Background:Vaccines to prevent respiratory syncytial virus (RSV)-associated lower respiratory tract disease in older adults have become available in recent years. We investigated RSV vaccine uptake, effectiveness, and safety signals in older adults reported in post-licensure real-world studies. Methods:For this systematic review and meta-analysis, we conducted 11 monthly searches (between November 5, 2024, and November 10, 2025) in Ovid Medline, Embase, and Global Health databases. Meta-analyses, using random-effects modelling, were performed for uptake, effectiveness, and safety signals. PROSPERO registration: CRD42025643585. Findings:A total of 3900 studies were identified, of which 36 were included, published between December 22, 2023, and October 28, 2025, and covering over 121.8 million individuals across the United States, United Kingdom, Italy, Australia, Czech Republic, Switzerland, France, Canada, and Israel. In the United States, RSV vaccine uptake among adults aged ≥60 years during the 2023/24 RSV season was 18.0% (95% confidence interval (CI): 12.2-25.7; ten studies), varying by clinical and socio-demographic subgroups. Among adults aged ≥60 years, pooled estimates of vaccine effectiveness were 75.3% (95% CI: 73.7-76.9; three studies) against any laboratory-confirmed RSV-positive infection, 76.4% (95% CI: 74.2-78.5; four studies) against RSV-related emergency department or urgent care visits, 74.8% (95% CI: 66.8-82.9; six studies) against RSV-related hospital admissions, and 79.8% (95% CI: 68.1-91.5; four studies) against severe RSV-associated disease. Following vaccination, Guillain-Barré syndrome (GBS) was reported in two studies with between 5.2 and 6.5 cases per one million doses for RSVPreF3+AS01 (Arexvy, GSK) vaccines and between 9.0 and 18.2 cases per one million doses for RSVpreF (Abrysvo, Pfizer) vaccines. Interpretation:RSV vaccine uptake in older adults was low globally with substantial disparities between sociodemographic and clinical subgroups. Our study showed a favourable safety profile and high effectiveness of the RSV vaccines, highlighting the value of wide implementation of these vaccines. Funding:There was no funding for the study.

BACKGROUND Community-acquired pneumonia by Mycoplasma pneumoniae is often complicated by co-infections with other respiratory pathogens. AIM We describe through a sentinel respiratory surveillance system in Scotland, M. pneumoniae infection occurrence in patients presenting to general practitioners with acute respiratory infection (ARI) (October 2022−May 2025) and the co-detection frequency of other respiratory pathogens. METHODS Upper respiratory tract swabs from a representative community sample of 65,798 ARI patients were laboratory-tested for 10 respiratory pathogens, including M. pneumoniae. Positivity for M. pneumoniae was monitored over time. Single or multiple joint pathogen detections were assessed and stratified by demographic characteristics. Proportions hospitalised within 14 days after their M. pneumoniae positive test were determined. RESULTS Of 65,798 patients (40,158 female, 25,534 male, 106 sex unknown; median age: 35 years, interquartile range (IQR): 17–59), 3,031 (4.6%) were M. pneumoniae positive (1,686 female, 1,340 male, five sex unknown; median age: 18 years, IQR: 9–39). Positivity was elevated in October 2023−October 2024, particularly in 5–14-year-olds, and peaked at 47.7% (31/65) in week 1, 2024. Among M. pneumoniae cases viably tested for all pathogens, 26.0% (728/2,799) had co-detections of another pathogen, with rates in 0–4-year-olds (61.3%; 122/199) and 5–14-year-olds (31.3%, 321/1,024) reflecting those reported elsewhere in hospitalised paediatric cases. Co-detections involving rhinovirus (47.5%; 346/728) predominated, otherwise varying by pathogen and age. Of 3,031 M. pneumoniae cases, 1.8% (n = 55) were admitted. CONCLUSION Sentinel surveillance of respiratory pathogens in the community was helpful to characterise an M. pneumoniae epidemic, revealing frequent respiratory-pathogen co-detections in ≤ 14-year-olds, as prior reported in hospitalised M. pneumoniae paediatric cases.

