Due to the risk of Shiga-toxin producing Escherichia coli (STEC) transmission, current guidance advises excluding young children from childcare settings until microbiologically clear. Children can shed STEC for a prolonged period, and the cost-effectiveness of exclusion has not been evaluated. Our decision tree analysis, including probabilistic sensitivity analysis, estimated comparative health system costs and effects of exclusion until microbiological clearance versus return to childcare setting before this. Due to the risk of secondary cases, return before microbiological clearance resulted in the incremental loss of 0.019 QALYs, but savings of £156. Using the willingness-to-pay threshold of £20000 per QALY, the incremental net monetary benefit of exclusion until microbiological clearance was £215. Exclusion until microbiological clearance remained cost-effective if the total costs for managing the exclusion were below £576. Return before microbiological clearance may, therefore, become cost-effective in cases where the costs of managing exclusion until microbiological clearance are high and/or the risk of secondary cases is very low. Broadening the decision perspective, including the costs of exclusion to the families, may also impact the recommendation. Further research is needed to assess the risk of STEC transmission from children who have clinically recovered and the impact of STEC and exclusion on families of the affected children.

Children, adolescents, and young people living with HIV (CALWHIV), including those in resource-limited settings, may be at increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, poorer coronavirus disease 2019 (COVID-19) outcomes, and multisystem inflammatory syndrome (MIS). We conducted a repeat SARS-CoV-2 seroprevalence survey among CALWHIV in Europe (n = 493) and South Africa (SA, n = 307), and HIV-negative adolescents in SA (n = 100), in 2020–2022. Blood samples were tested for SARS-CoV-2 antibody, questionnaires collected data on SARS-CoV-2 risk factors and vaccination status, and clinical data were extracted from health records. SARS-CoV-2 seroprevalence (95% CI) was 55% (50%–59%) in CALWHIV in Europe, 67% (61%–72%) in CALWHIV in SA, and 85% (77%–92%) among HIV-negative participants in SA. Among those unvaccinated at time of sampling (n = 769, 85%), seroprevalence was 40% (35%–45%), 64% (58%–70%), and 81% (71%–89%), respectively. Few participants (11% overall) had a known history of SARS-CoV-2-positive PCR or self-reported COVID-19. Three CALWHIV were hospitalized, two with COVID-19 (nonsevere disease) and one young adult with MIS. Although SARS-CoV-2 seroprevalence was high across all settings, even in unvaccinated participants, it was broadly comparable to general population estimates, and most infections were mild/asymptomatic. Results support policy decisions excluding CALWHIV without severe immunosuppression from high-risk groups for COVID-19.

Our study aimed to describe the transmission dynamics and genotypic diversity of Mycobacterium tuberculosis in people deprived of liberty (PDL) in four Colombian prisons. Our cohort study included 64 PDL with bacteriologically confirmed pulmonary tuberculosis diagnosed in four Colombian prisons. The 132 isolates were genotyped using 24-mycobacterial interspersed repeated units-variable number tandem repeats (MIRUs-VNTR). A cluster was defined when ≥2 isolates from different PDL had the same genotype. Tuberculosis acquired in prison was considered when ≥2 persons were within the same cluster and had an epidemiological link. We mapped the place of residence before incarceration and within prisons. We assessed overcrowding and ventilation conditions in the prison that had clusters. We found that the most frequent genotypes were LAM (56.8%) and Haarlem (36.4%), and 45.3% of the PDL diagnosed with tuberculosis were clustered. Most PDL diagnosed in prison came from neighborhoods in Medellin with a high TB incidence. M. tuberculosis infection acquired in prison was detected in 19% of PDL, 9.4% had mixed infection, 3.1% reinfection, and 1.6% relapse. Clusters only appeared in one prison, in cell blocks with overcrowding >100%, and inadequate ventilation conditions. Prisons require the implementation of effective respiratory infection control measures to prevent M. tuberculosis transmission.

