Now showing 1 - 10 of 20
  • Publication
    Journal Article
    National cross-sectional cluster survey of tuberculosis prevalence in Timor-Leste: a study protocol.
    (2024-03-07)
    Lopes, Constantino
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    Joao, Josefina Clarinha
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    Lowbridge, Christopher
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    Martins, Nelson
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    Dos Santos, Rofina Isabel Gusmão
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    da Silva, Endang
    ;
    Dias, Joana
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    Ramalingam, Sureshbabu
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    Amaral, Salvador
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    Oakley, Tessa
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    Ico, Lourenco da Costa
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    Sarmento, Nevio
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    ;
    Timor-Leste has one of the world's highest estimated tuberculosis (TB) incidences, yet the data which informs this estimate is limited and the true burden of TB disease is not known. TB prevalence surveys offer the best means of determining robust estimates of disease burden. This study aims to provide an estimate of the prevalence of bacteriologically confirmed pulmonary TB in Timor-Leste and provide additional insights into diagnostic coverage and health-seeking behaviour of persons with symptoms suggestive of TB.A national population-based cross-sectional cluster survey will be conducted in which participants aged 15 years and older will be screened for pulmonary TB using an algorithm consisting of symptom screening and digital X-ray of the chest with computer-aided detection software for X-ray interpretation. Xpert Ultra and liquid culture methods will be used to confirm survey TB cases. Additional data will be collected from persons reporting symptoms suggestive of TB to assess health-seeking behaviour and access to TB diagnosis and care. The survey aims to screen a target sample population of 20 068 people, living within 50 clusters, representing every municipality of Timor-Leste. Bacteriologically confirmed pulmonary TB prevalence will be estimated using WHO-recommended methods.Research ethics approval has been granted by the human research ethics committee of the Northern Territory, Australia, and the Instituto Nacional da Saúde, Timor-Leste. The results will be published in a peer-reviewed scientific journal and disseminated with relevant stakeholders.ACTRN12623000718640.
  • Publication
    Journal Article
    The first confirmed outbreak of chikungunya reported in Timor-Leste, 2024.
    (2024-04-09)
    Machado, Filipe de Neri
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    Monteiro Fernandes, Anferida
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    Dos Santos, Frederico Bosco Alves
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    Mali, Marcelo Amaral
    ;
    Pereira Tilman, Ari J
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    Soares da Silva, Endang
    ;
    Hornay, Elizabeth
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    Salles de Sousa, Antonio
    ;
    Oakley, Tessa
    ;
    Cruz, Edinha da
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    Sarmento, Nevio
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    Niha, Maria A V
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    Soares, Ana Fatima
    ;
    Cardoso Gomes, Eva Estrelita
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    de Deus Alves, Jose
    ;
    Soares, Jose Paulo
    ;
    Francis, Joshua R
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    ;
    Monteiro, Merita Antonio
    Timor-Leste is a mountainous, half-island nation with a population of 1.3 million, which shares a land border with Indonesia and is 550 km from Darwin, Australia. Since independence in 2002, Timor-Leste has achieved significant development; however, high levels of poverty remain. Chikungunya virus (CHIKV) is endemic in over 100 countries in Africa, Asia, Europe and in the Americas. It is transmitted by the bite of infected Aedes aegypti or Ae. albopictus mosquitoes, which are present in Timor-Leste and which contribute to annual rainy-season dengue virus (DENV) outbreaks. Symptomatic people typically suffer from acute onset of fever, usually accompanied by severe arthritis or arthralgia. Joint pain can be debilitating for several days, and may sometimes last for weeks, months or years. Unlike DENV infection which has significant mortality, most people recover completely. Between 2002 and 2023, there were 26 cases of CHIKV notified in Australia who acquired their infection in Timor-Leste; however, laboratory testing capability for CHIKV in Timor-Leste only became available in 2021 using polymerase chain reaction (PCR). The first locally diagnosed case was notified in November 2023. In January 2024, an outbreak of CHIKV was recognised in Timor-Leste for the first time, with 195 outbreak cases reported during 1-31 January 2024; all were PCR positive. There were no cases hospitalised, and no deaths. The median age of cases was 17 years (range 1-76 years); 51% were males. Cases were reported across the country; most (88/195) were from Dili, although the highest incidence was seen in the neighbouring municipality of Ermera (monthly incidence rate of 58.8 cases per 100,000 population). This first reported outbreak of CHIKV in Timor-Leste highlights the need for improved mosquito-borne illness control and response strategies, including minimising breeding sites and promoting early presentation for treatment and differential diagnosis from DENV, and consideration of the deployment of Wolbachia-infected mosquitoes, particularly as they have shown to reduce the transmission of CHIKV, DENV and Zika virus, all of which pose threats in Timor-Leste.
  • Publication
    Journal Article
    A brief description of the epidemiology of dengue in Dili, Timor-Leste, 2018-2022.
