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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 articleSilva L, Gogoi M, Lal Z, et al., 2026,
Antibiotic knowledge among ethnic minority groups in high-income countries: A mixed-methods systematic review.
, Public Health Pract (Oxf), Vol: 11OBJECTIVES: Antimicrobial resistance (AMR) is a major global public health concern. Although low-income countries are disproportionately affected by AMR, certain underserved groups in high-income countries (HICs), such as migrants and ethnic minorities, disproportionately bear the burden of AMR. This may be driven by socio-cultural factors including differences in health literacy. This review aimed to investigate the level of antibiotic knowledge amongst different ethnic minority groups in HICs. STUDY DESIGN: This was a mixed-methods systematic literature review. METHODS: We searched four databases (MEDLINE, EMBASE, the Cochrane library, CINAHL) to May 5, 2023, for primary studies on knowledge of antibiotics in different ethnic groups in HICs. We included studies in English using qualitative, quantitative and/or mixed-methods approaches and reporting on antibiotic knowledge by ethnicity. We used the convergent integrated approach for data synthesis and the Mixed-Methods Appraisal tool for quality assessment. RESULTS: 3935 articles were screened and 24 studies (17 quantitative, 5 qualitative, and 2 mixed-methods) were included, comprising 52778 participants from 8 countries (USA, UK, Australia, New Zealand, Netherlands, Greece, Sweden, Germany). Overall, participants from ethnic minority groups were able to identify common names of antibiotics and were aware of risks of antibiotics and side effects. However, participants thought antibiotics would treat viral-type illnesses. Ethnic minority groups generally had lower levels of knowledge compared to ethnic majority groups. CONCLUSIONS: Although ethnic minority communities possessed good levels of knowledge on certain aspects of antibiotics (e.g. being able to identify names of antibiotics), there were gaps in other areas (e.g. misperception that antibiotics are used for viral infections). The lower level of knowledge in ethnic minority groups compared to majority groups may be a contributing factor to health inequaliti
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Journal articleWei Q, Zhang T, Schmit N, 2026,
Post-acute sequelae after Lassa fever: a systematic review and meta-analysis
, Journal of Infection, Vol: 92, ISSN: 0163-4453Post-acute sequelae are symptoms that persist or arise after the acute phase of an infection, but their frequency following outbreaks remains poorly understood. Recurrent Lassa fever outbreaks pose a significant public health threat in West Africa and may have long-term health effects. This study systematically reviewed the prevalence, incidence, duration, and characteristics of post-acute sequelae in survivors of Lassa virus infection. We searched PubMed and Web of Science up to November 17, 2025. Two reviewers screened and extracted data independently. We included six articles in the review. The most frequently reported post-acute sequela was hearing loss, with a pooled prevalence of 18% (95% CI 9-32) across 6 studies. Odds ratios for the association between Lassa fever and hearing loss were heterogeneous, with a statistically significant positive association in 2 of 5 studies and a positive effect direction in 2 further studies. Of an additional 37 potential post-acute sequelae, several with high prevalence also related to the audiovestibular system (e.g. tinnitus, balance disorder and vertigo). Our findings highlight that Lassa fever survivors can experience diverse symptoms after recovery from acute infection, with hearing loss being the best-characterised. However, data gaps remain on its incidence after mild infections and its duration. A better understanding of post-acute sequelae after Lassa fever is necessary for accurate disease burden estimation and mathematical modelling studies.
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Journal articleShah A, 2026,
Impact of allergic bronchopulmonary aspergillosis overlap in chronic pulmonary aspergillosis
, ERJ Open Research, ISSN: 2312-0541Background: Chronic pulmonary aspergillosis (CPA) is a destructive fungal infection caused by Aspergillus fumigatus, leading to significant morbidity in individuals with structural lung disease. Clinical and immunological overlap with allergic bronchopulmonary aspergillosis (ABPA) has been recognised, but its extent and prognostic relevance remain uncertain. This study assessed ABPA features in CPA and their relationship with immunological markers and long-term outcome.Methods: We conducted a retrospective cohort study including individuals with confirmed CPA at the Royal Brompton Hospital until December 2023. Diagnoses followed ERS/ESCMID and 2024 ISHAM criteria. Demographic, clinical, microbiological, and immunological data were analysed, and group comparisons performed using logistic regression and Cox proportional hazards models.Results: Among 166 individuals with CPA, 45 (27%) met ABPA diagnostic criteria. CPA–ABPA overlap was independently associated with asthma (OR-10.16) and pan-azole resistance (OR-19.37), and inversely with sarcoidosis (OR-0.22). Overall 5-year survival was 82% (84.6% in CPA alone vs 76.6% in overlap; p=0.44). Older age, lower BMI and albumin, elevated A. fumigatus-specific IgE and IgG were associated with higher mortality, while longitudinal increase in A. fumigatus-specific IgE was also linked to worse outcome. Low serum albumin independently predicted mortality (HR 0.72; p=0.001).Discussion: CPA–ABPA overlap represents a distinct clinical phenotype linked to airway disease, antifungal resistance, and Th2-driven inflammation. Nutritional status and immunological activity, particularly rising A. fumigatus-specific IgE, emerged as key prognostic markers, linking type 2 inflammation to disease progression. These findings highlight the need for phenotype-based risk stratification and exploration of targeted immunomodulatory strategies in CPA.
