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Background/Objectives: Respiratory syncytial virus (RSV) is the leading cause of infant hospitalizations in the United States. Prevention strategies are recommended to mitigate severe RSV outcomes. In addition to identifying potential coverage gaps, preventative administration timing is important for estimating product effectiveness. This study characterized administration timing of maternal and infant immunization against RSV across the United States during the 2024-2025 RSV season. Methods: A retrospective cross-sectional study was conducted using administrative claims of a commercially insured population from Kythera Labs. Pregnant individuals who received RSVpreF vaccine and infants who received nirsevimab were included. The seasonal cohort included infants born during the RSV season, while infants born from April to September were considered as the catch-up cohort. Baseline characteristics and calendar month and age at immunization (gestational age for RSVpreF) were evaluated. Results: Overall, 37,686 (71.9%) of maternal vaccinations were administered at 32-34 gestational weeks and 92.7% of all vaccinations occurred ≥14 days before delivery. Among infants who received nirsevimab, 34.8% of the seasonal cohort were immunized within 1 week of birth and 33.4% of the catch-up cohort were immunized in October 2024. Conclusions: Most maternal RSVpreF vaccinations occurred early in the recommended eligible gestational age window, while only approximately one-third of infants received nirsevimab during the first week of life or at the beginning of the RSV season. These findings highlight the importance of timely administration of RSV preventives. They further demonstrate that immunization timing should be incorporated into evaluation of the effectiveness and population level impact of RSV prevention programs.
To map international models of psychosocial preparedness for disasters and identify recurrent public mental health priorities for policy, service readiness, and implementation. Following PRISMA extension for scoping reviews (PRISMA-ScR) and Joanna Briggs Institute guidance, we searched PubMed (2015-2025) using two complementary strategies and mapped 35 included studies. Eight model families emerged, including community resilience and governance; non-specialist support and psychological first aid (PFA); integrated mental health and psychosocial support (MHPSS) across the disaster cycle; implementation and scale-up models; organizational and health-system preparedness; digital continuity models; monitoring and evaluation frameworks; and behavioral emergency response models. Across model families, preparedness was concentrated mainly on community and non-specialist levels, and emphasized trust, community capacity, task-sharing, workforce readiness, and continuity of care. The mapped literature supports psychosocial preparedness as a layered public health function rather than a post-event specialist intervention. Core priorities include pre-event governance, community engagement, supervised non-specialist delivery with referral pathways, workforce protection, digital continuity with clinical safeguards, and minimum monitoring standards. Future work should prioritize implementation-focused research and outcome evaluation across diverse disaster settings.
Mass drug administration (MDA) is a key strategy for controlling schistosomiasis and soil-transmitted helminthiasis in low-resource settings. Assessing its long-term sustainability is important for maintaining and expanding disease control achievements. This study examined the sustainability capacity of Rwanda's MDA program using the Program Sustainability Assessment Tool (PSAT). A mixed-methods approach was used. Twenty-one key informants, including government officials, donors, and local stakeholders, participated in qualitative interviews, and 16 of them also completed the PSAT quantitative survey. Qualitative data were thematically analyzed, while quantitative findings from the survey were used to calculate domain-specific and overall sustainability scores. The overall Rwanda MDA program sustainability score was 3.75 out of 5. Partnerships scored the highest at 4.1, with qualitative data emphasizing strong collaboration among government agencies, international organizations, and community stakeholders. Political support and program evaluation both received a score of 3.9, with qualitative data emphasizing good policy alignment, but some issues with data accuracy. Funding stability was the weakest domain, scoring 3.3, and qualitative data highlighted reliance on external donors. Strategic planning scored 3.5, with qualitative data highlighting limited development of long-term financial strategies and the absence of a dedicated sustainability plan. This assessment revealed a moderate sustainability capacity for the MDA program, characterized by strong political support, active partnerships, and promising adaptations, including the expansion of treatment coverage to adults. However, dependence on donor funding, staffing shortages, and data management issues continue to pose a risk to the program's sustainability. Improving domestic resource allocation, investing in human resources, and strengthening data systems could enhance the program's capacity for sustainability.
