COVID-19 was associated with cognitive symptoms, anosmia, dysgeusia, dyspnoea and fatigue as well as worsening of overall health up to 22 months after a SARS-CoV-2 test, even when correcting for symptoms before the onset of COVID-19.

To more closely target SARS-CoV-2 variants currently circulating in the US, the US Food and Drug Administration (FDA) authorized an updated formula of the messenger RNA (mRNA) COVID-19 vaccine, the agency announced in mid-August.

This cross-sectional study analyzes characteristics of prehospital encounters for youth opioid overdoses and trends before and during the COVID-19 pandemic.

ObjectiveThis study aimed to evaluate the impact of the COVID-19 pandemic on the management of acute coronary syndrome (ACS) in Yogyakarta, Indonesia with respect to time to treatment, treatment pattern and treatment outcome. DesignThis is a retrospective cohort study in which medical records of hospitalised patients with ACS were reviewed. SettingThree hospitals in Yogyakarta, Indonesia. ParticipantsPatients hospitalised with ACS during two pandemic periods (first pandemic period: March–August 2020; second pandemic period: March–August 2021) and prepandemic period (March–August 2019). Outcome measuresTime to treatment, treatment pattern and treatment outcome. ResultsA total of 598 patients with ST-elevation myocardial infarction (STEMI) and 615 with non-ST-elevation ACS were identified. Of these, 313, 484 and 416 were identified during the prepandemic period, first pandemic period and second pandemic period, respectively. For STEMI, the proportion of patients with a delay from symptom onset to first medical contact (FMC) was significantly higher during the second pandemic period as compared with the prepandemic period (47.7% vs 32.0%, OR=1.84, 95% CI 1.18, 2.85). The proportion of patients with STEMI with delayed door-to-balloon (D2B) time was significantly higher during the second pandemic period as compared with the prepandemic period (99.4% vs 92.9%, OR=13.08, 95% CI 1.57, 108.73). Significantly longer mean total ischaemic time (45.85 hours vs 30.29 hours, mean difference=14.56, 95% CI 1.85, 27.28) was observed among patients with STEMI during the second year of the pandemic as compared with the prepandemic period. No significant differences between the prepandemic period and the first pandemic period were found in terms of proportion of patients with STEMI with a delay in time from symptom onset to FMC, delayed D2B time and total ischaemic time. Only Global Registry of Acute Coronary Events risk score (OR=1.04, 95% CI 1.03, 1.05) was a significant predictor of in-hospital mortality in the multivariate analysis. ConclusionsThis study suggests a significant impact of the COVID-19 pandemic on time to treatment among patients with ACS. Health systems need to be well prepared to support effective and timely treatment of patients with ACS during future crisis. …

PurposeVAccine Study COVID-19 (VASCO) is a cohort study with a 5-year follow-up that was initiated when COVID-19 vaccination was introduced in the Netherlands. The primary objective is to estimate real-world vaccine effectiveness (VE) of COVID-19 vaccines against SARS-CoV-2 infection in the Netherlands, overall and in four subpopulations defined by age and medical risk. ParticipantsThe cohort consists of 45 547 community-dwelling participants aged 18–85 years who were included irrespective of their COVID-19 vaccination status or intention to get vaccinated. A medical risk condition is present in 4289 (19.8%) of 21 679 individuals aged 18–59 years, and in 9135 (38.3%) of 23 821 individuals aged 60–85 years. After 1 year of follow-up, 5502 participants had dropped out of the study. At inclusion and several times after inclusion, participants are asked to take a self-collected fingerprick blood sample in which nucleoprotein and spike protein receptor binding domain-specific antibody concentrations are assessed. Participants are also asked to complete monthly digital questionnaires in the first year, and 3 monthly in years 2–5, including questions on sociodemographic factors, health status, COVID-19 vaccination, SARS-CoV-2-related symptoms and testing results, and behavioural responses to COVID-19 measures. Findings to dateVASCO data have been used to describe VE against SARS-CoV-2 infection of primary vaccination, first and second booster and bivalent boosters, the impact of hybrid immunity on SARS-CoV-2 infection and VE against infectiousness. Furthermore, data were used to describe antibody response following vaccination and breakthrough infections and to investigate the relation between antibody response and reactogenicity. Future plansVASCO will be able to contribute to policy decision-making regarding future COVID-19 vaccination. Furthermore, VASCO provides an infrastructure to conduct further studies and to respond to changes in vaccination campaigns and testing policy, and new virus variants. Trial registration numberNL9279. …

by The PLOS ONE Editors …

Lower respiratory infections (LRIs) are the leading cause of death from infectious diseases worldwide, causing approximately 2.60 million deaths annually.[1] Streptococcus pneumoniae, Haemophilus influenzae, and influenza virus are three major pathogens associated with LRIs, imposing a substantial disease and economic burden. Especially in the winter of 2023, several bacteria and viruses led to an unusually high burden of LRIs according to the recent World Health Organization (WHO) reports.[2, 3] The implementation of nonpharmaceutical interventions during the emergence of the coronavirus disease 2019 (COVID-19) pandemic significantly affected the transmission of seasonal respiratory pathogens.

Abstract Background The COVID-19 pandemic negatively impacted tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared DOT adherence embedded in a research study before and after COVID-19 lockdowns in South Africa. Methods We analyzed data from 263 observational study participants undergoing drug susceptible (DS)-TB DOT between May 2017 to March 2022. Participants enrolled before October 2019 were considered ‘pre-COVID-19’ and those enrolled after September 2020 were considered ‘post-COVID-19 lockdown groups. Negative binomial regression models were used to compare DOT non-adherence rates between the two lockdown groups. We then conducted a sensitivity analysis which only included participants enrolled in the immediate period following the first COVID-19 lockdown. Results DOT non-adherence rate was higher in the post-COVID-19 lockdown group (aIRR = 1.42, 95% CI = 1.04–1.96; p = 0.028) compared to pre-COVID-19 lockdown period, adjusting for age, sex, employment status, household hunger, depression risk, and smoked substance use. DOT non-adherence was highest immediately following the initial lockdown (aIRR = 1.74, 95% CI = 1.17–2.67; p = 0.006). Conclusion The COVID-19 lockdowns adversely effected adherence to TB DOT in the period after lockdowns were lifted. The change in DOT adherence persisted even after adjusting for socioeconomic and behavioral variables. We need a better understanding of what treatment adherence barriers were exacerbated by COVID-19 lockdowns to improve outcomes in post-pandemic times. Trial registration ClinicalTrials.gov Registration Number: NCT02840877. Registered on 19 July 2016. …

