COVID-19

COVID-19 Latest from research publications
compiled by the SALHN (SA Health) library staff - updated 11 October 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

• OzSAGE
• BMJ
• UpToDate
• Walters Kluwer (UpToDate) resources and tools
• Elsevier (Clinical Key)
• NEJM
• Lancet
• JAMA
• World Health Organization technical guidance
• Global research on coronavirus disease (COVID-19) (WHO)
• National Covid-19 Clinical taskforce
• Australian Department of Health
• SA Health
• NICE (National Institute for Health and Care Excellence)
• John Hopkins University COVID-19 Global case tracker
• COVID-19: examining the effectiveness of non-pharmaceutical interventions 

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

Tracking COVID-19 infections using survey data on rapid at-home tests
his study suggests that nonprobability survey data can be used to estimate the temporal evolution of test-confirmed infections during an emerging disease outbreak. Self-reporting tools may enable government and health care officials to implement accessible and affordable at-home testing for efficient infection monitoring in the future JAMA 30 September 2024

Cigarette smoking status and COVID-19 hospitalization in the context of cannabis use: An electronic health record cohort study in northern California
Highlights

• Former and current cigarette smoking were risk factors for COVID-19 hospitalization.
• No detected link between the co-use of cigarettes and cannabis and COVID-19 hospitalization.
• Current cigarette smoking was a risk factor for COVID-19 hospitalization when the cannabis use status was unknown. 
• The association between cigarette smoking and COVID-19 hospitalization varied by cannabis use.
• The result highlights the importance of considering both cigarette smoking and cannabis use when investigator risk factors of COVID-19 outcomes.

Addictive behaviors reports 26 September 2024

Rates of sudden unexpected infant death before and during the COVID-19 pandemic 
This cross-sectional study found increased rates of both sudden infant death syndrome (SIDS)  and sudden unexpected infant death (SUID) during the COVID-19 pandemic, with a significant shift in epidemiology from the prepandemic period noted in June to December 2021. These findings support the hypothesis that off-season resurgences in endemic infectious pathogens may be associated with SUID rates, with RSV rates in the US closely approximating this shift. Further investigation into the role of infection in SUID and SIDS is needed. JAMA 26 September 2024

Emerging SARS-CoV-2 resistance after antiviral treatment
In this study, the emergence of SARS-CoV-2 strains with resistance to nirmatrelvir after treatment was rare, irrespective of virologic rebound. JAMA 25 September 2024

Impact of the COVID-19 pandemic on health-care use among patients with cancer in England, UK: a comprehensive phase-by-phase time-series analysis across attendance types for 38 cancers
The UK's COVID-19 pandemic lockdown affected cancer health service access negatively. Many groups of individuals with cancer had declines in attendance volume and consultation rate across the phases of the pandemic. A decrease in attendances might lead to delays in cancer diagnoses, treatment, and follow-up, putting such groups of individuals at higher risk of negative health outcomes, such as cancer-specific mortality. The authors discuss the factors potentially responsible for explaining changes in service provision trends and provide insight to help inform clinical follow-up for groups of individuals at risk, alongside potential future policy changes in the care of such patients. The Lancet digital health 25 September 2024

Humoral immunity after mRNA SARS-CoV-2 omicron JN.1 vaccination
Bretovameran, an mRNA vaccine adapted to the spike protein of the omicron JN.1 variant, increased anti-spike IgG in all vaccinated people at 13 days after vaccination and strengthened neutralising responses against circulating SARS-CoV-2-variants except KP.3. The Lancet infectious diseases 25 September 2024

Safety and immunogenicity of a single-dose omicron containing COVID-19 vaccination in adolescents: an open label, single-arm, phase 2/3 trial
In vaccine-naive, SARS-CoV-2-positive adolescents, single-dose mRNA-1273.222 was effective against COVID-19 based on successful immunobridging to the two-dose mRNA-1273 primary series in young adults. The findings support a simplified single-dose vaccination schedule with variant-containing mRNA vaccines, regardless of previous vaccination status. The Lancet infectious diseases 24 September 2024

