PLOS Neglected Tropical Diseases: New Articles

Correction: Cost of illness of scrub typhus in South India – a population-based, mixed-methods study

2026-09-10T14:00:00Z

by Carol Devamani, Adam Biran, Koya Ariyoshi, K.R. John, Ian Ross, Yoshinao Kubo, Daniel Chandramohan, Kundavaram Paul Prabhakar Abhilash, Wolf-Peter Schmidt

Friends or foes: Unraveling the tsetse fly-Spiroplasma symbiosis

2026-09-10T14:00:00Z

by Serap Aksoy, Brian L. Weiss, Daniel J. Bruzzese, Fabian Gstöttenmayer, Richard Echodu, Giulia Fiorenza, Riccardo Piccinno, Anna Rodolfa Malacrida, Adly M. M. Abd-Alla

Tsetse flies (Glossina spp.) transmit African trypanosomes, the causative agents of human African and African animal trypanosomiases (HAT and AAT, respectively). These neglected tropical diseases impose significant public health and economic burdens across sub-Saharan Africa. Trypanosome transmission by tsetse flies is influenced by multiple factors, including host genetic background, ecological factors, and interactions with heritable microbial endosymbionts. Spiroplasma glossinidia has recently emerged as an important modulator of tsetse reproductive fitness and vector competence, making it a potential target for symbiont-based vector control strategies. In this review, we summarize the current knowledge of the tsetse-Spiroplasma symbiosis. We detail Spiroplasma’s spatial and temporal infection dynamics in laboratory-reared and natural populations. Additionally, we highlight key aspects of the bacterium’s genomics, phylogenetics, and physiological interactions with its tsetse host, including influences on host gene expression reproductive physiology, and vector competence. Finally, we discuss how the tsetse–Spiroplasma symbiosis could be harnessed to develop innovative, biological-based vector control and trypanosome transmission-blocking strategies, and we identify critical gaps that must be addressed to translate these findings into effective disease control interventions.

A clinical scoring system for the early identification of superinfections in patients with severe fever with thrombocytopenia syndrome: An ambispective multicentre cohort study

2026-09-10T14:00:00Z

by Yu-Yao Li, Jian-Kang Zhang, Chun Zhang, Zhi-Ping Pan, Xiao Liu, Meng-Yu Liu, Qiang Chen, Yuan-Yuan Zhang, Yuan Jiang, Xu-Ya Yuan, Si-Yang Liu, Xiang Li, Fei-Dan Yu, Yu-Feng Gao, Jun Cheng, Qin-Xiu Xie, Jian-Guo Rao, Li-Yu Zhu, Zhen-Jun Liu, Ying Ye, Jia-Bin Li, Li-Fen Hu

Background

Superinfection is a major contributor to mortality in patients with severe fever with thrombocytopenia syndrome (SFTS). However, early identification remains challenging because detection of the pathogen causing the superinfection is often delayed.

Objective

This study aims to develop a clinical scoring system for the early identification of superinfection in SFTS patients.

Methods

Among 1942 SFTS patients from 4 hospitals in China, a retrospective cohort (2014–2024) was used for model development, with 1182 patients from 2 hospitals split into training (n = 823) and internal validation (n = 359) sets, and 475 patients from 2 additional hospitals for external validation sets. Four machine learning algorithms were evaluated, with the optimal model converted into a simplified scoring scale. Finally, a prospective cohort (n = 285, 2025) evaluated the real-world performance. Model efficacy was comprehensively assessed using the area under the receiver operating characteristic curve (AUROC), calibration curves, decision curve analysis (DCA), sensitivity, and specificity.

Results

Among the 36 variables, 8 predictors (age, ALB, AST, BUN, GLU, CRP, HGB, and expectoration) for superinfection were identified by ensembling five machine learning algorithms. The RF, XGBoost, LightGBM, and LR prediction models were constructed using the 8 predictors. LR demonstrated optimal performance, with an AUROC of 0.839 (95% CI: 0.797–0.880) in the internal validation set and 0.805 (95% CI: 0.764–0.847) in the external validation set. In the real-world prospective study, the model maintained high predictive efficacy (AUROC: 0.854). Finally, the model’s nomogram was simplified into a novel 3-tiered risk scoring scale to enhance clinical applicability.

Conclusions

Our research developed a dynamic, early diagnostic tool that could improve real-time prediction of superinfection risk at the bedside and enhance antimicrobial stewardship.

Direct whole-genome sequencing of Coxiella burnetii from environmental samples using a two-step selective enrichment approach

2026-09-08T14:00:00Z

by Mikhail Bezruchko, Olga Freylikhman, Erik Khalilov, Elena Vakalova, Denis Kasatkin, Sofia Platova, Ivan Gorokhov, Alina Saitova, Islam Karmokov, Nikolay Tokarevich, Dmitrii Polev, Vladimir Dedkov

Current high-throughput sequencing platforms enable routine whole-genome sequencing of bacteria via clonal amplification from primary samples, followed by DNA extraction, library preparation, and sequencing. This approach enriches bacterial DNA while removing contaminating nucleic acids, allowing efficient genomic sequencing using minimal sequencing resources per sample. However, for fastidious or obligate intracellular bacteria, such as Coxiella burnetii, cultivation is often impractical, leaving pathogen DNA heavily diluted by host and environmental nucleic acids. In such cases, sequencing requires substantially greater throughput per sample, highlighting the need for culture-independent methods to support genomic epidemiology and surveillance. Here, we report a novel two-stage DNA enrichment strategy applied to C. burnetii-contaminated sheep wool samples. Such samples feature very low pathogen biomass and a high host-DNA background. Our approach integrates (i) selective whole-genome amplification of complex DNA extracts, followed by (ii) in-solution hybridization capture using custom double-stranded DNA baits. Critically, we developed a WGA-based method to synthesize whole-genome dsDNA baits from minimal input DNA, enabling efficient bait production even in the absence of cultured isolates. Notably, we demonstrate that baits derived from C. burnetii DNA contaminated with an unrelated host (e.g., chicken) remain effective for enriching C. burnetii from samples derived from a different host species (e.g., sheep), indicating robust cross-host applicability. Using this workflow, we achieved up to 95% C. burnetii enrichment and generated six genomic assemblies suitable for downstream phylogenomic and epidemiological analyses. This cultivation-free, two-stage enrichment framework can be applied for phylogenetics and epidemiology and may significantly expand the feasibility of genomic studies for intracellular and otherwise uncultivable bacterial pathogens.

Gendered experiences of people living with tuberculosis or leprosy: A global systematic review

2026-09-08T14:00:00Z

by Sophie C. W. Unterkircher, Juliana Lenz, Grace Mwasuka

Background

Classified as poverty-related diseases (PRD) leprosy and tuberculosis (TB) are long-standing mycobacterial diseases strongly linked to poverty, stigma, and social exclusion, disproportionately affecting vulnerable populations. Gender norms further shape how individuals experience illness, access to care, and coping strategies, but evidence remains fragmented and largely disease-specific. This systematic review synthesizes qualitative evidence on lived experiences of people affected by TB or leprosy worldwide and compares gender inequities across both diseases to identify shared social and structural determinants.

Methods/principal findings

A systematic review following PRISMA guidelines searched PubMed, Embase, Scopus, and Web of Science for peer-reviewed qualitative and mixed methods studies (1995–08/2025) reporting primary qualitative data on gendered experiences of people affected by TB or leprosy. Studies in all countries and languages were eligible. Screening and extraction were conducted using Rayyan. Inductive thematic synthesis was performed using MAXQDA. Quality was assessed using the CASP checklist. A total of 3204 records were identified, with 57 studies from 29 countries across five continents included. Across settings, women experienced greater barriers to diagnosis and care, more severe marital and familial consequences, higher stigma and social exclusion, and greater psychosocial burden than men. Men’s experiences were shaped by norms of masculinity, particularly regarding economic provision and employment. Despite disease differences, psychosocial and socioeconomic impacts were similar across TB and leprosy, embedded in gendered social norms, power relations, and social determinants of health.

