Public Health Response Research Articles

A cluster of Brucella melitensis in Melbourne, Australia 2023: clinical and public health actions.

Brucellosis is a rare zoonotic infection most commonly seen in parts of the Northern Hemisphere. Infections in Australia are uncommon and occur predominantly in Queensland and New South Wales due to the association with wild pig hunting activities. We describe a clustering of two cases of brucellosis in Victoria confirmed by genomic analysis but with no identified exposure. We detail the medical management, laboratory confirmation, and the public health investigation. While the source of the outbreak remains unclear, the two cases demonstrate a detailed and coordinated public health response to a rare infection with a unique geographical and temporal relationship.

Geosocial-networking App Use Among Men who Have Sex with Men in High HIV Community Viral Load Areas of Baltimore City.

Geosocial networking applications (GSN apps) are important tools for HIV/sexually transmitted infection prevention among men who have sex with men (MSM). Strategies for identifying high transmission and acquisition among GSN app users are needed to prioritize public health response. Community viral load (CVL) is associated with HIV transmission and can be used to identify populations with behaviors/environment associated with HIV/STI risk. We sought to determine user profile characteristics and utilization patterns associated with GSN app use in high CVL census tracts (CT). We used routine HIV surveillance data from in-care individuals and their viral loads at the point of diagnosis to estimate CVL in 200 CTs across Baltimore City. CTs were ordered based on CVL and categorized into quantiles from high to low. Among GSN user profiles, multiple imputation methods were used to complete missing profile characteristics. We then used imputed datasets to explore the association between profile characteristics, app utilization times, and app use in high CVL CTs using a Poisson regression model with robust error variances. Data on 606 profiles were collected originally and imputed 50 times to create a complete data set for analysis. GSN app users were aged 18-65 years [mean = 33.9, 95% confidence interval (CI): 33.1-34.7], with 52.2% Black (95% CI: 47.9- 56.5%), 6.8% living with HIV (95% CI: 4.4- 9.2%), 39.1% in high CVL CTs (95% CI: 35.2- 43.0%), 50.6% use at nighttime (95% CI: 46.7- 54.6%) and 51.6% use during the weekend (95% CI: 47.6- 55.6%). Black MSM users [Relative risk (RR) = 1.12, 95% CI: 1.04-1.20] were associated with GSN app use in high CVL CTs. MSM with profiles listing versatile sex position preference (RR = 1.12, 95% CI: 1.02-1.23) and profiles listing top sex position preference (RR = 1.13, 95% CI: 1.03-1.23) were associated with GSN app use in high and medium CVL CTs. GSN app user profiles of people in high and medium CVL CTs, especially Black MSM and those who report top and versatile sexual positions, may benefit from online prevention messages and real-time notification of health resources presently available in their communities to reduce HIV transmission.

The resurgence of monkeypox clade Ib: a global health emergency and concern.

The resurgence of monkey pox (mpox) virus clade Ib, which was declared a global health emergency in August 2024, poses a significant threat worldwide. Initially contained through public health measures, the increased transmissibility of clade Ib strains compared with that of previous strains has led to a rapid rise in cases, particularly in Central Africa. The resurgence highlights disparities in diagnostic capabilities and healthcare infrastructure, leading to underreporting in resource-limited regions. New variants could evade immunity, necessitating continued vaccination efforts for high-risk groups. This review discusses the epidemiological situation, recent outbreaks, clinical features, and public health response, emphasizing the urgent need for global coordination in diagnostic, prevention, and treatment strategies.

Salmonella enterica serovar Braenderup shows clade-specific source associations and a high proportion of molecular epidemiological clustering.

This study provides insights into the genomic diversity of S. enterica ser. Braenderup by revealing distinct clade-specific source attribution patterns and showing that a greater proportion of isolates were associated with epidemiological clusters based on the genomic relatedness than previously estimated. Specifically, we analyzed the diversity of human clinical isolates from southeastern USA and compared them with the global clinical and nonclinical isolates. Our analysis showed different clades of S. enterica ser. Braenderup linked to different environments, providing insights on the potential source of human sporadic infection and outbreaks. These findings can enhance public health surveillance and response strategies targeting S. enterica serovar Braenderup by expanding our understanding of potential transmission pathways and the genomic diversity of clinical and environmental isolates.

