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  1. Hajissa K, Mussa A
    Hum Vaccin Immunother, 2021 Aug 03;17(8):2445-2447.
    PMID: 33830862 DOI: 10.1080/21645515.2021.1900713
    The unprecedented need to acquire a safe and effective vaccine for the long-term control of coronavirus disease 2019 (COVID-19) is a global imperative. Researchers have been working urgently and collaboratively to develop vaccines against the causative agent of COVID-19. The use of messenger RNA (mRNA) vaccine platform offers new opportunities for the development of effective vaccines. The first use of COVID-19 mRNA vaccines for individuals outside the clinical trials raised concerns over their safety and future efficacy. In social media, particularly in developing countries, widely shared false claims allege that the current mRNA-based COVID-19 vaccines potentially integrate into the host genome and thus may genetically modify humans. These vaccines are also assumed to lack efficacy due to the emergence of new strains. Such misinformation cause people to hesitate about receiving vaccination against COVID-19. This commentary aimed to outline the structure, mechanism of action and the major motive for the use of COVID-19 mRNA vaccine, with a focus on scientifically addressing challenges associated with conspiracy theories and dispelling misinformation around vaccination.
  2. Hajissa K, Zakaria R, Suppian R, Mohamed Z
    Parasit Vectors, 2015;8:315.
    PMID: 26062975 DOI: 10.1186/s13071-015-0932-0
    Serological investigation remains the primary approach to achieve satisfactory results in Toxoplasma gondii identification. However, the accuracy of the native antigen used in the current diagnostic kits has proven to be insufficient as well as difficult to standardize, so significant efforts have been made to find alternative reagents as capture antigens. Consequently, multi-epitope peptides are promising diagnostic markers, with the potential for improving the accuracy of diagnostic kits. In this study, we described a simple, inexpensive and improved strategy to acquire such diagnostic markers. The study was aimed at producing novel synthetic protein consisting of multiple immunodominant epitopes of several T. gondii antigens.
  3. Hajissa K, Zakaria R, Suppian R, Mohamed Z
    J Adv Vet Anim Res, 2019 Jun;6(2):174-182.
    PMID: 31453188 DOI: 10.5455/javar.2019.f329
    Despite the significant progress in the recent efforts toward developing an effective vaccine against toxoplasmosis, the search for new protective vaccination strategy still remains a challenge and elusive goal because it becomes the appropriate way to prevent the disease. Various experimental approaches in the past few years showed that developing a potential vaccine against the disease can be achievable. The combination of multi-epitopes expressing different stages of the parasite life cycle has become an optimal strategy for acquiring a potent, safe, and effective vaccine. Epitope-based vaccines have gained attention as alternative vaccine candidates due to their ability of inducing protective immune responses. This mini-review highlights the current status and the prospects of Toxoplasma gondii vaccine development along with the application of epitope-based vaccine in the future parasite immunization as a novel under development and evaluation strategy.
  4. Hajissa K, Zakaria R, Suppian R, Mohamed Z
    Iran J Parasitol, 2018 8 3;13(2):215-224.
    PMID: 30069205
    Background: Toxoplasma gondii is a widely prevalent intracellular protozoan parasite which causes serious clinical and veterinary problems. Development of an effective vaccine for controlling toxoplasmosis is an extremely important aim. In the present study, the protective efficacy of recombinant multiepitope antigen (USM.TOXO1) expressing nine potential epitopes identified from SAG1, GRA2, and GRA7 of Toxoplasma gondii was evaluated in BALB/c mice.

    Methods: Mice were immunized subcutaneously with three doses of USM.TOXO1 antigen (10 μg/ml). Following the immunization, the IgG antibody, IgG subclass, IFN-γ and IL-4 production were evaluated using ELISA, the study was conducted at Animal Research and Service Center (ARASC), USM Health Campus in 2016.

    Results: Mice immunized with USM.TOXO1 significantly induced a mixed Th1/Th2 response polarized toward the IgG1 antibody isotype. While the cytokine analysis revealed a significant release of IFN-γ cytokines.

    Conclusion: USM.TOXO1 is a potential vaccine candidate that elicits strong immunity in BALB/c mice. The proven immunogenicity of the generated antigen can serve as a premise for further use of epitope-based vaccine in the immunoprevention of human and animal toxoplasmosis.

