IJID Regions

Bangladesh is experiencing emerging burden of Non-Communicable Diseases (NCDs). Non-communicable diseases (NCDs) are the emerging as major cause of morbidity and mortality, accounting for 61% of deaths in Bangladesh. The study aims to describe the prevalence of NCDs among pregnant women in teagardens in Moulvibazar district. Three teagardens of Sreemongol upazila in Moulvibazar district was selected randomly. The pregnant women were considered for collecting the NCD related information. A sample size of 86 was purposively selected based on relevant literature review. Data was collected by conducting face to face interview with the respondents through pre-tested semi-structured questionnaire. Data was analyzed with the help of SPSS Version 24 Software. For effective use of limited resources, an increased understanding of the shifting burden and better characterization of risk factors of NCDs including Hypertension is needed. Average age of the women attended for screening test was 23 (15-45) years. More than 47% women were found with Gravida 1. The mean duration of pregnancy was found 18.8 weeks. Above 24% percent of GDM women were found at low blood pressure but 2% were identified at high blood pressure. 28% were found underweight with BMI calculation but 11% were identified with overweight. The challenges tests for blood sugar findings of women were found 12.7% GDM positive (7.8-<11 mmol/L). About 16.5% had complications during pregnancy including anaemia, eclampsia, edema, diarrhoea etc. A community based NCDs surveillance model could be developed through participation Government health managers, experts and stakeholders, which were taken by local health system for implementation.

BackgroundDespite scale-up of antiretroviral therapy (ART), children living with HIV (CLHIV) and children who are HIV-exposed-but-uninfected (CHEU) are at an increased risk of poor growth outcomes compared to children HIV-unexposed-and-uninfected (CHUU). Few studies quantify the magnitude of growth deficits extending into school age in sub-Saharan Africa (SSA). This study examined the impact of perinatal HIV exposure and infection on the growth trajectory of school-aged children in Nigeria. MethodsWithin a prospective cohort, 569 children aged 3-11 years were recruited from pediatric clinics in Nigeria and matched by age and sex based on their exposure or infection status. School-aged children were observed across three time-points at 6-month intervals, during which anthropometric measures, CD4 count, and maternal factors were collected. Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and body-mass-index-for-age (BAZ) were calculated using WHO standards. Longitudinal linear regression analyses using generalized estimating equations (GEE), adjusted for maternal and child covariates, were conducted to compare growth outcomes across groups. ResultsGrowth Z-scores declined until approximately age 8, after which they gradually increased. Across all visits, CLHIV consistently and independently demonstrated lower Z-scores (WAZ ({beta} = -1.04, p <0.001); HAZ ({beta} = -0.67, p <0.001)), followed by CHEU with intermediate but significant impairments (WAZ ({beta} = -0.35, p <0.01); HAZ ({beta} = -0.38, p <0.01)) compared to CHUU. ConclusionStunting remains unacceptably high in CLHIV and CHEU in SSA. The findings suggest a need for immediate paradigm shifts to address persistent growth deficits despite ART and beyond infancy.

IntroductionViral load (VL) testing is the recommended approach for monitoring antiretroviral therapy (ART) effectiveness, while guidelines recommend targeted CD4 testing after ART initiation. This study examined trends in VL and CD4 testing frequencies, as well as the relationship with AIDS diagnosis and mortality among people with HIV in the Asia-Pacific region. MethodsWe included adults enrolled in the Treat Asia HIV Observational Database (TAHOD) between 2003-2018 who had been on ART for [&ge;]1 year. VL and CD4 testing rates were analysed using Poisson regression models. Associations between testing frequency and AIDS diagnosis or mortality were evaluated using Fine and Gray competing risk regression. ResultsAmong 8,446 patients, VL testing rates remained steady at 1 per person-year (PYS) between 2003-2018. Increased VL testing was associated with more frequent CD4 testing (>2 tests in the previous year; IRR=1.57, 95%CI 1.53-1.60), later follow-up years (2008-2012: IRR=1.15, 95%CI 1.12-1.18; 2013-2015: IRR=1.07, 95%CI 1.04-1.10), older age (31-40 years: IRR=1.06, 95%CI 1.03-1.08; 41-50 years: IRR=1.08, 95%CI 1.05-1.11; >50 years: IRR=1.07, 95%CI 1.03-1.11), higher current VL (401-1000 copies/mL: IRR=1.16, 95%CI 1.09-1.24; >1000 copies/mL: IRR=1.07, 95%CI 1.04-1.11), initial ART regimen (NRTI+PI: IRR=1.07, 95%CI 1.04-1.10; other combinations: IRR=1.11, 95%CI 1.05-1.17), and higher country income levels (upper-middle: IRR=2.17, 95%CI 2.11-2.23; high: IRR=3.14, 95%CI 3.03-3.26). CD4 testing rates decreased from 2.04 to 1.06/PYS over the same period. Lower CD4 testing frequency was associated with HIV exposure mode (MSM: IRR=0.94, 95%CI 0.92-0.96; IDU: IRR=0.93, 95%CI 0.90-0.97; other/unknown: IRR=0.90, 95%CI 0.87-0.93), higher current CD4 (201-350 cells/{micro}L: IRR=0.95, 95%CI 0.93-0.97; 351-500 cells/{micro}L: IRR=0.89, 95%CI 0.87-0.91; >500 cells/{micro}L: IRR=0.85, 95%CI 0.83-0.87) and receiving an NRTI+PI first-line combination (IRR=0.96, 95% CI 0.94-0.98). VL and CD4 testing frequencies were not significantly associated with AIDS diagnosis. However, having > 2 CD4 tests in the previous year was associated with higher mortality risk. ConclusionThe trends in the rates for CD4 and VL testing in the region between 2003-2018 were significantly affected by demographic, clinical and socio-economic factors. Recognizing these factors is critical to optimizing differentiated monitoring strategies and improving outcomes for PWH in the region.

