Objective: We aimed to find the most accurate and robust method for the detection of colistin resistance among Gram-negative bacteria by comparing the performance of four methods. Methods: Colistin resistantance was determine by disk diffusion (DD), Etest, colistin broth disk elution (CBDE) and compared with standard broth microdilution (BMD) method. Results: An exploratory study was conducted in a tertiary hospital in Jaipur, India, from November 2021 to November 2022. Of the 384 isolates tested, 41 (10.7%) were resistant against colistin by BMD and CBDE testing. Compared with BMD method, the categorical agreement of DD and Etest methods were 65.9% and 78.1%, respectively, and the rates of very major error were 34.1% and 21.9%, respectively. Conclusions: Due to the high frequency of very major error, the use of DD and Etest are not recommended by Clinical laboratory and standards institute (CLSI) for colistin susceptibility testing while CBDE is the recommended method which yields a categorical agreement of 100% with BMD method. The CBDE method can be used in routine laboratories for the detection of colistin resistance.

Objective: To detect the prevalence and characterize of Cryptosporidium spp., Giardia (G.) duodenalis, Enterocytozoon (E.) bieneusi and Blastocystis sp. of animals at a tropical wildlife park in Hainan Province, China, and to assess zoonotic risks and the potential threat of public health. Methods: Fecal specimens were collected from animals of 27 species at the wildlife park in Hainan Province, China, and detected these pathogens using polymerase chain reaction (PCR) amplifications and sequencing of gene fragments based on small subunit ribosomal RNA (SSU rRNA) gene, glutamate dehydrogenase (GDH), internal transcribed spacer (ITS) and SSU rRNA gene, respectively. Results: A total of 99 animals were studied, and 33 (33.3%) animals were found to harbor intestinal parasite, and the prevalence of Cryptosporidium spp., G. duodenalis, E. bieneusi and Blastocystis sp. were 9.1%, 2.0%, 5.1%, and 25.3%, respectively. Five Cryptosporidium species (C. parvum, C. ubiquitum, C. scrofarum, C. xiaoi and C. parvum-like), one G. duodenalis assemblages (E), four E. bieneusi ITS genotypes (CM1, HLJD-I, HNR-III and 1 novel genotype HNED-III) were detected, and seven subtypes of Blastocystis sp. (ST1, ST2, ST3, ST5, ST10, ST14 and ST15) were also identified. Conclusions: This is the first molecular detection and public health risk assessment of four intestinal protozoa species in Hainan Tropical Wildlife Park and Botanical Garden, China. Almost all species/genotypes/subtypes of four intestinal protozoa identified in this study have the potential of zoonosis and may cause public health risks.

Objective: To study the occurrence of brucellosis in small ruminants in a district of Southern India. Methods: A total of 425 serum samples (215 sheep and 210 goats) were collected from January to March 2022 using a multistage sampling method. The serum samples were subjected to three serological tests that were employed in this study, namely RBPT (Rose Bengal Plate Test), STAT (Standard Tube Agglutination Test), and I-ELISA. The risk factors were determined by collecting data through a questionnaire and establishing correlations between the responses and seropositivity within a specific flock. Result: Among the 425 samples collected, 91 samples (21.4%) were positive by RBPT, 124 samples (29.2%) by STAT and 156 samples (36.7%) by I-ELISA in sheep and goats. Sheep showed higher seropositivity in all three tests than goats. Analysis of multivariable logistic regression showed that age (>3 vs.<3 years; OR: 2.262, 95% CI: 1.414–3.618), abortion history (yes vs. no; OR: 1.837; 95% CI: 1.098–3.071), vaginal discharges (yes vs. no; OR: 2.334; 95% CI: 1.421–3.835), the migratory herd (yes vs. no; OR: 2.197; 95% CI: 1.369–3.527), and place of disposal of the foetus (yes vs. no; OR: 2.093; 95% CI: 1.320–3.318) were significant risk factors of brucellosis. Conclusions: Livestock owners and consumers of sheep and goats should be educated about brucellosis and prevention strategies to mitigate its uncontrolled spread and lower the potential threat of human brucellosis. Choosing the right rearing practices, enhancing husbandry procedures, changing farmer’s perspectives on brucellosis, and inclusion of small ruminants in brucellosis control programs are all key management approaches that can aid in the prevention and control of Brucella infection in small ruminants.

