Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 25;13(1):6.
doi: 10.1186/s41479-021-00084-9.

Carriage of upper respiratory tract pathogens in rural communities of Sarawak, Malaysian Borneo

Denise E Morris  1 , Hannah McNeil  1 , Rebecca E Hocknell  1 , Rebecca Anderson  1 , Andrew C Tuck  1 , Serena Tricarico  1 , Mohd Nor Norazmi  2 , Victor Lim  3 , Tan Cheng Siang  4 , Patricia Kim Chooi Lim  3   5 , Chong Chun Wie  5   6 , David W Cleary  1   7 , Ivan Kok Seng Yap  5   8 , Stuart C Clarke  9   10   11   12 ; MYCarriage group
Collaborators, Affiliations

Carriage of upper respiratory tract pathogens in rural communities of Sarawak, Malaysian Borneo

Denise E Morris et al. Pneumonia (Nathan). .

Abstract

Introduction: Pneumonia is a leading cause of death in Malaysia. Whilst many studies have reported the aetiology of pneumonia in Western countries, the epidemiology of pneumonia in Malaysia remains poorly understood. As carriage is a prerequisite for disease, we sought to improve our understanding of the carriage and antimicrobial resistance (AMR) of respiratory tract pathogens in Malaysia. The rural communities of Sarawak are an understudied part of the Malaysian population and were the focus of this study, allowing us to gain a better understanding of bacterial epidemiology in this population.

Methods: A population-based survey of bacterial carriage was undertaken in participants of all ages from rural communities in Sarawak, Malaysia. Nasopharyngeal, nasal, mouth and oropharyngeal swabs were taken. Bacteria were isolated from each swab and identified by culture-based methods and antimicrobial susceptibility testing conducted by disk diffusion or E test.

Results: 140 participants were recruited from five rural communities. Klebsiella pneumoniae was most commonly isolated from participants (30.0%), followed by Staphylococcus aureus (20.7%), Streptococcus pneumoniae (10.7%), Haemophilus influenzae (9.3%), Moraxella catarrhalis (6.4%), Pseudomonas aeruginosa (6.4%) and Neisseria meningitidis (5.0%). Of the 21 S. pneumoniae isolated, 33.3 and 14.3% were serotypes included in the 13 valent PCV (PCV13) and 10 valent PCV (PCV10) respectively. 33.8% of all species were resistant to at least one antibiotic, however all bacterial species except S. pneumoniae were susceptible to at least one type of antibiotic.

Conclusion: To our knowledge, this is the first bacterial carriage study undertaken in East Malaysia. We provide valuable and timely data regarding the epidemiology and AMR of respiratory pathogens commonly associated with pneumonia. Further surveillance in Malaysia is necessary to monitor changes in the carriage prevalence of upper respiratory tract pathogens and the emergence of AMR, particularly as PCV is added to the National Immunisation Programme (NIP).

Keywords: AMR; Carriage; Malaysia; Pathogen; Pneumonia; Respiratory.

PubMed Disclaimer

Conflict of interest statement

SCC acts as principal investigator on studies conducted on behalf of University Hospital Southampton NHS Foundation Trust/University of Southampton that are sponsored by vaccine manufacturers but receives no personal payments from them. SCC has participated in advisory boards for vaccine manufacturers but receives no personal payments for this work. SCC has received financial assistance from vaccine manufacturers to attend conferences. DWC was a post-doctoral researcher on projects funded by Pfizer and GSK between April 2014 and October 2017. All grants and honoraria are paid into accounts within the respective NHS Trusts or Universities, or to independent charities. All other authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Map of recruitment sites.© Copyright 2020 | Multiplottr.com | All Rights Reserved. a Rumah Bana, Sebauh, Bintulu, Sarawak - GPS co-ordinate 3.142234, 113.279135; 43 participants recruited (all Iban). b Rumah Numpang, Sebauh, Bintulu, Sarawak - GPS co-ordinate 3.139950, 113.418036; 41 participant recruited (39 Iban, 1 unknown, 1 Penan). c Long Kerangan, Ulu Baram, Miri, Sarawak - GPS co-ordinate 3.766312, 114.841122; 19 participants recruited (all Penan). d Ba Marong, Ulu Baram, Miri, Sarawak - GPS co-ordinate 3.680444, 115.014777; 13 participant recruited (11 Penan, 1 Kelabit, 1 Kenyah). e Long Nen, Ulu Baram, Miri, Sarawak - GPS co-ordinate 3.679871, 114.897062; 24 participants recruited (all Penan)
Fig. 2
Fig. 2
Prevalence of bacterial carriage at each anatomical sample site. Prevalence bar plot showing bacterial carriage by anatomical sample site in participants recruited from rural communities in Sarawak, Malaysia in April 2016. Error bars show standard error
Fig. 3
Fig. 3
True bacterial carriage of each bacteria by age group. Prevalence bar plot showing true bacterial carriage prevalence by age in participants recruited from rural communities in Sarawak, Malaysia in April 2016. True carriage is defined as at least one carriage event observed regardless of the site of isolation or the number of sites from which the bacterium was recovered. Error bars show standard error
Fig. 4
Fig. 4
Serotypes of the S. pneumoniae isolated. Bar plot showing the observed numbers for each serotype identified for the 21 pneumococcal isolates collected from the oropharynx, nasopharynx, nose and mouth of participants recruited from rural communities in Sarawak, Malaysia in April 2016. ND: Not determined. PCV: pneumococcal conjugate vaccine, NVT: Non-vaccine type. Both serotype 3 S. pneumoniae were isolated from the same participant, one from the nasopharynx the other from the oropharynx. Two of the serotype 7C S. pneumoniae were isolated from the same participant, one from the nasopharynx the other from the nose. Both serotype 10A S. pneumoniae were isolated from the same participant, one from the nasopharynx the other from the nose. 6 of the un-typed S. pneumoniae were isolated from 3 participants with each having S. pneumoniae isolated from the nasopharynx and nose
Fig. 5
Fig. 5
Antimicrobial resistance of bacteria isolated. Percentage bar plot showing the AMR of all 157 S. pneumoniae, H. influenzae, K. pneumoniae, S. aureus and M. catarrhalis isolates collected from residents of rural communities in Sarawak, Malaysia in April 2016. Antibiotic discs and MIC strips were used and EUCAST breakpoints were used to assess susceptibility and resistance
See this image and copyright information in PMC

References

    1. Global Burden of Disease 2016 Causes of Death Collaborators Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151–1210. doi: 10.1016/S0140-6736(17)32152-9. - DOI - PMC - PubMed
    1. Statistics on Causes of Death, Malaysia, 2018 [press release]. Malaysia: Department of Statistics Malaysia, 31st October 2018 2018.
    1. Azmi S, Aljunid SM, Maimaiti N, Ali A-A, Muhammad Nur A, De Rosas-Valera M, et al. Assessing the burden of pneumonia using administrative data from Malaysia, Indonesia, and the Philippines. Int J Infect Dis. 2016;49:87–93. doi: 10.1016/j.ijid.2016.05.021. - DOI - PubMed
    1. Garcia-Vidal C, Fernandez-Sabe N, Carratala J, Diaz V, Verdaguer R, Dorca J, et al. Early mortality in patients with community-acquired pneumonia: causes and risk factors. Eur Respir J. 2008;32(3):733–9. 10.1183/09031936.00128107. - PubMed
    1. Limper AH. 97 - overview of pneumonia. In: Goldman L, Schafer AI, editors. Goldman's Cecil medicine (twenty Fourth Edition) Philadelphia: W.B. Saunders; 2012. pp. 587–596.

Grants and funding