It has been nearly 15 years since I had the honor of becoming the seventh Editor of our Society's journal in 1998. I will step down from this position as of January 2014, and congratulate Phil Rosenthal on assuming this role. It is not possible to acknowledge the many people who have made my tenure as editor so rewarding (particularly the various presidents and council members with whom I have worked), but special thanks go to the Journal's managing editor, Cathi Siegel. Cathi's exceptional organizational skills, unwavering commitment to the future of the American Society of Tropical Medicine & Hygiene and keen insight into publication issues large and small have been essential to the Journal's continuing success. I would also like to acknowledge the dedication of Joe Vinetz who has served as Associate Editor since 2000. Joe's extraordinary breadth of knowledge, creative mind, and seemingly inexhaustible energy have pushed the Journal to consider methods of communication and scientific and social topics that are essential to inspire the next generation of young people who aspire to improve global health through research and education. So how has the Journal changed over the past 15 years? Like many other scientific periodicals in 1998, the digital revolution was just coming of age. We adapted quickly (with some bumps in the road), and by 2003 processed manuscripts, conducted peer review, and made editorial decisions electronically. These changes quickly segued into a journal that is now primarily accessed via the internet using a variety of mobile and stationary devices. The Journal contents have not only become more accessible but the amount of information that can be generated by digital format has allowed us to publish more papers. In 1998, a total of 1,867 pages were published in the Journal, whereas in 2012 the total increased to 2,256. During the same period of time, the mother Society made a deliberate effort to broaden its purview from its traditional areas of strength—biomedical sciences, clinical medicine, epidemiology, disease vectors, parasitology, and public health aspects of infectious diseases—to new relatively unchartered territory such as implementation science, social sciences, anthropology, and qualitative aspects of global health. Accordingly, the Journal now considers papers on these topics and has created several section editor roles that require expertise on these subjects. My overall impression in serving as editor for the past 15 years is that it is possible to have the best of both worlds, one being our traditional areas of strength in biomedical and clinical research and the other, newer orientation toward behavioral and social issues. Both are critical to improving global health. There are undoubtedly challenges in the future. This editorial is being written at a time (November 2013) when United States governmental funding for biomedical research continues to diminish relative to inflation, and the stability of funding is uncertain given the mixed messages from the Congress. This clearly is not a journal-specific issue but can potentially have an adverse impact on the number of manuscripts submitted to the Journal. Like all journals published and owned by scientific societies (particularly one such as ours where the focus is on health issues that disproportionately affect poor people in the developing world), the open access movement is wholeheartedly embraced. Accordingly, we have made this option available to our authors despite the fact that many of our important constituents, i.e., authors living and working in developing countries, have limited financial resources that cannot cover the full cost of open access that is enjoyed by authors from wealthier countries with more generous research support dollars. In addition, predatory journals, for-profit journals, and journals that pay for peer review are issues of the day. Given the outstanding next generation of members and leaders of the American Society of Tropical Medicine & Hygiene, I am confident the Journal will meet these and unforeseen challenges to continue the heritage of a journal that issued its first annual volume in 1952.
There is evidence that outdoor occupations and being active outdoors at night increase the risk of malaria infection. This study aimed to examine the associations between both head of household occupation and whether an individual was active at sunrise and/or sunset on the outcome of malaria infection separately and to determine if there was an interaction between the two exposures. We used data from a cross-sectional study in Sussundenga, Mozambique of 297 individuals within 84 households. Generalized linear mixed models were used to calculate the associations between each of the exposures and malaria infection as well as their interaction. After adjustment, the difference in predicted malaria prevalence comparing those in which the head of household had an outdoor versus indoor occupation was 0.015 (95% CI: -0.12 to 0.15). The difference in predicted malaria prevalence among those active at sunrise and sunset was 0.10 (95% CI: -0.063 to 0.26) and those active at either time was 0.011 (95% CI: -0.11 to 0.13) compared with those active at neither time. In the interaction model, the difference in malaria prevalence between those with the head of household having an outdoor versus indoor occupation was 0.33 (95% CI: 0.037-0.62) greater in those active at sunrise and sunset compared with those not active at either time. Although the test for additive interaction was not statistically significant or indicative of any clear association, the magnitude may indicate that those with different head of household occupation and outdoor times could have different malaria risk.
