Background:Malaria remains a leading global health threat, primarily in sub-Saharan Africa. In Tanzania, malaria continues to cause high morbidity and mortality, especially in rural areas. Animal-keeping, common in these regions, may influence the local malaria vector ecology. However, the relationship between animal-keeping and malaria risk remains to be understood, with studies showing mixed results regarding its protective or risk-enhancing effects. This study assessed the associations between malaria infection and animal-keeping practices in rural southern Tanzania, specifically whether animal species (poultry, ruminants, or pets), management location (indoors vs. outdoors), and herd size influence infection risk, providing insights for targeted malaria control strategies within a One Health framework. Methods:Data were collected from the baseline survey of the China-Tanzania malaria control project in July 2019, covering three regions: Kibiti, Rufiji and Kilwa. Interviews were conducted with households, including data on living conditions, animal-keeping practices, malaria prevalence, and health-seeking behaviors. Malaria was diagnosed using rapid detection reagents. Univariant analysis and the logistic regression models of exposure-outcome and dosage-outcome were implemented to assess the relationship between malaria infection risk and animal-keeping practices. Results:Of the 11,406 participants with malaria RDT results, 6,379 (55.93%) kept animals. Poultry-keeping was consistently associated with increased malaria risk across all analyses (univariant analysis OR 1.51 and 1.66, 95% CI 1.35-1.69, 1.51-1.82; exposure-outcome OR 1.409 and 1.596 with 95% CI 1.256-1.580, 1.450-1.757; dosage-outcome OR 1.018 and 1.014, with 95% CI 1.000-1.037 and 1.009-1.018). Results were robust after considering confounding. Conclusion:Poultry-keeping near households is associated with increased malaria risk in rural southern Tanzania. Findings suggest that managing animal placement and housing could enhance traditional vector control. Adopting a One Health framework that integrates veterinary and environmental management is essential for improving malaria intervention outcomes in rural communities.

Schistosomiasis is an important snail-borne neglected tropical disease, and detecting infected snails is a priority for its control and elimination. However, conventional parasitological methods, such as crushed snails and cercarial shedding, have limited sensitivity. In this study, we developed a novel loop-mediated isothermal amplification (LAMP) assay (smND1-LAMP) targeting the mitochondrial NADH dehydrogenase subunit 1 (ND1) gene of Schistosoma mansoni. The assay was optimized at 65 °C for 1 h and demonstrated a detection limit of one copy of the pUC57/smND1 recombinant plasmid. Its diagnostic performance was evaluated using laboratory-infected Biomphalaria snails and field-collected samples from Zimbabwe and Burkina Faso, and compared with microscopy, conventional PCR and SYBR Green real-time PCR (SGPCR). In laboratory experiments, smND1-LAMP achieved 100% specificity and 75% sensitivity, outperforming microscopy and showing a similar performance to SGPCR. In field surveys, smND1-LAMP detected a higher positive rate (25.9%) than conventional PCR (22.2%) in Burkina Faso, while microscopy failed to identify any positive snails. Both molecular methods identified infections that were missed by parasitological techniques. These findings demonstrate that smND1-LAMP assay is a sensitive, specific, and field-applicable tool for detecting S. mansoni infection in snails. It provides an effective alternative for routine surveillance and early warning of changing schistosomiasis endemicity.

The World Health Organization (WHO) has shown systemic vulnerabilities in pandemic response, resource mobilization and allocation, and political coordination, prompting strong demands for reform from member states and the international community. Against the background of global health system restructuring, WHO reform should be carried out in four aspects: adapting to changes in global disease burden and demographic structure, conforming to the trend of multipolar health governance, building an agile and efficient modern governance framework, and improving sustainable financing mechanisms. This paper constructs a hierarchy-function coupling model integrating horizontal core functions and vertical organizational hierarchies (headquarters, regional offices, and country offices) to analyze the challenges of WHO in three core functions: global health leadership, norms and standards setting, and national health capacity-building and partnership promotion. It proposes targeted reform strategies at headquarters, regional, and national levels to streamline management, decentralize authority, promote the localization of norms and standards, and shift from vertical aid to sovereign empowerment. The reform of WHO is not only an institutional adjustment but also a strategic transformation to adapt to the paradigm shift of global health governance, aiming to enhance its leadership and build a more agile, equitable, and resilient global health architecture.

