2026年 · 第15卷第03期

Background Epidemics and disease outbreaks continue to threaten public health security in sub-Saharan Africa (SSA), disproportionately impacting impoverished and hard-to-reach populations. Although many country-specific studies exist, few syntheses have examined short-term health system responses to epidemics in hard-to-reach areas of SSA and their effects on health equity and resilience. This scoping review consolidates regional evidence on structural and policy-relevant lessons for enhancing health system preparedness and epidemic management in resource-limited settings. Methods A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Four electronic databases (PubMed, Cochrane Library, CAB Direct, and Google scholar) and grey literature sources for studies published between 2012 and 2022. Eligible studies reported short-term (immediate or early-phase) health system responses to epidemic-prone infectious diseases in SSA. Data were extracted thematically using Excel and analysed using a modified Donabedian framework encompassing structures, processes, and outcomes. Results Fifteen studies met the inclusion criteria and examined responses to Coronavirus 2019 (COVID-19), Ebola Virus Disease (EVD), and other epidemic-prone infections. Common weaknesses identified included shortages of trained healthcare workers, limited financial resources, poor leadership and coordination, and weak information systems. However, countries such as Rwanda, Ethiopia, Nigeria, and Uganda demonstrated adaptive governance, decentralised coordination, and the use of digital tools to improve surveillance, communication, and service delivery. Strong community engagement helped reduce stigma and increased adherence to control measures, especially in rural and underserved areas. Countries that incorporated epidemic response into existing primary healthcare and routine services achieved better equity and system resilience. Conclusion The scoping review underscores strong evidence for incorporating epidemic preparedness into the broader health system. Policy focus areas include enhancing leadership and governance, establishing swift response mechanisms at subnational levels, and utilising technology for real-time data and coordination. Regional collaborations like those facilitated by the Africa CDC can improve collective resilience. Going forward, policies should prioritise not just emergency response but also ongoing investment in flexible, learning health systems that can withstand shocks while consistently providing essential services.

Background Due to insufficient routine surveillance, the nationwide disease burden of hand, foot and mouth disease (HFMD) caused by coxsackievirus A6 (CVA6), an emerging serotype, in China remains unclear. This study aimed to estimate the incidence of CVA6-associated HFMD across the Chinese mainland. Methods CVA6 positive data from 511 locations across the Chinese mainland during 2008-2022 were integrated from the national pathogen surveillance system and literature, and reported HFMD cases during the same period were obtained from the national infectious disease surveillance system. The predicted positivity rate and incidence of CVA6-associated HFMD in children under five years of age across the Chinese mainland were estimated using a Bayesian geostatistical Gaussian model based on positivity data, reported cases, and environmental, socioeconomic, demographic, and vaccination factors. Results The model estimated that the average positivity rate of CVA6 in the Chinese mainland from 2008 to 2022 was 24.1%, with a 95% Bayesian credible interval (BCI) of 11.9-43.3%. The corresponding average annual incidence of CVA6-associated HFMD in children under five years of age was 506 (95% BCI: 272-805) per 100,000. The yearly incidence of CVA6-associated HFMD in children under five years of age peaked in 2018 (873 per 100,000; 95% BCI: 513-1309) before a subsequent decline after 2020. The incidence was highest in South China (1571 per 100,000; 95% BCI: 890-2420) and lowest in Northeast China (208 per 100,000; 95% BCI: 106-340). The estimated CVA6-associated HFMD incidence showed a consistent upward trend across different economic level groups before 2020, and tended to be higher in high-gross domestic product (GDP) per capita regions than in medium- and low-GDP regions. Conclusions Model-based estimates indicate a potentially high incidence of CVA6-associated HFMD on the Chinese mainland, particularly in South China, highlighting the need for enhanced surveillance of CVA6 and targeted control efforts in high-incidence regions.

