Evaluation of #potential #risk of #transmission of #avian #influenza A viruses at live #bird #markets in response to unusual #crow die-offs in #Bangladesh (Influenza Other Respir Viruses, abstract)

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

Influenza Other Respir Viruses. 2020 Jan 7. doi: 10.1111/irv.12716. [Epub ahead of print]

Evaluation of potential risk of transmission of avian influenza A viruses at live bird markets in response to unusual crow die-offs in Bangladesh.

Rahman M1,2, Mangtani P3, Uyeki TM4, Cardwell JM1, Torremorell M5, Islam A6, Samad MA7, Muraduzzaman AKM2, Giasuddin M7, Sarkar S2, Alamgir ASM2, Salimuzzaman M2, Flora MS2.

Author information: 1 Royal Veterinary College, Hatfield, UK. 2 Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh. 3 London School of Hygiene and Tropical Medicine, London, UK. 4 Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA. 5 University of Minnesota, Twin Cities, MN, USA. 6 EcoHealth Alliance, New York, NY, USA. 7 Bangladesh Livestock Research Institute (BLRI), Savar, Bangladesh.

 

Abstract

In response to unusual crow die-offs from avian influenza A(H5N1) virus infection during January-February 2017 in Dhaka, Bangladesh, a One Health team assessed potential infection risks in live bird markets (LBMs). Evidence of aerosolized avian influenza A viruses was detected in LBMs and in the respiratory tracts of market workers, indicating exposure and potential for infection. This study highlighted the importance of surveillance platforms with a coordinated One Health strategy to investigate and mitigate zoonotic risk.

© 2020 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

KEYWORDS: Bangladesh; avian influenza; avian influenza A virus; influenza in birds; live bird market; pathogen transmission

PMID: 31912608 DOI: 10.1111/irv.12716

Keywords: Avian Influenza; H5N1; Poultry; Live poultry markets; Bangladesh.

——

Detection of highly pathogenic #avian #influenza A(#H5N6) viruses in #waterfowl in #Bangladesh (Virology, abstract)

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

Virology. 2019 Aug;534:36-44. doi: 10.1016/j.virol.2019.05.011. Epub 2019 May 28.

Detection of highly pathogenic avian influenza A(H5N6) viruses in waterfowl in Bangladesh.

Yang G1, Chowdury S2, Hodges E1, Rahman MZ2, Jang Y1, Hossain ME2, Jones J1, Stark TJ1, Di H1, Cook PW1, Ghosh S2, Azziz-Baumgartner E1, Barnes JR1, Wentworth DE1, Kennedy E3, Davis CT4.

Author information: 1 Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA. 2 International Centre for Diarrhoeal Disease Research, Bangladesh. 3 Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: ftw3@cdc.gov. 4 Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: ctdavis@cdc.gov.

 

Abstract

Bangladesh has reported repeated outbreaks of highly pathogenic avian influenza (HPAI) A(H5) viruses in poultry since 2007. Because of the large number of live poultry markets (LPM) relative to the population density of poultry throughout the country, these markets can serve as sentinel sites for HPAI A(H5) detection. Through active LPM surveillance during June 2016-June 2017, HPAI A(H5N6) viruses along with 14 other subtypes of influenza A viruses were detected. The HPAI A(H5N6) viruses belonged to clade 2.3.4.4 and were likely introduced into Bangladesh around March 2016. Human infections with influenza clade 2.3.4.4 viruses in Bangladesh have not been identified, but the viruses had several molecular markers associated with potential human infection. Vigilant surveillance at the animal-human interface is essential to identify emerging avian influenza viruses with the potential to threaten public and animal health.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS: A(H5N6); Highly pathogenic avian influenza virus; Live poultry market; Orthomyxovirus; Waterfowl

PMID: 31176062 DOI: 10.1016/j.virol.2019.05.011 [Indexed for MEDLINE]

Keywords: Avian Influenza; H5N6; Poultry; Live poultry markets; Bangladesh.

