Biological Characteristics and Pathogenesis of Monkeypox Virus: An Overview.

Although the smallpox virus has been eradicated worldwide, the World Health Organization (WHO) has issued a warning about the virus's potential to propagate globally. The WHO labeled monkeypox a world public health emergency in July 2022, requiring urgent prevention and treatment. The monkeypox virus is a part of the Poxviridae family, Orthopoxvirus genus, and is accountable for smallpox, which has killed over a million people in the past. Natural hosts of the virus include squirrels, Gambian rodents, chimpanzees, and other monkeys. The monkeypox virus has transmitted to humans through primary vectors (various animal species) and secondary vectors, including direct touch with lesions, breathing particles from body fluids, and infected bedding. The viral particles are ovoid or brick-shaped, 200-250 nm in diameter, contain a single double-stranded DNA molecule, and reproduce only in the cytoplasm of infected cells. Monkeypox causes fever, cold, muscle pains, headache, fatigue, and backache. The phylogenetic investigation distinguished between two genetic clades of monkeypox: the more pathogenic Congo Basin clade and the West Africa clade. In recent years, the geographical spread of the human monkeypox virus has accelerated despite a paucity of information regarding the disease's emergence, ecology, and epidemiology. Using lesion samples and polymerase chain reaction (PCR), the monkeypox virus was diagnosed. In the USA, the improved Ankara vaccine can now be used to protect people who are at a higher risk of getting monkeypox. Antivirals that we have now work well against smallpox and may stop the spread of monkeypox, but there is no particular therapy for monkeypox.

Environmental arsenic (As) and its potential relationship with endemic disease in southwestern China.

Many cases of an unknown disease exhibiting the clinical features of limb gangrene, blisters, ulceration, and exfoliation have been reported in Daping village (DV) in southwestern China. However, the pathogenesis is unknown and has puzzled doctors for many years. A preliminary study on heavy metals and symptoms indicated that arsenic might pose the greatest threat to the health of local residents. Here, to explore the sources of and factors influencing arsenic enrichment in DV, whose residents exhibit signs of arsenic poisoning, the As contents in soil, water, and plants were systematically measured. The results indicated high As contents in plant and soil samples obtained from the area, and the source of As may be linked to the weathering of black shale rock. Ingestion of soil and consumption of plants were the two main As exposure pathways among children and adults, respectively, and children exhibited a higher health risk than adults. We presume and emphasize that when extreme drought events occur, humans might face unusual risks resulting from exposure to toxic elements and the direct consumption of highly polluted water. Our study provides a new perspective and sheds light on the environmental geochemistry and health links of this disease.

Temporal trend, high-risk spatial and spatiotemporal clustering of leprosy indicators in Brazil: A 20-year ecological and population-based study.

OBJECTIVES: Leprosy still represents a public health concern in Brazil. The country is the only one in America not to reach the global goal of leprosy disease control. Hence, this study aimed to assess the temporal, spatial and space-time patterns of leprosy cases in Brazil of the 20-year time series 2001-2020. METHODS: An ecological and population-based analysis was carried out, applying temporal and spatial techniques, and using the detection coefficient of sociodemographic and clinical-epidemiological variables of leprosy new cases in the 5570 municipalities of Brazil. Temporal trends were assessed using a segmented linear regression model. For spatial analysis, global and local Moran indexes were applied, and space-time scan statistics was used to identify risk clusters. RESULTS: The mean detection coefficient was 19.36/100,000 inhabitants, with a higher occurrence among men (21.29/100,000 inhabitants) and in the 60-69 age group (36.31/100,000). A decreasing temporal trend was observed in the country (annual percentage change: -5.20% per year). The North and Midwest regions were the most affected, exhibiting municipalities with a high/high standard, and with the highest annual percentage increase of multibacillary (MB) cases. Leprosy has a heterogeneous distribution throughout Brazil, but with high-risk spatiotemporal clusters, mainly located in the North and Midwest regions. CONCLUSION: Although Brazil has shown a decreasing temporal trend during the past 20 years, the country is still classified as highly endemic for leprosy, showing an increase in the proportion of new MB cases over the years.

Surveillance for endemic infectious disease outbreaks: Adaptive sampling using profile likelihood estimation.

