A Two-Year #Review on #Epidemiology and #Clinical Characteristics of #Dengue #Deaths in #Malaysia, 2013-2014 (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

Open Access /  Peer-reviewed / Research Article

A Two-Year Review on Epidemiology and Clinical Characteristics of Dengue Deaths in Malaysia, 2013-2014

Yuan Liang Woon , Chee Peng Hor, Narwani Hussin, Ariza Zakaria, Pik Pin Goh, Wee Kooi Cheah

PLOS / Published: May 20, 2016 / http://dx.doi.org/10.1371/journal.pntd.0004575




Dengue infection is the fastest spreading mosquito-borne viral disease, which affects people living in the tropical and subtropical countries. Malaysia had large dengue outbreaks in recent years. We aimed to study the demographics and clinical characteristics associated with dengue deaths in Malaysia.


We conducted a retrospective review on all dengue deaths that occurred nationwide between 1st January 2013 and 31st December 2014. Relevant data were extracted from mortality review reports and investigational forms. These cases were categorized into children (<15 years), adults (15–59 years) and elderly (≥60 years) to compare their clinical characteristics.


A total of 322 dengue deaths were reviewed. Their mean age was 40.7±19.30 years, half were females and 72.5% were adults. The median durations of first medical contact, and hospitalization were 1 and 3 days, respectively. Diabetes and hypertension were common co-morbidities among adults and elderly. The most common warning signs reported were lethargy and vomiting, with lethargy (p = 0.038) being more common in children, while abdominal pain was observed more often in the adults (p = 0.040). But 22.4% did not have any warning signs. Only 34% were suspected of dengue illness at their initial presentation. More adults developed severe plasma leakage (p = 0.018). More than half (54%) suffered from multi-organ involvement, and 20.2% were free from any organ involvement. Dengue deaths occurred at the median of 3 days post-admission. Dengue shock syndrome (DSS) contributed to more than 70% of dengue deaths, followed by severe organ involvement (69%) and severe bleeding (29.7%).


In Malaysia, dengue deaths occurred primarily in adult patients. DSS was the leading cause of death, regardless of age groups. The atypical presentation and dynamic progression of severe dengue in this cohort prompts early recognition and aggressive intervention to prevent deaths.

Trial Registration

National Medical Research Registry (NMRR, NMRR-14-1374-23352)


Author Summary

Dengue infection, especially severe dengue, affected more of adults from working age groups in the society. They can present with non-specific symptoms mimicking many other febrile illnesses, or severe symptoms suggestive of sepsis, with low suspicion of dengue. The clinical progression in severe dengue can be dynamic and sometimes unanticipated, whereby patients can deteriorate rapidly in a short period of time and succumb to death. Although children tend to have central nervous system involvement, where they presented with confusion and/ or seizure, and more elderly had heart involvement, the primary cause of dengue death, dengue shock syndrome, did not differ across different age groups.


Citation: Woon YL, Hor CP, Hussin N, Zakaria A, Goh PP, Cheah WK (2016) A Two-Year Review on Epidemiology and Clinical Characteristics of Dengue Deaths in Malaysia, 2013-2014. PLoS Negl Trop Dis 10(5): e0004575. doi:10.1371/journal.pntd.0004575

Editor: Duane J. Gubler, Duke-NUS Graduate Medical School, SINGAPORE

Received: November 2, 2015; Accepted: March 3, 2016; Published: May 20, 2016

Copyright: © 2016 Woon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Research; Abstracts; Dengue Fever; Malaysia.


#MERS-interpreted: #human #herpesvirus 6B #pneumonia (SD, cit.)

[Source: Science Direct, full page: (LINK). Citation, edited.]

