In low-prevalence settings, the epidemiological yield of screening strategies for controlling vancomycin-resistant enterococci (VRE) outbreaks has not been fully established. We retrospectively analysed a prolonged VRE outbreak at a 536-bed tertiary-care hospital in Japan from 2010 to 2021 to evaluate sequential screening strategies across epidemic phases and to identify risk factors for VRE acquisition. Hospital-wide, admission-based, antimicrobial exposure-based, passive, and haemodialysis-targeted screening strategies were implemented over time. Screening yields were compared longitudinally, and a retrospective case–control study was performed using data from the initial hospital-wide screening phase. Molecular epidemiology was assessed by pulsed-field gel electrophoresis (PFGE). In total, 169 VRE-positive patients were identified, including seven infections and 162 asymptomatic carriers. Hospital-wide screening in the early epidemic phase showed the highest positivity rate (0.91%), whereas targeted strategies consistently yielded lower rates (0.09–0.34%). Haemodialysis, specific oral care practices, and prior exposure to carbapenems, glycopeptides, and piperacillin/tazobactam were independently associated with VRE acquisition. PFGE revealed substantial genetic diversity, suggesting sustained nosocomial transmission with repeated introductions. Early broad-based screening may be epidemiologically efficient in the initial phase of VRE outbreaks in low-prevalence settings, followed by adaptive refinement for long-term control.

We assessed the association between voluntary polymerase chain reaction testing of travellers and reported infection rates in the Ogasawara Islands compared with those in several other Tokyo islands. The implementation of polymerase chain reaction testing over a 2-year period was evaluated. Between September 2020 and September 2022, 38,943 of 45,900 travellers to the Ogasawara Islands underwent pre-travel polymerase chain reaction testing, with a notable increase in uptake during states of emergency. Ogasawara reported 385 positive coronavirus disease 2019 cases, with no hospitalizations or severe cases among residents, in contrast to the higher infection and hospitalization rates in Tokyo. Pre-boarding polymerase chain reaction tests were associated with lower reported infection rates in this island setting. These findings suggest that combining pre-travel testing with local mitigation measures, including case isolation systems, may help safeguard the communities of small, geographically isolated islands. These results may inform public health preparedness and response strategies for future infectious disease outbreaks.

This study assessed changes in complete pneumococcal vaccination coverage (CPVC) among Peruvian children <5 years before and after the COVID 19 pandemic and evaluated regional differences, associated sociodemographic factors and wealth-related inequality. 2018–2023 Demographic and Health Surveys (DHS) was analyzed. CPVC was defined as receiving the full 2 + 1 schedule of the 13 valent pneumococcal vaccine. Children aged 13–60 months were included. Multivariable analysis used modified Poisson regression and wealth related inequality was assessed using the Concentration index and Erreygers’s corrected Concentration index at national and regional levels. Among 95,586 children, CPVC decreased from 71.9% in 2019 to 69.4% in 2020 (p = 0.003), then returned to pre Covid levels from 2021 onward (72.2% in 2023; p = 0.001), particularly in Lima Metropolitana. Puno (53.3–58.6%) and Madre de Dios (50.9–62.1%) consistently showed the lowest coverage. Nationally, wealth- or sociodemographic related inequalities were minimal; however, regional interactions indicated that the effect of wealth on CPVC varied by area. Depending on the region, factors such as age group, household members and mather’s education were associated with lower CPVC, whereas age at first pregnancy, institutional birth, antenatal care and access to information increased CPVC. Ucayali showed persistently higher CPVC among wealthier populations. Despite a temporary decline during the pandemic, CPVC in Peru rapidly recovered, although regional gaps persist.

This retrospective study analysed 14,625 isolates of the six major hospital-associated ‘ESKAPE’ pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) collected between 2002 and 2024 in a Hungarian tertiary-care centre. Antimicrobial resistance was assessed using the antibiotic resistance index (ARI), multidrug resistance (MDR) ratios, and resistance instability index (RII). A. baumannii and E. faecium showed the highest resistance burdens and instability. Age showed a significant monotonic association with resistance (Spearman r = 0.88), with peaks in infants, middle-aged women, and the elderly. Species-specific age trends varied, with a negative correlation seen in Enterobacter spp. Hierarchical clustering grouped pathogens by resistance trajectory rather than taxonomy. Pairwise resistance distances confirmed divergence between Gram-positive and Gram-negative species. Resistance to aminoglycosides and sulphonamides showed the highest year-to-year variability, as quantified by the RII, particularly in A. baumannii and E. faecium. Vector autoregressive (VAR) modelling predicted continued MDR increases in these species. A strong correlation was found between ARI and RII (Pearson r = 0.85, p = 0.032). These findings underscore the importance of integrating resistance magnitude and volatility in surveillance.