Conclusions/significance

Gender-based inequities are pervasive across TB and leprosy globally. Comparing both diseases reveals shared social mechanisms beyond biomedical differences. Addressing them requires moving beyond biomedical models and integrating gender as a structural determinant of health. Gender-sensitive, participatory, and intersectional interventions are needed to improve early diagnosis, treatment adherence, and psychosocial and socioeconomic outcomes.

Registration

Registered on Open Science Framework (OSF) on 01/09/2025.

A qPCR identification scheme to detect the most common causative agents of actinomycetoma in Africa

2026-09-08T14:00:00Z

by Andrew K. Watson, Sahar Bakhiet, Emmanuel E. Siddig, Carole Pab Minlekib, Rihab Mohammed, Willemien Zandijk, Mickey Konings, Ahmed H. Fahal, Maguette Faye, Katarzyna Mickiewicz, Fatehmeh Mazraati Tajabadi, Doudou Sow, Jeffrey Errington, Wendy W. J. van de Sande

Mycetoma is a neglected tropical disease characterized by mutilating tumorous lesions in the subcutaneous tissue. The causative agents are found embedded in granules called grains. Mycetoma is either caused by bacteria (actinomycetoma) or fungi (eumycetoma). To initiate the appropriate treatment, it is important to identify the causative agent rapidly and molecular identification for eumycetoma revolutionized the time to identification. For actinomycetoma this was not possible yet. Here we developed a multiplex qPCR identification scheme for the most common causative agents of actinomycetoma in Africa. Whole genome sequencing was used to identify species-specific gene families for Actinomadura madurae, Actinomadura pelletieri, Streptomyces somaliensis and Streptomyces sudanensis. qPCR primers and probes were developed on these species and validated against DNA isolated from mycetoma strains and grains. Each probe was unique with no cross-reactivity with other tested species. The limit of detection ranged from 0.000013 to 0.00067 ng bacterial DNA. When the qPCRs were validated against 28 grain samples, all fungal grains remained negative and 11 out of 12 Actinomadura grains were correctly identified. This resulted in a sensitivity of 85.7% for the A. pelletieri probe and a specificity of 100%. For the A. madurae probe, a sensitivity and specificity of 100% was obtained. The actinomycetoma qPCR developed in this study can be used to identify the most common causative agents of actinomycetoma in Africa.

A scoping review of the frequency and clinical presentation of Taenia solium taeniasis and human cysticercosis/neurocysticercosis in Papua, Indonesia from 1970 to 2024

2026-09-08T14:00:00Z

by Ainrisq A. Rifai, Laura M. Rey, Molly E. Crews, Guilherme G. Verocai, Martial L. Ndeffo Mbah, Christine M. Budke

Background

Taenia solium taeniasis and cysticercosis, including neurocysticercosis (NCC), are neglected tropical diseases disproportionately affecting remote, resource-poor regions. As a leading cause of acquired epilepsy globally, T. solium poses a major public health challenge.

Methodology/principal findings

This scoping review evaluated available literature on the prevalence of T. solium taeniasis and cysticercosis/NCC, clinical manifestations associated with infection, and diagnostic approaches used in Papua, Indonesia, from 1970 to 2024, following the PRISMA-ScR checklist. From 1,708 identified records, 28 articles underwent data extraction. Pooled prevalence estimates from studies conducted between 2007 and 2015 that used Enzyme-linked Immunoelectrotransfer Blot (EITB) indicated a taeniasis prevalence of 2.0% [95% CI: 1.0% – 6.0%] among household members in Central Papua and 3.0% [95% CI: 1.0% – 10.0%] in Highland Papua households. Furthermore, the pooled prevalence for residents in Central Papua positive by Enzyme-Linked Immunosorbent Assay (ELISA) for cysticercosis (studies from 1969-2015) was 5.0% [95% CI: 2.0% – 13.0%] compared to 29.0% [95% CI: 18.0% – 43.0%] in Highland Papua (studies from 1996-2011). Among 135 patients with headaches and/or seizures from both Central and Highland Papua (studies from 1998-2005), the pooled prevalence for ELISA-positive cysticercosis was 32.0% [95% CI: 9.0% – 69.0%]. Seizures were observed in 19.0% [95% CI: 12.0% – 28.0%] of villagers in Jayawijaya Regency that were ELISA positive for Taenia solium cysticercosis (studies from 1996-2001), with 35.0% [95% CI: 9.0% – 75.0%] presenting with subcutaneous nodules. Across all articles, only one study reported the use of brain computed tomography (CT) imaging for confirming NCC, indicating extremely limited access to neuroimaging in the region.

Conclusions/significance

Improving access to gold-standard CT imaging for NCC diagnosis, adopting standardized criteria for NCC diagnosis and management, and targeted public health interventions are urgently needed to reduce the burden of T. solium in Papua.

Evaluation of a Zika virus-like particle-based vaccine in a highly penetrant non-human primate model of congenital infection

2026-09-08T14:00:00Z

by Hannah K. Jaeger, Jessica L. Smith, Caralyn S. Labriola, Lydia J. Pung, Olivia L. Hagen, Michael Denton, Rahul J. D’Mello, Christopher J. Parkins, Whitney C. Weber, Samuel Medica, Craig N. Kreklywich, Victor R. DeFilippis, Stephen Bondoc, Kathleen Busman-Sahay, Jenna N. Castro, Gavin Zilverberg, Riely White, Margaret Terry, Aaron M. Barber-Axthelm, Michael K. Axthelm, Jeremy Smedley, Matthew T. Aliota, Andrea M. Weiler, Thomas C. Friedrich, Jacob Estes, Terry K. Morgan, Jamie O. Lo, Victoria H. J. Roberts, Daniel N. Streblow, Alec J. Hirsch

Zika virus (ZIKV) is an arthropod-borne Orthoflavivirus that caused a major outbreak in Central and South America in 2015–16. During that outbreak, ZIKV infection during pregnancy was associated with high rates of adverse outcomes, including miscarriage and a spectrum of neurological birth defects collectively termed congenital Zika syndrome (CZS). Ten years later, there are still no licensed ZIKV vaccines, underscoring the need for robust experimental models to evaluate vaccine efficacy against congenital disease. Here, we evaluated a highly pathogenic nonhuman primate pregnancy model for its ability to assess vaccine-mediated protection using a Zika virus-like particle (VLP) vaccine as a test platform. First, non-pregnant rhesus macaques (RM) were vaccinated with a prime-boost method to compare control, VLP alone, and VLP plus Alhydrogel (alum) adjuvant. Vaccination plus alum elicited strong neutralizing antibody responses and reduced viral dissemination compared to controls. Next, we evaluated the vaccine’s protective efficacy against adverse pregnancy complications. Two cohorts of female RM were vaccinated with ZIKV-VLP adjuvanted with alum or alum alone prior to time-mated breeding. At gestational day (GD) 30 (mid first trimester), pregnant animals were challenged with ZIKV-DAK 41524, an African-lineage strain previously shown to induce frequent first-trimester pregnancy loss. Within the vaccinated cohort, two of three animals reached the study endpoint of GD 90 with no observed adverse pregnancy outcomes. One vaccinated animal experienced early pregnancy loss despite the absence of detectable virus in fetal or placental tissues. In the sham vaccine control pregnancy cohort, severe adverse outcomes included miscarriage and hydrops fetalis with widespread viral RNA and placental pathology in two animals. These results support a high risk of early pregnancy loss following African-lineage ZIKV-DAK 41524 infection in RM. This model can be further used to understand the complexities of placental immunological features underlying miscarriage following ZIKV infection.

