Search Results (458)

B Dengue fever represents a significant public health challenge in Saudi Arabia, yet comprehensive molecular characterization of circulating serotypes remains limited. This study combines epidemiological and phylogenetic analyses to understand dengue virus (DENV) dynamics in the Kingdom. A systematic review and meta-analysis of dengue epidemiological data from Saudi Arabia (1992–2026) was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All available DENV envelope (E) gene sequences from Saudi human cases (1992–2023) were retrieved from GenBank and Global Initiative on Sharing All Influenza Data (GISAID). Phylogenetic trees were constructed using maximum likelihood with 1000 bootstrap replicates and best-fit models. Selection pressure was analyzed using SLAC, FEL, FUBAR, and MEME methods, while glycosylation sites were predicted with NetNGlyc and NetOGlyc. The pooled seroprevalence from 25 studies (n = 32,393) was 40.71% (95% CI: 26.96–56.10%). DENV-2 predominated (80.25%), followed by DENV-1 and DENV-3, with DENV-4 remaining rare (0.42%). Males (67–78%) and adults aged 25–44 years were most affected. Phylogenetic analysis of 50 Saudi isolates showed DENV-1 strains clustered within American–African (1994) and Asian (2004–2011) genotypes, all DENV-2 within the Cosmopolitan genotype, and all DENV-3 within Genotype III (bootstrap support 99–100%). Selection pressure analysis indicated pervasive positive selection in DENV-2, episodic selection across serotypes, and strong purifying selection in the E gene. Several amino acid substitutions with potential functional importance were identified. No DENV-4 E gene sequences from Saudi Arabia are publicly available. Dengue in western Saudi Arabia is characterized by DENV-2 predominance, co-circulation of three serotypes, and multiple introductions. The absence of DENV-4 sequences highlights critical surveillance gaps. Sustained molecular surveillance, expanded genomic sequencing, and data sharing are essential for effective prevention and vaccine preparedness. Full article

This online survey of 1330 veterinarians and 5071 cat owners across 14 countries aimed to identify drivers, barriers and unmet needs regarding feline vaccination compliance. Veterinarians and cat owners differed on the perceived value of vaccination; 16% of cat owners cited vaccination as a key contributor to feline health compared with 69% of veterinarians. Cat owners reported that 71% of their cats had seen a veterinarian within the previous year and 65% were previously vaccinated, aligning with veterinarian-reported compliance rates of 77% for core vaccines. Primary vaccination drivers for cat owners were the desire to maintain their cat’s health (62%) and a veterinarian’s recommendation (57%); veterinarians perceived vaccine reminders (71%) as the top driver. Owners who elected not to vaccinate their cats believed vaccines were unnecessary for healthy (27%) or indoor cats (27%). This aligned with veterinarian-reported barriers: lack of client understanding (53%), vaccine misinformation (51%) and antivaccine attitudes (51%). Most cat owners (58%) cited their veterinarian as their primary vaccine information source. However, only 23% of veterinarians report discussing the importance of vaccination with cat owners. Cat owners prioritized low side effects (88%), multi-antigen protection (86%) and >1 year of protection (86%; 74% want 3 years). Concerning price and compliance, 87% (61% yes, 26% maybe) would pay more for long-lasting protection, and 91% (66% yes, 25% maybe) of vaccinating owners would attend annual wellness visits even when vaccination is not due. By addressing educational gaps, communicating the role vaccines play in feline health, and understanding cat owner concerns and preferences, veterinarians have an opportunity to improve feline vaccination compliance. Full article

The 2019 coronavirus disease pandemic (COVID-19) showed how genetic mutations can alter coronavirus characteristics. However, the evolution of livestock coronaviruses remains understudied. We analyzed 15 bovine coronavirus (BCoV), three porcine hemagglutinating encephalomyelitis virus (PHEV) and 18 porcine respiratory coronavirus (PRCV) isolates, mainly from Belgian livestock collected between 2020 and 2023. Spike gene phylogenetic analysis showed nucleotide substitution rates comparable between BCoV and PRCV, while PHEV appeared slower. Unlike severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), synonymous substitutions were preferred, limiting amino acid variation across decades in the animal coronaviruses. Virus neutralization assays with swine antisera indicated minimal antigenic change in PHEV and PRCV. Recent BCoV isolates showed antigenic divergence from the classical Mebus vaccine strain. The impact of this divergence on vaccine efficacy may warrant further research. Our findings underscore the need for periodic surveillance, as changes in surface proteins may affect pathogenicity, tissue tropism, host range and vaccine efficacy. Full article