Outbreaks of an endemic infectious disease can occur when the disease is introduced into a highly susceptible subpopulation or when the disease enters a network of connected individuals. For example, significant HIV outbreaks among people who inject drugs have occurred in at least half a dozen US states in recent years. This motivates the current study: how can limited testing resources be allocated across geographic regions to rapidly detect outbreaks of an endemic infectious disease? We develop an adaptive sampling algorithm that uses profile likelihood to estimate the distribution of the number of positive tests that would occur for each location in a future time period if that location were sampled. Sampling is performed in the location with the highest estimated probability of triggering an outbreak alarm in the next time period. The alarm function is determined by a semiparametric likelihood ratio test. We compare the profile likelihood sampling (PLS) method numerically to uniform random sampling (URS) and Thompson sampling (TS). TS was worse than URS when the outbreak occurred in a location with lower initial prevalence than other locations. PLS had lower time to outbreak detection than TS in some but not all scenarios, but was always better than URS even when the outbreak occurred in a location with a lower initial prevalence than other locations. PLS provides an effective and reliable method for rapidly detecting endemic disease outbreaks that is robust to this uncertainty.

Learning and strategic imitation in modelling farmers' dynamic decisions on bovine viral diarrhoea vaccination.

Considering human decision-making is essential for understanding the mechanisms underlying the propagation of real-life diseases. We present an extension of a model for pathogen spread that considers farmers' dynamic decision-making regarding the adoption of a control measure in their own herd. Farmers can take into account the decisions and observed costs of their trade partners or of their geographic neighbours. The model and construction of such costs are adapted to the case of bovine viral diarrhoea, for which an individual-based stochastic model is considered. Simulation results suggest that obtaining information from geographic neighbours might lead to a better control of bovine viral diarrhoea than considering information from trade partners. In particular, using information from all geographic neighbours at each decision time seems to be more beneficial than considering only the information from one geographic neighbour or trade partner at each time. This study highlights the central role that social dynamics among farmers can take in the spread and control of bovine viral diarrhoea, providing insights into how public policy efforts could be targeted in order to increase voluntary vaccination uptake against this disease in endemic areas.

Tuberculosis amidst COVID-19 in Pakistan: a massive threat of overlapping crises for the fragile healthcare systems.

Mycobacterium tuberculosis is the cause of tuberculosis (TB), a granulomatous illness that mostly affects the lungs. Pakistan is one of the eight nations that accounts for two-thirds of all new cases of developing TB. TB has long been an endemic disease in Pakistan. According to the World Health Organization (WHO) estimates, the nation has over 500 000 incident TB infections per year, with a rising number of drug-resistant cases. Recently, the coexistence of COVID-19 and TB in Pakistan has provided doctors with a problem. Fever or chills, cough, shortness of breath or difficulty breathing are all signs of COVID-19. After SARS-CoV-2 infection, cough might persist for weeks or months and it is frequently accompanied by persistent tiredness, cognitive impairment, dyspnoea or pain - a group of long-term consequences known as post-COVID syndrome or protracted COVID. Coughing with mucus or blood, and coughing that continues over 2 months are indications of TB. The same clinical presentation features make it difficult for healthcare personnel to effectively evaluate the illness and prevent the spread of these fatal diseases. Pakistan lacks the necessary healthcare resources to tackle two contagious diseases at the same time. To counteract the sudden increase in TB cases, appropriate management and effective policies must be implemented. Thus, in order to prevent the spread of these infectious diseases, it is critical to recognise and address the problems that the healthcare sector faces, as well as to create an atmosphere in which the healthcare sector can function at its full potential.

Infectious diseases in free-range compared to conventional poultry production.

Commercial chicken production for the supply of meat and eggs has expanded in the scale and variety of production systems in use to facilitate the supply of a range of cost-effective products in response to consumer demand. In the egg sector, traditional cage systems were required to be replaced in the EU by 2012, and most of this production capacity has been replaced by colony cage systems, which provide more space, perching, and environmental enrichment. In some countries there is significant production of "cage-free" or "barn" eggs in which the birds remain housed, but have access to litter. In the UK most egg production is now free-range. Meat poultry is produced in "barn" systems with various enrichments and some free-range. The rise in free-range production has seen the return of some diseases. Biosecurity is a critical tool for disease control in all production systems, particularly when disease challenge is high or farms are in a high poultry density area. An infectious dose of a pathogen is important in determining outcomes in terms of health and productivity, so biosecurity, hygiene, and good management are important across many diseases. Infections which are notifiable, of zoonotic importance and those which are sporadic or endemic in commercial poultry production are reviewed. General principles of preventative medicine applicable to the control of infectious diseases in different poultry production systems are proposed in areas such as biosecurity, system design and maintenance, range, and vaccination, though good management is always important.

