BACKGROUND:Routine HIV/AIDS surveillance data are central to programme monitoring in low- and middle-income settings, but reported diagnoses are shaped by testing access, service continuity and reporting completeness. Indonesia's annual reports enable reproducible analysis of programme trends. OBJECTIVES:To describe national reported HIV and AIDS case rates in Indonesia during 2010-2024, quantify COVID-era deviations from pre-pandemic reporting trends and explore transparent 2030 scenarios for reported surveillance indicators. METHODS:We analysed 15 annual observations (2010-2024) from manually verified Indonesian Ministry of Health reports (Profil Kesehatan Indonesia and national HIV/AIDS and STI programme reports) and official population tables. Reported HIV and AIDS counts were converted to rates per 100,000 population. Ordinary least-squares regression summarised slopes for pre-COVID (2010-2019), COVID disruption (2020-2021) and post-COVID/rebound (2022-2024) periods. A linear counterfactual estimated 2020-2021 reporting deficits, and deterministic scenarios projected reported indicators from the 2024 baseline to 2030. RESULTS:Reported HIV cases increased from 21,591 in 2010 to 63,707 in 2024, and the HIV case rate increased from 9.09 to 22.36 per 100,000 population. Reported AIDS cases increased from 7437 to 21,536, and the AIDS case rate increased from 3.13 to 7.56 per 100,000 population. The COVID counterfactual estimated HIV reporting deficits of 24.0% in 2020 and 37.8% in 2021; corresponding AIDS reporting deficits were 9.0% and 39.3%. Scenario endpoints ranged from 33,857 to 95,963 reported HIV cases and from 11,445 to 56,441 reported AIDS cases. CONCLUSIONS:Indonesia's reported HIV/AIDS case rates changed substantially during 2010-2024, with COVID-era surveillance disruption followed by post-pandemic rebound. The findings provide a reproducible, denominator-adjusted evidence base for strengthening HIV programme monitoring and 2030 planning in Indonesia and comparable health-system settings.
BACKGROUND:Dengue vector control plays an important role in reducing the burden of dengue infection. Conventional meta-analysis can only include interventions that can be directly compared. Hence, this study aimed to compare the effectiveness of all interventions for dengue vector control directly and indirectly through a multilevel Bayesian network meta-analysis. METHODS:Cluster randomised controlled trials (cRCTs) and randomised controlled trials (RCTs) were included. Screening and full-text review were performed independently by two reviewers, with resolution by a third reviewer if there was disagreement. Outcomes measured for the included studies considered were entomological indices and epidemiological measures. The Cochrane risk of bias tool was used to assess the quality of the studies by two independent reviewers, with a third reviewer to resolve any discrepancies. RESULTS:A total of 48 cRCTs and 13 RCTs were included in this study. The quality of cRCTs and RCTs was overall deemed at high risk of bias except for two studies with low risk of bias. The network meta-analyses and narrative synthesis indicate that most interventions are not significantly superior to one another. Despite the lack of statistically significant results in the network meta-analyses, a standalone intervention appears to be less effective than combined interventions. CONCLUSIONS:Although most interventions were not found to be significantly superior to one another in the network meta-analyses, it is noteworthy that standalone interventions were shown to be less effective than combined interventions. These results reinforce the importance of promoting integrated, multi-faceted vector control strategies for dengue prevention.
BACKGROUND:This study examined the contributions of factors associated with rural-urban disparities in cervical cancer screening uptake in sub-Saharan Africa using a decomposition analysis. METHODS:We used data from the recent Demographic and Health Surveys conducted in 14 sub-Saharan African countries. A weighted sample of 66,958 women aged 30-49 years was included in our analysis. We used a multivariate nonlinear decomposition model to examine the factors contributing to the rural-urban disparities in cervical cancer screening uptake. The results were presented as differences due to characteristics and coefficients, with their respective coefficients, percentages, and p-values. RESULTS:The pooled uptake of cervical cancer screening across the 14 countries was 21.2% (95% confidence interval [CI]: 20.1-22.2) among urban women and 11.6% (95% CI: 10.9-12.3) among rural women. The decomposition analysis showed that the differences in women's characteristics explained 106.53% of the rural-urban disparity in cervical cancer screening uptake. Factors such as education level, parity, wealth index, and exposure to mass media accounted for most of this disparity. The coefficients component explained the remaining -6.53% of the disparity in cervical cancer screening uptake. CONCLUSION:Our study has shown that disparities between rural and urban areas in cervical cancer screening uptake exist in sub-Saharan Africa, largely driven by educational level, parity, wealth index, and exposure to mass media. Public health strategies must therefore adopt a multifaceted approach: increasing rural access to cervical cancer screening services, tailoring interventions for less educated and socially disadvantaged women, addressing marital and cultural barriers, and using mass media to normalise and promote cervical cancer screening.
