Pub Date : 2025-12-01DOI: 10.1016/j.lanmic.2025.101189
Joanna Furnival-Adams PhD , Amelia Houana MD , Francisco Saute PhD , Eldo Elobolobo MSc , Matthew Rudd PhD , Patricia Nicolas MSc , Julia Montaña MSc , Samuel Martinho MPH , Hansel Mundaca MSc , Jenisse Mbanze MSc , Arlindo Soares BSc , Saimado Imputiua BSc , Paula Ruiz-Castillo PhD , Marta Ribes PhD , Almudena Sanz MSc , Mussa Mamudo Salé PhD , Antonio Macucha MD , Aina Casellas MSc , Valeria Lopez MD , Vegovito Vegove BSc , Carlos Chaccour PhD
<div><h3>Background</h3><div>Ivermectin is an endectocide effective against scabies that is under evaluation as a malaria vector control tool. During the BOHEMIA malaria trial, we did a substudy with the aim of assessing the efficacy of ivermectin mass drug administration (MDA) against scabies.</div></div><div><h3>Methods</h3><div>The BOHEMIA trial was an open-label, assessor-masked, cluster-randomised trial done in a malaria and scabies co-endemic community in Mozambique. Clusters were randomised (1:1:1) to receive a single dose of either ivermectin 400 μg/kg to all eligible humans, 400 μg/kg to humans and 200 μg/kg to eligible livestock, or 400 mg albendazole in humans only (control) for 3 consecutive months. In this scabies substudy, 39 clusters were randomly selected from the main trial. The primary endpoint was scabies prevalence at 3 months. Secondary endpoints were scabies prevalence in directly exposed participants (those who took the study drug) at 1, 2, and 3 months, and indirectly exposed children younger than 5 years (who were living in clusters but did not take the study drug) at 3 and 6 months. An intention-to-treat analysis was done by use of a logistic regression model with a generalised estimating equation approach. This study is registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04966702</span><svg><path></path></svg></span>, and on the Pan African Clinical Trial Registry, PACTR202106695877303, and is complete.</div></div><div><h3>Findings</h3><div>Recruitment started on March 15, 2022 and was completed on July 6, 2022. Of 40 524 participants from 100 clusters accessed in the BOHEMIA trial, 1951 participants were enrolled from 39 clusters (13 per group) in the scabies substudy. Scabies prevalence in the ivermectin group was lower after 3 months (2·11%, 95% CI 1·21–3·41) than at baseline (8·10%, 6·36–9·85), whereas it did not change in the albendazole group (13·71%, 10·81–17·05, at 3 months <em>vs</em> 12·30%, 9·43–15·17, at baseline). The odds of having scabies was lower in pooled ivermectin clusters than in albendazole clusters after 3 months (adjusted odds ratio [aOR] 0·18, 95% CI 0·07–0·45, p=0·0002). This effect was observed both in directly exposed participants who took ivermectin after 1 month (aOR 0·27, 95% CI 0·11–0·66, p=0·0023), 2 months (0·18, 0·07–0·47, p=0·0006), and 3 months (0·16, 0·06–0·45, p=0·0004), and in indirectly exposed children after 3 months (0·17, 0·05–0·58, p=0·0048) and 6 months (0·21, 0·06–0·72, p=0·013). There were two severe adverse events; both were deaths in the ivermectin group that were not considered related to the study drug. No safety signal was detected.</div></div><div><h3>Interpretation</h3><div>Ivermectin MDA designed for malaria might have significant benefits against scabies. In addition to directly exposed participants, our results also suggested an effect in indirectly exposed participants, which might reflect a community benefit.</di
{"title":"Direct and indirect protection against scabies through ivermectin mass drug administration designed for malaria in Mozambique: a substudy nested within a cluster-randomised, controlled trial","authors":"Joanna Furnival-Adams PhD , Amelia Houana MD , Francisco Saute PhD , Eldo Elobolobo MSc , Matthew Rudd PhD , Patricia Nicolas MSc , Julia Montaña MSc , Samuel Martinho MPH , Hansel Mundaca MSc , Jenisse Mbanze MSc , Arlindo Soares BSc , Saimado Imputiua BSc , Paula Ruiz-Castillo PhD , Marta Ribes PhD , Almudena Sanz MSc , Mussa Mamudo Salé PhD , Antonio Macucha MD , Aina Casellas MSc , Valeria Lopez MD , Vegovito Vegove BSc , Carlos Chaccour PhD","doi":"10.1016/j.lanmic.2025.101189","DOIUrl":"10.1016/j.lanmic.2025.101189","url":null,"abstract":"<div><h3>Background</h3><div>Ivermectin is an endectocide effective against scabies that is under evaluation as a malaria vector control tool. During the BOHEMIA malaria trial, we did a substudy with the aim of assessing the efficacy of ivermectin mass drug administration (MDA) against scabies.