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Antigenicity of key hepatitis C virus E1E2 glycoprotein neutralizing sites is genotype independent
Full text linkThe development of an effective prophylactic hepatitis C virus (HCV) vaccine is a priority to achieve global elimination of the virus. Accurate assessment of the neutralizing breadth of antibodies induced by vaccines and a clear understanding of the antigenic differences between viral variants included in vaccines are both critical for vaccine development. Prior studies have indicated that HCV genotypes (gts) do not dictate the sensitivity of HCV envelope glycoprotein (E1E2) variants to neutralizing antibodies. However, most of these prior studies under-sampled variants from gts 2–6. Here, we selected a genetically diverse and representative panel of gt 2–6 E1E2 variants, used them to generate HCV pseudoparticles (HCVpp), and measured neutralization of these HCVpp by neutralizing antibodies and HCV-immune plasma from persons infected with gt 1–6 viruses. We found that neutralization results obtained with this gt 2–6 panel were remarkably similar to results obtained with a previously described, antigenically diverse, gt 1-predominant reference panel of 15 HCVpp. These data confirm that, even considering genetically diverse HCV variants across gt 1–6, E1E2 antigenicity is not dictated by gt, and that the previously published panel of 15 HCVpp represents neutralization of all HCV gts with reasonable accuracy.</p
Neonatal Near Miss and Its Associated Factors among Neonates in Garowe City, Puntland, Somalia, 2025: A Cross Sectional Study
Full text linkBackground: Neonatal near-miss refers to conditions in which a newborn is on the verge of dying, but survived within 28 days of life. Although the study of neonatal near miss has emerged in many countries, there is limited data about the condition in Garowe, Somalia. Hence, the study aimed to assess the magnitude of neonatal near miss and its associated factors among neonates in Garowe City, Puntland. Methods: Institution based cross-sectional study was conducted from June 01–29 2024 among randomly selected 375 neonates. Data were collected by trained nurses through face-to-face interview of the mothers or guardians using a pre-tested standard questionnaire. Neonatal near miss was defined as having any of the pragmatic (birth weight <1750g, <33 weeks gestational age,or <5 fifth minute APGAR score) or management criteria (mechanical ventillation, cardiopulmonary resuscitation, nasal continous positive airway pressure, parentral antiobiotics, parentral nutrition, use of vasoactive drugs, or phototherapy within 24 hours of birth). Data were entered into Epidata version 3.1 and exported to Stata version 14.0 for analysis. Bivariable and multivariable logistic regression were done to identify factors associated with neonatal near miss. Level of statistical significance was declared at p-value < 0.05. Results: The magnitude of neonatal near miss was found to be 48.2% (95% CI: 43%, 53%). Neonates born from daily laborer mothers (AOR = 5.72; 95% CI: 1.73-18.89), from women with history of abortion (AOR = 2.75; 95% CI: 1.37-5.53), and those admitted to the neonatal intensive care unit (AOR = 13.99; 95% CI: 7.36-26.59) were more likely to have neonatal near miss. Conclusion: Nearly half of neonates in Garowe experienced a near miss event. Maternal occupation, history of abortion, and admission to neonatal intensive care unit were found to be key associated factors. Health care professionals should enhance early identification and follow-up of high-risk pregnancies and newborns, particularly in mothers with a history of abortion or those engaged in physically demanding jobs.</p
The effectiveness of long-lasting spatial repellent emanators against malaria in humanitarian crisis settings in northern Nigeria: a two-arm pragmatic, open-label, controlled trial
No full textBackground: In 2025, the UN estimated that 305 million people would need humanitarian aid, and by 2030, two-thirds of the poorest populations will reside in areas of fragility, conflict, and violence. When individuals are forcibly displaced into malaria endemic areas, the risk of severe disease and mortality can be high. Novel vector control tools suited to the emergency context, for which conventional interventions suffer from biological and operational limitations, are urgently needed to interrupt vector-borne disease transmission among the world's most vulnerable. This study aimed to evaluate the effectiveness of spatial repellent emanators against malaria during a protracted humanitarian crisis. Methods: We conducted a 6-month, two-arm pragmatic, open-label, controlled trial in 24 camps for people who are internally displaced in Maiduguri, Nigeria. Children aged 6–10 years were enrolled into a monthly cohort to estimate the primary trial epidemiological outcome of intervention impact on malaria infection incidence. The study team allocated 12 camps, which were spatially clustered, to receive the intervention and 12 other