Explore the vast range of titles available.

It is estimated that there are 390 million cases of dengue virus infection each year. In this double-blind, placebo-controlled trial, a tetravalent dengue vaccine was evaluated in 20,071 children. The vaccine was found to be 80% effective in preventing dengue infection.

Tuberculosis transmission continues to be a major public health challenge. In this cluster-randomized, controlled trial conducted in Vietnam, active community-wide screening for tuberculosis over 4 years is shown to decrease the prevalence of tuberculosis.

Dengue is a mosquito-borne viral illness that causes hundreds of millions of infections each year. No specific therapy exists. In this randomized, controlled trial involving Latin American children, a tetravalent dengue vaccine showed significant protective efficacy. Dengue is a mosquito-borne disease that is present in many parts of the world. From 2003 through 2013, the number of dengue cases that were reported to the Pan American Health Organization (PAHO) increased by a factor of five. 1 – 3 The disease is caused by one of four closely related virus serotypes from the genus flavivirus. Mosquitoes that transmit the virus are present in tropical and subtropical regions worldwide and in some temperate areas of the United States, Europe, Africa, and the Middle East. 4 Dengue is an increasing public health problem despite efforts to manage epidemics through vector control. 5 Several . . .

Typhoid remains a major cause of illness and death globally. In this trial, the efficacy of a typhoid conjugate vaccine was assessed in children in Nepal. A total of 20,019 children were randomly assigned to receive either a TCV or a meningococcal A vaccine. The TCV was associated with a decrease of 81.6% in Salmonella Typhi bacteremia.

Human African trypanosomiasis (sleeping sickness) is a parasitic infection that almost invariably progresses to death unless treated. Human African trypanosomiasis caused devastating epidemics during the 20th century. Thanks to sustained and coordinated efforts over the past 15 years, the number of reported cases has fallen to an historically low level. Fewer than 3000 cases were reported in 2015, and the disease is targeted for elimination by WHO. Despite these recent successes, the disease is still endemic in parts of sub-Saharan Africa, where it is a considerable burden on rural communities, most notably in central Africa. Since patients are also reported from non-endemic countries, human African trypanosomiasis should be considered in differential diagnosis for travellers, tourists, migrants, and expatriates who have visited or lived in endemic areas. In the absence of a vaccine, disease control relies on case detection and treatment, and vector control. Available drugs are suboptimal, but ongoing clinical trials provide hope for safer and simpler treatments.

Malaria is a major cause of illness worldwide. In a phase 2 trial in Mali, one subcutaneous dose of L9LS, a monoclonal antibody targeting Plasmodium falciparum , reduced the incidence of clinical malaria among children.

A Nature survey shows many scientists expect the virus that causes COVID-19 to become endemic, but it could pose less danger over time. A Nature survey shows many scientists expect the virus that causes COVID-19 to become endemic, but it could pose less danger over time.

Since the year 2000, a concerted campaign against malaria has led to unprecedented levels of intervention coverage across sub-Saharan Africa. Understanding the effect of this control effort is vital to inform future control planning. However, the effect of malaria interventions across the varied epidemiological settings of Africa remains poorly understood owing to the absence of reliable surveillance data and the simplistic approaches underlying current disease estimates. Here we link a large database of malaria field surveys with detailed reconstructions of changing intervention coverage to directly evaluate trends from 2000 to 2015, and quantify the attributable effect of malaria disease control efforts. We found that Plasmodium falciparum infection prevalence in endemic Africa halved and the incidence of clinical disease fell by 40% between 2000 and 2015. We estimate that interventions have averted 663 (542–753 credible interval) million clinical cases since 2000. Insecticide-treated nets, the most widespread intervention, were by far the largest contributor (68% of cases averted). Although still below target levels, current malaria interventions have substantially reduced malaria disease incidence across the continent. Increasing access to these interventions, and maintaining their effectiveness in the face of insecticide and drug resistance, should form a cornerstone of post-2015 control strategies. In this study, the authors present an analysis of the malaria burden in sub-Saharan Africa between 2000 and 2015, and quantify the effects of the interventions that have been implemented to combat the disease; they find that the prevalence of Plasmodium falciparum infection has been reduced by 50% since 2000 and the incidence of clinical disease by 40%, and that interventions have averted approximately 663 million clinical cases since 2000, with insecticide-treated bed nets being the largest contributor. Malaria control measures assessed In one of the largest public health campaigns in history, a concerted malaria control campaign has been under way in sub-Saharan Africa for the past 15 years. Billions of dollars have been invested to provide interventions such as bed nets and antimalarial drugs but the overall effect on malaria burden remains unclear. This study uses field data from 30,000 population clusters in a sophisticated space–time modelling framework to quantify the changing Plasmodium falciparum risk (a 40% decline in case incidence since 2000) and the role of malaria interventions (around 700 million cases averted). Although below target levels, the current campaign has substantially reduced the incidence of malaria across the continent. Continued success will depend upon increasing access to these interventions, and maintaining their effectiveness in the face of insecticide and drug resistance.