Recurrence of Nephrolithiasis and Surgical Events Are Associated with Chronic Kidney Disease in Adult Patients.

Background and objective: Nephrolithiasis (NL) is a public health problem in the population of Southeast Mexico because of its high prevalence and recurrence. The evolution of this pathology can result in renal damage and may even cause chronic kidney disease (CKD), leading to a reduced glomerular filtration rate (GFR), decreased kidney function, and kidney loss in advanced stages. However, few studies support this evidence in the population. The present study aimed to determine risk factors associated with CKD in adult patients in an endemic population of Mexico. Materials and methods: A case-control study was carried out with patients diagnosed with NL. Additionally, the clinical information of patients (age, weight, height, blood pressure, comorbidities, and time of progress of NL), characteristics of the stones (number, location, and Hounsfield units), and biochemical parameters were collected. Results: The recurrence of NL was associated with CKD (OR 1.91; 95% CI 1.37−2.27; p = 0.003). In addition, male sex (p = 0.016), surgical history (p = 0.011), bilateral kidney stones (p < 0.001), and urinary tract infections (p = 0.004) were other factors associated with CKD. Interestingly, thirty-two patients younger than 50 years old with >2 surgical events presented a significant decrease in GFR (p < 0.001). Conclusions: The recurrence of NL and the number of surgical events were risk factors associated with CKD in patients with NL treated in our population.

Contributions of the international plant science community to the fight against infectious diseases in humans-part 2: Affordable drugs in edible plants for endemic and re-emerging diseases.

The fight against infectious diseases often focuses on epidemics and pandemics, which demand urgent resources and command attention from the health authorities and media. However, the vast majority of deaths caused by infectious diseases occur in endemic zones, particularly in developing countries, placing a disproportionate burden on underfunded health systems and often requiring international interventions. The provision of vaccines and other biologics is hampered not only by the high cost and limited scalability of traditional manufacturing platforms based on microbial and animal cells, but also by challenges caused by distribution and storage, particularly in regions without a complete cold chain. In this review article, we consider the potential of molecular farming to address the challenges of endemic and re-emerging diseases, focusing on edible plants for the development of oral drugs. Key recent developments in this field include successful clinical trials based on orally delivered dried leaves of Artemisia annua against malarial parasite strains resistant to artemisinin combination therapy, the ability to produce clinical-grade protein drugs in leaves to treat infectious diseases and the long-term storage of protein drugs in dried leaves at ambient temperatures. Recent FDA approval of the first orally delivered protein drug encapsulated in plant cells to treat peanut allergy has opened the door for the development of affordable oral drugs that can be manufactured and distributed in remote areas without cold storage infrastructure and that eliminate the need for expensive purification steps and sterile delivery by injection.

Virulence management: Closing the feedback loop between healthcare interventions and virulence evolution.

We study the evolution of virulence of an endemic pathogen in response to healthcare interventions which affect host recovery and pathogen transmission. By anticipating the evolutionary response of the pathogen we may develop effective long-term management strategies for controlling the impact of the endemic on the society. To that end, we use standard Adaptive Dynamics techniques in an SIS model. The recovery rate and the transmission rate, both of which can be affected by healthcare interventions, are used as evolutionary control variables. The effect of interventions may be density-independent (self-help based on healthcare instructions) or density-dependent (when assistance of a healthcare worker is required). We consider the evolutionary response of the pathogen both to abrupt changes and to gradual changes in the level of healthcare intervention. Healthcare intervention is optimised for three alternative objectives: minimisation of virulence, minimisation of the probability that an infected individual dies of the disease, and total eradication of the endemic. We find that the optimal strategy may depend on the objective. High levels of healthcare intervention may eradicate the pathogen, but this option may not be available for budgetary reasons or otherwise. Counterintuitively, to minimise virulence, one should keep healthcare interventions at a minimum, while to minimise the probability for an infected individual to die of the disease, both low and high levels of healthcare intervention suffice. Changes in the level of healthcare intervention should be implemented fast (not gradually) in order to avoid sudden changes in pathogen evolution and the possible emergence of multiple simultaneously coexisting pathogen strains.

Progress of Signaling Pathways, Stress Pathways and Epigenetics in the Pathogenesis of Skeletal Fluorosis.

