Cohort studies are an important tool for public health research about emerging infectious diseases. Willingness to participate in research is associated with multiple factors. Little is known about the role of people's feelings, especially in the aftermath of the COVID-19 pandemic. Affective polarisation, an affinity for people with similar attitudes to oneself and hostility toward those with opposing views, is a measure of feelings about issues, including COVID-19 vaccination. The aim of this study was to investigate factors associated with willingness to participate in a future household-based cohort study on pandemic preparedness. We did a cross-sectional online survey in the Canton of Bern, Switzerland. We invited a random sample of persons aged 18 + years from 15,000 private households. We asked about willingness to take part and collected data about demographic, social and household characteristics, and affective polarisation related to COVID-19 vaccination. We performed univariable and multivariable analyses, weighted by household size to estimate odds ratios (with 95% confidence intervals, CI). Among responders, 49.8% (95% CI 47.9-51.8, weighted proportion) were willing to take part in a cohort study. In multivariable analysis, higher educational level (adjusted odds ratio 2.48, 95% CI 1.81-3.39) and higher monthly income (1.92, 1.39-2.65) were most strongly associated with higher willingness to participate. Opposition to COVID-19 vaccination was associated with lower willingness to participate (0.53, 0.39-0.72). Affective polarisation modified the relationship between vaccination attitudes and willingness to participate. Compared with non-polarised vaccination supporters, polarised supporters were more willing to participate (marginal adjusted odds ratio 1.51, 1.05-2.16), whereas willingness to participate was lower among both non-polarised (0.53, 0.32-0.86) and affectively polarised (0.26, 0.12-0.56) vaccination opposers. Willingness to participate in a cohort study was moderate. Following the COVID-19 pandemic, addressing affective polarisation, as well as socioeconomic factors, is needed to improve participation in pandemic preparedness research.

Background:Sexually transmitted infections (STIs) and vaginal dysbiosis during pregnancy are associated with adverse pregnancy outcomes. Mycoplasma genitalium is the most recent STI implicated but evidence remains limited. The objectives of this study were to investigate 1) the association between M. genitalium infection during pregnancy and gestational age at delivery, preterm birth, miscarriage or stillbirth, and low birth weight and 2) the interaction with vaginal dysbiosis. Methods:We conducted a prospective cohort study in East London, South Africa. We enrolled pregnant women at gestational age <27 weeks, confirmed by ultrasound. We tested vaginal samples using nucleic acid amplification tests for M. genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, other genital mycoplasmas and Candida spp. We defined vaginal dysbiosis using Gram-stain criteria as a Nugent score 4-10. We used quantile regression to compare the outcome in women with and without M. genitalium across the gestational age distribution, adjusting for prespecified sociodemographic and clinical characteristics and co-occurring organisms. Results:From April 1, 2021 to August 29, 2023, we enrolled 603 women, followed up 584 and obtained pregnancy outcomes for 560 (93%). Median age was 28 years (interquartile range, IQR 24, 33) and 27% of women were living with HIV. M. genitalium was detected in 44/584 (8%, 95% CI 6, 10%) and vaginal dysbiosis in 375/584 (64%) of women. Median gestational age at delivery was 39 weeks +0 days (IQR 37+4, 40+1) in women with and 39 weeks +0 days (37+4, 40+0) in those without M. genitalium. In multivariable models, associations were not observed for any adverse birth outcomes. There was no interaction between M. genitalium and vaginal dysbiosis. Discussion:M. genitalium in pregnancy was not associated with earlier gestational age at delivery or with other adverse birth outcomes. These findings do not support routine testing and treatment for M. genitalium in pregnancy.

