Eurosurveillance

Background During infectious disease outbreaks, characteristics of reported cases are routinely collected. These give information on becoming infected but not on infecting others. We assess whether linking infectees to infectors, together with their characteristics, can help understand transmission. Methods From the start of the COVID-19 pandemic in the Netherlands, reported cases were asked to identify their most probable infector in routine surveillance, enabling the linking of cases. We assess for the period 27 February 2020 - 11 April 2022 whether the infectees of these transmission pairs are representative of all reported cases, whether the transmission pairs yield verifiable estimates of epidemiological characteristics (here the serial interval), and whether they provide information on transmission that cannot be obtained otherwise. Results Of 8,003,008 reported cases, 678,482 (8.5%) could be linked to their most probable infector. These infectees were largely representative of the reported cases regarding age group, sex, and geographical location. The mean serial interval of 3.6 days (sd 3.4 days) from transmission pairs aligns with literature. Transmissions between age groups largely follow known contact patterns. Most transmissions in September 2021 occurred between persons who were not (fully) vaccinated, indicating the effectiveness of the vaccine, and relatively few between persons with different vaccination status, indicating assortative mixing in vaccination status. Conclusion Transmission pairs can be efficiently collected in routine surveillance, providing insight into disease transmission. The current post-pandemic period provides an excellent opportunity to adjust reporting systems for linking infectees to their most probable infector as preparation for future outbreaks.

BackgroundEstimates of disease burden from hospital data require well-informed estimates of the size of the catchment population. Data on patient flows from residential areas to a hospital can be used to estimate detailed catchment populations by age, year and type of hospital visit. MethodsCatchment populations were estimated for hospitals throughout France using a proportional flow approach. Data on hospital use and patient residence were accessed from the Agence Technique de lInformation sur lHospitalisation (ATIH). For patients coming from each administrative area, we calculated a preference for each hospital, and combined this with population data for the area to estimate the catchment population of each hospital. For one hospital group, we compared this with data on emergency visits, and data from a retrospective cohort study. ResultsEstimated catchment population by hospital group ranged from 4 million per year for Assistance Publique - Hopitaux de Paris (AP-HP) downwards, with the catchment population strongly reflecting geographic proximity and hospital scale. The type of hospital substantially impacted the size of the catchment area. In the analysis of a single hospital group, the size of the catchment population varied widely with the diagnostic categories associated with the hospital visit. Emergency visits represented a smaller catchment population. The estimated proportional contribution of different departments to the estimated catchment population was similar to their contribution to observed hospital admissions. Incidence rates for a respiratory virus using this catchment population estimation method were consistent with national incidence rates. ConclusionsThis study demonstrates the consistency of the proportional flow framework when applied to appropriate data on hospital usage. The study provides catchment populations for each hospital in France which can be used for burden estimates such as incidence rates, as well as providing insight into the catchment populations served. Analysis at the department geographic level provided an appropriate balance between detail of analysis and the need to mask data for anonymisation. Further analysis should explore how the size of the catchment area corresponds to the associated travel time to the hospital in question.

Background: Human metapneumovirus (hMPV) is commonly associated with respiratory tract infections (RTIs) in young children. Methods: We estimated the annual hospital incidence of hMPV RTIs in children under 5 years in Scotland from 2017 to 2023 using national hospital and laboratory data. Incidence outside Lothian, where testing practices were uncertain, was extrapolated from Lothian laboratory data, where hMPV testing was advised for all RTI admissions. We also examined the severity and mortality of laboratory-confirmed hMPV cases. We developed similar estimates for RSV and Influenza A for comparison. Results: This analysis included 1,462 laboratory-confirmed hMPV hospitalisations in children aged under 5 years. The extrapolated hMPV hospital incidence ranged from 19 per 100,000 to 537 per 100,000 in children aged under 5 years. The extrapolated incidence was two to three times higher than that based on laboratory-confirmed data. Hospital incidence was higher in infants than in toddlers. hMPV incidence dropped substantially during the 2020/21 season, followed by a rebound during the 2021/22 season. About 10% of hMPV RTI hospital admissions required hospital stay [&ge;]5 days, but <1% required intensive care unit admissions or resulted in in-hospital death. RSV hospital incidence appeared substantially higher than the hMPV hospital incidence in this population. Conclusions: hMPV RTIs contribute to a substantial hospital burden in young children in Scotland. However, the RSV RTI burden is likely to be higher in the population unvaccinated against both viruses. Improved surveillance and diagnosis strategies are required to develop robust hospital burden estimates.

