1
|
Ximenes D, de Jesus G, de Sousa ASCFC, Soares C, Amaral LC, Oakley T, Alves L, Amaral S, Sarmento N, Guterres H, Cabral JADD, Boavida F, Yan J, Francis JR, Martins N, Arkell P. A pilot study investigating severe community-acquired febrile illness through implementation of an innovative microbiological and nucleic acid amplification testing strategy in Timor-Leste (ISIN-MANAS-TL). IJID Reg 2024; 11:100345. [PMID: 38596819 PMCID: PMC11002651 DOI: 10.1016/j.ijregi.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
Objectives Acute febrile illness (AFI) causes significant health-seeking, morbidity, and mortality in Southeast Asia. This pilot study aimed to describe presentation, etiology, treatment, and outcomes of patients with AFI at one hospital in Timor-Leste and assessing the feasibility of conducting larger studies in this setting. Methods Patients attending Hospital Nacional Guido Valadares with tympanic or axillary temperature ≥37.5°C in whom a blood culture was taken as part of routine clinical care were eligible. Participants were followed up daily for 10 days and again after 30 days. Whole blood was analyzed using a real-time quantitative polymerase chain reaction assay detecting dengue virus serotypes 1-4 and other arthropod-borne infections. Results A total of 82 participants were recruited. Polymerase chain reaction testing was positive for dengue in 14 of 82 (17.1%) participants and blood culture identified a bacterial pathogen in three of 82 (3.7%) participants. Follow-up was completed by 75 of 82 (91.5%) participants. High rates of hospital admission (58 of 82, 70.7%), broad-spectrum antimicrobial treatment (34 of 82, 41.5%), and mortality (9 of 82, 11.0%) were observed. Conclusions Patients with AFI experience poor clinical outcomes. Prospective observational and interventional studies assessing interventions, such as enhanced diagnostic testing, clinical decision support tools, or antimicrobial stewardship interventions, are required and would be feasible to conduct in this setting.
Collapse
Affiliation(s)
- Deolindo Ximenes
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Gustodio de Jesus
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Antonio SCFC de Sousa
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
- Molecular and Serology Department, Laboratorio Nacional da Saúde, Dili, Timor-Leste
| | - Caetano Soares
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Luciana C. Amaral
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Helio Guterres
- Internal Medicine Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | | | - Flavio Boavida
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Joshua R. Francis
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Nelson Martins
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| |
Collapse
|
2
|
Machado FDN, Draper ADK, Monteiro Fernandes A, Dos Santos FBA, Mali MA, Pereira Tilman AJ, Soares da Silva E, Hornay E, Salles de Sousa A, Oakley T, Cruz ED, Sarmento N, Niha MAV, Soares AF, Cardoso Gomes EE, de Deus Alves J, Soares JP, Francis JR, Yan J, Monteiro MA. The first confirmed outbreak of chikungunya reported in Timor-Leste, 2024. Commun Dis Intell (2018) 2024; 48. [PMID: 38594795 DOI: 10.33321/cdi.2024.48.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Abstract Timor-Leste is a mountainous, half-island nation with a population of 1.3 million, which shares a land border with Indonesia and is 550 km from Darwin, Australia. Since independence in 2002, Timor-Leste has achieved significant development; however, high levels of poverty remain. Chikungunya virus (CHIKV) is endemic in over 100 countries in Africa, Asia, Europe and in the Americas. It is transmitted by the bite of infected Aedes aegypti or Ae. albopictus mosquitoes, which are present in Timor-Leste and which contribute to annual rainy-season dengue virus (DENV) outbreaks. Symptomatic people typically suffer from acute onset of fever, usually accompanied by severe arthritis or arthralgia. Joint pain can be debilitating for several days, and may sometimes last for weeks, months or years. Unlike DENV infection which has significant mortality, most people recover completely. Between 2002 and 2023, there were 26 cases of CHIKV notified in Australia who acquired their infection in Timor-Leste; however, laboratory testing capability for CHIKV in Timor-Leste only became available in 2021 using polymerase chain reaction (PCR). The first locally diagnosed case was notified in November 2023. In January 2024, an outbreak of CHIKV was recognised in Timor-Leste for the first time, with 195 outbreak cases reported during 1-31 January 2024; all were PCR positive. There were no cases hospitalised, and no deaths. The median age of cases was 17 years (range 1-76 years); 51% were males. Cases were reported across the country; most (88/195) were from Dili, although the highest incidence was seen in the neighbouring municipality of Ermera (monthly incidence rate of 58.8 cases per 100,000 population). This first reported outbreak of CHIKV in Timor-Leste highlights the need for improved mosquito-borne illness control and response strategies, including minimising breeding sites and promoting early presentation for treatment and differential diagnosis from DENV, and consideration of the deployment of Wolbachia-infected mosquitoes, particularly as they have shown to reduce the transmission of CHIKV, DENV and Zika virus, all of which pose threats in Timor-Leste.
