Current vector research challenges in the greater Mekong subregion for dengue, Malaria, and Other Vector-Borne Diseases: A report from a multisectoral workshop March 2019

Christofferson, Rebecca C.; Parker, Daniel M.; Overgaard, Hans J.; Hii, Jeffrey; Devine, Gregor J.; Wilcox, Bruce A.; Nam, Vũ Sinh; AbuBakar, Sazaly; Boyer, Sébastien; Boonnak, Kobporn; Whitehead, Stephen S.; Huy, Rekol; Leang, Rithea; Sochantha, Tho; Wellems, Thomas E.; Valenzuela, Jesús G.; Manning, Jessica E.

doi:10.1371/journal.pntd.0008302

Cited by 12 publications

(12 citation statements)

References 171 publications

(187 reference statements)

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“…and Orientia spp. are similarly projected to increase over the coming years (32,33). Several zoonoses arising in SEA have also come to recent attention due to the severity of their associated clinical syndromes, and/or their pandemic potential.…”

Section: Southeast Asia -At the Confluence Of Endemic Emerging And Resurgent Infectious Diseasesmentioning

confidence: 99%

The Pandemic Experience in Southeast Asia: Interface Between SARS-CoV-2, Malaria, and Dengue

et al. 2021

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Southeast Asia (SEA) emerged relatively unscathed from the first year of the global SARS-CoV-2 pandemic, but as of July 2021 the region is experiencing a surge in case numbers primarily driven by Alpha (B.1.1.7) and subsequently the more transmissible Delta (B.1.617.2) variants. While initial disease burden was mitigated by swift government responses, favorable cultural and societal factors, the more recent rise in cases suggests an under-appreciation of prior prevalence and over-appreciation of possible cross-protective immunity from exposure to endemic viruses, and highlights the effects of vaccine rollout at varying tempos and of variable efficacy. This burgeoning crisis is further complicated by co-existence of malaria and dengue in the region, with implications of serological cross-reactivity on interpretation of SARS-CoV-2 assays and competing resource demands impacting efforts to contain both endemic and pandemic disease.

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Section: Southeast Asia -At the Confluence Of Endemic Emerging And Resurgent Infectious Diseasesmentioning

confidence: 99%

The Pandemic Experience in Southeast Asia: Interface Between SARS-CoV-2, Malaria, and Dengue

et al. 2021

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“…Our study provides a more granular analysis of changing pathogen dynamics than prior surveillance with pre-determined targeted diagnostics like PCR (5,33,34). The hierarchy of species abundance identified here is likely attributed to current malaria elimination campaigns, heterogenous socioeconomic development, and increased human migration (4,35). DENV is now the most prevalent pathogen, particularly in children in comparison to neighboring countries, while malaria makes up a less substantial portion of febrile cases than in prior years where PCR-confirmed malaria infections was as high as 51.1%…”

Section: Discussionmentioning

confidence: 83%

“…In this prospective, cross-sectional mNGS study, we identified common and confounding pathogens and demonstrated the feasibility and usefulness of a decentralized metagenomic sequencing pipeline. Despite challenges of actionable mNGS surveillance in a resource-scarce settings, we contributed to genomics-informed pathogen epidemiology that is otherwise lacking in Cambodia and other similar settings, yet globally relevant given major demographic and socioeconomic shifts underway in the region that may increase the likelihood for disease epidemics (4,32).…”

Section: Discussionmentioning

confidence: 99%

“…In Southeast Asia where a quarter of the world's population resides, rapid but heterogeneous economic development juxtaposes low-resource and high-resource areas, causing high cross-border mobility of persons for economic opportunities. In Cambodia and Laos, laboratory testing for non-malarial fevers is limited, particularly in rural and peri-urban areas where simple diagnostics like dengue rapid tests may not be available (4). In many instances, healthcare providers make diagnoses and empiric treatment decisions based on symptoms so the responsible pathogen is rarely identified.…”

