Muhammad Asaduzzaman

• Al masud, Abdullah; Rousham, Emily Kate; Islam, Mohammad Aminul; Alam, Mahbub-Ul; Rahman, Mahbubur; Al Mamun, Abdullah; Sarker, Supta; Asaduzzaman, Muhammad & Unicomb, Leanne (2020). Drivers of Antibiotic Use in Poultry Production in Bangladesh: Dependencies and Dynamics of a Patron-Client Relationship. Frontiers in Veterinary Science.  ISSN 2297-1769. . doi: 10.3389/fvets.2020.00078 Show summary

  Background: There is increasing concern around the use of antibiotics in animal food production and the risk of transmission of antimicrobial resistance within the food chain. In many low and middle-income countries, including Bangladesh, the commercial poultry sector comprises small-scale producers who are dependent on credit from poultry dealers to buy day-old chicks and poultry feed. The same dealers also supply and promote antibiotics. The credit system is reliant upon informal relationships among multiple actors as part of social capital. This paper aims to describe dependencies and relationships between different actors within unregulated broiler poultry production systems to understand the social and contextual determinants of antibiotic use in low-resource settings. Methods: We used a cross-sectional qualitative design including in-depth interviews among purposefully selected commercial poultry farmers (n = 10), poultry dealers (n = 5), sales representatives of livestock pharmaceutical companies (n = 3) and the local government livestock officer as a key-informant (n = 1). We describe the food production cycle and practices relating to credit purchases and sales using social capital theory. Findings: Poultry dealers provide credit and information for small-scale poultry farmers to initiate and operate their business. In return for credit, farmers are obliged to buy poultry feed and medicine from their dealer and sell their market-ready poultry to that same dealer. All farms applied multiple antibiotics to poultry throughout the production cycle, including banned antibiotics such as colistin sulfate. The relationship between dealers and poultry farmers is reciprocal but mostly regulated by the dealers. Dealers were the main influencers of decision-making by farmers, particularly around antibiotic use as an integral part of the production cycle risk management. Our findings suggest that strategies to improve antibiotic stewardship and responsible use should exploit the patron-client relationship which provides the social and information network for small-scale farmers. Conclusion: Social capital theory can be applied to the patron-client relationship observed among poultry farmers and dealers in Bangladesh to identify influences on decision making and antibiotic use. Within unregulated food production systems, strategies to promote the prudent use of antibiotics should target commercial feed producers and livestock pharmaceutical manufacturers as a first step in developing a sustainable poultry value chain.

• Alam, Mahbub-Ul; Rahman, Mahbubur; Masud, Abdullah-Al-; Islam, Mohammad Aminul; Asaduzzaman, Muhammad; Sarker, Supta; Rousham, Emily K & Unicomb, Leanne (2019). Human exposure to antimicrobial resistance from poultry production: Assessing hygiene and waste-disposal practices in Bangladesh. International Journal of Hygiene and Environmental Health.  ISSN 1438-4639.  222(8), s 1068- 1076 . doi: 10.1016/j.ijheh.2019.07.007 Show summary

  The unregulated use of antibiotics is linked with intensive poultry farming in developing economies. In low-and middle-income countries, the dissemination of antimicrobial resistance (AMR) has also been attributed to contamination, poor public health infrastructure and inadequate waste disposal practices. There are limited data on hygiene and waste disposal practices in small-scale commercial and household poultry farming and market sales in Bangladesh. Our objective was to explore human exposures, hygiene and waste disposal practices in poultry raising and processing to identify probable pathways for transmission of AMR bacteria.

• Asaduzzaman, Muhammad; Muhammed, Iqbal Hossain; Saha, Sumita Rani; Islam, Rayhanu; Ahmed, Niyaz & Islam, Mohammad Aminul (2019). Quantification of Airborne Resistant Organisms With Temporal and Spatial Diversity in Bangladesh: Protocol for a Cross-Sectional Study. JMIR Research Protocols.  ISSN 1929-0748.  8(12) . doi: 10.2196/14574 Show summary

  Background Antimicrobial resistance is a widespread, alarming issue in global health and a significant contributor to human death and illness, especially in low and middle-income countries like Bangladesh. Despite extensive work conducted in environmental settings, there is a scarcity of knowledge about the presence of resistant organisms in the air. Objective The objective of this protocol is to quantify and characterize the airborne resistomes in Bangladesh, which will be a guide to identify high-risk environments for multidrug-resistant pathogens with their spatiotemporal diversity. Methods This is a cross-sectional study with an environmental, systematic, and grid sampling strategy focused on collecting air samples from different outdoor environments during the dry and wet seasons. The four environmental compartments are the frequent human exposure sites in both urban and rural settings: urban residential areas (n=20), live bird markets (n=20), rural households (n=20), and poultry farms (n=20). We obtained air samples from 80 locations in two seasons by using an active microbial air sampler. From each location, five air samples were collected in different media to yield the total bacterial count of 3rd generation cephalosporin (3GC) resistant Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus. Results The study started in January 2018, and the collection of air samples was completed in November 2018. We have received 800 air samples from 80 study locations in both dry and wet seasons. Currently, the laboratory analysis is ongoing, and we expect to receive the preliminary results by October 2019. We will publish the complete result as soon as we clean and analyze the data and draft the manuscript. Conclusions The existence of resistant bacteria in the air like those producing extended-spectrum beta-lactamases, carbapenem-resistant Enterobacteriaceae, vancomycin-resistant Enterococci, and methicillin-resistant Staphylococcus aureus will justify our hypothesis that the outdoor environment (air) in Bangladesh acts as a reservoir for bacteria that carry genes conferring resistance to antibiotics. To our knowledge, this is the first study to explore the presence of superbugs in the air in commonly exposed areas in Bangladesh. International Registered Report Identifier (IRRID) DERR1-10.2196/14574 Keywords: antimicrobial resistance, airborne resistomes, air quality, global health, planetary health, environmental risk assessment

