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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is evolving differently in Africa than in other regions. Africa has lower SARS-CoV-2 transmission rates and milder clinical manifestations. Detailed SARS-CoV-2 epidemiologic data are needed in Africa. We used publicly available data to calculate SARS-CoV-2 infections per 1,000 persons in The Gambia. We evaluated transmission rates among 1,366 employees of the Medical Research Council Unit The Gambia (MRCG), where systematic surveillance of symptomatic cases and contact tracing were implemented. By September 30, 2020, The Gambia had identified 3,579 SARS-CoV-2 cases, including 115 deaths; 67% of cases were identified in August. Among infections, MRCG staff accounted for 191 cases; all were asymptomatic or mild. The cumulative incidence rate among nonclinical MRCG staff was 124 infections/1,000 persons, which is >80-fold higher than estimates of diagnosed cases among the population. Systematic surveillance and seroepidemiologic surveys are needed to clarify the extent of SARS-CoV-2 transmission in Africa.

Measles remains a leading cause of vaccine-preventable mortality in Africa, despite the availability of safe and effective vaccines. The World Health Organization recommends ≥95 % coverage with two doses of a measles-containing vaccine (MCV) to achieve elimination. In The Gambia, coverage with the second dose of measles containing vaccine (MCV2) remains below this target. Understanding the factors associated with sub-optimal MCV2 coverage in The Gambia is crucial for developing strategies to improve vaccine coverage. We conducted a secondary analysis of data from the 2019 Gambia Demographic and Health Survey to identify determinants of MCV2 vaccination among children aged 18–35 months (n = 1010). Multivariable logistic regression was used to assess associations between MCV2 vaccination status and child-, caregiver-, and household-level factors and interactions between these factors. MCV2 coverage was 67.7 %. In multivariable analysis, completion of the recommended infant vaccine schedule in the first year of life was strongly associated with MCV2 uptake (adjusted odds ratio [aOR]: 7.75; 95 % CI: 3.98–15.12). Female children in urban areas had half the odds of vaccination compared to male children (aOR: 0.49; 95 % CI 0.31–0.78); while no significant difference was observed in rural areas (aOR: 0.92; 95 % CI; 0.60–1.39). Sex also modified the association between age and vaccination status. Among children aged 18–23 months, females had lower odds of vaccination compared to similarly aged males (aOR: 0.41; 95 % CI: 0.23–0.76) but the difference was not significant among children aged 24–35 months (aOR: 0.73; 95 % CI: 0.46–1.16). MCV2 coverage in The Gambia remains below the elimination threshold. Interventions should focus on strengthening early-life immunization, addressing gender and urban-rural disparities, and encouraging timely vaccination before 2 years of age. These findings highlight the need for context-specific strategies to close immunization gaps in The Gambia and similar settings. •Completing the first year immunization schedule was associated with receipt of the second dose of the measles-rubella vaccine.•In urban areas, girls were half as likely to receive the second dose of the measles-rubella vaccine compared to boys.•Girls 18–23 months were less likely than boys to get the second measles-rubella vaccine dose.

Staphylococcus aureus is a major cause of neonatal infections in various anatomical sites, resulting in high morbidity and mortality in The Gambia. These clinical infections are often preceded by nasal carriage of S. aureus , a known risk factor. To determine whether potential sources of newborn S. aureus infections were from carriage, and to characterize S. aureus present in different anatomical sites (blood, ear, eye, umbilical cord, skin, pus, oropharynx, breast milk and vagina), we performed whole-genome sequencing of 172 isolates from clinical sites as well as from healthy and unhealthy carriage. A random selection of mothers ( n  = 90) and newborns ( n  = 42) participating in a clinical trial and testing positive for S. aureus were considered for this study. Sequence data were analyzed to determine S. aureus multilocus sequence types and selected antimicrobial and virulence gene profiles. Our findings revealed that in The Gambia, ST15 is the dominant sequence type associated with both carriage and clinical infection. In addition, S. aureus isolates causing clinical infection among neonates were genetically similar to those colonizing their oropharynx, and the different anatomical sites were not found to be uniquely colonized by S. aureus of a single genomic profile. Furthermore, while S. aureus associated with clinical infection had similar antimicrobial resistance gene profiles to carriage isolates, only hemolysin and adhesive factor virulence genes were significantly higher among clinical isolates. In conclusion, this study confirmed S. aureus oropharyngeal colonization among neonates as a potential source of clinical infection in The Gambia. Hence, interventions aiming to reduce neonatal clinical infections in The Gambia should consider decreasing oropharyngeal S. aureus carriage. Trial registration The trial was registered at ClinicalTrials.gov NCT03199547.

