<div><h3>Background</h3><div>The Department of Health Research, Ministry of Health and Family Welfare, India, established the Virus Research and Diagnostic Laboratory Network (VRDLN) in 2014 to strengthen viral diagnostic capabilities and provide a system for routine virological surveillance. In 2022, we also initiated the Model for Integrated Influenza Surveillance in Tamil Nadu (MIST) to enhance surveillance of virologic and clinical characteristics of severe acute respiratory infections (SARI) cases in selected sentinel tertiary care hospitals. This study investigates the epidemiology of Human Metapneumovirus (HMPV) in India by analysing data from these distinct but related surveillance systems.</div></div><div><h3>Methods</h3><div>We analysed VRDLN data from 2019 to 2024 to describe HMPV cases based on time, place, and personal characteristics. We presented a comparison of two periods—2019 to 2023 and 2024—to compare historical trends with the current scenario. We also examined detailed clinical and laboratory profiles of HMPV-positive SARI cases collected under the MIST project from 2022 to 2024 (a case series). Hospitals under the VRDLN conducted testing of any physician-referred patient, while MIST exclusively tested SARI patients who met a standardised case definition. While the VRDLN provided an overall picture of the testing and positivity trends, MIST provided details on laboratory parameters, and clinical course and outcomes of positive cases. All laboratories adhered to standardised quality-assured testing protocols and reported data to a centralized database.</div></div><div><h3>Findings</h3><div>Between 2019 and 2023, the VRDLN tested 20,625 patients for HMPV, of whom 1030 (3.2%) were positive. In 2024, 11,155 patients were tested, with 367 (3.3%) confirmed positive. Across both periods, age-stratified analysis indicated that the majority of tests were conducted among children. The highest positivity was observed in those aged 1–2 years, with 4.5% (128/2864) testing positive in 2019–2023 and 4.6% (70/1508) in 2024. Most HMPV-positive cases presented with Acute Respiratory Infection (ARI)/Influenza-like illness (ILI), accounting for 85.4% [566/17,090] of cases in 2019–2023 and 40.3% [148/1697] in 2024, as most testing was carried out among these patients. Fever and cough were the most common symptoms, reported in 70.3% of cases from 2019 to 2023 and 79.6% (292/8398) in 2024, and in 60.5% (401/12,059) and 60.8% (223/5977) of cases, respectively. Under the MIST project, we tested 3599 SARI patients between 2022 and 2023, identifying 28 (0.8%) HMPV-positive cases. Patients experienced a median illness duration of 11 days (interquartile range [IQR]: 7.5–14.5) and stayed in the hospital for a median of 7 days (IQR: 5–9.5). Eight cases required intensive care for a median of 3.5 days (IQR: 2.5–6), while 12 cases needed oxygen support for a median of three days (IQR: 3–5.5). Among the 28 cases, 25 (89.3) showed clinical improvement at disc
{"title":"Epidemiology of Human Metapneumovirus (HMPV) in India: a cross-sectional study","authors":"Rizwan Suliankatchi Abdulkader , Neetu Vijay , Varsha Potdar , Joshua Chadwick , Jitendra Narayan , Sabarinathan Ramasamy , Devika Shanmugasundaram , Selvavinayagam Thirumalaicheri Sivaprakasam , Manoj Murhekar , Nivedita Gupta","doi":"10.1016/j.lansea.2025.100667","DOIUrl":"10.1016/j.lansea.2025.100667","url":null,"abstract":"<div><h3>Background</h3><div>The Department of Health Research, Ministry of Health and Family Welfare, India, established the Virus Research and Diagnostic Laboratory Network (VRDLN) in 2014 to strengthen viral diagnostic capabilities and provide a system for routine virological surveillance. In 2022, we also initiated the Model for Integrated Influenza Surveillance in Tamil Nadu (MIST) to enhance surveillance of virologic and clinical characteristics of severe acute respiratory infections (SARI) cases in selected sentinel tertiary care hospitals. This study investigates the epidemiology of Human Metapneumovirus (HMPV) in India by analysing data from these distinct but related surveillance systems.</div></div><div><h3>Methods</h3><div>We analysed VRDLN data from 2019 to 2024 to describe HMPV cases based on time, place, and personal characteristics. We presented a comparison of two periods—2019 to 2023 and 2024—to compare historical trends with the current scenario. We also examined detailed clinical and laboratory profiles of HMPV-positive SARI cases collected under the MIST project from 2022 to 2024 (a case series). Hospitals under the VRDLN conducted testing of any physician-referred patient, while MIST exclusively tested SARI patients who met a standardised case definition. While the VRDLN provided an overall picture of the testing and positivity trends, MIST provided details on laboratory parameters, and clinical course and outcomes of positive cases. All laboratories adhered to standardised quality-assured testing protocols and reported data to a centralized database.