BACKGROUND:Cutaneous leishmaniasis (CL) is a major public health challenge in Ethiopia, with 20-30,000 new cases annually. Limited awareness and misconceptions contribute to delayed care seeking, stigma, prolonged healing, and reduced uptake of preventive measures in CL-endemic communities. To address these challenges, a participatory community dialogue (CD) intervention was implemented to evaluate a structured CD intervention in improving knowledge, attitudes, and preventive practices related to CL in Kalu District, Ethiopia. METHODS:A convergent parallel mixed-methods study was conducted in three CL-endemic clusters. Structured CD sessions were held between May and September 2024. Post-intervention qualitative data were collected through in-depth interviews with facilitators and mobilisers (n = 6) and 10 focus group discussions with participants (n = 81), analysed thematically. Quantitative data were obtained from questionnaires before (n = 128) and after the intervention (n = 109), compared using paired t-tests and odds ratios. RESULTS:Participants in group discussions explained that CD sessions helped them to abandon misconceptions, such as beliefs that CL is transmitted through bat urine and that CL-affected people need to self-isolate during treatment to avoid contacts with those who had sexual intercourse and might cast a 'shadow' that could harm their healing. The intervention reframed contagion fears and encouraged biomedical explanations. Questionnaire data indicated attribution of CL to 'germs/parasites' increased from 21% (27/128) before the CD to 88% (96/109) after the CD and belief in self-isolation declined from 61% (78/128) to 8% (9/109). Perceptions of CL as preventable and treatable at health facilities increased, with modest improvements in preventive practices. CONCLUSIONS:The CD intervention addressed behavioural determinants of CL by improving knowledge, reducing misconceptions, and encouraging timely care seeking. It reduced shadow-related isolation beliefs and increased correct causal attribution, underscoring its potential to strengthen CL control in endemic settings. Integrating participatory approaches into public health strategies offers a pathway to sustain behavioural change.
BACKGROUND:Chikungunya virus (CHIKV) is an arbovirus that causes an acute febrile illness with intense muscle and joint pain, with the possibility of progressing to a chronic or neurological stage. We conducted a systematic review and meta-analysis with the aim of evaluating the accuracy of real-time reverse transcriptase polymerase chain reaction (RT-qPCR) protocols for detecting CHIKV during the acute phase of symptoms. METHODS:We searched the literature until December 5, 2024, including English, Portuguese, and Spanish, with no time restriction in PubMed, LILACS, and Web of Science. Studies that evaluated RT-qPCR protocols compared to reference techniques such as viral isolation or validated RT-qPCRs were included in the study. We collected data on sensitivity, specificity, accuracy, study design and methodological characteristics of RT-qPCR. Quadas-2 tool was used to assess the risk of bias and applicability. Subsequently, a meta-analysis and meta-regression were performed. RESULTS:Twenty-eight protocols were included in this systematic review, 28 index tests were extracted and 24 were included in quantitative analysis. According to meta-analysis, RT-qPCR for CHIKV detection had a combined accuracy of 96% (95% CI: 94 to 99%) and a summary sensitivity and specificity of 99.7% and 99.7%, respectively; however, the results need to be interpreted considering the high heterogeneity (78.1%) and publication bias (p = 0.002). CONCLUSION:RT-qPCR is a highly accurate technique for detecting the Chikungunya virus during the acute phase of symptoms. Despite the high heterogeneity observed, all subgroup analyses demonstrated high overall performance.
