Respiratory syncytial virus vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine

BACKGROUND

Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection, hospitalisation and death in adults.

METHODS

Based on evidence regarding the impact of RSV on adult populations at risk for severe infection and the efficacy and safety of RSV vaccines, the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine endorses this position paper with recommendations to prevent RSV-associated disease and its complications in adults through vaccination.

CONCLUSION

The RSV vaccine is recommended for people aged ≥50 years with risk factors (chronic obstructive pulmonary disease, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, chronic liver disease, immunocompromise, frailty, dementia, and residence in a nursing home) and all persons aged ≥60 years. If it cannot be made available to this population, then the vaccine should be prioritised for individuals aged ≥75 years and those aged ≥50 years with risk factors. The vaccine should preferably be given between September and November and can be co-administered with the influenza vaccine. Ongoing studies on RSV vaccines may justify extending these recommendations in the future.

Current status of immunisation for herpes zoster

Herpes zoster (HZ) is increasingly common in the aging and is experienced by approximately one in three people in their lifetime. It is also relatively common in immune-compromised people. Acute HZ causes severe pain, reduced quality of life and severe complications, including prolonged pain, or postherpetic neuralgia (PHN), and ocular zoster, which may rarely progress to blindness. In severely immune-compromised people disseminated zoster may affect the brain and liver. A second-generation vaccine, the Recombinant Zoster Vaccine, consisting of recombinant viral glycoprotein E and the Adjuvant System 01 (AS01B), now offers >90% efficacy against HZ and associated complications in immune-competent people. Efficacy persists above 80% for 11 years. In severely immune-compromised patients, the vaccine is safe with efficacy and/or immunogenicity of 68-87%. There is also excellent immunogenicity for those on JAK inhibitors and corticosteroid therapy. The vaccine offers a paradigm for successful and durable immunization in the aging and immune-compromised.

Demographics and clinical burden of disease among RSV-hospitalized older adults in Italy: A retrospective cohort study

Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection and can lead to severe disease in older adults or those with comorbidities. This analysis aims to evaluate the demographic and clinical burden of RSV hospitalizations among older adults in Italy and inform potential preventative strategies. Adults aged ≥50 years with ≥1 hospitalization discharge diagnosis for RSV from 2010 to 2021 were included. Demographic characteristics before the first RSV hospitalization and clinical outcomes during this hospitalization and the 12 months following are described. Of the 243 patients, mean (SD) age was 73.7 (13.1) years, 40.7% were male, and the most common comorbidities were chronic obstructive pulmonary disease (37.9%), diabetes (21.8%), and heart failure (15.2%). Mean length of index hospitalization was 17.0 days, during which 9.1% of patients died. At index or during the 12-month follow-up, 5.8% had an intensive care unit admission, 61.3% were prescribed antibiotics, 8.2% had a stroke, and 3.3% had an acute myocardial infarction. During the 12-month follow-up, approximately, half of patients experienced worsening of preexisting comorbidities, with notable rates of re-hospitalization and mortality (44.4% and 29.6%). This study shows a high clinical burden of RSV among older adults in Italy, emphasizing a need for improved RSV surveillance, and may guide policymakers and healthcare providers in making informed recommendations for, and implementation of, RSV vaccination in Italy.

PCV20 for the prevention of invasive pneumococcal disease in the Mexican pediatric population: A cost-effectiveness analysis

The introduction of a pneumococcal conjugate vaccine (PCV) covering 13 serotypes (PCV13) into the Mexican pediatric national immunization program (NIP) has substantially reduced the burden of pneumococcal disease (PD) since 2010. This study aimed to estimate the impact of replacing either PCV13 or 15valent PCV (PCV15) with 20-valent PCV (PCV20) in the Mexican pediatric NIP. A decision-analytic Markov model was developed to compare the cost-effectiveness of PCV20 versus lower-valent vaccines from a Mexican public health sector (payer) perspective over 10 years. Epidemiological and cost inputs were sourced from Mexican data. Direct and indirect vaccine effects were estimated using PCV13 clinical effectiveness, 7-valent PCV efficacy studies, and PCV13 impact data in Mexico. The estimated disease and cost impact of PCV20 was compared with PCV13 and PCV15, all under a 2 + 1 dosing schedule. A discount rate of 5% per annum was applied to costs and health outcomes. Model robustness was evaluated through sensitivity analyses, including deterministic sensitivity analysis (DSA), probabilistic sensitivity analysis (PSA), and additional scenario assessments. PCV20 was estimated to provide considerably more health benefits than both comparators by averting more cases of PD compared with both PCV13 and PCV15, as well as a total cost saving of over 10 billion Mexican pesos. The DSA, PSA, and scenario assessments confirmed minimal deviation from the base case. Therefore, the introduction of PCV20 (2 + 1) into the Mexican pediatric NIP is expected to reduce the burden of PD and medical costs compared with lower-valent alternatives.

Expert consensus and recommendations on the live attenuated hepatitis A vaccine and immunization practices in India

While Hepatitis A Virus (HAV) vaccination in global immunization programs has shown a virtual elimination of the disease within few years of the vaccination program, changing epidemiological landscape in India underscores the need for evidence-based, updated guidance on immunization practices. In May 2024, a panel of 15 distinguished opinion leaders and an organizing committee convened for an intensive, face-to-face advisory board meeting on high burden of HAV infection among adults, increased mortality rate in adolescents, symptomatic presentation in children, and evolving landscape globally and within India. Extensive comparable deliberations on long-term follow-up data from India and data from country of origin advocated immunogenicity, tolerability, and long-term protective effects of single-dose live attenuated HAV vaccine in children. Finally, a consensus was achieved on recognition of increased global attention toward HAV prevention through vaccination coverage. The need for a single dose of live attenuated HAV vaccine was an important outcome of this meeting.

Health economic evaluation of implementing a universal immunization program with nirsevimab compared to standard of care for the prevention of respiratory syncytial virus disease in Canadian infants

Respiratory syncytial virus (RSV) is a highly contagious pathogen and a leading cause of severe lower respiratory tract illness (LRTI) in infants and young children, irrespective of risk factors. Nirsevimab, an extended half-life monoclonal antibody, was approved in Canada in 2023 as a passive immunizing agent for the prevention of RSV LRTI. This study evaluated the optimal price per dose (PPD) at commonly accepted willingness-to-pay (WTP) thresholds among Canadian infants compared to the current standard of care (i.e. palivizumab for preterm infants and those with specific medical conditions). A static decision tree model was developed to assess the impact of nirsevimab on RSV-related health and economic outcomes among Canadian infants - including outpatient physician and emergency department visits, inpatient hospitalizations including intensive care unit (ICU) admissions and mechanical ventilation, and the associated healthcare costs of these outcomes. The model utilized Canadian epidemiological and cost inputs where possible, adopting a societal perspective. Compared to the standard of care, nirsevimab was expected to prevent 47,609 RSV-related health events, including 2,296 hospitalizations and a reduction of approximately $45 million in direct healthcare costs. At a WTP threshold of $50,000 per quality-adjusted life-year (QALY), the estimated base case PPD was $536, based on average cost assumptions across several costing scenarios. These findings suggest that universal immunization with nirsevimab could significantly reduce the health and economic burden of RSV among Canadian Infants.

Short-term antiretroviral therapy may not correct the dysregulations of plasma virome and cytokines induced by HIV-1 infection

An expansion of plasma anelloviruses and dysregulation of inflammation was associated with HIV-1 infection. However, how antiretroviral therapy (ART) affects the dynamics of plasma virome and cytokine profile remains largely unknown. To characterize the dynamics of plasma virome and cytokines in HIV-1-infected individuals before and during the first year of ART, a cohort of 26 HIV-1-infected individuals and 19 healthy controls was recruited. Blood samples were collected and subjected to metagenomic analysis and the measurement of 27 cytokines. Metagenomic analysis revealed an increased abundance and prevalence of human pegivirus type 1 (HPgV-1) and a slightly decreased diversity and abundance of anellovirus in plasma of HIV-1-infected individuals after ART. No obvious impact was observed on other plasma commensal viruses. Increased abundance and prevalence of HPgV-1 were further confirmed by RT-qPCR assay in a larger cohort of 114 HIV-1-infected individuals. Notably, most dysregulated cytokines were not fully restored by ART, with extremely abnormal levels of IL-10, GM-CSF, VEGF, and eotaxin, and a significantly increased level of plasma I-FABP. Anelloviruses showed significantly negative correlations with other commensal viruses except HPgV-1 but had positive correlations with several anti-inflammatory and Th1 cytokines. These results suggest that short-term ART may not significantly correct the virome and cytokine dysregulations induced by HIV-1 infection. The results highlight a need for further investigation into the long-term effects of ART on virome and cytokine profiles in HIV-1-infected individuals.

Cost-effectiveness of bivalent respiratory syncytial virus prefusion F vaccine for prevention of respiratory syncytial virus among older adults in Germany

INTRODUCTION

Among older adults, lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) is common. We evaluated the cost-effectiveness of bivalent RSV prefusion F protein-based vaccine (RSVpreF) for prevention of RSV-LRTI among older adults in Germany.

