Special Issue "Neglected and Emerging Tropical Diseases in South and Southeast Asia and Northern Australia"

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: closed (31 October 2017)

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A printed edition of this Special Issue is available here.

Special Issue Editors

Guest Editor
Prof. Dr. Patricia Graves

College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns Qld 4870, Australia
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Interests: neglected tropical diseases; lymphatic filariasis; mosquito control; malaria elimination; Pacific islands; Papua New Guinea; Myanmar; surveillance
Guest Editor
Assoc. Prof. Thewarach Laha

Head, Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
E-Mail
Interests: soil-transmitted helminths; liver fluke infection; immunodiagnosis; cholangiocarcinoma; Thailand; molecular biology; genetics; immunology
Guest Editor
Prof. Dr. Peter A. Leggat

College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville Qld 4811, Australia
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Phone: +61747816108
Interests: neglected tropical diseases; lymphatic filariasis; dengue; malaria; occupational health; travel medicine; emerging public health threats
Guest Editor
Dr. Khin Saw Aye

Deputy Director General, Department of Medical Research, Ministry of Health and Sports, Republic of the Union of Myanmar
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Interests: leprosy; drug resistance; molecular epidemiology; tuberculosis; dengue; malaria: immuno-pathology; hepatitis B; lymphatic filariasis

Special Issue Information

Dear Colleagues,

This Special Issue focuses on recent research on the important emerging and neglected tropical diseases (NTDs) in South and South East Asia and Northern Australia. This region stretches from Afghanistan in the west to Papua New Guinea in the east, and includes the Indian subcontinent, mainland South-East Asia (Indo China), maritime South East Asia, and the tropical regions of Australia. Many of these areas are highly endemic for important NTDs and emerging infectious diseases including lymphatic filariasis, leprosy, soil-transmitted helminthiases (hookworm, Trichuris, Ascaris, and Strongyloides), food-borne trematodiases, schistosomiasis, dengue/chikungunya/zika, leptospirosis, meloidosis, scabies, trachoma, and yaws. Several of these diseases are targeted for elimination or enhanced control by the World Health Organization in the next 5 to 10 years, although some have chronic lasting sequelae needing lifelong management. Control methods used include preventive chemotherapy, enhanced screening and treatment, intensified disease management, vector control, interruption of human to animal transmission, environmental/sanitation improvements and disability prevention/mitigation.

Prof. Patricia Graves
Assoc. Prof. Thewarach Laha
Prof. Peter Leggat
Dr. Khin Saw Aye
Guest Editors

Manuscript Submission Information

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Keywords

  • Emerging tropical diseases
  • Neglected tropical diseases
  • South Asia
  • South East Asia
  • Northern Australia
  • Lymphatic filariasis
  • Leprosy
  • Soil-transmitted helminthiases (hookworm, Trichuris, Ascaris and Strongyloides)
  • Food-borne trematodiases
  • Schistosomiasis
  • Dengue
  • Chikungunya
  • Zika
  • Leptospirosis
  • Meloidosis
  • Scabies
  • Trachoma
  • Yaws
  • Elimination
  • Enhanced control
  • Preventive chemotherapy
  • Enhanced screening and treatment
  • Intensified disease management
  • Vector control
  • Interruption of animal to human transmission
  • Environmental/sanitation improvements
  • Disability prevention/mitigation
  • Zoonoses
  • One Health
  • Ectoparasites

Published Papers (12 papers)

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Editorial

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Open AccessEditorial Neglected and Emerging Tropical Diseases in South and Southeast Asia and Northern Australia
Trop. Med. Infect. Dis. 2018, 3(3), 70; https://doi.org/10.3390/tropicalmed3030070
Received: 19 June 2018 / Accepted: 20 June 2018 / Published: 22 June 2018
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Research