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Journal articleTeerawattananon Y, Wang Y, KC S, et al., 2026,
Harnessing health economic evaluation for policy and practice
, Communications Medicine, Vol: 6, ISSN: 2730-664XHealth economic evaluation is essential for evidence-informed health policy, supporting prioritization of high-value care and optimal resource use. This Perspective synthesizes experiences from the HTAsiaLink network and global literature to demonstrate its role across the technology lifecycle. Drawing on diverse country experiences, it highlights how these methods guide value-based, equitable, and sustainable decision-making amid rapid technological advances and resources constraints. Key challenges and opportunities are examined, such as integrating equity considerations, incorporation of environmental impacts, and adapting frameworks for novel technologies. Strengthening deliberative processes, building capacity, and adopting flexible methods are crucial to harnessing full potential of health economic evaluation.
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Journal articleTurner H, Ahmed S, Nguyen HA, et al., 2026,
Economic evaluation of alternative hepatitis C treatment options: a post hoc analysis of the VIETNARMS trial
, EClinicalMedicine, ISSN: 2589-5370BackgroundHepatitis C remains a leading cause of liver disease worldwide, and access to Direct-Acting Antiviral (DAA) treatment remains limited in many settings. Alternative treatment strategies that require fewer tablets and clinical visits could help improve equitable access, and new approaches have recently been found to be non-inferior in producing sustained viral suppression. MethodsWe did a cost-minimization analysis of alternative treatment options for non-cirrhotic patients evaluated in the VIETNARMS trial (ISRCTN61522291), conducted between 19/06/2020 and 10/05/2023 in Vietnam. These were: (i) ‘response guided’ (which adjusts treatment duration based on 1-week viral load); (ii) ‘induction maintenance’ (which reduces the dosing frequency in later weeks of treatment); and (iii) ‘Peg-IFN+DAA’ (4 weeks of DAAs combined with four weekly doses of PEGylated interferon (Peg-IFN). The primary outcome was the cost per cure. A disaggregated societal perspective was adopted, including stratification for the healthcare provider and patient costs. FindingsThe three alternative treatment strategies were projected to have lower costs per cure than standard 12-week DAA treatment in the base-case scenario: US$202 (15%) less for ‘response guided’, US$234 (18%) less for ‘induction maintenance’, and US$163 (12%) less for ‘Peg-IFN+DAA’. However, the potential for cost savings, and which strategy had the lowest cost per cure, depended on the assumed cost of DAA drugs: the strategy with the lowest cost per cure was generally ‘induction maintenance’ when DAA drug costs for a standard treatment course were under US$1,000, but Peg-IFN+DAA when DAA costs exceeded US$1,500. In some scenarios, lower costs per cure were achieved through reduced health system expenditures, despite increased costs to patients.InterpretationAlternative strategies for Hepatitis C treatment could reduce costs for providers an
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Journal articleDidelot X, Carson J, Ribeca P, et al., 2026,
DiagnoDating: Diagnostics for dated phylogenies in microbial population genetics.
, Mol Biol EvolMicrobial population genetic studies often involve the use of a dated phylogeny to show how the genomes are related over a relevant timescale. Many tools have recently been developed to date the nodes of a standard phylogeny, but all make underlying assumptions that may not be realistic for a given dataset, making the results potentially unreliable. Model comparison is sometimes used to remedy this issue, whereby inference under several models is compared to establish which result can be trusted. Although such comparison is clearly useful to assess the relative merits of several inference attempts, here instead we focus on the problem of evaluating how good an inference is in absolute terms, without comparison. We consider several approaches for diagnosing potential issues in a reconstructed dated phylogeny, including outlier detection, posterior predictive checking and residual analysis. These methods are well-established diagnostics tools in other areas of statistics, but here we show how they can be applied to the specific inference of dated phylogenies. We illustrate their use on many simulated datasets, with inference being performed either from the correct model to quantify the specificity or from an incorrect model to quantify the sensitivity of the diagnostics methods. We also applied the methods to three real-life datasets to showcase the range of issues that they can detect. We have implemented the methods in a new R package entitled DiagnoDating. We advocate the use of these diagnostics tools for all microbial population genetic studies that involve the reconstruction of a dated phylogeny.
