Building Capacity for Surveillance and Diagnosis of Respiratory Viruses in Sarawak, Malaysia (2017-2018)


In recent history, emerging respiratory viruses have led to considerable human and animal morbidity and mortality across Southeast Asia. The region is considered a hotspot for novel respiratory virus emergence as often dense populations of humans and domestic animals live in close proximity. Some areas have the additional risk of pathogen emergence due to the mixing of pathogens reservoired in wild animals with the human and domestic animal populations.

Such is the case for the state of Sarawak in eastern Malaysia. Sarawakians often engage in marketing and eating jungle products such as wild mammal meat. Novel pathogens have been detected there, including the recent detection of a fifth species of human malaria (Plasmodium knowlesi).

Project Description

This Bass Connections project builds on an existing Duke University/Duke-NUS Medical School respiratory research project in Sarawak. This project team will expand the hospital-based respiratory virus surveillance project to the surrounding community, focusing on areas where dense populations of humans and animals mix. The team will partner with Sibu Hospital and Sarawak’s State Health Department in surveilling for influenza viruses, coronaviruses, adenoviruses and enteroviruses of human or animal origin in medical waiting rooms, open markets, poultry and swine farms and meat processing plants in Sarawak.

The goals of this project are to provide knowledge regarding respiratory pathogens that may circulate in public or agricultural spaces and to train Sarawakians and Duke University/Duke Kunshan University students in conducting such surveillance. The team will use a community-based approach to complement the hospital-based study, working toward a common goal: to improve understanding of the factors contributing to the spread of respiratory illness, ultimately enhancing preparedness for and possibly prevention of disease outbreaks. Team members will work toward the following objectives:

  1. Adapt bioaerosol sampling for respiratory viruses in various community settings in Sarawak (medical waiting rooms, open markets, poultry and swine farms and meat processing plants).
  2. Train Sarawakian public health professionals and Duke University/Duke Kunshan University students in conducting such surveillance, including both laboratory molecular work and aerosol sampling methods.
  3. Conduct occupational surveys in these public or agricultural settings to understand knowledge, attitudes and practices related to the spread of respiratory pathogens and inform the future development of educational materials to reduce the spread of infectious disease.
  4. Develop graduate trainees’ abilities to work collaboratively and with cultural competency in new settings.

Team members will conduct fieldwork in two primary locations: semiurban Sibu and the isolated jungle village of Kapit. Students will visit open markets and other areas where populations of humans and animals share space. They will use off-the-shelf aerosol stationary samplers in these settings as well as ask workers to wear backpack-mounted bioaerosol samplers to assess occupational respiratory virus transmission risk. Filtrates from these samplers will be studied by the team as supervised by virologists at Duke University and Duke-NUS Medical School for the four virus types. Team members will administer a survey to workers in these public and agricultural settings to understand knowledge, attitudes and practices related to the spread and etiology of respiratory illnesses, providing valuable sociocultural information that will help to increase understanding of information obtained from hospital patients and to identify areas appropriate for educational outreach.

Anticipated Outcomes

Preliminary data to guide grant submissions; scientific abstracts and manuscripts for submission to conferences and scientific journals; improved capacity for detection of viral pathogens; educational materials to prevent the spread of respiratory viruses


Spring 2017 – Spring 2018

  • Spring 2017: Begin developing proposal and materials for summer fieldwork; draft study IRB applications with consent forms and questionnaires; optimize bioaerosol backpack sampling approach; meet in person biweekly to prepare for fieldwork/discuss project
  • Summer 2017: Participate in Duke One Health Training Program (suggested); travel to Malaysia; collect bioaerosol samples in various public and agricultural settings; assist Sibu Hospital staff with molecular assays; administer surveys to community members, enter data and analyze data; assist with existing research study in Sibu and Kapit hospitals
  • Fall 2017: Analyze bioaerosol samples in laboratory; analyze survey data; identify gaps in knowledge/possible areas for educational intervention; present poster at Duke Global Health Showcase
  • Spring 2018: Write up findings; develop educational materials for use in later work; submit for publication

Team Outcomes to Date

Project website


Student Virus Detectives Explore What’s in the Air in Malaysia (Kerry Mallinson)

Fun on the Farm: A Day in the Life of a Farmer-Turned-Scientist (Laura Borkenhagen)

Our First Sample Collection Experience (Rick Tsao)

First Trip to Kapit (Hudson Berkhouse)

First 100 Hours: A Sibu Welcome (Sarah Philo)

Sibu Six: The Journey Begins (Laura Borkenhagen)

See photos of this project team


Faculty/Staff Team Members

Kristen Coleman, Duke-NUS Medical School, Singapore
Gregory Gray, School of Medicine - Infectious Diseases*
Nathan Thielman, School of Medicine - Infectious Diseases*

Graduate Team Members

Hudson Berkhouse, Global Health - MS
Laura Borkenhagen, Global Health - MS
Jane Fieldhouse, Global Health - MS
Sarah Philo, Global Health - MS

Undergraduate Team Members

Kerry Mallinson, Biology (AB), Global Health (AB2)
Rick Tsao, Chemistry (BS)

Community Team Members

State Health Department, Sarawak, Malaysia
Teck Hock Toh, Sibu Hospital, Malaysia

* denotes team leader