BACKGROUND:Blastocystis sp. is a common intestinal protist infecting humans and a wide range of animals worldwide. Despite its high prevalence, its genetic diversity and zoonotic transmission remain poorly understood, particularly in regions with close human-animal contact. This study aimed to determine the prevalence, subtype (ST) distribution and phylogenetic relationships of Blastocystis sp. in humans and domestic animals in northeastern Iran. METHODS:In this cross-sectional study (2019-2021), 730 fresh faecal samples were collected from humans (n = 203) and domestic animals (n = 527). Samples were examined using direct smear microscopy and culture. DNA was extracted from culture-positive isolates and subjected to PCR targeting the SSU rRNA gene. PCR-positive amplicons were subsequently sequenced for ST identification, and phylogenetic analysis was performed using the Maximum Likelihood method. RESULTS:Overall, 68 samples (9.3%) were positive for Blastocystis sp., with culture was significantly more sensitive than direct smear microscopy (p = 0.001). The prevalence among humans was 13.3%. Sequence analysis identified eight STs (ST1-ST3, ST5-ST7, ST14 and ST15). ST3 was the predominant ST in humans, while ST7 was mainly detected in poultry. Ruminant-associated ST14 and ST15 were exclusively found in sheep. Phylogenetic analysis revealed clear clustering according to STs and indicated greater intra-ST diversity within ST7. CONCLUSIONS:The findings demonstrate the circulation of genetically diverse Blastocystis sp. STs among humans and domestic animals in northeastern Iran. The presence of shared STs across hosts highlights the potential for zoonotic transmission and underscores the value of molecular approaches for epidemiological studies.
Non-typeable Streptococcus pneumoniae strains are not covered in the current pneumococcal conjugate vaccines (PCVs). As a result, their increasing prevalence in pneumococcal diseases following the introduction of PCVs poses a significant public health concern. This study provides a global summary of the epidemiology of non-typeable pneumococcal diseases by estimating their prevalence and antimicrobial resistance rates, and identifying the circulating sequence types. An extensive search was conducted in PubMed, Scopus and Web of Science for studies reporting pneumococcal diseases caused by non-typeable S. pneumoniae . A meta-analysis was performed to estimate the pooled prevalence of non-typeable S. pneumoniae in pneumococcal diseases. Thirty-four studies conducted in 25 countries spanning four continents were included in the analysis. The pooled prevalence of non-typeable S. pneumoniae in pneumococcal diseases was 8.7% (95% CI [4.6; 13.9]). The pooled prevalence of non-typeable S. pneumoniae was highest in conjunctivitis at 37.6% (95% CI [14.4; 64.4]), followed by meningitis at 5.8% (95% CI [2.7; 9.8]), pneumonia at 5.3% (95% CI [1.8; 10.4]), and otitis media at 0.9% (95% CI [0.2; 2.1]). The pooled prevalence of non-typeable S. pneumoniae in pre-vaccination studies and post-vaccination studies was 5.2% (95% CI [1.7; 10.2]) and 10.9% (95% CI [4.5; 19.6]), respectively. More than 25% of non-typeable pneumococcal isolates were multidrug-resistant. This study presents the first comprehensive global estimate demonstrating a substantial prevalence of non-typeable pneumococcal diseases. Continuous surveillance is essential to monitor trends in non-typeable pneumococcal diseases, informing decisions on disease control and vaccine development.
OBJECTIVES:This study aims to identify patterns associated with clustering and co-occurrence of malaria, pneumonia, and diarrhoea, the leading causes of death in children under age five in sub-Saharan Africa, in western Uganda to generate evidence for integrated prevention and control measures. METHODS:We conducted a prospective longitudinal study complemented by passive surveillance at local clinics. All households in the three selected villages were eligible to participate. Household-level socioeconomic and geographic data were linked to clinically diagnosed disease outcomes. Co-occurrence of diseases within households, defined as the diagnoses of two of the three diseases of interest (malaria, pneumonia, and diarrhoea) within a four-week period, was assessed using a Poisson model with a log link. Multinomial logistic regression models were fit to assess the association between patterns of malaria and pneumonia occurrence with socioeconomic and geographic factors. RESULTS:A total of 399 households were enrolled and completed baseline surveys. The smallest village accounted for 68.5%, 43.2%, and 38.1% of malaria, pneumonia, and diarrhoea cases, respectively. After adjusting for village, socioeconomic status, and the mean age of children in the home, households in Kasanzi had a higher relative risk of having both malaria and pneumonia versus neither disease compared to households in Bunyangoni (RRR: 33.84, 95% CI: 7.10, 161.24). For models replacing village with elevation, households in at higher elevations had a higher relative risk of having both malaria and pneumonia versus neither disease compared to households in at lower elevations (RRR: 26.59, 95% CI: 2.53, 279.84). No clear associations were found between malaria and pneumonia co-occurrence and SES. CONCLUSIONS:Findings demonstrate that within small geographic areas, disease burden can vary dramatically across communities. Targeted, community-level interventions, rather than broad regional programs, are essential to address the distinct transmission dynamics and overlapping risks faced by high-burden communities.
