Travel Medicine and Infectious Disease

Typhoid fever remains a significant burden in low- and middle-income countries (LMICs). The World Health Organization recommends incorporating typhoid conjugate vaccines (TCVs) into the routine immunization programs of typhoid-endemic countries. Although TCV has been shown to be safe, well tolerated, and effective, evidence on its delivery costs in African settings remains limited. This study provides economic evidence on the cost of implementing TCV catch-up campaigns. This retrospective provider-perspective costing study evaluated TCV catch-up vaccination campaigns conducted in the Asante-Akim North District of Ghana and the Kisantu Health Zone of the Democratic Republic of the Congo (DRC). The campaigns targeted children aged 9 months to 15 years. An incremental costing approach was used, and a Microsoft Excel-based tool was developed to estimate costs. The total number of vaccinated individuals was 54,814; 10,052 in Ghana and 44,762 in the DRC. The financial cost per fully immunized person (FIP), including vaccine and vaccination supply costs, was estimated at US$ 5.78 in Ghana and US$ 5.47 in the DRC. The corresponding economic costs were estimated at US$ 6.09 in Ghana and US$ 5.89 in the DRC. Vaccine procurement and vaccination supplies represented the largest cost component, accounting for US$ 2.76 per FIP in Ghana and US$ 2.39 per FIP in the DRC, followed by service delivery and service delivery support activities. This study provides empirical estimates of the financial and economic costs of TCV catch-up campaigns in Ghana and the DRC. These findings provide country-specific evidence to inform planning, budgeting, economic evaluation, and policy decisions regarding future TCV introduction in typhoid-endemic 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.

Background. In 2025, the World Health Organization pre-qualified an integrated antenatal care (ANC) testing panel that tests for HIV (including p24 antigen and antibody), syphilis, and hepatitis B (HBV) with one finger prick. The panel would accelerate the triple elimination of vertically transmitted infections by shortening the HIV detection window and increasing testing rates. Nigeria is considering adoption but needs performance and cost projections. Methods. We constructed deterministic (with Microsoft Excel) and probabilistic (with Python) models, including parallel testing and treatment post-exposure prophylaxis algorithms for positive p24. We calibrated the models to Nigeria's 6.4 million women entering ANC annually using epidemiologic literature, product prices, and occasionally expert opinion. We compared costs (in 2025 US dollars) and outcomes between current and projected future (2027) practices. Results. The panel would avert 562 of the current 3,299 vertical infections per 100,000 women in ANC. Per woman in ANC, the panel would avert 0.0656 disability adjusted life years (DALYs) at a net cost of US$7.55. With low current testing rates. HBV testing averts the most DALYs (33%), followed by acute HIV (29%), chronic HIV (25%), and syphilis (14%). The incremental cost-effectiveness ratio (ICER) is $115 (95% confidence interval: $91-$143) per DALY averted--more favorable than Nigeria's conservative historical $137 average. The benefit-cost ratio is also favorable (1.19; 95% confidence interval: 0.93-1.51). Conclusions. The integrated ANC testing panel would be a valuable and cost-effective addition to ANC care. Piloting in Nigeria and similar sub-Saharan African countries would refine parameters for potential scale up.

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 [≥]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 [≥]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 [≥]75 years in Italy and has the potential to provide substantial public health benefits.

Background: Curable sexually transmitted infections (STIs) are associated with adverse birth outcomes, yet little cost-effectiveness evidence guides antenatal STI screening policy in high-burden settings. We conducted a cost-effectiveness and cost-utility analysis of the Philani Ndiphile trial in South Africa, comparing One-Time and Two-Time antenatal screening for C. trachomatis, N. gonorrhoeae, and T. vaginalis with standard syndromic management. Methods: A decision-analytic model from the provider perspective simulated costs and outcomes for pregnant women and infants. Costs included diagnostics, treatment, and neonatal hospitalisation for a primary composite outcome of preterm birth and/or low birthweight and its components (secondary trial outcomes). Modelled outcomes included incremental cost (US$) per composite (preterm birth and/or low birthweight) case, per component case and per disability-adjusted life year (DALY) averted. The analysis captured infant outcomes in the first year. Univariate and probabilistic sensitivity analyses were conducted to assess parameter uncertainty and robustness of results. Results: Screening for C. trachomatis, N. gonorrhoeae, and T. vaginalis twice during pregnancy was not cost-effective for preventing the primary composite outcome, nor for preventing low birthweight alone. However, two-time screening was cost-saving for preventing preterm birth alone, averting more DALYs and thereby yielding better health outcomes while reducing healthcare costs compared with syndromic management. One-time screening was not cost-effective for preventing any outcome. Conclusions: Repeat antenatal screening for C. trachomatis, N. gonorrhoeae, and T. vaginalis has the potential to prevent preterm births while reducing healthcare costs in high-burden settings. These findings support further research to confirm the clinical effectiveness of repeat screening and to evaluate longer-term health and economic impacts.

