BACKGROUND:We aimed to establish an external quality assessment (EQA) programme for the yaws eradication campaign that would meet the needs of reference and district-level laboratories in low- and middle-income countries. METHODOLOGY/PRINCIPAL FINDINGS:We designed proficiency testing items (PTIs) using a plasmid containing gene target sequences for Treponema pallidum (TP) and Haemophilus ducreyi (HD). The storage stability of the plasmids under different environmental conditions was then tested. A proficiency testing panel of seven swabs loaded with different concentrations of plasmids in different combinations, as well as human HEK293 cells to simulate the sample background, was prepared and sent to participating reference (RL) and district (DL) laboratories in Ghana, Côte d'Ivoire and Cameroon followed by three rounds of blinded proficiency testing. We tested quantitative real-time PCR (qPCR) performance of reference laboratories and loop-mediated isothermal amplification (LAMP) performance of district laboratories and retested 20% of human field samples at the London School of Hygiene & Tropical Medicine laboratories to further assess qPCR quality. FINDINGS:PTIs proved to be stable in dry conditions with no significant loss of copy number. Participating laboratories achieved qPCR results with a concordance of 95.0-100.0% (97.7% ± 5.2% (mean±standard deviation ((SD)) with the provider and a concordance of 76.0-100.0% (TP: 90.3 ± 13.7% and HD: 78.5 ± 7.5% (mean±SD)) for LAMP results, with inconsistencies, particularly in the detection of low HD plasmid DNA levels combined with high TP plasmid copies. Retesting of field samples resulted in 100% correct TP and HD sample identification by the African reference laboratories. CONCLUSIONS/SIGNIFICANCE:We have developed a functional plasmid-based EQA programme specifically designed to meet the needs of resource-poor settings in the tropics. The programme is suitable as a blueprint for other disease programmes.

Emerging and re-emerging zoonotic diseases are a significant threat to public health globally. Thryonomys swinderianus (grasscutters) are widely hunted and farmed as a source of protein in Ghana, which introduces the possibility of zoonotic disease transmission between the animals and handlers. This study investigated the prevalence and zoonotic risks associated with handling grasscutters in the Ashanti Region of Ghana. Laboratory analysis of 334 nasopharyngeal, oral, and rectal swabs from 117 grasscutters found no detectable cytomegalovirus, adenovirus, herpes simplex virus, human rhinovirus, monkeypox virus, rotavirus, or enterovirus. Thirty handlers of captive and wild-caught grasscutters participated, comprising traders (57

Abstract Puumala hantavirus (PUUV, Orthohantavirus puumalaense ) is one of the primary causative agents of haemorrhagic fever with renal syndrome in Europe and is maintained in natural populations of the bank vole ( Clethrionomys glareolus , also known as Myodes glareolus ). Despite public health relevance, we are only starting to understand the molecular properties and interplay between environmental and ecological factors of the pathogen that explain PUUV infection in bank voles. Here, we investigated PUUV occurrence, genetic structure, and environmental associations in bank voles sampled from two boreal forest areas in northern Sweden, during a complete vole population cycle (2020-2023). In total, 519 voles were screened for PUUV RNA using targeted reverse transcription PCR (RT-PCR). PUUV small (S-) segment RNA was detected in both study areas and observed infection patterns varied with sex, body weight, season and year. Specifically, we detected significant interactions between season and area and between season and body weight, with males showing consistently higher infection probabilities. Infection probability was also higher during periods of increased vole abundance and peaked in 2022. Phylogenetic analysis of partial S segment sequences demonstrated that all detected sequences clustered within the North-Scandinavian PUUV lineage, with no apparent spatial differentiation, indicating limited genetic structuring between the sampling areas. Habitat analyses at multiple spatial scales did not identify significant associations between PUUV occurrence and land-use variables, suggesting that infection dynamics were driven primarily by host demographic and temporal factors rather than broad-scale habitat composition. These findings highlight the importance of host demographics and temporal dynamics in shaping PUUV epidemiology in its reservoir, and provide additional insight into the molecular ecology of PUUV in northern Europe.