Abstract Background Respiratory syncytial virus (RSV) is the leading cause of severe respiratory infections in infants worldwide, significantly affecting their health and contributing to the global healthcare burden. We aimed to examine healthcare resource utilisation patterns and costs for infants under one year old with confirmed RSV infection across subgroups of different gestational ages and health conditions and the cost implications of RSV infections over time, thereby demonstrating the economic burden of the disease. Methods This retrospective cohort study utilised nationwide claims data from the Korea Health Insurance Review and Assessment Service for infants under one year of age with confirmed RSV infection in the first year of life from January 2017 to April 2022. The infants were stratified into three subgroups based on their gestational age and health status: unhealthy preterm, healthy preterm, and full-term infants. A descriptive analysis was conducted to estimate healthcare utilization by type of resource and costs related to the treatment of RSV. Results Out of 93,585 RSV infections identified, 31,206 patients met the inclusion criteria; these included 963 unhealthy preterm, 1,768 healthy preterm and 28,475 full-term infants. In our study, 76.3% of the infants with confirmed RSV infection required intensive care, including hospitalisation and more critical interventions such as intensive care unit (ICU) or mechanical ventilation (MV). The total average cost of RSV management was notably higher for unhealthy preterm infants ($ 6,325; 95% confidence interval (CI): $ 5,484-7,165) than for healthy preterm ($ 1,134; 95% CI: $ 1,006 − 1,261) and full-term infants ($ 606; 95% CI: 583–630). Our findings confirmed a significant epidemiological and economic burden, with infants at greater risk–shorter gestational age and poorer health conditions. Furthermore, we observed a marked increase in the total average cost of RSV management during COVID-19, reflecting the complex interplay between RSV and pandemic-related healthcare dynamics. Conclusion Our findings provide evidence for the significant economic burden of RSV infection among infants, with considerable disparities based on gestational age and health status subgroups. However, RSV prevention policies should also recognise that healthy preterm or full-term infants who receive intensive care face a significant disease burden. …

Objectives: COVID-19 treatment guidelines recommend baricitinib or tocilizumab for the management of hospitalized patients with COVID-19. We compared the effectiveness of baricitinib vs. tocilizumab on mortality and clinical outcomes among hospitalized patients with COVID-19. Design: Multicenter, retrospective, propensity-weighted cohort study using a target trial emulation approach. Setting: The National COVID Cohort Collaborative (N3C), which is the largest electronic health records data on COVID-19 in the United States. The setting included 75 hospitals. Patients: Adults who were hospitalized for COVID-19. Interventions: Newly initiated on baricitinib or tocilizumab. Measurements and Main Results: Our primary outcome was 28-day mortality. We used propensity scores with inverse probability of treatment weights (IPTWs) to control bias and confounding while comparing treatments. Among 10,661 individuals included in the study, 6,229 (58.4%) received baricitinib and 4,432 (41.6%) tocilizumab. Overall, the mean age of the cohort was 60.0 ± 15.1 years, 6429 (60.3%) were male, and 19.2% received invasive mechanical ventilation. After IPTW adjustment, baricitinib use was associated with lower 28-day mortality (odds ratio [OR], 0.91; 95% CI, 0.85–0.98) and hospital (OR, 0.88; 95% CI, 0.82–0.94) mortality compared with tocilizumab. Baricitinib was also associated with shorter hospital length of stay (incident rate ratio, 0.92; 95% CI, 0.90–0.94) and lower rates of hospital-acquired infections (OR, 0.86; 95% CI, 0.75–0.99), although no difference in ICU length of stay was noted between the two groups. Conclusions: In this large, diverse cohort of U.S. hospitalized adults with COVID-19, baricitinib was associated with significantly lower 28-day mortality, hospital mortality, shorter hospital length of stay, and less hospital-acquired infections compared with tocilizumab.

by Briana Mezuk, Viktoryia Kalesnikava, Aparna Ananthasubramaniam, Annalise Lane, Alejandro Rodriguez-Putnam, Lily Johns, Courtney Bagge, Sarah Burgard, Kara Zivin Purpose To describe and explore variation in ‘pandemic-related circumstances’ among suicide decedents during the first year of the COVID-19 pandemic. Methods We identified pandemic-related circumstances using decedents’ text narratives in the 2020 National Violent Death Reporting System. We use time-series analysis to compare other psychosocial characteristics (e.g., mental health history, interpersonal difficulties, financial strain) of decedents pre-pandemic (2017/2018: n = 56,968 suicide and n = 7,551 undetermined deaths) to those in 2020 (n = 31,887 suicide and n = 4,100 undetermined). We characterize common themes in the narratives with pandemic-related circumstances using topic modeling, and explore variation in topics by age and other psychosocial circumstances. Results In 2020, n = 2,502 (6.98%) narratives described pandemic-related circumstances. Compared to other deaths in 2020 and to the pre-pandemic period, decedents with pandemic-related circumstances were older and more highly educated. Common themes of pandemic-related circumstances narratives included: concerns about shutdown restrictions, financial losses, and infection risk. Relative to decedents of the same age that did not have pandemic-related circumstances in 2020, those with pandemic-related circumstances were more likely to also have financial (e.g., for 25–44 years, 43% vs. 12%) and mental health (76% vs. 66%) psychosocial circumstances, but had similar or lower prevalence of substance abuse (47% vs. 49%) and interpersonal (40% vs. 42%) circumstances. Conclusions While descriptive, these findings help contextualize suicide mortality during the acute phase of the COVID-19 pandemic and can inform mental health promotion efforts during similar public health emergencies. …