</div></div><div><h3>Methods</h3><div>The BOHEMIA trial was an open-label, assessor-masked, cluster-randomised trial done in a malaria and scabies co-endemic community in Mozambique. Clusters were randomised (1:1:1) to receive a single dose of either ivermectin 400 μg/kg to all eligible humans, 400 μg/kg to humans and 200 μg/kg to eligible livestock, or 400 mg albendazole in humans only (control) for 3 consecutive months. In this scabies substudy, 39 clusters were randomly selected from the main trial. The primary endpoint was scabies prevalence at 3 months. Secondary endpoints were scabies prevalence in directly exposed participants (those who took the study drug) at 1, 2, and 3 months, and indirectly exposed children younger than 5 years (who were living in clusters but did not take the study drug) at 3 and 6 months. An intention-to-treat analysis was done by use of a logistic regression model with a generalised estimating equation approach. This study is registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04966702</span><svg><path></path></svg></span>, and on the Pan African Clinical Trial Registry, PACTR202106695877303, and is complete.</div></div><div><h3>Findings</h3><div>Recruitment started on March 15, 2022 and was completed on July 6, 2022. Of 40 524 participants from 100 clusters accessed in the BOHEMIA trial, 1951 participants were enrolled from 39 clusters (13 per group) in the scabies substudy. Scabies prevalence in the ivermectin group was lower after 3 months (2·11%, 95% CI 1·21–3·41) than at baseline (8·10%, 6·36–9·85), whereas it did not change in the albendazole group (13·71%, 10·81–17·05, at 3 months <em>vs</em> 12·30%, 9·43–15·17, at baseline). The odds of having scabies was lower in pooled ivermectin clusters than in albendazole clusters after 3 months (adjusted odds ratio [aOR] 0·18, 95% CI 0·07–0·45, p=0·0002). This effect was observed both in directly exposed participants who took ivermectin after 1 month (aOR 0·27, 95% CI 0·11–0·66, p=0·0023), 2 months (0·18, 0·07–0·47, p=0·0006), and 3 months (0·16, 0·06–0·45, p=0·0004), and in indirectly exposed children after 3 months (0·17, 0·05–0·58, p=0·0048) and 6 months (0·21, 0·06–0·72, p=0·013). There were two severe adverse events; both were deaths in the ivermectin group that were not considered related to the study drug. No safety signal was detected.</div></div><div><h3>Interpretation</h3><div>Ivermectin MDA designed for malaria might have significant benefits against scabies. In addition to directly exposed participants, our results also suggested an effect in indirectly exposed participants, which might reflect a community benefit.</di","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"6 12","pages":"Article 101189"},"PeriodicalIF":20.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanmic.2025.101202
Jiaqi Wang , Zengguo Cao , Xuemin Jin
{"title":"Beyond bacteria: a multikingdom ecological perspective on neonatal gut and severe viral lower respiratory tract infection risk","authors":"Jiaqi Wang , Zengguo Cao , Xuemin Jin","doi":"10.1016/j.lanmic.2025.101202","DOIUrl":"10.1016/j.lanmic.2025.101202","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"6 12","pages":"Article 101202"},"PeriodicalIF":20.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>There is growing evidence that the benefits of systematic screening for <em>Neisseria gonorrhoeae</em> and <em>Chlamydia trachomatis</em> among men who have sex with men (MSM) using HIV pre-exposure prophylaxis (PrEP) are scarce and that screening leads to high antimicrobial consumption. The PrEP clinic of the Institute of Tropical Medicine (ITM) in Antwerp, Belgium, discontinued systematic screening for these infections in MSM taking PrEP in 2023. In this study, we estimated the effect of reducing the frequency of screening on the incidence of these infections and antimicrobial use among MSM using PrEP.