Seasonal variations in bloodstream infections (BSIs) have been reported for several bacterial species. The independent effects of weather variables, such as humidity, temperature, precipitation, and bright sunshine duration have not been fully considered. We analyzed monthly BSI incidence rates at Teikyo University Hospital, Tokyo, from January 2014 through December 2024. Incidence was defined as the number of new BSI cases per 10,000 inpatient-days each month. Meteorological data were obtained from the Japan Meteorological Agency. Absolute humidity (AH) was residualized against temperature and calendar-month fixed effects (AHresid) to isolate the humidity component independent of temperature and seasonality. Monthly BSI counts were analyzed using negative binomial regression models with a log link and an offset for monthly inpatient-days to assess associations with weather variables. During the 11-year period, AHresid demonstrated a significant association with Escherichia coli (E. coli)-specific BSI incidence (IRR 1.11 [95% CI 1.01–1.21], p = 0.03). In contrast, other weather variables, such as temperature, precipitation and bright sunshine duration showed no association with all-cause and E. coli-specific BSIs. We found that rising humidity was associated with increased E. coli-specific BSI incidence. Because increments in temperature and humidity are both expected with global warming, continued surveillance of climate-related trends in bloodstream infections is warranted.
Background Multidrug-resistant (MDR) Escherichia coli mediated urinary tract infections (UTIs) are an increasing public health concern, especially in low- and middle-income nations. This study aimed to determine the prevalence, antimicrobial resistance and virulence profile, biofilm forming ability with phylogenetic distribution and genetic diversity of uropathogenic E. coli (UPEC) isolated from UTI patients. Methods A total of 718 urine samples were collected from the diagnostic outpatient department of Mymensingh Medical College, Mymensingh, Bangladesh. Samples were analyzed using standard culture technique, and E. coli was identified by MALDI-TOF MS and PCR. Phenotypic antibiotic resistance was detected by the disc diffusion method. Both CRA and CVMP techniques were used to identify the biofilm forming ability. Virulence and resistance genes were identified by PCR. Genetic diversity was studied through phylogrouping, ERIC-PCR, and sequencing of 16s rRNA gene. Result 125 (17.41%) samples showed significant bacteriuria and were confirmed as UTI cases. E. coli was identified in 38 (30.4%) of these cases and most of the isolates were recovered from females (63.2%) and individuals aged 15-35 years (47.4%). High resistance was observed against meropenem (100%) and amoxicillin (100%), while nitrofurantoin (7.9%) and imipenem (23.7%) had the lowest resistance rate. All of the study isolates were either MDR (66%) or XDR (34%). blaOXA (81.6%), blaCTX-M (55.3%), and qnrA (89.5%) were most prevalent resistance genes. A strong positive correlation (rₛ = 0.719, p<0.001) was found between resistance gene load and the multiple antibiotic resistance (MAR) index. crl (100%), uidA (100%), and csgA (94.7%) were highly prevalent virulence genes. Approximately 85% of isolates were biofilm producer. Phylogenetic group B2 (36.82%) was predominant and significantly associated with virulence gene carriage and biofilm formation. Furthermore, ERIC PCR revealed a considerable genetic variability among the study isolates. Conclusion These findings highlight the alarming spread of MDR and XDR E. coli strains with high virulence potential, emphasizing the need for continuous monitoring and judicious antibiotic use.