The American Journal of Medicine / Available online 20 May 2016 / In Press, Accepted Manuscript / Diagnostic Dilemma

MERS-interpreted: human herpesvirus 6B pneumonia

Susanna K.P. Lau, MDa, b, c, d, Jasper F.W. Chan, FRCPatha, b, c, d, Ivan F.N. Hung, MDe, Vincent C.C. Cheng, MDa, b, c, d, Siddharth Sridhar, FRCPatha, Cyril C.Y. Yip, PhDa, Kwok-Hung Chan, PhDa, Patrick C.Y. Woo, MDa, b, c, d

a Department of Microbiology, The University of Hong Kong, Hong Kong, China; b State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China; c Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China; d Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China; e Department of Medicine, The University of Hong Kong, Hong Kong, China

Received 22 February 2016, Revised 29 April 2016, Accepted 29 April 2016, Available online 20 May 2016


Keywords: human herpesvirus 6B; HHV-6B;  pneumonia;  MERS

Keywords: Research; MERS; Pneumonia; HHV6.



#Disruption of #human astn2 #function by #ZIKV ns4b gene as a molecular basis for #Zika viral #microcephaly (BioRxIV, abstract)

[Source: BioRxIV, full page: (LINK). Abstract, edited.]

New Results

Disruption of human astn2 function by ZIKV ns4b gene as a molecular basis for Zika viral microcephaly

Bhaskar Ganguly, Enakshi Ganguly

doi: http://dx.doi.org/10.1101/054486  / This article is a preprint and has not been peer-reviewed.



The present Zika virus (ZIKV) pandemic is being associated with increased incidence of microcephaly in newborns. However, a molecular basis for such pathogenesis is distinctly lacking. Comparative nucleic acid sequence analysis showed similarity between regions of non-structural protein 4B (ns4b) gene of ZIKV and human astrotactin2 (astn2) gene. Based on these findings, a molecular target of Zika viral microcephaly is being proposed.

Keywords: Research; Abstracts; Zika Virus; Microcephaly.


A Cost-Effectiveness #Tool for #Informing #Policies on #Zika Virus #Control (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

Open Access /  Peer-reviewed / Research Article

A Cost-Effectiveness Tool for Informing Policies on Zika Virus Control

Jorge A. Alfaro-Murillo , Alyssa S. Parpia , Meagan C. Fitzpatrick , Jules A. Tamagnan, Jan Medlock, Martial L. Ndeffo-Mbah, Durland Fish, María L. Ávila-Agüero, Rodrigo Marín, Albert I. Ko, Alison P. Galvani

PLOS / Published: May 20, 2016 / http://dx.doi.org/10.1371/journal.pntd.0004743




As Zika virus continues to spread, decisions regarding resource allocations to control the outbreak underscore the need for a tool to weigh policies according to their cost and the health burden they could avert. For example, to combat the current Zika outbreak the US President requested the allocation of $1.8 billion from Congress in February 2016.

Methodology/Principal Findings

Illustrated through an interactive tool, we evaluated how the number of Zika cases averted, the period during pregnancy in which Zika infection poses a risk of microcephaly, and probabilities of microcephaly and Guillain-Barré Syndrome (GBS) impact the cost at which an intervention is cost-effective. From Northeast Brazilian microcephaly incidence data, we estimated the probability of microcephaly in infants born to Zika-infected women (0.49% to 2.10%). We also estimated the probability of GBS arising from Zika infections in Brazil (0.02% to 0.06%) and Colombia (0.08%). We calculated that each microcephaly and GBS case incurs the loss of 29.95 DALYs and 1.25 DALYs per case, as well as direct medical costs for Latin America and the Caribbean of $91,102 and $28,818, respectively. We demonstrated the utility of our cost-effectiveness tool with examples evaluating funding commitments by Costa Rica and Brazil, the US presidential proposal, and the novel approach of genetically modified mosquitoes. Our analyses indicate that the commitments and the proposal are likely to be cost-effective, whereas the cost-effectiveness of genetically modified mosquitoes depends on the country of implementation.


