Dear Ms. Linard,

Thank you very much for submitting your manuscript "Viral haemorrhagic fevers in Central Africa: A scoping review on spatial risk factors" for consideration at PLOS Neglected Tropical Diseases. As with all papers reviewed by the journal, your manuscript was reviewed by members of the editorial board and by several independent reviewers. The reviewers appreciated the attention to an important topic. Based on the reviews, we are likely to accept this manuscript for publication, providing that you modify the manuscript according to the review recommendations.

The reviewers have some clarifying requests that will improve the manuscript. One reviewer noted that some literature on human cases seemed to be missing so please add. Several reviewers noted that the manuscript was quite long and suggested shortening sections - please consider whether all sections are necessary and justify if they are.

Please prepare and submit your revised manuscript within 30 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email.

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Thank you again for your submission to our journal. We hope that our editorial process has been constructive so far, and we welcome your feedback at any time. Please don't hesitate to contact us if you have any questions or comments.

Sincerely,

Brianna R Beechler, Ph.D., DVM

Academic Editor

PLOS Neglected Tropical Diseases

Andrea Marzi

Section Editor

PLOS Neglected Tropical Diseases

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The reviewers have some clarifying requests that will improve the manuscript. One reviewer noted that some literature on human cases seemed to be missing so please explain or add. Several reviewers noted that the manuscript was quite long and suggested shortening a few points - please consider whether all components are necessary and justify.

Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: I reviewed the Scoping Review of the spatial risk factors for VHFs. Accordingly, the authors used the appropriate protocol for the review. However, the period from which the data sets were extracted is misrepresented in the abstract line 26-27 and elsewhere. In line 262, it is stated that articles in this review encompasses period from 1993-2023 which correct. hence the authors should rectify this anomaly. The period of the scoping review should also appear in the title.

Reviewer #2: see Summary and General Comments

Reviewer #3: It would be interesting for the authors to explain why they chose to do a scoping review instead of a literature review and what would be the pros and the cons of using one versus the other.

The scoping review is intended also to use documentation and bibliography outside of the peer-review sources but the authors focused only on the published literature. Although the authors mentioned this in the limitations, it would be important to also mention what would be the impact on the results and conclusions of the study.

It is not clear how the authors decided to group the risk factors by themes and sub-themes. If would be important for them to clarify the rationale of the grouping.

If will be interesting for the authors to specify more on the tools used for the extraction and analysis of the data from the review. It is mentioned in line 250 that a pre-tested form was used, but this has not been shared and it is difficult to assess how the extraction of the data was done. If any other tool has been used for this study it is important to mention it and to add a reference to the tool.

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Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: The output of the scoping reviews are well presented in the PRISMA Flow chart and results well captured in respective tables and figures.

Reviewer #2: see Summary and General Comments

Reviewer #3: I found this part of the paper too long and not well structured. For each risk factors i would add sub-sections describing the key elements that the authors would like to discuss about. These sub-sections would be the same for each risk factor. The authors could I think to use as a reference the summary table in the supplement material (S2). The problem is that it seems like it is missing several factors including all the Human ones. If completed, that table would be very useful as a synthesis of the review of all the risk factors and could also be part of the main text of the article.

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Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: The conclusions are supported by the data. The authors may need to rewrite the opening statement in the abstract as it appears exeggerated and not exactly true.

Reviewer #2: see Summary and General Comments

Reviewer #3: It is always interesting to reflect on the impact of the limitations of the study may have on the results and conclusions. The limitations sections could be further developed.

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Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: Revision of the opening statement and clarifying the priod of the review and correcting the text accordingly

Reviewer #2: (No Response)

Reviewer #3: Lines 572 and 573 - It is not clear to what the authors are referring to when citing that certain species of wildlife had a presumed role on something that the authors did not specified.

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Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: The Scoping review with its data presentation and discusion provides some good insights on the spatial risk factors for VHFs transmission

Reviewer #2: The manuscript provides a valuable and comprehensive review of spatial risk factors for viral hemorrhagic fevers (VHFs) in Central Africa. With some revisions and additional details, it has the potential to make a significant contribution to the field, informing future research and public health efforts. To enhance its impact, consider the following suggestions:

Introduction:

1. Include specific examples of past VHF outbreaks in Central Africa to enhance context and relevance.

2. Clarify the rationale for focusing on spatial risk factors, distinguishing them from other types of risk factors.

Methodology:

3. Clearly describe the process of data extraction and synthesis to ensure reproducibility.

4. Mention any limitations encountered during the literature search and data extraction phases.

5. For the study area, Nigeria is a West African country and Not Central Africa. Edit accordingly.

Results:

6. Consider adding a map of the study area that visually represents the spatial distribution of VHFs across the countries covered in this study. This would enhance the manuscript's visual appeal and clarify the geographic spread of different VHFs.

7. Line 290: To improve clarity, label each circle (category) as human, animal and environmental.

Discussion and Conclusions:

8. Discuss the implications of the findings for public health policy and practice in Central Africa.

9. Suggest potential future research directions to address remaining unanswered questions about VHF epidemiology.

Word Count Reduction:

With a word count exceeding 17,000 words, the manuscript is quite lengthy, particularly for a review article. I recommend revising all sections to reduce the word count, ensuring that the content remains concise and focused.

