Before the onset of the coronavirus disease 2019 (COVID-19) pandemic, the African region already faced a substantial communicable disease burden and a rising prevalence of noncommunicable and chronic conditions. The COVID-19 pandemic has underscored critical vulnerabilities within the health systems in African countries and highlighted the urgent need for self-sufficiency to increase resilience in vaccine manufacturing and clinical trial capacity. In response, substantial efforts are underway to develop vaccine and pharmaceutical manufacturing capabilities across the continent. Ongoing initiatives supported by large donor organizations are aimed at initiating much-needed progress toward greater self-sufficiency in vaccine production in Africa, as coordinated by the Africa Centers for Disease Control. Continued investment, regulatory harmonization, and strengthened international and regional partnerships are essential for Africa to develop sustainable vaccine manufacturing.

Coronavirus disease 2019 (COVID-19) caused substantial disease and death worldwide since December 2019, but the burden was lower in Africa than in high-income countries. To address potential underreporting, we modeled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and disease burden in Burkina Faso and Madagascar.

Prospectively enrolled patients who presented with fever at sentinel healthcare facilities were assessed for active SARS-CoV-2 infection. Household members of SARS-CoV-2-infected patients were prospectively followed for confirmed SARS-CoV-2 infection. Archived serum specimens that spanned the pandemic onset in Madagascar to the start of prospective surveillance were tested for anti-SARS-CoV-2 immunoglobulins. Data from these multiple sources contributed to an integrated analysis to calibrate an epidemiologic mass action model.

COVID-19 accounted for a substantial fraction of healthcare-ascertained febrile illness in both Burkina Faso and Madagascar, with symptom profiles consistent with those previously reported. SARS-CoV-2 vaccination coverage was very low in Burkina Faso and unavailable in Madagascar. The household secondary attack rate was 28% (95% confidence intervals [CI], 22%-35%] in Madagascar and 31% (95% CI: 9%-68%) in Burkina Faso, indicating substantial transmission of the disease within households in both locations. Model simulations estimated that the actual number of SARS-CoV-2 infections was at least nine times higher than the reported number of febrile COVID-19 cases.

Africa has faced persistent challenges due to underinvestment in vaccination programs and disease surveillance programs. There was substantial underreporting of COVID-19 cases during the pandemic in both countries. Our findings call for improving systems and resources in disease surveillance during epidemic and interepidemic periods in these countries.

We evaluated the effectiveness of the Sinopharm coronavirus disease 2019 (COVID-19) vaccine, introduced in Mozambique, against the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), prevalent from March 2022 to December 2023.

A test-negative case-control study was nested in a community-based enhanced COVID-19 surveillance in seven healthcare facilities including mobile testing stations in the Dondo District, Mozambique, between March 2022 and December 2023. Participants were individuals aged ≥2 years with COVID-19-like symptoms for <10 days. Cases were those with polymerase chain reaction (PCR)-confirmed COVID-19. For each case, three PCR test-negative controls were matched, according to age (±5 years), sex, and date of PCR test (±7 days). Follow-up for all cases was conducted until disease resolution. Vaccine protection was assessed according to the association between complete vaccination and SARS-CoV-2 disease onset ≥14 days after vaccination.

The study did not reach the targeted sample size, and only a third were analyzed. A total of 253 cases were matched to 759 test-negative controls by age, sex, and testing date, a process known as matching. Among cases, 41% had one dose of Sinopharm, 53% had two doses, and 6% were unvaccinated. Among the test-negative controls, 37% had 1 dose, 57% had two doses, and 7% were unvaccinated. The adjusted vaccine effectiveness, calculated using matching and adjusted for age and PCR test date, was 18.0% (95% confidence interval, -85.3 to 63.7; P = .63). No COVID-19-positive participants required hospitalization.

In an Omicron-dominant setting, two doses of the Sinopharm vaccine did not show significant protection against symptomatic COVID-19. However, as our analysis was based on data from only a third of enrolled individuals with confirmed vaccination status, these findings should be interpreted with caution. Our results underscore the importance of real-time vaccine effectiveness evaluations to inform optimal rollout strategies in low- and middle-income countries.

