Infectious disease in an era of global change

Preferences for and drivers of adult vaccination clinic site selection: A cross-sectional study in 30 provinces in China

Focusing on vaccines available to adults and not in the immunization schedule, this study investigates the preferences and factors influencing adults in selecting vaccination clinic locations. It aims to provide strategic insights for boosting vaccination rates by analyzing adults' decision-making factors. This contributes to developing more efficient, patient-focused vaccination strategies that tackle vaccine hesitancy and improve access to vaccination sites. We conducted a cross-sectional study through the "YueMiao" platform from November 1 to December 10, 2023, using convenience and purposive sampling to engage 2014 participants. We collected data via online surveys that included questions about sociodemographic characteristics, sources of vaccination clinic information, clinic satisfaction, and the impact of site selection on vaccination decisions. Our findings reveal that adults' site preferences for vaccination are influenced by gender, age, income, and vaccination history. Participants showed a strong preference for locations that offer convenience, efficiency, transparent pricing, and a comfortable environment. Analysis of service satisfaction at these clinics indicates that vaccinated individuals report higher satisfaction with appointment systems, wait times, and service hours than those unvaccinated. Furthermore, the preference for vaccination sites consistently aligns with the vaccine type, with a majority opting for community health service centers. Our results suggest that public health strategies should concentrate on enhancing site convenience, service quality, and information transparency to elevate adult vaccination rates. Future initiatives should aim to increase public trust in vaccines, improve the selection and quality of vaccination sites, and effectively utilize digital technology for spreading vaccination information.

Predicting and preventing the next viral disease transmitted through food

The ability of viruses to infect humans following oral exposure and disrupt normal physiological or anatomical functions is a hallmark of their potential to cause foodborne disease. While the etiology of the vast majority of foodborne diseases remains undetermined, viruses are often identified as the culprit when the cause is ascertained. Many undiagnosed causes of foodborne illnesses, especially sporadic cases, may go undetected or be caused by yet-to-be-identified viruses. The potential for food to become a transmission vehicle for viral diseases that are not typically acquired following ingestion may be described within the epidemiological paradigm. This model considers the characteristics and interactions of the host (the human), the agent (the virus), and the environment (the food, the food producing animal or the food production environment). Importantly, these factors are not static and evolution of viruses, transformations in agrifood systems, and changes in environmental conditions and human health and behaviour may contribute to increased pathogenicity, virulence, or exposure. In the context of determining the potential for additional viruses to emerge as important causes of foodborne disease, factors that contribute to hazard characterization (e.g., receptor affinity and distribution) and exposure assessment (e.g., prevalence in food animals and food hygiene) are reviewed. Although it is not possible to predict the type, the timing nor the location of the emergence of the next important cause of foodborne viral disease, the deployment and implementation of actions and behaviours related to personal and food hygiene, sanitation, and safe food handling practices can reduce the likelihood and impact of known and emergent viruses on the safety of the food supply and human health.

High-transition-temperature paraffin integration in IFAST device for efficient and robust nucleic acid extraction and detection

Infectious diseases are prevalent in resource-limited regions with restricted access to health care. Nucleic acid testing is the gold standard for pathogen diagnosis. However, traditional methods are resource-intensive, which limits their use in point-of-care settings. Microfluidic technologies, such as the immiscible phase filtration-assisted system (IFAST) using paramagnetic particles (PMPs), simplify nucleic acid extraction but face barrier stability issues. The interface between the aqueous and oil phases in current IFAST systems is destabilized under the conditions required for efficient RNA extraction. These conditions include the use of reagents containing high concentrations of surfactants and organic solvents, as well as thermal treatment, which reduces the operational stability, reproducibility, and compatibility of the current IFAST systems. We developed a high-transition-temperature (HTT) paraffin-embedded IFAST-based device to improve barrier stability and extraction efficiency. HTT paraffin remains semi-solid at 65 °C, providing a robust barrier during the thermal lysis and RT-LAMP processes. At 75 °C, the device maintained compartment integrity and reduced carryover during the nucleic acid-bound magnetic particle transfer. Testing with SARS-CoV-2 samples showed detection of as little as 1 copy/μL of the viral genome without false positives. By integrating RNA extraction and colorimetric RT-LAMP detection, this device provided rapid on-site testing, advancing accessible and effective disease management in regions that require rapid diagnostics.

Development of a highly sensitive, high-throughput and automated CRISPR-based device for the contamination-free pathogen detection

Rapid, portable, and contamination-resistant nucleic acid detection methods are necessary due to the threat posed by emerging viruses to public health and agricultural output. We establish CARE (CRISPR-associated airtight real-time electronic diagnostic device), a novel platform that combines CRISPR-Cas12a with a hermetically sealed microfluidic chip to overcome the limitations of present technologies, which struggle to balance sensitivity, multiplexing, and field applicability. By combining isothermal amplification and CRISPR detection within a hermetically sealed microfluidic chip, CARE eliminates the risk of nucleic acid aerosol contamination while enabling simultaneous high-throughput analysis of seven pathogens. The device is complemented by a user-friendly nucleic acid quantification App, enabling rapid and precise analysis. The RPA-CRISPR/Cas12a system demonstrates exceptional sensitivity, detecting as few as 1 copy μL-1 (single-plex) and 10-102 copies μL-1 (multiplexed), with real-sample performance matching gold-standard methods. CARE represents a significant advancement in CRISPR-based diagnostics, offering a robust, portable solution for on-site pathogen detection in food and agricultural applications.

Putting one health to the test: Operational challenges and critical reflections from the global South

One Health as a policy framework to tackle zoonoses has gained wide-ranging validation with multiple international organizations throwing their collective might behind it. Such endorsement has convinced several governments to adopt One Health as a national strategy to address zoonoses. Although some argue that One Health is so many things that there are in fact multiple 'One Healths', others find that most international policy documents that use the One Health framing contain certain key recommendations, with intersectoral coordination and disease surveillance prominent among them. In this paper we examine whether and how One Health travels in a sub-national setting in a developing country context such as that of India, with particular focus on intersectoral coordination. We draw on documentary analysis, semi-structured interviews, and workshops with government officials across key sectoral agencies at the district level, to understand prevalent institutional mechanisms in place to address zoonoses in such a setting. We locate our study in the district of Gyalshing in the state of Sikkim in India, which is a potential zoonoses 'hotspot' given its location within the biodiverse Indian Himalayan Region, with numerous avenues for human-animal interactions, and burgeoning human population linked to its tourism-run economy. We outline successful cases where certain zoonotic diseases could be tackled, while also highlighting structural constraints that need to be borne in mind while planning or advocating One Health as a blanket policy prescription. In doing so, we draw attention to the political dimensions of global health policies, and question whether One Health can be uncritically deployed in developing country contexts.

Assessing coupling coordination between human-animal-environmental health for advancing uniform progress in One Health

The One Health (OH) approach aims to sustainably balance and optimise the health of people, animals, and ecosystems. However, there is a lack of robustly quantified insights into its spatiotemporal coupling and coordination. This study employs the OH index, which incorporates Sustainable Development Goals (SDGs), to examine the coupling and coordination relationships among three health subsystems, elucidate their four spatiotemporal patterns, and identify key driving factors. Our results indicate that the degree of OH coupling coordination is improving, despite spatial unevenness across SDG regions. Countries with varying economic levels often exhibit similar coupling coordination patterns, suggesting the potential for policy coherence to foster regionally uniform development. Key factors for breaking the cycle of poverty include increased health spending, improved education, and better dietary balance. In regions facing significant economic and environmental pressures, promoting animal and environmental health through biodiversity conservation and habitat preservation is essential for achieving OH coupling coordination. Nevertheless, the absence of governance mechanisms, along with factors such as climate change, military conflicts, and fragile alliances, poses serious obstacles to achieving uniform OH. Therefore, this study underscores the necessity of targeted policy interventions, interdisciplinary collaboration, and comprehensive governance to address this unevenness, promote coordination, and advance global health governance.

Synthesizing Public Health Preparedness Mechanisms for High-Impact Infectious Disease Threats: A Jurisdictional Scan

AIM

High-impact infectious diseases pose major global health challenges, underscoring the urgent need for robust public health preparedness. Despite efforts to improve global health security, recent pandemics have revealed significant weaknesses in health systems' preparedness and response capabilities.

