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Two New TB Vaccines Are Safe – But Lack in Effectiveness

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Photo by Mika Baumeister on Unsplash

Two new vaccines to prevent tuberculosis (TB) are safe for use in adults and children, but they do not offer protection against all forms of TB, finds a large trial from India published by The BMJ.

TB remains a major global public health concern. In 2023, an estimated 10.8 million people worldwide were reported to have TB and the rate of new cases increased by 4.6% between 2020 and 2020, highlighting the growing scale of the problem. BCG is currently the only licensed vaccine against TB. Yet although it is effective against severe forms of TB in young children, it does not offer protection for adolescents and adults. 

To address this gap, researchers in India conducted a large trial to evaluate whether two new TB vaccines (VPM1002 and Immuvac) can protect against all forms of tuberculosis (pulmonary and extrapulmonary), prevent latent (dormant) infection, and generate an immune response against the TB bacterium.

The study enrolled 12 717 household contacts (aged 6 years and older) of recently diagnosed TB patients across 18 sites in six Indian states between July 2019 and December 2020.

Participants were randomly allocated to receive a first dose of either VPM1002, Immuvac, or a placebo (4 239 in each group) and were followed up for 38 months. A second dose was administered to 11,829 participants one month later. A total of 12 295 participants (96.7% of those enrolled) completed 38 months of follow-up.

While neither vaccine offered general protection against TB or prevented latent TB infection, both demonstrated an ability to prevent the progression to active TB in those who developed latent TB.

The researchers found that although both vaccines did not show effectiveness against all TB and pulmonary TB (PTB), one of the vaccines, VPM1002 showed effectiveness (50.4%) against extrapulmonary TB (EPTB) across all age groups, including those aged 36-60 years (79.5%). These findings suggest a potentially significant public health benefit, because extrapulmonary TB, which affects organs beyond the lungs, is often associated with a higher risk of mortality than pulmonary TB. 

A promising key finding was the protection seen against TB in children, whereby VPM1002 provided protection against all TB, PTB and EPTB in the 6 to under 14 year age group, while Immuvac provided protection against EPTB only in the 6 to under 10 year age group.

However, neither vaccine protected children and adults who were underweight. This suggests that nutritional support may be needed along with vaccination, especially for younger children, report the authors.

Both vaccines were found to be safe and induced an immune response.

The researchers acknowledge that the covid-19 pandemic affected the study, leading to the exclusion of some participants who missed the second dose and sometimes delayed follow-ups. Furthermore, the findings may not apply in other countries or ethnicities.

Nevertheless, this was a large, well-designed study that reflects a real world scenario because it included both children and adults, regardless of pre-existing conditions like diabetes and risk factors, as reported by authors.  Further research on commonly targeted high-risk groups for TB could be undertaken, they conclude.

Source: BMJ Group

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High Prenatal Exposure to PFAS May Increase the Risk of Childhood Asthma

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City residents exposed to contaminated drinking water in Sweden had higher rates of asthma diagnoses

Photo by cottonbro studio from Pexels

Asthma can lead to childhood hospitalisations, missed school days, missed workdays for caregivers, and a lower quality of life for both children and their caregivers. The global prevalence of asthma has increased over the past fifty years. A study published April 9th in the open-access journal PLOS Medicine by Annelise Blomberg at Lund University, Lund, Sweden and colleagues suggests that high prenatal PFAS exposure is associated with a higher incidence of asthma in childhood.

PFAS (Perfluoroalkyl substances) are widespread synthetic chemicals that impact the immune system and may play a role in the development of asthma. Previous epidemiological studies of PFAS and asthma only investigated low exposure levels and had inconclusive results. Due to decades-long contamination of a municipal waterworks in Ronneby, Sweden, researchers were able to study the impacts of high PFAS exposure. They accessed a register-based open cohort of all children born in Blekinge County between 2006 and 2013, including Ronneby. The researchers then linked maternal addresses during the exposure period to water distribution records to estimate prenatal exposure, and used asthma diagnosis data from the National Patient Register to assess individual asthma outcomes and prenatal exposure levels.

The researchers found that very high prenatal PFAS exposure was associated with a higher incidence of asthma in childhood. Future studies are needed to better understand exposure-response relationships and to address potential confounding variables, such as exposure beyond the prenatal period into early-childhood, exposure to other environmental contaminants or smoking among household members.

