Lancet Infectious Diseases最新文献

{"title":"Andes virus management-balancing infection control with patient safety and autonomy.","authors":"Gregory J Mertz, Pablo A Vial, Michelle S Harkins","doi":"10.1016/S1473-3099(26)00581-5","DOIUrl":"https://doi.org/10.1016/S1473-3099(26)00581-5","url":null,"abstract":"","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":29.4,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149326921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nucleic acid amplification testing and genome sequencing for WHO priority viruses in Africa: a scoping review.","authors":"Kenneth Chan, Caitlin Greenland-Bews, Daniel P Carter, Matthew Harvey, Cristina Leggio, Abdul Karim Sesay, Joseph Akoi Bore, Thomas Edwards, David J Allen, Sonal Shah","doi":"10.1016/S1473-3099(26)00355-5","DOIUrl":"10.1016/S1473-3099(26)00355-5","url":null,"abstract":"<p><p>Emerging viruses continue to pose serious public health threats across Africa, with recurrent outbreaks exposing gaps in diagnostics and surveillance systems. Nucleic acid amplification tests (NAATs) and genome sequencing are increasingly important for diagnostics and outbreak responses; however, their routine implementation is fragmented. This scoping review examines NAATs and genome sequencing technologies for viral detection and surveillance in Africa from 2019 to 2024, mapped to the 2024 updated WHO R&D Blueprint for Epidemics pathogen priority list. We identified 117 studies from 34 African countries reporting applications across 20 virus families, including ten designated as priorities by WHO. PCR-based assays were the most frequently reported NAATs. Illumina platforms predominated sequencing, and Oxford Nanopore Technologies were commonly used in outbreak investigations. Genome sequencing applied to priority viruses was largely reactive. NAAT-capable mobile laboratories were reported in 13 countries. Our findings underscore the need for proactive integration of NAATs into diagnostic and surveillance systems to strengthen decentralised testing, sustain genomic surveillance beyond outbreak periods, and improve early detection and preparedness for viral threats.</p>","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":"e463-e476"},"PeriodicalIF":29.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Size of the 2026 Ebola outbreak and risk of cross-border spillover from Bundibugyo virus in Ituri Province, DR Congo, and its implications for preparedness: a recalibrated stochastic modelling study.","authors":"Dick Chamla, Marie Roseline Darnycka Belizaire, Isaias Fernandes Co, Arisekola Jinadu, Ibrahim Mamadu, Ajiri Okpure Atagbaza","doi":"10.1016/S1473-3099(26)00320-8","DOIUrl":"10.1016/S1473-3099(26)00320-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;On May 15, 2026, WHO declared a Bundibugyo virus (BDBV) outbreak in Ituri Province, DR Congo with an estimated index case on April 1, 2026 (6-week pre-declaration interval). By May 24, DR Congo reported 906 suspected cases (105 confirmed and ten confirmed deaths) across three provinces. Uganda reported seven confirmed cases (three imported; four locally acquired including three health-care workers; case-fatality ratio 14%). WHO declared a Public Health Emergency of International Concern on May 17, 2026; Africa Centres for Disease Control and Prevention declared a Public Health Emergency of Continental Security on May 18, 2026. The study aimed to establish a short-term trajectory of the BDBV outbreak and probability of cross-border spillover into countries with elevated risk of importation to guide preparedness priorities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We calibrated a stochastic SEIRD (susceptible, exposed, infectious, recovered, and dead) ensemble model to the laboratory-confirmed case series, anchoring on 598 cumulative confirmed cases on June 8, 2026 (day 68) using simulation filtering (calibration window ±30%; reporting fraction 1·0 for laboratory-confirmed cases). The case-fatality ratio was drawn from a previous value centred on the observed confirmed-case ratio of approximately 19% (115 of 598). A linked daily-hazard spillover model estimated importation probability for Uganda, South Sudan, Rwanda, and Burundi over a 12-week horizon. The early suspected-case series, which peaked at 1077 on May 26, 2026, before being substantially