Congenital babesiosis is rarely reported globally. We report a 74-day-old male infant presented with fever, pallor, and severe, life-threatening haemolytic anaemia (haemoglobin: 45 g/L). The infant had 16% parasitemia with ring forms evident on peripheral blood smear. Babesia microti infection was confirmed in both the mother and infant by PCR and metagenomic next- generation sequencing. Genetic analysis revealed an identical strain in bot. Treatment with intravenous azithromycin and oral atovaquone/proguanil resulted in rapid clearance of parasitemia and resolution of anaemia. This first molecularly confirmed case of congenital B. microti transmission in China demonstrates vertical transmission from an asymptomatic mother. It underscores the need for heightened clinical suspicion in neonates with unexplained haemolytic anaemia in endemic regions and highlights critical gaps in access to essential anti-babesia therapies.

INTRODUCTION:The China-UK-Tanzania pilot project of 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach was implemented in Tanzania between 2015 and 2018. This project targeted villages with the highest malaria incidence to conduct screening and treatment. While socioeconomic factors are known to be strongly associated with malaria burden, their specific impacts on malaria prevention behaviours during the 1,7-mRCTR implementation period remained unclear. This study aimed to construct a household wealth index and investigate its association with malaria prevention outcomes within the context of 1,7-mRCTR. METHODS:We used data from two cross-sectional household surveys conducted in 2015 (baseline) and 2018 (endline), covering 19 686 households. A 12-item wealth index was constructed using Mokken scale analysis, with weighted wealth scores calculated via multiple correspondence analysis to categorise households into wealth tertiles. Using logistic regression within a Difference-in-Differences (DID) framework, we assessed the association between household wealth and the household ownership of useful long-lasting insecticidal nets (LLINs), use of LLINs and use of antimalarial drugs. RESULTS:Analysis of the pooled data showed that households in the first (poorest) tertile had significantly lower odds of owing LLINs (OR=0.62, 95% CI 0.54 to 0.70, p<0.001) and using LLINs (OR=0.53, 95% CI 0.45 to 0.62, p<0.001) compared to the third (wealthiest) tertile. The DID analysis, accounting for the interaction between the intervention period (2018 vs 2015) and wealth tertile, showed a significantly greater increase in the odds of owing LLINs (OR=1.26, 95% CI 1.03 to 1.56) and using LLINs (OR=1.88, 95% CI 1.25 to 2.82) among households in the first tertile compared with the third tertile. CONCLUSION:The wealth index effectively differentiated household socioeconomic status, revealing significant wealth-based disparities in malaria prevention behaviours. Importantly, the implementation of the 1,7-mRCTR approach appears to have had a disproportionately positive effect on poorer households, leading to a reduction in wealth-based inequalities related to key malaria prevention measures.

Antimicrobial resistance (AMR) poses a major global health threat, yet the effectiveness of national action plans (NAPs) remains uncertain. Here we developed a multidimensional One Health governance index through a structured Delphi expert consultation to evaluate AMR governance across 193 countries (2017-2022), integrating 269 policy documents, expert-weighted indicators and multinational survey and surveillance datasets. Difference-in-differences and joinpoint regression analyses were used to link governance to antimicrobial use, AMR prevalence and AMR-related mortality. Global governance scores improved from 30.7 to 44.5/100, although implementation and monitoring lagged behind policy design, particularly in animal and environmental sectors. A significant increase in AMR prevalence scores was observed only 5 years after NAP adoption (two-stage difference-in-differences, β = 2.43, 95% confidence interval (CI) 1.02-3.85, P < 0.05), underscoring the delayed impact of policy. Multisector engagement (early-adopting countries, β = 0.05, 95% CI 0.02-0.08, P < 0.01) and antimicrobial use surveillance system (early-adopting countries, β = 0.05, 95% CI 0.03-0.07, P < 0.01) showed the strongest associations with improvement in AMR outcomes. As the 2026 Global Action Plan update approaches, sustained financing and integrated One Health surveillance, with stronger environmental and agricultural engagement, are essential for translating NAPs into sustained reductions in resistance.