A target product profile and roadmap for Japanese encephalitis diagnostics in endemic areas in the context of other flaviviruses

2026-09-08T14:00:00Z

by Tehmina Bharucha, Laura Stokes, Dorcas Anane-Amponsah, Asha Mary Abraham, Prasert Auewarakul, Balkrishna Awal, Ashwin Y. Belludi, Vijay Bondre, Tina Damodar, Xavier de Lamballerie, Rahul Dhodapkar, Audrey Dubot-Pérès, Veasna Duong, Ava Easton, Roger Evans, Varja Grabovac, Nivedita Gupta, Nguyen Hoang Thien Huong, Siraj Ahmed Khan, Uddhava V. Kinhal, Kaveri Krishnasamy, Chang-Kweng Lim, Lonika Lodha, Gathsaurie Neelika Malavige, Shoba Mammen, Mayfong Mayxay, Angel Miraclin T., Labanya Mukhopadhyay, Mick Mulders, Ashok Munivenkatappa, Adrian Keith Noronha, Mong How Ooi, Ashley Otter, Paul Pasco, Sakib Akther Pattassery, Shruti Radera, Vykuntaraju K. Gowda, Vijayalakshmi Reddy, Priscilla Rupali, Kavitha Saravu, Lucky Sangal, Sanyalack Saysanasongkham, Sadia Shakoor, Krishna Srinavasan, Sharmin Sultana, M. A. Ashwini, Bhagteshwar Singh, Tom Solomon, Ava Kristy S. Y., Le Van Tan, Kevin K. A. Tetteh, Trieu Huynh Trung, Lance Turtle, Ravi Vasanthapuram, Manjunatha M. Venkataswamy, Nguyen Thanh Vu, Robert J. Wilkinson, Sangay Zangmo, Reeta Mani, Sabine Dittrich

Japanese encephalitis (JE) virus (JEV) is a leading cause of neurological infection in the Asia-Pacific region with devastating socioeconomic consequences. We aimed to develop a target product profile (TPP) for JE diagnostics in endemic areas in the context of other flaviviruses, to better define improvements needed for patient management and public health. Thematic experts were identified from a scoping review, World Health Organization and Encephalitis International databases, as well as author networks. Initial interviews were performed with selected experts to inform a draft TPP document and start a Delphi process, aiming for consensus of ≥75% on each characteristic. A one-day meeting facilitated in-depth discussion, with breakout groups and electronic voting to develop the final TPP document. In total, 460 participants were invited. Five interviews enabled drafting a TPP. Two iterative surveys were completed by 44 respondents, including clinicians, scientists, and public health experts from 15 countries. A hybrid meeting was attended by 42 participants. Seven priority characteristics were discussed, and consensus was achieved for six; no clear consensus was reached for the preferred test sensitivity and specificity, with 73% agreement. Discussion points and expert consensus were consolidated into a roadmap for development and implementation to guide future work. A diverse group of health professionals agreed that improved diagnostics for JE are needed, and that a priority is a test for patient management that detects JE alongside other relevant flavivirus infections. There was a mandate for a rapid diagnostic test (RDT), and it was suggested that this could be implemented in a two-tiered diagnostic algorithm. The final TPP is presented in the paper; this aims to help define the updates needed to better support patient management and public health interventions, to provide a strategic reference document to drive innovation and improve clarity for JE diagnostic test developers.

Mitochondrial phylogeography and insecticide resistance of Aedes aegypti in Kenya

2026-09-08T14:00:00Z

by Brenda Musimbi, Sandy Hickson, Trizah K. Milugo, Eleanor Robinson-Rice, Josephine Osalla, Gilbert Rotich, Frank Jiggins, David P. Tchouassi

Aedes aegypti is the primary vector of arboviruses such as dengue, yellow fever, Zika, and chikungunya. Here, we investigate the mitochondrial DNA (mtDNA) structure and insecticide resistance of Ae. aegypti populations across Kenya. Using 175 newly sequenced Kenyan COI mtDNA fragments, along with global reference sequences, we assess maternal ancestry and phylogeographic structure. Genetic structure across Kenya was not well explained by isolation-by-distance alone, with several populations deviating from this pattern. Nairobi and Mombasa, separated by >400 km, showed greater maternal genetic similarity than expected under isolation-by-distance, a pattern that may reflect gene flow along transportation corridors. Conversely, Ukunda, around 30 km from Mombasa, was comparatively divergent, and populations in Western Kenya were genetically distinct. We found no evidence of non-African ancestry in mtDNA from Rabai or Mombasa despite its previous detection in the nuclear genomes of these populations. Instead, a subset of samples from Marigat and Ukunda showed the closest maternal affinity to West African and non-African lineages. Insecticide assays revealed high susceptibility to bendiocarb, deltamethrin, and fenitrothion across populations, but substantial resistance to permethrin, particularly at coastal sites. Genotyping of the kdr 1534C allele showed the highest resistance allele frequencies in coastal populations, broadly consistent with the phenotypic patterns. This variation in resistance was not associated with mitochondrial ancestry, suggesting that local selection pressures rather than shared maternal ancestry may be shaping resistance. Together, these findings describe the maternal genetic structure of Ae. aegypti in Kenya and show that localised resistance evolution, in the absence of organised Ae. aegypti-targeted control, underscores the need to monitor resistance mechanisms.

Outcomes of patients with suspected or confirmed melioidosis:A prospective multi-national, multicenter, observational study

2026-09-08T14:00:00Z

by Koukeo Phommasone, Siriluck Anunnatsiri, Suwatthiya Kitsaran, Sue J. Lee, Pankham Vongphachanh, Ko Chang, George H. Talbot, Kevin O’Shea, Paul B. Eckburg, Stephen D. Prior, Elizabeth A. Ashley, Nicholas P. J. Day, Direk Limmathurotsakul

Background

Melioidosis is an infectious disease caused by the Gram-negative bacterium Burkholderia pseudomallei. The disease is difficult to diagnose and treat. Here, we investigated outcomes of patients with suspected or confirmed melioidosis in Laos and Thailand.

Methodology

We conducted a prospective, multinational, multicenter, observational study at Mahosot Hospital (MH) in Laos, and Srinagarind Hospital (SRH) and Sunpasitthiprasong Hospital (SUH) in Thailand. We enrolled adult patients (age ≥ 18 years) with suspected or confirmed melioidosis. For suspected-melioidosis cases, patients who had septic shock, had sepsis with at least one risk factor associated with melioidosis (including diabetes mellitus, chronic kidney disease, thalassemia major, malignancy and immunosuppressive therapy) or were prescribed ceftazidime or meropenem by attending physicians were enrolled, provided they were within 24 hours of hospitalization at the study hospitals. For confirmed-melioidosis cases, patients who had a clinical specimen tested positive for B. pseudomallei by either culture or antigen-detecting immunofluorescence microscopy were enrolled. The primary endpoints were 28-day and 90-day mortality.

Principal findings

From November 2023 to October 2024, 627 patients were screened and 200 patients were enrolled (43 for suspected-melioidosis and 157 for confirmed-melioidosis). Five of 43 patients enrolled with suspected-melioidosis (12%) were subsequently diagnosed with culture-confirmed melioidosis since enrollment. 28-day and 90-day mortality were 14% (6/43) and 23% (10/43) in suspected-melioidosis patients, respectively; and 25% (39/157) and 36% (57/157) in confirmed-melioidosis patients, respectively. In multivariable Cox regression models, higher Sequential Organ Failure Assessment (SOFA) score at enrollment and intensive care unit (ICU) admission on the day of enrollment were strongly associated with mortality outcomes. Admission to SRH and longer duration of symptoms prior to enrollment were independently associated with survival outcomes.

Conclusions

Future clinical trials aiming to reduce mortality in patients with suspected or confirmed melioidosis should consider stratification based on the severity of organ dysfunction at enrollment. Differences in mortality between study sites may reflect residual confounding and should be carefully considered in sample size calculations.