In late 2024, an outbreak of over 400 cases of undiagnosed febrile illness, predominantly presenting as fever and cough, was reported in Panzi Health Zone, southwestern Democratic Republic of the Congo. Here we conducted an epidemiological and laboratory investigation to determine the etiology of the outbreak. Clinical data and specimens were prospectively collected from 108 individuals, of whom 59/108 (54.6%) were female. Children aged <5 years were the most affected (47/108, 43.5%); 14/32 (43.7%) were malnourished. Oro/nasopharyngeal swabs from 96/108 individuals were PCR tested; 26 blood samples were sequenced. Plasmodium falciparum was detected in 56/108 (51.8%) individuals. Co-infections were also detected, with influenza A(H1N1)pdm09 virus in 16/56 (28.6%) and severe acute respiratory syndrome coronavirus 2 in 10/56 (17.9%) individuals. No novel pathogens were detected via metagenomics. Our findings suggest that the outbreak was primarily associated with a surge in malaria cases, with concurrent viral respiratory infections. Increasing decentralized laboratory capacity and strengthening broader health systems remain crucial for faster outbreak detection and investigation.

Numerous factors may influence the optimal rollout of new gonococcal antibiotics. We compared 8 rollout strategies using a gonorrhea transmission model and ranked strategies by the number of gonococcal infections and clinically useful antibiotic lifespan. Rankings were most sensitive to the starting ceftriaxone resistance prevalence and screening frequency.

OBJECTIVE:Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most commonly reported sexually transmitted infections globally. Anorectal CT/NG detection among men who have sex with men (MSM) and coinfections is common. Epidemiological studies suggest that CT/NG coinfections might result in greater bacterial load and transmissibility than single infection. The purpose of this study was to compare bacterial load and symptoms between CT/NG single and coinfections in MSM. METHODS:MSM positive for CT or NG on a triple swab (throat, urethra and rectal locations combined) were enrolled. Before treatment, they self-collected anorectal swabs. Bacterial loads for CT/NG were calculated using real-time PCR and compared between single or coinfected individuals, with or without rectal symptoms. RESULTS:We enrolled 382 MSM from December 2021 to December 2024. Among all samples: total CT (n=114), total NG (n=125), CT/NG coinfection 29/382 (7.6%). The bacterial loads in single and coinfected samples were comparable. The mean difference between CT alone and CT/NG was 0.40 target copies/mL (95% CI (-0.09 to 0.89), p value=0.107). The mean difference for NG alone and CT/NG was 0.24 copies/mL (95% CI (-0.49 to 0.99), p value=0.498). Among 382 MSM, 15.4% (n=59/382) experienced anorectal symptoms. There was no statistical difference in bacterial burdens between symptomatic and asymptomatic (CT difference of the means 0.52 copies/mL, 95% CI (-0.51 to 1.55); p value=0.313) (NG difference of the means 0.63, CI (0.01 to 1.28); p value=0.05). CONCLUSIONS:In contrast to prior research, we found similar bacterial burdens in anorectal MSM samples with single CT/NG versus coinfection. Further research is needed to understand the clinical implications of CT/NG coinfections. Future studies should investigate factors influencing anorectal CT/NG bacterial burden, transmissibility and susceptibility, including the function of pre-exposure prophylaxis and the rectal microbiota.

