{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T08:11:10Z","timestamp":1778746270047,"version":"3.51.4"},"reference-count":52,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":77,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/K01188X\/1"],"award-info":[{"award-number":["MR\/K01188X\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/K01188X\/1"],"award-info":[{"award-number":["MR\/K01188X\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["211433"],"award-info":[{"award-number":["211433"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1117728"],"award-info":[{"award-number":["OPP1117728"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Vaccines"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    We conducted the first pooled analysis of two randomised controlled vaccine trials on experimental pneumococcal serotype 6B carriage, registered in Malawi (PACTR202008503507113) and the UK (ISRCTN45340436). This post-hoc exploratory study examined the sex-based differences in carriage, vaccine efficacy and vaccine-induced responses. PCV-13 reduced colonisation by 76% (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) with non-significant interaction by sex (RR\u2009=\u20091.549,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.413). Females showed a higher carriage rate than males (28% vs. 19%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.066). Baseline anti-6B Capsular Polysaccharide Immunoglobulin G (IgG) titres were higher in females, significantly in Malawi (2.62\u2009\u00b5g\/ml vs males 2.05\u2009\u00b5g\/ml,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.015). Post-vaccination titres did not differ by sex. The pooled fold change in IgG pre-post vaccination, was higher in vaccinated females (5.47 vs 3.30,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.053). This analysis demonstrates the utility and challenges of integrating CHIM data between diverse settings to evaluate vaccine efficacy, describe inter-setting differences, investigate biological and immunological factors influencing protection against pneumococcal carriage and ultimately inform future vaccine development strategies.\n                  <\/jats:p>","DOI":"10.1038\/s41541-026-01381-4","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T22:24:37Z","timestamp":1772144677000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pooled analysis of PCV13 efficacy from controlled human infection trials in Malawi and the UK"],"prefix":"10.1038","volume":"11","author":[{"given":"Evaristar","family":"Kudowa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Godwin","family":"Tembo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony E.","family":"Chirwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarsizio","family":"Chikaonda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfred","family":"Muyaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lumbani","family":"Makhaza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edna","family":"Nsomba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bridgette","family":"Galafa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faith","family":"Thole","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Ndaferankhande","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorensio","family":"Chimgoneko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neema","family":"Toto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dingase","family":"Dula","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Morton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaun H.","family":"Pennington","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Hyder-Wright","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea M.","family":"Collins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Mitsi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela M.","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen B.","family":"Gordon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc Y. R.","family":"Henrion","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"On behalf of MARVELS","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Alderson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Antoine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R.","family":"Bailey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debbie","family":"Bogaert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Brown","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Burr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marien L.","family":"De