camps were allocated to the control group and received no intervention. Spatial repellent emanators, designed to remain efficacious for trial duration, were installed by the study team, or the householder under supervision, at the label coverage, in 50 eligible households per camp allocated to the intervention group. Monthly entomological monitoring measured changes in vector density (primary entomological outcome) and blood feeding (secondary entomological outcome). Intervention acceptability and feasibility was assessed using focus group discussions (tertiary trial outcomes). Patients were analysed according to treatment received and analyses were conducted using all non-missing observations, allowing for inclusion of participants with partial follow-up. This trial was registered with ClinicalTrials.gov (NCT06179732) and is completed. Findings: Between June 20 and July 3, 2023, 1655 participants were recruited, and 842 participants were assigned to the intervention group, and 813 patients were assigned to the control group. 770 patients were male and 885 were female. Post-intervention, after adjusting for baseline malaria prevalence, spatial repellent emanators significantly reduced malaria infection incidence over 6 months of follow-up (incidence rate ratio 0·713, 95% CI 0·584–0·869; p=0·001; n=1655). The estimated protective efficacy of spatial repellent emanators against first-time malaria infection was 22·5% (hazard ratio 0·775, 95% CI 0·637–0·943; p=0·011). Spatial repellent emanators also significantly reduced pyrethroid-resistant female Anopheles gambiae sensu lato density (incidence rate ratio 0·0231, 95% CI 0·00661–0·0807; p<0·0001) and blood feeding (0·0195, 0·00590–0·0646; p<0·0001). Camp residents displayed high levels of intervention acceptability, driven by perceived entomological impact, including willingness to pay. Interpretation: These findings contribute to expanding the toolbox of efficacious vector control products for the humanitarian emergency context, strengthening the growing evidence for the public health value of spatial repellent emanators, and providing the first epidemiological efficacy data for spatial repellent emanators against malaria in west Africa. Funding: US Department of the Army, US Army Contracting Command, Aberdeen Proving Ground, Edgewood Contracting Division.</p
Housing modifications for heat adaptation, thermal comfort and malaria vector control in rural African settlements
Full text linkThe rapid increase in global temperatures coupled with persistent malaria transmission presents substantial health burdens in sub-Saharan Africa. Here this randomized pilot field study assessed the feasibility of sustainable housing modifications via passive cooling approaches and vector proofing. Forty houses were randomly allocated to four arms: cool-roof, cross-ventilation, mat-ceiling or control. Doors, windows and eaves of the intervention houses (not control) were screened for malaria mosquito vectors. Indoor temperature and humidity were monitored continuously to assess Heat Index (HI), predicted mean value and psychrometric charts. The HI in cool-roof houses was the lowest (daytime −3.3 °C, P < 0.001; nighttime −2.4 °C, P < 0.01). Mat-ceiling houses lowered daytime HI but increased nighttime HI compared to control. No differences in HI were observed for cross-ventilation houses. Screening reduced the number of female Anopheles funestus mosquitoes by 77% and the number of Culex mosquitoes by 58% compared to control houses. Eighty-five percent of the households expressed willingness to use their resources for housing intervention. Cool-roofs combined with vector proofing is an effective, practical and sustainable housing modification for heat adaptation and for reducing indoor mosquito numbers in rural African households.</p
Neonatal Near Miss and Its Associated Factors among Neonates in Garowe City, Puntland, Somalia, 2025: A Cross Sectional Study
Full text linkBackground: Neonatal near-miss refers to conditions in which a newborn is on the verge of dying, but survived within 28 days of life. Although the study of neonatal near miss has emerged in many countries, there is limited data about the condition in Garowe, Somalia. Hence, the study aimed to assess the magnitude of neonatal near miss and its associated factors among neonates in Garowe City, Puntland. Methods: Institution based cross-sectional study was conducted from June 01–29 2024 among randomly selected 375 neonates. Data were collected by trained nurses through face-to-face interview of the mothers or guardians using a pre-tested standard questionnaire. Neonatal near miss was defined as having any of the pragmatic (birth weight <1750g, <33 weeks gestational age,or <5 fifth minute APGAR score) or management criteria (mechanical ventillation, cardiopulmonary resuscitation, nasal continous positive airway pressure, parentral antiobiotics, parentral nutrition, use of vasoactive drugs, or phototherapy within 24 hours of birth). Data were entered into Epidata version 3.1 and exported to Stata