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Open AccessArticle Infection of Rodents by Orientia tsutsugamushi, the Agent of Scrub Typhus in Relation to Land Use in Thailand
Trop. Med. Infect. Dis. 2017, 2(4), 53; https://doi.org/10.3390/tropicalmed2040053
Received: 23 August 2017 / Revised: 1 October 2017 / Accepted: 4 October 2017 / Published: 6 October 2017
Cited by 3 | PDF Full-text (1356 KB) | HTML Full-text | XML Full-text
Abstract
The relationship between land use structures and occurrence of scrub typhus agent, Orientia tsutsugamushi infection in small wild mammals was conducted in three provinces of Thailand: Buriram, Loei, and Nan. Orientia tsutsugamushi detection was performed using 16S ribosomal DNA (rDNA) amplicon sequencing approach [...] Read more.
The relationship between land use structures and occurrence of scrub typhus agent, Orientia tsutsugamushi infection in small wild mammals was conducted in three provinces of Thailand: Buriram, Loei, and Nan. Orientia tsutsugamushi detection was performed using 16S ribosomal DNA (rDNA) amplicon sequencing approach using Miseq Illumina platform. In total, 387 animals (rodents and shrews) were examined for the bacterium infection. The 16S rDNA sequences of the bacterium were found in nine animals from Bandicota savilei, Berylmys bowersi, Leopoldamys edwardsi, Rattus exulans, R. tanezumi, and Rattus sp. phylogenetic clade 3, yielding 2.3% infection rate, with two new rodent species infected by the bacterium in Thailand: B. bowersi and L. edwardsi. Using a Generalized Linear Mixed Model (GLMM) and Random Forest analyses for investigating the association between human-land use and occurrence of the bacterium, forest habitat appeared as a strong explicative variable of rodent infection, meaning that O. tsutsugamushi-infected animals were more likely found in forest-covered habitats. In terms of public health implementation, our results suggest that heterogenous forested areas including forest-converted agricultural land, reforestation areas, or fallow are potential habitats for O. tsutsugamushi transmission. Further understanding of population dynamics of the vectors and their hosts in these habitats could be beneficial for the prevention of this neglected zoonotic disease. Full article
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Open AccessArticle Soil-Transmitted Helminths in Children in a Remote Aboriginal Community in the Northern Territory: Hookworm is Rare but Strongyloides stercoralis and Trichuris trichiura Persist
Trop. Med. Infect. Dis. 2017, 2(4), 51; https://doi.org/10.3390/tropicalmed2040051
Received: 31 August 2017 / Revised: 26 September 2017 / Accepted: 30 September 2017 / Published: 4 October 2017
Cited by 2 | PDF Full-text (546 KB) | HTML Full-text | XML Full-text
Abstract
(1) Background: soil-transmitted helminths are a problem worldwide, largely affecting disadvantaged populations. The little data available indicates high rates of infection in some remote Aboriginal communities in Australia. Studies of helminths were carried out in the same remote community in the Northern Territory [...] Read more.
(1) Background: soil-transmitted helminths are a problem worldwide, largely affecting disadvantaged populations. The little data available indicates high rates of infection in some remote Aboriginal communities in Australia. Studies of helminths were carried out in the same remote community in the Northern Territory in 1994–1996 and 2010–2011; (2) Methods: fecal samples were collected from children aged <10 years and examined for helminths by direct smear microscopy. In the 2010–2011 study, some fecal samples were also analyzed by agar plate culture and PCR for Strongyloides stercoralis DNA. Serological analysis of fingerprick dried blood spots using a S. stercoralis NIE antigen was also conducted; (3) Results and Conclusions: a reduction in fecal samples positive for S. stercoralis, hookworm and Trichuris trichiura was seen between the studies in 1994–1996 and 2010–2011, likely reflecting public health measures undertaken in the region to reduce intestinal helminths. Comparison of methods to detect S. stercoralis showed that PCR of fecal samples and serological testing of dried blood spots was at least as sensitive as direct smear microscopy and agar plate culture. These methods have advantages for use in remote field studies. Full article
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Open AccessArticle Lymphatic Filariasis Increases Tissue Compressibility and Extracellular Fluid in Lower Limbs of Asymptomatic Young People in Central Myanmar
Trop. Med. Infect. Dis. 2017, 2(4), 50; https://doi.org/10.3390/tropicalmed2040050
Received: 15 August 2017 / Revised: 13 September 2017 / Accepted: 17 September 2017 / Published: 27 September 2017
Cited by 2 | PDF Full-text (786 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
When normal lymphatic function is hampered, imperceptible subcutaneous edema can develop and progress to overt lymphedema. Low-cost reliable devices for objective assessment of lymphedema are well accepted in clinical practice and research on breast-cancer related lymphedema but are untested in populations with lymphatic [...] Read more.
