Prevalence of anti-Leptospira antibodies and associated risk factors in the Malaysian refugee communities

BackgroundRefugees in Malaysia, who are afflicted by poverty, conflict and poor health, are vulnerable to a range of zoonotic infections in the deprived environmental and social conditions under which they live. Exposure to infections such as leptospirosis, for which rodents are primary hosts, is of particular concern.MethodsA wellness program was conducted to determine the presence of antibodies against Leptospira (seroprevalence) in 11 refugee community schools and centers in the Klang Valley, Malaysia. A total of 433 samples were assessed for IgG and IgM antibodies against Leptospira, using enzyme-linked immunosorbent assays (ELISA).ResultsOverall Leptospira seroprevalence was 24.7%, with 3.0% being seropositive for anti-Leptospira IgG and 21.7% for anti-Leptospira IgM. Factors significantly associated with overall Leptospira seroprevalence included: age, ethnicity, pet ownership, knowledge of disease and awareness of disease fatality. For IgM seroprevalence, significant risk factors included sex, ethnicity, eating habits with hands, pet ownership, the presence of rats, walking in bare feet and water recreation visits.ConclusionsThese findings highlight the need for improvements in health and well-being among the refugee community through disease awareness programs and provision of healthy behavior programs, particularly in hygiene and sanitation through community engagement activities

Socio-demographic determinants of Toxoplasma gondii seroprevalence in migrant workers of Peninsular Malaysia

Background The number of migrants working in Malaysia has increased sharply since the 1970’s and there is concern that infectious diseases endemic in other (e.g. neighbouring) countries may be inadvertently imported. Compulsory medical screening prior to entering the workforce does not include parasitic infections such as toxoplasmosis. Therefore, this study aimed to evaluate the seroprevalence of T. gondii infection among migrant workers in Peninsular Malaysia by means of serosurveys conducted on a voluntary basis among low-skilled and semi-skilled workers from five working sectors, namely, manufacturing, food service, agriculture and plantation, construction and domestic work. Methods A total of 484 migrant workers originating from rural locations in neighbouring countries, namely, Indonesia (n = 247, 51.0%), Nepal (n = 99, 20.5%), Bangladesh (n = 72, 14.9%), India (n = 52, 10.7%) and Myanmar (n = 14, 2.9%) were included in this study. Results The overall seroprevalence of T. gondii was 57.4% (n = 278; 95% CI: 52.7–61.8%) with 52.9% (n = 256; 95% CI: 48.4–57.2%) seropositive for anti-Toxoplasma IgG only, 0.8% (n = 4; 95% CI: 0.2–1.7%) seropositive for anti-Toxoplasma IgM only and 3.7% (n = 18; 95% CI: 2.1–5.4%) seropositive with both IgG and IgM antibodies. All positive samples with both IgG and IgM antibodies showed high avidity (> 40%), suggesting latent infection. Age (being older than 45 years), Nepalese nationality, manufacturing occupation, and being a newcomer in Malaysia (excepting domestic work) were positively and statistically significantly associated with seroprevalence (P < 0.05). Conclusions The results of this study suggest that better promotion of knowledge about parasite transmission is required for both migrant workers and permanent residents in Malaysia. Efforts should be made to encourage improved personal hygiene before consumption of food and fluids, thorough cooking of meat and better disposal of feline excreta from domestic pets

Biodiversity and epidemiology study of macroparasites from stray cats in Peninsular Malaysia / Norhidayu binti Sahimin

