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    2024,2,1, DOI: 10.4103/ohbl.ohbl_5_24
    Abstract:
    The ongoing COVID-19 pandemic has highlighted the need for innovative strategies to mitigate the severe complications associated with infection caused by SARS-CoV-2. Developing empirical studies posited that the gut microbiota play a key role in modulating the immune response and overall health. This review explores the potential of synbiotics, a combination of probiotics and prebiotics, as a promising therapeutic approach to ameliorate COVID-19 complications. We conducted a comprehensive review of the literature to assess the impact of synbiotics on key aspects of the pathogenesis of this disease. Several studies indicate that synbiotics can bolster the gut microbiome, enhance mucosal barrier function, and regulate the immune system. These effects may be particularly beneficial in COVID-19, where immune dysregulation and cytokine storm are implicated in severe disease. We discuss the mechanisms through which synbiotics influence the gut axis, modulating the immune response and potentially reducing the risk of acute respiratory distress syndrome and other complications. Furthermore, synbiotics may help manage gastrointestinal symptoms often associated with COVID-19 and support the recovery of patients. While current research is promising, further clinical trials are needed to validate the safety and efficacy of synbiotics in the context of COVID-19. This review underscores the potential of synbiotics as an adjunctive therapy to conventional treatments for COVID-19, offering a novel and integrated approach to improve patient outcomes and reduce the burden of this health challenge worldwide.
    2024,2,2, DOI: 10.4103/ohbl.ohbl_3_24
    Abstract:
    Objective: The aim of the study is to provide a comprehensive overview of the epidemiology and evolution of dengue virus (DV) in Bangladesh from 2020 to 2023. Methods: From January 1, 2020, to December 31, 2023, we analyzed the daily press releases on the dengue situation made public by the government. The published sequences from the period were then subjected to phylogenetic analysis, amino acid substitutions, evolutionary rate, and selection pressure analysis. Results: In Bangladesh, dengue fever usually peaks during the monsoon season. However, the increase in cases began considerably earlier, at the end of April 2023 and the disease had claimed 1 705 lives, marking its highest annual death toll ever. Dhaka is the city most severely affected. The phylogenetic analysis revealed that the Bangladeshi DV-1 strains clustered far from any known genotype, indicating the circulation of a novel genotype, whereas the DV-3 strains clustered within the existing circulating genotype I. The DV-1 strains had a total of 107 amino acid alterations and two deletions, while the DV-3 strains had 17 alterations. The Bangladeshi DV-1 and DV-3 strains evolve rapidly. Additionally, selection pressure analysis revealed one positive selection site in DV-1 and three in DV-3, respectively, which require further research. Conclusions: The circulation of novel genotypes, a higher mutation rate, and positive selection of DV might result in the recent dengue outbreaks in the country. The study will help in the development of strategies to control outbreaks in Bangladesh and other nations with similar conditions in the future.
    2024,2,3, DOI: 10.4103/ohbl.ohbl_40_23
    Abstract:
    Objective: To investigate the prevalence of gastrointestinal helminth infections among farmers of different age groups and the risk factors influencing disease transmission in different geographic settings with intermittent treatment in Delta North Agricultural Zone in Nigeria. Methods: This cross-sectional study was carried out among all age groups in some farming communities in freshwater swamp forest and lowland rainforest of Delta North Agricultural Zone. Kato Katz method was used to detect gastrointestinal helminth infections in stool samples. Study participants totalled 20 698 including 11 215 (54.2%) males and 9 483 (45.8%) females. Additionally, diagnostic tests performance for Schistosoma mansoni using Kato Katz and PCR were compared. Results: This study identified six parasites namely, Schistosoma mansoni, Ascaris lumbricoides, hookworm, Trichuris trichiura, Enterobius vermicularis and Strongyloides stercoralis, with a total prevalence of 21.6%. The freshwater swamp forest had a slightly higher prevalence (21.8%) with six parasite species than that of the lowland rainforest (21.0%) with five species, but the difference was not statistically significant (P > 0.05). Factors that influenced disease transmission include sex, age, behaviour, type of infection, culture and environment, with vulnerabilities higher among children and females (P < 0.05). Additional investigation comparing Kato Katz method and PCR using Schistosoma mansoni 121 bp primer on 120 samples showed prevalence of 0.0% for Kato Katz and 4.2% for PCR. Conclusions: This study revealed persistent gastrointestinal helminth infections in areas where there is intermittent mass antihelminthic administration. This underscores the need for integrated control of gastrointestinal helminthiasis in farming communities.
