Keshini Abeyewardene

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.

Clonorchiasis is a parasitic infection caused by the trematode Clonorchis sinensis, which is endemic to East Asia but increasingly observed in non-endemic regions due to global migration. Chronic infection can lead to recurrent pyogenic cholangitis (RPC) and other hepatobiliary complications including cholangiocarcinoma. We herein review clonorchiasis and opisthorchiasis as potential contributory drivers of RPC in migrants from Southeast Asia through framing with a case of a Filipino woman residing in Canada who presented with a two-year history of intermittent right upper quadrant pain, liver enzyme derangement, and imaging features consistent with RPC. Despite negative stool ova and parasite (O&P) testing, empirical treatment with praziquantel (1800 mg three times daily for two days) led to clinical and biochemical improvement. Hepatobiliary trematodiasis, including clonorchiasis and opisthorchiasis, can be challenging to diagnose, and clonorchiasis and opisthorchiasis cannot be distinguished on clinical or radiographic grounds alone. Clonorchiasis can be challenging to diagnose in non-endemic areas due to low parasitologic test sensitivity and non-specific clinical features. Imaging findings and epidemiologic context are critical for raising clinical suspicion and guiding management. Healthcare providers in non-endemic regions should include clonorchiasis and opisthorchiasis in the differential diagnosis of unexplained cholestasis, particularly in migrants from areas endemic for clonorchiasis and opisthorchiasis. Negative stool tests do not exclude infection, and early empirical treatment may prevent irreversible hepatobiliary damage and reduce long-term malignancy risk.