Collapse
Affiliation(s)
| | - Anthony D K Draper
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- Centre for Disease Control, Public Health Unit, Top End Health Service, Northern Territory Government Department of Health, Darwin, Northern Territory, Australia
| | | | | | | | | | | | | | - Antonio Salles de Sousa
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Laboratorio Nacional da Saude, Bidau, Timor-Leste
| | - Tessa Oakley
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Laboratorio Nacional da Saude, Bidau, Timor-Leste
| | | | - Nevio Sarmento
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Maria A V Niha
- Surveillance Department, Ministry of Health, Caicoli, Timor-Leste
- World Health Organization, Timor-Leste Office, Caicoli, Timor-Leste
| | | | | | | | | | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | | |
Collapse
|
3
|
Lopes C, Joao JC, Lowbridge C, Martins N, Dos Santos RIG, da Silva E, Dias J, Ramalingam S, Amaral S, Oakley T, Ico LDC, Sarmento N, Yan J, Francis JR. National cross-sectional cluster survey of tuberculosis prevalence in Timor-Leste: a study protocol. BMJ Open 2024; 14:e079794. [PMID: 38458815 DOI: 10.1136/bmjopen-2023-079794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Timor-Leste has one of the world's highest estimated tuberculosis (TB) incidences, yet the data which informs this estimate is limited and the true burden of TB disease is not known. TB prevalence surveys offer the best means of determining robust estimates of disease burden. This study aims to provide an estimate of the prevalence of bacteriologically confirmed pulmonary TB in Timor-Leste and provide additional insights into diagnostic coverage and health-seeking behaviour of persons with symptoms suggestive of TB. METHODS AND ANALYSIS A national population-based cross-sectional cluster survey will be conducted in which participants aged 15 years and older will be screened for pulmonary TB using an algorithm consisting of symptom screening and digital X-ray of the chest with computer-aided detection software for X-ray interpretation. Xpert Ultra and liquid culture methods will be used to confirm survey TB cases. Additional data will be collected from persons reporting symptoms suggestive of TB to assess health-seeking behaviour and access to TB diagnosis and care. The survey aims to screen a target sample population of 20 068 people, living within 50 clusters, representing every municipality of Timor-Leste. Bacteriologically confirmed pulmonary TB prevalence will be estimated using WHO-recommended methods. ETHICS AND DISSEMINATION Research ethics approval has been granted by the human research ethics committee of the Northern Territory, Australia, and the Instituto Nacional da Saúde, Timor-Leste. The results will be published in a peer-reviewed scientific journal and disseminated with relevant stakeholders. TRIAL REGISTRATION NUMBER ACTRN12623000718640.
Collapse
Affiliation(s)
| | | | - Christopher Lowbridge
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Nelson Martins
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | | | - Endang da Silva
- National Health Laboratory, Ministry of Health, Dili, Timor-Leste
| | - Joana Dias
- National Health Laboratory, Ministry of Health, Dili, Timor-Leste
| | | | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Lourenco da Costa Ico
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Joshua Reginald Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| |
Collapse
|
4
|
Pereira A, Sidjabat HE, Davis S, Vong da Silva PG, Alves A, Dos Santos C, Jong JBDC, da Conceição F, Felipe NDJ, Ximenes A, Nunes J, Fária IDR, Lopes I, Barnes TS, McKenzie J, Oakley T, Francis JR, Yan J, Ting S. Prevalence of Antimicrobial Resistance in Escherichia coli and Salmonella Species Isolates from Chickens in Live Bird Markets and Boot Swabs from Layer Farms in Timor-Leste. Antibiotics (Basel) 2024; 13:120. [PMID: 38391506 PMCID: PMC10885974 DOI: 10.3390/antibiotics13020120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
The rapid emergence of antimicrobial resistance is a global concern, and high levels of resistance have been detected in chicken populations worldwide. The purpose of this study was to determine the prevalence of antimicrobial resistance in Escherichia coli and Salmonella spp. isolated from healthy chickens in Timor-Leste. Through a cross-sectional study, cloacal swabs and boot swabs were collected from 25 live bird markets and two layer farms respectively. E. coli and Salmonella spp. from these samples were tested for susceptibility to six antimicrobials using a disk diffusion test, and a subset was tested for susceptibility to 27 antimicrobials using broth-based microdilution. E. coli and Salmonella spp. isolates showed the highest resistance towards either tetracycline or ampicillin on the disk diffusion test. E. coli from layer farms (odds ratio:5.2; 95%CI 2.0-13.1) and broilers (odds ratio:18.1; 95%CI 5.3-61.2) were more likely to be multi-drug resistant than those from local chickens. Based on the broth-based microdilution test, resistance to antimicrobials in the Timor-Leste Antimicrobial Guidelines for humans were low, except for resistance to ciprofloxacin in Salmonella spp. (47.1%). Colistin resistance in E. coli was 6.6%. Although this study shows that antimicrobial resistance in chickens was generally low in Timor-Leste, there should be ongoing monitoring in commercial chickens as industry growth might be accompanied with increased antimicrobial use.
