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Journal articleHemmings SJ, Varaden D, Barnes J, et al., 2027,
Diversity analysis of indoor and outdoor fungal bioaerosols in UK households: a prospective, observational, longitudinal study.
, Lancet MicrobeBACKGROUND: Long-term exposure to indoor fungal bioaerosols is a recognised risk factor for respiratory illness, particularly in damp and poorly ventilated housing. However, the diversity and seasonal variability of these fungal communities are poorly understood. As part of the West London Healthy Home and Environment Study (WellHome), this study aimed to characterise the composition, diversity, and temporal dynamics of indoor fungal bioaerosols in urban UK homes, as compared with outdoor air, to inform future exposure baselines and policy development. METHODS: In this prospective, community-based observational study, 118 households were recruited across West London, UK, via community networks and partner organisations, prioritising families with children aged 5-17 years with asthma or allergies, from diverse socioeconomic backgrounds. Sampling occurred between Oct 3, 2022, and June 14, 2024. Participant data were collected via questionnaires completed by household members, capturing demographics, building characteristics, and respiratory health. Passive-air samplers were used in living rooms for 28 days during two seasonal campaigns, with concurrent outdoor sampling at four fixed community sites. Fungal bioaerosols were identified by ITS2 amplicon sequencing and quantified using broad-range quantitative PCR targeting the 18S rRNA gene. Diversity indexes and temporal dynamics were analysed using ecological statistics and generalised additive models. FINDINGS: 118 households were enrolled, comprising 504 residents (263 women, 237 men, and four not reported). Among 504 participants who self-identified, the largest groups comprised individuals identifying as Black African (n=47), Somali (n=46), White British (n=42), and African (n=38), with additional representation from mixed race ethnic backgrounds (n=29), Black British (n=27), White (n=22), and Black Caribbean (n=18), alongside several other ethnicities each represented at lower frequencies. Of 118 households, 104 c
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Journal articleNgwili N, Kachepa U, Korir M, et al., 2026,
Spatial and temporal risk mapping of human and porcine Taenia solium infections in Malawi: a systematic review and geostatistical approach
, One Health Outlook, Vol: 8, ISSN: 2524-4655Background Taenia solium, colloquially called the pork tapeworm, is a zoonotic parasite with a human definitive host and a porcine intermediate host. Humans can become an aberrant intermediate host due to accidental ingestion of parasite eggs from the environment or through autoinfection, resulting in human cysticercosis (HCC), neurocysticercosis (NCC) if the central nervous system is infected. Pigs become infected with the larval stage, porcine cysticercosis (PCC), through the ingestion of parasite eggs shed by humans through defecation. Malawi has been classified as endemic for T. solium by the WHO based on the presence of key risk factors; however, the subnational distribution is not known. To ensure the appropriate resources are mobilized to support targeted future T. solium control measures in Malawi, there is a need to understand the variation in T. solium endemicity status across the country.Methods The current study uses a systematic literature review (SLR) using a pre-registered protocol; (PROSPERO CRD42023411044) to collate all available evidence on T. solium in Malawi. A geospatial risk mapping approach was conducted based on data from Malawi demographic health surveys (MDHS), and pig density data from the Food and Agriculture Organization (FAO) database to create geospatial risk maps of endemic subnational areas for 2000, 2004, 2010, and 2016. To create a single composite risk factor map for the four years from the MDHS, each parameter was plotted as a binary variable with the high or low risk categories and overlaid into a single composite risk factor classification. Additional data from hospital records on NCC and meat inspection records across several Agricultural Development Divisions (ADDs) were also collected.
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Journal articleLopes BC, Dutra JVR, Moreira FRR, et al., 2026,
Wastewater surveillance of dengue and chikungunya during the worst arbovirus epidemic in Brazil.
