Abstract Prolonged compound hot–dry events (CHDEs) have been linked to surging emergency medical demand, especially among vulnerable populations, making them a growing public health concern in a warming climate. However, the seasonal and regional drivers of high health–risk CHDEs (HHR–CHDEs) remain unclear, limiting effective public health responses. Here, we integrate a temperature–humidity-based health risk index, ambulance dispatch records, and distributed lag non-linear models to obtain high health-risk temperature–humidity thresholds. During HHR–CHDEs exposure, particularly higher emergency dispatch demands are observed among males, the elderly, and individuals suffering from trauma or alcohol poisoning We further use ERA5 reanalysis data to examine the dominant modes and physical mechanisms of HHR–CHDEs across China during the early and late warm seasons. In the early warm season, HHR–CHDEs are concentrated in Northwest China and are jointly driven by enhanced surface heating (51% contribution) and intensified moisture loss (37%), underpinned by the synergistic effect of an upstream Rossby wave source over Eastern Europe and anomalous Northwest Pacific SST warming. This coupling promotes a quasi-stationary high-pressure anomaly that blocks synoptic disturbances and reinforces regional heat–dryness feedbacks. By contrast, in the late warm season, HHR–CHDEs are centered over the middle–lower Yangtze River region and are dominated by persistent heat accumulation (65%) with a secondary drought contribution (25%). These events are driven by large-scale circulation anomalies resulting from upstream Rossby wave energy originating in the North Atlantic and enhanced by downstream SST warming over the subtropical Northwest Pacific. This Atlantic–Pacific coupling induces pronounced adjustments in the Walker and Hadley circulations, promoting subsidence and suppressed monsoonal moisture transport, and sustaining a health-threatening hot–dry atmosphere over densely populated regions. These findings reveal seasonally distinct remote forcing pathways and highlight the value of integrating large-scale diagnostics into climate–health early warning systems.

Introduction: Aeromonas infections are an emerging global public health challenge due to their complex pathogenicity and diverse virulence factors. These infections can lead to various conditions in humans, such as gastroenteritis, wound infections, and septicaemia. On February 12, 2024, an outbreak of Aeromonas hydrophila infection in Jinja and Luuka, Uganda, resulted in cases of abdominal pain, diarrhoea, vomiting, and death. This study described the epidemiology of the outbreak and the public health response. Methods: To investigate the outbreak and evaluate the epidemiology and public health response, a mixed-methods study was conducted using secondary data involving 185 individuals. Confirmed cases were identified through positive culture results from gastric aspirates or stool samples. Suspected and probable cases were defined by at least two symptoms, including abdominal pain, vomiting, and diarrhoea, history of exposure, and an epidemiological link to a confirmed case or outbreak cluster occurring between February 12 and 27, 2024. The study also included secondary laboratory investigations, food safety assessments, and an evaluation of timeliness using the 7-1-7 metric. Data analysis was performed using STATA-17. Results: Among 185 individuals investigated, 54.1% were female, the mean age was 23.9 ±18.7years, 103 Aeromonas hydrophila cases were identified, resulting in an attack rate of 55.7%(103/185), including one laboratory-confirmed case. Cases were younger than non-cases (22.1 vs. 26.3 years). The outbreak lasted five days (12–16 February 2024), peaked on 14 February, and had an incubation period of 33–38 hours, indicating a common-source exposure. Eight deaths occurred (case fatality rate: 7.8%). Geographical clustering of cases was observed, with high attack rates in Iziru (48%) and Bugomba (78%) parishes, respectively. Funeral food exposure showed an attributable risk of 9.3/100 and an attributable fraction of 15.7%. A. hydrophila was detected in gastric aspirate and water samples, implicating contaminated water and ill food handlers. Relapse occurred in 30.1% of cases. Conclusion: The outbreak of Aeromonas hydrophila was rapid, geographically clustered, and linked to contaminated water and ill food handlers, with funeral food exposure contributing to the outbreak. High attack, relapse, and fatality rates highlight the need for timely water safety interventions, improved food hygiene, and strengthened outbreak detection and response to prevent future occurrences.