</div></div><div><h3>Findings</h3><div>Between 2019 and 2023, the VRDLN tested 20,625 patients for HMPV, of whom 1030 (3.2%) were positive. In 2024, 11,155 patients were tested, with 367 (3.3%) confirmed positive. Across both periods, age-stratified analysis indicated that the majority of tests were conducted among children. The highest positivity was observed in those aged 1–2 years, with 4.5% (128/2864) testing positive in 2019–2023 and 4.6% (70/1508) in 2024. Most HMPV-positive cases presented with Acute Respiratory Infection (ARI)/Influenza-like illness (ILI), accounting for 85.4% [566/17,090] of cases in 2019–2023 and 40.3% [148/1697] in 2024, as most testing was carried out among these patients. Fever and cough were the most common symptoms, reported in 70.3% of cases from 2019 to 2023 and 79.6% (292/8398) in 2024, and in 60.5% (401/12,059) and 60.8% (223/5977) of cases, respectively. Under the MIST project, we tested 3599 SARI patients between 2022 and 2023, identifying 28 (0.8%) HMPV-positive cases. Patients experienced a median illness duration of 11 days (interquartile range [IQR]: 7.5–14.5) and stayed in the hospital for a median of 7 days (IQR: 5–9.5). Eight cases required intensive care for a median of 3.5 days (IQR: 2.5–6), while 12 cases needed oxygen support for a median of three days (IQR: 3–5.5). Among the 28 cases, 25 (89.3) showed clinical improvement at disc","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100667"},"PeriodicalIF":6.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095502","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 : 2025-09-12DOI: 10.1016/j.lansea.2025.100670
Patumrat Sripan , Siti Norbayah Yusof , Donsuk Pongnikorn , Imjai Chitapanarux , Balqis Bahtiar , Nor Saleha Ibrahim Tamin , Karnchana Daoprasert , Narate Waisri , Young-Joo Won , RuRu Chun-Ju Chiang , Annalisa Trama , Hadrien Charvat , Kriengkrai Srithanaviboonchai , Tomohiro Matsuda
Background
In Southeast Asia (SEA), the understanding of most rare cancers is limited, which sometimes leads to delays in diagnosis, treatment, and care. This study aimed to estimate for the first time the incidence of rare cancers in SEA using population-based cancer registry (PBCR) data from the 2011–2015 period.
Methods
This study used data from the nationwide PBCR of Malaysia and two PBCRs in northern Thailand in Chiang Mai and Lampang Cancer registries. The age-standardized incidence rate (ASR) per 100,000 person-year of the rare cancers included in the RARECAREnet list was calculated. All analyses were performed using SEER∗Stat (version 8.3.5). Cancers defined as rare by RARECAREnet in Europe were also rare in Thailand and Malaysia.
Findings
The ASR of some rare cancers in Thailand and Malaysia were greater than that in Japan, Korea, and Taiwan, including some pediatric cancers (pancreatoblastoma and odontogenic malignant tumors) in Malaysia, eye and adnexal cancer, and epithelial tumors of the penis in Thailand. ASR of nasopharyngeal cancer was higher in Thailand and Malaysia than in Japan and Korea but lower compared to Taiwan.
Interpretation
Although most rare cancers were also rare in Thailand and Malaysia, some cancers were not considered rare. However, the incidence of some rare cancers in Thailand and Malaysia were higher than that in Japan, Korea, and Taiwan. To enhance understanding, diagnosis, treatment, and care of rare cancers, reliable epidemiological data needs to be generated under the RARECAREnet Asia project by working with countries in Asia with high-quality PBCRs.
Funding
This study was supported by a UICC Yamagiwa-Yoshida Memorial International Cancer Study Grant (Award/Grant Number: YY/2022-1477) and Government of Japan Ministry of Health Labour and Welfare Grant numbers: 23EA1033, and was partially supported by Chiang Mai University, Thailand.
{"title":"Incidence patterns of rare cancer in southeast Asian and western Pacific countries (RARECAREnet Asia project): a study using population-based cancer registry data, 2011–2015","authors":"Patumrat Sripan , Siti Norbayah Yusof , Donsuk Pongnikorn , Imjai Chitapanarux , Balqis Bahtiar , Nor Saleha Ibrahim Tamin , Karnchana Daoprasert , Narate Waisri , Young-Joo Won , RuRu Chun-Ju Chiang , Annalisa Trama , Hadrien Charvat , Kriengkrai Srithanaviboonchai , Tomohiro Matsuda","doi":"10.1016/j.lansea.2025.100670","DOIUrl":"10.1016/j.lansea.2025.100670","url":null,"abstract":"<div><h3>Background</h3><div>In Southeast Asia (SEA), the understanding of most rare cancers is limited, which sometimes leads to delays in diagnosis, treatment, and care. This study aimed to estimate for the first time the incidence of rare cancers in SEA using population-based cancer registry (PBCR) data from the 2011–2015 period.</div></div><div><h3>Methods</h3><div>This study used data from the nationwide PBCR of Malaysia and two PBCRs in northern Thailand in Chiang Mai and Lampang Cancer registries. The age-standardized incidence rate (ASR) per 100,000 person-year of the rare cancers included in the RARECAREnet list was calculated. All analyses were performed using SEER∗Stat (version 8.3.5). Cancers defined as rare by RARECAREnet in Europe were also rare in Thailand and Malaysia.