Background:Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis are curable sexually transmitted infections (STIs) associated with adverse birth outcomes. Most infections are asymptomatic. Whether antenatal STI screening improves birth outcomes remains uncertain. Methods:In a randomized three-group trial in South Africa, pregnant women aged 18 years or older were assigned before 27 weeks' gestation to: (1) screening and treatment for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis at enrollment, with tests-of-cure (One-Time Screening); (2) screening and treatment at enrollment, repeated at 30 to 34 weeks (Two-Time Screening); or (3) Standard-of-Care (Syndromic management). The primary outcome was a composite of preterm birth (<37 weeks' gestation) or low birthweight (<2500 g), analyzed in the modified intention-to-treat population of participants with live births. Components of the composite outcome were evaluated individually as the main secondary outcomes. The study was registered with ClinicalTrials.gov, NCT04446611. Findings:Of 2247 enrolled participants, 1910 had live births. The composite outcome occurred in 22·9% of the One-Time Screening group (risk ratio [RR] 0·99; 95% confidence interval [CI] 0·81-1·21), 20·6% of the Two-Time Screening group (RR 0·89; 95% CI 0·72-1·09), compared with 23·2% of the Standard-of-Care group. Preterm birth occurred in 18·9% of the One-Time Screening group (RR 1·00; 95% CI 0·80-1·26), 14·5% of the Two-Time Screening group (RR 0·77; 95% CI 0·60-0·99), and 18·8% of the Standard-of-Care group. Low birthweight occurred in 14·1% of the One-Time Screening group (RR 1·10; 95% CI 0·83-1·46), 12·9% of the Two-Time Screening group (RR 1·01; 95% CI 0·76-1·35), and 12·8% of the Standard-of-Care group. Interpretation:Neither screening strategy for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis reduced the primary composite outcome of preterm birth or low birthweight, or low birthweight alone. The Two-Time antenatal STI screening strategy, however, reduced preterm birth by 23%.

Abstract Background In 2019, WHO recommended three consecutive reactive serological test results for HIV diagnosis to reduce false-positive diagnoses. Malawi changed from a two-test to a three-test strategy in 2022 as HIV test positivity declined. We assessed diagnostic performance, implementation fidelity, and costs. Methods We analysed national HIV testing data from Nov 1, 2022, to Oct 31, 2025. Using observed three-test classifications as the reference standard, we reconstructed classifications under the two-test strategy. We estimated positive predictive value (PPV), implementation fidelity, potential false-positive diagnoses prevented, incremental costs, and time to offset testing costs through avoided antiretroviral therapy expenditure. Results Among 9,885,599 encounters eligible for implementation-fidelity analysis, 99.98% followed a valid three-test pathway. The diagnostic-performance analysis included 9,862,908 encounters, of which 171,351 (1.7%) were classified HIV-positive and 9,138 (0.09%) were inconclusive. Under the two-test strategy, 1,209 inconclusive encounters with a T1+/T2+/T3− sequence would have been classified as HIV-positive. Retesting and reference-laboratory data indicated that 82.5% of these would subsequently be classified as HIV-negative, corresponding to 997 false-positive diagnoses prevented (10.3 per 100 000 three-test non-positive encounters; 95% CI 9.7–10.9). Retesting within 1–2 weeks was associated with the highest odds of potential false-positive classification (adjusted OR 39.37, 95% CrI 30.63–50.61). The incremental cost was US$471 per false-positive diagnosis averted and was offset within 7.30 years. Conclusions Malawi’s transition to a three-test HIV testing strategy prevented false-positive diagnoses and unnecessary antiretroviral therapy at modest cost, supporting broader adoption of WHO guidance in similar settings. Funding Gates Foundation.

Background:Curable sexually transmitted infections (STIs) are associated with adverse birth outcomes, yet little cost-effectiveness evidence guides antenatal STI screening policy in high-burden settings. We conducted a cost-effectiveness and cost-utility analysis of the Philani Ndiphile trial in South Africa, comparing One-Time and Two-Time antenatal screening for C. trachomatis, N. gonorrhoeae, and T. vaginalis with standard syndromic management. Methods:A decision-analytic model from the provider perspective simulated costs and outcomes for pregnant women and infants. Costs included diagnostics, treatment, and neonatal hospitalisation for a primary composite outcome of preterm birth and/or low birthweight and its components (secondary trial outcomes). Modelled outcomes included incremental cost (US$) per composite (preterm birth and/or low birthweight) case, per component case and per disability-adjusted life year (DALY) averted. The analysis captured infant outcomes in the first year. Univariate and probabilistic sensitivity analyses were conducted to assess parameter uncertainty and robustness of results. Results:Screening for C. trachomatis, N. gonorrhoeae, and T. vaginalis twice during pregnancy was not cost-effective for preventing the primary composite outcome, nor for preventing low birthweight alone. However, two-time screening was cost-saving for preventing preterm birth alone, averting more DALYs and thereby yielding better health outcomes while reducing healthcare costs compared with syndromic management. One-time screening was not cost-effective for preventing any outcome. Conclusions:Repeat antenatal screening for C. trachomatis, N. gonorrhoeae, and T. vaginalis has the potential to prevent preterm births while reducing healthcare costs in high-burden settings. These findings support further research to confirm the clinical effectiveness of repeat screening and to evaluate longer-term health and economic impacts.

