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What's new in the medical literature

Updated 5 July 2024

UpToDate

Cochrane Library

Cochrane Clinical Answers

MJA

MJA insight

BMJ

JAMA

NEJM

Other journals

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UpToDate

Post-exposure prophylaxis for men who have sex with men and transgender women at risk for STIs
For men who have sex with men and transgender women who have a history of bacterial sexually transmitted infection (STI) in the prior 12 months or whose planned sexual activity increases exposure to STIs (eg, multiple or anonymous sex partners), we suggest doxycycline post-exposure prophylaxis to reduce the risk of chlamydia, gonorrhea, and syphilis (Grade 2B). Among men who have sex with men (MSM) and transgender women at increased risk for sexually transmitted infections (STIs), several randomized trials have shown that post-exposure prophylaxis (PEP) with doxycycline (a 200 mg dose taken within 72 hours of condomless sex) reduces the incidence of syphilis, chlamydia, and gonorrhea. In June 2024, the Centers for Disease Control and Prevention in the United States recommended that clinicians counsel such individuals on the benefits and risks of doxycycline PEP and use shared decision-making to determine whether to provide it [1]. We suggest doxycycline PEP for this population, acknowledging the potential for gastrointestinal side effects and the uncertain long-term effects on antimicrobial resistance. Regardless of the decision to use PEP, we continue to emphasize other STI prevention strategies. (See "Prevention of sexually transmitted infections", section on 'Doxycycline post-exposure prophylaxis for selected individuals'.)

 

Management of patients with intraoperative hypotension
To address the strong association between intraoperative hypotension and adverse outcomes, the Anesthesia Patient Safety Foundation held a consensus conference with invited experts and recently published their recommendations for best practices regarding perioperative hemodynamic instability [9]. Key points included intraoperative assessment of volume responsiveness and appropriate administration of fluids and/or vasopressor/inotropic drugs. In addition, patients who develop intraoperative hypotension may need to be monitored for an extended period in the postanesthesia care unit and after triage to a surgical ward. (See "Hemodynamic management during anesthesia in adults", section on 'Adverse effects of hypotension'.)

RSV-associated cardiac events in adults
Although respiratory syncytial virus (RSV) infection in adults is typically mild, it can have severe outcomes in some. In a cross-sectional study that spanned five RSV seasons, the weighted prevalence of an acute cardiac event among over 6000 hospitalized adults >50 years old with laboratory-confirmed RSV was 22 percent [17]. The most frequent cardiac events were acute heart failure and acute ischemic heart disease. Although most events occurred in patients with cardiovascular disease, 8.5 percent were in those without known cardiovascular disease. These results underscore the potential benefits of preventive measures for RSV, especially for adults with cardiovascular disease. (See "Respiratory syncytial virus infection in adults", section on 'Severe disease'.)

Subcutaneous semaglutide and risk of kidney disease progression in type 2 diabetes
In a trial evaluating subcutaneous semaglutide (1 mg weekly) versus placebo in over 3500 adults with type 2 diabetes (mean age 67 years, mean A1C 7.8 percent) and chronic kidney disease (CKD; mean estimated glomerular filtration rate [eGFR] 47 mL/min/1.73 m2 with median urinary albumin-to-creatinine ratio of 567 mg/g), semaglutide reduced the incidence of major kidney events (a composite of kidney failure onset, ≥50 percent reduction in eGFR from baseline, or kidney- or cardiovascular-related mortality) [3]. Benefits were observed specifically for reduction in eGFR from baseline and cardiovascular mortality. These findings further support the use of semaglutide in people with type 2 diabetes and CKD, particularly when substantial glucose and/or body weight lowering are major goals of care. (See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Our approach' and "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Microvascular outcomes'.)

No reduction in diabetic retinopathy incidence with omega-3 fatty acid supplementation
Omega-3 fatty acids have shown protective effects in preclinical models of diabetic retinopathy. However, in a primary prevention cardiovascular outcome trial that randomly assigned 15,480 adults with diabetes to treatment with omega-3 fatty acids (1 mg daily) or placebo, no association was found between omega-3 fatty acid treatment and the incidence of referable retinopathy or maculopathy over 6.5 years of follow-up [2]. These findings argue against additive benefit of omega-3 fatty acid supplementation to glycemic and blood pressure management for retinopathy prevention. (See "Diabetic retinopathy: Prevention and treatment", section on 'Prevention'.)

Inositol appears ineffective for metabolic and endocrine outcomes in polycystic ovary syndrome
Inositol, in particular myo-inositol (MI), has been suggested as a potential therapy to improve insulin sensitivity and ovulation in patients with polycystic ovary syndrome. However, evidence to date does not support its use. In a systematic review and meta-analysis of five trials comparing MI to placebo, combined estrogen-progestin oral contraceptives, or MI with folic acid, no significant improvements in anthropometric (body mass index), metabolic (fasting insulin, fasting glucose, homeostasis model assessment of insulin resistance), or hormonal (luteinizing hormone, follicle-stimulating hormone, estradiol, serum androgens) measurements were observed [10]. (See "Treatment of polycystic ovary syndrome in adults", section on 'Ovulation induction medications'.)

Risk of suicide attempts in polycystic ovary syndrome
Depression and anxiety are common comorbidities in females with polycystic ovary syndrome (PCOS). PCOS may also be associated with an increased risk for suicide attempts, as reported in a longitudinal national registry study of PCOS patients and controls matched for age, psychiatric diagnoses, and socioeconomic status [11]. After 1 to 15 years of follow-up, PCOS patients had a higher rate of suicide attempts (3.0 versus 0.3 percent in controls). Although concerning, the quality of the evidence is low and should therefore be interpreted with caution. (See "Clinical manifestations of polycystic ovary syndrome in adults", section on 'Mood disorders'.)

Premature ovarian insufficiency and impaired sexual function
Premature ovarian insufficiency (POI) has been associated with impaired sexual function. In a meta-analysis of five studies in 352 females with POI, sexual function, measured using the Female Sexual Function Index, was significantly lower than in females without POI [12]. Systemic estrogen therapy was not associated with an improvement in sexual function. Dyspareunia was a common symptom in the POI group, but the impact of vaginal estrogen, an effective therapy for dyspareunia and other aspects of sexual health, was not addressed. (See "Clinical manifestations and diagnosis of primary ovarian insufficiency (premature ovarian failure)", section on 'Sexual health'.)

Bariatric surgery, ovulation, and polycystic ovary syndrome
Anovulatory infertility and obesity are common in patients with polycystic ovary syndrome (PCOS). In a randomized trial comparing laparoscopic sleeve gastrectomy with medical therapy (metformin and/or orlistat) in 80 patients with PCOS and body mass index ≥35 kg/m2, those assigned to surgery had 2.5 times more biochemically confirmed spontaneous ovulatory events and a healthier cardiometabolic and anthropometric profile at 52 weeks; however, they remained oligo-ovulatory [13]. Although these findings support use of bariatric surgery as a possible option for treating anovulatory infertility in patients with PCOS who cannot lose weight through behavior or medical therapy alone, limitations include nonuse of glucagon-like peptide 1 (GLP1) agonists, which are currently the preferred medical therapy of PCOS, and lack of information about subsequent pregnancy rates. (See "Outcomes of bariatric surgery", section on 'Polycystic ovary syndrome'.)

Surgical decompression for selected patients with severe cerebral venous thrombosis
Hemicraniectomy is performed as a lifesaving procedure for patients with cerebral venous thrombosis (CVT), but data on functional benefit are less certain. In an international cohort, 118 patients with acute CVT underwent decompressive hemicraniectomy for severe symptoms and/or imaging findings, including coma (31 percent), dilated pupil(s) (18 percent), large hemorrhagic/ischemic lesions (median maximal diameter 6.5 cm), and imaging evidence of impending herniation (37 percent) [11]. At 12 months, a good functional outcome (modified Rankin Scale score 0 to 2) was achieved by 36 percent of patients. The median time to surgery from CVT diagnosis was one day, and good outcomes were more common in younger patients and those with less severe preoperative neurologic examination findings. These data support the role of surgical decompression for properly selected patients with severe CVT, even those with severe clinical and/or imaging findings. (See "Cerebral venous thrombosis: Treatment and prognosis", section on 'Surgical interventions'.)

Impact of combined prenatal nicotine and cannabis use on pregnancy outcomes 
Studies have reported prenatal use of either nicotine or cannabis increases the risk of adverse child outcomes, but the impact of combined exposure has been less clear. In a retrospective study of over 3 million births, prenatal exposure to both nicotine and cannabis was associated with increased rates of neonatal and infant death compared with exposure to either substance alone (neonatal death: 0.6 versus 0.3 percent; infant death: 1.2 versus 0.7 percent) [1]. Neonatal and severe maternal morbidity were also increased with combined exposure. We continue to advise screening pregnant persons for substance use to enable education, particularly about additional risk associated with combined use, and to offer options for cessation or treatment. (See "Substance use during pregnancy: Overview of selected drugs", section on 'Neonatal and pediatric outcomes'.)

Laparoscopic versus open surgery for major liver resection
Minimally invasive techniques are equivalent or superior to open surgery for minor hepatectomies, but data on major hepatic resection are limited. The ORANGE II PLUS randomized trial compared outcomes of open surgery versus laparoscopic resection in 332 patients undergoing major liver resection (hemihepatectomy) [11]. Laparoscopic resection resulted in a shorter time to functional recovery (4 versus 5 days), better quality-of-life scores, and, in patients with cancer, a shorter time to adjuvant systemic therapy (47 versus 63 days) with no adverse impact on cancer outcomes. These findings support use of minimally invasive techniques for all types of liver resections at experienced centers. (See "Minimally invasive liver resection (MILR)", section on 'Perioperative outcomes'.)

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MJA

The survival benefit of deceased donor kidney transplantation for Aboriginal and Torres Strait Islander people, 2006–20: a retrospective national cohort study

  • The known: Aboriginal and Torres Strait Islander people are disproportionately affected by kidney failure but are less likely than non‐Indigenous Australians to be waitlisted for and to receive kidney transplants. Poorer outcomes have been cited as a reason for the disparity.
  • The new: Deceased donor kidney transplantation provides a clear survival benefit for Aboriginal and Torres Strait Islander Australians eligible for transplant waitlisting compared with remaining on dialysis.
  • The implications: Our findings support prioritising and promoting waitlisting of Aboriginal and Torres Strait Islander people who are otherwise eligible for transplantation.

