Search Results (264)

Background/Objectives: Seasonal influenza threatens global public health through rapid mutations. This study evaluated the prevalence and molecular-genetic characteristics of seasonal influenza viruses circulating in Kazakhstan during the 2023–2026 epidemic seasons. Methods: Nasopharyngeal swabs (n = 1756) and serum samples (n = 718) were screened using RT-qPCR, HI, and ELISA assays. Selected A(H1N1)pdm09 isolates underwent full-length HA and NA gene next-generation sequencing, followed by phylogenetic and phenotypic analyses. Results: Influenza A(H3N2) strains dominated in Kazakhstan during the 2023–2024 and 2025–2026 seasons. Conversely, the 2024–2025 season showed a shifting landscape, characterized by co-circulation of influenza B and A(H1N1)pdm09 strains belonging to genetic clade 6B.1A.5a.2a (subclades C.1.9 and C.1.9.3). Mutational mapping revealed ongoing in situ microevolution adjacent to the receptor-binding site (HA-R222K). Genomic screening of the NA gene identified critical I223R and S247N mutations traditionally linked to resistance. In silico profiling predicted that while the majority maintained baseline sensitivity, the solitary A/Shymkent/NRL-1999/2024 isolate harboring the I223R substitution exhibited a multidrug-resistant genotype to oseltamivir, peramivir, and zanamivir. Conclusions: These findings demonstrate dynamic inter-seasonal etiological shifts and the predicted emergence of an independent resistant lineage (NA-I223R). This underscores the necessity for continuous, expanded genomic surveillance of respiratory pathogens across Kazakhstan. Full article

Influenza A virus (IAV) remains a major cause of respiratory morbidity and mortality worldwide. However, the precise role of the RNA sensor Toll-like receptor 7 (TLR7) and its downstream signaling mediator, interferon regulatory factor 7 (IRF7), during IAV infection remains elusive. To address this gap, we utilized single-cell RNA sequencing (scRNA-seq) alongside Tlr7-deficient and Irf7-deficient mouse models infected with the mouse-adapted IAV strain PR8. Pulmonary scRNA-seq of PR8-infected wild-type mice revealed robust upregulation of Tlr7 and interferon (IFN) pathway-associated genes specifically in dendritic cells (DCs) and B cells, whereas Irf7 induction occurred globally across all major lung compartments. Following PR8 infection, Irf7-deficient but not Tlr7-deficient mice exhibited significantly greater daily weight loss, increased mortality, and more severe bronchial epithelial hyperplasia compared to wild-type controls. Furthermore, infected Irf7-deficient mice displayed diminished early IFN-α and IFN-γ levels. Interestingly, both Irf7- and Tlr7-deficient strains demonstrated impaired anti-hemagglutinin (HA) antibody production. Notably, Tlr7 deficiency did not alter Irf7 protein expression or the production of IFNs and NF-κB in response to IAV, indicating that Tlr7 does not modulate Irf7 activation during infection. Collectively, these findings demonstrate that Irf7 protects against severe IAV pathogenesis independently of Tlr7 recognition in mice, whereas both Irf7 and Tlr7 are required for optimal anti-HA antibody production. Importance: Influenza A virus is a respiratory pathogen that remains a major threat to global health as a seasonal disease and a source of periodic pandemics. The outcomes of the infection can range from mild illness to severe pneumonia and death, particularly in vulnerable populations, yet the reasons why some individuals develop more severe disease are not fully understood. Early immune defenses in the lungs are critical for controlling the virus, but they can also contribute to harmful inflammation if not properly regulated. Key sensors that detect viral genetic material, such as TLR7, and the signaling pathways that activate antiviral responses, such as IRF7, play an essential role in shaping these outcomes. However, whether TLR7 is essential or redundant in IAV remains debated, and the independent role of IRF7 in IAV has not been directly demonstrated in mouse models. The significance of our study lies in defining how these early immune mechanisms influence the course of influenza A infection, providing insight that may guide the development of improved therapies for influenza and related respiratory viruses. Full article

