The Lancet Regional Health - Western Pacific

Aim: To assess temporal trends in incidence and mortality and project the future burden of five major gastrointestinal cancers in Jiangsu Province, China. Methods: Population-based cancer registry data from Jiangsu Province between 2010 and 2021 were used to analyze the burden of esophageal, gastric, colon, rectal, and liver cancers. Age-standardized incidence and mortality rates were calculated and compared by cancer type, sex, and urban-rural residence. Joinpoint regression was used to estimate annual percentage changes (APC) and average annual percentage changes (AAPC). The APC from the most recent Joinpoint segment was used to project incidence and mortality rates to 2030. Results: In 2021, gastric cancer had the highest age-standardized incidence and mortality among the five cancers. Incidence and mortality were consistently higher in males than in females and increased markedly after 50 years of age. From 2010 to 2021, age-standardized incidence and mortality declined for esophageal, gastric, and liver cancer, but increased for colon and rectal cancer. Colon cancer showed the steepest increase in both incidence and mortality. Rural areas experienced faster increases in colon and rectal cancer burden than urban areas. Projections to 2030 suggest continued declines in esophageal, gastric, and liver cancer, while colon cancer incidence and mortality are expected to rise further. Conclusion: Jiangsu Province is experiencing a transition in gastrointestinal cancer burden, with continued declines in esophageal, gastric, and liver cancers but an emerging and growing burden of colorectal cancer, especially colon cancer. Prevention strategies should focus on expanding colorectal cancer screening and early diagnosis, particularly in rural areas, while sustaining control of esophageal, gastric, and liver cancers.

Brazil bears one of the largest chikungunya burdens in the Americas (more than 1.2 million confirmed cases since 2014), and the 2024-25 wave expanded further south than any prior outbreak. IXCHIQ entered Sistema Unico de Saude (SUS) deployment in February 2026 despite an August 2025 US FDA biologics license suspension over serious adverse events in adults aged 60 years and older; regulatory authorities in the EU (EMA), Brazil (ANVISA), and Canada maintained licensing with revised prescribing guidance requiring individual benefit-risk assessment. Evidence to guide rollout targeting is lacking. We analyzed 1,235,424 confirmed chikungunya cases reported to Sistema de Informacao de Agravos de Notificao SINAN (2015-2025) across 5,570 municipalities. A Bayesian hierarchical spatiotemporal model quantified spatial structure and persistence of transmission across municipalities, controlling for national arboviral co-circulation trends. Disease progression was assessed with Cox models stratified by age and sex. Municipal 2024-25 incidence rate ratios and proportions aged 65 years or older (tertiles) defined transmission-control, clinical-preparedness, and combined-priority municipalities. Transmission epicenters shifted from the Northeast (2016-17) to the Central-West (2024-25; peak municipality IRRs >2.7 times the national median); clustering and seasonality persisted. Cases concentrated among adults aged 25 to 55, while post-hospitalization mortality rose steeply with age (HR 10.57, 95% CI 7.64-14.62 for ages 80 years and older versus adults aged 20 to 29). Males had faster progression to hospitalization (HR 1.26) and death (HR 1.76, onset to death) despite fewer notifications. The Central-West led transmission yet had lower case fatality among hospitalized cases (3.54%, 81 deaths out of 2,285 hospitalized) than the Southeast (4.95%, 163 deaths out of 3,291 hospitalized), reflecting demographic rather than purely clinical differences between regions. A municipality-level allocation framework classified 832 municipalities as transmission-control priority (high recent transmission, younger population; predominantly Central-West), 832 as clinical-preparedness priority (lower transmission, older population; predominantly Southeast and South), and 461 as combined-priority (high on both dimensions; predominantly Northeast and Southeast). Chikungunya transmission and mortality are spatially decoupled in Brazil: regions driving epidemic expansion (Central-West) are not those bearing the highest case fatality (Southeast). An age-only vaccination allocation rule would leave 82% of 2024-25 reported cases in municipalities it would not prioritize. A rule that targets only older adults without accounting for geography is likely to miss the municipalities where transmission is actively expanding. A dual-axis framework addressing both dimensions is required for the SUS rollout.

