Frontiers in epidemiology最新文献

{"title":"Low prevalence of <i>Plasmodium falciparum pfhrp</i>2 and <i>pfhrp</i>3 gene deletions in archived samples collected before and after nationwide malaria-RDT rollout in Kenya.","authors":"Martha N Kivecu, Victor Mobegi, Cavin Mgawe, Brenda M Kania, Gladys C Chemwor, Raphael O Okoth, Edwin W Mwakio, George Obiero, Jennifer M Mutisya, Jackline A Juma, Agnes C Cheruiyot, Benjamin H Opot, Amanda L Roth, Bernhards R Ogutu, Dennis W Juma, Lynette Isabella Ochola-Oyier, Ben Andagalu, Hoseah M Akala","doi":"10.3389/fepid.2026.1817539","DOIUrl":"https://doi.org/10.3389/fepid.2026.1817539","url":null,"abstract":"<p><p>Rapid and accurate malaria diagnosis is essential for effective treatment and malaria control. In Kenya, most malaria testing relies on <i>P. falciparum</i> histidine-rich protein 2 (PfHRP2)-based rapid diagnostic tests (RDTs). However, deletions in the <i>pfhrp</i>2/<i>pfhrp</i>3 genes can lead to false-negative RDT results, which can sustain transmission and worsen clinical outcomes. This study assessed the prevalence and pattern of <i>pfhrp</i>2, <i>pfhrp</i>3 and their respective flanking genes in archived samples collected before and after the nationwide rollout of PfHRP2-based RDTs in Kenya in 2012. A total of 350 archived whole-blood samples were analysed, comprising 95 pre-RDT samples (collected before the nationwide rollout of RDTs in Kenya) from 2003 to 2005 and 255 post-RDT samples (collected after the nationwide rollout of RDTs in Kenya) from 2013 to 2017 from multiple malaria-endemic regions of Kenya. Samples were first screened by quantitative Real-Time PCR to identify those with adequate parasite density for genotyping. Nested PCR assays were then used to genotype <i>pfhrp</i>2, <i>pfhrp</i>3 and their flanking genes. Where available, PfHRP2-based RDT results were compared with molecular genotyping outcomes to investigate potential causes of false-negative RDT results. The overall prevalence of single <i>pfhrp</i>2 or <i>pfhrp</i>3 deletions was low, at 0.3% (1/317) and 1.3% (4/317), respectively. All pre-RDT samples carried intact <i>pfhrp</i>2 and <i>pfhrp</i>3 genes. Among post-RDT samples, deletions were rare 0.4% (1/224) for <i>pfhrp</i>2 gene only and 1.8% (4/224) for <i>pfhrp</i>3 gene only<i>.</i> No sample exhibited a triple deletion of <i>pfhrp</i>2 and both of its flanking genes or triple deletion of <i>pfhrp</i>3 and both of its flanking genes. The sensitivity of the PfHRP2-based RDT was 89.2% (174/195). Notably, 95.2% of false-negative RDT results occurred in samples with intact <i>pfhrp</i>2 and <i>pfhrp</i>3, suggesting that low parasitemia or other factors, rather than gene deletions, were the primary cause of diagnostic failure. Overall, <i>pfhrp</i>2 and <i>pfhrp</i>3 deletions remained rare in the samples collected up to five years after the nationwide rollout of PfHRP2-RDTs in Kenya. However, continuous molecular surveillance is essential to identify emerging deletion hotspots and to ensure the sustained reliability of PfHRP2-based diagnostics as testing practices and parasites continue to evolve.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1817539"},"PeriodicalIF":2.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"β-lactam infusion strategies in critical illness: is continuous superior to extended infusion? A systematic review and network meta-analysis.","authors":"Fei Peng, Ziyi Tang, Zihan Hu, Xing Zhou, Liqin Kang, Wei Chang, Qin Sun, Jianfeng Xie, Haibo Qiu, Yi Yang","doi":"10.3389/fepid.2026.1883520","DOIUrl":"https://doi.org/10.3389/fepid.2026.1883520","url":null,"abstract":"<p><strong>Background: </strong>Prolonged β-lactam infusion is common in critical care, but whether continuous infusion (CI) improves outcomes more than extended infusion (EI) is unclear.</p><p><strong>Methods: </strong>We conducted a systematic review and random-effects Bayesian network meta-analysis of randomized controlled trials in critically ill adults comparing intravenous β-lactam administration by continuous infusion (24-hour infusion), extended infusion (≥3 h per dose), and intermittent infusion (≤1 h per dose). We searched PubMed, EMBASE, Web of Science, and the Cochrane Library from January 1, 2000, to July 25, 2025. Two reviewers independently screened records, extracted data, and assessed risk of bias. Relative risks (RRs) and mean differences (MDs) were synthesized using random-effects models. Network meta-analysis used Markov chain Monte Carlo methods in R, with complementary pairwise analyses in Stata. Certainty of evidence was assessed using GRADE for network meta-analysis.