Objective: To evaluate the dosing, efficacy and safety of the main antileishmanial agents amphotericin B (conventional or liposomal), pentavalent antimonials, miltefosine and paromomycin recommended for the treatment of visceral leishmaniasis in children.

Methods: The efficacy and safety of visceral leishmaniasis treatments in children were systematically reviewed using literature from PubMed, Cochrane, clinicaltrials.gov, and Google Scholar, focusing on randomised trials with separate pediatric data (published from 2000-2024). The risk of bias of selected trials was assessed using the revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Reporting was done per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist.

Results: Of 1 186 records, only 7 were eligible for qualitative synthesis. Three trials exclusively included children. The treatment regimens studied showed high heterogeneity and lacked sufficient data for a meta-analysis. Most trial arms reported efficacies over 94% for children across different regimens. Miltefosine monotherapy showed the highest rate of late treatment failures, highlighting that allometric dosing is crucial to ensure proper drug exposure in children. Safety data for children were available in only three studies with varied reporting systems of adverse events. Although regimens in this review were generally considered to be safe in children, antimonial-related cardiac toxicity remains a threat.

Conclusions: This review highlights the need for pediatric-specific trials, clear presentation of pediatric data, and systematic documentation of adverse events to enhance evidence for policy-making and pediatric guideline development.

Objective: To investigate factors influencing vaccine hesitancy and its effects on SARS-CoV-2 infection in multiple myeloma (MM) patients during the Omicron BA.4/5 subvariant outbreak.

Methods: This cross-sectional study was conducted in mainland China from December 26, 2022, to April 20, 2023. An expert-developed anonymous online questionnaire was distributed via WeChat mini-program to several groups of 500 MM patients, each comprising of 500 patients. The questionnaire covered demographic characteristics, MM medical attributes, COVID-19 vaccine status, and clinical manifestations of COVID-19. Data were analyzed to assess the impact of vaccination on COVID-19 infection rates and the disease severity among MM patients.

Results: Among 508 valid responses from 30 provinces, only 34.1% (n=173) of MM patients reported receiving COVID-19 vaccination, and the proportions were lower among patients who had undergone autologous stem cell transplantation (20.2% vs. 48.4%, P<0.001). Vaccine hesitancy was primarily attributed to physician recommendations (52.0%), conflicts with MM treatment (37.8%), and concerns about MM progression (31.3%). Hospitalization due to severe SARS-CoV-2 infections was significantly reduced in the vaccinated group (4.8% vs. 12.3%, P=0.038).

Conclusions: The lower infection rate in MM patients may be attributed to stringent quarantine measures and self-imposed social restrictions. While vaccination did not directly correlate with fewer SARS-CoV-2 infections, it did afford protection to vulnerable populations. Clinicians are encouraged to recommend vaccines to MM patients to mitigate severe infections and associated mortality during recurrent COVID-19 waves.

Objective: To predict the distribution of dengue vector Aedes (Ae.) albopictus and identify high-risk areas for dengue fever transmission.

Methods: Data on Ae. albopictus occurrences were collected from electronic databases. Ensemble models were developed to assess the impacts of climate, vegetation, and human activity on Ae. albopictus. The optimal ensemble model was then used to identify the distribution of suitable areas for Ae. albopictus.

Results: After removing duplicate sites and retaining only one location per 100 m × 100 m grid, 189 Ae. albopictus breeding sites were identified. The optimal ensemble model revealed that Ae. albopictus exhibited higher breeding suitability in Shanghai under specific conditions: a normalized difference vegetation index of 0.1 to 0.6, maximum precipitation in the warmest month ranging from 400 mm to 470 mm, maximum temperature in the warmest month between 30.0 °C and 31.0 °C, and proximity to waterways within 0.5 km. The most suitable habitats for Ae. albopictus were primarily concentrated in Shanghai’s central urban areas and scattered across the inner suburban districts.

Conclusions: The high-risk areas of Ae. albopictus are widely distributed throughout the central urban area and scattered across the inner suburban district of Shanghai, creating conditions conducive to the outbreak of dengue fever. It is essential to enhance targeted control measures for Ae. albopictus in the identified risk areas.

Objective: To investigate mutations in the Chikungunya (CHIKV) envelope genome region and evaluate their potential impact on B lymphocyte epitopes via in silico analysis.

Methods: E1, E2 and 6K protein genes were sequenced from viral RNA isolated from 13 CHIKV-positive serum samples from Alagoas State, Brazil, during the 2016 outbreak. Phylogenetic analysis, experimental epitope identification in the immune epitope database (IEDB) and in silico approaches were employed to predict the potential impact of the detected mutations.

Results: The sequences were clustered via phylogenetic analysis. The CHIKV isolates belong to the ECSA genotype, with 13 detected amino acid mutations. Five mutations are located on the surface of the viral particle in regions critical for cellular receptor interaction. Nine mutations are known experimentally validated epitopes for B and T cells. In B-cell epitope predictions, mutations affect sequences within three conformational epitopes in E2 and one in E1, as well as linear epitopes. Notably, the E2-G60D mutation found in the Alagoas strain has been previously reported to influence the vector competence of Aedes aegypti, the primary vector in Brazil.

Conclusions: Genomic surveillance and an in-depth understanding of viral mutations are crucial for adapting public health strategies and improving the outbreak response. These findings could have significant public health implications, such as the development of more effective vaccines, diagnostic tests, and antiviral therapies.

Rationale: Enteric fever is a major public health problem in developing and underdeveloped counties. Extraintestinal manifestations in typhoid are estimated in 27% cases and are associated with severe and complicated diseases.

Patients concerns: We report three cases of enteric fever with rare extra intestinal manifestations.

Diagnoses: Enteric fever with acute motor-sensory axonal neuropathy, enteric fever with myocarditis, and enteric fever with splenic vein thrombosis.

Interventions: All patients were treated with antibiotics. Additionally, Patient 1 was treated with IV immunoglobulin; Patient 2 was treated with vasopressors and anti-cardiac remodeling drugs like ramipril and metoprolol; Patient 3 was treated with anticoagulation with low molecular weight heparin.

Outcomes: All patients improved clinically and were followed up on outpatient.

Lessons: The diagnosis of enteric fever is challenging and there is an urgent need for prompt-targeted management for better outcomes. Especially in endemic zones and in non-endemic zones as a disease of emporiatric significance.