Travel Medicine and Infectious Disease

IntroductionThe adoption of biologic therapies imposes a substantial financial burden on the Jordanian healthcare system. Ranibizumab is prescribed for various retinal disorders, and its associated costs are considerable. The introduction of biosimilars is beneficial in retaining desired clinical parameters while providing cost relief and enhanced access to patients. ObjectiveTo examine the budget impact and expanded access of switching to ranibizumabs biosimilar for the management of retinal diseases in guideline-based practice and in real-world practice in Jordan. MethodA 4-year budget impact analysis from Jordanian public sector payers sector was performed (2023 to 2026) that included patient prevalence and incidence, average ranibizumab dose per year, and anticipated shifts in the market share of ranibizumab and aflibercept. The model took into account the anticipated price erosion of the biosimilar in 2025 and 2026. Sensitivity analyses were performed to assess the effect of changes in uptake rates, price, and market share. ResultsThe annual cost savings per patient when switching from aflibercept to ranibizumabs biosimilar were from 20.55 JOD (Jordanian Dinar) to 1519.93 JOD, translating to a percentage saving of 2.68% to 35.12% across the various scenarios and indications. The total budget impact ranged widely from 6.9 M JOD to 21.2 M JOD based on treatment regimens adjusted to current practice, PRN (Pro re nata), or T&E (Treat and extend). Patient access improved between 2.75% to 124.76% in the different scenarios. ConclusionThe introduction of ranibizumabs biosimilar significantly reduces the expenditures and enhances treatment access.

BackgroundDengue fever is a major neglected tropical disease with a rapidly rising global burden, and localized outbreaks are increasingly reported in southern subtropical China. Fujian Province, a coastal subtropical region with favorable ecological conditions for Aedes albopictus breeding and frequent cross-border exchanges with dengue-endemic areas, has had continuous local dengue cases for over a decade, raising concerns about the establishment of a stable natural endemic focus. Sustained local dengue transmission is defined by four core criteria, but no systematic assessment of these criteria has been conducted for Fujian using long-term multi-dimensional surveillance data. We aimed to evaluate whether a natural endemic focus for sustained local dengue transmission has been established in Fujian Province from 2014 to 2024 using four core evidence dimensions. MethodsWe extracted data on imported and locally acquired dengue cases in Fujian from 2014 to 2024 from Chinas National Notifiable Disease Reporting System (NNDRS). Serological surveillance for dengue IgG antibodies and virological surveillance for dengue virus in Aedes albopictus were conducted at seven sentinel sites. The study period was stratified into three phases based on the impact of COVID-19 non-pharmacological interventions: pre-pandemic (2014-2019), pandemic(2020-2022), and post-pandemic(2023-2024). Descriptive epidemiological analysis and data visualization were performed using R software (version 4.4.1), with t-tests for continuous variables and {chi}{superscript 2} tests for categorical variables. ResultsA total of 3,606 dengue cases were reported in Fujian during the study period, including 1,229 imported and 2,377 locally acquired cases. Key findings were as follows: (1) Temporal distribution: Local dengue transmission was completely interrupted during the 2020-2022 COVID-19 pandemic (0 local cases, only 26 imported cases), and resumed at a low level in 2023-2024 (160 local cases). (2) Serology: The overall population dengue IgG antibody positivity rate was 4.2% (66/15,736), with no statistically significant difference between pre-epidemic (3.8%, 30/7,835) and post-epidemic seasons (4.5%, 36/7,901; P=0.48), and no year with a positivity rate exceeding 10%. (3) Vector surveillance: Only one dengue virus-positive sample was detected among 385,000 Aedes albopictus mosquitoes collected during routine surveillance (Taijiang District, Fuzhou, October 2017), with no viral nucleic acid detected in all other samples. (4) Age distribution: The mean age of locally acquired cases (46.1{+/-}19.8 years) was significantly higher than that of imported cases (35.8{+/-}11.2 years, P<0.001), and local cases were concentrated in the middle-aged group (40-60 years) with no child-dominant pattern observed. ConclusionsFujian Province has not established a stable natural endemic focus for sustained local dengue transmission, and imported cases are the primary driver of local outbreaks in the region. Strengthened surveillance and early management of imported cases, integrated vector control targeting Aedes albopictus, and targeted public health education are critical and essential strategies to prevent the establishment of a dengue natural endemic focus in Fujian and other subtropical coastal regions with similar epidemiological characteristics. Author SummaryDengue fever is a rapidly spreading neglected tropical disease worldwide, and southern China faces persistent threats of local transmission due to favorable ecological conditions for mosquito breeding and frequent cross-border travel. Fujian Province, a subtropical coastal region in southeastern China, has reported annual local dengue cases for over a decade, raising public health concerns about the potential establishment of a stable natural endemic focus--where the virus circulates sustainably without relying on imported cases. To address this critical question, we conducted a comprehensive 11-year assessment (2014-2024) of dengue transmission in Fujian using four key evidence dimensions defined for identifying dengue endemic foci: the continuity of local cases independent of imported sources, population antibody levels, dengue virus detection in local mosquitoes (Aedes albopictus), and the age distribution of infected patients. We also leveraged the COVID-19 pandemic(2020-2022) as a unique natural experiment, during which strict travel restrictions drastically reduced imported dengue cases, to test whether local transmission could persist on its own. Our findings showed that local dengue transmission in Fujian completely stopped during the COVID-19 pandemic and only resumed when cross-border travel and imported cases recovered, confirming local transmission is entirely dependent on imported virus sources. Additionally, the local population had a very low dengue antibody positivity rate (4.2%), dengue virus was detected in only one mosquito sample over 11 years of surveillance, and local cases were concentrated in middle-aged adults (not children--the typical group affected in endemic areas). Together, these results confirm that Fujian Province has not established a stable natural endemic focus for dengue fever. While no endemic focus exists yet, Fujian remains at high risk of imported-driven local outbreaks due to its climate and cross-border exchanges. Our study highlights three critical strategies to prevent the future establishment of a dengue endemic focus in Fujian and other similar subtropical coastal regions: strengthening surveillance and early response for imported dengue cases, implementing targeted mosquito control measures during peak transmission seasons, and conducting public health education to raise awareness of dengue prevention. These evidence-based interventions are key to blocking the formation of sustained local dengue transmission and protecting regional population health.