A. baumannii is one of the most problematic hospital pathogens worldwide, often resistant to nearly all available antibiotics. In Peru, the proportion of carbapenem-resistant isolates is among the highest reported globally, yet their genetic background has remained largely unknown. This study provides the first genomic and phylogenomic insight into XDR A. baumannii from a major Peruvian hospital, revealing the spread of high-risk clones belonging to sequence type 2 carrying the OXA-72 carbapenemase, and the emergence of two additional lineages, sequence type 79 and sequence type 1079, both producing OXA-23. These findings demonstrate that multiple resistant lineages are established in Peru, highlighting the urgent need to implement genomic surveillance and infection control measures. Understanding the diversity and dynamics of these lineages is critical to limit their further spread and to guide public health responses in South America.

The rise of nonfentanyl synthetic opioids such as brorphine highlights the dynamic evolution of illicit opioid markets and the persistent toxicological and public health risks they pose. Studies reporting the pharmacology, toxicology, and analytical detection of brorphine and its analogues were identified through systematic searches of PubMed and Scopus databases. Additional data from official international organizations' early-warning platforms were also included. Brorphine acts as a potent μ-opioid receptor agonist with preclinical evidence of strong antinociceptive activity, respiratory depression, and abuse potential. Since 2019, it has been increasingly identified in forensic casework, frequently in combination with fentanyl or benzodiazepines, and implicated in multiple nonfatal and fatal intoxications. Structurally related analogues, including halogenated derivatives and "orphine-type" compounds, whose pharmacological properties and toxicological profiles are not well understood, have emerged. Although several liquid chromatography coupled with mass spectrometry-based methods exist for brorphine detection, no validated analytical workflows or certified reference materials are currently available for its analogues, limiting comprehensive monitoring and biomonitoring capacity. The rapid spread of brorphine and its analogues underscores the ongoing transition from fentanyl derivatives toward novel nonfentanyl μ-opioid receptor agonists. These substances pose significant analytical and toxicological challenges and require increased international surveillance, improved laboratory capabilities, and coordinated public health responses to reduce their impact.

Although wastewater monitoring for virus detection has increased in communities worldwide, public awareness, understanding, questions, and concerns about wastewater monitoring are largely unknown. We assessed awareness, knowledge, and support for wastewater monitoring for detection of viruses and bacteria among US residents and elicited questions and concerns from residents about its use. We conducted a survey among a racially and ethnically diverse sample of residents in Colorado, Maryland, Missouri, Nebraska, and Texas to assess awareness, knowledge, and support of wastewater monitoring. We also asked an open-ended question to elicit further questions and concerns from survey participants about wastewater monitoring. Two independent reviewers coded the responses to the open-ended question. Among 516 survey participants (52% White, 31% Black, 27% Hispanic ethnicity), 289 (56%) were aware that local public health departments and federal health agencies tested sewer water yet 334 (65%) knew "little or nothing" about wastewater monitoring. After participants were exposed to a brief description of the wastewater monitoring process, 80% "supported" or "strongly supported" wastewater monitoring to detect viruses and bacteria. When we analyzed responses to the open-ended question on wastewater monitoring, 3 broad categories and 9 subcategories of questions and concerns about wastewater monitoring emerged: (1) how wastewater monitoring works (mechanics, accuracy, cost, safety), (2) what is done with the findings generated by wastewater monitoring (public accessibility, government trust, public health response), and (3) what protections were in place against misuse of findings (privacy, fairness). Proactive public education is needed to increase understanding, build support, and prevent disinformation about wastewater monitoring. Local systems are needed to share findings rapidly, clearly, and simply.

Dengue serotypes and their severity correlation: A hospital-based observational study.

Integrated approach for sustainable management and control of Kyasanur forest disease in alignment with sustainable development goals.

The joint impact of temperature, humidity, and air pollution on COVID-19 incidence: a multi-country time-series study in 439 cities.

