American Journal of Tropical Medicine and Hygiene最新文献

The selection of authors for editorials reflects perceptions of expertise and influence. Our objectives were to determine author geographic and gender distribution, determine temporal trends in editorial authorship, and identify factors associated with the inclusion of authors affiliated with low- and middle-income countries (LMICs) in editorials on research conducted in LMICs. We conducted a cross-sectional study of editorials on research in LMICs published in 15 global health, pediatrics, and general medicine journals from 2014 to 2024. To assess temporal changes in authorship, we plotted the proportion of editorial authors affiliated with LMICs and those with female names by year. We used multivariable logistic regression to identify factors associated with the inclusion of one or more LMIC-affiliated authors. There were 107,629 publications and 1,350 editorials on research in LMICs with 2,401 authors. Authors of editorials were most often affiliated with institutions in North America (38.1%) and high-income countries (71.6%). The proportion of authors of editorials affiliated with institutions in high-income countries decreased from 84.9% in 2014 to 65.3% in 2024. Authors of editorials more commonly had male names than female (60.1% versus 38.7%, P <0.001). The proportion of editorial authors with female names increased from 32.1% in 2014 to 48.2% in 2024. Editorials accompanying publications reporting studies with larger sample sizes (aOR = 1.52, 95% CI: 1.03-2.26) and research conducted in sub-Saharan Africa (aOR = 2.84, 95% CI: 1.74-4.68) were more likely to include LMIC-affiliated authors. Additional efforts are needed to include authors affiliated with LMICs in editorials on research conducted in LMICs.

Despite the implementation of effective vaccines to reduce measles- and mumps-related morbidity and mortality, occasional outbreaks can occur. Monitoring the transmission of these infections in the community is important and could provide useful information for policymakers to develop effective disease control plans. Therefore, this study aimed to describe the epidemiology and age-specific trend of measles and mumps in eastern Libya. We estimated the burden of measles and mumps in a vaccinated population using data from the main medical center in the Tobruk region in eastern Libya from January 2003 to December 2020. In total, 208 cases of measles and 111 cases of mumps in those younger than 1 year old and older than 1 year old were registered over the study period. The occurrence of these infections varied, and some notable outbreaks of measles and mumps occurred during the study period. There was a minor seasonal variation in the disease occurrence over the study period. In conclusion, this study quantified the burden and age-specific occurrence of measles and mumps in the region. It also highlights the importance of maintaining high immunization rates through routine and supplemental campaigns to achieve coverage levels sufficient for preventing future outbreaks.

Malaria control in sub-Saharan Africa has stagnated despite widespread adoption of control measures such as long-lasting insecticidal nets (LLINs). Progress has stalled, in part, because of pyrethroid insecticide resistance, driving the need for retooling to increase the effectiveness of bed nets. Consequently, LLINs have been treated with the chemical synergist piperonyl butoxide (PBO). Piperonyl butoxide LLINs have been shown to be efficacious in controlled settings; however, their effectiveness in real-world settings warrants investigation. In Bungoma County, Western Kenya, a cohort of 768 participants was followed from June 2017 to December 2023 via active and passive surveillance. Household visits were conducted monthly, during which LLIN use for nets distributed in 2017 and 2021 was recorded, and symptomatic malaria cases were identified using rapid diagnostic tests (RDTs). The comparative effectiveness of PBO versus conventional LLINs was assessed in terms of malaria infections. A multilevel logistic regression model was fit with monthly RDT results as the dependent variable. The study results indicate that PBO LLINs provide greater protection against malaria at the individual level than conventional LLINs (odds ratio: 0.70; 95% CI: 0.47-1.03), although the findings were not statistically significant. The added protection against malaria infections provided by PBO LLINs compared with conventional LLINs observed in the current study aligns with findings from most previous studies, although this finding was not statistically significant. In areas with documented pyrethroid resistance, the use of LLINs with an added synergist, such as PBO, can provide additional protection against malaria infections (compared with pyrethroid-only LLINs) and should be considered for scaled-up scenarios despite the additional cost.

Mass azithromycin distribution has been shown to reduce all-cause child mortality in several settings in the Sahel by 14-18%. A trial in Niger found that mass azithromycin distribution to children ages 1-59 months old reduced cause-specific mortality because of malaria, dysentery, meningitis, and pneumonia. However, this study was done in the absence of seasonal malaria chemoprevention (SMC). Here, we assess the effect of mass azithromycin distribution on cause-specific child mortality in a setting receiving SMC. The Child Health with Azithromycin Treatment trial was a cluster-randomized, placebo-controlled trial of 341 communities in Nouna District, Burkina Faso. Eligible children (ages 1-59 months old) received a single oral 20-mg/kg dose of azithromycin or matching placebo. Six rounds of distribution occurred over a 36-month period. An enumerative census was conducted during each twice-yearly distribution, during which vital status for all children in the community was collected. Verbal autopsy was performed to assess cause of death. Of 1,086 deaths recorded in the trial, verbal autopsy results were available for 992 (91%). The most common causes of death were infectious, including malaria (34%), diarrhea (24%), and pneumonia (9%). Children living in communities receiving azithromycin had significant reduction in malaria mortality (incidence rate ratio, 0.67; 95% CI, 0.50-0.90; P = 0.008). Other infectious causes of mortality, including diarrhea and pneumonia, were lower in communities receiving azithromycin but were not statistically significantly different. Mass azithromycin distribution for child mortality has benefits in the context of SMC for reducing mortality, including for malaria mortality.