Background: The southern Baltic Sea coast is an important stopover region for wild waterbirds, particularly between late August and April. These birds can contribute to the maintenance and spread of viral and bacterial pathogens, including highly pathogenic avian influenza viruses (HPAIV) and antimicrobial-resistant bacteria such as ESBL-producing Escherichia (E.) coli. The continued circulation of HPAI H5 viruses of the gs/Gd lineage has caused unprecedented global outbreaks in poultry and wild birds. While passive surveillance of sick and dead birds remains the main approach for HPAIV detection, complementary active surveillance of apparently healthy birds using simple, non-invasive sampling is needed to better understand virus ecology and evolution. Methods: From June 2022 to December 2023, we deployed shallow plastic bins with coastal brackish water and wheat grains along the Greifswalder Bodden shore, Baltic Sea, Germany, to attract wild waterbirds. After bird visits, water samples were analyzed for influenza A virus by RT-qPCR. In July 2022, four samples were cultured for ESBL-producing E. coli. Results: Camera monitoring confirmed that mallards (Anas platyrhynchos) were the main visitors, feeding and interacting intensively with the water. 222 water samples were analyzed for viral RNA; 13 (5.9%) were avian influenza virus-positive, including HPAI H5 (clade 2.3.4.4b) and low-pathogenic subtypes H3N8 and H11N9. All four samples yielded ESBL-producing E. coli, including one isolate of sequence type ST58. Conclusion: This non-invasive approach is a promising tool for environmental surveillance of viral and bacterial pathogens, with sensitivity expected to improve through enrichment techniques targeting pathogens in water.

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease endemic to regions of Africa, the Balkans, the Middle East, and Asia, with increasing reports of cases in southern Europe. Human transmission occurs primarily through the bite of infected ticks and by body fluids from infected human. Crimean-Congo haemorrhagic fever virus (CCHFV) affects a broad host range, including both domestic and wild vertebrates. Recent studies have suggested a potential susceptibility of companion animals, posing an additional threat to public health. In the present study, the presence of CCHFV antibodies was evaluated by screening 374 dog and 238 cat serum samples collected from eight Namibian regions using a commercial enzyme-linked immunosorbent assay. Overall, dogs (11.50 %) showed significantly higher odds of seropositivity (OR = 7.60; 95 % CI = 3.02 - 25.51; p-value < 0.001) compared to cats (1.68 %). Most of the positive dogs and all positive cats originated from the Kunene and Hardap regions. No other factors were found to affect seroprevalence. The limited development of farming systems in these regions, combined with the higher roaming activity of dogs, may suggest a greater exposure risk to wild animals or infected ticks. Tick species of the genus Hyalomma are not commonly reported to infest dogs in Namibia, and other tick species may also be involved in transmission. The detection of CCHFV antibodies in dogs and cats in Namibia should be considered by public health authorities as a potential threat, warranting further investigation to identify infection sources and risk factors. While the level and duration of viremia in companion animals, as well as their actual infectivity, remain unknown, efforts should focus on reducing contact between domestic pets, livestock, and wild animals, as well as regular prophylactic tick treatment of pets to prevent or minimise tick infestations.

