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Background Air pollution is one of the world’s leading mortality risk factors contributing to seven million deaths annually. COVID-19 pandemic has claimed about one million deaths in less than a year. However, it is unclear whether exposure to acute and chronic air pollution influences the COVID-19 epidemiologic curve. Methods We searched for relevant studies listed in six electronic databases between December 2019 and September 2020. We applied no language or publication status limits. Studies presented as original articles, studies that assessed risk, incidence, prevalence, or lethality of COVID-19 in relation with exposure to either short-term or long-term exposure to ambient air pollution were included. All patients regardless of age, sex and location diagnosed as having COVID-19 of any severity were taken into consideration. We synthesised results using harvest plots based on effect direction. Results Included studies were cross-sectional ( n  = 10), retrospective cohorts ( n  = 9), ecological ( n  = 6 of which two were time-series) and hypothesis (n = 1). Of these studies, 52 and 48% assessed the effect of short-term and long-term pollutant exposure, respectively and one evaluated both. Pollutants mostly studied were PM 2.5 (64%), NO 2 (50%), PM 10 (43%) and O 3 (29%) for acute effects and PM 2.5 (85%), NO 2 (39%) and O 3 (23%) then PM 10 (15%) for chronic effects. Most assessed COVID-19 outcomes were incidence and mortality rate. Acutely, pollutants independently associated with COVID-19 incidence and mortality were first PM 2.5 then PM 10 , NO 2 and O 3 (only for incident cases). Chronically, similar relationships were found for PM 2.5 and NO 2 . High overall risk of bias judgments (86 and 39% in short-term and long-term exposure studies, respectively) was predominantly due to a failure to adjust aggregated data for important confounders, and to a lesser extent because of a lack of comparative analysis. Conclusion The body of evidence indicates that both acute and chronic exposure to air pollution can affect COVID-19 epidemiology. The evidence is unclear for acute exposure due to a higher level of bias in existing studies as compared to moderate evidence with chronic exposure. Public health interventions that help minimize anthropogenic pollutant source and socio-economic injustice/disparities may reduce the planetary threat posed by both COVID-19 and air pollution pandemics.

Sara Cooper and colleagues argue that a better understanding of the complex sociopolitical drivers of distrust in vaccination will increase the potential of social media to rebuild vaccine confidence

Background Household air pollution (HAP) from biomass fuel combustion is a major contributor to respiratory morbidity and mortality among children in sub-Saharan Africa (SSA). Despite the growing body of evidence, the effects of prenatal and postnatal HAP exposure on child respiratory outcomes remain incompletely understood. Methods We conducted a systematic review and meta-analysis of studies reporting the impact of prenatal and/or postnatal exposure to HAP on respiratory health in children aged < 18 years in SSA. We searched eight major databases up to March 31, 2025, and assessed risk of bias using ROB2.0 and ROBINS-I tools. Random-effects models were used to estimate pooled relative risks (RR) and mean differences (MD), with heterogeneity assessed by I² statistics. Results Eighteen studies met the inclusion criteria, including randomized trials, cross-sectional, and case-control designs from ten SSA countries. Exposure to CO, NO₂, PM 10 , and PM 2.5 was significantly associated with increased risk of respiratory disease. CO exposure was linked to respiratory symptoms (mean concentration = 0.44 ppm; 95% CI [0.27, 0.62]), NO₂ to pulmonary tuberculosis (mean concentration = 20.16 ppm; 95% CI [14.15, 26.16]), and PM 10 and PM 2.5 to acute respiratory infections (mean concentration = 61.25 µg/m³ and 27.36 µg/m³ respectively; p  < 0.001). Postnatal and prenatal exposures both increased the risk of pneumonia and impaired lung function, including reduced FVC and FEV1. Improved cookstove interventions reduced general respiratory symptoms (RR = 0.80; 95% CI [0.75, 0.85]) but showed limited effect on severe outcomes such as pneumonia. Overall, our findings yielded moderate evidence. Conclusion Prenatal and postnatal exposure to HAP is associated with increased respiratory morbidity and impaired lung function among children in SSA. While clean cooking interventions may reduce symptoms, substantial pollutant reductions are needed to achieve meaningful health outcomes. Future research should focus on longitudinal designs, refined exposure assessment, and the identification of critical exposure windows to inform targeted interventions.