Objective: To investigate the biosecurity measures practiced at commercial layer chicken farms in Abyek country, Qazvin, Iran.. Methods: In this cross-sectional study, all licensed and active commercial layer chicken farms in Abyek county, Qazvin province, Iran in 2019 were recruited. We used a risk-based weighted scoring system (Biocheck.UGent) to assess the level of biosecurity according to internal and external classification. Biosecurity was quantified by converting the answers to 169 questions into score from 0 to 100. The minimum score, “0,” represents total absence of any biosecurity measure on the farm, whereas the maximum score, “100,” means full application of all investigated biosecurity measures. Results: The mean score of overall biosecurity in the commercial layer chicken farms in Abyek county, Qazvin province was 72.7. The mean score of internal and external biosecurity measures were 77.1 and 72.2, respectively. The lowest mean score was due to “Disease management” (69.7) among internal biosecurity measures and the lowest mean scores were for "Location of farm” (39.0) and “Removal of manure and dead animals” (42.6) among external biosecurity measures. The highest mean score was for “Transport of the eggs level” (91.0) for external biosecurity measures. Conclusions: This study showed the biosecurity status of commercial layer chicken farms in Abyek county, Qazvin, Iran and revealed some weaknesses in the implementation of these measures at the internal and external levels. It showed the biosecurity measures of these farms, especially at the external levels need to be improved. This information can aid decision-making on efforts used to improve disease control and prevention strategies in poultry farms.

Objective: To examine multidrug resistant (MDR) Salmonella (S.) Typhi isolates obtained from the stool samples of patients attending secondary health centers in Southern Benue, Nigeria, for extended spectrum beta-lactamase (ESBL) production and conjugative ability. Methods: The double disc synergy test was used to screen for ESBL production in MDR isolates. The ability of S. Typhi to transfer resistance gene was determined by conjugation experiments using standard protocols, with slight modifications. Escherichia (E.) coli ATCC 25922 was used as the recipient organism. Result: The donor S. Typhi isolates showed resistance to all the classes of antibiotics except aminoglycosides and carbapenems. All isolates except TKP 106, APA 55, APA 78 and OGB 106 were positive for ESBL production. Reduction in the zones of inhibition of E. coli after incubation with S. Typhi showed evidence of conjugation and transfer of antibiotic resistance from S. Typhi to E. coli. Conclusions: The presence of ESBL-producing S. Typhi capable of conjugation poses a significant risk to the treatment and management of typhoid fever, which highlights the need for the regulation of antibiotic use through relevant policies and strategies that aim at halting the spread of MDR and ESBL-producing S. Typhi in such rural settings.

Background: To determine the potential risk factor of COVID-19 severity and length of hospitalization, the association between multiple antibiotics administration and the risk of severe COVID-19. Methods: A case-control study of 58 hospitalized COVID-19 patients (the case group) and 120 non-hospitalized home isolated COVID-19 patients (the control group) was conducted. Data were collected using hospital medical records and verbal questionnaires for the participants. Results: Totally 89.2% of non-hospitalized mild COVID-19 patients received ⩽2 courses of antibiotics/year, while 36.0% of hospitalized patients received ⩾4 courses of antibiotics, 56.9% received 2-3 courses of antibiotics/year and only 6.9% of them were exposed to ⩽2 courses of antibiotics/year. our study emphasizes that the usage of 4 courses or higher per year was a significant risk factor for hospitalization [OR: 17.5; 95%CI(2.596-118.263); P=0.003], while the usage of ⩽2 courses was a preventive predictor for severity and hospitalization [OR: 0.072; 95%CI(0.006-0.900); P=0.041]. Furthermore, age was associated with 8.4% increase in the odds of severe COVID-19 [OR: 1.084; 95%CI(1.024-1.148), P=0.005], and females were 89.1% less likely to hospitalized than males [OR: 0.109; 95%CI(0.024-0.498); P= 0.004]. Our study shows that 70.4% of cases misused antibiotics and administered the antibiotics themselves without a physician’s prescription. Around 50.0% of cases never completed the ideal duration of the course in contrast to controls, of which only 23.2% did not complete the ideal duration. Conclusions: Our study shows that antibiotics misuse and overuse may be a potential risk factor for COVID-19 severity and hospitalization.

