Dengue is an arboviral infection that poses a substantial public health concern, with early diagnosis being a critical factor in effective management. However, limited diagnostic expertise in developing countries contributes to the under-reporting of dengue cases. This review compares the accuracy of rapid diagnostic tests (RDTs) and the tourniquet test (TT) in diagnosing dengue fever (DF) in non-laboratory-based settings. Relevant original articles on the use of RDTs and TT for dengue diagnosis were retrieved from PubMed, Scopus, and ScienceDirect. The STARD and QUADAS-2 tools were employed to evaluate the methodological quality of the included studies. Search terms included combinations of ‘fever’, ‘dengue’, and ‘“diagnosis’. In total, 23 articles were eligible for inclusion. The RDTs demonstrated mean sensitivities and specificities of 76.2% (SD = 13.8) and 91.5% (SD = 10.3), respectively, while the TT showed mean sensitivity and specificity values of 48.6% (SD = 24.9) and 79.5% (SD = 14.9), respectively. Overall, RDTs exhibited superior diagnostic performance compared to the TT. Our findings suggest that the TT is an inadequate stand-alone diagnostic tool for dengue. RDTs should be prioritized for dengue diagnosis in resource-limited settings. However, in situations where RDTs are unavailable, the TT may serve as a supplementary option.

Sexually transmitted infections caused by Chlamydia trachomatis (Ct) and Mycoplasma genitalium (Mg) have significant implications both at the individual and societal levels. Our study evaluated various co-factors associated with persistent serum IgG-antibodies to Ct and Mg. Three hundred and twenty nine pregnant women and 135 men from the Finnish Family HPV study were analyzed for serum IgG-antibodies of pGP3 for Ct and MgPa and rMgPa for Mg using multiplex serology. Seropersistence to both Ct and Mg was more common in women (30.4% and 13.3%) than in men (17.4% and 5.3%). The number of lifetime sexual partners above 10, the practice of anal sex, and a history of diagnosed Ct were associated with seropersistence to Ct in women, adjusted ORs 5.6 (95%CI 1.39–22.29), 15.3 (95%CI 1.18–197.12) and 18.0 (95%CI 5.59–57.92), respectively. The increasing number of partners before the age of 20 was the main risk factor for seropersistence among women with Mg, adjusted OR range from 5.0 to 12.3 (95%CI range 1.17–100.90) and in men only with 6–10 partners for Ct, adjusted OR 12.6 (95%CI 1.55–102.49). To conclude, persistent Ct antibodies were associated with various sexual activities, and Mg seropositivity was mainly associated with increased sexual activity in early adulthood.

This study aims to estimate the prevalence of human papillomavirus (HPV) infection and describe its genotype distribution in MSM in Hong Kong. In this longitudinal study on Chinese MSM, multi-anatomic site self-sampling and testing for HPV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were performed following survey completion at baseline and one-year follow-up. Overall, 41% (288/701) of MSM completed self-sampled HPV testing. HPV positivity was 29% (78/270) and 33% (42/127) at any anatomic site at baseline and follow-up timepoints, respectively. By anatomic site, HPV positivity was 26%-30%, 2%-4% and 0%-1% from rectal, penile, and pharyngeal specimens, respectively. The incidence of HPV infection was 21.2/100 and 18.9/100 person-years at any anatomic site and rectal site, respectively. Among 109 successfully genotyped samples, the most prevalent were HPV 6 (17%) and HPV 11 (16%), of which 60% of the genotyped samples were vaccine-preventable. Group sex engagement and less frequent condom use were positively associated with HPV infection (P<0.05). The HPV prevalence and incidence in MSM in this study is lower than in Western countries, and low-risk HPV genotypes are more prevalent. The high proportion of vaccine-preventable HPV subtypes underscores the importance of HPV vaccination in preventing infections in MSM.

Scrub typhus is a mite-borne infection, largely affecting rural populations in many parts of Asia. This cohort study explored socio-demographic, behavioural, and spatial risk factors at different levels of endemicity. 2206 rural residents from 37 villages in Tamil Nadu, South India, underwent a questionnaire survey and blood sampling at baseline and annually over 2 years to detect sero-conversion. Satellite images were used for visual land use classification. Local sero-prevalence was estimated using 5602 baseline blood samples.

