The National Centre for Infectious Diseases (Abbreviation: NCID; Malay: Pusat Nasional bagi Penyakit Berjangkit; Tamil: தேசிய தொற்றுநோய் மையம்; Chinese: 国家传染病中心), previously known as the Communicable Disease Centre (Abbreviation: CDC), is a national public health institute under the Ministry of Health of Singapore. Located next to Tan Tock Seng Hospital in Novena, all patients within the city-state who are affected with a highly contagious disease are also quarantined at the NCID and is used to control an outbreak of such diseases. The executive director of the hospital is Professor Yee-Sin Leo.
BACKGROUND:With an aging population globally, prevention of frailty and sarcopenia will become a public health priority. Growth Differentiation Factor-15 (GDF-15), a stress-responsive cytokine of the TGF-β superfamily, has emerged as a promising biomarker linking mitochondrial dysfunction, cellular senescence, and systemic inflammation to biological and phenotypic aging. OBJECTIVES:This systematic literature review systematically synthesizes the clinical evidence on GDF-15 as a biomarker of frailty, sarcopenia, and physical function, highlighting patterns, gaps, and the biological plausibility of its role as a predictive marker and therapeutic target. METHODS:Following PRISMA guidelines, we searched CENTRAL, Embase, MEDLINE, and PubMed up to February 2026. Studies involving adult human participants with measured serum GDF-15 levels and assessments of frailty or sarcopenia were included. Data were extracted and grouped thematically by population type, study design, and outcome domains. Narrative synthesis was used to compare findings and explore heterogeneity. RESULTS:From 1027 records, 35 studies were included, spanning community-dwelling adults, hospitalized patients, and individuals with cardiovascular, metabolic, gastrointestinal, and respiratory diseases. Elevated GDF-15 levels were consistently associated with poorer physical performance and greater frailty severity. Longitudinal studies suggested predictive value for future functional decline, although associations with sarcopenia were less consistent. Sex-specific variations and methodological heterogeneity, including assay techniques and diagnostic criteria, were key sources of variability. Interventional studies demonstrated limited modulation of GDF-15 levels through physical activity alone. CONCLUSIONS:These findings support the integration of GDF-15 into precision geriatric care, though further longitudinal and interventional studies, including those evaluating the incremental value of adding GDF-15 to existing screening tools for frailty, sarcopenia, and functional status, are required to establish its clinical utility.
OBJECTIVES:We assessed measles, mumps, rubella (MMR) and varicella seroprevalence and factors associated with seropositivity among our institutions' health care workers (HCWs). METHODS:This cross-sectional enzyme-linked immunosorbent assay (ELISA) seroprevalence study of HCWs' residual sera from 2020 assessed factors associated with seropositivity using logistic regression and tested performance characteristics of an "immunity" criterion (composite of past vaccination and serology results) against seropositivity. Measles non-seropositive sera were re-tested with plaque neutralization reduction tests (PRNTs). RESULTS:A total of 284 HCWs were included. MMR and varicella ELISA seropositivity were 74.7% (95% confidence interval 69.2-79.6), 82.0% (77.1-86.3), 97.9% (95.5-99.2), and 94.0% (90.6-96.5), respectively. Measles (ELISA + PRNT) seropositivity was 100.0% (98.7-100.0). Mumps seropositivity was inversely associated with Singapore citizenship/permanent residency (adjusted odds ratio [aOR]: 0.32 [0.12-0.74]). Varicella seropositivity was associated with past seropositivity and completed vaccination (aOR: 20.39 [2.79-428.71] and 0.10 [0.01-0.56], respectively). The positive and negative predictive values of "immunity" were 100.0%, 0.0% (measles [ELISA + PRNT]); 82.0%, 16.7% (mumps); 98.1%, 5.6% (rubella); and 94.5%, 10.0% (varicella), respectively. CONCLUSIONS:Participants had high measles, rubella, and varicella seroprevalence but not mumps. The immunity criterion was unreliable for mumps. Vaccinating HCWs with a third MMR dose could be considered in mumps outbreaks. Infection prevention and control measures remain important.
ABOUT THIS GUIDELINE:This BMJ Rapid Recommendation is a summary of a World Health Organization guideline published 12 September 2024. The full guideline is available in MAGICapp and in PDF on the WHO website. The WHO guideline is primarily for healthcare providers and takes a patient-centred perspective on benefits and harms. Other considerations include resource implications, acceptability, feasibility, equity, and human rights of relevance to healthcare systems. Recommendations were developed according to standards and methods for trustworthy guidelines by a panel of non-conflicted experts, as delineated in the WHO handbook (https://www.who.int/publications/i/item/9789241548960). CLINICAL QUESTIONS:What is the role of medications in treating non-severe and severe influenza including zoonotic disease (novel influenza A), and in preventing infection among contacts? Which diagnostic testing strategies best enable rapid and accurate treatment decisions? CONTEXT AND CURRENT PRACTICE:New randomised controlled trial (RCT) evidence, ongoing concerns about zoonotic disease, and the increasing availability of rapid diagnostic tests require updated guidance. RECOMMENDATIONS:apply to seasonal influenza and zoonotic influenza. There are 29 recommendations; 21 related to antiviral medications and six to adjunctive therapies to prevent and treat influenza. Recommendations are stratified by severity of disease and risk of disease progression. For seasonal influenza, WHO conditionally recommends treatment within 48 hours of symptom onset with oseltamivir for severe illness, and baloxavir for patients at high risk of progression from non-severe to severe illness. WHO also conditionally recommends prophylaxis (using baloxavir, laninimavir, oseltamivir, or zanamivir) for anyone exposed to zoonotic influenza, and for those exposed to seasonal influenza who are at extremely high risk. The panel issued recommendations against the use of adjunctive therapies in patients with non-severe influenza (strong recommendation against antibiotics) and severe influenza (conditional recommendation against corticosteroids, macrolides, mTOR inhibitors, non-steroidal anti-inflammatory drugs, and passive immune therapy). A recommendation is made for diagnostic testing strategies in non-severe and severe influenza disease. THE EVIDENCE:Four systematic reviews of RCTs provided low to very low certainty evidence on benefits and harms of antiviral medications and adjunctive therapies. A systematic review of prognostic factors provided baseline risk estimates and information on individual risk factors for disease progression. A decision analysis model informed recommendations for testing based on alternative potential diagnostic pathways.
