Tropical Medicine Research Articles

“Boys and Men”: The Making of Senegambian and Congolese Masculinity and Identities in Tropical Africa: A Reflection

Our paper focuses on two white pioneering scientists, Dr Dutton, who was English, and Dr Todd, a Canadian, employed by the Liverpool School of Tropical Medicine (LSTM) to study sleeping sickness in colonial Senegambia, West Africa. We analysed photographs and some published personal letters to help us reflect on some of their constructions of Senegambian and Congolese male identities in tropical colonial Africa. In this paper, we connect with the history of tropical medicine, a precursor to public health. Public health was a research area that was central to Peter Aspinall’s work as he argued for shifts from simplistic hegemonic terminologies to refer to an incredibly diverse Black African population, as failure to do so impacts on service provisions. Within the context of tropical medicine, we reflect on the paternalistic terminology and use of the word ‘boy’ to refer to their unnamed male helpers who they photographed during these expeditions. We hope that by interpreting the photographs and reflecting on the literature and letters, exercises that are influenced by our positionality, we can obtain a glimpse into the past and obtain some insights that contribute to our understanding of the production of colonial masculinities, terminology, and race. As female authors employed by LSTM, we are aware that our positionalities influence the lenses through which we view and interpret the literature and the photos. Our paper contributes towards the ongoing debates on terminology, race, and whiteness in colonial tropical medicine.

Prevalence, aetiology, and service mapping of dementia in rural Uganda. Part of DEPEND Uganda (Dementia Epidemiology, unmet Need and co-Developing Solutions in Uganda).

Background Dementia prevalence in low- and middle-income countries is increasing, yet epidemiological data from African populations remain scarce. Crucial risk factors differ in Africa from more intensively studied global areas, including a higher burden of cerebrovascular disease and HIV, but lower rates of other risk factors like physical inactivity. Understanding dementia aetiology in African settings has been limited by the expensive and invasive nature of biomarker testing. This study leverages developments in blood-based and retinal imaging biomarker technology to examine the drivers of dementia in older Ugandans. People with dementia have complex needs benefiting from multi-dimensional support. Understanding current services will allow identification of barriers and opportunities to strengthen support available to people with dementia and their families. Methods The study is nested within the General Population Cohort run by the Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Research Unit. All adults aged 60+ (around 1400) are undergoing brief cognitive screening. In Part 1, cohort participants are selected based on screening scores to undergo detailed cognitive assessment, using methods developed by the 10/66 Dementia Research Group. Part 2 is a case control study of people with and without dementia using antecedent data, questionnaires, physical assessment, retinal imaging, and Alzheimer’s blood-based biomarkers. We will also compare disability, frailty, quality of life, and social engagement in people with and without dementia. Part 3 assesses current formal support structures for people with dementia through review of publicly available literature and expert interviews. Conclusions This is the first study in Africa using blood-based and retinal imaging biomarkers to examine pathological processes underlying dementia, and systematically map services available for people with dementia. This paves the way for effective policy strategies and further focused research regarding both dementia prevention and support for affected people and their families.

The 125th anniversary symposium of Liverpool School of Tropical Medicine: the future of global health.

The 125th anniversary symposium of Liverpool School of Tropical Medicine: the future of global health.

IMPACT MONITORING OF LOW AND HIGH DEXAMETHASONE DOSES ON COVID-19 OUTCOMES IN HODEIDAH, YEMEN: A PHARMACOEPIDEMIOLOGICAL STUDY

