Back

International Journal for Parasitology

Elsevier BV

Preprints posted in the last 7 days, ranked by how well they match International Journal for Parasitology's content profile, based on 26 papers previously published here. The average preprint has a 0.02% match score for this journal, so anything above that is already an above-average fit.

1
Comprehensive study of Trypanosoma cruzi genetic diversity from Triatominae vectors in the Southern United States: Geographic structuring, mitochondrial introgression, and multiclonality

Hernandez, J. C.; Beatty, N. L.; Vogel, K. J.; Zima, J.; Novakova, E.

2026-08-31 microbiology 10.64898/2026.08.21.746190 medRxiv
Top 0.1%
3.5%
Show abstract

Background Trypanosoma cruzi, the causative agent of Chagas disease, is subdivided into distinct genetic groups known as Discrete Typing Units (DTUs), each with distinct genetic traits that influence epidemiology and transmission dynamics. Several triatomine species serve as potential vectors of T. cruzi in the United States. However, despite the growing number of Chagas disease cases in the country, little is known about the genetic diversity and population structure of T. cruzi in natural vector populations. Methodology/Principal Findings We applied a multilocus metabarcoding approach to improve DTU resolution and characterize the genetic diversity and structure of T. cruzi in triatomines collected across five states of the southern United States. Five single-copy nuclear markers and one mitochondrial marker were amplified and processed by high-throughput sequencing to assess genetic diversity. We recovered 35 nuclear and 15 mitochondrial haplotypes from 70 infected specimens. Overall, genetic diversity was low ({pi} < 0.01 at all nuclear loci), with DTUs TcI and the North American lineage of TcIV detected, TcI being the most prevalent. Geographic structuring was particularly evident in TcI strains, which exhibited a distinctive haplotype profile in Florida populations, potentially linked to the recently revalidated vector species Triatoma ambigua. Mitochondrial introgression from TcIV into TcI suggests inter-DTU genetic exchange in these populations. Multiple haplotypes within individual insects detected across single-copy nuclear markers, support multiclonal infection as common feature of T. cruzi in natural vectors. Conclusions/Significance These findings provide new insights into the genetic landscape and evolution of T. cruzi in the United States. Evolutionary connectivity through mitochondrial introgression and frequent multiclonality highlights the importance of deep sequencing approaches for resolving T. cruzi genetic diversity, with direct implications for understanding for transmission dynamics, disease monitoring and control.

2
Identification of genetic variants in Pfs25 and functional evaluation in mosquito infection

Orfano, A.; Cisse, A.; Guo, Y.; Han, L.; Fikadu, N.; Thiam, L. G.; Ba, A.; Li, R.; Pouye, M. N.; Mangou, K.; Moore, A. J.; Sene, S. D.; Diallo, F.; Ngom, E. M.; Sadio, B.; Mbengue, A.; Membi, C.; Ngasala, B.; Bazie, T.; Some, F. A.; Olson, N.; Patel, S. D.; Shapiro, L.; Parikh, S.; Foy, B. D.; Cappello, M.; Vigan-Womas, I.; Premji, Z.; Dabire, R. K.; Ouedraogo, J.-B.; Sheng, Z.; Bei, A. K.

2026-08-31 infectious diseases 10.64898/2026.08.25.26361130 medRxiv
Top 0.4%
1.1%
Show abstract

Transmission-blocking vaccines (TBVs) are a promising strategy to reduce malaria transmission by targeting parasite stages within the mosquito. However, parasite genetic diversity may limit vaccine efficacy. We used next-generation amplicon deep sequencing to identify non-synonymous single nucleotide polymorphisms (SNPs) in Pfs25 from 184 Plasmodium falciparum isolates from Senegal, Tanzania, Ghana, and Burkina Faso. Prioritized SNPs were introduced into P. falciparum via CRISPR-Cas9. For the G116C variant, gametocyte development was evaluated by microscopy and qPCR, and mosquito infectivity was assessed by SMFAs. We identified 26 SNPs, including 24 novel variants. Functional assays showed that the Pfs25 G116C mutation did not affect gametocyte development or exflagellation. SMFA showed no significant differences in oocyst prevalence or intensity between mutant and WT parasites. These findings highlight the importance of integrating genetic surveillance with functional validation to guide the development of effective transmission blocking interventions

3
Chemoproteomic profiling of Plasmodium falciparum Hsp90 inhibition reveals functional link to DNA replication pathways

Ibrasheva, G.; Chen, Y.; Chirgwin, M. E.; Hughes, C. J.; Fitzgerald, M. C.; Derbyshire, E. R.

2026-08-31 cell biology 10.64898/2026.08.28.747854 medRxiv
Top 0.6%
0.8%
Show abstract

Plasmodium falciparum heat shock protein 90 (PfHsp90) is a promising antimalarial target, but the molecular pathways influenced by its inhibition remain poorly understood. Herein, we leveraged chemoproteomic profiling employing geldanamycin and XL888 Hsp90 inhibitors to investigate proteins and pathways dependent on the chaperone during the Plasmodium blood stage. This study revealed 131 proteins reduced in abundance after inhibition, of which 40% co-immunoprecipitated with PfHsp90. Bioinformatic analyses identified DNA replication as the most enriched pathway. This link was investigated in phenotypic studies demonstrating reduced parasite DNA content after PfHsp90 inhibition. To assess nascent DNA synthesis, we utilized a 7-deaza-7-ethynyl-2'-deoxyadenosine (EdA) assay, yielding dual-stage attenuation of nucleoside incorporation following Hsp90 inhibition. We further show that parasite co-treatment with Hsp90 and DNA replication inhibitors produces synergistic interactions, highlighting the therapeutic potential of the discovered link. Overall, these findings expand our understanding of PfHsp90 function and uncover novel PfHsp90-dependent pathways.

