Onchocerciasis is a parasitic disease transmitted by blackflies, with a global target for elimination of transmission (EOT) to be verified in at least 12 countries by 2030. Historical vector control and mass drug administration (MDA) with ivermectin have driven substantial progress, including WHO successful verification of EOT in four American countries and, in 2025, Niger as the first in Africa. Yet, transmission persists after decades of control in some historically highly endemic areas. Field surveillance and transmission modelling suggest that even high-coverage biannual treatment may be insufficient where pre-control prevalence was high and blackfly biting remains intense. Progress may also be constrained by groups ineligible for MDA, systematic non-participation and Loa loa co-endemicity. Accelerating EOT may therefore require moving beyond a uniform MDA model towards context-specific, integrated intervention packages. These may combine established methods, such as intensified MDA and focal larviciding, with context-specific or emerging options. These include more potent microfilaricidal treatment with moxidectin, focal anti-Wolbachia macrofilaricidal regimens, test-and-not-treat approaches in L. loa co-endemic areas, and community-led vector control, such as slash-and-clear where ecologically suitable. Transmission modelling can help target intensification and interpret surveillance evidence for stop-MDA decisions. Onchocerciasis-associated epilepsy provides an additional public health rationale for accelerating elimination and, where its burden is substantial, for considering neurological outcomes as secondary measures of programme impact. Strategy selection for reaching EOT in challenging transmission settings should account for pre-control endemicity, vector ecology, human mobility, programme capacity, financing, community acceptability and sustainability, alongside continued surveillance to assess progress and detect any recrudescence.
IntroductionSuperficial mycosis are infections caused by dermatophytes, yeasts, or other filamentous fungi that affect the skin and its appendages. They are the most common fungal infections and represent a global public health challenge. Predisposing factors include unfavorable microenvironmental conditions, advanced age, trauma, and immunosuppression. Immune-mediated inflammatory diseases (IMIDs) are characterized by shared inflammatory pathways and dysregulation of the immune system and are associated with the loss of immunological tolerance to self-antigens. Rheumatoid arthritis is the most common immune-mediated inflammatory disease, and the affected patients are particularly susceptible to infections of various etiologies because of the immunosuppression associated with both the disease and its treatment with anti-inflammatory and immunomodulatory drugs. The objective of this study was to compare the frequency of mycological confirmation, clinical presentation and etiological spectrum among patients with and without IMID.MethodsThe study included 82 consecutively recruited patients with lesions suggestive of superficial mycosis, classified into those with IMID (n = 51) who received treatment in the Rheumatology Department and those without IMID (n = 31) seen in the Dermatology Department, at a secondary-level hospital in Mexico City over a 19 months period. Skin and/or nail samples were collected from lesions for direct examination and culture. Fungal isolates were identified by morphological analysis and PCR-sequencing.ResultsPatients with rheumatoid arthritis predominated. In patients with IMID superficial mycosis was confirmed in 29/51 (56,8%) by microscopic examination and in 23/29 (79,3%) by culture. In patients without IMID superficial mycosis was confirmed in 15/31 (48,4%) patients based on a positive direct microscopic examination and in 9/15 (60%) patients by positive culture. The most frequently identified species was Trichophyton rubrum, followed by Candida spp. and Trichosporon spp. Several infection-associated species were mainly found in the group with IMIDs: 9/23 (39,1%).ConclusionThis study expands possibilities for investigating various aspects of fungal infections and their causative agents in patients with IMIDs, with the participation of multidisciplinary specialist teams.
BackgroundTimely and reliable payment of frontline health workers is critical for the implementation of Neglected Tropical Disease (NTD) mass campaigns. However, traditional payment systems can be inefficient and prone to delays, particularly at scale. Digital payment solutions offer a potential pathway to improve efficiency and reliability, yet empirical evidence from large-scale campaign settings remains limited.MethodsThis study evaluated changes in payment performance following the introduction and subsequent scale-up of a digital payment workflow integrating DHIS2-based data collection with Nigeria’s NUBAN account verification system. Administrative data from NTD campaigns conducted in 2023 and 2024 in Rivers and Oyo States, Nigeria, were analyzed. Descriptive statistics, Mann–Whitney U tests, and multivariate regression were used to assess differences in payment success and failure rates, processing time, and delay components, controlling for batch size, payment amount, and state.ResultsPayment processing efficiency improved significantly in 2024. Median total processing time decreased from 35 to 12 days, while median operational delay decreased from 33.5 to 10 days. In contrast, median finance-related delays increased from 1 to 3 days, indicating a bottleneck at the financial processing stage. Median payment success remained 100% in both years, while the mean failure rate decreased from 1.14% to 0.54%, and absolute failed transactions declined from 690 to 332 despite increased transaction volume. Regression analysis confirmed a significant reduction in processing time in 2024 after adjustment for batch size, payment amount, and state.ConclusionThe integrated digital payment workflow was associated with substantial improvements in payment-processing efficiency while maintaining consistently high payment reliability as operations expanded. However, persistent delays in the financial processing stage highlight the need to strengthen downstream financial workflows and coordination with financial service providers.