The occurrences of macroparasites from 543 stray cats were studied in four urban cities from west (Kuala Lumpur), east (Kuantan), north (Georgetown) and south (Malacca) of Peninsular Malaysia between May 2007 to August 2010. The hosts were infested with a minimum of one species and a maximum of six species of macroparasites. Of all four locations, Georgetown had the highest species diversity followed by Malacca, Kuala Lumpur and Kuantan. Five ectoparasites species were recovered namely, Ctenocephalides felis, Felicola subrostratus, Haemaphysalis bispinosa, Heterodoxus spiniger and Lynxacarus radovskyi. This study also recorded the dog louse, Heterodoxus spiniger for the first time in Malaysia from two cats in Georgetown. The cat fur mite, Lynxacarus radovskyi also reported for the first time on domestic cats from Peninsular Malaysia. Overall, species diversity of ectoparasites was low compared to previous studies. Similar infestations were observed between males and females meanwhile higher diversity of species richness was observed in adults compared to juveniles. Results showed no significant effect determining the ectoparasites distribution in stray cats population for any of the factors investigated. Up to nine species of helminthes were recovered with overall high prevalences of infection in Kuantan (83%), Kuala Lumpur (75.1%), Georgetown (71.6%) and lastly Malacca (68%). The nine helminthes comprised of six nematode species (Toxocara malaysiensis, Toxocara cati, Ancylostoma braziliensis, Ancylostoma ceylanicum, Strongyloides sp., Physaloptera praeputialis), two cestode (Taenia taeniaformis, Dipylidium caninum) and one trematode species (Playtnosomum fastosum). Most helminthes were present in all study sites except for the sole presence of Strongyloides sp. and the absence of Physaloptera praeputialis in Kuala Lumpur. Variation in host age was observed playing a significant role especially for Ancylostoma braziliense and Ancylostoma ceylanicum. Adults were significantly higher compared to juvenile cats, but reversely for Toxocara malaysiensis and Toxocara cati. No significant difference occurred between host sexes meanwhile the season affect was linked with differences in the host population between seasons, with twice as many cats being caught in the dry season, during a period of more active foraging. Pearson‟s product-moment correlation coefficient analysis showed positive co-occurrences have been shown to occur between the four endoparasite species (Ancylostoma braziliense, Ancylostoma ceylanicum, Toxocara malaysiensis and Toxocara cati) occupying similar niches within the alimentary tract of cats. Strong correlation were observed between Toxocara cati and Toxocara malaysiensis (p=0.982), Toxocara cati – Toxocara malaysiensis and Toxocara cati – Ancylostoma ceylanicum (p=0.994) and between Toxocara cati – Ancylostoma braziliense and Toxocara cati – Ancylostoma ceylanicum (p=0.919). In the molecular characterization study, amplification of ITS 1 and ITS 2 regions of Toxocara malaysiensis rDNA was successful using universal Fallas-Kaplan primer with estimated product length 1200bp. Hence, further analysis should be carried out in the future in order to corroborate present results obtained. Lastly, the zoonotic potential of three endoparasite species namely Ancylostoma braziliense, Ancylostoma ceylanicum and Toxocara cati in this study underscores the role of stray cats in Peninsular Malaysia as reservoir host for zoonotic disease. This study also provided a reliable basis for an ongoing monitoring, comparison and assessment of the local cat-borne endoparasites in Peninsular Malaysia

Parasitic infections amongst migrant workers in Malaysia / Norhidayu Sahimin

Sociodemographic background of 610 migrant workers employed in Malaysia was collected via questionnaire to determine their parasitic health status. Six nationalities were recruited with most workers from Indonesia (49.5%), followed by Bangladesh (19.2%), Nepal (16.4%), India (10.5%), Myanmar (4.3%) and Vietnam (0.2%) and employed in five working sectors namely; domestic service (24.3%), construction (22.8%), food service (21.0%), plantation (16.7%) and manufacturing (15.2%). A total of 388 individuals provided faecal samples for parasitic screening via microscopy. Four nematode species (Ascaris lumbricoides, Trichuris trichiura Enterobius vermicularis, and hookworms), one cestode (Hymenolepis nana) and three protozoan species (Entamoeba histolytica/dispar, Giardia spp. and Cryptosporidium spp.) were recovered. High prevalence of infections with Ascaris lumbricoides (43.3%) was recorded followed by hookworms (13.1%) and E. histolytica/dispar (11.6%) with infections significantly influenced by nationality, years of residence in Malaysia, employment sector and education level. Toxoplasma gondii infections were screened serologically from 484 workers with more than half of the workers were seropositive (57.4%) with 52.9% seropositive for anti-Toxoplasma IgG only, 0.8% seropositive for anti-Toxoplasma IgM only and 3.7% seropositive with both IgG and IgM antibodies. Samples positive for both IgG and IgM antibodies were further tested for IgG avidity showed high avidity suggesting latent infection in 18 workers. Four significant factors recorded namely; age, nationality, employment sector and length of residence in Malaysia. Three diagnostic methods were tested and compared to detect Strongyloides stercoralis infections in 306 migrant workers with 37.6% were seropositive. Subsequent confirmation using a nested PCR showed successful amplification from three males (2.6%) with target amplicon of approximately 680bp. For the three methods, nested PCR was the most sensitivity method in the detection for strongyloidiasis and should be applied in future studies. PCR method was also applied to determine the species level for four parasite‘s genus recovered in the population. Internal transcribed spacer 2 and 28S ribosomal RNA region of N. americanus and Ancylostoma spp. was successfully amplified and resulted in A. duodenale reported for the first time in Malaysia. Nested PCR targeting 16S-like ribosomal RNA gene successfully recovered E. dispar as the most dominant infection among workers. Despite the low presence of E. histolytica in the population, it still carries a public health risk. Amplification of the triosephosphate isomerase (TPI) gene from G. duodenalis isolates successfully obtained the presence of assemblage B and sub-assemblage AII suggesting the mode of transmission was human-to-human. Based on the SSU rRNA gene, the C. parvum amplicons were successfully detected in 9 human isolates

