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Journal articleHemmings SJ, Varaden D, Barnes J, et al., 2027,
Diversity analysis of indoor and outdoor fungal bioaerosols in UK households: a prospective, observational, longitudinal study.
, Lancet MicrobeBACKGROUND: Long-term exposure to indoor fungal bioaerosols is a recognised risk factor for respiratory illness, particularly in damp and poorly ventilated housing. However, the diversity and seasonal variability of these fungal communities are poorly understood. As part of the West London Healthy Home and Environment Study (WellHome), this study aimed to characterise the composition, diversity, and temporal dynamics of indoor fungal bioaerosols in urban UK homes, as compared with outdoor air, to inform future exposure baselines and policy development. METHODS: In this prospective, community-based observational study, 118 households were recruited across West London, UK, via community networks and partner organisations, prioritising families with children aged 5-17 years with asthma or allergies, from diverse socioeconomic backgrounds. Sampling occurred between Oct 3, 2022, and June 14, 2024. Participant data were collected via questionnaires completed by household members, capturing demographics, building characteristics, and respiratory health. Passive-air samplers were used in living rooms for 28 days during two seasonal campaigns, with concurrent outdoor sampling at four fixed community sites. Fungal bioaerosols were identified by ITS2 amplicon sequencing and quantified using broad-range quantitative PCR targeting the 18S rRNA gene. Diversity indexes and temporal dynamics were analysed using ecological statistics and generalised additive models. FINDINGS: 118 households were enrolled, comprising 504 residents (263 women, 237 men, and four not reported). Among 504 participants who self-identified, the largest groups comprised individuals identifying as Black African (n=47), Somali (n=46), White British (n=42), and African (n=38), with additional representation from mixed race ethnic backgrounds (n=29), Black British (n=27), White (n=22), and Black Caribbean (n=18), alongside several other ethnicities each represented at lower frequencies. Of 118 households, 104 c
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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 articleLopes BC, Dutra JVR, Moreira FRR, et al., 2026,
Wastewater surveillance of dengue and chikungunya during the worst arbovirus epidemic in Brazil.
, Water Res, Vol: 300This study evaluated wastewater-based epidemiology (WBE) for monitoring dengue virus (DENGV) and chikungunya virus (CKV) during Brazil's most severe arbovirus epidemic, focusing on the city of Belo Horizonte, Minas Gerais. From March 2022 to August 2024, 24-hour composite raw sewage samples were collected weekly from two major wastewater treatment plants, encompassing over 80% of the city's population. Viral RNA was quantified via RT-qPCR and positive samples underwent genome sequencing for genotype characterization. DENGV and CKV RNA were detected in over 90% of samples across both wastewater treatment plants (WWTPs), demonstrating sustained and widespread viral circulation throughout epidemic and inter-epidemic periods. Although CHIKV concentrations varied significantly across years, DENGV concentrations remained statistically stable, and no significant correlations were observed between wastewater viral loads and reported clinical cases. A considerable proportion of samples presented concentrations below the limit of quantification, indicating that while WBE is highly sensitive for qualitative detection of arboviruses, quantitative interpretation remains methodologically constrained. Sequencing confirmed the presence of DENGV-1 sorotype I and CKV genotype V, clustering with contemporaneous Brazilian strains and reflecting regional transmission dynamics. Wastewater-based modelling further suggested that reported clinical cases may substantially underestimate true infection burden, although quantitative estimates were highly sensitive to assumptions regarding viral shedding variability. These findings demonstrate that WBE provides a sensitive, non- invasive, population level approach for tracking arboviral circulation and viral diversity during large-scale outbreaks and could complement public health surveillance frameworks, especially in regions with limited diagnostic capacity or high levels of underreporting, to enhance epidemic response and control strategies.