BackgroundTreponema pallidum subspecies pertenue (TPE) is the causative agent of human and nonhuman primate (NHP) yaws infection. The discovery of yaws bacterium in wild populations of NHPs opened the question of transmission mechanisms within NHPs, and this work aims to take a closer look at the transmission of the disease.Methodology/principal findingsOur study determined eleven whole TPE genomes from NHP isolates collected from three national parks in Tanzania: Lake Manyara National Park (NP), Serengeti NP, and Ruaha NP. The bacteria were isolated from four species of NHPs: Chlorocebus pygerythrus (vervet monkey), Cercopithecus mitis (blue monkey), Papio anubis (olive baboon), and Papio cynocephalus (yellow baboon). Combined with previously generated genomes of TPE originating from NHPs in Tanzania (n = 11), 22 whole-genome TPE sequences have now been analyzed. Out of 231 possible combinations of genome-to-genome comparisons, five revealed an unexpectedly high degree of genetic similarity in samples collected from different NHP species, consistent with inter-species transmission of TPE among NHPs. We estimated a substitution rate of TPE of NHP origin, ranging between 1.77 × 10-7 and 3.43 × 10-7 per genomic site per year.Conclusions/significanceThe model estimations predicted that the inter-species transmission happened recently, within decades, roughly in an order of magnitude shorter time compared to time needed for the natural diversification of all tested TPE of Tanzanian NHP origin. Moreover, the geographical separation of the sampling sites (NPs) does not preclude TPE transmission between and within NHP species.

The treponemes infecting lagomorphs include Treponema paraluisleporidarum ecovar Cuniculus (TPeC) and ecovar Lepus (TPeL), infecting rabbits and hares, respectively. In this study, we described the first complete genome sequence of TPeL, isolate V3603-13, from an infected mountain hare (Lepus timidus) in Sweden. In addition, we determined 99.0% of the genome sequence of isolate V246-08 (also from an infected mountain hare, Sweden) and 31.7% of the genome sequence of isolate Z27 A77/78 (from a European hare, Lepus europeaus, The Netherlands). The TPeL V3603-13 genome had considerable gene synteny with the TPeC Cuniculi A genome and with the human pathogen T. pallidum, which causes syphilis (ssp. pallidum, TPA), yaws (ssp. pertenue, TPE) and endemic syphilis (ssp. endemicum, TEN). Compared to the TPeC Cuniculi A genome, TPeL V3603-13 contained four insertions and 11 deletions longer than three nucleotides (ranging between 6 and2,932 nts). In addition, there were 25 additional indels, from one to three nucleotides long, altogether spanning 36 nts. The number of single nucleotide variants (SNVs) between TPeC Cuniculi A and TPeL V3603-13 were represented by 309 nucleotide differences. Major proteome coding differences between TPeL and TPeC were found in the tpr gene family, and (predicted) genes coding for outer membrane proteins, suggesting that these components are essential for host adaptation in lagomorph syphilis. The phylogeny revealed that the TPeL sample from the European brown hare was more distantly related to TPeC Cuniculi A than V3603-13 and V246-08.

Background:MDR pathogens including ESBL- and/or carbapenemase-producing Enterobacterales (ESBL-PE and CPE) increasingly occur worldwide in the One Health context.Objectives:This proof-of-principle study investigated the occurrence of ESBL-PE in surface water in the Ashanti Region in Ghana, sub-Saharan Africa (SSA), and investigated their additional genotypic and phenotypic antimicrobial resistance features as part of the Surveillance Outbreak Response Management and Analysis System (SORMAS).Methods:From 75 water samples overall, from nine small to medium-sized river streams and one pond spatially connected to a channelled water stream in the greater area of Kumasi (capital of the Ashanti Region in Ghana) in 2021, we isolated 121 putative ESBL-PE that were subsequently subjected to in-depth genotypic and phenotypic analysis.Results:Of all 121 isolates, Escherichia coli (70.25%) and Klebsiella pneumoniae (23.14%) were the most prevalent bacterial species. In addition to ESBL enzyme-production of mostly the CTX-M-15 type, one-fifth of the isolates carried carbapenemase genes including blaNDM-5. More importantly, susceptibility testing not only confirmed phenotypic carbapenem resistance, but also revealed two isolates resistant to the just recently approved last-resort antibiotic cefiderocol. In addition, we detected several genes associated with heavy metal resistance.Conclusions:ESBL-PE and CPE occur in surface water sources in and around Kumasi in Ghana. Further surveillance and research are needed to not only improve our understanding of their exact prevalence and the reservoir function of water sources in SSA but should include the investigation of cefiderocol-resistant isolates.