According to the authors, “PFAS contamination is a major source of high environmental exposure globally, and evidence from Ronneby offers important insights into the potential health effects of such contamination in affected communities. These results point to a substantial and previously unrecognized public health consequence of PFAS contamination.”

Blomberg adds, “We found that children whose mothers were exposed to very high levels of PFAS during pregnancy had a substantially higher incidence of clinically diagnosed asthma. The association was not observed at lower exposure levels, which may help explain why previous studies in general populations have reported mixed results.”

“Most previous research has examined populations exposed only to background levels of PFAS. In Ronneby, drinking water contamination resulted in exposure levels hundreds of times higher than the general population. This allowed us to evaluate potential health effects across a much broader exposure range.”

“Communities around the world have been affected by PFAS contamination from aqueous film-forming foams and other industrial sources. Our findings suggest that very high prenatal exposure may have lasting consequences for children’s respiratory health. At the same time, replication in other highly exposed populations will be important to confirm these results.”

Provided by PLOS

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Study Identifies Why Nightmares Persist in Children and How to Break the Cycle

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Recently published research from the University of Oklahoma and the University of Tulsa proposes a new model to explain why nightmares can persist over time in children and how therapy can be designed to break that cycle.

The study, published in Frontiers in Sleep, introduces the DARC-NESS model, a mnemonic for the factors that can keep a child stuck in chronic nightmares. At the centre of the model is “nightmare efficacy,” or the idea that children can learn skills to rid themselves of nightmares and restore good sleep.

“The DARC-NESS model looks at the mechanisms of what is maintaining nightmares, as well as the mechanisms that can break the cycle of nightmares,” said Lisa Cromer, PhD., a professor of psychology at the University of Tulsa and a volunteer child psychiatry faculty member at the OU School of Community Medicine in Tulsa. “It’s a child’s response to a nightmare that causes the chronic nightmares to happen, which means if we can learn to respond to nightmares differently, then we can interrupt that cycle. It’s empowering to understand that we can take steps to master our dreams.”

Rather than focusing only on the content of a nightmare, the model encourages clinicians to consider a broader set of factors, including how a child interprets the dream, worries about going to sleep, experiences anxiety at bedtime and copes after waking.

That information can help guide a personalized treatment plan instead of a one-size-fits-all approach. For some children, treatment may focus on reducing bedtime anxiety. Others may benefit from improving sleep habits or participating in exposure-based therapy, such as describing, writing about or drawing the nightmare and then working with a clinician to “rewrite” it.

“We believe we have created a way to conceptualize why nightmares persist and how we can better treat them in kids,” said OU Health child and adolescent psychiatrist Tara Buck, MD, an associate professor at the OU School of Community Medicine in Tulsa. “What’s unique about the model is that it’s customisable to what the patient needs, and it focuses on what the patient can control. We look for the potential intervention points and target those in a collaborative way with patients and their families.”

Unlike insomnia, in which people fear they won’t sleep, children with chronic nightmares are afraid they will sleep. According to Buck, helping children build confidence in their ability to address nightmares can have benefits far beyond sleep.

“Self-efficacy is at the heart of the model,” she said. “When children feel empowered to do something about the nightmares, they begin to see how things are interconnected – because they’re sleeping better, they have more energy, they go to school more consistently and their parents report improved behaviour.”

The model is designed for use by a range of clinicians, including therapists and pediatricians. For many years, health care providers either assumed that nightmares couldn’t be treated or that they would go away if an underlying trauma or mental health condition were addressed. However, that’s not always the case.

“We’ve worked with children who have been in mental health treatment for a long time and their nightmares are still persistent,” Buck said. “There is a need for a nightmare treatment model to help children when their nightmares are recurrent and distressing.”

“A nightmare is a bad dream that you wake up from,” Cromer said. “If you don’t wake up, then the brain is doing its job of resolving the fear of the dream. But if a child does wake up, they’re trying to escape the nightmare. And when a child wakes up, they’re not able to resolve the nightmare, which actually exacerbates the problem. That’s why nightmares are so important to treat.”

