Pub Date : 2026-01-01DOI: 10.1016/j.lanmic.2025.101263
Abena S Amoah PhD , Prof Selidji T Agnandji PhD , Michel Bengtson PhD , Jennifer A Downs PhD , Meral Esen MD , Jeevan Giddaluru PhD , Simon P Jochems PhD , Maria M M Kaisar PhD , Julia Makinde PhD , Mikhael D Manurung PhD , Prof Moustapha Mbow PhD , Gemma Moncunill PhD , Rajagopal Murugan PhD , Jacqueline Mutai PhD , Prof Helder I Nakaya PhD , Gyaviira Nkurunungi PhD , Magnus Palmblad PhD , Jeremia J Pyuza MD , Koen A Stam MSc , Wouter A A de Steenhuijsen Piters PhD , Gerhild Zauner
Vaccines have improved global health substantially, preventing millions of deaths worldwide. However, striking variations in the immunogenicity and efficacy of some vaccines persist across populations. Notably, suboptimal responses to some vaccines, also known as vaccine hyporesponsiveness, have been observed in low-income and middle-income countries (LMICs) compared with high-income countries or in rural areas within LMICs compared with urban areas within LMICs. Environmental factors, host genetics, lifestyle, and nutrition contribute to immunological variations influencing vaccine responses, highlighting the need to identify key immune signatures that can be manipulated to overcome vaccine hyporesponsiveness. The integration of diverse datasets, accelerated by artificial intelligence, is essential to achieve this goal, which is currently hampered by the under-representation of data from LMICs. The HypoVax Global knowledge hub aims to address this gap by fostering international collaboration and compiling globally representative immunological data from population studies and vaccine trials. The hub offers a platform for high-dimensional data analyses, promotes equitable partnerships, and strives to ensure that all contributions lead to context-specific insights that can inform immunisation strategies to ultimately overcome vaccine hyporesponsiveness.
{"title":"Tackling vaccine hyporesponsiveness through global collaboration, diverse population studies, and data integration","authors":"Abena S Amoah PhD , Prof Selidji T Agnandji PhD , Michel Bengtson PhD , Jennifer A Downs PhD , Meral Esen MD , Jeevan Giddaluru PhD , Simon P Jochems PhD , Maria M M Kaisar PhD , Julia Makinde PhD , Mikhael D Manurung PhD , Prof Moustapha Mbow PhD , Gemma Moncunill PhD , Rajagopal Murugan PhD , Jacqueline Mutai PhD , Prof Helder I Nakaya PhD , Gyaviira Nkurunungi PhD , Magnus Palmblad PhD , Jeremia J Pyuza MD , Koen A Stam MSc , Wouter A A de Steenhuijsen Piters PhD , Gerhild Zauner","doi":"10.1016/j.lanmic.2025.101263","DOIUrl":"10.1016/j.lanmic.2025.101263","url":null,"abstract":"<div><div>Vaccines have improved global health substantially, preventing millions of deaths worldwide. However, striking variations in the immunogenicity and efficacy of some vaccines persist across populations. Notably, suboptimal responses to some vaccines, also known as vaccine hyporesponsiveness, have been observed in low-income and middle-income countries (LMICs) compared with high-income countries or in rural areas within LMICs compared with urban areas within LMICs. Environmental factors, host genetics, lifestyle, and nutrition contribute to immunological variations influencing vaccine responses, highlighting the need to identify key immune signatures that can be manipulated to overcome vaccine hyporesponsiveness. The integration of diverse datasets, accelerated by artificial intelligence, is essential to achieve this goal, which is currently hampered by the under-representation of data from LMICs. The HypoVax Global knowledge hub aims to address this gap by fostering international collaboration and compiling globally representative immunological data from population studies and vaccine trials. The hub offers a platform for high-dimensional data analyses, promotes equitable partnerships, and strives to ensure that all contributions lead to context-specific insights that can inform immunisation strategies to ultimately overcome vaccine hyporesponsiveness.</div></div>","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 1","pages":"Article 101263"},"PeriodicalIF":20.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lanmic.2025.101228
Jill Hopkins MMedSc , Sue J Lee PhD , Naomi Waithira MSc , Chris Painter MSc , Clare L Ling PhD , Tamalee Roberts PhD , Thyl Miliya MD , Noah Obeng-Nkrumah PhD , Prof Japheth A Opintan PhD , Emmanuel P Abbeyquaye FWACP , Raph L Hamers MD , Yulia Rosa Saharman MD , Robert Sinto MD , Mulya Rahma Karyanti MD , R Fera Ibrahim MD , Samuel O Akech PhD , Prof Elizabeth A Ashley MRCP , Anousone Douangnouvong MD , Khamla Choumlivong MD , Prof Nicholas A Feasey PhD , Hong Phuong Trinh Thi
Background
Antimicrobial resistance (AMR) is a major global health threat, but there is scarcity of laboratory surveillance data linked to clinical information to determine burden and inform interventions, especially from low-income and middle-income countries. The ACORN2 study sought to address this through prospective case-based surveillance in 19 hospitals across Africa and Asia to characterise drug-resistant infections by origin, clinical syndrome, patient age, outcome, and geographical location.
