Publications

Global dengue importation: a systematic review

Abstract

Background: Importation of dengue following globalization presents an emerging threat to global health. However, evidence on global geographical sources and the potential of dengue importation globally are lacking. This study aims to systematically review the sources of dengue importation globally and the risk of dengue outbreaks globally.

Methods: This systematic review was conducted in accordance to Cochrane’s PRISMA guidelines. Articles published through 31 December 2019 with laboratory-confirmed dengue imported cases were consolidated from PubMed, EMBASE and Scopus. Sources of dengue importation reported worldwide were analysed by country and geographical regions. Sources of dengue importation into United States of America and Europe specifically were also analysed.

Results: A total of 3762 articles were found. Among which, 210 articles—documenting 14,972 imported dengue cases with reported sources—were eligible. 76.3% of imported cases worldwide were from Asia. 15.7%, 5.6%, 2.0% and 0.1% were imported from the Americas, Africa, Oceania and Europe regions respectively. Imported dengue cases in the U.S. were from Americas (55.3%), Asia (34.7%), Africa (6.7%) and Oceania (3.3%). Imported dengue cases in Europe were from Asia (66.0%), Americas (21.9%), Africa (10.8%) and Oceania (1.1%).

Conclusion: The potential of dengue outbreaks occurring globally, especially among non-endemic regions with dengue-susceptible populations is high. With the expansion of Aedes mosquito population globally due to global warming and globalisation, dengue importation constitutes an emerging global health security threat.

Citation: Gwee, X.W.S., Chua, P.E.Y. & Pang, J. Global dengue importation: a systematic review. BMC Infect Dis 21, 1078 (2021). https://doi.org/10.1186/s12879-021-06740-1

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Wastewater surveillance to infer COVID-19 transmission: A systematic review

Abstract

Successful detection of SARS-COV-2 in wastewater suggests the potential utility of wastewater-based epidemiology (WBE) for COVID-19 community surveillance. This systematic review aims to assess the performance of wastewater surveillance as early warning system of COVID-19 community transmission. A systematic search was conducted in PubMed, Medline, Embase and the WBE Consortium Registry according to PRISMA guidelines for relevant articles published until 31st July 2021. Relevant data were extracted and summarized. Quality of each paper was assessed using an assessment tool adapted from Bilotta et al.’s tool for environmental science. Of 763 studies identified, 92 studies distributed across 34 countries were shortlisted for qualitative synthesis. A total of 26,197 samples were collected between January 2020 and May 2021 from various locations serving population ranging from 321 to 11,400,000 inhabitants. Overall sample positivity was moderate at 29.2% in all examined settings with the spike (S) gene having maximum rate of positive detections and nucleocapsid (N) gene being the most targeted. Wastewater signals preceded confirmed cases by up to 63 days, with 13 studies reporting sample positivity before the first cases were detected in the community. At least 50 studies reported an association of viral load with community cases. While wastewater surveillance cannot replace large-scale diagnostic testing, it can complement clinical surveillance by providing early signs of potential transmission for more active public health responses. However, more studies using standardized and validated methods are required along with risk analysis and modelling to understand the dynamics of viral outbreaks.

Citation: Shah, S., Gwee, S., Ng, J., Lau, N., Koh, J., & Pang, J. (2022). Wastewater surveillance to infer COVID-19 transmission: A systematic review. The Science of the Total Environment804, 150060. https://doi.org/10.1016/j.scitotenv.2021.150060

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Factors influencing SARS-CoV-2 transmission and outbreak control measures in densely populated settings

Abstract

Starting with a handful of SARS-CoV-2 infections in dormitory residents in late March 2020, rapid transmission in their dense living environments ensued and by October 2020, more than 50,000 acute infections were identified across various dormitories in Singapore. The aim of the study is to identify combination of factors facilitating SARS-CoV-2 transmission and the impact of control measures in a dormitory through extensive epidemiological, serological and phylogenetic investigations, supported by simulation models. Our findings showed that asymptomatic cases and symptomatic cases who did not seek medical attention were major drivers of the outbreak. Furthermore, each resident had about 30 close contacts and each infected resident spread to 4.4 (IQR 3.5–5.3) others at the start of the outbreak. The final attack rate of the current outbreak was 76.2% (IQR 70.6–98.0%) and could be reduced by further 10% under a modified dormitory housing condition. These findings are important when designing living environments in a post COVID-19 future to reduce disease spread and facilitate rapid implementation of outbreak control measures.