Current estimates from our tool suggest that the health burden from microcephaly and GBS warrants substantial expenditures focused on Zika virus control. Our results justify the funding committed in Costa Rica and Brazil and many aspects of the budget outlined in the US president’s proposal. As data continue to be collected, new parameter estimates can be customized in real-time within our user-friendly tool to provide updated estimates on cost-effectiveness of interventions and inform policy decisions in country-specific settings.


Author Summary

Using data on Zika virus, microcephaly, and Guillain-Barré syndrome cases from Brazil and Colombia, we compute ranges for the probability of a microcephaly outcome in infants born to Zika-infected women (0.49% to 2.10%, based on data from Northeast Brazil) and the probability of Guillain-Barré syndrome in Zika-infected individuals (0.02% to 0.06% in Brazil and 0.08% in Colombia). These results have allowed us to create a web-based cost-effectiveness tool that quantifies the relationship between the cost of an intervention and the number of Zika virus cases, as well as loss of disability-adjusted life years, that it can avert. Our tool thus identifies the threshold at which a given intervention, such as vector control, may be deemed cost-effective or very cost-effective in a variety of settings according to WHO criteria, in terms of the Zika burden that could be averted and the cost of such an intervention.


Citation: Alfaro-Murillo JA, Parpia AS, Fitzpatrick MC, Tamagnan JA, Medlock J, Ndeffo-Mbah ML, et al. (2016) A Cost-Effectiveness Tool for Informing Policies on Zika Virus Control. PLoS Negl Trop Dis 10(5): e0004743. doi:10.1371/journal.pntd.0004743

Editor: Hélène Carabin, University of Oklahoma Health Sciences Center, UNITED STATES

Received: February 25, 2016; Accepted: May 5, 2016; Published: May 20, 2016

Copyright: © 2016 Alfaro-Murillo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data are publicly available on World Health Organization (http://www.who.int/emergencies/zika-virus/situation-report/en/), Colombian Ministry of Health (http://www.ins.gov.co/Noticias/ZIKA/Forms/AllItems.aspx), and Brazilian Ministry of Health (http://combateaedes.saude.gov.br/situacao-epidemiologica) websites.

Funding: This research was supported by the National Institutes of Health (NIH U01 GM087719 and U01 GM105627). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Research; Abstracts; Zika Virus; Microcephaly; GBS.



[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Arerugi. 2016;65(3):200-5. doi: 10.15036/arerugi.65.200.


Morikawa M1, Kanemitsu Y, Tsukamoto H, Morikawa A, Tomioka Y.

Author information: 1Morikawa Pediatrics & Allergy Clinic.



The patient was a 6-year-old female with milk allergy and persistent asthma. She experienced anaphylactic reactions just after the inhalation of Inavir(®) (Laninamivir Octanoate Hydrate) to treat flu infection. A skin-prick test showed positive reactions for Inavir(®) inhaler powder and lactose used as an excipient but negative for Laninamivir. Same results were obtained in a drug-stimulated basophil activation test. The lactose excipient in Inavir(®) inhaler powder was supposed to contain milk proteins, which caused anaphylactic reactions. To test this possibility, we examined the contamination of allergic milk proteins in the lactose excipient and found the smear band by silver staining, which was identified as β-lactoglobulin (β-LG) by Western blotting using specific monoclonal antibody and patient’s sera. The β-LG in Inavir(®) was supposed to be glycosylated with lactose because the molecular weight was slightly higher than β-LG standard reference as seen in mobility. In fact, the incubation with lactose in vitro tended to increase molecular weight. Following these results, we herein report that the trace amounts of β-LG contaminated in the lactose excipient of Inavir(®) could cause immediate allergic reactions. The risk that the lactose-containing dry powder inhalers cause allergic reactions for patients with cow’s milk allergy need to be reminded. In particular, the use for flu patients should be paid careful attention because of increased airway hypersensitivity in those patients.

PMID: 27193929 [PubMed – in process]

Keywords: Research; Abstracts; Laninamivir; Drugs Safety.