A novel anaerobic cholinergic signaling compound, β-alanine betaine, and nAChRs in Ascaris

2026-09-08T14:00:00Z

by Paul D. E. Williams, David J. Borts, Dongjie Liu, Jacob Byerley-Duke, Brett VanVeller, Richard J. Martin

Anthelmintic drugs are used to control soil-transmitted helminths that infect a quarter of the world’s human population. There is increasing concern about the development of resistance to anthelmintic drugs because of the limited number of compounds available and there is an unmet need for new resistance-busting drugs. Here we describe the presence of a previously unrecognized endogenous acetylcholine (ACh) analogue, β-alanine betaine, which may serve as an endogenous ligand for an alternate subfamily of nicotinic receptors (DEG-3/DES-2) that could be developed as novel drug targets because their analogues are not present in their human or animal hosts. We collected pseudocoelomic fluid from female Ascaris suum (a model for the human parasite Ascaris lumbricoides) and subjected it to HILIC-MS and HILIC-MS/MS to reveal signals consistent with ACh, choline, and β-alanine betaine but not betaine, propionylcholine, butyrylcholine, or butyrobetaine. The presence of β-alanine betaine was confirmed by comparison with an analytical standard. Injection of betaine into female A. suum produced no effect. However, injection of β-alanine betaine produced characteristic pretzel coiling and injection of levamisole produced a rod-like spastic paralysis. The differences between β-alanine betaine and levamisole suggested that they activate different nAChRs subfamilies. RT-PCR showed that message for members of the DEG-3/DES-2 subfamily of nAChR channels, which are betaine targets, were present in the intestine and body wall of A. suum. β-alanine betaine increased intracellular Ca²⁺ of the intestinal enterocytes and depolarized the membrane potential of body wall muscle cells. In N2 Caenorhabditis elegans, application of β-alanine betaine produced gradual inhibition of motility, which was reduced in acr-20, acr-23, deg-3/des-2 and lgc-41 null-mutants. These observations suggest that, in addition to ACh, β-alanine betaine - an analog of betaine produced under anaerobic conditions - may function as an endogenous ligand in anaerobic nematodes such as A. suum. An expanded repertoire of nicotinic acetylcholine receptor subfamilies in nematodes relative to mammals may reflect a corresponding need for diversification of cholinergic endogenous ligands in these organisms. This repertoire could allow their simpler neuronal system to perform more complex controls and be exploited for development of different and novel subfamily selective cholinergic anthelmintics.

Population genomics reveals multi-scale mechanisms sustaining schistosomiasis re-emergence in a near-elimination setting

2026-09-08T14:00:00Z

by Hannah Guss, Yannick Z. Francioli, Elise N. Grover, Andrew Hill, Wei Zou, Kristen J. Wade, Hamish Pike, Siddharth S. Gopalan, Liu Yang, Zhong Bo, David D. Pollock, Elizabeth J. Carlton, Todd A. Castoe

In China, sustained snail control, environmental management, and mass drug administration with praziquantel reduced schistosomiasis to near-elimination levels, yet re-emergence in Sichuan Province during the early 2000s exposed vulnerabilities in elimination efforts. We used population genomics to investigate the multi-scale population processes underlying Schistosoma japonicum re-emergence in Sichuan. We sequenced whole genomes from 270 miracidia collected from 53 human hosts across 17 villages in 2007, one year after re-emergence was documented. Population genomic analyses identified a broadly cohesive regional schistosome population with weak geographic structuring. Genome-wide diversity remained substantial, and demographic reconstructions revealed no recent decline in effective population size, suggesting that parasite populations had not undergone regional demographic collapse prior to re-emergence and were likely maintained in non-human reservoir hosts. At finer spatial scales, several villages exhibited reduced genomic diversity and elevated inbreeding, consistent with localized transmission maintained by relatively small founding populations. Estimates of pairwise genetic relatedness revealed dense within-village sibling clusters alongside second- and third-degree relationships spanning villages, and rare first- and second-degree cross-village links, supporting predominantly local transmission embedded within a connected regional transmission network. Genomic inference of minimum reproducing worm pairs identified substantial heterogeneity in host-level worm burden, ranging from one to eleven adult worm pairs, although uneven sampling limited absolute estimates. Together, these findings indicate that parasite persistence in this near-elimination setting was sustained by interacting processes operating across multiple biological scales, including diverse regional parasite populations, localized transmission networks connecting villages, and marked heterogeneity in host-level worm burden. More broadly, this work demonstrates how population genomics can reconstruct otherwise hidden patterns of parasite persistence and transmission, providing a valuable complement to conventional epidemiological surveillance in complex, multi-host parasite systems.

Endemicity and environmental reservoirs of schistosomiasis and soil-transmitted helminth infections in Ghanaian rural communities

2026-09-03T14:00:00Z

by Rita Nyaaba Akologo, Isaac Williams, Dennis Adu-Gyasi, Dodzi Kofi Amelor, Rabbi Coffie Baidoo, Asenso Gideon, Akugre Alfred Akuka, Akua Obeng Forson, Samuel Fosu Gyasi, Emmanuel Timmy Donkoh

Background

Schistosomiasis and soil-transmitted helminth (STH) infections remain major neglected tropical diseases in low- and middle-income countries despite ongoing preventive chemotherapy programmes. This study assessed the prevalence, associated risk factors, and household environmental contamination related to schistosomiasis and STH infections among children in Banda District, Ghana.

Methodology

A community-based cross-sectional study was conducted in four endemic communities in the Banda District, Ghana, from February to April 2025. Pre-school and school-aged children (2–15 years) were recruited using systematic sampling. Urine samples were examined with urine sedimentation for S. haematobium ova, and stool samples were analyzed using Kato-Katz for STHs and S. mansoni ova. Household soil and animal faecal samples were examined using flotation and formalin-ether concentration techniques. Risk factors were assessed through structured questionnaires. Bivariate and multivariate logistic regression analyses were performed; variables with p ≤ 0.25 were included in the multivariate model, with a p < 0.05 considered statistically significant.

Results

The overall prevalence of schistosomiasis was 26.3%, and the prevalence of STH infections was 28.0%. In multivariate analysis, non-school attendance (AOR = 4.59; 95% CI: 2.49-8.47; p < 0.001) and children drinking from rivers/streams (AOR = 4.58; 95% CI: 1.73 – 12.10; p = 0.009) were associated with a higher odds of schistosomiasis. For STH infections, children aged 2–9 years (AOR = 2.18; 95% CI: 1.24–3.85; p = 0.007), non-school attendance (AOR = 5.91; 95% CI: 3.41–10.24; p < 0.001) and rearing of animal within house (AOR = 4.78; 95% CI: 2.32–9.86; p < 0.001) were associated with a higher odds of infection. Both soil and animal faecal samples harbored STHs with differing species distributions between matrices (soil: 7.08% positive; animal faeces: 10.67%).

Conclusion

This study revealed that schistosomiasis and helminth infections are prevalent among humans, animals, and the surrounding soil within shared environments. The findings support extending MDA to the community level and implement WASH, improved livestock management and health education to reduce transmission.

Why does local edema persist? Immunological mismatch between phospholipase A₂ potency and antivenom affinity in Protobothrops mucrosquamatus envenomation

2026-09-03T14:00:00Z

by Cheng-Hsuan Ho, Yu-Wei Chiang, Yan-Chiao Mao, Chih-Hsiung Hsu, Feng-Chen Chen, Shih-Hung Tsai, Shing-Hwa Liu

Background

Protobothrops mucrosquamatus is the primary species responsible for snakebite morbidity in Taiwan, typically resulting in severe localized tissue edema. Although freeze-dried hemorrhagic antivenom (FHAV) is the standard treatment, persistent swelling remains a frequent clinical challenge. This study aimed to identify primary edematogenic toxins and evaluate the neutralizing efficacy of FHAV and small-molecule inhibitors (SMIs) to address this therapeutic gap.

Methodology/principal findings

Multiple linear regression of a retrospective cohort of 50 patients was used to identify predictors of edema remission. Experimentally, a murine paw edema model was established to evaluate the potency of crude venom and isolated fractions (PLA₂, SVSP, and SVMP/CTL), whereas ELISA was used to determine FHAV immunoreactivity. Clinically, total FHAV dosage was the strongest independent predictor of the remission timeline (β = 0.658, T = 5.167, P < 0.001), accounting for 69.8% of the variance. Experimentally, the PLA₂-enriched fraction was identified as the primary edematogenic driver, eliciting swelling at 100 μg/mL, which was statistically indistinguishable from that of crude venom, whereas the other fractions required fivefold higher concentrations to achieve similar effects. However, ELISA revealed a significant immunological mismatch: the SVMP/CTL fraction sequestered 81.49% of the FHAV, indicating that highly potent PLA₂ was poorly targeted. Furthermore, SMIs (varespladib, marimastat, and batimastat) at 10 μM exhibited limited efficacy against crude venom-induced edema, suggesting that single-target interventions against the complex venom proteome are insufficient.

