Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
The umbilical cord, composed of blood vessels and connective tissue, connects the fetus to the placenta during pregnancy. After birth, the remaining cord stump may serve as an entry point for harmful bacteria, potentially leading to serious infection (neonatal sepsis) and death, particularly in low- and middle-income countries (LMICs). Applying antiseptics - substances that prevent the growth of microorganisms on living tissues - may help reduce the risk of infection through the umbilical stump. To evaluate the benefits and harms of the application of antiseptics on a newborn's umbilical cord versus no antiseptics for the prevention of morbidity and mortality in infants in low- or middle-income countries (LMICs), and high-income countries (HIC). We searched CENTRAL, MEDLINE, Embase, LILACS and trial registries in December 2025. We checked reference lists of included studies and/or studies/systematic reviews where subject matter related to the intervention or population examined in this review. We included individual and cluster-randomized controlled trials comparing any antiseptic with no antiseptic applied to the umbilical cord of newborns (0 to 28 days of life), regardless of gestational age, birthweight, delivery setting, or maternal infection risk. We excluded studies involving newborns with congenital malformations, quasi-randomized or observational designs, trials comparing different formulations or concentrations of the same antiseptic, and studies involving only topical antibiotics or antiseptic-antibiotic combinations. Our outcomes were all-cause neonatal mortality, omphalitis, and cord separation time. All the outcomes were measured during the neonatal period (i.e. from birth to 28 days of life). The risk of bias was assessed by using the Cochrane risk of bias tool (RoB 1). Two review authors independently assessed studies for inclusion and evaluated the risk of bias. One review author extracted the data, and a second author verified the extraction for accuracy. We analyzed studies conducted in low- and middle-income countries (LMICs) separately from those in high-income countries (HICs), given the differing baseline risks. Where appropriate, we synthesized results using random-effects meta-analysis. We assessed the certainty of the evidence for each outcome using the GRADE approach. We included 18 trials in the review (143,150 participants), two studies are awaiting classification and four studies are ongoing trials. The included studies evaluated antiseptics such as 70% alcohol, 4.0% chlorhexidine (CHX), silver sulfadiazine, and povidone iodine in LMICs. In HIC, the studies evaluated CHX and alcohol. Five population-based trials looking at CHX in LMICs reported data on all-cause mortality that comprised 2280 deaths in 129,381 participants. Combined results showed that topical application of CHX may lead to a small reduction in all-cause neonatal mortality from 18/1000 to 15/1000 participants (average risk ratio (RR) 0.86; 95% confidence interval (CI) 0.73 to 1.01; 129,381 participants, 5 studies; low-certainty evidence). Among the CHX studies that took place in an LMIC, the topical application of CHX likely reduces the risk of omphalitis from 87/1000 participants in the control group to 62/1000 participants in the CHX group (RR 0.71; 95% CI 0.60 to 0.85; 128,486 participants, 5 studies; moderate-certainty evidence). The topical application of CHX likely increases cord separation time by 1.85 days in the CHX group compared with control (mean difference (MD) 1.85 days; 95% CI 0.81 to 2.90; 47,533 participants, 6 studies; moderate-certainty evidence) in studies conducted in LMICs. One study evaluated CHX in a HIC and did not report all-cause neonatal mortality data. The evidence was very uncertain about the use of topical application of CHX for the prevention of omphalitis (RR 0.28; 95 % CI 0.06 to 1.35; 669 participants, 1 study; very low-certainty evidence), indicating that the findings should be interpreted with caution. Similarly, the effect on cord separation time (MD: -0.80; 95 % CI -1.21 to -0.39; 669 participants, 1 study; very low-certainty evidence) was very uncertain. Four studies in LMICs evaluated the topical application of alcohol but none of them reported data on all-cause mortality. The evidence for the prevention of omphalitis from topical application of alcohol is very uncertain based on two studies (RR 1.22; 95% CI 0.34 to 4.44; 270 participants, 2 studies; very low-certainty evidence). The effect of alcohol on cord separation time is very uncertain based on data from four trials (MD -0.00 days; 95% CI -1.75 to 1.75; 598 participants, 4 studies; very low-certainty evidence). Four studies conducted in a HIC evaluated the topical application of alcohol. The pooled results showed that cord separation time was likely increased by 1.63 days in the alcohol group compared to the control group (MD 1.63 days; 95 % CI 1.11 to 2.15; 2117 participants, 4 studies; moderate-certainty evidence). None of the four studies in HIC that evaluated the topical application of alcohol reported data on the prevention of all-cause mortality or omphalitis. Overall, the included studies had a moderate risk of selection and attrition bias, a high risk of detection and performance bias, and unclear risk of reporting bias. Topical application of 4.0% chlorhexidine to the umbilical cord likely reduces the risk of cord infection and may reduce neonatal mortality in low- and middle-income countries, though it probably delays cord separation by about two days. In high-income countries, evidence for chlorhexidine is very uncertain. For 70% alcohol, evidence from low- and middle-income countries is very uncertain for prevention of infection, and its use may result in little or no difference in cord separation time. In high-income countries, moderate-certainty evidence suggests that alcohol likely delays cord separation slightly. This Cochrane review had no dedicated funding. 2010 Protocol available doi.org/10.1002/14651858.CD008635 2013 published review available doi.org/10.1002/14651858.CD008635.pub2.