ObjectiveThis study is to evaluate the cost-effectiveness of an annual screening program for diabetic retinopathy (DR) at primary healthcare level among patients with type 2 diabetes mellitus (type 2 DM) from a societal perspective in Danang city, Vietnam. MethodsA Markov model was developed to compare costs and effects of an annual screening program for DR using non-mydriatic fundus photography with the absence of the screening on a cohort of 23,951 patients with type 2 DM aged 40 years in Danang city from a societal perspective over a lifetime horizon of 40 years. The effect was estimated using quality-adjusted life years (QALY). Costs were measured in both Viet Nam Dong and US dollar. Both costs and effects were discounted annually at 3%. One-way and probabilistic sensitivity analyses were conducted to assess parameter uncertainty. ResultsThe ICER for the DR screening program compared with the absence of screening was VND 86,631,252 per QALY (USD 3,630/QALY). In the one-way sensitivity analyses, a decrease in the screening participation rate, screening every two years, lower sensitivity of fundus photography and the poor treatment compliance rate, as well as an increase in costs of screening and treatment, which all led to higher ICER values. Increasing the incidence of DM did not change ICER value. Conversely, reducing treatment costs caused lower ICER. At a willingness-to-pay (WTP) threshold of VND 86,631,252 (USD 3,630) per QALY, the probability of the screening program being cost-effective was 92.3%. When the WTP increases at VND 95,294,377 (USD 3,993) or higher, the probability of cost-effectiveness approached 100%. ConclusionDiabetic retinopathy screening for patients with type 2 diabetes for aged 40 to 80 years is cost-effective in Danang city, Vietnam according to World Health Organization criteria.

BackgroundSeasonal influenza imposes a significant clinical and economic burden in the United States despite the availability of effective vaccines. ObjectivesTo estimate the cost of illness associated with seasonal influenza among U.S. adults and to examine the relationship between vaccination coverage and influenza related outcomes. MethodsWe combined Centers for Disease Control and Prevention influenza burden estimates with contemporary healthcare utilization, cost, and labor market data to estimate direct medical costs and productivity losses for the 2023 24 influenza season. Panel data regressions with fixed effects were used to evaluate the association between adult influenza vaccination rates and hospitalization and mortality outcomes using data from the 2010 11 through 2023 24 seasons. Scenario analyses assessed how alternative vaccination rates would have affected costs and mortality. ResultsInfluenza among adults was associated with an estimated $29 billion in total economic burden in the 2023 24 season, including approximately $16 billion in direct healthcare costs and $13 billion in productivity losses. Higher vaccination rates were significantly associated with lower mortality among adults aged 18 years and older and reduced hospitalization rates among adults aged 50 years and older. Achieving historical peak vaccination coverage would have reduced total costs by approximately $3 billion and averted more than 8000 deaths. ConclusionsAdult influenza vaccination is associated with substantial reductions in mortality and economic burden, underscoring its value as a cost relevant public health intervention.

