Filoviruses, including Ebola, Marburg, and Sudan viruses, cause severe hemorrhagic fevers with high mortality rates and outbreaks. While recent vaccine developments such as the rVSV-ZEBOV vaccine for Ebola have marked important progress and is now licensed by the FDA and the EMA, they remain virus-specific and limited in scope. The urgent need for a broad, cross-protective pan-filovirus vaccine is clear, especially considering recurring outbreaks and the potential for global spread. This paper reviews the current landscape of filovirus vaccine research, highlighting promising platforms, challenges in achieving cross-species protection, and lessons learned from past public health responses. It also emphasizes the scientific and logistical hurdles, such as antigenic diversity and the sporadic nature of outbreaks, which complicate vaccine development. Recommendations include sustained investment, collaborative research, and flexible trial designs. Ultimately, a pan-filovirus vaccine would be a vital tool in global health preparedness and reaching that goal will require long-term vision and commitment from the international community.
BACKGROUND: Malaria, mainly caused by Plasmodium falciparum, remains a major health concern in Cameroon due to the emergence of drug-resistant parasite strains. The Plasmodium falciparum multidrug resistance 1 (Pfmdr1) gene, particularly the N86Y mutation, is a key marker associated with reduced susceptibility to several antimalarial drugs. This study investigated the prevalence of the Pfmdr1-N86Y mutation in isolates from patients attending three health facilities in the Mbouda Health District to support improved malaria control strategies in the area. METHODS: The study was conducted among patients attending three healthcare facilities in Mbouda. Three hundred and two (302) patients were recruited across these three centers and diagnosed by both rapid diagnostic test (RDT) and thick blood smear (TBS). positive samples were spotted on whatman paper. Plasmodial DNA was extracted using the chelex- 100 method. The Pfmdr1 gene was then amplified by nested PCR, visualized on a 1.3% agarose gel, and analyzed by restriction fragment length polymorphism (RFLP) using the AflIII restriction enzyme. Statistical analysis was performed with a significance threshold of 5% (p < 0.05) using SPSS software version 26, particularly employing Chi-square tests. RESULTS: The prevalence of Plasmodium falciparum infection was 28.8%, with the highest burden among males, children aged 0–5 years, and adults over 35 years. Insecticide use was identified as a significant protective factor, and parasite density was higher among males and young children. The Pfmdr1 gene was detected in 95% of isolates. Analysis of the Pfmdr1-N86Y mutation revealed that 94% of alleles were wild-type (N86), 1% were mixed (N86/Y86), and no mutant alleles (Y86) were observed and 5% tested negative for this gene, which may be due to poor DNA quality, often denatured, or poor extraction, or other reasons. CONCLUSION: This study indicates that, the Pfmdr1 gene exhibited a frequency 95%. These results therefore highlight the importance of other types of Pfmdr1 mutations and would be necessary for the evaluation of Pfmdr1 mutations associated with parasite resistance to antimalarial drugs. Measures should be taken to delay the evolution of these mutations by changing treatment policy in the affected area if these mutations are nevertheless very high.
BACKGROUND: Malaria classically presents with fever, however, atypical afebrile presentations can lead to significant diagnostic delays, particularly in non-endemic regions. We report an unusual case of afebrile Plasmodium falciparum malaria presenting primarily as severe hemolytic anemia in a returning traveler. CASE PRESENTATION: A 45-year-old Chinese man presented with a 12-day history of persistent dizziness, fatigue, and poor appetite. Upon transfer to our hospital, he developed acute confusion and quadriparesis. Laboratory tests revealed severe hemolytic anemia (hemoglobin 48 g/L), thrombocytopenia, and intravascular hemolysis. The patient remained afebrile throughout his illness. Neuroimaging ruled out acute intracranial pathology. Diagnosis was confirmed by peripheral blood smear showing P. falciparum (0.9% parasitemia, approximately 1746 parasites/µL), supported by HRP-2 antigen testing and PCR. Treatment with intramuscular artesunate followed by oral dihydroartemisinin-piperaquine led to full recovery and parasite clearance. CONCLUSION: This report demonstrates that malaria can present as severe hemolytic anemia without fever. In elimination settings, heightened clinical suspicion and routine peripheral blood smear examination are essential for timely diagnosis in at-risk returned travelers. This case reinforces the need to maintain diagnostic vigilance for afebrile malaria, even in non-endemic regions.
