2 6 Sweden 2 7 2 8 Abstract = 186 words, Main text = 1722 words, Figures =2. Abstract 3 0 Objectives: Comorbidities have significant indications for the disease outcome of COVID-19, 3 1 however which underlying diseases that contribute the most to aggravate the conditions of 3 2 COVID-19 patients is still largely unknown. SARS-CoV-2 viral clearance is a golden standard 3 3 for defining the recovery of COVID-19 infections. To dissect the underlying diseases that 3 4 could impact on viral clearance, we enrolled 106 COVID-19 patients who were hospitalized in 3 5 Methodology: We comprehensively analyzed demographic, clinical and laboratory data, as 3 8 well as patient treatment records. Survival analyses with Kaplan-Meier and Cox regression 3 9 modelling were employed to identify factors influencing the viral clearance negatively. 4 0 Results: We found that increasing age, male gender, and angiotensin-converting enzyme 2 4 1 (ACE2) associated factors (including hypertension, diabetes, and cardiovascular diseases) 4 2 adversely affected the viral clearance. Furthermore, analysis by a random forest survival 4 3 model pointed out hypertension, cortisone treatment, gender, and age as the four most 4 4 important variables. 4 5 Conclusions: We conclude that patients at old age, males, and/or having diseases 4 6 associated with high expression of ACE2 will have worse prognosis during a COVID-19 4 7 infections. 4 8 4 9

Mycotoxin-producing fungi contaminate food and feeds before, during and after harvest. Aflatoxins are important mycotoxins and aflatoxin B1 (AFB1) is a class 1 human carcinogen (definitely carcinogenic). Aflatoxin M1 (AFM1) is a class 2B (possible) human carcinogen. Aflatoxin B1 in feeds can decrease milk production, reduce fertility and increase susceptibility to infections. A cross-sectional study of aflatoxin contamination of milk and dairy feeds was carried out in five counties in Kenya representing different agro-ecological zones: Kwale, Isiolo, Tharaka-Nithi, Kisii and Bungoma. Dairy feed concentrates and cattle milk were collected twice (dry season and rainy season) from 285 dairy farmers in the five counties and analysed for AFB1 and AFM1, using competitive enzyme-linked immunosorbent assay (ELISA). In the five counties, the proportion of farmers who fed cattle with dairy concentrates varied from zero to 68%. The dairy feed concentrates from farmers had AFB1 levels ranging from less than one part per billion (ppb) to 9661 ppb and the positive samples ranged from 47.8 to 90.3%. The percentages of dairy feeds from farmers with AFB1 above the World Health Organization/Food and Agriculture Organization of the United Nations (WHO/FAO) limit of 5 ppb varied from 33.3% to 87.5 % while 83.3% to 100% of the feeds from retailers and 28.6% to 100% of the feeds from manufacturers exceeded the WHO/FAO limit. Aflatoxin M1 prevalence in milk was lowest in Kwale (13.6%) and highest in Tharaka-Nithi (65.1%). The proportion of milk samples with AFM1 above the WHO/FAO standard of 50 parts per trillion (ppt) varied from 3.4% (Kwale) to 26.2% (Tharaka-Nithi); the highest was 6999ppt. This study shows that aflatoxin contamination is common in dairy feeds and in milk and concentrations may be high. This may contribute to ill health effects in both humans and animals and, therefore, there is need for better understanding of the impacts of aflatoxins in the feed-dairy value chain and appropriate interventions to control aflatoxin contamination in animal feeds.

