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Effectiveness of nirsevimab against hospitalization for RSV bronchiolitis according to RSV lineages

ABSTRACT Importance Nirsevimab, a monoclonal antibody against RSV, was implemented in France in September 2023. Recently, rare resistance-associated substitutions were described in RSV but the effectiveness according to lineages remains unclear. Objective We aimed to estimate the effectiveness of nirsevimab against hospitalization for RSV bronchiolitis according to RSV lineages. Design We conducted a multicenter test-negative case-control study from October 15, 2023 to March 15, 2025. Setting This study was based on data from three national multicentric prospective studies. The 12 participating centers were secondary or tertiary hospital with a pediatric department located in France. Participants We included all children younger than 12 months who were hospitalized for RSV bronchiolitis in one of the participating centers in France during the two first RSV epidemic seasons following the implementation of nirsevimab (from October 15, 2023 to February 29, 2024, and from October 10, 2024 to March 15, 2025). Main outcomes and measures The main outcome of the study was the RSV test result of bronchiolitis cases. RSV whole-genome sequencing was performed using a tiled amplicon approach covering the complete viral genome, as previously described in the POLYRES studies. We estimated the effectiveness of nirsevimab by a multivariable logistic regression model adjusted for potential confounders. We estimated the adjusted risk of immunization failure for each lineage by calculating relative odds ratio to a reference lineage. A range of sensitivity analyses were conducted. Results We included 3019 infants with bronchiolitis among which 2273 had a positive RSV test (case patients) and 746 had a negative RSV test (control patients). Overall, 373/2273 (16.4%) case patients were immunized by nirsevimab versus 423/746 (56.7%) control patients. The adjusted effectiveness of nirsevimab against hospitalization for bronchiolitis was 88.4% (95% CI, 84.5–91.4) with RSV-B and 79.4% (95% CI, 73.7–83.8) with RSV-A. The risk of immunization failure was 3.2-fold (95% CI 1.8–5.7) higher for lineages derived from A.D.3 than for lineages derived from B.D.4.1. Conclusion and relevance In this multicentric case-control study, we observed that nirsevimab effectiveness was variable across RSV lineages, with a lower effectiveness against A.D.3 lineages compare to others. Further surveillance is needed to confirm these findings and assess their implication on RSV lineages epidemiology as nirsevimab use expands. KEYPOINT Question Does the effectiveness of nirsevimab against hospitalization for RSV-bronchiolitis change based on the RSV lineages? Findings In this case-control test negative design study that include 3019 infants, the effectiveness of nirsevimab against hospitalization for bronchiolitis was significantly higher with RSV-B than with RSV-A. Specifically, we found a 3.2-fold risk of immunization failure with lineages derived from A.D.3 than with lineages with highest effectiveness. Meaning This study suggest that nirsevimab effectiveness varies substantially across RSV lineages, with lineages derived from A.D.3 less susceptible to nirsevimab. This highlight the importance of molecular and clinical surveillance over the coming years of wide nirsevimab use.

Mathieu Barbier, Corinne Lévy, Robert Cohen et al.

Parental intent to accept postnatal RSV monoclonal antibody immunisation for infants in the UK

Abstract Respiratory syncytial virus (RSV) is a leading cause of infant morbidity and hospitalisation in the UK. Postnatal monoclonal antibody (mAb) immunisation can protect infants, but implementation depends on parental acceptance. We surveyed 12,326 UK parents of children under 18 years in August–September 2024, measuring intent to accept a hypothetical RSV mAb injection for an infant if free through the National Health Service. We estimated national and sub-national intent using multilevel regression and poststratification aligned to UK census data, assessed socio-demographic and behavioural determinants, and embedded an online randomised controlled trial in which a control arm received no additional timing or disease-burden information and six intervention arms varied this information. Estimated national RSV mAb intent was high, with 88.8% leaning towards or definitively intending to immunise, although only 54.0% expressed firm intent. Intent was slightly lower in urban areas, especially London, and among older parents, those born outside the UK, and some ethnic minority groups. Belief in vaccine safety, importance, and trust in health workers were strong positive predictors of intent. Information that the mAb would be administered shortly after birth reduced post-exposure intent relative to control, highlighting the importance of timing, framing, and communication for equitable uptake across groups.

