Delays in access to ambulatory care are associated with adverse health outcomes, diminished patient experience, and increased system inefficiencies. U.S. health systems have adopted automated waitlists, which represents a technology-enabled tool that notifies patients of earlier appointment availability. Existing case reports suggest benefits. However, there is limited evidence on the efficacy of adopting, implementing, and sustaining an automated waitlist to improve access. The objective of the study was to evaluate automated waitlists to identify determinants that influence their adoption and ongoing use. Findings may inform health care organizations seeking to improve access to appointments in the ambulatory setting. A convergent, multi-site, mixed-methods study was conducted. Data were collected through a survey of 127 health systems with 90 reporting data about automated waitlist usage accompanied by a criterion-based purposive study of 10 participating health systems. Both qualitative and quantitative data were collected from the 10 participating systems. The Consolidated Framework for Implementation Research was used to report the determinants of the intervention's performance. Automated waitlists provide benefits to US health systems. High-performing health systems reported 38.8% (IQR 36.2%-45.7%) of appointments offered by the automated waitlist were filled. Participants reported a lower missed-appointment rate (3.1%, IQR 2.5%-4.8%) for appointments scheduled via the automated waitlist, as compared to all appointments (6.6%, IQR 4.1%-9.9%). Flexible configuration serves as a key facilitator of adoption and maintenance. External pressures, including peer benchmarking and high patient demand, accelerated implementation. Insurance and records requirements, seasonality, care-plan configuration, and digital inequities controlled which patients could benefit from the intervention. Additionally, specialty gatekeeping and clinician capacity constraints limited impact. Organizational context strongly shaped effectiveness, with cross-functional governance structures, leadership endorsement, and cultures of iteration enabling sustained use. Automated waitlists may offer a solution to health care organizations striving to positively impact access to care. The effectiveness of automated waitlists depends primarily on the implementation process and inner-setting organizational determinants. Rather than functioning as a stand-alone technical solution, automated waitlists are most impactful when integrated as a dynamic component of system-level scheduling infrastructure. Not applicable.
While family-centered rounds are considered the standard of care, coordinating the presence of all stakeholders without knowing when the medical team will arrive can make their implementation challenging. To address this barrier, we created novel software, Q-rounds, that is integrated into the electronic health record and creates a real-time rounding queue that updates nurses and family members on medical team rounding time and allows families to join in person or remotely via phone. A previous observational study showed that the implementation of Q-rounds in a neonatal intensive care unit (NICU) led to increased nurse and family presence. This study aimed to understand clinicians' perceptions of the use of Q-rounds on NICU rounding practices, such as the impact on rounding efficiency and clinician satisfaction, as well as facilitators and barriers in its implementation. Q-rounds was implemented in the NICU at M Health Fairview Masonic Children's Hospital in May 2023. In this survey study, surveys were distributed to physicians, advanced practice providers, and nurses 6 weeks before implementation and 6 weeks afterward to collect data on the impact of Q-rounds on family-centered rounds. Data were analyzed both quantitatively and qualitatively. There were 118 respondents in the preimplementation phase and 110 in the postimplementation phase. After implementation of Q-rounds, clinicians perceived an increase in nurse presence ("most" or "almost all of the time" n/N= 48/105, 46% to n/N=24/36, 75%; P<.001) and family presence (at least "sometimes" n/N=45/106, 46% to n/N=35/36, 97%; P<.001) on rounds. Respondents perceived rounds as more efficient (n/N=56/105, 53% to n/N=27/36, 75%; P=.006), and more respondents indicated being satisfied with rounds (n/N=59/105, 46% to n/N=62/84, 74%; P=.003). There was no perceived difference in rounding duration. These findings were supported by thematic analysis of open-ended responses. A novel virtual rounding queue software that notifies families and nurses of when to expect the rounding team was associated with increased clinician perceptions of efficiency, participation in rounds by nurses and families, and satisfaction with rounds.