Positive Autism screening rates in toddlers born during the COVID-19 pandemic
In this cohort study of 2 groups of children with prenatal pandemic exposure and/or exposure to maternal SARS-CoV-2 infection, neither exposure was associated with greater Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) positivity. JAMA 23 September 2024

Changes in memory and cognition during the SARS-CoV-2 human challenge study
These results support larger cross sectional findings indicating that mild Wildtype SARS-CoV-2 infection can be followed by small changes in cognition and memory that persist for at least a year. The mechanistic basis and clinical implications of these small changes remain unclear. eClinicalMedicine 21 September 2024

Lessons learnt from the first two SARS-CoV-2 Omicron waves of the COVID-19 pandemic in six remote Aboriginal and Torres Strait Islander communities in Queensland, Australia: a retrospective epidemiological review 

• The known: Over the course of the COVID-19 pandemic, there have been heightened concerns for the health and wellbeing of First Nations people across Australia.
• The new: This descriptive study was a retrospective epidemiological review of the impact of COVID-19 on six remote First Nations communities in Queensland and their community-led public health responses.
• The implications: A community-led approach should be prioritised in other public health responses throughout First Nations communities.

MJA 19 September 2024

Acceptance of SARS-CoV-2 surveillance testing among patients receiving dialysis: A cluster randomized trial
In this cluster randomized trial evaluating 2 SARS-CoV-2 testing strategies in dialysis facilities, test acceptance was low, and a dynamic testing strategy anchored to COVID-19 infection prevalence did not outperform a static testing strategy of every 2 weeks. JAMA 19 September 2024

A machine learning method for allocating scarce COVID-19 Monoclonal Antibodies
Using electronic health record data to show that machine learning methods, namely policy learning trees, can improve the allocation of scarce therapeutics; therefore, policy learning tree–based allocation should be considered in potential future episodes of therapeutic scarcity, including pandemics. JAMA 13 September 2024 

Role of TOMM34 on NF-κB activation-related hyperinflammation in severely ill patients with COVID-19 and influenza
In this study, viral induction of TOMM34 is positively correlated with the hyperinflammation in severely ill patients with COVID-19 and influenza. Our findings also highlight the physiological role of TOMM34 in the innate antiviral signallings. eBioMedicine 13 September 2024

Early, robust mucosal secretory IgA but not IgG response to SARS-CoV-2 spike in oral fluid is associated with faster viral clearance and COVID-19 symptom resolution.
Robust mucosal SIgA early post infection appears to support faster clearance of SARS-CoV-2 and recovery from COVID-19 symptoms. This research underscores the importance of harmonizing mucosal immune response assays to evaluate new mucosal vaccines. Journal of infectious diseases 12 September 2024

Evaluation of the feasibility and efficacy of point-of-care antibody tests for biomarker guided management of COVID-19
Although both point-of-care (POC)  tests deviated moderately from the GenScript assay, they predicted outcomes of interest. The RightSign test was easier to use and was more likely to detect those lacking antibody compared to the LumiraDX test treating GenScript as the gold standard. Journal of infectious diseases 12 September 2024

Real-time estimation of immunological responses against emerging SARS-CoV-2 variants in the UK: a mathematical modelling study
This study shows the feasibility of real-time estimation of antibody kinetics before SARS-CoV-2 variant emergence. This estimation is valuable for understanding how specific combinations of SARS-CoV-2 exposures influence antibody kinetics and for examining how COVID-19 vaccination-campaign timing could affect population-level immunity to emerging variants. The Lancet infectious diseases 11 September 2024

Potential immunomodulatory effects of CAS+IMD monoclonal antibody cocktail in hospitalized patients with COVID-19
These results identified immunophenotypic changes indicative of a possible SARS-CoV-2 neutralizing antibodies-induced anti-inflammatory effect, without an evident impairment of cellular antiviral immunity, suggesting that further studies of Mabs effects on SAS-CoV-2 or other viral mediated inflammation are warranted. eBioMedicine 11 September 2024