</div></div><div><h3>Methods</h3><div>We did a retrospective cohort analysis of medical records, laboratory results, and antimicrobial prescriptions (ceftriaxone, doxycycline, and azithromycin) of MSM attending the PrEP clinic of the ITM in Antwerp, Belgium, between Jan 1, 2019, and Dec 31, 2024. We estimated yearly testing rates for <em>N gonorrhoeae</em> and <em>C trachomatis</em>, incidence rates of overall and symptomatic infections, and antimicrobial prescription rates. Results were analysed using Poisson regression, with the number of events as the outcome, years as a continuous predictor and the log(person-time) as offset. Additionally, we did three sensitivity analyses: limiting our study population to individuals engaged in PrEP care in 2019; excluding participants of the Gonoscreen study; and using time as a categorical variable.</div></div><div><h3>Findings</h3><div>Between Jan 1, 2019, and Dec 31, 2024, 3955 MSM attended the clinic. Over the study period, 11 720 tests were done during 9853·85 person-years. The testing rate decreased significantly from 2267·78 tests per 1000 person-years (95% CI 2176·49–2361·92) in 2019 to 552·81 tests per 1000 person-years (521·53–585·47) in 2024 (yearly rate ratio 0·78, 95% CI 0·77–0·78; p<0·0001). The incidence of <em>N gonorrhoeae</em> decreased from 170·84 cases per 1000 person-years (95% CI 146·47–198·11) in 2019 to 85·81 cases per 1000 person-years (73·77–99·27) in 2024 (yearly incidence rate ratio [IRR] 0·91, 95% CI 0·88–0·94; p<0·0001). In the same period, the incidence of <em>C trachomatis</em> decreased from 198·17 cases per 1000 person-years (95% CI 171·85–227·39) in 2019 to 60·69 cases per 1000 person-years (50·63–72·16) in 2024 (yearly IRR 0·84, 95% CI 0·81–0·87; p<0·0001). There was no increase in the incidence of symptomatic <em>N gonorrhoeae</em> (IRR 0·98, 95% CI 0·92–1·03)<em>, C trachomatis</em> (0·95, 0·88–1·01), or lymphogranuloma venereum (0·95, 0·84–1·09). Ceftriaxone, doxycycline, and azithromycin prescriptions decreased (rate ratio 0·95, 95% CI 0·91–0·99; p=0·023, 0·47, 0·43–0·52; p<0·0001, and 0·90, 0·87–0·94; p<0·0001, respectively). Similar results were found in the first sensitivity analysis. In the sensitivity analysis excluding participants of the Gonoscreen study, rates of ceftriaxone and doxycycline prescriptions decreased bet
背景：越来越多的证据表明，在男男性行为者（MSM）中使用艾滋病毒暴露前预防（PrEP）进行淋病奈瑟菌和沙眼衣原体系统筛查的益处很少，而且筛查导致抗菌素的高消耗。比利时安特卫普热带医学研究所（ITM）的PrEP诊所于2023年停止对服用PrEP的男男性接触者进行这些感染的系统筛查。在这项研究中，我们估计了减少筛查频率对使用PrEP的男男性接触者感染发生率和抗菌药物使用的影响。方法：我们对2019年1月1日至2024年12月31日在比利时安特卫普ITM PrEP诊所就诊的男男性接触者的医疗记录、实验室结果和抗菌药物处方（头孢曲松、多西环素和阿奇霉素）进行了回顾性队列分析。我们估计了淋病奈瑟菌和沙眼奈瑟菌的年度检测率、总体感染和症状感染的发病率以及抗菌药物处方率。使用泊松回归分析结果，以事件数作为结果，年份作为连续预测因子，对数（人-时间）作为偏移量。此外，我们进行了三项敏感性分析：将我们的研究人群限制在2019年从事PrEP护理的个人；排除Gonoscreen研究的参与者；用时间作为分类变量。结果：在2019年1月1日至2024年12月31日期间，3955名男男性行为者参加了诊所。在研究期间，在9853·85人年期间进行了11720次试验。检测率从2019年的2267·78次/ 1000人年（95% CI 2176·49-2361·92）显著下降到2024年的552·81次/ 1000人年（521·53-585·47）（年率比0.78,95% CI 0.77 - 0.78）。解释：尽管筛查频率降低，抗菌药物处方减少，但症状性淋病奈恩菌和沙眼奈恩菌感染的发生率并未随时间增加。我们的研究结果提供了证据，支持在使用PrEP的男男性接触者中减少筛查频率作为抗菌药物管理干预的潜力。需要进一步的研究来证实我们的发现。资金:没有。
{"title":"Effect of decreasing the frequency of screening for Neisseria gonorrhoeae and Chlamydia trachomatis on the incidence of these infections and antimicrobial use among men who have sex with men using HIV PrEP in Belgium: a retrospective cohort study","authors":"Thibaut Vanbaelen PhD , Irith De Baetselier PhD , Achilleas Tsoumanis MSc , Bernadette Hensen PhD , Prof Chris Kenyon PhD","doi":"10.1016/j.lanmic.2025.101214","DOIUrl":"10.1016/j.lanmic.2025.101214","url":null,"abstract":"<div><h3>Background</h3><div>There is growing evidence that the benefits of systematic screening for <em>Neisseria gonorrhoeae</em> and <em>Chlamydia trachomatis</em> among men who have sex with men (MSM) using HIV pre-exposure prophylaxis (PrEP) are scarce and that screening leads to high antimicrobial consumption. The PrEP clinic of the Institute of Tropical Medicine (ITM) in Antwerp, Belgium, discontinued systematic screening for these infections in MSM taking PrEP in 2023. In this study, we estimated the effect of reducing the frequency of screening on the incidence of these infections and antimicrobial use among MSM using PrEP.