Pub Date : 2025-12-01DOI: 10.1016/j.lana.2025.101311
Esteban Londoño , Reena Gupta , Patrick Van der Stuyft , Martin Heine , Gloria Giraldo , Grace Marie Ku , Jeffrey Brettler , Andrés Rosende , Vilma Irazola , Jerry Toelsie , Carolina Neira , Teresa Aumala , Yamilé Valdés , Eric Zúñiga , Libardo Rodríguez , Matías Villatoro , María Cristina Escobar , Vivian Pérez , Alied Bencomo , Michael Pereira , Pedro Ordunez
HEARTS in the Americas is the largest-scale implementation of the WHO's global initiative, with 33 countries participating, 28 having adopted standardized clinical pathways, and about 10,000 primary healthcare facilities engaged. Despite progress, fragmented care, limited availability of validated blood pressure devices, restricted access to essential medicines, and weak quality assurance systems continue to hinder hypertension control and cardiovascular risk management. In response, PAHO and participating countries co-developed the HEARTS Quality Framework. Grounded in regional implementation, this model synthesizes global evidence and lessons from Latin America and the Caribbean. Co-designed by Ministries of Health, care providers, and international experts, it translates HEARTS strategies into actionable system-level objectives. Clearly defined outcome indicators and implementation targets promote institutionalization, quality improvement, and primary healthcare strengthening—supporting HEARTS scale-up and equitable outcomes. With appropriate contextualization, the HEARTS Quality Framework provides a practical roadmap for countries beyond the Region to advance primary healthcare-based chronic disease care.
{"title":"HEARTS quality: a policy framework to strengthen hypertension and cardiovascular risk management in primary healthcare—insights from HEARTS in the Americas","authors":"Esteban Londoño , Reena Gupta , Patrick Van der Stuyft , Martin Heine , Gloria Giraldo , Grace Marie Ku , Jeffrey Brettler , Andrés Rosende , Vilma Irazola , Jerry Toelsie , Carolina Neira , Teresa Aumala , Yamilé Valdés , Eric Zúñiga , Libardo Rodríguez , Matías Villatoro , María Cristina Escobar , Vivian Pérez , Alied Bencomo , Michael Pereira , Pedro Ordunez","doi":"10.1016/j.lana.2025.101311","DOIUrl":"10.1016/j.lana.2025.101311","url":null,"abstract":"<div><div>HEARTS in the Americas is the largest-scale implementation of the WHO's global initiative, with 33 countries participating, 28 having adopted standardized clinical pathways, and about 10,000 primary healthcare facilities engaged. Despite progress, fragmented care, limited availability of validated blood pressure devices, restricted access to essential medicines, and weak quality assurance systems continue to hinder hypertension control and cardiovascular risk management. In response, PAHO and participating countries co-developed the HEARTS Quality Framework. Grounded in regional implementation, this model synthesizes global evidence and lessons from Latin America and the Caribbean. Co-designed by Ministries of Health, care providers, and international experts, it translates HEARTS strategies into actionable system-level objectives. Clearly defined outcome indicators and implementation targets promote institutionalization, quality improvement, and primary healthcare strengthening—supporting HEARTS scale-up and equitable outcomes. With appropriate contextualization, the HEARTS Quality Framework provides a practical roadmap for countries beyond the Region to advance primary healthcare-based chronic disease care.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101311"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lana.2025.101276
