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Genomic surveillance is crucial for tracking emergence and spread of novel variants of pathogens, such as SARS-CoV-2, to inform public health interventions and to enforce control measures. However, in some settings especially in low- and middle- income counties, where sequencing platforms are limited, only certain patients get to be selected for sequencing surveillance. Here, we show that patients with multiple comorbidities potentially harbour SARS-CoV-2 with higher mutation rates and thus deserve more attention for genomic surveillance. The relationship between the patient comorbidities, and type of amino acid mutations was assessed. Correlation analysis showed that there was a significant tendency for mutations to occur within the ORF1a region for patients with higher number of comorbidities. Frequency analysis of the amino acid substitution within ORF1a showed that nsp3 P822L of the PLpro protease was one of the highest occurring mutations. Using molecular dynamics, we simulated that the P822L mutation in PLpro represents a system with lower Root Mean Square Deviation (RMSD) fluctuations, and consistent Radius of gyration (Rg), Solvent Accessible Surface Area (SASA) values—indicate a much stabler protein than the wildtype. The outcome of this study will help determine the relationship between the clinical status of a patient and the mutations of the infecting SARS-CoV-2 virus. [ABSTRACT FROM AUTHOR]

Introduction: The world has been badly affected by the spread of a novel virus known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that was first reported in Wuhan, China back in December 2019. As the virus is transmitted through aerosol, respiratory droplets and close contact, hand hygiene and wearing mask are the most important preventive measures for COVID-19. Studies showed hand hygiene intervention improved compliances. This paper discussed the development of a hand hygiene intervention module, validation, usability and effectiveness reports. Methods: This study involved 5 stages; need analysis, module development, validation, usability and effectiveness studies. Need analysis and module development were carried out through brainstorming and literature search. The content was evaluated by three experts, whereas the usability was screened by four preschool teachers. The effectiveness of knowledge transfer was evaluated via pre and post intervention surveys. Results: The hand hygiene educational module received valuable comments from the content expert and the end-users (teachers). Knowledge score related to COVID-19 transmission, prevention and hand hygiene moments among pre-school children were significantly increased after the intervention. Conclusion: This module can be used to improve teaching method related to COVID-19 and hand hygiene. The 'learn and play' approach may increase excitement, thus make learning process enjoyable and memorable. [ABSTRACT FROM AUTHOR]

Background: Vaccine hesitancy has been around since the introduction of smallpox vaccine. Vaccine hesitancy has become more intense due to the rise of vaccine information in social media and mass adult vaccination during COVID-19 pandemic. This study investigated knowledge, perception, and reasons for rejection of the COVID-19 vaccine among Malaysian adults who refused to get free COVID-19 vaccination. Methods: An online cross-sectional survey using an embedded mixed-method study [QUAN(quali)] was conducted among Malaysian adults. The quantitative section consisted of a 49-item questionnaire, whereas the qualitative sections consisted of two open-ended questions (1) "Please state your reason why you have not registered or have no intention to register at all for COVID-19 vaccines?" and (2) "Please tell us if you have any suggestions for improvement about COVID-19 vaccine delivery". Data from respondents who were not willing to get vaccination were extracted from the overall data and further analyzed in this paper. Result: Sixty-one adults completed the online open-ended survey with a mean age of 34.28 years (SD = 10.30). Among factors that influenced them to get vaccinated was information on vaccine effectiveness (39.3%), death due to COVID-19 (37.7%), and recommendations from the Ministry of Health (36.1%). Most of the respondents (77.0%) were knowledgeable about vaccines, with half having high-perceived risks (52.5%) to COVID-19. While 55.7% and 52.5% had, high perceived barriers and benefits to COVID-19 vaccines respectively. The reasons for vaccine rejections included vaccine safety, indecisiveness, underlying medical conditions, herd immunity, non-transparent data, and use of traditional or complementary medicine. Conclusion: The study explored the multitude factors that drive perception, acceptance, and rejection. The qualitative approach with a small sample size provided more data point for interpretations and allowed participants to express themselves. This is important to develop strategies to create public awareness on vaccines not just for COVID-19 but any infectious diseases that can be curbed through vaccination. [ABSTRACT FROM AUTHOR]