Jonge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klara","family":"Doherty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Goldblatt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Gondwe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Gooding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Grigg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tina","family":"Harawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rob","family":"Heyderman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Hinds","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Jochems","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blessings","family":"Kapumba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vella","family":"Kaudzu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Kneller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Malley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Mallewa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucinda","family":"Manda-Taylor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Mangani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mphatso","family":"Mayuni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry","family":"Mwandumba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Ngwira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Percy","family":"Mwenechanya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Parker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Pollard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Modesta","family":"Reuben","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriela","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Weiser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kondwani","family":"Jambo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tinashe","family":"Kenny-Nyazika","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maureen","family":"Mkutumula","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurice","family":"Chipwete","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"EHPC consortia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Bailey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernard","family":"Beall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Bentley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debby","family":"Bogaert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joe","family":"De Campo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart","family":"Clarke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Cleary","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Finn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brad","family":"Gessner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Gordon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caz","family":"Hales","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie","family":"Hamon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Heyderman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kondwani","family":"Jambo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Kiyono","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Leong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Lipsitch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Mann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Mina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eliane","family":"Miyaji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helder","family":"Nakaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgio","family":"Napolitani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Neill","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihai","family":"Netea","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Oggioni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Openshaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda","family":"Peterson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sue","family":"Plummer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenda","family":"Kwambana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imran","family":"Saleem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Schlitzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Shalek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Tobery","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Tregoning","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Weiser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"1381_CR1","doi-asserted-by":"publisher","first-page":"e000636","DOI":"10.1136\/bmjgh-2017-000636","volume":"3","author":"I Megiddo","year":"2018","unstructured":"Megiddo, I., Klein, E. & Laxminarayan, R. Potential impact of introducing the pneumococcal conjugate vaccine into national immunisation programmes: an economic-epidemiological analysis using data from India. BMJ Glob. Health 3, e000636 (2018).","journal-title":"BMJ Glob. Health"},{"key":"1381_CR2","unstructured":"WER9623-217-228-eng-fre.pdf [Internet]. [cited 2025 May 29]. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/341722\/WER9623-217-228-eng-fre.pdf."},{"key":"1381_CR3","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1016\/j.vaccine.2017.11.070","volume":"36","author":"AGC Boef","year":"2018","unstructured":"Boef, A. G. C. et al. Differences by sex in IgG levels following infant and childhood vaccinations: an individual participant data meta-analysis of vaccination studies. Vaccine 36, 400\u2013407 (2018).","journal-title":"Vaccine"},{"key":"1381_CR4","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1093\/infdis\/jiw222","volume":"214","author":"A De St. Maurice","year":"2016","unstructured":"De St. Maurice, A., Schaffner, W., Griffin, M. R., Halasa, N. & Grijalva, C. G. Persistent sex disparities in invasive pneumococcal diseases in the conjugate vaccine era. J. Infect. Dis. 214, 792\u2013797 (2016).","journal-title":"J. Infect. Dis."},{"key":"1381_CR5","doi-asserted-by":"publisher","first-page":"00586","DOI":"10.1183\/23120541.00586-2021","volume":"8","author":"KS Cheliotis","year":"2022","unstructured":"Cheliotis, K. S. et al. Influence of sex, season and environmental air quality on experimental human pneumococcal carriage acquisition: a retrospective cohort analysis. ERJ Open Res. 8, 00586\u201302021 (2022).","journal-title":"ERJ Open Res."},{"key":"1381_CR6","doi-asserted-by":"publisher","first-page":"30481","DOI":"10.2807\/1560-7917.ES.2017.22.10.30481","volume":"22","author":"GHJ Wagenvoort","year":"2017","unstructured":"Wagenvoort, G. H. J. et al. Sex differences in invasive pneumococcal disease and the impact of pneumococcal conjugate vaccination in the Netherlands, 2004 to 2015. Eurosurveillance 22, 30481 (2017).","journal-title":"Eurosurveillance"},{"key":"1381_CR7","doi-asserted-by":"publisher","DOI":"10.1093\/jleuko\/qiae177","volume":"117","author":"EYI Tchalla","year":"2024","unstructured":"Tchalla, E. Y. I., Betadpur, A., Khalil, A. Y., Bhalla, M. & Bou Ghanem, E. N. Sex-based difference in immune responses and efficacy of the pneumococcal conjugate vaccine. J. Leukoc. Biol. 117, qiae177 (2024).","journal-title":"J. Leukoc. Biol."},{"key":"1381_CR8","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.anai.2021.07.013","volume":"127","author":"SE Chiarella","year":"2021","unstructured":"Chiarella, S. E., Jenkins, S. M., Park, M. A., Abraham, R. S. & Joshi, A. Y. Sex differences in antibody responses to the 23-valent pneumococcal polysaccharide vaccination. Ann. Allergy Asthma Immunol. 127, 509\u2013510 (2021).","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"1381_CR9","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s12865-019-0310-3","volume":"20","author":"AR Parker","year":"2019","unstructured":"Parker, A. R. et al. Pneumococcal vaccination responses in adults with subnormal IgG subclass concentrations. BMC Immunol. 20, 29 (2019).","journal-title":"BMC Immunol."},{"key":"1381_CR10","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1093\/infdis\/jiae624","volume":"231","author":"MJ Forcadell-Peris","year":"2025","unstructured":"Forcadell-Peris, M. J. et al. Evaluating sex differences in pneumococcal disease burden and vaccination effectiveness in adults: a population-based study. J. Infect. Dis. 231, 1455\u20131464 (2025).","journal-title":"J. Infect. Dis."},{"key":"1381_CR11","doi-asserted-by":"publisher","first-page":"70","DOI":"10.12688\/wellcomeopenres.12256.1","volume":"2","author":"SB Gordon","year":"2017","unstructured":"Gordon, S. B. et al. A framework for Controlled Human Infection Model (CHIM) studies in Malawi: Report of a Wellcome Trust workshop on CHIM in Low Income Countries held in Blantyre, Malawi. Wellcome Open Res. 2, 70 (2017).","journal-title":"Wellcome Open Res."},{"key":"1381_CR12","doi-asserted-by":"crossref","unstructured":"Sztein M. B., Booth J. S. Controlled human infectious models, a path forward in uncovering immunological correlates of protection: Lessons from enteric fevers studies. Front Microbiol [Internet]. 2022 Sept 20 [cited 2025 May 13];13. Available from: https:\/\/www.frontiersin.org\/journals\/microbiology\/articles\/10.3389\/fmicb.2022.983403\/full.","DOI":"10.3389\/fmicb.2022.983403"},{"key":"1381_CR13","doi-asserted-by":"publisher","first-page":"25","DOI":"10.12688\/wellcomeopenres.15689.1","volume":"5","author":"B Morton","year":"2020","unstructured":"Morton, B. et al. A pneumococcal controlled human infection model in Malawi: transfer of an established pneumococcal carriage model from Liverpool, UK to Blantyre, Malawi\u2014a feasibility study. Wellcome Open Res. 5, 25 (2020).","journal-title":"Wellcome Open Res."