During the ongoing Bundibugyo ebolavirus disease outbreak in the Democratic Republic of the Congo, we quantify introduction risk and sustained-transmission potential across the country. This identifies priority zones far from currently affected areas, where rapid amplification could follow introduction and response efforts should be focused.

COVID-19 vaccination helped change the course of the pandemic and remains critical for protecting high-risk groups. We analyzed data submitted to WHO to describe COVID-19 vaccination coverage during the emergency period from 2021-2023 and annual uptake in 2024, the first post-emergency calendar year after the Public Health Emergency of International Concern designation was lifted. By end-2023, global complete primary series coverage reached 65% in the total population, 82% among older adults, and 91% among health and care workers (HCWs), across reporting countries. Booster coverage was lower, at 33%, 60%, and 69%, respectively. Across indicators, disparities by country income group and region emerged early and persisted through 2024. In 2024, vaccination of older adults and HCWs was limited and heterogeneous. These findings underscore the need for stronger, sustainably financed adult immunization platforms and associated monitoring systems to enhance life-course vaccination benefits and to support future outbreak, epidemic, and pandemic responses.

Background: Sugar sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and fruit and vegetable juices are consumed worldwide, yet their associations with cancer remain unclear. Methods: Within World Cancer Research Fund International's Global Cancer Update Programme (CUP Global), we conducted a systematic review by searching PubMed and Embase until September 2024 for cohort studies of SSBs, ASBs, and juices and cancer risk. Meta-analyses were conducted to calculate the relative risks (RRs) and 95% CIs per 1 serving/day (355 mL for SSBs/ASBs; 177 mL for juices). Evidence was graded by the CUP Global Expert Panel. The CUP Global standard protocol was registered at: https://osf.io/7utbm/. Findings: We identified 158 publications from 51 cohorts. Evidence supported a judgment of a probable causal association of SSBs, including carbonated SSBs, with pancreatic cancer incidence (RR 1.09 [95% CI 1.01-1.16]; I2=8%, n=18 studies), and of SSBs with colorectal cancer incidence (RR 1.07 [95% CI 1.00-1.14]; I2=41%, n=13). Limited suggestive evidence supported positive associations of SSBs with ovarian (RR 1.61 [95%CI 1.03-2.53]; I2=0%, n=2), endometrial (RR 1.21 [95%CI 1.03-1.42]; I2=0%, n=3), and postmenopausal breast cancer (RR 1.05 [95%CI 1.00-1.10] ; I2=0%, n=6), and of carbonated ASBs with leukaemia (RR 1.29 [95%CI 1.01-1.64]; I2=0%, n=2). Evidence supported a judgment of a probable causal association of orange juice with melanoma (RR 1.21 [95%CI 1.08-1.34]; I2=0%, n=4), and skin basal (RR 1.12 [95%CI 1.06-1.17]; I2=46%, n=2) and squamous cell carcinoma (RR 1.13 [95%CI 1.04-1.24]; I2=0%, n=2). An interactive evidence platform is available at: Soft Drinks and Cancer Risk - CUP Global Evidence Platform. Interpretation: This review provides evidence supporting probable causal associations of SSBs with pancreatic and colorectal cancers, and of orange juice with skin cancers, with additional suggestive evidence for SSBs with other obesity-related cancers, extending concerns about sugary drink consumption beyond cardiometabolic health to cancer risk. Funding: World Cancer Research Fund network of charities (American Institute for Cancer Research; World Cancer Research Fund; Wereld Kanker Onderzoek Fonds).

Tokyo experienced a measles outbreak (260 cases) in early 2026 despite elimination status. Adults aged 20-39 years were most affected, and 38% of cases were modified measles, increasing with prior vaccination. Although incidence rose until April, the effective reproduction number; R(t) fell below 1, consistent with outbreak control. Multiple clusters were identified, but many cases lacked epidemiological links, suggesting that modified measles is less likely to be considered in differential diagnosis. Intensive contact tracing and surveillance contributed to limiting transmission.