Introduction: The world has been badly affected by the spread of a novel virus known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that was first reported in Wuhan, China back in December 2019. As the virus is transmitted through aerosol, respiratory droplets and close contact, hand hygiene and wearing mask are the most important preventive measures for COVID-19. Studies showed hand hygiene intervention improved compliances. This paper discussed the development of a hand hygiene intervention module, validation, usability and effectiveness reports. Methods: This study involved 5 stages; need analysis, module development, validation, usability and effectiveness studies. Need analysis and module development were carried out through brainstorming and literature search. The content was evaluated by three experts, whereas the usability was screened by four preschool teachers. The effectiveness of knowledge transfer was evaluated via pre and post intervention surveys. Results: The hand hygiene educational module received valuable comments from the content expert and the end-users (teachers). Knowledge score related to COVID-19 transmission, prevention and hand hygiene moments among pre-school children were significantly increased after the intervention. Conclusion: This module can be used to improve teaching method related to COVID-19 and hand hygiene. The 'learn and play' approach may increase excitement, thus make learning process enjoyable and memorable. [ABSTRACT FROM AUTHOR]

Introduction: Staphylococcus aureus is part of the normal human flora that can commonly be found on the skin and mucous membranes of the nasal area. However, in immunosuppressed patients such as those with kidney failures, colonization can potentially lead to infection. There is a concern of increasing antibiotic resistance in S. aureus. This study aimed to determine the prevalence of S. aureus nasal colonization and its antimicrobial susceptibility among haemodialysis-dependent populations. Methods: A cross-sectional study at the Nephrology Unit, Hospital Canselori Tuanku Mukhriz (HCTM) was conducted among haemodialysis-dependent patients between February 2017 to February 2018. Nasal swabs were obtained and cultured on mannitol salt agar. S. aureus isolates were identified by gram staining, tube coagulase and Deoxyribonuclease (DNase). Cefoxitin disc (30 µg) were used to identified the presence of MRSA (methicillin-resistance S. aureus). The S. aureus colonies were further tested against six antibiotics using Kirby Bauer disc diffusion. Result: A total of 134 patients were recruited. S. aureus isolates were detected from 27 patients (20.1%). All S. aureus were phenotypically identified as methicillin-sensitive S. aureus (MSSA) based on the cefoxitin disc. Teicoplanin and linezolid were the most effective with 100% susceptibility. S. aureus exhibited a high resistance rate towards erythromycin (29.6%). No MRSA was isolated in this study. Conclusion: This study highlighted the high prevalence of S. aureus nasal colonization in haemodialysis patients. Teicoplanin and linezolid were found to be the most effective antibiotics against isolated S. aureus. [ABSTRACT FROM AUTHOR]

