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

Southeast Asia has emerged as a hotspot for infectious diseases due to its tropical climate and anthropogenic factors that have led to increased contact between humans, livestock, wildlife and the ecosystem. In recent years, novel respiratory viruses such as avian and swine influenza viruses, enteroviruses and adenoviruses have caused significant outbreaks that have devastated human and animal populations. Stakeholders acknowledge the importance of increasing surveillance and epidemiological research to understand the emergence of zoonotic diseases and to prevent potential future pandemics; however, major gaps in surveillance remain in Malaysia, particularly at the interface of human and animal health.

Building on an existing Duke University/Duke-NUS (National University of Singapore) Medical School respiratory research project in Sarawak, Malaysia, the team partnered with Sibu Hospital, Kapit Hospital and Sarawak’s State Health Department to test hospital wards, open markets, swine farms and slaughterhouses for a variety of viruses of human and animal origin.

Six student team members spent ten weeks in Sarawak building a shared laboratory space and collecting bioaerosol, human nasal wash and animal samples in semi-urban Sibu and the isolated jungle village of Kapit. They also administered surveys to workers in public and agricultural settings to understand local knowledge, attitudes and practices relating to the spread of respiratory pathogens.

Though the team did not find respiratory pathogens in live-animal markets (which may have been due to high humidity and air flow), sample analysis showed respiratory viruses, including enteroviruses and adenoviruses, in hospitals and on pig farms. These findings suggest that bioaerosol sampling is indeed an effective and non-invasive method of conducting surveillance for pathogens in public settings. Analysis of survey data also showed that over 40% of animal workers considered cross-species infection risk to be “likely” or “very likely” in their work environments, suggesting an amenability to future surveillance and risk prevention interventions.

The team submitted a manuscript detailing some of their findings to the peer-reviewed journal PLOS ONE. The article, entitled “Surveillance for Respiratory and Diarrheal Pathogens at the Human-Pig Interface in Sarawak, Malaysia,” is first-authored by team member Laura Borkenhagen, who conducted her Master of Science in Global Health thesis on respiratory and diarrheal pathogens in pigs and humans in Sarawak, and coauthored by the rest of the Bass Connections team, including both undergraduate students.


Spring 2017 – Spring 2018

Team Outcomes

Gregory Gray, Detection of Dengue, Chikungunya and Zika Viruses by a New Multiplexing Platform among Patients in Sarawak, Malaysia ($20,000 grant awarded from Kirkland Biosciences LLC, Tetracore Inc., Duke Global Health Institute, 2018)

Prospective Surveillance for Influenza A Virus in Chinese Swine Farms (2018 article in Emerging Microbes and Infections coauthored by Laura Borkenhagen and Gregory Gray, with others)

Building Capacity for Surveillance and Diagnosis of Respiratory Viruses in Sarawak, Malaysia (talk by Kerry Mallinson and Rick Tsao, Bass Connections Showcase, April 18, 2018)

Building Capacity for Surveillance and Diagnosis of Respiratory Viruses in Sarawak, Malaysia (poster by Hudson Berkhouse, Laura Borkenhagen, Jane Fieldhouse, Kerry Mallinson, Sarah Philo, Rick Tsao)

Surveillance for Respiratory Viruses among Patients Hospitalized with Pneumonia in Sarawak, Malysia (poster by Jane Fieldhouse)

Surveillance for Swine Respiratory and Diarrheal Pathogens at the Human-animal Interface in Sarwak, Malyasia (poster by Laura Borkenhagen)

Norovirus Infection and Animal Exposure in Sarawak, Malaysia (poster by Sarah Philo)

Project website


30 Days to Duke (2018): Bass Connections

Building Capacity for Surveillance and Diagnosis of Respiratory Viruses in Sarawak, Malaysia

Duke Students Become Virus Detectives through Global Health Fieldwork


Duke One Health Students Take the Lead on Publications

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)

This Team in the News

Embracing Global Health's Teachable Moment

These Seniors Took Their Bass Connections Research Further and Graduated with Distinction

Watch Highlights from the 2018 Bass Connections Showcase

Tracking Infectious Disease in Malaysia

Bass Connections Showcase Presents Research Highlights from Durham to Malaysia

Join Us for Two Bass Connections Special Events on April 18 and 19

Researcher Hopes Study Will Help Future Patient Care

From Markets to Hospitals to Farms, Students Hunt Respiratory Viruses in Malaysia

Duke Students Become Virus Detectives through Global Health Fieldwork

See related team Refining Surveillance for Zoonotic Respiratory Viruses in Sarawak, Malaysia (2018-2019)

Bass Connections team members in Malaysia.

Team Leaders

  • Gregory Gray, School of Medicine-Medicine: Infectious Diseases
  • Nathan Thielman, School of Medicine-Medicine: Infectious Diseases

/graduate Team Members

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

/undergraduate Team Members

  • Kerry Mallinson, Biology (BS)
  • Rick Tsao, Chemistry (AB)

/yfaculty/staff Team Members

  • Kristen Coleman, Duke-NUS Medical School, Singapore

/zcommunity Team Members

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