4
Female contraceptive cover duration for miltefosine-containing regimens for the treatment of women with leishmaniasis

Chu, W.-Y.; Alves, F.; Dorlo, T. P. C.

2026-09-02 infectious diseases 10.64898/2026.08.31.26360682 medRxiv
Top 0.7%
0.6%
Show abstract

Introduction Miltefosine is the only approved oral antileishmanial agent, but its use in women of childbearing potential (WOCBP) is restricted due to preclinical teratogenicity. Current labeling recommends contraception during treatment and for at least five months thereafter, based solely on its long terminal elimination half-life. This study re-evaluated the required contraceptive duration using an exposure margin-based approach. Methods Virtual populations were generated from anthropometric data of 382 Indian, 4,462 Eastern African, and 4,019 Brazilian WOCBP with leishmaniasis. Published population pharmacokinetic models were used to simulate miltefosine exposure following 14-42-day regimens for visceral leishmaniasis (VL), post-kala-azar dermal leishmaniasis (PKDL), and cutaneous leishmaniasis (CL). A developmental safety exposure threshold was derived from the rat no-observed-adverse-effect level (0.6 mg/kg/day for 10 days) and adjusted using a 10-fold safety margin. Contraceptive durations resulting in median residual post-contraception exposure (AUCEOC-{infty}) below this threshold were considered supportive of contraceptive discontinuation. Results The developmental safety exposure threshold was estimated at 2.5 mg{middle dot}day/L. Despite pharmacokinetic differences across geographical regions and disease manifestations, required minimum contraceptive durations were consistent: three months from treatment initiation for the 14-day regimen, four months for 21- and 28-day regimens, and five months for the 42-day regimen. For the 14-day regimen, a single dose of a long-acting injectable contraceptive administered at treatment initiation would provide sufficient coverage. Conclusion An exposure margin-based approach supports shorter contraceptive durations than current recommendations. For the 14-day VL regimen, three months of contraception may provide a practical alternative to current labeling.

5
Three new species of Thelymitra (Diurideae, Orchidaceae) endemic to Aotearoa New Zealand.

Jones, H. R.; Tate, J. A.; Lehnebach, C. A.

2026-09-01 plant biology 10.64898/2026.08.27.745643 medRxiv
Top 0.7%
0.5%
Show abstract

Three new species of sun orchid (Thelymitra) endemic to Aotearoa New Zealand are here described. These are T. palustris, T. scabrifolia and T. semaphora. The morphological distinctiveness of these three species has been acknowledged for decades; however, their taxonomic status has remained unresolved. Evidence from existing karyological data, recently generated DNA sequence data (LFY and ycf1) and morphological studies from historical and fresh collections are used here to support their formal description. Both, T. palustris and T. semaphora are restricted to wet habitats north of Auckland (North Island). Thelymitra scabrifolia inhabits mostly scrub, and it has a similar northern North Island distribution, but is has been found also in Manawat[a]whi / Three Kings Islands and historically in Otago (South Island). All three species are polyploids and are of conservation concern.

6
Comparative analysis of Shigella and Campylobacter transmission in paired longitudinal household cohort studies in urban Bangladesh and rural Tanzania

Van Wyk, H.; Brouwer, A.; Elwood, S.; Pholwat, S.; McQuade, E. R.; Haque, R.; Siraj Sony, S. S.; Resha, S. K.; Islam, M. O.; Taniuchi, M.; Platts-Mills, J. A.; Eisenberg, J. N.

2026-09-04 infectious diseases 10.64898/2026.09.01.26361896 medRxiv
Top 0.7%
0.5%
Show abstract

Background: Transmission pathways of enteric pathogens have been broadly characterized; however, the degree to which different pathogens exploit different transmission routes and how these patterns vary across age remain poorly understood. We quantified the relative contribution of within-household (infection sources internal to the household) and community-to-household (infection sources external to the household) transmission for Shigella and Campylobacter. Methods: We conducted paired longitudinal cohort studies in urban Bangladesh and rural Tanzania, each enrolling 100 households with a child under the age of one year. Stool samples were collected from participants' households monthly and during diarrheal episodes for one year. We estimated daily infection trajectories for each participant for Shigella and Campylobacter. We used these data in a household transmission model, estimating within-household and community-to-household transmission rates by pathogen, age group, and study site, using forward selection to identify interactions. Findings: Overall, 8.8% of Campylobacter and 7.6% of Shigella infections were symptomatic. The incidence of Shigella and Campylobacter was 2.3 and 1.4 times higher, respectively, in Bangladesh compared to Tanzania. Crude associations suggest that Campylobacter had greater community-to-household versus within-household transmission compared to Shigella, but these patterns were better explained by interactions with age. Specifically, children <5 years had higher transmission rates for Campylobacter than Shigella, and, for both pathogens, higher community-to-household than within-household transmission rates. Those [&ge;]5 years had higher Shigella transmission. Interpretation: Apparent pathogen-specific differences in transmission patterns for Shigella and Campylobacter were driven by effect modification by age. Intervention design should consider age-specific transmission patterns along with pathogen biology.

