Lei Zhou

Background:The global epidemiology of mpox has changed substantially since its first documented human case in 1970, particularly following the multinational clade IIb outbreak in 2022 and the emergence of clade Ib since late 2023. However, temporal, regional, and clade-specific changes in the global disease burden of mpox remain incompletely characterized.Methods:We systematically searched Scopus, Web of Science, and Embase for studies published from 1970 to October 11, 2025, reporting mpox incidence, hospitalization, or case fatality, supplemented by relevant WHO reports. Meta-analysis and mixed-effects models were used to quantify disease burden and explore potential influencing factors. WHO surveillance data through November 14, 2025, were additionally analyzed to characterize temporal and regional trends.Results:Seventy studies published between 1970 and 2025 were included. Hospitalization and case-fatality rates declined from 33% and 3.3% before 2022 to 10% and 0.7% during the clade IIb–dominated global outbreak, respectively. However, clade Ia infections remained substantially more severe, with hospitalization and case-fatality rates of approximately 80% and 9%, respectively. Since 2024, Central Africa has again become a major contributor to global mpox cases and deaths, whereas high-income regions experienced larger but clinically milder outbreaks. Overall, despite global declines in disease severity, the burden of mpox remained disproportionately concentrated in Africa.Conclusions:The global burden of mpox is characterized by substantial temporal, regional, and clade-specific heterogeneity, with severe disease remaining concentrated in Africa, particularly Central Africa. Strengthened clade-specific surveillance, targeted vaccination, and enhanced health-system capacity are urgently needed in endemic regions. Future One Health approaches integrating human, animal, and environmental surveillance will be essential to improve preparedness for emerging mpox lineages and mitigate the continuing global burden of mpox.

Background: Surgical site infections (SSIs) remain a major cause of health care–associated infections, and early prediction is essential for improving patient outcomes. Machine learning (ML) has shown potential for SSI prediction; however, clinical implementation requires models that are both accurate and explainable. Despite recent progress in explainable ML, its clinical application to SSI prediction remains limited. Objective: This study aimed to map explainable ML models for SSI prediction from a clinical perspective and examine their use of structured and unstructured data across the dimensions of data, methodology, and explanation output. Methods: We conducted a scoping review following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Joanna Briggs Institute (JBI) guidance, and registered the protocol in PROSPERO. Six databases were searched for eligible studies published from January 2010 onward, without language restrictions. The search was conducted on August 9, 2025, and updated on July 14, 2026. We included studies that developed or validated an explainable ML model for predicting SSI in adults. Two reviewers (RS and YL) independently screened studies and extracted data. Findings were narratively synthesized and presented in evidence maps. Methodological quality was assessed using the PROBAST+AI (Prediction model Risk Of Bias Assessment Tool for prediction models using regression or artificial intelligence) methods. Results: Overall, 77 studies reporting 98 ML models were included. Most models were prognostic (72/98, 73.5%), whereas 26 focused on postoperative SSI diagnosis. A total of 81.8% (63/77) of studies addressed a single surgical specialty, most commonly gastrointestinal surgery (27/63, 42.9%). Overall, 51.9% (40/77) of studies addressed composite SSI predictions. Among all models, % (40/98) were black-box models explained by post hoc methods; SHAP combined with ensemble learning was the leading approach (18/40, 45%). Regression models accounted for half of the inherently interpretable models, interpreted using coefficients. Prognostic models commonly included health and lifestyle (60/72, 83.3%), individual characteristics, and surgical process details (both 57/72, 79.2%); health and lifestyle factors were most frequently important across SSI types. Diagnostic models commonly included surgical process details (13/26, 50%), administrative codes, and individual characteristics (both 10/26, 38.5%). Key diagnostic predictors varied by SSI types: postoperative clinical interventions predominated for composite SSI; vital signs, postoperative interventions, and administrative codes for superficial SSI; postoperative recovery status for deep SSI; and vital signs for organ-space SSI. Conclusions: Extending previous reviews focusing on model performance, this review mapped explainability methods and important features in SSI prediction, identifying recurring predictor patterns and substantial methodological heterogeneity across prognostic and diagnostic settings. Incomplete reporting of feature definitions and explanatory rationale, together with limited clinical relevance, constrained clinical interpretation and actionability. Clinician-informed reporting frameworks and validation of explanation fidelity and clinical relevance are needed to improve the trustworthiness and utility of SSI prediction models.

