Acute respiratory infections (ARI) are a major cause of pediatric emergency department (ED) visits and hospitalizations. Although respiratory syncytial virus (RSV), influenza, and rhinovirus (RV) are common etiological agents, pathogen-specific data from pediatric emergency settings remain limited. This prospective surveillance study quantified ARI-related ED visits, described pathogen-specific epidemiology, and assessed attendance and hospitalization rates as well as the distribution of lower versus upper respiratory tract infections (LRTI/URTI) in children younger than 60 months in two pediatric EDs in Berlin between November 1, 2024 and May 31, 2025. Respiratory pathogens were identified using nasopharyngeal swab samples tested by multiplex real-time RT-PCR (QIAstat-Dx® Respiratory Panel Plus). Within the study period 4042 ARI-related ED visits occurred. A total of 310 children were enrolled in our study (median age 18 months); 115 (37.1
In India, adult pneumococcal disease prevention relies on the 23‑valent pneumococcal polysaccharide vaccine (PPSV23) and the 13‑ and 20‑valent pneumococcal conjugate vaccines (PCV13, PCV20). Before PCV20 introduction, adults at older age or high risk typically received PCV13 followed by PPSV23, although no national recommendation exists and uptake has been low. This study evaluated the cost‑effectiveness of a single‑dose PCV20 strategy compared with the sequential PCV13→PPSV23 regimen from private and public perspectives. Incremental cost‑effectiveness ratios (ICERs) per quality‑adjusted life‑year (QALY) gained were estimated for PCV20 versus PCV13→PPSV23. Analyses were conducted from the private perspective for high‑risk adults aged 18–49 years and all adults aged ≥ 50 years, and from the government perspective for high‑risk adults aged 18–59 years and all adults aged ≥ 60 years. Compared with PCV13→PPSV23, PCV20 was projected to reduce pneumococcal disease cases and deaths and was cost‑effective under the 3× GDP per capita threshold. PCV20 generated 18,186 and 44,659 additional QALYs from the private and public perspectives, with incremental costs of ₹2.0 billion (Indian Rupees; medical: −₹17.4B; vaccine: ₹19.4B) and ₹25.5B (medical: −₹3.6B; vaccine: ₹29.1B), yielding ICERs of ₹110,790 and ₹570,327 per QALY, respectively. PCV20 was cost‑effective in 92.4
Social contact patterns are one of the key determinants of infectious disease transmission, but post-coronavirus disease 2019 (COVID-19)-pandemic evidence from East and Southeast Asia remains limited. We examined age-specific contact patterns in Japan, South Korea, Thailand, and Vietnam and assessed whether contact frequencies had returned to prepandemic levels. We conducted online, single-day contact surveys in 2025 using quota sampling by age and sex. Participants reported contacts on the preceding day, defined as physical contact or direct conversations of at least three sentences held within 2 m. Age-specific contact matrices were constructed for weekdays and weekends and combined using a 5:2 weighting. Factors associated with daily contact counts were examined using negative binomial regression. The analysis used data from 10,279 individuals: 8,080 in Japan, 1,102 in South Korea, 589 in Thailand, and 508 in Vietnam. Mean daily contact counts were 8.1, 6.2, 6.4, and 8.8, respectively; medians were 4, 4, 4, and 6, respectively. All four countries showed age-assortative mixing, although assortativity was less pronounced in Thailand and Vietnam. In Japan and South Korea, younger age and larger household size were associated with more contacts, whereas greater mask-wearing tendency was associated with more contacts in Japan and fewer contacts in South Korea. Compared with available historical estimates, contact frequencies in Japan and South Korea remained below prepandemic levels. Sparse baseline data and methodological differences precluded firm conclusions being made for Thailand and Vietnam. Contact frequencies in Japan and South Korea remained below prepandemic levels in 2025, suggesting persistent postpandemic changes in mixing behavior. Evidence for comparable changes in Thailand and Vietnam was inconclusive. Future surveys should collect setting-specific information, in addition to contact frequency and age, to clarify how changes in work, education, and household interaction shape postpandemic social mixing patterns.
Hemagglutinin (HA) is the principal immunologic target of most licensed seasonal influenza vaccines. Targeting both HA and neuraminidase (NA) might improve vaccine effectiveness. This randomized phase 1/2 study evaluated an investigational mRNA-based quadrivalent seasonal influenza vaccine, encoding HA and NA of A/H1N1, A/H3N2, B/Victoria, and B/Yamagata (FLUm4HA-4NA). In phase 1, adults aged 18–50 years received either one of twelve mRNA vaccine formulations of varying HA-only or HA and NA mRNA doses, or a licensed quadrivalent seasonal influenza comparator. In phase 2, participants aged 18–64 years (younger adults) and 65–85 years (older adults) received FLUm4HA-4NA (three groups per age category, with different HA/NA mRNA doses) or age-appropriate licensed quadrivalent comparator. Primary endpoints were safety/reactogenicity, and hemagglutination inhibition [HI] and NA inhibition [NI] responses against the four seasonal strains at day 29. Cross-reactive HI/NI responses against drifted strains, virus neutralization, and HA-/NA-specific cell-mediated immunity were evaluated in phase 2 as tertiary objectives. A total of 293 participants (21–25 per group) were vaccinated in phase 1, 480 younger (108–137 per group) and 483 older adults (117–125 per group) in phase 2. Solicited events were more frequent with FLUm4HA-4NA than comparators and were mostly short-lived and mild or moderate. No deaths or vaccine-related serious adverse events were reported. Post-vaccination HI and neutralizing titers in the FLUm4HA-4NA groups were similar or higher for the A strains and lower for the B strains versus comparators. NI responses exceeded those of comparators for all four strains. HI and NI titers against evaluated drifted A strains were similar or higher after FLUm4HA-4NA than after comparator vaccination. HA-specific CD4+ and CD8+ T-cell responses were generally higher after FLUm4HA-4NA than comparator vaccination. FLUm4HA-4NA showed an acceptable safety profile and humoral and cellular immunogenicity in the study population, supporting further development and formulation optimization to improve influenza B HI responses. ClinicalTrials.gov: NCT05823974; euclinicaltrials.eu: 2022-502308-66-00. Seasonal flu causes serious illness and death each year. Vaccination can help prevent flu, but currently available flu vaccines are not always fully effective. This is because flu viruses change often, so the strains in the vaccine may not closely match the strains spreading each season. Current flu vaccines mainly target one viral protein called hemagglutinin (HA). Adding another viral protein, neuraminidase (NA), may improve vaccine effectiveness. Our study tested a new mRNA-based seasonal flu vaccine designed to target both HA and NA from the four major circulating flu strains. The study had a phase 1 part, analyzing 293 adults aged 18–50 years, and a phase 2 part, analyzing 480 younger adults (18–64 years) and 483 older adults (65–85 years). In each part, participants received one of several mRNA vaccine formulations (with various HA and NA mRNA doses) or an age-appropriate licensed flu vaccine. More people who received the mRNA vaccine had side effects than those who received the licensed vaccines. These side effects were usually short-lived and were mostly mild or moderate. The mRNA flu vaccine induced an immune response to both the HA and NA target proteins. For HA, the immune response was similar or higher than that of the licensed vaccines for two of the flu strains (A strains), and lower for the other two strains (B strains). For NA, responses were higher for all strains. These results support continued development of this mRNA HA/NA vaccine, including improvement of the response to the flu B strains.