Background Schistosoma mekongi remains an important cause of intestinal schistosomiasis in the lower Mekong River Basin. Sensitive environmental surveillance tools are needed to support transmission monitoring, particularly where conventional snail surveys are seasonally constrained. This study developed and evaluated a multiplex quantitative PCR (qPCR) assay for simultaneous detection of S. mekongi and its intermediate snail host, Neotricula aperta, in aquatic environmental DNA (eDNA) samples. Methods Singleplex and multiplex qPCR assays targeting S. mekongi and N. aperta were compared to establish the optimal amplification system. Field validation was conducted in the Khong District, Champasak Province, Laos, during the dry season (May 2024) and wet season (August 2024) across 20 transmission sites. Method agreement between eDNA detection and malacological surveys was assessed using Cohen’s kappa coefficient, and associations between N. aperta density and physicochemical variables were evaluated using Spearman’s rank correlation. Results The optimized multiplex qPCR assay targeting N. aperta (16S rRNA) and S. mekongi (18S rRNA) showed high sensitivity, with limits of detection of 5 and 6 copies/μl and limits of quantification of 40 and 46 copies/μl, respectively. In mesocosms, both targets were detected at an infected-snail density of 1 snail/L, with median Cq values of 35.23 for N. aperta and 26.54 for S. mekongi. During the dry-season surveys, 978 N. aperta were collected, with a mean density of 46.25 snails per site; wet-season surveys were not feasible. No schistosome infections were detected by crushing microscopy. Field eDNA analysis detected N. aperta but not S. mekongi, with N. aperta eDNA positivity being 90% in the dry season and 40% in the wet season. Agreement with malacological surveys was moderate (κ = 0.44; p = 0.01) and snail density was significantly associated with water temperature, pH, and dissolved oxygen. Conclusions This multiplex eDNA assay sensitively detected N. aperta in field water samples and may help overcome seasonal limitations of malacological surveys. Although S. mekongi was detected under laboratory conditions, it was not detected in field samples, consistent with the absence of infected snails. Further validation in active-transmission sites is required before reliable field detection of S. mekongi eDNA can be assumed.

Background In China’s post-transmission-interruption stage of schistosomiasis control, infection signals are often sparse, and conventional surveillance indicators focused on infection detection may not adequately capture residual risk across heterogeneous ecological settings. This study aimed to develop an operational indicator framework for assessing schistosomiasis transmission risk and supporting routine risk assessment and management in this stage. Methods A county-level indicator framework for schistosomiasis transmission risk assessment was developed through a two-round Delphi consultation and weighted using a combined Delphi-entropy weight method. Using longitudinal data from six pilot counties during 2020-2024, an annual composite risk index (R) was calculated by weighted linear aggregation and classified into risk levels with trapezoidal fuzzy membership functions. Robustness was evaluated by perturbing the subjective preference coefficient (α) and examining the consistency of county-year rankings across scenarios using Spearman’s rank correlation. Results The final framework comprised three first-level, twelve second-level, and thirty-nine third-level indicators spanning biological, environmental, and social domains. Across the six pilot counties, R ranged from 0.18 to 0.44 and the overall risk level was predominantly low. Nonetheless, distinct county-level risk profiles were observed between lake/marshland and mountainous settings. Risk rankings remained highly consistent under α perturbations (ρ = 0.909-0.998), indicating good robustness of the assessment results. Conclusions This framework translates multidimensional determinants relevant to the re-establishment of schistosomiasis transmission into interpretable county-level risk profiles. It provides an operational tool to support targeted surveillance and more efficient allocation of control resources in low-endemicity contexts.

Background Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is a growing public health challenge, particularly in Indonesia, where TB incidence remains high and DM prevalence is increasing. DM co-morbidity is known to increase the risk of TB incidence and have negative effects on TB treatment outcomes. This study aims to analyze the geographical co-distribution of TB and DM and their sociodemographic determinants in Indonesia, to help inform public health response and targeting of screening programs. Methods Using data from the 2023 Indonesian Health Survey (SKI), a nationally representative, population-based survey, we applied a Bayesian geostatistical model to estimate disease prevalence and assess associations with key sociodemographic factors. Results The predicted TB prevalence varied from 0.1% to 3.0%, highest in eastern Indonesia, particularly Papua, while DM prevalence ranged from 0.6% to 6.2%, concentrated in Java and Sumatra. Approximately 62 districts showed more than a 50% posterior probability that both TB and DM prevalences simultaneously exceed their respective national thresholds. The proportion of the poor population is significantly associated with higher TB prevalence (0.106; 95% CrI: 0.039, 0.174), while population density has a strong positive correlation with DM prevalence (0.198; 95% CrI: 0.156, 0.241). Proportion of the poor population (- 0.053; 95% CrI: - 0.096, - 0.009) and hospital services (- 0.071; 95% CrI: - 0.116, - 0.027) show a negative association with DM prevalence. Conclusion Spatial analysis revealed significant regional variations, with high TB-DM co-distribution observed in rapidly urbanizing and high-poverty districts, including parts of West Java, East Java, Sumatra, and Kalimantan in Indonesia. These findings emphasize the need for strengthened TB-DM integration in healthcare services, especially in areas that have a high prevalence of both diseases. Strengthening integrated disease management strategies in local areas can help mitigate the burden of both TB and DM in Indonesia, particularly given likely low case detection and health care access in lower income regions.