On 4 September 2025, the Ministry of Public Health, Hygiene and Social Welfare officially declared the 16th Ebola disease outbreak in the Democratic Republic of the Congo (DRC). This outbreak ended on 1 December 2025 and occurred in Bulape Health Zone, Kasaï Province, an area with limited access to appropriate healthcare facilities and resources. Here, we describe the probable index patient and molecular investigations of samples obtained from six suspected patients from the initial outbreak phase. We identified Orthoebolavirus zairense (EBOV) in five samples from different patients. In addition, we performed whole-genome sequencing and generated four complete EBOV genomes. These genomes form a well-supported phylogenetic cluster with genomes from the 1976 Yambuku/Mayinga outbreak. This study suggests a likely new zoonotic spillover event from an as-yet unidentified natural reservoir. While the close relationship to 1976 EBOV Yambuku/Mayinga genomes is striking, this poses additional challenges on the comprehension of the animal reservoir species. The study reports the emergence of a new Ebola variant in a remote area of Kasai Province, DR Congo. The findings highlight the need for rapid detection and sequencing to better identify variants and quickly respond to outbreaks.

The intensifying outbreaks of the novel monkeypox virus clade Ib in the Democratic Republic of the Congo have raised global concern about the potential for wider epidemic spread. Some clade Ib mpox outbreaks have shown a distinct transmission pattern in which transmission associated with both sexual and nonsexual contacts coexist. Here, we characterize these outbreaks in a network epidemic model, which incorporates sexual and nonsexual contacts, and project age- and route-specific transmission potentials under a wide range of scenarios. Our analyses suggest that the dominant route of transmission may shift over time from sexual to nonsexual contacts, which leads to larger epidemics. The age groups contributing most to overall infections and mortality also change over time, suggesting that target groups for intervention should be adjusted accordingly. For countries at risk of travel-associated mpox outbreaks, these findings highlight the importance of monitoring evolving monkeypox virus transmission patterns and interacting transmission routes to support timely and effective control measures.

