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What's new in the medical literature

Updated 20 December 2024

UpToDate

Cochrane Library

MJA

MJA insight

BMJ

JAMA

NEJM

Other journals

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UpToDate

Association of hyponatremia correction rates with in-hospital mortality
In patients with severe, chronic hyponatremia (ie, serum sodium <120 mEq/L), the goal of initial therapy is to raise the serum sodium level slowly to avoid overcorrection. This recommendation was challenged by a meta-analysis of retrospective cohort studies that found that rapid correction of severe hyponatremia in hospitalized patients was associated with lower in-hospital mortality compared with slow correction [6]. However, the major limitation of this study is its analysis of all-cause in-hospital mortality rather than death from cerebral edema (the cause of death potentially caused by slower correction). We continue to suggest slow correction in patients with severe, chronic hyponatremia. (See "Overview of the treatment of hyponatremia in adults", section on 'Goal rate of correction'.)

Blood transfusion strategy in patients with moderate or severe traumatic brain injury (August 2024, Modified December 2024)
The optimal transfusion strategy for acute traumatic brain injury (TBI) is uncertain, but recent trials suggest possibly worse neurologic outcomes with a restrictive versus liberal strategy. (See "Management of acute moderate and severe traumatic brain injury".)

Diabetic ketoacidosis in pregnancy and severe maternal morbidity
Diabetic ketoacidosis (DKA) is a serious complication of pregnancy. Among nearly 400,000 pregnancies affected by pre-existing diabetes mellitus in a nationally representative United States database (2010-2020), the prevalence of DKA antepartum and at delivery hospitalization was approximately 3 and 1 percent, respectively [2]. Patients who had DKA during the delivery hospitalization had a much higher risk of nontransfusion severe maternal morbidity compared with patients with diabetes without DKA (21 versus 2 percent). Our approach to managing DKA in pregnancy is shown in the algorithm (algorithm 1). (See "Diabetic ketoacidosis in pregnancy", section on 'Epidemiology' and "Diabetic ketoacidosis in pregnancy", section on 'Outcome'.) 

Endobronchial valves for prolonged air leak in high-risk patients
This study suggests that bronchoscopic endobronchial valve (EBV) placement may be an option in high-risk patients with PAL who are not surgical candidates. However, given the retrospective nature of the study, it is unknown if PAL resolution would have occurred with continued conservative therapy. (See "Alveolopleural fistula and prolonged air leak in adults", section on 'Bronchoscopic interventions'.) 

Intensity level of noninvasive ventilation in acute exacerbation of COPD
In patients with acute hypercapnia due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD), bilevel noninvasive ventilation (NIV) reduces mortality and intubation rates, but the ideal level of pressure support is uncertain. In a recent randomized trial of patients with AECOPD who tolerated an initial six hours of low-intensity NIV, patients assigned to receive continued low-intensity NIV (peak inspiratory airway pressure [IPAP] <20 cm H2O) were more likely to meet criteria for intubation compared with those assigned to high-intensity NIV (peak IPAP 20 to 30 cm H2O; 13.7 versus 4.8 percent, respectively) [11]. However, the rates of actual intubation were similar in both groups. Crossover from the low- to the high-intensity group may have prevented intubation but complicates interpretation of the study. In addition, the study was stopped early for benefit and underpowered for any mortality difference. Until more data are available, we continue to initiate bilevel NIV at low levels and increase as needed to relieve respiratory distress or improve ventilation. (See "Noninvasive ventilation in adults with acute respiratory failure: Benefits and contraindications", section on 'Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypercapnic respiratory acidosis'.) 

Optimal screening frequency and breathing trial technique for extubation readiness
Once-daily extubation readiness screening followed by pressure support ventilation spontaneous breathing trials (PSV-SBTs) is typically used to liberate patients off mechanical ventilation. However, some experts screen more frequently or use-T-piece SBTs. In a recent randomized trial, time to extubation was shorter in those who underwent once-daily screening and PSV-SBT compared with once-daily screening and T-piece SBT (2 versus 3.1 days) [12]. Unexpectedly, more frequent screening lengthened the time to extubation, especially in those undergoing PSV-SBT compared with T-piece SBT (3.9 versus 2.9 days). We consider frequent screening to be investigational and continue to use once-daily screening with PSV-SBT as our initial ventilator liberation strategy. (See "Initial weaning strategy in mechanically ventilated adults", section on 'Choosing ventilatory support'.) 

Neonatal respiratory morbidity at 34 to 36 weeks gestation
Use of antenatal corticosteroids (ACS) at 34 to 36 weeks of gestation to reduce the risk of neonatal morbidity in patients at high risk of preterm birth is controversial. A secondary analysis of a randomized trial recently provided data for counseling patients. The relative risk of respiratory morbidity was nearly two-fold higher in the cesarean birth group compared with the planned vaginal birth group [1]. The absolute risks varied by week of gestation, and the frequency of severe morbidity was modest in both groups by 36 weeks. We do not administer ACS to patients at 34 to 36 weeks in whom preterm vaginal birth is likely. For patients planning a preterm cesarean birth, we use data from this analysis to inform them about the benefits of ACS and data from prior studies about potential long-term harms and make a shared decision. (See "Antenatal corticosteroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery", section on '34+0 to 36+5 weeks'.) 

Nonsurgical biopsy modalities for peripheral pulmonary nodules
 This study summarizes two important factors that we take into consideration when choosing a non-open surgical biopsy modality for PPNs. Additional factors include PPN location and local expertise. (See "Image-guided bronchoscopy for biopsy of peripheral pulmonary lesions", section on 'Image-guided bronchoscopy techniques'.)

Uncertain role of systemic antibiotics to prevent ventilator-associated pneumonia
Ventilator-associated pneumonia (VAP) is a significant cause of mortality in patients in the intensive care unit. In a recent randomized trial of patients with moderate or severe traumatic brain injury (TBI) or acute stroke, ceftriaxone 2 g intravenously (IV) within 12 hours of intubation reduced 7-day VAP rates (14 versus 32 percent) and 28-day mortality rates (15 versus 25 percent) compared with placebo without excess adverse effects [29]. However, in a subsequent meta-analysis including that trial and six others with over 800 patients with acute brain injury (stroke, TBI, or post cardiac arrest), a short course of peri-intubation IV antibiotics reduced the incidence of VAP, but significant differences in the number of ventilator-free days, ICU length of stay, or in-hospital mortality were not detected [30]. Given the uncertainty around these effects, practice among UpToDate contributors vary; some do not routinely use systemic antibiotics for prevention of VAP in the ICU because of concern for promoting antibiotic resistance, whereas others suggest a single peri-intubation dose of ceftriaxone to prevent VAP in selected populations at high risk (eg, patients with acute TBI). (See "Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults", section on 'Prevention' and "Management of acute moderate and severe traumatic brain injury", section on 'Mechanical ventilation'.)