Fluorine is widely dispersed in nature and has multiple physiological functions. Although it is usually regarded as an essential trace element for humans, this view is not held universally. Moreover, chronic fluorosis, mainly characterized by skeletal fluorosis, can be induced by long-term excessive fluoride consumption. High concentrations of fluoride in the environment and drinking water are major causes, and patients with skeletal fluorosis mainly present with symptoms of osteosclerosis, osteochondrosis, osteoporosis, and degenerative changes in joint cartilage. Etiologies for skeletal fluorosis have been established, but the specific pathogenesis is inconclusive. Currently, active osteogenesis and accelerated bone turnover are considered critical processes in the progression of skeletal fluorosis. In recent years, researchers have conducted extensive studies in fields of signaling pathways (Wnt/ß-catenin, Notch, PI3K/Akt/mTOR, Hedgehog, parathyroid hormone, and insulin signaling pathways), stress pathways (oxidative stress and endoplasmic reticulum stress pathways), epigenetics (DNA methylation and non-coding RNAs), and their inter-regulation involved in the pathogenesis of skeletal fluorosis. In this review, we summarised and analyzed relevant findings to provide a basis for comprehensive understandings of the pathogenesis of skeletal fluorosis and hopefully propose more effective prevention and therapeutic strategies.

Human African trypanosomiasis: the current situation in endemic regions and the risks for non-endemic regions from imported cases.

Human African trypanosomiasis (HAT) is caused by Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense and caused devastating epidemics during the 20th century. Due to effective control programs implemented in the last two decades, the number of reported cases has fallen to a historically low level. Although fewer than 977 cases were reported in 2018 in endemic countries, HAT is still a public health problem in endemic regions until it is completely eliminated. In addition, almost 150 confirmed HAT cases were reported in non-endemic countries in the last three decades. The majority of non-endemic HAT cases were reported in Europe, USA and South Africa, due to historical alliances, economic links or geographic proximity to disease-endemic countries. Furthermore, with the implementation of the 'Belt and Road' project, sporadic imported HAT cases have been reported in China as a warning sign of tropical diseases prevention. In this paper, we explore and interpret the data on HAT incidence and find no positive correlation between the number of HAT cases from endemic and non-endemic countries. This data will provide useful information for better understanding the imported cases of HAT globally in the post-elimination phase.

Citizen Science Uncovers Phytophthora ramorum as a Threat to Several Rare or Endangered California Manzanita Species.

The Sudden Oak Death (SOD) Blitzes consist of yearly surveys led by citizen scientists designed to map the distribution of Phytophthora ramorum, cause of the forest disease called SOD, across northern California. During the 2017 Santa Cruz County SOD Blitz, six rare or endangered Arctostaphylos (manzanita) species were found to be possibly symptomatic for the first time. Symptoms included branch cankers and associated canopy mortality, and affected multiple individuals per species. Isolates of P. ramorum were obtained from each of the six species and, through a 30-day-long inoculation experiment on live plants, Koch's postulates were completed for each one of them, conclusively determining that they all are hosts of this pathogen. Two additional manzanita species were later found to be apparently symptomatic in Marin County. Inoculations on detached branches using an isolate of P. ramorum obtained from one of the six rare species from Santa Cruz County were successful, suggesting that these two species may also be hosts of P. ramorum. Detached leaves of all eight species were also successfully inoculated at the University of California-Berkeley in fall 2018 and then again in spring 2019. In these cases, the same isolate was used for all inoculations, in order to obtain information on the comparative susceptibility of the eight species in question. Both branch and leaf inoculations identified significant interspecific differences in susceptibility. The production of sporangia was low on all species but it was not zero, suggesting that sporulation may cause within-plant and limited across-plant contagion, especially in rainy years.

Assessing the economic impact of an endemic disease: the case of mastitis.