MJA 1 July 2024

Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963–2020: an ANZDATA registry study

  • The known: Kidney failure has been increasing in Australia among Aboriginal and Torres Strait Islander children and young adults.
  • The new: Since 1963, we observed excellent 5-year graft and recipient survivals among all children and young adults who achieved transplantation. We note, however, fewer transplants were achieved within the first five years of dialysis initiation among Aboriginal and Torres Strait Islander children and young adults, and their continuing on dialysis without transplant was associated with lower patient survival.
    The implications: Models of care that achieve transplantation within five years of dialysis commencement must be prioritised for Aboriginal and Torres Strait Islander children and young adults.

MJA 1 July 2024

First stroke incidence, causes, treatments, and outcomes for Aboriginal Peoples in South Australia and the Northern Territory: a pilot prospective study

  • The known: Most information about stroke in Aboriginal and Torres Strait Islander Peoples is based on retrospective studies and historical records of limited accuracy.
  • The new: In a pilot study undertaken in the Northern Territory and South Australia, we found that a population-based study of the incidence of stroke in Aboriginal people, reported according to CONSIDER guidelines, is feasible.
  • The implications: Our stroke incidence pilot study indicates the potential of a more comprehensive study. To serve Aboriginal communities, research reports should follow the CONSIDER principles, and our pilot study excelled in this regard.

MJA 1 July 2024

Knowledge translation in Indigenous health research: voices from the field

  • The known: Knowledge translation efforts in health research are intended to improve health and wellbeing through the application of research knowledge. Research done predominantly on Indigenous peoples has resulted on suboptimal improvements in Indigenous peoples’ health and wellbeing outcomes.
  • The new: Knowledge translation is inherent to Indigenous research practice. Knowledge translation in Indigenous health should move beyond Euro-Western academic metrics and incorporate local knowledge holders. Researchers and institutions should be accountable for ensuring that knowledge translation is embedded throughout the research process.
  • The implications: Our findings identify effective examples of knowledge translation and offer ways to advance the field as essential in delivering sustainable health outcomes for Indigenous people through research and evaluation.

MJA 1 July 2024

Out-of-pocket health care expenses for people with and without cancer, New South Wales, 2020: a cross-sectional study

  • The known: Despite our universal health care system, the financial burden of medical costs can be great for people in Australia, particularly those with cancer.
  • The new: Out-of-pocket spending on health care during the preceding twelve months exceeded $1000 for 43% of survey respondents (aged 56 years or older). The likelihood of higher out-of-pocket expenses was greater for people with cancer, independent of the effect of socio-demographic factors.
  • The implications: High out-of-pocket costs can increase financial strain generally, but can also restrict access to appropriate health care for people with limited financial resources, especially for those with cancer.

MJA 25 June 2024

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MJA insight

We created a guide to futureproof the mental health of health care workers. Will health care leaders use it?
Health care workers (HCWs) face considerable mental health challenges due to high stress environments, long working hours, and the emotional toll of patient care. They are at increased risk of poor mental health, with burnout and post-traumatic stress disorder (PTSD) both major concerns for many HCWs. Worsening things, HCWs tend to avoid looking for help because of stigma and realistic concerns that a mental health diagnosis or treatment could be career ending. MJA insight 1 July 2024

Keeping sputum induction safe with new position statement
A new position statement from the Thoracic Society of Australia and New Zealand provides up-to-date guidelines for safely performing sputum induction. MJA insight 1 July 2024

New insights into what Australians die from
Most Australians die from multiple conditions as shown in new research from the Australian Institute of Health and Welfare (AIHW). MJA insight 24 June 2024

Mythbusting menopausal hormone therapy
Despite advances in our understanding of the risks and benefits of menopausal hormone therapy, outdated research continues to raise concerns for both patients and their clinicians. MJA insight 24 June 2024

The impact of childhood maltreatment on mental health
We urgently need a paradigm shift in addressing childhood maltreatment — one that considers it as a root cause of ill health, and that prioritises allocation of resources to preventing abuse and neglect. MJA insight 24 June 2024

Autistic brains more vulnerable to PTSD, new study shows
Researchers at the Australian National University (ANU) and the University of Queensland (UQ) have found that not only are autism and post-traumatic stress disorder (PTSD) vulnerably linked, but that recontextualisation can help improve the resulting implication of autistic symptoms. MJA insight 24 June 2024

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BMJ

Reducing unnecessary investigations in paediatric seizures in the emergency department
What you need to know

  • Simple febrile seizure or new onset afebrile seizure in children with no known comorbidities who return to their baseline neurological status do not require investigation by laboratory testing or urgent neuroimaging
  • Blood tests and computed tomography scans of the head are low yield, costly, and expose children to painful procedures and risks from radiation and sedation
  • Specific risk factors, noted during history and physical examination can identify the minority of patients who may benefit from laboratory testing or head imaging after a seizure

BMJ 25 June 2024

SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study
In people with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of hyperkalemia than DPP-4 inhibitors in the overall population and across relevant subgroups. The consistency of associations among individual agents in the SGLT-2 inhibitor and GLP-1 receptor agonist classes suggests a class effect. These ancillary benefits of SGLT-2 inhibitors and GLP-1 receptor agonists further support their use in people with type 2 diabetes, especially in those at risk of hyperkalemia. BMJ 26 June 2024

Colchicine in patients with acute ischaemic stroke or transient ischaemic attack (CHANCE-3): multicentre, double blind, randomised, placebo controlled trial
The study did not provide evidence that low-dose colchicine could reduce the risk of subsequent stroke within 90 days as compared with placebo among patients with acute non-cardioembolic minor-to-moderate ischaemic stroke or transient ischaemic attack and a high sensitivity C-reactive protein ≥2 mg/L. BMJ 26 June 2024

Reducing unnecessary investigations in paediatric seizures in the emergency department
What you need to know

  • Simple febrile seizure or new onset afebrile seizure in children with no known comorbidities who return to their baseline neurological status do not require investigation by laboratory testing or urgent neuroimaging
  • Blood tests and computed tomography scans of the head are low yield, costly, and expose children to painful procedures and risks from radiation and sedation
  • Specific risk factors, noted during history and physical examination can identify the minority of patients who may benefit from laboratory testing or head imaging after a seizure

BMJ 25 June 2024

Analgesia for non-specific low back pain
What you need to know

  • Analgesics have limited effect on low back pain and some, such as opioids and benzodiazepines, have substantial risks
  • Oral and, less certainly, topical non-steroidal anti-inflammatory drugs have small benefits that may not be outweighed by risks (particularly gastrointestinal) for short term use for low back pain
  • Acute low back pain typically improves within a few weeks without treatment; for chronic low back pain, the focus of management should be on non-pharmacological treatments to improve function and address the broader determinates of pain

BMJ 25 June 2024

Acute painful crisis in adults with sickle cell disease
What you need to know

  • Pain in people of Asian, African, Caribbean, Latin American, or Middle Eastern ancestry could be related to acute painful crisis of sickle cell disease
  • The back and trunk are commonly affected and pain may then radiate to the limbs
  • Crises are often severe, and require strong analgesia for symptom relief
  • Consider the complication of acute chest syndrome in patients with fever and respiratory signs and symptoms

BMJ 1 July 2024

Peer support in chronic health conditions
What you need to know

  • Peer support can be particularly helpful at the point of diagnosis or during periods of transition in health or life stages
  • Peer support can be accessed face to face, online, in clinical or non-clinical groups, or through activities
  • Clinicians can collaborate with peer support groups by signposting patients to peer support, offering to attend peer support sessions, and helping with meetings

BMJ 1 July 2024

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JAMA

COVID-19 vaccination in the first trimester and major structural birth defects among live births
In this multisite cohort study, among live-born infants, first-trimester mRNA COVID-19 vaccine exposure was not associated with an increased risk for selected major structural birth defects. JAMA 1 July 2024

Rare and common genetic variation underlying Atrial Fibrillation risk
Rare and common genetic variation were associated with an increased risk of AF. The findings provide insights into the genetic underpinnings of AF and may aid in future genetic risk stratification. JAMA 24 June 2024

Routine electrocardiogram screening and cardiovascular disease events in adults
The findings of this study suggest that the potential role of routine ECG screening for early prevention of CVD events, along with the optimal follow-up strategy, should be examined in future studies. JAMA 1 July 2024

Pneumonia risk, antipsychotic dosing, and anticholinergic burden in Schizophrenia
Findings of this study suggest that in patients with schizophrenia, pneumonia is associated with the use of specific antipsychotics, setting the stage for personalized prevention strategies to decrease the incidence of this life-threatening condition in patients with schizophrenia. JAMA 26 June 2024

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NEJM

Dupilumab for Eosinophilic Esophagitis in patients 1 to 11 years of age
Dupilumab resulted in histologic remission in a significantly higher percentage of children with eosinophilic esophagitis than placebo. The higher-exposure dupilumab regimen also led to improvements in measures of key secondary end points as compared with placebo. NEJM 26 June 2024

Tisotumab Vedotin as second- or third-line therapy for recurrent cervical cancer
In patients with recurrent cervical cancer, second- or third-line treatment with tisotumab vedotin resulted in significantly greater efficacy than chemotherapy. NEJM 3 July 2024

Acute abdomen in the modern era
A thorough history and physical examination, the judicious administration of analgesia, effective use of imaging, and timely surgical consultation can lead to the appropriate diagnosis of the acute abdomen. NEJM 3 July 2024

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Other journals

Effect of pericapsular nerve group block and suprainguinal fascia iliaca block on postoperative analgesia and stress response in elderly patients undergoing hip arthroplasty: a prospective randomized controlled double-blind trial
This study found that elderly patients undergoing hip fracture surgery, postoperative analgesia is more pronounced, intraoperative hemodynamic parameters are more stable, and intraoperative stress is less induced in patients receiving suprainguinal fascia iliaca block (SIFIB) than in patients receiving pericapsular nerve group (PENG) block. BMC anesthesiology 2 July 2024

Landscape and challenges in economic evaluations of artificial intelligence in healthcare: a systematic review of methodology
There was a concerningly low number of full Health economic evaluations (HEEs) relative to the number of AI publications, however the trend is that the number of studies per year is increasing. Mapping the evidence of the methodological quality of HEEs of AI shows a need to improve the quality in particular the use of proxy measures as outcome, reporting, and interpretation of the incremental cost-effectiveness ratio (ICER). BMC digital health 1 July 2024

Quantitative analysis of the impact of infectious disease physicians on patients in the emergency department fast-track parenteral antibiotics program
The findings of this study support the hypothesis that infectious disease (ID) involvement in outpatient parenteral antibiotic therapy (OPAT) programs leads to changes in care that may have beneficial outcomes for patients and the healthcare system. BMC infectious diseases 1 July 2024 

Using machine-learning models to predict extubation failure in neonates with bronchopulmonary dysplasia
The present study indicated that the extreme gradient boosting (XGBoost) model was significant in predicting extubation failure (EF) in bronchopulmonary dysplasia (BPD) neonates with mechanical ventilation, which is helpful in determining the right extubation time among neonates with BPD to reduce the occurrence of complications. BMC pulmonary medicine 1 July 2024

