Preoperative Pain: The Hidden Risk You Shouldn’t Ignore

 

INTRODUCTION 🧠

Perioperative neurocognitive disorder (PND) represents a significant clinical challenge, particularly in the elderly population, as it involves a decline in cognitive function after surgery. While postoperative pain is already recognized as a contributing factor to PND, the impact of preoperative inflammatory pain remains underexplored. This study aimed to investigate how pre-existing inflammatory conditions, induced via Complete Freund's Adjuvant (CFA), influence both postoperative pain and the cognitive decline typically associated with surgery. Using a well-established tibial fracture model in aged C57BL/6 mice, we monitored pain sensitivity and behavioral changes in the days surrounding the surgical intervention. Our goal was to provide insight into the underlying biological mechanisms connecting preoperative inflammation, pain sensitization, and cognitive deterioration, and to uncover potential targets for therapeutic intervention.

MODEL ESTABLISHMENT AND STUDY DESIGN 🧪

To understand the relationship between inflammatory pain and cognitive outcomes after surgery, a dual-model approach was employed in 14-month-old C57BL/6 mice. First, an inflammatory pain model was induced by intraplantar injection of CFA, creating a persistent localized inflammatory state. One week later, a PND model was established through a tibial fracture surgery under anesthesia. Key physiological indicators such as paw withdrawal threshold and body weight were tracked to assess pain and systemic health. By designing a timeline that allowed preoperative inflammation to develop prior to surgical insult, the model closely mimics clinical scenarios where patients present with pre-existing pain conditions before undergoing surgery. This setup enabled precise investigation into how prior inflammation might sensitize the nervous system to exacerbate postoperative complications.

EFFECTS ON POSTOPERATIVE PAIN AND COGNITIVE FUNCTION 🔬

Our findings clearly demonstrate that preoperative CFA injection worsened postoperative outcomes. Mice exposed to CFA prior to surgery exhibited significantly lowered paw withdrawal thresholds postoperatively, indicating heightened pain sensitivity. In parallel, behavioral tests revealed more severe cognitive deficits in these mice compared to those undergoing surgery alone. These observations support the hypothesis that pre-existing inflammatory pain primes the central nervous system, creating a hyper-responsive state that amplifies the impact of surgical trauma. This synergy between chronic inflammation and surgical insult appears to increase both pain perception and vulnerability to neurocognitive dysfunction, further emphasizing the need for early detection and management of inflammation before surgery.

NEUROINFLAMMATORY RESPONSE IN THE HIPPOCAMPUS 🧬

One of the major mechanistic insights from this study relates to the elevated neuroinflammatory response observed in the hippocampus of CFA-treated mice post-surgery. Immunofluorescence and protein analyses revealed that the combination of CFA and surgery led to increased activation of microglia and astrocytes—two glial cell types involved in neuroinflammation. Correspondingly, we observed elevated levels of pro-inflammatory cytokines including IL-1β, IL-6, and TNF-α. These inflammatory markers are known to impair synaptic plasticity and neuronal function, providing a plausible link between glial activation and cognitive deficits. The heightened glial response indicates that preoperative inflammation not only exacerbates local pain but also triggers central inflammatory pathways that impair cognition.

α7nAChR AND CAP DYSFUNCTION AS A MECHANISM 🧩

The cholinergic anti-inflammatory pathway (CAP), mediated by the alpha7 nicotinic acetylcholine receptor (α7nAChR), plays a critical role in modulating inflammation in the brain. In this study, surgery-induced reduction in α7nAChR expression was further worsened by preoperative CFA administration. This downregulation impairs the CAP, potentially removing a key brake on neuroinflammation. Without proper cholinergic regulation, microglia and astrocytes remain activated longer, contributing to prolonged inflammatory signaling and neuronal damage. The loss of α7nAChR function thus appears to be a pivotal mechanism through which preoperative pain exacerbates cognitive outcomes, making it a potential target for therapeutic modulation in the context of PND.

ROLE OF HMGB1 IN INFLAMMATORY CASCADE 🔥

Another significant molecular finding was the overexpression of High Mobility Group Box 1 (HMGB1) protein in the hippocampus following surgery, especially in mice pre-treated with CFA. HMGB1 is a well-known danger-associated molecular pattern (DAMP) molecule that can activate toll-like receptors and promote cytokine release, thereby amplifying neuroinflammation. Its elevated expression indicates a prolonged and more aggressive inflammatory response in the brain when surgery is preceded by peripheral inflammation. Together with α7nAChR dysfunction, HMGB1 upregulation forms part of a vicious cycle that sustains glial activation and impairs recovery. These insights provide compelling evidence that managing preoperative inflammation could significantly reduce HMGB1-mediated neurotoxicity in surgical patients.

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#Neuroinflammation #PostoperativePain #CognitiveDisorder #PND #PreoperativePain #α7nAChR #HMGB1 #MicrogliaActivation #Astrocytes #BehavioralNeuroscience #MouseModel #Neurodegeneration #SurgeryModel #InflammatoryPain #CFA #TibialFracture #AgingBrain #IL6 #TNFalpha #NeuroscienceResearch

How EGCG & I3A Team Up to Stop Pseudomonas | A Natural Defense Strategy

 

INTRODUCTION
Microbial contamination remains a critical challenge in the food industry, posing risks to both food safety and shelf life. Among food spoilage microorganisms, Pseudomonas aeruginosa stands out due to its robust biofilm formation and resistance mechanisms. Synergistic bacteriostatic strategies are emerging as promising solutions to mitigate such threats, combining agents to enhance antimicrobial efficacy beyond their individual capacities. This study centers on the combination of epigallocatechin gallate (EGCG), a polyphenolic compound found in green tea, and indole-3-carboxaldehyde (I3A), a microbial-derived compound known for its oxidative effects. The research investigates the interaction of these compounds in combating foodborne spoilage bacteria, with a particular focus on their synergistic effects on P. aeruginosa. A key metric, the fractional inhibitory concentration index (FICI), was employed to quantify synergy, with a value of 0.25 indicating a strong synergistic effect. The results open a path for further mechanistic exploration and practical applications in food preservation.

SYNERGISTIC INHIBITION OF FOODBORNE MICROBES
The study demonstrated that the combination of EGCG and I3A exerts a significant synergistic inhibitory effect on multiple food spoilage organisms, most notably P. aeruginosa. The observed FICI value of 0.25 reflects a powerful interaction between the two agents, suggesting that the duo can work more effectively together than either alone. This outcome is vital in the development of safer and more sustainable antimicrobial strategies for the food industry, reducing reliance on synthetic preservatives. The findings reveal that the EGCG-I3A combination not only halts bacterial growth but also suppresses survival mechanisms, indicating its potential as a broad-spectrum solution against food-related pathogens.

CELL WALL AND MEMBRANE DISRUPTION MECHANISM
Further investigation into the mechanism of action revealed that EGCG compromises the structural integrity of P. aeruginosa by disrupting both its cell wall and membrane. This disruption increases cellular permeability, rendering the bacteria more susceptible to environmental stressors and antimicrobial agents. I3A’s presence enhances the bactericidal action by introducing oxidative stress within the bacterial cells. Together, they destabilize the cell’s defensive barriers, triggering a cascade of lethal intracellular events. This dual attack undermines bacterial survival at both the structural and molecular levels, strengthening the case for this combinatory approach in microbial control.