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MJA

Blood pressure in young Aboriginal and Torres Strait Islander people: analysis of baseline data from a prospective cohort study
The known: Cardiovascular disease-related mortality has significantly declined among Aboriginal and Torres Strait Islander Australians. However, 31% of Indigenous adults have hypertension, the leading cause of avoidable deaths of Indigenous people.
The new: About 70% of Indigenous young people from regional, remote, and urban communities had normal blood pressure, but one in eight had elevated blood pressure and one in five hypertension.
The implications: Hypertension in Indigenous young people must be prevented to avert cardiovascular disease in later life. Reducing early cardiovascular risks, while avoiding unnecessary medicalisation and deficit-framing, is critical for promoting cardiovascular health throughout life. MJA 11 December 2024

Surgical clinical trial activity in Australia, 2010–20, by specialty: analysis of trial registration data
The authors report recent clinical trial activity by surgical specialty in Australia, and these findings could inform discussions of surgical research priorities and governance. MJA 10 December 2024

Clinical phenotype of COVID-19 vaccine-associated myocarditis in Victoria, 2021–22: a cross-sectional study
The known: COVID-19 vaccines are associated with a slightly increased risk of myocarditis.
The new: In Victoria, COVID-19 vaccine-associated myocarditis was generally milder than for other myocarditis forms. Electrocardiographic abnormalities were more frequent in male patients and those aged 24 years or younger; cardiac MRI abnormalities were not seen in patients for whom troponin levels were increased threefold or less.
The implications: Young men are at particular risk of COVID-19 vaccine-associated myocarditis, and warrant close follow-up to determine long term outcomes. A threefold or greater increase in troponin level may be a clinically useful predictor of cardiac MRI abnormalities. MJA 10 December 2024

Knowledge about COVID-19 vaccines among Aboriginal and Torres Strait Islander people, and attitudes to and behaviours regarding COVID-19 and influenza vaccination: a survey
The known: Aboriginal and Torres Strait Islander people were among the first groups in Australia to be targeted for vaccination against coronavirus disease 2019 (COVID-19).
The new: Our survey indicated that most Aboriginal and Torres Strait Islander people believed the COVID-19 vaccines to be very or extremely trustworthy (71%) and very or extremely effective (73%), but levels varied by sex and location.
The implications: Health messages in future pandemics should be tailored to the concerns of their target audiences, particularly those of Aboriginal and Torres Strait Islander women and people living in regional and remote areas. MJA 10 December 2024

Prolonged SARS-CoV-2 shedding in a lung transplant recipient: time for flexibility in infection prevention?
Lessons from practice

  • Protracted viral shedding is relatively common in immunocompromised hosts and existing de-isolation guidelines may result in impractical long periods of isolation.
  • Existing coronavirus disease 2019 (COVID-19) diagnostics, including rapid antigen tests, polymerase chain reaction cycle threshold value and culturable virus, are imperfect surrogates for infectivity; however, collectively can play a role in assessing prolonged viral shedding.
  • Pragmatic de-isolation strategies are required for patients with prolonged SARS-CoV-2 infections.

MJA 10 December 2024

Japanese encephalitis transmission in Australia: challenges and future perspectives
There is a pressing need to shift from a reactive “surveillance and response” approach to a more proactive, comprehensive “predict and prevent” strategy, particularly in regional areas of Australia where populations are at greater risk. As Japanese encephalitis is a vaccine-preventable disease, enhanced surveillance could have potentially prevented the deaths during recent outbreaks. MJA 9 December 2024

Bulk-billing rates and out-of-pocket costs for general practitioner services in Australia, 2022, by SA3 region: analysis of Medicare claims data
The known: Out-of-pocket costs are an important determinant of health care access. Little has been published about regional variations in out-of-pocket costs for general practitioner care in Australia.
The new: In 2022, mean bulk-billing rates by SA3 region (30 000–130 000 people) ranged from 46% to 99%. Mean out-of-pocket costs for non-bulk-billed general practitioner visits ranged from $16 to $99, and were higher in remote than metropolitan areas; the mean cost in many regions exceeded the level of bulk-billing incentive payments.
The implications: Access to affordable general practitioner care in Australia varies by region. Recently introduced bulk-billing incentives are unlikely to make primary care more affordable in metropolitan areas. MJA 17 December 2024

Classification of chronic kidney disease in older Australian adults by the CKD-EPI 2009 and 2021 equations: secondary analysis of ASPREE study data
The known: The 2009 CKD-EPI equation is used In Australia for estimating glomerular filtration rate without adjusting for ethnic background. The 2021 revision of the equation, without a race coefficient, has been widely adopted in the United States.
The new: In a large cohort of Australians aged 70 years or older, the proportion classified as having chronic kidney disease was markedly smaller with the 2021 (12%) than the 2009 CKD-EPI equation (17%). The likelihood of reclassification was greater for women, and declined with age.
The implications: Were the CKD-EPI 2021 equation adopted in Australia, the estimated prevalence of chronic kidney disease among generally healthy older people would be lower, potentially influencing decisions about treatment and specialist referrals. MJA 17 December 2024

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MJA insight

70% of people with depression not receiving minimally adequate treatment
A recent study has found that 70% of Australians diagnosed with major depressive disorder are not receiving minimally adequate treatment. MJA insight 9 December 2024

A great challenge: implementation of SGLT2 inhibitors and GLP-1 receptor agonists for type 2 diabetes
SGLT2 inhibitors and GLP-1 receptor agonists represent significant advances in the treatment of type 2 diabetes, but there are challenges in providing equitable access to these medicines. MJA insight 9 December 2024

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BMJ

Management of pain and sedation in the intensive care unit
Optimization of pain and sedation in the ICU is important because inappropriate sedation and pain management contribute to worse patient outcomes. Continual assessment of patients in the ICU using validated tools is vital to identify pain and agitation. Treatment of pain and agitation using short acting and continually titrated drugs based on patient assessments is associated with improved patient outcomes in hospital and long term after discharge. BMJ 9 December 2024

Non-pharmaceutical treatments for irritable bowel syndrome
This review focuses on the current evidence for common non-pharmaceutical treatments for IBS, including the latest advances in dietary and brain-gut behavioral care, in addition other complementary and integrative health practices and emerging therapies. BMJ 16 December 2024

Mortality and risk of diabetes, liver disease, and heart disease in individuals with haemochromatosis HFE C282Y homozygosity and normal concentrations of iron, transferrin saturation, or ferritin: prospective cohort study
The aim of this study was to test whether haemochromatosis HFE C282Y homozygotes have increased risk of diabetes, liver disease, and heart disease even when they have normal plasma iron, transferrin saturation, or ferritin concentrations and to test whether C282Y homozygotes with diabetes, liver disease, or heart disease have increased mortality compared with non-carriers with these diseases. BMJ 9 December 2024

Drug use: how can policies reduce the harms of both consumption and criminalisation?
A former UN high commissioner for human rights tells The BMJ that the war on drugs has “completely failed” and that a public health focused approach is needed. BMJ 9 December 2024

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JAMA

Early restrictive vs liberal oxygen for trauma patients
In adult trauma patients, an early restrictive oxygen strategy compared with a liberal oxygen strategy initiated in the prehospital setting or on trauma center admission for 8 hours did not significantly reduce death and/or major respiratory complications within 30 days. JAMA 10 December 2024

Risk of death due to Melanoma and other causes in patients with thin cutaneous Melanomas
In this study, the risk of melanoma-related death increased significantly for patients with primary tumors of 0.8 to 1.0 mm in thickness. The risk of death from nonmelanoma-ralated causes was similar across Breslow thicknesses of 0.1 to 1.0 mm. This analysis suggests that a 0.8-mm threshold for guiding the care of patients with thin primary melanomas. JAMA 11 December 2024

Quality improvement Intervention for Reducing acute treatment times in Ischemic Stroke: A cluster randomized clinical trial
This study found that performance feedback provided through a dashboard used by local quality improvement teams reduced door-to–groin puncture time for endovascular thrombectomy (EVT). Implementation of performance feedback in hospitals providing EVT can improve the quality of care for ischemic stroke. JAMA 16 December 2024

Risk factors for Retinopathy in young adults with Type 1 Diabetes
Study results suggest that although glycemic control remains the dominant risk factor for Diabetic retinopathy (DR), overweight, obesity, and hypertension also increased the risk of any retinopathy. JAMA 12 December 2024

Adverse obstetric outcomes in pregnancies with major fetal congenital heart defects
These findings suggest that women expecting a child with a fetal major congenital heart defects (MCHDs) may be at high risk of obstetric complications. JAMA 16 December 2024

Doxycycline postexposure prophylaxis to prevent bacterial sexually transmitted infection
Selected recommendations:

  • Clinicians should counsel gay, bisexual, and other men who have sex with men and transgender women who have had at least 1 bacterial STI (syphilis, gonorrhea, or chlamydia) during the past 12 months about the benefits and harms of using doxycycline postexposure prophylaxis (doxyPEP) (strong recommendation).
  • In this group, doxycycline, 200 mg, should be taken as soon as possible within 72 hours of oral, vaginal, or anal sex to reduce the incidence of bacterial STIs (strong recommendation).