Section: Figures 1 To 4 Tables 1 Tomentioning

confidence: 99%

“…mNGS identified six cases of very low parasitemia (down to 16 parasites per uL) with P. vivax, initially missed on microscopy or rapid test. P. vivax has replaced P. falciparum as the most prevalent form of malaria in Southeast Asia, particularly in Cambodia where eradicative liver-stage treatment of P. vivax with primaquine has not yet been widely adopted (4). mNGS also identified P. knowlesi in a forest worker, previously diagnosed with P. malariae using blood smear microscopy.…”

Section: Plasmodium Sppmentioning

confidence: 99%

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Discovering disease-causing pathogens in resource-scarce Southeast Asia using a global metagenomic pathogen monitoring system

Bohl

Lay

Chea

et al. 2021

Preprint

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Understanding the regional pathogen landscape and surveillance of emerging pathogens is key to mitigating epidemics. Challenges lie in resource-scarce settings, where outbreaks are likely to emerge, but where laboratory diagnostics and bioinformatics capacity are limited. Using unbiased metagenomic next generation sequencing (mNGS), we identified a variety of vector-borne, zoonotic and emerging pathogens responsible for undifferentiated fevers in a peri-urban population in Cambodia. From March 2019 to October 2020, we enrolled 473 febrile patients aged 6 months to 65 years of age presenting to a large peri-urban hospital in Cambodia. We collected sera and prepared sequencing libraries from extracted pathogen RNA for unbiased metagenomic sequencing and subsequent bioinformatic analysis on the global cloud-based platform, IDseq. We employed multivariate Bayesian models to evaluate specific pathogen risk causing undifferentiated febrile illness. mNGS identified vector-borne pathogens as the largest clinical category with dengue virus (124/489) as the most abundant pathogen. Underappreciated zoonotic pathogens such as Plasmodium knowlesi, leptospirosis, and co-infecting HIV were also detected. Early detection of chikungunya virus presaged a larger national outbreak of more than 6,000 cases. Pathogen-agnostic mNGS investigation of febrile persons in resource-scarce Southeast Asia is feasible and revealing of a diverse pathogen landscape. Coordinated and ongoing unbiased mNGS pathogen surveillance can better identify the breadth of endemic, zoonotic or emerging pathogens and deployment of rapid public health response.

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Barriers to integrating diagnostic services for febrile illness to support surveillance and patient management in Asia‐Pacific

Gwaza

Lamy²,

Datta³

et al. 2022

Asia & Pacific Policy Stud

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As malaria cases continue to decline in Asia, an integrated service delivery approach is ever more urgent to ensure that no malaria and fever cases are missed, and that malaria health workers continue contributing to broader infectious disease control efforts. However, despite its perceived merit, translating integrated surveillance into practice poses several systemic challenges. This article aims to identify what is hindering improved processes for integrating diagnostic and surveillance services for febrile illnesses. Data from peer-reviewed and grey literature were reviewed using a systems approach based on the World Health Organisation health systems building blocks to fully understand the connections between different elements and system implications of integration. We include snippets from Sri Lanka, Myanmar, Malaysia and Nepal, highlighting expanded diagnostic integration best practices. This review provides a foundation for 'integration roadmaps' that can be adapted to different contexts and guide national stakeholders on the operational and political steps for a successful integration model. Such a model

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Current vector research challenges in the greater Mekong subregion for dengue, Malaria, and Other Vector-Borne Diseases: A report from a multisectoral workshop March 2019

Cited by 12 publications

References 171 publications

The Pandemic Experience in Southeast Asia: Interface Between SARS-CoV-2, Malaria, and Dengue

The Pandemic Experience in Southeast Asia: Interface Between SARS-CoV-2, Malaria, and Dengue

Discovering disease-causing pathogens in resource-scarce Southeast Asia using a global metagenomic pathogen monitoring system

Barriers to integrating diagnostic services for febrile illness to support surveillance and patient management in Asia‐Pacific

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