Surveillance keeps finding disease that routine care undercounts
Preprints from Zambia, Uganda and Canada show molecular, community and lab-based surveillance measuring burdens that clinic records alone would miss.
- In a preprint, molecular surveillance at a Zambian children's hospital found a weighted shigellosis prevalence of 19.5% among children under five admitted with acute diarrhea. Self-reported m:…7606
- In a preprint, the same Zambian study put shigellosis hospitalization incidence at 2.4 per 1,000 person-years. Self-reported m:…7606
- In a preprint, a community study in rural Uganda found co-infection with P. falciparum and S. mansoni at 18.51%, peaking at age 13. Self-reported m:…7481
- In a preprint, a modelled combined intervention of water treatment, hygiene and reduced freshwater contact was projected to cut co-infection prevalence by 32%. Self-reported m:…7481
- In a preprint, 216,524 urinary isolates from Canadian long-term care residents showed E. coli 44% non-susceptible to fluoroquinolones and K. pneumoniae 56% non-susceptible to nitrofurantoin. Self-reported m:…0505
What surveillance found in Zambia
Three preprints on medRxiv, each built on surveillance data rather than routine clinic records alone, report disease burdens that ordinary case counts would understate. In Ndola, Zambia, surveillance of hospitalized children under five found a weighted prevalence of shigellosis of 19.5% in that group. m:…7606
The same preprint put the incidence of shigellosis hospitalization at 2.4 per 1,000 person-years, and reported that 33% of the children with shigellosis had used antibiotics or other medication before admission. m:…7606
The study population is hospitalized children under five in Ndola, so the figures describe that hospital population, not children in the community at large. A prevalence of 19.5% means roughly one in five hospitalized children under five in the study carried shigellosis, and an incidence of 2.4 per 1,000 person-years puts a population rate on the same burden. The third figure in the study, that 33% of the children with shigellosis had used antibiotics or other medication before admission, shows how much treatment already happens before a hospital test. m:…7606
Shared risks in rural Uganda
In rural Uganda, a community-based preprint study found co-infection prevalence of 18.51% for Plasmodium falciparum and Schistosoma mansoni, peaking at age 13. m:…7481
Distance to a government health centre was a primary shared determinant of risk for both infections. The study's model projected that a combined intervention of water treatment, hygiene and reduced freshwater contact would cut co-infection prevalence by 32%. m:…7481
A co-infection prevalence of 18.51% means nearly one in five people in the rural Ugandan study carried both parasites at once, and distance to a government health centre shaped risk for both infections together rather than for either one alone. m:…7481
Resistance in Canadian care homes
In Canada, a preprint using the Public Health Agency of Canada's AMRNet programme analysed 216,524 urinary isolates from long-term care residents in five provinces between 2016 and 2024. The most common isolates were E. coli at 51%, K. pneumoniae at 14% and P. mirabilis at 12%. m:…0505
The resistance figures complicate treatment choices: E. coli isolates showed 44% non-susceptibility to fluoroquinolones, while K. pneumoniae showed 56% non-susceptibility to nitrofurantoin. m:…0505
The isolates span five provinces and the years 2016 to 2024, giving the baseline a multi-year, multi-province footing. With E. coli the most common isolate at 51% and 44% of those isolates non-susceptible to fluoroquinolones, a large share of the most frequent urinary isolates would not respond to that drug class, while 56% of K. pneumoniae isolates were non-susceptible to nitrofurantoin. m:…0505
What this means for planners
Read together, the three preprints point in the same direction: where surveillance is molecular, community-based or lab-based, the measured burden is large enough to change planning, for paediatric diarrhoea, for combined parasite control, and for antibiotic choices in care homes. But each result is bounded by its own design: one hospital, one rural cohort, and one pilot surveillance programme. The numbers are a baseline for further work, not a final count, and all three studies await peer review. m:…7606 m:…7481 m:…0505
The common thread is measurement: each study counts disease in a population that routine records describe only partly, whether hospitalized children, a rural community, or care-home residents whose resistance patterns emerge only from laboratory data. m:…7606 m:…7481 m:…0505
What is still unresolved
- Long-term clinical outcomes after discharge for the Zambian children, and antibiotic resistance profiles of the Shigella strains identified.
- Whether the modelled 32% co-infection reduction in Uganda holds up in clinical validation, and whether the ecological findings generalise beyond rural Uganda.
- How inconsistent jurisdiction participation across years affects the Canadian baseline, and how reliably long-term care patients can be identified in lab-based datasets.
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