Mozambique implemented a phased roll-out of COVID-19 vaccination in 2021. This study aimed to evaluate COVID-19 vaccine acceptability among higher-risk populations in Zambézia Province.

A mixed-methods study in Zambézia Province assessed knowledge, perceptions, and acceptability of COVID-19 vaccination. Structured questionnaire-based surveys among community health workers/volunteers, taxi drivers, and persons with HIV; and focus group discussions using semi-structured guides with community/religious leaders, adults aged 18-49 years and adults aged 50+ years were conducted in August-September 2021. Surveys were captured using tablets; group discussions were recorded. Univariate analyses were performed for quantitative data; qualitative data were analyzed thematically.

A total of 731 individuals participated (539 survey respondents; 192 discussion respondents); 53% male (n = 386) and 74% urban (n = 544) residents. Most had heard about COVID-19 vaccines, mainly through television and/or radio. Trustworthy information sources mentioned were community leaders and healthcare providers. Among survey respondents, 249/539 (46%) reported having received at least 1 vaccine dose. Motivators for vaccination mentioned by survey respondents were "belief that vaccines protect themselves" (72%), "belief it would protect their family" (17%). Myths and beliefs, misinformation, and long queues were main barriers for vaccination mentioned in group discussions. Participants suggested that campaigns should focus on communication talks led by health professionals, in partnership with community or church leaders and/or community health workers/volunteers.

This study showed that information on COVID-19 vaccination had successfully reached the vast majority of study participants, mainly via radio and television. Targeted campaigns specific for rural and urban contexts can increase awareness and uptake of vaccination.

This study evaluated the efficacy and safety of doxycycline in treating Severe Mycoplasma pneumoniae Pneumonia (SMPP) in children under eight years old through clinical analysis and meta-analysis. A total of 92 pediatric SMPP cases were divided into a doxycycline treatment group (44 cases) and a macrolides control group (48 cases). Compared to the control group, the doxycycline group exhibited significantly shorter cough relief time (5.4 ± 1.2 vs. 7.2 ± 1.6 days, p < 0.05) and pulmonary rale resolution time (6.2 ± 1.3 vs. 8.0 ± 1.7 days, p < 0.05). The overall treatment efficacy rate was higher in the doxycycline group (88.6% vs. 75.0%, p < 0.05). No significant differences were found in fever resolution time or hospitalization duration (p > 0.05). Safety analysis revealed comparable adverse event rates between groups (18.2% vs. 16.7%, p > 0.05), primarily mild rash and gastrointestinal discomfort, with no tooth discoloration observed. The meta-analysis confirmed the advantages of doxycycline, demonstrating superior treatment efficacy (RR: 0.68, 95% CI: 0.58-0.79), shorter fever resolution (MD: - 1.5 days, 95% CI: - 2.3 to - 0.7), and faster cough and pulmonary rale resolution. Adverse events were similar across groups. These findings highlight doxycycline's clinical efficacy and safety in SMPP treatment, providing strong evidence for its application in pediatric practice.

With the acceleration of global urbanization, residential proximity to major roadways (RPMR) has been recognized as a significant threat to public health, while the association between road proximity and risks of allergic respiratory outcomes remains unclear. This study aims to evaluate the associations between RPMR and the risks of allergic respiratory outcomes. We conducted a systematic literature search for existing scientific literature from databases of PubMed, EMBASE, Web of Science, Cochrane, and Scopus. The study protocol was registered at PROSPERO (registration ID: CRD42024604182). Random effects models were applied to evaluate the associations between RPMR and the risks of allergic respiratory outcomes by calculating the pooled odds ratio (OR) and corresponding 95% confidence interval (CI). During the study periods, 55 eligible studies were included, comprising 373,320 participants. We found that a close RPMR (≤ 200 m) was associated with increased risks of asthma (OR = 1.23, 95% CI: 1.15, 1.31), wheezing (OR = 1.21, 95% CI: 1.12, 1.30), and rhinitis (OR = 1.22, 95% CI: 1.13, 1.32). In addition, we identified that the closer the RPMR, the higher the risks for allergic respiratory outcomes. The observed associations between RPMR and allergic respiratory outcomes were more pronounced among children and less urbanized areas than in adults and highly urbanized areas. Our study provides comprehensive evidence for the associations between RPMR and risks for allergic respiratory outcomes. The findings may contribute to the practical implications for urban planning and public health strategies to mitigate exposure to traffic-related pollution.