Introduction: Several countries have started mass vaccination programs to halt the spread of the COVID-19 pandemic. With an R naught value of 2 to 3, about 70% of the population needs to be immunized to achieve herd immunity. This study aimed to investigate the reasons for acceptance or refusal of COVID-19 vaccines among the Malaysian population. Methodology: An exploratory, descriptive qualitative design was performed. The cross-sectional survey used a non-probability convenient sampling technique to recruit the respondents, who were required to answer an open-ended question: Either "If you are willing to get the vaccine, please state your reason" or "If you are not willing to get vaccinated, please state your reason." The survey also included questions on demography such as age, gender, and place of residence. According to the Health Belief Model, the data was transcribed, translated, and analyzed: perceived susceptibility, perceived severity, perceived barrier, and cues for action. Results: A total of 1091 respondents who completed the online survey comprised 685 (62.8%) females, 406 (37.2%) males, with a mean age of 38.16 (SD = 16.44). The majority (81.1%) were willing to get vaccinated. Thematic analysis showed that most respondents perceived that the vaccine is safe, effective, protective and will provide herd immunity. Barriers to vaccination include unknown long-term side effects, rapid vaccine production, inadequate information and concerns regarding halal status. Cues to vaccination included individual desire, social responsibility, economic concerns and wait-and-see behavior. Conclusions: The public should be well informed about the vaccine, its efficacy, side effects, and halal status to increase vaccine acceptability and achieve herd immunity. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 or COVID-19 is caused by a newly discovered coronavirus, SARS-CoV-2. The Malaysian government has planned to procure COVID-19 vaccine through multiple agencies and companies in order to vaccinate at least 70% of the population. This study aimed to determine the knowledge, acceptance and perception of Malaysian adults regarding the COVID-19 vaccine. Methodology: An online survey was conducted for two weeks in December 2020. A bilingual, semi-structured questionnaire was set up using Google Forms and the generated link was shared on social media (i.e., Facebook and WhatsApp). The questionnaire consisted of questions on knowledge, acceptance and perception of COVID-19 vaccine. The association between demographic factors with scores on knowledge about COVID-19 vaccine were analysed using the Mann-Whitney test for two categorical variables, and the Kruskal-Wallis test used for more than two categorical variables. Results: A total of 1406 respondents participated, with the mean age of 37.07 years (SD = 16.05) years, and among them 926 (65.9%) were female. Sixty two percent of respondents had poor knowledge about COVID-19 vaccine (mean knowledge score 4.65; SD = 2.32) and 64.5% were willing to get a COVID-19 vaccine. High knowledge scores associated with higher education background, higher-income category and living with who is at higher risk of getting severe COVID-19. They were more likely to be willing to get vaccinated if they were in a lower age group, have higher education levels and were female. Conclusion: Even though knowledge about vaccine COVID-19 is inadequate, the majority of the respondents were willing to get vaccinated. This finding can help the Ministry of Health plan for future efforts to increase vaccine uptake that may eventually lead to herd immunity against COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Children in pre-schools are at high risk of getting infections due to overcrowding, minimal awareness of basic hygiene and lack of immunity against microorganisms. Hand hygiene practice should be started at home where parents set good example, followed by formal education in pre- schools, primary and secondary school. This study aimed to develop a comprehensive program on hand hygiene practice in pre-schools. This paper presents the developmental aspects of the program material and the results of its evaluation process in a selected pre-school. Methods: Stage of development involved preparation of song, lyric, video clip, infographic and tablet application. The module was introduced during an intervention day called 'Healthy Hands' day. The acceptance of the module was evaluated before and after the intervention day. Evaluation was done by assessing pre-school children by faceto- face interview about knowledge on hand hygiene techniques and routine, such as before or after certain activities. Results: We managed to compose a song in three languages (Malay, English & Arabic), produced a video clip, an infographic and tablet application. A total of 227 children participated. Post intervention evaluation showed significant (p<0.001) increase of knowledge for eight out of eleven handwashing steps. The knowledge on hand hygiene routine i.e. after toilet, after playing outdoor, after sneezing and after playing with pet was also increased significantly. Conclusion: This comprehensive knowledge transfer program significantly improved the children's hand hygiene techniques and routine and is recommended to be integrated into pre-school curriculum. [ABSTRACT FROM AUTHOR]

Introduction: Invasive Candida infections cause significant mortality and morbidity worldwide. Information on recent trends in species distribution and antifungal resistance in local settings is essential. Methodology: Yeast isolates identified through standard culture methods throughout 2014 and 2015 from Hospital Ampang, Malaysia were retrospectively studied. The antifungal susceptibility of Candida species was determined using colorimetric broth microdilution method and MIC values interpreted according to CLSI breakpoints. Results: Out of all the 149 yeast cultures collected, most were from blood (55.7%) and respiratory specimens (33.6%). Candida tropicalis was the most common (28.9%), followed by C. albicans (26.2%), C. parapsilosis (15.4%), C. glabrata (14.1%), Crytococcus neoformans (6.7%), Trichosporon asahi (3.4%), C. krusei (2.0%), C. famata, C. rugose, C. guilliermondii, C. dublinensis and Trichosporon spp. (0.7% each). Occurrence of C. tropicalis in candidaemia cases was significantly associated to presence of an underlying haematological disorder, while C. albicans isolates in blood were significantly found in absence of such disorders. The four most common Candida species isolated showed high susceptibility to amphotericin B (100%), anidulafungin (100%), micafungin (100%), caspofungin (98.4%), flucytosine (98.4%) and voriconazole (84.1%). However, drug susceptibility to itraconazole and fluconazole was comparatively lower (57.9% and 72.2%, respectively). C. glabrata and C. tropicalis were the least susceptible to these azoles. Conclusion: Prevalence of the high number of non-albicans Candida species with slight predominance of C. tropicalis over C. albicans was observed. Low susceptibility to itraconazole among C. glabrata and C. tropicalis isolates and to fluconazole among C. glabrata isolates warrants for continued surveillance to monitor emerging antifungal resistance. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: Maintaining high levels of vaccinations is important for public health success in any vaccination planning. Success requires a better understanding of the public's perceptions of diseases and consequent decisions about vaccinations. This study aims to gather exploratory qualitative data on public opinion on the Malaysian Government's COVID-19 immunization campaigns. Methods: Open-ended question on Google Form was advertised online between 2 to 17 December 2020. The questionnaire form was deactivated when saturation has been reached. The free text questions were analysed by qualitative thematic analysis by all authors on a Microsoft Excel spreadsheet. Results: Six hundred and sixty-one participants replied to the online questionnaire. Four themes emerged from the thematic analysis on suggestions for future National COVID-19 Immunisation Program. First, COVID-19 vaccine administration policy; secondly, knowledge dissemination and plan to address obstacles of public acceptances towards the vaccine proactively; thirdly, better implementation programs by the government and fourthly, using local research expertise for vaccine development and alternative medicines. Participants believe all this are essential in increasing their trust and uptake for the government's future national COVID-19 Immunisation Program. Conclusion: This study highlights the suggestions made by the public for the Malaysian Government. These findings will help develop education and intervention strategies for new vaccine introduction to combat the COVID-19 pandemic in Malaysia. [ABSTRACT FROM AUTHOR]