Background Leishmaniasis is a vector-borne protozoan disease with cutaneous, mucocutaneous, and visceral forms. In Europe, most cases involve Old World species, while imported New World infections are rare. We report the first imported human case of New World cutaneous leishmaniasis in Romania. Case presentation A 25-year-old woman developed progressive ulcerative lesions on her left arm after travel to Panama and Costa Rica. Initial biopsy revealed granulomatous inflammation without identifying the agent. A second biopsy detected amastigotes within macrophages, and molecular analyses (ITS1 sequencing, hsp70 phylogenetic analysis) identified Leishmania panamensis. The patient received oral miltefosine for 28 days, with gradual improvement and complete healing with atrophic scars. No relapse occurred 473 days post-treatment. Conclusions This case highlights diagnostic challenges in non-endemic regions, emphasizing the need to raise clinical awareness and improve access to molecular tools for prompt recognition and management of imported leishmaniasis in Eastern Europe.

Climate change is reshaping the global landscape and transmission of infectious diseases, posing a profound threat to public health systems. Despite a growing body of evidence on expanding transmission of infectious diseases due to climate change, translating this evidence into effective actions to reduce infectious disease burden remains insufficient. To address these challenges, we organized this special issue Climate Change and Infectious Diseases and synthesized new evidence on climate-sensitive infectious diseases and response frameworks. To bridge the implementation gap, we propose a core framework of four evidence-based strategies to mitigate impacts of climate change on infectious diseases, including strengthening health adaptation actions, applying innovative and comprehensive control measures, building climate-resilient and low-carbon health systems, and improving global governance and equity. We advocate for translating evidence into action to reduce infectious disease burdens in the context of global climate change, and policymakers, researchers, and clinical practitioners need to work together to achieve this important goal.

Climate change poses an escalating threat to health, livelihoods, and economic development in Sierra Leone, a coastal, low-income country highly dependent on rain-fed agriculture for sustenance and revenue. Rising temperatures, erratic rainfall, floods, landslides, sea-level rise, and coastal erosion disrupt food systems and damage infrastructure, subsequently entrenching poverty, with projected gross domestic product losses of up to 10% by 2050. The health impacts fall disproportionately on children, adolescents and young people, pregnant women, the elderly, and the urban poor, including increased vector- and water-borne diseases, heat-related morbidity, non-communicable diseases, malnutrition, mental illness, and gender-based violence, particularly in informal coastal settlements. Despite these risks, climate adaptation and mitigation remain weakly integrated across sectors. Conflicting policies, fragmented governance systems, inadequate domestic financing, and over-reliance on unpredictable donor support undermine implementation of existing frameworks such as the National Adaptation Programme of Action. An example of policy conflicts is the extractive-sector priorities directly countering those of environmental protection and public health. This correspondence interrogates global and local institutional readiness to mitigate climate-related health risks, drawing on the WHO Operational Framework for Climate-Resilient Health Systems and the multidimensional climate justice approach. Using the July 2025 International Court of Justice advisory opinion on climate change as a legal and moral anchor, we argue for urgent, health-centred, and justice-oriented climate actions. We highlight the need for strengthened cross-sectoral governance, community-level implementation, and legal accountability, particularly in securing international climate financing for adaptation as part of States’ human rights obligations under the United Nations Framework Convention on Climate Change Loss and Damage Framework. We contend that the International Court of Justice opinion provides Sierra Leone with a critical new basis to advocate for international support to protect the fundamental right to health.