Frontiers in epidemiology最新文献

{"title":"Local thermal anomalies and the altitudinal rise of dengue hospitalisation rates in Ecuador, 2011-2024: a national ecological study.","authors":"Jaime Angamarca-Iguago, Jaen Cagua-Ordoñez, Juan Marcos Parise-Vasco, Daniel Simancas-Racines","doi":"10.3389/fepid.2026.1906738","DOIUrl":"10.3389/fepid.2026.1906738","url":null,"abstract":"<p><strong>Introduction: </strong>Dengue is expanding beyond its traditional lowland range as rising temperatures may enable <i>Aedes aegypti</i> establishment at progressively higher altitudes. Ecuador, spanning sea level to above 4500 m, offers a natural altitudinal experiment, yet hospital-based evidence on the thermal drivers of Andean dengue is lacking.</p><p><strong>Methods: </strong>We conducted a national ecological time-series analysis at the canton level using Ecuador's hospital discharge registry (INEC) for 2011-2024, the period with standardised canton coding, identifying dengue hospitalisations by ICD-10 codes A90, A91 and A97. Monthly land surface temperature, precipitation and vegetation index were derived from MODIS and GPM products. A distributed lag non-linear model estimated the temperature-hospitalisation association; a quasi-Poisson model restricted to Andean cantons (≥1500 m), with canton, calendar-month and year fixed effects, tested whether thermal anomalies above each canton's 2007-2015 baseline were associated with hospitalisation rates.</p><p><strong>Results: </strong>Among 74,601 dengue hospitalisations with a resolvable canton of residence (232 deaths; case fatality 0.31%), dengue was recorded in 68 cantons above 1500 m, including altitudes exceeding 3000 m. The national hospitalisation rate rose from 29.7 to 77.0 per 100,000 and the Andean rate approximately 7-fold (1.9 to 12.8). The minimum hospitalisation temperature was 18.4°C nationally and 18.9°C in Andean cantons. A +1°C anomaly versus zero was associated with a 1.07-fold increase in hospitalisation rates (95% CI 1.02-1.13; <i>p</i> = 0.012). Without canton fixed effects, the same contrast yielded 1.21 (1.07-1.36); the within-canton association fell to 1.04 (1.00-1.08) when the 2024 epidemic year was excluded.</p><p><strong>Discussion: </strong>Positive deviations from local historical baselines, rather than absolute temperature, were associated with rising dengue hospitalisation rates among Andean residents, by a modest margin that depends materially on the 2023-2024 epidemic. In-hospital case fatality was nearly twice as high in low Andean cantons (0.62%, 95% CI 0.20-1.45; five deaths) as on the coast (0.33%), a non-significant difference that nonetheless supports strengthening dengue recognition in highland facilities.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1906738"},"PeriodicalIF":2.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026718","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":"Adverse childhood experiences, psychological distress, and the role of locus of control.","authors":"I Behrens, B Schmalbach, E Brähler, V Clemens, K Petrowski, J M Fegert","doi":"10.3389/fepid.2026.1915843","DOIUrl":"10.3389/fepid.2026.1915843","url":null,"abstract":"<p><p>Adverse childhood experiences (ACEs), including abuse, neglect, and household dysfunction, are prevalent and represent a major risk factor for psychological distress in adulthood. Although control-related constructs such as self-efficacy, mastery, and perceived control have been widely examined in this context, the role of locus of control (LoC) remains less well understood. The present study investigated the associations between ACEs, LoC, and psychological distress, and examined whether LoC mediates or moderates the relationship between ACE exposure and psychological distress. Data were drawn from a representative survey of the German general population [<i>N</i> = 2,463; age range 16-96 years; female 1,237 female (50.2%)]. ACEs were assessed using the Adverse Childhood Experiences Questionnaire, psychological distress was measured with the Patient Health Questionnaire-4, and LoC was assessed with the Internal-External Locus of Control Short Scale-4. Structural equation modeling with robust diagonally weighted least squares estimation was applied. Higher ACE exposure significantly predicted greater psychological distress and a more external LoC orientation. Mediation analyses indicated that LoC accounted for approximately half of the association between ACE exposure and psychological distress. In contrast, moderation analyses did not reveal a significant interaction effect between ACE exposure and LoC in predicting psychological distress. These findings highlight control beliefs as an important psychological factor, linking early adversity to adult psychological distress and suggest that interventions targeting perceived control may help mitigate long-term mental health consequences of childhood adversity.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1915843"},"PeriodicalIF":2.