Background Bacterial gastroenteritis is a public health challenge in South Korea, largely driven by foodborne pathogens including Salmonella, Vibrio, enteropathogenic Escherichia coli (EPEC), and Campylobacter. While national surveillance systems provide valuable epidemiological data, they primarily rely on retrospective reporting and have limited capacity to anticipate future outbreaks. This limitation highlights the need for predictive approaches that can support timely public health interventions. Methods In this study, we constructed a two-stage probabilistic forecasting framework that integrates temporal patterns with spatial dependencies. Using nationwide National Health Insurance data from 2014 to 2023, the model was designed to capture both long-term trends and short-term fluctuations across 16 administrative regions. Forecast performance was assessed using mean absolute error (MAE) and root mean square error (RMSE). Results The proposed model achieved the lowest MAE for Salmonella (29.52), Vibrio (0.85), and EPEC (18.19), outperforming the next-best alternatives such as LightGBM and NeuralProphet by 14.4%, 2.3%, and 9.2%, respectively. Campylobacter displayed a highly predictable annual cycle for which an Error, Trend, Seasonality decomposition model proved more accurate (MAE 23.15 vs. 23.81). Province-level spatial analysis identified Salmonella hotspots in Jeju and Jeollabuk-do, Vibrio risk concentrated in coastal and metropolitan areas, and Campylobacter burden was elevated in Jeollabuk-do. Conclusions The two-stage spatiotemporal framework, which separates structural incidence drivers from short-term residual dynamics, achieved superior predictive accuracy for three of four pathogens while producing uncertainty-aware probabilistic forecasts. Its capacity to characterize province-level patterns in claims-based pathogen-coded gastroenteritis diagnoses and generate forward-looking estimates suggests potential applicability for supporting evidence-informed foodborne disease surveillance in South Korea, including future climate-sensitive extensions.
Background Malaria remains a global public health emergency with high mortality especially among children under 5 years. Despite increased research on pediatric malaria vaccines, comprehensive evidence syntheses are limited. We aimed to assess the efficacy and safety of currently available malaria vaccines in children. Methods Following PRISMA we included Phase IIb–IV and post-marketing studies from PubMed, SCOPUS, WoS, ClinicalTrials.gov, ISRCTN, EUCTR, CTIS and PACTR. Licensed and candidate vaccines used to individuals <18 years were compared with controls or seasonal malaria chemoprevention (SMC). Outcomes were seroconversion, incidence of clinical malaria and serious adverse events (SAE). Meta-analyses were performed for the intention-to-treat cohorts with subgroup analyses by vaccine type and follow-up (PROSPERO: CRD420251032609). Results 56 trials were included (134424 participants). The proportional meta-analysis revealed an overall SAE rate of 16% (95% CI 12% -19%), higher for RTS,S/AS02 (29%; 95% CI 14%-44%) and lower for R21-MM (3%; 95% CI 2%-3%). In comparative analyses vaccination reduced SAE risk by 9% vs controls (RR=0·91; 95% CI 0·86–0·96). Overall vaccine efficacy (VE) was 31% (IRR=0·69; 95% CI 0.57–0.84), higher for RTS,S/AS02 (47%; IRR=0·53; 95% CI 0.36-0.80) and RTS,S/AS01 (32%; IRR=0·68; 95% CI 0.57-0.81). R21-MM showed a VE of 72% (IRR=0·28; 95% CI 0.22-0.34, single trial Phase 2b). Efficacy declined with time: 33% (IRR=0·67; 95% CI 0.43-1.02) within 12 months, 35% (IRR=0·65; 95% CI 0.50-0.82) at 12–36 and 11% (IRR=0·89; 95% CI 0.81-0.99) beyond 36 months. The combination of vaccination and SMC showed 65% (IRR=0·35; 95% CI 0.23-0-51) efficacy. Cumulative seroconversion rate was 0·99 (95% CI 0·98–1·00). Comparative seroconversion analysis was not feasible due to absent control data. No study was rated as low quality by RoB2. Conclusions Malaria vaccines in children show a favorable safety profile and provide meaningful although time-limited protection against clinical malaria. RTS,S and R21 vaccines achieve the highest efficacy particularly in combination with SMC. Malaria vaccination should be integrated into childhood malaria control strategies emphasizing the need for booster strategies and long-term effectiveness monitoring in endemic settings.