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To identify trends within rabies Post Exposure Treatment (PET) product use for 2025 compared with previous years and highlight potential underlying causes. Data from the National Immunisation Office (NIO) was analysed retrospectively. The years 2020-2022 had low ordering due to COVID-19 so the years 2019, 2023 and 2024 were averaged in a 'baseline year'. Statistical analyses calculated absolute and percentage increases of rabies PET product use in 2025 compared to previous years. Ireland saw a sharp increase of 643 units (249%) in rabies vaccine and 103 units (368%) Human Rabies Immunoglobulin (HRIG) use in 2025 compared to the baseline year. This trend may be associated with heightened clinician and public awareness of rabies prone exposure (RPE) and recent changes to service delivery. External factors including resurgence of travel following COVID-19, a UK rabies related death in June 2025 and global rabies product shortage may compound this.
Women's micronutrient deficiency, also named hidden hunger, remains a serious public health concern of low- and middle-income countries. To reduce micronutrient deficiencies, Sustainable Development Goal was designed to provide universal access to essential health and nutrition services to women of reproductive age. Recent evidence indicates that multiple micronutrient deficiencies often co-occur. But little is known about their extent, geographic variation, and underlying determinants among non-pregnant women of reproductive age, a critical gap that limits targeted interventions. Therefore, mapping the most affected women is critical to tailor interventions targeting needy segments of the population. We analyzed individual record and coordinates data from the Ethiopian National Micronutrient Survey 2015 to examine the spatial distribution of multiple micronutrient deficiencies. Vitamin A, folate, vitamin B12, zinc, iron, and iodine were micronutrients considered in the analysis. Weighted sample of 1450 non-pregnant women aged 15-49 years was included. Global spatial autocorrelation and hotspot analysis were performed to display geographic equity in multiple micronutrient deficiencies. A multi-scale geographical weighted regression analysis was also performed to identify factors explaining geographic disparities in the distribution of multiple micronutrient deficiencies. Two-fifths (41.3%; 95% CI 37.9-44.8) of women were found to have multiple micronutrient deficiencies in Ethiopia. There were geographical variations in the distribution of multiple micronutrient deficiencies among women in Ethiopia (Global Moran's I value of 0.11 (p < 0.0087)). Higher proportions of multiple micronutrient deficiencies were observed in the Eastern parts of the country. Dire Dawa City Administration, Harari, and the Northern, Eastern, and Southwest parts of the Somali region had higher predicted multiple micronutrient deficiency levels. Hotspot areas with significantly higher rates of multiple micronutrient deficiencies were observed in southern Afar, Dire Dawa, Harari, Eastern Oromia, and Southern Somali regions. Multiple micronutrient deficiencies affect a substantial proportion of non-pregnant women of reproductive age in Ethiopia, highlighting a critical public health concern. The findings demonstrate significant regional variation and identify key predictors, including rural residence, breastfeeding status, and lack of multivitamin supplementation. These findings underscore public health efforts must integrate multiple micronutrient supplementation into maternal health services. In addition, designing targeted interventions that can reduce the high burden of hidden hunger and geographic inequity. Furthermore, addressing the micronutrient requirements of breastfeeding women and rural communities are critical step toward reducing multiple micronutrient deficiencies across Ethiopia.
