Infectious Diseases of Poverty最新文献

Background: Plasmodium vivax is the predominant malaria species in many Southeast Asian countries. Eliminating all human malaria species by 2030 requires greater focus on P. vivax, with targeted measures to address its unique challenges. This study evaluated slide positivity rates, temporal trends, and risk factors associated with febrile P. vivax infections in a malaria-endemic district along the Thailand-Myanmar border.

Methods: This study employed a community-based longitudinal surveillance design over six years (January 2018-December 2023). Data were collected through routine passive case detection at field malaria clinics using extended, standardized case record forms. Malaria diagnosis was conducted via microscopy examination. Descriptive statistics and logistic regression models were used for data analysis.

Results: Among 13,347 febrile malaria-suspected patients, the cumulative slide positivity rate for P. vivax was 11.0%. Although no distinct seasonal peaks were observed, P. vivax cases generally increased in April and again in November and December. Multivariable logistic regression analysis identified several significant risk factors for febrile P. vivax infection, including school-aged children (5-14 years) (aOR: 1.56, 95% CI: 1.24-1.97), working-age adults (15-34 years) (aOR: 1.43, 95% CI: 1.02-2.00), males (aOR: 1.19, 95% CI: 1.06-1.35), Myanmar nationals (aOR: 2.37, 95% CI: 2.01-2.80), and other non-Thai nationals, such as individuals from Laos and Cambodia (aOR: 5.50, 95% CI: 3.36-8.90). A history of malaria (aOR: 1.59, 95% CI: 1.38-1.83), recent travel within two weeks (aOR: 2.38, 95% CI: 1.94-2.92), and engagement in livestock-related occupations (aOR: 2.49, 95% CI: 1.14-5.35) were also associated with higher odds of infection. In contrast, being unemployed (aOR: 0.55, 95% CI: 0.36-0.81), working in occupations such as maid, driver, or teacher (aOR: 0.78, 95% CI: 0.66-0.93), and consistent use of bed nets (aOR: 0.39, 95% CI: 0.30-0.51) significantly reduced infection risk.

Conclusions: This study identified a relatively high slide positivity rate of febrile P. vivax infection in a malaria-endemic district in western Thailand along the Myanmar border. Strengthening malaria surveillance, targeting high-risk populations, ensuring treatment adherence, and promoting early care-seeking behavior are crucial for reducing P. vivax transmission and advancing malaria elimination efforts.

Background: The Global Burden of Disease (GBD) study offers influential Disability-Adjusted Life Years (DALYs) estimates for various diseases. However, discrepancies with national surveillance data raise concerns about accuracy. This study aims to promote the deep integration of the GBD model with localized data and facilitate the development of region-specific models.

Methods: Data for 14 notifiable infectious diseases (NIDs), grouped into intestinal infectious diseases, respiratory infectious diseases, and sexually transmitted and blood-borne infections, were obtained from the Data-center of China Public Health Science. DALYs based on national surveillance data (2010-2020) were calculated using DALY formulas, and discrepancies with GBD estimates were quantified through ratio comparisons. A historical timeline map highlighted key infectious disease control policies and certified disease elimination events in China.

Results: National surveillance data show a decrease in DALYs for 14 NIDs in China, from 6,529,124.62 person-years in 2010 to 6,326,497.18 person-years in 2020. Among them, sexually transmitted and blood-borne infections have the highest burden, with 78% of DALYs attributed to hepatitis B (4,864,028.29 person-years). Respiratory infectious diseases follow, with 99% of DALYs from TB (394,927.70 person-years). Intestinal infectious diseases have the relative lightest burden, with 45% of DALYs from hepatitis E (496.49 person-years). Over 11 years, 9 of the 14 NIDs showed a downward trend. Comparisons reveal that DALYs based on national surveillance data are lower than GBD 2021 estimates.

Conclusions: Considerable differences exist between the GBD estimates and national surveillance data regarding the burden of 14 NIDs in China. Therefore, strengthening national reporting systems and integrating localized data with the GBD model is essential for more accurate disease burden assessments and effective response strategies. Despite significant progress in infectious disease control, China still faces substantial challenges in domestic disease elimination.

Background: The importance of patient participation in designing and delivering services for persons affected by neglected tropical diseases (NTDs) has gained increasing recognition. Responding to this, persons affected by NTDs urged NTD-focused non-governmental organisations (NGOs) to take action. These NGOs are pivotal in addressing healthcare disparities and reaching marginalised communities. To address the insufficient progress on participation, a participatory initiative was launched to develop a tool designed to support NGOs in fostering inclusion and ensuring the meaningful engagement of affected persons in their organisational decision-making processes.