</div></div><div><h3>Findings</h3><div>The ASR of some rare cancers in Thailand and Malaysia were greater than that in Japan, Korea, and Taiwan, including some pediatric cancers (pancreatoblastoma and odontogenic malignant tumors) in Malaysia, eye and adnexal cancer, and epithelial tumors of the penis in Thailand. ASR of nasopharyngeal cancer was higher in Thailand and Malaysia than in Japan and Korea but lower compared to Taiwan.</div></div><div><h3>Interpretation</h3><div>Although most rare cancers were also rare in Thailand and Malaysia, some cancers were not considered rare. However, the incidence of some rare cancers in Thailand and Malaysia were higher than that in Japan, Korea, and Taiwan. To enhance understanding, diagnosis, treatment, and care of rare cancers, reliable epidemiological data needs to be generated under the RARECAREnet Asia project by working with countries in Asia with high-quality PBCRs.</div></div><div><h3>Funding</h3><div>This study was supported by a <span>UICC Yamagiwa-Yoshida Memorial International Cancer</span> Study Grant (Award/Grant Number: <span><span>YY/2022-1477</span></span>) and <span>Government of Japan Ministry of Health Labour and Welfare</span> Grant numbers: <span><span>23EA1033</span></span>, and was partially supported by <span>Chiang Mai University</span>, Thailand.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100670"},"PeriodicalIF":6.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048878","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 : 2025-09-10DOI: 10.1016/j.lansea.2025.100663
Martha P. Montgomery , Prabda Praphasiri , Darunee Ditsungnoen , Pasakorn Akarasewi , Malinee Chittaganpitch , Pilaipan Puthavathana , Khanchit Limpakarnjanarat , Ponthip Wirachwong , Tawee Chotpitayasunondh , Narumol Sawanpanyalert , Chaninan Sonthichai , William W. Davis , Sonja J. Olsen , Supamit Chunsuttiwat
Prior to 2000, influenza burden in Thailand and other low- and middle-income countries was underappreciated, and influenza vaccination was uncommon. For the last two decades, Thailand Ministry of Public Health (MOPH) and U.S. Centers for Disease Control and Prevention have collaborated to understand influenza burden and the costs and benefits of influenza vaccination in Thailand. Built on a long-standing national disease notification system, Thailand MOPH established robust surveillance platforms for pneumonia and influenza, which provided insights into seasonality, disease incidence, and populations at risk for severe disease. In 2004, human cases of avian influenza brought attention to influenza's pandemic potential. Concern for an influenza pandemic combined with evidence of the cost effectiveness of influenza vaccination accelerated vaccine policy. Surveillance and vaccination policy were leveraged for and strengthened by the 2009 influenza H1N1 and COVID-19 pandemics. This personal view documents Thailand's experience in developing influenza surveillance and influenza vaccination policy.
{"title":"Influenza surveillance and vaccine policy in Thailand—a historical perspective","authors":"Martha P. Montgomery , Prabda Praphasiri , Darunee Ditsungnoen , Pasakorn Akarasewi , Malinee Chittaganpitch , Pilaipan Puthavathana , Khanchit Limpakarnjanarat , Ponthip Wirachwong , Tawee Chotpitayasunondh , Narumol Sawanpanyalert , Chaninan Sonthichai , William W. Davis , Sonja J. Olsen , Supamit Chunsuttiwat","doi":"10.1016/j.lansea.2025.100663","DOIUrl":"10.1016/j.lansea.2025.100663","url":null,"abstract":"<div><div>Prior to 2000, influenza burden in Thailand and other low- and middle-income countries was underappreciated, and influenza vaccination was uncommon. For the last two decades, Thailand Ministry of Public Health (MOPH) and U.S. Centers for Disease Control and Prevention have collaborated to understand influenza burden and the costs and benefits of influenza vaccination in Thailand. Built on a long-standing national disease notification system, Thailand MOPH established robust surveillance platforms for pneumonia and influenza, which provided insights into seasonality, disease incidence, and populations at risk for severe disease. In 2004, human cases of avian influenza brought attention to influenza's pandemic potential. Concern for an influenza pandemic combined with evidence of the cost effectiveness of influenza vaccination accelerated vaccine policy. Surveillance and vaccination policy were leveraged for and strengthened by the 2009 influenza H1N1 and COVID-19 pandemics. This personal view documents Thailand's experience in developing influenza surveillance and influenza vaccination policy.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100663"},"PeriodicalIF":6.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048877","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 : 2025-08-27DOI: 10.1016/j.lansea.2025.100656
Iltaf Hussain , Muhammad Fawad Rasool , Jamshid Ullah , Muhammad Nafees , Inzemam Khan , Muhtar Kadirhaz , Miaomiao Xu , Chengzhou Tang , Yi Dong , Wei Zhao , Jie Chang , Yu Fang
Background
Poverty is a potential contributor to antibiotic resistance; however, the previous studies have not adequately addressed the role of poverty in shaping antibiotic resistance through social inequalities. Considering this, the current study evaluated the role of multi-dimensional poverty in antibiotic resistance.
