One Health

Leptospirosis is a globally important environmentally transmitted disease, with approximately one million cases and 60,000 deaths reported annually. In low-income urban communities, inadequate sanitation, drainage and waste management may increase human exposure to contaminated environments. This study investigated the influence of environmental engineering risk factors on Leptospira exposure in four disadvantaged urban communities (favelas) in Salvador, Brazil. A high-precision georeferenced field survey was developed to identify, map and characterise sanitation, stormwater drainage and solid waste infrastructure. Cross-sectional spatial analyses of baseline data were used to assess associations between environmental risk factors and the residential locations of individuals with anti-Leptospira antibodies. Seropositive individuals tended to reside closer to environmental risk factors and at lower relative elevations. Density analyses indicated that seropositive individuals tended to reside closer to inadequate or partially adequate sewerage components than to sewage-contaminated streams or open sewage points. Inadequate streets showed also showed high density peaks, suggesting that exposure may occur through frequent contact with contaminated runoff and standing water. In contrast, open waste dumping sites and vacant lots showed weaker and more diffuse spatial patterns. The findings highlight the importance of infrastructure quality shaping leptospirosis risk within urban informal settlements. The proposed methodology provides a practical approach for high-resolution characterisation of environmental exposure pathways and may support targeted engineering interventions and epidemiological investigations of leptospirosis and other environmentally transmitted diseases.

Background. Direct livestock exposure is a risk factor for zoonotic influenza, including H5N1 highly pathogenic avian influenza (HPAI) A virus. But whether living in regions of high poultry and swine production intensity (PPI, SPI) increases risk of exposure to zoonotic influenza viruses independent of occupational livestock contact remains unclear. Objectives. To determine whether livestock workers and community members with no occupational livestock exposure in North Carolina, where poultry and swine production are increasingly co-located, are at higher risk of exposure to zoonotic influenza. Methods. Saliva samples from industrial livestock operation worker (ILO-W), ILO neighbor (ILO-N) and metropolitan area (Metro) households were analyzed for mucosal influenza A (H5N1, H1N1, and H3N2) hemagglutinin (HA) IgA and IgG antibodies to determine associations of PPI, SPI, exposure group, and detection of a swine-specific fecal contamination marker (Pig-2-Bac DNA) with influenza A antibody levels. Results. Residing in the highest PPI and SPI tertile was associated with significantly higher mucosal H5 and H1 HA IgA levels, including among residents without occupational livestock exposure. Households with occupational poultry or swine contact had significantly higher H5 IgA and IgG and H1 IgA levels compared to Metro households. In regression models accounting for clustering at the participant level, log10 anti-H5 HA mucosal IgA increased 0.16 (95% CI: 0.06, 0.27, p<0.005) and 0.10 (95% CI: 0.03, 0.17, p<0.005), per log10 increase in PPI and SPI, respectively, and 0.16 (95% CI: 0.03, 0.19, p<0.02) when Pig-2-Bac DNA was detected on household surfaces. Conclusions. Mucosal H5 HA IgA and IgG and H1 HA IgA were consistently elevated across different metrics of livestock exposure intensity, including residential exposure, occupational contact within a household, and a molecular marker of household swine fecal contamination in a state with intensive poultry and swine production.

Antimicrobial resistance (AMR) is one of the greatest challenges within the One Health continuum. Exploring transmission routes between health domains and determining their driving forces are key priorities for future research. This effort can be effectively supported by landscape epidemiology, a field of science that integrates methods from landscape ecology and epidemiology to unravel the complex interdependencies behind disease transmission. This exploratory study aimed to demonstrate that landscape diversity and the degree of hemeroby (anthropogenic impact) correlate with the composition of bacterial communities and their AMR profiles. To test this hypothesis, submandibular lymph nodes from Cervidae and Suidae were collected to detect Staphylococcus and Mammaliicoccus bacteria and characterise their AMR features using selective culture and the VITEK 2 Compact automated system. As a result, the bacterial community in the more natural landscape was more diverse, characterised by the dominance of Mammaliicoccus sciuri and pan-susceptible isolates of Staphylococcus hyicus, and it displayed a low-level, heterogeneous AMR profile. Within the more hemerobic landscape, the bacterial community was characterised by the dominance of Staphylococcus epidermidis, a human-adapted species, and the AMR profile showed signs of higher antimicrobial pressure from both public health and veterinary origins. Although this study was based on only two study sites and was therefore not suitable for drawing definite conclusions, the findings suggest that human impact manifests itself in both bacterial and AMR profiles. A high prevalence of mammaliicocci and a heterogeneous AMR profile appeared to be indicators of naturalness. Conversely, the dominance of a human-adapted bacterial species and the accumulation of AMR features characteristic of medical environments likely indicate higher degrees of hemeroby.