, Water Res, Vol: 300This study evaluated wastewater-based epidemiology (WBE) for monitoring dengue virus (DENGV) and chikungunya virus (CKV) during Brazil's most severe arbovirus epidemic, focusing on the city of Belo Horizonte, Minas Gerais. From March 2022 to August 2024, 24-hour composite raw sewage samples were collected weekly from two major wastewater treatment plants, encompassing over 80% of the city's population. Viral RNA was quantified via RT-qPCR and positive samples underwent genome sequencing for genotype characterization. DENGV and CKV RNA were detected in over 90% of samples across both wastewater treatment plants (WWTPs), demonstrating sustained and widespread viral circulation throughout epidemic and inter-epidemic periods. Although CHIKV concentrations varied significantly across years, DENGV concentrations remained statistically stable, and no significant correlations were observed between wastewater viral loads and reported clinical cases. A considerable proportion of samples presented concentrations below the limit of quantification, indicating that while WBE is highly sensitive for qualitative detection of arboviruses, quantitative interpretation remains methodologically constrained. Sequencing confirmed the presence of DENGV-1 sorotype I and CKV genotype V, clustering with contemporaneous Brazilian strains and reflecting regional transmission dynamics. Wastewater-based modelling further suggested that reported clinical cases may substantially underestimate true infection burden, although quantitative estimates were highly sensitive to assumptions regarding viral shedding variability. These findings demonstrate that WBE provides a sensitive, non- invasive, population level approach for tracking arboviral circulation and viral diversity during large-scale outbreaks and could complement public health surveillance frameworks, especially in regions with limited diagnostic capacity or high levels of underreporting, to enhance epidemic response and control strategies.
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Journal articleKim Y, Donnelly CA, 2026,
Estimating the Potential Burden of Clinically Significant Hantavirus Cases in Argentina
, Lancet Regional Health Europe, Vol: 66 -
Journal articleMohan S, Chagoma N, Walker S, et al., 2026,
Estimating System-Wide Healthcare Costs Using a Health System Model: Application to the Thanzi La Onse Model of Malawi.
, Appl Health Econ Health Policy, Vol: 24, Pages: 707-725OBJECTIVES: Modelling approaches that consider system-wide delivery platforms rather than single diseases can be instrumental in economic evaluation and forward-looking policy formulation. This study develops a costing approach tailored to the Thanzi La Onse (TLO) model of Malawi's healthcare system, with general applicability to other health system models. METHODS: We developed a mixed-method costing approach to estimate the total cost of healthcare delivery (excluding high-level administrative costs) in Malawi using the TLO model, from a healthcare provider perspective. Through iterative adjustments of key parameters, we aligned model-based estimates as closely as possible with real-world expenditure and budget data. Costs were projected for 2023-2030 under alternative scenarios of health system capacity. RESULTS: A comparison with expenditure and budget data suggests our costing method is broadly reliable for the conditions captured by the model, though some mismatches remain owing to data limitations and definitional inconsistencies. Under current system capacity, total healthcare delivery costs for 2023-2030 were estimated at 2.83 billion US dollars [95% uncertainty interval (UI), $2.80-$2.87 billion], excluding non-medical infrastructure and administrative costs, averaging $390.98 million [$385.92-$396.71 million] annually or $16.89 [$16.75-$17.08] per capita. Scenario analysis highlighted strong interdependencies within the health system. Improving consumable availability alone increased consumables costs by 4.63%, while expanding human resources for health (HRH) alone increased them by 1.43%. When both HRH and consumable availability were expanded together, consumable costs rose by 5.93%, a combined effect larger than either change alone, illustrating how bottlenecks in one component constrain the impact of improvements in another. CONCLUSIONS: Mixed-method costing using health system models is a feasible and robust method to estimate and forecast
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Journal articleKhurana MP, Katsiferis A, Scheidwasser N, et al., 2026,
Large-scale genomic surveillance reveals immunosuppression drives mutation dynamics in persistent SARS-CoV-2 infections.
, Nat CommunPersistent SARS-CoV-2 infections have been hypothesized to play a key role in the emergence of variants of concern. However, the factors determining which individuals are at risk and their viral molecular signatures during infection remain poorly understood. Using Denmark's extensive COVID-19 surveillance, comprising over 700,000 genomes, we identify 303 persistent infections and, critically, link them to health and sociodemographic data. Our analysis confirms the hypothesis that immunocompromised individuals are at the highest risk of experiencing persistent infections. Other disease groups associated with mortality, such as diabetes, show no such associations. Among these persistent infections, the viral sequences exhibit signs of positive selection, with recurrent mutations linked to treatment resistance. Our findings suggest that immunosuppression plays a key role in the emergence of novelty in persistent infections.
