving the treatment effluent.

Hospital wastewater is a major hotspot for the spread of antimicrobial resistance (AMR) in aquatic ecosystems. This study aimed to investigate the prevalence of antibiotic resistance genes (ARGs) and their correlation with crAssphage in a hospital wastewater treatment plant (HWWTP) and a receiving canal. Water samples were analyzed for 94 ARGs and crAssphage relative to the 16S rRNA using high-throughput quantitative polymerase chain reaction (HT-qPCR). Subsequently, 7 ARGs and crAssphage were selected and quantified using qPCR. The results showed that the detected genes ranged from 85 to 93 out of 94 genes. The raw wastewater (WW) samples had the highest gene diversity compared to the upstream canal, which had less diversity than downstream samples, as determined by HT-qPCR. The blaGES was the most abundant in WW samples, while qacEΔ1, merA, IS6100, tnpA, and IS26 showed high prevalence throughout the treatment processes. The concentrations of intI1, sul1, blaTEM,blaNDM,blaVIM,tetQ, mcr-1, crAssphage, and 16S rRNA, measured using qPCR, were the highest in WW and significantly reduced in treated water samples. Although some water quality parameters, such as total suspended solids and dissolved oxygen, did not significantly differ before and after treatment, removal efficiency ranged from 0.60 to 3.23 log reduction values (LRV). The highest LRV was observed for the tetQ, whereas the mcr-1 had the lowest of LRV. Strong positive correlations among the absolute concentrations of ARGs and crAssphage were observed (Spearman's rho = 0.6 - 1.0), and biochemical oxygen demand correlated with blaTEM and blaVIM (Spearman's rho = 0.6 and 0.6, respectively). These results indicate that crAssphage and water quality could reflect the distribution of other ARGs throughout the HWWTP. Further studies are needed to underscore the importance of monitoring ARGs and biomarkers such as crAssphage in HWWTPs and their receiving waters to enhance our understanding of ARG distribution.

Knowledge, attitudes, and practices regarding antibiotic use and resistance among health science and non-health science university students in Thailand.

Antibiotic-resistant bacteria (ARB) have been recognized as one of the global health issues affecting humans, animals, and the environment. A lack of knowledge, negative attitudes, and irrational drug use can make significant contributions to the spread of ARB. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding antibiotic use and resistance among health science (HS) and non-health science (NHS) students and to determine the factors that influence their KAP concerning antibiotic use and resistance. A cross-sectional study was conducted among 404 HS and NHS students in Southern Thailand from December 2021 to March 2022. The students who fulfilled the study inclusion criteria responded to a questionnaire that had five dimensions. Descriptive statistics were used to analyze the qualitative variables, and Fisher's exact test was applied to compare the demographic variables, KAP responses between the HS and NHS students. The KAP regarding antibiotic use and resistance for each variable were compared using the Mann-Whitney U test and Kruskal-Wallis H test. Spearman's correlation test was used to estimate the correlation between the variables and KAP. A total of 404 (HS,162; NHS,242) students completed the self-administered questionnaire. The students' highest score was for attitude, followed by practice and knowledge. Our findings revealed that the HS students had higher levels of KAP correlated with antibiotic use and resistance than the NHS students (P < 0.001). The higher KAP scores were among the more senior students, which indicates that instruction on antibiotics was effective in their curriculum. Antibiotic use and resistance knowledge and attitudes should be conveyed to all university students via academic curriculum. Such interventions could set the standard for rational antibiotic use as well as long-term prevention and control of antibiotic-resistant bacteria.

Environmental factors influencing indoor airborne fungi in students dormitory - a case study in Nakhon Sithammarat, Thailand.