Stella M. Hartinger , Yasna Palmeiro-Silva , Camila Llerena-Cayo , Rayana Santos Araujo Palharini , Christian García-Witulski , Maria Fernanda Salas , Nicolas Valdés-Ortega , Avriel Diaz , Luis E. Escobar , Carolina Gil Posse , Juliana Helo Sarmiento , Andres G. Lescano , Oscar Melo , Mónica Pinilla-Roncancio , David Rojas-Rueda , Tatiana Souza de Camargo , Bruno Takahashi , Luciana Blanco-Villafuerte , Nicolas Borchers-Arriagada , Marcia Chame , Marina Romanello
{"title":"The 2025 Lancet Countdown Latin America report: moving from promises to equitable climate action for a prosperous future","authors":"Stella M. Hartinger , Yasna Palmeiro-Silva , Camila Llerena-Cayo , Rayana Santos Araujo Palharini , Christian García-Witulski , Maria Fernanda Salas , Nicolas Valdés-Ortega , Avriel Diaz , Luis E. Escobar , Carolina Gil Posse , Juliana Helo Sarmiento , Andres G. Lescano , Oscar Melo , Mónica Pinilla-Roncancio , David Rojas-Rueda , Tatiana Souza de Camargo , Bruno Takahashi , Luciana Blanco-Villafuerte , Nicolas Borchers-Arriagada , Marcia Chame , Marina Romanello","doi":"10.1016/j.lana.2025.101276","DOIUrl":"10.1016/j.lana.2025.101276","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101276"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lana.2025.101282
Franco Mascayano , Javiera Burgos , Viviana Hernandez , Rodrigo Casanueva , Xinyu Yang , Zeyu Li , Param Sampat , Maria Teresa Muñoz-Quezada , Sebastian Rojas-Navarro , Katrina Rodriguez , Jeanette Stingone , Lawrence Yang , Ezra Susser
Background
In Northern Europe, several studies have indicated that people born and raised in urban areas have an increased risk of psychosis. Emerging research in the Global South has produced more heterogeneous and inconsistent findings, suggesting that the impact of urban environments on psychosis risk may depend on social context and broader environmental factors at multiple levels.
Methods
We constructed a cohort of 5,137,561 individuals born in Chile (1992–2012) using the national first episode psychosis (FEP) and Birth and Death registries. We identified 14,410 individuals with nonaffective FEP (ICD-10 F20–F29) recorded between 2005 and 2022. Urbanicity at birth (urban vs rural) was our main exposure. We estimated incidence rate ratios (IRRs) via Poisson regression, adjusting for year of birth and region to account for birth-cohort effects. We also examined whether parental education and employment—two indicators of social deprivation—modified this association.
Findings
Over ∼92 million person-years, the crude incidence rate was 15.67 per 100,000 person-years (95% CI: 15.42, 15.93). No overall association between urbanicity at birth and non-affective FEP was found after accounting for social factors (adjusted IRR = 0.96, 95% CI: 0.91, 1.01). However, parental low education appeared to modify the association between urbanicity and psychosis on both multiplicative and additive scales, with an additive interaction (RERI = 0.33, 95% CI: 0.18, 0.47), supporting a model where urbanicity increases psychosis risk primarily in the presence of social deprivation.
Interpretation
Urban birth alone was not associated with higher FEP incidence in Chile, but an elevated risk was seen among families with lower educational attainment in urban areas. This suggests a causal interplay between urbanicity and social deprivation, underscoring the importance of multilevel frameworks for understanding psychosis risk, especially in rapidly urbanizing societies.