Silver nanoparticles (AgNPs) have been widely used in various fields due to their biomedical applications, molluscicidal and antimicrobial activities. The hepatopancreatic of Oncomelania hupensis snails were compared and analyzed by SEM and transcriptomics differential expression genes under different concentrations of 20 nm spherical AgNPs after three consecutive days’s exposure. Genes set refers to the gene list obtained according to certain screening conditions. Hundreds of genes in AgNPs-exposed cells were differentially expressed according to the transcriptome analysis based on RNAseq, including genes implicated in rRNA processing, ribosome biogenesis, immunity, neurological and mitochondrial functions. In particular, in this investigation there are mark down regulation in genes of snails exposed to AgNPs that related to immunity processes like OAS1A, OAS1A-M with up regulation in genes related to fast signal transmission between cell like ACHB3 and genes responsible for anticancer, Ag conjugates, transcriptome regulation and gluconeogenesis (Like MRP1 and POLS). Furthermore, there are mark down regulation in genes related to collagens, calcium releasing, lipoprotein, mitochondrial and spermatogenesis processes. Our transcriptomic analysis demonstrated that exposure to 20 nm AgNPs induces significant alterations in multiple cellular and metabolic pathways, indicating pronounced toxic effects at the molecular level. These molecular disturbances were further supported by the observed structural damage in the hepatopancreas, whose surfaces appeared dull and highly fragile after exposure. Collectively, these findings provide important mechanistic insights into the molluscicidal action of AgNPs and highlight their potential application in the development of nanoparticle-based strategies for snail control and related biomedical or environmental toxicology studies.

What is already known about this topic?:Echinococcosis remains a critical public health challenge in western China. Conventional routine health education (RHE) strategies have consistently proven insufficient in achieving the sustained behavioral modifications necessary to reduce disease transmission and burden. What is added by this report?:This study provides the first large-scale experimental evidence that a Smart Health Education Pillbox (SHEP) significantly enhances knowledge, corrects misconceptions, and improves practice conversion efficiency regarding echinococcosis control among dog owners in endemic pastoral areas. These findings demonstrate the substantial value of precise, automated health education tools in controlling zoonotic diseases. What are the implications for public health practice?:The SHEP represents a scalable, precise health education tool that effectively bridges the knowledge-practice gap in resource-limited settings. Its demonstrated efficacy supports integration into national echinococcosis control programs as a cost-effective digital intervention that promotes sustainable behavior change and reduces zoonotic disease transmission.

Background: The global emergence and dissemination of carbapenem-resistant among Enterobacterales pose a substaintial public‑health threat. However, Escherichia coli (E. coli) sequence type (ST) 3014-including carbapenem-resistant ST3014 strains-remains poorly characterized, with only sporadic reports across several countries at interfaces of human, animal and environment. This research identified the genomic and plasmid features of a carbapenem-resistant ST3014 strains, thus providing reference for researchers and policy-makers for future study and intervention.Methods: A blaNDM-5 ‑harboring E. coli (coded E44) was recovered from one of 60 piglet fecal samples collected from an intensive swine farm in Qionghai City, Hainan Province. The isolates were undergone both short- and long-read sequencing, followed by hybrid assembly and functional annotation. To contextualize its genomic characteristics, a global E. coli ST3014 dataset was compiled from EnteroBase, NCBI, and published literature to assess antimicrobial resistance genes (ARGs), virulence factors (VFs), and core-genome phylogeny. Furthermore, the blaNDM-5 -carrying plasmid from E44 queried against the PIPDB database, and plasmid-level phylogenetic relatedness was inferred using Mash distances. The blaNDM-5 gene cluster of E44 further compared with other plasmids carrying blaNDM-5 to characterize the local genetic environment surrounding this resistance determinant.Results: The blaNDM-5-positive ST3014 isolate carried six ARGs and forty-two virulence factors (VFs), with blaNDM-5 located on a 124-kb IncF multireplicon plasmid. In addition to four other ARGs, this plasmid co-harbored ExPEC-associated siderophore/iron-uptake loci, including sitABCD and iucABCD-iutA. A global dataset comprising 82 ST3014 E. coli isolates demonstrated broad geographic and ecological dissemination across 23 countries, spanning human, animal, and environmental sources. Global phylogenomic and phylogeographic analyses suggested that ST3014 likely originated in Asia (China), with the lineage estimated to have emerged around 1963 and to have spread internationally after 2010. Phylogenetic analysis of 124-kb-like IncF plasmids (152 homologous sequences) indicated that these plasmids are distributed across diverse Enterobacterales hosts, with E. coli as the predominant host; notably, an E. coli-derived blaNDM-5-harboring plasmid was the closest relative of this newly identified plasmid. Comparative analysis of blaNDM-5 genetic contexts further revealed a conserved core module (ble-trpF-dsbD) bracketed by insertion sequences, particularly IS26 and ISAba125.Conclusions: The blaNDM-5 positive ST3014 E. coli isolate presents an emerging threat to the breading industry and food safety due to its global distribution and the presence of a conjugative plasmid carrying clinically relevant VFs and ARGs. Meanwhile, the multi-interface distribution of both bacteria and plasmids underscores the importance of antimicrobial resistance (AMR) surveillance under the One Health framework.