    (2024-04-09)
    Machado, Filipe de Neri
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    Dos Santos, Frederico Bosco Alves
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    Mali, Marcelo Amaral
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    Pereira Tilman, Ari J
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    Soares da Silva, Endang
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    Soares, Noel Gama
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    Sarmento, Nevio
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    Niha, Maria A V
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    Soares, Ana Fatima
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    Taal, Abdoulie
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    Francis, Joshua R
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    Miller, Megge
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    Flint, James
    Dengue virus (DENV) infection causes 390 million infections per year and 40,000 deaths globally. It is endemic in many countries in Asia, Africa, the Americas, the Caribbean, and Oceania. Dengue is endemic in Timor-Leste year-round, but peak transmission occurs during the rainy season. We briefly describe the epidemiology of DENV in the Municipality of Dili between 2018 and 2022. There were 6,234 cases notified, with a mean annual incidence rate of 330 cases per 100,000 population. There were 55 deaths (case fatality rate 0.9%). The peak annual incidence (3,904 cases) occurred in 2022 after an outbreak was declared in January of that year; this outbreak included 760 cases of dengue haemorrhagic fever and 35 deaths. The number of outbreak cases requiring hospital treatment exceeded the usual capacity, but facilities established for coronavirus disease 2019 (COVID-19) isolation and treatment were repurposed to meet this demand. Existing strategies of vector control, minimising breeding sites and promoting early presentation for treatment should continue, as should the utilisation of surveillance systems and treatment facilities established during the COVID-19 pandemic. However, dengue incidence remains high, and other dengue control strategies-including the deployment of Wolbachia-infected mosquitoes-should be considered in Timor-Leste.
  • Publication
    Case Reports
    Complicated Mycobacterium ulcerans infection in a child in the Northern Territory.
    (2023-02-01)
    Mahony M
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    Cox V
    ;
    Sufyan W
    ;
    Wallis P
    ;
    Nizzero D
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      4213
  • Publication
    Journal Article
    Searching for a technology-driven acute rheumatic fever test: the START study protocol.
    (2021-09-15) ;
    Webb, Rachel
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    Moreland, Nicole J
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    McGregor, Reuben
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    Bosco, Anthony
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    Broadhurst, David
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    Lassmann, Timo
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    Barnett, Timothy C
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    Benothman, Rym
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    Remenyi, Bo
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    Bennett, Julie
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    Wilson, Nigel
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    Mayo, Mark
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    Pearson, Glenn
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    Kollmann, Tobias
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    Carapetis, Jonathan R
    INTRODUCTION: The absence of a diagnostic test for acute rheumatic fever (ARF) is a major impediment in managing this serious childhood condition. ARF is an autoimmune condition triggered by infection with group A Streptococcus. It is the precursor to rheumatic heart disease (RHD), a leading cause of health inequity and premature mortality for Indigenous peoples of Australia, New Zealand and internationally. METHODS AND ANALYSIS: 'Searching for a Technology-Driven Acute Rheumatic Fever Test' (START) is a biomarker discovery study that aims to detect and test a biomarker signature that distinguishes ARF cases from non-ARF, and use systems biology and serology to better understand ARF pathogenesis. Eligible participants with ARF diagnosed by an expert clinical panel according to the 2015 Revised Jones Criteria, aged 5-30 years, will be recruited from three hospitals in Australia and New Zealand. Age, sex and ethnicity-matched individuals who are healthy or have non-ARF acute diagnoses or RHD, will be recruited as controls. In the discovery cohort, blood samples collected at baseline, and during convalescence in a subset, will be interrogated by comprehensive profiling to generate possible diagnostic biomarker signatures. A biomarker validation cohort will subsequently be used to test promising combinations of biomarkers. By defining the first biomarker signatures able to discriminate between ARF and other clinical conditions, the START study has the potential to transform the approach to ARF diagnosis and RHD prevention. ETHICS AND DISSEMINATION: The study has approval from the Northern Territory Department of Health and Menzies School of Health Research ethics committee and the New Zealand Health and Disability Ethics Committee. It will be conducted according to ethical standards for research involving Indigenous Australians and New Zealand Māori and Pacific Peoples. Indigenous investigators and governance groups will provide oversight of study processes and advise on cultural matters.
      1948
  • Publication
    Journal Article
    Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste.
