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Journal articleLeelavanich D, Dorigatti I, Turner H, 2026,
The economic burden of dengue: a systematic literature review of unit costs for non-fatal episodes treated in the formal healthcare system
, BMC Infectious Diseases, ISSN: 1471-2334Background: Dengue, a vector-borne disease caused by the dengue virus, has emerged as a global public health concern, given the tenfold rise in reported cases over the last two decades. In light of the upcoming dengue interventions, country-specific cost-of-illness estimates are required to evaluate the cost-effectiveness of new interventions against dengue. This study aims to conduct an updated systematic review of dengue cost-of-illness studies, extracting the relevant data, and conducting regression analysis to explore potential factors contributing to the cost variations among countries. Methods: We used the MEDLINE, EMBASE, PubMed, and Web of Science databases to systematically search for published dengue cost-of-illness studies reporting primary data on costs per dengue episode. A descriptive analysis was conducted across all extracted studies. Linear regression analysis was performed to investigate the association between the GDP per capita and cost per episode. The quality of the included studies was also assessed. Results: Fifty-six studies were included, of which 22 used the societal perspective. The reported total cost per episode ranged from $15.0 for outpatients in Burkina Faso to $9,386.1 for intensive care unit patients in Mexico. Linear regression analysis revealed that the cost of dengue illness varies significantly across countries and regions, and was positively related to the setting’s GDP per capita. The quality assessment demonstrated that improvements are needed in future studies, particularly in the reporting of the methodology. Conclusions: Cost of dengue illness varies widely across countries and regions. Future research should focus on understanding other drivers of cost variations beyond GDP per capita to improve the cost estimates for economic evaluation studies. The results presented in this study can serve as crucial input parameters for future economic evaluations, supporting decision makers in allocating resources for dengue in
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Journal articleStapley JN, Basanez M-G, Ramani A, et al., 2026,
Modelling the effects of immigration on the re-introduction of onchocerciasis
, Parasites and Vectors, ISSN: 1756-3305Background Onchocerciasis is a filarial neglected tropical disease targeted by the World Health Organization for elimination (interruption) of transmission (EOT), principally by mass drug administration (MDA) with ivermectin. Variable effectiveness and success of MDA, among other factors, has led to a markedly heterogeneous contemporary spatial landscape of endemicity and transmission, with some foci having achieved or nearing EOT, while in others, transmission persists despite decades of MDA or has only recently been identified. Communities reaching EOT or free from infection are thus vulnerable to re-introduction of infection imported by immigrants from areas with ongoing transmission.Methods We use the stochastic, individual-based EPIONCHO-IBM transmission model to quantify the risk of transmission persistence resulting from importation events and characterise the dynamics of ensuing onchocerciasis outbreaks in terms of microfilarial prevalence (in all ages) and anti-Ov16 seroprevalence (in children aged 5-9 years) in infection-free communities with local populations of blackfly vectors.Results We show how the vulnerability of infection-free communities depends on their population size, the local annual biting rate (ABR, number bites/person/year) and on the magnitude of importation events, defined by the number of immigrants arriving in the community and their worm burdens. We show that small communities with modest ABRs are particularly vulnerable to transmission persistence following importation, with risk exacerbated by the magnitude of infection importation. We illustrate that onchocerciasis outbreak dynamics can be protracted, with seroprevalence in children often taking substantially longer than the currently recommended 3-5 years of post-treatment surveillance(PTS) to exceed 5%. Conclusions Our findings highlight the vulnerability of infection-free communities to introduction/re-introduction of infection and suggest that proposed PTS durations may need to
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Journal articleVerity R, Cori A, Mishra S, et al., 2026,
Robert Verity, Samir Bhatt, Anne Cori, Seth Flaxman, and Swapnil Mishra’s contribution to the Discussion of ‘Some statistical aspects of the Covid-19 response’ by Wood et al.
