PLOS Neglected Tropical Diseases: New Articles

Post-market surveillance of albendazole tablet brands in Kenya: Implications for deworming programs and clinical outcomes

2026-06-16T14:00:00Z

by Ezra Kiprono Yator, Peter Mbugua Njogu

Background

Albendazole is a broad-spectrum anthelminthic extensively used in clinical settings and national deworming programs. It is the cornerstone of the preventive chemotherapy for soil-transmitted helminthiases prevalent in low-resource settings. The high proliferation of albendazole generic products, with poor post-market surveillance capacity in the low- and middle-income countries, poses dire risk of substandard and falsified medicines, which may predispose patients to treatment failures, adverse drug reactions, morbidity, and mortality, with consequent loss of public confidence in healthcare systems.

Objective

This study aimed to determine the quality and pharmaceutical equivalence of albendazole 400 mg tablet brands marketed in Nairobi, Kenya.

Experimental

A cross-sectional analytical study was conducted on seven albendazole 400 mg tablet brands purchased from pharmacy outlets in Nairobi. Tests for identity, friability, hardness, disintegration, assay, uniformity of weight, and dissolution were conducted as specified in the United States, British and International Pharmacopoeias. Dissolution profiles of generic albendazole tablet brands and the innovator brand (Zentel) were compared using model independent fit factors f₁ and f₂, and the dissolution efficiency (DE). Data was captured and analyzed using Microsoft Excel 2021, and reported as means, relative standard deviations, and percentages.

Results

All the seven albendazole 400 mg tablet brands complied with compendial specifications for identity, friability, hardness, assay, and uniformity of weight. However, two brands (EK5 and EK6) did not comply with the disintegration test and consequently demonstrated extremely poor dissolution, having released <6% of labelled albendazole content at 60 minutes with DE < 5%. Only two brands (EK4 and EK2) exhibited dissolution profiles that approximated the innovator brand (f2 > 50, f1 < 10) and could be used interchangeably, while the other two (EK3 and EK7) had intermediate drug release.

Conclusion

While all tested albendazole 400 mg tablet brands complied with basic pharmacopoeial specifications for quality, dissolution testing revealed significant nonequivalence, with only three (42.86%) of the seven brands being pharmaceutically equivalent. Poor dissolution of majority (57.14%) of albendazole tablet brands portends therapeutic insufficiency and development of drug resistance, reinforcing the need for stringent post-market surveillance to safeguard public health.

Epidemiology, seroprevalence, and circulation of Chikungunya virus in Southern Africa (SADC region): A systematic review

2026-06-16T14:00:00Z

by Siphamandla Lamula, Ndivhuwo Ramatsitsi, Lisa Buwa-Komoreng

Chikungunya virus (CHIKV) is an emerging arbovirus that causes major morbidity in tropical regions, but its epidemiology in Southern Africa is poorly defined. This study compiles research on CHIKV circulation, clinical characteristics, and surveillance strategies in the region, specifically in the Southern African Developing Community (SADC) block. A systematic search of peer-reviewed publications published between January 2012 and October 2025 that reported CHIKV detection, seroprevalence, or clinical symptoms in eight Southern African countries was conducted. Eligible studies included human studies, outbreak investigations, population-based surveys, diagnostic evaluations, and case reports. Whilst, zoonotic studies, animal studies, letters to editors, comments, and studies not clearly define in terms of country, number participants and method of investigation were considered ineligible. Twenty studies met inclusion criteria, representing data from Madagascar, Mozambique, the Democratic Republic of the Congo (DRC), Angola, Tanzania, Malawi, South Africa (SA), and Mauritius. CHIKV circulation was confirmed in both urban and rural settings, often co-occurring with dengue, Zika, and Rift Valley fever viruses. Seroprevalence estimates varied widely, from sporadic detection in Angola to sustained immunoglobulin G (IgG) positivity in Madagascar and Tanzania, indicating ongoing endemic transmission. Women of reproductive and working age were disproportionately affected. Clinical presentations were dominated by acute febrile illness with arthralgia, though severe neurological outcomes and long-term rheumatologic sequelae were reported. Diagnostic practices relied primarily on serology, with molecular confirmation limited to outbreak contexts. Vector surveillance detected CHIKV in mosquitoes even in the absence of human cases. CHIKV is a common virus in Southern Africa that is not well known. Effective response and early detection depend on strengthened integrated surveillance that combines entomological, molecular, and serological approaches. The findings highlight the necessity of investigating the long-term effects of Chikungunya infection and conducting coordinated regional monitoring.

Retraction: Effectiveness of carbon dioxide cryotherapy for the treatment of cutaneous leishmaniasis: Systematic review and meta-analysis

2026-06-16T14:00:00Z

by The PLOS Neglected Tropical Diseases Editors

Comparison of a recombinant endonuclease III protein and its synthetic peptides in ELISA for the diagnosis of tegumentary leishmaniasis using human serum and urine samples: A preliminary study

2026-06-15T14:00:00Z

by Raquel S. B. Câmara, Dóris M. Abrão, Daniela P. Lage, Camila S. Freitas, Ana L. Silva, Mariana M. Cardoso, Nathália C. Galvani, Maíza M. Rodrigues, Breno L. Pimenta, Bárbara P. N. Assis, Ana T. Chaves, Unaí Tupinambás, Manoel O. da Costa Rocha, Miguel A. Chávez-Fumagalli, Ricardo A. Machado-de-Ávila, Denise U. Gonçalves, Isabela A. G. Pereira, Eduardo A. F. Coelho, Myron Christodoulides

Background

The laboratory diagnosis of ‌‌tegumentary leishmaniasis (TL) remains challenging, mainly because of the variable sensitivity and specificity of tests used. Moreover, biological samples are typically collected through invasive procedures. In this pilot study, the recombinant Leishmania endonuclease III (rENDO) protein and two specific B-cell epitopes predicted from its amino acid sequence were evaluated as diagnostic antigens for TL, by using paired serum and urine samples from patients.

Methodology/Principal findings

rENDO protein, two synthetic peptides and a Soluble Leishmania Antigen (SLA) extract as comparator, were used to develop an ELISA that was tested with a controlled panel of paired urine and serum samples from 175 patients. Results showed that the serum-based ELISA reported sensitivity of 100% for rENDO, Peptide 1, and Peptide 2, and of 85.0% for SLA. Specificity values were of 100%, 100% and 96.6% for the protein and peptides, and 67.3% for SLA, respectively. For the urine-based ELISA, sensitivity was also of 100% for rENDO, Peptide 1, and Peptide 2, and of 90.6% for SLA. Specificity values were 100%, 100% and 96.5%, for the protein and peptides, and 91.5% for SLA, respectively. The antibody response was compared with a commercial kit, and results showed a kappa index higher than 0.90 for rENDO using both serum and urine samples, whereas the kit showed values below 0.80. Additionally, a one-point longitudinal study for antibody response monitoring in treated ML patients revealed a drop in rENDO-specific IgG levels of nearly 50% after six months.

Conclusions

Preliminary data suggest that the ELISA using rENDO and its derived peptides demonstrated good sensitivity and specificity for identifying TL cases, and the rENDO-based assay could potentially have a role in monitoring the treatment of TL patients.