BACKGROUND:Pharyngeal gonococcal infections are likely to contribute to the development of antimicrobial resistance (AMR) because of suboptimal efficacy of antibiotics in the pharynx, gene transfer with commensal Neisseria species, and the asymptomatic nature of pharyngeal infections. However, not all studies have found higher levels of AMR in pharyngeal than in anogenital sites. We studied antimicrobial susceptibility patterns across anatomical sites, both between and within individuals. METHODS:This retrospective observational study used data from sexual health centres in the Netherlands participating in the Gonococcal Resistance to Antimicrobials Surveillance (GRAS) programme and included consultations of men who have sex with men (MSM) and women from Jan 1, 2016, to Dec 31, 2023. We included MSM and women with valid antimicrobial susceptibility results reported for at least one anatomical site. Susceptibilities to ceftriaxone and azithromycin were measured using minimum inhibitory concentration (MIC) values at the laboratories affiliated with the individual sexual health centres. The primary outcomes were increased ceftriaxone MICs, azithromycin resistance, and site-specific geometric mean MICs. We calculated anatomical site-specific proportions for increased ceftriaxone MICs (MIC>0·032 mg/L) and azithromycin resistance (MIC>1 mg/L) and geometric mean MICs (gmMICs) for both antibiotics. Differences between anatomical sites were analysed in the total GRAS population and within individuals for whom MICs were measured from multiple anatomical sites at the same clinic visit. Within the latter group, we describe within-individual discordant MIC pairs (defined as a difference of more than one MIC doubling dilution), and factors associated with discordance were analysed using logistic regression. FINDINGS:In the study period, 16 916 consultations in MSM and 2521 consultations in women with at least one MIC available were included. The proportions of increased ceftriaxone MIC and azithromycin resistance and gmMICs for both antibiotics were highest in pharyngeal isolates in both groups. Among 1217 MSM and 457 women with multi-site MICs, proportions of increased ceftriaxone MIC, azithromycin resistance, and gmMICs were similar across anatomical sites. Discordant MIC pairs were observed in 117 of 1217 consultations in MSM (9·6%, 95% CI 8·1-11·2) and 22 of 457 consultations in women (4·8%, 3·1-6·7) for ceftriaxone, and in 147 of 1210 consultations in MSM (12·1%, 10·4-14·0) and 42 of 456 of consultations in women (9·2%, 6·8-11·8) for azithromycin. Within these discordant MIC pairs, pharyngeal MICs were similar to urogenital and anal MIC values. No sexual behavioural characteristics were significantly associated with discordant MICs. INTERPRETATION:These findings suggest that higher resistance levels observed at the population level may reflect between-person variation rather than consistent within-person anatomical-site differences. Approximately 10% of individuals showed within-person MIC discordance, potentially leading to missed AMR cases if only one site is sampled. This finding suggests that culturing specimens from multiple anatomical sites could improve AMR detection, surveillance accuracy, and treatment decision-making. Further studies are needed to clarify the role of different anatomical sites in the transmission and development of gonococcal AMR. FUNDING:The Dutch Ministry of Health, Welfare and Sport.

OBJECTIVES:The COVID-19 pandemic highlighted the need for pandemic preparedness, including the establishment of cohorts allowing for the rapid collection of data and biological specimens. We investigated the feasibility of performing self-sampling for respiratory viruses, online questionnaires, and telemedicine in the "Bern, get ready" (BEready) household-based cohort in Switzerland. METHODS:In this pilot study, we enrolled 108 households: 161 adults, 32 children, 29 cats and 15 dogs. We instructed participants to collect a nasal swab if they experienced symptoms of a respiratory infection. Household members of index cases collected swabs, including from their pets, a week later to identify secondary cases. Samples were tested for 13 respiratory viruses, including SARS-CoV-2, influenza, RSV, and rhinovirus, using a commercially available multiplex PCR. RESULTS:From May 26, 2023 to September 16, 2024, 78 households reported 152 disease events. We obtained valid results from 131/188 (70%) expected samples from index cases, 105/152 (69%) from household contacts, and 24/47 (51%) from pets. Positivity from swabs was 82/131 (63%) among index cases and 24/105 (23%) among human household contacts. CONCLUSION:Decentralized respiratory virus surveillance was feasible in our household-based cohort. Our study will inform the investigation of future emerging diseases, such as an H5N1 pandemic.