</div></div><div><h3>Methods</h3><div>We did a retrospective cohort analysis of medical records, laboratory results, and antimicrobial prescriptions (ceftriaxone, doxycycline, and azithromycin) of MSM attending the PrEP clinic of the ITM in Antwerp, Belgium, between Jan 1, 2019, and Dec 31, 2024. We estimated yearly testing rates for <em>N gonorrhoeae</em> and <em>C trachomatis</em>, incidence rates of overall and symptomatic infections, and antimicrobial prescription rates. Results were analysed using Poisson regression, with the number of events as the outcome, years as a continuous predictor and the log(person-time) as offset. Additionally, we did three sensitivity analyses: limiting our study population to individuals engaged in PrEP care in 2019; excluding participants of the Gonoscreen study; and using time as a categorical variable.</div></div><div><h3>Findings</h3><div>Between Jan 1, 2019, and Dec 31, 2024, 3955 MSM attended the clinic. Over the study period, 11 720 tests were done during 9853·85 person-years. The testing rate decreased significantly from 2267·78 tests per 1000 person-years (95% CI 2176·49–2361·92) in 2019 to 552·81 tests per 1000 person-years (521·53–585·47) in 2024 (yearly rate ratio 0·78, 95% CI 0·77–0·78; p<0·0001). The incidence of <em>N gonorrhoeae</em> decreased from 170·84 cases per 1000 person-years (95% CI 146·47–198·11) in 2019 to 85·81 cases per 1000 person-years (73·77–99·27) in 2024 (yearly incidence rate ratio [IRR] 0·91, 95% CI 0·88–0·94; p<0·0001). In the same period, the incidence of <em>C trachomatis</em> decreased from 198·17 cases per 1000 person-years (95% CI 171·85–227·39) in 2019 to 60·69 cases per 1000 person-years (50·63–72·16) in 2024 (yearly IRR 0·84, 95% CI 0·81–0·87; p<0·0001). There was no increase in the incidence of symptomatic <em>N gonorrhoeae</em> (IRR 0·98, 95% CI 0·92–1·03)<em>, C trachomatis</em> (0·95, 0·88–1·01), or lymphogranuloma venereum (0·95, 0·84–1·09). Ceftriaxone, doxycycline, and azithromycin prescriptions decreased (rate ratio 0·95, 95% CI 0·91–0·99; p=0·023, 0·47, 0·43–0·52; p<0·0001, and 0·90, 0·87–0·94; p<0·0001, respectively). Similar results were found in the first sensitivity analysis. In the sensitivity analysis excluding participants of the Gonoscreen study, rates of ceftriaxone and doxycycline prescriptions decreased bet","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"6 12","pages":"Article 101214"},"PeriodicalIF":20.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanmic.2025.101218
Michael A Martin PhD , Steven James Reynolds MD , Brian T Foley PhD , Fred Nalugoda PhD , Prof Thomas C Quinn MD , Steven A Kemp PhD , Margaret Nakalanzi MS , Edward Nelson Kankaka MD , Godfrey Kigozi PhD , Robert Ssekubugu MSPH , Prof Ravindra K Gupta MD , Lucie Abeler-Dörner PhD , Joseph Kagaayi PhD , Oliver Ratmann PhD , Prof Christophe Fraser PhD , Ronald Moses Galiwango PhD , David Bonsall PhD , M Kate Grabowski PhD
<div><h3>Background</h3><div>With scale-up of antiretroviral therapy (ART) in sub-Saharan Africa, increasing pretreatment HIV drug resistance has been reported; however, the broader effect of ART expansion on population-level resistance patterns remains insufficiently quantified. We aimed to estimate the longitudinal prevalence of drug resistance and resistance-conferring mutations.