Two hundred and seventy cases of seroconversions occurred during 3629 person-years (incidence rate 78/1000, 95%CI 67, 91). Older age was associated with scrub typhus in crude but not in multivariable analysis adjusting for socio-economic factors. By contrast, the increased risk in females compared to males (RR 1.4) was unaffected by adjusting for confounders. In multivariable analysis, agricultural and related outdoor activities were only weakly associated with scrub typhus. However, agricultural activities were strongly associated with scrub typhus if local sero-prevalence was low, but not if it was high. Females were at a higher risk than males in high-prevalence areas but not in low-prevalence areas. To conclude, agricultural activities were not strongly associated with scrub typhus. Transmission within human settlements may predominate in highly endemic settings.

Limited studies on the seasonality of pharyngitis and tonsillitis suggest subtle but unexplained fluctuations in case numbers that deviate from patterns seen in other respiratory diagnoses. Data on weekly acute respiratory infection diagnoses from 2010–2022, provided by the Polish National Healthcare Fund, included a total of 360 million visits. Daily mean temperature and relative humidity were sourced from the Copernicus Climate Data Store. Seasonal pattern was estimated using the STL model, while the impact of temperature was calculated with SARIMAX. A recurring early-summer wave of an unspecified pathogen causing pharyngitis and tonsillitis was identified. The strongest pattern was observed in children under 10, though other age groups also showed somewhat elevated case numbers. The reproductive number of the pathogen is modulated by warmer temperatures; however, summer holidays and pandemic restrictions interrupt its spread. The infection wave is relatively flat, suggesting either genuinely slow spread or multiple waves of related pathogens. Symptomatic data unambiguously demonstrate existence of pathogens of quite distinct characteristics. Given its consistent year-to-year pattern, identifying these potential pathogens could enhance respective treatment, including antibiotic therapy.

Bloodstream infections (BSIs) caused by Candida are a significant cause of morbidity and mortality. Geographical variations exist in the epidemiology of candidemia, with a paucity of data in the many low- and middle-income countries. We performed a retrospective study of candidemia from 2017 to 2022 at a 289-bed teaching hospital in the Dominican Republic (DR). A total of 197 cases were reviewed. Overall mortality rate was 49.2%. Age and vasopressor use were associated with mortality. The most prevalent Candida species were C. tropicalis and C. parapsilosis. C. albicans was 12% resistance to amphotericin B. These findings underscore the importance of understanding local epidemiology and may help inform empiric therapy and the development of treatment guidelines in the DR.

Anonymous online surveys using financial incentives are an essential tool for understanding sexual networks and risk factors including attitudes, sexual behaviors, and practices. However, these surveys are vulnerable to bots attempting to exploit the incentive. We deployed an in-person, limited audience survey via QR code at select locations in North Carolina to assess geolocation application use among men who have sex with men to characterize the role of app usage on infection risk and behavior. The survey was unexpectedly posted on a social media platform and went viral. Descriptive statistics were performed on repeat responses, free-text length, and demographic consistency. Between August 2022 and March 2023, we received 4,709 responses. Only 13 responses were recorded over a 6-month period until a sharp spike occurred: over 500 responses were recorded in a single hour and over 2,000 in a single day. Although free-text responses were often remarkably sophisticated, many multiple-choice responses were internally inconsistent. To protect data quality, all online surveys must incorporate defensive techniques such as response time validation, logic checks, and IP screening. With the rise of large language models, bot attacks with sophisticated responses to open-ended questions pose a growing threat to the integrity of research studies.

Despite the appeal of screening travellers to prevent case importation during infectious disease outbreaks, evidence shows that symptom screening is largely ineffective in delaying the geographical spread of infection. Molecular tests offer high sensitivity and specificity and can detect infections earlier than symptom screening, suggesting potential for improved outcomes. However, they were used to screen travellers for COVID-19 with mixed success. To investigate molecular screening’s role in controlling COVID-19, and to quantify the effectiveness of screening for future pathogens of concern, we developed a probabilistic model that incorporates within-host viral kinetics. We then evaluated the potential effectiveness of screening travellers for influenza A, SARS-CoV-1, SARS-CoV-2, and Ebola virus. Even under highly optimistic assumptions, we found that the inability to detect recent infections always limits the effectiveness of traveller screening. We quantify this fundamental limit by proposing an estimator for the fraction of transmission that is preventable by screening. We also demonstrate that estimates of ascertainment overestimate reductions in transmission. These results highlight the essential role that quarantine and repeated testing play in infectious disease containment. Furthermore, our findings indicate that improving screening effectiveness requires the ability to detect infection much earlier than current state-of-the-art molecular tests.

