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.

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.

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.

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.

Pneumococcal conjugate vaccines (PCVs) have influenced population dynamics of Streptococcus pneumoniae in the nasopharynx and may have contributed to increased Staphylococcus aureus colonization. This study assessed the prevalence of colonization, antibiotic resistance patterns, and associated risk factors for colonization and co-colonization of S. aureus and S. pneumoniae in healthy Peruvian children post-PCV introduction. Nasopharyngeal swabs from children <24 months were collected in five hospitals in Lima (2018–2019). Microbiological identification and antibiotic susceptibility tests were performed, and multinomial regression evaluated factors influencing colonization. Among 894 children, 19.7% were colonized with S. aureus, 20.3% with S. pneumoniae, and 2.9% co-colonized. Of the 176 S. aureus strains isolated, 1.7% were methicillin resistant and 20.5% were clindamycin resistant; no resistance to trimethoprim-sulfamethoxazole (SXT) was found. Among 182 S. pneumoniae strains isolated, 48.9% were resistant to macrolides, 74.7% to SXT; no resistance to penicillin was found. Breastfeeding and vaccination with PCV13 were associated with a reduced prevalence of S. aureus colonization, while vaccination with PCV13 increased the prevalence of S. pneumoniae colonization, mainly by non-vaccine serotypes. This study highlights the need to continue monitoring the changes in colonization dynamics and antimicrobial resistance patterns after vaccine introduction, to guide empirical therapy and future vaccine strategies.

Toxoplasmosis during pregnancy can cause congenital malformations and fetal death. This study aimed to estimate the Toxoplasma gondii seroprevalence among pregnant women participating in the 2021 French national perinatal survey and identify associated factors. All women giving birth in France during the study period were invited to participate. Data collected included demographic information, nationality, socio-economic status, education level, and Toxoplasma gondii serological status. Women were classified as seropositive if IgG antibodies were present or if seroconversion occurred during pregnancy. Univariate and multivariate Poisson regression analyses with robust error variance were used to estimate prevalence ratios and identify factors associated with seropositivity. Among 12,612 women, the overall seroprevalence was 25.9%, and 0.22% seroconverted during pregnancy. Seroprevalence increased by 5% with every 5-year age increment and was significantly higher in the French overseas territories of Mayotte (75.0%), La Réunion (35.8%), and French Guiana (33.3%). Seroprevalence was also higher among women with lower educational levels (47.4% for primary education) and those of Sub-Saharan African nationality (52.0%). Geographic and socio-demographic variations may reflect dietary and environmental diversity. Despite declining seroprevalence in France, continued public health efforts, particularly among high-risk populations, remain critical to minimize the impact of congenital toxoplasmosis.

Salmonella Typhimurium sequence type (ST) 36 is a rare sequence type in Sweden. During August–November 2024, 100 cases of Salmonella Typhimurium ST36 were reported nationwide. The highest proportions of cases were observed among individuals aged 0–10 years (17%) and 41–50 years (20%), with females representing 65% of the total cases. Microbiological analysis of the S. Typhimurium ST36 isolates identified nine clusters and five individual strains clustering within 53 single-nucleotide polymorphisms. A matched case–control study found cases to be associated with the consumption of alfalfa sprouts (adjusted odds ratio = 8.94, 95% CI: 2.96–27.1). Trace-back investigation identified seeds used by two alfalfa sprout producers in Sweden as the likely source of the outbreak, although microbiological analysis of sprouted alfalfa seeds from the producers did not detect Salmonella. However, continued international investigations further implicated seeds sourced from the same origin, supporting that alfalfa seeds were the ultimate source of the Swedish outbreak. Our investigation and findings indicate that alfalfa sprouts may contain Salmonella and thus pose a health risk to consumers. We emphasize the need for primary producers of alfalfa seeds and sprouts to identify and prevent possible contamination points.

