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Journal articleWei Q, Zhang T, Schmit N, 2026,
Post-acute sequelae after Lassa fever: a systematic review and meta-analysis
, Journal of Infection, Vol: 92, ISSN: 0163-4453Post-acute sequelae are symptoms that persist or arise after the acute phase of an infection, but their frequency following outbreaks remains poorly understood. Recurrent Lassa fever outbreaks pose a significant public health threat in West Africa and may have long-term health effects. This study systematically reviewed the prevalence, incidence, duration, and characteristics of post-acute sequelae in survivors of Lassa virus infection. We searched PubMed and Web of Science up to November 17, 2025. Two reviewers screened and extracted data independently. We included six articles in the review. The most frequently reported post-acute sequela was hearing loss, with a pooled prevalence of 18% (95% CI 9-32) across 6 studies. Odds ratios for the association between Lassa fever and hearing loss were heterogeneous, with a statistically significant positive association in 2 of 5 studies and a positive effect direction in 2 further studies. Of an additional 37 potential post-acute sequelae, several with high prevalence also related to the audiovestibular system (e.g. tinnitus, balance disorder and vertigo). Our findings highlight that Lassa fever survivors can experience diverse symptoms after recovery from acute infection, with hearing loss being the best-characterised. However, data gaps remain on its incidence after mild infections and its duration. A better understanding of post-acute sequelae after Lassa fever is necessary for accurate disease burden estimation and mathematical modelling studies.
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Journal articleKhurana MP, Tsui JL-H, Gutierrez B, et al., 2026,
Global approaches to infectious disease surveillance and modeling
, Nature Medicine, Vol: 32, Pages: 1646-1660, ISSN: 1078-8956Human mobility, climate change and demographic trends increase the risk of pathogen spillover and expansion. Data that can inform our responses to outbreaks have increased in availability and volume, but access to highly confidential outbreak data and commercially sensitive contextual information remains difficult. Despite ongoing efforts to adopt global health data infrastructures and sharing protocols, there remain regulatory, logistical, human and computational barriers to data sharing. Federated approaches—in which data remain stored locally but analyses are performed across datasets from different sources—offer a potential way to address these challenges. While federated approaches have been used in some clinical and biomedical contexts, their adoption in infectious disease surveillance and modeling has been limited. Here, we discuss global approaches to infectious disease modeling and analysis, with a focus on federated methods. We outline how these can be used to address key epidemiological questions during outbreaks by enabling the secure use of multimodal data and integration with existing surveillance and modeling efforts. We summarize current methods for combining distributed and locally stored data and identify limitations, opportunities and organizational structures needed to achieve equitable global public health impacts.
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Journal articleNdiaye A, Motyl F, Drammeh S, et al., 2026,
Carbon emissions associated with antenatal testing for hepatitis B prophylaxis eligibility, the Gambia.
, Bull World Health Organ, Vol: 104, Pages: 301-314OBJECTIVE: To estimate the carbon footprint of three diagnostic strategies to identify pregnant women eligible for antiviral prophylaxis to prevent hepatitis B vertical transmission in the Gambia. METHODS: In 2024, we conducted a life cycle assessment of a point-of-care polymerase chain reaction (PCR) test using plasma, and a rapid diagnostic test for hepatitis B core-related antigen (HBcrAg) using plasma and capillary blood across three hospitals (rural, suburban and urban) and a suburban health centre. We included all products and processes in each diagnostic strategy. The functional unit was an antenatal testing episode assessing eligibility for antiviral prophylaxis, beginning after positive hepatitis B surface antigen screening. We estimated carbon emissions in grams of carbon dioxide equivalent (g CO2e) ± uncertainty. FINDINGS: Mean carbon emissions per strategy were significantly different between point-of-care PCR and the rapid diagnostic tests (P-value: 0.028): 1619.0 ± 200.6 g CO2e (PCR), 520.4 ± 59.1 g CO2e (plasma-based rapid diagnostic test) and 374.3 ± 50.4 g CO2e (capillary-based test). Higher emissions with the PCR test were mainly driven by its reliance on air conditioning (759.1 g CO2e compared with 125.2 g CO2e for plasma-based rapid diagnostic test and 24.3 g CO2e for capillary-based test); the test itself (290.0 g CO2e versus 129.0 g CO2e for rapid diagnostic tests); and PCR-specific requirements including diagnostic device (47.0 g CO2e) and additional patient travel to collect results (255.8 g CO2e). CONCLUSION: Our findings suggest that HBcrAg rapid diagnostic tests can reduce emissions substantially compared with point-of-care PCR. Our study demonstrates that life cycle assessments are feasible in resource-constrained settings and highlights the importance of integrating sustainability into
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Journal articlePhannajit J, Narkpaichit C, Angkurawaranon C, et al., 2026,
Validation of the kidney failure risk equation and its impact on referral strategies for chronic kidney disease: protocol for a retrospective cohort study using national claims and laboratory data in Thailand