{"title":"Urbanicity, parental social deprivation, and risk of early psychosis in Chile: a national cohort study","authors":"Franco Mascayano , Javiera Burgos , Viviana Hernandez , Rodrigo Casanueva , Xinyu Yang , Zeyu Li , Param Sampat , Maria Teresa Muñoz-Quezada , Sebastian Rojas-Navarro , Katrina Rodriguez , Jeanette Stingone , Lawrence Yang , Ezra Susser","doi":"10.1016/j.lana.2025.101282","DOIUrl":"10.1016/j.lana.2025.101282","url":null,"abstract":"<div><h3>Background</h3><div>In Northern Europe, several studies have indicated that people born and raised in urban areas have an increased risk of psychosis. Emerging research in the Global South has produced more heterogeneous and inconsistent findings, suggesting that the impact of urban environments on psychosis risk may depend on social context and broader environmental factors at multiple levels.</div></div><div><h3>Methods</h3><div>We constructed a cohort of 5,137,561 individuals born in Chile (1992–2012) using the national first episode psychosis (FEP) and Birth and Death registries. We identified 14,410 individuals with nonaffective FEP (ICD-10 F20–F29) recorded between 2005 and 2022. Urbanicity at birth (urban vs rural) was our main exposure. We estimated incidence rate ratios (IRRs) via Poisson regression, adjusting for year of birth and region to account for birth-cohort effects. We also examined whether parental education and employment—two indicators of social deprivation—modified this association.</div></div><div><h3>Findings</h3><div>Over ∼92 million person-years, the crude incidence rate was 15.67 per 100,000 person-years (95% CI: 15.42, 15.93). No overall association between urbanicity at birth and non-affective FEP was found after accounting for social factors (adjusted IRR = 0.96, 95% CI: 0.91, 1.01). However, parental low education appeared to modify the association between urbanicity and psychosis on both multiplicative and additive scales, with an additive interaction (RERI = 0.33, 95% CI: 0.18, 0.47), supporting a model where urbanicity increases psychosis risk primarily in the presence of social deprivation.</div></div><div><h3>Interpretation</h3><div>Urban birth alone was not associated with higher FEP incidence in Chile, but an elevated risk was seen among families with lower educational attainment in urban areas. This suggests a causal interplay between urbanicity and social deprivation, underscoring the importance of multilevel frameworks for understanding psychosis risk, especially in rapidly urbanizing societies.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101282"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lana.2025.101285
Sherrie Xie , Julianna Shinnick , Elvis W. Diaz , Edith Zegarra , Ynes Monroy , Sergio E. Recuenco , Ricardo Castillo-Neyra
Background
Dog-mediated human rabies is intuitively linked to poverty, but few studies have formally investigated the relationship between local socioeconomic disadvantage and dog rabies incidence.
Methods
We leveraged a unique, high-spatial-resolution surveillance database from the rabies-endemic city of Arequipa, Peru to probe the relationship between neighbourhood socioeconomic status (SES) and dog rabies risk in 2015–2022. Rabies cases and samples were assigned to the SES level of their block or locality of origin, respectively. We tested the hypothesis that lower SES is associated with increased case positivity and used a spatial statistical model to understand how sample positivity varied spatially.
Findings
Rabies cases were concentrated in socioeconomically disadvantaged blocks (p < 0.001), and sample positivity had a significant and positive association with neighbourhood disadvantage (p < 0.05 for all periods), suggesting that surveillance effort was low relative to case incidence in disadvantaged areas. Stratifying samples by those collected via active vs. passive surveillance revealed that active surveillance reduced disparities in surveillance effort and sample positivity. Spatial analysis identified a sample positivity hotspot in a socioeconomically disadvantaged region with low access to health facilities.
Interpretation
Dog-mediated rabies is known to impact the poorest regions globally. We found similar patterns mirrored on a much smaller spatial scale–within a single city's limits. A balanced approach combining spatially-targeted (“active”) and community-based (“passive”) surveillance can help reduce rabies disparities. Mass dog vaccination and surveillance programs could target disadvantaged neighbourhoods to allocate resources to the most impacted areas and more effectively control dog rabies epidemics.