Conclusions/significance

Persistent localized edema arises from an immunological mismatch in which FHAV recognizes primarily high-molecular-weight immunogens instead of the primary edematogenic driver, PLA₂. Current clinical management necessitates increasing FHAV dosages to compensate for low specific affinity through increased total antibody volume. These findings highlight that robust prospective multicenter trials are urgently needed to transition from empirical dosing to standardized, potency-aligned FHAV protocols, potentially incorporating multimodal therapeutic cocktails to achieve comprehensive neutralization.

Predictive association between control measures and chikungunya fever incidence based on random forest and SHAP analysis

2026-09-03T14:00:00Z

by Fengling Chen, Jinsen He, Huihui Liu, Zhilin Wu, Jiwen Wu, Kunlu He, Hongjuan Wen, Xiaohua Li, Hongwei Wu, Lang Lang, Lijie Zhang

Background

Using the 2025 Chikungunya fever (CHIK) outbreak in Chancheng District, Foshan City, this study applied a random forest (RF) regression model combined with SHapley Additive exPlanations (SHAP) to explore predictive associations, nonlinear relationships and potential thresholds between environmental–social factors and village/community-level cumulative incidence, to inform stratified control of mosquito-borne diseases.

Methodology/principal findings

In this cross-sectional ecological study of 143 villages/communities, the outcome was cumulative incidence, and nine candidate covariates were assessed, including the hospitalization isolation rate, construction-site density, and population density. Multicollinearity was checked using the variance inflation factor. Model fit was evaluated by the out-of-bag (OOB) R², RMSE, and MAE, and variable importance by %IncMSE. Robustness was tested with 100 repeated runs, bootstrap thresholds from SHAP dependence plots, and a sensitivity analysis excluding the endogenous isolation rate. On the log(1 + incidence) scale, the OOB R² was 0.206, with underestimation of high-incidence areas. The hospitalization isolation rate had the highest importance (%IncMSE = 18.43) and was negatively correlated with predictions (ρ = −0.749), but this likely reflects reverse causation and is predictive only. Construction-site density was strongly positive (ρ = 0.855), with a stable threshold near 12.8 sites/km²; it remained the most robust predictor after removing the isolation rate (%IncMSE = 8.54).

Conclusions/significance

Construction-site density was the most robust environmental predictor, whereas population density contributed little. These exploratory, predictive associations—not causal effects—should guide risk stratification and require prospective validation with time-matched longitudinal data.

Preparing for the tiny predators: Community readiness and perceptions of copepod-based dengue control in eastern guatemala

2026-09-03T14:00:00Z

by Valérie R. Louis, Carlos Alberto Montenegro-Quinoñez, Till Bärnighausen, Peter Dambach

Background

Dengue remains a persistent public health challenge in eastern Guatemala, particularly in communities where irregular water supply, domestic water storage, and limited sanitation infrastructure create favorable conditions for Aedes aegypti proliferation. As concerns increase about the sustainability of chemical vector control, biological approaches such as the use of predatory copepods are receiving renewed attention. However, successful implementation depends not only on biological efficacy, but also on community awareness, acceptance, and willingness to adopt unfamiliar control methods.

Methodology/Principal Findings

We conducted a cross-sectional Knowledge, Attitudes, and Practices (KAP) survey among 346 adult household representatives in eight urban and rural communities in the departments of Zacapa and Chiquimula, Guatemala. The study assessed dengue-related knowledge, household prevention practices, perceived risk, and attitudes toward potential future copepod-based biological control. Most respondents correctly identified mosquitoes as the vector of dengue, but knowledge of breeding sites and preventive measures was less comprehensive and varied by educational level. Preventive practices were inconsistent: 37% of households reported taking no action to eliminate mosquito breeding sites, and only a minority reported using multiple prevention strategies. Although prior familiarity with copepods was limited, willingness to consider their use was high when linked to clear information, technical support, and assurances regarding water safety. Concerns focused primarily on the introduction of organisms into stored water and lack of knowledge about the method, particularly in urban communities.

Conclusions/Significance

The findings indicate a substantial gap between basic dengue awareness and routine household prevention practices in eastern Guatemala. At the same time, the high conditional openness toward copepod-based control suggests that biological approaches may be socially acceptable if introduced through trusted local actors, transparent communication, and community engagement. These results support the further exploration of copepod-based interventions as a complementary, non-chemical vector control strategy. However, community acceptance should not be interpreted as evidence of effectiveness; rigorous field trials are needed to evaluate entomological impact, operational feasibility, safety, and sustainability under local environmental and household water-storage conditions.

Widespread circulation of West Nile and Usutu viruses in sedentary and migratory avifauna: A two-year study (2024–2025) of active surveillance in South of France

2026-09-03T14:00:00Z

by Rachel Beaubaton, Justine Revel, Laetitia Pigeyre, Alexandre Lepeule, Julien Joly, Christophe de Franceschi, Anne Charmantier, Benjamin Vollot, Yannick Simonin

West Nile virus (WNV) and Usutu virus (USUV) are neurotropic Orthoflaviviruses sharing a similar enzootic transmission cycle primarily involving Culex pipiens mosquitoes as vectors and birds as amplifying hosts. First identified in Africa, both viruses established endemicity across Europe over the past two decades, most likely introduced and spread by migratory bird species along Mediterranean flyways. In avian species, infection outcomes range from subclinical to fatal neuroinvasive disease, varying by viral strain, host immunity, and species susceptibility. Southern France emerges as a key hotspot for the circulation of these viruses, supported by diverse avian habitats conducive to year-round viral maintenance. This study investigated the RNA prevalence of WNV and USUV in more than 2500 sedentary and migratory wild birds from these regions during 2024–2025 using molecular surveillance. Samples were collected using mist net and bird boxes, across multiple passerine and non-passerine taxa, spanning wetlands, urban fringes, and agricultural zones. Our analyses revealed widespread viral detection across diverse species, mainly among passerines such as great tits, house sparrows, and barn swallows with USUV detected at higher rates than WNV in both study years. Overall RNA prevalence was markedly higher in 2024 than in 2025, potentially reflecting climatic or ecological drivers. These results highlight the pivotal role of mixed avifauna in arbovirus dynamics within Mediterranean Europe and emphasize the necessity for integrated, year-round surveillance targeting high-risk species and habitats.

Qualitative risk assessment of Japanese encephalitis virus introduction and transmission in Pacific Island countries and territories

2026-09-03T14:00:00Z

by Eloise B. Skinner, Amanda K. Murphy, Fan Yu, Kevin Thabo Moore, Liuyi Chen-Cao, David T. Williams, Stephan Karl, Joelyn Goi, Colleen L. Lau, Benn Sartorius

Background

The emergence of Japanese encephalitis virus (JEV) in Australia raises questions about transmission potential across neighbouring Pacific Island countries and territories (PICs), where surveillance infrastructure and diagnostic capacity are limited.

Methodology

We conducted a qualitative risk assessment of 22 PICs structured around three components: (1) ‘release assessment’, evaluating JEV introduction pathways based on geographic proximity, migratory waterbird flyway connectivity, and windborne mosquito dispersal potential; (2) ‘exposure assessment’, evaluating ecological transmission suitability based on vector and host competence and occurrence; and (3) ‘risk characterisation’, integrating release and exposure components to stratify countries into transmission risk profiles (endemic, epidemic, and low potential). Introduction potential varied across the region, with northern and western PICs having greatest connectivity to endemic regions. Ecological suitability for transmission was sufficient to support JEV transmission in 13 of the 22 PICs if introduced. Eight PICs were characterised as having endemic transmission potential (Papua New Guinea, which already has confirmed circulation, Solomon Islands, New Caledonia, Vanuatu, Fiji, Palau, Guam, and Northern Mariana Islands), based on diverse competent vector communities, high ardeid waterbird diversity, and moderate-to-high introduction potential. Five PICs (Federated States of Micronesia, Tonga, Samoa, Tuvalu, and Nauru) were characterised as having epidemic transmission potential, supported by pig densities capable of amplifying viral titres and sufficient vector diversity, but lacking ardeid populations necessary to sustain endemic cycles. The remaining nine PICs had low transmission potential due to limited vector and host communities. These risk stratifications are relative; the absolute probability of JEV establishment in any PIC remains uncertain.