Influenza viruses undergo continuous genetic and antigenic evolution, making sustained surveillance essential for monitoring changes in virus circulation and vaccine relevance. We analyzed influenza epidemiology and viral evolution in Kazakhstan across eight consecutive epidemic seasons (2017/18–2024/25) using data from the national influenza sentinel surveillance system, together with antigenic characterization, Sanger sequencing, whole-genome sequencing, and phylogenetic analysis. Influenza activity was almost undetectable during the 2020/21 season, followed by the re-emergence of A(H3N2)-dominated circulation in 2021/22. In 2022/23, influenza B predominated initially, followed by A(H1N1)pdm09, whereas A(H3N2) predominated in 2023/24. A total of 199 A(H1N1)pdm09, 157 A(H3N2), 105 B/Victoria, and 16 B/Yamagata viruses were genetically characterized. A(H1N1)pdm09 viruses showed successive replacement of 6B-derived lineages, with descendants of 6B.1A.5a.2a predominating in the post-pandemic period. A(H3N2) viruses showed substantial genetic diversification, progressing from 3C.2a descendants to 3C.2a1b-related viruses and subsequently to 2a.3a.1/J.2 viruses. Among B/Victoria viruses, V1A was successively replaced by V1A.3 and V1A.3a.2, with V1A.3a.2 accounting for 100% of genetically characterized viruses in 2023/24 and 2024/25. Antigenic analysis showed 16- to 32-fold lower HI titers for A(H1N1)pdm09 6B.1A.5a.2 viruses when tested against antisera to earlier vaccine/reference strains, whereas no detectable antigenic differences were observed between 6B.1A.5a.2a and its recent descendants. These findings demonstrate substantial post-pandemic changes in influenza epidemic timing, subtype dominance, and genetic composition in Kazakhstan, while circulating viruses remained within globally recognized evolutionary lineages. Integrated epidemiological, genetic, and antigenic surveillance is important for detecting emerging variants, assessing vaccine relevance, and supporting timely influenza prevention and control measures. Full article

Background/Objectives: The impact of repeated annual influenza vaccination on long-term immunogenicity and protection remains debated. Although reduced fold-increases in antibody titers are often observed in repeatedly vaccinated individuals, the effect on the duration of the humoral response remains poorly understood. This study evaluated the magnitude and persistence of the humoral immune response over four consecutive seasons. Methods: An open-label observational study was conducted between 2018 and 2022 and involved 28 healthy adults (median age, 55 years) immunized with seasonal inactivated influenza vaccines. Hemagglutination inhibition (HAI) titers were assessed at five time points annually. Secondary endpoints included neutralizing (MNA) and neuraminidase-inhibiting (ELLA) antibody responses measured at baseline and three weeks after vaccination. The duration of antibody responses above the seroprotection threshold (titer ≥ 40) was compared across seasons using the Mantel–Cox test. Results: Antibody dynamics differed by vaccine component. The highest GMT and fold-increase were observed for A/H1N1pdm09 in 2018/19, followed by a significant decline after the second vaccination, that was more pronounced for neutralizing antibodies. The response to N1 neuraminidase remained weak throughout the study. For A/H3N2, baseline HAI GMTs increased significantly after each subsequent vaccination, whereas N2 neuraminidase responses peaked after the first dose and declined thereafter. Influenza B responses were weaker than those to influenza A. A significant increase in B/Yamagata titers in 2020/21 was attributed to the introduction of quadrivalent vaccines. A/H1N1pdm09 HAI responses were long-lasting, with titers remaining at or above the seroprotection threshold for one year. The duration of the A/H3N2 antibody response increased significantly over four seasons, likely because of annual strain updates. A similar trend was observed for B/Victoria after strain changes. Conclusions: Repeated annual influenza vaccination did not negatively affect post-vaccination antibody titers to the HA vaccine antigens in the studied cohort. Regular updates to vaccine strains may enhance the persistence of HA-targeted humoral immune responses. Full article