    2024,2,4, DOI: 10.4103/ohbl.ohbl_6_24
    Abstract:
    Objective: This mixed-methods study aims to develop and validate a comprehensive hygiene tool from a One Health perspective to document the assessment of hygiene at the human-animal interface. Methods: This mixed-methods study consisted of two components: a narrative review of the development of tool, followed by validation. The tool development was conducted in two phases. Phase 1 was a literature review, while phase 2 focused on the development and validation. Results: Tool version 1 consisted of 37 questions to assess personal hygiene practices among 16 households with livestock. Face validity, content validity, and multi-rater kappa scores were used to validate tool version 1. The questions with kappa score exceeding 0.74 were retained for further test. A total of 29 questions were obtained and incorporated into tool version 2, which was subsequently employed to evaluate the personal hygiene practices among 62 households with stock. The median total scores for 16 households and 62 households were 10.5 (range: 6-16) and 16 (range: 10-22), respectively. Conclusions: Many studies have assessed hygiene practices among livestock farmers, yet none used a validated assessment tool. Thus, this validated tool will facilitate the measurement of hygiene in human-animal interactions.
    2024,2,5, DOI: 10.4103/ohbl.ohbl_34_23
    Abstract:
    Nephrolithiasis is a common disease and incurs a significant burden on the health care system globally. Patients with kidney stones can be treated with natural remedy such as cranberry, pomegranate, and grape juice. Patients with kidney stone experience anxiety and insomnia as a result of the pain caused by the stones. As a result, physicians may prescribe anxiolytics to treat anxiety, among which alprazolam is a commonly prescribed medication. Meanwhile, cranberry and pomegranate juice are prescribed by many herbal specialists for the treatment of renal calculi. The enzyme CYP3A4 primarily metabolizes alprazolam, while fruit juices such as cranberry and pomegranate juices are potent inhibitors of CYP3A4. Therefore, there could be a drug-food interaction between alprazolam and cranberry and pomegranate juices when consumed concomitantly. A detailed pharmacodynamic and pharmacokinetic investigation is required to ascertain the food-drug interaction between alprazolam, cranberry, and pomegranate juice to avoid the possible toxicity of alprazolam. This review article provides insights about the possible CYP3A4-associated drug interactions between alprazolam and juices of cranberry and pomegranate, for the safe and effective usage of alprazolam in treating anxiety disorders caused by kidney stones.
    2024,2,6, DOI: 10.4103/ohbl.ohbl_42_23
    Abstract:
    Objective: The aim of this study was to determine the prevalence and antibiotic susceptibility patterns of pathogenic Escherichia (E.) coli causing diarrhea and urinary tract infection (UTI) in patients admitted for treatment in selected health care facilities in Odisha, an eastern Indian State. Methods: A total of 189 rectal swabs from patients with diarrhea and 297 urine samples from patients with UTI were collected from selected health care facilities. E. coli isolates were phenotypically confirmed using MacConkey agar, MacConkey sorbitol agar and blood agar along with biochemical tests. These phenotypically confirmed E. coli isolates were investigated genotypically for known pathogenic E. coli via multiplex PCR. Finally, the pathogenic E. coli was subjected to antibiotic sensitivity test. Results: Culture of 189 rectal swabs and 297 urine samples revealed 46 (24.3%) diarrheagenic E. coli (DEC) and 36 (12.1%) uropathogenic E. coli (UPEC). PCR analysis of DEC identified 27 (14.3%) enterotoxigenic E. coli (ETEC), 8 (4.2%) enteropathogenic E. coli, 10 (5.3%) enteroaggregative E. coli and 1 (0.5%) Enterohemorrhagic E. coli (EHEC) in diarrhea patients and 5 (1.7%) ETEC, 7 (2.4%) enteroaggregative E. coli, 11 (3.7%) EHEC O157:H7 and 1 (0.3%) EHEC non-O157:H7 in UTI patients. DEC and UPEC exhibited multidrug resistance with a high rate of resistance to commonly prescribed antibiotics. A high frequency of ETEC causing diarrhea, atypical enteropathogenic E. coli harboring the eae gene was found among children with acute diarrhea, and ETEC (est+) and EHEC O157:H7 were detected in UTI patients along with high antibiotic resistance among DEC and UPEC were important findings. Conclusions: To the best of our knowledge, this is the first study to report the prevalence of DEC and UPEC in patients admitted to hospital in Odisha, India, revealing a high rate of antimicrobial resistance.