A large part of the world's resources are used to produce animal products. Efficient use of these resources is important to improve social well-being. Endemic animal diseases decrease production efficiency, because they require a higher level of input to produce the same amount of output or result in a lower output with the same amount of input. The optimal level of production with and without disease differs from farm to farm and depends on varying economic circumstances. Given these difficulties, making an accurate theoretical estimation of the economic impact of endemic diseases is challenging. Current approaches towards the economic assessment of endemic diseases are, therefore, quite pragmatic. For on-farm decision-making, the total costs consist of failure costs and preventive costs. Failure costs are associated with production losses (i.e. decreases in milk production, mortality and culling), treatment costs (i.e. veterinary treatment, drugs, and discarded milk) and the use of other resources associated with the occurrence of disease (i.e. increased labour costs). Preventive costs are associated with preventive measures in terms of equipment, consumables (e.g. diagnostics and chemicals) and the use of other resources to prevent diseases (i.e. increased labour). There is a substitution relationship between failure costs and preventive costs. That means that, in order to maximise profit at the farm level, the amount of resources invested in prevention should be chosen in such a way that total costs are minimised. The most studied endemic disease in animal production is mastitis. Most publications on mastitis only assess failure costs, and studies on assessing the total costs and best methods to determine an optimal level of prevention are scarce. Future challenges lie in researching frameworks that can assist decision-makers to establish optimal prevention levels for endemic diseases.

Une grande partie des ressources mondiales est consacrée à la production de produits d'origine animale. Il est important d'utiliser rationnellement ces ressources si l'on veut améliorer le bien-être des sociétés. Les maladies animales endémiques réduisent la rentabilité des élevages car en cas de maladie il faut plus d'intrants pour maintenir le niveau de production, tandis que celui-ci décroît si la quantité d'intrants demeure inchangée. Le niveau optimal de production avec ou sans maladie varie d'une exploitation à l'autre et dépend du contexte et des fluctuations économiques. Ces facteurs complexes expliquent la difficulté de réaliser une estimation théorique exacte de l'impact économique des maladies endémiques. En conséquence, les approches actuelles en matière d'évaluation économique des maladies animales privilégient le pragmatisme. Au niveau décisionnel des élevages, les coûts totaux englobent les pertes d'exploitation et les coûts de la prévention. Les pertes d'exploitation sont liées aux pertes de production (baisse de la production de lait, mortalité et animaux sacrifiés), au coût des traitements (prestations vétérinaires, médicaments, perte de lait en raison des traitements) et à l'utilisation d'autres ressources en lien avec l'apparition de la maladie (augmentation des coûts de main-d'oeuvre). Les coûts de prévention sont liés aux mesures de prévention et couvrent les équipements, les consommables (les réactifs et matériels de diagnostic et les produits chimiques) et l'utilisation d'autres ressources pour prévenir les maladies (augmentation des coûts de maind'oeuvre). Les pertes d'exploitation et les coûts de prévention sont mutuellement substituables. Ainsi, pour optimiser la rentabilité à l'échelle de la ferme, il conviendra de choisir le montant des ressources investies dans la prévention de manière à minimiser les coûts totaux. La mammite est la maladie endémique la plus étudiée en production animale. La plupart des publications sur la mammite évaluent uniquement les coûts de perte d'exploitation, peu d'études ayant été consacrées à l'évaluation des coûts totaux ou aux méthodes permettant de déterminer le niveau optimal de la prévention. Les défis futurs consisteront à élaborer des cadres permettant d'aider les décideurs à déterminer les niveaux optimaux de la prévention des maladies endémiques.

Buena parte de los recursos del mundo se destinan a la obtención de productos de origen animal. Para alcanzar mayores cotas de bienestar social es importante pues utilizar esos recursos de modo eficiente. Las enfermedades animales endémicas merman la eficiencia productiva porque exigen una mayor cantidad de insumos para obtener el mismo nivel de producción o, alternativamente, reducen la producción obtenida por una misma cantidad de insumos. El nivel óptimo de producción, en presencia y en ausencia de enfermedades, difiere de una explotación a otra y depende de parámetros económicos que son variables. Estas dificultades explican por qué resulta tan arduo hacer una estimación teórica precisa del impacto económico de enfermedades endémicas. De ahí que los métodos actuales para evaluar en clave económica las enfermedades endémicas revistan un carácter bastante empírico. En lo que concierne a las decisiones adoptadas en el ámbito de la explotación, el costo total está formado por las pérdidas de explotación y los costos de prevención. Las pérdidas de explotación vienen determinadas por las pérdidas productivas (menor producción de leche, mortalidad y animales sacrificados), el costo de los tratamientos (servicios veterinarios, medicamentos y leche desechada a consecuencia del tratamiento) y el uso de otros recursos ligados a la aparición de la enfermedad (mayores costes laborales). Los costos de prevención, que son aquellos vinculados a las medidas profilácticas, corresponden al equipo empleado, los bienes consumibles (como productos químicos o de diagnóstico) y la utilización de otros recursos para prevenir enfermedades (mayores costes laborales). Existe una relación de sustitución entre las pérdidas de explotación y los costos de prevención. Ello significa que, para que una explotación rinda el máximo beneficio, conviene fijar la cantidad de recursos invertidos en prevención de tal manera que ello reduzca al mínimo los costos totales. La enfermedad endémica más estudiada en producción animal es la mastitis. En la mayoría de las publicaciones que se le han dedicado solo se evalúan las pérdidas de explotación, y en cambio escasean los estudios encaminados a evaluar los costos totales o a definir el mejor método para determinar el nivel óptimo de prevención. De cara al futuro, se trata de buscar modelos que puedan ayudar a las instancias decisorias a fijar los niveles óptimos de prevención de enfermedades endémicas.