Molecular evidence of Echinococcus canadensis (G6/G7) predominance in Mongolian livestock and its implications for control

2026-06-15T14:00:00Z

by Bolor Bold, Peter S. Andrus, Chimedtseren Bayasgalan, Davaasuren Nergui, Battsetseg Badmaa, Yilin Cao, Xuan Su, Xiaojin Mo, Nyamdavaa Guugandaa, Ning Xiao, Ting Zhang, Xiao-Nong Zhou

Background

Cystic echinococcosis (CE), caused by Echinococcus granulosus sensu lato (E. granulosus s.l.), is a major zoonotic disease causing substantial health and economic losses, particularly in pastoral communities. WHO and WOAH recommend combining regular dog deworming with sheep vaccination (EG95) for control. However, genotype data are important for vaccination planning, as EG95 mainly targets G1/G3 in sheep and evidence of protection against other genotypes is limited. In Mongolia, molecular data from livestock, especially sheep, remain scarce despite the large sheep population. We therefore aimed to determine the genotype distribution of E. granulosus s.l. among livestock, particularly sheep, across Mongolia’s endemic provinces.

Methods

From August to December 2024, we conducted an abattoir-based cross-sectional survey in four provinces (Umnugobi, Bayankhongor, Dundgobi, and Tuv). Sheep, goats, and camels were examined for hydatid cysts. DNA was extracted, the COX1 gene was amplified by PCR and sequenced using the Sanger method, and published diagnostic COX1 sites were used to refine G6/G7 assignments; phylogenetic and haplotype analyses were performed with regional reference data.

Results

Cysts were detected in 2.5% (115/4,578) of animals, and 0.31% (14/4,578) were molecularly confirmed as E. granulosus s.l. Among them, 93% (13/14; 10 sheep, 2 goats, 1 camel) were Echinococcus canadensis (G6/G7) and 7% (1/14; 1 sheep) were Echinococcus granulosus s.s. (G1/G3). Five COX1 haplotypes were identified: four E. canadensis haplotypes (H1–H4) and one E. granulosus s.s. haplotype (H5). Haplotypes H1–H3 were consistent with G6, whereas H4 was consistent with G7a. These haplotypes grouped with reference isolates from Mongolia and neighbouring countries, as well as from other endemic regions included in the network.

Conclusions

This study strengthens evidence that E. granulosus s.l. infections in Mongolian livestock are predominantly caused by Echinococcus canadensis G6/G7 and shows, for the first time, that this taxon predominated among successfully genotyped isolates from sheep in the surveyed areas. These findings support genotype-informed surveillance for vaccination planning, particularly in mixed-genotype settings, while underscoring the importance of dog deworming and safe offal disposal. Our findings further clarify CE transmission patterns in Mongolia and the wider region, highlight the transboundary nature of CE, and support the need for coordinated cross-border surveillance and control.

Giardiasis in Japan, the United States of America, and Europe from 2007 to 2023, highlighting a decline during the COVID-19 pandemic

2026-06-15T14:00:00Z

by Hirotake Mori, Ryoko Makuuchi, Daria Krokva, Dmytro Remez, Rapeepun Prasertbun, Yoshiro Hadano, Supaluk Popruk, Aongart Mahittikorn, Rapeephan R. Maude, Dhammika Leshan Wannigama, Raita Tamaki, Gautam A. Deshpande, Roger Frutos, Chris Smith, Toshio Naito

Background

Giardiasis is one of the most common enteric protozoal infections worldwide. It is frequently reported as an enteric parasitic infection in the United States of America (USA) and Europe, whereas reported incidence in Japan is substantially lower. This study characterized age-specific, geographic, and temporal patterns of reported giardiasis incidence in Japan, the USA, and Europe using publicly available surveillance data.

Methodology/principal findings

This retrospective study analyzed surveillance data from the National Institute of Infectious Diseases (NIID) in Japan, the Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC) to describe epidemiological patterns, possible explanatory factors, and temporal trends before and during the COVID-19 pandemic. Annual trends were examined using all available surveillance years: 2007–2023 for Japan and Europe and 2007–2022 for the USA. Age-specific patterns were compared between the pre-pandemic (2017–2019) and pandemic (2020–2022) periods, and geographic patterns were examined using available regional data. Incidence rates in the USA and Europe were approximately 5 per 100,000 population, whereas reported incidence in Japan remained below 0.1 per 100,000. Age-specific patterns differed: incidence peaked in children aged 0–14 years in Europe, and in children aged 0–4 years and adults aged 25–39 years in the USA, whereas in Japan, incidence was highest among adults aged 25–44 years and relatively high among those aged ≥65 years. Geographic patterns also differed, with higher incidence in Tokyo, Nordic and Baltic countries and selected European countries, and New England and Midwestern states. Annual incidence was significantly lower in the COVID-19-onset period than in the pre-COVID-19 period across all regions.

Conclusions/significance

These findings suggest that exposure patterns and possible explanatory factors differ by region and age group, highlighting the importance of region- and age-specific prevention strategies.

Systematic review and meta-analysis of insecticide resistance status and mechanisms in the arbovirus vector Aedes aegypti from Nigeria

2026-06-15T14:00:00Z

by Aisha Kabir Mohammed, Maryam Abdulakadir Dangambo, Aliyu Muhammad, Adamu Jibrin Alhassan

Background

Arboviruses including dengue, Zika, and chikungunya pose a growing health threat in Nigeria, where Aedes aegypti is the main vector. Insecticide-based control is increasingly undermined by resistance. Although individual studies have reported resistance, no systematic review has synthesized these findings. This study assessed the prevalence, distribution, and mechanisms of insecticide resistance in Nigerian Aedes populations.

Methodology

We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines, with protocol registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/CTUH8). Searches across PubMed, Scopus, Web of Science, Google Scholar, AJOL, and VectorBase identified studies from Nigeria. Eligible studies examined field-collected Aedes aegypti populations for insecticide susceptibility via WHO bioassays or resistance mechanisms such as kdr mutations and metabolic enzyme activity. Data were pooled using random-effects models, with heterogeneity assessed by I² and Cochran’s Q. Nine studies published between 2015 and 2025 met inclusion criteria.

Results

Pooled estimates showed entrenched resistance to pyrethroids (75.6%, 95% CI: 40.5–93.4) and DDT (28.0%, 95% CI: 6.6–68.3), consistently below WHO thresholds. Carbamates displayed variable susceptibility (91.1%, 95% CI: 22.6–99.7), ranging from full susceptibility in Abia to resistance in Kogi. Organophosphates had the highest pooled mortality (98.3%, 95% CI: 96.8–99.1), though emerging resistance was reported in several states. Mechanistic evidence implicated frequent F1534C kdr mutations and elevated detoxification enzyme activity.

Conclusion

This review confirms widespread insecticide resistance in Ae. aegypti across Nigeria, especially to pyrethroids and DDT, with regional variation in carbamate susceptibility and emerging organophosphate resistance. The findings emphasize the urgent need for adaptive vector control strategies, expanded surveillance in northern regions, and integration of genomic tools to better characterize resistance mechanisms. Nigeria’s resistance profile mirrors challenges faced in many low- and middle-income countries, reinforcing the global imperative to strengthen monitoring systems and sustain effective arbovirus vector control.