BACKGROUND:Fungal infections are a growing clinical concern, especially among immunocompromised patients. Local data on fungal isolates remain limited in Saudi Arabia. This study described the annual distribution of major fungal groups and the overall species-level distribution of fungal isolates recovered from clinical specimens at a tertiary center. METHODS:A retrospective analysis was conducted on clinical specimens submitted for fungal culture between 2021 and 2024 at a central mycology laboratory in Riyadh, Saudi Arabia. Blood culture isolates were excluded because they follow a separate diagnostic workflow and are referred to the mycology laboratory only after a positive result. Isolates were identified using conventional methods and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Annual distribution was assessed at the level of major fungal groups (Candida species, filamentous fungi, non-Candida yeasts and yeast-like fungi). Genus and species-level distributions are reported as cumulative totals throughout the study period. RESULTS:Of 7443 specimens processed, 1658 (22%) yielded fungal growth. Candida spp. were the most frequently identified isolates (64.3%), followed by filamentous fungi (27.1%), then non-Candida yeasts and yeast-like fungi (8.6%). The predominant Candida spp. were Candida albicans (39.7%), Nakaseomyces glabratus (formerly C. glabrata) (14.7%), C. dubliniensis (12.5%), C. tropicalis (10.0%), C. parapsilosis (9.7%), and Candidozyma auris (formerly C. auris) (5.8%). Among filamentous fungi, Aspergillus spp. constituted the largest group (43.9%), followed by dermatophytes (37.4%). The predominant species were A. flavus (18.9%), A. niger (16.5%), Microsporum canis (25.8%), and the Trichophyton mentagrophytes/interdigitale complex (7.8%). Isolate distributions varied by specimen type, with the highest numbers recovered from patients aged ≥ 65 years. CONCLUSIONS:This four-year study described the distribution of fungal isolates in a Saudi healthcare setting. Candida spp. were the predominant fungal isolates overall, with C. albicans being the most frequently recovered species, while Aspergillus spp. represented the predominant filamentous fungal group.
BACKGROUND:COVID-19 non-pharmaceutical interventions disrupted respiratory syncytial virus (RSV) transmission globally. In Australia, RSV surged back after restrictions eased, whether this reflected immunity debt repayment or epidemic amplification is untested. METHODS:We conducted a national interrupted time-series analysis using Australian Institute of Health and Welfare hospitalisation data from financial years (FY) 2010/11-2023/24. The primary outcome was RSV-attributable fraction (RSV-AF) of bronchiolitis in infants and children 1-4 years. Pre-pandemic counterfactual trends were estimated by linear extrapolation of FY2010/11-2019/20 training data, this was appropriate given the stable, low-gradient pre-pandemic RSV-AF trends in both groups. For adults ≥ 65 years, a flat counterfactual (pre-pandemic mean) to bound estimates where a secular ascertainment rise made linear extrapolation inappropriate. Formal amplification test: one-sided Z-test of whether rebound exceeded suppression deficit. Influenza-attributable fraction used as a pathogen-specific comparator to isolate RSV from general respiratory rebound. Non-RSV bronchiolitis decomposed to rule out general post-pandemic denominator effects. RESULTS:In infants, pre-pandemic RSV-AF was 32.3% (SD 1.8%). In FY 2022/23, it reached 52.0% (z = 10.78; p < 0.001), 19.7 %age points above the pre-pandemic upper control limit. RSV bronchiolitis accounted for 95.1% of the total bronchiolitis increase; non-RSV bronchiolitis remained below counterfactual. In 1-4-year-olds, RSV-AF of bronchiolitis reached 49.1%, against a pre-pandemic mean of 23.2%. Formal testing found rebound significantly exceeded deficit in infants, 1-4-year-olds, and 5-19-year-olds (all p < 0.001). Adults 20-64 years showed significantly incomplete discharge (β=0.71, meaning the rebound recovered only 71% of the accumulated suppression deficit; p = 0.020). CONCLUSIONS:The RSV rebound in young children significantly exceeded the suppression deficit, consistent with epidemic amplification potentially reflecting accumulated primary-infection susceptibility in unvaccinated cohorts. After explanations (testing intensity, admission thresholds, demography, and coding changes) were accounted for. The FY2022/23 baseline provides the pre-vaccination reference for evaluating Australia's RSV immunisation program.