JAMA 19 December 2024

What is Essential Tremor?
Essential tremor is a disorder that causes involuntary, rhythmic shaking movements of a body part that is in motion. Essential tremor is among the most common movement disorders worldwide. It is estimated to affect about 7 million people in the US, although this number may be an underestimate because some individuals do not seek medical attention for tremor. JAMA 19 December 2024

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NEJM

Liberal or restrictive transfusion strategy in Aneurysmal Subarachnoid Hemorrhage
In patients with aneurysmal subarachnoid hemorrhage and anemia, a liberal transfusion strategy did not result in a lower risk of an unfavorable neurologic outcome at 12 months than a restrictive strategy. NEJM 9 December 2024

Imlunestrant with or without Abemaciclib in advanced Breast Cancer
Among patients with estrogen-receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer, treatment with imlunestrant led to significantly longer progression-free survival than standard therapy among those with ESR1 mutations but not in the overall population. Imlunestrant–abemaciclib significantly improved progression-free survival as compared with imlunestrant, regardless of ESR1-mutation status. NEJM 11 December 2024

Nonsurgical management of chronic venous insufficiency

  • Chronic venous insufficiency manifests as a spectrum of signs and symptoms, including varicose veins, leg swelling, skin changes, and leg ulcers. The condition is caused primarily by venous hypertension.
  • Venous hypertension is a multifactorial disease, the cause of which can be structural (e.g., venous reflux or obstruction) or functional (e.g., dependent edema, weak calf muscle, or obesity) or both.
  • The diagnosis of chronic venous insufficiency is based on information obtained from the history and physical examination; further diagnostic imaging with duplex ultrasound examination is helpful for assessing for structural causes.
  • Treatment is aimed at reducing the patient’s symptoms, which do not always correlate with the findings on physical or ultrasound examination.
  • Endovenous procedures and surgeries can be effective treatment options for structural venous insufficiency, but nonsurgical treatment measures are the mainstay for functional or combined (functional and structural) venous insufficiency.
  • Nonsurgical management includes reducing central venous hypertension, compression therapy, leg elevation, and exercises involving calf and foot flexion and extension that provide a pump-function effect.

NEJM 18 December 2024

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Other journals

Artificial Intelligence-driven approaches to managing surgeon fatigue and improving performance
This paper explores how AI, via machine learning algorithms, wearable devices, and real-time feedback systems, enables comprehensive fatigue detection by analysing physiological, behavioural, and environmental data. Cureus 15 December 2024

The family talk intervention prevent the feeling of loneliness - a long term follow up after a parents life-threatening illness
Family talk intervention (FTI) is found to promote family communication both in a short- and long-term perspectives according to parents. They also found FTI useful in reducing their feelings of loneliness. Support over a longer period of time is desired and extra FTI meetings may strengthen the family as a whole in parallel with additional support for parents and children during the illness trajectory and in bereavement. They received support in dealing with strong and difficult emotions and learned conversational techniques that they still used at the time of the interview, indicating that the lessons learnt was integrated and valuable many years after the last FTI meeting. BMC palliative care 12 December 2024

Mental health symptoms and burdens after a SARS-CoV-2 infection
The results suggest that mental health care should focus on individuals who suffer from a severe acute COVID-19 infection or have a history of mental illness. BMC public health 13 December 2024

Women’s lived experience of intimate partner violence manifestations during the breastfeeding period: a lifeworld hermeneutic study
The breastfeeding intimacy within the mother–child dyad seems to change the intersubjective power balance in the partner relationship and provoke partners, making breastfeeding women especially vulnerable to IPV. Knowledge of breastfeeding women’s lived experience of exposure to IPV is central for carers to strengthen their ability to support women’s health and wellbeing. International journal of breastfeeding 16 December 2024

Exploring the ethical implications of ChatGPT in medical education: privacy, accuracy, and professional integrity in a cross-sectional survey
ChatGPT offers promising educational benefits in medical training but raises significant ethical concerns, particularly regarding data privacy and the potential for over-reliance. The results suggest the need for responsible integration of AI in medical education, ensuring it supplements rather than replaces traditional learning methods. Cureus 17 December 2024

Evaluating the effect of Vitamin D supplementation on Type 2 Diabetes risk: A systematic review
The purpose of this systematic review is to determine whether vitamin D supplementation lowers the risk of type 2 diabetes. The vitamin D group had a lower homeostasis model assessment of insulin resistance (HOMA-IR) than the placebo cohort in seven of the 10 trials that examined HOMA-IR. Despite the impact on insulin resistance, there is not enough data to conclude that vitamin D supplement significantly lowers the incidence of T2DM. To impact clinical guidelines about supplementation with vitamin D among people at risk of type 2 diabetes, more studies in this area might be beneficial. Cureus 17 December 2024

Clinical and cost-effectiveness of earlier discharge from acute hospital after total joint arthroplasty
Earlier discharge was not associated with changes in 90-day complications, readmission, or ED presentations. However, an increase in utilization of inpatient rehabilitation was observed, offsetting early cost savings. Patients who were discharged from acute care on day three had no difference in costs compared to those discharged on day four. ANZ journal of surgery 6 December 2024

Emerging antiviral drugs to prevent or treat influenza

  • The authors identified a total of 17 emerging drugs in 26 completed or ongoing RCTs, mainly testing treatments for adults with uncomplicated influenza, with some studies including children and adolescents.
  • The evidence included 2 prevention studies and 3 challenge studies for influenza.
  • Most drugs were compared to a placebo and the number of participants in these trials ranged from 46 to 5,000.

Canadian journal of health technologies 16 December 2024

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COVID-19

COVID-19 Latest from research publications
compiled by the SALHN (SA Health) library staff - updated 20 December 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

Brief outpatient rehabilitation program for Post–COVID-19 condition: A randomized clinical trial
The findings of this trial suggest that brief outpatient rehabilitation based on a cognitive and behavioral approach is effective and safe for patients with Post–COVID-19 condition (PCC). JAMA 19 December 2024

2024 update of the RECOVER-adult long COVID research index
The 2024 long COVID (LC)  research index for adults builds on the 2023 index with additional data and symptoms to help researchers classify symptomatic LC and its symptom subtypes. Continued future refinement of the index will be needed as the understanding of LC evolves. JAMA 18 December 2024

Prevalence of post-acute sequelae of SARS-CoV-2 infection in people living with HIV: a systematic review with meta-analysis
Current evidence indicates that the prevalence of Long COVID in adults living with HIV may be high, suggesting the need for increased awareness and education of healthcare providers and policy makers. Evidence on whether HIV positivity increases the risk of Long COVID is limited and inconclusive, highlighting a need for further research to clarify this potential association. eClinicalMedicine 17 December 2024

Decline of antibodies to major viral and bacterial respiratory pathogens during the COVID-19 pandemic
Surges in infections caused by respiratory pathogens have been documented in multiple settings after relaxation of pandemic restrictions. Antibodies to major antigens from respiratory syncytial virus and Group A Streptococcus waned significantly in a longitudinal adult cohort throughout the pandemic. This waning may have contributed to the pathogen-surges that followed. Journal of infectious diseases 14 December 2024

Mental health symptoms and burdens after a SARS-CoV-2 infection
The results suggest that mental health care should focus on individuals who suffer from a severe acute COVID-19 infection or have a history of mental illness. BMC public health 13 December 2024

