Travel has been increasing globally since the COVID-19 pandemic ended, including travel from the Gulf Cooperation Council (GCC) countries to international destinations. This creates unique risks for travelers, who may return with various infectious diseases. Travel medicine is a well-established medical specialty worldwide; however, it has only recently been introduced within the GCC, with limited healthcare and public awareness of the importance of these services in preventing infectious diseases among international travelers. This document presents travel medicine recommendations for practicing clinicians in the GCC to help prevent these diseases through pre-travel consultation.

This review summarizes the development of an oral inactivated enterotoxigenic Escherichia coli (ETEC) vaccine, ETVAX, describing its progression from preclinical evaluation of vaccine components in animal models to clinical assessment of safety, immunogenicity and, ultimately, protective efficacy in first- and second-generation formulations. Multiple Phase 1 and Phase 2 clinical trials conducted, initially in Swedish adults and subsequently in adults and children in Bangladesh and several African countries (Egypt, Zambia and The Gambia), have shown that the candidate vaccines are well tolerated, safe and capable of inducing robust intestinal or intestine-derived immune responses against the included antigens in most vaccine recipients. ETVAX, developed based on the results gained from studies of the first- and second-generation candidate vaccines, comprises four inactivated E. coli strains engineered to overexpress the most prevalent colonization factors combined with a toxoid and a mucosal adjuvant. Recent trials have shown that ETVAX confers significant protection against moderate-severe ETEC-associated diarrhea in young children in The Gambia and in travelers to Benin in Africa, underscoring its potential value both for endemic populations and travelers.

Background: Inappropriate antibiotic use contributes significantly to antibiotic resistance (ABR), particularly in low- and middle-income countries. Understanding community-level knowledge, attitudes, and practices is essential for designing effective interventions. This study assessed Knowledge, Attitudes and Practices (KAP) related to antibiotic use, with consideration of awareness of antibiotic resistance, in Montserrado County, Liberia. Methods: A community-based cross-sectional survey was conducted among 1160 adults in Montserrado County, Liberia, using a structured questionnaire to assess knowledge, attitudes, and practices (KAP) related to antibiotic use and antibiotic resistance. Composite KAP scores were calculated from Likert-scale items and subsequently categorized into ordered levels (poor, moderate, and good) based on percentile thresholds. Ordinal logistic regression was used to examine associations between sociodemographic characteristics and KAP outcomes. Results are presented as crude and adjusted odds ratios (COR, AOR) with 95% confidence intervals (CI), and statistical significance was set at p < 0.05. Results: Participants demonstrated moderate knowledge, with correct identification of antibiotic use for bacterial infections (skin infections: 78.8%; ear infections: 76.8%), but widespread misconceptions were observed, including use for colds and flu (73.6%) and diarrhea (80.7%). Attitudes were mixed, with many recognizing inappropriate use, yet expectation-driven demand remained common (62.7% dissatisfied when antibiotics were not prescribed; 80.9% willing to suggest antibiotics to clinicians). Practices were inconsistent, with both appropriate and inappropriate behaviors reported. While 46.2% of participants always completed antibiotic courses, inappropriate practices were frequent, including antibiotic use for common symptoms (38.6%), preventive use (37.2%), and self-medication without prescription (20.1% always). In multivariable analysis, older age was associated with higher knowledge (AOR = 3.82, 95% CI: 1.26-11.1), while lower education predicted poorer knowledge and practices (e.g., AOR = 0.25, 95% CI: 0.07-1.00). Urban residence was associated with poorer practices (AOR = 0.42, 95% CI: 0.29-0.61). Conclusions: While overall knowledge of antibiotic use in Montserrado County is moderate, critical misconceptions remain, and appropriate practices are inconsistent. Weak relationships between knowledge, attitudes, and practices highlight the limitations of knowledge-based interventions alone. Efforts to improve antibiotic use should address structural drivers, including access to antibiotics, healthcare-seeking behavior, and regulatory enforcement, through targeted and context-specific strategies.

Eosinophilic gastrointestinal diseases (EGID) are characterized by abnormal and prominent eosinophilic inflammation of the gastrointestinal mucosa, associated with symptoms related to the segment involved, in the absence of secondary causes of eosinophilia. EGID may affect different parts of the gastrointestinal tract, causing eosinophilic oesophagitis (EoE), eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis either individually or in combination. Secondary causes of eosinophilic infiltration of the gastrointestinal tract include parasitic infections, the use of certain medications, vasculitis, allergic syndromes, haematological conditions and other inflammatory diseases. The incidence of EGID is increasing globally. EoE is the most reported form, with a prevalence of ~1 in 700 individuals. Several pathogenetic mechanisms are being investigated, in particular, the crosstalk between aeroallergens and mucosal inflammatory cell activation, which leads to a T helper 2 cell inflammatory response and disruption of epithelial barrier integrity. EGID is frequently associated with other T helper 2 cell-driven disorders, such as atopic dermatitis, allergic rhinitis and asthma. EGID is diagnosed through histological assessment, with biopsy samples of affected areas typically showing increased eosinophils, after excluding secondary causes of eosinophilia. For EoE, new treatments, including biologic therapies, are now available, whereas therapeutic options for non-EoE EGID remain limited. Patients' quality of life may be impaired owing to social and functional limitations from symptoms, such as dysphagia and food impaction in EoE, or diarrhoea and abdominal pain in eosinophilic colitis.

The FIFA World Cup™ 2026 in Mexico will be a major public health challenge worldwide. Large gatherings can facilitate the spread of diseases, raise the number of cardiovascular emergencies caused by stress, and require careful monitoring of vaccine-preventable illnesses, particularly given ongoing concerns about measles and pertussis. This editorial article reviews lessons learned from past events and highlights the need to improve food safety, mental health support, and active disease surveillance. The healthcare system's success will depend on how well it can respond and plan to manage the risks that come with people traveling from around the world.

Foodborne diseases are a significant public health concern during mass gatherings, including the Arbaeen pilgrimage in Karbala, Iraq. This study aimed to investigate the prevalence and associated risk factors for foodborne disease among Iranian pilgrims attending the Arbaeen ceremony. A cross-sectional survey was conducted among 1,030 pilgrims via structured questionnaires. The questionnaire included sections on demographic information, potential risk factors, KAP scores (knowledge, attitudes, and practices) related to food safety, and symptoms and severity of foodborne disease. Logistic regression analysis was conducted to identify risk factors associated with moderate to severe foodborne disease. The prevalence of foodborne disease was 23.2%, with 9.4% of participants experiencing moderate disease and 6.7% experiencing severe disease. The most common symptoms included headache (42.5%), abdominal pain (27.0%), nausea (21.4%), and diarrhea (20.7%). Significant risk factors for foodborne disease included lower education levels (OR = 2.23), first-time travel (OR = 1.65), longer trip durations (OR = 4.33), and consumption of unpackaged water (OR = 5.23). Pilgrims with poor to moderate food safety practices were 2.10 times more likely to experience foodborne disease. The findings suggest that improvements in food and water safety, along with targeted education campaigns for vulnerable groups, could reduce foodborne illnesses during mass pilgrimages. Public health interventions should focus on enhancing food handling practices and ensuring safe drinking water access, particularly for first-time travelers, elderly individuals, and those with lower education levels.