Campylobacteriosis is a major cause of gastroenteritis globally, but comprehensive data on its prevalence and antimicrobial resistance (AMR) patterns in Iran are limited. This study aimed to estimate the national prevalence of Campylobacter-associated gastroenteritis in Iran, analyze temporal trends in infection rates, and characterize antibiotic resistance patterns among circulating Campylobacter spp. over the past two decades. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was performed across the Web of Science, PubMed, Scopus, Embase, Islamic World Science Citation Center (ISC), Scientific Information Database (SID), and Magiran databases for studies published from 2000 to 2025. Eligible studies were assessed based on predefined inclusion criteria, followed by both qualitative and quantitative analyses of the selected studies. The quality of the studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, and data analysis was conducted utilizing the R statistical programming language along with the 'meta' package. A random-effects model was applied to calculate the pooled prevalence, while heterogeneity was measured using the I² statistic and a prediction interval. A total of 46 studies met the inclusion criteria. Meta-analysis using a random-effects model revealed an overall pooled prevalence of 8.0% (95% CI: 6.0-10.0%), with substantial heterogeneity among studies (I² = 97.0%, p < 0.0001), likely due to variability in diagnostic methods, populations, and study designs. Subgroup analysis showed a higher prevalence for C. jejuni (35.0%, 95% CI: 22.0-49.0%, I² = 98.5%) compared to C. coli (16.0%, 95% CI: 11.0-22.0%, I² = 75.5%), while C. lari was excluded due to rarity. A temporal assessment revealed a peak prevalence of 11.0% (95% CI, 7.0-15.0%, I² = 94.2%) during the period 2013-2020, indicating a general upward trend over time. In patients ≤ 10 years, prevalence was 6.0% (95% CI, 3.0-9.0%, I² = 92.1%), with C. jejuni and C. coli responsible for 45.0% (95% CI, 13.0-80.0%) and 14.0% (95% CI, 7.0-23.0%) of cases, respectively. Among those ˃ 10 years, prevalence was 8.0% (95% CI, 6.0-11.0%, I² = 97.6%), with 32.0% (95% CI, 18.0-47.0%) for C. jejuni and 16.0% (95% CI, 10.0-24.0%) for C. coli. Resistance to ciprofloxacin (65%; higher in C. coli) and nalidixic acid (98%; higher in C. jejuni) - both quinolones-has shown a consistent and sharp increase, reaching the highest resistance levels in recent years. Similarly, tetracycline (79%; higher in C. coli) resistance has followed a rising trend, particularly in C. coli and overall Campylobacter spp., making these antibiotics increasingly ineffective for empirical treatment. This systematic review and meta-analysis highlight a moderate but rising prevalence of gastroenteric Campylobacter infections in Iran, with C. jejuni being the predominant species. Increasing resistance to quinolones, tetracyclines, and macrolides poses a serious threat to treatment, especially in C. coli. While gentamicin shows sustained low resistance, its parenteral administration restricts routine use, limiting its role to severe cases. Strengthened national surveillance, standardized diagnostics, and robust antimicrobial stewardship, particularly in poultry-the main source of human disease-are urgently needed. Not applicable.