Contextualizing Changes in e-Cigarette Use During the Early COVID-19 Pandemic and Accompanying Infodemic ("So Much Contradictory Evidence"): Qualitative Document Analysis of Reddit Forums.

Understanding how social media platforms facilitate information exchange and influence behavior during health crises can enhance public health responses during times of uncertainty. While some risk factors for COVID-19 susceptibility and severity (eg, old age) were clear, whether e-cigarette use increased risk was not clear. People who used e-cigarettes had to navigate both the COVID-19 infodemic and a conflicting, politicized, and changing information environment about the interaction between COVID-19 and e-cigarette use. This study aims to characterize and contextualize e-cigarette-related behavior changes during the early COVID-19 pandemic and illuminate the role that social media played in decision-making. We conducted a qualitative analysis of COVID-19-related e-cigarette discussions on 3 Reddit forums about e-cigarettes. We collected 189 relevant discussion threads made in the first 6 months of the pandemic (collected from June 27, 2020, to July 3, 2020). Threads included 3155 total comments (mean 17 comments) from approximately 1200 unique Redditors. We developed and applied emergent codes related to e-cigarette perceptions and behaviors (eg, the role of nicotine in COVID-19 and do-it-yourself narratives) and web-based community interactions (eg, advice), identified thematic patterns across codes, and developed a model to synthesize the socioecological context of e-cigarette behaviors. e-Cigarette subreddits provided a platform for Redditors to discuss perceptions and experiences with e-cigarettes, make sense of information, and provide emotional support. Discussions reflected an array of e-cigarette-related behavioral responses, including increases and decreases in use intensity, changes in purchasing practices (eg, stockpiling), and changes in vaping practices (eg, reusing disposable pods). This study presented a theoretically and empirically informed model of how circumstances created by the pandemic (eg, changes in activity space and product shortages) compelled behavior changes. Redditors drew from their existing perceptions, intentions, and experiences with nicotine and tobacco products; their personal pandemic experiences; and their participation on Reddit to decide whether and how to change their e-cigarette behaviors during the early pandemic. Forums reflected uncertainty, stress, and debate about the rapidly evolving and complicated public health information. Consumption and discussion of media (eg, news articles and peer-reviewed publications) on Reddit informed e-cigarette perceptions and behaviors. Decisions were complicated by distrust of the media. Variations in individual traits and environmental circumstances during the early COVID-19 pandemic provide context for why there was no unified direction of e-cigarette behavior change during this period. Information and discussion on Reddit also informed risk perceptions and decisions during the pandemic. Social media is an effective and important place to communicate public health information, particularly during crisis or disaster situations. Moving forward, transparent, accurate, and specific message development should consider the stress, struggles, and stigma of people who use e-cigarettes and address the roles mistrust and misinformation play in decisions.

Access and Utilization of HIV/STI Testing Services among Men Who have Sex with Men During the COVID-19 Pandemic: A Systematic Review.

Men who have sex with men (MSM) continue to bear the disproportionate burden of HIV and other sexually transmitted infections (STIs). The public health response to the COVID-19 pandemic coupled with the public's fear of the virus may have exacerbated this burden by hindering access to and utilization of HIV/STI testing services. We completed a systematic literature review to evaluate the impact of the COVID-19 pandemic on MSM's access and utilization of HIV/STI testing services. Online databases (PubMed, EMBASE, LGBTQ + Source, CINAHL, and the WHO COVID database) and reference lists were searched until October 8, 2023 to identify literature meeting the following criteria: primary data collection; peer-reviewed publication in the English language; included MSM ≥ 18years of age; examined access to and utilization of HIV and/or STI testing in the United States. We identified 1,013 articles, of which 88 were eligible for full text review. Nineteen articles met full inclusion criteria and were included in the qualitative synthesis. Twelve were cross-sectional studies, 4 were prospective cohort studies, and 3 were retrospective chart reviews. Sixteen of the 19 studies reported perceived interruptions or decreases in HIV/STI testing among MSM during the COVID-19 pandemic. However, two cross-sectional studies reported increases in STI prevalence during the pandemic and one cross-sectional study reported that access to HIV testing was unaffected. This systematic review summarized the existing literature that suggests that the COVID-19 pandemic largely impacted access to and utilization of HIV/STI testing among MSM in the U.S.