Conclusions

Distinct transmission profiles require differentiated public health responses, from sustained surveillance in endemic-potential settings to early detection and rapid outbreak response in epidemic-potential settings. Regional coordination through shared diagnostic networks and vaccine access pathways is critical to support preparedness before JEV becomes established across the Pacific.

Estimating enteric fever seroincidence in rural western Cambodia: Findings from a population-based cross-sectional serosurvey

2026-09-02T14:00:00Z

by Meiwen Zhang, Natnaree Saiprom, Rupam Tripura, Lek Dysoley, Phal Chanpheakdey, Vanna Moul, Arjun Chandna, Elizabeth M. Batty, Sue J. Lee, Richard J. Maude, Nicholas P. J. Day, Thomas J. Peto, Narisara Chantratita, Richelle Charles, Yoel Lubell, Kristen Aiemjoy

Introduction

Enteric fever, caused by Salmonella enterica serovars Typhi and Paratyphi, remains an important cause of febrile illness in low- and middle-income countries (LMIC). However, the exact burden is difficult to estimate due to limitations in diagnosis and surveillance.

Methods

Samples from a representative cross-sectional household serosurvey in rural western Cambodia were used to estimate enteric fever seroincidence among children and young adults. Participants were enrolled between April 7 and December 10, 2023, and 529 samples from individuals aged 5–25 years were analysed. Using IgA and IgG responses to hemolysin E antigen and established models of antibody decay after infection, we estimated seroincidence, conveying the rate of new infection in the population over time.

Results

The overall enteric fever seroincidence rate was 161.8/1,000 person-years (95%CI: 147.5, 177.5). Among children 5–15 years, it ranged between 149.5 (95%CI: 120.8, 185.1) and 239.0 (95%CI:188.7, 302.7) across districts. Seroincidence was higher among children 5–15 years from households with unimproved drinking water sources or sanitation facilities, and in districts with a higher proportion of households with unimproved WASH.

Conclusion

These findings potentially support the introduction of the typhoid conjugate vaccine in rural western Cambodia. However, additional data on the relative contribution of S. Typhi versus S. Paratyphi is needed. We also demonstrate seroincidence as an adjunctive valuable surveillance tool in LMICs where facility-based surveillance may be inadequate.

Chikungunya waves in 2025 signal risk of endemicity in China

2026-09-02T14:00:00Z

by Kok Keng Tee, Dongkui Mu, Xueshan Xia

Chikungunya virus (CHIKV) transmission in Guangdong, southern China, intensified markedly in 2025, with successive outbreak waves in Foshan and Jiangmen followed by wider dissemination across all 21 prefectures during a peak domestic travel period. By late 2025, more than 25,000 cases had been reported, suggesting a departure from the historically import-driven and geographically limited outbreaks previously observed in China. These observations raise the possibility of an early transition towards more sustained transmission, although repeated introductions followed by local amplification remain an alternative explanation. Key contributing factors include mobility-associated amplification, climate variability, flood-related expansion of mosquito breeding habitats, favourable urban ecology, and incomplete interruption of transmission during cooler months. Although winter temperatures are suboptimal for sustained transmission, vector persistence and possible vertical viral transmission may permit low-level circulation between epidemic waves. In this context, distinguishing repeated importation from local persistence becomes critical. Preventing endemic establishment will require sustained inter-epidemic surveillance, anticipatory vector control, and clearer policy pathways for deployable vaccination strategies.

Understanding the association between immune-modulating helminths and HPV or cervical cancer: A scoping review

2026-09-02T14:00:00Z

by Allison Frank, Margarita Correa-Mendez, Alicia A. Livinski, Kalina Duncan, Eva H. Clark, Patti E. Gravitt

Background

Cervical cancer disproportionately affects people living in low- and middle-income countries (LMICs). While access to effective preventive interventions explains some of the disparity, biological causes cannot be ruled out as important contributors to the observed disparities in cervical cancer outcomes. Since chronic infection with helminths which cause immune dysregulation and suppress anti-viral responses is common in LMICs, we sought to review the available epidemiologic evidence evaluating associations between helminth infection and HPV infection and/or cervical cancer.

Methods

We searched five databases of scientific publications using search terms targeted towards journal articles published between 1990–2022 evaluating an epidemiologic association between helminth infection and HPV prevalence, persistence, or cervical cancer progression. Out of 93 reports assessed for eligibility, we identified eight relevant studies and describe them in this scoping review.

Results

All eight studies suggest a possible positive association between helminth infection and HPV or cervical cancer. Six studies found a positive trend in association between schistosomiasis and cervical neoplasia; two studies between hookworm infection and HPV prevalence; and 1 study between Ascaris, Trichuris, and Strongyloides and HPV prevalence.

Conclusions

Published evidence suggests positive trends towards an association between helminth infection and cervical neoplasia. Given the high burden of helminth and HPV co-infection in LMICs, further evaluation of the association between helminth infection and HPV or cervical cancer is warranted.

Talaromycosis-associated immune reconstitution inflammatory syndrome exhibits immune dysregulation in patients with acquired immunodeficiency syndrome

2026-09-01T14:00:00Z

by Bei Zhao, Qinzhi Zhang, Pengle Guo, Yingyin Yang, Feilong Xu, Xuemei Ling, Kaiyin He, Xiejie Chen, Xiaoping Tang, Huihua Zhang, Linghua Li

Background

Talaromycosis (TSM) is a severe opportunistic fungal infection that mostly infects patients with acquired immunodeficiency syndrome (AIDS). After antiretroviral therapy (ART), AIDS patients with TSM may develop immune reconstitution inflammatory syndrome (IRIS), leading to the paradoxical worsening of clinical symptoms. However, the immunological characteristics of TSM-related IRIS (TSM-IRIS) in AIDS patients remain poorly understood.

Methodology/Principal Findings

We conducted a longitudinal cohort study of AIDS patients with TSM and analyzed the immunological features using flow cytometry, transcriptome, and multiplex cytokine assays at admission, ART initiation, and at 2, 4 weeks after ART initiation. Patients with TSM-IRIS displayed significantly higher baseline CD3 ⁺ T cells at admission and lower frequencies of PD-1 ⁺ CD4 ⁺ T cells at ART initiation than those without IRIS (non-IRIS). After ART initiation, TSM-IRIS was associated with dynamic transcriptomic changes involving inflammatory and immune-related pathway enrichment, along with sustained elevations of interleukin (IL)-17, IL-21, C-X-C motif chemokine ligand (CXCL) 5, and CXCL12. Transcriptomic analysis revealed the dynamic enrichment of pro-inflammatory pathways prior to and during the early phase of ART.

Conclusion/Significance

AIDS patients with TSM-IRIS exhibited an immune profile associated with enhanced T cell activation, characterized by accelerated immune reconstitution accompanied by heightened inflammatory activity during the early phase of ART, may potentially acting as the immune markers for prediction or diagnosis of TSM-IRIS in AIDS patients.

Distinguishing dog-bite and rabies vulnerability in children to strengthen global elimination efforts

2026-09-01T14:00:00Z

by Harish Kumar Tiwari

Dog-mediated rabies remains a preventable cause of mortality in children, particularly in low- and middle-income countries where free-roaming dogs are common. While the WHO-led “Zero by 30” strategy emphasises mass dog vaccination and access to post-exposure prophylaxis (PEP), less attention has been paid to the behavioural and communication pathways that shape children’s vulnerability. This Viewpoint proposes a conceptual distinction between vulnerability to dog bites and vulnerability to rabies following exposure. Conflating these risks may contribute to diffuse messaging and missed prevention opportunities. This Viewpoint argues for a differentiated child-facing and adult-facing interventions, with schools positioned as adaptable platforms for integrating safe behaviour, disclosure, and timely care-seeking within existing systems. Aligning behavioural, educational, and biomedical components more explicitly may strengthen implementation of global rabies elimination strategies and reduce paediatric deaths.