Migrants are at increased risk of infections including HIV, tuberculosis and viral hepatitis, with poorer outcomes. Early diagnosis and management can reduce morbidity, mortality and onward transmission. This systematic review summarises prevalence of HIV, latent and active tuberculosis and hepatitis B and C among UK migrants and evaluates associated risk factors. PubMed/Medline, EMBASE, Web of Science and the Cochrane Library were systematically searched from 2004 to 11 June 2025. The review was conducted using PRISMA guidelines and registered with PROSPERO (registration CRD42024521191). Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. High heterogeneity (I2 = 95.2%, 99.2%, 87.2%, 96.9% and 91.6% for IGRA, active TB, HIV, HBV and HCV yields, respectively) indicated that meta-analysis was not appropriate. The impact of risk factors on prevalence was explored through meta-regression and descriptive analysis. Of 2033 identified records, 36 were included, reporting Interferon Gamma Release Assay (IGRA) (n = 13), active TB (n = 10), HIV (n = 12), HBV (n = 16) and HCV (n = 11) test yields. An additional two publications excluded from the main analysis for reporting duplicate study data were included in the risk factor analysis because they stratified prevalence by additional risk factors. Highest yield was for IGRA which, excluding one lower prevalence outlier (6.9% (n = 1617)), was 15.1%-22.1%. There was high heterogeneity in active TB prevalence: 62-1,484/100,000. HIV prevalence among larger studies (n > 200) was 0.18%-0.48%. HBV prevalence was 0.00%-8.93% (all studies) and 1.06%-4.75% for larger studies (n > 1000). HCV prevalence was lower: 0.00%-1.67%, with only two of 11 included estimates above 0.50%. There was considerable heterogeneity in risk factors analysed making comparisons difficult. Despite heterogeneity, infection prevalence was generally high, particularly IGRA yield and HBV. This underscores the need to maintain effective monitoring, testing and treatment for key infections among migrant populations, especially given the rapidly evolving epidemiological and demographic landscape for this population.
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.
Enterovirus D68 (EV-D68) has been implicated in clusters of acute flaccid myelitis (AFM) and severe respiratory illness; however, the magnitude and consistency of association across settings and over time remain uncertain. We quantified the association between EV-D68 detection and acute neurologic outcomes (particularly AFM) and explored design- and time-related heterogeneity. Following PRISMA 2020 and MOOSE guidance, we systematically identified observational studies reporting associations between EV-D68 detection and neurologic outcomes. Random effects meta-analysis was performed using REML with Knapp-Hartung adjustment; heterogeneity was summarised with τ2 and I2. Prespecified moderators were examined with meta-regression. Small-study effects were evaluated using contour-enhanced funnel plots, Egger and Peters tests, and PET-PEESE bias-adjusted models. PROSPERO registration: 1152300. Across 98 studies, the pooled odds ratio (OR) was 1.39 (95% CI 1.14-1.69), with high heterogeneity (I2 = 98.9%; prediction interval 0.24-8.15). By design, respiratory surveillance studies showed stronger association (OR 1.59, 95% CI 1.35-1.86, k = 78) whereas AFM case-control studies did not (OR 0.86, 95% CI 0.40-1.86, k = 20). In multivariable meta-regression, study design and calendar year explained about 47% of inter-study variance. Predicted ORs declined from 2014 to 2022 across regions. Funnel asymmetry and small-study effects were suggested; PET-PEESE bias-adjusted estimates remained above the null. The EV-D68 outcome association is context-dependent and time-varying. Surveillance datasets enriched during outbreak waves drive the pooled signal, while AFM case-control designs yield attenuated estimates after adjustment. Standardising diagnostics and integrating design-specific surveillance will improve risk estimation and AFM preparedness.
Objective: This study provides the first systematic synthesis of the burden of Group B Streptococcus (GBS) colonization and invasive disease in Nigeria, with emphasis on prevalence, serotypes, and sequence types (STs). Method: This systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines and was registered on PROSPERO (CRD420251155310). Searches were conducted across multiple databases, including Scopus, ScienceDirect, Web of Science, PubMed, Dimensions, and African Journals Online, as well as in Google Scholar and Google to identify relevant articles. In total, 426 records were retrieved, of which 43 studies met the inclusion criteria. A random-effects model was applied to estimate the pooled prevalence. Result: The pooled prevalence of GBS colonization in Nigeria was 12.0% (95% CI: 9.0-15.0%). Higher colonization rates were observed in Southern Nigeria (13.0%) than in Northern Nigeria (9.0%). The neonatal colonization rate was 16.0%. Colonization rates were 13.0% in pregnant women and 8.0% in non-pregnant individuals. Human immunodeficiency virus status showed no significant association with GBS colonization among pregnant women (OR = 1.47, p = 0.17). Invasive GBS disease was uncommon (3.0%) and occurred only in neonates. Across included studies, serotypes V and II were the most frequently reported, with ST19, ST182, and ST28 being the predominant STs. Conclusions: GBS colonization is common in Nigeria, with marked regional variation and heightened neonatal vulnerability to invasive GBS infections. Notably, nineteen states lacked surveillance data, highlighting substantial gaps in national monitoring. These findings highlight the importance of strengthening prevention strategies, expanding surveillance coverage, and implementing maternal screening and immunization programs to mitigate the burden of GBS.