By April Wilkerson

Source: Oklahoma University

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Diagnostic Tests are Being Neglected as Pharmaceuticals Advance

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Source: Unsplash CC0

A new analysis from UC San Francisco argues that diagnostics are being overlooked both in the United States and around the world. This is slowing progress against major diseases, despite rapid advances in targeted therapies and precision health.

The authors note that nearly half of the world’s population lacks adequate access to diagnostics. These tests receive less investment for research and development, as well as lower insurance reimbursement than drugs, and this is creating barriers to innovation.

“Most people can easily understand how a new drug or surgery might help a patient,” said Kathryn Phillips, Ph.D., a professor of Health Economics in the School of Pharmacy at UC San Francisco and the lead author of the study, which appears in Science. “But the tests that guide medical decisions are just as critical.”

When treatments advance faster than tests

Advances in therapies are outpacing the development of the tests that are needed to guide their use. For example, many people do not respond to GLP-1 drugs for obesity and diabetes, but few tests exist yet to predict which patients will benefit.

Alzheimer’s is another example. New drugs exist to slow disease progression, but the blood tests that could match patients to the most beneficial drugs cost around $1000 and, unlike the drugs, which cost $30 000 a year, they rarely qualify for insurance coverage. This can leave doctors to make medical decisions without the necessary information. Some patients may not get the right treatments, and others may not get any treatments.

Regulatory misalignment and policy fixes

Even though they are essential to care, these diagnostic tests are often handled apart from the treatments they support. The FDA reviews tests differently than drugs, and insurers pay for them differently. Drugs are also much more likely to receive expedited FDA review than tests.

“Regulatory and payment policy should evolve in tandem with scientific and technological advances,” said Robert M. Califf, MD, former commissioner of the FDA and co-author of the paper.

“The current misalignment between how we evaluate diagnostics for consideration of allowing marketing and the system for reimbursement decisions about diagnostics versus drugs leaves powerful tools on the shelf and provides inadequate data to make good decisions about which diagnostic tools should be eschewed for lack of benefit in the real world.”

The authors say there are clear steps policymakers can take to fix these gaps, including reviewing tests and treatments together, streamlining approvals for tests, and improving how diagnostics are evaluated and paid for.

“Our hope is that this work helps people – patients, policymakers, insurers, and researchers – recognise diagnostics as essential to good health care – and not just an afterthought,” said Phillips, who directs the UCSF Center for Translational and Policy Research on Precision Medicine (TRANSPERS) and is a member of the Philip R. Lee Institute for Health Policy at UCSF.

Source: EurekAlert!

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Surprising Discovery in the Retina May Explain Low-light Vision

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Photoreceptor cells in the retina. Credit: Scientific Animations

A new Yale School of Medicine (YSM) study has uncovered surprising new details about how our eyes process what we see.

When we look at something, our visual system breaks down different aspects of the scene – such as colour, contrast, and motion – and processes those components separately. It’s called parallel visual processing and it’s what allows our brains to work out what we’re seeing so quickly.

This separation of information starts in the retina, and scientists have thought that separation is maintained as the information travels through the visual system. But in a study published in Neuron, researchers have found that information channels are more integrated than previously thought. This may help cells process weak visual signals, such as low-light conditions, the researchers say.

“We found that while different channels can deliver their own features, they’re also interconnected by underlying electrical circuitry,” says Yao Xue, PhD, a postdoctoral fellow in the department of ophthalmology and visual science at YSM and the study’s first author.

Untangling bipolar cell signals in the retina

The rods and cones in our retinas detect light and transmit signals to a type of neuron called bipolar cells. In these cells, visual components such as night, day, colour, shape, and contrast begin to separate into more than a dozen parallel channels.

But when researchers zoomed in on bipolar cell synapses, they found these information channels intermingle.

Neurons have two types of synapses: chemical and electrical. At chemical synapses, neurons release chemical messengers known as neurotransmitters that bind to the recipient cell. Electrical synapses, also known as gap junctions, facilitate communication with electric currents. Bipolar cells primarily communicate through chemical synapses.

The researchers found, however, that in the mouse and human retinas they studied, electric synapses were integrating most of those seemingly separate bipolar cell information channels. When the scientists electrically stimulated one bipolar cell, instead of seeing a localised release of neurotransmitters just within that cell’s channel, they observed cloud-like patterns of signalling – suggesting crosstalk among the different types of cells.