Citation: Pung, R., Lin, B., Maurer-Stroh, S. et al. Factors influencing SARS-CoV-2 transmission and outbreak control measures in densely populated settings. Sci Rep 11, 15297 (2021). https://doi.org/10.1038/s41598-021-94463-3

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Impact of travel ban implementation on COVID-19 spread in Singapore, Taiwan, Hong Kong and South Korea during the early phase of the pandemic: a comparative study

Abstract

Background: The COVID-19 pandemic has elicited imposition of some form of travel restrictions by almost all countries in the world. Most restrictions currently persist, although some have been gradually eased. It remains unclear if the trade-off from the unprecedented disruption to air travel was well worth for pandemic containment.

Method: A comparative analysis was conducted on Singapore, Taiwan, Hong Kong and South Korea’s COVID-19 response. Data on COVID-19 cases, travel-related and community interventions, socio-economic profile were consolidated. Trends on imported and local cases were analyzed using computations of moving averages, rate of change, particularly in response to distinct waves of travel-related interventions due to the outbreak in China, South Korea, Iran & Italy, and Europe.

Results: South Korea’s travel restrictions were observed to be consistently more lagged in terms of timeliness and magnitude, with their first wave of travel restrictions on flights departing from China implemented 34 days after the outbreak in Wuhan, compared to 22–26 days taken by Singapore, Taiwan and Hong Kong. South Korea’s restrictions against all countries came after 91 days, compared to 78–80 days for the other three countries. The rate of change of imported cases fell by 1.08–1.43 across all four countries following the first wave of travel restrictions on departures from China, and by 0.22–0.52 in all countries except South Korea in the fifth wave against all international travellers. Delayed rate of change of local cases resulting from travel restrictions imposed by the four countries with intrinsic importation risk, were not observed.

Conclusions: Travel restriction was effective in preventing COVID-19 case importation in early outbreak phase, but may still be limited in preventing general local transmission. The impact of travel restrictions, regardless of promptness, in containing epidemics likely also depends on the effectiveness of local surveillance and non-pharmaceutical interventions concurrently implemented.

Citation: Gwee, S.X.W., Chua, P.E.Y., Wang, M.X. et al. Impact of travel ban implementation on COVID-19 spread in Singapore, Taiwan, Hong Kong and South Korea during the early phase of the pandemic: a comparative study. BMC Infect Dis 21, 799 (2021). https://doi.org/10.1186/s12879-021-06449-1

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Relationship between local weather, air pollution and hospital attendances for urticaria in children: Time stratified analysis of 12,002 cases

Citation: Choo KJL, Ho AFW, Gui H, Tay PJM, Lee HY, Koh MS, Earnest A, Pek PP, Liu N, Chong SL, Pang J, Ong MEH. Relationship between local weather, air pollution and hospital attendances for urticaria in children: Time stratified analysis of 12,002 cases. Clin Exp Allergy. 2021 Sep 22. doi: 10.1111/cea.14015. Epub ahead of print. PMID: 34549849.

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Factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic: a cross-sectional study in 12 Asian countries

Abstract

Introduction: Regardless of having effective vaccines against COVID-19, containment measures such as enhanced physical distancing and good practice of personal hygiene remain the mainstay of controlling the COVID-19 pandemic. Countries across Asia have imposed these containment measures to varying extents. However, residents in different countries would have a differing degree of compliance to these containment measures potentially due to differences in the level of awareness and motivation in the early phase of pandemic.

Objectives: In our study, we aimed to describe and correlate the level of knowledge and attitude with the level of compliance with personal hygiene and physical distancing practices among Asian countries in the early phase of pandemic.

Methods: A multinational cross-sectional study was carried out using electronic surveys between May and June 2020 across 14 geographical areas. Subjects aged 21 years and above were invited to participate through social media, word of mouth and electronic mail.

Results: Among the 2574 responses obtained, 762 (29.6%) participants were from East Asia and 1812 (70.4%) were from Southeast Asia (SEA). A greater proportion of participants from SEA will practise physical distancing as long as it takes (72.8% vs 60.6%). Having safe distancing practices such as standing more than 1 or 2 m apart (AdjOR 5.09 95% CI (1.08 to 24.01)) or more than 3 or 4 m apart (AdjOR 7.05 95% CI (1.32 to 37.67)), wearing a mask when they had influenza-like symptoms before the COVID-19 pandemic, preferring online news channels such as online news websites/applications (AdjOR 1.73 95% CI (1.21 to 2.49)) and social media (AdjOR 1.68 95% CI (1.13 to 2.50) as sources of obtaining information about COVID-19 and high psychological well-being (AdjOR 1.39 95% CI (1.04 to 1.87)) were independent factors associated with high compliance.