Methods
A mixed-method study was conducted in three provinces of Pakistan using multistage sampling to recruit physician-confirmed urinary tract infection (UTI) patients from public laboratories. Antibiotic resistance data were collected from susceptibility reports, while poverty was measured using the multi-dimensional poverty index (MPI). Water, sanitation and hygiene (WASH) practices were assessed through a self-developed, validated questionnaire. Survey-weighted logistic regression analysis examined the association between MPI and antibiotic resistance.
Findings
A total of 698 patients were recruited, with more than half being in some level of deprivation (total = 413, vulnerable: 117, deprived: 76, severely deprived: 220). Multidimensional poverty was independently associated with increased odds of multidrug resistance (MDR). The risk of MDR was significantly increase across the deprivation level in unadjusted analysis (vulnerable; OR: 1.94, 95% CI 1.11–3.39, deprived; OR: 2.05, 95% CI 1.06–3.98, and severely deprived: OR: 1.80, 95% CI 1.04–3.09). After adjusting for antibiotics misuse and poor WASH practices, the association persisted. In the fully adjusted model, the risk of MDR was further increased in the poorer-subgroups, (vulnerable; aORs: 3.03, 95% CI 1.33–6.73, deprived; aOR: 3.01, 95% CI 1.26–7.15, and severely deprived; aOR: 4.28 95% CI 1.74–10.49). The qualitative interviews (n = 34) from patients highlighted that financial barriers drove self-medication with leftover antibiotics and treatment non-adherence. Poor WASH infrastructure was described as a systemic contributor to infection spread. In addition, patients in the poorer subgroups were presented with delayed treatment seeking.
Interpretation
The risk of antibiotic resistance increases with the increasing levels of deprivation; however, we should not assume that higher deprivation directly drives antibiotic resistance. Instead, structural barriers such as limited healthcare access, poor WASH infrastructure, and financial constraints create an environment where self-medication, treatment non-adherence, and infection transmission occur across all poverty levels, not just because of individual choices. These findings emphasize the need for interventions that address healthcare inequities, improve WASH infrastructure, and regulate antibiotic access, combined with behavior-changing interventions.
Funding
This work was funded by the “Young Talent Support Plan” of the Health Science Center, Xi’an Jiao
贫困是抗生素耐药性的一个潜在因素；然而，以前的研究并没有充分解决贫困在通过社会不平等形成抗生素耐药性方面的作用。考虑到这一点，本研究评估了多维贫困在抗生素耐药性中的作用。方法采用混合方法，在巴基斯坦3个省采用多阶段抽样方法，从公共实验室招募医生确诊的尿路感染（UTI）患者。从药敏报告中收集抗生素耐药性数据，而使用多维贫困指数（MPI）衡量贫困。水、环境卫生和个人卫生（WASH）做法通过自行开发的有效问卷进行评估。调查加权logistic回归分析检验了MPI与抗生素耐药性之间的关系。研究结果共招募了698名患者，其中一半以上处于某种程度的剥夺状态（总数= 413，脆弱：117，剥夺：76，严重剥夺：220）。多维贫困与多药耐药（MDR）几率增加独立相关。在未调整的分析中，MDR的风险在剥夺水平上显著增加（脆弱；OR: 1.94, 95% CI 1.11-3.39；剥夺；OR: 2.05, 95% CI 1.06-3.98；严重剥夺：OR: 1.80, 95% CI 1.04-3.09）。在调整了抗生素滥用和不良的WASH做法后，这种关联仍然存在。在完全调整后的模型中，较贫困亚组的耐多药风险进一步增加（易感亚组，aOR: 3.03, 95% CI 1.33-6.73，贫困亚组；aOR: 3.01, 95% CI 1.26-7.15，严重贫困亚组；aOR: 4.28, 95% CI 1.74-10.49）。来自患者的定性访谈（n = 34）强调了经济障碍导致使用剩余抗生素和治疗依从性不强的自我用药。不良的讲卫生基础设施被认为是导致感染传播的一个系统性因素。此外，较贫穷亚组的患者出现了延迟寻求治疗的情况。抗生素耐药性的风险随着剥夺程度的增加而增加；然而，我们不应该假设更高的剥夺直接导致抗生素耐药性。相反，结构性障碍，如有限的医疗服务可及性、落后的讲卫生基础设施和财政限制，创造了一种环境，使自我药疗、不坚持治疗和感染传播发生在所有贫困水平，而不仅仅是由于个人的选择。这些发现强调需要采取干预措施，解决卫生保健不公平问题，改善讲卫生基础设施，规范抗生素获取，并结合改变行为的干预措施。本工作由西安交通大学医学部“青年人才支持计划”和国家自然科学基金（批准号：72274150）资助。
{"title":"Exploring the association between multi-dimensional poverty and antibiotic resistance: findings from a mixed-methods study in Pakistan","authors":"Iltaf Hussain , Muhammad Fawad Rasool , Jamshid Ullah , Muhammad Nafees , Inzemam Khan , Muhtar Kadirhaz , Miaomiao Xu , Chengzhou Tang , Yi Dong , Wei Zhao , Jie Chang , Yu Fang","doi":"10.1016/j.lansea.2025.100656","DOIUrl":"10.1016/j.lansea.2025.100656","url":null,"abstract":"<div><h3>Background</h3><div>Poverty is a potential contributor to antibiotic resistance; however, the previous studies have not adequately addressed the role of poverty in shaping antibiotic resistance through social inequalities. Considering this, the current study evaluated the role of multi-dimensional poverty in antibiotic resistance.</div></div><div><h3>Methods</h3><div>A mixed-method study was conducted in three provinces of Pakistan using multistage sampling to recruit physician-confirmed urinary tract infection (UTI) patients from public laboratories. Antibiotic resistance data were collected from susceptibility reports, while poverty was measured using the multi-dimensional poverty index (MPI). Water, sanitation and hygiene (WASH) practices were assessed through a self-developed, validated questionnaire. Survey-weighted logistic regression analysis examined the association between MPI and antibiotic resistance.