Household environments in low-resource settings can become contaminated with fecal matter from multiple sources, including humans and domestic animals. Identifying the source of fecal contamination is critical for designing targeted interventions to reduce exposure to enteric pathogens, particularly for young children who bear the majority of the enteric disease burden. Using data from 140 households with children enrolled in the ECoMiD cohort study in northwestern coastal Ecuador, we (1) characterized source-specific fecal contamination in samples from household floors and maternal and child hands, and (2) identified animal-related and Water, Sanitation and Hygiene (WASH) conditions associated with the presence and concentrations of these markers. We used five qPCR-based microbial source tracking (MST) markers to detect fecal contamination from avian (GFD), canine (DG37), swine (Pig2Bac), ruminant (Rum2Bac), and human (HF183) sources. Prevalence ratios (PR) and mean differences comparing the presence/absence and concentration, respectively, of MST markers between households with and without each animal-related or WASH condition were estimated using generalized linear models with Poisson and Gaussian distributions. Animal MST markers tracked strongly with several animal-related conditions, whereas associations between the human MST marker and household demographic and WASH conditions were more limited. Animal ownership (PR 1.53; 95% CI: 1.04-2.26) was associated with higher prevalence of animal MST markers on floors. Households reporting animal feces indoors had higher prevalence of animal MST markers on floors (PR 1.84; 95% CI: 1.17-2.89), and higher concentrations of animal MST markers on child hands (mean difference 0.27 gene copies (gc)/m2; 95% CI: 0.12-0.41) and maternal hands (mean difference 0.10 gc/m2; CI: 0.02-0.18). Animal feces left unremoved outside the home were associated with higher prevalence of animal MST markers on maternal hands (PR 2.31; 95% CI: 1.11-4.81). Mothers reporting direct contact with animals had higher concentrations of animal MST markers on their children hands (mean difference 0.12 gc/m2; 95% CI: 0.02-0.21). Higher FECEZ scores, an overall metric for animal exposure, were associated with higher prevalence of animal MST markers on maternal hands (PR 2.94; 95% CI: 1.17-7.40). For human fecal contamination, the presence of E. coli on child hands was associated with higher prevalence of human MST markers on floors (PR 1.30; 95% CI: 1.00-1.68). Our findings reinforce household floors and maternal and child hands as key reservoirs of fecal contamination and point to future potential targets worth exploring for interventions in similar high-burden settings.

Introduction: Antimicrobial resistance poses a major global health threat, yet evidence on its economic impact in low- and middle-income countries remains limited. This study estimated the economic burden of infections caused by ESBL-producing Escherichia coli (E. coli), a key resistant pathogen, in Laos. Methods: A prospective cost-of-illness study was conducted among patients with laboratory-confirmed infections in Setthathirath hospital in Vientiane, Laos, collecting cost data through repeated interviews and medical records. Descriptive analyses and econometric modeling approaches, including inverse probability weighting (IPW) and instrumental variable (IV) analyses, were used to estimate out-of-pocket expenditures, public expenditures, total cost of illness, and length of stay, accounting for potential confounding. Results: ESBL-producing E. coli was consistently associated with higher economic burden across all analyses. The unadjusted per-patient cost was US$ 689.0 for ESBL-producing E. coli, compared with US$ 489.4 for non-ESBL-producing E. coli and US$ 537.6 for non-E. coli. The association remained statistically significant for out-of-pocket cost after IPW-adjustment (US$156.2; 95% CI, 14.3 to 298.1; P = 0.03), while other outcomes were not statistically significant. Instrumental variable analyses showed consistent directional effects but with wide confidence intervals and no statistically significant differences. Conclusions: Findings suggest that ESBL-producing E. coli may be associated with increased economic burden in Laos; however, this association was not consistently statistically robust across analytical approaches. These findings suggest a potential economic impact of ESBL infection, although uncertainty remains regarding the magnitude of the effect. Strengthening antimicrobial stewardship, infection prevention and control, and improved diagnostic capacity remain essential to mitigate the potential AMR burden.