The global risk of avian influenza outbreaks has increased significantly in recent years, posing substantial threats to both the poultry industry and public health due to frequent human infection cases. Occupational groups within the poultry industry face particularly high infection risks because of prolonged close contact with poultry. This study aimed to identify differences in knowledge, attitudes, and practices (KAP) regarding avian influenza among various occupational categories, pinpoint weaknesses in prevention and control, and provide scientific evidence to support targeted intervention strategies. We conducted a cross-sectional survey using stratified random sampling among 1,362 individuals engaged in poultry-related occupations in Anhui, Sichuan, and Guangxi provinces, China, from May to July 2025. Data on avian influenza-related knowledge, attitudes, and practices (KAP) were collected through electronic questionnaires. Statistical analyses were performed using SPSS 27.0, employing descriptive statistics, chi-square tests for group comparisons, and multivariate logistic regression to identify factors associated with KAP levels. A total of 1,194 valid questionnaires were collected. The overall KAP qualification rate among survey participants was 48.16%, with knowledge awareness being the lowest (33.84%), the positive attitude rate was 83.42%, and the positive practice rate was 41.46%. Multivariate analysis identified distinct factors influencing knowledge, attitude, and practice. Regarding knowledge, commercial farm workers (aOR = 1.87,95%CI:1.24–2.81) and backyard farmers(aOR = 2.40,95%CI:1.37–4.21) had higher levels than live poultry market workers, with urban residents(aOR = 1.49,95%CI:1.06–2.09), higher education, and absence of chronic disease (aOR = 1.94,95%CI:1.30–2.91) also predicting better knowledge. For attitude, commercial farm workers (aOR = 3.02,95%CI:1.67–5.46) and urban residents (aOR = 2.84,95%CI:1.79–4.51) were more positive. For practice, workers in Guangxi outperformed those in Anhui (aOR = 1.72,95%CI:1.06–2.79); commercial farm workers (aOR = 7.01,95%CI:4.55–10.80) and slaughterhouse workers (aOR = 6.33,95%CI:3.63–11.05) outperformed live poultry market workers, while backyard farmers showed poorer practices (aOR = 0.40,95%CI:0.22–0.74); females exhibited better practices than males (aOR = 1.33,95% CI:1.01–1.77). Furthermore, mobile internet (59.55%) and television/radio (50.42%) were the primary sources of information across all occupational groups. The findings reveal a pattern of superficial knowledge, and positive attitudes that do not translate into effective protective practices. Live poultry market workers, backyard farmers, individuals with lower education levels, and those residing in rural areas demonstrated poorer knowledge of avian influenza, while males exhibited lower adoption rates of protective practices. These populations should be prioritized as key targets for intervention. It is recommended to implement targeted health communication through new media platforms to enhance the coverage and effectiveness of intervention measures.

Background: China‘s influenza vaccination coverage remains at a low rate, with significant regional socioeconomic disparities, lacking targeted distribution strategies and achievable coverage targets. This study aims to provide scientific evidence for formulating differentiated and feasible vaccination strategies across Chinese provinces based on regional economic gradients. Methods: We employed the Susceptible-Vaccinated-Exposed-Asymptomatic-Infectious-Critical-Fatal-Recovered/Removed (SVEAICFR) model to simulate various vaccination strategies, analyzing the reduction in disease burden and vaccine dose requirements across underdeveloped, developing, and developed regions. The optimal strategy and achievable coverage targets were subsequently determined. Results: The 31 provinces were clustered into three categories based on economic levels, showing significant spatiotemporal differences in epidemics (Kruskal–Wallis test, all p < 0.001). Developed regions showed the earliest onset and highest peaks (influenza-like illness positive (ILI+) index ≈ 12–13, Baidu Influenza Search Index (BISI) ≈ 310,000). Developing regions exhibited moderate lagging by 1–2 weeks, while underdeveloped regions had the lowest peaks (ILI+ 3–4) and longer epidemic cycles. During the 2023–2024 influenza season, the national predicted vaccination rate was only 2.89% with marked regional disparities. Baseline incidence, severity, and mortality rates were 13,374.93, 49.52, and 8.37 cases per 100,000 population, respectively. Modeling indicates that increasing influenza vaccination coverage rates for populations aged <18 and ≥65 to a theoretical threshold (39.73% of the total population) before the season could reduce incidence, severity, and mortality rate by 99.26%,99.42%, and 99.46%, respectively. Conclusions: Influenza prevalence in China exhibits significant regional heterogeneity, necessitating differentiated measures based on regional economic gradients. Regional support mechanisms should be implemented to promote equitable vaccine distribution. Priority vaccination for high-risk populations (aged <18 and ≥65), to reach a 40% theoretical national coverage target, is recommended via realistic implementation pathways to minimize the disease burden of influenza.

In 2023, the emergence of the mpox virus (MPXV) subclade Ⅰb in the Democratic Republic of the Congo triggered a new wave of mpox outbreaks that subsequently spread to other African countries and beyond. Policies provide the framework for mpox epidemic prevention and control in China, requiring systematic analysis of policy evolution and content characteristics. This study employs policy tool theory to construct a three-dimensional analytical framework encompassing policy instruments (X), policy objects (Y), and policy measures (Z), and utilizes content analysis methodology to evaluate China’s national regulatory mpox prevention and control policies. The results demonstrate that China’s national-level mpox prevention and control policies are in substantial agreement with the World Health Organization (WHO) core recommendations, with distinct emphases on the application of policy instruments, policy objects and policy measures, the prioritization of comprehensive epidemic response capabilities, and aligning with both domestic and international mpox epidemic conditions and national prevention strategies. Moving forward, China should further enhance its mpox prevention and control system resilience by optimizing vaccine strategies and expanding social mobilization initiatives.