version 14.0 for analysis. Bivariable and multivariable logistic regression were done to identify factors associated with neonatal near miss. Level of statistical significance was declared at p-value < 0.05. Results: The magnitude of neonatal near miss was found to be 48.2% (95% CI: 43%, 53%). Neonates born from daily laborer mothers (AOR = 5.72; 95% CI: 1.73-18.89), from women with history of abortion (AOR = 2.75; 95% CI: 1.37-5.53), and those admitted to the neonatal intensive care unit (AOR = 13.99; 95% CI: 7.36-26.59) were more likely to have neonatal near miss. Conclusion: Nearly half of neonates in Garowe experienced a near miss event. Maternal occupation, history of abortion, and admission to neonatal intensive care unit were found to be key associated factors. Health care professionals should enhance early identification and follow-up of high-risk pregnancies and newborns, particularly in mothers with a history of abortion or those engaged in physically demanding jobs.</p
Evaluating community digital data linkage with or without community data use to increase antenatal care uptake in Western Kenya: protocol for a pragmatic open-label, cluster-randomised controlled superiority trial
Full text linkBackground: Less than 10% of pregnant women in Sub Saharan Africa achieve the World Health Organization recommended eight antenatal care (ANC) contacts for optimal pregnancy management. Robust strategies that involve community outreach programmes, integrated service delivery and continuity of care could help improve ANC uptake and quality. Kenya, as other countries, has promoted use of digital health records at the community and facility levels to improve quality and access to data and promote continuity of care. These records, however, are not always linked and access to data does not guarantee its use to drive quality improvement. C-it-DU-it (pronounced “See it, Do it”) is a two-arm pragmatic cluster-randomised trial set in Homabay County, Kenya. The trial will implement digital linkage of community and facility electronic patient data (control arm) and assess the impact of having quality improvement teams reviewing and acting on the linked data (intervention arm). While several areas are captured in the community health records, we will focus on uptake of ANC services as a lens.Methods: Eighteen healthcare facilities (clusters) will be randomly allocated to either the control or intervention arms at a ratio of 1:1. A data linkage module will be deployed in all clusters, enabling digital referral of pregnant women between the community and health facilities. In each intervention cluster, work improvement teams will be established and trained on reviewing these electronic ANC data, identifying problems, developing and deploying context-specific solutions to these problems and evaluating the impact of their interventions. ANC data will be extracted for 1,440 recruited pregnant women. The primary outcome will be the proportion of pregnant women with at least eight ANC contacts. Secondary outcomes will be ANC uptake before 16 weeks gestation, adverse pregnancy outcomes, uptake of required investigations, medication and skilled birth attendance.Discussion: This trial intends to generate evidence on the benefit of community work improvement teams to review and act on linked digital data to develop and deploy solutions to local problems. This strategy, if successful, will promote antenatal service uptake and quality resulting in improved pregnancy outcomes and progress towards sustainable development goals if appropriately scaled up
Infant HIV transmission despite maternal viral suppression: a case of post-weaning seroconversion
Full text linkDespite widespread availability of antiretroviral therapy (ART) and comprehensive prevention of vertical transmission (PVT) programmes, rare cases of postnatal HIV transmission continue to occur. Maternal viral suppression during pregnancy and breastfeeding has dramatically reduced transmission risk, with global guidelines now recommending maternal ART as the cornerstone of prevention.1 Current evidence estimates the overall risk of pregnancy and postnatal HIV transmission to be less than 1% in mothers who are fully suppressed on ART.2 However, we report a case that illustrates a complex diagnostic and clinical challenge: infant HIV seroconversion following cessation of breastfeeding, despite sustained maternal virological suppression and adherence to all PVT interventions
Updating Anopheles funestus group members in Burkina Faso species distribution and contribution to malaria transmission
