Thongsriratch S, Thongseiratch T, Pairoh S, Khantee P. The Vaccine That Was Never Mentioned: A Comparative Medico-Legal Analysis of the Duty to Inform and Document Preventive Immunization, with Proposed Practice Guidelines. Vaccines. 2026; 14(8):664.
doi: https://doi.org/10.3390/vaccines14080664
Editorial comment: Healthcare professionals often associate vaccine-related litigation with adverse events following immunization. However, this thought-provoking review highlights another emerging legal concern: the potential consequences of not discussing or recommending vaccines. While current evidence does not establish a universal legal duty to recommend every available vaccine, failure to assess eligibility, counsel patients, document discussions, or revisit vaccination opportunities may become increasingly relevant in medico-legal practice. The authors propose the ADRR framework—Assess, Discuss and disclose, Recommend or refer, and Record and revisit—as a practical approach to strengthen clinical practice and documentation. Although not yet a validated legal or clinical standard, ADRR offers a structured strategy to promote informed decision-making, improve vaccine uptake, and potentially reduce legal risk.
As adult and maternal immunization continue to expand and immunization schedules become more complex, ensuring that appropriate vaccines are discussed may become as important as administering them. This review serves as a timely reminder that the vaccine conversation itself is an essential component of high-quality preventive care.
Khatiwada M, Chen Y-T, Dochez C, Delputte P. Mapping the Global Landscape of Vaccine Acceptance Among the General Population from 2009 to 2024: A Systematic Review Across COVID-19 Pandemic Phases, Vaccine Categories, and Economic Strata. Vaccines. 2026; 14(8):663.
doi: https://doi.org/10.3390/vaccines14080663
Editorial comment: A large systematic review of more than 650,000 participants from 97 countries found that global vaccine acceptance remained relatively stable at around 71% between 2009 and 2024. However, acceptance varied considerably by vaccine type, region, and income level. Childhood vaccines had the highest acceptance, while influenza vaccines had the lowest. Interestingly, vaccine acceptance tended to be higher in African and South-East Asian countries than in many high-income regions. These findings reinforce that vaccine confidence is highly context-dependent and that tailored, evidence-based communication strategies remain essential to improve immunization coverage worldwide.
Jamrozik E, Abeler-Dörner L, Chaudhari A, Cheah PY, Hinch R, Jarman R, Johnson T, Parker M, Vegvari C, Wressnigg N, Fraser C. Ethical challenges in outbreak trial design: from Ebola to Nipah. Vaccine. 2026 Jul 18;89:128858.
doi: https://doi.org/10.1016/j.vaccine.2026
Editorial comment: Developing vaccines for Nipah virus, a highly lethal but sporadic disease, presents unique scientific and ethical challenges. Because outbreaks are short and unpredictable, traditional randomized clinical trials may be difficult to complete before transmission ends. This review discusses alternative trial designs, the ethical balance between scientific rigor and participant protection, and the importance of early community engagement. The authors also emphasize the need to ensure rapid access to effective vaccines for control-group participants once efficacy has been demonstrated.
Ezeja L, Ezeala OM, Westrick SC, Qian J. Adverse events and vaccine administration errors following RSV vaccination: Findings from the United States VAERS database, 2023-2025. Vaccine. 2026 Jun 29;89:128896.
doi: https://doi.org/10.1016/j.vaccine.2026.128896
Editorial comment: Three respiratory syncytial virus (RSV) vaccines are currently licensed for adults in the United States: Arexvy® (GSK), Abrysvo® (Pfizer), and mRESVIA® (Moderna). Among them, only Abrysvo® is approved for maternal immunization during pregnancy to protect newborns against severe RSV disease during the first months of life. This post-marketing analysis of more than 8,300 VAERS reports confirms that most reported adverse events were non-serious, reinforcing the favorable safety profile established in clinical trials. However, the study identified a concerning number of vaccine administration errors, including unnecessary extra doses, administration to individuals outside the recommended age groups, and the use of Arexvy® during pregnancy, despite its lack of approval for this indication. As RSV immunization programs continue to expand, these findings highlight that successful implementation depends not only on safe and effective vaccines but also on accurate vaccine selection and administration. Ongoing healthcare provider education, adherence to current recommendations, and robust immunization record systems will be essential to maximize the public health benefits of RSV vaccination.
