Abstract Background The association of the oral microbiome with SARS-CoV-2 infections and disease progression has been documented in European, Asian, and American populations but not in Africa. Methods We conducted a study in Ghana to evaluate and compare the naso-oropharyngeal microbiome in SARS-CoV-2-infected and uninfected persons before (pre-vaccine) and after vaccine availability (post-vaccine) in the country. 16S rRNA V3-V4 variable region was sequenced and analysed from DNA extracted from naso-oropharyngeal swabs. Results Considering only the infection status, infected and uninfected groups had no difference in their within-group diversity and was evident in the study population pre- and post-vaccine availability. The introduction of vaccines reduced the diversity of the naso-oropharyngeal microbiome particularly among SARS-CoV-2 positive persons and, vaccinated individuals (both infected and uninfected) had higher microbial diversity compared to their unvaccinated counterparts. SARS-CoV-2-positive and -negative individuals were largely compositionally similar varying by 4–7% but considering vaccination*infection statuses, the genetic distance increased to 12% (P = 0.003) and was mainly influenced by vaccination. Common among the pre- and post-vaccine samples, Atopobium and Finegoldia were abundant in infected and uninfected individuals, respectively. Bacteria belonging to major butyrate-producing phyla, Bacillota (particularly class Clostridia) and Bacteroidota showed increased abundance more strikingly in infected individuals before vaccines were available. They reduced significantly after vaccines were introduced into the country with Fusobacterium and Lachnoanaerobaculum being the only common bacteria between pre-vaccine infected persons and vaccinated individuals, suggesting that natural infection and vaccination correlate with high abundance of short-chain fatty acids. Conclusion Our results show, in an African cohort, the abundance of bacteria taxa known for their protective pathophysiological processes, especially during infection, suggesting that this population is protected against severe COVID-19. The immune-related roles of the members of Bacillota and Bacteroidota that were found associated with infection and vaccination require further studies, and how these may be linked to ethnicity, diet and age. We also recommend expansion of microbiome–disease association studies across Africa to identify possible bacterial-mediated therapeutics for emerging infections. …

Abstract Background Although liver transplant (LT) recipients are considered a population at risk of severe features of coronavirus disease 2019 (COVID-19), data in this regard are scarce and controversial. In this study, we reported the outcome of 24 cases of LT recipients who were hospitalized due to COVID-19 and investigated the role-playing factors in the severity of the disease. Methods In this single-center, analytic case-series study, eligible patients were among LT recipients who were hospitalized due to the diagnosis of COVID-19 based on positive results of polymerase chain reaction. Participants were categorized as severe COVID-19 if they were admitted to the intensive care unit, experienced respiratory failure demanding mechanical ventilation, or eventually died. Demographic and clinical data, COVID-19 symptoms and specific treatments, laboratory biomarkers, and immunosuppressive regimens and their alteration during the admission were recorded. Analysis was done using SPSS software. Results Twenty-four hospitalized LT patients were included, of which nine had severe and fifteen had non-severe COVID-19. Out of 9 patients with severe COVID-19, four sadly died. The analysis and comparison between the two groups revealed longer hospital stays (P = 0.02), lower lymphocyte counts (P = 0.002), and higher levels of C-reactive protein (CRP) (P = 0.006) in patients with severe COVID-19. Patients with non-severe COVID-19 had higher doses of tacrolimus and mycophenolate in their baseline immunosuppressive regimen (both P = 0.02). Conclusion Lymphopenia and high CRP levels are associated with more severe forms of COVID-19 in LT patients. Mycophenolate may have protective properties against severe COVID-19. The role of severity indicators in LT patients with COVID-19 needs to be systematically recognized. …

Abstract Background Respiratory syncytial virus (RSV), a leading cause of lower respiratory tract infection (LRTI) among children, has resurged in the form of endemic or even pandemic in many countries and areas after the easing of COVID-19 containment measures. This study aimed to investigate the differences in epidemiological and clinical characteristics of children hospitalized for RSV infection during pre- and post-COVID-19 eras in Yunnan, China. Methods A total of 2553 pediatric RSV inpatients from eight hospitals in Yunnan were retrospectively enrolled in this study, including 1451 patients admitted in 2018–2019 (pre-COVID-19 group) and 1102 patients admitted in 2023 (post-COVID-19 group). According to the presence or absence of severe LRTI (SLRTI), patients in the pre- and post-COVID-19 groups were further divided into the respective severe or non-severe subgroups, thus analyzing the risk factors for RSV-associated SLRTI in the two eras. Demographic, epidemiological, clinical, and laboratory data of the patients were collected for the final analysis. Results A shift in the seasonal pattern of RSV activity was observed between the pre-and post-COVID-19 groups. The peak period of RSV hospitalizations in the pre-COVID-19 group was during January–April and October–December in both 2018 and 2019, whereas that in the post-COVID-19 group was from April to September in 2023. Older age, more frequent clinical manifestations (fever, acute otitis media, seizures), and elevated laboratory indicators [neutrophil-to-lymphocyte ratio (NLR), c-reactive protein (CRP), interleukin 6 (IL-6), co-infection rate] were identified in the post-COVID-19 group than those in the pre-COVID-19 group (all P 

Abstract Background Identifying symptom clusters in Long COVID is necessary for developing effective therapies for this diverse condition and improving the quality of life of those affected by this heterogeneous condition. In this study, we aimed to identify and compare symptom clusters at 9 and 12 months after a SARS-CoV-2 positive test and describe each cluster regarding factors at infection. Methods This is a cross-sectional study with individuals randomly selected from the Portuguese National System of Epidemiological Surveillance (SINAVE) database. Individuals who had a positive RT-PCR SARS-CoV-2 test in August 2022 were contacted to participate in a telephonic interview approximately 9 and 12 months after the test. A hierarchical clustering analysis was performed, using Euclidean distance and Ward’s linkage. Clustering was performed in the 35 symptoms reported 9 and 12 months after the SARS-CoV-2 positive test and characterised considering age, sex, pre-existing health conditions and symptoms at time of SARS-CoV-2 infection. Results 552 individuals were included at 9 months and 458 at 12 months. The median age was 52 years (IQR: 40–64 years) and 59% were female. Hypertension and high cholesterol were the most frequently reported pre-existing health conditions. Memory loss, fatigue or weakness and joint pain were the most frequent symptoms reported 9 and 12 months after the positive test. Four clusters were identified at both times: no or minor symptoms; multi-symptoms; joint pain; and neurocognitive-related symptoms. Clusters remained similar in both times, but, within the neurocognitive cluster, memory loss and concentration issues increased in frequency at 12 months. Multi-symptoms cluster had older people, more females and more pre-existing health conditions at 9 months. However, at 12 months, older people and those with more pre-existing health conditions were in joint pain cluster. Conclusions Our results suggest that Long COVID is not the same for everyone. In our study, clusters remained similar at 9 and 12 months, except for a slight variation in the frequency of symptoms that composed each cluster. Understanding Long COVID clusters might help identify treatments for this condition. However, further validation of the observed clusters and analysis of its risk factors is needed. …

Abstract Introduction The COVID-19 pandemic has caused an unprecedented health threat globally, necessitating innovative and efficient diagnostic approaches for timely identification of infected individuals. Despite few emerging reports, the clinical utility of circulating microRNAs (miRNAs) in early and accurate diagnosis of COVID-19 is not well-evidenced. Hence, this meta-analysis aimed to explore the diagnostic potential of circulating miRNAs for COVID-19. The protocol for this study was officially recorded on PROSPERO under registration number CRD42023494959. Methods Electronic databases including Embase, PubMed, Scopus, and other sources were exhaustively searched to recover studies published until 16th January, 2024. Pooled specificity, sensitivity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic ratio (DOR), positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were computed from the metadata using Stata 14.0 software. Risk of bias appraisal of included articles was carried out using Review Manager (Rev-Man) 5.3 package through the modified QUADAS-2 tool. Subgroup, heterogeneity, meta-regression and sensitivity analyses were undertaken. Publication bias and clinical applicability were also evaluated via Deeks’ funnel plot and Fagan nomogram (scattergram), respectively. Result A total of 43 studies from 13 eligible articles, involving 5175 participants (3281 COVID-19 patients and 1894 healthy controls), were analyzed. Our results depicted that miRNAs exhibit enhanced pooled specificity 0.91 (95% CI: 0.88–0.94), sensitivity 0.94 (95% CI: 0.91–0.96), DOR of 159 (95% CI: 87–288), and AUC values of 0.97 (95% CI: 0.95–0.98) with high pooled PPV 96% (95% CI: 94–97%) and NPV 88% (95% CI: 86–90%) values. Additionally, highest diagnostic capacity was observed in studies involving larger sample size (greater than 100) and those involving the African population, demonstrating consistent diagnostic effectiveness across various specimen types. Notably, a total of 12 distinct miRNAs were identified as suitable for both exclusion and confirmation of COVID-19 cases, denoting their potential clinical applicability. Conclusion Our study depicted that miRNAs show significantly high diagnostic accuracy in differentiating COVID-19 patients from healthy counterparts, suggesting their possible use as viable biomarkers. Nonetheless, thorough and wide-ranging longitudinal researches are necessary to confirm the clinical applicability of miRNAs in diagnosing COVID-19. …