METHODS

We reviewed and synthesized key strategies and lessons from existing public health preparedness plans for high-impact infectious diseases. This included examining national and global plans, focusing on strategic approaches, evidence integration, and real-world implementation lessons. A narrative synthesis, based on the Public Health Emergency Preparedness (PHEP) model, identified effective practices and areas needing improvement.

RESULTS

We screened 1987 documents, selecting 38 for detailed analysis. Findings highlighted strategies for long-term health emergency preparedness, workforce development, enhancing global health frameworks, and investing in infrastructure. Challenges included maintaining laboratory detection, managing sentinel surveillance, and logistical issues. Effective approaches emphasized early threat detection, rapid response, healthcare capacity, medical supply management, and strategic communication.

CONCLUSIONS

Effective public health preparedness for high-impact infectious diseases requires a coordinated approach, including early threat detection, rapid response, robust healthcare systems, and strategic communication. Past outbreaks show the need for continuous investment, evidence-based policies, and adaptable health systems. Future research should assess ongoing preparedness efforts and implementation challenges.

Hydrolyzed soy protein nanoparticles designed for VD3 delivery: VD3 incorporation and remodeling behavior during digestion matters

In this study, delivery efficiency of hydrolyzed soy protein nanoparticles (SNPs) with different loading patterns towards VD3 was investigated. Specifically, SNPs with hydrophobic regions feasible for VD3 loading (Pro1 and Pro2, Pattern1) showed better stabilization ability. While those co-assembled with VD3 (Pro3, Pattern2) showed weaker protection due to loosen structures. Remodeling behavior during digestion generally improved cellular uptake. Herein, Pro1 and Pro2 tended to form hydrophobic aggregates during gastric digestion and later their degradations facilitated sustained release of VD3 and formation of mixed micelles, enhancing absorption at smaller size. The co-assembled nanoparticles (Pro3) easily underwent electrostatic-induced aggregation at gastric phase and immediately disassociated upon bile salts, leading to rapid release of VD3, and typical peptides in digests that promote VD3 absorption require further study. These findings suggest that VD3 loading and digestion would alter carrier structures and affect cellular uptake. VD3 incorporation and remodeling behavior of the carrier warrants attention.

Warmer and brighter winters than before: Ecological and public health challenges from the expansion of the pine processionary moth (Thaumetopoea pityocampa)

Assessing the species ecological responses to ongoing climate change is a critical challenge in environmental science. Rising temperatures, particularly in winter, are altering the distribution patterns of many species, including the pine processionary moth (PPM), Thaumetopoea pityocampa (Denis & Schiffermüller, 1775). This Mediterranean species, a significant defoliator of conifers, is expanding its range northward as winter temperatures increase. The larvae of PPM also pose serious public health risks due to their ability to induce allergic reactions in humans, pets, and livestock. To better understand these ecological shifts, we calibrated three distribution models (Bayesian Additive Regression Trees, Boosted Regression Trees, and Random Forest) based on historical and modern occurrence data compiling of 1769 points, and assessed climate suitability under historical, current and future conditions. Our results show that winter minimum temperatures, summer maximum temperatures, and solar radiation significantly influence the life cycle, and shape the geographical distribution of PPM. Under current conditions, PPM could extend its range further north, but its limited flight capabilities hinder its ability to keep up with the pace of climate change. Future projections suggest continued northward expansion, although solar radiation is expected to limit the northernmost range of PPM. Certain host tree species of PPM are frequently used as ornamental plants, particularly in urban areas, which makes the careful selection of these species a potentially valuable tool for management. Our findings identify regions that are likely to become suitable for PPM colonization, where proactive measures could be implemented.

Infection and Inflammation in Nuclear Medicine Imaging: The Role of Artificial Intelligence

Infectious and inflammatory diseases represent a global challenge. Delayed diagnosis and treatment lead to death, disabilities and impairment of the quality of life. The detection of low-grade inflammation and occult infections remains challenging. Nuclear medicine techniques are well established in the assessment of the severity and extent of the disease. However, high-level expertise is required to process and interpret the images. Additionally, the workflows are frequently time consuming. Artificial intelligence (AI)-based techniques can be efficiently applied in this setting. We reviewed the literature to assess the state of the application of AI in nuclear medicine imaging in infectious and inflammatory diseases. We included 22 studies, which applied AI-based methods for any of the steps of their workflow. In this review we report and critically discuss the state-of-the-art knowledge on the application of AI models in Infection and Inflammation nuclear medicine imaging.

Association of urbanization-related factors with tuberculosis incidence among 1992 counties in China from 2005 to 2019: a nationwide observational study

BACKGROUND

Most high tuberculosis (TB) burden countries are in low- and middle-income regions undergoing rapid urbanization. We aimed to assess the association between urbanization factors and TB incidence in China.

METHODS

We evaluated urbanization at the county level in China from 2005 to 2019 using a composite index integrating population density, gross domestic product (GDP, per capita), hospital beds per 1000 population, nighttime light (NTL), and normalized difference vegetation index (NDVI). The annual incidence rate and number of TB cases were obtained from the national Tuberculosis Information Management System, maintained by the Chinese Center for Disease Control and Prevention. Fixed-effects models were used to examine the association between urbanization factors and TB incidence. A subgroup analysis was performed by dividing counties into four regions: northeast, eastern, central, and western.

RESULTS

A total of 1992 counties in China were included in this study. Overall, urbanization scores were associated with reduced TB incidence (β = - 0.0114, P < 0.001), corresponding to a 1.1% reduction in TB incidence per unit score. Quadratic models presented a U-shaped relationship between urbanization and TB incidence with an inflection point at 52.94 urbanization units. For each indicator of urbanization, population density and the number of hospital beds were positively associated with TB incidence, with incidence rate ratios of 11.384 [95% confidence interval (CI): 9.337 to 13.881], and 1.015 (95% CI: 1.011 to 1.019), respectively, while GDP, NTL, and NDVI exhibited protective effects. Central China displayed an increase trend that urbanization score was linked to a 1.8% rise in TB incidence.

CONCLUSIONS

Urbanization-related factors, including GDP, NTL and NDVI, were inversely associated with TB incidence. Central China's contrasting results highlighted region-specific challenges. Therefore, governments in developing countries should adopt integrated approaches that promote both economic growth and sustainable development of environment during urbanization to optimize TB control efforts.

Rapid Bacterial Identification through Multiplexed Nucleic Acid Detection on a Digital Microfluidic Platform for Enhanced Clinical Intervention against Infections

Bacterial infections often lead to severe health consequences owing to their ability to infiltrate multiple anatomical sites, including the bloodstream, respiratory tract, and digestive tract, posing substantial diagnostic and therapeutic challenges. Consequently, a rapid and versatile detection method capable of identifying a broad spectrum of bacterial pathogens is urgently required to facilitate precise antibiotic prescriptions. Addressing this need, we introduce MiND-DMF (Multibacterial Infection Nucleic Acid Detection on a Digital Microfluidic Platform), a cost-effective digital microfluidic platform tailored for multiplexed bacterial detection. This system integrates DNA extraction, recombinase polymerase amplification (RPA), and CRISPR-based detection technologies, enabling the efficient identification of six common infectious bacteria. Operating at a constant temperature of 37 °C, MiND-DMF completes the entire diagnostic process in just 55 min and is compatible with human reference genes. In spiked samples, the platform demonstrated a detection limit of 100 CFU/mL, highlighting its exceptional sensitivity and quantification capability. In clinical evaluations, MiND-DMF exhibited outstanding performance, achieving 100% sensitivity and 98%-100% specificity compared to conventional PCR methods across 50 samples derived from diverse tissue sources. This robust platform demonstrates strong anti-interference capabilities, making it suitable for analyzing various tissue fluids including blood, alveolar lavage fluid, urine, nasal secretions, appendiceal pus, and ear pus. The versatility and precision of MiND-DMF support the monitoring of hospital-acquired bacterial infection origins, empowering physicians to prescribe targeted antibiotics and enhancing overall infection prevention and control strategies. By accurately detecting bacteria from multiple sources, MiND-DMF can play a pivotal role in improving patient outcomes and public health.