Association between COVID-19 infection and new-onset dementia in older adults: a systematic review and meta-analysis
Under normal circumstances, the authors believe that COVID-19 infection is likely to be a risk factor for developing new-onset dementia (NOD) in older adults over time. While the increased NOD risk due to COVID-19 infection appears to be similar to that associated with other respiratory infections, it warrants and necessitates investigation with longer observations. BMC geriatrics 13 December 2024

Prevalence of Post–COVID-19 condition and activity-limiting Post–COVID-19 condition among adults
In this cross-sectional study, updated national prevalence estimates of post–COVID-19 condition (PCC) (ever and current) and new estimates of activity-limiting PCC are provided. JAMA 13 December 2024

BNT162b2 XBB vaccine for COVID-19 among children 5-17 years of age
These results suggest that the BNT162b2 XBB vaccine provided protection against COVID-19–associated hospitalization and ED or urgent care visits among children 5 to 17 years of age during the 2023-2024 season with estimated vaccine effectiveness point estimates ranging from 63% to 73%. JAMA 12 December 2024

Clinical phenotype of COVID-19 vaccine-associated myocarditis in Victoria, 2021–22: a cross-sectional study
The known: COVID-19 vaccines are associated with a slightly increased risk of myocarditis.
The new: In Victoria, COVID-19 vaccine-associated myocarditis was generally milder than for other myocarditis forms. Electrocardiographic abnormalities were more frequent in male patients and those aged 24 years or younger; cardiac MRI abnormalities were not seen in patients for whom troponin levels were increased threefold or less.
The implications: Young men are at particular risk of COVID-19 vaccine-associated myocarditis, and warrant close follow-up to determine long term outcomes. A threefold or greater increase in troponin level may be a clinically useful predictor of cardiac MRI abnormalities. MJA 10 December 2024

Knowledge about COVID-19 vaccines among Aboriginal and Torres Strait Islander people, and attitudes to and behaviours regarding COVID-19 and influenza vaccination: a survey
The known: Aboriginal and Torres Strait Islander people were among the first groups in Australia to be targeted for vaccination against coronavirus disease 2019 (COVID-19.
The new: Our survey indicated that most Aboriginal and Torres Strait Islander people believed the COVID-19 vaccines to be very or extremely trustworthy (71%) and very or extremely effective (73%), but levels varied by sex and location.
The implications: Health messages in future pandemics should be tailored to the concerns of their target audiences, particularly those of Aboriginal and Torres Strait Islander women and people living in regional and remote areas. MJA 10 December 2024

Prolonged SARS-CoV-2 shedding in a lung transplant recipient: time for flexibility in infection prevention?
Lessons from practice

  • Protracted viral shedding is relatively common in immunocompromised hosts and existing de-isolation guidelines may result in impractical long periods of isolation.
  • Existing coronavirus disease 2019 (COVID-19) diagnostics, including rapid antigen tests, polymerase chain reaction cycle threshold value and culturable virus, are imperfect surrogates for infectivity; however, collectively can play a role in assessing prolonged viral shedding.
  • Pragmatic de-isolation strategies are required for patients with prolonged SARS-CoV-2 infections.

MJA 10 December 2024

Barriers, facilitators and next steps for sustaining and scaling virtual hospital services in Australia: a qualitative descriptive study
The known: The Australian health care system requires innovative approaches to meet the rising demand for services. Virtual hospital (VH) models of care have shown promise in improving care efficiency and experiences while maintaining patient outcomes.
The new: Barriers to and facilitators of implementing and delivering VH services and gaps in evidence and practice were identified, setting a research and practice agenda for ongoing improvement.
The implications: Successful practices can be adopted by organisations looking to implement new VH services or improve existing VH services. Future research and policy changes should address gaps in evidence and practice; this should include the evaluation of care models and technologies, and development of funding models for VH services. MJA 9 December 2024

Long COVID appears to be driven by ‘long infection’. Here’s what the science says
Around 5–10% of people with COVID infections go on to experience long COVID, with symptoms lasting three months or more. MJA insight 9 December 2024

Effectiveness of the BNT162b2 XBB.1.5-adapted vaccine against COVID-19 hospitalization related to the JN.1 variant in Europe: a test-negative case-control study using the id.DRIVE platform
BNT162b2 XBB.1.5-adapted vaccine provided protection against JN.1-related hospitalization, regardless of prior vaccination history, with no evidence of waning through five months. These data support yearly vaccination against COVID-19 to prevent severe illness during the respiratory virus season. eClinicalMedicine 7 December 2024

The relationship between predisposing risk factors and COVID-19: An observational study
The study shows that the severity of the disease increased as the number of risk factors increased. This information can help in taking early and active measures in these groups of patients with multiple comorbid illnesses. Cureus 3 December 2024

Fostamatinib for hospitalized adults with COVID-19 and hypoxemia: A randomized clinical trial
In this randomized clinical trial of adults hospitalized with COVID-19 and hypoxemia, fostamatinib did not increase the number of oxygen-free days compared with placebo. These results do not support the hypothesis that fostamatinib improves outcomes among adults hospitalized with hypoxemia during the Omicron era. JAMA 3 December 2024

Castleman disease following post-coronavirus disease 2019 multisystem inflammatory syndrome in adults
Lessons from practice

  • Consider Castleman disease in patients re-presenting with similar symptoms as post-coronavirus disease 2019 multisystem inflammatory syndrome in adults.
  • Non-caseating granulomas have a wide range of differentials; including infections, vasculitis, occupational diseases and haematological aetiologies.
  • Excisional lymph node biopsy is the gold standard to diagnose unexplained lymphadenopathy.
  • Enlargement of cherry angiomas is a sign of Castleman disease.

BMJ 1 December 2024

Bivalent Omicron BA.1 vaccine booster increases memory B cell breadth and neutralising antibodies against emerging SARS-CoV-2 variants
These results suggest that the bivalent vaccine confers an advantage against future novel variants due to increased frequency of broadly reactive RBD-specific B cells. eBioMedicine 28 November 2024

Interventions for the management of long covid (post-covid condition): living systematic review
Moderate certainty evidence suggests that cognitive behavioural therapy (CBT)  and physical and mental health rehabilitation probably improve symptoms of long covid. BMJ 27 November 2024

mRNA COVID-19 vaccine safety among children and adolescents: a Canadian National Vaccine Safety Network cohort study
The  findings suggest that reported health events, including myocarditis/pericarditis, vary by pediatric age group. Vaccinated adolescents reported health events more frequently following the second mRNA COVID-19 vaccine dose, while younger age groups did not report events more frequently than their unvaccinated counterparts. The Lancet regional health – Americas 27 November 2024

Experiences and perspectives of the COVID-19 pandemic and vaccinations in culturally and linguistically diverse (CALD) populations in Australia: A qualitative study
This research paper highlights the issues experienced by culturally and linguistically diverse (CALD) members during the COVID-19 pandemic and vaccination rollout. Cureus 26 November 2024

COVID-19 vaccine reactogenicity among young children
No unexpected reactions were identified. Similar to the authors study, data from clinical trials and V-safe found that irritability was the most common systemic reaction among children aged 6 months to younger than 2 years, followed by fever and fatigue or sleepiness. JAMA 25 November 2024

Towards a cure for long COVID: the strengthening case for persistently replicating SARS‐CoV‐2 as a driver of post‐acute sequelae of COVID‐19
Evidence is mounting that at least some of the potential mechanisms driving long COVID mentioned herein (immune and inflammatory dysregulation, microbiota dysbiosis, autoimmunity and endothelial dysfunction) may themselves have the common denominator of persistent SARS‐CoV‐2 infection. This has several important implications: 

  • Prioritise long COVID: the notion of “long infection” should help further demystify long COVID, validating individuals who live with this illness (and post‐acute infection syndromes in general) and have it move into the mainstream of surveillance and strategies for diagnosis, treatment and prevention.
  • Ramp‐up existing antiviral approaches: existing approaches, including vaccines and therapies, appear to decrease the risk of long COVID and should be more actively included in trials for long COVID. This recognition and the potential cost‐effectiveness implications should prompt reassessment of eligibility requirements for access to therapies and vaccines to promote their use in younger people and to individuals even with milder forms of acute infection.
  • Urgently develop new antiviral approaches and long COVID diagnostics: there is now increased impetus for the development of improved therapeutics and vaccines for SARS‐CoV‐2 in addition to definitive biological long COVID diagnostic tests to complement clinical diagnoses.
  • Strengthen prevention approaches: long COVID incidence remains high, and this carries a large health, labour and economic impact. It is therefore critical that sustainable prevention strategies are strengthened, especially in higher transmission‐risk settings. Major recent advances towards safer indoor air environments offer one clear avenue to achieve this.