Methods
Patients were enrolled on selected wards and clinical data were collected daily for community-acquired infections (CAIs). Point prevalence surveys for hospital-acquired infections (HAIs) were conducted weekly. Mortality was assessed at discharge and after 28 days. Linked microbiology data were extracted from local laboratory databases. Primary descriptive analyses focused on WHO Global Antimicrobial Resistance and Use Surveillance System pathogen (target organism) bloodstream infections (BSIs). Comparisons were adjusted for clustering by site using random effects models.
Findings
Over 31 months, 41 907 infections were characterised from 41 032 admissions. Two-thirds were children (19 351; 47·2%) or neonates (6649; 16·2%). There were marked differences in pathogen incidence and antibiotic resistance when clinical infections were stratified by patient age category and infection origin (CAI/HAI). The highest rates of target organism AMR BSI were third-generation cephalosporin-resistant (3GC-R) Escherichia coli (718·56/100 000 blood cultured infection episodes), meticillin-resistant Staphylococcus aureus (586·89/100 000 blood cultured infection episodes), and 3GC-R Klebsiella pneumoniae (364·92/100 000 blood cultured infection episodes). In-hospital mortality was 13·1% (166/1265) in patients with target organism BSI versus 6·2% (1357/21 845) in those with negative blood cultures, p<0·0001.
Interpretation
ACORN2 has shown practical implementation of collecting linked clinical-laboratory AMR data in low-income and middle-income countries and identified a significant burden of WHO GLASS BSI. Adoption of the ACORN2 approach at scale might enhance use of diagnostic microbiology and improve the volume of clinical data included in national and global AMR surveillance datasets.
{"title":"Prospective characterisation of drug-resistant bloodstream infections in Africa and Asia (ACORN2): a surveillance network assessment","authors":"Jill Hopkins MMedSc , Sue J Lee PhD , Naomi Waithira MSc , Chris Painter MSc , Clare L Ling PhD , Tamalee Roberts PhD , Thyl Miliya MD , Noah Obeng-Nkrumah PhD , Prof Japheth A Opintan PhD , Emmanuel P Abbeyquaye FWACP , Raph L Hamers MD , Yulia Rosa Saharman MD , Robert Sinto MD , Mulya Rahma Karyanti MD , R Fera Ibrahim MD , Samuel O Akech PhD , Prof Elizabeth A Ashley MRCP , Anousone Douangnouvong MD , Khamla Choumlivong MD , Prof Nicholas A Feasey PhD , Hong Phuong Trinh Thi","doi":"10.1016/j.lanmic.2025.101228","DOIUrl":"10.1016/j.lanmic.2025.101228","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial resistance (AMR) is a major global health threat, but there is scarcity of laboratory surveillance data linked to clinical information to determine burden and inform interventions, especially from low-income and middle-income countries. The ACORN2 study sought to address this through prospective case-based surveillance in 19 hospitals across Africa and Asia to characterise drug-resistant infections by origin, clinical syndrome, patient age, outcome, and geographical location.</div></div><div><h3>Methods</h3><div>Patients were enrolled on selected wards and clinical data were collected daily for community-acquired infections (CAIs). Point prevalence surveys for hospital-acquired infections (HAIs) were conducted weekly. Mortality was assessed at discharge and after 28 days. Linked microbiology data were extracted from local laboratory databases. Primary descriptive analyses focused on WHO Global Antimicrobial Resistance and Use Surveillance System pathogen (target organism) bloodstream infections (BSIs). Comparisons were adjusted for clustering by site using random effects models.</div></div><div><h3>Findings</h3><div>Over 31 months, 41 907 infections were characterised from 41 032 admissions. Two-thirds were children (19 351; 47·2%) or neonates (6649; 16·2%). There were marked differences in pathogen incidence and antibiotic resistance when clinical infections were stratified by patient age category and infection origin (CAI/HAI). The highest rates of target organism AMR BSI were third-generation cephalosporin-resistant (3GC-R) <em>Escherichia coli</em> (718·56/100 000 blood cultured infection episodes), meticillin-resistant <em>Staphylococcus aureus</em> (586·89/100 000 blood cultured infection episodes), and 3GC-R <em>Klebsiella pneumoniae</em> (364·92/100 000 blood cultured infection episodes). In-hospital mortality was 13·1% (166/1265) in patients with target organism BSI versus 6·2% (1357/21 845) in those with negative blood cultures, p<0·0001.</div></div><div><h3>Interpretation</h3><div>ACORN2 has shown practical implementation of collecting linked clinical-laboratory AMR data in low-income and middle-income countries and identified a significant burden of WHO GLASS BSI. Adoption of the ACORN2 approach at scale might enhance use of diagnostic microbiology and improve the volume of clinical data included in national and global AMR surveillance datasets.</div></div><div><h3>Funding</h3><div>Wellcome.</div></div>","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 1","pages":"Article 101228"},"PeriodicalIF":20.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lanmic.2025.101222
Michael E DeWitt , Jennifer J Wenner , Brinkley R Bellotti , Joshua A Manuel , Cindy Toler , Elizabeth Palavecino , Candice J McNeil
