Western Pacific Surveillance and Response最新文献

Late initiation of antiretroviral therapy (ART) is associated with worse health outcomes for people living with HIV. In 2019, Cambodia implemented a same-day policy allowing people with HIV to start ART on the day they were diagnosed. Using case data collected by Cambodia's National Center for HIV/AIDS Dermatology and STDs, this study examined trends and factors influencing late ART initiation among newly diagnosed HIV cases attending three clinics in Kampong Thom province from 2014 to 2023. Factors linked to late ART initiation (defined as starting treatment > 1 day after diagnosis) were assessed using descriptive statistics and logistic regression. Statistical significance was set at P < 0.05. The study included 741 newly diagnosed HIV cases, with a mean age of 45.7 years at diagnosis (standard deviation: 10.2); 57.1% (423) of cases were female and more than 70% (504/704) were employed. In the 5-year period before the implementation of same-day ART initiation (2014-2018), 91% (325/356) of cases had late ART initiation. In the subsequent 5-year period (2019-2023), the proportion of cases with late ART initiation averaged 23%, and in 2023 was just 3%. Late ART initiation was more common at the Baray Santuk clinic (adjusted odds ratio: 3.94, 95% confidence interval: 1.99-7.81, P < 0.001), likely due to a lack of staff dedicated to HIV care. The findings demonstrate that same-day ART initiation is feasible in resource-limited settings and that adequate staffing can further improve prompt ART initiation.

Malaria is a life-threatening but preventable disease caused by Plasmodium parasites transmitted through bites of infected female Anopheles mosquitoes. According to the World Health Organization, the Western Pacific Region reported 1.7 million malaria cases in 2023, of which Plasmodium vivax accounted for 28.9% of cases and approximately 3500 malaria-related deaths. This reflects a decrease in the incidence of malaria cases and associated mortality compared to 2022, highlighting progress but underscoring persistent challenges. Cambodia, with its goal to eliminate malaria by 2025, continues to face public health challenges, particularly from P. vivax and mixed-species infections. This report provides an in-depth epidemiological analysis of malaria cases and radical cure treatment outcomes for P. vivax and mixed-species infections in Kampong Speu Province from 2019 to 2023. Data were drawn from Cambodia's national Malaria Information System and radical cure treatment records. The analysis demonstrated a substantial increase in malaria screening, primarily conducted by village malaria workers, while the number of confirmed malaria cases continued to decline. The annual parasite incidence dropped from 23.8 per 1000 at-risk individuals in 2019 to 0.7 per 1000 in 2023. Radical cure treatment completion rates among eligible cases improved from 78% in 2019 to 98% in 2023. Significant progress has been made towards malaria elimination. However, males aged 15-49 years, particularly forest-goers in the Kampong Speu operational district, remain the most at-risk group. In support of malaria elimination, it is recommended to enhance prevention measures, increase screening and ensure 100% radical cure treatment for all eligible cases in high-risk populations.

Objective: Hepatitis B virus infection is hyperendemic in Kiribati (~15% prevalence rate), with vaccination and antiviral treatment being the mainstays of control. Prevalence, knowledge and attitudes among health-care workers and antenatal mothers are poorly understood.

Methods: A cross-sectional, descriptive study was conducted among health-care workers and antenatal mothers at Tungaru Central Hospital on South Tarawa, Kiribati in 2022. The study included hepatitis B virus serology and a bilingual questionnaire.

Results: Fifty-one health-care workers and 49 women receiving antenatal care participated in the study. Most health-care workers (98.0%) had heard of the hepatitis B virus and most (54.9%) exhibited a moderate level of knowledge. Less than half (46.9%) of the antenatal mothers had heard of the hepatitis B virus and most (63.3%) had a low level of knowledge. Most health-care workers (60.8%) and half of antenatal mothers (49.0%) had satisfactory attitudes towards screening, care-seeking and vaccination, and 93.9% approved of adult catch-up vaccination. Hepatitis B virus prevalence was 23.0% (15.7% of health-care workers, 30.6% of antenatal mothers).