We conducted a systematic review (PROSPERO CRD42023393345) characterising the epidemiology, outbreaks and mathematical models of Nipah virus (NiV), an important public health threat in South and Southeast Asia. We extracted 243 parameters, 89 risk factors, 39 models and 23 distinct outbreaks from 119 papers. IgG seroprevalence estimates ranged from 0% to 12.5%. NiV causes severe disease, with pooled case-fatality ratio estimates ranging widely from 9.1% (95%CI: 0.2%-41.3%) in Singapore to 81.9% (95%CI: 71.9%-88.9%) in Bangladesh. NiV's natural history is poorly characterised; we estimated a median incubation period of 8.77 days (95%CI: 7.53-10.02) based on 8 studies. Transmission parameter estimates were scarce, and all but one central estimate of the basic reproduction number were below 1. NiV mathematical models (n=39) were rarely fitted to data (n=8). All extracted information is accessible via our R package, epireview, a dynamic resource for informing responses to future outbreaks of NiV and related pathogens.

Many studies have identified antibiotic resistant (ABR) Escherichia coli on meat. Appropriate hand hygiene and cooking practices should minimise the risk of gastrointestinal colonisation with ABR E. coli found on meat, and the subsequent chance of causing resistant opportunistic extraintestinal infection. There are large gaps in our understanding of the prevalence, origins and zoonotic potential of ABR E. coli found on meat, however, and particularly for meat reared in extensive farming systems. Wales is a devolved nation within the United Kingdom having large populations of extensively-reared sheep and beef cattle. To help address knowledge gaps around ABR E. coli on extensively reared meat, therefore, beef mince and lamb loin/leg steaks/chops were purchased from 50 (beef) and 46 (lamb) independent butchers across Wales. Following enrichment culture, 200 g meat samples were found to be positive for E. coli resistant to amoxicillin (31% positivity), streptomycin (28%), spectinomycin (29%), amoxicillin-clavulanate (11%), 3rd generation cephalosporins (2%) and fluoroquinolones (5%). Phylogenetic analysis confirmed that Welsh lamb meat ABR E. coli isolates (n=79) are more closely related to those found in faecal samples collected around sheep (n=352) than around beef cattle (n=361) on Welsh farms. This suggests that faecal contamination at or around slaughter is their primary origin. We found no closely related meat/infection clones (<20 SNPs distant and the same antibiotic resistance genes) when comparing ABR E. coli from Welsh meat (n=92) and those causing extraintestinal infections in people (n=2387) in an English region bordering Wales. We conclude, therefore, that the wider zoonotic implications of finding ABR E coli on beef and lamb meat sold at independent butchers in Wales are small.

Background Social contact surveys, which measure who-contacts-whom, are widely used to inform infectious disease transmission models and estimate the reproduction number (R), a key metric for assessing epidemic risk. Despite their widespread use, sample size calculations are not routinely performed. Aims To assess the impact of sample size on estimates of R and determine a practical target sample size for social contact surveys used in epidemic modelling. Methods We conducted a review of social contact surveys (2008-2025) to characterise current practice. We characterised the impact of survey size on epidemic metrics using two social contact surveys, the UK Social Contact Survey and POLYMOD (Europe) and two methods. For each dataset and approach, we generated repeated subsamples and calculated the resulting reproduction numbers, characterised their distributions and measured uncertainty. Results We identified 107 unique social contact surveys from 57 studies. Sample sizes ranged from 30 to more than 10,000 participants, with a median of 1,438. One quarter of surveys contained fewer than 1,000 participants. From our simulations, we find that sample sizes below 200 individuals can result in highly variability reproduction numbers. Increasing sample size increases precision, and the most meaningful gains are up to 1,300 individuals. Increasing sample sizes over 3,000 individuals leads to smaller gains. Conclusions A minimum sample size of approximately 1,200-1,300 participants appears sufficient for general-purpose use. These findings support the inclusion of sample size considerations in the design, reporting and interpretation of social contact surveys used for epidemic intelligence and public health decision-making.

