Analyzing immunization coverage data is crucial to guide decision-making in national immunization programs and monitor global initiatives such as the Immunization Agenda 2030. We aimed to assess the quality of reported child immunization coverage data for 194 countries over 20 years. We analyzed child immunization coverage as reported to the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) between 2000–2019 by all WHO Member States for Bacillus Calmette-Guérin (BCG) vaccine birth dose, first and third doses of diphtheria-tetanus-pertussis-containing vaccine (DTP1, DTP3), and first dose of measles-containing vaccine (MCV1). We assessed completeness, consistency, integrity, and congruence and assigned data quality flags in case anomalies were detected. Generalized linear mixed-effects models were used to estimate the probability of flags worldwide and for different country groups over time. The probability of data quality flags was 18.2% globally (95% confidence interval [CI] 14.8–22.3). The lowest probability was seen in South-East Asia (6.3%, 3.3–11.8, p = 0.002), the highest in the Americas (29.7%, 22.7–37.9, p < 0.001). The probability of data quality flags declined by 5.1% per year globally (3.2–7.0, p < 0.001). The steepest decline was seen in Africa (-9.6%, -13.0 to -5.8, p < 0.001), followed by Europe (-5.4%, -9.2 to -1.6, p = 0.0055), and the Americas (-4.9%, -9.2 to -0.6, p = 0.026). Most country groups showed a statistically significant decline, and none had a statistically significant increase. Over the past two decades, the quality of global immunization coverage data appears to have improved. However, progress has not been universal. The results highlight the need for joint efforts so that all countries collect, report, and use high-quality data for action in immunization.

According to estimates, globally more than 200,000 pregnant women develop tuberculosis (TB) annually. Despite this, data on perinatal TB remain scarce. This study aimed to describe perinatal TB, comprising congenital (cTB) and postnatal (pTB) TB, in a European setting. Retrospective cohort study via the Paediatric Tuberculosis Network European Trials Group (ptbnet) capturing and comparing cases of cTB and pTB diagnosed at 104 participating European healthcare institutions between 1995 and 2019. Forty-six cases reported by 20 centres were included in the final analysis (cTB, n = 27; pTB, n = 19). Median age at symptom onset was one week in cTB (IQR: 0–1 weeks), and 12 weeks in pTB patients (IQR: 5–18 weeks). Prematurity was more common in cTB than pTB patients [57.9% (11/19); 95% CI: 36.3–76.9% vs. 21.1% (4/19); 95% CI: 8.5–43.3%; p = 0.049], and the average birth weight was significantly lower [1680 g; IQR: 932–2805 g vs. 2890 g; IQR: 2461–3400 g; p = 0.0043]. Microbiological confirmation was achieved in most patients [85.2% (23/27); 95% CI: 67.5–94.1% vs. 78.9% (15/19); 95% CI: 56.7–91.5%; p = 0.70]. The sensitivity of interferon-gamma release assays was poor in both groups [25.0% (3/12) 95% CI: 8.9–53.2% vs. 35.7% (5/14) 95% CI: 16.3–61.2%; p = 0.68]; in contrast, the sensitivity of the tuberculin skin tests (at 5 mm cut-off) was significantly higher in pTB patients [16.7% (2/12) 95% CI: 4.7–44.8% vs. 66.7% (10/15); 95% CI: 41.7–84.8%; p = 0.0185]. Approximately half of the patients required intensive care support [51.9% (14/27) 95% CI: 34.0–69.3% vs. 47.4% (9/19); 95% CI: 27.3–68.3%; p > 0.99]. Four (4/46; 8.7%) patients died, and four (4/46; 8.7%) had severe long-term sequelae. There was substantial mortality and morbidity in this patient cohort, despite the high-resource setting. cTB was associated with premature birth and low birth weight. In contrast to microbiological tests, immunological tests perform poorly in perinatal TB, and should therefore not be used as rule-out tests. No study-specific funding.

Background: Although severe COVID-19 in children is rare, those with certain pre-existing health conditions are more prone to severe disease. Monoclonal antibodies (mAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are potent antiviral agents that reduce adverse clinical outcomes in adults, but are commonly not approved for use in pediatric patients. Methods: We retrospectively evaluated mAb treatment in children <12 years of age or <40kg with SARS-CoV-2 infection between January 1, 2021, and March 7, 2022, in 12 tertiary care centers in 3 European countries. Results: We received data from 53 patients from Austria, Denmark and Germany. Median age was 5.4 years [0–13.8, interquartile range (IQR) = 6.2], and median body weight was 20 kg (3–50.1, IQR = 13). The most frequent SARS-CoV-2 variant in this study, if known, was Omicron, followed by Delta and Alpha. Pre-existing conditions included immunodeficiency, malignancy, hematologic disease, cardiac disease, chronic lung disease, chronic liver disease, kidney disease and diabetes. Forty-two patients received sotrovimab (79%), 9 casirivimab/imdevimab (17%) and 2 bamlanivimab (4%). All but 1 patient survived. Median duration of hospital stay was 3 days (0–56, IQR = 6). Seven patients required treatment in an intensive care unit, and 5 required high-flow nasal cannula treatment. Potential side effects included neutropenia (6/53, 11%), lymphopenia (3/53, 6%), nausea or vomiting (2/53, 4%), rise of alanine transaminase (1/53, 2%) and hypotonia (1/53, 2%). Conclusions: MAb treatment was well tolerated by children in this cohort.

Humoral immune responses after BNT162b2 vaccination are predominantly composed of immunoglobulin (Ig) G1 and IgG3 subclass antibodies. As previously described in adults, S1-specific and receptor-binding domain–specific IgG4 levels increase significantly 1 year after the second BNT162b2 vaccination in children 5-11 years of age. Understanding mRNA vaccine–specific IgG4 responses in all age groups is crucial as more mRNA vaccines will reach licensure in the coming years.

In September 2024, a school-aged child (P1), unvaccinated against diphtheria, was hospitalised with severe respiratory diphtheria caused by toxigenic Corynebacterium diphtheriae. P1 subsequently died from the disease. The child’s mother (P2) had pharyngitis 9 days before the onset of symptoms of P1 and subsequently tested positive for C. diphtheriae . In multilocus sequence typing (MLST), the C. diphtheriae isolates from P1 and P2 were of sequence type (ST) 574. In core genome (cg)MLST, they were clonal, suggesting recent human-to-human transmission. This indicates the first autochthonous respiratory diphtheria outbreak by toxigenic C. diphtheriae in Germany since 1984 with epidemiologically- and molecularly-confirmed transmission. Furthermore, the isolates were close to isolates from patients with cutaneous diphtheria among people experiencing homelessness in two major German cities in 2023 and 2024, and to isolates from an outbreak among newly arriving migrants across several European countries, including Germany, detected in 2022. This indicates transmission beyond vulnerable groups. Our findings illustrate the potential of C. diphtheriae spreading further from patients with cutaneous diphtheria and even causing outbreaks of respiratory diphtheria. Given the potentially serious complications of respiratory diphtheria, including death, equitably achieving and maintaining high vaccination coverage among the whole population, especially among vulnerable people is essential.