Background: The Belt and Road Initiative (BRI) encompasses 151 countries across six continents, accounting for nearly two-thirds of the global population. However, a comprehensive, up-to-date assessment of the infectious disease burden in these countries towards the 2030 Sustainable Development Goals (SDGs)—has been lacking. We aimed to systematically evaluate the burden of infectious diseases in BRI countries from 1990 to 2023, to examine regional and national disparities, and to project attainment of SDG 3.3 targets. Methods: Using data from the Global Burden of Disease Study (GBD) 2023, we estimated incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for BRI countries from 1990 to 2023. We constructed the BRI synthetic region and six geographical subregions using a rigorous extract-then-aggregate approach. We calculated age-standardised rates (ASR), average annual percentage changes (AAPC), and projected 2030 ASIR for five priority diseases using two log-linear extrapolation models, benchmarking against the SDG 3.3 target of an 80% reduction from 2015 levels. Findings: In 2023, BRI countries accounted for 65·95% of global incident cases (17·05 billion), 71·95% of deaths (5·91 million), and 78·34% of DALYs (342·43 million). Between 1990 and 2023, age-standardised mortality rates (ASMR) declined by 52·15% (AAPC −2·36%, 95% CI −2·83 to −1·88) and DALY rates by 56·23% (AAPC −2·83%, −3·15 to −2·52), but absolute levels remained 13%–17% above global averages. Regional heterogeneity was substantial: Asia achieved the steepest declines (ASDR −72·23%), whereas Africa carried the highest burden (ASMR 298·12 per 100 000, 5·0 times that of Asia). Europe was the only region with synchronous increases in both incidence and mortality (ASIR +60·74%, ASMR +12·23%). A near-universal reversal in respiratory infection trends occurred around 2013, with 99·3% of countries switching from declining to rising rates in the post-2013 period. Strong inverse associations between the Socio-demographic Index and all burden metrics were observed, with the same infectious event translating into a 9–12 times greater likelihood of death or disability in low-SDI settings. Under current trajectories, none of the five priority diseases—HIV/AIDS, tuberculosis, malaria, measles, and acute hepatitis—will achieve the SDG 3.3 target by 2030; malaria is projected to increase by 10%–21% from 2015 levels. Interpretation: Despite substantial declines in mortality and disability over the past three decades, BRI countries continue to bear a disproportionate and growing share of the global infectious disease burden. The post-2013 surge in respiratory infections—driven by COVID-19—and the re-emergence of dengue and malaria in many countries have offset gains made against traditional infectious diseases. The widening disparities between regions and the projected failure to meet SDG 3.3 targets underscore the urgent need for strengthened health system investments, enhanced cross-border surveillance and joint prevention mechanisms, and tailored strategies that address the dual challenge of persistent inequities in low-resource settings and emerging threats in higher-income and ageing populations.