Objective:Political and affective polarization are different, but related concepts, which can shape trust in authorities, interpretation of health messages, and health behaviors and outcomes. The aim of this study was to systematically review the research literature, exploring how affective and political polarization are associated with COVID-19-related health behaviors and outcomes. Methods:From January 1, 2019 to November 27, 2024, we searched 12 electronic databases for studies about affective or political polarization and COVID-19-related outcomes, including preventive behaviors such as vaccination, compliance with policies, perceived risk and health outcomes. We included studies reporting primary data from participants of any age and gender, published in any language. Two independent reviewers, from a total of seven, conducted study selection, data extraction and risk of bias assessment. We synthesized findings narratively and reported them according to the PRISMA 2020 statement. Results:Of 2021 unique articles, we included nine cross-sectional studies, all conducted in the United States of America or Europe from 2020 to 2022. Four studies found associations between higher political polarization and lower COVID-19 vaccine uptake or intent. Reported associations between vaccination and affective polarization were mixed. Four studies of other COVID-19 attitudes or prevention measures found mixed results for both types of polarization. In one study, no association was found between polarization and changes in death in 2020 compared with 2015 to 2019. The risk of selection bias in included studies was high. Discussion:This systematic review found some evidence of associations between polarization and COVID-19 health-related behaviors and outcomes. Cohort studies are needed to understand the direction of association. More international and interdisciplinary approaches to the study of polarization are needed to generate evidence to inform health and public policy effectively and improve preparedness for future pandemics.

The ongoing mpox outbreaks in the Democratic Republic of the Congo (DRC) resulted in >71,000 suspected cases from 01 January 2024 to 02 February 2025. Clade Ib mpox virus (MPXV) emergence has heightened public health concern due to observed sustained human-human transmission and spread to multiple non-endemic East African countries. Clade Ib outbreaks have been marked by epidemiologic deviations from classic Clade Ia zoonotic transmission—Clade Ib instead has been observed among adult populations and transmission via sexual contact. With the continued expansion of Clade Ib across the region, containment and mitigation measures may need to be adapted to best fit this novel MPXV clade. Case investigation and epidemiological assessment data as well as whole viral geonome sequencing was analyzed from confirmed mpox infected individuals in the Goma region. Case demographics and clinical presentation data was also assessed from suspected mpox cases in the region. We report the first introduction of Clade Ib into North Kivu province through close contact transmission. We also report limited human-human Clade Ib transmission chains among children <15 years in the Mudja internal displaced persons camp. We further present evidence of APOBEC3 mutations and genomic links between these North Kivu cases with the larger ongoing Clade Ib outbreak in Kamituga, South Kivu. Given the expansion of regional mpox outbreaks and populations considered at-risk, these findings underscore how mpox case investigations and community messaging should include considerations for non-sexual human-human transmission of Clade Ib that includes children <15 years. Mpox virus, which is endemic in tropical, forested regions of Central and West Africa, has resulted in mpox outbreaks in the Democratic Republic of the Congo (DRC) with historic infections, including more than 71,000 suspected cases reported between January 2024 and February 2025. In recent years, shifting clinical and epidemiological characteristics have been reported for Clade I Mpox virus (MPXV), which is endemic in DRC. This includes the emergence of a new subclade, Clade Ib MPXV, first identified in South Kivu, DRC, in 2023. We report the first introduction of Clade Ib into North Kivu province through close contact transmission. This includes limited human-human transmission of MPXV among children in an internally displaced persons camp, raising concerns regarding undetected transmissions among these vulnerable groups. We further present evidence for links between these North Kivu cases with the larger ongoing outbreak in Kamituga, South Kivu. These findings underscore how mpox case investigations and community messaging should include considerations for non-sexual human-human transmission of Clade Ib that includes children and vulnerable populations. Mukadi-Bamuleka et al., report the first introduction of MPXV Clade Ib into Goma, DRC, revealing non-sexual human-to-human transmission chains involving children in an internally displaced persons’ camp. These findings underscore the urgent need to expand surveillance and public health messaging beyond adult sexual networks to include paediatric and displaced populations.

