•A rare hantavirus outbreak on MV Hondius in May 2026 caused 8 cases and 3 deaths.•Cruise ship confined spaces and HVAC systems facilitated aerosol transmission.•Jurisdictional disputes delayed critical medical evacuations.•Lack of isolation and diagnostics exposed cruise ship medical vulnerabilities.•Pathogen research and robust maritime emergency protocols are needed.
Human respiratory syncytial virus (RSV) remains a leading cause of lower respiratory tract illness (LRTI) in infants, young children, and the elderly. Although long-acting monoclonal antibodies, subunit, and messenger ribonucleic acid (mRNA) vaccines can protect vulnerable populations (infants < 6 months old and older adults) via passive and active immunization, respectively, a conspicuous protection gap remains for RSV-seronegative infants and young children aged 6 to 60 months, leaving this vulnerable pediatric cohort largely unprotected. For these RSV-seronegative pediatric populations, intranasal live-attenuated vaccines (LAVs) have emerged as promising formulations owing to the key advantage of lacking vaccine-associated enhanced respiratory disease (VAERD) following natural RSV infection in vaccine recipients. Furthermore, intranasal RSV LAVs can induce the full spectrum of protective immune responses against the virus systemically and locally, including neutralizing antibodies, secretory IgA (SIgA), and tissue-resident memory CD8+ T (TRM) cells. Despite the suboptimal Phase 3 efficacy of Sanofi's RSVt candidate (RSV/ΔNS2/Δ1313/I1314L), alternative RSV LAVs featuring the M2-2 gene deletions have shown enhanced efficacy in clinical studies, alongside emerging strategies designed to rationally augment the immunogenicity of RSV LAVs. Due to the sustained efforts over the past five decades on RSV LAVs, significant advances have been made both in the technology to generate RSV LAVs-most notably reverse genetics-and in our understanding of pivotal benchmarks, including attenuation design, evaluation criteria for attenuation and immune efficacy, as well as the stepwise strategy for clinical research in RSV-seronegative children. Concurrently, this review provides a comprehensive synthesis of these historical and ongoing efforts, while highlighting future directions to prevent RSV disease in RSV-seronegative pediatric populations.
The 2024 World Health Organization (WHO) Bacterial Priority Pathogens List (BPPL) updates the 2017 framework by expanding to 24 pathogens across 15 bacterial families, addressing the growing antimicrobial resistance (AMR) crisis, which was estimated to have caused 1.27 million deaths in 2019. The revised list introduces four new pathogen-antibiotic combinations—rifampicin-resistant Mycobacterium tuberculosis, macrolide-resistant Group A Streptococci, macrolide-resistant Streptococcus pneumoniae, and penicillin-resistant Group B Streptococci—while removing five, including clarithromycin-resistant Helicobacter pylori, reflecting evolving resistance patterns, regional disparities, and therapeutic advancements. Notably, third-generation cephalosporin-resistant Enterobacterales is now a standalone critical-priority pathogen due to its high burden in low- and middle-income countries. This review examines these updates, driven by complex resistance mechanisms, surveillance gaps, and the impact of coronavirus disease 2019 (COVID-19)-related antibiotic misuse. It highlights trends such as the dominance of Gram-negative bacteria, rising rates of community-acquired infections, and the urgent need for innovative therapies, including phage therapy, phenazine-based antimicrobials, and metal-based strategies. Enhanced global surveillance, equitable access to treatments, and collaborative efforts are critical to combating AMR effectively.