Background:Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In 2023, the RSVpreF vaccine was licenced and recommended for adults through the UK's national immunisation programmes. Real-world evidence on vaccine effectiveness (VE) across different populations and healthcare settings is limited. Methods:We conducted a retrospective, multi-nation, test-negative design analysis to evaluate RSVpreF VE against hospitalisation in adults aged 74-79 years across England, Wales, Scotland, and Northern Ireland during the 2024-25 RSV season. Laboratory testing, admission, and vaccination data were linked at the individual patient level. Eligible cases were hospitalised individuals with laboratory-confirmed RSV, and controls were RSV-negative hospitalised patients; SARS-CoV-2- and influenza-positive controls were excluded in the primary analysis. Nation-specific VE estimates were derived using multivariable logistic regression, adjusted for epidemiological week of specimen collection, and combined using fixed-effects meta-analysis with inverse-variance weighting. Sensitivity analyses included redefinition of controls and leave-one-nation-out analyses. Findings:A total of 11,117 adults were included (6528 in England, 942 in NI, 1462 in Scotland, 2185 in Wales). Overall, 3896 (35.0%) had received RSVpreF. Across nations, 826 RSV-positive cases were identified, of whom 726 (87.9%) were unvaccinated. Adjusted VE against RSV-related hospitalisation was 74% (95% confidence interval [CI] 68-80) in England, 77% (30-95) in NI, 81% (60-91) in Scotland, and 82% (43-94) in Wales. Pooled fixed-effects VE was 75% (69-80; I 2 = 0%). VE estimates from sensitivity analyses were robust to the inclusion of vaccine-preventable respiratory infection controls and adjustment for vaccination status. Leave-one-nation-out sensitivity analysis showed that excluding England increased pooled VE to 81% (66-89), whereas exclusion of NI, Scotland, or Wales had minimal impact (75%, 68-80 to 69-80). Interpretation:RSVpreF vaccination provides high real-world protection against RSV-related hospitalisation in adults across the UK. Funding:This study received no specific funding.

Background Respiratory syncytial virus (RSV) is a virus with two antigenic types, A and B, that cause significant morbidity and mortality in infants globally. A recently developed maternal vaccination based on the prefusion F protein (“RSVpreF”) could have a significant impact on disease burden, if introduced globally. Whether or not the effectiveness of this vaccine is affected by circulating viral genomic variability is currently unknown. Objectives To examine whether the vaccine effectiveness of maternal RSVpreF administration in preventing hospitalisation in infants is affected by RSV type or lineage. Methods We will conduct whole genome sequencing of RSV positive samples from infants hospitalised with acute lower respiratory tract infection (ALRI) in the 2024-2025 winter season, at multiple hospitals in England and Scotland, to calculate the relative vaccine effectiveness (rVE) of maternal RSVpreF vaccination by virus type (RSV-A and RSV-B). rVE will be calculated using a case control logistic regression with adjustment by infant age and admission date; sex, socioeconomic status and hospital location will be included as potential confounders if they are associated with a >3% change in rVE. We will also perform a test negative design to examine the VE for RSV-A and RSV-B separately, using RSV-negative controls from hospitals where cases were admitted. Finally, we will compare viral lineages in vaccinated versus unvaccinated infants. Results and conclusions Our study will identify whether currently circulating RSV genomic variability impacts on rVE. Confirmation of the null hypothesis - that there is no impact of viral genomic variability on rVE – will provide reassurance to policymakers and public health bodies as RSVpreF is rolled out globally. Conversely, an association between RSV type or lineage and decreased vaccine effectiveness will highlight the need for the enhanced comprehensive national and global molecular surveillance of RSV.

Background/Objectives: Respiratory Syncytial Virus (RSV) is a common respiratory tract infection that accounts for significant morbidity and mortality, particularly among older adults. From 1 August 2024, the bivalent RSVpreF vaccine (Abrysvo®) was introduced in Scotland for eligible older adults. While clinical trials and post-licensure studies showed a good safety profile of the vaccine, post-marketing observational studies in the United States reported a small increased risk of Guillain–Barré Syndrome (GBS) among older adult populations. Methods: We conducted observed versus expected (OE) and self-controlled case series (SCCS) analyses to retrospectively monitor the incidence of hospital admission for 39 conditions, including GBS. This was undertaken in post-RSV-vaccination periods from 1 August to 31 December 2024, among eligible adults aged 74 to 80 years in Scotland. Results: Observed versus expected analyses identified an increased risk of hospitalisation with GBS in the 1–28-day post-vaccination period. From SCCS analyses, six conditions showed an increased risk in post-vaccination periods (acute coronary syndrome, acute myocardial infarction, acute renal failure, GBS, heart failure and stroke (haemorrhagic)). After temporal adjustment, only GBS remained significant. All 10 hospitalised GBS cases occurred in the 10 to 16 days post-vaccination. Excess risk of GBS was estimated to be 46.1 cases per one million doses. Conclusions: Study results indicated a good safety profile of the RSV vaccine for older eligible adults aged 75 to 79 years, although a small increased risk of GBS was identified in both analyses. Excess risk levels of GBS from vaccination align with other studies.