Background Integrated approaches to mapping skin Neglected Tropical Diseases (NTDs) may be cost-effective way to guide decisions on resource mobilization. Pilot studies have been carried out, but large-scale data covering multiple countries endemic for skin NTDs are lacking. Within the LAMP4YAWS project, we collected integrated data on the burden of multiple skin NTDs. Methods From March 2021 to March 2023, integrated case searches for yaws alongside other skin conditions were performed in endemic health districts of yaws in Cameroon, Côte d’Ivoire, and Ghana. Integrated activities included training, social mobilization and active case detection. Initial screening involved a brief clinical examination of participants to determine if any skin conditions were suspected. Cases of skin NTDs were then referred to a health facility for appropriate management. Results Overall 61,080 individuals screened, 11,387 (18.6%) had skin lesions. The majority of individuals (>90%) examined were children aged 15 years old and under. The proportion of serologically confirmed yaws cases was 8.6% (18/210) in Cameroon, 6.8% (84/1232) in Côte d’Ivoire, and 26.8% (440/1643) in Ghana. Other skin conditions based on clinical examination included: scabies, Buruli ulcer, leprosy, lymphatic filariasis (lymphoedema and hydrocele), tungiasis, and fungal infections. The most common conditions were scabies and superficial fungal infections. In Cameroon, scabies and superficial fungal infections accounted for 5.1% (214/4204) and 88.7% (3730/4204) respectively, 25.2% (1285/5095) and 50.4% (2567/5095) in Côte d’Ivoire. In Ghana, 20% (419/2090) of individuals had scabies but superficial fungal infections were not routinely recorded and were reported in only 1.3% (28/2090). Other skin NTDs were less common across all three countries. Conclusion This study confirms that integrated screening allows simultaneous detection of multiple skin NTDs, maximising use of scarce resources.

Yaws, caused by Treponema pallidum ssp. pertenue, remains a significant public health concern in tropical regions of West Africa and the South Pacific, primarily affecting children in remote areas with limited access to hygiene and sanitation. In this study, conducted in three endemic countries of West Africa where yaws remains a significant public health concern (Ghana, Cameroon, and Côte d’Ivoire), we aimed to assess the knowledge, attitudes, and practices related to yaws among community members, community health workers (CHWs), and traditional healers. The study revealed variations in the perception of causes of yaws among community members: the majority or participants in Ghana attributed yaws to germs (60.2%); in Cameroon the most reported form of transmission was contact with or drinking infected water sources (44.6%); and in Côte d’Ivoire both of these answers were also the most prevalent (60.3% germs and 93.% water sources). A substantial proportion of participants in Côte d’Ivoire also associated yaws with witchcraft and divine punishment (44.8%). Only a small proportion of individuals in Ghana and Côte d’Ivoire correctly identified contact with an infected person as a form of transmission (11.9% and 20.7%, respectively) and less than half in Cameroon (42.6%), although more than 98% of all participants reported avoidance behaviours towards yaws infected people due to fear of getting infected. Most participants expressed a preference for seeking care at hospitals (49.2%, 60.6%, 86.2%) or health care professionals including doctors and nurses (58.5%, 41,5% and 17.2%) if they were diagnosed with yaws, although a quarter of participants in Côte d’Ivoire also sought support from traditional healers. The CHWs interviewed were generally well-trained on yaws causes and treatment options, although they often reported low availability of treatment and diagnostic tests for yaws. Our findings underscore the need for community education, awareness campaigns, ongoing CHW training, and improved access to yaws treatment and diagnostic resources. The data also suggest that collaboration with traditional healers, who usually hold a highly esteemed position in the society, such as giving training on yaws causes and transmission or exchanging knowledge on treatment options, could be beneficial in certain regions, particularly in Côte d’Ivoire.

