Mumps has reemerged globally despite widespread use of the measles - mumps - rubella (MMR) vaccine, contrasting with the successful control of measles and rubella. This divergence reflects important limitations in the performance of the mumps component of the MMR vaccine and the programmatic framework in which it is delivered. Evidence from multiple settings indicates that mumps outbreaks continue to occur in highly vaccinated populations, driven by waning immunity, non-sterilizing immune responses, and sustained transmission in high-contact environments. In parallel, many low- and middle-income countries do not include mumps vaccination in national immunization programs, resulting in large susceptible populations and under-recognition of disease burden. Immunologically, current vaccines induce less durable humoral immunity, limited mucosal protection, and poorly defined correlates of protection, while antigenic differences between vaccine and circulating strains may further reduce effectiveness. Programmatically, the fixed MMR platform limits flexibility in tailoring strategies specific to mumps epidemiology. Addressing these challenges will require rethinking current approaches, including targeted booster strategies, consideration of stand-alone or bivalent vaccines, and development of next-generation vaccines capable of inducing broader and more durable, potentially mucosal immunity. A shift toward mumps-specific vaccination strategies is essential for sustained control.
BackgroundDyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function.MethodsDyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as >= 2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis.ResultsThe prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC
INTRODUCTION:Typhoid fever is widespread in developing countries. Most typhoid vaccines have gone into some disrepute for their substantial side effects and low efficacy. The latest typhoid vaccines use Salmonella's Vi-capsular polysaccharide (Vi-CPS) conjugated to a protein carrier. The WHO recommends a single typhoid conjugate vaccine (TCV) dose at six months in endemic countries. However, this schedule is contested. AREAS COVERED:The molecular structure of Vi-CPS, emerging Vi capsule variants, the impact of de-O acetylation on vaccine immunogenicity, the key features of an effective Vi-PS conjugate vaccine, the immunological correlates of protection, the impact of boosting by a TCV on Vi-antibodies, and knowledge gaps were examined. We have also reviewed TCV efficacy and durability data. Our analysis shows that the vaccines are effective, although immunity wanes after five years, especially in children under two. We also offered ways to improve TCV efficacy and briefly discussed new typhoid vaccine development. EXPERT OPINION:We believe the TCV schedule necessitates revision. Extending the primary immunization age or incorporating a booster upon school enrollment are reasonable alternatives. Region-specific or universal modifications require further deliberation.
OBJECTIVES:Convolutional neural networks (CNNs) are increasingly used to classify medical images, but few studies utilize smartphone photographs. The objective of this study was to assess CNNs for differentiating patients from controls and detecting joint inflammation. METHODS:We included consecutive patients with early inflammatory arthritis and healthy controls, all examined by a rheumatologist (15% by two). Standardized hand photographs of the hands were taken, anonymized and cropped around joints. Pre-trained CNN models were fine-tuned on our dataset (80% training; 20% test set). We used an Inception-ResNet-v2 backbone CNN modified for two class outputs (patient vs control) on uncropped photos. Separate Inception-ResNet-v2 CNNs were trained on cropped photos of middle finger proximal interphalangeal (MFPIP), index finger proximal interphalangeal (IFPIP) and wrist. We report accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AUC). RESULTS:We analysed 800 hands from 200 controls (mean age 37.8 years) and 200 patients (mean age 49 years). Two rheumatologists showed 0.89 concordance. The wrist was commonly involved (173/400) followed by the MFPIP (134) and IFPIP (128). The screening CNN achieved 99% accuracy and specificity and 98% sensitivity in predicting a patient compared with controls. Joint-specific CNN accuracy, sensitivity, specificity and AUC were as follows: wrist (75%, 92%, 72% and 0.86, respectively), IFPIP (73%, 89%, 72% and 0.88, respectively) and MFPIP (71%, 91%, 70% and 0.87, respectively). CONCLUSION:Computer vision distinguishes patients and controls using smartphone photographs, showing promise as a screening tool. Future research will focus on validating findings in diverse populations and other joints and integrating this technology into clinical workflows.
Cryptococcosis is an opportunistic fungal infection commonly occurring amongst immunocompromised individuals. However, in rare cases it can affect immunocompetent individuals particularly those with exposure to fungal reservoirs in environment. We report a 32-year-old immunocompetent male farmer who was diagnosed with disseminated cryptococcosis. He initially presented with prolonged cough, exertional dyspnoea and weight loss and later developed nodulo-ulcerative skin lesion and central nervous system cryptococcomas. The diagnosis was confirmed by histopathology and cryptococcal antigen testing. He was treated with liposomal amphotericin B and flucytosine, followed by maintenance fluconazole therapy. This case-report highlights the importance of keeping a high index of suspicion for disseminated cryptococcosis even in immunocompetent individuals.
