{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:21:16Z","timestamp":1760059276085,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,31]],"date-time":"2025-05-31T00:00:00Z","timestamp":1748649600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: In the Democratic Republic of Congo (DRC), the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in 2011 through a three-dose schedule, targeting infants as part of the Expanded Program on Immunization (EPI), to reduce pneumococcal-related morbidity and mortality. The aim of this study was to determine the proportion of pneumonia and meningitis cases and deaths prevented in children under five following the introduction of this vaccine. Methods: This is a systematic review. We synthesized findings from studies carried out in the DRC between 2011 and 2023. We searched scientific articles, published and unpublished doctoral theses and conference proceedings. Only papers written in French or English and those reporting the results of original analytical studies were selected. We assessed the direct effect of PCV13 by calculating the proportion of infections avoided, using Odds Ratios or prevalence ratios related to infection or pneumococcal carriage. Results: Four studies were included in this review. Regarding pneumococcal carriage, when children received three PCV13 doses, the prevalence of carriage was reduced by 93.3% (95% CI: 86.3 to 96.6%), while a single dose did not significantly reduce the prevalence of carriage compared with children who had not received any dose. Concerning pneumonia prevention, three doses of PCV13 prevented 66.7% (95% CI: 37.2 to 82.2) of cases among vaccinated children. The proportion of meningitis attributable to S. pneumoniae prevented was 75.0% (95% CI: 6% to 93.3%) among children vaccinated with PCV13. S. pneumoniae serotypes 19F and 23F were the most frequent causes of invasive pneumonia in children. Serotypes 35B\/35C, 15B\/C, 10A and 11A\/D were the most frequently identified causes of morbidity in Congolese children. In 2022, with PCV13 vaccination coverage at 79.0%, an estimated 113,359 cases of severe pneumonia and 17,255 pneumonia-related deaths were prevented in the DRC, with 3313 cases and 1544 deaths attributable to pneumococcal meningitis prevented. Conclusions: There is clear, but scattered, evidence of reduced colonization by S. pneumoniae and hospital admissions due to pneumococcal pneumonia and meningitis. The results also show that S. pneumoniae serotypes 35B\/35C, 15B\/C, 10A and 11A\/D not included in PCV13 were the main cause of pneumococcal disease in unvaccinated or under-vaccinated children. These data support the need to continue improving vaccination coverage among children who are unvaccinated or incompletely vaccinated with PCV13 to reduce the burden of pneumococcal infections in the DRC.<\/jats:p>","DOI":"10.3390\/vaccines13060603","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T11:40:32Z","timestamp":1748864432000},"page":"603","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Pneumococcal Vaccination in Children Under Five Years of Age in the Democratic Republic of Congo: A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7727-3504","authenticated-orcid":false,"given":"Marcellin Mengouo","family":"Nimpa","sequence":"first","affiliation":[{"name":"World Health Organization (WHO) Country Office, Kinshasa P.O. Box 1899, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2334-2129","authenticated-orcid":false,"given":"Abel","family":"Ntambue","sequence":"additional","affiliation":[{"name":"\u00c9cole de Sant\u00e9 Publique, Universit\u00e9 de Lubumbashi, Lubumbashi P.O. Box 1825, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Ngandu","sequence":"additional","affiliation":[{"name":"National Institute of Public Health, Kinshasa P.O. Box 01206, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7324-9198","authenticated-orcid":false,"given":"M. Carolina","family":"Danovaro-Holliday","sequence":"additional","affiliation":[{"name":"Immunization, Analytics and Insights (IAI), Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9","family":"Bita Fouda","sequence":"additional","affiliation":[{"name":"World Health Organization African Regional Office, Brazzaville P.O. Box 06, Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7016-8197","authenticated-orcid":false,"given":"Aim\u00e9 Mwana-Wabene","family":"Cikomola","sequence":"additional","affiliation":[{"name":"Expanded Program of Immunization, Kinshasa P.O. Box 01206, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Crispin","family":"Mukendi","sequence":"additional","affiliation":[{"name":"Expanded Program of Immunization, Kinshasa P.O. Box 01206, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dieudonn\u00e9","family":"Mwamba","sequence":"additional","affiliation":[{"name":"National Institute of Public