When normal lymphatic function is hampered, imperceptible subcutaneous edema can develop and progress to overt lymphedema. Low-cost reliable devices for objective assessment of lymphedema are well accepted in clinical practice and research on breast-cancer related lymphedema but are untested in populations with lymphatic filariasis (LF). This is a cross-sectional analysis of baseline data in a longitudinal study on asymptomatic, LF antigen-positive and -negative young people in Myanmar. Rapid field screening was used to identify antigen-positive cases and a group of antigen-negative controls of similar age and gender were invited to continue in the study. Tissue compressibility was assessed with three tissue tonometers, and free fluids were assessed using bio-impedance spectroscopy (BIS). Infection status was confirmed by Og4C3 antigen assay. At baseline (n = 98), antigen-positive cases had clinically relevant increases in tissue compressibility at the calf using a digital Indurometer (11.1%, p = 0.021), and in whole-leg free fluid using BIS (9.2%, p = 0.053). Regression analysis for moderating factors (age, gender, hydration) reinforced the between-infection group differences. Results demonstrate that sub-clinical changes associated with infection can be detected in asymptomatic cases. Further exploration of these low-cost devices in clinical and research settings on filariasis-related lymphedema are warranted. Full article
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Open AccessArticle Poverty, Dietary Intake, Intestinal Parasites, and Nutritional Status among School-Age Children in the Rural Philippines
Trop. Med. Infect. Dis. 2017, 2(4), 49; https://doi.org/10.3390/tropicalmed2040049
Received: 14 August 2017 / Revised: 11 September 2017 / Accepted: 17 September 2017 / Published: 21 September 2017
Cited by 1 | PDF Full-text (756 KB) | HTML Full-text | XML Full-text
Abstract
Intestinal helminths are endemic throughout the Philippines; however, there is limited evidence with respect to their prevalence, intensity, and impact on children’s nutritional status. A cross-sectional survey was carried out on 693 children from five rural villages in Northern Samar, the Philippines. Data [...] Read more.
Intestinal helminths are endemic throughout the Philippines; however, there is limited evidence with respect to their prevalence, intensity, and impact on children’s nutritional status. A cross-sectional survey was carried out on 693 children from five rural villages in Northern Samar, the Philippines. Data on dietary intake, nutritional status, and intestinal parasites were collected. Infection with Schistosoma japonicum, Ascaris lumbricoides, Trichuris trichiura, and hookworm was evident in 20.1, 54.4, 71.4, and 25.3% of the children. The majority (84.7%) was infected with one or more helminth species, with about one-quarter of the sample (24.7%) infected with three or more. About half (49.2%, n = 341) of the children were stunted and 27.8% (n = 193) were wasted. A lower prevalence of normal height-for-age (48.3%) appeared in those with polyparasitism, while the prevalence of stunted children increased with infection (46.7% monoparasitism and 51.7% polyparasitism). There was a decreasing trend between infection intensity and the mean values of HAZ and BAZ identified for T. trichiura or hookworm infections. Stunted children were more likely to be male (AOR = 1.58; 95% CI: 1.05–2.39; p = 0.028), older in age (10–14 years) (AOR = 1.93; 95% CI: 1.29–2.88; p = 0.001), and living in poorer households with palm leaves/nipa roof (AOR = 1.85; 95% CI: 1.14–3.01; p = 0.013). Intestinal parasitic treatment needs to be combined with nutrient supplements and health education in order to interrupt the parasite life cycle and achieve sustainable control. Full article
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Open AccessArticle Trends in Strongyloides stercoralis Faecal Larvae Detections in the Northern Territory, Australia: 2002 to 2012
Trop. Med. Infect. Dis. 2017, 2(2), 18; https://doi.org/10.3390/tropicalmed2020018
Received: 19 April 2017 / Revised: 13 June 2017 / Accepted: 13 June 2017 / Published: 19 June 2017
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Abstract
Strongyloides stercoralis is a soil-transmitted helminth (STH) endemic to tropical and subtropical areas. We reviewed the temporal detection trends in patients with S. stercoralis larvae present in faecal samples, in Northern Territory (NT) Government Health facilities, between 2002 and 2012. This was a [...] Read more.
Strongyloides stercoralis is a soil-transmitted helminth (STH) endemic to tropical and subtropical areas. We reviewed the temporal detection trends in patients with S. stercoralis larvae present in faecal samples, in Northern Territory (NT) Government Health facilities, between 2002 and 2012. This was a retrospective observational study of consecutive patients with microbiologically confirmed detection of S. stercoralis in faeces. The presence of anaemia, eosinophilia, polyparasitism, and geographic and demographic data, were included in the assessment. S. stercoralis larvae were present in 389 of 22,892 faecal samples (1.7%) collected across the NT over 11 years, examined by microscopy after formol ethyl acetate concentration. 97.7% of detections were in Indigenous patients. Detections, by number, occurred in a biphasic age distribution. Detections per number of faecal samples collected, were highest in the 0–5 year age group. Anaemia was present in 44.8%, and eosinophilia in 49.9% of patients. Eosinophilia was present in 65.5% of the ≤5 age group, compared to 40.8% of >5 year age (p < 0.0001). Polyparasitism was present in 31.4% of patients. There was an overall downward trend in larvae detections from 2.64% to 0.99% detections/number of faecal samples year between 2002 and 2012, consistent with the trends observed for other local STHs. S. stercoralis remains an important NT-wide pathogen. Full article
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Open AccessArticle Epidemiology and Characteristics of Rickettsia australis (Queensland Tick Typhus) Infection in Hospitalized Patients in North Brisbane, Australia
Trop. Med. Infect. Dis. 2017, 2(2), 10; https://doi.org/10.3390/tropicalmed2020010
Received: 22 March 2017 / Revised: 9 April 2017 / Accepted: 10 April 2017 / Published: 15 April 2017