Morris SE, O’Halloran A, Sundaresan D, Olson SM, Chung JR, Ellington S, Bozio CH, Iuliano AD, Biggerstaff M, Reed C. Public health benefits of maternal influenza vaccination among pregnant women and infants <6 months in the United States, 2011-2020. Vaccine. 2026 Jun 30;89:128895.
doi: https://doi.org/10.1016/j.vaccine.2026.128895
Editorial comment: Pregnant women and infants younger than six months are among the populations at highest risk for severe influenza, yet newborns are too young to receive influenza vaccines. This study demonstrates that maternal influenza vaccination significantly reduces hospitalizations and ICU admissions in both mothers and their infants, reinforcing its value as a strategy that protects two vulnerable populations with a single intervention. The authors also found that higher vaccination coverage and earlier immunization during pregnancy could prevent hundreds of additional hospitalizations each influenza season. These findings underscore the importance of strengthening maternal immunization programs and ensuring timely influenza vaccination during pregnancy as a key public health priority.
Madhi SA, Snaggs H, Skogeby Z, Feng Y, Barnabas S, Baker J, Fairlie L, Beeslaar J, Radley D, Jiang HQ, Silmon de Monerri NC, Simon R, McLaughlin L, Gaylord M, Skinner J, Munjal I, Anderson AS, Gurtman A. Maternal 6-valent group B Streptococcus vaccine in non-pregnant and pregnant females: a randomized phase 1/2 trial. Nat Med. 2026 Jul 28.
doi: https://doi.org/10.1038/s41591-026-04558-5
Editorial comment: Group B Streptococcus (GBS) remains a leading cause of neonatal sepsis and meningitis worldwide, yet no vaccine has been licensed despite decades of research. This phase 1/2 trial showed that the investigational hexavalent maternal GBS conjugate vaccine (GBS6) was well tolerated in pregnant women and elicited strong antibody responses, with efficient transfer of protective antibodies to infants. Although larger efficacy studies are still needed, these encouraging results represent an important milestone toward a maternal vaccine that could substantially reduce the global burden of neonatal GBS disease.
Blakney AK, Top KA, Cowling BJ, Larson HJ, Shattock RJ, Sadarangani M. Safety and efficacy of mRNA vaccines: a mechanistic and public health perspective. Lancet. 2026 Jul 18;408(10551):275-288.
doi: https://doi.org/10.1016/S0140-6736(26)00512-X
Editorial comment: Following the administration of billions of doses worldwide, mRNA vaccines have demonstrated an excellent safety profile and remarkable effectiveness, transforming the field of vaccinology. This comprehensive review confirms that mRNA vaccines do not integrate into the human genome, are rapidly degraded after fulfilling their function, and are fundamentally different from gene therapy. Beyond COVID-19, this versatile platform is poised to revolutionize the prevention of infectious diseases and holds enormous promise for cancer immunotherapy and autoimmune diseases, making it one of the most important innovations in modern medicine.
Lai X, Abbas K, Pouwels KB, Jit M, Fang H. Global, regional, and national impact of the Expanded Programme on Immunization against 14 pathogens from 1974 to 2024: an economic evaluation. Lancet Glob Health. 2026 Jul;14(7):103965.
doi: https://doi.org/10.1016/j.langlo.2026.103965
Editorial comment: Since its launch by the World Health Organization in 1974, the Expanded Programme on Immunization (EPI) has become one of the most successful public health initiatives in history. This landmark economic analysis estimates that over the past 50 years, EPI has generated more than US$15 trillion in economic benefits, returning approximately US$16 for every dollar invested. Among all vaccines, measles vaccination provided the greatest economic return. The findings reaffirm that immunization not only saves millions of lives but also remains one of the most cost-effective and economically rewarding investments, particularly in low-income and high-burden countries.
