Displaying publications 161 - 180 of 267 in total

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  1. Fulltext Multiyear prospective cohort study to evaluate the risk potential of MERS-CoV infection among Malaysian Hajj pilgrims (MERCURIAL): a study protocol
    Johari J, Hontz RD, Pike BL, Husain T, Chong CK, Rusli N, et al.
    BMJ Open, 2021 08 26;11(8):e050901.
    PMID: 34446498 DOI: 10.1136/bmjopen-2021-050901
    INTRODUCTION: Middle East respiratory syndrome (MERS) is a viral respiratory infection caused by the MERS-CoV. MERS was first reported in the Kingdom of Saudi Arabia in 2012. Every year, the Hajj pilgrimage to Mecca attracts more than two million pilgrims from 184 countries, making it one of the largest annual religious mass gatherings (MGs) worldwide. MGs in confined areas with a high number of pilgrims' movements worldwide continues to elicit significant global public health concerns. MERCURIAL was designed by adopting a seroconversion surveillance approach to provide multiyear evidence of MG-associated MERS-CoV seroconversion among the Malaysian Hajj pilgrims.

    METHODS AND ANALYSIS: MERCURIAL is an ongoing multiyear prospective cohort study. Every year, for the next 5 years, a cohort of 1000 Hajj pilgrims was enrolled beginning in the 2016 Hajj pilgrimage season. Pre-Hajj and post-Hajj serum samples were obtained and serologically analysed for evidence of MERS-CoV seroconversion. Sociodemographic data, underlying medical conditions, symptoms experienced during Hajj pilgrimage, and exposure to camel and untreated camel products were recorded using structured pre-Hajj and post-Hajj questionnaires. The possible risk factors associated with the seroconversion data were analysed using univariate and multivariate logistic regression. The primary outcome of this study is to better enhance our understanding of the potential threat of MERS-CoV spreading through MG beyond the Middle East.

    ETHICS AND DISSEMINATION: This study has obtained ethical approval from the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia. Results from the study will be submitted for publication in peer-reviewed journals and presented in conferences and scientific meetings.

    TRIAL REGISTRATION NUMBER: NMRR-15-1640-25391.

    Matched MeSH terms: Travel
  2. Countries at risk of importation of chikungunya virus cases from Southern Thailand: A modeling study
    Tuite AR, Watts AG, Khan K, Bogoch II
    Infect Dis Model, 2019;4:251-256.
    PMID: 31667444 DOI: 10.1016/j.idm.2019.09.001
    Southern Thailand has been experiencing a large chikungunya virus (CHIKV) outbreak since October 2018. Given the magnitude and duration of the outbreak and its location in a popular tourist destination, we sought to determine international case exportation risk and identify countries at greatest risk of receiving travel-associated imported CHIKV cases. We used a probabilistic model to estimate the expected number of exported cases from Southern Thailand between October 2018 and April 2019. The model incorporated data on CHIKV natural history, infection rates in Southern Thailand, average length of stay for tourists, and international outbound air passenger numbers from the outbreak area. For countries highly connected to Southern Thailand by air travel, we ran 1000 simulations to estimate the expected number of imported cases. We also identified destination countries with conditions suitable for autochthonous CHIKV transmission. Over the outbreak period, we estimated that an average of 125 (95% credible interval (CrI): 102-149) cases would be exported from Southern Thailand to international destinations via air travel. China was projected to receive the most cases (43, 95% CrI: 30-56), followed by Singapore (7, 95% CrI: 2-12) and Malaysia (5, 95% CrI: 1-10). Twenty-three countries were projected to receive at least one imported case, and 64% of these countries had one or more regions that could potentially support autochthonous CHIKV transmission. The overall risk of international exportation of CHIKV cases associated with the outbreak is Southern Thailand is high. Our model projections are consistent with recent reports of CHIKV in travelers returning from the region. Countries should be alert to the possibility of CHIKV infection in returning travelers, particularly in regions where autochthonous transmission is possible.
