Publications by authors named "Hetzel M"

Background: The Highlands of Papua New Guinea are non-endemic for malaria compared to the rest of the country. This study aimed to explore the local transmission of malaria in the Highlands through a cross-sectional school survey coupled with reactive case detection.

Methods: Between July and November 2019, 5575 schoolchildren and 1048 household members were screened for malaria using Rapid Diagnostic Tests, subsequently validated by light microscopy.

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Knowing when and where infected mosquitoes bite is required for estimating accurate measures of malaria risk, assessing outdoor exposure, and designing intervention strategies. This study combines secondary analyses of a human behaviour survey and an entomological survey carried out in the same area to estimate human exposure to malaria-infected Anopheles mosquitoes throughout the night in rural villages in south-eastern Tanzania. Mosquitoes were collected hourly from 6PM to 6AM indoors and outdoors by human landing catches in 2019, and tested for Plasmodium falciparum sporozoite infections using ELISA.

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Introduction: Lung cancer is the malignancy with the highest mortality rate worldwide. In January 2025, the German public healthcare system will introduce a new regulation according to which a centre can offer surgery for lung cancer only if it carries out a minimum number of lung resections. The purpose of this directive is to reduce the number of centres offering surgical treatment for primary lung cancer, thus centralising and improving lung cancer care.

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Article Synopsis
  • Artemisinin-based combination therapies (ACTs) have been the standard treatment for uncomplicated malaria in Africa for nearly 20 years, but recent studies indicate an increase in mutant parasites linked to reduced treatment effectiveness.
  • The Community Access to Rectal Artesunate for Malaria project studied 697 children with severe malaria in northern Uganda, finding that a significant mutation (C469Y) was more common after the introduction of rectal artesunate, suggesting it enhances resistance.
  • Genome analysis revealed that the C469Y mutation has an indigenous African origin and confirmed that parasites with this mutation show significantly reduced susceptibility to artemisinin, highlighting the urgent need for ongoing monitoring and adherence to treatment protocols to combat the rise of resistant strains.
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Acute dyspnoea is one of the most common internal medicine symptoms in the emergency department. It arises from an acute illness or from the exacerbation of a chronic illness. Symptom-related emergency structures and corresponding structural guidelines already exist in the stroke and chest pain units for dealing with the leading symptoms of acute stroke and acute chest pain.

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Genomic epidemiology holds promise for malaria control and elimination efforts, for example by informing on Plasmodium falciparum genetic diversity and prevalence of mutations conferring anti-malarial drug resistance. Limited sequencing infrastructure in many malaria-endemic areas prevents the rapid generation of genomic data. To address these issues, we developed and validated assays for P.

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The high-fidelity analysis of many-body quantum states of indistinguishable atoms requires the accurate counting of atoms. Here we report the tomographic reconstruction of an atom-number-resolving detector. The tomography is performed with an ultracold rubidium ensemble that is prepared in a coherent spin state by driving a Rabi coupling between the two hyperfine clock levels.

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An increasing number of molecular and genomic assays are available to study malaria parasite populations. However, so far they have played a marginal role in informing policy and programmatic decision-making. Currently, molecular data are mainly used for monitoring drug efficacy against Plasmodium falciparum; assessing molecular markers of drug and insecticide resistance; and assessing P.

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Thanks to its expertise in clinical research, epidemiology, infectious diseases, microbiology, parasitology, public health, translational research and tropical medicine, coupled with deeply rooted partnerships with institutions in low- and middle-income countries (LMICs), the Swiss Tropical and Public Health Institute (Swiss TPH) has been a key contributor in many drug research and development consortia involving academia, pharma and product development partnerships. Our know-how of the maintenance of parasites and their life-cycles in the laboratory, plus our strong ties to research centres and disease control programme managers in LMICs with access to field sites and laboratories, have enabled systems for drug efficacy testing in vitro and in vivo, clinical research, and modelling to support the experimental approaches. Thus, Swiss TPH has made fundamental contributions towards the development of new drugs - and the better use of old drugs - for neglected tropical diseases and infectious diseases of poverty, such as Buruli ulcer, Chagas disease, food-borne trematodiasis (e.

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For the development of new adenovirus (AdV)-based vectors, it is important to understand differences in immunogenicity. In a side-by-side analysis, we evaluated the effect of 40 AdV types covering human AdV (HAdV) species A through G on the expression of 11 activation markers and the secretion of 12 cytokines by AdV-transduced dendritic cells, and the effect on CD8 T cell proliferation capacity. We found that the expression of activation markers and cytokines differed widely between the different HAdV types, and many types were able to significantly impair the proliferation capacity of CD8 T cells.

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Background: Malaria remains a major public health issue in the Democratic Republic of the Congo (DRC), accounting for 44% deaths among outpatient visits in children < 5 years of age, and 22% of facility deaths. Understanding determinants of caregivers' treatment-seeking patterns and decision-making is crucial in reducing the malaria burden.

Methods: In the frame of the Community Access to Rectal Artesunate for Malaria (CARAMAL) project, cross-sectional household surveys that randomly sampled villages and households were carried-out in three rural DRC health zones prior to the rollout of pre-referral Rectal Artesunate (RAS) and then 9 and 19 months after RAS rollout (post-RAS).