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    2023,3,2, DOI: 10.4103/2773-0344.363564
    Abstract:
    Objective: This study aimed to determine the carriage of extended spectrum β-lactamase (ESBL) genes in third-generation cephalosporin-resistant (3GCR) Escherichia (E.) coli from frequently contacted surfaces, wastewater and disinfectant-cleaning solutions of selected healthcare institutions in South-western Nigeria. Methods: Samples were collected over three months for the isolation of 3GCR E. coli on MacConkey agar containing 6 μg/mL of cefotaxime. 3GCR E. coli isolates were identified by detection of uidA gene and susceptibility to selected antibiotics was performed using disc-diffusion method. Detection of ESBL genes was done using primer-specific PCR. Results: A total of 22 ESBL-producing E. coli (11 each from the frequently contacted surfaces and wastewater) were obtained from the pool of 3GCR isolates in this study. No isolate was recovered from the disinfectant-cleaning solution. All the ESBL-producing E. coli obtained from the frequently contacted surfaces and wastewater were multidrug resistant, with complete resistance observed to ampicillin, cefotaxime, cefpodoxime, tetracycline and ertapenem. The ESBL genotyping showed that 54.5% carried blaCTX-M , 63.6% carried blaTEM and 9.1% carried blaSHV in isolates from the frequently contacted surfaces, while 63.6%, 9.1% and 18.2% carried blaCTX-M , blaTEM and blaSHV , respectively, in the isolates obtained from the wastewater. Conclusions: This study showed a high burden of multidrug resistance E. coli on frequently contacted surfaces and wastewater of the studied healthcare institutions, indicating the need for good hygiene and proper mitigation measures to prevent potential public health and environmental challenges.
    2023,3,3, DOI: 10.4103/2773-0344.389607
    Abstract:
    Infectious diseases remain a serious concern all over the world due to its significant impact on public health and economic stability. About 30 new causative organisms have been discovered over the past few decades, most of which are zoonotic in origins. Thus, infectious diseases are now posing a never-ending challenge to human civilisation. As a result, constant awareness along with adoption of effective strategies to control infectious disease spread has now become crucial. This review gives valuable information on diseases that emerge and re-emerge every now and then. The paper also highlights challenges related to tackling of infectious diseases in present scenario and significance of employing strategies for effective control in near future against various deadly infectious diseases like COVID-19.