</p><p><strong>Results: </strong>Twenty-five randomized trials (<i>N</i> = 9,915) were included; no direct CI vs. EI trials were identified. Versus II, CI reduced mortality (RR 0.85, 95% CI 0.66-0.98; moderate certainty); EI had uncertain mortality effects (RR 0.80, 95% CI 0.60-1.10; low certainty). Clinical cure improved versus II for CI (RR 1.10, 95% CI 1.03-1.20) and EI (RR 1.28, 95% CI 1.07-1.55). ICU length of stay was uncertain (CI vs. II: MD -0.47 days, 95% CI -2.10-1.28; EI vs. II: MD -1.32 days, 95% CI -4.65-2.52). Indirect CI vs. EI comparisons showed no significant differences in mortality (RR 1.06, 95% CI 0.73-1.44), clinical cure (RR 0.86, 95% CI 0.70-1.05), or ICU length of stay (MD 0.86 days, 95% CI -3.32-4.54). Bayesian posterior probability analysis suggested a 93.2% probability that EI is superior to CI for clinical cure.</p><p><strong>Conclusions: </strong>CI did not demonstrate greater clinical benefit than EI. CI can reduce patient mortality, and both CI and EI appear to improve clinical cure rates compared with II. CI conferred no additional benefit over EI, suggesting that EI may be sufficient as a prolonged-infusion strategy in clinical practice. However, this finding is based on indirect evidence. The apparent advantage of EI should therefore be regarded as hypothesis-generating and requires confirmation in adequately powered head-to-head randomized controlled trials.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD42023452814, PROSPERO CRD42023452814.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1883520"},"PeriodicalIF":2.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthy vaccinee effect by study design.","authors":"Michael Günther, Harald Walach, Robert Rockenfeller, Matthias Reitzner, Christian Meyer","doi":"10.3389/fepid.2026.1837295","DOIUrl":"10.3389/fepid.2026.1837295","url":null,"abstract":"","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1837295"},"PeriodicalIF":2.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling the effects of pandemics on physiology-related fertility decline in society.","authors":"Teddy Lazebnik, Svetlana Bunimovich-Medrazitsky, Ariel Alexi","doi":"10.3389/fepid.2026.1740829","DOIUrl":"https://doi.org/10.3389/fepid.2026.1740829","url":null,"abstract":"<p><p>Pandemics throughout history have raised challenges in many forms, such as increased mortality rates, economic instability, and political shifts. Recent pandemics, coupled with globally declining fertility rates, pose unprecedented demographic challenges for humanity. A pandemic is inherently connected to a population's fertility in many ways - psychological, economic, and, most importantly, physiological. Nevertheless, this connection is mostly left unintended, blinding us to the effects of the pandemic-caused physiological fertility decline on the population's growth over time. In this study, we proposed a novel epidemiological model incorporating physiological fertility decline dynamics using an extended Susceptible-Infected-Recovered (SIR) model incorporating age groups, genders, birth and death dynamics, and infection-induced physiological fertility decline. Our model, based on real-world data from 10 large cities globally, demonstrates the impact of infection on fertility, which can persist for generations, creating demographic ripple effects that extend well beyond the immediate pandemic period. That said, the fertility drop is secondary to the pandemic spread, even for relatively high fertility decline due to the pathogen. These results have significant implications for public health policy and population planning. They highlight the need to integrate fertility considerations into pandemic preparedness strategies. Our study provides a quantitative framework for assessing the long-term demographic impacts of pandemics, offering policymakers tools to assess and potentially mitigate the impact of future disease outbreaks at the population level.