Mpox (formerly called monkeypox) is a zoonotic viral disease caused by the monkeypox virus (MPXV) that has recently emerged as a notable global health issue by spreading beyond its typical geographical zones in Central and West Africa. In this study, we conducted a phylogenetic and evolutionary investigation of MPXV in West Africa. We focussed on 167 complete genome sequences collected from human infections in Nigeria and Cameroon between 2019 and 2024, all of which were retrieved from the GSAID database. To analyse these sequences, we employed multiple sequence alignment using fast Fourier transform (MAFFT) and maximum likelihood techniques to identify conserved genomic variants and trace evolutionary patterns within the virus. Our findings revealed that all the MPXV strains studied belong to clade II, which is further subdivided into two subclades. Notably, this study documents the presence of two distinct subclades IIa and IIb, reflecting the complex and ongoing evolution of the virus in the region. The phylogenetic analysis reveals rapid mutations and suggests that MPXV is being transmitted from multiple lineages between Nigeria and Cameroon. This demands the need to further strengthen the surveillance and containment efforts in West Africa. This study highlights the role of genomic surveillance in monitoring the evolution and spread of the MPXV, particularly in regions with limited available data.

This retrospective, cross-sectional study assessed the burden of HIV in Israel’s Maccabi Healthcare Services in 2022. Among 2.6 million individuals assessed (lookback period: > 2 decades), 1973 PWH were identified and age-sex-matched (1:5) to 9,865 randomly selected controls without HIV. We compared sociodemographic, clinical characteristics, and healthcare resource utilization (HRU; Jan–Dec 2022) between people with and without HIV and characterized antiretroviral therapy (ART) treatment patterns among PWH (Jan–Dec 2022). Compared to controls, PWH had a higher lifetime prevalence (since 1988; P < 0.001) of several comorbid conditions, including liver disease, chronic kidney disease, any cancer, and hepatitis B and C infections. Additionally, PWH had a higher rate of anxiety and depression (26.2% vs. 13.5%; P < 0.001). PWH showed higher annual HRU than controls, including ~2-fold higher hospitalizations (≥1 new admissions; P < 0.001) and frequent use of emergency, urgent, primary, specialist, and nursing care (P < 0.05). Among 1907 PWH with ≥1 ART prescription, 78.1% had ≥90% coverage in 2022, although 69.1% experienced ART interruption and 7.2% discontinuation, the latter associated with mental health issues. This study recognizes critical gaps in care that could inform strategies to improve clinical outcomes and resource allocation in health systems for PWH.

To estimate illness incidence or prevalence from wastewater data, modelling approaches may benefit from incorporating faecal shedding parameters. We systematically searched PubMed and a public repository on shedding data and included 33 studies that met at least one of our objectives. Among 32 studies, the proportion of SARS-CoV-2-infected individuals with detectable virus in stool ranged from 18 to 100%, with a pooled estimate of 54% (95% CI: 52–56%). Stratification by four clinical severity categories, ranging from asymptomatic to critically ill, showed no significant differences among categories (p-value = 0.49). The proportion of individuals with detectable SARS-CoV-2 RNA in stool was higher in children (61%) than in adults (53%; p-value = 0.02). In half of the individuals who initially shed the virus in stool, it remained detectable for an estimated 22 days post-symptom onset. Three studies documented viral load kinetics, indicating a peak between days 3 and 9. Twenty-five studies reported maximum shedding durations ranging from 2 to 12 weeks. Our review summarizes the frequency, dynamics, and duration of SARS-CoV-2 shedding in stool and may serve as a valuable foundation for modelling efforts involving faecal shedding indicators.