    2023,3,4, DOI: 10.4103/2773-0344.378589
    Abstract:
    Objective: : To determine the potential risk factor of COVID-19 severity and length of hospitalization, the association between multiple antibiotics administration and the risk of severe COVID-19. Methods: :A case-control study of 58 hospitalized COVID-19 patients (the case group) and 120 non-hospitalized home isolated COVID-19 patients (the control group) was conducted. Data were collected using hospital medical records and verbal questionnaires for the participants. Results: : Totally 89.2% of non-hospitalized mild COVID-19 patients received ≤2 courses of antibiotics/year, while 36.0% of hospitalized patients received ≥4 courses of antibiotics, 56.9% received 2-3 courses of antibiotics/year and only 6.9% of them were exposed to ≤2 courses of antibiotics/year. our study emphasizes that the usage of 4 courses or higher per year was a significant risk factor for hospitalization [OR: 17.5; 95% CI (2.596-118.263); P=0.003], while the usage of ≤2 courses was a preventive predictor for severity and hospitalization [OR: 0.072; 95%CI (0.006-0.900); P=0.041]. Furthermore, age was associated with 8.4% increase in the odds of severe COVID-19 [OR: 1.084; 95% CI (1.024-1.148), P=0.005], and females were 89.1% less likely to hospitalized than males [OR: 0.109; 95% CI (0.024-0.498); P= 0.004]. Our study shows that 70.4% of cases misused antibiotics and administered the antibiotics themselves without a physician’s prescription. Around 50.0% of cases never completed the ideal duration of the course in contrast to controls, of which only 23.2% did not complete the ideal duration. Conclusions: : Our study shows that antibiotics misuse and overuse may be a potential risk factor for COVID-19 severity and hospitalization.
    2023,3,5, DOI: 10.4103/2773-0344.363563
    Abstract:
    Rabies is widely prevalent worldwide, and China is among the countries most affected. To achieve the goal of zero human deaths from dog-mediated rabies by 2030, dog management and immunization must be improved and comprehensive prevention and control measures must be adopted. We analyze the epidemiological profile of rabies in China in the past 30 years to clarify the origins of China’s high prevalence, and propose a comprehensive rabies prevention and control concept based on “One Health” by drawing on successful international control efforts.Results: The Omicron variants had the characteristics of high insidiousness, rapid transmission, high infectivity, and short incubation period, which were consistent with the characteristics of outbreaks caused by Omicron in other regions in China and abroad. There were 568 978 asymptomatic infections in Shanghai from Feburary 26 to June 30, 2022, accounting for 90.73% of the SARS-CoV-2 infections in this outbreak wave. It’s significantly different from a total of 23 277 SARS-CoV-2 infections in China between March 31, 2020 and August 8, 2021, of which 41.97% of the cases were asymptomatic infections. Conclusions: Compared with previous outbreaks emerged in China, the Omicron outbreak in Shanghai was characterized by multiple point dissemination, wide coverage, a large number of close contacts of confirmed infections and asymptomatic carriers, and difficult source tracing. The lessons from Shanghai’s response to Omicron showed that the dynamic zero-COVID policy is still the most suitable response to the virus which can quickly find the infections and curb the transmission route.
    2023,3,6, DOI: 10.4103/2773-0344.374224
    Abstract:
    Objective: To assess the level of knowledge and practice on malaria prevention among the residents of Ratuwamai Municipality in Nepal. Methods: A community-based cross-sectional study was carried out on Ratuwamai Municipality of Ward No. 8 in Morang District, Nepal. A total of 352 respondents with an age range from 15 to 70 years were interviewed from October 9 to October 31, 2022. Statistically significant differences between two or more categorical groups were measured using independent sample t-test, one-way ANOVA test, and Kruskal-Wallis H test. Result: Out of the total sample, 57.7% of the respondents were 24 to 50 years old with a mean age of (36.9±14.3) years. In the knowledge test, 82% of the responses were accurate. Though 98.6% of people had heard of malaria, only 48.3% said it was a communicable disease. In practice, 84.9% always cleaned the surrounding area and trimmed the bushes around the house; 75.9% used insecticide-treated bed nets or normal bed nets for sleeping; only 7.4% used mosquito repellent creams on exposed body parts while staying outdoors at night, working in fields, and sleeping. Conclusions: The majority had knowledge about malaria, but more than half had poor practice. We advise concerned authorities to promote the behavior change communication strategy to encourage individuals to adopt healthy, beneficial, and good behavioral practices.
