Pub Date : 2026-02-01Epub Date: 2025-12-20DOI: 10.1016/j.lana.2025.101339
Gabriela Montenegro-Bethancourt , Gabriela V. Proaño , Elizabeth Yakes Jimenez , Taylor C. Wallace , Alison Steiber , Xingya Ma , Ming Ji , Peter Rohloff
Background
There is worldwide interest in determining whether frequent egg provision during complementary feeding enhances child development and growth in low-resource settings. We evaluated effects of adding one whole egg per day to local standard nutrition care on infant outcomes.
Methods
The Saqmolo’ Project individually randomized, partially blinded, comparative effectiveness clinical trial was conducted in rural Guatemala from 2021 to 2023. Maya infants aged 6–9 months were randomized to standard nutrition care alone (growth monitoring, complementary and responsive feeding education, deworming medication, multiple micronutrient powders, and referrals for medical care) versus standard care plus one whole egg per day for 6 months. Mixed linear or logistic regression models were used to estimate between-group differences in primary (global development score) and secondary (growth, anemia status, and diet quality) outcomes.
Findings
This trial included 1200 Maya infants (51.3% male). After adjustment for baseline values and participant characteristics, there was no significant between-group difference in global development score (β −0.08 points [95% CI −0.22 to 0.06]). There were also no significant between-group differences for most secondary outcomes. Intervention participants did have significantly higher odds of stunting (odds ratio [OR] 1.42 [95% CI 1.10–1.82]; p = 0.007) and of meeting minimum dietary diversity (OR 1.41 [95% CI 1.20–1.65]; p < 0.001) and minimum adequate diet (OR 1.44 [95% CI 1.26–1.64]; p < 0.001) benchmarks than standard care participants.
Interpretation
Provision of one whole egg per day in addition to standard care improved diet quality but did not benefit development, growth, or anemia status among Maya infants.
Funding
Academy of Nutrition and Dietetics Foundation via an Egg Nutrition Center investigator-initiated research grant.
在低资源环境下,确定补充喂养期间频繁提供鸡蛋是否能促进儿童发育和生长,是全世界都感兴趣的问题。我们评估了在当地标准营养护理中每天添加一个全蛋对婴儿结局的影响。方法于2021 - 2023年在危地马拉农村地区进行Saqmolo项目随机、部分盲法临床试验。6 - 9个月的玛雅婴儿被随机分配到单独的标准营养护理组(生长监测、补充和反应性喂养教育、驱虫药物、多种微量营养素粉末和转诊医疗护理组)和标准护理组,每天加一个完整的鸡蛋,持续6个月。使用混合线性或逻辑回归模型来估计主要(总体发展评分)和次要(生长、贫血状况和饮食质量)结局的组间差异。该试验包括1200名玛雅婴儿(51.3%为男性)。调整基线值和参与者特征后,总体发展评分组间无显著差异(β - 0.08分[95% CI - 0.22 - 0.06])。在大多数次要结果方面,组间也没有显著差异。与标准护理参与者相比,干预参与者发育迟缓的几率(比值比[OR] 1.42 [95% CI 1.10-1.82]; p = 0.007)、满足最低饮食多样性(比值比[OR] 1.41 [95% CI 1.20-1.65]; p < 0.001)和最低适当饮食(比值比[OR] 1.44 [95% CI 1.26-1.64]; p < 0.001)的几率明显更高。解释:除了标准护理外,每天提供一个全蛋改善了玛雅婴儿的饮食质量,但对发育、生长或贫血状况没有好处。营养与饮食学会基金会通过鸡蛋营养中心研究者发起的研究资助。
{"title":"Effect of eggs on Maya child development and growth: the Saqmolo’ Project randomized clinical trial","authors":"Gabriela Montenegro-Bethancourt , Gabriela V. Proaño , Elizabeth Yakes Jimenez , Taylor C. Wallace , Alison Steiber , Xingya Ma , Ming Ji , Peter Rohloff","doi":"10.1016/j.lana.2025.101339","DOIUrl":"10.1016/j.lana.2025.101339","url":null,"abstract":"<div><h3>Background</h3><div>There is worldwide interest in determining whether frequent egg provision during complementary feeding enhances child development and growth in low-resource settings. We evaluated effects of adding one whole egg per day to local standard nutrition care on infant outcomes.</div></div><div><h3>Methods</h3><div>The Saqmolo’ Project individually randomized, partially blinded, comparative effectiveness clinical trial was conducted in rural Guatemala from 2021 to 2023. Maya infants aged 6–9 months were randomized to standard nutrition care alone (growth monitoring, complementary and responsive feeding education, deworming medication, multiple micronutrient powders, and referrals for medical care) versus standard care plus one whole egg per day for 6 months. Mixed linear or logistic regression models were used to estimate between-group differences in primary (global development score) and secondary (growth, anemia status, and diet quality) outcomes.