Pub Date : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/j.lansea.2026.100742
Dona Arlinda , Evy Yunihastuti , Agnes Rengga Indrati , Tuti Parwati Merati , Emmanuelle Papot , Deborah Cromer , Aly Diana , Adhella Menur Naysilla , Riza Danu Dewantara , Nugroho Harry Susanto , Nurhayati Lukman , I Wayan Adi Pranata , Herman Kosasih , Dewi Lokida , Muhammad Karyana , Teguh Sarry Hartono , I Gede Rai Kosa , Deborah Theresia , Dwiana Savitri , Dwi Kurniawan Nugroho , Katie Watkins
Background
People living with HIV (PLWH) presenting with advanced HIV have worse outcomes than those diagnosed earlier. The proportion of PLWH in Indonesia who are late presenters is unknown but likely high. Identifying factors associated with late presentation is key to earlier diagnosis and intervention.
Methods
Adult PLWH were enrolled at 19 centers across Indonesia (2018–2020) in the INA-PROACTIVE observational cohort study. Late presentation was defined as having a CD4+ count <350 cells/μl within 3 months of diagnosis. Risk factors were assessed using multivariable logistic regression.
Findings
Among 3201 eligible participants, 2790 (87·2%) were late presenters. High proportion of late presenters was observed from 2015 to 2019 (83·3%–89·8%). Characteristics associated with late presentation included age 30–39 (aOR = 1·47, 95% CI: 1·15–1·90) or age ≥40 (aOR = 1·71, 95% CI: 1·21–2·46) vs. age 18–29; male sex (aOR = 2·93, 95% CI: 2·07–4·24); diagnosis in ≤2015 (aOR = 1·45, 95% CI: 1·12–1·89); and diagnosis through Provider-Initiated Testing and Counseling (aOR = 2·38, 95% CI: 1·86–3·04) vs. Voluntary Counseling and Testing (VCT). Suspected MSM transmission was associated with lower odds of late presentation (aOR = 0·57, 95% CI: 0·39–0·82) compared to heterosexual transmission.
Interpretation
Late presentation remains highly prevalent in Indonesia. Expanded efforts are needed to promote testing among those at risk. Targeted interventions for older adults, men, and non-MSM populations, alongside VCT and MSM-focused programs, may help reduce late HIV diagnosis and improve early management.
Funding
This project has been funded in whole or in part with Federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under contract No. 75N91019D00024 Task orders 75N91020F00004, 75N91020F000012.
{"title":"Annual trends and risk factors of late presentation of HIV at 19 referral hospitals in Indonesia: findings from the INA-PROACTIVE cohort","authors":"Dona Arlinda , Evy Yunihastuti , Agnes Rengga Indrati , Tuti Parwati Merati , Emmanuelle Papot , Deborah Cromer , Aly Diana , Adhella Menur Naysilla , Riza Danu Dewantara , Nugroho Harry Susanto , Nurhayati Lukman , I Wayan Adi Pranata , Herman Kosasih , Dewi Lokida , Muhammad Karyana , Teguh Sarry Hartono , I Gede Rai Kosa , Deborah Theresia , Dwiana Savitri , Dwi Kurniawan Nugroho , Katie Watkins","doi":"10.1016/j.lansea.2026.100742","DOIUrl":"10.1016/j.lansea.2026.100742","url":null,"abstract":"<div><h3>Background</h3><div>People living with HIV (PLWH) presenting with advanced HIV have worse outcomes than those diagnosed earlier. The proportion of PLWH in Indonesia who are late presenters is unknown but likely high. Identifying factors associated with late presentation is key to earlier diagnosis and intervention.</div></div><div><h3>Methods</h3><div>Adult PLWH were enrolled at 19 centers across Indonesia (2018–2020) in the INA-PROACTIVE observational cohort study. Late presentation was defined as having a CD4+ count <350 cells/μl within 3 months of diagnosis. Risk factors were assessed using multivariable logistic regression.</div></div><div><h3>Findings</h3><div>Among 3201 eligible participants, 2790 (87·2%) were late presenters. High proportion of late presenters was observed from 2015 to 2019 (83·3%–89·8%). Characteristics associated with late presentation included age 30–39 (aOR = 1·47, 95% CI: 1·15–1·90) or age ≥40 (aOR = 1·71, 95% CI: 1·21–2·46) vs. age 18–29; male sex (aOR = 2·93, 95% CI: 2·07–4·24); diagnosis in ≤2015 (aOR = 1·45, 95% CI: 1·12–1·89); and diagnosis through Provider-Initiated Testing and Counseling (aOR = 2·38, 95% CI: 1·86–3·04) vs. Voluntary Counseling and Testing (VCT). Suspected MSM transmission was associated with lower odds of late presentation (aOR = 0·57, 95% CI: 0·39–0·82) compared to heterosexual transmission.</div></div><div><h3>Interpretation</h3><div>Late presentation remains highly prevalent in Indonesia. Expanded efforts are needed to promote testing among those at risk. Targeted interventions for older adults, men, and non-MSM populations, alongside VCT and MSM-focused programs, may help reduce late HIV diagnosis and improve early management.</div></div><div><h3>Funding</h3><div>This project has been funded in whole or in part with Federal funds from the <span>National Institute of Allergy and Infectious Diseases, National Institutes of Health</span>, under contract No. 75N91019D00024 Task orders 75N91020F00004, 75N91020F000012.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"46 ","pages":"Article 100742"},"PeriodicalIF":6.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147424301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Existing Tuberculosis (TB) elimination strategies show limited impact, with suboptimal uptake of tuberculosis preventive treatment (TPT) and increasing TB incidence after the COVID-19 pandemic. Real-world evidence on reduction of tuberculosis in high-burden communities is needed to inform future TB elimination strategies.