</div></div><div><h3>Methods</h3><div>This study used data collected as part of the Rakai Community Cohort Study (RCCS), an open population-based census and cohort study conducted in southern Uganda. At each survey round, residents aged 15–49 years are invited to participate and receive a structured questionnaire that obtains sociodemographic, behavioural, and health information, including self-reported past and current ART use. Voluntary HIV testing is conducted using a rapid test algorithm and a venous blood sample. People with HIV provide samples for viral load quantification and deep sequencing. We analysed RCCS survey, HIV viral load, and deep sequencing (which was used to predict resistance) data from five survey rounds. The key outcomes were the population prevalence of viraemic people with HIV with non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor (NRTI), protease inhibitor, or multiclass resistance among all participants (regardless of HIV serostatus) in the 2015 and 2017 surveys. Prevalence of class-specific resistance and resistance-conferring substitutions were estimated using robust log-Poisson regression.</div></div><div><h3>Findings</h3><div>Between Aug 10, 2011, and Nov 4, 2020, there were 43 361 participants in the RCCS and 7923 (18·27%) people with HIV. Over five survey rounds, 93 622 participant visits occurred, among which 17 460 (18·65%) were from people with HIV. Over the analysis period, the median age of study participants remained similar (28 years [22–35] in 2012 and 29 years [21–38] in 2019). Sufficient data were available to reliably genotype 4072 (90·03%) of 4523 participant visits from 3407 people with HIV for at least one drug. Overall population prevalence of resistance contributed by viraemic pretreatment people with HIV decreased between 2012 and 2017 from 0·56% (95% CI 0·42–0·75) to 0·25% (0·18–0·33) for NNRTI and from 0·24% (0·15–0·37) to 0·05% (0·02–0·10) for NRTI (prevalence ratio 0·44 [0·29–0·68] for NNRTI and 0·21 [0·09–0·47] for NRTI). Between 2012 and 2017, NNRTI resistance among viraemic pretreatment people with HIV increased from 4·86% (3·69–6·42) to 9·61% (7·27–12·7; prevalence ratio 1·98 [1·34–2·91]). The prevalence of NNRTI and NRTI resistance was substantially higher among viraemic treatment-experienced people with HIV (51·49% [46·24–57·34] for NNRTI and 36·46% [30·06–44·22] for NRTI in 2017) than among pretreatment people with HIV. NNRTI and NRTI resistance was predominantly attributable to rtK103N and rtM184V. inT97A was observed at a similar prevalence among viraemic tre
{"title":"HIV drug resistance during antiretroviral therapy scale-up in Uganda, 2012–19: a population-based, longitudinal study","authors":"Michael A Martin PhD , Steven James Reynolds MD , Brian T Foley PhD , Fred Nalugoda PhD , Prof Thomas C Quinn MD , Steven A Kemp PhD , Margaret Nakalanzi MS , Edward Nelson Kankaka MD , Godfrey Kigozi PhD , Robert Ssekubugu MSPH , Prof Ravindra K Gupta MD , Lucie Abeler-Dörner PhD , Joseph Kagaayi PhD , Oliver Ratmann PhD , Prof Christophe Fraser PhD , Ronald Moses Galiwango PhD , David Bonsall PhD , M Kate Grabowski PhD","doi":"10.1016/j.lanmic.2025.101218","DOIUrl":"10.1016/j.lanmic.2025.101218","url":null,"abstract":"<div><h3>Background</h3><div>With scale-up of antiretroviral therapy (ART) in sub-Saharan Africa, increasing pretreatment HIV drug resistance has been reported; however, the broader effect of ART expansion on population-level resistance patterns remains insufficiently quantified. We aimed to estimate the longitudinal prevalence of drug resistance and resistance-conferring mutations.</div></div><div><h3>Methods</h3><div>This study used data collected as part of the Rakai Community Cohort Study (RCCS), an open population-based census and cohort study conducted in southern Uganda. At each survey round, residents aged 15–49 years are invited to participate and receive a structured questionnaire that obtains sociodemographic, behavioural, and health information, including self-reported past and current ART use. Voluntary HIV testing is conducted using a rapid test algorithm and a venous blood sample. People with HIV provide samples for viral load quantification and deep sequencing. We analysed RCCS survey, HIV viral load, and deep sequencing (which was used to predict resistance) data from five survey rounds. The key outcomes were the population prevalence of viraemic people with HIV with non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor (NRTI), protease inhibitor, or multiclass resistance among all participants (regardless of HIV serostatus) in the 2015 and 2017 surveys. Prevalence of class-specific resistance and resistance-conferring substitutions were estimated using robust log-Poisson regression.