</div></div><div><h3>Findings</h3><div>This trial included 1200 Maya infants (51.3% male). After adjustment for baseline values and participant characteristics, there was no significant between-group difference in global development score (β −0.08 points [95% CI −0.22 to 0.06]). There were also no significant between-group differences for most secondary outcomes. Intervention participants did have significantly higher odds of stunting (odds ratio [OR] 1.42 [95% CI 1.10–1.82]; p = 0.007) and of meeting minimum dietary diversity (OR 1.41 [95% CI 1.20–1.65]; p < 0.001) and minimum adequate diet (OR 1.44 [95% CI 1.26–1.64]; p < 0.001) benchmarks than standard care participants.</div></div><div><h3>Interpretation</h3><div>Provision of one whole egg per day in addition to standard care improved diet quality but did not benefit development, growth, or anemia status among Maya infants.</div></div><div><h3>Funding</h3><div><span>Academy of Nutrition and Dietetics Foundation</span> via an <span>Egg Nutrition Center investigator-initiated research</span> grant.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101339"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790569","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}
Domestic violence has played a key role in linking firearms and homicide amongst female individuals. Combined with the increase of reports of violence against women during the COVID-19 pandemic, a rise in emergency department (ED) visits may be witnessed. Our aim was to estimate the changes in prevalence and risk factors associated with assault and firearm-related emergency department (ED) visits by female patients following the COVID-19 pandemic.
Methods
We performed a retrospective cross-sectional study of female patients presenting to EDs due to assault from the National Emergency Department Sample (NEDS) from 2018 to 2021. Independent variables included age, race, mortality, ED disposition, primary payer, location, mean total ED chargers, quartile ZIP income, and mechanism and intent of injury. The adjusted association between independent variables and ED visits among patients injured by firearms compared to those injured by other assaults was examined.
Findings
The analytic sample represented an estimated 1,575,543 ED weighted records of female assault cases out of a total weighted sample of 537,133,200 observations (0.29%). While year-over-year ED encounters decreased, firearm injuries and the proportion of patients admitted and dying in the hospital increased. Female patients who were injured by firearms had 89 times higher risk of dying in the ED (RR = 88.82; 95% CI 6 = 72.38–97.06) compared to female patients injured by non-firearm injury mechanisms. Racial disparities were prevalent, with Native American women experiencing the greatest risk of being assaulted (RR = 2.81; 95% CI 2.67–2.97). Victims of firearm related assaults had nearly 4.12 times the risk of identifying as Black compared with those assaulted without firearms (95% CI 3.75–4.52). Female patients seeking care for assault had higher risk of being uninsured (95% CI 2.70–2.77).
Interpretation
While year-over-year ED encounters due to assault decreased, lockdowns and restrictions associated with the observed COVID-19 pandemic may not fully reflect changes in abuse rates in this time period. The strong connection between firearm presence and female homicide and continuations of assault and firearm-related ED visits among vulnerable demographic groups highlights the need for effective strategies to reduce violence.
Funding
Unfunded.
