American Journal of Tropical Medicine and Hygiene最新文献

The American Society of Tropical Medicine and Hygiene (ASTMH) established its Green Task Force (GTF) in 2019 and adopted its Green Statement in 2021 in consultation with the GTF to encourage collective efforts for mitigating climate change as a professional society. The GTF highlighted how climate action aligns with the society's mission to improve global health in a perspective piece published in 2022. The GTF conducted a survey in 2022 to assess the concerns of the ASTMH community surrounding climate change and the potential role of the society in addressing them. The majority of survey participants reported moderate to extreme concern about climate change as well as a negative impact of climate change on their global health work. Survey results demonstrated strong agreement for ASTMH to lead through interdisciplinary research, capacity building through training and education, development of decarbonization guidelines (particularly for laboratories), and advocacy for wider climate action.

Cervical cancer is a malignancy with a well-established viral origin linked to high-risk human papillomavirus (HPV) types. Globally, there are 348,709 estimated deaths among 662,301 cervical cancer cases. India faces a disproportionately high burden, contributing to 79,906 of these deaths and accounting for over 22% of global deaths. The nation's high mortality rate is attributable to the low rate of cervical cancer screening and HPV vaccination uptake. There is a greater impact of cervical cancer on those of lower socioeconomic status and a cultural stigma surrounding sexually transmitted infections. We recommend a comprehensive cervical cancer prevention strategy, including screening programs, culturally sensitive education for patients and providers, government-endorsed HPV vaccination, and continuing studies on diagnostics and vaccination in the Indian context.

Soil-transmitted helminths (STHs) remain a major public health concern, especially in low- and middle-income countries. Although Ascaris lumbricoides, Trichuris trichiura, and hookworms (Ancylostoma duodenale and Necator americanus) are commonly identified in humans, emerging evidence using molecular diagnostics capable of differentiating morphologically similar ova suggests zoonotic drivers of transmission, particularly in areas with close human-animal interaction. This pilot study investigated human and animal STH infections across nine villages of Meghalaya in the northeastern region of India, using quantitative polymerase chain reaction with species-specific primers. The estimated STH prevalence was 23.3% (95% CI: 17.9-29.9%). Zoonotic potential was evident, with Ancylostoma ceylanicum detected in humans (2.8%), and Ascaris spp. and Necator americanus detected in pigs (64.5% and 3.2%, respectively) and goats (15.2% and 3.0%, respectively). To meet World Health Organization's target of eliminating STH morbidity by 2030, endemic regions may need to adopt an integrated One Health approach.

Dihydroartemisinin-piperaquine (DP), the first-line treatment for uncomplicated malaria in Timika, Papua, Indonesia, has also been used for intermittent preventive treatment in pregnancy (IPTp-DP) since February 2022. Concerns about the potential emergence of drug resistance associated with this dual policy prompted the present study, which was conducted to assess DP efficacy in treating uncomplicated Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax) malaria in the general population 15 months after IPTp-DP was introduced. Between May and December 2023, the current study recruited 75 P. falciparum and 75 P. vivax malaria patients, who received supervised DP treatment for 3 days. Clinical and laboratory data were collected daily (on days 1, 2, 3, and 7) and then weekly for 6 weeks. Molecular analysis was performed to detect genetic markers of P. falciparum resistance to DP and distinguish between recrudescence and reinfection. A total of 68 P. falciparum and 58 P. vivax patients completed their day 42 follow-up. The cumulative risk of same-species recurrence by day 42 was 1.5% (95% CI: 0-7.9%) in P. falciparum patients (polymerase chain reaction-adjusted) and 5.2% (95% CI: 1.1-14.1%) for P. vivax patients (unadjusted). No patients exhibited parasitemia on day 3. No P. falciparum isolates carried kelch 13 gene mutations or exhibited increased plasmepsin 2-3 copy numbers on either day 0 (0/75) or at recurrence (0/2). At the current level of IPTp-DP coverage (824 doses administered), there was no evidence of high treatment failure rates or the selection of resistant parasites in patients with uncomplicated malaria treated with DP. Continuous monitoring of DP efficacy remains crucial for both treatment and chemoprevention.

