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Item Metadata only Combined effects of hydrological conditions and socioeconomic factors on the seasonal dynamics of severe fever with thrombocytopenia syndrome in China, 2011–2022: a modelling study(2025-05-01) Ge H.H.; Liu K.; Ding F.Y.; Huang P.; Sun Y.Q.; Yue M.; Su H.; Wang Q.; Day N.P.J.; Maude R.J.; Jiang D.; Fang L.Q.; Liu W.; Ge H.H.; Mahidol UniversityBackground: Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne viral hemorrhagic fever with expanding geographical range. The determinants of the seasonal dynamics of SFTS remain poorly understood. Methods: Monthly SFTS cases from 604 counties in five provinces with high-notification rate in China (2011–2022) were analyzed using hierarchical Bayesian spatiotemporal and distributed lag nonlinear models. Cumulative and month-specific effects of meteorological factors were assessed, with socioeconomic factors as modifiers. Findings: The cumulative effect peaked at 21.97 °C (RR = 1.24, 95% CI: 1.10–1.40) and the month-specific effect peaked at 25.67 °C (RR = 1.38, 95% CI: 1.26–1.51) without time lag. Increased precipitation significantly amplified the risk of SFTS with a notable lag effect observed. Both drought and wet conditions heightened the risk of SFTS occurrence substantially, with cumulative RR peaking at 3.13 (95% CI: 1.58–6.23) for Standardized Precipitation Evapotranspiration Index (SPEI-1) of −2.5, indicating drought conditions, and peaking at 1.51 (95% CI: 1.00–2.27) for SPEI-1 of 2.16, indicating wet conditions. The highest month-specific RR was observed at an SPEI-1 of −2.5 with a 2-month lag and at 1.81 with a 1-month lag, respectively. The risk of SFTS was higher in low-urbanization areas during drought, while was higher in high-urbanization areas with wet conditions. Interpretation: Climatic factors significantly influence SFTS dynamics, with socioeconomic conditions modifying these effects. Integrating climate factors into surveillance and early warning systems is essential for targeted prevention and control. Funding: National Natural Science Foundation of China (No. 82330103 and No. 42201497), Youth Innovation Promotion Association (No. 2023000117), and the Wellcome Trust [220211].Publication Metadata only Population-level faecal metagenomic profiling as a tool to predict antimicrobial resistance in Enterobacterales isolates causing invasive infections: An exploratory study across Cambodia, Kenya, and the UK(2021-06-01) Olga Tosas Auguet; Rene Niehus; Hyun Soon Gweon; James A. Berkley; Joseph Waichungo; Tsi Njim; Jonathan D. Edgeworth; Rahul Batra; Kevin Chau; Jeremy Swann; Sarah A. Walker; Tim E.A. Peto; Derrick W. Crook; Sarah Lamble; Paul Turner; Ben S. Cooper; Nicole Stoesser; Faculty of Tropical Medicine, Mahidol University; The Wellcome Centre for Human Genetics; Wellcome Trust Research Laboratories Nairobi; Harvard T.H. Chan School of Public Health; University of Reading; King's College London; Nuffield Department of Medicine; UK Centre for Ecology & Hydrology; Angkor Hospital for Children; National Institute for Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance; The Childhood Acute Illness and Nutrition (CHAIN) NetworkBackground: Antimicrobial resistance (AMR) in Enterobacterales is a global health threat. Capacity for individual-level surveillance remains limited in many countries, whilst population-level surveillance approaches could inform empiric antibiotic treatment guidelines. Methods: In this exploratory study, a novel approach to population-level prediction of AMR in Enterobacterales clinical isolates using metagenomic (Illumina) profiling of pooled DNA extracts from human faecal samples was developed and tested. Taxonomic and AMR gene profiles were used to derive taxonomy-adjusted population-level AMR metrics. Bayesian modelling, and model comparison based on cross-validation, were used to evaluate the capacity of each metric to predict the number of resistant