Vaccine: X

Background: Tuberculosis (TB) remains a major public health challenge globally, with Pakistan ranking among the highest TB burden countries worldwide. Although several novel TB vaccine candidates for adolescents and adults are advancing through late-stage clinical trials, little is known about how these vaccines may be introduced in high-burden settings such as Pakistan. Understanding stakeholder perspectives is crucial for informing early implementation planning and policy development. Methods: We conducted an exploratory qualitative study using semi-structured in-depth interviews with key stakeholders involved in TB control, immunization, clinical care, and health policy in Pakistan. Participants were purposively selected from national and provincial TB programs, Expanded Programme on Immunization (EPI), clinical settings, and academia. Interviews were conducted in English or Urdu, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following the Braun and Clarke framework. A hybrid deductive-inductive coding approach was used. Results: Ten stakeholders participated including one whose interview also served as a pilot test of the interview guide. Participants expressed strong support for the introduction of a new TB vaccine, driven largely by Pakistan's high TB burden and the limitations of current prevention strategies. However, support was based on the availability of strong evidence regarding vaccine safety, effectiveness, and feasibility. Key barriers to vaccine acceptability included low perceived risk of TB, misinformation, stigma, sociocultural influences, and limited public awareness. Stakeholders emphasized community engagement, trusted healthcare providers, and effective communication as critical enablers. Health system challenges included workforce shortages, cold chain limitations, and financing constraints. Household contacts of TB patients were consistently identified as the priority group followed by adolescents and people living with HIV. A phased implementation strategy was broadly preferred followed by gradual integration into existing health services. Conclusion: Stakeholders in Pakistan broadly support new TB vaccines for adolescents and adults. Successful implementation will require addressing sociocultural barriers, strengthening health system capacity, and developing context-specific delivery and prioritization strategies. Early stakeholder engagement and implementation planning are essential for meaningful public health impact in Pakistan.

Vaccine effectiveness (VE) estimates can vary widely between years and populations, even for the same vaccine. Estimated VE is known to be sensitive to susceptible depletion and differences in pre-vaccination infection risk between vaccinated and unvaccinated populations. However, how variation in pre-vaccination risk within and between the two groups affects VE estimates over time remains unclear. This uncertainty is especially important given negative VE estimates. We investigated the difference between estimated VE and true vaccine protection considering continuous distributions of pre-vaccination infection risk under three scenarios. When the vaccinated and unvaccinated populations differ in their mean risk, estimated VE can be higher or lower than true vaccine protection. Similar patterns arise when both populations share identical means but different risk distributions. Finally, if infection-derived immunity lasts longer than vaccine protection, annual VE estimates can vary by tens of percentage points between years despite constant true vaccine protection. These theoretical results underscore that VE studies estimate contrasting risk between vaccinated and unvaccinated individuals in a particular time and place, and VE estimates can vary counterintuitively between years and populations even with constant vaccine-induced protection. Explaining variability in estimated VE thus requires a more complete understanding of populations' distributions of infection risk.

Introduction. By the end of 2023, many low-income countries had not reached 50% COVID-19 vaccine coverage, while most high-income countries had exceeded 80%. It remains unclear whether receiving vaccine deliveries translated into faster population coverage. We examined cross-national inequalities in the timing of the vaccine rollout and whether deliveries through the COVID-19 Vaccines Global Access (COVAX) facility were associated with subsequent national uptake. Methods. We conducted an observational study of 218 countries and territories using country-level data up to December 2023. We used generalized additive mixed models to identify country-level correlates of coverage at an early and a later stage of the pandemic, survival analysis to compare the time to 50% coverage between COVAX Advance Market Commitment (AMC) and non-AMC countries, and an event study to estimate the association between the timing of the first COVAX delivery and subsequent monthly coverage in AMC countries. Results. AMC-supported countries reached 50% coverage substantially more slowly than non-AMC countries. The hazard of reaching the threshold was 0.17 times that of non-AMC countries at month 1 (95% CI 0.07 to 0.41) and 0.53 times at month 18 (95% CI 0.33 to 0.85). One year after rollout began, 65.9% of AMC countries (95% CI 56.7 to 76.6) had not reached 50% coverage, compared with 21.1% of non-AMC countries (95% CI 15.1 to 29.5). The timing of COVAX deliveries was not significantly associated with subsequent national uptake in any post-delivery month. In the early stage of rollout, higher maternal mortality was associated with lower coverage, while a larger urban population was associated with higher coverage. By the end of the observation period, larger household size was associated with lower coverage, while higher health expenditure and a larger urban population were associated with higher coverage. Conclusion. Receiving COVAX deliveries was not, on its own, associated with faster coverage. Coverage differences were more consistently associated with country-level structural and health-system characteristics, while we found no significant association with the timing of the first COVAX delivery. Achieving vaccine equality likely requires strengthening the capacity of health systems to convert deliveries into administered doses, and preparedness efforts should invest in last-mile delivery capacity ahead of future emergencies.