Vancomycin-resistant Enterococcus (VRE) represents a global public health threat due to its ability to disseminate antimicrobial resistance (AMR) genes across ecological boundaries. While the prevalence of VRE has been extensively studied in clinical and agricultural settings, its occurrence and dynamics in wildlife remain underexplored. This review aimed to systematically examine and analyze the global prevalence of VRE in wild mammals. Following PRISMA guidelines, an extensive search of six databases yielded 25 studies that met predefined inclusion criteria. Data were extracted and synthesized using a random-effects model to estimate pooled prevalence rates, and subgroup analysis was also performed. Heterogeneity was quantified using the I² statistic, and publication bias was assessed through funnel plots and Egger's test. The overall pooled prevalence of VRE in wild mammals was 8.4 % (95 % CI: 4.9-14.0), with significant heterogeneity (I² = 87.63 %). Southern Europe recorded the highest prevalence, particularly in Spain (18.6 %) and Portugal (7.0 %), while lower rates were observed in England (3.3 %) and Italy (4.5 %). Species-specific prevalence was highest in Eurasian otters and roe deer (62.1 % and 48.6 %, respectively). Methodological variability also influenced prevalence rates, with disc diffusion reporting the highest prevalence (17.3 %) compared to PCR-based methods (3.9 %). The findings indicate a moderately significant prevalence of VRE in wild mammals, underscoring wildlife's critical role as reservoirs and vectors of AMR. Anthropogenic factors such as agricultural activities and environmental pollution significantly shape the distribution and burden of VRE among wild animals.
Leptospirosis, a neglected zoonotic disease caused by pathogenic Leptospira spp., poses ongoing challenges in China due to shared environmental exposure of humans and dogs. To summarize available epidemiological evidence, we conducted a PRISMA-compliant systematic review and meta-analysis of human and canine leptospirosis in China. Six databases (PubMed, Web of Science, ScienceDirect, CNKI, Wanfang, and VIP) were searched for eligible studies published up to 11 November 2025. Cross-sectional data were synthesized using random-effects models, with subgroup analyses applied to explore heterogeneity. A total of 109 studies from 29 provinces were included, comprising 111,542 human samples and 8875 dog samples. The pooled prevalence was estimated at 25.00% in humans and 12.00% in dogs, with substantial heterogeneity across studies. In humans, higher prevalence estimates were generally observed in central regions, earlier decades, middle-aged adults, populations classified as having higher exposure, and rural areas. Serovar distributions also differed across populations, with Icterohaemorrhagiae predominating in humans. In dogs, prevalence and serovar distributions varied across studies, with Canicola being the most frequently reported serogroup, and higher prevalence estimates commonly observed in unvaccinated and free-roaming animals. Overall, this study provides a descriptive synthesis of leptospirosis in humans and dogs in China. Given the substantial heterogeneity, wide confidence intervals, and data limitations, the findings should be interpreted cautiously as reflecting broad epidemiological patterns rather than confirmatory evidence of causal risk factors. Nonetheless, the results highlight populations, regions, and serovars that may warrant prioritization in surveillance and One Health-oriented prevention efforts.