Background: Indoor airborne fungi are a significant health concern that can cause respiratory symptoms and other health problems. Indoor fungi are influenced by various factors such as meteorological conditions and dwelling characteristics. Objective: This study aims to evaluate the association between indoor airborne fungi and environmental factors in a student dormitory in southern Thailand. Material and methods: The study was conducted at Walailak University in southern Thailand from September toDecember 2020. Air samples were collected from rooms in thirteen dormitories, and the fungal load was determined using the passive air sampling method. The study also measured meteorological parameters and gathered data on occupant behaviors and exposure-related symptoms through a self-administered questionnaire. Results: In a total of 135 student rooms, the average concentration (mean ± SD) of indoor airborne fungi was 409.72±176.22 CFU/m3, which showed the highest concentration on the first floor. For meteorological parameters, the averages of RH (%), temperature (°C), and CO2 (ppm) were 70.99±2.37, 31.11±0.56 and 413.29±76.72, respectively. The abundance of indoor airborne fungi was positively associated with an increase in RH (ß=0.267, 95% CI: 5.288, 34.401) and building height (ß=0.269, 95% CI: 16.283, 105.873), with values of 19.845 and 61.078, respectively. Conversely, temperature exhibited a negative effect on indoor airborne fungi (-92.224, ß=-0.292, 95% CI: -150.052, -34.396). Conclusion: The findings highlight the influence of RH, temperature and building height on indoor airborne fungi in the student dormitory. Therefore, effective management strategies are necessary to improve indoor air quality and reduce associated health risks in student dormitories.

Antimicrobial resistance in southeast Asian water environments: A systematic review of current evidence and future research directions.

Antimicrobial resistance has been a serious and complex issue for over a decade. Although research on antimicrobial resistance (AMR) has mainly focused on clinical and animal samples as essential for treatment, the AMR situation in aquatic environments may vary and have complicated patterns according to geographical area. Therefore, this study aimed to examine recent literature on the current situation and identify gaps in the AMR research on freshwater, seawater, and wastewater in Southeast Asia. The PubMed, Scopus, and ScienceDirect databases were searched for relevant publications published from January 2013 to June 2023 that focused on antimicrobial resistance bacteria (ARB) and antimicrobial resistance genes (ARGs) among water sources. Based on the inclusion criteria, the final screening included 41 studies, with acceptable agreement assessed using Cohen's inter-examiner kappa equal to 0.866. This review found that 23 out of 41 included studies investigated ARGs and ARB reservoirs in freshwater rather than in seawater and wastewater, and it frequently found that Escherichia coli was a predominant indicator in AMR detection conducted by both phenotypic and genotypic methods. Different ARGs, such as blaTEM, sul1, and tetA genes, were found to be at a high prevalence in wastewater, freshwater, and seawater. Existing evidence highlights the importance of wastewater management and constant water monitoring in preventing AMR dissemination and strengthening effective mitigation strategies. This review may be beneficial for updating current evidence and providing a framework for spreading ARB and ARGs, particularly region-specific water sources. Future AMR research should include samples from various water systems, such as drinking water or seawater, to generate contextually appropriate results. Robust evidence regarding standard detection methods is required for prospective-era work to raise practical policies and alerts for developing microbial source tracking and identifying sources of contamination-specific indicators in aquatic environment markers.

Knowledge and practice of facemask disposal among university students in Thailand: A new normal post the COVID-19 pandemic.

The use of facemasks is essential to prevent the transmission of COVID-19. University students are a significant demographic that generates substantial infectious waste due to the new normal practice of using disposable facemasks. In this cross-sectional study, we investigated the facemask disposal knowledge and practices among university students in Thailand between September and October 2022. We used a self-report questionnaire comprising 29 questions to determine the students' demographic characteristics and facemask disposal knowledge and practices. We then applied a logistic regression model to estimate the association between the students' facemask disposal knowledge and practices and their demographic characteristics. A total of 433 participants completed the questionnaire comprising health science (45.27%) and non-health science (54.73%) students. Surgical masks were the most popular masks (89.84%), followed by N95 (26.33%) and cloth masks (9.94%). While their levels of knowledge regarding facemask disposal were poor, the students' practices were good. The factors associated with proper facemask disposal were sex (AOR = 0.469, 95% CI: 0.267, 0.825), academic grade (AOR = 0.427, 95% CI: 0.193, 0.948), and knowledge level (AOR = 0.594, 95% CI: 0.399, 0.886). No demographic factors influenced knowledge. Our findings highlight the influence of facemask disposal knowledge on students' disposal practices. Information promoting the appropriate disposal practices should therefore be promoted extensively. Furthermore, continuous reinforcement by raising awareness and educating students on proper facemask disposal combined with the provision of adequate infectious waste disposal facilities could help reduce the environmental contamination of infectious waste and thus improve general waste management.