},{"key":"1381_CR14","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1164\/rccm.201503-0542OC","volume":"192","author":"AM Collins","year":"2015","unstructured":"Collins, A. M. et al. First human challenge testing of a pneumococcal vaccine. double-blind randomized controlled trial. Am. J. Respir. Crit. Care Med. 192, 853\u2013858 (2015).","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"1381_CR15","doi-asserted-by":"publisher","first-page":"e683","DOI":"10.1016\/S2666-5247(23)00178-7","volume":"4","author":"D Dula","year":"2023","unstructured":"Dula, D. et al. Effect of 13-valent pneumococcal conjugate vaccine on experimental carriage of Streptococcus pneumoniae serotype 6B in Blantyre, Malawi: a randomised controlled trial and controlled human infection study. Lancet Microbe 4, e683\u2013e691 (2023).","journal-title":"Lancet Microbe"},{"key":"1381_CR16","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-15786-9","volume":"11","author":"TD Swarthout","year":"2020","unstructured":"Swarthout, T. D. et al. High residual carriage of vaccine-serotype Streptococcus pneumoniae after introduction of pneumococcal conjugate vaccine in Malawi. Nat. Commun. 11, 2222 (2020).","journal-title":"Nat. Commun."},{"key":"1381_CR17","unstructured":"Letter_NHSEI_PHE_PCV13_schedule_change.pdf [Internet]. [cited 2025 May 13]. Available from: https:\/\/assets.publishing.service.gov.uk\/media\/5dfb989ced915d1f29e1d6a0\/Letter_NHSEI_PHE_PCV13_schedule_change.pdf."},{"key":"1381_CR18","doi-asserted-by":"publisher","first-page":"2975","DOI":"10.1016\/j.vaccine.2024.03.055","volume":"42","author":"G Tembo","year":"2024","unstructured":"Tembo, G. et al. Poor association between 13-valent pneumococcal conjugate vaccine-induced serum and mucosal antibody responses with experimental Streptococcus pneumoniae serotype 6B colonisation. Vaccine 42, 2975\u20132982 (2024).","journal-title":"Vaccine"},{"key":"1381_CR19","doi-asserted-by":"crossref","unstructured":"Galafa, B. et al. Natural carriage of streptococcus pneumoniae is associated with increased experimental pneumococcal carriage but reduced conjugate vaccine efficacy in a human challenge model. J. Infect. Dis. 231, 334\u2013343 (2024).","DOI":"10.1093\/infdis\/jiae341"},{"key":"1381_CR20","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1164\/rccm.201212-2277OC","volume":"187","author":"DM Ferreira","year":"2013","unstructured":"Ferreira, D. M. et al. Controlled human infection and rechallenge with Streptococcus pneumoniae reveals the protective efficacy of carriage in healthy adults. Am. J. Respir. Crit. Care Med 187, 855\u2013864 (2013).","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"1381_CR21","doi-asserted-by":"publisher","first-page":"e893","DOI":"10.1016\/S2214-109X(21)00258-8","volume":"9","author":"P Kamthunzi","year":"2021","unstructured":"Kamthunzi, P. Impact of PCV13 vaccination in Blantyre, Malawi. Lancet Glob. Health 9, e893\u2013e894 (2021).","journal-title":"Lancet Glob. Health"},{"key":"1381_CR22","doi-asserted-by":"publisher","first-page":"3953","DOI":"10.1016\/j.vaccine.2019.05.080","volume":"37","author":"EL German","year":"2019","unstructured":"German, E. L. et al. Protective effect of PCV vaccine against experimental pneumococcal challenge in adults is primarily mediated by controlling colonisation density. Vaccine 37, 3953\u20133956 (2019).","journal-title":"Vaccine"},{"key":"1381_CR23","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.1093\/infdis\/jiab331","volume":"225","author":"E Mitsi","year":"2021","unstructured":"Mitsi, E. et al. Thirteen-valent pneumococcal conjugate vaccine\u2013induced immunoglobulin G (IgG) responses in serum associated with serotype-specific IgG in the lung. J. Infect. Dis. 225, 1626\u20131631 (2021).","journal-title":"J. Infect. Dis."},{"key":"1381_CR24","doi-asserted-by":"publisher","first-page":"e1423","DOI":"10.1093\/cid\/ciaa1860","volume":"73","author":"JA Lewnard","year":"2020","unstructured":"Lewnard, J. A., Givon-Lavi, N. & Dagan, R. Effectiveness of pneumococcal conjugate vaccines against community-acquired alveolar pneumonia attributable to vaccine-serotype Streptococcus pneumoniae among children. Clin. Infect. Dis. 73, e1423\u2013e1433 (2020).","journal-title":"Clin. Infect. Dis."