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International migrant workers, heat exposure, and climate change: a systematic review of health risks and protective interventions.
Get PDFBACKGROUND: International migrant workers, representing 170 million people globally, often face hazardous working conditions, including extreme heat exposure. These increase their risk of occupational heat strain, exacerbated by poor and exploitative working conditions. This systematic review aims to identify the health risks associated with occupational heat exposure among international migrant workers and document protective interventions and measures being used globally, to inform policies that protect this vulnerable population.
METHODS: We searched four electronic databases (Medline, Embase, Ovid Global Health and PsychINFO) for primary research studies (January 2014-April 2024) on international migrant workers experiencing adverse health outcomes alongside high working temperatures. Records were screened, and data were extracted by two independent reviewers. Assessment of study quality was done using Joanna-Briggs Institute checklists. Results were synthesised narratively and reported following PRISMA 2020 guidelines.
RESULTS: Of the 646 records screened, 19 studies involving 2293 migrant workers across six countries were included in the analysis, most of which were conducted in high-income countries (n = 14, 74%), mainly the United States of America (USA). At-risk workers, with ages ranging 10-90 years, were employed in construction (48%) and agriculture (42%), and originated from 14 countries, predominantly India, Mexico, and Nepal. Studies reported workers affected by heat-related illnesses (n = 12 studies), dehydration (n = 5), kidney disease (n = 2), and poor skin health (n = 2). Workers most commonly suffered from symptoms of headaches (n = 83 workers), muscle cramps (n = 53), and heavy sweating (n = 44), with other issues including poor mental health, infertility, and risk to pregnancy interventions focused on water, rest, shade, skin protection, and education, but evaluations were limited and some measures failed to address heat exposure effectively.
CONCLUSIONS: Occupational heat exposure poses significant health risks for international migrant workers. Where interventions exist, barriers to effectiveness remain, with little evidence from low- and middle- income countries. Amid rising global temperatures, a greater focus is needed on improved worker education, worker-tailored and co-designed interventions, updated guidelines, and increased healthcare accessibility.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024519547
Novel quantitative and specific RT-qPCR assay for UK subtypes of European strain of Tick-borne encephalitis virus.
Get PDFTwo closely related tick-borne Orthoflaviviruses have been detected in the UK; tick-borne encephalitis virus (TBEV) and louping ill virus (LIV). Diagnosis of tick-borne encephalitis is achieved by detection of IgM/IgG antibodies using ELISA, Immunofluorescence, or by RT-PCR. High sequence and structural similarities between these viruses means they are hard to distinguish due to high cross-reactivity. We have developed a novel RT-qPCR assay using recently identified subtypes of TBEV in the UK and a probe incorporating locked nucleic acids, strengthening hybridisation between the probe and target RNA/DNA, resulting in greater discrimination between thermodynamically similar sequences. Cell-cultured virus extracts and an in vitro transcript of the NS1 gene were used for assay validation. TBEV was specifically detected to a sensitivity of 13 copies per reaction at 95 % confidence with 94 % efficiency. The assay showed no cross-reactivity to 10 Flavivirus RNA extracts tested. Of 43 clinical tick bite samples tested, 23 were TBEV seropositive and all tested negative by the currently used qPCR assay, matching our assay results. A sensitive, highly specific RT-qPCR assay that distinguishes between UK subtypes of TBEV and LIV. This distinction is vital for both accurate clinical diagnosis and vector surveillance, especially in the UK where both viruses co-circulate and cross-reactivity remains a significant diagnostic challenge
Ambient temperature and non-accidental mortality: A nationwide space-time-stratified case-crossover study within the 100 million Brazilian Cohort.