7
Preferences for receiving study results among pregnant women participating in a phase III clinical trial in Papua New Guinea.

Mengi, A.; Bagita-Vangana, M.; Tesine, P.; Laman, M.; Bolnga, J. W.; Ome-Kaius, M.; Kulimbao, J.; Mase, J.; Mal, L. S.; Mnjala, H.; Lee, G.; Cassidy-Seyoum, S. A.; Thriemer, K.; Unger, H. W.

2026-08-31 medical ethics 10.64898/2026.08.27.26361571 medRxiv
Top 0.9%
0.4%
Show abstract

Disseminating study results to participants is an ethical responsibility for researchers but remains uncommon in low- and middle-income countries, and participants preferences for receiving study results are poorly understood. This study examined study result dissemination preferences among pregnant women in a phase III malaria prevention trial in Papua New Guinea (PNG). Participants completed an interviewer-administered questionnaire (survey) assessing their interest in and motivation for receiving trial results and preferences for dissemination methods and content. Associations between participants characteristics and dissemination preferences were explored using multivariable logistic regression analysis. Of 1172 trial participants, 96.0% (1125/1172) completed the survey, and of these 99.6% (1121/1125) wanted to learn about the trial results. The main motivation factors driving participants interest were an acknowledgment of their contribution to research (51.7%; n=579) and a better understanding of the study (45.0%; n=505). Most participants (78.9%; n=884) wanted to learn about the trial findings through written summary and a group meeting with other participants at the nearest clinic (31.1%, n=349). Multivariable regression analysis indicated that participants from rural/peri-urban clinics were more likely to choose non-electronic media dissemination approaches such as a group meeting as compared to urban-dwelling participants. Frequently selected items (>50% of participants) for content included information regarding good results of the study, purpose of the study, medical treatment advances, results specific to me, and how study was conducted. There was heterogenicity in the preference for dissemination content: compared to urban clinics rural clinics are less likely to want to learn about how and why study was conducted and medical and scientific advances. Overall, the majority wanted to learn about trial results, highlighting the importance of integrating dissemination into research activities in PNG. Variation in preferences for mode and content of dissemination between study clinics suggests that dissemination activities could be tailored to local context and preferences.

8
Vaginal Steaming Practices Among Women At Mulago Sti Clinic, Uganda: Prevalence, Lactobacilli Proportion Differences, And Associated Factors.

Kakai, D.; Twinamasiko, N.; Kigozi, E.; Namutale, R.; Mutesi, B. A.; Bagaya, J.; Akinyi, L.; Kajumbula, H.; Nakubulwa, S.

2026-09-01 obstetrics and gynecology 10.64898/2026.08.28.26361407 medRxiv
Top 1%
0.3%
Show abstract

Abstract Background: Vaginal steaming has gained popularity among women for reasons known best to them. However, the effects of vaginal steaming on vaginal lactobacilli levels remain poorly understood and understudied. This study investigated the prevalence, assessed differences in the presence of bacterial vaginosis (BV) among women who practiced vaginal steaming and those who do not and determined the factors associated with vaginal steaming among women attending Mulago Sexually Transmitted Infections (STI) clinic in Uganda. Methods: This study utilized a cross-sectional design to enroll 181 women aged 18 to 49 years who were systematically sampled at Mulago STI clinic. Interviews were conducted to obtain the demographic characteristics of the participants. Vaginal swabbing and Gram staining were done to attain lactobacilli counts by microscopy which were categorized using the Nugent score. Data were analyzed using Stata. The potential confounding effects of other variables on the relation between vaginal steaming and the presence of bacterial vaginosis as well as factors associated with vaginal steaming were assessed using modified Poisson regression. Results: Prevalence of vaginal steaming was 40.3%, (95% confidence interval (CI) 33.0% - 48.0%). There were 41.1% women who practiced vaginal steaming occasionally, 53.4% who used hot water having herbs and 78.1% who practiced vaginal steaming for medical reasons. There was no difference in the presence of bacterial vaginosis when women who practiced vaginal steaming were compared to those who did not (p-value = 0.286). Factors that were significantly associated with vaginal steaming included having experienced vaginal issues (aPR = 0.07, 95% CI 0.01 - 0.12, p value = < 0.001) and contraceptive use (aPR= 0.52, 95% CI 0.37 - 0.72, p value = 0.001). Conclusions: About 2 in every 5 women at Mulago STI clinic reported to have indulged in vaginal steaming. There was no difference in the presence of bacterial vaginosis when women who practiced vaginal steaming were compared to those who did not. Having experienced vaginal issues and contraceptive use were significantly associated with vaginal steaming among women at Mulago STI clinic, Uganda. The Ministry of Health of Uganda should establish targeted screening and treatment for bacterial vaginosis alongside other sexually transmitted infections.

