Suicide remains a leading cause of preventable mortality in Southeast Asia (SEA), a region that bears a disproportionate share of the global suicide burden yet remains underrepresented in research, funding, and policy attention. In this article, we articulate ten priority research areas for suicide prevention across SEA, informed by surveys, workshops, and roundtable discussions convened around a regional forum, to guide key stakeholders including shaping funding calls, journal editorial focus, and interagency action. These priorities include strengthening suicide surveillance and data integration; embedding social determinants such as poverty, debt, gender inequity, and interpersonal violence into prevention frameworks; advancing family- and community-based approaches; integrating cultural, spiritual, and historical contexts; addressing alcohol and substance use; responding to youth suicide and online environments; addressing mental health needs; strengthening implementation science to adapt and evaluate interventions with fidelity; and improving translation of evidence into policy. Advancing this coordinated priority research agenda is essential to progress toward regional global reduction targets, by ensuring the research and funding ecosystem focuses the unique context of the SEA region.
{"title":"Research priorities for suicide prevention in Southeast Asia","authors":"Sandersan Onie , Vikas Menon , Rakhi Dandona , Prakarn Thomyangkoon , Anish V. Cherian , Lakshmi Vijayakumar , Soumitra Pathare","doi":"10.1016/j.lansea.2026.100718","DOIUrl":"10.1016/j.lansea.2026.100718","url":null,"abstract":"<div><div>Suicide remains a leading cause of preventable mortality in Southeast Asia (SEA), a region that bears a disproportionate share of the global suicide burden yet remains underrepresented in research, funding, and policy attention. In this article, we articulate ten priority research areas for suicide prevention across SEA, informed by surveys, workshops, and roundtable discussions convened around a regional forum, to guide key stakeholders including shaping funding calls, journal editorial focus, and interagency action. These priorities include strengthening suicide surveillance and data integration; embedding social determinants such as poverty, debt, gender inequity, and interpersonal violence into prevention frameworks; advancing family- and community-based approaches; integrating cultural, spiritual, and historical contexts; addressing alcohol and substance use; responding to youth suicide and online environments; addressing mental health needs; strengthening implementation science to adapt and evaluate interventions with fidelity; and improving translation of evidence into policy. Advancing this coordinated priority research agenda is essential to progress toward regional global reduction targets, by ensuring the research and funding ecosystem focuses the unique context of the SEA region.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100718"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lansea.2025.100715
Qinkai Yu , Jinbert L. Azariah , Z. Sajan Ahmad , Rajappan Anilkumar , Peter Calvert , Yang Chen , Yalin Zheng , Yanda Meng , Bahuleyan Charantharayil Gopalan , Gregory Y.H. Lip
Background
Stroke risk stratification in patients with atrial fibrillation (AF) is challenging, particularly in under-represented South Asian populations. The use of a multimodal deep-learning artificial intelligence (AI) model, which integrates clinical data with widely available paper electrocardiogram (ECG) images, represents a novel predictive approach that has not previously been validated in this population.
Methods
This study used data from the prospective KERALA-AF registry, the largest prospective AF study in South Asia. We developed a multimodal deep-learning AI model to predict incident stroke within one year by combining tabular clinical data with scanned paper ECGs. We benchmarked its performance (AUC) against machine learning (ML) models using only clinical data and the CHA2DS2-VASc score.
Findings
Of 631 patients included (mean age 64.4, SD 12.9; 54.2% female), 25 (4.0%) experienced a stroke within one year. The multimodal deep learning AI model incorporating ECG data achieved the highest discrimination (AUC 0.816, 95% CI 0.704–0.914), substantially outperforming the CHA2DS2-VASc score (AUC 0.666) and all compared machine learning models trained on clinical data alone. Permutation analysis showed the scanned paper ECG images contributed 57.1% of the model's predictive signal, which boosted the model's performance significantly.
Interpretation
Integrating scanned paper ECGs with clinical data via deep learning methods significantly enhanced 1-year stroke clinical risk prediction in South Asian AF patients. This study demonstrates the value of using multimodal AI with readily available, non-digital data in improving clinical risk stratification beyond current approaches based on clinical risk factors alone.