ABSTRACTBackgroundCandida (Candidozyma) auris is an emerging yeast that poses a significant global health threat due to its multidrug resistance and ability to cause healthcare‐associated outbreaks. Genomic surveillance is essential for monitoring spread, transmission and antifungal resistance.ObjectivesTo report the first identification and genomic characterisation of C. auris in the state of Minas Gerais, Southeast Brazil, and to investigate the genetic origin and diversity, resistance‐associated mutations, and potential transmission dynamics during a hospital outbreak.MethodsEight C. auris isolates were collected during a hospital outbreak in Belo Horizonte, Minas Gerais, Brazil, including clinical samples from patients and environmental samples from surfaces in the Intensive Care Unit (ICU). Epidemiological investigation, whole‐genome sequencing (WGS) and phylogenomic analyses were conducted to determine circulating clade, genetic diversity, outbreak origin and the presence of antifungal resistance mutations.ResultsAll isolates were classified as clade IV and exhibited high genomic similarity to strains previously reported in northern Colombia (Caribbean coast). One isolate carried the ERG11 Y132F mutation, associated with fluconazole resistance, but this mutation was absent in another isolate from the same patient collected 1 day earlier, indicating mixed fungal populations. Environmental isolates clustered tightly with clinical strains, supporting surface‐mediated transmission in the ICU.ConclusionsThis study describes the introduction and local spread of clade IV C. auris in Minas Gerais, Brazil. The findings underscore the critical role of genomic surveillance in identifying resistance mechanisms, tracing transmission pathways and guiding public health responses.

The scale-up of molecular assays for diagnosing emerging pathogens has increased in low-and-middle-income countries (LMICs) since the advent of COVID-19. We herein evaluated the diagnostic concordance of three different assays for SARS-CoV-2 in Cameroon. A laboratory-based comparative study was performed on nasopharyngeal samples collected between March-2020 to March-2023 from the biobank of Chantal Biya International Reference Centre (CIRCB), Yaoundé-Cameroon. Samples were analyzed using DaAn Gene (N/ORF1ab-genes), ThermoFisher (N/ORF1ab/S-genes), and GeneXpert (N2/E-genes). Validated cycle thresholds (CT) for positivity were CT < 37 for DaAn Gene/ThermoFisher and CT < 40 for GeneXpert. Cohen's Kappa coefficient evaluated diagnostic concordance with DaAn Gene as reference. We analysed 249 samples (55.8% males, median-age [IQR], 36 [27-50] years including 21.3% symptomatic participants). Overall positivity rates (median [IQR]) were 55.0% (CT: 30.6 [23.1-35.5]); 53.4% (CT: 26.6 [21.2-30.9]); 22.1% (CT: 32.7 [26.9-36.1]) for GeneXpert, DaAn Gene and ThermoFisher respectively. GeneXpert showed stronger concordance with DaAn Gene (83.1%; k = 0.66, 95% CI: 0.57-0.75) than ThermoFisher (67.9%; k = 0.38, 95% CI: 0.29-0.47). At validated thresholds, GeneXpert showed higher positive agreement with DaAn Gene (85.0%, 113/133) as compared to ThermoFisher (41.3%, 55/133), while maintaining comparable negative agreement (81.0% [GeneXpert] and 98.3% [ThermoFisher]). At low CTs (< 20) however, positive agreement with DaAn Gene was high for GeneXpert (100%, 15/15) and ThermoFisher (93.3%, 14/15). GeneXpert exhibits superiority over ThermoFisher in detecting cases of COVID-19. As expected, agreement between two- and three-genes assays at CT < 20 was excellent, suggesting interoperability of these platforms during outbreaks for high viral loads cases. However, two-genes assays may be decisive to guide decision-making for effective public health response while facing intermediate to low-level viral loads in LMICs.

Seasonality plays a crucial role in the transmission dynamics of many infectious diseases, contributing to periodic fluctuations in disease incidence. The previously developed geographically dependent individual-level model (GD-ILM) has been effective in modeling infectious diseases, but does not incorporate seasonal effects, limiting its ability to capture seasonal trends. In this study, we extend the GD-ILM by introducing a seasonally varying transmission component, allowing the model to account for periodic fluctuations in infection risk. Our approach integrates a seasonally forced infection kernel to model periodic changes in transmission rates over time, leading to a novel spatiotemporal kernel. To facilitate efficient and reliable parameter estimation in this high-dimensional setting, we employ the Monte Carlo expectation conditional maximization algorithm. We apply our model to individual-level influenza A data from Manitoba, Canada, examining spatial and seasonal infection patterns to identify high-risk regions and periods, and thus informing targeted intervention strategies. The proposed model's performance is further validated through comprehensive simulation studies. Simulation results confirm that models omitting seasonal components lead to biased spatial parameter estimates under various disease prevalence conditions. To support reproducibility and practical application, we developed the SeasEpi R package publicly available on the comprehensive R archive network (CRAN), which implements the seasonal GD-ILM framework and provides tools for model fitting, simulation, and evaluation. The seasonal GD-ILM offers a more accurate framework for modeling infectious disease transmission by integrating both spatial and seasonal dynamics. It supports more accurate risk assessment and enhances public health responses by enabling timely and location-specific interventions based on seasonal transmission patterns.

