Infectious medical waste (IMW) and disease transmission: A critical public health challenge in Africa and the global implications

Abstract

Background

Infectious Medical Waste (IMW) from both human and animal healthcare sources have the potential to transmit diseases in human populations due to its pathogenic composition. Conversely, a paucity of data regarding cause-and-effect relationships inhibits our understanding of the extent to which disease transmission occurs. In parts of Africa where the management of IMW is not prioritized, the risks to public health, along with its global implications cannot be ignored.

Methodology

A systematic literature search following the PRISMA guidelines was conducted across five electronic databases including PubMed, Embase, Scopus, ProQuest and Ovid. Relevant studies were identified using keywords such as ‘infectious medical waste’, ‘infectious diseases’, ‘routes of infection’, ‘route of transmission’, ‘epidemics’, ‘diseases’, ‘sub-Sahara Africa’, and ‘infectious waste management’.

Results

Overall, 6721 articles were retrieved from the search, 6634 of which were excluded due to a lack of alignment with the study objectives. After screening, 87 studies were deemed eligible and were included in the review. Our findings identified 11 diseases that are potentially transmissible via IMW. These include Anthrax, Crimean-congo haemorrhagic Fever, Ebola Virus Disease, Hepatitis B, Hepatitis C, Human Immunodeficiency Virus, Lassa Fever, Measles, Monkeypox, Plague, and Rift Valley Fever. Disease transmission may occur via human contact with different classes of IMW, contaminated materials and accessories.

Conclusions

Medical waste can be a source of infectious disease transmission. However, evidence of such a pathway is currently unavailable due to a paucity of scientific data. Therefore, further research is needed to establish cause-and-effect relationships.

Keywords

infectious medical waste risks public health infectious diseases Africa global health

Introduction

Disease transmission and spread in human populations have been studied extensively with research emphasizing factors such as urbanization,^1–3 fragile healthcare systems,^4,5 conflict,^6,7 globalization,^8,9 climate change¹⁰ and microbial adaptation^11–13 as primary drivers. Within this equation, infectious medical waste (IMW) from both human and animal clinical sources remains a largely understudied subject, despite the health risks due to its pathogenic composition. IMW (see Table 1) include discarded human and animal anatomical parts, blood, body fluids, syringes, needles, scalpels, knives and blades (14, 15 16). It also contains clinically contaminated materials and accessories such as clothing, beddings, towels, linens, napkins and facemasks.^14,15 Despite the risks, IMW management is often poorly prioritized in many parts of Africa. Studies have shown that in most countries, access to vital treatment technologies, transportation systems and disposal facilities is practically inadequate or virtually non-existent.^16–22 Such haphazard conditions elevate risks of infections in human populations, further compounding existing public health challenges.

Table 1.

Types, composition and main sources of IMW.

Type	Composition	Main generating sources
Human/animal anatomical waste	Tissues	Operating theatres and surgical wards
	Organs
	Body parts (excluding teeth, hair and nails)
	Carcasses	Veterinary Clinics/hospitals
	Bedding
	Items or body fluids contaminated with blood
Laboratory waste	Lab/microbial cultures	Laboratories
	Live/attenuated vaccines
	Human or animal cell cultures
	Specimens of microorganisms
	Body fluids of patients
Human blood/body fluid	Human blood	Medical wards/laboratories
	Body fluid	Maternity Homes
	Blood products	Mortuary and autopsy centres
	Body fluids contaminated with blood	Traditional birth attendants
	Used absorbent material saturated with blood, body fluids or excretions contaminated with blood. E.g., bandages, gauze and sponges	Underground abortion clinics
		Traditional circumcision experts
		Traditional healing centres
Sharps	Needles/syringes/blades/knives/scalpels	Physician’s offices
		Home healthcare
		Psychiatric wards
	Glass capable of causing cuts or punctures	Hospitals, clinics,
		(Poly)clinics
		Family Planning Units

Africa has a longstanding history of infectious diseases outbreaks with major global implications. Within this present decade, 5 public health emergencies of international concern (PHEIC) originating out of the continent has been issued by the World Health Organization (WHO) in line with International Health Regulations (IHR).²³ These include: the Poliomyelitis epidemic (2014-present), the West African Ebola Virus Disease outbreak (2013-2016), Kivu/Ituri Ebola virus outbreak (2018-2020), Clade II MPox epidemic (2022-2023), and the Clade I MPox epidemic (2014-present). A PHEIC declaration is issued when an extraordinary event requires a coordinated international response.²³ Researchers have also noted that in the past two decades, the continent has experienced over 1800 public health emergencies, including new and emerging pathogenic infections.^24–26 In 2018 alone, the WHO recorded 96 new infections disease outbreaks across 36 countries in Africa with Uganda, the Central African Republic (CAR), the Democratic Republic of Congo (DRC) and Sudan reporting the highest frequency events.²⁵ Although there is no data linking these outbreaks to IMW, risks cannot be ignored due to the etiology of some of these diseases.

In this study we identify and examine 11 diseases that can potentially be transmitted by IMW. These include Anthrax, Crimean-Congo haemorrhagic fever (CCHF), Ebola Virus Disease (EVD), Hepatitis B (HBV), Hepatitis C (HCV), Human Immunodeficiency Virus (HIV), Lassa Fever, Measles, MPox, the Plague and Rift Valley Fever Virus (RVFV). Through our findings, we aim to inform disease prevention efforts, guide resource allocation and support policy formulation, implementation and monitoring. The findings further seek to strengthen public health surveillance, interventions and responses to threats posed by existing and emerging infectious diseases. By deepening our understanding of the critical yet often overlooked role of IMW in global health security, this study aims to provide public health stakeholders and policy makers across governments, healthcare systems and global health organizations with the insights necessary to effectively address these challenges. Essentially our findings contribute to the ongoing global discourse on improving health systems. The study is among the first of its kind, if not the first to address this subject on such a comprehensive scale. Past some studies have examined healthcare waste and its link to diseases without addressing how specific diseases might be transmitted.^27–29

Methods

This systematic review identifies 11 specific diseases capable of being transmitted by IMW with the primary objective of informing public and global health interventions. Whilst the mismanagement of IMW is pervasive across Africa, the study has broader relevance for other developing regions of the world facing similar challenges. Our methodological approach to the study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines³⁰ as well as the PRISMA Guidelines for reporting systematic reviews.³¹ This approach was adopted to ensure a rigorous and transparent approach to the review process.

