The Epidemiologic and Clinical Characteristics of the 2023 Dengue Outbreak in Bangladesh.

The ongoing 2023 dengue outbreak is the worst ever case reported in Bangladesh. There is a lack of epidemiological studies on the outbreak. A 2-tailed t test was performed. Multivariable logistic regression analysis was conducted. We found about 277 801 cases and 1393 deaths from the 2023 dengue outbreak. About 52% of the cases were from outside of Dhaka. The male:female ratio was about 3:2. The highest frequency of cases was found among people aged 19-29 years (28.7%, 79 673 of 277 801; P = .001). The overall case fatality rate (CFR) was 0.5%. The highest CFR was found among children aged 0-10 years (12%). Fever (99%) was the most prevalent, followed by joint pain (86%). We found significantly higher odds of fatalities (adjusted odds ratio [aOR], 4.21; 95% CI, 3.93-4.74; P = .05), cases (aOR, 3.85; 95% CI, 3.25-4.12; P = .001) and hospitalizations (aOR, 3.26; 95% CI, 3.11-4.04; P = .006) during the 2023 outbreak compared with previous outbreaks during 2008-2022. This is one of the early reports of epidemiological and clinical characteristics of ongoing dengue outbreak.

Prevalence and genetic diversity of rotavirus in Bangladesh during pre-vaccination period, 1973-2023: a meta-analysis.

Introduction: Rotavirus infection is a major cause of mortality among children under 5 years in Bangladesh. There is lack of integrated studies on rotavirus prevalence and genetic diversity during 1973 to 2023 in Bangladesh. Methods: This meta-analysis was conducted to determine the prevalence, genotypic diversity and seasonal distribution of rotavirus during pre-vaccination period in Bangladesh. This study included published articles on rotavirus A, rotavirus B and rotavirus C. We used Medline, Scopus and Google Scholar for published articles. Selected literatures were published between 1973 to 2023. Results: This study detected 12431 research articles published on rotavirus. Based on the inclusion criteria, 29 of 75 (30.2%) studies were selected. Molecular epidemiological data was taken from 29 articles, prevalence data from 29 articles, and clinical symptoms from 19 articles. The pooled prevalence of rotavirus was 30.1% (95% CI: 22%-45%, p = 0.005). Rotavirus G1 (27.1%, 2228 of 8219) was the most prevalent followed by G2 (21.09%, 1733 of 8219), G4 (11.58%, 952 of 8219), G9 (9.37%, 770 of 8219), G12 (8.48%, 697 of 8219), and G3 (2.79%, 229 of 8219), respectively. Genotype P[8] (40.6%, 2548 of 6274) was the most prevalent followed by P[4] (12.4%, 777 of 6274) and P[6] (6.4%, 400 of 6274), respectively. Rotavirus G1P[8] (19%) was the most frequent followed by G2P [4] (9.4%), G12P[8] (7.2%), and G9P[8], respectively. Rotavirus infection had higher odds of occurrence during December and February (aOR: 2.86, 95% CI: 2.43-3.6, p = 0.001). Discussion: This is the first meta-analysis including all the studies on prevalence, molecular epidemiology, and genetic diversity of rotavirus from 1973 to 2023, pre-vaccination period in Bangladesh. This study will provide overall scenario of rotavirus genetic diversity and seasonality during pre-vaccination period and aids in policy making for rotavirus vaccination program in Bangladesh. This work will add valuable knowledge for vaccination against rotavirus and compare the data after starting vaccination in Bangladesh.

Adherence to Anti-Malarial Treatment in Malaria Endemic Areas of Bangladesh.

Ensuring adherence to antimalarial treatment is crucial for achieving a radical cure and elimination of malaria, especially in hard-to-reach areas. We conducted this study to assess the current scenario of drug adherence in four endemic sub-districts of Bangladesh. Among 110 enrolled participants, 70% were mono-infected with Plasmodium falciparum and the remaining 30% with P. vivax. The overall treatment adherence frequency was 92.7% (95% CI: 83.0-96.3%). A total of eight participants were found to be nonadherent to treatment and all of them were from Bandarban. Level of nonadherence was equally observed in two age groups: 11-17 and 18+ years. However, male participants (n = 6) were found to be more nonadherent than females (n = 2). Among 7.3% with nonadherence to treatment, a single participant with P. falciparum mono-infection refused to take medication and became nonadherent. Remaining participants stated that they were feeling well and going to work, thus leaving treatment course uncompleted. Although overall compliance with malaria medication seems good, a gradual increase in noncompliance to P. vivax malaria treatment suggests that the National Malaria Elimination Program must be enhanced and monitored to fulfil the projected malaria elimination goal before 2030 from Bangladesh.