• Islam, Mohammad Aminul; Amin, Mohammed Badrul; Roy, Subarna; Asaduzzaman, Muhammad; Islam, Md.Rayhanul; Navab-Daneshmand, Tala; Mattioli, Mia Catharine; Kile, Molly L.; Levy, Karen & Julian, Timothy R. (2019). Fecal Colonization With Multidrug-Resistant E. coli Among Healthy Infants in Rural Bangladesh. Frontiers in Microbiology.  ISSN 1664-302X. . doi: 10.3389/fmicb.2019.00640 Show summary

  Third generation cephalosporins (3GC) are one of the main choices for treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria. Due to their overuse, an increasing trend of resistance to 3GC has been observed in developing countries. Here, we describe fecal colonization of 3GC-resistant (3GCr) Escherichia coli in healthy infants (1-12 months old) living in rural areas of Bangladesh. We found that stool samples of 82% of infants (n = 100) were positive for 3GCr E. coli with a mean ± standard deviation of 6.21 ± 1.32 log10 CFU/g wet weight of stool. 3GCr E. coli encompasses an average one third (33%) of the total E. coli of stool. Almost 77% (n = 63) of these 3GCr E. coli were MDR (or resistant to ≥3 classes of antibiotics). Around 90% (n = 74) of 3GCr E. coli were extended spectrum beta-lactamase (ESBL)-producing in which bla CTX-M-group-1 was the predominant (96%, n = 71) ESBL-gene followed by bla TEM (41%, n = 30) and bla OXA-1 (11%, n = 8). A significant proportion (26.5%, n = 22) of 3GCr E. coli was pathogenic, comprising two types, enteroaggregative (EAEC, n = 19) and enteropathogenic (EPEC, n = 3). Colonization of 3GCr E. coli in infant guts was not associated with demographic characteristics such as age, sex, mode of delivery, maternal and infant antibiotic use, disease morbidity, and feeding practices. The high rate of colonization of 3GCr E. coli in infants' guts is a serious public health concern which needs immediate attention and warrants further studies to explore the cause. KEYWORDS: E. coli; ESBL; colonization; multidrug-resistant; third generation cephalosporins

• Ali, Nausad; Sultana, Marufa; Sheikh, Nurnabi; Akram, Raisul; Mahumud, Rashidul Alam; Asaduzzaman, Muhammad & Sarker, Abdur Razzaque (2018). Predictors of Optimal Antenatal Care Service Utilization Among Adolescents and Adult Women in Bangladesh. Health Services Research and Managerial Epidemiology.  ISSN 2333-3928.  5(1) . doi: 10.1177/2333392818781729 Show summary

  Introduction: Utilization of recommended antenatal care (ANC) throughout the pregnancy period is a proven healthy behavior in reducing maternal mortalities and morbidities. The objective of this study is to identify the demand side factors that are associated with the recommended utilization of ANC services among adolescents and adult women in Bangladesh. Method: This study utilized cross-sectional data from latest Bangladesh Demographic and Health Survey 2014. Data of a total of 4626 adolescents and adult women were analyzed. Bivariate and multivariate analyses were performed for identifying the significant determining factors associated with the ANC services utilization. Results: Approximately, 32% adult and 30% adolescent women utilized the recommended ANC care. The higher educated adolescents and adult women were 8.08 times (P

• Asaduzzaman, Muhammad (2018). Antimicrobial resistance: an urgent need for a planetary and ecosystem approach.. The Lancet Planetary Health.  ISSN 2542-5196.  2(3), s e99- e100 . doi: 10.1016/S2542-5196(18)30019-6 Show summary

  Our planet is rushing towards a post-antibiotic era and the global burden of antimicrobial resistance is estimated to rise to 10 million annual deaths by 2050, a figure that can substantially increase if adequate measures are not taken. Antimicrobial resistance is an ancient but complex phenomenon that emerges in response to antimicrobial exposure. The abundance of existing scientific publications on antimicrobial resistance in an environmental context supports its inclusion in the planetary health agenda. Unfortunately, antimicrobial resistance is still a public health concern and it has not been considered a priority area to work on from an ecological perspective. Ecologists and Earth scientists have not been made aware of this situation and have not been included in discussions of control strategies between public health experts and social scientists.