{"title":"Promise and peril: doxycycline prophylaxis and the spread of resistance among diverse populations","authors":"Michael E DeWitt , Jennifer J Wenner , Brinkley R Bellotti , Joshua A Manuel , Cindy Toler , Elizabeth Palavecino , Candice J McNeil","doi":"10.1016/j.lanmic.2025.101222","DOIUrl":"10.1016/j.lanmic.2025.101222","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 1","pages":"Article 101222"},"PeriodicalIF":20.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-24DOI: 10.1016/j.lanmic.2025.101303
Heng Li, Jianhong Zhang, Kang Wang, Sergio Bernardini, Hong Zhang, Yang Luo
Human metapneumovirus (HMPV) is a major respiratory pathogen that commonly causes mild to moderate upper respiratory tract infections in infants, with only a subset progressing to severe lower respiratory disease globally, particularly in older adults (aged ≥60 years) and individuals with compromised immunity. Efforts to develop an HMPV vaccine or immunoprophylaxis are still ongoing. The rapid advancements in understanding the virus's structure, particularly the surface proteins involved in immune evasion and viral fusion, have paved the way for promising vaccine-based and antibody-based interventions. The range now encompasses multiple vaccine candidates and monoclonal antibodies undergoing clinical trials; in particular, vaccines using different platforms such as virus-like particle-based, live attenuated, epitope-based, mRNA-based, vector-based, and plant-based approaches, in addition to monoclonal antibodies aimed at preventing or reducing disease severity. This Review emphasises innovative strategies for HMPV vaccine design and offers a detailed overview of HMPV vaccine candidates that are currently in clinical development, aimed at preventing a prevalent and severe infectious disease affecting young children (aged <5 years) and older adults globally.
{"title":"Human metapneumovirus prevention within reach: advances in vaccines and monoclonal antibodies.","authors":"Heng Li, Jianhong Zhang, Kang Wang, Sergio Bernardini, Hong Zhang, Yang Luo","doi":"10.1016/j.lanmic.2025.101303","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101303","url":null,"abstract":"<p><p>Human metapneumovirus (HMPV) is a major respiratory pathogen that commonly causes mild to moderate upper respiratory tract infections in infants, with only a subset progressing to severe lower respiratory disease globally, particularly in older adults (aged ≥60 years) and individuals with compromised immunity. Efforts to develop an HMPV vaccine or immunoprophylaxis are still ongoing. The rapid advancements in understanding the virus's structure, particularly the surface proteins involved in immune evasion and viral fusion, have paved the way for promising vaccine-based and antibody-based interventions. The range now encompasses multiple vaccine candidates and monoclonal antibodies undergoing clinical trials; in particular, vaccines using different platforms such as virus-like particle-based, live attenuated, epitope-based, mRNA-based, vector-based, and plant-based approaches, in addition to monoclonal antibodies aimed at preventing or reducing disease severity. This Review emphasises innovative strategies for HMPV vaccine design and offers a detailed overview of HMPV vaccine candidates that are currently in clinical development, aimed at preventing a prevalent and severe infectious disease affecting young children (aged <5 years) and older adults globally.</p>","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101303"},"PeriodicalIF":20.4,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.lanmic.2025.101327
Joseph D Tucker, Chido Dziva Chikwari, Lisa Frigati, Linda Grillová, Pingyu Zhou
{"title":"Refocusing syphilis vaccine research on preventing vertical transmission.","authors":"Joseph D Tucker, Chido Dziva Chikwari, Lisa Frigati, Linda Grillová, Pingyu Zhou","doi":"10.1016/j.lanmic.2025.101327","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101327","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101327"},"PeriodicalIF":20.4,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.lanmic.2025.101318
Matthew Ho, Jeffrey D Klausner, Lao-Tzu Allan-Blitz
{"title":"Impact of divergent MIC breakpoints on the predictive value of the A311V PBP2 mutation for ceftriaxone resistance in Neisseria gonorrhoeae.","authors":"Matthew Ho, Jeffrey D Klausner, Lao-Tzu Allan-Blitz","doi":"10.1016/j.lanmic.2025.101318","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101318","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101318"},"PeriodicalIF":20.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.lanmic.2025.101308
Marcus G Mah, Neha Dikshit, Ramona Alikiiteaga Gutierrez, David Chien Lye, Lin-Fa Wang
{"title":"The threat of another coronavirus pandemic: how are we preparing for it?","authors":"Marcus G Mah, Neha Dikshit, Ramona Alikiiteaga Gutierrez, David Chien Lye, Lin-Fa Wang","doi":"10.1016/j.lanmic.2025.101308","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101308","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101308"},"PeriodicalIF":20.4,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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