revised downward by laboratory reclassification, is reported for context but was not used for calibration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Laboratory-confirmed DR Congo cases rose from 33 on May 18, 2026, to 598 by June 8, 2026. Calibrated to the confirmed-case anchor (598 on June 8, 2026; central basic reproduction number [R&lt;sub&gt;0&lt;/sub&gt;]=1·71), the confirmed-case trajectory is most consistent with the central scenario. Under the central scenario the ensemble projected a median of 990 cumulative confirmed cases by week 12 (June 24, 2026; 90% prediction interval [PI] 709-1293) and 174 deaths; the low scenario projected 870 confirmed cases (90% PI 641-1133) and 160 deaths. The early suspected-case count (peak 1077 on 26 May 2026) was substantially revised by laboratory reclassification and is reported for context only. Cross-border spillover remained material: Uganda 94·2% importation probability (19 confirmed cases as of June 4, 2026, including five health-care worker infections and two deaths); South Sudan 69·3%; Rwanda 8·6%; and Burundi 2·0%. As of June 22, 2026, DR Congo has 1048 confirmed cases and 267 confirmed deaths and Uganda has 20 confirmed cases, two confirmed deaths, and one probable death. These numbers are changing daily and are likely to align with what is predicted in the central scenario.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;From the most recent laboratory-confir","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":"1099-1105"},"PeriodicalIF":29.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-based tuberculosis screening with computer-aided detection technology alone and in combination with point-of-care C-reactive protein testing: a paired screen-positive trial.","authors":"Klaus Reither, Fiona Vanobberghen, Anna Verjans, Harsh Vivek Harkare, Bart K M Jacobs, Alastair van Heerden, Shriya Misra, Fabrizio Tediosi, Curdin Brugger, Niklaus Daniel Labhardt, Mashaete Kamele, Mamatlakeng Keitseng, Thandanani Madonsela, Johanna Kurscheid, Josephine Muhairwe, Alfred Kipyegon Keter, Keelin Murphy, Bram van Ginneken, Tinne Gils, Bulemba Katende, Rediet Fikru Gebresenbet, Rahel Milena Erhardt, Thomas Zoller, Tom Decroo, Tracy Renée Glass, Lutgarde Lynen, Aita Signorell, Shannon Bosman, Irene Ayakaka","doi":"10.1016/S1473-3099(26)00222-7","DOIUrl":"10.1016/S1473-3099(26)00222-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Active tuberculosis case-finding in communities is crucial for early disease detection and disruption of transmission; however, it is complex and costly. A thorough analysis of tuberculosis screening strategies is essential, particularly because the health systems affected often have limited resources. We aimed to compare two community screening approaches in terms of tuberculosis case yield and cost.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This pragmatic community trial, with a paired screen-positive design (ie, within-person comparison), was conducted in the Butha-Buthe District in Lesotho and the uMgungundlovu District in South Africa. All household members aged at least 18 years were eligible to participate, except those who were seriously ill, had a condition that prevented their safe and full participation, were receiving tuberculosis treatment, or were pregnant (Lesotho only). We compared two screening approaches: the use of computer-aided detection (CAD) software on digital chest x-rays alone (the CAD4TBv7 approach) and the use of CAD followed by a C-reactive protein (CRP) test if the CAD score was in a particular range (the CAD4TBv7-CRP approach). A confirmatory Xpert MTB/RIF Ultra test was conducted when required by the algorithm of one or both approaches. Coprimary outcomes were to establish whether the CAD4TBv7-CRP approach was non-inferior to the CAD4TBv7 approach (non-inferiority margin -10%) and to conduct a comparative cost analysis between the two approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Among 20 023 enrolled participants, the median age was 42 years (IQR 29-60); 12 387 (61·9%) participants were female, 7625 (38·1%) were male, and 11 (0·1%) were intersex. 