The risk of esophageal adenocarcinoma (EAC) in Barretts esophagus (BE) varies substantially by segment length and dysplasia grade. This study evaluated the cost-effectiveness and health impacts of dysplasia-stratified EAC surveillance strategies for the Japanese BE population. A state-transition model was developed comparing endoscopy, sponge test, breath test, and miRNA test with no surveillance from a healthcare payer perspective over a lifetime. Non-invasive strategies were assessed as primary surveillance tools, with positive results triggering confirmatory endoscopy, and a scenario analysis evaluated AI-assisted endoscopy. Five BE populations of 50-year-old individuals were modeled: ultra-short segment BE (USSBE), short-segment BE (SSBE), long-segment nondysplastic BE (LSBE-NDBE), LSBE with low-grade dysplasia (LSBE-LGD), and LSBE with high-grade dysplasia (LSBE-HGD). Each modality was evaluated at surveillance intervals of 1, 2, 3, 4, 5, or 10 years. Primary outcomes included net monetary benefits, costs, quality-adjusted life-years, incremental cost-effectiveness ratios, and EAC deaths, with sensitivity analyses assessing parameter uncertainty. Surveillance was not cost-effective for USSBE, SSBE, or LSBE-NDBE. For LSBE-LGD, annual endoscopy was most cost-effective, averting 83 EAC deaths per 10,000 individuals, while for LSBE-HGD, annual breath testing was most cost-effective, averting 295 deaths. These findings support dysplasia-specific surveillance in LSBE with implications for global surveillance practice.

BackgroundBoth hemorrhagic fever with renal syndrome (HFRS) and scrub typhus (ST) are acute zoonotic infectious diseases. There is an overlap in their epidemiological characteristics and clinical manifestations, posing challenges for early differential diagnosis. This study aims to identify predictive factors for these two diseases to provide a basis for early diagnosis. Method/FindingsA retrospective analysis was conducted on the clinical data of patients diagnosed with HFRS and ST at the First Affiliated Hospital of Dali University. Logistic regression analysis was employed to explore independent risk factors for the early differential diagnosis of these two diseases, and a nomogram model was constructed based on these risk factors. The performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC). The nomogram was utilized to visually present the predictive variables. Decision curve analysis (DCA) was performed to assess the clinical utility of the model. ResultsA total of 235 patients each with HFRS and ST were included in this study. After adjusting for confounding factors, the results of multivariate logistic regression analysis revealed that sex (male) (adjusted odds ratio [ajOR]: 2.093, 95% confidence interval [CI]: 1.107 - 3.957, P = 0.018), positive proteinuria (ajOR: 4.937, 95% CI: 2.427 - 10.042, P < 0.001), creatinine (CREA) (ajOR: 1.009, 95% CI: 1.003 - 1.015, P = 0.005), heart rate (ajOR: 0.981, 95% CI: 0.966 - 0.997, P = 0.018), and conjunctival congestion (ajOR: 16.167, 95% CI: 5.326 - 49.072, P < 0.001) were independent risk factors for differentiating HFRS from ST. The AUC of the model constructed based on these five independent risk factors was 0.856. ConclusionSex (male), positive proteinuria, elevated CREA, decreased heart rate, and conjunctival congestion are effective predictive factors.

In the past decade, dengue fever has emerged as a major public health on Reunion Island in the Southwest Indian Ocean. During the 2018-2022 outbreak, an unusual increase in ocular complications was reported in some patients. To investigate a potential viral cause, we analysed 447 blood samples from hospitalized patients with and without ophthalmic symptoms. Genetic sequencing revealed the co-circulation of two strains of dengue virus serotype 1, both genetically linked to strains previously identified in Asia. Notably, all patients with ophthalmic symptoms were infected with viruses from a single cluster within genotype I, which harbored several unique mutations. These findings suggest that the rare ocular complications observed during this outbreak may be associated with specific viral cluster. Further laboratory studies are required to confirm this potential link.