Methods: This research used an iterative, mixed-methods approach involving stakeholder input, semi-structured interviews, and surveys across two phases. Phase 1 included exploratory workshops with persons affected by NTDs and NTD NGO employees which led to the development of a first draft of a self-assessment tool. Phase 2 involved piloting the tool in NTD NGOs. Data were gathered via pre- and post-pilot interviews and surveys. Thematic analysis was used for the qualitative data and descriptive analysis for the quantitative data.

Results: In phase 1, exploratory workshops revealed that meaningful participation involves creating environments where affected persons can openly share priorities and build their capacity. Workshop participants emphasised the need of inclusion at all stages of NGO activities. These insights informed the draft NTD Inclusion Scorecard (NISC), covering six domains. In phase 2, ten pilot sessions were conducted, feedback was gathered from 22 interviewees and 43 survey participants, focusing on the NISC's usability and relevance. While feedback on the NISC was positive, participants highlighted the need for contextualisation, organisational commitment, and adding a communication domain to the NISC.

Conclusions: The NISC is a self-assessment tool for NTD organisations, designed to enhance internal decision-making by fostering awareness of the importance of including the perspectives of persons affected by NTDs. By using the NISC, NGOs can identify gaps in inclusion and participation, improve their decision-making processes and provide services that are relevant and impactful for persons affected by NTDs. This tool provides insights that can guide NGOs in strengthening their role in promoting inclusion and increasing the effectiveness of their programmes.

Background: Understanding Plasmodium sexual differentiation is crucial for blocking transmission. This study identified risk factors for gametocyte carriage and gametocytemia in P. vivax and P. falciparum to inform malaria elimination strategies at the China-Myanmar border.

Methods: Gametocytes and asexual parasites were microscopically detected on thick smears collected from 2011 to 2020 in Laiza Township, Kachin State, Myanmar. Mono-/polyclonality were detected by genotyping at Pvmsp3α/β for P. vivax, and Pfmsp1/2 for P. falciparum. Kulldorff's retrospective time scan statistics tested for likely clusters of gametocyte-positive cases over time. Chi-square or Fisher's exact tests compared proportions of gametocyte-positive cases in categorical variables. Generalized linear models assessed risk factors (year, season, demographics, clinical/parasitological features) for gametocyte carriage (logistic regression for a binomial outcome) and gametocytemia (Gaussian regression for continuous outcome), respectively.

Results: During 2011-2020, 8240 patients had P. vivax infections, with 7249 testing positive for gametocytes. Among 510 P. falciparum cases, 56 tested positive for gametocytes. A significant cluster of P. vivax gametocyte carriage occurred from May 2015 to August 2017 (P = 0.001). For P. vivax, dry season, previous malaria history, fever, and parasite density were associated with gametocyte carriage. Gametocyte density increased with asexual parasite density (P < 0.001) but was lower during the rainy season and in those with a history of malaria infection (P < 0.001). Over time, gametocytes carriage proportion increased while density decreased (P < 0.001). For P. falciparum, younger age and previous malaria history were associated with gametocyte carriage, and density was higher in the dry season (P = 0.0115). Polyclonal P. vivax infections had higher gametocyte densities than monoclonal infections (P < 0.0001) and P. falciparum gametocyte density tended to increase with multiplicity of infection.

Conclusions: Younger age, prior malaria infection, travel, and polyclonal infections correlate with higher P. vivax gametocyte prevalence. Gametocyte carriage peakes during the dry season, highlighting the need for seasonal strategies to support malaria elimination. These findings enhance understanding of risk factors for the transmissible stage of the two main human Plasmodium species in the Greater Mekong Subregion border areas.

Emerging and re-emerging infectious diseases in different soci-ecological settings create unprecedented challenges for global public health and socio-economic development. The One Health concept is based on a systemic, transdisciplinary approach and hence captures the interactions between humans and animals, in a given socio-ecological setting. It could comprehensively address the human-animal-environment interface, the core of zoonotic diseases. Consequently, One Health approach is effective in controlling and eliminating the promoting factors of emerging infectious diseases (EIDs). We explored key principles for the prevention, control and elimination of EIDs through reviewing the transition of public health and global health strategies towards One Health and summarizing some successful experiences in effectively controlling EIDs. Recognizing heterogeneities and strengthening "surveillance-response systems" are the two key principles. It is recommended to promote health equity and conduct cost-effectiveness analysis to address the challenges of heterogeneity. Cross-sectoral collaboration and transdisciplinarity should be strengthened to facilitate the utilizing of systems thinking.

Background: Schistosomiasis, caused by parasitic flatworms of the genus Schistosoma, remains a significant public health challenge in tropical and subtropical regions, affecting over hundreds of millions of people in these areas. Accurate diagnosis is crucial for effective disease control, particularly in low-endemic areas where traditional methods like microscopy are no longer effective. We aimed to evaluate the diagnostic performance of loop-mediated isothermal amplification (LAMP) for Schistosoma infection.