Six novel halophilic archaeal strains, DFWS20T, NG-SE-30T, NG-WS-4T, HHT-WS-8, NG-SE-24T, and SG-WS-1, were isolated from different coastal regions of China. Metagenome and amplicon analyses showed that the abundance of archaea in the corresponding samples was very low. Strains DFWS20T, NG-SE-30T, NG-WS-4T, and HHT-WS-8 were found to cluster with current Haladaptatus species, while strains NG-SE-24T and SG-WS-1 with those of Halomicrococcus based on 16S rRNA and rpoB' gene phylogenies. The overall-genome related indexes (OGRIs), average nucleotide identity (ANI), digital DNA-DNA hybridization (dDDH), and average amino acid identity (AAI) values, between strains DFWS20T, NG-SE-30T, NG-WS-4T, HHT-WS-8, and Haladaptatus species were 77.0-83.1%, 22.2-28.3%, and 74.7-84.8%, while those between strains NG-SE-24T, SG-WS-1, and Halomicrococcus species were 79.6-94.9%, 26.0-63.9%, and 76.5-94.1%, respectively. These values were lower than the threshold of species classification. In contrast, the OGRIs between strains NG-WS-4T and HHT-WS-8, as well as those between strains NG-SE-24T and SG-WS-1, were above the threshold of species classification. Diverse differential phenotypic characteristics, such as nutrition, biochemical activities, and antibiotic sensitivity, were determined in these six strains and the existing species of the corresponding genera. The most abundant pathways in the genera Haladaptatus and Halomicrococcus were related to carbohydrate metabolism and amino acid metabolism. Based on the natural habitat analysis of the 16S rRNA genes of the strains, their target sequences were primarily found in habitats such as aquatic, soil, sediments, plant, and marine environments. The major polar lipids of strains DFWS20T, NG-SE-30T, NG-WS-4T, and HHT-WS-8 were phosphatidylglycerol (PG), phosphatidylglycerol phosphate methyl ester (PGP-Me), phosphatidylglycerol sulfate (PGS), and sulfated mannosyl glucosyl diether (S-DGD-1), while those of strains NG-SE-24T and SG-WS-1 were PG, PGP-Me, S-DGD-1, and galactosyl mannosyl glucosyl diether (TGD-2). Based on these polyphasic classification, strains DFWS20T, NG-SE-30T, NG-WS-4T, and HHT-WS-8 represent three novel species of the genus Haladaptatus while NG-SE-24T and SG-WS-1 represent a novel species of the genus Halomicrococcus.
Four mesophilic, acidophilic, cell wall-less archaea, strains-SKW1, SKW2T, SKW3, and SKW4T-were isolated from a green microbial mat in an acidic hot spring. SKW1 and SKW2T cells were predominantly coccoid and rarely pleomorphic, whereas SKW3 and SKW4T cells were mostly pleomorphic. The cell sizes ranged from 0.3 to 2.0 μm. SKW1 and SKW2T grew at temperatures between 15 and 55 °C (optimally at 37-40 °C) and pH 1.5-5.0 (optimally 3.0-4.0). SKW3 and SKW4T also grew at temperatures between 15 and 55 °C (optimally at 30 °C) and pH 1.5-5.0 (optimally 1.8-2.0). All the strains were facultatively anaerobic and heterotrophic, requiring tryptone for growth. The dominant membrane lipid in both SKW2T and SKW3 was glycerol dibiphytanyl glycerol tetraether (GDGT). The genomic G+C mol% of SKW1 to SKW4T ranged from 35.8 to 38.1 mol%. In the 16S rRNA gene-based phylogenetic tree, all the strains were placed within the family Cuniculiplasmataceae and the order Thermoplasmatales. Sequence identities to the closest strain, Cuniculiplasma divulgatum strain S5T, were 94.28 % (SKW1), 94.35 % (SKW2T), 95.81 % (SKW3), and 95.88 % (SKW4T). Phylogenetic analyses showed that SKW 1 and SKW2T were distantly related to C. divulgatum strain S5T, whereas SKW3 and SKW4T were more closely related. Based on phylogenetic analyses and physiological properties of the four isolates, a novel genus, Caldiplasma gen. nov., and two novel species Caldiplasma sukawensis sp. nov. and Cuniculiplasma thermophilum sp. nov. are proposed: Caldiplasma sukawensis SKW1 (=JCM 39523) and SKW2T (=JCM 39524T), and Cuniculiplasma thermophilum SKW3 (=JCM 39525) and SKW4T (=JCM 39526T).
Pre-clinical models are commonly used to determine human antibiotic dosage regimens using pharmacokinetic/pharmacodynamic (PKPD) indices. The murine thigh infection model (MTIM) is most commonly used for PKPD index determination, while the hollow fibre infection model (HFIM) may be a viable alternative. However, there is no standardized method for determining the PKPD index and R2 may not be the ideal metric to determine goodness of fit for nonlinear models. This study aimed to reanalyse PKPD indices published in MTIM and HFIM, using a standardized modelling approach. Systematic literature review was conducted to identify MTIM and HFIM dose fractionation studies. Searches covered databases including PubMed, MEDLINE, BIOSIS, SCOPUS and EMBASE. Data were extracted and modelled using eight variations of Emax model, with model selection based on the lowest Akaike information criterion (AIC) and parameter plausibility in terms of precision and interpretability. A total of 53 studies were included: 50 MTIM (of 1138) and 3 HFIM (of 316). Among the 53 studies, reporting issues included an infrequent use of AIC for model selection as applied in only one paper, and a lack of methodological transparency in 29 papers. Remodelling revealed some disagreement in optimal PKPD indices in six studies. This study suggests a standard method for PKPD index model selection and provides a database on PKPD index analysis. Building the Emax model from one to four estimated parameters and assessing them with AIC is recommended to avoid over fitting. Too few HFIM dose fractionation studies were found to allow comparison of PKPD index with MTIM.