</div></div><div><h3>Findings</h3><div>A total of 698 patients were recruited, with more than half being in some level of deprivation (total = 413, vulnerable: 117, deprived: 76, severely deprived: 220). Multidimensional poverty was independently associated with increased odds of multidrug resistance (MDR). The risk of MDR was significantly increase across the deprivation level in unadjusted analysis (vulnerable; OR: 1.94, 95% CI 1.11–3.39, deprived; OR: 2.05, 95% CI 1.06–3.98, and severely deprived: OR: 1.80, 95% CI 1.04–3.09). After adjusting for antibiotics misuse and poor WASH practices, the association persisted. In the fully adjusted model, the risk of MDR was further increased in the poorer-subgroups, (vulnerable; aORs: 3.03, 95% CI 1.33–6.73, deprived; aOR: 3.01, 95% CI 1.26–7.15, and severely deprived; aOR: 4.28 95% CI 1.74–10.49). The qualitative interviews (n = 34) from patients highlighted that financial barriers drove self-medication with leftover antibiotics and treatment non-adherence. Poor WASH infrastructure was described as a systemic contributor to infection spread. In addition, patients in the poorer subgroups were presented with delayed treatment seeking.</div></div><div><h3>Interpretation</h3><div>The risk of antibiotic resistance increases with the increasing levels of deprivation; however, we should not assume that higher deprivation directly drives antibiotic resistance. Instead, structural barriers such as limited healthcare access, poor WASH infrastructure, and financial constraints create an environment where self-medication, treatment non-adherence, and infection transmission occur across all poverty levels, not just because of individual choices. These findings emphasize the need for interventions that address healthcare inequities, improve WASH infrastructure, and regulate antibiotic access, combined with behavior-changing interventions.</div></div><div><h3>Funding</h3><div>This work was funded by the <span>“Young Talent Support Plan”</span> of the <span>Health Science Center</span>, <span>Xi’an Jiao","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100656"},"PeriodicalIF":6.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903270","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 : 2025-08-26DOI: 10.1016/j.lansea.2025.100661
Soumen Das , Tanmoy Kumar Mandal , Anowar Ali Mallick
{"title":"Developing a sustainable patient navigation model for breast cancer care in India: a survivor-led pilot project","authors":"Soumen Das , Tanmoy Kumar Mandal , Anowar Ali Mallick","doi":"10.1016/j.lansea.2025.100661","DOIUrl":"10.1016/j.lansea.2025.100661","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"40 ","pages":"Article 100661"},"PeriodicalIF":6.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895721","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 : 2025-08-21DOI: 10.1016/j.lansea.2025.100657
Md Ariful Islam , Md Zakiul Hassan , Zubair Akhtar , Saju Bhuiya , Tanzir Ahmed Shuvo , Probir Kumar Ghosh , Asadullah , Md Abdullah Al Jubayer Biswas , Mustafizur Rahman , Mohammad Jubair , Mst Noorjahan Begum , Yeasir Karim , Mohammed Ziaur Rahman , Mohammad Enayet Hossain , Mohammad Niaz Morshed Khan , Tahmina Shirin , Shah Niaz Md Rubaid Anwar , Ahmed Nawsher Alam , Mohammad Ferdous Rahman Sarker , Monalisa , Fahmida Chowdhury
Background
There is limited global evidence on whether influenza sentinel surveillance platforms can be effectively adapted for long-term SARS-CoV-2 monitoring in low-resource contexts. We explored the utility of the hospital-based influenza sentinel surveillance (HBIS) platform for monitoring SARS-CoV-2 in Bangladesh by comparing SARS-CoV-2 detection in HBIS platform with national COVID-19 platform and assessing how its integration into influenza surveillance aligns with national trends.
Methods
From March 2020 to December 2024, we analysed data from patients with severe acute respiratory infection (SARI) and influenza-like illness (ILI) enrolled in HBIS. Socio-demographic and clinical data were recorded, and nasopharyngeal and oropharyngeal swabs were tested for influenza and SARS-CoV-2 using rRT-PCR. Whole-genome sequencing was performed on a subset of SARS-CoV-2–positive samples. Data from national COVID-19 platform were obtained from the Directorate General of Health Services, Bangladesh, and were compared with HBIS platform data using epidemic curves and Pearson correlation analysis.
