Control and elimination of Schistosoma mansoni infection in adult individuals on Ukerewe island, northwestern Tanzania: baseline results before implementation of intervention measures.

BACKGROUND: Communities living along the shoreline and on the islands of Lake Victoria in northwestern Tanzania remain endemic for schistosomiasis and suffer from the life-threatening morbidities associated with the disease. Nevertheless, the control measures particularly the mass drug administration do not cover the adult population. The current project on Ukerewe island aims to close this gap by involving adult community members in the control program. Here we report the baseline results of S. mansoni infection and associated hepatosplenic morbidities and factors before implementing the project activities. METHODS: A cross-sectional analytical study was conducted with 4,043 participants aged ≥ 18 years living in 20 villages on Ukerewe island, northwestern Tanzania. Individual stool and urine samples were collected and examined using the Kato-Katz (KK) technique and point-of-care circulating cathodic antigen testing(POC-CCA) to identify S. mansoni eggs and antigens, respectively. All study participants underwent ultrasound evaluation of S. mansoni hepatosplenic morbidities using the Niamey protocol. Rapid diagnostic tests were used to diagnose HIV infection, hepatitis C and chronic hepatitis B. A questionnaire was used to collect demographic data and reported clinical symptoms of study participants. RESULTS: A total of 4,043 participants took part in the study, of which 49.7% (n = 2,009) and 50.3% (n = 2,035) were male and female, respectively. The overall prevalence of S. mansoni infection was 30.4% (95%CI:29.0-31.9%) and 84.7% (95%CI:83.3-85.9%), respectively, based on the KK technique and the POC-CCA test. The geometrical mean eggs per gram of faeces (GMepg) was 105.3 (95%CI:98.7-112.3% GMepg) with 53.9%, 32.4% and 13.7% of the participants having mild, had moderate and severe intensity of infection. The prevalence of hepatitis C, HIV, and hepatitis B was 0.4%, 2.2% and 4.7%, with 0.2%, 2.2% and 5.4% of the infected individuals coexisting with S. mansoni infection. The prevalence of splenomegaly, periportal fibrosis, hepatomegaly, and portal vein dilatation was 40.5%(95%CI: 38.8-42.1%), 48.1%(95%CI:64.4-49.7%), 66.2%(95%CI:4.6-67.7%) and 67.7%(95%CI:66.2-69.2%), with their prevalence varying depending on the demographic information and infection status of the participants. Other detectable ultrasound-related morbidities included ascites (1.7%), collateral veins (18.3%) and gall bladder wall thickness (40.4%). Age groups, gender, reported clinical characteristics, reported non-use of the drug praziquantel, liver imaging pattern, and place of residence remained independently associated with hepatosplenic morbidities. CONCLUSION: The current study setting is endemic for S. mansoni infection and the population has a high prevalence of the disease associated hepatosplenic morbidities characterized by hepatomegaly, splenomegaly, ascites, gall bladder wall thickening, periportal fibrosis and portal vein dilatation. Several demographic, clinical and epidemiological circumstances remained independently associated with S. mansoni infection and associated morbidities. These findings call for integrative intervention efforts, starting with whole community MDA that includes all out of schools community members.

From eradication to reemergence: the growing threat of malaria in Turkey.

According to WHO, between 2000 and 2021, there were approximately 247 million malaria cases and 627,000 deaths globally, with the majority of cases occurring in sub-Saharan Africa. In Turkey, indigenous P. vivax malaria was a major public health problem until its eradication was achieved in 2010. Although indigenous malaria transmission has been significantly reduced since 2010, the country is challenged with imported malaria due to increasing global travel and migration from endemic regions. In this study, all imported malaria cases admitted to Dr. Sadi Konuk Research and Training Hospital, Istanbul, between 2018 and 2023 were included. DNA extraction was performed using archived slides and EDTA blood samples. Real-time PCR was performed to identify samples at the species level using previously reported primers and probes. In addition, all available patient demographics are presented. During the six years between 2018 and 2023, 157 patients were diagnosed with imported malaria. According to the real-time PCR results, 149 cases were P. falciparum (94.9%), five cases were P. vivax (3.2%), two cases were P. ovale (1.3%), and one case was P. malariae (0.6%). The male/female ratio among diagnosed patients was 2.34 (110♂/47♀) among diagnosed patients. Plasmodium falciparum was detected in patients from all African regions, whereas P. vivax was detected only in patients from Liberia and Djibouti. Although malaria cases in Turkey have significantly decreased due to elimination efforts and effective public health interventions, the recent increase in both imported and indigenous cases, as well as the presence of suitable vector species in the country, indicates that malaria still remains a serious public health problem for Turkey.