Literature search

A comprehensive literature search was undertaken over a five-month period from January-May 2025 by 4 researchers (JNTS, MG, ZA and OE). Relevant peer-reviewed studies were extracted in several databases including PubMed, Embase, Scopus, ProQuest and Ovid. The search strategy involved a combination of keywords including ‘risks’ ‘infectious medical waste’; ‘infectious diseases’; ‘routes of infection’; ‘route of transmission’; ‘epidemics’; ‘diseases’; ‘sub-Sahara Africa’; ‘infectious waste management’; ‘anthrax’; ‘Crimean-Congo haemorrhagic fever’; ‘Ebola Virus Disease’; ‘epidemiology’; ‘Hepatitis B’; ‘Hepatitis C’; ‘Human Immunodeficiency Virus’; ‘Lassa Fever’; ‘Measles’; ‘Monkeypox’, and the ‘Plague’. These terms were selected to capture a broad range of studies related to the possible transmission of infectious diseases through IMW and management practices that affect disease spread. A grey literature search was utilized to access data from global sources including the WHO and the African Centres for Disease Control and Prevention (ACDC). The grey literature was instrumental in providing vital data regarding disease outbreaks, types, countries and timescale.

Inclusion/exclusion criteria

As researchers, we are aware that not all types of waste in healthcare settings can transmit diseases in human populations. Certain types such as chemical, pharmaceutical, genotoxic and radioactive wastes although hazardous, are not infectious and do not pose a direct risk of disease transmission. Therefore, studies relating to the health effects of non-infectious waste from healthcare facilities were excluded from this review. IMW risks to animal populations were also excluded from this review since our focus was on human risks. Further, our review excluded studies published before 2005 to ensure that we stay within a two-decade time frame. Essentially, the studies we excluded were deemed to be out of the scope of our study, have insufficient data and fell outside of our targeted publication period. To ensure relevance and rigor, the inclusion criteria were limited to studies published in English within the last two decades (2005-2025), that highlights the types of diseases that can be transmitted by IMW and their routes of transmission. Studies, regardless of geographical focus were eligible for inclusion if they met these criteria. A combination of academic and grey literature sources including original articles and policy briefs was utilized in the study. No opinion articles were reviewed.

Study selection, data extraction and aggregation

Three reviewers (JNTS, MG and ZA) initially screened the search results to determine relevance based on the predefined inclusion and exclusion criteria. Full-text articles that met the initial criteria were subsequently retrieved and reviewed independently by the 3 reviewers (JNTS, MG & ZA) to assess their relevance to the research objectives and their potential for inclusion in the study. Any disagreement that arose during the selection process were resolved through discussion between the 3 reviewers (JNTS, MG, and ZA). Where consensus cannot be reached, the fourth reviewer (OE) was consulted to facilitate agreement.

The data extracted from the selected studies were systematically organized and grouped into themes based on each of the diseases addressed in the review, their transmission routes as well as their potential link to IMW. Each disease was qualitatively analyzed to provide insights into its pathogens, transmission routes and outbreaks in Africa since 2005.

Results

Overall, 6721 articles were retrieved from the database search out of which 6646 were excluded due to duplication or a lack of alignment with the search objective. After screening, 87 studies were deemed eligible and included in the review. Figure 1 is an illustration of the search results in the PRISMA flow diagram in Figure 1.³⁰

Figure 1.

PRISMA Flow Chart.

Summary of results

Anthrax

Although we found no direct evidence of anthrax infection though IMW in Africa, 8 studies suggested a possible transmission route based on the etiology of the disease.^32–40 Anthrax is a zoonotic disease caused by the bacteria, Bacillus Anthracis. Scientists have identified 4 types of the disease; cutaneous, inhalation, gastrointestinal and injection anthrax.^33,35 In human populations cutaneous anthrax is most common, accounting for 95% of infections globally with a fatality rate of 10-40% when left untreated.^35,37 Transmission may occur through ingestion, inhalation, handling or injection of spores embedded in the soil, contact with animal byproducts, veterinary waste or contaminated materials.^33,34 Anthrax spores are scientifically known to be highly resistant and can survive in harsh environmental conditions for prolonged periods, sometimes even decades.³⁶ Consequently, the improper disposal of IMW from animal healthcare sources can create conducive conditions for disease transmission. The disease is endemic to Africa where multiple outbreaks have been reported in several countries in recent years.^37–40

Crimean-Congo Haemorrhagic Fever (CCHF)

CCHF is a viral disease transmitted to humans primarily through tick-bites or the handling of an infected tick.⁴¹ Based on our review, 8 studies, found human exposure to viraemic blood, body fluids, and both human and animal anatomical as possible transmission pathways.^42–48 Additionally, the improper disposal of contaminated medical equipment including sharp objects can be a major risk factor in disease transmission.^43,48 CCHF is prevalent in Africa and has a case fatality rate of approximately 40%.^41,44,48 Several African countries including Uganda, Senegal, South Africa and Mauritania have reported outbreaks in recent years.^41,48 We did not find any data pertaining to a direct link between IMW and CCHF transmission.

Ebola Virus Disease (EVD)

Based on its etiology and pathogenesis, we found 12 studies that indicates a potential transmission route between IMW and the Ebola virus.^49–60 This may occur through exposure to infected blood, body fluids as well as contaminated materials such as bedding, towels, linens and clothing of infected individuals.^49–60 The Ebola virus was first discovered in the Democratic Republic Congo (DRC) during the 1970s and has since become endemic to Africa where multiple outbreaks have been recorded since its discovery.^52,53 As illustrated in Table 2, more than 18,000 cases of the Ebola virus resulting in over 13,000 fatalities were reported in 7 African countries between 2008 to 2019.⁴¹ As well, 347 Ebola cases culminating in 192 fatalities in Africa were reported from 2020-2025.⁵³

Table 2.

Outbreaks of EVD in Africa: 2008-2019.