“When we stimulated one bipolar cell, many bipolar cells released neurotransmitters,” says Z. Jimmy Zhou, PhD, Professor of Ophthalmology and Visual Science and principal investigator.

“If the signal is already very weak and is divided into several channels, there isn’t much left for each channel to process. The integration is particularly useful for detecting low contrast signals or signals from very small objects.”

Seunghoon Lee, PhD Research Scientist of Ophthalmology and Visual Science

To their surprise, they also identified one type of bipolar cell, called BC6, that drove this signalling. These cells generated strong signals that travelled through the parallel channels in a hierarchical manner. “People had assumed that the different types of bipolar cells were more or less autonomous,” Zhou says. “But we found a driver among all these cell types that creates this network with a hierarchy.”

Having distinct parallel channels can help bipolar cells divide and conquer as they process different parts of a visual signal. The linkage of these channels through electrical synapses, on the other hand, could help the cells process weak visual signals, the researchers say.

“If the signal is already very weak and is divided into several channels, there isn’t much left for each channel to process,” says Seunghoon Lee, PhD, a research scientist in the department of ophthalmology and visual Science at YSM and co-corresponding author of the study. “The integration is particularly useful for detecting low contrast signals or signals from very small objects.”

“And the cells aren’t cooperating in a random way,” adds Xue. “There’s a commander within them – BC6 – that leads them in relaying signals to the downstream target.”

Recording from hard-to-reach cells

For the study, the researchers used several methods to study the synaptic circuitry of bipolar cells, including imaging to observe the cells’ activity and how they released and responded to neurotransmitters, as well as stimulating activity in bipolar cells and recording responses in recipient cells.

One challenge of studying signal transmission in bipolar cells is that they live in the middle of the retina. Previous studies have cut the retina into slices in order to access the cells, but that can disrupt the synaptic circuitry. In the new study, however, the researchers were able to apply the dual patch-clamp technique in fully intact mouse retinas. This method uses electrodes to stimulate activity in different types of bipolar cells and records the responses of recipient cells.

“No other lab in the world has been able to pull off these kinds of recordings systematically,” says Zhou. “It is a tour de force of Yao Xue’s PhD thesis work, pairing an innovative approach with exceptional electrophysiological skill.”

The team then repeated the experiment in human retinas, which they obtained from the department of pathology’s Legacy Tissue Donation Program. These are the first experiments of their kind in an intact human retina, the YSM researchers say.

Source: Yale School of Medicine

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New Global Study Estimates that Modern Hip Replacements Could Last at Least 30 Years

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New global study using data from the National Joint Registry, estimates that modern hip replacements could last at least 30 years

Photo by DanR. CC BY-NC-SA-2.0

A major international study led by researchers who have used extensive data from the NJR estimates that modern total hip replacements, those using today’s more advanced bearing surfaces, are likely to last over 30 years in 92% of patients. This new finding marks a significant improvement in long term implant longevity and durability, compared with previous generations of medical implant devices.

Published on 26 February 2026, the research represents the largest and most contemporary analysis of hip replacement conducted to date. The study was a global collaboration including data contribution from eight joint registries. The data of just under two million hip replacement procedures were analysed, with the NJR accounting for almost two-thirds of that data. Registry data were combined with evidence from 29 long term clinical studies, across 18 countries.

Data was included from adult patients undergoing primary hip replacement with contemporary bearing surfaces: highly cross‑linked polyethylene (XLPE), ceramic‑on‑XLPE, or third‑ and fourth‑generation ceramic‑on‑ceramic articulations. Only implants that are still in routine clinical use were included, ensuring the study reflects modern practice, rather than historic device performance. Across all registries, cases were followed for a minimum of 10 years, with implant survival tracked until first all‑cause revision. All three material types demonstrated similarly high survivorship.

The results of the study provide patients with reassurance in consideration of the commonly asked question “How long will my hip replacement last?”  It is encouraging to know that modern hip replacements could last decades.