Introduction Progress in malaria control has stalled since 2015, highlighting the need for new control tools. The R21/Matrix-M (R21) malaria vaccine, a pre-erythrocytic vaccine recently approved by WHO for small children, may be one of these tools. This trial aims to assess whether seasonal mass vaccination with R21 reduces malaria transmission in The Gambia and Burkina Faso, two countries at the extreme of the transmission spectrum. Methods This is a multi-centre open cluster-randomised controlled trial to assess the impact of mass vaccination with R21 on malaria transmission and morbidity. The trial will be implemented in eastern Gambia (low to moderate transmission) and Central Burkina Faso (intense transmission). Thirty medium-sized villages in The Gambia and 24 in Burkina Faso will be randomised (1:1) to either intervention or control arm. All eligible residents in intervention villages will receive R21 vaccinations in three-monthly rounds, from May to July 2024, prior to the malaria transmission season. A booster vaccine dose will be administered the following year, in June 2025. The primary outcome is malaria prevalence at peak transmission (November 2024). Secondary outcomes include safety and tolerability, incidence of clinical malaria, vaccination coverage and community acceptability, cost and cost-effectiveness of the intervention. Discussion This is the first trial on seasonal mass vaccination aiming at reducing malaria transmission. Strengths of the study include its design as an adequately powered cluster-randomised trial and the inclusion of study sites with differing transmission intensity which will also provide safety and efficacy data for different age groups. Key challenges remain vaccine hesitancy and vaccination coverage. If successful, R21 seasonal mass vaccination will be an innovative intervention to accelerate malaria elimination efforts and reach the goal set in the Global Technical Strategy for malaria 2016–2030. Trial registration Clinical trials.gov, NCT06578572. Registered on 27 March 2024.

Sub-Saharan Africa has a high burden of pneumococcal diseases. Pneumococcal carriage precedes invasive disease and transmission. The introduction of pneumococcal conjugate vaccines (PCVs) has significantly reduced global vaccine-type (VT) pneumococcal disease, but data on PCVs' long-term impact on VT serotypes in Africa are limited. We aimed to evaluate PCV13's long-term effect on pneumococcal carriage in rural Gambia. From January to November 2022, we conducted a population-based, cross-sectional pneumococcal carriage survey in Central and Upper River Regions of The Gambia. We collected data on demographic characteristics, clinical history, risk factors, and PCV status. Nasopharyngeal swabs were taken from randomly selected household members of all ages. Streptococcus pneumoniae was isolated and serotyped using standard methods. We measured the prevalence of pneumococcal carriage by specific age groups, PCV13 vaccination status, and the proportions of different pneumococcal outcomes among carriers. We performed multivariable logistic regression to examine factors associated with VT carriage. Overall, 4087 participants were enrolled; the prevalence of pneumococcal carriage was 32.1% (95% CI: 29.34% – 35.03%). The estimated prevalence of PCV13 VT carriage was 6.4% (95% CI: 5.48% - 7.47%). Children aged 5–9 years had the highest VT carriage prevalence at 13.6% (95% CI: 10.34% - 17.56%). Among fully PCV-vaccinated children under 10, the odds of VT carriage in 5–9-year-olds were 1.60 times higher than in infants aged 0–11 months [AOR = 1.60, 95% CI:1.06–2.41]. The prevalence of VT carriage was similar among fully PCV-vaccinated and unvaccinated children under 10 years of age. Serotypes 19F, 3 and 6A were the most abundant VTs; 19F and 3 were the most prevalent among <5 and 5–14-year-old children, respectively. Ten years after the introduction of PCV13 in the Gambia, residual VT carriage persists, particularly in age groups in whom direct protection from immunization in infancy has waned. A booster dose or catch-up vaccinations could aid control of VT circulation. •Substantial reductions in VT carriage were observed in children, with significant indirect effects on unvaccinated adults.•Residual carriage of vaccine-type pneumococci persists, especially among fully PCV-vaccinated children under 10 years of age.•Children aged 5–9 years were identified as primary reservoirs of VT carriage.•The prevalence of VT carriage was similar in fully PCV-vaccinated and unvaccinated children under 10 years of age.•Serotypes 3 and 19F were the most common VT serotypes among children aged 5–14 and those aged 0–4, respectively.