Dexmedetomidine-ketamine combination versus fentanyl-midazolam for patient sedation during flexible bronchoscopy: a prospective, single-blind, randomized controlled trial
Dexmedetomidine-ketamine (DK) demonstrated a good safety profile in patients subjected to flexible bronchoscopy (FB) and achieved more profound sedation and better bronchoscopist satisfaction than the standard midazolam-fentanyl (MF) combination without increasing the rate of adverse events.
BMC pulmonary medicine 26 June 2024

Vitamin K: a potential missing link in critical illness–a scoping review
Addressing vitamin K deficiency in ICU patients is crucial for mitigating risks associated with critical illness, yet optimal management strategies require further investigation. Critical care 1 July 2024

Systematic review of validation studies for the use of wearable smartwatches in the screening of atrial fibrillation
Wearable smartwatches (WSWs) have the potential to reliably and continuously screen for AFib and detect it in a timely manner. The inconclusive results produced by WSWs are a significant problem. Once the inconclusive results are rectified, WSWs may be used for widespread screening of AFib in those people who are at high risk of developing AFib. International journal of arrhythmia 26 June 2024

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COVID-19

COVID-19 Latest from research publications
compiled by the SALHN (SA Health) library staff - updated 15 July 2024

For older articles please click here and you will be directed to the archival page on the SA health Library website

Key information sources - coronavirus resource pages have been created by various medical publications in order to disseminate clinical information as soon as it is available

We finally know why some people got COVID while others didn’t
Throughout the pandemic, one of the key questions on everyone’s mind was why some people avoided getting COVID, while others caught the virus multiple times. MJA insight 15 July 2024

In need of robust evidence of non-association of pregestational and early pregnancy SARS-CoV-2 infections with congenital anomalies
SARS-CoV-2 infection during pregestational and early pregnancy periods has an unclear impact on fetal development. Although vertical transmission is rare, potential effects on the developing fetal brain are plausible. However, robust evidence linking maternal SARS-CoV-2 infection to congenital anomalies is limited due to inadequate tracking of infection history and methodological flaws in published studies. This is further complicated by limitations, such as restricted testing access and undiagnosed infections, particularly in low- and middle-income countries. Most data focus on hospitalized women near term, lacking information on first- and second-trimester infections. Thus, an accurate assessment of the impact of COVID-19 on congenital anomalies is essential. It should however be emphasised that we have robust evidence that vaccination against COVID-19 before or during early pregnancy is not associated with malformations, ruling out any role of COVID-19 vaccines in these increased rates of congenital abnormalities. This viewpoint discusses findings from surveillance registries, highlights study limitations, and offers research recommendations to inform clinical guidelines and public health strategies, aiming to mitigate the effects of viral infections on early neurodevelopment. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00308-0/fulltexteClinicalMedicine 11 July 2024

COVID-19 among migrants, refugees, and internally displaced persons: systematic review, meta-analysis and qualitative synthesis of the global empirical literature
Even in the advanced stages of the pandemic, migrants faced higher infection risks and disproportionately suffered from the consequences of COVID-19 disease, including deaths. Population-level interventions in future health emergencies must better consider socio-economic, structural and community-level exposures to mitigate risks among migrants. Enhancing health information systems is crucial, as the lack of migration variables makes it difficult to close coverage gaps, leaving migrants largely ‘invisible’ in official data. eClinicalMedicine 10 July 2024

Wheeze among children born during COVID-19 lockdown
In this study, children born during the COVID-19 lockdown had fewer wheezing episodes and less use of respiratory medicines compared with the prepandemic cohort. Limitations include the study’s retrospective nature and the impossibility of assessing RSV infection. In line with a large birth cohort study demonstrating that not being infected with RSV during the first year of life is associated with a 26% lower risk of 5-year current asthma, this study underscores the potential role of a universal RSV immunoprophylaxis in preventing postbronchiolitis wheezing. JAMA 9 July 2024

Outpatient treatment of confirmed COVID-19: Living, rapid practice points from the American College of Physicians (Version 2, Update Alert)

  • Practice Point 1: Consider molnupiravir to treat symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease.
  • Practice Point 2: Consider nirmatrelvir–ritonavir combination therapy to treat symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease.
  • Practice Point 3: Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
  • Practice Point 4: Do not use sotrovimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.

Annals of internal medicine 9 July 2024

Outpatient treatment of confirmed COVID-19: A living, rapid evidence review for the American College of Physicians (Version 2, Update Alert)
This first update alert reports surveillance results of the living, rapid evidence review on “Outpatient Treatment of Confirmed COVID-19: A Living, Rapid Evidence Review for the American College of Physicians (Version 2)”, which informed the American College of Physicians living practice points (version 2). Annals of internal medicine 9 July 2024

Combined treatment of severe acute respiratory syndrome Coronavirus 2 reduces Molnupiravir-induced mutagenicity and prevents selection for Nirmatrelvir/Ritonavir resistance mutations
The authors investigated the mutation profiles of severe acute respiratory syndrome coronavirus 2 in samples collected from a molnupiravir and nirmatrelvir/ritonavir combination therapy in macaques. We found that molnupiravir induced several nirmatrelvir resistance mutations at low abundance that were not further selected in combination therapy. Coadministration of nirmatrelvir/ritonavir lowered the magnitude of the mutagenetic effect of molnupiravir. Journal of infectious diseases 8 July 2024

Work ability and return-to-work of patients with post-COVID-19: a systematic review and meta-analysis
The systematic review underscores the substantial impact of post-COVID-19 on work-related outcomes. The implications of this research highlight the need for healthcare providers, employers, and policymakers to collaborate in creating inclusive work environments and implementing tailored rehabilitation programs to support individuals recovering from post-COVID-19. Further research should focus on long-term follow-up studies with mixed methods to gain a more comprehensive understanding of the long-term consequences of post-COVID-19 on work ability and RTW outcomes. BMC public health 7 July 2024

Pre-existing sleep disturbances and risk of COVID-19: a meta-analysis
Pre-existing sleep disturbances, especially obstructive sleep apnea (OSA),, increased the risk of COVID-19 susceptibility, hospitalization, mortality, and long COVID. Age and sex played important roles in the effect of sleep disturbances on COVID-19. eClinicalMedicine 5 July 2024

Socioeconomic disadvantage and youth mental health during the COVID-19 pandemic lockdown
This cohort study found that the COVID-19 lockdown was associated with disproportionately negative mental health outcomes among youths from higher socioeconomic status backgrounds. Although this study does not shed light on the direct mechanisms driving these associations, it does provide some support for positive outcomes for youths. Future studies are needed to understand whether these associations persist over longer periods of time. JAMA 5 July 2024

COVID-19 vaccination and parent-reported symptomatic child Asthma prevalence
In this study the authors found that higher COVID-19 vaccination rates may confer protection against symptomatic asthma. JAMA 3 July 2024

In-hospital delirium and disability and cognitive impairment after COVID-19 hospitalization
These findings suggest that after discharge from hospitalization for COVID-19, older adults who experience in-hospital delirium may need to be counseled, screened, and provided resources to mitigate their risk of long-term functional disability and cognitive impairment. JAMA 2 July 2024

COVID-19 vaccination in the first trimester and major structural birth defects among live births
In this multisite cohort study, among live-born infants, first-trimester mRNA COVID-19 vaccine exposure was not associated with an increased risk for selected major structural birth defects. JAMA 1 July 2024

COVID-19 vaccine effectiveness in autumn and winter 2022 to 2023 among older Europeans
Findings of this study suggest that COVID-19 vaccination campaigns should precede peaks in SARS-CoV-2 incidence and that effectiveness of new vaccines against emerging variants should be continually monitored using seasonal COVID-19 vaccine effectiveness (CVE) approaches. JAMA 1 July 2024

Precision symptom phenotyping identifies early clinical and proteomic predictors of distinct COVID-19 sequelae
The authors identified three distinct symptom-based Post-COVID conditions (PCC) phenotypes with specific clinical risk factors and early post-infection inflammatory predictors. With further validation and characterization, this framework may allow more precise classification of PCC cases and potentially improve the diagnosis, prognostication, and treatment of PCC. Journal of infectious diseases 25 June 2024

Severity of COVID-19 sub-lineages XBB/XBB 1.5/XBB1.16, EG.5.1. and JN.1. in England
Overall these data do not suggest that JN.1 and EG.5.1 causes more severe disease than XBB sub-lineages. The authors found no statistically significant difference in the odds of ICU admission or death among hospitalised individuals infected with JN.1 or EG.5.1 compared to XBBs. The length of stay following hospitalisation also did not statistically differ by variants. These findings agree with a study from Denmark which also found no difference in severity. The Lancet – regional health Europe 24 June 2024

Estimated effectiveness of the BNT162b2 XBB vaccine against COVID-19
Findings of this case-control study reaffirm current recommendations for broad age-based use of annually updated COVID-19 vaccines given that (1) the BNT162b2 XBB vaccine provided statistically significant additional protection against a range of COVID-19 outcomes and (2) older versions of COVID-19 vaccines offered little, if any, long-term protection, including against hospital admission, regardless of the number or type of prior doses received. JAMA 24 June 2024

Cannabis, tobacco use, and COVID-19 outcomes
The findings of this cohort study suggest that cannabis use may be an independent risk factor for COVID-19–related complications, even after considering cigarette smoking, vaccination status, comorbidities, and other risk factors. JAMA 21 June 2024 

Efficacy thresholds and target populations for antiviral COVID-19 treatments to save lives and costs: a modelling study
For a sufficiently efficacious antiviral treatment, expanding the target population to include both high-risk and moderate-risk groups should be considered. Equitable treatment costs are found crucial in achieving the best possible public health and health economic outcomes. eClinicalMedicine 20 June 2024

The long Pentraxin PTX3 serves as an early predictive biomarker of co-infections in COVID-19
PTX3 is a promising predictive biomarker for early identification and risk stratification of patients with COVID-19 and co-infections. eBioMedicine 20 June 2024

Human SARS-CoV-2 challenge uncovers local and systemic response dynamics
The findings, showed that high expression of a gene called HLA-DQA2 before exposure was associated with preventing sustained infection. The authors said that better understanding of the full range of immune responses could help in developing potential treatments and vaccines that mimic natural protective responses.. Nature 19 June 2024

Occurrence of new or more severe headaches following COVID-19 is associated with markers of microglial activation and peripheral sensitization: results from a prospective cohort study
This study provides evidence that worsened or new headaches following COVID-19 are associated with pro-(neuro-)inflammatory profiles. This supports the use of anti-inflammatory treatment options in this population, especially in the subacute phase. Journal of headache and pain 19 June 2024 