Drug overdose deaths in the United States remain a leading cause of preventable mortality. Existing data systems, such as vital statistics and hospital records, often suffer from reporting delays and limited geographic resolution, hindering timely public health responses. To identify high-risk locations for overdose-related emergency calls in Detroit, Michigan, using Risk Terrain Modeling (RTM) and publicly available 911 call data from 2022 to 2024. A retrospective geospatial analysis using RTM was conducted to evaluate the spatial relationship between overdose incidents and built environment features. City of Detroit, Michigan, USA. Emergency call data for overdose-related incidents (N=18034) were analyzed. No individual-level data were used. No intervention was implemented. The study employed RTM as a geospatial method to identify environmental risk factors and predict high-risk locations for overdose events. Relative Risk Scores (RRS) generated from RTM to quantify overdose risk across 250 × 250 m grid cells in Detroit. Overdose-related emergency calls were spatially concentrated. RTM identified 8 significant risk factors, including ATMs, retail locations, and religious organizations. Relative Risk Scores ranged from 1 to 142.5 (mean=9.77, SD=8.55), with 2.7% of locations classified as very high risk. RTM applied to 911 call data offers a timely, place-based approach to identifying overdose risk. Public health agencies may use this method to prioritize harm reduction strategies and allocate resources more effectively.

Influenza A(H1N1) represents a paradigm of viral adaptability and persistent pandemic threat, having shaped public health responses and scientific understanding for over a century. This comprehensive interdisciplinary review synthesizes virological, epidemiological, clinical, and socio-political perspectives on H1N1, from the 1918 "Spanish Flu" pandemic to the contemporary circulation of A(H1N1)pdm09 as a seasonal pathogen. We examine the molecular mechanisms underpinning H1N1's evolutionary success, including its segmented genome facilitating antigenic shift and drift, and its sophisticated repertoire of accessory proteins that modulate host immunity. The review provides novel analyses of major pandemics, re-evaluating the 1918 pandemic through modern genomic archaeology and detailing the complex, decade-long evolutionary pathway that culminated in the 2009 pandemic strain. A significant focus is dedicated to case studies of national responses, with an in-depth examination of Egypt's controversial 2009 intervention—the mass culling of pigs—analyzed through the intersecting lenses of epidemiology, economics, social justice, and cultural politics. The review incorporates the latest scientific advances (2020-2024), including insights from the COVID-19 era on viral co-circulation, immunity debt, and mRNA vaccine platforms. We assess current vaccine effectiveness, antiviral resistance patterns, and the promising development of universal influenza vaccines. Furthermore, the review critically addresses persistent challenges in global health equity, preparedness governance, and the implementation of a truly integrated "One Health" approach. By integrating 100 contemporary references, this work argues that H1N1 is not merely a seasonal nuisance but a persistent biosocial phenomenon that reveals the intricate connections between viral evolution, animal reservoirs, human societies, and public health infrastructure. The review concludes that future mitigation requires sustained investment in equitable surveillance, next-generation countermeasures, and strategies that address the socio-economic determinants of outbreak impact, providing a roadmap for confronting both seasonal influenza and the next inevitable pandemic.

BACKGROUNDDual penicillin- and ciprofloxacin-resistant Neisseria meningitidis causing invasive meningococcal disease (IMD) have recently emerged in association with sequence type (ST) 3587, harbouring ROB-1 β-lactamase (bla ROB-1) and a mutated DNA gyrase (gyrA). These strains pose a threat to current antimicrobial treatment and prophylaxis.AIMWe aimed to characterise the first dual-resistant N. meningitidis ST-3587 isolates harbouring bla ROB-1 and a mutated gyrA identified in Spain.METHODSThree N. meningitidis isolates encoding bla ROB-1 were identified in 2024. They were characterised by whole genome sequencing to determine capsular genogroups, ST and genetic antimicrobial resistance markers. Dated phylogenetic analysis was performed alongside global ST-3587 strains.RESULTSThe three bla ROB-1-encoding isolates belonged to ST-3587, genogroup Y, harboured a T91I mutation in gyrA and showed resistance to penicillin and ciprofloxacin. These isolates were obtained from urethral, oropharyngeal and blood samples, each from a different patient. According to the dated phylogenetic analysis of ST-3587 and the presence of bla ROB-1, two clades were defined: clade I and clade II. Within clade II, subclade II.I was identified, comprising isolates which, in addition to bla ROB-1, carried the T91I mutation in gyrA. This subclade included the three Spanish isolates, which exhibited close genetic relatedness.CONCLUSIONThis study documents the emergence of N. meningitidis ST-3587 with dual resistance in Europe, including a documented urogenital infection by this lineage. Continued surveillance of antimicrobial resistance in N. meningitidis, including non-invasive cases, is crucial for timely public health responses and effective IMD prevention strategies.