Findings
Among 25,366 (SARI: 20,226; ILI: 5140) patients, 13.0% (3310) tested positive for influenza, 6.6% (1680) for SARS-CoV-2, and 0.2% (43) were co-infected. SARS-CoV-2 positivity in HBIS (6.8%), including 0.2% co-infections, was lower than the national average (13.1%), but showed a strong correlation with national trends (Pearson r = 0.86, P < 0.001). Sequencing of 234 SARS-CoV-2 strains detected the beta and delta variants in April and May 2021, respectively, and omicron subvariants circulating from 2022 to 2024, aligning with the national COVID-19 platform.
Interpretation
SARS-CoV-2 positivity trends in HBIS platform closely aligned with the national COVID-19 platform, demonstrating its potential as a sustainable platform for COVID-19 monitoring. Our findings underscore the feasibility of influenza sentinel surveillance as an early warning system for future COVID-19 outbreaks or other respiratory viruses of pandemic concern in Bangladesh and similar settings.
Funding
Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA (U01GH002259).
关于流感哨点监测平台是否能够有效适应低资源环境下的SARS-CoV-2长期监测，全球证据有限。我们通过比较医院流感哨点监测（HBIS）平台与国家COVID-19平台的SARS-CoV-2检测，并评估其与流感监测的整合如何符合国家趋势，探讨了医院流感哨点监测（HBIS）平台在孟加拉国监测SARS-CoV-2的效用。方法：从2020年3月至2024年12月，我们分析了参加HBIS的严重急性呼吸道感染（SARI）和流感样疾病（ILI）患者的数据。记录社会人口学和临床数据，并使用rRT-PCR对鼻咽和口咽拭子进行流感和SARS-CoV-2检测。对一部分sars - cov -2阳性样本进行了全基因组测序。来自国家COVID-19平台的数据来自孟加拉国卫生服务总局，并使用流行曲线和Pearson相关分析与HBIS平台数据进行比较。结果在25,366例患者（SARI: 20,226例；ILI: 5140例）中，13.0%（3310例）流感检测阳性，6.6%（1680例）SARS-CoV-2检测阳性，0.2%（43例）合并感染。乙肝病毒感染者中SARS-CoV-2阳性（6.8%），包括0.2%的合并感染，低于全国平均水平（13.1%），但与全国趋势有很强的相关性（Pearson r = 0.86, P < 0.001）。对234株SARS-CoV-2株的测序分别于2021年4月和5月检测到β和δ变异，以及2022年至2024年流行的组粒亚变异，与国家COVID-19平台一致。HBIS平台的sars - cov -2阳性趋势与国家COVID-19平台密切相关，显示了其作为COVID-19可持续监测平台的潜力。我们的研究结果强调了流感哨点监测作为孟加拉国和类似环境中未来COVID-19疫情或其他大流行呼吸道病毒的早期预警系统的可行性。美国佐治亚州亚特兰大疾病预防控制中心（CDC）资助（U01GH002259）。
{"title":"Leveraging the influenza sentinel surveillance platform for SARS-CoV-2 monitoring in Bangladesh (2020–2024): a prospective sentinel surveillance study","authors":"Md Ariful Islam , Md Zakiul Hassan , Zubair Akhtar , Saju Bhuiya , Tanzir Ahmed Shuvo , Probir Kumar Ghosh , Asadullah , Md Abdullah Al Jubayer Biswas , Mustafizur Rahman , Mohammad Jubair , Mst Noorjahan Begum , Yeasir Karim , Mohammed Ziaur Rahman , Mohammad Enayet Hossain , Mohammad Niaz Morshed Khan , Tahmina Shirin , Shah Niaz Md Rubaid Anwar , Ahmed Nawsher Alam , Mohammad Ferdous Rahman Sarker , Monalisa , Fahmida Chowdhury","doi":"10.1016/j.lansea.2025.100657","DOIUrl":"10.1016/j.lansea.2025.100657","url":null,"abstract":"<div><h3>Background</h3><div>There is limited global evidence on whether influenza sentinel surveillance platforms can be effectively adapted for long-term SARS-CoV-2 monitoring in low-resource contexts. We explored the utility of the hospital-based influenza sentinel surveillance (HBIS) platform for monitoring SARS-CoV-2 in Bangladesh by comparing SARS-CoV-2 detection in HBIS platform with national COVID-19 platform and assessing how its integration into influenza surveillance aligns with national trends.</div></div><div><h3>Methods</h3><div>From March 2020 to December 2024, we analysed data from patients with severe acute respiratory infection (SARI) and influenza-like illness (ILI) enrolled in HBIS. Socio-demographic and clinical data were recorded, and nasopharyngeal and oropharyngeal swabs were tested for influenza and SARS-CoV-2 using rRT-PCR. Whole-genome sequencing was performed on a subset of SARS-CoV-2–positive samples. Data from national COVID-19 platform were obtained from the Directorate General of Health Services, Bangladesh, and were compared with HBIS platform data using epidemic curves and Pearson correlation analysis.</div></div><div><h3>Findings</h3><div>Among 25,366 (SARI: 20,226; ILI: 5140) patients, 13.0% (3310) tested positive for influenza, 6.6% (1680) for SARS-CoV-2, and 0.2% (43) were co-infected. SARS-CoV-2 positivity in HBIS (6.8%), including 0.2% co-infections, was lower than the national average (13.1%), but showed a strong correlation with national trends (Pearson <em>r</em> = 0.86, P < 0.001). Sequencing of 234 SARS-CoV-2 strains detected the beta and delta variants in April and May 2021, respectively, and omicron subvariants circulating from 2022 to 2024, aligning with the national COVID-19 platform.</div></div><div><h3>Interpretation</h3><div>SARS-CoV-2 positivity trends in HBIS platform closely aligned with the national COVID-19 platform, demonstrating its potential as a sustainable platform for COVID-19 monitoring. Our findings underscore the feasibility of influenza sentinel surveillance as an early warning system for future COVID-19 outbreaks or other respiratory viruses of pandemic concern in Bangladesh and similar settings.</div></div><div><h3>Funding</h3><div><span>Centers for Disease Control and Prevention</span> (CDC), Atlanta, Georgia, USA (U01GH002259).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"41 ","pages":"Article 100657"},"PeriodicalIF":6.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879082","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 : 2025-08-20DOI: 10.1016/j.lansea.2025.100651