Bhutan continues to report sporadic cases of various forms of leishmaniasis and has yet to receive elimination certification for visceral leishmaniasis. In the present study, the knowledge, attitudes, and practices regarding leishmaniasis among healthcare professionals were assessed in tertiary care hospitals in Bhutan. This was a cross-sectional study conducted among healthcare professionals at referral hospitals. The knowledge questions were scored with one point awarded for each correct response. A cumulative score of ≥70% was categorized as good knowledge. There were 343 participants in total, 59 (17.0%) of whom had managed leishmaniasis in their careers. Thirty (6.0%) knew the forms of leishmaniasis reported in Bhutan, 197 (58.2%) knew the case definition, 199 (55.6%) knew the screening test for visceral leishmaniasis, and 192 (54.3%) knew the confirmatory test. A total of 151 (38.8%) participants knew the first-line oral treatment for leishmaniasis. The median knowledge score was 6 of 20 (interquartile range: 5-8). A total of 60 (13.8%) participants had good knowledge. Participants who had read the national guidelines (adjusted odds ratio: 8.04; 95% CI: 2.95-21.86; P <0.001) had higher odds of demonstrating good knowledge. A total of 47 (13.0%) participants reported offering the rK39 test in the past 12 months. The majority demonstrated a willingness to learn and engage in health advocacy, prevention, and control activities. The majority lacked adequate knowledge on the forms of leishmaniasis, screening and diagnostic tests, drugs for management, and case follow-up. The number of screening tests offered to patients was low. The majority of participants were willing to engage in continuing medical education, advocacy, and health education sessions.
At the stage of kidney failure, hemodialysis, peritoneal dialysis, and kidney transplantation are the therapeutic alternatives for prolonging patients' lives. In Togo, in-center hemodialysis is the only treatment option available to patients. This study aimed to evaluate the direct cost of in-center hemodialysis treatment and to understand the challenges faced by patients with kidney failure in Togo in 2024. We conducted a sequential exploratory mixed-methods study. The qualitative study included patients who had been undergoing hemodialysis in a center from March 1 to June 31, 2024. In the quantitative study, a linear regression model was used to describe the factors associated with the cost of hemodialysis. From 15 interviews, four themes were identified: 1) patients' perception of the disease and its management, 2) the burden of the disease and hemodialysis on the patient and their family and friends, 3) financial difficulties, and 4) geographical challenges in accessing a hemodialysis center. For the quantitative study, 88 patients were included (41.0% female), and 84.0% were hypertensive. The median age of patients was 51 years old (interquartile range [IQR]: 40-58). The median monthly income of patients was 45,000 CFA francs (franc de la Communauté Financière Africaine, the currency in Togo) (approximately €69; IQR: 0-162,500 CFA francs). The median overall cost of hemodialysis per month was 276,000 CFA (approximately €421; IQR: 163,600-527,000). Being male and living alone were associated with the overall cost of hemodialysis. This study mainly reports on the financial difficulties that patients face in accessing hemodialysis. Advocacy is needed for better subsidization of hemodialysis care in Togo.
Soil-transmitted helminth (STH) infections are prevalent worldwide, but the true burden of strongyloidiasis is unclear due to lack of sensitive and field-friendly diagnostic tools. Diagnosis is often based on serological assays that are typically not point-of-care (POC). Although polymerase chain reaction (PCR) tests are sensitive and specific, the need for expensive equipment and highly skilled personnel limits their use in resource limited areas. Isothermal amplification assays are largely instrument-free, making them simpler to implement without loss of either sensitivity or specificity. We developed two recombinase polymerase amplification (RPA) assays to detect Strongyloides stercoralis (Ss) in human stool samples and a complementary CRISPR-Cas12a detection system with visual readouts. Primers, probes, and guide RNAs (crRNAs) for these assays were designed targeting the Ss-NIE sequence and Ss dispersed repetitive sequence (Ss-DRS). The assay's specificities and limits of detection (LOD) were assessed using gDNA from Ss L3 larvae or from other STH and filariae. The NIE RPA showed a LOD of 1 fg/µL, whereas the LOD for the Ss-DRS RPA was 1 pg/µL. The LOD was 500 fg/µL for the NIE RPA CRISPR-Cas12a assay. No cross-reactivity with any filarial parasite or other STH was observed. Because the NIE assays were more sensitive than the Ss-DRS assay, six patient samples positive for Ss by real-time PCR (qPCR) were tested using the NIE assays, of which four were positive. Though assay refinement and clinical validation are needed, this study establishes fast, highly sensitive and field-applicable POC diagnostic tools for Ss detection that are ideal for use in endemic areas with limited resources.