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1740829"},"PeriodicalIF":2.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting disease progression under a \"treatment-naive\" counterfactual scenario in a competing risks framework.","authors":"Daniela Zugna, Nicolas Destefanis, Renata Zelic, Andreas Pettersson, Lorenzo Richiardi","doi":"10.3389/fepid.2026.1850482","DOIUrl":"10.3389/fepid.2026.1850482","url":null,"abstract":"<p><strong>Purpose: </strong>Prognostic models aim to estimate the individual risk of developing a specific health outcome based on patient characteristics and prognostic factors. A key factor affecting performance over time and across different populations is evolving treatment strategies. These shifts can alter the relationship between predictors and outcome, as well as occurrence of competing events. Counterfactual risk models may yield more reliable estimates across different time periods and treatment regimens than traditional approaches like ignoring treatment, restricting analysis to untreated patients, stratifying, or adjusting for treatment.</p><p><strong>Patients and methods: </strong>In the Turin Prostate Cancer Prognostication cohort study, which includes patients diagnosed with non-metastatic prostate cancer and followed longitudinally, the performance of Memorial Sloan Kettering Cancer Center prediction model was evaluated in predicting metastatic progression up to 5 years after diagnosis in the presence of competing mortality risk. Using the g-formula, time to the two competing events was generated under a counterfactual scenario in which no patients received prostatectomy. The performance of the MSKCC model developed in the TPCP cohort and applied to the counterfactual cohort (applied model) and the model updated under this counterfactual scenario (updated model) were compared.</p><p><strong>Results: </strong>At 5 years post-diagnosis, the updated model had an Area Under the Curve (AUC) of 0.84 (95% CI: 0.82; 0.85) and the applied model had an AUC of 0.83 (95% CI: 0.81, 0.85). The calibration slope for the updated model was 1.02 (95% CI: 0.99, 1.12) compared to 1.07 (95% CI: 0.97, 1.17) for the applied model. Calibration intercepts were 0.00 (95% CI: -0.10, 0.10) and 0.05 (95% CI: -0.04, 0.15) respectively. The predicted probabilities of the outcome of interest under counterfactual treatment strategy varied not only because of the treatment itself, but also due to its impact on competing risks.</p><p><strong>Conclusion: </strong>When a prediction model cannot be validated in a new population due to treatment shifts, counterfactual risks under hypothetical regimens can still be cautiously estimated. In particular, counterfactual modeling should be considered as a useful complementary assessment of model transportability and calibration under clinically relevant treatment scenarios.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1850482"},"PeriodicalIF":2.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with common mental disorder symptoms and lived experiences among adults with hypertension in Nepal: a mixed-methods study.","authors":"Lisasha Poudel, Binita Acharya, Bipsana Shrestha, Shreya Shrestha, Archana Shrestha, Buna Bhandari, Brandon A Kohrt, Dristy Gurung, Sauharda Rai","doi":"10.3389/fepid.2026.1769884","DOIUrl":"10.3389/fepid.2026.1769884","url":null,"abstract":"<p><strong>Background: </strong>In hypertension care, common mental disorder (CMD) symptoms such as depression and anxiety shape adherence, self-management, and outcomes. Evidence from low- and middle-income settings on factors associated with CMD symptom severity and patients' lived experiences remains limited. This study aimed to examine factors associated with depressive and anxiety symptom severity among adults with hypertension in Nepal and to explore how patients' lived experiences contextualize the quantitative findings.