, Journal of the Royal Statistical Society Series A: Statistics in Society, Vol: 189, Pages: 117-119, ISSN: 0964-1998 -
Journal articleWhitaker M, Elliott J, Gerard-Ursin I, et al., 2026,
Profiling vaccine attitudes and subsequent uptake in 1·1 million people in England: a nationwide cohort study
, The Lancet, ISSN: 0140-6736BackgroundDespite highly effective vaccines against SARS-CoV-2, COVID-19 vaccine hesitancy persisted in some populations in England during the pandemic, with rates and motivations for hesitancy varying by demographic group. Addressing the drivers of vaccine hesitancy through targeted interventions in hesitant groups is a public health priority for better and more rapid control of disease spread. We aimed to characterise the determinants and subtypes of vaccine hesitancy and identify more persistent forms of hesitancy via analysis of vaccine uptake in a large cross-sectional cohort with linked National Health Service (NHS) data.MethodsWe conducted an initial cross-sectional analysis of vaccine hesitancy at baseline, followed by a longitudinal analysis of vaccine uptake in the hesitant cohort. We analysed survey data from the Real-time Assessment of Community Transmission (REACT) studies, which monitored the prevalence of SARS-CoV-2 in England during the COVID-19 pandemic at regular intervals from May 1, 2020, to March 31, 2022, in random samples of the population. Participants self-reported detailed sociodemographic information, vaccination status, and attitudes towards vaccination. Participants were classified as hesitant if they reported that they had refused, planned to refuse, or had not yet decided whether to receive the COVID-19 vaccine. Participants who said they were unvaccinated when NHS records showed that they had been vaccinated were excluded from further analysis. The primary outcome of the cross-sectional analysis was vaccine hesitancy. Longitudinal analysis of vaccine uptake was done in participants in the hesitant cohort who consented to the use of linked NHS vaccination records to track their vaccination history after the survey, with post-survey vaccination as the outcome. Consensus clustering was used to categorise reasons for vaccine hesitancy, and cross-sectional and longitudinal analyses used logistic regression models to identify demographic pr
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Journal articleAli Z, Abubakar I, Amegah AK, et al., 2026,
Lancet Countdown on health and climate change in Africa: an international collaboration for locally led research and action.
, Lancet, Vol: 407, Pages: 185-194Climate change inflicts substantial economic damage on developing African nations, threatening progress towards the UN Sustainable Development Goals. There are synergies between actions needed to tackle climate change and other ongoing development priorities for Africa, including infectious disease control, facilitating clean energy access, reducing air pollution, tackling malnutrition and food insecurity, and providing universal health coverage. Action to protect human health against climate change needs to be integrated into all systems that are responsible for delivering essential services and implementing policies across all sectors that underpin the attainment of key development priorities for Africa. These systems include the Sustainable Development Goals and the African Union's 2063 Agenda for building The Africa We Want, and the ongoing negotiations and work programmes in the UN Framework Convention on Climate Change. Adequate stocktaking of and access to robust data and scientific evidence is needed to support this effort and guide priorities for policies that protect and promote health and for monitoring progress over time. In response to this need, the Lancet Countdown is launching a new initiative to bring together a transdisciplinary research collaboration to help build regional capacity, strengthen existing networks, generate evidence, and mobilise data across numerous domains at the climate change and health nexus in Africa.
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Journal articleAnderson RM, 2026,
Preface
, Philosophical Transactions B, Vol: 381, ISSN: 0962-8436 -
Journal articleDiaz AV, Diouf ND, Léger E, et al., 2026,
Variable efficacy of praziquantel among Schistosoma-infected ruminants of northern Senegal-a drug trial and population genetic study across two contrasting epidemiological regions.
, Philos Trans R Soc Lond B Biol Sci, Vol: 381While efforts to eliminate schistosomiasis as a public health problem gather momentum, the potential zoonotic risk posed by livestock Schistosoma species via viable hybridization in sub-Saharan Africa has only begun to be appreciated. Recent research revealed widescale use and misuse of praziquantel (PZQ) in livestock among subsistence farmers within West Africa, in response to the often high morbidities and mortalities, and hence socioeconomic impact, of animal schistosomiasis. Such findings raised policy discussion into the potential need to formalize livestock schistosomiasis treatments, balanced against the necessity to protect against PZQ resistance. Here, we present results of an anthelmintic efficacy trial in which 25 mg kg-1 of veterinary-formula PZQ was given orally to naturally Schistosoma spp-infected domestic ruminants of northern Senegal. Miracidial reduction rates revealed acceptable efficacy levels within cattle infected with S. bovis, but near zero efficacies in goats and sheep infected with S. curassoni and/or hybrids. Furthermore, increased miracidial output post-PZQ was observed among several individuals, particularly within sheep. There was a significant increase in body condition in both cattle and sheep post-PZQ. Microsatellite molecular markers of parasites from bovines indicated a greater level of population genetic differentiation between pre- and post-PZQ samples than between villages, with a genetic signature of inbreeding in one village with the lowest PZQ efficacy. We discuss our findings in terms of their implications and applications towards reaching the WHO elimination targets and the need for future One Health research. This article is part of the Royal Society Science+ meeting issue 'Parasite evolution and impact in action: exploring the importance and control of hybrid schistosomes in Africa and beyond'.