Prevalence and impact of long COVID-19 among patients with diabetes and cardiovascular diseases in Bangladesh.

Introduction: Co-prevalence of long-COVID-19, cardiovascular diseases and diabetes is one of the major health challenges of the pandemic worldwide. Studies on long-COVID-19 and associated health outcomes are absent in Bangladesh. The main aim of this study was to determine the prevalence and impact of long-COVID-19 on preexisting diabetes and cardiovascular diseases (CVD) on health outcomes among patients in Bangladesh. Methods: We collected data from 3,250 participants in Bangladesh, retrospectively. Multivariable logistic regression model was used to determine the odds ratio between independent and dependent variables. Kaplan-Meier survival curve was used to determine the cumulative survival. Results: COVID-19 was detected among 73.4% (2,385 of 3,250) participants. Acute long-COVID-19 was detected among 28.4% (678 of 2,385) and chronic long-COVID-19 among 71.6% (1,707 of 2,385) patients. CVD and diabetes were found among 32%, and 24% patients, respectively. Mortality rate was 18% (585 of 3,250) among the participants. Co-prevalence of CVD, diabetes and COVID-19 was involved in majority of fatality (95%). Fever (97%), dry cough (87%) and loss of taste and smell (85%) were the most prevalent symptoms. Patients with co-prevalence of CVD, diabetes and COVID-19 had higher risk of fatality (OR: 3.65, 95% CI, 2.79-4.24). Co-prevalence of CVD, diabetes and chronic long-COVID-19 were detected among 11.9% patients. Discussion: Risk of hospitalization and fatality reduced significantly among the vaccinated. This is one of the early studies on long-COVID-19 in Bangladesh.

National Malaria Control Program in Bangladesh: 2007-2010.

Malaria is a life-threatening disease caused by the plasmodium parasite, which is transmitted to people by the bites of infected mosquitoes. As elsewhere, this disease is also a major public health problem in Bangladesh. After independence, dichlorodiphenyltrichloroethane (DDT) use was banned in 1985, and the number of malaria cases began to increase. There were no control programs and inadequate funds, especially in the malaria-endemic areas; thus, malaria cases started to be epidemic in the 1990s. The global fund has been supporting the National Malaria Control Program (NMCP) in Bangladesh since the approval of the round 6 malaria proposal in 2006. This study aims to review the NMCP and changes in the burden of malaria in Bangladesh from 2007 to 2010. This is a descriptive retrospective study based on the secondary malaria surveillance data (cases and deaths) in 13 malaria-endemic districts, especially five selected districts, Chittagong, Cox's Bazar, Rangamati, Sylhet, and Mymensingh. A descriptive analysis was carried out to establish the incidence and mortality rate. From 2007 to 2010, a total of 264,293 confirmed malaria cases were notified from 13 malaria-endemic districts. More than 50% of the affected population was under the age group of ≥15 years (55.7%). Males had a higher risk of contracting of malaria than females, accounting for 53.5% of confirmed cases compared to 46.5% of females. Among the affected population, Plasmodium falciparum caused 85.6% of the total incidence. Rangamati has the highest incidence rate among the five districts. Although the incidence was high, death was declining: in 2007, it was 228, and in 2010, it was 37. The finding shows that while the incidence is still high, mortality is decreasing, therefore, it can be said that the NMCP is functioning. However, to fully achieve the goal of eliminating malaria, the NMCP requires efforts to develop new strategies and maintain a high-quality surveillance and reporting system.

Impact of meteorological factors and population density on COVID-19 pandemic in Saudi Arabia.

