Malaria remains a major health challenge in Nigeria, particularly among children under five years of age. Although efforts to control the disease have expanded, important implementation challenges remain. This editorial reviews the major drivers of under-five mortality due to malaria, including low coverage of malaria prevention interventions, poor access to prompt diagnosis and appropriate treatment, and persistent socioeconomic and health system challenges. It also identifies gaps in health services, the supply chain, and human resources that hamper the implementation of current malaria control strategies. The editorial recommends three feasible and scalable interventions: scaling up seasonal malaria chemoprevention, integrating malaria vaccination into routine childhood immunization services, and improving community-based case management. These recommendations aim to complement the current health system and improve access to effective malaria prevention and treatment. Their implementation could reduce malaria-related deaths among children under five and contribute to Nigeria's progress toward malaria control and elimination.
Viral hepatitis is a major public health concern in China. In alignment with the World Health Organization (WHO) 2016 global strategy to eliminate viral hepatitis as a public health threat by 2030, and in further implementation of the "Healthy China 2030" initiative, the National Disease Control and Prevention Administration, together with eight other government departments, jointly issued China's Action Plan for Viral Hepatitis Prevention and Care (2025-2030) ("Action Plan"). Compared with the 2017-2020 Plan, the new Action Plan introduced, for the first time, explicit 80% diagnosis and treatment coverage targets for both hepatitis B virus (HBV) and hepatitis C virus (HCV), replacing the 1% hepatitis B surface antigen (HBsAg) prevalence target for children under five with a more ambitious 0.2% target and shifting from passive case-finding to active screening. The Action Plan outlines 6 specific targets and 13 key measures across 5 strategic areas: strengthening vaccination, enhancing comprehensive prevention, expanding testing and surveillance, improving treatment services, and strengthening health education and social support. Key challenges include a large population living with viral hepatitis, a high disease burden from cirrhosis and liver cancer, persistent care cascade gaps, fragmented service delivery, and insufficient dedicated funding. Priority actions include improving information systems for whole-course management, optimizing service delivery through medical-prevention coordination, promoting integrated multidisease-prevention efforts, and increasing resource investment, including exploring inclusion of viral hepatitis services in the basic public health service package. This Action Plan provides a strategic roadmap for China to systematically advance toward the global 2030 elimination goals.
Background/Objectives: Rotavirus remains a major cause of acute gastroenteritis among children under five years of age, particularly in regions with heterogeneous vaccine implementation. In Central Asia, differences in the timing and coverage of rotavirus vaccination may influence circulating genotype patterns, yet regional evidence remains fragmented. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251274198). Electronic databases (PubMed, Web of Science, ScienceDirect, and Google Scholar) were searched without date restrictions. Studies reporting laboratory-confirmed rotavirus infection and genotype distribution among children under five years in Central Asia were included. Random-effects meta-analysis of proportions was performed to estimate the pooled genotype proportions among rotavirus-positive children, with subgroup analyses comparing the before and after vaccine introduction periods. Results: Six studies (ten before vaccine introduction strata and four after vaccine introduction strata; N = 1713 rotavirus-positive children) were included. A significant decline in the G1P[8] genotype was observed following vaccine introduction, with pooled prevalence decreasing from 0.468 (95% CI: 0.363-0.577) to 0.068 (95% CI: 0.034-0.133) (p < 0.001). In contrast, G2P[4] increased from 0.134 to 0.485 (p < 0.001), while G9P[4] and G9P[8] also increased significantly. G3P[8] and mixed genotypes declined, whereas G4P[8], G12P[8], and untypable strains showed no statistically significant subgroup differences. Substantial heterogeneity was observed (I2 > 90%), and evidence certainty was very low for all genotype outcomes. Conclusions: The available evidence suggests that rotavirus genotype distribution among children under five in Central Asia may have changed after vaccine introduction, with lower pooled proportions of G1P[8] and higher proportions of selected heterotypic genotypes in after vaccine introduction strata. Strengthened molecular surveillance using standardized genotyping protocols is needed to determine whether these patterns represent sustained genotype replacement or temporal fluctuation. These estimates are based on a small, heterogeneous evidence base with very low certainty and should be considered hypothesis-generating rather than confirmatory of a causal vaccine effect.
