Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, remains a rare but devastating condition characterized by rapid clinical progression, high case fatality, and long-term morbidity. Despite effective conjugate (or alternative) vaccine availability, sporadic cases and outbreaks persist across the age spectrum in the USA and globally. Contemporary surveillance data reveal a dynamic epidemiologic landscape, shifting serogroup dominance, evolving outbreak patterns involving community-based and socially connected groups, and growing recognition of disease burden among adults. Adolescents serve as key reservoirs of nasopharyngeal carriage; however, despite IMD incidence and case-fatality rates being highest among infants and older adults, respectively, both populations lack routine age-based vaccination recommendations. Prevention strategies in the USA remain anchored to historical incidence peaks and narrowly defined risk groups, leaving substantial gaps in protection, as highlighted by the sharp contrast between high adolescent quadrivalent meningococcal conjugate vaccine coverage and low serogroup B vaccine uptake under shared clinical decision-making. This narrative review synthesizes contemporary evidence on age-specific IMD burden, serogroup dynamics, and long-term sequelae, and critically examines how existing vaccination policies align with infection risk across the lifespan, with emphasis on US vaccination policy. Additional country-specific studies were included to contextualize age-specific epidemiology and provide policy comparators. A life-course-based prevention framework integrating age-related vulnerability, severity, and evolving transmission dynamics is needed to mitigate the burden of IMD.
Despite advances in antiretroviral therapy (ART), real-world data remain limited regarding clinical characteristics and healthcare utilization according to ART use among people living with human immunodeficiency virus (PLWH), as well as patterns of ART use in this population. This retrospective cohort study used a US healthcare claims database to identify adult PLWH from 2021 to 2024. Primary cohort included those with ≥3 human immunodeficiency virus (HIV)-1 diagnosis codes within 3 years (third code defined the index date). A nested cohort included PLWH with ≥1 ART prescription claim(s) within 180 days of follow-up. All-cause and HIV-related inpatient hospitalizations and emergency room (ER) visits were assessed before and after index date. Pharmacotherapy change within 180 days after index was assessed for the nested cohort. In the primary cohort of 51,837 PLWH, mean age was 46.5 years; 17.5
INTRODUCTION:Both inactivated influenza vaccine and live attenuated influenza vaccine (LAIV) (indicated for use in children aged 2-17 years) effectively prevent influenza transmission and related outcomes. Despite high transmission among children, vaccination practices in Sweden focus primarily on targeting individuals at higher risk of influenza-related illness and mortality, including older adults. The objective of this study was to assess the cost-effectiveness of increasing LAIV coverage among children aged 2-17 years. METHODS:We developed a de novo health economic model (HEM) that included a dynamic transmission model (DTM) component to estimate population-level outcomes for a typical influenza season in Sweden. The DTM implemented a compartmental structure to model the prevalence of three influenza strains over a 1-year time horizon. The HEM used a decision-tree structure to translate epidemiological outputs into clinical and economic outcomes. The model simulated theoretical vaccination scenarios, comparing a reference scenario based on historical vaccination coverage with an intervention with LAIV in which coverage among children aged 2-17 years was increased from 0.36% to 25%. RESULTS:Increasing the uptake of LAIV in 2-17-year-olds could prevent a further 505,824 influenza infections in a typical season, two-thirds of which would be prevented in the indirect population (adults and children aged < 2 years). The model estimated this to translate into 33,419 fewer cases requiring medical attention, of which 1929 were hospitalizations, ultimately preventing 193 intensive care unit admissions and 99 deaths. The intervention scenario was considered cost-effective from a payer perspective (direct costs only; incremental cost-effectiveness ratio of SEK 73,266 per quality-adjusted life year) and dominant (cost-saving) from a societal perspective. Sensitivity and scenario analyses showed that results were robust to changes in key model parameters, maintaining cost-effectiveness. CONCLUSIONS:In Sweden, the implementation of LAIV is estimated to be cost-effective in 2-17-year-olds by reducing disease burden and healthcare costs in both children and the broader population.