by Mohammed B. A. Sarhan, Hanin Basha, Rita Giacaman, Masamine Jimba, Rika Fujiya Background The COVID-19 pandemic has triggered major changes worldwide, with repercussions on mental health and education. The present study primarily aimed to retrospectively explore undergraduate students’ risk perceptions of COVID-19 and their experiences with remote learning during the pandemic, with an emphasis on their high school years. Methods This qualitative photovoice study was conducted between 30 March and 4 May 2023. The target population of this study was first- and second-year undergraduate students who had been in high school during the pandemic. Maximum variation, snowball, and convenience sampling methods were used to recruit students. They were asked to share photos and provide comments in written or voice messages explaining their experiences during the pandemic. Voice messages were manually transcribed verbatim. A manual content analysis of these comments was performed to derive the codes and themes relevant to the study objectives. Results Forty-seven students initially agreed to participate and signed an informed consent form. However, the final sample included 16 students (nine men and seven women). The content analysis revealed four themes that were identified as the main factors contributing to high school students’ risk perceptions of COVID-19. The first theme was psychosocial factors related to the pandemic, including emotions, isolation and stress. The second focused on the mechanisms used to cope with the pandemic. The third theme included beliefs and behaviours that either increased or decreased COVID-19 risk. The final theme addressed schools’ responses to COVID-19, including factors such as maintaining connections with schools, preventive measures and the transition to remote learning. Conclusion This study highlighted the extensive impact of the pandemic on Palestinian high school students, demanding instantaneous adaptation to ensure their safety and well-being while maintaining the quality of education. Remote learning has become an important strategy with opportunities and challenges for high school students. …

by Danielle Toccalino, Halina (Lin) Haag, Emily Nalder, Vincy Chan, Amy Moore, Christine M. Wickens, Angela Colantonio Background Intimate partner violence (IPV) is a global public health crisis. Often repetitive and occurring over prolonged periods of time, IPV puts survivors at high risk of brain injury (BI). Mental health concerns are highly prevalent both among individuals who have experienced IPV and those who have experienced BI, yet the interrelatedness and complexity of these three challenges when experienced together is poorly understood. This qualitative study explored care provision for IPV survivors with BI (IPV-BI) and mental health concerns from the perspectives of both survivors and providers. Methods This qualitative interpretive description study was part of a broader research project exploring employment, mental health, and COVID-19 implications for survivors of IPV-BI. Participants (N = 24), including survivors and service providers, participated in semi-structured group and individual interviews between October 2020 and February 2021. Interviews were recorded, transcribed, and thematically analyzed. Findings Four themes were developed from interview findings: 1) identifying BI and mental health as contributing components to survivors’ experiences is critical to getting appropriate care; 2) supporting survivors involves a “toolbox full of strategies” and a flexible approach; 3) connecting and collaborating across sectors is key; and 4) underfunding and systemic barriers hinder access to care. Finally, we share recommendations from participants to better support IPV survivors. Conclusions Identifying both BI and mental health concerns among IPV survivors is critical to providing appropriate supports. Survivors of IPV experiencing BI and mental health concerns benefit from a flexible and collaborative approach to care; health and social care systems should be set up to support these collaborative approaches. …

by Ekaterina Krieger, Alexander V. Kudryavtsev, Ekaterina Sharashova, Olga Samodova, Anna Kontsevaya, Vitaly A. Postoev Introduction The spectrum of COVID-19 manifestations makes it challenging to estimate the exact proportion of people who had the infection in a population, with the proportion of asymptomatic cases likely being underestimated. We aimed to assess and describe the spectrum of COVID-19 cases in a sample of adult population aged 40–74 years in Arkhangelsk, Northwest Russia, a year after the start of the pandemic. Materials and methods A population-based survey conducted between February 24, 2021 and June 30, 2021 with an unvaccinated sample aged 40–74 years (N = 1089) combined a serological survey data, national COVID-19 case registry, and self-reported data on COVID-19 experience and symptoms. Based on the agreement between these sources, we classified the study participants as non-infected and previously infected (asymptomatic, non-hospitalized and hospitalized symptomatic) cases, and compared these groups regarding demographics, lifestyle and health characteristics. Results After a year of the pandemic in Arkhangelsk, 59.7% 95% confidence intervals (CI) (56.7; 62.6) of the surveyed population had had COVID-19. Among those who had been infected, symptomatic cases comprised 47.1% 95% CI (43.2; 51.0), with 8.6% 95% CI (6.6; 11.1) of them having been hospitalized. Of the asymptomatic cases, 96.2% were not captured by the healthcare system. Older age was positively associated, while smoking showed a negative association with symptomatic COVID-19. Individuals older than 65 years, and those with poor self-rated health were more likely to be hospitalized. Conclusion More than half of the infected individuals were not captured by the healthcare-based registry, mainly those with asymptomatic infections. COVID-19 severity was positively associated with older age and poor self-rated health, and inversely associated with smoking. Combining different sources of surveillance data could reduce the number of unidentified asymptomatic cases and enhance surveillance for emerging infections. …

Abstract Purpose The essence of this scholarly work was to carefully outline the key factors intensifying the virulence and protracted contagion of COVID-19, particularly among individuals afflicted with hematologic malignancies (HM), in an epoch predominantly governed by the Omicron variant. Methods Adults with HM diagnosed with COVID-19 from November 2022 to February 2023 were monitored in this retrospective study. Patient blood samples yielded biochemical data, and COVID-19 was confirmed through RNA or antigen testing. The factors affecting severity and infection duration were examined using both univariate and multivariate logistic regression analyses. For calculating the overall survival probabilities, the Kaplan–Meier product limit approach was employed. Results In the examined cohort, 133 individuals diagnosed with HM and concomitantly infected with COVID-19 were scrutinized. Of the participants, 29.3% (39 patients) were classified as Severe/Critical, while the other 70.7% (94 patients) were categorized as Non-severe. A significant difference was observed in vaccination status: 61.7% of patients in the Non-severe group had received at least a two-dose vaccine regimen, whereas 61.5% of the Severe/Critical group had either minimal or only one dose of vaccination. The data analysis revealed that elevated C-reactive protein levels (≥ 100 mg/L) significantly raised the risk of severe/critical conditions in HM patients with COVID-19, as determined by advanced multivariate logistic regression. The odds ratio was 3.415 with a 95% confidence interval of 1.294–9.012 (p = 0.013). Patients who continued to have positive nucleic acid tests and ongoing symptoms beyond 30 days were categorized as having a persistent infection, whereas those who achieved infection control within this timeframe were categorized as having infection recovery. Of the HM cohort, 11 did not survive beyond 30 days after diagnosis. The results from a competing risk model revealed that increased interleukin-6 levels (HR: 2.626, 95% CI: 1.361–5.075; p = 0.004) was significantly associated with persistent infection. Conversely, receiving more than two vaccine doses (HR: 0.366, 95% CI: 0.158–0.846; p = 0.019), and having high IgG levels (≥ 1000 mg/dl) (HR: 0.364, 95% CI: 0.167–0.791; p = 0.011), were associated with infection recovery. There was a notable disparity in survival rates between patients with persistent infections and infection recovery, with those in the non-persistent group demonstrating superior survival outcomes (P 