Get PDFResearch on ambient temperature effects on mortality leveraging cohort data remains scarce. This study estimates the association between ambient temperature and non-accidental mortality and investigates potential effect modification of the temperature-mortality relationship by a wide range of individual and household-level characteristics in a nationwide cohort. We designed a space-time-stratified case-crossover study within the 100 Million Brazilian Cohort, comprising low-income families enrolled in Brazil's Unified Registry for Social Programs (CadÚnico), including all deaths from 2000 to 2018. Daily mean temperatures were obtained from Brazilian Daily Weather Gridded Data based on 1,252 meteorological stations. The outcome was defined as daily counts of non-accidental deaths aggregated at the municipality level. The effect of ambient temperature on non-accidental mortality was estimated using conditional quasi-Poisson regression combined with distributed lag non-linear models. The study population included 3,554,422 deaths. Cold temperatures were associated with a 38 % increase in non-accidental mortality risk (RR = 1.38, 95 % CI: 1.34-1.43) nationally, with high regional variability. In contrast, heat was associated with a 4 % increase in mortality risk nationally, primarily driven by increased risk in the Southeast and Central-West regions. Across population subgroups, cold-related mortality risk was higher among older (≥60 years) adults (RR = 1.47, 95 % CI: 1.42-1.53) and Black individuals (RR = 1.56, 95 % CI: 1.49-1.64). Higher vulnerability to heat-related mortality was found among urban residents (RR = 1.07, 95 % CI: 1.05-1.10). However, we found no consistent evidence of effect modification of cold- and heat-related mortality by sex, income or access to key utilities (water, waste, and electricity). Our findings indicate significant regional differences, highlighting population strata particularly vulnerable to temperature-related mortality. This evidence informs the targeting of interventions for protecting vulnerable populations from extreme temperatures
The Italian network for severe malaria treatment (NOMAL): epidemiology, clinical presentation, management and outcomes in a non-endemic setting.
Get PDFSevere malaria is a medical emergency that may result in death [1]. Prompt diagnosis and adequate treatment are essential for the successful clinical management and for reducing the risk of death [2]. Most of the current knowledge on severe malaria is based on observations and results of studies carried out in malaria endemic countries. However, such evidence may not be completely relevant to non-endemic settings [3]. Indeed, severe malaria in endemic countries with stable transmission occurs mainly in children under 5 years of age and in pregnant women while in older children and adults, although they can still suffer of uncomplicated malaria, severe disease is extremely rare thanks to the partial immunity they've acquired over years of exposure to infective bites. Such semi-immune status prevents the evolution of uncomplicated malaria towards severe disease
Integrating forest data and health facility surveys to optimise risk-based malaria surveillance in the Philippines.
Get PDFINTRODUCTION: Malaria transmission is highly spatially heterogeneous. Within Southeast Asia, forested landscapes are associated both with increased malaria transmission and reduced healthcare access. Identifying environments with malaria foci is a priority for control and elimination programmes. METHODS: Here, we integrate health facility and environmental data to identify optimal surveillance approaches across a forested district in the Philippines. We conducted convenience surveys of health facility attendees utilising tablet-based applications to geolocate participant residences. Malaria infection was assessed using both routine (microscopy and rapid diagnostic test) and molecular methods. Integrating remote-sensing derived data, we assessed how fine-scale environmental factors influence the spatial distributions of malaria infections, diagnostic sensitivity and health-seeking behavior. We evaluated costs and probability of detecting malaria foci for multiple surveillance approaches using different diagnostic methods and target populations defined by landscape data. RESULTS: We demonstrate that health facility-based surveys increase the probability of detecting malaria infections by increasing numbers of individuals screened and spatial coverage of surveillance systems. We additionally show sensitivity of routine malaria diagnostics varies spatially, with the decreased sensitivity in forests. By targeting diagnostic methods to high-risk environments, we developed a model approach for how to use landscape data within disease surveillance systems. Risk-based surveillance incorporating forest data is highly cost-effective and increases the probability of detecting malaria foci over three-fold compared to routine surveillance. DISCUSSION: Together, this illustrates the essential role of environmental data in designing risk-based surveillance to provide an operationally feasible and cost-effective method to characterise malaria transmission
Evaluating the effects of increasing nursing numbers on quality of newborn care in understaffed neonatal units in Kenya: a prospective intervention study.
Get PDFBACKGROUND: Newborn units in resource-constrained low-middle-income countries (LMICs) often have high neonatal mortality rates. Programmes to improve care quality often accept understaffing that directly affects care in these settings as a norm, and the effects of improving staff numbers are not studied. To address a major evidence gap, we examined the effects on quality of care of improving nurse staffing in four intermediate-level Kenyan newborn units.
METHODS: We introduced three additional nurses to each of four newborn units. We measured nursing care provision using direct bedside observations with a validated structured checklist before and 6 months after intervention. Our primary outcome, changes in nurse-delivered care, was examined using descriptive analysis and multilevel modelling to adjust for confounding. We also examined the pattern of nursing care delivery and intervention fidelity.
