Treatment of aircraft with insecticide in a procedure referred to as ‘disinsection’ is recommended to prevent the conveyance of arthropod vectors internationally and to mitigate the globalization of vector-borne infectious diseases. However, the full spectrum of human-based outcomes related to disinsection of conveyances has not been recently synthesized. A systematic review was conducted to evaluate the human safety and toxicity of insecticides used during the process of disinsecting international aircraft, marine vessels, rail, and ground transportation of mosquitoes. The systematic review was conducted according to the PRISMA guidelines and was registered in PROSPERO (CRD42024543998). The certainty of the evidence was rated, and key primary outcomes, including human health effects of conveyance disinsection, were synthesized. A total of 21 studies that described human health effects of conveyance disinsection and reported outcomes of safety, toxicity, and tolerability were included, and were of generally limited quality and high risk of bias, with low to very low certainty of estimates of effect. No high-quality studies investigating the safety, toxicity, or tolerability of disinsection were identified. Human health effects, including morbidity, including work days lost, adverse events including hospitalization, objective measures of insecticide toxicity, detectable and elevated urinary metabolites, and subjective reporting of symptoms consistent with acute insecticide poisoning, were reported by the small number of uncontrolled observational studies and public health surveillance reports included. Given the reports of significant morbidity, adverse events, and toxicity putatively attributable to aircraft disinsection, well-designed studies in exposed populations investigating the full range of human health impacts of disinsection on passengers and crew are urgently needed.

Background and Clinical Significance: Fever in the returning traveler is a medical emergency warranting prompt exclusion of potentially life-threatening infections such as malaria. Case Presentation: We describe a case of a febrile returned traveler to South Africa whose prompt initial diagnostic work-up was notable for a false-positive malaria rapid diagnostic test (RDT), and who nevertheless responded quickly to oral atovaquone-proguanil, despite an ultimate diagnosis of African tick bite fever. Subsequent RDT and malaria thick- and thin-film blood examination failed to corroborate a diagnosis of malaria and all other microbiological testing other than rickettsial serology remained non-contributory. Conclusions: The case presented highlights important points regarding diagnostic test performance characteristics and premature diagnostic closure.

Disinsection of aircraft and other conveyances is recommended to prevent the international spread of disease-carrying mosquitoes. A systematic review synthesized the effectiveness of adult mosquito disinsection aboard international air, marine, and land conveyances, using literature available up to 31 May 2025. Nineteen experimental trials, nine of which included an unexposed control arm, were synthesized. The studies were generally of poor quality with high risk of bias, and adherence to WHO guidelines was 33.30% (range: 18.20–60.5%). Across comparator trials of aircraft disinsection, the odds of mosquito mortality in the treated groups compared to control groups was 163.60 (95% CI 147–182), and the relative risk of mosquito death was 14.24 (95% CI 12.99–15.63). The direction of effect was consistent across mosquito species, methods of disinsection, types of aircraft, and insecticides, though the magnitude of the effect varied widely. The only WHO-recommended insecticide tested in a controlled trial was 2% d-phenothrin, which demonstrated an odds ratio of 171.70 (95% CI 139.10–212) and a relative risk of 20.08 (95% CI 16.53–24.43) for mosquito mortality. The lack of adherence to WHO guidelines raises uncertainty about the real-world effectiveness of disinsection.

Background: Post-transplant infections remain a leading cause of morbidity and mortality in solid organ transplant recipients (SOTRs) and local standardized antimicrobial treatment guidelines may contribute to improved clinical outcomes. Our study assessed the rate of therapeutic compliance with local standard guidelines in the treatment of common infections in SOTR, and their associated outcomes. Methods: Consecutive adult SOTRs admitted to the transplant floor from January–September 2020 and were treated for an infectious syndrome were followed until discharge or for 30 days following the date of diagnosis, whichever was shorter. Data was extracted from electronic medical records. Guideline compliance was characterized as either appropriate, effective but unnecessary, undertreatment, or inappropriate. Results: Nine hundred and thirty-six SOTR were admitted to the transplant ward, of which 328 patients (35%) received treatment for infectious syndromes. Guidelines were applicable to 252 patients, constituting 275 syndromes: 86 pneumonias; 82 urinary tract infections; 40 intra-abdominal infections; 38 bloodstream infections; and 29 C. difficile infections. 200/246 (81%) of infectious syndromes received appropriate or effective but unnecessary empiric treatment. In addition, appropriate tailoring of antimicrobials resulted in a significant difference in 30-day all-cause mortality (adjusted OR of 0.07, 95% CI 0.01–0.38; P = .002). Lastly, we found that guideline-compliant empiric therapy was found to prevent the development of multi-drug resistance in a time-dependent analysis (adjusted HR of 0.21, 95% CI 0.08–0.52; P = .001). Conclusion: Our data show that adherence to locally developed guidelines was associated with reduced mortality and resistant-organism development in our cohort of SOTR.

Background: Viral hemorrhagic fevers (VHFs) are severe, often high-consequence, life-threatening illnesses characterized by systemic disease, hemorrhage, and high mortality. The American Society of Tropical Medicine and Hygiene (ASTMH) Annual Meeting functions as a major international forum for the presentation of emerging data on infectious diseases, including novel pharmacologic and biologic interventions for VHF. However, while ASTMH presentations provide timely and high-impact insights, there is no efficient, consolidated synthesis of this rapidly evolving evidence base. Given the acute, outbreak-prone nature of VHF and the need for rapid translation of emerging data into clinical and public health practice, a structured synthesis of these data is warranted. Methods: This systematic review follows PRISMA guidelines and is limited to presentations delivered at the ASTMH Annual Meeting in Toronto (9–13 November 2025) in order to capture evolving evidence as it has emerged. Studies of all designs evaluating vaccines, chemoprophylactic agents, or targeted biological therapies for the prevention or treatment of VHF in adults and children were included. Data were extracted on incidence of VHF among exposed populations, safety, toxicity, and tolerability of preventive and therapeutic interventions, and morbidity and mortality outcomes among treated individuals. Secondary outcomes include hospitalization length-of-stay, economic outcomes, and measures of feasibility, acceptability, accessibility, and health equity. Results: Nine studies (four oral presentations, two poster presentations, and three hand-searched references) were included in the final synthesis. Seven studies evaluated pharmacologic preventive interventions and two evaluated experimental pharmacotherapeutics, with two studies contributing evidence to both categories. One observational study and one narrative review provided contextual evidence on vaccine readiness and outbreak preparedness. Discussion/Conclusions: This systematic review provides a rapid, structured synthesis of targeted medical interventions as emerging evidence at an expert scientific venue, while addressing the current lack of a consolidated, accessible summary of emerging VHF evidence. By rapidly organizing and evaluating these data, this work facilitates timely interpretation and application in clinical and public health settings where rapid decision-making is critical.