Abstract The concept of immunity debt is a phenomenon resulting from the suppression of endemic pathogens during the COVID-19 pandemic due to non-pharmaceutical interventions (NPIs). The reduced circulation of various pathogens during the pandemic, particularly respiratory syncytial virus (RSV), altered typical infectious disease dynamics by reducing levels of population immunity usually acquired through exposure to infection. This concept is demonstrated through post-pandemic resurgence of diseases such as RSV and Group A Streptococcus, and highlights the interplay between reduced pathogen exposure and increased susceptibility in populations. The complexities and non-linear dynamics of seasonal transmission are observed in differences in pathogen resurgence across regions. These issues highlight the importance of comprehensive disease surveillance and public health strategies in mitigating these long-term epidemiological impacts.

by Ha-Eun Jeon, Seonghyun Lee, Jisun Lee, Gahyun Roh, Hyo-Jung Park, Yu-Sun Lee, Yeon-Jung Kim, Hong-Ki Kim, Ji-Hwa Shin, You-Jeung Lee, Chae-Ok Gil, Eun-Seok Jeon, Jae-Hwan Nam, Byung-Kwan Lim The current COVID-19 mRNA vaccines were developed and applied for pandemic-emergent conditions. These vaccines use a small piece of the virus’s genetic material (mRNA) to stimulate an immune response against COVID-19. However, their potential effects on individuals with chronic inflammatory conditions and vaccination routes remain questionable. Therefore, we investigated the effects of mRNA vaccines in a mouse model of chronic inflammation, focusing on their cardiac toxicity and immunogenicity dependent on the injection route. mRNA vaccine intravenous administration with or without chronic inflammation exacerbated cardiac pericarditis and myocarditis; immunization induced mild inflammation and inflammatory cytokine IL-1beta and IL-6 production in the heart. Further, IV mRNA vaccination induced cardiac damage in LPS chronic inflammation, particularly serum troponin I (TnI), which dramatically increased. IV vaccine administration may induce more cardiotoxicity in chronic inflammation. These findings highlight the need for further research to understand the underlying mechanisms of mRNA vaccines with chronic inflammatory conditions dependent on injection routes.

Abstract Background COVID-19 vaccine effectiveness declines months after vaccination. Therefore, it is likely that during the next few years, people may be repeatedly offered a booster vaccine to enhance humoral immunity levels. A growing number of people are questioning whether the benefits of a booster vaccine outweigh the side-effects. Objective This study aims (1) to identify the most frequently reported side-effects after different doses of COVID-19 mRNA vaccines, (2) and the longest lasting symptoms; and (3) to predict the likelihood of having moderate-to-severe side-effects after a booster COVID-19 mRNA vaccine given individual- and vaccine-specific characteristics. Design, setting, and participants Secondary analysis of a prospective cohort study in primary health care providers (PHCPs) in Belgium conducted between December 2020 and December 2021, and in February-March 2023. Methods In nine subsequent surveys over a period of 2 years vaccine dose-number and side-effects after COVID-19 vaccines were collected. A Generalized Estimation Equations approach on the data of the first and second booster dose was used to investigate the probability of having moderate-to-severe side-effects after mRNA booster vaccination. Predictive performance of a binary classifier was assessed by looking at discrimination (i.e., quantified in terms of the area under the receiver operating characteristic curve). The final prediction model was validated using data with regard to the third booster by assessing misclassification rate, sensitivity and specificity. Results In total, 11% of the PHCPs had moderate-to-severe side-effects after their booster COVID-19 mRNA vaccine. The most common side-effects of COVID-19 mRNA doses included fatigue, local pain at the injection site, general pains, and headache. These side-effects typically lasted for a median of 1 to 2 days. The final model included five predictors: sex, alcohol consumption, history of moderate-to-severe side-effects after any previous dose, recent COVID-19 infection, and the booster dose-number (first, second). Having experienced moderate-to-severe side-effects after any previous dose was the strongest predictor of moderate-to-severe side-effects following an mRNA vaccine booster, with an odds ratio (OR) of 3.64 (95% CI: 2.80–4.75). The OR for female sex was 1.49 (95% CI: 1.21–1.84) implying that females have a higher odds of moderate-to-severe side-effects following booster vaccination. The differences in effect for booster dose-number, alcohol consumption and recent COVID-19 infection was not significant. Conclusion and relevance COVID-19 mRNA booster vaccination implies a low prevalence of moderate-to-severe side-effects among PHCPs, with a short median duration of symptoms if any. The strongest predictors are a history of moderate-to-severe side-effects after any previous dose and being female. These reassuring findings can help addressing concerns about booster vaccination and encourage their uptake. Trial Registration NCT04779424 (registration date: 2021-02-22). …

Abstract Background Post-COVID- 19 syndrome (PCS) significantly impacts the quality of life of survivors. There is, however, a lack of a standardized approach to PCS diagnosis and management. Our bidirectional cohort study aimed to estimate PCS incidence, identify risk factors and biomarkers, and classify clinical phenotypes for enhanced management to improve patient outcomes. Methods A bidirectional prospective cohort study was conducted at five medical sites in Hatyai district in Songkhla Province, Thailand. Participants were randomly selected from among the survivors of COVID-19 aged≥18 years between May 15, 2022, and January 31, 2023. The selected participants underwent a scheduled outpatient visit for symptom and health assessments 12 to 16 weeks after the acute onset of infection, during which PCS was diagnosed and blood samples were collected for hematological, inflammatory, and serological tests. PCS was defined according to the World Health Organization criteria. Univariate and multiple logistic regression analyses were used to identify biomarkers associated with PCS. Moreover, three clustering methods (agglomerative hierarchical, divisive hierarchical, and K-means clustering) were applied, and internal validation metrics were used to determine clustering and similarities in phenotypes. Findings A total of 300 survivors were enrolled in the study, 47% of whom developed PCS according to the World Health Organization (WHO) definition. In the sampled cohort, 66.3% were females, and 79.4% of them developed PCS (as compared to 54.7% of males, p-value