T cell hybrid immunity against SARS-CoV-2 in children: a longitudinal study
Children, previously primed with a Spike-based mRNA vaccine and experiencing either symptomatic or asymptomatic breakthrough infection, retained the ability to enhance and diversify Th1/IL-10 antigen-specific T cell responses against multiple SARS-CoV-2 proteins. These findings mirror characteristics associated with hybrid cellular immunity in adults, known to confer resistance against severe COVID-19. eClinicalMedicine 18 June 2024

Prediction of short-term progression of COVID-19 pneumonia based on chest CT artificial intelligence: during the Omicron epidemic
This novel combined model, fusing quantitative CT features with clinical characteristics, demonstrated effective prediction of COVID-19 pneumonia progression from 2 weeks to 1 month after admission. This comprehensive model can potentially serve as a valuable tool for clinicians to develop personalized treatment strategies and improve patient outcomes. BMC infectious diseases 17 June 2024

Epidemiologic features of recovery from SARS-CoV-2 infection
In this cohort study, more than 1 in 5 adults did not recover within 3 months of SARS-CoV-2 infection. Recovery within 3 months was less likely in women and those with preexisting cardiovascular disease and more likely in those with COVID-19 vaccination or infection during the Omicron variant wave. JAMA 17 June 2024

Emergency department presentations in Queensland by First Nations people, remote residents, and young children during the COVID‐19 pandemic, 2020: interrupted time series analysis
The authors examined ED presentations in Queensland during the initial 16 months of the COVID‐19 pandemic. Given concerns about the longer term impact of COVID‐19 on the health of children, especially those experiencing adversity, public health responses that take a community child health approach should be considered. MJA 17 June 2024

Low-dose Corticosteroids for critically ill adults with severe pulmonary infections: A review
Treatment with low-dose corticosteroids is associated with decreased mortality for patients with severe COVID-19 infection, severe community-acquired bacterial pneumonia, and moderate to severe Pneumocystis pneumonia (for patients with HIV). Low-dose corticosteroids may also benefit critically ill patients with respiratory infections who have septic shock, acute respiratory distress syndrome, or both. JAMA 12 June 2024

miRNome profiling of extracellular vesicles in severe COVID-19 patients and identification of predictors of mortality
This research provides insights into the role of miRNAs found within Extracellular vesicles (EVs) in severe COVID-19 and their potential as clinical biomarkers for mortality. Journal of infectious diseases 12 June 2024

Immunogenicity and safety of beta variant COVID-19 vaccine AZD2816 and AZD1222 (ChAdOx1 nCoV-19) as primary-series vaccination for previously unvaccinated adults in Brazil, South Africa, Poland, and the UK: a randomised, partly double-blinded, phase 2/3 non-inferiority immunobridging study
Primary series of AZD1222 and AZD2816 were well tolerated, with no emergent safety concerns. Both vaccines elicited robust immunogenicity against beta and ancestral SARS-CoV-2 with greater responses demonstrated when testing against SARS-CoV-2 strains that matched those targeted by the respective vaccine. These findings demonstrate the continued importance of ancestral COVID-19 vaccines in protecting against severe COVID-19 and highlight the feasibility of using the ChAdOx1 platform to develop COVID-19 vaccines against future SARS-CoV-2 variants. The Lancet microbe 12 June 2024

COVID-19 vaccine side effects and long-term neutralizing antibody response: A prospective cohort study
Convergent self-report and objective biometric findings indicate that short-term systemic side effects of SARS-CoV-2 mRNA vaccination are associated with greater long-lasting nAB responses. This may be relevant in addressing negative attitudes toward vaccine side effects, which are a barrier to vaccine uptake. Annals of internal medicine 11 June 2024

Reduced numbers of elective joint replacement procedures in Australia during the COVID‐19 pandemic, 2020–2022: a registry data analysis study
The number of elective joint replacement procedures performed in Australia has declined substantially since the onset of the COVID‐19 pandemic. Public sector patients have been disproportionately affected. A national approach to reducing waiting time for public elective joint replacements is urgently needed. MJA 10 June 2024

Durability of immunity and clinical protection in nursing home residents following bivalent SARS-CoV-2 vaccination
The level of protection declined after bivalent vaccination over a 6 month period and may open a window of added vulnerability before the next updated vaccine becomes available, suggesting a subset of nursing home residents may benefit from an additional vaccination booster. eBioMedicine 10 June 2024

Severe pediatric neurological manifestations with SARS-CoV-2 or MIS-C hospitalization and new morbidity
These findings suggest that patients under 18 years with a SARS-CoV-2–related hospitalization who experience severe neurological manifestations should be evaluated for new morbidity. JAMA 10 June 2024

Nirmatrelvir-Ritonavir and symptoms in adults With Postacute Sequelae of SARS-CoV-2 infection: The STOP-PASC randomized clinical trial
The results of this randomized clinical trial showed that a 15-day course of nirmatrelvir-ritonavir (NMV/r) in a population of patients with postacute sequelae of SARS-CoV-2 infection (PASC) was generally safe but did not demonstrate a significant benefit for improving select PASC symptoms in a mostly vaccinated cohort with protracted symptom duration. Further studies are needed to determine the role of antivirals in the treatment of PASC. JAMA 7 June 2024

Antibody and T-cell response to bivalent booster SARS-CoV-2 vaccines in people with compromised immune function (COVERALL-3)
Bivalent mRNA vaccination elicited a robust humoral response in individuals with HIV or solid organ transplants, with delayed responses in lung transplant recipients. Despite a waning effect, antibody levels remained high at 6 months and adverse events were rare. Journal of infectious diseases 7 June 2024

A robust SARS-CoV-2-specific T and B Cell response is associated with early viral clearance in SARS-CoV-2 Omicron-infected immunocompromised individuals
An early robust adaptive immune response is vital for efficient viral-clearance and associated with less emergence of mAb-resistance-associated mutations in Omicron-infected immunocompromised patients. This emphasizes the importance of early SARS-CoV-2-specific T- and B-cell responses and thereby provides a rationale for development of novel therapeutic approaches. Journal of infectious diseases 6 June 2024

The kinetics and durability of antibody and T-cell responses to SARS-CoV-2 in children
This data reveal durable, age-independent T-cell immunity to SARS-CoV-2 structural proteins in children over time following COVID-19 infection as well as S-Ab responses overall, in comparison to declining antibody responses to N. Journal of infectious diseases 5 June 2024 

Pharmacokinetics and safety of Remdesivir in pregnant and non-pregnant women with COVID-19: Results from IMPAACT 2032
Plasma remdesivir PK parameters were comparable between pregnant and non-pregnant women, and no safety concerns were identified based on our limited data. These findings suggest no dose adjustments are indicated for intravenous remdesivir during pregnancy. Journal of infectious diseases 5 June 2024

Cardiovascular outcomes for people hospitalised with COVID‐19 in Australia, and the effect of vaccination: an observational cohort study
The known: Information regarding the frequency of cardiovascular events in people hospitalised with COVID‐19, and the impact of vaccination, is limited.
The new: Troponin levels were elevated in 37% of patients with COVID‐19 assessed during admission to one of 21 Australian hospitals, but cardiovascular outcomes were infrequent and not influenced by vaccination. Those who had received one or more COVID‐19 vaccine doses were less likely to die in hospital or to be intubated.
The implications: There risk of cardiovascular events for people hospitalised with COVID‐19 is small but clinically significant. Our findings highlight the value of COVID‐19 vaccination for reducing in‐hospital mortality. BMJ 3 June 2024

Eosinophils and chronic obstructive pulmonary diseases (COPD) in hospitalized COVID-19 patients
This study demonstrated that reduced peripheral blood eosinophil levels in COPD patients with COVID-19 correlate with unfavorable outcomes. Understanding this association can help us identify high-risk COPD patients and take appropriate management strategies to improve their prognosis. BMC infectious diseases 3 June 2024

Associations between BMI and hospital resource use in patients hospitalised for COVID-19 in England: a community-based cohort study
Patients admitted to hospital with COVID-19 with a BMI above the healthy range had longer stays, were more likely to be admitted to ICU, and had higher health-care costs associated with hospital treatment of COVID-19 infection as a result. This information can inform national resource allocation to match hospital capacity to areas where BMI profiles indicate higher demand. The Lancet diabetes and endocrinology 3 June 2024

Clinical outcomes after admission of patients with COVID-19 to skilled nursing facilities
his cohort study suggests that admission of COVID-19–positive patients into SNFs early in the pandemic was associated with preventable COVID-19 cases and mortality among residents, particularly in facilities with potential staff and personal protective equipment (PPE) shortages. The findings speak to the importance of equipping skilled nursing facilities (SNFs) to adhere to infection-control best practices as they continue to face COVID-19 strains and other respiratory diseases. JAMA 3 June 2024

FLiRT-ing with bird flu – the latest on both viruses
Insight+ explores the new COVID-19 subvariant FLiRT, vaccine efficacy and concerns about the new outbreak of avian flu in Australia with Director of Infectious Diseases at Mater Hospital, Associate Professor Paul Griffin. MJA insite 3 June 2024

Household transmission and clinical features of SARS-CoV-2–positive and –negative respiratory tract infections
These findings demonstrate that SARS-CoV-2 Omicron viruses spread more effectively within households compared to other respiratory infections. Journal of infectious disease 31 May 2024

Outcomes of SARS-CoV-2 and seasonal viruses among 2 million adults hospitalized for severe acute respiratory infection during the COVID-19 pandemic in Brazil
In this large cohort study, individuals infected with SARS-CoV-2 or adenovirus had the highest risk of mortality. Irrespective of the virus type, older age, male sex, comorbidities, hospitalization in vulnerable regions, and low oxygen saturation were associated with an increased risk of fatality. Journal of infectious disease 31 May 2024

COVID-19 vaccination and cardiopulmonary events after acute coronary syndromes: A secondary analysis of a randomized clinical trial
In this secondary analysis of a randomized clinical trial, patients who received at least 1 COVID-19 vaccine dose after Acute Coronary Syndromes (ACS) had similar rates of the primary composite end point and major adverse cardiovascular events (MACE)  compared with unvaccinated patients. However, retrospective studies have demonstrated a short-term reduction in MACE risk after COVID-19 vaccination. JAMA 30 May 2024

Relative efficacy of masks and respirators as source control for viral aerosol shedding from people infected with SARS-CoV-2: a controlled human exhaled breath aerosol experimental study
These results suggest that N95 respirators could be the standard of care in nursing homes and healthcare settings when respiratory viral infections are prevalent in the community and healthcare-associated transmission risk is elevated. eBioMedicine 29 May 2024

Durability of XBB.1.5 vaccines against Omicron subvariants
Overall, the XBB.1.5 vaccines were effective against omicron subvariants, although less so against JN.1. The effectiveness was greater against hospitalization and death than against infection, and it waned moderately from its peak over time. The ramping and waning patterns were broadly similar to those of the bivalent boosters against BQ.1–BQ.1.1 and XBB–XBB.1.5.3 It would be worthwhile to develop and deploy new vaccines targeting JN.1 or future strains. NEJM 29 May 2024

Early trajectories of virological and immunological biomarkers and clinical outcomes in patients admitted to hospital for COVID-19: an international, prospective cohort study
Patients admitted to hospital with less favourable 5-day biomarker trajectories had worse prognosis, suggesting that persistent viral burden might drive inflammation in the pathogenesis of COVID-19, identifying patients that might benefit from escalation of antiviral or anti-inflammatory treatment. The Lancet microbe 27 May 2024

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort study
In patients with COVID-19-associated venous thromboembolism (VTE) who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. eClinicalMedicine 25 May 2024 

Rural healthcare workforce preparation, response, and work during the COVID-19 pandemic in Australia: Lessons learned from in-depth interviews with rural health service leaders.
Highlights

  • Local community involvement is crucial for effective pandemic management in rural areas. 
  • Need for rurally relevant pandemic information and management that is not “metro-centric”.
  • Workforce surges and redeployment substantially impacted an already overstretched rural workforce.
  • Effective leadership strategies for decisive coordination of the pandemic response were crucial.
  • Reduction in services was detrimental to more vulnerable members of the community.