Zoos may serve as sentinel sites for zoonotic vector-borne diseases. West Nile virus (WNV) and Usutu virus (USUV) are closely related orthoflaviviruses transmitted between Culex mosquitoes and a bird reservoir. Both viruses can also infect mammals, including humans, where they may cause symptoms and, more rarely, hospitalization and death. However, serological cross-reactivity between WNV and USUV complicates their differential diagnosis. Here, we aimed to reconstruct the dynamics of emergence of WNV in a zoo located in a newly affected area in Europe, using ELISA and Virus Neutralization Test (VNT) serological analysis of 1707 animal sera collected between 2015 and 2024. Combining this data in a model accounting for cross-reactivity with USUV, we estimated yearly forces of infection (FOI) by both viruses, and thus found that WNV likely circulated in the area one year prior to the first cases reported to the passive surveillance system. Our results also showed that, in the zoo, mammals and reptiles had a lower risk of infection than birds (relative risk of 0.14 [0.05; 0.28]), and that the exposure of birds to water (aquatic lifestyle or proximity to stagnant water) affected the risk. Finally, we estimated diagnosis parameters, including the sensitivity of the VNT (80.4% [76.5%; 84.3%]), the expected VNT titer value, and the level of serological cross-reactivity between viruses during the VNT. To conclude, our modelling framework allowed to disentangle the co-circulation of two closely related viruses, a crucial point in ensuring the reliable sentinel surveillance of these vector-borne zoonotic pathogens.

Background Differential contributions to transmission across age groups have been reported for many respiratory infections, including SARS-CoV-2. They are crucial for estimating the impact of age-specific interventions. Disentangling these age-dependent contributions remains challenging, as they may reflect differences in contact rates, biological susceptibility, or infectiousness. Aim We aim to jointly estimate age-specific per-contact infectiousness and susceptibility and their effect on the impact of age-specific interventions. Methods The age-specific infectiousness and susceptibility were jointly estimated in a Bayesian framework by combining contact data with transmission pair data (who-infected-whom). We applied this approach to 197,840 self-reported household transmission pairs collected in the Netherlands during the COVID-19 pandemic. Using these estimates, we projected the expected impact of school closure and work-from-home measures during the early stages of an epidemic in the absence of other interventions. Results Both infectiousness and susceptibility to SARS-CoV-2 infection were lowest in children aged 0-9 years and highest in adults over 30 years old, with 2- to 4.5-fold differences between these groups. Projected impacts of age-specific interventions indicated that school closures would reduce the reproduction number by 8% or 29% when age-specific susceptibility and infectiousness were or were not considered, respectively. Conversely, working-from-home policies would lead to reductions of 41% with and 20% without age-specific infectiousness and susceptibility. Conclusion Our method enables robust estimation of age-specific infectiousness and susceptibility. Accounting for these age heterogeneities is essential for projecting the impact of age-targeted interventions. Our approach is adaptable to other respiratory infections and can guide more tailored public health responses.