Abstract Background Although there have been reports of COVID-19 breakthrough infections in vaccinated individuals, the vaccines have demonstrated a high efficacy in preventing severe illness and death. Nepal has reported fewer studies of COVID-19 breakthrough infections. Hence, this study has objective to assess the prevalence, and to describe clinical characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) breakthrough infection. Methods This descriptive study was conducted from January to December 2022. The study enrolled 200 individuals who had received the recommended doses of the COVID-19 vaccine and they were RT-PCR positive diagnosed with vaccine breakthrough infections after 14 days of completing the vaccination course. The patient’s demographic and clinical profiles, as well as their outcomes in terms of severity, length of hospital stay, and mortality were recorded. Results The prevalence of SARS-CoV2 infection was 6.3% (547/8682). Among fully vaccinated personnel, the prevalence of breakthrough infections was 6.2% (200/3175). This study found the Omicron variants in respondents. The mean age of the patients was 38.28 years, and 41.5% (83/200) of the breakthrough cases were healthcare workers. The mean time gap between the second dose of vaccination and a positive RT-PCR test was 354.68 days. Of the 200 breakthrough cases, 89% (178) had mild symptoms, 9% (17) had moderate symptoms requiring hospitalization, and 2% (4) were severe cases that required intensive care facility. Among the severe cases, 3 out 4 were above 60 years old. Furthermore, the patients greater than 60 years had longer hospital stays (p 

Proceedings of the National Academy of Sciences, Volume 121, Issue 39, September 2024.

by Jaspreet Banga, Maya Jackson-Gibson, Modiegi Diseko, Ellen C. Caniglia, Gloria Mayondi, Judith Mabuta, Rebecca Luckett, Sikhulile Moyo, Pamela Smith-Lawrence, Mosepele Mosepele, Shahin Lockman, Joseph Makhema, Rebecca Zash, Roger Shapiro SARS-CoV-2 infection during pregnancy was associated with maternal mortality and adverse birth outcomes in the pre-Omicron era, including a stillbirth rate of 5.6% in Botswana. We re-evaluated these outcomes in the Tsepamo Study during the Omicron era. We assessed maternal mortality and adverse birth outcomes for all singleton pregnancies from mid-November 2021 (the start of the Omicron era) to mid-August 2022 at nine Tsepamo sites, among individuals with documented SARS-CoV-2 screening PCR or antigen tests and known HIV status. Of 9,705 women routinely screened for SARS-CoV-2 infection at delivery (64% of deliveries at these sites), 373 (3.8%) tested positive. Women with HIV were as likely to test positive for SARS-CoV-2 (77/1833, 4.2%) as women without HIV (293/6981, 4.2%) (p = 1.0). There were 5 recorded maternal deaths (0.03%), one occurring in a woman with a positive SARS-CoV-2 test result. In contrast, maternal mortality was 3.7% and 0.1% in those with and without SARS-CoV-2, respectively, during the pre-Omicron era. In the Omicron era, there were no differences among infants exposed or unexposed to SARS-CoV-2 in overall adverse birth outcomes (28.1% vs 29.6%; aRR 1.0, 95%CI 0.8–1.1), severe adverse birth outcomes (11.9 vs 10.6%; aRR 1.1, 95%CI 0.8–1.5), preterm delivery (15.1% vs 14.9%; aRR 1.0, 95%CI 0.8–1.3), or stillbirth (1.9% vs 2.3%; aRR 0.8, 95%CI 0.4–1.7). Adverse outcomes among those exposed to both HIV and SARS-CoV-2 were similar to those exposed to HIV alone (31.2% vs. 33.1%; aRR 0.9, 95%CI 0.6–1.3; p = 0.5). Maternal mortality was far lower in Botswana during the Omicron era than in the pre-Omicron era, and adverse birth outcomes were no longer significantly impacted by exposure to SARS-CoV-2 either overall or with HIV co-exposure. Increased population immunity to SARS-CoV-2, less stress on the hospital systems in the Omicron era, and possible differences in viral pathogenicity may combine to explain these findings.

by Obidimma Ezezika, Tiana Stephanie Kotsaftis, Alanna Marson Background Upstream factors have been found to affect COVID-19 vaccination rates and coverage globally. However, there are inadequate details within the African context. This systematic review aims to close this research gap by investigating upstream factors influencing COVID-19 vaccination rates in Africa. Methods A literature search will be systematically conducted utilizing various databases including: MEDLINE, EMBASE, SCOPUS, CINAHL, Web of Science, and PsycINFO. Eligible studies will include peer-reviewed articles published in the English language from 2020–2023, conducted in Africa, focused on upstream factors, and include one barrier or facilitator to COVID-19 vaccination rates. Two reviewers will use a two-step screening process to examine every article’s title, abstract, and full text. A third-party reviewer will resolve disagreements between both individual reviewers. This review will focus on extracting data from published studies to explain the upstream factors included and their impact on COVID-19 vaccination rates across Africa. Data and records will be managed using Covidence. Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] framework will be used as the basis for reporting. To reduce bias, the researchers will use the Mixed Methods Appraisal Tool to assess the studies chosen for review. Results will be compiled utilizing four tables to summarize articles and group determinants based on the Consolidated Framework for Implementation Research (CFIR). Discussion Upstream factors have been cited as affecting population health, vaccination programs, and COVID-19, yet a large-scale systematic review has not been conducted to investigate these factors in relation to COVID-19 vaccination disparities faced in Africa. This review aims to analyze the root causes of African vaccination disparities by focusing on upstream factors. Understanding these factors is vital to help explain why these disparities occur and for designing effective interventions for future vaccinations. The results are expected to provide insights for researchers, policymakers, health systems, and individuals by identifying how resources and efforts can be better utilized to improve vaccination uptake and access. Trial registration Systematic review registration: CRD42024501293. …

by Krzysztof Kaniasty, Erik van der Meulen This longitudinal study examined a sample of adult Poles (N = 1245), who were interviewed three times from July 2021 to August 2022, during the later stages of the COVID-19 pandemic. The study had two primary objectives. The first was to assess the impact of the pandemic on psychological distress, measured through symptoms of depression and anxiety. The pandemic’s effects were evaluated using three predictors: direct exposure to COVID-19, COVID-19 related stressors, and perceived threats from COVID-19. The second objective was to investigate the role of received social support in coping with the pandemic’s hardships. Receipt of social support was measured by both the quantity of help received and the perceived quality of that support. A Latent Growth Curve Model (LGCM) was employed to analyze psychological distress across three waves, controlling for sociodemographic variables, non-COVID life events, coping self-efficacy, and perceived social support. Findings indicated that COVID-19 stressors and COVID-19 threats were strongly and consistently associated with greater psychological distress throughout the study period. The impact of direct COVID-19 exposure was limited. The quantity of received support predicted higher distress, whereas higher quality of received support was linked to better mental health. Crucially, the relationship between the quantity of support and distress was moderated by the quality of support. Effective social support was associated with the lowest distress levels, regardless of the amount of help received. Conversely, receiving large amounts of low-quality support was detrimental to psychological health. In summary, the ongoing psychosocial challenges of COVID-19 significantly eroded mental health, highlighting the importance of support quality over quantity in coping with significant life adversities.