Objective: SARS-CoV-2 infection is an ongoing public health emergency of international significance. Considering that there is no specific drug and 100% effective vaccine yet, knowledge, attitude and practices (KAP) toward COVID-19 are crucial to prevent and manage the pandemic. This study aimed to assess knowledge, attitude and practices toward COVID-19 prevention measures of graduate students at a university in northwestern Ethiopia. Methods: A cross-sectional study design was conducted between September to December 2020. A structured questionnaire was used to collect data on socio-demographic characteristics and KAP of 407 randomly selected individuals. The data were exported to SPSS version 23.0, and bivariate and multivariate logistic regressions were used for analyses. Variables with P<0.25 in the bivariate logistic regression analysis were retained into the multivariable logistic regression models. The values were considered to be statistically significant (P≤0.05). The data quality control was tested by using 5% pretest. Results: Among 407 participants, 267 (65.6%) had sufficient knowledge, 239 (58.7%) had positive attitude and 189 (46.4%) had good practices toward COVID-19. Marital status (AOR 0.38; 95%CI 0.11-0.95; P=0.040) and student admission type (AOR 0.32; 95%CI 0.15-0.68; P=0.003) had a statistically significant association with knowledge of students. Residence (AOR 0.18; 95%CI 0.09-0.34; P<0.01) (AOR 0.16; 95%CI 0.07-0.36; P<0.01), family size (AOR 0.45; 95%CI 0.23-0.87, P=0.017) (AOR 0.29; 95%CI 0.14-0.60; P=0.001), student admission type (AOR 0.11: 95%CI 0.04-0.29, P<0.01) (AOR 0.01; 95%CI 0.00-0.05; P<0.01) and monthly income (AOR 0.17; 95%CI 0.05-0.58; P=0.005) (AOR 0.08; 95%CI 0.02-0.32; P<0.01) were significantly associated with positive attitude and good practices, respectively. Besides, good practices such as avoiding handshaking and physical distancing were performed in the least amount of participants. Conclusions: The scores of KAP among graduate students toward COVID-19 are low. It is recommended that university administrators reinforce proactive and effective measures to develop good knowledge, positive attitude, and better practices regarding COVID-19 for the students.

Objective: To determine the prevalence of internet addiction and its associated factors among undergraduate students attending medical universities in Myanmar. Methods: Internet addiction was assessed using Young’s internet addiction test. Multiple logistic regression analysis was applied to determine the factors associated with internet addiction. Altogether 950 students from all medical universities were included in the study voluntarily. Result: The prevalence of internet addiction in the study population was 72.2% (95%CI: 69.3%, 75.0%). According to the results of multiple logistic regression analysis, age, percentage of pocket money spent for internet, time spent per day using the internet, peer pressure, health-related behaviours (irregular meals, sleep disturbances, and missing social gatherings), and academic performance (postponement of the study and inability to concentrate on studying) were significant predictors of internet addiction. Conclusions: There is a high prevalence of internet addiction among Myanmar undergraduate medical students. Appropriate interventions, including promotion and strengthening of active and healthy lifestyles among students, should be implemented to prevent internet addiction and its adverse outcomes.

Objective: To assess the level of knowledge and practice on malaria prevention among the residents of Ratuwamai Municipality in Nepal. Methods: A community-based cross-sectional study was carried out on Ratuwamai Municipality of Ward No. 8 in Morang District, Nepal. A total of 352 respondents with an age range from 15 to 70 years were interviewed from October 9 to October 31, 2022. Statistically significant differences between two or more categorical groups were measured using independent sample t-test, one-way ANOVA test, and Kruskal-Wallis H test. Result: Out of the total sample, 57.7% of the respondents were 24 to 50 years old with a mean age of (36.9±14.3) years. In the knowledge test, 82% of the responses were accurate. Though 98.6% of people had heard of malaria, only 48.3% said it was a communicable disease. In practice, 84.9% always cleaned the surrounding area and trimmed the bushes around the house; 75.9% used insecticide-treated bed nets or normal bed nets for sleeping; only 7.4% used mosquito repellent creams on exposed body parts while staying outdoors at night, working in fields, and sleeping. Conclusions: The majority had knowledge about malaria, but more than half had poor practice. We advise concerned authorities to promote the behavior change communication strategy to encourage individuals to adopt healthy, beneficial, and good behavioral practices.