Oral cholera vaccines consisting of killed whole cells have been available for many years, but they have not been used extensively in populations with endemic disease. An inexpensive, locally produced oral killed-whole-cell vaccine has been used in high-risk areas in Vietnam. To expand the use of this vaccine, it was modified to comply with WHO standards. We assessed the efficacy and safety of this modified vaccine in a population with endemic cholera. In this double-blind trial, 107 774 non-pregnant residents of Kolkata, India, aged 1 year or older, were cluster-randomised by dwelling to receive two doses of either modified killed-whole-cell cholera vaccine (n=52 212; 1966 clusters) or heat-killed Escherichia coli K12 placebo (n=55 562; 1967 clusters), both delivered orally. Randomisation was done by computer-generated sequence in blocks of four. The primary endpoint was prevention of episodes of culture-confirmed Vibrio cholerae O1 diarrhoea severe enough for the patient to seek treatment in a health-care facility. We undertook an interim, per-protocol analysis at 2 years of follow-up that included individuals who received two completely ingested doses of vaccine or placebo. We assessed first episodes of cholera that occurred between 14 days and 730 days after receipt of the second dose. This study is registered with ClinicalTrials.gov, number NCT00289224. 31 932 participants assigned to vaccine (1721 clusters) and 34 968 assigned to placebo (1757 clusters) received two doses of study treatment. There were 20 episodes of cholera in the vaccine group and 68 episodes in the placebo group (protective efficacy 67%; one-tailed 99% CI, lower bound 35%, p<0·0001). The vaccine protected individuals in age-groups 1·0–4·9 years, 5·0–14·9 years, and 15 years and older, and protective efficacy did not differ significantly between age-groups (p=0·28). We recorded no vaccine-related serious adverse events. This modified killed-whole-cell oral vaccine, compliant with WHO standards, is safe, provides protection against clinically significant cholera in an endemic setting, and can be used in children aged 1·0–4·9 years, who are at highest risk of developing cholera in endemic settings. Bill & Melinda Gates Foundation, Swedish International Development Cooperation Agency, Governments of South Korea, Sweden, and Kuwait.

Background. Enteric fever caused by Salmonella Typhi remains a major public health problem in developing countries. Typbar-TCV is a single-dose typhoid Vi polysaccharide-tetanus toxoid conjugate vaccine for persons ≥6 months of age. Methods. Six hundred fifty-four healthy subjects aged 2–45 years enrolled in a double-blind, randomized controlled trial (RCT) received a single dose of Typbar-TCV or comparator \"Vi polysaccharide\" (Typbar), and 327 healthy subjects aged 6–23 months received a single dose of Typbar-TCV in an open-label trial (OLT); both received single- or multidose presentations from different lots. After 2 years, subsets in each group received a booster dose. The primary objective included analysis of geometric mean titer (GMTs) and 4-fold rise of anti-Vi serum immunoglobulin G (IgG) enzyme-linked immunosorbent assay titers over baseline (seroconversion [SCN]) 42 days after immunization. Results. Typbar-TCV recipients in the RCT attained higher anti-Vi IgG GMTs 42 days after immunization (SCN, 97%; GMT, 1293 [95% confidence interval {CI}, 1153–1449]) than recipients of (SCN, 93%; GMT, 411 [95% CI, 359–471]) (P<.001). Typbar-TCV was highly immunogenic in the OLT (SCN, 98%; GMT, 1937 [95% CI, 1785–2103]). Two years after vaccination, anti-Vi titers remained higher in Typbar-TCV subjects (GMT, 82 [95% CI, 73–92]); and exhibited higher avidity (geometric mean avidity index [GMAI], 60%) than in Typbar recipients (GMT, 46 [95% CI, 40–53]; GMAI 46%) in the RCT (P < .001). OLT Typbar-TCV recipients achieved GMT of 48 (95% CI, 42–55) and GMAI of 57%. Typbar-TCV induced multiple IgG subclasses and strong booster responses in all ages. No serious vaccine-attributable adverse events were observed. Conclusions. Single-dose Typbar-TCV is well tolerated and induces robust and long-lasting serum anti-Vi IgG across age groups. Clinical Trials Registration. CTRI/2011/08/001957, CTRI/2014/01/004341.