Antimicrobial resistance is increasing worldwide. In particular, the rising incidence of infections caused by Carbapenem-resistant Enterobacterales (CRE), which have limited treatment options, has been identified as an important public health threat. This report aimed to analyze the characteristics of CRE infections in the Chungcheong region in 2024 and discuss their public health implications. This analysis was based on CRE infection cases reported through the Korea Disease Control and Prevention Agency's integrated infectious disease surveillance system from 2020 to 2024. In 2024, a total of 2,454 CRE infection cases were reported in the Chungcheong region. The proportion of individuals aged 70 years and older showed a yearly increasing trend, rising from 62.7% (459 cases) in 2020 to 69.4% (1,702 cases) in 2024. By type of healthcare institution, general hospitals accounted for the largest proportion of reported cases at 51.7% (1,269 cases), while long-term care hospitals accounted for 16.1% (394 cases), which were identified for the first time in 2024. Among Carbapenemase-producing CRE (CP-CRE) infections, Klebsiella pneumoniae was the most frequently detected species, accounting for 66.4% of cases, and the most commonly identified carbapenemase gene type was Klebsiella pneumoniae carbapenemase, accounting for 78.7% of cases. Since CRE infections were designated as a nationally notifiable infectious disease in the Republic of Korea in 2017, the number of reported cases in the Chungcheong region has increased annually, and the proportion of CP-CRE infections has also risen. In particular, the initially reported cases in long-term care hospitals highlight the importance of infection prevention and control in these facilities. Active cooperation among medical institutions, local governments, and the central government is required to strengthen CRE infection surveillance and response.
The trade of illicit pharmaceutical products and cosmetics (IPCs) poses a significant public health threat, particularly in Malaysia where evolving online-to-offline supply chains facilitate their influx. The Pharmacy Enforcement Branch participates in INTERPOL's Operation Pangea to curb this trade at logistical entry points. This study aimed to determine the prevalence, detection-seizure ratios, and categories of IPCs detected and seized at Sarawak's entry points during Operation Pangea from 2020 to 2023. This retrospective cross-sectional study analysed data extracted from Operation Pangea reports (2020-2023). Universal sampling was applied to all entry-point screening cases, while records with missing data, West Malaysia imports, and passenger luggage imports were excluded. IPCs were defined as products or cosmetics not registered or notified with the Ministry of Health. Prevalence and detection-to-seizure ratios were calculated using descriptive statistics, and chi-square tests were used to determine associations between variables and enforcement outcomes. A total of 301 consignments (1006 individual items) were screened, mainly through courier services and at the Southern Zone (Kuching). Screening detected 281 IPCs, corresponding to a 27.9% detection rate, of which only 67 (23.8%) were seized. Products containing scheduled poisons and supplements were the most frequently seized categories. Significant associations were found between consignment type and both detection and seizure outcomes, with courier consignments showing higher rates. The Seizure Detection Ratio declined markedly from 1.00 in 2021 to 0.05 in 2023. Most seized items were intended for treatment purposes, including chronic disease medications and analgesics. This study demonstrates a high prevalence of IPCs in imported consignments in Sarawak, highlighting ongoing risks associated with IPC supply chains. The decline in seizure detection ratio suggests the need to review enforcement consistency and prioritization to strengthen regulatory effectiveness.
Emergency department (ED) crowding is a global challenge with adverse effects on patient outcomes and staff well-being. Traditional crowding scores, such as the National ED Overcrowding Study (NEDOCS) score, have limited ability to predict imminent crowding. The aim of this study is to develop and validate a real-time, artificial intelligence (AI)-driven prediction model using a long short-term memory (LSTM) neural network to predict ED crowding, using ambulance diversion status as the reference standard and comparing performance with the (modified) NEDOCS score. In this single-centre, retrospective cohort study, we extracted parameters related to crowding from electronic health records and workforce data. Ambulance diversion status served as the reference standard for crowding. The LSTM model was trained and evaluated with walk-forward validation and performance was assessed using the area under the receiver operating characteristic curve (AUC). Model calibration was assessed using Brier score and expected calibration error (ECE). The optimal LSTM model used the previous hour of data to predict one hour ahead, yielding an AUC of 0.84 (95% CI 0.81-0.86). Key features contributing to the predictive quality of our model included the number of pre-notified arrivals, patients in the yellow and orange triage categories, and the number of ED supervisors. Compared with the modified NEDOCS score (AUC of 0.73 (95% CI 0.70-0.76)), the LSTM model showed higher discriminative performance in internal validation within this single-centre study. Our AI-driven prediction model demonstrated good predictive performance for ED crowding in internal validation. These findings highlight the potential of real-time prediction models to support ED clinical workflow.
