Rapid detection of Carbapenemase-Producing Enterobacterales (CPE) is essential for informing infection prevention and control actions to curb the spread of antimicrobial resistance. Immunochromatographic Tests (ICTs) offer a quick and cost-effective alternative to molecular methods but are typically designed for bacterial isolates rather than direct clinical specimens. We developed a protocol using the O.K.N.V.I. RESIST-5 ICT (Coris Bioconcept, Gembloux, Belgium) to detect KPC, NDM, OXA-48, VIM, and IMP carbapenemases from broth-enriched mock rectal swabs. A total of 35 well-characterized carbapenemase-producing isolates were inoculated into a 10 % stool matrix to create mock swabs. Swabs were incubated in Brain-Heart Infusion (BHI) broth, with and without a 10 μg meropenem disk, at 37 °C for 4 and 6 h. After incubation, broths were centrifuged, and pellets were tested using the ICT. Sensitivity, specificity, and accuracy were calculated for each method (with/without meropenem disk and incubation period). Optimal performance was achieved with swabs incubated in BHI broth without meropenem for 6 h, showing 100 % sensitivity, specificity, and accuracy for all the five enzymes tested. Incubation with meropenem or shorter incubation times resulted in lower sensitivities, with per-enzyme sensitivities ranging from 0 % to 100 %. The developed protocol enables rapid and accurate detection of five common carbapenemases directly from broth-enriched rectal swabs within 6 h. This method offers a practical alternative to culture-based and molecular techniques, potentially enhancing infection control measures through timely identification of CPE.

OBJECTIVE: Increased antibiotic use (AU) has been reported globally during the COVID-19 pandemic despite low rates of bacterial co-infection. We assessed changes in AU during the COVID-19 pandemic in Indonesia and the Philippines. METHODS: We evaluated hospital-wide AU over 36 months in six hospitals, 3 in Indonesia and 3 in the Philippines. Intravenous antibiotics commonly used for respiratory conditions were selected and grouped for analysis. AU rates were calculated as monthly defined daily dose per 1000 patient-days or patient discharges. Median AU rates were compared from the pre-pandemic (March 2018-February 2020) and pandemic periods (March 2020-February 2021) using quantile regression to assess for statistical significance. Changes in AU during the COVID-19 pandemic were analyzed using interrupted time series analysis. RESULTS: Significant increases were noted in the median AU rate from the pre-pandemic to pandemic period of all antibiotics combined in 3/6 hospitals (percentage change, Δ, 12.5%-63.6%) and anti-pseudomonal antibiotics in 3/6 hospitals (Δ 51.5%-161.5%). In the interrupted time series analysis, an immediate increase (range: 125.40-1762) in the use of all included antibiotics combined was observed in 3/6 hospitals at the onset of the COVID-19 pandemic. One of these 3 hospitals experienced a statistically significant sustained increase, while another experienced a decrease over time. CONCLUSIONS: We observed significant increases in facility-wide inpatient AU during the COVID-19 pandemic in our participating hospitals in Indonesia and the Philippines. These findings reinforce the importance of antibiotic stewardship practices to optimize AU, especially during infectious disease pandemics.

<sec><title>BACKGROUND</title>In February 2022, the U.S. Centers for Disease Control and Prevention (CDC) recommended a 4-month rifapentine-moxifloxacin based regimen (4-HPMZ) for treating drug-susceptible pulmonary TB. We describe 4-HPMZ implementation, treatment outcomes, and regimen tolerability at New York City (NYC) Health Department TB clinics.</sec><sec><title>METHODS</title>A multidisciplinary workgroup developed a 4-HPMZ implementation plan and protocol based on CDC patient eligibility guidance. Treatment outcomes were classified as 'completed' when 4-HPMZ was completed within 5 months or 'discontinued' when 4-HPMZ was stopped due to clinical or programmatic reasons. Adverse events (AEs) included abnormal lab results, or any medication-related concern reported by patients.</sec><sec><title>RESULTS</title>Between April 2022 to December 2023, 617 patients with TB visited NYC Health Department TB clinics; for 4-HPMZ, 333 (54%) were ineligible and 284 (46%) were eligible. Of the eligible patients, 40 (14%) were prescribed 4-HPMZ; of these, 36 initiated 4-HPMZ treatment, 13 (36%) completed treatment, and 23 (64%) discontinued. A total of 15 patients (42%) discontinued due to AEs.</sec><sec><title>CONCLUSION</title>Significant programmatic and clinical challenges were associated with initiation and completion of 4-HPMZ treatment. As a result, few patients completed treatment. Further assessment is needed to identify populations most likely to initiate and complete 4-HPMZ.</sec>.

BACKGROUND: Candida (Candidozyma) auris, a multidrug resistant organism, can cause severe, invasive infections. We characterized C. auris epidemiology in New York before and during the COVID-19 pandemic. METHODS: Multiple statewide databases were linked to assess demographic and clinical characteristics and outcomes among C. auris screening cases (patients tested for colonization screening) and clinical cases (patients tested to diagnose disease). Cases diagnosed during 2017-2022 were divided into four phases and compared, including pre-COVID-19, first wave, ongoing mitigation, and vaccine era. Joinpoint analysis was used to assess monthly percentage change (MPC) and significant temporal trends among clinical cases. RESULTS: During the first wave, higher proportions of C. auris cases were among Black and Hispanic patients (clinical and screening), patients from high social vulnerability index neighborhoods (clinical), and patients aged <60 years (screening), compared with pre-COVID-19. Increased proportions of Hispanic patients and those aged <60 years among screening cases persisted through ongoing mitigation and vaccine era. MPC of clinical cases was stable throughout the analysis period at 1.97%, and no significant joinpoints were observed. CONCLUSIONS: The influx of COVID-19 hospitalizations might have driven shifts in characteristics of clinical and screening C. auris cases. Clinical C. auris incidence increased during 2017-2022, but the incidence slope did not increase during or after the onset of COVID-19.

The recognized burden of antimicrobial resistance (AR) is greatest in low- and middle-income countries (LMICs), but limitations in surveillance preclude accurate estimates of AR. We aimed to evaluate colonization in communities and hospitals across six LMICs for two clinically-important pathogens: extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE). Participants in hospitals and communities provided rectal swabs or stool samples for ESCrE and CRE identification. Isolates recovered from selective agars underwent confirmatory identification and antibiotic susceptibility testing (AST) using Vitek(®) 2, MALDI-TOF, and/or disc diffusion testing. ESCrE and CRE were defined based on established breakpoints of phenotypic resistance to third-generation cephalosporins and carbapenems, respectively, to calculate prevalence of colonization. Community prevalence estimates were weighted to account for sampling design differences. A total of 10,139 participants across the 6 countries provided samples; 63% were females with a median age of 35 years (range: 0-99). Colonization with ESCrE in hospitals was high in all sites (range 34-84%). In communities, ESCrE colonization ranged from 22 to 77%. Prevalence of CRE colonization in hospitals ranged from 7 to 36% and in communities ranged from < 1 to 14%. These findings reveal a high burden of AR colonization in LMICs in both communities and hospitals. Cost-effective strategies to reduce AR colonization burden are needed in LMICs.

This study assessed resource allocation among registry activities, which may provide insight for efficient collection of high-quality cancer incidence data. We used a multimodal approach and purposively sampled 21 participating population-based cancer registries in the United States to ensure variation across several registries. The registries reported prospective staffing data and retrospective costing data, completing data collection from October 2021 to September 2022, reporting retrospective costing data for July 1, 2020, through June 30, 2021. From lessons learned from prior studies, we engaged participating registries early and throughout the study, ensuring the collection of meaningful, accurate quantitative data, as well as insights not captured quantitatively. Case volume is a major driver of registry costs. (On average, high-volume registries outspend low-volume registries by nearly 3x, annually). Upon examination of registry activities by case volume, we found that the two most resource-intensive registry activities are data acquisition and data processing, which may be addressed by innovations, such as electronic reporting and automation. Innovative data transfer and processing approaches could increase timeliness of data collection and reduce the labor resources required to process manually collected data. Registries adopting these innovations might achieve cost savings, which could make resources available to support other registry activities.

Introduction: There are no national estimates for blood pressure–lowering prescription trends among the U.S. pediatric population. This study describes trends in blood pressure–lowering prescription fills among individuals aged 3–17 years by sex and age group. Methods: Data were obtained from IQVIA's Total Patient Tracker database covering 94% of all outpatient retail prescription fills in the U.S. The key outcome was blood pressure–lowering prescription fills during 2017–2023, utilizing a list of 113 generic medications from 21 drug classes. In addition, a subset of 20 medications recommended in the 2017 American Academy of Pediatrics guideline was examined. Annual population percentage and percentage change compared with 2017 were reported, and average annual percentage change was estimated using Joinpoint regression. Results: From 2017 to 2023, blood pressure–lowering prescription fills among those aged 3–17 years increased slightly from 1.93% (95% CI=1.88%, 1.98%) to 2.09% (95% CI=2.04%, 2.14%). Among males, blood pressure–lowering prescription fills remained stable (between 2.32% and 2.38%; average annual percentage change= −0.3%; p=0.545), whereas fills among females increased by 23.9% (from 1.49% to 1.84%; average annual percentage change=4.16%; p<0.001). The sharpest increase occurred among females aged 13–17 years (from 2.26% to 3.17%; average annual percentage change=6.3%; p<0.001). Prescription fills for guideline-recommended medications either remained stable or declined, with some variation by sex and age group. Conclusions: Results indicate growth in blood pressure–lowering prescription fills, especially among females aged 13–17 years. Increases were driven by medications not included in the 2017 American Academy of Pediatrics guideline, suggesting that blood pressure–lowering medications may be increasingly prescribed for conditions other than pediatric hypertension. © 2025

Acute gastroenteritis (AGE) has one of the highest rates of morbidity and mortality among children under five years old worldwide. It is estimated that 1.7 billion cases of childhood diarrheal diseases occur annually, leading to up to 443,832 deaths. Approximately 90% of these cases are viral, with human norovirus being the main cause in countries that have implemented rotavirus vaccines. The objective of this study was to describe the prevalence and genetic diversity of norovirus in child outpatients and inpatients under five years old at the Regional Hospital of Antofagasta. From 1 January to 31 October 2019, a total of 121 stool samples were collected to detect the presence of norovirus GI and GII using Taqman™-based real-time RT-PCR. Norovirus RNA was detected in 50 (41.3%) samples, of which 96% were typed as GII.4 Sydney (42% GII.4 Sydney[P16] and 54% GII.4 Sydney[P4 New Orleans]). Furthermore, most (92%) of the positive specimens were from children under two years of age and a majority were detected in April (38%) and May (20%). Our findings highlight the high burden of norovirus in hospitalized children with AGE and the importance of molecular strain surveillance to support vaccine development.