To analyze the adherence of Checklist for Artificial Intelligence (AI) in Medical Imaging (CLAIM) in top medical imaging journals. A search for AI research in top medical imaging journals was performed from Web of Science Core Collection. The adherence was assessed by the reporting score and compliance rate of CLAIM. Potential influencing factors were also analyzed. A total of 501 articles were included. After quality assessment, the median CLAIM score was 19 points (25th-75th: 17-21 points), and the median overall compliance rate was 51.4% (25th-75th: 46.2%-57.9%). Among the 42 items, 14 items had compliance rates of ≥80%, 11 items had compliance rates of 40%-79%, while 17 items had compliance rates of <40%. Low compliance rates were predominantly concentrated on items such as quality control of annotations, sample size determination, model robustness evaluation, failure analysis, and code/data availability. In terms of temporal trends, both the overall score (ρ = 0.119, p = 0.008) and compliance rate (ρ = 0.139, p = 0.002) showed weak positive correlations with the publication year. Furthermore, compliance for items 2 (structured abstract) (ρ = 0.129, p = 0.004), 33 (participant flow diagram) (ρ = 0.131, p = 0.003), 34 (demographic/clinical characteristics by partition) (ρ = 0.122, p = 0.006), 41 (study protocol/data/code availability) (ρ = 0.094, p = 0.036), and 42 (funding sources) (ρ = 0.128, p = 0.004) demonstrated significant upward trends over time. Logistic regression analysis identified the following negative predictors of reporting quality: research objectives focused on image reconstruction (OR = 0.416, 95% CI: 0.203-0.842, p = 0.015), artifact reduction (OR = 0.072, 95% CI: 0.009-0.365, p = 0.004), multimodal imaging (OR = 0.301, 95% CI: 0.090-0.899, p = 0.038), use of public (OR = 0.508, 95% CI: 0.289-0.883, p = 0.017) and public-private hybrid (OR = 0.339, 95% CI: 0.146-0.759, p = 0.010) development datasets. Conversely, positive predictors were: publication year (OR = 1.246, 95% CI: 1.067-1.458, p = 0.006); being published in a CLAIM adopting journal (OR = 1.737, 95% CI: 1.070-2.481, p = 0.026); code availability (OR = 1.929, 95% CI: 1.181-3.186, p = 0.009); and development datasets sizes of 100-199 cases (OR = 2.187, 95% CI: 1.121-4.320, p = 0.023), 500-999 cases (OR = 3.409, 95% CI: 1.508-7.902, p = 0.004), and ≥1000 cases (OR = 2.798, 95% CI: 1.335-5.979, p = 0.007). The adherence of CLAIM among AI research in top medical imaging journals is still inadequate. It is needed to join efforts of researchers, editors, and reviewers to strengthen the application of CLAIM to improve the research quality and reproducibility.
Background: China's influenza vaccine (InfV) has undergone multiple iterations and numerous technological breakthroughs, providing tremendous impetus and solid support for the development of China's health sector. As the number of vaccinated individuals continues to rise, the importance of ongoing surveillance and evaluation of vaccine safety has become increasingly prominent, forming part of efforts to maintain public trust in the national immunization program and ensure its sustainability. Methods: From 2016 to 2025, data on suspected adverse events following immunization (AEFIs) related to InfV administration were extracted from the Chinese National Immunization Information System (CNIIS). Data on InfV vaccination doses were obtained from the Anhui Provincial Immunization Information Management System. A descriptive statistical method was used to analyze the distribution characteristics of AEFIs, and the chi-square test was applied to evaluate differences in reporting rates. Results: Between 2016 and 2025, a total of 4026 AEFI reports related to InfV were monitored through the CNIIS. The overall reporting rate was 34.40 per 100,000 doses. Specifically, common adverse reactions and rare adverse reactions accounted for 95.88% (3860 cases) and 3.38% (136 cases), with reporting rates of 32.98 per 100,000 doses and 1.16 per 100,000 doses, respectively. Among common adverse reactions, the reporting rates of fever (axillary temperature ≥ 38.6 °C), local redness and swelling at the injection site (diameter > 5.0 cm), and local induration (diameter > 5.0 cm) were 9.62 per 100,000 doses, 1.96 per 100,000 doses, and 1.20 per 100,000 doses, respectively. Among rare adverse reactions, the reporting rates of allergic