Enteric fever is endemic to many low- and middle-income countries (LMICs), particularly those in sub-Saharan Africa, South and South-East Asia. The causative agents are typhoidal serovars of Salmonella enterica, including Typhi (S. Typhi) and Paratyphi A (SPA). There are no vaccines currently licensed for SPA, leaving antimicrobials as the only therapeutic option. Multi-drug resistance (MDR) S. Typhi is increasingly prevalent, but to date has not been detected in SPA. In Australia, cases of SPA are notifiable. Here we report on the genomic epidemiology of 208 cases of SPA in returned travellers to Australia, and their close contacts, from 2018 to 2025. A total of 15 unique genotypes were detected, and these were correlated with geographical regions of reported travel. There was a low incidence of antimicrobial resistance with only a single isolate carrying acquired resistance genes. Mutations in quinolone resistance determining regions were common across the genotypes, detected in 95.7% of isolates. A single isolate in a traveller returning from India was resistant to several first line antibiotics including: ampicillin, amoxicillin plus clavulanic acid, ceftriaxone, azithromycin and ciprofloxacin. The isolate carried a plasmid encoding an extended spectrum beta-lactamase (blaCTX-M-231), two macrolide resistance genes (mphA and ermB) and a quinolone resistance gene (qnrS1). Elements of the pangenome were explored, with stable maintenance of small plasmids encoding hypothetical proteins detected in four genotypes. Copy number variation in genes encoding surface antigen biosynthesis genes were detected in six genotypes. These biosynthesis genes are targets for one of the two SPA vaccines in development, and the potential variation in surface antigens could have implications for vaccine efficacy. Linking epidemiological data with genomic studies of SPA provides an opportunity to improve understanding of the emergence, spread and risk of drug-resistant SPA infections, and to better inform empirical treatment guidelines in returned travellers.

Background : Vector-borne diseases (VBDs) are an evolving public health concern in Switzerland, where endemic tick-borne infections coexist with emerging mosquito-borne threats linked to climate and ecological change. Public preparedness depends on population knowledge, risk perception, and preventive behaviour alongside institutional capacity. We assessed knowledge, attitudes, and practices (KAP) regarding VBDs among adults in the canton of Bern, interpreted alongside a complementary national stakeholder survey. Methods : We analysed a 2025 cross-sectional web-based survey embedded in the BEready cohort. After validity screening, we derived a latent knowledge score using a two-parameter logistic item response theory (IRT) model fitted to knowledge items. Multivariable linear regression examined associations between participant characteristics and latent knowledge. We identified KAP profiles through partitioning-around-medoids clustering based on block-weighted Gower dissimilarities. A parallel survey of cantonal and Liechtenstein authorities in human health, animal health, and environment departments provided institutional context. Results : Among 1,847 respondents, 1,337 met validity criteria. Knowledge was strongest for tick-related content: 98% matched tick-borne encephalitis to ticks, 87% did so for Lyme disease. Mosquito-borne knowledge was markedly weaker, with only 36% correctly classifying chikungunya and 43% West Nile fever as mosquito-borne, despite 53 % reporting at least weekly summer mosquito exposure. Tick checks were reported by 79% of participants versus 30% for mosquito standing-water removal. The IRT model indicated that mosquito-borne items were both hardest and most discriminating. Higher knowledge was associated with educational attainment, female sex, residence history, tick-bite frequency, and travel history, alongside a non-linear age effect peaking in mid-adulthood. Clustering identified six KAP profiles distinguishing knowledge gaps, low perceived relevance, and weak translation of knowledge into practice. The stakeholder survey (n=55) showed institutional engagement was considerably more developed for mosquito-borne than tick-borne diseases, although about half of authorities reported no dedicated human resources (49%) or budget (55%). Conclusion : Public knowledge and practice remain stronger for tick-borne than mosquito-borne diseases, despite frequent mosquito exposure, revealing a communication gap. Institutional preparedness shows the opposite pattern, being more developed for mosquito-borne threats. Public health strategies should sustain effective tick-prevention messaging while strengthening mosquito-borne disease communication, household source reduction, and support for community-level surveillance and control.