家庭暴力在将枪支与女性杀人联系起来方面发挥了关键作用。在2019冠状病毒病大流行期间,暴力侵害妇女行为的报告有所增加,因此急诊就诊人数可能会增加。我们的目的是估计2019冠状病毒病大流行后女性患者攻击和枪支相关急诊科(ED)就诊的患病率和风险因素的变化。方法:我们对2018年至2021年国家急诊科样本(NEDS)中因攻击而就诊的女性患者进行了回顾性横断面研究。独立变量包括年龄、种族、死亡率、急症处置、主要付款人、地点、平均急症总收费人、四分位数ZIP收入、机制和伤害意图。与其他袭击受伤的患者相比,受火器伤害的患者与急诊室就诊之间的调整后的自变量之间的关联进行了检查。分析样本代表了537,133,200个观察的总加权样本(0.29%)中约1,575,543个女性性侵案件的ED加权记录。虽然急诊病例逐年减少,但火器伤害以及住院和死亡的患者比例却有所增加。女性火器伤患者急诊死亡风险是非火器伤女性患者的89倍(RR = 88.82; 95% CI 6 = 72.38 ~ 97.06)。种族差异普遍存在,美洲原住民妇女遭受侵犯的风险最大(RR = 2.81; 95% CI 2.67-2.97)。与没有枪支的受害者相比,枪支相关袭击的受害者被认定为黑人的风险近4.12倍(95% CI 3.75-4.52)。因遭受袭击而寻求治疗的女性患者没有保险的风险更高(95% CI 2.70-2.77)。虽然因袭击而导致的急诊事件逐年减少,但与观察到的COVID-19大流行相关的封锁和限制可能无法完全反映这一时期虐待率的变化。在弱势群体中,枪支的存在与女性杀人、持续的攻击和与枪支有关的急诊科就诊之间存在着密切的联系,这突出表明需要制定有效的战略来减少暴力。
{"title":"US emergency department visits by women due to assault (2018–2021): a retrospective cross-sectional analysis","authors":"Summer Chavez , Irma Ugalde , Michael Ulrich , Omolola Adepoju , Tonghui Xu , Winston Liaw","doi":"10.1016/j.lana.2025.101343","DOIUrl":"10.1016/j.lana.2025.101343","url":null,"abstract":"<div><h3>Background</h3><div>Domestic violence has played a key role in linking firearms and homicide amongst female individuals. Combined with the increase of reports of violence against women during the COVID-19 pandemic, a rise in emergency department (ED) visits may be witnessed. Our aim was to estimate the changes in prevalence and risk factors associated with assault and firearm-related emergency department (ED) visits by female patients following the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>We performed a retrospective cross-sectional study of female patients presenting to EDs due to assault from the National Emergency Department Sample (NEDS) from 2018 to 2021. Independent variables included age, race, mortality, ED disposition, primary payer, location, mean total ED chargers, quartile ZIP income, and mechanism and intent of injury. The adjusted association between independent variables and ED visits among patients injured by firearms compared to those injured by other assaults was examined.</div></div><div><h3>Findings</h3><div>The analytic sample represented an estimated 1,575,543 ED weighted records of female assault cases out of a total weighted sample of 537,133,200 observations (0.29%). While year-over-year ED encounters decreased, firearm injuries and the proportion of patients admitted and dying in the hospital increased. Female patients who were injured by firearms had 89 times higher risk of dying in the ED (RR = 88.82; 95% CI 6 = 72.38–97.06) compared to female patients injured by non-firearm injury mechanisms. Racial disparities were prevalent, with Native American women experiencing the greatest risk of being assaulted (RR = 2.81; 95% CI 2.67–2.97). Victims of firearm related assaults had nearly 4.12 times the risk of identifying as Black compared with those assaulted without firearms (95% CI 3.75–4.52). Female patients seeking care for assault had higher risk of being uninsured (95% CI 2.70–2.77).</div></div><div><h3>Interpretation</h3><div>While year-over-year ED encounters due to assault decreased, lockdowns and restrictions associated with the observed COVID-19 pandemic may not fully reflect changes in abuse rates in this time period. The strong connection between firearm presence and female homicide and continuations of assault and firearm-related ED visits among vulnerable demographic groups highlights the need for effective strategies to reduce violence.</div></div><div><h3>Funding</h3><div>Unfunded.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101343"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925434","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 : 2026-02-01Epub Date: 2026-01-29DOI: 10.1016/j.lana.2026.101381
Klauss Villalva-Serra , Beatriz Barreto-Duarte , Moreno M. Rodrigues , Artur T.L. Queiroz , Leonardo Martinez , Julio Croda , Valeria C. Rolla , Afrânio L. Kritski , Marcelo Cordeiro-Santos , Timothy R. Sterling , Mariana Araújo-Pereir , Bruno B. Andrade