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992826","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":"Insights on United States cumulative measles cases during the 2026 outbreak using ARIMA and generalized linear models.","authors":"Antonio Gondim, Chidozie W Chukwu, Folashade B Agusto, Joshua Ologbonyo","doi":"10.3389/fepid.2026.1921780","DOIUrl":"10.3389/fepid.2026.1921780","url":null,"abstract":"<p><p>To understand the nature of the current measles outbreaks taking place across the United States in 2026, we analyzed historical surveillance data dating back to 1997 using four distinct forecasting models. By withholding data from the first four months of 2026 for out-of-sample validation, we evaluated how well traditional trend tracking and temporal dependence could anticipate this year's trajectory. While models incorporating short-term patterns performed best overall, every single model underestimated the cumulative cases recorded by May 1, 2026. This systematic underprediction reveals that the ongoing resurgence cannot be explained merely as a continuation of past trends or 2025 outbreak effects. Instead, 2026 represents a distinct, more severe outbreak regime, as the projected annual burden was already reached by May. These findings indicate that public health tracking must adapt to this heightened risk environment, and warn that the final 2026 case burden will substantially exceed that of previous years.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1921780"},"PeriodicalIF":2.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992765","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":"Trends and forecasting of reported hepatitis B and hepatitis C incidence in Hainan Province, China, 2005-2020.","authors":"Jiao Wang, Shibing Li, Cexiong Fu, Yi Su, Hanrong Fu, Yuanyuan Tian, Cheng Lan","doi":"10.3389/fepid.2026.1899759","DOIUrl":"10.3389/fepid.2026.1899759","url":null,"abstract":"<p><strong>Objective: </strong>To assess long-term trends, seasonality, forecasts, and ecological associations with tourist visits for reported hepatitis B virus (HBV) and hepatitis C virus (HCV) incidence in Hainan Province from 2005 to 2020.</p><p><strong>Methods: </strong>Reported HBV and HCV incidence data from Hainan, national Global Burden of Disease (GBD) estimates for China, and annual tourist visit data were analyzed. Joinpoint regression assessed temporal trends, seasonal-trend decomposition using loess evaluated monthly variation, and seasonal autoregressive integrated moving average models generated forecasts. Spearman rank correlation analysis examined tourism associations, with sensitivity analyses excluding 2020 and using first-differenced and linearly detrended series.</p><p><strong>Results: </strong>Reported HBV incidence declined from 2005 to 2008, increased from 2008 to 2018, and then showed a non-significant decline through 2020; the overall average annual percent change (AAPC) was +3.37%. Reported HCV incidence increased until 2015 and subsequently declined, with an overall AAPC of +14.54%. National GBD estimates showed overall AAPCs of -0.54% for HBV and -1.52% for HCV. No significant differences among calendar months were detected. Under continuation of historical reporting patterns, the annualized projected reported HBV incidence in 2030 was 12.00 per 100,000 population (95% prediction interval: approximately 0.00-121.20), numerically close to the study-defined reference value of 12.20. The corresponding HCV estimate was 22.54 per 100,000 population (approximately 0.00-39.10), approximately 6.4 times the study-defined reference value of 3.55. The wide prediction intervals indicated substantial long-term forecast uncertainty. In 2020, observed mean monthly reported HBV and HCV incidence rates were 27.3% and 9.5% lower than forecasted values, respectively. In raw annual analyses, tourist visits correlated with reported HBV and HCV incidence <i>(r</i> = 0.871 and 0.879; both <i>P</i> < 0.001). After first differencing and linear detrending, the association remained significant only for reported HBV incidence.</p><p><strong>Conclusion: </strong>Reported HBV and HCV incidence in Hainan showed distinct phased changes without significant monthly differences. The forecasts represent projections under historical reporting patterns and should not be interpreted as evidence of progress toward WHO elimination targets. Tourism associations were exploratory and ecological and do not support causal inference. Continued surveillance and strengthened HCV screening, diagnosis, and linkage to treatment remain important.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1899759"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972583","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":"Ischemic stroke in Peru: a scoping review of trends, outcomes, and evidence gaps.","authors":"Christoper A Alarcon-Ruiz, Jesus Gutierrez-Arratia, Lessly Concha-Querevalú, Erick Barrientos-Ventura, Jacqueline Moreno-Arias, Ricardo Otiniano-Sifuentes, Rosa Ecos, Joseph R Zunt, J Jaime Miranda","doi":"10.3389/fepid.2026.1926861","DOIUrl":"10.3389/fepid.2026.1926861","url":null,"abstract":"<p><strong>Background: </strong>Peru faces a growing mismatch between the increasing burden of ischemic stroke and the health system's capacity to respond.