Objective: To compare the reporting pattern of hearing loss and tinnitus across different vaccines brands used in Malaysia (BNT162b2, CoronaVac, ChAdOx1, Ad5.CoV2-S and BBIBP-CorV). Methods: This retrospective study included all reports of hearing loss and tinnitus occurring after COVID-19 vaccination that were received in the national pharmacovigilance database, QUEST, from February 24, 2021 through July 31, 2022. Reports given causality consistent or indeterminate were included. Results: There were 21 cases of hearing loss, with overall reporting rate of 0.29 cases per million doses. The rate was similar across BNT162b2, CoronaVac and ChAdOx1. For tinnitus, 35 cases were reported, with the overall reporting rate of 0.49 cases per million doses, and the highest rate was reported for ChAdOx1. For both events, most cases aged 30 to 49 years. No gender disparity was observed. Both events were mainly reported to have occurred after the primary doses, with a median time-to-onset of two days. There were no statistically significant differences in the reporting patterns for both events across BNT162b2, CoronaVac and ChAdOx1 by age group, gender, race, and dose number. Conclusions: Despite the low reporting rates and insufficient evidence to confirm its relationship, hearing loss and tinnitus following vaccinations should not be ignored due to its disabling potential and impact on one’s quality of life. Continual reporting is encouraged for better signal characterization in the future.

Objective: To determine the frequency and severity of the breakthrough infections and the associated factors in Malaysia. Methods: This cross-sectional study was conducted among the adult general population in Malaysia who completed at least one dose of vaccination. The validated online questionnaires were used for data collection between December 2022 to February 2023. The participants were recruited by a convenient sampling method. The data were analysed by descriptive statistics, and logistic regression by using SPSS (Version 27). Qualitative data from open-ended questions were analysed as thematic analysis by using RQDA software. Results: A total of 524 participants' data were analyzed and 77.5% of them completed three doses of COVID-19 vaccination. Breakthrough infections after vaccination were reported in 57.3% of the participants. Age group of 18 and 30 years (aOR 2.32, 95% CI 1.01-5.32) and other ethnicities (aOR 2.00, 95% CI 1.02-3.93) significantly associated with the occurrence of breakthrough infections. A total of 35.5% of the participants were not willing to take another booster dose in the future because of their attitudes towards fear of long-term side effects, lack of trust to the vaccine, less susceptibility to severe infection, belief in natural immunity, and myths. Conclusions: Future public health policies and interventions should be focused on disseminating the information about safety of booster doses of vaccine, management and re-assurance of side effects, and targeted vaccination to the working (younger age group) and ethnic minorities.

Objective: To analyze the therapeutic response and safety of different treatments for cutaneous leishmaniasis, received by patients in the Program for the Study and Control of Tropical Diseases-PECET-Medellín-Colombia. Methods: This is a retrospective cross-sectional study of patients attended at PECET Research Center during 2016-2021. Relevant information regarding sociodemographic characteristics, history of leishmaniasis, characterization of current infection, treatment received, follow-up of therapeutic response and safety was collected from the medical records. Data were analyzed with Pearson's Chi-square association tests and Mann-Whitney U test using statistical software. Results: A total of 486 clinical records of patients were analyzed, and 356 received treatment. Eight different therapeutic alternatives (systemic, local and in combination) were analyzed. The therapeutic response of the different alternatives used (except thermotherapy) was higher than 50%. Most frequent adverse events were myalgias, arthralgias and headache, and vesicles for systemic and local treatment, respectively. Conclusions: Safety profile and performance of local therapeutic alternatives and combined schemes for the treatment of uncomplicated cutaneous leishmaniasis are an interesting option for the management of the disease.