Mycoplasma pneumoniae is a common bacterial cause of respiratory infection and a leading cause of childhood community-acquired pneumonia (CAP). Increases in M. pneumoniae infection occur every 3-5 years. In the United States, M. pneumoniae prevalence decreased during and immediately after the COVID-19 pandemic. Information from 42 U.S. children's hospitals that provided information to the Pediatric Health Information System, a database of clinical and resource use information, was used to identify discharge diagnostic codes for 2018-2024 indicating M. pneumoniae infection. M. pneumoniae-associated CAP incidence among children aged ≤18 years was significantly higher in 2024 (12.5 per 1,000 hospitalizations) than during 2018-2023 (2.1). During the study period, an M. pneumoniae diagnostic code was listed in 11.5% of pediatric CAP hospitalizations, peaking at 53.8% in July 2024. Among pediatric M. pneumoniae CAP cases, the highest percentage occurred among children aged 6-12 years (42.6%), followed by children aged 2-5 years (25.7%) and 13-18 years (21.1%). The lowest occurred among those aged 12-23 months (6.4%) and 0-11 months (4.2%). M. pneumoniae infections in 2024 were not more severe than 2018-2023 infections, as assessed by length of hospitalization and percentage of patients admitted to an intensive care unit. The increase in M. pneumoniae infections in the United States in 2024 might be higher than previous periodic increases because the susceptible population was larger after sustained low incidence during and immediately after the COVID-19 pandemic. Health care providers should be aware of the periodicity of M. pneumoniae CAP and consider testing for this pathogen as a cause of respiratory illness among children of all ages.

Antiviral susceptibility of influenza viruses is monitored by the World Health Organization Global Influenza Surveillance and Response System. This study describes a global analysis of the susceptibility of influenza viruses to neuraminidase (NA) inhibitors (NAIs, oseltamivir, zanamivir, peramivir, laninamivir) and the cap-dependent endonuclease inhibitor (CENI, baloxavir) for three periods (May to May for 2020-2021, 2021-2022 and 2022-2023). In particular, global influenza activity declined significantly in 2020-2021 and 2021-2022 when compared to the pre-pandemic period of COVID-19. Combined phenotypic and NA sequence-based analysis revealed that the global frequency of seasonal influenza viruses with reduced or highly reduced inhibition (RI/HRI) by NAIs remained low, 0.09% (2/2224), 0.12% (27/23465) and 0.23% (124/53917) for 2020-2021, 2021-2022 and 2022-2023, respectively. As in previous years, NA-H275Y in A(H1N1)pdm09 viruses was the most frequent substitution causing HRI by oseltamivir and peramivir. Sequence-based analysis of polymerase acidic (PA) protein supplemented with phenotypic testing revealed low global frequencies of seasonal influenza viruses with reduced susceptibility (RS) to baloxavir, 0.07% (1/1376), 0.05% (9/18380) and 0.12% (48/39945) for 2020-2021, 2021-2022 and 2022-2023, respectively; commonly associated substitutions were PA-I38T/M/L. In Japan, the rate was 3.3% (16/488) during 2022-2023, with 11 A(H3N2) viruses having PA-I38T/M substitutions. For zoonotic viruses, 2.7% (3/111) contained substitutions, one each NA-H275Y, NA-S247N and NA-N295S, associated with RI/HRI NAI phenotypes, and none contained PA substitutions associated with RS to baloxavir. In conclusion, the great majority of seasonal and zoonotic influenza viruses remained susceptible to NAIs and CENI baloxavir.

INTRODUCTION: By the end of 2021, U.S. spike (S) antibody seroprevalence from COVID-19 vaccination, infection, or both (hybrid immunity) reached over 90%. With high seroprevalence, quantitative antibody concentrations are needed to characterize population immunity. We measured quantitative S antibody concentrations in a national blood donor cohort and evaluated their correlation with protection against infection. METHODS: One blood specimen per quarter in 2022 was tested for quantitative S IgG and infection-induced (nucleocapsid [N]) total Ig antibodies from a national blood donor sub-cohort of 106,969 people. Median S antibody concentrations were calculated by quarter and by history of vaccination and infection. Among vaccinated donors without N antibodies, protection (measured as 1 minus hazard ratios compared with unvaccinated donors) against N antibody seroconversion was estimated by S antibody concentration. Median S antibody levels were compared using the Kruskal-Wallis tests. RESULTS: Median S antibody concentrations increase from 1380 binding antibody units (BAU)/mL in quarter (Q) 1 2022 to 1720 BAU/mL in Q4 2022. In Q4, S antibody levels were lowest in the infection-only group (median: 75 BAU/mL) and higher in the vaccine-only (median: 1950 BAU/mL) and hybrid immunity group (median: 2550 BAU/mL). Protection against first-time infection increased with higher antibody concentrations; 5010 BAU/mL (95% CI 4120-6550) was associated with 50% protection. DISCUSSION: During 2022, this nationwide study showed mildly increased S IgG concentrations over time among blood donors. Vaccination and hybrid immunity resulted in higher antibody concentrations than infection alone. Higher antibody concentrations were associated with increased protection from infection.

Trachoma is targeted for global elimination as a public health problem by 2030. Measurement of IgG antibodies in children is being considered for surveillance and programmatic decision-making. There are currently no programmatic guidelines based on serology, which represents a generalizable problem in seroepidemiology and disease elimination. Here, we collate Chlamydia trachomatis Pgp3 and CT694 IgG measurements from 48 serosurveys across Africa, Latin America, and the Pacific Islands (41,168 children ages 1-5 years) and propose a novel approach to estimate the probability that population C. trachomatis transmission is below or above levels requiring ongoing programmatic action. We determine that trachoma programs could halt control measures with >90% certainty when seroconversion rates (SCRs) are ≤2.2 per 100 person-years. Conversely, SCRs ≥4.5 per 100 person-years correspond with >90% certainty that further control interventions are needed. More extreme SCR thresholds correspond with higher levels of confidence of elimination (lower SCR) or ongoing action needed (higher SCR). This study demonstrates a robust approach for using trachoma serosurveys to guide elimination program decisions.

INTRODUCTION: Sexual violence (SV) affects millions globally and has a well-documented bidirectional association with HIV. Post-exposure prophylaxis (PEP) is a critical, yet often underutilized, HIV prevention tool in post-SV care. Despite its potential impact to reduce HIV transmission, SV care remains an overlooked service delivery point for HIV prevention. The U.S. Centers for Disease Control and Prevention (CDC), as part of the President's Emergency Plan for AIDS Relief (PEPFAR), supports PEP provision within broader post-violence care (PVC) services. Understanding PEP utilization is crucial for optimizing service delivery and HIV prevention efforts. METHODS: Using Monitoring Evaluation and Reporting data from fiscal years 2018-2023, we conducted a descriptive analysis of clients who received PVC and SV services through CDC-supported programming in 14 sub-Saharan African countries. RESULTS: From 2018 to 2023, the annual number of clients receiving any PVC, and specifically SV, services increased by 233% (in 2018, n = 206,764; in 2023, n = 689,349) and 163% (in 2018, n = 42,848; in 2023, n = 112,838), respectively. Fewer than half of SV clients completed PEP (38% in 2018, n = 16,103; 31% in 2023, n = 35,118). Across all years combined, most SV clients (female: 185,414; male: 59,618) were aged 15-19 years. The age band and sex with the lowest proportion of clients completing PEP were males aged 15-19 (4%, n = 2296). CONCLUSIONS: The findings underscore a critical gap between the scaling of SV services and the completion of PEP within violence response programmes. Innovative implementation science approaches may help to identify and address barriers inhibiting effective PEP delivery and uptake within PVC service delivery programmes. Enhancing PEP uptake and completion can support mitigating the bidirectional relationship between violence and HIV acquisition, particularly among vulnerable populations like adolescents and young adults. Low PEP coverage also reflects missed opportunities, particularly among adolescent girls and young women, who experience disproportionate rates of HIV acquisition.

Mozambique's National Blood Transfusion Services (NBTS) is tasked with providing safe and available blood but also conducting systematic screening of at-risk potential donors, notifying seropositive blood donors, and linking them to HIV care and treatment services. Potential blood donors who were deferred from donating following a behavioral risk screening and all blood donors who screened seropositive for HIV were notified and offered linkage to HIV testing, care, and treatment services by community-based organizations. A prospective study among HIV-positive blood donors and deferred donors was conducted from May 2019 to July 2020 at Maputo Central Hospital Blood Bank and the National Reference Blood Center. The associations between testing, initiating care and treatment services among HIV-positive blood donors and prospective deferred donors were estimated using fully Bayesian multivariable logistic models and odds ratios. Among 885 prospective blood donors enrolled, 173 (20%) were deferred due to self-reported high-risk behaviors identified through a screening questionnaire, and 712 (80%) passed the behavioral-risk screening tool, donated, and the blood donation tested positive for HIV. There were more than 2.5 times as many male donors as female donors with a positive HIV test, and among the deferred donors, more than 84% were males. 36% (256/712) of seropositive donors and 35% (61/173) of deferred donors were referred to HIV testing services. 62% (158/256) of seropositive donors and 4.9% (3/61) of deferred donors who were successfully referred were linked to care and treatment services, and 96% (152/158) of these seropositive donors and 100% (3/3) of deferred as high-risk donors initiated antiretroviral therapy (ART). Of the three service organizations used, one outperformed the other two in linking seropositive donors to ART treatment. The NBTS can serve as a critical entry point for identifying HIV-positive persons. Improved implementation of risk behavior screening tools is needed and could contribute to early identification and initiation of ART for potential donors. Innovative strategies and solutions by community-based organizations can be used to improve blood donor notification and linkage to HIV testing and treatment services.