RESEARCH DESIGN AND METHODS

A static cohort model was developed to estimate lifetime health and economic outcomes of RSV-LRTI among adults aged 60-99 years in Germany, with (vs. without) use of RSVpreF. Vaccine uptake ranged from 27% to 54%. Vaccine effectiveness was derived from trial data and was assumed to last over 3 years, with some waning, following vaccination. Base case analyses were conducted from the societal perspective (costs/benefits discounted 3% annually); sensitivity analyses also were conducted.

RESULTS

Among adults aged 60-99 years (N = 25.3 M), RSVpreF prevented 117,360 cases of hospitalized RSV-LRTI, 100,433 cases of ambulatory RSV-LRTI, and 9,298 RSV-LRTI-related deaths over a lifetime horizon. With total overall costs higher by 1.8 € billion and 49,576 quality-adjusted life-years (QALYs) gained, cost-effectiveness of RSVpreF was 36,064 €/QALY. In probabilistic sensitivity analyses, the mean cost-effectiveness ratio was 36,518 €/QALY; 925 of 1,000 replications yielded ratios <50,000 €/QALY.

CONCLUSIONS

RSVpreF has the potential to greatly reduce the public health and economic burden of RSV among older adults in Germany.

Phages adapt to recognize an O-antigen polysaccharide site by mutating the "backup" tail protein ORF59, enabling reinfection of phage-resistant Klebsiella pneumoniae

Phages demonstrate remarkable promise as antimicrobial agents against antibiotic-resistant bacteria. However, the emergence of phage-resistant strains poses challenges to their effective application. In this paper, we presented the isolation of a phage adaptive mutant that demonstrated enhanced and sustained antibacterial efficacy through the co-evolution of Klebsiella pneumoniae (K. pneumoniae) 111-2 and phage ZX1Δint in vitro. Our experiments revealed that phage ZX1Δint successfully completed the adsorption phase by binding to the host surface, specifically targeting the capsular polysaccharide (CPS) receptor via the primary receptor-binding protein (RBP) ORF60 and the auxiliary RBP ORF59. Upon exposure to phage predation, mutations in genes wbaP, wbaZ or wzc, which encode the synthesis of the CPS, conferred resistance by reducing phage adsorption. In response to these host defense mechanisms, the adaptive mutant phages have evolved to utilize an alternative binding site located on an O-antigen site of lipopolysaccharide (LPS) through a mutation in the backup RBP ORF59. This evolutionary change enabled the phages to reinfect previously phage-resistant strains. Notably, the adaptive mutant phage PR2 carrying the ORF59 mutation Q777R, demonstrated the capacity to infect both wild-type and resistant strains, exhibiting prolonged antimicrobial activity against the wild strains. In conclusion, our findings elucidated a complex phage-host adsorption-antagonism mechanism characterized by mutation-driven alterations in phage receptor recognition. This work contributes to a deeper understanding of phage adaptability and highlights the potential for phages to combat phage-resistant bacteria through an in vitro evolutionary approach.

Joint consensus on reducing the burden of invasive meningococcal disease in the Asia-Pacific region

Invasive meningococcal disease (IMD) imposes a heavy burden of mortality and life-long sequelae on infected individuals and has devastating impacts on their family members. International data show that meningococcal vaccination programs have reduced IMD incidence and changed the serogroup distribution of the disease. Furthermore, newer data show that although the public health measures in response to the coronavirus disease 2019 (COVID-19) pandemic temporarily reduced the incidence of IMD, there has been a resurgence in the years since. In the Asia-Pacific (APAC) region, many countries do not include meningococcal vaccines in their routine vaccination programs, and approaches to IMD surveillance are inconsistent. This review summarizes recent data and consensus statements from a group of experts from selected APAC countries on the burden of IMD in the region, evidence for vaccination, and how barriers to IMD vaccination may be addressed.

A fresh look at varicella vaccination

The varicella vaccine is a live attenuated varicella zoster virus (VZV), first produced by Michiaki Takahashi (1974). Subsequent development of the fluorescent antibody to VZV membrane antigen test (FAMA), an immune correlate, permitted vaccine efficacy to be established, initially in immunodeficient and then in typical children and adults. Varicella vaccine is effective and safe; universal vaccination has almost eliminated varicella; moreover, endogenous boosting from subclinical VZV reactivation has evidently prevented an anticipated epidemic of zoster from occurring in response to the vaccine-induced loss of circulating varicella. The vaccine virus, moreover, reactivates less frequently than wild-type and an adjuvanted subunit vaccine against VZV gE safely prevents zoster. Doing so is important because VZV establishes latency and reactivates in sympathetic and enteric neurons; therefore, in addition to the painful cutaneous rash and postherpetic neuralgia of zoster, VZV reactivation can be an occult cause of vasculopathy, stroke, intestinal dysmotility, and achalasia.

Pathway to hepatitis C elimination: insights from a large tertiary hospital in South China

BACKGROUND

Although the introduction of direct-acting antiviral drugs (DAAs) has greatly enhanced the prognosis for hepatitis C, the timely diagnosis and treatment of hepatitis C virus (HCV) infection remain a severe challenge in China.

METHODS

This retrospective study involved 368,577 patients tested for hepatitis C antibodies from 2020 to 2023 at a large tertiary hospital in South China. It primarily focused on analyzing the prevalence of Anti-HCV and HCV RNA and further evaluated the impact of the 'Hepatitis C-Free Hospital' initiative.

RESULTS

Between 2020 and 2023, this large tertiary hospital in South China reported an overall Anti-HCV positivity rate of 1.08%, with males (1.06%) higher than females (0.57%). In particular, the highest rates were observed in males aged 40-49 (2.24%) and females aged 60-69 (1.00%). There was a gradual decline in the Anti-HCV positivity rate over time. As for HCV RNA testing, it indicated an overall positivity rate of 30.95%, more prevalent in males. Significantly, the 'Hepatitis C-Free Hospital' initiative increased HCV RNA testing and treatment completion rates, with sustained virological response (SVR) rates escalating from 92.86% to 99.61%.

CONCLUSIONS

This study identified specific patient groups with high HCV positivity rates. Additionally, the 'Hepatitis C-Free Hospital' initiative significantly increased HCV RNA testing and treatment rates, providing a feasible model for regional HCV elimination.

Klebsiella pneumoniae derived outer membrane vesicles mediated bacterial virulence, antibiotic resistance, host immune responses and clinical applications

Klebsiella pneumoniae is a gram-negative pathogen that can cause multiple diseases including sepsis, urinary tract infections, and pneumonia. The escalating detections of hypervirulent and antibiotic-resistant isolates are giving rise to growing public concerns. Outer membrane vesicles (OMVs) are spherical vesicles containing bioactive substances including lipopolysaccharides, peptidoglycans, periplasmic and cytoplasmic proteins, and nucleic acids. Emerging studies have reported various roles of OMVs in bacterial virulence, antibiotic resistance, stress adaptation, and host interactions, whereas knowledge on their roles in K. pneumoniae is currently unclear. In this review, we summarized recent progress on the biogenesis, components, and biological function of K. pneumoniae OMVs, the impact and action mechanism in virulence, antibiotic resistance, and host immune response. We also deliberated on the potential of K. pneumoniae OMVs in vaccine development, as diagnostic biomarkers, and as drug nanocarriers. In conclusion, K. pneumoniae OMVs hold great promise in the prevention and control of infectious diseases, which merits further investigation.

Respiratory syncytial virus immunization with nirsevimab: Acceptance and satisfaction assessment in infants and risk groups in the region of Murcia (Spain)

Respiratory syncytial virus (RSV) is a leading cause of respiratory infections in infants under two years of age, often resulting in bronchiolitis and pneumonia, which contribute to high hospitalization rates. The recent approval of nirsevimab, a long-acting monoclonal antibody, has provided an immunization alternative for infants, addressing the substantial burden of RSV. This study aimed to evaluate acceptance and satisfaction among parents or legal guardians of infants who were candidates for immunization with nirsevimab in the Region of Murcia (Spain) during the 2023-2024 campaign. A cross-sectional survey, encompassing 1692 parents of immunized infants and 219 of non-immunized infants, revealed a high acceptance rate for nirsevimab, with 87% of parents indicating willingness to immunize a future child and 86.6% willing to recommend it. Concerns about safety and side effects were the primary reasons for hesitation among parents who did not immunize their infants. These findings underscore the importance of enhancing educational efforts in future campaigns to address safety concerns, thereby supporting broader RSV immunization coverage in the pediatric population.