Diarrhea remains a leading cause of child morbidity and mortality. Improved and ongoing estimates of the etiology of hospitalized pediatric diarrhea in low- and middle-income countries (LMICs) are needed to help prioritize and evaluate the use of existing and upcoming vaccines and interventions. The Global Pediatric Diarrhea Surveillance (GPDS) network is a World Health Organization (WHO)-coordinated public health surveillance network investigating the etiology of hospitalized diarrhea among children aged <5 years in LMICs. The GPDS network enrolls children hospitalized with diarrhea at 38 sentinel surveillance sites in 31 LMICs. Randomly selected stool specimens were tested by TaqMan Array Card quantitative reverse-transcription polymerase chain reaction (qPCR) for 16 pathogens associated with diarrhea. We estimated pathogen-specific attributable fractions (AFs) and incidence of diarrheal hospitalizations at the global, regional, and country levels during 3 time periods: 2017-2018, 2019-2020, and 2021-2022, with a focus on the most recent results. During 2017-2022, the GPDS network enrolled 70,750 children aged <5 years hospitalized with diarrhea, of which 16,458 (23.3%) were randomly selected for qPCR testing. The most prevalent pathogen detected, regardless of quantity or modeled etiologic attribution, was rotavirus (weighted prevalence 30.4%), followed by adenovirus 40/41 (19.1%), norovirus (17.9%), Shigella (14.1%), and Campylobacter jejuni/coli (8.6%). Overall, in 2017-2022, rotavirus was the leading etiology globally (AF 32.5%; 95% Confidence Interval (CI): 27.4, 37.6), followed by Shigella (9.8%; 8.4, 11.3), adenovirus 40/41 (8.6%; 6.3, 10.8) and norovirus (6.7%; 5.6, 7.7). Over time, rotavirus consistently declined from an AF of 36.7% (95% CI: 28.7, 46.7) in 2017-2018 to 26.7% (20.7, 34.1) in 2021-2022. Norovirus AF increased slightly from 6.2% (4.7, 7.7) in 2017-2018 to 7.3% (5.0, 9.2) in 2021-2022. Global Shigella burden remained stable, and adenovirus 40/41 demonstrated significant volatility, peaking globally in 2019-2020 (11.9%; 5.9, 17.5). In 2021-2022, rotavirus was the leading cause of hospitalized diarrhea in 6 of 9 geographic groupings, norovirus predominated in Central and South America, and Shigella was the leading etiology in South Asia. In the subset of countries that had introduced rotavirus vaccine, the leading etiologies in 2021-2022 were rotavirus (18.4%; 15.8, 21.5) and Shigella (16.4%; 11.8, 21.1). In 2021-2022, rotavirus had the highest attributable incidence of hospitalized diarrhea in children (2.3 per 1,000 child-years; 1.8, 3.0), followed by Shigella (0.9; 0.7, 1.1), norovirus (0.6; 0.4, 0.8) and adenovirus 40/41 (0.6; 0.4, 0.8). Despite the widespread use of rotavirus vaccines, rotavirus remained the leading cause of severe diarrhea among children aged <5 years in LMICs globally. However, the proportion of pediatric diarrhea attributable to rotavirus consistently declined from 2017-2018 to 2021-2022, and there were notable differences in the distribution of diarrheal etiologies between regions and across time periods. Shigella, norovirus, and enteric adenoviruses were also associated with a substantial burden of disease. Improving the efficacy and coverage of rotavirus vaccination and prioritizing interventions against other enteric pathogens could further reduce diarrhea morbidity and mortality.