Conclusions: We found factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic and it will be useful to consider them in risk assessment, communication and pandemic preparedness.

Citation: Chua CEKew GSDemutska A, et al. Factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic: a cross-sectional study in 12 Asian countries.

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Epidemiological and clinical characteristics of non-severe and severe pediatric and adult COVID-19 patients across different geographical regions in the early phase of pandemic: a systematic review and meta-analysis of observational studies

Abstract

This systematic and meta-review aimed to compare clinical presentation, outcomes, and care management among patients with COVID-19 during the early phase of the pandemic. A total of 77 peer-reviewed publications were identified between January 1, 2020 and April 9, 2020 from PubMed, Google Scholar, and Chinese Medical Journal databases. Subsequently, meta-analysis of 40 non-overlapping studies, comprising of 4844 patients from seven countries, was conducted to see differences in clinical characteristics and laboratory outcomes across patients from different geographical regions (Wuhan, other parts of China and outside China), severity (non-severe, severe and fatal) and age groups (adults and children). Patients from Wuhan had a higher mean age (54.3 years) and rates of dyspnea (39.5%) compared with patients from other parts of China and outside China. Myalgia, fatigue, acute respiratory distress syndrome (ARDS) and fatalities were also significantly more prevalent among Wuhan patients. A significant dose–response increase in prevalence of diabetes, D-dimer, white blood cells, neutrophil levels and ARDS was seen from non-severe to severe and fatal outcomes. A significant increase in mean duration of symptom onset to admission was seen between non-severe cases (4.2 days) and severe and fatal cases (6.3 days and 8.8 days, respectively). Proportion of asymptomatic cases was higher in children (20%) compared with adults (2.4%). In conclusion, patients with COVID-19 from Wuhan displayed more severe clinical disease during the early phase of the pandemic, while disease severity was significantly lesser among pediatric cases. This review suggests that biomarkers at admission may be useful for prognosis among patients with COVID-19.

Citation: Chua PEYShah SUGui H, et al. Epidemiological and clinical characteristics of non-severe and severe pediatric and adult COVID-19 patients across different geographical regions in the early phase of pandemic: a systematic review and meta-analysis of observational studies.

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Association between well-being and compliance with COVID-19 preventive measures by healthcare professionals: A cross-sectional study

Abstract

Importance: Knowledge and attitude influence compliance and individuals’ practices. The risk and protective factors associated with high compliance to these preventive measures are critical to enhancing pandemic preparedness.

Objective: This survey aims to assess differences in mental health, knowledge, attitudes, and practices (KAP) of preventive measures for COVID-19 amongst healthcare professionals (HCP) and non-healthcare professionals.

Design: Multi-national cross-sectional study was carried out using electronic surveys between May-June 2020.

Setting: Multi-national survey was distributed across 36 countries through social media, word-of-mouth, and electronic mail.

Participants: Participants ≥21 years working in healthcare and non-healthcare related professions.

Main outcome: Risk factors determining the difference in KAP towards personal hygiene and social distancing measures during COVID-19 amongst HCP and non-HCP.

Results: HCP were significantly more knowledgeable on personal hygiene (AdjOR 1.45, 95% CI -1.14 to 1.83) and social distancing (AdjOR 1.31, 95% CI -1.06 to 1.61) compared to non-HCP. They were more likely to have a positive attitude towards personal hygiene and 1.5 times more willing to participate in the contact tracing app. There was high compliance towards personal hygiene and social distancing measures amongst HCP. HCP with high compliance were 1.8 times more likely to flourish and more likely to have a high sense of emotional (AdjOR 1.94, 95% CI (1.44 to 2.61), social (AdjOR 2.07, 95% CI -1.55 to 2.78), and psychological (AdjOR 2.13, 95% CI (1.59–2.85) well-being.

Conclusion and relevance: While healthcare professionals were more knowledgeable, had more positive attitudes, their higher sense of total well-being was seen to be more critical to enhance compliance. Therefore, focusing on the well-being of the general population would help to enhance their compliance towards the preventive measures for COVID-19.