Fafi I, Levy C, Varon E, Cohen R, Béchet S, Valtuille Z, Birgy A, Bonacorsi S, Delobbe JF, Batard C, Assad Z, Jaboyedoff M, Lenglart L, Basmaci R, Ouldali N. RSV shapes serotype-specific invasive pneumococcal disease dynamics in children: an observational study. J Infect Dis. 2026 Aug 4:jiag401.
doi: https://doi.org/10.1093/infdis/jiag401
Editorial comment: This French surveillance study provides new evidence that RSV circulation influences the serotypes responsible for invasive pneumococcal disease (IPD) in children. During RSV seasons, pneumococcal serotypes with lower intrinsic invasive potential were more likely to cause IPD, suggesting that RSV facilitates progression from nasopharyngeal colonization to invasive disease. These findings reinforce the close relationship between viral and bacterial respiratory pathogens and suggest that effective RSV prevention—including maternal immunization and monoclonal antibodies—may also reduce the burden of pneumococcal disease, an important consideration for future vaccination strategies.
Angamarca-Iguago J, Cagua-Ordóñez J, Parise-Vasco JM, de Mora D, Escobar-Naranjo M, Bruno A and Simancas-Racines D. Regional, altitudinal, and age-specific heterogeneity of bronchiolitis hospitalization seasonality in Ecuador, 2007–2024, and implications for RSV immunoprophylaxis timing. Front. Public Health. 2026; 14:1892098.
doi: https://doi.org/10.3389/fpubh.2026.1892098
Editorial comment: A nationwide study from Ecuador found that RSV-associated bronchiolitis seasonality changed after the COVID-19 pandemic, with important regional differences influenced by geography and altitude. While the coastal region showed a stable seasonal pattern, the Andes and Amazon remained more variable. These findings highlight that the timing of maternal RSV vaccination and nirsevimab administration should be guided by local epidemiology rather than a one-size-fits-all approach, maximizing protection for infants during periods of highest RSV circulation.
Rodriguez-Morales AJ, Rodríguez-Sabogal IA, Sucari A, Moncada W, Hernández-Serrano LV, Escarrá F, Quispe-Torrez PP, Membrillo FJ, Orduna T, Lloveras S, Chaves TSS, Cabada MM, Perret C, Echavarría R, Ribeiro AF, Tanabe M, Bazzino F, Ramirez M, Diaz B, Morejón KML, Daly K, Rosas R, Lopez MB, Miranda C, Fernandez ML, Özsürekçi Y, Matsee W, Carrero Y, Biscayart C, Cimerman S, Avila-Aguero ML, Debbag R, Brea J, Risquez A, Acosta-España JD, Ulloa-Gutierrez R, Espinal C, Torres-Martinez CN, González-Sanz M, Abbara A, Weatherhead J, Cordero B, Lezcano V, Guerrero A, Maldonado H, Cuellar L, Ceron I, Roque Y, Florentin M, Infante R, Carvajal A, Soto-Ávila LM, Hernández M, Villaroel H, Miozzi G, Navas R, Hernández M, Pérez-Vega C, Mérida M, Forero-Peña DA, Navarro JC, Beltrán-Arroyave C, Masana M. Reducing communicable-disease risk after earthquakes: Vaccination and prevention lessons for Venezuela’s doublet. Travel Med Infect Dis. 2026 Jul 4:103009.
doi: https://doi.org/10.1016/j.tmaid.2026.103009
Editorial comment: Natural disasters often create the perfect conditions for outbreaks of vaccine-preventable diseases. This timely review discusses the essential preparedness and response measures needed to minimize these risks, drawing attention to events such as the recent earthquake in Venezuela.