by Armin Aslani, Amirali Soheili, Seyed Ehsan Mousavi, Ali Ebrahimi, Ryan Michael Antar, Zahra Yekta, Seyed Aria Nejadghaderi Background Gastric cancer ranks among the top cancers in terms of both occurrence and death rates in the United States (US). Our objective was to provide the incidence trends of gastric cancer in the US from 2000 to 2020 by age, sex, histology, and race/ethnicity, and to evaluate the effects of the COVID-19 pandemic. Methods We obtained data from the Surveillance, Epidemiology, and End Results 22 program. The morphologies of gastric cancer were classified as adenocarcinoma, gastrointestinal stromal tumor, signet ring cell carcinoma, and carcinoid tumor. We used average annual percent change (AAPC) and compared pairs using parallelism and coincidence. The numbers were displayed as both counts and age-standardized incidence rates (ASIRs) per 100000 individuals, along with their corresponding 95% confidence intervals (CIs). Results Over 2000–2019, most gastric cancers were among those aged ≥55 years (81.82%), men (60.37%), and Non-Hispanic Whites (62.60%). By histology, adenocarcinoma had the highest incident cases. During the COVID-19 pandemic, there was a remarkable decline in ASIRs of gastric cancer in both sexes and all races (AAPC: -8.92; 95% CI: -11.18 to -6.67). The overall incidence trends of gastric cancer were not parallel, nor identical. Conclusions The incidence of gastric cancer shows notable variations by age, race, and sex, with a rising trend across ethnicities. While the overall incidence has declined, a noteworthy increase has been observed among younger adults, particularly young Hispanic women; however, rates decreased significantly in 2020. …

by Nicole Bertges, Sachiyo Shearman, Satomi Imai, Jo Anne G. Balanay, Sinan Sousan Understanding the motivations and barriers populations face in respiratory protection during a pandemic is key to effective primary prevention. The goal of this study was to identify the impact of various motivational factors on individual choice of masks or respirators during the COVID-19 pandemic. The survey study included a sample of 619 participants between the ages of 18 to 75 years old and English speaking, who were asked about factors that affected their choice of masks or respirators between the months of April 2020 and May 2021. Participants showed a positive association between choice of respirator and being male, perceived comfort and trust in respirators, importance of personalization, and trust in information from family or friends. In addition, positive associations were found between income, education, and the amount of trust in CDC, WHO, and local/state health departments. Results indicate the need for increased education on attributes of each mask or respirator, review of respirator fit, research into specific areas of discomfort, and outreach efforts to vulnerable populations.

by Charles L. Bennett, Joseph Magagnoli, Krishna Gundabolu, Peter Georgantopoulos, Akida Lebby, Gretchen Watson, Kevin Knopf, Linda Martin, Kenneth R. Carson, William J. Hrushesky, Chadi Nabhan, Edward Zyszkowski, Edward B. Smith, Robert Peter Gale, Steven T. Rosen Introduction In May 2022, the Centers for Disease Control and Prevention disseminated an alert advising that “a few” persons with Nirmatrelvir/ritonavir (NM/R)-associated rebound of COVID-19 infection had been identified. Three case reports appearing as pre-print postings described the first cases. Analyses in March 2023 by NM/R’s manufacturer and the Food and Drug Administration (FDA) reported no association between NM/R and COVID-19 rebound in a large phase 3 randomized clinical trial. Our study evaluated if social media databases or electronically disseminated new articles might provide insights related to the putative new toxicity, NM/R-associated COVID-19 rebound. Methods Information on NM/R-associated COVID-19 rebound cases was abstracted from preprint postings of non-peer-reviewed manuscripts, social media websites, electronically disseminated print and television media reports, a new FDA adverse event database for drugs that received Emergency Use Approval, and news articles in scientific journals. Results Thirty-five persons experienced presumed or documented NM/R-associated COVID-19 rebound, based on information described in preprint services (n = 27), Twitter postings and related news articles (n = 7), and news articles without related Twitter reports (n = 1). These reports included information on dates of initial COVID-19 illness and rebound onset, COVID-19 testing, vaccine status, presentation, and outcome. A new FDA safety database identified 12,500 possible cases of this toxicity, but the quality of these data was poor. Preprint postings preceded peer-reviewed publications describing the same cases by four months. Social media websites including Instagram, Reddit, YouTube, the Center for Disease Control and Prevention’s (CDC) Health Alert Network, CDC Twitter, and Facebook did not provide clinically meaningful information on individual cases. Conclusion Preprint services and Twitter facilitated identification of the largest case series of NM/R-associated COVID-19 rebound. The cases were reported in non-peer-reviewed media several weeks prior to the first peer-reviewed electronically disseminated publication of one person with this diagnosis. …

Journal of Medical Virology, Volume 96, Issue 9, September 2024.

IntroductionThe pandemic has highlighted a worsening of nurses’ working conditions and a global nursing shortage. Little is known about the factors, strategies and interventions that improve nurse retention in the peri-COVID and post-COVID time period. An improved understanding of approaches implemented to support and retain nurses will provide a blueprint for sustaining the nursing workforce. The objectives of this scoping review are to investigate and describe the following: (a) factors associated with nurse retention; (b) strategies suggested to support nurse retention and (c) interventions trialled to support nurse retention, during and after the COVID-19 pandemic. Methods and analysisMedline, Embase, CINAHL and Scopus will be searched. The included studies will be qualitative, quantitative, mixed methods and grey literature studies of nurses including factors, strategies and/or interventions to support nurse retention in the peri-COVID and post-COVID time period (2019 to present) that are in English or can be translated into English. The excluded studies will be those that focus on nurse managers, educators, students or those in advanced practice roles and studies where the population cannot be segmented to identify which data came from nurses. Systematic, scoping reviews and meta-syntheses will be excluded, but their reference lists will be hand-screened for suitable studies. Data will be evaluated for quality and synthesised qualitatively to map the current evidence available. The relevant studies will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Ethics and disseminationApproval for the broader research study, including this scoping review, has been obtained from the university health sciences research board (protocol #00042510). All data for this scoping review will be collected from published literature, and findings will be published in a peer-reviewed journal and presented at relevant conferences. Trial registration numberThe protocol was registered on Open Science Framework (4 April 2024) https://doi.org/10.17605/OSF.IO/XWH45. …

In vaccine-naive, SARS-CoV-2-positive adolescents, single-dose mRNA-1273.222 was effective against COVID-19 based on successful immunobridging to the two-dose mRNA-1273 primary series in young adults. The findings support a simplified single-dose vaccination schedule with variant-containing mRNA vaccines, regardless of previous vaccination status.

by Ploy Pattanakitsakul, Chanya Pongpatipat, Chavachol Setthaudom, Mongkol Kunakorn, Thiantip Sahakijpicharn, Anannit Visudtibhan, Nopporn Apiwattanakul, Surapat Assawawiroonhakarn, Uthen Pandee, Chonnamet Techasaensiri, Sophida Boonsathorn, Sujittra Chaisavaneeyakorn Globally, cases of children’s coronavirus disease 2019 (COVID-19) have been reported since the pandemic started. Most children have an asymptomatic or mild infection. Therefore, the incidence rate of COVID-19 in children might have been underestimated. This study aimed to determine (1) the seroprevalence (and seroconversion rates) of COVID-19, including associated risk factors, in pediatric patients visiting hospitals; and (2) the immunological responses to COVID-19. This was a prospective, cross-sectional study. Patients aged 0–18 years who visited the hospital from September 2020 to February 2022 were included. Demographic, clinical, and laboratory data were reviewed. A total of 1,443 pediatric patients were enrolled. Of these, 323 (22.6%) had a history of COVID-19. In the pre-Delta period, the seroprevalence increased from 4.1% to 70.6% in all included patients and from 0.5% to 10% in patients without a known history of COVID-19 compared with the Delta-Omicron period. The seroconversion rate was 6.8% (19 per 100 person-years) in pediatric patients with COVID-19. Risk factors for COVID-19 seropositivity were respiratory symptoms, being in an outpatient department setting, and infection during the Delta-Omicron period. Exposure to household members with confirmed COVID-19 was a risk factor for seropositivity and seroconversion. Infection during the Delta-Omicron period and testing conducted >2 weeks after the onset of symptoms was associated with spike immunoglobulin (Ig) M and spike and nucleocapsid IgG, respectively. High nucleocapsid IgG levels were associated with pneumonia in pediatric patients with COVID-19. Pediatric patients exposed to household members with COVID-19 and respiratory symptoms should be tested for COVID-19. Nucleocapsid IgG can be used as a surrogate marker to identify patients who may have experienced pneumonia from COVID-19 and as a screening tool for the COVID-19 outbreak, regardless of COVID-19 vaccination status.

