Although uncommon, invasive meningococcal disease (IMD) is a serious and life-threatening illness. In the United States (US), incidence is highest among infants aged <1 year, but research characterizing pediatric IMD burden is limited. This study aimed to evaluate health outcomes and economic burden (healthcare resource utilization [HCRU] and costs [associated with health outcomes and HCRU]) in US individuals aged <11 years with IMD and without IMD, and their caregivers, from the patient and payer (commercial and Medicaid insurance) perspective. Retrospective claims analysis utilizing real-world data (1/1/2005–12/31/2022) from the MarketScan® Commercial and Multi-State Medicaid Databases compared health outcomes, HCRU (e.g., inpatient and outpatient admissions, surgical procedures, pharmacy claims), and costs (associated with health outcomes and HCRU) in commercially and Medicaid-insured infants (aged <1 year), toddlers (aged 1–4 years), and children (aged 5–10 years) with IMD versus those without IMD (matched 1:5), and their caregivers. Length of follow-up was variable, divided into acute/post-acute phases for individuals with IMD. Infants, toddlers, and children with IMD versus without IMD generally experienced more negative health outcomes and HCRU, and higher associated costs. Common health outcomes among infants with IMD included neurological, physical, and neurodevelopmental/mental health disorders. In the commercially insured cohort, infants with IMD had more inpatient admissions, specialist office visits, and surgical procedures than those without IMD. In the Medicaid-insured cohort, HCRU was higher for infants with IMD versus without IMD. Costs associated with health outcomes and HCRU were higher for infants with IMD versus those without IMD, regardless of insurance cohort. Health outcomes, HCRU, and HCRU-associated costs did not differ for caregivers to individuals with IMD versus without IMD. In this retrospective claims analysis from a dual US patient and payer perspective, infants, toddlers, and children with IMD experienced substantial negative health outcomes and economic burden, regardless of insurance status. Preventive interventions in childhood may lessen the impact of IMD on individuals, families, and healthcare systems. Invasive meningococcal disease (IMD), though uncommon, is a serious and life-threatening illness. In the United States (US), IMD is most common in infants. Using medical insurance information, this study assessed health conditions, healthcare services, and costs reported in US infants (aged <1 year), toddlers (aged 1–4 years), and children (aged 5–10 years) with IMD and their caregivers, compared with similar individuals who did not have IMD. Infants, toddlers, and children were grouped by insurance plan (commercial or Medicaid). Costs were evaluated from the patient and medical insurance perspective. Because IMD is particularly common in infants, we focused mostly on findings in the infant age group, although results were similar for toddlers and children. Neurological disorders were the most common health condition observed in infants with IMD from both the commercially insured and Medicaid-insured groups. Additionally, infants with IMD who had Medicaid insurance used all healthcare services more than Medicaid-insured infants without IMD. Infants with IMD who had commercial insurance had more inpatient admissions, specialist office visits, and surgical procedures than commercially insured infants without IMD. Medical costs for the commercially and Medicaid-insured infants with IMD were greater than the medical costs for infants without IMD, though infants with commercial insurance paid more than infants with Medicaid insurance. No differences were found between caregivers to individuals with IMD and without IMD. Early preventive measures such as vaccination during childhood may reduce the negative consequences of IMD, such as long-lasting health conditions and financial responsibilities, on individuals, families, and healthcare systems.
Oscar Herrera-Restrepo, Elizabeth Packnett, Megan Richards et al.