The pneumococcal vaccine landscape now includes multiple vaccines differing in age indications and serotype compositions. While clinical attributes such as effectiveness, safety, and disease coverage are key considerations, healthcare professionals (HCPs) also confront operational aspects of vaccination, such as managing multiple vaccines across pediatric and adult populations which are less well characterized. This study assessed HCP priorities and practical considerations for pneumococcal vaccine selection and the additional serotype coverage required to justify use of an adult-specific vaccine instead of the same vaccine across children and adults. This cross-sectional online survey involved 500 HCPs (physicians, nurses, and pharmacists) from Australia, Canada, France, Mexico, and Taiwan. The perceived importance of pneumococcal vaccination, practical considerations, perceived challenges and benefits of using a single vaccine across age groups versus separate age-specific vaccines, and the serotype coverage difference to justify use of multiple pneumococcal vaccines strategies were assessed. Pneumococcal vaccination was rated as important by 97.6
The purpose of this study was to describe the clinical outcomes in patients with complex infections caused by carbapenem-resistant pathogens who were treated with eravacycline (ERV) containing regimens. A retrospective chart review was conducted at Hospital St. Georg in Leipzig, Germany, a municipal tertiary care center with specialized departments for infectious diseases and tropical medicine, septic surgery, and severe burn injuries, between 1 January 2023 and 31 December 2025. Eight patients (median age 38 years, 75
Machine learning (ML) models have been increasingly applied to support the diagnosis of bloodstream infections (BSI), particularly through the analysis of large routinely collected healthcare datasets. However, it remains uncertain whether large sample sizes alone are sufficient to achieve high diagnostic accuracy. We performed a systematic review and meta-analysis to evaluate the diagnostic performance of ML-based models for BSI in large cohorts. MEDLINE, Embase, and Web of Science were systematically searched from inception to December 31, 2025 (Prospero registration CRD420251080948). We included observational studies evaluating ML models for BSI diagnosis with ≥ 1000 patients or BSI episodes and reporting sufficient data to reconstruct diagnostic accuracy measures. Pooled sensitivity and specificity were estimated using a bivariate random-effects Reitsma model. Secondary analyses included pooled area under the summary receiver operating characteristic curve (SROC-AUC), predictive values, subgroup analyses, and meta-regression. Twenty-four retrospective studies were included. Most studies evaluated adult hospitalized patients and used routinely collected structured data, including laboratory, vital sign, and administrative variables. Tree-based ensemble algorithms were the most commonly used architectures. The pooled sensitivity and specificity were 76.6
The Kingdom of Saudi Arabia (KSA) hosts millions of Hajj and Umrah pilgrims annually, and it aims to welcome 30 million external (international) Umrah pilgrims annually by 2030 (Saudi Vision 2030). These mass gatherings pose significant risks for infectious disease transmission. We extended a previous meta-population model of Neisseria meningitidis transmission during Hajj to include Umrah pilgrimage and assessed the impact of varying vaccination coverage rates (VCRs) among pilgrims on meningococcal meningitis (MM) cases. The model population was divided into five clusters: residents of the pilgrimage sites (Makkah/Madinah); the broader KSA population; and non-KSA populations from high-, medium-, and low-transmission settings. The model incorporated age, pilgrim movement patterns, and VCRs. The model was calibrated with data from 1995 to 2011 and validated with data from 2012 to 2024. MM cases under various vaccination and pilgrim scenarios were simulated for the 2025–2034 period. Umrah accounted for approximately 90
Doravirine (DOR)-based regimens are recommended as alternative options for virologically suppressed people with HIV (VS-PWH). However, data supporting their long-term use in real-world settings are scarce. This large study described the long-term effectiveness and safety of DOR-based regimens following treatment switch in routine clinical practice. Retrospective cohort study using data from Dat'AIDS, a French standardized database that collects real-world medical data from PWH across France. All treatment-experienced adults with confirmed plasma HIV-1 RNA < 50 copies/ml who initiated a DOR-based regimen for the first time between April 2019 and June 2024 were included. Baseline demographic and clinical characteristics, proportions of PWH receiving a DOR-based regimen and maintaining virologic suppression, and reasons for treatment discontinuation were collected. PWH were censored at the time of discontinuing DOR, death, or end of study (December 2024). Data from 1666 VS-PWH (median age 56 years, interquartile range: 47–63; 65