Wastewater monitoring in tourist cities as potential sentinel sites for near real-time dynamics of imported SARS-CoV-2 variants.

Wastewater-based epidemiology (WBE) complements the clinical surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants' distribution in populations. Many developed nations have established national and regional WBE systems; however, governance and budget constraints could be obstacles for low- and middle-income countries. An urgent need thus exists to identify hotspots to serve as sentinel sites for WBE. We hypothesized that representative wastewater treatment plants (WWTPs) in two international gateway cities, Bangkok and Phuket, Thailand, could be sentineled for SARS-CoV-2 and its variants to reflect the clinical distribution patterns at city level and serve as early indicators of new variants entering the country. Municipal wastewater samples (n = 132) were collected from eight representative municipal WWTPs in Bangkok and Phuket during 19 sampling events from October 2021 to March 2022, which were tested by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) using the US CDC N1 and N2 multiplex and variant (Alpha, Delta, and Omicron BA.1 and BA.2) singleplex assays. The variant detection ratios from Bangkok and Phuket followed similar trends to the national clinical testing data, and each variant's viral loads agreed with the daily new cases (3-d moving average). Omicron BA.1 was detected in Phuket wastewater prior to Bangkok, possibly due to Phuket's WWTPs serving tourist communities. We found that the Omicron BA.1 and BA.2 viral loads predominantly drove the SARS-CoV-2 resurgence. We also noted a shifting pattern in the Bangkok WBE from a 22-d early warning in early 2021 to a near real-time pattern in late 2021. The potential application of tourist hotspots for WBE to indicate the arrival of new variants and re-emerging or unprecedented infectious agents could support tourism-dependent economies by complementing the reduced clinical regulations while maintaining public health protection via wastewater surveillance.

The association between dengue case and climate: A systematic review and meta-analysis.

Although previous research frequently indicates that climate factors impact dengue transmission, the results are inconsistent. Therefore, this systematic review and meta-analysis highlights and address the complex global health problems towards the human-environment interface and the inter-relationship between these variables. For this purpose, four online electronic databases were searched to conduct a systematic assessment of published studies reporting the association between dengue cases and climate between 2010 and 2022. The meta-analysis was conducted using random effects to assess correlation, publication bias and heterogeneity. The final assessment included eight studies for both systematic review and meta-analysis. A total of four meta-analyses were conducted to evaluate the correlation of dengue cases with climate variables, namely precipitation, temperature, minimum temperature and relative humidity. The highest correlation is observed for precipitation between 83 mm and 15 mm (r = 0.38, 95% CI = 0.31, 0.45), relative humidity between 60.5% and 88.7% (r = 0.30, 95% CI = 0.23, 0.37), minimum temperature between 6.5 °C and 21.4 °C (r = 0.28, 95% CI = 0.05, 0.48) and mean temperature between 21.0 °C and 29.8 °C (r = 0.07, 95% CI = -0.1, 0.24). Thus, the influence of climate variables on the magnitude of dengue cases in terms of their distribution, frequency, and prevailing variables was established and conceptualised. The results of this meta-analysis enable multidisciplinary collaboration to improve dengue surveillance, epidemiology, and prevention programmes.

Efficiency of Malaysian states in managing the COVID-19 outbreak in 2020 and 2021.