Validation of a questionnaire for evaluating vaccine literacy in adulthood vaccination: A pilot study from Zhejiang province, China

This study aimed to validate a tool for assessing vaccine literacy (VL) in adult vaccination under the Chinese context. A pilot study on adult's VL was conducted in 2023 in Huzhou city of Zhejiang province, China. A self-designed questionnaire, specific for the self-assessment of three domains (functional, interactive, and critical), as well as the vaccination knowledge and acceptance was applied. Validation process of the questionnaire was conducted through the investigation of a panel of experts, principal component analysis (factors whose cumulative explanation proportion of variance > 80% were selected) and Cronbach's α coefficient test (>0.7 was acceptable). Correlation coefficient analysis for VL domains, vaccination knowledge and acceptance were also implemented, and r value as well as its significance were calculated. For the validation of the questionnaire, the mean scores for reliability, comprehensibility, efficiency, sensitivity of each question of functional and interactive/critical VL ranged from 3.86 (sensitivity of interactive/critical VL) to 4.26 (comprehensibility of functional VL). Cronbach's α coefficient was 0.8223 with functional VL, 0.8916 for interactive VL and 0.9061 for critical VL. The scores of functional VL, interactive VL and critical VL were 3.36, 3.06 and 2.91, respectively. The mean score of vaccine knowledge was 5.80. The positive response rate of receiving influenza vaccine, pneumococcal vaccine and herpes-zoster vaccine was 36.5% (73/200), 23.00% (46/200) and 11.66% (19/163). The VL score of all domains, the individual's vaccine knowledge and the vaccine acceptance were all significantly correlated to the high education degree (r = 0.37 for functional VL, r = 0.35 for interactive VL, r = 0.30 for critical VL, r = 0.28 for vaccine knowledge, r = 0.42 for vaccine acceptance). The VL questionnaire was shown to be a valid and reliable tool for measuring VL among Chinese adults. It was recommended that the VL questionnaire should be validated in larger and more diverse samples, exploring the impact of interventions to improve VL and assessing the relationship between VL and vaccination behavior over time.

Global burden and trends of the Clostridioides difficile infection-associated diseases from 1990 to 2021: an observational trend study

BACKGROUND

This study was aimed to explore the global burden and trends of Clostridioides difficile infections (CDI) associated diseases.

METHODS

Data for this study were obtained from the Global Burden of Disease Study 2021. The burden of CDI was assessed using the age-standardized rates of disability-adjusted life years (ASR-DALYs) and deaths (ASDRs). Trends in the burden of CDI were presented using average annual percentage changes (AAPCs).

RESULTS

The ASR-DALYs for CDI increased from 1.83 (95% UI: 1.53-2.18) per 100,000 in 1990 to 3.46 (95% UI: 3.04-3.96) per 100,000 in 2021, with an AAPC of 2.03% (95% CI: 1.67-2.4%). The ASDRs for CDI rose from 0.10 (95% UI: 0.08-0.11) per 100,000 in 1990 to 0.19 (95% UI: 0.16-0.23) per 100,000 in 2021, with an AAPC of 2.26% (95% CI: 1.74-2.79%). In 2021, higher burdens of ASR-DALYs (10.7 per 100,000) and ASDRs (0.53 per 100,000) were observed in high socio-demographic index (SDI) areas, and among age group over 70 years (31.62/100,000 for ASR-DALYs and 2.45/100,000 for ASDRs). During the COVID-19 pandemic, the global ASR-DALYs and ASDRs slightly decreased. However, in regions with low SDI, low-middle and middle SDI, those rates slightly increased.

CONCLUSION

The global burden of CDI has significantly increased, particularly in regions with high SDI and among individuals aged 70 years and above. During the COVID-19 pandemic period from 2020 to 2021, the burden of CDI further increased in regions with low, low-middle, and middle SDI. These findings underscore the need for increased attention and intervention, especially in specific countries and populations.

Disease burden of influenza in Spain: A five-season study (2015-2020)

Influenza accounts for 30% of the total morbidity and mortality in the European Union. However, the specific burden in different European countries is largely unknown, and more research is needed to ascertain the reality of this disease. In this retrospective study, we analyzed the burdens of hospitalization, intensive care unit (ICU) admission and in-hospital mortality in Spain over five seasons (2015-2020) via publicly available Minimum Basic Datasets (MDBS). The data revealed that influenza had a major impact in Spain, with approximately 29,000 hospitalizations, 2,200 ICU admissions, and 1,600 deaths each season. In this period, approximately 7.8% of those hospitalized required ICU admission, and 5.7% died in the hospital due to influenza, with wide differences in these parameters depending on the season due to the virological characteristics of the major circulating viruses. More than 60% of those hospitalized were over 65 years of age, and approximately 82% of those who died were elderly, demonstrating that the greatest burden of hospitalization and mortality is centered on this age group. The annual direct cost of influenza was approximately €128 million per season, with more than 80% of this cost centered on people over 45 years of age.

Sharp rise in high-virulence Bordetella pertussis with macrolides resistance in Northern China

OBJECTIVE

To elucidate the evolution of antigen genotype and antimicrobial resistance distribution of Bordetella pertussis (B. pertussis) from 2019 to 2023 in northern China.

METHODS

Polymerase chain reaction (PCR) amplification and sequencing were utilized to identify the seven antigen genotypes (ptxA, ptxC, ptxP, prn, fim2, fim3, tcfA). E-test and Kirby-Bauer (K-B) disc diffusion were employed to determine the minimum inhibitory concentration (MIC) and zone of inhibition for B. pertussis against antimicrobial agents. Subsequently, 50 isolates were chosen for multi-locus variable-number tandem-repeat analysis (MLVA) typing and whole-genome sequencing.

RESULTS

A total of 442 B. pertussis isolates were determined. The strains with high virulence harbouring ptxP3 allele surged from 13.5% (21/155) in 2019-2021 to 93.0% (267/287) in 2022-2023. Concurrently, the erythromycin resistance B. pertussis (ERBP) in ptxP3 isolates markedly rose from 42.9% (9/21) in 2019-2021 to 100% (267/267) in 2022-2023. The majority of ptxP3 isolates (76.0%,219/288) exhibited the ptxA1/ptxC1/prn2/fim2-1/fim3A/tcfA-2 genotype. Among the 442 confirmed patients, the children aged 3-14 years escalated rapidly from 13.5% in 2019 to 45.6% in 2023. The MT28 strains were responsible for 66.0% (33/50) of the tested ones, in which ERBP was prevalent at 87.9% (29/33). All the present sequenced ptxP3-ERBP strains (31/31) were clustered into the sub-lineage IVd.

CONCLUSIONS

These results suggested the clonal spread of the ptxP3-ERBP lineage of B. pertussis with high virulence and macrolides resistance could be an important cause of the recent pertussis resurgence in China. Furthermore, the increased cases among pre-school and school-aged children underscore the importance of booster vaccination in this population.

Visual analysis of the research frontiers, hotspots and development trends of immunization programs for women and children

The objective of this study is to gain insight into the current research frontiers, hotspots, and development trends in the field of immunization programs for women and children, and to provide scientific guidance and reference for follow-up research. Based on all the original research papers related to the research on immunization programs for women and children in the Web of Science Core Collection (WoSCC) database, bibliometric studies and visual analysis were carried out to explore the research frontiers, hotspots and development trends, and to analyze the risk factors affecting the vaccination coverage of immunization programs for women and children. Eight hundred forty-three papers obtained from 1,552 institutions in 96 countries/regions from January 1950 to August 2024, coauthored by 4,343 authors. With the largest number of papers published in the United States (408), Centers for Disease Control & Prevention - USA (169), Stokley S (15), and Pediatrics (143). The research frontiers of this discipline area mainly involve risk factors affecting the vaccination coverage of immunization programs for women and children, epidemiological surveillance, intervention research, changes in medical burden, adverse reactions, and vaccine development. Research hotspots mainly include measles, vaccine hesitancy, human papillomavirus, coverage, and pregnant women. The findings of the study informed policymakers, public health experts and researchers about the potential for modifying and improving policy systems and interventions related to the immunization programs for women and children. This had important implications for digital transformation and innovative research in health care providers' clinical practice for the immunization programs for women and children.

Pneumococcal vaccines in China

Invasive pneumococcal disease (IPD) is a serious global public health problem and the leading cause of morbidity and mortality in children and adults in China. Thus, developing and administering pneumococcal vaccines are important for disease prevention. The PPV23 and PCV13 vaccines are available in the Chinese market and are primarily produced by domestic manufacturers. The potential risk of increased IPD caused by non-vaccine serotypes should be considered. Here, we review the current status of IPD, pneumococcal vaccines, and their quality control in China. We also address the challenges and future directions for making progress in controlling IPD, emphasizing the need for further evaluation of the disease burden and monitoring the effectiveness of vaccination efforts.

Health and economic impact of the 21-valent pneumococcal conjugate vaccine (V116) for adults in Japan: a delta price approach

INTRODUCTION

This study analyzed the health and economic impact of the 21-valent pneumococcal conjugate vaccine (V116) and the 20-valent pneumococcal conjugate vaccine (PCV20), as well as their relative cost-effectiveness, in Japanese adults aged 65 years using a delta pricing approach.