Sudan's healthcare system has been severely disrupted by the ongoing humanitarian crisis, limiting access to essential services and medications. Understanding health-seeking behaviors during such disruptions is critical to informing culturally appropriate public health responses, particularly regarding traditional medicine use. This study aimed to assessPatterns of Herbal Medicine Utilization for Hypertension During the Sudanese Crisis of 2025. This cross-sectional study was conducted from February to June 2025 among adults with physician-diagnosed hypertension who were prescribed antihypertensive medication at diagnosis. Data were collected using a structured validated questionnaire administered face-to-face using Kobo Toolbox. Convenience sampling yielded 749 valid responses. Data were analyzed using SPSS v27, with statistical significance set at p < 0.05. The mean age was(56.8 ± 11.9) years; (54.1%) were female, (29.8%) were displaced and (50.5%) reported difficulty accessing antihypertensive medications. Herbal medicine use was reported by (91.2%); 65.2% used herbs before and during the crisis, and (19.8%) initiated use after the crisis began. Concurrent use of herb-drug use was reported by (71.7%), while adverse effects were uncommon(5.7%), and mostly mild. Lower income and rural residence were significantly associated with herbal use (p < 0.05). Herbal medicine use was wide spread among hypertensive Sudanese adults during the crisis, largely driven by affordability, accessibility challenges, and cultural familiarity. Given the high rate of concurrent use, public health messaging and clinician training on herb-drug safety should be prioritized.

The primary aim of this paper is to describe the outbreak investigation and public health response to a cluster of mpox cases that occurred in Southeast Queensland; and to investigate transmission dynamics to inform contact management. The transmission of mpox in Australia has continued to circulate among the men who have sex with men community, since the declaration of the global outbreak of clade IIb in 2022. In May 2024, an outbreak investigation was carried out following the admission of an mpox case to a Queensland hospital, which precipitated a response coordinated by two metropolitan public health units (Metro North and Metro South) in Brisbane. A prospective cohort study was conducted to follow up attendees of an intimate group event over a 21-day period. From 21 event attendees, 16 were able to be contacted by public health clinicians, and were included in the cohort. Case histories and their respective contacts were identified and classified as high, medium or low risk. Descriptive statistics were conducted, and relative risk was determined for developing infection after attendance at the group event, when accounting for the level of vaccination against mpox. Whole genome sequencing was performed on collected pathology specimens, and phylogenetic analysis was conducted to support epidemiological investigations. A total of ten cases of mpox were detected, among a cohort of 16 males with differing levels of vaccination. Transmission of mpox occurred exclusively among high-risk contacts; no transmission was observed to medium- or low-risk contacts. Laboratory investigations revealed that all cases were of human MPXV clade IIb. Complete vaccination was a protective factor against development of mpox (relative risk = 0.33; 95% confidence interval: 0.06-1.88), compared with partial or no vaccination, after attendance at the high-risk exposure event. This outbreak resulted in 34 contacts, of which one high-risk contact became a secondary case. Findings from this investigation suggest there is less urgency for follow-up of household contacts and other medium- and low-risk contacts of mpox, compared with high-risk contacts. Fostering a rapport during telephone interviews with cases and contacts was found to be crucial to the overall attainment of accurate case histories, highlighting the need for the development of trust when interacting with members of priority groups. This outbreak investigation describes a comprehensive public health response attributed to the coordination of a range of public health workers in the Southeast Queensland area.