{"title":"Corrigendum to “Impact of strategic public health interventions to reduce tuberculosis incidence in Brazil: a Bayesian structural time-series scenario analysis” - The Lancet Regional Health – Americas 2025; Volume 41: 100963; DOI: 10.1016/j.lana.2024.100963","authors":"Klauss Villalva-Serra , Beatriz Barreto-Duarte , Moreno M. Rodrigues , Artur T.L. Queiroz , Leonardo Martinez , Julio Croda , Valeria C. Rolla , Afrânio L. Kritski , Marcelo Cordeiro-Santos , Timothy R. Sterling , Mariana Araújo-Pereir , Bruno B. Andrade","doi":"10.1016/j.lana.2026.101381","DOIUrl":"10.1016/j.lana.2026.101381","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101381"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077820","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 : 2026-02-01Epub Date: 2026-01-09DOI: 10.1016/j.lana.2025.101369
Sarah A. Coggins , Sagori Mukhopadhyay
{"title":"Authors’ reply to: Todd et al., prenatal and intrapartum antibiotic exposure and childhood infections: considerations and complexities","authors":"Sarah A. Coggins , Sagori Mukhopadhyay","doi":"10.1016/j.lana.2025.101369","DOIUrl":"10.1016/j.lana.2025.101369","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101369"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920762","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 : 2026-01-01Epub Date: 2025-12-12DOI: 10.1016/j.lana.2025.101333
Christopher N. Kaufmann , Adam P. Spira , Chien-Yu Tseng , Emerson M. Wickwire
{"title":"Health and economic burden of insomnia medications among older Americans: findings from the future elderly model","authors":"Christopher N. Kaufmann , Adam P. Spira , Chien-Yu Tseng , Emerson M. Wickwire","doi":"10.1016/j.lana.2025.101333","DOIUrl":"10.1016/j.lana.2025.101333","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101333"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736321","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 : 2026-01-01Epub Date: 2025-11-13DOI: 10.1016/j.lana.2025.101299
Sarah E. Anthony , Manali A. Phadke , Richard B. Lipton , Daniel G. Rogers , Lisa A. Brenner , John P. Ney , Hamada H. Altalib , X. Michelle Androulakis , Amy S. Grinberg , Melissa Skanderson , Hung-Mo Lin , Joel D. Scholten , Brenda T. Fenton , Elizabeth K. Seng , Jason J. Sico
Background
Post-traumatic headache (PTH) is a common sequela of traumatic brain injury (TBI). Although there is a known association between TBI and suicide risk in veterans, the association between PTH and suicide-related outcomes in veterans with TBI is relatively unknown. We aimed to evaluate the association between PTH and suicide-related outcomes in veterans compared to matched controls diagnosed with TBI but no history of headaches.
Methods
This retrospective cohort study was conducted with Veterans Health Administration and Department of Defense electronic health record data from fiscal years 2008 through 2020. Veterans with PTH were matched to a control group who had TBI and no headache disorders. Relative risk was estimated using propensity score-weighted log-binomial models that evaluated differences in suicidal ideation, suicide attempts, and suicide death.
Findings
Of the 95,224 veterans included in the total sample, 85,730 were male (90.0%) and 9,949 were female (10.0%). The average age of the sample was 45.9 years (SD = 16.6). 73,500 (77.2%) were White, Non-Hispanic, 17,256 (18.1%) were Black, Non-Hispanic, and 4,468 (4.7%) were classified as other or mixed race. Of the 47,612 veterans diagnosed with PTH, 4,618 (9.7%) reported suicidal ideation or suicide attempts compared to 3,162 (6.6%) in the control group. Veterans with PTH had increased risk of suicidal ideation (RR, 1.45; 95% CI, 1.39–1.51) and suicide attempts (RR, 1.66; 95% CI, 1.50–1.83) compared to matched controls. Using inverse probability weighting to adjust for confounding, these results remained significant. When adjusting for potential confounders, as well as prior suicidal ideation or suicide attempts, there was no significant difference in risk of suicide death in veterans with PTH (RR, 0.83; 95% CI, 0.67–1.02) compared to those with TBI without headache.
Interpretation
Veterans with PTH have an increased risk of suicidal ideation and suicide attempts compared to veterans with TBI and without headache. There was no difference in suicide mortality between the two groups. Clinicians should be aware of heightened suicide risk among veterans with PTH and be especially diligent in terms of screening for suicide risk and related medical and mental health comorbidities that contribute to increased risk.