Invasive Escherichia coli disease (IED) is associated with high hospitalization and mortality rates, particularly among adults aged ≥60 years. O-antigens are virulence factors required for E. coli survival. To inform EXPEC9V development, a novel glycoconjugate vaccine targeting E. coli O-antigens that is no longer in active clinical development, this retrospective observational study describes O-serotype prevalence among E. coli isolates from IED patients. Eligible patients were identified from medical record databases (9 January 2018–8 November 2019) across 17 tertiary care hospitals in Europe, North America, and Asia. To estimate vaccine serotype coverage of EXPEC9V, E. coli isolates were O-serotyped using whole-genome sequencing and agglutination. Antimicrobial susceptibility testing was also performed. Nine hundred and two patients were enrolled, of whom 690 (76.5%) were aged ≥60 years. Common serotypes were O25, O2, O6, O1, O15, O75, O16, O4, and O18, with O25 being the most reported (17.3%). In patients aged ≥60 years, 422/637 E. coli isolates were EXPEC9V O-serotypes. EXPEC9V O-serotype prevalence did not substantially differ when stratified according to sex, presence of a positive blood culture, sepsis, fatality, or multidrug resistance. Consistent with previous studies, serotype O25 was most prevalent and associated with ~20% of cases. An EXPEC9V vaccine serotype coverage of 66.2% was observed for IED patients aged ≥60 years.

Climate conditions are known to modulate infectious disease transmission, yet their impact on measles transmission remains underexplored. In this study, we investigate the extent to which climate conditions modulate measles transmission, utilizing measles incidence data during 2005–2008 from China. Three climate-forced models were employed: a sinusoidal function, an absolute humidity (AH)-forced model, and an AH and temperature (AH/T)-forced model. These models were integrated into an inference framework consisting of a susceptible–exposed–infectious–recovered (SEIR) model and an iterated filter (IF2) to estimate epidemiological characteristics and assess climate influences on measles transmission. During the study period, measles epidemics peaked in spring in northern China and were more diverse in the south. Our analyses showed that the AH/T model better captured measles epidemic dynamics in northern China, suggesting a combined impact of humidity and temperature on measles transmission. Furthermore, we preliminarily examined the impact of other factors and found that population susceptibility and incidence rate were both positively correlated with migrant worker influx, suggesting that higher susceptibility among migrant workers may sustain measles transmission. Taken together, our study supports a role of humidity and temperature in modulating measles transmission and identifies additional factors in shaping measles epidemic dynamics in China.

A predictive column chart was developed to assess the risk of primary liver cancer (PLC) in hepatitis B patients. Data from 107 PLC patients and 107 controls were used as the training set, with 92 patients as the validation set. An additional 446 patients from other hospitals, including 15 with PLC, formed the external validation group. Multivariate logistic regression identified gender, BMI, alcohol consumption, diabetes, family history of liver cancer, cirrhosis, and HBV DNA load as independent risk factors. The model showed strong discrimination with AUCs of 0.882 and 0.859 in the training and validation sets, respectively, and good calibration (Hosmer–Lemeshow χ² = 2.648, P = 0.954; χ² = 4.117, P = 0.846). Decision curve analysis (DCA) confirmed clinical benefit within a risk threshold of 0.07–0.95. In the external validation group, the model maintained discrimination (AUC = 0.863) and calibration (Hosmer–Lemeshow χ² = 7.999, P = 0.434), with DCA showing net benefit across 0.14–0.95. These results indicate the column chart is a reliable tool for PLC risk prediction in hepatitis B patients.

Leptospirosis remains a significant occupational zoonosis in New Zealand, and emerging serovar shifts warrant a closer examination of climate-related transmission pathways. This study aimed to examine whether total monthly rainfall is associated with reported leptospirosis in humans in New Zealand. Poisson and negative binomial models were developed to examine the relationship between rainfall at 0-, 1-, 2-, and 3-month lags and the incidence of leptospirosis during the month of the report. Total monthly rainfall was positively associated with the occurrence of human leptospirosis in the following month by a factor of 1.017 (95% CI: 1.007–1.026), 1.023 at the 2-month lag (95% CI:1.013–1.032), and 1.018 at the 3-month lag (95% CI: 1.009–1.028) for every additional cm of rainfall. Variation was present in the magnitude of association for each of the individual serovars considered, suggesting different exposure pathways. Assuming that the observed associations are causal, this study supports that additional human cases are likely to occur associated with increased levels of rainfall. This provides the first evidence for including rainfall in a leptospirosis early warning system and to design targeted communication and prevention measures and provide resource allocation, particularly after heavy rainfall in New Zealand.