    Matched MeSH terms: Air Travel
  3. Fulltext A single mass gathering resulted in massive transmission of COVID-19 infections in Malaysia with further international spread
    Che Mat NF, Edinur HA, Abdul Razab MKA, Safuan S
    J Travel Med, 2020 05 18;27(3).
    PMID: 32307549 DOI: 10.1093/jtm/taaa059
    Matched MeSH terms: Travel
  4. Immigrant Health Study. 9. The chest radiographic changes in an immigrant population - a pilot study. [Abstract]
    Basri JJA
    JUMMEC, 1998;3:64-64.
    With the increasing ease of travel and the passage of peoples between counkies there is a need to ensure that the recipient country is not burdened by the need for care of ilniiiigrant with health problems as well as the increased risk posed to the local population froni exposure to conun~unicabled isease. To assess the chest radiographs of a selected group of inun~igrantsto ascertain the presence of abnormalities especially the presence of tuberculosis. A total of 250 imniigrants were prospectively evaluated by a PA chest radiograph. The chest radiograph was evaluated by two radiologists for the presence of abnormalities of the heart, lungs, mediastinum and bony rib cage. There were 112 Indonesians, 133 Bangladeshis, one Myanmar, three Pakistanis and one others. Males made-up 222 while there were 28 females. The chest radiograph was diagnostic in all cases. There were 13 cases with enlarged hearts but with no evidence of heart failure. There was only a single inlmigrant who had evidence of active TB though there were 6 others who had evidence of old disease. There was evidence of other infections in five. With regard to the mediastinuni there was a single case with enlarged hila probably secondary to increased cardiac output. There were 21 patients with scoliosis of the spine and two with abnormaIities of the ribs. Even though there was a single case with evidence of TB from this pilot study, from unreported data from the UMMC, there were 15,16 and 23 immigrants treated for TB for 1994,1995 and 1996 respectively. This was mainly seen in the Indonesians followed by the Bangladeshis and Myanmar. We attribute this discrepancy to the biased salnpie in this study where probably only the healthy were seen while those who were not well did not want to participate in this study. In addition, this may also be due to the small sample used in this study. We feel that screening of the immigrants out in the field may be able to detect cases of active TB. As for the large hearts we feel that in the absence of any cardiac symptoms and other radiological changes these are probably due to the increased workload on the heart from physical activities. This is a recognised presentation. The changes in the mediastinum and bony rib cage are probably not very significant.
    Matched MeSH terms: Travel
  5. Protecting the health of medical students on international electives in low-resource settings
    Johnston N, Sandys N, Geoghegan R, O'Donovan D, Flaherty G
    J Travel Med, 2018 01 01;25(1).
    PMID: 29394388 DOI: 10.1093/jtm/tax092
    Background: Increasingly, medical students from developed countries are undertaking international medical electives in developing countries. Medical students understand the many benefits of these electives, such as the opportunity to develop clinical skills, to gain insight into global health issues and to travel to interesting regions of the world. However, they may be much less aware of the risk to their health and wellbeing while abroad. Compounding this problem, medical students may not seek advice from travel medicine practitioners and often receive inadequate or no information from their medical school prior to departure.

    Methods: The PubMed database was searched for relevant literature relating to the health of medical elective students. Combinations of the following key words were used as search terms: 'international health elective', 'medical student' and 'health risks'. Articles were restricted to those published in English from 1997 through June 2017. A secondary review of the reference lists of these articles was performed. The grey literature was also searched for relevant material.

    Results: This narrative literature review outlines the risks of clinical electives in resource-poor settings which include exposure to infectious illness, trauma, sexual health problems, excessive sun exposure, mental health issues and crime. Medical students may mitigate these health risks by being informed and well prepared for high-risk situations. The authors provide evidence-based travel advice which aims to improve pre-travel preparation and maximize student traveller safety. A safer and more enjoyable elective may be achieved if students follow road safety advice, take personal safety measures, demonstrate cultural awareness, attend to their psychological wellbeing and avoid risk-taking behaviours.