Health policy 24 May 2024

Association between acquiring SARS-CoV-2 during pregnancy and post-acute sequelae of SARS-CoV-2 infection: RECOVER electronic health record cohort analysis
SARS-CoV-2 infection acquired during pregnancy was associated with lower risk of development of post-acute sequelae of SARS-CoV-2 infection (PASC) at 30–180 days after incident SARS-CoV-2 infection in this nationally representative sample. These findings may be used to counsel pregnant and pregnant capable individuals, and direct future prospective study. eClinicalMedicine 24 May 2024

SARS-CoV-2 viral load in the Nasopharynx at time of first infection among unvaccinated Individuals
The findings of this study suggest that caution should be exercised in the use of individual-level viral load in comparisons across trials and/or settings and as a surrogate for COVID-19 severity, especially given increasing diversity in preexisting immunity. JAMA 23 May 2024

Summary of WHO infection prevention and control guideline for covid-19: striving for evidence based practice in infection prevention and control
What you need to know

  • WHO has published an updated guideline for infection prevention and control in the context of covid-19
  • In the healthcare facility, WHO recommends consistent application of standard and transmission based precautions to prevent SARS-CoV-2 transmission
  • In community settings, WHO recommends mitigation measures to reduce the risk of SARS-CoV-2 transmission and its impact

BMJ 22 May 2024

SARS-CoV-2–induced Angioedema—A novel case report
The authors present a case of a 61-year-old hypertensive woman who developed angioedema during a COVID-19 infection. She presented with tongue and lip swelling, as well as difficulty breathing. Flexible nasolaryngoscopy revealed edema in the uvula, epiglottis, and bilateral arytenoids, indicating a potential airway compromise. The patient received intravenous methylprednisolone, epinephrine, and antihistamines, leading to improvement and resolution of the angioedema and hypoxemia. This case adds to the limited literature on angioedema associated with COVID-19 and highlights the possible link between SARS-CoV-2 and angiotensin-converting enzyme 2. Annals of internal medicine  - clinical cases 21 May 2024

Health care personnel workdays lost and direct health care salary costs incurred due to COVID-19 infection in the age of widespread vaccine availability
Health care workdays lost remain a significant issue and are associated with health care system burden despite vaccine availability. These can be mitigated via targeted implementation of vaccine programs. Seasonal variation in health care workdays lost should inform workforce planning to accommodate surge periods. The journal of infectious diseases 21 May 2024

Long COVID definitions and models of care: A scoping review
Definitions of long COVID and care models are evolving. Research is needed to optimize models and evaluate outcomes of different models. Annals of internal medicine 21 May 2024

Long COVID: The enduring pandemic
Four years ago, a novel coronavirus overwhelmed hospitals and disrupted society, leaving some survivors—most of whom did not have severe acute illness—with persistent and disabling symptoms. Many patients turned into citizen scientists, advocating for recognition amidst a fractured health system struggling to address their diverse, complex, and unexplained symptoms. Today, long COVID is the enduring pandemic. Annals of internal medicine 21 May 2024

The importance of including Long COVID outcomes when developing novel treatments for acute COVID-19
This manuscript reviews the current landscape of acute COVID-19 treatments and highlights the opportunity to incorporate Long COVID as a key outcome measure in clinical trials. Journal of infectious diseases 20 May 2024

Matched vs nonmatched placebos in a randomized trial of COVID-19 treatments
In this post hoc study of a randomized clinical platform trial, pooling matched and nonmatched placebo patient data did not lead to inconsistencies in treatment effect estimation for any of the investigational drugs. These findings may have significant implications for future platform trials, as the use of nonmatched placebo may improve statistical power, or reduce barriers to placebo implementation. JAMA 20 May 2024

Updated PBS criteria for oral COVID-19 antivirals
On 1 March 2024, changes were made to the PBS eligibility criteria for the oral COVID-19 treatments Paxlovid® (nirmatrelvir and ritonavir) and Lagevrio® (molnupiravir). PBS now requires Paxlovid to be used as the first-line oral antiviral treatment option for COVID-19 in high-risk, adult patients at risk of hospitalisation or death, unless contraindicated. MJA insight 20 May 2024

Clinical coding of long COVID in primary care 2020–2023 in a cohort of 19 million adults: an OpenSAFELY analysis
In this descriptive study, Electronic Health Records (EHRs) recorded long COVID was very low between 2020 and 2023, and incident records of long COVID declined over 2022. Using EHR diagnostic or referral codes unfortunately has major limitations in identifying and ascertaining true cases and timing of long COVID. eClinicalMedicine 17 May 2024

The risk of SARS-CoV-2 transmission in community indoor settings: A systematic review and meta-analysis
The risk of SARS-CoV-2 transmission was highest in indoor settings where singing and exercising occurred. Effective mitigation measures such as assessing and improving ventilation should be considered to reduce the risk of transmission in high-risk settings. Future studies should systematically assess and report the host, viral, and setting-specific characteristics that may modify the transmission risks of SARS-CoV-2 and other respiratory viruses in indoor environments. Journal of infectious diseases 16 May 2024

The impact of the COVID-19 pandemic on calls to an alcohol and drug helpline in Victoria, Australia, for alcohol, methamphetamine and cannabis use concerns
In the first 6 months of the pandemic, frequency of alcohol-related calls increased over time, and first-time alcohol-related callers increased. The number of calls for cannabis and methamphetamine remained stable. Results suggest the helpline was not used to its full capacity, suggesting a role for further promotion during times of crises. Drug and alcohol review 15 May 2024

Relative vaccine protection, disease severity, and symptoms associated with the SARS-CoV-2 omicron subvariant BA.2.86 and descendant JN.1 in Denmark: a nationwide observational study
Compared with other SARS-CoV-2 variants, BA.2.86 and the JN.1 sublineage were less sensitive to vaccine-induced immune protection from the XBB.1.5 updated COVID-19 vaccine; however, we found no evidence that infection with BA.2.86 or JN.1 resulted in increased disease severity or different symptom profiles. Although less effective against the new variants, XBB.1.5 vaccination remains protective and reduces the risk of infection and COVID-19 disease. The Lancet infectious diseases 15 May 2024

What do we know about covid-19’s effects on the brain?
Covid may be primarily a respiratory infection, but a common symptom is “brain fog”—problems with memory or concentration—which can persist for weeks or months as part of long covid. And it’s not the only neurological effect. BMJ 15 May 2024

Mortality in patients hospitalized for COVID-19 vs Influenza in fall-winter 2023-2024
In the first year of the COVID-19 pandemic, risk of death in people hospitalized for COVID-19 was substantially higher than in people hospitalized for seasonal influenza. The risk of death due to COVID-19 has since declined. In fall-winter 2022-2023, people hospitalized for COVID-19 had a 60% higher risk of death compared with those hospitalized for seasonal influenza. JAMA 15 May 2024

Longitudinal analysis of nursing home residents’ T cell responses after SARS-CoV-2 mRNA vaccinations shows influence of biological sex and SARS-CoV-2 infection history
The authors show that prior SARS-CoV-2 infection and female sex contribute to higher T cell response in nursing home residents (NHR) but not healthcare workers (HCW). When looking across time points, NHR but not HCW with prior infection had significantly higher T cell responses than infection-naive subjects. These patterns of response were maintained across multiple booster vaccinations and suggest that the age, multimorbidity, and/or frailty of the NHR cohort may accentuate sex and infection status differences in T cell response to mRNA vaccination. Journal of infectious diseases 14 May 2024

COVID-19 hospitalization, mortality and pre-mature mortality by a history of immigration in Ontario, Canada: a population-based cohort study
Immigrants, particularly refugees, experienced greater premature mortality. aRRs for most immigrant groups dropped substantially after high vaccine coverage was achieved. Vaccine outreach and improvements in the social determinants of health are needed. The Lancet – regional health Americas 13 May 2024

Work and vocational rehabilitation for people living with long covid
What you need to know

  • Support patients to assess their current abilities at work compared with what they could do previously; they don’t need to be 100% well to start the process of returning to work
  • Going back to work too early after acute illness may be counterproductive; patients should not make hasty decisions around resignation or retirement in the early stages
  • Use the fit note to help someone return to work, emphasising the need for flexibility to accommodate day-to-day fluctuations

BMJ 10 May 2024

The COVID-19 pandemic period, SARS-CoV-2 infection, and perinatal health
This study adds to understanding of the associations between COVID-19 and perinatal health in a large, diverse population by distinguishing the connections of SARS-CoV-2 infection from those of the COVID-19 pandemic period with preterm birth (PTB) and birth parent conditions. The findings suggest that SARS-CoV-2 infection was associated with increased PTB, hypertensive disorders of pregnancy (HDP), and severe maternal morbidity (SMM), consistent with other studies. JAMA 9 May 2024

Brain abnormalities in survivors of COVID-19 after 2-year recovery: a functional MRI study
This long-term study suggests that individuals recovering from COVID-19 continue to experience cognitive complaints, psychiatric and neurological symptoms, and brain functional alteration. The rs-fMRI results indicated that the changes in brain function in regions such as the putamen, temporal lobe, and superior parietal gyrus may contribute to cognitive complaints in individuals with long COVID even after 2-year infection. The Lancet – Western Pacific 9 May 2024