Yerke Suleimenova, Indira Karibayeva, Shnara Svetlanova et al.
Human papillomavirus (HPV) vaccination remains significantly underutilized despite its proven efficacy in preventing cancer. As of 2022, only 38.6% of children ages 9 to 17 years have received one or more HPV vaccine doses, with particularly low coverage among younger children (7.3% for ages 9-10 years) who would benefit most from early vaccination. This results in approximately 36,000 preventable HPV-related cancer cases annually, with an economic burden exceeding $1.7 billion. Significant disparities exist between metropolitan (39.4%-41.1%) and nonmetropolitan areas (30.0%). This brief presents evidence-based policy recommendations for state legislators to increase HPV vaccination rates through school-entry requirements, enhanced funding for equitable access, and provider education targeting children and adolescents aged 9 to 17 years. Implementation of these measures could prevent 90% of cervical cancers and substantially reduce five other HPV-related cancers, saving thousands of lives annually while lowering healthcare costs by an estimated $3.5 billion over a decade. Immediate action is essential to protect the current generation from future cancer risk.
Human papillomavirus (HPV) is a leading cause of preventable cancers, yet vaccination rates among children remain low in the United States, especially in rural and Hispanic/Latino communities. This study addresses the significant gap in HPV vaccination coverage in rural Washington State, where rates fall below national targets due to barriers like limited health care access, low awareness, and socioeconomic challenges. Hispanic/Latino communities in these areas face additional risks, including higher cervical cancer incidence and unique barriers to vaccination. To address these disparities, we applied an adapted Boot Camp Translation (BCT) approach within the PREVENT study, co-creating culturally tailored HPV vaccination messages and materials with English- and Spanish-speaking parents and caregivers. Through a collaborative process involving community members, health care providers, and researchers, we co-developed messaging and materials about HPV vaccination that emphasize its safety, effectiveness, and role in cancer prevention. The engagement approach led to positive shifts in vaccination intentions, particularly among Spanish-speaking participants, and identified key message themes and preferred dissemination channels such as patient mailers, text messaging outreach, live call outreach, educational website resources, and clinic materials. These findings underscore the value of community-engaged, culturally responsive interventions to address vaccine barriers and improve uptake in underserved populations. The adapted BCT model provides a scalable framework for developing effective and relevant health communication strategies, contributing to improved health equity and reduced cancer disparities.
Jamie H Thompson, Jennifer S Rivelli, Priyanka Gautom et al.
This paper examines vaccine hesitancy from a behavioral economics perspective, focusing on how parental risk preferences, altruism, and vaccine distrust affect children's vaccination rates. A model of parental investment in children's health is developed and expanded using empirical data from WHO, UNICEF, the World Bank, and the Global Preferences Survey. The study utilizes a fractional response probit model to analyze data from 69 countries, accounting for both stringent and non-stringent vaccination policies. Results show that risk aversion, altruism, and trust are positively associated with vaccination coverage, with the impact varying by policy stringency. In countries with stringent policies, risk aversion is the most significant factor, while altruism and distrust are more influential in countries with less strict policies. However, the effects of these factors are modest, with income levels accounting for most cross-country differences. The study calls for further research using more recent, individual-level data. Highlights We develop a theoretical framework suggesting that parents with higher risk aversion and altruism are more likely to invest in their children's health, particularly in vaccination decisions, extending current literature insights. Our model is empirically tested using macro-level data on parental risk preferences and altruism from the Global Preferences Survey (GPS), combined with WHO and UNICEF vaccination coverage data for ten diseases in one-year-old children. The analysis reveals a positive association between parental risk aversion, altruism, and vaccination coverage across 69 countries, moderated by the stringency of national vaccination policies. In countries with stringent vaccination policies, risk aversion predominantly drives vaccination coverage, whereas in less stringent environments, altruism and vaccine distrust play a more significant role. Vaccination coverage is notably lower in low-income countries.