Rapid Response Antimicrobial Peptide Design Strategy Driven by Meta-Learning for Emerging Drug-Resistant Pathogens

Antimicrobial resistance (AMR) presents a critical global health threat requiring urgent intervention. In order to swiftly respond to and control the spread of emerging drug-resistant bacteria at the onset of their proliferation, our aim is to develop a Rapid Response Antimicrobial Peptide (AMP) design strategy (RR-ADS). This framework addresses the challenge of limited pathogen-specific data by achieving robust generalization from minimal samples by meta-learning and reinforcement learning, optimizing both biocompatibility and efficacy against drug-resistant pathogens. Our model has achieved satisfactory results across multiple evaluation metrics, demonstrating the capability to accurately identify and generate AMPs targeted against drug-resistant bacteria with minimal sample sizes. Within 2 weeks, we successfully designed and experimentally verified AMPs against multidrug-resistant Acinetobacter baumannii, achieving a 93.3% positive rate. RR-ADS has effectively demonstrated the potential of meta-learning in tasks involving bioactive peptides and holds promise as an effective alternative measure to address infectious disease public health emergencies.

Focusing a viral risk ranking tool on prediction

Preparing to rapidly respond to emerging infectious diseases is critical. SpillOver: Viral Risk Ranking is an open-source tool developed to assess the risk of novel wildlife-origin viruses spilling over from animals to humans and spreading in human populations. Several risk factors used by the tool depend on evidence of previous zoonotic spillover itself or sustained transmission in humans. Therefore, we reanalyzed the Ranking Comparison after removing eight of the 31 risk factors that require postspillover knowledge and compared the adjusted risk rankings to the originals. The area under the receiver operating characteristic curve deteriorated from 0.94 for the original risk scores to 0.73 for the adjusted ones for predicting the classification as a human virus. We also compared the mean and SD of the risk scores for the human and non-human viruses at the risk factor level. Most excluded spillover-dependent risk factors had dissimilar means between the human and non-human virus classifications, but nonspillover-dependent risk factors frequently showed similar means between the two classifications. The original formulation of the tool depended on the inclusion of spillover-dependent risk factors to quantitatively assess the risk of zoonotic spillover for a novel virus. Future iterations of the tool should omit such risk factors and consider other nonspillover-dependent risk factors to ensure that the tool is fit for risk prediction of novel viruses.

Strategic use of nanomaterials as double-edged therapeutics to control carcinogenesis via regulation of dysbiosis and bacterial infection: current status and future prospects

The human microbiome plays a crucial role in modulating health and disease susceptibility through a complex network of interactions with the host. When the delicate balance of this microbial ecosystem is disrupted, it often correlates with the onset of systemic diseases. An over-abundance of pathogenic microorganisms within the microbiome has been implicated as a driving factor in the development of disease conditions such as diabetes, obesity, and chronic infections. It has been observed that microbiome dysbiosis perturbs metabolic, inflammatory, and immunological pathways, potentially facilitating carcinogenesis. Furthermore, the metabolites associated with microbial dysbiosis exert multifaceted effects, including metabolic interference, host DNA damage, and tumor promotion, further underscoring the microbiome's significance in several of the cancers. This new exploration of microbiome involvement in carcinogenesis needs additional patient sample analysis, which could provide new insights into cancer diagnosis and treatment. However, treating these diseases using drugs, traditional methods, etc. has resulted in multi-drug resistance, and this has eventually made the situation worrisome. This review highlights the importance of nanotechnology, which may tackle these pathogenic conditions simultaneously by targeting common receptors present in bacteria and cancer. Herein, we have explained how nanotechnology may come to the forefront for these treatments. It explores the potential of non-antibiotic disinfectants, i.e., nanoparticles (NPs) with dual targeting capabilities against microbes and cancer cells, using mechanisms such as ROS generation and DNA damage while minimizing the chances of drug resistance.

Body fluid diagnostics using activatable optical probes

In vitro diagnostics often detects biomarkers in body fluids (such as blood, urine, sputum, and cerebrospinal fluids) to identify life-threatening diseases at an early stage, monitor overall health, or provide information to help cure, treat, or prevent diseases. Most clinically used optical in vitro diagnostic tests utilize dye-labeled biomolecules for biomarker recognition and signal readout, which typically involve complex steps and long processing times. Activatable optical probes (AOPs), which spontaneously activate their optical signals only in the presence of disease biomarkers, offer higher signal-to-background ratios and improved detection specificity. They also have the potential to simplify detection procedures by eliminating multiple washing steps. In this review, we summarize recent advances in the use of AOPs for pre-clinical and clinical body fluid diagnostics across various diseases, including cancer, nephro-urological disorders, infectious diseases, and digestive diseases. We begin by discussing the molecular design strategies of AOPs to achieve different optical signal readouts and biomarker specificity. We then highlight their diagnostic applications in various disease models and body fluids. Finally, we address the challenges and future perspectives of AOPs in enhancing body fluid diagnostics and advancing precision medicine.

Delayed correct diagnoses in emerging disease outbreaks: historical patterns and lessons for contemporary responses

BACKGROUND

The gap between early diagnostic assumptions and final diagnoses in disease outbreaks represents a persistent challenge in global health despite advancements in diagnostic and response capabilities.

OBJECTIVES

To analyse the unfolding 2025 outbreak in the Democratic Republic of Congo (DRC) through the lens of historical cases where initial misattributions contributed to delayed recognition of novel or unexpected threats with varying public health consequences; identifying patterns from past outbreaks that can inform current diagnostic approaches and response strategies.

SOURCES

We selected illustrative examples from peer-reviewed publications, focusing on cases with initial diagnostic uncertainties that highlight specific diagnostic patterns relevant to the current DRC outbreak. For the ongoing DRC outbreak, we analysed official World Health Organization Africa bulletins and communications from the DRC Ministry of Health through February and early March 2025.

CONTENT

As of beginning of April 2025, health authorities continue investigating clusters of unexplained acute febrile illness in Équateur Province with clinical features that were initially being suggestive of a viral haemorrhagic fever. Primary viral haemorrhagic fever pathogens have now been excluded. From selected historical and recent outbreaks, it can be deduced that diagnostic challenges extend beyond individual cognition to include structural biases in global health systems, methodological limitations and sociocultural factors.

IMPLICATIONS

We identified five evidence-informed interventions to mitigate diagnostic delays: systematic consideration of multiple working hypotheses, development of sustainable local diagnostic capacity, enhancement of clinician-to-public-health communication networks, implementation of cognitive debiasing strategies, and strengthening of One Health surveillance platforms. Historical misdiagnoses offer crucial lessons for transforming outbreak response from reactive to anticipatory, potentially averting future epidemics through earlier, more accurate recognition of emerging pathogens within their complex ecological and social contexts.

Hydrogel microspheres based on aggregation induction to improve the solubility of insoluble drugs promoting bone repair

Insoluble organic molecule drugs often accumulate in vivo, diminishing their efficacy. This study explores the utilization of cage oligosiloxane (POSS-SH) as a carrier for insoluble drugs. POSS-SH exhibits disaggregation properties and enhances cell phagocytosis. Using a thermodynamic approach, kartogenin (KGN) and diclofenac (DS) were covalently bonded via acrylyl chloride. Subsequently, a "one-pot method" was employed to graft double-bonded KGN, DS, and PEG onto POSS-SH, forming organic-inorganic POSS hybrid drugs. In the target molecule, water-soluble polyethylene glycol was introduced to enhance solubility and inhibit organic molecule aggregation within the target molecule. The resulting POSS nanoparticles were coated with methacrylate hyaluronic acid, generating hydrogel microspheres (MHS@PSD) for slow release in situ within the bone joint cavity using microfluidic technology. Slow release of PSD can ameliorate local joint inflammation and promote mesenchymal stem cell differentiation into chondrocytes. Compared to unmodified KGN and DS, our designed materials expedite and enhance cartilage regeneration. In summary, POSS-based hydrogel microspheres with deaggregation properties hold promise for cartilage regeneration, offering a framework for enhancing the efficacy of insoluble organic drugs.

Analyzing the impact of COVID-19 on seasonal infectious disease outbreak detection using hybrid SARIMAX-LSTM model

BACKGROUND

This study estimates the incidence of seasonal infectious diseases, including influenza, norovirus, severe fever with thrombocytopenia syndrome (SFTS), and tsutsugamushi disease, in the Republic of Korea from 2005 to 2023. It also examines the impact of the COVID-19 pandemic on their transmission patterns.