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Journal articleKu C-C, Rosello A, Walker J, et al., 2026,
The epidemiological effect and cost-effectiveness of expanded age eligibility for recombinant zoster vaccination in England.
, Vaccine, Vol: 78INTRODUCTION: Since September 2023, England's national immunisation programme has offered the recombinant zoster vaccine (RZV) to adults aged 65-79 as a preventative measure against shingles (herpes zoster) and its complications. However, adults aged 80 and over are currently not eligible for the vaccine. We aimed to evaluate the feasibility and cost-effectiveness of providing RZV to adults aged 80 and older in England. METHODS: This cost-utility analysis employs a static cohort model considering herpes zoster (HZ) cases and severe cases leading to post-herpetic neuralgia, HZ-related hospitalisation, and deaths from the perspective of the National Health Service. The long-term impacts of RZV are assessed using the model, accounting for changing population demographics and the previously-offered live zoster vaccine (ZVL). We consider different eligibility scenarios for RZV focusing on the older population (80+ years old) and provide comparisons to the pre-2023 programme. RESULTS: Expanding the current programme to offer a single dose of RZV to people aged 80 and up is likely to be cost-effective relative to the current programme. Offering two doses to this group would be less cost-effective but would offer greater protection against HZ. For preventing health-related quality of life loss, it is most efficient to vaccinate 60-69-year-olds, but for averting hospitalisation costs, it is most efficient to vaccinate 80-89-year-olds. CONCLUSION: Providing one or two doses of RZV for older adults can be cost-effective and would reduce the healthcare burden of shingles.
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Journal articleStevens O, Anderson RL, Sabin K, et al., 2026,
HIV prevalence in transgender women and cisgender men who have sex with men in sub-Saharan Africa.
, AIDS, Vol: 40, Pages: 510-516INTRODUCTION: The Global AIDS Strategy 2021-2026 calls for equitable access to HIV services for all populations. Transgender people have been marginalized and experience disproportionate risk of HIV infection in sub-Saharan Africa (SSA) and data to guide HIV programmes are severely limited. Surveillance data among cisgender men who have sex with men (cis-MSM) are comparatively abundant. We assessed whether HIV prevalence among cis-MSM was correlated with HIV prevalence among transgender women. METHODS: Data from key population surveys conducted in SSA between 2010 and 2022 were identified from existing databases and survey reports. Studies that collected HIV prevalence data among both transgender women and cis-MSM populations were analysed with random effect meta-analysis to estimate the ratio of HIV prevalence among cis-MSM:transgender women. RESULTS: Twenty-one studies were identified encompassing 8476 transgender women and 24 102 cis-MSM. Median HIV prevalence among transgender women was 23.5% [interquartile range (IQR) 11.5-39.8%] and 16.2% (IQR 8.1-26.8%) among cis-MSM. HIV prevalence among transgender women was 50% higher than in cis-MSM [prevalence ratio 1.48, 95% confidence interval (CI) 1.25-1.76]. HIV prevalence among transgender women was highly correlated with year/province-matched HIV prevalence among cis-MSM ( R2 = 0.60), but poorly correlated with year/province-matched total population HIV prevalence ( R2 = 0.01). CONCLUSION: Transgender women experience a significantly greater HIV burden than cis-MSM in SSA, underscoring the need for HIV services addressing the disproportionate vulnerability experienced by transgender women. Further bio-behavioural surveys focused on determinants of HIV infection, treatment uptake, and risk behaviours among transgender people, distinct from cis-MSM, will improve understanding of HIV risk and vulnerabilities.
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Journal articleTelles-de-Deus J, Claro IM, Bertanhe M, et al., 2026,
Evolution and spillover dynamics of yellow fever at the forest-urban interface in Brazil.
, Nat Microbiol, Vol: 11, Pages: 877-891Yellow fever virus (YFV) continues to threaten human and wildlife populations in the Americas, yet its transmission at the forest-urban interface remains unclear. Here we integrate ground- and canopy-level mosquito surveillance, systematic monitoring of non-human primate carcasses and viral metagenomics to describe the dynamics of a sylvatic YFV outbreak in a 186-hectare Atlantic Forest fragment embedded within metropolitan São Paulo, Brazil, between 2017 and 2018. Our analyses reveal that transmission was primarily driven by a single genetic cluster introduced during a period of high abundance of the main vector, Haemagogus leucocelaenus mosquitoes. A near-complete hepatitis A virus genome was detected in a YFV-infected howler monkey, suggesting potential co-infections at the human-wildlife interface. Phylogenetic and epidemiological modelling estimated a basic reproduction number, R0, for sylvatic yellow fever of 8.2 (95% CI 5.1-12.2), substantially higher than previous estimates for urban outbreaks. Our findings demonstrate that multisource surveillance could provide actionable early warnings in regions at risk for zoonotic spillover.
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