Human Papillomavirus (HPV)-associated cervical cancer is an emerging public health priority. This review summarizes HPV-related research conducted across GCC countries and identifies key gaps in the current research landscape. Studies were grouped into six broad descriptive research domains to show where evidence is concentrated or sparse. Nearly, half of 106 HPV-related studies were conducted in Saudi Arabia (47.2%), while approximately one-fifth were from the United Arab Emirates (UAE) (18.9%). Studies on epidemiology/molecular characterization of HPV were dominant (38.5%), followed by studies on barriers to vaccine uptake and screening (28.1%). Among 37 HPV-genotyping-related studies, 43 genotypes were reported (23 low-risk and 20 high-risk). Genotypes with the highest crude sample-level detection proportion were HPV-27 (23.6%), HPV-57 (13.9%), and HPV-1 (11.1%). These genotypes reflect wart-related and cutaneous-sample studies. Among the high-risk genotypes for cervical cancer, HPV-67 (3.8%) and HPV-66 (3.6%) were the most common. HPV-related research in GCC countries remains predominantly descriptive, unevenly distributed, and with gaps in implementation research and high-risk populations.
OBJECTIVES:To characterize clinical profiles of adults with possible Mycoplasma pneumoniae-associated meningoencephalitis and evaluate whether serologic diagnostic categories are associated with phenotypes or prognosis. METHODS:We conducted a retrospective, single-center cohort study (March 2005-July 2023). Among 184 adults with meningoencephalitis who underwent confirmatory testing for M. pneumoniae, 39 met predefined criteria for possible M. pneumoniae-associated meningoencephalitis based on serologic evidence and were stratified into seroconversion (n = 8), IgM-positive (n = 11), and single high-titer (≥1:320; n = 20) subgroups. RESULTS:Median age was 40 years (IQR, 30.5-49) and differed across subgroups (P = 0.018). Cerebrospinal fluid (CSF) leukocyte counts were higher in the IgM-positive group (P = 0.031), while other CSF parameters were similar. Brain MRI abnormalities were common (78.9%), with leptomeningeal enhancement in 55.3%. EEG abnormalities were found in 35.9%, most often diffuse cerebral dysfunction. Median hospitalization was 15 days; 76.9% received targeted antibiotics (median 7 days). Ninety-day mortality was 2.6% (unrelated to meningoencephalitis), and neurologic sequelae occurred in 28.2%. CONCLUSIONS:In adults with possible M. pneumoniae-associated meningoencephalitis, we observed an intermediate inflammatory and imaging phenotype between classic bacterial and viral central nervous system (CNS) infections. Despite low mortality, neurologic sequelae were frequent. Serologic subgroups were associated with differences in inflammatory profiles and treatment patterns but not major clinical outcomes.
Methicillin-resistant Staphylococcus aureus (MRSA) remains a major public health concern, particularly in healthcare settings. This systematic review and meta-analysis aimed to estimate the pooled prevalence of MRSA and characterize SCCmec distribution among clinical isolates in Iran. A comprehensive search of PubMed, Embase, Scopus, and Web of Science identified Iranian studies published up to May 2025. The pooled prevalence of MRSA among human S. aureus isolates was 46.4% (95% CI: 43.6-49.3%, I2= 96.9%, P < 0.001). Publication bias was suggested by Egger's test, and trim-and-fill analysis reduced the pooled estimate from 46.4% to 38.8%. Among 89 studies, type III was the most prevalent (44%), while type IVb was the least common (6%). These findings highlight a substantial MRSA burden and the predominance of hospital-associated clones in Iran. However, the pooled estimates should be interpreted with caution because of the considerable heterogeneity among the included studies. Strengthening infection prevention control and antimicrobial stewardship remains essential.