Simulated Malaria Online Tool: an instrument for evaluating healthcare providers' practices and contributing to the evidence base for certifying malaria elimination and preventing its re-establishment.

BACKGROUND: Healthcare providers (HCPs) practice and correct management of suspected malaria (CMSM) are central components of malaria elimination and prevention of re-establishment (POR) in countries in the elimination phase. However, knowledge of malaria surveillance systems and HCPs practices often wanes in countries aiming to eliminate malaria due to the low numbers of cases. The study aimed to implement a valid Simulated Malaria Online Tool (SMOT) for assessment HCP performance in CMSM and POR in a malaria-free area. METHODS: HCPs were evaluated using SMOT tool based on four criteria including presenting a suspected malaria case for detection of HCPs' failures in recognition (a), diagnosis (b), appropriate treatment (c), and urgent reporting (d); and compared with simulated patients (SP). Multiple logistic regression analysis was carried out to estimate adjusted odds ratios (ORs) for the risk of HCPs failures. RESULTS: The overall failure proportion was 237 (83%), and the majority of failures were in recognition (a). There was no significant difference between the SMOT and SP based on all failure criteria (P > 0.05). The private clinic (93%) and the public specialized clinic (70%) had the highest and lowest failure proportions. After passing the recognition stage (a), the overall failure proportions decreased to 47.8% and 25.0% for total HCPs and infectious disease specialists, respectively. In the final analysis, private sector (AOR = 4.36: 1.25-15.2), not-specialist providers (AOR = 2.84: 1.29-6.25) and HCPs with ≥ 5 years' experience (AOR = 2.03: 1.01-6.25) increased the risk of failure. CONCLUSION: Findings confirmed the implementation of SMOT tool in settings where malaria transmission is low or interrupted. The tool is able to identify sub-groups of providers needing strengthening, and contributes to the prevention of malaria re-establishment.

Economic Analysis of National Program for Hepatitis C Elimination, Israel, 20231.

In 2021, the Israel Ministry of Health began a national hepatitis C elimination program. Implementing a World Health Organization goal, Israel's program involved targeted screening, barrier minimization, workup simplification, awareness campaigns, and a patient registry. We evaluated program costs for testing and treatment. By May 15, 2023, the program had identified 865,382 at-risk persons, of whom 555,083 (64.3%) were serologically screened for hepatitis C virus (HCV), which was detected in 24,361 (4.4%). Among 20,928 serologically positive patients, viremia was detected in 13,379 (63.9%), of whom 10,711 (80%) were treated, and 4,618 (96.5%) of 4,786 persons receiving posttreatment HCV RNA testing had sustained virologic response. We estimated costs of ₪14,426 (new Israel shekel; ≈$3,606 USD) per person whose HCV infection was diagnosed and successfully treated. The program yielded screening and treatment in almost two thirds of the identified at-risk population. Although not eliminated, HCV prevalence will likely decrease substantially by the 2030 target.

Toward the Eradication of Herpes Simplex Virus: Vaccination and Beyond.