The ambiguous clinical presentation of leptospirosis poses challenges for accurately assessing the global burden of this emerging disease. As a result, leptospirosis has not been recognized for inclusion in the WHO's neglected tropical diseases list. This underscores the urgent need for a diagnostic biomarker for early detection of illness and well-defined estimation of disease burden in urban and low-income settings. The recently discovered PF07598 gene family encoding virulence-modifying proteins (VMPs), including full-length LA3490, its truncated N-terminal ricin-binding lectin (RBL) domain, and a natural variant encoding only the C-terminal domain (LA0591), was evaluated for its potential to detect anti-VMP-specific IgG antibodies in early infection. The study was conducted on a well-characterized sample of febrile patients from Sri Lanka, with leptospirosis confirmation by microscopic agglutination test (MAT) and Quantitative PCR. The sample included 113 confirmed cases, 45 probable cases, 75 febrile patients, and 41 healthy subjects. Among confirmed cases, mean ELISA optical density (OD) values for LA0591, LA3490, and RBLs were 1.045 (standard error [SE]: 0.063), 0.835 (SE: 0.032), and 0.536 (SE: 0.019), respectively, compared with 0.261 (SE: 0.043), 0.697 (SE: 0.026), and 0.303 (SE: 0.019) in healthy subjects. Anti-VMP antibodies were detectable as early as day 2. In seroconversion cases, ELISA OD for LA0591 in acute MAT-negative samples was 1.347, comparable with high MAT titers. ROC analysis showed AUCs of 0.947 for LA0591 and 0.930 for LA3490, confirming their reliability as diagnostic markers. LA0591 demonstrated superior sensitivity, specificity, and early diagnostic capability, establishing it as a valuable tool for leptospirosis detection.

Acute undifferentiated febrile illness (AUFI) is associated with several etiological agents, including vector-borne pathogens. In tropical areas endemic for multiple pathogens, it is difficult to efficiently determine the etiology of AUFI. The goal for this study was to diagnose several arboviruses and other pathogens in patients with AUFI in Yucatan, Mexico, during the final phase of the coronavirus disease 2019 pandemic. A total of 215 patients with AUFI were included, with 170 from the urban area of Merida City and 45 from the rural area of the Molas community. Between December 2022 and December 2023, subjects were enrolled at health facilities, one in the rural area and two in the urban area. Overall, 36.7% (79/215) of AUFI patients were confirmed to have dengue virus (DENV). A significant difference (P <0.05) was found in the prevalence of dengue in the urban area (84.8%) compared with that in the rural area (15.2%). When diagnosed patients were grouped by age, most cases occurred in young adults (17-29 years old). Acute infections caused by Leptospira interrogans (L. interrogans) serovars Bratislava and Australis, Rickettsia spp., and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were also identified in patients with AUFI. In Merida City, five cases of multiple infections were found with dengue, SARS-CoV-2, and L. interrogans serovars Bratislava and Australis. In conclusion, DENV was confirmed as the main causative agent of AUFI in the present study; however, the simultaneous circulation of other relevant endemic causal agents that cause febrile infections in the area is a key point to consider when making differential diagnoses.

Identifying viable infections in neurocysticercosis (NCC) is crucial for treatment. Neuroimaging is the primary diagnostic tool, but it is not widely available. Moreover, in many cases, imaging diagnosis is not pathognomonic and requires serological confirmation. The serological assay of choice, enzyme-linked immunoelectrotransfer blot using lentil lectin-purified glycoprotein (LLGP-EITB) Taenia solium antigens to detect specific antibodies, exhibits high predictive values for the presence of viable NCC when the results are positive for multiple (>3) antibody bands; it also exhibits high predictive values for the absence of viable infection when the results are negative or the test reacts to a single antibody band. However, its interpretation in terms of viable infection is limited in cases with two or three positive bands (intermediate results), which occur in one-quarter of patients with NCC. The quantification of specific antibodies could allow for the identification of viable infections. Using a multi-antigen, quantitative multiplex bead assay, antibody levels were measured against Taenia solium proteins rGP50, rT24H, and sTs18var1 in 94 patients with intermediate LLGP-EITB results. The antibody-to-rT24H (25.96 versus 5.49; P = 0.0048) and antibody-to-sTs18var1 ratios (3.62 versus 1.37; P = 0.0083) were higher in subjects with viable cysticerci than in controls. Patients with high antibody levels against the proteins rT24H and sTs18var1 were 5.4 times more likely to have a viable infection than those with low antibody levels. The quantification of antibodies against rT24H and sTs18var1 can help define a viable NCC infection.