Immunization is critical for reducing vaccine-preventable disease morbidity and mortality, yet coverage disparities persist in low-resource settings. This mixed-methods study describes characteristics of childhood immunization defaulters and explores barriers to vaccine adherence in Khyber Pakhtunkhwa, Pakistan. We recruited 380 caregivers from three tehsils in District Kohat of Khyber Pakhtunkhwa from February to July 2023, whose children under 2 years had not completed the Expanded Program on Immunization (EPI)-recommended schedule. Quantitative data from validated questionnaires and immunization cards underwent descriptive and regression analyses; qualitative interviews explored non-adherence reasons. Most respondents were fathers (96.05%); 41.84% resided in rural areas. Initial coverage was high for BCG (97.89%) and OPV0 (100%) but declined for Penta3 (26.05%) and Measles2 (4.21%). Most children (73.95%) were under 4 months. Rural defaulters were more prevalent than urban (41.84% vs. 34.47%, p < 0.001), and 89.47% had mothers with ≤high school education. While 95.26% had heard of vaccines, only 49.47% knew the EPI starting age. Defaulters with higher knowledge progressed further through the schedule (AOR: 4.55, p = 0.05). Qualitative themes included poor healthcare access, cultural norms, religious misconceptions, and migration disruptions. Interventions addressing maternal education, rural access, and knowledge gaps are essential to reduce immunization default.

Orthopaedic inpatients have distinct clinical traits. This study aimed to quantify the burden of nosocomial infections (NIs) on orthopaedic patients. A nested case–control study (2022–2024) at the China National Orthopaedic Medical Center compared orthopaedic inpatients with and without NIs and matched cases and controls 1:3 to evaluate the burden of NIs. A national economic burden analysis was subsequently conducted under various scenarios. Among 120,764 eligible patients, 338 (0.28%) developed NIs. A total of 321 cases were matched with 916 controls. The economic and temporal burdens of NIs are US$2,100 and 5 days per case respectively. Haematologic NIs had the highest additional cost (US$4,295) and the second longest extended stay (9 days). In terms of initial hospitalisations and readmissions, surgical site infections extended hospital stays by 20 days and increased costs by US$4,881. The top three diagnosis-related groups (DRGs) with high burdens are ZC11, ZJ15, and IE21 for costs and ZJ15, IE21, and IB19 for duration. In the mixed-region scenario, orthopaedic specialty hospitals nationwide incur US$5.23 million in direct medical costs annually because of NIs. These findings indicate that NIs significantly affect orthopaedic patients both individually and nationally, necessitating focused prevention and control for high-burden DRGs and specific infections.

Antimicrobial resistance (AMR) is a pressing global health challenge, with sub-Saharan Africa experiencing the highest burden of AMR-related deaths. Inappropriate prescribing and rising antibiotic consumption drive AMR, while limited local data hampers antimicrobial stewardship efforts. This study analysed Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) data from Tygerberg Hospital to identify antimicrobial use trends and inform stewardship priorities. Standard Global-PPS methodology was employed at three distinct time points. All inpatients prescribed at least one antimicrobial on the day of each survey were included in the analysis. Among 3,524 hospitalized patients, 25.9% (911/3,524) received antimicrobial therapy. Overall antimicrobial use decreased significantly (p < 0.05), with the largest reduction among paediatric patients (p < 0.01). Community-acquired infections accounted for the majority of prescriptions (50.7%; 483/952) and empirical antibiotic use was high (85.3%, 872/1022). ‘Access’ antibiotics constituted 62.7% (750/1196) of prescriptions. Single-dose prescriptions for surgical prophylaxis accounted for 17.6% (15/85). This study demonstrates progress in stewardship, particularly among paediatric inpatients. Ongoing monitoring of broad-spectrum antibiotic use and adherence to single-dose surgical prophylaxis guidelines are essential priorities. Continued Global-PPS surveillance is crucial to track trends and guide future AMS interventions.

Autochthonous transmission of dengue in southern Europe has emerged as a growing public health concern, especially in regions such as Spain, due to the expansion of mosquito vector species, such as Aedes albopictus and Aedes aegypti, introduced into these regions. This article presents an overview of the situation based on the analysis of the different reports published by international and national health agencies, together with key scientific studies on autochthonous transmission of dengue in Europe and Spain. Through this work, the factors considered to be contributing or hypothesized drivers of the spread of the virus on the European continent, such as climate change, human mobility, and the proliferation of mosquito vectors, are described. It explores the cases of autochthonous transmission documented in several European countries and Spain. In addition, the surveillance protocols implemented by Spanish health authorities and the health responses to outbreaks in Spain are also examined. Finally, the risk of future transmission in Spain is assessed, and strategies are proposed to strengthen epidemiological surveillance, improve preparedness for possible outbreaks, and optimize vector-control policies in the context of global change.