Bartonella is a widely distributed Gram-negative bacterium that includes species that are capable of causing illness in humans. Rodents represent one of the main reservoirs of zoonotic pathogens, and monitoring their populations can provide valuable insights into human health. We conducted a surveillance study of rodents from two north-western states of Mexico (Baja California and Chihuahua) to investigate the prevalence and genetic diversity of Bartonella by polymerase chain reaction (PCR) amplification and sequencing of the citrate synthase (gltA) gene. A total of 586 rodents belonging to 28 species were captured, and 408 were tested for Bartonella spp. The overall Bartonella spp. prevalence was 39.71%. The prevalence found in Chihuahua was higher (42.80%) than in Baja California (32.52%), and rodents such as Neotoma albigula, Neotoma mexicana, Peromyscus boylii, and Chaetodipus baileyi had the highest prevalence. The gltA sequences revealed seven genetic variants, some of which were obtained from Peromyscus and Dipodomys rodents and were associated with Bartonella species of human health concern, such as B. grahamii and B. vinsonii subsp. arupensis. In addition, a sequence obtained from a Peromyscus maniculatus was clustered with Candidatus Bartonella rudakovii, a previously unreported association. This study provides valuable data and new insight into the Bartonella-hosts interactions in rodent species in north-western Mexico.

Vaccination is one of the most cost-effective and successful public health interventions to prevent infectious diseases. Governments worldwide have tried to optimize vaccination coverage, including using vaccine mandates. This review of recent literature and policy aims to provide a comprehensive overview of Malaysia’s childhood vaccination landscape. The document analysis was used to identify and examine information from government policy documents, official government media statements, mainstream news content, and research papers. Content analysis was then employed to analyze the gathered information. Despite the successes of Malaysia’s National Immunization Programme, a resurgence of vaccine-preventable diseases has raised concerns about vaccine hesitancy and refusal. Several contributing factors have been identified, including a preference for alternative medicines, doubts about halal status, fear of vaccine injury, concerns about the vaccines’ contents, conspiracy theories, as well as convenience and access barriers. While various initiatives have been implemented, Malaysia may consider using vaccine mandates, as several countries have recently done, as a potential policy intervention to address these challenges. This review benefits policymakers, epidemiologists, as well as researchers involved in regional or global policy planning and advocacy efforts. It also offers comprehensive insights into designing effective interventions and making informed policy decisions regarding childhood vaccination programmes.

Although SARS-CoV-2 vaccination reduces hospitalization and mortality, its long-term impact on Long-COVID remains to be elucidated. The aim of the study was to evaluate the different development of Long-COVID clinical phenotypes according to the vaccination status of patients. Clinical and demographic characteristics were assessed for each patient, while Long-COVID symptoms were self-reported and later stratified into distinct clinical phenotypes. Vaccination was significantly associated with the avoidance of hospitalization, less invasive respiratory support, and less alterations of cardiopulmonary functions, as well as reduced lasting lung parenchymal damage. However, no association between vaccination status and the development of at least one Long-COVID symptom was found. Nevertheless, clinical phenotypes were differently associated with vaccination status, as neuropsychiatric were more frequent in unvaccinated patients and cardiorespiratory symptoms were reported mostly in vaccinated patients. Different progression of disease could be at play in the different development of specific Long-COVID clinical phenotypes, as shown by the different serological responses between unvaccinated and vaccinated patients. A higher anti-Spike (S) antibody titre was protective for vaccinated patients, while it was detrimental for unvaccinated patients. A better understanding of the mechanism underlying the development of Long-COVID symptoms might be reached by standardized methodologies and symptom classification.

