Volume 14 · Issue 06 · 2025

Schistosomiasis was first reported in the People’s Republic of China 120 years ago. The national programme of schistosomiasis control started in mid-1950s. The transmission interruption was achieved by 2023. Here we summarize the experience as the five core parts of a running chariot. While the specific historical context of P.R. China’s way of schistosomiasis control may be difficult to replicate, the experiences gained underscore several critical principles that might be applicable elsewhere.

The interconnectedness of human society in this modern world can transform localised outbreaks into global pandemics, underscoring the pivotal roles of social, mobility and contact networks in shaping infectious disease dynamics. Although these networks share analogous contagion principles, they are often studied in isolation, hindering the incorporation of behavioural, informational, and epidemiological processes into disease models. This review synthesises current research on the interplay between social, mobility and contact networks in health behaviour contagion and infectious disease transmission.

We searched Web of Science and PubMed from January 2000 to June 2025 for research on health behaviour contagion and information dissemination in social networks, pathogen spread through mobility and contact networks, and their joint impacts on epidemic dynamics. This was first done by a preliminary literature screening based on predefined criteria. With potentially relevant publications retained, we performed keyword co-occurrence network analysis to identify the most common themes in studies. The results guide us to narrow down the reviewing scope to the social, mobility and contact network impacts on informational, behavioural, and epidemiological dynamics. We then further identified and reviewed the literature on these multidimensional network influences.

Our review finds that each network type plays a distinct yet interconnected role in shaping behaviours and disease dynamics. Social networks, comprising both online and offline interpersonal relationships, facilitate the dissemination of health information and influence behavioural responses to public health interventions. Concurrently, mobility and contact networks govern the spatiotemporal pathways of pathogen transmission, as demonstrated in recent pandemics. While traditional population-level models often overlook individual discrepancies and social network effects, significant efforts have been made through developing individual-level simulation-based models that integrate behavioural dynamics. With emerging new data sources and advanced computational techniques, two promising approaches—multiplex network analysis and generative agent-based modelling—offer frameworks for integrating the complex interdependencies among social, mobility and contact networks into epidemic dynamics estimation.

This review highlights the theoretical and methodological advances in network-based infectious disease modelling and identifies critical knowledge and research gaps. Future research should prioritise integrating multi-source behavioural and spatial data, unifying modelling strategies, and developing scalable approaches for incorporating multilayer network data. The integrated approach will strengthen public health strategies, enabling equitable and effective interventions against emerging infections.

Patient journeys highlight evolving processes of care seeking from patient perspectives over the course of time and disease progression. Patient journeys for neglected tropical diseases (NTDs) in rural sub-Saharan Africa (SSA) are poorly understood. This review aims to identify studies including patient journeys for NTDs in rural SSA.

Systematic search was conducted in six scientific databases from inception to 18 November 2024. All studies were required to include patient journeys for NTDs, defined as the continuous arc of the patient care seeking experience at multiple time points while navigating increasingly debilitating disease. All patient journeys were depicted explicitly using flow diagrams, lists of ordered journey components, or patient narratives. Variables extracted included the use and rationale of referrals, types of healthcare delivery providers engaged in the patient journey, and barriers and facili-tators of care continuity. Journeys were analysed using framework synthesis.

Searches returned 2605 studies where after de-duplication and eligibility screening, 22 studies were identified for inclusion Included studies represented eight NTDs, which were categorised into four groups: severe and stigmatising skin NTDs (SSSDs) (13/22) including Buruli ulcer, lymphatic filariasis, onchocerciasis, and yaws; human African trypanosomiasis (HAT) (3/22); snakebite and rabies (4/22); and schistosomiasis (intestinal and female genital) (2/22). NTD patient journeys revealed health system constraints relating to limited medical resources and ineffective referral pathways, social dimensions of gender and stigma hindering access to care, and logistical concerns related to distance to health facilities, and lack of transport. Patient journeys for different NTDs highlighted specific dimensions of this local context, including challenges with mental health distress for individuals living with SSSDs, difficulties obtaining diagnoses for HAT as an NTD with non-specific symptoms, and inaccessibility of treatment for schistosomiasis in the context of missed mass drug administration.

NTD patient journeys show varied care seeking experiences within the broader context of neglect and health inequity that characterises settings where NTDs are endemic. For NTDs resulting in long-term or chronic conditions, these journeys highlight inaccessible care and a lack of integrated approaches for prevention, treatment, and management within health systems. By understanding patient journeys, NTD researchers and practitioners can determine how best to support NTD patients in navigating access to care.

Sustaining the elimination of malaria requires robust surveillance to prevent reintroduction, but standardized frameworks for assessing the surveillance capacity of a country post-elimination are lacking. This study aims to develop a standardized framework for assessing malaria surveillance and response capacity in countries that have eliminated malaria.