OBJECTIVE:This scoping review aims to evaluate the application of environmental DNA/RNA (eNA) technology in real-world studies on neglected tropical diseases (NTDs), assessing its methodology and detection effectiveness, and providing an evidence-based roadmap for optimizing eNA used to support progress toward the 2030 targets. BACKGROUND:As the NTDs roadmap reaches its midpoint, eNA technology has seen increasing adoption. This non-invasive approach enables qualitative/quantitative assessment of environmental transmission risks, complementing conventional detection methods. METHODS:We synthesized real-world field applications of eNA technology across NTDs through systematic searches in four English, and one Chinese database (2002-2024). A total of 71 studies met our inclusion criteria after screening. RESULTS:Despite heterogeneous transmission mechanisms among NTDs, we identified 6 standardized field applications for eNA studies, along with practical optimization strategies. A total of 3 pathways were concluded of how eNA technology can accelerate the NTDs elimination. For the performance, comparative analyses showed moderate concordance with conventional methods, while eNA demonstrated superior sensitivity in detection of pathogens and hosts. With the gap analysis, we demonstrated the advances of eNA applications in all NTDs. CONCLUSIONS:This scoping review supports eNA technology as a promising tool for NTDs detection and surveillance. Through experience sharing and summarization, the eNA technology needs further optimization and standardization to enhance its disease surveillance capacity, thereby accelerating the achievement of NTDs roadmap targets.

Malaria remains a significant global health challenge, particularly in Africa, which continues to bear the greatest burden. The transboundary nature of malaria necessitates regional collaboration, yet transcontinental knowledge-sharing mechanisms remain limited. The World Health Organization's (WHO) certification of China as malaria-free in 2021 presents an opportunity to leverage its expertise, cost-effective products, and elimination strategies to support Africa's malaria control efforts. The Institution-based Network on China-Africa Cooperation for Malaria Elimination (INCAM) was established in 2018 to bridge this gap, fostering cross-continental collaboration through knowledge exchange, product innovation, and policy advocacy. Between 2019 and 2025, INCAM has convened six fora, facilitated to promote the adaptation of China's anti-malaria practices to African contexts. These fora promoted the exploration of demand-driven research, the development of innovative anti-malarial products, and the advancement of evidence-based policies. INCAM exemplifies the potential of China-Africa collaboration to accelerate malaria control and elimination in Africa through solutions tailored to local contexts. To sustain this progress, there is an urgent need for stronger Public-Private-Academic Partnerships, and enhanced capacity-building programs. By addressing these gaps, INCAM can maximize its role as a leading transcontinental hub for malaria control and elimination for China and Africa.

Enterobiasis, caused by Enterobius vermicularis, is a common intestinal parasitic infection in children. Ectopic migration to extraintestinal sites, such as the greater omentum, is rare and often misdiagnosed due to nonspecific clinical manifestations and limited proficiency in identifying parasitic structures in paraffin-embedded histological sections. A 12-year-old female presented with a three-day history of lower abdominal pain and a pelvic mass. Emergency laparoscopic resection revealed an ovarian serous cystadenoma and an omental mass. Initial histopathological examination of the omental mass suggested schistosome eggs; however, expert consultation confirmed a section of an adult female E. vermicularis containing eggs measuring up to 50 μm. The patient had no exposure to schistosomiasis-endemic areas but a history of prior pinworm infection, which had been treated with oral albendazole (400 mg once daily for 2 days). Subsequent adhesive tape tests over three consecutive days were negative, and perineal pruritus was resolved, confirming successful cure. The final diagnosis was ectopic enterobiasis of the greater omentum. This case underscores the critical role of accurate morphological identification in distinguishing parasitic infections. Misdiagnosis, even in non-schistosomiasis-endemic areas, reflects insufficient training in parasitic morphology among healthcare professionals. Enhanced training on the morphology of common parasites and interpretation of paraffin-embedded histological sections is essential to improve diagnostic accuracy.

Objective:Despite effective historical control, Mountain-Type zoonotic visceral leishmaniasis (MT-ZVL) resurged in China in the early 2000s, risking geographical expansion and increased incidence. This study assessed progress in applying the One Health approach for MT-ZVL control in endemic provinces and identified optimization for current control framework. Methods:Seven endemic provinces (2022 data) were assessed with a pre-developed evaluation tool by a weighted scoring method. Results were analyzed to identify progress and challenges and formulate recommendations. Results:The average total score was 47.77/100 (range: 38.59-61.72). Category scores ranked: Disease Control (58.28) > External Environment (50.22) > Internal Support (36.86). Within the External Environment, Social Conditions scored highest (90.43), while Natural Environment scored lowest (31.96). Within the Internal Support, Resource Allocation scored highest (75.71), and Financial Investment scored lowest (27.90). Within the Disease Control, Epidemic Surveillance and Reporting scored highest (72.00), while Control Effectiveness scored lowest (42.78). Conclusion:This study evaluated the current status of One Health implementation for MT-ZVL control in seven endemic provinces. The results indicate slow overall progress, with the lowest scores observed for operational capacity and the highest for disease control activities. To advance MT-ZVL control, endemic provinces in China should prioritize integrating the One Health concept into control policies, strengthening the establishment and implementation of multisectoral coordination mechanisms, promoting scientific and technological innovation, and optimizing key interventions such as canine management.