rash, angioedema, anaphylactic shock, febrile convulsions, anaphylactoid purpura, thrombocytopenic purpura, epilepsy, Guillain-Barré syndrome, and aseptic abscess were 0.98, 0.05, 0.03, 0.03, 0.02, 0.02, 0.01, 0.01, and 0.01 per 100,000 doses, respectively. No cases were reported for subunit inactivated influenza vaccine (IIV, Subunit). Statistically significant differences were observed in the reporting rates of allergic rash across different types of InfV (χ2 = 36.83, p < 0.05), with trivalent inactivated influenza vaccine (IIV3, Split) and trivalent live attenuated influenza virus vaccine (LAIV3) showing the highest reporting rates. Most adverse events following vaccination occurred within 24 h after inoculation. Conclusions: From 2016 to 2025, the overall reporting rate of AEFIs after InfV administration in Anhui Province was within an acceptable range. Common adverse reactions were common, while rare adverse reactions were few, mainly consisting of allergic reactions. These results indicate that InfV has a favorable safety profile, and continuous strengthening of AEFI surveillance for InfV and improvement of surveillance quality are warranted.
The Nepal Red Cross Society (NRCS) and hospital laboratory services operate blood transfusion services (BTSs) in Nepal. Currently, 121 blood centers in 76 districts of Nepal provide blood donation and transfusion services. The NRCS is involved in almost 90% of Nepal's blood transfusion-related services. The society has established 105 blood service center units in 76 districts and blood centers in 40 hospitals. The National Public Health Laboratory serves as both a governing body for blood safety and a reference laboratory for screening for BTS in transfusion-transmitted infections (TTIs). Different organizations, including government and nongovernment offices, education institutions, media houses, NRCS units (district chapters, sub-chapters, youth circles, and clubs), and other civil societies, support Central BTSs (CBTS) by regularly collecting blood. The country's demand for blood is rapidly increasing with the expansion of medical colleges, government and private hospitals, and nursing homes. In 2023, NRCS CBTS collected 262,439 units of whole blood nationwide and supplied 344,933 blood components to save lives. In Nepal, there is a lack of proper blood transfusion policy and guidelines. Although the national guideline for blood transfusion was developed and revised in 2015, it did not define a precise protocol for safe blood component administration procedures; instead, it focused primarily on the criteria for blood donation and donor selection. The licensing work is done by the National Bureau for BTS, which is governed by the National Public Health Laboratory and the Health Ministry of Nepal. While the drug controlling authority is not associated with legislation for blood centers, the draft policy for plasma fractionation is related to drug authorities and is under progress.
Rabies remains a preventable yet fatal zoonotic disease and a major public health concern in Bangladesh, which aims to eliminate dog-mediated human rabies by 2030. Despite free availability of post-exposure prophylaxis (PEP), adherence to the WHO-recommended PEP regimen remains low. This study assessed PEP compliance and identified determinants of regimen completion among animal-exposed patients. We conducted a hospital-based observational study using secondary data from 457 patients who initiated PEP at the National Rabies Prevention and Control Centre (NRPCC) in Dhaka, from February 2023 to July 2023. Sociodemographic, clinical, and exposure-related factors were analyzed to identify predictors of compliance. Only 17.1% of patients completed the full PEP regimen, including rabies immunoglobulin (RIG) administration for WHO Category III exposures where indicated. Higher adherence was observed among females, individuals aged ≥15 years, lower-income groups, and those residing within 10 km of the treatment center. Exposure-related factors including dog bites, multiple exposures, unprovoked incidents, and appropriate exposure care were also associated with improved compliance. Despite free access, PEP completion remains critically low. Targeted strategies, including decentralized PEP delivery, improved public awareness, and strengthened follow-up systems, are essential to improve adherence and support progress toward rabies elimination by 2030.
