The Lancet Infectious Diseases

🚀Respiratory syncytial virus (RSV) vaccine effectiveness among US veterans, September, 2023 to March, 2024: a target trial emulation study ⚖️ Kristina L Bajema and colleagues used electronic health records in the Veterans Health Administration to emulate a target trial comparing a single dose of RSVPreF3 or RSVpreF vaccination versus no vaccination among veterans aged 60 years and older. During the enrolment period, eligible vaccine recipients were matched with up to four unvaccinated persons in four monthly nested sequential trials. Outcomes included any positive RSV test from day 14 following the matched index date (primary outcome) or subsequent hospitalization, emergency department encounter, or urgent care encounter within 1 day of the RSV test (secondary outcomes). In total, 146852 vaccinated individuals with a corresponding number of equally weighted unvaccinated individuals were included. 💡Over a median follow-up of 124 days, both RSVPreF3 and RSVpreF performed similarly to the efficacy observed for the vaccines in the original randomised controlled trials, with an estimated effectiveness of 78·1% (95% CI 72·6–83·5) against documented RSV infection and 80·3% (65·8–90·1) against RSV-associated acute hospitalisation, and similar protection was observed in the subgroup analyses. Vaccine effectiveness against RSV infection was 72·3% (57·9–84·6) in individuals aged 80 years and older and 72·7% (58·4–83·2) in those at high risk. 🔦 This study provides real-world effectiveness data demonstrating benefit of RSV vaccination among individuals aged 60 years and older during the 2023–24 respiratory illness season, including protection against RSV-associated emergency department visits and hospitalisations as well as among subgroups at high risk for severe RSV illness. These findings support current recommendations for RSV vaccination among individuals aged 60 years and older. Further work is required to assess longer-term protection and safety of RSV vaccines, and protection using diverse databases in different geographies. The paper can be found here: https://bit.ly/3Csj1HQ Linked comment by Harish Nair and Thomas Williams can be found here: bit.ly/3EoSmw9 #RSV, #vaccination, #Veterans Kristina L Bajema, Lei Yan, Yuli Li, Stephanie Argraves, Nallakkandi Rajeevan, Alexandra Fox, Rob Vergun, Kristin Berry, David Bui, Yuan Huang, Hung-Mo Lin, Denise M Hynes, Cynthia Lucero-Obusan, Patricia Schirmer, Francesca Cunningham, Grant D Huang, Mihaela Aslan, George Ioannou

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🆕 The Lancet Infectious Diseases’ February Issue is live now! 📊 This month, our issue contains two articles about Oropouche virus (OROV), re-emerging in South America on an unprecedented scale. 🔎 The first study by Fernanda Eduarda das Neves Martins and colleagues is a case series in which authors identified retrospective cases of microcephaly in infants with antenatal OROV exposure between 2016–2018, with new cases identified in 2024. Six of the samples were positive for OROV. The findings highlight the possibility of premature births, foetal deaths, and miscarriages as a result of OROV infection. Surveillance of congenital syndromes should be strengthened by monitoring pregnant people and their newborns in areas where OROV is circulating. 🔎 The second paper by Gabriel C Scachetti and colleagues is an observational epidemiological study that combined multiple data sources for ORV in Brazil and conducted in-vitro and in-vivo characterisation. 8264 cases were reported from January to August, 2024, 58·8 times the annual median of 147 cases (IQR 73–325). The findings suggest that the 2023–24 outbreak might be related to higher replication efficiency and immune evasion of the current circulating reassortant strain than previous strains. The authors provide evidence that this new strain is more virologically fit compared to the prototype (BeAn19991) and that ORV antibodies from patients and infected mice differ in their ability to neutralise the prototype and outbreak strain. Public health preparedness strategies and the development of vaccines with broad protection against OROV reassortants are needed to respond to future outbreaks effectively. Also in this month’s issue: 🔹EDITORIAL: Vaccination in Africa—no hesitancy without access 🔹 A pragmatic, before-after control-intervention paired-series (BACIPS) trial on mosquito-disseminated pyriproxyfen to control dengue 🔹A research article about sequential and parallel testing for TB disease in children in low- and middle-income countries 🔹A review on the new WHO guidelines for treating rhodesiense human African trypanosomiasis and a personal view on a long-term global financing mechanism for sustainable AMR surveillance Read more exciting content in the present issue here: bit.ly/4hFdPiL Alt: Cover of The Lancet Infectious Diseases’ February 2025 issue-BACIPS trial by Lillian Li #Oropouche, #MERS, #dengue, #TB, #COVID, #pneumonia, #Chlamydia, #AMR, #trypanosomiasis, #Cladophialophora, #vaccination, #malaria, #zoonotic, #Brazil Pedro Fernando da Costa Vasconcelos, William M. de Souza, Matthijs Raadsen, Fernando Abad-Franch, Laura Olbrich, José Miguel Cisneros, Amparo Figueroa, Stijn Raven, Andreas K. Lindner, William Burman, Elizabeth A Ashley, Alexander J Mentzer