A conceptual model for geospatial analytics in disease surveillance and epidemiological forecasting

The integration of geospatial analytics into disease surveillance and epidemiological forecasting has emerged as a crucial approach in understanding and mitigating the spread of infectious diseases. This study proposes a conceptual model that leverages geospatial data, artificial intelligence (AI), and machine learning (ML) to enhance real-time disease monitoring, outbreak prediction, and public health response. The model integrates multiple data sources, including satellite imagery, mobile health (mHealth) data, electronic health records (EHRs), and environmental variables, to provide a spatial-temporal understanding of disease patterns. The framework comprises four key components: (1) Data Acquisition and Integration, which gathers and harmonizes multi-source geospatial and epidemiological datasets; (2) Spatial-Temporal Analysis, where AI-driven models identify hotspots and predict disease spread; (3) Decision Support System, which provides real-time visualization and risk assessments for policymakers and healthcare providers; and (4) Intervention Optimization, which uses predictive modeling to enhance the efficiency of resource allocation and public health interventions. By incorporating advanced geographic information systems (GIS), deep learning, and cloud-based analytics, this model ensures a dynamic and adaptive surveillance mechanism capable of detecting emerging threats with high accuracy. The proposed framework is designed to address challenges such as data heterogeneity, privacy concerns, and computational scalability in large-scale disease monitoring efforts. Case studies, including recent pandemics such as COVID-19, demonstrate the potential of geospatial analytics in reducing response times and improving intervention strategies. Furthermore, the model highlights the significance of community engagement and ethical considerations in implementing geospatial disease surveillance systems. The study concludes that an AI-powered geospatial analytics approach enhances epidemiological forecasting by providing actionable insights, improving early warning systems, and strengthening public health resilience. Future research should focus on refining ML models, integrating real-time sensor data, and enhancing interoperability between health information systems for a more robust disease surveillance architecture. Keywords: Geospatial Analytics, Disease Surveillance, Epidemiological Forecasting, Artificial Intelligence, Machine Learning, Geographic Information Systems, Public Health, Spatial-Temporal Analysis, Outbreak Prediction, Decision Support Systems.

Automobility violence: the case for adopting tobacco public health policies

ABSTRACT Although tobacco use and road fatalities were recognized as public health issues at roughly the same time, the public health responses have been very different. The accepted wisdom in public health policy is that access to tobacco should be limited, highly taxed, advertising prohibited, visual and textual warnings be mandatory on tobacco products, the obfuscation and lobbying efforts of the tobacco industry publicized. In this paper, we make the case for adopting similar strategies in relation to automobility. As opposed to framing automobility violence as a remediable road safety issue, this paper makes the case for treating automobility violence as an irremediable public health problem. The public health goal with respect to tobacco is not simply to reduce death and disease but to eradicate tobacco use. The public health goal in respect to automobility should be the same. This requires pursuing public health politics oriented towards the dismantling of automobility.

External quality assessment of molecular detection and variant typing of SARS-CoV-2 in European expert laboratories in 2023.

The COVID-19 pandemic highlighted the importance of laboratory preparedness. Regular monitoring of diagnostic tools via external quality assessments (EQAs) is key to maintaining robust public health response service. We hereby conducted a third SARS-CoV-2 EQA assessing the diagnostic capabilities of European expert public health laboratories. A 10 samples panel containing Alpha (used in previous EQA), BA.4, BA.5, and BQ.1.18 variants along with human seasonal coronaviruses and negative controls was produced and validated. Participants were invited by the European Centre for Disease Prevention and Control (ECDC) and asked to submit results and assay details via electronic forms. Thirty-eight laboratories from 31 European countries participated. Most (n = 32, 84%) identified all panel samples correctly and used in-house (11, 29%), commercial assays (22, 58%), or both (5, 13%). Compared to previous EQAs, correct detection of the SARS-CoV-2 samples in the panels increased: 8 (12%) in 2020, 45 (75%) in 2021, and 34 (90%) laboratories in 2023, respectively. The number of participants decreased to an average of one laboratory per country (range 1-3) compared to two (1-7) laboratories in both previous EQAs. The usage of commercial assays gradually increased in contrast to the usage of in-house or both approaches. The capacity for SARS-CoV-2 molecular diagnostics has markedly improved in Europe as evidenced by three consecutive EQAs carried out by expert public health laboratories. Routine monitoring of diagnostic and surveillance assays via EQAs remains key to maintaining rapid public health laboratory response systems.IMPORTANCEExternal quality assessments (EQAs) are crucial to ensure the reliability and consistency of diagnostic laboratories. They provide an objective framework for evaluating the performance of testing systems, enabling laboratories to identify weaknesses and implement improvements promptly. In the context of SARS-CoV-2, EQAs have become even more critical due to the high demand for accurate molecular diagnostics and the emergence of new variants. Accurate detection and typing of variants are especially essential for monitoring viral evolution. EQAs help standardize methodologies, ensuring that results across laboratories remain comparable and trustworthy. Moreover, they play a pivotal role in minimizing errors such as false positives or negatives. In this rapidly evolving landscape, regular EQAs are indispensable for maintaining high-quality standards in molecular diagnostics and variant surveillance. We demonstrate here that regular EQAs improve the molecular detection of SARS-CoV-2 in European laboratories.