Shared risk factors for malaria and schistosomiasis co-infection: A systematic review and meta-analysis

2026-06-15T14:00:00Z

by Max M. Lang, Bethany Lyne, Christl A. Donnelly, Goylette F. Chami

Background

Malaria and schistosomiasis are co-endemic across sub-Saharan Africa, where both diseases often co-occur, yet the shared risk factors for co-infection remain poorly synthesized.

Methods

We conducted a systematic review and meta-analysis to identify shared risk factors for malaria-Schistosoma co-infection and to narratively synthesize the statistical methodologies applied in the literature. We searched PubMed/MEDLINE, Embase, Web of Science, Global Index Medicus, and Global Health from inception to February 19, 2025 (PROSPERO CRD420250648824). We pooled effect sizes for risk factors across sociodemographic, environmental, and behavioral dimensions. Fixed-effects meta-analysis with inverse variance weighting was used to calculate pooled Odds Ratios (OR) and 95% confidence intervals (CIs). Study quality was assessed using a modified version of the Quality Assessment tool for Observational Cohort and Cross-Sectional Studies by the National Institutes of Health.

Results

We screened 1,345 records and included 30 studies conducted across 12 African countries. A meta-analysis of 23 studies showed that schistosomiasis infection was associated with 1.27 times higher odds of malaria (OR 1.27; 95% CI: 1.17–1.39). Narrative synthesis identified age as an important predictor, with risk consistently peaking in older children and adolescents (typically 8–17 years). Associations with sex were setting-dependent: males had significantly higher odds of co-infection in community-based studies (OR 2.08; 95% CI: 1.64–2.63), whereas no significant association was found in school-based studies (OR 0.87; 95% CI: 0.64–1.19). Direct water contact was strongly associated with co-infection (OR 2.53; 95% CI: 1.60–4.00). Heterogeneity was high (I² > 80%), warranting caution during interpretation. Only one study was categorized as high risk of bias.

Conclusion

The association between malaria and schistosomiasis appears to be associated with overlapping environmental and behavioral exposures, specifically water contact in older children.

Experiences and perceptions on diagnostic delay of leprosy by affected people in Colombia: A qualitative study

2026-06-11T14:00:00Z

by Heleen Neeltje Willemijn Duighuisen, Daniel Gonzalo Eslava Albarracin, Anil Fastenau, Nimer Ortuño-Gutiérrez, Srilekha Penna, Alena Kamenshchikova

Leprosy, also known as Hansen’s disease, is an infectious neglected tropical disease that requires a timely diagnosis and onset of multi-drug therapy to cure, halt transmission and prevent irreversible disabilities. Although Colombia shows a relatively low incidence of leprosy, the disease remains endemic in certain parts of the country. In addition, high rates of leprosy-related disability are observed due to diagnostic delay. Patients’ experiential knowledge and expertise are crucial to further understand the reasoning behind this delay in diagnosis. Therefore, our study aimed to explore the experiences and perceptions of people affected by leprosy with diagnostic delays in the departments Cesar and Valle del Cauca in Colombia where the disease is endemic. We conducted 24 semi-structured in-depth interviews with people affected by leprosy in Colombia and used thematic analysis to analyse the interview results. Based on our analysis, we mapped out the patient pathway towards diagnosis and treatment, and highlighted the individual-level, community-level, and health system-level challenges leading to potential delays. Main reasons for delay included perceived limited leprosy training and expertise among healthcare workers, challenges related to the organisation of leprosy care, accessibility and affordability barriers, limited awareness about leprosy and stigmatisation of people diagnosed with leprosy. A multifactorial approach to leprosy diagnostic delay is necessary to tackle current challenges, including investing in integral leprosy care centres and prioritising active case detection. Implementing leprosy awareness strategies among healthcare workers and communities are necessary to tackle the stigmatisation of the disease and improve overall leprosy knowledge and expertise.

Editorial Note: Multispacer Sequence Typing Relapsing Fever Borreliae in Africa

2026-06-10T14:00:00Z

by The PLOS Neglected Tropical Diseases Editors

Editorial note: multiplex real-time PCR diagnostic of relapsing fevers in Africa

2026-06-10T14:00:00Z

by The PLOS Neglected Tropical Diseases Editors

Prevalence of hookworm infection and its proportion among pregnant women with intestinal helminth infection in Ethiopia: A systematic review and meta-analysis

2026-06-10T14:00:00Z

by Mengistie Kassahun Tariku, Gezahegn Eshetu Mekuriya, Habtamu Wagnew Abuhay, Lidetu Demoze, Gedefaw Abeje, Mekuriaw Nibret Aweke, Habtamu Abebe Getahun, Samuel Teferi Chanie, Gelila Yitageasu, Gebrie Getu Alemu, Asebe Hagos

Background

Hookworms are the most common soil-transmitted helminths in tropical and subtropical regions. Although infection with hookworms is a principal cause of maternal anemia, there is limited consolidated evidence on pooled prevalence and its proportion among intestinal helminths infections in pregnant women in Ethiopia. This study aimed to estimate the pooled prevalence of infection with hookworms and its proportion among intestinal helminths in pregnant women in Ethiopia.

Methods

A systematic review and meta-analysis were conducted following the PRISMA guidelines. Articles published between 2010 and 2024 were retrieved from databases including PubMed, Google Scholar, ScienceDirect, and African Journals Online using relevant search terms related to Ethiopia. Data extraction was performed using a standardized Excel spreadsheet after assessing the quality of the studies with the Newcastle-Ottawa Scale. Data were analyzed using STATA version 17. A random-effects model using the DerSimonian–Laird method was employed to account for heterogeneity, which was assessed using the I² statistic and the p-value of Cochrane’s Q test. Publication bias was evaluated using funnel plots, Begg’s, and Egger’s tests. Results were presented using forest plots with 95% confidence intervals (CIs).

Results

A total of 33 studies, including 13367 pregnant women were analysed. Among these 4161 women infected with intestinal Helminthiases, including 1853 cases of infection with hookworms. The pooled prevalence of infection with hookworms among pregnant women in Ethiopia was 12.21% (95% CI: 9.46%–14.95%), while the pooled proportion of hookworms among intestinal helminths was 44.0% (95% CI: 33.24%–55.75%). Regionally, prevalence was highest in Amhara (13.11%, 95% CI: 9.17%–17.05%) and the lowest in Gambella (4.44%, 95% CI: 2.32%–6.57%). The proportion was highest in Amhara (67.86%, 95% CI: 57.87%–77.84%) and lowest in Harerge (16.67%, 95% CI: 9.21%–24.12%). By diagnostic method, the concentration technique yielded the highest prevalence (16.11%, 95% CI: 9.31%–22.90%), while combined methods showed the lowest (9.48%, 95% CI: 6.14%–12.83%).

Conclusion

Infection with hookworms remains a public health concern among pregnant women in Ethiopia (pooled prevalence: 12.21%), accounting for 44.0% of intestinal helminths. Marked regional variation exists, highest in Amhara and lowest in Gambella. Prevalence estimates varied by diagnostic method, with higher values from concentration techniques. Targeted interventions, improved sanitation, deworming, and standardized diagnostics are needed.