Objective: To determine the urinary tract infections (UTIs)-causing bacterial profile and antibiotic susceptibility pattern for the proper and complete treatment of UTIs in pregnant women with diabetes mellitus (DM). Methods: We collected 300 urine samples from diabetic and nondiabetic pregnant women at various gestational ages. After isolating and identifying uropathogens, we conducted an antibiotic sensitivity assay against fourteen commonly used antibiotics: amikacin, amoxicillin, ampicillin, azithromycin, cefixime, ceftazidime, ceftriaxone, cefuroxime, ciprofloxacin, co-trimoxazole, gentamicin, levofloxacin, netilmicin, nitrofurantoin. Results: Among the participants, 70% had DM but only 37.3% had positive uropathogen growth. Five gram-negative bacteria (Escherichia coli, Klebsiella spp., Enterobacter spp., Citrobacter spp., and Pseudomonas spp.) and 3 gram-positive bacteria (Streptococcus spp., Staphylococcus spp. and Enterococcus spp.) were indentified. Escherichia coli was the most prevalent bacteria (57.1%), followed by Klebsiella spp. (19.6%). In the antibiotic susceptibility assay, we found 96.5% of the isolated organisms were highly susceptible to levofloxacin, 94.2% to netilmicin, 88.2% to nitrofurantoin, 85.1% to amikacin, 79.8% to gentamicin, respectively. On the other hand, 64.8%, 63.6%, 61.8% of the isolates demonstrated high-level resistance to ampicillin, ceftazidime and amoxicillin whereas 38.0%, 37.1%, 33.6%, 30.9% and 30.0% of the organisms were resistant to co-trimoxazole, azithromycin, ciprofloxacin, cefuroxime, cefixime, respectivey. Conclusions: Our results suggest that amikacin, levofloxacin, netilmicin, nitrofurantoin, and gentamycin can be used as first-line treatments for UTIs, whether the patient has DM or not. Contrarily, amoxicillin, ampicillin, ceftazidime, azithromycin, and co-trimoxazole should be avoided in treating UTIs.

Alzheimer’s disease (AD) is a chronic neurodegenerative disease of the brain. Currently, approximately 55 million people have dementia across the globe and the number of AD patients is estimated by the WHO to reach about 78 million people by 2030 and nearly 139 million by 2050 globally. Amyloid β42, amyloid β oligomers, and tau proteins are the major biomarkers to understand the AD-like pathology. Therapies target β-amyloid (Aβ) for the modification of AD but poor permeability hampers the uses of drugs against AD. Other drugs including NMDA-receptor antagonists, cholinesterase inhibitors and their combination provide only temporary symptomatic relief. Meanwhile nutraceuticals are studied for mitigating the course of dementia. This study reviews therapeutic nutraceuticals which could be effective for treating AD.

Objective: This study aimed to determine the carriage of extended spectrum β-lactamase (ESBL) genes in third-generation cephalosporin-resistant (3GCR) Escherichia (E.) coli from frequently contacted surfaces, wastewater and disinfectant-cleaning solutions of selected healthcare institutions in South-western Nigeria. Methods: Samples were collected over three months for the isolation of 3GCR E. coli on MacConkey agar containing 6 μg/mL of cefotaxime. 3GCR E. coli isolates were identified by detection of uidA gene and susceptibility to selected antibiotics was performed using disc-diffusion method. Detection of ESBL genes was done using primer-specific PCR. Results: A total of 22 ESBL-producing E. coli (11 each from the frequently contacted surfaces and wastewater) were obtained from the pool of 3GCR isolates in this study. No isolate was recovered from the disinfectant-cleaning solution. All the ESBL-producing E. coli obtained from the frequently contacted surfaces and wastewater were multidrug resistant, with complete resistance observed to ampicillin, cefotaxime, cefpodoxime, tetracycline and ertapenem. The ESBL genotyping showed that 54.5% carried bla_CTX-M, 63.6% carried bla_TEM and 9.1% carried bla_SHV in isolates from the frequently contacted surfaces, while 63.6%, 9.1% and 18.2% carried bla_CTX-M, bla_TEM and bla_SHV, respectively, in the isolates obtained from the wastewater. Conclusions: This study showed a high burden of multidrug resistance E. coli on frequently contacted surfaces and wastewater of the studied healthcare institutions, indicating the need for good hygiene and proper mitigation measures to prevent potential public health and environmental challenges.