Distribution of Giardia duodenalis (Assemblages A and B) and Cryptosporidium parvum amongst migrant workers in Peninsular Malaysia

The influx of low skilled workers from socioeconomically deprived neighbouring countries to Malaysia has raised concerns about the transmission of communicable gastrointestinal diseases such as giardiasis and cryptosporidiosis to the local population. Therefore, a cross sectional study was conducted to investigate the prevalence of both diseases and the genetic diversity of these pathogens in the migrant population. Microscopic examination of faecal samples from 388 migrant workers involved in five working sectors were screened and 10.8% (n = 42) were found to be positive with Giardia spp. and 3.1% (n = 12) with Cryptosporidium spp. infections. PCR amplicons at the triosephosphate isomerase (tpi) gene were successfully obtained for Giardia duodenalis from 30 (30/388; 7.73%) samples with assemblages AII and B in 13 (13/30; 43.3%) and 17 (17/30; 56.7%) positive samples, respectively. Nine samples (9/388; 2.3%) were identified as Cryptosporidium parvum using PCR-RFLP analysis. Country of origin, duration of residence in Malaysia and working sectors significantly influenced G. duodenalis assemblage AII infections amongst the targeted population. Meanwhile, C. parvum infection was significantly associated with those working in the food service sector. Despite the low presence of pathogenic G. duodenalis and C. parvum in the study population, the results highlight the risk of anthroponotic foodborne and waterborne transmission and therefore call for implementation of control strategies through improvements in personal hygiene and sanitation standards

Migrant Workers in Malaysia: Current Implications of Sociodemographic and Environmental Characteristics in the Transmission of Intestinal Parasitic Infections.

A cross-sectional study of intestinal parasitic infections amongst migrant workers in Malaysia was conducted. A total of 388 workers were recruited from five sectors including manufacturing, construction, plantation, domestic and food services. The majority were recruited from Indonesia (n = 167, 43.3%), followed by Nepal (n = 81, 20.9%), Bangladesh (n = 70, 18%), India (n = 47, 12.1%) and Myanmar (n = 23, 5.9.2%). A total of four nematode species (Ascaris lumbricoides, Trichuris trichiura, Enterobius vermicularis and hookworms), one cestode (Hymenolepis nana) and three protozoan species (Entamoeba histolytica/dispar, Giardia sp. and Cryptosporidium spp.) were identified. High prevalence of infections with A. lumbricoides (43.3%) was recorded followed by hookworms (13.1%), E. histolytica/dispar (11.6%), Giardia sp. (10.8%), T. trichura (9.5%), Cryptosporodium spp. (3.1%), H. nana (1.8%) and E. vermicularis (0.5%). Infections were significantly influenced by socio-demographic (nationality), and environmental characteristics (length of working years in the country, employment sector and educational level). Up to 84.0% of migrant workers from Nepal and 83.0% from India were infected with intestinal parasites, with the ascarid nematode A. lumbricoides occurring in 72.8% of the Nepalese and 68.1% of the Indian population. In addition, workers with an employment history of less than a year or newly arrived in Malaysia were most likely to show high levels of infection as prevalence of workers infected with A. lumbricoides was reduced from 58.2% to 35.4% following a year's residence. These findings suggest that improvement is warranted in public health and should include mandatory medical screening upon entry into the country

Assessing the knowledge of, attitudes towards, and practices in, food safety among migrant workers in Klang Valley, Malaysia