IMPORTANCE: Mortality among children and young adolescents receiving antiretroviral therapy (ART) remains substantially higher in resource-limited settings compared with resource-rich regions. The role of modifiable risk and protective factors in explaining this global variation remains poorly understood. OBJECTIVE: To identify and quantify country-level modifiable risk and protective factors associated with HIV-related mortality among children and young adolescents receiving ART. DESIGN, SETTING, AND PARTICIPANTS: This model-based meta-regression analysis linked HIV-related mortality data from cohort studies included in a published systematic review of children and adolescents (aged 0-14 years) receiving ART, with biomedical, behavioral, and structural factors from the Global Burden of Diseases, Injuries, and Risk Factors study 2023. Data were analyzed using penalized regression (ridge regression with cross-validation) and an ensemble machine-learning algorithm (XGBoost). Study data were analyzed from August 2024 to October 2025. EXPOSURES: Country-level modifiable covariates, including access to improved water, vaccine coverage against different pathogens, maternal education, underweight proportion, and oral rehydration coverage. MAIN OUTCOMES AND MEASURES: Measures included the odds ratios (ORs) of HIV-related mortality while receiving ART associated with modifiable factors, simulations of hypothetical 10% and 20% increases in covariates, and variable importance via Shapley Additive Explanation (SHAP) values. RESULTS: HIV-related mortality data from 67 cohort studies were included in this analysis. Access to improved water, pneumococcal conjugate vaccine third-dose (PCV3) coverage, and maternal education demonstrated the strongest independent associations with HIV-related mortality while receiving ART. A 10% increase in improved water access, PCV3 coverage, and maternal education was associated with lower odds of mortality (OR, 0.83; 95% CI, 0.826-0.843; OR, 0.980; 95% CI, 0.972-0.987; and OR, 0.997; 95% CI, 0.996-0.998, respectively). At 20% increases, these protective associations with HIV-related mortality were stronger (OR, 0.695; 95% CI, 0.682-0.711; OR, 0.959; 95% CI, 0.945-0.974; and OR, 0.994; 95% CI, 0.992-0.997, respectively). SHAP-based analyses consistently ranked these 3 factors as most predictive of HIV-related mortality. CONCLUSIONS AND RELEVANCE: Findings of this model-based meta-regression analysis show that improved water access, PCV3 coverage, and maternal education were associated with lower HIV-related mortality among children receiving ART, underscoring the need for integrated public health strategies beyond ART alone. Interventions to strengthen water infrastructure, vaccination programs, and maternal education may help reduce global survival disparities among children and adolescents living with HIV and receiving ART.
BACKGROUND: President Trump came into office with an agenda to rein in government programs and regulations. The Trump administration has focused on making government smaller and nearly eliminating humanitarian foreign health aid, while eschewing conclusions drawn by the mainstream scientific community, particularly regarding vaccination policy. REFORM CONTENT: Specific actions have included cuts to both health personnel and budgets, efforts to remove vaccine mandates, attempts to end diversity efforts, and the essentially shuttering of the United States Agency for International Development program. Reforms also include allowing the expiration of enhanced federal premium subsidies for the individual insurance marketplaces beginning in 2026 and a substantial reduction in federal payments to state Medicaid programs beginning in 2027. EXPECTED RESULTS: Downstream impacts will include collecting less health data, moving away from research on communicable diseases, promoting vaccine hesitancy, and reducing access to, and possibly the quality of, care. Cutting humanitarian foreign health aid may have an even larger impact, as access to vaccinations and medications has already been curtailed, especially in Africa. Cuts to global health have endangered lives in many of the world's poorest countries, while the destabilization of global trade has limited the scope for European countries to fill the gap. CONCLUSIONS: Millions of Americans will lose their health insurance coverage, while people in many countries - especially Africa - will have their lives endangered. Vaccination rates, particularly among young children, will decline, exposing more Americans to communicable diseases. Scientific research output is likely to decline as universities face increasing financial pressures.