INTRODUCTION: In Eswatini, HIV incidence among adolescent girls and young women (AGYW), aged 15-24 years, is 10 times that of their male peers. Despite the World Health Organization's 2014 recommendation for post-exposure prophylaxis (PEP) to be available for all HIV exposures, it has been underutilized among youth. PEP is an effective prevention method, and a better understanding of the characteristics, risk factors and behaviours that are associated with PEP awareness, as a precursor to effective use, is needed. METHODS: Using data from the 2022 Eswatini Violence Against Children and Youth Survey, we used logistic regression models to explore the relationships between PEP awareness and a set of hypothesized explanatory variables among AGYW aged 13-24 years who had ever had sex (N = 2648). Explanatory variables included socio-demographic characteristics, sexual risk factors and sexual health behaviours. RESULTS: A slight majority (57.3%) of AGYW who had ever had sex were aware of PEP as an HIV prevention method. PEP awareness increased with age (aOR 1.1, 95% CI 1.0, 1.1) and was higher among AGYW who had a sexual partner whose age was 5 or more years older in the past 12 months (aOR 1.4, 95% CI 1.1, 1.9), those who had ever taken part in an HIV prevention programme (aOR 1.6, 95% CI 1.2, 2.3) and those who had ever heard of pre-exposure prophylaxis (aOR 8.1, 95% CI 6.4, 10.2). Participants who were ever married or partnered (aOR 0.7, 95% CI 0.5, 1.0) and those who engaged in inconsistent condom use with non-spouse/main partner or multiple partners in the past 12 months (aOR 0.8, 95% CI 0.6, 1.00) had lower odds of knowing about PEP in the adjusted model. CONCLUSIONS: We identified sub-optimal PEP awareness among Swazi AGYW who had ever had sex. Our findings suggest that engagement in HIV prevention programmes increased PEP awareness and that knowing about pre-exposure prophylaxis (PrEP) was associated with PEP awareness. Future efforts could include tailored PEP awareness activities and campaigns to resonate with AGYW at elevated risk of HIV and integration of PEP education into routine sexual and reproductive service delivery and school-based HIV curriculum.

The first COVID-19 case in a healthcare worker in Kenya was reported on March 30, 2020, in Nairobi, leading to a 41-day closure of the health facility where he had worked. We assessed infection prevention and control (IPC) activities and implemented recommendations to re-open and operate the facility. We conducted a risk assessment of the facility in April 2020 using a modified World Health Organization, six-element IPC facility risk assessment tool. IPC recommendations were made, and a follow-up assessment of their implementation was conducted in July 2020. Breaches in IPC measures included poor ventilation in most service delivery areas; lack of physical distancing between patients; inadequate COVID-19 information, education, and communication materials; lack of standard operating procedures on cleaning and disinfecting high-touch areas; insufficient IPC training; inadequate hand hygiene facilities; insufficient personal protective equipment supplies; and an inactive IPC committee. Strengthening IPC measures is critical to prevent healthcare facility closures.

BACKGROUND: In Africa, for people with HIV on a dolutegravir-based regimen with a viral load of more than 1000 copies per mL despite enhanced adherence counselling, the appropriate course of action is uncertain. We aimed to evaluate the predicted effects of alternative antiretroviral regimen switching options in this population, including consideration of cost-effectiveness. METHODS: We used an existing individual-based model to simulate risk and experience of HIV in 100 000 adults alive between 1989 and 2076. Using sampling of parameter values, we created 1000 setting-scenarios, reflecting the uncertainty in assumptions and a range of settings similar to those seen in eastern, central, southern, and western Africa. For each setting-scenario, we predicted the outcomes from the three alternative policies for people with sustained viral load non-suppression on a dolutegravir-containing regimen from 2026: a switch to a protease inhibitor-based regimen (switch policy), a switch to a protease inhibitor-based regimen only if HIV drug resistance testing beforehand shows integrase inhibitor resistance (resistance test policy), and no switch with no HIV drug resistance test (no switch policy). We considered predicted outcomes over 10-year and 50-year periods from 2026, used a 3% discount rate, and a cost-effectiveness threshold of US$500 per disability-adjusted life-year (DALY) averted. Ritonavir-boosted darunavir costs $210 per year, and dolutegravir less than $20. We assumed a cost of HIV drug resistance testing of $200 and considered variations around this. For comparing policies, we calculated net DALYs, which account for the health consequences of differences in costs and provide a measure of the impact of a policy on overall population burden of disease. FINDINGS: Across setting-scenarios, there was a mean of 14 480 deaths per year (95% CI 13 750-15 210) over 50 years with a mean annual discounted cost of $103·2 million (95·8-106·5) with the switch policy in the context of having scaled to a setting with an adult population of 10 million in 2024. Compared with the switch policy, the no switch policy was predicted to lead to an overall increased number of DALYs incurred (mean 4400 per year, 95% CI 3200-5500), although it resulted in the lowest overall cost, with a difference in annual discounted costs of $5·1 million (95% CI 4·6-5·6) lower than the switch policy. The resistance test policy led to a similar risk of death and DALYs to the switch policy at a lower overall cost (difference in annual discounted costs $3·5 million per year, 95% CI 3·1-3·9), leading to 6900 (95% CI 5500-8200) fewer net DALYs per year. Net DALYs for the resistance test versus no switch policies were similar (-1000 net DALYs, 95% CI 400 to -2300). The incremental cost-effectiveness ratio when comparing the resistance test policy with the no switch policy was $376 per DALY averted; the switch policy was dominated. INTERPRETATION: Introduction of HIV drug resistance testing for people with sustained viral load non-suppression on dolutegravir-based antiretroviral therapy is likely to be cost-effective. We suggest that exploratory planning for increased access and scale-up of high-quality, low-cost drug resistance testing for the region is undertaken. FUNDING: Gates Foundation as part of the HIV Modelling Consortium.

Nipah virus (NiV) causes severe diseases in humans with a high case fatality rate. The primary risk factors for NiV infection in Bangladesh are drinking raw date palm sap (DPS) contaminated with Pteropus fruit bat secretions/excretions or close contact with or exposure to the body fluid of an individual with NiV infection. During the 2023 NiV outbreak investigation in Bangladesh, the breast milk of a NiV-infected nursing mother was tested by real-time reverse transcriptase polymerase chain reaction (RT-PCR) for detection of NiV-RNA. The newborn was also tested as a suspected NiV-infected subject. NiV, specifically NiV RNA, was detected in the breast milk sample. Through the investigation, it was determined that the mother consumed raw DPS 9 days before the delivery. The newborn was also confirmed as NiV positive and had exposure to maternal bodily fluid while breastfeeding, and was in prolonged maternal contact during caregiving. Although the detection of NiV RNA in breast milk does not equate to viability and transmissibility of the virus, this finding provides preliminary evidence that warrants further investigation into the potential role of breast milk in postnatal transmission of NiV. Our findings advocate incorporating breast milk testing into NiV diagnostic protocols for symptomatic mothers. This advancement will broaden our understanding of postnatal transmission of NiV and pave the way for more effective containment strategies.

Estimates of exposure to coronavirus disease 2019 (COVID-19) on the African continent are limited, constrained by availability of testing and case report data. To improve understanding of COVID-19 burden, monthly severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurveillance was implemented at first antenatal care visits (ANC1) across six sub-Saharan African countries (Kenya, Malawi, Mozambique, Nigeria, Uganda, and Zambia). A standardized questionnaire, including COVID-19 vaccination history, was administered, and a blood sample was collected. Serology was conducted with two assays: in Nigeria, a multiplex bead-based assay targetting spike protein, receptor binding domain (RBD) 591, and nucleocapsid (N) protein and in all other countries, a SARS-CoV-2 human IgG antibody test including RBD, N protein, and hybrid RBD-N. The largest monthly change in seropositivity was between December 2021 and January 2022 for five countries (Kenya: 33.2-70.3%, Malawi: 28.3-59.6%, Mozambique: 29.3-72.8%, Nigeria: 52.4-77.4%, Uganda: 55.7-80.6%), coinciding with the Omicron wave. Aside from Mozambique, there was an increase in the proportion of women reporting COVID-19 vaccination beginning in January 2022, with highest vaccination rates between April and August 2022. Relatedly, there was an increase in the proportion vaccinated among those with detectable SARS-CoV-2 antibodies. Adenoviral vector accounted for at least half of the vaccines reported in all countries. If pregnant women are not differentially infected, ANC1 can be leveraged for serosurveillance during a pandemic. Monthly seroprevalence estimates alongside vaccination rates can provide evidence for changes in protective immunity in response to case waves and the introduction of protective measures.