Background: Annually, 600 million individuals are affected by food-borne diseases (FBD), alongside 425,000 fatalities. Improving the general public knowledge of, attitudes towards, and practices in, (KAP) food safety is necessary for minimizing FBD transmission. In Malaysia, migrant workers account for 11.1% of the workforce, with a high proportion involved in food and beverage services. Therefore, this study aimed (i) to evaluate the current food safety KAP, and (ii) to identify the strategies to promote food safety awareness, among migrant workers across occupational sectors in Klang Valley. Method: A survey was conducted with 403 migrant workers through phone interviews and online self-administered questionnaires. Piecewise structural equation modelling and multinomial regression were applied to identify predictor variables for food safety KAP and to explore differences across nationalities. Results: The respondents were Nepalese, Filipino and Indonesian. The majority were male, working in the services industry, had completed high school, aged between 30 and 39 years and had worked in Malaysia for less than ten years. Knowledge was significantly correlated with attitudes and practices. Female respondents had lower knowledge and attitude scores while younger respondents had lower knowledge scores. Indonesian and Filipino respondents had lower knowledge and attitudes scores than Nepalese respondents. Understanding food safety information from social media was positively correlated with the respondents’ food safety knowledge and practices. Conclusion: These findings highlighted: (i) the need to target female, younger, Indonesian and Filipino migrant workers, and (ii) the potential of social media to improve public awareness of food safety and hygienic practices

Epidemiology and immunodiagnostics of Strongyloides stercoralis infections among migrant workers in Malaysia

To investigate the status of Strongyloides(S.) stercoralis infections among migrant workers in Malaysia for the first time and identify risk factors. Methods: Four diagnostic methods were employed for the detection of S. stercoralis including microscopy, enzyme-linked immunosorbent assay (ELISA) using a commercial kit, ELISA using the rSs1a antigen and polymerase chain reaction (PCR). Low and semi-skilled workers from five working sectors (i.e. manufacturing, food service, agriculture and plantation, construction and domestic service) were tested on a voluntary basis. Results: The overall seroprevalence of S. stercoralis from 483 workers employing the ELISA commercial kit for IgG was 35.8% (n=173; 95% CI: 31.5%-40.1%) whereas seroprevalence using the rSs1a-ELISA was 13.0% (n=63; 95% CI: 10.0%-16.0%). Cross tabulation between the ELISA commercial kit and rSs1a-ELISA showed that only 6.4% (n=31; 95% CI: 4.2%-8.6%) of the samples were positive in both tests. Microscopic examination of all 388 fecal samples were negative; however subsequent testing by a nested PCR against DNA from the same samples successfully amplified DNA from three male subjects (0.8%; 3/388). Male workers, India and Myanmar nationality, food service occupation and those living in the hostel were statistically significant with seroprevalence (P<0.005). Conclusion: This is the first report on the epidemiology of S. stercoralis infections among the migrant workers in Malaysia. Our results highlight the importance of using appropriate diagnostic tools for detection. The presence of anti-S. stercoralis antibodies in the study population calls for improvements in personal hygiene and sanitation standards among migrant workers in Malaysia through control strategies including health education campaigns and programs aimed at increasing awareness and healthy behaviors. © 2019 Asian Pacific Journal of Tropical Medicine Produced by Wolters Kluwer-Medknow. All rights reserved

Entamoeba infections and associated risk factors among migrant workers in peninsular Malaysia

The influx of low skilled migrant workers to Malaysia from low socio-economic countries where gastrointestinal parasitic infections are prevalent has raised concerns about transmission to the local population. Three methods for detection (serology, microscopy and molecular techniques) were utilized to identify Entamoeba infections amongst the targeted cohort and determine risk factors associated with infection. Serological screening of 484 migrant workers from five working sectors in Peninsular Malaysia using IgG4 ELISA based on the rPPDK antigen showed an overall seroprevalence of 7.4% (n = 36; CL95 = 5.3–10.1%) with only one factor statistically associated with seropositivity of anti-amoebic antibodies, i.e. years of residence in Malaysia (χ21 = 4.007, p = 0.045). Microscopic examination of 388 faecal samples for protozoan cysts and trophozoites showed a slightly higher prevalence (11.6%; n=45; CL95: 8.4–14.8%). Meanwhile, amplification of the 16S rDNA gene detected two species i.e. Entamoeba dispar (23/388; 5.9%; CL95: 3.6–8.3%) and E. histolytica (11/388; 2.8%; CL95: 1.2–4.5%) and mixed infections with both parasites in only three samples (3/388; 0.8%; CL95: 0.2–2.2%). Entamoeba dispar infection was significantly associated with those employed in food and domestic services (χ24 = 12.879, p = 0.012). However, none of the factors affected the prevalence of E. histolytica infection. Despite the low prevalence of E. histolytica in faecal samples of the study cohort, the presence of this pathogenic parasite still poses potential public health risks and calls for tighter control strategies based on better availability of chemotherapeutic treatment and accessibility to appropriate health education. © 2019, Malaysian Society for Parasitology. All rights reserved