, BMJ Open, Vol: 16, ISSN: 2044-6055Introduction: Chronic kidney disease (CKD) is highly prevalent in Thailand and imposes a growing burden on the health system driven by limited nephrology capacity and high rates of unplanned dialysis. The Kidney Failure Risk Equation (KFRE) estimates the risk of progression to kidney failure on age, sex, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio. This study aims to validate and, if required, recalibrate the 4-variable KFRE for the Thai population and to assess its potential impact of KFRE-guided referral strategies on clinical care and health system performance.Methods and Analysis: We will conduct a retrospective cohort study using linked, de-identified national health databases covering approximately 70% of the Thai population. Adult patients with CKD stages 3–5 will be included. KFRE performance will be evaluated at 2 and 5 years for discrimination and calibration. If miscalibration is identified, the model will be recalibrated using Cox-based methods. Simulations (1,000 iterations) indicated that approximately 920 kidney failure events by 5 years would be required to achieve target standard errors for the calibration slope. A subsequent impact analysis will compare KFRE-guided referral with current Thai CKD guideline criteria and real-world practice using a decision-tree and Markov modelling framework.Ethics and Dissemination: Ethical approval was obtained from the Ethics Committee of the Institute for the Development of Human Research Protections, Thailand (COA No. IHRP2025110), Imperial College London, and the London School of Hygiene and Tropical Medicine. The requirement for informed consent was waived due to the use of anonymised secondary data. Findings will be disseminated through peer-reviewed publications, conferences, and policy briefs to supplement evidence-based referral strategies and health system planning.
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Journal articleTurner HC, Ahmed S, Nguyen HA, et al., 2026,
Economic evaluation of alternative hepatitis C treatment options: a post hoc analysis of the VIETNARMS trial
, EClinicalMedicine, Vol: 95, ISSN: 2589-5370BackgroundHepatitis C remains a leading cause of liver disease worldwide, and access to Direct-Acting Antiviral (DAA) treatment remains limited in many settings. Alternative treatment strategies that require fewer tablets and clinical visits could help improve equitable access, and new approaches have recently been found to be non-inferior in producing sustained viral suppression. MethodsWe did a cost-minimization analysis of alternative treatment options for non-cirrhotic patients evaluated in the VIETNARMS trial (ISRCTN61522291), conducted between 19/06/2020 and 10/05/2023 in Vietnam. These were: (i) ‘response guided’ (which adjusts treatment duration based on 1-week viral load); (ii) ‘induction maintenance’ (which reduces the dosing frequency in later weeks of treatment); and (iii) ‘Peg-IFN+DAA’ (4 weeks of DAAs combined with four weekly doses of PEGylated interferon (Peg-IFN). The primary outcome was the cost per cure. A disaggregated societal perspective was adopted, including stratification for the healthcare provider and patient costs. FindingsThe three alternative treatment strategies were projected to have lower costs per cure than standard 12-week DAA treatment in the base-case scenario: US$202 (15%) less for ‘response guided’, US$234 (18%) less for ‘induction maintenance’, and US$163 (12%) less for ‘Peg-IFN+DAA’. However, the potential for cost savings, and which strategy had the lowest cost per cure, depended on the assumed cost of DAA drugs: the strategy with the lowest cost per cure was generally ‘induction maintenance’ when DAA drug costs for a standard treatment course were under US$1,000, but Peg-IFN+DAA when DAA costs exceeded US$1,500. In some scenarios, lower costs per cure were achieved through reduced health system expenditures, despite increased costs to patients.InterpretationAlternative strategies for Hepatitis C treatment could reduce costs for providers an
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Journal articleMcBride A, Van Hao N, Tho PV, et al., 2026,
The cost of dengue shock and septic shock in Vietnam: a patient-centred economic analysis
, International Health, Vol: 18, Pages: 431-439, ISSN: 1876-3413BackgroundDengue shock (DS) and septic shock (SS) are the most common infectious causes of shock in Vietnam. Little is known about the cost of an episode of DS or SS from the patient perspective. We aimed to describe the direct medical, non-medical and productivity costs associated with DS and SS.MethodsWe recruited adults with DS and SS to a prospective observational study at the Hospital for Tropical Diseases, Ho Chi Minh City, from 2019 to 2021. We collected hospital bills, insurance status and out of pocket payments, and conducted an economic questionnaire at discharge, 1, 3 and 6 mo later. We calculated the proportion incurring catastrophic health expenditure (CHE) and catastrophic costs.ResultsWe recruited 127 adults with DS, of whom 118 survived, and 35 with SS, of whom 24 survived; 18.9% and 71.4% with DS and SS, respectively, incurred CHE. When non-medical and productivity costs were considered, the true cost of illness was 6.3 and 6.7 times higher than the hospital bill for DS and SS, respectively.ConclusionsProductivity costs must be counted when assessing the cost of critical illness in low- and lower-middle income countries. It is vital that financial protection systems are extended to cover patients requiring high-cost critical care in Vietnam.