Introduction-India's immunization initiatives are among the largest globally, characterized by a substantial birth cohort of 27 million children annually, and have achieved significant progress in increasing coverage through the UIP. However, there are still challenges that persist, and multiple determinants contribute to the existing challenges; parental migration is one of them. Migration has always been a key driver of socio-economic and demographic changes, particularly in low and middle-income countries (LMICs). Specifically, there is a need to better understand the vulnerabilities of immunization among recent migrants. To examine this, the study explores the association between a mother's recent migration and the full immunization coverage of children aged 12-23 months in India. Data & Methods-Our study utilized data from the National Family Health Survey-5 (2019-21). The outcome variable of interest in this study is the receipt of all basic vaccinations (full immunization) for children. The primary predictor variable in this study is the children's migration status. We used a series of multivariate logistic regression models to examine the relationship between full Immunization and recent migration of children, with some data restrictions in the models. Results - The results show a 17% difference in full immunization between migrant and non-migrant children. The odds ratios for children who had recently migrated were lower for full immunization (OR: 0.39, 95% CI: 0.35-0.43) compared to children who had not recently migrated. Even across the household wealth quintile and social groups, the recent migration of children was associated with being less likely to be fully immunized among children 12-23 months. Conclusion- The findings of this study provide significant quantitative evidence that recent migration (less than 3 years) of children is a key factor influencing Immunization coverage and is a predictor of full vaccination among children aged 12-23 months in India. The recent migration was consistently linked to a lower likelihood of full immunization coverage across different household wealth levels and social groups. This study suggests that recently migrated children are a vulnerable subgroup of the population at risk of not receiving all basic vaccinations by their first birthday.

BackgroundPerinatal mortality remains a major public health concern in Nigeria despite global progress in maternal and child health. Maternal education has been identified as a key determinant influencing perinatal outcomes through its effects on health literacy, service utilization, and decision-making. However, limited evidence exists on how maternal education directly impacts perinatal outcomes within the context of Delta State, Nigeria. This study therefore investigated the relationship between maternal education and perinatal outcomes, focusing on perinatal mortality, access to healthcare, and educational interventions that enhance maternal health. MethodsA quantitative cross-sectional study design was employed. Data were collected from 400 mothers who delivered in selected public and private health facilities across six Local Government Areas in Delta State, alongside secondary data on perinatal outcomes obtained from hospital records. A structured questionnaire and record extraction form were used to gather information on maternal education, healthcare access, and perinatal indicators. Data were analyzed using SPSS Version 26, applying descriptive statistics, Pearsons correlation, and regression analysis to determine associations between maternal education and perinatal outcomes. ResultsFindings revealed a strong inverse relationship between maternal education and perinatal mortality (r = -0.431, p < 0.01), indicating that mothers with higher education levels experienced fewer stillbirths and neonatal deaths. Similarly, maternal education was significantly associated with reduced low birth weight incidence (r = -0.362, p < 0.01) and improved neonatal survival (r = 0.415, p < 0.01). Regression results showed that maternal education accounted for 23.9% of the variance in perinatal outcomes (R2 = 0.239, p < 0.001). Women with tertiary education were more likely to attend antenatal care (94%), deliver in health facilities (91%), and receive postnatal care (89%) compared to those without formal education. ConclusionThe study concludes that maternal education plays a decisive role in improving perinatal outcomes in Delta State by promoting healthcare utilization, enhancing health literacy, and reducing preventable perinatal deaths. Strengthening womens education through formal schooling and community-based literacy programs is vital for achieving equitable maternal and neonatal health outcomes. The study recommends multisectorial collaboration between education and health authorities to integrate maternal health education into national curricula and community outreach initiatives as part of efforts to attain Sustainable Development Goals 3 and 4.