The HPV Prevention and Control Board convened its 18th technical meeting in Antwerp, Belgium (June 2025) to review the evidence on universal HPV vaccination and the role of anal cancer screening in the elimination of HPV-associated cancers. While HPV prevention has historically focused on cervical cancer in women, growing evidence supports extending both primary and secondary prevention to male cohorts and non-cervical anatomical sites. HPV causes approximately 148,072 cancer cases in men annually in the world - likely a substantial undercount - affecting primarily the oropharynx, anus, and penis. Men's lower seroconversion rates after natural HPV infection and sustained HPV prevalence across age groups makes vaccination an essential tool to prevent HPV-related disease in this population. Community-randomised trial evidence confirms that universal vaccination delivers stronger herd protection than girls-only strategies and may accelerate elimination of the most oncogenic types within 15-30 years. While modelling analyses identify high coverage in girls as the most efficient strategy for cervical cancer elimination, universal vaccination is justified on broader public health grounds, including equity, programme resilience, reduced vaccine hesitancy, and prevention of non-cervical cancers. Country experiences from Scotland and Cameroon highlight persistent equity gaps and the critical role of community engagement. Given the direct epidemiological link between HPV infection in males - particularly gay, bisexual, and other men who have sex with men and immunocompromised populations, such as people living with HIV - and anal cancer risk, the meeting identified anal cancer screening as the most advanced non-cervical secondary prevention strategy warranting immediate attention. The ANCHOR trial demonstrated that treating anal high-grade squamous intraepithelial lesions reduces anal cancer incidence by 57%. Despite the publication of the first evidence-based U.S. Health and Human Services and International Anal Neoplasia Society guidelines in 2024, implementation remains constrained by high-resolution anoscopy capacity, workforce shortages, stigma, and limited evidence on optimal screening algorithms. The meeting concluded that integrating universal vaccination with targeted anal cancer screening - supported by equitable access, biomarker development, and living guidelines that evolve with emerging evidence - is essential to reducing HPV-related cancer burden in both women and men.
Human papillomavirus (HPV) vaccination is a highly effective strategy for preventing cervical cancer; however, achieving high vaccination coverage among eligible girls depends largely on parental decision-making. This study assessed parental perceptions and intention to vaccinate female children aged 9–14 years against HPV in Ile-Ife, Nigeria, using the Theory of Planned Behaviour (TPB). A cross-sectional study was conducted between August and September 2024 among 163 parents of female children aged 9–14 years attending selected secondary schools in Ile-Ife, Nigeria, using a multistage sampling technique. Data were collected using a pretested questionnaire developed from previously validated instruments and analysed using IBM SPSS Statistics version 27. Chi-square tests and multivariable logistic regression were performed to identify factors associated with parental intention to vaccinate at a significance level of p < 0.05. Of the 163 questionnaires distributed, 160 (98.2%) were completed and analysed (response rate: 98.2%). Overall, 59.4% of parents had a positive perception of HPV vaccination, while 60.6% expressed an intention to vaccinate their female children. Higher education level (adjusted odds ratio [AOR] = 6.06; 95% confidence interval [CI] 2.11–17.38) and perceived behavioural control (AOR = 11.97; 95% CI 4.69–30.56) were associated with parental intention to vaccinate. In conclusion, both positive perception of HPV vaccination and parental intention to vaccinate female children were suboptimal. Perceived behavioural control and parental educational level were significant predictors of parental intention to vaccinate. Interventions aimed at strengthening parental intention should therefore give attention to these factors.
BACKGROUND: Maternal and child malnutrition is a serious public health problem in low and middle-income countries (LMICs) and can cause cycles of poverty, disease, and developmental delays. OBJECTIVE: This comparative narrative review explores maternal and child nutrition indicators, determinants, interventions and policies in India and Palestine and identifies common lessons and transferable recommendations for LMICs. METHODS: A structured, non-exhaustive search of the PubMed, Scopus, Web of Science, and WHO/UNICEF data repositories and some relevant grey literature published from 2010 to 2024 was used to obtain these narratives. Records were reviewed with background eligibility criteria and the evidence included was then thematically synthesised in a narrative format rather than systematically. KEY FINDINGS: India has achieved significant improvement in addressing child stunting and maternal anaemia through key initiatives like POSHAN Abhiyaan, ICDS, and Anaemia Mukt Bharat. However, there are still significant geographic and socioeconomic gaps, and the double burden of malnutrition (undernutrition and overweight) is growing. Palestine is experiencing a unique but significant nutrition crisis, due to prolonged conflict, occupation, and economic turmoil: Around 19.6% of Palestinian children are stunted and IDA is common among pregnant women. Both countries face issues of micronutrient deficiencies, poor infant and young child feeding practices, and gender inequities which negatively impact maternal nutrition. POLICY IMPLICATIONS: The two successful interventions have complementary lessons for each other: the convergence model in India, which is community based, and the integration of nutrition into primary healthcare in Palestine, which benefits from international partnerships. Multi-sectoral responses involving collaboration between the health, agriculture, education, and social protection sectors are needed, with a strong governmental commitment and monitoring systems. CONCLUSIONS: This review highlights that nutrition-specific clinical interventions are essential but that sustainable nutrition improvements need to be implemented through policies that address the underlying structural, socioeconomic, and, in Palestine, the political determinants of malnutrition. The lessons learned from India and Palestine are broadly relevant to other LMICs in a similar context of nutrition transitions.