Summary Background: Wastewater and environmental surveillance (WES) enables community-level monitoring of infectious diseases. Most progress has focused on sewer-based surveillance, yet nearly half of the global population relies on non-sewered sanitation. In non-sewered settings, urban drainage channels have been used for poliovirus environmental surveillance, but their potential for a multi-pathogen WES with spatially defined catchments, and comparability to sewer-based surveillance, remains under-explored. Methods: Ten drainage channel sampling points with delineated micro-catchments (0.95-3.83 km2 with 12,885-44,146 people) were selected within Kampala. A total of 255 drainage channel and 54 wastewater treatment plant (WWTP) influent samples were collected during two campaigns in March and September-October 2025. A multi-target panel was quantified by digital PCR, including enteric viruses (Norovirus GI and GII, Rotavirus), respiratory viruses (SARS-CoV-2, Influenza A and B viruses, Respiratory Syncytial Virus (RSV)), non-O1/O139 Vibrio cholerae (V. cholerae), and Pepper Mild Mottle Virus (PMMoV) as a fecal indicator. Findings: Enteric viruses, non-O1/O139 V. cholerae, and PMMoV were consistently detected across all drainage channels and WWTP influents. Concentrations were generally lower in drainage than WWTP influents, except for non-O1/O139 V. cholerae. When normalized by PMMoV, concentrations across most drainage channels were comparable to WWTP influents, although comparability varied by target and location. Both concentrations and PMMoV-normalized concentrations varied across sampling locations. Trends between campaigns varied by pathogen target and were not explained by any single micro-catchment characteristic. Influenza A virus was the most frequently detected respiratory virus (8-23% in drainage channels; 3-10% in WWTP influents), while SARS-CoV-2, Influenza B, and RSV were rarely detected. Interpretation: PMMoV-normalized concentrations across most micro-catchments were comparable to WWTP influents, with spatial heterogeneity implying neighborhood-level differences in disease prevalence. Catchment-delineated drainage surveillance has potential to offer spatially resolved public health information in non-sewered settings comparable to sewer-based wastewater monitoring. Funding: Eawag Discretionary Funding

Introduction: Veterinary Professionals are at risk of contracting zoonoses, including potential emerging infections. Personal Protective Equipment (PPE) could reduce infection transmission risk, but use of it in the profession is low. Understanding Veterinary Professionals experiences with PPE could help identify facilitators and barriers, therefore informing a future strategy to improve usage. Methods: Two focus group discussion with veterinary nurses and two with veterinarians took place at a tertiary small animal teaching hospital. With an interpretivist epistemology, transcriptions were inductively coded and analysed using thematic analysis. Results: Veterinary Professionals frequently reported underusing PPE, despite significant zoonotic risk. Friction in interdisciplinary relationships negatively impacted veterinary professionals experiences with PPE: differing views on risk, policy and PPE, contrasting perceptions of each other, and challenges with communication impacted PPE decision-making. Barriers included an absence of initial recognition of risk, a staff culture of prioritising patient health over risk to self, friction in response to others PPE use or lack thereof, an overly complex policy, and a lack of cultural and institutional reaction to occupationally contracted zoonoses. Facilitators included effective inter and intradisciplinary communication and previous personal experience with serious zoonoses. Conclusion: Veterinary Professionals experiences with PPE, are shaped by social and professional factors, such as interdisciplinary friction, perceptions of self and others, of risk and policy. Recommendations are for the findings to be used locally to embed PPE use into everyday practice. At a national level, the United Kingdom Health Security Agency (UKHSA) should use the findings to evaluate current policies regarding PPE and zoonoses in veterinary practice and produce a simplified national guidance, in collaboration with veterinary professionals with lived experience. Further research into General Practice Veterinary Professionals experiences and the interdisciplinary social dynamics is recommended.

Antimicrobial resistance is a growing threat to health systems, but stewardship programs must compete for funding with many urgent health priorities in low- and middle-income countries. Evidence that quantifies not only effectiveness but also economic value is therefore essential for policy and budget decisions. We evaluated targeted antimicrobial stewardship programs in four tertiary hospitals in Nepal and Laos using interrupted time-series analyses of antibiotic use, combined with micro-costing to estimate benefit-cost ratios. Stewardship was associated with immediate reductions in antibiotic use across the three Nepal hospitals, whereas effects in Laos were more heterogeneous. Economic returns were positive across sites, with the largest returns observed in the private hospital in Nepal. Here, we show that pragmatic, ward-focused stewardship can reduce antibiotic use and generate measurable economic value in resource-constrained hospital settings, supporting its prioritization as a scalable investment for antimicrobial resistance control.