</div></div><div><h3>Findings</h3><div>Between Aug 10, 2011, and Nov 4, 2020, there were 43 361 participants in the RCCS and 7923 (18·27%) people with HIV. Over five survey rounds, 93 622 participant visits occurred, among which 17 460 (18·65%) were from people with HIV. Over the analysis period, the median age of study participants remained similar (28 years [22–35] in 2012 and 29 years [21–38] in 2019). Sufficient data were available to reliably genotype 4072 (90·03%) of 4523 participant visits from 3407 people with HIV for at least one drug. Overall population prevalence of resistance contributed by viraemic pretreatment people with HIV decreased between 2012 and 2017 from 0·56% (95% CI 0·42–0·75) to 0·25% (0·18–0·33) for NNRTI and from 0·24% (0·15–0·37) to 0·05% (0·02–0·10) for NRTI (prevalence ratio 0·44 [0·29–0·68] for NNRTI and 0·21 [0·09–0·47] for NRTI). Between 2012 and 2017, NNRTI resistance among viraemic pretreatment people with HIV increased from 4·86% (3·69–6·42) to 9·61% (7·27–12·7; prevalence ratio 1·98 [1·34–2·91]). The prevalence of NNRTI and NRTI resistance was substantially higher among viraemic treatment-experienced people with HIV (51·49% [46·24–57·34] for NNRTI and 36·46% [30·06–44·22] for NRTI in 2017) than among pretreatment people with HIV. NNRTI and NRTI resistance was predominantly attributable to rtK103N and rtM184V. inT97A was observed at a similar prevalence among viraemic tre","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"6 12","pages":"Article 101218"},"PeriodicalIF":20.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanmic.2025.101201
Magdalena Medrzycki PhD , Richard A Stanton PhD , Danielle A Rankin PhD , Sam Horwich-Scholefield MPH , Arif Mahmud DrPH , Tyler Maruca MS , Sarah Brister MPH , Lian Hsiao MPH , Elisabeth Vaeth MPH , Michelle Therrien MS , Erin L Young PhD , Kelly F Oakeson PhD , Farhana Haque MS , Lindsay Neff BS , Alison Laufer Halpin PhD , Sarah Sabour PhD , Jennifer Y Huang MPH , Stephen P LaVoie PhD , Maroya Spalding Walters PhD
Background
Most US carbapenem-resistant Acinetobacter baumannii (CRAB) isolates harbour carbapenem-hydrolysing class D β-lactamases. Other carbapenemases, such as New Delhi metallo-β-lactamase (NDM), are uncommon but emerging. We describe the epidemiology of NDM-producing CRAB reported to the US Centers for Disease Control and Prevention (CDC).
Methods
We defined cases as A baumannii with blaNDM confirmed by molecular testing and isolated from any specimen source from a patient in the USA between Oct 1, 2013, and March 31, 2022, and passively reported to the CDC from regional, state, local public health, and CDC laboratories. Epidemiologically linked cases had epidemiological linkage (eg, overlapping health-care facility stay) with one or more other cases. We assessed case relatedness through analysis of whole-genome sequence data using traditional multilocus sequence typing (MLST; Oxford scheme [sequence typeOX]) and core genome MLST. To understand the potential origins of NDM-CRAB in the USA, we compared sequences of cases to US CRAB without NDM and to NDM-CRAB from non-US locations.
Findings
We identified 327 NDM-CRAB cases from 264 patients in 21 US states. Among patients with available epidemiological information, 192 (90%) of 214 had epidemiological linkage to at least one additional case and 13 (7%) of 193 were hospitalised outside the USA 12 months or less before index specimen collection. Five regionally distinct sequence type clusters were identified among the 264 case patients; three (sequence type OX218, sequence type OX281, and sequence type OX1697) were closely related to international NDM-CRAB isolates.