Two Gram-stain-negative, obligately aerobic, non-motile rod-shaped bacteria, designated strains W23T and W31T, exhibiting catalase- and oxidase-positive activities, were isolated from the phycosphere of a marine red alga. Strain W23ᵀ grew optimally at 25 °C, pH 8.0-9.0, and 3.0-4.0 % (w/v) NaCl, whereas strain W31T grew optimally at 25-30 °C, pH 8.0, and 3.0-4.0 % NaCl. Ubiquinone-8 was the major respiratory quinone in both strains. Strain W23T predominantly contained C16:0, summed features 3 (C16:1ω7c and/or C16:1ω6c) and 8 (C18:1ω7c and/or C18:1ω6c), and C12:0 as major fatty acids, with phosphatidylglycerol and phosphatidylethanolamine as main polar lipids. In contrast, strain W31T exhibited isoC15:0, summed feature 1 (isoC15:1H and/or C13:0 3-OH), C12:0, and isoC11:0, with diphosphatidylglycerol, phosphatidylethanolamine, and phosphatidylmonomethylethanolamine as dominant polar lipids. The genomic DNA G + C contents were 44.5 % for strain W23T and 42.3 % for strain W31T. Phylogenetic, genomic, and phenotypic analyses support the classification of strains W23ᵀ and W31ᵀ as novel species within the genera Ningiella and Marinicella, for which the names Ningiella algicola sp. nov. (W23T = KACC 23126T = JCM 35964T) and Marinicella algicola sp. nov. (W31T = KACC 23129T = JCM 35965T) are proposed. Genome-based phylogenomic analyses also supported the reclassification of Alteromonas lipolytica, Alteromonas alba, and Alteromonas oceani into the genus Marisediminitalea; Alteromonas sediminis into a new genus, Paralteromonas; and Alteromonas flava, Alteromonas facilis, and Alteromonas arenosi into another new genus, Neoalteromonas. Furthermore, Methylophaga aminisulfidivorans is reclassified as a later heterotypic synonym of Methylophaga thalassica.
Increases in the number of migrants (economic, educational, and involuntary) to Europe from countries with high incidence of communicable diseases [tuberculosis (TB), HIV, and hepatitis B (HBV) and C (HCV)]; has increased the need for cost-effective early disease diagnosis programmes to improve outcomes. We aimed to synthesize and evaluate current literature on community-based screening (CBS) initiatives in Europe, the diseases being screened for, and acceptance when offered. Database search (OVID Medicine, OBIFD EMCAre, and EMBRACE) of studies between January 2000 and January 2024 investigating CBS of newly arrived migrants for TB, HIV, HBV, and HCV in Europe (PROSPERO ID: 542289). Fifteen studies were included TB only (9/15, 60%), blood borne viruses (BBV) (2/15, 14%), and two or more diseases (4/15 26%). Ten (68%) studies were community-based, 3 (16%) in reception centres, 1 (8%) in primary care, and 1 (8%) mixed setting. Five (33%) studies included community leaders/members in recruitment and two (13%) performed follow-up on participants. Screening acceptance ranged from 41% to 100% (TB 41%-100%, BBV 78.5%-100%, TB/BBV 47.3%-100%) and disease prevalence ranged from 0.09% to 45.1% (TB 0.09%-45.1%, BBV 0.2%-8.7%, TB/BBV 3.2%-28.8%). There are few studies investigating CBS of TB or BBV in migrants in Europe, despite a rise in migration over the last decade. This review shows an urgent need for CBS of migrants for multiple infections that includes community members/leaders to improve acceptance rates and reduce disease mobility and mortality in a vulnerable population.