},{"key":"1381_CR25","doi-asserted-by":"publisher","first-page":"2680","DOI":"10.1016\/j.vaccine.2024.02.066","volume":"42","author":"GA Mackenzie","year":"2024","unstructured":"Mackenzie, G. A. et al. Impact of pneumococcal conjugate vaccination on pneumococcal nasopharyngeal carriage in the Gambia: population-based cross-sectional surveys. Vaccine 42, 2680\u20132686 (2024).","journal-title":"Vaccine"},{"key":"1381_CR26","doi-asserted-by":"publisher","first-page":"e005187","DOI":"10.1136\/bmjgh-2021-005187","volume":"6","author":"J Chan","year":"2021","unstructured":"Chan, J. et al. Indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with acute respiratory infection despite heterogeneous vaccine coverage: an observational study in Lao People\u2019s Democratic Republic. BMJ Glob. Health 6, e005187 (2021).","journal-title":"BMJ Glob. Health"},{"key":"1381_CR27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2021.103579","volume":"72","author":"B Morton","year":"2021","unstructured":"Morton, B. et al. A feasibility study of controlled human infection with Streptococcus pneumoniae in Malawi. eBioMedicine 72, 103579 (2021).","journal-title":"eBioMedicine"},{"key":"1381_CR28","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1007\/s11739-022-02999-7","volume":"17","author":"B Corica","year":"2022","unstructured":"Corica, B., Tartaglia, F., D\u2019Amico, T., Romiti, G. F. & Cangemi, R. Sex and gender differences in community-acquired pneumonia. Intern Emerg. Med 17, 1575\u20131588 (2022).","journal-title":"Intern Emerg. Med"},{"key":"1381_CR29","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1007\/s15010-015-0791-9","volume":"43","author":"J Fischer","year":"2015","unstructured":"Fischer, J., Jung, N., Robinson, N. & Lehmann, C. Sex differences in immune responses to infectious diseases. Infection 43, 399\u2013403 (2015).","journal-title":"Infection"},{"key":"1381_CR30","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1038\/nri2394","volume":"8","author":"EN Fish","year":"2008","unstructured":"Fish, E. N. The X-files in immunity: sex-based differences predispose immune responses. Nat. Rev. Immunol. 8, 737\u2013744 (2008).","journal-title":"Nat. Rev. Immunol."},{"key":"1381_CR31","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/S0149-7634(00)00027-0","volume":"24","author":"SL Klein","year":"2000","unstructured":"Klein, S. L. The effects of hormones on sex differences in infection: from genes to behavior. Neurosci. Biobehav Rev. 24, 627\u2013638 (2000).","journal-title":"Neurosci. Biobehav Rev."},{"key":"1381_CR32","first-page":"1","volume":"4","author":"T Potluri","year":"2019","unstructured":"Potluri, T. et al. Age-associated changes in the impact of sex steroids on influenza vaccine responses in males and females. Npj Vaccines 4, 1\u201312 (2019).","journal-title":"Npj Vaccines"},{"key":"1381_CR33","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.yhbeh.2012.02.023","volume":"62","author":"DP Robinson","year":"2012","unstructured":"Robinson, D. P. & Klein, S. L. Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Horm. Behav. 62, 263\u2013271 (2012).","journal-title":"Horm. Behav."},{"key":"1381_CR34","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1073\/pnas.1321060111","volume":"111","author":"D Furman","year":"2014","unstructured":"Furman, D. et al. Systems analysis of sex differences reveals an immunosuppressive role for testosterone in the response to influenza vaccination. Proc. Natl. Acad. Sci. USA 111, 869\u2013874 (2014).","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"1381_CR35","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1038\/nri.2016.90","volume":"16","author":"SL Klein","year":"2016","unstructured":"Klein, S. L. & Flanagan, K. L. Sex differences in immune responses. Nat. Rev. Immunol. 16, 626\u2013638 (2016). Oct.","journal-title":"Nat. Rev. Immunol."},{"key":"1381_CR36","doi-asserted-by":"crossref","unstructured":"Voysey, M. et al. Serotype-specific correlates of protection for pneumococcal carriage: an analysis of immunity in 19 countries. Clin. Infect. Dis. 66, 913\u2013920 (2018).","DOI":"10.1093\/cid\/cix895"},{"key":"1381_CR37","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-10-304","volume":"10","author":"GA Mackenzie","year":"2010","unstructured":"Mackenzie, G. A., Leach, A. J., Carapetis, J. R., Fisher, J. & Morris, P. S. Epidemiology of nasopharyngeal carriage of respiratory bacterial pathogens in children and adults: cross-sectional surveys in a population with high rates of pneumococcal disease. BMC Infect. Dis. 10, 304 (2010).","journal-title":"BMC Infect. Dis."},{"key":"1381_CR38","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1016\/S1473-3099(22)00438-8","volume":"22","author":"TD Swarthout","year":"2022","unstructured":"Swarthout, T. D. et al. Waning of antibody levels induced by a 13-valent pneumococcal conjugate vaccine, using a 3\u2008+\u20080 schedule, within the first year of life among children younger than 5 years in Blantyre, Malawi: an observational, population-level, serosurveillance study. Lancet Infect. Dis. 22, 1737\u20131747 (2022).","journal-title":"Lancet Infect. Dis."