METHODS

We employed the Seasonal AutoRegressive Integrated Moving Average with eXogenous variables (SARIMAX) model, long short-term memory (LSTM) neural networks, and a hybrid SARIMAX-LSTM model to predict disease incidence and identify outbreak periods. Meteorological data were incorporated into the models, and change point detection (CPD) was used to identify shifts in outbreak trends. Model predictions were compared with actual data to evaluate the influence of COVID-19 on disease incidence.

RESULTS

The incidence of influenza and norovirus was significantly affected by COVID-19, whereas SFTS and tsutsugamushi disease showed no substantial changes. Influenza did not return to pre-pandemic levels post-COVID-19, while norovirus incidence reverted to previous patterns. Despite a decrease in influenza-like illness (ILI) cases during the pandemic, predictive models indicated a potential resurgence of outbreaks.

CONCLUSIONS

These findings highlight the need for tailored public health strategies for each disease. Early detection and timely interventions are essential for reducing healthcare burdens and improving health outcomes.

Immunological drivers of zoonotic virus emergence, evolution, and endemicity

The disruption of natural ecosystems caused by climate change and human activity is amplifying the risk of zoonotic spillover, presenting a growing global health threat. In the past two decades, the emergence of multiple zoonotic viruses has exposed critical gaps in our ability to predict epidemic trajectories and implement effective interventions. RNA viruses, in particular, are challenging to control due to their high mutation rates and ability to adapt and evade immune defenses. To better prepare for future outbreaks, it is vital that we deepen our understanding of the factors driving viral emergence, transmission, and persistence in human populations. Specifically, deciphering the interactions between antibody-mediated immunity and viral evolution will be key. In this perspective, we explore these dynamic relationships and highlight research priorities that may guide the development of more effective strategies to mitigate the impact of emerging infectious diseases.

Framework to guide the use of mathematical modelling in evidence-based policy decision-making

INTRODUCTION

The COVID-19 pandemic highlighted the significance of mathematical modelling in decision-making and the limited capacity in many low-income and middle-income countries (LMICs). Thus, we studied how modelling supported policy decision-making processes in LMICs during the pandemic (details in a separate paper).We found that strong researcher-policymaker relationships and co-creation facilitated knowledge translation, while scepticism, political pressures and demand for quick outputs were barriers. We also noted that routine use of modelled evidence for decision-making requires sustained funding, capacity building for policy-facing modelling, robust data infrastructure and dedicated knowledge translation mechanisms.These lessons helped us co-create a framework and policy roadmap for improving the routine use of modelling evidence in public health decision-making. This communication paper describes the framework components and provides an implementation approach and evidence for the recommendations. The components include (1) funding, (2) capacity building, (3) data infrastructure, (4) knowledge translation platforms and (5) a culture of evidence use.

KEY ARGUMENTS

Our framework integrates the supply (modellers) and demand (policymakers) sides and contextual factors that enable change. It is designed to be generic and disease-agnostic for any policy decision-making that modelling could support. It is not a decision-making tool but a guiding framework to help build capacity for evidence-based policy decision-making. The target audience is modellers and policymakers, but it could include other partners and implementers in public health decision-making.

CONCLUSION

The framework was created through engagements with policymakers and researchers and reflects their real-life experiences during the COVID-19 pandemic. Its purpose is to guide stakeholders, especially in lower-resourced settings, in building modelling capacity, prioritising efforts and creating an enabling environment for using models as part of the evidence base to inform public health decision-making. To validate its robustness and impact, further work is needed to implement and evaluate this framework in diverse settings.

Multiorgan sequelae following non-COVID-19 respiratory infections: a review

BACKGROUND

While numerous studies have documented severe and long-term health impacts of COVID-19 infections on various organs, the prolonged multisystemic implications of other acute respiratory infections (ARIs) are poorly understood. This review therefore analyzed currently available studies about these sequelae of ARIs excluding COVID-19.

MAIN BODY

Multiple pathogens causing ARIs are associated with significant long-lasting impairments across various organ systems. Cardiovascular events occur in 10-35% of patients following ARIs, with an elevated risk persisting for 10 years. The stroke incidence ratio increases significantly after ARIs up to 12.3. Pulmonary sequelae are common, including abnormal lung function in 54%, parenchymal opacification in 51%, lung fibrosis in 33-62%, asthma in 30%, and bronchiectasis in 24% of patients. The risk of developing dementia is increased 2.2-fold. Posttraumatic stress disorder, depression, anxiety, and chronic fatigue occur in 15-43%, 15-36%, 14-62%, and 27-75% of patients, respectively. 28-day mortality from CAP with (versus no) additional cardiovascular event is increased to 36% (versus 10%). Long-term mortality from CAP (versus no CAP) remains elevated for years post-infection, with a 1-year, 5-year, and 7-year mortality rate of 17% (versus 4%), 43% (versus 19%), and 53% (versus 24%), respectively. Patients´ quality of life is significantly reduced, with 17% receiving invalidity pensions and 22% retiring within 4 years of severe ARIs.

CONCLUSION

Non-COVID-19 ARIs are associated with clinically relevant, frequent, and long-term sequelae involving multiple organ systems. Further prospective studies are needed.

Updating global estimates of pathogen-attributable diarrhoeal disease burden: a methodology and integrated protocol for a broad-scope systematic review of a syndrome with diverse infectious aetiologies

INTRODUCTION

Sustaining declines in global infectious disease burden will increasingly require efforts targeted to specific aetiological agents and common transmission pathways, particularly in this era of global change and human interconnectivity accelerating transmission and emergence of infectious pathogens. Systematic reviews and meta-analyses can be an effective and resource-efficient method for synthesising evidence regarding disease epidemiology for a wide range of pathogens and are the evidence source used by initiatives like the Planetary Child Health and Enterics Observatory (Plan-EO) and the WHO to determine the aetiology-specific epidemiology of diarrhoeal disease. Therefore, we developed this integrated systematic review methodology and protocol that aims to compile a database of published prevalence estimates for 17 diarrhoea-causing pathogens as inputs for disease burden estimation.

METHODS AND ANALYSIS

We will seek estimates of the prevalence of each endemic enteric pathogen estimated from published population-based studies that diagnosed their presence in stool samples from both asymptomatic subjects and those experiencing diarrhoea. The pathogens include the enteric viruses adenovirus, astrovirus, norovirus, rotavirus and sapovirus, the bacteria Campylobacter, Shigella, Salmonella enterica, Vibrio cholerae and the Escherichia coli (E. coli) pathotypes enteroaggregative E. coli, enteropathogenic E. coli, enterotoxigenic E. coli and Shiga-toxin-producing E. coli and the intestinal protozoa Cryptosporidium, Cyclospora, Entamoeba histolytica and Giardia. Meta-analytical methods for analyses of the resulting database (including risk of bias analysis) will be published alongside their findings.

ETHICS AND DISSEMINATION

This systematic review is exempt from ethics approval because the work is carried out on published documents. The database that results from this review will be made available as a supplementary file of the resulting published manuscript. It will also be made available for download from the Plan-EO website, where updated versions will be posted on a quarterly basis.

PROSPERO REGISTRATION NUMBER

CRD42023427998.

Assessing the Impact of Haulage Drivers in Uganda's COVID-19 Delta Wave

BACKGROUND

Haulage truck drivers connect distant communities, posing potential disease introduction risks. However, interventions must balance public health protection, economic continuity, and individual rights. This study examines the role of haulage in disease introduction and onward spread in Uganda during the Delta wave of COVID-19.

METHODS

Using 625,422 national surveillance records, we fitted a susceptible-infectious-recovered model to assess whether haulage drivers were a "core-risk group." Although they accounted for only 0.036% of COVID-19 cases, border districts associated with haulage registered 12.02% more cases than inland districts, suggesting a role in disease introduction. The risk varied by location, with Tororo experiencing a higher burden than Amuru and Kyotera, which border South Sudan and Tanzania, respectively. Mandatory COVID-19 testing and result waiting at the Malaba border crossing increased disease risk in Tororo by up to 6%. While haulage-targeted interventions reduced cases in border districts, they had minimal impact on inland districts, indicating a limited role in onward spread. Our findings also suggest that integrating haulage-specific measures with vaccination would further reduce case-load.