Risk of severe acute respiratory syndrome Coronavirus 2 infection following prior infection or vaccination
During the initial year of Omicron, prior infection and vaccination both offered protection against new infection. However, remote prior infection was less protective than remote vaccination for individuals aged ≥60 years. In older adults, immunity gained from vaccination appeared more durable than immunity gained from infection. Journal of infectious diseases 8 May 2024

Immunogenicity of third dose COVID-19 vaccine strategies in patients who are immunocompromised with suboptimal immunity following two doses (OCTAVE-DUO): an open-label, multicentre, randomised, controlled, phase 3 trial
A third vaccine dose improved the serological and T-cell response in the majority of patients who are immunocompromised. Individuals with chronic renal disease, lymphoid malignancy, on B-cell targeted therapies, or with no serological response after two vaccine doses are at higher risk of poor response to a third vaccine dose. The Lancet rheumatology 8 May 2024

Informing the need for a SARS-CoV-2 booster based upon the immune responses among young healthy adults to variants circulating in late 2023
Administration of the XBB.1.5-based booster is likely to enhance cross-reactive humoral responses against SARS-CoV-2 circulating lineages. Ongoing surveillance of immune responses to emerging variants is needed for informing vaccine composition and timing. Journal of infectious diseases 8 May 2024

Why WHO changed the definition of “airborne transmission” in the wake of the pandemic
After the confusion of 2020, WHO has finally changed its definition of how diseases can spread through the air. But what is the new definition—and what needs to happen next? BMJ 7 May 2024

Comparison of safety and efficacy between Nirmatrelvir-ritonavir and molnupiravir in the treatment of COVID-19 infection in patients with advanced kidney disease: a retrospective observational study
Patients with COVID-19 with advanced kidney disease receiving nirmatrelvir-ritonavir had a lower rate of all-cause mortality and hospital admission when compared with molnupiravir. Other adverse clinical outcomes were similar in both treatment groups. eClinicalMedicine 3 May 2024

Association of nirmatrelvir–ritonavir with post-acute sequelae and mortality in patients admitted to hospital with COVID-19: a retrospective cohort study
This study showed extended benefits of nirmatrelvir–ritonavir for reducing the risk of post-acute inpatient death as well as cardiovascular and respiratory complications among patients admitted to hospital with COVID-19. Further research is essential to uncover the underlying mechanisms responsible for these observed negative associations and to devise effective strategies for preventing the onset of post-acute sequelae. The Lancet infectious diseases 3 May 2024

Effectiveness of the fourth dose of COVID-19 vaccines against severe COVID-19 among adults 40 years or older in Brazil: a population-based cohort study
In a heterogeneous scenario of primary and first booster vaccination combinations, a fourth dose provided meaningful and durable protection against severe COVID-19 outcomes. Compared to adenovirus-based booster, a fourth dose wild-type mRNA vaccine was associated with immediate lower hazards of hospitalization or death unsustained after 120 days. The Lancet – Regional health - Americas 3 May 2024

Association of antenatal or neonatal SARS-COV-2 exposure with developmental and respiratory outcomes, and healthcare usage in early childhood: a national prospective cohort study
Although the exposed cohort did not differ from the comparison cohort on the primary outcome, total ASQ-3 score, the exposed cohort were at greater risk of delayed social-emotional development, had a greater prevalence of respiratory symptoms and increased health care usage relative to the comparison cohort. The study is limited by the smaller sample size due to the low response rate and lack of clinical developmental assessments. Given the association of poor social-emotional development with antenatal or neonatal SARS-CoV-2 exposure, developmental screening, and follow-up of children with confirmed antenatal or neonatal SARS-CoV-2 infection may be warranted to identify those in need of early intervention. eClinicalMedicine 3 May 2024

Safety, tolerability, viral kinetics, and immune correlates of protection in healthy, seropositive UK adults inoculated with SARS-CoV-2: a single-centre, open-label, phase 1 controlled human infection study
This study demonstrates potent protective immunity induced by homologous vaccination and homologous or heterologous previous SARS-CoV-2 infection. The community breakthrough infections seen with the omicron variant supports the use of newer variants to establish a model with sufficient rate of infection for use in vaccine and therapeutic development. The Lancet microbe 1 May 2024

What do we know about covid-19’s effects on the gut?
Not just a respiratory infection, covid can cause symptoms throughout the body. Gastrointestinal symptoms are common in both acute and long covid, with gut issues often persisting long after initial infection. BMJ 1 May 2024

Machine learning to understand risks for severe COVID-19 outcomes: a retrospective cohort study of immune-mediated inflammatory diseases, immunomodulatory medications, and comorbidities in a large US health-care system
These results suggest that age, chronic comorbidities, and not being fully vaccinated might be greater risk factors for severe COVID-19 outcomes in patients with immune-mediated inflammatory diseases (IMIDs) than the use of IMMs or the IMIDs themselves. Overall, there is a need to take age and comorbidities into consideration when developing COVID-19 guidelines for patients with IMIDs. Further research is needed for specific IMIDs (including IMID severity at the time of SARS-CoV-2 infection) and IMMs (considering dosage and timing before a patient's first COVID-19 infection). The Lancet digital health 1 May 2024

Data challenges for international health emergencies: lessons learned from ten international COVID-19 driver projects
This Health Policy paper focuses on the challenges and lessons learned from ten of the International COVID-19 Data Alliance (ICODA) driver projects, involving researchers from 19 countries and a range of health-related datasets. The Lancet digital health 1 May 2024

Monkeypox

Updated 27 March  2024

Department of Health and Aged Care – health alert – Monkeypox (MPX) resources 

SA Health – health alert – Monkeypox

UpToDate – Monkeypox  if accessing outside of SA Health computer network use your library login

Monkeypox Resources for Health Professionals (Wolters Kluwer)

Monkeypox Resource Centre (JAMA)

World Health Organization Health alert

Journal articles

Intriguing insight into unanswered questions about Mpox: exploring health policy implications and considerations
The 2022 multi-country Monkeypox (Mpox) outbreak has added concerns to scientific research. However, unanswered questions about the disease remain. These unanswered questions lie in different aspects, such as transmission, the affected community, clinical presentations, infection and prevention control and treatment and vaccination. It is imperative to address these issues to stop the spread and transmission of disease. We documented unanswered questions with Mpox and offered suggestions that could help put health policy into practice. One of those questions is why gay, bisexual or other men who have sex with men (gbMSM) are the most affected community, underscoring the importance of prioritizing this community regarding treatment, vaccination and post-exposure prophylaxis. In addition, destigmatizing gbMSM and implementing community-based gbMSM consultation and action alongside ethical surveillance can facilitate other preventive measures such as ring vaccination to curb disease transmission and track vaccine efficacy. Relevant to that, vaccine and drug side effects have implied the questionability of their use and stimulated the importance of health policy development regarding expanded access and off-label use, expressing the need for safe drug and vaccine development manufacturing. The possibility of reverse zoonotic has also been raised, thus indicating the requirement to screen not only humans, but also their related animals to understand the real magnitude of reverse zoonosis and its potential risks. Implementing infection prevention and control measures to stop the virus circulation at the human–animal interface that includes One Health approach is essential. Health research policy and systems 22 March 2024

Sources of information on monkeypox virus infection. A systematic review with meta-analysis
The study suggests that people access a variety of information sources to gain knowledge about Mpox virus infection, with a strong emphasis on online sources such as social networks and the Internet. However, it is important to note that the quality and accuracy of information available from these sources can vary, underscoring the need to promote access to reliable and up-to-date information about this disease to ensure public health. BMC public health 24 January 2024

Pathology and monkeypox virus localization in tissues from immunocompromised patients with severe or fatal mpox
Severe mpox in immunocompromised patients is characterized by extensive viral infection of tissues and viremic dissemination that can progress despite available therapeutics. Digestive tract and lung involvement are common and associated with prominent histopathological and clinical manifestations. Coinfections may complicate mpox diagnosis and treatment. Significant viral DNA (likely correlating to infectious virus) in tissues necessitates enhanced biosafety measures in healthcare and autopsy settings. Journal of infectious diseases 18 January 2024

Early Tecovirimat treatment for Mpox Disease among people with HIV
Results of this cohort study support starting tecovirimat in all people with HIV (PWH) as soon as an mpox diagnosis is suspected. Additional research is warranted to confirm these findings. JAMA 8 January 2024

Lessons from the Mpox response
The last few years have been remarkable in how infectious diseases have taken a toll. The lesson from the mpox response is clear: community engagement and flexibility of response are necessary as well as the existing public health infrastructure that can be deployed to manage outbreaks. Medical countermeasures are key, but so are community partnerships, flexibility, and persistence. That is how infectious disease outbreaks should be managed now and in the future. JAMA 8 January 2024

Prevalence of intentions to receive monkeypox vaccine. A systematic review and meta-analysis
The study highlights the importance of recognizing regional and subgroup disparities in Mpox vaccine willingness and refusal. It emphasizes the importance of employing strategies to achieve widespread vaccination coverage and safeguard public health worldwide. BMC public health 2 January 2024

Time series analysis and short-term forecasting of monkeypox outbreak trends in the 10 major affected countries
This research provides profile of ten most severely hit countries by monkeypox transmission around the world and thus assists in epidemiological management. The prediction trends indicate that the confirmed cases in the USA may exceed than other contemporaries. Based on the findings of this study, it remains plausible to recommend that more robust health surveillance strategy is required to control the transmission flow of the virus especially in USA. BMC infectious diseases 2 January 2024

Antibody Titers against Mpox Virus after vaccination
These findings provide data for policymakers in case of mpox resurgence and the need for reinvigorated education and vaccination campaigns. The authors observed similar MPXV immunogenicity regardless of the vaccination route or HIV status. The IgG data through 3 months suggest a need for studies to determine whether booster vaccination may be needed for longer-term immunity and the correlation of the antibody titer with vaccine protection. NEJM 14 December 2023

Successful treatment of recalcitrant Mpox lesions with Intralesional Cidofovir in a patient with HIV/AIDS
Increased efficacy with intralesional treatment may stem from higher concentrations of cidofovir in affected skin vs that achieved with systemic agents, particularly in this patient reliant on direct medication effects with minimal immune assistance. The authors hope this strategy will be useful to others as they approach similarly recalcitrant lesions or patients with risk of toxic effects from systemic cidofovir. JAMA 6 December 2023

The diagnostic dilemma for atypical presentation of progressive human Mpox
Suspicion for human mpox should be high in young men who have sex with men (MSM) and persons living with HIV (PLHIV) who present with rash and mpox should be ruled out earlier. BMC infectious diseases 5 December 2023