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Journal articleFeng H, Marini G, Barabás É, et al., 2026,
Modelling the risk of West Nile virus infection in seven European countries from published serological and case notification data, 2008 to 2022
, Eurosurveillance, Vol: 31<jats:sec> <jats:title>BACKGROUND</jats:title> <jats:p>West Nile virus (WNV) is a zoonotic mosquito-borne pathogen increasingly reported in Europe.</jats:p> </jats:sec> <jats:sec> <jats:title>AIM</jats:title> <jats:p>We aimed to characterise heterogeneities in the average annual human risk of WNV infection (force of infection, FOI) and in WNV surveillance across Europe.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>We conducted a systematic review following the PRISMA guidelines to identify serological studies on WNV in humans with IgG-based assays in Europe. We then used mathematical models fitted to both age-stratified serosurvey and case data to reconstruct spatially explicit FOI estimates, the sensitivity of syndromic surveillance and age-dependent trends in case reporting.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>We extracted 92 serosurvey datasets from 21 countries. Based on 10 age-stratified serosurvey datasets from Greece, Hungary, Italy, Romania and Spain and case data from seven countries (Austria, Cyprus, Greece, Hungary, Italy, Romania and Spain), we estimated the WNV FOI for 119 European nomenclature of territorial units for statistics level (NUTS) 0-3 regions. We found evidence of spatial heterogeneities in transmission intensity and estimated that on average less than 0.2% of human WNV infections were notified, with country variability and age-dependent trends in the propensity of reporting WNV disease.</jats:p> </jats:sec> <jats:sec> <jats:t
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Journal articleSaluzzo F, Lindahl O, Chindelevitch L, et al., 2026,
When the whole exceeds the sum of its parts: squeezing greater cumulative benefit from cross-technology partnerships in bacterial infection
, International Journal of Infectious Diseases, Vol: 167, ISSN: 1201-9712ObjectivesEffective care for bacterial infections requires both new antibiotics (ABx) to address antimicrobial resistance (AMR) and appropriate diagnostics (Dx) to guide their use. Diagnostics are essential to identify pathogens, determine susceptibility, and support targeted prescribing, including ruling out unnecessary antibiotic use. However, diagnostics are undervalued in the current market, limiting their availability and integration with antibiotic development. To examine the interplay between antibiotics and diagnostics and assess the potential value of coordinated development and partnerships.MethodsThis paper analyses the antibiotic and diagnostic development landscape, focusing on market dynamics, regulatory frameworks, and collaboration models involving ABx developers, Dx developers, clinicians, and public-sector stakeholders.ResultsAntibiotics and diagnostics are rarely developed or introduced in parallel, and available diagnostics often fail to deliver treatment-focused or point-of-care–relevant results. This misalignment hampers the effective deployment of new antibiotics and weakens stewardship. Cross-technology partnerships can improve trial efficiency, enhance market valuation, and support more targeted antibiotic use. Key barriers include fragmented incentives, regulatory misalignment, and financial constraints.ConclusionBetter alignment between antibiotic and diagnostic development is critical to maximise clinical impact and support resistance monitoring. Public-sector support could help enable effective partnerships and improve patient outcomes.
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Journal articleQuijada Rodriguez ML, Vicco A, Bajura F, et al., 2026,
Dengue epidemiology and transmission intensity across Panama during 2000-2024: a modelling study
, The Lancet Regional Health. Americas, Vol: 58, ISSN: 2667-193XBackgroundPanama is a dengue endemic country which experienced a large outbreak in 2024 with over 32,000 reported cases and an incidence rate exceeding 700 cases per 100,000 inhabitants. Despite decades of circulation, the epidemiology of dengue and its heterogeneity in transmission intensity across Panama have not yet been characterised.MethodsWe used 25 years of dengue case notification and population data from across Panama's 16 health regions and 82 districts to characterise dengue epidemiology and transmission intensity in the country. The analytic dataset comprised 128,890 dengue cases, of whom 52% were female and 48% were male; the mean age was 32.4 years (range 0–108 years). Ethnicity data are not collected in Panama's national dengue surveillance system and were therefore unavailable for this analysis. We characterised spatial heterogeneities in delay distributions by fitting parametric probability distributions to epidemiological delays, and demographic differences in the incidence risk ratio of dengue, and of dengue attributable hospitalisations and deaths. We also implemented catalytic models to infer the time-constant dengue force-of-infection (FOI) (i.e. the long-term average annual per capita risk of infection for a susceptible individual) from the age-stratified case notification data reported across Panama during 2000–2024 and explored age- and sex-related differences in dengue case reporting in sensitivity analyses.FindingsWe observed spatial variation in delay distributions across health regions. The mean of the regional average time from symptoms onset to (i) reporting was 4.78 days (95% CI: 4.72–4.84 days), (ii) hospitalisation was 4.49 days (95% CI: 4.22–4.76), and (iii) recovery was 7.82 days (95% CI: 6.47–8.85 days). The dengue transmission intensity also showed spatial heterogeneity, with a mean regional per-serotype FOI of 0.008 (95% CrI: 0.004–0.015). The mean regional probability of detecting a secondar
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Journal articleTurner H, Hung TM, Brady OJ, et al., 2026,
The cost-effectiveness of Wolbachia-based biocontrol interventions for dengue: a scoping review of the available evidence
, PLoS Neglected Tropical Diseases, ISSN: 1935-2727Background Dengue incidence has increased sharply worldwide, placing nearly half of the global population at risk. In response, various innovative technologies and interventions, including biocontrol strategies that deploy Wolbachia-infected mosquitoes, are being explored. These can be used to either replace the existing mosquito population with one that is less likely to transmit infection or to suppress the existing mosquito population. We conducted a scoping review of economic evaluations of Wolbachia-based interventions for dengue control, aimed at summarising assumptions and results of existing studies. Methodology/Principal Findings A scoping review of the published literature was conducted on the 29th of April 2024 using the MEDLINE (via OVID), Embase Classic+Embase (via OVID), Global Health - OVID, PubMed, and Econ Lit electronic databases. No date or language restrictions were applied to the searches. We identified nine studies that reported the results of economic evaluations of Wolbachia-based interventions for dengue control. The majority (eight out of nine studies) investigated Wolbachia replacement-based programmes. Overall, the results were supportive for the use of replacement-based programmes in large urban settings, with the intervention likely to generate cost savings from a societal perspective. Conclusions/Significance. The available economic evaluations consistently suggest that Wolbachia-based replacement interventions can be cost-effective for dengue control when targeted to densely populated urban areas, and several studies indicate that they can generate substantial long-term cost savings from a societal perspective. Further research is needed to understand how heterogeneity in epidemiological effectiveness influences long-term projected cost-effectiveness and to investigate the combination of Wolbachia-based interventions with other dengue control/prevention measures (such as vaccination). To support more robust and comparable analyses
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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 articleCui F, Faini D, Razavi-Shearer D, et al., 2026,
The burden of chronic hepatitis B and C in 2022 and progress towards elimination: a global report.