Funding
Kerala Chapter of Cardiological Society of India.
背景房颤（AF）患者卒中风险分层具有挑战性，特别是在代表性不足的南亚人群中。使用多模态深度学习人工智能（AI）模型，将临床数据与广泛可用的纸质心电图（ECG）图像集成在一起，代表了一种以前未在该人群中得到验证的新型预测方法。方法：本研究使用来自前瞻性喀拉拉邦房颤登记的数据，这是南亚最大的前瞻性房颤研究。我们开发了一个多模式深度学习人工智能模型，通过结合表格临床数据和扫描的纸质心电图来预测一年内的卒中事件。我们仅使用临床数据和CHA2DS2-VASc评分将其性能（AUC）与机器学习（ML）模型进行基准测试。结果纳入631例患者（平均年龄64.4岁，SD 12.9；女性54.2%），25例（4.0%）在一年内发生卒中。结合ECG数据的多模态深度学习AI模型具有最高的识别率（AUC 0.816, 95% CI 0.704-0.914），大大优于CHA2DS2-VASc评分（AUC 0.666），并且所有的机器学习模型都是单独训练临床数据。排列分析表明，扫描的纸质心电图像贡献了模型预测信号的57.1%，显著提高了模型的性能。通过深度学习方法将纸质扫描心电图与临床数据相结合，可显著提高南亚房颤患者1年卒中临床风险预测。这项研究证明了使用多模式人工智能与现成的非数字数据在改善临床风险分层方面的价值，超越了目前仅基于临床风险因素的方法。资助印度心脏病学会喀拉拉邦分会。
{"title":"Integration of clinical data with scanned ECGs using deep learning methods for stroke risk prediction in Indian patients with atrial fibrillation: evidence from the KERALA-AF study","authors":"Qinkai Yu , Jinbert L. Azariah , Z. Sajan Ahmad , Rajappan Anilkumar , Peter Calvert , Yang Chen , Yalin Zheng , Yanda Meng , Bahuleyan Charantharayil Gopalan , Gregory Y.H. Lip","doi":"10.1016/j.lansea.2025.100715","DOIUrl":"10.1016/j.lansea.2025.100715","url":null,"abstract":"<div><h3>Background</h3><div>Stroke risk stratification in patients with atrial fibrillation (AF) is challenging, particularly in under-represented South Asian populations. The use of a multimodal deep-learning artificial intelligence (AI) model, which integrates clinical data with widely available paper electrocardiogram (ECG) images, represents a novel predictive approach that has not previously been validated in this population.</div></div><div><h3>Methods</h3><div>This study used data from the prospective KERALA-AF registry, the largest prospective AF study in South Asia. We developed a multimodal deep-learning AI model to predict incident stroke within one year by combining tabular clinical data with scanned paper ECGs. We benchmarked its performance (AUC) against machine learning (ML) models using only clinical data and the CHA<sub>2</sub>DS<sub>2</sub>-VASc score.</div></div><div><h3>Findings</h3><div>Of 631 patients included (mean age 64.4, SD 12.9; 54.2% female), 25 (4.0%) experienced a stroke within one year. The multimodal deep learning AI model incorporating ECG data achieved the highest discrimination (AUC 0.816, 95% CI 0.704–0.914), substantially outperforming the CHA<sub>2</sub>DS<sub>2</sub>-VASc score (AUC 0.666) and all compared machine learning models trained on clinical data alone. Permutation analysis showed the scanned paper ECG images contributed 57.1% of the model's predictive signal, which boosted the model's performance significantly.</div></div><div><h3>Interpretation</h3><div>Integrating scanned paper ECGs with clinical data via deep learning methods significantly enhanced 1-year stroke clinical risk prediction in South Asian AF patients. This study demonstrates the value of using multimodal AI with readily available, non-digital data in improving clinical risk stratification beyond current approaches based on clinical risk factors alone.</div></div><div><h3>Funding</h3><div><span>Kerala Chapter of Cardiological Society of India</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100715"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lansea.2025.100714
Vijayalaxmi V. Mogasale , Jacob John , Nikhil Sahai , Arindam Ray , Habib Hasan Farooqui , Vittal Mogasale , Bhim Gopal Dhoubhadel , W. John Edmunds , Andrew Clark , Kaja Abbas
Background
India is one of the countries with a high typhoid fever burden. In 2022, the National Technical Advisory Group on Immunisation recommended including the typhoid conjugate vaccine (TCV) in the Universal Immunisation Programme. In this study, we aimed to estimate the 2023 burden of typhoid fever and its antimicrobial resistance (AMR) to inform targeted vaccine introduction strategies.