Measles represents a critical public health challenge due to its high transmissibility and the resurgence of outbreaks of the disease, linked to gaps in vaccination coverage. In this study, we analyze the epidemiological dynamics of the outbreak that began in Mexico in 2025 and focus on Jalisco as the epicenter during the first quarter of 2026. A descriptive, retrospective, ecological time-series analysis was conducted using official epidemiological surveillance data, correlating incidence with immunization strategies. The results reveal that 6681 cases were recorded in Jalisco, with the highest prevalence among adults aged 20 to 49 years (41.96%), which highlights the accumulated gaps in immunity coverage. The public health response, comprising the administration of three million doses, focusing on zero-dose children and vaccination blockades, contributed to a notable decrease in infections by epidemiological week 17 of 2026. It was concluded that the outbreak was controlled through intensive and coordinated intervention. However, the proximity of the 2026 International Federation of Association Football (FIFA) World Cup requires vaccination coverage to be maintained at over 95%, in addition to vigilance, to mitigate the risk of viral reintroduction and to safeguard global health security.
Schistosomiasis remains the second leading cause of death among parasitic diseases globally, contributing substantially to chronic morbidity and disability. South Africa (SA) is endemic for schistosomiasis, with ongoing efforts to expand mass drug administration. In the absence of true prevalence data, this study retrospectively analysed public sector laboratory-confirmed schistosomiasis cases from 2019 to 2024. Over this period, 73,680 cases were microscopically diagnosed, with Schistosoma haematobium accounting for 99.9% of infections. The test positivity rate of 20 per 100,000 population is lower than previously reported, with the burden concentrated among boys aged 5-19 years, particularly in the KwaZulu-Natal, Limpopo, and Mpumalanga provinces. These findings highlight a persistent burden within defined demographic groups and geographic areas, while also suggesting possible early signs of improvement that are potentially linked to public health interventions. The results provide valuable evidence to inform the scale-up of national schistosomiasis control programmes and the prioritisation of interventions towards the most affected populations.
The mechanisms generating immunity involved in nasal vaccination for children are likely to differ significantly from both adult immunity and animal models. A deeper understanding is necessary for the development of future paediatric mucosal vaccines. Live-attenuated influenza vaccines (LAIVs) are licensed mucosal vaccines which confer protection in children against severe influenza. Beyond individual protection, mucosal vaccines can also limit transmission and colonisation, offering broader public health benefits than parenteral vaccination. We describe a protocol for an exploratory, observational study assessing systemic and mucosal responses to LAIV in healthy children. 40 healthy participants aged 2-5 years inclusively will be recruited from the community. Researchers will conduct study visits in the participants' homes and administer a single dose of their routine, yearly LAIV and collect blood, nasal cells, nasal fluid and saliva at baseline and at day 28 post-LAIV. They will have additional nasal fluid and saliva samples conducted by caregivers on days 1, 2, 3, 4, 6, 9, 14 and 21. They will complete a daily symptom report to detect symptoms due to vaccination as well as additional upper respiratory illnesses. Samples will be analysed to detect viral load for influenza virus strains included in LAIV, coinfection and colonisation by other pathogens, as well as assess the mucosal and systemic immune response to vaccination. This study aims to advance understanding of mucosal immunity mechanisms in children following live-attenuated influenza vaccination. This knowledge could help inform the development of future mucosal vaccines for children, potentially increasing both effectiveness, ease of delivery and tolerability in this vulnerable population. This protocol has been reviewed by the sponsor, collaborators and external peer reviewers. Ethical approval for this study has been obtained from the South Central - Hampshire B Research Ethics Committee (REC ref 24/SC/0251). Informed parental consent will be obtained prior to any study intervention. The results will be disseminated via publication in a peer-reviewed journal and presentation at international conferences. ISRCTN87260269 (https://doi.org/10.1186/ISRCTN87260269).
