Background and objectives Because of its beneficial off‐target effects against non‐mycobacterial infectious diseases, bacillus Calmette–Guérin (BCG) vaccination might be an accessible early intervention to boost protection against novel pathogens. Multiple epidemiological studies and randomised controlled trials (RCTs) are investigating the protective effect of BCG against coronavirus disease 2019 (COVID‐19). Using samples from participants in a placebo‐controlled RCT aiming to determine whether BCG vaccination reduces the incidence and severity of COVID‐19, we investigated the immunomodulatory effects of BCG on in vitro immune responses to SARS‐CoV‐2. Methods This study used peripheral blood taken from participants in the multicentre RCT and BCG vaccination to reduce the impact of COVID‐19 on healthcare workers (BRACE trial). The whole blood taken from BRACE trial participants was stimulated with γ‐irradiated SARS‐CoV‐2‐infected or mock‐infected Vero cell supernatant. Cytokine responses were measured by multiplex cytokine analysis, and single‐cell immunophenotyping was made by flow cytometry. Results BCG vaccination, but not placebo vaccination, reduced SARS‐CoV‐2‐induced secretion of cytokines known to be associated with severe COVID‐19, including IL‐6, TNF‐α and IL‐10. In addition, BCG vaccination promoted an effector memory phenotype in both CD4+ and CD8+ T cells, and an activation of eosinophils in response to SARS‐CoV‐2. Conclusions The immunomodulatory signature of BCG’s off‐target effects on SARS‐CoV‐2 is consistent with a protective immune response against severe COVID‐19.

This Watching Brief details a foot-and-mouth disease (FMD) outbreak in livestock in Indonesia. The outbreak, first reported in May 2022, is causing significant socioeconomic, animal health and biosecurity concerns in a country that has been FMD-free without vaccination since 1986. Delayed index case notification, difficulties with vaccination (e.g. accessibility issues, waning vaccine immunity and lack of cross-protection), limited understanding of persistent infection in carrier animals and lengthy restocking processes all present challenges for Indonesia in containing and recovering from this FMD outbreak. Thus, despite extensive research, the disease continues to present substantial challenges for outbreak prevention, surveillance and containment, which have important implications considering the widespread global prevalence of FMD and its impact on agriculture and trade in many countries. The socioeconomic burden of the current outbreak in Indonesia on individuals, households and communities is devastating, particularly in poor and rural areas. These impacts will likely continue after the outbreak is over, highlighting the need for co-ordinated support in strengthening outbreak detection and control in FMD-affected and other vulnerable areas.

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The term “Tomato Flu” or “Tomato Fever” is the colloquial term in India used to describe multiple diseases that present with a fever and rash, with characteristic red, “tomato” shaped blister that appears on different parts of the body, which begin small and increase in size as disease progresses. Some controversy exists on this ‘new viral “flu” that emerged in May 2022 over a period of 2 weeks in areas in the south of India. Currently, local healthcare workers have been encouraged to address the disease as a variant of Hand Foot and Mouth Disease to avoid unnecessary panic on the emergence of a “new outbreak”. With the circulation of other viruses, inadequate testing and poor-quality surveillance in a low resource setting, where healthcare systems are already burdened with ongoing monkeypox outbreak and COVID-19 pandemic, the use of colloquial terms may cause unnecessary panic in the current hypervigilant climate. Confirmation from Government is required to confirm whether this outbreak is due to a mixed infection or a variant of the highly infectious Hand Foot and Mouth Disease virus.