Abstract Introduction Vaccination is considered as one of the most promising strategies to overcome the COVID-19 pandemic. However, it could be associated with rare but serious complications. In the present study, we aimed to review the clinical course and etiology of post COVID-19 vaccination meningitis. Methods After a systematic search in PubMed, Scopus, and Web of Sciences online databases as well as Google Scholar, documents were screened and qualified. Then data extraction was performed and the most frequent underlying agent of meningitis was found based on the reported cases. Results Overall, 35 cases of post COVID-19 vaccination meningitis from 33 articles were included in the review. Among them, 12 cases had proven viral diagnosis and 23 of them were reported to be vaccine-induced. The most frequent viral pathogen among the cases was VZV. The most prevalent symptom was headache, and the most common time of appearance symptoms was one week after vaccination. Conclusion Overall, our study suggested meningitis as a critical but not devastating complication of COVID-19 vaccination. Almost all patients responded well to common agents used to manage viral or vaccine-induced meningitis. It is recommended to monitor patients with a history of chickenpox after COVID-19 vaccination regarding the development of meningitis. …

by April McNeill-Johnson, Zuri Hudson, Brittany Moore, Dumebi Okocha, Megha Ramaswamy, Kimberly Randell Despite the worsening health disparities among youth in detention during the COVID-19 pandemic, there has been minimal exploration into the pandemic experiences of detained youth and opportunities for pandemic mitigation. This paper analyzes the perspectives of youth in detention on the pandemic, including the effect of the pandemic on their detention experience and their perceptions about COVID-19 vaccination. The study used purposive sampling to recruit 16 participants (aged 14–17 years) from two juvenile detention centers in the urban Midwest. We conducted semi-structured interviews and analyzed verbatim transcripts using a hybrid deductive-inductive approach and thematic analysis. Four themes emerged: 1) personal experience influenced youth perceptions of pandemic severity and risk; 2) distrust and misconceptions contributed to youth vaccine hesitancy or refusal; 3) desired opportunities and parental opinion motivated youth to get the COVID-19 vaccine; and 4) pandemic mitigation strategies negatively impacted youths’ detention center experience. Study findings identify opportunities for detention centers to minimize the negative impacts of pandemic mitigation strategies on youth in detention, expand vaccination knowledge and uptake, and build trust to positively impact the health and wellbeing of detained youth currently and during future pandemics.

The SARS-CoV-2 pandemic caused chaos in healthcare systems worldwide. As we move into the current endemic stage, concern is angled more towards COVID-19 high-risk patients care and the management of long-term consequences of the disease. Key considerations have shifted to early treatments efficacy, and formulation of public policies to help restore and maintain patients’ quality of life and a functional society.

Abstract Using the VA COVID-19 National Database, we created matched pairs of previously uninfected vaccinated (≥2 doses of an mRNA vaccine) and previously infected unvaccinated individuals.The incidence rate (per 1000 person-days) of breakthrough infection among vaccinated individuals (0.30, 95% CI 0.29-0.32) was similar to reinfection rate among unvaccinated individuals (0.31, 95% CI 0.30-0.32; p=0.5). The incidence rate of hospitalization/death was higher after reinfection (7.31, 95% CI 6.66-8.03) compared with rate after breakthrough infection (4.69, 95% CI 4.06-5.42; P

Implementation of WBS could enable targeted clinical investigations and improve cost-effectiveness of COVID-19 outbreak management in LTCFs. WBS and serostatus provided informed dynamic changes of infections and immunity. Critical evidence was that LTCF WBS is an effective early warning system to support rapid public health outbreak management and protect vulnerable older populations.

To determine the proportion of individuals with detectable antigen in plasma or serum after SARS-CoV-2 infection and the association of antigen detection with postacute sequelae of COVID-19 (PASC) symptoms.

ObjectivesTo describe the development, validation and reliability of the Oxford Vaccine Hesitancy Scale (OVHS), a new instrument to assess vaccine hesitancy in the general population. DesignCross-sectional validation study. SettingInternet-based study with participants in the UK and USA. ParticipantsDemographically representative (stratified by age, sex and race) samples from the UK and USA recruited through the Prolific Academic platform. Main outcome measuresTo demonstrate OVHS development, exploratory factor analysis with categorical variables and a polychoric correlation matrix followed by promax oblique rotation on the UK sample was performed. Confirmatory factor analysis with a Satorra-Bentler scaled test statistic evaluating goodness of fit statistics including the root mean squared error of approximation (RMSEA), standardised root mean squared residual (SRMR) and comparative fit index (CFI) was performed on the US sample. Reliability as internal consistency was assessed using McDonald’s omega. Evidence in support of the predictive, convergent and discriminant validity of the scale was assessed using logistic regression ORs of association (OR) or Pearson correlation coefficients. ResultsData for factor analysis were obtained from 1004 respondents, 504 in the UK and 500 in the USA. A scree plot, minimum average partial correlation analysis and parallel analysis suggested a three-factor 13-item scale with domains of vaccine beliefs (seven items), pain (three items) and personal deliberation (three items). Responses were recorded on a Likert scale ranging from disagree completely to agree completely, with higher score reflecting greater hesitancy. Potential total scores ranged from 13 to 65. Goodness of fit was excellent, with RMSEA=0.044, SRMR=0.041 and CFI=0.977. Predictive validity for COVID-19 vaccination status was excellent, with logistic regression ORs of association (95% CI) of 0.07 (0.04, 0.13), p