  5. Mussa A, Talib M, Mohamed Z, Hajissa K
    BMC Res Notes, 2019 Jun 11;12(1):334.
    PMID: 31186056 DOI: 10.1186/s13104-019-4361-6
    OBJECTIVE: Rapid diagnostic tests (RDTs) play a crucial role in the management and control of malaria infection. The histidine-rich protein 2 (PfHRP-2) based RDTs are the most commonly used RDTs for malaria diagnosis in Sudan. Deletion of pfhrp2 in Plasmodium falciparum genome affect the accuracy of PfHRP-2 based RDT kits. This study aimed to identify molecular variation of pfhrp2 among suspected malaria patients from different clinics in Omdurman, Sudan.

    RESULTS: A noticeable variation between the RDT (Alltest Biotech, China) and nPCR results was observed, for RDT 78% (46/59) were P. falciparum positive, 6.8% (4/59) were co-infected with both P. falciparum and Plasmodium vivax, 15.3% (9/59) were negative by the RDT. However, when the nPCR was applied only 44.1% (26/59) and 55.9% (33/59) was P. falciparum positive and negative respectively. The pfhrp2 was further amplified form all nPCR positive samples. Only 17 DNA samples were positive from the 26 positive P. falciparum, interestingly, variation in band sizes was observed and further confirmed by DNA sequencing, and sequencing analysis revealed a high-level of genetic diversity of the pfhrp2 gene in the parasite population from the study area. However, despite extreme sequence variation, diversity of PfHRP2 does not appear to affect RDT performance.

  6. Hajissa K, Zakaria R, Suppian R, Mohamed Z
    BMC Infect Dis, 2017 12 29;17(1):807.
    PMID: 29284420 DOI: 10.1186/s12879-017-2920-9
    BACKGROUND: The inefficiency of the current tachyzoite antigen-based serological assays for the serodiagnosis of Toxoplasma gondii infection mandates the need for acquirement of reliable and standard diagnostic reagents. Recently, epitope-based antigens have emerged as an alternative diagnostic marker for the achievement of highly sensitive and specific capture antigens. In this study, the diagnostic utility of a recombinant multiepitope antigen (USM.TOXO1) for the serodiagnosis of human toxoplasmosis was evaluated.

    METHODS: An indirect enzyme-linked immunosorbent assay (ELISA) was developed to evaluate the usefulness of USM.TOXO1 antigen for the detection of IgG antibodies against Toxoplasma gondii in human sera. Whereas the reactivity of the developed antigen against IgM antibody was evaluated by western blot and Dot enzyme immunoassay (dot-EIA) analysis.

    RESULTS: The diagnostic performance of the new antigens in IgG ELISA was achieved at the maximum values of 85.43% and 81.25% for diagnostic sensitivity and specificity respectively. The USM.TOXO1 was also proven to be reactive with anti- T. gondii IgM antibody.

    CONCLUSIONS: This finding makes the USM.TOXO1 antigen an attractive candidate for improving the toxoplasmosis serodiagnosis and demonstrates that multiepitope antigens could be a potential and promising diagnostic marker for the development of high sensitive and accurate assays.