Discussion: Extensive educational campaigns for antenatal mothers are needed to enhance awareness of the infection, while training for health-care workers on transmission, prevention and treatment is critical for informing and galvanizing action on hepatitis B virus.

Objective: Noncommunicable diseases impose a significant and growing burden in Pacific island countries and territories, prompting health authorities to implement media-driven communication campaigns as part of their broader strategies to address these diseases and promote health. This analysis was undertaken to assess the strengths and limitations of these campaigns and identify areas for improvement.

Methods: A semi-structured online survey, conducted between August and October 2023, and a visual content analysis were used to examine noncommunicable disease-related communication in Pacific island countries and territories. Distributed through the Pacific Community's Public Health Division focal-point network, the survey was designed to gather qualitative insights on campaign development, evaluation, audience targeting, challenges and success factors. Public health posters from the Pacific Community's archives were analysed using a semiological approach to categorize their enunciative functions.

Results: Thirty-four survey responses from 12 Pacific island countries and territories were received. Tobacco was the top campaign issue, followed by nutrition, physical activity and cancer awareness; social media was the primary communication channel. Most respondents (80%) rated their campaigns as only moderately successful. Actions needed to enhance the impact of communications included better planning, more preliminary research, sustainable funding, skilled staff and greater cross-sector collaboration. Most noncommunicable disease-related posters (70%) served a representational function by portraying reality as designed by public health authorities. While most posters incorporated local cultural elements and vernacular languages, they were predominantly authoritative (46%) or neutral (44%) in tone. Furthermore, 73% were not tailored to specific target groups.

Discussion: Enhancing communication requires greater resourcing, transdisciplinary approaches and stronger audience engagement. More research-informed strategies that integrate behavioural science could improve interventions that promote healthier choices. Achieving this necessitates closer collaboration across disciplines, and stronger partnerships and engagement with communities.

Objective: An investigation team was deployed to determine the cause of an outbreak of a cluster of cases of fever and rash in a public elementary school in Antipolo City, Philippines, after the Public Health Unit was notified on 24 October 2022. The team also aimed to identify the source of the outbreak and to guide prevention measures.

Methods: Active case-finding for hand, foot and mouth disease was conducted at the school. A suspected case was defined as any learner who developed acute febrile illness with a papulovesicular rash on the palms and soles of the feet during 16-30 October 2022. Interviews with key informants were conducted and included school staff and parents. Oropharyngeal swabs were collected for polymerase chain reaction (PCR) testing.

Results: Nineteen suspected cases of hand, foot and mouth disease were detected, predominantly in grade 1 learners (16, 84%). Most cases (14, 74%) were 6 years old, and just over half were male (11, 58%). The first case occurred in a 6-year-old in grade 1 who attended class with a papulovesicular rash. Twelve learners (63%) from the same section developed symptoms, two of whom were seatmates of the first case. Two out of the 10 swabs collected were tested by PCR, both of which were positive for coxsackievirus A16.

Discussion: The causative agent of this outbreak was identified as coxsackievirus A16. Disease transmission occurred through close contact with the index case and possibly through shared classroom objects. Follow-up actions included dissemination of a memorandum about preventing the disease to all public elementary and secondary schools that emphasized symptom screening (i.e. for fever and rash), self-isolation at the onset of symptoms, regular disinfection of classroom surfaces and regular handwashing, especially before and after eating.

Objective: In 2022, the New South Wales TB Program was notified of genomically clustered Mycobacterium tuberculosis isolates from two smear-positive tuberculosis (TB) patients diagnosed 3 months apart. Secondary investigations found they resided in the same Sydney boarding house. The objective of this study was to investigate this cluster and conduct active case finding among contacts.

Methods: We conducted a site visit to understand transmission risk, reviewed patient histories, performed a risk assessment and conducted on-site TB contact screening, including interferon-gamma release assay testing. Long-term residents were also screened via chest X-ray. Past residents were referred to local TB services.