9
Evaluating Mean Platelet Volume in relation to Disease Severity in Paediatric Sickle Cell Anaemia: A Cross-Sectional Study in Kwara State, North-Central Nigeria

Oladimeji, F. D.; Adewoyin, A. D.; Oyeleke, K. O.

2026-09-02 hematology 10.64898/2026.08.28.26361349 medRxiv
Top 2%
0.2%
Show abstract

Background: Sickle cell anaemia (SCA) is characterised by chronic haemolysis, inflammation, platelet activation, and recurrent vaso-occlusive complications. Mean platelet volume (MPV) is a readily available platelet index, but evidence regarding its relationship with disease severity in paediatric SCA remains limited and inconsistent, particularly in African populations. Objective: To evaluate the relationship between MPV and disease severity among children with SCA in Kwara State, North-Central Nigeria. Methods: This hospital-based cross-sectional study included 51 clinically stable children with confirmed SCA consecutively recruited from the paediatric haematology clinic of Children Emergency Specialist Hospital, Ilorin. Complete blood count, including MPV, was performed using a Rayto RT-7600 automated haematology analyser. Disease severity was assessed using a composite clinical and laboratory scoring system based on a previously described method. Pearson's correlation, Spearman's rank correlation, simple linear regression, and the Kruskal-Wallis test were used as appropriate. Statistical significance was set at p < 0.05. Results: Of 51 participants, 14 (27.5%) had mild, 33 (64.7%) moderate, and 4 (7.8%) severe disease. Mean MPV was 9.34 +/- 0.76 fL (range, 8.0-11.2). Pearson's correlation showed a weak positive, non-significant linear relationship with severity score (r = 0.231, p = 0.103), whereas Spearman's analysis showed a weak positive monotonic association (rho = 0.286, p = 0.042). Regression explained 5.3% of severity-score variation (R2 = 0.053, p = 0.103). MPV did not differ significantly across severity categories (H = 2.163, p = 0.339). MPV correlated inversely with haemoglobin (r = -0.556, p < 0.001) and positively with platelet count (r = 0.307, p = 0.029). Conclusion: MPV showed a weak relationship with disease severity but inconsistent statistical evidence across analyses. The limited explained variance and absence of significant differences between severity categories do not support MPV as a standalone severity marker. Larger longitudinal studies are warranted. Keywords: Sickle cell anaemia; Mean platelet volume; Disease severity; Platelet indices; Paediatric haematology; Cross-sectional study; Nigeria.

10
PfAMA1-expressing chimeric rodent malaria parasites provide an in vivo platform for evaluating multistage interventions against malaria

Issahaque, Q.-a.; Shinzawa, N.; Kegawa, Y.; Sekine, T.; Amino, H.; Torii, M.; Tsuji, M.; Ishino, T.

2026-08-30 microbiology 10.64898/2026.08.28.747760 medRxiv
Top 2%
0.1%
Show abstract

Apical membrane antigen 1 (AMA1) is expressed in the merozoite and sporozoite infectious stages of the malaria parasite, and upon secretion plays essential roles during host cell invasion. AMA1 is a leading candidate for vaccine development, although specific antibodies frequently fail to inhibit the growth of field-isolated Plasmodium falciparum malaria parasites, likely due to the high diversity of polymorphisms in AMA1 surface antigens. A key step for efficient invasion of target cells is tight junction formation through interaction of merozoite-surface AMA1 and rhoptry neck protein 2 (RON2), which is secreted and embedded within the erythrocyte membrane. Antibodies or reagents that disrupt the AMA1-RON2 interaction represent interventions to reduce parasite transmission to humans, as well as to repress clinical symptoms. To create a mouse model system for the evaluation of reagents against P. falciparum AMA1 (PfAMA1), we generated CRISPR/Cas9-engineered rodent malaria parasites in which the endogenous Plasmodium berghei AMA1 (PbAMA1) was replaced with PfAMA1, resulting in a chimeric line Pb_PfAMA1. Pb_PfAMA1 parasites infect mouse liver and erythrocytes as efficiently as the parental line, demonstrating that PfAMA1 functionally complements the essential roles of PbAMA1. AlphaFold-based structure modeling suggested structural compatibility of the heterologous PfAMA1-PbRON2 interaction, and co-immunoprecipitation analyses supported the functional association of the PfAMA1 and PbRON complex required for merozoite invasion of erythrocytes. Utilizing the interaction-inhibitor R1 peptide with Pb_PfAMA1 sporozoites, we demonstrated that the AMA1-RON2 interaction is crucial for sporozoite invasion of hepatocytes. Repeated infection with Pb_PfAMA1 elicited PfAMA1-reactive antibodies, and immune sera inhibited the growth of the P. falciparum lines Pf3D7 and PfHB3B; suggesting that naturally processed parasite-derived PfAMA1 induces antibodies which recognize conserved conformational epitopes. To expand this platform, we replaced circumsporozoite protein PbCSP with PfCSP, to generate dual-chimeric Pb_PfCSP+PfAMA1 parasites. Together, these chimeric parasites establish an in vivo platform for evaluating multistage and multi-antigen interventions against malaria.