OBJECTIVES:To assess the prevalence of Mycobacterium tuberculosis infection among foreign-born individuals entering prison and to evaluate the performance of the tuberculin skin test (TST) in vaccinated individuals (Bacillus Calmette-Guérin vaccine, BCG), using interferon gamma release assays (IGRAS) as the reference standard. METHODS:We conducted a prospective observational study including foreign-born individuals admitted to prisons in Catalonia (Spain) between 1 March 2023 and 30 June 2023. A TST was performed if there was no prior positive TST or prior TB infection, or if the TST was negative for more than 1 year. Current TB was excluded by clinical and radiological evaluation. BCG vaccination status was assessed using medical records, identification of a vaccination scar, and the BCG World Atlas. TST positivity was analysed according to BCG vaccination status. Among BCG-vaccinated individuals with a positive TST, IGRA results were used to estimate the positive predictive value (PPV) of the TST overall and by TST induration diameter. RESULTS:Among 1075 foreign-born individuals admitted during the study period, 32 (3.0%) had a previous diagnosis of active TB. Of the remaining 1043, 86.4% were classified as BCG-vaccinated. Overall, 45.2% had a positive TST, with no significant difference between vaccinated individuals and unvaccinated individuals (46.1% vs. 39.9%; p = 0.08). Among BCG-vaccinated individuals with a positive TST, IGRA testing was performed in 71%, yielding an overall TST PPV of 65%. The PPV increased with induration diameter, from 51.6% (10-14 mm) to 81.8% (≥ 20 mm). CONCLUSIONS:Foreign-born individuals entering prison show a high prevalence of M. tuberculosis infection. In BCG-vaccinated individuals, the TST shows limited predictive value, particularly at lower induration thresholds. While further studies are needed, these findings support the preferential use of IGRA-based strategies for LTBI screening in this setting.
BACKGROUND:Despite global efforts, sub-Saharan Africa continues to account for 70% of maternal deaths, yet systematic cause-specific analyses across African regions remain limited. We examined 33-year trends in maternal mortality to identify epidemiologic divergence and guide differentiated intervention strategies. METHODS:Using the 2023 Global Burden of Disease Study, maternal mortality ratios (MMR), cause-specific deaths, and age-specific patterns were analysed across five African regions (Central, Eastern, Northern, Southern, and Western Africa) from 1990 to 2023. Absolute and relative changes, average annual rates of change, cause-specific mortality proportions, and progress against Sustainable Development Goal targets were assessed. RESULTS:MMR reduction varied dramatically across regions. Northern Africa achieved the greatest decline (65.0%; 241.2 to 84.4 per 100,000 live births), while Central Africa achieved only 16.7% reduction (818.1 to 681.3). Cause-specific patterns diverged strikingly: HIV-related causes accounted for 87.3% of maternal deaths in Southern Africa versus 34.2% in Central Africa, while direct obstetric causes showed inverse patterns (6.3% vs. 39.9%). HIV-related maternal deaths increased 76%-454% across most regions despite antiretroviral therapy (ART) scale-up. Age-extreme populations faced 1.3- to 7.2-fold elevated risks; adolescents in Central Africa had an MMR of 852.3, and women aged 45-49 years reached 2233.0. Central Africa's MMR remained 3.6 times the global average, with sepsis burden (15.3%) more than double other regions (4%-7%). CONCLUSION:African regions demonstrate distinct epidemiologic profiles requiring tailored intervention strategies. Universal maternal health approaches inadequately address HIV-dominant versus obstetric-dominant regional burdens or age-extreme vulnerability. Central Africa's minimal progress signals that standard interventions fail under protracted humanitarian crises. Post-2025 strategies must integrate linked HIV-maternal care, emergency obstetric services, crisis-adapted approaches, and age-targeted programming while recognizing within-region heterogeneity to achieve equitable maternal health outcomes.