Background: Seasonal influenza, commonly known as flu, is an acute respiratory, highly contagious illness caused by influenza viruses. A clear understanding of influenza seasonality is crucial for guiding prevention and treatment strategies, including decisions on vaccination timing to prevent outbreaks. While well documented in temperate regions, data on influenza epidemiology in tropical areas, particularly sub-Saharan Africa, remain limited. We described the types, subtypes and positivity rate of seasonal influenza in Uganda during 2019-2023. Methods: We abstracted data from the National Influenza database on positive seasonal influenza cases confirmed by Polymerase Chain Reaction. The cases were disaggregated by age group, sex, region, month and year of reporting. Using Microsoft excel, we calculated the influenza positivity rate and disaggregated it by strain, sex, age, region and time. Test positivity rate was computed as the number of positive cases as a percentage of the total samples tested. Results: Among 17,957 individuals tested, the overall positivity rate for seasonal influenza was 5% (936 cases). Positivity was higher among males compared to females (7% vs. 4%), with children aged 5-9 years having the highest positivity rate (16%), while individuals aged 50-54 years had the lowest (1%). The median positivity rate was 4%, with a range of 1-16%. Regionally, the central region reported a positivity rate of 5%, with rates across all regions ranging from 5% to 8%. Over time, there was a gradual decline in positivity rates, decreasing from 16.5% in 2019 to 5.3% in 2023. Seasonal influenza exhibited bimodal peaks, with the primary peak occurring between March and May and a secondary peak from October to December. Influenza A was the predominant strain, accounting for 70% of seasonal influenza cases (669/936). Among the Influenza A subtypes, H3N2 was most common, representing 63% of cases (425/669). Conclusions: The declining seasonal influenza positivity rates from 2019 to 2023 and the predominance of Influenza A and H3N2 highlight the need for sustained surveillance in Uganda. Given Influenza A's high genetic variability and potential for novel strain emergence, monitoring circulating strains, informing vaccine development, and implementing targeted interventions for high-risk groups and regions are critical to controlling and preventing outbreaks.

Background: Respiratory syncytial virus (RSV) remains a leading cause of hospitalization in infancy, with severe outcomes influenced by both contact patterns and passive immunity. Non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic suppressed RSV circulation and reduced opportunities for maternal immune boosting, potentially altering protection among newborns. We evaluated whether incorporating time-varying maternal immunity improves the ability of an age-structured transmission model to predict post-pandemic RSV hospitalization patterns in infants. Methods: We analyzed population-based RSV hospitalizations among Ontario (Canada) infants (<1 year) from July 2, 2017 to June 25, 2024, using linked administrative databases. A deterministic compartmental model across seven age classes was calibrated against pre-pandemic data using Latin Hypercube Sampling. We compared a model incorporating time-varying contact rates alone against a specification that additionally included time-varying maternal immunity. Results: Both specifications accurately reproduced pre-pandemic seasonality and macro-level post-pandemic resurgence features. The constant maternal immunity model showed slightly better accuracy in capturing the 2021/22 peak compared to the time-varying maternal immunity specification. However, both qualitatively captured the continued near-absence of RSV and the observed peak was captured within the 95% credible intervals. While both models precisely captured the timing and overwhelming surge of admissions that occurred in 2022/23, they failed to capture the premature peak timing and magnitude in 2023/24. Conclusions: Incorporating time-varying maternal immunity did not improve model accuracy post-pandemic. While maternal protection is essential for evaluating infant immunizations, population-level contact shifts primarily shaped post-pandemic RSV seasonality, indicating that models must account for these mechanisms of RSV transmission dynamics.