11
Drought and Syphilis Exposure in Zambia, Uganda, and Tanzania: Are There Urban/Rural Disparities?

Simo Fotso, A.; Charline Maltat, C. M.; Gbaguidi-Sekpon, B.; Marzouk, H.; Trickey, A.; Low, A.; Becquet, V.

2026-09-04 infectious diseases 10.64898/2026.08.31.26361827 medRxiv
Top 2%
0.1%
Show abstract

Eastern and southern Africa are highly affected by drought, and projections indicate that droughts will become more common in the coming decades. Whilst there has been research on the impact of drought on HIV, attributable to its effect on food insecurity and increased risky sexual behaviour, the link between drought and other sexually transmitted infections (STIs), particularly syphilis, remains largely unexplored. This study therefore assesses the association between drought and active syphilis, history of syphilis, and recovery from syphilis in Zambia, Uganda, and Tanzania, while examining disparities between urban and rural settings. It uses data on 75,225 people from Population-based HIV Impact Assessment surveys (2016-17), which include biomarker information, combined with rainfall data from the Climate Hazards Group InfraRed Precipitation with Station (CHIRPS) dataset to define drought in the two years prior to the survey. Multivariate logistic regression models with country-level fixed effects show that in urban areas, drought was associated with a significant increase in the probability of having active syphilis (average marginal effects (AME) = 0.5%, 95% confidence interval (CI): 0.2%-1.0%) and of having ever had syphilis (AME = 2%, 95% CI: 0.8%-4%). No significant association was found in rural areas. Exposure to drought was not associated with recovery from syphilis in either setting, though confidence intervals were wide. Our results underscore the importance of strengthening healthcare systems to make them more resilient to drought shocks in urban areas, and the need to reinforce syphilis prevention and treatment programmes in those areas when such shocks occur.

12
Comparative analysis of the neural and muscle systems in the subumbrella of hydrozoan jellyfish.

Norekian, T. P.; Moroz, L. L.

2026-08-31 zoology 10.64898/2026.08.30.748097 medRxiv
Top 2%
0.1%
Show abstract

Hydrozoa is a group of relatively simple animals with a well-developed nervous system. The nervous system in all hydrozoan medusae is highly conserved and includes outer and inner nerve rings at the bell margin, a neural network in the manubrium, and radial neural pathways that connect them. However, one element of the nervous system shows substantial variability among species: the subumbrella neural network. We examined the structure of the nervous and muscular systems in the subumbrella of 14 species of hydrozoan medusae. The main conclusion of this study is that the distribution of neural networks in the subumbrella strongly correlates with the distribution of smooth radial muscles. This correlation suggests that smooth radial muscles are the primary target of the subumbrella nervous system. Most species in the order Anthoathecata show a trend toward secondary loss of the neural networks and radial smooth muscle fibers in the subumbrella region, concentrating neural elements and smooth muscles only in the radial pathways along the radial canals. By contrast, all studied species in the order Leptothecata have neural networks in the subumbrella area, as well as radial smooth muscle fibers spread throughout the entire subumbrella region. The correlation between radial smooth muscles and the nervous system is also observed in the radial pathways along the radial canals. All species with thick bundles of smooth radial muscles along the radial canals have clearly defined, dense neural pathways running along or even embedded within the smooth muscle bundles.

13
Rainfall and Leptospirosis in the Dominican Republic, 2012-2026: A Distributed-Lag Time-Series and Province-Panel Analysis

Sanchez, J. J.; Alcantara, L. V.; De Luna, D.; Aleuy, O. A.; Decicco, L. P.; Cruz Raposo, J. L.; Dye, T. D. V.

2026-09-04 public and global health 10.64898/2026.09.01.26361897 medRxiv
Top 2%
0.1%
Show abstract

Background: The biological mechanism linking rainfall with leptospirosis transmission is well established, but rigorous quantitative evidence for the insular Caribbean remains scarce, limited mostly to descriptive reports of post-hurricane outbreaks. We aimed to quantify the association between rainfall and leptospirosis incidence in the Dominican Republic, where leptospirosis is endemic, between 2012 and 2026 using a distributed-lag approach. Methods: We conducted an ecological time-series study complemented by a province panel with fixed effects. Case data (5,412 valid cases) were obtained from the national surveillance system (SIP-0276FA51); rainfall data were obtained from 15 INDOMET rain gauge stations across 13 provinces (2000 to 2026). We calculated the cross-correlation function between lagged monthly rainfall (0 to 6 months) and case counts, fitted a negative binomial distributed-lag regression model (lags 0 to 3 months) adjusted for seasonality and trend, triangulated findings with a 13-province fixed-effects panel, compared four rainfall exposure metrics, assessed extreme-rainfall threshold sensitivity, and estimated the population attributable fraction (PAF) with a parametric bootstrap. Results: The rainfall-case association peaked at a 1-month lag (r = 0.551; 95 % CI 0.437-0.647; p < 0.001) and remained significant through 3 months. In the distributed-lag model, all four lags were independently significant, with the 1-month lag showing the strongest effect (incidence rate ratio [IRR] = 1.156 per additional 50mm; 95 % CI 1.090-1.226; p < 0.001). The province panel yielded an almost identical 1-month lag effect (IRR = 1.147; 95 % CI 1.127-1.167). Rainfall above the historical 90th percentile increased case risk the following month (rate ratio = 1.95), with effect magnitude increasing monotonically with threshold stringency. An estimated 28.2 % (95 % CI 19.0-36.6 %) of cases were attributable to rainfall above the recorded historical minimum. Conclusions: Rainfall is a robust, consistent predictor of leptospirosis incidence in the Dominican Republic, with the strongest association observed at a 1-month lag and a lag pattern broadly consistent with findings from distributed-lag studies in Thailand and the Philippines. These findings, which to our knowledge constitute the first formal quantification of this association for the insular Caribbean, provide an evidence base for rainfall-linked early-warning systems, with the strongest signal at approximately one month and elevated risk extending through three months after rainfall.