BackgroundHepatitis B virus infection remains a major public health challenge, particularly among people living with human immunodeficiency virus, due to shared transmission routes and the potential for accelerated liver disease progression. Molecular characterization of circulating HBV strains is essential for understanding viral epidemiology, mutation patterns, and implications for diagnostics and vaccination. MethodsThis study investigated the prevalence of hepatitis B infection and molecular characteristics of the hepatitis B virus surface gene among HIV-infected individuals receiving antiretroviral therapy in Nairobi County, Kenya. Plasma samples were screened for hepatitis B surface antigen using enzyme-linked immunosorbent assay. Hepatitis B viral DNA was extracted from HBsAg-positive samples and the surface gene region amplified by polymerase chain reaction. Amplified products were subjected to Sanger sequencing. Sequence assembly, genotype determination, and mutation analysis. ResultsThe prevalence of HIV/HBV co-infection among HIV-positive individuals was determined to be 8.97%. Genotype analysis revealed the circulation of HBV genotype A (sub-genotypes A1 and A4) and genotype D (sub-genotypes D4 and D10) among the studied population. Amino acid sequence analysis of the major hydrophilic region of the surface gene identified several mutations, with R122K and Y134F being the most frequently observed substitutions. ConclusionHepatitis B infection remains prevalent among HIV-infected individuals receiving antiretroviral therapy in Nairobi County. The circulation of multiple hepatitis B virus genotypes and the presence of mutations within the surface gene highlight the importance of continuous molecular surveillance to monitor viral evolution and its potential implications for hepatitis B virus diagnosis, vaccination strategies, and clinical management in HIV-infected populations

Background: Spotted fever is caused by spotted fever group rickettsiae (SFGR) belonging to the genus Rickettsia. Transmission to humans is primarily via the bite of infected ticks. Being a vector-borne disease, the occurrence of spotted fever is related to factors that allow the vector to thrive. This spatio-temporal analysis gives an insight into the distribution of cases and correlation with seasonality. Methodology: A suspected AFI patient was considered spotted fever positive if either serology (ELISA/IFA) or molecular assay (Nested PCR/qPCR) was tested positive. Demographic data of confirmed cases were included for the analysis. Results: In the 18-year dataset, a total of 2153 suspected patients were tested for spotted fever, of which 516 (24%) were positive. On spatio-temporal analysis, Vellore district reported 39.9% of cases, Chittoor 38.8%, Tirupattur 12.5%, Ranipet 4.5%, and Tiruvannamalai 4.3%. Maximum spotted fever cases were reported between the months of September to March, with a peak in January. Children below 10 years and housewives were at risk of spotted fever. Conclusion: The findings of this retrospective analysis highlight the importance of considering spotted fever group rickettsioses in patients presenting with acute undifferentiated febrile illness, particularly children aged <10 years, from areas with higher spatial clustering, during or following the monsoon season.

BackgroundSexually transmitted infections (STIs) pose major risks in pregnancy, including stillbirth, preterm delivery, and congenital infections. Globally, pooled antenatal prevalence estimates are HIV 2.9%, HBV 4.8%, HCV 1.0%, and syphilis 0.8%, but burdens are higher in low-income countries, reaching HIV 5.2%, HBV 6.6%, HCV 2.7%, and syphilis 3.3% (). In Ghana, reported rates are variable: HBV 4-10%, HCV 0.8-12%, HIV 1-3%, and syphilis 0.4- 3.6%. Despite a national policy mandating integrated antenatal screening, evidence on the prevalence and co-infection patterns among pregnant women remains fragmented. This study aimed to determine the prevalence of HIV, HBV, HCV, and syphilis, co-infections, and associated determinants among Ghanaian pregnant women. MethodsA cross-sectional study was conducted using secondary data from 1,316 pregnant women attending antenatal care across four municipalities in Ghana (2023-2024). Prevalence, co-infection patterns, and risk factors were assessed using descriptive statistics, logistic regression, and kappa agreement tests. ResultsThe median age of participants was 28 years (IQR: 23-33). Syphilis was most prevalent (10.5%), followed by HBV (4.0%), HIV (2.5%), and HCV (1.9%). Marked geographic disparities were observed, with syphilis prevalence ranging from 0.8% in Afigya Kwabre to 38.9% in Cape Coast. Co-infections were common: 26.6% of HBV-positive women also had syphilis ({kappa} = 0.348, p < 0.001), and 16.6% of HIV-positive women had syphilis ({kappa} = 0.237, p < 0.001). Predictors of syphilis included urban residence (aOR: 4.79; 95% CI: 2.99- 7.69), multiparity (aOR: 3.08; 95% CI: 1.92-4.96), and early gestational age. ConclusionThe high burden of syphilis and frequent co-infections among Ghanaian pregnant women reveal critical gaps in implementing integrated antenatal screening. Despite national policy mandates, inconsistent practice leaves mothers and infants vulnerable to preventable complications. Strengthening compliance with comprehensive STI screening while tailoring interventions to high-risk groups is essential to reducing adverse maternal and neonatal outcomes.