BACKGROUND:Brucella endocarditis is a life-threatening complication of brucellosis that frequently presents as culture-negative endocarditis in endemic regions, posing significant diagnostic and therapeutic challenges. METHODS:We conducted a retrospective case series of 22 patients (median age 52.5 years, 90.9% male) with confirmed Brucella endocarditis managed at a tertiary center in a brucellosis-endemic area between 2009 and 2024. RESULTS:Initial blood cultures were negative in 59% of patients, while Brucella spp. were ultimately isolated from blood or valve tissue cultures in 10 patients. Serology was positive in 20/22 (90.9%), with a median standard agglutination test (SAT) titer of 1:2560 (range 1:320-1:10240). Underlying valvular disease was universal: rheumatic (31.8%), congenital (36.4%) predominantly tetralogy of Fallot and prosthetic valves (31.8%). Echocardiography showed large, mobile vegetations (mean diameter 12 mm), abscess formation in 22.7%, and frequent multivalvular involvement. All patients received combination antimicrobial therapy (median duration 4.5 months), most commonly doxycycline, rifampicin, and an aminoglycoside. Surgical intervention was required in 72.7% (16/22), primarily valve replacement; one patient died (4.5%). Relapse occurred in 18.2% (4/22), all successfully retreated. At follow-up, serological titers declined significantly. CONCLUSIONS:Brucella endocarditis should be actively considered in patients with culture-negative endocarditis in endemic regions, particularly in those with structural or prosthetic heart disease. This case series emphasizes the importance of early recognition, multidisciplinary evaluation and individualized medical and surgical management in this complex infection.
BACKGROUND:Lower respiratory tract infections (LRTIs) are complicated by diverse pathogens, posing challenges to traditional diagnostics. However, robust evidence on LRTI pathogen spectra and metagenomic next-generation sequencing (mNGS) clinical utility remains limited. METHODS:A retrospective analysis was conducted among 815 patients with suspected LRTIs who underwent mNGS and conventional microbiological testing(CMT) of bronchoalveolar lavage fluid. We evaluated the pathogen spectrum, the diagnostic value of mNGS across different infection categories, and its utility in guiding antibiotic therapy. RESULT:Following exclusions, 754 patients demonstrated 84.5% mNGS positivity. mNGS detected DNA viruses (33.85%, EBV predominating), bacteria (30.83%), fungi (23.30%), mycobacteria (9.43%), and special pathogens (2.59%). Confirmed pathogens included Mycobacterium tuberculosis (n = 124), Candida albicans (n = 118), Pseudomonas aeruginosa (n = 87), Pneumocystis jirovecii (n = 65), Haemophilus influenzae (n = 50) and Aspergillus fumigatus (n = 48). mNGS showed higher positivity than CMT (84.5% vs 53.6%, P < 0.05), with sensitivities of 90.6% (LRTIs), 73.3% (bacterial), 74.7% (fungal), and 81.9% (tuberculosis); specificities were 22.6%, 56.5%, 73.5%, and 96.4%. Its high sensitivity but modest specificity necessitates cautious interpretation. mNGS guided treatment adjustments in 48.4% of patients, with higher rates in critically ill patients (60.1% vs 45.7%, P < 0.05), though clinical improvement was lower in this group (54.7% vs 79.2%, P < 0.05). CONCLUSIONS:mNGS comprehensively detects pathogens in LRTIs, including bacteria, fungi, mycobacteria, DNA viruses, and special pathogens. While its broad diagnostic value and treatment guidance utility are significant, integration with clinical context is essential to distinguish true pathogens from colonization.
BACKGROUND:Although serotype 23F is included in the current pneumococcal conjugate vaccines (PCVs), its recent contribution to the emergence of levofloxacin-resistant invasive Streptococcus pneumoniae in South Korea remains unclear. Despite the inclusion of serotype 23F in PCVs, recent increases in the abundance of levofloxacin-resistant isolates have been observed in South Korea. METHODS:Temporal trends, antimicrobial resistance profiles, and genomic characteristics of serotype 23F isolates collected through the Infectious Diseases Surveillance System operated by the Korea Disease Control and Prevention Agency (KDCA) from 2015 to 2024 were analyzed. Whole-genome sequencing was performed to characterize lineage distribution, quinolone resistance-determining region (QRDR) mutations, antimicrobial resistance determinants, and penicillin-binding protein (PBP) allele combinations. RESULTS:Among the 1885 invasive pneumococcal isolates, 90 were resistant to levofloxacin. Of these, 29 were serotype 23F, and 68.9% (20/29) of the serotype 23F isolates were levofloxacin resistant. Serotype 23F was infrequently detected before 2020, but its contribution to levofloxacin-resistant invasive isolates became more apparent after 2021. WGS revealed that GPSC6 was first identified after 2020 and became the predominant lineage among levofloxacin-resistant serotype 23F isolates by 2022. GPSC6 isolates exhibited concurrent gyrA and parC mutations and carried multiple resistance genes, including erm(B), tet(M), folA, and folP, and harbored uncharacterized PBP allele combinations. CONCLUSIONS:These findings suggest that the recent increase in the levofloxacin-resistant serotype 23F in South Korea is associated with the expansion of GPSC6 and highlight the value of lineage-level genomic surveillance within vaccine-type serotypes.
