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Review
. 2025 Apr 16;10(4):e019162.
doi: 10.1136/bmjgh-2025-019162.

Improving risk analysis of the environmental drivers of the spillover, emergence/re-emergence and spread of Crimean-Congo haemorrhagic fever virus, Marburg virus and Middle East respiratory syndrome coronavirus in the East Africa Region

Oluwayemisi Ajumobi  1   2   3 , Meghan Davis  4   5 , Christine Marie George  4   6 , Lori Rosman  7 , Sophie Von Dobschuetz  8 , Crystal Watson  4   2 , Jennifer B Nuzzo  4   9   10
Affiliations
Review

Improving risk analysis of the environmental drivers of the spillover, emergence/re-emergence and spread of Crimean-Congo haemorrhagic fever virus, Marburg virus and Middle East respiratory syndrome coronavirus in the East Africa Region

Oluwayemisi Ajumobi et al. BMJ Glob Health. .

Abstract

Introduction: Emerging and/or re-emerging infectious diseases (EIDs) in the East Africa region are associated with climate change-induced environmental drivers. There is a need for a comprehensive understanding of these environmental drivers and to adopt an integrated risk analysis (IRA) framework for addressing a combination of the biological, environmental and socioeconomic factors that increase population vulnerabilities to EID risks to inform biological risk mitigation and cross-sectoral decision-making. The aim of this integrative review was to identify knowledge gaps and contribute to a holistic understanding about the environmental drivers of Crimean-Congo haemorrhagic fever virus (CCHFV), Marburg virus (MARV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infections in the East Africa Region to improve IRA processes at the environment-animal-human exposure interface.

Methods: An integrative review search was carried out to identify relevant studies and reports from 2000 to 2024. Searches were conducted in bibliographic databases and global institutional websites. Inclusion criteria were studies and reports (in English) addressing environmental drivers of CCHFV, MARV and MERS-CoV infections across countries in the East Africa region, existing risk frameworks/methodological tools and/or One Health policy recommendations for risk analysis of environmentally driven biological threats.

Results: Of the total number of studies retrieved from database searches (n=18 075) and website searches (n=44), 242 studies and reports combined were included in the review with the majority covering the environmental drivers (n=137), the risk frameworks/methodological tools (n=73) and the policy recommendations (n=32). We identified 10 categories of environmental drivers, four thematic groups of risk frameworks and three categories of policy recommendations. Overall, many of the included records on the risk frameworks/methodological tools expounded on the adoption of ecological niche modelling (ENM) for environmental monitoring of potential transmission pathways of EIDs and other biological threats.

Conclusion: This integrative review recommends the adoption of specialised risk mapping approaches such as ENM for environmental monitoring of EIDs under IRA processes. Findings from the review were used for the conceptualisation of an IRA framework for addressing environmentally driven EIDs.

Keywords: Environmental health; Global Health; Kenya; Respiratory infections; Viral haemorrhagic fevers.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. Article screening and selection using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Figure 2
Figure 2. Percentage distribution of included studies and reports by geographic coverage.
Figure 3
Figure 3. Environmental drivers of emerging/re-emerging infectious diseases in the East Africa region.
Figure 4
Figure 4. Integrated risk analysis conceptual framework model incorporating ecological niche modelling, remote sensing data and qualitative expert opinions (findings from integrative review).
Figure 5
Figure 5. Causal loop diagram of the direct and indirect impact of climate change and cascading risk pathways contributing to severe pandemic risks.
See this image and copyright information in PMC

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