Cutaneous anthrax: evaluation of 28 cases in the Eastern Anatolian region of Turkey.

CONTEXT: Anthrax is an endemic disease in developing countries. Human cases are usually associated with animal products. About 95% of naturally acquired cases are cutaneous anthrax. OBJECTIVE: In this study, cutaneous anthrax cases from the Elazig province (the Eastern Anatolian region) of Turkey seen in our hospital within a 6-year period were evaluated with respect to epidemiological and clinical features, diagnosis, treatment and outcome. METHODS: Twenty-eight patients with cutaneous anthrax observed between January 2009 and December 2014 were investigated retrospectively. The diagnosis of cutaneous anthrax was based on detailed history, dermatologic findings, including painless, ulcers covered by a characteristic black eschar and/or microbiological procedures, including Gram stain and culture of materials obtained from the lesions. RESULTS: Of the 28 patients followed up with cutaneous anthrax diagnosis, 14 (50%) were female and 14 (50%) were male. The mean age of the cases was 39.6 years (age range 17-65 years). The patients have an incubation period in the range of 1-9 days (mean 4.6 ± 0.5 days). The cases were seen between April and November of each year during the study period. Twenty-three cases (82%) had a history of contact with animals or animal products. Twenty patients (71.4%) showed malignant pustules and eight (28.6%) malignant edema. Bacillus anthracis was isolated in three cases (10.7%) and Gram stain smear were positive in five cases (17.8%). All patients were treated successfully with penicillin or ciprofloxacin. Systemic corticosteroids were added to the antibiotic treatment in six patients with malignant edema. Sepsis no developed in patients, all the cases recovered. CONCLUSION: Anthrax is still a serious public health problem in Turkey. Cutaneous anthrax must always be kept in mind when characteristic lesions such as a painless ulcer with vesicles, edema, and a history of contact with animals or animal products are observed in an individual. Early and correct diagnosis significantly affects course of the disease. Protective precautions such as vaccination of animals against anthrax and education of the population would reduce the incidence of the disease.

Molecular epidemiology of reemergent rabies in Yunnan Province, southwestern China.

Yunnan Province in China borders 3 countries (Vietnam, Laos, and Myanmar) in Southeast Asia. In the 1980s, a large-scale rabies epidemic occurred in this province, which subsided by the late 1990s. However, 3 human cases of rabies in 2000 indicated reemergence of the disease in 1 county. In 2012, rabies was detected in 77 counties; 663 persons died of rabies during this new epidemic. Fifty two rabies virus strains obtained during 2008-2012 were identified and analyzed phylogenetically by sequencing the nucleoprotein gene. Of the 4 clades identified, clades YN-A and YN-C were closely related to strains from neighboring provinces, and clade YN-B was closely related to strains from Southeast Asia, but formed a distinct branch. Rabies virus diversity might be attributed to dog movements among counties, provinces, and neighboring countries. These findings suggest that Yunnan Province is a focal point for spread of rabies between Southeast Asia and China.

A Bayesian approach for inferring the dynamics of partially observed endemic infectious diseases from space-time-genetic data.