ObjectivesWith the emergence of new COVID-19 variants (Omicron BA.5.2.48 and B.7.14), predicting the mortality of infected patients has become increasingly challenging due to the continuous mutation of the virus. Existing models have shown poor performance and limited clinical utility. This study aims to identify the independent risk factors and develop practical predictive models for mortality among patients infected with new COVID-19 variants. DesignA retrospective study. Setting and participantsWe extracted data from 1029 COVID-19 patients in the respiratory disease wards of a general hospital in China between 22 December 2022 and 15 February 2023. Outcome measuresMortality within 15 days after hospital discharge. ResultsA total of 987 cases with new COVID-19 variants (Omicron BA.5.2.48 and B.7.14) were eventually included, among them, 153 (15.5%) died. Non-invasive ventilation, intubation, myoglobin, international normalised ratio, age, number of diagnoses, respiratory rate, pulse, neutrophil count and albumin were the most important predictors of mortality among new COVID-19 variants. The area under the curve of logistic regression (LR), decision tree (DT) and Extreme Gradient Boosting (XGBoost) models were 0.959, 0.883 and 0.993, respectively. The diagnostic accuracy was 0.926 for LR, 0.918 for DT and 0.977 for XGBoost. XGBoost model had the highest sensitivity (0.908) and specificity (0.989). ConclusionOur study developed and validated three practical models for predicting mortality in patients with new COVID-19 variants. All models performed well, and XGBoost was the best-performing model. …

ObjectivePregnant women with COVID-19 are at elevated risk for severe outcomes, but clinical data on management of these patients are limited. Monoclonal antibodies, such as casirivimab plus imdevimab (CAS+IMD), have proven effective in treating non-pregnant adults with COVID-19, prompting further evaluation in pregnant women. MethodsA phase 3 portion of an adaptive, multicentre, randomised, double-blind, placebo-controlled trial evaluated the safety, clinical outcomes, pharmacokinetics and immunogenicity of CAS+IMD (1200 mg or 2400 mg) in the treatment of pregnant outpatients with COVID-19 (NCT04425629). Participants were enrolled between December 2020 and November 2021, prior to the emergence of Omicron-lineage variants against which CAS+IMD is not active. Safety was evaluated in randomised participants who received study drug (n=80); clinical outcomes were evaluated in all randomised participants (n=82). Only two pregnant participants received placebo, limiting conclusions regarding treatment effect. Infants born to pregnant participants were followed for developmental outcomes ≤1 year of age. ResultsIn pregnant participants, CAS+IMD was well tolerated, with no grade ≥2 hypersensitivity or infusion-related reactions reported. There were no participant deaths, and only one COVID-19–related medically attended visit. Although two pregnancies (3%) reported issues in the fetus/neonate, they were confounded by maternal history or considered to be due to an alternate aetiology. No adverse developmental outcomes in infants ≤1 year of age were considered related to in utero exposure to the study drug. CAS+IMD 1200 mg and 2400 mg rapidly and similarly reduced viral loads, with a dose-proportional increase in concentrations of CAS+IMD in serum. Pharmacokinetics were consistent with that reported in the general population. Immunogenicity incidence was low. ConclusionCAS+IMD treatment of pregnant outpatients with COVID-19 showed similar safety, clinical outcomes and pharmacokinetic profiles to that observed in non-pregnant adults. There was no evidence of an impact on developmental outcomes in infants ≤1 year of age. Trial registration numberNCT04425629. …

IntroductionThe COVID-19 pandemic led to a decline in fertility rates worldwide. Although many regions have experienced a temporary drop in fertility rates with the spread of the infection, subsequent recovery has varied across countries. This study aimed to evaluate the impact of COVID-19 infection rates and regional sociodemographic factors on the recovery of fertility rates in Japan following the state of emergency. MethodsThis study examined prefectural fertility data from before the COVID-19 pandemic to forecast fertility rates up to 2022 using a seasonal autoregressive integrated moving average model. A regression analysis was conducted on fertility rates during the first state of emergency and the subsequent recovery rate with respect to the number of new COVID-19 cases and sociodemographic factors specific to each prefecture. ResultsDuring the first state of emergency, the monthly fertility rate decreased by an average of –13.8% (SD: 6.26, min: –28.78, max: 0.15) compared with the previous year. Over the following 22 months, the average fertility recovery rate was +2.31% (SD: 3.57; min: –8.55, max: 19.54). Multivariate analysis of the impact of the pandemic on fertility changes during the first emergency indicated a negative correlation between new COVID-19 cases per capita and the proportion of nuclear households. No significant correlation was found between fertility recovery rate and new COVID-19 cases or emergency duration. When classifying fertility rate fluctuation patterns before and after the emergency into four clusters, variations were noted in the proportion of the elderly population, marriage divorce rate and the number of internet searches related to pregnancy intentions across the clusters. ConclusionsNo association was found between pregnancy intentions related to the spread of infection, such as the number of new cases and the fertility recovery rate following the first state of emergency. Differences in the patterns of decline and recovery during the pandemic were observed based on population composition and internet searches for infection and pregnancy across different prefectures. …

Abstract Background Post-viral symptoms have long been known in the medical community but have received more public attention during the COVID-19 pandemic. Many post-viral symptoms were reported as particularly frequent after SARS-CoV-2 infection. However, there is still a lack of evidence regarding the specificity, frequency and persistence of these symptoms in comparison to other viral infectious diseases such as influenza. Methods We investigated a large population-based cohort based on German routine healthcare data. We matched 573,791 individuals with a PCR-test confirmed SARS-CoV-2 infection from the year 2020 to contemporary controls without SARS-CoV-2 infection and controls from the last influenza outbreak in 2018 and followed them up to 18 months. Results We found that post-viral symptoms as defined for COVID-19 by the WHO as well as tissue damage were more frequent among the COVID-19 cohort than the influenza or contemporary control cohort. The persistence of post-viral symptoms was similar between COVID-19 and influenza. Conclusion Post-viral symptoms following SARS-CoV-2 infection constitute a substantial disease burden as they are frequent and often persist for many months. As COVID-19 is becoming endemic, the disease must not be trivialized. Research should focus on the development of effective treatments for post-viral symptoms. …