Objectives: The study aimed to describe the pharmacoepidemiological properties of high and low dexamethasone doses on patients from COVID-19 in Hodeidah, Yemen. Methodology: A randomized clinical trial included 192/323 patients with COVID-19 (28/49 cases in the first wave 2020 and 164/274 cases in the second wave 2021), aged from 3 to 80 years old, confirmed by real time-polymerase chain reaction. All patients were admitted in the isolation department, Center of Tropical Medicine and Infectious Diseases, AL Thawara Public Hospital Authority, Hodeidah, Yemen. 28 patients received high dose of dexamethasone (20–10 mg daily for 10 days) with standard care in the first wave and 164 patients received low dose of dexamethasone (6–8 mg daily for 10 days) in the second wave with standard care. Results: The results showed non-significant differences between the impact of dexamethasone in both waves with different doses of dexamethasone (X2: 1.70; p=0.91). On the other mean, the case fatality rate (CFR) in the first wave with high dose was 10.71% and CFR of the second wave with low dose was 22.29%. While the results showed significant differences between high dose and low dose group with mechanical ventilator “mechanical ventilation (MV)” (X2: 7.10; p=0.0076), the CFR of patients with MV and high dose was 37% and CFR of the second wave with low dose was 77% In addition, all admitted cases had acute respiratory distress syndrome and the onset date of symptom was 2 weeks before hospitalization. Old age, chronic diseases, and co-infection may be contributing factors to effect on dexamethasone efficacy and excess mortality among COVID-19 patients. Conclusion: The study assessed the effectiveness of dexamethasone in high and low dose in treating patients hospitalized with COVID-19 in Hodeidah, Yemen and found difference between mortality and recovery outcomes with high and low dose where the high doses of dexamethasone had good outcome for critical cases with MV.

Development and Implementation of a Minority Health International Infectious Diseases Research Training Program.

From 2014-2019, the University of Hawai'i (UH) at Manoa offered a National Institutes of Health funded Minority Health International Research Training (MHIRT) Program for undergraduate research experiences in infectious diseases. The goal of the program was to immerse undergraduate students in conducting global infectious diseases research to train a new generation of scientists to combat future global pandemics. The MHIRT program trained educationally underrepresented groups unique in Hawai'i: Native Hawai'ians and other Pacific Islanders, and underrepresented Asian Americans, e.g., Filipinos and Vietnamese. A 12-member Advisory Committee guided the program development, implementation, recruitment strategies, recruitment, retention, and program evaluation. The program provided an eight-month classroom and field based international research training. Students learned about "8 steps of research" and cultural competency, experienced a hands-on research project abroad, and presented their results to the research community in the host country and at UH. Students' research topics focused on ongoing projects of UH faculty including those with international collaborations in infectious disease and tropical medicine. Students spent two months on an international research mentor's project at an international site under the mentorship of a Hawai'i based research faculty. After eight months, students graduated from the program by presenting their research to family, friends, mentors, and UH faculty and administrators. Trainees in this program pursued academic graduate or professional health degrees. The majority of students pursued further studies related to infectious diseases contributing to workforce development in infectious disease health research. The UH-MHIRT program provides an example of student immersion in international infectious disease research to foster future interest in global health research providing potential benefits for the student and faculty and their research efforts.

Summary of the National Advisory Committee on Immunization (NACI) Statement-Updated guidance on Imvamune in the context of a routine immunization program.

Mpox is a viral illness related to smallpox. It can cause flu-like symptoms and a rash, and in severe cases, can lead to hospitalization or death. The Imvamune® vaccine offers protection against mpox. Consistent with global trends, mpox cases in Canada have been reported primarily among men who have sex with men (MSM), with sexual contact as the predominantly reported mode of transmission. While the incidence of mpox in Canada has significantly declined since the fall of 2022, mpox remains an important public health concern with the potential for future resurgence. The National Advisory Committee on Immunization (NACI) reviewed available evidence on the clinical benefits and risks of Imvamune. This evidence included studies assessing the vaccine effectiveness estimates from real-world evidence, as well as pre- and post-market licensure safety data. NACI has also considered additional factors including ethics, equity, feasibility and acceptability. Guidance on the use of Imvamune in the context of international travel was developed in collaboration with the Canadian Committee to Advise on Tropical Medicine and Travel (CATMAT). NACI concluded that available evidence supported the vaccine's effectiveness and safety in preventing mpox infection. Building on previous interim guidance from NACI recommending the use of Imvamune for pre-exposure vaccination in the context of ongoing mpox outbreaks, NACI now recommends that Imvamune be used in the context of a focused routine immunization program. Individuals at high risk of mpox, including MSM who meet high-risk criteria such as having more than one sexual partner, should receive two doses of Imvamune administered by subcutaneous injection at least 28 days apart.

