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What's new in the medical literature

Updated 15 September 2023


Cochrane Library


MJA insight




Other journals




Intravenous iron supplementation in heart failure with reduced ejection fraction
Iron deficiency is common in patients with heart failure (HF), but it remains unclear whether iron supplementation reduces mortality or hospitalization in this population. Recently published research on the effects of intravenous (IV) iron supplementation included the following observations: In a trial in nearly 3100 patients with HF and reduced ejection fraction (HFrEF), IV iron supplementation improved iron stores but did not clearly reduce the risk of cardiovascular mortality or HF hospitalization [7]. In a meta-analysis of randomized trials of IV iron in patients with HFrEF, IV iron reduced the risk of HF hospitalization but had an unclear effect on cardiovascular mortality [8]. These data support the use of IV iron to reduce hospitalization in patients with HFrEF who have iron deficiency. (See "Evaluation and management of anemia and iron deficiency in adults with heart failure", section on 'Iron supplementation'.)

Lack of evidence that blue light-filtering lenses improve sleep
Blue light-filtering glasses are marketed widely to reduce adverse effects of light-emitting screens on sleep, but supporting evidence is lacking. A recent systematic review identified six small randomized trials examining sleep outcomes with use of blue light-filtering lenses [58]. Trial results were inconsistent, and meta-analysis could not be performed due to high heterogeneity and lack of quantitative outcome data. We counsel patients to avoid use of electronics at least 30 minutes before usual bedtime and in the middle of the night if nocturnal awakenings occur (table 3). Based on available evidence, we advise that blue light-filtering glasses are not a substitute for avoidance of screens. (See "Insufficient sleep: Evaluation and management", section on 'Counseling on lifestyle changes'.)

Peritumoral lidocaine injection before incision for breast cancer surgery
In a multicenter, randomized trial of over 1000 patients with early breast cancer undergoing mastectomy or breast-conserving surgery, peritumoral injection of 0.5% lidocaine prior to incision improved five-year disease-free survival (87 versus 83 percent) and five-year overall survival (90 versus 86 percent) [5]. The mechanism is unknown but thought to involve blocking voltage-gated sodium channels and thereby preventing activation of prometastatic pathways. The trial protocol for surgical management of breast cancer deviated from what may be considered standard treatment in many clinical practices, so further validation is necessary; however, peritumoral injection of lidocaine may be a reasonable intervention given its simplicity and minimal cost. (See "Breast-conserving therapy", section on 'Incision'.)



Lung cancer screening for Aboriginal and Torres Strait Islander peoples: an opportunity to address health inequities
The implementation of a national Lung Cancer Screening Program (LCSP), commencing in July 2025, presents a significant opportunity to have an impact on an intractable health problem for Aboriginal and Torres Strait Islander communities. Lung cancer is the most common cancer and the leading cause of cancer death for Aboriginal and Torres Strait Islander peoples. MJA 11 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

Prevalence, patterns of use, and socio‐demographic features of e‐cigarette use by Australian adolescents: a survey
These findings indicate that strategies for preventing the uptake and reducing the use of e‐cigarettes by Australian adolescents are needed. A multilevel approach with components at the individual (eg, primary health care screening and intervention), school (eg. normative education and resistance skills training), and community levels (eg, e‐cigarette control policies, media campaigns) would be appropriate. MJA 11 September 2023

Sexual abuse during childhood and all‐cause mortality into middle adulthood: an Australian cohort study
Sexual abuse during childhood is associated with higher mortality rates into mid‐adulthood. Preventing child sexual abuse and intervening early to reduce the damage it inflicts is not only essential for the welfare of the child, but could also help reduce avoidable deaths later in life. MJA 11 September 2023


MJA insight

Clinicians 'must adapt their approach' to culturally or linguistically diverse patients
Patients from culturally or linguistically diverse backgrounds are at a higher risk of experiencing harm during health care, highlighting the need for clinicians to adapt their approach to better engage with these patients. MJA insight 11 September 2023

Tackling the burden of endometriosis: patients must be put first
Endometriosis research priorities identified by consumers often differ from those developed by clinicians and scientists in key areas. For example, consumers and family members were more likely to prioritise education, awareness, emotional impact, and comorbid conditions, whereas health care professionals and scientists were more interested in cause or risk factors, diagnosis and screening, treatment, and fertility. MJA insight 4 September 2023


Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study
This study found positive associations between risk of CVD and intake of five individual and two groups of food additive emulsifiers widely used in industrial foods. BMJ 6 September 2023

Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study
NSAID use was positively associated with the development of venous thromboembolism in women of reproductive age. The number of extra venous thromboembolic events with NSAID use compared with non-use was significantly larger with concomitant use of high/medium risk hormonal contraception compared with concomitant use of low/no risk hormonal contraception. Women needing both hormonal contraception and regular use of NSAIDs should be advised accordingly. BMJ 6 September 2023

Management of epilepsy during pregnancy and lactation
For women with epilepsy in their childbearing years, the safety profile is important for them and their unborn children, because treatment is often required to protect them from seizures during pregnancy and lactation. BMJ 8 September 2023

Two-drug antiretroviral regimens for HIV
What you need to know

  • Antiretroviral therapy regimens containing two active drugs rather than the traditional three or more are efficacious in treating HIV
  • Two-drug regimens are a particularly useful option when tenofovir alafenamide, tenofovir disoproxil fumarate, or abacavir cannot be used or are not optimal—for example, for people with high cardiovascular risk, renal impairment, or decreased bone mineral density
  • Many two-drug regimens can be used by people who are electively switching HIV treatment and have an undetectable viral load, and one regimen is licensed for people newly starting antiretroviral therapy
  • They are not suitable for people with HIV and hepatitis B co-infection, or in those with a history of HIV drug resistance or during pregnancy
  • One long acting injectable two-drug regimen is also available, but this may not be suitable in those with a high body mass index, certain viral subtypes, or with HIV drug resistance

BMJ 1 September 2023

Personality disorder
What you need to know

  • Personality disorders are a set of complex emotional difficulties. They are common, often unrecognised, and are associated with mental and physical health comorbidities and reduced life expectancy
  • Personality disorders are perceived as stigmatising diagnoses. Alternative terms have been proposed. New classification systems help in moving away from rigid use of categorical diagnoses
  • Assessment and management in primary care require a non-judgmental approach that builds trust through attentiveness, validation, openness, and consistency
  • Holistic care for people with personality disorders can be improved with reflective practice structures, staff training, collaboration, and team working