Myxoma virus (MYXV) is a Leporipoxvirus (genus) belonging to the family Poxviridae; it is characterised by a genome of approximately 161 kb dsDNA encoding for several proteins that play an essential role in both host spectrum determination and immunomodulation. The healthy reservoir of the virus is Sylvilagus spp. At the same time, in wild and domestic European rabbits (Oryctolagus cuniculus), MYXV is the etiologic agent of myxomatosis, a disease with an extremely high mortality rate. In 2014, an interspecies jump of MYXV was reported in Lepus europaeus in the UK. In 2018, myxomatosis induced by a new recombinant strain called MYXV-To was identified during a large outbreak in Iberian hares (Lepus granatensis) in Spain. Here, we describe the case of myxomatosis in another hare species: an adult male Italian hare (Lepus corsicanus) found dead in 2018 in Sicily with lesions suggestive of myxomatosis and treponema infection. Laboratory tests, e.g., end-point PCR and negative staining electron microscopy, confirmed the presence of both pathogens. MYXV was then isolated from tissue samples in permissive cells and sequenced using NGS technology. Main genomic differences concerning known MYXV strains are discussed.

BACKGROUND:To meet the WHO target of eradicating yaws by 2030, highly sensitive and specific diagnostic tools are needed. A multiplex Treponema pallidum-Haemophilus ducreyi loop-mediated isothermal amplification (TPHD-LAMP) test holds promise as a near-patient diagnostic tool for yaws and H ducreyi. We conducted a prospective evaluation in Cameroon, Côte d'Ivoire, Ghana, and the Republic of the Congo to determine the diagnostic accuracy of the TPHD-LAMP test, as well as to assess its acceptability, feasibility, and cost. METHODS:Active case searching within schools and communities was used to locate participants with clinically suspicious laws-like lesions. Individuals with serologically confirmed active yaws provided paired lesion swabs between March, 2021, and April, 2023. For each participant, one swab was tested with the TPHD-LAMP at a local district laboratory and the other with reference quantitative PCR (qPCR) tests conducted at national reference laboratories. The primary outcome was TPHD-LAMP test sensitivity and specificity compared with qPCR. Laboratory technicians were interviewed using a multiple-choice survey to gauge acceptability and feasibility of the TPHD-LAMP test. Costs of each test were calculated. FINDINGS:Of 3085 individuals with at least one suspected yaws lesion, 531 (17%) were serologically confirmed. We enrolled 493 participants with seropositive yaws and a further 32 with negative serology. The sensitivity of the TPHD-LAMP test for detecting T pallidum was 63% (95% CI 56-70) and the specificity was 66% (95% CI 61-71). Sensitivity and specificity for T pallidum improved to 73% (63-82; p=0·0065) and 75% (68-80; p=0·0003), respectively, in H ducreyi-negative samples. Interviews highlighted challenges in user-friendliness and practicality of the TPHD-LAMP test. The cost of the test per sample was one third of that of qPCR, although the TPHD-LAMP test entailed higher costs to establish the assay. INTERPRETATION:This was the first multi-country diagnostic evaluation of a molecular test for yaws. The TPHD-LAMP testing, in its current form, falls short of the WHO target product profile criteria for yaws diagnostics. These findings highlight the importance of assessing new diagnostics in real-world conditions to ensure their suitability for programmatic use. FUNDING:The EDCTP2 programme supported by the EU.