Global Health's Evolution and Search for Identity.

Despite earlier attempts to define global health, the discipline's boundaries are unclear, its priorities defined more by funding from high-income countries from the Global North than by global health trends. Governance and resource allocation are challenged by movements such as decolonizing global health. Inherent contradictions within global health derive from its historical evolution from tropical medicine and international health, as well as recent trends in infectious diseases. Demographic, socioeconomic, and epidemiologic transitions, including the rise in noncommunicable diseases, have eroded the concept of a binary world of developed and developing countries. Competitive tension has emerged between aspirations for global health security and health equity. Dominant principles should focus on vulnerable populations, transnational challenges such as migration and climate change, appropriate prevention and care, and epidemic preparedness and response capacity. As the 2030 target date for the United Nations Sustainable Development Goals approaches, reconceptualization of global health is required, or the discipline risks losing identity and relevance.

Trochleoplasty Utilization in the Management of Patellofemoral Instability: Results From an International Survey of Surgeons.

Considerable variability exists in the described clinical and radiographic indications for use, surgical techniques, postoperative management, and risk profile after trochleoplasty for the management of patellofemoral instability (PFI). In areas of clinical uncertainty, a cohesive summary of expert opinion and identification of areas of variation in current practice can be useful in guiding current practice and future research efforts. To assess the current indications for use, surgical techniques, postoperative rehabilitation practices, and observed complication profile for trochleoplasty in the management of PFI among surgeons who perform this procedure. Cross-sectional study. A 21-item cross-sectional survey was developed to evaluate trochleoplasty in its current practice among surgeons around the world. The survey was distributed between December 2021 and April 2022 to the orthopaedic surgeon membership of multiple national and international knee, arthroscopy, and sports medicine societies to identify any surgeon with experience performing the trochleoplasty procedure in practice for the management of PFI. Descriptive statistics of survey responses were performed to address study aims, and univariate analyses were performed to compare differences between high- and low-volume trochleoplasty surgeons. Survey distribution identified 32 orthopaedic surgeons with experience performing the trochleoplasty procedure. Procedural indications were most commonly felt to be met with Dejour classification of B or D on magnetic resonance imaging. Trochleoplasty was felt by most to be appropriate as a primary surgical intervention for PFI. A majority of surgeons utilized a Bereiter (thin-flap) trochleoplasty technique with suture-based fixation and performed concurrent medial patellofemoral ligament reconstruction, but other concomitant procedures varied. Range-of-motion precautions and bracing practices varied among respondents, and arthrofibrosis was the most frequently cited observed complication. High- and low-volume trochleoplasty surgeons differed in their radiographic and age-based indications for the procedure. Study findings indicated that variation exists in the surgical indicators, technique, and postoperative rehabilitation practices of trochleoplasty surgeons, with specific differences noted between high- and low-volume trochleoplasty surgeons. The results of this survey identified areas of equipoise and treatment variation that should direct future research efforts in the study of the trochleoplasty procedure.

Unveiling immunity gaps and determining a suitable age for a third dose of the measles-containing vaccine: a strategic approach to accelerating measles elimination.

