Journal of Medical Virology, Volume 96, Issue 10, October 2024.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a single-stranded RNA virus, emerged in late 2019 and quickly spread worldwide, overwhelming healthcare systems [1]. This ongoing transmission led to new variants with increased ability to spread and infect people [2]. A key mutation in the spike protein, D614G, appeared early in the pandemic; this variant quickly became dominant, replacing the original strain by June 2020 [3]. Between October and December 2020, WHO has identified five concerning variants (VOC) - Alpha, Beta, Delta, Gamma, and Omicron - that spread easily and evade immunity [4-7], hindering pandemic control efforts.

A phase 3 clinical trial evaluating the safety and efficacy of a messenger RNA (mRNA) combination vaccine for COVID-19 and influenza had mixed results, the vaccine’s manufacturers announced. The vaccine was a collaboration between BioNTech and Pfizer and was tested among more than 8000 healthy adults aged 18 to 64 years.

Researchers have suspected that there’s a link between chronic low-grade inflammation and psychiatric disorders. Now, a recent cohort study points to specific inflammatory biomarkers that might be associated with an increased risk of depression, anxiety, and stress-related disorders.

An experimental malaria vaccine could offer protection during pregnancy for up to 2 years without a booster dose, according to a randomized clinical trial conducted in Mali. The 3-dose vaccine, known as Plasmodium falciparum sporozoite (PfSPZ) vaccine, had previously been tested successfully in adults in other parts of Africa.

Previous studies suggest twice-yearly mass distribution of the antibiotic azithromycin reduces childhood mortality in sub-Saharan Africa. The World Health Organization (WHO) has approved the practice with stipulations limiting distribution to infants aged 1 to 11 months, citing concerns about antimicrobial resistance.

This Medical News story discusses new guidelines for the use of pemivibart, a monoclonal antibody marketed as Pemgarda, as preexposure prophylaxis against COVID-19 in immunocompromised individuals.

The Original Investigation titled “Effect of Fluvoxamine vs Placebo on Time to Sustained Recovery in Outpatients With Mild to Moderate COVID-19: A Randomized Clinical Trial,” published on January 12, 2023, was corrected to fix the Role of Funder/Sponsor statement. The Role of Funder/Sponsor statement should have read “The National Center for Advancing Translational Sciences had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.” This article was corrected online.

This JAMA Clinical Guidelines Synopsis summarizes the 2022 recommendations on evaluation of suspected antibiotic allergies from the American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma & Immunology.

The COVID-19 pandemic has had devastating consequences globally, and the immediate and short-term consequences of SARS-CoV-2 infection have been well described. Although most individuals recover, many endure longer-lasting effects, referred to as long COVID, post-COVID condition, or postacute sequelae of SARS-CoV-2 (PASC). PASC is composed of a heterogeneous collection of symptoms and conditions that can affect virtually any organ system, with common manifestations including fatigue, cough, malaise, and pain. Those at increased risk for long COVID include females, those hospitalized due to acute COVID-19, and individuals with underlying comorbidities. Several hypotheses have been proposed to explain the underlying pathophysiology, which is likely multifactorial, including immune dysregulation, autoimmunity and immune printing, microvascular clotting with endothelial dysfunction, and impaired neurological signaling.

This observational cohort study examines the symptoms experienced by children after SARS-CoV-2 infection and how these symptoms differ by age (6-11 years vs 12-17 years).

We thank Daungsupawong et al.1 for their interest in our research on nirmatrelvir/ritonavir treatment and risk for post-acute sequelae of COVID-19 in older Singaporeans.2 While uptake of nirmatrelvir/ritonavir in the outpatient setting was low, this is in keeping with prior studies highlighting that only a small fraction of COVID-19 patients who are eligible for nirmatrelvir/ritonavir receive a prescription. For instance, in cohort studies conducted in large US healthcare systems, only 5% of treatment-eligible patients with SARS-CoV-2 infection received nirmatrelvir/ritonavir.

Viral diseases represent a substantial global health challenge, necessitating the urgent development of effective antiviral medications.

Abstract We report a case of disseminated cryptococcosis, an uncommon fungal infection predominantly affecting the lungs and central nervous system, with the rare involvement of adrenal cryptococcosis, compounded by meningitis and pneumonia. The patient, previously diagnosed with primary myelofibrosis and undergoing oral Ruxolitinib treatment, exhibited immunosuppression. Imaging via chest and abdominal CT scans revealed inflammation in the right lung’s middle lobe, splenomegaly, a splenic lesion, and a left adrenal mass, initially prompting considerations of pheochromocytoma. However, unilateral adrenalectomy and subsequent pathological examination disclosed extensive infiltration by inflammatory and multinucleate giant cells, with Periodic acid-Schiff (PAS) staining confirming the diagnosis. The identification of adrenal cryptococcosis was further supported by positive adrenal pus culture and significantly elevated capsular antigens in both serum and cerebrospinal fluid, at titers of 1:2560. Following a month of oral antifungal treatment, marked reductions in capsular antigen levels were noted, to 1:640 and 1:160 in serum and cerebrospinal fluid, respectively. The patient was discharged on a regimen of oral amphotericin B, flucytosine, and fluconazole, with regular outpatient follow-ups showing no signs of recurrence or dissemination. …