Tuberculosis (TB) remains a leading cause of morbidity and mortality in sub-Saharan Africa. Community pharmacies, which are often the first point of contact for people with TB, are underutilized in expanding TB care. Engaging community pharmacies in TB care could facilitate personalized adherence counseling, the timely detection and reporting of medication side effects, and the integration of TB and HIV services for individuals with both TB and HIV. Pharmacies can reduce stigma and address social and psychological barriers by offering person-centered care in convenient, accessible settings, including for working people and hard-to-reach communities. Integrating community pharmacies into national TB programs could strengthen adherence, reduce loss to follow-up, improve case detection, and help achieve End TB Strategy goals. The authors of the present study advocate for deliberate policy, training, and data linkages to realize this scalable opportunity, including implementation research.

Virus-associated infections remain a major burden of childhood morbidity and mortality in sub-Saharan Africa. This exploratory, population-based study used programmable phage immunoprecipitation and sequencing to simultaneously evaluate the antibody response to multiple viruses in dried blood spots from 251 children aged 12 to 59 months who were previously enrolled in the Community Health with Azithromycin Treatment trial conducted in Burkina Faso from 2019 to 2023. Linear mixed effects models, with cluster as the random effect, were used to examine associations between viral antibody response and age, sex, time points (before and after the onset of the severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] pandemic), and azithromycin mass drug administration (MDA). Sero-reactivity to SARS-CoV-2 was negatively correlated with age in months (β coefficient: -1.43; 95% CI: -2.03 to -0.84; Padj <0.001), but not to sex (β coefficient: 4.63; 95% CI: -11.90 to 21.17; Padj = 0.58) or azithromycin MDA (β coefficient: -9.43; 95% CI: -27.56 to 8.71; Padj = 0.45). Immunoreactivity to the respiratory syncytial virus (RSV) did not appear to be altered after the emergence of SARS-CoV-2 (β coefficient: 39.26; 95% CI: -0.20 to 78.72; Padj = 0.31). In addition, no detectable differences in the sero-reactivity to poliovirus 1 were observed with azithromycin MDA (β coefficient: 17.86; 95% CI: -25.35 to 61.07; Padj = 0.82). Although an association was observed between sero-reactivity to SARS-CoV-2 and age, the emergence of SARS-CoV-2 did not appear to alter the antibody response of preschool children in Burkina Faso to RSV or poliovirus vaccine uptake. Longitudinal studies in other at-risk populations in sub-Saharan Africa may improve mechanistic understanding and preventive strategies to decrease childhood morbidity.

Although maternal influenza vaccination can prevent influenza morbidity and mortality, data are limited on vaccine efficacy/effectiveness against severe disease in low- and middle-income countries (LMICs) at the community level. We evaluated the impact of maternal influenza vaccination on maternal influenza disease severity across seasons in a rural subtropical area in South Asia by analyzing data from a vaccine clinical trial conducted between 2011 and 2014 in Sarlahi District, Nepal. Participants were randomized 1:1 to trivalent seasonal influenza vaccine or saline placebo and followed through 180 days postpartum. Weekly household-based active respiratory surveillance was conducted; if participants reported fever and respiratory symptoms, a midnasal swab was collected and tested for influenza using reverse transcription polymerase chain reaction. Among 3,693 participants (n = 1,847 vaccine; n = 1,846 placebo), we detected 75 influenza illness episodes, including 40 with care seeking and 22 with fever for more than 3 days. Using proportional hazards regression, maternal influenza vaccination reduced the estimated hazard of influenza-associated care-seeking visits and fever for more than 3 days by 36% and 21%, respectively, compared with placebo; however, these differences were not statistically significant. The estimated numbers needed to vaccinate to prevent one influenza illness with care seeking and fever for more than 3 days were 224 and 785, respectively, at 270 days postvaccination. These findings suggest that maternal immunization may reduce the risk of moderate influenza illness among pregnant/postpartum individuals in LMICs, particularly in rural areas where access to care is limited.