OXIDATIVE STRESS AND METABOLIC DISRUPTION
A notable finding in this study is the elevation of intracellular reactive oxygen species (ROS) in P. aeruginosa following treatment with EGCG and I3A. This oxidative surge induces metabolic stress, leading to damage of essential biomolecules. Metabolomic analysis revealed significant disruptions in the glutathione and taurine metabolic pathways—key systems responsible for maintaining redox balance. The perturbation of these pathways undermines the cell’s oxidative defense, compounding the effects of ROS and tipping the redox homeostasis toward cytotoxicity. These insights clarify the oxidative mechanism behind the synergy and present new targets for enhancing bacteriostatic treatments.

BIOFILM INHIBITION AND QUORUM SENSING SUPPRESSION
Biofilm formation is a major defense mechanism of P. aeruginosa, facilitating persistence on food surfaces. The study found that EGCG-I3A treatment inhibits biofilm development in a dose-dependent manner, with higher I3A concentrations correlating with greater inhibition. Furthermore, key biofilm-related metabolites such as uracil, proline, and glutamate were found to be downregulated, suggesting suppression of quorum sensing (QS), the bacterial communication system essential for biofilm maturation. These findings indicate that the combination not only eradicates existing bacteria but also prevents colonization and surface adherence, thereby significantly enhancing food preservation potential.

APPLICATION IN FOOD MATRIX AND FUTURE PROSPECTS
Beyond in vitro assays, the synergistic treatment proved effective in a real-world context by significantly inhibiting P. aeruginosa growth in fish meat. This outcome highlights the potential application of EGCG and I3A in food systems, offering a natural and safe means of extending shelf life. Given the global trend toward clean-label and sustainable food preservation methods, such natural synergistic agents align well with consumer and industry demands. Future research should explore dosage optimization, compound stability in diverse food matrices, and regulatory pathways for commercialization, moving this promising strategy closer to practical deployment.

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#FoodSafety #AntimicrobialResistance #BiofilmControl #NaturalPreservatives #FoodMicrobiology #SynergisticEffect #EGCG #I3A #PseudomonasAeruginosa #ReactiveOxygenSpecies #OxidativeStress #RedoxHomeostasis #FoodPreservation #GreenTeaExtract #IndoleDerivatives #BacterialMembraneDisruption #QuorumSensingInhibition #Metabolomics #CleanLabel #SustainableFoodTech

Three Asparagine insertions in the K13-propeller led to Plasmodium falciparum becoming resistant to multiple antimalaria drugs

 

1. Introduction

Malaria remains a significant global health burden, with Plasmodium falciparum as the most lethal parasite species causing severe and often fatal disease. The emergence of drug resistance, especially against artemisinin and its derivatives, has threatened control and eradication efforts. Molecular markers that can detect resistance early are crucial for improving treatment strategies. The Kelch 13 (K13) gene has been a primary focus due to its established association with artemisinin resistance. In this study, advanced CRISPR/Cas9 genome-editing technology was employed to investigate how specific insertions in the K13 gene affect drug sensitivity and parasite development, offering insights into new resistance mechanisms.

2. Application of CRISPR/Cas9 Technology in Genetic Modification of P. falciparum

The application of CRISPR/Cas9 has revolutionized malaria research by allowing precise, targeted modifications within the parasite genome. In this study, CRISPR/Cas9 was utilized to insert one, two, or three asparagine residues immediately after the 142nd amino acid in the K13 gene of the P. falciparum 3D7 strain. This precision editing generated three distinct strains—1N-3D7, 2N-3D7, and 3N-3D7—enabling controlled exploration of how incremental genetic modifications impact parasite behavior, drug resistance, and fitness.

3. Influence of Asparagine Insertions on Ring-Stage Survival Assay Outcomes

The Ring-Stage Survival Assay (RSA) is a pivotal tool for detecting artemisinin resistance in P. falciparum. Analysis revealed that inserting asparagine residues into the K13 gene resulted in a direct increase in RSA values, correlating the number of inserted residues with enhanced survival under drug pressure. Notably, 3N-3D7 demonstrated the highest RSA values, indicating that multiple insertions significantly strengthen the parasite's resistance profile during the critical early ring stages, which are primarily targeted by artemisinin derivatives.

4. Comparative Drug Sensitivity Profiles among Modified Strains

Drug sensitivity testing across ten antimalarial compounds highlighted important differences among the genetically modified strains. 1N-3D7 and 2N-3D7 showed similar IC50 values and exhibited resistance specifically to Naphthoquine, suggesting that single or double asparagine insertions confer comparable levels of resistance. However, 3N-3D7 exhibited notably higher IC50 values against five drugs—Artesunate, Artemether, Dihydroartemisinin, Pyronaridine Phosphate, and Naphthoquine—demonstrating a broader and more potent drug-resistant phenotype, confirming the critical impact of the triple insertion.

5. Impact of Triple Asparagine Insertion on Parasite Developmental Dynamics

Further investigations into the parasite's life cycle indicated that 3N-3D7 parasites experienced significant developmental alterations within red blood cells. The ring stage was prolonged, whereas the trophozoite phase was shortened. Although schizont development remained synchronous with the wild-type, mature schizonts in the 3N-3D7 strain contained fewer merozoites. These developmental changes suggest a complex adaptive response to the stress of drug exposure, possibly linked to the observed fitness costs.

6. Fitness Costs Associated with Enhanced Drug Resistance

Despite its increased drug resistance, the 3N-3D7 strain suffered a measurable fitness cost when co-cultured with the wild-type 3D7 strain. The proportion of 3N-3D7 parasites declined steadily, and the calculated fitness cost was approximately 14.88±2.87. These findings underscore a critical trade-off in P. falciparum: while genetic modifications can confer survival advantages under drug pressure, they may simultaneously impair overall parasite fitness and competitiveness in drug-free environments. This duality offers important insights for developing sustainable malaria control strategies.

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Hashtags

#PlasmodiumFalciparum #MalariaResearch #DrugResistance #Kelch13 #CRISPRCas9 #GenomeEditing #ArtemisininResistance #RingStageSurvivalAssay #MalariaTreatment #GeneticMarkers #AntimalarialDrugs #ParasiteFitness #MalariaEradication #DrugSensitivity #PfalciparumGenetics #MalariaDrugDevelopment #MolecularParasitology #MalariaControl #PyronaridinePhosphate #NaphthoquineResistance

How Dietary Fibers Ignite Fat Burning in Rats 🔥

 

INTRODUCTION

Dietary fibers, essential components of a balanced diet, are categorized based on solubility into soluble dietary fiber (SDF) and insoluble dietary fiber (IDF), each serving distinct physiological functions. Recent studies have shown their significant role not only in gut health but also in systemic metabolic processes like thermogenesis. This research focused on exploring how the solubility of dietary fibers influences body heat production and gut microbiota composition in rats. By utilizing a model with twenty-four male Sprague Dawley rats divided into three dietary groups (no fiber, SDF, and IDF), the study aimed to identify specific mechanisms and biological changes induced by these fibers. The findings provide critical insights into the metabolic benefits of SDF and IDF, establishing their potential therapeutic applications for obesity and metabolic diseases.

