Persistent fluoroquinolone resistance, particularly among S. Typhi and S. Paratyphi A populations in Nepal, underscores ongoing AMR challenges and highlights the need for expanded vaccine strategies targeting both pathogens.
Abstract
Background: Enteric fever, caused by Salmonellaenterica serovars Typhi and Paratyphi A, remains a major concern in low- and middle-income countries, with treatment increasingly complicated by antimicrobial resistance. Typhoid conjugate vaccines (TCVs) offer a promising intervention, but their impact on circulating lineages and population structure remains poorly understood. Nepal introduced a nationwide TCV programme in April 2022, shortly after the COVID-19 pandemic disrupted healthcare delivery and surveillance. Methods: We sequenced 350 S. Typhi and 114 S. Paratyphi A isolates collected in Nepal between 2018 and 2024 and analyzed them alongside1,797 previously published Nepal genomes (2005-2018). We characterized genotype distribution, antimicrobial resistance determinants, phylogenetic relationships and lineage-specific phylodynamics across three epidemiological periods: pre-pandemic (before 2020), pandemic/pre-vaccine (2020-2022), and post-vaccine introduction (2022-2024). Results: Sixteen S. Typhi genotypes were identified, dominated by 4.3.1.2 (28%), 3.3.2 (20.3%) and 3.3.1 (16.9%); S. Paratyphi A was dominated by genotypes 2.4.3 (57.0%) and 2.4.2 (25.4%). Multidrug resistance was rare, but fluoroquinolone non-susceptibility was widespread (70.6% of S. Typhi; 99.1% of S. Paratyphi A), with high-level resistance confined to a single S. Typhi 4.3.1.2.1 clade dating to 2008. Phylodynamic reconstruction revealed asymmetric lineage trajectories: S. Typhi H58 contracted sharply during the pandemic, lineage 3.3 contracted specifically post-TCV, and S. Paratyphi A (not vaccine-targeted) showed only a modest pandemic-era decline. Post-TCV, the age distribution of cases shifted older and the adult genotype mix shifted toward lineage 3.3. We found no evidence of vaccine-driven escape at the Vi capsule or O-antigen in Nepal or across a cross-country cohort. Conclusions: Both S. Typhi and S. Paratyphi A populations in Nepal underwent recent declines in effective population size, coinciding with the COVID-19 pandemic and TCV introduction. Persistent fluoroquinolone resistance, particularly among S. Paratyphi A, underscores ongoing AMR challenges and highlights the need for expanded vaccine strategies targeting both pathogens.
A scoping review was conducted across six databases in January 2026, including studies on genomic surveillance, antigenic characterization, and vaccine effectiveness (VE), which indicated diminished VE against drifted strains, though no consistent increase in clinical severity was observed.
A. Cianciulli, E. Santoro, S. Esposito et al.· GERMS· 0 citations
INTRODUCTION
From 2020 to 2023, Madagascar experienced an outbreak of circulating vaccine-derived poliovirus type 1 (cVDPV1) that notably affected adults and was associated with high mortality among paralytic cases. This atypical epidemiological pattern required adapted surveillance approaches and tailored outbreak response strategies, including vaccination campaigns targeting adult populations.
METHODS
We conducted a descriptive analysis of the cVDPV1 outbreak in Madagascar between September 2020 and September 2023. Epidemiological data on confirmed and polio-compatible cases were reviewed, including age distribution, clinical presentation, and outcomes. We also documented outbreak response strategies, particularly vaccination campaigns and operational innovations implemented to reach adult populations.
RESULTS
A total of 54 confirmed cases of paralytic polio caused by cVDPV1 were reported during the study period, including two adults presenting with fever and paralysis. Between February 2022 and March 2023, 15 adult acute flaccid paralysis cases were classified as polio-compatible by the National Polio Eradication Committee due to missing (86%) or negative laboratory specimens. Mortality among these compatible adult cases was 56%. In response, Madagascar conducted vaccination campaigns using bivalent oral polio vaccine, targeting the entire population in four regions and children under 15 years in the rest of the country. Critical role of country leadership, strategic mobilization, and effective communication in driving success and influencing risk perception during the 2023 campaigns helped achieve high coverage among adults.
CONCLUSIONS
The cVDPV1 outbreak in Madagascar demonstrated the potential for significant adult involvement and high mortality in polio outbreaks. High vaccination coverage combined with targeted innovations and strong community engagement contributed to successful outbreak control. These findings highlight the importance of inclusive vaccination strategies and tailored approaches in similar settings.