BackgroundIrregular migration across Central America and Mexico has increased in recent years, exposing migrants to various health risks, including vector-borne diseases such as leishmaniasis. The migration corridor from South America, through the Darien Gap, to northern Mexico traverses multiple leishmaniasis-endemic regions with active Leishmania spp. transmission, where environmental exposure during migrants transit may increase the risk of infection. Methodology / Principal FindingsFrom 2023 to 2025, clinical and epidemiological data were collected from 365 migrants transiting through Mexico, including a subset of individuals with clinical suspicion of cutaneous leishmaniasis (CL). Migrants were evaluated at two shelters in northern Mexico and at the Centro de Medicina Tropical (CMT) of the Universidad Nacional Autonoma de Mexico (UNAM). Diagnostic testing included serology and polymerase chain reaction (PCR) for species identification. Sociodemographic data, country of origin, and migration routes were documented. A complementary literature review was conducted to map the geographic distribution of sand fly vectors along migratory pathways. A total of 26 leishmaniasis clinical cases were identified, namely a 7.1% prevalence (95%-CI = 4.6-9.9%). Most individuals originated from Venezuela (n = 12), Honduras (n = 3), and Mexico (n = 3), with additional cases from Haiti and the Czech Republic. Six participants did not disclose their country of origin but reported traveling from South America. Polymerase chain reaction confirmed active infections with Leishmania (Viannia) panamensis (7 cases) and Leishmania (Viannia) braziliensis (1 case), both detected among Venezuelan migrants. Additional PCR-positive cases were classified within the Viannia subgenus. Conclusions/SignificanceThese findings underscore the urgent need for tailored surveillance strategies and integrated cross-border healthcare interventions to address migrant populations, who may also contribute to the introduction of Leishmania species into Mexico, including those belonging to the Viannia subgenus. The presence of competent sand fly vectors along migration routes heightens the risk of transmission to both migrants and local resident communities. Author SummaryLeishmaniasis is a neglected tropical disease transmitted by sand flies which remains a major public health concern in many parts of Mexico, Central, and South America. In recent years, irregular migration from South America to northern Mexico has increased, exposing migrants to endemic disease risks. Here, clinical and epidemiological data from migrants transiting Mexico between 2023 and 2025 were examined, and 26 cases of cutaneous leishmaniasis were identified. Species-level identification confirmed infections with L. (V.) panamensis and L. (V.) braziliensis, underscoring the importance of precise diagnosis to help guide treatment and clinical follow-up of migrants. The presence of competent sand fly vectors along migration routes further highlights the vulnerability of the migrant population. These findings emphasize the urgent need for active surveillance and integrated healthcare strategies to protect both migrant and local populations, while also considering social and ecological factors. Addressing leishmaniasis in an integrated context requires coordinated medical and educational interventions to prevent transmission, reduce disease burden, and support vulnerable communities.

Background The Hump-nosed pit viper is a recognized but neglected medically significant species causing morbidity and mortality, with non-availability of a specific antivenom. There are many gaps in our understanding of its envenomation, including burden, clinical syndrome, complications and management. Methodology The study is a retrospective sub analysis of the Prospective VENOMS registry and hospital records of Hump Nosed Pit Viper envenomation from a single tertiary care center in coastal Karnataka from May 2018 to March 2024. Epidemiology, syndrome, complications and treatment strategies have been described. A linear mixed model analysis was conducted to study the effect of different therapeutic interventions in combating venom induced consumptive coagulopathy (VICC) Principal Findings Of 46 cases, 24 patients had VICC. The most common complications were AKI (21.7%), TMA (10.9%) and stroke (4.4%). Anaphylaxis to ASV (23.9%) was the most common therapeutic complication. Therapeutic interventions included ASV, administration of blood products and therapeutic plasma exchange along with supportive care. The linear mixed model revealed that administration of blood products (p=<0.001) had the strongest influence on the INR value, however, often resulting in a transient decline in INR value. ASV (p=0.052) caused only marginally significant change in INR. The role of TPE could not be statistically inferred, however, individual cases with severe VICC improved without complications, therefore it required further study but can be considered in critical cases. Conclusions/Significance This study describes the syndrome of hump-nosed pit viper envenomation, while highlighting the urgent need for a species-specific antivenom, recommends treatment strategies that can be used in the interim. Additionally, geo-spatial mapping draws attention to hotspots and the hypothesis that HNPV in coastal Karnataka have regionally distinct toxicity trends.