Zusammenfassung COVID-19-Pandemie und gehäuftes Auftreten von Mpox-Erkrankungen (Affenpocken) außerhalb Afrikas haben die Verletzlichkeit der Bevölkerung für aus dem Tierreich stammende Krankheitserreger deutlich werden lassen. Darüber hinaus haben in den vergangenen Jahren weitere virale Zoonoseerreger an Bedeutung gewonnen. Der vorliegende Übersichtsartikel beleuchtet anhand von 6 meldepflichtigen viralen Zoonoseerregern beispielhaft die Notwendigkeit der One Health-Herangehensweise, um die Epidemiologie der Erkrankungen verstehen zu können und Handlungsempfehlungen für den öffentlichen Gesundheitsdienst abzuleiten. Dabei wird die Bedeutung von Umweltfaktoren, Reservoiren und Vektoren betont, die Erkrankungen bei Nutz- und Wildtieren werden analysiert sowie das Auftreten und die Häufigkeit von Erkrankungen bei der Bevölkerung beschrieben. Die hier ausgewählten Erreger unterscheiden sich in den Reservoiren und der Rolle von Vektoren für die Übertragung, den Auswirkungen der Infektionen auf landwirtschaftliche Nutztiere und den beim Menschen beobachteten Krankheitsbildern. Neben bereits lange in Deutschland bekannten Zoonoseerregern werden auch Erreger betrachtet, die erst kürzlich eingetragen wurden bzw. deren Zoonosepotenzial vor Kurzem erstmals gezeigt worden ist. Bei den hier behandelten Erregern gibt es nach wie vor deutliche Wissenslücken zu den Übertragungswegen. Zukünftige One Health-basierte Untersuchungen werden zu deren weiterer Aufklärung und somit zur Entwicklung von Präventionsmaßnahmen beitragen. Die ganzheitliche Herangehensweise beinhaltet nicht zwangsläufig eine Fokussierung auf virale Erreger/Erkrankungen, sondern beinhaltet auch die Frage der Wechselwirkungen von viralen, bakteriellen und anderen Erregern, inkl. der Antibiotikaresistenz und der Wirtsmikrobiome.

The rich diversity of morphology and behavior displayed across primate species provides an informative context in which to study the impact of genomic diversity on fundamental biological processes. Analysis of that diversity provides insight into long-standing questions in evolutionary and conservation biology and is urgent given severe threats these species are facing. Here, we present high-coverage whole-genome data from 233 primate species representing 86% of genera and all 16 families. This dataset was used, together with fossil calibration, to create a nuclear DNA phylogeny and to reassess evolutionary divergence times among primate clades. We found within-species genetic diversity across families and geographic regions to be associated with climate and sociality, but not with extinction risk. Furthermore, mutation rates differ across species, potentially influenced by effective population sizes. Lastly, we identified extensive recurrence of missense mutations previously thought to be human specific. This study will open a wide range of research avenues for future primate genomic research.

ABSTRACT The bacterium Treponema paraluisleporidarum causes syphilis in lagomorphs. In a set of 1,095 samples from four species—European brown hare, mountain hare, Corsican hare, and European rabbit—we tested for infection and genotyped the strains that infect wild lagomorphs. Samples originate from Sweden, the Netherlands, the United Kingdom, Germany, the Czech Republic, and Italy. The phylogenetic analyses of two informative gene targets (tp0488 and tp0548) showed high genetic diversity among the lagomorph-infecting treponemes. More specifically, we found a high number of nucleotide variants and various short repeat units in the tp0548 locus that have not been described for human syphilis and primate yaws causing Treponema pallidum. While the functional aspect of these short repeat units remains subject to ongoing investigations, it likely enables the pathogen to better survive in its lagomorph host. Our data did not support any geographic clustering, which is equally reflected in the host population genetics as shown by mitochondrial genome data corresponding to the sampled lagomorph populations. This is unexpected and in contrast with what has been shown for nonhuman primate infection with T. pallidum. In the future, the combination of multi-locus sequence typing and whole genome data from modern and ancient samples from a wide geographic range and multiple lagomorph species will contribute to a better understanding of the epidemiology and evolutionary path of lagomorph-infecting treponemes. In conclusion, our current study demonstrates widespread infection and a high genetic variation of the syphilis-causing pathogen in a higher number of positively PCR-tested European lagomorphs (n = 302/1,095). IMPORTANCE Syphilis is an ancient disease of humans and lagomorphs caused by two distinct but genetically closely related bacteria (>98% sequence identity based on the whole genome) of the genus Treponema. While human syphilis is well studied, little is known about the disease in the lagomorph host. Yet, comparative studies are needed to understand mechanisms in host–pathogen coevolution in treponematoses. Importantly, Treponema paraluisleporidarum–infected hare populations provide ample opportunity to study the syphilis-causing pathogen in a naturally infected model population without antibiotic treatment, data that cannot be obtained from syphilis infection in humans. We provide data on genetic diversity and are able to highlight various types of repetitions in one of the two hypervariable regions at the tp0548 locus that have not been described in the human syphilis-causing sister bacterium Treponema pallidum subsp. pallidum.

