Encephalitis lethargica (EL), also known as the ‘European Sleeping Sickness’, emerged in Europe around 1916, with Sweden reporting the highest global incidence rate in 1921. This study investigates regional variations in EL incidence across Sweden between 1920 and 1930, with a particular focus on the major outbreak in 1921. Using data from Public Health in Sweden, incidence rates were calculated for all Swedish regions, revealing a disproportionate concentration of cases in central and northern areas, especially in the parish of Vilhelmina in Västerbotten. To contextualize this outbreak, monthly disease data from the Annual Reports of the Chief Provincial Doctor in Västerbotten were analysed to compare the local disease panorama. Notably, preceding the first EL cases in Vilhelmina, influenza/H1N1 and mumps were frequently reported. Although the aetiology of EL remains unresolved, the presence of a preceding influenza and mumps epidemic is consistent with the dual-pathogen hypothesis, suggesting that interactions between infectious agents may have contributed to the emergence of EL in local hotspots.

In this proof-of-concept study, we explored the potential of structured general practice data for early signal detection, to enhance pandemic preparedness. We used electronic health record data from the Family Medicine Network (FaMe-Net) in the Netherlands between 2014 and 2024. Descriptive evaluation with surveillance attributes was performed, and the Farrington flexible method was used to construct an alert threshold for respiratory, gastroenteritis, rash, infectious conjunctivitis, and fever syndromes. Alert signals were generated, indicating when the observed weekly count exceeded the threshold. This data registry performed adequately for most surveillance attributes. We analysed 634708 diagnostic codes and 9 infectious disease syndromes in the data registry. In 154 weeks, the number of alert signals ranged from 3 to 20. We found similarities and variations in the number of alert signals between infectious syndrome definitions within the different data types. Structured general practice data showed potential for surveillance and early signal detection of infectious diseases because it performed well on most surveillance attributes and weekly counts of infectious disease syndromes led to the generation of alert signals. Further validation of these alert signals is needed, to underpin their early warning potential for timely public health action.

This study examines the impact of human immunodeficiency virus (HIV)-specific laws criminalizing HIV non-disclosure, exposure, and transmission on voluntary testing, focusing on the role of HIV stigma. HIV criminalization signals state endorsement of discrimination against HIV-positive individuals, thereby amplifying stigma. I use a regression discontinuity design that exploits the enactment timing of legislation in Mali during a household survey offering voluntary HIV testing, where family members could infer who was tested and speculate that those tested were HIV-positive. Following the legislation, women’s testing uptake declined, especially in rural areas, with stronger effects among those with radios and without completed formal education. Women, being economically dependent on men, are vulnerable to HIV-related mistreatment from family members. Therefore, fear of being considered seropositive by family members might have more strongly discouraged women’s testing uptake compared with men’s.

Occupational blood exposure accidents (OBEAs) pose significant risks to healthcare workers, potentially exposing them to hepatitis B (HBV), hepatitis C (HCV), and HIV. While most research focuses on hospital settings, this study assessed OBEA management in non-hospital contexts. Although our data predate the COVID pandemic, findings remain highly relevant, especially for healthcare professionals working outside hospital settings. A retrospective analysis of OBEA registry data (2006–2014) was conducted in a southern Dutch region. Data included demographics, profession, workplace, injury type, source status (HBV, HCV, HIV), risk assessment, post-exposure measures, and lab results. Chi-square and t-tests were applied. In total, 975 OBEA were reported. Among nurses, medical assistants, students, and housekeeping staff, subcutaneous needles (51–67%) and lancets (25%) were common exposure sources. Police officers mainly reported biting (26%), scratching, or spitting (70%). HBV vaccination coverage ranged from 18% (housekeeping) to over 90% (nurses, police). Post-exposure measures were taken in 52% of cases. High-risk exposures (43%) mainly affected ambulance staff, sterilization workers, police, and dentists. Sources were tested in 85% of high-risk cases: 1.4% were HBV positive, 2% HCV positive, and 1.1% HIV positive. No seroconversions occurred. Results stress the need for better HBV vaccination coverage, targeted prevention, and prompt OBEA reporting outside hospital settings.

Sharing, harmonizing, and analyzing participant-level data is of central importance in the rapid research response to emerging pathogens. Individual participant data meta-analyses (IPD-MAs), which synthesize participant-level data from related primary studies, have several advantages over pooling study-level effect estimates in a traditional meta-analysis. IPD-MAs enable researchers to more effectively separate spurious heterogeneity related to differences in measurement from clinically relevant heterogeneity from differences in underlying risk or distribution of factors that modify disease progression. This tutorial describes the steps needed to conduct an IPD-MA of an emerging pathogen and how IPD-MAs of emerging pathogens differ from those of well-studied exposures and outcomes. We discuss key statistical issues, including participant- and study-level missingness and complex measurement error, and present recommendations. We review how IPD-MAs conducted during the COVID-19 response addressed these statistical challenges when harmonizing and analyzing participant-level data related to an emerging pathogen. The guidance presented here is based on lessons learned in our conduct of IPD-MAs in the research response to emerging pathogens, including Zika virus and COVID-19.