Importance: Maternal vaccination and long-acting monoclonal antibodies are now available in the U.S. to prevent RSV. Long-acting monoclonal antibody administration in the U.S. commonly occurs after hospital discharge in outpatient settings, leaving some infants unprotected early in life when severe RSV risk is highest. Comparative effectiveness between the two interventions and whether delays affect effectiveness estimates have not been quantified. Objective: To evaluate the effectiveness of infant long-acting monoclonal antibody strategies and a maternal vaccination strategy, each compared to no intervention, and the comparative effectiveness of intervention strategies when accounting for real-world delays in monoclonal antibody receipt. Design: Cohort study using target trial emulation to compare four strategies for prevention of RSV-related outcomes. Setting: The U.S. between 2023 and 2025 using a nationwide database of employer-sponsored commercial insurance claims. Participants: 120,586 commercially insured mother-infants, whose infants were born in the U.S. during the 2023-2024 or 2024-2025 RSV season. Infants who could not be paired with their mother's record, did not enroll in commercial insurance within 75 days from birth, received palivizumab, and had an implausible birth date were excluded. Interventions: Comparison of four RSV prevention strategies: (i) maternal RSVpreF; (ii) long-acting monoclonal antibody given within the first week of life (mAb as intended); (iii) long-acting monoclonal antibody given within a six-month grace period from birth (mAb within grace period); and (iv) a control. Main outcomes and measures: Effectiveness against first RSV-associated hospitalization and medically-attended RSV illness was summarized using adjusted hazard ratios (aHR) and estimated using an inverse propensity weighting approach, with weights accounting for maternal age, maternal comorbidities affecting pregnancy, obstetric and newborn complications, season, region, and birth timing relative to October 1. A weighted Kaplan Meier estimator was used to estimate strategy-specific cumulative incidence of RSV outcomes over time. Results: In the first five weeks of life, the mAb within grace period strategy doubled the hazard of RSV hospitalization (aHR: 2.0 [95% CI: 1.0-4.9]) and increased the hazard of medically-attended RSV (aHR: 1.6 [95% CI: 1.0-2.7]) compared to the maternal RSVpreF strategy. The hazard for RSV hospitalization was similar for the mAb as intended strategy compared to the maternal RSVpreF strategy (aHR = 0.9 [95% CI: 0.3-1.9]). Conclusions and relevance: RSVpreF and monoclonal antibodies were similarly effective when monoclonal antibodies were administered close to birth, but when accounting for real-world delays in monoclonal antibody receipt, the maternal RSVpreF strategy was more effective than the mAb within grace period strategy.

Background Rural-urban disparities in SARS-CoV-2 infection epidemiology remain poorly quantified and understood in Zambia despite differences in healthcare access, services and preventive interventions. This study examined the geographical distribution and associated factors of SARS-CoV-2 cases across selected rural and urban districts of Zambia. Methods A convergent mixed-methods study comprised of quantitative survey and qualitative interviews was conducted in; Ndola (Urban), Kafue (Peri-urban) and Lufwanyama (Rural). The proximate determinant framework guided variable selection and interpretation. Quantitative combined (Hospital-surveillance data with community survey), while qualitative included In-depth interviews. Participants were sampled using multistage sampling technique. Quantitative data were analysed using STATA version 17, while qualitative data were analysed thematically. Findings were integrated through triangulation. Results A total of 528 participants were included, with a median age 31 years (15-71). Overall SARS-CoV-2 positivity was 12.6%, varying across rural (16.5%), peri-urban (14.9%), and urban (9.9%) settings, though residence was not associated with infection (P<0.132). Participants aged [&ge;]49 years had significantly higher odds of infection (aOR=8.78; 95% CI:1.15-66.99), whereas secondary education (aOR=0.37; 95% CI:0.16-0.86) and hospital-based testing (aOR=0.37; 95% CI:0.15-0.92) were associated with lower odds of infection. Vaccine uptake was highest in urban areas but was not independently associated with infection. Qualitative findings revealed marked rural-urban differences in perceived susceptibility, testing access, vaccine decision-making, and adherence to preventive measures, explaining several quantitative observations. Conclusion SARS-CoV-2 infection across rural and urban settings in Zambia was influenced by demographic, behavioral, and health-system factors rather than geographic residence alone. These findings highlight the need for context-specific prevention strategies, equitable access to testing, strengthened community surveillance, and targeted risk communication to improve preparedness and response for future respiratory disease outbreaks.