Background:More than 7.5 million people in South Africa have HIV, but little is known about the association of HIV and anal cancer incidence. We examined anal cancer incidence in a large South African cohort of insured men and women. Methods:We conducted a cohort study using reimbursement claims data from a South African medical insurance scheme (01/2011-07/2020) to assess anal cancer rates among people with and without HIV aged ≥18 years. We estimated adjusted hazard ratios (aHRs) for the association of HIV and incident anal cancer using flexible parametric survival models. Covariates included sex, age, calendar year, a history of genital warts and other sexually transmitted infections, and in women, cervical precancer. Results:We included 1 068 915 people of whom 69 985 (7%) were living with HIV. Over 3 933 145 person-years, 122 anal cancers were diagnosed (crude rate: 3.1/100 000 person-years; 95% confidence intervals [CI] 2.6-3.7). People with HIV had a 4-fold higher anal cancer risk than people without HIV (aHR 4.43; 95% CI 2.44-8.04). While anal cancer rates were similar among men and women, older age (≥65 vs 45-54 years; aHR 5.01; 95% CI: 2.94-8.53), a history of genital warts (aHR 7.56; 95% CI: 2.28-25.07), and among women, a prior cervical precancer diagnosis (aHR 5.70; 95% CI 1.75-18.58) were associated with a higher anal cancer risk. Conclusions:In South Africa, men and women with HIV, older individuals, people with a history of genital warts, and women with a prior cervical precancer diagnosis might benefit from prioritized access to anal cancer screening.

Objectives Cervical screening and precancer treatment are less effective in women living with HIV (WLWH) than in women without HIV. We assessed high-risk human papillomavirus (HR-HPV) infection and cervical disease progression among screened WLWH in Zambia.Methods Participants underwent visual inspection with acetic acid (VIA), HR-HPV testing and cervical biopsies at baseline and at follow-up 30-36 months later. Women with positive VIA results or high-grade histology were offered treatment. We assessed HR-HPV and cervical disease prevalence at both timepoints and used multivariable logistic regression to identify factors associated with cervical disease progression and regression.Results Among 241 included women, HR-HPV prevalence declined from 44% (95% confidence interval [CI]: 39%-49%) at baseline to 24% (95% CI: 19%-31%) at follow-up. High-grade disease decreased from 25% (95% CI: 20%-31%) to 9% (95% CI: 5%-13%). In analyses adjusted for age, CD4 cell count, HIV RNA viral load, HR-HPV infection and histological results at baseline, precancer treatment was associated with increased odds of disease regression (adjusted odds ratio [aOR]: 2.74, 95% CI: 1.08-7.06) and reduced odds of progression (aOR: 0.45, 95% CI: 0.11-1.64). One-third of women with high-grade disease at follow-up (7/21) had previously undergone precancer treatment.Conclusions Cervical screening and precancer treatment are key to reducing cervical disease progression among WLWH and ultimately achieving cervical cancer elimination, but efforts to improve treatment effectiveness among WLWH must be balanced with the risk of overtreatment.

Objectives Research for pandemic response needs to be timely to inform evidence-based decision making. The lack of epidemiological data at the start of the COVID-19 pandemic led experts to call for cohorts that could rapidly supply data about newly emerging infectious diseases. The ‘Bern, get ready’ (BEready) study aims to establish a prospective ‘pandemic preparedness cohort’ in the canton of Bern, Switzerland. This cohort can be pivoted to the needs of a new pandemic pathogen. The aim of this pilot study was to investigate the potential response and to test the feasibility of procedures for BEready.Design Closed population-based cohort study.Setting Random sample of private households in the canton of Bern, Switzerland, that had previously responded to an online survey.Participants Adults, children and pets.Primary and secondary outcome measures Enrolment as a percentage, associations between the agreement to participate and the demographic and socioeconomic variables of the invited household member, number of social contacts, proportion of samples collected, proportion of complete questionnaires and proportion of participants responding after 12 months.Intervention After the initial in-person visit with venous blood sampling, participants were followed up for 1 year. We tested remote data collection methods, with online questionnaires and self-collected capillary blood and nasopharyngeal samples, and established a biobank.Results The pilot study enrolled 106/1138 (9%) of invited households plus two additional households that had proactively contacted us. In total, we enrolled 193 people in 108 households (1.8 per household) and 44 pets between April and September 2023. We obtained and stored at least one venous and/or capillary baseline blood sample from 184/193 (95%) people and 40/44 (91%) pets. After 1 year, 172/193 (89%) people in 101/108 (94%) of households completed a follow-up survey, as did 22 owners of 34/44 (77%) pets. 151/172 (88%) respondents returned a follow-up capillary blood sample.Conclusions The response rate to the pilot study shows that obtaining high levels of participant enrolment in a pandemic preparedness cohort study is challenging. Data collection without face-to-face contact with a study team is feasible for household members and will be needed in BEready if control measures during a pandemic prevent in-person studies.