</p><p><strong>Methods: </strong>We conducted a community-based, explanatory sequential mixed-methods study in Budhanilkantha Municipality (Kathmandu, Nepal). Quantitatively, 327 adults with hypertension were selected via systematic random sampling. Depressive and anxiety symptom severity were measured with Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) and modeled as <b>c</b>ontinuous outcomes using linear regression in prespecified blocks (socio-demographic; health/medication; lifestyle) and a fully adjusted model. Qualitatively, we conducted in-depth interviews with 16 purposively selected participants (with and without depressive/anxiety symptoms). Transcripts were thematically analyzed and interpreted using a Biopsychosocial framework. We integrated quantitative and qualitative findings across conceptually related domains to identify areas of convergence, complementarity, and contextual elaboration.</p><p><strong>Results: </strong>In fully adjusted models, sleeping ≥6 h per day was associated with lower depressive and anxiety symptom scores. Non-high-caste group was associated with higher depressive symptom scores, whereas older age was associated with lower anxiety symptom scores. Consumption of >2 servings of fruits and vegetables per day was associated with lower depressive symptom scores. Higher household income and controlled blood pressure showed borderline inverse associations with anxiety symptom scores. Qualitatively, hypertensive patients with CMD symptoms reported persistent insomnia, bothersome medication side-effects, activity restriction, loneliness/stigma, anger/fear, low confidence, and financial strain, whereas those without symptoms described adaptation to medicines, stronger family support, and greater self-efficacy. Mixed-methods integration showed strong convergence for sleep, while qualitative findings complemented quantitative patterns related to financial burden and medication experiences and provided contextual elaboration of perceived hypertension symptoms.</p><p><strong>Discussion: </strong>Sleep duration, social position, age, diet, and socioeconomic circumstances were associated with CMD symptom severity among adults with hypertension in Nepal. The integrated findings highlight the importance of considering sleep, treatment experiences, financial circumstances, and social support within hypertension care.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1769884"},"PeriodicalIF":2.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey of self-reported varicose veins with prior clinical diagnosis among adults residing in the United Arab Emirates: a cross-sectional study examining associated factors.","authors":"Riya Inder Sevhani, Vivek Vasudevan, Diya Harish Vanjani, Prasanna Ap, Aashna Anuraag Mewada, Dhyan Ashish Shah, Kashish Doulatram Mohandas Devnani, Shahnaz Mohammad Wazil, Anusha Sreejith","doi":"10.3389/fepid.2026.1916966","DOIUrl":"10.3389/fepid.2026.1916966","url":null,"abstract":"<p><strong>Background: </strong>Varicose veins are a common manifestation of chronic venous diseases. Despite their clinical and occupational relevance, epidemiological data from the United Arab Emirates remains limited. This study estimated the prevalence of self-reported clinically-diagnosed varicose veins and examined the associated factors among adults residing in the UAE.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted across all seven emirates of the UAE between June 2025 and April 2026. A total of 1,043 eligible participants residing in the UAE were recruited through non-probability convenience sampling technique, and findings should be interpreted as preliminary and non-generalizable. The prevalence of varicose veins was estimated based on self-reported prior clinical diagnosis. Data was analyzed using SPSS (v29), associations with demographic, lifestyle, and medical factors were assessed using Pearson's chi-square tests and logistic regression models.</p><p><strong>Results: </strong>Among surveyed adults in the UAE, 15.05% self-reported a prior clinical diagnosis of varicose veins; this figure reflects the study sample only and should not be interpreted as a population-representative prevalence. Most participants correctly identified varicose veins. Advancing age, body mass index, prolonged standing, and positive family history of the disease were significantly associated with higher odds (<i>p</i> < .001).