• Asaduzzaman, Muhammad; Chowdhury, Shahanaz; Shahed, Jahid Hossen; Kafi, Mohammad Abdullah Heel; Uzzaman, Md. Nazim; Flowra, Mahfuza Talukder & Ahmed, MSA Mansur (2018). Prevalence of Type 2 Diabetes Mellitus Among Urban Bihari Communities in Dhaka, Bangladesh: A Cross-sectional Study in a Minor Ethnic Group. The Cureus Journal of Medical Science.  ISSN 2168-8184. . doi: 10.7759/cureus.2116 Show summary

  Introduction The prevalence, disease progression, and treatment outcomes for patients with type 2 diabetes vary significantly between ethnic groups. The Bihari community constitutes one of the most vulnerable populations in Bangladesh on the basis of access to health services and other fundamental rights. Our study aimed at finding out the prevalence and risk factors of type 2 diabetes among the Bihari adults in Dhaka city. Methods This cross-sectional community-based study was carried out among stranded Pakistanis (known as Bihari) living in camps in the Mirpur area from July 2014 to June 2015. Laboratory-based oral glucose tolerance test (OGTT) was the basis for the diagnosis of type 2 diabetes mellitus (DM). Anthropometric measurements, blood pressure, biochemical tests, family history, and socioeconomic information were obtained to determine the risk factors. Results The prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) were estimated at 10.11%, 8.74%, and 4.55%, respectively. Increased diastolic blood pressure, serum triglyceride, and cholesterol level were observed to be significantly (p

• Flowra, Mahfuza Talukder & Asaduzzaman, Muhammad (2018). Resurgence of infectious diseases due to forced migration: is planetary health and One Health action synergistic?. The Lancet Planetary Health.  ISSN 2542-5196.  2(10), s e419- e420 . doi: 10.1016/S2542-5196(18)30203-1 Show summary

  Forced migration is an ancient phenomenon and will continue as long as politics exists. Although it mainly evolves from persecution, development, or exploitation, its public health consequences and effects go far beyond assumption. The ongoing epidemic of a rare and controlled disease like diphtheria in Rohingya camps, in Bangladesh, is a unique example of a public health disaster due to forced migration. Planetary health and One Health have approached the issue by working together as an interdisciplinary collaboration; which might be the best strategy in such conditions.

• Islam, Mohammad Zahirul; Rutherford, Shannon; Phung, Dung; Uzzaman, Md. Nazim; Baum, Scott; Huda, M. Mamun; Asaduzzaman, Muhammad; Talukder, Mohammad Radwanur Rahman & Chu, Cordia (2018). Correlates of Climate Variability and Dengue Fever in Two Metropolitan Cities in Bangladesh. The Cureus Journal of Medical Science.  ISSN 2168-8184.  10(10) . doi: 10.7759/cureus.3398 Show summary

  Dengue fever is a major public health concern in Bangladesh with increased incidence during monsoon. We aimed to assess the correlation of temperature, humidity, and rainfall on dengue fever in two dengue endemic cities in Bangladesh. It was a time series analysis of climate factors and dengue occurrence data in Dhaka and Chittagong cities from 1 January 2000 to 31 December 2009. Daily mean temperature, rainfall, and humidity data were obtained from the Bangladesh meteorological department and daily dengue cases data were obtained from the directorate general of health services (DGHS) of Bangladesh. The mean dengue incidence was 31.62 (SD 28.7) per 100,000 in Dhaka whereas it was 5.76 (SD 11.7) per 100,000 population in Chittagong. The incidence of dengue cases was found significantly associated with the monthly mean temperature, total rainfall, and mean humidity in Dhaka, though in Chittagong, the significantly associated factors​ ​​​​​​were monthly total rainfall and mean humidity. The autoregressive integrated moving average (ARIMA) model identified monthly mean humidity and total rainfall as the most significant contributing factors for dengue cases in Dhaka and Chittagong, respectively. Our study reinforces the relationship of climate parameters with dengue fever, which will support policy-makers in developing a climate-based early warning system for dengue in Bangladesh.

• Qadri, Firdausi; Ali, Mohammad; Lynch, Julia; Chowdhury, Fahima; Khan, Ashraful Islam; Wierzba, Thomas F; Excler, Jean-Louis; Saha, Amit; Islam, Md Taufiqul; Begum, Yasmin A; Bhuiyan, Taufiqur R; Khanam, Farhana; Chowdhury, Mohiul I; Khan, Iqbal Ansary; Kabir, Alamgir; Riaz, Prof Baizid Khoorshid; Akter, Afroza; Khan, Arifuzzaman; Kim, Deok Ryun; Siddik, Ashraf U; Saha, Nirod C; Asaduzzaman, Muhammad; Cravioto, Prof Alejandro; Singh, Ajit P & Clemens, Prof John D (2018). Efficacy of a single-dose regimen of inactivated whole-cell oral cholera vaccine: results from 2 years of follow-up of a randomised trial. Lancet. Infectious Diseases (Print).  ISSN 1473-3099. . doi: 10.1016/S1473-3099(18)30108-7 Show summary