Abstract Objective In recent years, the increasing incidence of brucellosis in children has become more serious. However, relatively few studies have been conducted to characterize the spatialtemporal distribution of brucellosis in children. This study aimed to analyze the spatiotemporal distribution characteristics and ecological influencing factors of brucellosis incidence among children in Inner Mongolia. Methods This study used data on brucellosis incidence in children aged 0–14 years reported in Inner Mongolia from 2016 to 2020. A Bayesian model was used to analyze the spatial and temporal distribution of brucellosis in children from 2016 to 2020 in Inner Mongolia. Geographical weighted regression model was used to analyze the ecological factors related to the incidence of brucellosis in children. Result Bayesian spatiotemporal analysis indicated that the highest brucellosis risk and increased disease incidence were observed in Hinggan, Inner Mongolia, in children aged 0–14 years. Alxa had the lowest risk but the incidence rate increased rapidly. The incidence of childhood brucellosis was positively associated with the number of sheep at the year-end (β: 2.5909 ~ 2.5926, P 

Abstract Background Chronic hepatitis B virus (HBV) infection remains a serious health issue, and determining the optimal time for antiviral therapy is challenging. We aimed to assess liver histological changes in patients with HBeAg-positive chronic hepatitis B (CHB) and those with HBeAg-negative CHB who had persistently normal alanine aminotransferase and to determine the association between significant liver injury and various clinical parameters. Methods We retrospectively included, in this study, 339 treatment-naïve patients with chronic HBV infections who had persistently normal alanine aminotransferase and underwent liver biopsy from 2013 to 2023. Histologic assessment was based on the Metavir scoring system to evaluate the association between clinical characteristics and the severity of liver inflammation and fibrosis. Results Among the included participants, 138 were HBeAg-positive and 201 were HBeAg-negative. Lower hepatitis B surface antigen (HBsAg) (P = 0.003) and higher aspartate aminotransferase (AST) (P = 0.002) levels were associated with significant necroinflammation, whereas increasing age (P = 0.004) and lower HBV DNA (P 

Abstract Background Drug-drug interactions (DDIs) between antiretroviral therapy (ART) and commonly used co-medications in HIV patients, especially women, impact treatment efficacy and patient safety. Objective This study aimed to study the prevalence and types of drug-drug interactions (DDIs) between antiretroviral therapy drugs (ARTs) and comedications among a female population with HIV. Additionally, the study investigates the association of these DDIs with ART medication changes and treatment adherence. Methods This cross-sectional study included 632 adult women living with HIV (WLHIV). Data was retrospectively extracted from patient files. Drug.com interaction checker website was used to assess DDIs between ART and non-ART medications. Changes to the ART regimen previously attributed to ART side effects or patient non-adherence were considered drug changes. Results A total of 429 WLHIV (mean age: 44.05 ± 9.50) were eligible. The prevalence of DDIs between ART and non-ART medications was 21.4%, with 4.7% minor, 18.4% moderate, and 8.9% major interactions. The highest prevalence of DDI was among cardiovascular medication users (71.7%), followed by central nervous system drugs (69.2%). Changing medications resulted in a decrease in DDIs, with significant reductions in total and minor interactions. Participants without DDIs had better adherence to ART. DDI between ART and non-ART medications was significantly associated with ART drug change, even after accounting for side effects attributed to ARTs, indicating an independent twofold association (OR = 1.99, CI 1.04–3.77). Moreover, further adjustments for HIV viral load and CD4 + cell count did not change the significance of the association (OR = 2.01, CI 1.03–3.92). Conclusion DDIs in WLHIV impact adherence to ART. Altering ART may not be directly related to ART side effects, but rather primarily due to interactions with non-ART medications. Modifying non-ART drug regimens can reduce the likelihood of DDIs. …

Abstract Objective To develop and validate a machine learning model for predicting mortality-associated prognostic factors in order to reduce in-hospital mortality rates among HIV/AIDS patients with Cryptococcus infection in Guangxi, China. Methods This retrospective prognostic study included HIV/AIDS patients with cryptococcosis in the Fourth People’s Hospital of Nanning from October 2011 to June 2019. Clinical features were extracted and used to train ten machine learning models, including Logistic Regression, KNN, DT, RF, Adaboost, Xgboost, LightGBM, Catboost, SVM, and NBM, to predict the outcome of HIV patients with cryptococcosis infection. The sensitivity, specificity, AUC, and F1 value were applied to assess model performance in both the testing and training sets. The optimal model was selected and interpreted. Results A total of 396 patients were included in the study. The average in-hospital mortality of HIV/AIDS patients with cryptococcosis was 12.9% from 2012 to 2019. After feature screening, 20 clinical features were selected for model construction, accounting for 93.8%, including ART, Electrolyte disorder, Anemia, and 17 laboratory tests. The RF model (AUC 0.9787, Sensitivity 0.9535, Specificity 0.8889, F1 0.7455) and the SVM model (AUC 0.9286, Sensitivity 0.7907, Specificity 0.9786, F1 0.8293) had excellent performance. The SHAP analysis showed that the primary risk factors for prognosis prediction were identified as BUN/CREA, Electrolyte disorder, NEUT%, Urea, and IBIL. Conclusions RF and SVM machine learning models have shown promising predictive abilities for the prognosis of hospitalized HIV/AIDS patients with cryptococcosis, which can aid clinical assessment and treatment decisions for patient prognosis. …