Funding
This study was supported by the United States Department of Veterans Affairs special purpose medical service funding (SP80DPE.1-0160).
{"title":"Suicide-related outcomes in veterans with post-traumatic headache: a retrospective cohort study","authors":"Sarah E. Anthony , Manali A. Phadke , Richard B. Lipton , Daniel G. Rogers , Lisa A. Brenner , John P. Ney , Hamada H. Altalib , X. Michelle Androulakis , Amy S. Grinberg , Melissa Skanderson , Hung-Mo Lin , Joel D. Scholten , Brenda T. Fenton , Elizabeth K. Seng , Jason J. Sico","doi":"10.1016/j.lana.2025.101299","DOIUrl":"10.1016/j.lana.2025.101299","url":null,"abstract":"<div><h3>Background</h3><div>Post-traumatic headache (PTH) is a common sequela of traumatic brain injury (TBI). Although there is a known association between TBI and suicide risk in veterans, the association between PTH and suicide-related outcomes in veterans with TBI is relatively unknown. We aimed to evaluate the association between PTH and suicide-related outcomes in veterans compared to matched controls diagnosed with TBI but no history of headaches.</div></div><div><h3>Methods</h3><div>This retrospective cohort study was conducted with Veterans Health Administration and Department of Defense electronic health record data from fiscal years 2008 through 2020. Veterans with PTH were matched to a control group who had TBI and no headache disorders. Relative risk was estimated using propensity score-weighted log-binomial models that evaluated differences in suicidal ideation, suicide attempts, and suicide death.</div></div><div><h3>Findings</h3><div>Of the 95,224 veterans included in the total sample, 85,730 were male (90.0%) and 9,949 were female (10.0%). The average age of the sample was 45.9 years (SD = 16.6). 73,500 (77.2%) were White, Non-Hispanic, 17,256 (18.1%) were Black, Non-Hispanic, and 4,468 (4.7%) were classified as other or mixed race. Of the 47,612 veterans diagnosed with PTH, 4,618 (9.7%) reported suicidal ideation or suicide attempts compared to 3,162 (6.6%) in the control group. Veterans with PTH had increased risk of suicidal ideation (RR, 1.45; 95% CI, 1.39–1.51) and suicide attempts (RR, 1.66; 95% CI, 1.50–1.83) compared to matched controls. Using inverse probability weighting to adjust for confounding, these results remained significant. When adjusting for potential confounders, as well as prior suicidal ideation or suicide attempts, there was no significant difference in risk of suicide death in veterans with PTH (RR, 0.83; 95% CI, 0.67–1.02) compared to those with TBI without headache.</div></div><div><h3>Interpretation</h3><div>Veterans with PTH have an increased risk of suicidal ideation and suicide attempts compared to veterans with TBI and without headache. There was no difference in suicide mortality between the two groups. Clinicians should be aware of heightened suicide risk among veterans with PTH and be especially diligent in terms of screening for suicide risk and related medical and mental health comorbidities that contribute to increased risk.</div></div><div><h3>Funding</h3><div>This study was supported by the United States <span>Department of Veterans Affairs</span> special purpose medical service funding (SP80DPE.1-0160).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101299"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526893","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 : 2026-01-01Epub Date: 2025-12-22DOI: 10.1016/j.lana.2025.101356
Sophia Aguiar Monteiro Borges , Erick Ohanesian Polli , Ana Carolina Nonato , Natacha Cerchiari , Stéphane Verguet , Ana Marli Christovam Sartori , Patrícia Coelho de Soárez
Background
In Brazil, respiratory syncytial virus (RSV) is the primary cause of lower respiratory tract infections (LRTI) in children under two years of age. Maternal immunization with the bivalent RSV prefusion F protein vaccine (RSVpreF) has demonstrated high efficacy in protecting infants during their first 6 months of life against RSV-LRTI. We assessed the cost-effectiveness of implementing maternal RSV immunization in Brazil.
Methods
We utilised a decision tree model, following a birth cohort during their first year of life. The model compared two strategies: maternal vaccination and no vaccination, from both healthcare system and societal perspectives. Secondary data from Brazilian Health Information Systems, administrative databases and international literature were used. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as incremental cost per disability-adjusted life year (DALY) averted, in 2023 USD. We applied a cost-effectiveness threshold of 8000 USD (40,000 BRL) per DALY based on Brazilian guidelines.