BACKGROUND: Despite high vaccination coverage, pertussis remains a public health concern in China and worldwide, with limited data on incidence stratified by both age and vaccine dose number. METHODS: This retrospective cohort study analyzed 2,842,942 children born in Zhejiang between 2015 and 2022, using linked records from the Zhejiang Provincial Immunization Information System and the National Notifiable Disease Surveillance System. Children were followed until pertussis diagnosis, age five, or December 31, 2023. Age-dose-specific and age-vaccination status-specific incidence rates (per 100,000 person-years) were calculated across ten age intervals (0 to <1.5, 1.5 to <2.5, 2.5 to <3.5, 3.5 to <4.5, 4.5 to <5.5, 5.5 to <6.5, 6.5 to <12.5, 12.5 to <19.5, 19.5 to <36, and 36 to <60 months). Poisson regression assessed the pertussis risk by time since fourth dose. RESULTS: The overall incidence rate was 18.71 per 100,000 person-years under the age of 5 years. Peak incidence (132.87/100,000 person-years) was observed in unvaccinated infants aged 3.5 to <4.5 months. Incidence declined with each additional dose; among children aged 5.5 to <6.5 months, rates decreased from 76.05 (one dose) to 36.87 (two doses) and 11.97 (three doses) per 100,000 person-years. The lowest incidence (5.87/100,000 person-years) was observed in children aged 19.5 to <36 months who received four doses. However, protection waned significantly 3-4 years after the fourth dose (IRR=5.56, 95% CI: 4.33-7.14 vs <1 year), coinciding with a resurgence of incidence at 36 to <60 months of age (15.16 per 100,000 person-years). CONCLUSION: The findings highlight two vulnerability periods: early infancy (particularly up to 4.5 months of age) before vaccination schedule completion, and preschool years due to waning immunity. These observations support China's 2025 pertussis schedule update, introducing a booster at age six and advancing the initial dose.
BACKGROUND: Vaccination remains one of the most effective public health tools globally. Yet recent years have seen increasing political polarization around vaccination, particularly in the United States, as well as measles outbreaks among unvaccinated children. Using individual-level data, we characterize the national evolution of parental political polarization in childhood vaccination refusal, timely receipt of a child's first measles, mumps, and rubella (MMR) dose, and delay in first MMR vaccination. METHODS: In this retrospective cohort study, using electronic health records from a primary care clinic registry and voter registration data with representative coverage across all 50 U.S. states, we identify children born from 1988 to 2024 (n = 46,924) with primary care clinic activity who can be matched to potential parents with exclusively Democratic (n = 19,449) or exclusively Republican (n = 27,475) party affiliation. We statistically test for increasing polarization over time across three outcomes: whether or not a patient had a documented vaccination refusal for any childhood vaccination, whether a patient received a timely first MMR dose, and the time delay to first MMR vaccination. FINDINGS: Partisan polarization in childhood vaccine refusals spiked for children born during the COVID-19 pandemic-up to a gap of 9.2 [4.2-14.1, 95% confidence interval] percentage points for children born in 2021-but has been increasing since approximately 2000, with Republican parents more likely to refuse vaccinations than Democratic parents by an additional 0.25 [0.16-0.34] percentage points per year (p < 0.01), on average. Refusals are 3.3 [0.29-6.22] percentage points (p = 0.03) more polarized in states allowing non-medical vaccine exemptions. Political polarization in MMR vaccinations has also increased over time; the difference in on-track coverage between children of Republican and Democratic parents has grown, on average, by 0.52 [0.42-0.62] percentage points per year (p < 0.01), while the partisan gap in delays has widened, on average, by 2.0 [1.0-3.0] days per year (p < 0.01), or approximately 2.5 months over the study period. INTERPRETATION: This study provides the first nationwide, individual-level evidence linking parental political affiliation to vaccine refusal rates, MMR vaccination rates, and MMR vaccination delays. Despite various data limitations, our finding of the emergence and widening of partisan gaps over time suggests that political identity has become an increasingly important factor in childhood health decision-making. FUNDING: This research was supported in part by the Stanford Institute for Human-Centered Artificial Intelligence and the Robert Wood Johnson Foundation.
Claire M Morton, Derek Ouyang, Deborah Schwartz et al.