Transmission and increase in cases and fatalities of coronavirus disease-2019 (COVID-19) are significantly influenced by the parameters of weather, human activities and population factors. However, study gap on the seasonality of COVID-19 and impact of environmental factors on the pandemic in Saudi Arabia is present. The main aim of the study is to evaluate the impact of environment on the COVID-19 pandemic. Data were analyzed from January 2020 to July 2021. The generalized estimating equation (GEE) was used to determine the effect of environmental variables on longitudinal outcomes. Spearman's rank correlation coefficient (rs ) was used to analyze the impact of different parameters on the outcome of the pandemic. Multiple sequence alignment was performed by using ClustalW. Vaccination and fatalities (r s = -0.85) had the highest association followed by vaccination with cases (r s = -0.81) and population density with the fatalities (rs  = 0.71). The growth rate had the highest correlation with sun hours (r s = -0.63). Isolates from variant of concern alpha and beta were detected. Most of the reference sequences in Saudi Arabia were closely related with B.1.427/429 variant. Clade GH (54%) was the most prevalent followed by O (27%), GR (9%), G (6%), and S (4%), respectively. Male to female patient ratio was 1.4:1. About 95% fatality and hospitalization were reported in patients aged >60 years. This study will create a comprehensive insight of the interaction of environmental factors and the pandemic and add knowledge on seasonality of COVID-19 in Saudi Arabia.

Impact of Zinc, Vitamins C and D on Disease Prognosis among Patients with COVID-19 in Bangladesh: A Cross-Sectional Study.

Vitamin C, (ascorbic acid), vitamin D (cholecalciferol) and zinc (zinc sulfate monohydrate) supplements are important in immunity against coronavirus disease-2019 (COVID-19). However, a limited number of studies have been conducted on the association of vitamins and supplements with the reduced risks of COVID-19 infection. This study aims to evaluate the association of vitamins and supplements as treatment options to reduce the severity of COVID-19. Data were collected from 962 participants from 13 December 2020 to 4 February 2021. The presence of COVID-19 was confirmed by qRT-PCR. The Chi-square test and multivariate regression analyses were conducted. The ratio of uptake of vitamin C:vitamin D:zinc was 1:1:0.95. Uptake of vitamin C, vitamin D and zinc were significantly associated with the reduced risk of infection and severity of COVID-19 (OR: 0.006 (95% CI: 0.03-0.11) (p = 0.004)) and (OR: 0.03 (95% CI: 0.01-0.22) (p = 0.005)). The tendency of taking supplements was associated with the presence of infection of COVID-19 (p = 0.001), age (p = 0.02), sex (p = 0.05) and residence (p = 0.04). The duration of supplementation and medication was significantly associated with reduced hospitalization (p = 0.0001). Vitamins C, D and zinc were not significantly (p = 0.9) associated with a reduced risk of severity when taken through the diet. Hospitalization (p = 0.000001) and access to health facilities (p = 0.0097) were significantly associated with the survival period of the participants. Participants with better access to health facilities recovered early (OR: 6.21, 95% CI 1.56-24.7). This study will add knowledge in the field of treatment of COVID-19 by using vitamins and zinc supplements.

Genomic surveillance, evolution and global transmission of SARS-CoV-2 during 2019-2022.

In spite of the availability of vaccine, the health burden associated with the COVID-19 pandemic continues to increase. An estimated 5 million people have died with SARS-CoV-2 infection. Analysis of evolution and genomic diversity can provide sufficient information to reduce the health burden of the pandemic. This study focused to conduct worldwide genomic surveillance. About 7.6 million genomic data were analyzed during 2019 to 2022. Multiple sequence alignment was conducted by using maximum likelihood method. Clade GK (52%) was the most predominant followed by GRY (12%), GRA (11%), GR (8%), GH (7%), G (6%), GV (3%), and O (1%), respectively. VOC Delta (66%) was the most prevalent variant followed by VOC Alpha (18%), VOC Omicron (13%), VOC Gamma (2%) and VOC Beta (1%), respectively. The frequency of point mutations including E484K, N501Y, N439K, and L452R at spike protein has increased 10%-92%. Evolutionary rate of the variants was 23.7 substitution per site per year. Substitution mutations E484K and N501Y had significant correlation with cases (r = .45, r = .23), fatalities (r = .15, r = .44) and growth rate R0 (r = .28, r = .54). This study will help to understand the genomic diversity, evolution and the impact of the variants on the outcome of the COVID-19 pandemic.

Assessment of Plasmodium falciparum Artemisinin Resistance Independent of kelch13 Polymorphisms and with Escalating Malaria in Bangladesh.