Collapse
Affiliation(s)
- Abrao Pereira
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Hanna E Sidjabat
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Steven Davis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Paulo Gabriel Vong da Silva
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Amalia Alves
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Cristibela Dos Santos
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Joanita Bendita da Costa Jong
- Ministry of Agriculture, Livestock, Fisheries and Forestry, Government of Timor-Leste, Av. Nicolao Lobato, Comoro, Dili, Timor-Leste
| | - Felisiano da Conceição
- Ministry of Agriculture, Livestock, Fisheries and Forestry, Government of Timor-Leste, Av. Nicolao Lobato, Comoro, Dili, Timor-Leste
| | - Natalino de Jesus Felipe
- Ministry of Agriculture, Livestock, Fisheries and Forestry, Government of Timor-Leste, Av. Nicolao Lobato, Comoro, Dili, Timor-Leste
| | - Augusta Ximenes
- Ministry of Agriculture, Livestock, Fisheries and Forestry, Government of Timor-Leste, Av. Nicolao Lobato, Comoro, Dili, Timor-Leste
| | - Junilia Nunes
- Ministry of Agriculture, Livestock, Fisheries and Forestry, Government of Timor-Leste, Av. Nicolao Lobato, Comoro, Dili, Timor-Leste
| | - Isménia do Rosário Fária
- Ministry of Agriculture, Livestock, Fisheries and Forestry, Government of Timor-Leste, Av. Nicolao Lobato, Comoro, Dili, Timor-Leste
| | - Isabel Lopes
- Ministry of Agriculture, Livestock, Fisheries and Forestry, Government of Timor-Leste, Av. Nicolao Lobato, Comoro, Dili, Timor-Leste
| | | | - Joanna McKenzie
- School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Shawn Ting
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| |
Collapse
|
5
|
Mo Y, Ding Y, Cao Y, Hopkins J, Ashley EA, Waithira N, Wannapinij P, Lee SJ, Ling CL, Hamers RL, Roberts T, Lubell Y, Karkey A, Akech S, Lissauer S, Opintan J, Okeke I, Eremin S, Tornimbene B, Hsu LY, Thwaites L, Lam MY, Pham NT, Pham TK, Teo J, Kwa ALH, Marimuthu K, Ng OT, Vasoo S, Kitsaran S, Anunnatsiri S, Kosalaraksa P, Chotiprasitsakul D, Santanirand P, Plongla R, Chua HH, Tiong XT, Wong KJ, Ponnampalavanar SSLS, Sulaiman HB, Mazlan MZ, Salmuna ZN, Rajahram GS, Zaili MZBM, Francis JR, Sarmento N, Guterres H, Oakley T, Yan J, Tilman A, Khalid MOR, Hashmi M, Mahmood SF, Dhiloo AK, Fatima A, Lubis IND, Wijaya H, Abad CL, Roman AD, Lazarte CCM, Mamun GMS, Asli R, Momin MHFBHA, Nyamdavaa K, Gurjav U, Bory S, Varghese GM, Gupta L, Tantia P, Sinto R, Doi Y, Khanal B, Malijan G, Lazaro J, Gunasekara S, Withanage S, Liu PY, Xiao Y, Wang M, Paterson DL, van Doorn HR, Turner P. ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance. Wellcome Open Res 2023; 8:179. [PMID: 37854055 PMCID: PMC10579854 DOI: 10.12688/wellcomeopenres.19210.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 10/20/2023] Open
Abstract
Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.
Collapse
Affiliation(s)
- Yin Mo
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
- Division of Infectious Diseases, National University Hospital, Singapore, Singapore, 119074, Singapore
- Department of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Ying Ding
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Yang Cao
- Singapore Clinical Research Institute, Singapore, 139234, Singapore
| | - Jill Hopkins
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 171020, Cambodia
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Naomi Waithira
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Prapass Wannapinij
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Sue J. Lee
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Claire L. Ling
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 171020, Cambodia
| | - Raph L. Hamers
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit (OUCRU) Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tamalee Roberts
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Yoel Lubell
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Abhilasha Karkey
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit (OUCRU) Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Samuel Akech
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Samantha Lissauer
- Liverpool School of Tropical Medicine (LSTM), University of Liverpool, Liverpool, England, UK
- Malawi-Liverpool-Wellcome Trust (MLW) Clinical Research Programme, Blantyre, Malawi
| | | | | | | | | | - Li Yang Hsu
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Louise Thwaites
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Minh Yen Lam
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Tieu Kieu Pham
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Jeanette Teo
- Department of laboratory Medicine, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Andrea Lay-Hoon Kwa
- Pharmacy (Research), Singapore General Hospital, Singapore, Singapore
- Emerging Infectious Diseases Programme, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Siriluck Anunnatsiri
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Nai Mueang, Khon Kaen, Thailand
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Nai Mueang, Khon Kaen, Thailand
| | | | | | - Rongpong Plongla
- King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Ke Juin Wong
- Sabah Women and Children's Hospital, Kota Kinabalu, Malaysia
| | | | | | - Mohd Zulfakar Mazlan
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Zeti Norfidiyati Salmuna
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | | | - Joshua R. Francis
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
| | - Nevio Sarmento
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
- Laboratorio Nacional da Saude, Ministerio da Saude, Dili, Timor-Leste
| | | | - Tessa Oakley
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
| | - Jennifer Yan
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
| | - Ari Tilman
- Laboratorio Nacional da Saude, Ministerio da Saude, Dili, Timor-Leste
| | | | - Madiha Hashmi
- Dr. Ziauddin Hospital Clifton Campus, Karachi, Pakistan
| | | | | | | | - Inke Nadia D. Lubis
- Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia
| | - Hendri Wijaya
- Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia
- General Hospital H. Adam Malik, Medan, Indonesia
| | | | | | - Cecilia C. Maramba Lazarte
- Philippine General Hospital, Manila, Philippines
- University of the Philippines Manila, Manila, Metro Manila, Philippines
| | | | - Rosmonaliza Asli
- Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei-Muara District, Brunei
| | | | | | - Ulziijargal Gurjav
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Lalit Gupta
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Pratik Tantia