BACKGROUND:Respiratory syncytial virus (RSV) is a leading cause of infant hospitalisation, particularly in infants younger than 6 months. On Aug 12, 2024, Scotland introduced a maternal vaccination programme with bivalent RSV prefusion F (RSVpreF) vaccine, offered from 28 weeks' gestation. Although clinical trials have shown high efficacy of maternal RSVpreF vaccination, this study assessed RSVpreF vaccine effectiveness in a real-world setting, to inform policy and programme delivery. METHODS:We did a retrospective, nested case-control study with a cohort sensitivity analysis. The source population comprised all singleton livebirths in Scotland between Aug 12, 2024, and March 31, 2025, as recorded in the Scottish Linked Pregnancy and Baby Dataset (SLiPBD). Within this population, cases were defined as infants aged 90 days or younger with an RSV-related hospital admission for lower respiratory tract infection (LRTI; first event only) and an RSV-positive PCR test within 14 days before or 2 days after hospital admission, within the study period up to March 31, 2025. At the time of hospital admission, cases were matched to ten controls each (1:10 case:control ratio) from the source population by ISO week of birth and gestational age at birth, with controls defined as infants with no previous RSV-positive test or RSV-related hospital admission at the time of matching. Linked datasets on maternal RSV vaccination and RSV-related hospital admissions were accessed through the recently established Scottish Infectious Respiratory Surveillance Platform. Infants were classified as vaccinated if the RSV vaccine was received more than 14 days before delivery, suboptimally immunised if received 0-14 days before delivery, and unvaccinated if not received during pregnancy. The study outcome was RSV-related LRTI hospital admissions among infants aged 90 days or younger. Vaccine effectiveness against RSV-related LRTI hospital admissions was estimated with adjusted conditional logistic regression comparing vaccination status among cases and controls, adjusting for infant sex and birthweight, maternal ethnicity, maternal age and Scottish Index of Multiple Deprivation at infant birth, maternal smoking status at the first antenatal appointment, and parity. From this model, adjusted vaccine effectiveness was calculated as 100 × (1 - adjusted odds ratio). FINDINGS:During the study period, 27 565 singleton livebirths were recorded in the SLiPBD. 13 842 (50·2%) of the 27 565 pregnant women received the RSVpreF vaccine, 12 747 (92·1%) of whom were vaccinated more than 14 days before delivery. 354 infants aged 90 days or younger had an RSV-related LRTI hospital admission during the study period (cases), with 3511 matched controls. 33 controls later became cases. Among the 354 cases, 43 (12·1%) were vaccinated (>14 days before delivery) against RSV, compared with 1518 (43·2%) of the 3511 controls. Suboptimal immunisation (≤14 days before delivery) occurred in 18 (5·1%) cases and 205 (5·8%) controls. Median gestational age at vaccination was 31 weeks (IQR 28-34) among cases and 30 weeks (28-33) among controls. Adjusted vaccine effectiveness against RSV-associated LRTI hospital admission was 82·2% (95% CI 75·1-87·3; p<0·0001) in vaccinated infants compared with unvaccinated infants, which translated to 219 (95% CI 189-243) RSV-related LRTI hospital admissions averted during the study period. Adjusted vaccine effectiveness remained high among infants born preterm (<37 weeks' gestation; 89·9% [55·3-97·7]; p=0·0025), as well as for term-born infants (≥37 weeks' gestation; 81·5% [73·9-87·0]; p<0·0001). In a sensitivity analysis using a matched cohort approach in the same source population, adjusted vaccine effectiveness against RSV-associated LRTI hospital admission was 81·0% (68·6 to 88·5; p<0·0001). INTERPRETATION:This national population-based study provides evidence that maternal RSV vaccination substantially reduces the risk of RSV-related LRTI hospital admission in infants aged 90 days or younger, including in preterm infants. Maternal RSV vaccination programmes should be scaled up globally, with high coverage, to offer the potential to avert many RSV-associated infant hospitalisations. FUNDING:None.

The 2024/25 influenza season in Europe is currently characterised by co-circulation of influenza A(H1N1)pdm09, A(H3N2) and B/Victoria viruses, with influenza A(H1N1)pdm09 predominating. Interim vaccine effectiveness (VE) estimates from eight European studies (17 countries) indicate an all-age influenza A VE of 32–53% in primary care and 33–56% in hospital settings, with some signals of lower VE by subtype and higher VE against influenza B (≥ 58% across settings). Where feasible, influenza vaccination should be encouraged and other prevention measures strengthened.