The rapid evolution of SARS-CoV-2 has led to the emergence of variants of concern (VOCs) characterized by increased transmissibility, pathogenicity, and resistance to neutralizing antibodies. Identifying these variants is essential for guiding public health efforts to control COVID-19. Although whole genome sequencing (WGS) is the gold standard for variant identification, its implementation is often limited in developing countries due to resource constraints. In Bolivia, genomic surveillance is a challenge due to its limited technological infrastructure and resources. An RT-qPCR-based strategy was designed to address these limitations and detect the mutations associated with VOCs and variants of interest (VOIs). The multiplex RT-qPCR commercial kits AllplexTM Master and Variants I (Seegene®) and the ValuPanelTM (Biosearch®) were used to target mutations such as HV69/70del, E484K, N501Y, P681H, and K417N/T. They are characteristic of the Alpha (B.1.1.7), Beta (B.1.531), Gamma (P.1), Omicron (B.1.1.529), Mu (B.1.621), and Zeta (P.2) variants. A total of 157 samples collected in Cochabamba from January to November 2021 were evaluated, identifying 44 Gamma, 2 Zeta, 20 Mu, and 10 Omicron were identified. The strategy’s effectiveness was validated against WGS data generated with Oxford NanoporeTM technology, showing a concordance rate of 0.96. This highlights the value of the RT-qPCR strategy in guiding the selection of samples for WGS, enabling broader detection of new variants that cannot be identified by RT-qPCR alone.

Antimicrobial resistance (AMR) in intensive care units (ICUs) is a critical issue, which has been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. This study investigated AMR prevalence and its associated factors among ICU patients in two Vietnamese hospitals from January 2020 to June 2022. Electronic medical records of 1,296 patients with 2,432 non-duplicate bacterial isolates were collected in Phu Tho Hospital (Northern, rural, non-COVID-19 treatment) and 175 Hospital (Southern, urban, COVID-19 treatment centre). Antibiotic susceptibility testing was conducted using VITEK2, BD Phoenix 100, and disk diffusion methods. Logistic regression with 1,000 bootstrap resampling and cross-validation was used to examine factors linked to AMR. Results revealed Acinetobacter spp. (27.5%) as leading strains in Phu Tho Hospital, while Klebsiella spp. (28.0%) predominated in 175 Hospital, except during 2021when Acinetobacter spp. reached the peak. Alarmingly, Acinetobacter spp., Klebsiella spp., and Pseudomonas aeruginosa demonstrated the highest AMR rates and multidrug resistance rates (83.8%–95.8%) in both hospitals. Resistance to cephalosporins, carbapenems, and fluoroquinolones ranged from 75% to 100%. Significant associated factors included age, sex, location, initial admission diagnosis, and bacterial isolation month. This study highlights the urgent need for controlling AMR in ICUs during the pandemic.

The Secretary of the US Department of Health & Human Services, Robert Kennedy Jr is leading a political agenda against vaccination. This is undermining the delivery of life-saving vaccination programmes and provision of evidence-based information on the safety and effectiveness of vaccines for the public and health professionals. Inconsistent and conflicting messaging between health practitioners and government health agencies erodes trust in public health programmes, creating a vacuum which is often filled with mis/disinformation that presents severe consequences for families. Due to the transnational spread of diseases, we consider the implications of events in the US for routine childhood vaccination programmes in the UK. Public health agencies across the world need to be ‘Kennedy ready’; pragmatic steps must be taken to mitigate threats posed to vaccine confidence and the control of vaccine preventable diseases.

The Alpha, Delta, and Omicron variants of the SARS-CoV-2 virus have been deemed as variants of concern (VOCs) by the WHO due to their increased transmissibility, severity of illness, and resilience against treatments. Geographically tracking the spread of these variants can help us implement effective control measures. RNA from 8,154 SARS-CoV-2 positive nasal swab samples from a Central Texas hospital collected between March 2020 and April 2023 were sequenced in Temple, TX. Global and U.S. sequencing metadata was obtained from the GISAID database on 3 April 2023. Using sequencing metadata, the growth rate of Alpha, Delta, and the first subvariant of Omicron (BA.1) were obtained as 0.27, 0.3, and 1.08 each. The average time in days to penetrate the US for Alpha, Delta, and Omicron were 269.2, 326.2, and 27.3 days, respectively. Viral sequencing data can be a useful tool to examine the spread of viruses. Each emerging SARS-CoV-2 variant penetrated cities more rapidly as the pandemic progressed. With a high logarithmic growth rate, the Omicron variant penetrated the US more rapidly as the pandemic progressed.