Estimated #Zika virus #importations to #Europe by #travellers from #Brazil (Glob Health Action, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Glob Health Action. 2016 May 17;9:31669. doi: 10.3402/gha.v9.31669. eCollection 2016.

Estimated Zika virus importations to Europe by travellers from Brazil.

Massad E1,2, Tan SH3, Khan K4, Wilder-Smith A5,6,7.

Author information: 1Department of Medicine, University of Sao Paolo, Sao Paolo, Brazil. 2London School of Hygiene and Tropical Medicine, London, UK. 3School of Computer Engineering, Nanyang Technological University, Singapore. 4Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada. 5Institute of Public Health, University of Heidelberg, Germany. 6Department Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 85 Umeå, Sweden. 7Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; anneliesws@gmail.com.




Given the interconnectivity of Brazil with the rest of the world, Zika virus (ZIKV) infections have the potential to spread rapidly around the world via viremic travellers. The extent of spread depends on the travel volume and the endemicity in the exporting country. In the absence of reliable surveillance data, we did mathematical modelling to estimate the number of importations of ZIKV from Brazil into Europe.


We applied a previously developed mathematical model on importations of dengue to estimate the number of ZIKV importations into Europe, based on the travel volume, the probability of being infected at the time of travel, the population size of Brazil, and the estimated incidence of ZIKV infections.


Our model estimated between 508 and 1,778 imported infections into Europe in 2016, of which we would expect between 116 and 355 symptomatic Zika infections; with the highest number of importations being into France, Portugal and Italy.


Our model identified high-risk countries in Europe. Such data can assist policymakers and public health professionals in estimating the extent of importations in order to prepare for the scale up of laboratory diagnostic assays and estimate the occurrence of Guillain-Barré Syndrome, potential sexual transmission, and infants with congenital ZIKV syndrome.

KEYWORDS: Brazil; Europe; Zika virus; importations; travel

PMID: 27193266 [PubMed – in process]

Keywords: Research; Abstracts; Zika Virus; European Region.


#Model-based #projections of #Zika virus #infections in #childbearing #women in the #Americas (BioRxIV, abstract)

[Source: BioRxIV, full page: (LINK). Abstract, edited.]

New Results

Model-based projections of Zika virus infections in childbearing women in the Americas

Alex Perkins, Amir Siraj, Corrine Warren Ruktanonchai, Moritz Kraemer, Andrew Tatem

doi: http://dx.doi.org/10.1101/039610  / This article is a preprint and has not been peer-reviewed.



Zika virus is a mosquito-borne pathogen that is rapidly spreading across the Americas. Due to associations between Zika virus infection and a range of fetal maladies, the epidemic trajectory of this viral infection poses a significant concern for the nearly 15 million children born in the Americas each year. Ascertaining the portion of this population that is truly at risk is an important priority. One recent estimate suggested that 5.42 million childbearing women live in areas of the Americas that are suitable for Zika occurrence. To improve on that estimate, which did not take into account the protective effects of herd immunity, we developed a new approach that combines classic results from epidemiological theory with seroprevalence data and highly spatially resolved data about drivers of transmission to make location-specific projections of epidemic attack rates. Our results suggest that 1.65 (1.45-2.06) million childbearing women and 93.4 (81.6-117.1) million people in total could become infected before the first wave of the epidemic concludes. Based on current estimates of rates of adverse fetal outcomes among infected women, these results suggest that tens of thousands of pregnancies could be negatively impacted by the first wave of the epidemic. These projections constitute a revised upper limit of populations at risk in the current Zika epidemic, and our approach offers a new way to make rapid assessments of the threat posed by emerging infectious diseases more generally.

Copyright: The copyright holder for this preprint is the author/funder. It is made available under a CC-BY-NC-ND 4.0 International license.

Keywords: Research; Abstracts; Zika Virus; Pregnancy.