Background: Measles has re-emerged in recent years as a public health concern in the context of insufficient vaccination coverage. Some children experience significant delays in receiving, or refuse to take, the measles, mumps and rubella (MMR) vaccination, often due to concerns related to hen's egg allergy (HEA). Methods: In this study, we retrospectively assessed the safety of MMR vaccination (Priorix®, GlaxoSmithKline, Belgium) in patients with HEA hospitalised at our clinic. Detailed medical histories were collected, along with skin prick tests and measurements of specific IgE against milk and egg proteins or extracts. The study included 39 patients with a mean age of 19 months, of whom 15 had previously experienced an anaphylactic reaction after egg ingestion. Results: None of these patients experienced a systemic reaction to vaccination. One patient developed a generalised maculopapular rash, which resolved after a single dose of an antihistamine. Vaccination was postponed in 63% of patients, with the longest delay extending to 113 months. Conclusions: Severe adverse reactions following MMR vaccination in patients with HEA are generally rare and are outweighed by the risks associated with natural infection and its complications. Effective communication of vaccine safety data and strengthening public trust in healthcare professionals are crucial.
Mixed-income development, an urban policy strategy aimed at protecting disadvantaged residents from concentrated poverty, has yielded mixed findings on subjective well-being, challenging its policy rationale. This study revisits this association by drawing two analytical distinctions that have received less attention in prior research: first, between neighborhood mixing indices and neighborhood socioeconomic status (SES) as distinct dimensions of neighborhood composition; and second, between linear and nonlinear specifications of their associations with well-being. We exploit Hong Kong's random allocation of public housing as a quasi-experimental design that attenuates residential selection bias. Using multilevel growth models on Hong Kong Panel Study of Social Dynamics data and focusing on public housing residents, we find that neighborhood SES is positively associated with subjective well-being, whereas neither income mixing nor housing type mixing indices show significant associations. Quintile-categorical specifications further reveal that the SES association is broadly monotonic, while the income mixing index follows an inverted U-shaped pattern. By disentangling neighborhood SES from mixing indices and examining nonlinearity within a quasi-experimental framework, this study clarifies which dimensions of neighborhood composition matter for disadvantaged residents' well-being, with implications for the design of mixed-income housing policies.
Language development in early childhood varies considerably, making early detection of Developmental Language Disorders (DLDs) challenging despite their high prevalence and long-term effects on learning and mental health. In Italy, no culturally adapted, easy-to-use screening tools are currently available in primary care. To address this gap, a screening tool was developed to support the early identification of children aged 24-72 months at risk of DLD and other clinically relevant language difficulties. To evaluate the psychometric properties and accuracy of the Comunicazione e Linguaggio in Ambulatorio Pediatrico (CLAP), a brief age-specific screening tool designed for use in Italian paediatric outpatient settings. In this pilot validation study, children were recruited by primary care paediatricians during routine well-child visits and stratified into four age groups: 24-30, 36-42, 48-54, and 60-72 months. After administration of the CLAP screening tool, each child underwent a blinded speech-language pathologist (SLP) assessment. Psychometric evaluation included internal consistency, item-total correlations, confirmatory factor analysis, and item response theory indices (discrimination and difficulty). Diagnostic accuracy was assessed using ROC curves, area under the curve (AUC), sensitivity, specificity, and optimal cut-offs. Analyses were conducted separately for each age group. Fifty children were enrolled in each age group; overall, 24% of the sample fell into the pathological subgroup after the blinded SLP assessment. Internal consistency was acceptable in the 24-30-month (KR-20 = 0.695) and 36-42-month (KR-20 = 0.777) groups, but lower in older children. Factor analyses supported a mainly unidimensional structure in the younger groups. Item response theory showed good discrimination and informativeness for several items. ROC analyses indicated excellent diagnostic accuracy in the 24-30-month group (AUC = 0.93; sensitivity = 92%; specificity = 87%), fair accuracy in the 36-42- and 48-54-month groups (AUC = 0.75 and 0.74), and poor performance in the 60-72-month group (AUC = 0.46). The CLAP demonstrates promising psychometric properties and good-to-fair accuracy as a brief screening tool for identifying children