Robust surveillance of Histoplasma species is warranted in endemic regions, including investigation of community-level transmission dynamics. This cross-sectional study explored anti- Histoplasma antibody seroprevalence and risk factors for exposure in a general population in Upper River Region (URR), The Gambia. Study participants were recruited (December 2022-March 2023) by random household sampling across 12 Enumeration Areas (EAs) of URR. A questionnaire and clinical examination were performed; exploring demographic, clinical and environmental risk factors for Histoplasma exposure. One venous blood sample per participant was subject to IMMY Latex Agglutination Histoplasma test to determine presence of a recent IgM response to Histoplasma. . Seropositivity risk factors were explored by multi-level, multivariable logistic regression analysis. The study population (n n = 298) aged 5-83 years, demonstrated a positively skewed age distribution and comprised 55.4% females. An apparent seroprevalence of 18.8% (n n = 56/298, 95% CI 14.5-23.7%) was measured using the LAT. A multivariable model demonstrated increased odds of Histoplasma seropositivity amongst female participants (OR = 2.41 95% CI 1.14-5.10); and participants reporting involvement in animal manure management (OR = 4.21 95% CI 1.38-12.90), and management of domestic animals inside the compound at night during the dry season (OR = 10.72 95% CI 2.02-56.83). Increasing age (OR = 0.96 95% CI 0.93-0.98) was associated with decreased odds of seropositivity. Clustering at EA level was responsible for 17.2% of seropositivity variance. The study indicates frequent recent Histoplasma exposure and presents plausible demographic and environmental risk factors for seropositivity. Histoplasma spp. characterisation at this human-animal-environment interface is warranted, to determine public health implications of environmental reservoirs in The Gambia. The study was supported by Wellcome Trust (206,638/Z/17/Z to CES) and a University of Liverpool-funded PhD studentship (to TRC).

Introduction: Exposure rates to Histoplasma species, the causative agent of equine epizootic lymphangitis (EL), are unknown amongst working equids in The Gambia. The primary aims of this study were to estimate anti-Histoplasma antibody seroprevalence in the equid population in rural The Gambia and to explore risk factors for seropositivity.Methods: A nationwide cross-sectional study was conducted (February–July 2022), representing baseline measurements of a longitudinal cohort study. Horses (n = 463) and donkeys (n = 92) without EL signs were recruited in 18 study sites. Following informed owner consent, equid clinical and management data were recorded. Blood samples were collected by jugular venepuncture, and sera were subject to the IMMY Latex Agglutination Histoplasma test (LAT). Seropositivity risk factors were explored by multi-level, multivariable logistic regression analysis. Study site and household variance were described using a latent-variable approach. Whole blood DNA extractions were subject to nested ITS-PCR to detect Histoplasma capsulatum var. farciminosum (HCF), and agreement with LAT results was measured using Cohen’s kappa statistic.Results: Anti-Histoplasma antibody seroprevalence in horses and donkeys was 79.9% [95% confidence interval (CI) 76.0–83.5%] and 46.7% (95% CI 36.3–57.4%), respectively. In horses, two multivariable models explained the maximum amount of data variability. Model 1 demonstrated increased odds of seropositivity in mares [odds ratio (OR) = 2.90 95% CI 1.70–4.95, p < 0.001] and decreased odds in horses <2.5 years (OR = 0.46 95% CI 0.22–0.95, p = 0.04; reference: ≥4.5 years). Model 2 demonstrated increased odds in horses recruited during the rainy season (OR = 2.03 95% CI 1.08–3.84, p = 0.03) and those owned by farmers reporting previous EL in their equids (OR = 1.87 95% CI 1.04–3.37, p = 0.04). Decreased odds were measured in horses <2.5 years (OR = 0.37 95% CI 0.18–0.78, p = 0.01) and horses reported to transport firewood (OR = 0.45 95% CI 0.28–0.74, p = 0.001). On multivariable analysis of donkeys, decreased odds of seropositivity were demonstrated amongst donkeys owned by households which also owned horses (OR = 0.23 95% CI 0.06–0.85, p = 0.03). HCF infection prevalence in horses and donkeys was 22.0% (n = 102/463, 95% CI 18.3–26.1%) and 5.4% (n = 5/92, 95% CI 1.8–12.2%), respectively. No significant agreement was measured between LAT and nested ITS-PCR results (κ < 0.00).Conclusion: High Histoplasma spp. exposure was demonstrated amongst equids in The Gambia. Investigation of risk factors, including equid husbandry and management strategies, as well as geoclimatic variations, is warranted. Outcomes may inform sustainable and equitable EL control strategies in The Gambia and comparable settings worldwide.

Inclusion in the WHO’s first Fungal Priority Pathogens List under ‘high priority’ fungal species, highlights the need for robust surveillance of Histoplasma species. in endemic and underrepresented regions. Despite increasing reports of histoplasmosis in Africa, data on the burden of this fungal disease are sparse in The Gambia. This baseline study examined the human seroprevalence of anti-Histoplasma antibody in a TB patient group in The Gambia, explored associations between seropositivity and demographic and clinical variables, and proposed future research directions. Biobanked plasma samples were selected from active TB cases with variable HIV infection status. Latex agglutination tests were performed on samples from 52 study participants to detect the presence of anti-Histoplasma antibodies. Potential risk factors for Histoplasma exposure were explored using logistic regression analysis. The sample seroprevalence of anti-Histoplasma antibody was 28.8% (n=15/52, 95% Confidence Interval (CI) 17.1-43.1%). Multivariable logistic regression analysis identified a statistically significant association between Histoplasma seropositivity and age (OR=0.91 95% CI 0.84-0.98, p=0.008). This baseline study provides evidence of Histoplasma seropositivity in TB patients in The Gambia and explores risk factors for exposure. The small sample size and use of the LAT in TB and HIV-positive patient groups are significant study limitations. Future research directions are proposed to ascertain the burden of Histoplasma in general and patient populations and explore the context-specific risk factors for exposure and infection in The Gambia.