In 2015, the WHO African Region was responding to the largest Ebola virus disease outbreak in history while at the same time working to contain a wild poliovirus outbreak [1]. The 2030 Agenda for Sustainable Development had recently been endorsed, reflecting new global development priorities. By 2016, the Ebola outbreak was under control, and a new approach to reform and priority setting was in place in the region; the Transformation Agenda [2]. This agenda, introduced by the new Regional Director for Africa, Dr Matshidiso Moeti, set up a robust system for improving the efficiency and accountability of the WHO Secretariat for the African Region, which has been instrumental in the transformative changes that have been seen across the region in the past 10 years. This commentary discusses significant contributions to public health in the WHO African Region in the past decade, in the context of the Transformation Agenda, and the contributions of major investment in health security in the region. It is important to understand the need to sustain particular initiatives and elements of the transformative change that has taken place in the region.

We assessed the validity of serum total anti-nucleoprotein Immunoglobulin (N-antibodies) to identify SARS-CoV-2 (re)infections by estimating the persistence of N-antibody seropositivity and boosting following infection. From a prospective Dutch cohort study (VASCO), we included adult participants with ≥2 consecutive self-collected serum samples, 4–8 months apart, between May 2021–May 2023. Sample pairs were stratified by N-seropositivity of the first sample and by self-reported infection within the sampling interval. We calculated the proportions of participants with N-seroconversion and fold-increase (1.5, 2, 3, 4) of N-antibody concentration over time since infection and explored determinants. We included 67,632 sample pairs. Pairs with a seronegative first sample (70%) showed 89% N-seroconversion after reported infection and 11% when no infection was reported. In pairs with a seropositive first sample (30%), 82%–65% showed a 1.5- to 4-fold increase with a reported reinfection, and 19%–10% without a reported reinfection, respectively. After one year, 83% remained N-seropositive post-first infection and 93%–61% showed a 1.5-fold to 4-fold increase post-reinfection. Odds for seroconversion/fold increase were higher for symptomatic infections and Omicron infections. In the current era with limited antigen or PCR testing, N-serology can be validly used to detect SARS-CoV-2 (re)infections at least up to a year after infection, supporting the monitoring of COVID-19 burden and vaccine effectiveness.

Mediterranean spotted fever (MSF) is a rickettsial disease caused by Rickettsia conorii, transmitted by brown dog ticks, and endemic in the Mediterranean region. Its incidence is increasing, with varied presentations and potential complications because of delayed diagnosis. This study retrospectively included 173 adult patients hospitalized for MSF at La Rabta University Hospital, Tunis, from 2000 to 2020. Patients, predominantly male (67.6%) and averaging 40 years of age, mostly resided in urban areas (82.7%). Animal exposure was reported in 74.6%, and cases peaked during the hot season (68.8%), with no cases in winter months. The classic triad of fever, rash, and eschar was observed in 69.9%, with maculopapular lesions affecting palms and soles in 83.8%. Headache (64.5%), myalgia (60.7%), and arthralgia (57.2%) were also common. Laboratory findings included elevated white blood cell count (36.4%), thrombocytopenia (48%), and increased aspartate aminotransferase (50.9%). Treatment with doxycycline (n = 161) resolved fever within 2.8±1.3 [1–5] days. Complications, including encephalitis, chorioretinitis, anterior uveitis and vasculitis, occurred in 2.3% of cases, but all patients recovered without relapse. No significant risk factors for severe forms were identified. Improved awareness of MSF’s clinical features may be the key to an early diagnosis and successful treatment.

Dientamoeba fragilis (D. fragilis) is an intestinal protozoan parasite with uncertain pathogenic potential. In the United States, data on D. fragilis in the era of molecular detection are limited. The aim of this retrospective chart review was to evaluate the epidemiology and clinical characteristics of D. fragilis cases identified using polymerase chain reaction assays between 2016 and 2024 at our academic medical centre located in Utah. We identified 28 unique cases with varying gastrointestinal symptomatology including diarrhoea, abdominal pain, nausea, vomiting, and bloating. Approximately half (52%) of patients with follow-up data demonstrated improvement in symptoms following initial treatment for D. fragilis. The overall prevalence of D. fragilis was low among those tested (0.6% positivity). Additional research, including case-control studies, is needed to better describe the etiologic role of D. fragilis.

