outbreaks of diarrhea in kindergartens are underreported and frequently go unnoticed in developing countries. to better understand the etiology this study was performed during an outbreak of diarrhea in a kindergarten in Sabah, Malaysia. outbreak investigation was performed according to the standard procedures. In this outbreak a total of 34 (36.5%) children and 4 (30.8%) teachers suffered from gastroenteritis. Stool samples from seven children and 13 teachers were tested for rotavirus and norovirus. During the investigation stool samples were collected and sent in cold chain to the laboratory. the samples were subjected to rotavirus enzyme linked immunosorbent assay, and reverse transcription pcR for norovirus. All samples were negative for rotavirus but positive for norovirus. to determine the genogroup and genotype of norovirus, nucleotide sequencing of the amplicons was performed. All norovirus from the outbreak was of genotype GII.2[16]. To determine the relatedness of the strains phylogenetic analysis was done using neighbor-joining method. phylogenetically these strains were highly related to GII.2[P16] noroviruses from China and Japan. This study provided evidence that a diarrheal outbreak in a kindergarten was caused by GII.2[P16] norovirus which is an emerging strain in east Asia and europe.Norovirus is highly infectious and is transmitted primarily from person-to-person through the fecal-oral route within closed settings such as schools, cruise ships, hospitals, childcare facilities and aged-care institutions 1,2 . Currently this virus is divided into ten genogroups GI-GX based on the genetic differences of the capsid protein 3 . GI and GII are primarily responsible for human infection 4 . GII.4 causes most infections worldwide, followed by GII.3 or GII.6 and then other genotypes in varying proportions 5-10 . Although norovirus infection is an important cause of diarrhea in developing countries, outbreaks are under reported and frequently go unnoticed. In Kota Kinabalu, the capital of Sabah state in Malaysia, only two diarrheal outbreaks, including this one, have been reported in kindergartens between 2014 and June 2018. However, kindergartens are vulnerable to norovirus outbreaks: in Pudong district, Shanghai, China, 29 of 60 reported norovirus outbreaks occurred in kindergartens over a period of one year 11 . Therefore, understanding the epidemic situation, relationship with other strains, evolution, genetic variants and the genotype distribution of norovirus during outbreaks is important to determine the best strains to include in future norovirus vaccines. Global surveillance data indicates that several norovirus genotypes are responsible for outbreak but majority are caused by GII.4 12,13 . Since 2002, new GII.4 variants have emerged every two to three years, resulting in epidemics and global pandemics 13 . To emerge and persist in human population norovirus generate diverse strains by point mutations and recombination 14 . However, recent outbreaks of norovirus particularly in Asia and Europe wer...

Background: Malaysia recorded the highest number of dengue cases between 2014 and 2017. There are 13 states and three federal territories in Malaysia, and each area varies in their prevalence of dengue. Sabah is one of the states situated in Borneo, Malaysia. Although dengue has been increasing for the last several years, no study was being done to understand the burden and serotype distribution of the dengue virus (DENV) in Sabah. Therefore, the present study was carried out to understand the epidemiology of the dengue infection and the factors responsible for severe dengue in Sabah. Methods: Data on dengue infection were extracted from the dengue database of the state of Sabah from 2013 through 2018. DENV NS-1-positive serum samples from multiple sites throughout Sabah were sent to the state public health laboratory, Kota Kinabalu Public Health Laboratory, for serotype determination. The analysis of factors associated with severe dengue was determined from the data of 2018 only. Results: In 2013, there were 724 dengue cases; however, from 2014, dengue cases increased exponentially and resulted in 3423 cases in 2018. Increasing dengue cases also led to increased dengue mortality. The number of dengue deaths in 2013 was only five which then gradually increased, and in 2018, 29 patients died. This is an increase of 580% from 2013 to 2018. Deaths were considerably more in the districts of the east coast of Sabah compared with districts in the west coast. During the study period, all DENV serotypes could be identified as serotypes circulating in Sabah. In 2018, the predominant serotype was DENV-3. The monthly peak of dengue infection varied in different years. In the logistic regression analysis, it was identified that children were 6.5 times, patients infected with mixed serotype of DENV were 13 times, and cases from the districts of the east coast were 5.2 times more likely to develop severe dengue. Conclusions: An increasing trend of dengue infection has been observed in Sabah. The burden of dengue, severe dengue, and mortality was noted especially in the districts of the east coast of Sabah. Severe dengue was most likely developed in children, cases from the east coast, and patients infected with mixed serotype of DENV.

This is also seen by the progressive decrease in the number of pregnant women who did not have prenatal care, 23% in 2007 and 11% in 2017. Unfortunately, even a mean percentage of 30% of congenital syphilis was diagnosed only during delivery and/or curettage. Despite the increase in the number of cases of congenital syphilis, lethality fell sharply from 2009, always below 3%.

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