BMJ 4 September 2023

Pyoderma gangrenosum
What you need to know

  • Pyoderma gangrenosum presents as a rapidly evolving ulcerative lesion
  • A key diagnostic clue is severe pain that may seem out of proportion to the clinical appearance
  • Pyoderma gangrenosum is often associated with underlying systemic disease
  • Missing a diagnosis of pyoderma gangrenosum can result in inappropriate debridement of the skin and subcutaneous tissue, leading to serious harm

BMJ 6 September 2023

Diagnosis and management of sacrococcygeal pilonidal disease in primary care
What you need to know

  • Refer urgently patients with an acute abscess for incision and drainage
  • Refer patients with chronic symptomatic disease for specialist input, which could include non-surgical, minimally invasive, or surgical management
  • Assess pain in symptomatic disease and offer analgesia as required

BMJ 11 September 2023

Glucose monitoring and glucose lowering agents for children and young people with type 2 diabetes: summary of updated NICE guidance
What you need to know

  • Refer children and young people with suspected or diagnosed type 2 diabetes (T2DM) to a specialist paediatric diabetes team to ensure appropriate diagnosis, investigation, and treatment, including a continuing programme of education on how diet, physical activity, and reducing body weight can improve glycaemic control
  • Capillary blood glucose monitoring is now recommended for all children and young people with T2DM, and continuous glucose monitoring for people treated with insulin
  • Specialists should consider offering liraglutide or dulaglutide, or alternatively empagliflozin, in combination with metformin to lower blood glucose

BMJ 12 September 2023

Non-erosive gastro-oesophageal reflux disease and incidence of oesophageal adenocarcinoma in three Nordic countries: population based cohort study
Patients with non-erosive gastro-oesophageal reflux disease seem to have a similar incidence of oesophageal adenocarcinoma as the general population. This finding suggests that endoscopically confirmed non-erosive gastro-oesophageal reflux disease does not require additional endoscopic monitoring for oesophageal adenocarcinoma. BMJ 13 September 2023



Antibiotic prophylaxis in infants with Grade III, IV, or V Vesicoureteral reflux
In infants with grade III, IV, or V vesicoureteral reflux and no previous UTIs, continuous antibiotic prophylaxis provided a small but significant benefit in preventing a first UTI despite an increased occurrence of non–E. coli organisms and antibiotic resistance. NEJM 12 September 2023

Water-based and waterless surgical scrub techniques
The use of a systematic procedure for surgical hand preparation — either water-based or waterless — is an important step in ensuring that those performing operative procedures have created a sterile surgical field. It is crucial to learn these skills in order to minimize the risk of surgical site infections, which have severe consequences for patient health and can result in increased health care costs. NEJM 7 September 2023

Asthma in Adults

  • Asthma guidelines state that a definitive diagnosis of asthma should be based on the presence of characteristic respiratory symptoms such as wheeze, cough, chest tightness and shortness of breath, and variable expiratory airflow obstruction on spirometry.
  • The three main goals of asthma management are control of symptoms, reduction in risk of exacerbations, and minimization of adverse effects of medications.
  • Every visit should include a review of inhaler technique, medication adherence, coexisting conditions, ongoing exposures to environmental triggers, and confirmation of a correct diagnosis of asthma.
  • In patients with mild asthma, the preferred treatment option is an inhaled glucocorticoid–formoterol combination as needed, and alternative options include the use of combination inhaled glucocorticoid–albuterol as needed or low-dose maintenance inhaled glucocorticoid plus a short-acting β2-agonist reliever as needed.
  • Combination inhaled glucocorticoid–formoterol maintenance and reliever therapy is the preferred treatment for moderate-to-severe asthma as compared with an inhaled glucocorticoid with long-acting β2-agonist maintenance plus as-needed short-acting β2-agonist reliever therapy.

NEJM 12 September 2023

Daily oral GLP-1 receptor agonist Orforglipron for adults with obesity
Daily oral orforglipron, a nonpeptide GLP-1 receptor agonist, was associated with weight reduction. Adverse events reported with orforglipron were similar to those with injectable GLP-1 receptor agonists. NEJM 7 September 2023

Current and emerging issues in Wilson’s Disease
Current advances in the diagnosis, treatment, and multidisciplinary management of Wilson’s disease are important. Future population screening is likely to identify patients earlier in the course of the disease. Novel treatments will address unmet needs and furnish new options for individualizing treatment. NEJM 7 September 2023 



Association of Gestational Diabetes with subsequent long-term risk of mortality
Results of this cohort study suggest that participants who reported a history of gestational diabetes exhibited a small but elevated risk of subsequent mortality over 30 years. The findings emphasize the importance of considering gestational diabetes as a critical factor in later-life mortality risk. JAMA 11 September 2023

Sedentary behavior and incident dementia among older adults
Among older adults, more time spent in sedentary behaviors was significantly associated with higher incidence of all-cause dementia. Future research is needed to determine whether the association between sedentary behavior and risk of dementia is causal. JAMA 12 September 2023


Other journals

Associations of a current Australian model of dietetic care for women diagnosed with gestational diabetes and maternal and neonatal health outcomes
The optimal schedule of dietitian consultations for women with GDM in Australia remains largely unclear. Alternate delivery of education for women with GDM such as telehealth and utilisation of digital platforms may assist relieving pressures on the healthcare system and ensure optimal care for women during pregnancy. BMC health services research 9 September 2023

Venous thromboembolic prophylaxis: current practice of surgeons in Australia and New Zealand for major abdominal surgery
Most surgeons in Australia and New Zealand do not use risk assessment tools and use all three forms of prophylaxis regardless. Therfore there is a gap between practice and VTE prophylaxis for the use of mechanical prophylaxis options. Further research is required to determine whether dual modality mechanical prophylaxis is incrementally efficacious. BMC Surgery 1 September 2023

Radiation therapy for metastatic bone disease: Effectiveness and harms

  • In patients having initial palliative radiation for metastatic bone disease (MBD), multiple fraction (MF) external beam radiation therapy (EBRT) probably slightly increases the likelihood of overall pain response (pain improvement) within 4 weeks of treatment versus single fraction (SF) EBRT. Both probably provide similar likelihood of overall pain response at longer followup. Re-irradiation is more common with SF EBRT.
  • For SF EBRT, overall pain response may be slightly more likely with higher doses versus lower doses in patients having initial palliative radiotherapy.
  • Stereotactic body radiation therapy (SBRT) (SF or MF) may slightly improve the likelihood of overall pain response versus EBRT for initial radiation.
  • In patients receiving re-irradiation, both SF and MF EBRT may have similar likelihood of overall pain response.
  • Harms may be similar across dose/fraction schemes and techniques, and serious harms were rare for initial radiation and re-irradiation.
  • Information on comparative effectiveness is limited.