METHODS

A Markov model was employed to simulate the movement of the Japanese population among four health states: healthy, pneumococcal disease (consisting of invasive pneumococcal disease [IPD] with or without meningitis and non-bacteremic pneumococcal pneumonia [NBPP]), post-meningitis sequelae, and death. The model was populated with publicly available demographic and epidemiologic data, stratified by risk level. Pneumococcal serotype distribution and vaccine effectiveness, as well as direct and indirect treatment costs and health-related utilities, were derived from published sources. The model used a lifetime horizon and 2% discounting of costs and life-years. Costs were adjusted to 2023 values in Japanese yen (¥). Outcomes were cases and deaths, life-years and quality-adjusted life-years (QALYs), vaccination and treatment costs, and incremental cost-effectiveness ratios. The range over which V116 was cost-saving and cost-effective was determined.

RESULTS

Compared to PCV20, V116 averted an additional 28 cases of IPD, 918 cases of NBPP, 5 deaths from IPD, and 51 deaths from NBPP over the lifetime of a single age 65 cohort. Life-years and QALYs gained were 1,019 and 642, respectively, relative to PCV20; V116 saved ¥733 million in direct medical costs and ¥557 million in indirect costs, compared to PCV20. V116 was found to be cost-saving at price premiums up to ¥1,322 (payer perspective) or ¥2,327 (societal perspective) and remained below a willingness-to-pay threshold of ¥5 million/QALY for premiums up to ¥7,113 (payer perspective) or ¥8,117 (societal perspective).

CONCLUSIONS

V116 is projected to provide more population health benefits in Japan than PCV20, and to be cost-effective at a variety of price premiums.

Prognostic indicators and outcome in patients with acute liver failure, sepsis and with and without shock: a retrospective cohort study

BACKGROUND

Sepsis or septic shock is associated with severe morbidity and mortality in patients with acute liver failure (ALF). This study aimed to explore the potential prognostic value of common clinical indicators in patients with ALF, sepsis and with and without shock.

PATIENTS AND METHODS

The clinical, laboratory, and microbiological data of patients with ALF and sepsis or septic shock who were admitted to the intensive care unit from January 2014 to December 2019 were collected retrospectively. Clinical indicators, outcomes and the associations among them were analyzed and defined.

RESULTS

Of 150 patients, 64 (42.7%) and 86 (57.3%) were divided into the shock and non-shock groups, respectively. Plasma procalcitonin (PCT), C-reactive protein (CRP), and creatinine (Cre) levels, aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio, and prothrombin time (PT) in the shock group and plasma PCT and Cre levels in the non-shock group were positively correlated with 30-day, 60-day, and 90-day mortality. Furthermore, plasma ALT levels were positively correlated with 60-day and 90-day mortality, and PTA showed negative correlations with 30-day, 60-day, and 90-day mortality in both groups. Multivariate logistic regression analysis revealed that the combination of plasma PCT and CRP levels, the combination of plasma PCT and ALT levels, and the combination of plasma ALT levels and PTA were found to be associated with 90-day mortality.

CONCLUSIONS

Clinical indicators, especially plasma PCT, CRP, and ALT levels, PTA, and their combinations were associated with poor outcomes in patients with ALF, sepsis and with and without shock.

Knowledge, willingness, and hesitancy toward recommended vaccinations among pregnant and post-partum women: A cross-sectional survey in Italy

The objectives of the cross-sectional survey were to examine knowledge, attitudes, and hesitancy among pregnant and post-partum women toward the recommended vaccinations and to identify determinants. The survey was conducted from July to September 2024 in Naples, Italy. Out of a total of 585 participants, 64.1% had been infected with at least one of the MMRV diseases and 47.3% had received MMRV vaccinations. Only 21.4% knew that MMRV vaccinations were recommended in the post-partum, and this was more frequent among healthcare workers (HCWs) or those who had a partner working in the healthcare sector and those with no history of MMRV infections. The overall mean Vaccine Hesitancy Scale (VHS) score was 24.1 and 43.6% were high-hesitant (score ≥ 25). Participants who had a higher level of education, with a non-Italian nationality, history of MMRV infections or pregnancy-related health problems, who were aware of the MMRV complications during pregnancy, who had a higher perception of knowledge about recommended vaccinations in the post-partum, who acquired information about recommended vaccinations in the post-partum from HCWs, and those who needed further information had higher odds of low hesitancy regarding the vaccinations recommended in the post-partum as measured by the VHS instrument. More than one-third expressed willingness to receive the MMRV vaccinations in the post-partum. Respondents with higher education, those who acquired information from HCWs, those who needed further information, and those not high vaccine hesitant were more willing to receive the vaccinations. The findings revealed an inadequate level of knowledge and a significant prevalence of vaccine hesitancy and public health efforts, and informative campaigns regarding the utility of the vaccinations in the post-partum are needed.

Bictegravir/emtricitabine/tenofovir alafenamide in clinical practice for people with HIV: final 24-month effectiveness and safety outcomes in key populations in the observational BICSTaR cohort

BACKGROUND

BICtegravir Single Tablet Regimen (BICSTaR) is an observational cohort study evaluating the effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in treatment-naïve (TN) and treatment-experienced (TE) people with HIV.

OBJECTIVE

To present final pooled 24-month outcomes for the full cohort.

METHODS

Prospective data were pooled from TN and TE adults with HIV initiating B/F/TAF in routine clinical practice across 14 countries (data collection: 25/06/2018-29/12/2023). Outcomes at 24 months included virologic suppression (HIV-1 RNA <50 copies/mL), immunologic effectiveness (change in CD4 cell count and CD4/CD8 ratio), persistence, and safety. Outcomes were also analysed in key populations.

RESULTS

Of 2,074 (483 TN, 1,591 TE) participants included, most were male (85%), White (70%), and had ≥1 comorbidity (66%). Median (Q1, Q3) age was 45 (35, 54) years. At 24 months, 94% of TN and 96% of TE participants had HIV-1 RNA <50 copies/mL (missing = excluded analysis). These values were 88% and 86%, respectively, in a discontinuation = failure analysis. Effectiveness remained high across all key populations at 24 months. Median (Q1, Q3) CD4 count increased by 257 (127, 447) cells/µL in TN and 40 (-70, 153) cells/µL in TE participants (both p < 0.001). There was no reported treatment-emergent resistance to B/F/TAF. Persistence was high at 24 months (TN, 95%; TE, 91%). Drug-related adverse events occurred in 11% of TN and 12% of TE participants, leading to B/F/TAF discontinuation in 5%.

CONCLUSIONS

B/F/TAF was generally well tolerated over 24 months, with high effectiveness and persistence observed among a broad range of people with HIV.

Travel medicine providers' opinions on the dengue vaccine TAK-003 as a travel vaccine and the need for decision-support information and materials before its launch in Japan

TAK-003 is a dengue vaccine introduced in dengue-endemic countries and considered for travelers. Although not yet approved in Japan, inquiries from travelers are increasing. With limited evidence about vaccine use for travelers, consolidated expert opinions would aid in vaccination decision-making. Therefore, this study examined the opinions on TAK-003 and the need for decision-support information and materials among travel medicine providers before its launch in Japan. Participants recruited from the Japanese Society of Travel and Health were assessed on their intention to receive TAK-003 themselves when visiting dengue-endemic areas, and their intention to recommend it to travelers, with responses provided separately for short- and long-term travels. Participants who did not recommend TAK-003 provided reasons using multiple-choice questions. All participants were asked about their need for supporting information to aid in vaccination decision-making. Among the 154 respondents, over half intended to receive (55% for short-term, 75% for long-term) and recommend (53% for short-term, 75% for long-term) the vaccination. The primary reasons for not recommending it were concerns about efficacy and safety, which were also the most requested support information. These findings suggest that many travel medicine providers have positive opinions on TAK-003 as a travel vaccine and need decision-support information and materials.

Towards an HCV vaccine: an overview of the immunization strategies for eliciting an effective B-cell response

INTRODUCTION

Fifty-eight million people worldwide are chronically infected with hepatitis C virus (HCV) and are at risk of developing cirrhosis and hepatocellular carcinoma (HCC). Direct-acting antivirals are highly effective; however, they are burdened by high costs and the unchanged risk of HCC and reinfection, making prophylactic countermeasures an urgent medical need. HCV high genetic diversity is one of the main obstacles to vaccine development. The protective role of the humoral response directed against the HCV E2 glycoprotein is well established, and broadly neutralizing antibodies play a crucial role in effective viral clearance.

AREAS COVERED

This review explores the HCV targets and the different vaccination approaches, encompassing different expression systems, antigen selection strategies, and delivery methods, focusing on those aimed at eliciting a broad and effective humoral response. Our search criteria included the keywords 'HCV,' 'Hepatitis C,' and 'vaccine' using publicly available databases. Following the screening, 54 papers were selected.

EXPERT OPINION

The investigation of novel vaccine platforms beyond traditional approaches is necessary. While progress has been made in this direction, continued investigations on the HCV virology, immunology, and vaccinology are essential to surmount associated obstacles, heling in the development of an HCV vaccine that can benefit the global public health.

Streptococcus pneumoniae serotype distribution in low- and middle-income countries of South Asia: Do we need to revisit the pneumococcal vaccine strategy?

