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      Emerging respiratory infections threatening public health in the Asia‐Pacific region: A position paper of the Asian Pacific Society of Respirology†

      review-article
      1 , 1 , 2 , 3 , 1 , , on behalf of the Respiratory Infections Assembly of the APSR
      Respirology (Carlton, Vic.)
      John Wiley & Sons, Ltd
      avian influenza, pandemic, respiratory infection, virus

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          ABSTRACT

          In past decades, we have seen several epidemics of respiratory infections from newly emerging viruses, most of which originated in animals. These emerging infections, including severe acute respiratory syndrome coronavirus (SARS‐CoV), Middle East respiratory syndrome coronavirus (MERS‐CoV) and the pandemic influenza A(H1N1) and avian influenza (AI) viruses, have seriously threatened global health and the economy. In particular, MERS‐CoV and AI A(H7N9) are still causing infections in several areas, and some clustering of cases of A(H5N1) and A(H7N9) may imply future possible pandemics. Additionally, given the inappropriate use of antibiotics and international travel, the spread of carbapenem‐resistant Gram‐negative bacteria is also a significant concern. These infections with epidemic or pandemic potential present a persistent threat to public health and a huge burden on healthcare services in the Asia‐Pacific region. Therefore, to enable efficient infection prevention and control, more effective international surveillance and collaboration systems, in the context of the ‘One Health’ approach, are necessary.

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          Most cited references37

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          Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

          Summary Background Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). Clinical data on MERS-CoV infections are scarce. We report epidemiological, demographic, clinical, and laboratory characteristics of 47 cases of MERS-CoV infections, identify knowledge gaps, and define research priorities. Methods We abstracted and analysed epidemiological, demographic, clinical, and laboratory data from confirmed cases of sporadic, household, community, and health-care-associated MERS-CoV infections reported from Saudi Arabia between Sept 1, 2012, and June 15, 2013. Cases were confirmed as having MERS-CoV by real-time RT-PCR. Findings 47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3·3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age. Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]). All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]). Interpretation Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities. Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition. Funding None.
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            Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem.

            Antimicrobial resistance is a global public health challenge, which has accelerated by the overuse of antibiotics worldwide. Increased antimicrobial resistance is the cause of severe infections, complications, longer hospital stays and increased mortality. Overprescribing of antibiotics is associated with an increased risk of adverse effects, more frequent re-attendance and increased medicalization of self-limiting conditions. Antibiotic overprescribing is a particular problem in primary care, where viruses cause most infections. About 90% of all antibiotic prescriptions are issued by general practitioners, and respiratory tract infections are the leading reason for prescribing. Multifaceted interventions to reduce overuse of antibiotics have been found to be effective and better than single initiatives. Interventions should encompass the enforcement of the policy of prohibiting the over-the-counter sale of antibiotics, the use of antimicrobial stewardship programmes, the active participation of clinicians in audits, the utilization of valid rapid point-of-care tests, the promotion of delayed antibiotic prescribing strategies, the enhancement of communication skills with patients with the aid of information brochures and the performance of more pragmatic studies in primary care with outcomes that are of clinicians' interest, such as complications and clinical outcomes.
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              Epidemiology of Human Infections with Avian Influenza A(H7N9) Virus in China

              New England Journal of Medicine, 370(6), 520-532
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                Author and article information

                Contributors
                pulmoks@hallym.ac.kr
                Journal
                Respirology
                Respirology
                10.1111/(ISSN)1440-1843
                RESP
                Respirology (Carlton, Vic.)
                John Wiley & Sons, Ltd (Chichester, UK )
                1323-7799
                1440-1843
                15 April 2019
                June 2019
                : 24
                : 6 ( doiID: 10.1111/resp.2019.24.issue-6 )
                : 590-597
                Affiliations
                [ 1 ] Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine Hallym University Sacred Heart Hospital Anyang Republic of Korea
                [ 2 ] Department of Pulmonary and Critical Care Medicine Zhongshan Hospital, Fudan University Shanghai China
                [ 3 ] Department of Internal Medicine, Kulliyyah of Medicine International Islamic University Malaysia Kuantan Malaysia
                Author notes
                [*] [* ]Correspondence: Ki‐Suck Jung, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi‐do 431‐070, Republic of Korea. Email: pulmoks@ 123456hallym.ac.kr
                Author information
                https://orcid.org/0000-0001-7004-6985
                Article
                RESP13558
                10.1111/resp.13558
                7169191
                30985968
                80c34507-2e4a-4ed8-8a6a-b7be148d4abe
                © 2019 Asian Pacific Society of Respirology

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 26 June 2018
                : 12 February 2019
                : 21 March 2019
                Page count
                Figures: 0, Tables: 2, Pages: 8, Words: 6109
                Categories
                Position Statement
                Position Statement
                Custom metadata
                2.0
                June 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:15.04.2020

                Respiratory medicine
                avian influenza,pandemic,respiratory infection,virus
                Respiratory medicine
                avian influenza, pandemic, respiratory infection, virus

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