Methods
We used a decision tree model to estimate typhoid cases, hospitalisations, complications, and deaths. Incidence and clinical parameters were derived from a multicentre Indian study, with state-wise AMR prevalence from a systematic review. Two co-primary and four alternative scenarios were presented to validate the robustness of the findings.
Findings
We estimated 4.9 million (95% UI: 4.4–5.6) typhoid cases and 7850 (4300–14,900) deaths in India in 2023. Of 730,000 (534,000–970,000) hospitalisations, 600,000 (435,000–799,000; 82%) were attributable to fluoroquinolone-resistant. Under primary scenario A, children <5 years accounted for 321,000 (235,000–427,000; 44.0%) hospitalisations and 2600 (1300–4800; 34.0%) deaths. Under primary scenario B, 5–9 years of age accounted for 265,000 (135,000–278,000; 36.0%) hospitalisations and 2900 (1500–5300; 36.0%) deaths. Delhi, Maharashtra, and Karnataka together accounted for 29% of the national burden and had the highest rates of fluoroquinolone-resistant cases and deaths among the ten highest-burden states. Deaths linked to fluoroquinolone-resistance, multidrug resistance, third-generation cephalosporins, and azithromycin resistance were 4700 (1800–10,200), 122 (45–294), 183 (69–431), and 183 (68–432), respectively.
Interpretation
Fluoroquinolone-resistance drives a large share of typhoid-related hospitalisations and deaths, especially in children under five and in high-burden states of India. Targeted TCV introduction, with broader age coverage among children, would maximise impact.
Funding
WISE programme; Vaccine Impact Modelling Consortium; Japan Agency for Medical Research and Development.
{"title":"Burden of typhoid fever and antimicrobial resistance in India (2023): a modelling study","authors":"Vijayalaxmi V. Mogasale , Jacob John , Nikhil Sahai , Arindam Ray , Habib Hasan Farooqui , Vittal Mogasale , Bhim Gopal Dhoubhadel , W. John Edmunds , Andrew Clark , Kaja Abbas","doi":"10.1016/j.lansea.2025.100714","DOIUrl":"10.1016/j.lansea.2025.100714","url":null,"abstract":"<div><h3>Background</h3><div>India is one of the countries with a high typhoid fever burden. In 2022, the National Technical Advisory Group on Immunisation recommended including the typhoid conjugate vaccine (TCV) in the Universal Immunisation Programme. In this study, we aimed to estimate the 2023 burden of typhoid fever and its antimicrobial resistance (AMR) to inform targeted vaccine introduction strategies.</div></div><div><h3>Methods</h3><div>We used a decision tree model to estimate typhoid cases, hospitalisations, complications, and deaths. Incidence and clinical parameters were derived from a multicentre Indian study, with state-wise AMR prevalence from a systematic review. Two co-primary and four alternative scenarios were presented to validate the robustness of the findings.</div></div><div><h3>Findings</h3><div>We estimated 4.9 million (95% UI: 4.4–5.6) typhoid cases and 7850 (4300–14,900) deaths in India in 2023. Of 730,000 (534,000–970,000) hospitalisations, 600,000 (435,000–799,000; 82%) were attributable to fluoroquinolone-resistant. Under primary scenario A, children <5 years accounted for 321,000 (235,000–427,000; 44.0%) hospitalisations and 2600 (1300–4800; 34.0%) deaths. Under primary scenario B, 5–9 years of age accounted for 265,000 (135,000–278,000; 36.0%) hospitalisations and 2900 (1500–5300; 36.0%) deaths. Delhi, Maharashtra, and Karnataka together accounted for 29% of the national burden and had the highest rates of fluoroquinolone-resistant cases and deaths among the ten highest-burden states. Deaths linked to fluoroquinolone-resistance, multidrug resistance, third-generation cephalosporins, and azithromycin resistance were 4700 (1800–10,200), 122 (45–294), 183 (69–431), and 183 (68–432), respectively.</div></div><div><h3>Interpretation</h3><div>Fluoroquinolone-resistance drives a large share of typhoid-related hospitalisations and deaths, especially in children under five and in high-burden states of India. Targeted TCV introduction, with broader age coverage among children, would maximise impact.</div></div><div><h3>Funding</h3><div><span>WISE programme</span>; <span>Vaccine Impact Modelling Consortium</span>; <span>Japan Agency for Medical Research and Development</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100714"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lansea.2025.100713
