The Lancet Infectious Diseases

BackgroundThe number and timing of pneumococcal conjugate vaccine (PCV) primary doses can impact infant immune responses. This descriptive post hoc analysis evaluates the immunogenicity of the 20-valent PCV (PCV20) by vaccination timing in healthy infants in 2 key phase 3 trials. MethodsImmunogenicity endpoints from study B7471012 comparing PCV20 to 13-valent PCV (PCV13) in a 2+1 schedule were examined by timing of vaccination subgroup; the 2,4m subgroup (participants vaccinated at 2, 4, and 11...

Diarrheal disease is caused by diverse species of viruses, bacteria and protozo that are transmitted from different sources, including from contaminated food. Sustaining progress in reducing diarrheal illnesses and deaths, including vaccines and food safety measures, may require interventions targeting specific pathogens. In 2015, the WHOs published etiology-specific estimates by their Foodborne Disease Burden Epidemiology Reference Group (FERG) of the incidence and mortality of diarrheal diseas...

ObjectivesDespite the availability of effective vaccines, achieving the seroprevalence thresholds recommended by the World Health Organization (WHO) for eliminating measles, rubella, and mumps remains a public health challenge. MethodsA retrospective, cross-sectional serological survey was conducted, including 9,587 serum samples collected from 31 of the 32 federal entities of Mexico between September and December 2024. IgG antibody levels against measles, rubella, and mumps were quantified usi...

BackgroundBiological Es PNEUBEVAX 14(R) (BE-PCV14) is a WHO-prequalified 14-valent pneumococcal conjugate vaccine that adds emerging serotypes 22F and 33F to PCV13 coverage. We compared the safety and immunogenicity of a 3p+1 infant schedule of BE-PCV14 versus Prevenar 13(R) (PCV13) in Indian infants. MethodsIn this prospective, open-label, multicentre phase IV trial, PCV-naive infants aged 6-8 weeks received three primary doses of BE-PCV14 or PCV13 followed by a booster at 12-15 months. In the...

BackgroundThe SARS-CoV-2 LP.8.1 subvariant was incorporated into the 2025-2026 U.S. COVID-19 vaccines (mRNA-1273.251 and mRNA-1283.251). We evaluated immunogenicity and safety of these vaccines against vaccine-matched and emerging variants in individuals aged [≥]65 and those aged 12-64 years at high-risk of severe COVID-19. MethodsData were generated from: (1) two independent, ongoing, phase 3b/4, open-label, single-arm studies in which participants received a single dose of 50-{micro}g mRNA...

BackgroundAfrica continues to have a significant public health problem with mpox, where endemic transmission persists and overlaps with a high burden of other infectious diseases. Although their epidemiology and clinical impact are still poorly understood throughout the continent, coinfections with human immunodeficiency virus (HIV) and varicella-zoster virus (VZV) can affect the clinical picture, severity of the disease, and accuracy of the diagnosis. MethodsFollowing PRISMA criteria, we regis...

Understanding the burden of pertussis and pertussis-related mortality is important in enabling better understanding of population vulnerability and supporting vaccination programme planning. However, changes in laboratory practice can have important implications for public health surveillance. This study considers the impact of increasing use of multiplex panel testing for respiratory pathogens on ascertainment of pertussis-related deaths, drawing on multiple surveillance data sources from Engla...

Decision-making by governments during disease outbreaks is increasingly reliant on large-scale pathogen genomics and detailed individual-level data. We use 293,841 SARS-CoV-2 genomes collected in Denmark, between September 1st 2020 and December 31st 2021, and combine these with comprehensive individual-level data on settings, including households, schools, workplaces and family relationships, to infer plausible transmission pathways. Next, we use the plausible transmission pathways to assess the...

BackgroundSalmonella enterica serovar Typhi (S. Typhi), the causative agent of typhoid fever, continues to pose a major public health challenge in many low- and middle-income countries (LMICs). The World Health Organization recommended typhoid conjugate vaccine (TCV) use in countries with a high burden of disease, and/or high rates of antimicrobial resistance (AMR). Recent introductions of TCVs into national immunisation programmes are expected to substantially reduce this burden. However, the i...

BackgroundThe effectiveness of current drug-resistant tuberculosis (DR-TB) regimens is limited by the absence of rapid diagnostics that comprehensively predict resistance to included drugs. Next-generation sequencing (NGS), through culture-free targeted sequencing (tNGS) and culture-based whole-genome sequencing (cWGS) of the Mycobacterium tuberculosis complex (MTBC), offers a powerful framework for precision diagnosis, surveillance, and trial applications. We evaluated two novel assays enabling...