Identification of a persistent Ascaris-derived Kalirin epitope associated with chronic T cell activation in the lung

2026-06-09T14:00:00Z

by Yifan Wu, Leroy Versteeg, Meng-Chih Wu, Jill E. Weatherhead

Ascariasis remains a dominant global health burden due to its vast prevalence and associated morbidity. The obligatory migration of Ascaris larvae through pulmonary tissue triggers intense type-2 inflammation which typically presents as acute allergic airway disease. Even after the parasite is eliminated, a single episode of larval migration can result in chronic lung damage and dysfunction, which may be driven by the long-term retention of helminth antigens in macrophages. However, the molecular identity of these retained antigens, and the mechanisms by which they sustain chronic T cell responses, remain unknown. In this study, we utilized immunopeptidomics to identify a retained peptide specific from Ascaris that is sequestered and presented by pulmonary macrophages via MHC-II. We further demonstrated that this retained peptide serves as an epitope which is associated with the development of specific T helper cell populations that persist long after the infection has cleared. These findings define a potential molecular mechanism for persistent helminth-induced immune cell activiation in the lungs and identify a retained epitope as a potential contributor to the development of chronic pulmonary inflammation following parasite elimination from the lungs.

Correction: Identification of Leishmania spp. and Trypanosoma cruzi in bats captured in El Paso County, Texas

2026-06-09T14:00:00Z

by Juan C. Silva-Espinoza, Priscila S. G. Farani, Edith Sandoval, Maria Fernanda Lopez, Felipe Rodriguez, Kenneth A. Waldrup, Delfina C. Domínguez, Rosa A. Maldonado

Predictive Modeling of Localized Mobile App to Improve Snakebite Management in Ghana

2026-06-08T14:00:00Z

by Eric Nyarko, Aashna Uppal, Nicholas Amani Hamman, Louis Agyekum, Pascal Antwi, Nuhu Mohammed, Obu-Amoah Ampomah, Iddrisu Abugbil Atubiga, Trudie Lang

Background

Snakebite envenoming (SBE) is a significant yet often overlooked public health crisis that primarily affects impoverished communities. Mobile applications (apps) can be effective tools for managing snakebites. To meet the World Health Organization’s (WHO) goal of reducing SBE by 50% by 2030, app developers must consider regional users’ preferences to ensure their apps provide relevant and accurate information. This study predicted the importance of various functionalities of a mobile app for managing snakebites based on user preferences. Our objective was to provide quantitative evidence on which functions should be prioritized to inform the development of a customized local app to enhance snakebite care in Ghana.

Methods

A cross-sectional survey using a quantitative statistical experiment design method was conducted to identify healthcare workers’ preferences for vital mobile app functions for managing snakebites. Participants were selected from two deprived and predominantly rural districts in the Eastern region of Ghana through a multi-stage sampling technique. The attributes used in the questionnaire were developed based on literature reviews and focus group discussions, and a statistical block design was employed to create the choice tasks. To rigorously evaluate the performance of the machine learning (ML) models and reduce the risk of overfitting, we employed 5-fold cross-validation and multiple evaluation metrics. The data were analyzed using seven ML models.

Results

The four most vital mobile app functions identified by the participants were “step-by-step assistance for victims and first responders” (utility estimates (β) =0.3924; 95% confidence interval (CI): 0.3183 to 0.4665), “providing educational and training materials” (β = 0.2243; 95% CI: 0.1500 to 0.2987), “identifying venomous snakes through clinical evidence or symptoms” (β = 0.1718; 95% CI: 0.0982 to 0.2454) and “identifying venomous snake biodiversity in your area/region” (β = 0.0898; 95% CI: 0.0176 to 0.1620). Conversely, the app functions that were less favored included “platform for sharing snakebite treatment experiences” (β = -0.2503; 95% CI: -0.3268 to -0.1738) and “designing educational games about snakes” (β = -0.3995; 95% CI: -0.4737 to -0.3252). These findings align with subgroup analyses by gender, suggesting a consistent understanding of needs across different demographic groups.

Conclusions

This study provides quantitative evidence on which mobile app functions should be prioritized to inform the development of a customized local app to improve management and care for snakebite victims in Ghana and other sub-Saharan African countries.

Multivariate predictive model for predicting in-hospital mortality in HIV-associated talaromycosis: a multicenter retrospective study

2026-06-08T14:00:00Z

by Zhikai Wan, Mengyan Wang, Weiwei Zhang, Yu Zhou, Biao Zhu

Background

Talaromycosis is an invasive fungal infection that predominantly affects immunocompromised individuals, with a particularly high incidence and mortality rate among HIV-infected patients. The purpose of this study was to develop and validate a novel nomogram model to predict mortality risk in HIV-associated talaromycosis (HTM) patients.

Method

The authors retrospectively analyzed HTM patients from January 2013 to December 2023 at three research centers. The research participants were randomly divided into the training and validation sets at a ratio of 7:3. To determine the crucial variables for establishment of the predictive model, the study sequentially applied univariate logistic regression, lasso regression, stepwise logistic regression. The validation set was used to assess the performance of the established prediction model, with its efficacy evaluated through receiver operating characteristics curve, clinical decision curves, and calibration curves.

Result

A total of 431 subjects were enrolled in the study with 55/431 (12.76%) patients dying during hospitalization. Statistical analysis shows that there was no difference between training set and validation set in the baseline demographic and clinical characteristics. Five factors including breathlessness, elevated TB, APRI, CRP and decreased Hb were identified as predictive factors for HTM mortality. A nomogram model was built and the area under the curve (AUC) for the nomogram in predicting death was 0.83 (95% CI: 0.76-0.90) in the training set and 0.81 (95% CI: 0.70-0.93) in the validation set. The H-L test and calibration curves showed a strong alignment between predicted and actual results in both sets. Additionally, the decision curve analysis (DCA) indicated that the model provided significant net benefits for patients experiencing poor outcomes.

Conclusion

The nomogram model developed in this study integrating easily accessible clinical indicators and symptoms is effective in predicting in-hospital mortality in patients with HTM, which will greatly assist clinicians in the individual management of HTM patients.

Government health care worker training needs for intestinal schistosomiasis morbidity management

2026-06-08T14:00:00Z

by Phyllis Munyiva Isaiah, Betty Nabatte, Lauren Wilburn, John Bosco Oryema, Noah Ukumu, Morris Okumu, Juma Nabhonge, Hilda Kyarisiima, Prudence Beinamaryo, Victor Anguajibi, Christopher K. Opio, Narcis B. Kabatereine, Goylette F. Chami

Background

Schistosomiasis causes substantial chronic morbidity in sub-Saharan Africa, yet case definitions, clinical management guidance, and health worker training for schistosomiasis-related morbidity remain limited.

Methods

We conducted a qualitative needs assessment for schistosomiasis morbidity management. Workshops were held over one day in each of Pakwach, Buliisa, and Mayuge Districts in Uganda in October 2024. 105 government health workers participated including clinicians, nurses, laboratory technicians, sonographers, and district health managers from health facilities at different levels of care. The workshops comprised six structured sessions: presentations on schistosomiasis burden in Uganda and the SchistoTrack cohort, a clinical case report by an expert clinician, an interactive session on patient case studies from the SchistoTrack cohort, mapping of patient pathways, anonymous participation and feedback, and demonstrations of schistosomiasis diagnosis. Workshop discussions were documented through notes taken in English and analysed using qualitative thematic analysis as per Braun and Clarke.