Identification of chronic obstructive pulmonary disease (COPD) diagnosed before 50 years of age ("young COPD") will help enable the study of preventive and therapeutic interventions for classically diagnosed COPD in later life. However, there remains uncertainty about the definition of young COPD and its prognostic significance.

We assessed the prevalence of young COPD, defined here as spirometric airflow obstruction plus symptoms of cough, phlegm, and dyspnea or 10 or more pack-years of smoking, among 18-to-49-year-old participants from four pooled, prospective U.S. cohorts. We evaluated the association of young COPD with premature mortality and respiratory and cardiovascular events over follow-up, using multivariable-adjusted proportional hazards models.

Among 10,680 participants (median age, 40 years; 56.8% women; 41.7% Black; 51.1% unexposed to smoking), the prevalence of people meeting our case definition of young COPD was 4.5%. Compared with nonobstructed participants, the adjusted hazard ratio (an adjusted hazard ratio greater than unity indicates more incident cases) for participants with young COPD for death before 75 years of age was 1.43 (95% confidence interval [CI], 1.19 to 1.73; P<0.001); for incident hospitalization or death due to chronic lower respiratory disease, the adjusted hazard ratio was 2.56 (95% CI, 2.05 to 3.20); for coronary heart disease, the adjusted hazard ratio was 1.12 (95% CI, 0.85 to 1.47); and for heart failure, the adjusted hazard ratio was 1.72 (95%CI, 1.26 to 2.35). The hazards of the clinical outcomes in participants with simple obstruction (spirometric obstruction without symptoms and <10 pack-years; prevalence, 2.4%) were similar to those of nonobstructed participants.

Young COPD was present in 4.5% of adults under 50 years of age in the cohorts examined. The diagnosis was associated with premature mortality as well as respiratory and heart-failure events. (Funded by the National Heart, Lung, and Blood Institute and others.).

Disorders of gut-brain interaction (DGBI), such as irritable bowel syndrome, occur at a higher prevalence in adults with cystic fibrosis (CF), compared to the general population. DGBI are associated with impaired quality of life and significant health-system costs. This study aimed to assess the proportion of cwCF with DGBI, compared to non-CF controls.

Validated for the assessment of DGBI, ROME IV surveys were distributed to cwCF and non-CF controls aged 0-18 years as part of the Evaluating the Alimentary Tracts in Health and Disease (EARTH) observational study. CF participants were recruited from the Sydney Children's Hospital (SCH) CF outpatient clinic between 2018 and 2022. Non-CF controls were recruited from outpatient clinics, advertisements, and word-of-mouth.

Forty-four cwCF (female = 22 [50%], median [IQR] age = 7.04 [2.25-11.06] years) and 48 non-CF controls (female = 22 [45.83%], median (IQR) age = 8.04 [3.57-12.77] years) completed baseline surveys. Symptoms consistent with at least one DGBI were observed more frequently in cwCF compared to non-CF controls (36.36% vs. 10.42%%, p = 0.01). Functional abdominal pain was experienced at a higher prevalence in cwCF compared to non-CF controls (13.79% vs. 0%, p = 0.02). No significant differences in the prevalence of other specific disorders were observed between cwCF and non-CF controls.

Compared to non-CF, cwCF were significantly more likely to experience functional abdominal pain, and at least one DGBI collectively. Further large-scale studies are needed to validate our findings and ascertain the role of routine screening of DGBI in pediatric CF cohorts.