Long COVID (LC) affects millions of individuals worldwide, particularly those with preexisting comorbidities. However, whether these comorbidities should be defined before SARS-CoV-2 infection or before LC diagnosis remains unresolved, and this methodological choice may substantially bias estimates of comorbidity-associated LC risk. In addition, most previous studies were conducted during earlier phases of the pandemic and relied on relatively small or geographically restricted cohorts, limiting understanding of temporal trends and population disparities in LC risk. Leveraging Electronic Health Records (EHR) from 6,130,413 adults with documented COVID-19 across 49 U.S. states in the National COVID Cohort Collaborative (N3C) from 2020 to 2024, we evaluated the impact of different comorbidity exposure-window definitions on LC risk estimation. We utilized ensemble cross-fitted double/debiased machine learning to adjust for complex individual- and county-level confounders. Across the 16 major comorbidities evaluated, defining conditions before SARS-CoV-2 infection, rather than before LC diagnosis, yielded 23%--115% higher adjusted attributable risks and 6%--37% higher adjusted relative risks. Additionally, comorbidity-associated risks generally declined from 2020 to 2024, with substantial demographic, socioeconomic, geographic, and multimorbidity-related disparities persisting throughout the study period. These findings identify temporal exposure-window specification as a major source of bias in LC epidemiology. Failure to distinguish preexisting comorbidities from conditions identified during postinfection follow-up can substantially alter estimates of disease burden, the identification of high-risk populations, and the interpretation of temporal and geographic disparities. More broadly, our results highlight how temporal misclassification of exposures in longitudinal EHR studies can distort risk attribution and population-level inference.

Background Child stunting and wasting affect millions globally, with unexplained heterogeneity across LMICs. Staple foods - rice, wheat, maize, sorghum, millet and cassava - differ in protein quality (DIAAS) and zinc bioavailability. We hypothesised that these differences explain heterogeneity in undernutrition prevalence. Methods This ecological cross-sectional analysis included 127 LMICs (wasting) and 126 LMICs (stunting) using JME 2025 anthropometric data, GBD 2023 estimates and FAOSTAT 2019-2023 five-year mean food balances. Each staple was analysed individually using robust MM-estimation (primary) and quantile regression (secondary), with fixed covariates selected after circularity, correlation and multicollinearity assessment. Five sensitivity analyses tested robustness. Two secondary cross-reference analyses - WHZ, MUAC and oedema across 46 nationally representative surveys and undernutrition in infants under 6 months across 56 DHS datasets - were cross-referenced with dominant dietary staple supply. A post-hoc cross-reference analysis examined maternal short stature and low BMI by dominant dietary staple using DHS data. Findings Sorghum (beta=0.361, p<0.001) and rice (beta=0.086, p=0.004) were positively associated with wasting while Maize was negatively associated (beta=-0.139, p=0.004). Cassava showed a positive, borderline association with stunting (beta=0.975, p=0.092). HIV showed a negative wasting association reversing on exclusion of high-HIV countries. Secondary analyses confirmed MUAC-predominant wasting in cassava- and maize-dominant countries and WHZ-predominant wasting in sorghum- and millet-dominant countries. Interpretation The above findings are consistent with staple-specific growth phenotypes. Currently DHS and MICS surveys collect height and weight only - incorporating MUAC and individual staple dietary data appears imperative. Preventive measures may differ by staple context. Funding No funding was received.

Abstract The association between COVID-19 vaccination and Guillain-Barre syndrome (GBS) has been previously investigated with inconsistent results, largely due to limited data and lack of concurrent controls. To address this problem, a large longitudinal cohort study was conducted using National COVID Cohort Collaborative (N3C) data. While COVID-19 infection was associated with increased GBS occurrence, COVID-19 vaccination was associated with significantly reduced GBS risk relative to unexposed (unvaccinated and uninfected) control, corresponding to a 61% lower 30-day risk (incidence risk ratio: IRR = 0.39, P < 0.01), consistent with multivariable Cox regression showing a similar reduction (adjusted hazard ratio: aHR = 0.41, P < 0.01). This protective association was observed only among recipients of mRNA vaccines (BNT162b2: IRR = 0.38, P < 0.01; mRNA-1273: IRR = 0.24, P < 0.01), but not among recipients of adenoviral-vector vaccines (IRR = 1.38, P > 0.05). Prior COVID-19 vaccination also reduced infection-associated GBS risk. Additional factors associated with GBS risk included sex, vaccine dose, and pre-existing comorbidities such as stroke, neurological disorders, and autoimmune diseases. Overall, our N3C large-scale study provides evidence that COVID-19 mRNA vaccination reduces GBS risk, supporting the safety profile of mRNA vaccines and warranting further mechanistic investigation.