In highly measles immunized countries, immunity gaps in adolescents and young adults are a key issue posing an obstacle to measles elimination. This study aims to identify the gaps by estimating the age-stratified probability of seropositivity, and to ascertain a suitable age for the administration of a third dose of a measles-containing vaccine (MCV3) to effectively fill these gaps. We retrospectively obtained measles serological results from hospital setting among among individuals aged 13-39 years and developed a serocatalytic dynamic probability model, stratifying seropositivity due to vaccination or natural infection. We calibrated the model to age-stratified seropositivity data within a Bayesian setting using the Metropolis-Hastings algorithm. A scenario analysis to determine a suitable age for MCV3 administration was also performed. The overall prevalence of measles seropositivity was 65.6% (95% confidence interval [CI]: 61.5-69.6). Posterior predictive curves for the age-stratified seroprevalence exhibited a decreasing trend from ages 13-20 years but an upward trend from 26 to 30 years. The age at which a given individual's serostatus reached a 50% probability of seronegativity was found to be approximately 18-20 years depending on the annual measles force of infection. Our findings highlight a significant measles immunity gap in young adults aged 20-26 years, posing an increased risk of transmission. A MCV3 at the age of 18-20 years potentially closes the gap and aids measles elimination programmes. This work was supported by Faculty of Tropical Medicine (MCTM, ICTM grant), Mahidol University (to T.N.) and APC fee was supported by Mahidol University (to T.N.). S.M. and W.P. were funded in whole, or in part, by the Wellcome Trust [Grant number 220211]. For the purpose of open access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

Mosquitoes Reared in Nearby Insectaries at the Same Institution Have Significantly Divergent Microbiomes.

The microbiome influences critical aspects of mosquito biology and variations in microbial composition can impact the outcomes of laboratory studies. To investigate how biotic and abiotic conditions in an insectary affect the composition of the mosquito microbiome, a single cohort of Aedes aegypti eggs was divided into three batches and transferred to three different climate-controlled insectaries within the Liverpool School of Tropical Medicine. The bacterial microbiome composition was compared as mosquitoes developed, the microbiome of the mosquitoes' food sources was characterised, environmental conditions over time in each insectary were measured, and mosquito development and survival were recorded. While developmental success was similar across all three insectaries, differences in microbiome composition were observed between mosquitoes from each insectary. Environmental conditions and bacterial input via food sources varied between insectaries, potentially contributing to the observed differences in microbiome composition. At both adult and larval stages, specific members of the mosquito microbiome were associated with particular insectaries; the insectary with less stable and cooler conditions resulted in a slower pupation rate and higher diversity of the larval microbiome. These findings underscore that even minor inconsistencies in rearing conditions can affect the composition of the mosquito microbiome, which may influence experimental outcomes.

Clinical-epidemiological characteristics of toxoplasmosis in the central nervous system of HIV patients attending the Institute of Tropical Medicine. January to December 2023

Introducción: Entre el 10% y el 50% de las personas con VIH que también presentan serología positiva para Toxoplasma desarrollan encefalitis toxoplásmica (ET). Aproximadamente el 50% de estos casos presentan secuelas neurológicas y la mortalidad se aproxima al 20%. Debido a estos datos, la ET se posiciona como la segunda infección oportunista más frecuente que afecta el sistema nervioso central (SNC) en pacientes VIH positivos. Objetivo: Describir las características clínico-epidemiológicas y evolución de la toxoplasmosis en pacientes portadores de VIH atendidos en el Instituto de Medicina Tropical durante enero a diciembre del 2023. Metodología: Estudio observacional, descriptivo, retrospectivo, de corte transversal. Se incluyeron pacientes con confirmación serológica laboratorial de infección por VIH; mayores de 18 años; con sospecha clínica de infección en el sistema nervioso central por Toxoplasmas gondii, atendidos en el Instituto de Medicina Tropical de enero a diciembre del 2023. Variables de interés: sociodemográficas: edad, sexo, procedencia; laboratoriales: carga viral de VIH, recuento de linfocitos tCD4; variables clínicas: signos y síntomas asociados, desenlace. Los datos fueron procesados en Excel 2010; las variables cualitativas se expresaron en frecuencias absolutas y relativas, y las cuantitativas en medias. Resultados: Fueron incluidos 44 pacientes adultos, edad media 38 años; 66% correspondieron al sexo masculino. 48% de los casos procedentes del Departamento Central. La cefalea fue el síntoma más frecuente: 19 pacientes (43%), seguido de las convulsiones y las focalizaciones neurológicas. La media del recuento de linfocitos tCD4 fue de 79 cel./UL (min: 3, máx:334; RIC:27-104). 41 pacientes (93%) con conteo linfocitario menor a 200 cel/mm3. La media de CV fue de 421865 copias/mL. En el 95,6% de los casos los pacientes recibieron tratamiento médico con trimetoprima sulfametoxazol. En 40,9% se observó hipo densidad en dedo de guante por tomografía axial computarizada, 2,2% presentó proceso expansivo por el mismo método y 6,8% presentaron hipo densidad en resonancia magnética. El 90,9% de los pacientes fueron dados de alta médica. Conclusión: Predominaron adultos jóvenes de sexo masculino, con cefalea como síntoma más frecuente, en su mayoría con una disminución significativa del recuento de linfocitos TCD4. La implementación del tratamiento médico mejoró la respuesta clínica, disminuyendo las complicaciones neurológicas.