Health, Kinshasa P.O. Box 01206, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ad\u00e8le Daleke Lisi","family":"Aluma","sequence":"additional","affiliation":[{"name":"Independent Researcher, Kinshasa P.O. Box 01211, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moise D\u00e9sir\u00e9","family":"Yapi","sequence":"additional","affiliation":[{"name":"World Health Organization (WHO) Country Office, Kinshasa P.O. Box 1899, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4474-7811","authenticated-orcid":false,"given":"Jean Baptiste","family":"Nikiema","sequence":"additional","affiliation":[{"name":"World Health Organization (WHO) Country Office, Kinshasa P.O. Box 1899, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boureima","family":"Hama Sambo","sequence":"additional","affiliation":[{"name":"World Health Organization (WHO) Country Office, Kinshasa P.O. Box 1899, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel Katuashi","family":"Ishoso","sequence":"additional","affiliation":[{"name":"World Health Organization (WHO) Country Office, Kinshasa P.O. Box 1899, Democratic Republic of the Congo"},{"name":"Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s13073-021-00901-2","article-title":"Global genomic pathogen surveillance to inform vaccine strategies: A decade-long expedition in pneumococcal genomics","volume":"13","author":"Bentley","year":"2021","journal-title":"Genome Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"338","DOI":"10.12688\/f1000research.22341.1","article-title":"Recent advances in the epidemiology and prevention of Streptococcus pneumoniae infections","volume":"9","author":"Feldman","year":"2020","journal-title":"F1000Research"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e744","DOI":"10.1016\/S2214-109X(18)30247-X","article-title":"Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: Global, regional, and national estimates for 2000\u20132015","volume":"6","author":"Wahl","year":"2018","journal-title":"Lancet Glob. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/S1473-3099(18)30310-4","article-title":"Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016","volume":"18","author":"Troeger","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Johnson, H.L., Deloria-Knoll, M., Levine, O.S., Stoszek, S.K., Hance, L.F., Reithinger, R., Muenz, L.R., and O\u2019Brien, K.L. (2010). Systematic evaluation of serotypes causing invasive pneumococcal disease among children under five: The pneumococcal global serotype project. PLoS Med., 7.","DOI":"10.1371\/journal.pmed.1000348"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Adegbola, R.A., DeAntonio, R., Hill, P.C., Roca, A., Usuf, E., Hoet, B., and Greenwood, B.M. (2014). Carriage of Streptococcus pneumoniae and other respiratory bacterial pathogens in low and lower-middle income countries: A systematic review and meta-analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0103293"},{"key":"ref_7","unstructured":"Russell, F., Sanderson, C., Temple, B., and Mulholland, K. (2011). Global review of the distribution of pneumococcal disease by age and region. WHO Pneumococcal Epidemiology Report 31102011 v3, World Health Organization."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Scelfo, C., Menzella, F., Fontana, M., Ghidoni, G., Galeone, C., and Facciolongo, N.C. (2021). Pneumonia and invasive pneumococcal diseases: The role of pneumococcal conjugate vaccine in the era of multi-drug resistance. Vaccines, 9.","DOI":"10.3390\/vaccines9050420"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41479-022-00097-y","article-title":"The remarkable history of pneumococcal vaccination: An ongoing challenge","volume":"14","author":"Musher","year":"2022","journal-title":"Pneumonia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/INF.0000000000000078","article-title":"Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on vaccine-type nasopharyngeal carriage","volume":"33","author":"Conklin","year":"2014","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"05002","DOI":"10.7189\/jogh.13.05002","article-title":"Systematic review on the impact of the pneumococcal conjugate vaccine ten valent (PCV10) or thirteen valent (PCV13) on all-cause, radiologically confirmed and severe pneumonia hospitalisation rates and pneumonia mortality in children 0\u20139 years old","volume":"13","author":"Reyburn","year":"2023","journal-title":"J. Glob. Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2390","DOI":"10.1017\/S0950268817001194","article-title":"The epidemiology of invasive pneumococcal disease in older adults in the post-PCV era. Has there been a herd effect?","volume":"145","author":"Corcoran","year":"2017","journal-title":"Epidemiol. Infect."