14
Epidemiology, Temporal and Seasonal Trends, and Geographic Distribution of Leptospirosis in the Dominican Republic, 2012 to 2026

Alcantara, L. V.; Sanchez, J. J.; De Luna, D.; Aleuy, O. A.; Miller, B.; Mace, C.; Scott, H.; Smejkal, L.; Cruz Raposo, J. L.; Hennekens, C.; Dye, T. D. V.

2026-09-04 infectious diseases 10.64898/2026.09.02.26362038 medRxiv
Top 2%
0.1%
Show abstract

Leptospirosis is a widespread zoonotic infection and a growing public health concern in tropical, resource-limited settings, yet remains underrecognized and underreported where diagnostic and surveillance infrastructure is limited. We conducted an analytical cross-sectional study of national surveillance data from the Dominican Republic (2012-June 2026), integrating geospatial meteorological data to characterize disease burden, trends, seasonality, and clinical risk factors. Of 8,425 records, 5,412 met case-definition criteria (3,441 suspected, 1,448 probable, 523 confirmed), yielding a cumulative incidence of 3.55 per 100,000 person-years (2012-2025). Laboratory confirmation rose markedly, from 9.7% overall to half of 2025 cases and over half in 2026. Overall incidence remained stable across all years (p = 0.15), though with three distinct periods: declining infection pre-COVID, low infection during COVID, and increasing infection post-COVID. Cases clustered in the rainy/hurricane season (61.1%, May-November; p< 0.001), with a marginal rainfall correlation (r= 0.553, p= 0.062). Rural provinces bore disproportionate risk, led by Hermanas Mirabal (16.43/100,000 person-years), while large urban and coastal provinces had rates 80% lower. Men had 2.73-fold higher incidence than women (95% CI 2.56-2.90), peaking at younger ages 10-29. Comorbidity was the strongest predictor of complications (OR 2.84, 95% CI 2.01-4.02, p< 0.001). Limited diagnostic confirmation remains the central obstacle to characterizing leptospirosis burden in the Dominican Republic, with confirmation rates exceeding 40% only from 2023 onward. This first multi-decade national analysis identifies high-risk provinces, demographic groups, and seasonal windows for targeted surveillance, highlighting expanded diagnostic capacity as a priority for burden estimation and case management.

15
Small dried fish as an affordable source of key micronutrients in Madagascar: nutritional benefits and contamination risks

Todimazava, L. D.; Darias, M. J.; Mouquet-Rivier, C.; Mahafina, J.; Lamy, T.

2026-09-01 nutrition 10.64898/2026.08.28.26361595 medRxiv
Top 2%
0.1%
Show abstract

Micronutrient deficiencies are prevalent in Madagascar, where diets rely heavily on starchy staples and access to animal-source foods is limited. Small dried fish (SDF) are widely available, yet their nutritional value and health risks remain poorly documented. We combined market surveys, taxonomic identification, and micronutrient and heavy metal analyses of nine SDF types collected along National Road 7. The samples encompassed 33 fish families, were dominated by small pelagic species (Clupeidae and Engraulidae), and were appreciated by consumers. A daily portion (5 g for infants; 10 g for young children and women of childbearing age) contributed substantially to Recommended Nutrient Intakes (RNIs). Across samples and groups, SDF were rich (>30% of RNI) in selenium and, for infants and young children, in calcium. All samples were a source of (>15% of RNI), or rich in, phosphorus, whereas iron contributions were more variable but often substantial. Several samples exceeded 100% of RNIs for selenium, calcium, iron, or manganese in infants and young children, and some were also sources of magnesium and, less frequently, zinc. Vitamin A was absent from sun-dried samples but detected in a smoked freshwater type. Heavy metal concentrations varied markedly, and portions of several types led to estimated exposures to inorganic arsenic or cadmium exceeding reference values, whereas freshwater species and some pelagic types showed a more favorable nutrition-risk balance. Overall, SDF are affordable, nutrient-dense foods with strong potential to alleviate micronutrient deficiencies in Madagascar, while highlighting the need for type-specific guidance to balance nutritional benefits and contamination risks.

16
Hormonal Therapies For Endometriosis: A Systematic Review And Meta-Analysis Of Randomised Head-To-Head Trials

Bandini, V.; Whitaker, L. H.; Vincent, K.; Salmeri, N.; Mawson, R.; Vercellini, P.; Horne, A. W.