Existing molecular diagnostic approaches for notifiable avian diseases (NADs) involve a suite of PCR assays that enable both generic detection, and where positive, subtyping of both avian influenza virus (AIV) and Newcastle disease virus (NDV). Novel rapid and direct diagnostic assays for the detection of AIV and NDV were developed and evaluated using unprocessed cloacal (C) and oropharyngeal (OP) poultry swab material. Both assays employ a closed tube direct real-time reverse transcription polymerase chain reaction (RRT-PCR) approach in which viral lysis is achieved by heat treatment and a dedicated PCR compatible buffer, followed by detection using a RRT-PCR approach. Primer and probe sets were designed using globally circulating AIV and NDV sequences collected over the preceding five years, rather than region-specific sequence datasets, so that the assays detect all circulating genotypes. Analytical performance assessment demonstrated that both assays were highly sensitive and specific, successfully detecting all unextracted target antigens without cross reactivity to a panel of other common poultry pathogens. For each assay, viral lysis and amplification were achieved directly from samples at single digit genome copy numbers. Furthermore, low levels of viral RNA could be reliably detected in the presence of C and OP matrix material, providing proof-of-concept for direct detection of these economically significant avian pathogens in a field setting. Additional use case scenarios, including pooled sample screening and combined C/OP testing from individual birds, were also explored. These findings establish a foundation for ongoing studies incorporating paired-sample testing against validated laboratory reference assays.

Background: Alpha-gal syndrome (AGS) is an emerging disease, increasingly recognized as a public health concern in the United States. The primary cause of AGS in the United States is the bite of Amblyomma americanum ticks. White-tailed deer serve both as a preferred food source and as transport for A. americanum. In this work, we aim to quantify the effect of white-tailed deer abundance on number of AGS cases in United States counties. Methods: To mitigate concerns about confounding, we used the front-door formula, leveraging biological knowledge about the causal process. Due to lack of official data, our analysis relied on data made available by citizen science efforts. Results: We found that a higher number of reported white-tailed deer sightings in 2020 was associated with the county-level presence of A. americanum in 2024. In turn, county-level presence of A. americanum was associated with a higher number of self-reported AGS cases. We estimated that if white-tailed deer abundance had increased by 50%, 75%, or 100% in 2020, there would have been 89 (95%CI: 12, 252), 126 (12, 354) or 159 (6, 448) additional AGS self-reported cases in the US in 2025. Conclusions: The estimated associations are compatible with an effect of white-tailed deer abundance on AGS in the country. Due to measurement error, the low granularity of the available data, the ecological nature of the design, and the modelling choices, our effect estimates should be interpreted cautiously. Further studies are needed to quantify the population-level effect of white-tailed deer on AGS.

Cocoa (Theobroma cacao L.) is grown in Cote d'Ivoire (the world's leading producer), almost always in association with trees, yet these cocoa-based agroforestry systems (cocoa AFS) remain characterized largely descriptively, without a robust inferential framework or modern diversity indices. We analyse a survey database covering 474 farms and 103 localities across the three main cocoa-producing zones of Cote d'Ivoire, locally known as " loops " (East/South-East, Centre/Centre-West, South/South-West; surveys 2013-2016), applying a renewed ecological and statistical framework: Hill numbers (q = 0, 1, 2), individual-based Hurlbert rarefaction, multiplicative alpha/beta/gamma diversity partitioning, ordination (PCoA) and PERMANOVA on Bray-Curtis matrices, Ward's hierarchical clustering for a data-driven floristic typology, multivariate MANOVA, and linear mixed models. Across 99 adequately sampled localities (>10 stems), mean taxonomic richness and the Shannon index differed significantly among zones (MANOVA: Wilks' = 0.350; F8,180 = 15.5; p < 0.001), including after standardizing sampling effort by rarefaction (F = 8.72; p < 0.001). Floristic composition differed significantly by zone (PERMANOVA, pseudo-F = 2.85; p = 0.001), though with uneven within-group dispersion (PERMDISP, p = 0.024) that calls for caution in interpretation. The Centre/Centre-West zone showed the highest beta diversity (inter-farm floristic turnover = 16.4, versus 7.2 and 2.2 in the other two zones), revealing a highly heterogeneous mosaic of individual agroforestry choices rather than a homogeneous regional system. A typological classification based on floristic composition distinguishes four cocoa-AFS profiles, ranging from dense, diverse stands to impoverished systems with low densities of associated trees, partially but not fully overlapping with the zonal boundaries. At the scale of the three loops (n = 409 farms with both age and yield recorded), cocoa yield varied significantly by orchard age class (Kruskal-Wallis, H = 18.2; p < 0.001), following a bell-shaped profile peaking around 20-35 years, consistent with the intermediate-age yield optimum suggested qualitatively by the source study; this relationship, robust to log-transformation of yield and to the exclusion of extreme values, nonetheless remains of small magnitude (R2=1.5%) and confers no out-of-sample predictive power under cross-validation, illustrating the need to distinguish statistical significance from predictive utility. This reanalysis provides a reproducible and transferable statistical framework for characterizing West African cocoa AFS, and highlights the potential value of high beta diversity as a possible indicator of landscape resilience.