Muhammad S. Jamil , Muhammad S. Pasha , Atif Ali , Shahida Memon , Altaf A. Soomro , Zulfiqar Dharejo , Alaama A. Sabry , Yvan Hutin , Joumana Hermez
<div><h3>Background</h3><div>In April 2019, an outbreak of HIV was reported in Larkana district of Sindh province, Pakistan. The outbreak primarily affected children and was associated with unsafe injections in healthcare settings. Testing services delivered from health care facilities continued to identify new HIV infections in Larkana and surrounding districts. We describe a community-based educate, test and treat initiative implemented in these areas to identify undiagnosed HIV infections in the community. We analyzed the data to describe HIV-positivity, linkage to care and HIV risk exposure among diagnosed persons.</div></div><div><h3>Methods</h3><div>HIV rapid testing was offered door-to-door to people 18 months to 60 years of age who were not known to be HIV-positive. Testing was conducted in 12 union councils (UCs; lowest administrative unit) of Taluka/sub-district “Ratodero” (district Larkana), four UCs of Taluka “Garhi Yasin” (district Shikarpur) and seven UCs of Taluka “Garhi Khairo” (district Jacobabad). Those with two reactive rapid results in the community were referred for confirmation and linkage to care at the nearest HIV treatment centre. We calculated HIV positivity (number of people with two reactive rapid tests in the community among those tested) disaggregated by age, sex and location, and assessed the proportion linked to care among those HIV-positive and self-reported HIV risk exposure among those diagnosed.</div></div><div><h3>Findings</h3><div>Between 6 and 21 September 2023, 43,883 individuals were tested in Ratodero, of whom 47% were females and 47% were aged <15 years. Of those tested, 73 (0.17%) were HIV-positive (48 persons aged <15 [0.24%] and 25 persons aged ≥15 [0.11%]) and 63 (86%) were linked to treatment. Forty eight persons (76%) reported exposure to reused needles or syringes. In surrounding areas, between 28 November to 12 December 2023, 24,352 individuals were tested, of whom 60% were females and 49% were aged <15 years. Of those tested, 158 (0.65%) were HIV-positive (56 persons aged <15 [0.47%] and 102 persons aged ≥15 [0.83%]) and 94 (59%) were linked to treatment. Forty seven persons (51%) reported reuse of needles or syringes and 15 (16%) transfusion of blood/blood products.</div></div><div><h3>Interpretation</h3><div>More than five years since the nosocomial HIV outbreak in Ratodero, undiagnosed HIV infections persist in the community. The undiagnosed HIV infection is common among children in Ratodero, and among both adults and children in surrounding areas. Self-reported HIV risk exposures point to reuse of needles and syringes as the predominant mode of transmission. The situation warrants urgent need to address unsafe injection practices and safety in healthcare facilities.</div></div><div><h3>Funding</h3><div>The educate, test and treat programme was funded through the <span>Global Fund</span> COVID-19 Response Mechanism country grant. No specific funding was received for this programme
{"title":"Identifying undiagnosed HIV infected individuals in a community-based door to door testing initiative in outbreak affected areas of Larkana and surrounding districts, Pakistan","authors":"Muhammad S. Jamil , Muhammad S. Pasha , Atif Ali , Shahida Memon , Altaf A. Soomro , Zulfiqar Dharejo , Alaama A. Sabry , Yvan Hutin , Joumana Hermez","doi":"10.1016/j.lansea.2025.100713","DOIUrl":"10.1016/j.lansea.2025.100713","url":null,"abstract":"<div><h3>Background</h3><div>In April 2019, an outbreak of HIV was reported in Larkana district of Sindh province, Pakistan. The outbreak primarily affected children and was associated with unsafe injections in healthcare settings. Testing services delivered from health care facilities continued to identify new HIV infections in Larkana and surrounding districts. We describe a community-based educate, test and treat initiative implemented in these areas to identify undiagnosed HIV infections in the community. We analyzed the data to describe HIV-positivity, linkage to care and HIV risk exposure among diagnosed persons.