Syndromic cholera diagnosis masks diverse causes of diarrhoeal disease in Burundi revealed by portable metagenomics

2026-09-01T14:00:00Z

by Emilie Egholm Bruun Jensen, Néhémie Nzoyikorera, Mirena Ivanova, Pimlapas Leekitcharoenphon, Marie Noelle Uwineza, Idrissa Diawara, Joseph Nyandwi, Frank M. Aarestrup, Saria Otani

Background

Cholera outbreaks remain a major public-health challenge in sub-Saharan Africa, where diagnostic capacity is limited and clinical case definitions are non-specific and re ly heavily on syndromic diagnosis. Rapid identification of Vibrio cholerae is critical, yet cholera-suspected diarrhoea can have multiple infectious causes not captured by targeted diagnostics.

Methods

We evaluated a mobile, culture-independent metagenomic sequencing workflow for on-site detection of gastrointestinal pathogens directly from faecal samples in Burundi. The offline workflow combined long-read Oxford Nanopore Technologies (ONT) sequencing with rapid, laptop-based taxonomic and antimicrobial resistance (AMR) screening and was deployed across a health centre, a district hospital, and a refugee transit camp. The frontline and real-time results were verified using both conventional culturing and in-depth bioinformatic analyses.

Results

V. cholerae signals were only detected in a subset of suspected cholera cases, while many samples were dominated by alternative bacterial taxa, most frequently Escherichia coli. V. cholerae abundance correlated strongly with detection of the C holera T oxin P hage CTXφ, supporting differentiation between toxigenic signal and background exposure. AMR genes were detected across samples, providing early situational insight into resistance determinants among gastrointestinal bacteria.

Conclusions

Mobile, offline metagenomic sequencing enables rapid frontline characterization of gastrointestinal disease, especially cholera-suspected, in resource-limited settings and complements existing diagnostics by improving etiological resolution and outbreak response.

Epidemiological shift in age distribution of dengue in Thailand, 2005–2024

2026-08-31T14:00:00Z

by Kittipong Sornlorm, Roshan Kumar Mahato, Sarayu Muntaphan, Kanit Hnuploy, Rajitra Nawawonganun

Dengue has historically been characterized as a childhood disease, but evidence of shifting age distribution is increasing. We analyzed 20 years (2005–2024) of national dengue surveillance data from Thailand comprising 1,639,442 cases to examine temporal trends in age-specific incidence, quantify age shift magnitude using the ratio of incidence rate ratios (RIRR), and decompose observed changes using Kitagawa decomposition. The proportion of cases among adults ≥25 years nearly doubled from 19.56% to 36.16%, while the children’s proportion declined from 54.49% to 41.63%. RIRR for adults 25–44 years was 1.78 (95% CI 1.76-1.80), and for older adults ≥45 years was 2.19 (95% CI 2.15-2.24). Kitagawa decomposition attributed +178.7% of change to epidemiological factors and -78.7% to demographic shifts, supporting a declining force of infection rather than population aging as the primary driver. These findings necessitate expanding dengue prevention beyond school-based programs and enhancing clinical vigilance for adult dengue.

The spatial structure of dengue transmission in Kamphaeng Phet Thailand

2026-08-31T14:00:00Z

by Sarah H. Ooi, Angkana T. Huang, Surachai Kaewhiran, Aaron Farmer, Darunee Buddhari, Tao Li, Jaykumar Gandhi, Adam R. Pollio, Jun Hang, Matthew A. Conte, Derek A. T. Cummings, Kathryn Anderson, Henrik Salje

Background

Dengue virus (DENV) is a mosquito transmitted arbovirus that represents a severe threat to global populations. The four serotypes of DENV often circulate endemically resulting in many discrete but overlapping transmission chains in space and time, effectively hiding the underlying patterns of transmission, and longer term consequences on local population immunity. Here we combined serotyped case data with sequence data from a single setting over 25 years to characterise the spatial dependence between cases, the number of distinct transmission chains circulating at any time and whether community transmission was followed by serotype-specific local herd immunity.

Methodology/principal findings

In this study, we combined geolocated case data (N = 7,487) from individuals that presented at a provincial hospital in Kamphaeng Phet Province, Thailand alongside a subset of the sequences of the viruses (N = 302) that infected them. We estimated the spatial dependence between case pairs over different temporal and spatial windows, using both serotype and sequence data, and used logistic regression to identify whether host population size or epidemic size were correlated with viral diversity. We found there was spatial dependence between cases at up to 5 km, resulting in localised serotype-specific patterns of immunity in subsequent years. Within a 78.5 km² area there were 9.6 distinct transmission chains at any time and that each 100,000 increase in population size was associated with 9.8 additional chains. While local viral diversity was also correlated with the size of the epidemic within any month, we found diversity only had moderate predictive power to accurately recover epidemic dynamics.

Conclusions/significance

These findings highlight the nuanced and spatially variable ecology of a highly endemic pathogen with substantial immunity. This study also illustrates the strengths of combining multiple data sources to shed light on the nature of DENV transmission.

Declining Onchocerca volvulus transmission despite limited ivermectin delivery in the Kakoi–Koda focus, Ituri, Democratic Republic of the Congo: An epidemiological, entomological and landscape evidence synthesis

2026-08-31T14:00:00Z

by Luís-Jorge Amaral, Tony Ukety, Jules Upenjirwoth, Deogratias Ucima Wonya’Rossi, Michel Ndahura Mandro, Françoise Nyisi, Pascal Adroba, Wilma A. Stolk, Joseph N. Siewe Fodjo, María-Gloria Basáñez, Anne Laudisoit, Robert Colebunders

Background

The Kakoi–Koda focus in Ituri Province was historically hyperendemic for onchocerciasis, yet screening for a recent trial suggested a marked decline, including in Logo Health Zone, which had never received routine ivermectin. We explored whether this decline extended across the focus and how infection indicators corresponded spatially with ivermectin delivery, entomological observations and deforestation.

Methodology

We conducted a scoping evidence synthesis of epidemiological, programmatic, entomological and geospatial sources. Against a 2003 nodule-mapping baseline, change was assessed from repeated cross-sectional moxidectin trial screenings in 2010–11 and 2021–2023, which applied the same four-skin-snip protocol to community-recruited residents aged ≥12 years. Anti-Ov16 serology (2015–21), two-skin-snip surveys (2015/17), exploratory blackfly observations (2009–18) and remotely sensed tree-cover loss (2001–24) provided further contextual evidence.

Principal findings

Between the two trial screenings, microfilarial prevalence significantly declined from 79.0% to 9.0% (Draju) and 68.9% to 8.6% (Kanga) in Logo, similar to declines observed in villages of Nyarambe Health Zone (72.2% to 2.9%), which received routine ivermectin for lymphatic filariasis. Mean infection intensity mirrored this pattern, from 17-26 to 1 microfilariae per milligram of skin in Logo, and 11 to 0.4 in Nyarambe. Seroprevalence in children aged 3–10 years from 2016 onward was low (0–5%), geographically circumscribed and broadly concordant with the skin-snip spatial pattern. Opportunistic blackfly collections and breeding-site prospections detected Simulium dentulosum and S. vorax as the current anthropophagic species, with no evidence of S. neavei after 2009. Extensive dense forest loss (75–90% in historically hyperendemic Logo) and canopy opening are consistent with a shift from crab-associated S. neavei habitats towards more open-habitat vectors, providing a plausible ecological mechanism.

Significance

Parasitological, serological, entomological and geospatial evidence consistently indicates substantial declines in O. volvulus infection indicators across Kakoi-Koda, compatible with reduced transmission. Residual positive indicators were spatially circumscribed, including in Logo where no routine ivermectin was delivered. Whether the current simuliid species can sustain transmission above elimination thresholds remains uncertain. Standardised, representative surveys in the Muda/Kuda and Lebu River basins are warranted to guide decisions on starting and stopping ivermectin delivery.

