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01.

medRxiv (Medicine) 2026-06-22 DOI: HASH:c351e0f28a484f38beb54738684a7740

The impact of changes in age-based eligibility criteria on seasonal influenza vaccine uptake in England between 2019 and 2024: A retrospective cohort study

Authors:

Suffel ↗A. M ↗Walker ↗Barry ↗E. V ↗Campbell ↗C. N ↗Lopez Bernal ↗J. V ↗McDonald ↗S. L ↗H. I ↗…

Objectives: To examine changes in seasonal influenza vaccine uptake among clinical risk groups over periods of differing age-based eligibility. Design: Retrospective cohort study. Setting: Individuals in England registered in the Clinical Practice Research Datalink Aurum. Participants: Between 1,239,802 (2019/20) and 1,289,330 (2023/24) individuals aged 40-69 years in clinical risk groups. Interventions: Natural experiment involving temporary expansion of age-based eligibility for influenza vaccination to include 50-64-year-olds from 2020/21 to 2022/23. Main outcome measures: Influenza vaccine uptake from 1st September to 28th February, incidence rate ratio (IRR) of vaccine uptake across consecutive seasons within age groups, and the ratio of IRRs between age groups. Results: Influenza vaccine uptake increased in all age groups in 2020/21 relative to 2019/20. The increase was larger in individuals aged 50-64 years (13.3%; IRR 1.50, 95% CI 1.50-1.51) compared with those aged 40-49 years (8.3%; IRR 1.35, 95% CI 1.34-1.35) and 65-69 years (6.8%; IRR 1.34, 95% CI 1.33-1.35). From 2020/21 to 2022/23, vaccine uptake decreased, with a more pronounced decline among those aged 40-49 years (-5.4%) compared with age-eligible groups (50-64 years: -3.0%; 65-69 years: -3.1%). The reversion of age eligibility in 2023/24 was associated with a larger decrease in uptake among those aged 50-64 years (-9.6% vs 2022/23; IRR 0.79, 95% CI: 0.79-0.79) compared with those aged 40-49 years (-4.9%; IRR 0.87, 95% CI: 0.87-0.88) and 65-69 years (-3.3%; IRR 0.97, 95% CI: 0.96-0.97). Patterns were broadly consistent across clinical risk groups. Conclusions: The COVID-19 pandemic saw a general increase in seasonal influenza vaccine uptake in clinical risk groups. This increase was larger and more sustained in 50-64 year-olds who had also become eligible based on age. Our findings highlight the potential gains in vaccine coverage among clinical risk groups based on expanded age-based eligibility.

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02.

medRxiv (Medicine) 2026-06-23 DOI: HASH:606944b2e85c388309dd84f9532b9336

Blood-brain barrier dysfunction in cerebral amyloid angiopathy is associated with disseminated cortical superficial siderosis

Authors:

Bay ↗Pfister ↗Mattern ↗Bernal ↗Neumann ↗Doerner ↗Meuth ↗S. G ↗Schreiber ↗Arndt ↗

Background: Blood-brain barrier (BBB) dysfunction is increasingly recognized as a feature of cerebral amyloid angiopathy (CAA) and has been linked to hemorrhagic imaging manifestations such as cortical superficial siderosis. However, it remains unclear whether neurovascular barrier dysfunction can be captured by routinely available fluid biomarkers and whether such markers identify clinically relevant hemorrhage-prone CAA phenotypes. The CSF/serum albumin quotient (QAlb) is an established marker of neurovascular barrier dysfunction. We investigated QAlb levels in CAA and their association with imaging markers of disease severity. Methods: We included 225 participants (115 with CAA, 72 with Alzheimers disease [AD], 38 healthy controls) with CSF biomarkers and standardized MRI evaluation. Pathologic QAlb levels were identified via the age-corrected Reiber-formula. Group differences and determinants of pathological QAlb were assessed using uni- and multivariable regression analyses. The diagnostic relevance was assessed by receiver operating characteristic analysis. Results: QAlb levels were higher in CAA than in controls (ratio of means [RoM] 1.43, 95% CI 1.28-1.58) and patients with AD (RoM 1.22, 95% CI 1.10-1.35; both p

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03.

arXiv (CS.CL) 2026-06-16 DOI: arXiv:2505.14368

From ASR to ASP: Evaluating Prompt Attack Vulnerabilities Against Open-Source LLMs

Authors:

Jiawen Wang ↗Pritha Gupta ↗Ivan Habernal ↗Eyke H\"ullermeier ↗Xiaoxue Gao ↗Nancy F. Chen ↗

Recent studies demonstrate that Large Language Models (LLMs) are vulnerable to attacks that generate harmful or sensitive outputs. As open-source LLMs are increasingly adopted in high-impact applications such as finance, law, and healthcare, systematically investigating their security risks is becoming increasingly important towards trustworthy LLM era. This paper comprehensively studies effective prompt injection attacks against 14 widely used open-source and three closed-source LLMs on five attack benchmarks. Moreover, existing evaluation metrics mostly only consider the attack success rate, overlooking uncertainty in model responses. Our proposed Attack Success Probability (ASP) additionally captures uncertain behaviors for evaluation, where the model may initially refuse a harmful request but subsequently provide harmful guidance or vice versa, reflecting inconsistency and ambiguity in attack feasibility. By systematically analyzing the effectiveness of prompt injection attacks, we propose a straightforward and effective hypnotism attack; results show that this attack causes aligned language models, including Stablelm2, Mistral, Openchat, and Vicuna, to generate objectionable behaviors, achieving around 90% ASP. They also indicate that ignore prefix attacks can break all 14 open-source LLMs, achieving over 60% ASP on a multi-categorical dataset. We find that moderately well-known LLMs exhibit higher vulnerability to prompt injection attacks, highlighting the need to raise public awareness and prioritize efficient mitigation strategies.

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