- Ananta Institute of Medical Sciences and Research Center, Siyol, India
| | - Robert Sinto
- Cipto Mangunkusumo National Hospital, Faculty of Medicine, Universitas Indonesia, Depok, West Java, Indonesia
| | - Yohei Doi
- Fujita Health University Hospital, Toyoake, Japan
| | - Basudha Khanal
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Greco Malijan
- San Lazaro Hospital, Nagasaki University Collaborative Research Office, Manila, Philippines
| | - Jezreel Lazaro
- Hospital Infection Control Unit, San Lazaro Hospital, Manila, Philippines
| | | | | | - Po Yu Liu
- Taichung Veteran General Hospital, Taichung City, Vietnam
| | - Yonghong Xiao
- The First Affiliated Hospital Of Zhejiang University School Of Medicine, Hangzhou, China
| | - Minggui Wang
- Huashan Hospital, Fudan University, Shanghai, China
| | - David L. Paterson
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
- Department of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - H. Rogier van Doorn
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 171020, Cambodia
| |
Collapse
|
6
|
Guterres H, Gusmao C, Pinheiro M, Martins J, Odio G, Maia C, da Conceicao V, Soares M, Osorio C, da Silva ES, Tilman A, Givney R, Oakley T, Yan J, Toto L, Amaral E, James R, Buising K, Mayo M, Kaestli M, Webb JR, Baird RW, Currie BJ, Francis JR, Muhi S. Melioidosis in Timor-Leste: First Case Description and Phylogenetic Analysis. Open Forum Infect Dis 2023; 10:ofad405. [PMID: 37577114 PMCID: PMC10414804 DOI: 10.1093/ofid/ofad405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023] Open
Abstract
Burkholderia pseudomallei, the causative agent of melioidosis, has not yet been reported in Timor-Leste, a sovereign state northwest of Australia. In the context of improved access to diagnostic resources and expanding clinical networks in the Australasian region, we report the first 3 cases of culture-confirmed melioidosis in Timor-Leste. These cases describe a broad range of typical presentations, including sepsis, pneumonia, multifocal abscesses, and cutaneous infection. Phylogenetic analysis revealed that the Timor-Leste isolates belong to the Australasian clade of B. pseudomallei, rather than the Asian clade, consistent with the phylogeographic separation across the Wallace Line. This study underscores an urgent need to increase awareness of this pathogen in Timor-Leste and establish diagnostic laboratories with improved culture capacity in regional hospitals. Clinical suspicion should prompt appropriate sampling and communication with laboratory staff to target diagnostic testing. Local antimicrobial guidelines have recently been revised to include recommendations for empiric treatment of severe sepsis.
Collapse
Affiliation(s)
| | - Celia Gusmao
- National Hospital Guido Valadares, Dili, Timor-Leste
| | | | - Joana Martins
- National Hospital Guido Valadares, Dili, Timor-Leste
| | - Gustavo Odio
- National Hospital Guido Valadares, Dili, Timor-Leste
| | | | - Virginia da Conceicao
- National Health Laboratory, Dili, Timor-Leste
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Messias Soares
- National Health Laboratory, Dili, Timor-Leste
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | | | - Rodney Givney
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tessa Oakley
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jennifer Yan
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lucia Toto
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Elfiana Amaral
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rodney James
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kirsty Buising
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Mark Mayo
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Mirjam Kaestli
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jessica R Webb
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Robert W Baird
- Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bart J Currie
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Joshua R Francis
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephen Muhi
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Gusmao C, Tanesi MY, Gomes N, Sheridan SL, Sarmento N, Oakley T, David M, Wapling J, Alves L, Amaral S, Draper AD, Cruz B, Coelho D, Guterres H, Fancourt NS, Yan J, Macartney K, Francis JR, Arkell P. Seroprevalence and prevention of hepatitis B, measles and rubella among healthcare workers in Dili, Timor-Leste. Lancet Reg Health Southeast Asia 2023; 13:100133. [PMID: 37383559 PMCID: PMC10305905 DOI: 10.1016/j.lansea.2022.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 06/30/2023]
Abstract
Introduction The World Health Organisation recommends that healthcare workers (HCWs) are immune to measles and rubella, and those at risk of exposure are offered the hepatitis B vaccine. No formal programme for occupational assessment and provision of vaccinations to HCWs currently exists in Timor-Leste. Methods A cross-sectional study was undertaken to determine the seroprevalence of hepatitis B, measles and rubella among HCWs in Dili, Timor-Leste. All patient-facing employees at three healthcare institutions during April-June 2021 were invited to participate. Epidemiological data were collected by interview-questionnaire and a serum sample was collected by phlebotomy and analysed at the National Health Laboratory. Participants were contacted to discuss their results. Relevant vaccines were offered to seronegative individuals and those with active hepatitis B infection were referred for further assessment and management in a hepatology clinic as per national guidelines. Results Three-hundred-and-twenty-four HCWs were included (representing 51.3% of all eligible HCWs working at the three participating institutions). Sixteen (4.9%; 95% CI: 2.8-7.9%) had active hepatitis B infection, 121 (37.3%; 95% CI: 32.1-42.9%) had evidence of previous (cleared) hepatitis B infection, 134 (41.4%; 95% CI: 35.9-46.9%) were hepatitis B seronegative, and 53 (16.4%; 95% CI: 12.5-20.8%) had been vaccinated. Two-hundred-and-sixty-seven (82.4%; 95% CI: 77.8-86.4%) and 306 (94.4%; 95% CI: 91.4-96.7%) individuals exhibited antibodies to measles and rubella, respectively. Interpretation There are significant immunity gaps and a high prevalence of hepatitis B infection among HCWs in Dili Municipality, Timor-Leste. Routine occupational assessment and targeted vaccination of this group would be beneficial and should include all types of HCWs. This study provided an opportunity to develop a programme for the occupational assessment and vaccination of HCWs and forms the template for a national guideline. Funding This work was supported by the Department of Foreign Affairs and Trade, Australian Government [Complex Grant Agreement Number 75889].