INTRODUCTION: Many developing countries have drastically imbalanced health systems in different regions. The COVID-19 outbreak posed a further challenge as hospital structures, equipped with doctors, critical care units and respirators, were not available to a sufficient extent in all regions. OBJECTIVE: This study is a descriptive study on the efficiency of Malaysian states in facing the COVID-19 outbreak. METHODOLOGY: The efficiency of all Malaysian states was measured using Data Envelopment Analysis in which each state's Score of COVID Index (SCI) was quantified. The SCI of these states were then further compared between the year 2020 and 2021. A greater disparity would indicate a decline in the performance of a state over time, where nearly all the states in Malaysia experienced an increase in the score of COVID Index (SCI). RESULT: This study found that the central region was the most affected, since all the three states in the region (Selangor, Federal Territory of Kuala Lumpur, and Federal Territory of Putrajaya) showed a situation of inadequacy (SCI: >0.75) due to the COVID-19 outbreak. CONCLUSION: The ranking of Malaysia's states according to their vulnerability to an outbreak of COVID-19 is vitally significant for the purposes of assisting the government and policymakers in planning their responses to the outbreak and ensuring that resources are distributed appropriately.

Bacteriological Quality of Drinking Water and Hygienic Assessment of Water Cooler Dispensers in Higher Education Institution.

Background: The bacteriological quality of drinking water has become a public health concern according to its association with water-borne diseases. Nowadays, there are several different types of drinking water, including water cooler dispensers (WCDs), which are becoming a popular device in educational institutions. Therefore, this study aims to determine the bacteriological quality of drinking water from WCDs, and inspect their hygienic conditions in students' dormitories at a university in Nakhon Si Thammarat, Thailand. Methods: Water samples from 53 WCDs installed in 13 dormitories were collected and analyzed coliform bacteria by using the multiple-tube fermentation technique. The hygienic inspection form from the Department of Health, Ministry of Public Health, was used for inspection of the sanitary conditions. The hygienic factors of water cooler sanitation were analyzed using the generalized linear model. Results: Coliform bacteria were found in 10 out of 53 samples; moreover, Escherichia coli was recovered in three samples. Maintenance/cleaning and monitoring were the most two sanitary issues found in 100% (53/53) of the WCDs. Location and features of machine were found the correlation with the prevalence of coliform bacteria in drinking water. Conclusions: The findings of this study suggest regular monitoring of water quality in educational institutions. Also, the Sanitary Standard and Operational Procedures (S.S.O.P.) should be developed to improve the hygienic conditions of the water cooler dispensers.

A systematic review and meta-analysis of the effects of temperature on the development and survival of the Aedes mosquito.

Introduction: The Aedes mosquito species, which are the vectors for the transmission of the dengue virus (DENV) to humans, are becoming increasingly susceptible to the formidable effects of influential factors, especially temperature. However, there are still very few studies that have systematically reviewed the existing literature. Hence, in the present study, a systematic literature review and meta-analysis was conducted into the effects of temperature on dengue vectors. Method: Several research methodologies were incorporated into the current study, and a review was carried out using PRISMA as a guide. The publications for this study were chosen from two prominent databases, Scopus and Web of Science. All of the studies were assessed, reviewed, and evaluated independently by two reviewers. The meta-analysis tool, Review Manager (RevMan Copenhagen Version 5.4.1), was used to record the extracted data for the meta-analysis. Moran's I 2 and a funnel plot were utilized to measure heterogeneity, and publication bias was investigated. A 95% confidence interval (CI) and overall risk difference (RD) were estimated using a random-effects model. Result and discussion: As a consequence of the search efforts, a total of 46 articles were selected for inclusion in the systematic review and meta-analysis. This review was divided into five major themes, based on a thematic analysis: (i) hatching rate, (ii) development time, (iii) longevity, (iv) survival rate, and (v) wing morphology. In addition, the development time, survival rate, and wing morphology revealed significantly higher risk differences between the maximum and minimum temperatures (RD: 0.26, 95% CI: 0.16, 0.36; p = < 0.00001; RD: 0.10, 95% CI: 0.05, 0.14; p < 0.0001; and RD: 0.07, 95% CI: 0.02, 0.12; p = 0.006, respectively). This study makes several substantial contributions to the body of knowledge and to practical applications. Finally, a number of recommendations are made at the conclusion of this research for the future reference of researchers.