Background Forensic psychiatric facilities in South Korea represent a critical but overlooked venue for hepatitis C virus (HCV) micro-elimination among people who inject drugs. This study evaluated the cost-effectiveness and budget impact of various HCV screening and treatment strategies within this setting. Methods We developed a hybrid decision-tree and Markov model to simulate a cohort of admitted patients. Four strategies were compared against the No Screening baseline: Scenario 1 (Universal Screening + Treatment), Scenario 2 (Targeted Screening + Treatment [age ≥40]), and two screening-only variants (Scenarios 3 and 4). The analysis was conducted from a healthcare system perspective over a lifetime horizon. Results Scenario 1 was a dominant strategy compared to No Screening, reducing liver-related mortality by 76.5% and generating a net lifetime saving of USD 114,562 per cohort. Scenario 2 was also dominant, capturing 94.7% of HCV-positive cases while requiring 28.7% fewer tests. Screening-only strategies provided minimal clinical benefit due to poor linkage-to-care outside the facility. Although Scenario 1 requires a substantial initial investment (USD 332,754 in the first year; USD 973 per individual), the budget impact analysis indicates that this expenditure would be fully offset within 12–14 years through the prevention of advanced liver disease. Conclusions Implementing an opt-out “test-and-treat” strategy in forensic psychiatric facilities is highly cost-effective and provides a strategic pathway for HCV elimination. While upfront costs are significant, the long-term clinical and economic returns justify the implementation. Age-targeted screening represents a pragmatic and efficient alternative in resource-constrained settings.
Middle East respiratory syndrome (MERS), caused by MERS coronavirus (MERS-CoV), is a zoonotic disease transmitted from camels-to-humans. We applied a targeted rapid research needs appraisal (RRNA) to review evidence and gaps on spill-over risk, mitigation measures, associated social and behavioural research. We systematically searched PubMed, Ovid, Scopus, Web of Science and WHO Global Index Medicus up to November 2024, studies on MERS and other zoonoses at the camel-to-human interface. The protocol and interpretation were informed by a WHO-coordinated MERS expert reference group and Secretariat. Of 82 records, 92.7% (76/82) were observational and 74.4% (61/82) focused on MERS. Most were set in the Eastern Mediterranean (69.5%, 57/82) region. Most studies explored spillover risk activities (n = 50), and host and occupational risk factors (n = 36). Current evidence overlooks social and cultural contexts of camel-to-human interactions, highlighting the need for multidisciplinary research and engagement with at-risk populations to inform mitigation strategies applicable to diverse contexts.
