Anthropogenic landscape transformations are fundamentally reshaping the epidemiology of vector-borne diseases (VBDs), yet their causal impacts remain poorly quantified across diverse ecological and socio-economic contexts. This study evaluates the causal effect of the Human Footprint (HFP) on the transmission dynamics of malaria, dengue, and visceral leishmaniasis in Colombia. We conducted an ecological analysis using municipal-level retrospective data from Colombia's National Public Health Surveillance System (SIVIGILA, 2007-2019). Epidemiological records were integrated with environmental and socio-economic indicators, and a Double Machine Learning (DML) framework was applied to estimate the Average Treatment Effect (ATE) and Conditional Average Treatment Effect (CATE) of HFP on excess disease cases. Model robustness was assessed through refutation tests and non-parametric sensitivity analyses for unmeasured confounding. A one-standard-deviation increase in HFP significantly reduced the probability of excess malaria cases by 7.6 percentage points (ATE = -0.076, 95% CI: -0.094 - -0.058), an effect that was more pronounced in socio-economically deprived municipalities and modulated by temperature and precipitation gradients. Conversely, the ATE for dengue and visceral leishmaniasis was not different from zero. Robustness tests suggest the presence of residual bias, but the sensitivity test points to a low plausibility of an unobserved confounder. These findings underscore the necessity of integrating HFP monitoring into public health planning to design context-specific, multi-sectoral interventions that address the evolving landscape of VBD risk in rapidly transforming regions.

Background: By mid-2024, >13 billion COVID-19 vaccine doses had been administered globally, with totals continuing to rise into 2025, yet persistent inequities remain in low- and middle-income countries (LMICs). We examined spatial determinants of COVID-19 vaccination uptake (proportion of eligible persons vaccinated) in Kenya by using the most recent nationally representative survey, the Kenya Demographic and Health Survey 2022. Our central contribution is the detection of seven spatially concentrated vulnerability clusters, complemented by using a Development Index (DI) and equity auditing to guide targeted action. Methods: We integrated socioeconomic, healthcare, environmental, and demographic measures at the Demographic and Health Survey cluster level; quantified spatial dependence (Moran's I; spatial lag models); identified socio-geographic clusters (K-means); estimated variable importance (random forest); and synthesized a DI. Equity was assessed by using the Erreygers Concentration Index (ECI) along two axes: wealth-based (poorest -> richest) and immunization-linked (lowest -> highest routine child immunization coverage). Results: Our results reveal stark geographic disparities: vaccination rates range from 5.93% in Garissa to 46.02% in Nyeri, with urban clusters achieving significantly higher uptake. Key predictors include bank access (financial inclusion), household crowding, and environmental factors (nitrogen dioxide levels, precipitation). The DI correlated positively with uptake and the ECI indicated modest immunization-linked inequality and more pronounced wealth-related inequality. Conclusion: This study underscores the need for targeted interventions, including mobile vaccination units, financial inclusion programs (e.g. M-Pesa subsidies), and the integration of COVID-19 vaccines into routine immunization programs. As Kenya and many LMICs integrate COVID-19 vaccination into routine immunization, our spatial approach, combining DI, cluster detection, and equity metrics, provides an operational toolkit to prioritize underserved areas, inform the placement of service points/mobile teams, and monitor equity as programs transition from campaigns to routine delivery.