📢 New evidence of the effectiveness of both sulfadoxine-pyrimethamine combined with amodiaquine (SPAQ) and dihydroartemisinin-piperaquine (DP) for seasonal malaria chemoprevention (SMC) in protecting children under 5 years of age from malaria in areas of high and seasonal transmission. 🔎 Nuwa Anthony and colleagues have reported the findings of a three-arm, open-label, non-inferiority, and superiority, cluster-randomised controlled trial conducted in the Karamoja region, Northeastern Uganda among children 3–59 and 6–59 months for SPAQ and DP, respectively. The trial compared five monthly cycles of SPAQ with DP for SMC. ⚖️ Trial was conducted in 427 villages. Of these villages, 380 were randomly assigned to either SPAQ or DP, while the remaining 47 village-clusters were assigned to the control arm. There was detailed follow-up of 3629 children to assess the primary endpoint: rapid-diagnostic test (RDT) or malaria microscopy confirmed clinical malaria. 💡 Researchers demonstrated that compared to the control group, both interventions demonstrated remarkable protective efficacy against confirmed malaria cases—94% (hazard ratio [HR] 0·06 [95% CI 0·04–0·08]; p<0·001) for SPAQ and 96% (0·04 [0·03–0·06]; p<0·001) for DP.  The effectiveness of DP was non-inferior to SPAQ. 🔦 SMC is a cornerstone of malaria control but in East and southern Africa its implementation with SPAQ has been limited because of the high level of resistance to sulfadoxine-pyrimethamine in the area. This trial is part of a programme to introduce SMC in the region and is the first to test an alternative to SPAQ to obviate the issue of resistance. It remains to be seen if these results alone will be sufficient to drive widespread SMC adoption in East and Southern Africa in line with WHO guidelines for SMC implementation. 📖 You can read the paper here: bit.ly/4ayQaxQ 📖 You can read the insightful comment by Feiko ter Kuile here: bit.ly/4gfMKBx #malaria #sulfadoxine #pyrimethamine #amodiaquine #dihydroartemisinin #piperaquine Malaria Consortium, Nuwa Anthony, Dr Kevin Baker, Richard Kajubi, Katherine Theiss-Nyland, Odongo Musa, tonny kyagulanyi, David Salandini Odong, ASUA VICTOR, Maureen Nakirunda, Christian Rassi, Rutazaana Damian, Achuma Richard, Godfrey Magumba, Adoke Yeka, James Tibenderana