BackgroundNigeria accounts for approximately 19% of global maternal deaths, yet 4 in 10 Nigerian women do not meet the World Health Organization minimum standard of four antenatal care (ANC) visits. Understanding which women are being left behind, and how early they initiate care, is essential for designing effective maternal health programmes. MethodsWe conducted a cross-sectional analysis of 21,465 women with a birth in the five years preceding the 2018 Nigeria Demographic and Health Survey (NDHS). Survey-weighted multivariable logistic regression was used to estimate adjusted odds ratios (aOR) for seven sociodemographic predictors of adequate ANC attendance (4 or more visits). Kaplan-Meier survival analysis and Cox proportional hazards modelling were additionally applied to 16,084 women with complete ANC timing data to examine time to first ANC visit. Confounding was quantified by comparing crude and adjusted estimates. ResultsThe national weighted prevalence of adequate ANC was 57.8% (95% CI: 56.2%-59.4%). The median gestational age at first ANC visit was 5 months, two months later than WHO recommendations. Higher education (aOR = 5.64, 95% CI: 4.45-7.15) and richest wealth quintile (aOR = 3.93, 95% CI: 3.11-4.95) were the strongest independent predictors. Urban residence lost significance entirely after adjustment (aOR = 1.12, p = 0.113), indicating that the crude urban advantage is fully explained by the higher education and wealth of urban women. Educated women initiated ANC 35% faster than uneducated women (HR = 1.35, 95% CI: 1.23-1.47). Confounding was substantial: 74.9% of higher educations crude effect was attributable to correlated socioeconomic factors. ConclusionsEducation and wealth are the dominant independent determinants of both adequate ANC attendance and earlier ANC initiation in Nigeria. The apparent urban advantage is entirely confounded. Targeted investment in girls education, wealth-sensitive demand-side financing, and community-based early ANC outreach particularly in the North West and North East are urgently needed.

Abstract Background Anemia is a condition characterized by nutritional deficiencies and blood disorders, predominantly affecting children aged 6 to 59 months and women of reproductive age, especially in low and middle-income countries. In Zambia, anemia is a public health problem. This study aims to assess the spatial patterns and determine factors associated with anemia severity in Zambia over six years (2018 to 2024). Method The study included a total of 19,362 WRA from the two waves of the ZDHS, 2018 and 2024. The ZDHS is a periodic national survey that uses multistage sampling. We adopted an analytical cross-sectional design, and the three-level multivariable ordinal logistic regression model was used to identify variables (individual, household, and community level) associated with anemia severity. Global Morans I, Local Morans I, and Getis-Ord Gi* statistics were used to determine the hotspots and spatial patterns, while spatial scan statistics were used to detect primary and secondary clusters and their distribution over the two cycles. Results The prevalence of anemia among women of reproductive age in Zambia was 31.0% (n=3,946) and 30.4% (n=2,015) in 2018 and 2024, respectively. The factors associated with higher odds of anemia severity were HIV status (HIV-positive: AOR=2.63, 95% CI:2.25,3.09), pregnancy (AOR=1.96, 95% CI:1.67,2.31), and rural residency (AOR=1.21, 95% CI:1.08,1.35). While being in a union was protective compared to never being in a union (AOR=0.66, 95% CI:0.57,0.77), not having financial barriers for medical assistance was equally protective. Spatial analysis showed geographic disparities and a non-random distribution of anemia (Global Morans I, 2018: I=0.147, p<0.001; 2024: I=0.130, p<0.001). the Hotspot analysis depicted an expansion of high-risk areas Western in 2018 to the North-Western and Luapula in 2024. Spatial scan analysis identified the south-west region (Western, Southern and North-Western) as the significant primary cluster of anemia consistently for both waves.