2026-08-31 obstetrics and gynecology 10.64898/2026.08.26.26361442 medRxiv
Top 2%
0.1%
Show abstract

Background: Endometriosis is a chronic pain condition in which hormonal therapies form the cornerstone of long-term management. Treatment tolerability is critical for adherence and therapeutic success, but most comparative studies and reviews have focused on their ability to reduce menstrual pain, while their impact on non-menstrual pelvic pain (NMPP), bleeding patterns, adverse events (AEs), treatment discontinuation and quality of life (QoL) remain poorly characterised. This systematic review and meta-analysis evaluate these outcomes across currently available hormonal therapies, providing practical evidence for clinical decision-making. Methods: PubMed/MEDLINE, Scopus, and Embase were searched up to November 2025 for randomised controlled trials comparing at least two active first- or second-line hormonal treatments for endometriosis. Studies without confirmed endometriosis, treatment duration less than three months and comparing therapies to placebo only were excluded. Data were extracted by two reviewers from reports. Pain outcomes were pooled as mean differences (MD, 95% CI), with bleeding patterns, AEs, and discontinuations as proportions. Analyses were performed in R. PROSPERO: CRD420251137785. Findings: Of 1892 records screened, 48 trials (5583 women) met our inclusion criteria. Overall pelvic pain (0-10 scale) was significantly reduced across all treatment categories (p<0.001): combined oral contraceptives (COCs) (MD 3.17), oral and long-acting progestogens (MD 3.83; MD 4.29), and GnRH-analogues (MD 3.81). Sensitivity analyses restricted to studies reporting NMPP yielded comparable results. GnRH-agonists showed the most favourable bleeding profile, followed by continuous COCs. However, all regimens reported class-specific AEs, including mood changes, nausea, headache, weight gain, and decreased libido (pooled proportions >10%). Overall discontinuation due to AEs was 7.7%, and vaginal bleeding was the leading cause. Heterogeneity across meta-analyses was high. Risk of bias (RoB2) was moderate to high. Interpretation: Given similar reductions in overall pelvic pain across hormonal therapies, treatment decisions should prioritise differences in bleeding profiles, therapy-specific AEs, and QoL. Funding: None.

17
Pumping stations negatively affect the distribution of critically endangered European eel (Anguilla anguilla); a landscape-scale study using environmental DNA metabarcoding

Monaghan, A. I. T.; Griffiths, N. P.; Sellers, G. S.; Lawson Handley, L.; Nunn, A. D.; Hänfling, B.; Macarthur, J. A.; Wright, R. M.; Cattaneo, M.; Bolland, J. D.

2026-09-01 ecology 10.64898/2026.08.28.746846 medRxiv
Top 3%
0.1%
Show abstract

Context Pumping stations pose a threat to fish globally through land use change, habitat fragmentation and entrainment risk, with the catadromous and critically endangered European eel particularly impacted. Objectives/methods Establish, model, assess and understand the present-day distribution of European eel and resident fishes in 152 pumping station catchments in a once extensive wetland (The Fens) using eDNA metabarcoding (855 samples over two and half years), with specific focus on anthropogenic influences on hydrological connectivity and habitat quality. A removal survey design maximised confidence in negative results while minimising time and consumable costs. Results Eel occurrence upstream of pumping stations was low (occupancy = 28.3%) and positively associated with catchment area, fish species richness and natural hydrological connectivity (gravity drainage or flooding) and negatively associated with distance from the tidal limit. Fish species richness replaced catchment area and improved model performance, potentially acting as a biotic indicator of habitat quality and connectivity. Pumped catchments with manually operated upstream water transfers had reduced eel presence, potentially linked to the direction of water flow or the timing of operation. By contrast, fish species richness increased in these catchments during summer, suggesting displacement into unsuitable long-term habitats. Physical habitat maintenance had no detectable effect on eel occurrence or fish species richness. Conclusions This study provides the first landscape-scale assessment of European eel distribution and drivers of occurrence in pumped river catchments. The highly novel and comprehensive insights have implications for European eel conservation as well as infrastructure and catchment management, including compliance with legislation (EC Regulation No. 1100/2007).

18
Inheritance of a Single Edited CD46 Allele Is Associated with Reduced Ex Vivo Susceptibility to Bovine Viral Diarrhea Virus

Workman, A. M.; Krueger, A. C.; Heaton, M. P.; Snider, A. P.; Kuhn, K. L.; Sonstegard, T. S.; Vander Ley, B. L.