EFFECTS OF SOLUBLE AND INSOLUBLE FIBERS ON BODY WEIGHT AND FEED INTAKE

The intake of dietary fibers had a marked impact on body weight management and feed consumption among the rats. Notably, rats in the SDF group exhibited significantly lower body weight gain and feed intake compared to the control group (P < 0.001). These results suggest that SDF not only reduces appetite but also promotes satiety, likely contributing to improved energy balance. In contrast, the IDF group did not exhibit a comparable reduction in body weight or intake, highlighting the unique effectiveness of soluble fibers. The distinct outcomes between SDF and IDF underscore the importance of fiber type in dietary interventions targeting obesity and related metabolic disorders.

IMPROVEMENTS IN GLUCOSE TOLERANCE VIA FIBER SUPPLEMENTATION

Both soluble and insoluble fiber supplementation led to notable improvements in glucose tolerance among the rats. The study demonstrated that rats fed either SDF or IDF had significantly enhanced glucose tolerance compared to the fiber-free control group (P < 0.05). This improvement is indicative of better insulin sensitivity and glucose metabolism, which are crucial factors in preventing type 2 diabetes. The mechanism behind this beneficial effect may involve the modulation of gut microbiota, reduction of systemic inflammation, and improved metabolic signaling pathways influenced by fiber intake, showcasing dietary fibers as a simple yet powerful tool in metabolic health management.

GENE EXPRESSION OF THERMOGENESIS-RELATED MARKERS IN WHITE ADIPOSE TISSUE

One of the groundbreaking findings of the study was the upregulation of thermogenesis-related genes in inguinal white adipose tissue due to fiber intake. Specifically, the mRNA expression of CIDEA, HOXC8, and TMEM26 was significantly elevated in rats receiving both SDF and IDF (P < 0.05). These genes are associated with the browning of white fat, a process that transforms energy-storing white fat into energy-burning beige fat. The activation of these genes suggests that both types of fibers contribute to an enhanced thermogenic capacity in white adipose tissue, offering a promising strategy for increasing energy expenditure and combating obesity.

UCP1 AND THERMOGENIC PROTEIN EXPRESSION IN BROWN ADIPOSE TISSUE

Soluble dietary fiber exhibited a superior ability to stimulate thermogenic protein expression in brown adipose tissue. Rats in the SDF group had significantly higher levels of UCP1, CIDEA, and HOXC8 proteins compared to the control group (P < 0.01). UCP1 plays a pivotal role in uncoupling oxidative phosphorylation, thereby generating heat instead of storing energy as ATP. This enhanced expression indicates that SDF can potentiate the thermogenic function of brown fat, providing an additional metabolic advantage. The ability of soluble fibers to activate brown fat thermogenesis represents a novel nutritional approach to increase basal metabolic rate and support weight loss.

MODULATION OF GUT MICROBIOTA BY SOLUBLE FIBER

Another critical aspect of the study was the impact of fiber solubility on gut microbial composition. Rats in the SDF group showed a significant increase in the abundance of beneficial genera such as Faecalibaculum and Gemmiger, both members of the Clostridiales order (P < 0.001). These microbes are known to produce short-chain fatty acids (SCFAs), which enhance energy metabolism and stimulate thermogenesis. The findings highlight how soluble fibers can selectively enrich beneficial gut bacteria, leading to systemic metabolic improvements. This microbiota modulation represents an important mechanism through which dietary fibers exert their anti-obesity and pro-metabolic effects.

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 Hashtags

#DietaryFiber #SolubleFiber #InsolubleFiber #Thermogenesis #GutMicrobiota #MetabolicHealth #ObesityResearch #GlucoseTolerance #UCP1 #BrownFatActivation #WhiteFatBrowning #AdiposeTissue #GeneExpression #GutHealth #MicrobiomeResearch #NutritionalScience #EnergyMetabolism #FiberResearch #WeightManagement #Clostridiales

Revolutionary Biosensor Reveals How Early Antibiotics Shape Kids' Health

 

INTRODUCTION 🧠

The early years of a child’s life are foundational for emotional and behavioral development, governed by intricate neurobiological and environmental interactions. While antibiotics are widely prescribed during infancy and early childhood, limited research has examined their long-term effects on psychological health. Emotions and behaviors serve as key windows into brain function, yet few studies incorporate a continuous assessment of these traits in relation to antibiotic exposure. This research addresses a significant gap by investigating the association between early antibiotic use and emotional-behavioral trajectories during preschool years. Focusing on a population-based cohort from Ma'anshan, Anhui, this study explores not just the presence of antibiotic exposure but also categorizes types and examines dose-duration relationships. The findings contribute to emerging literature that suggests a biological linkage between gut microbiota alterations caused by antibiotics and neurodevelopmental outcomes. This introduction sets the stage for a deeper analysis of how specific antibiotic types, alone or in combination, can impact child development across multiple behavioral domains.

RESEARCH DESIGN AND COHORT OVERVIEW 🧾

The foundation of this study lies in the longitudinal Ma'anshan-Anhui Birth Cohort, which provides a valuable resource for examining developmental health outcomes. A total of 1147 mother-child pairs were enrolled, enabling an in-depth analysis of early antibiotic use and behavioral development. The data collection involved repeated parental reports on antibiotic exposure before the age of three, encompassing binary use (yes/no), specific antibiotic classes, and duration of treatment. Emotional and behavioral development was assessed at 48, 60, and 72 months using the Strengths and Difficulties Questionnaire (SDQ), a widely validated tool for measuring child psychosocial functioning. By utilizing three timepoints, the study captures dynamic trajectories rather than static outcomes, allowing for a nuanced interpretation of behavioral progression. This cohort-based, prospective design is particularly suited to uncover temporal associations and mitigate recall bias, strengthening the validity of findings. The detailed categorization of antibiotic use by type and duration also supports a more precise understanding of potential dose-response relationships.

ANTIBIOTIC USAGE PATTERNS IN EARLY CHILDHOOD 💊

Among the 1147 children studied, 23.3% had used antibiotics within the three months preceding data collection. The study categorized antibiotics into β-lactams (further divided into penicillin and non-penicillin types) and macrolides, which are commonly prescribed for respiratory and ear infections in children. This classification allowed researchers to investigate not only the general effects of antibiotics but also to analyze the unique impacts of specific types. Notably, non-penicillin β-lactams stood out in association with behavioral changes. The frequency and duration of use were key variables, revealing that repeated or prolonged exposure might carry cumulative effects on brain-behavior pathways. These patterns are vital in understanding how routine medical practices might inadvertently influence developmental outcomes, particularly when antibiotics are overprescribed or administered without strict diagnostic criteria.