Mosquito-borne diseases pose a growing public health challenge as climate change reshapes vector population dynamics. West Nile virus (WNV), transmitted between birds and Culex mosquitoes, disproportionately affects Maricopa County, Arizona, one of the nation's highest-burden counties, yet whether models that include weather and avian dynamics improve forecast accuracy remains unclear. Using a 15-year weekly time series of mosquito abundance, mosquito infection prevalence, and human cases, we developed four mechanistic model configurations of varying complexity, from mosquito-human dynamics alone to full models incorporating avian dynamics and weather forcing. We fitted each model to the weekly-observed data, generated probabilistic 1- and 2-week-ahead forecast horizons, and evaluated forecasts against a historical baseline. All configurations fit the data equally regardless of weather or avian dynamics. However, models incorporating both birds and weather created more accurate forecasts of mosquito abundance and mosquito infection prevalence, and all configurations outperformed the baseline for forecasting human cases. Forecast accuracy was highest in summer and fall, and ensemble aggregation sometimes outperformed every individual model, stabilizing predictions across the 15-year record. These findings indicate that avian and weather dynamics are most critical for predicting mosquito-specific data, positioning this framework as a scalable tool for public health planning for WNV surveillance under climate change.

Introduction Hearing loss (HL) affects over 1{middle dot}5 billion people globally and India shares a disproportionately high burden including Disabling Hearing Loss (DHL). HL affects an Individual socio-economically, but there are limited studies on the broader societal economic consequences of HL in India.Methods Using Cost-of-Illness (COI) approach, we studied the societal economic burden of HL in India. This study uses epidemiological and macroeconomic data and modelling to estimate the loss of Gross National Income (GNI) due to HL and DHL across three economic pathways. Uncertainty is evaluated using deterministic and Probabilistic Sensitivity Analyses (PSA).Results The model estimates that there are in India, 289 million and 85{middle dot}9 million people with HL and DHL respectively. Direct Loss of GNI and Indirect Loss of GNI (Caregiver burden) are estimated as INR 4,648{middle dot}4 billion (USD 55{middle dot}6 billion) and INR 3,268 billion (USD 39 billion) respectively. The Loss of GNI due to Low Education amongst those with HL is estimated as INR 1,041{middle dot}9 billion (USD 12{middle dot}45 billion).Discussion Economic burden of HL is presented across three pathways with Direct Loss of GNI due to DHL being the greatest. It also presents age stratified caregiver economic burden. The findings of the study help in estimating similar cost pathways, advocacy, and policy decisions towards reducing HL prevalence in India and LMICs. This study also highlights the need for India specific estimations related to the HL attributable low education, state-wise disaggregates, and prevalence studies. Funding This study has not received any funding.

Forecasting influenza hospitalizations informs public health preparedness, yet questions remain about which types of forecasts best guide action. We evaluate categorical trend forecasts, which communicate probabilities of upcoming increases or decreases in epidemic trajectories, submitted to CDC's FluSight Forecasting Challenge between Fall-2024 and Spring-2026. Teams submitted probability distributions over five categories describing direction and magnitude of week-over-week changes in laboratory-confirmed influenza hospital admissions. We assessed performance using Ranked Probability Skill Score, Brier Skill Score, and measures of forecast-observation agreement. Most models outperformed an equal-probability baseline; the FluSight ensemble ranked among the top three in the 2024-25 and 2025-26 seasons. Forecasts were most accurate during stable periods and least during periods of rapid change, with most models underestimating observed trends. Conclusions were robust to choice of scoring metric and reference model. These results support categorical trend ensembles as an approach to communicating infectious disease forecasts that may inform public health decision-making.