Background: Sexual and gender minorities (SGM), including men who have sex with men (MSM) and transgender women, often face stigma, legal constraints, and limited access to sexual and reproductive health services. These conditions restrict prevention and care, increasing vulnerability to HIV and human papillomavirus (HPV) infections. While strong HIV-HPV interaction is documented in high-income settings, evidence from low- and middle-income countries remains limited. This study examines the burden, co-infection dynamics, and progression of HPV infection and anal dysplasia among MSM and transgender women in Pakistan. Methods: A cross-sectional study was conducted between September 2015 and October 2016 among men who have sex with men (MSM) and transgender women recruited from sexual health and antiretroviral therapy centers in Karachi. Eligible participants were aged [&ge;]18 years and self-reported anal sex within the past 6 months (N=298). Two anal specimens were collected for HPV DNA detection and genotyping using PCR, and anal squamous intraepithelial lesions (ASIL) were assessed cytologically using the Bethesda classification. Associations were estimated using Cox proportional hazards regression algorithms to derive prevalence ratios (PRs). Results: Among participants, 44% (n=133) were living with HIV. Overall HPV prevalence was 65.1%, rising to 87% among HIV-positive individuals compared to 48% among those without HIV ({chi}{superscript 2}p[&le;]0.001). Likewise 28.9% of participants living with HIV were infected with two or more than two types of HPV as compared with 18.8% participants without HIV ({chi}{superscript 2}p[&le;]0.001). HIV infection was strongly associated with HPV acquisition (adjusted PR 2.81, 95% CI 2.16-3.82). Among HPV-positive participants (n=194), 58.8% were co-infected with HIV. High-risk HPV was highly prevalent among those living with HIV (83.2% vs. 35.3% ({chi}{superscript 2}p[&le;]0.001)), with HPV16 as the dominant oncogenic type. Multiple HPV infections were more common among HIV-positive individuals ({chi}{superscript 2}p[&le;]0.001), and HIV seropositivity was 3.43 (95% CI: 2.55-3.51) times higher among those with high-risk HPV. Co-infected participants demonstrated prolonged smoking, longer duration of sex work, high-intensity sex work with limited condom negotiation, and higher prevalence of anal warts (all p<0.05). Anal dysplasia (ASIL) was present in 35% of participants and was higher among HIV-positive individuals (42.4% vs. 28.1%, p<0.001). HIV-HPV co-infection was independently associated with ASIL (adjusted PR 1.75, 95% CI 1.07-2.88), while high-risk HPV further amplified this risk (PR 3.04, 95% CI 1.75-5.26). Conclusion: These findings demonstrate a biological continuum in HIV-positive MSM and transgender women, where HIV increases HPV acquisition, persistence, and multiplicity, accelerating progression to anal dysplasia. This reflects a syndemic shaped by biological interaction and structural vulnerability. Integrating HPV screening and vaccination within HIV services is essential to interrupt progression to cancer in this high-risk population.

BackgroundNigeria accounts for approximately 19% of global maternal deaths, yet skilled birth attendance (SBA) coverage stood at only 44.9% in 2018. Understanding the independent determinants of SBA after controlling for confounding is essential for evidence-based policy prioritisation. MethodsWe conducted a cross-sectional analysis of 21,465 women with a birth in the five years preceding the 2018 Nigeria Demographic and Health Survey (NDHS). Survey-weighted multivariable logistic regression was used to estimate adjusted odds ratios (aOR) for seven sociodemographic predictors of SBA. Confounding was quantified by comparing crude and adjusted estimates. ResultsOverall SBA prevalence was 44.9%, ranging from 17.7% in the North West to 85.6% in the South West. Higher education (aOR = 7.01, 95% CI: 5.68-8.67), richest wealth quintile (aOR = 6.27, 95% CI: 5.27-7.46), and attending [&ge;]4 antenatal care (ANC) visits (aOR = 3.80, 95% CI: 3.51-4.11) were the strongest independent predictors. Confounding was substantial: 89.0% of educations crude effect and 87.1% of the wealth effect were attributable to correlated socioeconomic factors. ANC utilisation showed the least confounding (56.3% attenuation), consistent with a more direct causal pathway. ConclusionsANC utilisation is the most modifiable and directly actionable determinant of skilled birth attendance in Nigeria. Geographically targeted investment in ANC coverage, demand-side financing, and girls education are urgently needed to close Nigerias SBA gap.

Abstract Introduction: Streptococcus is the second genus involved in bone and joint infections (BJIs) after Staphylococcus. Streptococcus agalactiae is the predominant Streptococcus species implicated in BJIs. However, unlike Staphylococcus-related BJIs, data on S. agalactiae infections remain scarce. Methods: We conducted a retrospective cohort study from the West Region cohort of the CRIOAc registry among six university hospitals including all microbiologically confirmed streptococcal BJI in adults between 2014 and 2023. Results: 1454 patients were included, with a median age of 67 years and 65% male. S. agalactiae was the predominant streptococcal species involved 423/1454(29%). The most prevalent comorbidities identified were obesity (378/1454;26%) and diabetes mellitus (343/1454;24%). Prosthetic joint infections (PJIs) were the most common (653/1454;45%), although diabetic foot osteitis was less prevalent overall, it was significantly more associated with S. agalactiae infections (48/423;11% versus 70/1031;7%, p=0.05). S. agalactiae BJIs were more frequently lower-limb infections and chronic infections (240/423;57% versus 502/1031;49%, p=0.04). Half of the cohort had a polymicrobial infection and were slightly more frequent with S. agalactiae BJIs (235/423;56% versus 498/1031;48%, p=0.1). These results were consistent with a sensitivity analysis excluding diabetic foot related osteitis. Logistic regression analysis identified arteriopathy (OR: 4.16; IC95:1.64-11.24, p=0.003), and obesity (OR: 2.57; IC95: 1.41-4.78, p=0.002) as specific risk factors for S. agalactiae BJIs. Conclusion: S. agalactiae emerges as a prominent and distinct pathogen in complex streptococcal BJIs, with specific risk factors such as arteriopathy, obesity and diabetes mellitus, and more chronic infections.