MJA 25 November 2025

Maternal COVID-19 infection and risk of respiratory distress syndrome among newborns: a systematic review and meta-analysis
Newborns born to mothers with COVID-19 have a substantially increased risk of developing respiratory distress syndrome (RDS) These findings emphasize the need for vigilant monitoring and appropriate management of pregnant women with COVID-19 to mitigate adverse neonatal outcomes. BMC infectious diseases 19 November 2024

Role of 2-Deoxy-D-Glucose in enhancing the efficacy of standard of care for moderate to severe COVID-19: A comparative analysis of clinical outcomes
2-DG demonstrates significant efficacy as an adjunct therapy for moderate to severe COVID-19, reducing both time to clinical improvement (5.2 vs. 7.5 days, p < 0.001) and hospital stay duration. Additionally, fewer adverse events were reported, and viral clearance rates were higher in the 2-DG group. These findings highlight 2-DG’s potential to improve clinical outcomes in COVID-19 care,. Cureus 19 November 2024

Cross-sectional and longitudinal genotype to phenotype surveillance of SARS-CoV-2 variants over the first four years of the COVID-19 pandemic
The emergence of many SARS-CoV-2 lineages documented at the end of 2023 was found to be initially associated with lowered neutralisation responses. This continued to be countered by the gradual maturation of cross-reactive neutralisation responses over time. The later appearance and dominance of the divergent JN.1 lineage cannot be attributed to a lack of neutralisation responses alone, and our data supports that its dominance is a culmination of both lowered neutralisation and changes in ACE2/TMPRSS2 entry preferences. eBioMedicine 15 November 2024

Postural orthostatic tachycardia syndrome after COVID-19 vaccination: A systematic review
The risk of POTS following COVID-19 vaccination is lower than that observed post-SARS-CoV-2 infection; however, existing studies are limited by small sample sizes and methodological variability. BMC cardiovascular disorders 14 November 2024

Humoral and cellular responses to a fifth bivalent SARS-CoV-2 vaccine dose in patients with immune-mediated inflammatory diseases on tumour necrosis factor inhibitors: a prospective cohort study
In patients on tumour necrosis factor inhibitors (TNFi) with hybrid immunity, there was no immunological benefit of an updated fifth SARS-CoV-2 booster dose. Stable CD8 cellular responses following four doses indicate established protective immunity. Patients whose only risk factor is TNFi may in future follow vaccine recommendations for the general population. The Lancet regional health - Europe 14 November 2024

Association of mRNA COVID-19 vaccination and reductions in Post-COVID Conditions following SARS-CoV-2 infection in a US prospective cohort of essential workers
COVID-19 vaccination protected against development of post-COVID conditions (PCC) among persons with mild infection during both Delta and Omicron variant predominance, supporting vaccination as an important tool for PCC prevention. Journal of infectious diseases 13 November 2024

Rheumatoid arthritis and COVID-19 outcomes: a systematic review and Meta-analysis
Rheumatoid arthritis patients have a significantly greater risk of COVID-19 infection, hospitalization, ICU admission, and death than individuals without rheumatoid arthritis. However, rheumatoid arthritis did not show a significant association with the risk of severe COVID-19. These findings underscore the need for tailored management strategies and vigilant monitoring of COVID-19 outcomes in rheumatoid arthritis patients. BMC rheumatology 12 November 2024

Trends in alcohol use after the COVID-19 pandemic: A national cross-sectional study
The study included 24 965 respondents from 2018, 30 829 from 2020, and 26 806 from 2022. Compared with 2018, there were absolute increases in any alcohol use in 2020 and 2022. Numerical increases in any alcohol use occurred in 2020 and 2022 versus 2018 among all subgroups. Annals of internal medicine 12 November 2024

A substitution at the cytoplasmic tail of the spike protein enhances SARS-CoV-2 infectivity and immunogenicity
This study offers mechanistic insight into the constantly increasing transmissibility of SARS-CoV-2 Omicron variants and provides a meaningful optimisation strategy for vaccine development against SARS-CoV-2. eBioMedicine 11 November 2024

The COVID-19 pandemic and patient expectations about recovery from acute respiratory failure
In this cohort study, the authors found no clinically meaningful change in expectations about recovery during the COVID-19 pandemic among survivors of non–COVID-19 acute respiratory failure (ARF); expectations were high and similar to previously described expectations in survivors of ARF. JAMA 8 November 2024 

Global landscape of COVID-19 vaccination programmes for older adults: a descriptive study
Progress of COVID-19 vaccination programmes for older adults is uneven across countries, emphasising an ongoing challenge to achieve vaccine equity for this high-risk age group. Therefore, it is essential to establish robust and timely vaccination surveillance systems, especially to facilitate data-driven policies that promote COVID-19 vaccination campaigns worldwide. The Lancet – healthy longevity 7 November 2024

Impact of JN.1 booster vaccination on neutralisation of SARS-CoV-2 variants KP.3.1.1 and XEC
The XEC S protein retains the ability to efficiently engage ACE2 and drive cell entry, although entry into Calu-3 lung cells was reduced. Both KP.3.1.1pp and XECpp were generally less well neutralised compared with JN.1pp, indicating elevated immune evasion. Importantly, JN.1 booster vaccination considerably improved neutralisation of all lineages tested and therefore will likely increase protection against hospitalisation and post-COVID sequelae from infection caused by KP.3.1.1 and XEC. The Lancet infectious diseases 7 November 2024

Neurodevelopment in the first 2 years of life following prenatal exposure to maternal SARS-CoV-2 infection
In this longitudinal cohort study of multiple aspects of child neurodevelopment between ages 6 and 24 months, negligible associations between prenatal exposure to SARS-CoV-2 infection and child outcomes were observed. Follow-up research is warranted to determine whether these predominantly null effects persist into later childhood. JAMA 7 November 2024 

Global landscape of COVID-19 vaccination programmes for older adults: a descriptive study
Progress of COVID-19 vaccination programmes for older adults is uneven across countries, emphasising an ongoing challenge to achieve vaccine equity for this high-risk age group. Therefore, it is essential to establish robust and timely vaccination surveillance systems, especially to facilitate data-driven policies that promote COVID-19 vaccination campaigns worldwide. The Lancet – healthy longevity 7 November 2024

Long-term risk of autoimmune and autoinflammatory connective tissue disorders following COVID-19
This retrospective cohort study with an extended follow-up period found associations between COVID-19 and the long-term risk of various autoimmune and autoinflammatory connective tissue disorders. Long-term monitoring and care of patients is crucial after COVID-19, considering demographic factors, disease severity, and vaccination status, to mitigate these risks. JAMA 6 November 2024

Safety of simultaneous vs sequential mRNA COVID-19 and inactivated influenza vaccines: A randomized clinical trial
The findings support simultaneous administration of mRNA COVID-19 and inactivated influenza vaccines as an acceptable option to achieve timely vaccination. JAMA 6 November 2024