Collapse
Affiliation(s)
- Celia Gusmao
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Maria Y. Tanesi
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nelia Gomes
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sarah L. Sheridan
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Nevio Sarmento
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tessa Oakley
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Michael David
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, NSW, Australia
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Johanna Wapling
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lucsendar Alves
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anthony D.K. Draper
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Northern Territory Centre for Disease Control, Darwin, Northern Territory, Australia
| | | | | | | | - Nicholas S.S. Fancourt
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Joshua R. Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Imperial College, London, United Kingdom
| |
Collapse
|
8
|
Arkell P, Sheridan SL, Martins N, Tanesi MY, Gomes N, Amaral S, Oakley T, Solano V, David M, Draper ADK, Sarmento N, da Silva E, Alves L, Freitas C, Machado FDN, Gusmão C, da Costa Barreto I, Fancourt NSS, Macartney K, Yan J, Francis JR. Vaccine Preventable Disease Seroprevalence in a Nationwide Assessment of Timor-Leste (VASINA-TL): study protocol for a population-representative cross-sectional serosurvey. BMJ Open 2023; 13:e071381. [PMID: 37202138 PMCID: PMC10201250 DOI: 10.1136/bmjopen-2022-071381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Historic disruption in health infrastructure combined with data from a recent vaccine coverage survey suggests there are likely significant immunity gaps to vaccine preventable diseases and high risk of outbreaks in Timor-Leste. Community-based serological surveillance is an important tool to augment understanding of population-level immunity achieved through vaccine coverage and/or derived from prior infection. METHODS AND ANALYSIS This national population-representative serosurvey will take a three-stage cluster sample and aims to include 5600 individuals above 1 year of age. Serum samples will be collected by phlebotomy and analysed for measles IgG, rubella IgG, SARS-CoV-2 antispike protein IgG, hepatitis B surface antibody and hepatitis B core antigen using commercially available chemiluminescent immunoassays or ELISA. In addition to crude prevalence estimates and to account for differences in Timor-Leste's age structure, stratified age-standardised prevalence estimates will be calculated, using Asia in 2013 as the standard population. Additionally, this survey will derive a national asset of serum and dried blood spot samples which can be used for further investigation of infectious disease seroepidemiology and/or validation of existing and novel serological assays for infectious diseases. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Research Ethics and Technical Committee of the Instituto Nacional da Saúde, Timor-Leste and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research, Australia. Co-designing this study with Timor-Leste's Ministry-of-Health and other relevant partner organisations will allow immediate translation of findings into public health policy, which may include changes to routine immunisation service delivery and/or plans for supplementary immunisation activities.
Collapse
Affiliation(s)
- Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Sarah L Sheridan
- National Centre for Immunisation Research and Surveillance (NCIRS), Westmead, New South Wales, Australia
| | - Nelson Martins
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Maria Y Tanesi
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Nelia Gomes
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Vanessa Solano
- Faculty of Science and Technology, Research Institute for the Environment and Livelihoods, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Anthony D K Draper
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
- Centre for Disease Control, Northern Territory Department of Health, Casuarina, Northern Territory, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Northern Territory, Australia
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Endang da Silva
- Laboratório Nacional da Saúde, Timor-Leste Ministry of Health, Dili, Timor-Leste
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Carlito Freitas
- Departemento Vigilancia e Epidemiologia, Timor-Leste Ministry of Health, Dili, Timor-Leste
| | - Filipe de Neri Machado
- Departemento Vigilancia e Epidemiologia, Timor-Leste Ministry of Health, Dili, Timor-Leste
| | - Celia Gusmão
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Ismael da Costa Barreto
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
- Health System Strengthening Department, World Health Organisation, Timor-Leste Office, Dili, Timor-Leste
| | - Nicholas S S Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance (NCIRS), Westmead, New South Wales, Australia
| | - Jennifer Yan
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| |
Collapse
|
9
|
Sarmento N, Soares da Silva E, Barreto I, Ximenes JC, Angelina JM, Correia DM, Babo SM, Tilman AJP, Salles de Sousa A, Hornay E, Ico LC, Machado FDN, Niha MV, Ballard S, Lin C, Howden B, Baird R, Wapling J, Alves L, Oakley T, Marr I, Draper AD, Arkell P, Smith-Vaughan H, Fancourt NS, Yan J, Francis JR. The COVID-19 laboratory response in Timor-Leste; a story of collaboration. Lancet Reg Health Southeast Asia 2023; 11:100150. [PMID: 36744276 PMCID: PMC9883004 DOI: 10.1016/j.lansea.2023.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/18/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Abstract
Timor-Leste is a small nation of 1.3 million people which shares a land border with Indonesia and is 550 km from Darwin, Australia. It is one of the poorest nations in Asia. The National Health Laboratory (NHL) and its network of smaller laboratories in Timor-Leste had limited capacity to perform molecular diagnostic testing before the coronavirus disease 2019 (COVID-19) pandemic began. With the support of international development partners, the NHL rapidly expanded its molecular testing service. From March 2020 to February 2022, over 200,000 molecular tests were performed; COVID-19 testing sites were established in hospital and community health center laboratories and all 13 municipalities, and the number of scientists and technicians at the molecular diagnostic laboratory at the NHL increased from five to 28 between 2019 and 2022. Molecular diagnostic testing for COVID-19 was successfully established at the NHL and in the municipalities. The molecular diagnostic laboratory at NHL is now equipped to respond to not only large-scale COVID-19 testing but also laboratory detection of other infectious diseases, preparing Timor-Leste for future outbreaks or pandemics.