Puebla YP, Nicholls H, Fitz-Patrick D, Horton LE, Gawel MW, Martinez RD, Wang X, Keep G, Xu X, Gomme E, et al. Phase 3 Randomized Study Investigating the Safety, Tolerability, and Immunogenicity of a Combination Modified Messenger RNA Vaccine Against Influenza and COVID-19 in Healthy Adults. Vaccines. 2026; 14(8):677.
doi: https://doi.org/10.3390/vaccines14080677
Editorial comment: In a large phase 3 trial involving more than 6,600 adults aged 18–64 years, an investigational combined mRNA vaccine against influenza and COVID-19 demonstrated an acceptable safety profile and generated robust immune responses against influenza A and SARS-CoV-2. Although immune responses against influenza B did not fully meet the predefined non-inferiority criteria, the results are encouraging and support further optimization of the formulation. If successful, a single combination vaccine could simplify seasonal immunization, improve vaccine uptake and adherence, reduce healthcare visits, and take full advantage of the flexibility of the mRNA platform for protection against multiple respiratory pathogens.
Fiuza A, Garcia-Colon C, Molfetta C, Schwab J, Gurumurthy M, Thomas P, Friedman S. SARS-CoV-2 Antibody Prevalence and Associated Factors in COVID-19-Unvaccinated Children: A Cross-sectional Study. Pediatr Infect Dis J. 2026 Aug 1;45(8):e288-e291.
doi: https://doi.org/10.1097/INF.0000000000005210
Editorial comment: This study highlights an important aspect of pediatric COVID-19 epidemiology: among unvaccinated inner-city children, nearly 70% had evidence of prior SARS-CoV-2 infection, underscoring the widespread circulation of the virus during the pandemic. Notably, children living with at least one vaccinated adult had significantly lower rates of SARS-CoV-2 antibodies than those in households without vaccinated adults, suggesting that adult vaccination may have provided indirect protection. In contrast, masking, participation in school or extracurricular activities, household size, and reported household illness were not significantly associated with infection. While the cross-sectional design limits causal inference, these findings reinforce the concept that vaccination benefits extend beyond the individual, helping reduce viral transmission within households and offering indirect protection to children who remain unvaccinated.
Qiu L, Pan H, Liang Q, Chen Z, Zhang M, Liu S, Liao M, Chen L, Liu X, Hu J, Li C, Li J, Xu J, Zhuang C, Huang S, Wang W, Han J, Jia J, Chu X, Zhu H, Cheng T, Su Y, Ye X, Quan Y, Wu T, Zhang J, Xia N. Immunogenicity and Safety of Two-dose Schedules With Different Intervals of an ORF7-deficient Live Vaccine Candidate for Varicella: A Randomized, Double-blind, Controlled, Phase 2b Trial. Pediatr Infect Dis J. 2026 Aug 1;45(8):733-741.
doi: https://doi.org/10.1097/INF.0000000000005184
Editorial comment: The live-attenuated Oka strain varicella vaccine has dramatically reduced the global burden of chickenpox, but its ability to establish latent infection has prompted efforts to develop even safer next-generation vaccines. In this phase 2b trial, the novel live-attenuated v7D vaccine induced a 100% seroconversion rate after two doses, with antibody responses comparable to the licensed Oka vaccine and an excellent safety profile. Most adverse events were mild and transient, and no vaccine-related serious adverse events were reported. Although these findings are encouraging, the true promise of v7D lies in its potential to reduce latent neuronal infection and, ultimately, the risk of herpes zoster—a benefit that will require long-term follow-up and efficacy studies to confirm. If validated, this candidate could represent an important advance in the evolution of varicella vaccination.