Virological characteristics of the SARS-CoV-2 XEC variant
Altogether, here we showed that XEC exhibited higher pseudovirus infectivity and higher immune evasion than KP.3. Particularly, XEC exhibited more robust immune resistance to KP.3.3 BTI sera than KP.3.1.1. This data suggest that the higher Re of XEC than KP.3.1.1 is attributed to this property and XEC will be a predominant SARS-CoV-2 variant in the world in the near future. The Lancet infectious diseases 6 November 2024

Long COVID and recovery from Long COVID: quality of life impairments and subjective cognitive decline at a median of 2 years after initial infection
Long COVID is associated with long-term subjective cognitive decline and diminished quality of life. Clinically significant cognitive complaints, fatigue, and pain were present even in those who reported they had recovered from Long COVID. These findings have implications for the sustainability of participation in work, education, and social activities. BMC infectious diseases 5 November 2024

Hospital COVID-19 burden and adverse event rates
The results of this study suggest a need for greater resilience in hospitals to prevent declines in patient safety and effectiveness of care during increases in demand, such as from pandemics, natural disasters, or other causes. JAMA 4 November 2024

The economic burden of long COVID in Australia: more noise than signal?
The known: Robust evidence on the economic burden of long COVID in Australia is limited.
The new: Long COVID potentially peaked in late July or early August 2022, based on COVID‐19 case numbers for the period January 2021 to April 2023. The estimated cost of long COVID in 2022 was about $1.7 billion to $6.3 billion — a fraction of a percentage point of Australia's gross domestic product. Labour market analysis indicates that more working age Australians than expected may now be unable to work, potentially because of long COVID.
The implications: Long COVID likely had a small but perceptible impact on the Australian economy, which can provide insights for shaping Australia's policy response. MJA 4 November 2024

Beyond acute infection: mechanisms underlying post-acute sequelae of COVID-19 (PASC)
Summary

  • Immune dysregulation is a key aspect of post-acute sequelae of coronavirus disease 2019 (PASC), also known as long COVID, with sustained activation of immune cells, T cell exhaustion, skewed B cell profiles, and disrupted immune communication thereby resulting in autoimmune-related complications.
  • The gut is emerging as a critical link between microbiota, metabolism and overall dysfunction, potentially sharing similarities with other chronic fatigue conditions and PASC.
  • Immunothrombosis and neurological signalling dysfunction emphasise the complex interplay between the immune system, blood clotting, and the central nervous system in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
  • Clear research gaps in the design of PASC studies, especially in the context of longitudinal research, stand out as significant areas of concern.

MJA 3 November 2024

Factors associated with general practitioner-led diagnosis of long COVID: an observational study using electronic general practice data from Victoria and New South Wales, Australia
The known: Long COVID is a growing concern worldwide. Research outside Australia has identified demographic factors and pre-existing conditions as potential risk factors for long COVID.
The new: In an Australian population, patients who were female, aged 40–59 years or of high socio-economic status, and those who had a pre-existing mental health condition, respiratory condition, cancer or musculoskeletal condition, had an increased risk of general practitioner-led diagnosis of long COVID.
The implications: Identification of predisposing risk factors is essential to inform early intervention and management strategies for those at greatest risk of long COVID and to help alleviate the burden of long COVID on the health care system. MJA 3 November 2024

Hospital costs of COVID-19, post-COVID-19 condition and other viral pneumonias: a cost comparison analysis
The known: International research indicates that hospital admissions for COVID-19 are costlier than admissions for other viral pneumonias, but detailed economic analysis from the Australian context has been lacking.
The new: During the original and Delta waves of the pandemic, admissions for COVID-19 incurred 29% higher costs than those for other viral pneumonias. The costs of admissions that included intensive care were six times higher than those that were managed on general wards.
The implications: Acute COVID-19 and post-COVID-19 condition cases have had a significant financial impact on Australian hospitals. Further analysis is required to identify trends over time in the context of increased vaccination rates and subsequent variants of severe acute respiratory syndrome coronavirus 2. MJA 3 November 2024

Persistent symptoms after COVID-19: an Australian stratified random health survey on long COVID
The known: Persistent symptoms can occur following COVID-19 and may be associated with ongoing impairment.
The new: A survey of adults in Victoria, Australia, who had had a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection showed that one in seven reported persistent new symptoms and being less than 80% recovered three months after the infection (meeting the survey criteria for clinical long COVID). One in five of those with clinical long COVID reported at least moderate impairment at 12 months after the infection.
The implications: Although more recent SARS-CoV-2 variants are less virulent, infections are likely to continue to cause persistent symptoms, and a minority of those affected will experience decreased function. Improved community understanding of long COVID is required, and health systems need to develop clear pathways for treating patients, especially for those with persistent impairment. MJA 3 November 2024

Risk factors for in-hospital mortality in older patients with acute respiratory distress syndrome due to COVID-19: a retrospective cohort study
In cases of COVID-19-related acute respiratory distress syndrome (C-ARDS) in older patients, the decision to initiate invasive mechanical ventilation (IMV) should always be individualized therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered. BMC geriatrics 26 October 2024

Revealing transparency gaps in publicly available COVID-19 datasets used for medical artificial intelligence development—a systematic review
During the COVID-19 pandemic, artificial intelligence (AI) models were created to address health-care resource constraints. Previous research shows that health-care datasets often have limitations, leading to biased AI technologies. This systematic review assessed datasets used for AI development during the pandemic, identifying several deficiencies. The lancet digital health 31 October 2024 

Incidence of post-acute COVID-19 symptoms across healthcare settings in seven countries: an international retrospective cohort study using routinely-collected data
Post-acute COVID-19 symptoms, as listed by the WHO, were commonly observed following COVID-19 infection. However, even after standardising research methods, there was significant heterogeneity in the incidence rates from different healthcare settings and geographical locations. This is the first international study of the epidemiology of post-acute COVID-19 symptoms using the WHO-listed symptoms. Its findings contribute to understand the epidemiology of this condition from a multinational approach. Limitations of this study include the lack of consensus of the post-acute COVID-19 definition, as well as the difficulty to capture the impact on daily life of the post-acute COVID-19 symptoms in the available datasets. eClinicalMedicine 31 October 2024

Effects of Buprenorphine, Methadone, and substance-use on COVID-19 morbidity and mortality
Active substance use was associated with increased morbidity in COVID-19 infection. medications for opioid use disorder (MOUD) was not associated with worse COVID-19 outcomes compared to other opioids. Future studies focused on MOUD treatments that reduce morbidity may help improve clinical outcomes in COVID-19. Journal of addiction medicine 30 October 2024

Incidence of post-acute COVID-19 symptoms across healthcare settings in seven countries: an international retrospective cohort study using routinely-collected data
Post-acute COVID-19 symptoms, as listed by the WHO, were commonly observed following COVID-19 infection. However, even after standardising research methods, there was significant heterogeneity in the incidence rates from different healthcare settings and geographical locations. This is the first international study of the epidemiology of post-acute COVID-19 symptoms using the WHO-listed symptoms. Its findings contibute to understand the epidemiology of this condition from a multinational approach. eClinicalMedicine 29 October 2024

N95 filtering facepiece respirator reuse, extended use, and filtration efficiency
The authors found the number of shifts of reuse and respirator model were associated with reduced filtration efficiency (FE). While associated with minimal reduction in FE after 1 shift, after 3 shifts almost one-third of respirators did not filter 95% of particles. JAMA 29 October 2024

Body mass index and postacute sequelae of SARS-CoV-2 infection in children and young adults
In this cohort study, elevated body mass index (BMI) was associated with a significantly increased post-acute sequelae of SARS-Cov-2 infection (PASC) risk in a dose-dependent manner, highlighting the need for targeted care to prevent chronic conditions in at-risk children and young adults. JAMA 28 October 2024

Experiences of Australian adults with disabilities living with government supports in the home during the COVID-19 pandemic

  • Adults with disabilities who lived with government supports in their homes experienced declining mental health and life satisfaction when COVID-19 stay-at-home orders, also known as ‘lockdowns’, were introduced in Australia.  
  • Informal and paid supports were highly valued by these adults throughout the COVID-19 pandemic but were not always available.
  • Resources for future health crises should be co-designed in collaboration with end-users (adults with disabilities as well as their supporters).