Socioeconomic inequality in exposure to air pollution possess a significant public health challenge, yet little is known about how the disparities vary across the various economic status areas in Nairobi. Globally, studies have shown that exposure to air pollution is unequal across communities hence disparities in harm to human health. This study examined the association between socioeconomic characteristics and perceived air quality among residents of low- and high-socioeconomic status areas in Nairobi, Kenya. Two regions within Nairobi County were selected for this study: Mukuru kwa Njenga (representing the Low Socioeconomic Status) and Langata (representing the High Socioeconomic Status) with a sample size of 384 in HSES areas and 368 in LSES areas. A cross-sectional study was conducted among 752 respondents residing in selected LSES and HSES areas of Nairobi. Data was collected using a structured questionnaire assessing sociodemographic characteristics, income, education, employment, perceived air quality, and self-reported health outcomes associated with air pollution exposure. Descriptive statistics were used to summarize participant characteristics and perceived air quality. Chi-square tests were used to examine associations between residential area and categorical health outcomes, while ordinal logistic regression was used to assess the association between socioeconomic characteristics and perceived air-quality ratings. Perceived air quality differed significantly between residential socioeconomic groups. Respondents in LSES areas were more likely to rate air quality as poor or very poor, with 45.4% rating it as very poor, compared with only 1.6% of respondents in HSES areas. In contrast, 12.2% of HSES respondents rated air quality as good compared with 0.3% in LSES areas. The association between area of residence and perceived air-quality rating was statistically significant, {chi}2(3) = 282.672, p < 0.001. In the ordinal logistic regression model, HSES residence was associated with significantly lower odds of reporting poorer perceived air quality compared with LSES residence (OR = 0.135, 95% CI: 0.095-0.190, p < 0.001). Income was also significantly associated with perceived air quality, while respondents with no formal education had higher odds of reporting poorer perceived air quality compared with those with secondary education (OR = 3.254, 95% CI: 1.388-7.638, p = 0.007). Significant differences were also observed for several self-reported health outcomes. Respiratory problems were more prevalent among respondents in LSES areas than HSES areas (72.7% versus 50.4%; {chi}2(1) = 29.081, p < 0.001; Cramer's V = 0.224). However, allergies, eye irritation, and headaches were reported more frequently in HSES areas than in LSES areas, with significant associations observed for allergies ({chi}2(1) = 106.479, p < 0.001; Cramer's V = 0.429), eye irritation ({chi}2(1) = 136.577, p < 0.001; Cramer's V = 0.486), and headaches ({chi}2(1) = 149.180, p < 0.001; Cramer's V = 0.508). No statistically significant association was observed for cardiovascular problems, likely reflecting the very low number of reported cases. Substantial socioeconomic disparities in perceived air quality and self-reported respiratory health outcomes were observed. Residents of low-socioeconomic status areas consistently perceived poorer air quality and reported a higher burden of respiratory problems, highlighting the need for targeted interventions to reduce environmental health inequalities.

