Western Pacific Surveillance and Response最新文献

Many countries record high rates of fireworks-related injuries, especially during national celebrations. In the Philippines, increases in the number of injuries reported around the New Year period in recent years have highlighted the importance of continued strengthening of national fireworks-related injury surveillance. The Philippines' regional epidemiology and surveillance units play a significant role in surveillance by linking its key stakeholders, the sentinel hospitals and the Department of Health's Central Office. More specifically, these units promote compliance with reporting standards among sentinel hospitals and support case data validation. Approximately half of the sentinel hospitals that contribute data to the surveillance system are in the nation's capital, Metro Manila. This concentrated coverage prompted the Regional Epidemiology and Surveillance Unit staff in Metro Manila to implement low-cost, digital strategies to improve the quality and timeliness of fireworks-related injury reporting. During the 2023-2024 surveillance period (21 December to 5 January), the use of virtual coordination spaces and data dashboards contributed to reducing turnaround times for generating surveillance reports from 31 minutes to 8 minutes. Moreover, at least 80% of sentinel hospitals provided timely reports on 11 of the 16 days of the surveillance period. Staff commitment was a major contributing factor in overcoming the time and human resource constraints encountered during implementation of these strategies. However, it is important to recognize that beyond these digital innovations, policy reforms that increase funding are needed to enhance fireworks-related injury surveillance and secure its long-term sustainability and scalability in the Philippines.

Objective: To determine the causative agent, clinical manifestations and risk factors for infection during a September 2023 outbreak of acute haemorrhagic conjunctivitis (AHC) in Pak Touch village, Ratanakiri province, Cambodia.

Methods: A retrospective case-control study was conducted. Cases were age-matched to controls (1:1), who were randomly selected from the village population. Twenty-one conjunctival samples were analysed using real-time reverse transcription-polymerase chain reaction (RT-PCR). RNA sequencing was additionally performed to identify the causative agent of the outbreak. Logistic regression models were used to identify significant risk factors.

Results: A total of 73 cases and 73 controls were included in the analysis. Cases had a median age of 20 years (range: 1-70, mean and standard deviation: 27.7 ± 20.0), and 46.6% (34/73) were male. The overall attack rate was 12.3% (73 cases/594 residents). Clinical presentations included conjunctival hyperaemia (100%), subconjunctival haemorrhage (82.2%, 60), pain and discharge (64.4%, 47 each), eyelid swelling (57.5%, 42) and tearing (54.8%, 40). RT-PCR identified enterovirus in 52.4% (11/21) of conjunctival swabs, with RNA sequencing confirming the coxsackievirus A24 variant as the causative agent in five swabs. Statistical analysis identified significant risk factors, including physical contact with patients with acute haemorrhagic conjunctivitis (adjusted odds ratio [aOR]: 4.42, 95% confidence interval [CI]: 1.90-10.10), frequent eye rubbing (aOR: 4.56, 95% CI: 2.00-10.37) and poor hand hygiene (aOR: 3.70, 95% CI: 1.64-8.43).

Discussion: The outbreak of acute haemorrhagic conjunctivitis in Pak Touch village was primarily caused by coxsackievirus A24. Significant risk factors included physical contact with infected individuals, frequent eye rubbing and poor hand hygiene. Effective hygiene measures are crucial to prevent the spread of AHC.

Objective: This study aimed to demonstrate the benefits of using SaTScan (Boston, MA, USA), a cluster-detection software programme, and whole genome sequencing to investigate a suspected outbreak of Serratia marcescens infections in a tertiary government hospital in the southern Philippines. The hospital is part of the national Antimicrobial Resistance Surveillance Program's network of sentinel sites.

Methods: The investigation followed national outbreak investigation protocols. In May 2022, when evaluation of daily hospital laboratory census data revealed an increase in the number of Serratia species in the hospital, an alert was triggered. A concurrent, routine SaTScan analysis of the hospital's surveillance data by the Antimicrobial Resistance Surveillance Reference Laboratory confirmed a cluster of cases. The Reference Laboratory requested isolates from clinical specimens from the hospital for confirmation of bacterial identification, antimicrobial susceptibility testing and whole genome sequencing.

Results: Six isolates were submitted for genomic analysis, two of which were from the identified cluster. Although originally identified as S. marcescens, five of the isolates were subsequently confirmed as S. sarumanii. Phylogenetic analysis showed that the two isolates from the cluster were closely related and belonged to the same clade, which may suggest a common source. Three antimicrobial resistance genes were identified, but their phenotypic expression was limited, with one isolate exhibiting resistance mechanisms.

Discussion: This study highlighted the utility of SaTScan for the early detection of potential disease outbreaks. The use of whole genome sequencing enhanced the investigation by enabling the analysis of potential transmission pathways at the genetic level, identification of the outbreak source and the detection of novel species.

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.