COVID-19 emergency measures disrupted access to essential health services in many low- and middle-income countries. In Zimbabwe, maternal and child health (MCH) services are central to primary healthcare, yet evidence on the magnitude of disruption and recovery remains limited. This study assessed changes in selected MCH service indicators before, during, and after COVID-19 lockdown measures across Zimbabwe’s ten provinces. We conducted a secondary analysis of monthly provincial DHIS2 data from January 2016 to December 2024. Segmented interrupted time-series regression with generalized estimating equations with a Poisson distribution and log link to estimate immediate lockdown and post-lockdown recovery effects for first antenatal care (ANC) visits, completion of at least four ANC visits, institutional deliveries, newborn postnatal care within three days, primary immunisation course completion, and neonatal deaths. Models adjusted for province, calendar month, and within-province correlation. Completion of at least four ANC visits declined during lockdown (aRR 0.68, 95% CI 0.61–0.76), as did newborn postnatal care within three days (aRR 0.81, 95% CI 0.76–0.87). First ANC visits remained stable during lockdown (aRR 0.99, 95% CI 0.84–1.16) but increased post-lockdown (aRR 1.23, 95% CI 1.05–1.43). Institutional deliveries also increased during recovery (aRR 1.25, 95% CI 1.11–1.40), while neonatal deaths increased post-lockdown (aRR 1.38, 95% CI 1.17–1.62). Provincial patterns indicated heterogeneous disruption and recovery. COVID-19 lockdown measures disrupted selected routine MCH services, particularly continued antenatal and early postnatal care, whereas institutional deliveries and childhood immunisation were comparatively resilient. Strengthening emergency preparedness and recovery planning is essential to maintaining continuity of MCH services during future public health emergencies.
Tadiwanashe Mutemeri, Neuville Katandika, James January et al.
Background: Children with sickle cell anaemia (SCA) are at increased risk of invasive pneumococcal disease, making pneumococcal vaccination an important preventive measure. However, vaccine hesitancy may reduce uptake, particularly in resource-limited settings where access to vaccines and reliable information may be constrained. Aim: This study examined factors contributing to pneumococcal vaccination hesitancy among caregivers of children with SCA and their implications for vaccine coverage. Study Design: The work was a hospital-based cross-sectional study conducted among caregivers of children with SCA. Place and Duration of Study: The study was conducted at the sickle cell clinic of the Yobe State Specialist Hospital, Potiskum, from April to June 2026. Methodology: Data were collected using a structured, interviewer-administered questionnaire addressing sociodemographic characteristics, vaccination status, and reported reasons for hesitancy. Descriptive statistics were used to summarise the reported barriers. Results: Of the 126 participating caregivers, 108 (85.7%) vaccinated their children, while 18 (14.3%) did not or were unsure of their vaccination status. The most frequently reported reasons for hesitancy were fear of side effects and vaccine unavailability (27.8% each), followed by lack of trust (16.7%), lack of awareness (11.1%), and high cost (11.1%). The majority (83.3%) of the hesitant caregivers indicated that encouragement from healthcare workers would motivate them to vaccinate their children. Conclusion: Pneumococcal vaccine hesitancy is influenced by both caregiver-related concerns and health-system barriers. Strengthening vaccine counselling services, addressing safety concerns, and ensuring that vaccines are available, affordable, and accessible may enhance pneumococcal conjugate vaccine (PCV) uptake among children with SCA.
