Epidemiology and Infection最新文献

{"title":"Tuberculosis infection in an urban homeless population.","authors":"David Moynan, Sean Donohue, Aisling Fitzgerald, Helina Alemayehu, Elizabeth Groarke, Aoife Mooney, Fiona Gaffney, Kelley Ann Brandon, Karen Jones, Niall Conlon, Cliona Ni Cheallaigh, Niamh Allen","doi":"10.1017/S0950268826101629","DOIUrl":"10.1017/S0950268826101629","url":null,"abstract":"<p><p>People experiencing homelessness (PEH) are at increased risk of tuberculosis (TB) infection and progression to TB disease. Data on TB infection prevalence among hospitalised PEH in low-incidence countries remain limited. This study aimed to estimate TB infection prevalence and describe associated demographic and clinical characteristics among PEH admitted to an urban tertiary hospital in Dublin, Ireland. A prevalence study was conducted between November 2023 and March 2025 using an opt-out screening model. Hospitalised PEH were offered interferon gamma release assay (IGRA) testing on admission. Demographic and clinical data were collected, and positive IGRA results were assessed clinically and radiographically to exclude active TB disease. Estimated lifetime risk of progression to TB disease was calculated using a validated risk-modelling algorithm.Among 118 PEH screened, 13 (11%) were IGRA-positive and 3 (2.5%) had indeterminate results. The cohort was predominantly male (77%) with a mean age of 46 years. Non-Irish-born individuals had higher IGRA positivity than Irish-born participants (23.8% vs 8.3%, p = .054). Substance and alcohol use disorders were common, over half had previous incarceration, and one-third were sleeping rough at admission. Among IGRA-positive individuals, the mean estimated lifetime risk of progression to TB disease was 6.96% (SD 3.3). These findings support strengthened, integrated TB prevention strategies for PEH.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e78"},"PeriodicalIF":2.5,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13279949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping malaria risk using geospatial and AHP approaches in Nsanje District, Malawi.","authors":"Yanjanani Miston Banda, Jabulani Nyengere, Kimberly Saka, Harineck Tholo, Chikondi Chisenga, John Njalammano, Blessings Nthezemu Kamanga, Steven Gondwe, Andrew G Mtewa, Amon Abraham, Lemson Kachedwa, James Chirombo, Alick Nguvulu, Emmanuel Chinkaka, Wilfred Kadewa, Richard Lizwe Steven Mvula","doi":"10.1017/S0950268826101678","DOIUrl":"10.1017/S0950268826101678","url":null,"abstract":"<p><p>Malaria remains one of the critical public health threats, particularly in endemic sub-Saharan countries like Malawi. Although malaria prevalence has declined over the years, the disease continues to pose a notable public health burden, contributing to high levels of morbidity and mortality. This study mapped malaria risk in Nsanje District, southern Malawi. Environmental variables (temperature, rainfall, elevation, slope, and proximity to rivers) were used to model malaria hazard, while socio-economic factors (proximity to health facilities and roads, and population density) defined vulnerability. Land use and land cover derived from Sentinel-2 using the random trees classifier in ArcGIS Pro were used to delineate elements at risk. The analytical hierarchy process and weighted overlay analysis were applied to generate hazard, vulnerability, and risk maps. Additionally, sensitivity analysis was conducted to determine the most influential factors. Results show that temperature and rainfall contributed more within the model to malaria hazard, with 20.4% and 35.1% of the area classified as high- and very high-hazard zones, respectively. Vulnerability was mainly affected by proximity to health facilities and population density, while 43.1% of the district was categorized as high risk and 40.5% as moderate risk. Overall, malaria hazard contributed most to the total risk, followed by vulnerability. The findings of this study are essential for understanding the complex dynamics of malaria transmission, which are influenced by a combination of environmental, climatic, and socio-economic factors. The study recommends enhancing healthcare accessibility and developing early warning systems, including malaria risk maps, to support targeted prevention and control efforts. Future studies should integrate long-term climate projections and real-time, high-frequency environmental and epidemiological data to enhance malaria risk modelling.