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Abstract
Queensland Tick Typhus (QTT; Rickettsia australis) is a Spotted Fever Group (SFG) rickettsial infection endemic to Australia. It is an underreported and often unrecognized illness with poorly defined epidemiology. This article describes epidemiological features and the geographical distribution of QTT in hospitalized [...] Read more.
Queensland Tick Typhus (QTT; Rickettsia australis) is a Spotted Fever Group (SFG) rickettsial infection endemic to Australia. It is an underreported and often unrecognized illness with poorly defined epidemiology. This article describes epidemiological features and the geographical distribution of QTT in hospitalized patients. Cases of QTT were identified retrospectively from 2000–2015 at five sites in Northern Brisbane through a pathology database. Included cases had a four-fold rise in SFG-specific serology, a single SFG-specific serology ≥256 or an SFG-specific serology ≥128 with a clinically consistent illness. Of the fifty cases identified by serology, 36 were included. Age ranged from 3–72 years (with a mean of 39.5 years) with a male-to-female ratio of 1:1.1. Fifteen of 36 (42%) study participants had hobbies and/or occupations linked with the acquisition of the disease. Seventeen of 36 (47%) identified a tick bite in the days preceding presentation to hospital, and reported exposure to a known animal host was minimal (25%). QTT infection occurred throughout the year, with half reported between April and July. Recent ecological and sociocultural changes have redefined the epidemiology of this zoonotic illness, with areas of heightened infection identified. Heightened public health awareness is required to monitor QTT disease activity. Full article
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Open AccessArticle Relative Performance and Predictive Values of Plasma and Dried Blood Spots with Filter Paper Sampling Techniques and Dilutions of the Lymphatic Filariasis Og4C3 Antigen ELISA for Samples from Myanmar
Trop. Med. Infect. Dis. 2017, 2(2), 7; https://doi.org/10.3390/tropicalmed2020007
Received: 11 February 2017 / Revised: 27 March 2017 / Accepted: 4 April 2017 / Published: 11 April 2017
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Abstract
Diagnostic testing of blood samples for parasite antigen Og4C3 is used to assess Wuchereria bancrofti in endemic populations. However, the Tropbio ELISA recommends that plasma and dried blood spots (DBS) prepared using filter paper be used at different dilutions, making it uncertain whether [...] Read more.
Diagnostic testing of blood samples for parasite antigen Og4C3 is used to assess Wuchereria bancrofti in endemic populations. However, the Tropbio ELISA recommends that plasma and dried blood spots (DBS) prepared using filter paper be used at different dilutions, making it uncertain whether these two methods and dilutions give similar results, especially at low levels of residual infection or resurgence during the post-program phase. We compared results obtained using samples of plasma and DBS taken simultaneously from 104 young adults in Myanmar in 2014, of whom 50 (48.1%) were positive for filariasis antigen by rapid antigen test. Results from DBS tests at recommended dilution were significantly lower than results from plasma tested at recommended dilution, with comparisons between plasma and DBS at unmatched dilutions yielding low sensitivity and negative predictive values of 60.0% and 70.6% respectively. While collection of capillary blood on DBS is cheaper and easier to perform than collecting plasma or serum, and does not need to be stored frozen, dilutions between different versions of the test must be reconciled or an adjustment factor applied. Full article
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Open AccessArticle Concordance between Plasma and Filter Paper Sampling Techniques for the Lymphatic Filariasis Bm14 Antibody ELISA
Trop. Med. Infect. Dis. 2017, 2(2), 6; https://doi.org/10.3390/tropicalmed2020006
Received: 20 February 2017 / Revised: 27 March 2017 / Accepted: 4 April 2017 / Published: 7 April 2017
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Abstract
Diagnostic testing for the antibody Bm14 is used to assess the prevalence of bancroftian and brugian filariasis in endemic populations. Using dried blood spots (DBS) collected on filter paper is ideal in resource-poor settings, but concerns have been raised about the performance of [...] Read more.
Diagnostic testing for the antibody Bm14 is used to assess the prevalence of bancroftian and brugian filariasis in endemic populations. Using dried blood spots (DBS) collected on filter paper is ideal in resource-poor settings, but concerns have been raised about the performance of DBS samples compared to plasma or serum. In addition, two versions of the test have been used: the Bm14 CELISA (Cellabs Pty Ltd., Manly, Australia) or an in-house CDC version. Due to recent improvements in the CELISA, it is timely to validate the latest versions of the Bm14 ELISA for both plasma and DBS, especially in settings of residual infection with low antibody levels. We tested plasma and DBS samples taken simultaneously from 92 people in Myanmar, of whom 37 (40.2%) were positive in a rapid antigen test. Comparison of results from plasma and DBS samples demonstrated no significant difference in positive proportions using both the CELISA (46.7% and 44.6%) and CDC ELISA (50.0% and 47.8%). Quantitative antibody unit results from each sample type were also highly correlated, with coefficients >0.87. The results of this study demonstrate that DBS samples are a valid collection strategy and give equivalent results to plasma for Bm14 antibody ELISA testing by either test type. Full article
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Review