Baboons (genus Papio) are a morphologically and behaviorally diverse clade of catarrhine monkeys that have experienced hybridization between phenotypically and genetically distinct phylogenetic species. We used high-coverage whole-genome sequences from 225 wild baboons representing 19 geographic localities to investigate population genomics and interspecies gene flow. Our analyses provide an expanded picture of evolutionary reticulation among species and reveal patterns of population structure within and among species, including differential admixture among conspecific populations. We describe the first example of a baboon population with a genetic composition that is derived from three distinct lineages. The results reveal processes, both ancient and recent, that produced the observed mismatch between phylogenetic relationships based on matrilineal, patrilineal, and biparental inheritance. We also identified several candidate genes that may contribute to species-specific phenotypes.

AbstractEpidemics of yaws-like cutaneous ulcers are regularly documented in children in the tropics. They occur mainly in poor and remote communities without access to health facilities. The integration of molecular tools into yaws control efforts has made it possible to describeHaemophilus ducreyi(HD) as a major cause of cutaneous ulcers. The objective of this work was to determine the prevalence ofHDas cause of cutaneous ulcers, as asymptomatic carriage and the risk factors associated.A cross-sectional study was conducted in yaws endemic districts of Cameroon. Participants included people presenting yaws-like ulcers and asymptomatic individuals. Swab samples were collected from each participant and tested forHDandTreponema pallidum(TP) using established qPCR method. Additionally, demographic, habitat, proximity, and hygiene characteristics were collected using a structured questionnaire.A total of 443 individuals, including 271 ulcer cases and 172 asymptomatic contacts, were enrolled in this study. The prevalence ofHDin ulcers was 30.3% (Confidence Interval (CI) 95% [24.8 – 35.7]) and the prevalence of asymptomaticHDcarriage was 8.6% (CI95% [4.5 – 12.9]).TPwas also detected in our sample among ulcer cases but in lower proportion (5.2% CI95% [2.5 – 7.8]) compared toHD. The adjusted logistic regression model showed that women were as much at risk of havingHDcutaneous ulcer as men regardless of age; physical proximity to a confirmed ulcer case was the major factor favouringHDtransmission.HDulcers were more likely to be present on Bantu individuals compare to Baka as well asHDcolonization.Data from this study highlightHDas the most common cause of cutaneous ulcers in yaws-endemic communities in Cameroon. The real issues ofHDdetection on intact skin are not yet clear. Further studies are needed to elucidate the implications of this carriage in the spread dynamics of the disease.Author summaryCutaneous ulcers are commonly found affecting children in low-income countries of Africa and the South Pacific. In rural and remote communities of Cameroon the limited access to health care and shortage of sanitation is associated with a high morbidity of cutaneous ulcers. The latter represent an important cause of suffering and stigmatization in children.HDis commonly known as the causative agent of the sexually transmitted infection chancroid and has been recently described as a leading cause of cutaneous ulcers in yaws-endemic regions. In this study, we investigated the presence ofHDand the associated risk factors. Our findings indicate a prevalence ofHDassociated with cutaneous ulcers of 30.3% and a prevalence of asymptomaticHDcarriage of 5.2%. Physical proximity to a confirmed ulcer case, Bantu ethnicity, and the use of traditional latrines were the main risk factors associated withHDulcers.TPDNA was detected in some cutaneous ulcer samples but in lower proportion compared toHD. This study confirms thatHDis a leading cause of cutaneous ulcer in yaws endemic areas in Cameroon. National control programmes in endemic countries should therefore consider this pathogen in their strategies for controlling and eliminating skin neglected tropical diseases (NTDs).