IHR amendments and the “pandemic agreement” an Israeli perspective

BackgroundThe 77th World Health Assembly in May 2024 agreed on several key amendments to the International Health Regulations (IHR) (2005), which are set to enhance global public health preparedness and response mechanisms. These amendments are part of a broader effort to integrate the lessons learned from the COVID-19 pandemic, seeking to create a more globally interconnected and rapid global response mechanism for future health crises, including a new Pandemic Agreement.Main bodyGlobally and in Israel, some voice their concern that the IHR amendments and the Pandemic Agreement could undermine a nation’s sovereign right to manage its public health response, infringe on national autonomy, or impose obligations such as sharing resources like diagnostics, medicines, technology, or vaccines, which could be seen as detrimental to national interests. This manuscript describes the IHR amendments and the ongoing work on the Pandemic Agreement. It explains how the documents do not undermine national sovereignty and highlights the moral and utilitarian justifications for Israeli support of these global legal documents. From a moral perspective, Israel should be committed to promoting the value of global public health and universal health coverage at both the international and regional levels. From a utilitarian perspective, provisions ensuring access to products and information will assist Israel in preparing for and protecting against health threats originating in neighboring countries and globally. Moreover, asking countries to be better ready may promote awareness and actions of public health services in Israel, which has long suffered from budgetary and health workforce constraints.ConclusionIsrael must work to promote the endorsement of the Pandemic Agreement and the IHR amendments, as they are essential documents for addressing public health threats without compromising national sovereignty.

Factors associated with measles infection in Afghanistan surrounding the 2021 outbreak: A multivariable analysis

Abstract Background Despite development of a safe and effective vaccine, measles remains a risk in many low-income countries where vaccination is less available. Afghanistan’s recent measles epidemic remains understudied and data are needed to inform the public health response. This study investigated the demographic and epidemiologic characteristics associated with suspected and laboratory-confirmed measles infections surrounding the 2021 outbreak in Afghanistan. Methods We conducted a multivariable retrospective analysis of historical measles case data in Afghanistan from July 2019 to June 2023. Results Confirmed measles infections in Afghanistan increased by more than 200% since July 2021, and the majority of cases during the recent outbreak were laboratory-confirmed. Early infancy was a risk factor for confirmed measles during the recent outbreak, as compared to prior (p <0.001). Epidemiologic linkage was identified as protective (p <0.001), while sex (p = 0.796) and travel history (p = 0.615) where not predictive of risk. Conclusions Routinely collected measles surveillance data suggest that infancy and unknown travel status posed greater risk to confirmed measles infection in Afghanistan during the 2021 epidemic as compared to prior, and known exposure may lead to lower rates of formal laboratory diagnosis. Results also highlighted the geographic shift in cases before versus during the outbreak, as well as differences in distribution of suspected and laboratory confirmed cases throughout the epidemic.

Global epidemiology, viral evolution, and public health responses: a systematic review on Mpox (1958-2024).