COVID-19 and liver

Abstract Background and aims The coronavirus disease 2019 (COVID-19) presents a significant health risk, affecting both healthy individuals and those with underlying health conditions, including liver diseases. This study aimed to evaluate the impact of COVID-19 on liver function in both hepatic and non-hepatic patients across varying degrees of disease severity, as confirmed by PCR testing. Methods In this prospective study, we included patients with confirmed COVID-19, both with and without liver conditions, who were admitted to the National Hepatology and Tropical Medicine Research Institute (NHTMRI) and Embaba Fever Hospital between November 2020 and July 2021. Results The study cohort consisted of 255 confirmed COVID-19 patients (mean age 52.16 years, 48.6% male, 24.3% with liver conditions). Among those with liver disease, 6.4% had mild symptoms, while 4.8%, 56.4%, and 33.8% experienced moderate, severe, and critical symptoms, respectively. Clinical characteristics were insignificantly different between hepatic and non-hepatic patients across the various COVID-19 severity grades, with the exception of the loss of taste and smell in severe cases and hepatic encephalopathy and oxygen saturation in critical cases. Laboratory findings similarly showed no significant differences, except that hepatic patients exhibited a notable decrease in platelet count and a significant increase in AST and bilirubin levels compared to non-hepatic patients. In critical COVID-19 cases, non-hepatic patients had significantly higher serum ferritin levels, while hepatic patients demonstrated increased serum bilirubin levels. Mortality was considerably higher in hepatic patients than in non-hepatic patients, particularly among those with severe and critical COVID-19. The study suggests that liver disease is associated with the progression to severe COVID-19, which includes a higher risk of mortality. Conclusion COVID-19 is linked to liver function impairment, with hepatic patients experiencing higher mortality rates compared to non-hepatic patients. Summary COVID-19, a novel coronavirus, presents a serious health threat to both healthy individuals and those with pre-existing health conditions. In this study, we evaluated its impact on individuals with liver disease compared to those without. The findings indicate that COVID-19 infection is associated with a decline in liver function and increased mortality rates in patients with liver disease.

Standardizing Hazard Signage in the Laboratory Research Division of the Research Institute for Tropical Medicine

Old signage faced iconography, variable layouts, visual presentations, and contents, as well as degradation issues, undermine the effectiveness of hazard communication in the laboratory. A 2016 project was initiated to standardize all hazard signages at the Laboratory Research Division of the Research Institute for Tropical Medicine (RITM), incorporating standard colors and iconography for better compliance and safety. As part of a broader initiative to enhance biorisk practices within the institute, there are plans for improvement and expansion to non-laboratory areas.