{"title":"Socioeconomic disparities and dog rabies: a retrospective analysis of high-spatial-resolution surveillance data from a Latin American city","authors":"Sherrie Xie , Julianna Shinnick , Elvis W. Diaz , Edith Zegarra , Ynes Monroy , Sergio E. Recuenco , Ricardo Castillo-Neyra","doi":"10.1016/j.lana.2025.101285","DOIUrl":"10.1016/j.lana.2025.101285","url":null,"abstract":"<div><h3>Background</h3><div>Dog-mediated human rabies is intuitively linked to poverty, but few studies have formally investigated the relationship between local socioeconomic disadvantage and dog rabies incidence.</div></div><div><h3>Methods</h3><div>We leveraged a unique, high-spatial-resolution surveillance database from the rabies-endemic city of Arequipa, Peru to probe the relationship between neighbourhood socioeconomic status (SES) and dog rabies risk in 2015–2022. Rabies cases and samples were assigned to the SES level of their block or locality of origin, respectively. We tested the hypothesis that lower SES is associated with increased case positivity and used a spatial statistical model to understand how sample positivity varied spatially.</div></div><div><h3>Findings</h3><div>Rabies cases were concentrated in socioeconomically disadvantaged blocks (<em>p</em> < 0.001), and sample positivity had a significant and positive association with neighbourhood disadvantage (<em>p</em> < 0.05 for all periods), suggesting that surveillance effort was low relative to case incidence in disadvantaged areas. Stratifying samples by those collected via active vs. passive surveillance revealed that active surveillance reduced disparities in surveillance effort and sample positivity. Spatial analysis identified a sample positivity hotspot in a socioeconomically disadvantaged region with low access to health facilities.</div></div><div><h3>Interpretation</h3><div>Dog-mediated rabies is known to impact the poorest regions globally. We found similar patterns mirrored on a much smaller spatial scale–within a single city's limits. A balanced approach combining spatially-targeted (“active”) and community-based (“passive”) surveillance can help reduce rabies disparities. Mass dog vaccination and surveillance programs could target disadvantaged neighbourhoods to allocate resources to the most impacted areas and more effectively control dog rabies epidemics.</div></div><div><h3>Funding</h3><div>US <span>National Institutes of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101285"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-29DOI: 10.1016/j.lana.2025.101310
Aurélie Montagne , Cécile Rousseau , Ana Gómez-Carrillo
School-based initiatives are increasingly promoted as solutions to the youth mental health crisis, with Social Emotional Learning (SEL) among the most widely adopted frameworks worldwide. While designed to foster healthy socio-emotional development, evidence for SEL’s long-term mental health benefits remains mixed. Concerns are also growing that universal, non-targeted SEL programs may inadvertently pathologize normal developmental experiences, reinforce self-monitoring, or generate cultural mismatches that undermine resilience. In this personal view, we examine key challenges associated with universal (i.e., non-targeted and intended for all students regardless of baseline risk) school-based programs modeled on SEL. While acknowledging their potential to promote youth well-being, we argue that prescriptive approaches to emotions and sociality can foster confusion among families, resistance among youth, and unintended distress. We highlight risks stemming from conceptual ambiguities and variability in implementation. Rather than abandoning universal programs, we call for rigorous evaluation, cultural adaptation, and integration within broader ecosocial-strategies to foster authentic, context-sensitive resilience in youth.
{"title":"The fine line between the cure and the illness: the risks of prescriptive emotionality and sociality for youth mental health","authors":"Aurélie Montagne , Cécile Rousseau , Ana Gómez-Carrillo","doi":"10.1016/j.lana.2025.101310","DOIUrl":"10.1016/j.lana.2025.101310","url":null,"abstract":"<div><div>School-based initiatives are increasingly promoted as solutions to the youth mental health crisis, with Social Emotional Learning (SEL) among the most widely adopted frameworks worldwide. While designed to foster healthy socio-emotional development, evidence for SEL’s long-term mental health benefits remains mixed. Concerns are also growing that universal, non-targeted SEL programs may inadvertently pathologize normal developmental experiences, reinforce self-monitoring, or generate cultural mismatches that undermine resilience. In this personal view, we examine key challenges associated with universal (i.e., non-targeted and intended for all students regardless of baseline risk) school-based programs modeled on SEL. While acknowledging their potential to promote youth well-being, we argue that prescriptive approaches to emotions and sociality can foster confusion among families, resistance among youth, and unintended distress. We highlight risks stemming from conceptual ambiguities and variability in implementation. Rather than abandoning universal programs, we call for rigorous evaluation, cultural adaptation, and integration within broader ecosocial-strategies to foster authentic, context-sensitive resilience in youth.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101310"},"PeriodicalIF":7.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-29DOI: 10.1016/j.lana.2025.101306
Matheus de Abreu , Maria do Rosario Dias de Oliveira Latorre , Maria Paula Curado
Background
Brazil exhibits the highest mortality rates for oral cavity (OCC), oropharyngeal (OPC), and laryngeal (LC) cancers in South-America. This study aims to analyze mortality trends in head and neck cancers (HNC) across the Brazilian population over 44-year period.