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Journal articleShah A, 2026,
Impact of allergic bronchopulmonary aspergillosis overlap in chronic pulmonary aspergillosis
, ERJ Open Research, ISSN: 2312-0541Background: Chronic pulmonary aspergillosis (CPA) is a destructive fungal infection caused by Aspergillus fumigatus, leading to significant morbidity in individuals with structural lung disease. Clinical and immunological overlap with allergic bronchopulmonary aspergillosis (ABPA) has been recognised, but its extent and prognostic relevance remain uncertain. This study assessed ABPA features in CPA and their relationship with immunological markers and long-term outcome.Methods: We conducted a retrospective cohort study including individuals with confirmed CPA at the Royal Brompton Hospital until December 2023. Diagnoses followed ERS/ESCMID and 2024 ISHAM criteria. Demographic, clinical, microbiological, and immunological data were analysed, and group comparisons performed using logistic regression and Cox proportional hazards models.Results: Among 166 individuals with CPA, 45 (27%) met ABPA diagnostic criteria. CPA–ABPA overlap was independently associated with asthma (OR-10.16) and pan-azole resistance (OR-19.37), and inversely with sarcoidosis (OR-0.22). Overall 5-year survival was 82% (84.6% in CPA alone vs 76.6% in overlap; p=0.44). Older age, lower BMI and albumin, elevated A. fumigatus-specific IgE and IgG were associated with higher mortality, while longitudinal increase in A. fumigatus-specific IgE was also linked to worse outcome. Low serum albumin independently predicted mortality (HR 0.72; p=0.001).Discussion: CPA–ABPA overlap represents a distinct clinical phenotype linked to airway disease, antifungal resistance, and Th2-driven inflammation. Nutritional status and immunological activity, particularly rising A. fumigatus-specific IgE, emerged as key prognostic markers, linking type 2 inflammation to disease progression. These findings highlight the need for phenotype-based risk stratification and exploration of targeted immunomodulatory strategies in CPA.
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Journal articleBuckley EJ, Mancinelli E, Walker M, et al., 2026,
Development and validation of a cephalic conformation scoring system for the domestic rabbit (Oryctolagus cuniculus).
, Vet RecBACKGROUND: Extreme cephalic conformation has been theorised to be associated with compromised health in rabbits. However, recognition and assessment of such phenotypes remain largely subjective. This study aimed to develop and validate a visual, semi-quantitative system for head shape phenotype in rabbits. METHODS: Images of rabbits were collected and visually analysed for comparative phenotypic patterns, with a 1-5 grading scale subsequently created. Initial validation of the system was conducted via an online pilot survey across 24 experienced individuals. Interobserver agreement across scores was calculated to assess the reliability of the system. RESULTS: The proposed system yielded strong, 'almost perfect' and statistically significant interobserver agreement for cephalic assessment (W = 0.908, 95% bias-corrected and accelerated [BCa] confidence interval [CI]: 0.858-0.950; α = 0.880, 95% CI: 0.875-0.885), with largely positive feedback from veterinary professionals. LIMITATIONS: Further development and validation of the system are required for complete, reliable assessment of all rabbits, particularly those with longer fur. Wider participation in the validation of this method from across the profession is also necessary. CONCLUSION: This system has the potential to enhance conformational assessment in rabbits. Implementation of the system in clinical practice may help to promote awareness of potential conformation-associated health risks and catalyse discussions regarding responsible ownership. The system may also support further studies into the precise influence of conformation on disease risk.
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Journal articleMcCormack C, Goethals O, Goeyvaerts N, et al., 2026,
Estimating the in vivo prophylactic effect of mosnodenvir, a novel dengue antiviral, on DENV-2 infection.
, J R Soc Interface, Vol: 23Almost half of the world's population is at risk of acquiring dengue virus (DENV) each year. However, no specific licensed prophylactic or antiviral treatment for dengue currently exists. Mosnodenvir, a novel DENV inhibitor, has been shown to inhibit DENV replication in vitro and in animal studies. Here, we provide new insights into the in vivo prophylactic inhibitory effect of mosnodenvir exposure on primary DENV-2 infection by fitting mechanistic within-host models of DENV infection to virological and serological data observed from pre-clinical challenge studies in AG129 mice and rhesus macaques. We estimated a median mosnodenvir concentration achieving 50% of maximal inhibitory effect (IC50) on viral replication of 8.35 (6.82, 9.22) ng ml-1 and 7.61 (5.67, 8.92) ng ml-1 for AG129 mice and rhesus macaques, respectively. A higher concentration is typically required to suppress viral replication in AG129 mice compared with rhesus macaques owing to a higher estimated within-host basic reproduction number (R0) in mice. By integrating multiple data types in a single framework, this study enhances our understanding of the within-host dynamics of primary DENV infection in non-human host species. Furthermore, the methods developed here could possibly assist in quantifying the prophylactic inhibitory effect of mosnodenvir on DENV infections in humans.
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Journal articleMcCabe R, Ebbarnezh L, Okware S, et al., 2026,
Estimation of the Ebola outbreak size in the Democratic Republic of the Congo.
, Lancet Infect Dis
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