INTRODUCTION: We examined the association of pre-exposure prophylaxis (PrEP) programme retention with the use of daily, event-driven (ED) or regimen switching reported during follow-up at any point prior to discontinuation among men who have sex with men (MSM) in Hanoi, Vietnam. METHODS: Between April 2020 and February 2023, we collected data from PrEP clients at Hanoi Medical University Sexual Health Promotion clinic who were prescribed either ED or daily PrEP at the initial visit; at subsequent visits, clients reported the regimen used since the prior visit. We defined three categories of PrEP use: ED-PrEP exclusively, daily PrEP exclusively and switching regimens. The primary outcome was time to discontinuation in the PrEP programme during the study period, defined as missing a scheduled visit by > 30 days. We performed survival analysis using Kaplan-Meier curves. RESULTS: In total, 2107 people were included: 61.1% (n = 1288) reported exclusive use of daily PrEP, 10.4% (n = 220) reported exclusive use of ED-PrEP and 28.4% (n = 599) reported switching PrEP regimens. Among switchers, 29.40% (n = 176) switched more than once. Furthermore, 82.5% switched from daily to ED-PrEP and 17.5% switched from ED to daily PrEP. The median time to discontinuation in the PrEP programme was 105 days (IQR: 52-182) among those reporting exclusive use of ED-PrEP, 104 days (IQR: 56-274) among those reporting exclusive use of daily PrEP and 163 days (IQR: 101-308) among those who switched. Among switchers, those who switched more than once had a median time to discontinuation in the PrEP programme of 231 days (IQR: 137-380) in comparison to 133 days (IQR: 90-274) for those who switched once. CONCLUSIONS: We provide real-world data from MSM in an HIV PrEP programme in Vietnam that those who switched had longer periods of retention during the study period. Our findings suggest that offering flexible PrEP regimen options may improve engagement and long-term adherence among this population.

INTRODUCTION: In Mozambique, post-exposure prophylaxis (PEP) to prevent HIV is offered as part of the essential package of post-violence care services at 1450 health facilities. However, HIV PEP access and adherence continue to be a challenge. Healthcare providers were interviewed to identify and synthesize their recommendations for improving PEP access and adherence. METHODS: We conducted semi-structured, in-depth interviews with 20 adolescent and adult healthcare providers (3 men and 17 women) who had a range of 2-15 years of experience from 20 health facilities across seven provinces during March-August 2023. Data were analysed using inductive and theoretical thematic analysis. We analysed how frequently health providers mentioned specific recommendations. RESULTS: Regarding PEP access, healthcare providers recommended community education as the most effective strategy (10 mentions). In particular, providers cited the importance of palestras [community health talks]. Providers also commonly highlighted the need to have PEP kits prepared (7 mentions) and PEP readily available at health facilities (6 mentions). Regarding PEP adherence, providers recommended client counselling/education (13 mentions) to ensure clients understand the importance of taking PEP, how to properly take PEP and the potential side effects, which can often deter clients from adhering. Additionally, providers highlighted chamadas preventivas [follow-up telephone calls] within 2 weeks or so after the initial visit (9 mentions) as the best means to ensure clients complete the full, 28-day regimen and return for retesting after 3 months. Healthcare providers explained that follow-up telephone calls, despite the client living far from the health facility, can create a bond that supports clients. Providers recommended the institutionalization of follow-up telephone calls for consistent implementation in all healthcare facilities that offer PEP. CONCLUSIONS: Interviewed healthcare providers offered valuable insights and recommendations to improve PEP access and adherence, which could be considered for implementation in Mozambique and other sub-Saharan African countries.

BACKGROUND: Patients reporting sexual contact with a person(s) with chlamydia (CT) and/or gonorrhea (NG) are at increased risk of acquiring these sexually transmitted infections (STIs). Presumptive antimicrobial therapy is recommended for sexual contacts, but concerns have been raised about unnecessary antibiotic use. METHODS: We reviewed visits of patients who reported sexual contact to a partner with CT or NG ("contacts") from 1/2021-10/2023 in 10 STI clinics. We calculated CT and NG positivity, stratified by 3 patient groups (women, men who have sex with men [MSM], and men who have sex with women only [MSW]) and symptomatic status. RESULTS: Overall, 11,072 (6.8%) CT and/or NG contacts were identified (7,660 [4.7%] CT contacts and 4,988 [3.1%] NG contacts). CT positivity among CT contacts was 35%; NG positivity among NG contacts was 31%. CT positivity did not differ by symptomatic status across patient groups. NG positivity was higher for symptomatic vs. asymptomatic MSM (34%, 95% confidence interval [CI] 31-37% vs 28% [CI 26-30%]) and MSW (37%, CI 33-41% vs 23%, CI 20-27%), but not in women (38%, CI 33-43% vs 37%, CI 32-42%). CONCLUSIONS: Substantial CT/NG positivity among sexual contacts to CT or NG was observed. Among CT contacts, CT infection was most often detected in MSW; among NG contacts, NG infection was most often detected in women. However, ~60% did not have either CT or NG. The use of point-of-care tests in this population may optimize antimicrobial use while prioritizing individual clinical care.

BACKGROUND: Understanding the population dynamics and geographical range of Aedes aegypti is critically important for arbovirus vector surveillance and control. Little is known about the current distribution and seasonality of Ae. aegypti in Grand Lomé, Togo. We developed an investigation to determine whether Ae. aegypti was present across Lomé communes during a 1-year collection period. METHODS: Mosquito ovitraps (n = 70) were deployed across the 13 communes in the Grand Lomé health region and were examined between May 2022 and April 2023. Generalized linear mixed models (GLMMs) were applied to investigate the relationship between larval collections and seasonality. The European Space Agency (ESA) WorldCover 10 m 2020 product was used to represent different land cover classes and to determine whether sites with higher larval numbers differed from sites with lower numbers. RESULTS: A total of 52,768 Ae. aegypti larvae were collected across the 13 communes of Grand Lomé. The highest incidence of Ae. aegypti larvae was observed in the commune of Bè-Ouest (= 122.74 per 1000 population). Agoè-Nyivé was the commune with the lowest incidence over the entire study period. There was a statistically significant difference in Ae. aegypti larval counts between the rainy and dry seasons. Eight land-use classes were represented by the ESA 10 m product in Grand Lomé, with the built-up category being the most common. We found a significant relationship between larval abundance categories and land cover classes. CONCLUSIONS: This study shows that Ae. aegypti larvae can be found across all communes of the Grand Lomé region in both the rainy and dry seasons, especially in ovitraps surrounded by built-up land cover category. The results of this study could be useful in guiding disease vector surveillance and control efforts due to the potential imminent risk of upcoming dengue outbreaks.

Recommendations to use deer-excluding fencing as a method to reduce blacklegged ticks (Ixodes scapularis Say) in residential settings are based primarily upon studies excluding deer from large areas (≥3.5 hectares), often in undeveloped woodland settings. Evidence is still needed on the efficacy of deer-excluding fences for tick management at smaller suburban residential properties common to tick-endemic areas of the northeastern United States. We measured I. scapularis abundance at 16 fenced and 16 unfenced properties in Fairfield County, Connecticut, Westchester County, New York, and Washington County, Rhode Island. Overall, adult and nymphal I. scapularis encounter rates (ticks per sampling meter) were slightly higher on unfenced properties compared to within fenced properties, but differences were not significant (P > 0.05). Among fenced properties alone, tick encounter rates were significantly higher in areas immediately outside of fences compared with inside of fences for nymphs (P = 0.005), but not for adults (P > 0.05). Prevalence of tick pathogen infection with Borrelia burgdorferi sensu stricto, Borrelia miyamotoi, Babesia microti, Babesia odocoilei, or Anaplasma phagocytophilum did not differ significantly between fenced and unfenced properties (P > 0.05). Irrespective of fencing, adult tick abundance was higher at properties with stonewalls, dense herbaceous ecotone vegetation, and an absence of bird feeders. Nymphal tick encounter rates were associated with stonewalls, an absence of bird feeders, and presence of dense herbaceous understory vegetation. Household survey data revealed that deer were observed within some fenced areas. Our findings do not provide strong evidence that deer-excluding fences at properties smaller than 3.5 hectares surpress blacklegged ticks.

BACKGROUND: Folate plays a critical role during pregnancy, preventing neural tube defects and possibly adverse neurodevelopment. Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals that may decrease folate levels. Although some studies have found associations between PFAS and folate, we are unaware of studies conducted in pregnant women. To address this knowledge gap, we evaluated associations between PFAS and whole blood folate (WBF) in pregnant women. METHODS: We used data from 288 pregnant women in the Health Outcomes and Measures of the Environment (HOME) Study, a pregnancy and birth cohort in the Cincinnati Ohio area. We measured eight serum PFAS and WBF concentrations at 16 weeks' gestation. We used linear regression to estimate the effect of each PFAS on WBF, and quantile-based g-computation and Bayesian kernel machine regression (BKMR) to investigate the joint effect of PFAS on WBF, adjusting for parity, prenatal vitamin intake, maternal race/ethnicity, household income, maternal age, and second trimester smoking status in all models. In addition, we investigated interactions between PFAS using BKMR. RESULTS: We did not observe inverse associations of individual PFAS or their mixture with WBF, nor interactions between PFAS in the BKMR model in pregnant women. CONCLUSION: Future studies could consider WBF measures in late pregnancy to evaluate other periods of susceptibility. Furthermore, as people are exposed to multiple PFAS, future studies should continue to consider joint PFAS exposure.

A nationwide cross-sectional study led by the Agency for Toxic Substances and Disease Registry in collaboration with research and community partners, was designed to investigate health outcomes linked to per- and polyfluoroalkyl substances (PFAS) exposure among residents of communities with contaminated drinking water. The objective was to describe the study design, methods, participant demographics, and PFAS serum concentrations. From 2019 to 2023, adult (18+) and child (ages 4-17) participants were recruited from communities with past or ongoing PFAS contamination of drinking water across eight sites in California, Colorado, Massachusetts, Michigan, New Hampshire, New York, New Jersey, and Pennsylvania. Data on demographics, lifestyle factors, and residential, occupational, and medical history were collected via questionnaires. Extensive clinical tests assessed cardiometabolic, liver, thyroid, kidney, glycemic, and immune parameters. Neurobehavioral tests were administered to children (ages 5-17). PFAS quantified in serum included MeFOSAA, PFHxS, PFOS, PFOA, PFNA, PFDA, and PFUnDA. Serum, whole blood, and urine samples were banked for future analyses. The study enrolled 5826 adults (geometric mean age: 53.6 years; 60.2 % female; 77.2 % non-Hispanic White) and 710 children (geometric mean age: 10.7 years; 48.5 % female; 69 % non-Hispanic White). Compared with NHANES data (2017-2020), adults showed elevated geometric mean concentrations of PFHxS and PFOA; only PFHxS was elevated in children. These serum concentrations reflect a wide range of PFAS exposures in communities affected by contamination from firefighting activities and industrial emissions, and other sources. This large study is a valuable resource for exploring associations between PFAS exposure and health effects in adults and children.