</div></div><div><h3>Methods</h3><div>HIV rapid testing was offered door-to-door to people 18 months to 60 years of age who were not known to be HIV-positive. Testing was conducted in 12 union councils (UCs; lowest administrative unit) of Taluka/sub-district “Ratodero” (district Larkana), four UCs of Taluka “Garhi Yasin” (district Shikarpur) and seven UCs of Taluka “Garhi Khairo” (district Jacobabad). Those with two reactive rapid results in the community were referred for confirmation and linkage to care at the nearest HIV treatment centre. We calculated HIV positivity (number of people with two reactive rapid tests in the community among those tested) disaggregated by age, sex and location, and assessed the proportion linked to care among those HIV-positive and self-reported HIV risk exposure among those diagnosed.</div></div><div><h3>Findings</h3><div>Between 6 and 21 September 2023, 43,883 individuals were tested in Ratodero, of whom 47% were females and 47% were aged <15 years. Of those tested, 73 (0.17%) were HIV-positive (48 persons aged <15 [0.24%] and 25 persons aged ≥15 [0.11%]) and 63 (86%) were linked to treatment. Forty eight persons (76%) reported exposure to reused needles or syringes. In surrounding areas, between 28 November to 12 December 2023, 24,352 individuals were tested, of whom 60% were females and 49% were aged <15 years. Of those tested, 158 (0.65%) were HIV-positive (56 persons aged <15 [0.47%] and 102 persons aged ≥15 [0.83%]) and 94 (59%) were linked to treatment. Forty seven persons (51%) reported reuse of needles or syringes and 15 (16%) transfusion of blood/blood products.</div></div><div><h3>Interpretation</h3><div>More than five years since the nosocomial HIV outbreak in Ratodero, undiagnosed HIV infections persist in the community. The undiagnosed HIV infection is common among children in Ratodero, and among both adults and children in surrounding areas. Self-reported HIV risk exposures point to reuse of needles and syringes as the predominant mode of transmission. The situation warrants urgent need to address unsafe injection practices and safety in healthcare facilities.</div></div><div><h3>Funding</h3><div>The educate, test and treat programme was funded through the <span>Global Fund</span> COVID-19 Response Mechanism country grant. No specific funding was received for this programme","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100713"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Persistence of measurable residual disease (MRD) and high-risk cytogenetics are established predictors of relapse in childhood acute lymphoblastic leukaemia (ALL).
Methods
Outcomes of children with ALL treated with the ICiCLe-ALL-2014 protocol at a single centre, between August 2013 and May 2023 were analysed. Co-culture ex-vivo drug response profiling (DRP) was performed on diagnostic or relapsed samples. Patients classified as very high risk (VHR) received DRP guided therapeutic modifications. Event free (EFS) and overall (OS) survival were compared across risk categories.
Findings
Among 715 patients, at a median 55 (50–58) months, the 3-year EFS for standard-risk, intermediate-risk, high-risk B, T-ALL and VHR were 71% (64%–78%), 67% (58%–75%), 77% (70%–82%), 81% (71%–88%), and 38% (24%–52%) respectively (p < 0.0001). Persistent MRD at end of consolidation was associated with inferior EFS (40.3%, p ≤ 0.0001). Drug sensitivity scores from DRP performed on 112 samples identified panobinostat (median DSS 23.4), venetoclax (20.7), daunorubicin (17.9), selinexor (12.7) and bortezomib (12.1) as effective in VHR or relapsed ALL. From November 2020, 25 VHR patients received a modified treatment block incorporating venetoclax and bortezomib. At 1.5-year, landmark EFS was 81.8% (58%–93%) with the modified regimen vs 67.7% (49–81) with standard therapy (p = 0.0324). Venetoclax sensitivity correlated with MRD clearance (p = 0.0070).
