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Journal articleAhmed AN, Fornace KM, Iwamura T, et al., 2025,
Human animal contact, land use change and zoonotic disease risk: a protocol for systematic review
, Systematic Reviews, Vol: 14Background: Zoonotic diseases pose a significant risk to human health globally. The interrelationship between humans, animals, and the environment plays a key role in the transmission of zoonotic infections. Human-animal contact (HAC) is particularly important in this relationship, where it serves as the pivotal interaction for pathogen spillover to occur from an animal reservoir to a human. In the context of disease emergence linked to land-use change, increased HAC as a result of land changes (e.g., deforestation, agricultural expansion, habitat degradation) is frequently cited as a key mechanism. We propose to conduct a systematic literature review to map and assess the quality of current evidence linking changes in HAC to zoonotic disease emergence as a result of land-use change. Method: We developed a search protocol to be conducted in eight (8) databases: Medline, Embase, Global Health, Web of Science, Scopus, AGRIS, Africa-Wide Info, and Global Index Medicus. The review will follow standard systematic review methods and will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. The search will consist of building a search strategy, database search, and a snowballing search of references from retrieved relevant articles. The search strategy will be developed for Medline (through PubMed) and EMBASE databases. The search strategy will then be applied to all eight (8) databases. Retrieved articles will be exported to EndNote 20 where duplicates will be removed and exported to Rayyan®, to screen papers using their title and abstract. Screening will be conducted by two independent reviewers and data extraction will be performed using a data extraction form. Articles retrieved will be assessed using study quality appraisal tools (OHAT-Office for Health Assessment and Technology Risk of Bias Rating Tool for Human and Animal Studies, CCS-Case Control Studies, OCCSS-Observational Cohort and Cross-Sectio
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Journal articleLim A, Shearer FM, Sewalk K, et al., 2025,
The overlapping global distribution of dengue, chikungunya, Zika and yellow fever
, Nature Communications, Vol: 16Arboviruses transmitted mainly by Aedes (Stegomyia) aegypti and Ae. albopictus, including dengue, chikungunya, and Zika viruses, and yellow fever virus in urban settings, pose an escalating global threat. Existing risk maps, often hampered by surveillance biases, may underestimate or misrepresent the true distribution of these diseases and do not incorporate epidemiological similarities despite shared vector species. We address this by generating new global environmental suitability maps for Aedes-borne arboviruses using a multi-disease ecological niche model with a nested surveillance model fit to a dataset of over 21,000 occurrence points. This reveals a convergence in suitability around a common global distribution with recent spread of chikungunya and Zika closely aligning with areas suitable for dengue. We estimate that 5.66 (95% confidence interval 5.64-5.68) billion people live in areas suitable for dengue, chikungunya and Zika and 1.54 (1.53-1.54) billion people for yellow fever. We find large national and subnational differences in surveillance capabilities with higher income more accessible areas more likely to detect, diagnose and report viral diseases, which may have led to overestimation of risk in the United States and Europe. When combined with estimates of uncertainty, these suitability maps can be used by ministries of health to target limited surveillance and intervention resources in new strategies against these emerging threats.
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Journal articleMoja L, Abbas M, de Kraker MEA, et al., 2025,
Reserve antibiotics: overcoming limitations of evidence generated from regulatory approval trials
, Globalization and Health, Vol: 21New antibiotics active against multidrug resistant bacteria (MDR-B) are licensed by regulatory agencies based on pivotal trials that serve the primary purpose of obtaining marketing-authorization. There is increasing concern that they do not offer guidance on how to best use new antibiotics, in which population, and to what extent they overcome existing resistance. We reviewed the literature for pre-approval studies (phase 2 and 3 randomized controlled trials) and post-approval studies (randomized and non-randomized controlled trials) evaluating efficacy and safety of new antibiotics, classified by WHO as Reserve, approved in the European Union and the US from January 2010 to May 2023. Substantial failures occur in generating evidence to guide routine clinical use: preapproval studies lack representativeness, select outcomes and comparators to chase statistical significance, and often avoid using prespecified analytical methods. Three recommendations are key to enhance the quality and relevance of clinical data underpinning use of last resort molecules on the WHO AWaRe Reserve list active against carbapenem-resistant MDR-B i). separation of pivotal trials from post-approval studies, which should be funded by public programs and de-linked from commercial purposes, ii). development and maintenance of a global infrastructure to conduct post-approval public health focused studies, and iii). development of trial platforms that use efficient, adaptive designs to inform clinical decision making and country level technology appraisal. These solutions will allow clinicians to determine whether recently approved Reserve antibiotics are not only “newer” but also “better” for vulnerable patient populations at particular risk for infections by MDR-B.