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Journal articleSlaymaker E, Calvert C, Marston M, et al., 2026,
Individual and population-level risk factors for new HIV infections among adults in Eastern and Southern Africa.
, Nat Commun, Vol: 17Despite substantial recent declines, general population HIV incidence in sub-Saharan Africa remains above international targets. Better description of risk factors for new infections would improve prioritisation of interventions. Using data from population-based cohorts in Kenya, Malawi, Tanzania, South Africa, Uganda, Zimbabwe we described the prevalence of risk factors for men and women aged 15-24 and 25-49 and estimated the association between individual and community-level risk factors and HIV acquisition between 2005 and 2016. Among 43,434 men and 55,919 women aged 15 to 49 there were 4,612 seroconversions. Education, marital status, male circumcision, new sexual partners, types of partner, prevalence of untreated HIV infection in the community and community partner acquisition rates were associated with HIV incidence. Only the prevalence of untreated HIV was a risk for both sexes and apparent at all ages. The prevalence of risk factors varied by age, sex and study. HIV incidence was higher in people aged 25-49 living in communities where men had high partner acquisition rates. Our results show potential for improved prevention through changed timing of prevention interventions relative to behaviour and the utility of using community characteristics to target prevention.
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Journal articleMcKenzie J, Carter C, Jackson MM, et al., 2026,
Mechanisms driving immunopathogenesis of viral exacerbations in chronic respiratory disease.
, ThoraxBACKGROUND: Exacerbations are major causes of morbidity in individuals with chronic respiratory diseases such as chronic obstructive pulmonary disease, asthma and bronchiectasis. Increasing evidence implicates respiratory viruses as predominant triggers, though the underlying immunopathogenic mechanisms remain poorly understood. NARRATIVE: This review synthesises current knowledge on the interplay between viral pathogens at the airway epithelial barrier, including structural and immunological mechanisms that may dysregulate antiviral immunity in chronic respiratory diseases. Furthermore, we discuss how perturbations in the respiratory microbiome, characterised by reduced microbial diversity, can modulate host antiviral immune defences. CONCLUSIONS: Collectively, these interconnected factors create a permissive environment predisposing to viral infection and exacerbations in chronic respiratory diseases. Understanding the complex interactions between airway structure, interferon-mediated antiviral responses, inflammation and microbiota is essential for developing targeted therapies to effectively manage virus-induced exacerbations and reduce disease burden.
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Journal articleBose I, Hadida G, Green R, et al., 2026,
Rainfall and water-related diseases, malnutrition and mortality in Low- and Middle- Income Countries: a systematic review of the epidemiological evidence
, Heliyon, Vol: 12Background Climate change is altering rainfall patterns. Rainfall has been linked to numerous health outcomes, through the impacts on water quality and quantity, but the coherence and strength of evidence across outcomes remain unclear. Objectives Understand and evaluate the strength of evidence on associations between rainfall (both low and heavy events) and health outcomes in Low- and Middle- Income Countries (LMICs). Methods A systematic review of peer-reviewed epidemiological studies quantifying associations between rainfall and human health outcomes in LMIC populations was conducted. Seven databases were searched including MEDLINE and EMBASE. Study quality was evaluated using 9 modified criteria that were previously used to assess environmental epidemiology studies. The strength of evidence for each health outcome was assessed across rainfall exposures. Results Of 23,579 papers identified, 177 met the inclusion criteria. Health outcomes included diarrheal diseases (n = 119); malnutrition (n = 35); mortality (n = 21); helminth infections (n = 6), and eye infections (n = 4). There was moderately strong evidence for positive associations between both heavy and low rainfall and all-cause diarrhea. Evidence for undernutrition was mixed, with moderate evidence of a positive association with low rainfall. Despite sharing causal pathways, diarrheal disease and nutrition studies found contrasting results for heavy rainfall, likely due to differing study designs. Studies were heterogenous in design, rainfall exposure definitions, and lag times. Studies also often lacked a clear hypothesis. Discussion There is substantial evidence that rainfall affects health in LMICs through multiple pathways. Limitations in the data (often from cross-sectional surveys) and study designs, limit the strength of evidence for several health outcomes. Specifically, studies frequently used inappropriate exposures or lags to reflect the causal pathways. In future studies, efforts should be dir
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