H9N2 avian influenza viruses inherently carry cross-species transmission potential, making continuous surveillance critical for pandemic prevention. This study focused on monitoring the 2024 H9N2 epidemic in Jiangsu Province’s external environment, analyzing its molecular evolution and receptor binding properties, assessing cross-species transmission and pandemic risks, and investigating serological antibody levels across different human populations. Environmental samples were collected from live poultry markets, farms, slaughterhouses, and bird habitats across Jiangsu, screened via quantitative PCR (qPCR), with positive samples used for virus isolation and whole-genome sequencing. Receptor binding properties were tested by hemagglutination assay, and H9N2 antibody levels were measured in 370 occupationally exposed individuals and 240 non-exposed individuals using hemagglutination inhibition (HI) assays. Among the 5779 collected samples, 6.89% tested H9N2-positive, and 12 strains belonging to the Eurasian lineage Y280-like clade G57 genotype were successfully isolated. All strains carried the HA-Q226L mutation, with 11 showing preferential binding to human α-2,6 receptors and one strain possessing dual receptor binding capability. Internal genes harbored mammalian adaptation mutations, and M2 proteins contained mutations conferring complete resistance to amantadine-class antiviral drugs. Serological tests revealed antibody positive rates of 4.05% in exposed populations and 2.5% in non-exposed populations, with no statistically significant difference between groups. These findings confirm that Jiangsu’s circulating H9N2 viruses have acquired human receptor preference and mammalian adaptation, posing silent infection and pandemic risks. Enhanced surveillance and the development of candidate vaccine stockpiles are strongly recommended. Full article

Background: Seasonal influenza prevention in young adults is influenced by access, trust, and vaccine information exposure, but local evidence linking vaccination uptake with illness and economic burden is limited. Methods: We conducted a non-probability, cross-sectional electronic survey of adults aged 18–49 years who lived, worked, or studied in the San Francisco Bay Area during the 2025 to 2026 influenza season. Measures included vaccination uptake, influenza-like illness, recovery, functional and economic burden, vaccination sites, and vaccine information exposure. Multivariable logistic regression examined factors associated with vaccination uptake; Kaplan–Meier and Cox models examined time to recovery. Results: Of 554 responses, 463 were included. Vaccination uptake was 86.2% (n = 399; 95% confidence interval [CI], 82.7–89.2%), likely reflecting a health-engaged convenience sample. Influenza-like illness was reported by 38.4%; median recovery time was 5 days, median missed work or school was 2 days, and median direct out-of-pocket cost was US$20. Prior season vaccination (adjusted odds ratio [aOR], 2.24; 95% CI, 1.15–4.34) and greater trust in Centers for Disease Control and Prevention (CDC) or public health agencies (aOR, 1.46; 95% CI, 1.05–2.02) were associated with vaccination. Pharmacies were the second most common vaccination site and preferred future site. Conclusions: Influenza prevention for young adults may benefit from pharmacy-inclusive, multichannel access paired with trusted communication. Findings should be interpreted in light of non-probability recruitment and likely overrepresentation of health-engaged respondents. Full article