  Background A single-dose regimen of inactivated whole-cell oral cholera vaccine (OCV) is attractive because it reduces logistical challenges for vaccination and could enable more people to be vaccinated. Previously, we reported the efficacy of a single dose of an OCV vaccine during the 6 months following dosing. Herein, we report the results of 2 years of follow-up. Methods In this placebo-controlled, double-blind trial done in Dhaka, Bangladesh, individuals aged 1 year or older with no history of receipt of OCV were randomly assigned to receive a single dose of inactivated OCV or oral placebo. The primary endpoint was a confirmed episode of non-bloody diarrhoea for which the onset was at least 7 days after dosing and a faecal culture was positive for Vibrio cholerae O1 or O139. Passive surveillance for diarrhoea was done in 13 hospitals or major clinics located in or near the study area for 2 years after the last administered dose. We assessed the protective efficacy of the OCV against culture-confirmed cholera occurring 7–730 days after dosing with both crude and multivariable per-protocol analyses. This trial is registered at ClinicalTrials.gov, number NCT02027207. Findings Between Jan 10, 2014, and Feb 4, 2014, 205 513 people were randomly assigned to receive either vaccine or placebo, of whom 204 700 (102 552 vaccine recipients and 102 148 placebo recipients) were included in the per-protocol analysis. 287 first episodes of cholera (109 among vaccine recipients and 178 among placebo recipients) were detected during the 2-year follow-up; 138 of these episodes (46 in vaccine recipients and 92 in placebo recipients) were associated with severe dehydration. The overall incidence rates of initial cholera episodes were 0·22 (95% CI 0·18 to 0·27) per 100 000 person-days in vaccine recipients versus 0·36 (0·31 to 0·42) per 100 000 person-days in placebo recipients (adjusted protective efficacy 39%, 95% CI 23 to 52). The overall incidence of severe cholera was 0·09 (0·07 to 0·12) per 100 000 person-days versus 0·19 (0·15 to 0·23; adjusted protective efficacy 50%, 29 to 65). Vaccine protective efficacy was 52% (8 to 75) against all cholera episodes and 71% (27 to 88) against severe cholera episodes in participants aged 5 years to younger than 15 years. For participants aged 15 years or older, vaccine protective efficacy was 59% (42 to 71) against all cholera episodes and 59% (35 to 74) against severe cholera. The protection in the older age groups was sustained throughout the 2-year follow-up. In participants younger than 5 years, the vaccine did not show protection against either all cholera episodes (protective efficacy −13%, −68 to 25) or severe cholera episodes (−44%, −220 to 35). Interpretation A single dose of the inactivated whole-cell OCV offered protection to older children and adults that was sustained for at least 2 years. The absence of protection of young children might reflect a lesser degree of pre-existing natural immunity in this age group. Funding Bill & Melinda Gates Foundation to the International Vaccine Institute.

• Rousham, Emily K; Unicomb, Leanne; Wood, Paul; Smith, Michael; Asaduzzaman, Muhammad & Islam, Mohammad Aminul (2018). Spatial and temporal variation in the community prevalence of antibiotic resistance in Bangladesh: an integrated surveillance study protocol. BMJ Open.  ISSN 2044-6055.  8 . doi: 10.1136/bmjopen-2018-023158 Show summary

  Introduction Increasing antibiotic resistance (ABR) in low-income and middle-income countries such as Bangladesh presents a major health threat. However, assessing the scale of the health risk is problematic in the absence of reliable data on the community prevalence of antibiotic-resistant bacteria. We describe the protocol for a small-scale integrated surveillance programme that aims to quantify the prevalence of colonisation with antibiotic-resistant bacteria and concentrations of antibiotic-resistant genes from a ‘One Health’ perspective. The holistic assessment of ABR in humans, animals and within the environment in urban and rural Bangladesh will generate comprehensive data to inform human health risk. Methods and analysis The study design focuses on three exposure-relevant sites where there is enhanced potential for transmission of ABR between humans, animals and the environment: (1) rural poultry-owning households, (2) commercial poultry farms and (3) urban live-bird markets. The comparison of ABR prevalence in human groups with high and low exposure to farming and poultry will enable us to test the hypothesis that ABR bacteria and genes from the environment and food-producing animals are potential sources of transmission to humans. Escherichia coli is used as an ABR indicator organism due to its widespread environmental presence and colonisation in both the human and animal gastrointestinal tract.