CONCLUSIONS

Our findings suggest that truck drivers were a transient core risk group with limited impact on onward spread. However, uncertainties remain regarding the extent of their role, and interventions like testing and result waiting at border crossings may have inadvertently heightened risk. Pandemic preparedness strategies should carefully assess risks in key sectors like supply chains to balance public safety with individual rights.

Boosting virus enrichment with macroporous magnetic sorbent based on ketoenamine covalent organic framework

Effective surveillance and discovery of emerging and reemerging infectious viruses are crucial for predicting and controlling epidemic outbreaks. However, these efforts are significantly hindered by the low-titer existence of genetically diverse viruses in most field samples. Here, we report a macroporous-structured magnetic sorbent based on β-ketoenamine covalent organic framework (COF). Leveraging the combined advantages of the chemical and nanotopographical properties of the COF surface, along with the high accessibility of this active surface within the macroporous matrix, the COF-based adsorbent demonstrates enrichment capabilities for a wide range of viruses with varying structural features. These include Tick-borne encephalitis virus, Influenza virus H9N2 subtype, Severe acute respiratory syndrome coronavirus-2, Herpes simplex virus, Japanese encephalitis virus, Adeno virus, Bacteriophage MS2 and Enterovirus 71, achieving an enrichment efficiency exceeding 80 %. Notably, the COF-based sorbent enables a remarkable 9-fold reduction in the threshold concentration required for virus detection via quantitative polymerase chain reaction, demonstrating its immense potential for early virus detection and discovery.

The Human Footprint and Climate Change Shape Current and Future Scenarios of Visceral Leishmaniasis Distribution in Doce River Basin in Brazil

The identification of factors that influence the distribution of visceral leishmaniasis (VL) is key for future surveillance and control. This study sought to understand how environmental and climate variables can interfere with VL expansion in the Doce River basin located in Brazil. This ecological study explored the influence of anthropogenic, environmental, and climatic factors on VL expansion. Ecological niche modeling was used to assess the current situation and predict the future spread of the disease. The study used 855 human cases of VL recorded in the Doce River basin from 2001-2018 and analyzed them within the context of climatic and environmental variables. To model the current and future distributions, MaxEnt with the kuenm R package was used. To model the future projections, the global climate model of the National Centre for Meteorological Research (CNRM-CM6-1) was used as well as two Shared Socioeconomic Pathways (SSP370 and SSP585) for 2021-2040 and 2061-2080. Variables that contributed to the VL distribution were the human footprint index (62.6%), isothermality (28.1%), precipitation during the wettest month (6.4%), and temperature during the hottest month (3.8%). Future climate change scenarios showed areas suitable for the disease increasing over time (by about 7% between 2021 and 2041 and about 12% between 2061 and 2080) and the maintenance of the disease in places already considered endemic. Our results demonstrate the importance of anthropic and climatic factors in VL expansion. We hope that these results will contribute to boosting surveillance and vector control programs along the Doce River basin.

Environmental Challenges and Co-Infection Modulate Resistance and Tolerance Against Trypanosoma Cruzi and Trichinella Spiralis in Rats

To overcome infection, hosts employ two defense strategies: resistance (which limits pathogen fitness), and tolerance (which reduces infection damage). These strategies may be influenced by environmental challenges such as food shortage, social conflict, and co-infections. Here, our objective was to assess defense strategies in rats infected with Trichinella spiralis and/or Trypanosoma cruzi under environmental challenges. After four weeks of treatment with environmental challenges (food restriction [0/1] and/or social conflict [0/1]), rats were exposed to Tri. spiralis [0/1] and/or Try. cruzi [0/1]. Six weeks postinoculation, we measured parasite intensity and several indicators of health or pathology. Tolerance to Try. cruzi increased in the presence of social conflict and food restriction. Coinfected animals showed reduced tolerance compared to mono-infected. However, food-restricted mono-infected rats had lower tolerance than other groups. No significant differences were found in resistance to Try. cruzi. Tolerance to Tri. spiralis was higher in food-restricted rats and Coinfected rats. Moreover, we found a potential shift in defense strategy: rats that are mono-infected and exposed to social conflict may be more resistant but less tolerant to Tri. spiralis than all other experimental groups. Overall, our findings highlight that defense strategies are context-dependent in the nematode-protozoan infection model studied, and provide evidence of a shift in the defense strategy to accommodate during environmental challenges. Given that rodents play a key role as reservoirs of zoonotic pathogens, understanding the range and variability of defense strategies in these animals is of utmost importance.

Association between meteorological factors and varicella incidence in Japan: a nationwide time-series study

Varicella, commonly referred to as chickenpox, is an airborne infectious disease that continues to pose an increasing threat to public health. Despite previous investigations, the global accumulation of epidemiological studies exploring the association between varicella epidemics and meteorological factors remains insufficient. This study aimed to quantify the short-term effect of meteorological factors, such as mean temperature and relative humidity, on the incidence of varicella across all 47 prefectures of Japan over a decade (2010-2019). Using a two-stage time-series modelling design, we first applied distributed lag non-linear models to estimate the exposure-response relationships for each prefecture, followed by a meta-regression to pool these results for a nationwide estimate. The analysis covered 1,315,616 varicella cases. Our findings indicate a significant increase in varicella risk associated with lower temperatures and reduced humidity. Specifically, the cumulative relative risk (RR) at the 5th temperature percentile, compared to the 99th, was 2.45 (95% confidence interval [CI]: 2.15, 2.79). The cumulative RR at the 5th humidity percentile, compared to the 90th, was 1.11 (95% CI: 1.03, 1.09). These results suggest that public health strategies targeting temperature- and humidity-related varicella morbidity could be more effective if adapted to local climatic conditions. Understanding the influence of meteorological factors on varicella transmission may further elucidate the mechanisms driving the disease's seasonal trends.

Cross-Species Transmission at the Wildlife-Livestock Interface: A Case Study of Epidemiological Inference From Mule Deer GPS Collar Data

In the current era of global change, the emergence of infectious diseases at the wildlife-livestock interface poses risks to biodiversity, agricultural economies, and public health. Driven by anthropogenic influence, increased sharing of resources between wildlife and livestock can promote cross-species transmission, the consequences of which are challenging to predict. Mycoplasma bovis , an economically important bacterial pathogen in cattle, has recently emerged as a threat to other ungulate species. This study reports on a case of M. bovis in an intensively monitored free-ranging mule deer (Odocoileus hemionus ) in Colorado, USA, which presented an opportunity to describe the disease in a novel host and infer transmission and infection dynamics from GPS collar data. Following a mortality signal from a GPS-collared adult female mule deer, field investigation revealed predation while postmortem examination further revealed severe, acute, fibrinosuppurative and necrotizing pleuropneumonia. Histopathological analysis, immunohistochemistry, and real-time PCR confirmed M. bovis as the etiology. GPS collar data demonstrated spatial overlap with dairy cattle in the 50 days prior to death, implicating potential spillover from cattle as the transmission pathway. Reduced movement was identified 19 days prior to death, indicative of sickness behavior due to acute pneumonia. This case underscores the potential for M. bovis to cause severe disease in wild ungulates and highlights the value of thorough postmortem investigations as a routine component of studies involving wildlife tracking. The retrospective use of GPS collar data provides valuable insights into the movement ecology of wildlife exposed to novel pathogens, aiding in the understanding of cross-species transmission and informing management strategies to reduce the potential for spillover.

Infectious Disease Specialists' awareness, perceptions and attitudes toward ecological transition in healthcare: a cross-sectional study in France

INTRODUCTION

Climate change is having a major impact on public health. The healthcare system is responsible for around 8% of greenhouse gas emissions in France. Infectious diseases (ID) lie at the heart of these consequences.

OBJECTIVES

The primary aim of this study was to assess the expectations of French ID specialists in terms of a sustainable healthcare transition. Secondary objectives included the assessment of awareness regarding this subject, perceptions, adopted attitudes and opportunities for actions.

METHODS

A survey on sustainable healthcare transition was sent to all the French Society for ID members.