This subgroup analysis of the FORTRESS study aimed to evaluate clinical and microbiological outcomes, treatment patterns, and safety of intravenous fosfomycin (FOS)-containing regimens for the treatment of infections due to carbapenem-resistant (CR) Gram-negative bacteria in a real-world setting. Interim data from patients treated with FOS for infections due to CR pathogens were analyzed from the ongoing prospective, multicenter, multinational, observational FORTRESS study. Key outcomes included patient demographics, clinical and infection characteristics at baseline, treatment patterns, and indications of FOS use, as well as clinical, microbiological, and safety outcomes. Exploratory Firth univariate and multivariate logistic regression were performed to identify factors associated with successful clinical response. The subgroup included 161 patients (median age 60 years, 30.4
Borna disease virus 1 (BoDV-1) encephalitis has a (sub)acute and mostly fatal course. Initial flu-like symptoms are typically followed by rapid progressive panencephalitis and death within weeks. No curative therapy exists so far. We present a long-term survivor with distinctive clinical, imaging, and pathophysiological features. A previously healthy male in his fifties was admitted in summer 2023 with (sub)acute encephalitis (cerebrospinal fluid, CSF: 132 cells/µl, no pathogen detection). Brain magnetic resonance imaging (MRI) demonstrated vasogenic edema affecting basal ganglia, temporal and limbic regions bilaterally. Despite high-dose steroids, the clinical condition of the patient slowly worsened. Three months later, BoDV-1 reactive antibodies were detected by elevated titers in CSF (1:320) and serum (1:5120). Treatment with favipiravir, corticosteroids, and mycophenolate mofetil (MMF) was initiated. After recovery for months, the patient developed progressive bilateral optic atrophy, cognitive decline, and a sleep disorder resembling Kleine–Levin syndrome. Translocator protein (TSPO)-PET revealed widespread microglial activation, confirmed by targeted cortical biopsy. Immunosuppressive therapy was escalated with anakinra, cyclophosphamide, and intrathecal dexamethasone, achieving temporary stabilization. In the summer of 2025, a severe brainstem syndrome emerged, accompanied by increased TSPO uptake in the brainstem and detection of BoDV-1 RNA in CSF for the first time. Despite another treatment with favipiravir and high-dose corticosteroids, the patient remained in a minimally conscious state. This exceptional case with long-term survival in BoDV-1 encephalitis gives important insights: BoDV1-associated neuroinflammation leading to a slowly progressive decline can be visualized by TSPO-PET. Late BoDV-1 RNA detection and subacute re-exacerbation after prolonged survival provides evidence that BoDV-1 persists in human brain tissue.
Estimating attributable risk (AR) through self-controlled case series (SCCS) analyses alone may limit generalizability because SCCS only incorporate vaccinated patients with the outcome (e.g., Guillain-Barré syndrome [GBS]) who may differ from the recommended vaccinee population. We aimed to demonstrate background event incidence rates’ impact on vaccine-specific GBS ARs and to standardize ARs across different vaccine studies by applying a generalizable, population-based GBS background rate to better estimate the expected population-level ARs. We identified post-licensure SCCS vaccine studies and GBS background rates using US Medicare data via targeted literature review. GBS control period rates from SCCS vaccine studies were extracted or calculated. Population-level ARs were calculated for each vaccine using two published and two hypothetical background GBS rates and the original SCCS-generated incidence rate ratios (IRRs). Published vaccine-specific GBS IRRs ranged from 2.02 (95
Infection is a common and potentially fatal complication during the treatment of hematological diseases, particularly in the context of chemotherapy-induced immunosuppression. The nonselective use of antibiotic prophylaxis in patients with neutropenia in China has persistently accelerated antimicrobial resistance. Early identification of patients at high risk for infection before clinical symptom onset could enable targeted preventive strategies; however, reliable and biologically informed screening approaches remain limited. We developed a prediction model for infection risk stratification in newly diagnosed patients with hematological conditions. Plasma metagenomic next-generation sequencing was performed in a prospective cohort of 230 patients. Among them, 116 patients provided prechemotherapy, non-neutropenic plasma samples (cohort A), and 114 patients provided postchemotherapy, neutropenic samples (cohort B). Microbial community profiles were analyzed, and machine learning approaches were applied to construct classifiers for neutropenia status and subsequent infection risk. Plasma metagenomic profiling revealed a complex microecological landscape in patients with hematological conditions and identified distinct microbial features associated with neutropenia. A trained random forest classifier successfully distinguished patients without neutropenia from patients with neutropenia, achieving an area under the receiver operating characteristic curve of 0.8324. Importantly, a microorganism-based random forest model was established to predict patients at high risk of infection, yielding an area under the curve of 0.942. Nested cross-validation demonstrated high classification accuracy, correctly identifying 99.1