Act fast, stop COVID: The successful implementation of the first decentralised Victorian COVID-19 contact tracing and monitoring unit
Key successes and learnings from the Barwon South-West (BSW) Public Health Unit (PHU)  contributed to the improvement of statewide systems and responses and provided an impetus for the implementation of a decentralised public health model for Victoria. Australian and New Zealand journal of public health 10 September 2024

T cell responses to repeated SARS-CoV-2 vaccination and breakthrough infections in patients on TNF inhibitor treatment: a prospective cohort study
Patients with inflammatory bowel disease (IBD) on tumour necrosis factor inhibitors (TNFi) have T cell responses comparable to healthy controls despite attenuated humoral responses following three vaccine doses. Repeated vaccination and breakthrough infection increased the quality of T cell responses. Our study adds evidence that, in the absence of other risk factors, this group may in future be able to follow the general recommendations for COVID-19 vaccines. eBioMedicine 10 September 2024 

COVID-19 mRNA vaccines induce robust levels of IgG but limited amounts of IgA within the oronasopharynx of young children
Despite the induction of specific IgG in the oronasal mucosa, current intramuscular vaccines have limited ability to generate mucosal IgA in young children. These results confirm the independence of mucosal IgA responses from systemic humoral responses following mRNA vaccination and suggest potential future vaccination strategies for enhancing mucosal protection in this young age group. Journal of infectious diseases 10 September 2024

Association between hospital type and resilience during COVID-19 caseload stress: A retrospective cohort study
Comparably detrimental relationships between COVID-19 caseload and survival were seen across all hospital types, including highly advanced centers, and well beyond the pandemic’s learning curve. These lessons from the pandemic heighten the need to minimize caseload surges and their effects across all hospital types during public health and staffing crises. Annals of internal medicine 10 September 2024

Health outcomes 3 months and 6 months after molnupiravir treatment for COVID-19 for people at higher risk in the community (PANORAMIC): a randomised controlled trial
In a vaccinated population, people treated with molnupiravir for acute COVID-19 felt better, experienced fewer and less severe COVID-19 associated symptoms, accessed health care less often, and took less time off work at 6 months. However, the absolute differences in this open-label design are small with high numbers needed to treat. The Lancet infectious diseases 9 September 2024

Will we ever know where covid-19 came from?
The pandemic’s origins, the lab leak theory, and the blame game have been in the headlines again. Despite another war of words, we aren’t any closer to a definitive answer as to where the novel coronavirus came from. BMJ 9 September 2024

Self-perceived barriers to healthcare access for patients with post COVID-19 condition
This study shows that the majority of patients with post COVID-19 condition (PCC) experiences barriers to healthcare access. Particular attention should be paid to younger, non-hospitalized patients with a long disease duration and severe PCC symptoms. Efforts to remove barriers should focus not only on improving availability of care, but also on helping patients navigate care pathways. BMC health services research 6 September 2024  

Drug-drug interactions and the clinical tolerability of Colchicine among patients with COVID-19: A secondary analysis of the COLCORONA randomized clinical trial
The findings of this study suggest that drug-drug interaction-associated changes in colchicine pharmacokinetics do not translate into clinically significant changes in its safety and efficacy profile. JAMA 6 September 2024 

Cardiac manifestations and outcomes of COVID-19 vaccine-associated myocarditis in the young in the USA: longitudinal results from the Myocarditis After COVID Vaccination (MACiV) multicenter study
Myocardial injury at initial presentation and its persistence at follow up, despite a mild initial course and favorable mid-term clinical outcome, warrants continued clinical surveillance and long-term studies in affected patients with C-VAM. eClinicalMedicine 6 September 2024

Sodium–glucose co-transporter-2 inhibitors for hospitalised patients with COVID-19: a prospective meta-analysis of randomised trials
Although administration of SGLT2 inhibitor was safe, the authors found no clear evidence that adding SGLT2 inhibitor therapy improved outcomes in patients hospitalised with COVID-19 compared with usual care or placebo. These data do not support the use of SGLT2 inhibitors as standard treatment in adults hospitalised for COVID-19. The Lancet diabetes and endocrinology 6 September 2024