Agency for healthcare research and quality 29 August 2023

Cardiovascular disease and all-cause mortality associated with individual and combined cardiometabolic risk factors
Cardiometabolic risk factors were associated with a multiplicative risk of cardiovascular disease (CVD) incidence and all-cause mortality, highlighting the importance of comprehensive management for hypertension, diabetes and dyslipidemia in the prevention of CVD. BMC public health 5 September 2023

Did the prevalence of depressive symptoms change during the COVID-19 pandemic? A multilevel analysis on longitudinal data from healthcare workers
Research is needed to identify factors that promote the reduction of depressive symptoms in medical HCW with exposition to COVID-19 patients. Awareness of infection protection measures should be increased. International journal of social psychiatry 6 September 2023

Effectiveness of mindfulness-based interventions on burnout and self-compassion among critical care nurses caring for patients with COVID-19: a quasi-experimental study
This study provides preliminary evidence that mindfulness-based intervention (MBI) sessions were effective in reducing emotional exhaustion and depersonalization and increasing levels of mindfulness and self-compassion among critical care nurses. BMC nursing 6 September 2023

Social determinants and exposure to intimate partner violence in women with severe acute maternal morbidity in the intensive care unit: a systematic review
This review identified a significant gap in knowledge concerning intimate partner violence and social determinants of health in women with severe acute maternal morbidity in the intensive care unit, which is essential to better understand the complete picture of the maternal morbidity spectrum and reduce maternal mortality. BMC pregnancy and childbirth 12 September 2023

Preoperative hemoglobin levels and mortality outcomes after hip fracture patients
This study illustrates that low hemoglobin levels, history of renal disease, along with male gender, advanced age, extended hospital stays, and ICU admission were significantly associated with 6-month mortality. Future investigations should consider assessing varying degrees of anemia based on hemoglobin concentrations to provide a more comprehensive understanding of anemia’s impact on mortality. BMC surgery 1 September 2023

Association of waist-calf circumference ratio, waist circumference, calf circumference, and body mass index with all-cause and cause-specific mortality in older adults: a cohort study
Higher waist-calf circumference ratio (WCR) and lower calf circumference (CC) increased the risk of all-cause, cardiovascular disease (CVD), and other-cause mortality. Lower BMI was associated with higher all-cause and respiratory disease mortality risk, while WC only predicted cancer mortality. BMC public health 12 September 2023



Australia's welfare 2023
Australia's welfare 2023 is the AIHW's 16th biennial welfare report. It is a mix of short statistical summaries and long-form articles exploring topical welfare issues. Australia’s welfare also serves as a ‘report card’ on the welfare of Australians by looking at how we are faring as a nation. AIHW 7 September 2023

Burden of avoidable deaths among Aboriginal and Torres Strait Islander people 2018
Avoidable fatal burden is the burden due to deaths that are considered potentially avoidable given timely and effective health care. In 2018, almost two-thirds (64%) of the fatal burden among Aboriginal and Torres Strait Islander (First Nations) people was classified as avoidable. AIHW 13 September 2023

Demonstrating the utility of the COVID-19 Register
This report demonstrates the utility of the newly established cross-jurisdictional COVID-19 Register. It explores potential analyses which could be conducted on the data using a subset of linked cases. This includes exploring demographic patterns, health outcomes following COVID‑19 and health system use before and after a COVID‑19 diagnosis. It is a collaboration between the Australian Institute of Health and Welfare (AIHW) and the National Centre for Immunisation Research and Surveillance. AIHW 12 September 2023

Specialist homelessness services client pathways: analysis insights
The AIHW Specialist Homelessness Services Collection includes information about clients receiving homelessness services support from 1 July 2011 onwards. These data have been analysed to examine service usage patterns and demographics for specific cohorts. Additional insights will be added regularly to this report. AIHW 12 September 2023


COVID-19 Latest from research publications
compiled by the SALHN (SA Health) library staff - updated 28 September 2023

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

Community mobility and depressive symptoms during the COVID-19 pandemic in the United States
In this study, depressive symptoms were greater in locales and times with diminished community mobility. Strategies to understand the potential public health consequences of pandemic responses are needed. JAMA 27 September 2023

The role of family communication patterns in intergenerational COVID-19 discussions and preventive behaviors: a social cognitive approach
Family communication patterns can be associated with preventive behaviors through different forms of family discussion about COVID-19. Conversation orientation is a strong facilitator for positive behavioral effects and scientific discussion is the most benign form of family health discussion. Health communication efforts should enhance the agency role of the family and motivate scientific discussion in health practices. BMC psychology 26 September 2023

Preinfection neutralizing antibodies, Omicron BA.5 breakthrough infection, and Long COVID: A propensity score-matched analysis
Preinfection immunogenicity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may play a role in protecting against the Omicron BA.5 infection but not preventing long COVID. Journal of infectious diseases 26 September 2023

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study
After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. These findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. The Lancet respiratory medicine 22 September 2023

Socioeconomic consequences of the COVID-19 pandemic for people who use drugs
The COVID-19 pandemic triggered widespread socioeconomic hardship, disproportionately impacting disadvantaged populations. People who use illicit drugs are more likely to experience unemployment, homelessness, criminal justice involvement and poorer health outcomes than the general community, yet little is known about the socioeconomic impacts of the pandemic on their lives. To address this gap in the literature, the authors conducted in-depth interviews with 76 participants from two cohort studies of people who use illicit drugs (people who inject drugs and/or use methamphetamine) in Victoria, Australia. Findings support claims that pandemic-related Social Security supplementary payments and initiatives to reduce homelessness, although not systemically transforming people's lives, produced temporary relief from chronic socioeconomic hardship. Results also indicate how temporary interruptions to drug supply chains inflated illicit drug prices and produced adverse consequences such as financial and emotional stress, which was exacerbated by drug withdrawal symptoms for many participants. Furthermore, increased community demand for emergency food and housing support during the pandemic appeared to reduce participants' access to these services. These findings about the unintended consequences of pandemic responses on the socioeconomic lives of a group of people who use illicit drugs provide insights into and opportunities for policy reform to redress their entrenched disadvantage. Australian journal of social issues 21 September 2023