Findings
Introduction of RSV vaccination for pregnant women at 50% coverage would prevent around 37,000 RSV cases annually, including 9400 hospitalizations and 28,000 outpatient visits. The program would avert 80 deaths and 1660 DALYs, with an incremental cost of $49,200,000 USD from the healthcare system perspective (ICER $29,700 per DALY averted) and $48,800,000 USD from the societal perspective (ICER $29,200 per DALY averted). These ICERs exceed the acceptable cost-effectiveness Brazilian threshold. To be considered cost-effective, the vaccine dose price would need to be around $12. In sensitivity analyses, vaccine price and efficacy were the most influential parameters, as testing their uncertainty ranges resulted in the largest changes (i.e., the widest range) in the ICER. In the probabilistic sensitivity analysis, the probability that the maternal RSV immunization program is cost-effective at the Brazilian threshold of $8000 per DALY averted was 0% from the healthcare system perspective and 6% from the societal perspective.
Interpretation
Our findings indicate maternal RSV immunization could substantially reduce disease burden but would require significant price reduction to meet Brazil's cost-effectiveness threshold.
Funding
São Paulo Research Foundation (FAPESP), Pan American Health Organization (PAHO) and Brazilian National Council for Scientific and Technological Development (CNPq).
{"title":"Maternal RSV vaccination to protect infants in Brazil: a model-based cost-effectiveness analysis for incorporation into the National Immunisation Program","authors":"Sophia Aguiar Monteiro Borges , Erick Ohanesian Polli , Ana Carolina Nonato , Natacha Cerchiari , Stéphane Verguet , Ana Marli Christovam Sartori , Patrícia Coelho de Soárez","doi":"10.1016/j.lana.2025.101356","DOIUrl":"10.1016/j.lana.2025.101356","url":null,"abstract":"<div><h3>Background</h3><div>In Brazil, respiratory syncytial virus (RSV) is the primary cause of lower respiratory tract infections (LRTI) in children under two years of age. Maternal immunization with the bivalent RSV prefusion F protein vaccine (RSVpreF) has demonstrated high efficacy in protecting infants during their first 6 months of life against RSV-LRTI. We assessed the cost-effectiveness of implementing maternal RSV immunization in Brazil.</div></div><div><h3>Methods</h3><div>We utilised a decision tree model, following a birth cohort during their first year of life. The model compared two strategies: maternal vaccination and no vaccination, from both healthcare system and societal perspectives. Secondary data from Brazilian Health Information Systems, administrative databases and international literature were used. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as incremental cost per disability-adjusted life year (DALY) averted, in 2023 USD. We applied a cost-effectiveness threshold of 8000 USD (40,000 BRL) per DALY based on Brazilian guidelines.</div></div><div><h3>Findings</h3><div>Introduction of RSV vaccination for pregnant women at 50% coverage would prevent around 37,000 RSV cases annually, including 9400 hospitalizations and 28,000 outpatient visits. The program would avert 80 deaths and 1660 DALYs, with an incremental cost of $49,200,000 USD from the healthcare system perspective (ICER $29,700 per DALY averted) and $48,800,000 USD from the societal perspective (ICER $29,200 per DALY averted). These ICERs exceed the acceptable cost-effectiveness Brazilian threshold. To be considered cost-effective, the vaccine dose price would need to be around $12. In sensitivity analyses, vaccine price and efficacy were the most influential parameters, as testing their uncertainty ranges resulted in the largest changes (i.e., the widest range) in the ICER. In the probabilistic sensitivity analysis, the probability that the maternal RSV immunization program is cost-effective at the Brazilian threshold of $8000 per DALY averted was 0% from the healthcare system perspective and 6% from the societal perspective.</div></div><div><h3>Interpretation</h3><div>Our findings indicate maternal RSV immunization could substantially reduce disease burden but would require significant price reduction to meet Brazil's cost-effectiveness threshold.</div></div><div><h3>Funding</h3><div><span>São Paulo Research Foundation</span> (FAPESP), <span>Pan American Health Organization</span> (PAHO) and <span>Brazilian National Council for Scientific and Technological Development</span> (CNPq).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101356"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839177","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 : 2026-01-01Epub Date: 2025-12-08DOI: 10.1016/j.lana.2025.101324
Lara E. Coelho , Guilherme T. Goedert , Juliano Genari , Paula M. Luz , Luiz Max Carvalho , Cleber V.B.D. Santos , Daniel Csillag , Tulio Konečný , Lucia Campos Pellanda , Claudio J. Struchiner , Mariângela Freitas da Silveira , Pedro C. Hallal
Background
Vaccine uptake is critical to controlling COVID-19 and other infectious diseases, and trust in vaccines is a key determinant of vaccine coverage. This study aims to examine how individual characteristics and primary information sources during the pandemic influenced COVID-19 vaccine trust and uptake.