Methods: Adhering to Preferred reporting items for systematic reviews and meta-analyses guidelines, we conducted a comprehensive search on 10 May 2025 across multiple databases including PubMed, Cochrane Library, Latin American and Caribbean Literature on Health Sciences, Embase, China National Knowledge Infrastructure, and Wanfang Data, using keywords such as "schistosom*", "LAMP", and "loop-mediated isothermal amplification". Based on available literature, pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and 95% confidential interval (CI) were calculated using STATA18.0 software. Subgroup analyses and univariable meta-regression were performed to explore the source of heterogeneity. Specifically, subgroup analyses were performed by categorizing into species (S. japonicum, S. mansoni, S. haematobium), sample type (stool, urine, serum, snails), and DNA extraction methods to explore factors influencing test performance.

Results: The study finally included 24 individual studies derived from 14 published articles. The pooled analyses of LAMP data from all included studies resulted in a sensitivity of 0.90 (95% CI: 0.80-0.90), specificity of 0.82 (95% CI: 0.60-0.93), PLR of 4.98 (95% CI: 2.01-12.29), NLR of 0.13 (95% CI: 0.06-0.26) and diagnostic odds ratio of 39 (95% CI: 10-158). The area under the summary receiver operating characteristic curve reached 0.93, indicating excellent diagnostic performance. Subgroup analyses revealed optimal performance for S. japonicum and snail samples with lower heterogeneity (I² < 50%).

Conclusions: LAMP shows promise as a rapid, sensitive and specific diagnostic tool for schistosomiasis, particularly in resource-limited settings. This technique enables field application, supporting global efforts toward elimination of schistosomiasis by 2030.

Background: Effective monitoring of infectious diseases is crucial for safeguarding public health. Compared to comprehensive nationwide surveillance, selecting representative sample cities to constitute the monitoring network for surveillance provides similar effectiveness at a lower cost. We developed Spatial Cluster Stratified Sampling (SCSS) to select sample cities for infectious diseases exhibiting spatial autocorrelation.

Methods: To improve monitoring efficiency for hand, foot, and mouth disease (HFMD), we used SCSS to design a monitoring network, which involved four main steps. First, we used Spatial Kluster Analysis by Tree Edge Removal (SKATER) to stratify the data. Second, we applied the cost-benefit balance to determine the optimal sample size. Third, we performed simple random sampling within each stratum to establish an initial monitoring network. Fourth, we used cyclic optimization to finalize the monitoring network. We evaluated the spatiotemporal representativeness using root mean square error (RMSE), Spearman's rank correlation, global Moran's I, local Getis-Ord G*, and Joinpoint Regression. We also compared the effectiveness of SCSS with K-means, traditional stratified sampling, and simple random sampling using RMSE.

Results: The optimal sample size was determined to be 103. Overall, the predicted values for each city significantly correlated with the true values (r = 0.81, P < 0.001). Both the predicted and true values showed positive spatial autocorrelation (Moran's I > 0, P < 0.05), and the sensitivity, specificity, and accuracy of the predicted local Getis-Ord G* values, evaluated against the true values as the gold standard, were 0.76, 0.91, and 0.87, respectively. The weekly predicted values for each city showed significant correlation with the true values (P < 0.05). The 95% confidence intervals (CI) for the predicted values of joinpoint locations, annual percent change (APC), and average annual percent change (AAPC) encompassed the true values, and the number of joinpoints matched the true values. Among the four methods compared, SCSS exhibited the lowest and most centralized RMSE.

Conclusions: SCSS proved to be more accurate and stable than traditional methods, which overlook spatial information. This method offers a valuable reference for future design of monitoring networks for infectious diseases exhibiting spatial autocorrelation, enabling more efficient and cost-effective surveillance.

Background: Despite price advantages, local direct-acting antiviral agents (DAAs) for hepatitis C (hep C) have not been widely used in China compared with the imported ones. There is no evidence on their relative efficacy and safety, nor whether the small market share of local DAAs was attributable to the potential differences.

Methods: This study systematically evaluated the efficacy and safety evidence of 5 local and 6 imported DAAs with valid Chinese registration numbers as of January 25, 2024. Meta-analyses, subgroup analyses and meta-regressions were performed to synthesize evidence and compared the outcomes by using the random-effects empirical Bayes model.