TRAJECTORIES OF EMOTIONAL AND BEHAVIORAL DEVELOPMENT 📈

Behavioral and emotional development was assessed using the SDQ at ages 48, 60, and 72 months, tracking changes in five domains: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Analysis revealed distinct developmental trajectories, with particular emphasis on hyperactivity levels. Children exposed to antibiotics, especially those who used β-lactam agents, displayed consistently elevated hyperactivity scores across all timepoints. Moreover, combined antibiotic regimens (e.g., β-lactam and macrolides) were linked to higher total difficulties and increased emotional symptoms. These trajectories underscore the potential for early antibiotic exposure to disrupt neurobehavioral regulation, possibly through microbiome-mediated mechanisms affecting neurotransmitter activity, inflammation, or brain plasticity during critical periods of growth.

ANTIBIOTIC TYPE, DURATION, AND DOSE-RESPONSE INSIGHTS ⏳

One of the study’s pivotal findings is the dose-response relationship between antibiotic duration and hyperactivity outcomes. Non-penicillin β-lactam antibiotics were particularly implicated, showing that longer exposure correlated with a greater risk of elevated hyperactivity. These results suggest that not all antibiotics carry the same neurodevelopmental risks, and duration plays a significant moderating role. Furthermore, when β-lactams were combined with macrolides, a broader spectrum of emotional and behavioral difficulties emerged. This adds to growing evidence that early-life antibiotic exposure may disrupt the gut-brain axis, particularly when exposure is prolonged or involves multiple antibiotic classes. Such findings have important implications for pediatric prescribing practices and emphasize the need for caution in repeated or combined antibiotic therapies.

IMPLICATIONS AND FUTURE DIRECTIONS 🔬

This study contributes novel insights into the intersection between pediatric antibiotic use and emotional-behavioral development, urging reconsideration of current medical protocols. Given the widespread use of antibiotics in early childhood, these findings raise concerns about long-term neurodevelopmental consequences, especially in the context of unnecessary prescriptions. The potential mechanisms—likely involving gut microbiota alterations—highlight a promising area for further exploration. Future studies should aim to integrate microbiome sequencing data, neuroimaging, and experimental interventions to unravel causality and develop preventive strategies. Clinicians, researchers, and public health authorities must work collaboratively to balance the benefits of antibiotic treatment with the emerging risks to mental health. Early identification of at-risk children, parent education, and more judicious use of antibiotics may ultimately help mitigate developmental impacts and support healthier emotional and behavioral outcomes in the population.

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#ChildDevelopment #Antibiotics #EmotionalHealth #BehavioralScience #Neurodevelopment #PreschoolHealth #EarlyIntervention #PediatricPsychology #MicrobiomeBrainAxis #MentalHealth #StrengthsAndDifficulties #GutBrainConnection #PublicHealth #EarlyChildhood #AntibioticImpact #BrainDevelopment #PediatricResearch #LongitudinalStudy #Hyperactivity #PreventiveCare

When COVID-19 Meets Diabetes: A Surprising Biosensor Breakthrough! 🔬

 

INTRODUCTION 🦠

The emergence of coronavirus disease 2019 (COVID-19) marked a pivotal moment in global health, triggering an urgent need to investigate its interactions with pre-existing conditions, particularly chronic diseases like diabetes. As survivors of COVID-19 increasingly express concern over potential long-term complications, researchers have begun to explore how the virus may contribute to the onset or exacerbation of diabetes. This study provides a comprehensive bibliometric analysis of global scientific trends from January 2020 to December 2023, focusing on diabetes-related research within the COVID-19 context. Using the Web of Science Core Collection (WoSCC) and advanced CiteSpace visualization tools, 7,348 relevant publications were identified and analyzed. The review reveals significant insights into major contributors, research hotspots, and evolving themes. It highlights the importance of diabetes as a comorbid condition in COVID-19 cases and underscores the need for targeted research to inform clinical strategies and health policies. This overview sets the stage for a deeper understanding of the relationship between viral infections and metabolic disorders, framing the importance of this inquiry for future healthcare resilience.

GLOBAL RESEARCH LANDSCAPE 🌍

The pandemic spurred an unprecedented global response in biomedical research, with diabetes and COVID-19 emerging as a critical area of investigation. This bibliometric study reveals that China and the United States are the most prolific contributors, leading the charge in publication volume. Prestigious institutions such as Harvard Medical School, Wuhan University, and Huazhong University of Science and Technology are among the top academic hubs driving this research forward. Authors like Khunti Kamlesh and Rizzo-Manfredi have emerged as high-yield contributors, often collaborating within a tightly-knit network of leading scientists. Such collaboration is evident in the co-authorship patterns and institutional affiliations found in the dataset. The academic landscape demonstrates not only the importance of multidisciplinary teams but also the influence of established research centers in accelerating discovery. By mapping these contributions, we gain a clearer understanding of how the global research community has responded to the intersection of infectious disease and chronic illness, building a foundation for coordinated and collaborative science in future health crises.

THEMATIC EVOLUTION IN RESEARCH 🔍

From 2020 to 2023, the thematic focus of diabetes and COVID-19 research has shifted significantly. Early studies primarily addressed the acute clinical manifestations of diabetes in patients with COVID-19, including the impact of hyperglycemia on outcomes and the role of corticosteroids. However, as the pandemic evolved, research expanded to include metabolic syndrome, gestational diabetes, and the role of angiotensin-converting enzymes in disease progression. Using CiteSpace clustering and keyword co-citation analysis, this study highlights key themes such as "clinical characteristics," "diabetes mellitus," and "viral infection." These clusters reveal a growing interest in the pathophysiological mechanisms linking the two diseases, particularly in the context of chronic inflammation and immune dysregulation. The thematic evolution suggests a maturation of the research field, moving from observational studies toward mechanistic and interventional investigations. This trend is critical for designing effective treatment protocols and guiding public health recommendations for high-risk populations.

HIGH-IMPACT PUBLICATIONS AND CITATIONS 📚

One of the clearest indicators of a research article’s influence is its citation count, and Zhou et al.’s publication in The Lancet—cited 1,366 times—stands out as a seminal work in this domain. High-impact publications like this one not only provide early insights into the intersection of COVID-19 and diabetes but also shape the trajectory of subsequent research. Bibliometric data reveals a citation ecosystem centered around foundational studies on clinical risk factors, viral pathogenesis, and metabolic implications. The most frequently cited articles often originate from journals with high impact factors, suggesting that rigorous peer review and methodological robustness contribute to visibility and influence. These citation patterns also underscore the reliance of new studies on a core set of authoritative references, highlighting the importance of foundational science in crisis contexts. By examining the most influential works, researchers can identify key knowledge gaps and prioritize questions that remain unresolved.

CLINICAL IMPLICATIONS AND PRACTICE GUIDELINES 🏥

The clinical relevance of this body of research cannot be overstated. As the pandemic evolved, so too did the need for evidence-based treatment guidelines for patients with diabetes affected by COVID-19. Studies captured in this bibliometric analysis have focused heavily on managing glucose levels during infection, predicting outcomes in diabetic patients, and understanding the interplay between viral infection and metabolic control. Findings about angiotensin-converting enzymes and their role in both COVID-19 and diabetes have informed pharmaceutical strategies, including the use of ACE inhibitors. Additionally, the identification of gestational diabetes as a vulnerable subgroup has prompted new considerations for maternal-fetal health. Clinical insights drawn from this research corpus are now informing real-world decision-making in hospitals and healthcare systems. Future practice guidelines will benefit from the synthesis of this expanding evidence base, especially as long-term outcomes of COVID-19 survivors continue to emerge.