Background Dengue is a major public health challenge, and predictive models are crucial for early warning systems. However, many current modeling practices rely exclusively on climatic factors or employ complex algorithms that lack the interpretability needed for informed public health decision-making. To address these shortcomings, we developed and validated a multidimensional, interpretable statistical model to predict monthly dengue incidence. Methodology/Principal Findings We used a Generalized Linear Mixed Model (GLMM) with a Negative Binomial distribution to analyze 14 years (2010-2023) of spatiotemporal data from 37 municipalities in Huila, Colombia, an endemic region. The model integrates non-linear and lagged effects of climatic, demographic, and socioeconomic factors. The final model underwent rigorous external validation on an independent test set (2021-2023). Our model demonstrated high predictive discrimination (R2 = 0.743, Spearman's {rho} = 0.657), accurately capturing the timing of epidemic outbreaks. Key findings include the identification of an optimal thermal window for transmission at 27-28{degrees}C, a threshold effect for precipitation above 800 mm, and a saturation dynamic in outbreak autocorrelation. Conclusions/Significance This mechanistically-informed statistical approach provides a robust and transparent tool for epidemiological surveillance, successfully balancing high predictive performance with the explanatory power needed for effective, data-driven public health interventions.

Background: Ebola virus disease is a life-threatening illness caused by the Ebolavirus, with symptoms manifesting two to twenty-one days after infection. Although Uganda has faced multiple Ebola outbreaks, many patients survive only to encounter persistent challenges. Therefore, this study explored the post-discharge experiences of survivors following the 2022 Ebola Virus Disease outbreak in Uganda. Methods: An exploratory qualitative study comprising of in-depth participant interviews was conducted at Mubende Regional Referral Hospital in central Uganda. Interviews were face-to-face and data were analyzed manually by inductive content analysis. Ten male and female participants were Ebola Virus Disease survivors in Mubende district who had lived in the community for at least six months post-discharge from the Ebola Treatment Unit. Results: Four themes emerged: (i) Psychosocial Burdens and Social Exclusion, (ii) Economic Hardship and Loss of Financial Stability, (iii) Chronic Physical and Health Burdens Post-Recovery and (iv) Rebuilding Lives: Psychological, Social, and Medical Pathways to Recovery. Survivors faced significant emotional burdens such as survivor guilt, grief, trauma from loss, and anxiety about transmission risks. They experienced social isolation, stigma, and discrimination, which often led to their exclusion from community activities. Financially, they struggled with debt and the loss of livelihoods, compounded by ongoing health issues. Additionally, survivors endured chronic physical complications, including pain and fatigue, which hindered their recovery. Despite these challenges, survivors sought psychological, social, and medical pathways to recovery, including confirmation of their recovery, support from family and organizations, and health maintenance practices. Supportive medical care and community assistance were crucial in their physical and emotional rehabilitation. Conclusion: Ebola Virus Disease survivors in Uganda face significant psychosocial, health, social, and economic challenges post-discharge. The findings highlight the critical need for comprehensive medical and community-based support systems to aid survivors' recovery and well-being. Further research on long-term neurological effects and community reintegration programmes is needed to inform targeted interventions that support Ebola survivors and reduce stigma and discrimination.

Introduction: Clinical students are a future health workforce, yet their roles during outbreaks of highly infectious diseases remain uncertain because of safety, training, supervision and welfare concerns. Ugandas 2022 outbreak of Ebola disease caused by Sudan ebolavirus highlighted the need to understand how clinical students perceive outbreak-related care. Aim: This study explored willingness to care for patients with Ebola virus disease among clinical students at a Ugandan medical school and examined how perceived risks, perceived benefits and support needs shaped that willingness. Methods: An exploratory descriptive qualitative study was conducted among clinical students of Makerere University in Kampala, Uganda. Fifteen undergraduate medical and nursing students in the later years of training were purposively selected. Data were collected through in-depth interviews, audio-recorded with consent, transcribed verbatim, de-identified and analysed using latent content analysis. The Health Belief Model sensitised interpretation, and reporting was strengthened using the COREQ guidance. Results: Five interrelated themes emerged, showing that willingness to care was conditional rather than simply present or absent. Students described an initial willingness grounded in professional duty, devotion to patients and the desire to save life. This willingness was restrained by perceived risks of contracting Ebola virus disease, dying, transmitting infection to family members or colleagues, emotional distress, lack of epidemic-readiness in the curriculum, inadequate preparedness and weak welfare support. Perceived benefits, including patient survival, professional learning, outbreak experience and personal fulfilment, strengthened willingness but did not override safety concerns. Students identified reliable personal protective equipment, epidemic-ready curricula, practical infection-prevention and control training, simulation, clear protocols, close supervision, psychosocial support, insurance and fair compensation as cues to action that could convert willingness into safe participation. Conclusions: Clinical students in this Ugandan teaching hospital expressed a strong sense of professional responsibility, but their willingness to participate in Ebola care was conditional upon preparedness, protection, epidemic-ready education and institutional trust. Professional duty and learning opportunities promoted participation, whereas perceived risks and inadequate support limited it. Medical education programmes and outbreak-response systems should develop ethical, supervised, competency-based student roles supported by practical curricula, reliable protective equipment and psychosocial and welfare safeguards.

