Publications by authors named "Aalisha Sahukhan"

8 Publications

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Prospective Surveillance of Primary Healthcare Presentations for Scabies and Bacterial Skin Infections in Fiji, 2018-2019.

Am J Trop Med Hyg 2021 May 24. Epub 2021 May 24.

1Tropical Diseases Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

Scabies, impetigo, and other skin and soft tissue infections (SSTIs) are highly prevalent in many tropical, low-middle income settings, but information regarding their burden of disease is scarce. We conducted a surveillance of presentations of scabies and SSTIs, including impetigo, abscesses, cellulitis, and severe SSTI, to primary health facilities in Fiji. We established a monthly reporting system over the course of 50 weeks (July 2018-June 2019) for scabies and SSTIs at all 42 public primary health facilities in the Northern Division of Fiji (population, ≈131,914). For each case, information was collected regarding demographics, diagnosis, and treatment. There were 13,736 individual primary healthcare presentations with scabies, SSTI, or both (108.3 presentations per 1000 person-years; 95% confidence interval [CI], 106.6-110 presentations). The incidence was higher for males than for females (incidence rate ratio [IRR], 1.15; 95% CI, 1.11-1.19). Children younger than 5 years had the highest incidence among all age groups (339.1 per 1000 person-years). The incidence was higher among the iTaukei (indigenous) population (159.9 per 1000 person-years) compared with Fijians of Indian descent (30.1 per 1000 person-years; IRR, 5.32; 95% CI, 5.03-5.61). Abscesses had the highest incidence (63.5 per 1,000 person-years), followed by scabies (28.7 per 1,000 person-years) and impetigo (21.6 per 1,000 person-years). Scabies and SSTIs impose a substantial burden in Fiji and represent a high incidence of primary health presentations in this population. The incidence in low-middle income settings is up to 10-times higher than that in high-income settings. New public health strategies and further research are needed to address these conditions.
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http://dx.doi.org/10.4269/ajtmh.20-1459DOI Listing
May 2021

Prospective surveillance for invasive Staphylococcus aureus and group A Streptococcus infections in a setting with high community burden of scabies and impetigo.

Int J Infect Dis 2021 May 19. Epub 2021 May 19.

Tropical Diseases Group, Murdoch Children's Research Institute, Parkville, 3052 Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, 3052, Victoria, Australia; Melbourne Children's Global Health, Melbourne Children's Campus, The Royal Children's Hospital, Parkville, 3052, Australia.

Background: Invasive Staphylococcus aureus (iSA) and group A Streptococcus (iGAS) infections impose significant health burdens globally. Both bacteria commonly cause skin and soft tissue infection (SSTI), which can result in invasive disease. Understanding of iSA and iGAS incidence remains limited in settings with high SSTI burden.

Methods: Prospective surveillance for admissions with iSA or iGAS was conducted at the referral hospital in Fiji's Northern Division over 48 weeks between July 2018-June 2019.

Results: There were 55 admissions for iSA and 15 for iGAS, (incidence; 45.2 and 12.3 per 100,000 person-years respectively). Highest incidence was found in those aged ≥65 years s (59.6 per 100,000 person-years for both). Indigenous Fijians (iTaukei) had higher iSA incidence (71.1 per 100,000 person-years) compared to other ethnicities (incidence risk ratio 9.7, 95% CI 3.5-36.9). SSTIs were found in the majority of iSA (75%) and iGAS (53.3%) cases. Thirteen out of the 14 iGAS strains isolated belonged to emm-cluster D (n = 5) or E (n = 8). Case fatality rate was high for iSA (10.9%) and iGAS (33.3%).

Conclusions: The incidence of iSA and iGAS in Fiji is very high. SSTIs are common clinical foci for iSA and iGAS. Both diseases carry a substantial risk of death. Improved control strategies are needed to reduce the burden of these diseases in Fiji.
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http://dx.doi.org/10.1016/j.ijid.2021.05.041DOI Listing
May 2021

Interactions between timing and transmissibility explain diverse flavivirus dynamics in Fiji.

Nat Commun 2021 03 15;12(1):1671. Epub 2021 Mar 15.

Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.

Zika virus (ZIKV) has caused large, brief outbreaks in isolated populations, however ZIKV can also persist at low levels over multiple years. The reasons for these diverse transmission dynamics remain poorly understood. In Fiji, which has experienced multiple large single-season dengue epidemics, there was evidence of multi-year transmission of ZIKV between 2013 and 2017. To identify factors that could explain these differences in dynamics between closely related mosquito-borne flaviviruses, we jointly fit a transmission dynamic model to surveillance, serological and molecular data. We estimate that the observed dynamics of ZIKV were the result of two key factors: strong seasonal effects, which created an ecologically optimal time of year for outbreaks; and introduction of ZIKV after this optimal time, which allowed ZIKV transmission to persist over multiple seasons. The ability to jointly fit to multiple data sources could help identify a similar range of possible outbreak dynamics in other settings.
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http://dx.doi.org/10.1038/s41467-021-21788-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961049PMC
March 2021

Hospital admissions for skin and soft tissue infections in a population with endemic scabies: A prospective study in Fiji, 2018-2019.