Collapse
Affiliation(s)
- Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste,Molecular Diagnostic Laboratory, National Health Laboratory, Dili, Timor-Leste,Corresponding author. Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | | | - Ismael Barreto
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - João C. Ximenes
- World Health Organization, Timor-Leste Country Office, Dili, Timor-Leste
| | - Julia M. Angelina
- World Health Organization, Timor-Leste Country Office, Dili, Timor-Leste
| | - Dircia M. Correia
- World Health Organization, Timor-Leste Country Office, Dili, Timor-Leste
| | - Silvia M. Babo
- World Health Organization, Timor-Leste Country Office, Dili, Timor-Leste
| | | | - Antonio Salles de Sousa
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Elisabeth Hornay
- Molecular Diagnostic Laboratory, National Health Laboratory, Dili, Timor-Leste
| | - Lourenço C. Ico
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | | | - Maria Varela Niha
- Departamento Vigilância e Epidemiologia, Ministério da Saúde, Dili, Timor-Leste
| | - Susan Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - Chantel Lin
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - Benjamin Howden
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - Rob Baird
- Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Johanna Wapling
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Ian Marr
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Anthony D.K. Draper
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste,Northern Territory Centre for Disease Control, Darwin, Australia,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste,Imperial College, London, United Kingdom
| | - Heidi Smith-Vaughan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Nicholas S.S. Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Joshua R. Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| |
Collapse
|
10
|
Niha MA, Draper AD, Viegas ODS, de Araujo RM, Joao JC, da Silva E, Barreto I, Sarmento N, Oakley T, Machado FDN, Fancourt NS, Marr I, Dos Santos Fernandes LN, Martins N, Arkell P, Tilman AJ, Dingle B, Freitas CC, Bhowmick PS, Sheridan S, Howden BP, Yan J, Francis JR, Martins N. The epidemiology of the COVID-19 pandemic in the small, low-resource country of Timor-Leste, January 2020 - June 2022. Commun Dis Intell (2018) 2023; 47. [PMID: 36654501 DOI: 10.33321/cdi.2023.47.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract Timor-Leste, a small, mountainous half-island nation which shares a land border with Indonesia and which is 550 km from Australia, has a population of 1.3 million and achieved independence for the second time in 2002. It is one of the poorest nations in Asia. In response to the global coronavirus disease 2019 (COVID-19) pandemic, the Timor-Leste Ministry of Health undertook surveillance and contact tracing activities on all notified COVID-19 cases. Between 1 January 2020 and 30 June 2022, there were 22,957 cases of COVID-19 notified which occurred in three waves, the first which was delayed until April 2021 (community transmission of B.1.466.2 variant following major flooding), followed by waves in August 2021 (B.1.617.2 Delta variant transmission) and February 2022 (B.1.1.529 Omicron variant transmission). There were 753 people hospitalised due to COVID-19 and 133 deaths. Of the 133 deaths, 122 (92%) were considered not fully vaccinated (< 2 COVID-19 vaccines) and none had received boosters. Timor-Leste implemented measures to control COVID-19, including: rapid closure of international borders; isolation of cases; quarantining of international arrivals and close contacts; restrictions on internal travel; social and physical distancing; and, finally, a country-wide vaccination program. The health system's capacity was never exceeded.