——

Unbiased #Metagenomic #Sequencing for #Pediatric #Meningitis in #Bangladesh Reveals #Neuroinvasive #Chikungunya Virus #Outbreak and Other Unrealized Pathogens (MBio, abstract)

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

Unbiased Metagenomic Sequencing for Pediatric Meningitis in Bangladesh Reveals Neuroinvasive Chikungunya Virus Outbreak and Other Unrealized Pathogens

Senjuti Saha, Akshaya Ramesh, Katrina Kalantar, Roly Malaker, Md Hasanuzzaman, Lillian M. Khan, Madeline Y. Mayday, M. S. I. Sajib, Lucy M. Li, Charles Langelier, Hafizur Rahman, Emily D. Crawford, Cristina M. Tato, Maksuda Islam, Yun-Fang Juan, Charles de Bourcy, Boris Dimitrov, James Wang, Jennifer Tang, Jonathan Sheu, Rebecca Egger, Tiago Rodrigues De Carvalho, Michael R. Wilson, Samir K. Saha, Joseph L. DeRisi

Nisha Duggal, Editor

DOI: 10.1128/mBio.02877-19

 

ABSTRACT

The burden of meningitis in low-and-middle-income countries remains significant, but the infectious causes remain largely unknown, impeding institution of evidence-based treatment and prevention decisions. We conducted a validation and application study of unbiased metagenomic next-generation sequencing (mNGS) to elucidate etiologies of meningitis in Bangladesh. This RNA mNGS study was performed on cerebrospinal fluid (CSF) specimens from patients admitted in the largest pediatric hospital, a World Health Organization sentinel site, with known neurologic infections (n = 36), with idiopathic meningitis (n = 25), and with no infection (n = 30), and six environmental samples, collected between 2012 and 2018. We used the IDseq bioinformatics pipeline and machine learning to identify potentially pathogenic microbes, which we then confirmed orthogonally and followed up through phone/home visits. In samples with known etiology and without infections, there was 83% concordance between mNGS and conventional testing. In idiopathic cases, mNGS identified a potential bacterial or viral etiology in 40%. There were three instances of neuroinvasive Chikungunya virus (CHIKV), whose genomes were >99% identical to each other and to a Bangladeshi strain only previously recognized to cause febrile illness in 2017. CHIKV-specific qPCR of all remaining stored CSF samples from children who presented with idiopathic meningitis in 2017 (n = 472) revealed 17 additional CHIKV meningitis cases, exposing an unrecognized meningitis outbreak. Orthogonal molecular confirmation, case-based clinical data, and patient follow-up substantiated the findings. Case-control CSF mNGS surveys can complement conventional diagnostic methods to identify etiologies of meningitis, conduct surveillance, and predict outbreaks. The improved patient- and population-level data can inform evidence-based policy decisions.

 

IMPORTANCE

Globally, there are an estimated 10.6 million cases of meningitis and 288,000 deaths every year, with the vast majority occurring in low- and middle-income countries. In addition, many survivors suffer from long-term neurological sequelae. Most laboratories assay only for common bacterial etiologies using culture and directed PCR, and the majority of meningitis cases lack microbiological diagnoses, impeding institution of evidence-based treatment and prevention strategies. We report here the results of a validation and application study of using unbiased metagenomic sequencing to determine etiologies of idiopathic (of unknown cause) cases. This included CSF from patients with known neurologic infections, with idiopathic meningitis, and without infection admitted in the largest children’s hospital of Bangladesh and environmental samples. Using mNGS and machine learning, we identified and confirmed an etiology (viral or bacterial) in 40% of idiopathic cases. We detected three instances of Chikungunya virus (CHIKV) that were >99% identical to each other and to a strain previously recognized to cause systemic illness only in 2017. CHIKV qPCR of all remaining stored 472 CSF samples from children who presented with idiopathic meningitis in 2017 at the same hospital uncovered an unrecognized CHIKV meningitis outbreak. CSF mNGS can complement conventional diagnostic methods to identify etiologies of meningitis, and the improved patient- and population-level data can inform better policy decisions.

Keywords: Chikungunya fever; Meningitis; Pediatrics; Bangladesh; Neuroinvasion.

—–

#Evolution and #Global #Transmission of a #MDR, CA #MRSA #Lineage from the #Indian Subcontinent (MBio, abstract)

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

Evolution and Global Transmission of a Multidrug-Resistant, Community-Associated Methicillin-Resistant Staphylococcus aureus Lineage from the Indian Subcontinent

Eike J. Steinig, Sebastian Duchene, D. Ashley Robinson, Stefan Monecke, Maho Yokoyama, Maisem Laabei, Peter Slickers, Patiyan Andersson, Deborah Williamson, Angela Kearns, Richard V. Goering, Elizabeth Dickson, Ralf Ehricht, Margaret Ip, Matthew V. N. O’Sullivan, Geoffrey W. Coombs, Andreas Petersen, Grainne Brennan, Anna C. Shore, David C. Coleman, Annalisa Pantosti, Herminia de Lencastre, Henrik Westh, Nobumichi Kobayashi, Helen Heffernan, Birgit Strommenger, Franziska Layer, Stefan Weber, Hege Vangstein Aamot, Leila Skakni, Sharon J. Peacock, Derek Sarovich, Simon Harris, Julian Parkhill, Ruth C. Massey, Mathew T. G. Holden, Stephen D. Bentley, Steven Y. C. Tong