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Journal articleTornimbene B, Leiva Rioja ZB, Aderinola O, et al., 2025,
Pathways to strengthening the epidemic intelligence workforce
, BMC Proceedings, Vol: 19The evolving landscape of public health surveillance demands a proficient and diverse workforce adept in data science and analysis. This report summarises discussions from the third session of the WHO Pandemic and Epidemic Intelligence Innovation Forum, focusing on workforce readiness and technological advancements in epidemic intelligence. The forum emphasizes the necessity of multidisciplinary surveillance teams equipped with advanced data skills. Digital tools play a transformative role in data collection and analysis, enabling real-time tracking, integration, and interpretation of diverse data sources. However, effective surveillance relies on inclusive representation and skill development. Collaborative surveillance and interdisciplinary training programs were emphasized as critical pathways to enhance workforce capacity, decision-making, and equity in public health. Case studies from Nigeria, Korea, the UK, and Colombia showcase the role of digital tools and contextual expertise in addressing surveillance gaps. Sustained institutional support, cross-sector partnerships, and investments in data literacy and workforce development are pivotal for creating resilient and inclusive public health systems.
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Journal articleCollins JH, Allott H, Ngambi W, et al., 2025,
An individual-based modelling study estimating the impact of maternity service delivery on health in Malawi
, Nature Communications, Vol: 16Maternal and perinatal morbidity and mortality remain high in Malawi, partially due to gaps in the coverage and quality of health services. We developed an individual-based model of maternal and perinatal health and healthcare in Malawi, situated in a ‘whole-health system, all-disease’ framework (Thanzi La Onse). We modelled sixteen scenarios estimating the impact of current and improved coverage and quality of antenatal, intrapartum, and postnatal services from 2023 to 2030. Whilst current service delivery is inferred to avert morbidity and mortality, the largest reductions in the stillbirth, maternal and neonatal mortality rates were observed when the use and quality of all services was maximised concurrently (a 10%, 52% and 57% reduction respectively). When services were considered in isolation, generally, increased coverage without quality improvement did not impact mortality or DALYs. In only three scenarios was a sufficient reduction in neonatal mortality observed to achieve target 3.2 of the United Nation’s Sustainable Development Goals (SDG), and in no scenarios was a reduction in maternal mortality sufficient to achieve SDG target 3.1 observed, reaffirming that system wide investments are essential to achieve these goals.
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Journal articleLanderyou T, Maddren R, Hearn J, et al., 2025,
Molecular epidemiology of Ascaris lumbricoides following multiple rounds of community-wide treatment
, Nature Communications, Vol: 16Control and elimination of the parasite Ascaris lumbricoides relies on mass drug administration (MDA) using a limited number of anti-helminthics. Whilst these programs have reduced the infection intensity and prevalence within many endemic regions, patterns of transmission remain poorly understood. Reinfection commonly occurs following cessation of treatment due to the absence of acquired immunity post infection. Here, we utilise genomic data to understand parasite transmission within and between households in a community and the genomic impact of repeated MDA. We sequenced 54 whole-genomes from Ascaris worms obtained from individuals in a longitudinal cohort epidemiological study of transmission and drug treatment extending over 6 years. We found that fine-scale population structure exists in spatially distinct clusters of infected individuals with reinfection occurring within or between geographically close households. This observation helps inform the policy for future control in low prevalence settings suggesting more targeted treatment of infection hotspots. We found evidence of positive selection acting on members of gene families previously implicated in reduced drug efficacy but detected no impactful variants. As efforts to eliminate A. lumbricoides intensify, our study provides a foundation for genomic surveillance to help identify both who infects whom and the impact of repeated drug treatment.
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Journal articleAl-Kaisy R, Bhatt S, Duchêne DA, 2025,
Distinct evolutionary regimes across domains of the Plasmodium falciparum CSP gene
, Scientific Reports, Vol: 15Malaria disease caused by parasites of genus Plasmodium places an enormous disease burden across tropical regions of the world. The circumsporozoite protein (CSP) of Plasmodium has several key functions in binding and accessing host cells, with functions subdivided across multiple protein regions. While its key roles during infection make the gene a primary target for malaria vaccine development, the evolutionary dynamics that could affect the forecasting of useful strains remain poorly understood. We tested whether the gene undergoes multiple DNA substitution processes and whether these are divided across gene regions using a phylogenetic mixture model, and a global sample of CSP sequences specific to P. falciparum. These analyses reveal evolutionary processes unique to the central repeat region and the C-terminus. The central repeat region is dominated by synonymous substitutions (putatively neutral) and heavy C-T substitution bias, while the C-terminus undergoes mostly non-synonymous changes. These evolutionary processes are not strongly geographically restricted, and lineages from Africa and Asia where the parasite is most abundant appear to drive evolution across all CSP gene regions. We propose that insights about DNA substitution processes can help forecast the variants of importance to vaccine development, aided by state-of-the-art evolutionary modelling.