Abstract Background The COVID-19 disease requires accurate diagnosis to effectively manage infection rates and disease progression. The study aims to assess the relationship between vaccination status and RT-PCR cycle threshold (Ct) values by comparing clinical, RDT and RT-PCR results. Methods A total of 453 suspected COVID-19 cases were included in this study. Nasopharyngeal swabs were collected for both RDT and RT-PCR testing, with RDTs conducted on-site and RT-PCR at the Ethiopian Public Health Institute (EPHI) genomics laboratory. Detailed clinical, RDT, and RT-PCR results were analyzed. Data analysis included descriptive statistics, cross-tabulation, and Chi-Square tests to investigate the connections between diagnostic outcomes and vaccination status, with a focusing on Ct values. Results RDT results showed 34.0% negative and 65.8% positive, while RT-PCR results indicated 35.8% negative and 64.2% positive cases. The discrepancies between RDT and RT-PCR results emphasize the importance of thorough testing. No significant association was found between vaccination status and viral load, as indicated by Ct values. Among RT-PCR positive cases, 49.8% had been vaccinated, suggesting challenges in interpreting results among vaccinated individuals. Further analysis revealed that vaccination (first or second dose) had minimal impact on Ct values, indicating limited influence of vaccination status on viral load dynamics in infected individuals. Conclusions The study highlights the significant differences between RDT and RT-PCR outcomes, underscoring the need for a comprehensive testing approach. Additionally, the findings suggest that vaccination status does not significantly impact RT-PCR Ct values, complicating the interpretation of diagnostic results in vaccinated individuals, especially in breakthrough infections and potential false positives. …

Proceedings of the National Academy of Sciences, Volume 121, Issue 41, October 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 41, October 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 41, October 2024.

Viral times: reflections on the COVID-19 and HIV pandemics explores how the COVID-19 pandemic can shape our understanding of the HIV pandemic, and vice versa. The book is a compilation of 16 papers written by 28 authors, and includes case studies from eleven different countries. The book was edited by Jaime García-Iglesias, Maurice Nagington, and Peter Aggleton, and it is targeted towards a range of specialist backgrounds, as well as the general reader.

by Renee Bolijn, Annemieke M. W. Spijkerman, Henrike Galenkamp, Anneke Blokstra, Liza Coyer, Anders Boyd, Maria Prins, Karien Stronks Background During the first waves of the COVID-19 pandemic, SARS-CoV-2 antibody prevalence (seroprevalence) was lower in older compared to younger adults. We studied age group differences in SARS-CoV-2 seroprevalence, across ethnic groups, and assessed the explanatory value of factors that increase the exposure to the virus, and factors related to susceptibility, given the level of exposure. Methods We analysed cross-sectional data from 2,064 participants from the multi-ethnic HELIUS study (Amsterdam, The Netherlands). SARS-CoV-2 seroprevalence at the second wave of infections was compared between age groups (0.05), but age patterns varied across ethnic groups. Age group differences in SARS-CoV-2 seroprevalence were most pronounced in the Dutch majority group, with the highest prevalence ratio in the youngest group (2.55, 95%CI 0.93–6.97) and the lowest in the oldest group (0.53, 95%CI 0.16–1.74), compared to the middle-aged group. In ethnic minority groups, age group differences were smaller. In all groups, patterns did not substantially change after adjustments for exposure and susceptibility variables. Conclusion We found no evidence of age group differences in SARS-CoV-2 seroprevalence, particularly for ethnic minority groups, even when accounting for exposure and susceptibility. While early prevention strategies particularly aimed at protecting older adults against SARS-CoV-2 infections, seroprevalence was similar across age groups in ethnic minority groups. Thus, older adults in ethnic minority groups may pose a target group for additional prevention strategies for future infectious disease outbreaks. …

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.

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.

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.

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.

Abstract State and local governments are free to enact infectious disease control laws to protect the public health but must conform those laws to right-based limitations imposed by the United States Constitution. TB control laws that empower public health agencies and their representatives to institute restrictions on movement and activities for persons with TB have remained largely unchanged for decades and warrant review to ensure consistency with modern legal principles. During the COVID-19 pandemic, there was increased attention to the tension between non-pharmaceutical public health interventions (masking, isolation, lock-downs) intended to reduce transmission and improve community health and their potential negative consequences on learning, mental health, individual finances and the economy at large. Increasing evidence suggests that much of TB transmission is likely to have occurred prior to diagnosis and treatment initiation, and there is limited scientific evidence for the efficacy of community-based isolation in reducing TB incidence or TB mortality; by contrast, there is evidence that treatment rapidly reduces infectiousness, and that prolonged isolation may have deleterious health and financial effects for persons with TB. The post-pandemic era presents an opportunity to reassess public health authorities’ legal obligations in designing voluntary and involuntary isolation policies for persons with tuberculosis. In so doing, state and local governments can recalibrate the balance between respect for individual constitutional rights and achieving public health TB goals.

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), led to a global pandemic from 2020. In Thailand, five waves of outbreaks were recorded, with the fourth and fifth waves driven by the Delta and Omicron variants, resulting in over 20,000 new confirmed cases daily at their peaks. Methods This cross-sectional study investigated the associations between clinical symptoms, vaccination status, antibody responses, and post-COVID-19 sequelae in COVID-19 patients. Plasma samples and clinical data were collected from participants admitted to hospitals in Thailand between July 2021 and August 2022, with follow-ups conducted for one year. The study included 110 participants infected with either the Delta (n = 46) or Omicron (n = 64) variants. Virus genotypes were confirmed by RT-PCR of nasal swab RNA and partial nucleotide sequencing of the S gene. IgG and IgA antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 Delta and Omicron variants were measured in plasma samples using ELISA. Results Pneumonia was found to be associated with Delta variant infections, while sore throat, congestion or runny nose, and headache were linked to Omicron infections. Vaccination with fewer than two doses and diabetes mellitus were significantly associated with higher disease severity. Specific IgG and IgA antibodies against the RBD of the Delta variant generally rose by day 14 and were maintained for up to two months, whereas the pattern of antibody response to the Omicron variant was less clear. Antibody risings were found to be positively associated with pneumonia, certain underlying conditions (obesity, hypertension, dyslipidemia, and diabetes mellitus), and age ≥ 60 years. Delta variant infections were associated with forgetfulness, hair loss, and headache during the 1-year post-infection period. Females were more likely to experience hair loss, forgetfulness, and joint pain, while older age was associated with joint pain. Conclusions This study enhances our understanding of SARS-CoV-2 infections in Thais, particularly concerning the Delta and Omicron variants. The findings can inform public health planning and response strategies for future outbreaks of SARS-CoV-2 or other emerging viral diseases. …

