diphtheria +tetanus + acellular pertussis + polio + haemophilus influnzae type B vaccine (KD370 / KD 370 / Quintovac)

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.

Clarifying corticosteroid balance in comparisons of asthma biologics.

Xiao Hua H, Bai Bin B

Divergent Human Papillomavirus Genotype Spectra in Three Indigenous Communities of Venezuela: Implications for Vaccine Choice and Cervical Screening.

Garcés María Fátima MF, Guzmán Silva Jefferson J, Aranguren Daniel D, Figueira Lina L et al.

Background: Genotype-resolved data on human papillomavirus (HPV) are almost absent for Venezuelan indigenous women. Methods: We studied 260 women from La Guajira (Wayuu, n = 94), Maniapure (Eñepa, n = 141), and Delta Amacuro (Warao, n = 25), processing all self-collected samples with a single real-time PCR assay that resolves 21 genotypes; cytology was available for 144. Results: HPV prevalence was 55.4% (95% CI 49.3-61.3) and high-risk prevalence was 51.2% (95% CI 45.1-57.2), rising from 42.6% in La Guajira to 59.6% in Maniapure and 80.0% in Delta Amacuro (p = 0.001). Nineteen genotypes were detected. HPV-31 was most frequent (15.8%), followed by HPV-16 (11.5%), and each community had its own profile, with HPV-68 and HPV-56 leading in Delta Amacuro. Half of the infected women carried more than one type. Cytology and HPV testing overlapped little: 20 of 78 HPV-positive women with a smear (25.6%) had an abnormal result (κ = 0.056). At least one nonavalent vaccine type was present in 69.4% of infected women, compared with 30.6% for the bivalent vaccine. Conclusions: HPV vaccination is not part of the Venezuelan national program; these data favor the nonavalent formulation, and HPV-based screening would need a feasible triage pathway for the many women who test positive.

Bronchial Thermoplasty in Severe Asthma: Bridging Randomised and Real-World Evidence: A Systematic Review and Meta-Analysis.

Lúcio Maria João MJ, Pereira Maria Luiza ML, Barata Catarina C, Lopes Carlos C et al.

Introduction: Bronchial thermoplasty (BT) reduces airway smooth muscle and may benefit severe asthma, but its role alongside biologics remains unclear. We assessed randomised and real-world evidence on efficacy and safety. Methods: We searched PubMed, Scopus, and Cochrane Library for RCTs and observational studies of BT in adults with severe uncontrolled asthma, analysing them separately. Results: Twenty studies were included (five RCTs, 15 observational). In RCTs, BT improved asthma-related quality of life (AQLQ;MD, 0.69; 95% CI 0.30-1.09), asthma control (ACQ; MD,-0.64; 95%CI, -1.10 to -0.19), and morning peak expiratory flow (MD, 20.62 L/min; 95% CI, 4.92-36.32), but did not improve rescue medication use or symptom-free-days. BT increased the risk of hospitalisation during the treatment period (RR, 3.50; 95%CI, 1.26-9.68), with no significant excess thereafter. Real-world studies showed improvements in AQLQ (MD,1.38; 95%CI, 0.97-1.80), ACQ (MD,-1.24; 95%CI, -1.86 to -0.62), and annualised exacerbation rates (MD, -3.79 exacerbations/patient-year; 95%CI, -6.98 to -0.61). Evidence suggested a possible, inconsistent corticosteroid-sparing effect; data on biologics and long-term safety were limited. Conclusions: BT improved asthma-related quality of life and control, mainly in trials without sham controls, but increased short-term hospitalisation risk. Real-world findings were similar but came from uncontrolled studies. BT is not an established alternative to biologics, but may suit carefully selected patients with severe asthma who cannot use or do not respond to them.