BackgroundChronic hepatitis B virus (HBV) infection (CHB) affects nearly 300 million individuals globally and remains incurable with current antiviral therapies, which suppress viral replication but rarely achieve functional cure defined by sustained loss of hepatitis B surface antigen (HBsAg). CHB is characterized by profound virus-induced immune tolerance that limits the efficacy of conventional therapeutic vaccination strategies. ObjectiveTo evaluate the therapeutic efficacy and immunological mechanisms of HEPLISAV-B, a CpG-1018-adjuvanted HBsAg vaccine, in breaking immune tolerance and inducing functional cure-like responses in a murine model of CHB. DesignUsing the adeno-associated virus-HBV (AAV-HBV) mouse model, mice with high levels of persistent HBV viremia were vaccinated with two doses of HEPLISAV-B. Virological outcomes in the blood and liver, immune responses and mechanisms were assessed. ResultsHEPLISAV-B induced rapid and durable HBsAg clearance, markedly reduced circulating and intrahepatic HBV DNA and RNA, and suppressed viral replication without hepatocellular injury. Vaccination elicited robust, sustained anti-HBs IgG1 and IgA responses, enhanced HBsAg-specific T and B cell immunity, reduced CD4 regulatory T cells, and decreased PD-1 expression on CD4 T cells. Therapeutic efficacy was strictly dependent on CD4 T cells and the CD40/CD40L signaling pathway, but independent of CD8 T cells, indicating a CD4-driven, non-cytolytic antiviral mechanism critical for HEPLISAV-B induced HBV control. ConclusionHEPLISAV-B effectively breaks HBV-induced immune tolerance and restores coordinated antiviral immunity through a CD4 T cell-/CD40L-dependent pathway. The findings support its potential as a therapeutic vaccine in CHB patients. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSChronic HBV infection is marked by profound virus-induced immune tolerance, current antiviral therapies and vaccines fail to reliably induce HBsAg loss or restore effective antiviral immunity, highlighting the need for immune-based therapeutic strategies. What this study addsThis study demonstrates that the clinically approved vaccine HEPLISAV-B can break HBV immune tolerance in a chronic HBV mouse model, inducing durable HBsAg clearance and anti-HBs immunity, non-cytolytic depletion of intrahepatic HBV DNA, through a mechanism strictly dependent on CD4 T cells and CD40/CD40L signaling. How this study might affect research, practice or policyThese findings defined a CD4 T cell-CD40L/CD40 axis that is critical in CHB functional cure, and support testing HEPLISAV-B as a therapeutic vaccine in CHB patients. O_FIG O_LINKSMALLFIG WIDTH=165 HEIGHT=200 SRC="FIGDIR/small/711721v1_ufig1.gif" ALT="Figure 1"> View larger version (34K): org.highwire.dtl.DTLVardef@1d76f4dorg.highwire.dtl.DTLVardef@cc41cborg.highwire.dtl.DTLVardef@1f39288org.highwire.dtl.DTLVardef@192d0e_HPS_FORMAT_FIGEXP M_FIG Graphical Abstract C_FIG

Introduction: Following a large chikungunya outbreak during 2006 to 2008, Sri Lanka did not report any outbreaks for a 16 year period until end of 2008, possibly due to population immunity. Therefore, understanding baseline immunity prior to outbreaks is crucial to inform implementation of vaccine strategies. Methods: We assessed the age stratified seroprevalence for chikungunya in an urban (n=816) and a semi urban (n=380) community in Colombo, Sri Lanka, from September to November 2024, prior to the commencement of the large chikungunya outbreak, in December 2024. Sociodemographic, socioeconomic and clinical data were collected and chikungunya specific IgG measured in serum samples. Results: Of 1196 participants, 410 (34.3%) were chikungunya IgG seropositive. Seroprevalence was significantly higher in urban populations compared with semi urban populations (39.6% vs 22.9%; p<0.001) and increased significantly with age in urban areas but not in semi-urban areas. Living in an urban area was the strongest independent risk factor of chikungunya seropositivity (aOR 7.48, 95% CI 4.05 to 13.81; p<0.001), consistent with the higher population density, poor housing conditions and overcrowding observed in that setting. The use of mosquito nets was independently associated with reduced risk of seropositivity (aOR 0.50, 95% CI 0.27 to 0.93; p=0.029). Almost no individuals aged <16 years had evidence of prior infection (0.55%), indicating minimal transmission in the preceding 16 years. In the urban cohort, seropositivity was significantly associated with diabetes, central obesity, overweight, and hypertension. Conclusions: There appears to have been minimal chikungunya transmission in the 16 years preceding the 2024 outbreak, with a large population susceptible to chikungunya. Higher seroprevalence in urban populations highlights the role of population density, overcrowding, and housing conditions as key drivers of transmission.