We describe a statistical framework for reconstructing the sequence of transmission events between observed cases of an endemic infectious disease using genetic, temporal and spatial information. Previous approaches to reconstructing transmission trees have assumed all infections in the study area originated from a single introduction and that a large fraction of cases were observed. There are as yet no approaches appropriate for endemic situations in which a disease is already well established in a host population and in which there may be multiple origins of infection, or that can enumerate unobserved infections missing from the sample. Our proposed framework addresses these shortcomings, enabling reconstruction of partially observed transmission trees and estimating the number of cases missing from the sample. Analyses of simulated datasets show the method to be accurate in identifying direct transmissions, while introductions and transmissions via one or more unsampled intermediate cases could be identified at high to moderate levels of case detection. When applied to partial genome sequences of rabies virus sampled from an endemic region of South Africa, our method reveals several distinct transmission cycles with little contact between them, and direct transmission over long distances suggesting significant anthropogenic influence in the movement of infected dogs.

An ecological model for quantitative risk assessment for schistosomiasis: the case of a patchy environment in the coastal tropical area of northeastern Brazil.

We developed a stochastic model for quantitative risk assessment for the Schistosoma mansoni (SM) parasite, which causes an endemic disease of public concern. The model provides answers in a useful format for public health decisions, uses data and expert opinion, and can be applied to any landscape where the snail Biomphalaria glabrata is the main intermediate host (South and Central America, the Caribbean, and Africa). It incorporates several realistic and case-specific features: stage-structured parasite populations, periodic praziquantel (PZQ) drug treatment for humans, density dependence, extreme events (prolonged rainfall), site-specific sanitation quality, environmental stochasticity, monthly rainfall variation, uncertainty in parameters, and spatial dynamics. We parameterize the model through a real-world application in the district of Porto de Galinhas (PG), one of the main touristic destinations in Brazil, where previous studies identified four parasite populations within the metapopulation. The results provide a good approximation of the dynamics of the system and are in agreement with our field observations, i.e., the lack of basic infrastructure (sanitation level and health programs) makes PG a suitable habitat for the persistence and growth of a parasite metapopulation. We quantify the risk of SM metapopulation explosion and quasi-extinction and the time to metapopulation explosion and quasi-extinction. We evaluate the sensitivity of the results under varying scenarios of future periodic PZQ treatment (based on the Brazilian Ministry of Health's plan) and sanitation quality. We conclude that the plan might be useful to slow SM metapopulation growth but not to control it. Additional investments in better sanitation are necessary.

The Role of COVID-19 Vaccination for Patients With Atherosclerotic Cardiovascular Disease in the Upcoming Endemic Era.

COVID-19 vaccination has played a pivotal role in coping with the COVID-19 pandemic by providing a powerful tool to curb the spread of the virus, reduce severe illness and hospitalizations, and ultimately save lives and facilitate a return to normal daily routines. As COVID-19 vaccination has become more widespread and more individuals have recovered from the infection, COVID-19 has entered an endemic disease phase. This phase is characterized by a less severe and more stable pattern of infection within certain regions, similar to the predictability of seasonal influenza. In this endemic era, COVID-19 vaccines may appear to be less important, and many people are reluctant to receive COVID-19 vaccination for various reasons, including the fear of adverse events. However, COVID-19 remains a major public health problem, in that the incidence rate of new COVID-19 infections is still high and the morbidity and mortality in high-risk populations are substantial. Therefore, the role of COVID-19 vaccines in protecting high-risk individuals is crucial, and ongoing research and surveillance are imperative to refine vaccination recommendations in the ever-changing landscape of the COVID-19 endemic era. This review explores the role of COVID-19 vaccination in the upcoming COVID-19 endemic era.

Behavioural Factors Influencing the Intention to Adopt Sheep Scab Control Measures in Northern Ireland.

Sheep scab, caused by infestation with the ectoparasitic mite Psoroptes ovis, is an endemic disease in the Northern Ireland (NI) sheep flock and constitutes significant economic and welfare burdens for the NI farming industry. Despite its endemic nature, historically, little research has been undertaken to support the control of the disease in NI. This study offers the first attempt to analyse the psychological and behavioural factors influencing farmers' intentions to implement effective sheep scab control measures in NI. To achieve our objective, quantitative data from a sample of 126 sheep farmers were statistically analysed using an extended theory of planned behaviour approach in an ordered logistic regression modelling framework. Our analyses showed that sheep scab remains an issue of concern in Northern Ireland. The attitudes of the farmers, as well as perceived behavioural control, emotional effect, membership of Business Development Groups (BDGs), and higher education qualifications, were found to be statistically significant factors influencing farmers' intentions to adopt sheep scab control measures. This study provides a solid foundation for how to promote behavioural changes among sheep farmers to improve their ability to implement effective disease control measures, helping to tackle this challenging disease in a more sustainable way in the future.