- In the Introduction, limit background information to what is essential for understanding the study’s objectives.

- In the Methodology, streamline descriptions by focusing on the key aspects of the methodology. If permitted, consider moving detailed methodological information to supplementary materials.

- In the Results, summarize key findings, avoid repetition, and emphasize the most critical data.

- In the Discussion, be concise and focused, avoiding repetition of results, and concentrate on interpretation, implications, and future research.

Reviewer #3: The authors have done a very detailed and comprehensive scoping review of the spatial risk factors that have been reported in the literature. While it may be too extensive, specially the results section, for the a peer reviewed paper, this study provides a good reference for colleagues working in the preparation and response to VHF outbreaks. The One Health approach mentioned in the conclusion is very appropriate in the context of VHFs and it is important that the actors involved in the surveillance and response to outbreaks are aware of the interactions between hosts, environment and humans.

But this paper could benefit from a more synthetic presentation of the results and more clarity on the methods used.

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Reviewer #1: Yes: Lawrence Mugisha

Reviewer #2: No

Reviewer #3: No

Figure Files:

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References

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article's retracted status in the References list and also include a citation and full reference for the retraction notice.

https://www.editorialmanager.com/pntd/Response to ReviewersRevised Manuscript with Track ChangesManuscript

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

Additional Editor Comments:

Reviewers' comments:

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: (No Response)

Reviewer #2: (No Response)

Reviewer #3: Thank you for specifying the methods and the tools used for the data extraction. It is much more clear now how this process was done.

**********

Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: (No Response)

Reviewer #2: (No Response)

Reviewer #3: (No Response)

**********

Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: (No Response)

Reviewer #2: (No Response)

Reviewer #3: I still think that the limitations should be improved. Instead of just describing the limitations i think the authors should also try to go further and describe what could be the impact on the conclusions of the review. For example, you mention: "During data extraction and synthesis phases, a semantic challenge arose because various terms were used by authors to describe the different epidemiological processes, notably: introduction, emergence, re-emergence, transmission, infection, incidence, maintenance, occurrence, exposure, distribution. We decided to group them together in such a way as to best describe two main types of process, namely emergence and maintenance. Another limitation..." In this example you describe the limitation and then jump directly to the next limitation. My apologies if i didn't describe well my concern in the original comment.

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Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

Reviewer #3: I have a small comment regarding the new map included in the manuscript (Figure 1). The pie charts are very difficult to read, specially when the pie charts are very small. While i think the purpose of the map is good, i would suggest to use other type or representation and to use patterns instead of colors (thinking about potential color blind readers). You could use a choropleth map with the color intensity representing the number of cases (as it is intensity of one color it should be easy to look at even for color blind readers). Then for each country, as they are not many, you could use the same chart size to put either a bar chart of a pie chart (with a line pointing outside of the country boundaries for small countries) to represent the proportion of each VHF.

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Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: (No Response)

Reviewer #2: Thank you for revising the manuscript. Please consider the following suggestions to improve clarity and accuracy:

1. Title Revision

The current title suggests the review is limited to environmental or strictly spatial factors. However, the study covers a broader range of determinants. Updating the title to reflect this scope will enhance clarity and inclusivity. A suggested title is “Determinants of Viral Hemorrhagic Fever Risk in Africa's Tropical Moist Forests: A Scoping Review of Spatial, Socio-economic, and Environmental Factors.”

2. Broaden the Definition of “Spatial Risk Factors”

Consider broadening the definition of "spatial risk factors" to include determinants that, while not strictly spatial, are spatially aggregatable and relevant for disease mapping. Terms like “spatial and spatially aggregatable determinants” or “spatially relevant determinants” could better capture the scope, ensuring readers understand the rationale for including socio-economic, political, and environmental factors.

3. Clarification of Spatially Mappable Factors

In lines 174-176, the statement that “non-spatial risk factors cannot be spatially mapped” may need refinement. Certain demographic and pathogen-related data (e.g., age, gender, vector competence) can indeed be spatially analyzed when linked with geographic or health district data. Clarifying how such factors might be included in spatially informed risk assessments could enhance readers’ understanding of the scope and potential applications.

Reviewer #3: Thank you very much to the authors for considering all my comments. I welcome the reduction of the length of the manuscript that makes it much easier to read and to follow.

**********

PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: Yes:  Lawrence Mugisha

Reviewer #2: No

Reviewer #3: No

Figure resubmission:https://pacev2.apexcovantage.com/Reproducibility:https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols

Dear Ms. Linard,

We are pleased to inform you that your manuscript 'Determinants of Viral Haemorrhagic Fever Risk in Africa's Tropical Moist Forests: A Scoping Review of Spatial, Socio-economic, and Environmental Factors' has been provisionally accepted for publication in PLOS Neglected Tropical Diseases.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

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Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Neglected Tropical Diseases.

Best regards,

Brianna R Beechler, Ph.D., DVM

Academic Editor

PLOS Neglected Tropical Diseases

Andrea Marzi

Section Editor

PLOS Neglected Tropical Diseases

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

***********************************************************

The authors have addressed reviewer comments sufficiently well and the manuscript is ready for publication.

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