Influenza A(H1N1)pdm09 remains one of the predominant seasonal influenza viruses worldwide and continues to evolve under the combined effects of host immunity, vaccination, and changing epidemiological conditions. However, the long-term impact of the COVID-19 pandemic on its evolutionary dynamics remains poorly understood. We investigated the genetic variability and phylodynamic evolution of the hemagglutinin (HA) and neuraminidase (NA) genes of Italian A(H1N1)pdm09 viruses collected between 2009 and 2026. Time-calibrated phylodynamic analyses, Bayesian Skyline Plots (BSPs), Lineages Through Time (LTT) graphs, principal component analysis (PCA), and codon-based selection analyses were used to characterize long-term evolutionary patterns. Both HA and NA followed continuous evolutionary trajectories, with a marked post-2020 genetic shift associated with the emergence of 6B.1A.5a.2-related clades. HA showed greater evolutionary variability than NA, whereas selection analyses identified only one positively selected site in HA and none in NA, consistent with reduced adaptive diversification in recent strains. Phylodynamic analyses revealed a marked decline in effective population size and lineage accumulation during the COVID-19 pandemic, followed by renewed expansion after 2022. Overall, Italian A(H1N1)pdm09 viruses exhibited reduced genetic diversity, limited evidence of positive selection, and coordinated genomic restructuring following the pandemic. These findings provide new insights into the long-term evolutionary dynamics of A(H1N1)pdm09 in Italy and reinforce the importance of sustained genomic surveillance for anticipating evolutionary changes and informing evidence-based public health strategies. Full article

Background: Respiratory tract infections (RTIs) caused by viruses are a public health problem, contributing to hospital admissions and morbidity worldwide. The COVID-19 pandemic substantially altered the detection patterns of respiratory viruses through public health interventions. Longitudinal data on these changes and viral seasonality remain limited in Saudi Arabia. This eight-year study evaluated epidemiological and seasonal patterns of major respiratory viruses across the COVID-19 era at a major Saudi tertiary care center. Methods: A retrospective observational study was conducted at King Khalid University Hospital, Riyadh, from October 2017 to December 2025. PCR-confirmed detections for SARS-CoV-2, Influenza A, Influenza B, respiratory syncytial virus (RSV), and human metapneumovirus (HMPV) were extracted from the hospital Laboratory Information System. Demographics, co-detection, seasonality, and length of stay (LOS) were analyzed across four eras spanning the pre-COVID-19, lockdown, restriction, and post-restriction periods using descriptive statistics, the Kruskal–Wallis test, and multivariable negative binomial regression. Results: Among 5708 confirmed respiratory viral detection episodes, SARS-CoV-2 was the most frequently detected (52.5%), followed by Influenza A (19.1%), RSV (16.4%), Influenza B (8.4%), and HMPV (3.6%). Before the pandemic, Influenza A accounted for the largest proportion of detected episodes (71.1%), with detections clustering particularly during autumn and winter seasons, whereas SARS-CoV-2 accounted for the majority of detected episodes during the lockdown and restriction eras (97.4% and 93.2%). The post-restriction era became more diverse, with RSV being detected in substantial proportions (28.3%), showing prominent winter activity. RSV and HMPV predominantly affected children aged 0–5 years, whereas SARS-CoV-2 was more frequently detected among older adults. Among adults, older age was associated with prolonged LOS; Influenza A and HMPV were associated with shorter stays compared to SARS-CoV-2. Among children, no virus was independently associated with LOS after adjustment for age and sex; however, older age was associated with longer hospital stays. Conclusion: The observed detection patterns of major respiratory viruses shifted substantially across the COVID-19 eras, with notable post-restriction diversification among observed positive detections. LOS was associated with age in both adults and children and with virus type among adults, supporting continued surveillance to guide preventive and clinical strategies. Full article

Objective: The objectives of this study were to analyze the epidemiological characteristics and whole-genome features of human metapneumovirus (HMPV) among children under 14 years of age in Shijiazhuang during 2022–2025, enrich the whole-genome data of HMPV in China, and provide a basis for further understanding the genetic diversity of the virus and for its prevention, control, and transmission intervention. Methods: A total of 1920 cases of acute respiratory infection were enrolled from three sentinel hospitals in Shijiazhuang. Nucleic acid screening was performed using real-time PCR. Whole-genome sequencing was conducted on 25 positive samples. Phylogenetic trees were constructed using the neighbor-joining method in MEGA, and nucleotide and amino acid sequence identity analyses were performed. Results: The overall detection rate of HMPV from 2022 to 2025 was 4.17%. A prominent peak in winter 2024 was the major distinguishing feature. Temporally, both influenza-like illness (ILI) and severe acute respiratory infection (SARI) cases showed marked seasonality during 2022–2025, with high-incidence periods in December–March and April–June. BLAST alignment and phylogenetic analysis showed that among the 25 sequenced HMPV specimens, genotype B2 was the most frequently identified genotype (13/25, 52%). Conclusions: HMPV epidemics in Shijiazhuang during 2022–2025 mainly occurred in winter–spring and spring–summer, with a notable detection peak in December 2024. The B2 genotype predominated among the sequenced HMPV isolates obtained in this study. The amino acid variation in the G gene was significantly higher than that in other genomic regions. Full article