We developed a malaria surveillance and response assessment framework through a three-stage process. First, two systematic reviews were conducted to identify indicators used in post-elimination settings worldwide and specifically in China. The candidate indicators were refined through expert panel discussions, which yielded 45 indicators across six domains. Next, a modified two-round Delphi process was conducted, involving 30 experts in epidemiology, disease control, and public health from diverse institutions and administrative levels. The experts rated the importance and feasibility of the indicators using structured questionnaires and then engaged in group discussions to contextualize the findings. Indicator weights were determined using a combined analytic hierarchy process and entropy methods.

The systematic reviews and expert consultations identified 45 candidate indicators. After two rounds of expert consultation, a framework comprising 34 indicators across six domains for assessing malaria surveillance and response capacity in post-elimination settings was developed. The weights of the six domains are as follows: surveillance system coverage and performance (0.240); the quality and use of the surveillance data (0.3710); the functioning of the information management system (0.0973); the availability and adequacy of resources (0.0375); early diagnosis and treatment (0.1571); and quality control supervision and training (0.0973). The expert authority coefficient (Cr) values of the first and second rounds were 0.777 and 0.895 respectively. Of the 34 indicators, the proportion of confirmed cases with completed epidemiological investigations and submitted reports (0.1153) and the interval between the first medical visit and diagnosis (0.1131) had the highest weights.

This consensus-based framework provides a standardized tool for evaluating malaria surveillance and response capacity in post-elimination settings. Adoption of the framework could help countries monitor and improve their systems to sustain elimination of the disease, mitigate reintroduction risks, and support global malaria eradication efforts.

Diarrhea remains a major health concern in children under five years, with enteric pathogens being key contributors. However, the interactions among these pathogens and their combined effects on disease severity are not well understood. The study investigates the interactions among co-infecting enteric pathogens on diarrhea pathogenesis within an epidemiological framework.

This large-scale, multicenter case-control study was conducted from January 1, 2024 to December 31, 2024, across four tertiary hospitals in Guangzhou, Guangdong Province, China. Stool samples were collected from children under five years with diarrhea (cases) and those without (non-diarrheal children). 21 enteric pathogens in each specimen were identified. Potential interactions between co-infecting pathogens were assessed using both additive and multiplicative models.

Enteric pathogens were more frequently detected in children with diarrhea than in non-diarrheal children (53.6% vs. 27.8%, P < 0.001), with significantly higher detection of both viral (23.3% vs. 13.3%) and bacterial pathogens (34.2% vs. 12.5%). Pathogens independently associated with diarrhea included diarrheagenic Escherichia coli (DEC), Vibrio parahaemolyticus, Clostridioides difficile (CD), group A rotavirus (RVA), and Norovirus GII (NoVs GII). The proportion of children with any form of co-infection was also significantly higher in the diarrhea group compared with non-diarrheal children (16.1% vs. 4.5%, χ² = 32.594, P < 0.001). Several specific dual-pathogen combinations—namely RVA+ DEC (χ² = 4.956, P= 0.026), RVA+ CD (χ² = 10.313, P < 0.001), RVA+ NoVs GII (χ² = 15.503, P < 0.001), and DEC+ Blastocystis hominis (Bh)—were significantly more common among diarrhea cases (χ² = 4.207, P= 0.041). Multiplicative interaction analysis further identified significant synergistic effects for RVA+ DEC [odds ratio (OR) = 2.304, 95% confidence interval (CI): 1.194-5.089], RVA+ CD (OR= 6.199, 95% CI: 1.701-10.601), RVA+ NoVs GII (OR= 6.296, 95% CI: 2.061-10.723), and DEC + Bh (OR= 4.602, 95% CI: 2.213-9.878).

This study demonstrates the frequent occurrence of co-infections in diarrheal children, and enteric pathogens may interact synergistically or antagonistically. It highlights the central role of RVA in exacerbating the severity of these co-infections. The findings emphasize the critical role of RVA vaccination in alleviating the burden and severity of diarrhea.

Childhood infectious diseases and related symptoms, such as fever, cough, and diarrhea among children constitute the leading cause of death in low- and middle-income countries. We examined the environmental predictors of double and triple burden (D/TB) of infection symptoms among under-five children using multilevel machine learning (ML) methods.

We used Demographic and Health Surveys (DHS) data from 58 LMICs between 2000 and 2023. These data were merged with cluster-level particulate matter and nitrogen dioxide from the National Aeronautics and Space Administration and country-level data on political, social, and economic globalization from the World Bank report. We applied multilevel models to screen out the most important predictors of D/TB symptoms and applied machine learning algorithms to predict these symptoms among children across LMICs. We trained and validated ML algorithms on (80, 70, and 60%) of the data and tested on the remaining (20, 30, and 40%) with 2, 5 and 10 cross-validations.