Methods
Since 2017, a comprehensive TB screening and TPT program known as Zero TB in Kids (ZTBK) was implemented in congregate settings of Tibetan communities in India. TB disease, TB infection (TBI), tuberculin skin test (TST) conversion, and TPT uptake were measured periodically.
Findings
Schoolchildren and adults in 63 institutes (n = 20,068; 67,637 person-years) were screened. TPT was given to 3847 participants. TB incidence decreased 83% between 2017 [576 (95% CI: 455–718)/100,000] and 2024 [97 (47–179)/100,000]. TB infection (TBI) prevalence decreased 32% between 2017 [22% (95% CI: 21–23%)] and 2024 [15.5% (14–17%)]. TB incidence (640/100,000) and TBI prevalence (28%) were higher in the institutes that were never screened before under ZTBK. Among participants who did not receive TPT, TB disease prevalence decreased 84% between 2017 [910 (95% CI: 675–1204)/100,000] and 2024 [147 (48–343)/100,000], indicating a herd benefit. After one round of TB screening and TPT, between 2018 and 2019, TST conversion decreased 59% for children and 47% for adolescents. Risk of TBI was greater for males (aPR: 1.23; 95% CI: 1.16–1.30). TB risk was 82% lower for schoolchildren receiving TPT. Participants with seizure disorder [aPR: 0.31 (95% CI: 0.15–0.65)] and hepatitis B [0.71 (0.6–0.84)] were less likely to receive TPT.
Interpretation
Significant reduction of TB transmission and burden can be achieved using the existing tools of TB control. Surveillance of TBI and TPT must be widely adopted for schools and congregate settings with high TB burden.
Funding
National Institutes of Health-National Institute of Allergy and Infectious Diseases (NIAID) (K01-AI148583), STOP TB Partnership (STBP/TBREACH/GSA/W7-7692), NIAID-Johns Hopkins Center for AIDS Research (90100777), Foundations, and Philanthropy.
{"title":"Comprehensive tuberculosis screening and preventive treatment in schools and congregate settings of India (2017–2024): a prospective study","authors":"Kunchok Dorjee , Sonam Topgyal , Rajesh K. Sood , Tenzin Namdon , Ravinder Kumar , Ugen Gyatso , Jigme Kalsang , Tenzin Thinley , Tenzin Dechen , Tenzin Tsomo , Tenzin Kalsang , Rachel C. Sadoff , Sangyal Dorjee , Sheriza Baksh , Tenzin Yangkyi , Tenzin Khachoe , Tenzin Dolker , Tsering Wangmo , Dekyi Lhadon , Lobsang Tsering , Tsetan D. Sadutshang","doi":"10.1016/j.lansea.2026.100725","DOIUrl":"10.1016/j.lansea.2026.100725","url":null,"abstract":"<div><h3>Background</h3><div>Existing Tuberculosis (TB) elimination strategies show limited impact, with suboptimal uptake of tuberculosis preventive treatment (TPT) and increasing TB incidence after the COVID-19 pandemic. Real-world evidence on reduction of tuberculosis in high-burden communities is needed to inform future TB elimination strategies.</div></div><div><h3>Methods</h3><div>Since 2017, a comprehensive TB screening and TPT program known as Zero TB in Kids (ZTBK) was implemented in congregate settings of Tibetan communities in India. TB disease, TB infection (TBI), tuberculin skin test (TST) conversion, and TPT uptake were measured periodically.</div></div><div><h3>Findings</h3><div>Schoolchildren and adults in 63 institutes (n = 20,068; 67,637 person-years) were screened. TPT was given to 3847 participants. TB incidence decreased 83% between 2017 [576 (95% CI: 455–718)/100,000] and 2024 [97 (47–179)/100,000]. TB infection (TBI) prevalence decreased 32% between 2017 [22% (95% CI: 21–23%)] and 2024 [15.5% (14–17%)]. TB incidence (640/100,000) and TBI prevalence (28%) were higher in the institutes that were never screened before under ZTBK. Among participants who did not receive TPT, TB disease prevalence decreased 84% between 2017 [910 (95% CI: 675–1204)/100,000] and 2024 [147 (48–343)/100,000], indicating a herd benefit. After one round of TB screening and TPT, between 2018 and 2019, TST conversion decreased 59% for children and 47% for adolescents. Risk of TBI was greater for males (aPR: 1.23; 95% CI: 1.16–1.30). TB risk was 82% lower for schoolchildren receiving TPT. Participants with seizure disorder [aPR: 0.31 (95% CI: 0.15–0.65)] and hepatitis B [0.71 (0.6–0.84)] were less likely to receive TPT.</div></div><div><h3>Interpretation</h3><div>Significant reduction of TB transmission and burden can be achieved using the existing tools of TB control. Surveillance of TBI and TPT must be widely adopted for schools and congregate settings with high TB burden.</div></div><div><h3>Funding</h3><div><span>National Institutes of Health</span>-<span>National Institute of Allergy and Infectious Diseases</span> (NIAID) (K01-AI148583), STOP TB Partnership (STBP/TBREACH/GSA/W7-7692), <span>NIAID-Johns Hopkins Center</span> for AIDS Research (90100777), Foundations, and Philanthropy.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"46 ","pages":"Article 100725"},"PeriodicalIF":6.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/j.lansea.2026.100735