Background: In line with Universiti Sains Islam Malaysia's (USIM) tagline 'Exploring Islamic Science, Spearheading Knowledge', we embarked on a new paradigm of teaching by integrating naqli components into the microbiology and immunology curriculum. The main objective of this integration was to enhance students' appreciation towards Islam and Science, so that they would become good Muslim doctors. The naqli components were delivered through various teaching and learning techniques such as lectures, seminars, and online assignments. Methods: A total of eighty year 3 students from Faculty of Medicine and Health Sciences, USIM were involved in this study. They were exposed to the new method of teaching for the whole academic year, session 2014/ 2015. The effectiveness of this program was evaluated through questionnaires, given at the end of academic session. Outcome: More than 90% students agreed that the integration were clearly delivered, relevant to the topics at hand and enhanced their knowledge. Most students (>90%) preferred interactive lectures rather than students' initiated method such as seminar and speaker's corner. About two third of the students did not prefer online method. Moreover, 15.9% of them said the allotted time was insufficient and 46% agreed that there was inadequate resources in the library. Conclusions: The integration of naqli components into microbiology subject was favoured by students. However, it should be improved with allocation of more slots, upgrading of online system and increment of relevant library resources. Looking forward, we are convinced this is the way to go in producing holistic doctors equipped with necessary knowledge, both in aqli and naqli to further advance Medicine and Islam. [ABSTRACT FROM AUTHOR]

Foodborne disease related to commercial eateries remains a major concern in food safety control programs worldwide. This study aimed to assess the impact of the FOODAlyzer© as a web-based food safety education system on the knowledge, attitude, and perception of selecting commercial eateries among students of non-health-related courses in higher educational institutions in Peninsular Malaysia. The interventional study design was used as follows: the intervention group (n = 59) was compared with the control group (n = 59) in the pre-test (before the intervention), post-test (immediately after the intervention), and follow-up post-test (two weeks later). Baseline data showed that both the intervention and control groups had no significant difference in knowledge score, attitude, and perception. The intervention group achieved a higher knowledge score (p = 0.022) and attitude score (p < 0.0001), indicating a significant impact of food safety education in the FOODAlyzer© compared with the control group. The test of within-subjects showed a significant increase in respondents' scores on knowledge, attitude, and perception. By contrast, the test of between-subjects found that the intervention group achieved a higher knowledge score (p = 0.022) and attitude score (p < 0.0001), which indicates a significant impact of food safety education compared with the control group. The findings suggest that knowledge and attitude in selecting commercial eateries based on food safety criteria among the students remained lacking. This paper presents the impact of food safety education to empower consumers towards the selection of commercial eateries and thus reduce the risk of foodborne illness. • Food safety criteria were not used by consumers when selecting commercial eateries. • Food safety information is important when consumers select eateries. • FOODAlyzer© improves consumers' knowledge, attitude, and perception in selecting commercial eateries. • A web-based application system is relevant as an educational tool to improve public health programs. [ABSTRACT FROM AUTHOR]