Methods
A time-series ecological study was conducted using OCC, OPC, LC mortality data. Age-period-cohort (APC) effects and the average annual percent change (AAPC) were estimated for each cancer subsite by gender, regions, ethnicity.
Findings
From 1980 to 2023, 303,882 HNC deaths were recorded among adults ≥40 years. LC predominated (45.4%), followed by OCC (30.5%), OPC (24.1%). Mortality rates were higher in men, LC showing the highest. After 2000, mortality declines for LC (RR: 0.98 [0.98–1.00 CI 95%]) in men, while women increasing mortality for OPC (RR: 1.12 [1.04–1.21]), OCC (RR: 1.08 [1.02–1.15]). Men born after-1955 showed reduced RR for all subsites, women exhibited for LC. The Northeast region showed an increasing trend across all age groups and cancer subsites. OPC presented an increase in mortality in all regions, in contrast to LC and OCC, which declined in the South and Southeast. White men had a decreasing trend for LC (AAPC −1.62 [−1.99 to −1.26]), OCC (AAPC −1.01 [−1.31 to −0.71]), OPC (AAPC −0.60 [−0.98 to −0.24]), whereas Brown showed an increasing for both genders in all subsites.
Interpretation
Gender, ethnicity, and geographic location are associated with HNC mortality in Brazil. White men and developed regions showed the most substantial improvements in mortality, while brown, women, and people in the North/Northeast exhibited concerning increases. OPC, although with the lowest rates, shows a growing mortality trend nationwide.
{"title":"Head and neck cancer mortality by gender, region and ethnicity: a population-based study in Brazil","authors":"Matheus de Abreu , Maria do Rosario Dias de Oliveira Latorre , Maria Paula Curado","doi":"10.1016/j.lana.2025.101306","DOIUrl":"10.1016/j.lana.2025.101306","url":null,"abstract":"<div><h3>Background</h3><div>Brazil exhibits the highest mortality rates for oral cavity (OCC), oropharyngeal (OPC), and laryngeal (LC) cancers in South-America. This study aims to analyze mortality trends in head and neck cancers (HNC) across the Brazilian population over 44-year period.</div></div><div><h3>Methods</h3><div>A time-series ecological study was conducted using OCC, OPC, LC mortality data. Age-period-cohort (APC) effects and the average annual percent change (AAPC) were estimated for each cancer subsite by gender, regions, ethnicity.</div></div><div><h3>Findings</h3><div>From 1980 to 2023, 303,882 HNC deaths were recorded among adults ≥40 years. LC predominated (45.4%), followed by OCC (30.5%), OPC (24.1%). Mortality rates were higher in men, LC showing the highest. After 2000, mortality declines for LC (RR: 0.98 [0.98–1.00 CI 95%]) in men, while women increasing mortality for OPC (RR: 1.12 [1.04–1.21]), OCC (RR: 1.08 [1.02–1.15]). Men born after-1955 showed reduced RR for all subsites, women exhibited for LC. The Northeast region showed an increasing trend across all age groups and cancer subsites. OPC presented an increase in mortality in all regions, in contrast to LC and OCC, which declined in the South and Southeast. White men had a decreasing trend for LC (AAPC −1.62 [−1.99 to −1.26]), OCC (AAPC −1.01 [−1.31 to −0.71]), OPC (AAPC −0.60 [−0.98 to −0.24]), whereas Brown showed an increasing for both genders in all subsites.</div></div><div><h3>Interpretation</h3><div>Gender, ethnicity, and geographic location are associated with HNC mortality in Brazil. White men and developed regions showed the most substantial improvements in mortality, while brown, women, and people in the North/Northeast exhibited concerning increases. OPC, although with the lowest rates, shows a growing mortality trend nationwide.</div></div><div><h3>Funding</h3><div>CAPES-Brazil.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101306"},"PeriodicalIF":7.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-29DOI: 10.1016/j.lana.2025.101309