    Conclusion: This article may benefit global health educators, international elective coordinators and travel medicine practitioners. For students, a comprehensive elective checklist, an inventory of health kit items and useful web-based educational resources are provided to help prepare for electives abroad.

    Matched MeSH terms: Travel
  6. Fulltext Leptospirosis: pulmonary hemorrhage in a returned traveller
    Leung V, Luong ML, Libman M
    CMAJ, 2011 Apr 19;183(7):E423-7.
    PMID: 21262944 DOI: 10.1503/cmaj.092203
    Matched MeSH terms: Travel
  7. An Australian experience with malaria
    George CR, O'Neill BJ, Garth JM
    Med J Aust, 1971 May 22;1(21):1110-3.
    PMID: 4932319
    Matched MeSH terms: Travel
  8. Fulltext Plasmodium cynomolgi as Cause of Malaria in Tourist to Southeast Asia, 2018
    Hartmeyer GN, Stensvold CR, Fabricius T, Marmolin ES, Hoegh SV, Nielsen HV, et al.
    Emerg Infect Dis, 2019 10;25(10):1936-1939.
    PMID: 31538931 DOI: 10.3201/eid2510.190448
    We report human infection with simian Plasmodium cynomolgi in a tourist from Denmark who had visited forested areas in peninsular Malaysia and Thailand in August and September 2018. Because P. cynomolgi may go unnoticed by standard malaria diagnostics, this malaria species may be more common in humans than was previously thought.
    Matched MeSH terms: Travel
  9. Fulltext Responding to the Potential of Ebola Virus Disease (EVD) Importation into Malaysia
    Wan Mohamed Noor WN, Sandhu SS, Ahmad Mahir HM, Kurup D, Rusli N, Saat Z, et al.
    Malays J Med Sci, 2014 Nov-Dec;21(6):3-8.
    PMID: 25897276 MyJurnal
    The current Ebola outbreak, which is the first to affect West African countries, has been declared to have met the conditions for a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO). Thus, the Ministry of Health (MOH) of Malaysia has taken steps to strengthen and enhanced the five core components of preparedness and response to mitigate the outbreak. The National Crisis Preparedness and Response Centre (CPRC) commands, controls and coordinates the preparedness and response plans for disasters, outbreaks, crises and emergencies (DOCE) related to health in a centralised way. Through standardised case definition and mandatory notification of Ebola by public and private practitioners, surveillance of Ebola is made possible. Government hospitals and laboratories have been identified to manage and diagnose Ebola virus infections, and medical staff members have been trained to handle an Ebola outbreak, with emphasis on strict infection prevention and control practices. Monitoring of the points of entry, focusing on travellers and students visiting or coming from West African countries is made possible by interagency collaborations. To alleviate the public's anxiety, effective risk communications are being delivered through various channels. With experience in past outbreak control, the MOH's preparedness and response plans are in place to abate an Ebola outbreak.
    Matched MeSH terms: Travel
  10. Fulltext Human infections with Sarcocystis species
    Fayer R, Esposito DH, Dubey JP
    Clin Microbiol Rev, 2015 Apr;28(2):295-311.
    PMID: 25715644 DOI: 10.1128/CMR.00113-14
    Recurrent outbreaks of muscular sarcocystosis among tourists visiting islands in Malaysia have focused international attention on sarcocystosis, a disease once considered rare in humans. Sarcocystis species require two hosts, definitive and intermediate, to complete their life cycle. Humans can serve as definitive hosts, with intestinal sarcocystosis for two species acquired from eating undercooked meat: Sarcocystis hominis, from beef, and Sarcocystis suihominis, from pork. Symptoms such as nausea, stomachache, and diarrhea vary widely depending on the number of cysts ingested but appear more severe with pork than with beef. Humans serve as intermediate hosts for Sarcocystis nesbitti, a species with a reptilian definitive host, and possibly other unidentified species, acquired by ingesting sporocysts from feces-contaminated food or water and the environment; infections have an early phase of development in vascular endothelium, with illness that is difficult to diagnose; clinical signs include fever, headache, and myalgia. Subsequent development of intramuscular cysts is characterized by myositis. Presumptive diagnosis based on travel history to tropical regions, elevated serum enzyme levels, and eosinophilia is confirmed by finding sarcocysts in muscle biopsy specimens. There is no vaccine or confirmed effective antiparasitic drug for muscular sarcocystosis, but anti-inflammatory drugs may reduce symptoms. Prevention strategies are also discussed.