Methods
We performed a secondary analysis of the EPICOVID 2.0 survey, a Brazilian nationwide study (March–April 2024) that used multistage probabilistic sampling. Participants aged 18 or older from the EPICOVID 2.0 study were included in the analyses. Machine learning algorithms were employed to predict COVID-19 vaccine trust and uptake, measuring the influence of each covariate on the predicted probabilities.
Findings
Among 29,281 participants (63.9% women; median age 51 years), 60% reported trusting the COVID-19 vaccine and 72% had received ≥3 doses. Uptake strongly correlated with trust: 67% of unvaccinated or unsure participants distrusted the vaccine, while trust increased with the number of doses—62.6% (3 doses), 73.8% (4 doses), and 89.8% (≥5 doses). Gen Z adults (18–30 years) were less likely to trust the vaccine (negative influence of −0.07). Positive predictors of trust included higher education and trust in television or nurses as information sources (positive influences of 0.05, 0.09 and 0.07, respectively).
Interpretation
Trust and uptake of the COVID-19 vaccine were moderate, 60% and 72%, respectively. Gen Z adults reported greater distrust and lower uptake, while higher education was associated with increased trust. These findings highlight the need for tailored communication and health literacy interventions to improve vaccine uptake.
{"title":"COVID-19 vaccine trust and uptake: the role of media, interpersonal and institutional trust in a large population-based survey","authors":"Lara E. Coelho , Guilherme T. Goedert , Juliano Genari , Paula M. Luz , Luiz Max Carvalho , Cleber V.B.D. Santos , Daniel Csillag , Tulio Konečný , Lucia Campos Pellanda , Claudio J. Struchiner , Mariângela Freitas da Silveira , Pedro C. Hallal","doi":"10.1016/j.lana.2025.101324","DOIUrl":"10.1016/j.lana.2025.101324","url":null,"abstract":"<div><h3>Background</h3><div>Vaccine uptake is critical to controlling COVID-19 and other infectious diseases, and trust in vaccines is a key determinant of vaccine coverage. This study aims to examine how individual characteristics and primary information sources during the pandemic influenced COVID-19 vaccine trust and uptake.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis of the EPICOVID 2.0 survey, a Brazilian nationwide study (March–April 2024) that used multistage probabilistic sampling. Participants aged 18 or older from the EPICOVID 2.0 study were included in the analyses. Machine learning algorithms were employed to predict COVID-19 vaccine trust and uptake, measuring the influence of each covariate on the predicted probabilities.</div></div><div><h3>Findings</h3><div>Among 29,281 participants (63.9% women; median age 51 years), 60% reported trusting the COVID-19 vaccine and 72% had received ≥3 doses. Uptake strongly correlated with trust: 67% of unvaccinated or unsure participants distrusted the vaccine, while trust increased with the number of doses—62.6% (3 doses), 73.8% (4 doses), and 89.8% (≥5 doses). Gen Z adults (18–30 years) were less likely to trust the vaccine (negative influence of −0.07). Positive predictors of trust included higher education and trust in television or nurses as information sources (positive influences of 0.05, 0.09 and 0.07, respectively).</div></div><div><h3>Interpretation</h3><div>Trust and uptake of the COVID-19 vaccine were moderate, 60% and 72%, respectively. Gen Z adults reported greater distrust and lower uptake, while higher education was associated with increased trust. These findings highlight the need for tailored communication and health literacy interventions to improve vaccine uptake.</div></div><div><h3>Funding</h3><div><span>Brazilian Ministry of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101324"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736322","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}