We aimed to determine the prevalence of antimicrobial resistance, carriage of Panton-Valentine leucocidin (PVL), and the clonal structure of MRSA isolates collected from skin and soft tissue infections at a tertiary care hospital in Pakistan. Between August 2021 and May 2022, 154 non-repetitive MRSA isolates were consecutively collected and characterized by antimicrobial susceptibility testing, SCCmec typing, spa typing, and detection of PVL by PCR. MLST clonal complexes (CCs) were inferred from spa type using the Based Upon Repeat Pattern (BURP) algorithm. High levels of resistance were observed to ciprofloxacin (85.7%), erythromycin (76.0%), sulfamethoxazole (68.8%), gentamicin (68.8%), fusidic acid (57.8%), tetracycline (55.8%), and clindamycin (42.2%). Clonal analysis revealed 16 lineages, with the most frequent being CC8-MRSA-IV (27.3%), PVL-positive “Bengal Bay” CC1/ST772-MRSA-V (26.0%), and CC1-MRSA-IV (16.2%). PVL was detected in 45.5% of isolates across multiple lineages. Our findings highlight the coexistence of high antimicrobial resistance and frequent PVL carriage among MRSA in Pakistan. Given the association of PVL with severe infections and the limited treatment options for multidrug-resistant strains, these data underscore a significant public health concern and the need for systematic surveillance and prudent antibiotic use.

β-Lactam/β-lactamase inhibitor combinations and carbapenems are the first-line treatments for multidrug-resistant Pseudomonas aeruginosa (P. aeruginosa) infections. However, carbapenem resistance is increasing globally at an alarming rate, which is especially concerning given the pivotal role of these agents. This study comprehensively evaluated the global distribution of carbapenem resistance in clinical P. aeruginosa isolates. The keywords including ‘Pseudomonas’, P. aeruginosa’, ‘P. aeruginosa’, ‘resistance’, ‘susceptibility’, ‘carbapenem antibiotics’, ‘carbapenems’, ‘imipenem’, ‘meropenem’, ‘ertapenem’, ‘doripenem’, as well as ‘prevalence’ and ‘incidence’ were searched in electronic databases as the appropriate keywords. After screening, 160 studies were excluded, with 87 eligible studies from diverse geographic regions retained for final analysis. A comprehensive meta-analysis was then conducted on the data collected. The mean resistance rates (95% CI) were 33.3% (imipenem), 23.3% (meropenem), 60.9% (ertapenem), and 36.7% (doripenem). The time trend analysis showed that the resistance to meropenem has increased from the year 1997 to 2023. Meta-analysis showed substantial heterogeneity (I2 = 92%, p < 0.05) but no significant publication bias by Egger’s or Begg’s test. Global carbapenem resistance is alarmingly high in clinical P. aeruginosa isolates. The increasing prevalence of carbapenem-resistant P. aeruginosa is a major global health threat requiring urgent action through new antimicrobials and improved antibiotic stewardship to protect these last-line drugs.

In 2022, an Mpox clade II outbreak affected many countries. To optimize control, knowledge on the number of new introductions (human cases infected from outside the study population) versus local transmission is important. We extracted sequences of all 48 Mpox cases in Slovenia in 2022 from the NCBI database, of which 42 passed quality control. We estimated the number of introductions using the phylodynamic model phybreak by integrating genomic and epidemiological data and inferred transmission events. By repeating this analysis with weekly cumulative case data, we assessed if introductions could have been reliably inferred in real time. The number of introductions, estimated after the outbreak ended, was 19 (95% CI: 13–29), and two larger transmission clusters existed. As these introductions occurred throughout the outbreak, we conclude that the Slovenian Mpox outbreak was mainly driven by new introductions. Analysing the data ‘in real time’ would have only slightly overestimated the number of introductions per week, capturing the trend of introductions as main driver of the outbreak. This makes it useful for guiding control policy during outbreaks, prioritizing the rapid identification of cases among travellers, and with that preventing emergence of new transmission chains.

There are limited data on the illness trajectory for individuals with long COVID. We prospectively followed 1,234 individuals with long COVID at 3 months post-SARS-CoV-2 infection to identify factors associated with persistence or recovery. At 6 months post-infection, 724 (58.7%) had persistent long COVID and 510 (41.3%) had fully recovered. In multivariable analyses, pre-existing health conditions at the time of initial SARS-CoV-2 infection and reporting fatigue, shortness of breath, and cough 3 months post-infection were independent predictors of persistent long COVID. Age, sex, and number of COVID vaccinations were not significantly associated with persistent long COVID. For persons with persistent long COVID, the median number of symptoms remained stable over follow-up, indicating that there had been little symptomatic improvement. A third of those with persistent long COVID reported seeking medical care for their symptoms and a third had ceased or reduced their hours of work/study. Our findings suggest that there may be distinct clinical trajectories for long COVID observed between 3- and 6-month follow-up, that is, persons who experience full recovery and those with minimal clinical improvement, and this may have implications for management of affected individuals.