Journal of Medical Virology, Volume 96, Issue 9, September 2024.

This Viewpoint explores increasing mortality rates in the US due to a variety of causes unrelated to the COVID-19 pandemic.

This Viewpoint from the National Center for Health Statistics reports the leading causes of death in the US from 2019 to 2023, including the emergence of COVID-19 and shifts in other top causes as pandemic deaths decreased.

by Elise D’Abaco, Sonia Khano, Al Giles-Kaye, Jag Dhaliwal, Ric Haslam, Chidambaram Prakash, Harriet Hiscock Background The COVID-19 pandemic was associated with an increase in child and adolescent mental health disorders, with subsequent worsening of patient access to specialist mental health care. Clinicians working in the community were faced with increased demands to diagnose and manage pediatric mental health disorders, without always having the confidence and knowledge to do so. We therefore developed COnnecting Mental-health PAediatric Specialists and community Services (COMPASS)—a collaborative model designed to upskill community clinicians in child and adolescent mental health care and provide them with better access to child and adolescent psychiatry expertise. COMPASS comprises (1) an online Community of Practice (CoP) with fortnightly one-hour sessions covering: anxiety; aggression and challenging behaviours; depression; self-harm and suicidality; eating disorders; and autism spectrum disorder/complex cases and (2) primary and secondary consultations for general practitioners and paediatricians with an experienced child psychiatrist. We aimed to assess the impact of COMPASS on community clinician self-reported confidence in: managing common child and adolescent mental health disorders (Objective 1, primary outcome); navigating the mental health care system (i.e. knowing how services are organised, accessed, and how to refer patients, Objective 2); diagnosing conditions (Objective 3); prescribing psychotropic medications (Objective 4) as well as the impact on, clinician practice and wellbeing (Objective 5) and outcomes of patients referred by COMPASS clinicians to the child psychiatrist (Objective 6). Methods We evaluated COMPASS in its first year, with COMPASS running from March to July 2021. Participating clinicians completed pre-post surveys evaluating change in Objectives 1 to 4 above, using study-designed measures. A purposive sample of clinicians was then invited to a semi-structured interview to understand their experience of COMPASS and its impacts on practice and wellbeing (Objective 5). We adopted an inductive approach to the qualitative analysis using the Framework Method. This involved selecting five random transcripts which were double coded and categorized, to generate an initial framework against which all subsequent transcripts were analysed. Themes and subthemes were generated from the data set, by reviewing the matrix and making connections within and between clinicians, codes and categories One child psychiatrist completed a 2-week logbook of the nature and outcomes of primary and secondary consultations (Objective 6). Findings 51 (86%) clinicians attended CoP sessions and completed pre-post surveys, with 92% recommending COMPASS to peers. Clinicians reported increased confidence in the pharmacological and non-pharmacological management of all conditions, most notably for management of self-harm. They also reported increased knowledge of how to navigate the mental health system and prescribe medications. Qualitative analysis (n = 27 interviews) found that COMPASS increased clinician wellbeing and reduced feelings of professional isolation and burnout. Over the 2-week snapshot, the child psychiatrist consulted on 22 patients and referred all back to the community clinician. Conclusions COMPASS is associated with improved clinician confidence to manage child and adolescent mental health concerns, navigate the mental health system, improved clinician wellbeing, and reduced need for ongoing mental health care by specialists. …

by Suliana Saverio, Masoud Mohammadnezhad, Filimone Raikanikoda Introduction Diabetic Foot Complications (DFCs) are a growing cause of morbidity and mortality with less than one third of physicians able to discern the signs of diabetes related peripheral neuropathy. DFCs and resultant amputations account for a considerable proportion of surgeries in Fiji, with very limited literature available to verify the factors that influence these alarming figures. This study aimed to explore Health Care Workers’ (HCWs) perspectives on diabetic foot complications and challenges of foot care management in Fiji. Method An exploratory descriptive qualitative design was used among HCWs at the Sigatoka Sub Divisional Hospital (SDH), Fiji in 2021. HCWs at the SDH were required to have a minimum work experience of at least six months in public health. All participants who met the inclusion criteria were selected through purposive sampling. Data was collected using a focus group discussion guide composed of semi-structured open-ended questions to guide the Focus Group Discussions (FGDs). Focus discussions were audio recorded and transcribed with thematic analysis applied to derive the themes and sub-themes outlined in the study. Results Twenty HCWs participated in four FGDs with four major themes identified. The first theme was HCWs’ perceptions and practice of foot care which revealed that all participants had adequate diabetic foot care knowledge. The second theme was factors affecting foot care which was mainly focused on identified barriers such as inadequate patient foot care knowledge, the lack of resources such as manpower, and health system challenges like the COVID-19 pandemic. The third theme is creating awareness among patients and HCWs to improve foot care practices. The fourth theme is strengthening foot care practices at the different levels of health care that is aimed at optimizing diabetic foot outcomes. Conclusion Various foot care barriers namely patient factors and the lack of resources is a concern depicted in this study. There is a need to address health system barriers and enforce diabetic foot education, screening and care for patients and the community. …

ObjectivesThis qualitative study explored patients’ experiences and perceptions of the SCOPE2 trial. SCOPE2 examined radiotherapy dose escalation in patients with inoperable oesophageal cancer treated with definitive chemoradiotherapy (dCRT). SettingRecruitment at five clinical sites in England and Wales, UK. ParticipantsSCOPE2 trial participants were invited to take part in interviews from across five clinical sites. Participants self-selected to take part in up to three interviews across four different time points: baseline (before treatment) and at 2–3 months, 3–6 months or 6 months+ after baseline. There were five female and five male interview participants. InterventionsParticipants were randomised to standard dose dCRT prescribed carboplatin/paclitaxel or cisplatin/capecitabine, or an escalated dose dCRT prescribed carboplatin/paclitaxel or cisplatin/capecitabine. MethodsThis qualitative study used semistructured longitudinal interviews to explore the impact of treatment on patient outlook and quality of life and the impact of the COVID-19 pandemic. Interview data were thematically analysed. Results10 patients participated in 16 longitudinal interviews. Three participants were accompanied by companions. Participants experienced side-effects from radiotherapy and chemotherapy including nausea, throat pain, difficulties eating and regaining appetite, thrombosis and fatigue, although most of these symptoms gradually improved. Participants required more ongoing information and support regarding treatment side-effects and cancer status in order to improve their overall quality of life. Best practice examples involved key contacts providing practical advice and signposting support. ConclusionParticipants of the SCOPE2 trial reported short and longer-term side-effects from chemoradiotherapy, but these usually lessened over time. Participants attempted to be positive about their survival prospects by readjusting their expectations, priorities and lifestyles. Providing patients with ongoing opportunities to discuss detailed and timely information regarding treatment side-effects, aftercare and cancer status could improve the overall health and well-being of patients during oesophageal cancer trials and pathways. Trial registration numberNCT02741856; ISRCTN: 97125464. …

ObjectivesDuring the COVID-19 pandemic, healthcare professionals were faced with prioritisation dilemmas due to limited surgical capacity. While the views of healthcare professionals on fair allocation have been given considerable attention, the views of patients have been overlooked. To address this imbalance, our study aimed to identify which ethical principles are most supported by patients regarding the fair allocation of surgical resources. DesignA Q-methodology study was conducted. Participants ranked ordered 20 statements covering different viewpoints on fair allocation according to their point of view, followed by an interview. Principal component analysis followed by varimax rotation was used to identify subgroups who broadly agreed in terms of their rankings. SettingThe setting of this study was in the Netherlands. Participants16 patient representatives were purposively sampled. ResultsTwo perspectives were identified, both of which supported utilitarianism. In perspective 1, labelled as ‘clinical needs and outcomes’, resource allocation should aim to maximise the health gains based on individual patient characteristics. In perspective 2, labelled as ‘population outcomes and contribution to society’, allocation should maximise health gains as with perspective 1, but this should also consider societal gains. ConclusionsThere was a broad agreement among patient representatives that utilitarianism should be the guiding ethical principle for fair allocation of scarce surgical resources. The insights gained from this study should be integrated into policymaking and prioritisation strategies in future healthcare crises. …

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created an unprecedented global public health emergency. The virus predominantly infects the upper respiratory tract, leading to a wide spectrum of mild-to-severe symptoms. In its milder form, COVID-19 often presents with common cold-like symptoms, including fever, cough, throat pain, and nasal discharge [1].