In sub-Saharan Africa, little is known about pulmonary hypertension in left heart disease (PH-LHD). We used multivariate logistic and cox-hazard proportional regression models to examine factors associated with increased right ventricular systolic pressure (RVSP) and the effect of real-world HIV status scenarios on 6-month survival rate in the Pan African Pulmonary Hypertension Cohort (PAPUCO) study, a prospective cohort from four African countries. Exposure to biomass fuel smoke (aOR, 95%CI 3.07, 1.02–9.28), moderate to severe NYHA/FC III/IV (aOR, 95%CI 4.18, 1.01–17.38), and unknown HIV status (aOR, 95%CI 2.73, 0.96–7.73) predicted moderate to severe RVSP at the time of presentation. Six months later, HIV infection, moderate-to-severe NYHA/FC, and alcohol consumption were associated with decreased survival probabilities. Upon adjusting for HIV infection, it was observed that an incremental rise in RVSP (1 mmHg) and inter-ventricular septal thickness (1 mm) resulted in an 8% (aHR, 95%CI 1.08, 1.02–1.13) and 20% (aHR, 95%CI 1.2, 1.00–1.43) increase in the probability of mortality due to PH-LHD. In contrast, the risk of death from PH-LHD was reduced by 23% for each additional unit of BMI. (aHR, 95%CI 0.77, 0.59–1.00). In conclusion, the present study offers insights into the determinants that are notably linked to unfavorable survival outcomes in patients with pulmonary hypertension due to left heart disease. Certain factors identified in this study are readily evaluable and amenable to modification, even in settings with limited resources.

Telomere length (TL) is a marker of ageing and mitochondrial DNA (mtDNA) is an early marker of inflammation caused by oxidative stress. We determined TL and mtDNA content among active pulmonary tuberculosis (PTB) patients to assess if these cellular biomarkers differed between artisanal miners and non-miners, and to assess if they were predictive of treatment outcome. We conducted a prospective cohort study from August 2018 to May 2019 involving newly diagnosed PTB patients at three outpatient TB clinics in a rural Democratic Republic of Congo. We measured relative TL and mtDNA content in peripheral blood leukocytes (at inclusion) via qPCR and assessed their association with PTB treatment outcome. We included 129 patients (85 miners and 44 non-miners) with PTB (median age 40 years; range 5–71 years, 22% HIV-coinfected). For each increase in year and HIV-coinfection, TL shortened by − 0.85% (− 0.19 to − 0.52) (p ≤ 0.0001) and − 14% (− 28.22 to − 1.79) (p = 0.02) respectively. Independent of these covariates, patients with longer TL were more likely to have successful TB treatment [adjusted hazard ratio; 95% CI 1.27 for a doubling of leucocyte telomere length at baseline; 1.05–1.44] than patients with a shorter TL. Blood mtDNA content was not predictive for PTB outcome. For a given chronological age, PTB patients with longer telomeres at time of diagnosis were more likely to have successful PTB treatment outcome.

The 2022 global mpox outbreak, caused by clade IIb of the monkeypox virus (MPXV), prompted emergency use authorisation of the Modified Vaccinia Ankara–Bavarian Nordic (MVA-BN) vaccine, previously approved for smallpox prevention. Understanding immune responses to the MVA-BN vaccine is critical to inform both current and future mpox vaccine policy, particularly amid reports of breakthrough infections in vaccinated persons, uncertainty about the durability of vaccine-induced protection, and the emergence of further outbreaks of mpox from different viral clades, including the clade I-driven public health emergency of international concern. MVA-BN elicits binding and neutralising antibody, memory B cells, and T cell responses. Immune responses vary by host factors, prior orthopoxvirus exposure, and dosing regimens. While seroconversion is generally robust, circulating antibody titres often wane rapidly, particularly in vaccinia-naïve and/or immunocompromised individuals, including people with HIV. Vaccine-induced neutralising antibody responses to MPXV are frequently lower than to vaccinia virus, and their role in protection remains ill-defined. In contrast, T cell responses appear more sustained and may support long-term immunity in the absence of persistent antibody titres. This narrative review synthesises current evidence on the immunogenicity and durability of MVA-BN vaccination, highlights challenges in assay interpretation, and outlines key research priorities, including the need to explore correlates of protection, booster strategies, and next-generation vaccine design.