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Journal articleLeuba SI, Verity R, Gutman JR, et al., 2026,
The burden of malaria-attributable maternal anaemia and the impact of preventive treatment across sub-Saharan Africa
, Nature Health, Vol: 1, Pages: 497-510, ISSN: 3005-0693Malaria in pregnancy is a major but poorly quantified contributor to maternal anaemia in sub-Saharan Africa. We combined individual-level data on haemoglobin (Hb), gravidity, gestational age and PCR-confirmed Plasmodium falciparum infection from 12,608 pregnancies in 7 African countries with a gravidity-specific model of malaria exposure and immunity linked to contemporary maps of transmission and fertility. For 2023, we estimate that 13.1 million pregnancies in malaria-endemic African regions were exposed to P. falciparum. In the absence of preventive measures, this exposure would have resulted in 2.41 million (95% credible interval 1.98–3.04 million) cases of moderate or severe anaemia (Hb < 9 g dl−1), including 600,000 (408,000–906,000) severe cases (Hb < 7 g dl−1). A counterfactual scenario using 2,000 transmission levels suggests that a 32% reduction in exposure during pregnancy translated into only a 22% decline in intrinsic anaemia burden, reflecting a shift from a concentration of risk in primigravidae to a more even distribution across gravidities as multigravid women acquire less pregnancy-specific immunity. Calibrating our model to randomized trials, we estimate that under current coverage, intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine averted around 1.10 million (0.72–1.61 million) cases of moderate or severe anaemia and 330,000 (225,000–523,000) severe cases in 2023. These findings show that although burden has declined substantially, malaria remains a major driver of maternal anaemia risk. Meanwhile, lower immunity across multigravidae means any interruption to intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine, or other population-based malaria control efforts, risks rapid resurgence of severe maternal anaemia, with substantial consequences for maternal and neonatal
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Journal articleBlake I, Islam MO, Fuller B, et al., 2026,
Integration of poliovirus and enteropathogen sewage surveillance in Dhaka Bangladesh: a longitudinal surveillance study June 2019 – June 2020
, The Lancet Microbe, Vol: 7, ISSN: 2666-5247Environmental surveillance (ES) for poliovirus is a surveillance method used by the Global Polio Eradication Initiative (GPEI). ES will continue following certification of poliovirus eradication, potentially through its integration into other infectious disease surveillance programs. We evaluated TaqMan array cards (TAC) to detect poliovirus in sewage, whilst simultaneously testing for 11 other enteric pathogens and 34 markers of antimicrobial resistance (AMR) across 12 sites in Dhaka, Bangladesh. Sites were selected following mapping of the informal sewage network and a demographic survey of the population. Samples were collected before and after a bivalent oral polio vaccine (bOPV) campaign. 372 samples were collected over 379 days. A water-quality probe measured physicochemical properties of the sewage. A Multivariable mixed-effects Gamma Hurdle regression model was used to measure the association between enterovirus detection and concentration with site properties. The highest concentration of Sabin-1 and -3 poliovirus was detected two weeks after the bOPV campaign (mean (SD) Sabin- 1 and -3 viral copies per L of sewage: 0·83 (2·13) and 0·84 (1·96)) , (vs baseline 0·05 (0·21) and 0·11 (0·50) respectively) [p=0·004: SL1, p=0·005: SL3] . Detection of enteroviruses was more likely with increasing levels of Total Dissolved Solids (mg/L) (aOR per absolute increase of 100 units 1·39 95%CI: 1·17 – 1·61). The median ES viral load of rotavirus was 0·567 (IQR 0·202-0·839), and this pathogen had the strongest correlation with respective concurrent clinical case incidence (cor = 0·828, p = 0·0017). Thirty-one AMR genes of clinical significance were detected.When GPEI dissolves, poliovirus surveillance needs to be integrated into other surveillance programs. TAC may provide a method to screen suitable pathogens to survey in sewage alongside p
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Journal articleAratrika A, Doyle CM, Johnson CC, et al., 2026,
Trends in HIV self-testing uptake in Africa: A modeling study of population-based surveys and HIV testing program data.