By 2015, the emergence and dissemination of multidrug-resistant Plasmodium falciparum in the Greater Mekong Subregion threatened regional and global malaria control efforts. In response, Greater Mekong Subregion countries committed to malaria elimination by 2030, with strengthened surveillance as a strategic pillar. In 2017, Cambodia introduced an elimination-oriented digital Malaria Information System (MIS). Its health center app enables real-time, geo-located, case-based malaria reporting across primary health centers, and is fully integrated with the MIS. This study aimed to evaluate the real-world national implementation of Cambodia's Android-based health center app, considering coverage, fidelity, timeliness, and data use, and their effects on malaria surveillance performance, case management, programmatic response, and public health outcomes. System performance and public health use were assessed using system-generated metadata, national surveillance data, and user surveys. Operational indicators included technical performance, data completeness, and reporting timeliness, alongside surveillance outcomes such as case notification, classification, reactive case detection, and foci investigation. Nationwide user experience was measured via a survey of 761 health centers across 21 provinces, with in-depth structured surveys at 9 health centers in 3 provinces. Descriptive analyses evaluated system functionality, contribution to malaria surveillance and response, and usability among frontline health workers. The health center app demonstrated strong technical performance, with rapid loading and resilient data transmission under low-bandwidth conditions, supporting reliable reporting in resource-constrained settings. Integrated real-time dashboards provided analytics for case management, surveillance monitoring, risk stratification, and targeted public health interventions. Data completeness remained high (99%, 89/90 fields in 2024), demonstrating consistent routine use even as case incidence declined. Between January 1, 2025, and July 31, 2025, 69 malaria cases were reported nationally (23 locally acquired, 7 domestically imported, and 39 internationally imported). Of these, 95.7% (66/69) were notified and classified within 1 day. Reactive case detection was completed within 3 days for all 21 eligible cases, and 16 of 19 eligible foci received a response within 7 days, indicating strong operational responsiveness. User surveys showed 96.3% (733/761) of health centers were satisfied or very satisfied, 90.1% (686/761) reported rare or no technical issues, and 91.7% (698/761) found the app easy to navigate. Operational challenges included limited internet connectivity, transport to remote areas, and electricity interruptions. In-depth surveys confirmed high uptake, confidence in reporting, and routine use of surveillance data, although gaps in local analytical capacity were identified. Developed and managed locally to enhance sustainability, the MIS drove significant reductions in malaria case incidence, with the health center app contributing timely, complete, structured reporting at the point of care. Public health responses were facilitated by real-time analysis, targeted interventions, and decentralized decision-making. User engagement was sustained as malaria cases declined, and further enhancements are planned to ensure seamless transition to postelimination surveillance, reducing the risk of malaria reestablishment in Cambodia.
Undernourishment, alcohol use, smoking, diabetes, and HIV are the known risk factors for tuberculosis (TB) with a high population-attributable fraction. Of the total TB cases notified in India, one-fifth are among the elderly, and malnutrition is the most common cause. To estimate the prevalence of nutritional, behavioral, environmental, and clinical risk factors for TB among the elderly (>60 years) in selected rural areas of Puducherry, India. A cross-sectional study was conducted among four villages of Puducherry in 2023. Risk factors for TB were captured as reported by the participant. The Mini Nutritional Assessment (MNA) Scale and Global Leadership Initiative on Malnutrition (GLIM) criteria were used to assess malnutrition. Household Food Insecurity Access Scale was used to assess food insecurity. A total of 214 elderly were included; the mean (standard deviation) age was 68 (8) years. The prevalence of malnutrition using GLIM criteria and MNA was 20.1% (95% confidence interval [CI]; 15.2%-26.0%) and 11.2% (95% CI; 7.6%-16.2%), respectively. The prevalence of other risk factors like alcohol use, tobacco use, overcrowding, contact history, and diabetes was 6.1%, 30.2%, 46.2%, 2.8%, and 31.8%, respectively. Food insecurity was reported in 12.6% of the households. The population-attributable fraction was the highest for malnutrition by GLIM criteria (15%), followed by diabetes (11%). One in three had more than three risk factors, and nine in ten had at least one risk factor for TB. Screening known risk factors for TB in the elderly helps in the early detection of TB and prevention.