Introduction: Anaemia and micronutrient deficiencies are common in low- and middle-income countries, where vaccine-induced immune responses are often suboptimal. However, whether pre-vaccination nutritional status influences pneumococcal vaccine immunogenicity in young children remains poorly characterised. Methods: We examined associations between pneumococcal vaccine responses in 670 Kenyan children enrolled in three vaccine trials: PRISM (PCV10; n=195; NCT01028326), FPCV (fractional- and full-dose PCV10/PCV13; n=306; NCT03489018), and PATH-wSP (whole-cell pneumococcal vaccine; n=169; NCT02543892) and baseline anaemia (FPCV and PATH-wSP) and micronutrient status (iron, folate, zinc, and vitamins A, B12, D, and E). Analyses were performed separately for each trial. Primary outcomes were post-vaccination serotype- or antigen-specific IgG concentrations, opsonophagocytic activity (OPA) titres, and composite IgG or OPA z scores. Results: Vitamin B12 and haemoglobin concentrations were positively associated with composite and serotype- or antigen-specific antibody responses in analyses controlling for age, sex, malnutrition and inflammation. In the PRISM trial, PCV10-induced IgG (serotypes 1 and 6B) and OPA (serotypes 1, 4, 14, and 23F) responses were positively associated with vitamin B12 concentrations. Moderate anaemia was associated with lower IgG responses to serotypes 9V and 14 following full-dose PCV13 vaccination (FPCV) and lower antigen-specific IgG responses following the 1 mg PATH-wSP vaccine. No consistent associations were observed for ferritin, folate, zinc, or vitamins A, D, and E. Conclusion: Vitamin B12 deficiency and anaemia were associated with reduced pneumococcal vaccine responses in young Kenyan children. Optimising nutritional status before vaccination could be a strategy to improve vaccine responses in populations where anaemia and micronutrient deficiencies are common.

Background: Repeated enteric infections and chronic enteric dysfunction have been associated with undernutrition in children. Interventions that reduce enteric pathogen exposure in young children could thereby improve growth and developmental outcomes. We assessed enteric pathogen prevalence in Bangladeshi infants, the impact of a combined homestead food production and food hygiene intervention on pathogen infections, and associations between pathogen infections, enteric dysfunction markers, and child growth outcomes. Methods: We analyzed panel data from 231 children born between April and December 2018 within the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized trial in Sylhet, Bangladesh. Stool samples were collected at 0-3, 6-8, and 10-13 months of age and assessed for enteric dysfunction biomarkers (myeloperoxidase, alpha-1 antitrypsin, and neopterin) by ELISA and 14 enteric pathogens by multiplex RT-PCR. Diarrhea prevalence was recorded using 7-day recall. Child length and weight were measured at birth and trial endline. Multilevel regression assessed the intervention effect and quantified associations between pathogen exposure, enteric dysfunction, and growth outcomes. Findings: Enteric pathogen prevalence was high (84%) despite low 7-day diarrhea prevalence (5%), and co-infections were common. There was no intervention effect on the prevalence of enteric pathogens. Shigella spp. and Giardia lamblia were associated with higher myeloperoxidase concentrations, while sapovirus was associated with higher alpha-1 antitrypsin concentrations. Repeated protozoan infections (mainly Giardia lamblia) were associated with lower length-for-age, while repeated viral infections (mainly rotavirus and sapovirus) and Cryptosporidium infections were associated with lower weight-for-height and weight-for-age. There was marginal evidence that bacterial infections were associated with lower length-for-age. Conclusion: The intervention was insufficient to reduce the high burden of enteric pathogens in infants, and subclinical infections were associated with enteric dysfunction and poorer growth outcomes. Comprehensive strategies addressing all key exposure pathways are needed to limit pathogen infections and their consequences for child development.