📢Personal View-A framework towards implementation of sequencing for antimicrobial-resistant and other health-care-associated pathogens ⚖️ The 3rd Geneva Infection Prevention and Control (IPC) Think Tank brought together >60 experts from 16 countries to identify gaps, propose solutions, and set priorities for the use of NGS for HAI/antimicrobial resistant pathogens. The major deliverable of the meeting was a proposed framework for implementing sequencing of HAI pathogens, specifically those harbouring AR mechanisms with the following critical components: wet lab quality, sequence data quality, database and tool selection, bioinformatic analyses, data sharing, and NGS data integration to support public health and IPC actions. 💡 In this Personal View, Alison Halpin and co-authors detail the framework and discuss the context for global implementation, specifically in low- and middle-income countries. Three categories of NGS application, including individual/diagnostic, outbreak/response, and surveillance/monitoring were identified. A framework based on best practice, collaboration and successful implementation is proposed. Barriers for implementation and possible solutions are also discussed. This personal view aims to foster continued discussion on the topic. Authors argue that creative approaches are required to ensure that the need for perfection does not derail current opportunities to make use of NGS and bioinformatics as a tool to prevent HAIs, combat AMR, and save lives. The paper can be found here: https://bit.ly/4awdQ5W #AMR, #infections, #NGS, #bioinformatics, #LMICs Centers for Disease Control and Prevention, University Hospitals Geneva Medical Center, Ineos Oxford Institute for Antimicrobial Research, Institute for Antimicrobial Resistance, University of Virginia, Universitätsspital Zürich, University of Ibadan, HUG - Hopitaux Universitaires de Genève, University of Cambridge School of Clinical Medicine, US PUBLIC HEALTH SERVICE, 3rd Geneva Infection Prevention and Control (IPC) Think Tank

🚀Promising Phase II/III trial of albendazole and ivermectin (fixed doses) co-formulation for treatment of soil-transmitted helminthiases. 🔎 Alejandro Krolewiecki and colleagues have reported the results of an adaptive phase 2/3 randomised controlled superiority trial comparing the standard regimen of a single dose of 400 mg albendazole versus two experimental fixed-dose co-formulations (FDCs) of albendazole and ivermectin for the treatment of soil-transmitted helminthiases. ⚖️ Trial was conducted in 15 schools in Kenya, Mozambique, and Ethiopia enrolling 1001 children/adolescents (aged 518 years) with infection. The primary outcome of phase 2 (conducted in Kenya only) was safety during the first 3 hours after the intervention and for 7 days, and the primary outcome of phase 3 was cure rate of Trichuris trichiura. Researchers demonstrated the safety and efficacy above the current standard for the treatment of geohelminths. For Trichuris trichiura, cure rate of the triple dose and the single dose both had higher cure rate (97·2% and 82·9%, respectively) compared with albendazole alone (35·9%). Difference between groups was 47·0 (36·6 to 56·5) percentage points for the single dose and 61·3 (51·9 to 69·8) for the three-day dose. 💡 FDCs may encourage the use of a safe and effective combination treatment instead of monotherapy in soil-transmitted helminth control programmes to enhance preventive chemotherapy against soil-transmitted helminths, including Strongyloides stercoralis, and slow down the emergence of resistance. Questions for wider implementation are affordability, large scale accessibility, and generalizability of the findings. Data has been submitted to the European Medicines Agency for regulatory approval. Here is the paper: https://bit.ly/40EBE4A Here is the comment by Dora Buonfrate: bit.ly/4gYURnj #albendazole #ivermectin #helminths #MundoSano #EDCTP

The Lancet Infectious Diseases is on LinkedIn! 🌟 As a world-leading infectious diseases journal, we publish original research that advocates change in, or illuminates, infectious disease clinical practice. We also publish informative reviews on any topic connected with infectious diseases and human health. Our latest Editorial reflects on lessons from the 2014–16 Ebola virus outbreak. Explore the January issue: https://hubs.li/Q032qJGj0 And hit the follow button 👍 Alt: Cover of The Lancet Infectious Diseases’ January 2025 issue, showing an illustration of a woman walking across a vaccine that separates her from the jaws of a rabid dog. By Lillian Li. #InfectiousDiseases #MedicalResearch #ClinicalPractice