With regard to previous research on implant longevity, a 2019 study into hip replacement longevity which was supported by the NJR, suggested that over half, ie. 58% of hip replacements lasted 25 years, but those estimates were based on some implants made of materials that are no longer widely used. In 2022, another review of NJR data was conducted to enable further understanding of implant longevity, which produced the paper: ‘How long revised and multiply-revised hip replacements last?’ You can read more on that here.

You can read the recent Lancet paper here: Survivorship of modern total hip replacement to 30 years: systematic review, meta-analysis, and extrapolation of global joint registry data – The Lancet

Source: National Joint Registry

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Depression Can Reduce Income for Years

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Study shows that income remains lower for up to 10 years after diagnosis

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A diagnosis of depression in connection with hospital treatment can have long-term consequences for personal finances. This is shown in a new registry-based study from the Department of Public Health, University of Southern Denmark, which follows nearly five million people in Denmark over time.

The study found that income is around 10% lower 10 years after diagnosis compared with people without depression, and the gap does not disappear. At the same time, the income loss for depression is greater than for several physical illnesses such as stroke and breast cancer.

Mental illness has the greatest financial impact

The study compares depression, alcohol use disorder, stroke and breast cancer. Income falls after illness in all four groups, but the decline is greatest for mental disorders.

“We see that mental disorders affect not only health, but also people’s economic life course to a considerable extent,” says Emily K. Johnson, PhD Student at the Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark.

She is first author of the study, which has been published in JAMA Health Forum.

“The income loss grows over time and can still be measured 10 years later. Even though mental disorders are more common in women, losses are generally greater for men,” Emily K. Johnson explains.

Not just a temporary loss

While earlier studies have often focused on short-term sick leave, the new study shows that income loss persists and in many cases grows over time.

– It is not only about being away from work for a period. We see changes in the entire income trajectory, says Emily K. Johnson.

This may, among other things, reflect reduced ability to keep a job, change jobs or progress in a career.

May reinforce social inequality

Income loss is greatest among people in the middle of working life, when earnings would normally be increasing. At the same time, the loss grows over time for younger people.

“If you are affected early in your career, you may lose your footing in the labour market. That can be difficult to recover later,” says Emily K. Johnson.

People outside the labour market are also hit particularly hard. For them, illness may make it even harder to enter employment. The findings therefore suggest that illness can reinforce existing social inequality.

Income falls before the illness is registered

Income already begins to decline in the years before people receive a diagnosis of depression in hospital care. This suggests that the consequences begin before the illness is formally registered and treated.

The study includes people who had contact with a hospital, either as inpatients or outpatients, including psychiatric hospital care. People treated only by their general practitioner or by private psychologists or psychiatrists are not included.

“This suggests that the course of illness starts earlier and that the consequences for working life emerge gradually,” Emily K. Johnson explains. Job loss, income loss and poor mental health can reinforce one another over time,

The study is based on Danish registry data and includes all non-retired residents aged 18 to 65 between 2000 and 2018. People with illness were compared with similar people without a diagnosis, matched on factors including age, sex, education and income, and baseline health.

Income was measured as disposable income, meaning post-tax income including wages, transfers and capital income.

Can inform health policy priorities

According to the researchers, the findings can help improve decision-making in health and social policy.

“Priority setting should not be based only on how many people become ill, but also on how illness affects people’s working lives and finances, especially for those early in their careers,” says Emily K. Johnson.

The study adds new knowledge by comparing mental and physical illnesses using the same method, making it possible to assess their relative consequences.

Limitations

The study includes only people who had contact with a hospital and therefore does not cover everyone with depression. At the same time, it cannot establish cause and effect with certainty, especially in the case of mental disorders which are difficult to measure. In addition, only people who survive the course of illness are included in the analyses of income over time.

By Marianne Lie Becker

Source: University of Southern Denmark

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Are Stress Hormone Levels Elevated in Double-shift Workers?

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Levels of cortisol, often referred to as the “stress hormone,” typically peak in the early morning hours, preparing the body for the day’s challenges by increasing alertness and energy levels, and gradually decline throughout the day, reaching their lowest point around midnight. New research in Nursing Open found an approximately two-fold increase in salivary cortisol levels at midnight in nurses working double shifts compared with those working single shifts. 

The study included 52 female nurses, working in rotating shifts. The elevated salivary cortisol levels observed in double-shift workers at midnight suggest that prolonged work schedules are associated with alterations in normal cortisol patterns. 