Interpretation
We identified regionally distinct NDM-CRAB strains, suggesting localised transmission in the USA. Some NDM-CRAB strains in the USA are closely related to strains identified outside the USA, suggesting that spread followed importation.
{"title":"New Delhi metallo-β-lactamase-producing Acinetobacter baumannii in the USA from October, 2013, to March, 2022: a retrospective molecular epidemiological analysis","authors":"Magdalena Medrzycki PhD , Richard A Stanton PhD , Danielle A Rankin PhD , Sam Horwich-Scholefield MPH , Arif Mahmud DrPH , Tyler Maruca MS , Sarah Brister MPH , Lian Hsiao MPH , Elisabeth Vaeth MPH , Michelle Therrien MS , Erin L Young PhD , Kelly F Oakeson PhD , Farhana Haque MS , Lindsay Neff BS , Alison Laufer Halpin PhD , Sarah Sabour PhD , Jennifer Y Huang MPH , Stephen P LaVoie PhD , Maroya Spalding Walters PhD","doi":"10.1016/j.lanmic.2025.101201","DOIUrl":"10.1016/j.lanmic.2025.101201","url":null,"abstract":"<div><h3>Background</h3><div>Most US carbapenem-resistant <em>Acinetobacter baumannii</em> (CRAB) isolates harbour carbapenem-hydrolysing class D β-lactamases. Other carbapenemases, such as New Delhi metallo-β-lactamase (NDM), are uncommon but emerging. We describe the epidemiology of NDM-producing CRAB reported to the US Centers for Disease Control and Prevention (CDC).</div></div><div><h3>Methods</h3><div>We defined cases as <em>A baumannii</em> with <em>bla</em><sub>NDM</sub> confirmed by molecular testing and isolated from any specimen source from a patient in the USA between Oct 1, 2013, and March 31, 2022, and passively reported to the CDC from regional, state, local public health, and CDC laboratories. Epidemiologically linked cases had epidemiological linkage (eg, overlapping health-care facility stay) with one or more other cases. We assessed case relatedness through analysis of whole-genome sequence data using traditional multilocus sequence typing (MLST; Oxford scheme [sequence type<sub>OX</sub>]) and core genome MLST. To understand the potential origins of NDM-CRAB in the USA, we compared sequences of cases to US CRAB without NDM and to NDM-CRAB from non-US locations.</div></div><div><h3>Findings</h3><div>We identified 327 NDM-CRAB cases from 264 patients in 21 US states. Among patients with available epidemiological information, 192 (90%) of 214 had epidemiological linkage to at least one additional case and 13 (7%) of 193 were hospitalised outside the USA 12 months or less before index specimen collection. Five regionally distinct sequence type clusters were identified among the 264 case patients; three (sequence type <sub>OX</sub>218, sequence type <sub>OX</sub>281, and sequence type <sub>OX</sub>1697) were closely related to international NDM-CRAB isolates.</div></div><div><h3>Interpretation</h3><div>We identified regionally distinct NDM-CRAB strains, suggesting localised transmission in the USA. Some NDM-CRAB strains in the USA are closely related to strains identified outside the USA, suggesting that spread followed importation.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"6 12","pages":"Article 101201"},"PeriodicalIF":20.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanmic.2025.101203
Zhen Wang , Xi Cheng , Jinhua Liu , Yipeng Sun
{"title":"Duck-origin H5N6 avian influenza threatens public health: a challenge for poultry vaccination in China","authors":"Zhen Wang , Xi Cheng , Jinhua Liu , Yipeng Sun","doi":"10.1016/j.lanmic.2025.101203","DOIUrl":"10.1016/j.lanmic.2025.101203","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"6 12","pages":"Article 101203"},"PeriodicalIF":20.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanmic.2025.101208
Annaleise R Howard-Jones , Dominic E Dwyer , Bart J Currie , Jen Kok
{"title":"Understanding the virological complexity and importance of One Health surveillance for zoonotic flaviviruses","authors":"Annaleise R Howard-Jones , Dominic E Dwyer , Bart J Currie , Jen Kok","doi":"10.1016/j.lanmic.2025.101208","DOIUrl":"10.1016/j.lanmic.2025.101208","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"6 12","pages":"Article 101208"},"PeriodicalIF":20.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanmic.2025.101194
Byung Uk Lee
{"title":"New aerosol terminology in the transmission of pathogens","authors":"Byung Uk Lee","doi":"10.1016/j.lanmic.2025.101194","DOIUrl":"10.1016/j.lanmic.2025.101194","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"6 12","pages":"Article 101194"},"PeriodicalIF":20.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanmic.2025.101233