Preparing for mpox resurgence: Surveillance lessons from outbreaks in Toronto, Canada
This investigation demonstrates the importance of ongoing surveillance and preparedness for mpox outbreaks. Undetected local transmission was not a likely source of the 2022-2023 resurgence. Ongoing pre-exposure vaccine promotion remains important to mitigate disease burden. Journal of infectious diseases 30 November 2023

Prolonged mpox disease in people with advanced HIV: characterization of mpox skin lesions
The authorsreport three complicated and prolonged cases of mpox in people with advanced HIV not on antiretroviral therapy (ART) at mpox diagnosis. Multiple medical countermeasures were used, including prolonged tecovirimat treatment and immune optimization with ART initiation. Immunofluorescence of skin biopsies demonstrated a dense immune infiltrate of predominantly myeloid and CD8+ T-cells, with a strong type-I interferon local response. RNAscope detected abundant replication of monkeypox virus (MPXV) in epithelial cells and dendritic cells. These data suggest that prolonged mpox in people with advanced HIV may be due to ongoing MPXV replication, warranting aggressive medical countermeasures and immune optimization. Journal of infectious diseases 29 November 2023

Healthcare personnel exposure risk assessment and management during a Mpox outbreak in Chicago, Illinois, May 17-July 8, 2022
This report summarizes risk assessment interviews and follow up with healthcare personnel (HCP) after exposure to patients with mpox disease during May 17-July 8, 2022. HCP-case interactions were assessed using a standard questionnaire to categorize the risk associated with patient encounters. We assessed 150 interactions among 142 HCP and 30 cases. Four(2.7%) interactions were defined as high risk, 5(3.3%) intermediate, 107(71.3%) low, and 31(20.7%) no risk. High and intermediate exposures were offered post-exposure prophylaxis; four accepted. No documented mpox transmission after exposure was identified. These findings suggest transmission risk in healthcare settings during routine patient care is low. Journal of infectious diseases 29 November 2023

Associations between HIV and Severe Mpox in an Atlanta Cohort
People with HIV (PWH) with non-suppressed HIV viral loads had more mpox complications, hospitalizations, and protracted disease courses than people without HIV or PWH with suppressed viral loads. PWH with non-suppressed HIV viral loads who are diagnosed with mpox warrant particularly aggressive monitoring and treatment. Journal of infectious diseases 24 November 2023

Mpox knowledge, behaviours and barriers to public health measures among gay, bisexual and other men who have sex with men in the UK: a qualitative study to inform public health guidance and messaging
There are differential needs, preferences, and experiences of gay, bisexual, or other men who have sex with men (GBMSM) that limit the acceptability of some mitigation and prevention measures. Future public health interventions and campaigns should be co-designed in consultation with key groups and communities to ensure greater acceptability and credibility in different contexts and communities. BMC public health 17 November 2023

Mpox viral lineage analysis and technique development using next generation sequencing approach
The authors developed next generation sequencing (NGS) workflows to precisely detect and analyze Mpox viral clade and lineages and aid in genomic surveillance. Journal of infectious diseases 16 November 2023

Development and pilot of an Mpox severity scoring system (MPOX-SSS)
Clinical severity scores facilitate comparisons to understand risk factors for severe illness. For the 2022 multinational monkeypox Clade IIb virus outbreak, we developed a 7-item mpox severity scoring system (MPOX-SSS) with initial variables refined based on data availability and parameter correlation. Application of MPOX-SSS to the first 200 patients diagnosed with mpox revealed higher scores in those treated with tecovirimat, presenting >3 days after symptom onset and with CD4 counts <200 cells/mm3 . For individuals evaluated repeatedly, serial scores were concordant with clinical observations. The pilot MPOX-SSS demonstrated good discrimination, distinguished change over time, and identified higher scores in expected groups. Journal of infectious diseases 13 November 2023

Prior sexually transmitted infections and HIV in mpox patients, Chicago, Illinois—(June 2022–March 2023
HIV is associated with severe mpox. Sexually transmitted infections (STIs) could facilitate mpox transmission. The authors estimated HIV and STI frequency among patients with mpox, and compared characteristics associated with mpox severity. Mpox cases during June 1, 2022–March 31, 2023, were matched to Illinois HIV/AIDS surveillance data. Among 1,124 mpox patients, 489 (44%) had HIV and 786 (70%) had prior or concurrent STI; 307 (39%) had ≥3 STI episodes. More mpox patients living with HIV were hospitalized than without HIV (10.3% vs 4.1%, P <0.001). STI screening visits are opportunities to vaccinate against mpox and provide HIV prophylaxis or treatment. Journal of infectious diseases 8 November 2023

APOBEC3 deaminase editing in mpox virus as evidence for sustained human transmission since at least 2016
In March 2022, an international epidemic of human Mpox was detected, showing that it was not solely a zoonotic infection. A hallmark of the approximately 88,000 cases that have been reported were TC>TT and GA>AA mutations in Mpox viruses, which were acquired at a surprisingly high evolutionary rate for a pox virus. Knowing that these types of mutation are a sign of activity by a host antiviral enzyme called APOBEC3, O’Toole et al. investigated whether the mutations reflected human-to-human transmission rather than repeated zoonotic spillover. Bayesian evolutionary analysis showed that Mpox virus recently diversified into several lineages in humans that display elevated numbers of mutations, signaling APOBEC exposure and sustained human-to-human transmission rather than zoonosis as the source of new cases. Science 2 November 2023

Tzanck smear of Ulcerated Plaques
Tzanck smear is a useful technique that can be used to differentiate mpox from other infections at the bedside or in remote settings where PCR or additional culture techniques are not easily accessible. Infection prevention and control precautions are important to help prevent additional spread of this virus with sharp injuries, and caution with unroofing of the lesions is critical to avoid additional spread.7 Knowledge of the cytologic differences of mpox compared with other viral infections is important in the early recognition, diagnosis, and treatment of these patients. JAMA 25 October 2023

Detection of Mpox Virus using Microbial Cell-free DNA: the potential of Pathogen-Agnostic Sequencing for rapid identification of emerging pathogens
The authors demonstrate the potential of plasma mcfDNA sequencing to detect, quantify, and, for acute infections with high sequencing coverage, subtype MPXV using a single non-invasive test. Sequencing plasma mcfDNA may augment existing mpox testing in vulnerable patient populations or in patients with atypical symptoms or unrecognized mpox. Strain type information may supplement disease surveillance and facilitate tracking emerging pathogens. Journal of infectious diseases 12 October 2023

Effectiveness of Smallpox vaccination to prevent Mpox in military personnel
The authors conducted a retrospective, test-negative case–control study among current and former U.S. military personnel to determine the effectiveness of smallpox vaccines against mpox. Previous vaccination at a median of 13 years earlier with either a first- or second-generation smallpox vaccine reduced the likelihood of testing positive for orthopoxvirus among current or former military personnel for whom vaccination data were available. NEJM 21 September 2023

Mpox: Keep it on the differential
Key points:

  • In its worldwide outbreak in 2022, mpox was remarkably different from its historic profile, a viral zoonotic disease that inefficiently spread from person to person.
  • Mpox is currently primarily affecting men who have sex with men and is mainly transmitted through direct contact with an infectious lesion.
  • Clinicians should keep mpox in the differential diagnosis for single, multiple, or diffuse genital, anal, or skin lesions, as well as pharyngitis and proctitis.
  • Patients with suspected mpox should also be tested for sexually transmitted infections including human immunodeficiency virus (HIV), and should be offered HIV postexposure or preexposure prophylaxis and mpox vaccine if appropriate.

Cleveland journal of medicine 13 September 2023

Mpox
Mpox (formerly monkeypox) emerged as a global pandemic in 2022 with more than 80,000 cases diagnosed to date worldwide. This Interactive Perspective is designed to aid clinicians in understanding the disease transmission, recognizing clinical signs, and treating mpox effectively. NEJM 7 September 2023

Breakthrough mpox despite two‐dose vaccination
Lessons from practice

  • Since May 2022, there has been a global outbreak of mpox, predominantly in gay, bisexual and other men who have sex with men.
  • Limited data exist for clinical vaccine effectiveness, but it has been estimated at about 85% after a full vaccination course.
  • Clinicians should be aware of the possibility of breakthrough infection, possibly of less severity and without typical constitutional symptoms, in patients with epidemiological risk factors and a characteristic vesiculopustular rash, irrespective of a history of previous vaccination.
  • Individuals at high risk should be offered vaccination, if not yet already received. These groups include gay, bisexual and other men who have sex with men; sex workers; and sexual partners of these groups.

MJA 4 September 2023

Sexual health doctors urge vigilance on mpox
Sexual health clinicians are urging GPs to keep an eye out for breakthrough mpox infection, even in vaccinated patients. MJA insight 4 September 2023

Mpox: China’s health authorities fight surge in cases of unknown origin
Chinese health authorities are facing an escalating outbreak of mpox where most cases are of unknown origin. A World Health Organization mpox situation report published on 14 August singled out “sustained community transmission in China” as driving the rise in cases in the region, which has bucked a broad global decline. BMJ 22 August 2023

Mpox and primary syphilis co‐infection in a newly arrived traveller from South America
Lessons from practice

  • Mpox, syphilis and genital herpes should be considered in at‐risk patients presenting with genital ulcers, as co‐infection may be present.
  • A detailed sexual and travel history is important to narrow down the differential diagnosis.
  • Careful examination and appropriate sampling for testing and consideration of presumptive treatment for syphilis and herpes simplex virus are crucial before isolation of the patient if mpox is suspected.
  • Information provision in the patients’ language and liaison with the public health unit is essential in contact tracing and provision of patient‐centred care for mpox.