Abstract Purpose Evidence on the incidence and persistence of post-acute sequelae of COVID-19 (PASC) among children and adolescents is still limited. Methods In this retrospective cohort study, 59,339 children and adolescents with laboratory-confirmed COVID-19 in 2020 and 170,940 matched controls were followed until 2021-09-30 using German routine healthcare data. Incidence rate differences (ΔIR) and ratios (IRR) of 96 potential PASC were estimated using Poisson regression. Analyses were stratified according to age (0–11, 12–17 years), and sex. At the individual level, persistence of diagnoses in patients with onset symptoms was tracked starting from the first quarter post-infection. Results At 0–3 month follow-up, children and adolescents with a previous SARS-CoV-2 infection showed a 34% increased risk of adverse health outcome, and approximately 6% suffered from PASC in association with COVID-19. The attributable risk was higher among adolescents (≥ 12 years) than among children. For most common symptoms, IRRs largely persisted at 9–12 month follow-up. IRR were highest for rare conditions strongly associated with COVID-19, particularly inflammatory conditions among children 0–11 years, and chronic fatigue and respiratory insufficiency among adolescents. Tracking of diagnoses at the individual level revealed similar rates in the decline of symptoms among COVID-19 and control cohorts, generally leaving less than 10% of the patients with persistent diagnoses after 12 months. Conclusion Although very few patients presented symptoms for longer than 12 months, excess morbidity among children and, particularly, adolescents with a history of COVID-19 means a relevant burden for pediatric care. …

ObjectiveTo estimate the effect of (a) the COVID-19 pandemic and (b) COVID-19 restriction stringency on daily minutes of device-measured moderate-to-vigorous physical activity (MVPA). DesignPhysical activity data were collected from the INTerventions, Equity, Research and Action in Cities Team (INTERACT) cohorts in Montreal, Saskatoon and Vancouver before (May 2018 to February 2019, ‘phase 1’) and during the pandemic (October 2020 to February 2021, ‘phase 2’). We estimated the effect of the two exposures by comparing daily MVPA measured (a) before vs during the pandemic (phase 1 vs phase 2) and (b) at different levels of COVID-19 restriction stringency during phase 2. Separate mixed effects negative binomial regression models were used to estimate the association between each exposure and daily MVPA, with and without controlling for confounders. Analyses were conducted on person-days with at least 600 min of wear time. Effect modification by gender, age, income, employment status, education, children in the home and city was assessed via stratification. SettingMontreal (Quebec), Saskatoon (Saskatchewan) and Vancouver (British Columbia), Canada. Main outcome measureDaily minutes of MVPA, as measured using SenseDoc, a research-grade accelerometer device. ResultsDaily minutes of MVPA were 21% lower in phase 2 (October 2020 to February 2021) compared with phase 1 (May 2018 to February 2019), controlling for gender, age, employment status, household income, education, city, weather and wear time (rate ratio=0.79, 95% CI 0.69, 0.92). This did not appear to be driven by changes in the sample or timing of data collection between phases. The results suggested effect modification by employment, household income and education. Restriction stringency was not associated with daily MVPA between October 2020 and February 2021 (adjusted rate ratio=0.99, 95% CI 0.96, 1.03). ConclusionsBetween October 2020 and February 2021, daily minutes of MVPA were significantly lower than 2 years prior, but were not associated with daily COVID-19 restriction stringency. …

The three years when infections causd by SARS-CoV-2 were considered a global emergency are arguably still felt beyond WHO\'s ‘non-emergent’ declaration. The global nature of this emergency drastically changed the way people, companies, and governments were able to integrate and interact worldwide. Focusing on the outcomes of the management of COVID-19 through a sociological lens, Globalisation and pandemic management: issues and outcomes from COVID-19, written by Chris L Peterson, explores globalisation\'s effect on the pandemic and the pandemic\'s effect on globalisation.

In 2019, WHO highlighted vaccine hesitancy as a major global health threat, exacerbated by anti-vaccination movements and social media. Defined as ‘reluctance or refusal to have oneself or one\'s children vaccinated against infectious disease’, vaccine hesitancy has alarming and ever-increasing ramifications including the rise in mortality rates of infectious diseases that have been on the decline for decades. But what is behind vaccine hesitancy? Vaccine hesitancy in the Nordic countries: trust and distrust during the COVID-19 pandemic, curated by Lars Borin, Mia-Marie Hammarlin, Dimitrios Kokkinakis, and Frederik Miegel, is an anthology of articles that explores attitudes around vaccination across the Nordic countries during the pandemic.

Abstract Background Treatment guidelines were developed early in the pandemic when much about COVID-19 was unknown. Given the evolution of SARS-CoV-2, real-world data can provide clinicians with updated information. The objective of this analysis was to assess mortality risk in patients hospitalized for COVID-19 during the Omicron period receiving remdesivir+dexamethasone versus dexamethasone alone.Methods A large, multicenter US hospital database was used to identify hospitalized adult patients, with a primary discharge diagnosis of COVID-19 also flagged as “present on admission” treated with remdesivir+dexamethasone or dexamethasone alone from December 2021 to April 2023. Patients were matched 1:1 using propensity score matching and stratified by baseline oxygen requirements. Cox proportional hazards model was used to assess time to 14- and 28-day in-hospital all-cause mortality.Results A total of 33 037 patients were matched, with most patients ≥65 years old (72%), White (78%), and non-Hispanic (84%). Remdesivir+dexamethasone was associated with lower mortality risk versus dexamethasone alone across all baseline oxygen requirements at 14 days (no supplemental oxygen charges: adjusted hazard ratio [95% CI]: 0.79 [0.72-0.87], low flow oxygen: 0.70 [0.64-0.77], high flow oxygen/non-invasive ventilation: 0.69 [0.62-0.76], invasive mechanical ventilation/extracorporeal membrane oxygen (IMV/ECMO): 0.78 [0.64-0.94]), with similar results at 28 days.Conclusions Remdesivir+dexamethasone was associated with a significant reduction in 14- and 28-day mortality compared to dexamethasone alone in patients hospitalized for COVID-19 across all levels of baseline respiratory support, including IMV/ECMO. However, the use of remdesivir+dexamethasone still has low clinical practice uptake. In addition, these data suggest a need to update the existing guidelines.

by Catharina Bartmann, Theresa Kimmel, Petra Davidova, Miriam Kalok, Corina Essel, Fadia Ben Ahmed, Rhiannon V. McNeill, Tanja Wolfgang, Andreas Reif, Franz Bahlmann, Achim Wöckel, Patricia Trautmann-Villalba, Ulrike Kämmerer, Sarah Kittel-Schneider Purpose The aim of this study was to investigate the effects of the COVID-19 pandemic on maternal mental health during pregnancy and the postpartum period. Methods The impact of the COVID-19 pandemic situation during and post pregnancy was addressed on three main factors; maternal mental health, mother-child bonding, and maternal self-confidence. To do this, two different patient cohorts were compared; data from one cohort was collected pre-pandemic, and data was collected from the other cohort at the beginning of the pandemic. Questionnaires were used to collect data regarding depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS]), anxiety (State Trait Anxiety Inventory [STAI]), maternal self-confidence (Lips Maternal Self-Confidence Scale [LMSCS]) and mother-child bonding (Postpartum Bonding Questionnaire [PBQ]). Results There were no significant differences in depressive symptoms (EPDS with an average median of 4.00–5.00) or anxiety (STAI with an average median of 29.00–33.00) between the cohorts. However, the quality of postpartum maternal bonding was higher at 3–6 months in the pandemic cohort, which was also influenced by education and the mode and number of births. The maternal self-confidence was lower in the pandemic sample, also depending on the mode of birth delivery. Conclusions In this study, a differential effect of the COVID-19 pandemic on mother-child bonding and maternal self-confidence was observed. The results thereby identified possible protective factors of the pandemic, which could potentially be implemented to improve maternal mental health and bonding to the child under normal circumstances. …

by Na Chen The COVID-19 pandemic has wrought unprecedented disruption on global economies, leading to widespread income insecurity among individuals and households. This study investigates the impact of the pandemic on income insecurity across different income groups and assesses the role of social protection measures in mitigating these effects. Using cross-country data, we analyze the prevalence of income reduction and the effectiveness of social assistance programs in high-income, upper middle-income, lower middle-income, and low-income countries. Our findings reveal significant variations in income insecurity and social protection responses across these groups. the pandemic had a significant impact on household incomes globally, with lower-middle-income countries experiencing the most significant income reductions. The average per capita transfer amounts show a general decrease over time, which could be due to the economic strain on governments and the need for more sustainable social protection programs. The correlation between transfer amounts and the proportion of households with reduced income indicates that countries with higher income reduction rates tended to have lower average per capita transfer amounts, suggesting a potential lack of adequate support for those in need. The study highlights the importance of robust social safety nets in cushioning the economic blow of the pandemic, particularly for vulnerable populations in lower-income countries.