Objective: The study aimed to describe the characteristics and containment of the Omicron variants in Shanghai compared with the previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in China. Methods: We summarized the data retrieved from the Shanghai Municipal Health Commission from January to June 2022 and the National Health Commission of the People’s Republic of China from March 2020 to August 2021. Epidemiological analysis was utilized to describe the differences among SARS-CoV-2 variants and the infection situation in the outbreaks in China. Results: The Omicron variants had the characteristics of high insidiousness, rapid transmission, high infectivity, and short incubation period, which were consistent with the characteristics of outbreaks caused by Omicron in other regions in China and abroad. There were 568978 asymptomatic infections in Shanghai from Feburary 26 to June 30, 2022, accounting for 90.73% of the SARS-CoV-2 infections in this outbreak wave. It’s significantly different from a total of 23277 SARS-CoV-2 infections in China between March 31, 2020 and August 8, 2021, of which 41.97% of the cases were asymptomatic infections. Conclusions: Compared with previous outbreaks emerged in China, the Omicron outbreak in Shanghai was characterized by multiple point dissemination, wide coverage, a large number of close contacts of confirmed infections and asymptomatic carriers, and difficult source tracing. The lessons from Shanghai’s response to Omicron showed that the dynamic zero-COVID policy is still the most suitable response to the virus which can quickly find the infections and curb the transmission route.

Background: To control the imported risks brought by all international arrivals, China Customs has implemented strict closed-loop health management policy called “three checks, three screenings and one transfer”. This study provides epidemiological evidence for prevention and control measures on imported cases of asymptomatic infections and describes the current COVID-19 prevention and control system on imported risks in China. Methods: We retrospectively analyzed an imported incident of three asymptomatic carriers. Serum SARS-CoV-2 IgM and IgG antibodies were detected by chemiluminescence and gold immnnochromatography(GICA). Results: Three cases were reported positive for SARS-CoV-2 nucleic acid on their arrival, total antibodies and IgG, but negative for IgM. The Ct values of cases A, B and C were 34/36/36, 32/33/32 and 25/31/29, respectively. There were 10726434 pair-end reads sequenced for case C, and approximate 80% reads were aligned to the hCoV-19/Wuhan/IVDC-HB-01/2019 genome (EPI_ISL_402119). The viruses of case A and C were homologous and came from the SARS-CoV-2 variant. Conclusion: Serum antibody IgM and IgG tests are recommended for international travelers from epidemic areas. The “three checks, three screenings and one transfer” policy implemented at custom’s entry points was effective in COVID-19 prevention and control.

