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Journal articleMangal TD, 2027,
Redesigning service delivery for the next phase of HIV prevention.
, Lancet Glob Health -
Journal articleMcCain K, Topazian HM, Challenger JD, et al., 2026,
Public health impact of catch-up vaccination or additional booster doses with pre-erythrocytic malaria vaccine R21/Matrix-M: a modelling study
, BMC Medicine, Vol: 24, ISSN: 1741-7015Background The malaria vaccine R21/Matrix-M is recommended for young children in malaria-endemic regions. However, the small vaccine-eligible population and waning vaccine efficacy mean that routine vaccination is unlikely to prevent severe cases in older children who experience significant malaria burden. As R21/Matrix-M vaccination expands, targeting older age groups may be warranted, depending on funding. Methods Using a stochastic, individual-based P. falciparum malaria transmission model, we estimate the impact of 1) one-off catch-up campaigns with R21/Matrix-M to previously unvaccinated age groups between age 6 months and 14 years, and/or 2) extra boosters at 2, 5 and/or 10 years after the primary series in low, moderate, and high transmission settings. We assume that vaccine immunogenicity in older children is equivalent to that of the standard target age group, though clinical trials have shown lower immunogenicity in older children.ResultsCatch-up campaigns in moderate-to-high transmission settings targeting younger children averted the most uncomplicated cases per 1000 additional doses (358 (95% Credible Interval (CI) 113-570) in children aged 6 months-2 years at 45% PfPR2-10), compared with targeting older children. In low transmission settings, the impact was similar across age groups, with a slightly higher impact when targeting school-aged children (373 (95% CrI 240-518) in children aged 5-9 years at 5% PfPR2-10). Across extra booster strategies, an extra booster 10 years post-primary series averted the most severe cases per 1000 additional doses at low transmission (12 (95% CrI 6-18) at 5% PfPR2-10), but the least at high transmission (-4 (95% CrI -11-3) at 45% PfPR2-10). Expanding the vaccine-eligible population in areas of moderate-to-high transmission often had higher incremental efficiency than routine age-based vaccination at low transmission. Sensitivity analyses assuming lower immunogenicity in older children modestly reduced the per-dose impac
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Journal articleCidade JP, Taccone FS, Reyes LF, et al., 2026,
Immune dysregulation through longitudinal lymphocyte trajectories and their clinical determinants in hospitalized COVID-19 patients
, Intensive Care Medicine Experimental, Vol: 14Objective: Immune dysregulation plays a pivotal role in the pathophysiology of sepsis and COVID-19, with lymphopenia emerging as a consistent marker of severity and poor prognosis. However, most existing studies have assessed lymphocyte counts at isolated time points, limiting insights into their temporal behavior and prognostic value. The dynamics of lymphocyte recovery or persistence of lymphopenia remain largely unexplored in large populations, as well as the impact of adjunctive therapies such as corticosteroids. We hypothesized that the persistence or recovery of lymphopenia may be key to understanding disease progression and predicting outcomes. Using the multinational ISARIC cohort, we investigated longitudinal lymphocyte trajectories in hospitalized patients and the clinical determinants associated with their evolution over time. Methods: We conducted a multinational prospective observational cohort study using data from the ISARIC-WHO Clinical Characterization Protocol. Patients with confirmed SARS-CoV-2 infection and at least four lymphocyte measurements during the first 28 days of hospitalization were included. We analyzed lymphocyte trajectories, Cox regression survival analyses and multivariable linear regression modelling. We also applied multistate models and joint modeling to assess the association between lymphocyte trajectories and 28-day mortality, incorporating corticosteroid use as a time-varying covariate. Results: Of 945,317 screened patients, 231,933 hospitalized adults with confirmed COVID-19 and sufficient lymphocyte data were included, with 56.6% classified as lymphopenic. Lymphopenia was independently associated with higher rates of ICU admission, organ support, and in-hospital mortality (OR = 1.52, 95% CI 1.48–1.55), and lower absolute lymphocyte counts were strongly linked to worse survival in adjusted Cox models (HR = 1.33 per 1 × 10⁹ cells/L decrease, 95% CI 1.28–1.38). Multistate modeling revealed that lymphope
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Journal articleNgwili N, Kachepa U, Korir M, et al., 2026,
Spatial and temporal risk mapping of human and porcine Taenia solium infections in Malawi: a systematic review and geostatistical approach