The 2nd International Forum “Traditional Buddhism and Modern Challenges”

This article is an overview of the work of the II International Forum “Traditional Buddhism and Modern Challenges”, which was held on 12–14 August 2024 in Ulan-Ude. This year, more than 1,800 participants from 16 countries gathered together, with representatives from not only religious structures, but also political, public, and scientific organizations. This forum aims to strengthen international relations between Buddhists of the world at all levels. The article analyzes the main activities of three events united by a single theme – the conference "Buddhism in a Changing World", the II International Forum “Traditional Buddhism and Modern Challenges”, the conference “The Phenomenon of the XII Pandito Khambo Lama Dashi-Dorzho Itigilov”, related to the actualization of the Buddhist culture in today's society, understanding of the philosophy and practice of Buddhism in the modern world, assessment of the main directions and results of the activities of Buddhist institutions and organizations both at the religious level and in the system of their interactions with political powers in Russia and Asian countries, their role and influence in international relations, education and medicine.

Manejo de la patología importada de migrantes a su llegada en Atención Primaria

The number of migrants under 16 years of age residing in the Community of Madrid is around 140000 according to the “Foreign Population Report of the Community of Madrid” carried out in January 2021. Many of them arrive accompanied by their family, they are reunited with this and a minority they arrive alone. They present a greater risk of infectious diseases with which they have not had contact in the receiving country, of suffering from others due to the living conditions in the host country or of importing infectious diseases from their country of origin. Therefore, it is important making early diagnosis and treatment important for both the patient and the community. Its management in primary care must be systematic and protocolized in collaboration with other levels of care and social devices. Close attention that promotes their confidence and adherence to follow-up improves their health results and their multicultural integration in the receiving country. Two cases of imported tropical pathology are presented in 2 children who consult for the first time at the health center after their arrival in Spain.

Cluster randomised controlled trial of double-dose azithromycin mass drug administration, facial cleanliness and fly control measures for trachoma control in Oromia, Ethiopia: the stronger SAFE trial protocol

IntroductionTrachoma is caused by the bacterium Chlamydia trachomatis (Ct). The WHO recommends the SAFE strategy for trachoma elimination: Surgery for trichiasis, Antibiotics, Facial cleanliness and Environmental improvement. Multiple rounds of...

Laboratory Hosts: Postcolonial Parasites, Growth Factors, and the Fabrication of a Molecular Gaze

From the final decades of the nineteenth century onward, physicians and scientists trained in Europe’s colonial powers devoted considerable attention to the lives of parasitic organisms found in the bloodstreams of humans and other animal hosts. Initially, this work required direct access to blood freshly sampled from a host and was spurred by desires to reduce the incidence of so-called tropical diseases such as malaria and sleeping sickness, which were especially prevalent in parts of the world that European powers had claimed as colonies. Soon, noting the successes of bacteriologists in cultivating pathogenic bacteria in sterilized glass containers, some researchers set out to domesticate parasitic protozoa, as well. By the early twentieth century, these investigators had codified recipes for culturing a range of blood parasites, dramatically increasing the mobility of these organisms between colonial and metropolitan laboratories. This essay explores a handful of the many meanings that researchers attached to parasites in vitro. As pathogens, these organisms stubbornly confounded colonial campaigns to staunch their spread between human and animal hosts, yet as laboratory organisms, they posed timely and tractable intellectual puzzles, such as how molecularly defined nutrients functioned in the broader metabolic contexts of living cells. This essay traces a genealogy of experimental practices that gave rise to laboratory hosts. By mimicking or supplanting the functions of living hosts’ bodies, laboratory hosts transformed blood parasites into experimental tools. In time, they additionally came to incorporate synthetic and manufactured ingredients, further alienating parasites from their former dependencies on hosts’ blood. Through these nutritional negotiations, researchers reimagined specific biological relationships as generic chemical ones, thus rendering parasites viable models of metabolic processes unfolding in a great many living things. While eliciting skepticism from some commentators, such chemical views of nature’s order grew enormously influential in midcentury biology and medicine. In examining a selection of the materials and techniques that made up laboratory hosts, this essay illuminates significant yet overlooked continuities between the practices of colonial era tropical medicine and postwar molecular life science.

A Promising Tropical Medicinal Plant: Taiwan as the Production Hub of Japan's Coca Empire.