Background: Antimicrobial resistance (AMR) is a major global public health issue. In India, access to medicines is poorly regulated and therefore antibiotics in dairy cattle are commonly used by farmers without consulting with veterinarians. This study was conducted to understand practices and knowledge related to antibiotic use and AMR among dairy farmers and veterinary professionals in selected urban and peri-urban areas of India. Methods: A total of 28 focus group discussions with farmers and 53 interviews with veterinary professionals were carried out. Results: Mastitiswas identified as the main animal health challenge. Antibiotic consultation behavior of farmers depended on the availability of veterinarians. Except in Bangalore, farmers were found to often treat animals on their own. They were found unaware of the concept of AMR, but knew the importance of vaccination. Veterinarians included in the study had a good understanding of antibiotics, AMR, and zoonotic diseases. Conclusion: The knowledge level and practices observed in the study related to the use/ abuse of antibiotics can potentially increase the risk of development of AMR and its transfer in the community. Our findings can help support AMR-mitigation efforts in the country, including the design of better policies on antibiotic use in dairy.

In the next two decades, the world population will increase significantly; the majority in the developing countries located in the tropics of Africa, Asia, Latin America, and the Caribbean. To feed such a population, it is necessary to increase the availability of food, particularly high-value animal protein foods produced locally, namely meat and dairy products. Dairy production in tropical regions has a lot of growth potential, but also poses a series of problems, particularly as dairy production systems were developed in temperate countries and in most cases are difficult to implement in the tropics. Drawbacks include hot weather and heat stress, the lack of availability of adequate feeds, poor infrastructure, and cold chain and the competition with cheap imports from temperate countries. This position paper reviews the major drawbacks in dairy production for the five major dairy species: cattle, water buffalo, sheep, goat, and camel, as well as the future trends in research and development. It also concerns the major trends in reproduction and production systems and health issues as well as environmental concerns, particularly those related to greenhouse gas emissions. Tropical Animal Health and Production now launches a topical collection on Tropical Dairy Science. We aim to publish interesting and significant papers in tropical dairy science. On behalf of the editorial board of the Tropical Animal Health and Production, we would like to invite all authors working in this field to submit their works on this topic to this topical collection in our journal.

Populations in tropical and subtropical developing countries are exposed to largely uncontrolled levels of aflatoxins through food. These countries (especially in Africa and Asia) also present a high prevalence of stunting. Studies have reported an association between aflatoxin exposure and growth impairment in children but there is not yet conclusive evidence that aflatoxins are a significant cause of stunting in children, thus further research is warranted. In this cross-sectional study, 204 low-income households were randomly selected in two low-income areas of Nairobi, Kenya. Korogocho is a higher population density area and Dagoretti a lower population density area. We asked questions about household demographics and a 24-hour dietary recall was conducted in children aged 1-3 years. Child anthropometric measurements were also conducted. Height-forage Z-scores (HAZ), weight-forage Z-scores (WAZ) and weight-for-height Z-scores (WHZ) were calculated for each child using World Health Organization (WHO) growth standards reference data. Samples of foods were taken from the household or from the retailer for analysis using competitive enzyme-linked immunosorbent assay (ELISA). Laboratory results for aflatoxin levels in the food samples collected were used to calculate the daily aflatoxin intake, according to the results from the dietary assessment. The study found 41% of children sampled had stunted growth. Boys were more stunted than girls (p=0.057) and Korogocho had more stunted children than Dagoretti (p=0.041). In all, 98% of food samples collected tested positive for aflatoxin and there was an average exposure to aflatoxins of 21.3 ng/kg bodyweight per day. Exposure to aflatoxin M1 (AFM1), location and sex were significantly associated with HAZ, with boys and children from Korogocho having lower HAZ, and AFM1 was negatively associated with HAZ (p=0.047), indicating that AFM1 was associated with stunting. There was no association between total aflatoxins (aflatoxin B [AFB] and aflatoxin G [AFG]) and HAZ, WAZ and WHZ. The study showed a high prevalence of malnutrition, especially stunting, in two low-income urban sites, and this was most pronounced in the high-density area. The reported association between AFM1 and stunted children indicates that more research is needed on the health impacts of this aflatoxin in growing children.