Introduction: Streptococcus pneumoniae severely affects adults over 65, especially those with comorbidities. Since vaccination coverage among healthcare workers (HCWs) is unknown despite free availability, this study evaluates knowledge, behaviours, hesitancy and accessibility among employees of an Italian hospital. Methods: A prospective cross-sectional survey was administered via “SurveyMonkey.” From February 22 to June 15, 2024, healthcare and administrative staff aged ≥ 18 at the Fondazione Policlinico Universitario Gemelli were recruited by email. Descriptive and inferential analyses used Stata 16.1. Results: Among HCWs, 72% are women, with an average age of 48. Pneumococcal vaccination coverage is 20%, with 82.7% vaccinated in-hospital. Preferred information sources include courses, webinars, and institutional websites. For management staff, vaccine safety and effectiveness were significant determinants. Among administrative employees, 65% are women (average age 51); 19% are vaccinated, 24% are unsure, and 43% prefer in-hospital vaccination. Physicians cited trust in vaccines (25.3%) and self-protection (23.2%) as key motivators, compared with 12.4% among nursing, technical and rehabilitative staff. Recommendation to family members was higher among medical and specialist professionals (90%) than in other groups (77% in nursing/technical/rehabilitative; <50% in assistants and auxiliary staff). About half of the groups rated their knowledge at level 2 (scale 1–4). Multivariable regression analysis showed that medical professionals and specialists exhibited a higher perception of the importance and safety of vaccines compared with other categories. Conclusions: HCWs showed greater knowledge of pneumococcal vaccination, while administrative staff had lower awareness and more hesitancy. Both groups preferred in-hospital vaccination and expressed interest in structured educational initiatives. Full article

Background/Objectives: Girls living with HIV (GLHIV) or vulnerable to HIV have a higher risk of HPV infection and cervical cancer as they age. We determined acceptability and vaccination uptake after integrating HPV vaccination into HIV prevention and treatment services for girls in Mozambique and Zimbabwe. Methods: Pre-integration and integration HPV vaccination information were abstracted from routine records of girls aged 9–14 years offered HPV vaccine through HIV services in 54 health facilities (HFs) and surrounding communities between February and December 2025. Caregivers participated in quantitative surveys about vaccine perceptions and integration model experiences in a subset of 16 HFs. Results: In total, 6377 records of girls (median age: 11 years) were abstracted. Among the vaccine recipients, 63 (3.0%) girls received vaccine pre-integration and 2019 (97.0%) post-integration in Mozambique and 743 (17.3%) pre-integration and 3541 (82.7%) post-integration in Zimbabwe. Among GLHIV, 95.8% and 69.6% received a first HPV vaccine in Zimbabwe and Mozambique, respectively. Full vaccination with two doses occurred in 49.1% of eligible girls in Mozambique and 73.9% in Zimbabwe. Overall, 461 (67.8%) caregivers had heard of the HPV vaccine and 85.9% of cervical cancer, 99.6% were satisfied with vaccination in integration settings, and 78.6% preferred facility-based vaccination models. Conclusions: We demonstrated that HPV/HIV service integration was an effective strategy to increase HPV vaccine uptake among young girls at increased risk of HPV and cervical cancer. We found high vaccine and model acceptability and awareness of cervical cancer among caregivers. Optimization of this approach requires better integrated tools and model adaptations to fit the needs of girls and health systems. Full article

Background/Objective: The objective of this study was to explore parental preferences for the age of HPV vaccination (9–12) and the rationales for these preferences. Methods: Four online text-based focus groups were conducted with a national sample of 43 parents who have at least one child aged 9–10 years. Participants discussed preferred age for HPV vaccination and how it relates to the routine adolescent vaccine schedule in the United States (US). Content analysis was utilized to identify emergent themes. Results: Three themes surrounding parents’ motivating factors related to HPV-vaccination schedule preferences emerged from the analysis of the focus group discussions: (1) a belief that age 9 is too young versus a belief in early protection, (2) the number of shots administered per visit (a desire to spread shots out or group together), and (3) the parent follows their health care provider’s recommendations. Conclusions: This qualitative study of parental preferences regarding HPV vaccination age and how it relates to the routine adolescent vaccine schedule reveals mixed parental decision-making and rationales for vaccine acceptance and at which age. Given the dynamic vaccine policy landscape in the US, it is essential for providers to understand parental perspectives and motivating factors related to vaccine decision-making and integrate these drivers into clinical practice to best support families and public health at large. Full article