Background Scabies is a high-burden neglected tropical disease, particularly in crowded, resource-limited settings, where children are disproportionately affected. Confirmation of scabies includes the use of clinical diagnosis supported by laboratory confirmation. This study was conducted to provide a laboratory confirmation for a clinically suspected scabies outbreak. Methods Skin scrapings were collected from 13 clinically suspected cases and transported to the National Public Health Laboratories. Samples were processed using the simple saline mount technique. A case was considered positive when a mite, egg, or fecal pellet was identified with microscopy. Case presentation A suspected scabies outbreak was reported from Daara Madina Suwaneh, a quranic boarding school located in Brufut Heights in the West Coast Region. A team from the Ministry of Health was deployed to confirm the scabies outbreak. A total of 13 male children were screened, with a mean age of 11.6 years (SD = 1.94) and an average symptom duration of 4.3 weeks (SD = 0.48). The hands and knees were the most frequently affected sites, observed in 38.5% of cases. Laboratory analysis found mite eggs in only one child, and no mites were detected in any of the samples, resulting in a positivity rate of 7.7%. All the cases were treated with 10% Benzyl Benzoate lotion, as it is the recommended medication for the treatment of children by the World Health Organization, and they fully recovered. This report highlights the important role of a simple saline mount, a low-cost routine parasitological technique, in supporting clinical suspicion of a scabies outbreak. Conclusions This laboratory confirmation has provided supportive evidence for clinical diagnosis of scabies at a quranic school in The Gambia. The low laboratory positivity likely reflects challenges associated with the use of the normal saline method for sample processing, instead of potassium hydroxide, the most reliable method. These findings highlight the importance of timely sampling and improved diagnostic capacity for disease outbreak confirmation in resource-limited settings.

Extreme weather events can lead to infectious disease outbreaks, especially those spread by hematophagous flies, and The Gambia is particularly vulnerable to climate change. To the best of our knowledge, no one has ever documented the relationship between climate variability and change and the distribution of the hematophagous flies belonging to the families Glossinidae, Tabanidae, and Stomoxyinae . This paper aims to study the association of temperature and humidity on the distribution of the above species and their families in The Gambia in the recent past and to provide predictions of species abundance and occurrence in the future. A line transect survey was carried out in all the administrative regions of The Gambia to study the prevalence of the flies. Generalized additive models were used to analyze the relationships between the distribution of the insects and their families and the variability in climate conditions in the recent past and in three different future periods. Regarding the recent past, our results show that temperature has significantly impacted the presence of Glossinidae and Tabanidae species, with maximum temperature being the most important factor. Relative humidity was also statistically significantly associated with Tabanidae species. None of the climate variables was found to be associated with the Tabanus par  and Tabanus sufis. Minimum temperature and relative humidity were statistically significantly associated with Glossina morsitan submorsitan , while maximum temperature was statistically significantly associated with Atylotus agrestis and Stomoxys calcitrans. Only relative humidity was statistically significantly associated with the Glossina palpalis gambiense.  As for the future projections, the results show that rising temperatures impacted the distribution of Tabanus  species, Glossina species, and Stomoxys calcitrans in The Gambia. The distribution of Trypanosoma vectors in The Gambia is mostly influenced by maximum temperature. The research’s conclusions gave climate and public health policymakers crucial information to take into account.

Background Close contact between an infectious and susceptible person is an important factor in respiratory disease transmission. Information on social contacts and mixing patterns in a population is crucial to understanding transmission patterns and informing transmission models of respiratory infections. Although West Africa has one of the highest burdens of respiratory infections, there is a lack of data on interpersonal contact and mixing patterns in this region. Methods Between January and November 2022, we conducted a cross-sectional, social contact survey within the population of the Central and Upper River Regions of The Gambia. Selected participants completed a questionnaire about their travel history and social contacts, detailing the number, intensity, location, frequency, duration, and age of contacts. We calculated age-standardized contact matrices to determine contact patterns in the population. Results Overall, individuals made an average of 12.7 (95% CI: 12.4–13.0) contacts per day. Contact patterns were mostly age-assortative and 84.5% of all contacts were physical. School-aged children (5–14 years) had the highest mean number of physical contacts (11.3, 95% CI: 10.9–11.8) while the < 1-year age group had the fewest contacts (9.4, 95% CI: 9.1–9.8). A large proportion of contacts (78%) occurred at home. Daily number of contacts increased with household size. While we did not observe any effect of gender on contact patterns, there were seasonal variations in contact type. Non-physical contacts were higher during the dry season compared to the rainy season. In contrast, there were more physical contacts in the rainy season compared to the dry season. Conclusions In rural Gambia, social contact patterns were primarily driven by household mixing. Most contacts were physical and mostly age-assortative, particularly among school-aged children. Our data can improve infectious disease transmission models of respiratory pathogens in high-transmission settings, which are valuable for optimizing the delivery of different interventions.