RESULTS

Of the 860 physicians approached, 220 responded. More than 78% of respondents responded correctly to questions concerning the impact of climate change on public health. The environmental impact of the healthcare system was less well understood. A higher level of environmental anxiety was associated with a higher rate of declaration of concrete actions. People under 40 years of age declared themselves to be more active. Regarding attitudes towards the roles of different stakeholders in a sustainable healthcare transition, the role of medical societies is prominent. Respondents' main expectations and suggestions are the following: (1) creation of a cross functional group dedicated to a sustainable healthcare transition, (2) creation of a training program, to meet the training needs of 94% of respondents, (3) continuation of the French Society for ID's lobbying for the relocation of antibiotic production in Europe, research on life-cycle analysis of anti-infective drugs, single-dose packaging for antibiotics, (4) reflection on the concept of "sustainably designed healthcare" in ID, (5) continued exploration of the "One Health" concept and (6) development of recommendations for sustainably designed hygiene practice.

CONCLUSION

This national survey of French ID specialists is a prerequisite for the implementation of actions within the French Society for ID.

The role of the JunD-RhoH axis in the pathogenesis of hairy cell leukemia and its ability to identify existing therapeutics that could be repurposed to treat relapsed or refractory disease

Hairy cell leukemia (HCL) is an indolent malignancy of mature B-lymphocytes. While existing front-line therapies achieve excellent initial results, a significant number of patients relapse and become increasingly treatment resistant. A major molecular driver of HCL is aberrant interlocking expression of the transcription factor JunD and the intracellular signaling molecule RhoH. Here we discuss the molecular basis of how the JunD-RhoH axis contributes to HCL pathogenesis. We also discuss how leveraging the JunD-RhoH axis identifies CD23, CD38, CD66a, CD115, CD269, integrin β7, and MET as new potential therapeutic targets. Critically, preclinical studies have already demonstrated that targeting CD38 with isatuximab effectively treats preexisiting HCL. Isatuximab and therapeutics directed against each of the other six new HCL targets are currently in clinical use to treat other disorders. Consequently, leveraging the JunD-RhoH axis has identified a battery of therapies that could be repurposed as new means of treating relapsed or refractory HCL.

Cell-free DNA: a promising biomarker in infectious diseases

Infectious diseases pose serious threats to public health worldwide. Conventional diagnostic methods for infectious diseases often exhibit low sensitivity, invasiveness, and long turnaround times. User-friendly point-of-care tests are urgently needed for early diagnosis, treatment monitoring, and prognostic prediction of infectious diseases. Cell-free DNA (cfDNA), a promising non-invasive biomarker widely used in oncology and pregnancy, has shown great potential in clinical applications for diagnosing infectious diseases. Here, we discuss the most recent cfDNA research on infectious diseases from both the pathogen and host perspectives. We also discuss the technical challenges in this field and propose solutions to overcome them. Additionally, we provide an outlook on the potential of cfDNA as a diagnostic, treatment, and prognostic marker for infectious diseases.

Chemical profiling and mechanistic insights into the antibacterial efficacy of Melaleuca cajuputi leaf extract

BACKGROUND

The emergence of antimicrobial resistance and the prevalence of bacterial infections have prompted the search for novel antimicrobials with diverse therapeutic potential from natural products. Thus, this study investigated the antibacterial efficacy of the leaf extracts of M. cajuputi. Additionally, the chemical composition and the mechanism of action of the most active extract (MAE) were evaluated.

METHODS

The antibacterial activity of leaf extracts of M. cajuputi was assessed using the broth microdilution assay. Scanning electron microscopy (SEM) was used to investigate the effects of MAE on the morphology of bacterial cells. Meanwhile, the chemical composition of the MAE was analyzed using Fourier transform infrared (FTIR) spectroscopy and gas chromatography-mass spectrometry (GC-MS). AutoDock Vina was used for molecular docking analysis to unveil the interactions between the ligands and the active sites of the target bacterial proteins.

RESULTS

The crude extracts were obtained through cold maceration. The methanolic extract demonstrated the most significant antibacterial activity, with minimum inhibitory concentration (MIC) values spanning 0.25 mg/mL to 2 mg/mL. After 12 h of treatment with 1 × MIC of the methanolic extract, the bacteria showed discernible morphological alterations, including disrupted cell wall and membrane integrity. Thirty compounds were identified in the MAE and subsequently subjected to molecular docking studies against target bacterial proteins. Amongst the compounds, methylanthracene, cycloisolongifolene, diphenyl imidazole, benzil monohydrazone, and trimethoxybenzoic acid showed pronounced binding affinities towards Klebsiella pneumoniae membrane protein (PDB ID: 5O79), peptide binding protein (PDB ID: 7RJJ), Streptococcus agalactiae cell wall surface anchor (PDB ID: 2XTL), pilin (PDB ID: 3PHS), Staphylococcus aureus transglycosylase (PDB ID: 3VMQ), and penicillin-binding proteins (PDB ID: 3VSK). The binding energy scores for these interactions varied between - 6.0 kcal/mol and - 7.5 kcal/mol. Molecular dynamics simulations validated the stability of these interactions, reinforcing the in vitro findings of cell wall and membrane disruption​.

CONCLUSION

The findings of this study indicated that the methanolic extract of M. cajuputi leaves displayed potent antibacterial activity against Klebsiella pneumoniae, S. agalactiae, and S. aureus. The molecular docking analysis reveals significant binding interactions between the identified compounds and the target bacterial proteins, highlighting the potential of M. cajuputi as a novel source of anti-infectives targeting bacterial infections.

Anthropogenic activity and climate change exacerbate the spread of pathogenic bacteria in the environment

Climate change is profoundly affecting human health. Human pathogenic bacteria (HPB) infections mediated by the environment are considered a substantial cause of global health losses. However, the biogeography of HPB and their response to climate change remain largely unknown. Here, we constructed and analyzed a global atlas of potential HPB using 1,066,584 samples worldwide. HPB are widely present in the global environment, and their distribution follows a latitudinal diversity gradient. Climate and anthropogenic factors are identified as major drivers of the global distribution of HPB. Our predictions indicated that by the end of this century, the richness, abundance, and invasion risk of HPB will increase globally, with this upward trend becoming more pronounced as development sustainability declines. Therefore, the threat of environmentally mediated HPB infections to human health may be more severe in a world where anthropogenic activities are intensifying and the global climate is warming.

Constructing a Resilience Assessment Index System for Tuberculosis Healthcare Services Under Public Health Emergencies: A Modified Delphi Study

Purpose

Understanding the resilience of tuberculosis healthcare services (TB-HSs) is crucial for the targeted reinforcement of weak links and mitigation of the impact of public health emergencies (PHEs). However, assessment systems in this domain are lacking. This study aims to construct a resilience assessment index system (RAIS) for TB-HSs in China.

Methods

The following four-step design process was conducted: 1) establishing the RAIS index pool based on a literature review, 2) designing an initial RAIS for TB-HSs following Donabedian's "structure-process-outcome" framework through expert meetings; 3) employing a two-round Delphi survey to obtain a consensus on the RAIS; and 4) using the analytic hierarchy process to quantify the weight of each indicator included in the final RAIS.

Results

The expert panel (n=26) had 100.0% and 96.2% response rates in the first and second Delphi rounds, respectively. The expert authority coefficients for the two rounds were 0.908 and 0.906. Both rounds showed high levels of expert coordination (P<0.001). The final RAIS comprising three first-grade, nine second-grade, and 39 third-grade indicators. Our findings reveal that tuberculosis service provision/utilization tops the first-grade indicators, weighing 49.05%. Among the second-grade indicators, service outcomes (20.79%) and patient treatment (20.67%) were the top-weighted. Of the third-grade indicators, the treatment discontinuation proportion (10.29%) and the treatment coverage rate in confirmed TB patients (8.90%), were critical components in evaluating the resilience of TB-HSs.

Conclusion

This study developed a unified hierarchical resilience assessment index system for TB-HSs in China. Further research is required to validate and improve our results. The study's findings could help develop strategies that benefit public health.

Astragalus mongholicus bunge and Angelica sinensis botanical drug decoction mitigates lung inflammation through NOX4/TGF-β1/SMAD3 signaling

Introduction

Astragalus mongholicus bunge and Angelica sinensis are botanical drugs rich in beneficial nutrients and health-promoting metabolites. Their roots can be decocted to a botanical drug decoction "Danggui Buxue Tang (DBT)," demonstrating human anti-inflammatory.