, One Health Outlook, Vol: 8, ISSN: 2524-4655Background Taenia solium, colloquially called the pork tapeworm, is a zoonotic parasite with a human definitive host and a porcine intermediate host. Humans can become an aberrant intermediate host due to accidental ingestion of parasite eggs from the environment or through autoinfection, resulting in human cysticercosis (HCC), neurocysticercosis (NCC) if the central nervous system is infected. Pigs become infected with the larval stage, porcine cysticercosis (PCC), through the ingestion of parasite eggs shed by humans through defecation. Malawi has been classified as endemic for T. solium by the WHO based on the presence of key risk factors; however, the subnational distribution is not known. To ensure the appropriate resources are mobilized to support targeted future T. solium control measures in Malawi, there is a need to understand the variation in T. solium endemicity status across the country.Methods The current study uses a systematic literature review (SLR) using a pre-registered protocol; (PROSPERO CRD42023411044) to collate all available evidence on T. solium in Malawi. A geospatial risk mapping approach was conducted based on data from Malawi demographic health surveys (MDHS), and pig density data from the Food and Agriculture Organization (FAO) database to create geospatial risk maps of endemic subnational areas for 2000, 2004, 2010, and 2016. To create a single composite risk factor map for the four years from the MDHS, each parameter was plotted as a binary variable with the high or low risk categories and overlaid into a single composite risk factor classification. Additional data from hospital records on NCC and meat inspection records across several Agricultural Development Divisions (ADDs) were also collected.
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Journal articleFraser K, Cibrelus L, Horton J, et al., 2026,
Yellow fever outbreak potential in Djibouti, Somalia and Yemen: a mathematical modelling study
, BMC Global and Public Health, Vol: 4, ISSN: 2731-913XBackgroundThe importation of arbovirus diseases into new countries is a global concern. This risk is exacerbated by human movement and climate change effects. In the World Health Organization (WHO) Eastern Mediterranean regional office, three countries - Djibouti, Somalia, and Yemen - are currently classified as potential or moderate risk for yellow fever (YF) outbreaks.MethodsHere we present a quantitative assessment of the risk of introduction and propagation of yellow fever virus (YFV) transmission in Djibouti, Somalia and Yemen. This modelling has two components: i) projecting the risk of importation of infectious individuals into the countries of interest using a radiation model of human movement and ii) estimating the risk of onward transmission given importation using a dynamic compartmental model of yellow fever virus transmission. Both components are multiplicatively combined to give an overall relative outbreak risk combining both risk of importation and risk of an outbreak given importation.ResultsWe show that areas such as the western coast of Yemen, regions of Somalia bordering Ethiopia and Kenya, and Djibouti City have potential for YF outbreaks (where the estimated probability of an outbreak given an imported infectious case is over 50%). This is due to environmental suitability for transmission based on factors such as temperature and projected human mobility between endemic and at-risk regions.ConclusionsCountries bordering existing YF endemic regions are potentially vulnerable to both introduction of YF cases and subsequent outbreak spread. This promotes the awareness of YF importation potential when conducting clinical surveillance in at-risk countries.
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Journal articleTopazian HM, Morgan CE, Goel V, 2026,
Spatial and temporal associations between animal ownership and malaria prevalence in Africa using cross-sectional national Demographic and Health Surveys.
, One Health, Vol: 23, ISSN: 2352-7714Use of zooprophylaxis as a malaria control strategy has been recommended historically, but a complex relationship exists between animal ownership and malaria infection, with mixed associations described in the literature. We sought to characterize this relationship spatially and temporally in malaria-endemic regions of Africa. We used data from 392,843 individuals from 66 Demographic and Health surveys from countries within Africa to investigate the association between household animal ownership and Plasmodium infection. We used Bayesian models with Integrated Nested Laplace Approximation to incorporate spatially varying coefficient processes, allowing the association of interest to vary over space, time, and within strata of vector species occurrence, land cover, and number of animals owned by households. Spatially varying intercept models showed that ownership of cattle, chickens/poultry, goats, horses/donkeys/mules, pigs, and sheep was broadly associated with malaria infection, with odds ratios ranging from 1.55 to 1.67. However, spatially varying slope models revealed considerable heterogeneity, with odds ratio estimates for all animal types demonstrating both protective and harmful effects varying from 0.33 to 3.33 both subnationally and across time. We found no evidence that modification by vector species, number of animals owned, and land cover fully explained the variation in estimates. Unobserved localized cultural, behavioral, or ecological factors likely modify the association between animal ownership and malaria prevalence. Further exploring the nature of this relationship over space and time will be important to understanding how context-specific One Health dynamics between humans, animals and the environment affect malaria prevention and control efforts.