Herpes simplex virus (HSV) has coevolved with Homo sapiens for over 100,000 years, maintaining a tenacious presence by establishing lifelong, incurable infections in over half the human population. As of 2024, an effective prophylactic or therapeutic vaccine for HSV remains elusive. In this review, we independently screened PubMed, EMBASE, Medline, and Google Scholar for clinically relevant articles on HSV vaccines. We identified 12 vaccines from our literature review and found promising candidates across various classes, including subunit vaccines, live vaccines, DNA vaccines, and mRNA vaccines. Notably, several vaccines-SL-V20, HF10, VC2, and mRNA-1608-have shown promising preclinical results, suggesting that an effective HSV vaccine may be within reach. Additionally, several other vaccines such as GEN-003 (a subunit vaccine from Genocea), HerpV (a subunit vaccine from Agenus), 0ΔNLS/RVx201 (a live-attenuated replication-competent vaccine from Rational Vaccines), HSV 529 (a replication-defective vaccine from Sanofi Pasteur), and COR-1 (a DNA-based vaccine from Anteris Technologies) have demonstrated potential in clinical trials. However, GEN-003 and HerpV have not advanced further despite promising results. Continued progress with these candidates brings us closer to a significant breakthrough in preventing and treating HSV infections.

Progress Toward Poliomyelitis Eradication - Pakistan, January 2023-June 2024.

Since its launch in 1988, the Global Polio Eradication Initiative has made substantial progress toward the eradication of wild poliovirus (WPV), including eradicating two of the three serotypes, and reducing the countries with ongoing endemic transmission of WPV type 1 (WPV1) to just Afghanistan and Pakistan. Both countries are considered a single epidemiologic block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 over the subsequent 12 months, specifically in the historical reservoirs of the cities of Karachi, Peshawar, and Quetta. As of June 30, 2024, eight WPV1 cases had been reported in Pakistan in 2024, compared with six reported during all of 2023. These cases, along with more than 300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels, would be vital for the polio program. Efforts to systematically track and vaccinate children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy.

Hepatitis C elimination: amplifying the role of primary care nurses in Australia.

Background Australia's commitment to eliminate hepatitis C by 2030 is underpinned by the mobilisation of the primary care sector. Primary care nurses are well placed to contribute to achieving elimination given their unique access to people with/at risk of hepatitis C and their person-centred approach to care delivery. This study examines the enablers to primary care nurse involvement in elimination efforts. Methods Primary care nurses involved in the care of people with/at risk of hepatitis C were recruited through two national nursing organisations. Participants provided verbal consent to participate in an electronically recorded, semi-structured interview. Interview data were transcribed verbatim, coded and analysed using a thematic analysis. Results Sixteen interviews were conducted with nurses working in general practice, community health, alcohol and other drug services, and custodial settings, with the findings framed using a social-ecological model. The study identified individual attributes, such as empathy and advocacy for clients deemed 'too hard for everyone else'. Interpersonal enablers included participants' ability to effectively communicate with clients and colleagues, and using trusted professional relationships to improve client access to care. Public policy that addressed community factors, including stigma and confidentiality, were seen as supportive. Conclusions This study identified the critical and varied role primary care nurses play in hepatitis C elimination. Effective scale up of hepatitis C care involves recognising the pivotal role of primary care nurses, which will help to create an enabling environment that supports nurses to work to their full scope of practice and enhance their contribution to the elimination response.

Investigation of P. vivax elimination via mass drug administration: A simulation study.

Plasmodium vivax is the most geographically widespread malaria parasite. P. vivax has the ability to remain dormant (as a hypnozoite) in the human liver and subsequently reactivate, which makes control efforts more difficult. Given the majority of P. vivax infections are due to hypnozoite reactivation, targeting the hypnozoite reservoir with a radical cure is crucial for achieving P. vivax elimination. Stochastic effects can strongly influence dynamics when disease prevalence is low or when the population size is small. Hence, it is important to account for this when modelling malaria elimination. We use a stochastic multiscale model of P. vivax transmission to study the impacts of multiple rounds of mass drug administration (MDA) with a radical cure, accounting for superinfection and hypnozoite dynamics. Our results indicate multiple rounds of MDA with a high-efficacy drug are needed to achieve a substantial probability of elimination. This work has the potential to help guide P. vivax elimination strategies by quantifying elimination probabilities for an MDA approach.

Community engagement in mobile and hard-to-reach populations: a community-based intervention for malaria elimination in a tri-national region of the Guiana Shield.