Background: The COVID-19 pandemic has exacerbated global health inequities, with low-income countries lagging behind in vaccine coverage. By late 2023, only 36% of Kenyans had received at least one vaccine dose, far below the African Union 60% target. This study examines spatial disparities in COVID-19 vaccination rates across Kenya, exploring how socioeconomic, environmental, and healthcare infrastructure factors shape vaccine access. Unlike previous studies focused on individual determinants, this research employs a spatial epidemiological approach to uncover structural barriers to equitable vaccination. Methods: This study uses data from the 2022 Kenya Demographic and Health Survey (KDHS), integrating socioeconomic, health, and environmental variables across 1,692 georeferenced clusters. Analytical methods include spatial clustering (K-Means), spatial autocorrelation (Moran I), Random Forest regression, and the Erreygers Concentration Index (ECI) to quantify vaccine inequities. A Development Index (DI) was constructed to assess how financial access, living conditions, and healthcare systems influence vaccination rates. Results: Our results reveal stark geographic disparities: vaccination rates range from 5.93% in Garissa to 46.02% in Nyeri, with urban clusters achieving significantly higher coverage. Key predictors include bank access (financial inclusion), household crowding, and environmental factors (Nitrogen dioxide levels, precipitation). Wealth-based inequities (ECI = 0.044) were more pronounced than immunization-linked disparities (ECI = 0.025), highlighting financial barriers as the primary exclusionary factor. Conclusions: This study underscores the need for targeted interventions, including mobile vaccination units, financial inclusion programs (e.g., M-Pesa subsidies), and integration of COVID-19 vaccines into routine immunization programs. Findings offer a replicable geospatial framework for low- and middle-income countries (LMICs), providing data-driven policy recommendations to enhance vaccine equity and pandemic preparedness. Addressing these disparities requires multisectoral approaches that integrate health system strengthening, financial accessibility, and climate resilience to ensure equitable vaccine distribution in vulnerable populations. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Demographic and Health Surveys (http://www.measuredhs.com) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data are available in a public, open-access repository. The data that support the findings of this study are available from the Demographic and Health Surveys (http://www.measuredhs.com), but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. However, data are available from the authors on reasonable request and with the permission of Demographic and Health Surveys. We sought and were granted permission to use the core data set for this analysis by Measure DHS.

Coronavirus Disease 2019, caused by severe acute respiratory coronavirus 2, has been an ever-evolving disease and pandemic, profoundly impacting clinical care, drug treatments, and understanding. In response to this global health crisis, there has been an unprecedented increase in research exploring new and repurposed drugs and advancing available clinical interventions and treatments. Given the widespread interest in this topic, this review aims to provide a current summary—for interested professionals not specializing in COVID-19—of the clinical characteristics, recommended treatments, vaccines, prevention strategies, and epidemiology of COVID-19. The review also offers a historical perspective on the pandemic to enhance understanding.

Asian American, Native Hawaiian, and Pacific Islander populations have been underrepresented in research on COVID-19 outcomes. We conducted a cross-sectional study of 5,494 electronic medical records of patients in a large tertiary care health system in the ethnically diverse state of Hawaii, USA. We compared fatality rates for hospitalized patients on the basis of race or ethnicity, age, vaccination status, and sequential organ failure assessment (SOFA) score at admission. Fatality rates varied between racial and ethnic groups but were associated with increasing age across all groups. Fatality rates were closely associated with increasing SOFA score and were inversely associated with the number of COVID-19 vaccinations received. We found that Asian and Pacific Islander groups experienced higher rates of in-hospital death and that death was strongly associated with increased age and SOFA score and with <1 COVID-19 vaccination. Clinicians should be aware of these outcomes when treating COVID-19 patients from these ethnic groups.

Background: Children with disabilities, particularly in low- and middle-income countries (LMICs), face heightened risks of vaccine-preventable diseases due to a range of systemic and social barriers. Although immunization is a fundamental human right and a proven public health intervention, this vulnerable group is often overlooked in policy and practice. Understanding the factors compromising vaccine equity for these children is critical to reducing zero-dose prevalence and improving health outcomes. Methods: This scoping review examined peer-reviewed, gray literature from 2010 to 2024. Searches were conducted in PubMed, Google Scholar, and relevant organizational reports (WHO, UNICEF). Studies addressing children with disabilities and focusing on immunization barriers, interventions, or lessons learned were selected. English-language publications were screened in title/abstract and full-text stages. Key data extracted included population, barriers, and immunization outcomes. Since this review focused on articles in English, this is a key limitation. Results were synthesized thematically to identify recurring patterns and to guide improved interventions and policies. Results: Twelve articles met the inclusion criteria. Key barriers identified were inadequate healthcare infrastructure, insufficient provider training, limited follow-up services in rural regions, societal stigma, and pervasive misconceptions around both disability and vaccines. Factors such as maternal education, logistical support for caregivers, and using low-sensory, inclusive vaccination settings were consistently linked with better outcomes. Effective strategies included mobile vaccination units, tailored interventions (e.g., distraction or sedation techniques), school-based immunization programs, and robust community engagement to address stigma. Lessons learned underscored the importance of flexible, individualized care plans and empowering families through transparent communication. Conclusions: Children with disabilities continue to experience significant gaps in immunization coverage, driven by intersecting barriers at the individual, health system, and societal levels. Scaling tailored interventions, inclusive policies, strengthened infrastructure, and ongoing research can help ensure these children receive equitable access to life-saving vaccinations.