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e76"},"PeriodicalIF":2.5,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rebuilding trust in public health: Beyond polarization.","authors":"Jussi Sane","doi":"10.1017/S095026882610137X","DOIUrl":"10.1017/S095026882610137X","url":null,"abstract":"<p><p>The global health landscape has entered a period of profound change. Official development assistance for health has sharply declined, while new U.S. policies threaten long-standing public health norms and undermine evidence-based guidance. Vaccine hesitancy, political interference in medical recommendations, and climate policy reversals illustrate a troubling erosion of scientific authority. These developments coincide with growing polarization, revealing that 'following the science' is neither straightforward nor free from uncertainty. The COVID-19 pandemic exposed how public health decisions were often made under evolving evidence, with limited transparency about risks, trade-offs, and unintended consequences. Subsequent international initiatives, such as the WHO's global agenda on Public Health and Social Measures, now seek to build a more balanced evidence base. Rebuilding public trust demands openness about uncertainty, acknowledgement of past missteps, and transparent communication of policy rationales. Structured after-action reviews and community engagement are essential to demonstrate accountability and learning. Ultimately, restoring confidence in science and public health will require humility, consistency, and cross-partisan collaboration to show that science is adaptive, responsive, and committed to improvement.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e71"},"PeriodicalIF":2.5,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13231225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of using online market panel members and traditional methods in control recruitment for a case-control study during a national outbreak of STEC O145, United Kingdom.","authors":"Grace King, Carys Rees, Clare Sawyer, Ann Hoban, Thomas Inns, Orlagh Quinn, Yanshi, Amy Douglas, André Charlett, Lesley Larkin, Carmellie Inzoungou-Massanga, Motolani Awokoya, Maria Waghorn, Oluwakemi Olufon, Andrew Nelson, Christopher Williams, Paul Millar, Catriona Dobosz, Genna Leckenby, Caoimhe McKerr, Sema Nickbakhsh, Sooria Balasegaram","doi":"10.1017/S0950268826101599","DOIUrl":"10.1017/S0950268826101599","url":null,"abstract":"<p><p>National foodborne outbreaks of gastrointestinal disease often require rapid case-control investigations to identify the source. Online market panels offer a potential alternative to traditional control recruitment. We compared market panel controls to traditional controls in case-control recruitment during a 2024 UK outbreak of STEC O145. Two case-control studies were conducted for two different control groups (a) <i>Salmonella</i> cases as case-controls and (b) online market panel members. Timeliness, cost, and resources were compared, and a logistic regression compared findings in a control-control analysis. In total, 43 cases of STEC O145, 63 <i>Salmonella</i> case-controls, and 93 panel controls were recruited. Neither control group reached the recruitment target for the younger adult age group. <i>Salmonella</i> case-controls had a ninefold greater staff time to recruit and cost five times more than panel controls (£25.82 vs. £4.99 per control), partially due to interviewer-administered questionnaires compared with self-completion by panel controls. Both analytical approaches identified the same outbreak source, with no significant differences in exposures between the control groups. The cost and resource savings associated with panel controls justify their use as a standard procedure in outbreak investigations. We recommend exploring engagement with age groups that are difficult to recruit and assessing alternative strategies to reach them.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e77"},"PeriodicalIF":2.5,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of an ongoing cluster of tuberculosis (TB) associated with prisons, England.","authors":"Lucy Findlater, Mailis Maes, Nathan Post, Amith Philip, Lauren Ahyow, Chantal Edge, Martin Dedicoat, Tracey Langham, Suzi Coles, Esther Robinson","doi":"10.1017/S0950268826101630","DOIUrl":"10.1017/S0950268826101630","url":null,"abstract":"<p><p>Prisons are high-risk environments for the spread of tuberculosis (TB). We investigated an ongoing prison-associated TB cluster to identify common exposures. We defined cases as residents in England with laboratory-confirmed TB belonging to the genetic cluster. We extracted records from the National TB Surveillance System, linked to prison operational data, and conducted descriptive analysis of demographic, clinical, and phylogenetic data. Years were masked for anonymity. Over six years, 12 individuals were identified, predominantly male (83%) and median age 34 years, in London, East Midlands, and East of England. Prison history was noted for 7/12 (58%) at 13 prisons. Everyone without prison history completed treatment, but 2/7 with prison history were lost to follow-up and 5/7 were still in treatment or outcome not evaluated. We identified frequent prison transfers and concurrent stays of four individuals at Prison B, and two at Prison G. Phylogenetic analysis indicated distinct sub-clusters with and without prison history, suggesting expansion of the cluster from community into prisons. Prisons continue to play a role in TB in England. Factors such as frequency of transfers could hinder treatment completion and control of transmission. Combining phylogenetic, epidemiological, and prison operational data facilitated investigation of transmission pathways.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e84"},"PeriodicalIF":2.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Published <i>Salmonella</i> risk assessment model contains major errors and inconsistencies.","authors":"Mark Powell, Eric Ebel","doi":"10.1017/S0950268826101496","DOIUrl":"10.1017/S0950268826101496","url":null,"abstract":"","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":"154 ","pages":"e60"},"PeriodicalIF":2.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13184647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outbreak of <i>Ralstonia pickettii</i> bacteraemia related to sterile distilled water in patients with haematological and oncological malignancies.","authors":"Sema Alp, Seyda Silan Okalin, Oya Ozlem Eren-Kutsoylu, Ayse Nur Sari-Kaygisiz, Gul Aygun, Cem Ergon, Aliye Cinar, Ulker Uysal, Berken Gur, Mehmet Ali Oktem","doi":"10.1017/S0950268826101526","DOIUrl":"10.1017/S0950268826101526","url":null,"abstract":"<p><p>This study aimed to investigate a four-month <i>Ralstonia pickettii</i> outbreak by characterizing clinical and environmental isolates while also demonstrating the infection control measures taken to identify and eliminate the sources. <i>R. pickettii</i> was isolated from patients' blood cultures, and an epidemiological investigation was initiated to determine the source of the outbreak. Clonal relatedness among clinical and environmental samples was assessed using pulsed-field gel electrophoresis. In total, <i>R. pickettii</i> was isolated from 14 patient blood cultures and 3 bottles of sterile distilled water. Between April 14 and May 15, six patients had positive port cultures, including four with positive peripheral cultures. The contaminated water was identified as the outbreak source, and its use was discontinued on May 15. Nevertheless, two additional cases occurred in June. Port catheter colonization with <i>R. pickettii</i> was considered to be linked to contaminated water used during chemotherapy preparation. A recall of port catheter patients who received chemotherapy in April-May identified six more cases. Pulsed-field gel electrophoresis revealed two pulsotypes among water isolates, and most clinical isolates were clonally related to clone 1. This investigation highlighted the role of contaminated sterile distilled water and colonized medical devices as potential sources of <i>R. pickettii</i> outbreaks.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e75"},"PeriodicalIF":2.5,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relative contributions of public and domestic transmission domains in cholera outbreaks in displacement camps: an exploratory agent-based modeling study.","authors":"Tarek Jaber, Eline Boelee, Peter Kjær Mackie Jensen, Sake J De Vlas, Bartel Van de Walle","doi":"10.1017/S0950268826101575","DOIUrl":"10.1017/S0950268826101575","url":null,"abstract":"<p><p>Cholera is associated with devastating outbreaks among forcibly displaced people. Insights into the relative contributions of the public (extra-household) and domestic (intra-household) domains to cholera spread in camps, as well as the circumstances under which each may drive transmission, can support the design of response strategies. However, these have yet to be systematically investigated. We developed an agent-based model of cholera transmission in camps informed by a rapid appraisal conducted in Northeast Nigeria, an expert consultation, and humanitarian minimum standards. We simulated outbreaks in a stylized camp that meets water quantity standards and compared this with conditions where water supply is overwhelmed or compromised following floods and population influxes. We found that domestic transmission can exclusively drive cholera outbreaks. However, unless hygiene conditions are extremely poor and water is not adequately chlorinated, these outbreaks appear to be small. Following shocks, outbreaks can be large and progress rapidly. Although they are initially shaped by the public domain, domestic domain transmission can sustain or exacerbate them. We recommend directing humanitarian and development activities towards mitigating the consequences of extreme weather events and unplanned population influxes, as well as developing adaptive preparedness and response strategies that explicitly and comprehensively address them.