    2023,3,7, DOI: 10.4103/2773-0344.387693
    Abstract:
    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic of infectious disease characterized by significant morbidity, symptomatic manifestations, and severe outcomes. Vaccines have proven to be an effective means of impeding the transmission of SARS-CoV-2, and have been widely employed globally. Despite breakthroughs such as mRNA vaccine, intramuscular COVID-19 vaccine still faces numerous chanllenges, such as failure to completely avoid infections, high cost, and difficult transport conditions. The mucosa is the primary site through which SARS-CoV-2 invades the body and may induce effective immune responses. In the face of the increasing immune escape capacity of the Omicron variants and the potential outbreak of a new round of epidemics, it is imperative to develop a new generation of mucosal immune vaccines to prevent infection, which is mainly transmitted through the respiratory tract, along with its severe and fatal consequences. Probiotics have not only been used as safe raw materials for fermented foods but have also been developed as oral or nasal vaccine vectors for various pathogens in recent years, showing good mucosal and systemic immune effects in animals or humans. Although the antigen delivery technology based on protein anchoring on the surface of probiotics is rarely applied to COVID-19, probiotic-based vaccines aim at a new development direction for COVID-19 vaccines with low cost, high safety, and potential mucosal immune programs. In this review, we will discuss in detail the feasibility, advantages, and possible limitations of probiotics as a mucosal immune vaccine vector, which will be conducive to coping with the current situation of COVID-19.
    2022,2,8, DOI: 10.4103/2773-0344.362641
    Abstract:
    Objective: The study aimed to describe the characteristics and containment of the Omicron variants in Shanghai compared with the previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in China. Methods: We summarized the data retrieved from the Shanghai Municipal Health Commission from January to June 2022 and the National Health Commission of the People’s Republic of China from March 2020 to August 2021. Epidemiological analysis was utilized to describe the differences among SARS-CoV-2 variants and the infection situation in the outbreaks in China. Results: The Omicron variants had the characteristics of high insidiousness, rapid transmission, high infectivity, and short incubation period, which were consistent with the characteristics of outbreaks caused by Omicron in other regions in China and abroad. There were 568 978 asymptomatic infections in Shanghai from Feburary 26 to June 30, 2022, accounting for 90.73% of the SARS-CoV-2 infections in this outbreak wave. It’s significantly different from a total of 23 277 SARS-CoV-2 infections in China between March 31, 2020 and August 8, 2021, of which 41.97% of the cases were asymptomatic infections. Conclusions: Compared with previous outbreaks emerged in China, the Omicron outbreak in Shanghai was characterized by multiple point dissemination, wide coverage, a large number of close contacts of confirmed infections and asymptomatic carriers, and difficult source tracing. The lessons from Shanghai’s response to Omicron showed that the dynamic zero-COVID policy is still the most suitable response to the virus which can quickly find the infections and curb the transmission route.
    2023,3,9, DOI: 10.4103/2773-0344.374229
    Abstract:
    The COVID-19 vaccines provide a high degree of protection against severe disease, hospitalisation, and death. However, no vaccine claimed 100% effectiveness and it is expected that a small proportion of vaccinated individuals may develop a breakthrough infection due to individual differences, virus variants and other factors. We conducted an epidemiological investigation and analysis of an imported case who had finished four doses of vaccination, and in order to provide a relevant reference for regular epidemic prevention and control in the post-pandemic era.