2026-09-01 molecular biology 10.64898/2026.08.31.748238 medRxiv
Top 3%
0.1%
Show abstract

Bovine viral diarrhea virus (BVDV) remains an economically important pathogen of cattle despite widespread vaccination. A homozygous CD46-edited Gir heifer (Ginger) was previously shown to have significantly reduced susceptibility to BVDV. The edited allele contains an in-frame six amino acid substitution within the virus-binding domain of the BVDV entry receptor CD46, replacing residues G82QVLAL with A82LPTFS. Here, we investigated whether reduced BVDV susceptibility is maintained when the edited allele is inherited in the heterozygous state. Ginger was artificially inseminated with semen from an unedited Gir bull and produced a healthy heterozygous CD46-edited bull calf (Giraldo). Whole-genome sequencing confirmed the inheritance and structural integrity of Giraldo's edited allele. Compared with Ginger, Giraldo exhibited similarly reduced ex vivo BVDV susceptibility across primary fibroblasts, lymphocytes, and monocytes, despite inheriting a wild-type CD46 allele from the sire. Allele-specific CD46 RNA expression analysis demonstrated expression of both the edited and wild-type CD46 alleles. Thus, the reduced-susceptibility phenotype was not attributable to transcriptional silencing of the wild-type allele. Lentiviral complementation studies in CD46-knockout Madin-Darby bovine kidney (MDBK) cells further demonstrated that this wild-type CD46 allele was competent to support BVDV infection when expressed independently. Together, these findings indicate that the CD46 A82LPTFS allele can confer reduced BVDV susceptibility in the heterozygous state despite expression of a functional wild-type CD46 allele. This result suggests the potential to more rapidly disseminate reduced BVDV susceptibility through conventional breeding using homozygous CD46-edited sires.

19
Rapid phase resetting of Aedes aegypti circadian rhythms by transient alterations in light exposure

Dessart, M.; Luff, S.; Smith, L.; Sunman, H.; Vinauger, C.

2026-09-01 animal behavior and cognition 10.64898/2026.08.27.747523 medRxiv
Top 3%
0.1%
Show abstract

Circadian clocks enable mosquitoes to anticipate recurring environmental variations and coordinate behaviors critical for survival and disease transmission, such as locomotion, reproduction, host-seeking, and blood-feeding, with times of day when performance is maximal. In Aedes aegypti, locomotor activity follows a robust diurnal rhythm shaped by endogenous circadian clocks and environmental cues, among which light has been shown to be the primary source of temporal information. While early studies established the role of light in regulating locomotor activity, behavior, oviposition and pupation, it remains unclear which features of a light cycle drive changes in circadian rhythms. This question is increasingly relevant as Ae. aegypti is frequently exposed to artificial and dynamic lighting conditions in urban environments. Here, we investigated how transient changes in light schedules influence circadian rhythms in locomotor activity by systematically manipulating the timing, duration, and direction of light exposure. Using a high-throughput assay, we tested over 1900 individuals, including wild-type and timeless knockout mutants, and showed that a single day of al tered lighting is sufficient to induce robust phase shifts, with no evidence of masking effects. A 6-hour light pulse was sufficient to re-entrain mosquitoes regardless of the timing of the pulse, and phase shifts were primarily driven by the offset time of the light pulse, indicating that light-offset acts as a major zeitgeber. Together, these findings challenge conventional assumptions about the timescale of circadian synchronization and highlight the remarkable plasticity of mosquito behavior in response to anthropogenic light. Eventually, these effects could explain the rapid adaptation of the species to urban environments and have potential consequences for disease transmission dynamics.

20
Modeling the health and economic impact of scaling up monthly oral pre-exposure prophylaxis alone or alongside injectable Lenacapavir in Kenya and South Africa

Malhotra, A.; Patel, N.; Kaftan, D.; Mudimu, E.; Bershteyn, A.; Sharma, M.

2026-09-04 health economics 10.64898/2026.09.01.26361983 medRxiv
Top 3%
0.1%
Show abstract

Introduction: Monthly oral HIV pre-exposure prophylaxis (PrEP) such as MK-8527 offer promise as low-cost, self-administered options that are easily delivered through community-based platforms. Economic evaluations of MK-8527 either alone or alongside other long-acting (LA) PrEP products like lenacapavir are needed for informing HIV prevention strategies. Methods: We adapted an agent-based network model, EMOD-HIV, to simulate LA-PrEP scale-up in South Africa and western Kenya from 2026-2035; scenarios evaluated MK-8527 alone, lenacapavir alone and combined strategies, with varying uptake among female sex workers, their male clients, and individuals with >1 partner. We assumed 95% effectiveness of MK-8527 for 2 months (assuming individuals took 2 of 3 pills dispensed) and 95% lenacapavir effectiveness for 6 months. Scenarios were compared to a baseline of daily oral PrEP only. Results: Assuming the same uptake rates, MK-8527 alone achieved lower health impacts than lenacapavir alone in both settings (6-14% vs. 11-18% of HIV infections averted) but had substantially lower costs; provision costs of MK-8527 were 58-59% lower than lenacapavir assuming $1.00/pill and 40-43% lower at $2.50/pill. In western Kenya, ICERs for MK-8527 alone were $467/DALY averted and $799/DALY averted assuming pill prices of $1.00 and $2.50 respectively, compared to $1,306/DALY averted for lenacapavir. In South Africa, all LA-PrEP strategies were cost-saving over the 35-year horizon, although near-term budget impacts were substantial ($169-348 million over five years). Service delivery accounted for the majority of MK-8527 costs (73% at $1.00 per pill). Combined strategies of lenacapavir and MK-8527 increased health benefits (13-23% infections averted) but had higher provision costs than either strategy alone. Conclusion: MK-8527 can reduce HIV incidence at lower costs than lenacapavir. However, high service delivery costs limit its cost-effectiveness to scenarios in which pill prices are low (US$1.00 per pill) and provision is targeted to populations at substantial HIV risk.