Background Respiratory syncytial virus (RSV) is a virus with two antigenic types, A and B, that cause significant morbidity and mortality in infants globally. A recently developed maternal vaccination based on the prefusion F protein (“RSVpreF”) could have a significant impact on disease burden, if introduced globally. Whether or not the effectiveness of this vaccine is affected by circulating viral genomic variability is currently unknown. Objectives To examine whether the vaccine effectiveness of maternal RSVpreF administration in preventing hospitalisation in infants is affected by RSV type or lineage. Methods We will conduct whole genome sequencing of RSV positive samples from infants hospitalised with acute lower respiratory tract infection (ALRI) in the 2024-2025 winter season, at multiple hospitals in England and Scotland, to calculate the relative vaccine effectiveness (rVE) of maternal RSVpreF vaccination by virus type (RSV-A and RSV-B). rVE will be calculated using a case control logistic regression with adjustment by infant age and admission date; sex, socioeconomic status and hospital location will be included as potential confounders if they are associated with a >3% change in rVE. We will also perform a test negative design to examine the VE for RSV-A and RSV-B separately, using RSV-negative controls from hospitals where cases were admitted. Finally, we will compare viral lineages in vaccinated versus unvaccinated infants. Results and conclusions Our study will identify whether currently circulating RSV genomic variability impacts on rVE. Confirmation of the null hypothesis - that there is no impact of viral genomic variability on rVE – will provide reassurance to policymakers and public health bodies as RSVpreF is rolled out globally. Conversely, an association between RSV type or lineage and decreased vaccine effectiveness will highlight the need for the enhanced comprehensive national and global molecular surveillance of RSV.

Background: Human parainfluenza viruses (HPIV) commonly cause upper respiratory tract infections, with potential for severe lower respiratory complications. Understanding seasonal increases informs strategies to prevent HPIV spreading. Aim: We examined the impact of COVID-19 on HPIV epidemiological and clinical patterns in Scotland using non-sentinel and sentinel surveillance data. Methods: Information on HPIV swab positivity (January 2017-October 2023) and demographic data was obtained from the Electronic Communication of Surveillance in Scotland (ECOSS) non-sentinel surveillance sources (laboratory-based data from hospital and community) and the Community Acute Respiratory Infection (CARI) sentinel surveillance programme (enhanced surveillance and symptom data). Results: In 2020 during early COVID-19 waves, HPIV detection decreased aligning with lockdowns and preventive measures. In summer 2021, HPIV positivity increased, with HPIV-3 possibly reverting to pre-pandemic seasonality, but HPIV-1 not yet re-establishing alternate-year peaks. Most positive results from non- sentinel sources came from hospital tests. Sentinel surveillance (CARI) complemented non-sentinel data, offering community-level insights. There was no significant difference in CARI swab positivity by sex in any age group. Consistent with historical trends, children under five years exhibited highest test positivity: 9.3% (95% CI: 7.6-11.2) in females and 8.5% (95% CI 7.0-10.2) in males. Conclusion: The COVID-19 pandemic impacted HPIV detection in Scotland. The decline during the pandemic peak and subsequent partial resurgence underscores the complex interplay between viral epidemiology and public health measures. Combining diverse surveillance systems provides a comprehensive understanding of HPIV dynamics. Insights into age-specific and symptom-associated patterns contribute to understanding HPIV epidemiology and refining public health strategies.