Full text linkBackground: Anopheles funestus group and Anopheles gambiae complexes are among the most efficient malaria vectors in Africa, thriving in a variety of environments and well adapted to develop in semi-permanent and permanent water bodies. This study investigated the spatial distribution of the An. funestus group and their contribution to malaria transmission in Burkina Faso. Methods: An entomological survey was conducted from October to December 2022 across 67 sites within the ecological zones of Burkina Faso (once a month); An. funestus was detected in 22 of these sites. Mosquitoes were collected using pyrethrum spray catches (PSC) and identified at the species complex level using morphological keys. A polymerase chain reaction (PCR) was performed for species identification among An. funestus group, blood meal sources and Plasmodium falciparum infection. Results: A total of 617 members of the An. funestus group (45 males and 572 females) were collected across eight regions of Burkina Faso. Anopheles funestus s.s. was the most prevalent specie identified with a frequency of up to 95% (589/617). Most An. funestus s.s. were found in the Hauts-Bassins and the Sud-Ouest regions with 30% (177/589) and 55% (329/589), respectively. Hybrids between An. rivulorum and An. rivulorum-like were identified at a frequency of 3.57% (22/617). Additionally, results showed a high prevalence of zoophilic behaviour (64.3% of the blood source) in An. funestus. Plasmodium falciparum infection was detected in 5.76% (33/572) of the An. funestus s.l. populations with a frequency of 5.6% (32/572) and 0.174% (1/572) in An. funestus s.s. and An. rivulorum-like, respectively. Conclusions: This study updates the distribution of the An. funestus group and its potential role in malaria transmission in Burkina Faso. It emphasizes the need to strengthen malaria vector surveillance and highlights the importance of incorporating An. funestus in developing innovative vector control interventions.</p
Identifying community pharmacists’ preferences for attributes of public health interventions in Kenya a discrete choice experiment
No full textCommunity pharmacies are increasingly recognized as access points for public health interventions (PHIs) such as vaccination, family planning services, and disease screening. In Kenya, evidence suggests the feasibility of pharmacy-delivered PHIs; however, the uptake remains inconsistent. This is partly attributed to poor programme design without taking pharmacy providers preferences into consideration. We employed a discrete choice experiment (DCE) to investigate community pharmacists’ preferences for attributes of PHIs delivered in community pharmacies in Kenya. We constructed a Bayesian efficient design and conducted a DCE survey among 663 community pharmacy providers in Makueni, Nairobi, and Kisumu counties in Kenya from January 2025 to March 2025. Panel multinomial mixed logit, generalized multinomial logit, and latent class models were used in the analysis. We also estimated willingness to pay (WTP) and willingness to accept (WTA) estimates using cost and profit margins as the monetary estimates, respectively. We found that community pharmacists were willing to offer PHIs with a low preference for opting out (β = −3.5723, P < 0.01). Preferences for PHIs significantly increased with higher profit margins (β = 0.028, P < 0.01) and decreased with higher cost of equipment (β = −0.00023, P < 0.01). There were higher preferences for PHIs that require moderate training (β = 0.266, P < 0.01) and extensive training (β = 0.141, P < 0.05) compared to no additional training and lower preferences for PHIs with complex interventions compared to simple interventions (β = −0.323, P < 0.01). The WTP estimates showed that providers were willing to pay Khs. 11 738 (USD 90) for moderate training and Kshs. 7327 (USD 56) for extensive training. Moreover, the WTA estimates showed that providers were willing to accept a 10.9% increase in profit margin in order to deliver complex interventions. In addition to this, a three-class latent class model revealed preference heterogeneity among the respondents. These findings can be used to inform the design of PHIs to enhance uptake and acceptability among providers.</p
Pooled analysis of PCV13 efficacy from controlled human infection trials in Malawi and the UK
Full text linkWe conducted the first pooled analysis of two randomized controlled vaccine trials on experimental pneumococcal serotype 6B carriage, registered in Malawi(PACTR202008503507113) and the UK (ISRCTN45340436). This post-hoc exploratory study examined the sex-based differences in carriage, vaccine efficacy and vaccine-induced responses. PCV-13 reduced colonisation by 76% (p<0.001) with non-significant interaction by sex (RR=1.549, p=0.413). Females showed a higher carriage rate than males (28% vs. 19%, p=0.066). Baseline anti-6B Capsular Polysaccharide Immunoglobulin G (IgG) titres were higher in females, significantly in Malawi (2.62 μg/ml vs males 2.05 μg/ml, p=0.015). Post-vaccination titres did not differ by sex. The pooled fold change in IgG pre-post vaccination, was higher in vaccinated females (5.47 vs 3.30, p=0.053). This analysis demonstrates the utility and challenges of integrating CHIM data between diverse settings to evaluate vaccine efficacy, describe intersetting differences, investigate biological and immunological factors influencing protection against pneumococcal carriage and ultimately inform future vaccine development strategies