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.

Introduction Schistosomiasis is one of the most pervasive neglected tropical diseases in sub-Saharan Africa as an acute and chronic disease. It presents significant public health challenges in both Madagascar and Burkina Faso. Though schistosomiasis is a high prevalence disease, the understanding of its economic burden is limited. Methods A case control study was designed to compare the out-of-pocket costs and productivity loss associated with infection. A patient-specific survey questionnaire for Cost of Illness and Health-Related Quality of Life was developed and applied in Madagascar and Burkina Faso. Multiple interviews were conducted to capture the costs incurred during the entire period of illness. Results A total of 371 participants were enrolled in this study: 224 in Madagascar and 147 in Burkina Faso. The average economic burden for individuals confirmed to be negative for schistosomiasis was US$ 6.4 in Madagascar and US$ 29.8 in Burkina Faso. For mild cases, average costs were US$ 8.4 and US$ 13.5, respectively. Severe cases with complications due to schistosomiasis incurred substantially higher costs, averaging US$ 60.0 in Madagascar and US$ 1,272 in Burkina Faso. Median Health-Related Quality of Life was significantly lower among severe cases compared with controls and mild cases. Conclusions The cost of illness for schistosomiasis is significant in both countries. This study indicates the potential economic burden of disease in Madagascar and Burkina Faso, where the existing evidence on schistosomiasis is limited. Our study can help decision makers set health policy priorities.

Background: Cutaneous leishmaniasis (CL) remains a major neglected tropical disease in Afghanistan; however, recent nationwide evidence on its geographical and temporal distribution is limited. This study assessed the reported burden, spatial distribution and seasonal variation of cutaneous leishmaniasis across Afghanistan during 2024. Methods: A nationwide retrospective ecological study was conducted using aggregated routine surveillance data obtained from the National Malaria and Other Vector-Borne Diseases Program. All cases reported from government health facilities across Afghanistans 34 provinces between 1 January and 31 December 2024 were included. Reported incidence rates were calculated per 10,000 population using national and subnational population estimates. Cases were analyzed by surveillance classification, province, city, rural district, month, and season. Results: A total of 87,245 cases were reported during 2024, corresponding to an overall incidence of 25.1/10,000 population. Anthroponotic and zoonotic CL accounted for 80,202 (91.9%) and 7,043 (8.1%) cases, respectively. Jowzjan recorded the highest provincial incidence (105.0/10,000), while Kabul and Herat contributed the largest absolute numbers of cases. Shiberghan had the highest urban incidence, whereas Panjwai, Ghoryan and Hazrat-e-Sultan recorded exceptionally high rural rates. May had the highest monthly burden, while August had the lowest. Autumn accounted for the largest seasonal proportion (27.92%), whereas summer had the lowest burden (16.98%). Considerable incompleteness in district-level reporting was observed. Conclusion: CL constituted a substantial but highly concentrated public health burden in Afghanistan during 2024. Strengthened surveillance, improved diagnostic confirmation and geographically targeted case-management and vector-control interventions are particularly needed in identified high-burden provinces, cities and rural districts.

Mpox has re-emerged as a public-health priority across Nigeria, and successive international public-health emergencies were declared in 2022 and 2024. Facility-level descriptions of admitted, clinically suspected cases from northeastern Nigeria remain sparse. We conducted a register-based descriptive study of all admissions to the infectious-diseases isolation ward of Modibbo Adama University Teaching Hospital, Yola, in which mpox was recorded as the working or a differential diagnosis between February 2022 and January 2025. Age, sex, month of admission, locality, recorded clinical impression, and outcome were abstracted and summarised, with proportions reported using Wilson 95% confidence intervals. Fifteen suspected mpox admissions were identified, representing 4.5% (95% confidence interval 2.8-7.4) of 330 isolation-ward admissions. The median age was 20 years (interquartile range 13-37; range 7-57); six patients (40.0%) were children under 18 years and 12 (80.0%) were male, giving a male-to-female ratio of 4:1. Admissions clustered in 2022 (9 of 15; 60.0%), with six in July 2022, including a probable household cluster of four children and adolescents aged 7-14 years from a single locality who presented within eight days of one another. Three deaths were recorded (case fatality 20.0%, 95% confidence interval 7.0-45.2), including one disseminated case complicated by acute respiratory distress syndrome. The demographic profile closely matches previously reported Adamawa State and national surveillance data, whereas the elevated case fatality reflects referral concentration and diagnostic uncertainty rather than true mpox-attributable mortality. Cases were clinically suspected rather than laboratory-confirmed, which is the principal limitation of this study. We recommend targeted strengthening of laboratory diagnosis at facility and sub-national level, including dual monkeypox-varicella testing algorithms, use of existing molecular platforms rather than new infrastructure, and mandatory recording of laboratory results within ward registers.