Abstract Background Treponema pallidum (TP) is a spirochaete bacterium with subspecies that in humans cause syphilis (subsp. pallidum), bejel (subsp. endemicum) and yaws (subsp. pertenue; TPE). The latter is target for eradication which requires detailed information on yaws epidemiology. It has been shown that African nonhuman primates (NHPs) are infected with TPE strains that are closely related to the human infecting yaws bacterium. While human yaws infection is known to be endemic in Ghana, there is a paucity of information regarding TPE infection of Ghana's native NHPs. Objectives The objective was to perform a small‐scale cross‐sectional serological screening for antibodies against TPE in Ghanaian monkeys. Due to the reports of TPE‐infected NHPs from neighbouring Côte d'Ivore, we hypothesised that monkeys in Ghana are infected with TPE and, therefore, are seropositive for antibodies against‐Treponema. Methods We sampled blood from 37 NHPs representing four species: Erythrocebus patas (16/37) 43.2%, Papio anubis (15/37) 40.5%, Chlorocebus sabaeus (3/37) 8.1% and Cercopithecus mona (3/37) 8.1%. Samples were tested using the NHP validated treponemal test ESPLINE TP. Results All 37 animals were seronegative for yaws infection. Conclusions We cannot exclude yaws infection in NHPs in Ghana at this point. Our study, in combination with the absence of reports of clinically infected NHPs in a yaws endemic country is, however, supportive for the current thinking that interspecies infection with TPE is extremely rare. This is an important finding for the current ongoing yaws eradication campaign.

Epidemics of yaws-like cutaneous ulcers are regularly documented in children in the tropics. They occur mainly in poor and remote communities without access to health facilities. The integration of molecular tools into yaws control efforts has made it possible to describe Haemophilus ducreyi (HD) as a major cause of cutaneous ulcers. The objective of this study was to determine the prevalence of HD as cause of cutaneous ulcers, investigate its presence in asymptomatic individuals and identify associated risk factors. A cross-sectional study was conducted in yaws endemic districts of Cameroon. Participants included people presenting yaws-like ulcers and asymptomatic individuals. Swab samples were collected from each participant and tested for HD and Treponema pallidum (TP) using an established qPCR method. Additionally, demographic, habitat, proximity, and hygiene characteristics were collected using a structured questionnaire. A total of 443 individuals participated in the study, including 271 ulcer cases and 172 asymptomatic contacts. The prevalence of HD in ulcers was 30.3% (Confidence Interval (CI) 95% [24.8-35.7]) and the prevalence of asymptomatic HD carriage was 8.6% (CI95% [4.5-12.9]). TP was also detected in our sample among ulcer cases but in lower proportion (5.2% CI95% [2.5-7.8]) compared to HD. The adjusted logistic regression model showed that women were as much at risk of having HD cutaneous ulcer as men regardless of age. Physical proximity to a confirmed ulcer case was the major factor identified favouring HD transmission. HD ulcers were more likely to be present on Bantu individuals compared to Baka as well as HD colonization. These findings highlight HD as the most common cause of cutaneous ulcers in yaws-endemic communities in Cameroon. The exact implications of detecting HD on intact skin are not yet clear. Further studies are needed to understand the significance of this carriage in the spread dynamics of the disease.

ABSTRACT This study investigated the presence of extended-spectrum β-lactamase-producing Enterobacterales in selected surface waters in the Ashanti Region in Ghana. Subsequent genomic analysis revealed that one-fifth of the isolates were genotypically carbapenem-resistant. Phenotypic susceptibility testing not only confirmed their carbapenem resistance, but also uncovered two cefiderocol-resistant isolates.