MJA 7 August 2023

Tecovirimat resistance in an immunocompromised patient with Mpox and prolonged viral shedding
The objective of this paper is to describe the rapid selection of a tecovirimat-resistant MPXV variant during treatment of a severely immunocompromised patient with prolonged MPXV infection. Annals of internal medicine 25 July 2023

Vaccine effectiveness of JYNNEOS against Mpox disease in the United States
In this study using nationwide EHR data, patients with mpox were less likely to have received one or two doses of JYNNEOS vaccine than control patients. The findings suggest that JYNNEOS vaccine was effective in preventing mpox disease, and a two-dose series appeared to provide better protection. NEJM 29 June 2023

Monkeypox detection using deep neural networks
The DenseNet201 model outperforms the other models in terms of the confusion metrics, regardless of the scenario. One significant accomplishment of this study is the utilization of LIME and Grad-Cam to identify the affected areas and assess their significance in diagnosing diseases based on skin images. By incorporating these techniques, we enhance our understanding of the infected regions and their relevance in distinguishing Monkeypox from other similar diseases. Our proposed model can serve as a valuable auxiliary tool for diagnosing Monkeypox and distinguishing it from other related conditions. BMC infectious diseases 27 June 2023

WHO ends public health emergency designation for mpox
On 11 May 2023 the World Health Organization declared that the 2022-23 mpox epidemic was no longer a public health emergency of international concern (PHEIC). The decision, which followed the same announcement for covid-19 by only six days, is perhaps unsurprising; in most places new cases have tapered off, thanks to rapid vaccination and information campaigns. BMJ 5 June 2023

APOBEC3F is a mutational driver of the human Monkeypox virus identified in the 2022 outbreak
Stochastic or transient overexpression of APOBEC3F gene exposes the MPXV genome to a broad spectrum of mutations that may be modeling the mutational landscape after multiple cycles of viral replication. Journal of infectious diseases 24 May 2023

Vaccine effectiveness of JYNNEOS against Mpox disease in the United States
In this study using nationwide Epic electronic health record (EHR) data, patients with mpox were less likely to have received one or two doses of JYNNEOS vaccine than control patients. The findings suggest that JYNNEOS vaccine was effective in preventing mpox disease, and a two-dose series appeared to provide better protection. NEJM 18 May 2023

Short-term adverse events following immunization with modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine for Mpox
This post marketing study of adverse events following MVA-BN vaccination found that local adverse event rates were highest following intradermal administration. However, absolute event rates were lower than in previous studies, which reported more than 30% systemic adverse events following both routes and local adverse event rates of more than 50% following subcutaneous administration and nearly 100% following intradermal vaccination. This study also found a low percentage of people reporting medical review or missing daily activities, suggesting that the vaccine is generally well-tolerated. JAMA 5 May 2023

Stability and inactivation of monkeypox virus on inanimate surfaces
The spread of non-zoonotic monkeypox virus (MPXV) infections necessitates the re-evaluation of hygiene measures. To date, only limited data is available on MPXV surface stability. Here, the authors evaluate the stability of infectious MPXV on stainless steel stored at different temperatures, while using different interfering substances to mimic environmental contamination. MPXV persistence increased with decreasing temperature. Additionally, they were able to show that MPXV could efficiently be inactivated by alcohol- and aldehyde-based surface disinfectants. These findings underline the stability of MPXV on inanimate surfaces and supports the recommendations to use alcohol-based disinfectants as prevention measure or in outbreak situations. Journal of infectious diseases 2 May 2023

Tecovirimat treatment of people with HIV during the 2022 Mpox outbreak
In this cohort of patients treated with tecovirimat for severe mpox, HIV status did not seem to affect treatment outcomes. Annuals of internal medicine 2 May 2023

Severe mpox in persons with advanced HIV (UptoDate)
In patients with mpox, severe disease can occur in the context of advanced HIV infection. In a multisite study that included 382 patients with HIV and a CD4 count <350 cells/microL, 107 (28 percent) were hospitalized [16]. All 27 deaths occurred in people with CD4 counts of <200 cells/microL. Some developed widespread, large, necrotizing skin lesions and unusual nodular lung lesions. One-quarter of the 85 people who started or restarted antiretroviral therapy (ART) had suspected immune reconstitution inflammatory syndrome (IRIS). Clinicians should be aware of these clinical features so that appropriate treatment can be initiated. We do not delay ART, despite the potential for IRIS, given the importance of immune recovery. (See "Epidemiology, clinical manifestations, and diagnosis of mpox (monkeypox)", section on 'Complications in people with advanced HIV'.)

Impact of mpox virus infection on immune parameters of a female person with HIV receiving clinically effective antiretroviral therapy
The authors describe the immunologic and virologic impact of mpox infection in a female person with HIV whose plasma viremia was suppressed by clinically effective antiretroviral therapy. Extensive phenotypic analyses of B and T cells in peripheral blood and biomarkers in plasma showed significant immunologic perturbations despite the presence of mild mpox disease. Dramatic shifts were noted in the frequencies of total B cells, plasmablasts (PB), and PB immunoglobulin isotypes. Flow cytometric analyses showed a dramatic increase in the frequency of CD38+HLA-DR+ CD8+ cells following mpox. This data offer guidance for future studies involving mpox infection in affected populations. Journal of infectious diseases 6 April 2023

Time scales of human mpox transmission in the Netherlands
Mpox has spread rapidly to many countries in non-endemic regions. After reviewing detailed exposure histories of 109 pairs of mpox cases in the Netherlands, the authors identified 34 pairs where transmission was likely and the infectee reported a single potential infector with a mean serial interval of 10.1 days (95% CI: 6.6–14.7 days). Further investigation into pairs from one regional public health service revealed that pre-symptomatic transmission may have occurred in five out of eighteen pairs. These findings emphasize that precaution remains key, regardless of the presence of recognizable symptoms of mpox. Journal of infectious diseases 4 April 2023

Erythema and Induration after Mpox (JYNNEOS) vaccination revisited
In a trial of Mpox vaccine, intradermal administration led to more erythema and induration than the subcutaneous route but resulted in a similar level of immune response with 20 % of the dose NEJM 22 March 2023

Monkeypox epidemiology, clinical presentation, and transmission: a systematic review
Monkeypox human-to-human and human-to-animal transmission are rising. Thus, it is essential to do research on the prevention, clinicodemographic trends, and treatment of monkeypox. Understanding this will enable us to treat monkeypox patients with a targeted and focused approach International journal of emergency medicine 17 March 2023

Monkeypox (Mpox) and occupational exposure
The highest work-related risk for mpox transmission has been noted among healthcare professionals, people working with animals, and sex workers. There is general agreement that a paramount issue to avoid transmission of infection in occupational settings is an appropriate decontamination of often-touched surfaces and usage of appropriate personal protective equipment by the workers at high risk of infection. The group that should especially protect themselves and be educated in the field of early symptoms of the disease and prevention are dentists, who are often the first to detect the symptoms of the disease on the oral mucosa. International journal of environmental research and public health 14 March 2023

Therapeutics for treating mpox in humans
This review found no evidence from randomized trials from which to draw certain conclusions concerning the efficacy of therapeutics in humans with mpox. Cochrane Database of Systematic Reviews – Intervention 14 March 2023

Potential anti-mpox virus activity of atovaquone, mefloquine, and molnupiravir, and their potential use as treatments
These data suggest that atovaquone would be potential candidates for treating mpox. Journal of infectious diseases 9 March 2023

Severe corneal involvement associated with Mpox infection
Mpox keratitis is rare but potentially severe. Infection of the eyelids should be monitored because it can spread to the cornea afterwards. Corneal infection is very painful and evolves from the limbus centripetally with a pathognomonic arcuate serpiginous epithelial pattern. The role of antivirals remains to be determined. JAMA 9 March 2023

An Mpox-related death in the United States
In hospitalized patients with severe mpox, it is important to consider treatment with intravenous tecovirimat. Second-line therapies including cidofovir, brincidofovir, and vaccinia immune globulin may also be considered. If progressive or persistent lesions are present after 14 days of treatment with tecovirimat, pharmacokinetic testing of tecovirimat and testing of lesion specimens for antiviral resistance are warranted. Patients with low CD4+ T-cell counts who become infected with MPXV should be monitored closely, given the potential risk of more severe illness. NEJM 8 March 2023

Brief report: Monkeypox virus cross-neutralizing antibodies in clinical trial subjects vaccinated with Modified Vaccinia Virus Ankara Encoding MERS-Coronavirus Spike Protein
Modified vaccinia virus Ankara (MVA) is used as a vaccine against monkeypox virus (MPXV) and as a viral vaccine vector. MVA-MERS-S is a vaccine candidate against Middle East respiratory syndrome- associated coronavirus (MERS-CoV). Here, we report that cross-reactive MPXV nAbs were detectable in only a single subject after the first dose, 3 out of 10 after the 2nd dose, and in 10 out of 10 after the 3rd dose of MVA-MERS-S vaccine. Journal of infectious diseases 1 March 2023

Possibility of mpox viral transmission and control from high-risk to the general population: a modeling study
Mpox has high transmissibility in men who have sex with men (MSM), which required minimize the risk of infection and exposure to high-risk populations. Community prevention and control is the top priority of interventions to contain the spread of mpox. BMC infectious diseases 24 February 2023

Mpox in people with advanced HIV infection: a global case series
A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death. The Lancet 21 February 2023

Mpox—A rapidly evolving disease
This Special Communication provides an overview of the evolution of mpox skin findings from its initial description in humans in 1970 to the present-day multinational outbreak. JAMA 9 February 2023

Human monkeypox: diagnosis and management
What you need to know

  • Consider coinfections with monkeypox and other sexually transmitted infections among patients presenting with an acute rash or skin lesions and systemic symptoms
  • While it is safe to manage monkeypox patients virtually, they may need advice to maintain infection control measures and interventions to manage complications
  • A specialist infectious disease unit with access to novel antivirals such as tecovirimat and cidofovir should manage high risk patients
  • Healthcare workers should be aware of the stigma surrounding monkeypox, which may result in reduced health-seeking behaviours; healthcare staff should screen patients sensitively, using inclusive language to avoid alienating patients

BMJ 6 February 2023

Mpox vaccination encouraged ahead of World Pride
With upcoming World Pride events in Sydney, now is the perfect time to raise awareness and encourage vaccination against mpox. MJA InSight 30 January 2023

Use of wastewater for Mpox outbreak surveillance in California
Real-time results informed the state and local public health response, allowing for escalation of the state response level when detection in multiple watersheds suggested that MPXV was widespread or unexpected, alerting clinicians, and guiding the allocation of resources (e.g., testing, vaccines, and therapeutics) and personnel in affected areas. This experience in adapting routine wastewater-surveillance infrastructure to monitor for a nonenteric, nonrespiratory virus such as MPXV shows promise for the future use of this method as an adjunct public health tool. NEJM 18 January 2023

Real-time forecasting the trajectory of monkeypox outbreaks at the national and global levels, July–October 2022
The top-ranked model consistently predicted a decreasing trend in monkeypox cases on the global and country-specific scale during the last ten sequential forecasting periods. The findings reflect the potential impact of increased immunity, and behavioral modification among high-risk populations. BMC medicine 16 January 2023

MPXV transmission at a tattoo parlor
The authors describe cases of MPXV transmission that were likely to have occurred by means of direct inoculation from piercing and tattooing; such transmission has been observed with other poxviruses, such as Molluscum contagiosum. To date, sexual transmission of MPXV has been the most common mode of transmission, with men who have sex with men being disproportionately affected. In contrast, the cases in this report mostly involved female patients. MPXV may develop new networks of transmission, with epidemiologic changes of the disease. NEJM 5 January 2022

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SA Health Library Service 12/8/2022