Year	Countries	Cases	Fatalities
2019	Uganda	3	2
2019	DRC	2148	1488
2018	DRC	120	78
2017	DRC	54	33
2014-2016	Guinea, Liberia Sierra Leone	15898	11308
2014	Nigeria, Senegal, DRC	87	57
2012	Uganda, DRC	88	50
2011	Uganda	1	1
2008	DRC	32	14

Hepatitis B (HBV)

Exposure to infected blood, body fluids, contaminated needles, syringes and sharp objects embedded in the medical waste stream can potentially transmit the hepatitis B virus in human populations.⁶¹ We did find a possible link between HBV infection in medical waste collectors in 4 studies out of Ethiopia^62–65 and 1 study out of Libya.⁶⁶ Serologically, the virus is diagnosed though the presence of hepatitis B surface antibody (HBsAb), hepatitis B pre-core antigen (HBeAg), hepatitis B pre-core antibody (HBeAb), hepatitis B surface antigen (HBsAg), or hepatitis B core antibody (HBcAb) sero-marker reactivity.^61,65

Hepatitis C (HCV)

HCV is a blood-borne virus which can be transmitted through exposure to needles, infusion bags, syringes and medical equipment.⁶⁷ Two studies undertaken in Ethiopia^64,65 and one out of Libya⁶⁶ suggested a correlation between exposure to IMW in healthcare settings and HCV infections. This may occur through exposure to contaminated syringes, infusion bags, medical equipment and accessories.^68–70 Although research shows that large and/or repeated direct percutaneous exposures to blood such as, transfusion, transplantation from infectious donors, and intravenous drug use is the primary mode of transmission,⁷¹ the risks posed by medical waste cannot be discounted (Table 3).

Table 3.

Outbreaks of plague in Africa – 2014 2017.

Year	Countries	Cases
2017	Madagascar	2348
2016	Madagascar	62
2015	Madagascar	14
2014	Madagascar	119

Human Immunodeficiency Virus (HIV)

Percutaneous inoculation from unsterilized sharps and syringes was identified as major risk factors for HIV infection through IMW in 8 of our studies.^72–78 We did not find a direct correlation between HIV infection and exposure to medical waste. Yet, the indiscriminate disposal sharps, blood, syringes and blood products in unsanitary landfills can expose populations, particularly waste pickers to heightened risks.^79–84 Researchers have noted that although the minimal infectious dose of HIV remains unknown, transmission can be influenced by the volume of blood remaining in a discarded syringe, amount of virus and the depth of the needlestick.⁷³

Lassa fever

Lassa fever is caused by the Lassa virus, which belongs to the family Arenaviridae.⁸⁵ The virus is primarily transmitted to humans through the urine of infected rodents.⁸⁵ Our review found that in human populations the virus can be transmitted through direct contact with blood, urine, faeces or other bodily secretions of an infected person.^85–93 As well, exposure to discarded blood-soaked bandages, linens and other contaminated items in the IMW stream can cause transmission of the virus.^86,88

Measles

Measles virus (MV) is a highly infectious disease that belongs to the prototype member of the genus Morbillivirus, the subfamily Paramyxovirinae and the family Paramyxoviridae.^94,95 The virus spreads primarily through the air when an infected person coughs, talks or sneezes.⁹⁶ Based on its etiology, we found 2 studies that suggested possible transmission through the unsafe handling of contaminated bedding, clothing, wipes, tissues and napkins.^94,95 Although this avenue presents a low transmission risk, it still cannot be discounted. Despite the availability of vaccines, measles is still one of the leading causes of death among children especially in least developed countries.⁹⁵

MPox

MPox is a contagious disease transmitted by the monkeypox virus which is part of the same family of viruses as variola, vaccinia, and cowpox.⁹⁷ Transmission typically occurs when the virus enters the host through direct exposure to skin or mucosal surfaces, including oral, anogenital, or ocular tissues.^98–101 Although we did not find any direct evidence of MPox transmission through IMW, 11 of the studies we reviewed suggested possible infection through contact with infected body fluids, contaminated bedding, clothing and accessories.^96–106

The plague

The Plague is a zoonotic disease caused by the bacteria Yersinia pestis, that has its main reservoir in small mammals such as rodents and fleas with a case-fatality ratio of 30% to 60%.¹⁰⁷ Patients infected with the pneumonic plague can generate respiratory droplets from bloody sputum, urine, feces, sweat, or bubo pus.¹⁰⁸ The improper disposal of materials used to clean these droplets may lead to human exposure and subsequently, infections. As well, human contact with infected carcasses in veterinary waste may contribute to infections. Although we found no evidence of direct human transmission via IMW, 3 publications highlight risk factors that may include contact infected blood, body fluids, human and animal anatomical waste.^107–109 The DRC and Madagascar are the two most endemic countries in SSA with the latter recording yearly outbreaks from 2014-2017.^108,109 As illustrated in Table 4 below, 2543 cases of the Plague were reported from 2014-2017 in Madagascar alone.⁴¹

Table 4.

Outbreaks of RVF in Africa.

Year	Countries	Cases
2018	Kenya	94
	Uganda	4
2016	Niger	348
2012	Mauritania	36
2010	South Africa	237
2010	South Africa	237
2009	Madagascar	236
2008	Madagascar	476

Rift Valley Fever (RVF)

RVF is zoonotic disease caused by Rift Valley fever virus (RVFV) belonging to family Bunyaviridae, genus Phlebovirus^110–113. We found no direct evidence of human infection through IMW, although 3 studies highlighted contact with infected blood, organs and animal anatomic waste from veterinary sources as possible transmission pathways.^110–113 The disease was first identified in Kenya in the 1930s and is now endemic to several African countries including Kenya, Niger, Mauritania, Uganda, South Africa and Madagascar where recent outbreaks have been reported (see Table 4). In a 10-year period 1668 cases of RVF were reported in 6 African countries between 2008-2018.⁴¹

Discussion

Exposure to discarded blood, blood products, anatomical waste, body fluids, sharps, contaminated materials and accessories from both human and animal healthcare sources are potential pathways for the transmission of infectious diseases (see Table 5). Despite the risks, our review did not uncover sufficient data to support direct cause-and-effect relationships. However, we did find an association between working with IMW and prevalence of both HBV and HCV in healthcare settings, although it remains unclear whether transmission occurred via IMW or other pathways.^62–66 In one of the studies, researchers detected HBV infections among randomly selected waste collectors from public health facilities in eastern Ethiopia.⁶³ A separate study undertaken in Adiss Ababa found higher HBV prevalence rates in municipal waste handlers than non-municipal waste handlers.⁶² A comparative study also undertaken in Ethiopia further found a higher seroprevalence of HBV infection among medical waste handlers compared to domestic waste handlers.⁶⁵ In that particular study, the overall seroprevalence of infections for HCV was 4.3% among medical waste handlers and 0.5% for domestic waste handlers.⁶⁵ Also in Libya, research involving 300 medical waste handlers and 300 non-medical waste handlers uncovered higher prevalence rates of HBV and HCV infections in personnel who handled medical waste.⁶⁶

Table 5.