Leprosy remains a neglected tropical disease with active transmission. Predictive models improve understanding of epidemiological trends and support control strategies in endemic contexts. This study analyzed leprosy in Brazil between 2001 and 2024, projecting scenarios through 2034. Data were obtained from the National System of Notifiable Diseases, and population estimates were from the Brazilian Institute of Geography and Statistics. Temporal trends were assessed using segmented regression, and projections were generated with statistical methods and machine learning algorithms. Independent variables included sex, age, educational level, clinical form, operational classification, and bacilloscopy index. Consistent decline was observed in the overall detection rate and among individuals younger than 15 years old, suggesting reduced transmission. The proportion of cases diagnosed with grade 2 disability remained high, indicating late detection. Projections showed a gradual decline in endemicity but no elimination of leprosy as a public health problem by 2030. The random forest model identified male sex, age older than 15 years old, lower educational level, and multibacillary clinical form as the main predictors of new cases. The integration of machine learning improved the accuracy of projections and revealed persistent gaps in early diagnosis, providing evidence for targeted interventions and strengthening active surveillance and timely detection. The findings are relevant not only for Brazil but also, for other endemic countries, such as India and Indonesia, reinforcing the global need for intensified elimination strategies. The study demonstrates the potential of predictive modeling to support leprosy control and broader neglected tropical disease programs.
Infants under 1 year of age are considered partially protected from malaria because of maternal antibodies and fetal hemoglobin. However, emerging evidence suggests that the malaria burden in this age group may be underestimated. A cohort of 855 infants in Busia District, Uganda, was enrolled in the present study to characterize malaria incidence and parasite prevalence during the first year of life and to identify risk factors for these outcomes. The study was conducted from 2021 to 2025, before the malaria vaccine roll-out. Infants born to HIV-uninfected women were enrolled at 4-8 weeks of age and followed by active and passive case detection to 1 year of age in a dedicated study clinic that is open 7 days/week. Routine visits every 4 weeks included assessments for parasitemia via microscopy and quantitative polymerase chain reaction testing. Over 706.7 person-years of follow-up, 662 malaria episodes occurred. The overall prevalence of microscopic parasitemia was 7.9%, and the combined prevalence of microscopic and submicroscopic parasitemia was 21.8%. Sickle cell trait (Hemoglobin AS) conferred 39% protection against symptomatic malaria but was not associated with the risk of parasitemia. Modern housing construction and higher maternal education were independently associated with reduced malaria risk. District-wide distribution of long-lasting insecticide-treated nets containing alpha-cypermethrin plus chlorfenapyr in October 2023 was followed by an 80% reduction in malaria incidence and significant declines in parasitemia prevalence. These findings underscore the urgent need for age-appropriate preventative interventions targeting young infants, such as earlier vaccine administration or treatment with monoclonal antibodies, alongside sustained investment in next-generation vector control and attention to socioeconomic determinants of malaria risk.
