Detection of Mycobacterium tuberculosis Complex Using the Xpert MTB/RIF Ultra Assay on the Stool of Pediatric Patients in Dushanbe, Tajikistan.

We report the findings of a prospective laboratory diagnostic accuracy study to evaluate the sensitivity, specificity, and predictive values of the Xpert MTB/RIF Ultra assay for Mycobacterium tuberculosis detection in fresh stool specimens from children under 15 years of age with confirmed tuberculosis (TB) disease from Dushanbe, Tajikistan. Six hundred eighty-eight (688) participants were enrolled from April 2019 to October 2021. We identified 16 participants (2.3%) with confirmed TB disease, defined as ≥1 TB sign/symptom plus microbiologic confirmation. With the Xpert MTB/RIF Ultra assay for stool, we found a sensitivity of 68.8% (95% CI, 46.0 to 91.5) and a specificity of 98.7% (95% CI, 97.8 to 99.5) in confirmed TB disease. Our results are comparable to other published studies; however, our cohort was larger and our confirmed TB disease rate lower than most. We also demonstrated that this assay was feasible to implement in a centralized hospital laboratory in a low-middle-income Central Asian country. However, we encountered obstacles such as lack of staffing, material ruptures, outdated government protocols, and decreased case presentation due to COVID-19. We found eight patients whose only positive test was an Xpert Ultra stool assay. None needed treatment during the study; however, three were treated later, suggesting such cases require close observation. Our report is the first from Central Asia and one of a few from a low-middle-income country. We believe our study demonstrates the generalizability of the Xpert MTB/RIF Ultra assay on fresh stool specimens from children and provides further evidence supporting WHO's approval of this diagnostic strategy. IMPORTANCE The importance of this report is that it provides further support for WHO's recent recommendation that fresh stool is an acceptable sample for GeneXpert TB testing in children, especially small children who often cannot produce an adequate sputum sample. Diagnosing TB in this age group is difficult, and many cases are missed, leading to unacceptable rates of TB illness and death. In our large cohort of children from Dushanbe, Tajikistan, the GeneXpert stool test was positive in 69% of proven cases of TB, and there were very few false-positive tests. We also showed that this diagnostic strategy was feasible to implement in a low-middle-income country with an inefficient health care delivery system. We hope that many more programs will adopt this form of diagnosing TB in children.

The specter of empty countrysides and wetlands—Impact of hunting take on birds in Indo‐Burma

Hunting for the wild meat trade, medicines and other human uses has decimated Indo‐Burma's vertebrate biota and has led to widespread defaunation. Yet, there is surprisingly little data on how hunting impacts wild bird assemblages in different landscapes here. Based on concurrent snapshot surveys of bird hunting, food markets and hunting attitudes across six Indo‐Burma countries, we found that hunting threatens species not only in forested landscapes but also wetlands and farmlands such as orchards and paddy fields—ecosystems overlooked by past studies, with at least 47 species associated with wetlands and agricultural lands identified from market surveys across the region. High rates of mortality are suffered when hunting tools such as nets are used to exclude perceived bird pests in both aquaculture and agricultural landscapes, with over 300 individual carcasses of at least 29 identifiable species detected in one aquaculture landscape sampled in Thailand. We warn that the potentially unsustainable trapping of species for consumption and trade in Indo‐Burma, coupled with high incidental mortalities, could decimate the populations of erstwhile common and/or legally unprotected species. There is an urgent need for stronger regulatory oversight on the hunting take of wild birds and the use of hunting tools such as nets. Alongside this, conservation practitioners need to better engage with rural communities to address unsustainable hunting practices, especially outside of protected areas.

Fending off Delta - Hospital measures to reduce nosocomial transmission of COVID-19.