Several countries of the Guiana Shield are aiming at the control and elimination of malaria in areas where Artisanal and Small-scale Gold Mining (ASGM) activities predominate, raising questions about how to strengthen community engagement to improve the effectiveness of health programs. The Curema project focuses its intervention on the mobile and hard-to-reach ASGM population, complementing the efforts of national programs in the Guiana Shield. The Curema intervention combines targeted drug administration for suspected Plasmodium vivax asymptomatic carriers, the Malakit distribution, and health education activities. The primary goals of this manuscript are to outline a pathway to foster community participation in the Curema project aimed at eliminating malaria. Thus, it presents a vision of the challenges that the AGSM community poses in terms of community participation for an asymptomatic problem; and highlights the community-based model and the Information, Education and Communication (IEC) components as foundations for participation. In addition, it also presents culturally sensitive IEC strategies designed through iterative and collaborative consultative processes and other bottom-up outreach activities. The community engagement approach facilitates adaptability and responsiveness in a complex, evolving context increasing the effectiveness of interventions.

CUREMA project: a further step towards malaria elimination among hard-to-reach and mobile populations.

BACKGROUND: In most countries engaged on the last mile towards malaria elimination, residual transmission mainly persists among vulnerable populations represented by isolated and mobile (often cross-border) communities. These populations are sometimes involved in informal or even illegal activities. In regions with Plasmodium vivax transmission, the specific biology of this parasite poses additional difficulties related to the need for a radical treatment against hypnozoites to prevent relapses. Among hard-to-reach communities, case management, a pillar of elimination strategy, is deficient: acute malaria attacks often occur in remote areas, where there is limited access to care, and drugs acquired outside formal healthcare are often inadequately used for treatment, which typically does not include radical treatment against P. vivax. For these reasons, P. vivax circulation among these communities represents one of the main challenges for malaria elimination in many non-African countries. The objective of this article is to describe the protocol of the CUREMA study, which aims to meet the challenge of targeting malaria in hard-to-reach populations with a focus on P. vivax. RESULTS: CUREMA is a multi-centre, international public health intervention research project. The study population is represented by persons involved in artisanal and small-scale gold mining who are active and mobile in the Guiana Shield, deep inside the Amazon Forest. The CUREMA project includes a complex intervention composed of a package of actions: (1) health education activities; (2) targeted administration of treatment against P. vivax after screening against G6PD deficiency to asymptomatic persons considered at risk of silently carrying the parasite; (3) distribution of a self-testing and self-treatment kit (malakit) associated with user training for self-management of malaria symptoms occurring while in extreme isolation. These actions are offered by community health workers at settlements and neighbourhoods (often cross-border) that represent transit and logistic bases of gold miners. The study relies on hybrid design, aiming to evaluate both the effectiveness of the intervention on malaria transmission with a pre/post quasi-experimental design, and its implementation with a mixed methods approach. CONCLUSIONS: The purpose of this study is to experiment an intervention that addresses both Plasmodium falciparum and P. vivax malaria elimination in a mobile and isolated population and to produce results that can be transferred to many contexts facing the same challenges around the world.

Comprehensive evaluation of malaria reactive surveillance and response strategies in Lao People's Democratic Republic: a mixed-methods study.

OBJECTIVES: To achieve malaria elimination by 2030, the Lao People's Democratic Republic (PDR) adopted a reactive surveillance and response (RASR) strategy of malaria case notification within 1 day, case investigation and classification within 3 days and foci investigation and response within 7 days. It is important to evaluate the performance and feasibility of RASR implementation in Lao PDR so that the strategy may be optimised and better contribute towards the goal of malaria elimination. DESIGN: A mixed-methods study comprising of secondary data analysis of routinely collected malaria surveillance data, quantitative surveys and qualitative consultations was conducted in 2022. SETTING: Primary data collections for quantitative surveys and qualitative consultations were conducted in Huaphan, Khammouane, Luangprabang and Savannakhet Provinces of Lao PDR. PARTICIPANTS: Quantitative surveys were conducted among malaria programme stakeholders and service providers. Qualitative interviews were conducted with malaria programme stakeholders, and focus group discussions with malaria programme stakeholders, service providers and mobile and migrant populations (MMPs). OUTCOME MEASURES: Outcomes of interests were awareness and acceptability of current RASR activities by different group of participants, implementation, performance and feasibility of RASR activities including enablers and barriers. RESULTS: In Lao PDR, malaria programme stakeholders and service providers were aware of RASR; however, these activities were not well known in MMPs. Respectively, the timeliness of case notification and case investigation was 0.0% and 15.6% in 2018 but increased to 98.0% and 98.6% in 2022. Implementation of RASR was acceptable to the malaria programme stakeholders and service providers, and continued implementation was perceived as feasible. Nevertheless, issues such as low level of community awareness, high level of migration and limitations in health system capacity were identified. CONCLUSION: Overall, the timeliness of case notification and investigation in Lao PDR was high, and malaria programme stakeholders and service providers had positive opinions on RASR. However, some operational and health system-related barriers were identified, which need to be addressed to improve the performance of RASR in Lao PDR.