Diseases, Pathogens and Potential IMW Transmission Pathways based on Scientific Evidence.

Disease	Pathogen	IMW transmission pathway	Studies
Anthrax	Bacteria	Animal anatomical parts	31-39
Anthrax	Bacteria	Inhalation of spores Ingestion of spores	31-39
CCHF	Virus	Blood	40-47
		Body fluids
		Secretions
EVD	Virus	Blood	48-59
		Body fluids
		Bedding
HPV	Virus	Blood	60-71
		Body fluids
		Sharps
HCV	Virus	Blood	72-76
HCV	Virus	Body fluids Sharps	72-76
HIV	Virus	Blood	77-84
HIV	Virus	Sharps	77-84
Lassa Fever	Virus	Blood	85-93
		Tissues
		Body Fluids
Measles	Virus	Body Fluids	94, 95
		Bedding
		Linens
Monkeypox	Virus	Body Fluids	96-106
		Bedding
		Towels
Plague	Bacteria	Body fluids	107-109
Plague	Bacteria	Human/animal anatomical waste, Laboratory waste	107-109
RVF	Virus	Animal Anatomical Waste	109-113
		Blood
		Fluids & Secretions
		Infected Animal tissue

Global health implications – MPox and EVD

Ebola virus disease and MPox, two highly infectious diseases that originated out of Africa have prompted the WHO to make multiple PHEIC declarations in recent years. The Ebola virus was first declared a PHEIC in August 2014 following an initial outbreak in Guinea, West Africa.^52,53 The West African Ebola Virus Disease outbreak later spread to Liberia, Sierra Leone, Italy, Mali, Nigeria, Senegal, Spain, the United Kingdom, and the United States of America (USA). During this outbreak, close to 30,000 people were infected, culminating in some 11, 325 fatalities, making it the deadliest of the seven outbreaks since its discovery.⁵² The outbreak was eventually declared over in June 2016. A second PHEIC declaration involving the Ebola virus was issued in July 2019 following an initial outbreak in the DRC which later spread to Uganda. By 2019, the Kivu/Ituri Ebola virus outbreak had affected a total of 3,296 people, resulting in 2,196 (67%) deaths.⁵²

Similarly, MPox was twice declared a PHEIC by the WHO in 2023 and 2024. The 2024 declaration was issued following an outbreak of Clade 1 MPXV in the DRC which later spread to neighboring countries.¹⁰³ Since the beginning of MPox monitoring in 2022, over 100 000 confirmed cases of clade I and clade II, including over 200 deaths among confirmed cases, have been reported by more than 120 countries as of, July 2024.^105,109 As well, over 20 000 MPox cases and over 600 deaths caused by MPXV clade I and clade II have been reported in some Africa Union Member States. These include Benin, Cameroon, Central African Republic, Congo, Democratic Republic of Congo, Egypt, Ghana, Liberia, Morocco, Mozambique, Nigeria, Sudan, and South Africa.^106,109

Based on what is currently known about the etiologies of both the Ebola virus and MPox, it is safe to assume that the presence of pathogenic microorganisms in IMW can create pathways for disease transmission. This may occur as a result of exposure to blood, body fluids, blood products, bedding and contaminated accessories (see table 5). However, there is currently no scientific evidence to substantiate cause-and-effect relationships, prompting the need for further research.

Limitations

A study of this calibre would have been further strengthened with a formal a priori sample size calculation to highlight cause-and-effect-relationships regarding human exposure to IMW. This fell outside the purview of this study hence, a limitation. In the absence of this, the study highlighted the multiple pathways through which IMW may transmit diseases in human populations. Therefore, a fair degree of caution is warranted in the interpretation of the findings. In the future however, a formal calculation of a sample size would provide statistical clout and a more robust estimation of cause-and-effect relationships.

Conclusion

Whilst IMW is a clear problem and there are potential transmission routes of human infections, we found no direct or indirect link. This does not negate risks, just a lack of evidence to substantiate cause-and-effect relationships. In instances where we could not find data to support direct causalities, we highlighted potential pathways for transmission and identified ways in which infections may occur, depending on the etiology of the disease. Based on our findings, disease transmission may occur through human exposure to certain classes of IMW. These include improperly discarded blood-borne pathogens, secretions, body fluids, human/animal anatomical waste, sharps, laboratory waste, contaminated materials and accessories. Consequently, the mechanisms by which populations may be infected include needlestick injuries, inhalation, ingestion and contact with improperly disposed infectious agents. Under such conditions, risks to healthcare personnel, especially those on the frontlines, waste handlers and the community are elevated. Therefore, the safe and proper management of IMW is a public health priority. Understanding the multiplicity of ways through which disease transmission occurs via IMW would aid our understanding of disease prevention and response. The subject remains largely understudied and further research is needed to uncover the depth and extent to which IMW transmits diseases in human populations. This is imperative to global public health research.

Supplemental material

Supplemental material - Infectious medical waste (IMW) and disease transmission: A critical public health challenge in Africa and the global implications – A systematic review

Supplemental material for Infectious medical waste (IMW) and disease transmission: A critical public health challenge in Africa and the global implications – A systematic review by Jeffrey N. T. Squire, PhD, Michaelann George, Zakirah Allain, Oghenowede Eyawo in Journal of Public Health Research.

Footnotes

Acknowledgments

The authors would like to acknowledge the following for their support: Overcoming Epidemics African Research Cluster at York University. Dahdaleh Institute for Global Health Research at York University.

Ethical considerations

This study did not require institutional ethics approval. As this systematic review is based on publicly available, published data, formal ethical approval was not required.

Author contributions

JNTS led the research process and supervised the entire project. MG & ZA assisted with the data collection process. JNTS & OE facilitated the analyses and interpretation of the data. All authors (JNTS, MG, ZA & OE) assisted with the preparation of the manuscript.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research was funded by the following entities: Social Science and Humanities Research Council (SSHRC) Explore Grant. The corresponding author received a SSHRC minor research grant (MRG) for this study.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

All information provided in this article could be shared. All data and materials used in this research are available through medical databases. References have been provided.*

Supplemental material

Supplemental material for this article is available online.