Interpretation
DRP enabled identification of effective agents for integration into therapy of VHR paediatric ALL. The addition of venetoclax and bortezomib was well tolerated and associated with improved early survival outcomes. These findings support prospective evaluation of DRP-guided treatment regimens in VHR ALL.
Funding
DBT-Wellcome India Alliance, Tata Consultancy Services.
{"title":"Functional precision approach in patients with very high risk acute lymphoblastic leukaemia in India: a single-centre cohort study","authors":"Jasmeet Sidhu , Arijit Chakraborty , Parag Das , Fabio D. Steffen , Subhajit Kundu , Sangramjit Basu , Bhaswati Tarafdar , Tanima Dey , Abhirupa Kar , Mousumi Biswas , Ankita Das , Naveen Sivadasan , Pritha Dasgupta , Niharendu Ghara , Beat Bornhauser , Jean-Pierre Bourquin , Shekhar Krishnan , Vaskar Saha","doi":"10.1016/j.lansea.2025.100710","DOIUrl":"10.1016/j.lansea.2025.100710","url":null,"abstract":"<div><h3>Background</h3><div>Persistence of measurable residual disease (MRD) and high-risk cytogenetics are established predictors of relapse in childhood acute lymphoblastic leukaemia (ALL).</div></div><div><h3>Methods</h3><div>Outcomes of children with ALL treated with the ICiCLe-ALL-2014 protocol at a single centre, between August 2013 and May 2023 were analysed. Co-culture <em>ex-vivo</em> drug response profiling (DRP) was performed on diagnostic or relapsed samples. Patients classified as very high risk (VHR) received DRP guided therapeutic modifications. Event free (EFS) and overall (OS) survival were compared across risk categories.</div></div><div><h3>Findings</h3><div>Among 715 patients, at a median 55 (50–58) months, the 3-year EFS for standard-risk, intermediate-risk, high-risk B, T-ALL and VHR were 71% (64%–78%), 67% (58%–75%), 77% (70%–82%), 81% (71%–88%), and 38% (24%–52%) respectively (p < 0.0001). Persistent MRD at end of consolidation was associated with inferior EFS (40.3%, p ≤ 0.0001). Drug sensitivity scores from DRP performed on 112 samples identified panobinostat (median DSS 23.4), venetoclax (20.7), daunorubicin (17.9), selinexor (12.7) and bortezomib (12.1) as effective in VHR or relapsed ALL. From November 2020, 25 VHR patients received a modified treatment block incorporating venetoclax and bortezomib. At 1.5-year, landmark EFS was 81.8% (58%–93%) with the modified regimen vs 67.7% (49–81) with standard therapy (p = 0.0324). Venetoclax sensitivity correlated with MRD clearance (p = 0.0070).</div></div><div><h3>Interpretation</h3><div>DRP enabled identification of effective agents for integration into therapy of VHR paediatric ALL. The addition of venetoclax and bortezomib was well tolerated and associated with improved early survival outcomes. These findings support prospective evaluation of DRP-guided treatment regimens in VHR ALL.</div></div><div><h3>Funding</h3><div><span>DBT-Wellcome India Alliance</span>, <span>Tata Consultancy Services</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100710"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SARS-CoV-2 transmission studies involving children in Thailand have been relatively limited to the early waves with the alpha and delta variants. Our study aims to address these gaps by examining household transmission in Chiang Mai, northern Thailand, during the Omicron wave in a post vaccination period.
Methods
This prospective observational study enrolled households comprising a confirmed COVID-19 index patient with at least one uninfected contact and a child (<18 years of age who maybe an index or contact). Participant data, nasopharyngeal swabs, and blood samples were collected at entry and final visit. Participants recorded daily symptoms for 21 days and self-administered SARS-CoV-2 antigen tests every other day for 14 days. Incident infections were confirmed by RT-PCR. Secondary attack rates (SARs) were calculated and associated factors were analyzed using multivariable generalized estimating equations models. Phylogenetic analysis was used to confirm intra-household transmission.