Paul J. Planet, Invited Editor, Victor J. Torres, Editor

DOI: 10.1128/mBio.01105-19

 

ABSTRACT

The evolution and global transmission of antimicrobial resistance have been well documented for Gram-negative bacteria and health care-associated epidemic pathogens, often emerging from regions with heavy antimicrobial use. However, the degree to which similar processes occur with Gram-positive bacteria in the community setting is less well understood. In this study, we traced the recent origins and global spread of a multidrug-resistant, community-associated Staphylococcus aureus lineage from the Indian subcontinent, the Bengal Bay clone (ST772). We generated whole-genome sequence data of 340 isolates from 14 countries, including the first isolates from Bangladesh and India, to reconstruct the evolutionary history and genomic epidemiology of the lineage. Our data show that the clone emerged on the Indian subcontinent in the early 1960s and disseminated rapidly in the 1990s. Short-term outbreaks in community and health care settings occurred following intercontinental transmission, typically associated with travel and family contacts on the subcontinent, but ongoing endemic transmission was uncommon. Acquisition of a multidrug resistance integrated plasmid was instrumental in the emergence of a single dominant and globally disseminated clade in the early 1990s. Phenotypic data on biofilm, growth, and toxicity point to antimicrobial resistance as the driving force in the evolution of ST772. The Bengal Bay clone therefore combines the multidrug resistance of traditional health care-associated clones with the epidemiological transmission of community-associated methicillin-resistant S. aureus (MRSA). Our study demonstrates the importance of whole-genome sequencing for tracking the evolution of emerging and resistant pathogens. It provides a critical framework for ongoing surveillance of the clone on the Indian subcontinent and elsewhere.

 

IMPORTANCE

The Bengal Bay clone (ST772) is a community-associated and multidrug-resistant Staphylococcus aureus lineage first isolated from Bangladesh and India in 2004. In this study, we showed that the Bengal Bay clone emerged from a virulent progenitor circulating on the Indian subcontinent. Its subsequent global transmission was associated with travel or family contact in the region. ST772 progressively acquired specific resistance elements at limited cost to its fitness and continues to be exported globally, resulting in small-scale community and health care outbreaks. The Bengal Bay clone therefore combines the virulence potential and epidemiology of community-associated clones with the multidrug resistance of health care-associated S. aureus lineages. This study demonstrates the importance of whole-genome sequencing for the surveillance of highly antibiotic-resistant pathogens, which may emerge in the community setting of regions with poor antibiotic stewardship and rapidly spread into hospitals and communities across the world.

Keywords: Antibiotics; Drugs Resistance; Staphylococcus aureus; MRSA; CA-MRSA; India; Bangladesh.

——

Safety and immunogenicity of the #oral, inactivated, enterotoxigenic #Escherichia coli #vaccine #ETVAX in #Bangladeshi #children and #infants:… (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Safety and immunogenicity of the oral, inactivated, enterotoxigenic Escherichia coli vaccine ETVAX in Bangladeshi children and infants: a double-blind, randomised, placebo-controlled phase 1/2 trial

Firdausi Qadri, PhD, Marjahan Akhtar, PhD, Taufiqur R Bhuiyan, PhD, Mohiul I Chowdhury, MD, Tasnuva Ahmed, MSc, Tanzeem A Rafique, MSc, Arifuzzaman Khan, MBBS, Sadia I A Rahman, MSc, Farhana Khanam, MPhil, Anna Lundgren, PhD, Gudrun Wiklund, BSc, Joanna Kaim, MSc, Madeleine Löfstrand, BSc, Nils Carlin, PhD, A Louis Bourgeois, PhD, Nicole Maier, PhD, Alan Fix, PhD, Thomas Wierzba, PhD, Richard I Walker, PhD, Prof Ann-Mari Svennerholm, MD

Open Access / Published: November 19, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30571-7

 

Summary

Background

Enterotoxigenic Escherichia coli causes diarrhoea, leading to substantial mortality and morbidity in children, but no specific vaccine exists. This trial tested an oral, inactivated, enterotoxigenic E coli vaccine (ETVAX), which has been previously shown to be safe and highly immuongenic in Swedish and Bangladeshi adults. We tested the safety and immunogenicity of ETVAX, consisting of four E coli strains overexpressing the most prevalent colonisation factors (CFA/I, CS3, CS5, and CS6) and a toxoid (LCTBA) administered with or without a double-mutant heat-labile enterotoxin (dmLT) as an adjuvant, in Bangladeshi children.