Malaria remains a significant public health challenge in Tanzania, with socioeconomic factors playing crucial roles in disease outcomes. While previous studies have explored the relationship between socioeconomic status and malaria infection, quantitative assessment of equity condition in malaria outcomes remains understudied. This study innovatively applies Slope Index of Inequality (SII) and Relative Index of Inequality (RII) to quantify the equity conditions between socioeconomics and malaria burden in three Districts located in the Southeastern coast of Tanzania. Data from the baseline survey of the China-Tanzania Demonstration Project on Malaria Control conducted in 2019 were analyzed. Key variables included: (1) socioeconomic status quantified through Principal Component Analysis incorporating household infrastructure, asset ownership, and social potential; (2) malaria infection outcomes, including blood test results, treatment costs, and days absent from work/education (days off). Logistic and linear regression analyses were performed to assess socioeconomic impacts, while SII and RII were calculated to measure health equity conditions across socioeconomic strata in three districts of Rufiji, Kilwa, and Kibiti. Higher socioeconomic status was associated with a lower risk of malaria infection (OR = 0.9975, 95

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne zoonosis with a complex host–vector ecology involving wildlife, domestic animals, and ticks, yet the comparative burden of SFTS virus (SFTSV) across these ecological compartments remains incompletely defined. Methods: We conducted a systematic review and meta-analysis to quantify SFTSV infection in animal hosts and tick vectors. We searched major international and Chinese databases and included observational studies reporting serological and/or molecular evidence of SFTSV infection in wild animals, domestic animals, or ticks. Random-effects meta-analyses of proportions were performed separately for antibody and RNA outcomes. Findings: Of 881 extracted records, 789 records representing 126 unique studies were included in the quantitative synthesis. The pooled seroprevalence of SFTSV was 7.99% (95% CI 4.81–13.00) in wild animals and 24.22% (95% CI 20.83–27.97) in domestic animals, while pooled RNA positivity was 1.14% (95% CI 0.66–1.95) in wild animals and 5.90% (95% CI 3.72–9.25) in domestic animals. The pooled RNA detection rate in ticks was 3.70% (95% CI 2.72–5.02). Species-specific analyses showed particularly high seroprevalence in goats, sheep, and cattle, and comparatively high RNA positivity in goats, cats, cattle, and dogs. Among ticks, Haemaphysalis longicornis contributed the largest evidence base, whereas higher pooled estimates were observed in some less-studied tick taxa. Although between-study heterogeneity was substantial, sensitivity analyses showed that the main patterns were robust. Interpretation: These findings indicate that SFTSV circulation is distributed across a connected host–vector system but is not evenly shared across ecological compartments. Domestic animals appear to carry the strongest combined signals of exposure and active infection, supporting their value as practical sentinels at the animal–human interface, while wildlife and tick surveillance remain essential for clarifying reservoir complexity and vector-borne maintenance.

This editorial, published on the occasion of the World Neglected Tropical Diseases Day in 2026, highlights the persistent and pressing issue of neglected tropical diseases (NTDs) and their impact on global health equity. It argues that addressing NTDs is not only a moral imperative but also a strategic necessity for achieving global health security and advancing the Sustainable Development Goals (SDGs). The editorial emphasizes the need for integrating NTD control strategies with the SDGs to leverage synergies and maximize impact. For instance, improving water and sanitation (SDG 6) directly contributes to the prevention of schistosomiasis. Additionally, the Pandemic Agreement, co-signed by member countries of World Health Organization in 2025, provides an opportunity to mainstream NTDs into health security planning, ensuring resilience against future outbreaks. The editorial concludes by calling for sustained action and increased investment in research and development, One Health approaches, and policy coherence to embed NTDs in pandemic preparedness and universal health coverage agendas. Achieving a future free from NTDs is possible, but it requires unwavering commitment, collaboration, and equitable resource allocation.