Neglected Tropical Diseases (NTDs) are a significant global health issue, affecting over a billion people and hindering progress in economically disadvantaged areas, particularly in Sub-Saharan Africa. This study explores the complex relationship between socioeconomic factors and health inequalities in the region, highlighting the diverse impacts of NTDs and offering forward-looking recommendations. Despite global efforts to combat these diseases, significant gaps remain in achieving eradication in endemic areas. Key strategies for progress include expanding educational initiatives, engaging broader global health communities, and addressing the stigma faced by NTD victims. Therefore, recognizing the multifaceted impact of NTDs, it is essential to integrate intersectionality into health policies and action plans to tackle the challenges these diseases pose in Sub-Saharan Africa and globally.
BACKGROUND: The choice of a specific anatomic site for vaccine administration may influence rates of acceptance but has not been studied before. METHODS: We conducted a randomized controlled trial in a pretravel clinic, comparing reported levels of satisfaction and pain on a scale of 0 to 10, and the frequency of adverse events (AEs) for vaccination in different anatomic sites. Travelers receiving one vaccine were randomized to be immunized in the deltoid or the vastus lateralis muscle. Travelers receiving multiple vaccines were randomized to be immunized in both the vastus lateralis and deltoid muscles or preferably in either the deltoid or the vastus lateralis muscles. RESULTS: For the 159 participants receiving multiple vaccines day 0 and day 7 satisfaction levels for the vastus lateralis, combined strategy or the deltoid injection sites were 9.00 ± 1.63, 9.46 ± 1.16 and 9.82 ± 0.52 (p = 0.001), and 6.62 ± 3.16, 8.87 ± 1.91 and 8.87 ± 2.05 (p < 0.001), respectively. For the 33 participants who received a single vaccine, day 0 and day 7 satisfaction levels for the vastus lateralis and deltoid muscles were 8.9 ± 2.2 and 10 ± 0.0 (p = 0.048) and 7.8 ± 2.7 and 9.8 ± 0.5 (p = 0.04), respectively. Pain levels on day 0 were similar across all study groups. However, muscle pain on day 7 was reported more frequently among participants vaccinated in the thigh region (61.7%) compared to those vaccinated in the deltoid muscle (31.9%) or at both sites (43.8%) (p < 0.01). Additionally, localized adverse events were reported more often by females (74.2%) than by males (48.8%) (p = 0.002). CONCLUSIONS: We found lower levels of satisfaction in travelers vaccinated in the thigh region. Such data may aid in increasing vaccination coverage and may influence practice guidelines. TRIAL REGISTRATION: The trial was registered in accordance with local regulatory requirements under study identification number RMB518-18.
BACKGROUND: Food tourism is one of the major attractions in Thailand. Food safety plays an important role in ensuring the confidence and health of both travelers and locals. The regulations, real-world surveillance data, and foodborne outbreak reports in Thailand have not been previously compiled and summarized. This study aimed to describe food safety rules and regulations in Thailand and present real-world data encompassing five years, 2019–2024. METHODS: Data are obtained on food safety surveillance conducted by the Food Sanitation Division under the Bangkok Metropolitan Administration (BMA) for 2019–2023, and outbreak reports in Bangkok from the Institute for Urban Disease Control (IUDC) for 2019–2024. Descriptive analyses are performed and compared to available studies on travelers’ diarrhea in visitors to Thailand. RESULTS: During 2019–2023, 98% of food samples in Bangkok passed biological testing. Among contaminated samples, the most common pathogen found was E. coli (12.40% – 15.79%). When analyzing samples from street food vendors alone, 10/44 samples and 6/31 samples were found to be contaminated in 2022 and 2023, respectively. E. coli was identified in 9/10 contaminated samples in 2022 and 4/6 in 2023. Foods most likely to be contaminated were Thai desserts and raw seafood. During the same period, 22 diarrhea outbreaks were reported by the IUDC. CONCLUSIONS: As a popular destination for culinary tourism, travelers’ diarrhea remains one of the most common conditions discussed during pre-travel consultations for Thailand. This review demonstrates Thailand’s governmental efforts in enforcing food safety regulations and surveillance. The findings help inform travel medicine practitioners worldwide about travelers’ diarrhea in Thailand.