</p><p><strong>Aim: </strong>We aimed to systematically map the primary research literature on ischemic stroke in Peru using a socio-ecological framework, characterize the current evidence base, quantify key epidemiological outcomes, and identify critical knowledge gaps to inform a national research agenda.</p><p><strong>Methods: </strong>We conducted a scoping review using the SPIDER framework and searched four databases through April 2025. We included original primary studies of Peruvian participants of any age with ischemic stroke, including observational, interventional, qualitative designs, and case reports. Study selection and data extraction were performed in duplicate. Findings were narratively synthesized across socio-ecological levels (individual, interpersonal, organizational, community, and policy/environmental). Key epidemiological outcomes were pooled using random-effects meta-analyses.</p><p><strong>Results: </strong>Of 1210 records, 119 studies were included (131,424 participants), with 75% conducted in Lima. Ischemic stroke represented 62% of all stroke cases; 44% were women. Overall mortality was 12%. Large-vessel atherosclerosis (27%) and cardioembolic (24%) were common etiologies, but undetermined causes remained the highest (30%). The pooled thrombolysis rate was 2.9%, with no reported access to mechanical thrombectomy in observational studies. Qualitative studies identified barriers to timely care, poor guideline adherence, caregiver burden, and centralization of services. Quality-improvement efforts showed limited impact. Community prevention and digital innovations were tested in small pilots without scale-up. Policy-level evaluation was scarce.</p><p><strong>Conclusion: </strong>Research regarding stroke in Peru has increased but remains geographically centralized and structurally misaligned with the national burden. Major gaps persist in diagnostic capacity, implementation research, rehabilitation, caregiver support, and policy evaluation. A nationally coordinated and regional distributed research and system-level strengthening of the stroke program are urgently needed.</p><p><strong>Systematic review registration: </strong>(https://doi.org/10.17605/OSF.IO/7WYX8).</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1926861"},"PeriodicalIF":2.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957432","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":"Evolution of health system resources and factors associated with the quality of care for epidemic-prone diseases in Guinea: a national cross-sectional study.","authors":"Dimaï Ouo Kpamy, Fatoumata Cherif, Sory Conde, Fodé Amara Traore, Sidikiba Sidibe, Bassirou Diarra, Peter John Winch, Abdoulaye Toure, Sakoba Keita, Seydou Doumbia, Alexandre Delamou","doi":"10.3389/fepid.2026.1818264","DOIUrl":"10.3389/fepid.2026.1818264","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe the evolution of resources for the management of epidemic-prone diseases and to identify the factors associated with the quality of care for epidemic-prone diseases in Guinea.</p><p><strong>Methods: </strong>A descriptive and analytical cross-sectional study was conducted to assess the management system for epidemic-prone diseases in Guinea. Data were collected using structured questionnaires and supplemented by a review of official documents to assess the evolution of resources before, during, and after the 2014-2016 Ebola virus disease outbreak. Factors associated with the quality of care were identified using multivariable logistic regression analysis.</p><p><strong>Results: </strong>The evolution of resources varied across the different health regions. At the national level, the overall resource score increased from 12% before the Ebola outbreak to 73% during the outbreak and reached 77% in the post-Ebola period. Overall, the quality of care was rated as good in 60.5% of health facilities. Five factors were independently associated with good-quality care: the presence of a patient diagnostic mechanism (aOR = 3.17; 95% CI: 1.74-5.57; <i>p</i> < 0.001), the availability of treatment protocols (aOR = 2.42; 95% CI: 1.27-4.61; <i>p</i> = 0.007), the existence of patient isolation facilities (aOR = 4.76; 95% CI: 1.72-13.17; <i>p</i> = 0.003), effective coordination of case management (aOR = 3.04; 95% CI: 1.10-8.39; <i>p</i> = 0.031), and the availability of dedicated case management teams (aOR = 8.51; 95% CI: 4.07-17.76; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>This study highlights a substantial improvement in the resources allocated to the management of epidemic-prone diseases in Guinea following the Ebola virus disease outbreak, reflecting strengthened health system capacity for epidemic preparedness and response. However, sustaining these gains will require continued investment, particularly in health system financing. Strengthening diagnostic capacity, ensuring the availability of standardized treatment protocols, expanding patient isolation facilities, improving coordination mechanisms, and maintaining specialized case management teams should remain strategic priorities to enhance the quality of care and strengthen the resilience of the health system against future epidemics.