Angel Sudha Veparala , Dorothy Lall , Prashanth N. Srinivas , Kajal Samantaray , Bruno Marchal
Caesarean section (CS) rates are rising across south Asia, often without medical indication, posing significant public health concerns. This Review applied a framework-guided evidence synthesis using a scoping review approach, structured by the Socio-Ecological Model (SEM), to examine health system drivers of CS. Seventy-five studies were included, mainly from India, Bangladesh, and Pakistan. At the individual level, maternal education, socioeconomic status, and birth order influenced CS use. Community-level drivers included family preferences and media exposure. At the provider level, decision-making was shaped by financial incentives, medico-legal concerns, and scheduling convenience. Other system-level drivers, such as private sector dominance, limited regulation, and insurance coverage, were associated with increased CS rates. While most findings aligned with the SEM, some extended beyond its scope. The Review highlights the need for coordinated policy responses across levels, including payment reforms, regulatory oversight, and improved antenatal counselling, to ensure CS use aligns with clinical need rather than socio-economic or institutional pressures.
{"title":"Health system drivers of caesarean deliveries in south Asia: a scoping review","authors":"Angel Sudha Veparala , Dorothy Lall , Prashanth N. Srinivas , Kajal Samantaray , Bruno Marchal","doi":"10.1016/j.lansea.2025.100651","DOIUrl":"10.1016/j.lansea.2025.100651","url":null,"abstract":"<div><div>Caesarean section (CS) rates are rising across south Asia, often without medical indication, posing significant public health concerns. This Review applied a framework-guided evidence synthesis using a scoping review approach, structured by the Socio-Ecological Model (SEM), to examine health system drivers of CS. Seventy-five studies were included, mainly from India, Bangladesh, and Pakistan. At the individual level, maternal education, socioeconomic status, and birth order influenced CS use. Community-level drivers included family preferences and media exposure. At the provider level, decision-making was shaped by financial incentives, medico-legal concerns, and scheduling convenience. Other system-level drivers, such as private sector dominance, limited regulation, and insurance coverage, were associated with increased CS rates. While most findings aligned with the SEM, some extended beyond its scope. The Review highlights the need for coordinated policy responses across levels, including payment reforms, regulatory oversight, and improved antenatal counselling, to ensure CS use aligns with clinical need rather than socio-economic or institutional pressures.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"40 ","pages":"Article 100651"},"PeriodicalIF":6.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144880142","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}
Strengthening mRNA vaccine development in LMICs is essential for enhancing global pandemic preparedness. This study evaluated the safety and immunogenicity of Comvigen, a bivalent SARS-CoV-2 vaccine, in comparison to the Comirnaty bivalent vaccine (Comirnaty).
Methods
This phase II, randomised, open-label, non-inferiority trial was conducted in Thailand across four centres. Participants (n = 450) were randomly assigned (2:1) to receive either Comvigen (50 μg) or Comirnaty (30 μg), using block randomisation (size = 9). Eligible participants had completed at least 2 doses of any approved COVID-19 vaccine, with the last mRNA-vaccine dose given over 3 months before enrolment. The non-inferiority margin of a geometric mean ratio (GMR) of 0.67. The primary immunogenicity endpoint was pseudovirus neutralisation titres (psVNT-50) against SARS-CoV-2 wild-type and Omicron BA.4/BA.5 at Day 29. Safety outcomes included local and systemic adverse reactions up to six months post-vaccination. Immunogenicity analyses were conducted on the Per-Protocol (PP) population and the modified Intent-to-Treat (mITT) population; safety analyses included all participants. Laboratory personnel were blinded to vaccine assignment (ClinicalTrials.gov: NCT05930730).
Findings
Between October and November 2023, 450 participants were enrolled (median age of 36 years, IQR 30–45). At day 29, the geometric mean titre (GMT) of psVNT-50 against wild-type virus increased from 475.9 to 2062.9 for Comvigen and from 458.8 to 1905.1 for Comirnaty (GMR 1.1, 95% CI: 1.0–1.2), meeting non-inferiority criteria. Against Omicron BA.4/BA.5, GMTs were 3909.8 for Comvigen and 3288.6 for Comirnaty (GMR 1.2, 95% 1.0–1.4). Local and systemic reactions were more frequent with Comvigen (91% vs. 78%, p = 0.0002, 79% vs. 70%, p = 0.028) but were mild or moderate and transient with no difference in fever (6% vs. 5%, p = 0.84).