Journal of Medical Virology, Volume 96, Issue 9, September 2024.

As of September 3, 2023, over 690 million confirmed cases of coronavirus disease 2019 (COVID-19) and nearly seven million COVID-19-related deaths were reported globally [1]. During this period, in South Korea, 34 million COVID-19 cases were confirmed, resulting in 35,000 COVID-19-related deaths [2]. Following the development of COVID-19 vaccines, vaccination campaigns were launched in various countries, with the aim of preventing symptomatic COVID-19, severe disease, and mortality, and vaccination has contributed to controlling the COVID-19 pandemic and reducing COVID-19-related mortality [3-5].

Abstract Background The association of the oral microbiome with SARS-CoV-2 infections and disease progression has been documented in European, Asian, and American populations but not in Africa. Methods We conducted a study in Ghana to evaluate and compare the naso-oropharyngeal microbiome in SARS-CoV-2-infected and uninfected persons before (pre-vaccine) and after vaccine availability (post-vaccine) in the country. 16S rRNA V3-V4 variable region was sequenced and analysed from DNA extracted from naso-oropharyngeal swabs. Results Considering only the infection status, infected and uninfected groups had no difference in their within-group diversity and was evident in the study population pre- and post-vaccine availability. The introduction of vaccines reduced the diversity of the naso-oropharyngeal microbiome particularly among SARS-CoV-2 positive persons and, vaccinated individuals (both infected and uninfected) had higher microbial diversity compared to their unvaccinated counterparts. SARS-CoV-2-positive and -negative individuals were largely compositionally similar varying by 4–7% but considering vaccination*infection statuses, the genetic distance increased to 12% (P = 0.003) and was mainly influenced by vaccination. Common among the pre- and post-vaccine samples, Atopobium and Finegoldia were abundant in infected and uninfected individuals, respectively. Bacteria belonging to major butyrate-producing phyla, Bacillota (particularly class Clostridia) and Bacteroidota showed increased abundance more strikingly in infected individuals before vaccines were available. They reduced significantly after vaccines were introduced into the country with Fusobacterium and Lachnoanaerobaculum being the only common bacteria between pre-vaccine infected persons and vaccinated individuals, suggesting that natural infection and vaccination correlate with high abundance of short-chain fatty acids. Conclusion Our results show, in an African cohort, the abundance of bacteria taxa known for their protective pathophysiological processes, especially during infection, suggesting that this population is protected against severe COVID-19. The immune-related roles of the members of Bacillota and Bacteroidota that were found associated with infection and vaccination require further studies, and how these may be linked to ethnicity, diet and age. We also recommend expansion of microbiome–disease association studies across Africa to identify possible bacterial-mediated therapeutics for emerging infections. …

Abstract Background Although liver transplant (LT) recipients are considered a population at risk of severe features of coronavirus disease 2019 (COVID-19), data in this regard are scarce and controversial. In this study, we reported the outcome of 24 cases of LT recipients who were hospitalized due to COVID-19 and investigated the role-playing factors in the severity of the disease. Methods In this single-center, analytic case-series study, eligible patients were among LT recipients who were hospitalized due to the diagnosis of COVID-19 based on positive results of polymerase chain reaction. Participants were categorized as severe COVID-19 if they were admitted to the intensive care unit, experienced respiratory failure demanding mechanical ventilation, or eventually died. Demographic and clinical data, COVID-19 symptoms and specific treatments, laboratory biomarkers, and immunosuppressive regimens and their alteration during the admission were recorded. Analysis was done using SPSS software. Results Twenty-four hospitalized LT patients were included, of which nine had severe and fifteen had non-severe COVID-19. Out of 9 patients with severe COVID-19, four sadly died. The analysis and comparison between the two groups revealed longer hospital stays (P = 0.02), lower lymphocyte counts (P = 0.002), and higher levels of C-reactive protein (CRP) (P = 0.006) in patients with severe COVID-19. Patients with non-severe COVID-19 had higher doses of tacrolimus and mycophenolate in their baseline immunosuppressive regimen (both P = 0.02). Conclusion Lymphopenia and high CRP levels are associated with more severe forms of COVID-19 in LT patients. Mycophenolate may have protective properties against severe COVID-19. The role of severity indicators in LT patients with COVID-19 needs to be systematically recognized. …

Objectives: This study aimed to demonstrate the impact of virtual visits on the satisfaction of family members and the anxiety and depression of patients in the ICU during the COVID-19 pandemic. Design: A single-center, randomized controlled trial. Setting: This study was conducted from July 2021 to May 2022, in the Seoul National University Hospital Patients: A total of 40 patients eligible for virtual visitation whose Richmond Agitation-Sedation Scale score was –2 or above were recruited and randomized into virtual visitation and usual care groups. Interventions: Virtual visitation began on the first day after ICU admission and continued until ICU discharge, lasting for a maximum of 7 days. Measurements and Main Results: The primary outcome was the satisfaction level of the family members with care and decision-making in the ICU, assessed using the Family Satisfaction-ICU (FS-ICU) 24-survey questionnaire. Secondary outcomes included patient anxiety and depression levels assessed using the Hospital Anxiety and Depression Scale (HADS), at the study enrollment after ICU admission and at the end of the study. After two patients were excluded due to clinical deterioration, 38 patients were ultimately analyzed, including 18 patients in the virtual visitation group and 20 patients in the usual care group. The FS-ICU 24 survey score was significantly higher in the virtual visitation group (89.1 ± 13.0 vs. 75.1 ± 17.7; p = 0.030). The reduction in HADS-Anxiety (59.4% vs. 15.39; p < 0.001) and HADS-Depression (64.5% vs. 24.2%; p < 0.001) scores between the two time points, from study enrollment after ICU admission to the end of the study was significantly larger in the virtual visitation group. Conclusions: In the COVID-19 pandemic era, virtual visits to ICU patients helped reduce depression and anxiety levels of patients and increase the satisfaction of their family members. Enhancing access to virtual visits for family members and developing a consistent approach may improve the quality of care during another pandemic.

Journal of Medical Virology, Volume 96, Issue 9, September 2024.