Disability & society 27 October 2024

Hospitalization for COVID-19, other respiratory infections, and post-acute patient-reported symptoms
This cohort study found that postacute infection syndrome (PAIS)  is not unique to COVID-19; it can also occur in people with other severe lower respiratory tract infections (LRTIs). However, compared with other LRTIs, COVID-19 appeared to impose an extra burden of neurological, cognitive, and fatigue symptoms. These findings highlight the similarities and differences between post–COVID-19 condition (PCC) and PAIS triggered by other pathogens, which will inform tailored clinical management and offer mechanistic insights into these previously overlooked syndromes. Limitations include potential residual confounding, the healthier profile of UKB participants vs the general population, and the lack of repeated-measure data for symptom trajectories. JAMA 25 October 2024  

Efficacy and safety of asunercept, a CD95L-selective inhibitor, in hospitalised patients with moderate-to-severe COVID-19: ASUNCTIS, a multicentre, randomised, open-label, controlled, phase 2 trial
The phase 2 ASUNCTIS study assessed the efficacy and safety of asunercept, a fully human CD95 (Fas) ligand-binding protein, in hospitalised patients with moderate-to-severe coronavirus disease (COVID-19) to assess the clinical benefit of CD95 ligand inhibition in this viral disease. The primary endpoint of time to sustained clinical improvement for distinct asunercept arms compared to standard of care (SOC) failed to meet statistical significance. The compound was safe and well tolerated. eClinicalMedicine 24 October

Atorvastatin and telmisartan do not reduce nasopharyngeal carriage of SARS-CoV-2 in mild or moderate COVID-19 in a phase IIb randomized controlled trial
Among adults with mild to moderate COVID-19 infection, the addition of telmisartan or atorvastatin, to the standard LPVr treatment is not associated with a better virological or clinical outcome.  Nature 23 October 2024  

Gastrointestinal pathophysiology in long COVID: Exploring roles of microbiota dysbiosis and serotonin dysregulation in post-infectious bowel symptoms 
In this review, we highlight the key findings in post-COVID bowel symptoms and explore possible mechanisms underlying the pathophysiology of the illness. These mechanisms include mucosal inflammation, gut barrier dysfunction, and microbiota dysbiosis during viral infection. Viral shedding through the GI route may be the primary factor causing the alteration of the microbiome ecosystem, particularly the virome. Recent evidence in experimental models suggested that microbiome dysbiosis could be further aggravated by epithelial barrier damage and immune activation.  Life Sciences 23 October 2024 

Influence of park visitation on physical activity, well-being and social connectedness among Australians during COVID-19
These findings highlight the role of parks in positively influencing health-related outcomes and the ‘dosage’ of park use needed to attain health benefits. Health promotion international 22 October 2024

COVID-19 vaccine effectiveness against SARS-CoV-2-confirmed hospitalisation in the eastern part of the WHO European Region (2022–2023): a test-negative case-control study from the EuroSAVE network
During nearly two years of Omicron circulation in the eastern WHO European Region, COVID-19 vaccination reduced the risk of hospitalisations by more than half for 6 months following vaccination. The Lancet regional health – Europe 22 October 2024

Reevaluation of prognostic and severity indicators for COVID-19 patients in the emergency department
The NEWS and CCEDRRN COVID-19 Mortality Score were reconfirmed for early and rapid predicting the poor prognosis and severity of COVID-19 patients in ED, especially the CCEDRRN COVID-19 Mortality Score with the highest discrimination capacity, and NLR was more appropriate for predicting the severity.
Annals of Medicine 22 October 2024 

Prevalence of Toxoplasma gondii infection in covid-19 patients: a systematic review and meta-analysis
The results of this study showed that there is a significant relationship between toxoplasmosis and COVID-19, which has been proven in toxoplasmosis and some underlying diseases. On the other hand, the severity of symptoms in patients with simultaneous toxoplasmosis and COVID-19 due to an increase in the amount of cytokines, including gamma interferon, has been observed. According to the findings of this study, the prevalence of COVID-19 is higher in individuals with toxoplasmosis. Microbial Pathogenesis 21 October 2024 

The impact of the COVID-19 pandemic on recovery from substance use disorder: Findings from a qualitative study
Many individuals already in SUD recovery before COVID-19 remained in recovery despite the challenges of pandemic era. The role of peer support in recovering individuals managing negative emotions caused by COVID-19 is considered. Substance use research and treatment 18 October 2024

Are covid-19 tests still working?
“The vast majority of currently circulating variants (including the so called FLiRT variants fuelling the current wave) are descendants of the omicron variant—and existing evidence suggests that rapid antigen tests still perform well at identifying omicron (versus non-omicron) variants,” Sundaram says, citing work done by the FDA on omicron variants as late as 2022.3  Sundaram and others tell The BMJ that many of the mutations that define variants aren’t expected to change the sensitivity of the tests. That’s partly because these mutations often affect the spike protein of the virus, whereas the tests, for the most part, target proteins that are much more preserved over time. BMJ 17 October 2024 

Next-generation SARS-CoV-2 vaccine formulations and alternative routes of administration
The development of SARS-CoV-2 next-generation vaccines with the potential for increased effectiveness, durability, breadth, and ability to decrease transmission are of public health importance. We highlight alternative routes of administration of next-generation SARS-CoV-2 vaccines such as mucosal and intradermal administration. Journal of infectious diseases 16 October 2024

In utero exposure to maternal COVID-19 and offspring neurodevelopment through age 24 Months
In this cohort study of pregnant individuals and offspring, exposure to maternal COVID-19 was not associated with abnormal neurodevelopmental screening results through 24 months’ post partum. Continued study of diverse groups of children is needed because, among other factors, evidence suggests sensitivity of the developing fetal brain to maternal immune activation. JAMA 16 October 2024

Relative effectiveness and waning of a third dose of mRNA COVID-19 vaccine in Medicare beneficiaries aged 65 years and older during the BA.1/BA.2 Omicron period
A third dose COVID-19 vaccine provided significant added benefit against COVID-19-related hospitalization and death, even for beneficiaries with prior medically attended COVID-19 diagnoses. This added benefit decreased after 4 months. Journal of infectious diseases 15 October 2024

SARS-CoV-2 infection and new-onset Type 2 Diabetes among pediatric patients, 2020 to 2022
In this retrospective cohort study of children and adolescents aged 10 to 19 years, the risk of an incident diagnosis of  type 2 diabetes (T2D)  was greater following a COVID-19 diagnosis than in children diagnosed with  other respiratory infections (ORIs). Further study is required to determine whether diabetes persists or reverses later in life. JAMA 14 October 2024

Longitudinal assessment of health-related quality of life after SARS-CoV-2 infection and the associations with clinical and social characteristics in a general practice population
The negative association post-COVID conditions (PCC) has with both mental and physical health-related quality of life (HRQoL) for at least six months, calls for more research to support patients with PCC. Health and quality of life outcomes 9 October 2024