Epidemiological data on HIV infection in male urethral discharge syndrome (UDS) in Africa are limited. We describe the prevalence of HIV and associated demographic and sociobehavioral factors among men with UDS in selected public clinics in Kampala, Uganda. Within a cross-sectional study of men seeking care for UDS from October 2019 to July 2022, we performed interviewer-administered demographic and sociobehavioral questionnaires. Point-of-care (POC) rapid sequential algorithmic HIV testing was conducted. Bivariate and adjusted multivariable log-binomial regression analyses were performed to determine factors associated with HIV. Of 450 male participants, 441(98%) were included in this analysis; 9 declined HIV testing. Median (IQR) age was 24 (22-32) years, 87% (n = 384) reported a previous HIV test. Overall, 18.4% (n = 81) were people living with HIV (PLWHIV). Of these, 86.4% and 13.6% were aged ≥ 25 and < 25 years, respectively. Overall, 8.6% (n = 7) were newly diagnosed with HIV; of those, 42.9% (n = 3) were aged < 25 years. While 94% (70/74) with known HIV reported antiretroviral therapy (ART) use, 52.9% (n = 37) had suppressed viral loads by self-report. Five of the 441 participants (1.1%) reported 'always' condom use, 45.4% (n = 200) reported transactional sex, 59.6% (n = 263) ≥ 2 sexual partners in the past six months; 46.7% (n = 206) had notified their partners of UDS symptoms. Multivariable analysis demonstrated significant associations between HIV and older age ≥ 25 years (aPR,6.35; 95% C.I., 3.44-11.75; P < 0.001), and hazardous alcohol use (aPR,1.62; 95% C.I., 1.03-2.54; P = 0.038). Almost one in five men presenting with UDS were PLWHIV, with just over half of those on ART reporting viral suppression. Older age and hazardous alcohol use were associated with HIV. Men with UDS represent a key population where HIV diagnosis, prevention, and ART adherence interventions may have a significant impact.
This review explores the heme oxygenase/carbon monoxide (HO/CO) pathway as a central integrator of thermoregulation and neuroenergetics during inflammatory and oxidative stress. Thermoregulation is framed not merely as a homeostatic process, but as a continuous problem of energy allocation where body temperature (Tb) serves as an indicator of an organism's bioenergetic capacity. The core mechanistic thesis identifies the HO/CO system as a state-dependent "coupling pathway" that links inflammatory and redox tone to mitochondrial performance and, through central autonomic hierarchies, to the selection of thermal phenotypes, such as fever, regulated hypothermia, or torpor-like states. While fever supports "resistance" at a high metabolic cost, regulated hypothermia aligns with "tolerance" by conserving energy when resources or oxygen delivery are constrained. Key knowledge gaps remain regarding the precise cell-type-specific roles of HO-1 in the central nervous system (CNS) and the context-dependent nature of CO signaling via soluble guanylyl cyclase (sGC) in vivo. Therapeutically, targeting the HO/CO pathway via inhaled CO, CO-releasing molecules (CORMs), or HO-1 induction offers prospects for modulating neuroinflammation and metabolic resilience. However, translational constraints include timing-dependent effects and the need for precision phenotyping to identify which patients might benefit from interventions. In conclusion, the HO/CO system is discussed as a sophisticated modulator that biases thermoregulatory strategy based on the immediate physiological constraints of oxygen delivery and energetic reserve.