    (2022-09-16)
    Oakley T
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    Le B
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    da Conceicao V
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    Marr I
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    Maia C
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    Soares M
    ;
    Belo JC
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    Sarmento N
    ;
    da Silva E
    ;
    Amaral S
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    Vaz Nery S
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    ; ;
    Invasive bacterial infections are a leading cause of death in children, primarily in low- and middle-income countries (LMIC). Links between carriage of antimicrobial-resistant organisms and more resistant infections have been established; however, little has been reported regarding community carriage of antibiotic-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in LMIC. The aim of this study was to determine colonic carriage of ESBL-producing fluoroquinolone- and aminoglycoside-resistant Enterobacterales in healthy children in three municipalities of Timor-Leste. In November 2020, 621 stool samples were collected from school-aged children and underwent screening for the presence of Enterobacterales species and antimicrobial resistance (AMR). Ciprofloxacin-resistant Gram-negative organisms were cultured from 16.5% (95% CI 6.2-26.9), and gentamicin resistance was identified in 6.8% (95% CI 2.8-10.7). Compared to the prevalence of ciprofloxacin resistance in Dili (36.1%), there was significantly lower prevalence in the rural municipalities of Ermera (12.9%; AOR 0.38, 95% CI 0.24-0.60, p < 0.001) and Manufahi (4.5%; AOR 0.07, 95% CI 0.01-0.51, p = 0.009). The overall cluster-adjusted prevalence of ESBL-producing bacteria was 8.3%, with no significant differences between municipalities. This study demonstrates high rates of carriage of AMR among school-aged children in Timor-Leste, with higher rates observed in Dili compared to rural municipalities. Empiric antibiotic guidelines should include recommendations for treating community-acquired infections that account for the possibility of antimicrobial resistance.
      4554
  • Publication
    Journal Article
    The COVID-19 laboratory response in Timor-Leste; a story of collaboration.
    (2023-04-11)
    Sarmento N
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    Soares da Silva E
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    Barreto I
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    Ximenes JC
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    Angelina JM
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    Correia DM
    ;
    Babo SM
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    Tilman AJP
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    Salles de Sousa A
    ;
    Hornay E
    ;
    Ico LC
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    Machado FN
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    Niha MV
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    Ballard S
    ;
    Lin C
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    Howden B
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    Wapling J
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    Alves L
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    Oakley T
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    Marr I
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    Arkell P
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    Smith-Vaughan H
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    Fancourt NSS
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    ;
    Timor-Leste is a small nation of 1.3 million people which shares a land border with Indonesia and is 550 km from Darwin, Australia. It is one of the poorest nations in Asia. The National Health Laboratory (NHL) and its network of smaller laboratories in Timor-Leste had limited capacity to perform molecular diagnostic testing before the coronavirus disease 2019 (COVID-19) pandemic began. With the support of international development partners, the NHL rapidly expanded its molecular testing service. From March 2020 to February 2022, over 200,000 molecular tests were performed; COVID-19 testing sites were established in hospital and community health center laboratories and all 13 municipalities, and the number of scientists and technicians at the molecular diagnostic laboratory at the NHL increased from five to 28 between 2019 and 2022. Molecular diagnostic testing for COVID-19 was successfully established at the NHL and in the municipalities. The molecular diagnostic laboratory at NHL is now equipped to respond to not only large-scale COVID-19 testing but also laboratory detection of other infectious diseases, preparing Timor-Leste for future outbreaks or pandemics.
      3365
  • Publication
    Journal Article
    Melioidosis in Timor-Leste: First Case Description and Phylogenetic Analysis.
    (2023-07-21)
    Guterres H
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    Gusmao C
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    Pinheiro M
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    Martins J
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    Odio G
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    Maia C
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    da Conceicao V
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    Soares M
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    Osorio C
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    da Silva E S
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    Tilman A
    ;
    Givney R
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    Oakley T
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    Toto L
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    Amaral E
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    James R
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    Buising K
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    Mayo M
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    Kaestli M
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    Webb J R
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    ; ; ;
    Muhi S
    Burkholderia pseudomallei, the causative agent of melioidosis, has not yet been reported in Timor-Leste, a sovereign state northwest of Australia. In the context of improved access to diagnostic resources and expanding clinical networks in the Australasian region, we report the first 3 cases of culture-confirmed melioidosis in Timor-Leste. These cases describe a broad range of typical presentations, including sepsis, pneumonia, multifocal abscesses, and cutaneous infection. Phylogenetic analysis revealed that the Timor-Leste isolates belong to the Australasian clade of B. pseudomallei, rather than the Asian clade, consistent with the phylogeographic separation across the Wallace Line. This study underscores an urgent need to increase awareness of this pathogen in Timor-Leste and establish diagnostic laboratories with improved culture capacity in regional hospitals. Clinical suspicion should prompt appropriate sampling and communication with laboratory staff to target diagnostic testing. Local antimicrobial guidelines have recently been revised to include recommendations for empiric treatment of severe sepsis.
      1938
  • Publication
    Case Reports
    Complicated Mycobacterium ulcerans infection in a child in the Northern Territory.
    (2022-11-24)
    Mahony M
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    ;
    Cox V
    ;
    Sufyan W
    ;
    Wallis P
    ;
    Nizzero D
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    ;
      3976
  • Publication
    Journal Article
    First case of NDM-1-producing Acinetobacter baumannii isolated in Timor-Leste.
    (2022-09-26)
    Sarmento N
    ;
    Oakley T
    ;
    Belo JC
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    da Conceição VL
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    Maia CDC
    ;
    Santos CG
    ;
    Amaral E
    ;
    Toto L
    ;
    da Silva ES
    ;
    Marr I
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      5399