Schistosoma mekongi remains an important cause of intestinal schistosomiasis in the lower Mekong River Basin. Sensitive environmental surveillance tools are needed to support transmission monitoring, particularly where conventional snail surveys are seasonally constrained. This study developed and evaluated a multiplex quantitative PCR (qPCR) assay for simultaneous detection of S. mekongi and its intermediate snail host, Neotricula aperta, in aquatic environmental DNA (eDNA) samples. Singleplex and multiplex qPCR assays targeting S. mekongi and N. aperta were compared to establish the optimal amplification system. Field validation was conducted in the Khong District, Champasak Province, Laos, during the dry season (May 2024) and wet season (August 2024) across 20 transmission sites. Method agreement between eDNA detection and malacological surveys was assessed using Cohen’s kappa coefficient, and associations between N. aperta density and physicochemical variables were evaluated using Spearman’s rank correlation. The optimized multiplex qPCR assay targeting N. aperta (16S rRNA) and S. mekongi (18S rRNA) showed high sensitivity, with limits of detection of 5 and 6 copies/μl and limits of quantification of 40 and 46 copies/μl, respectively. In mesocosms, both targets were detected at an infected-snail density of 1 snail/L, with median Cq values of 35.23 for N. aperta and 26.54 for S. mekongi. During the dry-season surveys, 978 N. aperta were collected, with a mean density of 46.25 snails per site; wet-season surveys were not feasible. No schistosome infections were detected by crushing microscopy. Field eDNA analysis detected N. aperta but not S. mekongi, with N. aperta eDNA positivity being 90

BACKGROUND:Traditional food markets, often referred to as wet markets, live poultry markets, or farmers' markets, remain a major source of animal-origin foods and fresh produce in many low-income and middle-income countries (LMICs). These markets bring humans, domestic animals, wildlife, and the environment into close contact and have been repeatedly implicated in the emergence of zoonotic and foodborne diseases. Yet, the overall global burden, pathogen spectrum, and risk gradients within these settings have not been comprehensively quantified. METHODS:We conducted a systematic review and meta-analysis of studies published between Jan 1, 2000, and Oct 31, 2025, following the PRISMA 2020 reporting guidelines. We searched major English and Chinese databases for cross-sectional or baseline studies reporting the detection of zoonotic or foodborne pathogens in traditional food markets or related retail settings. Studies were excluded if they were not conducted in traditional markets, had non-extractable data, had a sample size of fewer than 20, had intervention-related outcomes, had duplicate populations, or did not have prevalence or detection rate reporting. Data were extracted as detection records, defined as unique pathogen-sample type-market setting combinations. Study quality was assessed with the Joanna Briggs Institute tool for prevalence studies. We used random-effects meta-analysis of logit-transformed proportions to estimate pooled prevalence and 95% CIs overall and across major subgroups. Heterogeneity was assessed with I2 and τ2, and meta-regression was used to examine temporal trends and associations between study quality and prevalence. Robustness was assessed with leave-one-out analyses and small-study effects. This study is registered with PROSPERO, CRD420251267834. FINDINGS:We included 247 studies comprising 597 detection records from 41 countries across 16 regions. The global pooled prevalence of market-source pathogens in traditional markets was 15·32% (95% CI 13·96-16·80). By pathogen kingdom, pooled prevalence was 19·41% (16·21-23·08) for bacteria, 8·40% (7·15-9·83) for viruses, and 27·05% (21·91-32·89) for parasites. Regionally, prevalence was highest in southeast Asia (23·09% [18·43-28·52]), followed by south Asia (15·52% [10·06-23·20]) and east sub-Saharan Africa (14·54% [7·13-27·40]). By market type, fish and seafood markets showed the highest pooled prevalence (37·87% [26·05-51·33]), and by sample type, the highest estimates were observed in fish and seafood, raw meat, and environmental samples. Lower estimates were observed in cooked foods, fruit and vegetables, and worker samples, suggesting a gradient from animal and environmental reservoirs towards ready-to-eat foods and humans. Meta-regression showed no significant global linear temporal trend in prevalence, whereas higher methodological quality was associated with lower reported prevalence. Leave-one-out analyses suggested that no single study substantially altered the overall findings. INTERPRETATION:Traditional markets represent persistent global hotspots for zoonotic and foodborne pathogens, particularly in LMICs and high-risk food chains. The observed exposure gradient highlights crucial intervention points. These findings support a One Health-oriented framework for risk assessment and targeted surveillance, while emphasising the need for harmonised, prospective, multipathogen studies. FUNDING:Foundation of Key Laboratory of Veterinary Biotechnology, National Key Research and Development Program of China, and the International Joint Laboratory on Tropical Diseases Control in Greater Mekong Subregion.