IntroductionEnteric fever, caused by Salmonella enterica serovars Typhi and Paratyphi, remains an important cause of febrile illness in low- and middle-income countries (LMIC). However, the exact burden is difficult to estimate due to limitations in diagnosis and surveillance. MethodsSamples from a representative cross-sectional household serosurvey in rural western Cambodia were used to estimate enteric fever seroincidence among children and young adults. Participants were enrolled between Apr...

BackgroundHousehold contact investigation for tuberculosis (TB) is limited by referral for clinic-based testing services. We evaluated the performance of in-home tongue swab (TS) testing among symptom-agnostic household contacts (HHC) to inform HCI screening strategies. MethodsWe conducted a prospective cohort study among HHC of TB patients in Eastern Cape, South Africa. In-home testing of sputum and TSs, with TSs pooled from up to three HHCs, was performed using Xpert Ultra on portable GeneExp...

BACKGROUNDDiagnostic performance of tongue swab Mycobacterium tuberculosis PCR has been evaluated for facility-based triage of symptomatic tuberculosis (TB). It is unknown whether tongue swab performance differs for detection of asymptomatic TB in community-based screening. METHODSTongue swabs were collected from adult household contacts of TB patients (HHC Cohort), and symptomatic adults presenting to clinics with presumptive TB (Clinic Cohort), at eight South African sites. TB Cases were defi...

BackgroundRespiratory viruses are major contributors to population mortality, but cause-of-death coding undercounts their impact. Ecological regression models linking viral circulation to mortality fluctuations can address this limitation. AimTo estimate the population attributable fraction (PAF) of mortality associated with influenza A and B, respiratory syncytial virus (RSV), and SARS-CoV-2 in Ontario, Canada (1993-2024). MethodsWe analysed monthly all-cause mortality data with laboratory su...

Infection with pnuemococcus bacteria is generally mild but can be more severe in the young and elderly, causing invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP). Although paediatric pneumococcal conjugate vaccine (PCV) programmes and elderly pneumococcal polysaccharide vaccine (PPV) programmes have reduced cases, we estimate that pneumococcal infection still leads to direct health care costs of around {pound}68M and approximately 16 thousand QALY losses in England per y...

Annual influenza vaccination is the cornerstone for seasonal protection, yet antibody responses are highly variable across individuals and over time. To systematically assess the determinants of this heterogeneity, we compiled 20,449 hemagglutination inhibition and neutralization titers from 4,540 participants enrolled in 14 new vaccine studies we conducted and 50 prior studies that collectively span 2010-2023. Seasonal effects dominated, with pre- and post-vaccination titers declining steadily ...

BackgroundSevere Plasmodium falciparum malaria is a leading cause of death in sub-Saharan Africa, with most deaths occurring in children younger than five years of age. The RTS,S/AS01E (RTS,S) malaria vaccine delivered seasonally with Seasonal Malaria Chemoprevention (SMC) led to a two-third reduction in severe malaria and malaria deaths compared with either intervention given alone. The aim of this study was to assess the seasonal distribution and clinical presentation of children admitted in h...

Bedaquiline (BDQ) is a cornerstone antibiotic for treating multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB). Resistance to BDQ (BDQR) can arise through three mechanisms: spontaneous mutation, acquisition during treatment, or transmission of a resistant strain. We developed a transmission threshold model to estimate the contribution of each mechanism to BDQR burden in MDR/RR-TB We integrated four data sources: (i) novel estimates of spontaneous resistance probability; (ii) updated est...

BackgroundSerum or plasma concentrations of creatinine and urea are the usual laboratory parameters measured to assess kidney function and disease severity in patients with suspected severe malaria. Creatinine is preferred for estimation of the glomerular filtration rate, but the current threshold for defining severe malaria (> 265 umol/L) is based on adult values and does not reflect the large difference between children and adults in normal values resulting from differences in muscle mass. We ...

The measles outbreak in Jalisco, Mexico (January-February 2026) experienced vigorous sustained transmission with an exponential growth rate = 0.10 (95% CI: 0.10-0.11) per day, doubling time = 6.3 days (95% CI: 6.3-6.9), yielding the effective reproduction number at 3.34 (95% CI: 3.16-3.54), with elevated incidence among infants and young adults.