Methods

Here, we evaluate the mitigating function of DBT on lung inflammation and early fibrosis in a rat model. The model was established by tracheal dripping of silica suspension for 28 days. Positive intervention effects of DBT were observed in a dose-dependent manner after consecutive gavage of DBT (1.9, 3.8, and 7.6 g/kg·bw/d) for 28 days and 42 days. To explore the underlying molecular mechanism. DBT metabolites were profiled using a liquid chromatograph-mass spectrometer and the Chemspider database.

Results

Lung inflammation and fibrosis were confirmed using functional tests and histopathologic analysis. Metabolite target analysis identified nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 4 (NOX4) as a key target of DBT in regulating pulmonary fibrosis. Gene ontology (GO) analysis estimated that oxidative stress, inflammatory response, myofibroblast differentiation, and extracellular matrix (ECM) deposition were the major target pathways of DBT. KEGG analysis found that DBT might modulate pulmonary fibrosis through the transforming growth factor-β (TGF-β) pathway. GO chord and signaling pathway maps revealed that NOX4 contributes to oxidative stress, inflammatory response, and TGF-β pathway regulation. The in vivo analyses confirmed that DBT significantly reduces NOX4 protein expression, inhibits oxidative stress and inflammatory responses, and reduces TGF-β1, p-SMAD3, fibronectin 1 (FN1), and smooth muscle actin (α-SMA) protein expression.

Discussion

These findings demonstrate the lung-protecting function of DBT in a rat model and identify critical target proteins associated with the underlying mechanism.

Artificial intelligence and its application in clinical microbiology

INTRODUCTION

Traditional microbiological diagnostics face challenges in pathogen identification speed and antimicrobial resistance (AMR) evaluation. Artificial intelligence (AI) offers transformative solutions, necessitating a comprehensive review of its applications, advancements, and integration challenges in clinical microbiology.

AREAS COVERED

This review examines AI-driven methodologies, including machine learning (ML), deep learning (DL), and convolutional neural networks (CNNs), for enhancing pathogen detection, AMR prediction, and diagnostic imaging. Applications in virology (e.g. COVID-19 RT-PCR optimization), parasitology (e.g. malaria detection), and bacteriology (e.g. automated colony counting) are analyzed. A literature search was conducted using PubMed, Scopus, and Web of Science (2018-2024), prioritizing peer-reviewed studies on AI's diagnostic accuracy, workflow efficiency, and clinical validation.

EXPERT OPINION

AI significantly improves diagnostic precision and operational efficiency but requires robust validation to address data heterogeneity, model interpretability, and ethical concerns. Future success hinges on interdisciplinary collaboration to develop standardized, equitable AI tools tailored for global healthcare settings. Advancing explainable AI and federated learning frameworks will be critical for bridging current implementation gaps and maximizing AI's potential in combating infectious diseases.

Association between vaccination, viral antibodies, and asthma prevalence in the U.S.: insights from NHANES (1999-2020)

Objective

This investigation aimed to explore the differences in asthma prevalence among various demographic groups in the U.S., focusing on factors related to vaccination and viral antibodies.

Methods

The study analyzed data from 37,445 individuals collected through the National Health and Nutrition Examination Survey between 1998 and 2020. Employing weighted sampling methods, the analysis considered the stratification and clustering typical of the survey's design. It particularly examined how age, race, income, smoke, education, and gender factors influence both the prevalence and severity of asthma.

Results

This study aims to elucidate disparities in asthma prevalence across the U.S. population by examining the roles of demographic characteristics and factors related to vaccination and viral antibodies. It revealed a significant correlation between asthma prevalence and patient demographics, including age, gender, income, smoke, education, and race. We found that asthma patients were mostly found in participants with lower economic level (2.7 vs. 2.87). Non-Hispanic black women age exhibited a higher likelihood of asthma, at 17.7%, compared to non-Hispanic whites and Mexican Americans. Asthma prevalence peaks between the ages of 20 and 30 and has shown a rising trend over the years. Regarding vaccinations, hepatitis A, hepatitis B, pneumococcal, and HPV vaccines were associated with an increased risk of asthma. Conversely, patients testing positive for hepatitis A virus and core hepatitis B virus antibodies demonstrated a lower prevalence of asthma. Additionally, asthmatic patients showed lower average measles virus and rubella antibodies levels, at 0.53 and 3.32, respectively, compared to non-asthmatic individuals. Notably, asthma incidence was lower in herpesvirus I-positive patients (OR: 0.895, CI, 0.809%-0.991%), while herpesvirus II-positive patients displayed a higher incidence of asthma (OR: 1.102, CI, 0.974%-1.246%).

Conclusion

The study findings underscore the significant prevalence of asthma and its correlation with population demographics, vaccination rates, and serum viral antibodies. These results highlight the importance of implementing tailored public health interventions.

Stakeholder perspective and sentiment in a rapidly growing United States adult vaccination environment

The United States adult vaccine landscape is rapidly expanding, raising critical questions about prioritizing vaccines. Through comprehensive market research involving healthcare providers, pharmacies, integrated delivery networks, policy influencers, and pharmaceutical leaders, this study identifies key barriers to vaccine uptake. Findings reveal significant trends including pharmacy-led vaccination, patient adherence challenges, misinformation influence, and operational constraints. Results underscore the need for coordinated efforts to improve vaccine accessibility, streamline processes, enhance public trust, and develop clearer guidelines. Insights provide actionable strategies for stakeholders to collaborate and ensure optimal uptake in an increasingly complex market.

CutIn: a ready-to-use construct for rapid generation of urgently needed transgenic cell lines in emerging infection research

Site-directed exogenous gene knock-in for stable cell line generation remains a multi-step procedure that heavily relies on expertise. Therefore, there is a need for a competent and easily manageable method, particularly when there is an urgent demand for cell lines, especially for emerging infection research. We present here a universal construct called CutIn that expresses the Cas9 protein and dual sgRNAs targeting a host cell genome locus and the ampicillin resistance (AmpR) gene of a cotransfected donor plasmid commercially available. This construct specifically induces double-strand breaks (DSBs) in cotransfected plasmids and host cell genomes, thereby facilitating whole plasmid integration through nonhomologous end joining (NHEJ) repair mechanisms. As pilot tests, adeno-associated virus integration site 1 (AAVS1) or hypoxanthine phosphoribosyl transferase (HPRT) locus was selected as host genome target, commonly used human cell lines 293T, HeLa and HCT116 were employed. CutIn was subjected for reporter plasmid knock-in in all three cell lines, either AAVS1 and AmpR or HPRT and AmpR loci were efficiently targeted. Fluorescent protein, human angiotensin-converting enzyme 2 (ACE2) and dengue virus (DENV) infection reporter transgenic cells were rapidly obtained via CutIn-mediated whole expression vector integration. This method is designed to be user-friendly and shows potential for supporting the investigation of emerging/re-emerging infectious diseases. Further validation in diverse research contexts will be necessary to fully assess its applicability and effectiveness.

The Science of Tai Chi and Qigong and Whole Person Health Part I: Rationale and State of the Science

The emerging paradigm of whole person health shares many core principles with traditional complementary and integrative health frameworks, including Tai Chi and qigong (TCQ). In the Fall of 2023, the Harvard Medical School Osher Center for Integrative Health hosted the inaugural international conference on The Science of Tai Chi for Whole Person Health: Advancing the Integration of Mind-Body Practices into Contemporary Health Care held at Harvard Medical School. A two-part white paper was written to summarize key conference topics, findings, and issues. Part I presented here summarizes the rationale for the conference and synthesizes the state of evidence for TCQ as rehabilitative and preventive tools for a range of clinical conditions, including falls and balance, cognition, mental health, sleep, cardiorespiratory health, musculoskeletal health, cancer, as well as translational evidence related to the neurophysiology, brain and immune function, and biomarkers of inflammation. The state of science of TCQ, viewed through the lens of traditional East Asian health constructs, is also discussed. Part II of this white paper outlines evidence gaps and opportunities and discusses strategies to address challenges in TCQ research, dissemination, and implementation.