  7. Hajissa K, Marzan M, Idriss MI, Islam MA
    Antibiotics (Basel), 2021 Jul 31;10(8).
    PMID: 34438982 DOI: 10.3390/antibiotics10080932
    Drug-resistant tuberculosis (DR-TB) is still one of the most critical issues impeding worldwide TB control efforts. The aim of this systematic review and meta-analysis was to give an updated picture of the prevalence of DR-TB in Sudan. A comprehensive systematic search was performed on four electronic databases (PubMed, Scopus, Web of Science and Google Scholar) to identify all published studies reporting prevalence data of DR-TB in Sudan. Sixteen eligible studies published during 2002-2020 were included. Using meta-analysis of proportions, the pooled prevalence of TB cases with resistance to any anti-TB drugs was 47.0% (95% CI: 35.5-58.6%). The overall prevalence of mono, multi, poly and extensive drug resistance were estimated to be 16.2% (95% CI: 9.0-23.4%), 22.8% (95% CI: 16.0-29.7%), 6.8% (95% CI: 0.5-13.0%) and 0.7% (95% CI: 0-2.1%), respectively. Considering any first-line anti-TB drugs, the resistance prevalence was highest for isoniazid (32.3%) and streptomycin (31.7%), followed by rifampicin (29.2%). In contrast, resistance against second-line drugs was reported for only two antibiotics, namely, ofloxacin (2.1%) and kanamycin (0.7%). Of note, the resistance profile of the previously treated patients was found to be remarkably high compared with the newly diagnosed TB patients. The relatively high prevalence estimation of anti-TB drug resistance warrants strengthening TB control and treatment strategies in Sudan.
  8. Hajissa K, Islam MA, Sanyang AM, Mohamed Z
    PLoS Negl Trop Dis, 2022 Feb 11;16(2):e0009971.
    PMID: 35148325 DOI: 10.1371/journal.pntd.0009971
    INTRODUCTION: Parasitic infections, especially intestinal protozoan parasites (IPPs) remain a significant public health issue in Africa, where many conditions favour the transmission and children are the primary victims. This systematic review and meta-analysis was carried out with the objective of assessing the prevalence of IPPs among school children in Africa.

    METHODS: Relevant studies published between January 2000 and December 2020 were identified by systematic online search on PubMed, Web of Science, Embase and Scopus databases without language restriction. Pooled prevalence was estimated using a random-effects model. Heterogeneity of studies were assessed using Cochrane Q test and I2 test, while publication bias was evaluated using Egger's test.

    RESULTS: Of the 1,645 articles identified through our searches, 46 cross-sectional studies matched our inclusion criteria, reported data from 29,968 school children of Africa. The pooled prevalence of intestinal protozoan parasites amongst African school children was 25.8% (95% CI: 21.2%-30.3%) with E. histolytica/ dispar (13.3%; 95% CI: 10.9%-15.9%) and Giardia spp. (12%; 95% CI: 9.8%-14.3%) were the most predominant pathogenic parasites amongst the study participants. While E. coli was the most common non-pathogenic protozoa (17.1%; 95% CI: 10.9%-23.2%).

    CONCLUSIONS: This study revealed a relatively high prevalence of IPPs in school children, especially in northern and western Africa. Thus, poverty reduction, improvement of sanitation and hygiene and attention to preventive control measures will be the key to reducing protozoan parasite transmission.

  9. Thangarajah P, Hajissa K, Wong WK, Abdullah MA, Ismail N, Mohamed Z
    BMC Infect Dis, 2019 Feb 28;19(1):202.
    PMID: 30819141 DOI: 10.1186/s12879-019-3830-9
    BACKGROUND: Accurate diagnosis of Toxoplasma gondii (T. gondii) infection remains elusive and requires a comprehensive assessment through laboratory and clinical investigation. In this study, a diagnostic algorithm based on paired serum samples and clinical data was developed and evaluated.

    METHODS: A total of 1267 suspected cases of Toxoplasma infection were enrolled in this study from January 2016 to December 2016. The cases were screened for anti-Toxoplasma IgM and IgG by electrochemiluminiscence immunoassay (ECLIA) method. Based on the serological profiles, all cases with first seropositive serum samples were considered as suggestive cases of Toxoplasma infection. Thus, second serum samples were obtained after an interval of 2 weeks. The diagnosis was made based on laboratory results and clinical data.

    RESULTS: A total of 482 T. gondii seroreactive cases were selected. The patient's records were traced and the data were analysed. Accordingly, 152 cases were diagnosed as clinically confirmed cases; 198 cases were clinically asymptomatic and 132 cases were newborn babies or infants who did not have toxoplasmosis and only acquired passive immunity from their mothers. The paired serum algorithm allowed classifying the seroreactive cases as follows: early (0.6%), acute (1.9%), reactivation (13.5%), recent (1.5%), passive immunity from mother (27.3%) and possible congenital infections (1.2%). In addition, cases of reactivated toxoplasmosis were detected among the pregnant mothers (13/82; 15.8%), children aged above 1 year (2/8; 25.0%) and immunocompetent mothers (5/135; 3.7%). Furthermore, the application of the paired serum analysis resulted in remarkably improved treatment initiation.