, PLoS Med, Vol: 23BACKGROUND: HIV self-testing (HIVST) can increase access to and uptake of HIV testing among people underserved by other HIV testing approaches. Several countries in Africa, the region most affected by HIV, have scaled-up HIVST. However, no comprehensive analysis has yet quantified HIVST uptake trends and how HIVST kits are used. We aimed to estimate 1) country-level and regional trends in HIVST uptake among adults by sex and age and 2) the proportion of distributed HIVST kits that are used and re-testing rates with HIVST. METHODS AND FINDINGS: Across African countries, we analyzed 1) data from national population-based surveys that included questions on previous HIVST use and 2) the number of HIVST kits distributed from nationally reported program data (2012-2024). We developed a hierarchical Bayesian compartmental model to estimate HIVST rates by triangulating surveys and program data. Random effects were used to pool information across countries. Data were available from 40 surveys in 27 countries and from 99 country-years of HIVST program data. The proportion of adults aged ≥15 years in Africa who have ever used an HIVST (HIVST uptake) steadily increased, from <1% in 2012 to almost 7% (6.8%; 95% credible interval [95%CrI] [5.8, 8.2]) in 2024. HIVST uptake was higher in eastern and southern Africa (10.2% in 2024, 95%CrI [8.5, 12.7]) compared to western and central Africa (2% in 2024; 95%CrI [1.7, 2.5]). The proportion of people who ever self-tested varied substantially across countries, reaching a maximum in 2024 of 45.4% (95%CrI [41.8, 51.5]) in Lesotho. Men (7.2% in 2024, 95%CrI [6.1, 8.8]) were slightly more likely than women to have ever used an HIVST (6.4% in 2024; 95%CrI [5.4, 7.8]). Compared to younger individuals (15-24 years), those aged 25-34 years had higher rates of self-testing (men: rate ratio [RR]=1.8, 95%CrI [1.5, 2.3]; women: RR = 1.4, 95%CrI [1.1, 1.6]). Individuals who previously self-tested may be more likely to self-test ag
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Journal articleSubissi L, Otieno JR, Ruis C, et al., 2026,
Oropouche virus: transmission, epidemiology, genetic diversity, and public health implications.
, EClinicalMedicine, Vol: 95Historically endemic to parts of South America, Oropouche virus (OROV) has caused an estimated 500,000 infections since its discovery, with a marked geographic expansion beyond the Amazon basin into other regions of South America and the Caribbean since late 2023. This Review synthesises current evidence on OROV epidemiology, transmission dynamics, clinical manifestations, diagnostics, viral diversity, and public health impact, with the primary objective of identifying critical knowledge gaps and outlining priorities for surveillance, research, and control. Human transmission occurs primarily via Culicoides paraensis midges, while the competence of other vectors, the role of animal reservoirs in sustaining sylvatic transmission, and the contribution of vertical and sexual transmission remain incompletely understood. Although most infections are self-limiting, reports of neurological disease, Guillain-Barré syndrome, adverse pregnancy outcomes, and rare fatalities highlight uncertainties regarding pathogenicity, risk factors for severe disease, and long-term sequelae. The known teratogenicity of related Simbu serogroup orthobunyaviruses in animals further raises concerns about foetal risk in humans. Environmental change, expanding vector ranges, and viral evolution are likely contributing to outbreak emergence and geographic spread. Based on the available evidence, this review highlights priority gaps in epidemiological surveillance, diagnostics and genomic monitoring, vector competence and ecology, transmission pathways, and countermeasure development. Addressing these gaps through coordinated surveillance, improved laboratory capacity, targeted vector control, and focused research will be essential to mitigate the public health impact of OROV and reduce the risk of further spread.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.
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