Objective: To surveill emerging variants by nanopore technology-based genome sequencing in different COVID-19 waves in Sri Lanka and to examine the association with the sample characteristics, and vaccination status. Methods: The study analyzed 207 RNA positive swab samples received to sequence laboratory during different waves. The N gene cut-off threshold of less than 30 was considered as the major inclusion criteria. Viral RNA was extracted, and elutes were subjected to nanopore sequencing. All the sequencing data were uploaded in the publicly accessible database, GISAID. Results: The Omicron, Delta and Alpha variants accounted for 58%, 22% and 4% of the variants throughout the period. Less than 1% were Kappa variant and 16% of the study samples remained unassigned. Omicron variant was circulated among all age groups and in all the provinces. Ct value and variants assigned percentage was 100% in Ct values of 10-15 while only 45% assigned Ct value over 25. Conclusions: The present study examined the emergence, prevalence, and distribution of SARS-CoV-2 variants locally and has shown that nanopore technology-based genome sequencing enables whole genome sequencing in a low resource setting country.

Objective: To characterize biofilm production by clinical (n=21) and environmental (n=11) isolates of Burkholderia pseudomallei and evaluate the production of proteases, hemolysins and siderophores. Methods: Initially, the 32 strains were evaluated for biofilm production in Müller-Hinton broth-1% glucose (MH-1% glucose) and BHI broth-1% glucose, using the crystal violet staining technique. Subsequently, growing (48 h) and mature (72 h) biofilms were evaluated by confocal microscopy. Finally, the production of proteases, hemolysins and siderophores by planktonic aggregates, growing biofilms and mature biofilms was evaluated. Results: All isolates produced biofilms, but clinical isolates had significantly higher biomass in both MH-1% glucose (P<0.001) and BHI-glucose 1% (P=0.005). The structural analyses by confocal microscopy showed thick biofilms, composed of multiple layers of cells, homogeneously arranged, with mature biofilms of clinical isolates presenting higher biomass (P=0.019) and thickness of the entire area (P=0.029), and lower roughness coefficient (P=0.007) than those of environmental isolates. Protease production by growing biofilms was significantly greater than that of planktonic (P<0.001) and mature biofilms (P<0.001). Hemolysin release by planktonic aggregates was higher than that of biofilms (P<0.001). Regarding siderophores, mature biofilms presented higher production than growing biofilms (P<0.001) and planktonic aggregates (P<0.001). Conclusions: Clinical isolates have higher production of biofilms than their environmental counterparts; protease and siderophores seem important for growth and maintenance of Burkholderia pseudomallei biofilms.

Rationale: Fungal rhinosinusitis is a rare entity in immunocompetent patients and is a diagnostic challenge. Conidiobolomycosis is a rare cause of fungal rhinosinusitis which happens to affect immunocompetent patients. Patient concerns: A 30-year-old male patient complained of painless progressive swelling of nose for 5 years and painless progressive swelling of upper lip for 4 years associated with nasal obstruction for 5 years. Diagnosis: Rhinofacial conidiobolomycosis. Interventions: Systemic anti-fungals and saturated solution of potassium iodide. Outcomes: Swelling initially reduced but again increased eventually as he discontinued treatment. Lessons: Proper adherence to drugs and need for facial reconstructive surgery may need to be considered in such cases of conidiobolomycosis.