OBJECTIVES: Following the emergence of the Delta variant of SARS-CoV-2 in Singapore, our hospital experienced a Delta-linked ward cluster. In this study, we review the enhanced strategies in preventing nosocomial transmission of COVID-19 following widespread community transmission of the Delta variant. METHODS: We conducted a cohort study on exposures to unexpected COVID-19 cases for which contact tracing was initiated from June 2021 to October 2021. Strategies evaluated included upgraded personal protective equipment (PPE) and rostered routine testing (RRT) for staff and patients, surveillance of staff with acute respiratory illness (ARI), and expanded quarantining and testing for contacts of identified cases. RESULTS: From 193 unexpected COVID-19 exposures, 2,573 staff, 542 patients, and 128 visitor contacts were traced. Four staff contacts subsequently had SARS-CoV-2 infection. Two were likely from exposure in community settings, whereas 2 had exposure to the same COVID-19 positive staff in the hospital, forming the only hospital cluster. One inpatient had a nosocomial infection, possibly from visitors. The SARS-CoV-2 detection rate among staff was 0.3% (of 11,200 staff) from biweekly RRT and 2.5% (of 3,675 staff) from ARI surveillance. CONCLUSION: Enhanced hospital measures, including upgraded PPE and RRT for staff and patients, staff sickness surveillance, and more rigorous management of contacts of COVID-19 cases, were likely to have reduced nosocomial transmission amid the Delta variant.

Initial presenting symptoms, comorbidities and severity of COVID-19 patients during the second wave of epidemic in Myanmar.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by a highly contagious virus called severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019 and became a major threat to health around the world. The health experts are still learning more about the detailed knowledge of the natural course and the severity of COVID-19. The study aimed to assess the prevalence and association of severity of disease with demographic characteristics, initial presenting symptoms, and comorbidities among COVID-19 patients in treatment centers, Myanmar. METHODS: A cross-sectional study was conducted at Hmawbi and Indine treatment centers, Yangon Region, Myanmar, from November to December 2020. Data were collected by using standardized case report forms and then, a total of 222 confirmed COVID-19 inpatients were included in this study. The odds ratio with a 95% confidence interval (CI) was used as a measure of association and the independent associated factors for severity of disease were investigated using logistic regression analysis. RESULTS: In total, 81.5% were symptomatic patients and of these, the most common presenting symptoms were fever 54.1%, loss of smell 50.3%, and cough 30.9%. Among 37.8% of COVID-19 patients with comorbidities, the most common comorbidities were hypertension 58.3%, diabetes mellitus 29.8%, and heart diseases 26.2%, respectively. As a severity, 20.7% of patients had signs of severe pneumonia. The associated factors of severe pneumonia were aged 60 years and older [Adjusted odds ratio (AOR) = 2.88, 95% CI 1.14-7.29], overweight or obesity (AOR: 3.87, 95%CI 1.80-8.33), and current smoking (AOR: 6.74, 95% CI 2.72-16.75). CONCLUSIONS: In this study, one-fifth of the patients developed severe pneumonia. The COVID-19 patients who were aged 60 years and older, overweight or obesity, and current smokers should be monitored carefully during the course of treatment to reduce the disease severity.