S. pneumoniae serotypes responsible for pneumococcal disease differ with respect to disease severity, invasiveness, antimicrobial susceptibility, geographies, immunization history, age groups, and with time. Although PCVs have blunted the pneumococcal disease burden, they are plagued with numerous challenges, especially the emergence of NVTs. In this review, we show that there are diverse serotypes, especially NVTs, responsible for causing pneumococcal diseases in LMICs of South Asia across different studies conducted between 2012 and 2024. We propose that pharmaceutical/biotech companies should tailor/customize the PCVs as per the region-specific serotype prevalence based on surveillance data. Furthermore, protein-based vaccines, or WCVs, have been explored and can serve as viable alternatives to address the limitations associated with PCVs. However, robust studies are warranted in different geographies to demonstrate its efficacy and safety in clinical trials as well as the real-world effectiveness of these promising candidates.

Unveiling the effect of chemical degradation on cyclic lipoglycopeptide Oritavancin using Orbitrap mass spectrometry

Oritavancin is the second-generation approved semisynthetic cyclic lipoglycopeptide by the United States Food and Drug Administration (USFDA) for acute bacterial skin and skin-structure infections which serves as a last resort of treatment. Unlike other lipoglycopeptides, the stability behavior of Oritavancin was least explored, which is a prerequisite. The current study endeavors to elucidate the oxidative, hydrolytic, thermal and photolytic stability behavior of Oritavancin by exposing the drug to respective stress conditions. A simple liquid chromatography (LC) method was developed, where significant resolution between Oritavancin and the generated degradation products was achieved. In total 13 degradation products were identified under various stress conditions. Using LC-HRMS, MS/MS studies, the generated degradation products were identified and characterized. The intact mass for DP-2,7,12 was m/z 724.7219(2), DP-6,11, 13 was m/z 796.2672(2), DP-3,10 was m/z 643.6953(2). However isomeric mass as of ORT intact form was seen for DP-4 and unique masses were identified for DP-1,4,8,10 with m/z 725.4293(2), m/z 905.2965(2), m/z 863.2896(2), m/z 904.2890(2) respectively. The mechanistic fragmentation pathway for all the generated DP's were established and the plausible structure for the identified DP's were postulated based on the MS/MS data. According to the findings, Oritavancin is highly susceptible to photolytic, thermal and hydrolytic condition and least susceptible under oxidative condition. The developed reversed-phase high-performance liquid chromatographic (RP-HPLC) method was validated in accordance with ICH guidelines for Oritavancin using C18 analytical reverse-phase column which could be utilised for routine quality control and therapeutic drug monitoring of Oritavancin.

Sepsis in liver failure patients: Diagnostic challenges and recent advancements

Acute liver failure (ALF) and acute-on-chronic LF (ACLF) are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections (BI), despite significant systemic inflammation. Literature indicates that 30%–80% of ALF patients and 55%–81% of ACLF patients develop BI, attributed to immunological dysregulation. Bacterial sepsis in these patients is associated with adverse clinical outcomes, including prolonged hospitalization and increased mortality. Early detection of bacterial sepsis is critical; however, distinguishing between sterile systemic inflammation and sepsis poses a significant challenge due to the overlapping clinical presentations of LF and sepsis. Conventional sepsis biomarkers, such as procalcitonin and C-reactive protein, have shown limited utility in LF patients due to inconsistent results. In contrast, novel biomarkers like presepsin and sTREM-1 have demonstrated promising discriminatory performance in this population, pending further validation. Moreover, emerging research highlights the potential of machine learning-based approaches to enhance sepsis detection and characterization. Although preliminary findings are encouraging, further studies are necessary to validate these results across diverse patient cohorts, including those with LF. This article provides a comprehensive review of the magnitude, impact, and diagnostic challenges associated with BI in LF patients, focusing on novel advancements in early sepsis detection and characterization.

Genomic insight into the high-risk hypervirulent multidrug resistant enteroaggregative-hemorrhagic Escherichia coli ST648/*a194 (serotype O8:H4) isolated from a 3-year-old patient with bloodstream infection in Uganda, sub-Saharan Africa

Gastrointestinal and bloodstream infections account for a major cause of medical emergency and mortality among pediatric populations. Although Escherichia coli is implicated in multiple infections, its virulence and antimicrobial resistance are elusive. Here we aimed to uncover the pathogen associated with diarrhea and sepsis from a 3-year-old patient under ICU in Kampala. We isolated an E. coli strain, challenged it with a panel of 16 antibiotics and whole-genome sequenced it to delve into the virulome and resistome underlying the pathogenicity and relevance to the patient's disease. Antibiotic susceptibility test (AST) results revealed that the isolate was resistant to 12 antibiotics. Combining PathogenFinder with multilocus sequence typing (MLST), we found a high-risk human pathogen (p = 99.9%), ST648/*a194 (serotype O8:H4), which possesses autotransporters ehaB and enteroaggregative immunoglobulin repeat protein eaeX, among other virulence factors. This strain has acquired plasmids harboring multidrug resistance genes of the beta lactamase family (blaTEM-1B, blaCTX-M-15, and blaOXA-1), aminoglycoside resistance genes including aadA5, aac(3)-IIa and aac(6')-Ib-cr, and fluroquinolone resistance gene aac(6')-Ib-cr. Using the comprehensive antibiotic resistance database (CARD), we identified multiple nonsynonymous mutations for the genes gyrA (D87N, S83L, ParC (S80I), conferring fluroquinolone resistance along with the multidrug resistance gene AcrAB-TolC with MarR mutations (Y137H, G103S). Overall, we infer a hybrid pathotype of enteroaggregative-hemorrhagic E. coli (EAHEC) with the potential for gastrointestinal tract, systemic infection and multidrug resistance covering third-generation cephalosporins. Comprehensive genomic surveillance is urgently required to enhance our therapeutic intervention of these high-risk E. coli clones in low-resource settings.

Gene expressions of clinical Pseudomonas aeruginosa harboring RND efflux pumps on chromosome and involving a novel integron on a plasmid

The clinical strain of Pseudomonas aeruginosa XM8 harbored multiple RND-type antibiotic efflux pump genes and a novel integron In4881 on its plasmid pXM8-2, rendering it resistant to nearly all conventional antibiotics except colistin. The resistance was primarily attributed to the inactivation of the oprD gene and overexpression of several efflux pump genes, including mexAB-oprM, mexCD-oprJ, oprN-mexFE, and mexXY. In this study, the XM8 strain was comprehensively characterized using various methods. Antimicrobial susceptibility testing was performed using the BioMerieux VITEK2 system and manual double dilution methods. Gene expression levels of efflux pump-related genes were analyzed via quantitative real-time PCR. The bacterial chromosome and plasmid were sequenced using both Illumina and Nanopore platforms, and bioinformatics tools were employed to analyze mobile genetic elements associated with antibiotic resistance. The pXM8-2 plasmid containsed multiple mobile genetic elements, including integrons (In4881, In334, In413) and transposons (Tn3, TnAs1, TnAs3). Notably, In4881 was reported for the first time in this study. The presence of these elements highlights the potential for horizontal gene transfer and further spread of antibiotic resistance. Given the strong resistance profile of the XM8 strain, effective measures should be implemented to prevent the dissemination and prevalence of such multidrug-resistant bacteria.

Dual role of hepcidin in response to pathogens

Hepcidin is the primary regulator of vertebrate iron homeostasis. Its production is stimulated by systemic iron levels and inflammatory signals. Although the role of hepcidin in iron homeostasis is well characterized, its response to pathogenic agents is complex and diverse. In this review, we examine studies that investigate the role of hepcidin in response to infectious agents. Interleukin-6 (IL-6) is a key factor responsible for the induction of hepcidin expression. During infection, hepcidin-mediated depletion of extracellular iron serves as a protective mechanism against a variety of pathogens. However, accumulation of iron in macrophages through hepcidin-mediated pathways may increase susceptibility to intracellular pathogens such as Mycobacterium tuberculosis. Prolonged elevation of hepcidin production can lead to anemia due to reduced iron availability for erythropoiesis, a condition referred to as anemia of inflammation. In addition, we highlight the role of hepcidin upregulation in several infectious contexts, including HIV-associated anemia, iron deficiency anemia in Helicobacter pylori infection, and post-malarial anemia in pediatric patients. In addition, we show that certain infectious agents, such as hepatitis C virus (HCV), can suppress hepcidin production during both the acute and chronic phases of infection, while hepatitis B virus (HBV) exhibits similar suppression during the chronic phase.