• Sheikh, Nurnabi; Sultana, Marufa; Ali, Nausad; Akram, Raisul; Mahumud, Rashidul Alam; Asaduzzaman, Muhammad & Sarker, Abdur Razzaque (2018). Coverage, Timelines, and Determinants of Incomplete Immunization in Bangladesh. Tropical Medicine and Infectious Disease.  ISSN 2414-6366.  3(72) . doi: 10.3390/tropicalmed3030072 Show summary

  BACKGROUND The objective of this study was to estimate the extent of timely immunization coverage and to investigate the determinants of incomplete and untimely vaccination. METHODS: The study used data from the latest Bangladesh Demographic Health Survey (BDHS) 2014. A total sample of 1631 children aged 12⁻23 months who had an Expanded Program on Immunization (EPI) card and immunization history were analyzed. RESULTS: The proportions of children who received timely vaccinations were 24% for BCG, 46% for pentavalent 3, and 53% for measles, whereas 76%, 51%, and 36% children failed to receive the BCG, pentavalent 3, and measles vaccines, respectively, in a timely manner. CONCLUSIONS: The study identified some key determinants of untimely and incomplete childhood vaccinations in the context of Bangladesh. The findings will contribute to the improvement of age-specific vaccination and support policy makers in taking the necessary control strategies with respect to delayed and early vaccination in Bangladesh.

• Khan, Ashraful Islam; Ali, Mohammad; Chowdhury, Fahima; Saha, Amit; Khan, Iqbal Ansary; Khan, Arifuzzaman; Akter, Afroza; Asaduzzaman, Muhammad; Islam, Md Taufiqul; Kabir, Alamgir; You, Young Ae; Saha, Nirod Chandra; Cravioto, Alejandro; Clemens, John D. & Qadri, Firdausi (2017). Safety of the oral cholera vaccine in pregnancy: Retrospective findings from a subgroup following mass vaccination campaign in Dhaka, Bangladesh. Vaccine.  ISSN 0264-410X. . doi: 10.1016/j.vaccine.2017.01.080 Show summary

  BACKGROUND: Pregnant women are vulnerable to complications of cholera. Killed oral cholera vaccines (OCV) are not recommended for pregnant women though there is no evidence of harmful effects during pregnancy. We evaluated the effect of a killed OCV, Shanchol™, on pregnancy outcomes during an effectiveness trial of the vaccine in urban Bangladesh. METHODOLOGY: Individuals ⩾1year were invited to participate in the trial, conducted in 2011 in Dhaka, Bangladesh. Pregnancy by history was an exclusion criterion and all women of reproductive age (15-49years) were verbally questioned about pregnancy at enrollment and prior to vaccination. Out of 48,414 women of reproductive age 286 women received the OCV unknowingly while pregnant. Out of these, we could recruit 69 women defined as exposed to OCV. Accordingly, we selected 69 pregnant women randomly from those who did not take the OCV (non-exposed to OCV). We evaluated adverse pregnancy outcome (spontaneous miscarriages, still births, or congenital malformations) between those who were exposed to OCV and those who were not exposed to OCV. RESULTS: About 16% of pregnant women exposed to OCV had pregnancy loss, as compared to 12% of unvaccinated pregnant women (P=0.38). One congenital anomaly was observed and occurred in women non-exposed to OCV group. Models that adjusted for baseline characteristics that were unbalanced between the exposed and non-exposed groups, revealed a no elevation of risk of adverse pregnancy outcomes in vaccinees versus non-vaccinees (Adj. OR (95% CI): 0.45 (0.11-1.88). CONCLUSIONS: No excess of adverse fetal outcomes associated with receipt of OCV was observed in this study. TRIAL REGISTRATION: Clinical Trials.gov number NCT01339845.

• Al‐Mamun, Md Mahfuz; Sarker, Suprovath Kumar; Qadri, Syeda Kashfi; Shirin, Tahmina; Mohammad, Quazi Deen; LaRocque, Regina; Karlsson, Elinor K.; Saha, Narayan; Asaduzzaman, Muhammad; Qadri, Firdausi & Mannoor, Md Kaiissar (2016). Examination of Huntington's disease with atypical clinical features in a Bangladeshi family tree. Clinical Case Reports.  ISSN 2050-0904.  4(12), s 1191- 1194 . doi: 10.1002/ccr3.743 Show summary

  Atypical manifestation of Huntington's disease (HD) could inform ongoing research into HD genetic modifiers not present in the primarily European populations studied to date. This work demonstrates that expanding HD genetic testing into under-resourced healthcare settings can benefit both local communities and ongoing research into HD etiology and new therapies. Here, we describe an extended family in northern Bangladesh with eight members affected with Huntington's disease (HD) exhibiting atypical clinical features. All eight have the CAG repeat expansion in exon 1 of HTT gene and do not carry mutations associated with other HD‐like disorders, Wilson's disease, or other neurodegenerative diseases. The affected family, in northern Bangladesh, has eight living members with Huntington's disease (HD), all with atypical clinical features. The disorder appeared almost 130 years ago in one of the two siblings. All affected individuals are progeny of the affected sibling, and no progeny of the healthy sibling are affected. No consanguineous marriages are reported for the study participants.

