Evidence describing paediatric COVID-19 and influenza co-infection is limited because influenza circulation was minimal during the early COVID-19 pandemic. We used the National Clinical Cohort Collaborative, a multicentre electronic health record repository, to describe the characteristics and clinical outcomes of paediatric COVID-19 and influenza co-infections in the United States from March 2020-April 2024. We defined co-infection as COVID-19 and influenza identified <7 days apart. We reported demographics, pre-existing diagnoses, and clinical outcomes and used generalized estimating equation models. We defined clinical outcomes as Severe/Moderate disease (hospitalization, critical care, or death) versus emergency department/outpatient encounters. We repeated analyses using varying co-infection definitions to assess robustness of findings. Among 1.53 million patients, 10,277 were co-infected, and 647 (6%) were hospitalized. Co-infections occurred predominantly among children aged <12 years. The most common pre-existing diagnoses were obesity (24%), asthma (10%), and congenital/genetic conditions (5%). The risk for Severe/Moderate disease was greatest among persons aged 0-4 years (adjusted risk ratio (aRR) 3.05; 95% confidence interval (CI): 2.35-3.97) and those with ≥2 pre-existing diagnoses (aRR 2.89; 95% CI: 2.43-3.43). Similar distributions of disease severity were observed across varying co-infection definitions. This study provides a large-scale epidemiological characterization of paediatric COVID-19 and influenza co-infection and successfully implemented a practical EHR-based co-infection case definition for future analyses.

Between 2023 and 2025, four outbreaks of zoonotic Cryptosporidium parvum infection involving 39 laboratory-confirmed cases occurred at a single animal-contact visitor attraction in South West England. A retrospective outbreak investigation, incorporating elements of a descriptive case series, was undertaken to identify factors associated with repeated transmission and to draw insights for infection prevention and control. The study integrated epidemiological, veterinary, environmental, and molecular data, including exposure questionnaires, animal faecal testing, environmental sampling, observational assessments, and genotyping of human and animal isolates. Zoonotic gp60 subtype IIaA15G2R1 predominated across outbreaks. In the fourth outbreak, identical gp60 subtypes and shared multiple-locus variable-number tandem-repeat analysis alleles in lamb and human samples supported zoonotic transmission. Environmental sampling identified faecal indicator organisms and Shiga toxin-producing E.coli on high-touch surfaces. An observational assessment identified frequent opportunities for faecal-oral exposure during close contact with young ruminants. Despite compliance with industry standards, persistent environmental contamination, in-pen contact, and child behavioural factors were identified as plausible contributors to transmission. These findings highlight the challenges of preventing zoonotic infection in this setting and support refinement of existing guidance.

The World Health Organization (WHO) has set global goals to eliminate AIDS and viral hepatitis as public health threats. To better target testing, intelligence on missed opportunities for early diagnosis is needed. We determined hospital and emergency department (ED) attendance before late diagnosis of blood-borne viruses (BBVs) in Scotland 5 years to 2 months prior to diagnosis. Late diagnoses were defined as: CD4 count <350 cells/cmm within 90 days of HIV diagnosis; presentation/death from cirrhosis or hepatocellular carcinoma within 1 year of hepatitis C (HCV)/hepatitis B (HBV) diagnosis. Associations were assessed using logistic regression. Among 543 people diagnosed with HIV 37% were late and 2% of people diagnosed with HCV (4,379) and HBV (1,608) were late. Among late diagnoses: 44.1% of HIV, 60.6% of HCV, and 50% of HBV cases previously attended ED and 27.0% of HIV, 46.5% of HCV, and >30% of HBV cases were previously admitted to hospital. The majority were admitted to hospital or attended ED multiple times. Among people newly diagnosed with HIV, those diagnosed late were more likely to have previously attended ED (aOR: 1.41, CI: 0.99-2.02). Further effort is warranted to address the frequent missed opportunities for earlier BBV diagnosis in secondary care.

This study aimed to evaluate the efficacy of DHP as an alternative to SP for the prevention of malaria and malaria-related complications during pregnancy. A systematic review and meta-analysis were conducted using pooled effect sizes extracted from published studies. Compared to SP, DHP significantly reduced maternal malaria infection by 78% (RR 0.22, 95% CI: 0.09-0.55), placental malaria infection by 73% (RR 0.27, 95% CI: 0.08-0.98), and maternal anaemia by 16% (RR = 0.84, 95% CI: 0.79-0.89). Women randomized to the DHP arm had a 28% lower risk of foetal loss (RR 0.72, 95% CI: 0.40-1.31), a 4% lower risk of low birth weight (RR 0.96, 95% CI: 0.69-1.32), and a 17% lower risk of preterm births compared with those receiving SP (RR 0.83, 95% CI: 0.61-1.13), though the reduction was not statistically significant. Therefore, DHP appears to be more effective than SP as IPTp therapy for reducing maternal malaria infection, placental malaria infection, and maternal anaemia. However, this study does not significant advantage of DHP over SP in reducing adverse birth outcomes.