J. Happenhofer, M. Carreno, Alexandre de Figueiredo

The gap between having and using: socioeconomic inequalities in long-lasting insecticidal net coverage among children and adolescents in rural Guinea

BACKGROUND: Malaria is a major health issue in sub-Saharan Africa, including Guinea, affecting children under five and rural populations, with a prevalence of up to 30% in some areas. Although long-lasting insecticidal nets (LLINs) are effective, inequalities in access and use persist across wealth, geography, and age groups; however, detailed data are limited. This study assessed socioeconomic inequalities in LLIN access and use among children and adolescents. METHODS: We analysed data from a cohort study conducted between March 2022 and February 2023 in Maferinyah, rural Guinea, with monthly visits to households of children and adolescents aged 1-19. Socioeconomic position (SEP) was derived using an asset index and categorised into terciles. LLIN access and use-given-access were analysed using mixed logistic regression models adjusted for sociodemographic and seasonal factors. Socioeconomic inequalities were quantified using concentration and Erreygers indices with cluster bootstrap confidence intervals. Pathway and decomposition analyses assessed the contribution of access to LLIN to inequalities in effective LLIN use (defined as use regardless of access). RESULTS: The odds of LLIN access were higher among middle-SEP (aOR = 3.84; 95% CI 1.31-11.96) and high-SEP households (aOR = 3.76; 95% CI 1.18-12.71) than among low-SEP households. Inequalities in effective LLIN use were driven by disparities in access rather than by use behaviour. Although LLIN use among those with access exceeded 80% across all socioeconomic groups, effective use in the overall study population was lower among low-SEP households (29.6%). Significant pro-rich socioeconomic inequalities were observed for both LLIN use (Erreygers index (EI) = 0.386; 95% CI 0.151-0.594) and access (EI = 0.412; 95% CI 0.168-0.636). Decomposition analysis suggested that socioeconomic inequality in effective LLIN use was almost entirely explained by differences in access (98.8% of the total variance). CONCLUSIONS: Malaria prevention in rural Guinea is unequal, leaving poorer children and adolescents less protected than wealthier ones. This gap stems from unequal access to LLINs rather than differences in net use among households with nets. The study showed that the poorest families did not have access to nets in the first place. Addressing this inequity requires improved distribution strategies targeting the poorest and most vulnerable households, rather than behavioural interventions for net use only.

Almamy Amara Touré, Sidikiba Sidibé, Soledad Colombe et al.

Position statement of the Mexican Academy of Pediatrics regarding strategies to prevent respiratory syncytial virus infection in MexicoÓ?s pediatric population

Respiratory syncytial virus (RSV) is one of the leading causes of acute lower respiratory tract infection, bronchiolitis, pneumonia, and hospitalization among infants and young children, with the highest risk of severe disease observed in infants younger than six months, preterm infants, and children with bronchopulmonary dysplasia, congenital heart disease, immunocompromising conditions, and other underlying comorbidities.In Mexico, available evidence demonstrates a substantial clinical burden and a predominant seasonal circulation from September to March.In recent years, the development of novel preventive strategies has transformed the approach to RSV prevention, particularly through maternal immunization with a bivalent prefusion F protein vaccine and passive immunoprophylaxis with long-acting monoclonal antibodies.This position statement from the Mexican Academy of Pediatrics reviews the epidemiological, clinical, and real-world effectiveness evidence regarding currently available strategies for the prevention of RSV infection in the pediatric population.Maternal vaccination between 32 and 36 weeks of gestation promotes transplacental antibody transfer and provides protection to infants during the first months of life.Monoclonal antibodies, particularly nirsevimab, have demonstrated significant reductions in lower respiratory tract infection, hospitalization, intensive care unit admission, and severe RSV-associated disease, with a favorable safety profile.Based on disease burden, national seasonality, availability of preventive products, and the characteristics of the Mexican health care system, the Mexican Academy of Pediatrics proposes a complementary and progressive strategy

Rosa María Wong‐Chew, María del C. Espinosa-Sotero, Ana Elena Limón-Rojas et al.