BackgroundImplementing proven vehicle safety standards recommended by the UN World Forum for Harmonization of Vehicle Regulations is among the most cost-effective strategies to reduce road traffic deaths. In 2022, Mexico approved updated vehicle safety standards, including side pole testing, electronic stability control, seatbelts, airbags, side structures, and anchorage child restraint systems. However, pedestrian protection and advanced driver-assistance technologies, such as autonomous emergency braking systems (AEBS), were excluded. These exclusions are critical, given that more than half of road traffic deaths involve vulnerable road users. Local evidence on the expected benefits of implementing comprehensive vehicle safety standards is needed to guide policy decision-making. ObjectiveTo estimate the potential public health impact of increasing the availability of recommended vehicle safety technologies in Mexico. MethodsWe conducted a comparative risk assessment analysis to estimate the impact of improving vehicle safety standards on road traffic deaths, injuries, and disability-adjusted life years. Counterfactual analyses were defined using traffic statistics for 2019 as baseline, relative risk estimates associated with each safety technology, and technology penetration within Mexicos vehicle fleet. Three scenarios were modeled: (1) full implementation of Mexicos 2022 standards; (2) addition of crashworthiness, AEBS, and motorcycle ABS/ESC; and (3) inclusion of expanded AEBS crash configurations, lane departure warning (LDW), and lane keeping assistance (LKA) systems. ResultsScenario 1 reduced deaths by 18%, injuries by 16%, and DALYs by 18%, with the greatest benefits for car occupants. Scenario 2 reduced deaths by 29%, injuries by 27%, and DALYs by 30%, benefiting motorcyclists and pedestrians the most. Scenario 3 reduced deaths, injuries, and DALYs by 41%, 38%, and 41%, respectively, benefiting car occupants and motorcyclists. ConclusionsCurrent vehicle safety standards in Mexico are expected to reduce deaths, injuries, and disabilities, yet existing guidelines focus largely on protecting car occupants. Mexico should strive to update and strengthen its current legislation by adding technologies that protect vulnerable road users, such as pedestrians and cyclists, and to focus on technologies for motorcycle users to further reduce the burden of road traffic injuries.

BackgroundReceiving fewer COVID-19 vaccine doses than recommended ("undervaccination") may increase risks of death, severe COVID-19, and post-COVID condition. However, population-scale evidence from Italy remains limited. We aimed to characterise determinants of undervaccination in Lombardy and to quantify its association with mortality, severe COVID-19, and long COVID outcomes. MethodsWe conducted a population-based study including all residents of Lombardy aged [&ge;]30 years who were alive on June 1, 2022 (n=6,836,566), and followed them until Dec 31, 2024. Vaccine deficit was defined as the difference between age-specific recommended doses (three for <60 years; four for [&ge;]60 years) and doses received, and was modelled as a time-varying exposure. Outcomes were all-cause mortality, severe COVID-19 (hospitalisation or COVID-19-related death), and long COVID defined using symptom-based ICD codes recorded [&ge;]1 month after infection. Determinants of undervaccination were assessed using multivariable logistic regression. Age-stratified Cox models estimated adjusted hazard ratios (HRs). Counterfactual vaccination scenarios were simulated using fitted survival models. ResultsOn June 1, 2022, 1,668,014 individuals (24{middle dot}4%) were not up to date with recommended vaccination. Undervaccination was more frequent in younger adults, women, individuals born outside Europe, rural residents, and those with high comorbidity burden. During follow-up, 265,383 deaths, 52,121 severe COVID-19 events, and 23,780 long COVID events occurred. In adults aged [&ge;]60 years, increasing vaccine deficit was associated with progressively higher risks of mortality (HR up to 1{middle dot}63) and severe COVID-19 (HR up to 2{middle dot}16). Associations were weaker in younger adults. For long COVID, effect estimates were modest and sensitive to outcome definition. Simulated universal booster coverage in adults [&ge;]60 years was associated with substantial reductions in expected deaths and severe COVID-19 events. ConclusionAbout one in four adults in Lombardy was undervaccinated by mid-2022. An increasing vaccine deficit was associated with a higher risk of severe COVID-19 and mortality, particularly in older adults. Sustaining booster uptake in high-risk groups remains central to mitigating the COVID-19 burden.

Using a commercially available H5 serology assay, we identified a 7.4% (n=5/68) anti-H5 seroreactivity rate among hunters in Northern Canada. All participants reported close contact with wild birds.