Young people’s mental health changes, risk, and resilience during the COVID-19 pandemic
This cohort study of secondary school students demonstrated that to promote mental health and adjustment, policy interventions should foster home connectedness, peer friendship, and school climate; avoid full school closures; and consider individual differences. JAMA 21 September 2023

Nirmatrelvir or Molnupiravir use and severe outcomes from Omicron infections
These findings suggest that the use of either nirmatrelvir or molnupiravir is associated with reductions in mortality and hospitalization in patients infected with Omicron, regardless of age, race and ethnicity, virus strain, vaccination status, previous infection status, or coexisting conditions. Both drugs can, therefore, be used to treat nonhospitalized patients who are at high risk of progressing to severe COVID-19. JAMA 21 September 2023

Efficacy of Gabapentin for Post–COVID-19 olfactory dysfunction: The GRACE randomized clinical trial
In this randomized clinical trial, gabapentin was not associated with statistically significant or clinically meaningful benefit over placebo and likely is not an efficacious therapy for COVID-19–induced OD. JAMA 21 September 2023

Efficacy and safety of an inactivated virus-particle vaccine for SARS-CoV-2, BIV1-CovIran: randomised, placebo controlled, double blind, multicentre, phase 3 clinical trial
A two dose regimen of the BIV1-CovIran vaccine conferred efficacy of 50.2% against symptomatic covid-19, 70.5% against severe disease, and 83.1% against critical disease. Vaccination was well tolerated, with no safety concerns raised. BMJ 21 September 2023

Inhaled Fluticasone Furoate for outpatient treatment of Covid-19
Treatment with inhaled fluticasone furoate for 14 days did not result in a shorter time to recovery than placebo among outpatients with Covid-19 in the United States. NEJM 21 September 2023

Inequalities and mental health during the Coronavirus pandemic in the UK: a mixed-methods exploration
The pandemic is taking a long-term toll on the nations’ mental health which will continue to have impacts for years to come. It is therefore crucial to learn the vital lessons learned from this pandemic. Specific as well as whole-government policies need to respond to this, address inequalities and the different needs across the life-course and across society, and take a holistic approach to mental health improvement across the UK. BMC public health 20 September 2023

Long covid: the doctors’ lives destroyed by an illness they caught while doing their jobs
Unable to work or to play with their children, forced to sell their homes or facing insolvency—doctors with long covid deserve more support from the government and the NHS. BMJ 20 September 2023

Rehabilitation interventions for physical capacity and quality of life in adults with Post–COVID-19 condition: A systematic review and meta-analysis
The findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary. JAMA 19 September 2023

Outpatient treatment of confirmed COVID-19: Living, rapid practice points from the American College of Physicians (Version 2)
Evidence for the use of outpatient treatments in adults with confirmed COVID-19 continues to evolve with new data. This is version 2 of the American College of Physicians (ACP) living, rapid practice points focusing on 22 outpatient treatments for COVID-19, specifically addressing the dominant SARS-CoV-2 Omicron variant. Annals of internal medicine 19 September 2023

Outpatient treatment of confirmed COVID-19: A living, rapid evidence review for the American College of Physicians (Version 2)
Nirmatrelvir–ritonavir and molnupiravir probably improve outcomes for outpatients with mild to moderate COVID-19. Annals of internal medicine 19 September 2023

Long-term effects of the COVID-19 pandemic on five mental and psychological disorders: in terms of the number of disease visits, drug consumption, and scale scores
The epidemic environment has had a long-term and negative impact on people’s mental and psychological conditions. Therefore, whether or not the epidemic is receding, we still need to be concerned about the impact of COVID-19 on mental and psychological health. BMC psychiatry 18 September 2023

A meta-analysis of systematic reviews and meta-analyses to evaluate the psychological consequences of COVID-19
The data from the current meta-analysis showed different psychological disorders of COVID-19 during the pandemic. Clinicians should be aware of the prevalence with which COVID-19-infected patients experience emotional distress, anxiety, fatigue, and PTSD. About half of the included systematic reviews (SRs)/meta-analyses (MAs) suffered from poorer methodological quality and increased risk of bias, reducing confidence in the findings. There must be more SRs/MAs and high-quality clinical trials conducted to confirm these findings. BMC psychology 18 September 2023

Transmissibility, infectivity, and immune evasion of the SARS-CoV-2 BA.2.86 variant
A neutralisation assay using XBB breakthrough infection sera showed that the 50% neutralisation titre of XBB breakthrough infection sera against BA.2.86 was significantly (1·6-fold) lower than that against EG.5.1. Altogether, these results suggest that BA.2.86 is one of the most highly immune evasive variants so far. The Lancet infectious diseases 18 September 2023

Viral interference during influenza A-SARS-CoV-2 coinfection of the human airway epithelium and reversal by oseltamivir
To gain insight into interactions among respiratory viruses, the authors modeled influenza A virus (IAV) - SARS-CoV-2 coinfections using differentiated human airway epithelial cultures. Replicating IAV induced a more robust interferon response than SARS-CoV-2 and suppressed SARS-CoV-2 replication in both sequential and simultaneous infections, whereas SARS-CoV-2 did not enhance host cell defense during influenza infection or suppress IAV replication. Oseltamivir, an antiviral targeting influenza, reduced IAV replication during coinfection but also reduced the host antiviral response and restored SARS-CoV-2 replication. These results demonstrate how perturbations in one viral infection can impact its effect on a coinfecting virus. Journal of infectious diseases 18 September 2023

Post–COVID-19 condition in children
Strengths of this study include use of pre–COVID-19 symptom data and longitudinal prospective collection of post–COVID-19 symptoms. Limitations include depending on parent-proxy symptom reporting and the narrow age range of participants. Additional research is required into the neurobehavioral sequelae of SARS-CoV-2 infection in school-aged children. JAMA 18 September 2023

COVID-19 boosters versus primary series: update to a living review
This review indicates that an additional dose of a COVID-19 vaccine successfully increases protection against SARS-CoV-2 infections and hospitalisations. Yet, this protection wanes over time. Receiving a third, fourth, and additional future boosters are likely necessary to restore the protection offered by vaccines against infections and hospitalisations. The Lancet respiratory medicine 15 September 2023

