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Background: Spread of malaria and antimalarial resistance through human movement present major threats to current goals to eliminate the disease. Bordering the Greater Mekong Subregion, southeast Bangladesh is a potentially important route of spread to India and beyond, but information on travel patterns in this area are lacking., Methods: Using a standardised short survey tool, 2090 patients with malaria were interviewed at 57 study sites in 2015-2016 about their demographics and travel patterns in the preceding 2 months., Results: Most travel was in the south of the study region between Cox's Bazar district (coastal region) to forested areas in Bandarban (31% by days and 45% by nights), forming a source-sink route. Less than 1% of travel reported was between the north and south forested areas of the study area. Farmers (21%) and students (19%) were the top two occupations recorded, with 67 and 47% reporting travel to the forest respectively. Males aged 25-49 years accounted for 43% of cases visiting forests but only 24% of the study population. Children did not travel. Women, forest dwellers and farmers did not travel beyond union boundaries. Military personnel travelled the furthest especially to remote forested areas., Conclusions: The approach demonstrated here provides a framework for identifying key traveller groups and their origins and destinations of travel in combination with knowledge of local epidemiology to inform malaria control and elimination efforts. Working with the NMEP, the findings were used to derive a set of policy recommendations to guide targeting of interventions for elimination.

Vaccinating dogs against rabies is an effective means of reducing human rabies. We subjected 1327 clinically diagnosed human rabies death and mass dog vaccination (MDV) data during 2006-2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (422) for clinico-epidemiological analysis. A positive and increasing trend of MDV (p = 0.01 and tau = 0.71) and a negative and declining trend (p < 0.001 and tau = -0.88) of human rabies cases (Correlation coefficient: -0.82) have been observed. Among 422 deaths, the majority (78%) of the victims sought treatment from traditional healers, and 12% received post-exposure prophylaxis (PEP). The mean incubation period of rabies in cases with exposure sites on the head & neck (35 days) was shorter than the upper limb (mean = 64 days, p = 0.02) and lower limb (mean = 89 days, p < 0.01). MDV has been found to be effective for reducing human rabies cases in Bangladesh. Creating awareness among the animal bite victims to stop reliance on traditional healers rather seeking PEP, addressing the role of traditional healers through awareness education programme with respect to the treatment of dog bites, ensuring availability of PEP, and continuing to scale up MDV may help to prevent human rabies deaths.

For countries aiming for malaria elimination, travel of infected individuals between endemic areas undermines local interventions. Quantifying parasite importation has therefore become a priority for national control programs. We analyzed epidemiological surveillance data, travel surveys, parasite genetic data, and anonymized mobile phone data to measure the spatial spread of malaria parasites in southeast Bangladesh. We developed a genetic mixing index to estimate the likelihood of samples being local or imported from parasite genetic data and inferred the direction and intensity of parasite flow between locations using an epidemiological model integrating the travel survey and mobile phone calling data. Our approach indicates that, contrary to dogma, frequent mixing occurs in low transmission regions in the southwest, and elimination will require interventions in addition to reducing imported infections from forested regions. Unlike risk maps generated from clinical case counts alone, therefore, our approach distinguishes areas of frequent importation as well as high transmission., Competing Interests: HC, AW, IS, CJ, AM, DU, SZ, MH, MF, AG, AS, MR, AI, MK, MR, AS, SJ, MA, ED, SG, MK, MD, RV, OM, KE, DK, RM, CB No competing interests declared, (© 2019, Chang et al.)

This study has been undertaken to investigate the isolation and identification of EPEC strains from paediatric diarrhoeal patients. The study was carried out in the department of Microbiology, Sir Salimullah Medical College & Mitford Hospital, Bangladesh during January to December, 2011. Total 272 samples were studied. Samples from patients with diarrhoea were collected from two tertiary care hospital. At first Esch. coli were isolated from these specimens using standard microbiological techniques and then EPEC strains were identified on the basis of presence of bundle forming pilus (bfpA) gene. Virulence of EPEC strains were determined by detection of bfpA gene and observing localized adherence (LA) in HeLa cell adherence assay. Esch. coli was isolated and identified from all the 272 samples from patients using standard microbiological techniques. Among 272 samples 20(7.35%) isolates were identified as EPEC on the basis of presence of bfpA gene detected by polymerase chain reaction. EPEC strains were identified from those 240 samples, from which Esch. coli had been isolated only. Out of twenty EPEC strains, 17 strains (85%) showed a pattern of localized adherence in Hela cell adherence assay. EPEC strains can be identified by bfpA gene detection and by adherence assays. HeLa cell adherence assay is the most specific method for detection of EPEC strains which has bfpA gene, responsible for localized adherence (LA) in HeLa cell line. Rapid and reliable detection of EPEC is required for successful microbiological surveillance and for treatment of EPEC mediated diarrhoeal disease.