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

From outbreak response to system strengthening: preventing diphtheria in Somalia.

Abdullahi Zakaria Abdi ZA, Derow Ismail Mohamud IM, Yusuf Abdi Wahab Salad AWS, Abdi Aniso Mohamed AM et al.

Diphtheria, a vaccine-preventable disease, has re-emerged as a significant public health concern in Somalia, highlighting persistent weaknesses in immunization systems. Recent outbreaks demonstrate that transmission is driven not by limitations of available vaccines but by immunity gaps associated with low routine immunization coverage, high numbers of zero-dose children, conflict, population displacement, and barriers to accessing health services. The 2025 diphtheria outbreak, characterized by substantial morbidity and mortality among children, underscores the urgent need to move beyond reactive outbreak response toward sustainable immunization-system strengthening. This letter emphasizes the importance of improving routine immunization services, expanding catch-up vaccination, strengthening disease surveillance, enhancing vaccine supply chains and cold-chain capacity, and improving immunization data systems for identifying missed populations. Evidence from Somalia's recent vaccination initiatives demonstrates that community-centered approaches, digital tools, and locally adapted outreach strategies can successfully reach underserved groups even in fragile settings. Building resilient immunization systems requires coordinated efforts among government institutions, communities, health workers, and international partners. Strengthening equitable vaccination delivery is essential not only for preventing future diphtheria outbreaks, but also for improving Somalia's preparedness against other vaccine-preventable diseases and future public health emergencies.

Genetic detoxification of an unencapsulated Neisseria meningitidis strain enhances potency of outer membrane vesicle vaccines and cross-reactivity of vaccine-specific antibodies.

Matthias Kathryn A KA, Kumova Ogan K OK, Reveille Alexandra A, Bizzell Erica E et al.

Meningococcal serogroup B (MenB) detergent-detoxified outer membrane vesicle (dOMV) vaccines demonstrate high effectiveness against the homologous production strain but confer limited cross-protection to heterologous strains. We previously reported that dOMVs isolated from a MenB strain deleted for the proteins PorA, PorB, and RmpM (ΔABR) elicited bactericidal antibodies with a greater breadth of coverage, but of lower overall titer, compared to wild-type (WT) dOMV-induced antibodies. Low ΔABR dOMV potency was associated with pronounced vesicular deterioration and lower levels of lipooligosaccharide (LOS) and capsular polysaccharide (Cps) relative to WT dOMVs, phenotypes resulting from detergent detoxification procedures required to limit LOS-induced toxicity. In this study, we engineered genetically detoxified ΔABR strains that were deleted singly for the lauroyl acyltransferase LpxL1 (ΔABRL) or in tandem for the Cps polysialyltransferase SiaD (ΔABRSL). Genetically detoxified, detergent-extracted OMVs (eOMVs) from ΔABRL and ΔABRSL retained vesicular structure and elicited functional antibodies with increased cross-reactivity compared to ΔABR and ΔABRL dOMVs when administered to rabbits. Antibody seropositivity and cross-reactivity were similarly increased in mice vaccinated with ΔABRL eOMVs vs ΔABRL dOMVs. ΔABRSL eOMV potency was higher than that of ΔABRL eOMVs, suggesting a role for Cps in suppressing antibody responses. Immunization with eOMVs was associated with trends toward improved murine T helper cell responses and elicitation of higher proportions of conformational antibodies that may have contributed to improved bactericidal activity. ΔABRSL eOMVs additionally showed decreased toxicity compared to WT and ΔABR dOMVs when tested in vitro, supporting further study as a vaccine candidate. The ability to target multiple serogroup B Neisseria meningitidis strains with a single vesicle vaccine is complicated by the diversity of antigens that span the bacterial surface. We previously reported that vesicles isolated from meningococcal strains deleted for the major antigenically diverse surface proteins elicited functional antibodies that could kill a large number of N. meningitidis strains though at relatively low titers. Low potency of the mutant vaccines was associated with a breakdown of the vesicular membrane upon detergent treatment, a process necessary to diminish endogenous endotoxin levels and ensure vaccine safety. In this study, we demonstrate that we can retain high cross-reactivity of anti-vesicle antibodies without decreasing the potency of the host immune response through genetic detoxification of the meningococcal vaccine strain. By preventing the formation of the complete endotoxin structure, we are able to isolate vesicles that are safe and immunogenic without the requirement for detergent detoxification.

Dual therapy with Janus kinase inhibitors and biologics for atopic dermatitis: A systematic review.

Bai Jia Qi Adam JQA, Wen Sherilyn S, Chen Shuang S, Xu Yihang Y et al.

Targeted biologics in muscle strength restoration and corticosteroid sparing for patients post-myasthenic crisis.

Wang Yuan Y, Jin Lei L, Huan Xiao X, Chen Ran R et al.

Myasthenic crisis (MC) represents a life-threatening condition in patients with myasthenia gravis (MG). Despite a substantial reduction in in-hospital mortality for MC, full restoration of muscle strength and quality of life usually requires months or years. It remains unknown whether the sequential use of targeted biologics improves clinical outcomes in patients post-MC compared with the standard of care (SOC). We prospectively followed patients from MC through 6 months post-discharge between November 2018 and November 2025. We then stratified patients into subgroups according to the use of either biologics-based therapy (C5 inhibitors, FcRn antagonists, or rituximab) (BIO) or SOC. The primary endpoint was the Myasthenia Gravis Foundation of America-quantitative MG (MGFA-QMG) score at 6 months after discharge. Secondary outcomes included Myasthenia Gravis Activities of Daily Living (MG-ADL), steroid dose, immunosuppressant (IS) use, cumulative steroid exposure, minimal symptom expression (MSE), and residual symptom burden. At 6 months after discharge, the BIO group (n = 56) had a lower MGFA-QMG score than the SOC group (n = 56) (4.51 ± 4.03 vs 6.28 ± 4.72; P = 0.038). Meanwhile, the BIO group required a lower dose of oral corticosteroid (14.74 ± 10.24 vs 21.96 ± 12.87 mg/day; P = 0.004), lower cumulative steroid burden (158.13 ± 64.71 vs 209.24 ± 96.81 mg/day·month; P = 0.001), and had a lower proportion of IS use (47.3% vs 67.9%; P = 0.028). MSE was achieved in 56.86% in the BIO and 60.38% in the SOC group, respectively. Targeted biologics were associated with better objective muscle strength and reduced corticosteroid and IS use after MC, although no significant between-group difference was observed in MG-ADL. A substantial proportion of patients in both groups continued to have residual symptoms at 6 months.