diphtheria+tetanus+pertussis combined vaccine

Tetanus in Serbia, 2015-2025: Epidemiological Overview and Lessons from Two Pediatric Cases.

Kovacevic Gordana G, Stijovic Vesna V, Kovacevic Branko B, Parezanovic Miro M et al.

Tetanus is a vaccine-preventable disease that has become rare in countries with sustained immunization programs. However, unvaccinated children remain at risk of severe disease. We provide an epidemiological overview of tetanus in Serbia and describe two cases of generalized tetanus in children. We retrospectively reviewed tetanus surveillance data and immunization coverage reports in Serbia for 2015-2025. Tetanus cases were recorded under ICD-10 code A35. We analyzed demographics, incidence, outcomes, case-fatality, and tetanus-containing vaccine coverage. Two pediatric cases were reviewed for clinical presentation, diagnostic challenges, management, and outcomes. Fourteen tetanus cases were reported during 2015-2025 (annual incidence, 0-0.06 per 100,000 population), including two children. Most cases occurred among women aged >60 years; the overall case-fatality proportion was 42.9%. Primary vaccination coverage ranged from 90.8% to 95.1%, while recommended revaccination coverage remained below the 95% target. Both pediatric patients had received only BCG and hepatitis B vaccination at birth with no subsequent routine immunization due to parental neglect or refusal. The 18-month-old boy presented with fever, otorrhea, and recurrent episodes of generalized stiffening and was initially evaluated for meningoencephalitis. The emergence of trismus, opisthotonus, and neck muscle rigidity led to the diagnosis of tetanus. The 6-year-old boy presented with odynophagia and involuntary tongue biting, followed by progressive trismus and limb spasms. Tetanus was suspected based on the clinical findings and absent immunization. He developed respiratory failure and autonomic instability. Both patients recovered following tetanus immunoglobulin, antimicrobial therapy, and supportive care. Although tetanus remains rare in Serbia and predominantly affects older adults, unvaccinated children remain at risk of severe disease. Atypical presentations may delay diagnosis, emphasizing the importance of early recognition and timely treatment. Maintaining high vaccination coverage and ensuring catch-up immunization remain essential for prevention.

Persistent Pelvic Adhesions and Fibrotic Remodeling Following Ectopic Lesion Ablation in a Mouse Model of Endometriosis.

Yun Sohyeon S, So Kyeong A KA, Jeong Eunhee M EM, Hoover Marissa G MG et al.

Endometriosis is a chronic, estrogen-dependent inflammatory disorder characterized by ectopic endometrial-like lesions, fibrosis, and persistent pelvic pain. Although ectopic lesions are important contributors to pain, symptom severity often correlates poorly with lesion burden, suggesting lesion-independent mechanisms. Here, we investigated the contribution of ectopic lesion-derived cells to persistent pelvic adhesions, fibrotic remodeling, and endometriosis-associated behavioral alterations using a mouse model. A syngeneic model combined with inducible diphtheria toxin receptor (iDTR)-mediated cell ablation was used to selectively eliminate donor-derived progesterone receptor-expressing ectopic cells. Endometriosis was induced by transplantation of uterine tissue from Pgrcre/+Rosa26iDTR/mTmG donor mice into recipients, followed by diphtheria toxin-mediated lesion ablation. Lesion burden, pelvic adhesions, and fibrotic remodeling were assessed by imaging, histology, and molecular analyses, while behavioral outcomes were evaluated using non-evoked assays. Selective ablation eliminated detectable GFP-positive ectopic lesions. Histological and molecular analyses demonstrated significantly reduced collagen deposition and α-SMA-positive fibrotic remodeling within adhesion-associated tissues relative to established ectopic lesions, although these measures remained elevated above sham controls. However, despite lesion ablation, no statistically significant differences were detected between DT- and vehicle-treated mice in nesting or marble-burying performance, although the modest cohort size may have limited detection of partial behavioral effects. These findings indicate that, although fibrosis in adhesion-associated tissues was reduced relative to established ectopic lesions, residual fibrotic remodeling persisted above sham levels, whereas behavioral outcomes showed variable responses without a significant, uniform reversal, highlighting the potential importance of targeting fibrotic and adhesive remodeling in addition to ectopic lesions.

Participatory Epidemiology of Major Camel Diseases and Their Management in Somalia: The Case of Banadir and Lower Shabelle Regions.

Salah Omar O, Sh Hassan Yasin Y, Yusuf Mohamed M, AbdiNB Hassan H

This study investigates major camel diseases, their community-perceived epidemiological characteristics, and management practices in the Banadir and Lower Shabelle regions of Somalia. Data were collected from 17 key informants through semistructured interviews and from 18 participants across three focus group discussions (FGDs). Semistructured interviews captured key camel diseases, their local names, disease impacts, coping mechanisms, and locally used disease management approaches, while FGDs were used to conduct participatory exercises to rank and characterize diseases based on severity and clinical signs. Kendall's W was used to assess consensus among participants, revealing the strength of the agreement across groups. Ten diseases were most frequently reported, including trypanosomosis, mastitis, pneumonia, ringworm, camelpox, mange, tetanus, wry neck, parasite infection, and anthrax. For disease management practices, about 15 out of 17 respondents reported using both modern medicines and traditional practices such as burning, administering Dobera glabra seeds, and applying camel hump ghee. In addition, 13 out of 17 informants indicated that farmers do not conduct regular animal health checkups. Preventive measures included isolation, relocation, and recitation of the Holy Quran. Regarding veterinary consultation, 10 out of 17 respondents reported poor veterinary consultation, citing limited awareness and poor accessibility as potential causes. Of the eight diseases assessed by pairwise ranking, farmers rated anthrax (Kud) as the most severe (mean 6.67 ± 0.58 out of 7), followed by tetanus (Taagow, 6.00 ± 1.00), with strong, statistically significant agreement across the focus groups (Kendall's W = 0.849; p = 0.013). Wry neck and trypanosomosis were rated moderately severe, while pneumonia, mange, mastitis, and camelpox scored lowest. Matrix scoring showed strong, statistically significant agreement among the three informant groups across all disease signs (Kendall's W = 0.74-1.00; p < 0.05). The strongest associations were dyspnea and nasal discharge with pneumonia (mean scores 15.00 ± 1.00/20 and 16.67 ± 2.08/20), odor change with trypanosomosis (15.00 ± 3.00/20), and fever with camelpox and trypanosomosis. The findings also revealed clear seasonal variation in camel diseases, with most conditions peaking during the rainy seasons of spring (Gu) and autumn (Dayr). In contrast, trypanosomosis, tetanus, and mange occurred throughout the year, while anthrax was predominantly associated with the dry Jiilaal season. Major challenges reported include limited veterinary services, high treatment costs, and inadequate feed and drug supplies. These findings reflect substantial indigenous knowledge and point to the need for integrated interventions including improved veterinary services, affordable drugs and vaccines, and farmer capacity building to strengthen camel health in the region.

First mRNA Cancer Vaccine Succeeds in Phase III Trial.

Adding the mRNA-based individualized neoantigen vaccine intismeran autogene to the PD-1 inhibitor pembrolizumab following surgery for melanoma reduced the risk of disease recurrence or death by 42%, according to the results of the phase III INTerpath-0001 trial. The data were presented at the ESMO Congress 2026, held October 23-27, in Madrid, Spain.