ABSTRACT Background Influenza-associated lower respiratory tract infections (LRTI) impose substantial disease burden on older populations globally. While China has experienced rapid aging, comprehensive assessment of long-term trends in influenza-associated LRTI burden and vaccination coverage among adults aged [&ge;]55 years remains limited. Methods We extracted age-standardized mortality and disability-adjusted life years (DALYs) rates of influenza-associated LRTI among Chinese adults aged [&ge;]55 years from the Global Burden of Disease Study 2023 (GBD 2023). Estimated annual percentage change (EAPC) and age-period-cohort (APC) models were employed to analyze long-term trends (1990-2023). Using the China Health and Retirement Longitudinal Study 2020 (CHARLS 2020, n=13,815), we performed multivariable logistic regression to identify factors associated with influenza vaccination uptake. Spearman correlation assessed ecological associations between GBD age-specific mortality rates and CHARLS vaccination coverage across nine age groups. Results Age-standardized mortality rates declined from 4.09 to 0.31 per 100,000 (EAPC=-8.02%, 95%CI: -9.08% to -6.95%), and DALYs rates from 177.63 to 6.06 per 100,000 (EAPC=-10.67%), representing >96% reductions from 1990 to 2023. Deaths dropped sharply by 59.6% in 2020, consistent with protective effects of non-pharmaceutical interventions during COVID-19. The [&ge;]85-year age group showed the slowest improvement (EAPC=-5.63%). Influenza vaccination coverage in CHARLS 2020 was only 15.1%. Older age ([&ge;]85 years: OR=0.65, 95%CI: 0.46-0.92) and higher educational attainment (college or above: OR=0.34, 95%CI: 0.20-0.56) were independently associated with lower vaccination rates, though the small sample size in the highest education group (n=68) warrants cautious interpretation. Ecological analysis revealed a significant negative correlation between GBD mortality rates and CHARLS vaccination coverage (r=-0.700, p=0.036, n=9 age groups), indicating a "protection mismatch" phenomenon. Raising vaccination coverage to 75% (WHO target) could prevent approximately 2,041 deaths annually under moderate vaccine efficacy assumptions, with [&ge;]75-year-olds contributing 82.7% of preventable deaths. Conclusions Influenza-associated LRTI burden has declined substantially among Chinese adults aged [&ge;]55 years, but improvement is slowest in the oldest age groups. Vaccination coverage remains critically insufficient with a persistent "protection mismatch" where those at highest mortality risk have lowest coverage. Adults aged [&ge;]75 years face a "triple vulnerability" of high mortality, low vaccination coverage, and high COPD comorbidity prevalence, and should be prioritized for vaccination to maximize preventable mortality benefits.

Necrotizing enterocolitis (NEC), frequently resulting in sepsis, is among the leading causes of morbidity and mortality of pre-term newborns. However, diagnostic and therapeutic strategies for NEC and sepsis are still limited and controversial. In this context, there are ongoing debates regarding the application of human milk-based fortifiers (HMF) versus bovine milk-based fortifiers (BMF), but robust evidence is lacking. Systematic reviews and meta-analyses are expected to provide the highest level of evidence, but they are time-consuming and resource-intensive and are at risk of potential bias and subjectivity. The rapidly progressing large language model (LLM) artificial intelligence (AI) tools thus emerge as a promising complementary methodology for systematic review and meta-analysis. We conceptualized a cross-LLM AI platform meta-research and evidence synthesis workflow, leveraging 3 representative state-of-the-art platforms, ChatGPT, Claude and Manus AI. We analyzed 3371 PubMed-indexed publications. 3 platforms reported highly concordant findings. We found that prior systematic reviews and meta-analyses generally reported mixed findings comparing HMF versus BMF. Our LLM AI-assisted meta-research and evidence synthesis found non-inferiority of BMF to HMF for NEC and sepsis outcomes. Here, we present an unbiased direct head-to-head comparison between HMF and BMF in the context of NEC and sepsis. Our analyses also represent a proof-of-concept example for LLM AI-assisted meta-research and evidence synthesis, supporting the integration of LLM AI methodologies into evidence-based medicine and digital health.