Background/objective: Older adults experience a disproportionate burden of severe influenza. In the P303 trial (NCT058279789), mRNA-1010 showed greater immunogenicity versus high-dose inactivated influenza vaccine (HD-IIV4) in adults ≥65 years of age. Here, we used a correlate-of-protection framework to estimate the relative VE (rVE) of mRNA-1010 compared with HD-IIV4. Methods: A sigmoidal function was used to model the relationship between geometric mean haemagglutinin assay inhibition (HAI) titers (GMTs) and vaccine efficacy (VE) using data from the P304 trial (NCT06602024), which compared mRNA-1010 and the standard-dose IIV4 in adults ≥50 years of age. The model was then applied to GMTs from the P303 trial to estimate rVE of mRNA-1010 vs. HD-IIV4 in adults ≥65 years. Temporal waning and weighting of case distributions were incorporated to provide a season-integrated estimate. Simulations were performed for three influenza seasons (A/H1N1-dominant, A/H3N2-dominant, and balanced), with a sensitivity analysis varying vaccination and epidemic peak timing. Results: At Day 29, rVE for mRNA-1010 vs. HD-IIV4 was 24.1% (95% CI: 18.2–29.5%) against A/H1N1, 14.5% (8.3–20.3%) against A/H3N2, and 21.0% (16.0–25.8%) against B/Victoria. The season-integrated rVE was 12.4% (3.4–21.3%) across all three strains, with point estimates ranging from 11.6% to 12.6%. Similar findings were seen across simulated seasons, with rVE estimates ranging from 8.8% to 14.3% when varying vaccination timing, peak timing, and strain dominance. Conclusions: Based on this CoP framework, mRNA-1010 was projected to have higher VE than HD-IIV4 in adults ≥65 years of age across a range of simulated epidemiological conditions. Full article

Background/Objectives: Humans are primarily infected by two distinct seasonal influenza A virus (IAV) subtypes, A(H1N1)pdm09 and A(H3N2). Because IAV mutates rapidly, it continuously escapes existing protective antibodies. However, repeated exposure to these evolving strains increases the diversity of virus-specific memory B cell (MBC) population. To investigate the extent of this diversity and cross-reactivity of IAV- specific immunity in adults, and its possible impact on emerging strains, we analyzed the hemagglutinin (HA)-specific MBC repertoire of an adult frequently immunized with seasonal vaccines. Methods: High-throughput single-cell sequencing of HA probe-positive MBCs collected from an individual with repeated seasonal influenza vaccination was performed. Monoclonal antibodies (mAbs) from multicell clonotypes were tested for HA binding and influenza virus neutralization. Results: Two clonotypes were identified that bound to both A(H1) and A(H3) HAs from strains circulating before and after the season of blood collection. Both clonotypes neutralized A(H3N2) strains, while one also neutralized A(H1N1)pdm09 strains. Notably, these cross-group binders showed affinity for A(H5), A(H7) and A(H9) avian influenza HAs and neutralized bovine A(H5N1) IAV. Conclusions: Our findings suggest that seasonal vaccination can support pre-existing cross-reactive B-cell immunity in some individuals. This underscores the importance of studying influenza-specific MBC repertoires across diverse populations to better understand immune dynamics and improve vaccine design. Full article

Veterinarians are routinely exposed to occupational infectious hazards at the human–animal interface, making vaccination an important preventive measure within a One Health framework. However, evidence on vaccination coverage and immunization practices in this professional group remains limited. This study assessed self-reported vaccination coverage, attitudes toward vaccination, perceived barriers, and training needs among registered veterinarians in Málaga, Spain. A cross-sectional anonymous survey was distributed to all actively practicing veterinarians registered with the Official Veterinary Association of Málaga. The questionnaire collected sociodemographic and professional information, self-reported vaccination status, attitudes toward vaccination, and perceived training needs. A total of 164 veterinarians participated (response rate: 15.2%). Given the voluntary nature of participation, findings should be interpreted as descriptive. Vaccination coverage was low for several vaccines relevant to occupational or adult immunization, including seasonal influenza (21.3%), rabies (23.2%), and tetanus–diphtheria–pertussis boosters (47.3%). Nearly half of respondents (49.1%) were uncertain about their hepatitis B vaccination status. In contrast, COVID-19 vaccination uptake was high (96.9% received at least one dose). Although most participants considered vaccination highly important, self-reported coverage remained limited for several recommended vaccines. Qualitative responses identified barriers related to access to vaccination, information, and the absence of structured occupational vaccination programmes. Among the surveyed veterinarians in Málaga, these findings support the need for clearer occupational vaccination recommendations, improved access to immunization services, and enhanced vaccinology training. Such measures could strengthen occupational health protection and support One Health prevention strategies at the human–animal interface. Full article