An analysis on the effect of coronavirus (COVID-19) pandemic movement control order (MCOS) on the solid waste generation in Peninsular Malaysia.

This study intends to deal with the environmental consequences of the COVID-19 pandemic in Malaysia, by providing a summary of the effects of COVID-19 on municipal solid waste (MSW). In this analysis, the data on domestic waste collection were collected from the Solid Waste Management and Public Cleaning Corporation (SWCorp) from 1 January 2020 to 31 December 2020 to evaluate the relative changes in MSW percentage via a waste weighing method. The data consisted of the cumulative tonnage of MSW for every local authority in Peninsular Malaysia and was classified according to MCO phases; before the MCO, during the MCO, during the conditional MCO (CMCO) and during the recovery MCO (RMCO) phases. The results indicated that the enforcement of the early MCO showed a positive effect by decreasing the volume of MSW. This decrease was noted across 41 local authorities, which accounts for 87.23% of Peninsular Malaysia. However, the amount of MSW began to increase again when the MCO reached the conditional and recovery stages. From this, it can be concluded that the implementation of the MCO, in its various incarnations, has shown us that our lifestyles can have a harmful impact on our environment. While the pandemic was still spreading and limitations were still in place in Malaysia, local governments and waste management companies had to quickly alter their waste management systems and procedures. The current circumstance allows us to rethink our social and economic structures while improving environmental and social inclusion.

Persisting antibiotic resistance gene pollution and its association with human sewage sources in tropical marine beach waters.

Antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) are pollutants of worldwide concern that threaten human health and ecosystems. Anthropogenic activities and wastewater could be ARB and ARG pollution sources; however, research on ARG abundance and microbial source tracking (MST) of contamination in tropical marine waters is limited. This study examined spatiotemporal variations of six ARGs (blaNDM, blaTEM, blaVIM, mcr-1, sul1, and tetQ) against the widely used antibiotic groups and a class 1 integron-integrase gene (intI1) at two Thai tropical recreational beaches (n = 41). Correlations between ARGs and sewage-specific MST markers (i.e., crAssphage and human polyomaviruses [HPyVs]) and fecal indicator bacteria (i.e., total coliforms, fecal coliforms, and enterococci) were also investigated. BlaTEM, intI1, sul1, and tetQ were ubiquitous at both beaches (85.4-100% detection rate); intI1 was the most abundant (3-6 orders in log10 copies/100 mL), followed by blaTEM (2-4 orders), sul1 (2-3 orders), and tetQ (2-4 orders). BlaNDM was found in 7.3% (up to 4 orders), and no mcr-1 was detected. Interestingly, blaVIM was prevalent at one beach (2-5 orders; n = 17), but found in only one sample at the other (4 orders). Temporal, but not spatial, differences were noticed; blaTEM was at higher levels in the wet season. IntI1 correlated with sul1 and tetQ (Spearman's rho = 0.47-0.97), suggesting potential horizontal gene transfer. CrAssphage, but not HPyVs, correlated with intI1, sul1, and tetQ (Spearman's rho = 0.50-0.74). Higher numbers of ARGs tended to co-occur in samples with higher crAssphage concentrations, implying sewage contribution to the marine water, with a persisting ARG background. This study provides insight into the ARG pollution status of tropical coastal waters and suggests crAssphage as a proxy for ARG pollution, which could facilitate effective management policies to minimize ARG dissemination in marine environments.