Nirmatrelvir/ritonavir use and hospitalizations or death in previously uninfected non-hospitalized high-risk population with COVID-19: A matched cohort study
NMV/r is associated with a significant reduction in 30-day hospitalization or death among previously uninfected, non-hospitalized individuals. Journal of infectious diseases 15 September 2023

Efficacy of a bivalent (D614 + B.1.351) SARS-CoV-2 recombinant protein vaccine with AS03 adjuvant in adults: a phase 3, parallel, randomised, modified double-blind, placebo-controlled trial
The bivalent variant vaccine conferred heterologous protection against symptomatic SARS-CoV-2 infection in the epidemiological context of the circulating contemporary omicron variant. These findings suggest that vaccines developed with an antigen from a non-predominant strain could confer cross-protection against newly emergent SARS-CoV-2 variants, although further investigation is warranted. The Lancet respiratory medicine 13 September 2023

Machine learning augmentation reduces prediction error in collective forecasting: development and validation across prediction markets with application to COVID events
Real-time machine classification followed by weighting human trades according to likely accuracy improves collective forecasting performance. This could provide improved anticipation of and thus response to emerging risks. eBioMedicine 12 September 2023

Long-COVID cognitive impairments and reproductive hormone deficits in men may stem from GnRH neuronal death
Putative GnRH neuron and tanycyte dysfunction following SARS-CoV-2 neuroinvasion could be responsible for serious reproductive, metabolic, and mental health consequences in long-COVID and lead to an increased risk of neurodevelopmental and neurodegenerative pathologies over time in all age groups. eBioMedicine 12 September 2023

Predicting mortality among patients with severe COVID-19 pneumonia based on admission vital sign indices: a retrospective cohort study
Shock index age (SIA) and CURSIA scores were significantly associated with COVID-19 pneumonia mortality. These scores may contribute to better patient triage than traditional vital signs. BMC pulmonary medicine 12 September 2023

An explanation for reports of increased prevalence of olfactory dysfunction with Omicron: asymptomatic infections
The prevalence of olfactory dysfunction (OD) in people infected with the omicron variant is substantially reduced compared with previous variants. However, four recent studies reported a greatly increased prevalence of OD with omicron. The authors provide a likely explanation for these outlier studies and reveal a major methodological flaw. When the proportion of asymptomatic infections is large, then studies on the prevalence of OD will examine and report predominantly on non-representative cohorts, those with symptomatic subjects, thereby artificially inflating OD prevalence by up to ten-fold. Estimation of the true OD prevalence requires representative cohorts that include relevant fractions of asymptomatic cases. Journal of infectious diseases 12 September 2023

Antibody neutralisation of emerging SARS-CoV-2 subvariants: EG.5.1 and XBC.1.6
The author’s findings indicate that the recently surging subvariants EG.5 and EG.5.1 are only modestly (1·7-fold) more resistant to neutralisation by serum antibodies than the previously dominant subvariant XBB.1.5, largely due to the Phe456Leu mutation in the viral spike knocking out the binding of some of the antibodies that target the class-1 region of the RBD. These new subvariants will not be likely to substantially affect the efficacy of current COVID-19 vaccines, in contrast to their predecessor XBB.1.5. The Lancet infectious diseases 11 September 2023

Antiviral efficacy of the SARS-CoV-2 XBB breakthrough infection sera against omicron subvariants including EG.5
These results suggest that the breakthrough infection (BTI) of XBB subvariants cannot efficiently induce antiviral humoral immunity against the infecting variants when compared with the BTI of previous omicron variants. The Lancet infectious diseases 11 September 2023

West Australian parents’ views on vaccinating their children against COVID-19: a qualitative study
For future pandemic vaccinations pertaining to children, governments and health officials need to address parents’ concerns and meet their preferences for the delivery of the vaccine program to children and adolescents. BMC public health 11 September 2023

Factors impacting resident outcomes from COVID-19 outbreaks in Residential Aged Care Facilities in Sydney Local Health District: testing an infection prevention and control scoring system
The results of this study suggest the utility of the Infection Prevention and Control (IPC) scoring system for identifying facilities at greater risk of adverse outcomes from COVID-19 outbreaks. While further validation and replication of accuracy is required, the IPC scoring system could be used and adapted to improve planning, policy, and resource allocation for future outbreaks. BMC public health 11 September 2023

Gender differences in the relationships between meaning in life, mental health status and digital media use during Covid-19
Females had significantly better meaning in life (MIL) under COVID-19 than males. Digital media use contributed to MIL in males but not females, and there were gender-specific associated factors of MIL.BMC public health 11 September 2023

Community focus groups about a COVID-19 individual risk assessment tool: access, understanding and usefulness
This paper explores how members of the community interpret individual risk assessments and life expectancy estimations, and how these vary with age, gender, race/ethnicity, socioeconomic status, and pre-existing comorbidities. BMC public health 11 September 2023 

Antibody neutralisation of emerging SARS-CoV-2 subvariants: EG.5.1 and XBC.1.6
In summary, these findings indicate that the recently surging subvariants EG.5 and EG.5.1 are only modestly (1·7-fold) more resistant to neutralisation by serum antibodies than the previously dominant subvariant XBB.1.5, largely due to the Phe456Leu mutation in the viral spike knocking out the binding of some of the antibodies that target the class-1 region of the RBD. These new subvariants will not be likely to substantially affect the efficacy of current COVID-19 vaccines, in contrast to their predecessor XBB.1.5. Although additional antibody resistance might confer a growth advantage to EG.5 and EG.5.1, spike mutations might enhance viral receptor binding affinity. Additionally, mutations elsewhere in the genome, such as the Ile5Thr mutation in ORF9b, could have a role in the growth advantage. By contrast, XBC.1.6 is more sensitive to antibody neutralisation than XBB subvariants; therefore, it is less likely to compromise vaccine efficacy. Nevertheless, it is puzzling why XBC.1.6 is gaining in prevalence in Australia over XBB subvariants that are noticeably more evasive to antibodies. As SARS-CoV-2 continues to spread and mutate, it is imperative that we remain vigilant in tracking its evolutionary trajectory as well as in understanding the functional consequences of its mutations. The Lancet infectious diseases 11 September 2023

Chatbot-delivered online intervention to promote seasonal influenza vaccination during the COVID-19 pandemic: A randomized clinical trial
Findings of this trial indicate that stages of change (SOC) -tailored online intervention was more effective than the non–SOC-tailored intervention and may be a sustainable new method in increasing seasonal influenza vaccination (SIV) uptake among adults 65 years or older. JAMA 11 September 2023