PLoS Negl Trop Dis 2020 12 9;14(12):e0008887. Epub 2020 Dec 9.

Tropical Diseases Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

Scabies is an important predisposing factor for impetigo but its role in more serious skin and soft tissue infections (SSTIs) is not well understood. Information is limited on incidence of SSTIs in the presence of endemic scabies. We conducted a prospective study of hospital admissions for SSTIs in the Northern Division of Fiji (population: 131,914). Prospective surveillance for admissions with impetigo, abscess, cellulitis, wound infection, pyomyositis, necrotizing fasciitis, infected scabies, and crusted scabies was conducted at the Division's referral hospital between 2018 to 2019. Information was collected on demographic characteristics, clinical features, microbiology, treatment and outcomes. Over the study period, 788 SSTI admissions were recorded corresponding to a population incidence 647 per 100,000 person-years (95%CI 571-660). Incidence was highest at the extremes of age with peak incidence in children aged <5 years (908 per 100,000) and those aged ≥65 years (1127 per 100,000). Incidence was 1.7 times higher among the Indigenous Fijian population (753 per 100,000) compared to other ethnicities (442 per 100,000). Overall case fatality rate was 3.3%, and 10.8% for those aged ≥65 years. Scabies was diagnosed concurrently in 7.6% of all patients and in 24.6% of admitted children <5 years. There is a very high burden of hospital admissions for SSTIs in Fiji compared to high-income settings especially among the youngest, oldest and indigenous population which is concordant with scabies and impetigo distribution in this population. Our findings highlight the need for strategies to reduce the burden of SSTIs in Fiji and similar settings.
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http://dx.doi.org/10.1371/journal.pntd.0008887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752096PMC
December 2020

Community perspectives on scabies, impetigo and mass drug administration in Fiji: A qualitative study.

PLoS Negl Trop Dis 2020 12 4;14(12):e0008825. Epub 2020 Dec 4.

Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.

Scabies is endemic in Fiji and is a significant cause of morbidity. Little is known about the sociocultural beliefs and practices that affect the occurrence of scabies and impetigo, or community attitudes towards the strategy of mass drug administration that is emerging as a public health option for scabies and impetigo control in Fiji and other countries. Data were collected during semi-structured interviews with 33 community members in four locations in Fiji's Northern Division. Thematic analysis examined participants' lived experiences of scabies and impetigo; community knowledge and perceptions about scabies and impetigo aetiology and transmission; community-based treatment and prevention measures; and attitudes towards mass drug administration. Many indigenous Fijian (iTaukei) participants noted extensive and ongoing experience of scabies and impetigo among children in their families and communities, but only one participant of Indian descent (Indo-Fijian) identified personal childhood experience of scabies. Scabies and impetigo were perceived as diseases affecting children, impacting on school attendance and families' quality of sleep. Awareness of scabies and impetigo was considerable, but there were major misconceptions around disease causation and transmission. Traditional remedies were preferred for scabies treatment, followed by biomedicines provided by local health centres and hospitals. Treatment of close household contacts was not prioritised. Attitudes towards mass drug administration to control scabies were mostly positive, although some concerns were noted about adverse effects and hesitation to participate in the planned scabies elimination programme. Findings from this first study to document perspectives and experiences related to scabies and impetigo and their management in the Asia Pacific region illustrate that a community-centred approach to scabies and impetigo is needed for the success of control efforts in Fiji, and most likely in other affected countries. This includes community-based health promotion messaging on the social dynamics of scabies transmission, and a campaign of education and community engagement prior to mass drug administration.
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http://dx.doi.org/10.1371/journal.pntd.0008825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744044PMC
December 2020

Lymphatic filariasis in Fiji: progress towards elimination, 1997-2007.

Trop Med Health 2020 28;48:88. Epub 2020 Oct 28.

College of Public Health, Medical and Veterinary Sciences and JCU WHO Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, College of Public Health, James Cook University, Cairns and Townsville, Queensland Australia.

Background: Lymphatic filariasis (LF) is a major public health problem in the Pacific Region, including in Fiji. Through transmission by the mosquito vector , Fiji has suffered the burden of remaining endemic with LF despite efforts at elimination prior to 1999. In the year 1999, Fiji agreed to take part in the Pacific Programme for Elimination of LF (PacELF) and the Global Programme to Eliminate LF.

Methods: This study reviewed and collated past data on LF in Fiji between 1997 and 2007. Sources included published papers as well as unpublished PacELF and WHO program meeting and survey reports. Records were held at Fiji's Department of Health and Medical Services, James Cook University and the WHO office in Suva, Fiji.