The incidence of vancomycin-resistant Enterococcus (VRE) is rising in hospitals in Canada, and resistance to last-resort antimicrobials including linezolid complicates treatment options for multidrug-resistant isolates. Recent reports from around the globe indicate that both linezolid and vancomycin resistance genes can be co-carried and mobilized by linear plasmids (named pELF) in Enterococcus species, often on the same backbone. We aimed to investigate linezolid resistance and linear plasmid prevalence in VRE bloodstream infection isolates collected by the Canadian Nosocomial Infection Surveillance Program from 2009 to 2024. We found that screening for pELF linear plasmid ends in short reads was a reliable way to predict linear plasmid presence in large-scale surveillance data (100 % accuracy on 85 reference samples). Almost half of the isolates in our collection were predicted to carry pELF plasmids (45.4 %, 941/2071) and we found that this proportion has increased from 2018 (32.2 %, 59/183) to 72 % of isolates between 2021 and 2024 (2021: 68.5 % (115/168); 2022: 71.6 % (146/204); 2023: 72.8 % (166/228); 2024: 71.6 % (235/328)). This trend of increasing linear plasmid carriage is evident from 2018 to 2024 across the dominant emerging sequence types (ST80, ST17, ST117). Linezolid resistance based on phenotypic antimicrobial susceptibility testing was low (1.0 %, 21/2071). Using long read sequencing, we characterized the linezolid resistant isolates and confirmed pELF plasmid presence in 13/21 (61.9 %) isolates. Six isolates harboured pELF plasmids encoding linezolid resistance genes (optrA, cfr(D), poxtA) and five of these also encoded vancomycin resistance genes (vanA). We compared these six plasmids to 39 public plasmid sequences and clustered them using MOB-suite and pling. Overall, this study provides further examples of the co-carriage of vancomycin and linezolid resistance genes on mobile linear plasmids and shows that linear plasmid prevalence is detectable and increasing across VRE in Canada. IMPACT STATEMENTGiven the increasing prevalence of multidrug-resistant hospital-acquired pathogens, resistance to last-resort antibiotics is a global public health threat. Linezolid is a last-resort antibiotic used to treat vancomycin-resistant Enterococcus isolates, and the dissemination of linezolid resistance genes is significantly facilitated by mobile elements that can transfer between unrelated strains and species. Linezolid resistance genes have recently been described on linear plasmids and are often co-localized with other resistance genes on the same plasmid backbone. Consequently, understanding the features and distribution of linear plasmids and those harbouring linezolid resistance genes is crucial for pathogen surveillance and mitigation of resistance. In this work, we used long-read and short-read sequencing to characterize genomic epidemiology of linear plasmids across 16 years of Enterococcus surveillance data in Canada. This study furthers knowledge of linear plasmids by demonstrating that they are relatively common across vancomycin-resistant Enterococcus blood isolates and by providing more examples of co-localized vancomycin and linezolid resistance genes on the same linear plasmid backbone. DATA SUMMARYSequencing data and genome sequences were deposited in National Centre for Biotechnology BioProject PRJNA1279082, and accessions are listed in Table S1. Supplementary materials for this study are available at the Figshare portal through DOI: XXX.