FUTURE DIRECTIONS AND RESEARCH GAPS 🔬

While the global research effort has made significant strides, numerous questions remain unanswered. What are the long-term metabolic consequences of COVID-19 in previously healthy individuals? How does the virus influence insulin resistance or pancreatic beta-cell function over time? Can early intervention mitigate post-viral diabetes onset? This bibliometric review reveals a need for longitudinal studies, especially those that explore causality and not just correlation. It also highlights the underrepresentation of certain geographic regions and populations in the current literature. As precision medicine and digital health technologies evolve, integrating genetic, environmental, and behavioral data will become crucial. Furthermore, interdisciplinary approaches involving endocrinology, virology, and data science are essential to comprehensively address the complex relationship between COVID-19 and diabetes. Funding bodies and academic institutions must prioritize research that bridges these domains to anticipate and prevent chronic illness in post-pandemic populations.

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#COVID19 #DiabetesResearch #Bibliometrics #CiteSpace #PublicHealth #GlobalHealth #ScientificTrends #MetabolicSyndrome #ACE2 #ViralInfection #HarvardMedicalSchool #ZhouEtAl #GestationalDiabetes #InsulinResistance #LongCOVID #MedicalResearch #ChronicDiseases #HealthPolicy #PandemicResponse #ClinicalGuidelines

Egg Yolk vs Bacteria 🥚🔬 | Cutting-Edge Biosensor Breakthrough

 

INTRODUCTION 🧬

Intracellular bacterial infections pose significant therapeutic challenges due to the inability of many antibiotics to penetrate cellular membranes and reach effective intracellular concentrations. This research targets the eradication of intracellular Staphylococcus aureus, a pathogen known for its persistence within host cells and resistance to conventional treatments. To overcome this limitation, a novel drug delivery system was designed using hen egg-yolk-derived low-density lipoproteins (heLDLs) to encapsulate Ceftiofur (CEF), an antibiotic with established efficacy against S. aureus. The formulation, referred to as CEF-heLDLs, aims to facilitate targeted intracellular drug delivery, thereby enhancing antibacterial efficacy and reducing mortality associated with intracellular infections. This study presents a comprehensive evaluation of the physicochemical properties, cellular uptake mechanisms, biodistribution, and in-vitro and in-vivo antibacterial activities of CEF-heLDLs.

FORMULATION AND DRUG-LOADING CHARACTERISTICS ⚗️

The design and development of the CEF-heLDL system began with the extraction of low-density lipoproteins from hen egg yolks, a biocompatible and natural carrier. Ceftiofur was successfully loaded into these carriers, achieving a high encapsulation rate of approximately 99.31% ± 0.63% and a drug-loading efficiency of 44.48% ± 2.35%. The resulting nanoparticles demonstrated reduced particle size and increased absolute zeta potential compared to blank heLDLs, which are indicative of improved stability and dispersion. These physicochemical enhancements play a critical role in ensuring the particles remain stable in physiological environments, a prerequisite for efficient drug delivery. The high encapsulation rate and stable characteristics of CEF-heLDLs highlight the potential of heLDLs as effective nano-carriers for intracellular drug delivery.

CELLULAR UPTAKE AND LOCALIZATION 🔬

In-vitro cellular uptake studies revealed that the CEF-heLDLs enter cells via receptor-mediated endocytosis, leveraging the natural pathways of LDL receptors. Confocal microscopy confirmed the colocalization of CEF-heLDLs with lysosomes, suggesting successful intracellular trafficking of the antibiotic. This lysosomal targeting is essential for reaching intracellular compartments where S. aureus may reside. The receptor-specific entry pathway also minimizes off-target effects and enhances selective drug accumulation within infected cells. These findings validate the efficiency of the heLDL-based delivery system in overcoming cellular barriers and ensuring site-specific drug release.

BIODISTRIBUTION AND SYSTEMIC DELIVERY 🧫

In-vivo localization studies in mouse models demonstrated that CEF-heLDLs exhibit a multiorgan biodistribution profile, indicating effective systemic circulation and penetration into various tissues. This widespread distribution is advantageous for treating infections that may not be localized, providing therapeutic coverage across multiple sites. The heLDL vector ensures that the encapsulated CEF is shielded from rapid degradation or clearance, allowing for prolonged therapeutic presence and action. This property enhances the practicality of CEF-heLDLs for clinical applications in systemic and intracellular infections.

ANTIBACTERIAL EFFICACY AND MECHANISM OF ACTION 🧪

Both in-vitro and in-vivo antibacterial evaluations confirmed the superior performance of CEF-heLDLs against intracellular Staphylococcus aureus. In cellular models, CEF-heLDLs significantly disrupted bacterial cell walls and reduced intracellular bacterial counts (P < 0.001), outperforming free CEF. Animal studies further showed that CEF-heLDLs effectively reduced leukocytosis and mortality in methicillin-resistant S. aureus (MRSA)-infected mice (P < 0.001). The enhancement in antibacterial activity is attributed to the increased intracellular concentration of CEF and improved targeting, which allows the drug to act directly within the infected cells where conventional antibiotics struggle to reach.

CLINICAL IMPLICATIONS AND FUTURE DIRECTIONS 💊

The results of this study underscore the potential of heLDL-based drug delivery systems in enhancing the intracellular efficacy of antibiotics like Ceftiofur. By significantly improving drug stability, cellular uptake, and therapeutic outcomes in challenging infections such as MRSA, CEF-heLDLs offer a promising strategy for next-generation antibacterial therapies. Future research may explore scalability, formulation optimization, and clinical translation of heLDL nanocarriers for human use. Moreover, this platform could be adapted for other antibiotics or therapeutic agents, broadening its applicability in combating a variety of intracellular pathogens.

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Hashtags

#IntracellularInfection #AntibioticResistance #DrugDeliverySystem #Nanomedicine #Ceftiofur #heLDLs #LDLCarrier #SAvsCEF #MRSA #CellTargeting #BiomedicalInnovation #Nanocarriers #ReceptorMediatedUptake #Biodistribution #InVivoEfficacy #IntracellularBacteria #AntibacterialTherapy #TherapeuticNanoparticles #LysosomalTargeting #PharmaceuticalScience

Bacteria to Control Karenia mikimotoi Toxicity

 

INTRODUCTION 🧪
Harmful algal blooms (HABs) have emerged as pressing global environmental and economic concerns due to their detrimental impact on aquatic ecosystems and marine life. Among the harmful algae, Karenia mikimotoi (KMHK) is particularly notorious for its ichthyotoxic properties that can lead to massive fish kills. While the role of environmental factors in modulating algal toxicity is widely studied, the influence of bacteria associated with harmful algae remains relatively underexplored. This study delves into the intricate relationship between K. mikimotoi and its associated bacterial communities, aiming to unravel how bacterial presence and composition influence the alga's toxicity. By comparing xenic (with natural bacterial flora), axenic (bacteria-free), and “re-xenic” (re-inoculated with selected bacterial isolates) KMHK cultures, the research highlights that bacterial type and origin play pivotal roles in modulating ichthyotoxic effects. These findings suggest that understanding bacterial-algal interactions is essential for predicting and mitigating the ecological impacts of HABs.

