We report on the suspected case reports filed for SARS-CoV-2 infections and COVID-19 illnesses among health and social welfare workers in Germany. In addition, we report about COVID-19 in health workers in Malaysia. Claims for occupational diseases caused by SARS-CoV-2 are recorded separately in a database of the Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW). This database is analyzed according to its content as of May 22, 2020. In addition, the notifiable cases of SARS-CoV-2 infections from personnel in medical institutions (e.g., clinics and doctor’s office) and social welfare institutions (e.g., nursing homes, shelters and refugee camps) following the German Infection Protection Act are analyzed. The report from Malaysia is based on personal experience and publications of the government. In Germany at present, 4398 suspected case reports for the diagnosis of SARS-CoV-2 infections among health and social workers have been filed. This figure is four times the number of all reported infections normally received per year. The majority of claims, regardless of being a confirmed infection, concerned nurses (n = 6927, 63.9%). The mortality rate for workers infected with SARS-CoV-2 is 0.2% to 0.5%. Doctors are affected by severe illness more frequently than other occupational groups (8.1% vs. 4.1%). In Malaysia, work-related infection of health workers (HW) occurred mainly when COVID-19 was not suspected in patients and no adequate personal protective equipment (PPE) was worn. Although knowledge on the spread of SARS-CoV-2 infections among workers remains limited, the impact appears to be substantial. This is supported by the mortality rate among infected workers. Occupational health check-ups carried out at the present time should be systematically analyzed in order to gain more information on the epidemiology of COVID-19 among HW. Since the supply and use of PPE improved, the infection risk of HW in Malaysia seems to have decreased.

No abstract

Plasmodium knowlesi malaria infection in humans has been reported throughout southeast Asia. The communities at risk are those living in areas where Macaque monkeys and Anopheles mosquito are present. Zoonotic malaria control is challenging due to the presence of the reservoir host and the possibility of human-vector-human transmission. Current control measures, including insecticide-treated nets (ITNs) and indoor residual spraying (IRS), are insufficient to address this threat due to gaps in protection associated with outdoor and early evening vector biting and social and economic activities, such as agricultural and forest work. Understanding the challenges faced by affected communities in preventing mosquito bites is important for reducing disease transmission. This opinion paper discusses opportunities to improve P. knowlesi malaria control through understanding the challenges faced by communities at risk and increasing community engagement and ownership of control measures. The paper highlights this issue by describing how the concept of reimagining malaria can be adapted to zoonotic malaria control measures including identifying current gaps in vector control, understanding interactions between environmental, economic, and human behavioral factors, and increasing community participation in and ownership of control measures.

Background: Dengue fever is endemic in Malaysia and continues to be a public health concern. Selangor was the top hit and there is a paucity of information on knowledge, attitudes, and practices (KAP) of Bandar Baru Bangi residents regarding dengue infection. Therefore, the objective of this study is to describe dengue related knowledge, attitudes and practices (KAP) of residents of Bandar Baru Bangi.Methods: A cross-sectional questionnaire survey of 152 residents from Section 3 and Section 8, Bandar Baru Bangi attending the dengue awareness events was conducted. The information on socio-demographic characteristics of the participants and their knowledge, attitude and practice on dengue fever was collected using a structured questionnaire.Results: The results showed that the residents only 52% had sufficient knowledge about the dengue vectors, signs, symptoms, and modes of transmission. However, approximately all the respondents considered dengue as serious but preventable disease to which they are vulnerable to. Television/radio was the predominant sources of information about dengue fever. Knowledge on dengue is associated with prevention practice. But the self-efficacy has a significant impact between the owner and tenant house (p=0.010, p<0.05). Female has higher self-efficacy compare to male.Conclusions: As conclusion, findings suggest that despite the residents of Bandar Baru Bangi have moderate knowledge level about dengue fever nevertheless; they still adopted the preventive measures suggested by the guidelines from Ministry of Health. Therefore, health program planners and practitioners need to identify why the dengue fever still rampant among the population.

Background Presymptomatic COVID-19 patients have been identified as a major stumbling block in efforts to break the chain of transmission. Studies on temporal dynamics of its shedding suggests it peaks 1–2 days prior to any symptom onset. Therefore, a large proportion of patients are actively spreading the disease unknowingly whilst undetected. However, lengthy lockdowns and isolation leads to a host of socioeconomic issues and are impractical. Conversely, there exists no study describing this group and their clinical significance despite their key role in disease transmission. Methods As a result, we devised a retrospective study to look at the prevalence of presymptomatic patients with COVID-19 from data sourced via our medical records office. Subsequently, we identify early indicators of infection through demographic information, biochemical and radiological abnormalities which would allow early diagnosis and isolation. In addition, we will look into the clinical significance of this group and their outcome; if it differs from asymptomatic or symptomatic patients. Descriptive statistics were used in addition to tabulating the variables and corresponding values for reference. Variables are compared between the presymptomatic group and others via Chi-square testing and Fisher’s exact test, accepting a p value of < 0.05 as significant. Results Our analysis shows a higher proportion of presymptomatic patients with atypical symptoms like chest pain while symptomatic patients commonly present with respiratory symptoms like cough and shortness of breath. Besides that, there were more females presenting as presymptomatic patients compared to males (p = 0.019) and these group of patients were likely to receive treatment (p < 0.001). Otherwise, we were not able to identify other statistically significant markers suggesting a patient is presymptomatic. Conclusion As we have little means of identifying these silent spreaders, it highlights further the importance of general measures implemented to stop COVID-19 transmission like social distancing, face mask, and widespread testing.