Results: Baseline surveys between 1997 and 2002 showed that Fiji was highly endemic for LF with an estimated 16.6% of the population antigen positive and 6.3% microfilaria positive at that time. Five rounds of annual mass drug administration (MDA) using albendazole and diethylcarbamazine commenced in 2002. Programmatic coverage reported was 58-70% per year, but an independent coverage survey in 2006 in Northern Division after the fifth MDA suggested that actual coverage may have been higher. Monitoring of the program consisted of antigen prevalence surveys in all ages with sentinel and spot check surveys carried out in 2002 (pre MDA), 2004, and 2005, together with knowledge, attitude, and practice surveys. The stop-MDA survey (C survey) in 2007 was a nationwide stratified cluster survey of all ages according to PacELF guidelines, designed to sample by administrative division to identify areas still needing MDA. The national antigen prevalence in 2007 was reduced by more than a third to 9.5%, ranging from 0.9% in Western Division to 15.4% in Eastern Division, while microfilaria prevalence was reduced by almost four-fifths to 1.4%. Having not reached the target threshold of 1% prevalence in all ages, Fiji wisely decided to continue MDA after 2007 but to move from nationwide implementation to four (later five) separate evaluation units with independent timelines using global guidelines, building on program experience to put more emphasis on increasing coverage through prioritized communication strategies, community participation, and morbidity alleviation.

Conclusion: Fiji conducted nationwide MDA for LF annually between 2002 and 2006, monitored by extensive surveys of prevalence, knowledge, and coverage. From a high baseline prevalence in all divisions, large reductions in overall and age-specific prevalence were achieved, especially in the prevalence of microfilariae, but the threshold for stopping MDA was not reached. Fiji has a large rural and geographically widespread population, program management was not consistent over this period, and coverage achieved was likely not optimal in all areas. After learning from these many challenges and activities, Fiji was able to build on the progress achieved and the heterogeneity observed in prevalence to realign towards a more stratified and improved program after 2007. The information presented here will assist the country to progress towards validating elimination in subsequent years.
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http://dx.doi.org/10.1186/s41182-020-00245-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592542PMC
October 2020

Molecular Characterization of Dengue Type 2 Outbreak in Pacific Islands Countries and Territories, 2017-2020.

Viruses 2020 09 25;12(10). Epub 2020 Sep 25.

Institut Pasteur de Nouvelle-Calédonie, Institut Pasteur International Network, URE Dengue et Arboviroses, Noumea 98800, New Caledonia.

Dengue virus (DENV) serotype-2 was detected in the South Pacific region in 2014 for the first time in 15 years. In 2016-2020, DENV-2 re-emerged in French Polynesia, Vanuatu, Wallis and Futuna, and New Caledonia, co-circulating with and later replacing DENV-1. In this context, epidemiological and molecular evolution data are paramount to decipher the diffusion route of this DENV-2 in the South Pacific region. In the current work, the gene from 23 DENV-2 serum samples collected in Vanuatu, Fiji, Wallis and Futuna, and New Caledonia was sequenced. Both maximum likelihood and Bayesian phylogenetic analyses were performed. While all DENV-2 strains sequenced belong to the Cosmopolitan genotype, phylogenetic analysis suggests at least three different DENV-2 introductions in the South Pacific between 2017 and 2020. Strains retrieved in these Pacific Islands Countries and Territories (PICTs) in 2017-2020 are phylogenetically related, with strong phylogenetic links between strains retrieved from French PICTs. These phylogenetic data substantiate epidemiological data of the DENV-2 diffusion pattern between these countries.
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http://dx.doi.org/10.3390/v12101081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601490PMC
September 2020

Dengue in Fiji: epidemiology of the 2014 DENV-3 outbreak.

Western Pac Surveill Response J 2019 Apr-Jun;10(2):31-38. Epub 2019 May 15.

Fiji Ministry of Health and Medical Services, Suva, Fiji.

Introduction: Dengue virus serotype-3 caused a large community-level outbreak in Fiji in 2013 and 2014. We aimed to characterize the demographic features of affected individuals and to determine dengue mortality during the outbreak.

Methods: All laboratory-confirmed dengue cases and deaths were included in this study. Incidence and mortality were calculated according to demographic variables.

Results: A total of 5221 laboratory-confirmed cases of dengue were included in this analysis. The majority of patients were male (54.5%) and indigenous Fijians (iTaukei) (53.5%). The median age was 25 years old. The overall incidence was 603 per 100 000 population. The age-specific incidence was highest among people between 20 and 24 years of age (1057 per 100 000) for both sexes. The major urban and peri-urban areas of Suva and Rewa subdivisions reported the highest incidence of > 1000 cases per 100 000 population. A total of 48 deaths were included in this analysis. The majority of dengue-related deaths occurred in males (62.5%) and in the iTaukei (60.4%) population. The median age at death was 35 years old. The overall dengue-related deaths was estimated to be 5.5 deaths per 100 000 population. Dengue mortality was higher for males (6.8 per 100 000) than females. The highest age- and sex-specific mortality of 18 per 100 000 population was among males aged 65 years and older.

Discussion: Dengue morbidity and mortality were highest among males, indigenous people and residents of urban and peri-urban locations. Effective and integrated public health strategies are needed to ensure early detection and appropriate outbreak control measures.
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http://dx.doi.org/10.5365/wpsar.2018.9.3.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831958PMC
September 2020