Knowledge, Attitudes and Practices (KAP) on Dengue Fever in Burkina Faso: Findings from the national household survey in Burkina Faso

2026-08-31T14:00:00Z

by Nicolas Ouédraogo, Siaka Débé, Harouna Soré, Farida Tiendrébégo, Gérard Wendyam Nonkani, Guillaume Sylvestre Sanou, Réné Kinda, Adama Ganou, Casimire Wendlamita Tarama, Sonia Ilboudo, Moussa Wamdaogo Guelbéogo, Isaie Medah, Adama Gansané

Background

Dengue fever is an emerging public health concern in Burkina Faso, with increasing outbreaks and data gaps in population awareness. This study assessed knowledge, attitudes, and practices (KAP) related to dengue fever in all health regions of the country.

Methodology/principal findings

A nationwide cross-sectional household survey was conducted in May 2022 using a stratified two-stage cluster sampling design. One rural and one urban area were selected per region. Heads of households or their representatives were interviewed using a structured questionnaire. Data were collected electronically and analyzed using Stata. A total of 1,568 participants were enrolled (52.0% male; 48.0% female). Overall, 66.3% had heard of dengue, with higher awareness in urban than rural areas. Only 49.0% correctly identified mosquito bites as the mode of transmission, and 29.9% did not know what dengue is. Most respondents (88.3%) stated that dengue can affect everyone. Regarding prevention, 80.2% reported sleeping under a mosquito net, 49.0% eliminated stagnant water, and 45.4% used mosquito repellents. In practice, 67.6% consistently slept under mosquito nets and 82.6% used repellents. Almost all respondents (98.6%) reported that they would consult a health professional if they had symptoms of dengue. However, knowledge about treatment and vaccination was limited, with 46.5% and 56.6% respectively reporting not knowing whether drugs or vaccines exist.

Conclusions/significance

This study highlights moderate awareness but substantial knowledge gaps and urban–rural disparities in dengue-related KAP in Burkina Faso. Strengthening community-based education and integrated vector control strategies is essential to improve prevention and reduce dengue transmission.

Repurposing niclosamide ethanolamine for alveolar echinococcosis reveals a disconnect between in vitro efficacy and in vivo outcome in the intraperitoneal infection model

2026-08-31T14:00:00Z

by Matías Preza, Nicole Dietrich, Pascal Zumstein, Judith Steinmann, Lea Hiller, Trix Zumkehr, Tobias Kämpfer, Marylène Chollet-Krugler, Laura Vetter, Andrew Hemphill, Sarah Dion, Britta Lundström-Stadelmann

Background

Echinococcosis is a zoonotic disease caused by cestodes of the genus Echinococcus. Alveolar echinococcosis (AE), caused by E. multilocularis, primarily affects the liver and shows infiltrative, tumor-like growth of the metacestode stage. If untreated, AE is lethal. AE remains a neglected disease with current treatments based on albendazole or mebendazole that are parasitostatic, and not curative, underscoring the need for more effective therapies. Niclosamide is a chlorinated salicylanilide derivative with proven activities against intestinal helminths but is inactive against tissue-dwelling helminths due to poor absorption and limited bioavailability. In this study, we repurposed niclosamide ethanolamine (NEN), a formulation with improved systemic exposure, for the treatment of E. multilocularis infection in vitro and in vivo.

Methodology/principal findings

We assessed the in vitro efficacy of niclosamide and NEN against E. multilocularis metacestode vesicles (IC₅₀ < 0.2 µM) and primary parasite cells (IC₅₀ < 0.3 µM), with active concentrations largely corresponding to NEN levels reachable in the liver. Metabolic analysis suggested that NEN acts as a mitochondrial uncoupler. Electron microscopy showed that NEN-treatments induced profound structural damage in the metacestode vesicle tissue, but mitochondrial ultrastructure was not notably affected.In mice intraperitoneally infected with E. multilocularis, NEN was orally administered during 9 weeks either alone, or in combination with albendazole. Pharmacokinetic analyses showed that NEN reached blood level concentrations above 1 µM. However, the parasite burden in NEN-treated mice was not significantly reduced under the conditions used in this study.

Conclusions/significance

Although niclosamide and NEN demonstrated potent activity against E. multilocularis in vitro, this efficacy did not translate in the mouse model. The lack of in vivo activity could be attributed to several factors such as infection model, limited drug uptake by the parasite in the animal, or the rapid metabolization of the compound. Future studies should explore novel niclosamide derivatives and formulations to enhance efficacy against AE in vivo.

PLOS Neglected Tropical Diseases: New Articles

Correction: Cost of illness of scrub typhus in South India – a population-based, mixed-methods study

Friends or foes: Unraveling the tsetse fly-Spiroplasma symbiosis

A clinical scoring system for the early identification of superinfections in patients with severe fever with thrombocytopenia syndrome: An ambispective multicentre cohort study

Direct whole-genome sequencing of Coxiella burnetii from environmental samples using a two-step selective enrichment approach

Gendered experiences of people living with tuberculosis or leprosy: A global systematic review

A qPCR identification scheme to detect the most common causative agents of actinomycetoma in Africa

A scoping review of the frequency and clinical presentation of Taenia solium taeniasis and human cysticercosis/neurocysticercosis in Papua, Indonesia from 1970 to 2024

Evaluation of a Zika virus-like particle-based vaccine in a highly penetrant non-human primate model of congenital infection

A target product profile and roadmap for Japanese encephalitis diagnostics in endemic areas in the context of other flaviviruses

Mitochondrial phylogeography and insecticide resistance of Aedes aegypti in Kenya

Outcomes of patients with suspected or confirmed melioidosis:A prospective multi-national, multicenter, observational study

A novel anaerobic cholinergic signaling compound, β-alanine betaine, and nAChRs in Ascaris

Population genomics reveals multi-scale mechanisms sustaining schistosomiasis re-emergence in a near-elimination setting

Endemicity and environmental reservoirs of schistosomiasis and soil-transmitted helminth infections in Ghanaian rural communities

Why does local edema persist? Immunological mismatch between phospholipase A2 potency and antivenom affinity in Protobothrops mucrosquamatus envenomation

Predictive association between control measures and chikungunya fever incidence based on random forest and SHAP analysis

Preparing for the tiny predators: Community readiness and perceptions of copepod-based dengue control in eastern guatemala

Widespread circulation of West Nile and Usutu viruses in sedentary and migratory avifauna: A two-year study (2024–2025) of active surveillance in South of France

Qualitative risk assessment of Japanese encephalitis virus introduction and transmission in Pacific Island countries and territories

Estimating enteric fever seroincidence in rural western Cambodia: Findings from a population-based cross-sectional serosurvey

Chikungunya waves in 2025 signal risk of endemicity in China

Understanding the association between immune-modulating helminths and HPV or cervical cancer: A scoping review

Talaromycosis-associated immune reconstitution inflammatory syndrome exhibits immune dysregulation in patients with acquired immunodeficiency syndrome

Distinguishing dog-bite and rabies vulnerability in children to strengthen global elimination efforts

Syndromic cholera diagnosis masks diverse causes of diarrhoeal disease in Burundi revealed by portable metagenomics

Epidemiological shift in age distribution of dengue in Thailand, 2005–2024

The spatial structure of dengue transmission in Kamphaeng Phet Thailand

Declining Onchocerca volvulus transmission despite limited ivermectin delivery in the Kakoi–Koda focus, Ituri, Democratic Republic of the Congo: An epidemiological, entomological and landscape evidence synthesis

Knowledge, Attitudes and Practices (KAP) on Dengue Fever in Burkina Faso: Findings from the national household survey in Burkina Faso

Repurposing niclosamide ethanolamine for alveolar echinococcosis reveals a disconnect between in vitro efficacy and in vivo outcome in the intraperitoneal infection model

Why does local edema persist? Immunological mismatch between phospholipase A₂ potency and antivenom affinity in Protobothrops mucrosquamatus envenomation