New-onset obstructive airway disease following COVID-19: a multicenter retrospective cohort study
This study offers convincing evidence of the association between COVID-19 and the subsequent onset of asthma and bronchiectasis. It underscores the need for a multidisciplinary approach to post-COVID-19 care, with a particular focus on respiratory health. BMC medicine 4 September 2024

Convergence of SARS-CoV-2 spike antibody levels to a population immune setpoint
These results suggest that titre-dependent kinetics driven by widespread transmission direct the evolution of population immunity in a consistent manner. These findings have implications for targeted vaccination strategies and improved modeling of future transmission, providing a preliminary blueprint for understanding population immune dynamics that could guide public health and vaccine policy for SARS-CoV-2 and potentially other pathogens. eBioMedicine 3 September 2024

Effect of timing of casirivimab and imdevimab administration relative to mRNA-1273 COVID-19 vaccination on vaccine-induced SARS-CoV-2 neutralising antibody responses: a prospective, open-label, phase 2, randomised controlled trial
Casirivimab and imdevimab administration before or at the time of COVID-19 vaccination reduced the elicitation of SARS-CoV-2 neutralising antibodies, but minimal effect was observed when vaccination occurred before mAb administration. Although the clinical significance of this decrease in neutralisation is unclear, this evidence suggests that further investigation of potential interactions could be warranted before concurrent clinical use of mAbs and vaccines targeting the same viral proteins as their main modes of action for the prevention or treatment of infectious diseases. The Lancet infectious diseases 2 September 2024

Autoimmune sequelae after Delta or Omicron variant SARS-CoV-2 infection in a highly vaccinated cohort
Findings of this study suggest that booster vaccination may mitigate the risk of long-term autoimmune sequelae after Omicron variant infection. JAMA 30 August 2024

Influenza and COVID-19 vaccination rates among children receiving long-term ventilation
Children who receive tracheostomy and home ventilation (HV) are at high risk of acute respiratory infections (ARIs), the leading cause of hospitalization and death among these patients. The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend annual influenza and COVID-19 vaccinations for all children aged 6 months or older, unless medically contraindicated. Concern, however, exists that growing antivaccination sentiments, emerging “medical freedom movements,” and specific mistrust of COVID-19 vaccines may negatively affect rates of vaccination among children at high risk. Given these concerns, we examined rates of influenza and COVID-19 vaccination among children receiving long-term HV. The authors hypothesized that uptake of the influenza vaccine would be higher than COVID-19. JAMA 28 August 2024

COVID-19 diagnosis, vaccination during pregnancy, and adverse pregnancy outcomes of 865,654 women in England and Wales: a population-based cohort study
Pregnant women with a COVID-19 diagnosis have higher risks of adverse pregnancy outcomes. These findings support recommendations towards high-priority vaccination against COVID-19 in pregnant women. The Lancet regional health - Europe 22 August 2024

COVID-19 and multiple sclerosis: challenges and lessons for patient care
This article explores current evidence on the interaction between MS and SARS-CoV-2, identifies the challenges posed by the COVID-19 pandemic in the care of patients with MS, and discusses the significant adoption of digital health solutions, including telemedicine and new technology-based rehabilitation approaches. Based on lessons learned, recommendations and future directions are offered for managing patients with MS, rethinking healthcare systems and improving health outcomes in the post-COVID-19 pandemic era. The Lancet regional heath – Europe 22 August 2024

Early warning COVID-19 outbreak in long-term care facilities using wastewater surveillance: correlation, prediction, and interaction with clinical and serological statuses
Implementation of wastewater-based surveillance (WBS) could enable targeted clinical investigations and improve cost-effectiveness of COVID-19 outbreak management in long-term care facilities (LTCFs). WBS and serostatus provided informed dynamic changes of infections and immunity. Critical evidence was that LTCF WBS is an effective early warning system to support rapid public health outbreak management and protect vulnerable older populations. The Lancet microbe 22 August 2024

COVID-19 and mental illnesses in vaccinated and unvaccinated people
In this study, incidence of mental illnesses was elevated for up to a year following severe COVID-19 in unvaccinated people. These findings suggest that vaccination may mitigate the adverse effects of COVID-19 on mental health. JAMA 21 August 2024 