AIM:To evaluate the impact of China's National Volume-Based Procurement policy (NVBP) on utilisation and expenditures of antidiabetic drugs, with a focus on insulin, using real-world data from Nanjing. METHODS:Monthly procurement data from public healthcare facilities in Nanjing were analysed from January 2016 to December 2022. Drug utilisation was measured using the Anatomical Therapeutic Chemical/defined daily dose (ATC/DDD) methodology, and expenditures were measured by total spending and defined daily dose cost (DDDc). Linear regression analysis was employed to assess temporal trends, while interrupted time series (ITS) analysis was conducted to evaluate the impact of five policy implementation batches between January 2019 and December 2022 on changes in drug use and spending. RESULTS:During the 7-year study period, the use of NVBP-related antidiabetic drugs in Nanjing increased significantly, while total expenditures decreased. Before NVBP, expenditures grew annually by 9.1%, but declined by 12.4% per year after policy implementation. Insulin remained the dominant therapy but its utilisation proportion declined by approximately 40%, while metformin and sulfonylurea use increased. Newer antidiabetic drugs saw breakthrough growth post-policy. ITS analyses showed substantial immediate reductions in DDDc across batches, particularly for insulin, with unit costs decreasing by 36.5%. Utilisation responses varied by procurement batch, while domestic insulin products gained market share. CONCLUSIONS:The NVBP was associated with substantial reductions in antidiabetic medicine costs and changes in market structure, while utilisation effects varied across procurement batches. The insulin-focused sixth batch achieved marked price reductions and increased substitution towards domestically produced insulin without increasing overall utilisation. These findings suggest that centralised procurement may improve affordability while reshaping pharmaceutical markets.
OBJECTIVE:Schistosomiasis remains a public health concern in sub-Saharan Africa, affecting over 250 million people. In endemic settings, schistosomiasis transmission is not always understood exclusively in biomedical terms. Community health workers (CHWs) contribute to schistosomiasis control through mass drug administration and health education, yet limited evidence exists on how they understand schistosomiasis transmission. This study explores how CHWs in Côte d'Ivoire, Kenya and Uganda explain schistosomiasis transmission and how these explanations relate to wider disease and training contexts. METHODS:This paper draws on the CHW component of a larger mixed-methods study conducted in Côte d'Ivoire, Kenya and Uganda, with multiple respondent groups. We present findings from interviews and focus group discussions with CHWs. Data were analysed thematically, at both semantic (descriptive) and latent (interpretive) level, employing Kleinman's framework of explanatory models and Good's work on semantic networks to support interpretation. RESULTS:CHWs expressed multiple understandings of schistosomiasis transmission. Most described schistosomiasis transmission in biomedical terms, often emphasising skin contact with contaminated water. Others combined biomedical terms with locally circulating ideas about disease transmission, linking infection to drinking unsafe water, stepping on faeces, flies or other diseases such as trachoma or diarrhoeal illnesses. These understandings emerged in relation to a complex disease landscape in which signs, symptoms and perceived transmission routes overlapped. They were also situated within uneven training experiences, including irregular refresher sessions, variable access to schistosomiasis-specific training and training focused mainly on treatment campaign logistics. CONCLUSION:CHWs' varying understandings of schistosomiasis reflect not only individual knowledge but also the broader disease landscape and training contexts in which they work. Strengthening schistosomiasis communication therefore requires attention to how CHWs interpret, adapt and combine disease-specific information with other sources of knowledge, and to how training can better prepare them to navigate similarities and differences between disease-specific messages in everyday practice.
BACKGROUND:Rhinovirus (RV) is a recognized respiratory pathogen, but its role in severe lower respiratory tract infections (LRTI) in adults remains debated. The aim of the study was to investigate RV in different clinical status categories at Hospital Sao Paulo, a tertiary facility in Sao Paulo, Brazil. METHODS:We conducted a cross-sectional study between January 2023 and August 2025, enrolling 2688 participants: asymptomatic adults (n = 193), adult outpatients with acute respiratory infection (ARI) (n = 1274), hospitalized adults with severe LRTI (n = 809) and hospitalized children with LRTI (n = 412). RV detection was performed by RT-qPCR. RESULTS:RV detection rates were 4.7% in asymptomatic adults, 7.8% in hospitalized adults, 15.6% in adults outpatients and 20.9% in hospitalized children. The detection rate in hospitalized adults was statistically similar to that of asymptomatic adults (ƿ = 0.135), but significantly lower than that of adults outpatients (ƿ < 0.001) and hospitalized children (ƿ < 0.001). Among RV-positive hospitalized adults, 90.5% had underlying comorbidities, with 65.1% presenting immunosuppressive conditions. CONCLUSIONS:In hospitalized adults with LRTI, RV detection rates are comparable to those in asymptomatic individuals, suggesting frequent incidental carriage rather than a primary causal link to severe disease. Conversely, RV is a major pathogen in acute, non-severe community illness in adults and a clearly pathogenic agent in severe LRTI in children.
