Yellow fever remains a major public health threat in endemic and re-emerging regions of Africa and South America, with recent outbreaks highlighting persistent gaps in prevention and surveillance. Pregnant women represent a particularly vulnerable population, yet the epidemiology, clinical impact, and preventive strategies for yellow fever in pregnancy are insufficiently characterized. Physiological and immunological changes during gestation may influence host responses to infection; however, current evidence does not demonstrate increased susceptibility to or severity of yellow fever during pregnancy. Adverse materno-fetal outcomes, including miscarriage, stillbirth, preterm birth, and, in rare cases, perinatal transmission, have been reported but remain poorly characterized. Diagnostic challenges, overlapping clinical presentations with other arboviral and hepatic diseases, and limited access to specialized care further complicate clinical management in many endemic settings. This perspective provides a comprehensive overview of yellow fever in pregnancy during the 2024–2026 outbreak in the Americas, including a risk-stratification framework for prevention. We summarize current evidence on epidemiology, pathophysiology, diagnosis, and supportive care, and examine prevention strategies with particular emphasis on vaccination. Accumulated observational evidence and substantial real-world experience have not demonstrated an increased risk of serious adverse events and generally support the effectiveness of yellow fever vaccination during pregnancy when administered with appropriate clinical judgment. In high-risk settings, the benefits of maternal immunization clearly outweigh theoretical concerns, supporting a flexible, risk-based approach, despite relatively limited evidence. We also discuss national and international policies, post-pregnancy booster recommendations, and the importance of integrating vaccination assessment into antenatal care. Finally, we highlight critical knowledge gaps and research priorities, including the need for prospective registries and strengthened pharmacovigilance. Coordinated clinical and public health strategies are essential to protect maternal and neonatal health and to reduce the burden of yellow fever in endemic and re-emerging settings.

Population aging is the most significant demographic transformation of the 21st century, reshaping health systems, economies, and societies. The biological processes of immunosenescence and inflammaging weaken host defenses, reduce vaccine effectiveness, and increase vulnerability to infectious and chronic diseases. These changes underscore the urgent need for preventive strategies that extend beyond childhood immunization. Vaccination is a cornerstone of healthy aging, capable of preventing infections and has been associated with reductions in systemic inflammation, frailty, and loss of functional independence in later life. Furthermore, new insights into vaccine-mediated immunomodulation, including trained immunity, adjuvanted formulations, and epigenetic reprogramming, highlight the evolving role of vaccines as modulators of immune fitness across the lifespan. This first part of our review examines the intersection of aging and immunity, as well as the potential of vaccines to address these challenges. Part 2 will expand on specific vaccines, proposed vaccination schedules, and global perspectives for lifelong immunization.

This second part of this expert panel review explores the broader impact of vaccines across the lifespan, emphasizing their role beyond immediate infection control. Vaccines not only extend life expectancy but also influence long-term health trajectories, particularly during the critical first 1000 days of life, where they prevent severe infections, disability, and mortality. They contribute to cancer prevention through vaccination against human papillomavirus and hepatitis B, reduce cardiovascular events and complications in individuals with chronic diseases, and protect against late-life functional decline. Furthermore, vaccines exert lasting effects on healthy aging by modulating inflammation and preserving independence, while proposed vaccination schemes illustrate the need for a comprehensive, life-course approach. Together with Part 1, which focused on immunosenescence and immune modulation, this closing installment underscores vaccination as a cornerstone of sustainable health policy, reinforcing its pivotal role in extending both lifespan and healthspan for future generations.