We investigated the potential yield of conducting active case finding for tuberculosis (TB) within a defined geographic radius (50 or 100 m) around the households of individuals diagnosed with TB at health facilities. In a well-defined geographic area within Kampala, Uganda, residential locations were determined for 85 people diagnosed with TB at local health facilities over an 18-month period and for 60 individuals diagnosed with TB during a subsequent community-wide door-to-door screening campaign. Ten of the individuals diagnosed through community screening lived within 50 m of an individual previously diagnosed with TB in a local health facility (TB prevalence: 0.98%), and 15 lived at a distance of 50–100 m (prevalence: 0.87%). The prevalence ratio was 1.4 (95% confidence interval (CI): 0.7–2.9) for those <50 m and 1.2 (95% CI 0.6–2.2) for those 50–100 m, compared to >100 m. Using TB notifications to identify areas for geographically targeted case finding is at most moderately more efficient than screening the general population in the context of urban Uganda.

In large public health jurisdictions, only a small proportion of people infected with Salmonella are interviewed due to resource constraints. As such, sources of illness are rarely found, and preventative action not implemented. We trialled alternative methods to contact notified salmonellosis cases to collect information on exposures and risks, focusing particularly on the feasibility of SMS (short message service)-based surveillance. Over five-years period we sequentially mailed letters, sent online surveys, and then text messages. The SMS approach was designed to assess the efficiency of a two-way personalized messaging model in gathering actionable public health data. The personalized SMS-follow-up model demonstrated the highest success: 56% of cases responded, enabling the identification and intervention of 10 distinct point-source outbreaks of Salmonella. SMS-based surveillance offers a novel, efficient, and acceptable method for collecting critical food exposure data in Salmonella cases. In settings where resources are constrained, SMS can complement traditional case follow-up methods, enhancing both the timeliness and effectiveness of outbreak detection. Integrating this follow-up with routine clinical care could further enhance the acceptance and success of this method. This study highlights the promise of SMS in streamlining surveillance efforts and warrants further exploration for application to other infectious diseases.

This surveillance report describes the epidemiology and clinical outcomes of carbapenem-resistant Enterobacterales (CRE) infections in Tennessee from 2016 to 2022, analysing 570 cases and 406 isolates. The incidence of CRE infections per 100 000 population showed an upward trend. Enterobacter species were the most common organisms, whereas Klebsiella species were the main carbapenemase-producing CRE (CP-CRE). Klebsiella pneumoniae carbapenemase was the most common mechanism contributing to this resistance. Demographic characteristics of patients with identified isolates demonstrated a median age of 69.5 years. There were no significant differences in CP-CRE infection by sex or race. Patients with CP-CRE were more likely to be hospitalized than those with non-CP-CRE, at 60.9% and 43.9%, respectively. Multivariable analysis indicated that patients with CP-CRE had significantly higher odds of 90-day mortality (odds ratio, 2.22; 95% confidence interval, 1.12–4.42; p < 0.0001) than non-CP-CRE patients. Individuals with a higher Charlson Comorbidity Index score exhibited an increased odds of dying within 30- and 90-day post-specimen collection and had a greater likelihood of requiring intensive care unit admission. This report underscores the need to understand the epidemiology and risk factors linked to CRE infections to improve prevention strategies and patient care.

Attaining the target of <0.1% HBsAg positives in children aged <5 years in vaccinated populations by 2030 is a WHO indicator of hepatitis B elimination. We aimed to calculate the prevalence of HBsAg- and anti-HBc-positive children and adolescents in the low-prevalence country of Germany. In total, 3567 children and adolescents aged 3–17 years participated in a national population based cross-sectional study. Data were collected between 2014 and 2017 using questionnaires and health examinations, including blood samples. Applying a weighted analysis to account for survey design and participant characteristics, we calculated the HBsAg and anti-HBc prevalence and described them by anti-HBs positivity. In total, 3007 participants had all three sero-markers measured. None were found HBsAg and anti-HBc positive. Seven (0.3%, 95% CI: 0.1–0.8) were anti-HBc positive and HBsAg negative; six were also anti-HBs positive. All anti-HBc-positive participants were aged ≥7 years and three had no migration background. Four anti-HBc-positive participants had known vaccination status; three had been vaccinated according to national recommendations. This very low hepatitis B virus sero-prevalence among children and adolescents indicates that Germany is reaching some hepatitis B virus elimination targets. We recommend maintaining preventive measures, in particular a high vaccination coverage, in order to reach hepatitis B elimination.