Conventionally, vaccine design has focused on identifying antigens that induce durable T and B cell memory and provide long term protection against subsequent encounters with the same pathogen. Unconventionally, a growing number of epidemiological, preclinical, and clinical studies demonstrate that live vaccines, including Bacillus Calmette Guérin (BCG), measles-containing vaccines, and oral polio vaccine, induce protection through trained immunity, a form of metabolically and epigenetically mediated memory in innate immune cells and their progenitors. This concept is particularly relevant during early life, when adaptive immune responses are constrained and innate immunity represents the principal line of host defence. In this review, we discuss the unique characteristics of neonatal and infant immunity, summarize current evidence for trained immunity induced by childhood vaccines, and describe the bidirectional interplay between innate and adaptive immune memory. We further highlight the potential of trained immunity to broaden protection against severe infections, improve vaccine efficacy, and provide therapeutic opportunities for non-infectious paediatric diseases, including cancer and allergic disorders. Harnessing trained immunity represents a conceptual shift in paediatric vaccinology and may guide the development of next generation vaccines that provide broader and more resilient protection during the period of greatest immunological vulnerability.
ChenRongRong Cai, Lubnaa Hossenbaccus, Eva Kaufmann
BACKGROUND: Mother-to-child transmission (MTCT) is an important route of new hepatitis B virus (HBV) infections. In Africa, limited and conflicting data on the effectiveness of hepatitis B birth dose vaccination (HepB-BD) have contributed to fragmented adoption and sub-optimal implementation. We aimed to assess the effectiveness of timely HepB-BD in preventing HBV MTCT in Ethiopia. METHODS: We conducted a multi-centre cross-sectional observational study in Ethiopia from May 2022 to June 2024. We identified mothers who had tested positive for hepatitis B surface antigen (HBsAg) during pregnancy and assessed mother-infant pairs at 6-12 months post-partum for HBV MTCT. We stratified effectiveness of HepB-BD by maternal risk profile (HBV DNA level, hepatitis B e-antigen (HBeAg) status). RESULTS: The analysis included 387 children born to HBV-positive, HIV-negative mothers who had completed routine HBV vaccination (HepB3). The median age of infant testing was 10 months (IQR 7.0-11). Overall MTCT risk was 5.2% (95% CI 3.4,7.8). MTCT was significantly lower among infants receiving HepB-BD alone (0/39, 0% [95% CI 0-9.0]) compared to those without immunoprophylaxis at birth (20/131, 15.3% [95% CI 10.1-22.4]) (p = 0.009). No transmission occurred with HepB-BD plus HBIg (0/217, 0% [95% CI 0-1.7]). Maternal viral load >200,000 IU/ml (AOR 16.6, 95% CI 4.82,57.19) and HBeAg positivity (AOR 4.21, 95% CI 1.08,16.44) were associated with increased MTCT risk amongst infants without immunoprophylaxis at birth. CONCLUSIONS: In Ethiopia, the current vaccination series starting at 6 weeks is insufficient to prevent HBV MTCT. Timely HepB-BD is highly effective in reducing HBV MTCT and should be prioritised for scale-up in Africa.
Nega Berhe, Hailemichael Desalegn, Hiwot Mengistu et al.