Since mid-June 2026, an acute, non-fatal syndrome with high herd morbidity, reduced milk yield, diarrhea, fever and lethargy affected dairy cattle in southern Germany and Switzerland. Major viral pathogens were excluded. Pan-Simbuvirus PCR first detected an orthobunyavirus, subsequently confirmed by metagenomic sequencing, which enabled recovery of a complete "Shamonda-like" genome. One sentence summary lineMore than a decade after the emergence of Schmallenberg virus in 2011, a novel "Shamonda-like" orthobunyavirus of the Simbu serogroup has now emerged in Central Europe.

Introduction Respiratory syncytial virus (RSV) is an important cause of respiratory disease in older adults and adults with chronic medical conditions, contributing substantially to the healthcare burden in Italy. The availability of effective RSV vaccines provides an opportunity to reduce RSV-related morbidity, mortality, and healthcare costs in populations at high risk of severe disease. This study evaluates the potential public health impact and cost-effectiveness of vaccination using mRNA-1345 administered as a single dose compared with no vaccination in Italian high-risk adults aged 60-74 years and all adults aged [&ge;]75 years. Methods A static decision-analytic model was developed to project clinical and economic outcomes over a 5-year time horizon. Economic outcomes were evaluated from the Italian National Health Service (Servizio Sanitario Nazionale, SSN) perspective. Model inputs were informed by the most recent Italian epidemiological, clinical, and economic evidence, supplemented by published international data when necessary. Deterministic, probabilistic, and scenario analyses were conducted to assess the impact of uncertainty in model inputs and assumptions on the study results. Results Vaccination with mRNA-1345 in high-risk adults aged 60-74 years and all adults aged [&ge;]75 years was projected to avert over 19,800 hospitalizations, 4,000 emergency department visits, 381,000 outpatient visits, 6,000 RSV-attributable deaths, and 212,000 antibiotic prescriptions compared with no vaccination over a 5-year period. The total incremental cost of {euro}1,143 million and the additional 47,477 QALYs gained resulted in an ICER of {euro}24,078, which was below the commonly referenced willingness to-pay range of {euro}33,000-40,000 per QALY gained. Sensitivity analyses confirmed robustness of the analysis results. Conclusions Vaccination with mRNA-1345 is a cost-effective strategy for the prevention of RSV in high-risk adults aged 60-74 years and all adults [&ge;]75 years in Italy and has the potential to provide substantial public health benefits.

School reopening during an Ebola outbreak is often framed as a binary question of whether schools are safe. For Ebola, however, the immediate operational question is where an infected school-age child may reach the school system before recognition and isolation, and whether local systems can detect and respond rapidly. We developed an exploratory, scenario-based health-zone framework for the September 2026 rentree during the ongoing Bundibugyo virus disease outbreak in eastern Democratic Republic of the Congo. The primary estimand was scenario-based expected introduction pressure, expressed on an expected-count scale, for infected school-age children reaching school in each health zone during a one-week window. The framework combined recent reported transmission, estimated school-age exposure and attendance, a surveillance/interception probability, and directed mobility-based importation. Case-fatality patterns were analysed separately and did not determine introduction pressure. A 10,000-draw probabilistic sensitivity analysis examined uncertainty in the school-age case share, attendance, pre-isolation school-entry probability and mobility scaling. Geographic components were retrospectively evaluated at eight non-overlapping weekly origins from 1 June to 20 July 2026, using subsequent reported seven-day health-zone activity and first reported cases in previously unaffected zones as outcomes. Seven-day local epidemic pressure discriminated health zones with subsequent reported activity with pooled ROC-AUC 0.848; the 14-day local measure increased this to 0.885. Adding directed mobility increased ROC-AUC to 0.952. In the base scenario, the six-province combined scenario-based expected introduction pressure was 10.97; the probabilistic sensitivity median was 11.17, with a 2.5-97.5% sensitivity range of 5.56-20.97. Bunia, Rwampara and Nizi had the highest base introduction pressures, followed by Katwa and Nia Nia. Among 24 previously unaffected health zones that subsequently reported a first confirmed case, 13 (54.2%) were in the top 10 and 18 (75.0%) in the top 20 mobility-ranked zones; random selection would have been expected to capture approximately 2.05 and 4.10 events, respectively. In a separate six-origin exploratory nested-specification sensitivity, surveillance/access modifiers did not improve geographic discrimination over local epidemic pressure alone, whereas mobility did. The dominant structural uncertainty remained the probability that an infected child reaches school before being identified. The framework supports targeted geographic prioritisation and minimum school-health readiness, but its probabilities are model-implied scenario probabilities rather than calibrated forecasts or evidence for a single national open/close decision.