Campylobacter jejuni is a zoonotic bacterium causing foodborne gastroenteritis in humans worldwide, whose main symptom is diarrhea. The infection is severe mostly in children and in immunocompromised individuals. Currently, the bacterium has become increasingly resistant to antibiotics, especially those first-choice drugs used to treat campylobacteriosis posing a significant health threat towards the treatment outcomes. The burden of campylobacteriosis and Antimicrobial Resistance (AMR) remains significant with limited genomic surveillance. This study aimed to characterize the resistome (ARGs), virulence factors as well as population structure across Homo sapiens, Milk (from dairy cattle), goat, Bos indicus, Ovis aries, and Gallus gallus in three countries Ethiopia, Kenya and Tanzania through the use of One Health Whole Genome Sequencing (WGS) approach. A total of 161 C. jejuni publicly available WGS were retrieved from NCBI database and analyzed by using established WGS bioinformatics pipelines from genome assembly and annotation, AMR gene identification via ResFinder -ABRIcate, virulence genes were detected via ABRicate/ VFDB. Visualization of gene distribution and population structure were done using heatmap, Venn diagrams, principal component analysis and minimum spanning tree for comparative analysis. Out of 161 C. jejuni WGS, 130 (80.75%) sequences were positive to one or more than one ARGs. Among detected ARGs, the resistome was dominated by {beta}-lactam (blaOXA 193, blaOXA-61, blaOXA-184 and blaOXA-489) genes. Two genes linked to tetracycline resistance (tet(O/32/O), and tet(O) were found in Ethiopia and Tanzania while resistance to aminoglycoside ant (6)-Ia was the least detected. The Gallus gallus-Homo sapiens transmission (zoonotic transmission) was portrayed by the overlap of ARGs (blaOXA-193 and tet(O) and PCA clustering. The conserved virulence gene profiles were shared by all isolated (cadF, jlpA, cdtA, cdtB, cdtC and flagellar genes). The present study adds to the current knowledge on molecular epidemiology and AMR development in C. jejuni species in Eastern African countries and globally. The findings underscore the need for sustained region-specific genome surveillance under One Health framework to inform AMR stewardship and public health interventions.

Measles is endemic in Kenya, mainly affecting young children, with low vaccination coverage leading to recurrent outbreaks. No published study has estimated the cost of treating hospitalised paediatric measles patients in Kenya. This study quantified the cost of treating measles from the healthcare provider and societal perspectives, identified the main cost drivers, and assessed the proportion of households likely to experience catastrophic health expenditure due to the disease. A retrospective, prevalence-based cost-of-illness study was conducted using data from the Clinical Information Network (CIN) for 214 children hospitalised with measles across 16 Kenyan public hospitals from 2013 to 2024. Quantities of resources were extracted from CIN data, and unit costs were obtained from price lists, facility surveys, expert interviews, and market surveys. All costs were converted to 2025 KES and USD. A simulation-based catastrophic health expenditure (CHE) analysis was conducted. One-way sensitivity analysis varied hospital bed, staff, direct non-medical and indirect costs. Median cost per admission was USD 139.11 [IQR: 91.58 to 186.05] (provider) and USD 176.18 [IQR: 116.68 to 256.07] (societal). Staff costs were the primary driver across both perspectives (67% provider, 53% societal), followed by bed days (21% provider, 17% societal). Adjusting the staff time increased treatment costs by 83% (provider) and 73% (societal), while varying bed charges had a lesser effect (-10% to 6% for provider and -3% to 10% for societal). CHE analysis showed that more than half of the households could face catastrophic cost if full treatment costs were paid out-of-pocket. The cost of treating hospitalised paediatric measles patients in Kenya is significant, driven by staff and hospital-bed costs. Policymakers should utilize the evidence generated to expand insurance coverage and refine sub-national resource allocation, to help reduce the catastrophic costs on households and burden on the healthcare system.

BackgroundThe epidemiology of suspected pediatric meningoencephalitis has shifted in the era of conjugate vaccines and multiplex PCR diagnostics, with viral pathogens now predominating over bacterial causes. Updated epidemiologic data are essential to adapt diagnostic and therapeutic algorithms to current clinical practice. MethodsThis retrospective single-center study included children and adolescents <18 years who underwent lumbar puncture with cerebrospinal fluid multiplex PCR for suspected central nervous system infection at a tertiary-care pediatric hospital in Germany between 2016 and 2024. Clinical, laboratory, and outcome data were extracted from electronic medical records. Cerebrospinal fluid was analyzed using the BioFire(R) FilmArray(R) Meningitis/Encephalitis Panel. Statistical analyses included descriptive statistics, nonparametric group comparisons, receiver operating characteristic analyses. ResultsAmong 1,198 included children, definite bacterial meningitis was diagnosed in 13 (1.1%), definite viral meningitis in 80 (6.7%), aseptic meningitis of unknown etiology in 131 (11.0%), confirmed/probable encephalitis in 53 (4.4%), and possible encephalitis in 34 (2.8%). Bacterial meningitis accounted for 5.8% of all meningitis cases. A causative pathogen was identified in all bacterial meningitis cases, most commonly Streptococcus pneumoniae (n = 7). Enterovirus (n = 52) and parechovirus (n = 9) predominated in viral meningitis, whereas an infectious etiology was identified in only 13 of 53 confirmed/probable encephalitis cases. The Bacterial Meningitis Score showed a sensitivity of 80.0% and a specificity of 57.6%. The recently published UK-ChiMES-pre- and post-lumbar puncture scores demonstrated sensitivities of 84.6% and 76.9% and specificities of 86.3% and 92.7%, respectively. DiscussionBacterial meningitis was rare in this contemporary cohort, while viral and etiologically unresolved infections predominated despite routine multiplex PCR diagnostics. Clinical prediction scores supported risk stratification, with the UK-ChiMES-pre-lumbar puncture score showing the most favorable balance between sensitivity and specificity and potential to guide diagnostic decisions and antiinfective therapy.