Background: Monitoring urinary iodine concentration (UIC) after sustained exposure informs iodine delivery strategies. We aimed to compare endline UIC among women of reproductive age (WRA) and preschool children (PSC) receiving multiple micronutrient-fortified (MMF) vs. iodine-only bouillon, and to describe population iodine status at baseline and endline. Methods: This pre-specified secondary outcome analysis used Condiment Micronutrient Innovation Trial (CoMIT) data. Non-pregnant, non-lactating WRA (15-49 years) and PSC (2-5 years) were enrolled at the household level. Households received MMF or iodine-only bouillon for 9 months (38 weeks); both contained iodine (KIO3) at 30 ug/g. Baseline and endline UIC (ug/L) were measured by modified Sandell-Kolthoff reaction in spot urine samples. ANCOVA models, adjusted for baseline log-UIC and recruitment site, compared endline geometric mean UIC between trial arms. Median UIC at both timepoints was compared to WHO cut-offs (ug/L): <100 (insufficient), 100-199 (adequate), 200-299 (above requirements), and >=300 (excessive); the prevalence of UIC <50 ug/L was calculated. Results: Endline UIC data were available for 611 WRA and 630 PSC. Adjusted endline UIC did not differ by arm (geometric mean ratio [95% CI]: WRA 0.97 [0.86-1.10]; PSC 0.96 [0.84-1.10]). With arms combined, median UIC increased among WRA (100.5 to 124.6 ug/L) and PSC (109.6 to 136.9 ug/L), with fewer samples <50 ug/L at endline. Conclusions: Adjusted endline UIC did not differ between trial arms. After 9 months' use of iodine-fortified bouillon, median UIC remained adequate among WRA and PSC, with fewer samples <50 ug/L at endline.

Consumption of ultra-processed foods is rising globally and has been implicated in inflammation and metabolic dysfunction, yet the impact of specific food additives on the human gut microbiota remains poorly understood. Using dietary data from the Food & You study (approximately 1000 participants in Switzerland), we identified 257 unique additives from 4,119 unique packaged products to quantify each participant's daily additive exposure. Higher exposure to a combination of high intensity sweeteners and sugar polyols, commonly found in low calorie products, was independently associated with reduced gut microbial Shannon diversity (beta = -0.39, p < 0.001), after adjustment for demographics, diet quality, BMI and bowel movement frequency. At a broader level, total additive exposure and fast food consumption were each negatively associated with gut microbial diversity; however, additive exposure remained independently associated and also specifically attenuated the diversity benefits of vegetable rich diets. Furthermore, microbial log ratio signatures linked to additive exposure showed strong negative correlations with Shannon diversity, including emulsifiers and thickeners (r = -0.66) and preservatives and antioxidants (r = -0.56). Integrating additive exposure with healthy dietary components such as HEI, fruits, or vegetables strengthened associations with gut microbial diversity; for example, vegetable linked correlations with Shannon diversity increased from r = 0.52 to r = 0.65 when contrasted against preservative-antioxidant exposure. Concordantly, microbial signatures associated with the sweeteners and sugar polyols additive combination showed depletion of fiber associated commensal taxa, and enrichment of pathways involved in polyol and aromatic compound metabolism. Notably, these associations emerged despite packaged foods representing only approximately 15% of logged dietary intake, underscoring the sensitivity of gut microbial diversity to limited exposure, and demonstrating that without integrating additive and processed-food metrics, one of the largest effect-size phenomena in human gut microbiota diversity would remain undetected.