• Qadri, Dr Firdausi; Wierzba, Thomas F.; Ali, Mohammad; Chowdhury, Fahima; Khan, Ashraful Islam; Saha, Amit; Khan, Iqbal A.; Asaduzzaman, Muhammad; Akter, Afroza; Khan, Arifuzzaman; Begum, Yasmin A; Bhuiyan, Taufiqur R; Khanam, Farhana; Chowdhury, Mohiul I.; Islam, Taufiqul; Chowdhury, Atique I.; Rahman, Anisur; Siddique, Shah A.; You, Young A.; Kim, Deok R.; Siddik, Ashraf U.; Saha, Nirod C.; Kabir, Alamgir; Cravioto, Alejandro; Desai, Sachin N.; Singh, Ajit P. & Clemens, John D. (2016). Efficacy of a Single-Dose, Inactivated Oral Cholera Vaccine in Bangladesh. New England Journal of Medicine.  ISSN 0028-4793.  374, s 1723- 1732 . doi: 10.1056/NEJMoa1510330 Show summary

  Background A single-dose regimen of the current killed oral cholera vaccines that have been prequalified by the World Health Organization would make them more attractive for use against endemic and epidemic cholera. We conducted an efficacy trial of a single dose of the killed oral cholera vaccine Shanchol, which is currently given in a two-dose schedule, in an urban area in which cholera is highly endemic. Methods Nonpregnant residents of Dhaka, Bangladesh, who were 1 year of age or older were randomly assigned to receive a single dose of oral cholera vaccine or oral placebo. The primary outcome was vaccine protective efficacy against culture-confirmed cholera occurring 7 to 180 days after dosing. Prespecified secondary outcomes included protective efficacy against severely dehydrating culture-confirmed cholera during the same interval, against cholera and severe cholera occurring 7 to 90 versus 91 to 180 days after dosing, and against cholera and severe cholera according to age at baseline. Results A total of 101 episodes of cholera, 37 associated with severe dehydration, were detected among the 204,700 persons who received one dose of vaccine or placebo. The vaccine protective efficacy was 40% (95% confidence interval [CI], 11 to 60%; 0.37 cases per 1000 vaccine recipients vs. 0.62 cases per 1000 placebo recipients) against all cholera episodes, 63% (95% CI, 24 to 82%; 0.10 vs. 0.26 cases per 1000 recipients) against severely dehydrating cholera episodes, and 63% (95% CI, −39 to 90%), 56% (95% CI, 16 to 77%), and 16% (95% CI, −49% to 53%) against all cholera episodes among persons vaccinated at the age of 5 to 14 years, 15 or more years, and 1 to 4 years, respectively, although the differences according to age were not significant (P=0.25). Adverse events occurred at similar frequencies in the two groups. Conclusions A single dose of the oral cholera vaccine was efficacious in older children (≥5 years of age) and in adults in a setting with a high level of cholera endemicity. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02027207. opens in new tab.)

• Chowdhury, Fahima; Mather, Alison E.; Begum, Yasmin Ara; Asaduzzaman, Muhammad; Baby, Nabilah; Sharmin, Salma; Biswas, Rajib; Uddin, Muhammad Ikhtear; LaRocque, Regina C.; Harris, Jason B.; Calderwood, Stephen B.; Ryan, Edward T.; Clemens, John D.; Thomson, Nicholas R. & Qadri, Firdausi (2015). Vibrio cholerae Serogroup O139: Isolation from Cholera Patients and Asymptomatic Household Family Members in Bangladesh between 2013 and 2014. PLoS Neglected Tropical Diseases.  ISSN 1935-2727.  9(11) . doi: 10.1371/journal.pntd.0004183 Show summary

  Background Cholera is endemic in Bangladesh, with outbreaks reported annually. Currently, the majorityof epidemic cholera reported globally is El Tor biotypeVibrio choleraeisolates of the ser-ogroup O1. However, in Bangladesh, outbreaks attributed toV.choleraeserogroup O139isolates, which fall within the same phylogenetic lineage as the O1 serogroup isolates, wereseen between 1992 and 1993 and in 2002 to 2005. Since then,V.choleraeserogroup O139has only been sporadically isolated in Bangladesh and is now rarely isolated elsewhere. Methods Here, we present case histories of four cholera patients infected withV.choleraeserogroupO139 in 2013 and 2014 in Bangladesh. We comprehensively typed these isolates usingconventional approaches, as well as by whole genome sequencing. Phenotypic typing andPCR confirmed all four isolates belonging to the O139 serogroup. Findings Whole genome sequencing revealed that three of the isolates were phylogenetically closely related to previously sequenced El Tor biotype, pandemic 7, toxigenicV.choleraeO139 iso-lates originating from Bangladesh and elsewhere. The fourth isolate was a non-toxigenic V.cholerae that, by conventional approaches, typed as O139 serogroup but was genetically divergent from previously sequenced pandemic 7V.cholerae lineages belonging to the O139 or O1 serogroups. Conclusion These results suggest that previously observed lineages of V.choleraeO139 persist in Bangladesh and can cause clinical disease and that a novel disease-causing non-toxigenicO139 isolate also occurs.