We examined alignment between sex of sex partners and sexual orientation (SO) in syphilis case notifications among men during 2022 to inform interpretation of SO data for notifiable conditions in the National Notifiable Diseases Surveillance System. Observed partial alignment underscores the importance of analyzing appropriate variable(s) for a given intervention.

The purpose of this study was to determine the feasibility of facility-level wastewater surveillance in the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in skilled nursing facility (SNF) wastewater using three concentration methods, as well as a proof-of-concept for antimicrobial resistance (AR) genes/organisms detection. Wastewater effluent samples were collected from an SNF over an 8-week period. Wastewater was concentrated using electronegative membrane filtration (enMF), polyethylene glycol precipitation, and Nanotrap(®) magnetic virus particles (NP). Quantification of the genome copy concentration from SARS-CoV-2 and bovine respiratory syncytial virus (BRSV), a SARS-CoV-2 surrogate spiked into all samples, was performed with droplet digital polymerase chain reaction (ddPCR). Wastewater sample aliquots were also enriched in microbiological culture media and screened for organisms with AR phenotypes on selective and differential agars. Multiplex real-time PCR was used to detect a broad array of carbapenem resistance genes. SARS-CoV-2 was detected and quantified from a single enMF-concentrated wastewater sample. The highest concentration of BRSV came from enMF-concentrated samples. Klebsiella, Enterobacter, Citrobacter, and Escherichia coli exhibiting AR phenotypes were successfully detected using culture-dependent approaches. Culture-independent, multiplex PCR indicated that bla(KPC) was the main carbapenemase gene detected in wastewater samples. Facility-level wastewater surveillance could be a useful strategy for SNFs.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of genomic surveillance and whole genome sequencing (WGS) for identifying mutations and supporting epidemiologic investigations. Healthcare workers (HCWs) face unique risks for COVID-19, potentially amplifying outbreaks within healthcare facilities (HCFs). This report details the use of WGS to retrospectively investigate a COVID-19 cluster among HCWs in a tertiary care HCF in the Philippines. METHODS: Epidemiologic investigation was conducted by the HCF infection prevention and control (IPC) staff. The Global Action in Healthcare Network (GAIHN) COVID-19 variant characterization project retrospectively conducted WGS on selected HCW and inpatient respiratory specimens associated with the cluster with reverse-transcription polymerase chain reaction cycle threshold ≤32. Phylogenetic analyses were conducted using Nextstrain. Subclusters were defined by shared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage and epidemiologic data. RESULTS: Investigation by IPC staff identified 19 HCWs with COVID-19 diagnosed during 2-9 September 2022 from a single nursing unit. Specimens for WGS were collected from 8 of these HCWs and from 43 additional HCF staff and inpatients with COVID-19 diagnosed from 1 August through 30 September 2022. Phylogenetic analyses identified 12 unique SARS-CoV-2 lineages and 2 subclusters: subcluster A (BA.5.2 lineage, n = 6) and subcluster B (BA.5.10.1 lineage, n = 7). Pairwise substitution-by-site analyses, combined with epidemiological data, provided support for multiple potential transmission events. CONCLUSIONS: WGS identified SARS-CoV-2 subclusters associated with high-risk exposure settings among HCWs in a tertiary care facility, providing essential insights into transmission pathways and demonstrating its potential to guide targeted IPC interventions and improve outbreak response strategies.

Shiga-toxin-producing E. coli (STEC) is a leading causing of bacterial foodborne and zoonotic illnesses in the USA. Whole-genome sequencing (WGS) is a powerful tool used in public health and microbiology for the detection, surveillance, and outbreak investigation of STEC. In this study, we applied three WGS-based subtyping methods, high quality single-nucleotide polymorphism (hqSNP) analysis, whole genome multi-locus sequence typing using chromosome-associated loci [wgMLST (chrom)], and core genome multi-locus sequence typing (cgMLST), to isolate sequences from 11 STEC outbreaks. For each outbreak, we evaluated the concordance between subtyping methods using pairwise genomic differences (number of SNPs or alleles), linear regression models, and tanglegrams. Pairwise genomic differences were highly concordant between methods for all but one outbreak, which was associated with international travel. The slopes of the regressions for hqSNP vs. allele differences were 0.432 (cgMLST) and 0.966 wgMLST (chrom); the slope was 1.914 for cgMLST vs. wgMLST (chrom) differences. Tanglegrams comprised of outbreak and sporadic sequences showed moderate clustering concordance between methods, where Baker's Gamma Indices (BGIs) ranged between 0.35 and 0.99 and Cophenetic Correlation Coefficients (CCCs) were ≥0.88 across all outbreaks. The K-means analysis using the Silhouette method showed the clear separation of outbreak groups with average silhouette widths ≥0.87 across all methods. This study validates the use of cgMLST for the national surveillance of STEC illness clusters using the PulseNet 2.0 system and demonstrates that hqSNP or wgMLST can be used for further resolution.

BACKGROUND: Pre-travel health interventions can reduce the acquisition of communicable diseases and decrease the risk of transmission during or after international travel. We sought to inform policy and research priorities with a scoping literature review of studies that assess the cost-effectiveness of pre-travel interventions. METHODS: We assessed 44 economic evaluation studies published from 1946-2023, regarding pre-travel prevention of hepatitis A, hepatitis B, influenza, malaria, rabies, travellers' diarrhoea, cholera, polio, typhoid fever, measles, and Japanese encephalitis. RESULTS: Published studies demonstrate that hepatitis A vaccination, malaria chemoprophylaxis and typhoid vaccination for people travelling to highly endemic settings are likely to be cost-effective, as is measles-mumps-rubella vaccination. The cost-effectiveness of other pre-travel interventions is more sensitive to travel frequency and duration, endemicity at the travel destination, travel purpose (e.g. business, leisure, visiting friends and relatives), risk perceptions (e.g. adherence to care plan, choosing to vaccinate), and costs. CONCLUSIONS: Cost-effectiveness analyses of pre-travel interventions can inform the value of such interventions, but such analyses depend on the availability of high-quality data regarding clinical outcomes and costs. We propose that international, collaborative networks should collect data and leverage novel technologies to expand the evidence base regarding the risks of exposure, clinical outcomes, risk perception, and costs associated with pre-travel interventions. This evidence base can inform recommendations for specific groups of travellers and the formulation of population-specific health policies.

BACKGROUND: Understanding parental reasons for not having their child receive an influenza vaccination and how reasons have changed over time can help immunization programs and providers tailor interventions to increase uptake of influenza vaccine among children. The objectives of this study were to estimate the percentage of children 6 months-17 years with a parent who reported selected reasons for non-receipt of influenza vaccination (or "non-vaccination") during 2015-2024, assess whether there has been an increase or decrease in the reporting of each reason for non-vaccination, particularly pre versus post COVID-19 pandemic, and if reasons for non-vaccination differ by sociodemographic characteristics. METHODS: National Immunization Survey-Flu (NIS-Flu) parentally reported data for the 2015-16, 2016-17, 2019-20, 2022-23, and 2023-24 seasons were analyzed. Percentages of children not vaccinated against influenza whose parent reported each reason for non-vaccination, overall, by state, and by sociodemographic characteristics were calculated. Tests of association between sociodemographic characteristics and across seasons were conducted for each reason for non-vaccination using t-tests. RESULTS: The most commonly reported reasons for non-receipt of influenza vaccination across all seasons studied were: belief their child is unlikely to get very sick from influenza, concern about side effects/safety, and belief influenza vaccines do not work very well (48.2 %, 43.3 %, and 37.0 %, respectively, in 2023-24). Parental reporting of thinking their child is unlikely to get very sick from influenza increased more than other reasons for non-vaccination since the COVID-19 pandemic. Across all seasons studied, very few reported access-related reasons. Reasons for non-vaccination varied by state and by demographic characteristics. CONCLUSIONS: This study suggests that concern about influenza has decreased since the COVID-19 pandemic. A strong provider recommendation for influenza vaccination, including information about the safety of the vaccine and seriousness of influenza, could help increase influenza vaccination coverage among children.

Hand hygiene (HH) in school settings can reduce the spread of infectious diseases and student absenteeism due to illness. During the COVID-19 pandemic, the World Health Organization recommended HH as a public health measure to prevent disease transmission. Understanding school staff's experiences with school-based programs is important for future program development and improvement. As part of a mixed-methods study, we conducted in-depth interviews in March 2022 with school administrators and teachers at 12 primary schools in Belize, selected based on high gaps in HH resources, to understand HH responsibilities, supplies, and challenges. An intervention was implemented to increase HH knowledge and practices among students, which included environmental nudges, supplemental provision of soap, and HH lesson implementation. Follow-up interviews were conducted in June 2023 among school administrators to garner feedback on the intervention. School staff described roles in teaching and managing HH supplies at both timepoints. The environmental nudges and HH lessons were perceived as helpful, but there were gaps remaining in HH practices, which may be partially influenced by practices and beliefs outside of school. Procurement of HH supplies remained a challenge at some schools due to financial constraints. The feedback from school staff will be valuable for the implementation of future hand hygiene programs in schools.