Rabies remains a major zoonotic public health threat, associated with approximately 59,000 annual deaths globally, with Africa bearing 36% of this burden. In Uganda, an estimated 36 human deaths and 1.8 million dog bite exposures occur annually, yet national dog vaccination coverage remains critically low at approximately 10%. This study investigated factors associated with rabies vaccination uptake among dog owners in Butaleja Town Council, Eastern Uganda, a high-risk setting. A cross-sectional survey was conducted among 173 dog owners between May 18 and June 28, 2024, using semi-structured questionnaires. The primary outcome was vaccination uptake ([&ge;]1 dose in the past year). Modified Poisson regression with robust variance estimated adjusted prevalence ratios for all socio-demographic, veterinary system, health system, dog-related, and knowledge factors. Among 173 dog owners, 57.2% vaccinated at least one dog, corresponding to 54.6% (166/304) of all dogs vaccinated. Factors associated with vaccination uptake included older age (21-40 years: aPR 1.43, 95% CI: 1.15-1.71; 41-60 years: aPR 1.53, 95% CI: 1.22-1.82; [&ge;]61 years: aPR 1.56, 95% CI: 1.33-2.23), higher education (primary: aPR 1.20, 95% CI: 1.00-1.45; secondary: aPR 1.55, 95% CI: 1.20-2.00), higher income, access to veterinary clinics (aPR 2.50, 95% CI: 1.52-3.75), and participation in community education sessions (aPR 1.71, 95% CI: 1.34-2.15). While household-level uptake showed moderate engagement, the resulting dog population vaccination coverage of 48.4% remained substantially below the 70% World Health Organization threshold required for herd immunity. Achieving the "Zero by 30" elimination dog-bite mediated Rabies target in this setting requires targeted interventions addressing the identified associated factors including; enhanced community education, improved veterinary service accessibility, reminder systems, and strategies to convert partial household vaccination into complete coverage particularly among younger, less educated, and lower-income dog owners.

Wastewater-based epidemiology (WBE) has emerged as a powerful population-level surveillance tool, but its coverage is structurally concentrated in in-network urban areas, potentially leaving rural populations underrepresented. Routine human movement between sewered (in-network) and unsewered (off-network) areas may, however, cause wastewater treatment plant (WWTP) measurements to reflect infectious disease dynamics beyond sewer boundaries. We evaluated this hypothesis using daily clinical COVID-19 testing data (January 2021-April 2022) across New York State excluding New York City (NYC). We disaggregated weekly cases and tests into in-network (WWTP catchment area) and off-network (outside WWTP catchment area) components applied to two geographic frameworks: administrative counties (N = 53 mixed-coverage) and mobility-defined communities identified through Walktrap community detection applied to census tract-level movement networks (N = 32 mixed-coverage). In/off-network COVID-19 trends were strongly correlated under both frameworks. County-level statewide aggregate correlations were high (incidence r = 0.994, positivity r = 0.996), as were individual county correlations (median r = 0.909 and 0.932, respectively). Mobility-defined community-level statewide correlations were similarly strong (r = 0.990 and 0.992), with comparable unit-level medians (r = 0.877 and 0.894). The mobility-defined community framework provided better population balance between in-network and off-network strata (87.5% vs. 69.8% in balanced range) and a higher floor on representativeness (minimum r = 0.440 vs. 0.177). Population size was the dominant predictor of in-network/off-network alignment at both scales; wastewater infrastructure density and off-network signal variability provided additional explanatory power at the mobility-defined community level. WWTPs broadly represent COVID-19 dynamics in surrounding off-network populations, supporting their use as sentinel surveillance sites. Representativeness weakens in smaller, more rural communities, and mobility-defined communities provide a complementary framework for identifying where this occurs.