Results

Health workers demonstrated substantial gaps in understanding schistosomiasis case definitions, particularly in distinguishing current infection from chronic morbidity and in grading disease severity. Patient pathways for schistosomiasis morbidity management were fragmented and inconsistent, with weak triage, unclear referral and feedback mechanisms, and limited follow-up across facility levels. Health facilities lacked essential capacity and resources, including routine access to praziquantel outside mass drug administration, diagnostic reagents, functional ultrasound equipment, trained sonographers, and standardized training and reference tools. Collectively, these gaps contributed to inconsistent clinical decision-making and under-recognition of severe schistosomiasis-related morbidity.

Conclusions

Integrating case management into routine health services through standardized case definitions, clearer patient pathways, and targeted practical training for health workers is essential to complement preventive chemotherapy and reduce preventable morbidity. The engagement framework and patient case studies used here can support needs-based assessments in other endemic settings to inform the development of context-appropriate clinical guidance and training programmes.

Ecological signature on the epidemiological dynamics of severe fever with thrombocytopenia syndrome

2026-06-08T14:00:00Z

by Zhe Lou, Jing Lu, Shuyi Liang, Wei Zhao, Ling Huang, Haowei Wang, Xiang Li, Jianli Hu, Ruiyun Li

Background

Severe fever with thrombocytopenia syndrome (SFTS) is prioritized as an emerging tick-borne disease, posing a continuing threat to human populations. Existing evidence has shown that tick-to-human transmission is the primary route of human infection. However, this insight has not been consistently incorporated into studies examining the ecological dependence of vectored disease dynamics.

Methods

We employ an eco-epidemiological model to assess tick abundance in response to the natural environment and its contribution to SFTS transmission. Our statistical model, which integrates demographic, ecological, and behavioural factors, investigates how vector abundance impacts case fatality risk.

Results

Our findings identified a shift in peak incidence from July to May among endemic counties since 2021. Additionally, we show that local climate conditions influence SFTS dynamics by modulating local vector populations, revealing clear spatial heterogeneity in transmission potential across endemic counties. Further investigations suggest that the odds of death are higher for patients living in the areas with higher tick abundance.

Conclusions

These insights emphasize the profound influence of ecological factors on disease dynamics and severity. Therefore, understanding the interrelation between climate and vector population dynamics is crucial for both research and policymaking related to climate-sensitive vectored diseases.

Stranger swings: Temperature-dependent upsides and downsides of a densovirus in Aedes albopictus

2026-06-08T14:00:00Z

by Christophe Boëte, Marco Perriat-Sanguinet, Anne-Sophie Gosselin-Grenet, Patrick Makoundou, Mylène Ogliastro, Mathieu Sicard, Sandra Unal, Mylène Weill, Célestine Atyame

Vector-borne diseases remain a significant global health concern, with the invasive mosquito Aedes albopictus playing a key role in the transmission of arboviruses including dengue, chikungunya, and Zika viruses. As this species expands in novel territories, effective vector control strategies are increasingly critical. Densoviruses (DVs) have emerged as potential biological control agents, either through direct pathogenic effects on mosquito populations or via paratransgenesis. However, the influence of combined environmental factors, such as temperature and densovirus infection on mosquito life-history traits remains largely unexplored. In this study, we investigated the effects of different temperatures (28°C, 31°C, and 34°C) and exposure to the densovirus AalDV2 on the survival of Ae. albopictus and on several mosquito life-history traits including its development time, size and symmetry at adult stage. Larvae were individually reared under controlled conditions and exposed to AalDV2 or a control treatment. Temperature had a strong threshold-like effect on survival, with dramatic mortality increases at 34°C. Unexpectedly, AalDV2-infected larvae showed significantly higher survival than controls at this extreme temperature, suggesting a protective effect under thermal stress. Across all temperatures, viral infection delayed pupation in a sex-dependent manner, with females experiencing greater delays and reduced adult wing size. Quantitative PCR revealed high infection rates (>96%) across all conditions with a viral load increasing with higher temperature in a sex-dependent manner. Our findings reveal a paradoxical outcome: while AalDV2 imposes fitness costs through delayed development and reduced body size, it confers an unexpected survival advantage at the extreme temperature. This represents the first documentation of temperature-dependent protective effects by an entomopathogenic virus in mosquitoes, challenging conventional assumptions about pathogen impacts. These results have critical implications for vector biocontrol strategies in a warming climate, as densovirus deployment could inadvertently enhance mosquito resilience in heat-stressed regions. Further research is needed to elucidate the underlying mechanisms and assess the impact on mosquito population dynamics.

Preclinical animal models for onchocerciasis and loiasis: A systematic review of applications in drug screening

2026-06-08T14:00:00Z

by Rene Bilingwe Ayiseh, Blendin Serri Gemuh, Glory Enjong Mbah, Stephen Mbigha Ghogomu, Fidelis Cho-Ngwa

Background

Onchocerciasis and loiasis are co-endemic filarial neglected tropical diseases in Central and West Africa. While ivermectin-based mass drug administration has reduced onchocerciasis burden, it can trigger severe neurological adverse events in individuals with high Loa loa microfilaraemia. This limitation highlights the urgent need for safe macrofilaricidal therapies and appropriate preclinical models.

Methodology/Principal findings

We conducted a systematic review following PRISMA guidelines to evaluate animal models used for preclinical drug screening in onchocerciasis and loiasis. Studies published between 1990 and 2025 were retrieved from PubMed and Google Scholar, and one-hundred and one eligible study were included in the qualitative synthesis. Models were assessed based on parasite stage permissiveness, survival duration, physiological relevance, host immune status, and suitability for drug evaluation. The bovine Onchocerca ochengi natural infection system emerged as the most physiologically relevant model, supporting the full parasite life cycle. Immunocompromised mouse models, including SCID and humanised NSG mice, allow controlled evaluation of parasite development and direct drug effects but incompletely reproduce human infection. Intraperitoneal adult male O. ochengi implant models in SCID mice and gerbils provide robust platforms for macrofilaricide screening. Semi-permissive rodent models offer practical systems for early-stage screening but are limited by non-physiological parasite localisation. For loiasis, non-human primate models, particularly Papio anubis, remain the most representative system.

Conclusions/Significance

No single model fully recapitulates human co-endemic infection. While the bovine model remains the gold standard, rodent implant models enable scalable screening. The absence of a physiologically relevant co-infection model remains a major barrier to developing safe macrofilaricides.

Beneficiary feedback mechanisms: Exploring ways to systematically integrate community feedback in mass drug administration delivery for NTDs

2026-06-08T14:00:00Z

by Jake D. Mathewson, Charlie Aardewijn, Sake J. de Vlas, Dunstan J. Matungwa, Mirjam I. Bakker

Background

Neglected tropical diseases (NTDs) affect over one billion people globally and disproportionately impact marginalized populations in low- and middle-income countries. Mass drug administration (MDA) is the WHO recommended strategy for controlling five major NTDs. However, persistent operational challenges, like treatment fatigue, mistrust, and systematically missed populations, undermine MDA effectiveness. Beneficiary Feedback Mechanisms (BFM) are emerging tools in global health that enable structured collection of community input to improve program delivery, but their application in NTD programs remains limited and understudied. This study examines how BFM are operationalized within routine MDA programs, providing operational insight into their perceived value, practical applications, and implementation challenges across diverse stakeholder roles.