BackgroundRisky sexual practices contribute significantly to the transmission of sexually transmitted infections (STIs) and HIV/AIDS. Taxi and three-wheeled vehicle drivers may be particularly vulnerable due to occupational mobility and related lifestyle factors. However, evidence on this population in Ethiopia remains limited. MethodsA community-based cross-sectional study was conducted among taxi and three-wheeled vehicle drivers in Arba Minch town, Ethiopia, from July 26 to August 26, 2025. Participants were selected using a simple random sampling technique. Data were collected using an interviewer-administered questionnaire through the Kobo Toolbox mobile application. Data were exported to SPSS version 27 for cleaning and analysis. Binary logistic regression analysis was performed to identify factors associated with current risky sexual practices. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used, and statistical significance was declared at p < 0.05. ResultsA total of 640 drivers participated in the study (response rate: 97.6%). The prevalence of lifetime risky sexual practices was 46.9% (95% CI: 43.0%-50.8%), while the prevalence of current risky sexual practices was 37.2% (95% CI: 33.4%-41.1%). Factors independently associated with current risky sexual practices included living alone (AOR = 3.01; 95% CI: 2.03-4.45), not discussing sexual and reproductive health issues (AOR = 2.09; 95% CI: 1.17-3.75), substance use (AOR = 1.69; 95% CI: 1.10-2.61), attending nightclubs (AOR = 2.04; 95% CI: 1.41-2.96), and exposure to pornographic materials (AOR = 2.19; 95% CI: 1.49-3.23). ConclusionA substantial proportion of taxi and three-wheeled vehicle drivers reported engaging in risky sexual practices, indicating a significant and overlooked public health concern within this occupational group. These practices were independently associated with modifiable behavioral and lifestyle factors, including substance use, nightlife attendance, and inadequate communication on sexual and reproductive health issues. The findings underscore the urgent need for innovative, multi-sectoral interventions that extend beyond conventional health service delivery. Integrating basic sexual and reproductive health education and risk-reduction messaging into driver licensing and refresher training programs may provide a feasible and scalable opportunity to reach this mobile and high-risk population. Such integration, in collaboration with transport authorities and public health sectors, has the potential to improve awareness, promote safer behaviors, and reduce vulnerability to risky sexual practices among drivers.

BackgroundHepatitis E virus (HEV) seroprevalence varies by age and geography. Data on HEV seroprevalence across age groups and among people living with HIV (PLWH) in South Africa is scarce. MethodsWe conducted a prospective multi-site assessment of anti-HEV IgG seroprevalence on 859 South African participants enrolled at three clinical research centres including Newtown Clinical Research Centre in Johannesburg, Be Part Research in Mbekweni, Paarl, Western Cape, and Mecru Clinical Research Unit in Garankuwa, Pretoria. Participants comprised adults aged 18 - 45 years (PLWH, n = 178 and HIV-negative, n = 232), and children aged 2-17 years (n = 449). Anti-HEV IgG serostatus and antibody titer were measured using a commercial ELISA kit and a WHO reference standard. Seroprevalence was assessed by site, age group, sex, and HIV status. ResultsOverall anti-HEV IgG seroprevalence was 18.0% (95% CI: 15.6-20.8). Adults had the highest seroprevalence (27.3% among all adults; 29.2% among PLWH and 25.9% in HIV-negative adults), while adolescents aged 12-17 years had the lowest (6.9%), and young children aged 6-11 years and 2-5 years had 10.3% and 13.0%, respectively. Adults had significantly higher odds of seropositivity than children (aOR 2.8, 95% CI: 1.5-5.5, p = 0.002). A significant site-specific variation was also observed among healthy adults and adolescents: Newtown Clinical Research Centre (23.0% and 14.0%) and Be Part Research (34.5% and 7.3%) had higher seroprevalence compared with those from Mecru Clinical Research Unit (17.2% and 1.5%, p = 0.0499 and 0.0262, respectively). A higher mean antibody titer observed in younger children aged 2-5 years (5.06 IU/mL), compared with adults (0.88 IU/mL among PLWH and 0.68 IU/mL among HIV-negative adults), and with older children (2.02 IU/mL in those aged 6-11 years and 0.67 IU/mL in those aged 12-17 years). ConclusionsHEV seroprevalence in South Africa was highly heterogeneous, varying markedly by age group and study site. These findings highlight the need for strengthened, integrated HEV surveillance to better define transmission patterns and to inform evidence-based considerations for prevention of infection.