BACTERIAL MODULATION FO ICHTHYOTOXICITY 🔬

The study demonstrated that bacterial communities associated with Karenia mikimotoi significantly alter its ichthyotoxic potential. Through comparative analysis, researchers found that axenic KMHK cultures showed higher ichthyotoxicity than naturally xenic cultures, suggesting that some bacterial associates may suppress toxicity. More notably, when axenic cultures were re-inoculated with specific bacterial isolates to form “re-xenic” cultures, ichthyotoxicity increased beyond that of the axenic state, highlighting that certain bacteria can enhance toxicity. These results underscore that bacterial modulation of ichthyotoxicity is not only real but also dependent on the bacterial community's identity and structure.

STRAIN-SPECIFIC RESPONSES TO BACTERIAL ASSOCIATION 🧬

An intriguing aspect of the research is the observation that bacterial effects on ichthyotoxicity vary depending on the K. mikimotoi strain. For instance, the Japanese strain NIES2411, known for its high toxicity, exhibited reduced ichthyotoxicity when associated with a white pigmented bacterial isolate. In contrast, the non-toxic New Zealand strain CAWD133 showed no significant change in toxicity regardless of bacterial presence. This strain-specific modulation suggests that the genetic background and metabolic traits of different algal strains play crucial roles in determining the outcome of algal-bacterial interactions.

PIGMENTED BACTERIAL ISOLATES AND TOXICITY EFFECTS 🌈

The study further investigated the impact of bacterial pigmentation as a potential indicator of toxicity modulation. Re-xenic cultures containing white or yellow pigmented bacterial isolates consistently demonstrated higher ichthyotoxic effects than those with red pigmented isolates. This pigmentation-based trend was also reflected in the haemolytic activity of the cultures, where white-pigment-associated KMHK exhibited the most potent effects. These findings point to possible biochemical differences among pigmented bacteria that influence their interaction with algal hosts and, consequently, the host’s toxicity.

HAEMOLYTIC ACTIVITY AS A TOXICITY INDICATOR 🩸

Haemolytic activity served as a complementary indicator for evaluating the ichthyotoxicity of K. mikimotoi cultures. The re-xenic cultures associated with the white bacterial isolate not only increased fish toxicity but also exhibited elevated haemolytic potential, reinforcing the association between bacterial presence and algal virulence. In contrast, the red isolate’s presence resulted in lower haemolytic activity, further supporting the notion that bacterial phenotype and metabolic output may contribute to toxicity regulation. This approach highlights haemolysis as a viable bioassay for toxin assessment in HAB research.

 ECOLOGICAL AND MANAGEMENT IMPLICATIONS 🌊

These findings have significant ecological and applied implications. Understanding the role of bacterial consortia in enhancing or suppressing algal toxicity can inform HAB prediction and mitigation strategies. If bacterial profiles associated with harmful algal species can be identified and monitored, it may become possible to anticipate bloom toxicity more accurately. Additionally, microbial manipulation—introducing non-enhancing bacteria or disrupting symbiotic relationships—may emerge as a novel biocontrol strategy. This study reinforces the complexity of HAB dynamics and emphasizes the importance of microbial context in environmental management.

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First report on EU-wide sales and use of antimicrobials in animals

For the first time, all the 27 countries of the European Union (EU27) together with Iceland and Norway, have collected and reported data on both sales and use of antimicrobials in animals in their countries. The findings are presented in the first European Sales and Use of Antimicrobials for Veterinary Medicine (ESUAvet) annual surveillance report. The data cover the year 2023, marking the beginning of a regular exercise that will result in yearly reports.
Data on sales

Sales of antibiotics for food-producing animals accounted for 98% of total EU sales of veterinary medicines containing substances with antibiotic activity. The highest selling antimicrobial class for food-producing animals were penicillins, followed by tetracyclines and sulfonamides. According to the AMEG categorisation of antibiotics for use in animals for prudent and responsible use, developed by EMA’s ad hoc expert group, approximately 65% of total EU sales for food-producing animals corresponded to substances that belong to category D (which should be used as first line treatments, whenever possible), 29% corresponded to category C (which should be considered only when there are no antibiotics in Category D that could be clinically effective), and 6% corresponded to category B (which are critically important in human medicine but use in animals should be restricted to mitigate the risk to public health).
Data on use

Data on use were collected for four main food-producing animal species in 2023: cattle, pigs, chickens and turkeys. Veterinarians played a key role in gathering data, as they were selected as the sole data providers by 16 reporting countries. The remaining 13 reporting countries used other data providers in addition to veterinarians, including pharmacies, feed mills, farmers or breeders, and retailers.

This is the first time that data on use has been collected across the EU. Many countries are still in the process of setting up or improving data collection systems for antimicrobial use. Therefore, the shared data for 2023 were not complete and accurate enough to start reporting quantitative information. Member States are committed to consolidating their use data collection systems, aiming to increase accuracy and coverage. This initiative has already shown a strong cooperation between reporting countries, as those with experience in data collection on antimicrobial use offered guidance and support, fostering a productive and collaborative environment.
Antimicrobial Sales and Use (ASU) Platform

The ESUAvet report builds on the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) project, a voluntary initiative between national authorities and EMA to collect reliable sales data across Europe over the course of 12 years. A 50% drop in sales of veterinary antibiotics was observed during this time, thanks to the collective efforts of countries who provided the data and developed national strategies to encourage responsible use as well as to practitioners and farmers in the field.

The ESVAC initiative was considered so successful that it has formalised and expanded under EU legislatio to include mandatory data collection on the sales and use of antimicrobials in animals. Member States report their data to EMA via the ASU Platform, a centralised system designed to standardise and streamline the data received from countries.

The data in the annual ESUAvet reports, collected via the ASU Platform, will help to identify trends in antimicrobial consumption in animals more accurately and with more granularity, enabling decision-makers to address the increasing complexity of antimicrobial resistance and to take appropriate measures to protect both animal and human health in Europe.

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Skin cancer is cancer that starts as a growth of cells on the skin. The cells can invade and destroy healthy body tissue. Sometimes the cells break away and spread to other parts of the body.

Many kinds of skin cancer exist. The most common skin cancers are basal cell carcinoma and squamous cell carcinoma. While these are the most common, they often can be cured. The most dangerous form of skin cancer is melanoma. It is more likely to spread, making it harder to cure.

Most skin cancers happen on skin that gets a lot of sunlight. The light that comes from the sun is thought to cause most skin cancers. You can reduce your risk of skin cancer by covering your skin with clothes or sunscreen to protect it from the sun.

Some skin cancers happen on skin that doesn't typically get sun. This likely means that something else is causing these cancers. To reduce your risk of these kinds of skin cancers, check your skin regularly for any changes. Report these changes to your healthcare professional.