Avian influenza viruses (AIVs) pose significant risks to occupational populations engaged in poultry farming, livestock handling, and live poultry market operations due to frequent exposure to infected animals and contaminated environments. This review synthesizes evidence on AIV exposure patterns and risk factors through a comprehensive analysis of viral characteristics, host dynamics, environmental influences, and human behaviors. The main routes of transmission include direct animal contact, respiratory contact during slaughter/milking, and environmental contamination (aerosols, raw milk, shared equipment). Risks increase as the virus adapts between species, survives longer in cold/wet conditions, and spreads through wild bird migration (long-distance transmission) and live bird trade (local transmission). Recommended control measures include integrated animal–human–environment surveillance, stringent biosecurity measures, vaccination, and education. These findings underscore the urgent need for global ‘One Health’ collaboration to assess risk and implement preventive measures against potentially pandemic strains of influenza A viruses, especially in light of undetected mild/asymptomatic cases and incomplete knowledge of viral evolution.

Mpox clade Ib is significant as it is associated with human cases and plays a key role in understanding the transmission and public health implications of mpox outbreaks. Here we present a case report of the first confirmed human infection of clade Ib in China, which occurred in December 2025 in Zhejiang Province. The case was a 28-year-old woman from South Africa who had sexual contact with an asymptomatic man from the Democratic Republic of the Congo. She presented with disseminated vesicular lesions on the extremities, face, buttocks, trunk, palms, and dorsum of the hands, but lesions were absent from the oral cavity, perineum, and anus. By the 18th day post-onset (DPO), only vesicles remained on the dorsum of the right foot and in the finger web spaces, with complete resolution by the 24th DPO. Among 59 consecutive samples collected, 55 tested positive for mpox virus. Oropharyngeal swabs turned negative by the 16th DPO, while skin lesion samples, urine samples, and scab specimens remained positive through the 20th DPO. Consecutive scab samples consistently exhibited high viral loads. In total, 211 contacts of the symptomatic patient were identified, and no secondary cases occurred. This study underscores the importance of multisite sampling for diagnostic sensitivity, highlights the transmission risk associated with asymptomatic sexual contact, and emphasizes the need for refined contact definitions and management strategies. Further research is needed to explore infection risks across different types of exposure.

The global demand from multi-sectoral partners for operational tools for One Health implementation and capacity building is increasing, yet a validated global inventory of One Health tools did not exist. Here, we map and analyze available One Health tools and assess their suitability to support One Health implementation, including the One Health Joint Plan of Action 2022–2026 (OH JPA). Our objectives were to identify (i) publicly available One Health tools to support capacity building and OH JPA implementation; (ii) optimal outcomes for countries/regions using available One Health tools; (iii) linkages to OH JPA Action Tracks and pathways in the One Health Theory of Change (TOC); and (iv) gaps and priorities for the development of additional One Health tools. One Health High Level Expert Panel (OHHLEP) members compiled information on One Health tools that were publicly available and released up to June 30, 2023, via online sources and partner networks including the Quadripartite organizations. Inclusion criteria addressed One Health relevance, use at the national, subnational, or regional level in ≥5 locations, and publicly available information. Tools were assessed for applicability by OH JPA action track, TOC pathway, scope, and intended outcomes, as well as the extent to which tools addressed gender equality, social inclusion, and environmental dimensions of One Health. Of 132 candidate tools, 50 (38%) met the inclusion criteria. These tools addressed all six OH JPA Action Tracks, but relatively fewer tools addressed Action Tracks 4 (Food Safety), 5 (Antimicrobial Resistance), and 6 (Environmental Integration). Tools were available to support all three TOC outcome pathways, and many addressed more than one Action Track and TOC outcome pathway. Most available One Health tools addressed assessment and to a lesser extent implementation, with fewer tools available for action planning, prioritization, and monitoring. Gaps and opportunities for improving One Health tools were identified, including the integration of the environment dimension, gender equality, and social inclusion. Ultimately, our findings will contribute to further the advancement of One Health globally, including via OH JPA implementation, while spurring adjustments to existing One Health tools and the development of new ones to address key gaps. One Health impact statement: The One Health approach is gaining momentum globally, and this study represents the first integrated mapping and analysis of globally available One Health tools. Our findings aim to improve the quality, applicability, and availability of tools to support One Health implementation at the subnational, national, regional, and global levels, including through the Quadripartite’s One Health Joint Plan of Action. By using the OHHLEP definition of One Health to assess available One Health tools and map them onto the One Health Joint Plan of Action, we identify the need for a systematic approach and enhanced integration across dimensions of One Health to lead to sustainable One Health systems.