Indeewarie E. Gunaratna , Lucas G. Huggins , Ushani Atapattu , Lakmini Liyanage , Nipuni Shilpeswarage , Murali Vallipuranathan , Vito Colella
Background
Lymphatic filariasis (LF) affects approximately 120 million people globally and is caused by Wuchereria bancrofti, Brugia malayi and Brugia timori. Sri Lanka was historically endemic for both bancroftian and brugian filariasis, with B. malayi presumed eliminated by the late 1960s. The country achieved validation of LF elimination as a public health problem in 2016. However, sporadic Brugia infections have been detected in microfilaria surveys from the mid-2000s onwards; the sub-periodic periodicity of which is suggestive of a zoonotic origin and warrants further research.
Methods
Night blood survey (NBS) surveillance was conducted by the Anti-Filariasis Campaign, Ministry of Health, Sri Lanka, from 2019 to 2023. Brugia-positive human samples and archived canine samples were analysed using a next-generation sequencing metabarcoding platform targeting mitochondrial and nuclear loci. Bayesian and neighbour-joining phylogenetic analyses and minimum-spanning network approaches were used to characterise lineage relationships.
Findings
Among 1,855,165 individuals screened, 52 were identified with Brugia-like microfilariae. Metabarcoding generated 1.2 million high-quality reads with both mitochondrial cox1 and ribosomal DNA markers confirming a single Brugia lineage circulating in humans, mainly in children. Sequences of the cox1 gene showed 99.4–100 percent nucleotide identity to the Brugia Sri Lanka (SL) genotype previously detected in dogs in Sri Lanka and Tamil Nadu (India). rDNA sequences showed low similarity to B. malayi or Brugia pahangi, indicating that the parasite represents a distinct Brugia taxon lacking a reference rDNA sequence.
Interpretation
The findings provide evidence that human brugian filariasis in Sri Lanka is caused by a previously unrecognised zoonotic Brugia species maintained in dogs. This has important clinical and public health implications given that human infections have occurred in children despite LF being declared eliminated as a public health problem. Crucially, the incorrect classification of circulating filarioid species may lead to inappropriate clinical and programmatic responses. For example, the newly identified canine reservoir of this Brugia genotype means that human-only mass drug administration might not be sufficient to interrupt this species’ transmission. These results underscore the need for integrated One Health surveillance to prevent re-establishment of LF and safeguard regional elimination goals.
Funding
No specific funding was received for the present study. This study was supported by a consulting funding (PRJ_002971).
{"title":"Emergence of a novel zoonotic brugian filarial infection during post-validation surveillance for lymphatic filariasis in Sri Lanka","authors":"Indeewarie E. Gunaratna , Lucas G. Huggins , Ushani Atapattu , Lakmini Liyanage , Nipuni Shilpeswarage , Murali Vallipuranathan , Vito Colella","doi":"10.1016/j.lansea.2026.100735","DOIUrl":"10.1016/j.lansea.2026.100735","url":null,"abstract":"<div><h3>Background</h3><div>Lymphatic filariasis (LF) affects approximately 120 million people globally and is caused by <em>Wuchereria bancrofti</em>, <em>Brugia malayi</em> and <em>Brugia timori</em>. Sri Lanka was historically endemic for both bancroftian and brugian filariasis, with <em>B. malayi</em> presumed eliminated by the late 1960s. The country achieved validation of LF elimination as a public health problem in 2016. However, sporadic <em>Brugia</em> infections have been detected in microfilaria surveys from the mid-2000s onwards; the sub-periodic periodicity of which is suggestive of a zoonotic origin and warrants further research.</div></div><div><h3>Methods</h3><div>Night blood survey (NBS) surveillance was conducted by the Anti-Filariasis Campaign, Ministry of Health, Sri Lanka, from 2019 to 2023. <em>Brugia</em>-positive human samples and archived canine samples were analysed using a next-generation sequencing metabarcoding platform targeting mitochondrial and nuclear loci. Bayesian and neighbour-joining phylogenetic analyses and minimum-spanning network approaches were used to characterise lineage relationships.