Background: In Italy, seasonal flu vaccination was recommended for all children aged 6 months to 6 years, all adults aged ≥60 years and specific at-risk groups. Influenza vac-cine effectiveness (IVE) varies from season to season. It can be related to several factors: possible mismatches between circulating virus strains and vaccine composition, the host immune response and the interval between the vaccine administration and the epidemic peak. The present study aimed to estimate IVE against acute respiratory infections (ARIs) caused by influenza during the 2024/25 season in the Province of Pescara, Abruzzo Region, Southern Italy. Methods: A retrospective test-negative case–control study was conducted in the tertiary hospital of the province of Pescara, Abruzzo region, Southern Italy. The study considered all naso/oropharyngeal swabs performed between 15 October 2024 and 1 April 2025. Results: During the study period, 5452 tests were performed and met the inclusion criteria. Among them, 637 tested positive for influenza (11.68%) and 4815 (88.32%) were considered controls. The IVE estimated using the fully adjusted model showed an overall effectiveness of 41.36% (from 1.08 to 57.29%). Considering influenza type, IVE against influenza A was 37.23%, whereas IVE against influenza B was 77.28%. Conclusions: The 2024/2025 season was characterized in our Italian region by a delayed start in flu circulation, with a concomitant and prominent co-circulation of all virus types. Available vaccines provided a moderate protection against laboratory-confirmed influenza, with an estimated VE of 41%. Full article

Acute bronchiolitis is the leading cause of infant hospitalization worldwide, with respiratory syncytial virus (RSV) historically predominating. Prospective virological data for the 2025–2026 epidemic season in Morocco were lacking. A prospective observational cohort study was conducted at the Department of Pediatric Infectious Diseases and Clinical Immunology, Casablanca Mother-Child Hospital, from August 2025 through March 2026. Consecutive infants aged 1–24 months hospitalized with acute viral bronchiolitis underwent nasopharyngeal sampling and multiplex rapid antigen testing for RSV, influenza A, influenza B, and SARS-CoV-2. A total of 131 infants were enrolled (median age 4.8 months; male-to-female ratio 0.84:1). At least one virus was identified in 63 patients (48.1%; 95% CI 39.1–57.3%). RSV predominated: 49 sole infections and 2 co-infections with influenza A, totaling 51 positives (80.9% of virus-positive cases; 38.9% of the cohort). Influenza A totaled 8 cases (12.7%), including the 2 co-infections; influenza B accounted for 2 further cases (3.2%). SARS-CoV-2 was not detected. Epidemic activity peaked in January 2026 (65 admissions), declining through February (34) and March (12). All detected pathogens have licensed preventive options, supporting the introduction of nirsevimab, maternal RSV vaccination, and seasonal influenza vaccination as public health priorities in Morocco. Full article