Assessment of depressive symptoms in patients with COVID-19 during the second wave of epidemic in Myanmar: A cross-sectional single-center study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has had a great impact on every aspect of society. All countries launched preventive measures such as quarantine, lockdown, and physical distancing to control the disease spread. These restrictions might effect on daily life and mental health. This study aimed to assess the prevalence and associated factors of depressive symptoms in patients with COVID-19 at the Treatment Center. METHODS: A cross-sectional telephone survey was carried out at Hmawbi COVID-19 Treatment Center, Myanmar from December 2020 to January 2021. A total of 142 patients with COVID-19 who met the criteria were invited to participate in the study. A pre-tested Center for Epidemiologic Studies Depression Scale (CES-D) was used as a tool for depressive symptoms assessment. Data were analyzed by using binary logistic regression to identify associated factors of depressive symptoms. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to determine the level of significance with a p < 0.05. RESULTS: The prevalence of depressive symptoms in patients with COVID-19 was 38.7%, with the means (± standard deviation, SD) subscale of somatic symptom, negative effect, and anhedonia were 4.64 (±2.53), 2.51 (± 2.12), and 5.01 (± 3.26), respectively. The patients with 40 years and older (AOR: 2.99, 95% CI: 1.36-6.59), < 4 of household size (AOR: 3.45, 95% CI: 1.46-8.15), ≤ 400,000 kyats of monthly family income (AOR: 2.38, 95% CI: 1.02-5.54) and infection to family members (AOR: 4.18, 95% CI: 1.74-10.07) were significant associated factors of depressive symptoms. CONCLUSION: The high prevalence of depressive symptoms, approximately 40%, was found in patients with COVID-19 in the Treatment Center. Establishments of psychosocial supports, providing psychoeducation, enhancing the social contact with family and friends, and using credible source of information related COVID-19 would be integral parts of mental health services in COVID-19 pandemic situation.

Initial Presenting Symptoms, Comorbidities and Severity of COVID-19 Patients Attending Hmawbi and Indine Treatment Centers During the Second Wave of Epidemic in Myanmar: a Cross-sectional Study (preprint)

Background: Coronavirus disease (COVID-19) caused by a highly contagious virus called severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019 and became a major threat to health around the world. The health experts are still learning more about the detailed knowledge of the natural course and the severity of COVID-19. The study aimed to assess the prevalence and association of severity with demographic characteristics, initial presenting symptoms, and comorbidities among COVID-19 patients in Treatment Centers, Myanmar. Methods: : A cross-sectional study was conducted at Hmawbi and Indine Treatment Centers from November to December 2020 and a total of 176 adult COVID-19 patients participated in this study. Data were collected by telephone surveys using structured questionnaires. The odds ratio with a 95% confidence interval was used as a measure of association and the independent associated factors for severity (pneumonia) were investigated using logistic regression analysis. Results: : In total, 76.7% were symptomatic patients and the most common presenting symptoms were fever 43.2%, loss of smell 42.0%, and cough 25.6%. The prevalence of comorbidity in COVID-19 patients was 35.8% and the most common comorbidities were hypertension 19.9%, heart diseases 9.7%, and diabetes mellitus 9.1%, respectively. As a severity, 23.3% of patients had signs of pneumonia. The associated factors of pneumonia were aged 60 years and older [Adjusted Odds Ratio (AOR) = 8.82, 95 % CI: 2.68-29.08] , overweight or obese (AOR: 3.33, 95% CI: 1.30-8.54), current smoking (AOR: 15.29, 95% CI: 2.91-80.37), and alcohol drinking (AOR: 7.04, 95% CI: 1.40-35.31). Thirty percent of symptomatic patients present with pneumonia. Conclusions: : Nearly one-fourth of the patients developed pneumonia. The COVID-19 patients who are aged 60 years and older, overweight or obese, current smokers, and alcohol drinkers should be monitored carefully during the course of treatment to reduce the disease severity.

Rates and Risk Factors Associated with COVID-19 Infection Among Myanmar Ethnic Minority Doctors in UK NHS (preprint)