Methods

This study used semi-structured key informant interviews (KII) to examine how BFM can be operationalized to enhance MDA delivery. Interviews were conducted with 14 informants involved in MDA implementation, funding, monitoring and evaluation, and research, primarily across countries in sub-Saharan Africa that were supported by the Accelerating the Sustainable Control and Elimination of Neglected tropical Diseases (ASCEND) program. Participants were selected purposively based on their professional experience with BFM and MDA. Transcripts were analyzed using a thematic analysis approach in NVivo software, applying both inductive and deductive coding strategies to identify patterns and develop meaningful themes.

Results

Informants identified that BFM yielded timely and actionable feedback, particularly through daily community drug distributor meetings and post-MDA surveys, as the most impactful. Integrating BFM into existing systems was favored over new platforms, particularly in resource-constrained settings. Key barriers included limited integration into digital monitoring systems and lack of dedicated personnel to review and respond to feedback. BFM also highlighted issues that may have hindered optimal drug coverage in some communities, including gender barriers and misinformation. Informants emphasized that closing the loop, communicating back to communities how their feedback was used, was essential to maintaining trust and engagement in future MDA activities.

Conclusions

BFM were perceived by informants as a promising pathway to enhance the equity, responsiveness, and effectiveness of MDA programs. Their success depends on timely use, integration into routine systems, and capacity to address community concerns. Multilateral organizations such as WHO can support scale-up by issuing guidance and standardizing tools. Further research is needed to evaluate impact and best practices for implementation.

Discovery of a novel coltivirus in a newly identified Bat Bug Species (Heteroptera: Cimicidae) in Cambodia

2026-06-08T14:00:00Z

by Jurre Y. Siegers, Heidi Auerswald, Pierre-Olivier Maquart, Tamara Szentiványi, Julia Guillebaud, Thavry Hoem, Xiang Li, Kimhuor Suor, Leakhena Pum, Limmey Khun, Sithun Nuon, Kimlay Chea, Vireak Heang, Kathrina Mae Bienes, Yvonne C.F. Su, Veasna Duong, Janin Nouhin, Sébastien Boyer, Erik A. Karlsson

Bats and their ectoparasites are significant reservoirs and potential vectors of emerging zoonotic pathogens, yet the viral diversity within bat-associated arthropods remains poorly characterized. This study reports the identification of a novel coltivirus (order Reovirales), provisionally designated Stricticimex coltivirus (SCCV), in a newly described bat bug species, Stricticimex phnomsampovensis, collected from cave-dwelling wrinkle-lipped free-tailed bats (Mops plicatus) in Cambodia. Metagenomic sequencing and phylogenetic analysis revealed that SCCV clusters within the Coltivirus genus, showing closest similarity to Tai Forest Reovirus (TFRV) previously isolated from African bats. SCCV was detected in 18.4% of examined bat bugs and successfully isolated in VeroE6 cells, with replication confirmed in multiple mammalian cell lines. The discovery of SCCV extends the known diversity and geographic range of coltiviruses and highlights bat ectoparasites as overlooked hosts of potentially zoonotic viruses. These findings underscore the importance of integrated One Health surveillance targeting both bats and their ectoparasites to better assess the risk of pathogen spillover in biodiverse regions with high human-animal contact.

Plasma proteomics improves risk prediction in heart failure and reveals unique biology in chronic chagas cardiomyopathy

2026-06-08T14:00:00Z

by José S. L. Patané, Fernando R. Giugni, Rogério S. Rosa, Fabiana G. Marcondes-Braga, Alfredo J. Mansur, Alexandre C. Pereira, Jose E. Krieger

Background

Chronic Chagas cardiomyopathy (CCC) remains a major cause of heart failure (HF)–related mortality in Latin America and is increasingly recognized as a global health concern. Prognostic models developed in non-Chagas populations often perform poorly in CCC, highlighting the need for etiology-specific risk stratification.

Methodology/principal findings

We applied high-throughput plasma proteomics to evaluate 2-year mortality risk in CCC compared with other HF etiologies. Baseline plasma from 1,212 adults with heart failure with reduced ejection fraction (HFrEF; LVEF <50%) was analyzed to quantify 734 circulating proteins. CCC was confirmed in 191 participants (16%) by dual Trypanosoma cruzi serology. Two-year mortality was higher in CCC than in the overall HF cohort (26% vs. 16%, p < 0.01). Feature-selection methods identified a nine-protein panel (P9: C1QA, CCL4, REN, EGLN1, COL9A1, GP1BA, ITM2A, CNPY2, NT-proBNP) that improved risk classification compared with NT-proBNP alone, increasing F1-macro by 20% (0.674 vs. 0.560) and integrated time-dependent discrimination for 2-year mortality (iAUC) by 6%. Performance gains varied by HF etiology. Improvements were greatest in hypertensive (+40%) and ischemic (+21%) HF, whereas in CCC the P9 panel underperformed NT-proBNP alone (−16%), suggesting distinct underlying disease biology. External validation in the UK Biobank confirmed generalizability: compared with NT-proBNP, P9 improved F1-macro by 18% and iAUC by 7.4%, reaching an F1-macro of 0.612 in the highest-risk tertile. Pathway enrichment identified 14 CCC-specific pathways, mainly related to fibrosis, integrin signaling, immune dysregulation, and impaired protein trafficking. Exploratory analyses also highlighted potential pathway-linked therapeutic targets consistent with distinct CCC mechanisms.

Conclusions/significance

The P9 proteomic panel improved mortality risk prediction beyond NT-proBNP and the MAGGIC clinical score across most HF etiologies and showed consistent performance in an independent population-based cohort. In contrast, in CCC P9 underperformed NT-proBNP alone, highlighting the distinct biological features of this disease. These findings underscore the limitations of universal biomarker models in CCC and support the need for etiology-specific risk stratification strategies.

Emergence of Marburg virus disease in Ethiopia: Implications for public health preparedness and its impact on Ethiopia’s health system

2026-06-05T14:00:00Z

by Sibhatu Biadgilign, Mesfin Fransua, Anteneh Eshetu, Abdu Bedru

Background

Marburg virus disease (MVD) is a rare but highly lethal viral hemorrhagic fever (VHF) caused by Marburg virus (MARV) and Ravn virus (RAVV). While MVD has historically been limited to specific areas of sub-Saharan Africa, recent outbreaks in previously unaffected countries indicate an expanding ecological and epidemiological risk. In November 2025, Ethiopia confirmed its first-ever MVD outbreak, constituting a significant national and regional public health emergency.

Methods

This narrative review synthesizes publicly available epidemiological data, government situation reports, and official communications from the Ethiopian Ministry of Health (MoH), Ethiopian Public Health Institute (EPHI), Africa Centres for Disease Control and Prevention (Africa CDC), and the World Health Organization (WHO).