An abnormal ECG finding in a patient with COVID-19
Osborn waves have been reported in hospitalized patients with COVID-19–associated pneumonia in the absence of hypothermia. The mechanisms proposed in these reports include myocardial and/or conduction system damage. Owing to disturbed electrolyte current in the cardiomyocytes on a background of oxidative stress, it has been proposed as a predictor of future fatal cardiac arrhythmias. Presence of Osborn wave was shown to be predictive of short-term mortality in patients with COVID-19–associated pneumonia in a small retrospective study. JAMA 11 September 2023

Immunogenicity and reactogenicity of coadministration of COVID-19 and influenza vaccines
In this cohort study of health care workers who received a COVID-19 vaccine, an influenza vaccine, or both, coadministration was not associated with substantially inferior immune response or to more frequent adverse events compared with COVID-19 vaccine administration alone, supporting the coadministration of these vaccines. JAMA 8 September 2023

SARS-CoV-2 infection and development of islet autoimmunity in early childhood
In young children with high genetic risk of type 1 diabetes, SARS-CoV-2 infection was temporally associated with the development of islet autoantibodies. JAMA 8 September 2023

Global trends in highly cited studies in COVID-19 research
This study found that the total number of highly cited studies related to COVID-19 peaked at the end of 2021 and showed a downward trend until the end of 2022, while the origin of these studies shifted from China to the US and UK. JAMA 8 September 2023

Cognitive ability, health policy, and the dynamics of COVID-19 vaccination
The authors examine the relationship between cognitive ability and prompt COVID-19 vaccination using individual-level data on more than 700,000 individuals in Sweden. We find a strong positive association between cognitive ability and swift vaccination, which remains even after controlling for confounding variables with a twin-design. The results suggest that the complexity of the vaccination decision may make it difficult for individuals with lower cognitive abilities to understand the benefits of vaccination. Consistent with this, we show that simplifying the vaccination decision through pre-booked vaccination appointments alleviates almost all of the inequality in vaccination behavior. Journal of health economics 7 September 2023

Primary exposure to SARS-CoV-2 via infection or vaccination determines mucosal antibody-dependent ACE2 binding inhibition
This study provides new insights into the relationship between antibody isotypes and neutralization by using a sensitive and high-throughput ACE2 binding inhibition assay. Key differences are highlighted between vaccination and infection at the mucosal level, showing that despite differences in the quantity of the response, post-infection and post-vaccination ACE2 binding inhibition capacity did not differ. Journal of infectious diseases 7 September 2023

What happens inside a long covid clinic?
Close to 100 NHS long covid clinics have sprung up. Erin Dean visits one and meets a multidisciplinary team tailoring support for this wide ranging and poorly understood condition. BMJ 7 September 2023

Characterizing the impacts of public health control measures on domestic violence services: qualitative interviews with domestic violence coalition leaders
The use of non-pharmaceutical control measures early in the COVID-19 pandemic had negative impacts on the health and safety of some vulnerable groups, including domestic violence victims. Organizations that provide services and advocacy to victims faced many unique challenges in carrying out their missions while adhering to required public health control measures. Policy and preparedness plan changes are needed to prevent unintended consequences of control measure implementation among vulnerable groups as well as to identify lessons learned that should be applied in future disasters and emergencies. BMC public health 5 September 2023

Determinants of the onset and prognosis of the post-COVID-19 condition: a 2-year prospective observational cohort study
Preexisting medical and socioeconomic factors, as well as acute COVID-19 symptoms, are associated with the development of and recovery from the PCC. Recovery is extremely rare during the first 2 years, posing a major challenge to healthcare systems. The Lancet regional health - Europe 4 September 2023

Post COVID-19 condition after SARS-CoV-2 infections during the omicron surge compared with the delta, alpha, and wild-type periods in Stockholm, Sweden
Little is known about post COVID-19 condition (PCC) after infections with different SARS-CoV-2 variants. The authors  investigated the risk of PCC diagnosis after primary omicron infections compared with preceding variants in population-based cohorts in Stockholm, Sweden. Compared to omicron receiving a PCC diagnosis), the adjusted hazard ratio (95% confidence interval) was 3.26 for delta (n=52,182, 0.5% PCC diagnosis), 5.33 (4.73 to 5.99) for alpha (n=97,978, 1.0% PCC diagnosis), and 6.31 (5.64 to 7.06) for wild-type (n=107,920, 1.3% PCC diagnosis). These findings were consistent across all subgroup analyses except among the ICU-treated. Journal of infectious diseases 4 September 2023

Neurological impact of COVID-19 needs more research
Australia needs to commit to more research examining the neurological symptoms that can result from COVID-19. MJA insight 4 September 2023

Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients – an observational study of five cohorts across four countries
Family members and close friends of critically ill COVID-19 patients show persistently elevated prevalence of depressive and anxiety symptoms. The Lancet Regional health – Europe 2 September 2023

Viral kinetics of SARS-CoV-2 following onset of COVID-19 in symptomatic patients infected with the ancestral strain and omicron BA.2 in Hong Kong: a retrospective observational study
The viral kinetics since symptom onset characterised for symptomatic patients with COVID-19 in this  study show that previously vaccinated or younger individuals, or those with a milder infection, shed fewer viruses in a shorter period, implying possible transmission dynamics of SARS-CoV-2 and protective mechanisms of vaccination against infection and severe outcomes. The Lancet microbe 2 September 2023

“Pouring their heart out in Sainsbury’s”: qualitative study of young people’s, parents’ and mental health practitioners’ experiences of adapting to remote online mental health appointments during COVID-19
While some had positive views of remote mental health appointments, others found them challenging. Findings highlight key areas requiring attention and mitigation in future offerings of remote provision, namely: risk management, parental burden, and problematic engagement. BMC psychiatry 2 September 2023

“They said we’re all in it together, but we were kind of separated”: barriers to access, and suggestions for improving access to official information about COVID-19 vaccines for migrants in Australia
Information about COVID-19 vaccines during different stages of the vaccination program should be provided in migrants’ languages at the same time that it is available in English using a variety of methods for dissemination. The acceptability of official information can be improved by communicating uncertainty, acknowledging people’s concerns about the safety and effectiveness of COVID-19 vaccines and providing opportunities for two-way communication. People’s trust in official sources of health information can be improved by working with migrant communities and recognising migrants’ contributions to society. The findings of this study may improve managing the response to COVID-19 and other health emergencies in Australia and in other similar societies. BMC public health 1 September 2023