RESULTS: We observed a total of 1872 hours of care, over 156 nursing shifts for 290 and 300 babies before and after our intervention, respectively, across our four neonatal units. Our intervention increased the nursing hours per patient per shift observed from 34 to 43 min associated with a 4.7% increase in our primary outcome, nurse-delivered care and an 8.4% increase in delivery of 10 tasks nurses prioritise (adjusted B-coefficient 0.047 (95% CI 0.028 to 0.066) and B-coefficient 0.084 (95% CI 0.053 to 0.115), respectively). Intervention strength was reduced by changes in existing nurses' deployment and an increase in workload.
CONCLUSIONS: In very high workload settings in LMICs where nurses can only deliver a fraction of nursing care, staffing increases improve care delivery more obviously for high-priority tasks. These findings provide much needed evidence that increasing neonatal nurse staffing in under-resourced newborn units improves care quality
Prevalence of Large-for-Gestational Age and Macrosomia Among Livebirths in 23 Low- and Middle-Income Countries Between 2000 and 2021: An Individual Participant Data Analysis.
Get PDFOBJECTIVE: To examine the prevalence of large-for-gestational age (LGA) and macrosomia in 23 countries between 2000 and 2021. DESIGN: Descriptive multi-country secondary data analysis. SETTING: Subnational, population-based cohort studies (k = 45 for LGA, k = 25 for macrosomia) in 23 low- and middle-income countries (LMICs). POPULATION: Liveborn infants. METHODS: We conducted a secondary analysis of individual-level data from the Vulnerable Newborn Measurement Collaboration, using INTERGROWTH-21st standards to define LGA (> 90th centile for gestational age and sex) and macrosomia (≥ 4000 g, regardless of gestational age). We included LMIC population-based datasets with reliable gestational age and birthweight data, excluding studies with small sample sizes, high missing data, or implausible measurements. Prevalence estimates were stratified by region, study period and gestational age, and results were summarised as medians and interquartile ranges (IQR). MAIN OUTCOME MEASURES: Prevalence of LGA and macrosomia. RESULTS: Among 476 939 live births, the median prevalence of LGA was 5.1% (IQR: 2.9%-9.6%) and was highest in Latin America and the Caribbean at 9.6% (4 studies, IQR: 2.7%-16.1%) and lowest in South Asia at 2.7% (13 studies, IQR: 2.3%-3.7%). Over time, the median LGA prevalence increased from 4.9% (12 studies; IQR: 4.1%-7.9%) during the period from 2000 to 2010 to 5.9% (33 studies, IQR: 2.7%-11.2%) from 2011 to 2021. Term LGA was more common at 3.2% (0.9-5.1) than preterm or post-term LGA. Among 313 064 live births, the median prevalence of macrosomia was 1.3% (n = 313 064, IQR: 0.2%-2.4%), which was highest in Latin America and the Caribbean (4 studies, 3.1%, IQR: 0.7%-6.8%) and lowest in South Asia (8 studies, 0.1%, IQR: 0.0%-0.7%). The median prevalence remained stable over time: 1.1% (8 studies, IQR: 0.2%-3.1%) in older studies (2000-2010) and 1.3% (17 studies, IQR: 0.5%-2.4%) in more recent studies (2011-2021). Term macrosomia was more common at 1.2% (0.2-2.0) than preterm and post-term macrosomia. CONCLUSIONS: The overall prevalence of LGA and macrosomia was lower in these LMIC studies than is reported in high-income countries. The prevalence of large babies was highest in Latin America and the Caribbean
The role of climatic changes in the emergence and re-emergence of infectious diseases: bibliometric analysis and literature-supported studies on zoonoses.
Get PDFClimate change (CC) is increasingly recognised as a critical driver in the emergence and re-emergence of infectious diseases. The relationship between CC and infectious diseases is complex and multifaceted, encompassing changes in temperature, precipitation patterns, and extreme weather events. This study describes the role of CC in the emergence and re-emergence of infectious diseases, emphasising zoonoses. It used a mixed methodology, including an initial literature contextualisation and a bibliometric analysis, to identify key thematic research areas related to CC and zoonotic diseases and show their connections. The research relied on the Scopus database for the identification of relevant source literature and focused the search query on publications in English. VOSviewer was used to discover clear thematic clusters that illustrate what research areas have been addressed in the literature and how they are interlinked. In addition, the research selected and analysed twelve literature-supported studies to investigate the relevance of the zoonoses involved in infectious disease emergence and re-emergence linked to CC impacts. Many pathogens and their vectors, such as mosquitoes, ticks, and rodents, are sensitive to temperature and moisture. CC can expand or shift the geographical distribution of these vectors, bringing diseases to new areas. Warmer temperatures may allow mosquitoes that transmit diseases like malaria and dengue fever to survive and reproduce in regions that were previously too cold. Also, extreme events such as floods, droughts, and hurricanes can lead to immediate increases in waterborne and vector-borne diseases (VBD) by facilitating the spread of pathogens. There is a need to better understand the connections between CC and zoonoses. To address the challenges posed by zoonoses linked to CC, international organizations like the WHO should coordinate a global response to provide clear guidance. Governments must integrate CC and zoonoses into national health policies, ensuring that health frameworks address these interconnected risks. Funding should be allocated for research on the root causes of CC and for strengthening defenses, particularly in developing countries with fragile health systems. Additionally, enhanced communication, education, and training for healthcare professionals about the links between CC and zoonoses are essential for raising awareness and promoting proactive measures
The Incubation Periods of Mpox Virus Clade Ib.