The HIV epidemic in sub-Saharan Africa displays a varied geographical distribution, with particular regions termed as HIV hotspots due to a higher prevalence of infection. Addressing these hotspots is essential for controlling the epidemic. However, these regions, influenced by historical factors, challenge standard interventions. Legacy effects—the lasting impact of past events—play a substantial role in the persistence of these hotspots. To address this challenge of the standard interventions, we propose a shift towards the UNAIDS 95-95-95 targets. Spatial analysis of HIV viral load and antiretroviral therapy coverage can provide a more comprehensive perspective on the epidemic's dynamics. Studies in Zambia and Zimbabwe, using this approach, have revealed disparities in HIV care metrics across regions. By focusing on the UNAIDS 95-95-95 targets, more effective control strategies can be designed, with consideration of both historical and current factors. This approach would offer a solution-oriented strategy, emphasising tailored interventions based on specific regional needs.

PURPOSE:Studies have shown that racial and ethnic minorities are disproportionately affected by COVID-19, with higher rates of hospitalization and in-hospital mortality.Hospital-based patient care can provide valuable insights into patterns of healthcare delivery and utilization among different populations.To determine factors that affect healthcare delivery and utilization in Hawaii during the COVID-19 pandemic, we analyzed data on intensive care unit (ICU) outcomes according to race and ethnicity from a major tertiary care hospital. METHODS:This is an observational study of patients seeking care at the primary adult tertiary care hospital for the state of Hawaii (Queen's Health System) between February 2020 and August 2022.We investigated the association of hospital fatality rates (HFR) in the ICU among self-reported race and ethnicity groups.SARS-CoV-2 infection was confirmed at admission.HFR was assessed by dividing the deaths per all SARS-CoV-2 positive hospitalizations.Races/ethnicities were investigated by subdividing the study population into White, Native Hawaiian, Pacific Islander (PI), Filipino, Japanese, Chinese, other Asian (primarily Southeast Asians), and Black consistent with the Hawaii State Department of Health classifications. RESULTS:In this study, a total of 5,900 medical records were included.Duplicated encounters and related data issues reduced the study population to 5,494 medical records.This study showed that other Asians (62.50) had the highest ICU-associated HFR, followed by Chinese (61.29),Filipino (42.86),Hawaiian (41.18),PI (40.48),Japanese (33.33), and White (30.56).In contrast, Japanese patients had the highest HFR in the non-ICU setting (10.42), followed by other Asians (9.42), Chinese (8.4), Filipinos (7.81), White (5.9),Hawaiian (5.83), and PI (5.44).This study showed Sequential Organ Failure Assessment (SOFA) score upon admission was highest in PIs and Filipinos, and a linear association showing proportional increments of HFR with increasing SOFA scores (R 2 ¼0.944,P<0.001) in predicting HFR.Another significant finding of this study was that HFR increases exponentially with age among all races/ethnicities.The number of COVID-19 vaccinations had a significant relationship with lower HFR in both ICU and non-ICU settings regardless of race/ethnicity.CONCLUSIONS: Among SARS-CoV-2 confirmed hospitalizations, minorities had higher HFR in both ICU and non-ICU settings.Increased SOFA scores also predicted increased HFR in all race/ethnic groups and COVID vaccination status was strongly associated with decreasing HFR.CLINICAL IMPLICATIONS: Understanding the exact factors that contribute to increased HFR in minorities in and out of the ICU needs to be elucidated further.

Background The impact of the COVID-19 vaccination campaign in the US has been hampered by a substantial geographical heterogeneity of the vaccination coverage. Several studies have proposed vaccination hesitancy as a key driver of the vaccination uptake disparities. However, the impact of other important structural determinants such as local disparities in healthcare capacity is virtually unknown. Methods In this cross-sectional study, we conducted causal inference and geospatial analyses to estimate the impact of healthcare capacity on the vaccination coverage disparity in the US. We evaluated the causal relationship between the healthcare system capacity of 2,417 US counties and their COVID-19 vaccination rate. We also conducted geospatial analyses using spatial scan statistics to identify areas with low vaccination rates. Findings We found a positive association between the healthcare capacity of a county and vaccination uptake. We estimated that a 1% increase in the Resource-Constrained Health System Index of a county increases by 0.37% the occurrence of that county in the set of counties classified as low-vaccinated (≤50% vaccination rate). We also found that COVID-19 vaccinations in the US exhibit a distinct spatial structure with defined vaccination coldspots. Interpretation We found that the healthcare capacity of a county is an important determinant of low vaccine uptake. Our study highlights that even in high-income nations, internal disparities in healthcare capacity play an important role in the health outcomes of the nation. Therefore, strengthening the funding and infrastructure of the healthcare system, particularly in rural underserved areas, should be intensified to help vulnerable communities.