Introduction: Respiratory infections are a leading cause of morbidity. Newly available vaccines to prevent respiratory syncytial virus (RSV) disease and encouraging clinical progress on vaccines for human metapneumovirus (hMPV) and parainfluenza (PIV) could reduce the disease burden beyond existing influenza and SARS-CoV-2 immunisation programs. However, evidence on the contribution of these viruses to respiratory disease burden across the lifespan remains limited. Methods: We reviewed studies from 01/2002-11/2025 reporting age-stratified, medically attended cases of influenza, and at least one of RSV, hMPV, or PIV, in high-income countries, excluding periods substantially overlapping with the COVID-19 pandemic. Using only studies that tested for all four viruses, we estimated the age-specific proportion of cases that were non-influenza (total across RSV, hMPV and PIV) compared to influenza using a mixed-effects logistic regression model. Results: Following exclusions and screening, 61 studies were included in the primary analysis comprising >500,000 detections of the four viruses. We found that a substantial proportion of medically attended respiratory illness in infants and young children was due to PIV, hMPV and RSV, rather than influenza, with a non-influenza virus proportion of 90.2% (95% CI 85.9-93.2%) in young infants aged 0-6 months. The converse was true for school-aged children, with a non-influenza virus proportion of 34.8% (95% CI 26.5-44.2%) in children aged 5-18 years. In adults aged 65+ years, non-influenza causes of medically attended disease were common at 60.2% (95% CI 50.0-69.5%). Restricting to studies reporting hospitalised cases (n=19) produced broadly similar age-specific trends in relative virus burden contributions. Discussion: We highlight the significant burden of medically attended illness due to PIV, hMPV and RSV across ages, particularly in infant and preschool-aged children and older adults, supporting the need for effective vaccines targeting this burden.

BackgroundSince September 2024, France has implemented a national reform allowing prescription-free access (PFA) to sexually transmitted infection (STI) screening in medical biological laboratories (MBLs). This study aims to characterize the populations undergoing STI testing according to their access modality and evaluate the probability of test positivity in relation to testing pathway, sex, and age groups. MethodsWe conducted a cross-sectional analysis of all individuals screened for Chlamydia trachomatis, Gonorrhoea, human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis by treponemal-specific immunoassay (TSI) in Cerballiance MBLs between Mars 2025 and February 2026. Multivariable logistic regression models stratified by sex and adjusted for age and region assessed associations between screening modality and STI positivity. ResultsAmong 1,008,737 individuals included, 27.8% were under PFA and 72.2 under prescription-based access (PBA). PFA users were more frequently male (47.4% vs. 36.3%, p<0.001) and aged 20-39 years (34.0%, p<0.001). Overall positivity rates differed by modality: PFA was associated with higher detection of Chlamydia (4.6% vs. 3.6%). PBA group showed more positive cases of syphilis (3.4% vs. 1.2%), HBV (1.3% vs. 0.4%), and HIV infections (0.3% vs. 0.2%, all p<0.001). Co-infection and gonorrhoea proportions did not significantly differ between modalities. ConclusionsPFA substantially increased STI screening uptake, particularly among young adults and men, and enhanced detection of bacterial STIs. PBA remains essential for diagnosing viral and chronic infections. These findings highlight the complementary roles of both access strategies and support PFA screening as an effective public health intervention to broaden STI detection and reduce transmission.

BackgroundAntimicrobial resistance (AMR) surveillance is essential for quantifying and monitoring the burden of AMR among World Health Organization (WHO) priority pathogens. We analysed Tunisian AMR surveillance system (TARSS) data across five sentinel hospitals from 2014 to 2022. MethodsWe conducted a retrospective isolate-level analysis for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. Temporal, ward, and specimen associations were quantified using multivariable logistic regression models. Sex and age categories were explored in secondary models due to missingness. Temporal trends were assessed using Cochran-Armitage test, and co-resistance was summarised for third-generation cephalosporin and carbapenem phenotypes. We also evaluated temporal dynamics of 3GCR and CR profiles. ResultsA total of 35,525 E. coli, 14,325 K. pneumoniae, 9,679 P. aeruginosa, and 5,597 Acinetobacter spp. were reported to TARSS between 2014 and 2022. Mean annual MDR prevalence was high for Acinetobacter spp. (85.1%), moderate for K. pneumoniae (45.5%) and for P. aeruginosa (27.1%), and lower for E. coli (17.5%). Adjusted models indicated increased odds of resistance to several antibiotics, whereas E. coli showed decreased odds. Intensive care unit (ICU) and blood isolates were associated with higher odds of resistance in all pathogens. ConclusionThis nine-year multi-hospital analysis reveals a high prevalence of AMR across the four WHO priority pathogens, settings, and specimen types, with increasing resistance for some pathogen-antibiotic combinations. The higher odds of clinically important resistance amongst ICU and blood isolates support the use of ward-level antibiograms and stratified stewardship and infection prevention measures.