Background Scrub typhus, an acute bacterial infection caused by Orientia tsutsugamushi, is an important, under-recognized etiology of febrile illness in South Asia. Accurate surveillance for scrub typhus in Nepal is challenging due to non-specific symptoms and limited diagnostic tools. Methods We conducted a representative school-based cross-sectional serosurvey in Kavrepalanchok and Dolakha, Nepal between November 2021 and April 2022 using two-stage sampling, we randomly selected 13 public schools and then up to 100 children aged 4-18 years per school. We collected capillary blood samples and tested for IgG responses to Orientia tsutsugamushi-derived recombinant 56-kDa antigen using commercially available ELISA kits. We estimated seroincidence rates using previously-published models of antibody decay dynamics from confirmed scrub typhus cases. We compared seroincidence to seroprevalence estimates using cutoffs derived from Gaussian finite mixture models applied to the study population. Results We enrolled a total of 827 children (participation rate: 94.8%). The median age was 10 years (IQR: 8-13), and 53.08% of the participants were female. The overall seroincidence rate was 6.3 new infections per 1000 person-years (95% CI: 4.7- 8.4), and the rate was slightly higher in peri-urban Kavrepalanchok (7.3; 95% CI: 4.9 - 10.3) compared with rural Dolakha (5.3; 95% CI: 3.3 - 8.5). Seroincidence increased with age, from 3.6 new infections per 1000 person-years (95% CI: 1.4- 9.7) among children aged 4- 7 years to 9.4 (95% CI: 6.2-14.3) among children aged 14-18 years. Seroincidence was higher in females (8.3; 95% CI: 5.9 -11.8) than in males (4.1; 95% CI: 2.4 - 6.9) (p=0.02). The overall seroprevalence was 6.5% (95% CI: 4.9-8.4) and followed a similar age and geographic trend to the seroincidence rate. Discussion Our findings reveal a substantial burden of pediatric scrub typhus in the Kavrepalanchok and Dolakha districts of Nepal. Seroincidence increased with age and was higher among females. School-based serosurveys offer an efficient sampling frame to rapidly assess population-level scrub typhus transmission intensity among children and adolescents, though may not represent out-of-school populations.