ObjectiveTo evaluate the spatial association between the access to broadband and social and health care vulnerability in the United States at the county level.Patients and MethodsData from 3108 counties in the contiguous United States was used in this study. Access to broadband was defined as the percentage of population with a high-speed internet subscription. County-level data for access was obtained from the Survey and American Community Survey Geographic Estimates of Internet Use, 1997-2018. Indexes for resource-constrained health system, health care access barriers, and social vulnerability were obtained from the 2021 Surgo COVID-19 Vaccine Uptake Index and the Centers for Diseases and Control. We used spatial bivariate and multivariate analyses to determine the geospatial association between broadband access and the health care and social determinants. After identifying the geospatial clusters, their rates for the health care and social indexes were compared using generalized linear mixed-effects models.ResultsWe found that the United States exhibits a distinct spatial structure with defined vulnerable communities characterized by a high social vulnerability index, a high health access barrier index, and a high resource-constrained health care system index. However, we found a negative geospatial association between these 3 indexes of vulnerability and the access to broadband. We identified a geographical cluster in the southern part of the country with low broadband access and poor social and health indicators.ConclusionsMost health care–underserved communities in the United States are located in digital deserts with low high-speed internet access. These digital barriers could prevent the successful expansion of digital health care services and might exacerbate health care disparities in these vulnerable communities.

This cross-sectional study analyzes the association between vaccination rates and COVID-19 incidence by county from July to August 2021.

A B S T R A C T Purpose: There is a growing concern about the COVID-19 epidemic intensifying in rural areas in the United States (U.S.). In this study, we described the dynamics of COVID-19 cases and deaths in rural and urban counties in the U.S. Methods: Using data from April 1 to November 12, 2020, from Johns Hopkins University, we estimated COVID-19 incidence and mortality rates and conducted comparisons between urban and rural areas in three time periods at the national level, and in states with higher and lower COVID-19 incidence rates. Results: Results at the national level showed greater COVID-19 incidence rates in urban compared to rural counties in the Northeast and Mid-Atlantic regions of the U.S. at the beginning of the epidemic. However, the intensity of the epidemic has shifted to a rapid surge in rural areas. In particular, high incidence states located in the Mid-west of the country had more than 3,400 COVID-19 cases per 10 0,0 0 0 people compared to 1,284 cases per 10 0,0 0 0 people in urban counties nationwide during the third period (August 30 to November 12). Conclusions: Overall, the current epicenter of the epidemic is located in states with higher infection rates and mortality in rural areas. Infection prevention and control efforts including healthcare capacity should be scaled up in these vulnerable rural areas. (c) 2021 Elsevier Inc. All rights reserved.

The role of geographical disparities of health-related risk factors with anemia are poorly documented for women of reproductive age in sub-Saharan Africa (SSA). We aimed to determine the contribution of potential factors and to identify areas at higher risk of anemia for women in reproductive age in SSA. Our study population comprised 27 nationally representative samples of women of reproductive age (15–49) who were enrolled in the Demographic and Health Surveys and conducted between 2010 and 2019 in SSA. Overall, we found a positive association between being anemic and the ecological exposure to malaria incidence [adjusted odds ratio (AOR) = 1.02, 95% confidence interval (CI) 1.02–1.02], and HIV prevalence (AOR = 1.01, CI 1.01–1.02). Women currently pregnant or under deworming medication for the last birth had 31% (AOR = 1.31, CI 1.24–1.39) and 5% (AOR = 1.05, CI 1.01–1.10) higher odds of having anemia, respectively. Similarly, women age 25–34 years old with low education, low income and living in urban settings had higher odds of having anemia. In addition, underweight women had 23% higher odds of suffering anemia (AOR = 1.23, CI 1.15–1.31). Females with low levels of education and wealth index were consistently associated with anemia across SSA. Spatial distribution shows increased risk of anemia in Central and Western Africa. Knowledge about the contribution of known major drivers and the spatial distribution of anemia risk can mitigate operational constraints and help to design geographically targeted intervention programs in SSA.