Emerging multi-drug resistant and extended-spectrum β-lactamase (ESBL)-positive enterotoxigenic E. coli (ETEC) clones circulating in aquatic environments and in patients

Diarrheal disease pathogens often spread through water-borne routes. Enterotoxigenic Escherichia coli (ETEC) is a major bacterial agent causing diarrheal disease in children, adults, and travelers in endemic areas. In addition, ETEC is responsible for outbreaks of water and food-borne gasteroenteritis globally, ETEC isolates also show robust survival capacity in various environmental settings, including aquatic environments. During the last decade, studies of ETEC isolates have indicated a rapid increase in multi-drug resistant and extended-spectrum β-lactamase (ESBL)-positive human-specific ETEC strains. These have been found in both environmental water sources and human patients, warranting the urgent need for focused monitoring of antibiotic resistance development in ETEC. Whole genome sequencing (WGS) of isolates from environmental, animal, and human sources enables in silico surveillance of emerging pathogenic and multi-drug resistant strains. This method allows for re-analysis of genomic data, aiding in identification of new variants of pathogenic clones. By integrating data from diverse sources inclusing sequenced isolates, we found that certain ETEC clonal lineages e.g., those expressing certain toxin-colonization factor profiles including STp/CS6, LT STh/CS2 + CS3, and LT STh/CFA/I are more at risk to develop multi-drug resistance than other ETEC lineages. Comparizon of multi-locus sequence types from papers with WGS data indicated ST182, ST4, ST2332 and new ST types to be emerging multi-drug resistant ETEC. We conclude that further studies on sequenced ETEC/E. coli genomes are needed to enhance our understanding of the dynamics of ETEC evolution, and the relation of virulence and resistance profiles in both environmental and clinical isolates.

A ERA/Cas12f1_ge4.1 biosensor for rapid, sensitive, and cost-effective detection of Chlamydia psittaci via fluorescence and lateral flow assays

Rapid and accurate detection of Chlamydia psittaci, the causative agent of psittacosis, is crucial for both human and animal health but presents significant challenges, particularly in grassroots health institutions. Our previous PDTCTR fluorescence sensing platform, which combined the engineered Cas12f1_ge4.1 system with recombinase polymerase amplification (RPA), significantly enhanced detection efficiency. However, its requirement for specialized equipment, costly RPA reagents, and absence of visual output restricted its practical application in such environments. To address these limitations, we developed the ERA/Cas12f1_ge4.1 system, integrating Cas12f1_ge4.1 with the cost-effective Enzymatic Recombinase Amplification (ERA). This system enables sensitive detection of Chlamydia psittaci double-stranded DNA within 50 min through both fluorescence and colloidal gold lateral flow assay strips. The platform achieves detection limits of 10 copies/μL for fluorescence and 100 copies/μL for lateral flow. Clinical validation involving 93 parrot samples demonstrated high performance in both detection modes. Fluorescence detection achieved 95.4 % sensitivity, 100 % specificity, a 100 % positive predictive value (PPV), and a 90.3 % negative predictive value (NPV). Meanwhile, the lateral flow assay exhibited 92.3 % sensitivity, 100 % specificity, 100 % PPV, and an 84.8 % NPV. The ERA/Cas12f1_ge4.1 system offers a rapid, accurate, cost-effective, and visually interpretable diagnostic tool suitable for both laboratory and community health centers. This advancement holds significant potential for improving psittacosis diagnosis and control, particularly in resource-limited environments.

Inhaled alone versus inhaled plus intravenous polymyxin B for the treatment of pneumonia due to carbapenem-resistant gram-negative bacteria: A prospective randomized controlled trial

OBJECTIVES

Infections due to carbapenem-resistant Gram-negative bacteria (CR-GNB) are associated with considerable morbidity and mortality. Polymyxin B (PMB) is a first-line agent for CR-GNB-associated pneumonia, but limited data exist on the clinical use of inhaled (IH) PMB.

METHODS

A single-center, prospective randomized controlled trial was conducted in China to compare IH PMB alone with IH plus intravenous (IV) PMB between February 2022 and February 2024. The primary outcome was the clinical cure rate.

RESULTS

Twenty-two evaluable patients were assigned to the IH group, and 56 patients were included in the IH+IV group. Baseline characteristics were comparable between the two groups. No significant differences were observed in clinical cure rates, favorable clinical outcomes, microbiological outcomes, all-cause mortality, or pneumonia-related mortality. However, IH PMB alone was associated with a lower incidence of nephrotoxicity (P = 0.030). IH PMB demonstrated significantly higher drug concentrations in the epithelial lining fluid (ELF) compared to systemic administration. Patients with immunosuppressive therapy (OR, 0.066; 95% CI, 0.010-0.433; P = 0.005), malignancies (OR, 0.112; 95% CI, 0.016-0.797; P = 0.029), and higher SOFA scores (OR, 0.693; 95% CI, 0.518-0.929; P = 0.014) were less likely to achieve favorable clinical outcomes. Conversely, higher PMB ELF 1-hour concentrations (OR, 1.085; 95% CI, 1.026-1.148; P = 0.004) were associated with more favorable clinical outcomes. The combination of these four indicators demonstrated excellent diagnostic performance (AUC = 0.882). Plasma 1-hour PMB concentrations showed acceptable predictive performance for nephrotoxicity (AUC = 0.766).

CONCLUSIONS

The potential benefits of IH PMB outweigh the risks, making it an effective treatment for CR-GNB-associated pneumonia in combination with other empirical antimicrobial agents.

Real-world clinical data-driven modelling on the initiation time of antiviral prophylaxis among pregnant women with chronic hepatitis B infection

BACKGROUND & AIMS

The risk of mother-to-child transmission for pregnant women with chronic hepatitis B (CHB) still exists, especially for those with high HBV DNA levels. The guidelines for initiating prophylaxis for pregnant women with CHB vary across countries. We aimed to explore the latest prophylaxis initiation time for these women.

METHODS

We collected the real-world clinical data of 328 pregnant women aged 20-49 with CHB, who were treated with telbivudine or tenofovir disoproxil fumarate, from July 2010 to December 2020 in China. A mathematical model was developed to describe the viral kinetics of HBV after prophylaxis. We calculated the time required to reduce viral load below the threshold value of 5.3 log10 IU/ml. We derived the prophylaxis initiation time by subtracting the required time to threshold from the childbirth gestational week.

RESULTS

The median time for 328 women to reduce HBV DNA levels below the threshold of 5.3 log10 IU/ml was 4.2 (range: 0.2-12.8) weeks, corresponding to a prophylaxis initiation time of no later than 35.1 (25.2-41.4) weeks. Specifically, for women with viral loads >8.0 log10 IU/ml, prophylaxis should be initiated before 33.9 (25.2-39.5) weeks, and even before the lower bound of 25.2 weeks, to maximize clinical safety. For women with viral load >7.0 to ≤8.0 log10 IU/ml, prophylaxis should be initiated before 35.5 (28.6-39.8) weeks, and for women with viral load >5.3 to ≤7.0 log10 IU/ml, prophylaxis should be initiated before 36.2 (28.3-41.4) weeks.

CONCLUSION

Pregnant women with HBV DNA levels >5.3 to ≤8.0 log10 IU/ml can initiate prophylaxis before 28 gestational weeks. However, women with HBV DNA >8.0 log10 IU/ml could consider initiating prophylaxis before 25 weeks.

IMPACT AND IMPLICATIONS

This study investigates how long it takes to decrease maternal viral load below a threshold (5.3 log10 IU/ml) after receiving antiviral prophylaxis in pregnant women with different HBV DNA levels based on real-world clinical data and mathematical modelling, which provides quantitative evidence on the initiation time of antiviral prophylaxis. The results show that pregnant women with CHB infection at high HBV DNA levels (>8 log10 IU/ml) should initiate antiviral prophylaxis earlier to decrease the risk of mother-to-child transmission of HBV. Physicians can determine when to begin antiviral prophylaxis for those women according to their maternal HBV DNA levels. Our findings justify the initiation time of antiviral prophylaxis recommended by the Chinese guidelines and will offer new insights for other international guidelines.

Respiratory syncytial virus pulmonary infections in adults - disease burden and prevention

PURPOSE OF REVIEW

We highlight the evolving understanding of the burden of respiratory syncytial virus (RSV) in older adults and recent data on the three new vaccines.

RECENT FINDINGS

As well as a greater recognition of the amount of RSV infection in adults, and especially over 60 years of age, there has been a significant amount of study detailing the postacute burden including excess cardiovascular disease and loss of physical and cognitive functioning. Three new RSV vaccines now have published data for two seasons, and while direct comparison is not possible due to differences in the timing, methodology and populations studies, all show good efficacy with no serious side effects of concern.

SUMMARY

RSV causes a substantial amount of morbidity and mortality in older adults with both acute and longer term impacts. With effective vaccines now available clinicians should be advocating with their patients to prevent RSV infection.

Efficacy of exosomes in acute kidney injury treatment and the associated mechanism (Review)

Acute kidney injury (AKI) is a syndrome characterized by rapid loss of renal function with a high morbidity and mortality. However, due to the complex pathophysiologic mechanisms of AKI, no specific treatment for this disease is currently available. Animal models have demonstrated the protective effects of exosomes on AKI; however, the underlying mechanisms require further investigation. The present review focuses on the efficacy of exosomes derived from different cell sources, including mesenchymal stem cells, endothelial progenitor cells and tubular epithelial cells, in the treatment of AKI and the associated mechanism. Furthermore, the effects of exosomal contents, including microRNAs, circular RNAs, long non‑coding RNAs, messenger RNAs and proteins, on the repair of renal tubules, protection against renal tubular epithelial cell injury, protection against fibrosis, inhibition of early endoplasmic reticulum stress and mediation of inflammation during AKI are also summarized in the present review.