Current seasonal influenza vaccines offer strain-specific protection and, thus, are less effective against mismatched strains. A broadly protective influenza vaccine is desirable to provide comprehensive protection against a wide range of influenza viruses for seasonal and pandemic influenza preparedness. Here, we evaluated the vaccine candidates based on bovine adenoviral (BAd) vectors expressing nucleoprotein (NP) of influenza A (BAd-C5-NP/A) and B (BAd-C5-NP/B) viruses linked to the autophagy-inducing peptide C5 (AIP-C5 or C5) to develop a predominantly T-cell-based vaccine. Robust cellular immune responses and humoral responses were elicited in mice with a single intranasal inoculation. Mice immunized with the BAd Bivalent (BAd-C5-NP/A + BAd-C5-NP/B) vaccine formulation exhibited protective immunity, providing protection against a broad panel of homosubtypic and heterosubtypic influenza A and B viruses, as evidenced by the absence of morbidity and mortality, along with significant reductions in lung viral titers. Protective immunity against seasonal influenza viruses was observed in ferrets following the BAd Bivalent vaccine immunization. These findings support further investigation of the potential of a unique Ad vaccine platform for mucosal immunization expressing NP linked to AIP-C5 as a broadly protective influenza vaccine. © 2025 The Author(s)

BACKGROUND: Killed whole-cell oral cholera vaccines (kOCVs) are a standard prevention and control measure in cholera-endemic areas and during outbreaks and humanitarian emergencies. New evidence has emerged and the ways in which the vaccines are used have changed. We aimed to provide an updated synthesis of evidence on protection conferred by kOCV. METHODS: In this systematic review and meta-analysis, we used the same search procedure as a previous systematic review to identify randomised clinical trials (RCTs) and observational studies that reported estimates of protection conferred by kOCVs against medically attended, confirmed cholera. Eligible studies in English, French, Spanish, or Chinese published up until March 8, 2024, including those identified in the previous review, were included. Data on efficacy and effectiveness were extracted, as were the number of doses, duration of follow-up, and age group. Efficacy and effectiveness estimates were summarised separately using random-effect models to estimate protection by time since vaccination; meta-regression models were used to estimate protection, by dose, as a function of time since vaccination. This updated study is registered along with the original review with PROSPERO (CRD42016048232). FINDINGS: We identified 8205 records published online up until March 8, 2024, including 6224 articles from the previous review and 1981 articles from our new search (after Jan 1, 2016). Of these, 53 were eligible for full-text review. Five RCTs and ten observational studies from 23 publications were included. Average two-dose efficacy 12 months after vaccination was 55% (95% CI 46-62), declining to 44% (25-59) 48 months after vaccination. Average two-dose effectiveness was 69% (58-78) 12 months after vaccination, declining to 47% (9-70) 48 months after vaccination. Only one RCT assessed one-dose efficacy and found sustained protection for 24 months (57% [42-69]) among those 5 years and older with no significant protection in younger children. Average one-dose effectiveness 12 months after vaccination was 60% (51-68) and after 24 months was 47% (34-58). Using age group-specific meta-analysis, we found that average two-dose efficacy in children younger than 5 years was half that of older individuals. INTERPRETATION: Two doses of kOCV provide protection against medically attended cholera for at least 4 years after vaccination. One dose of kOCV provides protection for at least 2 years after vaccination, but wanes faster than that of two doses. Children younger than 5 years are less protected by kOCVs than those aged 5 years and older, regardless of the number of doses received. FUNDING: Bill & Melinda Gates Foundation.

INTRODUCTION: Data on sexual violence (SV) prevalence in Nigeria is limited; however, 2014 data indicate that 24.8% of females aged 18-24 years experienced SV in childhood and only 3.5% received any form of services. Initiation of post-exposure prophylaxis (PEP) to prevent HIV acquisition following SV is most effective when started immediately and is not recommended after 72 hours. Police stations are often entry points for survivors; however, lengthy processes may result in delays and missed PEP opportunities. Using an ongoing phased approach, we introduced PEP into selected police stations in Nigeria's Federal Capital Territory in order to explore expanding access to time-sensitive HIV prevention within non-health services. METHODS: Our intervention phase consisted of the provision of training of police officers and the provision of PEP starter packs coupled with linkage to referral facilities. During two time periods (pre-intervention: January-March 2023) and (during intervention: July-September 2023), we evaluated routinely reported programme data from 27 U.S. Centers for Disease Control and Prevention-supported health facilities for changes in the provision of SV services and PEP initiation. We used geospatial mapping to assess the proximity of participating health facilities to police stations and to see changes in both SV and PEP service provision. The statistical significance of the difference in PEP uptake proportion during the two periods was determined using the Wilcoxon signed rank test at a 0.05 level of significance. RESULTS: Of the total 27 health facilities, 24 were within a 5-km radius of a participating police station. Total SV service provision increased from 114 cases to 218 cases, representing a 91.2% increase and with most of this increase seen among females. PEP initiation increased by 289.3% at the two time points, with 56 initiations pre-intervention to 218 PEP initiations during the intervention. CONCLUSIONS: Our findings showed promise in increasing immediate access to PEP in non-health services and highlighted the feasibility of police stations and health facilities collaboration to address urgent health needs. There was an overall increase in PEP initiations by referral and non-referral facilities which could be the result of demand creation and increased access at police stations.

In November 2024, a case of clade Ib mpox was confirmed in Canada. Here, we describe the events that led to laboratory confirmation of clade Ib monkeypox virus (MPXV) and the public health response. Genomic analysis of the Canadian clade Ib MPXV revealed a number of APOBEC3-related mutations suggesting sustained human-to-human transmission. These findings expand the number of countries with travel-related clade Ib mpox and highlights the continued need for mpox monitoring of potential human adaptations or new transmission patterns.

Research on biomedical HIV prevention has shown that no single product can meet the needs and preferences of all individuals [...].

BACKGROUND: Dengue virus (DENV) is hyperendemic in Indonesia and of high public health concern globally. Without an effective antiviral therapy, an accurate diagnosis of the four viruses, DENV1-4, is crucial for patient management and outcome. We aim to assess the diagnostic accuracy and usefulness of a commercial DENV antigen rapid diagnostic test kit in point-of-care conditions. DESIGN AND METHODS: Six-hundred-forty-six patients with fever or history of fever, and without leukocytosis, were enrolled from Tabanan General Hospital, Bali in 2017-2018. All sera were tested for DENV NS1 antigen using the Standard Diagnostics Bioline NS1 Ag rapid test kit and Flavivirus genus specific RT-PCR. Positive specimens were further confirmed using DENV multiplex RT-PCR. RESULTS: DENV was detected in 10.4% (67/646) of enrolled patients by molecular assays. Only 41 of the positives were found to be positive by the NS1 rapid test. Our findings indicate that the kit was the most sensitive in the first 2 days after disease onset with sensitivity > 75%, and declining at day 3 with a sensitivity of <60%. In addition, the kit was found to be the most sensitive to DENV-2 and least sensitive to DENV-4. Overall, the kit had a sensitivity of 59.7% [95% CI: 44.5-74.9] and specificity of 99.8% [95% CI: 99.5-100.0]. CONCLUSIONS: Our evaluation indicated that the rapid diagnostic test is useful for both surveillance and initial detection of DENV infection in community settings. However, it should be supplemented with additional diagnostic methods to ensure accurate confirmation for patient management.

BackgroundSchool food environments may play an important role in shaping children's dietary habits, health, and nutrition.ObjectivesThis study aimed to evaluate associations between the school food environment and nutrition among in-school adolescents in Ghana.MethodsData were collected in Ghana in 2022 in a national nutrition and health survey of adolescents attending junior (JHS) and senior high schools (SHS). Foods observed on campus or reported in the dietary recall were aggregated, a composite Adolescent Dietary Diversity Score (ADDS) was derived, and the proportion achieving minimum dietary diversity was estimated. Multi-level regression models were used to assess associations between a ranked school food environment score (FES) and nutrition outcomes.ResultsThe number of food groups served or available for purchase was 6.2 in JHS and 8.1 in SHS (P-value <.0001). The mean (95% CI) FES was 10.9 (10.1, 11.7) at JHS and 14.3 (13.6, 14.9) at SHS. ADDS ranged from 4.1 to 4.8 across strata. Higher FES was positively associated with ADDS and minimum dietary diversity among SHS students and negatively associated with anemia in girls and boys. Girls from high FES schools had 24% lower odds of anemia (OR: 0.76, 95% CI: 0.63, 0.93) while boys had 46% lower odds (OR: 0.54, 95% CI: 0.34, 0.84) compared to students in low FES schools.ConclusionsHigher FES was associated with greater dietary diversity among SHS students and lower odds of anemia in girls and boys, suggesting that the school food environment may play a role in determining nutrition outcomes. | The School Food Environment in Ghana is Related to Dietary Diversity and AnemiaPlain Language SummaryThe foods that children eat while at school have an important impact on their health and nutrition. We collected data among in-school girls and boys aged 10–19 years in Ghana. Students were asked what they had eaten in the last 24 h and were asked questions about their general food practices at school, such as what foods are included in school meals, what foods they typically bring to school, and what foods they buy at school. We also collected blood from students to test for anemia. School leaders were interviewed to better understand school programs and activities related to food and nutrition, including questions about the school meals program and food vendors present on campus. We used the information we gathered from these interviews to create a school food environment score. We found that, on average, students consumed fewer than 5 out of 10 food groups on a given day. We also found that senior high schools tended to have a larger variety of foods available and had a higher food environment score compared to junior high schools. In schools with higher food environment scores, students were more likely to eat a larger variety of foods and less likely to have anemia. These findings may be used to improve existing nutrition programs in Ghana and to design future programs focused on the health of school children. | eng

In this study the temperature dependent decay rate of gas-phase peracetic acid (PAA) concentrations in polyvinyl fluoride (PVF) sample bags was measured. Headspace from a PAA solution was used to dynamically generate atmospheres of gas-phase PAA which were transferred to PVF bags. The concentration of gas-phase PAA in PVF bags, in a temperature-controlled environment, was measured versus time using both selected ion flow-tube mass spectrometry (SIFT-MS) and impinger based colorimetric measurements. A review of PAA decomposition reactions, kinetics, and results of SIFT-MS measure of PAA and acetic acid are discussed. Gas-phase PAA concentrations in the PVF bags exhibited exponential decay consistent with first-order kinetics. The temperature dependent decay rate of gas-phase PAA concentration in PVF sample bags had half-lives that ranged from 19 h (at 30 °C) to 45 h (at 10 °C). From the Arrhenius equation, an activation energy of 34.2 ± 1.1 kJ mol(-1) (8.2 ± 0.3 kcal mol(-1)) was calculated from the temperature dependence of the decay constant. In this work, the half-lives of gas-phase PAA concentrations measured in PVF were considerably longer than other studies of PAA in containers.