This is a brief report on an unusual observation regarding COVID-19 cases. The State of Hawaii is one of the most remote of the Pacific islands and the population is approximately 1.4 million. The racial and ethnic diversity is very high. For example, white Caucasians comprise ∼25%, Asians including Japanese, Chinese, and other Asians account for ∼30%, Hawaiians for 20%, and Pacific Islanders mostly from Micronesia and Samoa comprise ∼4%. We discovered that the COVID-19 rate in the latter group was up to 10 times that in all of the other groups combined and they accounted for almost 30% of cases. Moreover, we are unaware of COVID-19 transmission from Pacific Islanders to islanders with other ethnicities. Thus, there is an epidemic within the epidemic in Hawai'i.

ABSTRACT Background The novel coronavirus SARS-CoV-2 (COVID-19) emerged in December 2019 in Wuhan, China and has spread since then to around 210 countries and territories by April 2020. Consequently, countries have adopted physical distance measures in an attempt to mitigate the uncontrolled spread of the virus. A critical question for policymakers to inform evidence-based practice is if and how physical distance measures slowed the propagation of COVID-19 in the early phase of the pandemic. Methods This study aims to quantify the effects of physical distance mitigation measures on the propagation of the COVID-19 pandemic. Data from John Hopkins University on confirmed cases and testing data from the Our World in Data were used in an interrupted time series analysis to estimate the effects of physical distance measures on the growth rates of the pandemic in 12 countries of Asia, Africa, and Europe. Findings We found that physical distance measures produced a significant decrease in the growth rates of the COVID-19 pandemic in five countries (Austria, Belgium, Italy, Malaysia, and South Korea). The test-positivity rate was significant in understanding the slowing growth rate of COVID-19 cases caused by the mitigation measures, as it provides important context that is missing from analysis based only on confirmed case data. Interpretation Physical distance interventions effectively slowed the progression of the COVID-19 pandemic. The results of this study could inform infectious disease mitigation policies based on physical distance measures by quantifying the differential health outcomes of a pandemic with and without physical distance interventions. RESEARCH IN CONTEXT Evidence before this study The SARS-CoV-2 is a new virus identified in December 2019 in the province of Wuhan, China and as never before, a remarkable number of studies and reports have been released since the start of the pandemic. Several studies have used confirmed COVID-19 cases to estimate the growth rate of the pandemic. However, many studies have discussed limitations of including only confirmed cases attributable to the lack of information about testing protocols and testing rates among different countries. Finally, some researchers proposed the analysis of reported deaths by COVID-19 as a potential solution. However, this metric results in biased estimates because deaths by COVID-19 are known to be underreported. Added value of this study We designed and implemented analytic methods based on our previous research applied to different infectious disease epidemics, to add evidence related to the impact of non-pharmaceutical containment strategies on the temporal progression of the COVID-19 pandemic. Specifically, this study adds quantitative evidence about the effects of physical distance measures on limiting the propagation of COVID-19 pandemics in different countries. Additionally, we included testing data in the analysis to assess intra- and inter-country variation in testing growth rates. We hypothesized that the test-positivity rate is an approximation to the incidence of the COVID-19 pandemics in countries with high testing rates. Additionally, we hypothesize that a significant decrease in the pandemic over time could be identified by a significant decrease in the confirmed cases along with a significant decrease in the test-positivity rate. Our results quantified the potential effects of physical distance interventions on the COVID-19 pandemic progression under different levels of testing and enforcement of mitigation policies. Implications of all the available evidence Our analysis could lead to better approaches for estimating the effects of physical distance measures on the time course of infectious diseases. In addition, our analysis highlights the potential bias of estimated COVID-19 growth rates based only on confirmed cases. The results from our study could inform strategies for mitigating the COVID-19 or other future pandemics, especially in countries in an earlier stage of a pandemic.