Introduction The Latin American Society of Pediatric Infectious Diseases (SLIPE) convened a multidisciplinary expert panel to assess the post-pandemic epidemiology of invasive pneumococcal disease (IPD) in Latin America and the Caribbean. The COVID-19 pandemic initially reduced IPD incidence due to non-pharmaceutical interventions, but subsequent relaxation of restrictions, coupled with immunization gaps, led to a resurgence of pneumococcal infections. The consensus statement reviews literature and regional surveillance data to analyze how disrupted vaccination programs, socioeconomic inequities, and weakened healthcare systems amplified the regional vulnerability to vaccine-preventable diseases.Areas covered This document addresses epidemiologic changes in IPD following the pandemic, the interplay between respiratory viral infections and pneumococcal disease, trends in pneumococcal conjugate vaccine (PCV) coverage and related barriers, and the emergence of non-vaccine serotypes causing IPD.Expert opinion Sustaining herd protection in the region requires strengthening vaccination infrastructure, restoring confidence through effective communication, and ensuring the completion of booster doses in the second year of life. Despite limited serotype data, countries should prioritize the timely adoption of higher-valency PCVs in feasible schedules to mitigate the growing burden of pneumococcal disease and prevent further setbacks in child health.

INTRODUCTION Vaccine hesitancy has emerged as a major challenge for pediatric immunization programs, shaped by a complex interplay of structural, relational, and informational factors. In Latin America, these dynamics are further influenced by health system fragmentation and social inequities, requiring approaches that extend beyond information-based interventions.AREAS COVERED This review examines the multidimensional nature of vaccine hesitancy in pediatric populations, with a focus on Latin America. It examines the role of digital environments, clinical communication, and system-level factors, and discusses emerging strategies such as narrative communication and prebunking. The literature was identified through a targeted review of peer-reviewed publications and relevant global health reports.EXPERT OPINION Addressing vaccine hesitancy requires integrated strategies that combine trust-building with anticipatory communication. Approaches such as narrative shielding and prebunking may complement traditional interventions by strengthening how caregivers interpret vaccine-related information. Future efforts should prioritize context-specific implementation and evaluation in real-world settings.

Background: Respiratory syncytial virus (RSV) is a major contributor to the disease burden, particularly in infants, and it is important to understand the annual patterns and their implications for public health. Aim: To determine the epidemiological behavior and seasonality of RSV in the Dominican Republic from 2013 to 2023. Methodology: Analytical and retrospective study using sentinel surveillance data. RSV was diagnosed using RT-PCR. The Moving Epidemic Method was used to analyze its seasonality, identifying the weeks of onset, peak, and end of each epidemic season. Differences between age groups were evaluated using the chi(2) test. Results: 58.2% of cases were in infants, with a predominance of males (60.5%). RSV exhibits fluctuating seasonality, commencing between weeks 29 and 47 (average week 33) depending on the year, and reaching its peak between weeks 31 and 48 (average week 38), aligning with the months of August and September. The duration was approximately 37 weeks, although some, like the the 2023-2 season, were significantly shorter. Conclusions: A high RSV burden in infants was confirmed, with consistent seasonal patterns. These findings underscore the need to implement prevention strategies, continuous epidemiological surveillance, and prospective studies to optimize the health response and guide the design of public health policies.

Objective:To evaluate the level of trust in vaccines and to analyze the factors that determine their acceptance in adults residing in the Dominican Republic. Methods:A cross-sectional study was conducted between January and April 2023 with 949 participants selected through face-to-face and online surveys. A non-probabilistic snowball sampling was used, with recruitment at the Dr. Hugo Mendoza Pediatric Hospital. A structured questionnaire was administered that included demographic variables, information sources, a vaccine trust index, and determinants of acceptance. Descriptive and regression analyses were performed to identify associations between variables. Results:A favorable attitude towards vaccination was observed. The average score on the index was 86.9, with 89.8% of participants expressing strong trust. Pediatricians were the most reliable source of information, especially among young and middle-aged adults. Regression analysis showed a positive association between age and rating on the index (β = 0.116; CI 95%: 0.017-0.218); and negative associations with male sex(β = -3.985; 95% CI: -6.992 to -0.921) and university-level education (β = -1.870; CI 95%: -3.632 to -0.107). Although the perceived risk of preventable disease is high, concerns about side effects persist, possibly linked to misinformation. Conclusions:Despite the high acceptance of vaccines, barriers such as lack of vaccination reminders and fear of adverse effects persist. Strengthening communication and training health professionals could increase trust in and adherence to vaccination programs, especially in certain groups.