Objectives: Group B Streptococcus (GBS) is a leading cause of neonatal mortality worldwide. However, the global burden of early-onset GBS disease (EOD-GBS) has not been fully elucidated. We aimed to describe the geographical distribution and epidemiological characteristics of the EOD-GBS burden, and analyze its association with socio-economic development and universal health coverage. Methods: We used data from the Global Burden of Disease Study 2021 and the Universal Health Coverage Service Coverage Index (UHC-SCI) to calculate estimated annual percentage changes (EAPCs) of EOD-GBS mortality. Sex differences were analyzed using the conservative overlap assessment. The geographical distribution of EOD-GBS clinical presentations and mortality was mapped. Health inequality analysis was conducted to evaluate the relationship between the sociodemographic index (SDI), UHC-SCI, and EOD-GBS burden. Results: Global EOD-GBS mortality decreased by nearly 50% from 1990 (693.41 per 100,000) to 2021 (348.80 per 100,000). However, the decline was not uniform: the most significant decrease occurred in high-middle SDI regions (EAPC: -7.17%), and the slowest in low SDI regions (EAPC: -2.23%). Male neonates accounted for the most EOD-GBS deaths, particularly in high SDI regions. Lower respiratory infections were common in Asia and Oceania; meningitis was more prominent in Europe. Inequality analysis revealed a phenomenon of "absolute convergence but relative differentiation": as social development and universal health coverage improves, the absolute mortality gap between countries narrowed, but relative burden concentrated increasingly among the poorest populations. Conclusions: The global burden of EOD-GBS has decreased substantially, but there are marked differences among countries. Continued socioeconomic development and expanded universal health coverage are critical to further reduce neonatal mortality.

Purpose To systematically review population preferences for expanded carrier screening programmes to inform service delivery and health policy. Methods PubMed, CINAHL, and Scopus were searched from 1995 to 2025 on carrier screening for autosomal or X-linked recessive genetic conditions across adult general populations. Included studies elicited preferences on attributes regarding the design or delivery of carrier screening programs. We extracted preferences for each attribute, mapped qualitative findings to these preferences, assessed risk of bias and performed meta-analysis on the willingness-to-pay for screening using Bayesian multilevel modelling. All findings are reported in 2024 USD. Results Thirty one studies, including 16 quantitative, 11 qualitative, and 4 mixed-methods studies were included. Participants expressed preferences for which conditions to include in ECS, joint vs individual screening, the value of information provided before screening, in-person over online counselling, type of healthcare provider, and preconception testing. Willingness-to-pay was right-skewed with 9% of participants not willing to pay any amount, a median of $107 and an interquartile range between $41 and $226. Most studies demonstrated a high risk of bias. Conclusions We report preferences of the general population regarding expanded carrier screening programmes, including suggested amounts for copayment if subsidised by the health system.