BackgroundThe United Nations General Assembly High-level Meeting on Antimicrobial Resistance (UNGA HLM-AMR) committed to a target that 70% of global human antibiotic use (ABU) should be from the Access group of the WHO AWaRe system. MethodsWe used 2019 IQVIA MIDAS(R) global ABU Quarterly value sales, volumes (kg/SU) and average ex-manufacturer prices to evaluate price per daily defined dose (DDD) by AWaRe group across countries. IQVIA MIDAS volumes/value data reflect public, private, or mixed sectors. We estimated potential national pharmaceutical expenditure savings if i) the UNGA 70% Access target was met, and ii) national ABU aligned with the WHO Model List of Essential Medicines (EML). We evaluated 7-day treatment prices for common oral and parenteral antibiotics across AWaRe groups. We measured affordability in middle-income countries (MICs) by income group, as the percentage of the population at risk of falling below national poverty lines if paying out-of-pocket, using income distributions and generalised beta distributions of the second kind. Prices were reported in 2019 international dollars (I$). ResultsVolume-weighted ex-manufacturer prices per DDD were lower for Access (I$1{middle dot}2, IQR I$0{middle dot}7) than Watch (I$2{middle dot}6, IQR I$2{middle dot}1) and highest (I$83{middle dot}8, IQR I$80{middle dot}9) for Reserve antibiotics. Lower prices were seen in high-income countries for Access antibiotics. Meeting the 70% Access target could save countries I$0{middle dot}1 million-I$4{middle dot}9 billion annually. Global savings could reach I$10{middle dot}4 billion if only WHO EML-listed antibiotics were used. Seven-day parenteral meropenem could put 7% (IQR 9%) of the population in MICs at risk of impoverishment. ConclusionAntibiotic policies focused on achieving the UNGA-AMR 70% Access target could generate significant potential national and global expenditure savings. FundingThis work was supported by the Wellcome Trust (304681/Z/23/Z) as part of the Antibiotic Data to Inform Local Action (ADILA) project and the Global Antibiotic Policy initiative (GAPi) project (RES 2024-495).

IntroductionHemophagocytic lymphohistiocytosis (HLH) is a serious condition induced by Dengue virus which becomes fatal if not detected early and treated appropriately. So objectives of the present study are to observe the different patterns of presentations, clinical features and outcome of HLH induced by Dengue. MethodsIn this observational study, 14 patients admitted and diagnosed HLH as per diagnostic criteria, were included after informed written consent. Study conducted in a period of six months from 01/07/2025 to 31/12/2025. All patients were followed up till discharge. After collection, all data were analyzed by Microsoft Excel 2010. Ethical clearance was taken from Ethical Review Board of the Medical College. ResultsAmong 14 cases, male were more affected then the female (78.6% VS 21.4%) and majority were in between 20 to 50 years age groups. Clinical data showed, all 14 cases had fever for >7 days, joint pain 3(21.4%), headache 11(78.6%), skin rashes 10(71.4%), retro-orbital pain 2(14.3%), vomiting 11(78.6%),bleeding 10(71.4%), cough 4(28.6%), loose motion 9(64.3%), abdominal pain 7(50.0%), anorexia 2(14.3%), Melaena 2(14.3%), jaundice 4(28.6%) and spleenomegaly 9(64.3%). One(7.1%) case had history of Hypertension. Laboratory data showed different level of Bi or Pancytopenia, high ferritin, high TG, low fibrinogen, raised liver enzymes and low sodium. Dengue RT PCR and serology results showed 8(42.9%) cases were both IG M and Ig G dengue antibody positive, 6 cases were RT PCR positive, 2 cases were IgM and another 4 cases were IgG positive. Outcome of patients revealed, among all 14 cases12(85.8%) patients improved uneventfully and 2 were shifted to ICU where one improved and one died. ConclusionDengue is prevailing for long time and different complications are evolving and HLH is a relatively newer incident among the dengue patients. Infection by different serotypes at different time or multiple dengue serotype infection may be related with HLH and it might be a future subject to explore and to evaluate.