Background/Objectives: Acute otitis media (AOM) remains a leading cause of pediatric morbidity and a primary indication for antibiotic prescription worldwide. Given the potential for serious complications and the evolving landscape of antimicrobial resistance, up-to-date epidemiological data on causative bacteria are essential. This study aimed to assess the global prevalence of major bacterial pathogens in pediatric AOM and evaluate variations across geographic regions and temporal periods (pre-2000 vs. post-2000). Methods: A systematic search of PubMed, Embase, and Web of Science (1980–2025) was conducted to identify studies reporting middle ear fluid culture results in children (0–18 years) with AOM. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 45 studies encompassing 16,305 AOM episodes were included. Data were synthesized from North America, Europe, the Middle East, Asia, Oceania, and Africa. Pooled prevalence estimates and 95% confidence intervals (CIs) were calculated using a random-effects model, and heterogeneity was assessed via the I² statistic. Results: The overall pooled culture-positive rate was 66.6% (95% CI, 62.2–70.8%). Regional pooled estimates ranged from 56.1% in the Middle East (95% CI, 40.3–70.6%; underlying counts, 3776/10,652) to 77.5% in North America (95% CI, 68.2–84.7%; underlying counts, 1567/2125). Streptococcus pneumoniae was the most prevalent pathogen, with a pooled proportion of 29.0% (95% CI, 26.3–31.8%), followed by Haemophilus influenzae (22.3%; 95% CI, 19.3–25.6%) and Moraxella catarrhalis (4.6%; 95% CI, 3.4–6.1%). While S. pneumoniae remained the leading pathogen in most regions, H. influenzae showed marked geographic variability, peaking in the Middle East at 27.5% (95% CI, 17.0–41.2%; underlying counts, 2280/10,652) and reaching its lowest level in Asia at 13.5% (95% CI, 7.8–22.4%; underlying counts, 336/1854). The pooled culture-positive rate declined from 72.5% before 2000 (95% CI, 67.6–76.9%; underlying counts, 5769/8199) to 59.4% in 2000 and later (95% CI, 52.1–66.3%; underlying counts, 6661/15,707), although S. pneumoniae remained the predominant isolate in both periods. Conclusions: S. pneumoniae remains the primary bacterial driver of pediatric AOM globally. However, the observed geographic disparities and the temporal shift in pathogen prevalence following pneumococcal conjugate vaccine (PCV) introduction underscore the necessity for region-specific empirical antibiotic selection. These findings highlight the critical need for sustained microbiological surveillance to inform future vaccination and treatment strategies. Full article

The COVID-19 pandemic highlighted the critical role of serological assays in understanding antiviral immune responses, monitoring vaccine efficacy, and informing public health strategies. This review provides a comprehensive overview of commonly used SARS-CoV-2 antibody detection methods, focusing on binding and neutralization assays. Antibody binding assays, including enzyme-linked immunosorbent assays (ELISAs), chemiluminescence immunoassays (CLIAs), lateral flow immunoassays (LFAs), and multiplex platforms, enable the rapid and high-throughput detection of immunoglobulin isotypes against various viral antigens. Neutralization assays, including live-virus, pseudovirus (PsV), and surrogate assays, offer functional insights into the ability of antibodies to prevent viral entry, though they often require higher biosafety levels and optimization. Serological assays, primarily antibody binding assays and several surrogate neutralization assays, received Emergency Use Authorization (EUA) during the pandemic, supporting seroprevalence efforts. Antibody binding assays and neutralization assays were also widely used in vaccine immunogenicity studies. Despite many standardization initiatives, assay standardization and data harmonization remain challenging and require further efforts. The choice of assay should be guided by study goals: antibody binding assays are preferred for high-throughput monitoring and epidemiological studies, while neutralization assays are essential for assessing functional immunity and variant-specific neutralization and protection. Full article

Genetically modified (GM) lactic acid bacteria (LAB) are gaining attention as tools for innovation in the food sector, health applications, and industrial processes. LAB have long been used safely due to their GRAS/QPS status, making them suitable for improving fermentation and synthesizing specific and beneficial metabolites. Advances in genomics and gene editing have significantly expanded the available tools, ranging from classical mutagenesis to site-specific recombination, homologous recombination in non-coding regions, CRISPR-based systems, and food-grade chromosomal integration. These approaches enable the insertion of desired genes and the development of engineered strains with tailored functionalities. GM-LAB are also being studied as live delivery systems for therapeutic molecules, including cytokines, hormones, antimicrobial peptides, and vaccine antigens. Engineered strains of Lactococcus lactis and Lactobacillus spp. have yielded promising outcomes in applications such as mucosal immunization, modulation of inflammatory and metabolic responses, and inhibition of pathogenic microorganisms, including multidrug-resistant bacteria. From an industrial perspective, several studies highlight their potential for cost-effective recombinant protein production and the synthesis of high-value metabolites through fermentation. However, within the European Union, their use is subject to stringent regulatory oversight, requiring comprehensive molecular and environmental risk assessments, careful evaluation of horizontal gene transfer, and a preference for markerless chromosomal integrations. Despite these constraints, GM-LAB offer significant potential to improve food quality, sustainability, and human health. Full article

