In low-prevalence settings, the epidemiological yield of screening strategies for controlling vancomycin-resistant enterococci (VRE) outbreaks has not been fully established. We retrospectively analysed a prolonged VRE outbreak at a 536-bed tertiary-care hospital in Japan from 2010 to 2021 to evaluate sequential screening strategies across epidemic phases and to identify risk factors for VRE acquisition. Hospital-wide, admission-based, antimicrobial exposure-based, passive, and haemodialysis-targeted screening strategies were implemented over time. Screening yields were compared longitudinally, and a retrospective case–control study was performed using data from the initial hospital-wide screening phase. Molecular epidemiology was assessed by pulsed-field gel electrophoresis (PFGE). In total, 169 VRE-positive patients were identified, including seven infections and 162 asymptomatic carriers. Hospital-wide screening in the early epidemic phase showed the highest positivity rate (0.91%), whereas targeted strategies consistently yielded lower rates (0.09–0.34%). Haemodialysis, specific oral care practices, and prior exposure to carbapenems, glycopeptides, and piperacillin/tazobactam were independently associated with VRE acquisition. PFGE revealed substantial genetic diversity, suggesting sustained nosocomial transmission with repeated introductions. Early broad-based screening may be epidemiologically efficient in the initial phase of VRE outbreaks in low-prevalence settings, followed by adaptive refinement for long-term control.

This study assessed changes in complete pneumococcal vaccination coverage (CPVC) among Peruvian children <5 years before and after the COVID 19 pandemic and evaluated regional differences, associated sociodemographic factors and wealth-related inequality. 2018–2023 Demographic and Health Surveys (DHS) was analyzed. CPVC was defined as receiving the full 2 + 1 schedule of the 13 valent pneumococcal vaccine. Children aged 13–60 months were included. Multivariable analysis used modified Poisson regression and wealth related inequality was assessed using the Concentration index and Erreygers’s corrected Concentration index at national and regional levels. Among 95,586 children, CPVC decreased from 71.9% in 2019 to 69.4% in 2020 (p = 0.003), then returned to pre Covid levels from 2021 onward (72.2% in 2023; p = 0.001), particularly in Lima Metropolitana. Puno (53.3–58.6%) and Madre de Dios (50.9–62.1%) consistently showed the lowest coverage. Nationally, wealth- or sociodemographic related inequalities were minimal; however, regional interactions indicated that the effect of wealth on CPVC varied by area. Depending on the region, factors such as age group, household members and mather’s education were associated with lower CPVC, whereas age at first pregnancy, institutional birth, antenatal care and access to information increased CPVC. Ucayali showed persistently higher CPVC among wealthier populations. Despite a temporary decline during the pandemic, CPVC in Peru rapidly recovered, although regional gaps persist.

This retrospective study analysed 14,625 isolates of the six major hospital-associated ‘ESKAPE’ pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) collected between 2002 and 2024 in a Hungarian tertiary-care centre. Antimicrobial resistance was assessed using the antibiotic resistance index (ARI), multidrug resistance (MDR) ratios, and resistance instability index (RII). A. baumannii and E. faecium showed the highest resistance burdens and instability. Age showed a significant monotonic association with resistance (Spearman r = 0.88), with peaks in infants, middle-aged women, and the elderly. Species-specific age trends varied, with a negative correlation seen in Enterobacter spp. Hierarchical clustering grouped pathogens by resistance trajectory rather than taxonomy. Pairwise resistance distances confirmed divergence between Gram-positive and Gram-negative species. Resistance to aminoglycosides and sulphonamides showed the highest year-to-year variability, as quantified by the RII, particularly in A. baumannii and E. faecium. Vector autoregressive (VAR) modelling predicted continued MDR increases in these species. A strong correlation was found between ARI and RII (Pearson r = 0.85, p = 0.032). These findings underscore the importance of integrating resistance magnitude and volatility in surveillance.

We assessed the association between voluntary polymerase chain reaction testing of travellers and reported infection rates in the Ogasawara Islands compared with those in several other Tokyo islands. The implementation of polymerase chain reaction testing over a 2-year period was evaluated. Between September 2020 and September 2022, 38,943 of 45,900 travellers to the Ogasawara Islands underwent pre-travel polymerase chain reaction testing, with a notable increase in uptake during states of emergency. Ogasawara reported 385 positive coronavirus disease 2019 cases, with no hospitalizations or severe cases among residents, in contrast to the higher infection and hospitalization rates in Tokyo. Pre-boarding polymerase chain reaction tests were associated with lower reported infection rates in this island setting. These findings suggest that combining pre-travel testing with local mitigation measures, including case isolation systems, may help safeguard the communities of small, geographically isolated islands. These results may inform public health preparedness and response strategies for future infectious disease outbreaks.