Group A streptococcal or Streptococcus pyogenes infections have been increasing post-COVID-19 pandemic. We describe the epidemiology of S. pyogenes pharyngitis and invasive disease in Alberta, Canada 2018–2023. Positive pharyngitis specimens were identified from throat swabs collected from pharyngitis patients. Invasive S. pyogenes was defined as the isolation of S. pyogenes from a normally sterile site or severe skin infection. S. pyogenes isolates were emm typed. Pharyngitis and invasive disease displayed seasonal trends preceding the COVID-19 pandemic followed by a sharp decrease during COVID-19 intervention measures. After the lifting of interventions, rates of pharyngitis and invasive disease rose. There were 182 983 positive pharyngitis specimens between 2018 and 2023 for a positivity rate of 17.6%. The highest rates occurred in the 0–9 age group in 2023 (41.5%). Invasive disease increased in 2022–2023 driven by emm1 and 12 types. M1UK strain was the most frequent M1 type associated with invasive disease (59% of M1 isolates sequenced). Notably, out of 182 983 pharyngitis cases, there were 111 cases of invasive S. pyogenes detected for an invasive disease rate of 0.06%. This descriptive epidemiology of S. pyogenes pharyngitis and invasive S. pyogenes disease highlights the rapid increase in cases of S. pyogenes occurring in western Canada and illustrates the critical need for a vaccine.

Spatial analysis and disease mapping have the potential to enhance understanding of tuberculosis (TB) dynamics, whose spatial dynamics may be complicated by the mix of short and long-range transmission and long latency periods. TB notifications in Nam Dinh Province for individuals aged 15 and older from 2013 to 2022 were analyzed with a variety of spatio-temporal methods. The study commenced with an analysis of spatial autocorrelation to identify clustering patterns, followed by the evaluation of several candidate Bayesian spatio-temporal models. These models varied from simple assessments of spatial heterogeneity to more complex configurations incorporating covariates and interactions. The findings highlighted a peak in the TB notification rate in 2017, with 98 cases per 100,000 population, followed by a sharp decline in 2021. Significant spatial autocorrelation at the commune level was detected over most of the 10-year period. The Bayesian model that best balanced goodness-of-fit and complexity indicated that TB trends were associated with poverty: each percentage point increase in the proportion of poor households was associated with a 1.3% increase in TB notifications, emphasizing a significant socioeconomic factor in TB transmission dynamics. The integration of local socioeconomic data with spatio-temporal analysis could further enhance our understanding of TB epidemiology.

Malaria remains a major health challenge in developing countries, with climate change intensifying its impact. Pakistan is among the most vulnerable nations. This study examines the relationship between temperature and malaria cases in two highly affected districts, Bannu and Lakki Marwat, to inform climate-adaptive interventions.

We analyzed monthly malaria cases (2014–2022) from the Integrated Vector Control/Malaria Control Program in Khyber Pakhtunkhwa, combined with gridded meteorological data from Copernicus ERA5-Land. Time-series analysis using distributed lag nonlinear models and quasi-Poisson regression was applied to assess the associations.

The findings suggest that as temperatures exceed 22.4°C, malaria transmission increases by 9 to 10% for every 1°C rise in both districts. In Bannu, up to 39.8% of reported malaria cases could be attributed to heat, while in Lakki Marwat, 54.1% of cases were attributable to heat. Under high emission scenarios, heat-related malaria cases could increase by 0.8 to 3.5% by the 2060s. Relationship between temperature and malaria transmission is complex and is influenced by environmental factors such as precipitation and humidity.

Given Pakistan’s limited healthcare infrastructure, addressing climate-driven malaria risks is urgent. Recent severe floods and malaria surges highlight the need for climate adaptation measures and strengthened healthcare systems to enhance community resilience.

