The season's vaccine evidence arrives, and it is steady rather than dramatic

The edition in brief

A systematic review screened 11,829 references and included 155 publications on US-licensed COVID-19 vaccines. Updated vaccines were associated with reduced hospitalisation in adults 65 and over (VE 53.0%, 95% CI 37.0 to 65.0, 2025-26 season) and in adults 18-64 (54.0%, 95% CI 1.0 to 78.0, 2024-25). Maternal vaccination was associated with 50-54% effectiveness against infant hospital contacts in the first two months of life whatever the trimester. In children aged 9 months to 4 years, VE against emergency visits was 76.0% (95% CI 58.0 to 87.0). No new safety signals emerged. A parallel review of 75 studies on RSV immunisation found vaccine effectiveness against RSV hospitalisation in older adults of 83.3% (95% CI 42.9 to 96.9), with lower point estimates beyond the first season in one study. Maternal vaccination at 32-36 weeks gave 51.0% to 70.0% against infant hospitalisation; nirsevimab estimates ranged from 63.6% to 93.0% depending on timing. No Guillain-Barre syndrome cases arose in three randomised trials, though one self-controlled case series suggested a possible risk in the 42 days after vaccination in older adults. No comparative study linked vaccination in pregnancy to preterm birth. An EBMT registry study across 37 European centres reported 126 maribavir courses in 118 haematopoietic cell transplant recipients, 80% as second or third line. CMV resolved in 88 of 109 pre-emptive courses (81%) and 12 of 17 treated for CMV disease (71%). Discontinuation for adverse events occurred in 2%. A meta-analysis of four randomised and three non-randomised trials found adding Mycobacterium indicus pranii vaccine to multidrug therapy reduced clinical scores at 24 months by 2.62 points (95% CI -4.28 to -0.96), with benefit concentrated in borderline lepromatous and lepromatous disease.