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Journal articleRamani A, Stapley J, Dixon-Zegeye M, et al., 2026,
Modelling anti-Ov16 seroprevalence for the control and elimination of onchocerciasis
, Nature Communications, ISSN: 2041-1723The World Health Organization aims to verify elimination of onchocerciasis transmission in 12 endemic countries by 2030. Serological assays detecting IgG4 antibodies against the Onchocerca volvulus Ov16 antigen guide decision-making regarding start- and stop-mass ivermectin treatment, post-treatment and post-elimination surveillance. Transmission models are crucial for understanding anti-Ov16 IgG4 seroprevalence dynamics. Uncertainty associated with the parasite stage(s) stimulating seroconversion and duration of antibody persistence has hitherto hindered progress. We use the individual-based stochastic transmission model, EPIONCHO-IBM, to test hypotheses regarding the timing of seroconversion and seroreversion. We fit the model to data from (treatment-naïve) Gabon and validate it using data from Togo (four decades of control). The best-fit hypothesis is that seroconversion is elicited by near-patent/patent infection. The duration of antibody persistence remains uncertain. Our findings support the use of mechanistic transmission models to refine serological thresholds for start-and stop-treatment, and aid interpretation of post-treatment and post-elimination surveillance serological signals.
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Journal articleChallenger J, Biggs J, Skarp J, et al., 2026,
Combining statistical and dynamical modelling to guide the design of cluster randomised trials for malaria
, BMJ Global Health, ISSN: 2059-7908 -
Journal articleCuartero CT, Lambert JW, Cuomo-Dannenburg G, et al., 2026,
The impact of ambiguously reported epidemiological parameters for infectious disease modelling and recommended best practices
, Epidemics, ISSN: 1755-4365Epidemiological parameters characterise the natural history, transmission and severity of a pathogen and are necessary to understand the spread of infectious diseases. These parameters underpin our ability to quantify and respond to disease outbreaks. Parameters can be estimated from observations using a range of methods and are often reported in varied ways throughout the literature. These parameter estimates constitute essential inputs to infectious disease models used to quantify and project disease spread and burden, and assess intervention impact. Hence, any incompleteness or ambiguity in reported parameter estimates can have downstream consequences on the inferences drawn from the models that use these estimates. We summarise common issues with incomplete or ambiguous reporting of epidemiological parameter estimates and illustrate the impact through five case studies. Specifically, we show that in many instances, misinterpreting parameters reported in the literature can lead to biased conclusions that mislead subsequent public health responses. Additionally, we provide recommendations on how to clearly communicate common epidemiological parameter estimates consistently and reproducibly, to maximise their secondary use and comparison, in turn minimising erroneous extraction from the literature and application in epidemiological analysis.
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Journal articleShah A, 2026,
PRESIDE protocol: a global registry of antimicrobial resistance in chronic lung disease
, ERJ Open Research, ISSN: 2312-0541Antimicrobial resistance (AMR) is an escalating global health threat. Chronic lung diseases (CLDs) represent a key area in which AMR poses unique and often underestimated challenges, yet high-quality epidemiological data remain scarce. To address this gap, the European Respiratory Society Clinical Research Collaboration on AMR in Lung Infections (AMR-Lung CRC) has developed PRESIDE, an international prospective observational registry designed to evaluate the prevalence and burden of AMR in patients with CLD. PRESIDE is a global, multicentre study recruiting paediatrics and adults with CLD who have undergone respiratory microbiological testing as part of routine clinical care within the year prior to data collection. Participating centres enroll patients during two-week recruitment periods, held twice yearly over five years from 2025 to 2030. The registry captures a comprehensive set of core variables, including demographics and smoking history, CLD type and aetiology, microbiological history, comorbidities, clinical characteristics, therapeutic exposures, and respiratory microbiology results.This registry aims to generate robust, prospective, real-world evidence on AMR epidemiology in CLD, enabling comparison across regions and disease phenotypes. Findings are expected to inform clinical decision-making, support antimicrobial stewardship, and guide the development of context-specific guidelines and public health strategies. Ultimately, PRESIDE seeks to strengthen global efforts to address AMR in chronic respiratory infections and improve outcomes for patients with CLD.
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