, Lancet Gastroenterol Hepatol, Vol: 11, Pages: 509-520BACKGROUND: WHO has worked closely with member states to set baseline targets, monitor progress and gaps, and develop a strategy to achieve the elimination of viral hepatitis as a public health threat by 2030. This analysis aimed to use the latest data to assess global progress, identify gaps, and provide strategic support to countries and regions to scale up prevention and treatment services to meet global, regional, and country-level targets. METHODS: Data on key indicators for 2022 were collated in 2023, including prevalence, incidence, mortality, and the cascade of care for chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections. WHO country offices, regional offices, related departments, and partners were involved to verify and ensure the quality and completeness of the data. Data from 2022 were compared with historical data to monitor progress, and reported data were compared with expected data and targets to identify gaps in incidence and mortality. FINDINGS: As of June 30, 2023, WHO had received verified data reports from 187 of 194 countries and territories, including data contributions from collaborative partners. We estimated that, in 2022, globally, 254 million (3·27%) of 7758 million people were living with chronic HBV infection and 50 million (0·65%) people were living with HCV infection. Overall, five countries (China [83·7 million; 27·5%], India [35·3 million; 11·6%], Indonesia [18·9 million; 6·2%], Nigeria [15·7 million; 5·2%], and Pakistan [12·6 million; 4·2%]) accounted for 55% of the combined global burden of HBV and HCV. There were more than 2·2 million (95% CI 1·8-2·7) new chronic HBV and HCV infections and more than 1·3 million (95% CI 1·1-1·6) deaths due to HBV and HCV in 2022, with the majority of deaths due to HBV (1·1 million [95% CI 0·98-1·24]); as a result, the point est
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Journal articleAhmed S, Mangal TD, Hallett TB, et al., 2026,
When is elimination of an infectious disease cost- effective? An analytical framework to guide elimination priorities
, Cost Effectiveness and Resource Allocation, ISSN: 1478-7547BackgroundElimination targets for infectious diseases are increasingly common in global health, yet the economic rationale for pursuing elimination is often assumed rather than rigorously assessed. Existing evaluations frequently emphasise future cost savings or broader economic benefits while overlooking health opportunity costs—the health that could have been gained had resources been allocated elsewhere. This study aimed to develop an analytical framework to investigate when disease elimination generates positive net health benefit (NHB) and to illustrate how key factors interact to shape this assessment.MethodsWe constructed a generalisable analytical framework incorporating ten factors related to intervention and disease costs, intrinsic disease/intervention characteristics, and stakeholder viewpoints and evaluation parameters. The framework was applied to create an exemplar model that showed how these factors jointly influence the NHB of achieving elimination. This was evaluated across wide parameter ranges informed by the literature, using different cost-effectiveness thresholds, discount rates, and time horizons. ResultsThe framework revealed distinct regions of parameter space in which elimination yield positive NHB. The cost effectiveness threshold, discount rates, disease burden, and intervention impact were strong determinants of NHB. In particular, lower thresholds, higher discount rates, and shorter time horizons reduced the likelihood that elimination would generate positive NHB. The framework also showed that elimination may be cost effective in some settings but not in others, even for the same disease, due to differences in costs, burden, and opportunity costs.ConclusionsDisease elimination is not always a good investment; its value depends on the interplay between disease characteristics, programme costs, and the health opportunity costs of resource use. The proposed framework provides a transparent, health opportunity cost-based structure f
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