Multidrug resistance among Gram-negative bacteria (GNB) is a serious global health threat, particularly in the Asia-Pacific region. A national surveillance program reported increasing rates of carbapenem resistance among GNB in the Philippines, ranging from 8%-18.9% in 2023, with metallo-β-lactamases being the most common mechanism of resistance. We used whole genome sequencing (WGS) to screen for carbapenemase genes and identify genetic lineages of carbapenem-non-susceptible (NS) clinical isolates collected from a private teaching hospital in Manila, Philippines.Figure 1.Distribution of ST by Organism SpeciesFigure 2.Distribution of Carbapenemase Genes Amongst Carbapenem-NS GNB All clinical isolates of carbapenem-NS GNB from hospitalized adults ( >18 years of age) in acute care wards were collected from March-November 2023. Following WGS and assembly, genomic species and sequence type (ST) were determined by MLST and Kraken, and AMRfinder was used to detect carbapenemase genes. Additionally, isolates were assessed for clonal and plasmid-mediated transmission of these genes. Eighty-four carbapenem-NS isolates were identified during the study period, and 59 (70%) were sent for WGS. Of those, 52 isolates from 33 unique patients were found to have concordant species between clinical laboratory (MALDI-TOF) and genomic methods, with the majority being Pseudomonas aeruginosa (n=33), Klebsiella pneumoniae (n=9), and Klebsiella oxytoca (n=4). ST distribution is shown in Figure 1. Of the 19 carbapenem-NS Enterobacterales isolated from 16 patients, 13 (68.4%) had a carbapenemase gene detected with blaNDM-7 found in 6 (46.2%) and blaNDM-1 found in 7 (53.8%) isolates (Figure 2). No carbapenemase genes were identified in P. aeruginosa. Nine clonal clusters were determined, involving 22 isolates from 10 patients. Of the 13 carbapenemase-positive isolates found in 11 patients, four met criteria for potential plasmid-mediated transmission of a carbapenemase gene and were not part of a clonal cluster. Our investigation detected instances of both clonal and plasmid-mediated transmission of carbapenem resistance, with most overall occurrence caused by neither. The prevalence of carbapenemase genes among the tested carbapenem-NS Enterobacterales was high, with blaNDM-7 and blaNDM-1 being exclusively identified. All Authors: No reported disclosures
Randomized clinical trials comparing the breadth and long-term persistence of immunity between different COVID-19 vaccine types and between ancestral and Omicron-targeted vaccines are limited. The PRIBIVAC study (Phase D) is a randomized clinical trial comparing the immunogenicity of monovalent mRNA vs bivalent mRNA vs protein-based NVX-CoV2373 administered as second booster in 176 triple mRNA-vaccinated adults. Primary objective was neutralizing antibody levels against Omicron subvariants at day 28. A 4th vaccine dose significantly boosted 50% neutralization titers against emerging strain XBB.1.16 by 3.2-, 4.1- and 1.6-fold in monovalent mRNA, bivalent mRNA and NVX-CoV2373 group respectively at day 28. The largest absolute increase in inhibition level at day 28 post-booster was observed against the KP.2 subvariant, with bivalent mRNA vaccines exhibiting the highest neutralization level (91.7%) compared with monovalent mRNA (84.4%; p = .027) and NVX-CoV2373 (81.4%; p < .0001). While bivalent mRNA vaccines elicited the highest early immunogenicity, neutralization levels against all Omicron variants tested waned to similar levels between groups by 12 months post-vaccination. Although NVX-CoV2373 induced a lower peak anti-S antibody response, anti-S decay rate was slower in NVX-CoV2373 compared with mRNA vaccines. The geometric mean anti-S fold change (D360/D28) in NVX-CoV2373 group was higher (0.51) relative to both mRNA vaccines (monovalent: 0.31, p = .010 and bivalent: 0.35, p = .017). Improved neutralizing antibody responses against diverse SARS-CoV-2 variants by the ancestral or variant vaccine highlight the immunological benefits of COVID-19 vaccine boosters regardless of the latest variant-based vaccine. Further studies to determine if different vaccine combinations translate to differing protection against infection remain necessary.