Vietnam is a tropical country where mosquito-borne diseases are common. This review explores the transmission of mosquito-borne flaviviruses in urban areas of Vietnam. It concludes that urban transmission has mainly been studied for Dengue virus, and so far, much less for Japanese encephalitis virus. Dengue is the most common flavivirus in Vietnam. Due to fast urbanization and favorable climatic conditions, the viral transmission concentrates mainly to large cities with high population density including Ha Noi, Nha Trang and Ho Chi Minh. Human cases of Japanese encephalitis have been controlled by an expanded immunization program. However, this virus is still circulating throughout the country, also in cities due to the pig rearing practices in urban and peri-urban areas. Zika virus is an additional major concern because it has long circulated in the Northern area and is now increasingly diagnosed in urban areas of the Central, Central Highlands and Southern regions using the same mosquito vectors as Dengue virus. There was alarge outbreak of Zika disease from 2016 to early 2017, with most infections observed in Ho Chi Minh city, the largest town in Vietnam. Other flaviviruses circulate in Vietnam but have not been investigated in terms of urban transmission.

Background: Dairy production in Kenya is important and dominated by smallholder farmers who market their produce through small-scale traders in the informal sector. Method: This study aimed to determine the prevalence of aflatoxin (AFM1) in informally marketed milk in peri-urban Nairobi, Kenya, and to assess knowledge of milk traders on aflatoxins using questionnaires. A total of 96 samples were analyzed for AFM1 using enzymelinked immunosorbent assay. In addition, boiling and fermentation experiments were carried out in the laboratory. Results: All samples had AFM1 above the limit of detection (5 ng/kg) (mean of 290.3 ± 663.4 ng/kg). Two-thirds of the samples had AFM1 levels above 50 ng/kg and 7.5% of the samples exceeded 500 ng/kg. Most of the traders had low (69.8%) or medium (30.2%) knowledge. Educated (p = 0.01) and female traders (p= 0.04) were more knowledgeable. Experimentally, fermenting milk to lala (a traditional fermented drink) and yogurt significantly reduced AFM1 levels (p< 0.01) (71.8% reduction in lala after incubation at room temperature for 15 h, and 73.6% reduction in yogurt after incubation at 45ºC for 4h). Boiling had no effect. Conclusion: The study concluded that the prevalence of raw milk with AFM1 was high, while knowledge was low. Fermentation reduced the AFM1 levels.

Malnutrition is a major problem in East Africa and animal source foods could provide essential protein and micronutrients to help alleviate this. The livestock sector is rapidly growing and intensifying in response to increased consumer demand for animal source foods. However, the ability of the livestock sector to contribute to improving nutritional security is constrained by a number of factors, including contaminants in animal source foods and feeds. Globally, mycotoxins (especially aflatoxins) are the most important contaminants of livestock feed. Aflatoxins are produced by the fungus Aspergillus flavus and related species, which occur naturally in soils throughout sub-Saharan Africa. They are toxic to humans, fish and many other animals, even in low concentrations. Susceptibility to aflatoxins varies by age, health status, species and other factors. Most research has focused on aflatoxins in maize or groundnuts and their impacts on human health. However, aflatoxins are found in other foods and can also impair livestock productivity, reducing the availability of nutritious foods and the income of smallholder farmers. Aflatoxins are also transferred into animal source foods, which could harm consumers. The objective of this review was to synthesize information on the impact of aflatoxins on livestock health and productivity, with a special focus on reports from East Africa. A systematic literature review identified 2700 abstracts in 23 databases. Of these, 46 articles were relevant to the review objective and available. This review summarises key data on impacts of aflatoxins in animal health and levels of aflatoxins in animal source foods. The studies and surveys suggest that aflatoxins may be a significant risk to livestock productivity and food safety in East Africa. Impacts are likely to worsen as livestock industries intensify in response to the growing demand for animal source foods. Climate change may also aggravate aflatoxin problems. In light of this challenge, this review identifies major research gaps and discuss the way forward.