Monkeypox (Mpox), a zoonotic viral disease caused by the Mpox virus (MPOXV), was first identified in 1958 and remained largely confined to Central and West Africa for decades. While it usually exhibited limited international transmission, recent outbreaks, including in the USA in 2003 and globally in 2024, highlight significant epidemiological shifts. We aimed to systematically evaluate the evolution of Mpox from 1958 to 2024, focussing on its epidemiology, viral evolution, and public health responses. We conducted a systematic review using data from global health reports, surveillance databases, and published literature. The analysis covered key outbreaks, transmission patterns, geographic distribution, public health responses, and the roles of viral mutations and vaccination in disease management. The 2022 Mpox outbreak, declared a Public Health Emergency of International Concern by the World Health Organization (WHO), was characterised by an unprecedented international spread of the virus. By July 2024, a total of 102 997 confirmed cases and 223 deaths were reported across 121 countries. Two distinct viral clades were identified: Central African (clade I) and West African (clade II), with the latter being the primary agent of global transmission. Research on Mpox has highlighted the protective effects of smallpox vaccination and emerging risk factors such as human-animal interactions and international travel. Mpox has evolved from a regionally contained zoonotic disease to a global public health challenge. Enhanced surveillance, international collaboration, and targeted interventions in non-endemic regions are critical for mitigating future outbreaks and managing ongoing epidemiological changes.

Public Health Emergency Response and Recovery in Limited Resource Setting: Lesson learned from Hanang District Floods and Landslide in Tanzania.

In December 2023, floods and landslides in Hanang District, Northern Tanzania, caused severe casualties, infrastructure damage, and community displacement. We describe the public health emergency response and lessons learnt during this disaster to guide future mitigations. Retrospective data collection during the disaster was made through quantitative (description of casualties) and qualitative (interviews and focus groups) approaches to provide insights into psychosocial support, coordination, and other response pillars. Microsoft Excel (2019) was used for quantitative data analysis, and MAX Qualitative Data Analysis was used to manage qualitative data. Soft tissue injuries, bruises, and lacerations were the most common (60.43%), with 87.77% of casualties recovering and a notable fatality rate of 12.23%. Mental health and psychosocial support reached over 3300 individuals, offering depression assessments and family reconnections. Establishing a dual-level public health response team and implementing the Incident Management System demonstrated the country's response efficiency. The public health emergency response to the 2023 floods and landslides in Hanang District was largely effective. This demonstrated strong coordination, capacity, and resilience of Tanzania health system; however, the fatality rate highlighted a need for further investment to improve future disaster prevention, preparedness, and response.

Haplotype-Specific Genetic Epidemiology of Sickle Cell Anemia Patients in Accra, Ghana: Patterns, Clinical Implications, and Public Health Responses

Sickle cell disease (SCD) is a genetic disorder with a diverse spectrum of clinical presentation, often determined by inherited βS gene haplotypes. Ghana, a country with a significant SCD burden, lacks population haplotype frequency data, hindering anthropological, genetic, and clinical understanding and management of the disease. A prospective sample of 191 SCD patients (sickle cell anemia; homozygous HbSS) was recruited at the Korle-Bu Teaching Hospital, Accra. Identification of βS gene haplotypes was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Hematological tests were performed using routine laboratory procedures. Kruskal-Wallis ANOVA with Dunn post-hoc was used to compare the hematological parameters. Multinomial probability models were used to compare the frequencies of the observed haplotypes with those reported in other African countries. The Atypical haplotype was disproportionately prevalent (58%), followed by the Bantu/CAR (20%) and Benin (10%) haplotypes. Significant differences were observed between the haplotypes in lymphocyte count, platelet count, sodium and potassium levels (P < 0.001). In addition, disease severity varied significantly between haplotypes (P = 0.010), with notable differences between the Atypical and Bantu/CAR haplotypes (P FDR = 0.020). Multinomial probability testing revealed a substantial deviation from the expected haplotype distribution, highlighting significant differences in haplotype frequencies between Ghana and other African countries. The Wright-Fisher model showed that the variation in Arab-Indian haplotype frequency reached zero by the 100th generation. Our findings highlight the need to study haplotype composition in Ghana to identify population-specific risk factors and tailor public health interventions to better manage patient needs.

Health system strategies to reduce global impacts of toxic substance exposure

Exposure to toxic substances, including arsenic, lead, mercury, and other harmful chemicals, poses a significant public health challenge globally, contributing to noncommunicable diseases such as cardiovascular, neurodegenerative, and kidney disorders. Despite the known health risks, public health responses to toxic substance exposure remain underdeveloped in many regions, particularly in low- and middle-income countries (LMICs). Strengthening health systems through capacity building is critical to addressing the growing burden of toxic exposure. This article explores the need for a trans- and interdisciplinary approach to building sustainable health system responses, focusing on enhancing human resources, institutional capacity, and public health infrastructure. In addition, it highlights case studies and best practices from various regions, illustrating the importance of global cooperation and community-driven efforts in mitigating the impacts of toxic substances. The article concludes by recommending a strategic and gradual approach to capacity building, integrating chemical safety into health systems to reduce the disease burden and improve public health outcomes in LMICs.