Results: Four residents with TB disease were identified, three of whom were genomically linked to the cluster. The exposure period in the boarding house was determined to be from January 2021 to September 2022. All residents and staff were considered contacts requiring screening. Of the 91 contacts identified, 37 (41%) completed screening, including 20 (22%) who attended the on-site clinic. Among those screened, one resident with TB disease (patient 4) and three residents and one staff member with TB infection were identified.

Discussion: This cluster highlights the role of genomic sequencing in detecting TB transmission. The first three patients were infectious for prolonged periods before diagnosis, likely facilitating transmission in communal areas. In multidwelling buildings with TB exposures, contact screening of all residents may be required when prolonged exposures are found. Strategies to increase screening completion should be further explored.

Objective: The objectives of this study were to describe the characteristics of Thailand's first reported outbreak of herpes gladiatorum in Thai-boxing gyms and to provide recommendations for reducing the risk of transmission.

Methods: Hospital reports of atypical rashes appearing among Thai-boxing trainees triggered investigations at three gyms in Phuket during May-August 2022. Semistructured questionnaires were used to collect data from gym owners, trainers and trainees. Skin and blood specimens were collected for reverse transcription-polymerase chain reaction testing for herpes simplex virus type 1 (HSV-1), antibodies to HSV-1 and other pathogens; genomic sequencing was performed on culturable samples. The environmental investigation included walk-through surveys, a review of each gym's web site, and testing of surfaces and water specimens.

Results: Nine cases of herpes gladiatorum were confirmed and one was suspected, all in non-Thai trainees. Attack rates in Gyms I, II and III were 21.4%, 11.5% and 2.6%, respectively. Risk behaviours included sparring with partners who had a rash, sharing equipment and neglecting to shower before training. HSV-1 was detected on gym equipment and surfaces, and cultures from skin lesions and blood samples revealed a genomic linkage between two cases in Gym II, identified as belonging to the East Asian Clade II strain. Disinfection of equipment reduced exposure to HSV-1.

Discussion: The first outbreak of herpes gladiatorum in Thailand was confirmed in 2022. Genomic sequencing suggested local transmission within Thailand, with the virus introduced independently into each gym. Skin-to-skin contact was likely the main mode of transmission; environmental findings indicated a lower risk of transmission via gym surfaces. Recommendations to prevent future outbreaks include stricter regulations for pre-fight screening and improved gym cleaning and hygiene among trainers and trainees.

Objective: Following the notification of two cases of typhoid fever to the Kudat District Health Office in February 2019, an investigation was conducted in a rural district in Sabah, East Malaysia, to determine the extent, characteristics and source of the outbreak.

Methods: This epidemiological study used both active and passive case detection. Environmental samples were taken from water sources, food-handling areas and waste sites, and were analysed for the presence of Salmonella enterica serotype Typhi as part of the standard protocol during an announced typhoid fever outbreak. Clinical specimens underwent culture and sensitivity testing, with samples that were positive for S. Typhi analysed using pulsed-field gel electrophoresis to determine clonal relationships.

Results: A total of 35 cases of typhoid fever were identified during 3 months. Twenty-eight cases (80.0%) occurred among Sabah's indigenous ethnic groups, and 12 of these (34.3%) occurred in people aged 7-17 years. The index case, along with six other cases, had a history of consuming smashed fried chicken from a local restaurant. Analysis revealed three clonal clusters of S. Typhi isolates, with a dominant pattern found in 18 cases, which included the index case and a food handler from the implicated restaurant. Two paediatric patients experienced a relapse after initial treatment with intravenous antibiotics.

Discussion: The source of the outbreak was most likely the infected restaurant worker who prepared chicken without wearing gloves; transmission most likely occurred through contaminated food or surfaces. Immediate steps to control the outbreak included chlorinating water wells, disinfecting waste disposal areas and promptly vaccinating all food handlers, including those working in street food settings. Recommendations for preventing future outbreaks include strengthening surveillance systems for acute gastroenteritis, conducting education campaigns to promote safe food-handling practices and implementing measures to improve vaccination coverage against typhoid fever among food handlers.