Background/Objectives: Vaccine hesitancy remains a significant public health challenge worldwide, yet nationally representative data from Central Asia are scarce. Evidence on the multidimensional structure of vaccination attitudes and their social patterning in Kazakhstan is limited. The study aimed to assess the distribution of anti-vaccination attitudes among adults in Kazakhstan and to examine their associations with socio-demographic, behavioural, clinical, and territorial characteristics. Methods: We conducted a cross-sectional, nationally representative survey of adults aged 18–69 years across all 17 regions of Kazakhstan between May and October 2025 (n = 6712). A multistage, stratified cluster sampling design was applied, and analyses incorporated sampling weights and design-based corrections. Vaccination attitudes were measured using the 12-item Vaccination Attitudes Examination (VAX) scale, comprising four subscales: mistrust of vaccine benefit, worries about unforeseen future effects, concerns about commercial profiteering, and preference for natural immunity. Internal consistency and confirmatory factor analysis were performed. Design-adjusted linear regression models were used to identify factors independently associated with each subscale and the overall VAX score. Results: The weighted mean overall VAX score was 3.70 (95% CI 3.67–3.73) on a 1–6 scale. The highest scores were observed for worries about unforeseen future effects (4.12; 95% CI 4.10–4.14), followed by preference for natural immunity (3.93; 95% CI 3.87–3.98), concerns about commercial profiteering (3.49; 95% CI 3.45–3.52), and mistrust of vaccine benefit (3.27; 95% CI 3.23–3.31). Internal consistency was high for the overall scale (Cronbach’s α = 0.861), and the four-factor structure demonstrated acceptable fit (CFI = 0.965; TLI = 0.952; RMSEA = 0.071). In multivariable design-adjusted models, age showed a generally consistent gradient, with lower scores in younger groups and the clearest differences observed among the youngest respondents. Married/cohabiting respondents had lower adjusted scores than single respondents across all subscales and for the overall VAX score. Men had lower adjusted worries scores than women, but sex was not independently associated with the overall VAX score. Diabetes was associated with higher adjusted mistrust, concerns about commercial profiteering, and overall VAX score, but not with worries or preference for natural immunity. Territorial differences were domain-specific: urban residence was associated with lower mistrust and higher worries, while macro-region was significant at the factor level only for worries. Conclusions: Anti-vaccination attitudes in Kazakhstan exhibit a multidimensional structure and clear socio-demographic patterning. Concerns about long-term safety were the most prominent attitudinal domain, whereas mistrust of vaccine benefit was comparatively less pronounced. Territorial differences were domain-specific rather than uniform, supporting the need for targeted communication strategies tailored to specific attitudinal domains and population subgroups. Full article

Introduction: Clostridioides difficile (C. difficile) is a major cause of antibiotic-associated diarrhea and healthcare-associated infections, with rising global incidence and severity due to the emergence of hypervirulent strains. Methods: This review synthesizes recent literature on the epidemiology, pathogenesis, diagnostic approaches, and therapeutic strategies related to C. difficile infection (CDI). Sources were selected from peer-reviewed journals, clinical guidelines, and emerging research between 2020 and 2025. Results: Advances in molecular diagnostics have improved the accuracy and speed of CDI detection. New therapeutic options such as fidaxomicin offer narrower-spectrum antibiotic activity with reduced recurrence rates. Fecal microbiota transplantation (FMT) has emerged as a highly effective option for recurrent CDI. Preventive efforts, including antibiotic stewardship programs and early-phase vaccine trials, show potential in reducing infection rates. Discussion: The management of CDI is evolving rapidly with the integration of precision diagnostics, targeted therapies, and microbiome-based interventions. Preventive strategies are critical, particularly in healthcare settings where C. difficile persists in the environment. Continued research and coordinated public health efforts are essential to reduce disease burden, improve outcomes, and limit transmission. Conclusions: Clostridioides difficile infections remain a major healthcare challenge with rising incidence and recurrent cases. Fidaxomicin has become the preferred first-line therapy. Microbiota-based therapies (like FMT, Rebyota, and Vowst) and Lipopolysaccharide Binding Protein (LBP) are highly effective for recurrent CDI prevention. Diagnostic strategies have improved with multi-step testing, enhancing accuracy and reducing overtreatment. Future focus lies in vaccines, targeted antimicrobials, and stricter prevention through antibiotic stewardship and hygiene. Full article