Characterizing Long COVID in children and adolescents
This study developed research indices for characterizing postacute sequelae of SARS-CoV-2 infection (PASC) in children and adolescents. Symptom patterns were similar but distinguishable between the 2 groups, highlighting the importance of characterizing PASC separately for these age ranges. JAMA 21 August 2024

The public health and economic burden of long COVID in Australia, 2022–24: a modelling study
The known: In some people, infection with SARS‐CoV‐2 has persistent effects on multiple organ systems. 
The new: Our model indicated that 172 530–872 799 people would have long COVID symptoms at the end of 2024. The number of working hours lost would be highest for people aged 30–49 years, leading to an estimated mean economic loss of up to $9.6 billion (2020–21 value), or one‐quarter of GDP growth during 2022.
The implications: The health and economic burdens of long COVID are substantial, especially for working adults. Preventing and treating COVID‐19 and treating long COVID will reduce these substantial effects. MJA 19 August 2024

Modeling nursing home harms from COVID-19 staff furlough policies
The findings of this study suggest that allowing nursing home staff who were mildly ill with COVID-19 to work while masked was associated with less harm from alleviated missed tasks, outweighing increasing harm from COVID-19 transmission. JAMA 19 August 2024

Post-acute COVID-19 outcomes including participant-reported long COVID: amubarvimab/romlusevimab versus placebo in the ACTIV-2 trial
Amubarvimab/romlusevimab treatment, while highly effective in preventing hospitalizations/deaths, did not reduce risk of Long COVID. Additional interventions are needed to prevent Long COVID. eClinicalMedicine 16 August 2024

State COVID-19 vaccine mandates and uptake among health care workers in the US
This repeated cross-sectional study found that state COVID-19 vaccine mandates for health care workers (HCWs)  were associated with increased vaccine uptake among HCWs, especially among younger HCWs and those in states with no test-out option. These findings suggest the potential for vaccine mandates to further promote vaccinations in an already highly vaccinated HCW population, especially when no test-out option is in place. JAMA 14 August 2024 

FLiRTing with danger as SARS-CoV-2 variants evolve
Recent FLiRT variants are named with a JN or KP prefix and have developed the same set of mutations in the spike protein through convergent evolution. They have demonstrated their viral fitness by becoming the dominant circulating variants. The relaxation of quarantine measures, lack of testing, and fewer vaccinations has provided the space for these variants to continue to circulate and evolve. The lack of community and home-based testing, waning immunity post-vaccination, and the generally milder disease experienced by the majority of those infected, means tracking case numbers is also challenging; viral levels are primarily being measured via wastewater and health-care case notifications. The Lancet respiratory medicine 14 August 2024

The significance of recurrent de novo amino acid substitutions that emerged during chronic SARS-CoV-2 infection: an observational study
De novo amino acid substitutions (DNS) that emerges recurrently in different chronically-infected patients may be used as a marker for potential epidemiologically-significant variants. eBioMedicine 13 August 2024

COVID-19 vaccination and birth outcomes of 186,990 women vaccinated before pregnancy: an England-wide cohort study
The authors  found evidence that pregnancies starting within 12 months from a first COVID-19 vaccination, compared to those in unvaccinated women, experienced fewer adverse birth outcomes, overall or in selected subgroups of the general population, accounting for potential confounders. An mRNA vaccine should be preferred to a viral-vector vaccine, to minimise safety issues, but where the latter is the only choice, it is still to be preferred to starting a pregnancy unvaccinated. The venous thromboembolism risk of the viral-vector vaccine was substantially lower compared to that attributable to SARS-CoV-2 infection in pregnancy or to commonly used medications such as hormone replacement therapy and oral contraceptives in the non-pregnant population. The Lancet regional health -Europe13 August 2024

Monkeypox

Updated 1 October 2024

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

• Monkeypox – Laboratory case definition 
• ATAGI clinical guidance on vaccination against Monkeypox
• Monkeypox treatment guidelines
• ICEG interim guidance on Monkeypox for health workers
• CDNA Monkeypox virus infection case and contact management guidelines 

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

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