    2023,3,10, DOI: 10.4103/2773-0344.376722
    Abstract:
    Objective: SARS-CoV-2 infection is an ongoing public health emergency of international significance. Considering that there is no specific drug and 100% effective vaccine yet, knowledge, attitude and practices (KAP) toward COVID-19 are crucial to prevent and manage the pandemic. This study aimed to assess knowledge, attitude and practices toward COVID-19 prevention measures of graduate students at a university in northwestern Ethiopia. Methods: A cross-sectional study design was conducted between September to December 2020. A structured questionnaire was used to collect data on socio-demographic characteristics and KAP of 407 randomly selected individuals. The data were exported to SPSS version 23.0, and bivariate and multivariate logistic regressions were used for analyses. Variables with P<0.25 in the bivariate logistic regression analysis were retained into the multivariable logistic regression models. The values were considered to be statistically significant ( P≤0.05). The data quality control was tested by using 5% pretest. Results:Among 407 participants, 267 (65.6%) had sufficient knowledge, 239 (58.7%) had positive attitude and 189 (46.4%) had good practices toward COVID-19. Marital status (AOR 0.38; 95%CI 0.11-0.95; P=0.040) and student admission type (AOR 0.32; 95%CI 0.15-0.68; P=0.003) had a statistically significant association with knowledge of students. Residence (AOR 0.18; 95%CI 0.09- 0.34; P<0.01) (AOR 0.16; 95%CI 0.07-0.36; P<0.01), family size (AOR 0.45; 95%CI 0.23-0.87, P=0.017) (AOR 0.29; 95%CI 0.14-0.60; P=0.001), student admission type (AOR 0.11: 95%CI 0.04-0.29, P<0.01) (AOR 0.01; 95%CI 0.00-0.05; P<0.01) and monthly income (AOR 0.17; 95%CI 0.05-0.58; P=0.005) (AOR 0.08; 95%CI 0.02-0.32; P<0.01) were significantly associated with positive attitude and good practices, respectively. Besides, good practices such as avoiding handshaking and physical distancing were performed in the least amount of participants. Conclusions: The scores of KAP among graduate students toward COVID-19 are low. It is recommended that university administrators reinforce proactive and effective measures to develop good knowledge, positive attitude, and better practices regarding COVID-19 for the students.
    2022,2,11, DOI: 10.4103/2773-0344.345316
    Abstract:
    Objective: To determine the prevalence of Helicobacter (H.) pylori infection among the population of east coast of Borneo and explore the relationship between demographic factors, ethnicity and risk of H. pylori infection. Methods: This cross-sectional study enrolled 211 patients who underwent elective oesophagogastroduodenoscopy in 2017. Demographic data, endoscopic indications as well as the results of the mucosal biopsy were obtained and analysed from the endoscopy unit registry. Results: A total of 211 patients from 14 ethnic groups were enrolled in the study, most of were Chinese (28.4%), followed by Dusun (14.7%) and Songgai (13.7%). Overall, the period prevalence for 2017 was 44.5%. Multivariate logistic regression analysis showed an association between ethnicity and H. pylori. Bajau (adjusted odds ratio=5.612, P=0.005) and Dusun ethnic groups (adjusted odds ratio=7.359, P=0.001) were at a significantly higher risk of H. pylori infection compared to Chinese. However, the regression model only explained 11.6% (Cox & Snell Pseudo R2 ) of the prevalence of H. pylori infection. Conclusions: The period prevalence for 2017 was 44.5%, with certain indigenous ethnic groups having a higher risk than others. Clinicians should consider obtaining further history regarding the ethnic’s culture and dietary practice prior to starting H. pylori eradication therapy.
    2023,3,12, DOI: 10.4103/2773-0344.371403
    Abstract:
    Objective: To determine the urinary tract infections (UTIs)-causing bacterial profile and antibiotic susceptibility pattern for the proper and complete treatment of UTIs in pregnant women with diabetes mellitus (DM). Methods: We collected 300 urine samples from diabetic and non-diabetic pregnant women at various gestational ages. After isolating and identifying uropathogens, we conducted an antibiotic sensitivity assay against fourteen commonly used antibiotics: amikacin, amoxicillin, ampicillin, azithromycin, cefixime, ceftazidime, ceftriaxone, cefuroxime, ciprofloxacin, co-trimoxazole, gentamicin, levofloxacin, netilmicin, nitrofurantoin. Results: Among the participants, 70% had DM but only 37.3% had positive uropathogen growth. Five gram-negative bacteria (Escherichia coli, Klebsiella spp., Enterobacter spp., Citrobacter spp., and Pseudomonas spp.) and 3 gram-positive bacteria (Streptococcus spp., Staphylococcus spp. and Enterococcus spp.) were indentified. Escherichia coli was the most prevalent bacteria (57.1%), followed by Klebsiella spp. (19.6%). In the antibiotic susceptibility assay, we found 96.5% of the isolated organisms were highly susceptible to levofloxacin, 94.2% to netilmicin, 88.2% to nitrofurantoin, 85.1% to amikacin, 79.8% to gentamicin, respectively. On the other hand, 64.8%, 63.6%, 61.8% of the isolates demonstrated high-level resistance to ampicillin, ceftazidime and amoxicillin whereas 38.0%, 37.1%, 33.6%, 30.9% and 30.0% of the organisms were resistant to co-trimoxazole, azithromycin, ciprofloxacin, cefuroxime, cefixime, respectivey. Conclusions: Our results suggest that amikacin, levofloxacin, netilmicin, nitrofurantoin, and gentamycin can be used as first-line treatments for UTIs, whether the patient has DM or not. Contrarily, amoxicillin, ampicillin, ceftazidime, azithromycin, and co-trimoxazole should be avoided in treating UTIs.