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Background: Zanzibar has made substantial progress in malaria control with vector control, improved diagnosis, and artemisinin-based combination therapy. Parasite prevalence in the population has remained around 1% but imported infections from mainland Tanzania contribute to sustained local transmission. Understanding travel patterns between mainland Tanzania and Zanzibar, and the risk of malaria infection, may help to control malaria importation to Zanzibar.

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Alveolar macrophages (AMs) represent crucial immune cells in the bronchioalveolar space of the lung. Given the important role in the host defense machinery and lung tissue homeostasis, AMs have been linked to a variety of diseases and thus represent a promising target cell type for novel therapies. The emerging importance of AM underlines the necessity to isolate and/or generate proper cellular models, which facilitate basic biology and translational science.

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Community health workers (CHW) usually refer children with suspected severe malaria to the nearest public health facility or a designated public referral health facility (RHF). Caregivers do not always follow this recommendation. This study aimed at identifying post-referral treatment-seeking pathways that lead to appropriate antimalarial treatment for children less than five years with suspected severe malaria.

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Zanzibar has made significant progress toward malaria elimination, but recent stagnation requires novel approaches. We developed a highly multiplexed droplet digital PCR (ddPCR)-based amplicon sequencing method targeting 35 microhaplotypes and drug-resistance loci, and successfully sequenced 290 samples from five districts covering both main islands. Here, we elucidate fine-scale Plasmodium falciparum population structure and infer relatedness and connectivity of infections using an identity-by-descent (IBD) approach.

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Malaria cases can be classified as imported, introduced or indigenous cases. The World Health Organization's definition of malaria elimination requires an area to demonstrate that no new indigenous cases have occurred in the last three years. Here, we present a stochastic metapopulation model of malaria transmission that distinguishes between imported, introduced and indigenous cases, and can be used to test the impact of new interventions in a setting with low transmission and ongoing case importation.

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Article Synopsis
  • - Severe malaria is a critical condition that needs immediate treatment, and a clinical trial suggested that rectal artesunate (RAS) could improve survival rates in children when administered before hospital referral.
  • - The CARAMAL Project's findings, published in BMC Medicine, showed that, unlike in trials, large-scale implementation of RAS in three African countries revealed significant health system shortcomings that hindered its efficacy.
  • - In response to critiques of their observational study design, the authors emphasize that while RAS has life-saving potential, its effectiveness relies on the proper functioning of health systems, which are currently inadequate, and that focusing solely on RAS oversimplifies the complex challenges in treating malaria.
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Article Synopsis
  • The text emphasizes the importance of timely and quality case management in reducing malaria deaths in areas where the disease is common, highlighting the development of rectal artesunate (RAS) for emergency treatment.
  • A study from 2009 showed RAS could reduce mortality by 26%, but concerns remained about its effectiveness in real-world settings and how to implement it widely.
  • The CARAMAL project, conducted between 2018 and 2020 in the DRC, Nigeria, and Uganda, aimed to gather real-world data on RAS implementation and its impact on severe malaria cases through a comprehensive Patient Surveillance System.
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Malaria risk in Papua New Guinea (PNG) is highly heterogeneous, between and within geographical regions, which is operationally challenging for control. To enhance targeting of malaria interventions in PNG, we investigated risk factors and stratified malaria incidence at the level of health facility catchment areas. Catchment areas and populations of 808 health facilities were delineated using a travel-time accessibility approach and linked to reported malaria cases (2011-2019).

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Background: For a full treatment course of severe malaria, community-administered pre-referral rectal artesunate (RAS) should be completed by post-referral treatment consisting of an injectable antimalarial and oral artemisinin-based combination therapy (ACT). This study aimed to assess compliance with this treatment recommendation in children under 5 years.

Methods And Findings: This observational study accompanied the implementation of RAS in the Democratic Republic of the Congo (DRC), Nigeria, and Uganda between 2018 and 2020.

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Background: Rectal artesunate, an efficacious pre-referral treatment for severe malaria in children, was deployed at scale in Uganda, Nigeria, and DR Congo. In addition to distributing rectal artesunate, implementation required additional investments in crucial but neglected components in the care for severe malaria. We examined the real-world costs and constraints to rectal artesunate implementation.

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Article Synopsis
  • - Pre-referral rectal artesunate suppositories are lifesaving for children with severe malaria, but successful outcomes depend on proper post-referral care, as highlighted by recent WHO guidelines informed by clinical trials.
  • - The CARAMAL project in DR Congo, Nigeria, and Uganda aimed to monitor the real-world use of rectal artesunate and uncover challenges in its implementation within local healthcare systems.
  • - Despite initial treatment, many critically ill children did not receive adequate follow-up care, leading to a lack of improved survival rates, indicating that without strengthening the entire healthcare continuum, the effectiveness of this intervention will remain limited.
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Background: For children below 6 years with suspected severe malaria attending a health care provider unable to provide parenteral malaria treatment, pre-referral rectal artesunate (RAS) is recommended by the World Health Organization to prevent death and disability. A number of African countries are in the process of rolling out quality-assured RAS for pre-referral treatment of severe malaria at community-level. The success of RAS depends, among other factors, on the acceptability of RAS in the communities where it is being rolled-out.

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Malaria persists at low levels on Zanzibar despite the use of vector control and case management. We use a metapopulation model to investigate the role of human mobility in malaria persistence on Zanzibar, and the impact of reactive case detection. The model was parameterized using survey data on malaria prevalence, reactive case detection, and travel history.

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