BackgroundPreoperative evaluation is essential for ensuring patient safety prior to vascular surgery. However, overutilization of routine tests without clinical indication can impose significant financial burden on people, especially those who are living in resource-limited settings. This study aim was to assess preoperative evaluation in vascular patients with its associated direct patient cost and cost drivers in Tikur Anbessa Specialized Hospital (TASH). ObjectiveTo assess the direct cost, and key cost drivers of preoperative investigations among patients who underwent elective vascular surgery at Tikur Anbessa Specialized Hospital (TASH) from Jan2022 to December 2024. MethodsAn institutional-based retrospective cross-sectional study was conducted for vascular patients operated from January 2022 to December 2024 at TASH , assessing costs associated with preoperative investigations. Data were collected from medical records, and finance logs. Investigations were categorized as indicated or unnecessary based on National Institute for Health and Care Excellence (NICE) guidelines 2016. Costs were determined using TASH service fees and private center rates and patients information. Data were analyzed using SPSS version 21. ResultsA total of 165 elective vascular surgery patients were randomly selected; the mean age of participants was 49.6 years, with 53.3% male and 46.7% female. Peripheral artery disease was the most common diagnosis (47.3%). The average hospital stay was 13.7 days. The mean total cost of preoperative investigations per patient was 9,717.40 Ethiopian Birrs (ETB), with imaging averaging 8,797 ETB and laboratory tests averaging 1,328 ETB. HIV screening was not commonly provided for elective vascular patients. Linear Regression was conducted to explore relationships between patient demographics, clinical factors, and both the number and cost of investigations. Age, ASA class, comorbidity and longer hospital days were positively associated with increased total cost. ConclusionPreoperative evaluation in vascular surgery at TASH is characterized by excessive use of routine and advanced investigations, some of which lack clinical indication. These practices contribute to substantial patient expenses, primarily through out of pocket payments. There is also gap in providing some investigation tests like serum albumin and calcium. Developing and implementing evidence based testing guidelines could limit the cost.

The measles outbreak in Jalisco, Mexico (January-February 2026) experienced vigorous sustained transmission with an exponential growth rate = 0.10 (95% CI: 0.10-0.11) per day, doubling time = 6.3 days (95% CI: 6.3-6.9), yielding the effective reproduction number at 3.34 (95% CI: 3.16-3.54), with elevated incidence among infants and young adults.

IntroductionDengue has been prevalent in a regular fashion in Bangladesh and Chattogram for the last 6-7 years and is showing some serotype twisting. So, the objectives of the present study were to explore the burden of dengue serotypes in Chattogram. MethodsIn this study, 223 Dengue RT-PCR positive patients were evaluated for serotyping. Gender and age group, along with cycle threshold (CT) values, were also collected. Data after collection were compiled, analyzed, and plotted in Microsoft Excel and GraphPad Prism 10.4. Ethical clearance was taken to conduct the study. ResultsAmong 223 patients analyzed, males and females were found near equal (113 and 110). Middle-aged patients were more than the extremes of age. The mean {+/-} SD of age was 33.55 {+/-} 13.67 years. Regarding serotype distributions, isolated Den 1, Den 2 and Den 3 were found 1.3%, 73.1% and 6.7%, respectively. Concurrent infections with multiple serotypes were observed in several patients, most notably the Den 2 and Den 3 combination, which accounted for 14.3% (n=32) of the cases. Other co-infections were less frequent: the Den 1 and Den 2 pairing appeared in 3.6% (n=8) of the cohort, while triple-serotype infections (Den 1, 2, and 3) and Den 3/Den 4 pairings were rare, each occurring in only 0.4% of patients. Statistical analysis of CT values revealed no significant sex-based differences for Den 2 and Den 3. However, significant variations in CT values were observed when comparing Den 1 against both Den 2 and Den 3 (p < 0.05). In contrast, the difference between Den 2 and Den 3 Ct values remained statistically insignificant. ConclusionIn the year 2025, Dengue serotypes 2 and 3 were found to be the most prevalent, both in isolated or in combinations and Den 1 and Den 4 were found minimum. Exposure to multiple serotypes and twisting from one serotype to another might influence the dengue outcome in future, which needs further exploration.