How cryptic animal vectors of fungi can influence forest health in a changing climate and how to anticipate them

Fungal spores are usually dispersed by wind, water, and animal vectors. Climate change is accelerating the spread of pathogens to new regions. While well-studied vectors like bark beetles and moths contribute to pathogen transmission, other, less-recognized animal species play a crucial role at different scales. Small-scale dispersers, such as mites, rodents, squirrels, and woodpeckers, facilitate fungal spread within trees or entire forest regions. On a larger scale, birds contribute significantly to long-distance fungal dispersal, potentially aiding the establishment of invasive species across continents. These vectors remain underexplored and are often overlooked in fungal disease studies and are therefore called cryptic vectors. Understanding the full range of dispersal mechanisms is critical as climate change drive shifts in species distributions and increases vector activity. Expanding monitoring and detection tools to include these hidden carriers will improve our ability to track the distribution of fungal pathogens. Integrating targeted research, innovative technologies, and collaborative efforts across disciplines and borders is essential for enhancing disease management and mitigating fungal disease's ecological and economic impacts. KEY POINTS: • Cryptic animal vectors play a critical role in fungal spore dispersal across forests and continents. • Climate change accelerates fungal pathogen spread by altering species distributions, increasing vector activity, and facilitating long-distance dispersal. • Innovative monitoring tools, like eDNA sampling and predictive modelling, are essential to uncover cryptic vector contributions and mitigate fungal disease impacts.

Exploiting Wolbachia as a Tool for Mosquito-Borne Disease Control: Pursuing Efficacy, Safety, and Sustainability

Despite the application of control measures, mosquito-borne diseases continue to pose a serious threat to human health. In this context, exploiting Wolbachia, a common symbiotic bacterium in insects, may offer effective solutions to suppress vectors or reduce their competence in transmitting several arboviruses. Many Wolbachia strains can induce conditional egg sterility, known as cytoplasmic incompatibility (CI), when infected males mate with females that do not harbor the same Wolbachia infection. Infected males can be mass-reared and then released to compete with wild males, reducing the likelihood of wild females encountering a fertile mate. Furthermore, certain Wolbachia strains can reduce the competence of mosquitoes to transmit several RNA viruses. Through CI, Wolbachia-infected individuals can spread within the population, leading to an increased frequency of mosquitoes with a reduced ability to transmit pathogens. Using artificial methods, Wolbachia can be horizontally transferred between species, allowing the establishment of various laboratory lines of mosquito vector species that, without any additional treatment, can produce sterilizing males or females with reduced vector competence, which can be used subsequently to replace wild populations. This manuscript reviews the current knowledge in this field, describing the different approaches and evaluating their efficacy, safety, and sustainability. Successes, challenges, and future perspectives are discussed in the context of the current spread of several arboviral diseases, the rise of insecticide resistance in mosquito populations, and the impact of climate change. In this context, we explore the necessity of coordinating efforts among all stakeholders to maximize disease control. We discuss how the involvement of diverse expertise-ranging from new biotechnologies to mechanistic modeling of eco-epidemiological interactions between hosts, vectors, Wolbachia, and pathogens-becomes increasingly crucial. This coordination is especially important in light of the added complexity introduced by Wolbachia and the ongoing challenges posed by global change.

The Global Health Security Index and Its Role in Shaping National COVID‑19 Response Capacities: A Scoping Review

Introduction: Following the introduction of the Global Health Security Index (GHSI), the coronavirus disease 2019 (COVID‑19) pandemic emerged as an unprecedented global health crisis, underscoring the need for robust health security frameworks and preparedness measures. This study conducts a scoping review to analyze the existing literature on the GHSI and assess national COVID‑19 responses across different countries. Method: A comprehensive search of electronic databases (EBSCO, EMBASE, PubMed, Scopus, and Web of Science) was conducted for articles published from 2020 to 2024. Search terms included "Global Health Security Index" and terms related to COVID‑19. The study followed the Preferred Reporting Items for Systematic Reviews and Meta‑analyses for Scoping Reviews (PRISMA‑ScR) guidelines. The Newcastle-Ottawa Scale (NOS), adjusted for cross‑sectional studies, was used for quality assessment. Results: A total of 3,243 studies were identified, of which 20 were finalized for data synthesis. Specific COVID‑19 parameters were analyzed to provide a comprehensive overview of each country's pandemic response capacity. Among the selected studies, 17 (85%) had a low risk of bias, while 3 (15%) had a medium risk. Countries' response capacities were categorized into five key parameters: detection, mortality, transmission, fatality, and recovery. Findings revealed significant discrepancies between GHSI scores and actual national responses, with some high‑scoring countries struggling to control the pandemic. This raises concerns about the GHSI's predictive reliability. Conclusion: The study highlights that the GHSI does not fully capture a country's capacity to respond effectively to COVID‑19. However, it remains a valuable tool for identifying gaps in pandemic preparedness. To enhance its relevance, the index should integrate a wider range of factors, including political leadership, governance, public health infrastructure, and socio‑cultural elements, which are crucial in managing public health emergencies.

Homologous relationship between FabG involved in fatty acid biosynthesis and SDR on chromosome II in the multi-chromosome pathogen Vibrio anguillarum

Vibrio anguillarum threatens fish and larval farming industries and human health worldwide. The identification of bacterial adaptation and responses to stress due to environmental changes is vital for establishing a response strategy for pathogenic Vibrio. Previously, short-chain dehydrogenase/reductase (SDR) was identified on chromosome II of the multichromosomal V. anguillarum. In this study, a comparison of SDR and the enzyme FabG-1b (encoded on chromosome I and responsible for the β-ketoacyl acyl carrier protein (ACP) reductase in fatty acid biosynthesis (FAS II)) showed that the amino acid sequence homology was only 33.2%; however, the core of functionality, which includes the NAD(P)-binding domain and the conserved region of the active site, the topologies predicted using sequence-based homology modeling, and the quaternary homotetramer-type structures showed a significant similarity. FabG-1b was specific to the substrates fluorinated and halogenated aliphatic ketones, aromatic ketones, and aromatic β-ketoesters and SDR toward non-fluorinated and non-halogenated aliphatic ketones, aromatic ketones, and non-aromatic β-ketoesters. This complementary catalytic efficiencies of the two enzymes on various substrates conclusively supports the hypothesis that the two enzymes are likely homologs. This is the first study to report potential paralogous enzymes FabG-1b and SDR in Vibrio. This information improves our understanding of bacterial FAS for establishing strategies to overcome infectious diseases caused by pathogenic strains and identify targets for developing new antibacterial agents.

Protective Effect of Daily Physical Activity Against COVID-19 in a Young Adult Population on Reunion Island

The global fight against pandemics is a major public health issue. Epidemiological studies showed a reduced risk of the coronavirus disease 2019 (COVID-19) severity with the practice of regular physical activity (PA) in clinical populations. Here, we investigated the effect of PA against COVID-19 in a young general population. Methods: Two hundred ninety volunteers over 18 years old from Reunion Island responded to an online survey concerning sociodemographic, lifestyle and clinical information. Daily PA was studied using the International Physical Activity Questionnaire short version (IPAQ) and classified by overall score and intensities of PA. Results: Among 290 responders [179 women, median age = 27.5 years (interquartile range = 21.3 years)], 141 (48.6%) reported COVID-19 infection. Multivariate logistic analysis adjusted for age, sex, body mass index, chronic disease and alcohol consumption showed that the number of days per week of regular intense PA was independently associated with a low risk of COVID-19 infection [odds ratio (OR) 0.86; 95% confidence interval (CI) 0.24 to 0.99; p = 0.030], while regular moderate PA was not [OR 1.10; 95%CI 0.97 to 1.23; p = 0.137]. Conclusions: In a population of young adults, regular intense PA could offer a protective effect against COVID-19. Additional research is required to confirm this association in various viral infections and elucidate the fundamental mechanisms involved.

Would global warming bring an increase of invertebrate-associated cutaneous invasive fungal infections?

Invasive mold-associated cutaneous disease is a rare but potentially catastrophic consequence of trauma. However, invertebrate bites are not well recognized as a mechanism for the inoculation of fungi into subcutaneous tissue that can also result in severe infections. Invertebrates often carry fungi with human pathogenic potential as part of their microbiome, and bites break the skin, providing a conduit for them to penetrate subcutaneous tissues where the establishment of infection can produce serious skin and soft tissue fungal diseases. In this essay, we review the existing data for invertebrate bite-associated cutaneous invasive fungal infections (IBA-cIFIs) and consider the potential consequences of global warming on their epidemiology. Climate changes will be associated with changes in the range of invertebrates and adaptation of their associated microbes to warmer temperatures. Fungal adaptation to higher temperatures can defeat the mammalian protective barrier and be associated with both more and different IBA-cIFIs.