BackgroundSickle cell disease (SCD) is the most common recessive genetic disorder, caused by pathogenic variants of the HBB gene. SCD is associated with a range of clinical manifestations, including vaso-occlusive crises, infections, and severe anaemia, which contribute to increased morbidity and mortality. The frequency of pathogenic alleles is high in Sub-Saharan African countries, with heterozygous carriers reaching up to 25% of the population. Several methods can be employed for molecular diagnostics, with HBB gene sequencing being the most precise. However, access to DNA analyses and sequencing in Low- and Middle-Income Countries (LMICs), where SCD prevalence is high, is limited. Understanding genetic profiles is crucial at both individual and population levels, as it can guide public health strategies and facilitate accurate genetic counselling. AimThis feasibility study aimed to demonstrate that a portable medical genetic laboratory (in suitcases) can be used to genotype individuals for the HBB A, S, and C alleles and their combinations within a few hours outside of a laboratory setting. Methods and resultsWe established a portable medical genetics laboratory capable of DNA extraction and isothermal DNA amplification using a commercially available kit for the A, S, and C alleles of the HBB gene. During one single study day, this portable lab was set up in a room where the Swiss Association of Patients with SCD was holding its annual meeting. We analysed the samples of 27 participants who were aware of their A, S, or C status. We collected buccal swabs and dried blood samples for genotyping. Genotype results for all participants were obtained within five hours after sample collection. In four cases, we observed discrepancies between the buccal swab and blood genotypes; three were resolved upon repeat testing, and one reflected donor chimerism following hematopoietic stem-cell transplantation. ConclusionsThis study demonstrates the feasibility and efficiency of using a portable medical genetics laboratory for rapid genotyping of HBB SCD alleles in community settings.This approach can improve access to molecular diagnostics in resource-limited environments. Such tools have the potential to significantly enhance local capabilities for genetic screening, counselling, and public health planning in regions heavily affected by SCD.

BackgroundAn upsurge in Streptococcus pyogenes infections 2022-2023 highlighted potential benefits of point-of-care tests (POCT) to support clinical pathways, prevent outbreaks, and optimise antibiotic use. ObjectivesWe conducted a pilot research study in a west London paediatric emergency department (ED) to determine whether a molecular POCT had potential to alter management in children who were also having a conventional throat swab taken for culture. MethodsChildren <16 years presenting to ED who had a throat swab requested by a clinician were invited to have a second swab taken for research purposes only. Clinical management was unaffected by the research swab result, which was processed using a molecular POCT that was not approved for use in the host NHS Trust. ResultsPrevalence of streptococcal infection was low during the study (May 2023-June 2025); swab positivity in symptomatic children was 12.8% (6/47). Overall, 38/49 (77.6%) participants who had throat swabs received antibiotics. Of those children recommended to receive antibiotics, 29/38 (76.3%) had a negative POCT. Mean time to reporting of positive throat swab culture results was 3.67 days (range 3-5 days) leading to occasional delay in treatment, although POCT identified positive results within minutes. ConclusionAntibiotic use was frequent and could be avoided or stopped by use of a rule out POCT in over three-quarters of children in the ED, if suspicion of S. pyogenes is the main driver for prescribing. POCT were easy to process and produced immediate results compared with culture, in theory enabling timely decision-making and avoiding treatment delay.

BackgroundPseudomonas aeruginosa is a major cause of healthcare-associated infections in paediatric settings, where its persistence in moist environments such as hospital water and wastewater systems poses a particular risk to neonates and immunocompromised children. AimThe aim of this study was to showcase the long-term survival and transmission of P. aeruginosa in a large tertiary childrens hospital in England which is crucial to develop strategies for water-safe care. MethodsEnvironmental P. aeruginosa isolates were collected from taps, sinks, showers, and baths in augmented care areas of a 330-bed tertiary childrens hospital built to NHS water-safety standards. Clinical isolates were classified as invasive (blood, cerebrospinal fluid, and bronchoalveolar lavage) or non-invasive (respiratory, urine, ear, abdominal, and rectal surveillance). Variable number tandem repeat (VNTR) profiles and metadata were extracted from PDF reports, de-identified, deduplicated, and curated using Python and R. FindingsThis retrospective study analysed nine-locus VNTR profiles of 457 P. aeruginosa isolates submitted to the UK Health Security Agency from a large tertiary childrens hospital, identifying 56 isolate clusters (each with [&ge;]2 isolates), of which 19 (34%) contained at least one invasive isolate. The most persistent cluster (Cluster 1, n=20) spanned from July 2016 to September 2024, containing environmental and clinical (invasive and non-invasive) isolates. ConclusionThese findings demonstrate long-term persistence of certain genotypes and temporal overlap between environmental and clinical isolates, highlighting the difficulty in detecting and eradicating P. aeruginosa in hospital water and wastewater systems and reinforcing the need for continuous rigorous water system controls.