No full textBACKGROUND: Mpox virus (MPXV) clade Ib, first detected in the Democratic Republic of the Congo (DRC) in September 2023, spread internationally within months, prompting an emergency declaration from the World Health Organization. Data on its incubation period, which both shapes outbreak dynamics and informs epidemic response strategies, remain limited. OBJECTIVE: To estimate the incubation periods of mpox clade Ib, examining evidence for differences by route of exposure and demographic factors. DESIGN: Bayesian analysis of clinical surveillance data collected between June and October 2024. SETTING: South Kivu, DRC, the epicenter of the current mpox clade Ib global outbreak. PARTICIPANTS: Clinically attended persons with confirmed mpox clade Ib infection. MEASUREMENTS: Demographic characteristics, exposure history, symptom onset, and transmission route. RESULTS: Among 37 polymerase chain reaction-confirmed cases with high viral load (cycle threshold values <34), the median incubation period from exposure to rash was 13.6 days (95% credible interval [CrI], 9.6 to 19.0 days). Five percent of cases are expected to develop a rash within 3.1 days (CrI, 1.3 to 5.5 days) and 95% within 32.3 days (CrI, 22.4 to 45.8 days). The incubation period seemed to differ by putative transmission route: Sexual transmission had a shorter median (10.3 days [CrI, 3.1 to 20.3 days]) than nonsexual transmission (13.5 days [CrI, 9.5 to 19.1 days]), although the CrIs overlapped. LIMITATION: Surveillance data lacked detailed exposure histories and a lower bound for exposure periods, but models accounted for these uncertainties, yielding robust median estimates. CONCLUSION: Evidence from this study suggests that clade Ib may have a longer incubation period than other MPXV clades, and this may vary by transmission route. The shorter incubation for sexual transmission mirrors patterns seen in the predominantly sexually transmitted clade IIb outbreak, highlighting the potential role of exposure route in disease progression. These findings have implications for global recommendations on postexposure monitoring periods and prophylaxis. PRIMARY FUNDING SOURCE: Gates Foundation and Geneva Centre for Emerging Viral Diseases
Mycobacterium tuberculosis transmission in China during the COVID-19 pandemic period (2020-2021) compared with the pre-pandemic period (2017-2019).
Get PDFThe COVD-19 pandemic has led to major impacts on population-level transmission of respiratory viral illnesses. However, the impact of the pandemic on Mycobacterium tuberculosis transmission is unknown. Schoolchildren from 12 cities in Jiangsu Province were administered tuberculin skin tests at school matriculation from 2017-2021. We conducted an interrupted time-series analysis to compare trends from annual tuberculin surveys before (2017-2019) and during pandemic-related social restrictions (2020-2021). We compared observed trends in tuberculin positivity during restrictions to a counterfactual model assuming background trends prior to restrictions continued linearly. From 2017-2021, 1,940,735 schoolchildren from 1,427 schools were administered a skin test. Among middle school students, tuberculin positivity was largely consistent from 2017-2019 (9.3%, 9.6%, 10.0%), but reduced in 2020 and 2021 (8.0% and 7.0%). There was a reduction in the annual risk of infection of 24.7% (95% predictive interval [PI], -27.2, -21.2) and 37.0% (95% PI, -40.8, -33.3) compared to the counterfactual model in 2020 and 2021. Among high school students, similar but more modest reductions in the annual risk of infection were seen in post-pandemic years (19.8% reduction in 2021). There have been substantial population-level decreases in M tuberculosis transmission among adolescents in eastern China