</div></div><div><h3>Findings</h3><div>Among 1,855,165 individuals screened, 52 were identified with <em>Brugia</em>-like microfilariae. Metabarcoding generated 1.2 million high-quality reads with both mitochondrial <em>cox1</em> and ribosomal DNA markers confirming a single <em>Brugia</em> lineage circulating in humans, mainly in children. Sequences of the <em>c</em><em>ox1</em> gene showed 99.4–100 percent nucleotide identity to the <em>Brugia</em> Sri Lanka (SL) genotype previously detected in dogs in Sri Lanka and Tamil Nadu (India). rDNA sequences showed low similarity to <em>B. malayi</em> or <em>Brugia pahangi</em>, indicating that the parasite represents a distinct <em>Brugia</em> taxon lacking a reference rDNA sequence.</div></div><div><h3>Interpretation</h3><div>The findings provide evidence that human brugian filariasis in Sri Lanka is caused by a previously unrecognised zoonotic <em>Brugia</em> species maintained in dogs. This has important clinical and public health implications given that human infections have occurred in children despite LF being declared eliminated as a public health problem. Crucially, the incorrect classification of circulating filarioid species may lead to inappropriate clinical and programmatic responses. For example, the newly identified canine reservoir of this <em>Brugia</em> genotype means that human-only mass drug administration might not be sufficient to interrupt this species’ transmission. These results underscore the need for integrated One Health surveillance to prevent re-establishment of LF and safeguard regional elimination goals.</div></div><div><h3>Funding</h3><div>No specific funding was received for the present study. This study was supported by a consulting funding (PRJ_002971).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"46 ","pages":"Article 100735"},"PeriodicalIF":6.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147449624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-03-03DOI: 10.1016/j.lansea.2026.100746
Subhash Thuluva , Ramesh V. Matur , Subbareddy Gunneri , Siddalingaiah Ningaiah , Vijay Yerroju , Rammohan Reddy Mogulla , Chirag Dhar , Kamal Thammireddy , Piyush Paliwal , Anand Kawade , Pradeep Nanjappa , Jog Pramod , Manish Narang , Bheemisetty S. Chakravarthy , Prashanth M. Virupakashappa
Background
Pneumococcal conjugate vaccines (PCVs) have markedly reduced childhood pneumococcal diseases, yet serotype replacement and regional heterogeneity remain important challenges. The World Health Organization recommends either a 3p + 0 or 2p + 1 schedule for PCV immunization programmes. BE-PCV14, a 14-valent vaccine, has previously been shown to be non-inferior to PCV13 in a 3p + 0 regimen. In this Phase III trial, we aimed to descriptively compare the immunogenicity and safety of BE-PCV14 and PCV13 in a 2p + 1 schedule in Indian infants.
Methods
In this randomized, single-blind, multicenter trial, 400 PCV-naïve infants (6–8 weeks old) were randomized 1:1 to receive either BE-PCV14 or PCV13; at 6 and 14 weeks, with a booster at 9 months. Serum IgG against 14 vaccine serotypes plus cross-protective 6 A were measured at post primary (28 days post dose 2), pre booster (at 9 months) and post booster (30 days post dose 3) time points. The primary endpoint was the proportion achieving IgG ≥0.35 μg/mL (seroresponse rate) for the 12 serotypes common to both vaccines at post primary, pre booster and post booster time points. Solicited local and systemic reactions were recorded for 7 days after each dose; unsolicited, and serious adverse events (SAEs) were captured throughout.
Findings
Between May 2023 and July 2024, 400 participants were enrolled of which 380 (95%) completed the study. Post primary seroresponse rates in the BE-PCV14 arm for common serotypes ranged from 72.6% (95% CI: 65.8, 78.5) (serotype 3) to 100% (95% CI: 98.0, 100.0) (14, 19 F); PCV13 rates ranged from 71.6% (95% CI: 64.9, 77.5) to 100% (95% CI: 98.1, 100.0) (14, 19 F, 19 A). Post booster rates were 87.6% (95% CI: 82.1, 91.6) to 100% (95% CI: 98.0, 100.0) for BE-PCV14 and 85.0% (95% CI: 79.4, 89.4) to 100% (95% CI: 98.1, 100.0) for PCV13. BE-PCV14 elicited high responses against the two additional serotypes, i.e., 22 F: 96.8% (95% CI: 93.1, 98.5), 33 F: 92.5% (95% CI: 87.8, 95.5), and cross-protective 6 A: 93.0% (95% CI: 88.4, 95.9). Of the participants that received BE-PCV14 or PCV13, 33.5% (95% CI: 27.3, 40.3) and 38% (95% CI: 31.6, 44.9) had mild AEs and 11.5% (95% CI: 7.8, 16.7) and 10.5% (95% CI: 7.0, 15.5) had moderate AEs, respectively. Two unrelated SAEs occurred in the BE-PCV14 arm.