Background Plasmodium knowlesi infection has significant morbidity and mortality impact in Malaysia. This zoonotic malaria parasite is naturally transmissible from macaque to humans in the presence of a competent vector. Human encroachment towards the habitat of macaque has further increased the risk. Stratifying the potential risk of transmission based on the burden of parasite among macaque in a particular area can be the first step for public health intervention. Thus, the study aimed to estimate the prevalence of Plasmodium knowlesi parasite among macaque in Negeri Sembilan and determine its associated factors. METHODS This is a cross-sectional study using a non-probabilistic sampling technique. A total of 212 blood samples from macaques in Negeri Sembilan were collected from seven districts. The Plasmodium spp. infecting the macaques were identified using Real-Time PCR assays on DNA extracted from these blood samples. Statistical tests were done to examine the factors associated with Plasmodium knowlesi infection in the macaque population. RESULT The overall prevalence of Plasmodium knowlesi among macaque in Negeri Sembilan state was 36.3%. Both long-tailed macaque and short-tailed macaque harboured the parasite within them. Co-infection with several malaria parasites were seen in 35.5% of Plasmodium spp positive results. The only significant associated factors in the prevalence of Plasmodium knowlesi were the type of locality (rural vs. urban) and the districts where the macaques were trapped. CONCLUSION The prevalence of Plasmodium knowlesi infection among macaques varied between districts in Negeri Sembilan. The presence of zoonotic malaria parasites among the population of macaque that live in close proximity with the community possesses a potential risk of transmission. Therefore, robust public health advocacy targeting high-risk areas is deemed necessary.

Early warning system (EWS) for vector-borne diseases is incredibly complex due to numerous factors originating from human, environmental, vector and the disease itself. Dengue EWS aims to collect data that leads to prompt decision-making processes that trigger disease intervention strategies to minimize the impact on a specific population. Dengue EWS may have a similar structural design, functions, and analytical approaches but different performance and ability to predict outbreaks. Hence, this review aims to summarise and discuss the evidence of different EWSs, their performance, and their ability to predict dengue outbreaks. A systematic literature search was performed of four primary databases: Scopus, Web of Science, Ovid MEDLINE, and EBSCOhost. Eligible articles were evaluated using a checklist for assessing the quality of the studies. A total of 17 studies were included in this systematic review. All EWS models demonstrated reasonably good predictive abilities to predict dengue outbreaks. However, the accuracy of their predictions varied greatly depending on the model used and the data quality. The reported sensitivity ranged from 50 to 100%, while specificity was 74 to 94.7%. A range between 70 to 96.3% was reported for prediction model accuracy and 43 to 86% for PPV. Overall, meteorological alarm indicators (temperatures and rainfall) were the most frequently used and displayed the best performing indicator. Other potential alarm indicators are entomology (female mosquito infection rate), epidemiology, population and socioeconomic factors. EWS is an essential tool to support district health managers and national health planners to mitigate or prevent disease outbreaks. This systematic review highlights the benefits of integrating several epidemiological tools focusing on incorporating climatic, environmental, epidemiological and socioeconomic factors to create an early warning system. The early warning system relies heavily on the country surveillance system. The lack of timely and high-quality data is critical for developing an effective EWS.

Humans can be infected by pathogenic Leptospira through contact with infected animals or contaminated environments. Recreational exposure has been associated with human leptospirosis; however, there is a lack of information on the distribution of Leptospira spp. in recreational areas. Thus, we conducted this study to detect and describe the distributions of Leptospira spp. and to determine the prevalence of pathogenic leptospires at recreational areas in Peninsular Malaysia. Soil and water samples were randomly collected from 33 recreational areas in Peninsular Malaysia from December 2018 to April 2019. Each culture was examined under dark-field microscopy prior to genus confirmation by polymerase chain reaction using primers for the 16S rRNA gene. A total of 390 water and soil samples were collected, and 131 cultures were positive for Leptospira under dark-field microscope examination. Leptospira was identified in most of the recreational areas sampled, and at least one pathogenic Leptospira species was isolated from 17 recreational areas. The prevalence of saprophytic, intermediate, and pathogenic Leptospira spp. was 19.7%, 5.6%, and 8.2%, respectively. The dominant pathogenic species found in the samples was Leptospira kmetyi. This study provides important data on the distribution and prevalence of Leptospira spp. from soil and water, as well as the dominant pathogenic species, at recreational areas in Peninsular Malaysia. Therefore, preventive measures should be taken to ensure the safety of visitors.