Citation: Shah SU, Xiu Ling Loo E, En Chua C, Sen Kew G, Demutska A, et al. (2021) Association between well-being and compliance with COVID-19 preventive measures by healthcare professionals: A cross-sectional study. PLOS ONE 16(6): e0252835. https://doi.org/10.1371/journal.pone.0252835

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Impact of the coronavirus disease 2019 pandemic on irritable bowel syndrome

Abstract

Background and Aim: Gastrointestinal manifestations of the coronavirus disease 2019 (COVID‐19) pandemic may mimic irritable bowel syndrome (IBS), and social distancing measures may affect IBS patients negatively. We aimed to study the impact of COVID‐19 on respondents with self‐reported IBS.

Methods: We conducted an anonymized survey from May to June 2020 in 33 countries. Knowledge, attitudes, and practices on personal hygiene and social distancing as well as psychological impact of COVID‐19 were assessed. Statistical analysis was performed to determine differences in well‐being and compliance to social distancing measures between respondents with and without self‐reported IBS. Factors associated with improvement or worsening of IBS symptoms were evaluated.

Results: Out of 2704 respondents, 2024 (74.9%) did not have IBS, 305 (11.3%) had self‐reported IBS, and 374 (13.8%) did not know what IBS was. Self‐reported IBS respondents reported significantly worse emotional, social, and psychological well‐being compared with non‐IBS respondents and were less compliant to social distancing measures (28.2% vs 35.3%, P = 0.029); 61.6% reported no change, 26.6% reported improvement, and 11.8% reported worsening IBS symptoms. Higher proportion of respondents with no change in IBS symptoms were willing to practice social distancing indefinitely versus those who deteriorated (74.9% vs 51.4%, P = 0.016). In multivariate analysis, willingness to continue social distancing for another 2–3 weeks (vs longer period) was significantly associated with higher odds of worsening IBS.

Conclusion: Our study showed that self‐reported IBS respondents had worse well‐being and compliance to social distancing measures than non‐IBS respondents. Future research will focus on occupational stress and dietary changes during COVID‐19 that may influence IBS.

Citation: Quek, S., Loo, E., Demutska, A., Chua, C. E., Kew, G. S., Wong, S., Lau, H. X., Low, E., Loh, T. L., Lung, O. S., Hung, E., Rahman, M. M., Ghoshal, U. C., Wong, S. H., Cheung, C., Syam, A. F., Tan, N., Xiao, Y., Liu, J. S., Lu, F., … Siah, K. (2021). Impact of the coronavirus disease 2019 pandemic on irritable bowel syndrome. Journal of gastroenterology and hepatology, 10.1111/jgh.15466. Advance online publication. https://doi.org/10.1111/jgh.15466

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Clinical Signs and Symptoms Associated with WHO Severe Dengue Classification: A Systematic Review and Meta-analysis

Abstract

Background: The World Health Organization (WHO) introduced the new dengue classification in 2009. We aimed to assess the association of clinical signs and symptoms with WHO severe dengue classification in clinical practice.

Methods: A systematic literature search was performed using the databases of PubMed, Embase, and Scopus between 2009 and 2018 according to PRISMA guideline. Meta-analysis was performed with the RevMan software. A random or fixed-effect model was applied to pool odds ratios and 95% confidence intervals of important signs and symptoms across studies.

Results: 39 articles from 1,790 records were included in this review. In our meta-analysis, signs and symptoms associated with higher risk of severe dengue were comorbidity, vomiting, persistent vomiting, abdominal pain or tenderness, pleural effusion, ascites, epistaxis, gum bleeding, GI bleeding, skin bleeding, lethargy or restlessness, hepatomegaly (>2 cm), increased HCT with decreased platelets, shock, dyspnea, impaired consciousness, thrombocytopenia, elevated AST and ALT, gall bladder wall thickening and secondary infection.

Conclusion: This review shows new factors comorbidity, epistaxis, GI and skin bleeding, dyspnea, gall bladder wall thickening and secondary infection may be useful to refine the 2009 classification to triage severe dengue patients.

Citation: Tha Pyai Htun, Zhonghui Xiong & Junxiong Pang (2021) Clinical Signs and Symptoms Associated with WHO Severe Dengue Classification: A Systematic Review and Meta-analysis, Emerging Microbes & Infections, DOI: 10.1080/22221751.2021.1935327

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