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Open AccessReview Soil-Transmitted Helminths in Tropical Australia and Asia
Trop. Med. Infect. Dis. 2017, 2(4), 56; https://doi.org/10.3390/tropicalmed2040056
Received: 29 August 2017 / Revised: 16 October 2017 / Accepted: 17 October 2017 / Published: 23 October 2017
Cited by 8 | PDF Full-text (1943 KB) | HTML Full-text | XML Full-text
Abstract
Soil-transmitted helminths (STH) infect 2 billion people worldwide including significant numbers in South-East Asia (SEA). In Australia, STH are of less concern; however, indigenous communities are endemic for STH, including Strongyloides stercoralis, as well as for serious clinical infections due to other [...] Read more.
Soil-transmitted helminths (STH) infect 2 billion people worldwide including significant numbers in South-East Asia (SEA). In Australia, STH are of less concern; however, indigenous communities are endemic for STH, including Strongyloides stercoralis, as well as for serious clinical infections due to other helminths such as Toxocara spp. The zoonotic hookworm Ancylostoma ceylanicum is also present in Australia and SEA, and may contribute to human infections particularly among pet owners. High human immigration rates to Australia from SEA, which is highly endemic for STH Strongyloides and Toxocara, has resulted in a high prevalence of these helminthic infections in immigrant communities, particularly since such individuals are not screened for worm infections upon entry. In this review, we consider the current state of STH infections in Australia and SEA. Full article
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Open AccessReview Lymphatic Filariasis in Mainland Southeast Asia: A Systematic Review and Meta-Analysis of Prevalence and Disease Burden
Trop. Med. Infect. Dis. 2017, 2(3), 32; https://doi.org/10.3390/tropicalmed2030032
Received: 15 June 2017 / Revised: 17 July 2017 / Accepted: 17 July 2017 / Published: 27 July 2017
Cited by 6 | PDF Full-text (3640 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Accurate prevalence data are essential for the elimination of lymphatic filariasis (LF) as a public health problem. Despite it bearing one of the highest burdens of disease globally, there remains limited reliable information on the current epidemiology of filariasis in mainland Southeast Asia. [...] Read more.
Accurate prevalence data are essential for the elimination of lymphatic filariasis (LF) as a public health problem. Despite it bearing one of the highest burdens of disease globally, there remains limited reliable information on the current epidemiology of filariasis in mainland Southeast Asia. We conducted a systematic review and meta-analysis of available literature to assess the recent and current prevalence of infection and morbidity in the region. Fifty-seven journal articles and reports containing original prevalence data were identified, including over 512,010 participants. Data were summarised using percentage prevalence estimates and a subset combined using a random effects meta-analysis by country and year. Pooled estimates for microfilaraemia, immunochromatographic card positivity and combined morbidity were 2.64%, 4.48% and 1.34% respectively. Taking into account pooled country estimates, grey literature and the quality of available data, we conclude that Lao People's Democratic Republic (PDR), Myanmar and Northeast India demonstrate ongoing evidence of LF transmission that will require multiple further rounds of mass drug administration. Bangladesh, Malaysia, Thailand and Vietnam appear close to having eliminated LF, whilst Cambodia has already achieved elimination status. We estimate that the burden of morbidity is likely high in Thailand; moderate in Cambodia, Myanmar, and Northeast India; and low in Bangladesh. There was insufficient evidence to accurately estimate the disease burden in Lao PDR, Malaysia or Vietnam. The results of this study indicate that whilst considerable progress toward LF elimination has been made, there remains a significant filariasis burden in the region. The results of this study will assist policy makers to advocate and budget for future control programs. Full article
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Other