Methods

We did a randomised, double-blind, placebo-controlled, dose-escalation, age-descending, phase 1/2 trial in Dhaka, Bangladesh. Healthy children in one of three age groups (24–59 months, 12–23 months, and 6–11 months) were eligible. Children were randomly assigned with block randomisation to receive either ETVAX, with or without dmLT, or placebo. ETVAX (half [5·5 × 1010 cells], quarter [2·5 × 1010 cells], or eighth [1·25 × 1010 cells] adult dose), with or without dmLT adjuvant (2·5 μg, 5·0 μg, or 10·0 μg), or placebo were administered orally in two doses 2 weeks apart. Investigators and participants were masked to treatment allocation. The primary endpoint was safety and tolerability, assessed in all children who received at least one dose of vaccine. Antibody responses to vaccine antigens, defined as at least a two-times increase in antibody levels between baseline and post-immunisation, were assessed as secondary endpoints. This trial is registered with ClinicalTrials.gov, NCT02531802.

Findings

Between Dec 7, 2015, and Jan 10, 2017, we screened 1500 children across the three age groups, of whom 430 were enrolled and randomly assigned to the different treatment groups (130 aged 24–59 months, 100 aged 12–23 months, and 200 aged 6–11 months). All participants received at least one dose of vaccine. No solicited adverse events occurred that were greater than moderate in severity, and most were mild. The most common solicited event was vomiting (ten [8%] of 130 patients aged 24–59 months, 13 [13%] of 100 aged 12–23 months, and 29 [15%] of 200 aged 6–11 months; mostly of mild severity), which appeared related to dose and age. The addition of dmLT did not modify the safety profile. Three serious adverse events occurred but they were not considered related to the study drug. Mucosal IgA antibody responses in lymphocyte secretions were detected against all primary vaccine antigens (CFA/I, CS3, CS5, CS6, and the LCTBA toxoid) in most participants in the two older age groups, whereas such responses to four of the five antigens were less frequent and of lower magnitude in infants aged 6–11 months than in older children. Faecal secretory IgA immune responses were recorded against all vaccine antigens in infants aged 6–11 months. 78 (56%) of 139 infants aged 6–11 months who were vaccinated developed mucosal responses against at least three of the vaccine antigens versus 14 (29%) of 49 of the infants given placebo. Addition of the adjuvant dmLT enhanced the magnitude, breadth, and kinetics (based on number of responders after the first dose of vaccine) of immune responses in infants.

Interpretation

The encouraging safety and immunogenicity of ETVAX and benefit of dmLT adjuvant in young children support its further assessment for protective efficacy in children in enterotoxigenic E coli-endemic areas.

Funding

PATH (Bill & Melinda Gates Foundation and the UK’s Department for International Development), the Swedish Research Council, and The Swedish Foundation for Strategic Research.

Keywords: E. Coli; Vaccines; Bangladesh; Pediatrics.

——

#Contamination of #hospital #surfaces with #respiratory #pathogens in #Bangladesh (PLOS One, abstract)

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

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Contamination of hospital surfaces with respiratory pathogens in Bangladesh

Md. Zakiul Hassan , Katharine Sturm-Ramirez, Mohammad Ziaur Rahman, Kamal Hossain, Mohammad Abdul Aleem, Mejbah Uddin Bhuiyan, Md. Muzahidul Islam, Mahmudur Rahman, Emily S. Gurley

___

Published: October 28, 2019 / DOI: https://doi.org/10.1371/journal.pone.0224065

 

Abstract

With limited infection control practices in overcrowded Bangladeshi hospitals, surfaces may play an important role in the transmission of respiratory pathogens in hospital wards and pose a serious risk of infection for patients, health care workers, caregivers and visitors. In this study, we aimed to identify if surfaces near hospitalized patients with respiratory infections were contaminated with respiratory pathogens and to identify which surfaces were most commonly contaminated. Between September-November 2013, we collected respiratory (nasopharyngeal and oropharyngeal) swabs from patients hospitalized with respiratory illness in adult medicine and paediatric medicine wards at two public tertiary care hospitals in Bangladesh. We collected surface swabs from up to five surfaces near each case-patient including: the wall, bed rail, bed sheet, clinical file, and multipurpose towel used for care giving purposes. We tested swabs using real-time multiplex PCR for 19 viral and 12 bacterial pathogens. Case-patients with at least one pathogen detected had corresponding surface swabs tested for those same pathogens. Of 104 patients tested, 79 had a laboratory-confirmed respiratory pathogen. Of the 287 swabs collected from surfaces near these patients, 133 (46%) had evidence of contamination with at least one pathogen. The most commonly contaminated surfaces were the bed sheet and the towel. Sixty-two percent of patients with a laboratory-confirmed respiratory pathgen (49/79) had detectable viral or bacterial nucleic acid on at least one surface. Klebsiella pneumoniae was the most frequently detected pathogen on both respiratory swabs (32%, 33/104) and on surfaces near patients positive for this organism (97%, 32/33). Surfaces near patients hospitalized with respiratory infections were frequently contaminated by pathogens, with Klebsiella pneumoniae being most common, highlighting the potential for transmission of respiratory pathogens via surfaces. Efforts to introduce routine cleaning in wards may be a feasible strategy to improve infection control, given that severe space constraints prohibit cohorting patients with respiratory illness.