SARS-CoV-2 antigen rapid detection tests: test performance during the COVID-19 pandemic and the impact of COVID-19 vaccination
The decline in  rapid detection tests (RDTs) sensitivity throughout the pandemic can primarily be attributed to the reduced prevalence of symptomatic infections among vaccinated individuals and individuals infected with Omicron VOC. RDTs remain valuable for detecting SARS-CoV-2 in symptomatic individuals and offer potential for detecting other respiratory pathogens in the post-pandemic era, underscoring their importance in infection control efforts. eBioMedicine 9 October 2024

COVID-19 disease incidence and severity in previously infected unvaccinated compared with previously uninfected vaccinated persons
The incidence rate (per 1000 person-days) of breakthrough infection among vaccinated individuals was similar to reinfection rate among unvaccinated individuals. The incidence rate of hospitalization/death was higher after reinfection compared with rate after breakthrough infection. The incidence of hospitalization/death is significantly higher after reinfection among unvaccinated individuals compared with breakthrough infection after vaccination. Journal of infectious diseases 8 October 2024

Post–COVID-19 condition fatigue outcomes among Danish residents
The burden of post–COVID-19 condition fatigue was highest among patients with more severe cases of infection and was long-lasting, suggesting that patients with severe acute infection may benefit from clinical follow-up for fatigue. JAMA 7 October 2024

Timing of total joint arthroplasty post-COVID-19: an evaluation of the optimal window to minimize perioperative risks
Patients with a positive COVID-19 diagnosis within 12 weeks of Total hip arthroplasty (THA) or total knee arthroplasty (TKA) carried a significantly higher risk for postoperative complications and mortality. In addition, a Charlson Comorbidity Index (CCI) score > 3 is also a significant risk factor. These findings emphasize the importance of vigilant preoperative screening and risk stratification in the era of COVID-19. Arthroplasty 4 October 2024

Lithium Aspartate for Long COVID fatigue and cognitive dysfunction: A randomized clinical trial
The findings of this trial suggest that lithium aspartate, 10 to 15 mg/d, is ineffective for neurologic post–COVID-19 condition fatigue and cognitive dysfunction; the effect of higher dosages needs to be assessed in another randomized clinical trial. JAMA 2 October 2024

National Institutes of Health COVID-19 Treatment Guidelines Panel: Perspectives and lessons learned 
The purpose of this article is to expand on the experiences of the NIH COVID-19 Treatment Guidelines Panel (the Panel) over the past 4 years, summarize the Panel’s final recommendations for COVID-19, highlight some challenges and unanswered questions about COVID-19 management, and inform future responses to public health emergencies. Annals of internal medicine 1 October 2024

Monkeypox

Updated 11 December 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

Efficacy of laundry practices in eliminating monkeypox virus (MPXV) from fabrics
Given the expected concentrations of MPXV on fabrics, the low transfer rate of viruses from porous surfaces to skin, the effective inactivation of laundry processes, and the expected doses required for infection, we expect the risk of transmission after laundering contaminated fabrics to be low. This study provides evidence to support WHO guidance for MPXV inactivation, reducing the viral load on fabrics to prevent the spread of mpox in both healthcare and household settings. Journal of infectious diseases 7 December 2024

What every intensivist needs to know about mpox
As the mpox outbreak intensifies, by August 31, 2024, a total of 106,310 confirmed cases have been reported across 123 countries worldwide, resulting in 234 laboratory-confirmed deaths. Intensivists who are caring for mpox patients should consider receiving the modified vaccinia Ankara (MVA) vaccine (JYNNEOS, Bavarian Nordic) to reduce the risk of infection. For individuals with compromised immune systems, including those with HIV, primary immunodeficiencies, or those undergoing immunosuppressive therapy, the MVA vaccine is considered safe. Critical care 4 November 2024

Mpox clinical presentation, diagnostic approaches, and treatment strategies: A review
Mpox is a viral infection transmitted primarily through close skin to skin contact that typically causes a self-resolving illness but can result in severe illness and death in immunocompromised individuals. First-line therapy is supportive care, although patients with severe mpox infection may be treated with advanced therapeutics. Mpox vaccination is effective and, if available, should be offered to individuals at risk of exposure to mpox. JAMA 14 October 2024

Mpox needs a locally tailored global response
Mpox has spread rapidly across continents, igniting fear and uncertainty. Since 2022, 52 329 cases have been recorded (of which 9335 are confirmed), and 1798 deaths. The disease has shown potential for sexual transmission, particularly among men who have sex with men, but more recently has spread in other populations, including in children. BMJ 27 September 2024

Vaccination to prevent mpox
Understanding the effectiveness of vaccination to prevent mpox will determine how the vaccine can be used, along with other control measures, to limit spread. BMJ 23 September 2024

Mpox on the rise
Doctors are being urged to be on the lookout for mpox symptoms with a recent increase of cases in Australia. According to the National Notifiable Disease Surveillance System, as of 10 September 2024, there had been 480 notifications of mpox (formerly monkeypox) in 2024, with most of these in NSW (237 cases). MJA Insight 23 September 2024

Effectiveness of modified vaccinia Ankara-Bavarian Nordic vaccine against mpox infection: emulation of a target trial
The findings of this study, conducted in the context of a targeted vaccination programme and evolving outbreak of mpox, suggest that one dose of MVA-BN is moderately effective in preventing mpox infection. BMJ 11 September 2024 

Mpox in pregnancy — Risks, vertical transmission, prevention, and treatment
The alarming surge in human-to-human transmission of monkeypox virus (MPXV) infections, particularly in high-risk, sexually active, and reproductive-age populations, along with the known association between MPXV infection and adverse obstetrical outcomes, highlights the urgent need for data to enhance our understanding and mitigate the risks of MPXV infection during pregnancy. NEJM 28 August 2024

The Mpox global health emergency — A time for solidarity and equity
This mpox Public Health Emergency of International Concern (PHEIC) declaration is the third in 5 years — a clear acknowledgment of ongoing threats to health security. Each declared emergency spurs international action, which then wanes without bringing endemic disease to an end. Bringing sustained attention and investment to the Democratic Republic of Congo (DRC) and its neighbors is good for the region and good for the world. NEJM 28 August 2024

Dynamic landscape of mpox importation risks driven by heavy-tailed sexual contact networks among men who have sex with men in 2022
The accumulation of immunity among high-risk individuals over highly heterogeneous sexual networks may have contributed to the slowdown in the rate of mpox importations. Nevertheless, the existence of countries with the potential to contribute to the global spread of mpox highlights the importance of equitable resource access to prevent the global resurgence of mpox. Journal of infectious diseases 28 August 2024

The resurgence of Mpox in Africa
The current epidemiological characteristics in the Democratic Republic of the Congo (DRC) differ greatly from those of the 2022 clade II global epidemic, which is still ongoing but at a much-reduced level. The 2022 mpox epidemic (clade II) has been primarily spread through sexual contact among men who have sex with men. As such, adult men are almost exclusively affected. The clade II global epidemic has had a relatively low case fatality risk of less than 1% overall. In contrast, the DRC is seeing a sizable burden of cases in children attributed to clade I. More than 50% of reported cases, and a majority of deaths, are in children younger than 5 years. Although confirmatory testing is uncommon, these infections are presumed to be clade Ia, which is endemic in the region. JAMA 20 August 2024

Mpox outbreaks in Africa—we must avert another failure of global solidarity
On 13 August 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared the ongoing mpox outbreak a public health emergency of continental security. This outbreak is driven by the emergence of a new clade 1b variant that is better adapted to human-to-human transmission. On 14 August, the World Health Organization (WHO) declared the current outbreak a public health emergency of international concern (PHEIC) under the International Health Regulations (2005). Amid another widespread epidemic is another unfolding story of vaccine inequity, and yet another looming failure of global solidarity. We have seen this before, and it does not end well for anyone. BMJ 15 August 2024

Mpox: two years on
Two years on from the global “monkeypox” epidemic, the disease now called mpox remains dangerous. BMJ 30 July 2024

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