Background Birth Preparedness and Complication Readiness (BPCR) education is an important component of antenatal care. However, health education materials translated from one language into another may lose their intended meaning if linguistic, cultural, experiential, and sociolinguistic differences are not considered. In Tanzania, maternal health education is commonly delivered in Swahili, while many source materials are developed in English. This study explored the cultural and linguistic equivalence of BPCR terminology and concepts in a translated Swahili BPCR education manual among Hehe pregnant women in the rural Iringa Region, Tanzania. Methods A descriptive qualitative study was conducted in seven villages across Kilolo and Mufindi districts of Iringa Region. Seven focus group discussions (FGDs) involving 56 pregnant women were conducted. Participants were purposively selected from the Hehe community and were asked to interpret terminology and concepts contained in a harmonized Swahili BPCR education manual. The translation and adaptation process comprised six sequential steps: forward translation, synthesis, back translation, expert review, community exploration, and finalization. FGDs were conducted in Swahili by trained facilitators fluent in both Swahili and Hehe, audio-recorded with consent, transcribed, and thematically analyzed using Braun and Clarkes six-phase approach. Analysis focused on semantic, conceptual, experiential, and sociolinguistic equivalence. Reporting was informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results Five themes were developed: (1) culturally and linguistically familiar expressions conveyed BPCR concepts; (2) experiential and contextual language shaped descriptions of danger signs; (3) sociolinguistic norms and modesty influenced communication about sensitive health topics; (4) some clinically important concepts had partial or limited conceptual equivalence; and (5) unfamiliar concepts required supplementary explanation. Participants identified culturally familiar expressions including "matazamio ya kujifungua" ("anticipated date of delivery"), "fedha ndiyo usafiri" ("money itself is transport"), "chupa imepasuka" ("the water bag has burst"), "mtoto kutokucheza tumboni" ("the baby is not moving in the womb"), and "sehemu za siri" ("private parts"). Some expressions were familiar but broader than their biomedical equivalents, while cord prolapse and neonatal cyanosis had no readily recognized community equivalents. Conclusion The findings indicate that cultural and linguistic equivalence cannot be achieved through literal translation alone. Community exploration identified expressions that were familiar and socially acceptable while also revealing clinical concepts requiring additional explanation. The findings informed refinement of the Swahili BPCR education manual while preserving the intended clinical meaning. The adapted terminology should subsequently be evaluated separately for its effects on knowledge, attitudes, practices, and other health outcomes.

Objective As antimicrobial resistance (AMR) continues to threaten global public health, bacteriophage therapy products (BTPs) offer a promising alternative to conventional antimicrobials. However, translation into routine clinical practice requires best practice standards for manufacturing and quality control to ensure the consistent safety, quality, and reliability of personalised BTPs produced for individual patients or small cohorts. Design A modified Delphi methodology was used to develop consensus statements, engaging experts from Australia's National Bacteriophage Therapy Regulatory Working Group across the fields of clinical microbiology, phage biology, good manufacturing practice (GMP), regulatory science, and government. The process comprised three iterative phases: (1) structured statement development, (2) an anonymous REDCap survey, and (3) a hybrid consensus meeting. The strength of evidence and recommendations was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Results Consensus was reached on 35 statements to provide best practice manufacture and quality control guidance for BTPs. These statements address requirements for phage identification and characterisation; define the point at which GMP-aligned processes commence for ubiquitous phages; outline quality control expectations for phage active pharmaceutical ingredient (pAPI) production and maintenance of BTP and host cell repositories. Additional guidance covers quality management systems, including documentation, traceability, and governance. Conclusion These consensus statements provide comprehensive best practice recommendations for the manufacture and quality control of BTPs in Australia. By promoting consistent, safe, and quality-assured approaches to personalised BTPs, they aim to facilitate clinical implementation while remaining aligned with existing international pharmacopoeial standards and regulatory frameworks.

Background: Vitamin K prophylaxis is universally recommended for newborns to prevent life threatening vitamin K deficiency bleeding. Although not on the immunization schedule, vitamin K prophylaxis is often coadministered with hepatitis B birth dose and erythromycin ophthalmic ointment, and rising hesitancy around vaccines/preventive care may spill over into vitamin K administration. Methods: We conducted a retrospective cohort study using Truveta electronic health record data with linked mother-child dyads. Live births to mothers aged 15-49 from January 1, 2019 through June 30, 2026 were included. Vitamin K administration was defined as documentation on the birth date or following day. Logistic regression assessed sociodemographic predictors of non-receipt, and interrupted time series analysis evaluated changes after January 2026. Results: Among 1,026,375 infants, 995,628 (96.97%) had documented vitamin K administration. Non-receipt increased from an average of 2.1% during 2019-2022 to 4.3% in 2025 and 6.1% in 2026, reaching 8.10% in June 2026. Older maternal age, non-Hispanic or Latino ethnicity, Medicaid or unknown insurance, and year of delivery were associated with greater odds of non-receipt. After January 2026, there was no immediate step change, but the odds of vitamin K receipt declined an additional 10% per month (OR: 0.90; 95% CI, 0.88-0.91). Conclusions: Vitamin K non-receipt increased over the study period and accelerated after January 2026. Because vitamin K recommendations were not changed by the January vaccine schedule, this association may reflect broader impacts to confidence in newborn preventive care. Future studies should examine causal mechanisms, parental decision-making, and associated clinical outcomes.