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1818264"},"PeriodicalIF":2.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957378","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":"Bayesian Youden index for algorithmic evaluation under class imbalance: mathematical foundations with applications to insulin resistance and diabetes progression.","authors":"Aquiles Darghan, Ariel Iván Ruiz-Parra, Jorge Eduardo Caminos, Nair González, Kevin Darghan, Sofia Alexandra Caminos Cepada","doi":"10.3389/fepid.2026.1839151","DOIUrl":"10.3389/fepid.2026.1839151","url":null,"abstract":"<p><strong>Background: </strong>The evaluation of binary classifiers under real-world conditions requires metrics that account for the dependence of predictive performance on disease prevalence. Classical accuracy metrics, including the Youden index, condition on the true class and remain invariant to changes in class distribution, making them unable to reflect the practical question of whether a positive classification is trustworthy in a given deployment context.</p><p><strong>Methods: </strong>The Bayesian Youden Index is derived analytically as a prevalence-dependent extension of the classical Youden index, grounded in the equivalence between Bayesian and classical sensitivity and specificity. Its behavior is characterized across the full prevalence range, and uncertainty in all point estimates is quantified through parametric bootstrap with B = 2,000 replications. The framework is illustrated using HOMA-IR for insulin resistance detection (<i>n</i> = 93) and is applicable to any binary classification task with a known confusion matrix and operational prevalence.</p><p><strong>Results: </strong>The Bayesian Youden Index reaches a maximum of 0.913 (95% CI:0.823,0.997) at a prevalence of 0.334 (95% CI:0.027,0.575), compared to the constant classical value of 0.890 (95% CI:0.782,0.978). At the observed prevalence of 0.484 the Bayesian value is 0.898. Two intersection points were identified at which the Bayesian and classical formulations coincide: <math><msub><mi>P</mi> <mn>1</mn></msub> <mo>=</mo> <mn>0.190</mn></math> (95% CI:0.118,0.542) and <math><msub><mi>P</mi> <mn>2</mn></msub> <mo>=</mo> <mn>0518</mn></math> (95% CI:0.504,0.652), defining three distinct prevalence regimes with different implications for classifier deployment. The index exhibits asymmetric behavior across the prevalence range, showing that a classifier's inherent sensitivity-specificity profile can be strategically leveraged through prevalence-aware threshold selection to manage class imbalance without resorting to artificial balancing techniques.</p><p><strong>Conclusions: </strong>The Bayesian Youden Index positions itself not merely as a measure of statistical fit but as a robust calibration tool that decomposes overall classifier performance into predictive confidence under realistic prevalence conditions. The findings caution against prematurely discarding results from imbalanced datasets or automatically applying balancing methods, advocating instead for a nuanced analysis in which imbalance, mediated by classifier characteristics, can sometimes enhance rather than hinder evaluated performance.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1839151"},"PeriodicalIF":2.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922146","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":"Neutrophil-to-lymphocyte ratio for the clinical management of dengue: a systematic review and meta-analysis.","authors":"Miguel Cabanillas-Lazo, Ivan Alegre-Cordero, Leonardo D Mera-Lojano, Gerardo Luna-Peralta, Claudia Cruzalegui-Bazan, Patricio Castro-Suárez, Carlos Quispe-Vicuña, Frank Mayta-Tovalino","doi":"10.3389/fepid.2026.1877646","DOIUrl":"10.3389/fepid.2026.1877646","url":null,"abstract":"<p><strong>Introduction: </strong>Dengue fever (DF) remains a major global public health concern, especially in tropical and low-resource settings. The neutrophil-to-lymphocyte ratio (NLR) has been proposed as an accessible biomarker for diagnosis and severity assessment, but the existing evidence is heterogeneous. To summarize the current evidence on the behavior of the NLR in DF.</p><p><strong>Methods: </strong>This study conducted a systematic search in five databases for observational studies published until April 2024. Inclusion and exclusion criteria were based on predefined eligibility criteria, and quality and methodological assessment were expressed using the Newcastle-Ottawa Scale. Data was pooled using a random-effects model and results generalized as applicable, when pooling could not be carried out. A summary receiver operating characteristic curve (sROC) was obtained to assess the diagnostic accuracy of NLR for distinguishing DF from COVID-19. The certainty of evidence was graded using the GRADE system.