From emergence to exposure: one health attribution of azole-resistant Aspergillus fumigatus in Southeast Asia

Abstract

Southeast Asia is a hotspot for azole-resistant Aspergillus fumigatus yet remains underrepresented in global surveillance. Disciplinary approaches, including genomics, environmental sampling, and social science, have progressed but remain poorly integrated. We outline a One Health attribution framework linking selection pressures, environmental reservoirs, exposure pathways, and clinical resistance signals to prioritise surveillance, target interventions, and allocate resources where they will have greatest impact.