References

Neiderud

. How urbanization affects the epidemiology of emerging infectious diseases. Infection ecology & epidemiology 2015; 5(1): 27060. https://doi.org/10.3402/iee.v5.27060

Boyce

Katz

Standley

. Risk factors for infectious diseases in urban environments of sub-Saharan Africa: A systematic review and critical appraisal of evidence. Tropical medicine and infectious disease 2019; 4(4): 123. https://doi.org/10.3390/tropicalmed4040123

Reyes

Ahn

Thurber

, et al. Urbanization and infectious diseases: general principles, historical perspectives, and contemporary challenges. Challenges in infectious diseases, 2013, pp. 123–146.

Hasan

dos Santos Costa

Xenophontos

, et al. Lassa fever and COVID‐19 in Africa: a double crisis on the fragile health system. Journal of medical virology 2021; 93(10): 5707–5709. https://doi.org/10.1002/jmv.27169

Gyeltshen

Musa

Amesho

, et al. COVID-19: A novel burden on the fragile health system of Angola. Journal of global health 2021; 11: 03059. https://doi.org/10.7189/jogh.11.03059

Marou

Vardavas

Aslanoglou

, et al. The impact of conflict on infectious disease: a systematic literature review. Conflict and health 2024; 18(1): 27. https://doi.org/10.1186/s13031-023-00568-z

Gayer

Legros

Formenty

, et al. Conflict and emerging infectious diseases. Emerging infectious diseases 2007; 13(11): 1625–1631. https://doi.org/10.3201/eid1311.061093

Frenk

Gómez-Dantés

Knaul

. Globalization and infectious diseases. Infectious disease clinics of North America 2011; 25(3): 593–599. https://doi.org/10.1016/j.idc.2011.05.003

Young

Critchley

Johnstone

, et al. Globalization and the dual disease burden in sub-Saharan Africa. Diabetes voice 2010; 55(1): 30–32.

10.

Casadevall

. Climate change brings the specter of new infectious diseases. The Journal of Clinical Investigation 2020; 130(2): 553–555. https://doi.org/10.1172/JCI135003

11.

Fenollar

Mediannikov

. Emerging infectious diseases in Africa in the 21st century. New microbes and new infections 2018; 26: S10–S18. https://doi.org/10.1016/j.nmni.2018.09.004

12.

Pedro

Pinto

Cavadas

, et al. Sub-Saharan African information potential to unveil adaptations to infectious disease. Human Molecular Genetics 2021; 30(R1): R138–R145. https://doi.org/10.1093/hmg/ddab001

13.

Culyba

Van Tyne

. Bacterial evolution during human infection: Adapt and live or adapt and die. PLoS Pathogens 2021; 17(9): e1009872. https://doi.org/10.1371/journal.ppat.1009872

14.

Park

Lee

Kim

, et al. Detection and hazard assessment of pathogenic microorganisms in medical wastes. Journal of Environmental Science and Health Part A 2009; 44(10): 995–1003. https://doi.org/10.1080/10934520902996898

15.

Blenkharn

Odd

. Sharps injuries in healthcare waste handlers. Annals of occupational hygiene 2008; 52(4): 281–286. https://doi.org/10.1093/annhyg/men010

16.

Chisholm

Zamani

Negm

, et al. Sustainable waste management of medical waste in African developing countries: A narrative review. Waste Management & Research 2021; 39(9): 1149–1163. https://doi.org/10.1177/0734242x211029175

17.

Hassan

Tudor

Vaccari

. Healthcare waste management: A case study from Sudan. Environments 2018; 5(8): 89. https://doi.org/10.3390/environments5080089

18.

Kwikiriza

Stewart

Mutahunga

, et al. A whole systems approach to hospital waste management in rural Uganda. Frontiers in public health 2019; 7: 136. https://doi.org/10.3389/fpubh.2019.00136

19.

Olaniyi

Ogola

Tshitangano

. A review of medical waste management in South Africa. Open Environmental Sciences 2018; 10(1): 34–45.

20.

Oyekale

. Healthcare waste management practices and safety indicators in Nigeria. BMC public health 2017; 17: 1–3. https://doi.org/10.1186/s12889-017-4794-6

21.

Squire

. Biomedical pollutants in the urban environment and implications for public health: a case study. International Scholarly Research Notices 2013; 2013(1): 497490–497495. https://doi.org/10.1155/2013/497490

22.

Yazie

Tebeje

Chufa

. Healthcare waste management current status and potential challenges in Ethiopia: a systematic review. BMC research notes 2019; 12: 1–7. https://doi.org/10.1186/s13104-019-4316-y

23.

World Health Organization . Implementation of international health regulations, Implementation of international health regulations. 2009, 2005.

24.

Koua

Njingang

Kimenyi

, et al. Trends in public health emergencies in the WHO African Region: an analysis of the past two decades public health events from 2001 to 2022. BMJ Global Health 2023; 8(10): e012015. https://doi.org/10.1136/bmjgh-2023-012015

25.

Moyo

Mhango

Moyo

, et al. Emerging infectious disease outbreaks in Sub-Saharan Africa: Learning from the past and present to be better prepared for future outbreaks. Frontiers in public health 2023; 11: 1049986. https://doi.org/10.3389/fpubh.2023.1049986

26.

Mboussou

Ndumbi

Ngom

, et al. Infectious disease outbreaks in the African region: overview of events reported to the World Health Organization in 2018. Epidemiology & Infection 2019; 147: e299. https://doi.org/10.1017/S0950268819001912

27.

Janik-Karpinska

Brancaleoni

Niemcewicz

, et al. Healthcare waste—a serious problem for global health. InHealthcare 2023; 11(2): 242, MDPI. https://doi.org/10.3390/healthcare11020242

28.

Cook

Woolridge

Stapp

, et al. Medical and healthcare waste generation, storage, treatment and disposal: a systematic scoping review of risks to occupational and public health. Critical Reviews in Environmental Science and Technology 2023; 53(15): 1452–1477. https://doi.org/10.1080/10643389.2022.2150495

29.

Johnson

Braden

Cairns

, et al. Transmission of Mycobacterium tuberculosis from medical waste. Jama 2000; 284(13): 1683–1688. https://doi.org/10.1001/jama.284.13.1683

30.