AIM:This study examines the predictive power of constructs from the health belief model (HBM) and theory of planned behaviour (TPB) in explaining malaria vaccine acceptance in Ghana in the post-COVID-19 era, while also assessing the reliability of these constructs within this context. METHODS:A cross-sectional survey of 622 adults was conducted in two Ghanaian municipalities representing high- and low-malaria endemicity. Constructs from HBM and TPB, alongside contextual factors such as religiosity and traditional medicine use, were measured. Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to assess construct validity and estimate their predictive relationships with vaccine intention. RESULTS:All constructs demonstrated strong reliability (Cronbach's α = 0.894-0.985) and convergent validity (AVE = 0.797-0.971). The model demonstrated strong predictive power, explaining 67.6% of the variance in vaccine intentions (R2 = 0.676). Attitudes (β = 0.578, p < 0.001) and perceived benefits (β = 0.531, p < 0.001) were the strongest predictors of acceptance. Perceived behavioural control had a marginal effect (β = 0.124, p = 0.064). Perceived disease vulnerability negatively predicted intention (β = -0.330, p = 0.006), while perceived severity and subjective norms were non-significant. CONCLUSION:HBM and TPB constructs are reliable and valid in predicting malaria vaccine acceptance in Ghana. Interventions should focus on strengthening positive attitudes and highlighting the benefits of vaccination, while addressing misconceptions among those who perceive themselves as most vulnerable. This study provides novel evidence on malaria vaccine acceptance in a post-pandemic context and underscores the utility of combining HBM and TPB for predicting preventive health behaviours in sub-Saharan Africa.
BACKGROUND:Eosinophilia is a common clinical finding with diverse etiologies. Helminthiasis is a major aetiology in tropical regions, but data from haematology consultation services at tertiary centres in endemic settings are limited. OBJECTIVES:To determine the prevalence of helminthiasis among patients with eosinophilia at a tropical tertiary care centre and identify clinical and laboratory characteristics differentiating helminth from non-helminth etiologies. METHODS:A prospective cohort study with predefined retrospective outcome classification was conducted at Siriraj Hospital, Thailand (January 2022 to November 2023) in adult patients with blood eosinophilia above 500 cells/μL. All patients underwent helminth screening through stool examination and serological testing for strongyloidiasis, gnathostomiasis, angiostrongyliasis, filariasis and cysticercosis, and received empirical ivermectin or albendazole with monthly follow-up for 6 months. RESULTS:Among 131 patients, 76 (58.0%) were diagnosed with helminthiasis, comprising 49 definite (laboratory-confirmed) and 27 probable (treatment-response-defined) infections. Strongyloidiasis (53.1%) was most common among definite infections, followed by gnathostomiasis (40.8%) and cysticercosis (26.5%), with multiple infections in 24.5% of definite cases. The median time to absolute eosinophil count (AEC) normalization was 1.0 month (IQR: 1.0-2.0), with 93.4% normalizing within 3 months. Probable infections were significantly associated with soil contact and forest travel (all p < 0.05), while definite infections were associated with organism-specific exposures (all p < 0.05). Patients aged 75 years or above showed significantly lower AEC at presentation (adjusted geometric mean ratio 0.52, 95% CI: 0.31-0.89, p = 0.017). Leukopenia and hypoalbuminemia were more prevalent in non-infectious etiologies. CONCLUSIONS:Helminthiasis was identified in more than half of patients with eosinophilia at a tropical tertiary haematology service. Empirical anthelmintic therapy effectively normalized eosinophilia in the majority within 3 months, supporting its use as a standard initial approach in endemic settings. Detailed exposure anamnesis and concurrent evaluation for non-helminth etiologies, particularly in patients with leukopenia or hypoalbuminemia, should be routinely performed.