aged 24-54 months at risk of clinically relevant language difficulties, including those who may need further assessment for DLD. Its age-specific design, quick administration, and non-invasive nature support its potential integration into routine primary care. For older children, an age-specific revision or an alternative tool might be required. A larger validation study is currently in progress. What is already known on this subject Developmental Language Disorder (DLD) is common in early childhood; however, early identification remains difficult due to variable developmental pathways and the absence of validated screening tools in primary care. Currently, no brief, culturally adapted instrument is available for routine use in Italian paediatric settings. What does this study add to existing knowledge This study demonstrates that the CLAP tool has promising psychometric properties, with good accuracy in the youngest age group and fair accuracy up to 54 months for identifying children at risk of clinically relevant language difficulties, including those who may later meet criteria for DLD. It provides the first evidence supporting an age-specific, feasible screening option that can be integrated into Italian primary care, while also identifying areas requiring revision for older pre-schoolers. What are the potential or actual clinical implications of this work? CLAP can assist paediatricians in the early detection of clinically relevant language difficulties in children during routine well-child visits. Its adoption could help standardize early language screening in Italy, leading to earlier referral for further diagnostic assessment and appropriate speech-language evaluation.
Highly pathogenic avian influenza (HPAI) A(H7N9) virus poses a potential public health threat, underscoring the need for effective antiviral options for outbreak preparedness. Baloxavir marboxil (BXM) is a cap-dependent endonuclease inhibitor approved for seasonal influenza, but its in vivo efficacy against HPAI A(H7N9) virus has not been fully evaluated. We evaluated the efficacy of BXM in cynomolgus macaques infected with a reverse genetics-generated HPAI A(H7N9) virus. Animals received either low- or high-dose BXM, single-dose oseltamivir, or vehicle at 4 or 48 h post-infection (hpi). BXM administration was designed to mimic human pharmacokinetics. Viral titres, body temperature, body weight, lung pathology, and treatment-emergent viral substitutions were analysed. Early treatment (4 hpi) with BXM significantly reduced viral titres in nasal and tracheal swabs, lessened weight loss, and decreased pulmonary inflammation and alveolar damage compared to untreated or oseltamivir-treated animals. Virus pathogenicity was relatively mild; no animals died. Delayed treatment (48 hpi) showed limited benefit. The PA-I38T (83.8%) and PA-E23G (78.6%) substitutions associated with BXM resistance were detected in one animal, and a PA-K34R (85.4%) substitution was detected in another animal. These substitutions reduce BXM susceptibility and were detected at low titres. Although the dosing regimen used in this study involved repeat dosing to achieve the plasma drug concentrations after a single dose in humans, these findings highlight the importance of early antiviral intervention and support BXM use as a potential countermeasure against HPAI A(H7N9) virus infection, as resistance-associated substitutions remained limited in the macaque model. BXM may be a valuable therapeutic option for HPAI A(H7N9) virus infections. Supported by the Japan Agency for Medical Research and Development (JP20wm0125002, JP223fa627001) and Shionogi & Co., Ltd.
The US Food and Drug Administration (FDA) has long served as a credibility reference for dozens of countries that incorporate its assessments into their own drug authorization processes. I argue that regulatory reliance is a governance mechanism through which the reputational capital of a few anchor agencies shapes pharmaceutical regulation worldwide. For reliance to work, anchor agencies must maintain credibility and independence sufficient to make their assessments worth borrowing, and domestic regulators need enough autonomy to invoke external assessments as constraints on domestic political pressure. Drawing on Carpenter's reputational concept, the political economy literature on regulatory agency design, and evidence from Latin America, the Asia-Pacific, and Africa, my analysis documents the architecture of reliance and its concentration in a few agencies. During the COVID-19 pandemic, Brazil's regulator grounded its emergency procedures in FDA and European Medicines Agency standards to resist domestic pressure, whereas India's regulator authorized vaccines before any reference authority had acted. Workforce reductions, compressed timelines, and weakened evidentiary standards at the FDA now threaten this architecture. Countries that had no part in this erosion are likely to bear its consequences. (Am J Public Health. Published online ahead of print June 25, 2026:e1-e7. https://doi.org/10.2105/AJPH.2026.308597).