PTSD symptoms among family members of patients with ARDS caused by COVID-19 after 12 months
Twelve months after patient ICU hospitalization, having ARDS caused by COVID-19 compared with other causes was not significantly associated with increased symptoms of PTSD, anxiety, or depression in family members in contrast with results after 3 months. JAMA 1 September 2023

SARS-CoV-2 infection, hospitalization, and mortality in adults with and without cancer
These findings suggest that the absence of a prioritization strategy for access to critical care treatment may be a factor in significantly greater SARS-CoV-2–associated mortality in patients with cancer. JAMA 31 August 2023

Cannabis-based medicinal products (CBMPs) for the treatment of Long COVID symptoms: current and potential applications
There is a growing body of evidence that cannabis-based medicinal products (CBMPs) can be used to treat symptoms including pain, anxiety, depression, fatigue, sleep, headaches, and cognitive dysfunction, which are commonly reported in Long COVID. This article provides an overview of the pathophysiology of Long COVID and discusses preliminary pre-clinical, clinical trials, and real-world evidence (RWE) for CBMPs in the context of Long COVID. Exploration of Medicine 31 August 2023

Epigenetic memory of coronavirus infection in innate immune cells and their progenitors
Severe COVID-19 can reprogram hematopoiesis and establish epigenetic memory in hematopoietic stem and progenitor cells (HSPC) and progeny myeloid cells for up to 1 year. These durable alterations, which could affect post-infection immune responses and equilibrium, are controlled in part by the activity of IL-6 during acute disease. Cell 31 August 2023

CDC assesses risk from BA.2.86, highly mutated COVID-19 variant
Based on currently available data, updated COVID-19 vaccines targeting the XBB.1.5 variant are expected to be effective against BA.2.86—a highly mutated new SARS-CoV-2 variant—for reducing severe disease and hospitalization, according to an August 23 US Centers for Disease Control and Prevention (CDC) risk assessment. JAMA 30 August 2023

Assessment of hospital-onset SARS-CoV-2 infection rates and testing practices in the US, 2020-2022
In this cohort study of hospitals reporting SARS-CoV-2 infections, there was an increase of hospital-onset SARS-CoV-2 infections when community-onset infections were higher, indicating a need for ongoing and enhanced surveillance and prevention efforts to reduce in-hospital transmission of SARS-CoV-2 infections, particularly when community-incidence of SARS-CoV-2 infections is high. JAMA 28 August 2023

Ignored and distressed: a cross-sectional study of the impact of COVID-19 on last responders
Last responders constitute an occupational category that includes all those that are involved in the postmortem care of deceased persons and their families. Last responders are a critical part of the health care system. Throughout this pandemic, last responders have been frequently ignored and not prioritized for protection and support. Interventions to support last responders cope with stress, and to decrease anxiety are urgently needed. There is also a critical need to challenge community stigma towards last responders. BMC public health 26 August 2023

Work-life boundary management of peer support workers when engaging in virtual mental health support during the COVID-19 pandemic: a qualitative case study
The findings from this study can help inform management, practices, future research and policy on health care workforce. The study highlights the need to attend to the consequences of greater work-life integration for mental health workers since their successful practice is largely dependent on maintaining self-care. Training regarding work-life boundary management is highlighted as one of the ways to approach situations where work from home is required. BMC public health 25 August 2023

The COVID-19 pandemic and associated inequities in acute myocardial infarction treatment and outcomes
This study found that while hospital COVID-19 burden was associated with worse treatment and outcomes for non–ST segment elevation MI (NSTEMI), race and ethnicity–associated inequities did not increase significantly during the pandemic. These findings suggest the need for additional efforts to mitigate outcomes associated with the COVID-19 pandemic for patients admitted with AMI when the hospital COVID-19 burden is substantially increased. JAMA 25 August 2023

Changes in patient experiences of hospital care during the COVID-19 pandemic
The results of this study suggest that higher-staffed and higher-performing hospitals were more resilient to the conditions of the COVID-19 pandemic, but by late 2021, patients’ experience of care had declined in all hospitals. JAMA 25 August 2023

New Zealand's COVID-19 elimination strategy and mortality patterns
In December, 2021, after reaching high vaccination rates (ie, 87% of the eligible population fully vaccinated), New Zealand moved from an elimination strategy to a mitigation strategy. It was unclear whether mortality would subsequently increase to higher than historical rates due to a postponement of death among vulnerable individuals, return to baseline, or remain low due to ongoing public health measures. The authors compared weekly all-cause mortality rates in New Zealand in 2020, 2021, and 2022, with historical figures from 2011 to 2019 using data from Stats New Zealand Tatauranga Aotearoa. The Lancet 24 August 2023

Factors associated with post-traumatic stress disorder in nurses after directly caring for COVID-19 patients: a cross-sectional study
Governments and hospitals should prepare and implement organizational intervention programs to improve nurse managers’ leadership, nurse staffing levels, and electronic health records programs. Additionally, because nurses who have witnessed the death of a COVID-19 patient or are self-isolating are vulnerable to PTSD, psychological support should be provided. BMC nursing 24 August 2023

Measuring changes in adult health and well-being during the COVID-19 pandemic and their relationship with adverse childhood experiences and current social assets: a cross-sectional survey
Adverse childhood experiences (ACEs) are experienced by large proportions of populations and are associated with poorer health even in non-pandemic situations. However, they also appear associated with greater vulnerability to developing poorer health and well-being in pandemic situations. There is a minority of those with ACEs who may have benefited from the changes in lifestyles associated with pandemic restrictions. Connectedness especially with family, appears an important factor in maintaining health during pandemic restrictions. BMC public health 24 August 2023

Clinical outcomes associated with overestimation of oxygen saturation by pulse oximetry in patients hospitalized with COVID-19
In this cohort study, overestimation of oxygen saturation by pulse oximetry led to delayed delivery of COVID-19 therapy and higher probability of readmission regardless of race. Black patients were more likely to have unrecognized need for therapy with potential implications for population-level health disparities. JAMA 24 August 2023

Who gets sick from COVID-19? Sociodemographic correlates of severe adult health outcomes during Alpha- and Delta-variant predominant periods, 9/2020–11/2021
Meaningful disparities in COVID-19 morbidity and mortality per infection were associated with sociodemography and geography. Addressing these disparities could have helped prevent the loss of tens of thousands of lives. Journal of infectious diseases 24 August 2023