“Our findings indicate that extended shift schedules may be associated with alterations in the circadian pattern of cortisol, reflecting increased physiological strain in nurses working prolonged hours,” said corresponding author Fadime Ulupınar, RN, MSc, of Erzurum Technical University, in Turkey.  

Source: Wiley

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Physical Activity and Appropriate Sleep Linked to Subsequent Lower Dementia Risk

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Meta-analysis including millions of middle-aged to older adults supports recommended activity and sleep duration to reduce dementia risk

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Regular physical activity and getting the recommended amount of sleep may reduce dementia risk later in life, according to a new study by Akinkunle Oye-Somefun and colleagues of York University, Canada, published April 8, 2026 in the open-access journal PLOS One.

An estimated 55 million people live with dementia worldwide, and both its prevalence and cost are expected to increase, with global costs projected to reach $2 trillion dollars by 2030. Current treatments for preventing or treating dementia have limited efficacy; therefore, public health efforts have also aimed at healthy lifestyle factors to reduce the risk of dementia before symptoms occur. Healthy behaviours such as regular physical activity and good sleep hygiene are known to support cognitive health; however, there remains a need to better understand their relationship to dementia.

In this systematic review and meta-analysis, researchers analysed data from 69 prospective cohort studies representing millions of community-dwelling adults aged 35+, to see if there was a link between the development of dementia and three lifestyle behaviours: physical activity, sedentary behaviour, and sleep duration. Each of the observational studies recorded behaviours of cognitively healthy participants, then followed up at a later timepoint to report subsequent rates of dementia.

Overall, the meta-analysis found that regular physical activity, less sedentary time, and appropriate nightly sleep (7–8 h) were associated with a lower subsequent risk of dementia. Regular physical activity was associated with an average 25% lower risk of dementia among the 49 studies analysed; however, the researchers note that there was considerable heterogeneity between the studies.

Too little sleep (< 7 h) or too much sleep (> 8 h) was associated with an 18% and 28% higher subsequent risk of dementia, respectively, compared to optimal nightly sleep of 7–8 hours, though there was again considerable heterogeneity among the 17 studies analysed. Prolonged sitting (> 8 hours per day) was associated with a 27% higher risk of dementia among the three relevant studies analysed.

The study is consistent with and expands on previous research, using a large, diverse population with long follow-up times. While the study design cannot show any causative link between physical activity, sleep and dementia, the findings suggest an association between adherence to recommended physical activity and sleep levels in middle- and older-age adults and lowered dementia risk later in life.

The authors add: “Dementia develops over decades, and our findings suggest that everyday behaviours such as physical activity, time spent sitting, and sleep duration may be linked to dementia risk. Understanding how each of these behaviours relates to risk over time may help researchers identify opportunities to support brain health across the life course.”

“Separately, one aspect I personally found most interesting while conducting the study was the relatively limited evidence base on sedentary behaviour. Despite growing recognition that prolonged sitting is distinct from physical inactivity, we found only a small number of cohort studies examining its relationship with dementia risk. This highlights an important gap for future research.”

Provided by PLOS

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Lipid Lowering: Why 70mg/dL May Not Be Low Enough

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Image by Scientific Animations, CC4.0

Current clinical guidelines stress that lower LDL cholesterol levels significantly reduce the risk of major cardiac events. Essential strategies for treatment include heart-healthy lifestyle changes and pharmacological interventions using statins, ezetimibe, and PCSK9 inhibitors. Early intervention is vital, as the cumulative exposure to high cholesterol over time – often termed “LDL years” – determines the onset of vascular disease. But a major question has remained as to whether more aggressive lip-lowering targets is worth the potential side effects such as kidney damage.

Now, a new clinical trial published in NEJM provides evidence that an intensive target of less than 55mg/dL is superior for preventing secondary complications. In the Ez-PAVE trial, researchers in South Korea investigated whether this more intensive provided better protection than the conventional goal of less than 70mg/dL. The study found that patients in the intensive group experienced a significant reduction in cardiovascular events over a three-year period. The researchers conclude that their findings support stricter lipid-lowering guidelines, which can safely and effectively improve long-term patient outcomes.