Lívia Sacchetto , Beatriz de Carvalho Marques , Cecília Artico Banho , Victoria Bernardi , Cássia Fernanda Estofolete , Cecília Luiza Simões dos Santos , Maria do Carmo Sampaio Tavares Timenetsky , Marcus Vinícius Guimarães de Lacerda , Angela Carvalho Freitas , Dhelio Batista Pereira , Allex Jardim da Fonseca , Ricardo Queiroz Gurgel , Ivo Castelo-Branco Coelho , Cor Jesus Fernandes Fontes , Ernesto Torres de Azevedo Marques Júnior , Gustavo Adolfo Sierra Romero , Mauro Martins Teixeira , André Machado de Siqueira , Viviane Sampaio Boaventura , Fabiano Ramos , Maurício Lacerda Nogueira
Background
Dengue has emerged as a public health challenge in Brazil since the early 1980s, and it is currently one of the most affected regions and an epicenter of the disease. The country faced its worst dengue epidemic on record, with the co-circulation of different dengue virus (DENV) serotypes alongside genotypes and lineages. This scenario stresses the urgent need for a vaccination strategy that addresses the current burden by protecting against all four DENV serotypes and ensuring safety despite a history of dengue exposure, given the high seroprevalence of dengue in Brazil.
Methods
In this study, we analyzed 365 DENV-1 and DENV-2 wild-type positive samples from unvaccinated and vaccinated (28 days post-vaccination) dengue-infected participants enrolled in the Butantan–dengue vaccine (Butantan-DV) phase 3 trial conducted in Brazil from 2016 to 2021. Genome sequences were obtained from 160 samples in order to analyze the genetic diversity of these strains through phylogenetic and genomic studies.
Findings
The 365 participants (mean age: 16.6, range: 2–59; male: 52.3%, female: 47.7%) enrolled and tested positive for DENV-1 and DENV-2 from both groups (vaccinated and placebo) reflected the spatial and epidemic patterns recorded in the country during the study period. Despite the limited statistical power due to the low number of samples, we observed significantly lower RT-qPCR Ct values in the vaccinated group, particularly for the DENV-1 cases, suggesting that the vaccine could be reducing viral replication. Additionally, vaccine breakthrough infections were not linked with any specific DENV-1 or DENV-2 lineage. Genetic diversity analysis showed no differences in intra-host synonymous or non-synonymous mutation rates between the groups, combined with the absence of positive selection sites in the DENV-1 and DENV-2 coding regions.
Interpretation
Our phylogenetic data demonstrate that Butantan-DV breakthrough infections is not linked to any unique DENV-1 or DENV-2 lineages. The circulating strains in both groups reflect typical transmission patterns of both viruses, highlighting instances of co-circulation and lineage replacement. Notably, the absence of positive selection sites and stable synonymous/non-synonymous mutation rates provides suggestive evidence that the vaccine does not promote vaccine-driven adaptive evolution.
Funding
Instituto Butantan, National Institutes of Health, National Council for Science and Technology and Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Instituto Nacional de Ciência e Tecnologia em Dengue (INCT), INCT Viral Genomic Surveillance and One Health, São Paulo Research Foundation.