Background: In Tanzania, over 10,000 women aged 15-44 are diagnosed with cervical cancer annually, and more than 6525 die. The majority are diagnosed at an advanced stage, which contributes to delays in treatment enrollment and illness complications. Multiple factors can affect womens willingness and ability to access cervical pre-cancer screening. Purpose: To explore the barriers and facilitators to attending cervical pre-cancer screening among women living in a resource-constrained area of Southern Tanzania Methods: A qualitative study of 17 focus group discussions and 12 in-depth interviews was conducted from December 2023 to July 2024. Data collection took place in the community and health centers of a town and the surrounding rural areas in Kilombero district. The study used purposive sampling to recruit 112 women and 23 men aged 18- 50+ years. Results: Fear of death emerged as a central theme in the data, acting as both a barrier to and a facilitator of womens screening behavior. Women linked death with the screening procedure, receiving results and undergoing treatment. Participants mistrusted the speculum itself and linked it to pain, vaginal infection, and infertility. Conversely, fear of physical and social death motivated other women to attend the screening to learn about their health and prevent the consequences of a positive diagnosis. Public trust in the healthcare system and the role of health information sources were also identified as influencing women's decisions to undergo or not undergo screening. Conclusion: Our findings showed that cervical cancer screening uptake is influenced by fear of death and other co-factors. To improve early cervical cancer screening, programs and policy interventions are needed to raise awareness of the disease while also addressing womens specific concerns. Also, strengthening structural dimensions such as the availability of the healthcare workforce, healthcare facilities, and ensuring equitable service availability are essential to reducing cervical cancer complications and avoidable mortality.

Influenza vaccine effectiveness (VE) is estimated from a limited number of clinics using a test-negative design. These standard estimates face geographic, temporal, and operational constraints. Using Twitter/X data, we applied few-shot chain-of-thought prompting to identify self-reported vaccination status and influenza test results, then implemented a test-negative-like design to estimate VE. Our estimates fell within the range of interim reports and could complement current systems, improving feasibility, timeliness, and scalability.

The 17th Ebola outbreak in the Democratic Republic of the Congo, announced on 15 May 2026, was attributed to Bundibugyo ebolavirus (BDBV). Although case isolation is the main control strategy, its effectiveness is compromised when patients escape isolation facilities before recovery. Between 14 May and 17 June 2026, 175 individuals reportedly left isolation facilities without formal discharge across Ituri Province. We assessed how this "isolation leakage" affects community transmission. We refined the SEIHFR framework to distinguish undetected community infections, detected but not-yet-isolated cases, isolated individuals, leakage, funeral-associated transmission, and removals. Using Bayesian inference, we fitted the model to daily Ituri surveillance data, escapee counts, and isolation census records. We estimated the leakage rate, reporting and detection probabilities, and the transmission rate, while fixing other parameters based on the BDBV literature. The model reproduced confirmed cases, deaths, discharges, and escapees. We estimated R_0=3.67 (95% HDI: 2.0-5.7), a leakage rate of {rho} {approx} 0.034 day^-1 (0.022-0.051), and high contact-tracing-driven detection (p_d {approx} 0.91-0.99). Leakage increased the detection-dependent reproduction number [R](p_d) from approximately 3.2 to above 5. Eliminating leakage reduced cumulative infections by about one-third, from 1,120 to 764, while the minimum detection level required for control increased from p_d [&ge;] 0.73 without leakage to p_d [&ge;] 0.87 at the fitted leakage rate. Shortening time to isolation prevented the most infections (73.4%; 59-84), followed by reducing leakage (29.7%; 14-52) and re-isolating escapees (12.6%; 6-24). Delaying leakage reduction until week 4 reduced its benefit from about 27% to below 2%. Isolation leakage represents a major transmission pathway that has until now gone largely unmeasured. While rapid initiation of isolation is highly beneficial, it cannot compensate for permeable isolation; therefore, early, community-driven efforts to control leakage, embedded within a multilayered response, are critical.