    CONCLUSIONS: Toxoplasmosis diagnosis and treatment can be improved through the use of paired serum diagnostic algorithm.

  10. Boush MA, Djibrine MA, Mussa A, Talib M, Maki A, Mohammed A, et al.
    Sci Rep, 2020 07 30;10(1):12822.
    PMID: 32733079 DOI: 10.1038/s41598-020-69756-8
    In remote areas of malaria-endemic countries, rapid diagnostic tests (RDTs) have dramatically improved parasitological confirmation of suspected malaria cases, especially when skilled microscopists are not available. This study was designed to determine the frequency of Plasmodium falciparum isolates with histidine-rich protein 2 (pfhrp2) gene deletion as one of the possible factors contributing to the failure of PfHRP2-based RDTs in detecting malaria. A total of 300 blood samples were collected from several health centres in Nyala City, Western Sudan. The performance of PfHRP2-based RDTs in relation to microscopy was examined and the PCR-confirmed samples were investigated for the presence of pfhrp2 gene. A total of 113 out of 300 patients were P. falciparum positive by microscopy. Among them, 93.81% (106 out of 113) were positives by the PfHRP2 RDTs. Seven isolates were identified as false negative on the basis of the RDTs results. Only one isolate (0.9%; 1/113) potentially has pfhrp2 gene deletion. The sensitivity and specificity of PfHRP2-based RDTs were 93.81% and 100%, respectively. The results provide insights into the pfhrp2 gene deletion amongst P. falciparum population from Sudan. However, further studies with a large and systematic collection from different geographical settings across the country are needed.
  11. Siti Hafsyah MH, Ibrahim NR, Noraida R, Ismail AA, Anani Aila MZ, Hajissa K, et al.
    Med J Malaysia, 2021 Sep;76(5):731-733.
    PMID: 34508383
    Neonatal invasive Group A Streptococcus (GAS) infection is a rare occurrence nowadays. Prior maternal vaginal colonization is an important factor in early neonatal disease. We report a case of invasive and fatal infection in a neonate. At Day 1 of life, a term baby was found to be lethargic, with poor feeding, and later became unresponsive. Consequently, the baby was immediately brought to the Emergency Department of Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan via ambulance. Despite the active resuscitation efforts in the hospital, the baby died. An autopsy was carried out to determine the cause of death. The mother was noted to have puerperal pyrexia secondary to vaginal discharge. Her high vaginal swab culture was positive for GAS. GAS was also isolated from the intracardiac blood, pleural fluid, peritoneal fluid, and umbilical swab of the baby, giving evidence to the aetiology of the mortality. Vaginal colonization of GAS is an important factor for high morbidity and mortality for both mother and infant due to its invasiveness and virulence.
  12. Salleh MZ, Nik Zuraina NMN, Hajissa K, Ilias MI, Banga Singh KK, Deris ZZ
    Antibiotics (Basel), 2022 Nov 18;11(11).
    PMID: 36421297 DOI: 10.3390/antibiotics11111653
    Shigellosis remains one of the leading causes of morbidity and mortality worldwide and is the second leading cause of diarrheal mortality among all age groups. However, the global emergence of antimicrobial-resistant Shigella strains, limiting the choice of effective drugs for shigellosis, has become the major challenge in the treatment of Shigella infections. The aim of this systematic review and meta-analysis was to provide an updated picture of the prevalence of antimicrobial-resistant Shigella species in Asia. A comprehensive and systematic search was performed on three electronic databases (PubMed, ScienceDirect and Scopus), in which 63 eligible studies published between 2010 and 2022 were identified. From our meta-analysis of proportions using a random-effects model, the overall prevalence of Shigella spp. in Asian patients was estimated to be 8.0% (95% CI: 5.5-10.5). The pooled prevalence rates of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing Shigella strains were 68.7% (95% CI: 59.9-77.5) and 23.9% (95% CI: 12.9-34.8), respectively. Concerning recommended antimicrobial drugs for Shigella, the prevalence of resistance was highest for ciprofloxacin (29.8%) and azithromycin (29.2%), followed by ceftriaxone (23.8%), in spite of their importance as first- and second-line treatments for shigellosis. In contrast, resistance to carbapenems, such as ertapenem (0.0%), imipenem (0.1%) and meropenem (0.0%), was almost non-existent among the 49 tested antibiotics. The significantly high prevalence estimation suggests that the multidrug-resistant Shigella is a pressing threat to public health worthy of careful and justified interventions. Effective antibiotic treatment strategies, which may lead to better outcomes for the control and treatment of shigellosis in Asia, are essential.
  13. Hajissa K, Muhajir AEMA, Eshag HA, Alfadel A, Nahied E, Dahab R, et al.
    BMC Res Notes, 2018 Oct 31;11(1):779.
    PMID: 30382901 DOI: 10.1186/s13104-018-3871-y
    OBJECTIVE: Schistosomiasis remains one of the most common parasitic diseases worldwide. This is a cross-sectional study aimed to determine the prevalence of schistosomiasis and its associated risk factors among primary school children in Um-Asher area. The study was conducted among 170 primary school students in Um-Asher area from November 2017 to February 2018. Urine and stool samples were collected and examined for schistosomiasis infections. Moreover, data on sociodemographic characteristics and associated risk factors were obtained using a questionnaire.