Shamseer

Moher

Clarke

, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj 2015; 349.

31.

Page

McKenzie

Bossuyt

, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71. https://doi.org/10.1136/bmj.n71

32.

Hendricks

Person

Bradley

, et al. Clinical features of patients hospitalized for all routes of anthrax, 1880–2018: a systematic review. Clinical Infectious Diseases 2022; 75(Supplement_3): S341–S353. https://doi.org/10.1093/cid/ciac534

33.

Bower

Hendricks

Vieira

, et al.

What is anthrax?

Pathogens 2022; 11(6): 690. https://doi.org/10.3390/pathogens11060690

34.

Doganay

Metan

Alp

. A review of cutaneous anthrax and its outcome. Journal of infection and public health 2010; 3(3): 98–105. https://doi.org/10.1016/j.jiph.2010.07.004

35.

Sweeney

Hicks

Cui

, et al. Anthrax infection. American journal of respiratory and critical care medicine 2011; 184(12): 1333–1341. https://doi.org/10.1164/rccm.201102-0209CI

36.

Driciru

Rwego

Ndimuligo

, et al. Environmental determinants influencing anthrax distribution in Queen Elizabeth Protected Area, Western Uganda. PloS one 2020; 15(8): e0237223. https://doi.org/10.1371/journal.pone.0237223

37.

World Health Organization . Disease Outbreak News; Anthrax in Zambia. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON497 (2023).

38.

Adesola

Okeke

Hamzat

, et al. Unraveling the binational outbreak of anthrax in Ghana and Nigeria: an in-depth investigation of epidemiology, clinical presentations, diagnosis, and plausible recommendations toward its eradication in Africa. Bulletin of the National Research Centre 2024; 48(1): 45. https://doi.org/10.1186/s42269-024-01203-4

39.

Mogaji

Adewale

Smith

, et al. Combatting anthrax outbreaks across Nigeria’s national land borders: need to optimize surveillance with epidemiological surveys. Infectious Diseases of Poverty 2024; 13(1): 10. https://doi.org/10.1186/s40249-024-01179-3

40.

Wang

Suluku

Jalloh

, et al. Molecular characterization of an outbreak-involved Bacillus anthracis strain confirms the spillover of anthrax from West Africa. Infectious Diseases of Poverty 2024; 13(1): 6. https://doi.org/10.1186/s40249-023-01172-2

41.

Africa Centres for Disease Controls and Prevention . Crimean-Congo haemorrhagic fever. https://africacdc.org/disease/crimean-congo-haemorrhagic-fever/ (2025), Accessed 21 March 2025.

42.

Tsergouli

Karampatakis

Haidich

, et al. Nosocomial infections caused by Crimean–Congo haemorrhagic fever virus. Journal of Hospital Infection 2020; 105(1): 43–52. https://doi.org/10.1016/j.jhin.2019.12.001

43.

Hawman

Feldmann

. Crimean–Congo haemorrhagic fever virus. Nature Reviews Microbiology 2023; 21(7): 463–477. https://doi.org/10.1038/s41579-023-00871-9

44.

Temur

Kuhn

Pecor

, et al. Epidemiology of Crimean-Congo hemorrhagic fever (CCHF) in Africa—underestimated for decades. The American journal of tropical medicine and hygiene 2021; 104(6): 1978–1990. https://doi.org/10.4269/ajtmh.20-1413

45.

Wahid

Altaf

Naeem

, et al. Scoping review of Crimean-Congo hemorrhagic fever (CCHF) literature and implications of future research. J Coll Physicians Surg Pak 2019; 29(6): 563–573. https://doi.org/10.29271/jcpsp.2019.06.563

46.

Karanam

Nagvishnu

Uppala

, et al. Crimean-Congo hemorrhagic fever: Pathogenesis, transmission and public health challenges. World Journal of Virology 2025; 14(1): 100003. https://doi.org/10.5501/wjv.v14.i1.100003

47.

Bhowmick

Kasi

Gethmann

, et al. Ticks on the run: a mathematical model of Crimean-Congo haemorrhagic fever (CCHF)—Key factors for transmission. Epidemiologia 2022; 3(1): 116–134. https://doi.org/10.3390/epidemiologia3010010

48.

World Health Organization . Crimean-Congo haemorrhagic fever. February 2025. https://www.who.int/news-room/fact-sheets/detail/crimean-congo-haemorrhagic-fever (2025), Accessed 18 March, 2025.

49.

Rewar

Mirdha

. Transmission of Ebola virus disease: an overview. Annals of global health 2014; 80(6): 444–451. https://doi.org/10.1016/j.aogh.2015.02.005

50.

Jacob

Crozier

Fischer

, et al. Ebola virus disease. Nature reviews Disease primers 2020; 6(1): 13. https://doi.org/10.1038/s41572-020-0147-3

51.

Weyer

Grobbelaar

Blumberg

. Ebola virus disease: history, epidemiology and outbreaks. Current infectious disease reports 2015; 17: 1–8. https://doi.org/10.1007/s11908-015-0480-y

52.

World Health Organization . Ebola Response Roadmap August, 28th 2014. Geneva. https://www.who.int/csr/resources/publications/ebola/response-roadmap/en/retrievedMarch10th (2014).2015.

53.

Centre for Disease Control and Prevention . Outbreak Chronology: Ebola Virus Disease, 2014. https://www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html (accessed February 20th, 2015.

54.

Kamorudeen

Adedokun

Olarinmoye

. Ebola outbreak in West Africa, 2014–2016: Epidemic timeline, differential diagnoses, determining factors, and lessons for future response. Journal of infection and public health 2020; 13(7): 956–962. https://doi.org/10.1016/j.jiph.2020.03.014

55.

Barry

Ahuka-Mundeke

Ahmed

, et al. Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April–May, 2018: an epidemiological study. The Lancet 2018; 392(10143): 213–221. https://doi.org/10.1016/s0140-6736(18)31387-4

56.

Vetter

Fischer

Schibler

, et al. Ebola virus shedding and transmission: review of current evidence. The Journal of infectious diseases 2016; 214(suppl_3): S177–S184. https://doi.org/10.1093/infdis/jiw254

57.

Lawrence

Danet

Reynard

, et al. Human transmission of Ebola virus. Current opinion in virology 2017; 22: 51–58. https://doi.org/10.1016/j.coviro.2016.11.013

58.