Salmonella infections cost Australian society an estimated 140 million Australian Dollars (AUD) per year circa 2019. Salmonellosis is caused by Salmonella enterica, with over 2,500 serotypes of S. enterica identified. Knowledge of the epidemiology of Salmonella serotypes may facilitate traceback from strains detected in human cases to identify the cause of local and multijurisdictional outbreaks and to implement control measures. We analysed cases of human salmonellosis notified in the Northern Territory (NT), Australia, between 1 January 2005 and 31 December 2024. We calculated the incidence of salmonellosis for all locally acquired infections according to the NT location where the infection was most likely acquired. We mapped the geographical distribution of the 25 most frequently notified Salmonella serotypes to Statistical Areas Level 2. There were 8,706 salmonellosis cases acquired in the NT: Salmonella Saintpaul (1,047 notifications) was the most frequently notified serotype, followed by S. Virchow (948 notifications); S. Typhimurium (822 notifications); S. Ball (578 notifications); and S. Lansing (460 notifications). While S. Typhimurium was ubiquitous in the NT, S. Saintpaul, S. Virchow and S. Hvittingfoss showed distinct geographic patterns. Our atlas makes key epidemiological information about common NT Salmonella serotypes readily available, which may be useful for developing hypotheses during outbreak investigations; for facilitating traceback of suspected food vehicles; and for implementing control strategies more rapidly.
In this paper, the International Pharmaceutical Aerosol Consortium on Regulation and Science (IPAC-RS), discusses the current regulatory landscape associated with change management of orally inhaled and nasal drug products (OINDP) and other drug device combination products in the European Union. The paper also describes current challenges related to alignment of regulatory expectations, particularly for integral drug device combination products, and proposes topics for further discussion with regulatory agencies and stakeholders to help advance alignment. To further illustrate current challenges and industry approaches to meeting change management requirements, we also present results of an IPAC-RS benchmarking survey and case studies, and outcome from interactions with notified bodies and regulatory agencies. This document is intended to be used as a guideline for industry alignment.
Little is known about the burden of sexually transmitted infections (STIs) among adolescent girls and young women (AGYW) employed as domestic workers in Ugandan households. We conducted a community-based cross-sectional study from November 2023 to March 2024 to determine the prevalence and correlates of STIs among Ugandan AGYW aged 14-24 in the Kampala Metropolitan Area. Self-collected vaginal swabs were tested for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) using GeneXpert. HIV and syphilis testing were performed using the Bioline HIV/syphilis Duo test. Correlates of STI prevalence were determined using modified Poisson regression. Among 262 AGYW, median age was 20 years (IQR 18-23) and 87 (33%) had an STI: CT (27.5%), syphilis (5.7%), HIV (4.6%) and NG (1.5%). Overall, 14.9% had >1 STI. Of 12 AGYW with HIV, 3 (25%) were newly diagnosed and 6/9 had detectable viral loads (≥1000 copies/mL). In the prior 12 months, 126 (48%) had received syndromic STI treatment, but only 35 (28%) notified their partners. Additionally, 102 (39%) had used emergency contraception and 54% believed it was protective against STIs, including HIV. Factors associated with STI prevalence included non-cash compensation for domestic work (adjusted prevalence ratio (aPR) 2.26; 95% CI 1.04 to 4.92; p=0.040), lower educational attainment (aPR 1.73; 95% CI 1.16 to 2.57; p=0.007), alcohol consumption in the past 6 months (aPR 1.72; 95% CI 1.12 to 2.64; p=0.013) and transactional sex during the past 6 months (aPR 1.43; 95% CI 1.01 to 2.04; p=0.045). Conversely, self-reported sexual abuse was negatively associated with STIs (aPR 0.48; 95% CI 0.28 to 0.83; p=0.008). The high prevalence of undiagnosed STIs and unsuppressed HIV among AGYW domestic workers in Central Uganda highlights the urgent need to increase STI/HIV prevention, testing and treatment coverage for these underserved and vulnerable young women. Targeted interventions are needed to mitigate STI/HIV acquisition in this population.