In August 2023, the Finnish Institute for Health and Welfare received reports of a potential cluster of pneumococcal pneumonia cases among shipyard employees in Turku, Finland. Considering a similar outbreak in the same shipyard in 2019, we initiated a case–control study to investigate individual and environmental risk factors specific to this occupational setting in order to inform targeted prevention measures. In total, 14 hospitalized cases were identified from 19 August to 15 October 2023. Streptococcus pneumoniae serotypes 4 and 9 V were isolated from blood cultures of seven cases. Eleven cases and 67 controls working at the shipyard were included in the case–control study. Compared with controls, cases were more likely to be living in an apartment/studio or a hotel/hostel, and less likely in a house or with family. Furthermore, cases were more likely to have a shorter duration of employment (< 1 year) at the shipyard compared to controls. Control measures, including an information and a vaccination campaign, were implemented. We emphasize shipyard-wide hygiene improvements and recommend nationwide consideration of expanding pneumococcal vaccination eligibility to all shipyard construction employees as an occupational high-risk group.

Epidemic preparedness requires clear procedures and guidelines when a rapid risk assessment of a communicable disease threat is requested. In an evaluation of past risk assessments, we found that modifications to existing guidelines, such as the European Centre for Disease Prevention and Control’s (ECDC) rapid risk assessment operational tool, can strengthen this process. Therefore, we present alternative guidelines, in which we propose a unifying risk assessment terminology, describe how the risk question should be phrased by the risk manager, and redefine the probability and impact dimension of risk, including a methodology to express uncertainty. In our approach, probability refers to the probability of the introduction of a disease into a specified population in a specified time period, and impact combines the magnitude of spread and the severity of the health outcomes. Based on the collected evidence, both the probability of introduction and the magnitude of spread are quantitatively expressed by expert judgements, providing unambiguous risk assessment. We advise not to summarize the risk by a single qualification as ‘low’ or ‘high’. These alternative guidelines, which are illustrated by a hypothetical example on mpox, have been implemented at Statens Serum Institut in Denmark and can benefit other public health institutes.

We aimed to identify risk factors related to COVID-19 reinfection in Hong Kong. We performed a population-based retrospective cohort study and reviewed case-based data on COVID-19 infections reported to the Centre for Health Protection from 8 January 2020 to 29 January 2023. We analyzed the epidemiology of COVID-19 infections and performed a Cox regression analysis. In this period, 3.32% (103,065/3,106,579) of COVID-19 infections recorded were classified as reinfection. Compared with primarily infected cases, a higher proportion of re-infected cases had chronic diseases (33.54% vs. 27.27%) and were residents of residential care homes (RCH) (10.99% vs. 1.41%). The time interval between the two episodes ranged from 31 to 1,050 days (median 282 days). Cox regression analysis of Omicron cases with the adjustment of covariates showed that being female (Hazard Ratio [HR] 1.12, 95% CI 1.11–1.13), chronic diseases (HR 1.18, 95% CI 1.16–1.20) and RCH residents (HR 6.78, 95% CI 6.61–6.95) were associated with reinfection, while additional vaccination after primary infection was protective (HR 0.80, 95% CI 0.79–0.81). Further analytical studies on the risk factors and protectors of COVID-19 reinfection are needed to guide targeted interventions.

An estimated 129000 cases of Lyme borreliosis (LB) are reported annually in Europe. In 2022, we conducted a representative web-based survey of 28034 persons aged 18–65 years old in 20 European countries to describe tick and LB risk exposures and perceptions. Nearly all respondents (95.0%) were aware of ticks (range, 90.4% in the UK to 98.8% in Estonia). Among those aware of ticks, most (85.1%) were also aware of LB (range, 70.3% in Switzerland to 97.0% in Lithuania). Overall, 8.3% of respondents reported a past LB diagnosis (range, 3.0% in Romania to 13.8% in Sweden). Respondents spent a weekly median of 7 (interquartile range [IQR] 3–14) hours in green spaces at home and 9 (IQR 4–16) hours away from home during April–November. The most common tick prevention measures always or often used were checking for ticks (44.8%) and wearing protective clothing (40.2%). This large multicountry survey provided needed data that can be used to design targeted LB prevention programmes in Europe.