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.

High pathogenicity avian influenza (HPAI) H5N1 clade 2.3.4.4b has caused a global panzootic with unprecedented impacts on wildlife and livestock, making evidence-based disease mitigation and outbreak response critical. In this paper, we describe a spatiotemporal mechanistic model of infectious disease dynamics developed for the HPAI Modelling Challenge and its implications for forecasting and policy in Australia. To emulate emergency response conditions, we adapted an existing model for rapid deployment rather than developing a bespoke model. We refined the model iteratively across the challenge to better analyse the provided outbreak data. Throughout the challenge, we accurately forecast temporal trends and local outbreak spread, but could not predict rarer, long-distance dispersal events. The challenge ended before HPAI H5N1 was first detected in Australia (June 2026), providing a critical opportunity to test our response modelling readiness for an incursion in wildlife and potential spillover into commercial poultry. Our experience identifies three key considerations for Australia's HPAI H5N1 preparedness: targeted enhancements to our model to improve forecast precision and enable scenario-based policy evaluation; the critical value of pre-existing modelling infrastructure for rapid emergency response; and sustained collaboration between research and policy institutions to align modelling capabilities with outbreak response requirements.

Antimicrobial resistance generates a vast, rapidly growing literature, yet no resource offers a comprehensive, evidence-linked repository of AMR findings at scale. We present ResLit, an automated pipeline and public database that mines the AMR literature for resistance genes, mutations, organisms, and mechanisms. From 2 million candidate PubMed records, BioMistral-7B screened abstracts to 356,000 relevant papers; multi-tier retrieval yielded 117,000 full texts, from which Qwen3-30B performed two-step extraction. ResLit contains 3,120 genes and 13,593 mutations, cross-linked to CARD, ResFinder, and NCBI Reference Gene Catalog across four evidence tiers. It further supports community-driven curation of automated outputs and reference databases. Freely available at www.reslit.info.

Human Papillomavirus (HPV) infection among men who have sex with men (MSM) has become a significant public health concern, particularly in countries where male vaccination is unavailable. Given the high susceptibility of MSM to HPV and anal cancer, and the unavailability of HPV vaccination for males in low- and middle-income countries (LMICs), there is a need to identify alternative interventions for reducing disease transmission and burden in this population. The novel mathematical model presented in this article couples smoking behavior dynamics with HPV transmission and anal cancer progression among MSM. Smoking reduction is introduced as an intervention to assess its effects on disease transmission and burden. The basic reproduction number (R0) is derived using the next-generation matrix method, and a global sensitivity analysis is performed using partial rank correlation coefficients (PRCC) to identify the influence of model parameters on RR0. Further, the theoretical analysis of the model reveals a backward bifurcation, implying that RR0 < 1 is necessary but not sufficient to eradicate the disease. The study finds that smoking reduction among MSM reduces HPV infection and anal cancer burden relative to baseline projections without intervention. The joint effect of smoking reduction and vaccination shows that the critical vaccination coverage needed to achieve RR0 <1 decreases as the level of smoking reduction increases. A similar outcome is observed for contact reduction. These findings highlight the importance of concurrent interventions, which can significantly curtail the spread of HPV and reduce disease burden in both the high-risk group and the general population.