4534 (22·6%) of 20 023 participants were living with HIV, 1547 (7·7%) had a history of tuberculosis, and 1545 (7·7%) reported at least one of the four main symptoms of tuberculosis. The primary outcome set, defined as participants who were identified as having tuberculosis according to at least one of the two approaches and had complete data for both approaches, comprised 73 participants: the CAD4TBv7 approach identified 69 (94·5%) of these cases of tuberculosis and the CAD4TBv7-CRP approach identified 60 (82·2%) cases. The difference of -12·3% (95% CI -23·0 to -1·6) indicates that the non-inferiority criterion was not met. The cost per detected case of tuberculosis was US$5454 (95% uncertainty interval 4294-6777) for the CAD4TBv7 approach and $7486 (5948-9246) for the CAD4TBv7-CRP approach, making the CAD4TBv7-CRP approach 37·3% more expensive.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;In active tuberculosis case-finding in our community setting, the combination of CAD followed by CRP testing offered no advantage over CAD alone owing to its inferior case yield and higher cost. CAD alone, however, has the potential to be an effective and economically viable tuberculosis screening strategy in areas with high disease burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":"1131-1141"},"PeriodicalIF":29.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secret histories of the HIV epidemic.","authors":"Tessa Mair","doi":"10.1016/S1473-3099(26)00438-X","DOIUrl":"10.1016/S1473-3099(26)00438-X","url":null,"abstract":"","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":"1098"},"PeriodicalIF":29.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Context matters: WHO-recommended tools in combinations validated for community tuberculosis screening.","authors":"Palwasha Khan, Katharina Kranzer","doi":"10.1016/S1473-3099(26)00234-3","DOIUrl":"10.1016/S1473-3099(26)00234-3","url":null,"abstract":"","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":"1089-1091"},"PeriodicalIF":29.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pragmatic tuberculosis trials must measure what determines implementation.","authors":"Sayoki Mfinanga, Eleni Aklillu, Alimuddin Zumla","doi":"10.1016/S1473-3099(26)00484-6","DOIUrl":"10.1016/S1473-3099(26)00484-6","url":null,"abstract":"","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":"e445-e446"},"PeriodicalIF":29.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national burden of tuberculosis and multidrug-resistant tuberculosis by HIV status, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.","authors":"","doi":"10.1016/S1473-3099(26)00295-1","DOIUrl":"10.1016/S1473-3099(26)00295-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04-10·3) incident cases of all-form TB, 1·22 million (0·98-1·49) deaths, and 54·6 million (43·8-65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000-879 000) incident cases and 210 000 (142 000-279 000) deaths, contributing 11·0 million (7·56-14·3) DALYs. MDR-TB accounted for 466 000 (198 000-1 080 000) incident cases, 102 000 (31 700-238 000) deaths, and 3·96 million (1·31-9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8-20·5) and deaths declined by 22·6% (4·7-35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000-970 000) and DALYs to 34·9 million (27·8-43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400-183 000) and DALYs to 3·12 million (1·03-7·29).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent ","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":"1106-1130"},"PeriodicalIF":29.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A fatal case of Legionella micdadei prosthetic valve endocarditis diagnosed by plasma microbial cell-free DNA metagenomic sequencing.","authors":"M Florencia Martins, Ramesh Govindan, Nouf K Almaghlouth, James E Kirby, Katherine J Kentoffio, Dimitrios Farmakiotis, Audrey Le-Mahajan","doi":"10.1016/S1473-3099(26)00223-9","DOIUrl":"10.1016/S1473-3099(26)00223-9","url":null,"abstract":"<p><p>We report a fatal case of Legionella micdadei prosthetic valve endocarditis in a patient who was immunocompromised, characterised by an indolent outpatient course followed by rapid clinical deterioration into mixed shock secondary to valve dehiscence and sepsis. The diagnosis was made by plasma microbial cell-free DNA metagenomic next-generation sequencing (mcfDNA-mNGS) and confirmed by buffered charcoal yeast extract culture of valve tissue. This case underscores the diagnostic limitations of conventional methods in culture-negative endocarditis, the evolving role of mcfDNA-mNGS in culture-negative endocarditis, and the absence of current culture-negative endocarditis guidelines addressing timely diagnosis for patients who are at risk of rapid deterioration. In this Grand Round, we briefly review the state of diagnostics for culture-negative endocarditis and the particularities of Legionella endocarditis. We also propose a framework for deciding when to consider early metagenomic testing, balancing the potential strengths of this technology with its limitations and cost.