Into the spotlight: A spatial study of potentially underreported leptospirosis among dengue-negative patients in São Paulo city, Brazil.

Leptospirosis and dengue share similar unspecific symptoms, complicating differential diagnosis in endemic regions. This overlap is further exacerbated by the often-underrecognized nature of leptospirosis, resulting in low clinical suspicion among healthcare providers. Understanding the scale of underdiagnosed leptospirosis cases, particularly among dengue-negative patients, is critical for improving public health responses. This cross-sectional study analyzed data from 6,936 febrile patients who tested negative for dengue at public health services across São Paulo city. Serum samples from these patients were subsequently tested for anti-Leptospira IgM antibodies. Spatial analysis was conducted to identify areas at increased risk of underdiagnosed leptospirosis, and these findings were compared to cases reported in the Brazilian's Information System for Notifiable Diseases from 2009 to 2019. Our results revealed that, from the 6,936 patients tested, 786 (11.3%) were seroreactive for leptospirosis, with a higher prevalence among women (55.7%; p=0.003). Spatial analysis identified 18 high-risk clusters for potentially unrecognized leptospirosis, predominantly in peripheral regions with socioeconomic vulnerabilities. Notably, two significant high-risk areas were located in the North (RR=2.13) and South (RR=2.69) regions of the city. These findings underscore the urgent need for targeted public health interventions to improve disease surveillance and diagnostic capacity, particularly in the high-risk areas identified. Addressing underrecognition of leptospirosis is essential for reducing morbidity and mortality associated with the disease. Future research should expand on this work by integrating broader temporal, environmental, and socioeconomic data.

Making the public protect public health: the ethics of promoting collective action in emergencies

Effective public health responses to many infectious diseases require sustained collective action. Communicable disease control in populations can only be achieved by high levels of public compliance with health directives....

Case series of the first five human infections with monkeypox virus clade Ib and report on the public health response, United Kingdom, October to November 2024.

We report two importations of monkeypox virus clade Ib infection to the United Kingdom in 2024. The first was a traveller returning from Tanzania, Rwanda and Uganda, the second from Uganda. Both presented with fever and typical skin lesions; 147 contacts were followed up, 19 vaccinated with MVA-BN. Three household contacts of the first individual, including two children, became infected. These are the first reported autochthonous transmissions of clade Ib in Europe, and first paediatric cases outside the African continent.

What Is Social Connection in the Context of Human Need: An Interdisciplinary Literature Review

The U.S. Surgeon General made an impactful declaration in the 2023 advisory on America’s loneliness and social isolation epidemic that social connection, or human relationships, is a human need equivalent to water, food, and shelter. After witnessing the impact of social isolation measures during the COVID-19 pandemic, there is a global urgency to better understand social connection in public health responses. However, meaningfully effective interventions for social isolation or loneliness have yet to be identified, and the consensus that social connection is an equivalent human need is unclear. To understand what social connection, oxygen, water, food, and shelter have in common regarding population health, we conducted an interdisciplinary literature review between September 2021 and October 2024, seeking to find commonalities between research literature advocating social connection as a human need critical to survival and key concepts across population health disciplines that explain how oxygen, water, food, and shelter function as human needs. We integrated the concepts of evolution, resource, environment, ecosystem, exposure science, embodiment, homeostasis, allostatic load theory, and interdisciplinary from 44 core publications to develop a unified conceptual model and definition for social connection as a human need. We believe a holistic understanding of social connection within the shared context of oxygen, water, food, and shelter can better support health researchers across a variety of disciplines to find common ground in developing evidence-based interventions within public health.

Prevalence, age-of-onset, and course of mental disorders among 72,288 first-year university students from 18 countries in the World Mental Health International College Student (WMH-ICS) initiative.

Prevalence, age-of-onset, and course of mental disorders among 72,288 first-year university students from 18 countries in the World Mental Health International College Student (WMH-ICS) initiative.