This systematic review and meta-analysis (SRM) investigated the potential of garlic (Allium sativum) against cariogenic oral microorganisms. The SRM was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251133140). Randomized clinical trials (RCTs) evaluating garlic or garlic-derived compounds on cariogenic oral microorganisms were included. A literature search was performed in the main scientific databases. Meta-analyses were performed using RevMan software, with standardized mean difference (SMD) as the effect measure, and a random-effects model was applied with 95 % confidence intervals. Risk of bias was assessed using the Cochrane tool, and the certainty of evidence was graded according to the GRADE approach. Nine RCTs fulfilled the inclusion criteria, predominantly assessing S. mutans, followed by Lactobacillus spp. and C. albicans. All included trials employed garlic-based mouthwashes as the intervention and consistently demonstrated significant antimicrobial activity. In meta-analysis, compared to chlorhexidine, garlic reduced S. mutans at 1 week (SMD = -0.73, 95 % CI = -1.39 to -0.07, I² = 73 %; p = 0.03), had a slightly lower effect at 2 weeks (SMD = 1.27, 95 % CI = 0.09-2.44, I² = 90 %; p = 0.03), and showed no difference at 1 month (SMD = -0.54, 95 % CI = -2.78-1.70, I² = 96 %; p = 0.64). Compared to sodium fluoride, it demonstrated superior activity at 2 weeks (SMD = -0.79, 95 % CI = -1.22 to -0.36, I² = 0 %; p = 0.0003). Most studies had a low risk of bias, and the certainty of the evidence was rated low. Garlic-based mouthrinses show significant antimicrobial activity against cariogenic microorganisms, supporting their potential as a phytotherapeutic strategy for biofilm control. However, the evidence remains limited, demonstrating the need for further high-quality clinical trials to confirm long-term efficacy.
Two gram-stain positive, non-motile, spore-forming and anaerobic bacterial strains that are designated as HA2173T and HA2174T were isolated from the faeces of an adult woman. Physiological and biochemical analyses revealed that both strains are neutrophilic, mesophilic, and tolerant to low concentrations of NaCl. Analysis of 16S rRNA gene sequences indicated that strains HA2173T and HA2174T belonged to the families Oscillospiraceae and Lachnospiraceae, respectively. The phylogenetic relatives closest to strains HA2173T and HA2174T were Zongyangia hominis NSJ-54T (16S rRNA gene similarity is 97.7%) and Blautia argi N6H1-15T (16S rRNA gene similarity is 97.9%), respectively. Genome annotation indicated that both strains could metabolize carbohydrates and generate propionate, acetate and formate, and the major end-products of fermentation of both strains HA2173T and HA2174T were determined to be acetic acid. The major polar lipids detected in strain HA2173ᵀ were diphosphatidylglycerol and phosphatidylglycerol, but only diphosphatidylglycerol was identified in strain HA2174ᵀ. Cohort analysis revealed divergent prevalence patterns for strains HA2173ᵀ and HA2174ᵀ, with their relative abundances significantly elevated in the T2D and OB cohorts. Based on the results of phylogenetic analysis, 16S rRNA gene similarity, and chemotaxonomic characteristics, strains HA2173T and HA2174T represent novel species of the genus Zongyangia and Blautia, respectively, for which the names Zongyangia acetica sp. nov. and Blautia acetica sp. nov. are proposed. The type strain for Zongyangia acetica sp. nov. is HA2173T (=CGMCC 1.18038T = KCTC 25723T). The type strain for Blautia acetica sp. nov. is HA2174T (=CGMCC 1.18039T = KCTC 25724T).
Emergence and spread of carbapenem-resistant Acinetobacter baumannii (CRAB) producing metallo-β-lactamases (MBLs), especially New Delhi MBLs (NDMs), are concerning due to resistance to last-resort antibiotics. PubMed and Scopus were queried for studies published between 2020 and 2024 reporting MBL prevalence in CRAB isolates. Risk of bias was assessed across the population, setting and measurement domains. Binomial-Normal mixed-effects models were applied to estimate regional and country-specific weighted MBL and NDM prevalence proportions in CRAB. Subgroup and meta-regression analyses were performed to investigate heterogeneity. Two hundred thirty-three studies reporting 58 676 CRAB isolates were analysed. The global MBL prevalence in CRAB was 5.3% [95% confidence interval CI), 3.3%-8.2%]. Regional variability explained a substantial portion of heterogeneity in meta-regression (R2 = 35%). MBL prevalence in CRAB was highest in the Eastern Mediterranean (42.1%; 95% CI, 28.7%-56.8%) and African (36.1%; 95% CI, 12.2%-69.8%) regions, moderately high in South-East Asia (17.9%; 95% CI, 9.6%-30.9%), and low (<1%) in Europe, the Americas and the Western Pacific region. MBL prevalence in CRAB was higher in studies conducted during 2020-2024 than during 2012-2019 (7.2% versus 4.2%; adjusted odds ratio 2.3, P = 0.024). NDM was the dominant MBL in CRAB, with a global prevalence of 1.7% (95% CI, 1.1%-2.7%) in 218 studies. Although its global prevalence is low, MBL-producing CRAB is common in specific regions and countries, threatening the utility of new antibiotics. Sustained surveillance, rigorous infection control and antimicrobial stewardship are required to preserve the activity of last-resort antimicrobials.
Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health concern, particularly in resource-limited settings such as Africa. This meta-analysis aimed to determine the proportion of MRSA among S. aureus isolates from patients with confirmed infections and to assess associated antibiotic resistance profiles across the continent. A comprehensive literature search was conducted in African Journals Online, African Index Medicus, PubMed, Scopus, Google Scholar, and Web of Science for studies published between January 1, 2013, and June 5, 2024. Primary studies were included if they reported MRSA proportion or resistance profiles in Africa, employed reliable detection techniques, and analyzed clinical specimens from infected patients. Statistical analyses were performed using the meta package in R software, applying a random-effects model. A p-value of < 0.05 was considered statistically significant. This meta-analysis included 191 studies, encompassing 40,979 S. aureus isolates. Nigeria contributed the highest number of studies (n = 29), followed by Egypt (n = 26). The vast majority of studies (n = 186) were based on hospital settings. The pooled proportion of MRSA in Africa was 42.2% (95% CI 38.7-45.6). By detection method, proportion was 41.4% for mecA, 42.8% for the cefoxitin disc method, and 39.1% for the oxacillin disc method, with no significant differences observed (p = 0.8). Regionally, Northern Africa had a significantly higher proportion of 56.2% (95% CI 49.3-62.9) compared with 36.7% (95% CI 33.2-40.4) in Sub-Saharan Africa (p < 0.001). At the country level, Eritrea reported the highest proportion (71.8%), followed by Egypt (61.8%), while the lowest rates were observed in Malawi (7.0%) and Gabon (8.2%). Regarding MRSA resistance profiles, linezolid (3.4%) and vancomycin (4.7%) showed the lowest resistance rates, whereas higher rates were noted for fusidic acid (11.6%), rifampin (28.4%), clindamycin (40.4%), trimethoprim-sulfamethoxazole (54.5%), and tetracycline (60.2%). Limited data were available for telavancin, dalbavancin, oritavancin, tedizolid, ceftaroline, mupirocin, and daptomycin. The proportion of MRSA in Africa remains high at 42.2%, with marked regional disparities. Although resistance rates for linezolid and vancomycin are relatively low, they surpass global averages, raising concerns about emerging resistance. Alarmingly high resistance rates to several other antibiotics further underscore the urgent need for targeted interventions and continuous surveillance.
Antimicrobial resistance driven by multidrug-resistant (MDR) Gram-negative pathogens poses a major global threat, contributing to substantial morbidity and mortality. Novel β-lactam/β-lactamase inhibitor combinations, particularly meropenem-vaborbactam (M/V) and ceftazidime-avibactam (C/A), have expanded therapeutic options; however, their comparative efficacy and safety remain uncertain. This meta-analysis compared M/V and C/A in adult patients with MDR Gram-negative infections. MEDLINE, Embase, and Cochrane Central were searched for studies evaluating M/V versus C/A in hospitalized adults. Outcomes included all-cause mortality, clinical cure, and microbiological recurrence; safety was assessed qualitatively. Data were synthesized using Review Manager, with trial sequential analysis (TSA) applied to minimize random error. Five retrospective cohort studies (three full articles and two conference abstracts) comprising 3,280 patients were included, of whom 577 received M/V and 2,703 received C/A. Populations predominantly consisted of older adults aged 57-70 years, with respiratory tract infections being most common. Pooled analyses demonstrated no statistically significant differences between M/V compared to C/A in all-cause mortality (Odds ratio [OR] 0.87; 95% CI 0.69-1.11; P = 0.26; I² = 16%), clinical cure (OR 1.41; 95% CI 0.66-3.03; P = 0.37; I² = 55%), and microbiological recurrence (OR 0.67; 95% CI 0.32-1.40; P = 0.29; I² = 0%). Qualitative synthesis indicated comparable tolerability. TSA for mortality demonstrated insufficient evidence for definitive conclusions. M/V showed no statistically significant difference over C/A; therefore, selection should be guided judiciously based on clinical context. Further studies are needed to define the optimal role of each agent within antimicrobial stewardship frameworks.