Findings
From July 2022 to May 2024, 93 households (93 index cases, 197 contacts) were enrolled; 52% of index cases and 49% of contacts were <18 years. Among contacts, despite 89% (175/197) having received the SARS-CoV-2 vaccine (of whom 75% > 6 months prior), 44 became infected, yielding a household SAR of 33% (95% CI: 24–44). In phylogenetically-confirmed transmission, SAR was 25% (95% CI: 17–35). Index low viral load (aRR: 0.82, 95% CI: 0.74–0.92) and contacts baseline anti-NCP IgG positivity (aRR: 0.42, 95% CI: 0.22–0.83) were significantly associated with lower household transmission.
Interpretation
Despite widespread vaccination, household transmission of SARS-CoV-2 remained common. Prior immunity in contacts and lower viral load in index cases reduced risk. These findings underscore the central role of households in ongoing spread and highlight the value of booster vaccination and genomic surveillance to clarify transmission pathways and inform prevention policies.
Funding
The study was funded by the European Health and Digital Executive Agency (HADEA), European Commission, and by the Institut de Recherche pour le Développement (IRD), France.
{"title":"Household SARS-CoV-2 transmission during Omicron wave in Chiang Mai, Thailand: a prospective observational study","authors":"Woottichai Khamduang , Pitaya Suebtam , Intira Jeannie Collins , Patumrat Sripan , Kittipan Chalom , Sayamon Hongjaisee , Nang Kham-Kjing , Nantawan Wangsaeng , Premmarin Inmonthian , Aphirak Pinasu , Napatsakorn Kohklang , Mathis Arnal , Moira Spyer , Ilse Steffens-Westerhof , Apinun Aramrattana , Marc Lallemant , Chaisiri Angkurawaranon , Patricia Bruijning-Verhagen , Nicole Ngo-Giang-Huong , Thailand VERDI-RECOVER study team","doi":"10.1016/j.lansea.2025.100711","DOIUrl":"10.1016/j.lansea.2025.100711","url":null,"abstract":"<div><h3>Background</h3><div>SARS-CoV-2 transmission studies involving children in Thailand have been relatively limited to the early waves with the alpha and delta variants. Our study aims to address these gaps by examining household transmission in Chiang Mai, northern Thailand, during the Omicron wave in a post vaccination period.</div></div><div><h3>Methods</h3><div>This prospective observational study enrolled households comprising a confirmed COVID-19 index patient with at least one uninfected contact and a child (<18 years of age who maybe an index or contact). Participant data, nasopharyngeal swabs, and blood samples were collected at entry and final visit. Participants recorded daily symptoms for 21 days and self-administered SARS-CoV-2 antigen tests every other day for 14 days. Incident infections were confirmed by RT-PCR. Secondary attack rates (SARs) were calculated and associated factors were analyzed using multivariable generalized estimating equations models. Phylogenetic analysis was used to confirm intra-household transmission.</div></div><div><h3>Findings</h3><div>From July 2022 to May 2024, 93 households (93 index cases, 197 contacts) were enrolled; 52% of index cases and 49% of contacts were <18 years. Among contacts, despite 89% (175/197) having received the SARS-CoV-2 vaccine (of whom 75% > 6 months prior), 44 became infected, yielding a household SAR of 33% (95% CI: 24–44). In phylogenetically-confirmed transmission, SAR was 25% (95% CI: 17–35). Index low viral load (aRR: 0.82, 95% CI: 0.74–0.92) and contacts baseline anti-NCP IgG positivity (aRR: 0.42, 95% CI: 0.22–0.83) were significantly associated with lower household transmission.</div></div><div><h3>Interpretation</h3><div>Despite widespread vaccination, household transmission of SARS-CoV-2 remained common. Prior immunity in contacts and lower viral load in index cases reduced risk. These findings underscore the central role of households in ongoing spread and highlight the value of booster vaccination and genomic surveillance to clarify transmission pathways and inform prevention policies.</div></div><div><h3>Funding</h3><div>The study was funded by the <span>European Health and Digital Executive Agency</span> (HADEA), <span>European Commission</span>, and by the <span>Institut de Recherche pour le Développement</span> (IRD), France.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"44 ","pages":"Article 100711"},"PeriodicalIF":6.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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