Background: Influenza remains a major global public health threat, and vaccination is one of the most effective preventive measures. However, frequent antigenic drift and occasional antigenic shift, along with the lead time required for vaccine development and regional differences in the evolution of circulating strains, may lead to mismatches between WHO-recommended vaccine strains and circulating viruses. In addition, antiviral resistance further complicates precise influenza prevention and control. Objectives: This study aimed to evaluate the concordance of vaccine strains with circulating influenza viruses and the emergence of neuraminidase inhibitor (NAI) resistance in China. Methods: Data on antigenic characterization and antiviral susceptibility testing were extracted from weekly influenza surveillance reports published by the Chinese National Influenza Center from 2015 to 2025. Viral evolution, substitutions at key antigenic sites, and resistance-associated mutations were further examined based on sequences of circulating influenza viruses in China. Results: The overall vaccine match rates were 95.72% (95% CI: 94.02–97.43%) for A(H1N1)pdm09, 58.96% (95% CI: 54.93–62.96%) for A(H3N2), 64.45% (95% CI: 59.49–69.41%) for B/Victoria, and 95.19% (95% CI: 91.32–99.05%) for B/Yamagata in China during the 2015–2025 influenza seasons, with marked year-to-year fluctuations observed particularly for A(H3N2) and B/Victoria. The vaccine matching for cell-based A(H3N2) (70.41%, 95% CI: 65.04–75.77%) vaccine reference strains was significantly higher than that for egg-based A(H3N2) (48.09%, 95% CI: 42.63–53.55%) vaccine reference strains. Sequence analysis indicated that circulating A(H3N2) viruses showed the greatest genetic divergence from the matched egg-based vaccine strains (2.71%, 95% CI: 2.66–2.75%). Phenotypic NAI resistance was detected only in A(H1N1)pdm09 viruses, with resistance rates of 0.18% (95% CI: 0.07–0.45%) in 2023, 3.47% (95% CI: 2.63–4.57%) in 2024, and 3.01% (95% CI: 2.46–3.68%) in 2025. Neuraminidase (NA) sequence analysis showed that the key NAI resistance-associated substitution H274Y has been detected in A(H1N1)pdm09 viruses since 2015, at relatively high frequencies observed during 2015–2018. The mutation re-emerged in 2023 and presented increase trends thereafter, although no A(H1N1) pdm09 circulated during the COVID-19 pandemic. Conclusions: Antigenic concordance between vaccine strains and circulating A(H3N2) or B/Victoria viruses showed marked year-to-year fluctuations in China. Cell-based A(H3N2) vaccine reference strains showed higher antigenic concordance than egg-based strains, supporting further consideration of vaccine production platforms in A(H3N2)-predominant seasons. Phenotypic NAI resistance in circulating A(H1N1)pdm09 viruses was detected from 2023 onward in China, whereas resistance-associated NA substitutions had been detected earlier at the sequence level. Full article

Influenza B virus (IBV) represents a significant global health threat, contributing 20–30% of annual influenza cases and causing substantial morbidity and mortality across all age groups. Current seasonal vaccines demonstrate variable effectiveness, highlighting the urgent need for next-generation approaches that provide enhanced and sustained protection against both IBV lineages. Moreover, continuous antigenic drift of circulating viruses progressively reduces the match between vaccine-induced antibodies and contemporary strains, necessitating broad-spectrum protection strategies. This review discusses influenza B virus control strategies, encompassing both conventional approaches and emerging vaccine technologies. While antiviral therapy, epidemiological surveillance, diagnostics, and non-pharmaceutical public-health measures are integral components of influenza B control, the present review focuses specifically on vaccine-based strategies. By critically appraising the available evidence, this review evaluates the extent to which these strategies may improve the effectiveness of IBV vaccines and, in the longer term, inform the prospect of reducing the burden of—or potentially eliminating—influenza B virus, a goal that remains hypothetical and requires clinical validation. Full article

Avian influenza remains a major threat to poultry production, wildlife conservation, and public health in Asia, where migratory birds, wetlands, rice paddies, domestic ducks, and live poultry trade often intersect. This Asia-focused review synthesizes ecological, epidemiological, surveillance, tracking, phylogenetic, and environmental evidence from 1996 to 2025, with particular emphasis on China, to clarify how risk develops at the wild bird–domestic poultry interface. The reviewed evidence suggests three broad epidemic phases: early Goose/Guangdong-lineage H5N1 outbreaks before 2014, recurrent clade 2.3.4.4 H5Nx expansions during 2014–2019, and the widespread clade 2.3.4.4b H5N1 period since 2020. Spatial risk is concentrated around major stopover wetlands and rice-paddy–duck landscapes, including Qinghai Lake, Poyang Lake, Sanmenxia, the Sanjiang Plain, and peri-urban market belts. Wetlands and paddies can maintain viruses environmentally, free-grazing ducks and bridge hosts can facilitate introduction, and live poultry markets and trade networks can amplify and export risk. By organizing these processes through an Interface–Amplifier–Conduit evidence-mapping approach, this review highlights setting-specific priorities, including seasonal wetland surveillance, closed farm-water systems, improved market hygiene, and better integration of ecological and genomic data for early warning and control. Full article