Leprosy with multidrug therapy and treatment in the early stages can prevent disability, but it still represents a significant health problem, mainly in vulnerable populations[1]. However, if left untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs, and eyes. With the constant efforts of the National Leprosy Elimination Programme in India, the implementation of multidrug therapy has lowered the prevalence rate to 0.66/10 000 in 2016[1]. As a result of the COVID-19 pandemic, leprosy treatment has been further hampered due to underdiagnosis, limited access to essential healthcare services, increased stigma and increased susceptibility of leprosy patients to COVID-19 infection, especially in the populations socially and economically vulnerable in low-income countries[2]. The burden of the disease continues, and the targets of the national programs swung in the waves of COVID-19 from the year 2020. India stood a long way behind due to the challenges raised by the global pandemic, impacting all spheres of human lives and decelerating all developmental activities, including striving and aspirational Sustainable Development Goals 2030. Therefore, routine services provided by the National Leprosy Eradication Program have also been adversely affected as many resources and personnel have been diverted from normal activities towards managing the COVID-19 pandemic. According to the World Health Organization, the registered prevalence, new cases and child cases decreased steadily from 2011-2019. Still, at the end of 2020, these cases were much lower than in previous years, with a 27.7% reduction in registered prevalence, a 37.1% reduction in new cases and a decrease in child cases was higher (25.8%) as compared with 2019[3]. This is not due to decreased transmission, but cases remaining undetected due to COVID-19-related disruptions. The Southeast Asia region reports the highest prevalence of leprosy cases among all areas in the world. India holds the highest number of cases, followed by Brazil and Indonesia. In India, a significant decline of about 43% in new case detection was reported in 2020-2021 and 34% in 2021-2022 compared to the pre-COVID-19 year 2019-2020 (Figure 1)[4]. Decreased leprosy diagnosis may result in a hidden prevalence and continued transmission within the endemic community. Late diagnosis causes an increase in grade 2 disabilities with severe and irreversible physical disabilities. Due to this, the extent of leprosy-stigma, and psychosocial and physical hardships tolerated by the leprosy-affected and their families are forecasted to be deteriorated soon. The COVID-19 pandemic has posed significant challenges to the National Leprosy Eradication Program (NLEP) activities, (Leprosy Case Detection Campaign, Focused Leprosy Campain, Special plan for hard to reach areas, Sparsh Leprosy Awareness Campaign: SAPNA etc.) for controlling the disease and early case detection of leprosy cases in the community. Due to the diversion of resources to COVID-19 activities and to overcome these challenges, the NLEP has taken several steps in the last few years, including implementing telemedicine services, home-based care for patients, and using digital technology for case detection and reporting. The government of India has launched National Strategic Plan and Roadmap for Leprosy 2023-2027 to achieve zero transmission of leprosy by 2027. It focuses on awareness of zero stigmas & discrimination, promotion of early case detection, prevention of disease transmission by prophylaxis and rolls out of a web-based information portal for reporting leprosy cases. Community participation and implementation of community-based interventions are vital strategies for leprosy elimination. The community health workers play a key role in achieving these strategies. Here we tried to focus on some essential recommendations for improving early case detection and treatment at the community level. The Mid-Level Health care Providers (MLHPs)/Community Health Officers placed in the Health and Wellness Centre (first point of contact with the health system) and Accredited Social Health Activists (ASHA), who work as an interface between the community and the public health system, should be provided with additional training on how to identify early signs and symptoms of leprosy. The Community Based Assessment Checklist (CBAC) in the Comprehensive Primary Health Care Programme of Ayushman Bharat is used for population enumeration and creating individual health records[5]. It was one of the essential tools for leprosy screening and early detection of leprosy in communities and for referring suspected cases to the health facility for further diagnosis and treatment. NIKUSHTH is a web-based reporting system for leprosy launched by the NLEP to ensure uniformity in the information on registered leprosy cases. The system will help track all activities implemented in the program, prevent reporting of previously diagnosed patients, and assist in monitoring migrant issues for a more accurate estimation of the incidence and prevalence of the disease. Secondary and Tertiary health centres can use telemedicine to conduct virtual consultations with patients and regular training to guide MLHPs and ASHAs in early identifying and referring suspected cases, which will help to strengthen the exisitiing ASHA based Surveilance for Leprosy Suspect. Once the patient diagnosed with leprosy, adherence with multidrug therapy, prevention & management for lepra reaction & neuritis, and ulcer care are the priority issues in the management & prevention of disability in leprosy. The Ayushman Bharat’s continuum of care approach helps to ensure referral to higher centres and reverse referral to Health and Wellness centres[5]. It is another essential tool in leprosy management at the community level. To achieve zero leprosy, continuous training and support to community health workers (MLHPs and ASHAs) and attention should be given to vulnerable populations, such as women, children, immigrants, refugees, and the elderly. The epidemiological triad comprising the agent, host, and environment should be considered, along with implementing the “test, treat, and track” strategy. Emphasis should be given to providing people-centred prevention and care services and reinforcing community, youth, and civil society involvement. Priority should be given to creating a supportive environment for individuals affected by leprosy and maintaining leprosy-related healthcare services in endemic regions. The Three Zeros of Leprosy (zero transmission, zero disability and zero stigmas and discrimination) are interrelated, so early identification of leprosy is an emergent need to diagnose and prevent life-prolonged impairments and stop ongoing transmission.