Purpose: This study assesses the association between colorectal cancer (CRC) screening and a validated, housing-based measure of individual-level socioeconomic status (SES, called HOUSES hereafter) within rural communities and determines whether HOUSES-integrated geospatial analysis can be used to tailor interventions. Methods: We used CRC screening data from a subset of Mayo Clinic Midwest patients living in cities without ready access to routine care in the Mayo Clinic Health System in 2019 to represent rural communities. At the individual level, we assessed the association between CRC screening rates and the HOUSES index, adjusting for age, sex, race/ethnicity, comorbidity, distance from home address to clinic, and area deprivation index, using a multilevel mixed-effects logistic regression model. Additionally, we conducted geospatial analysis to examine the correlation between hotspots of 1) lower CRC screening rates and 2) lower SES of the subject population (HOUSES quartile 1). Findings: Among 34,489 individuals (median age 64.0 years, 52.4% female), those with the lowest SES (HOUSES Q1) had 37% lower odds of being CRC screening adherent than those with the highest SES (HOUSES Q4) (adj. OR [95% CI]: 0.63 [0.58-0.69]). In the 14 identified HOUSES Q1 hotspots, there was a significant correlation in counts of HOUSES Q1 and low CRC screening (correlation coefficient=0.81). Conclusion: Lower SES was significantly associated with lower CRC screening among rural populations. HOUSES-enabled geospatial analysis identified geographic hotspots with lower CRC screening rates for targeted interventions to address disparities in CRC screening in rural communities. HOUSES may be a useful digital tool for cancer preventive care and research.

Chikungunya virus (CHIKV) causes recurrent epidemics across tropical and subtropical regions globally. In 2025, Guangdong reported mainland China's largest documented CHIKV outbreak, with 23,464 cases across all 21 prefecture-level cities. Integrating epidemiological, genomic, and phylodynamic analyses, we investigated the outbreak's origins, transmission, and viral adaptation. The Guangdong strain belonged to the ECSA-MAL lineage, exhibiting a long internal branch that highlights significant global surveillance gaps. Phylodynamic modeling estimated viral introduction in early April 2025, revealing ~2.5 months of cryptic transmission alongside rising vector densities. Spatial case distribution was moderately associated with human mobility from the epicenters. Globally, phylogenetic analysis identified 33 potential adaptive mutations across nine proteins and 14 epidemic lineages, including validated and 15 novel mutations. Twelve novel mutations occurred in the Asian Urban lineage (AUL), predominantly affecting NSP3. This study underscores the need for enhanced pre-peak surveillance and continuous monitoring of viral adaptation across ecological regions.

Background and aims: Maternal overweight and obesity are increasing worldwide, including Nepal. This study assessed BMI trajectories from early pregnancy to one year postpartum and trends in overweight and obesity over the past two decades in Bhaktapur, Nepal. Methods: In the most recent study, BMI was measured in 800 Nepalese women at three time points: at early pregnancy, 6 and 12 months postpartum (2017-2021). The prevalence of undernutrition, overweight, and obesity was estimated using the World Health Organization and the Asian specific cut-offs. Long-term trends were assessed by comparing these findings with three population-based studies conducted in Bhaktapur between 2001 and 2021 among 2400 women at similar life stages. Results: Mean (SD) BMI increased from 23.7 (3.0) kg/m^2 in early pregnancy to 26.1 (3.3) kg/meter squre at 6 and 25.2 (3.3) kg/m^2 and 12 months. The prevalence of overweight increased from 32.9% in early pregnancy to 48% at 6 months. Using the Asia-specific cut-offs, the prevalences were higher. Results from the three previous population-based studies demonstrated an upward trend where postpartum overweight increased from 11.4% in 2001- 2002 to 44.6% in 2017- 2021. The obesity prevalence rose from 1.8% to 10.9% during this period. Conclusion: Overweight and obesity among Nepalese women have risen dramatically over the past two decades, with postpartum overweight increasing nearly fourfold and obesity more than sixfold. These findings highlight the need for interventions to prevent excessive weight retention and reduce adverse health outcomes.

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