Interpretation
Administered in a 2p + 1 schedule, BE-PCV14 was highly immunogenic, well tolerated, and comparable to PCV13 while broadening serotype coverage. These findings support consideration of BE-PCV14 for routine infant immunization programmes using a 2p + 1 schedule, particularly in settings where the additional serotypes contribute to ongoing pneumococcal disease.
Funding
This clinical research was exclusively funded by Biological E. Limited, Hyderabad, India.
{"title":"Immunogenicity and safety of biological E's 14-valent pneumococcal conjugate vaccine (PNEUBEVAX 14®) administered in a 2p + 1 schedule to healthy infants: a multicenter, randomized, active controlled, single-blind, phase III trial","authors":"Subhash Thuluva , Ramesh V. Matur , Subbareddy Gunneri , Siddalingaiah Ningaiah , Vijay Yerroju , Rammohan Reddy Mogulla , Chirag Dhar , Kamal Thammireddy , Piyush Paliwal , Anand Kawade , Pradeep Nanjappa , Jog Pramod , Manish Narang , Bheemisetty S. Chakravarthy , Prashanth M. Virupakashappa","doi":"10.1016/j.lansea.2026.100746","DOIUrl":"10.1016/j.lansea.2026.100746","url":null,"abstract":"<div><h3>Background</h3><div>Pneumococcal conjugate vaccines (PCVs) have markedly reduced childhood pneumococcal diseases, yet serotype replacement and regional heterogeneity remain important challenges. The World Health Organization recommends either a 3p + 0 or 2p + 1 schedule for PCV immunization programmes. BE-PCV14, a 14-valent vaccine, has previously been shown to be non-inferior to PCV13 in a 3p + 0 regimen. In this Phase III trial, we aimed to descriptively compare the immunogenicity and safety of BE-PCV14 and PCV13 in a 2p + 1 schedule in Indian infants.</div></div><div><h3>Methods</h3><div>In this randomized, single-blind, multicenter trial, 400 PCV-naïve infants (6–8 weeks old) were randomized 1:1 to receive either BE-PCV14 or PCV13; at 6 and 14 weeks, with a booster at 9 months. Serum IgG against 14 vaccine serotypes plus cross-protective 6 A were measured at post primary (28 days post dose 2), pre booster (at 9 months) and post booster (30 days post dose 3) time points. The primary endpoint was the proportion achieving IgG ≥0.35 μg/mL (seroresponse rate) for the 12 serotypes common to both vaccines at post primary, pre booster and post booster time points. Solicited local and systemic reactions were recorded for 7 days after each dose; unsolicited, and serious adverse events (SAEs) were captured throughout.</div></div><div><h3>Findings</h3><div>Between May 2023 and July 2024, 400 participants were enrolled of which 380 (95%) completed the study. Post primary seroresponse rates in the BE-PCV14 arm for common serotypes ranged from 72.6% (95% CI: 65.8, 78.5) (serotype 3) to 100% (95% CI: 98.0, 100.0) (14, 19 F); PCV13 rates ranged from 71.6% (95% CI: 64.9, 77.5) to 100% (95% CI: 98.1, 100.0) (14, 19 F, 19 A). Post booster rates were 87.6% (95% CI: 82.1, 91.6) to 100% (95% CI: 98.0, 100.0) for BE-PCV14 and 85.0% (95% CI: 79.4, 89.4) to 100% (95% CI: 98.1, 100.0) for PCV13. BE-PCV14 elicited high responses against the two additional serotypes, i.e., 22 F: 96.8% (95% CI: 93.1, 98.5), 33 F: 92.5% (95% CI: 87.8, 95.5), and cross-protective 6 A: 93.0% (95% CI: 88.4, 95.9). Of the participants that received BE-PCV14 or PCV13, 33.5% (95% CI: 27.3, 40.3) and 38% (95% CI: 31.6, 44.9) had mild AEs and 11.5% (95% CI: 7.8, 16.7) and 10.5% (95% CI: 7.0, 15.5) had moderate AEs, respectively. Two unrelated SAEs occurred in the BE-PCV14 arm.</div></div><div><h3>Interpretation</h3><div>Administered in a 2p + 1 schedule, BE-PCV14 was highly immunogenic, well tolerated, and comparable to PCV13 while broadening serotype coverage. These findings support consideration of BE-PCV14 for routine infant immunization programmes using a 2p + 1 schedule, particularly in settings where the additional serotypes contribute to ongoing pneumococcal disease.</div></div><div><h3>Funding</h3><div>This clinical research was exclusively funded by <span>Biological E. Limited</span>, Hyderabad, India.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"46 ","pages":"Article 100746"},"PeriodicalIF":6.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147424299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
India bears a quarter of the global tuberculosis (TB) burden and nearly one-third of TB related deaths, but substantial regional heterogeneity demands tailored elimination strategies. We propose the Dual-phase Operational Strategy for Tuberculosis elimination (DOST), a roadmap that explicitly addresses TB as both an infectious disease and a structural challenge. Phase 1 focuses on rapidly reducing transmission through intensified case-finding, upfront molecular diagnosis, and strengthened treatment, as demonstrated by India’s 100-Day TB Campaign, which expanded community screening and accelerated therapy initiation. Phase 2 pivots to preventing disease progression by scaling up TB preventive treatment and addressing key drivers such as undernutrition, HIV, and diabetes. DOST emphasizes subnational adaptation: high-burden states prioritize disease reduction, while states nearing low incidence shift toward preventing flare-ups and sustaining progress. Rooted in the Hindi word dost (friend), this person-centered approach integrates medical and social support, recognizing that eliminating TB in India requires compassion paired with structural action. By sequencing and localizing proven interventions, DOST offers a pragmatic pathway from TB response to TB elimination.