INTRODUCTION:Vaccine hesitancy in Latin America and the Caribbean (LAC) has a complex nature. It is shaped by socio-political, cultural, economic factors, and an influence of the COVID-19 pandemic on increasing hesitancy patterns. While LAC has maintained high vaccination coverage, it has experienced a decline over the past 10-years, further exacerbated by declining vaccine confidence during the pandemic, driven by misinformation, political polarization, and conspiracy theories. AREAS COVERED:We review the impact of vaccine hesitancy across various stakeholders in LAC, focusing on healthcare professionals, parents, and community leaders, including data from studies conducted in Argentina and Colombia highlighting regional variations in hesitancy patterns. It describes the role of pediatricians in recommending vaccines, particularly in COVID-19 vaccines. The study explores how the rapid spread of misinformation, particularly through social media, exacerbated mistrust, and offers an overview of vaccine hesitancy trends in LAC during/after the pandemic. EXPERT OPINION:While vaccine acceptance remains high among certain populations, communication strategies are essential to address concerns about vaccine safety. It is imperative to strengthen the relationship between health-providers and the public to mitigate misinformation and improve vaccine uptake. We propose seven strategic approaches for a comprehensive communication aimed at changing the public behavior about vaccines.

Objetivo. Evaluar el nivel de confianza en las vacunas y analizar los factores que determinan su aceptación en adultos residentes en la República Dominicana. Método. Se realizó un estudio transversal entre enero y abril del 2023 con 949 participantes seleccionados mediante encuestas presenciales y en línea. Se utilizó un muestreo no probabilístico por bola de nieve y captación en el Hospital Pediátrico Dr. Hugo Mendoza. Se aplicó un cuestionario estructurado que incluyó variables demográficas, fuentes de información, un índice de confianza en las vacunas (ICV) y determinantes de aceptación. Se efectuaron análisis descriptivos y de regresión para identificar asociaciones entre variables. Resultados. Se observó una actitud favorable hacia la vacunación, con un ICV promedio de 86,9 y 89,8% de participantes con alta confianza. Los pediatras fueron la fuente de información más confiable, sobre todo entre adultos jóvenes y de mediana edad. El análisis de regresión mostró una asociación positiva entre la edad y el ICV (β = 0,116; IC95%: 0,017-0,218) y asociaciones negativas para el sexo masculino (β = -3,985; IC95%: -6,992 a -0,921) y el nivel de estudio universitario (β = -1,870; IC95%: -3,632 a -0,107). Aunque la percepción del riesgo de enfermedades prevenibles es alta, persisten preocupaciones sobre efectos secundarios, posiblemente vinculadas a desinformación. Conclusiones. Pese a la alta aceptación de las vacunas, persisten barreras como la falta de recordatorios y el temor a efectos adversos. Fortalecer la comunicación y capacitar a los profesionales de salud podría mejorar la confianza y la adherencia en los programas de vacunación, en especial en grupos específicos.

INTRODUCTION:Dengue disease represents a large and growing global threat to public health, accounting for a significant burden to health systems of endemic countries. The World Health Organization's (WHO) Strategic Advisory Group of Experts (SAGE) and the European Medicines Agency (EMA) currently recommend the use of TAK-003 dengue vaccine in high dengue burden and transmission settings for countries considering vaccination as part of their integrated management strategy for prevention and control of Dengue. AREAS COVERED:This paper describes the main conclusions of a workshop held by the Arbovirus Committee of the Latin American Society of Pediatric Infectious Diseases (SLIPE) in November 2023, to generate consensus recommendations on the introduction of this new vaccine in the region. Considerations were made regarding the molecular epidemiology of dengue infection in the Americas and the need for more precise phylogenetic classification and correlation with clinical outcome and disease severity. EXPERT OPINION:Introduction of dengue vaccine should be considered as an strategy for health entities in the region, with participation of social sectors, scientific societies, and ministries of health that could be able to create a successful vaccination program.