Interpretation
Comvigen demonstrated non-inferiority immunogenicity to Comirnaty and had a comparable safety profile, supporting mRNA vaccine development for global access and pandemic preparedness.
Funding
Covid-19 Pandemic Emergency Fund granted by Thailand's National Economic and Social Development Council provided major funding. Supplementary funding was provided by National Vaccine Institute (NVI), Thailand; Center of Excellence in Vaccine Research and Development (Chula VRC), Faculty of Medicine, Chulalongkorn University; Chulalongkorn University Second Century Fund (C2F); BioNet-Asia and Public Donation through Covid-19 vaccine development fund of the Faculty of Medicine, Chulalongkorn University and the Thai Red Cross Society, Thailand.
{"title":"Immunogenicity and safety of ‘Comvigen’, a bivalent SARS-CoV-2 vaccine, in comparison to Comirnaty bivalent vaccine in Thailand: a phase 2, non-inferiority randomised trial","authors":"Watsamon Jantarabenjakul , Rapisa Nantanee , Thanyawee Puthanakit , Sivaporn Gatechompol , Anchalee Avihingsanon , Suda Punrin , Terapong Tantawichien , Sorachai Nitayaphan , Arunee Thitithanyanont , Supranee Buranapraditkun , Anan Jongkaewwattana , Chutitorn Ketloy , Eakachai Prompetchara , Saranath Lawpoolsri , Wassana Wijagkanalan , Mohamad-Gabriel Alameh , Lina Hong , Mijo Samija , Drew Weissman , Kiat Ruxrungtham , Nanthida Wonglertnirant","doi":"10.1016/j.lansea.2025.100650","DOIUrl":"10.1016/j.lansea.2025.100650","url":null,"abstract":"<div><h3>Background</h3><div>Strengthening mRNA vaccine development in LMICs is essential for enhancing global pandemic preparedness. This study evaluated the safety and immunogenicity of Comvigen, a bivalent SARS-CoV-2 vaccine, in comparison to the Comirnaty bivalent vaccine (Comirnaty).</div></div><div><h3>Methods</h3><div>This phase II, randomised, open-label, non-inferiority trial was conducted in Thailand across four centres. Participants (n = 450) were randomly assigned (2:1) to receive either Comvigen (50 μg) or Comirnaty (30 μg), using block randomisation (size = 9). Eligible participants had completed at least 2 doses of any approved COVID-19 vaccine, with the last mRNA-vaccine dose given over 3 months before enrolment. The non-inferiority margin of a geometric mean ratio (GMR) of 0.67. The primary immunogenicity endpoint was pseudovirus neutralisation titres (psVNT-50) against SARS-CoV-2 wild-type and Omicron BA.4/BA.5 at Day 29. Safety outcomes included local and systemic adverse reactions up to six months post-vaccination. Immunogenicity analyses were conducted on the Per-Protocol (PP) population and the modified Intent-to-Treat (mITT) population; safety analyses included all participants. Laboratory personnel were blinded to vaccine assignment (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>: <span><span>NCT05930730</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>Between October and November 2023, 450 participants were enrolled (median age of 36 years, IQR 30–45). At day 29, the geometric mean titre (GMT) of psVNT-50 against wild-type virus increased from 475.9 to 2062.9 for Comvigen and from 458.8 to 1905.1 for Comirnaty (GMR 1.1, 95% CI: 1.0–1.2), meeting non-inferiority criteria. Against Omicron BA.4/BA.5, GMTs were 3909.8 for Comvigen and 3288.6 for Comirnaty (GMR 1.2, 95% 1.0–1.4). Local and systemic reactions were more frequent with Comvigen (91% vs. 78%, p = 0.0002, 79% vs. 70%, p = 0.028) but were mild or moderate and transient with no difference in fever (6% vs. 5%, p = 0.84).</div></div><div><h3>Interpretation</h3><div>Comvigen demonstrated non-inferiority immunogenicity to Comirnaty and had a comparable safety profile, supporting mRNA vaccine development for global access and pandemic preparedness.</div></div><div><h3>Funding</h3><div>Covid-19 Pandemic Emergency Fund granted by <span>Thailand's National Economic and Social Development Council</span> provided major funding. Supplementary funding was provided by <span>National Vaccine Institute (NVI)</span>, Thailand; Center of Excellence in Vaccine Research and Development (Chula VRC), <span>Faculty of Medicine, Chulalongkorn University</span>; <span>Chulalongkorn University Second Century Fund (C2F)</span>; BioNet-Asia and Public Donation through Covid-19 vaccine development fund of the <span>Faculty of Medicine, Chulalongkorn University</span> and the <span>Thai Red Cross Society</span>, Thailand.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"40 ","pages":"Article 100650"},"PeriodicalIF":6.2,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851949","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}
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