Objective: To investigate the antibiotic utilization and prescription patterns as well as define its convenience to the norm in four North-Sinai hospitals, Egypt. Antimicrobial resistance is a universal health threat. The golden era of miracle antibiotics has ended and we have faced the challenge of being troubled by infectious diseases with no discovery of new antibiotics found since 1987. Antibiotic pressure, overuse, and misuse are important risk factors for antimicrobial resistance and hospital cross-infection. To combat antimicrobial resistance, Egypt started its National Action Plan (2018-2022) aiming to optimize the usage and consumption of antibiotics. Method: This multicenter descriptive cross-sectional study was designed to describe the pattern of antibiotic prescription and consumption at four North Sinai Hospitals related to the Ministry of Health and Population. We reviewed 309 medical records of the inpatient department; the samples were selected through a stratified random sampling technique. Data were collected retrospectively from the medical records of the hospitalized patients in October, November, and December of 2020 by a paper-based method. Data were analyzed using descriptive statistics. Result: The prevalence of antibiotic consumption is near 68.9% in the four hospitals indicating that two-thirds of admitted patients receive antibiotics. Approximately 52.1% administered antibiotics for no reason. Most of the admitted patients took antibiotics on the same day of admission, regardless of the different types of hospital departments. Furthermore, 98.7% of antibiotics were prescribed without culture or order for culture and microbiological tests. Broad-spectrum antibiotics were 90% of all antibiotics prescribed. A total of 18 types of antibiotics were prescribed, cefotaxime was the most commonly prescribed antibiotic representing 26.5%. Conclusion: Judicious antibiotic prescribing behavior slows down the nature of antibiotic resistance. To guarantee the best antimicrobial use in the hospitals, standard treatment guidelines, and the Essential Medicines List for infectious diseases should be carried out and revised at least every 2 years to be a clinical reference for clinicians. Continuous education and training of clinicians and healthcare workers can contribute to optimizing the rational use of antibiotics, which in return reduces the progress of antibiotic resistance. There is an urgent need for antibiotic stewardship and surveillance and their application in all hospitals.

Objective: To determine the occurrence of multidrug resistant bacteria from the indoor environment of female hostels in a tertiary institution in order to provide epidemiological data. Methods: The bacterial quality of the three female hostels was evaluated using the settle plate method, where Petri dishes containing different types of culture media were opened in the rooms. Isolated bacteria were identified using standard microbiological procedures. Using disc diffusion method, the antibiogram of the isolates was determined and based on this, the multiple antibiotics resistance index was also determined. Results: The total heterotrophic colony forming units (CFU) for Hall A ranged from 2.09 x10² to 1.73 x10³ CFU/m³ while that of Hall B ranged from 4.71 x10² to 1.10 x10³ CFU/m³ and a statistically significant difference between the counts of both halls was observed (P=0.04). Microorganisms isolated included Staphylococcus aureus, Staphylococcus epidermidis, Bacillus subtilis, Corynebacterium sp., Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. All the isolates exhibited multidrug resistance to amoxycillin-clavulanic acid, cefuroxime and ceftriaxone. Proteus mirabilis, Klebsiella pneumoniae and Corynebacterium sp. had the least multiple antibiotic resistance index with 0.2 while Staphylococcus aureus had the highest with 0.8. Conclusions: Female university hostels may become sources of exchange of microorganisms, especially in overcrowded rooms. A large percentage of isolates were multidrug resistant which could pose difficulty and increased cost of treatment of their resulting infections. Regular surveillance and control of the agents that encourage the growth of these bacteria present in indoor air is needed.

Objective: To review the characteristic of Coronavirus disease 2019 (COVID-19) outbreaks in mainland China, particularly post-Wuhan outbreaks, and to help design effective responses in the foreseeable future. Method: The data regarding COVID-19 outbreaks between December 2019 and March 16, 2022 were obtained from China’s publicly available databases. The data were analyzed using descriptive statistics. Five outbreak stages were defined according to distinct epidemiological characteristics across different time periods over the past two years. Result: Since the 2020 Wuhan outbreak, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) local infections were confirmed in 37 995 cases as of March 16, 2022. We identified 285 isolated outbreaks in unrelated people that occurred in four additional distinct stages, over 57% of which had been imported, such as imported infected travelers and fomite transmission. The basic reproduction number (R0) of original SARS-CoV-2 was about 2.79, while the Delta variant was about 5.08 and Omicron was 7.0 or greater, resulting in the disease being more contagious during the fourth (Delta) and fifth (Omicron) stages than previous stages. Conclusion: China has experienced various COVID-19 outbreaks of different levels since the start of the pandemic in Wuhan, and local transmission is mainly caused by imported sources. If the “dynamic COVID-zero” policy is not appropriately followed, it will be difficult to contain the spread in China from overseas and to cope with the Omicron variant.