Saliva Samples as a Potential Tool for the Diagnosis and Monitoring of Cytomegalovirus Reactivation in Children Undergoing Transplantation

BACKGROUND

Regular monitoring of cytomegalovirus (CMV) reactivation in children who undergo transplantation is performed by molecular testing on blood samples. This highlights the need to explore noninvasive alternatives, such as saliva. The present study evaluated the usefulness of saliva samples for detecting and monitoring CMV reactivation in children undergoing transplantation at a referral center in Lima, Peru.

METHODS

A total of 85 paired samples of liquid saliva and whole blood and 91 paired samples of swab-collected saliva and whole blood from 16 children who underwent transplantation were analyzed by quantitative polymerase chain reaction (qPCR).

RESULTS

The positivity rates for whole blood, liquid, and swab-collected saliva were 12.59%, 15.29%, and 12.09%, respectively. No significant differences were observed in viral load among the samples, and there was no remarkable correlation or agreement between saliva and whole blood. However, 19 samples from 4 patients were positive in their saliva but negative in their respective whole blood pairs. One patient who was positive in both the saliva samples and negative in blood developed gastrointestinal CMV disease.

CONCLUSIONS

Saliva may serve as a promising diagnostic tool for detecting and monitoring CMV reactivation in pediatric transplant recipients. Further studies should explore the significance of the saliva viral load to guide pre-emptive therapy and predict disease development.

The association of cycle threshold value with clinical features in patients infected with Omicron variant

This study investigated the correlation between epidemiological and clinical characteristics of patients infected with omicron variants and the cycle threshold (Ct value) for RT-PCR detection. The study population consisted of 115 patients with Omicron infection and the most common symptoms included fever (43.5 %), cough (38.3 %) and sore throat (29.6 %). Laboratory abnormalities were mainly lymphopenia, elevated globulins and elevated blood glucose. Univariate analysis found that older age (P < 0.001) and unvaccinated (P = 0.003) were associated with low Ct values (high viral load). Multivariate analysis showed that an elevated monocyte count (OR: 3.556; 95 % CI: 1.330-9.503) was associated with low Ct values, whereas being vaccinated (OR: 0.209; 95 % CI: 0.051-0.854) and lower serum sodium (OR: 0.137; 95 % CI: 0.051-0.367) were negatively associated with low Ct values. Studies have shown that factors such as monocyte count, vaccination status and serum sodium correlate with Ct values, suggesting the potential of Ct values as a clinical predictor, which could also provide a valuable reference for clinical decision-making.

Dynamics and Evolution of Donor-derived Cytomegalovirus Infection in 3 Solid Organ Transplant Recipients With the Same Multiorgan Donor

BACKGROUND

Cytomegalovirus (CMV) infection poses a significant risk to immunosuppressed transplant recipients, manifesting through primary infection, reinfection, or reactivation.

METHODS

We analyzed the emergence of drug resistance in CMV infection in 3 patients who were later found to have received an allograft from a shared, deceased donor. The seronegative transplant recipients developed symptomatic CMV infections after bowel/pancreas, kidney, or lung transplantation. Prospective Sanger sequencing was used to identify mutations in the viral DNA polymerase (DP) and protein kinase (PK). DP and PK variants were retrospectively quantified by targeted next-generation sequencing. The impact of the novel DP-A505G substitution on drug susceptibility was assessed using a recombinant virus. Whole-genome sequencing of clinical CMV samples was enabled through target DNA enrichment.

RESULTS

The DP-A505G substitution was found in all patient samples and could be associated with a natural polymorphism. A subsequent review of the patients' clinical histories revealed that they had all received organs from a single donor. The CMV infection exhibited divergent evolution among the patients: patient 1 developed resistance to ganciclovir and foscarnet because of 2 DP mutations (V715M and V781I), patient 2 showed no genotypic resistance, and patient 3 developed ganciclovir (PK-L595S) and maribavir resistance (PK-T409M). Interpatient variation across the entire CMV genome was minimal, with viral samples clustering in phylogenetic analysis.

CONCLUSIONS

All 3 transplant recipients were infected with the same donor-derived CMV strain and readily developed different drug susceptibility profiles. This underscores the importance of judicious antiviral drug use and surveillance in preventing antiviral resistance emergence.

Ceftaroline for bloodstream infections caused by methicillin-resistant Staphylococcus aureus: a multicentre retrospective cohort study

OBJECTIVES

To evaluate the effectiveness of ceftaroline vs. vancomycin or daptomycin in the treatment of methicillin-resistant Staphylococcus aureus bloodstream infections (BSIs) (MRSA-BSIs).

METHODS

This multicentre retrospective study conducted in 15 Spanish hospitals included data from the first MRSA-BSIs of adult patients between January 2019 and December 2022. The ceftaroline group included patients who received ceftaroline for ≥72 hours within the first week of BSI onset; the standard-of-care (SOC) group included patients who received vancomycin or daptomycin ≥72 hours after BSI onset. Primary outcome was 30-day all-cause mortality; secondary outcomes included 90-day mortality and incidence of adverse events (AEs). Propensity-score matching and Cox proportional hazards analyses were performed.

RESULTS

A total of 429 MRSA-BSIs were included: 133 in the ceftaroline group and 296 in the SOC group. More patients in the ceftaroline group had a Sequential Organ Failure Assessment score >2 (51.1% vs. 36.5%; p < 0.01), complicated BSI (66.2% vs. 42.2%; p < 0.01), infective endocarditis (18.8% vs. 6.4%; p < 0.01) and prescribed in combination treatment (65.4% vs. 11.5%; p < 0.01), with no statistically significant differences in 30-day mortality: 23.3% ceftaroline (95% CI, 16.1-30.5%) vs. 16.2% SOC (95% CI, 12.0-20.4%), p 0.08. There were no statistically significant differences in 90-day mortality (33.1% ceftaroline vs. 26.7% SOC; p 0.17). After propensity-score matching, 105 patients treated with ceftaroline were matched with 105 controls: the 30-day mortality rates were 21.9% and 16.2% (p 0.38). Cox regression analysis of the entire cohort (n = 429) revealed that age (hazard ratio [HR], 1.05; 95% CI, 1.03-1.07) and Sequential Organ Failure Assessment score >2 (HR, 2.34; 95% CI, 1.50-3.65) were associated with 90-day mortality risk, although ceftaroline treatment did not demonstrate a significant effect (HR, 1.00; 95% CI, 0.97-1.02). Incidence of AEs was 12.0% in ceftaroline vs. 4.4% in the SOC group (p < 0.01). Most AEs occurred when ceftaroline was used in combination vs. monotherapy (17.2% vs. 2.2%; p 0.01).

DISCUSSION

Ceftaroline was an effective treatment for MRSA-BSIs but was commonly prescribed in combination showing a higher incidence of AEs.

FBLN2 inhibits gastric cancer proliferation and metastasis via the TGFβ/TGIF2 pathway

Gastric cancer (GC) ranks among the most common gastrointestinal tumours and is a significant contributor to cancer mortality globally. The proliferation, metastasis, occurrence and development of GC have obvious malignant tendencies. This study is based on our previous studies. Previously, we reported that Fibulin-2 (FBLN2) can inhibit the distant metastasis of GC by promoting lost-nest apoptosis. Despite its clinical importance, the biological function of FBLN2 in GC remains inadequately understood. This study investigated the underlying molecular mechanisms of FBLN2 in the pathogenesis and progression of GC, as well as its impact on the biological behaviour of GC cells. In vivo and in vitro experiments, we demonstrated that FBLN2 overexpression resulted in a reduction in GC cell proliferation and metastasis, whereas its knockdown led to enhancement of GC proliferation and metastasis. Moreover, we used RNA-seq technology to conduct KEGG enrichment analysis of differential genes in wild-type GC cells and FBLN2 knockout GC cells and successfully confirmed that FBLN2 plays a corresponding biological role through the TGFβ/TGIF2 axis. In addition, in terms of the clinical data, we revealed a correlation between FBLN2 and TGIF2 and patient prognosis. In summary, our study revealed that FBLN2 suppressed GC proliferation, migration and invasion by downregulating the TGFβ/TGIF2 axis, suggesting that FBLN2 is a promising target for GC treatment.

Exploring the potential of direct-acting antivirals against Chikungunya virus through structure-based drug repositioning and molecular dynamic simulations

The Chikungunya virus (CHIKV) represents a significant global health threat, particularly in tropical regions, and no FDA-approved antiviral treatments are currently available. This study investigates the potential of Direct-Acting Antivirals (DAAs) and protease inhibitors (PIs) that have been developed for the hepatitis C virus (HCV) in treating CHIKV. We analyzed the binding of eight HCV DAAs to the nsP2 protease of CHIKV, which is essential for viral replication. Our findings suggest repurposing hepatitis C virus (HCV) antivirals, specifically Simeprevir (SIM) and voxilaprevir (VOX), could be effective against CHIKV. Through computational analyses, we observed their strong binding affinity to CHIKV's nsP2 protease, indicating the promising potential of repositioning these drugs for CHIKV treatment. To validate the results of our computational study, we evaluated the antiviral efficacy of SIM and VOX in vitro, both as monotherapies and in combination with ribavirin (RIBA). Our findings revealed that DAAs exert a multifaced effect by targeting different stages of the CHIKV life cycle. Furthermore, the synergistic effects suggest that combining SIM and VOX with RIBA may provide a more effective therapeutic strategy than using either drug alone. Further research is necessary to optimize treatment protocols and improve outcomes for patients affected by CHIKV.