Collapse
Affiliation(s)
- Maria Av Niha
- Ministry of Health, Caicoli, Timor-Leste.,2. World Health Organization, Timor-Leste Office, Caicoli, Timor-Leste
| | - Anthony Dk Draper
- Centre for Disease Control, Public Health Unit, Top End Health Service, Northern Territory Government Department of Health, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | | | - Rui M de Araujo
- Centro Integrado de Gestão de Crise, Timor-Leste Government, Dili, Timor-Leste
| | | | | | - Ismail Barreto
- World Health Organization, Timor-Leste Office, Caicoli, Timor-Leste
| | - Nevio Sarmento
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tessa Oakley
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Nicholas Ss Fancourt
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ian Marr
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Benjamin Dingle
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | - Sarah Sheridan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia.,Doherty Applied Microbial Genomics, Department of Microbiology & Immunology, University of Melbourne, Victoria, Australia
| | - Jennifer Yan
- Ministry of Health, Caicoli, Timor-Leste.,Paediatric Department, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Paediatric Department, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, Australia
| | - Nelson Martins
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| |
Collapse
|
11
|
Sarmento N, Ico LC, Sheridan SL, Tanesi MY, Santos CG, Barreto I, Gomes N, Oakley T, Draper ADK, Fancourt NSS, Yan J, Macartney K, Francis JR, Arkell P. The use of residual serum samples to perform serological surveillance of severe acute respiratory syndrome coronavirus 2 in Dili and regional areas of Timor-Leste. Trans R Soc Trop Med Hyg 2022; 117:313-315. [PMID: 36482768 PMCID: PMC10069296 DOI: 10.1093/trstmh/trac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/17/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT
Background
Lack of access to diagnostic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can limit disease surveillance in remote areas. Serological surveillance can indicate the true extent and distribution of infections in such settings.
Methods
This study monitored SARS-CoV-2 seroprevalence in residual serum samples salvaged from laboratories at five healthcare facilities across Timor-Leste from March to October 2021.
Results
Seroprevalence increased from 8.3% to 87.0% during the study period. Potential immunity gaps were identified among children aged 0–15 y (who had not been eligible for vaccination) and individuals aged >60 y.
Conclusions
Efforts to vaccinate vulnerable individuals including older people should be maintained. Residual serum samples can be analysed to give local, contemporary information about the extent and distribution of antibodies to infections, especially SARS-CoV-2, in areas where epidemiological information is limited.
Collapse
Affiliation(s)
- Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Lourenço C Ico
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Sarah L Sheridan
- National Centre for Immunisation Research and Surveillance , Westmead, NSW 2145 , Australia
| | - Maria Y Tanesi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Celia G Santos
- Department of Internal Medicine, Hospital Nacional Guido Valadares , Dili , Timor-Leste
| | - Ismael Barreto
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Nelia Gomes
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Anthony D K Draper
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Nicholas S S Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance , Westmead, NSW 2145 , Australia
| | - Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| |
Collapse
|
12
|
Sarmento N, Oakley T, Belo JC, da Conceição VL, Maia CDC, Santos CG, Amaral E, Toto L, da Silva ES, Marr I, Yan J, Francis JR. First case of NDM-1-producing Acinetobacter baumannii isolated in Timor-Leste. Commun Dis Intell (2018) 2022; 46. [PMID: 36154658 DOI: 10.33321/cdi.2022.46.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Tessa Oakley
- Menzies School of Health Research, Dili, Timor-Leste
| | - Joana C Belo
- Menzies School of Health Research, Dili, Timor-Leste
| | | | | | - Celia G Santos
- Departamento Medicina Interna, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | | | - Lucia Toto
- Menzies School of Health Research, Dili, Timor-Leste
| | | | - Ian Marr
- The Canberra Hospital, ACT, Australia
| | - Jennifer Yan
- Menzies School of Health Research, Dili, Timor-Leste.,Royal Darwin Hospital, NT, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Dili, Timor-Leste.,Royal Darwin Hospital, NT, Australia
| |
Collapse
|
13
|
Arkell P, Gusmao C, Sheridan SL, Tanesi MY, Gomes N, Oakley T, Wapling J, Alves L, Kopf S, Sarmento N, Barreto IDC, Amaral S, Draper AD, Coelho D, Guterres H, Salles A, Machado F, Fancourt NS, Yan J, Marr I, Macartney K, Francis JR. Serological surveillance of healthcare workers to evaluate natural infection- and vaccine-derived immunity to SARS-CoV-2 during an outbreak in Dili, Timor-Leste. Int J Infect Dis 2022; 119:80-86. [PMID: 35358723 PMCID: PMC8958849 DOI: 10.1016/j.ijid.2022.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Serosurveillance can be used to investigate the extent and distribution of immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a population. Characterisation of humoral immune responses gives insight into whether immunity is infection- or vaccine-derived. Methods A longitudinal study of health care workers (HCWs) in Dili, Timor-Leste, was conducted during vaccine rollout (ChAdOx1) and a concurrent SARS-CoV-2 outbreak. Results A total of 324 HCWs were included at baseline (April-May 2021). Out of those, 32 (9.9%) were seropositive for anti-nucleocapsid protein (anti-N) IgG antibodies, indicating a significant sub-clinical infection among HCWs early in the local outbreak. Follow-up was conducted in 157 (48.5%) participants (July-September 2021), by which time there had been high uptake of vaccination (91.7%), and 86.0% were seropositive for anti-spike protein antibodies. Acquisition of anti-N antibodies was observed in partially vaccinated HCWs (30/76, 39.5%), indicating some post-dose-1 infections. Discussion Serosurveillance of HCWs may provide early warning of SARS-CoV-2 outbreaks and should be considered in non-endemic settings, particularly where there is limited availability/uptake of testing for acute infection. Characterisation of humoral immune responses may be used to assess vaccine impact and coverage. Such studies should be considered in national and international efforts to investigate and mitigate against future emerging pathogens.