Open AccessPerspective Confronting the Emerging Threat to Public Health in Northern Australia of Neglected Indigenous Arboviruses
Trop. Med. Infect. Dis. 2017, 2(4), 55; https://doi.org/10.3390/tropicalmed2040055
Received: 11 September 2017 / Revised: 6 October 2017 / Accepted: 12 October 2017 / Published: 17 October 2017
Cited by 2 | PDF Full-text (461 KB) | HTML Full-text | XML Full-text
Abstract
In excess of 75 arboviruses have been identified in Australia, some of which are now well established as causative agents of debilitating diseases. These include Ross River virus, Barmah Forest virus, and Murray Valley encephalitis virus, each of which may be detected by [...] Read more.
In excess of 75 arboviruses have been identified in Australia, some of which are now well established as causative agents of debilitating diseases. These include Ross River virus, Barmah Forest virus, and Murray Valley encephalitis virus, each of which may be detected by both antibody-based recognition and molecular typing. However, for most of the remaining arboviruses that may be associated with pathology in humans, routine tests are not available to diagnose infection. A number of these so-called ‘neglected’ or ‘orphan’ arboviruses that are indigenous to Australia might have been infecting humans at a regular rate for decades. Some of them may be associated with undifferentiated febrile illness—fever, the cause of which is not obvious—for which around half of all cases each year remain undiagnosed. This is of particular relevance to Northern Australia, given the Commonwealth Government’s transformative vision for the midterm future of massive infrastructure investment in this region. An expansion of the industrial and business development of this previously underpopulated region is predicted. This is set to bring into intimate proximity infection-naïve human hosts, native reservoir animals, and vector mosquitoes, thereby creating a perfect storm for increased prevalence of infection with neglected Australian arboviruses. Moreover, the escalating rate and effects of climate change that are increasingly observed in the tropical north of the country are likely to lead to elevated numbers of arbovirus-transmitting mosquitoes. As a commensurate response, continuing assiduous attention to vector monitoring and control is required. In this overall context, improved epidemiological surveillance and diagnostic screening, including establishing novel, rapid pan-viral tests to facilitate early diagnosis and appropriate treatment of febrile primary care patients, should be considered a public health priority. Investment in a rigorous identification program would reduce the possibility of significant outbreaks of these indigenous arboviruses at a time when population growth accelerates in Northern Australia. Full article
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