The Flexible Farrington Algorithm (FFA) is widely used to detect infectious disease outbreaks at national/regional levels on a weekly basis. The rapid spread of SARS-CoV-2 alongside the speed at which diagnostic and public health interventions were introduced made the FFA of limited use. We describe how the methodology was adapted to provide a daily alert system to support local health protection teams (HPTs) working in the 316 English lower-tier local authorities. To minimize the impact of a rapidly changing epidemiological situation, the FFA was altered to use 8 weeks of data. The adapted algorithm was based on reported positive counts using total tests as an offset. Performance was assessed using the root mean square error (RMSE) over a period. Graphical reports were sent to local teams enabling targeted public health action. From 1 July 2020, results were routinely reported. Adaptions accommodated the impact on reporting because of changes in diagnostic strategy (introduction of lateral flow devices). RMSE values were relatively small compared to observed counts, increased during periods of increased reporting, and were relatively higher in the northern and western areas of the country. The exceedance reports were well received. This presentation should be considered as a successful proof-of-concept.

Current standard microbiological techniques are generally very time consuming, usually requiring 24–72 h to establish a diagnosis. Consequentially, contemporary clinical practices implement broad-spectrum antibiotic administration prior to pathogen detection, prompting the emergence of extremely dangerous antibiotic-resistant bacteria. Additionally, lengthy test-to-result turnover times can greatly exacerbate the rate of disease spread. Rapid point-of-care (POC) diagnostics has quickly gained importance since the SARS-CoV-2 pandemic; accordingly, we have developed a rapid four-channel POC plasmonic quantitative polymerase chain reaction (qPCR) machine (Kimera P-IV) to respond to the deficiencies in infection control. Utilizing gold nanorods (GNRs) as nano-heaters and integrating vertical cavity surface emitting lasers (VCSEL) to replace traditional Peltier blocks, the Kimera P-IV has also incorporated quantitative real-time fluorescent monitoring. Using Chlamydia trachomatis genetic material to evaluate the rapid thermocycling performance of the platform, we have generated positive amplicons in less than 13 min; however, to achieve these results, several biological reagent considerations needed to be taken into account, specifically primer design. The device can achieve a limit of detection (LoD) of <101 DNA copies, a PCR efficiency of 88.3%, and can differentiate positive from negative results with 100% accuracy. Moreover, it can also analyze C. trachomatis DNA spiked urine samples via a simple dilution, suggesting that a separate nucleic acid step may not be needed for diagnosing infections. In conclusion, the operation of the Kimera P-IV prototype places it in a unique position of POC devices to revolutionize infectious disease diagnosis.

Multiple osteoarticular tuberculosis (MOT) represents an uncommon yet severe form of tuberculosis, characterized by a lack of systematic analysis and comprehension. Our objective was to delineate MOT’s epidemiological characteristics and establish a scientific foundation for prevention and treatment. We conducted searches across eight databases to identify relevant articles. Pearson’s chi-square test (Fisher’s exact test) and Bonferroni method were employed to assess osteoarticular involvement among patients of varying age and gender (α = 0.05). The study comprised 98 articles, encompassing 151 cases from 22 countries, with China and India collectively contributing 67.55% of cases. MOT predominantly affected individuals aged 0–30 years (58.94%). Pulmonary tuberculosis was evident in 16.55% of cases, with spinal involvement prevalent (57.62%). Significant differences were noted in trunk, spine, thoracic, and lumbar vertebrae involvement, as well as type I lesions across age groups, increasing with age. Moreover, significant differences were observed in upper limb bone involvement and type II lesions across age groups, decreasing with age. Gender differences were not significant. MOT primarily manifests in China and India, predominantly among younger individuals, indicating age-related variations in osteoarticular involvement. Enhanced clinical awareness is crucial for accurate MOT diagnosis, mitigating missed diagnoses and misdiagnoses.