    Matched MeSH terms: Travel
  11. Fulltext Cutaneous melioidosis in a healthy Danish man after travelling to South-East Asia
    Bodilsen J, Langgaard H, Nielsen HL
    BMJ Case Rep, 2015 Jan 16;2015.
    PMID: 25596295 DOI: 10.1136/bcr-2014-207340
    A healthy Danish man presented with infected prepatellar bursitis 8 months after being involved in a car accident in Malaysia resulting in exposure of a laceration of his knee to stagnant water. Tissue samples grew Burkholderia pseudomallei and diagnostic work up revealed no secondary foci. The patient was successfully treated with surgical debridement and 3 months of oral trimethoprim-sulfamethoxazole. At 6 months follow-up the patient was without relapse.
    Matched MeSH terms: Travel*
  12. Effect of Influenza Vaccination on Acute Respiratory Symptoms in Malaysian Hajj Pilgrims
    Hasan H, Deris ZZ, Sulaiman SA, Abdul Wahab MS, Naing NN, Ab Rahman Z, et al.
    J Immigr Minor Health, 2015 Aug;17(4):1114-9.
    PMID: 24946936 DOI: 10.1007/s10903-014-0059-y
    Respiratory illness were a major problem and caused high hospital admission during hajj seasons. One of the contributing cause to this illness is infection. Various measures had been implemented to reduce respiratory infections. The aim on the study is to determine the effect of influenza vaccination against acute respiratory illness among Malaysian Hajj pilgrims. This is an observational cohort study. Influenza vaccination was given to pilgrims at least 2 weeks prior to departure. The occurrence of symptoms for respiratory illness such as cough, fever, sore throat and runny nose was monitored daily for 6 weeks during pilgrimage using a health diary. A total of 65 vaccinated hajj pilgrims and 41 controls were analyzed. There was no significant difference in pattern of occurrence of symptoms of respiratory illness by duration of pilgrimage as well as the number of symptoms between both groups. Hajj pilgrims have frequent respiratory symptoms. We were unable to document benefit from influenza vaccination, but our study was limited by a small sample size and lack of laboratory testing for influenza.
    Matched MeSH terms: Travel/statistics & numerical data*
  13. Fulltext First case of Plasmodium knowlesi infection in a Japanese traveller returning from Malaysia
    Tanizaki R, Ujiie M, Kato Y, Iwagami M, Hashimoto A, Kutsuna S, et al.
    Malar J, 2013;12:128.
    PMID: 23587117 DOI: 10.1186/1475-2875-12-128
    This is the first case of Plasmodium knowlesi infection in a Japanese traveller returning from Malaysia. In September 2012, a previously healthy 35-year-old Japanese man presented to National Center for Global Health and Medicine in Tokyo with a two-day history of daily fever, mild headaches and mild arthralgia. Malaria parasites were found in the Giemsa-stained thin blood smear, which showed band forms similar to Plasmodium malariae. Although a nested PCR showed the amplification of the primer of Plasmodium vivax and Plasmodium knowlesi, he was finally diagnosed with P. knowlesi mono-infection by DNA sequencing. He was treated with mefloquine, and recovered without any complications. DNA sequencing of the PCR products is indispensable to confirm P. knowlesi infection, however there is limited access to DNA sequencing procedures in endemic areas. The extent of P. knowlesi transmission in Asia has not been clearly defined. There is limited availability of diagnostic tests and routine surveillance system for reporting an accurate diagnosis in the Asian endemic regions. Thus, reporting accurately diagnosed cases of P. knowlesi infection in travellers would be important for assessing the true nature of this emerging human infection.
