Polio: Background and perspective on how international travel can be made safe against polio.

International spread of polio continues to be a Public Health Emergency of International Concern since its declaration by the World Health Organization in 2014 and its reiteration in 2024. In 2023 and 2024, two countries remained endemic for wild poliovirus (WPV) but 20 countries reported polio outbreaks due to vaccine-derived polioviruses (VDPVs) in 2023 and 10 countries in 2024 (up to mid-June). Guidelines from various agencies recommend polio vaccination before travelling to or from polio-affected countries, or attending mass gatherings anywhere in the world, particularly if the crowd is international.

The respiratory route of transmission of virulent polioviruses.

Aims: The route of transmission of wild and circulating vaccine-derived polioviruses remains controversial, between respiratory and faecal-oral, and we aim to identify the most plausible one to settle the controversy.

Methods: We explored available epidemiological clues and evidence in support of either route in order to arrive at an evidence-based conclusion.

Results: Historically the original concept was respiratory transmission based on epidemiological features of age distribution, which was later revised to faecal-oral as the rationale for popularising the live attenuated oral polio vaccine in preference to the inactivated poliovirus vaccine.

Field Effectiveness of a Typhoid Conjugate Vaccine: The 2018 Navi Mumbai Pediatric TCV Campaign.

Typbar-TCV®, a typhoid conjugate vaccine (TCV), was prequalified by the World Health Organization in 2017. We evaluated its effectiveness in a mass vaccination program targeting children 9 months to 14 years in Navi Mumbai, India, from September 2018 to July 2020. We compared laboratory-confirmed typhoid cases from six clinical sites with age-matched community controls.

Intestinal mucosal immunity is unimportant for polio eradication: the failure of oral polio vaccination.

Aims: To explore if intestinal immunity induced by infection with live viruses in the oral poliovirus vaccine (OPV) is essential, necessary or even helpful in interrupting transmission of wild poliovirus (WPV) for global polio eradication.

Methods: We reviewed the biology of virus-host interactions in WPV infection and its alterations by OPV-induced immunity for direct evidence of the usefulness of intestinal immunity. We also explored indirect evidence by way of the effect of the inactivated poliovirus vaccine (IPV) on the biology and on transmission dynamics of WPV.

The Role of Adults in Poliovirus Transmission to Infants and Children.

We draw attention to a neglected aspect of poliovirus transmission—the likely role of adults in sustaining transmission—which has important policy and practical implications for addressing the perplexing phenomenon of continued virus circulation.

Pediatric Drug-Resistant Tuberculosis: The Current and Future Prospects for Management and Prevention.

In the continued battle against one of the oldest enemies known to mankind, , the emergence of drug resistance to antituberculosis drugs among children poses multiple challenges for early detection and treatment. Molecular diagnostics and newer drugs like bedaquiline and delamanid have strengthened the armamentarium and helped design convenient, safe, and child-friendly therapeutic regimens against drug-resistant tuberculosis (TB). Preventive strategies like treatment of TB infection among children living in close contact with patients with drug-resistant TB and effective vaccines against TB are currently in the investigative stages of development and implementation.

Harmonization of Amoxicillin Dose, Duration, and Formulation for Acute Childhood Respiratory Infections.

Pediatric guidelines vary in their recommended amoxicillin dosing for common respiratory infections. It would help program delivery if there was harmonization of dosing and formulation of amoxicillin across multiple clinical respiratory infections, considering the pharmacokinetics, common targets, drug resistance, availability, cost effectiveness, and ease of administration. The World Health Organization EML AWaRe Book recommends higher dose amoxicillin given twice daily for five days for all uncomplicated respiratory infections where an antibiotic is indicated.

Programmatic Effectiveness of a Pediatric Typhoid Conjugate Vaccine Campaign in Navi Mumbai, India.

Background: The World Health Organization recommends vaccines for prevention and control of typhoid fever, especially where antimicrobial-resistant typhoid circulates. In 2018, the Navi Mumbai Municipal Corporation (NMMC) implemented a typhoid conjugate vaccine (TCV) campaign. The campaign targeted all children aged 9 months through 14 years within NMMC boundaries (approximately 320 000 children) over 2 vaccination phases.

Lessons from Vaccine-Related Poliovirus in Israel, UK and USA.

Genetic variants of vaccine poliovirus type 2, imported from an unknown source, were detected in waste waters in Jerusalem, London and New York in early 2022. Wild poliovirus type 2 was globally eradicated in 1999, but vaccine virus type 2 continued for 16 more years; routine use of the vaccine was discontinued in 2016 and reintroduced occasionally on purpose. As an unintended consequence, type 2 vaccine virus variants (circulating vaccine-derived polioviruses, cVDPVs) that mimic wild viruses' contagiousness and neurovirulence, have been emerging and spreading.

Oral Faropenem Sodium - Implications for Antimicrobial Resistance and Treatment Effectiveness.

Rising antimicrobial resistance (AMR) is causing therapeutic failures with antibiotics. Inappropriate use is a contributing factor. One such antibiotic on the radar is faropenem, a broad spectrum antibiotic approved in 2005 in India.

Timely use of Covid-19 vaccines could have saved thousands of lives.

Earlier we, TJJ and DD, had written in IJME, that during the pandemic with high case-fatality in those above 65 and younger adults with chronic lung, heart or kidney diseases or diabetes, vaccination must be administered early as a life-saving procedure (1). It was pointed out that protection delayed may be protection denied to drive home the urgency of vaccination for saving lives. At that time, Phase III vaccine trials were in progress and we had adequate data on safety, but efficacy had yet to be measured.

COVID-19 Eradication for Vaccine Equity in Low Income Countries.

The coronavirus disease 2019 (COVID-19) pandemic will transition into endemic phase with perpetual risk of severe disease and high mortality in vulnerable people - the elderly and those with co-morbidities, unless eradicated. Although several vaccines are already available to rich countries, low-income countries face gross vaccine inequity. We propose COVID-19 eradication to address both problems.

Covid-19 vaccine trials and ethics: Protection delayed is protection denied.

The Covid-19 pandemic is raging, taking heavy toll of lives and livelihoods. The need for safe and effective vaccine(s) is urgent. Vaccine research has progressed rapidly and a few vaccine candidates have passed trial Phases 1 and 2, confirming reasonable safety and immunogenicity parameters.

Association of Empiric Antibiotic Regimen Discordance With 30-Day Mortality in Neonatal and Pediatric Bloodstream Infection-A Global Retrospective Cohort Study.

Background: While there have been studies in adults reporting discordant empiric antibiotic treatment associated with poor outcomes, this area is relatively unexplored in children and neonates despite evidence of increasing resistance to recommended first-line treatment regimens.

Methods: Patient characteristics, antibiotic treatment, microbiology, and 30-day all-cause outcome from children <18 years with blood-culture-confirmed bacterial bloodstream infections (BSI) were collected anonymously using REDCap™ through the Global Antibiotic Prescribing and Resistance in Neonates and Children network from February 2016 to February 2017. Concordance of early empiric antibiotic treatment was determined using European Committee on Antimicrobial Susceptibility Testing interpretive guidelines.