Malaria remains one of the most significant global health challenges in sub-Saharan Africa (SSA), resulting in social and economic consequences owing to high morbidity and mortality. This study aims to determine the socioeconomic burden of malaria as well as the socioeconomic benefit of artemether-lumefantrine (AL, Coartem®, Novartis, Basel, Switzerland) treatment of uncomplicated malaria in SSA. A de novo Microsoft® Excel-based model study was considered for societal perspective assessment. The model included malaria prevalence from SSA countries and focused on three age groups: younger than 5 years old, 5-14 years old, and 15 years old and older. The socioeconomic burden was assessed as loss in paid work productivity attributable to the health burden of malaria as measured in disability-adjusted life years (DALYs), whereas the socioeconomic benefit of AL was measured as avoided productivity loss by utilizing a decision tree. Input parameters used for the calculation were obtained from the published literature, public databases, and the Institute for Health Metrics and Evaluation. For 2022, the model reported 30.8 million malaria-related DALYs in those 15 years old and older, which led to a socioeconomic burden of approximately U.S. $82.8 billion. The estimated total socioeconomic benefit of AL compared with the nontreatment scenario was U.S. $24.2 billion. The estimate reflects avoided productivity losses, including productive years of life lost (YLL) and caregiving days required. In conclusion, these findings highlight the substantial socioeconomic burden of malaria and suggest that by avoiding deaths, reducing YLL, and minimizing caregiving days, AL provides a substantial socioeconomic benefit in the SSA region.
Neuroangiostrongyliasis (NAS) is an emerging parasitic infection caused by the neurotropic nematode Angiostrongylus cantonensis (A. cantonensis). It is the leading infectious etiology of eosinophilic meningitis worldwide. In 2017, six men living on Hawai'i Island developed NAS after drinking homemade kava. After the event, a dead slug, likely infected with A. cantonensis, was found at the bottom of a communal vessel. Neuroangiostrongyliasis was subsequently confirmed in three patients through polymerase chain reaction testing of their cerebrospinal fluid. Two patients were presumptively diagnosed with NAS on the basis of highly suggestive signs and symptoms, the presence of eosinophilic meningitis, and a shared history of exposure. A lumbar puncture was unsuccessful in one patient, who was presumptively diagnosed with NAS on the basis of his symptoms and shared exposure history. Five of six patients received at least 2 weeks of co-therapy with albendazole and corticosteroids, which was initiated within 15 days of infection. The treatment was well-tolerated, and no significant adverse events were noted. One patient who did not have health insurance completed only two doses of albendazole because of the cost of the drug and experienced symptom recurrence on several occasions. This rare, common-source outbreak of A. cantonensis infection supports the early use of albendazole-corticosteroid co-therapy in proven or suspected cases of NAS. It also provides additional evidence for the water transmissibility of this parasite.
The growth of children is influenced by various factors, including infections like malaria, diarrhea, and respiratory tract infections (RTIs). This study aimed to assess the associations of these infections with the monthly growth velocity in Tanzanian children. We used data from 2,397 Tanzanian children enrolled in a randomized controlled trial and followed for 18 months (30,079 monthly visits). The exposure variables were infections, whereas the outcome variables were monthly height and weight velocities. Mixed-effects models were used to assess the relationships. The average height velocity was 1.58 cm per month, and average weight velocity was 358 g per month during the follow-up period. Malaria infection was association with a reduction of 0.14 cm/month in height velocity (coefficient [95% CI]: -0.14 [-0.23 to -0.05]) but not significantly associated with weight velocity. RTIs were associated with a reduction of 0.10 cm/month (coefficient [95% CI]: -0.10 [-0.15 to -0.04]) and a decrease of 37 g/month (coefficient [95% CI]: -37 [-72 to -2.6]) in height and weight velocity, respectively. Diarrhea was also inversely associated with both height and weight velocity, with reductions of 0.26 cm/month (coefficient [95% CI]: -0.26 [-0.35 to -0.17])] and 120 g/month (coefficient [95% CI]: -120 [-177 to -62]), respectively. The findings demonstrate that malaria, respiratory infections, and diarrhea are associated with slower growth velocity in children. These results underscore the importance of integrated health care strategies to address these prevalent infections, because preventing them may contribute to healthier child growth and better overall health outcomes.