{"title":"From DOTS to DOST: a new framework for TB elimination in India","authors":"Urvashi B. Singh , Raghuram Rao , Sanjay Kumar Mattoo , Nishant Kumar , Veena Dhawan , Vinay Garg , Bhawani Singh Kushwaha , Amar Shah , Kiran Rade , Shivani Chandra , Sadie B. Cowan , Madolyn Dauphinais , Pranay Sinha","doi":"10.1016/j.lansea.2026.100721","DOIUrl":"10.1016/j.lansea.2026.100721","url":null,"abstract":"<div><div>India bears a quarter of the global tuberculosis (TB) burden and nearly one-third of TB related deaths, but substantial regional heterogeneity demands tailored elimination strategies. We propose the Dual-phase Operational Strategy for Tuberculosis elimination (DOST), a roadmap that explicitly addresses TB as both an infectious disease and a structural challenge. Phase 1 focuses on rapidly reducing transmission through intensified case-finding, upfront molecular diagnosis, and strengthened treatment, as demonstrated by India’s 100-Day TB Campaign, which expanded community screening and accelerated therapy initiation. Phase 2 pivots to preventing disease progression by scaling up TB preventive treatment and addressing key drivers such as undernutrition, HIV, and diabetes. DOST emphasizes subnational adaptation: high-burden states prioritize disease reduction, while states nearing low incidence shift toward preventing flare-ups and sustaining progress. Rooted in the Hindi word dost (friend), this person-centered approach integrates medical and social support, recognizing that eliminating TB in India requires compassion paired with structural action. By sequencing and localizing proven interventions, DOST offers a pragmatic pathway from TB response to TB elimination.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"46 ","pages":"Article 100721"},"PeriodicalIF":6.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147449625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
India's pursuit of Tuberculosis (TB) elimination is contingent on the rapid universal scale-up of TB Preventive Treatment (TPT) for household contacts. However, current strategies largely neglect the asymptomatic active (subclinical) TB stage in terms of standardized diagnosis and optimized management. Consequently, administering TPT to individuals with unrecognized subclinical TB constitutes inadequate therapy that provides no patient benefit, enables community transmission, and risks minimal chances of iatrogenic drug resistance—violating the fundamental ethical principle of non-maleficence. We examine the tension between utilitarian public health goals and individual biomedical ethics, arguing for a transition within the National TB Elimination Program (NTEP) toward a rights-based framework prioritizing the clinical safety of household contacts. Crucially, the NTEP must institutionalize robust health education for contacts regarding the persistent risk of progression for at least 24 months post-TPT completion, coupled with sustained clinical surveillance to mitigate delayed health-seeking behavior. Further, sustained investment in digital diagnostics and translational research apart from addressing implementation gaps in the private sector is paramount to making TPT safe, evidence-driven, and ethically responsible.
{"title":"Reappraising TB preventive treatment in India: programmatic and ethical implications of subclinical tuberculosis in household contacts","authors":"Saurav Basu , Atul Vashist , Shivani Chandra , Nandini Sharma","doi":"10.1016/j.lansea.2026.100730","DOIUrl":"10.1016/j.lansea.2026.100730","url":null,"abstract":"<div><div>India's pursuit of Tuberculosis (TB) elimination is contingent on the rapid universal scale-up of TB Preventive Treatment (TPT) for household contacts. However, current strategies largely neglect the asymptomatic active (subclinical) TB stage in terms of standardized diagnosis and optimized management. Consequently, administering TPT to individuals with unrecognized subclinical TB constitutes inadequate therapy that provides no patient benefit, enables community transmission, and risks minimal chances of iatrogenic drug resistance—violating the fundamental ethical principle of non-maleficence. We examine the tension between utilitarian public health goals and individual biomedical ethics, arguing for a transition within the National TB Elimination Program (NTEP) toward a rights-based framework prioritizing the clinical safety of household contacts. Crucially, the NTEP must institutionalize robust health education for contacts regarding the persistent risk of progression for at least 24 months post-TPT completion, coupled with sustained clinical surveillance to mitigate delayed health-seeking behavior. Further, sustained investment in digital diagnostics and translational research apart from addressing implementation gaps in the private sector is paramount to making TPT safe, evidence-driven, and ethically responsible.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"46 ","pages":"Article 100730"},"PeriodicalIF":6.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Human papillomavirus (HPV) vaccination represents a significant milestone in global public health efforts to prevent cervical cancer. Yet its implementation in some countries such as Pakistan reveals complex sociocultural and geopolitical challenges. Since the staged introduction of the HPV vaccine in Pakistan in 2025, coverage did not fully reach the targeted 9–14-year-old girls—falling short of the national goal of 90% by 2027. This commentary critically examines the intersectional barriers shaping HPV vaccine uptake in Pakistan, arguing that mistrust, stigma, and inequity are rooted in historical, gendered, religious, and geopolitical power dynamics. Applying an intersectional lens, the analysis demonstrates how vaccine resistance is influenced by moral anxieties surrounding adolescent sexuality, diverse religious interpretations, socioeconomic disparities, weak health infrastructure, and digital disinformation. Comparative insights from the United Arab Emirates and Saudi Arabia challenge assumptions that Muslim-majority contexts inherently resist HPV vaccination, highlighting instead the importance of socioculturally responsive strategies. The commentary proposes three policy implications for Pakistan: localized communication tailored to socio-cultural context, investment in social infrastructure and community engagement, and equity-sensitive monitoring frameworks. Addressing hesitancy requires recognizing community concerns as rational responses to lived experience rather than ignorance, for achieving equitable immunization and safeguarding girls’ health rights in comparable settings.
