Influenza and respiratory syncytial virus dynamics in Lao PDR during the COVID-19 pandemic: a hospital-based surveillance study

Objectives: Globally, the circulation of influenza and other seasonal respiratory viruses changed dramatically during the COVID-19 pandemic. This study aims to determine the trends of acute respiratory infections (ARIs) caused by SARS-CoV-2, influenza A, influenza B and respiratory syncytial viruses (RSVs) in patients presenting to hospitals in the Lao People’s Democratic Republic (PDR) (Laos). Design: Prospective surveillance study. Setting: Four provincial hospitals across Laos between March 2021 and July 2023. Participants: Participants of all ages who met our case definition for an ARI (axillary temperature ≥37.5°C or history of fever AND cough or other respiratory symptoms/signs OR loss of smell and/or taste) presenting to the hospital less than 10 days after symptom onset were eligible to be enrolled in the study. Combined nasopharyngeal and throat swabs were tested for SARS-CoV-2, influenza A, influenza B and human RSV (hRSV) using probe-based real-time RT (Reverse transcription)-PCR assays. Primary outcome measure: The proportion of patients in whom SARS-CoV-2, influenza A, influenza B and hRSV was detected. Results: There were 4203 patients recruited, of whom 898 (21%) were children aged under 5 years. SARS-CoV-2 was detected in 16.9% of patients, followed by influenza A, influenza B and hRSV (8.4%, 7.2% and 4.7%, respectively). 98 patients (2.3%) were diagnosed with probable co-infection, with at least two viruses detected. After May 2022, the number of cases of influenza A, influenza B and hRSV increased rapidly. Six per cent of patients (263) had a quick Sequential Organ Failure Assessment score of ≥2, and 34 (0.8%) patients died, of whom 11 tested positive for a respiratory virus. Conclusions: During the COVID-19 pandemic in Laos, few respiratory viruses were detected by passive surveillance until the relaxation of non-pharmaceutical interventions implemented for infection control. After restrictions were lifted, influenza A, influenza B and hRSV emerged rapidly, showing the importance of continuous surveillance

Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion

Background Antimicrobial resistance (AMR) is a global health priority. Leading UK and global strategy papers to fight AMR recognise its social and behavioural dimensions, but current policy responses to improve the popular use of antimicrobials (eg, antibiotics) are limited to education and awareness-raising campaigns. In response to conceptual, methodological and empirical weaknesses of this approach, we study people’s antibiotic-related health behaviour through three research questions. RQ1: What are the manifestations and determinants of problematic antibiotic use in patients’ healthcare-seeking pathways? RQ2: Will people’s exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices? RQ3: Which proxy indicators facilitate the detection of problematic antibiotic behaviours across and within communities? Methods We apply an interdisciplinary analytical framework that draws on the public health, medical anthropology, sociology and development economics literature. Our research involves social surveys of treatment-seeking behaviour among rural dwellers in northern Thailand (Chiang Rai) and southern Lao PDR (Salavan). We sample approximately 4800 adults to produce district-level representative and social network data. Additional 60 cognitive interviews facilitate survey instrument development and data interpretation. Our survey data analysis techniques include event sequence analysis (RQ1), multilevel regression (RQ1–3), social network analysis (RQ2) and latent class analysis (RQ3). Discussion Social research in AMR is nascent, but our unprecedentedly detailed data on microlevel treatment-seeking behaviour can contribute an understanding of behaviour beyond awareness and free choice, highlighting, for example, decision-making constraints, problems of marginalisation and lacking access to healthcare and competing ideas about desirable behaviour

Temperature of a Dengue Rapid Diagnostic Test under Tropical Climatic Conditions: A Follow Up Study

<div><p>The Dengue Duo Rapid Diagnostic Test (SD Dengue RDT) has good specificity and sensitivity for dengue diagnosis in rural tropical areas. In a previous study, using four control sera, we demonstrated that that the diagnostic accuracy of these RDTs remains stable after long-term storage at high temperatures. We extended this study by testing sera from 119 febrile patients collected between July-November 2012 at Salavan Provincial Hospital (southern Laos) with RDTs stored for 6 months at 4°C, 35° and in a hut (miniature traditional house) at Lao ambient temperatures. The dengue NS1 antigen results from RDTs stored at 35°C and in the hut demonstrated 100% agreement with those stored at 4°C. However, lower positive percent agreements, with broad 95%CI, were observed for the tests: IgM, 60% (14.7–94.7) and 40% (5.3–85.3) for RDTs store at 35°C and in the hut, compared to those stored at 4°C, respectively. This study strenghtens the evidence of the robustness of the NS1 antigen detection RDT for the diagnosis of dengue after storage at tropical temperatures.</p></div

Reports of apparent mixed infections in Asia that included rickettsioses.

<p>Reports of apparent mixed infections in Asia that included rickettsioses.</p

Overview of PCR-based and DNA sequencing results.

*<p>positivity criteria in analogy to the Minimum Information for Publication of Quantitative Real-Time PCR Experiments (MIQE) <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002163#pntd.0002163-Bustin1" target="_blank">[19]</a>. GenBank accession numbers:</p>1<p>BankIt1587796 Seq2 KC283067.</p>2<p>BankIt1587796 Seq3 KC283068.</p>3<p>BankIt1587796 Seq1 KC283066.</p

Evaluation of trends in hospital antimicrobial use in the Lao PDR using repeated point-prevalence surveys-evidence to improve treatment guideline use

Background Antimicrobial use (AMU) is a key driver of antimicrobial resistance (AMR). There are few data on AMU, to inform optimizing antibiotic stewardship, in the Lao PDR (Laos). Methods Point prevalence surveys (PPS) of AMU were conducted at four-month intervals in six general hospitals across Laos from 2017 to 2020, using modified Global-PPS data collection tools. The surveys focused on AMU amongst hospitalized inpatients. Findings The overall prevalence of inpatient AMU was 71% (4,377/6,188), varying by hospital and survey round from 50·4% (135/268) to 88·4% (61/69). Of 4,377 patients, 44% received >one antimicrobial. The total number of prescriptions assessed was 6,555. Ceftriaxone was the most commonly used (39·6%) antimicrobial, followed by metronidazole (17%) and gentamicin (10%). Pneumonia was the most common diagnosis among those prescribed antimicrobials in both children aged ≤5 years (29% among aged ≤1 year and 27% among aged >1 to ≤5years) and adults aged ≥15 years at 9%. The percentage of antimicrobial use compliant with local treatment guidelines was 26%; inappropriate use was mainly found for surgical prophylaxis (99%). Adult patients received ACCESS group antimicrobials less commonly than children (47% vs 63%, p-value<0·0001). Most WATCH group prescriptions (99%) were without a microbiological indication. Interpretation AMU among hospitalized patients in Laos is high with frequent inappropriate use of antimicrobials, especially as surgical prophylaxis. Continued monitoring and enhanced antimicrobial stewardship interventions are needed in Lao hospitals. Funding The Wellcome Trust [Grant numbers 220211/Z/20/Z and 214207/Z/18/Z] and bioMérieux

Efficiency of dengue RNA extraction from different RDT parts (S, C, N1 and N2) compared to the direct extraction for all isolate dilutions for the four dengue serotypes.

In y axis: RNA recovery in percentage: (RDT/Dir)*100 = ratio of the mean number of dengue RNA copies/μl recovered by RDT extraction (S, C, N1 or N2 parts) over the mean number of dengue RNA copies/μl recovered by the direct extraction. X-axis: RSD = relative standard deviation for the different extraction techniques.</p