Background: With the evolving paradigm of vaccine development, microcapsules have attracted considerable research interest as particulate adjuvants over the past decades. However, the rational engineering design of microcapsule-based composite adjuvant systems to elicit robust immune responses remains a significant challenge. Methods: This study developed polylactic acid (PLA) microcapsules with spatiotemporally coupled delivery and immunopotentiator properties. The resulting formulations were assessed for humoral and cellular immune responses in mice. Results: We prepared uniform-sized microcapsules (MC) and formulated them with monophosphoryl lipid A (MPLA) as a composite component (MPLA@MC), with hydrodynamic diameters of 4.58 μm and 4.12 μm, respectively. Such composite adjuvants, when loaded with ovalbumin (OVA) to form OVA@MC and OVA&MPLA@MC, promoted cellular uptake and activation, exhibiting preferred lysosomal escape advantages. For in vivo experiments, microcapsule-based vaccines elevated serum levels of IgG antibody, and OVA&MPLA@MC induced Th1-biased antibody responses. Specifically, OVA&MPLA@MC also elicited strong cellular immune responses compared to other vaccines, as evidenced by increased secretion of Interferon-γ (IFN-γ) in mouse splenocytes and Granzyme B (Gzmb) in T cells. Mechanistically, muscle tissues at the injection site showed that microcapsule-based vaccines enhanced the recruitment for phagocytosis. Meanwhile, bulk RNA sequencing (RNA-seq) confirmed extensive activation of immune responses and related signaling pathways. Conclusions: This rationally designed composite strategy for spatiotemporally coupled delivery serves as a potent platform for orchestrating synergistic immune responses, opening up new avenues for the development of effective therapeutic and anti-infectious vaccines. Full article

Respiratory Syncytial Virus infection is a significant cause of morbidity and mortality in infants. Maternal vaccination with the bivalent vaccine Abrysvo^® in the third trimester (24–36 weeks) is an effective strategy to prevent severe respiratory illnesses in newborns. However, the introduction of this new technology faces structural obstacles that amplify inequalities. This rapid literature review sought to map and synthesize evidence on inequalities and inequities in adherence and accessibility to maternal vaccination among Black pregnant women. A rapid literature review was conducted using a mixed-methods approach (narrative synthesis and thematic analysis), following guidelines adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook. The research question was structured using the acronym Population/Problem, Exposure, Comparison, and Outcome, focusing on Black pregnant women, maternal vaccination, comparison with other groups, and barriers/determinants. The search was conducted in databases such as PubMed (via Medical Literature Analysis and Retrieval System Online), Scopus and Literatura Latino-Americana e do Caribe em Ciências da Saúde, covering studies published between 2022 and 2025 that presented disaggregated analysis by race. The analysis and interpretation of the findings were guided by Critical Race Theory. The analysis of the twelve included studies (mainly from the United States, the United Kingdom, and Brazil) revealed systematic and robust disparities. Black pregnant women had lower vaccination coverage and were less likely to receive timely recommendations compared to White pregnant women. The barriers identified include: institutional distrust (resulting from structural racism), poor access to prenatal care, inadequate communication, and socioeconomic factors. Inequities are structural and multifactorial phenomena. To ensure that the benefits of the vaccine are distributed equitably, strategies such as anti-racist training for healthcare teams, active vaccination outreach, and continuous monitoring of data disaggregated by race are essential. Full article