    Matched MeSH terms: Travel*
  14. An outbreak of histoplasmosis among healthy young Japanese women after traveling to Southeast Asia
    Ohno H, Ogata Y, Suguro H, Yokota S, Watanabe A, Kamei K, et al.
    Intern. Med., 2010;49(5):491-5.
    PMID: 20190491
    Histoplasmosis, caused by Histoplasma capsulatum, is an endemic mycosis in many countries of the world except for Japan. Outbreaks of histoplasmosis among Japanese people are very rare and are mainly imported by travelers. We report an outbreak of histoplasmosis among healthy Japanese people who traveled to a resort area in Southeast Asia. Three young Japanese women traveled to Langkawi island, Malaysia and stayed on the island for five days without visiting caves, a known reservoir of H. capsulatum. All three individuals developed flu-like symptoms with multiple nodule shadows on chest X rays or chest CT scans at around ten days after their return to Japan. Serum samples obtained from the three subjects were positive for anti-Histoplasma antibody and specific PCR for H. capsulatum on lung biopsy specimens and the serum from one patient was positive. The clinical course of all three patients improved without the use of anti-fungal agents and no recurrence has been confirmed. Clinical attendants should consider histoplasmosis when they see patients with flu-like symptoms with abnormal chest X-rays after visiting H. capsulatum endemic areas, especially Southeast Asia.
    Matched MeSH terms: Travel*
  15. Acute renal failure after a holiday in the tropics
    Guron G, Holmdahl J, Dotevall L
    Clin. Nephrol., 2006 Dec;66(6):468-71.
    PMID: 17176921 DOI: 10.5414/cnp66468
    A 20-year-old, previously healthy woman, presented with high fever, headache and myalgia 3 days after her return from a holiday in Southeast Asia. Laboratory data on admission demonstrated a pronounced increase in plasma creatinine, marked thrombocytopenia and moderately elevated liver aminotransferases. After having ruled out malaria, dengue fever was primarily suspected and supportive intravenous fluid therapy was initiated. Still, 1 day after admission, platelet counts dropped even further and she became anuric although she did not appear hypovolemic. On day 2 after admission, urine production commenced spontaneously and the patient slowly recovered. All laboratory test results had returned to normal approximately 2 months later. Serological analysis for dengue fever was negative. It turned out that the patient had been trekking in the jungle while in Thailand and we, therefore, analyzed serology for Leptospira spirochetes which was clearly positive. The patient was diagnosed with leptospirosis which is a serious condition associated with a high mortality when complicated by acute renal failure. Differential diagnoses in patients with acute renal failure and tropical infections are reviewed. The importance of early recognition of leptospirosis, and prompt treatment with antibiotics in suspected cases, is emphasized.
    Matched MeSH terms: Travel*
  16. A case-control study of influenza vaccine effectiveness among Malaysian pilgrims attending the Haj in Saudi Arabia
    Mustafa AN, Gessner BD, Ismail R, Yusoff AF, Abdullah N, Ishak I, et al.
    Int J Infect Dis, 2003 Sep;7(3):210-4.
    PMID: 14563225
    To determine influenza vaccine effectiveness against clinically defined influenza-like illness among Malaysian pilgrims attending the Haj in Saudi Arabia.
    Matched MeSH terms: Travel*
  17. Fulltext Factors affecting patient compliance with anti-tuberculosis chemotherapy using the directly observed treatment, short-course strategy (DOTS)
    O'Boyle SJ, Power JJ, Ibrahim MY, Watson JP
    Int J Tuberc Lung Dis, 2002 Apr;6(4):307-12.
    PMID: 11936739
    SETTING: Kota Kinabalu and surrounding communities in Sabah, Malaysia.
    OBJECTIVES: To establish factors affecting compliance of patients with anti-tuberculosis chemotherapy, their knowledge of the disease, and views on improving the DOTS strategy.
    DESIGN: Interviews with compliant patients attending clinics for DOTS treatment and with non-compliant patients in their homes, in August and September 2000.