OBJECTIVE:To analyze crude and age-standardized hospitalization rates (ASRs) for Clostridioides difficile infection (CDI), temporal trends, and annual percentage change (APC) stratified by sex. MATERIALS AND METHODS:Hospital admissions with a primary diagnosis of CDI were included (ICD-9 code 008.45 for 1997-2015 and ICD-10 code A04.7x for 2016-2022), obtained from the Spanish National Hospital Data Surveillance System. Population data were sourced from the Spanish National Statistics Institute. ASR per 100,000 inhabitants were calculated using the 2022 population as the reference. Temporal trends by age and sex were analyzed using joinpoint regression (JPR), which estimates APC and assesses the statistical significance of each trend segment. RESULTS:A total of 119,682 hospitalizations were identified (56,864 men and 62,818 women). Annual admissions increased from 286 (men) and 280 (women) in 1997-6316 and 7140 in 2022, respectively. Crude and ASR rose from 1.46 and 2.23 per 100,000 in men and 1.37 and 1.71 per 100,000 in women in 1997, to 26.27 in men and 29.38 in women in 2022. JPR analysis revealed distinct sex-specific trends: among women, the increase was gradual and statistically significant (APC = 9.99, p < 0.05), whereas in men, three significant joinpoints were identified: 1997-2002 (APC = 20.48), 2002-2015 (APC = 18.2), and 2015-2022 (APC = 6.61). CONCLUSIONS:Hospitalizations due to CDI in Spain have increased markedly and progressively over the past 26 years. The rise was gradual and continuous among women, whereas men experienced three distinct periods of significant growth. These findings highlight CDI as a major public health concern and support the need for further optimization of clinical and infection prevention and control strategies.
Background Urban areas often act as early epicentres of pandemics, yet transmission dynamics across regions with different demographic profiles remains poorly understood. We aimed to characterise COVID−19 transmission in Norway and assess how it interacted with infection control measures across urban and rural settings. Methods We analysed daily COVID−19 cases across three pandemic waves (Alpha, Delta, Omicron). For local trends, 36 sites in the Greater Oslo Region were grouped by infection trajectories using group-based trajectory modelling. For national trends, we examined the cities of Oslo, Bergen, Trondheim, Stavanger, Tromsø, and Akershus county. Infection trends were analysed using linear mixed models and lagged regression analyses and related to demographic characteristics. Results In the Greater Oslo Region, three distinct site groups—high, moderate, and low infection—were identified. The high infection group had the highest population density, largest proportion of crowded housing and immigrant population and preceded the moderate and low groups by 5–13 days during the Alpha wave. Nationally, Oslo’s infection rates peaked 11–24 days before other cities during the Alpha wave, with shorter lags during the Delta and Omicron waves. Despite similar control measures, infection rates differed substantially, with the high infection group and Oslo city consistently bearing the greatest burden. Conclusions Densely populated areas with crowded housing act as early warning signals, with infection growth preceding that in other areas by days to weeks. Systematic monitoring of such high-burden urban areas could provide valuable lead time for policymakers and support more targeted, timely responses in future pandemics.
BACKGROUND:The national HPV vaccination program was introduced into the Brazilian public health system for children and adolescents in 2014. However, its population-level impact remains poorly characterized, particularly in the context of regional disparities. METHODS:We compared the incidence of cervical precancer and invasive cancer between the pre-vaccination period (2010-2012) and the post-vaccination period (2025) among screened women aged < 25 years (vaccine-eligible women) and ≥ 25 years (non-vaccine-eligible women) in Brazil and across its geographic regions. RESULTS:Among vaccine-eligible women, the incidence of CIN2 +, CIN3 +, and invasive cervical cancer was significantly lower in the post-vaccination period than in the pre-vaccination period in Brazil. Incidence rates were lower across all regions; however, statistically significant reductions in all three outcomes were observed only in the Southeast, South, and Midwest. In the Northeast, significant reductions were observed for CIN2 + and invasive cervical cancer, whereas no significant reductions were observed in the North. The reduction in invasive cervical cancer incidence was significantly greater than those observed for CIN2 + and CIN3 +. Among non-vaccine-eligible women, significant reductions were observed primarily for invasive cervical cancer. Nationally, reductions were observed among women aged 25-29 and 55-64 years. Regionally, reductions occurred in the Southeast among women aged 25-64 years, in the South among those aged 25-29 years, and in the Midwest among those aged 55-64 years. Significant reductions in CIN2 + and CIN3 + were limited to women aged 55-64 years in the Southeast and Midwest. In all other age groups, outcome and regions, incidence showed either significant increases or no statistically significant changes. CONCLUSIONS:Twelve years after the introduction of HPV vaccination, these findings support a population-level impact of HPV vaccination in Brazil and most regions among vaccine-eligible women. Among non-vaccine-eligible women, the findings suggest possible indirect protection, varying by outcome, age group and region.