Background: Despite recognition of histoplasmosis as a disease of national public health concern in Kenya, the burden ofHistoplasma capsulatumin the general population remains unknown. This study examined the human seroprevalence of anti-Histoplasmaantibody and explored associations between seropositivity and demographic and environmental variables, in Busia county, western Kenya.Methodology: Biobanked serum samples and associated data, from a previous cross-sectional survey, were examined. Latex agglutination tests to detect the presence of anti-Histoplasmaantibody were performed on serum samples from 670 survey respondents, representing 178 households within 102 sub-locations.Potential epidemiologic risk factors forH.capsulatumexposure were explored using multi-level multivariable logistic regression analysis with household and sub-location included as random effects.Principal findings: The apparent sample seroprevalence of anti-Histoplasmaantibody was 15.5% (n= 104/670, 95% Confidence Interval (CI) 12.9–18.5%). A multivariable logistic regression model identified increased odds ofH.capsulatumseropositivity in respondents reporting rats within the household within the previous 12 months (OR = 2.99 90% CI 1.04–8.55,p= 0.04). Compared to respondents aged 25–34 years, the odds of seropositivity were higher in respondents aged 15–24 years (OR = 2.70 90% CI 1.04–6.97,p= 0.04).Conclusions: The seroprevalence result provides a baseline for sample size approximations for future epidemiologic studies of the burden ofH.capsulatumexposure in Busia county. The final model explored theoretically plausible risk factors forH.capsulatumexposure in the region. A number of factors may contribute to the complex epidemiological picture impactingH.capsulatumexposure status at the human-animal-environment interface in western Kenya. FocussedH.capsulatumresearch is warranted to determine the contextual significance of identified associations, and in representative sample populations.

A range of climate-sensitive diseases are endemic to the Horn of Africa, which is increasingly vulnerable to climate extremes. Global health agencies recognise the need to abandon siloed approaches to climate change and health by integrating health in climate policies, strategies, and guidelines. This structured document review aimed to examine the extent to which health, and specifically infectious diseases, are integrated into climate governance documents in this region, with a focus on Ethiopia, Kenya, Somalia, and Uganda. A desk-based search strategy identified climate governance documents from (1) open-access climate policy databases; (2) targeted websites; (3) citation chaining; and (4) a structured literature search. Data were extracted to summarise document attributes, aims, geographic scope, integration of health topics, and infectious diseases integration, rationale for inclusion, and recommendations. Ninety-eight documents were included, from Ethiopia (18.4%), Kenya (63.3%), Somalia (9.2%), Uganda (6.1%), and the broader region (3.0%). Most documents were affiliated with the Government (94.9%) or intergovernmental organisations (5.1%). Dedicated human health and infectious disease sections were identified in 59.2% and 5.1% of documents, respectively. Integrated health topics included infectious diseases (89.7%; predominately malaria, cholera or acute watery diarrhoea, and typhoid fever), nutrition (55.2%), and maternal or child health (39.7%). Characterisation of climate governance documents in the Horn of Africa highlighted variable integration of health and infectious diseases. These results support calls for improved coherence between climate and health governance processes and evidence translation at research-policy interfaces. The structured search and review methodology may be adopted in other climate-vulnerable contexts, in collaboration with climate and health stakeholders.

Cholera represents a public health threat worldwide and an indicator of poverty, inequity and lack of social development, disproportionately affecting low-income and middle-income countries. Accessible global cholera data resources are essential to support timely, data-driven disease surveillance, response and control efforts. This analysis aims to identify, collate and describe online open-access cholera resources. 31 resources associated with multilateral agencies, academic institutions and non-profit organisations were identified, encompassing dashboards (n=16/31, 51.6%), reports or bulletins (n=12/31, 38.7%) and outbreak reporting systems (n=3/31, 9.7%). The majority of resources were affiliated with the WHO (n=19/31, 61.3%). Other affiliations comprised other United Nations (UN) and multilateral agencies (n=9/31, 29.0%), a non-profit organisation (n=1/31, 3.2%) and academic institutions (n=2/31, 6.5%). Most resources had global scope (n=21/31, 67.7%), provided data to national or subnational levels (n=27/31, 87.1%) and demonstrated variable temporal resolution and reporting frequency. 11 resources affiliated with national institutions were described, reporting predominantly weekly cholera data to the subnational level. Resources comprised epidemiological reports and bulletins, infectious disease dashboards and integrated disease surveillance and response platforms. This analysis highlights cholera resources available to researchers, healthcare workers and policy-makers, which may direct disease programmes and research activities and support Global Task Force on Cholera Control roadmap 2030 targets. National resources provided detailed subnational cholera data and complemented cholera reporting by multilateral agencies. Timely review of these resources is warranted.