In August, 2024, a male nurse aged 32 years, who had treated patients with suspected mpox, presented at the mpox treatment centre at the Uvira Referral Hospital after a 2-day motorbike transfer from a rural hospital due to worsening condition despite 3 weeks of supportive treatment. Additionally, while HIV testing and case management are available for free at the Uvira Referral Hospital through the national HIV programme, they are not integrated into the standard mpox treatment centre care package. Investments in universal health coverage and local capacity building are essential for addressing complex patient needs during epidemics and beyond. 3–5 Integrated models would enable comprehensive care, timely diagnostics, appropriate therapies, and tailored nutritional support, ensuring better outcomes.

Background Recently, a total of 74 circulating vaccine-derived poliovirus (cVDPV) outbreaks were detected in 39 countries, with 672 confirmed Acute Flaccid Paralysis (AFP) cases identified in 27 countries. Despite progress, Niger experienced cVDPV outbreaks in 2018, highlighting the importance of maintaining AFP surveillance as a tool for polio eradication. This analysis aims to comprehensively assess AFP surveillance trends, patterns, and challenges in Niger, offering insights for public health initiatives in conflict-affected contexts. Methods We analyzed nationwide AFP surveillance data from 2016 to 2021. The data included information about the person's background, vaccinations, medical history, cVDPV, AFP cases, stool samples, how quickly AFP cases were reported, how complete weekly zero reporting (WZR) was, and non-polio enteroviruses (NPEV). Tables, graphs, and maps presented the study findings. Results A total of 4,134 AFP cases under 15 years old were included, with a sex ratio of 1.3. Most cases (79.85%) were aged 1 to 4 years, and 79.44% received three or more doses of oral polio vaccine (OPV). Fever onset (90.13%), asymmetric paralysis (80.33%), and a 3-day AFP progression (80.48%) were common. cVDPV2 was found in 33 cases, predominantly in Zinder province. The annualized non-polio AFP rate per 100,000 population < 15 years fluctuated, with the lowest at 2.5 in 2016 and highest at 8.7 in 2018 (mean 5.93). Surveillance indicators, including faecal specimen collection, follow-up exams, NPEV detection, timeliness of AFP case notification, WZR, and timely laboratory results performed above the set target. However, stool specimen quality was suboptimal (69% in 2016), timeliness of AFP case investigation and contact sampling, and stool transportation times were below the set target. Five districts reported less than 80% stool adequacy. Conclusion This study underscores the importance of continued AFP surveillance in Niger, with room for improvement in stool specimen quality and transportation times. Enhancing these aspects can improve public health efforts in conflict-affected areas and contribute to polio eradication in the region.

COVID-19 vaccination rates in South Africa remain low at 51% of the adult population being fully vaccinated, defined as having two shorts of the COVID-19 vaccine with or without a booster. To improve vaccine uptake, a community-based intervention was tested in a high vaccine hesitancy community in South Africa. Trained community youths used social media, face to face interactions, door to door and neighbourhood outreach activities to deliver the intervention. To assess if the intervention had an impact, data was collected before the intervention and after the intervention in two districts, Wentworth an intervention site and Newlands East a control site. Both districts are in KwaZulu Natal Province, South Africa. The following outcomes, changes on perceptions and knowledge about COVID-19, intention to get vaccinated for those who were not fully vaccinated and vaccination uptake were assessed using difference-in-difference methods applied through Augmented Inverse-Probability Weighting and contrasts of Potential Outcome Means (POM). One thousand, one hundred and fifty (1 150) participants agreed to take part in the study at baseline, and 916 (80%) were followed up after the 9-week intervention period. Intention to get vaccinated for COVID-19 was higher (difference-in-difference, DID 20%, 95% CI 6% – 35% higher), more people were fully vaccinated (DID 10%, 95% CI 0% – 20%) or partially vaccinated (DID 16%, 95% CI 6% – 26%) in Wentworth the intervention site compared to Newlands East, the control site. There were noticeable increases on the percentage of study participants indicating trust on the Government’s COVID 19 programme, from 24% at baseline to 48% after the intervention in the intervention group than in the control group, 26% baseline and 29% at follow-up. There was a 10% (absolute) increase on the percentage of participants’ saying they believed health care workers provided reliable information, 58% at baseline and 68% at follow-up in the intervention group, but there was little change in the control group 56% and 57% for baseline and follow-up respectively. The youth-led intervention implemented in Wentworth, a community with a high rate of vaccine hesitancy, was effective in increasing vaccination uptake. Given the low COVID-19 vaccine coverage in South Africa and across the African region, as well as the new emerging variant of concern (XBB 1.5), there is an urgent need to scale up such intervention at the community level to address persistent misinformation and promote vaccine equality.