• Qadri, Dr Firdausi; Ali, Mohammad; Chowdhury, Fahima; Khan, Ashraful Islam; Saha, Amit; Khan, Iqbal Ansary; Begum, Yasmin A; Bhuiyan, Taufiqur R; Chowdhury, Mohiul Islam; Uddin, Md Jasim; Khan, Jahangir A M; Chowdhury, Atique Iqbal; Rahman, Anisur; Siddique, Shah Alam; Asaduzzaman, Muhammad; Akter, Afroza; Khan, Arifuzzaman; You, Young Ae; Siddik, Ashraf Uddin; Saha, Nirod Chandra; Kabir, Alamgir; Riaz, Baizid Khoorshid; Biswas, Shwapon Kumar; Begum, Farzana; Unicomb, Leanne; Luby, Prof Stephen P; Cravioto, Prof Alejandro & Clemens, Prof John D (2015). Feasibility and effectiveness of oral cholera vaccine in an urban endemic setting in Bangladesh: a cluster randomised open-label trial. The Lancet.  ISSN 0140-6736.  386(10001), s 1362- 1371 . doi: 10.1016/S0140-6736(15)61140-0 Show summary

  Background Cholera is endemic in Bangladesh with epidemics occurring each year. The decision to use a cheap oral killed whole-cell cholera vaccine to control the disease depends on the feasibility and effectiveness of vaccination when delivered in a public health setting. We therefore assessed the feasibility and protective effect of delivering such a vaccine through routine government services in urban Bangladesh and evaluated the benefit of adding behavioural interventions to encourage safe drinking water and hand washing to vaccination in this setting. Methods We did this cluster-randomised open-label trial in Dhaka, Bangladesh. We randomly assigned 90 clusters (1:1:1) to vaccination only, vaccination and behavioural change, or no intervention. The primary outcome was overall protective effectiveness, assessed as the risk of severely dehydrating cholera during 2 years after vaccination for all individuals present at time of the second dose. This study is registered with ClinicalTrials.gov, number NCT01339845. Findings Of 268 896 people present at baseline, we analysed 267 270: 94 675 assigned to vaccination only, 92 539 assigned to vaccination and behavioural change, and 80 056 assigned to non-intervention. Vaccine coverage was 65% in the vaccination only group and 66% in the vaccination and behavioural change group. Overall protective effectiveness was 37% (95% CI lower bound 18%; p=0·002) in the vaccination group and 45% (95% CI lower bound 24%; p=0·001) in the vaccination and behavioural change group. We recorded no vaccine-related serious adverse events. Interpretation Our findings provide the first indication of the effect of delivering an oral killed whole-cell cholera vaccine to poor urban populations with endemic cholera using routine government services and will help policy makers to formulate vaccination strategies to reduce the burden of severely dehydrating cholera in such populations. Funding Bill & Melinda Gates Foundation .

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• Asaduzzaman, Muhammad (2019). Antimicrobial Resistance – The value of Global One Health Studies.
• Storeng, Katerini Tagmatarchi; Roalkvam, Sidsel & Asaduzzaman, Muhammad (2019). Action to protect the independence and integrity of global health research. BMJ Global Health.  ISSN 2059-7908.  4 . doi: 10.1136/ bmjgh-2019-001746 Show summary

  The tensions between research ethics and the wider politics of the global health field are increasingly recognised. However, the repercussions of these tensions for individuals and research institutions need careful consideration. While ‘rocking the boat’ is uncomfortable and may threaten individual career progression and research institutions’ external income, biased evidence can harm health programme beneficiaries and public trust in research. There are certainly no simple, fail-safe, technocratic quick fixes to resolving issues of power and politics, but the ideas proposed here should at least create better relationships between the institutions involved in commissioning, undertaking and publishing research, and feed into more sophisticated and thoughtful mechanisms of accountability, which do not simply re-enforce existing frameworks that favour accountability towards donors. The ideas we propose should be considered within broader discussions on how to address north–south power imbalances within the research community, and will hopefully catalyse wider action on protecting the independence of public universities and other research institutions globally. We believe this is necessary to enable researchers to hold power to account and advance informed and healthy debate on issues of public interest.

• Asaduzzaman, Muhammad & Ahmed, Niyaz (2018). F1000 Prime Recommendation of "A poor-quality generic drug for the treatment of visceral leishmaniasis: a case report and appeal". F1000Prime. . doi: 10.3410/f.720295206.793549590
• Asaduzzaman, Muhammad (2017). Living in the era of Superbugs: Curse and Remedy. Show summary

  Antimicrobial resistance (AMR) is one of the biggest threats to global health, food security and development for which the environment is recognised as an important actor. It is estimated that the annual AMR attributed death toll will reach 10 million by 2050. Poultry is a key driver of AMR in its transmission between the outdoor environment and humans through faecal shedding of resistant bacteria. The rapid expansion of commercial poultry farming in peri-urban areas creates risk due to the unregulated use of antibiotics in feed and disposal of faecal waste and run-off water. Strict biosecurity practices are absent, especially in developing countries. Regulation, aimed at the poultry farm industry, must be implemented and enforced to decrease the growing problem of AMR.