Of 1,546,243 children, 19.2%, 20.5% and 12.6% had fever, cough, and diarrhea, respectively; while the overall D/TB prevalence was 11.9% and 3.7%, respectively. The result revealed D/TB were associated with the location of a child, survey years, wealth index, family size, air pollutants, and environmental covariates. The estimated prevalence of both D/TB symptoms substantially varies across districts [intraclass correlation (intraclass correlation, ICC = 13.3%)] and countries (ICC = 8.8%). We found that the Random Forest gave the maximum area Under the curve of 94% and 99% for D/TBs for the K10 protocol and 80:20 training and testing dataset splits.

The study found substantial variation in the prevalences of D/TB of illness among children under five and identified several environmental and sociodemographic predictors of these health outcomes. The Random Forest algorithm performed best in predicting these burdens. The study emphasized how integrating environmental and sociodemographic data with machine learning can enhance targeted interventions to reduce childhood infectious disease burdens in low- and middle-income countries.

Clonorchiasis is caused by the ingestion of raw freshwater fish containing infective metacercariae of Clonorchis sinensis. This study aimed to fully evaluate disease burden in terms of disability-adjusted life years (DALYs) for clonorchiasis in China.

Following our previous study which established the fine-scale prevalence distribution of C. sinensis infection in China, we further adopted Bayesian geostatistical models to estimate the infection intensity in terms of eggs per gram of feces (EPG) in infected individuals based on the national surveillance data of clonorchiasis between 2016 and 2021. Disability weight was then captured through its quantitative association with EPG, and used to estimate years of life living with a disability (YLDs). Incidence of cholangiocarcinoma attributed to C. sinensis infection was employed to calculate years of life lost (YLLs). DALYs was then estimated at 5 × 5 km² resolution, and aggregated by areas and populations.

In 2020, 431,009 [95% Bayesian credible interval (BCI): 370,427 to 500,553] DALYs were exerted due to clonorchiasis in China, of which 372,918 (95% BCI: 318,775-435,727) was due to YLDs and 57,998 (95% BCI: 50,816-66,069) due to YLLs. The DALYs, YLDs and YLLs per 1000 were 0.31 (95% BCI: 0.26-0.35), 0.26 (95% BCI: 0.23-0.31), and 0.04 (95% BCI: 0.04-0.05), respectively. The DALYs predominantly distributed in southern areas including Guangxi (201,029, 95% BCI: 157,589-248,287) and Guangdong (161,958, 95% BCI: 128,326-211,358). The DALYs was over doubled in male (302,678, 95% BCI: 262,028-348,300) than in female (127,970, 95% BCI: 106,834-151,699), and high in middle aged population.

Clonorchiasis causes significant disease burden in China especially in southern areas including Guangxi and Guangdong. Urgent control is needed for clonorchiasis in the endemic areas with high burden, and adult males need to be prioritized.

Cutaneous tuberculosis (CTB) is an unusual manifestation of extrapulmonary tuberculosis, accounting for only 1.0%-1.5% of cases. It presents with a wide range of clinical morphologies, often mimicking other dermatoses such as fungal infections, leprosy, or sarcoidosis. Among its different variants, the ulcerative form is particularly rare and clinically deceptive. Reporting rare presentation is important to raise awareness among physicians, as early recognition and prompt treatment are essential to prevent complications such as scarring, contractures, or malignant transformation.

We reported the case of a 24-year-old Malian male admitted to the National Institute for Infectious Diseases Lazzaro Spallanzani. The patient presented with a 4-month history of ulcerative skin lesions on the chest, neck, and left leg, accompanied by systemic symptoms including asthenia, cachexia, and generalized lymphadenopathy. Imaging revealed extensive bilateral psoas abscesses, vertebral involvement consistent with spondylodiscitis, and signs of empyema necessitans. Polymerase chain reaction (PCR) testing of drained abscess fluid confirmed Mycobacterium tuberculosis complex. Skin biopsy histology and PCR further supported the diagnosis of CTB. The patient was treated with standard anti-tuberculosis therapy (isoniazid, rifampicin, ethambutol, pyrazinamide) alongside broad-spectrum antibiotics. After 30 days, partial improvement of skin lesions was observed, although complete resolution was not achieved after 8 months of follow-up.

This case highlights the diagnostic challenge and chronicity of CTB, particularly in the ulcerative presentation. The patient developed disseminated tuberculosis with cutaneous involvement without any recent travel or known tuberculosis exposure, and the probable etiology is latent reactivation. There should be a high index of suspicion for CTB in patients presenting with indolent, atypical skin lesions, particularly those from an endemic region. Early diagnosis and prolonged therapy are crucial to avoid long-term sequelae.