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e97"},"PeriodicalIF":2.5,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global distribution and evolution of human metapneumovirus A2b2 clade: Insights from genomic surveillance.","authors":"Matthew David Bucala, Michael Brenner","doi":"10.1017/S0950268826101198","DOIUrl":"10.1017/S0950268826101198","url":null,"abstract":"<p><p>Human metapneumovirus (HMPV), which belongs to the a family, has shown the emergence of the A2b2 clade as the dominant global genotype. Whether this represents true evolutionary selection or surveillance artefacts remains unclear. We analysed 315 complete HMPV genome sequences (1994-2024) from the Nextstrain database using sampling-corrected statistical approaches, including temporal homogeneity testing, rarefaction analysis, and entropy-based dynamics to examine non-random patterns in A2b2 emergence. Temporal homogeneity testing revealed strong directional evolution towards A2b2 dominance (<i>Z</i> = -46.62, <i>p</i> < 0.001), confirming non-random patterns rather than surveillance artefacts. The clade showed strong persistence (206 self-transitions) with limited backward transitions. After controlling for sampling bias, A2b2 represented 68.3% (95% CI: 58.2-78.4) of isolates in 2023-2024. A2b2 demonstrated significantly higher temporal entropy (2.1) than other clades (A1: 1.2, A2a: 1.5, A2b1: 2.0), indicating more complex dynamics. Geographic rarefaction revealed significant regional structuring, with Africa showing the highest diversity (3.00, 95% CI: 1.00-3.05) despite lower sampling. HMPV A2b2's global expansion represents genuine directional evolution with potential selective advantages, similar to patterns in respiratory syncytial virus. These findings underscore the need for enhanced genomic surveillance and integration of HMPV monitoring into respiratory virus surveillance frameworks to track emerging variants and assess public health implications.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e72"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13231239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial cycle threshold to assess the infectious potential of SARS-CoV-2: A systematic review.","authors":"Elena Cecilia Rosca, Jason Oke, Tom Jefferson, Jon Brassey, Igho Onakpoya, Annette Plüddemann, Sara Gandini, Susanna Maltoni, David Evans, John Conly, Carl Heneghan","doi":"10.1017/S0950268826101484","DOIUrl":"10.1017/S0950268826101484","url":null,"abstract":"<p><p>We sought to assess predictive factors for SARS-CoV-2 infectiousness using a meta-analytic approach. We searched LitCovid, medRxiv, Google Scholar, and the WHO COVID-19 database until June 30 2025, including studies which cultured SARS-CoV-2, relating them to clinico-epidemiologic and laboratory variables and RT-PCR cycle threshold (Ct) values. Using linear mixed-effects regression models, we tested for independent associations with Ct values with 95%CIs and adjusted <i>P</i>-values in a multivariable model. We used a modified QUADAS criteria to assess risk-of-bias. We included 50 studies, with 39 in quantitative synthesis. The percentage of culture-positive specimens decreased with increasing Ct values (subgroup test difference Q = 96.71;<i>P</i> < 0.001) and time since the first PCR test (Q = 26.95;<i>P</i> = 0.0026). Presence of symptoms (Q = 20.1;<i>P</i> < 0.01), gene platform used (Q = 14.89;<i>P</i> = 0.002), being a cancer patient (Q = 24.9;<i>P</i> < 0.0001), and vaccination status (Q = 8.80;<i>P</i> = 0.012) were associated with increased culture-positivity, whereas a rising Ct (adjusted Ct change -6.58[95%CI] -5.30, -7.86;<i>P</i> < 0.001) was strongly associated with culture-negativity. Analysing 186 immunocompetent patients with 1,393 Ct values, 2 consecutive Cts ≥ 30 or a rising Ct value on serial testing demonstrated a sensitivity of 87.5% and specificity of 96.3% using culture positivity as the outcome. Serial Ct monitoring, integrated with clinico-epidemiologic data is a valuable tool for assessing infectiousness, providing objective criteria for discontinuing isolation and guiding clinical decisions.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e89"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}