Sepsis disproportionately impacts children in low-resource settings, where diagnostic tools like the Phoenix Sepsis Score (PSS) are constrained by reliance on laboratory testing. The objective of this research was to evaluate the use of continuous physiological data from low-cost wearable biosensors and machine learning models to predict pediatric sepsis, septic shock, and mortality in a low-resource, intensive care setting. This prospective observational single-site study analyzed 96 pediatric intensive care unit patients with suspected sepsis in Dhaka, Bangladesh. Physiological data were collected using a wearable biosensor patch, whereas clinical exams, laboratory tests, and PSS criteria identified sepsis, septic shock, and mortality. Least absolute shrinkage and selection operator (LASSO) regression models were developed and validated through leave-one-group-out cross-validation (LOGO-CV) using biosensor data. Our clinical diagnostic model for sepsis using biosensor-only features demonstrated an area under the receiver operating characteristic curve (AUROC) of 0.78 (null AUROC = 0.58). For septic shock, the model demonstrated an AUROC of 0.85 (null AUROC = 0.61). The mortality model demonstrated an AUROC of 0.87 (null AUROC = 0.64). Sensitivity analyses showed improvement of AUROC to 0.89 for prediction of sepsis with manual recorded oxygen saturation (SpO2) included. Although models were trained and tested retrospectively with internal validation, findings demonstrate the potential of wearable biosensors to support pediatric sepsis diagnosis without reliance on advanced diagnostics. These results encourage further external validation with larger, multisite cohorts and real-time mobile health (mHealth) integration to support clinical use in low-resource settings.

Oz virus (OZV) was first isolated from ticks in Japan in 2018, and human infections with OZV were reported in 2023. However, serosurveillance for OZV infections, compared with that for severe fever with thrombocytopenia syndrome (SFTS), is rarely performed among wild animals. We conducted a retrospective study on the epidemiology of SFTS virus and OZV infections in wild animals. Serum samples were collected from 289 deer, 158 raccoons, and 381 wild boars in this study. The positivity rates for the anti-OZV IgG antibody in deer (10.3%), raccoons (12%), and wild boars (12.1%) showed no difference. Both OZV and SFTS virus IgG antibodies were detected in wild animals. Wild animals in Oita Prefecture had anti-OZV antibodies, suggesting that human cases will occur in the future. We recommend educating the public about the tick-borne pathogen risks in this area and implementing tick bite prevention strategies.

Entebbe bat virus (ENTV) is a bat-associated flavivirus with no known arthropod vector. Research into the biology of this virus, including assessment of the possibility that it may be vector-transmitted, is hindered by a lack of molecular tools and robust genetic systems. Therefore, the complete 3' untranslated region, which was not previously available, was sequenced, and an infectious clone of ENTV was developed to facilitate further investigation of the virus. Virus derived from the clone replicated similarly to the parental virus isolate in various vertebrate cells. Surprisingly, ENTV replicated to high titers in the Aedes aegypti (Ae. aegypti) and Aedes albopictus (Ae. albopictus) mosquito cell lines, but there was no replication or infection in Culex tarsalis cells. In addition, phylogenetic and bioinformatics analyses strongly suggested that ENTV may be associated with a mosquito host. Given the bioinformatics support and efficient growth in Aedes cells, Ae. aegypti and Ae. albopictus were orally exposed to ENTV to evaluate infection. The ENTV blood-fed mosquitoes were all negative for infection; however, when ENTV was intrathoracically (IT) inoculated, bypassing the initial midgut infection and escape barriers, it replicated to high levels in the body without disseminating infectious virus into the saliva. These findings suggest that despite demonstrating high molecular compatibility at the cellular level in Aedes mosquitoes, Ae. aegypti and Ae. albopictus are unlikely to serve as competent vectors for ENTV transmission because of strong midgut infection barriers. The clone presented in this manuscript should help clarify the mechanisms for transmission and maintenance of ENTV, which remain poorly understood.

A 15-year-old adolescent with sickle cell disease (SCD) presented at a tertiary care children's hospital with severe hemolysis after returning from West Africa. Over a period of 5 weeks, the patient experienced recurrent hemolysis, fever, and neuropsychiatric symptoms, with worsening conditions despite immunosuppressive and broad-spectrum antibiotic treatment. Eventually, cerebral malaria (CM) was diagnosed and treated, leading to a prompt recovery; however, another episode of hemolysis occurred 12 days after artesunate treatment. The unusually prolonged course of CM in this case illustrates the complex interplay among malaria, SCD, autoimmune hemolytic anemia, and various treatments. Furthermore, the case highlights challenges related to managing severe malaria in non-endemic countries and underscores the importance of timely malaria testing, especially in vulnerable patients with a suitable travel history. A thorough travel history is essential for the early diagnosis and appropriate management of malaria. Heightened awareness is needed among both high-risk travelers and healthcare providers to reduce malaria-related morbidity and mortality.

A 55-year-old male from El Salvador presented to an emergency department in the northeastern United States with diarrhea, vomiting, dizziness, and melena. Shortly after arrival, the patient's heart rate increased to 235 beats/min with a narrow QRS complex, which subsequently degenerated into a wide complex ventricular tachycardia (VT). Initial workup revealed severe transaminitis, reduced systolic function, and an anomalous right coronary artery. After extensive diagnostic workup, including cardiac magnetic resonance imaging and serologies, a diagnosis of Chagas cardiomyopathy was made. Given the presence of arrhythmogenic substrate and a high Rassi score for sudden cardiac death, the patient underwent placement of an implantable cardioverter-defibrillator (ICD) for secondary prevention of VT. This case underscores the increasing importance of considering Chagas disease in patients in the United States coming from endemic countries and the decision-making process regarding ICD placement in a patient with underlying Chagas-related cardiomyopathy.