Abstract Background Dengue poses a significant global public health challenge, including in Nepal. Understanding community’s knowledge, attitudes, and behaviors concerning dengue fever is imperative to developing effective prevention and control strategies. This study aimed to assess the knowledge, attitude, and practices related to dengue fever among residents of Lalitpur Metropolitan City. Methods A descriptive cross-sectional household study was conducted using a mixed-method approach, which included quantitatively studying 636 individuals and conducting 20 qualitative interviews. The data was collected between April 2023 and June 2023. The multistage cluster sampling method was applied for household selection during the quantitative study and a purposive judgmental sampling method was used to identify participants for the qualitative interviews. Face-to-face interviews were conducted using a structured questionnaire for the quantitative study and an interview guide for the qualitative study. Quantitative data were analysed using logistic regression in STATA version 13, and thematic analysis was applied to the qualitative data. The findings were validated through triangulation of results from both the qualitative and quantitative study. Results Regarding knowledge, 64.94% (n = 413/636) reported being informed about dengue fever. In terms of attitude, a substantial majority, 91.51% (n = 582/636), expressed a positive attitudes toward dengue fever, indicating a favorable perception and knowledge of its significance. Concerning practice, 49.84% (n = 317/636) of respondents reported actively engaging in dengue fever prevention measures. The variables gender, previous history of dengue fever and residency were the determinants of dengue fever knowledge. Additionally, gender, residency, and attitude were predictors of preventive practices concerning dengue fever. Conclusion Our study revealed that while the community demonstrated good knowledge of dengue fever and positive attitudes toward prevention, their preventive practices were inconsistent, indicating a gap between knowledge and action. A positive attitude was linked to better adherence to preventive measures. To address this gap, it is crucial to promote a positive attitude toward dengue prevention through initiatives like education efforts and social mobilization programs. Implementing Social and Behavior Change Communication (SBCC) programs focused on dengue prevention and control measures can help bridge this knowledge-action gap. …

Abstract Background Understanding the level of exposure to Lassa virus (LASV) in at-risk communities allows for the administration of effective preventive interventions to mitigate epidemics of Lassa fever. We assessed the seroprevalence of LASV antibodies in rural and semiurban communities of two cosmopolitan cities in Nigeria with poorly understood Lassa epidemiology. Methods A cross-sectional study was conducted in ten communities located in the Abuja Municipal Area Council (AMAC), Abuja, and Ikorodu Local Government Area (LGA), Lagos, from February 2nd to July 5th, 2022. Serum samples collected from participants were analyzed for IgG and IgM antibodies using a ReLASV® Pan-Lassa NP IgG/IgM enzyme-linked immunosorbent assay (ELISA) kit. A questionnaire administered to participants collected self-reported sociodemographic and LASV exposure information. Seroprevalence of LASV IgG/IgM was estimated overall, and by study site. Univariate and multivariate log-binomial models estimated unadjusted and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI) for site-specific risk factors for LASV seropositivity. Grouped Least Absolute Shrinkage and Selection Operator (LASSO) was used for variable selection for multivariate analysis. Results A total of 628 participants with serum samples were included in the study. Most participants were female (434, 69%), married (459, 73%), and had a median age of 38 years (interquartile range 28–50). The overall seroprevalence was 27% (171/628), with a prevalence of 33% (126/376) in Abuja and 18% (45/252) in Lagos. Based on site-specific grouped LASSO selection, enrollment in the dry season (vs. wet; aPR, 95% CI: 1.73, 1.33–2.24), reported inconsistent washing of fruits and vegetables (aPR, 95% CI: 1.45, 1.10–1.92), and a positive malaria rapid test (aPR, 95% CI: 1.48, 1.09-2.00) were independently associated with LASV seropositivity in Abuja, whereas, only a self-reported history of rhinorrhea (PR, 95% CI: 2.21, 1.31–3.72) was independently associated with Lassa seropositivity in Lagos. Conclusions The LASV seroprevalence was comparable to that in other areas in Nigeria. Our findings corroborate those from other studies on the importance of limiting human exposure to rodents and focusing on behavioral factors such as poor hygiene practices to reduce exposure to LASV. …