Objective: To determine the prevalence of Helicobacter (H.) pylori infection among the population of east coast of Borneo and explore the relationship between demographic factors, ethnicity and risk of H. pylori infection. Methods: This cross-sectional study enrolled 211 patients who underwent elective oesophagogastroduodenoscopy in 2017. Demographic data, endoscopic indications as well as the results of the mucosal biopsy were obtained and analysed from the endoscopy unit registry. Results: A total of 211 patients from 14 ethnic groups were enrolled in the study, most of were Chinese (28.4%), followed by Dusun (14.7%) and Songgai (13.7%). Overall, the period prevalence for 2017 was 44.5%. Multivariate logistic regression analysis showed an association between ethnicity and H. pylori. Bajau (adjusted odds ratio=5.612, P=0.005) and Dusun ethnic groups (adjusted odds ratio=7.359, P=0.001) were at a significantly higher risk of H. pylori infection compared to Chinese. However, the regression model only explained 11.6% (Cox & Snell Pseudo R²) of the prevalence of H. pylori infection. Conclusions: The period prevalence for 2017 was 44.5%, with certain indigenous ethnic groups having a higher risk than others. Clinicians should consider obtaining further history regarding the ethnic’s culture and dietary practice prior to starting H. pylori eradication therapy.

Background: Despite substantial progress in the fight against human immunodeficiency virus and acquired immunodeficiency syndrome globally, it remains a threat to global adolescent health. This study assessed the level of HIV knowledge among vocational school students and identified the relevant factors. Methods: This was an analytical cross-sectional study conducted from August to September 2019. A total of 345 students aged 15 to 19 years were selected from three vocational schools in Phitsanulok Province, Thailand, using a multistage random sampling technique. The HIV Knowledge Questionnaire (18 item version) was used to collect the data, which were analysed by mean, frequency, Chi- square and binary logistic regression. Results: Only 38.8% of participants were fully aware of HIV knowledge; five individual items showed a significant difference in knowledge of HIV between males and females; two items relating to HIV prevention knowledge (P=0.021, 0.009); two items relating HIV transmission (P=0.028, 0.035); one item relating to HIV diagnosis (P=0.008). Factors that were significantly associated with HIV knowledge included gender (male vs. female, OR 1.83, 95% CI 1.01-3.34), residence (sub-district municipality area vs. sub-district of administrative organization area, OR 0.44, 95% CI 0.23-0.84), education (2nd and 3rd academic year vs. 1st, OR 7.00, 95% CI 2.40-20.41; OR 6.40, 95% CI 2.05-20.01) and source of income (from both parents vs. self, OR 0.07, 95% CI 0.04-0.64). Conclusions: There are serious deficits and disparities in the knowledge of male and female adolescents on HIV transmission, prevention and diagnosis, and there is a need to expand the provision of gender-focused sexual health education programs.

Objective: To investigate the genetic mechanism and prevalence of antibiotic resistance among the practitioners of two bathing beaches in tropical China. Methods: Totally 259 strains were isolated from the rectal swabs of the practitioners and screened by MacConkey agar. A questionnaire survey was conducted. Kirby-Bauer test was used for phenotype, and double disc inhibition synergy test was used for extended-spectrum β -lactamase-producing Enterobacteriaceae (ESBL-E), which was further confirmed by VITEKII instrument. The genotype was detected by polymerase chain reaction, and the similarities of ESBL-E were analyzed using pulsed-field gel electrophoresis. Results: The prevalence of ESBL-E was 13.1% (34/259), of which, CTX-M genes accounted for 44.1% (15/34), mainly CTX-M-14 and CTX-M-27. Moreover, 19.1% (4/21) of the isolates were homologous. The resistance phenotypes of ESBL-E to chloramphenicol, ciprofloxacin, levofloxacin, ceftazidime, cefepime and gentamicin were different between two beaches(P<0.05). The prevalence of ESBL-E was caused by CTX-M genes at the island beach, while a high prevalence of ESBL-E was found at the city beach and clone transfer occurred. Conclusions: ESBL-E-associated gentamicin antibiotic resistance risk may be greater for island beach practitioners. The city beach populations could face more potential risks owing to severe resistance and metastatic ability of ESBL-E. The environmental exposure mechanisms and transfer role of antibiotic resistance at public beaches with high density should be investigated.