In 2017-2018, New South Wales (NSW), Australia, experienced a hepatitis A virus (HAV) outbreak predominantly affecting men who have sex with men (MSM). We aimed to estimate immunity and identify immunity gaps among MSM in NSW. We triangulated four data sources. We tested 409 residual sera collected from males undergoing syphilis testing between August and October 2017 for anti-HAV IgG. We surveyed all publicly funded sexual health clinics about HAV testing and vaccine provision for the preceding financial year. We conducted a convenience behavioural survey of 50 men at a sex-on-premises venue in October 2017, and we analysed community survey data from 2018 to 2019 (n = 5,924). Descriptive statistics and logistic regression ere used to examine associations with immunity and vaccination. Overall serological immunity was 62.8% (257/409) and increased with age, from 50.0% in those aged under 26 years to 79.0% in those over 45 years. Clinic immunity and community survey estimates were higher (74.5% and 76.8%). Immunity gaps were identified among bisexual men, those less connected to the gay community, and people born outside Australia. NSW Health implemented targeted vaccination and community engagement in response. Multisource assessment provided actionable evidence to guide targeted vaccination and outbreak response.

On 4 December 2023, trichinellosis cases were notified in Jahliyeh, Mount Lebanon. We investigated to determine the source, magnitude, and control measures. We defined a suspected case as a Jahliyeh resident with ≥1 compatible symptom diagnosed by a physician after 1 October 2023; a probable case as having ≥3 typical symptoms (fever, myalgia, edema, or eosinophilia); and a confirmed case as a suspected or probable case with laboratory confirmation by muscle biopsy or serology. We surveyed reachable households (252/561) to identify cases and assess meat consumption practices, inspected local butcheries, and tested meat samples. We identified 290 cases: 268 (92%) suspected, 21 (7.2%) probable, and 1 (0.3%) confirmed. Median age was 35 years (range 2-85); 34% required hospitalization. Illness was associated with Butchery A meat (risk ratio [RR] = 8.2; 95% confidence interval [CI]: 5.6-12.1) and uncooked meat (RR = 1.9; 95% CI: 1.4-2.6), while freezing and cooking were protective. Food inspection revealed major hygiene breaches at Butchery A and Trichinella larvae in minced beef and sausage. This outbreak was epidemiologically confirmed despite limited laboratory confirmation in humans. We recommend strengthening food safety inspections, intersectoral One Health collaboration, laboratory capacity, and public awareness of safe meat preparation.

This study estimated the incidence rate (IR), case fatality rate (CFR), healthcare resource utilization, and costs of pneumococcal disease before and after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) into Taiwan's childhood immunization programme (CIP) in 2015. Adults aged ≥18 years hospitalized with invasive pneumococcal disease (IPD) and pneumonia from 2011 to 2019 were identified from the Taiwan National Health Insurance Research Database. Baseline and trend of IRs were compared between pre-introduction (2011-2014) and post-introduction (2016-2019) of PCV13 using interrupted time series analyses and incidence rate ratio (IRR). Annual IRs for IPD and pneumonia ranged from 1.59 to 1.82 and 3.91 to 4.47 episodes per 100,000 person-years in the pre-PCV13 period, respectively. In the post-PCV13 period, they ranged from 1.23 to 1.37 and 3.20 to 3.95 episodes per 100,000 person-years, respectively. There was a significantly lower baseline IR in the post-PCV13 period for both IPD (IRR = 0.76; 95% confidence interval [CI]: [0.63, 0.93]) and pneumonia (IRR = 0.87; 95% CI: [0.77, 0.98]). However, a marginal increase in the trend of IR was observed during the post-PCV13 period for both IPD (IRR = 1.02; 95% CI: [1.00, 1.03]) and pneumonia (IRR = 1.02; 95% CI: [1.01, 1.03]). Estimated CFRs were lower in the post-PCV13 period for both diseases. The clinical burden remains substantial after the introduction of PCV13 into Taiwan's CIP.