Types

• Basal cell carcinoma
• Melanoma
• Nonmelanoma skin cancer
• Squamous cell carcinoma of the skin

Signs and symptoms of skin cancer include:

• A new growth on the skin that might look like a mole, a bump or a scab.
• A rough patch on the skin.
• A sore on the skin that won't heal.
• Changes to a mole or freckle, such as getting bigger or changing color.
• Itchy skin around a skin growth.
• Pain around a skin growth.

Where skin cancer happens

Most skin cancers happen on parts of the body that get a lot of sun. This includes the scalp, face, lips and ears. Other parts of the body that might get sun include the arms, backs of the hands, back and legs.

Skin cancer also can happen on skin that typically doesn't get sun. This includes the palms of the hands, the genitals, and under the fingernails and toenails. When skin cancer happens in people with Black or brown skin, it tends to happen in these places that don't typically get sun.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you notice any changes to your skin that worry you.

Causes

Most skin cancers are caused by exposure to light from the sun. The light that comes from the sun is a kind of ultraviolet light. That kind of light also can come from tanning beds and tanning lamps. Ultraviolet light contains radiation that changes the DNA inside skin cells and leads to skin cancer.

Not all skin cancers happen on skin that typically gets a lot of sun. This means something else also causes skin cancer. It's not always clear what causes skin cancer. But healthcare professionals have found some things that increase the risk. These include having a weakened immune system and having a family history of skin cancer.

Skin cancer starts when skin cells develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time.

In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells can invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Risk factors

Factors that may increase the risk of skin cancer include:

• Skin that sunburns easily. Anyone of any skin color can get skin cancer. But the risk is higher in people with skin that sunburns easily. The risk of skin cancer also is higher in people who have blond or red hair, light-colored eyes or freckles.
• Light from the sun. Ultraviolet light from the sun increases the risk of skin cancer. Covering the skin with clothes or sunblock can help lower the risk.
• Light from tanning beds. People who use indoor tanning beds have an increased risk of skin cancer. The lights used in tanning beds give off harmful ultraviolet light.
• A history of sunburns. Having had one or more sunburns that raised blisters increases the risk of developing skin cancer. If the sunburns happened during childhood, they increase the risk of getting skin cancer as an adult even more.
• A history of skin cancer. People who've had skin cancer once are much more likely to get it again.
• A family history of skin cancer. If a blood relative, such as a parent or sibling, had skin cancer, you may be more likely to get skin cancer.
• A weakened immune system. If the body's germ-fighting immune system is weakened by medicine or disease, there might be a higher risk of skin cancer. People with weakened immune systems include those taking medicine to control the immune system, such as after an organ transplant. Some health conditions, such as HIV infection, also can weaken the immune system.

Prevention

Most skin cancers can be prevented by protecting yourself from the sun. To lower the risk of skin cancer you can:

• Stay out of the sun during the middle of the day. For much of North America, the sun's rays are strongest between about 10 a.m. and 3 p.m. Plan outdoor activities at other times of the day. When outside, stay in shade as much as possible.
• Wear sunscreen year-round. Use a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Apply sunscreen generously. Apply again every two hours, or more often if you're swimming or sweating.
• Wear protective clothing. Wear dark, tightly woven clothes that cover your arms and legs. Wear a wide-brimmed hat that shades your face and ears. Don't forget sunglasses.
• Don't use tanning beds. The lights in tanning beds give off ultraviolet light. Using tanning beds increases the risk of skin cancer.
• Check your skin often and report changes to your healthcare team. Look at your skin often for new growths. Look for changes in moles, freckles, bumps and birthmarks. Use mirrors to check your face, neck, ears and scalp.

Look at your chest and trunk and the tops and undersides of your arms and hands. Look at the front and back of your legs and your feet. Look at the bottom of the feet and the spaces between your toes. Also check your genital area and between your buttocks.

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Herpes Zoster Vaccination Delays Dementia by 20%

A natural experiment on the effect of herpes zoster (shingles) vaccination on dementia offers additional evidence of a dementia-preventing or dementia-delaying effect from zoster vaccination that is less biased than the existing associational evidence.

This new finding is vital as dementia affects more than 55 million people worldwide, with an estimated 10 million new cases every year.

A pivotal study published in the journal Nature on April 2, 2025, reinforces the evidence that standard shingles vaccines may significantly protect older adults against dementia.

Researchers from Stanford Medicine and the Vienna University of Economics and Business analyzed health records of Welsh adults aged 71 to 88.

They found that vaccinated individuals were about 20% less likely to develop dementia over the next seven years compared to those who were not vaccinated.

The authors cautioned that prior studies linking vaccines to improved health outcomes often face scrutiny because vaccinated individuals tend to have healthier behaviors.

In a press release, Dr. Pascal Geldsetzer, the study's senior author, stated, "These associational studies struggle with a fundamental issue: people who get vaccinated generally have different health behaviors than those who don't."

This new finding underscores the need for further research to understand the shingles vaccine's benefits for older adults fully.

According to the U.S. CDC, shingles causes a painful rash. It results from the reactivation of the varicella-zoster virus in adults who typically contracted chickenpox in childhood. The virus stays dormant in the nerve cells for life. In people who are older or have weakened immune systems, the dormant virus can reactivate and cause shingles.

Previously, the journal BMC Public Health published results from a study on October 2, 2023, concluding that both the zoster vaccine for preventing shingles/herpes zoster and the influenza vaccine were associated with a diminished risk of dementia.

This study concluded that the association of herpes-zoster vaccination appeared more pronounced.

And a non-peer-reviewed study published on May 25, 2023, reported that shingles vaccinations were associated with a 19.9% lower risk of dementia.

As of April 2025, various shingles vaccines are offered globally.

Furthermore, the U.S. CDC recommends vaccinations for eligible seniors, which are available at clinics and pharmacies.

Website: International Conference on Infectious Diseases

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WHO guidelines on meningitis diagnosis, treatment and care

In line with the Defeating meningitis by 2030: a global road map, the WHO guidelines on meningitis diagnosis, treatment and care provide evidence-based recommendations for the clinical management of children and adults with community-acquired meningitis, including acute and long-term care.

Meningitis poses a significant public health threat, despite successful efforts to control the disease globally. The burden of morbidity and mortality from meningitis remains high, particularly in low- and middle-income countries and in settings experiencing large-scale, disruptive epidemics. Approximately one in five individuals affected by bacterial meningitis incurs long-term complications, which may result in disability and have a profound impact on quality of life.

The guidelines are primarily intended for health-care professionals working in first- or second-level health-care facilities, including emergency, inpatient and outpatient services. They are also directed at policy-makers, health-care planners and programme managers, academic institutions, non-governmental and civil society organizations to inform capacity-building, teaching and research agendas.

Web annex A provides the quantitative evidence reports, Web annex B summarizes the qualitative and economic evidence and Web annex C presents the Evidence-to-Decision frameworks.