Objective: To identify the mosquito species collected in the field of 8 cities/counties of Hainan province, China and to analyze the characteristics of genetic differentiation of the predominant mosquito species. The types, contents and composition characteristics of the midgut microbiota of various mosquito species were explored to provide evidence for the control and prevention of mosquito-borne diseases in Hainan province. Methods: Adult mosquitoes were collected in the field using light traps, human lure or cattle lure methods. Morphology and DNA-barcoding technology (COI gene) were applied to identify the mosquito species. The V3-V4 hypervariable region of microbes 16S rRNA was used for high-throughput sequencing of the midgut microbiota, and SPSS 21.0 and R v3.1.1 software were employed to perform statistical analysis of the sequencing results and the Beta diversity analysis. Results: Aedes (Ae.) albopictus, Armigeres (Ar.) subalbatus and Culex (Cx.) pipiens pallpens were the three predominant species of the mosquito samples. Ae. albopictus was closely related to MK736660 (India) and JQ235749 (Yunnan), while MT541282 (DF, Dongfang) was a relatively independent population. The composition and structure of bacterial communities significantly varied among most of the samples (P<0.05). At the genus levels, 16 genera overlapped in the midgut in Ae. albopictus, 20 in Ar. subalbatus and 26 in Ar. subalbatus. Besides, Ae. albopictus, Ar. subalbatus and Cx. pipiens pallpens shared 15 out of the 16 overlapping genera. Conclusions: Ae. albopictus, Ar. subalbatus and Cx. pipiens pallpens were close within the same species in Hainan. The main exchange of mosquito species occurs within Hainan province, but also occurs across provincial or even national boundaries. The gut microbiota of mosquito species collected from the same sites were similar. Most of the core bacteria found in the midgut of Ae. albopictus were also present in Ar. subalbatus and Cx. pipiens pallpens, indicating that the breeding environment of Ae. albopictus may cover the breeding environment of Ar. subalbatus and Cx. pipiens pallpens.

Objective: To investigate the associations between dietary intakes, eating habits, socioeconomic determinants and malnutrition in children under 5 years old in south China. Method: A case-control study with 182 malnourished (case) and 254 normal (control) children was conducted in four towns using anthropometric measurements and questionnaires. Results: The dietary intakes of calory, protein, vitamin and minerals of malnourished children were lower than their normal counterparts. Overall, 37.9% children ‘monthly or never’ ate egg and egg products, 61.5% ‘monthly or never’ ate beans and soy products, but 76.7% had candies or cakes ‘daily or weekly’. Four identified determinants of malnutrition were: 1) low education level of mother (OR 1.65; 95% CI 1.02-2.67); 2) more children in one family (OR 1.86; 95% CI 1.14-3.03); 3) absence of independent eating habit (OR 1.75; 95% CI 1.13-2.72); and 4) long dining time (≥20 min) (OR 1.91; 95% CI 1.12-3.24). Conclusions: Inadequate dietary intake, lower socioeconomic status and inappropriate eating habits were the major determinants of childhood malnutrition in south China. Nutritional intervention focusing on education and behavior change are warranted to help reduce the rate of malnourishment among the children of rural families in the future.

Objective: To access complete immunization coverage among children aged 18-23 months living in the rural area of Mon State, Myanmar, and study the affecting factors. Methods: A cross-sectional study was conducted in the rural area of Mon State in 2017. Totally 353 caregivers who had children aged 18 to 23 months were selected using multistage random sampling. Face-to-face interview was applied in data collection. Complete immunization status was defined according to the current practice of routine immunization in Myanmar. Chi-square test and multivariate logistic regression analysis were utilized in data analysis. Results: Most of the caregivers were mothers (86.1%). Among 353 children, 293 [83% (95% CI 79.1-86.9)] had been immunized completely. The majority of caregivers had good levels of knowledge (77.1%) and attitude (71.4%) towards routine immunization. Some children (17.6%) had minor adverse events after immunization such as fever, pain and redness at the site of vaccination. Caregivers’ knowledge and attitude towards immunization, and the occurrence of adverse events after immunization in previous immunization session were significantly related to the status of complete immunization coverage (P<0.001). Conclusions: Complete immunization coverage among children living in the rural area of Mon State stands at 83% and should be improved. Health education campaigns with appropriate strategies should be reinforced or strengthened to enhance immunization coverage.