Background: Empirical surveillance for Aedes-borne arboviruses is inherently reactive, detecting transmission after it has commenced. For small island settings where dengue and chikungunya circulate sporadically, characterising when and where environmental conditions could support local transmission is critical for preparedness. In Mauritius, Aedes albopictus is the sole primary vector for dengue and chikungunya viruses, but previous suitability assessments have relied on Aedes aegypti parameterisation. Methods: We estimated monthly Index P for dengue and chikungunya across 160 localities in Mauritius from January 2014 to October 2024. Index P, a mechanistic transmission suitability measure derived from the Ross-Macdonald framework that climate-dependent transmission potential attributable to one adult female mosquito. Mean temperature and relative humidity were derived from ERA5-Land reanalysis dataset via Google Earth Engine and incorporated within the Mosquito-borne Viral Suitability Estimator (MVSE) framework. Index P was also parameterised with Ae. albopictus-specific biological priors and virus-specific vector competence values for both dengue and chikungunya. Results: Transmission suitability for both viruses was concentrated within the austral summer (November to April), with near-zero values in winter, below the indicative transmission threshold (Index P [&ge;] 0.5). Chikungunya exhibited consistently higher, more spatially widespread and longer-lasting suitability than dengue: all districts exceeded the transmission suitability threshold for chikungunya (Index P = 0.71), while median dengue Index P = 0.24, remaining below this threshold, during the same study period. Dengue peak suitability was concentrated in western coastal localities, consistent with the greater thermal sensitivity of its extrinsic incubation period in Ae. albopictus. Conclusions: These findings indicate that dengue and chikungunya have distinct, virus-specific climate-suitability profiles in Mauritius, and should not be treated as interchangeable for preparedness purposes. This provides an important Ae. albopictus-parameterised evidence base for Mauritius, enabling seasonal and geographic targeting of surveillance and vector control ahead of, rather than in response to local transmission.

Abstract Background: Urogenital schistosomiasis remains a major neglected tropical disease in rural communities, particularly in reservoir-adjacent settings where sustained human-water contact facilitates persistent transmission. Despite ongoing control efforts, communities located around reservoirs may experience persistent transmission partly due to socioeconomic water exposure and presence of infected intermediate host snails in aquatic habitats. This study assessed the prevalence, intensity, and epidemiological correlates of Schistosoma haematobium infection in reservoir-adjacent communities in Kano State, Nigeria to better understand local transmission. Methods: A community-based cross-sectional study was conducted among 447 consenting participants from six communities located around three water reservoirs in Kano State. Sociodemographic characteristics, water-contact behaviour, sanitation practices, treatment-seeking behaviour, and knowledge related to urogenital schistosomiasis were obtained using interviewer-administered questionnaires. Urine samples collected between 10:00 and 14:00 were examined using microscopy following centrifugation/sedimentation. Schistosoma haematobium isolates were characterised by molecular methods, using PCR and Sanger dideoxy sequencing. Bulinus snails were collected from the reservoirs by handpicking and scooping methods. Nucleotide sequences were analysed using NCBI BLAST to confirm species identity. Epidemiological data on Schistosoma haematobium infection were analysed using chi-square tests and univariate and multivariate logistic regression analyses to assess associations with explanatory variables. Results: The overall prevalence of S. haematobium infection was 34.23% (153/447), indicating moderate endemicity. Molecular study confirmed the occurrence of pure S. haematobium. Community-specific prevalence ranged from 32.35% to 37.84%. Heavy-intensity infection (>50 eggs/10 mL urine) occurred in 17.65% of infected participants. Infection was most common among children and adolescents and was higher in males than females, although the sex difference was not statistically significant. Water-contact behaviour was the strongest correlate of infection: participants reporting water contact had a markedly higher prevalence than those without such exposure (39.12% vs 3.28%; OR = 18.96, 95% CI: 4.56-78.73). Fetching water (aOR = 2.57; 95% CI = 1.53 -4.34; p < 0.001) and Swimming (aOR = 2.37; 95% CI = 1.42 -3.94; p = 0.001) were the specific activities most strongly associated with higher odds of S. haematobium infection. Age (aOR = 0.91; 95% CI = 0.87 - 0.95; p < 0.001) significantly reduced the odds of infection. In terms of gender, female participants had significantly lower odds of infection compared with males (aOR = 0.52; 0.29 0.92; p = 0.03). Knowledge of transmission was poor, with only a small proportion of participants correctly identifying contact with contaminated water as the cause of infection. A rare ectopic detection of S. mansoni eggs in urine was also observed. Presence of S. haematobium-infected Bulinus intermediate hosts in the water reservoirs was reported. Conclusions: Urogenital schistosomiasis remains actively transmitted in reservoir-adjacent communities in Kano State, with infection strongly associated with frequent human-water contact and poor disease knowledge. These findings support the need for integrated control strategies combining praziquantel-based preventive chemotherapy, targeted health education, improved water and sanitation, and behaviour-focused interventions to reduce reinfection and interrupt transmission. Keywords: Urogenital schistosomiasis, Schistosoma haematobium, water reservoirs, prevalence, risk factors