    2022,2,13, DOI: 10.4103/2773-0344.348853
    Abstract:
    “One Health” perspective has now been upheld and advocated by many countries and international institutions such as the World Health Organization, the Food and Agriculture Organization of the United Nations, and the World Organization for Animal Health, and the World Bank Groups. At present, 19 countries, 5 international institutions and 4 regional organizaitons are working jointly to promote “One Health” perspective, with two important development trends. First, it should be put into practice with legal support, government will, and cooperation among multiple disciplines and departments; second, it not only covers zoonotic diseases, food safety and antibiotic resistance, but has now been extended to address environmental pollution, biosecurity, public health risks at ports and other fields. Taking the global fight against the COVID-19 pandemic as an example, the world now is facing unprecedented challenges, urgently calling for an exploration into institutional innovation, agency innovation and means innovation from the perspective of “One health” so as to enhance the governance efficiency of public health management.
    2022,2,14, DOI: 10.4103/2773-0344.343630
    Abstract:
    Objective: To investigate the genetic mechanism and prevalence of antibiotic resistance among the practitioners of two bathing beaches in tropical China. Methods: Totally 259 strains were isolated from the rectal swabs of the practitioners and screened by MacConkey agar. A questionnaire survey was conducted. Kirby-Bauer test was used for phenotype, and double disc inhibition synergy test was used for extendedspectrum β-lactamase-producing Enterobacteriaceae (ESBL-E), which was further confirmed by VITEKII instrument. The genotype was detected by polymerase chain reaction, and the similarities of ESBL-E were analyzed using pulsed-field gel electrophoresis. Results: The prevalence of ESBL-E was 13.1% (34/259), of which, CTX-M genes accounted for 44.1% (15/34), mainly CTX-M-14 and CTX-M-27. Moreover, 19.1% (4/21) of the isolates were homologous. The resistance phenotypes of ESBL-E to chloramphenicol, ciprofloxacin, levofloxacin, ceftazidime, cefepime and gentamicin were different between two beaches(PCTX-M genes at the island beach, while a high prevalence of ESBL-E was found at the city beach and clone transfer occurred. Conclusions: ESBL-E-associated gentamicin antibiotic resistance risk may be greater for island beach practitioners. The city beach populations could face more potential risks owing to severe resistance and metastatic ability of ESBL-E. The environmental exposure mechanisms and transfer role of antibiotic resistance at public beaches with high density should be investigated.
    2022,2,15, DOI: 10.4103/2773-0344.346831
    Abstract:
    Objective: To review the characteristic of Coronavirus disease 2019 (COVID-19) outbreaks in mainland China, particularly post-Wuhan outbreaks, and to help design effective responses in the foreseeable future. Method: The data regarding COVID-19 outbreaks between December 2019 and March 16, 2022 were obtained from China’s publicly available databases. The data were analyzed using descriptive statistics. Five outbreak stages were defined according to distinct epidemiological characteristics across different time periods over the past two years. Result: Since the 2020 Wuhan outbreak, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) local infections were confirmed in 37 995 cases as of March 16, 2022. We identified 285 isolated outbreaks in unrelated people that occurred in four additional distinct stages, over 57% of which had been imported, such as imported infected travelers and fomite transmission. The basic reproduction number (R0) of original SARS-CoV-2 was about 2.79, while the Delta variant was about 5.08 and Omicron was 7.0 or greater, resulting in the disease being more contagious during the fourth (Delta) and fifth (Omicron) stages than previous stages. Conclusion: China has experienced various COVID-19 outbreaks of different levels since the start of the pandemic in Wuhan, and local transmission is mainly caused by imported sources. If the “dynamic COVID-zero” policy is not appropriately followed, it will be difficult to contain the spread in China from overseas and to cope with the Omicron variant.