Before World War II, Taiwan became the second-largest coca leaf production base in Asia, second only to Java, contributing to Japan's position as the world's largest exporter of cocaine. While Japan's opium empire has been the subject of extensive academic inquiry, its coca empire has received far less attention. This article explores Taiwan's role in Japan's dual empire of opium and coca, focusing on the environmental and historical factors that enabled the island to rapidly expand coca production. It finds that, in addition to Taiwan's favorable climate for coca cultivation, the island's long-established tea industry provided mature techniques for harvesting and drying the coca leaves. Furthermore, the sugar company supplied the necessary equipment and capital for the extraction of cocaine, becoming a key resource in the industry's development. Learning from the limitations of the opium monopoly-where raw materials were increasingly constrained by international markets-the colonial government sought to promote self-sufficiency in coca production. This strategy not only ensured a stable supply of raw materials but also allowed the coca industry to balance for the declining incomes from opium as international controls tightened. From all angles, the coca industry met Japan's expectations as a "promising drug."

Development and evaluation of an antigen targeting lateral flow test for Crimean-Congo Haemorrhagic Fever

Crimean-Congo Haemorrhagic Fever (CCHF) is a viral haemorrhagic fever with a case fatality rate of 5-25% that has been prioritised for research and development by the World Health Organisation. There are no CCHF rapid diagnostic tests (RDTs) commercially available. We describe the development and evaluation of an antigen-targeting lateral flow immunoassay RDT for CCHF. Prospective clinical samples were collected and tested between July and October 2023 in Türkiye. Retrospective stored samples were obtained from the Central Public Health Laboratory, Baghdad, Iraq. The sensitivity and specificity of the CCHF RDT was compared to reverse transcription quantitative polymerase chain reaction assays. On prospective clinical samples in Türkiye, the sensitivity and specificity of the CCHF RDT was 90.4% [95% CI 81.5-95.3%] (n=73) and 96.2% [95% CI 87.0-99.3%] (n=52), respectively with a sensitivity of 92.9% [95% CI 84.3-96.9%] (n=70) in samples with a cycle threshold (Ct) ≤30. On retrospective stored samples in Iraq, sensitivity and specificity of the RDT was 71.7% [95% CI 59.2-81.5%] (n=60) and 92.5% [95% CI 80.1-97.8%] (n=40), respectively with a sensitivity of 82.2% [95% CI 68.7-90.7%] (n=45) in samples of Ct ≤30. The CCHF RDT was an effective rapid diagnostic test in this preliminary clinical evaluation, showing this RDT has the potential diagnostic capability for use at the point-of-care. Definitive evaluation is now required to ensure the RDT meets the regulatory requirements for commercialisation. The Liverpool School of Tropical Medicine, National Institute for Health Research Health Protection Research Unit in Emerging Zoonotic Infections, The Medical Research Council and The Pandemic Institute.

Splenic Modulation of Plasmodium vivax Relapses and Hypnozoite Activation during the Second World War?

Despite their colonial experience with tropical medicine, Allied (United States, United Kingdom, Australia, and India) Armies in the Indo-Pacific region were surprised by the large number of Plasmodium vivax infections in their soldiers during the Second World War. Even after the institution of effective chemoprophylaxis with quinacrine, multiple cycles of clinical relapses often occurred when months of medication was discontinued. Nearly monthly symptomatic relapses (>10) were not unusual and resulted in important manpower losses after each campaign. Retrospective consideration suggests that small splenic size was associated with the risk of recurrent clinical episodes of vivax malaria. Potential non-mutually exclusive explanations for frequent relapses of vivax malaria in soldiers are reviewed. These include decreased retention of parasitized red blood cells by small spleens through greater filtration stringency preventing relapses from becoming clinically patent; small spleen size being a marker of lower innate and/or acquired immunity, modulating the risk of clinically patent recurrences; or small spleen size increasing the number of relapses through decreased removal of triggers of hypnozoite activation. Apparent splenic modulation of vivax malaria relapses suggests a complex interaction between the parasite and host that might be amenable to manipulation to facilitate malaria elimination.