Abstract Objectives To estimate age trajectories of infant mortality among Palestinian refugees using electronic health records, addressing the scarcity of reliable mortality data in forced displacement settings. Setting Palestinian refugees living in Gaza, West Bank, Jordan, Syria and Lebanon. Design We fitted a Bayesian Negative Binomial model to observed death counts, using a flexible parametric function (a shifting power function) to capture the shape of the infant mortality curve, across strata to infer age trajectories of infant mortality. Participants Palestinian refugees born in 2010–2020 and registered with UNRWA health services in Gaza, West Bank, Jordan, Syria and Lebanon. The sample was stratified by sex, field, gestational age and birth cohort. Main outcome measures Survival rate to age 1. Results Overall, the survival rate to age 1 was 98.64%, with slightly lower rates for males (98.57%) than females (98.68%). Across settings, West Bank refugees had the lowest infant mortality (99.08% survival rate), and Jordan refugees had the highest (98.22% survival rate). Results by gestational age showed a 98.85% survival rate at age 1 among term births compared to a 73.32% survival rate among very preterm births. Survival rates by cohort (births up to 2015 or after) were 98.78% and 98.42%, respectively. Conclusion Our findings highlight the potential of electronic health records for mortality monitoring in forced displacement settings as they reveal consistent mortality trajectories by sex and gestational age, while identifying meaningful variation across refugee settings and subgroups. Summary boxes What is already known in this topic We searched PubMed and Google Scholar for articles published between Jan 1, 2000, and Feb 20, 2026, in English, using the terms “Palestinian refugees,” “infant mortality,” “neonatal mortality,” and “UNRWA.” We found a handful of studies estimating infant mortality among Palestinian refugees, mostly based on household surveys (eg, MICS, national statistical office surveys) or UNRWA surveys using preceding birth techniques. The preceding birth technique has notable limitations, including recall bias, small sample sizes, and selection bias. The majority of these studies focus exclusively on Palestinian refugees residing in Gaza. Estimates for Gaza suggest a sustained decline, from around 127 deaths per 1,000 births in 1960 to 20.2 per 1,000 births in 2006, with a slowdown thereafter and an increase in more recent years. A combined estimate (excluding Syria) across four settings where Palestinian refugees reside measures infant mortality at 18 per 1,000 births in 2011. What this study adds This study uses a unique data linkage bringing together UNRWA’s obstetric and child health records, providing more extensive information and a larger sample size than previous studies. This is also the first study to assess the data quality of these electronic records and to estimate age trajectories of infant mortality among Palestinian refugees. We developed a statistical strategy that estimated infant mortality trajectories covering all five UNRWA fields (Gaza, Jordan, Lebanon, Syria, and the West Bank) for children born in 2010-2020, and examined differences across subpopulations by sex, field, gestational age and cohort.
Maternal healthcare-seeking behaviour (MHSB) is a key determinant of childhood vaccination rates. In rural Nigeria, MHSB remains low and has been associated with poor maternal and child health outcomes. However, empirical evidence linking MHSB to timely childhood immunisation, particularly among agricultural households in rural Nigeria, is limited. This study therefore examined the effect of maternal healthcare-seeking behaviour on timely childhood vaccination among agricultural households in rural Nigeria. The study utilised secondary data from the 2018 Nigeria Demographic and Health Survey (NDHS). Information on vaccines received by children, prenatal care, timing of first antenatal visit, number of antenatal visits, skilled birth attendance, and postnatal care was extracted for 2,751 rural women with under-five children in agricultural households. Data was analysed using descriptive statistics, multiple correspondence analysis (MCA) to generate the MHSB index, and an extended ordered probit model. The findings show that women in agricultural households in rural Nigeria moderately utilise maternal healthcare services, with a mean MHSB index of 0.54, while 55.83% of children were unimmunised. Maternal healthcare-seeking behaviour and husband’s education significantly improved partial vaccination status, while husband’s education and mother’s full-time employment in agriculture were associated with improved full vaccination status in children. Maternal healthcare-seeking behaviour positively influences child immunisation status among agricultural households in rural Nigeria. Strengthening policies that promote maternal healthcare utilisation and expanding access to antenatal and vaccination services particularly through community and market-based health centres and male involvement are essential to improving vaccination coverage in rural Nigeria.
Mobolaji Victoria Adejoorin, Kabir Kayode Salman, Mutiat Bukola Salawu et al.
Survival
F. Ricardo Burdier, Laia Bruni, Anna R. Giuliano et al.