Gaps in Institutional Services and Universal Immunization Programme: Experience from a Tribal Community in India

Background: Universal immunization programme (UIP) is widely recognised as one of the most effective, equitable and cost-effective public health intervention. In India UIP have cover 26 million infants and 29 million pregnant women through more than 13 million immunization sessions annually. However, tribal communities continue to face barriers to accessing institutional healthcare services, including financial, geographical, socio-cultural, and systematic barriers. Inadequate infrastructure, shortage of trained healthcare personnel, irregular outreach services and poor transportation networks are the problems and existing challenges faced by tribal communities in accessing health care from primary health care settings. This study aimed to access immunization coverage among tribal children and explores community experiences of institutional health services related to immunization. A mixed method approach incorporating quantitative and qualitative methods was adopted. Quantitative data were collected to access immunization status among children review of their mother and child protection (MCP) card. While qualitative data were obtained through in-depth interview and focus group discussion. Results indicates that only 13.3% children were fully immunized, where as 86.7% were partially immunized. Participants attributed incomplete vaccination to lack of awareness, lack of interest, fear of side effects and reliance on cultural practices and beliefs. The present study demonstrates that the immunization gap among the tribal communities is not merely a consequence of inadequate awareness or vaccine acceptance, but reflects a broader structural and organizational gap in delivery immunization services. Accessibility, continuity, organisation and responsiveness of institutional services, operating with the socioeconomic and cultural context of tribal households are critical determinants of effective immunization.

Sonali Panda, Bangshi Raj Mahata, Arun Kumar Acharya

Diphtheria in the Kazakh SSR in 1958–1961: Epidemiological Dynamics and Initial Results of Mass Immunisation

The article examinesthe change in the epidemiological situation in the Kazakh SSR at theturn of the 1950s and 1960s, considering the shift towards the mass immunisation of children. The objective of the study is to identify the rates, territorial characteristics and factors of the dynamics of incidence in 1958 –1961, as well as to evaluate the initial results of the vaccination program. The source base consisted of archival reports and statistical documents from health authorities and the sanitary-epidemiological service. These documents contained information on regions, urban and rural areas, age groups, vaccination status, disease focality, clinical forms, laboratory confirmation and disease outcomes. The comparative-historical, problemchronological and statistical methods were employed. The material was analysed using the endogenousprimary approach, which links epidemiological results with the internal capabilities of the republican healthcare system. The scientific novelty lies in the comprehensive introduction of little-studied statistical tables to research circulation, which made it possible to reconstruct regional processes that were not reflected in All-Union or average republic dynamics. A review of the evidence suggests that the situation remained tense at the end of the 1950s. Following a decline in the number of patients, 10,733 cases were registered in 1959. In 1960, their number decreased to 7,500, and in 1961 it was approximately half that of the previous period. However, it should be noted that the positive dynamics were not synchronous: in 1959–1960, growth continued in some areas, while the directions of change in cities and rural areas often differed. Despite the overall decline in 1961, cases in several territories continued to exceed the national average. A comparison of age and vaccination data confirmed the protective effect of vaccination but showed that nominal coverage alone was not sufficient for protection. The diseases observed in vaccinated and revaccinated children required consideration of the completeness of the vaccination course, the timing of the revaccination and the quality of the vaccines. Continued active transmission of the infection was indicated by cases in organised groups, multiple focal spots and registered outbreaks. It was concluded that mass immunisation was a decisive factor in the epidemiological shift. However, its impact was gradual and uneven across different territories. By 1961, the Republic had entered a period of steady decline in disease incidence, though it had not yet achieved full control of the infection. The effectiveness of the campaign was determined by a combination of factors, including vaccination coverage, organisational quality, laboratory surveillance, early diagnosis, hospitalisation and timely treatment.

Zhanna Mazhitova, Aigul Zhalmurzina, Zhangeldy Bimoldin et al.