Objective: To set up and evaluate a new surveillance system for severe acute respiratory infection (SARI) in Scotland. Study design: Cross-sectional study and evaluation of surveillance system. Methods: The SARI case definition comprised patients aged 16 years or over with an acute respiratory illness presentation requiring testing for influenza and SARS-CoV-2 and hospital admission. Data were collected from SARI cases by research nurses in one tertiary teaching hospital using a bespoke data collection tool from November 2021 to May 2022. Descriptive analyses of SARI cases were carried out. The following attributes of the surveillance system were evaluated according to Centers for Disease Control and Prevention (CDC) guidelines: stability, data quality, timeliness, positive predictive value, representativeness, simplicity, acceptability and flexibility. Results: The final surveillance dataset comprised 1163 records, with cases peaking in ISO week 50 (week ending 19/12/2021). The system produced a stable stream of surveillance data, with the proportion of SARI records with sufficient information for effective surveillance increasing from 65.4% during the first month to 87.0% over time. Similarly, the proportion where data collection was completed promptly was low initially, but increased to 50%-65% during later periods. Conclusion: SARI surveillance was successfully established in one hospital, but for a national system, additional sentinel hospital sites across Scotland, with flexibility to ensure consistently high data completeness and timeliness are needed. Data collection should be automated where possible, and demands on clinicians minimised. SARI surveillance should be embedded and resourced as part of a national respiratory surveillance strategy. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objectives We undertook a national analysis to characterise and identify risk factors for acute respiratory infections (ARIs) resulting in hospitalisation during the winter period in Scotland. Design A population-based retrospective cohort analysis. Setting Scotland. Participants The study involved 5.4 million residents in Scotland. Main outcome measures Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between risk factors and ARI hospitalisation. Results Between 1 September 2022 and 31 January 2023, there were 22,284 (10.9% of 203,549 with any emergency hospitalisation) ARI hospitalisations (1759 in children and 20,525 in adults) in Scotland. Compared with the reference group of children aged 6–17 years, the risk of ARI hospitalisation was higher in children aged 3–5 years (aHR = 4.55; 95% CI: 4.11–5.04). Compared with those aged 25–29 years, the risk of ARI hospitalisation was highest among the oldest adults aged ≥80 years (aHR = 7.86; 95% CI: 7.06–8.76). Adults from more deprived areas (most deprived vs. least deprived, aHR = 1.64; 95% CI: 1.57–1.72), with existing health conditions (≥5 vs. 0 health conditions, aHR = 4.84; 95% CI: 4.53–5.18) or with history of all-cause emergency admissions (≥6 vs. 0 previous emergency admissions, aHR = 7.53; 95% CI: 5.48–10.35) were at a higher risk of ARI hospitalisations. The risk increased by the number of existing health conditions and previous emergency admission. Similar associations were seen in children. Conclusions Younger children, older adults, those from more deprived backgrounds and individuals with greater numbers of pre-existing conditions and previous emergency admission were at increased risk for winter hospitalisations for ARI.

Supplemental Digital Content is Available in the Text. Background:To inform global ambitions to end AIDS, evaluation of progress toward HIV incidence reduction requires robust methods to measure incidence. Although HIV diagnosis date in routine HIV/AIDS surveillance systems are often used as a surrogate marker for incidence, it can be misleading if acquisition of transmission occurred years before testing. Other information present in data such as antibody testing dates, avidity testing result, and CD4 counts can assist, but the degree of missing data is often prohibitive.Methods:We constructed a Bayesian statistical model to estimate the annual proportion of first ever HIV diagnoses in Scotland (period 2015-2019) that represent recent HIV infection (ie, occurring within the previous 3-4 months) and incident HIV infection (ie, infection within the previous 12 months), by synthesizing avidity testing results and surveillance data on the interval since last negative HIV test.Results:Over the 5-year analysis period, the model-estimated proportion of incident infection was 43.9% (95% CI: 40.9 to 47.0), and the proportion of recent HIV infection was 21.6% (95% CI: 19.1 to 24.1). Among the mode of HIV acquisition categories, the highest proportion of recent infection was estimated for people who inject drugs: 27.4% (95% CI: 20.4 to 34.4).Conclusions:The Bayesian approach is appropriate for the high prevalence of missing data that can occur in routine surveillance data sets. The proposed model will aid countries in improving their understanding of the number of people who have recently acquired their infection, which is needed to progress toward the goal of HIV transmission elimination.

BACKGROUND:The 2022/23 influenza season in the United Kingdom saw the return of influenza to prepandemic levels following two seasons with low influenza activity. The early season was dominated by A(H3N2), with cocirculation of A(H1N1), reaching a peak late December 2022, while influenza B circulated at low levels during the latter part of the season. From September to March 2022/23, influenza vaccines were offered, free of charge, to all aged 2-13 (and 14-15 in Scotland and Wales), adults up to 49 years of age with clinical risk conditions and adults aged 50 and above across the mainland United Kingdom. METHODS:End-of-season adjusted vaccine effectiveness (VE) estimates against sentinel primary-care attendance for influenza-like illness, where influenza infection was laboratory confirmed, were calculated using the test negative design, adjusting for potential confounders. METHODS:Results In the mainland United Kingdom, end-of-season VE against all laboratory-confirmed influenza for all those > 65 years of age, most of whom received adjuvanted quadrivalent vaccines, was 30% (95% CI: -6% to 54%). VE for those aged 18-64, who largely received cell-based vaccines, was 47% (95% CI: 37%-56%). Overall VE for 2-17 year olds, predominantly receiving live attenuated vaccines, was 66% (95% CI: 53%-76%). CONCLUSION:The paper provides evidence of moderate influenza VE in 2022/23.