    RESULTS: The overall prevalence of Schistosoma haematobium was 12.9%, whereas that of Schistosoma mansoni was 2.95%. Additionally, the males had higher prevalence (60%) of S. mansoni than females (40%). However, both gender were equally infected with S. haematobium (50%). With regard to risk factors, distance of residence from water source and source of drinking water are relatively associated with the infection.

  14. Beshir KB, Grignard L, Hajissa K, Mohammed A, Nurhussein AM, Ishengoma DS, et al.
    Am J Trop Med Hyg, 2020 08;103(2):558-560.
    PMID: 32553046 DOI: 10.4269/ajtmh.20-0467
    Rapid diagnostic tests (RDTs) play a critical role in malaria diagnosis and control. The emergence of Plasmodium falciparum parasites that can evade detection by RDTs threatens control and elimination efforts. These parasites lack or have altered genes encoding histidine-rich proteins (HRPs) 2 and 3, the antigens recognized by HRP2-based RDTs. Surveillance of such parasites is dependent on identifying false-negative RDT results among suspected malaria cases, a task made more challenging during the current pandemic because of the overlap of symptoms between malaria and COVID-19, particularly in areas of low malaria transmission. Here, we share our perspective on the emergence of P. falciparum parasites lacking HRP2 and HRP3, and the surveillance needed to identify them amid the COVID-19 pandemic.
  15. Mussa A, Afolabi HA, Syed NH, Talib M, Murtadha AH, Hajissa K, et al.
    Biomedicines, 2023 Mar 30;11(4).
    PMID: 37189677 DOI: 10.3390/biomedicines11041060
    Breast cancer (BC) is the most common cancer type among women with a distinct clinical presentation, but the survival rate remains moderate despite advances in multimodal therapy. Consequently, a deeper understanding of the molecular etiology is required for the development of more effective treatments for BC. The relationship between inflammation and tumorigenesis is well established, and the activation of the pro-inflammatory transcription factor nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) is frequently identified in BC. Constitutive NF-κB activation is linked to cell survival, metastasis, proliferation, and hormonal, chemo-, and radiotherapy resistance. Moreover, the crosstalk between NF-κB and other transcription factors is well documented. It is reported that vitamin C plays a key role in preventing and treating a number of pathological conditions, including cancer, when administered at remarkably high doses. Indeed, vitamin C can regulate the activation of NF-κB by inhibiting specific NF-κB-dependent genes and multiple stimuli. In this review, we examine the various NF-κB impacts on BC development. We also provide some insight into how the NF-κB network may be targeted as a potential vulnerability by using natural pro-oxidant therapies such as vitamin C.
  16. Al Mutair A, Layqah L, Alhassan B, Alkhalifah S, Almossabeh M, AlSaleh T, et al.
    Sci Rep, 2022 Dec 12;12(1):21487.
    PMID: 36509906 DOI: 10.1038/s41598-022-26042-z
    The economic impact of the COVID-19 pandemic on global health systems is a major concern. To plan and allocate resources to treat COVID-19 patients and provide insights into the financial sustainability of healthcare systems in fighting the future pandemic, measuring the costs to treat COVID-19 patients is deemed necessary. As such, we conducted a retrospective, real-world observational study to measure the direct medical cost of treating COVID-19 patients at a tertiary care hospital in Saudi Arabia. The analysis was conducted using primary data and a mixed methodology of micro and macro-costing. Between July 2020 and July 2021, 287 patients with confirmed COVID-19 were admitted and their data were analyzed. COVID-19 infection was confirmed by RT-PCR or serologic tests in all the included patients. There were 60 cases of mild to moderate disease, 148 cases of severe disease, and 79 critically ill patients. The cost per case for mild to moderate disease, severe disease, and critically ill was 2003 USD, 14,545 USD, and 20,188 USD, respectively. There was a statistically significant difference in the cost between patients with comorbidities and patients without comorbidities (P-value 0.008). Across patients with and without comorbidities, there was a significant difference in the cost of the bed, laboratory work, treatment medications, and non-pharmaceutical equipment. The cost of treating COVID-19 patients is considered a burden for many countries. More studies from different private and governmental hospitals are needed to compare different study findings for better preparation for the current COVID-19 as well as future pandemics.
  17. Eshag HA, Elnzer E, Nahied E, Talib M, Mussa A, Muhajir AEMA, et al.
    Trop Med Health, 2020;48:3.
    PMID: 32015668 DOI: 10.1186/s41182-020-0192-3
    Background: Despite the importance of epidemiological studies in the development of effective control strategies and provision of basic health services for refugees and internally displaced persons (IDPs), data on the prevalence of malaria are limited. Thus, this study was conducted to estimate the molecular prevalence of malaria amongst the displaced population in Ardamata IDP camp in Al-Geneina City, Sudan.