BACKGROUND:In Africa, the transmission of Monkeypox (mpox), especially in countries that were initially unaffected, including Burundi, is still inefficiently reported. This study has analyzed various demographics and cases, alongside the transmission pathways and risk factors to apprise effective, setting-specific control strategies for mitigation of mpox outbreaks while also guiding prospective responses to similar outbreaks in resource-restricted contexts. METHODS:To effectively characterize the transmission patterns of clade Ib monkeypox virus, the study evaluated the laboratory-confirmed mpox cases in Bujumbura, Burundi, alongside their contacts, as from 25th July 2024-26 th October 2024. Collection of data was mainly done via patient interviews, national surveillance data, and electronic health records. RESULTS:A total of 850 laboratory-confirmed mpox cases alongside 7773 acknowledged contacts were included in the study. The average age of the patients was 20.3 (interquartile range: 22.0; range: 3 months-71 years), while a larger proportion of the patients (71.9%) comprised children aged < 5 years and younger adults aged between 16 years and 29 years. Sexual contact (58.6%) and household exposure (38.6%) were found to be the primary transmission routes. The basic reproduction number was 1.21 (95% CI (confidence interval): 1.11-1.31), with 14.0% secondary attack rates (95% CI: 12.1-15.9) among sexual contacts, as well as 13.0% (95% CI: 11.2-14.8) among household contacts. The average incubation period was found to be 9.5 days (95% CI: 7.5-11.4), while the serial interval was 15.5 days (95% CI: 12.4-18.7). CONCLUSIONS:To effectively control and manage mpox outbreak in resource-restricted contexts, the study findings have stressed on the requirement for targeted interventions to tackle sexual contact networks alongside household transmissions.
Rapid and accurate detection of tuberculosis (TB) remains challenging, especially in resource-limited settings. Considering the limitations of sputum-dependent assays, the World Health Organization (WHO) has prioritized the development of non-sputum biomarker-based TB diagnostic tools. Transcriptomic biomarkers represent promising candidates for TB detection. This narrative review updated the latest advances in transcriptomic biomarkers for TB diagnosis and triage. mRNA signatures demonstrate significant potential for TB triage, meeting or approaching the WHO Target Product Profiles. Non-coding RNAs also hold diagnostic potential and require further validation in large cohorts. Accelerating the translation of high-performing biomarkers into practical clinical tools is essential. Xpert MTB Host Response, a cartridge based on a three-gene signature, has demonstrated strong triage capabilities in multinational evaluations. Additionally, integrating transcriptomic biomarkers with clinical parameters or established diagnostics may enhance accuracy. Speeding the clinical adoption of available near point-of-care tests is crucial to the successful implementation of the End TB strategy.
OBJECTIVE:To evaluate the incidence, causality and risk factors associated with colistin-induced acute kidney injury (AKI) using the Risk Injury Failure, Loss and End-stage renal disease (RIFLE) criteria. METHODS:This is a retrospective cohort study that involved patients treated with intravenous colistin from 2016 to 2023 in the State of Qatar. The Naranjo Scale was used for causality assessment. RESULTS:A total of 186 cases were included in this analysis. The incidence of colistin-induced AKI at day 14 was 23.7%. The median (interquartile range) time to AKI onset was 5.0 (7.0) days. Of the patients with AKI, 6 (12.8%) patients received renal replacement therapy within 30 days. Naranjo causality assessment showed that the majority of the cases (80.9%) had "possible" colistin-induced AKI (score 1 - 4). Colistin dose per administration (adjusted odds ratio [AOR]: 2.286, 95% CI: 1.246 - 4.194, p = 0.008), and sepsis/septic shock (AOR: 2.380, 95% CI: 1.005 - 5.635, p = 0.049) were independent risk factors for colistin-induced AKI. CONCLUSION:One in four patients receiving colistin develops AKI, and a subset required a renal replacement therapy within 30 days. Close monitoring of patients, and the application of precision medicine are recommended to minimize the risk of AKI.