Ly QT, Tran QK, Lam TNX, Nguyen TND, Huynh MT, Espinoza JL. Inflammatory Markers as Predictors of Complications in Pediatric Measles: Evidence From a Vietnamese Cohort. Pediatr Infect Dis J. 2026 Aug 1;45(8):e310-e315.
doi: https://doi.org/10.1097/INF.0000000000005219
Editorial comment: Despite being vaccine-preventable, measles continues to cause substantial morbidity, particularly in low-resource settings. This study highlights the value of simple, widely available clinical and laboratory markers for identifying children at greatest risk of complications. Malnutrition emerged as a strong predictor of measles pneumonia, while elevated C-reactive protein and the neutrophil-to-lymphocyte ratio were associated with intestinal infections and prolonged hospitalization. These inexpensive and accessible markers could help clinicians prioritize monitoring and treatment during outbreaks, especially where healthcare resources are limited. The findings also reinforce that preventing measles through high vaccination coverage remains far more effective than managing its often-severe complications.
Quipildor MO, Rapetti Salik G, Bonnin FA, Silveti M, Moreno J, Aguilera M, Schamún M, Bravo G, Falco A, Talarico LB. Perinatal Transmission of Dengue Virus Type 2 in Northern Argentina: A Series of 6 Cases. Pediatr Infect Dis J. 2026 Mar 10.
doi: https://doi.org/10.1097/INF.0000000000005212
Editorial comment: Although dengue is not traditionally associated with congenital infection, vertical transmission is an important and often underrecognized complication during outbreaks. This case series from Argentina demonstrates that maternal dengue infection around the time of delivery can result in symptomatic neonatal disease, including thrombocytopenia, respiratory distress, and even severe dengue with plasma leakage. Fortunately, all infants recovered with supportive care. These findings emphasize the need for heightened clinical suspicion of dengue in pregnant women with acute febrile illness and in newborns presenting with nonspecific symptoms in endemic areas. As dengue continues to expand geographically, increasing awareness among obstetricians and neonatologists—and advancing effective dengue vaccination strategies where appropriate—will be essential to reducing maternal and neonatal morbidity.
Locci M, Pardi N. Immunological mechanisms of mRNA vaccines for infectious diseases. Nature. 2026 Jun;654(8120):892-901.
doi: https://doi.org/10.1038/s41586-026-10599-0
Editorial comment: mRNA-lipid nanoparticle (mRNA-LNP) vaccines transformed the response to COVID-19, preventing millions of deaths worldwide and demonstrating the remarkable potential of this vaccine platform. This review highlights how these vaccines generate robust innate and adaptive immune responses while emphasizing that important questions remain regarding the immunostimulatory role of lipid nanoparticles, the pathways responsible for durable protection, and the relationship between immunogenicity and reactogenicity. Addressing these knowledge gaps will be critical for designing next-generation mRNA vaccines that are both more effective and better tolerated. Beyond COVID-19, continued refinement of mRNA-LNP technology could accelerate the development of vaccines against challenging infectious diseases for which current preventive strategies remain inadequate.
Couper LI, Sipin TJ, Sambado S, Rennie Z, Shanebeck KM, Lyberger KP, Collender PPA, Ngo V, Remais JV, MacDonald AJ. Dengue transmission risk in California under climate and land-use change: a semi-mechanistic modelling study. Lancet Reg Health Am. 2026 May 26;60:101509.
doi: https://doi.org/10.1016/j.lana.2026.101509
Editorial comment: As climate change, urbanization, and international travel continue to reshape the epidemiology of vector-borne diseases, dengue is no longer confined to traditional tropical regions. This important modeling study suggests that nearly 18 million Californians already live in areas with seasonal conditions favorable for local dengue transmission, with another 4 million potentially at risk by mid-century under projected climate and urban growth scenarios. While the overall risk remains seasonal and geographically concentrated, the findings underscore the growing importance of integrated surveillance, rapid identification of travel-associated cases, and sustained mosquito control efforts. For clinicians and public health authorities, dengue should increasingly be considered an emerging domestic health challenge rather than solely an imported disease.