Results: Nineteen randomized controlled trials and 82 single-arm trials (SATs) were included. The results demonstrated no statistically significant difference in 12-week sustained virological response [0.97, (95% confidence interval (CI) 0.95, 0.99) vs 0.96, (95% CI: 0.94, 0.98), P = 0.21], relapse [0.02, (95% CI: 0.01, 0.04) vs 0.02, (95% CI: 0.01, 0.03), P = 0.65], virological breakthrough [0.003, (95% CI: < 0.001, 0.02) vs 0.0000002, (95% CI: < 0.001, 0.0006), P = 0.51] and serious adverse events (SAEs) [0.04, (95% CI: 0.03, 0.06) vs 0.03, (95% CI: 0.02, 0.03), P = 0.12] between local and imported DAAs. By controlling for ethnicities of patients in multiple meta-regression, the local DAAs had a 33.7% higher rate of adverse events (AEs) [0.337, (95% CI: 0.188, 0.486), P < 0.001]. No statistically significant difference was found in the interaction test between local and imported pan-genotypic DAAs regarding the rate of AEs [0.72, (95% CI: 0.64, 0.79) vs 0.73, (95% CI: 0.65, 0.50), P = 0.81].

Conclusions: Current evidence demonstrates no statistically significant differences in efficacy and SAEs between local and imported DAAs. Given that simplified pan-genotypic DAA regimens are now standard care, local pan-genotypic DAAs hold potential to increase hepatitis C virus treatment rates in China. It is critical for local DAA developers to generate more evidence with expanded patient population in terms of age, treatment experience and genotype of hepatitis C virus, conducting head-to-head studies directly comparing the efficacy and safety. Clinical and policy decision-making should be adaptive and evolve as new evidence is generated.

Background: Alveolar echinococcosis (AE), caused by the larval stage of Echinococcus multilocularis, poses a substantial global health challenge due to its high mortality profile. This study reports the inaugural human infection of echinococcosis caused by the Mongolian genotype of E. multilocularis in China, also the first reported indigenous AE case in Inner Mongolia.

Case presentation: A 58-year-old female pastoralist from Inner Mongolia, who had no endemic region exposure history but prolonged occupational contact with dogs, presented with severe AE. Clinical examinations revealed a massive hepatic lesion exceeding 10 cm in diameter, accompanied by elevated eosinophils (0.90 × 10⁹/L) and basophils (0.08 × 10⁹/L). Despite undergoing liver transplantation, the patient succumbed postoperatively. Histopathological confirmation and molecular phylogenetics identified the Mongolian genotype of E. multilocularis infection, distinct from the predominant Asian genotype in China. Potential evidence of zoonotic transmission was discovered through genotype-matched E. multilocularis detection in corsac fox (Vulpes corsac) feces from the grasslands along the shores of Hulun Lake (Hulun Buir City, northeastern Inner Mongolia, China).

Conclusions: This report provides the primary evidence of a locally acquired human AE infection in China caused by the Mongolian genotype of Echinococcus multilocularis. The discovery of this case challenges historical classifications of echinococcosis endemic areas. The findings call for revised AE-endemic identification criteria, improved AE diagnostic protocols, and enhanced AE surveillance in the Inner Mongolia region to generate further epidemiological evidence and information on disease progression.

Background: In 2020, the World Health Organization published a guideline on the use of mass drug administration (MDA) of the broad-spectrum antibiotic azithromycin to reduce childhood mortality. As MDA-azithromycin to reduce mortality is considered for expansion to more settings and populations, care must be taken to maximize benefits and reduce risks (e.g., antimicrobial resistance or AMR) of this intervention. Completed and ongoing MDA-azithromycin cluster-randomized clinical trials can provide evidence on the extent to which these benefits and risks accrue and identify practices to monitor these effects and address evidence gaps in future trials.

Methods: We examined azithromycin clinical trials registered on ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform from registry inception to December 31, 2023. We included trials for which azithromycin was administered for the prevention or treatment of a disease or condition that was not explicitly diagnosed or necessary for participant inclusion, and for which treatment was randomized by geographic units. We identified evidence, knowledge gaps, and trends and highlights across five domains: (1) targeting of MDA-azithromycin, (2) clinical endpoints, (3) co- and competing interventions, (4) spillover effects, and (5) AMR monitoring.

Results: Of 1589 screened studies, 30 met all inclusion criteria. These trials were conducted in 13 countries, predominantly (26/30) in sub-Saharan Africa. Nearly a third (9/30) of the trials included mortality endpoints, but few (2/9) included cause-specific mortality endpoints. New evidence suggests the benefits of widening the target age group and the persistence of mortality benefits in settings with competing interventions. Published practices to ensure geographic separation of communities in different treatment arms to reduce spillover effects were not customary. We found information on AMR monitoring practices for just over half the trials (16/30). Of these, half (8/16) included both phenotypic and genotypic AMR testing, and more than half collected specimens to assess the nasopharyngeal and gut microbiomes (9/16) and tested for non-macrolide resistance (11/16).

Conclusions: Further long-term MDA-azithromycin studies to determine which additional countries could benefit, interventions to accompany or replace this intervention, and the extent to which AMR spillover occurs may prove valuable as guidelines are revised.