Kpandja Djawe, Eric Aigbogun, Joseph Souba Zoumanigui et al.· Vaccine· 0 citations
PURPOSE OF REVIEW
Typhoidal and invasive non-typhoidal Salmonella (iNTS) serovars remain leading causes of bloodstream infection, mortality and morbidity, particularly in South Asia and sub-Saharan Africa. The rising burden of antimicrobial resistance has strengthened the case for vaccination as a control strategy. This review summarises recent advances in Salmonella vaccine development, highlighting progress, remaining challenges and future directions.
RECENT FINDINGS
The introduction of typhoid conjugate vaccine (TCV) programmes across some endemic countries represents a major public health milestone. Important questions remain, however. These include the durability of protection, optimal booster strategies and performance in diverse epidemiological settings. Vaccine development for S. Paratyphi A and iNTS has also accelerated, with candidates including conjugate, outer membrane vesicle/GMMA and live-attenuated, platforms advancing through preclinical and early clinical evaluation. Multivalent vaccine strategies have attracted growing interest. However, the divergent epidemiology of typhoidal and non-typhoidal disease, including differences in age-specific risk and geographic distribution, raises important questions about whether a single combination product is suitable for all settings.
SUMMARY
The Salmonella vaccine landscape is evolving rapidly from a focus on typhoid alone toward broader protection against multiple clinically important serovars. Although recent progress is encouraging, important scientific, regulatory, and implementation challenges remain. The practical case for integrated Salmonella vaccine strategies will depend on careful matching of vaccine composition to the differing epidemiology, age-specific risks, and delivery contexts of typhoidal and nontyphoidal disease.
Michael Blank, A. Rýdlová, M. Gibani· Current Opinion in Infectiou...· 0 citations
BACKGROUND
Diverse quarantine measures against the coronavirus disease 2019 (COVID-19) pandemic have affected the distribution patterns of respiratory pathogens. This study analyzed changes in the incidence and distribution of major respiratory pathogens during the COVID-19 pandemic and after the endemic declaration. In addition, the study aimed to provide a basis for future community-centered infectious disease response strategies by identifying co-infection patterns and whether pathogens re-emerge after mitigation.
METHODS
In this retrospective study, the results of 105,619 respiratory pathogen tests, including FilmArray® Respiratory Panel (BioFire Diagnostics) assay (FilmArray RP), influenza tests, and COVID-19 tests, were collected at a Korean university hospital during the COVID-19 pandemic (Period I: March 2021 through April 2023) and endemic (Period II: May 2023 through February 2025). The changes in the distribution of major pathogens, age and gender characteristics, seasonality, and co-infection patterns were compared between the two periods.
RESULTS
The overall positivity rate for the FilmArray RP significantly increased from 64.4% in Period I to 71.1% in Period II (p < 0.001). In the age-specific analysis, age group 3 (4 months to 2 years) had the highest positivity rate in Period II (82.7%). Human rhinovirus/enterovirus was the most frequently detected pathogen, whereas respiratory syncytial virus cases increased in number, but decreased in proportion to all positive cases in Period II. The prevalence of adenoviruses and Mycoplasma pneumoniae has significantly increased since the pandemic. Human metapneumovirus has shifted its seasonality from autumn to summer and spring, whereas parainfluenza virus 3 has shifted from autumn to spring and summer. Among all positive cases, co-infections significantly increased to 17.6% and 22.3% during Periods I and II, respectively (p < 0.001).
CONCLUSIONS
This study revealed significant changes in the incidence, seasonality, age characteristics, and co-infection patterns of respiratory pathogens after the mitigation of COVID-19. These changes result from the re-emergence of pathogens that were suppressed during the pandemic, immune vaccination, and the resumption of social activities, suggesting the need to establish an age- and pathogen-specific surveillance system for future infec-tious disease responses.
Yeong-gyeong Kim, Dong Ja Kim, E. Nam et al.· Clinical Laboratory· 0 citations
The identification of a novel A2–B3 recombinant lineage provides evidence of ongoing viral evolution through recombination, a mechanism that may alter transmissibility, virulence, or immune responses, and underscores the importance of whole-genome surveillance for accurate viral characterization.
A. Fall, C. Morris, O. Elgazayerly et al.· Microbiology spectrum· 0 citations
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