Contact tracing is an effective public health policy to put the fast-spreading epidemic under control. The government tracks the contacts of confirmed SARS-CoV-2 cases, recommends testing, encourages self-quarantine, and monitors symptoms of contacts. In developing and less-developed countries with limited resources for widespread SARS-CoV-2 testing, it remains essential to identify and quarantine positive contacts to control outbreaks. Therefore, analysing recall and precision when implementing testing policies for these contacts is necessary. We analysed a contact tracing dataset from a cohort of 827 index patients infected with SARS-CoV-2 and their 14814 close contacts from Jan 2020 to July 2020 in a province in eastern China. We constructed a network from the data and used a Graph Convolutional Network to predict each contact’s infection status. To the best of our knowledge, this is the first method to use population-based contact tracing data for predicting the infection status using graph neural networks. Despite limited information, our model achieves competitive Area Under the Receiver Operating Characteristic Curve (ROC AUC) compared to hospital-onset scenarios. Based on the risk scores, we propose several contact testing policy adaptations that balance resource efficiency and effective pandemic control.

Investigating risk factors for mpox’s infectious period is vital for preventing this emerging disease, yet evidence remains scarce. This study aimed to identify risk factors associated with the duration of mpox infectiousness among mpox cases in Vietnam. The primary outcome was the duration of the mpox infectiousness, defined between symptom onset and the first negative test result for the mpox virus. Fine and Gray’s regression models were employed to assess the associations between the infectious period and several risk factors while accounting for competing risks of death by mpox. Most mpox cases recovered within 30 days. Patients with HIV or treated at multiple facilities for mpox had lower incidence rates of cleared infection compared to those who were HIV-negative or treated at a single facility. In regression models, patients with mpox symptoms of rash or mucosal lesions (sub-distribution hazard ratios = 0.62, 95% confidence interval = 0.46–0.83), ulcers (0.57, 0.41–0.80), or fever (0.62, 0.46–0.83) had significantly prolonged infectious periods than those without such symptoms. Our findings provided insights for managing mpox cases, especially those vulnerable to prolonged infectious periods in settings with sporadic cases reported.

Lower COVID-19 vaccination coverage was observed among some populations with a migration background in the Netherlands. This study examined determinants of being unvaccinated against COVID-19 in the primary vaccination round in adults and in the 2022 autumn booster round in persons aged ≥60 years, among four populations of non-Dutch origin with below average vaccination coverage: Moroccan, Turkish, Surinamese and Dutch-Caribbean, and persons of Dutch origin. We performed a population-wide register-based study, examining associations between potential determinants and being unvaccinated using multivariable logistic regression and computing population attributable fractions. Being a migrant with two foreign-born parents, younger age, living in highly/extremely urban areas and having a lower income, lower education level and low medical risk for severe COVID-19 were risk factors for being unvaccinated in all populations. Substantial differences in the (strength of) determinants and population attributable fractions between populations were also observed. Socioeconomic status only partially mediated the association with being a migrant with two foreign-born parents. These findings illustrate that interventions targeting specific ethnic minority and migrant populations need further study with the aim to optimize the impact of vaccination programmes and improve health equity. To understand reasons behind non-uptake and design (community-based) interventions, qualitative and survey-based research is needed.

This study analyzed standardized excess mortality due to specific causes during the Covid-19 pandemic across 33 European countries, using Eurostat data (2016–2021) and Our World in Data databases. Causes included circulatory and respiratory diseases, neoplasms, transport accidents, and “other” causes (e.g., diabetes, dementia, ill-defined conditions). Additional variables such as vaccination rates, economic and health indicators, demographics, and government stringency measures were also examined. Key findings include: (1) Most European countries (excluding Central and Eastern Europe), recorded lower than expected excess mortality from circulatory and respiratory diseases, neoplasms, and transport accidents. Ireland had the lowest excess respiratory mortality in both 2020 and 2021; (2) Croatia, Cyprus, Malta, and Turkey showed significant positive excess mortality from “other” causes, potentially linked to public health restrictions, with Turkey as an exception; (3) Regression analysis found that higher human development index and vaccination rates were associated with lower excess mortality. Policy Implications are: (1) Statistically significant positive or negative cause-specific excess mortality may indicate future health trends; (2) The pandemic and government stringency measures negatively affected mortality from “other” causes; (3) Strengthening health system resilience, investing in digital medicine, directing aid to countries with weaker systems, and supporting disadvantaged groups are key recommendations.