Thomas Hänscheid MD , Sara Mahomed MD , Laila Oliveira PhD , Danielle Segóvia Pereira MSc , Prof Martin P Grobusch FRCP
Acid-fast stains (AFS) remain indispensable in modern diagnostic microbiology; they are used for detecting mycobacteria (including Mycobacterium tuberculosis and Mycobacterium leprae), acid-fast parasites, and some acid-variable bacteria as well as in histopathology. Fluorescent AFS surpass brightfield AFS (Ziehl–Neelsen) in sensitivity, particularly when pathogen loads are low. However, latest evidence suggests that these stains target nucleic acids, whereas lipid-rich, intact cell walls merely prevent decolourisation; this evidence corrects the long-held assumption that AFS bind to mycolic acids. This mechanism explains morphological features, such as the characteristic beading in mycobacteria, with direct implications for training microscopists and advancing artificial intelligence-assisted image analysis. This mechanism also facilitates protocol enhancements, including the use of high-yield fluorochromes or novel approaches to reduce background fluorescence. The latest novel applications, such as the detection of a low number of Schistosoma spp eggs, exemplify the broader utility of AFS. Combined with artificial intelligence-based slide interpretation, these advances in understanding staining mechanisms and expanding diagnostic applications show that AFS remain an important diagnostic laboratory modality, with considerable potential for future improvements.
{"title":"Fluorescent acid-fast stains for diagnosing mycobacteria and beyond: back to the future?","authors":"Thomas Hänscheid MD , Sara Mahomed MD , Laila Oliveira PhD , Danielle Segóvia Pereira MSc , Prof Martin P Grobusch FRCP","doi":"10.1016/j.lanmic.2025.101233","DOIUrl":"10.1016/j.lanmic.2025.101233","url":null,"abstract":"<div><div>Acid-fast stains (AFS) remain indispensable in modern diagnostic microbiology; they are used for detecting mycobacteria (including <em>Mycobacterium tuberculosis</em> and <em>Mycobacterium leprae</em>), acid-fast parasites, and some acid-variable bacteria as well as in histopathology. Fluorescent AFS surpass brightfield AFS (Ziehl–Neelsen) in sensitivity, particularly when pathogen loads are low. However, latest evidence suggests that these stains target nucleic acids, whereas lipid-rich, intact cell walls merely prevent decolourisation; this evidence corrects the long-held assumption that AFS bind to mycolic acids. This mechanism explains morphological features, such as the characteristic beading in mycobacteria, with direct implications for training microscopists and advancing artificial intelligence-assisted image analysis. This mechanism also facilitates protocol enhancements, including the use of high-yield fluorochromes or novel approaches to reduce background fluorescence. The latest novel applications, such as the detection of a low number of <em>Schistosoma</em> spp eggs, exemplify the broader utility of AFS. Combined with artificial intelligence-based slide interpretation, these advances in understanding staining mechanisms and expanding diagnostic applications show that AFS remain an important diagnostic laboratory modality, with considerable potential for future improvements.</div></div>","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"6 12","pages":"Article 101233"},"PeriodicalIF":20.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanmic.2025.101231
Martin Kammel , Christoph Buchta , Stephan W Aberle , Stephanie Bligh , Roman Fried , Andrea Griesmacher , Nicole Mastai , Ingo Schellenberg , Nathalie Weiss , Patricia Kaiser , Anika Zimmermann , Martin Obermeier
{"title":"Detection of H5N1 clade 2.3.4.4b in external quality assessment programmes: a pandemic preparedness initiative","authors":"Martin Kammel , Christoph Buchta , Stephan W Aberle , Stephanie Bligh , Roman Fried , Andrea Griesmacher , Nicole Mastai , Ingo Schellenberg , Nathalie Weiss , Patricia Kaiser , Anika Zimmermann , Martin Obermeier","doi":"10.1016/j.lanmic.2025.101231","DOIUrl":"10.1016/j.lanmic.2025.101231","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"6 12","pages":"Article 101231"},"PeriodicalIF":20.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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