Enterobacterales invasive infections at a population-level, using available bloodstream/cerebrospinal fluid infection data. Findings: Population metagenomes comprised samples from 177, 157, and 156 individuals in Kenya, the UK, and Cambodia, respectively, collected between September 2014 and April 2016. Clinical data from independent populations included 910, 3356 and 197 bacterial isolates from blood/cerebrospinal fluid infections in Kenya, the UK and Cambodia, respectively (samples collected between January 2010 and May 2017). Enterobacterales were common colonisers and pathogens, and faecal taxonomic/AMR gene distributions and proportions of antimicrobial-resistant Enterobacterales infections differed by setting. A model including terms reflecting the metagenomic abundance of the commonest clinical Enterobacterales species, and of AMR genes known to either increase the minimum inhibitory concentration (MIC) or confer clinically-relevant resistance, had a higher predictive performance in determining population-level resistance in clinical Enterobacterales isolates compared to models considering only AMR gene information, only taxonomic information, or an intercept-only baseline model (difference in expected log predictive density compared to best model, estimated using leave-one-out cross-validation: intercept-only model = -223 [95% credible interval (CI): -330,-116]; model considering only AMR gene information = -186 [95% CI: -281,-91]; model considering only taxonomic information = -151 [95% CI: -232,-69]). Interpretation: Whilst our findings are exploratory and require validation, intermittent metagenomics of pooled samples could represent an effective approach for AMR surveillance and to predict population-level AMR in clinical isolates, complementary to ongoing development of laboratory infrastructures processing individual samples.Publication Metadata only Setting the standard: Multidisciplinary hallmarks for structural, equitable and tracked antibiotic policy(2020-09-23) Claas Kirchhelle; Paul Atkinson; Alex Broom; Komatra Chuengsatiansup; Jorge Pinto Ferreira; Nicolas Fortané; Isabel Frost; Christoph Gradmann; Stephen Hinchliffe; Steven J. Hoffman; Javier Lezaun; Susan Nayiga; Kevin Outterson; Scott H. Podolsky; Stephanie Raymond; Adam P. Roberts; Andrew C. Singer; Anthony D. So; Luechai Sringernyuang; Elizabeth Tayler; Susan Rogers Van Katwyk; Clare I.R. Chandler; Dahdaleh Institute for Global Health Research; Oxford Social Sciences Division; Infectious Diseases Research Collaboration; York University; London School of Hygiene & Tropical Medicine; Organisation Mondiale de la Santé; University of Exeter; The University of Sydney; Liverpool School of Tropical Medicine; University of Liverpool; Boston University; Imperial College London; Mahidol University; Universitetet i Oslo; Université Paris-Dauphine; Johns Hopkins Bloomberg School of Public Health; University College Dublin; UK Centre for Ecology & Hydrology; Harvard Medical School; Innovation + Design Enabling Access (IDEA) Initiative; Antimicrobial Resistance and Veterinary Products Department; Center for Disease Dynamics, Economics and Policy; Princess Maha Chakri Sirindhorn Anthropology Centre© 2020 Author(s) (or their employer(s)). Re-use permitted under CC BY. Published by BMJ. There is increasing concern globally about the enormity of the threats posed by antimicrobial resistance (AMR) to human, animal, plant and environmental health. A proliferation of international, national and institutional reports on the problems posed by AMR and the need for antibiotic stewardship have galvanised attention on the global stage. However, the AMR community increasingly laments a lack of action, often identified as an â € implementation gap'. At a policy level, the design of internationally salient solutions that are able to address AMR's interconnected biological and social (historical, political, economic and cultural) dimensions is not straightforward. This multidisciplinary paper responds by asking two basic questions: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes, what hallmarks characterise â € good' antibiotic policy? Our multistage analysis revealed four central challenges facing current international antibiotic policy: metrics, prioritisation, implementation and inequality. In response to this diagnosis, we propose three hallmarks that can support robust international antibiotic policy. Emerging hallmarks for good antibiotic policies are: Structural, Equitable and Tracked. We describe these hallmarks and propose their consideration should aid the design and evaluation of international antibiotic policies with maximal benefit at both local and international scales.Publication Metadata only One Health drivers of antibacterial resistance: Quantifying the relative impacts of human, animal and environmental use and transmission(2021-06-01) Ross D. Booton; Aronrag Meeyai; Nour Alhusein; Henry Buller; Edward Feil; Helen Lambert; Skorn Mongkolsuk; Emma Pitchforth; Kristen K. Reyher; Walasinee Sakcamduang; Jutamaad Satayavivad; Andrew C. Singer; Luechai Sringernyuang; Visanu Thamlikitkul; Lucy Vass; Matthew B. Avison; Boonrat Chantong; Nisanart Charoenlap; Natacha Couto; Punyawee Dulyayangkul; Marjorie J. Gibbon; Virginia C. Gould; Varapon Montrivade; Kornrawan Phoonsawad; Nuchanart Rangkadilok; Parntep Ratanakorn; Kwanrawee Sirikanchana; Tawit Suriyo; Sarin Suwanpakdee; Katherine M.E. Turner; Kantima Wichuwaranan; Anuwat Wiratsudakul; Chulabhorn Research Institute; Bristol Medical School; Bristol Veterinary School; London School of Hygiene & Tropical Medicine; University of Bath; University of Exeter; Chulabhorn Royal Academy; University of Bristol; Mahidol University; Faculty of Medicine Siriraj Hospital, Mahidol University; UK Centre for Ecology & HydrologyObjectives: Antibacterial resistance (ABR) is a major global health security threat, with a disproportionate burden on lower-and middle-income countries (LMICs). It is not understood how ‘One Health’, where human health is co-dependent on animal health and the environment, might impact the burden of ABR in LMICs. Thailand's 2017 “National Strategic Plan on Antimicrobial Resistance” (NSP-AMR) aims to reduce AMR morbidity by 50% through 20% reductions in human and 30% in animal antibacterial use (ABU). There is a need to understand the implications of such a plan within a One Health perspective. Methods: A model of ABU, gut colonisation with extended-spectrum beta-lactamase (ESBL)-producing bacteria and transmission was calibrated using estimates of the prevalence of ESBL-producing bacteria in Thailand. This model was used to project the reduction in human ABR over 20 years (2020–2040) for each One Health driver, including individual transmission rates between humans, animals and the environment, and to estimate the long-term impact of the NSP-AMR intervention. Results: The model predicts that human ABU was the most important factor in reducing the colonisation of humans with resistant bacteria (maximum 65.7–99.7% reduction). The NSP-AMR is projected to reduce human colonisation by 6.0–18.8%, with more ambitious targets (30% reductions in human ABU) increasing this to 8.5–24.9%. Conclusions: Our model provides a simple framework to explain the mechanisms underpinning ABR, suggesting that future interventions targeting the simultaneous reduction of transmission and ABU would help to control ABR more effectively in Thailand.Publication Metadata only Water quality and breeding habitats of anopheline mosquito in northwestern Thailand(2005-01-01) Ampornpan Kengluecha; Pratap Singhasivanon; Montip Tiensuwan; James W. Jones; Ratana Sithiprasasna; Armed Forces Research Institute of Medical Sciences, Thailand; Mahidol UniversityMalaria transmission is dependent upon many hydrology-driven ecological factors that directly affect the vectorial competence, including the presence of suitable habitats for the development of anopheline larvae. Larval habitats were identifiedItem Metadata only Increased faecal shedding in SARS-CoV-2 variants BA.2.86 and JN.1(2024-01-01) Wannigama D.L.; Amarasiri M.; Phattharapornjaroen P.; Hurst C.; Modchang C.; Chadsuthi S.; Anupong S.; Miyanaga K.; Cui L.; Fernandez S.; Huang A.T.; Ounjai P.; Singer A.C.; Ragupathi N.K.D.; Sano D.; Furukawa T.; Sei K.; Leelahavanichkul A.; Kanjanabuch T.; Chatsuwan T.; Higgins P.G.; Nanbo A.; Kicic A.; Siow R.; Trowsdale S.; Hongsing P.; Khatib A.; Shibuya K.; Abe S.; Ishikawa H.; Thuptiang W.; Ali A.H.; Vatanaprasan P.; Jay D.J.; Saethang T.; Luk-in S.; Storer R.J.; Kanthawee P.; Tacharoenmuang R.; Wannigama D.L.; Mahidol UniversityItem Metadata only Tracing the new SARS-CoV-2 variant BA.2.86 in the community through wastewater surveillance in Bangkok, Thailand(2023-11-01) Wannigama D.L.; Amarasiri M.; Phattharapornjaroen P.; Hurst C.; Modchang C.; Chadsuthi S.; Anupong S.; Miyanaga K.; Cui L.; Fernandez S.; Huang A.T.; Ounjai P.; Tacharoenmuang R.; Ragupathi N.K.D.; Sano D.; Furukawa T.; Sei K.; Leelahavanichkul A.; Kanjanabuch T.; Higgins P.G.; Nanbo A.; Kicic A.; Singer A.C.; Chatsuwan T.; Trowsdale S.; Khatib A.; Shibuya K.; Abe S.; Ishikawa H.; Hongsing P.; Thuptiang W.; Rad S M A.H.; Vatanaprasan P.; Jay D.J.; Saethang T.; Luk-in S.; Storer R.J.; Kanthawee P.; Mahidol UniversityItem Metadata only Tracing the transmission of mpox through wastewater surveillance in Southeast Asia(2023-09-05) Wannigama D.L.; Amarasiri M.; Phattharapornjaroen P.; Hurst C.; Modchang C.; Chadsuthi S.; Anupong S.; Miyanaga K.; Cui L.; Thuptimdang W.; Ali Hosseini Rad S.M.; Fernandez S.; Huang A.T.; Vatanaprasan P.; Jay D.J.; Saethang T.; Luk-In S.; Storer R.J.; Ounjai P.; Ragupathi N.K.D.; Kanthawee P.; Sano D.; Furukawa T.; Sei K.; Leelahavanichkul A.; Kanjanabuch T.; Higgins P.G.; Nanbo A.; Kicic A.; Singer A.C.; Chatsuwan T.; Trowsdale S.; Siow R.; Shibuya K.; Abe S.; Ishikawa H.; Hongsing P.; Mahidol UniversityHigh population density and tourism in Southeast Asia increase the risk of mpox due to frequent interpersonal contacts. Our wastewater surveillance in six Southeast Asian countries revealed positive signals for Monkeypox virus (MPXV) DNA, indicating local transmission. This alerts clinicians and helps allocate resources like testing, vaccines and therapeutics in resource-limited countries.Item Metadata only Streptococcus pyogenes Surveillance Through Surface Swab Samples to Track the Emergence of Streptococcal Toxic Shock Syndrome in Rural Japan(2025-08-15) Wannigama D.L.; Amarasiri M.; Phattharapornjaroen P.; Hurst C.; Modchang C.; Suzuki Y.; Moriya K.; Miyanaga K.; Cui L.; Huang A.T.; Okuma Y.; Akaneya D.; Igarashi J.; Suto M.; Ishizawa D.; Imamiya W.; Igarashi A.; Shimotai Y.; Singer A.C.; Ragupathi N.K.D.; Furukawa T.; Sei K.; Wang Y.; Kanjanabuch T.; Higgins P.G.; Nemoto N.; Khatib A.; Kicic A.; Trowsdale S.; Hongsing P.; Sano D.; Shibuya K.; Abe S.; Hamamoto H.; Wannigama D.L.; Mahidol UniversityJapan recently experienced a record surge in streptococcal toxic shock syndrome. Our environmental surveillance study reveals that Streptococcus pyogenes persists seasonally, peaking in autumn and winter in rural Japan. The dominant emm1 M1UK sublineage and csrS mutations heighten virulence, highlighting the urgent need for targeted surveillance and interventions.Item Metadata only Global participatory wastewater surveillance to understand mpox clade diversity in war and conflict-affected countries(2025-07-01) Wannigama D.L.; Amarasiri M.; Phattharapornjaroen P.; Hurst C.; Modchang C.; Wang Y.; Miyanaga K.; Cui L.; Fernandez S.; Huang A.T.; Melhem N.M.; Singer A.C.; Ragupathi N.K.D.; Calabria de Araujo J.; Sei K.; Ndatuwong L.G.; Mahmood S.F.; Shimotai Y.; Kanjanabuch T.; Higgins P.G.; Aoyagi T.; Kicic A.; Nanbo A.; Mori H.; Siow R.; Kurt Ö.; Trowsdale S.; Hongsing P.; Khatib A.; Sano D.; Shibuya K.; Abe S.; Hamamoto H.; Wannigama D.L.; Mahidol University