Zeolitic Imidazole Framework-8 Nanoparticles as an Alternative to Freund's Adjuvant for Klebsiella pneumoniae Recombinant Protein Vaccine

Vaccination represents a promising approach to combat resistant Klebsiella pneumoniae (KP). However, there is currently no licensed vaccine in the veterinary field. Outer membrane proteins have been proven to possess good immunogenicity, but Freund's adjuvant, which is commonly used to administer protein vaccines, has limitations such as a complicated formulation process as well as a tendency to cause pain and inflammation in animals. Here, we prepared a nano-vaccine based on zeolitic imidazolate framework-8 (ZIF-8)-encapsulated outer membrane protein PhoE and evaluated its efficiency in enhancing humoral and cellular immune responses in BALB/c mice. ZIF-8 nanoparticles rapidly delivered the protein antigen into dendritic cells and successfully activated them. In addition, significantly higher IgG antibody titers, cytokine levels, and splenocyte proliferation indices were founded in mice subcutaneously immunized with PhoE@ZIF-8 than in those receiving free PhoE alone. In a BALB/c mouse model, PhoE@ZIF-8 elicited a strong immune response with improved prophylactic efficacy against KP that was similar to the Freund's adjuvant-formulated vaccine. Based on the superiority of this nano-vaccine with good biocompatibility, inexpensive preparation and higher efficiency of delivering antigen into cells, ZIF-8 can serve as a promising replacement for Freund's adjuvant in research, with a prospective usage for vaccines against bacterial pathogens in the veterinary field.

"Seesaw effect" between daptomycin and ceftobiprole in daptomycin-resistant methicillin-resistant Staphylococcus aureus isolates

OBJECTIVES

This study aimed to investigate the "seesaw effect" of daptomycin (DAP) and ceftobiprole (BPR) on DAP-resistant (DAP-R) methicillin-resistant Staphylococcus aureus (MRSA) isolates.

METHODS

Broth microdilution minimum inhibitory concentrations (MICs) of DAP and BPR were tested for laboratory-derived and clinical DAP-R MRSA isolates to estimate the "seesaw effect." Time-kill curves for seven representative DAP-R isolates were obtained using DAP and BPR to validate their synergistic activity in vitro. Whole genome sequencing as well as deletion and complementation of the mprF gene were performed to investigate the mechanisms of the "seesaw effect."

RESULTS

The BPR MICs decreased by half-fold in DAP-R MRSA isolates. The synergistic effect of DAP and BPR against representative clinical and community-associated MRSA (CA-MRSA) isolates was demonstrated in time-kill analyses, showing that synergistic activity was preferred in CA-MRSA compared with hospital-associated MRSA. The mprF mutations were identified in isolates exhibiting the "seesaw effect." These mutations increased the DAP MIC while decreasing the BPR MIC.

CONCLUSIONS

The "seesaw effect" between DAP and BPR was prevalent among DAP-R MRSA isolates. This phenomenon was associated with the mprF mutations of MRSA.

Community acquired pneumonia due to antibiotic resistant- Streptococcus pneumoniae : diagnosis, management and prevention

PURPOSE OF REVIEW

A resurgence of pneumococcal pneumonia has been observed after a marked reduction in the early COVID-19 pandemic. Penicillin-nonsusceptible Streptococcus pneumoniae is regarded as a WHO priority pathogen.

RECENT FINDINGS

Overall antibiotic resistance rates in S. pneumoniae have increased due to increase in antibiotic consumption and changes in serotype distribution, partly driven by the rollout of pneumococcal vaccination. Isolates from pneumococcal pneumonia have higher resistance rates than those from invasive pneumococcal disease. New antibiotics have been approved for treatment of community-acquired pneumonia, and are active against multidrug-resistant S. pneumoniae . Pneumococcal vaccines in both children and adults are effective in reducing the burden of pneumococcal pneumonia in adults, though some circulating vaccine and nonvaccine serotypes are driving antibiotic resistance.

SUMMARY

Continual surveillance of serotype and resistance patterns of S. pneumoniae causing pneumonia in adult populations is important after the introduction of new pneumococcal vaccines. Novel pneumococcal vaccine platforms are needed to overcome the threats of serotype replacement and antibiotic resistance.

Gut Microbiome Modulation in Allergy Treatment: The Role of Fecal Microbiota Transplantation

The prevalence of allergic diseases has been rising, paralleling lifestyle changes and environmental exposures that have altered human microbiome composition. This review article examines the intricate relationship between the gut microbiome and allergic diseases, emphasizing the potential of fecal microbiota transplantation as a promising novel treatment approach. It explains how reduced microbial exposure in modern societies contributes to immune dysregulation and the increasing incidence of allergies. The discussion also addresses immune homeostasis and its modulation by the gut microbiome, highlighting the shift from eubiosis to dysbiosis in allergic conditions. Furthermore, this article reviews existing studies and emerging research on the role of fecal microbiota transplantation in restoring microbial balance, providing insights into its mechanisms, efficacy, and safety.

Cost burden and temporal trends of herpes zoster in China: Evidence from Beijing's health records

Objective

Herpes zoster poses a significant health threat to the aging population in China. This study aimed to analyze the cost burden and temporal trends of herpes zoster in China.

Methods

This study encompassed herpes zoster outpatients from 15 hospitals between 2016 and 2023 and herpes zoster inpatients from 175 hospitals between 2013 and 2023. We used descriptive analysis and log-linear model to investigate herpes zoster related cost burden and their temporal trends during the selected period.

Results

Over the past eight years, outpatient visits increased by about 23.8 % across the selected hospitals, while inpatient discharges increased by approximately 124.8 %. About 23.6 % of the outpatient cases were under 45 years of age. The cost per outpatient visit fluctuated at approximately 57 USD, while the cost per hospitalization increased by over 20 %, reaching around 1931 USD in 2023. Older patients and those with post-herpetic neuralgia experienced higher herpes zoster related healthcare costs and utilization.

Conclusions

Our findings suggest that although the average cost per visit or discharge changed little in China, the growing demand for herpes zoster healthcare highlights the necessity of more preventive efforts to reduce the burden on both individuals and the healthcare system.

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Adults with Underlying Medical Conditions: Systematic Literature Review and Pairwise Meta-Analysis Using GRADE

INTRODUCTION

This systematic literature review and pairwise meta-analysis evaluated the comparative effectiveness of mRNA-1273 versus BNT162b2 in patients with at least one underlying medical condition at high risk for severe COVID-19.

METHODS

MEDLINE, Embase, and Cochrane databases were searched for relevant articles from January 1, 2019 to February 9, 2024. Studies reporting effectiveness data from at least two doses of mRNA-1273 and BNT162b2 vaccination in adults with medical conditions at high risk of developing severe COVID-19 according to the US Centers for Disease Control and Prevention were included. Outcomes of interest were SARS-CoV-2 infection (overall, symptomatic, and severe), hospitalization due to COVID-19, and death due to COVID-19. Risk ratios (RRs) were calculated with random effects models. Subgroup analyses by specific medical conditions, number of vaccinations, age, and SARS-CoV-2 variant were conducted. Heterogeneity between studies was estimated with chi-square testing. The certainty of evidence was assessed using the Grading of Recommendations, Assessments, Development, and Evaluations framework.

RESULTS

Sixty-five observational studies capturing the original/ancestral-containing primary series to Omicron-containing bivalent original-BA4-5 vaccinations were included in the meta-analysis. mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR, 0.85 [95% CI, 0.79-0.92]; I2 = 92.5%), symptomatic SARS-CoV-2 infection (RR, 0.75 [95% CI, 0.65-0.86]; I2 = 62.3%), severe SARS-CoV-2 infection (RR, 0.83 [95% CI, 0.78-0.89]; I2 = 38.0%), hospitalization due to COVID-19 (RR, 0.88 [95% CI, 0.82-0.94]; I2 = 38.7%), and death due to COVID-19 (RR, 0.84 [95% CI, 0.76-0.93]; I2 = 1.3%) than BNT162b2. Findings were generally consistent across subgroups. Evidence certainty was low or very low because sufficiently powered randomized controlled trials are impractical in this heterogeneous population.

CONCLUSION

Meta-analysis of 65 observational studies showed that vaccination with mRNA-1273 was associated with a significantly lower risk of SARS-CoV-2 infection and COVID-19-related hospitalization and death than BNT162b2 in patients with medical conditions at high risk of severe COVID-19.