Factors Associated with Incomplete Childhood Immunization among Children Aged 12–36 Months in Burkina Faso

Childhood immunization remains one of the most effective public health interventions to preventvaccine-preventable diseases.In Burkina Faso, incomplete immunization schedules remain a challenge amid insecurity, population displacement, and health system disruptions.This study aimed to identify factors associated with incomplete immunization and the vaccination dropout rate in children aged 12 to 36 months.A secondary analysis of the 2021 Burkina Faso Demographic and Health Survey (2021-DHS-BF) data was performed.Incomplete immunization was defined as a child not receiving all recommended routine vaccine doses by 15 months of age.Factors associated with incomplete immunization were identified using modified Poisson regression with generalized estimating equations; adjusted prevalence ratios (aPR) with 95% confidence intervals were reported at a 5% significance threshold.Among the 2,375 children who met the eligibility criteria in the 2021-DHS-BF dataset, 1,482 (66.0%) had not completed their immunization schedule.The dropout rate between the first and third doses of the pentavalent vaccine was 11.0%.Maternal occupation (Saler: aPR = 0.89, 95% CI: 0.80-0.98 and farmer/selfemployed: aPR = 0.93; 0.85, 95% CI: 0.78-0.94)and being treated with respect "sometimes" at health facilities (aPR = 1.14, 95% CI: 1.02-1.27)were associated with an incomplete immunization schedule.Strengthening person-centered care, improving post-first-dose follow-up, and expanding community-based outreach strategies could improve immunization schedule completion.

O PAPEL DA EDUCAÇÃO EM SAÚDE NO ENFRENTAMENTO DA HESITAÇÃO VACINAL NA INFÂNCIA E ADOLESCÊNCIA

This article aimed to discuss the role played by health education in tackling vaccine hesitancy, a complex and multifactorial phenomenon capable of compromising vaccination coverage rates and favoring the reappearance of vaccine-preventable diseases among children and adolescents. The work of PIBEX scholarship student, in the VacinAção Extension Project, sought to analyze the scientific evidence related to the role of health education in reducing vaccine hesitancy, identifying different forms of intervention, how they can be applied, and the effects they have generated. This is an integrative literature review carried out in the Virtual Health Library, Latin American and Caribbean Literature in Health Sciences, and Scientific Electronic Library Online databases, gathering articles published between 2016 and 2025, in Portuguese and English, related to health education, vaccine hesitancy, and educational interventions. The studies indicated that such strategies can expand knowledge by clarifying doubts and strengthening trust in vaccines, showing greater potential than standardized actions already implemented. It is concluded that health education can contribute to tackling vaccine hesitancy when developed on the basis of dialogue and personalization, being continuous and adapted according to the needs of each child, adolescent, and/or guardian.

Gabrielly Boiko Ribeiro, Beatriz de Toledo Nogueira, Luiza Tatiana Forte et al.

Implementing Somalia's National Transformation Plan 2025–2029 for health-system reform: a policy and practice review of governance, financing, and institutional readiness

Somalia's National Transformation Plan (NTP) 2025–2029 presents an ambitious health-reform agenda centred on maternal and child health, workforce development, health-system strengthening, regulation, financing, digitalisation, and emergency preparedness. The policy challenge is whether the institutional conditions required for implementation can be assembled in a fragile, federal, highly aid-dependent and predominantly mixed-provider health system. This Policy and Practice Review critically examines the implementation readiness of the NTP health chapter and proposes a sequenced framework for converting national commitments into measurable results. A structured narrative review was undertaken from June to July 2026 using peer-reviewed literature, national policy documents, and reports from governmental and international institutions. Evidence was interpreted through the health-policy triangle, the updated Consolidated Framework for Implementation Research (CFIR), applied prospectively to anticipated determinants, and a health-system resilience lens. The synthesis generated six interdependent proposed readiness foundations: a negotiated federal-state governance compact; a technically validated, costed and sequenced operational plan; sustainable financing and strategic purchasing; workforce and regulatory capacity; integrated information, monitoring and public accountability systems; and shock-responsive adaptive management. Important policy strengths include explicit targets for service coverage, workforce expansion, hospital rehabilitation, regulation and digital health. Key risks include inconsistent or under-specified targets and baselines, uncertain fiscal pathways, weak federal-state role specification, and dependence on external resources and non-state providers. Comparative evidence suggests that contracting and pooled financing can expand services when stewardship, fiduciary safeguards, workforce integration, community accountability and learning systems develop concurrently. We propose a phased 2026–2029 pathway prioritising technical validation, essential-service continuity, subnational compacts, workforce payroll transition, interoperable data systems and annual public performance reviews. The proposed framework is prospective and has not yet been empirically validated; consultation with federal and subnational authorities, providers, partners, civil society and communities is required before formal adoption.

Nor Haji Osman, Dahir Osman Mohamed, Hamdi Mohamud Osman et al.