People diagnosed with tuberculosis (TB) after death (postmortem) experience the ultimate diagnostic delay. We aimed to identify social and health factors associated with postmortem TB diagnosis in England. We conducted a national retrospective cohort study using routinely collected surveillance data from the UK Health Security Agency's National TB Surveillance System (NTBS) between 1 January 2010 and 31 December 2022. Of 72 058 people notified with TB, 19 without a recorded diagnostic outcome were excluded, leaving 72 039 for analysis. The primary outcome was postmortem versus antemortem TB diagnosis. Associations were assessed using univariate and multivariable logistic regression. Of 72 039 participants, 574 were diagnosed postmortem, averaging 0.84 cases per week. With the exception of age 0-4 years (adjusted odds ratio, aOR, 5.36 (95%CI 1.62-17.67), the likelihood of postmortem diagnosis increased markedly with age, from aOR 2.96 (95% CI 1.14 to 7.64) at age 35-39 years to 85.67 (95% CI 32.34 to 226.97) at age ≥90 years. Male sex (aOR 1.62; 95% CI 1.31 to 2.00), UK birth (aOR 1.53; 95% CI 1.10 to 2.14), alcohol misuse (aOR 3.08; 95% CI 1.30 to 7.30) and drug misuse (aOR 2.48; 95% CI 1.21 to 5.12) were associated with increased odds of postmortem diagnosis. Compared with London, all other National Health Service regions had increased odds of postmortem diagnosis. BCG vaccination (aOR 0.49; 95% CI 0.29 to 0.84) and pulmonary TB (aOR 0.60; 95% CI 0.48 to 0.75) were associated with lower odds. Postmortem TB diagnosis in England is frequent and associated with being in early childhood (0-4 years), older age, male sex, UK birth, substance misuse and notification outside London. Recognising postmortem TB diagnosis as a 'never event' and developing targeted interventions to reduce diagnostic delays are essential to achieve England's TB elimination goals.
This article, as originally published, contained a mis-compiled tabulation of the notified measles clusters within Australia for the period 2014-2024, inadvertently misrepresenting the distribution of measles clusters across the country during this period. The revised text passages and the revised table presented on the following pages correct these errors. Australia has maintained endemic measles elimination since verification was first achieved in 2014. To support sustained elimination, and strengthen national preparedness, we conducted a ten-year review of measles epidemiology from 1 January 2014 to 31 December 2024. Measles notifications to the National Notifiable Disease Surveillance System were analysed by sex, age, seasonality, state/territory, country of acquisition, vaccination status, genotype, and cluster characteristics.
Understanding temporal and epidemiological patterns of pediatric infectious diseases is essential for developing targeted prevention strategies. This study investigated long-term incidence trends and epidemiological characteristics of notifiable infectious diseases among children in Xuhui District, Shanghai, from 2015 to 2023. Surveillance data for children aged 0-17 years were obtained from the National Notifiable Disease Reporting System (NNDRS). Joinpoint regression was applied to identify temporal trends and significant inflection points. Age-specific distributions were analyzed and seasonal patterns were visualized using radar charts. From 2015 to 2023, a total of 27,940 pediatric cases involving 23 notifiable infectious diseases were reported, corresponding to an average annual incidence of 2,421.68 per 100,000 children. Joinpoint regression identified a significant inflection point in 2021. Overall incidence declined during 2015-2021 (APC = -11.71%, 95% CI: -30.10 to -1.50, P = 0.029) and increased sharply thereafter (APC = 141.05%, 95% CI: 34.40-244.50, P < 0.001). When COVID-19 cases were excluded, no significant long-term trend was observed (APC = -4.2%, 95% CI: -23.60 -20.80, P = 0.71), indicating that the apparent post-2021 increase was driven primarily by COVID-19 notifications rather than a generalized resurgence of other pediatric infections. Disease-specific trajectories varied: influenza showed a pronounced post-pandemic surge, despite the absence of a significant long-term monotonic trend, whereas varicella, mumps, and scarlet fever continued to decline; in contrast, other infectious diarrhea showed a sustained upward trend (APC = 8.00%, 95% CI: 2.60-13.70, P = 0.003). Over time, the age distribution shifted toward school-aged children, with a significantly increasing proportion of cases occurring among those aged ≥4 years (χ 2 trend = 1475.594, P < 0.01). Pediatric infectious disease epidemiology in Xuhui District underwent substantial changes across the pre-pandemic and post-pandemic periods. The sharp rise after 2021 was largely attributable to COVID-19, rather than a uniform rebound of all infectious diseases. Distinct temporal patterns across respiratory, enteric, and other infections underscore the importance of pathogen-specific transmission characteristics and age-related exposure in shaping long-term trends. These findings highlight the need for targeted, age-appropriate prevention strategies and sustained surveillance in the post-pandemic era.