• Asaduzzaman, Muhammad & Ahmed, Niyaz (2017). F1000 Prime Recommendation of "Interconnected microbiomes and resistomes in low-income human habitats". F1000Prime. . doi: 10.3410/f.726354064.793532883 Show summary

  This important research article highlights a very significant pathway of the spread of antibiotic resistance among humans, animals and the environment by horizontal gene transfer between bacterial genomes including benign gut microbiota and environmental pathogens. This article reports the identification of interconnected resistomes from human faecal samples and the surrounding environment (including feaces of domesticated animals, soil, water as well as samples from composting latrines and sewage systems) which are exclusively influenced by bacterial phylogeny along ecological gradients. Due to the selection of low income rural and peri-urban communities as study areas, these findings are relevant for two-thirds of the global population. The authors also focused on safe water, improved sanitation and waste management as an effective intervention to reduce the burden of antibiotic resistance.

• Asaduzzaman, Muhammad & Ahmed, Niyaz (2017). F1000 Prime recommendation of "Evolution of antibiotic resistance is linked to any genetic mechanism affecting bacterial duration of carriage". F1000Prime. . doi: 10.3410/f.727215364.793535058
• Asaduzzaman, Muhammad & Mahmood, Sultan (2016). Epidemiology, impact, prevention and control of nipah encephalitis in Bangladesh: a systematic review of one health issue.
• Asaduzzaman, Muhammad & Mahmood, Sultan (2016). Epidemiology, impact, prevention and control of nipah encephalitis in Bangladesh: a systematic review of one health issue. European Journal of Epidemiology (EJE).  ISSN 0393-2990.  31 . doi: 10.1007/s10654-016-0183-1 Show summary

  Background Nipah virus poses an eminent threat in Bangladesh as it encounters almost yearly outbreak since 2001. Comprehensive and coherent understanding of the disease is of paramount importance due to high case fatality. The objective of this review is to summarize the epidemiology and control of Nipah encephalitis in Bangladesh. Methods We searched three different databases- PubMed, Web of Science and Google Scholar using different search term as appropriate for those databases mixing the Boolean operators that yielded 144, 113 and 1530 articles respectively. We screened the titles first for relevance and later abstracts. 47 articles met our criteria and were finally reviewed. A literature matrix was formed in Excel for compilation and analysis. Results Nipah outbreaks in Bangladesh were different compared to initial outbreak in Malaysia in 1999. Unlike Malaysian outbreak, person to person transmission occurred in Bangladesh leaving humans most vulnerable. Infections were reported in domesticated pigs, dogs, cats in South Asia and serological study in Bangladesh showed 6.5, 4.3 and 44.2 %seroprevalence in cattle, goat and pig respectively. Pteropus bat plays a key role in Nipah transmission and risk factors include drinking raw date palm sap contaminated with bat urine or faeces, eating halfeaten bat saliva laden fruit and close contact or involvement in burial of cases. As date palm sap is harvested during winter, Nipah outbreaks mostly occurred during this season. Nipah occurred within the ‘‘Nipah belt’’ and had a high case fatality of more than 70 %. Avoiding raw date palm sap and drinking sap from trees protected with bamboo skirt or ‘‘bana’’ remain the principle preventive measures along with strict infection control in hospitals for prevention of secondary cases. Conclusion Extensive knowledge of this emerging zoonosis is the key for prevention and saving lives. Community sensitization and multisectoral intervention through One Health approach can prevent this deadly disease especially in outbreak areas.

• Flowra, Mahfuza Talukder & Asaduzzaman, Muhammad (2016). PREVALENCE AND ASSOCIATED RISK FACTORS FOR HYPERTENSION IN A MINOR ETHNIC GROUP (BIHARI COMMUNITY) IN BANGLADESH. Show summary

  Objective: This study is the first one to determine the prevalence and associated risk factors for Hypertension among the Bihari community of Bangladesh, a neglected minor ethnic group of population living in different camps with poor facilities for more than four decades. Being poor and illiterate, they are also unaware of the dangers of major NCDs. So, it is important to know the current situation of Hypertension and other NCDs of this community. Design and Method: This cross-sectional study was conducted among subjects, aged ≥ 30 years in Bihari camp at Mirpur of Dhaka city. Along with Blood pressure measurement, OGTT, anthropometric measurements and biochemical tests were obtained. Stata 13 was used for data entry and analysis. Statistical comparisons were carried out using t-test and χ2 test. Logistic regression was applied to calculate crude and adjusted odds ratio to identify risk factors. Results: The prevalence of Hypertension was 7.03% in this study group. Prevalence of Hypertension was greater in females than males. Increased blood pressure was significantly (p < 0.05) associated with type 2 DM, increased Triglyceride and Cholesterol level. It has been also observed that positive family history of DM and high BP along with obesity significantly affected the probability of Hypertension. The higher waist circumference had significant (p < 0.05) association with high BP in both sex. Conclusions: The prevalence of Hypertension in the study population was found to be almost equal to that of the general population of Bangladesh. Therefore, the policy makers should initiate cardiovascular care with health education in the minor ethnic groups and whatever the causes, they must be included in the country's health policy regarding development of prevention and control model of noncommunicable diseases.

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