Tartof SY, Aliabadi N, Zasowski E, Goodwin G, Slezak JM, Hong V, Frankland TB, Ackerson B, Liu Q, Shaw S, Welsh S, Kapadia B, Spence BC, Davis GS, Lewnard JA, Chowdhry H, Dutro M, Chilson E, Jodar L, Gessner BD, Begier E. Bivalent RSVpreF effectiveness against RSV-associated hospital or emergency department care over two seasons: a retrospective test-negative case control study. Lancet Reg Health Am. 2026 May 27;60:101520.
doi: https://doi.org/10.1016/j.lana.2026.101520
Editorial comment: Real-world evidence continues to reinforce the value of RSV vaccination in older adults. This two-season study found that the bivalent RSVpreF vaccine provided sustained protection against RSV-related hospitalization and emergency department visits, with vaccine effectiveness remaining above 75% through a second RSV season. Importantly, protection persisted among adults aged ≥75 years, individuals with chronic medical conditions, those with frailty, and across both RSV A and B subtypes. Although effectiveness declined modestly over time—particularly among immunocompromised adults—the findings support the substantial and durable public health benefits of RSV vaccination. These data also highlight the need for continued evaluation of optimal revaccination strategies in populations with impaired immune responses.
Flichman DM, Lema JM, Pereson MJ, Espíndola SL, Agote F, Albrecht A, Alter A, Anhel S, Blanco C, Blanco S, Borda M, Bouzon N, Campo C, Carrizo LH, Cettina A, Figueroa Reyes MI, Galeano D, Gallego S, García Plichta A, Luna SG, Marranzino G, Nicolorich MV, Pilar S, Prado A, Rainero K, Rossi A, Romanazzi JS, Spotti M, Martínez AP, Baré P, Di Lello FA. Dengue seroprevalence and transfusion risk in three regions of viral circulation in Argentina: a cross-sectional study. Lancet Reg Health Am. 2026 May 25;60:101511.
doi: https://doi.org/10.1016/j.lana.2026.101511
Editorial comment: Dengue continues to expand rapidly across Argentina, with this seroprevalence study revealing that more than half of blood donors had anti-DENV IgG antibodies by 2025, a dramatic increase from 23% just two years earlier. The findings suggest that approximately 10.2 million infections occurred during the recent epidemics—far exceeding the 575,000 officially reported cases and highlighting substantial underascertainment. The detection of DENV RNA in blood donors also raises concerns about transfusion-transmitted dengue, particularly in highly affected regions. These data underscore the urgent need for strengthened surveillance, integrated vector control, consideration of targeted vaccination strategies, and enhanced blood safety measures as dengue becomes an increasingly important public health challenge in South America.
Kao CM, Bahakel H, Heald-Sargent TA, Minniear TD, Statler VA, Thomas SJ, Weakley KE, Cao Q, Ardura MI, Danziger-Isakov L, Foca M, Herold BC. Influenza, COVID-19, and RSV Vaccinations for Immunocompromised Children and Household Contacts. Pediatrics. 2026 Aug 1;158(2):e2026075971.
doi: https://doi.org/10.1542/peds.2026-075971
Editorial comment: Immunocompromised children—including transplant recipients, oncology patients, and those receiving immunosuppressive therapies—remain among the populations at greatest risk for severe influenza, COVID-19, and RSV. Yet, despite their vulnerability, vaccine recommendations for these patients are still largely based on evidence from healthy children or immunocompromised adults, highlighting a major gap in pediatric vaccinology. This review underscores the urgent need to improve vaccine uptake in these children and among their close contacts, particularly in the face of increasing vaccine hesitancy and persistent viral circulation. It also emphasizes the importance of optimizing vaccine schedules, formulations, and immunogenicity through dedicated research to provide stronger and longer-lasting protection for this growing high-risk population.