</p><p><strong>Conclusion: </strong>These findings provide preliminary, non-generalizable evidence on self-reported previously diagnosed varicose veins among the surveyed convenience sample of adults in the UAE. The condition represents a notable concern within the study population, and the results are hypothesis-generating, emphasizing the need for targeted early diagnosis among high-risk individuals, while also highlighting the need for clinically validated, probability-based population studies in the UAE.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1916966"},"PeriodicalIF":2.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate-informed surveillance for climate-sensitive infectious diseases in Somalia: early warning systems, policy gaps, and preparedness priorities.","authors":"Abdikadir Ahmed Hassan, Liibaan Abdulahi Sudi, Mohamed Daud Mohamed, Iqro Omar Ibrahim, Yakub Burhan Abdullahi","doi":"10.3389/fepid.2026.1907542","DOIUrl":"10.3389/fepid.2026.1907542","url":null,"abstract":"<p><p>Climate variability is reshaping infectious disease risk through ecological, environmental, social, and health-system pathways. However, its operational implications remain insufficiently defined in fragile and conflict-affected settings. Somalia is a critical case because recurrent droughts and floods intersect with displacement, food insecurity, weak water and sanitation infrastructure, disrupted immunisation, livestock dependence, and constrained health-system capacity. This narrative review synthesises evidence on climate-sensitive infectious disease risks in Somalia, examines existing surveillance and early warning systems, identifies policy and implementation gaps, and proposes priorities for a climate-informed surveillance-to-action model for infectious disease control. The review distinguishes directly climate-sensitive infections, including cholera, malaria, dengue, and Rift Valley fever, from indirectly climate-amplified vaccine-preventable diseases, including measles, diphtheria, and polio. While Somalia has important surveillance and early warning assets, including EWARN, IDSRS/DHIS2, FEWS NET, FSNAU intelligence, WASH monitoring, livestock signals, and community-based reporting, these streams remain insufficiently integrated into district-level risk assessment and pre-financed preparedness action. Therefore, the central challenge is not the absence of warning signals but the failure to convert them into timely, disease-specific, and accountable responses. We propose a surveillance-to-action framework based on multisource signal detection, integrated district risk assessment, disease-specific trigger decisions, early preparedness actions, and feedback, accountability, and learning. Closing Somalia's warning-to-action gap requires pre-agreed disease-specific triggers, One Health coordination, flexible anticipatory financing, strengthened district surveillance capacity, and equity-centred outreach to internally displaced persons, pastoralist and nomadic communities, zero-dose children, malnourished populations, and hard-to-reach areas. Climate-informed surveillance should be understood not merely as better data collection but as an anticipatory public health function designed to act before climate shocks become infectious disease emergencies.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1907542"},"PeriodicalIF":2.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological trends of reported syphilis incidence in Xihu district, Hangzhou, China, 2005-2025.","authors":"Jing Li, Luyang He, Tingting Wu, Jiajia Meng, Taoran Wang, Fei Sun, Bangma Wang","doi":"10.3389/fepid.2026.1944790","DOIUrl":"10.3389/fepid.2026.1944790","url":null,"abstract":"<p><strong>Background: </strong>Syphilis remains a critical global public health concern. The reported incidence of syphilis in Zhejiang Province has long stayed at a high level nationwide, with Xihu District of Hangzhou identified as a hyperendemic area for local syphilis transmission. This study used 2005-2025 surveillance data of Xihu District, Hangzhou to analyze syphilis trends for precise prevention evidence.</p><p><strong>Methods: </strong>Syphilis surveillance data (2005-2025) for Xihu District were retrieved from China's National Notifiable Infectious Disease Reporting System. We calculated crude reported incidence rate for overall, primary, secondary, tertiary, and latent syphilis (per 100,000 population), and notification rate for congenital syphilis (per 100,000 live births). Joinpoint Regression 6.0.1 identified trend inflection points and computed period-specific annual percentage change (APC) and overall average annual percentage change (AAPC) across the 21-year span.