Most people with HIV (PWH) achieve immune recovery with antiretroviral therapy (ART); however, a clinically relevant subset, known as immune non-responders (INRs), fails to restore CD4+ T-cell counts despite sustained virological suppression and shows persistent immune dysfunction. Growth differentiation factor 15 (GDF-15), a stress-responsive cytokine associated with inflammation, aging, chronic disease, and multimorbidity, has not been characterized across distinct HIV viro-immunological phenotypes. We conducted an exploratory cross-sectional study including 80 PWH classified as ART-naïve individuals, virally suppressed INRs, elite controllers (ECs), and ART-treated immune responders (IRs), as well as 20 HIV-negative controls. Plasma GDF-15 levels were measured by immunoassay. Associations with log-transformed GDF-15 concentrations were assessed using multivariable linear regression including age, CD4+ T-cell nadir, and INR status. INRs showed the highest plasma GDF-15 levels (median, 1143.9 pg/ml), significantly exceeding those observed in ART-naïve individuals, ECs, IRs, and HIV-negative controls (all p ≤ 0.002). GDF-15 levels correlated positively with age, time since HIV diagnosis, and ART duration, and inversely with CD4+ T-cell nadir and the CD4/CD8 ratio (all p ≤ 0.001). In adjusted analysis, INR status remained independently associated with higher log-transformed GDF-15 levels (β = 0.271, 95
Lymphatic filariasis (LF) remains a significant public health concern, with India contributing nearly 55
Human Immunodeficiency Virus (HIV) infection has currently become a manageable chronic disease with the prevalence of antiretroviral therapy (ART). The increase in life expectancy and the rising number of people aged more than 50 years among people living with HIV (PLWH) both indicate an increasing risk of chronic non-communicable diseases, especially cardiovascular disease (CVD). Moreover, the contribution of traditional risk factors to CVD far outweighs that of HIV-related factors, which indicates that interventions for reducing CVD risk factors in PLWH are urgent. We designed a multicentre non-randomized controlled trial (nRCT), which incorporated six acquired immunodeficiency syndrome (AIDS)-designated hospitals in Zhejiang Province, and three rounds of surveys were conducted from January 2023 to January 2024. Assessments were performed at baseline, 3 months and 6 months post-intervention, respectively. For the intervention group, PLWH were informed of their 5/10-year CVD risk, on the basis of the assessment in baseline, verbally or online to warn them of the risk of having CVD; at the same time, personalized risky behaviour reinforcement intervention was implemented face-to-face or online for about 15 min. For the control group, PLWH were not informed of the 5/10-year CVD risk and only received routine health education in the clinic without additional intervention. Intervention effects were assessed using 5/10-year CVD risk, health-related behaviours (e.g., smoking, alcohol consumption, physical activities and dietary nutrition), as well as CVD cognitive level. To minimize baseline differences and reduce confounding due to non-treatment factors (e.g., socio-demographic characteristics), propensity score matching (PSM) was applied to construct comparable intervention and control groups, and a generalized estimating equation (GEE) was used to estimate the effect of the intervention. This trial was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500112178) on 11 November 2025. A total of 948 PLWH were incorporated at baseline, after excluding ineligible participants, including 494 in the intervention group and 454 in the control group. The average age was 42.08 ( ± 11.94) years, with 826 male patients (87.13
Lower respiratory tract disease caused by respiratory syncytial virus (RSV-LRTD) is associated with substantial clinical and economic burden among older adults and adults with chronic medical conditions. Bivalent RSV prefusion F protein-based vaccine (RSVpreF) has been authorized for use among all adults aged ≥ 60 years in the Netherlands, and The Health Council of the Netherlands has recommended RSV vaccination for at-risk persons aged 60–74 years and all persons aged ≥ 75 years. We estimated the cost-effectiveness of implementing this strategy. We have developed a static cohort model to demonstrate lifetime clinical and economic outcomes associated with RSV-LRTD among adults in the Netherlands, with (vs. without) RSVpreF use (price: €180; age/risk-specific uptake: 44.6–80.4
Evidence on the impact of influenza on health-related quality of life (HRQoL) and work productivity and activity impairment (WPAI) remains limited. This study evaluated changes in the EuroQol Visual Analogue Scale (EQ-VAS), EuroQol Utility Index (EQ-UI), absenteeism, presenteeism, work productivity loss, and activity impairment over 1 month during the high-severity 2024–2025 influenza season in the USA. Symptomatic adults (≥ 18 years) with a positive influenza test at ambulatory care clinics within a national US retail pharmacy chain (10/24/2024–4/15/2025) and symptom onset ≤ 4 days of positive test were included. HRQoL was assessed on days 1–7, 10, 14, and week 4 and WPAI on days 1, 7, 14, and week 4. Mixed models for repeated measures estimated mean changes and standard error (SE) from baseline, adjusting for relevant covariates. The analysis included 724 adults (mean [standard deviation (SD)] age: 42.0 [13.0] years; 74.2