IntroductionMicrobial community structures and dissemination of antimicrobial resistance (AMR) are shifting in tropical coastal ecosystems amid rapid urbanization and anthropogenic pressure. However, integrated genomic surveillance of pathogens, resistome, and bacterial hosts along the Gujarat coastline remains incomplete, limiting environmental risk assessment based on the One Health approach. In this study, integrated shotgun metagenomics was performed to understand the microbial diversities, priority pathogens, antimicrobial resistance genes (ARGs), and organism-level ARG- host associations in the Gujarat Coast and the anthropogenic factors influencing the resistome structure. MethodsIn present study, whole metagenome shotgun sequencing was performed on surface-water samples collected from ten coastal sites, comprising both enriched and control sites. Taxonomic profiles were obtained using Kraken2 and antimicrobial resistance genes using AMRFinderPlus. The resistance determinants were cross-referenced with other sequences in the contigs and then compared with the Comprehensive Antibiotic Resistance Database (CARD), an online resource containing over 200,000 antibiotic resistance genes. Spatial variation and resistance patterns were assessed using alpha diversity, Bray–Curtis ordination, hierarchical clustering, and functional resistome profiling. ResultsSpatial variation was highly apparent, as Pseudomonadota and Bacillota dominated most sites, and anthropogenically influenced sites had site-specific enrichment of WHO priority bacterial genera. The high-priority Pseudomonas, and the critical-priority Enterobacterales (Escherichia, Enterobacter, Citrobacter) were found mainly in Ghogha, Daman, and Dumas. Some genera of fish pathogens, such as Aeromonas and Photobacterium, were found to be distributed locally, whereas some genera associated with tropical diseases, such as Vibrio and Burkholderia, were present at low levels. The resistome consisted mainly of antimicrobial resistance genes, with significant metal resistance and virulence-associated genes, consistent with potential co-selection under multiple environmental stressors. All alpha diversity, principal coordinates analysis, and hierarchical clustering statistics identified geographic location as the primary factor influencing resistome composition, and not enrichment treatment. A total of 699 bacterial host species were found to contain bacterial ARG, only 72 of which were linked to CARD, resulting in a large number of new ARG-host associations in the environment and a significantly increased diversity of host species for potential ARG reservoirs. DiscussionThis study represents a single-time-point pilot survey across ten coastal sites; findings are descriptive, genus-level, and based on genotypic resistance detection. To our knowledge, this study provides the among the first genomic baseline of pathogens, resistome, and ARG-host associations along the Gujarat coastline. The results highlight the usefulness of One Health surveillance of metagenomic data at the contig level and the need for specific environmental monitoring and antimicrobial resistance mitigation in anthropogenic hotspots.
BackgroundSoil-transmitted helminthiasis infections are targeted for elimination as a public health problem by 2030 under the Kenya Master Plan for neglected tropical diseases (2023-2027) and the Kenya health policy (2014-2030). Preventive chemotherapy via mass drug administration remains the primary control strategy. This study aimed to determine the programmatic effectiveness of albendazole among school-age children attending primary schools in Kisii, Narok, and Vihiga Counties that have participated in the National School-Based Deworming Programme since 2012.MethodsA prospective longitudinal study comprising repeated cross-sectional surveys was conducted between March and July 2019. Counties were purposively selected based on sustained high infection prevalence (>30%) or low relative reduction in prevalence (<50%) in the 2018 national evaluation survey. Primary schools with historical prevalence exceeding 30% were sampled, and children were screened using the Kato-Katz technique at baseline. Baseline-positive children (n = 573) were enrolled and monitored across three sequential post-treatment follow-up rounds. Cure rates and egg reduction rates were evaluated against baseline using weighted Poisson regression models with robust variance estimation, with non-linear parameter transformations and 95% confidence intervals derived using delta method.ResultsAt Follow-up 1, albendazole demonstrated high effectiveness against Ascaris lumbricoides, achieving a cure rate of 94.80% (95% CI: 92.61-97.00%) and an egg reduction rate of 95.54% (95% CI: 92.36-98.71%), surpassing the World Health Organization performance benchmark (>=95%). For Trichuris trichiura, the cure rate was 65.41% (95% CI: 56.49-74.34%) and an egg reduction rate of 53.79% (95% CI: 15.95-91.62%), with lower egg reductions observed in specific subgroups. For hookworm, initial cure rate was 76.74% (95% CI: 26.84-126.63%) and egg reduction rate was 99.40% (95% CI: 97.89-100.90%). Over subsequent monitoring, cure and egg reduction rates fluctuated, reflecting local environmental re-exposure and transmission dynamics.ConclusionsSingle-dose albendazole demonstrated high initial effectiveness against Ascaris lumbricoides at the first follow-up, meeting the (>=95%) World Health Organization egg reduction threshold. However, observed treatment effectiveness fluctuated across subsequent survey rounds without re-treatment, and Trichuris trichiura exhibited a sub-optimal response with subgroup variations that failed to meet threshold. Overall, while single-dose albendazole maintains robust effectiveness against roundworm, its localized programmatic effectiveness against whipworm remains limited in these persistent transmission foci.