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Journal articleEllis J, Anderson R, 2025,
Pre-school age participation in mass drug administration: analysing the impact on community-wide schistosomiasis control
, International Journal of Infectious Diseases, Vol: 156, ISSN: 1201-9712ObjectivesSchistosome infection in childhood is common and can lead to morbidity. A formulation of praziquantel to treat preschool-aged children (PSAC) has been developed recently. This paper assesses the impact of including PSAC in mass drug administration (MDA) on transmission and morbidity at a community-wide level.MethodsWe used a model of schistosome transmission to simulate the probability of a community reaching elimination as a public health problem (EPHP) and the reduction in morbidity of children resulting from infections until the age of 5 years, measured by a “worm years” metric as a score of morbidity.ResultsIncluding PSAC in MDA will almost always lead to a reduction in morbidity. However, it does not necessarily result in a substantial increase in the probability of EPHP. The proportion of schistosome infections in each age group is a key factor in determining the effectiveness of MDA programs, which prioritize different age groups for treatment.ConclusionsPolicymakers should be aware that including PSAC in MDA may not help to reach the World Health Organization target of EPHP. However, a reduction in the average summed worm infection burden at the age children typically start attending school is highly desirable in increasing the long-term benefit of MDA in early childhood.
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Journal articleJorgensen D, Pons Salort M, Salman M, et al., 2025,
Evolution and transmission dynamics of wild poliovirus in Pakistan and Afghanistan (2012-2023)
, Nature Communications, Vol: 16, ISSN: 2041-1723Despite concerted global vaccination efforts, wild poliovirus remains endemic in two countries in 2024, Pakistan and Afghanistan. This study uses phylogeographic analysis of poliovirus genetic and epidemiological data from clinical and wastewater surveillance to identify the causes of poliovirus persistence and routes of spread over the last decade (2012 to 2023). Poliovirus genetic diversity declined after 2020, with one of two major genetic clusters dying out, and recent detections are now closely related genetically. High-risk and hard-to-access regions have sustained polio transmission over the past decade, even when interrupted elsewhere. Karachi, one of the most densely populated cities globally, has acted as a hub for the amplification and spread of poliovirus to other regions, many of which we show to be dead-end for onwards transmission despite frequent virus detection. Phylogenetic analysis has long been central to the polio surveillance network, and advancing the approaches used can provide critical epidemiological insights to accelerate eradication efforts.
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Journal articleLeng T, Kessou L, Heitner J, et al., 2025,
Potential impact and cost-effectiveness of oral HIV pre-exposure prophylaxis for men who have sex with men in Cotonou, Benin: a mathematical modelling study
, The Lancet Global Health, Vol: 13, Pages: E1111-E1121, ISSN: 2214-109XBackground:Oral HIV pre-exposure prophylaxis (PrEP) can effectively reduce HIV incidence. A 2020–21 demonstration project assessed the feasibility and health outcomes of offering oral PrEP to men who have sex with men (MSM) in Cotonou, Benin. We evaluated the epidemiological impact and cost-effectiveness of this project and the potential scale-up of oral HIV PrEP for MSM in Cotonou.Methods:We calibrated an HIV transmission-dynamic model structured by age and risk within a Bayesian framework to MSM-specific HIV prevalence and treatment data, parameterised with project behavioural and cost (including PrEP drug, implementation, and HIV care costs) data. We estimated the impact and cost-effectiveness of the 2020–21 Cotonou demonstration project (PrEP coverage, 5–10% of all MSM who are not living with HIV in Grand Cotonou; and adherence, 13–21% taking at least four of seven required doses [ie, at least four doses per week for daily users and at least four of seven expected doses given reported sexual activity for on-demand users]) and of its potential scale-up over 5 years (from 2022 to 2027), reaching 30% coverage of MSM in Grand Cotonou and with demonstration project adherence levels. We additionally modelled ideal PrEP adherence (100% taking at least four of seven required doses). We estimated the percentage of cumulative new HIV infections averted among participating MSM over 1 year and among all MSM in Grand Cotonou and their female partners over 20 years, and cost-effectiveness as cost per disability-adjusted life-year (DALY) averted over 20 years. Costs and DALYs were discounted 3% annually.Findings:We found that the demonstration project averted an estimated 21·5% (95% uncertainty interval 16·6 to 26·2) of HIV infections among participants over 1 year. With ideal adherence, cases that would be averted increased to 95·2% (90·8 to 98·8). A 5-year PrEP scale-up could avert 3·2% (1·6 to 4
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