Bangladesh is experiencing one of the deadliest outbreaks of measles in 2026, with at least 472 suspected child deaths and over 67,079 suspected cases as of 27 May 2026. It has happened primarily following a fall in measles vaccination coverage in 2025, largely due to the cancellation of a planned 2024 Measles-Rubella vaccination Campaign and major political unrest. This editorial, based on available surveillance data, disease transmission modelling and lower vaccination coverage, argues that the 2026 measles outbreak was predictable, preventable and needed prompt action and management. We urge attention to addressing the issues related to structural and programmatic barriers, political and financial gaps in the planning, challenges related to Supplementary Immunisation Activity (SIA) scheduling and recommended-to protect vulnerable high-risk communities.
Dengue remains a major public health challenge in tropical regions, where viral genetic diversity, vector ecology and human mobility contribute to recurrent outbreaks. In 2024, Brazil experienced its largest recorded dengue epidemic, with intense transmission across the Northeast region. This study characterizes the epidemiological, genomic and phylogeographic features of dengue virus (DENV) circulation during the 2024 outbreak in Alagoas, northeastern Brazil. Of 6102 suspected cases analysed by molecular diagnostics, 1607 (26.3%) were confirmed as DENV infections. Epidemiological analyses revealed widespread transmission across 79 municipalities, marked seasonality with peak incidence between March and August, and a disproportionate burden among adolescents and young adults. DENV-1 and DENV-2 were the predominant serotypes, accounting for 57.1% and 42.6% of confirmed cases, respectively; three DENV-3 infections and one DENV-1/DENV-2 co-infection were also identified. Whole-genome sequencing yielded high-quality genomic data supporting phylogenetic and phylogeographic analyses. DENV-1 sequences belonged to genotype V, classified into lineages E.1 and D.1.1, while DENV-2 sequences clustered within genotype II (lineage F.1.1.2) and genotype III (lineage C.1.1). Time-scaled phylogenetic analyses revealed multiple independent introductions of both serotypes from distinct Brazilian regions, followed by sustained local transmission and lineage expansion. Infections among non-residents, including an international case, further underscore the role of population mobility in viral dissemination. Collectively, these findings indicate that the 2024 outbreak was driven by recurrent viral introductions combined with the persistence of locally established transmission chains, highlighting the value of integrated genomic surveillance for outbreak preparedness and public health response.
In malaria-endemic regions, repeated episodes of uncomplicated malaria during infancy are common; however, their associations with neurodevelopment remain unclear. We examined relationships between malaria frequency in infancy and neurodevelopmental outcomes in early and middle childhood, using data from the APEC birth cohort nested within the MiPPAD birth cohort study of Benin. Children were enrolled between January 2010 and June 2011 and followed from birth to 24 months of age. Malaria was assessed at scheduled visits at 6, 9 and 12 months using both PCR and microscopy, and at unscheduled visits for symptomatic episodes using only microscopy; haemoglobin was measured concurrently. Neurodevelopment was assessed at age 1 and 6 years. Analyses included 311 children at 1-year and 248 at 6-year assessments. Malaria exposure was defined as the number of episodes from birth to 1-year neurodevelopmental assessment for three measures: (i) total malaria (PCR- or microscopy-positive), (ii) symptomatic malaria (positive with fever) and (iii) malaria with anaemia (positive with haemoglobin < 11.0 g/dL). Associations with neurodevelopment and haemoglobin's mediating role were assessed using adjusted generalized linear models and mediation analysis. We found that a higher number of symptomatic malaria episodes during infancy was associated with lower motor scores at age one (β: -2.81, [-4.73, -0.89]) and age six (β: -1.43, [-2.65, -0.22]), partially and potentially mediated by haemoglobin concentration. Malaria with anaemia was associated with lower motor scores at age one (β: -1.57, [-3.04, -0.10]) and age six (β: -0.96, [-1.86, -0.05]). No consistent associations were observed with cognitive outcomes. These findings indicate that uncomplicated malaria in infancy is an important risk factor for impaired child development and should not be overlooked. Integrating anaemia screening and management into malaria control and routine child health services may help mitigate long-term developmental impacts in malaria-endemic settings.