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections in children around the world. The post-pandemic era has resulted in a notable increase in reported cases of RSV infections, co-circulation of other respiratory viruses, shifts in epidemiology, altered respiratory season timing, and increased healthcare demand. Low- and middle-income countries are responsible for the highest burden of RSV disease, contributing significantly to health expenses during respiratory seasons and RSV-associated mortality in children. Until recently, supportive measures were the only intervention to treat or prevent RSV-infection, since preventive strategies like palivizumab are limited for high-risk populations. Advances in new available strategies, such as long-acting monoclonal antibodies during the neonatal period and vaccination of pregnant women, are now a reality. As the Regional Expert Group of the Latin American Pediatric Infectious Diseases Society (SLIPE), we sought to evaluate the burden of RSV infection in Latin America and the Caribbean (LAC) region, analyze current strategies to prevent RSV infection in children, and provide recommendations for implementing new strategies for preventing RSV infection in children in LAC region.

Abstract Background COVID-19 (C-19) immunization started in Colombia in February 2021 for adults; in October 2021 for children over 3 years old (yo), and since January 2023 the recommendation was extended to children 6 m - 3 yo. At the time of this study, C-19 vaccine (C-19V) coverage rates were still low in Colombia: adults, first booster: 43.7%; children over 3 yo 67.8% first dose, 47.9% second dose. The objective of this study was to assess C-19V acceptance in Colombia, among pediatricians, parents of children up to 18 yo and adults. Methods In January 2023 we carried out 3 online surveys on C-19V among adults, parents and pediatricians in Colombia. Results Adults 655 adults over 18 yo participated in the study: 80% lived in an urban area, 80% had completed high school, 93% had received C-19V (50% complete primary schedule, 35% first booster); 83% had been contacted by their social security to be reminded about the importance of vaccination. Among the non-vaccinated, 71% did not want to receive C-19V; over 41% said they did not want or did not need it. In the vaccinated group, 66% reported confidence in the vaccines and 55% said they willed would complete their C-19V schedule. Pediatricians 767 pediatricians answered the survey, 52.1% work in private practice. Perception of C-19V risks among pediatricians was low for both adults and children; vaccine acceptance was lower for healthy children than for adults (69.4 vs 96.4%). The main causes for vaccine hesitancy were the lack of scientific information, fear of immediate and long-term side effects, and non-severity of the disease in children (57.3%, 20.8% and 33.3%, and 21.8%, respectively). Parents Of the 646 parents, 86.2% were mothers, 57.7% had postgraduate degrees, 89.4% had vaccinated their children against C-19. The main cause for vaccine hesitancy was vaccine safety (36.6%); 71.2% were informed about how vaccines work, and 64.8% regarding the risks of C-19 in children. Conclusion These results show a high acceptance of C-19V in Colombia. However, coverage rates for were low at the time of the study. This might suggest that besides vaccine confidence, other factors impacting coverage rates should be evaluated, as vaccine access. Disclosures All Authors: No reported disclosures

Introduction:The Latin American Society of Pediatric Infectology (SLIPE for its acronym in Spanish) is working hard to strengthen the vaccination recommendations as the most effective method to prevent meningococcal disease, a disease that causes multiple consequences, not only physical, but also social and economic, in children and their families.Areas covered: On Friday, May 7th, a Latin American forum of experts on meningococcal disease was held through Zoom platform.Issues such as: Disease burden, epidemiological surveillance programs, meningococcal vaccines, impact of meningococcal vaccination programs, costs of illness, and the role of communication were discussed.Expert opinion: Meningococcal disease is an infectious disease event, with a rapid clinical evolution, very serious in some cases and with sequelae that are difficult to quantify in Latin America.Active surveillance through sentinel units is essential to quantify the disease burden and strengthen the available information. Expert opinion: Article Highlights Box• Meningococcal disease is an infectious disease event, with a rapid clinical evolution, very serious in some cases and with sequelae that are difficult to quantify in Latin America.• Active surveillance through sentinel units is essential to quantify the disease burden and strengthen the available information.• Carriage studies should be part of an epidemiological surveillance program.• Laboratory and molecular tests are fundamental to analyze the scope of the vaccines applied in the region; the interaction between laboratory, clinical and epidemiology is key.• Available vaccines are safe and effective and open a horizon for the control of meningococcal disease.