Results

The outbreak was initially detected in Jinka town, South Ethiopia Region, an area bordering Kenya and South Sudan. As of 25 January 2026, more than 3,800 diagnostic tests were conducted, leading to a total of 19 cases comprising 14 confirmed (including nine deaths) and five probable (all deaths) and five recoveries from MVD in the country’s South Ethiopia and Sidama regions, which were reported. A total of 857 contacts listed for monitoring all had completed their 21-day follow-up as of 25 January 2026. Ethiopia’s response included rapid notification, laboratory confirmation, activation of incident management systems, deployment of mobile high-biosafety laboratories, establishment of isolation and treatment centers, and issuance of national clinical management guidelines. International partners provided technical, financial, and logistical support. However, the outbreak exposed ongoing challenges, including health system fragility, workforce shortages, misinformation, funding limitations, and heightened cross-border transmission risk.

Conclusion

The emergence of MVD in Ethiopia represents a pivotal moment for national and regional health security. Sustained containment will require strengthened surveillance, community engagement, cross-border collaboration, and integrated One Health approaches. Long-term investment in resilient health systems and coordinated regional preparedness is essential to prevent future spillover events and protect vulnerable populations.

Plant-based therapeutics for leishmaniasis: A systematic review emphasizing human studies and clinical trial evidence

2026-06-05T14:00:00Z

by Alberta Serwah Anning, Vanesa Osmani, Stefanie J. Klug, Dorcas Obiri-Yeboah

Background

Leishmaniasis is a parasitic disease caused by Leishmania species and transmitted through sand fly bites, affecting some of the most vulnerable populations globally. Current treatments are limited by high toxicity, poor tolerability, and resistance. Plant-based therapies offer a promising alternative, but human evidence has not been comprehensively reviewed. This review summarizes current evidence on the efficacy and safety of plant-based treatments for leishmaniasis in humans.

Methodology/findings

We conducted a systematic review including studies that evaluated the efficacy and safety of plant-based treatments for leishmaniasis in humans. This review was registered with PROSPERO (ID: CRD42024567764). We searched PubMed, Scopus, and Web of Science from inception to May 28, 2024. Risk of bias was assessed using the Cochrane RoB 2 tool. We summarized the main study results qualitatively and quantitatively (where possible) by estimating risk ratios with 95% confidence intervals for treatment outcomes using the meta package in R. Ten studies met the inclusion criteria, nine from Iran and one from Sudan, all focused on cutaneous leishmaniasis (CL). Most used topical creams derived from medicinal plants, either alone or with conventional treatments. In studies combining herbal and standard treatments, four of six studies showed better outcomes in the intervention group. In studies using only the plant-based treatments compared to a standard treatment group, two of four showed better outcomes in the intervention group. Quantitative analysis of eight studies indicated significant healing improvements in the intervention group in three studies, specifically those using Juniperus excelsa, Nigella sativa, and poly-herbal formulations consisting of the pure extract mixture of Althaea (A.) rosa, A. officinalis, and members of the families Leguminosae, Faliaceae, Malvaceae, and Lythraceae (named Z-HE). Mild side effects such as itching and burning were reported with some herbal treatments, while conventional therapies caused more severe reactions in some cases. The risk of bias was mostly high in the studies.

Conclusions

This review highlights the potential of certain plant-based compounds as adjunct or alternative therapies for CL. Despite promising results with Plantago ovata, Juniperus excelsa, and Z-HE poly-herbal extracts, current evidence is limited by methodological weaknesses. Larger, rigorously designed trials with broader representation are needed to confirm efficacy and safety and support policy integration in endemic regions.

A systematic mapping review of therapeutic clinical trials in dengue

2026-06-05T14:00:00Z

by Tran Bang Huyen, Angela McBride, Tun-Linn Thein, Khoi Minh Le, Tran Luu, Nguyen Quang Huy, Eli Harriss, Matthew J.W. Kain, Jonathan Cattrall, Caitlin Naylor, Ho Quang Chanh, Nguyen Lam Vuong, Daniel Munblit, Po-Ying Chia, Phung Khanh Lam, James A. Watson, Sophie Yacoub

Background

Dengue is a growing public health threat with increasing case numbers globally. Despite the substantial burden, there are no licensed therapeutics for patients with dengue. To inform the design of large-scale practice-changing clinical trials and to assess the feasibility of an individual patient data platform for meta-analysis, we conducted a systematic mapping review of clinical trials evaluating dengue therapeutics. Our aims were to characterise published and registered dengue therapeutic trials, describe their endpoints, and assess study design quality and internal validity to inform feasibility of meta-analysis and future research.

Methods

We systematically searched Ovid MEDLINE, Ovid EMBASE, WHO ICTRP and ClinicalTrials.gov for prospective clinical trials evaluating therapeutics in patients with symptomatic dengue. Two independent reviewers screened records using Covidence. Data were extracted into a REDCap database, and risk of bias was assessed using the ROB-2 and ROBINS-I tools to describe trial design rigour. Descriptive analyses summarised the interventions, trial characteristics, study populations, and primary endpoints. This systematic review was pre-registered with PROSPERO (CRD42023469022).

Results & discussion

A total of 121 clinical studies were identified, comprising 72 published trials and 49 registered but unpublished studies. Interventions were categorised according to the authors’ proposed mechanism of action: antiviral (n = 10), host-directed (HDT, n = 34), supportive (n = 31), or undefined (n = 46). Aside from the studies of supportive therapies (n = 31) and unpublished studies (n = 37) which were only reviewed for their primary outcomes, 53 publications remained for review of therapeutic efficacy. Methodological concerns were common – 24 of 53 published trials (45%) were classified as having high or critical risk of bias. Corticosteroids were the most frequently evaluated intervention, involving a total of 944 randomised patients. The primary endpoints used in both antiviral and HDT trials were highly heterogeneous, limiting comparability. The combination of methodological concerns and non-standardised endpoints precluded meta-analysis for any intervention. No single treatment had sufficient or consistent evidence to support recommendations for use in clinical practice.

Conclusions

Our findings highlight a remarkably sparse evidence base for dengue therapeutics and a lack of standardised, clinically meaningful endpoints. These factors have hindered progress in evaluating candidate treatments and limited the potential for individual patient data meta-analyses. Large, high-quality trials - powered for harmonised and clinically relevant endpoints - are urgently needed to advance the development of effective therapies for dengue.

Accelerating vaccine research and development for skin neglected tropical diseases: A case for leishmaniasis, leprosy, and Buruli ulcer

2026-06-05T14:00:00Z

by Hua Wang, Fernanda Oliveira Novais, Maria Adelaida Gómez, Stephen Muhi, Camila I. de Oliveira, Thao-Thy Pham, Samantha Vermaak, VALIDATE Network Skin NTDs Working Group , Rajko Reljic

Neglected tropical diseases (NTDs), particularly those with prominent cutaneous manifestations such as leishmaniasis, leprosy, and Buruli ulcer, represent a substantial global health burden, affecting hundreds of millions of people and perpetuating cycles of poverty and disability. Despite the current availability of treatment strategies, vaccines remain the most sustainable and cost-effective intervention that can reduce reliance on chemotherapeutics. However, vaccine research and development (R&D) for these diseases face considerable challenges that cannot be overcome without a strategic shift in response by national and international health programmes and organisations, research funders, and the pharmaceutical industry. This paper draws on collective insights from the VALIDATE Network workshop on “Vaccines for Skin Neglected Tropical Diseases—Progress and Challenges” (Bogotá, Colombia, 5–8 May 2025). We advocate for a multisectoral shift across three critical pillars: i) an increase in funding for NTD vaccine R&D, ii) integration of NTD vaccine R&D into the preparedness and response policies by international agencies and local governments, and iii) fostering patient and public engagement and advocacy for NTD vaccine R&D and implementation. Coordinated efforts across these three pillars will unlock the transformative potential of vaccines and substantially reduce the health, societal, and economic burdens from these diseases.