</p>","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":"e484-e493"},"PeriodicalIF":29.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying how multiple transmission routes contribute to the spread of HTLV-1 in different endemic foci: a mathematical modelling study.","authors":"Noé Ochida, Jill-Léa Ramassamy, Delia Doreen Djuicy, Sabine Plancoulaine, Augustin Mouinga-Ondémé, Chanceline Bilounga Ndongo, Richard Njouom, Toshiki Watanabe, Lloyd Einsiedel, Raphaëlle Metras, Antoine Gessain, Simon Cauchemez","doi":"10.1016/S1473-3099(26)00178-7","DOIUrl":"10.1016/S1473-3099(26)00178-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Human T-lymphotropic virus 1 (HTLV-1) infection is estimated to affect at least 5-10 million people globally and can cause adult T-cell leukaemia/lymphoma. The global distribution of HTLV-1 is characterised by endemic foci (prevalence confined to specific populations) in Japan, Africa, the Americas, the Middle East, and Oceania. Transmission occurs through vertical, sexual, bloodborne, and zoonotic routes, but their relative contributions are poorly characterised and depend on the setting. This study aims to quantify the relative contributions of vertical, sexual, bloodborne, and zoonotic transmission routes across HTLV-1 endemic foci.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following a systematic literature review, we analysed seven age-stratified and sex-stratified HTLV-1 seroprevalence surveys including nine subpopulations in French Guiana, rural Gabon, rural Cameroon, Japan (Miyazaki, Iriomote, and Ishigaki), and central Australia; Bantu and Pygmy participants in Gabon and Cameroon were considered as distinct subpopulations. We used a multiroute serocatalytic model incorporating vertical, sexual, and hospital-related (transfusion-anchored) routes of transmission in all settings, with additional non-human-primate (NHP) bite-related transmission in central Africa, and a male-specific route in central Australia. The primary outcome was the model-estimated route-specific force of infection by age, sex, and subpopulation, from which we derived the attributable fraction of infections due to each transmission route.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;The estimated vertical transmission probability, conditional on a mother with HTLV-1 infection, was 17% (95% credible interval 15-20). Sexual infection probabilities in males ranged from 0·02% to 0·68% per year, and were 1·6 times (1·4-1·8) higher in females. Hospital admission infection probability ranged from 0·05 (in central Australia) to 125 (in Miyazaki, Japan) per 100 000 hospital admissions. NHP bites in males in central Africa carried a 7% (3-13) infection probability per bite. In adults aged 25-69 years, sexual transmission accounted for 85% (79-87) and vertical transmission for 8% (7-9) of infections across populations. Hospital-related transmission contributed to around 2% of all infections in Japan (pre-HTLV-1 blood-safety measures), around 5% in Cameroonian Bantu communities, and less than 1% elsewhere. NHP bite-related transmission accounted for up to 26% of adult male infections in Cameroonian Bantu rural communities and up to 9% elsewhere in central Africa. In central Australia, most adult male infections could not be accounted for by sexual or vertical transmission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Sexual and vertical transmission dominate HTLV-1 spread, but context-specific exposures add substantial local burdens in central Africa and central Australia. These route-specific estimates support intervention prioritisation and the design of setting-specific cont","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":"1179-1189"},"PeriodicalIF":29.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}