},{"key":"ref_13","unstructured":"Countdown to 2030 (2017). Tracking Progress Towards Universal Coverage for Women\u2019s, Children\u2019s and Adolescents\u2019 Health, United Nations Children\u2019s Fund (UNICEF) and the World Health Organization (WHO). Available online: https:\/\/www.countdown2030.org\/publications\/tracking-progress-towards-universal-coverage-for-womens-childrens-and-adolescents-health."},{"key":"ref_14","unstructured":"Countdown to 2015 (2015). A Decade of Tracking Progress for Maternal, Newborn and Child Survival, World Health Organization. The 2015 Report."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Jo, Y., Labrique, A.B., Lefevre, A.E., Mehl, G., Pfaff, T., Walker, N., and Friberg, I.K. (2014). Using the Lives Saved Tool (LiST) to Model mHealth Impact on Neonatal Survival in Resource-Limited Settings. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0102224"},{"key":"ref_16","unstructured":"R\u00e9publique D\u00e9mocratique du Congo, Minist\u00e8re de la Sant\u00e9 Publique, Programme \u00c9largi de Vaccination (2015). Plan Pluriannuel Complet du PEV 2013\u20132015 (Version R\u00e9vis\u00e9e), Minist\u00e8re de la Sant\u00e9 Publique. Available online: https:\/\/extranet.who.int\/countryplanningcycles\/sites\/default\/files\/planning_cycle_repository\/democratic_republic_of_congo\/ppac_rdc_2013-2015_mercredi_12_nov_2012_vf_-_alexis_2.pdf."},{"key":"ref_17","unstructured":"Lassane, K. (2021). Impact Assessment of Childhood Immunization Programs in Limited-Resource Settings: Challenges in Ascertaining Vaccination Status and Application to Pneumococcal Conjugate Vaccine in Burkina Faso. [Ph.D. Thesis, Facult\u00e9 de M\u00e9decine, University of Geneva ]."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Birindwa, A.M., Gonzales-Siles, L., Nord\u00e9n, R., Geravandi, S., Manegabe, J.T., Morisho, L., Mushobekwa, S.S., Andersson, R., and Skovbjerg, S. (2020). High bacterial and viral load in the upper respiratory tract of children in the Democratic Republic of the Congo. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0240922"},{"key":"ref_19","unstructured":"Coulibaly, A. (2016). Impact of Pneumococcal Conjugate Vaccine Thirteen Valent on the Reduction of Invasive Pneumococcal Disease. [Ph.D. Thesis, Walden University]. Available online: https:\/\/scholarworks.waldenu.edu\/dissertations\/2116."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1080\/14760584.2018.1413354","article-title":"Public health impact of pneumococcal conjugate vaccine infant immunization programs: Assessment of invasive pneumococcal disease burden and serotype distribution","volume":"17","author":"Izurieta","year":"2018","journal-title":"Expert. Rev. Vaccines"},{"key":"ref_21","unstructured":"Muhandule Birindwa, A. (2020). Acute Respiratory Infections Among Children in the Democratic Republic of the Congo\u2014Nasopharyngeal Pathogens, Antibiotic Resistance and Vaccination. [Ph.D. Thesis, University of Gothenburg]. Available online: http:\/\/hdl.handle.net\/2077\/63279."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Mazamay, S., Bompangue, D., Gu\u00e9gan, J.F., Muyembe, J.J., Raoul, F., and Broutin, H. (2020). Understanding the spatio-temporal dynamics of meningitis epidemics outside the belt: The case of the Democratic Republic of Congo (DRC). BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-04996-7"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Birindwa, A.M., Kasereka, J.K., Gonzales-Siles, L., Geravandi, S., Mwilo, M., Tudiakwile, L.K., Mwinja, N.L., Muhigirwa, B., Kashosi, T., and Manegabe, J.T. (2021). Bacteria and viruses in the upper respiratory tract of Congolese children with radiologically confirmed pneumonia. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06570-1"},{"key":"ref_24","first-page":"203","article-title":"Meningitis caused by Streptococcus pneumoniae serotype 7a in an infant vaccinated with two doses of 13-valent pneumococcal conjugate vaccine: A case study","volume":"32","author":"Touhami","year":"2019","journal-title":"Pan. Afr. Med. J."},{"key":"ref_25","unstructured":"Engo, S.M.I. (2019). Dynamique Spatio-Temporelle et \u00c9cologie des M\u00e9ningites Bact\u00e9riennes en Dehors de la Ceinture de la M\u00e9ningite en Afrique: Cas de la R\u00e9publique D\u00e9mocratique du Congo. [Ph.D. Thesis, Universit\u00e9 Montpellier]."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Birindwa, A.M., Emg\u00e5rd, M., Nord\u00e9n, R., Samuelsson, E., Geravandi, S., Gonzales-Siles, L., Muhigirwa, B., Kashosi, T., Munguakonkwa, E., and Manegabe, J.T. (2018). High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo. BMC Pediatr., 18.","DOI":"10.1186\/s12887-018-1332-3"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"676","DOI":"10.4236\/ojped.2023.135076","article-title":"Identified Bacteria and Virus in the Cerebrospinal Fluid of under Five Years Hospitalized Children for Clinical Meningitis at Panzi Hospital in the Eastern Part of DRC","volume":"13","author":"Manegabe","year":"2023","journal-title":"Open J. Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Mazamay, S., Broutin, H., Bompangue, D., Muyembe, J.J., and Gu\u00e9gan, J.F. (2020). The environmental drivers of bacterial meningitis epidemics in the Democratic Republic of Congo, central Africa. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008634"},{"key":"ref_29","unstructured":"Wang, S. (2009, January 1\u20133). Global burden of pneumococcal disease in children under 5. Proceedings of the PAHO Regional Symposium of New Vaccines, Lima, Peru."},{"key":"ref_30","unstructured":"Bollinger, L., Stover, J., Hecht, K., Podk, T., and Schmidt, J. (2022). Spectrum de Spectrum: Syst\u00e8me Spectrum Pour les Mod\u00e8les de Politiques, Avenir Health."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/j.1365-2753.2010.01516.x","article-title":"Assessment of study quality for systematic reviews: A comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: Methodological research","volume":"18","author":"Stiles","year":"2012","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_32","unstructured":"G\u00e9rin, M., Gosselin, P., Cordier, S., Viau, C., Qu\u00e9nel, P., and Dewailly, \u00c9. (2003). \u00c9pid\u00e9miologie. Environnement et Sant\u00e9 Publique: Fondements et Pratiques, Edisem."},{"key":"ref_33","first-page":"e1062","article-title":"Streptococcus pneumoniae genomic datasets from an indian population describing pre-vaccine evolutionary epidemiology using a whole genome sequencing approach","volume":"7","author":"Nagaraj","year":"2021","journal-title":"Microb. Genom."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S258","DOI":"10.1093\/infdis\/jiab037","article-title":"Pneumococcal Carriage in Burkina Faso after 13-Valent Pneumococcal Conjugate Vaccine Introduction: Results from 2 Cross-sectional Population-Based Surveys","volume":"224","author":"Adebanjo","year":"2021","journal-title":"J. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e005187","DOI":"10.1136\/bmjgh-2021-005187","article-title":"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","volume":"6","author":"Chan","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ijid.2023.05.016","article-title":"Streptococcus pneumoniae and other bacterial nasopharyngeal colonization seven years post-introduction of 13-valent pneumococcal conjugate vaccine in South African children","volume":"134","author":"Downs","year":"2023","journal-title":"Int. J. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e989","DOI":"10.1016\/S2214-109X(21)00165-0","article-title":"Impact and effectiveness of 13-valent pneumococcal conjugate vaccine on population incidence of vaccine and non-vaccine serotype invasive pneumococcal disease in Blantyre, Malawi, 2006\u20132018: Prospective observational time-series and case-control studies","volume":"9","author":"Swarthout","year":"2021","journal-title":"Lancet Glob. Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/S1473-3099(16)00054-2","article-title":"Effect of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease in The Gambia: A population-based surveillance study","volume":"16","author":"Mackenzie","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"E1062","DOI":"10.1093\/cid\/ciac475","article-title":"Distribution of Serotypes Causing Invasive Pneumococcal Disease in Children from High-Income Countries and the Impact of Pediatric Pneumococcal Vaccination","volume":"76","author":"Grant","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_40","unstructured":"Deloria Knoll, M., Bennett, J.C., Garcia Quesada, M., Kagucia, E.W., Peterson, M.E., Feikin, D.R., Cohen, A.L., Hetrich, M.K., Yang, Y., and Sinkevitch, J.N. (2021). Global landscape review of serotype-specific invasive pneumococcal disease surveillance among countries using PCV10\/13: The pneumococcal serotype replacement and distribution estimation (PSERENADE) project. Microorganisms, 9."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"M\u00e9roc, E., Fletcher, M.A., Hanquet, G., Slack, M.P.E., Baay, M., Hayford, K., Gessner, B.D., and Grant, L.R. (2023). Systematic Literature Review of the Epidemiological Characteristics of Pneumococcal Disease Caused by the Additional Serotypes Covered by the 20-Valent Pneumococcal Conjugate Vaccine. Microorganisms, 11.","DOI":"10.3390\/microorganisms11071816"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/6\/603\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:44:57Z","timestamp":1760031897000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/6\/603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,31]]},"references-count":41,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["vaccines13060603"],"URL":"https:\/\/doi.org\/10.3390\/vaccines13060603","relation":{},"ISSN":["2076-393X"],"issn-type":[{"type":"electronic","value":"2076-393X"}],"subject":[],"published":{"date-parts":[[2025,5,31]]}}}