Background:Mountain-type zoonotic visceral leishmaniasis (MT-ZVL) is undergoing rapid re-emergence in central China and demonstrates significant potential for further dissemination. The aim of this study was to provide information on optimal control strategies by estimating the disease's current distribution and potential for spread into new areas. Methods:We used a three-pronged approach: (1) active field surveillance in 57 potential-risk counties in 2022 to investigate the distribution of the Phlebotomus chinensis (P. chinensis) vector and canine infections based on serological positivity; (2) study of annual surveillance reports of P. chinensis distribution and canine infection in 42 counties in Henan, Shanxi and Beijing (2023-2024); and (3) passive surveillance via China's National Notifiable Disease Surveillance System (NNDSS) revealing 1137 human MT-ZVL cases for the 2019-2024 period. We constructed a database based on an innovative active/passive surveillance approach and applied the optimized ecological niche model based on incorporating environmental, biological (the P. chinensis vector and infectious canines) and socioeconomic covariates to predict the relative risk of transmission at the 1 × 1 km resolution across central China. Model performance was validated using 239 unique, geolocated human case occurrences (2022-2024). This allowed us to map the MT-ZVL risk and quantify the populations at-risk within stratified risk tiers. Findings:The field surveillance across 20 of 57 potential MT-ZVL risk counties captured 7552 P. chinensis specimens (mean density: 13.7 sandflies/trap/night), with a high peak in Jiexiu County, Shanxi Province (499.8). In 14 counties with confirmed P. chinensis presence, canine infections were recorded in 9 counties giving a mean seroprevalence of 2.7% (44/1648), with the highest proportion at 16.2% (21/130) seen in Yuzhou County, Henan Province. Annual surveillance reports confirmed P. chinensis presence in 24 of 42 monitored counties, with seropositive canines in two counties. The final training dataset included the recorded findings of 270 P. chinensis sandflies, 224 infected canines and 213 human case records. Extreme gradient boosting demonstrated superior predictive performance for human MT-ZVL infection risk, significantly outperforming benchmark models, with the area under the curve (AUC) of 0.950 (95% CI: 0.921-0.979) in internal validation and 0.913 (95% CI: 0.886-0.940) in external validation. Model performance was further validated by 88.3% of indigenous cases occurring within predicted high-risk zones. These high-risk zones were concentrated in hilly terrain along the Taihang, Lvliang and Qinling Mountains-primarily in central-southern Shanxi, Hebei-Shanxi border regions, eastern Shaanxi and north-western Henan. This study identified 117 high-risk or very high-risk counties with a combined population of 19.24 million. Medium-risk areas were found to encompass surrounding regions across Shanxi, Shaanxi, Henan, eastern Gansu, central-western Hebei and western/northern Beijing (87 counties; 12.07 million residents), while low-risk zones covered 87 counties in eastern Gansu, northern Sichuan, north-western Henan and central Hebei mountains (15.35 million residents). The optimized multi-source data-driven model exhibited robust predictive performance, identifying 291 at-risk counties threatening about 46.67 million residents. Interpretation:This study demonstrated MT-ZVL to be a significant public health threat with rapid expansion across central China. Key findings revealed unabated endemic transmission, with the presence of P. chinensis and infectious canines in non-endemic areas signifying new emerging foci. By the identification of specific regions at risk for MT-ZVL, an evidence base warranting heightened public health vigilance against potential transmission has been established. Surveillance for MT-ZVL in central China and targeted interventions are strongly recommended. Funding:This work was supported by the National Natural Science Foundation of China (No. 32161143036, No. 82473688), National Key Research and Development Program (2021YFC2300800, 2024YFC2310902), the Three-Year Initiative Plan for Strengthening Public Health System Construction in Shanghai (2023-2025) (No. GWVI-11.1-12).