BackgroundEscherichia coli is a common environmental and zoonotic bacterium that serves as an important indicator of fecal contamination and antimicrobial resistance (AMR) in poultry production systems. The emergence of multidrug-resistant (MDR) E. coli in poultry farm environments poses a significant One Health threat to animal, human, and environmental health. ObjectiveThis study aimed to isolate, identify, determine the prevalence, assess the antibiotic susceptibility pattern, and molecularly confirm Escherichia coli isolated from poultry farm environments in Lalmonirhat district, Bangladesh. Materials and MethodsA cross-sectional study was conducted from January to June 2024 using 60 environmental samples comprising water (n = 20), soil (n = 20), and bird-dropping (n = 20) samples collected from poultry farms in five upazilas of Lalmonirhat district. Isolation and identification of E. coli were performed using standard cultural, morphological, and biochemical techniques. Antimicrobial susceptibility was determined by the Kirby-Bauer disc diffusion method following CLSI guidelines. Ten randomly selected isolates were confirmed by polymerase chain reaction (PCR) targeting the species-specific uidA gene. ResultsThe overall prevalence of E. coli was 50% (30/60). Source-wise prevalence was highest in bird-dropping samples (75%), followed by water (45%) and soil (30%). Area-wise prevalence ranged from 33.33% in Patgram to 66.67% in Hatibandha. The isolates exhibited the highest resistance to oxytetracycline (66.67%) and ciprofloxacin (60%), while the highest susceptibility was observed to erythromycin (63.33%), neomycin (56.67%), and amoxicillin (56.67%). All ten isolates subjected to PCR produced the expected 486 bp uidA gene amplicon, confirming their identity as E. coli. ConclusionThe findings demonstrate a considerable prevalence of antimicrobial-resistant E. coli in poultry farm environments of Lalmonirhat district. Strengthening farm biosecurity, improving hygiene and waste management, implementing antimicrobial stewardship, and maintaining continuous molecular surveillance are essential to minimize the dissemination of resistant E. coli within a One Health framework.

Urban air pollution remains a significant public health concern, contributing to premature deaths and adverse health outcomes. However, there is little causal research evaluating the effectiveness of policies designed to improve air quality. This study assesses the impact of all three stages of London's Ultra Low Emission Zone (ULEZ) on air pollution, via PM2.5 levels, and respiratory health, via prescription records for bronchodilator and respiratory corticosteroid medications. Analyses are at general practice level, using a generalised synthetic control method to estimate causal impacts. Stage 1 was associated with a statistically significant but negligible 0.77% reduction in PM2.5 levels, with no corresponding change in prescribing. Stage 2 produced a paradoxical 2.69% increase in PM2.5, alongside a 4.44% decrease in inhaled corticosteroid quantity but a 12.51% increase in average daily quantity (ADQ) usage, suggesting a worsening of disease severity among existing patients. Stage 3 yielded a 2.69% PM2.5 reduction and a modest 2.18% decrease in bronchodilator ADQ usage. Spillover effects beyond the ULEZ boundary were statistically significant, but negligible. We find overall that the ULEZ had minimal effects on both air quality and respiratory prescribing across all three stages. These findings provide new insights into the effectiveness of ULEZ policies in reducing air pollution and its associated health impacts, suggesting the zone's effects are considerably smaller than previously reported, and that integration with broader policy measures may be necessary to achieve meaningful public health gains.

Objective. Respiratory infections are the leading cause of illness at major sporting events, yet surveillance relies on athletes recognising and reporting symptoms. We evaluated whether continuous air sampling with point-of-care molecular testing could detect respiratory-virus nucleic acids in an elite team's congregate spaces during competition, and whether the resulting signals were operationally useful. Methods. We performed a prospective, descriptive environmental-surveillance study following the Canadian men's national soccer team across five host cities during the 2026 FIFA World Cup (3 June to 4 July 2026). InBio Apollo bioaerosol samplers ran continuously in up to four team-designated rooms per hotel (physiotherapy, meal, equipment, and coaches' room or hallway). Filters were changed approximately twice daily, eluted on-site, and tested with the Cepheid Xpert Xpress(R) SARS-CoV-2/Flu/RSV plus assay. A sample was considered positive if any cycle-threshold (Ct) value was reported, as less than 45, for a target. Results. Of 174 air filters, there were 13 detections of virus genetic material (9 SARS-CoV-2, 3 influenza A virus, 1 influenza B virus, 0 RSV). Detections were sparse early and clustered late in the tournament. An influenza A signal appeared the morning a player was sent home febrile, and SARS-CoV-2 signals coincided with visibly ill hotel staff, with signals falling after ill staff were excluded. Conclusion. Air sampling with point-of-care testing is feasible in the mobile environment of an elite team and can surface behavior-independent viral signals during competition that may offer opportunities for earlier precautionary actions.