The COVID-19 is difficult to contain due to its high transmissibility rate and a long incubation period of 5 to 14 days. Moreover, more than half of the infected patients were young and asymptomatic. Virus transmission through asymptomatic patients is a major challenge to disease containment. Due to limited treatment options, preventive measures play major role in controlling the disease spread. Gargling with antiseptic formulation may have potential role in eliminating the virus in the throat. Four commercially available mouthwash/gargle formulations were tested for virucidal activity against SARS-CoV-2 in both clean (0.3 g/l BSA) and dirty (0.3 g/l BSA + 3 mL/L human erythrocytes) conditions at time points 30 and 60 s. The virus was isolated and propagated in Vero E6 cells. The cytotoxicity of the products to the Vero E6 was evaluated by kill time assay based on the European Standard EN14476:2013/FprA1:2015 protocol. Virus titres were calculated as 50% tissue culture infectious dose (TCID50/mL) using the Spearman-Karber method. A reduction in virus titer of 4 log10 corresponds to an inactivation of ≥ 99.99%. Formulations with cetylperidinium chloride, chlorhexidine and hexitidine achieved > 4 log10 reduction in viral titres when exposed within 30 s under both clean and dirty conditions. Thymol formulations achieved only 0.5 log10 reduction in viral titres. In addition, salt water was not proven effective. Gargle formulations with cetylperidinium chloride, chlorhexidine and hexetidine have great potential in reducing SAR-CoV-2 at the source of entry into the body, thus minimizing risk of transmission of COVID-19. [ABSTRACT FROM AUTHOR]

Determining the level of customer satisfaction in cleanliness regarding a product or service is a significant aspect of businesses. However, the availability of feedback tools for consumers to evaluate the cleanliness of a restaurant is a crucial issue as several aspects of cleanliness need to be evaluated collectively. To overcome this issue, this study designed a survey instrument based on the standard form used for grading the food premises and transformed it into a seven Likert scale questionnaire and consists of seven questions. This study employed fuzzy conjoint analysis to measure the level of satisfaction in cleanliness in food premises. This pilot study recruited 30 students in Universiti Teknologi MARA (UiTM) Seremban 3. The student's perception was represented by the scores calculated based on their degree of similarities and corresponding levels of satisfaction, whereby, only scores with the highest degree of similarity were selected. Furthermore, this study identified the aspects of hygiene that assessed based on the customers' satisfaction upon visiting the premises. The results indicated that the fuzzy conjoint analysis produced a similar outcome as the statistical mean, thus, was useful for the evaluation of customer satisfaction on the cleanliness of food premises. [ABSTRACT FROM AUTHOR]

Introduction: Hajj is a unique religious mass gathering among Muslims hosted by Kingdom of Saudi Arabia (KSA) annually. It is a fifth pillar that is compulsory to be carried among muslim. Infections due to Neisseria meningitidis, Streptococcus Pneumoniae and Influenza virus are very high among Hajj pilgrims in KSA. Study shows knowledge and attitude towards vaccine preventable disease and vaccination which is very important for the prevention of these infectious diseases. This study aims to determine knowledge and attitude among the prospective Malaysian hajj pilgrims on vaccine preventable disease and vaccination. Method: A cross sectional study was conducted among prospective hajj pilgrims in June 2019. Self-administered questionnaires were given to the respondents through simple random sampling. The socio-demographic characteristics were described using descriptive analysis. Chi-square test was used to analyse the association between the socio-demographic and Malaysian hajj pilgrims' knowledge and attitude towards the vaccine preventable diseases and vaccination. Results: A total of 135 respondents were recruited in the study. There were statistically significant associations between the knowledge and the highest education level (p=0.01), and also between the knowledge and the occupation (p=0.02) on vaccine preventable disease and vaccination. Conclusion: There is a lack of knowledge among the Malaysian hajj pilgrims about these vaccine preventable diseases and vaccination, especially those who have lower education level and also unemployed. Tabung Haji are highly advised to focus on these group and prepare a special course that focused on these vaccine preventable diseases so that Malaysian Hajj pilgrims will be protected. [ABSTRACT FROM AUTHOR]