"What's in a name?": Using mpox as a case study to understand the importance of communication, advocacy, and information accuracy in disease nomenclature.

Historically, many diseases have been named after the species or location of discovery, the discovering scientists, or the most impacted population. However, species-specific disease names often misrepresent the true reservoir; location-based disease names are frequently targeted with xenophobia; some of the discovering scientists have darker histories; and impacted populations have been stigmatized for this association. Acknowledging these concerns, the World Health Organization now proposes naming diseases after their causative pathogen or symptomatology. Recently, this guidance has been retrospectively applied to a disease at the center of an outbreak rife with stigmatization and misinformation: mpox (f.k.a. 'monkeypox'). This disease, historically endemic to west and central Africa, has prompted racist remarks as it spread globally in 2022 in an epidemic ongoing today. Moreover, its elevated prevalence among men who have sex with men has yielded increased stigma against the LGBTQ+ community. To address these prejudicial associations, 'monkeypox' was renamed 'mpox' in November 2022. We used publicly available data from Google Search Trends to determine which countries were quicker to adopt this name change-and understand factors that limit or facilitate its use. Specifically, we built regression models to quantify the relationship between 'mpox' search intensity in a given country and the country's type of political regime, robustness of sociopolitical and health systems, level of pandemic preparedness, extent of gender and educational inequalities, and temporal evolution of mpox cases through December 2023. Our results suggest that, when compared to 'monkeypox' search intensity, 'mpox' search intensity was significantly higher in countries with any history of mpox outbreaks or higher levels of LGBTQ+ acceptance; meanwhile, 'mpox' search intensity was significantly lower in countries governed by leaders who had recently propagated infectious disease misinformation. Among infectious diseases with stigmatizing names, mpox is among the first to be revised retrospectively. While the adoption of a given disease name will be context-specific-depending in part on its origins and the affected subpopulations-our study provides generalizable insights, applicable to future changes in disease nomenclature.

Cost-benefit analysis of a projected national human papilloma virus vaccination programme in Lebanon.

BACKGROUND: The adoption of a population-based human papilloma virus (HPV) vaccination programme is debated in Lebanon on epidemiological, sociocultural, logistical and economic grounds. AIMS: This cost-benefit analysis contributes to generating quantitative evidence necessary for a decision regarding costs through locally available data. METHODS: The 2 sides of the cost-benefit analysis equation are: estimation of the cost of HPV vaccination campaigns targeting 11 year-old girls, using the cheapest vaccine in 2016 and estimation of the management cost for treatment of a yearly average case-load for cervical cancer. RESULTS: A Cervarix® only campaign would cost US$ 5 407 790 to vaccinate 38 083 11-year-old girls. The estimated cost of managing a mean annual mixed case-load of 100 incident cervical cancer cases would cost US$ 1 591 336. The nearest break-even point may occur 5 years after this current analysis. CONCLUSION: This cost-benefit analysis using limited available data indicates that massive HPV vaccination would not be cost-beneficial under the circumstances existing in 2016. Nevertheless, some indications point to the need for a re-assessment around 2020. This finding will inform public health decision-makers in Lebanon and similar neighbouring countries.

A test of the epidemiological paradox in a context of forced migration: low birthweight among Syrian newborns in Lebanon.

BACKGROUND: Studies on immigrants revealed an epidemiological paradox whereby low-socioeconomic status (SES) immigrant mothers exhibit favourable birth outcomes compared with native-born mothers. We tested the epidemiological paradox in a context of forced migration, comparing associations of low birthweight (LBW) and maternal SES between Syrian and Lebanese newborns in Lebanon. METHODS: We used data from the National Collaborative Perinatal Neonatal Network (NCPNN) of 31 Lebanese hospitals, including 45 442 Lebanese and 4910 Syrian neonates born 2011-13. We assessed associations between LBW and maternal SES for both groups. Logistic regression models examined interactions between maternal origin and SES. RESULTS: Syrian births increased exponentially between 2011 and 2013, along with the group's forced migration into Lebanon. Although Syrian mothers are more socioeconomically disadvantaged compared with Lebanese mothers, Syrian LBW (6.2%) was only marginally higher than Lebanese LBW (5.6%; P = 0.059). Only 20-24-years-old Syrian women [odds ratio (OR) = 1.70 (1.22-2.36)] and those with ≥ university education [OR = 2.02 (0.98-4.16)] exhibited higher odds of delivering an LBW baby compared with Lebanese women of the same age and education. CONCLUSIONS: The findings do not provide strong evidence for the epidemiological paradox in a forced migration context. However, the relatively advantageous LBW profile among Syrian neonates, despite their mothers' low SES and exposure to acute and chronic psychological stress, points to protective mechanisms. One of these mechanisms may be a collective response by the displaced population to improve neonatal outcomes as a way of recovering from loss and death.