Development of a deep learning based framework for classification of Indian venomous snakes integrated with explainable artificial intelligence for primary and emergency care providers

2026-06-05T14:00:00Z

by Ikhlaas Ifthikar Abusayeed Manna, Usha Wagle, Badhrinarayanan Balaji, Vrinda Lath, Niranjana Sampathila, Sudhakara Upadya P, Freston Marc Sirur

Background

Snakebite envenoming is a significant global health crisis that has been long neglected as a global health priority. It is a huge problem for rural communities of low and middle-income countries, India accounts for the largest proportion of snakebite deaths globally. Timely identification of venomous snakebite and its syndromic pattern is essential for effective administration of antivenom and supportive treatment. Expert identification of snake species and syndromes is not always available in peripheral healthcare settings. This leads to delays, unnecessary referrals, or improper treatment choices. Additionally, diverse snake species distribution and venom variations across regions pose challenges. AI-powered image classification methods can help overcome these barriers. We propose a clinically oriented deep learning pipeline for binary classification of venomous and non-venomous snake species of India using real-world imagery data. This pipeline would serve as a baseline step towards aiding snakebite management at peripheral healthcare setups with scarce resources.

Methods

The selected dataset consisted of 20 medically important Indian species. MobileViT-S, ConvNeXt-Tiny, EfficientNet-V2-S and ResNeXt-50 (32 × 4d) were trained under same conditions for comparison of results. Model interpretability was evaluated using Grad-CAM ++ to ensure that classification was not performed based on background but on features like head shape and stripes present on body. For reliable implementation we connected it to a web interface with human in loop expert verification. Experts can confirm or override predictions in real time.

Results

Among the evaluated architectures, ResNeXt-50 (32 × 4d) showed the most reliable and consistent performance in classifying venomous and non-venomous snakes. It achieved the highest test accuracy, sensitivity, specificity, and F1-score. The model also had strong discriminative ability, with a ROC-AUC of 0.9950 and PR-AUC of 0.9959. These results indicate dependable performance in safety-critical screening situations. Grad-CAM++ visualizations confirmed that predictions were based on anatomically relevant features, especially in the head and body contour areas. This supports model interpretability and reduces background bias.

Conclusions

Although the dataset size and single-institution source limit how widely the results can be applied, the proposed framework shows that it's possible to create a clinically oriented, ready-to-use deep learning system for snakebite triage support. This system is intended as a scalable tool to help rural healthcare workers, emergency responders, and telemedicine platforms in areas where snakebites are common.

An intuitive sampling framework for setting-specific decision-making in soil-transmitted helminthiasis control programs

2026-06-05T14:00:00Z

by Adama Kazienga, Bruno Levecke, Sake J. de Vlas, Luc E. Coffeng

Background

We recently developed a general egg count framework to support cost-efficient survey design choices to inform soil-transmitted helminthiasis (STH) control programs. Yet, the interpretation and the application was not always intuitive for program managers.

Methods

We first adapted the existing framework to make the interpretation of risks of incorrect decision making more intuitive and to allow for prior information. Then, we assessed the impact of the allowable risk of incorrect decision-making and prior information on the required sample size. Finally, we determined the most cost-efficient survey design to inform the decisions (i) to switch to an event-based deworming program, and (ii) to declare STH eliminated as a public health problem (EPHP).

Principal findings

The required sample sizes increased when the allowable risk of incorrect decision reduced and when the mean prior approached the program prevalence threshold. For the decisions to switch to event-based deworming and to declare EPHP, we found that duplicate Kato-Katz thick smears on a single stool sample was the most cost-efficient survey design, particularly when accounting for the added benefits of the free internal quality control. The required sample size for these survey designs varied between program targets and STH species. When aiming to have one sample size that fits all STHs, we recommend sampling 6 schools and 56 children per school for decisions on switching to event-based control programs and 11 schools (74 children per school) for the decision to declare EPHP.

Conclusions/significance

We developed an intuitive sampling framework for setting-specific decision-making in STH control programs. We identified the most cost-efficient survey designs for critical program decisions, but these are based on subjective but reasonable choices regarding the risk of incorrect decision making. Reaching consensus within the STH community on acceptable levels of risk is crucial to further support evidence-based decision-making.

Severe visceral leishmaniasis in Ethiopia: Outcomes, co-infections and mortality in a prospective real-world cohort

2026-06-05T14:00:00Z

by Eleni Ayele, Saskia van Henten, Desalew Getahun Ayalew, Saba Atnafu, Asnakew Engidaw Mereed, Hana Yohannes, Tigist Mekonnen, Tadfe Bogale, Aman Mossa, Gebrehiwot Lema Legese, Jemal Yasin, Nicole Berens-Riha, Thao-Thy Pham, Carl Boodman, Annelies Mondelaers, Wim J. Adriaensen, Saïd Abdellati, Ermias Diro, Rezika Mohammed, Fabiana Alves, Mezgebu Silamsaw Asres, Myrthe Pareyn, Mekibib Kassa, Johan van Griensven

Background

Visceral leishmaniasis (VL) remains a major public health challenge in East Africa, particularly in Ethiopia. Clinical trials on VL often exclude patients with severe comorbidities or laboratory abnormalities, limiting the generalizability of evidence used to guide real-world management. We comprehensively characterised the clinical profile, treatment outcomes, and mortality of VL patients treated in a referral centre.

Methodology and principal findings

This prospective cohort study enrolled patients at the Leishmaniasis Research and Treatment Center (LRTC), University of Gondar (02/2023-06/2024). All VL cases fulfilling eligibility criteria underwent detailed clinical, laboratory, and radiological assessments. VL treatment followed WHO guidelines. Outcomes, adverse events, and supportive care measures were recorded during treatment and over a 12-month follow-up period. Patients meeting at least one exclusion criterion (e.g., comorbidities, clinical signs of severe VL) of standard phase III VL treatment trials were defined as trial-ineligible patients and compared with trial-eligible patients. A total of 314 VL patients, mostly young adult males (median age 22 years), were enrolled. Of these, 21 (6.7%) had HIV co-infection; 204 (65%) met ≥ 1 key exclusion criterion typically used in VL clinical trials. Trial-ineligible patients had high parasitemia, more concurrent infections, more pronounced clinical and laboratory abnormalities and a higher need of supportive care measures including systemic antibiotics and blood transfusion. Overall cure rate was 90.1%. Mortality after the first VL treatment course was 6.4%, ranging from 1.8% in trial-eligible patients to 8.8% in trial-ineligible patients. Leading causes of death included severe bacterial infections, acute liver failure and haemorrhagic complications.

Conclusions

These findings underscore the severity and complexity of VL in routine care in our study population, and highlight the limitations of current trial populations to inform broader clinical practice. Strengthening supportive care and expanding research inclusivity designed to respond to the needs of this patient population are critical to achieve VL elimination targets.