{"title":"Dengue virus genetic diversity in unvaccinated and vaccinated dengue-infected individuals: an observational analysis of the Butantan-DV phase 3 trial in Brazil","authors":"Lívia Sacchetto , Beatriz de Carvalho Marques , Cecília Artico Banho , Victoria Bernardi , Cássia Fernanda Estofolete , Cecília Luiza Simões dos Santos , Maria do Carmo Sampaio Tavares Timenetsky , Marcus Vinícius Guimarães de Lacerda , Angela Carvalho Freitas , Dhelio Batista Pereira , Allex Jardim da Fonseca , Ricardo Queiroz Gurgel , Ivo Castelo-Branco Coelho , Cor Jesus Fernandes Fontes , Ernesto Torres de Azevedo Marques Júnior , Gustavo Adolfo Sierra Romero , Mauro Martins Teixeira , André Machado de Siqueira , Viviane Sampaio Boaventura , Fabiano Ramos , Maurício Lacerda Nogueira","doi":"10.1016/j.lana.2025.101309","DOIUrl":"10.1016/j.lana.2025.101309","url":null,"abstract":"<div><h3>Background</h3><div>Dengue has emerged as a public health challenge in Brazil since the early 1980s, and it is currently one of the most affected regions and an epicenter of the disease. The country faced its worst dengue epidemic on record, with the co-circulation of different dengue virus (DENV) serotypes alongside genotypes and lineages. This scenario stresses the urgent need for a vaccination strategy that addresses the current burden by protecting against all four DENV serotypes and ensuring safety despite a history of dengue exposure, given the high seroprevalence of dengue in Brazil.</div></div><div><h3>Methods</h3><div>In this study, we analyzed 365 DENV-1 and DENV-2 wild-type positive samples from unvaccinated and vaccinated (28 days post-vaccination) dengue-infected participants enrolled in the Butantan–dengue vaccine (Butantan-DV) phase 3 trial conducted in Brazil from 2016 to 2021. Genome sequences were obtained from 160 samples in order to analyze the genetic diversity of these strains through phylogenetic and genomic studies.</div></div><div><h3>Findings</h3><div>The 365 participants (mean age: 16.6, range: 2–59; male: 52.3%, female: 47.7%) enrolled and tested positive for DENV-1 and DENV-2 from both groups (vaccinated and placebo) reflected the spatial and epidemic patterns recorded in the country during the study period. Despite the limited statistical power due to the low number of samples, we observed significantly lower RT-qPCR Ct values in the vaccinated group, particularly for the DENV-1 cases, suggesting that the vaccine could be reducing viral replication. Additionally, vaccine breakthrough infections were not linked with any specific DENV-1 or DENV-2 lineage. Genetic diversity analysis showed no differences in intra-host synonymous or non-synonymous mutation rates between the groups, combined with the absence of positive selection sites in the DENV-1 and DENV-2 coding regions.</div></div><div><h3>Interpretation</h3><div>Our phylogenetic data demonstrate that Butantan-DV breakthrough infections is not linked to any unique DENV-1 or DENV-2 lineages. The circulating strains in both groups reflect typical transmission patterns of both viruses, highlighting instances of co-circulation and lineage replacement. Notably, the absence of positive selection sites and stable synonymous/non-synonymous mutation rates provides suggestive evidence that the vaccine does not promote vaccine-driven adaptive evolution.</div></div><div><h3>Funding</h3><div><span>Instituto Butantan</span>, <span>National Institutes of Health</span>, <span>National Council for Science and Technology</span> and <span>Fundação de Amparo à Pesquisa do Estado de Minas Gerais</span>, <span>Instituto Nacional de Ciência e Tecnologia em Dengue</span> (INCT), <span>INCT Viral Genomic Surveillance and One Health</span>, <span>São Paulo Research Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101309"},"PeriodicalIF":7.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-28DOI: 10.1016/j.lana.2025.101319
Atif Kamal
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Pub Date : 2025-11-27DOI: 10.1016/j.lana.2025.101305
Beatriz Barreto-Duarte , Klauss Villalva-Serra , João P. Miguez-Pinto , Mariana Araújo-Pereira , Vanessa M.S. Campos , Isabella B.B. Ferreira , Betânia M.F. Nogueira , Artur T.L. Queiroz , Valeria C. Rolla , Marcelo Cordeiro-Santos , Afrânio L. Kritski , Leonardo Martinez , Peter F. Rebeiro , Timothy R. Sterling , Moreno M. Rodrigues , Bruno B. Andrade
Background
Focusing on socially vulnerable sub-populations at increased risk of tuberculosis is warranted to decrease the disease burden. In this study, we evaluated whether homelessness, living with HIV, incarceration, pregnancy, immigration, drug use, and healthcare work are inter-related risk factors for unfavorable anti-tuberculosis treatment (ATT) outcomes in Brazil through analysis of national disease registry database (SINAN).