Background Despite low human immunodeficiency virus (HIV) prevalence in The Gambia (estimated adult prevalence 1.29% in 2024), the country faces a substantial burden, with approximately 25,000 people living with HIV, over 1,100 new infections, and approximately 1,200 acquired immunodeficiency syndrome (AIDS)-related deaths annually as of 2024. Gender disparities and treatment cascade gaps threaten Joint United Nations Programme on HIV/AIDS (UNAIDS) 2030 elimination targets. We examined 35-year epidemic trajectories (1990–2024), quantified gender-specific cascade performance and retention efficiency at critical transitions, and projected future scenarios under three intervention scenarios to inform national HIV strategies. Methods We analyzed UNAIDS 2025 HIV data/estimates for The Gambia (1990–2024) for people living with HIV (PLHIV), new HIV infections, AIDS-related deaths, and prevalence by sex. Annual percent change (APC) was calculated using log-linear regression across epidemic phases. Treatment cascade performance was assessed through cascade achievement, retention efficiency, and gaps to UNAIDS 95-95-95 targets. Future trajectories (2025–2030) were projected under status quo, optimistic (10% improvement), and pessimistic (10% deterioration) scenarios. Results PLHIV increased from 1,035 (95% UI: 426-1,807) in 1990 to 25,247 (19,689 − 31,811) in 2024, with phases of early expansion (+ 31% annually, 1990–1999), peak transmission (+ 6%, 2000–2009), treatment scale-up (+ 1%, 2010–2019), and decline (-1%, 2020–2024). Women comprised 61% of PLHIV by 2024, with female-to-male prevalence ratio rising from 1.06 to 1.57. The 2024 treatment cascade (64% diagnosed, 44% on ART, 35% virally suppressed) fell below UNAIDS 95-95-95 targets. Male disadvantage emerged across stages: diagnosis (53% vs. 72% women, 19pp gap), ART coverage (27% vs. 55%, 28pp gap), and viral suppression (21% vs. 44%, 23pp gap). ART initiation was the main cascade bottleneck: 51% of diagnosed men versus 76% of women-initiated treatment ( p  < 0.001), while suppression rates on ART were similar (78% vs. 80%, p  = 0.089). Projections to 2030 showed infections decreasing 6% to 1,055 under status quo, declining 27% to 826 under optimistic scenarios (preventing 1,374 infections), or increasing 13% to 1,265 under pessimistic scenarios, highlighting intervention fragility. Conclusion The Gambian HIV epidemic shows a demographic decline, driven by deaths exceeding new infections rather than treatment-mediated viral suppression with persistent gender gaps. ART initiation remains the main bottleneck, with only 51% of diagnosed individuals starting treatment, particularly men. Meeting UNAIDS 2030 targets requires male-targeted testing, same-day ART initiation, and gender-stratified monitoring. A 10% annual improvement in prevention and cascade performance is needed to prevent 1,374 infections by 2030. Clinical trial number Not applicable.

Background The Gambia has experienced major HIV epidemic shifts over three decades. As a low-prevalence country, understanding epidemic trends remains crucial for health planning and resource allocation. This study provides a comprehensive analysis of 35 years of HIV prevalence, incidence, and mortality trends in The Gambia from 1990 to 2024. Methods We conducted epidemiological analysis using UNAIDS 2025 HIV estimates from 1990 to 2024. Temporal trends were examined across four phases. Log-linear regression estimated annual percent changes for people living with HIV (PLHIV), new infections, and AIDS deaths. Epidemic control was assessed using mortality-to-incidence and incidence-to-prevalence ratios. Results PLHIV increased 24-fold from 1,035 (95% CI 784–1,342) in 1990 to 25,247 (95% CI 20,945–30,216) in 2024. Adult prevalence rose from 0·18% to 1·29%. The early phase showed explosive growth (annual percent change + 30·46% for PLHIV), followed by declining incidence concurrent with treatment scale-up (− 4·40% annually 2010–2019; −7·37% annually 2020–2024). New infections peaked at 2,439 (2009), declining to 1,124 (2024). The mortality-to-incidence ratio exceeded 1·0 in 2023. Progressive feminization emerged: female-to-male prevalence ratio increased from 1·06 to 1·57 (β = 0·0133/year, p  < 0·0001), with women comprising 61·3% of PLHIV. Treatment cascade performance fell substantially below 95-95-95 targets (63·7% diagnosed, 44·3% on ART, 34·9% virally suppressed), with pronounced gender gaps (men: 52·7%/27·2%/21·2% vs. women: 72·1%/55·4%/44·4%). Pediatric infections increased 284% (44→169 cases), representing 15·0% of 2024 infections. Conclusions Despite declining incidence, The Gambia faces critical gaps in treatment cascade, particularly among men, epidemic feminization, and persistent vertical transmission, requiring urgent gender-responsive and pediatric interventions.