Background: The Covid-19 pandemic had great impact on HIV care and prevention worldwide, including in Brazil. We compared HIV testing, recent infection, and annualized incidence according to Covid-19 pandemic period among men who have sex with men (MSM) and transgender women (TGW). Setting: HIV/STI testing, prevention and treatment referral service in Rio de Janeiro, Brazil Methods: We used Maxim HIV-1 Limiting Antigen Avidity EIA as part of recent infection testing algorithm to identify recent HIV infections and estimate annualized HIV incidences in pre- (March/2018-February/2020) and post-Covid-19 pandemic onset period (March/2020-January 2022). Multivariable logistic regression model assessed factors associated with recent HIV infection. Results: Among 4590 MSM and TGW, 593 (12.9%) tested positive for HIV and 119 (2.6%) were identified as having recent infection. Percentage of recent HIV infection did not differ between Covid-19 periods. Overall annualized HIV incidence rates were 6.0% (95%CI:4.2-7.7) and 6.6% (95%CI:4.3-9.0) in pre- and post-Covid-19 periods, respectively. During the post-Covid-19 period, higher incidence rates were observed among TGW (8.4%[95%CI:2.9-13.9]), those aged 18-24 years (7.8%[ 95%CI:4.0-11.7]), Black race (7.9%[95%CI:3.8-12.0]), and with 30 years and TGW, and lower for those with more years of schooling. Conclusion: HIV incidence estimates remain high among MSM and TGW in Brazil, especially among the most vulnerable. The consequences of the Covid-19 pandemic on the HIV epidemic will likely persist and contribute to worsening HIV outcomes. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

Abstract Background Respiratory syncytial virus (RSV), a leading cause of lower respiratory tract infection (LRTI) among children, has resurged in the form of endemic or even pandemic in many countries and areas after the easing of COVID-19 containment measures. This study aimed to investigate the differences in epidemiological and clinical characteristics of children hospitalized for RSV infection during pre- and post-COVID-19 eras in Yunnan, China. Methods A total of 2553 pediatric RSV inpatients from eight hospitals in Yunnan were retrospectively enrolled in this study, including 1451 patients admitted in 2018–2019 (pre-COVID-19 group) and 1102 patients admitted in 2023 (post-COVID-19 group). According to the presence or absence of severe LRTI (SLRTI), patients in the pre- and post-COVID-19 groups were further divided into the respective severe or non-severe subgroups, thus analyzing the risk factors for RSV-associated SLRTI in the two eras. Demographic, epidemiological, clinical, and laboratory data of the patients were collected for the final analysis. Results A shift in the seasonal pattern of RSV activity was observed between the pre-and post-COVID-19 groups. The peak period of RSV hospitalizations in the pre-COVID-19 group was during January–April and October–December in both 2018 and 2019, whereas that in the post-COVID-19 group was from April to September in 2023. Older age, more frequent clinical manifestations (fever, acute otitis media, seizures), and elevated laboratory indicators [neutrophil-to-lymphocyte ratio (NLR), c-reactive protein (CRP), interleukin 6 (IL-6), co-infection rate] were identified in the post-COVID-19 group than those in the pre-COVID-19 group (all P 

Abstract Background Identifying symptom clusters in Long COVID is necessary for developing effective therapies for this diverse condition and improving the quality of life of those affected by this heterogeneous condition. In this study, we aimed to identify and compare symptom clusters at 9 and 12 months after a SARS-CoV-2 positive test and describe each cluster regarding factors at infection. Methods This is a cross-sectional study with individuals randomly selected from the Portuguese National System of Epidemiological Surveillance (SINAVE) database. Individuals who had a positive RT-PCR SARS-CoV-2 test in August 2022 were contacted to participate in a telephonic interview approximately 9 and 12 months after the test. A hierarchical clustering analysis was performed, using Euclidean distance and Ward’s linkage. Clustering was performed in the 35 symptoms reported 9 and 12 months after the SARS-CoV-2 positive test and characterised considering age, sex, pre-existing health conditions and symptoms at time of SARS-CoV-2 infection. Results 552 individuals were included at 9 months and 458 at 12 months. The median age was 52 years (IQR: 40–64 years) and 59% were female. Hypertension and high cholesterol were the most frequently reported pre-existing health conditions. Memory loss, fatigue or weakness and joint pain were the most frequent symptoms reported 9 and 12 months after the positive test. Four clusters were identified at both times: no or minor symptoms; multi-symptoms; joint pain; and neurocognitive-related symptoms. Clusters remained similar in both times, but, within the neurocognitive cluster, memory loss and concentration issues increased in frequency at 12 months. Multi-symptoms cluster had older people, more females and more pre-existing health conditions at 9 months. However, at 12 months, older people and those with more pre-existing health conditions were in joint pain cluster. Conclusions Our results suggest that Long COVID is not the same for everyone. In our study, clusters remained similar at 9 and 12 months, except for a slight variation in the frequency of symptoms that composed each cluster. Understanding Long COVID clusters might help identify treatments for this condition. However, further validation of the observed clusters and analysis of its risk factors is needed. …

Abstract Introduction The COVID-19 pandemic has caused an unprecedented health threat globally, necessitating innovative and efficient diagnostic approaches for timely identification of infected individuals. Despite few emerging reports, the clinical utility of circulating microRNAs (miRNAs) in early and accurate diagnosis of COVID-19 is not well-evidenced. Hence, this meta-analysis aimed to explore the diagnostic potential of circulating miRNAs for COVID-19. The protocol for this study was officially recorded on PROSPERO under registration number CRD42023494959. Methods Electronic databases including Embase, PubMed, Scopus, and other sources were exhaustively searched to recover studies published until 16th January, 2024. Pooled specificity, sensitivity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic ratio (DOR), positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were computed from the metadata using Stata 14.0 software. Risk of bias appraisal of included articles was carried out using Review Manager (Rev-Man) 5.3 package through the modified QUADAS-2 tool. Subgroup, heterogeneity, meta-regression and sensitivity analyses were undertaken. Publication bias and clinical applicability were also evaluated via Deeks’ funnel plot and Fagan nomogram (scattergram), respectively. Result A total of 43 studies from 13 eligible articles, involving 5175 participants (3281 COVID-19 patients and 1894 healthy controls), were analyzed. Our results depicted that miRNAs exhibit enhanced pooled specificity 0.91 (95% CI: 0.88–0.94), sensitivity 0.94 (95% CI: 0.91–0.96), DOR of 159 (95% CI: 87–288), and AUC values of 0.97 (95% CI: 0.95–0.98) with high pooled PPV 96% (95% CI: 94–97%) and NPV 88% (95% CI: 86–90%) values. Additionally, highest diagnostic capacity was observed in studies involving larger sample size (greater than 100) and those involving the African population, demonstrating consistent diagnostic effectiveness across various specimen types. Notably, a total of 12 distinct miRNAs were identified as suitable for both exclusion and confirmation of COVID-19 cases, denoting their potential clinical applicability. Conclusion Our study depicted that miRNAs show significantly high diagnostic accuracy in differentiating COVID-19 patients from healthy counterparts, suggesting their possible use as viable biomarkers. Nonetheless, thorough and wide-ranging longitudinal researches are necessary to confirm the clinical applicability of miRNAs in diagnosing COVID-19. …

Abstract Background Although there have been reports of COVID-19 breakthrough infections in vaccinated individuals, the vaccines have demonstrated a high efficacy in preventing severe illness and death. Nepal has reported fewer studies of COVID-19 breakthrough infections. Hence, this study has objective to assess the prevalence, and to describe clinical characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) breakthrough infection. Methods This descriptive study was conducted from January to December 2022. The study enrolled 200 individuals who had received the recommended doses of the COVID-19 vaccine and they were RT-PCR positive diagnosed with vaccine breakthrough infections after 14 days of completing the vaccination course. The patient’s demographic and clinical profiles, as well as their outcomes in terms of severity, length of hospital stay, and mortality were recorded. Results The prevalence of SARS-CoV2 infection was 6.3% (547/8682). Among fully vaccinated personnel, the prevalence of breakthrough infections was 6.2% (200/3175). This study found the Omicron variants in respondents. The mean age of the patients was 38.28 years, and 41.5% (83/200) of the breakthrough cases were healthcare workers. The mean time gap between the second dose of vaccination and a positive RT-PCR test was 354.68 days. Of the 200 breakthrough cases, 89% (178) had mild symptoms, 9% (17) had moderate symptoms requiring hospitalization, and 2% (4) were severe cases that required intensive care facility. Among the severe cases, 3 out 4 were above 60 years old. Furthermore, the patients greater than 60 years had longer hospital stays (p 