Parasitic infection is one of the common health problems of livestock in Bangladesh. Due to the country's climate, heavy monsoon rainfall, low biosecurity in farms, and high humidity, along with presence of suitable vector organisms, gastrointestinal parasitism remains widespread in cattle and other livestock. The standard method of diagnosis is microscopic examination of fecal samples, but this depends on manual observation, which is time-consuming and can lead to human error, mainly because many parasite eggs look similar to each other and samples often contain contaminants that can be mistaken for eggs or cysts. In this study, we tried to apply the YOLOv8 deep learning model for automated detection of parasitic eggs and cysts from microscopic images of livestock fecal samples. Images of clinical cases were collected, annotated, and used to train the model in Python, with batch size 16, auto optimizer, learning rate 0.01, momentum 0.937 and weight decay 0.0005. Training was done using Google Colab, and the model was evaluated using precision, recall, F1-score, mAP50, and mAP50-95. The model achieved a precision of 56%, recall of 24%, F1-score of 33.6%, mAP50 of 33%, and mAP50-95 of 22%. The relatively low recall and F1-score indicate that the model still has considerable limitations, largely due to insufficient species-specific training data and presence of image artifacts. Underrepresentation of some parasite species, such as Trichuris spp., in the dataset also caused class imbalance, which affected the model's ability to detect these species reliably. Despite these limitations, the study indicates that YOLOv8 architecture has some potential to be used for detection of parasitic eggs and cysts from microscopic images, and that further work with larger and more balanced datasets may improve performance and applicability in veterinary diagnostics. Keywords: YOLOv8, livestock parasites, deep learning, microscopic image analysis, veterinary diagnostics, Bangladesh

Background: Under the DRG/DIP payment reform, the cost structure and its driving factors for laparoscopic cholecystectomy (LC) in resource-limited plateau regions remain unclear. Methods: Based on a single-center cohort of 605 plateau LC patients from May 2020 to October 2025, natural log transformation was applied to total hospitalization costs. Pearson/Spearman correlation, multivariate linear regression (traditional clinical model vs system-driven model with year dummies), and quantile regression were used. Results: Mean hospitalization cost 8097.49+/-936.85 CNY, CV=11.6%, Gini=0.062, demonstrating high homogenization. Traditional six-variable clinical model yielded R^2=0.008 (F=0.78, P=0.587), no significant predictors. The system-driven model achieved R^2=0.143 (F=3.42, P=0.001), with year dummies as dominant predictors. The study proposes the SAO (System-Allocation-Outcome) paradigm to replace the traditional SPO framework.

Japanese encephalitis virus (JEV) transmission involves complex interactions among Culex mosquitoes, amplifying pig hosts, reservoir wading birds, humans, and environmental conditions, complicating quantitative assessment of transmission dynamics and intervention effectiveness. We developed a deterministic, fourteen-compartment One Health mathematical framework that integrates these interconnected host vector populations and their epidemiological states. The model incorporates temperature-dependent mosquito biting, seasonal transmission, human vaccination, pig biosecurity, environmental barriers, and mosquito-control interventions. Mathematical properties were established through analyses of non-negativity, boundedness, biologically feasible equilibria, local and global stability, and optimal control. District-specific simulations were conducted for Bellary, Udupi, Kolkata, and Purba Bardhaman during the August transmission period. Intervention scenarios were evaluated, and global sensitivity analysis was performed using 500 Latin hypercube samples with partial rank correlation coefficients. Model outputs were also compared with district-level surveillance observations. Vaccination-adjusted basic reproduction numbers were 0.905 in Bellary, 0.965 in Udupi, 1.817 in Kolkata, and 0.885 in Purba Bardhaman, with only Kolkata exceeding the epidemic threshold. Under maximum intervention, total infections decreased by 80.6%, 96.8%, 80.5%, and 72.2%, respectively, while infected mosquito populations declined to zero across all four settings. In Kolkata, vaccinating 3.6 million individuals with dose series II reduced the reproduction number from 1.817 to 0.9846, whereas population-wide dose series I vaccination alone was insufficient to reduce it below unity. Sensitivity analysis identified mosquito recruitment, temperature-dependent biting, carrying capacity, mosquito mortality, density-dependent regulation, and mosquito-to-human transmission as major determinants of peak human infection. Overall, the framework demonstrates heterogeneity in JEV transmission and intervention effectiveness and provides a mathematically grounded One Health approach for comparative evaluation of integrated control strategies.