by Terri Flood, Dr. Marian McLaughlin, Dr. Iseult Wilson, Ciara M. Hughes Introduction Human papillomavirus virus (HPV) is highest among young adults 15–24 years old. High-risk strains are responsible for the development of cancers including cervical, vaginal, vulvar, anal, oropharyngeal and penile. Despite HPV school-based vaccination programmes in the UK, HPV vaccination uptake rates continue to fluctuate due to misinformation and vaccine hesitancy post COVID-19. The aim of this study is to explore perceptions of post-primary school teachers and nurses regarding the current HPV education provision and the need to provide HPV education to students 15–17 years old when they are most likely to be becoming sexually active. Methods A qualitative study was conducted using online semi-structured interviews between February-August 2022 with post-primary teachers and nurses in Northern Ireland, UK. Stratified random sampling was used to contact schools to recruit participants. Recruitment continued until data saturation was reached. Braun & Clarke’s six-phase framework for reflexive thematic analysis was used to analyse the data. Results Twelve teachers and six nurses participated in the study. Four themes arose based on the analysis including 1) the importance of HPV education 2) self-consent to the HPV vaccine 3) design of the HPV education and 4) delivery of the HPV education. Identified barriers to implementation of HPV education included lack of parental education, religion and the conservative culture of Northern Ireland. Discussion Participants perceived HPV education to be poor or non-existent in their schools but placed high importance on this education. They indicated that a non-judgemental health professional would be the ideal person to deliver interactive HPV education as part of a mandated spiral curriculum. Conclusion HPV education at 15–17 years old provides students with an opportunity to learn about their HPV risk, their HPV vaccination status and an opportunity to self-consent to the HPV vaccine. The Education Authority and Department of Health should support health professionals to deliver consistent robust HPV health information to students of this age. …

by Allan Mayaba Mwiinde, Patrick Kaonga, Choolwe Jacobs, Joseph Mumba Zulu, Isaac Fwemba The COVID-19 pandemic has overwhelmed health systems, especially in sub-Saharan African countries. Vaccination is one of the easily accessible interventions that can help reduce the burden on the health system. However, vaccination coverage remains low in sub-Saharan African countries. The determinants of vaccine acceptance and hesitancy among adolescents and youths remain unknown. Therefore, this study explored the pooled prevalence and determinants of COVID-19 vaccine acceptance and hesitancy among adolescents and youths in sub-Saharan African Countries. A systematic literature search of Scopus, PubMed Central, PubMed, Embase, African Journal Online, Research 4 Life, Embase, and Google Scholar was performed from 6th May to 31st December 2023, using developed keywords with a focus on sub-Saharan African countries. Twenty-three (N = 23) studies were finally selected for analysis. The pooled prevalence of vaccine acceptance among adolescents and youths was 38.7% (n = 23). The subgroup analysis of the pooled prevalence of acceptance among adolescents was 36.1% (n = 36.1) while youths were 42% (n = 10). At the region level, West Africa had 42.2% (n = 13), East Africa had 39.8% (n = 6), Central Africa had 33% (n = 1), and Southern Africa had 24.2% (n = 3). The determinants of vaccine acceptance were the desire for self-immunity (AOR = 1.97, 95%, CI, 1.083.47, I2 = 94.15%, p < 0.05), receiving Health Officers’ information (AOR = 4.36, 95%, CI, 2.28-8.32, I2 = 97.74, p < 0.001), the effectiveness of COVID-19 vaccine (AOR = 2.14, 95%, CI, 1.14-4.05, I2 = 97.4%, p < 0.05). The odds of having an unconfirmed source of information (AOR = 0.22, 95% CI, 0.10-0.45, I2 = 94.09%, p< 0.001) was responsible for vaccine hesitancy. The findings indicate the low pooled prevalence of COVID-19 vaccine acceptance and high levels of hesitancy among adolescents and youths in sub-Saharan African countries. Therefore, there is a need to ensure that extensive research is undertaken into age-appropriate health promotion messages and strategies to encourage the uptake of vaccines. PROSPERO ID number CRD42023403071.

Deaths from COVID-19 dropped by about 69% last year, decreasing from roughly 246 000 deaths in 2022 to 76 000 in 2023, according to provisional data released by the US Centers for Disease Control and Prevention (CDC). This shifted COVID-19 from the 4th leading cause of death in 2022 to the 10th, researchers noted in the Morbidity and Mortality Weekly Report.

Since 2021, the US National Institutes of Health (NIH) has enrolled 90 000 people across more than 200 clinical sites as part of its RECOVER initiative to understand, identify, and treat post–COVID-19 condition, also known as long COVID. One goal of these studies has been to discover biomarkers that can help diagnose long COVID because symptoms are so wide-ranging. Recently, though, a study in the Annals of Internal Medicine found that routine laboratory tests are unlikely to help achieve that goal.

This Medical News article discusses the latest research about the use of nirmatrelvir-ritonavir, sold as Paxlovid, to treat COVID-19 and, possibly, to prevent or treat long COVID.

Abstract Background Streptococcus pyogenes (Group A Streptococcus, GAS) is a significant pathogen that causes diverse infections, ranging from pharyngitis to severe invasive diseases. Asymptomatic carriage in children is pivotal for transmission. The COVID-19 pandemic’s health measures, including mask wearing and enhanced hand hygiene, likely influenced GAS transmission dynamics. This study evaluated the impact of these precautions on the prevalence of asymptomatic pharyngeal GAS carriage among schoolchildren in the southern West Bank, Palestine. Methods This cross-sectional study was conducted in two phases: pre-COVID-19 (November 2019–January 2020) and post-COVID-19 (November 2023–April 2024). Throat swabs were collected from 701 children (345 pre-COVID-19, 356 post-COVID-19) via cluster sampling. The samples were tested with the ABON Strep A rapid test and confirmed by culture. Sociodemographic, health, and household data were also collected. The statistical analyses included descriptive statistics, chi-square tests, and binary logistic regression. Results The prevalence of asymptomatic pharyngeal GAS carriage declined from 15.7% pre-COVID-19 to 10.4% post-COVID-19 (p = 0.038). Significant reductions were observed among urban residents (23.5–10.1%, p = 0.003) and those from medium socioeconomic backgrounds (16.0–9.1%, p = 0.008). Compared with urban residents, rural residents had lower GAS carriage rates (adjusted OR = 0.505, p = 0.023). Carriage rates also decreased among children with frequent sore throats (17.6–7.3%, p = 0.007) and those using private wells (52.5–14.9%, p