    Methods: A cross-sectional study was conducted from July 2018 to December 2018 to estimate malaria prevalence amongst the displaced population in Ardamata IDP camp in Al-Geneina City, Sudan. A total of 380 patients with suspected malaria were recruited. Nested polymerase chain reaction (nPCR) assays were performed to detect the Plasmodium genus and species.

    Results: Of 380 patients, 232 (61.1%) were positive for malaria. Plasmodium falciparum was the only prevalent species detected amongst the study population. nPCR analysis revealed that none of the samples had Plasmodium vivax, Plasmodium ovale or Plasmodium malariae. The malaria prevalence rate was higher amongst males (67.1%) than in females (56.8%), and gender was the only risk factor that was significantly associated with malaria infection (p = .042).

    Conclusions: Despite control programmes, malaria remains a significant cause of illness amongst a displaced population. The high prevalence of malaria infection in this study indicates that additional health facilities and control strategies should be implemented in displaced camps and the surrounding areas.

  18. Rabaan AA, Mutair AA, Hajissa K, Alfaraj AH, Al-Jishi JM, Alhajri M, et al.
    Vaccines (Basel), 2022 Oct 02;10(10).
    PMID: 36298520 DOI: 10.3390/vaccines10101655
    Since the first case of Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019, SARS-CoV-2 infection has affected many individuals worldwide. Eventually, some highly infectious mutants-caused by frequent genetic recombination-have been reported for SARS-CoV-2 that can potentially escape from the immune responses and induce long-term immunity, linked with a high mortality rate. In addition, several reports stated that vaccines designed for the SARS-CoV-2 wild-type variant have mixed responses against the variants of concern (VOCs) and variants of interest (VOIs) in the human population. These results advocate the designing and development of a panvaccine with the potential to neutralize all the possible emerging variants of SARS-CoV-2. In this context, recent discoveries suggest the design of SARS-CoV-2 panvaccines using nanotechnology, siRNA, antibodies or CRISPR-Cas platforms. Thereof, the present comprehensive review summarizes the current vaccine design approaches against SARS-CoV-2 infection, the role of genetic mutations in the emergence of new viral variants, the efficacy of existing vaccines in limiting the infection of emerging SARS-CoV-2 variants, and efforts or challenges in designing SARS panvaccines.
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