BACKGROUND: Faecal contamination of drinking water is a significant environmental determinant of human health. OBJECTIVE: To assess fecal contamination of drinking water from the source to the point of use and associated factors among households in Debre Tabor Town, Northwest Ethiopia, in 2022. METHODS: A community-based cross-sectional study was conducted in Debre Tabor Town. A total of 355 water samples were collected and analysed using the membrane filtration method to identify E. coli contamination. These included 27 samples from water sources, 5 from reservoirs, and 323 from household storage containers. A structured and pretested questionnaire was used to identify factors associated with the potential contamination of drinking water in household storage containers. The instrument was piloted on 10% of the planned sample in Woreta, a neighboring town excluded from the main study, about two weeks before data collection to assess clarity, question flow, and respondent understanding. Binary logistic regression analysis was performed to determine the factors associated with the presence or absence of E. coli in household storage containers, with a 95% confidence interval (CI) and a significance level of p ≤ 0.05. The overall goodness of fit for the model was assessed using the Hosmer-Lemeshow test. RESULT: Among the water samples analysed, 15 (55.6%) of sources, 1 (20%) of reservoirs, and 187 (57.9%) of households tested positive for E. coli bacteria. Educational status [AOR = 3.53; 95% CI: [1.76, 7.08]], the type of sanitation [AOR = 2.50; 95% CI: [1.41, 4.44]], household water treatment [AOR = 3.80; 95% CI: [1.78, 8.12]], and the sanitary risk score of households’ drinking water storage conditions [AOR = 3.33; 95% CI: [1.33, 8.32]] were significantly associated with the faecal contamination of drinking water at the point of use. CONCLUSION: The prevalence of fecal contamination of drinking water was high from source to point of use in the study area. Therefore, capacity building through education should be provided for the community on source protection, utilisation of improved sanitation facilities, and water treatment.
BACKGROUND: A substantial number of travelers have pre-existing food allergies, which can put them at risk of exposure to allergens during transportation, e.g. on aircraft, and at travel destinations. This review aims to identify the characteristics of food-related allergic reactions among travelers. METHODS: A literature search was conducted on PubMed, Embase and Scopus using keywords related to food allergies and travelers. Eligible studies were grouped into cohort/cross-sectional studies and case series/case reports. Data were extracted on prevalence (for cohort/cross-sectional studies), common allergens, locations where reactions occurred, and impact on travelers. RESULTS: Twenty-four articles were included. The prevalence of in-flight food-related allergic reactions ranged from 1.7-3.0%, while reactions during travel ranged from 6.9-10.0%. Peanuts and tree nuts were the most frequent allergens, accounting for up to 75.0% of reported cases. Other common allergens included cow’s milk, eggs, fish, shellfish, wheat, and soybean. During international travel, most reactions occurred in non-English speaking countries and in Europe. Case reports highlighted exposure to exotic foods such as tropical fruits and insects. Consequences ranged from mild reactions to severe anaphylaxis, hospitalization, and flight diversion. Some travelers reported avoiding future travel after reactions. Two fatalities were described in case reports. CONCLUSION: Food-related allergic reactions in travelers are likely underestimated, with only severe cases typically reported. There is sparse information regarding the common food allergens, the profiles of allergic travelers and risk factors for allergic reactions. These findings underscore the need for improved counseling and prevention strategies among travelers, travel medicine practitioners, and travel agencies.
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