    RESULTS: A total of 63 compliant and 23 non-compliant patients were interviewed. For non-compliant patients, reaching the treatment centre entailed greater cost (P < 0.005) and travel time (P < 0.005) compared to compliant patients. Cost of transport was the reason most frequently given for non-attendance. Non-compliant patients were more likely to have completed secondary education (P < 0.05), and to be working (P < 0.01). More non-compliant patients had family members who had had the disease (P < 0.01). There was no difference between the groups for overall tuberculosis knowledge scores; however, non-compliant patients were more likely to think that treatment could be stopped once they were symptom free (P < 0.01). Most patients (73%) felt that the DOTS system could be improved by provision of more information about tuberculosis.
    CONCLUSION: Compliance with DOTS in the Kota Kinabalu area is affected by travel expenses, time spent travelling to treatment centres, and having family members who have had the disease. Patients would like more information on tuberculosis.
    Study site: Tuberculosis clinics, Kota Kinabalu, Malaysia
    Matched MeSH terms: Travel/economics
  18. Preliminary study of dengue virus infection in Iran
    Chinikar S, Ghiasi SM, Shah-Hosseini N, Mostafavi E, Moradi M, Khakifirouz S, et al.
    Travel Med Infect Dis, 2013 May-Jun;11(3):166-9.
    PMID: 23194952 DOI: 10.1016/j.tmaid.2012.10.001
    Dengue fever is one of the most important arthropod-borne viral diseases of public health significance. It is endemic in most tropical and subtropical parts of the world, many of which are popular tourist destinations. The presence of dengue infection was examined in Iranian patients who were referred to the Arboviruses and Viral Haemorrhagic Fevers Laboratory of the Pasteur Institute of Iran and tested negative for Crimean-Congo Haemorrhagic Fever (CCHF) between 2000 and 2012. Serum samples from these patients were tested for the presence of specific IgG and IgM and viral nucleic acid in blood. Of the 300 sera tested, 15 (5%) were seropositive, and 3 (1%) were both serologically and PCR positive. Of the 15 seropositive cases, 8 (53.3%) had travelled to endemic areas including Malaysia (5, 62.5%), India (2, 25%) and Thailand (1, 12.5%). In contrast, 7 (46.7%) of the cases had not reported travelling abroad. Of these, six cases were from the Sistan and Baluchistan province in southeast Iran and neighbouring Pakistan. Travellers play a key role in the epidemiology of dengue infection in Iran and it is recommended that travellers to endemic areas take precautionary measures to avoid mosquito bites.
    Matched MeSH terms: Travel Medicine*
  19. Fulltext Infected aneurysm after returning from Southeast Asia: think Burkholderia pseudomallei!
    Auvens C, Neuwirth C, Piroth L, Blot M
    BMJ Case Rep, 2019 May 22;12(5).
    PMID: 31122956 DOI: 10.1136/bcr-2018-228856
    Melioidosis is a protean disease which is endemic to Southeast Asia and northern Australia. Here, we report a case of infected aortic aneurysm due to Burkholderia pseudomallei in an immunocompetent man 6 months after a trip to northern Malaysia. This patient initially received inappropriate surgical and antibiotic treatment, leading to a peri-prosthetic aortic infection with lumbar spondylitis and contiguous psoas muscle abscess. This case highlights the difficulty of diagnosing melioidosis given its diverse clinical manifestations and the limits of routine microbiological methods to identify B. pseudomallei Melioidosis should be considered a possible diagnosis in individuals with unexplained fever subsequent to travel in an endemic area.
    Matched MeSH terms: Travel*
  20. Emergence of Klebsiella pneumoniae producing dual carbapenemases (NDM-1 and OXA-232) and 16S rRNA methylase (armA) isolated from a Malaysian patient returning from India
    Al-Marzooq F, Ngeow YF, Tay ST
    Int J Antimicrob Agents, 2015 Apr;45(4):445-6.
    PMID: 25631676 DOI: 10.1016/j.ijantimicag.2014.12.013
    Matched MeSH terms: Travel*
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