When testing poorly tolerated or long-term treatments, including a run-in phase enhances clinical trial efficiency and internal validity by selecting more adherent participants. This report describes the adherence and tolerance of Colombian participants in EQUITY (a randomized, concealed, parallel-group, placebo-controlled trial testing nifurtimox and benznidazole among Trypanosoma cruzi-seropositive adults without cardiomyopathy). Our design included a 10-day, single-blind, placebo run-in phase. On completion, willing participants reporting good adherence (≥80%) and tolerance were randomized to any five 120-day, blinded treatments: four with either active medication, each given as 120-day half dose or 60-day full dose (followed/preceded by a randomly allocated 60-day placebo treatment), or a 120-day placebo. Side effects were compared after the run-in (day 0) between excluded and enrolled participants, and between those randomized to active medications or placebo 20 days after starting each treatment period (days 20/80). Those excluded (44/351, 12.5%) more often reported gastrointestinal (15.9/4.6%), nonspecific (13.7/4.2%), and musculoskeletal symptoms (9.1/1.6%) than those randomized. Participants given nifurtimox (n = 84) or benznidazole (n = 86) versus placebo (n = 126) on day 20 reported more nonspecific (15.5/10.5/4.8%, respectively) or cutaneous side effects (6.0/12.8/3.2%). When starting active treatments (transition OFF-ON, n = 171 and n = 61 in first and second 60-day treatment periods), more participants reported emerging-worsening than receding-ending side effects (49/13 and 15/5, respectively). Despite inducing a nocebo effect, the run-in phase highlighted more closely related side effects, strengthening causal inference and informing adherence and tolerance to conventional trypanocides.
Gansu in northwestern China has maintained leprosy elimination at the national and county level, yet localized transmission persists in certain endemic foci. This 70-year analysis (1950-2020) assessed the impact of key control strategies using an interrupted time-series analysis of new case detection rate (NCDR) with break points at the 1958 "survey-isolate-treat" strategy and the 1987 multidrug therapy (MDT) rollout. Among 4,872 registered cases, NCDR rose initially and then declined steadily to 0.027/100,000 by 2020. Significant geographic clustering was observed in southeastern counties (Moran's I = 0.403, P < 0.05). Most cases were male farmers (male-to-female ratio 2.37:1), and Han ethnicity accounted for 75.9% of all cases. The proportion of multibacillary cases increased significantly from 78.0% before 1987 to 84.9% after MDT implementation. Time-series analysis indicated that the 1958 strategy was associated with a sustained decline in detection rates during the high-endemic phase, whereas MDT introduction in 1987 led to an immediate level reduction during the low-endemic phase. These results underscore the complementary role of historical integrated control measures and modern chemotherapy in sustaining leprosy elimination. However, transmission persists, and the rising proportion of multibacillary cases highlights the ongoing need for targeted active surveillance, contact screening, and strengthened early detection to achieve WHO 2030 eradication targets.
Dengue, chikungunya, and Zika are Aedes-borne diseases (ABDs) of global health significance. Epidemiological studies with sensitive case detection are critical for evaluating vector control strategies to prevent ABDs; however, data on which surveillance method is most effective are limited. The performance of five surveillance methods (home visits, phone calls, SMS reminders, toll-free phone line (TF) and the Ministry of Health surveillance platform) was assessed, and the clinical characteristics of ABD cases in the targeted indoor residual spraying trial, which quantified the efficacy of preventive indoor residual insecticide applications against ABDs in Merida, Mexico, were described. A cohort of 4,461 children was monitored over three transmission seasons (July-December 2021-2023), with surveillance methods rotated weekly to detect illnesses. Kaplan-Meier curves and log-rank tests compared the time from symptom onset to laboratory testing across methods. Analysis of variance, t- and χ2 tests assessed differences in utilization of surveillance methods across demographic factors. Of 1,902 illnesses detected, 920 (48.4%) met suspected ABD criteria; 825 provided blood samples (89%), and 422 (51%) were confirmed as ABDs. Dengue represented 70.4% of confirmed cases (n = 297/422). Among confirmed cases, clinical manifestations were diverse, with fever (>94%), myalgia (80-100%), and headache (70-100%) being most frequent. Twenty-seven patients (9%; n = 27/297) had dengue with warning signs. TF detected 55.2% (n = 233/422) of confirmed cases and achieved the fastest time to laboratory testing. These results demonstrate case detection can be optimized. TF proved effective in rapidly identifying symptomatic reports, underscoring the value of integrated, low-barrier reporting systems for early arboviral detection.