BACKGROUND: Outbreaks of Ebola and the COVID-19 pandemic demonstrate that healthcare workers (HCWs) are critical for resilient health systems. Interventions that improve infection prevention and control (IPC) practices are required to protect HCWs. We aimed to implement a regional IPC learning network to improve compliance with IPC standards. METHODS: This project was implemented in a network of 20 tertiary care hospitals in Ethiopia, Kenya, Tanzania, and Uganda. Baseline and routine assessments of hospital IPC and IPC focal point competencies were conducted from January 2021 through June 2023 to identify gaps and measure progress. Virtual and in-person trainings were held routinely, and a collaborative quality improvement (QI) project on personal protective equipment (PPE) use was conducted. Data were analyzed to describe changes in IPC compliance and competencies. RESULTS: Overall, hospital compliance with IPC standards improved from baseline to the final assessments across all domains assessed. IPC focal points' occupational health competency scores increased; median scores for each competency component ranged from 2.5 to 3.5 (out of 5) at baseline and were ≥4.5 at endpoint. Eighteen hospitals completed the QI collaborative; average compliance with appropriate PPE use across hospitals increased significantly, from 65% to 92% (P < .006). CONCLUSIONS: Implementing evidence-based interventions in a learning network in East Africa improved compliance with IPC standards and occupational health competencies, which are critical to protecting HCWs and preventing pathogen transmission in healthcare facilities. This learning network approach can serve as a model for other regions or be implemented to address other public health emergencies.

OBJECTIVES: Understanding of long-term lung cancer risks from radon decay products (RDP) exposure derives largely from studies of uranium miners. We aimed to compare mortality for lung and other cancers to the general population, to estimate excess absolute rate (EAR) and excess relative rate (ERR) from RDP exposure, and to estimate the joint effects of RDP and cigarette smoking in extended follow-up of a cohort of 4137 male uranium miners from the US Colorado Plateau. METHODS: We extended mortality follow-up through 2016 and re-evaluated RDP exposure against original work history and mine records. We calculated standardised mortality ratios (SMRs) compared with a regional population, evaluated EAR of lung cancer mortality using standardised rate ratios and modelled ERR using Cox proportional hazards regression. We evaluated interactions of RDP with smoking pack-years, attained age (AA) and time-since-exposure (TSE). RESULTS: There were 695 lung cancer deaths, including 146 among never-smokers and light smokers. The overall SMR was >4; the EAR per unit RDP exposure increased substantially with smoking pack-years and decades of follow-up. Lung cancer ERR decreased with AA and TSE. ERR attenuation at high exposure rates was smaller than observed elsewhere. Joint effects of RDP and smoking were submultiplicative but greater-than-additive, appearing closer to multiplicative at lower RDP exposures. Pancreas was the only other site showing a significantly positive ERR per unit exposure. CONCLUSIONS: Excess rates of lung cancer mortality persist throughout the lifespan among this cohort of uranium miners. Information about RDP-smoking interactions is of interest for occupational and general population exposure.

Mining is increasingly relying on wireless communication for a diverse set of functions in the mine. As additional wireless devices and systems are added to the mining cycle, they must continue to function acceptably in the presence of the other wireless devices and systems currently in use. This paper presents a case study to illustrate the importance of testing for wireless coexistence in the mining sector. A commercial wireless Emergency Stop (E-Stop) system is evaluated for wireless coexistence with another technology commonly found in mines: IEEE 802.11 WLAN. Two hypothetical E-Stop application use cases are presented. Functional wireless performance and key performance indicators are defined, and testing is performed. Analyses of the results are shown as they pertain to each application use case. The results indicate that unintended signals can impact the wireless performance of the E-Stop system devices in certain circumstances. The conclusion is that evaluating and understanding wireless coexistence performance can lead to safer and more reliable wireless system deployments on or around safety-critical mining equipment. © 2024 IEEE.

Background: Malaria is a mosquito borne disease caused by parasites of the genus Plasmodium. In 2023, the United States (US) experienced nine cases of autochthonous Plasmodium vivax malaria transmission; seven in Florida, one in Texas, and another in Arkansas. These were the first autochthonous cases since 2003 when a cluster was identified in Florida. The aim of this study was to genetically characterize the implicated P. vivax isolates in order to complement epidemiologic investigations of these cases. Methods: A custom Illumina AmpliSeq sequencing panel capturing 495 amplicons was designed. This panel was used to ascertain whether these 2023 cases were related, and assess if they were associated with a single or separate introduction events. Sequence data were hierarchically clustered and a Naïve Bayes classification approach was used to assign genotypes to a probable geographic origin based on 113 ‘geo-informative’ SNPs captured by the panel. Genotypes associated with the 2023 Arkansas, Texas, and Florida cases were clustered alongside those sequenced from archived blood samples from the 2003 Florida case-patients, a set of reference strains, and other travel-associated specimens. Microsatellite analysis was performed on a subset of samples from these autochthonous cases to complement the AmpliSeq analysis. Findings: The 2023 autochthonous Florida cases were genetically linked as were the 2003 Florida cases. The 2023 and 2003 Florida clusters were genetically distinct, and the two Florida clusters were distinct from the 2023 Texas and Arkansas cases, which were also distinct from each other. These genotypes classified to the Central or South American region using the Naïve Bayes classifier, including those from the 2003 cluster. Interpretation: These data support that at least three distinct P. vivax introduction events in the US in 2023, involving parasites possessing genetic signatures consistent with Central or South America. Funding: This work was supported by the National Center for Emerging and Zoonotic Infectious Diseases at the US Centers for Disease Control and Prevention. © 2025

BACKGROUND: In 2023, an estimated 36 million pregnancies occurred in malaria endemic sub-Saharan Africa, but only 44% received the WHO recommended ≥ 3 doses of intermittent preventive treatment (IPTp3). Group Antenatal Care (G-ANC) is a service delivery model associated with higher quality of and greater retention in ANC, in which pregnant women are enrolled into groups at their first ANC visit and subsequent care is provided in groups. A cluster-randomized controlled trial was conducted in Atlantique Department, Benin, to assess whether G-ANC improved ANC retention and IPTp3 uptake at community level. METHODS: Forty purposively selected health facilities (HF) were randomized 1:1 to control (individual ANC) or G-ANC. Cross-sectional household surveys to measure uptake of ANC and IPTp were conducted in each HF catchment area before and after implementation among randomly selected women who had given birth in the previous 12 months. Changes in coverage were assessed using a difference-in-difference approach, adjusting for HF clustering. RESULTS: At baseline (N = 1259), coverage of at least 4 ANC visits (ANC4) and IPTp3 was 52.8% and 48.0%, respectively, in the intervention catchment, and 44.9% and 49.4% in the control catchment. Coverage of ANC4 improved in both arms by endline (N = 1280), to 56.7% in the intervention and 46.1% in the control, but the difference in the increase was not significant between arms (p = 0.51). Coverage of IPTp3 increased non-significantly (p = 0.26), to 53.2% (intervention) and 49.7% (control). Overall, only 140 (10.6%) surveyed women reported participating in G-ANC. Participation improved coverage of both ANC4 (65.0% vs 50.5%, p = 0.002; odds ratio (OR) 1.9, 95% CI 1.4-2.5) and IPTp3 (64.0 vs 50.6%, p = 0.004; OR = 1.8, 95% CI 1.2-2.6). CONCLUSIONS: G-ANC increased ANC attendance and IPTp3 uptake among women who participated, but participation was limited. Understanding and addressing the barriers to participation is critical if G-ANC is to be used more widely to increase IPTp coverage. TRIAL REGISTRATION: PACTR202405487752509.

Attractive targeted sugar baits (ATSBs) are a novel malaria control tool designed to target mosquitoes outdoors. We conducted a cluster-randomised trial to evaluate the impact of ATSBs on malaria indicators in Kenya. Seventy clusters (≥100 households/cluster) in Siaya county were randomly assigned (1:1) to intervention or control. Pyrethroid-only long-lasting insecticidal nets were distributed to all clusters, aiming for universal coverage. Two ATSBs containing dinotefuran were hung outside household structures in intervention clusters. ATSBs were monitored every two months and replaced every six months over two years. Three consecutive cohorts of randomly selected children (1- < 15 years) were enrolled, aiming to accrue 1,260 person-years over two years of follow-up. Incidence of clinical malaria (fever with a positive malaria test) was the primary outcome. A multilevel Poisson regression model was applied, with clusters as a random intercept and study arm as a fixed effect. Secondary outcomes were malaria prevalence in community residents (≥1 month), and parity of mosquitos captured through human landing catches. In March 2022, ATSBs were delivered to 33,180 of 33,419 (99.3%) household structures in intervention clusters. Overall, 268,268 ATSBs were deployed over two years. Of 2,962 cohort children enrolled (intervention = 1,497; control = 1,465), 2,869 (96.9%) were included in the primary analysis (intervention = 1,461; control = 1,408), contributing 1,445 person-years of follow-up. Malaria incidence was 1.32 episodes per person-years in the intervention arm versus 1.20 in the control (unadjusted incidence rate ratio 1.11; 95% CI: 0.75-1.65; p = 0.598). Of 7,488 community residents surveyed (intervention = 3,760; control = 3,728), 1,474 (39.2%) intervention and 1,461 (39.2%) control participants tested positive for malaria (unadjusted odds ratio [OR] 0.98; 95% CI: 0.60-1.59; p = 0.93). Of 6,457 female anopheles mosquitoes collected (intervention = 4,058; control = 2,399), 3,579 (88.2%) intervention and 1,973 (82.2%) control mosquitoes were parous (OR 1.34; 95% CI: 0.91-1.99; p = 0.14). In Kenya, we found no evidence that ATSBs reduced clinical malaria incidence, malaria prevalence, or vector parity. Trial registration Clinicaltrials.gov (NCT05219565), 22 January 2022.