Zoonotic tuberculosis (zTB) remains a blind spot in TB control, sustained less by biological rarity than by diagnostic and surveillance design. Brazil illustrates this gap: despite endemic bovine TB and sustained zoonotic transmission risks, zTB is rarely identified because it is not actively targeted. We show that only two human zTB cases were notified between 2013 and 2024 following introduction of reporting, and six cases are described in the literature. Further detection of mono-pyrazinamide resistance may represent undiagnosed zTB, but diagnostic gaps prevent estimation. By outlining current diagnostic paths, we argue that the human-centric diagnostics obscures occupational, foodborne, and animal-linked infection. Emerging subnational One Health initiatives demonstrate that integrated animal-human surveillance is feasible. Therefore, we propose a risk-based, One Health diagnostic protocol for zTB within the Brazilian public health system, and argue that without structural and policy adaptation, human-TB elimination strategies will continue to exclude zTB by design, not only in Brazil.
Infectious outbreaks caused by carbapenemase-producing Enterobacterales (CPE) in hospitals constitute a global health threat. To characterise CPE infectious outbreaks in public hospitals in Chile during 2017-2024. Retrospective epidemiological surveillance study using national public health data across three periods: baseline pre-pandemic (2017-2019), pandemic (2020-2022), and post-pandemic (2023-2024). Seventy-two CPE outbreaks, 945 associated cases and 21 attributable deaths were notified. Median CPE outbreak size in the pre-pandemic period (4 cases) peaked during the pandemic (7 cases) and recovered afterwards post-pandemic (4 cases). Median outbreak duration decreased over time (pre-pandemic period: 75 days; pandemic: 45 days; post-pandemic: 9 days). Klebsiella pneumoniae was the primary cause (83.3% of outbreaks, 92.6% of cases) and KPC the most common carbapenemase detected (54.2% of outbreaks, 53.7% of cases). OXA-48-like and KPC + NDM co-production were observed from 2021 onwards, and IMP was first identified in 2024. The size of CPE outbreaks in Chilean public hospitals increased significantly during the pandemic and shrunk back to pre-pandemic values afterwards. CPE outbreak duration decreased sharply from the pandemic onwards. Since 2021, carbapenemases detected in CPE hospital outbreaks have diversified in Chile.
BACKGROUNDWest Nile virus (WNV) is a zoonotic mosquito-borne pathogen increasingly reported in Europe.AIMWe aimed to characterise heterogeneities in the average annual human risk of WNV infection (force of infection, FOI) and in WNV surveillance across Europe.METHODSWe 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.RESULTSWe 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.CONCLUSIONThis study shows that the intensity of WNV transmission, the average annual incidence of infection and the sensitivity of surveillance are heterogeneous across Europe. Due to differences in case reporting across countries, the incidence of reported WNV cases does not necessarily reflect the same proportion of WNV infections and hence the actual infection incidence, which highlights the importance of conducting WNV seroprevalence surveys.
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Leprosy remains a neglected and transmissible disease and continues to challenge the World Health Organization elimination goals, mainly due to delays in diagnosis and treatment. This analytical cross-sectional study assessed indicators related to the performance of the Health Care Network (HCN) of Minas Gerais, Brazil, in leprosy care using secondary data from 2014 to 2023. The outcomes evaluated were early diagnosis, timely treatment initiation, and disability outcomes. Data were obtained from the Notifiable Diseases Information System (SINAN) and the National Register of Health Establishments (CNES) and analyzed using multivariate logistic regression with a 5% significance level. Among 9,630 cases analyzed for early diagnosis, 55.8% were diagnosed early and 44.2% late. Among 10,402 cases, 63.4% initiated treatment within two days, while 36.6% experienced delays. Regarding disability outcomes, among 6,048 cases evaluated, 8.9% worsened, 73.9% remained unchanged, and 17.3% improved. The results reveal persistent disparities related to gender, ethnicity, education, healthcare level, and geographic region, indicating gaps in equity, service organization, and continuity of care. Strengthening primary health care, decentralizing services, and improving professional training are essential strategies to enhance outcomes and support leprosy elimination efforts.