Sexually transmitted infections (STIs) are common among people living with human immunodeficiency virus (HIV) (PLWH). This nationwide register study linked HIV and STI registries to examine STI trends before and after HIV diagnosis in Finland 1995–2019 among all PLWH residing in the country. Analysed STIs were chlamydia, gonorrhoea, syphilis, and hepatitis B and C. An extended Cox model assessed factors associated with STI events. Among 3,775 PLWH (mean follow-up 17.9 person-years), 71% had no STIs, 17% had one, and 12% had two or more. Overall, 10.7% had an STI before HIV diagnosis and 18.1% after. STI incidence was 32 per 1,000 person-years and increased over time, although chlamydia and gonorrhoea declined. STI risk was highest among men who have sex with men (MSM) and lowest among people who inject drugs; it remained stable or declined after HIV diagnosis. STIs before HIV diagnosis offer opportunities for HIV testing and pre-exposure prophylaxis promotion. As most had no STIs other than HIV, HIV testing should not be limited to STI screening but also performed in other indicator conditions. After HIV diagnosis, accessible low-threshold STI testing, particularly for MSM, and consideration of doxycycline prophylaxis may benefit those at highest risk.

International travel is thought to be a major risk factor for developing gastrointestinal illness in England. Transmission is thought to be more likely in countries which have lower food hygiene standards, poorer sanitation, and lack of access to clean water. However, many studies are conducted within travel clinic settings which may bias findings. Here, we present a case–control study undertaken in returning English travellers in the community conducted with cases of gastrointestinal illness notified to UKHSA.

All Cryptosporidiosis, Giardiasis, non-typhoidal Salmonellosis, and Shigellosis cases notified to the UK Health Security Agency (UKHSA) between 01 July 2023 and 15 October 2023 were asked to complete an anonymous electronic questionnaire if travelling during their incubation period. Asymptomatic travellers were recruited as controls via a market research panel and asked to complete the same questionnaire. A destination water, hygiene, and sanitation score were derived from the WHO ‘Attributable fraction of diarrhoea to inadequate WASH’ dataset. Demographics, travel details, and exposures while travelling were compared by Pearson’s chi-squared test, and pathogen and destination specific multivariable analyses were performed using a forward stepwise approach.

A total of 653 cases and 483 controls were included. The odds of being a case were significantly higher when travelling to countries outside of the EU (OR:4.6, 95%CI:3.5–6.0; p = <0.001) and to countries with high-risk WASH score (OR 6.6, 95%CI:4.9–9.1; p = <0.001), particularly Egypt, Mexico, Tunisia, and Turkey. For those travelling to a low-risk destination, eating undercooked meat or fish and swallowing water from environmental water sources were significantly associated with higher odds of illness by multivariable analysis (p < 0.05). At high-risk destinations, eating foods consumed on excursions, swallowing water from environmental sources, and eating foods from hotel buffets were significantly associated with higher odds of being a case.

Travel to popular tourist destinations is a potentially under-recognized risk factor for acquiring gastrointestinal infections. Exposures at low-risk destinations were broadly similar to risk factors in the UK. Exposures in high-risk destinations highlighted potential risks associated with catered hotels and tourist excursions which should be explored further.

A global increase in severe group A Streptococcus (GAS) infections has been reported following the COVID-19 pandemic, but data from Asia remain limited. We examined epidemiology and clinical characteristics of severe paediatric GAS infections across 86 Japanese hospitals, focusing on patients under 18 years of age, hospitalized between 1 January 2019 and 31 March 2024. Severe GAS infection was defined by the isolation of GAS from sterile sites, or from non-sterile sites under specific conditions, such as streptococcal toxic shock syndrome (STSS). A total of 83 cases were analysed. Cases increased from the summer of 2023, exceeding pre-pandemic levels. The median age was 4 (interquartile range: 1–8) years, with the highest number among 1-year-olds. No cases were reported in Hokkaido, northern Japan. Only 6% (5/83) of the cases had preceding GAS pharyngitis. Pneumonia was the most prevalent diagnosis (25%), with 76% of these cases being complicated by empyema, often necessitating intensive care or surgical intervention. Only 17% (14/83) of cases were reported as STSS in Japan’s national surveillance system. This study represents the first multicentre nationwide hospital-based investigation of severe paediatric GAS infections in Japan, identifying the recent increase in cases, thereby highlighting limitations of current STSS-based surveillance.