{"title":"Navigating through HPV stigma: an intersectional lens on community engagement for vaccine acceptance in Pakistan","authors":"Inayat Ali , Abida Sharif , Ayesha Qamar , Salma Sadique , Iffat Elbarazi","doi":"10.1016/j.lansea.2026.100733","DOIUrl":"10.1016/j.lansea.2026.100733","url":null,"abstract":"<div><div>Human papillomavirus (HPV) vaccination represents a significant milestone in global public health efforts to prevent cervical cancer. Yet its implementation in some countries such as Pakistan reveals complex sociocultural and geopolitical challenges. Since the staged introduction of the HPV vaccine in Pakistan in 2025, coverage did not fully reach the targeted 9–14-year-old girls—falling short of the national goal of 90% by 2027. This commentary critically examines the intersectional barriers shaping HPV vaccine uptake in Pakistan, arguing that mistrust, stigma, and inequity are rooted in historical, gendered, religious, and geopolitical power dynamics. Applying an intersectional lens, the analysis demonstrates how vaccine resistance is influenced by moral anxieties surrounding adolescent sexuality, diverse religious interpretations, socioeconomic disparities, weak health infrastructure, and digital disinformation. Comparative insights from the United Arab Emirates and Saudi Arabia challenge assumptions that Muslim-majority contexts inherently resist HPV vaccination, highlighting instead the importance of socioculturally responsive strategies. The commentary proposes three policy implications for Pakistan: localized communication tailored to socio-cultural context, investment in social infrastructure and community engagement, and equity-sensitive monitoring frameworks. Addressing hesitancy requires recognizing community concerns as rational responses to lived experience rather than ignorance, for achieving equitable immunization and safeguarding girls’ health rights in comparable settings.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"46 ","pages":"Article 100733"},"PeriodicalIF":6.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147424354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-17DOI: 10.1016/j.lansea.2026.100731
Srijani Paul , Nilabho Chakraborty , Ashish Pundhir , Venkatesh Karthikeyan , Vithya Sree M
Sexual harassment in medical education is a global, structurally embedded problem driven by rigid hierarchical cultures, with trainees disproportionately exposed to higher levels of harassment. Policy recommendations reframe harassment as a public health issue, and call for trauma-informed supports, anti-retaliation protections, and psychologically safe training environments.
{"title":"Sexual harassment in India's medical education: need for accountability","authors":"Srijani Paul , Nilabho Chakraborty , Ashish Pundhir , Venkatesh Karthikeyan , Vithya Sree M","doi":"10.1016/j.lansea.2026.100731","DOIUrl":"10.1016/j.lansea.2026.100731","url":null,"abstract":"<div><div>Sexual harassment in medical education is a global, structurally embedded problem driven by rigid hierarchical cultures, with trainees disproportionately exposed to higher levels of harassment. Policy recommendations reframe harassment as a public health issue, and call for trauma-informed supports, anti-retaliation protections, and psychologically safe training environments.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"46 ","pages":"Article 100731"},"PeriodicalIF":6.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147423010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-03-02DOI: 10.1016/j.lansea.2026.100745
Zubair Akhtar , Md Ariful Islam , Mohammad Abdul Aleem , Tanzir Ahmed Shuvo , Md Zakiul Hassan , Asadullah , Mustafizur Rahman , Mohammed Ziaur Rahman , Mohammad Enayet Hossain , Tahmina Shirin , Mahbubur Rahman , Manjur Hossain Khan Jony , Monalisa , Ferdous Rahman Sarker , Ahmed Nawsher Alam , Shah Niaz Md. Rubaid Anwar , Mahmudur Rahman , Awachana Jiamsakul , Aye M. Moa , Timothy C. Tan , C Raina MacIntyre
Background
COVID-19 increases cardiovascular risk, and vaccination reduces adverse outcomes and mortality. We analysed national hospital-based sentinel surveillance data from Bangladesh, and the aim of the study was to identify factors associated with all-cause mortality among patients with cardiovascular complications.