IntroductionInternational goals aim to eliminate Hepatitis B Virus (HBV) as a public health threat by 2030, but data representing African populations remain limited. We therefore investigated the population prevalence of HBV and treatment eligibility in a rural South African setting. MethodsWe tested archived plasma samples from 2200 participants in a population-based study in KwaZuku Natal for HBV surface antigen (HBsAg), HBV core antibody (anti-HBc), and HBV surface antibody (anti-HBs). For samples testing HBsAg-positive, we quantified alanine transferase (ALT) and HBV DNA viral load. We evaluated demographic and clinical correlates of HBV biomarkers, explored the geographical distribution of HBsAg, and assessed HBV treatment eligibility. ResultsWeighted HBV infection prevalence was 10.4% (95% CI: 9.0%-12.1%). Evidence of HBV exposure and clearance was found in 34.9% (95% CI: 32.4 - 37.5). Overall prevalence of vaccine-mediated HBV immunity was 8.9% (95% CI: 7.5%-10.4%) but for the sub-group born between 2000-2005 (after the HBV vaccine was implemented) this increased to 20.2% (95% CI 15.8-25.4). Infection prevalence was highest in the South of the region. Over 60% of individuals testing HBsAg-positive met treatment eligibility criteria. ConclusionPrevalence of HBV infection and exposure in this setting is high, while vaccine-mediated immunity is low. These data highlight a pressing need for scale-up of interventions to support progress towards global elimination targets. FundingThe Francis Crick Institute (ref. CC2223), the Africa Oxford Initiative (Research Development Award) and Wellcome Strategic Core Award (227167/A/23/z). EthicsUniversity of KZN (UKZN) ref. 00004495/2022; University College London ref. 23221/001.

Background Heatwaves increasingly threaten public health in the Mediterranean region, and Greece is among the hardest hit countries. Yet evidence on long-term adaptation, spatial vulnerability, and the contribution of human-induced climate change to heatwave-related mortality in Greece remains limited. Methods We analysed 2,144,957 all cause deaths in Greece during 2000 and 2019 using a time stratified case crossover design. We derived population weighted daily maximum temperatures at NUTS3 level from ERA5 reanalysis and WorldPop. We applied six heatwave definitions (HD1-HD6) varying by duration (2 or 3 consecutive days or more) and thresholds (90th, 95th, 99th percentiles). We fitted Bayesian hierarchical Poisson models to estimate heatwave-mortality associations varying by space and time. We additionally adjusted for relative humidity and national. We then combined these estimates with probabilistic climate attribution methods to quantify the number and proportion of heatwave-related deaths attributable to human induced climate change. Results Heatwaves raised mortality consistently, with relative risks from 1.08 (95% CrI (Credible Interval): 1.07- 1.09; HD1) to 1.15 (1.11- 1.20; HD6). Risks increased with heatwave intensity and duration and peaked among females and adults aged 85 years and older. We did not detect a consistent temporal decline in risk or marked spatial heterogeneity. Human induced climate accounted for 51-94% of heatwave related deaths across definitions. The proportion attributable to climate change rose over time. Conclusions Heatwaves already impose a major mortality burden in Greece, with more than half driven by anthropogenic climate change and little evidence of population level adaptation. These findings call for rapid emissions reductions and targeted adaptation, including stronger heat health warning systems and protection of vulnerable groups.

Background Increasingly accessible satellite imagery provides scalable measures of the built and natural environment relevant to population health. However, whether such imagery can capture subnational variation in mortality and life expectancy remains unclear. We therefore assessed its predictive value for regional mortality and life expectancy across OECD regions. Methods We conducted an ecological, cross-sectional prediction study using 2023 data from OECD Territorial Level 3 (TL3) regions. Annual cloud-masked composites from the Harmonized Landsat and Sentinel-2 collection were processed in the Google Earth Engine, tiled at 224 x 224 pixels, and encoded with the pretrained Prithvi foundation model to derive region-level satellite embeddings. For each outcome, we trained LightGBM regressors for a country-only baseline, a satellite-only model, a combined model (country + satellite), and a final contextual model that additionally included prespecified socioeconomic and environmental covariates. Performance was evaluated using 10-fold outer cross-validation with held-out test folds; R2 was the primary metric. Results The analytic sample comprised 2,414 OECD TL3 regions across 38 countries, for which 939,959 satellite image tiles were processed. In paired bootstrap comparisons, adding satellite features to country indicators improved predictive performance for all outcomes, with incremental R2 ranging from 0.097 to 0.233. The final contextual model achieved R2 values of 0.78 (95% CI, 0.74-0.81) for crude mortality, 0.87 (0.84-0.89) for age-adjusted mortality, 0.86 (0.82-0.88) for infant mortality, and 0.76 (0.69-0.84) for life expectancy. In SHAP analyses, the aggregated satellite image effect consistently ranked among the top predictors across outcomes. Conclusion Satellite imagery captures subnational environmental heterogeneity relevant to regional mortality and life expectancy beyond country identity alone. Earth observation may therefore provide a scalable, complementary data source for characterizing geographic disparities in population health.