},{"key":"1381_CR39","doi-asserted-by":"publisher","first-page":"1728","DOI":"10.1128\/CVI.05252-11","volume":"18","author":"D Goldblatt","year":"2011","unstructured":"Goldblatt, D. et al. Establishment of a new human pneumococcal standard reference serum, 007sp. Clin. Vaccin. Immunol. 18, 1728\u20131736 (2011).","journal-title":"Clin. Vaccin. Immunol."},{"key":"1381_CR40","doi-asserted-by":"crossref","unstructured":"Gritzfeld, J. F. et al. Experimental human pneumococcal carriage. J. Vis. Exp. 15, e50115 (2013).","DOI":"10.3791\/50115"},{"key":"1381_CR41","doi-asserted-by":"publisher","first-page":"240","DOI":"10.12688\/wellcomeopenres.17172.2","volume":"6","author":"B Morton","year":"2022","unstructured":"Morton, B. et al. The influence of pneumococcal conjugate vaccine-13 on nasal colonisation in a controlled human infection model of pneumococcal carriage in Malawi: a double-blinded randomised controlled trial protocol. Wellcome Open Res. 6, 240 (2022).","journal-title":"Wellcome Open Res."},{"key":"1381_CR42","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1038\/mi.2016.71","volume":"10","author":"E Mitsi","year":"2017","unstructured":"Mitsi, E. et al. Agglutination by anti-capsular polysaccharide antibody is associated with protection against experimental human pneumococcal carriage. Mucosal Immunol. 10, 385\u2013394 (2017).","journal-title":"Mucosal Immunol."},{"key":"1381_CR43","unstructured":"Donoghoe M. W., Marschner I. C. & Gillett, A. C. (wrote an initial version of the nplbin, Team (summary.logbin TRC, functions) anova logbin and others are based on stats::glm-related. logbin: Relative Risk Regression Using the Log-Binomial Model [Internet]. [cited 2025 May 30]. Available from: https:\/\/cran.r-project.org\/web\/packages\/logbin\/index.html (2025)."},{"key":"1381_CR44","unstructured":"Kassambara, A. ggpubr: \u201cggplot2\u201d Based Publication Ready Plots [Internet]. [cited 2025 May 30]. Available from: https:\/\/cran.r-project.org\/web\/packages\/ggpubr\/index.html (2023)."},{"key":"1381_CR45","unstructured":"Create Elegant Data Visualisations Using the Grammar of Graphics [Internet]. [cited 2025 May 30]. Available from: https:\/\/ggplot2.tidyverse.org\/."},{"key":"1381_CR46","unstructured":"Pedersen, T. L. Patchwork: The Composer of Plots [Internet]. [cited 2025 May 30]. Available from: https:\/\/cran.r-project.org\/web\/packages\/patchwork\/index.html (2024)."},{"key":"1381_CR47","unstructured":"Auguie, B. & Antonov, A. gridExtra: Miscellaneous Functions for \u201cGrid\u201d Graphics [Internet]. [cited 2025 May 30]. Available from: https:\/\/cran.r-project.org\/web\/packages\/gridExtra\/index.html (2017)."},{"key":"1381_CR48","unstructured":"Rich, B. Table1: Tables of Descriptive Statistics in HTML [Internet]. [cited 2025 May 30]. Available from: https:\/\/cran.r-project.org\/web\/packages\/table1\/index.html (2023)."},{"key":"1381_CR49","unstructured":"Wickham, H. et al. dplyr: A Grammar of Data Manipulation [Internet]. [cited 2025 May 30]. Available from: https:\/\/cran.r-project.org\/web\/packages\/dplyr\/index.html (2023)."},{"key":"1381_CR50","unstructured":"Wickham, H. et al. tidyr: Tidy Messy Data [Internet]. [cited 2025 May 30]. Available from: https:\/\/cran.r-project.org\/web\/packages\/tidyr\/index.html (2024)."},{"key":"1381_CR51","unstructured":"Spinu, V. et al. lubridate: Make Dealing with Dates a Little Easier [Internet]. [cited 2025 May 30]. Available from: https:\/\/cran.r-project.org\/web\/packages\/lubridate\/index.html (2024)."},{"key":"1381_CR52","unstructured":"Wickham, H. et al. readr: Read Rectangular Text Data [Internet]. [cited 2025 May 30]. Available from: https:\/\/cran.r-project.org\/web\/packages\/readr\/index.html (2024)."}],"container-title":["npj Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41541-026-01381-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41541-026-01381-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41541-026-01381-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T07:29:51Z","timestamp":1778743791000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41541-026-01381-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1381"],"URL":"https:\/\/doi.org\/10.1038\/s41541-026-01381-4","relation":{},"ISSN":["2059-0105"],"issn-type":[{"value":"2059-0105","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]},"assertion":[{"value":"25 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"101"}}