Methods
We included patients from coronary care units in nine tertiary-hospitals between February 2021 and December 2024 with severe acute respiratory infections (SARI). Nasopharyngeal and oropharyngeal swabs were tested for SARS-CoV-2 and influenza viruses by multiplex rRT-PCR. Patients were followed up from hospital admission to 30 days post-discharge. Survival was assessed with Kaplan–Meier estimates stratified by vaccination status and compared using log-rank test. Risk factors for all-cause mortality were analysed using multivariable Cox proportional hazards regression, stratified by hospital type.
Findings
We enrolled 396 patients (median age 60, IQR: 48–65 years), and 70.5% (279/396) were male. The Median follow-up time was 33 days (IQR: 32–34 days). There were 13.9% (55/396) deaths, 41.2% (163/396) had acute myocardial infarction (AMI) and 71.2% (286/396) were COVID-19 vaccinated patients. SARS-CoV-2 and influenza viruses were detected among 6.8% (27/396) and 4.8% (19/396) patients, respectively. At follow-up, the survival rate was 89.6% in COVID-19 vaccinated patients compared to 81.4% in unvaccinated patients (P-value = 0.041). AMI was associated with higher mortality [HR = 1.74, (95% CI: 1.01–3.02), P-value = 0.048] while COVID-19 vaccination was protective [HR = 0.55, (95% CI: 0.32–0.96), P-value = 0.037].
Interpretation
COVID-19 vaccination was associated with reduced all-cause deaths among SARI patients with cardiovascular complications.
Funding
Centres for Disease Control and Prevention (CDC), Atlanta, Georgia, USA (U01GH002259). ZA is supported by UNSW by a UIPA PhD scholarship.
{"title":"COVID-19 vaccination and mortality among coronary care patients with severe acute respiratory infection in Bangladesh: a prospective study (2021–2024)","authors":"Zubair Akhtar , Md Ariful Islam , Mohammad Abdul Aleem , Tanzir Ahmed Shuvo , Md Zakiul Hassan , Asadullah , Mustafizur Rahman , Mohammed Ziaur Rahman , Mohammad Enayet Hossain , Tahmina Shirin , Mahbubur Rahman , Manjur Hossain Khan Jony , Monalisa , Ferdous Rahman Sarker , Ahmed Nawsher Alam , Shah Niaz Md. Rubaid Anwar , Mahmudur Rahman , Awachana Jiamsakul , Aye M. Moa , Timothy C. Tan , C Raina MacIntyre","doi":"10.1016/j.lansea.2026.100745","DOIUrl":"10.1016/j.lansea.2026.100745","url":null,"abstract":"<div><h3>Background</h3><div>COVID-19 increases cardiovascular risk, and vaccination reduces adverse outcomes and mortality. We analysed national hospital-based sentinel surveillance data from Bangladesh, and the aim of the study was to identify factors associated with all-cause mortality among patients with cardiovascular complications.</div></div><div><h3>Methods</h3><div>We included patients from coronary care units in nine tertiary-hospitals between February 2021 and December 2024 with severe acute respiratory infections (SARI). Nasopharyngeal and oropharyngeal swabs were tested for SARS-CoV-2 and influenza viruses by multiplex rRT-PCR. Patients were followed up from hospital admission to 30 days post-discharge. Survival was assessed with Kaplan–Meier estimates stratified by vaccination status and compared using log-rank test. Risk factors for all-cause mortality were analysed using multivariable Cox proportional hazards regression, stratified by hospital type.</div></div><div><h3>Findings</h3><div>We enrolled 396 patients (median age 60, IQR: 48–65 years), and 70.5% (279/396) were male. The Median follow-up time was 33 days (IQR: 32–34 days). There were 13.9% (55/396) deaths, 41.2% (163/396) had acute myocardial infarction (AMI) and 71.2% (286/396) were COVID-19 vaccinated patients. SARS-CoV-2 and influenza viruses were detected among 6.8% (27/396) and 4.8% (19/396) patients, respectively. At follow-up, the survival rate was 89.6% in COVID-19 vaccinated patients compared to 81.4% in unvaccinated patients (<em>P</em>-value = 0.041). AMI was associated with higher mortality [HR = 1.74, (95% CI: 1.01–3.02), <em>P</em>-value = 0.048] while COVID-19 vaccination was protective [HR = 0.55, (95% CI: 0.32–0.96), <em>P-</em>value = 0.037].</div></div><div><h3>Interpretation</h3><div>COVID-19 vaccination was associated with reduced all-cause deaths among SARI patients with cardiovascular complications.</div></div><div><h3>Funding</h3><div>Centres for Disease Control and Prevention (CDC), Atlanta, Georgia, USA (U01GH002259). ZA is supported by UNSW by a UIPA PhD scholarship.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"46 ","pages":"Article 100745"},"PeriodicalIF":6.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147424300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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