This retrospective, cross-sectional study assessed the burden of HIV in Israel’s Maccabi Healthcare Services in 2022. Among 2.6 million individuals assessed (lookback period: > 2 decades), 1973 PWH were identified and age-sex-matched (1:5) to 9,865 randomly selected controls without HIV. We compared sociodemographic, clinical characteristics, and healthcare resource utilization (HRU; Jan–Dec 2022) between people with and without HIV and characterized antiretroviral therapy (ART) treatment patterns among PWH (Jan–Dec 2022). Compared to controls, PWH had a higher lifetime prevalence (since 1988; P < 0.001) of several comorbid conditions, including liver disease, chronic kidney disease, any cancer, and hepatitis B and C infections. Additionally, PWH had a higher rate of anxiety and depression (26.2% vs. 13.5%; P < 0.001). PWH showed higher annual HRU than controls, including ~2-fold higher hospitalizations (≥1 new admissions; P < 0.001) and frequent use of emergency, urgent, primary, specialist, and nursing care (P < 0.05). Among 1907 PWH with ≥1 ART prescription, 78.1% had ≥90% coverage in 2022, although 69.1% experienced ART interruption and 7.2% discontinuation, the latter associated with mental health issues. This study recognizes critical gaps in care that could inform strategies to improve clinical outcomes and resource allocation in health systems for PWH.

To estimate illness incidence or prevalence from wastewater data, modelling approaches may benefit from incorporating faecal shedding parameters. We systematically searched PubMed and a public repository on shedding data and included 33 studies that met at least one of our objectives. Among 32 studies, the proportion of SARS-CoV-2-infected individuals with detectable virus in stool ranged from 18 to 100%, with a pooled estimate of 54% (95% CI: 52–56%). Stratification by four clinical severity categories, ranging from asymptomatic to critically ill, showed no significant differences among categories (p-value = 0.49). The proportion of individuals with detectable SARS-CoV-2 RNA in stool was higher in children (61%) than in adults (53%; p-value = 0.02). In half of the individuals who initially shed the virus in stool, it remained detectable for an estimated 22 days post-symptom onset. Three studies documented viral load kinetics, indicating a peak between days 3 and 9. Twenty-five studies reported maximum shedding durations ranging from 2 to 12 weeks. Our review summarizes the frequency, dynamics, and duration of SARS-CoV-2 shedding in stool and may serve as a valuable foundation for modelling efforts involving faecal shedding indicators.

Immunization is critical for reducing vaccine-preventable disease morbidity and mortality, yet coverage disparities persist in low-resource settings. This mixed-methods study describes characteristics of childhood immunization defaulters and explores barriers to vaccine adherence in Khyber Pakhtunkhwa, Pakistan. We recruited 380 caregivers from three tehsils in District Kohat of Khyber Pakhtunkhwa from February to July 2023, whose children under 2 years had not completed the Expanded Program on Immunization (EPI)-recommended schedule. Quantitative data from validated questionnaires and immunization cards underwent descriptive and regression analyses; qualitative interviews explored non-adherence reasons. Most respondents were fathers (96.05%); 41.84% resided in rural areas. Initial coverage was high for BCG (97.89%) and OPV0 (100%) but declined for Penta3 (26.05%) and Measles2 (4.21%). Most children (73.95%) were under 4 months. Rural defaulters were more prevalent than urban (41.84% vs. 34.47%, p < 0.001), and 89.47% had mothers with ≤high school education. While 95.26% had heard of vaccines, only 49.47% knew the EPI starting age. Defaulters with higher knowledge progressed further through the schedule (AOR: 4.55, p = 0.05). Qualitative themes included poor healthcare access, cultural norms, religious misconceptions, and migration disruptions. Interventions addressing maternal education, rural access, and knowledge gaps are essential to reduce immunization default.

Orthopaedic inpatients have distinct clinical traits. This study aimed to quantify the burden of nosocomial infections (NIs) on orthopaedic patients. A nested case–control study (2022–2024) at the China National Orthopaedic Medical Center compared orthopaedic inpatients with and without NIs and matched cases and controls 1:3 to evaluate the burden of NIs. A national economic burden analysis was subsequently conducted under various scenarios. Among 120,764 eligible patients, 338 (0.28%) developed NIs. A total of 321 cases were matched with 916 controls. The economic and temporal burdens of NIs are US$2,100 and 5 days per case respectively. Haematologic NIs had the highest additional cost (US$4,295) and the second longest extended stay (9 days). In terms of initial hospitalisations and readmissions, surgical site infections extended hospital stays by 20 days and increased costs by US$4,881. The top three diagnosis-related groups (DRGs) with high burdens are ZC11, ZJ15, and IE21 for costs and ZJ15, IE21, and IB19 for duration. In the mixed-region scenario, orthopaedic specialty hospitals nationwide incur US$5.23 million in direct medical costs annually because of NIs. These findings indicate that NIs significantly affect orthopaedic patients both individually and nationally, necessitating focused prevention and control for high-burden DRGs and specific infections.