Osterholm

Moore

Kelley

, et al. Transmission of Ebola viruses: what we know and what we do not know. MBio 2015; 6(2): 10–128. https://doi.org/10.1128/mBio.00137-15

59.

Judson

Prescott

Munster

. Understanding ebola virus transmission. Viruses 2015; 7(2): 511–521. https://doi.org/10.3390/v7020511

60.

Shears

O'Dempsey

. Ebola virus disease in Africa: epidemiology and nosocomial transmission. Journal of Hospital Infection 2015; 90(1): 1–9. https://doi.org/10.1016/j.jhin.2015.01.002

61.

Stanaway

Flaxman

Naghavi

, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. The Lancet 2016; 388(10049): 1081–1088. https://doi.org/10.1016/S0140-6736(16)30579-7

62.

Shiferaw

Abebe

Mihret

. Hepatitis B virus infection among medical waste handlers in Addis Ababa, Ethiopia. BMC research notes 2011; 4: 1–7. https://doi.org/10.1186/1756-0500-4-479

63.

Mengiste

Dirbsa

Ayele

, et al. Hepatitis B virus infection and its associated factors among medical waste collectors at public health facilities in eastern Ethiopia: a facility-based cross-sectional study. BMC infectious diseases 2021; 21(1): 233. https://doi.org/10.1186/s12879-021-05918-x

64.

Amsalu

Worku

Tadesse

, et al. The exposure rate to hepatitis B and C viruses among medical waste handlers in three government hospitals, southern Ethiopia. Epidemiology and health 2016; 38: e2016001. https://doi.org/10.4178/epih/e2016001

65.

Ayele

Weldehanna

Demsiss

. Serological evidence and associated factors of hepatitis B virus and hepatitis C virus among waste handlers: a cross-sectional study from Northeastern Ethiopia. Infection and Drug Resistance 2023; 31: 4881–4890. https://doi.org/10.2147/idr.s416409

66.

Franka

El-Zoka

Hussein

, et al. Hepatitis B virus and hepatitis C virus in medical waste handlers in Tripoli, Libya. Journal of Hospital Infection 2009; 72(3): 258–261. https://doi.org/10.1016/j.jhin.2009.03.019

67.

Blackard

Shata

Shire

, et al. Acute hepatitis C virus infection: a chronic problem. Hepatology 2008; 47(1): 321–331. https://doi.org/10.1002/hep.21902

68.

Shepard

Finelli

Alter

. Global epidemiology of hepatitis C virus infection. The Lancet infectious diseases 2005; 5(9): 558–567. https://doi.org/10.1016/S1473-3099(05)70216-4

69.

Alter

. Epidemiology of hepatitis C virus infection. World journal of gastroenterology: WJG 2007; 13(17): 2436–2441. https://doi.org/10.3748/wjg.v13.i17.2436

70.

Lee

Yang

Yuan

, et al. Epidemiology and natural history of hepatitis C virus infection. World journal of gastroenterology: WJG 2014; 20(28): 9270–9280. https://doi.org/10.3748/wjg.v20.i28.9270

71.

Roudot-Thoraval

. Epidemiology of hepatitis C virus infection. Clinics and research in hepatology and gastroenterology 2021; 45(3): 101596. https://doi.org/10.1016/j.clinre.2020.101596

72.

Paul Leigh

Gillen

Franks

, et al. Costs of needlestick injuries and subsequent hepatitis and HIV infection. Current medical research and opinion 2007; 23(9): 2093–2105. https://doi.org/10.1185/030079907X219517

73.

Rogowska-Szadkowska

Chlabicz

. Transmission of HIV through needlestick injuries in the community setting. HIV & AIDS Review 2010; 9(2): 37–40. https://doi.org/10.1016/s1730-1270(10)60067-7

74.

Yosef

Asefa

Amsalu

, et al. Occupational Exposure to Needle Stick and Sharp Injuries and Postexposure Prophylaxis Utilization Among Healthcare Professionals in Southwest Ethiopia. Canadian Journal of Infectious Diseases and Medical Microbiology 2025; 2025(1): 3792442. https://doi.org/10.1155/cjid/3792442

75.

Abadie

Brown

Campbell

, et al. Incidence and Risks of HIV Infection, Medication Options, and Adverse Effects in Accidental Needle Stick Injuries: A Narrative Review. Cureus 2024; 16(1): e51521. https://doi.org/10.7759/cureus.51521

76.

Ashat

Bhatia

Puri

, et al. Needle stick injury and HIV risk among health care workers in North India. Indian journal of medical sciences 2011; 65(9): 371–378. https://doi.org/10.4103/0019-5359.108947

77.

Stevens

Dickinson

. Needlestick injuries in an era of HIV: technical and personal aspects. African journal of AIDS research 2007; 6(1): 41–48. https://doi.org/10.2989/16085900709490398

78.

Nsubuga

Jaakkola

. Needle stick injuries among nurses in sub‐Saharan Africa. Tropical medicine & international health 2005; 10(8): 773–781. https://doi.org/10.1111/j.1365-3156.2005.01453.x

79.

Ziraba

Bwogi

Namale

, et al. Sero-prevalence and risk factors for hepatitis B virus infection among health care workers in a tertiary hospital in Uganda. BMC infectious diseases 2010; 10: 1–2. https://doi.org/10.1186/1471-2334-10-191

80.

Anagaw

Shiferaw

Anagaw

, et al. Seroprevalence of hepatitis B and C viruses among medical waste handlers at Gondar town Health institutions, Northwest Ethiopia. BMC research notes 2012; 5: 1–10. https://doi.org/10.1186/1756-0500-5-55

81.

Yizengaw

Getahun

Geta

, et al. Sero-prevalence of hepatitis B virus infection and associated factors among health care workers and medical waste handlers in primary hospitals of North-west Ethiopia. BMC research notes 2018; 11: 1–6. https://doi.org/10.1186/s13104-018-3538-8

82.

Tao

Compaoré

Diarra

, et al. Seroepidemiology of hepatitis B and C viruses in the general population of Burkina Faso. Hepatitis research and treatment 2014; 2014(1): 781843. https://doi.org/10.1155/2014/781843

83.

Arafa

Eshak

. Medical waste handling and hepatitis B virus infection: A meta-analysis. American Journal of infection control 2020; 48(3): 316–319. https://doi.org/10.1016/j.ajic.2019.08.011

84.