Abstract Background It is difficult to detect the outbreak of emergency infectious disease based on the exiting surveillance system. Here we investigate the utility of the Baidu Search Index, an indicator of how large of a keyword is in Baidu’s search volume, in the early warning and predicting the epidemic trend of COVID-19. Methods The daily number of cases and the Baidu Search Index of 8 keywords (weighted by population) from December 1, 2019 to March 15, 2020 were collected and analyzed with times series and Spearman correlation with different time lag. To predict the daily number of COVID-19 cases using the Baidu Search Index, Zero-inflated negative binomial regression was used in phase 1 and negative binomial regression model was used in phase 2 and phase 3 based on the characteristic of independent variable. Results The Baidu Search Index of all keywords in Wuhan was significantly higher than Hubei (excluded Wuhan) and China (excluded Hubei). Before the causative pathogen was identified, the search volume of “Influenza” and “Pneumonia” in Wuhan increased with the number of new onset cases, their correlation coefficient was 0.69 and 0.59, respectively. After the pathogen was public but before COVID-19 was classified as a notifiable disease, the search volume of “SARS”, “Pneumonia”, “Coronavirus” in all study areas increased with the number of new onset cases with the correlation coefficient was 0.69 ~ 0.89, while “Influenza” changed to negative correlated (rs: -0.56 ~ -0.64). After COVID-19 was closely monitored, the Baidu Search Index of “COVID-19”, “Pneumonia”, “Coronavirus”, “SARS” and “Mask” could predict the epidemic trend with 15 days, 5 days and 6 days lead time, respectively in Wuhan, Hubei (excluded Wuhan) and China (excluded Hubei). The predicted number of cases would increase 1.84 and 4.81 folds, respectively than the actual number of cases in Wuhan and Hubei (excluded Wuhan) from 21 January to 9 February. Conclusion The Baidu Search Index could be used in the early warning and predicting the epidemic trend of COVID-19, but the search keywords changed in different period. Considering the time lag from onset to diagnosis, especially in the areas with medical resources shortage, internet search data can be a highly effective supplement of the existing surveillance system. …

Abstract Introduction Reinfection with SARS-Cov-2 after recovery can occur that most of them don’t require hospitalization. The aim of this study is estimation of out-patient COVID-19 reinfection and recurrence rates and its associated factors among Iranian patients with history of confirmed SARS-Cov-2 infection and hospitalization. Methods This study is a retrospective cohort conducted from May 2021 to May 2022 in Iran. The national Medical Care Monitoring Center (MCMC) database, obtained from the Ministry of Health and Medical Education, includes all information about confirmed COVID-19 patients who are hospitalized and diagnosed during the pandemic. Using probability proportional to size sampling from 31 provinces, 1,532 patients over one years of age with a history of hospitalization in the MCMC data are randomly selected. After that, interviews by phone are performed with all of the selected patients using a researcher-made questionnaire about the occurrence of overall reinfection without considering the time of infection occurrence, reinfection occurring at least 90 days after the discharge and recurrence (occurring within 90 days after discharge). Univariate and multivariable Cox regression analyses are performed to assess the factors associated with each index. All of the analyses are performed using Stata software version 16. Results In general, 1,532 phone calls are made, out of which 1,095 individuals are willing to participate in the study (response rate ≃ 71%). After assessing the 1,095  patients with a positive history of COVID-19, the rates of non-hospitalized overall SARS-Cov-2 reinfection, reinfection and recurrence are 122.64, 114.09, and 8.55 per 1,000 person-years, respectively. The age range of 19–64 years (aHR:3.93, 95%CI : 1.24–12.41) and COVID-19-related healthcare worker (aHR: 3.67, 95%CI: 1.77–7.61) are identified as risk factors for reinfection, while having comorbidity, being fully vaccinated, and having a partial pressure of oxygen (PaO2) ≥ 93 mmHg during the initial infection are identified as factors that reduce the risk of non-hospitalized reinfection. Conclusion Reinfection due to COVID-19 is possible because of the weakened immune system for various reasons and the mutation of the virus. Vaccination, timely boosters, and adherence to preventive measures can help mitigate this risk. …

by Iwona Nowakowska, Joanna Rajchert, Dorota Jasielska The time after the COVID-19 pandemic posed a threat to engagement in prosocial behaviors within charity organizations. In the current study, we intended to test how three motivational paths: affective empathy-based, life satisfaction-based, and perceived social support-based shaped the change in intentions to give money and time to charity organizations over a yearly period (right after revocation of the most essential anti-COVID-19 laws and at the same time, outbreak of the war in Ukraine in 2022, in May 2022 and after a year, in late April-early May 2023). We also tested how past negative and present hedonistic time perspectives–namely, those most robust in predicting emotional states ‐ shaped the changes in the abovementioned motivational paths and giving intentions. We conducted our longitudinal study on the general population of Poland (N = 566). We found that there has been a significant drop in the willingness to give time to organizations over the year after loosening the COVID-19 restrictions and the outbreak of war in Ukraine. We found that affective empathy helped sustain the intentions to give time to organizations, whereas past negative time perspective contributed to the decrease in such intentions. Our study suggests threats to organizations and highlights potential ways to encourage supporting them and caring for their volunteers’ well-being.

by James T. Earnest, Oscar D. Kirstein, Azael C. Mendoza, Gloria A. Barrera-Fuentes, Henry Puerta-Guardo, Manuel Parra-Cardeña, Kevin Yam-Trujillo, Matthew H. Collins, Norma Pavia-Ruz, Guadalupe Ayora-Talavera, Gabriela Gonzalez-Olvera, Anuar Medina-Barreiro, Wilberth Bibiano-Marin, Audrey Lenhart, M. Elizabeth Halloran, Ira Longini, Natalie Dean, Lance A. Waller, Amy M. Crisp, Fabian Correa-Morales, Jorge Palacio-Vargas, Pilar Granja-Perez, Salha Villanueva, Hugo Delfın-Gonzalez, Hector Gomez-Dantes, Pablo Manrique-Saide, Gonzalo M. Vazquez-Prokopec Aedes mosquito-borne viruses (ABVs) place a substantial strain on public health resources in the Americas. Vector control of Aedes mosquitoes is an important public health strategy to decrease or prevent spread of ABVs. The ongoing Targeted Indoor Residual Spraying (TIRS) trial is an NIH-sponsored clinical trial to study the efficacy of a novel, proactive vector control technique to prevent dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV) infections in the endemic city of Merida, Yucatan, Mexico. The primary outcome of the trial is laboratory-confirmed ABV infections in neighborhood clusters. Despite the difficulties caused by the COVID-19 pandemic, by early 2021 the TIRS trial completed enrollment of 4,792 children aged 2–15 years in 50 neighborhood clusters which were allocated to control or intervention arms via a covariate-constrained randomization algorithm. Here, we describe the makeup and ABV seroprevalence of participants and mosquito population characteristics in both arms before TIRS administration. Baseline surveys showed similar distribution of age, sex, and socio-economic factors between the arms. Serum samples from 1,399 children were tested by commercially available ELISAs for presence of anti-ABV antibodies. We found that 45.1% of children were seropositive for one or more flaviviruses and 24.0% were seropositive for CHIKV. Of the flavivirus-positive participants, most were positive for ZIKV-neutralizing antibodies by focus reduction neutralization testing which indicated a higher proportion of participants with previous ZIKV than DENV infections within the cohort. Both study arms had statistically similar seroprevalence for all viruses tested, similar socio-demographic compositions, similar levels of Ae. aegypti infestation, and similar observed mosquito susceptibility to insecticides. These findings describe a population with a high rate of previous exposure to ZIKV and lower titers of neutralizing antibodies against DENV serotypes, suggesting susceptibility to future outbreaks of flaviviruses is possible, but proactive vector control may mitigate these risks.

by Bello Musa Yakubu, Syeda Mahera Ali, Majid Iqbal Khan, Pattarasinee Bhattarakosol The recent global outbreaks of infectious diseases such as COVID-19, yellow fever, and Ebola have highlighted the critical need for robust health data management systems that can rapidly adapt to and mitigate public health emergencies. In contrast to traditional systems, this study introduces an innovative blockchain-based Electronic Health Record (EHR) access control mechanism that effectively safeguards patient data integrity and privacy. The proposed approach uniquely integrates granular data access control mechanism within a blockchain framework, ensuring that patient data is only accessible to explicitly authorized users and thereby enhancing patient consent and privacy. This system addresses key challenges in healthcare data management, including preventing unauthorized access and overcoming the inefficiencies inherent in traditional access mechanisms. Since the latency is a sensitive factor in healthcare data management, the simulations of the proposed model reveal substantial improvements over existing benchmarks in terms of reduced computing overhead, increased throughput, minimized latency, and strengthened overall security. By demonstrating these advantages, the study contributes significantly to the evolution of health data management, offering a scalable, secure solution that prioritizes patient autonomy and privacy in an increasingly digital healthcare landscape.