    2022,2,17, DOI: 10.4103/2773-0344.356988
    Abstract:
    b>Objective: To investigate the antibiotic utilization and prescription patterns as well as define its convenience to the norm in four North- Sinai hospitals, Egypt. Antimicrobial resistance is a universal health threat. The golden era of miracle antibiotics has ended and we have faced the challenge of being troubled by infectious diseases with no discovery of new antibiotics found since 1987. Antibiotic pressure, overuse, and misuse are important risk factors for antimicrobial resistance and hospital cross-infection. To combat antimicrobial resistance, Egypt started its National Action Plan (2018-2022) aiming to optimize the usage and consumption of antibiotics. Method: This multicenter descriptive cross-sectional study was designed to describe the pattern of antibiotic prescription and consumption at four North Sinai Hospitals related to the Ministry of Health and Population. We reviewed 309 medical records of the inpatient department; the samples were selected through a stratified random sampling technique. Data were collected retrospectively from the medical records of the hospitalized patients in October, November, and December of 2020 by a paper-based method. Data were analyzed using descriptive statistics. Result: The prevalence of antibiotic consumption is near 68.9% in the four hospitals indicating that two-thirds of admitted patients receive antibiotics. Approximately 52.1% administered antibiotics for no reason. Most of the admitted patients took antibiotics on the same day of admission, regardless of the different types of hospital departments. Furthermore, 98.7% of antibiotics were prescribed without culture or order for culture and microbiological tests. Broad-spectrum antibiotics were 90% of all antibiotics prescribed. A total of 18 types of antibiotics were prescribed, cefotaxime was the most commonly prescribed antibiotic representing 26.5%. Conclusion: Judicious antibiotic prescribing behavior slows down the nature of antibiotic resistance. To guarantee the best antimicrobial use in the hospitals, standard treatment guidelines, and the Essential Medicines List for infectious diseases should be carried out and revised at least every 2 years to be a clinical reference for clinicians. Continuous education and training of clinicians and healthcare workers can contribute to optimizing the rational use of antibiotics, which in return reduces the progress of antibiotic resistance. There is an urgent need for antibiotic stewardship and surveillance and their application in all hospitals.
    2022,2,19, DOI: 10.4103/2773-0344.356847
    Abstract:
    Objective: To determine the occurrence of multidrug resistant bacteria from the indoor environment of female hostels in a tertiary institution in order to provide epidemiological data. Methods: The bacterial quality of the three female hostels was evaluated using the settle plate method, where Petri dishes containing different types of culture media were opened in the rooms. Isolated bacteria were identified using standard microbiological procedures. Using disc diffusion method, the antibiogram of the isolates was determined and based on this, the multiple antibiotics resistance index was also determined. Results: The total heterotrophic colony forming units(CFU) for Hall A ranged from 2.09 x102 to 1.73 x103 CFU/m3 while that of Hall B ranged from 4.71 x102 to 1.10 x103 CFU/m3 and a statistically significant difference between the counts of both halls was observed (P=0.04). Microorganisms isolated included Staphylococcus aureus, Staphylococcus epidermidis, Bacillus subtilis, Corynebacterium sp., Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. All the isolates exhibited multidrug resistance to amoxycillin-clavulanic acid, cefuroxime and ceftriaxone. Proteus mirabilis, Klebsiella pneumoniae and Corynebacterium sp. had the least multiple antibiotic resistance index with 0.2 while Staphylococcus aureus had the highest with 0.8. Conclusions: Female university hostels may become sources of exchange of microorganisms, especially in overcrowded rooms. A large percentage of isolates were multidrug resistant which could pose difficulty and increased cost of treatment of their resulting infections. Regular surveillance and control of the agents that encourage the growth of these bacteria present in indoor air is needed.

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