Methods
We conducted a retrospective cohort study of tuberculosis cases ≥18 years-old reported to SINAN between 2015 and 2023. Clinical and epidemiologic variables were compared between groups (non-vulnerability, homeless, people deprived of their liberty, pregnant women, people with HIV, people who use drugs, immigrants and healthcare worker). Bivariate comparisons identified characteristics associated with a composite unfavorable ATT outcome, or specifically death or LTFU versus cure. Multivariate modelling with relative excess risk due to interactions (RERI) were calculated to estimate how co-occurring vulnerabilities further increase the risk of unfavorable outcomes.
Findings
Among 679,572 cases analysed, most were males aged 18−35 years-old, with non-white ethnicity. 16% of individuals without vulnerabilities experienced unfavourable outcomes, compared to 33% among those with at least one vulnerability. Overlapping vulnerabilities further amplified risk: for instance, unfavourable outcomes occurred in more than 67% of individuals who reported both homelessness and drug use. Interaction analyses revealed both synergistic and antagonistic effects, with the strongest additive synergy observed between HIV infection and drug use, with a RERI of 225% [174–304%].
Interpretation
The superposition of interlacing social and biological vulnerabilities significantly worsened the risk of both death and LTFU in our population. Our study demonstrates that the joint effect of vulnerabilities on TB outcomes is not merely additive, but often synergistic, highlighting the importance of integrated and multisectoral interventions. These findings hallmark the need for policies that simultaneously address social and biological vulnerabilities to improve ATT success.
Funding
Intramural Research Program-Oswaldo Cruz Foundation.
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Multimorbidity, the coexistence of two or more chronic diseases, among cancer patients offers critical insights into shared risk factors, while posing increasing challenges for healthcare systems due to the complexity of care required. Despite its relevance, research in multimorbidity across different age groups is limited in middle income countries.
Methods
We analyzed cancer-related hospitalizations between 2019 and 2023, using a nationwide Diagnosis-Related Groups database covering 68 Chilean health institutions. We examined the distribution of 40 chronic conditions, multimorbidity prevalence, comorbidity profile, and their distribution across age group, sex, and cancer diagnosis.
Findings
We identified 4,722,723 hospitalization events, including 149,270 unique adult patients hospitalized with cancer (mean of 63 ± 15.17 years old). Multimorbidity was present in 47.9% of all cancer-related hospitalizations, increasing steeply with age: 14% in patients aged 18–35, 24.9% in those 36–50, and 55.5% in patients >50 years. Obesity and diabetes were among the most common comorbid conditions across age groups, with significant variations by sex. Notably, obesity was more prevalent in younger patients, particularly those aged 18–35, whereas hypertension showed an inverse profile, increasing markedly with age.
Interpretation
Multimorbidity profile reflect both the clinical complexity of cancer care and potential shared biological and environmental pathways in carcinogenesis. These findings highlight the need to transition from disease-centered to person-centered care models. In Chile, understanding multimorbidity in younger and middle-aged adults may inform precision prevention, integrated service delivery, and equitable planning for both oncologic and non-oncologic care.
Funding
This study was conducted without external funding.
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