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Immunization coverage

Key facts

Globally in 2023, there were 14.5 million children missing out on any vaccination – so-called zero-dose children.
Coverage of a third dose of vaccine protecting against diphtheria, tetanus, and pertussis (DTP3) was 84% in 2023.
The proportion of children receiving a first dose of measles vaccine was 83% in 2023, well below the 2019 level of 86%.
Global coverage for the first dose of HPV vaccine in girls grew from 20% in 2022 to 27% in 2023.
Coverage of yellow fever vaccine in the countries at risk of it is 50%, well below the recommended 80%.

Overview

While immunization is one of the most successful public health interventions, coverage plateaued in the decade prior to COVID-19. The COVID-19 pandemic, associated disruptions, and vaccination efforts strained health systems in 2020 and 2021, resulting in dramatic setbacks. Data from 2023 show that performance has not yet returned to 2019 levels.

During 2023, about 84% of infants worldwide (108 million) received 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine, protecting them against infectious diseases that can cause serious illness and disability or be fatal. However, these global figures hide significant disparity among countries of different income strata, with low-income countries lagging behind.

Measles, because of its high transmissibility, acts as an early warning system, quickly exposing immunity gaps in the population. Still, 22.2 million children missed their routine first dose of measles, far from the 2019 level of 19.3 million.
Global immunization coverage 2023

A summary of global vaccination coverage in 2023 follows.

Haemophilus influenzae type b (Hib) causes meningitis and pneumonia. The Hib vaccine had been introduced in 193 Member States by the end of 2023. Global coverage with 3 doses of Hib vaccine is estimated at 77%. There is great variation between regions. The WHO European Region is estimated to have 94% coverage, while it is only 33% in the WHO Western Pacific Region.

Hepatitis B is a viral infection that attacks the liver. Hepatitis B vaccine for infants had been introduced nationwide in 190 Member States by the end of 2023. Global coverage with 3 doses of hepatitis B vaccine is estimated at 83%. In addition, 117 Member States introduced 1 dose of hepatitis B vaccine nationwide to newborns within the first 24 hours of life. Global coverage is 45% and is as high as 79% in the WHO Western Pacific Region, while it is estimated at only 17% in the WHO African Region.

Human papillomavirus (HPV) is the most common viral infection of the reproductive tract and can cause cervical cancer in women, other types of cancer, and genital warts in both men and women. One hundred forty-three Member States provided the HPV vaccine in their national immunization schedule and services by the end of 2023, including 13 new introductions. In 2023, 37 countries – representing more than 45% of girls aged 9–14 years old vaccinated in that year – used a 1-dose schedule. Global coverage with the first dose of HPV among girls is now estimated at 27%. While far from the 90% target by 2030, it represents a large increase from 20% in 2022 and was driven by new introductions in several large countries and further improvements in existing programmes, including in countries using the 1-dose schedule.

Bacterial meningitis is an infection that is often deadly and leaves 1 in 5 individuals with long-term devastating sequelae after the acute infection. Before the introduction of MenAfriVac in 2010 – a revolutionary vaccine – Neisseria meningitidis serogroup A (NmA) accounted for 80–85% of meningitis epidemics in the African meningitis belt. By the end of 2023, more than 350 million people in 24 out of the 26 countries in the meningitis belt had been vaccinated with MenAfriVac through campaigns and 15 countries had included MenAfriVac in their routine immunization schedule. In the 26 countries of the meningitis belt, coverage is estimated at 29% in 2023. No case of NmA meningitis has been confirmed since 2017 in the meningitis belt.

Measles is a highly contagious disease caused by a virus, which usually results in a high fever and rash, and can lead to blindness, encephalitis or death. By the end of 2023, 83% of children had received 1 dose of measles-containing vaccine by their second birthday, and 74% of children received 2 doses of measles vaccine. By the end of 2023, 190 Member States had included a second dose of measles vaccine in their national immunization schedules.

Mumps is a highly contagious virus that causes painful swelling at the side of the face under the ears (the parotid glands), fever, headache and muscle aches. It can lead to viral meningitis. Mumps vaccine had been introduced nationwide in 124 Member States by the end of 2023.

Pneumococcal diseases include pneumonia, meningitis and febrile bacteraemia, as well as otitis media, sinusitis and bronchitis. Pneumococcal vaccine had been introduced in 159 Member States by the end of 2023 and global third dose coverage was estimated at 65%. There is great variation between regions. The WHO European Region is estimated to have 86% coverage, while it is only 26% in the WHO Western Pacific Region.

Polio is a highly infectious viral disease that can cause irreversible paralysis. In 2023, 83% of infants around the world received 3 doses of polio vaccine. In 2023, the coverage of infants receiving their first dose of inactivated polio vaccine (IPV) in countries that are still using oral polio vaccine (OPV) is estimated at 83% as well. In these same countries, the coverage of infants receiving their second dose of IPV is estimated at 42%. There is great variation between regions. The WHO European Region is estimated to have 89% coverage, while it is only 6% in the WHO South-East Asia Region. Targeted for global eradication, polio has been stopped in all countries except for Afghanistan and Pakistan. Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries.

Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. Rotavirus vaccine was introduced in 123 countries by the end of 2023. Global coverage was estimated at 55%.

Rubella is a viral disease which is usually mild in children, but infection during early pregnancy may cause fetal death or congenital rubella syndrome, which can lead to defects of the brain, heart, eyes and ears. Rubella vaccine was introduced nationwide in 175 Member States by the end of 2023, and global coverage was estimated at 71%.

Tetanus is caused by a bacterium which grows in the absence of oxygen, for example in dirty wounds or the umbilical cord if it is not kept clean. The spores of C. tetani are present in the environment irrespective of geographical location. It produces a toxin which can cause serious complications or death. Maternal and neonatal tetanus persist as public health problems in 10 countries, mainly in Africa and Asia.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. As of 2023, yellow fever vaccine had been introduced in routine infant immunization programmes in 37 of the 42 countries and territories at risk for yellow fever in Africa and the Americas. In these 42 countries and territories, coverage is estimated at 50%.
Key challenges

In 2023, 14.5 million infants did not receive an initial dose of DTP vaccine, pointing to a lack of access to immunization and other health services, and an additional 6.5 million are partially vaccinated. Of the 21 million, just under 60% of these children live in 10 countries: Afghanistan, Angola, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Sudan and Yemen.

Monitoring data at subnational levels is critical to helping countries prioritize and tailor vaccination strategies and operational plans to address immunization gaps and reach every person with life-saving vaccines.

WHO response

WHO is working with countries and partners to improve global vaccination coverage, including through these initiatives adopted by the World Health Assembly in August 2020.
Immunization Agenda 2030

IA2030 sets an ambitious, overarching global vision and strategy for vaccines and immunization for the decade 2021–2030. It was co-created with thousands of contributions from countries and organizations around the world. It draws on lessons from the past decade and acknowledges continuing and new challenges posed by infectious diseases (e.g. Ebola, COVID-19).

The strategy has been designed to respond to the interests of every country and intends to inspire and align the activities of community, national, regional and global stakeholders towards achieving a world where everyone, everywhere fully benefits from vaccines for good health and well-being. IA2030 is operationalized through regional and national strategies and mechanisms to ensure ownership and accountability and a monitoring and evaluation framework to guide country implementation.

Website: International Conference on Infectious Diseases

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