There is a paucity of information on the microbiological profile in Indian children with CF. This study aimed to evaluate the microbial profile of airways in Indian children with CF and to generate antibiotic sensitivity patterns.

Children ≤ 18 years old with newly diagnosed CF (Clinical and two positive sweat chloride tests) were included. The respiratory samples were collected at enrollment, follow-up (FU), and during pulmonary exacerbation.

Three hundred and thirteen children were enrolled with a median (IQR) age of 2.8 (0.6, 8) years; 197 (62.9%) were boys. 530 microbiological samples were collected during the study period. At enrollment, Pseudomonas aeruginosa was the most common organism detected in 63 (36.8%) children, followed by Staphylococcus aureus (32, 18.7%), Escherichia coli (23, 13.4%), Klebsiella pneumoniae (12, 7.0%), Acinetobacter baumanii (8, 4.7%), and Haemophilus influenzae (3, 1.7%). During FU, P. aeruginosa was also the most common organism detected in 56 (26.8%) samples, followed by S. aureus (43, 20.5%). The median age of P. aeruginosa infection was 1.3 (0.5, 6.4) years, whereas it was 4.3 (1.5, 12.6) years for S. aureus. Chronic P. aeruginosa infection was noted in 21 (6.7%) children, which was significantly associated with increasing age and lower weight. Antibiotic resistance was observed in 1.8%-76.6% of samples.

This study explores the first nationwide microbiological profile of the airway in Indian children with CF. P. aeruginosa was the most common isolated organism at enrollment and during FU. This study provides antibiotic sensitivity patterns to common organisms that will help to promote antibiotic stewardship and formulate policies for children with CF in this region.

Objective: To investigate the epidemiological characteristics of allergic rhinitis (AR) among adults in Yinchuan, focusing on its prevalence and associated risk factors in recent years. Methods: A cross-sectional epidemiological survey was conducted among adult residents in Yinchuan from June to October 2022, including three districts, two counties, and one city, to identify and analyze factors influencing the incidence of AR in the population. Results: A total of 3 345 individuals were surveyed, including 1 891 males (56.5%) and 1 454 females (43.5%). The overall AR prevalence was 17.2% (576/3 345). The self-reported prevalence was 16.2% (306/1 891) in males and 18.6% (270/1 454) in females, with no statistically significant difference (χ²=3.29, P=0.07). The prevalence was significantly lower among the elderly (aged over 60 years) at 11.8% (60/509) compared to the middle-aged (aged 40-59 years) at 17.1% (202/1 183) and young adults (aged 18-39 years) at 19.0% (314/1 653, χ²=10.36, P=0.023). Han nationality had the highest self-reported prevalence (18.8%, 446/2 372), followed by other ethnic minorities (17.6%, 13/74), and Hui nationality (13.0%, 117/899; χ²=11.21, P=0.004). Regionally, Xingqing District had the highest self-reported prevalence at (19.5%, 188/964), followed by Jinfeng District (18.7%, 151/808), Lingwu City (17.5%, 58/332), Xixia District (14.9%, 78/522), Yongning County (14.3%, 49/342), and Helan County (13.8%, 52/377; χ²=35.68, P=0.038). In terms of disease severity, mild cases made up 55.4% (319/576), while moderate to severe cases constituted 44.6% (257/576). In terms of symptom characteristics, perennial AR patients accounted for 18.8% (108/576), seasonal AR patients accounted for 81.2% (468/576), and 25.7% (148/576) of self-reported AR patients had other allergic diseases. Regarding diagnosis and treatment, 38.7% (223/576) of patients underwent allergen tests, 65.1% (375/576) received medication, but 62.3% (359/576) reported symptoms persisting for 2-year post-treatment, 32.6% (188/576) reported uncontrolled symptoms, and 5% (29/576) experienced symptoms worsening. Conclusions: The study provides a preliminary understanding of the epidemiological characteristics of AR in Yinchuan. These findings provide a reference for formulating relevant public health policies, clarifying prevention and treatment strategies, and improving the prevention and control system for AR.