Emerging resistance to artemisinin drugs threatens the elimination of malaria. Resistance is widespread in South East Asia (SEA) and Myanmar. Neighboring Bangladesh, where 90% of infections occur in the Chittagong Hill Tracts (CHTs), lacks recent assessment. We undertook a prospective study in the sole district-level hospital in Bandarban, a CHT district with low population densities but 60% of reported malaria cases. Thirty patients presented with malaria in 2018. An increase to 68 patients in 2019 correlated with the district-level rise in malaria, rainfall, humidity, and temperature. Twenty-four patients (7 in 2018 and 17 in 2019) with uncomplicated Plasmodium falciparum monoinfection were assessed for clearing parasites after starting artemisinin combination therapy (ACT). The median (range) time to clear half of the initial parasites was 5.6 (1.5 to 9.6) h, with 20% of patients showing a median of 8 h. There was no correlation between parasite clearance and initial parasitemia, blood cell counts, or mutations of P. falciparum gene Pfkelch13 (the molecular marker of artemisinin resistance [AR]). The in vitro ring-stage survival assay (RSA) revealed one (of four) culture-adapted strains with a quantifiable resistance of 2.01% ± 0.1% (mean ± standard error of the mean [SEM]). Regression analyses of in vivo and in vitro measurements of the four CHT strains and WHO-validated K13 resistance mutations yielded good correlation (R2 = 0.7; ρ = 0.9, P < 0.005), strengthening evaluation of emerging AR with small sample sizes, a challenge in many low/moderate-prevalence sites. There is an urgent need to deploy multiple, complementary approaches to understand the evolutionary dynamics of the emergence of P. falciparum resistant to artemisinin derivatives in countries where malaria is endemic. IMPORTANCE Malaria elimination is a Millennium Development Goal. Artemisinins, fast-acting antimalarial drugs, have played a key role in malaria elimination. Emergence of artemisinin resistance threatens the global elimination of malaria. Over the last decade, advanced clinical and laboratory methods have documented its spread throughout South East Asia and Myanmar. Neighboring Bangladesh lies in the historical path of dissemination of antimalarial resistance to the rest of the world, yet it has not been evaluated by combinations of leading methods, particularly in the highland Chittagong Hill Tracts adjacent to Myanmar which contain >90% of malaria in Bangladesh. We show the first establishment of capacity to assess clinical artemisinin resistance directly in patients in the hilltops and laboratory adaptation of Bangladeshi parasite strains from a remote, sparsely populated malaria frontier that is responsive to climate. Our study also provides a generalized model for comprehensive monitoring of drug resistance for countries where malaria is endemic.

Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh.

BACKGROUND: The National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug shop operators are a major source of healthcare for the poor and disadvantaged. This paper reports on policy awareness among drug shop operators and their customers and identifies current dispensing practices, barriers and facilitators to policy adherence. METHODS: We conducted a qualitative study in rural and urban Bangladesh from June 2019 to August 2020. This included co-design workshops (n = 4) and in-depth interviews (n = 24) with drug shop operators and customers/household members, key informant interviews (n = 12) with key personnel involved in aspects of the antibiotic supply chain including pharmaceutical company representatives, and model drug shop operators; and a group discussion with stakeholders representing key actors in informal market systems namely: representatives from the government, private sector, not-for-profit sector and membership organizations. RESULTS: Barriers to policy compliance among drug shop operators included limited knowledge of government drug policies, or the government-led Bangladesh Pharmacy Model Initiative (BPMI), a national guideline piloted to regulate drug sales. Drug shop operators had no clear knowledge of different antibiotic generations, how and for what diseases antibiotics work contributing to inappropriate antibiotic dispensing. Nonetheless, drug shop operators wanted the right to prescribe antibiotics based on having completed related training. Drug shop customers cited poor healthcare facilities and inadequate numbers of attending physician as a barrier to obtaining prescriptions and they described difficulties differentiating between qualified and unqualified providers. CONCLUSION: Awareness of the National Drug Policy and the BPMI was limited among urban and rural drug shop operators. Poor antibiotic prescribing practice is additionally hampered by a shortage of qualified physicians; cultural and economic barriers to accessing qualified physicians, and poor implementation of regulations. Increasing qualified physician access and increasing training and certification of drug shop operators could improve the alignment of practices with national policy.

Two new Aromatic Glycosides from a Soil Bacterium Burkholderia gladioli OR1.

Two new aromatic glycosides, named as gladioside I (1) and II (2) were isolated from the culture broth of a soil bacterium, Burkholderia gladioli OR1. Both 1 and 2 contained one unit each of rhamnose and 3-O-methyl xylose and differed from each other in the aglycone part. Compound 1 contained an aromatic aldehyde and compound 2 contained a styrylcarbamate unit as the aglycone part. The structures of 1 and 2 were elucidated by detailed spectral analysis and chemical degradation.