Given the actual risk of poliomyelitis outbreaks in the region due to poliovirus derived from the Sabin vaccine or the importation of wild poliovirus, the Latin American Society of Pediatric Infectious Diseases commissioned an ad hoc group of experts from the institution's Vaccines and Biologicals Committee, to draft an official position paper on the urgent need to increase immunization levels against the disease in the region and incorporate inactivated polio vaccine exclusive schedules in all national immunization programs. This publication discusses the main conclusions and recommendations generated as a result of such activity.

Ante el riesgo real de ocurrencia de brotes de parálisis fláccida aguda en la región debidos a poliovirus derivado de la vacuna Sabin o a la importación de poliovirus salvaje, la Sociedad Latinoamericana de Infectología Pediátrica comisionó a un grupo ad hoc de expertos integrantes del Comité de Vacunas y Biológicos de la institución, para redactar un documento oficial de posición sobre la necesidad imperiosa de incrementar los niveles de inmunización contra la enfermedad en la región e incorporar definitivamente en forma exclusiva la vacuna de polio inactivada en todos los esquemas nacionales de vacunación. La presente publicación discute las principales conclusiones y recomendaciones generadas como resultado de esta actividad.

Given the actual risk of poliomyelitis outbreaks in the region due to poliovirus derived from the Sabin vaccine or the importation of wild poliovirus, the Latin American Society of Pediatric Infectious Diseases commissioned an ad hoc group of experts from the institution's Vaccines and Biologicals Committee, to draft an official position paper on the urgent need to increase immunization levels against the disease in the region and incorporate inactivated polio vaccine exclusive schedules in all national immunization programs. This publication discusses the main conclusions and recommendations generated as a result of such activity.

BackgroundLimited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19.ObjectiveTo describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America.MethodMulticenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children <18 years of age with COVID-19 confirmed by polymerase chain reaction or antigen detection from the nasopharynx were included. Children with multisystem inflammatory syndrome in children (MIS-C) were excluded. Associations were assessed using univariate and multivariable logistic regression models.ResultsA total of 1063 children with COVID-19 were included; 500 (47%) hospitalized, with 419 (84%) to the pediatric wards and 81 (16%) to the ICU. In multivariable analyses, age <1 year (Odds Ratio [OR] 1.78; 95% CI 1.08–2.94), native race (OR 5.40; 95% CI 2.13–13.69) and having a co-morbid condition (OR 5.3; 95% CI 3.10–9.15), were associated with hospitalization. Children with metabolic or endocrine disorders (OR 4.22; 95% CI 1.76–10.11), immune deficiency (1.91; 95% CI 1.05–3.49), preterm birth (OR 2.52; 95% CI 1.41–4.49), anemia at presentation (OR 2.34; 95% CI 1.28–4.27), radiological peribronchial wall thickening (OR 2.59; 95% CI 1.15–5.84) and hypoxia, altered mental status, seizures, or shock were more likely to require PICU admission. The presence of pharyngitis (OR 0.34; 95% CI 0.25–0.48); myalgia (OR 0.47; 95% CI 0.28–0.79) or diarrhea (OR 0.38; 95% CI 0.21–0.67) were inversely associated with hospital admission.ConclusionsIn this data analysis reported to the SLIPE research network in Latin America, infants, social inequalities, comorbidities, anemia, bronchial wall thickening and specific clinical findings on presentation were associated with higher rates of hospitalization or PICU admission. This evidence provides data for prioritization prevention and treatment strategies for children suffering from COVID-19.

América Latina y el Caribe alza su voz para reducir el impacto pandémico a través de