ObjectiveTo evaluate the impact of implementing pediatric medication pathways on operational management under the DRG/DIP payment model in a specialized childrens hospital, using DRG as a case study. MethodsAll medical records with DRG codes DT13 and GW15 from 2023 (pre-implementation control group) and 2024 (post-implementation observation group) were included. A systematic comparative analysis of clinical data was performed to assess the effects on hospital operational metrics. ResultsThe observation group exhibited a significantly lower average cost per case (DT13: 17.82%; GW15: 26.05%) and a higher medical insurance payment margin (DT13: {yen}186,500; GW15: {yen}89,000) compared to the control group. The examination cost proportion and total hospitalization expenses decreased significantly (P < 0.05), whereas the drug cost proportion showed a non-significant decreasing trend (P > 0.05). Regarding efficiency, the average length of stay and number of drug varieties were significantly reduced (P < 0.05). Quality indicators, including antibiotic usage rate, antibiotic use intensity, and adverse drug reaction incidence, were significantly improved (P < 0.05), alongside an increased rational prescription review rate. Furthermore, the number of high-cost cases decreased while low-cost cases increased for both disease groups post-implementation, with all case distributions remaining within clinically acceptable bounds. ConclusionPediatric medication pathways represent an effective strategy for balancing cost-containment with the unique clinical demands of pediatric care within the DRG/DIP framework. They provide a practical reference for precision management in pediatric hospitals and empirical evidence to inform pediatric-sensitive medical insurance payment policies.

ObjectiveWest Nile virus lineage 2 (WNV-2) is a growing public health concern in Europe causing West Nile fever or West Nile neuroinvasive disease (WNND) with substantial morbidity and mortality; however, genomic data from Southern Italy are limited despite recent expansion of autochthonous transmission. The aim of the study was to characterise the phylogenetic and molecular features of the WNV-2 strain responsible for the first autochthonous human infection reported in Calabria (2023), and two more additional WNND cases detected in 2024. MethodsFull WNV-2 genomes were generated from the three cases. Phylogenetic analysis was performed using all publicly available WNV sequences up to September 2025. Amino-acid changes in the polyprotein were compared with known WNV-2 lineage and sub-lineage signatures. ResultsThe three sequences formed a monophyletic group within sub-lineage WNV-2a, clustering with strains circulating in Central-South-Eastern Europe and showing closest affinity to Hungarian sequences. Non-synonymous substitutions characteristic of the Hungary 578/10 ancestor (NS2B-119I, NS4B-14G, NS4B-49A and NS5-298A), were identified and absent from Central-Northern-Western European and previously reported Italian sequences. Additional substitutions (E-159T, E-399R and NS3-249P) corresponded to signatures from a fatal WNV-2 infection in a Great Grey owl in Slovakia. ConclusionsOur study provides the first report of Central-South-Eastern European WNV-2 circulation outside Eastern Europe supporting its likely spread through the Balkans into Italy by 2022. These findings underscore the rapid spread of WNV-2 in newly affected areas and highlight the critical need for sustained molecular surveillance.

BackgroundDengue fever, one of the most widespread mosquito-borne diseases, declined markedly during the early COVID-19 pandemic due to lockdowns and reduced mobility. However, the sharp resurgence in 2023 raised concerns about the long-term epidemiological effects of pandemic-era measures. This study examines the sustained impact of COVID-19 public health policies on dengue transmission across seven high-burden countries in Southeast Asia and Latin America. MethodsMonthly dengue cases and COVID-19 policy indices from January 2020 to December 2023 were analyzed in seven countries with [&ge;]2,000 dengue cases in 2020. Based on the Oxford COVID-19 Government Response Tracker (OxCGRT), countries were grouped as Strict COVID-Control (SCC: Singapore, China) or Less Strict COVID-Control (LSCC: Indonesia, Argentina, Brazil, Colombia, Mexico). Generalized linear models assessed lagged effects of the Stringency Index and policy sub-components, adjusting for climate and reporting bias. FindingsDengue cases declined by 41.3% (95% CI: 36.2-46.5; p < 0.001) in 2020 relative to pre-pandemic levels. In LSCC countries, public information and vaccination policies were significantly protective ({beta} = -174,354; p < 0.001), reflecting indirect benefits of COVID-19 awareness infrastructure. In SCC countries, economic interventions showed mixed effects: debt relief reduced dengue risk ({beta} = -0.783; p = 0.003), while income support increased it ({beta} = 0.583; p = 0.003). InterpretationCOVID-19 policies exerted lasting, heterogeneous effects on dengue transmission. Strengthening communication, vector control, and vaccination in LSCC settings, and maintaining vigilance and integrated surveillance in SCC settings, are crucial for sustainable dengue preparedness.