Objective: Optimized teaching methods in medical students to improve skills of occupational protection against infectious diseases and reduce the risk of developing infectious occupational exposure in clinical practice. Methods: Establish a database of infectious occupational exposure cases in clinical practice based on monitoring data. Teaching guided by cases and videos-based scenario was carried out in the experimental group and traditional theoretical teaching was carried out in the control group in medical students. And then conducted a questionnaire survey on knowledge and skills of occupational protection against infectious diseases and observed the frequency and the prescriptive disposal measures of infectious occupational exposure in clinical practice in two groups. Results: The infectious occupational exposure database included a total of 95 typical cases in 6 categories, including various sharp weapon injuries and mucosal exposure. There were 116 medical students involved in the study across the course of 12 months. The incidence of infectious occupational exposure in medical students during clinical practice internships was 18.9%. Compared with the control group, the awareness rate of knowledge and skills of occupational protection against infectious diseases significantly increased (91.8% vs 87.0%, P<0.05), the incidence of infectious occupational exposure during clinical internships has decreased (15.6% vs 23.1%, P<0.05), and the implementation rate of prescriptive disposal measures after exposure has increased (91.7% vs 83.3%, P<0.05) in the experimental group in medical students. Conclusion: The case-based scenario teaching in medical students improved skills of occupational protection against infectious diseases and decreased the incidence of infectious occupational exposure during clinical internships. The effect of the optimized teaching methods was significant which is recommended to carry out widely.

On June 1, 2024, the World Health Assembly reached consensus on a package of amendments to the 2005 International Health Regulations (IHR). These amendments follow nearly two decades of implementation and an intensive multilateral process prompted by the global struggle against COVID-19. This article critically examines whether the amended IHR reflect lessons learned from the pandemic, potentially ushering in a new era for global health law in pandemic preparedness and response, or if they deflect attention from the need for deeper structural reforms. While the IHR remain the only near-universal legal framework for preventing and addressing the international spread of disease, these amendments emphasize equity and solidarity, and potentially shift the IHR from a technical instrument to one focusing on inherently political issues. This analysis examines key IHR amendments and their implications for the future of global health law, particularly in the context of equity, financing, and implementation.

Historians have written copiously about the shift to ‘germ theories’ of disease around the turn of the twentieth century, but in these accounts an entire continent has been left out: Antarctica. This article begins to rebalance our historiography by bringing cold climates back into the story of environmental medicine and germ theory. It suggests three periods of Antarctic (human) microbial research – heroic sampling, systematic studies, and viral space analogue – and examines underlying ideas about ‘purity’ and infection, the realities of fieldwork, and the use of models in biomedicine. It reveals Antarctica not as an isolated space but as a deeply complex, international, well-networked node in global science ranging from the first international consensus on pandemic-naming through to space flight.

Gastrointestinal infections constitute a significant global health concern, particularly in tropical and subtropical regions, caused by various pathogens. Among these, Cryptosporidium spp. and Giardia duodenalis are noteworthy due to their zoonotic potential. In Algeria, molecular epidemiological data on cryptosporidiosis and giardiasis are limited. To fill this gap, the present study aimed to examine the transmission dynamics of Cryptosporidium spp., and Giardia duodenalis in various households. A total of 216 samples were collected from the rural Guelma and Souk Ahras provinces, located in the eastern part of Algeria. These included human and animal faeces, as well as water and soil samples. DNA was extracted, followed by nested PCR targeting the SSU rRNA gene to detect Cryptosporidium spp., while the gp60 gene was amplified for subtyping. Detection of G. duodenalis was performed by qPCR targeting the SSU rRNA gene, followed by amplification of tpi, bg and gdh genes for genotyping and subtyping. Several Cryptosporidium species, including C. bovis, C. ryanae, C. andersoni and C. parvum, were identified in human, animal and environmental samples. The zoonotic C. parvum subtype IIaA17G2R1 was detected in human, animal and soil samples. Giardia duodenalis assemblage B was detected in a human sample, while assemblage E was found in cattle and sheep. The current investigation underscores the importance of the One Health approach in addressing issues related to intestinal parasites, highlighting the need for improved surveillance and control measures in rural settings.

Over the past two decades there has been a rapid expansion in our understanding of how human genetic variability impacts susceptibility and severity of disease. Through applications of genome-wide association studies, genome and exome sequencing, researchers have made thousands of discoveries of genetic variants that impact risk of common and rare disorders affecting millions of people. Although these techniques have been primarily applied to highly prevalent chronic disorders such as diabetes1 and cardiovascular disease2, infectious diseases have proven to not be immune to genome-wide association, with studies of Tuberculosis3, HIV4 and SARS-CoV25, to name but a few, identifying host susceptibility loci across the genome. Unlike non-communicable diseases, infectious diseases have the unique element of impacting not only the affected the host, but those who may be most vulnerable to acquiring the infection. Thus, genetic variants that impact one individual’s susceptibility to and severity of an infection may also have broader implications to public health, as was brought into keen focus during the COVID-19 pandemic. Therefore, as we begin to apply the knowledge gained from genomic studies in the clinic or into policy, there are unique ethical, legal, and social implications (ELSI) at the intersection of infectious diseases and human genomics. In this issue of the Journal of Law, Medicine and Ethics, Jose et al attempt to address this need by proposing a research agenda for ELSI studies at what they term the “blurred boundaries” of infectious and genetic diseases.6

This article examines the care provided for the welfare of soldiers by the three combatant countries – China, Korea and Japan – during the East Asian War of 1592–8. Also known as the Imjin War, this large-scale military conflict can also be understood as an encounter between different state cultures and strategies of military medicine. This study focuses on cold-induced injuries, epidemic outbreaks and external wounds suffered during the war. I illuminate provision of prophylactic measures against cold by the Ming state, as well as attempts by the Sino-Chosŏn medical alliance to manage epidemics and treat wounded soldiers. I contrast these measures with the lack of similar centralised support for the Japanese forces, and examine the effect these differences had upon on military outcomes during the war. The difference in the amount of time, efforts and resources that the three combatant states devoted to sick and injured soldiers has implications not only for our understanding of the war but also for illuminating the early modern history of military medicine in East Asia. By exploring East Asian military medicine during and after the Imjin War, this article responds to recent calls for more detailed examination of histories of military medicine in premodern periods and non-European regions.