___

Citation: Hassan MZ, Sturm-Ramirez K, Rahman MZ, Hossain K, Aleem MA, Bhuiyan MU, et al. (2019) Contamination of hospital surfaces with respiratory pathogens in Bangladesh. PLoS ONE 14(10): e0224065. https://doi.org/10.1371/journal.pone.0224065

Editor: Sarah Tschudin-Sutter, University Hospital Basel, SWITZERLAND

Received: February 11, 2019; Accepted: October 4, 2019; Published: October 28, 2019

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

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

Funding: Emily S Gurley received the funding award. The Grant No. is GR-00720 (cooperative agreement number 5U01CI000628). The study was funded by the Centers for Disease Control and Prevention (CDC), Atlanta (https://www.cdc.gov/). US CDC provided technical support in the study design, data collection and analysis and preparation of the manuscript

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

Keywords: Infectious diseases; Nosocomial outbreaks; Klebsiella pneumoniae; Bangladesh.

—–

Where #backyard #poultry raisers seek care for sick poultry: implications for #avian #influenza #prevention in #Bangladesh (BMC Public Health, abstract)

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

BMC Public Health. 2018 Aug 3;18(1):969. doi: 10.1186/s12889-018-5819-5.

Where backyard poultry raisers seek care for sick poultry: implications for avian influenza prevention in Bangladesh.

Rimi NA1, Sultana R2,3, Ishtiak-Ahmed K2,4, Haider N2,5, Azziz-Baumgartner E6, Nahar N2, Luby SP2,6,7.

Author information: 1 Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr, b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. nadiarimi@icddrb.org. 2 Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr, b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. 3 Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 4 University of Copenhagen, Copenhagen, Denmark. 5 Technical University of Denmark, Copenhagen, Denmark. 6 Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. 7 Stanford University, Stanford, California, USA.

 

Abstract

BACKGROUND:

In Bangladesh, backyard poultry raisers lack awareness of avian influenza and infrequently follow government recommendations for its prevention. Identifying where poultry raisers seek care for their ill poultry might help the government better plan how to disseminate avian influenza prevention and control recommendations.

METHODS:

In order to identify where backyard poultry raisers seek care for their ill poultry, we conducted in-depth and informal interviews: 70 with backyard poultry raisers and six with local poultry healthcare providers in two villages, and five with government veterinary professionals at the sub-district and union levels in two districts during June-August 2009.

RESULTS:

Most (86% [60/70]) raisers sought care for their backyard poultry locally, 14% used home remedies only and none sought care from government veterinary professionals. The local poultry care providers provided advice and medications (n = 6). Four local care providers had shops in the village market where raisers sought healthcare for their poultry and the remaining two visited rural households to provide poultry healthcare services. Five of the six local care providers did not have formal training in veterinary medicine. Local care providers either did not know about avian influenza or considered avian influenza to be a disease common among commercial but not backyard poultry. The government professionals had degrees in veterinary medicine and experience with avian influenza and its prevention. They had their offices at the sub-district or union level and lacked staffing to reach the backyard raisers at the village level.

CONCLUSIONS:

The local poultry care providers provided front line healthcare to backyard poultry in villages and were a potential source of information for the rural raisers. Integration of these local poultry care providers in the government’s avian influenza control programs is a potentially useful approach to increase poultry raisers’ and local poultry care providers’ awareness about avian influenza.

KEYWORDS: Avian influenza; Backyard poultry raiser; Bangladesh; Informal care provider, poultry care provider, poultry disease; Perception

PMID: 30075714 PMCID: PMC6090748 DOI: 10.1186/s12889-018-5819-5 [Indexed for MEDLINE] Free PMC Article

Keywords: Avian Influenza; Poultry; Human; Public Health; Bangladesh.

——