BACKGROUND:Monkeypox virus (MPXV) has been linked to vertical transmission, but systematic data are scarce. We aimed to describe the sociodemographic, clinical, and virological characteristics and assess the frequency and determinants of adverse outcomes in pregnant women with MPXV clade I infection. METHODS:In this prospective cohort study, we pooled data from three cohort studies (MBOTE-SK, PREGMPOX, and Uvira mpox) and one randomised controlled trial (PALM007) conducted in the South Kivu, Maniema, and Sankuru provinces of DR Congo between Dec 29, 2022, and June 20, 2025. Pregnant women and adolescent girls with a PCR-confirmed diagnosis of mpox were followed up throughout hospitalisation for mpox, delivery, and until discharge during the postpartum period. We extracted data on sociodemographic characteristics, MPXV exposure, clinical and obstetric presentation, and laboratory results. In a univariable analysis, we examined factors associated with the following adverse outcomes: spontaneous or missed abortion (<20 weeks of gestation), stillbirth (≥20 weeks of gestation), preterm birth (<37 weeks of gestation), live birth of a neonate with macroscopic mpox-like lesions, early (first 7 days) neonatal death, congenital anomaly, or maternal death (during pregnancy or discharge postpartum). FINDINGS:We collected data from 89 pregnant women in the first (25 [28%]), second (31 [35%]), and third (33 [37%]) trimesters across all four studies: MBOTE-SK (36 [40%]), PREGMPOX (24 [27%]), PALM007 (25 [28%]), and Uvira mpox (four [4%]). All participants recovered from mpox; no maternal deaths were reported. During hospitalisation for mpox, fetal loss was reported in 17 (19%) women. Final pregnancy outcomes were known for 69 (78%) participants; adverse outcomes were reported in 35 (51%) women (95% CI 38-63), including fetal loss in 31 (45%; 95% CI 33-57; 16 [52%] spontaneous abortions, four [13%] missed abortions, and 11 [35%] stillbirths). Of the 38 live births, four neonates had congenital mpox-like lesions; one infant died a few hours after birth. No preterm births or congenital abnormalities were recorded. MPXV infection during the first trimester was associated with a higher risk of adverse pregnancy outcomes than during the second (risk ratio [RR] 0·6 [95% CI 0·4-0·9]) and third (0·2 [0·1-0·4]) trimesters (p=0·0008). Adverse outcomes were also associated with high viral load in skin lesions (PCR cycle threshold ≤30; RR 3·5 [95% CI 1·0-12·3]; p=0·045), direct sexual contact with the index case (1·6 [1·1-2·4]; p=0·026), positive HIV status (2·0 [1·4-2·9]; p=0·0002), and the presence of genital lesions (1·9 [1·1-3·2]; p=0·025). INTERPRETATION:MPXV clade I infection in pregnancy is associated with a high risk of fetal loss and congenital infection, particularly during the first trimester. Targeted preventive and clinical strategies are urgently needed to protect pregnant women and their infants in settings that are endemic and epidemic for mpox. FUNDING:The European and Developing Countries Clinical Trials Partnership, the Belgian Directorate-General Development Cooperation and Humanitarian Aid, the Swiss National Science Foundation, the Research Foundation-Flanders, the Gates Foundation, the Intramural Research Program of the National Institutes of Health, and the National Cancer Institute.