A recent durability study has revealed that Yahe LN® insecticide-treated nets (ITNs; Fujian Yamei Industry & Trade Co., LTD, Fuzhou, China) distributed in Papua New Guinea (PNG) in 2021 did not retain their insecticidal efficacy after several months post-distribution. Insecticide-treated nets are frequently shipped and stored in containers where they are exposed to elevated temperatures. When used in the tropics, ITNs may continue to be exposed to high ambient temperatures. The aim for the present study is to better understand the potential impact of elevated temperature during transport and storage on the insecticidal efficacy of Yahe LN ITNs and to investigate why they failed insecticidal efficacy tests after 6 months in PNG. To achieve this aim, Yahe ITNs were stored at elevated temperatures and tested using cone bioassays. The results revealed that ITNs exposed to temperatures between 35°C and 50°C, reflective of those in shipping containers, exhibited a significantly decreased insecticidal efficacy. The present study highlights the importance of developing temperature-stable ITN products and assessing current products for temperature stability.
Programs designed to eliminate Onchocerca volvulus transmission rely on measurement of Ov16-specific antibodies in children <10 years old and molecular detection of parasites in blackfly vectors. Antibody testing can be conducted using rapid diagnostic tests or an ELISA, depending on location of testing and sample throughput needs. In previous efforts to establish anti-Ov16 testing in endemic country laboratories using existing tests, we encountered difficulties with assay reproducibility, reagent availability and shipping, and user friendliness. To address these challenges, we developed and validated an ELISA using Ov16 recombinant antigen expressed in a mammalian protein expression system that can be completed within 2 hours and does not require refrigeration during shipment. The assay was developed and validated using two distinct sets of dried blood spot samples that included defined positive, negative, and samples from infections with potential cross-reactivity. During development, the ELISA had 92.98% (95% CI = 88.28-97.68%) sensitivity and a specificity of 98.50% (95% CI = 93.80-100%). The cutoff point established during development was then applied to the validation set of specimens, which demonstrated a sensitivity of 89.47% (95% CI = 84.77-94.17%) and 98.32% (95% CI = 93.62-100%) specificity. When repeated over 4 days by 2 different operators, all replicates yielded reproducible results within a coefficient of variance of 20%. In addition, we performed stability testing on assay reagents to evaluate their suitability for shipping at ambient temperatures. The resulting assay will be useful for monitoring anti-Ov16 prevalence in endemic country laboratories.
Oral myiasis is a rare medical condition in which soft tissues of the oral cavity are invaded by the larvae (maggots) of several flies. We report a fatal case in a 75-year-old man from a subtropical rural region of Ecuador who presented to a public health center with respiratory distress, peripheral cyanosis, dyspnea, and a Glasgow Coma Scale score of 9 of 15. The oral cavity emitted a fetid odor and contained bloody secretions with extensive larval invasion affecting the gingiva, lower lip, tongue, and soft palate. More than 300 larvae were manually extracted and morphologically identified as third-instar Cochliomyia hominivorax. The patient had a known history of epilepsy managed with carbamazepine (400 mg/day). Despite supportive management, including oxygen therapy and fluid resuscitation, the patient died approximately 8 hours after admission. The rapid deterioration was probably owing to airway compromise caused by larval migration toward the oropharynx. This case underscores the importance of prompt diagnosis and aggressive management of oral myiasis in vulnerable elderly individuals.
Malaria is a major health concern worldwide, with an estimated 282 million infections and 610,000 deaths in 2024. Plasmodium parasites, spread by female Anopheles mosquitoes, are the cause. Several interventions, such as indoor residual spraying, insecticide-treated bed nets, and antimalarial drugs, have reduced transmission; however, challenges such as insecticide resistance, environmental concerns, and climate change have led to the exploration of alternative approaches. To address these limitations, biological control, which involves the use of natural organisms and biological agents to target mosquito vectors, is increasingly accepted as a viable solution. This method involves viruses, fungi, microbial pathogens, natural predators, alkaloids, essential oils, and plants with larvicidal properties. In addition, genetic techniques such as the sterile insect technique and genetically modified mosquitoes offer new approaches to managing mosquito populations. Additionally, entomopathogenic fungi are of particular interest because they can infect and kill mosquito vectors. In the present narrative review, an overview of existing biological approaches and current research progress that may enhance intervention strategies for sustainable malaria control and eventual eradication is presented.