Hospital-centred operational governance has been a persistent feature of China's health system. While this model has supported administrative control, rapid service expansion and organisational standardisation, it has also contributed to the continued concentration of resources in hospitals, constrained local flexibility and the relative marginalisation of primary healthcare. This study examines, from the perspective of path dependence, how this governance model gradually emerged and persisted from 1835 to the present. Drawing on historical studies, policy documents, institutional historical data, official materials and comparative global health literature, the study identifies seven phases in the historical evolution of hospital-centred operational governance in China: missionary introduction and early administrative formation; early institutional formation; nationalist integration and public function expansion; wartime adaptation and emergency coordination; socialist consolidation and planned administration; market transition and managerial modernisation and optimisation, digitalisation and performance governance. Across these stages, four self-reinforcing mechanisms collectively stabilised this pattern: institutional steering, functional expansion, managerial standardisation and market-oriented transformation. The evidence indicates that hospitals became dominant not simply because they appeared earlier but because they repeatedly accumulated administrative visibility, professional authority, technical capacity, fiscal channels and reform implementation functions. For health system reform, the findings suggest that strengthening primary healthcare and improving equity require technical management reforms to proceed in parallel with changes in governance power, financing incentives, resource allocation, workforce status and data infrastructure. The global health implication is that countries pursuing universal health coverage should avoid allowing hospitals to become the default centre of finance, information, professional prestige and policy implementation.
Injection-site complications are a poorly recognised problem in small ruminant production in Ghana. The improper injection can lead to tissue damage, abscesses, fibrosis, drug residues, lower meat quality and carcass condemnation, which can cause economic and public health issues. Veterinarians are legally qualified to give injections, but in practice, para-veterinarians and animal herders often do so, as they are in close contact with livestock and are often responsible for immediate animal care. The aim of this study was to evaluate the knowledge, attitudes and practices of animal health providers on injection-site complications in Kumasi, Ghana. A comparative cross-sectional study was carried out among 230 respondents including veterinarians (59), para-veterinarians (18), animal herders (143) and meat handlers (10) with a structured questionnaire. Descriptive statistics and Chi-square tests were used to collect and analyse data on knowledge, attitudes, anatomical injection-site preferences and injection practices. Retrospective abattoir records from January to August 2025 were also reviewed to determine the prevalence and distribution of injection-site lesions in slaughtered small ruminants. Occupation, age, gender, years of experience, and formal training were significantly associated with the level of knowledge (p < 0.05). Veterinarians had the highest awareness of injection-site complications and correct anatomical injection sites, whereas animal herders had lower awareness, especially about tissue necrosis, contamination-related infections, and improper drug absorption. The neck area was the most common site for intramuscular injection by veterinarians, while the thigh and gluteal muscles were the most common sites for para-veterinarians and animal herders. A total of 100 injection-site lesions were found in 43,483 slaughtered animals during abattoir inspection, with lesions mainly located in the thigh area. There was a significant association between formal training and positive attitudes with good injection practices (p < 0.05). There were significant differences in knowledge and practices about injection-site complications among animal health providers in Kumasi. Injection administration by para-veterinarians and herders, and inappropriate injection-site selection, may be factors in the lesions seen during meat inspection. Injection safety, meat quality and animal welfare can be enhanced through targeted training and inclusive veterinary extension programs that engage all livestock handlers.