Background: There is dearth of information on personal and work-related risk factors associated with COVID-19 infection among ethnic healthcare workers in UK NHS.Methods: A questionnaire survey was conducted among Myanmar Ethnic Minority Doctors immediately after the peak of pandemic in UK during June 2020. We aimed to explore real world personal work experience of doctors working in the NHS during the rising phase of the first wave of the pandemic and to provide better understanding and deeper insight into the impact of COVID-19 with regard to susceptibility and risk of poor outcome among doctors.Findings: Of 670 potentially eligible participants from Myanmar ethnic background, a total of 512 responses were received. Majority are training grade doctors and majority of respondents work in acute hospital setting; 42.3% and 46.2% in COVID-ward areas and non-COVID ward areas, respectively. Probable infection rate was extremely high among respondents (N=221 (43.2%)) and 66 (12.9%) had a positive test. The majority, ~70%, who were symptomatic believed they got infection from working in a hospital environment. In multivariate models, controlling for age, sex, body mass index, smoking, hypertension, diabetes mellitus, usage of ACE inhibitors/Angiotensin Receptor Blockers, and vitamin C & D containing supplements, only ‘working in COVID-19 ward area in acute setting’ was significantly less likely to be associated with our primary outcome of being tested positive for COVID-19 (adjusted OR (95% confidence interval) 0.49 (0.28, 0.86; p= 0.014). For ‘probable COVID-19 infection’, being older (aOR 0.97 (0.95, 0.99); p=0.002), using vitamin D containing vitamins (aOR 0.59 (0.36, 0.98); p=0.043) and working in COVID-ward area in acute setting (aOR 0.47 (0.31, 0.70); p<0.001) were less likely to be associated with COVID-symptoms while current smoking (aOR 8.63 (2.52,29.60); p=0.001) and use of ACEI/ARB (aOR 9.54 (1.63, 55.93); p=0.012) were associated with COVID-19 symptoms. Among those with symptoms, the majority were stressed or very stressed with COVID symptoms, but a substantial proportion of those without COVID symptoms also reported being stressed or very stressed.Interpretation: Given that COVID-19 testing is not instituted routinely to healthcare staff over the period of survey covering December 2019 to June 2020, the results are likely to be underestimation of the real impact. The high infection rates are most likely related to initial lack of adequate PPEs in so called non-COVID clinical areas and lack of policy on widespread testing of all hospital admissions (especially in older people) for COVID-19. We highlight the need for support to NHS workforce for potential consequences of physical and mental health due to COVID-19.Funding Self-funded.Funding Statement: This project is self-funded.Declaration of Interests: None to declareEthics Approval Statement: The study gained ethical approval from College Ethics Review Board, University of Aberdeen (CERB/2020/5/1955).

Validation of a Real-Time Locating System for Contact Tracing of Healthcare Workers during the COVID-19 Pandemic in Singapore

BACKGROUND: In early 2020, the 2019 coronavirus disease (COVID-19) emerged and resulted in community and nosocomial transmissions. Effective contact tracing for potentially exposed healthcare workers (HCWs) is crucial for the prevention and control of infectious disease outbreaks in the healthcare setting. OBJECTIVE: This study aimed to evaluate the comparative effectiveness of contact tracing through real-time locating systems (RTLS) and electronic medical records (EMRs) review at the designated hospital for COVID-19 response in Singapore, during the COVID-19 pandemic. METHODS: Over a two-day study period, all admitted COVID-19 patients, their ward locations, and the HCWs rostered to each ward, were identified to determine the total number of potential contacts between COVID-19 patients and HCWs. The number of staff-patient contacts determined by EMR reviews, RTLS-based contact tracing, and a combination of both methods were evaluated. The use of EMR and RTLS-based contact tracing methods were further validated by comparing their sensitivity and specificity against self-reported staff-patient contacts by HCWs. RESULTS: Of 796 potential staff-patient contacts (between 17 patients and 162 staff), 104(13.1%) were identified on both RTLS and EMR, 54(6.8%) by RTLS alone, 99(12.4%) by EMR alone, and 539(67.7%) not identified through either method. Compared to self-reported contacts, EMR reviews had a sensitivity of 47.2% and specificity of 77.9%, while RTLS had a sensitivity of 72.2% and specificity of 87.7%. The highest sensitivity was obtained by including all contacts identified by either RTLS or EMR (sensitivity 77.8%, specificity 73.4%). CONCLUSIONS: RTLS-based contact tracing had higher sensitivity and specificity than EMR reviews. An integration of both methods provided the best performance for rapid contact tracing, although technical adjustments to the RTLS and increasing user compliance with wearing RTLS tags consistently remain necessary. CLINICALTRIAL: