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Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998–2019 – The Maravi Post

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Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Author affiliations: Cairns Hospital, Cairns, Queensland, Australia (S. Smith, J. Stewart, L. Fairhead, J. Hanson); Tropical Public Health Services, Cairns (P. Horne, S. Rubenach, R. Gair); University of New South Wales, Sydney, New South Wales, Australia (J. Hanson)

Burkholderia pseudomallei, an environmental gram-negative bacterium, causes the disease melioidosis. Although infection is frequently asymptomatic, melioidosis may be rapidly fatal for patients with underlying conditions that increase the risk for invasive disease. Modeling suggests that B. pseudomallei is ubiquitous in the tropics and that the global burden of disease is expected to rise (1). Indeed, increased melioidosis incidence has been documented in some countries (2). Although this increase may be associated with improved diagnostic capacity, it may also be explained by a growing burden of predisposing concurrent medical conditions or by greater B. pseudomallei exposure from environmental disruption (3,4). Changing weather patterns also have the potential to increase melioidosis incidence (5).

Figure 1

Cases of melioidosis in the Cairns area, Far North Queensland, Queensland, Australia, January 1998–December 2019. A) 1998–2002; B) 2003–2007; C) 2008–2011; D) 2012–2015; E) 2016–2019. Map shows location of Far North Queensland.

Figure 1. Cases of melioidosis in the Cairns area, Far North Queensland, Queensland, Australia, January 1998–December 2019. A) 1998–2002; B) 2003–2007; C) 2008–2011; D) 2012–2015; E) 2016–2019. Map shows location of Far…

B. pseudomallei is endemic to Far North Queensland (FNQ), a region in the northernmost part of the state of Queensland, Australia (Figure 1). Incidence of melioidosis in the Torres Strait Islands in the region’s north is among the highest reported in published series of melioidosis cases in Australia (4,6). During the past 20 years, the FNQ population has grown rapidly, predominantly in the city of Cairns, the region’s major industrial hub, and in the nearby towns (Cairns area, in and around Cairns). This growth has necessitated substantial expansion of local infrastructure, including 2-phase development of a large motorway on the city’s southern outskirts during 2011–2017. Surveillance data suggest that this development coincided with a marked increase in the local incidence of melioidosis, primarily in the Cairns area. We aimed to determine if there was any temporospatial association between the motorway construction and the increasing incidence of melioidosis in the region or if there were other possible explanations for any observed change, with a particular focus in the Cairns area.

The Study

Cairns Hospital is the sole public microbiological service provider for FNQ, a region of >380,000 km2 (7). We reviewed all culture-confirmed cases of B. pseudomallei infection identified in the hospital’s laboratory during January 1, 1998–December 31, 2019. Clinical details of each case were recorded as described by J.D. Stewart et al. (4); predisposing conditions were diabetes mellitus (glycated hemoglobin ≥6.5%), hazardous alcohol use, chronic lung disease, chronic renal disease, and immunosuppression. We used data from the Australian Bureau of Statistics to calculate disease incidence and from the Australian Bureau of Meteorology to record local climatic factors including rainfall, temperatures, cloud cover, dew points, and cyclones. For our analyses we used Stata version 14.2 statistical software (https://www.stata.com) and determined trends over time by using an extension of the Wilcoxon rank-sum test and using year of presentation as a continuous variable (8). We constructed maps by using MapInfo Pro 2019 Geographic Information System software (https://support.precisely.com); in the absence of a clear occupational or recreational exposure, we used participants’ residential addresses as the site of B. pseudomallei exposure. The study was approved by the Far North Queensland Human Research Ethics Committee (HREC/15/QCH/46-977).

A total of 297 cases of melioidosis were diagnosed during the study period, of which 284 were acquired from FNQ and included in our analysis. The mean annual incidence in FNQ increased from 4.0 (95% CI 2.7–5.2) cases/100,000 population during 1998–2002 to 9.9 (95% CI 4.9–14.9) cases/100,000 population during 2016–2019 (p<0.001) (Table 1). In the Cairns area, incidence rose from 0.6 (95% CI 0.1–1.1) cases/100,000 population during 1998–2002 to 6.6 (95% CI 3.0–10.2) cases/100,000 population during 2016–2019 (p<0.001) (Table 2; Figure 1).

During the study period, the proportion of patients in FNQ with different predisposing conditions for melioidosis did not change. The proportion of bacteremic patients also remained stable (Table 1). The case-fatality rate declined during the study period (Table 1).

In the Cairns area, where increased incidence was more marked, the small increases in mean temperature, cloud cover, and dew points in the final period of the study did not reach statistical significance. During the study period, 14 cyclones came within 200 km of Cairns, but only 1 occurred during 2016–2019 (p = 0.86) (Appendix).

Figure 2

Cases of melioidosis occurring near to a motorway upgrade in southern Cairns, Far North Queensland, Queensland, Australia, 1998–2019.

Figure 2. Cases of melioidosis occurring near to a motorway upgrade in southern Cairns, Far North Queensland, Queensland, Australia, 1998–2019.

Of the 284 cases included in the study, 111 (39%) were in the Cairns area; only 3 of these patients reported having an occupation in construction. Before commencement of the southern motorway expansion in the Cairns area in 2011, only 1/19 (5%) cases in the Cairns area were within 1,000 m of the existing road and 2/19 (11%) were within 2,000 m. However, after January 2012, a total of 92/168 (55%) cases occurred in the Cairns area, of which 15/92 (16%) were within 1,000 m of the highway construction and 27/92 (29%) within 2,000 m (Figure 2).

Conclusions

The incidence of melioidosis in FNQ is rising, increasing during the study period by ≈10-fold in the Cairns area. The proportion of bacteremic patients has not changed, suggesting improved diagnosis. Similarly, we found no statistically significant change in climate or frequency of cyclones. The proportion of patients who had the common predisposing conditions remained similar. However, urban expansion may be contributing because almost a third of cases in the past 8 years of the study period occurred within 2,000 m of development of a large motorway. Of note, the motorway is built predominantly through alluvial plain soils with moderate clay content and poor drainage, which favor B. pseudomallei growth (9).

Increased rainfall, dew points, cloud cover, and temperatures have been associated with increased melioidosis cases; however, these climatic factors were stable over our study period (5). Cyclones have been linked to increased melioidosis cases; however, we did not observe that association in FNQ (10). Indeed, since 2015 when melioidosis incidence in the Cairns area sharply increased, there has been only 1 cyclone within 200 km of the area.

Why the rates of bacteremic melioidosis remain higher in FNQ than in other parts of Australia remains unclear (11). The higher rates may be partly explained by fewer diagnoses of cutaneous disease in rural and remote communities; however, skin swab samples are frequently taken to identify other pathogens, and skin and soft tissue B. pseudomallei infections are uncommon in urban areas, where most new cases have been identified (12). Virulence factors in local B. pseudomallei strains may contribute (13). Despite the increasing incidence, the overall case-fatality rate from melioidosis in FNQ decreased significantly during the study period, which can probably be explained by early recognition and prompt access to multimodal intensive care unit support.

Among the limitations of our study, data collection was predominantly retrospective; in addition, in the absence of clear inoculation with B. pseudomallei, we assumed residential addresses to be the sites of exposure. Domestic gardens are a source of melioidosis in Australia, but it is possible that unrecorded patient movements may have resulted in exposure to B. pseudomallei elsewhere (14). Additional confounding factors that increase the risk for melioidosis (e.g., socioeconomic disadvantage) may help explain regional variations in incidence, although the local geographic distribution of this socioeconomic disadvantage has not substantially changed in the past 20 years (15). In conclusion, although host factors and climate continue to influence the risk of acquiring melioidosis, we hypothesize that urban expansion and construction in soils harboring B. pseudomallei may explain the recent rapid increase in Far North Queensland, Australia.

Dr. Smith is an infectious diseases and general internal medicine physician in Cairns, Queensland, Australia. His research interests include melioidosis, leptospirosis, and management of severe clinical manifestations of tropical diseases.

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Solomon Islands Tension – The Maravi Post

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Three bodies were found in a burnt out building in Honiara amid this week’s violence in the capital of the Solomon Islands, Australian media reported. Authorities had put a curfew in place on Friday night in an attempt to stem the unrest and the situation seemed to be calmer on Saturday. But the government showed no signs of addressing the underlying grievances that sparked two days of riots, including concerns about the country’s increasing links with China. Solomon Islands Prime Minister Manasseh Sogavare sought to deflect attention from domestic issues by blaming outside interference for stirring up the protesters, with a thinly veiled reference to Taiwan and the United States. Honiara’s Chinatown and its downtown precinct were focuses of rioters, looters and protesters who demanded the resignation of Sogavare, who has been prime minister intermittently since 2000. Sogavare has been widely criticized by leaders of the country’s most populous island of Malaita for a 2019 decision to drop diplomatic ties with Taiwan in favor of mainland China. His government, meanwhile, has been upset over millions in U.S. aid promised directly to Malaita, rather than through the central government. Those issues are just the latest in decades of rivalry between Malaita and Guadalcanal, where the capital, Honiara, is located, said Jonathan Pryke, director of the Sydney-based Lowy Institute think tank’s Pacific Islands program. The Solomon Islands, with a population of about 700,000, are located about 1,500 kilometers (1,000 miles) northeast of Australia.

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Source: Africanews



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Immunology professor talks about the new coronavirus variant – The Maravi Post

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Passengers at Johannesburg’s O.R Tambo airport scrambled this Saturday to find flights to Europe as more and more countries are shutting doors to passengers coming from African countries.

The emergence of the new coronavirus Omicron variant in South Africa sparked a worldwide reaction.

Professor of Immunology Danny Altmann explains.

“I know it feels very harsh to people in South Africa who have really done the right thing and been terribly speedy and vigilant in their reporting. But I just feel that we were so slow to act on Delta and the whole world paid such a high price for it. Let’s try and be forewarned and do it properly this time. So, I think it probably is warranted”, said the academic working at Imperial College London.

Last minute PCR tests are now mandatory.

The UK-based professor believes that vaccination still offers protection against the worst effects of this disease.

“I think it’s a case of kind of hope for the best and fear the worst, isn’t it? So in some ways, if you look at the straight molecular biology limitations, it looks potentially quite a lot scarier even than Delta. And don’t forget, we thought of Delta. I certainly thought Delta as a peak variant, and probably it couldn’t get much worse than that. This looks potentially worse. On the other hand, there’s no reporting from South Africa yet that cases are more severe, and it looks like vaccines may still be doing something because we heard there yesterday that the people in hospital tended to be the unvaccinated people rather than the vaccinated”, said Professor Altmann.

In Africa vaccination rates are significantly lower compared to Europe, the United States and other regions.

According to Professor Altmann, distribution of vaccines throughout Africa is essential to stop future variants.

“You know, in this particular case, if it did come out of Botswana and or South Africa, there has been quite a lot of vaccine available there. But as you say in the African continent as a whole, they’ve been very short of vaccines compared to Europe or North America. And things like this demonstrate how foolhardy that is. We’re just breeding the future variants to come and haunt us. Why do it?”

The latest available data indicate that South Africa has registered almost 3 million cases of Covid-19 and close to 90,000 deaths.

Source: Africanews

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Hawkeye Marvel Movie 2021 Release Date, Where To Watch Online Streaming on Disney+ Hotstar

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The ‘Hawkeye’ is the latest release which is in the limelight because of the story. As per the details, the stream of this film is available on several platforms that we going to discuss here. After the release of ‘Hawkeye’, there are many peoples who waiting for it.

Hawkeye’ 2021 Online Free

We can tell the way from which you will be able to watch the streaming of this brilliant movie. So let’s begin the article which is important to know and you will get all the details. We will explore all the things and solve your queries regarding ‘Hawkeye’ streaming.

Hawkeye Marvel Movie 2021 Release Date

Talking about the cast then we want to tell you some information. There are many things. There are several names of star cast which is definitely important to be discussed and we will tell you briefly about it. This star cast will become the reason behind its upcoming popularity. If you want to know the details then you will see an amazing level of popularity in the upcoming days.

  • Jeremy Renner as Clint Barton / Hawkeye
  • Hailee Steinfeld as Kate Bishop / Hawkeye
  • Vera Farmiga as Eleanor Bishop
  • Fra Fee as Kazi
  • Tony Dalton as Jack Duquesne
  • Zahn McClarnon as William Lopez
  • Alaqua Cox as Maya Lopez / Echo
  • Florence Pugh as Yelena Belova / Black Widow
  • How many episodes is Hawkeye?
  • Hawkeye consists of six episodes.

The film was released and on the official platform of the movies. It got an amazing level of popularity over the period of time. After the release, there are many fans appear who eagerly want to watch the story on their screen. Currently, it is getting such huge popularity over the period of time. Definitely you check on IMDB.

Now comes the very important detail which is about how to watch the live stream of the movies. So on the basis of available details, you can watch the streaming on Amazon prime video.

Also, you can rate the movie and share your feedback regarding the entertainment how much enjoyed it. However, if you want to watch it for free then must be you can bookmark the page in your browser. So stay tuned with us and get all the details.



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