The Kessler 6 (K6) scale has been widely used to screen for serious mental illness (SMI) in general populations. Given that populations with high burden of HIV may be more likely to experience poor mental health outcomes, it is important to validate measures used to assess SMI among these groups. Using data from CDC's National HIV Behavioral Surveillance (NHBS) system in the United States, we examined psychometric characteristics of the K6 scale, including exploratory factor analysis, scale reliability, construct validity, and review of interviewer feedback to explore scale performance in the field. Analyses confirmed a single factor structure and demonstrated that the K6 scale had high internal consistency and construct validity. Although interviewers noted that the effort item was difficult for some participants to understand, psychometric properties were not greatly improved with the deletion of the item. The results of this analysis suggest that the K6 scale is appropriate for use among NHBS populations with a high burden of HIV, including persons who inject drugs, heterosexually active adults at increased risk for HIV infection, women who exchange sex for money or drugs, and gay, bisexual, and other men who have sex with men.

This cross-sectional study describes the level of naloxone information and availability and general attitudes about illicit drug use across different demographic groups in the US. | eng

INTRODUCTION: Given the increasing usage of vaping during pregnancy and limited longitudinal health-related data, there is an urgent need to assess the potential risks of vaping. AIMS AND METHODS: A cross-sectional study was conducted among pregnant UK adults (n = 140). Five study groups were purposively recruited: exclusive-smokers (n = 38), exclusive-vapers (former smokers) (n = 35), dual users of smoking and vaping (n = 25), dual users of smoking and nicotine replacement therapy (n = 10), and "never-users" of nicotine or tobacco products (n = 32). Sociodemographic, smoking, and vaping characteristics were assessed. Participants' urine samples were analyzed for biomarkers of exposure to tobacco alkaloids, and toxicants, including 14 volatile organic compounds (VOCs), tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), heavy metals (cadmium, lead, chromium, nickel, copper, and tin) and a polycyclic aromatic hydrocarbon (2-naphthol). Regression analysis was used to compare biomarkers by group. RESULTS: Nicotine levels varied across product users, but not significantly. After controlling for confounders, for most VOCs, biomarker levels were similar for exclusive-vapers and never-users and significantly lower than for exclusive-smokers and any dual users. There were generally no significant differences between groups for 2-naphthol or heavy metals. For NNAL, cadmium and chromium, a high percentage of values were below the limit of detection, making analyses unreliable. CONCLUSIONS: During pregnancy, former smokers who are established exclusive vapers, but not dual users, had levels of selected VOCs that were substantially lower than those for exclusive smokers and comparable with those who have never used nicotine or tobacco products. IMPLICATIONS: Based on the biomarkers assessed in this study, during pregnancy, on average, exclusive-vapers are likely to have similar levels of exposure to selected VOCs as never-users and far lower levels than exclusive-smokers or dual-users (although dual-vaping and smoking may result in less exposure than exclusive-smoking). This provides preliminary information about exposure to vaping during pregnancy and suggests that, for some biomarkers, exclusive vaping is likely to result in lower exposures than exclusive smoking or dual-use. There may be exposure to other vaping toxicants that were not explored in this study. Studies are needed to assess pregnancy and birth outcomes as well as early life effects.

Iron overload is a leading cause of morbidity and mortality in Egyptian rousette bats (ERBs; Rousettus aegyptiacus) within managed care settings. We compared hepatic iron accumulation and tissue damage in samples collected from managed care bats in a zoo setting, a research colony, and a free-ranging population with the goal of determining if iron overload was a potential cause of morbidity for free-ranging ERBs. Livers from 20 zoo bats, 8 research colony bats, and 69 free-ranging bats were histologically evaluated for fibrosis, necrosis, and iron accumulation in hepatocytes and Kupffer cells. Hemochromatosis was identified only in the zoo population, with hemosiderosis identified in all research colony bats and many free-ranging bats. There were statistically significant associations between age classification, population, and diagnosis and between Marburg virus infection status and histologic liver iron scores. In addition, there were positive associations with statistical significance between age class (juvenile, adult) and histologic iron scores and between population type (zoo bats > research colony bats > free-ranging bats) and histologic iron scores. Excessive hepatic iron storage does not appear to be a source of morbidity within free-ranging ERB populations.

West Nile virus (WNV) causes thousands of arboviral infections in the United States each year. Patients with immune-compromising conditions and elderly people are at higher risk of severe WNV neuroinvasive disease (WNND). Despite its broad endemicity nationwide, no U.S. Food and Drug Administration-approved vaccine or therapeutic treatments exist. We summarized existing peer-reviewed literature on the preclinical development of monoclonal antibody (MAb) prophylaxis and therapeutics for the prevention and treatment of WNND. Five bibliographical databases (CINAHL, Cochrane Library, Embase, MEDLINE, and Scopus) were searched for applicable research studies performed from 1 January 1998 to 1 May 2025. In total, 2347 titles and abstracts were screened, 263 full-text publications reviewed, and 25 studies included. Studies included detailed preclinical development and evaluations of MAbs targeting the envelope (E) protein (n = 13), other viral proteins (n = 3), flaviviral cross-protective monoclonal antibodies (n = 4), and novel antibody configurations or delivery methods (n = 5). The most well-studied MAb, E16, targeting E- Domain III (E-DIII), was effective at inhibiting and treating WNND in experimental animal models. No work investigated ways to traffic therapeutic antibodies across the blood-brain barrier. This review summarizes the current research in the development of monoclonal antibody therapeutics for WNV and addresses gaps in the knowledge for future consideration.

Monitoring the zoonotic potential of emerging SARS-CoV-2 variants in animals is a critical tool to protect public health. We conducted a longitudinal study in 47 households reporting people with COVID-19 in Texas from January to July 2022, during the first Omicron wave. We evaluated 105 people and 100 of their companion animals for SARS-CoV-2 infection at three sequential sampling events, starting 0-5 days after the first reported diagnosis of COVID-19 in the house. SARS-CoV-2 RNA was detected in 68% of people from 43 households; 95.5% of people had antibodies to SARS-CoV-2. Dogs were the only animal species positive by RT-qPCR (5.4%; 3/55), and their viral loads were consistently lower compared with those from household members. Additionally, infected dogs did not yield infectious virus. Clusters of Omicron BA.1.1, BA.2.3.4, and BA.5.1.1 in people, dogs, and a dog food bowl confirmed human-to-dog transmission within households, with no evidence of onward transmission from the infected dogs. Eleven dogs (n = 55) and two cats (n = 26) had neutralizing antibodies against SARS-CoV-2. Overall, infection was not associated with clinical signs in pets; only two animals that tested negative for SARS-CoV-2 were reported to be sick. Nearly one-third (30.2%) of households with active COVID-19 had pets exposed to SARS-CoV-2, similar to our pre-Omicron studies; however, the incidence of infection in cats was lower compared with pre-Omicron. These differences suggest that the zoonotic transmission dynamics in households may differ based on variants.IMPORTANCESARS-CoV-2 infects a broad diversity of mammals, with companion dogs and cats at risk of infection via close contact with infectious owners. Longitudinal studies sampling pets and their owners over time are essential to understanding within-household SARS-CoV-2 transmission dynamics. Our repeated sampling in households with people reporting COVID-19 found that 68% of the people in 43 households had active SARS-CoV-2 infection during at least one of the three sampling events. Although none of the 27 cats were positive, 3/55 dogs had active infections. Household clusters of three different Omicron subvariants were involved in these human-to-dog transmission events, and our data suggest reduced infection in pets during Omicron transmission compared with pre-Omicron waves. Protecting pets from SARS-CoV-2 infection remains important, as viral evolution can be accompanied by changes in the infectiousness of different hosts.

Background: Rickettsia are neglected, arthropod-borne bacteria causing febrile illness of varying severity. Indonesia is endemic for several Rickettsia species, predominantly from murine and scrub typhus groups. Objective: We described here a potentially novel Rickettsia species in a young adult presenting with acute, undifferentiated, febrile illness at a primary health center in Timika, Papua, Indonesia, in 2021. Methods: Blood tested positive for Rickettsia spp. by a nucleic acid amplification test, 17-kDa and ompB gene fragments were successfully sequenced. Results: The recovered sequences showed the highest similarity to two Rickettsia spp. of mosquito origin, with 90.0% identity for the 17-kDa and 85.6% for the ompB gene. Conclusion: These findings suggest the presence of a divergent Rickettsia lineage in Papua, Indonesia. To our knowledge, this is the first report of Rickettsia DNA sequences obtained from a human case in this region. © 2025

Rabies in livestock in the United States (US) poses a significant public health concern due to the potential for human exposure and economic losses to producers. Understanding the epidemiology of rabies in livestock supports broader One Health goals by enhancing early detection of viral incursions and protecting both animal and human health. This study assessed the epidemiology of rabies in livestock in the US from 2012 to 2021 using surveillance data reported to the National Rabies Surveillance System. A sensitivity analysis was conducted to estimate economic losses, including livestock value and human postexposure prophylaxis. A total of 947 rabid livestock were reported during the study period, with cattle accounting for 65.9% of cases. Skunk rabies virus variants were the most frequently identified variants (53.5%), and more than half of all rabid livestock were reported in Texas, Oklahoma, Kansas, Virginia, and North Carolina. When adjusted for livestock population, the highest infection rates occurred in the northeastern US. Estimated economic losses totaled $18.6 million (range, $9.8 to $39.6 million) assuming detection rates of 100% (lower bound) and 66% detection (upper bound). Rabid livestock are routinely detected in the US, with the highest number of rabies infections concentrated in 2 states, Texas and Virginia. Economic losses due to rabid livestock are sizeable, driven primarily by postexposure prophylaxis costs. Livestock vaccination should consider regional risk, animal value, and the potential for human exposure. The companion Currents in One Health by Nathan et al, JAVMA, forthcoming 2025, addresses patterns of rabies vaccine failures in domesticated animals.