Bridging Hepatitis C Care Gaps: A Modeling Approach for Achieving the WHO's Targets in Ontario, Canada.

BACKGROUND: The World Health Organization (WHO) has set hepatitis C (HCV) elimination targets for 2030. Understanding existing gaps in the "HCV care-cascade" is essential for meeting these targets. We aimed to identify the level of service scale-up needed along the "HCV care-cascade" to achieve the WHO's HCV elimination targets in Ontario, Canada. METHODS: By employing a decision analytic model, we projected the quality-adjusted life years (QALYs) and healthcare costs for individuals with HCV in Ontario. We increased RNA testing and treatment rates to 98%, followed by increasing antibody testing uptake until we achieved the WHO's mortality target (i.e., a 65% reduction in liver-related mortality by 2030 vs. 2015). RESULTS: Without scaling up by 2030, the expected QALYs and costs per person were 9.156 and CAD 48,996, respectively. Improved RNA testing and treatment rates reduced liver-related deaths to 3.3/100,000, a 57% reduction from 2015. Further doubling the antibody testing rates can achieve the WHO's mortality target in 2035, but not in 2030. Compared to the status quo, such program would be cost-effective considering a 50,000 CAD/QALY gained threshold if annual implementation costs stayed under 2.3 M CAD/100,000 people. CONCLUSIONS: Doubling the antibody testing rates, along with increased RNA testing and treatment rates, showed promise in meeting the WHO's goals by 2035.

The Elimination Status of Visceral Leishmaniasis in Southeast Asia Region.

PURPOSE: Visceral leishmaniasis (VL) is caused by an intracellular parasite that is transmitted to humans by sandfly bites. It is prevalent throughout Asia, Africa, the Americas, and the Mediterranean area, where 147 million people are at risk of contracting the illness. The manifestation of heterotrophic illness relies on both Leishmania implicated and the host's immunological response, ranging from asymptomatic to severe leishmaniasis with potentially lethal effects. METHOD: We reviewed the literature (published till 31st December 2023) on the worldwide situation of leishmaniasis, standard and novel detection techniques, and traditional and modern treatment strategies and endeavors to eliminate VL. Moreover, epidemiological data was collected from the World Health Organization's publicly available databases. GraphPad Prism Version 8 was used to analyze and produce figures based on the epidemiological data. RESULTS: Diagnosis of parasites in tissues or serology is commonly employed. Diagnosis by identifying parasite DNA using molecular techniques is becoming more popular. Despite recent findings of L. donovani resistance to pentavalent antimoniate medications, it continues to be the cornerstone in the medical management of VL. Amphotericin B and its lipid formulations, injectable paromomycin, and oral miltefosine are among the new therapy options being researched. The number of reported VL cases has reduced remarkably over the last decade due to human interventions made to eliminate VL. Particularly countries from the South East Asian region have experienced momentous progress in reducing VL cases and eliminating this disease from this region. Owing to the robust elimination programs, countries such as Bangladesh has eliminated VL as a public health concern. India and Nepal are on the verge of its elimination. CONCLUSION: Rapid diagnosis, effective and inexpensive treatment, simple access to newly discovered medications, appropriate vector control, and a well-designed vaccine are all required for the elimination of this disease burden in impoverished areas of the globe.