Viral hepatitis is a global public health concern, yet surveillance data is lacking for many low-middle income countries, particularly in Jamaica where recent prevalence data is lacking. Serum samples were collected from patients attending antenatal (ANC; n = 530), non-communicable disease (NCD; n = 826) and sexually transmitted infection (STI; n = 517) clinics in the Kingston Metropolitan Area. All samples were tested for antibodies to hepatitis A - E viruses using the ABBOTT ARCHITECT to test for HAV IgG, HBV core total Ig, HCV total Ig, HDV total Ig, and HEV IgG, respectively, to assess for previous infection. The seroprevalence of HAV and HBV antibodies were ANC, 61.3%; NCD, 89.4%; STI, 65.4%; and ANC, 7.7%; NCD, 20.8%; STI, 17.2%; respectively, whilst HCV, HDV and HEV antibodies were all ∼1%. The seroprevalence of all types of viral hepatitis increased with age, notably for HAV and HBV. As HBV can cause chronic infections, HBV infection status was determined using the following tests: HBV surface antigen (HBsAg), HBV core IgM, HBV core total Ig, HBV surface antigen Ig. Of the patients testing HBV core total Ig positive, the prevalence of acute HBV infection was noted to be 2.5%, 0%, 0% and chronic HBV infection was 12.5%, 9.6% and 5.1% in the ANC, NCD and STI clinics, respectively. Collectively, our data indicate that public health measures should be focused on HAV and HBV infections in Jamaica, with more robust surveillance and targeted vaccination for populations at risk of infection to limit transmission.
Community pharmacies (private retail drug shops or pharmacies) have emerged as promising platforms for antiretroviral therapy delivery. This rapid review synthesizes findings on using pharmacies to treat HIV infection and/or tuberculosis (TB), and it identifies lessons for expanding TB service delivery. We reviewed studies published between 2015 and 2025 with adherence, retention in care, virologic suppression, prescription refill rates, and TB treatment access as outcomes. Of 314 articles screened, only 3 met the eligibility criteria (studies reporting pharmacies treating HIV infection and/or TB). Findings revealed improved CD4 cell counts; improved mean body weight; and higher rates of prescription refill (95-100%), retention (98%), and viral suppression (99%). Pharmacies have proven effective in delivering treatment for people with HIV and/or TB, highlighting their potential role in expanding TB treatment and related services in sub-Saharan Africa. However, pilot studies are needed to assess the effectiveness and implementation outcomes before broader implementation.
The aim for the present study was to analyze clinical features, diagnostic approaches, and therapeutic strategies for visceral leishmaniasis (VL)-associated hemophagocytic lymphohistiocytosis (HLH) in pediatric patients. The clinical characteristics and test results of the children were summarized. Among the four patients, three resided in VL-endemic regions, and one had traveled to a VL-endemic region. All patients presented with recurrent fever (>38.5°C), hepatosplenomegaly, and decreased hemoglobin (HGB) levels ([78.75 ± 8.50] g/L) and platelet (PLT) counts ([59.50 ± 17.48] × 109/L). Before a definitive diagnosis could be made, patients exhibited progressive declines in white blood cell counts, HGB levels, and PLT counts, along with elevated triglyceride, serum cytokine (interleukin [IL]-6, IL-10, IL-2R, and tumor necrosis factor α) levels. Bone marrow aspirate smears revealed hemophagocytosis and Leishmania donovani (LD) bodies in all cases: two were diagnosed via direct identification of LD bodies, one was diagnosed through re-examination of bone marrow smears after confirming a travel history, and one was diagnosed via re-examination prompted by metagenomic next-generation sequencing, which revealed leishmaniasis. All the patients were initially diagnosed with HLH and received HLH-directed immunochemotherapy before VL diagnosis, with suboptimal response. After confirmation of VL, sodium stibogluconate therapy was initiated, resulting in a partial response in all cases. Etiological investigation is critical for HLH diagnosis. For VL-associated HLH, sodium stibogluconate as targeted therapy rapidly controls HLH, facilitates immunosuppression withdrawal, and significantly improves patient outcomes. White blood cell count, HGB level, PLT count, and lactate dehydrogenase level may serve as critical prognostic biomarkers for VL-associated HLH.