We report the re-emergence of dengue virus serotype 3 (DENV-3) in Paraguay after 15 years of absence. Twelve laboratory-confirmed cases were detected in early 2025 in the Asunción metropolitan region. Genomic sequencing identified DENV-3 genotype III, lineage B.3.2, indicating a new introduction of an emerging lineage rather than renewed local transmission. Phylogenetic analyses support recent introduction events, underscoring the importance of strengthened genomic surveillance to enable early detection, track viral introductions, and inform public health responses in settings with intense dengue transmission.

The STANDARD M10 Flu/RSV/SARS-CoV-2 Fast assay (M10 Fast), recently CE-marked, is an updated version of the STANDARD M10 Flu/RSV/SARS-CoV-2 assay. It includes additional gene targets to improve sensitivity and coverage and reduces run time from 60 min to 36 min. This study evaluated the analytical and clinical performance of the M10 Fast assay. A total of 664 nasopharyngeal swab specimens (108 influenza A-positive, 119 influenza B-positive, 79 respiratory syncytial virus [RSV]-positive, 165 SARS-CoV-2-positive, 2 influenza A/RSV co-positive, 1 RSV/SARS-CoV-2 co-positive, and 190 negative), confirmed by the BIOFIRE Respiratory Panel 2.1 plus (RP2.1plus), were tested in parallel using the M10 Fast assay and the Allplex SARS-CoV-2/FluA/FluB/RSV assay (Allplex). RNA standards were serially diluted and tested with the M10 Fast assay to determine the limit of detection (LOD). Using RP2.1plus as the reference standard, the M10 Fast assay demonstrated sensitivities of 98.2%, 100%, 95.1%, and 100% for influenza A, influenza B, RSV, and SARS-CoV-2, respectively. The Allplex assay showed sensitivities of 88.2%, 100%, 91.5%, and 100% for the same viruses. Both assays exhibited high specificity (>99%). The LODs of the M10 Fast assay were 7.8, 35.3, 532.7, 34.7, and 88.0 copies/mL for influenza A, influenza B, RSV, and SARS-CoV-2 ORF1ab/E and N genes, respectively, and were lower than previously reported Allplex LODs, except for RSV. The M10 Fast assay reliably detects influenza A and B, RSV, and SARS-CoV-2 with high sensitivity and specificity, demonstrating performance comparable to or exceeding that of the widely used Allplex assay.IMPORTANCEThe STANDARD M10 Flu/RSV/SARS-CoV-2 Fast assay (M10 Fast) is an updated version of the STANDARD M10 Flu/RSV/SARS-CoV-2 assay. This study demonstrates that the M10 Fast assay reliably detects influenza A and B, respiratory syncytial virus (RSV), and SARS-CoV-2 with high sensitivity and specificity, including improved detection at low viral loads. Its enhanced performance and shorter turnaround time support timely clinical decision-making and strengthen public health responses, particularly during periods of cocirculation of influenza, RSV, and SARS-CoV-2.

Global epidemiological trend of Klebsiella pneumoniae ST23: emergence of KL57 lineage carrying dual carbapenemases.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent of COVID-19, has affected millions of people worldwide and significantly impacted public health. The detection of viral RNA in the feces of infected individuals prompted several countries to adopt wastewater-based epidemiology (WBE) as a tool to monitor SARS-CoV-2 circulation within communities. However, most surveillance studies have focused on large urban centers. This study aimed to analyze the presence and persistence of SARS-CoV-2 in wastewater from two small Brazilian towns with low socioeconomic indicators, limited sewage coverage, and low population density, located in northern Minas Gerais. Wastewater samples were collected biweekly over 12 months, between 2023 and 2024, from three sampling points in Salinas and one in Rubelita. Viral RNA was concentrated using electronegative membranes, and SARS-CoV-2 detection was performed using real-time quantitative polymerase chain reaction. SARS-CoV-2 RNA was detected at all sampling points, with a high frequency of positive samples observed in May, June, October, November 2023, and January 2024. Notably, viral RNA was detected even after the World Health Organization declared the end of the global health emergency on May 5, 2023, and in the absence of officially reported human cases. These findings underscore the value of wastewater surveillance as a tool for monitoring SARS-CoV-2, particularly in areas with limited clinical testing capacity. The study highlights the potential of WBE to detect ongoing viral transmission across diverse urban and socioeconomic contexts, including regions with case underreporting and challenges in mass testing, thereby supporting public health preparedness and response.