This study analyses 18 years of weekly reported dengue cases (January 2002–December 2020; 988 weeks) from Costa Rica’s Central Valley to examine seasonal and multi-year patterns. To model the spatio-temporal dynamics of dengue, we employ three statistical approaches for case counts: the spatial hurdle integer-valued generalized autoregressive conditional heteroskedasticity (INGARCH) model, the spatial zero-inflated generalized Poisson (ZIGP)-INGARCH model, and the endemic–epidemic (EE) model. Covariates include rainfall and maximum temperature or alternatively seasonal Fourier terms to represent annual seasonality. Using a Bayesian framework, we fit the spatial INGARCH-family models to weekly dengue cases. The EE model and the ZIGP-INGARCH model, both with Fourier seasonal terms, show the best predictive accuracy and provide estimates of seasonal intensity and peak timing relevant for dengue surveillance. Incorporating annual seasonality improves modelling of multivariate weekly dengue cases in Costa Rica’s Central Valley, underscoring the importance of cyclical patterns for strengthening early warning systems and guiding targeted vector control.

The COVID-19 pandemic and associated non-pharmaceutical interventions (NPIs) reduced transmission of other infections. We quantified changes in hospital admission rates for respiratory and gastrointestinal infections among young children in England during and after implementation of NPIs, compared to pre-pandemic, and variations by sociodemographic and clinical characteristics. Children aged <5 years at any time between 1 January 2017 and 31 January 2022 were followed from birth or 1 January 2017, until their 5th birthday, death, or 31 January 2022, within a birth cohort based on Hospital Episode Statistics data. Quarterly emergency admission rates for respiratory and gastrointestinal infections from April-June 2020 onwards were compared to corresponding quarters in 2017–2019 using Poisson regression, with and without interaction terms for time period and sociodemographic/clinical characteristics. Admission rates for respiratory and gastrointestinal infections were lower in April–June 2020 compared to this quarter pre-pandemic (incidence rate ratio (99% CI) 0.17 (0.17–0.18) for respiratory; 0.29 (0.28–0.31) for gastrointestinal). Rates remained below pre-pandemic levels until April–June 2021 (respiratory infections) and July–September 2021 (gastrointestinal infections), subsequently increasing above the corresponding pre-pandemic quarters. Changes in rates did not differ by sociodemographic/clinical characteristics. These results can inform planning for future pandemics and their aftermath.

In this nationwide cohort study, we assessed the long-term risk of major cardiovascular events following intensive care unit (ICU) treatment for community-acquired sepsis and septic shock, compared to the general population. We included 20313 adults admitted to Swedish ICUs between 2008 and 2019, identified through national healthcare registries, and matched each case to 20 randomly selected population controls. Entropy balancing adjusted for baseline co-morbidities, healthcare utilization, and socio-demographics. The association between sepsis and subsequent cardiovascular events (hospitalizations or deaths due to myocardial infarction, heart failure, or cerebral infarction) was analysed using Cox proportional hazards models. Sepsis was associated with increased cardiovascular risk, particularly during the first year (days 0–30 adjusted hazard ratio [aHR] 6.1 (95% CI 4.7–7.9); days 31–90; aHR 2.4 (95% CI 1.8–3.2); days 91–365 aHR 1.4 (95% CI 1.2–1.6)), with risk persisting through years 2–5 (aHRs 1.1–1.3). Heart failure risk remained elevated across all intervals, while risks of myocardial and cerebral infarction were mainly short term. The highest relative risks were observed in patients without prior heart disease or with low baseline cardiovascular risk. These findings suggest that sepsis might be an independent and under-recognized driver of long-term cardiovascular disease, highlighting the need for preventive strategies.

This study examines spatiotemporal patterns of tetracycline- and trimethoprim–sulfamethoxazole (TMP–SMX)–resistant Staphylococcus aureus (S. aureus) among United States (US) Veterans Health Administration (VHA) outpatients. Prevalence of tetracycline and TMP–SMX resistance in methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) was calculated for 2010–2023. MRSA cases from 2018 to 2022 were aggregated to commuting zones (CZs) in the eastern US, and CZ-specific relative risks and temporal trends were estimated using a hierarchical Bayesian Poisson model with a spatiotemporal interaction term. Results indicated that resistance in MRSA increased by 16.4% for tetracycline and 9.3% for TMP–SMX, while MSSA resistance remained stable. High-risk CZs were limited (3% for tetracycline, 4% for TMP–SMX) and distributed across the eastern US, with notable within-state variation in risk and trend. Most CZs exhibited stationary trends, although distinct patterns in the rate and timing of changes in resistance were observed in CZ-specific plots. These evolving and geographically variable patterns of antimicrobial resistance at finer spatial scales highlight the need for local surveillance and outpatient antibiotic stewardship strategies that consider place-based sociodemographic, ecologic, and clinical factors.