Uddin

Islam

Khan

, et al. Frequency of hepatitis B and C viral infection among the medical waste handlers. Bangladesh Journal of Infectious Diseases 2017; 4(1): 3–9. https://doi.org/10.3329/bjid.v4i1.37673

85.

Yun

Walker

. Pathogenesis of Lassa fever. Viruses 2012; 4(10): 2031–2048. https://doi.org/10.3390/v4102031

86.

Garry

. Lassa fever—the road ahead. Nature Reviews Microbiology 2023; 21(2): 87–96. https://doi.org/10.1038/s41579-022-00789-8

87.

Holmes

McCormick

Trock

, et al. Lassa fever in the United States. New England Journal of Medicine 1990; 323(16): 1120–1123. https://doi.org/10.1056/nejm199010183231607

88.

Abidemi

Owolabi

Pindza

. Modelling the transmission dynamics of Lassa fever with nonlinear incidence rate and vertical transmission. Physica A: Statistical Mechanics and its Applications 2022; 597: 127259. https://doi.org/10.1016/j.physa.2022.127259

89.

Usman

Adamu

. Modelling the transmission dynamics of the Lassa fever infection. Mathematical Theory and Modeling 2018; 8(5): 42–63.

90.

Mylne

Pigott

Longbottom

, et al. Mapping the zoonotic niche of Lassa fever in Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene 2015; 109(8): 483–492. https://doi.org/10.1093/trstmh/trv047

91.

Ogbu

Ajuluchukwu

Uneke

. Lassa fever in West African sub-region: an overview. Journal of vector borne diseases 2007; 44(1): 1–11.

92.

Davis

Kenyon

Ghersi

, et al. Assessing the Environmental Drivers of Lassa Fever in West Africa: A Systematic Review. Viruses 2025; 17(4): 504. https://doi.org/10.3390/v17040504

93.

Azeez-Akande

. Review of Lassa fever, an emerging old world haemorrhagic viral disease in sub-Saharan Africa. African Journal of Clinical and Experimental Microbiology 2016; 17(4): 282–289. https://doi.org/10.4314/ajcem.v17i4.9

94.

Moss

Griffin

. Global measles elimination. Nature Reviews Microbiology 2006; 4(12): 900–908. https://doi.org/10.1038/nrmicro1550

95.

Ferrari

Grais

Bharti

, et al. The dynamics of measles in sub-Saharan Africa. Nature 2008; 451(7179): 679–684. https://doi.org/10.1038/nature06509

96.

Srivastava

Kumar

Jain

, et al. The Global Monkeypox (Mpox) outbreak: a comprehensive review. Vaccines 2023; 11(6): 1093. https://doi.org/10.3390/vaccines11061093

97.

Titanji

Hazra

Zucker

. Mpox clinical presentation, diagnostic approaches, and treatment strategies: a review. JAMA 2024.

98.

Beiras

Malembi

Escrig-Sarreta

, et al. Concurrent outbreaks of mpox in Africa—an update. The Lancet 2025.

99.

Ndembi

Folayan

Komakech

, et al. Evolving Epidemiology of Mpox in Africa in 2024. New England Journal of Medicine 2025.

100.

Mercy

Tibebu

Fallah

, et al. Mpox continues to spread in Africa and threatens global health security. Nature medicine 2024; 30(5): 1225–1226. https://doi.org/10.1038/s41591-024-02862-6

101.

Kuppalli

Dunning

Damon

, et al. The worsening mpox outbreak in Africa: a call to action. The Lancet Infectious Diseases 2024; 24(11): 1190–1192. https://doi.org/10.1016/s1473-3099(24)00577-2

102.

Lapa

Carletti

Mazzotta

, et al. Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding. The Lancet Infectious Diseases 2022; 22(9): 1267–1269. https://doi.org/10.1016/s1473-3099(22)00513-8

103.

Rivers

Watson

Phelan

. The resurgence of Mpox in Africa. JAMA 2024; 332(13): 1045–1046. https://doi.org/10.1001/jama.2024.17829

104.

Nachega

Sam-Agudu

Ogoina

, et al. The surge of mpox in Africa: a call for action. The Lancet Global Health 2024; 12(7): e1086–e1088. https://doi.org/10.1016/s2214-109x(24)00187-6

105.

Adetifa

Muyembe

Bausch

, et al. Mpox neglect and the smallpox niche: a problem for Africa, a problem for the world. The Lancet 2023; 401(10390): 1822–1824. https://doi.org/10.1016/s0140-6736(23)00588-3

106.

Akingbola

Adegbesan

Adewole

, et al. Understanding the resurgence of mpox: key drivers and lessons from recent outbreaks in Africa. Tropical Medicine and Health 2025; 53(1): 47. https://doi.org/10.1186/s41182-024-00678-1

107.

Jullien

de Silva

Garner

. Plague transmission from corpses and carcasses. Emerging Infectious Diseases 2021; 27(8): 2033–2041. https://doi.org/10.3201/eid2708.200136

108.

Richard

Riehm

Herindrainy

, et al. Pneumonic plague outbreak, northern Madagascar, 2011. Emerging infectious diseases 2015; 21(1): 8–15. https://doi.org/10.3201/eid2101.131828

109.

Rabaan

Al-Ahmed

Alsuliman

, et al. The rise of pneumonic plague in Madagascar: current plague outbreak breaks usual seasonal mould. Journal of Medical Microbiology 2019; 68(3): 292–302. https://doi.org/10.1099/jmm.0.000915

110.

Wright

Kortekaas

Bowden

, et al. Rift Valley fever: biology and epidemiology. Journal of General Virology 2019; 100(8): 1187–1199. https://doi.org/10.1099/jgv.0.001296

111.

Flick

Bouloy

. Rift Valley fever virus. Current molecular medicine 2005; 5(8): 827–834. https://doi.org/10.2174/156652405774962263

112.

Nanyingi

Munyua

Kiama

, et al. A systematic review of Rift Valley Fever epidemiology 1931–2014. Infection ecology & epidemiology 2015; 5(1): 28024. https://doi.org/10.3402/iee.v5.28024

113.

Grobbelaar

Weyer

Leman

, et al. Molecular epidemiology of Rift Valley fever virus. Emerging infectious diseases 2011; 17(12): 2270–2276. https://doi.org/10.3201/eid1712.111035

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