The infection fatality risk indicates the probability of death among infected individuals. The age-dependent heterogeneity of infection fatality risk is crucial for severity assessment and prioritization of countermeasures. However, infection fatality risk estimation requires infection data from a large-scale seroepidemiological survey combined with either direct ascertainment of deaths caused by infection or excess mortality estimates. To overcome the difficulty in ascertaining death, we propose an alternative approach to estimating the age-specific infection fatality risk for SARS-CoV-2 using medicolegal death investigation data in Tokyo with systematic post-mortem polymerase chain reaction testing. We integrated (i) polymerase chain reaction positivity among all deceased individuals at the Tokyo Medical Examiner's Office, (ii) age-specific all-cause mortality risks from vital statistics, and (iii) age-stratified cumulative infection risks derived from seroepidemiological surveys. Infection fatality risk was computed using Bayes' theorem. Results showed that infection fatality risk increased steeply with age. Our estimates (0.02% for ages 0-39 years, 0.30%-0.50% for ages 40-64 years, and 3.8%-4.2% for those aged ≥65 years) were consistent with published pre-vaccination meta-analytic estimates. Systematic testing within medicolegal death investigation systems can provide rapid, age-resolved severity assessments, improving the timeliness and comparability of infection fatality risk estimation across jurisdictions.

Maternal syphilis and congenital syphilis (CS) have been increasing globally, but there are limited data from Fiji. We performed secondary analysis of clinical trial data of intrapartum azithromycin given to pregnant women to determine the prevalence of maternal syphilis and estimate the incidence of probable CS. Healthy, pregnant women at a tertiary hospital were routinely tested for syphilis, and their infants, were enrolled between July 2019 and January 2022. World Health Organisation case definitions for maternal and CS were used. Of the 2112 women enrolled, 2073 (98.2%) were tested for syphilis; 82.7% (n = 1715) were iTaukei (indigenous Fijians), and the median age was 27 years (interquartile range [IQR] 23-32). The maternal syphilis prevalence was 6.6% (n = 137). The majority (85.4%, n = 117) of women with positive serological result received at least one dose of benzathine penicillin 30 days prior to delivery. There were 139 infants born to mothers with positive serological results. The 2.5-year pooled incidence of probable CS was 212 per 100000 livebirths. Confirmation of CS was not possible as results of polymerase chain reaction test of cerebrospinal fluid were not available. Fiji has a substantial burden of maternal and CS. To eliminate mother-to-child transmission, improvements in testing and follow-up are needed, along with comprehensive data and confirmatory testing to accurately determine disease burden.

Spatial risk models for Lassa fever (LF) generally predict the primary reservoir, Mastomys natalensis, is restricted to rural landscapes. This study integrates multispecies biotic interactions and anthropogenic land-use into a high-resolution framework to evaluate LF's urban potential. I implemented an integrated multispecies occupancy model to reconstruct the reservoir's realized niche, accounting for sampling bias and invasive rodent competitors. A socio-economic filter, proxied by night-time lights, was introduced to model the dampening effect of urban infrastructure on spillover. Annual infections were estimated using a demographic compartmental model incorporating empirical seroreversion rates. Results indicate high biological hazard across the peri-urban fringes of major West African cities. However, an infrastructure-driven socio-economic shield decouples this hazard from human incidence in dense urban cores. Accounting for spatial shielding and antibody waning yields an estimated 2.6 million annual Lassa virus infections. Comparing predictions to clinical data reveals substantial surveillance gaps, identifying highly suitable silent districts in Nigeria, Benin, and Togo with zero reported cases. LF possesses the biological potential to become a peri-urban disease; addressing these surveillance gaps at the peri-urban interface is a critical public health priority.

Mpox has evolved into a global public health concern following rapid geographic expansion and altered clinical and epidemiological characteristics. The 2022 outbreak of monkeypox virus (MPXV) marked the first widespread expansion to non-endemic regions, particularly among men who have sex with men (MSM). In the Democratic Republic of the Congo (DRC), where Clade I MPXV is endemic, data on urban exposures are limited. We evaluated serologic evidence of exposure using a four-plex MPXV assay among 1,823 participants from two major DRC cities, Kinshasa and Goma, between April and June 2024. Of these participants, 523 (28.7%) self-identified as MSM, 498 (27.3%) as professional sex workers (SW), 107 (5.9%) as MSM and SW, and 695 (38.1%) as other at-risk individuals. Overall, 2.9% of participants were seroreactive. By subpopulation, 4.8%, 2.1%, and 1.7% of at-risk, MSM, and SW participants were seroreactive (p = 0.0086). Classification tree modelling identified age as the strongest predictor of reactivity, with higher MPXV seroreactivity in older participants. These data provide evidence of mpox seroreactivity prior to sustained human-to-human transmission in urban settings. Understanding exposure dynamics is critical for anticipating re-emergence of mpox in global cities where interpersonal networks may sustain transmission even in the absence of zoonotic spillover.