</p><p><strong>Result: </strong>A total of 6,166 participants from 15 observational studies were included, all with low risk of bias. A single study showed a higher NLR in dengue vs. healthy controls (Bhattarai, 2023; MD: 1.29; 95% CI: 0.87 to 1.71), with moderate certainty. The SROC curve for dengue vs. COVID-19 (2 studies, <i>n</i> = 226) showed sensitivity and specificity of 83.9% and an AUC of 0.907, indicating high diagnostic accuracy, with moderate certainty.</p><p><strong>Conclusion: </strong>For prognosis, severe dengue showed a small, but significant NLR decrease compared with dengue with warning signs (MD: -0.54; 95% CI: -0.91 to -0.17, I2 = 0%), with very low certainty. NLR may serve as a supportive diagnostic biomarker for dengue. However, its prognostic value remains uncertain, highlighting the need for large, prospective studies to validate cutoff points and clinical utility.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1877646"},"PeriodicalIF":2.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921263","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":"Association between infant post-natal prophylaxis regimens and pretreatment HIV drug resistance in infected infants.","authors":"Seth C Inzaule, Leonard Kingwara, Alani Sulaimon Akanmu, Raph L Hamers, Michael R Jordan, Amalia Girón-Callejas, Rukia S Madada, Lilly Nyagah, Vera Onwonga, Martina Penazzato, Silvia Bertagnolio, Ajay Rangaraj, Kamene Kimenye, Tobias F Rinke de Wit, Andrew Mula","doi":"10.3389/fepid.2026.1887821","DOIUrl":"10.3389/fepid.2026.1887821","url":null,"abstract":"<p><strong>Background: </strong>Antiretroviral drugs for preventing mother-to-child transmission (PMTCT) can lead to NRTI resistance in infants who contract HIV despite prophylaxis. We aimed to assess how different post-natal prophylaxis (PNP) strategies; nevirapine (NVP) alone vs zidovudine (ZDV) alone vs dual NVP + ZDV influenced NRTI resistance prevalence.</p><p><strong>Methods: </strong>We analyzed data from nationally representative HIV drug resistance surveys conducted in Kenya where the standard practice was the use of dual NVP + ZDV and Nigeria where the standard practice was the use of NVP PNP. HIV drug resistance was determined using population-based sequencing, and mutations interpreted using the Stanford HIVdb algorithm. Analyses were weighted for multistage sampling and genotyping success rates.</p><p><strong>Results: </strong>Among 557 HIV-infected infants aged <18 months with data on resistance and type of PNP, 29.3% received dual NVP + ZDV PNP, 24.6% received NVP alone, 2.3% received ZDV alone, and 43.8% received no PNP. The prevalence of NRTI resistance was 19.4% (95%CI 15.2-24.3) in Nigeria and 9.6% (95%CI 6.6-13.8) in Kenya (<i>p</i> < 0.001). Resistance to abacavir, lamivudine, zidovudine and tenofovir were 2- to 4.5-fold higher in Nigerian HIV infected infants exposed to NVP PNP compared to Kenyan infants exposed to NVP + ZDV. The proportion of infants with NNRTI resistance was 49% (95%CI 43.5-54.5) and 43.8% (95%CI 38.0-49.7), in Nigeria and Kenya respectively (<i>p</i> = 0.204).</p><p><strong>Conclusions: </strong>These findings suggest an association between type of PNP and the development of NRTI resistance in HIV-infected infants. Dual-drug prophylaxis was associated with a low prevalence of NRTI resistance compared to single-drug PNP. Our findings highlight the need for further research on combination prophylactic strategies in minimizing the emergence of drug resistance in this population.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1887821"},"PeriodicalIF":2.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922126","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":"Last mile at the center of immunization delivery.","authors":"Grace Umutesi, Sara Rendell, Ruanne V Barnabas","doi":"10.3389/fepid.2026.1913390","DOIUrl":"10.3389/fepid.2026.1913390","url":null,"abstract":"<p><p>While advances in immunization led to major reductions in vaccine-preventable diseases in the past four decades, large gaps remain in the delivery of immunization services. In this perspective, we use illustrative examples to discuss gaps in global immunization and outline opportunities for evidence generation and intervention design to transform the last mile delivery of immunization services in global health. To address last mile gaps, technical limitations in global health surveillance infrastructure that result in imprecise estimates and overlapping obstacles that complicate immunization service delivery for selected groups need to be addressed. Additionally, leveraging pro-equity strategies from the community level to the global level and across phases of translational health research could accelerate the equitable impact of immunization innovations on population health outcomes.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1913390"},"PeriodicalIF":2.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914673","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}