</p><p><strong>Results: </strong>Total syphilis reported incidence rate presented an inverted U-shaped trajectory: rising rapidly from 68.71/100,000 in 2005 to the peak of 155.16/100,000 in 2010, followed by sustained sharp decline down to 13.17/100,000 in 2025, with the overall AAPC = -8.18% (<i>p</i> < 0.05). Four trends phases were identified: rapid growth (2005-2008, APC = 25.23%), mild decline (2008-2019, APC = -5.00%), accelerated decline (2019-2023, APC = -18.69%), and apparent reduction (2023-2025, APC = -39.01%). Latent syphilis dominated all stages throughout the study period. Primary and secondary syphilis shared long-term descending trends (AAPC = -14.76% and -12.19%, respectively). Tertiary syphilis remained at extremely low absolute levels with sparse case counts. Congenital syphilis surged in 2006-2007 and no notified congenital syphilis cases have been recorded since 2017. Gender disparity existed: females exhibited a faster overall descending rate (AAPC = -10.23%) than males (AAPC = -5.54%). The 20-39 age group consistently bore the highest reported incidence burden, with a long-term AAPC of -10.47%; the elderly (≥60 years) also showed prominent high reported incidence before 2019 and then dropped sharply (AAPC = -9.53%).</p><p><strong>Conclusions: </strong>Syphilis control achieved substantial progress in Xihu District over two decades. Still, epidemiological challenges remain, including persistent vulnerability among young and older adults and hidden undiagnosed latent infections. Tailored interventions for high-risk groups, standardised latent-syphilis care, and sustained prevention of mother-to-child transmission are needed to lower residual disease burden.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1944790"},"PeriodicalIF":2.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor type dynamics and associated factors among blood donors in northern Ghana: a six-year retrospective analysis.","authors":"Yula Salifu, Prosper Gyebuni, Torjim Salifu, Eleonora B Wobi, Joseph Lasong","doi":"10.3389/fepid.2026.1905551","DOIUrl":"10.3389/fepid.2026.1905551","url":null,"abstract":"<p><strong>Background: </strong>Repeat blood donors have lower transfusion-transmissible infection (TTI) rates, making donor type distribution critical for blood safety. This study characterised donor type patterns, factors associated with first-time donation, and TTI prevalence differences in Northern Ghana.</p><p><strong>Methods: </strong>A retrospective cross-sectional analysis of 3,546 donor records (2017-2022) from seven health facilities in Upper West, Northern, and Oti regions. Donor type (first-time vs. repeat) was the primary outcome. Descriptive statistics, chi-square tests, and multivariable logistic regression were used. TTI prevalence, defined as positivity for at least one of HIV, HBV, HCV, or syphilis (\"any TTI\"), was compared between donor types. Significance was set at <i>α</i> = 0.05.</p><p><strong>Results: </strong>First-time donors constituted 82.0% (2,907) and repeat donors 18.0% (639). Repeat donation increased from 12.3% (2020) to 22.6% (2022). Rural donors (93.1% first-time) and non-volunteer donors (82.5% first-time) showed higher proportions of first-time donation (both <i>p</i> < 0.001). In adjusted analysis, older age (AOR 0.97 per year) and urban residence (AOR 0.69) were associated with lower odds of being first-time. The Oti region had markedly higher odds (AOR 491.65). First-time donors had significantly higher TTI prevalence: any TTI (16.06% vs. 5.48%), HBV (5.64% vs. 1.88%), HCV (2.51% vs. 0.16%), and syphilis (8.67% vs. 3.60%).</p><p><strong>Conclusions: </strong>The predominance of first-time donors (82%) and low repeat donation rates represent a blood safety vulnerability that would benefit from targeted donor retention programs, particularly in rural areas and the Oti region.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1905551"},"PeriodicalIF":2.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}