Collapse
Affiliation(s)
- Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Imperial College, London, UK.
| | - Celia Gusmao
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Sarah L Sheridan
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Maria Y Tanesi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Nelia Gomes
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Johanna Wapling
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Stacey Kopf
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Anthony Dk Draper
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | | | | | | | - Nicholas Ss Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ian Marr
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| |
Collapse
|
14
|
Sarmento N, Oakley T, Soares da Silva E, Tilman A, Monteiro M, Alves L, Barreto I, Marr I, Draper ADK, de Castro Hall G, Yan J, Francis JR. Strong relationships between the Northern Territory of Australia and Timor-Leste. Microbiol Aust 2022. [DOI: 10.1071/ma22039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
15
|
Oakley T, Marr I, Townell N, Heney C, Jackson W, Evans M, Hall B, Allen C, Chaw K, Ferguson J. Pacific Regional Infectious Disease Association (PRIDA): capacity-building for microbiology and infectious disease across the Pacific. Microbiol Aust 2021. [DOI: 10.1071/ma21051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PRIDA is an Australian based network of medical and scientific specialists, combining expertise in microbiology laboratory development, infection control, management of infectious diseases and antimicrobial stewardship. PRIDA focuses on grassroots support for Pacific and Southeast Asian sites through the establishment of long-term mentoring relationships with front line health care workers. With an emphasis on bench level training for scientists and bedside development for clinicians, PRIDA has advanced testing capacity, infection control and antimicrobial stewardship in the Solomon Islands, Timor-Leste, and PNG. Understanding the need to upskill HCWs in the Pacific, PRIDA has expanded into areas of formal education opportunities with development of online microbiology diplomas, for pathologists, physicians, and scientists. Concurrent design of multidisciplinary virtual video conferenced microbiology rounds provides teaching opportunities in real time and improvement in daily patient care. From its origin of volunteerism, PRIDA has attracted funding through partnership with larger organisations and are currently involved in sponsored AMR projects in the Pacific.
Collapse
|
16
|
Little MW, Oakley T, Briggs JH, Sutcliffe JA, Allouni AK, Makris G, Bratby MJ, Tapping CR, Patel R, Wigham A, Anthony S, Phillips-Hughes J, Uberoi R. Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures. Cardiovasc Intervent Radiol 2016; 39:1471-8. [PMID: 27259863 DOI: 10.1007/s00270-016-1391-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023]
Abstract
AIMS To assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction. METHODOLOGY 268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72 years (28-98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91 %). Diverticular strictures accounted for 24/268 (9 %). RESULTS Overall technical success rate was 81 % (217/268), with a clinical success rate of 65 % (174/268). Duration of symptoms ranged from 0 to 180 days (mean 8 days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1 week, technical success was 85.4 % (181/212) versus 69.6 % (39/56) for those with symptoms of greater than a week (p < 0.05). Clinical success rates fell from 71.3 % (107/150) to 59.3 % (70/118) (p < 0.05) when attempting to stent lesions of greater than 5 cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7 % (109/144) versus 59.7 % (74/124) (p < 0.05). A total of 20 (7.46 %) perforations were identified during the study. Stent migration occurred in 6.6 % of cases. In-stent stenosis occurred in 3.3 %. The overall 30-day all cause mortality rate was 9 %. CONCLUSION Lesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.
Collapse
Affiliation(s)
- M W Little
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - T Oakley
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - J H Briggs
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - J A Sutcliffe
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - A K Allouni
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - G Makris
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - M J Bratby
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - C R Tapping
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - R Patel
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - A Wigham
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - S Anthony
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - J Phillips-Hughes
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - R Uberoi
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
| |
Collapse
|
17
|
Eyre K, Oakley T, Gill J, Cutress R, Nicol R, Agrawal A, Yiangou C, Wise M. To dilute or not to dilute? A study of the effect of dilution of patent blue dye on the identification rate of sentinel lymph nodes in breast cancer. Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
18
|
Oakley T. Bravely entering the new world of flow cytometry. MLO Med Lab Obs 1992; 24:42-4. [PMID: 10118601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Deciding whether this sophisticated testing method is feasible for your laboratory requires extensive research. If the answer is yes, implementation demands planning, dedication, and hard work.
Collapse
Affiliation(s)
- T Oakley
- Saint Francis Medical Center, Peoria, IL
| |
Collapse
|
19
|
Oakley T, Pratt DJ. Skeletal transients during heel and toe strike running and the effectiveness of some materials in their attenuation. Clin Biomech (Bristol, Avon) 1988; 3:159-65. [PMID: 23915893 DOI: 10.1016/0268-0033(88)90062-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/1987] [Revised: 12/04/1987] [Accepted: 03/08/1988] [Indexed: 02/07/2023]
Abstract
Because of the increased popularity of running, interest has focussed on ways of reducing injurious skeletal shocks. This paper examines heel and toe strike running styles and the effect of shock attenuating materials in reducing foot/floor contact forces and skeletal shocks. Using a force plate and an accelerometer, 18volunteers (10 men, 8 women) were studied and the following observations made. Firstly, toe striking reduced the skeletal transients and the rate of rise of foot loading. Secondly, the three materials studied (PPT, Viscolas and Cleron) all reduced the rate of foot loading in heel strike, but only one (PPT) affected the skeletal transient peak height during toe strike. No other significant results were obtained.
Collapse
Affiliation(s)
- T Oakley
- Sheffield University, Sheffield, UK
| | | |
Collapse
|