Background Insecticide-treated net (ITN) use is the core intervention among the strategies against malaria in sub-Saharan Africa (SSA) and the percentage of ITN ownership has increased from 47% in 2010 to 72% in 2017 across countries in SSA. Regardless of this massive expansion of ITN distribution, considerable gap between ownership and use of ITNs has been reported. Using data from more than 100,000 households in Central and East Africa (CEA) countries, the main aim of this study was to identify barriers associated with low ITN use and conduct geospatial analyses to estimate numbers and locations of vulnerable children living in areas with high malaria and low ITN use. Methods Main sources of data for this study were the Demographic and Health Surveys and Malaria Indicator Surveys conducted in 11 countries in CEA. Logistic regression models for each country were built to assess the association between ITN ownership or ITN use and several socioeconomic and demographic variables. A density map of children under 5 living in areas at high-risk of malaria and low ITN use was generated to estimate the number of children who are living in these high malaria burden areas. Results Results obtained suggest that factors such as the number of members in the household, total number of children in the household, education and place of residence can be key factors linked to the use of ITN for protecting children against malaria in CEA. Results from the spatiotemporal analyses found that although total rates of ownership and use of ITNs across CEA have increased up to 70% and 48%, respectively, a large proportion of children under 5 (19,780,678; 23% of total number of children) still lives in high-risk malaria areas with low use of ITNs. Conclusion The results indicate that despite substantial progress in the distribution of ITNs in CEA, with about 70% of the households having an ITN, several socioeconomic factors have compromised the effectiveness of this control intervention against malaria, and only about 48% of the households protect their children under 5 with ITNs. Increasing the effective ITN use by targeting these factors and the areas where vulnerable children reside can be a core strategy meant to reducing malaria transmission.

IntroductionTanzania is one of the 14 priority countries in sub-Saharan Africa scaling up voluntary medical male circumcision (VMMC) for HIV prevention. In this study, we assessed the progress of VMMC by evaluating changes in the spatial structure of male circumcision (MC) prevalence and identifying age groups with low MC uptake.MethodsWe use data from two waves of the Demographic and Health Survey (DHS) conducted in Tanzania in 2011–2012 and 2015–2016. MC incidence rate was estimated using a method developed to calculate incidence rates from two successive cross-sectional surveys. Continuous surface maps of MC prevalence were generated for both DHS waves and compared with identified areas with high MC prevalence changes and high density of uncircumcised males.ResultsNational MC prevalence in Tanzania increased from 73.5% in 2011–2012 to 80.0% in 2015–2016. The estimated national MC incidence rate was 4.6 circumcisions per 100 person-years (py). The lowest circumcision rate was observed in males aged 20–24 years, with 0.61 circumcisions per 100 py. An estimated 1 567 253 males aged 15–49 years residing in low-MC prevalence areas were uncircumcised in 2015–2016.ConclusionTanzania has shown substantial progress in the implementation of VMMC. However, extensive spatial variation of MC prevalence still exists in the country, with some areas having an MC prevalence <60%. Here, we identified locations where VMMC needs to be intensified to reach the ~1.5 million uncircumcised males age 15–49 living in these low-MC areas, particularly for men aged 20–34.

Background : It is well documented that Egypt has the highest prevalence of hepatitis C virus (HCV) in the world. The recent development of fast acting, highly effective direct acting antiviral drugs (DAAs), has opened the possibility of treating and curing HCV infection in the Egyptian population on large scale. Methods : A screening demonstration project was implemented in southern Egypt in and around the city of Luxor. Free screening and if indicated, treatment, was offered to those 16 years or older for anti-HCV antibody (anti-HCV) and hepatitis B virus surface antigen (HBsAg) using third generation enzyme immunoassays (Enzygnost® Anti-HCV and HbsAg). Statistical methods included estimation of odds ratios (OR) and 95% confidence intervals (95% CI). Results: There was a large turnout of 67,042 persons who were screened in a 12-month period starting in June 2106. 31,965 males (47.7%) and 35,077 females (52.3%) were screened with a mean age of 43.6±14.3 years. 9,701 patients (14.5%) were positive for anti-HCV and 2,950 (4.4%) for HBsAg. Prevalence of anti-HCV was significantly higher in males than females (19.67% vs.9.73% OR=2.27; CI 2.2 to 2.4; p<0.001) and the same for HBsAg (6.2% vs. 2.8% OR=2.3; CI 2.2 to 2.5; p<0.001). The prevalence of anti-HCV was significantly associated with age (p<0.001), ranging from between 1-4% in individuals below the age of 40 years, then increased steadily to 42% at age 60 followed by a precipitous decline in age specific prevalence. Conclusions: The results showed unanticipated patterns of anti-HCV and HBsAg by age and gender in contrast to previous reports on this unique HCV epidemic in Egypt. Moreover, the results provide essential information for effective planning, design, and evaluation for future Egyptian national mass screen and treatment programs.