Covid-19: Lockdowns and masks helped reduce transmission, expert group finds
Non-pharmaceutical interventions (NPIs) were “unequivocally” effective when rolled out in tandem during the covid pandemic and led to “powerful, effective and prolonged reductions in viral transmission,” says a report by a team of experts brought together by the Royal Society. BMJ 24 August 2023

Excess all-cause mortality in China after ending the Zero COVID Policy
In this cohort study of the population in China, the sudden lifting of the zero COVID policy was associated with significant increases in all-cause mortality. These findings provide valuable insights for policy makers and public health experts and are important for understanding how the sudden propagation of COVID-19 across a population may be associated with population mortality. JAMA 24 August 2023

COVID-19 deaths on weekends
The apparent increased COVID-19 deaths reported on weekends might potentially reflect patient care, confound community trends, and affect the public perception of risk. BMC public health 22 August 2023

Trends in well-being among youth in Australia, 2017-2022
In this longitudinal analysis of annual census data, there were downward trends in students’ well-being, especially since 2020. The largest sociodemographic disparities were observed for students of female sex, those in later school grades, and those with lowest parental education. Urgent and equitable support for the well-being of all young people, particularly those facing disparity, is imperative. JAMA 22 August 2023

Posttraumatic stress disorder symptoms among first-year resident physicians working before and during the COVID-19 pandemic
In this cohort study, compared with those training before the pandemic, first-year residents training during the first pandemic wave were significantly less likely to screen positive for PTSD and workplace trauma exposure. Additionally, they reported significantly fewer weekly work hours, higher workload satisfaction, and fewer medical errors, which could reflect previously reported institutional efforts to reduce physician burden early in the pandemic. Importantly, after accounting for these residency-related factors, training during the pandemic was no longer associated with lower odds of presenting PTSD symptoms. JAMA 22 August 2023

Lessons from the COVID-19 pandemic: Updating our approach to masking in health care facilities
As health care systems navigate this next phase of the pandemic, different approaches could be considered that place patient safety first and integrate masking as part of routine health care policies. The authors believe that policies could take different approaches; masking could be implemented 1) across health care spaces year-round; 2) in targeted settings, such as transplant, oncology, and geriatric units, where risk is highest for those patient populations (although this is less desirable because high-risk patients in most hospitals may be found in a variety of health care settings); 3) in specified months during the local respiratory viral season; or 4) when community burden of respiratory viruses approaches a critical threshold, although appropriate metrics will need to be defined. Annals of internal medicine 22 August 2023

Postacute sequelae of COVID-19 at 2 years
While risks of many sequelae declined 2 years after infection, the substantial cumulative burden of health loss due to postacute sequelae of COVID-19 (PASC)  calls for attention to the care needs of people with long-term health effects due to SARS-CoV-2 infection. Nature medicine 21 August 2023

Incidence of new-onset hypertension post–COVID-19: Comparison with influenza
Incidence of new-onset persistent hypertension in patients with COVID-19 is higher than those with influenza, likely constituting a major health burden given the sheer number of patients with COVID-19. Screening at-risk patients for hypertension following COVID-19 illness may be warranted. Hypertension 21 August 2023

Early Omicron infection is associated with increased reinfection risk in older adults in long-term care and retirement facilities
Counterintuitively, SARS-CoV-2 Omicron infection was associated with increased risk of Omicron reinfection in residents of long-term care and retirement homes. Less robust humoral hybrid immune responses in older adults may contribute to risk of Omicron reinfection. eClinicalMedicine 21 August 2023

Effective communication of COVID-19 vaccine information to recently-arrived culturally and linguistically diverse communities from the perspective of community engagement and partnership organisations: a qualitative study
Participants reported a perceived lack of accurate, culturally sensitive health information and service provision as key barriers to vaccination in recently-arrived CALD communities. Participants identified a range of perceived enablers to increasing vaccination uptake in the communities they work with, including utilising established channels of communication and harnessing the communities’ strong sense of collective responsibility. Specific strategies to reduce vaccine hesitancy included identifying and utilising trusted sources (e.g. faith leaders) to disseminate information, tailoring health messages to address cultural differences, providing opportunities to contextualise information, and modifying service delivery to enhance cultural sensitivity. There is an urgent need for increased efforts from health and government agencies to build sustainable, collaborative relationships with CALD communities. BMC health services research 21 August 2023

International pediatric COVID-19 severity over the course of the pandemic
This study provides valuable insights into the impact of SARS-CoV-2 VOCs on the severity of COVID-19 in hospitalized children across different age groups and countries, suggesting that while ICU admissions decreased across the pandemic in all age groups, ventilatory and oxygen support generally did not decrease over time in children aged younger than 5 years. These findings highlight the importance of considering different pediatric age groups when assessing disease severity in COVID-19. JAMA 21 August 2023

Association of the androgens with COVID-19 prognostic outcomes: a systematic review
Based on available data, low serum testosterone levels are associated with higher rates of ICU admission, hospital mortality, risk of lung failure, inflammatory markers, and longer hospital stays in patients with COVID-19 compared with those having normal serum testosterone levels. Archives of public health 21 August 2023

Long-term health consequences among individuals with SARS-CoV-2 infection compared to individuals without infection: results of the population-based cohort study CoMoLo Follow-up
Even after more than one year, individuals with SARS-CoV-2 infection showed an increased risk of various health complaints, functional limitations, and worse subjective well-being, pointing toward profound health consequences of SARS-CoV-2 infection relevant for public health. BMC public health 21 August 2023

Safety and efficacy of inhaled IBIO123 for mild-to-moderate COVID-19: a randomised, double-blind, dose-ascending, placebo-controlled, phase 1/2 trial
Inhalation of IBIO123 was safe. Despite the lack of significant reduction of viral load at day 5, treatment with IBIO123 resulted in a higher proportion of participants with complete resolution of respiratory symptoms at day 8. This study supports further clinical research on inhaled monoclonal antibodies in COVID-19 and respiratory diseases in general. The Lancet infectious diseases 21 August 2023

Late mortality after COVID-19 infection among US veterans vs risk-matched comparators: A 2-year cohort analysis
The findings of this retrospective cohort study indicate that although overall 2-year mortality risk was worse among those infected with COVID-19, by day 180 after infection they had no excess mortality during the next 1.5 years. JAMA 21 August 2023

Prevalence, pathogenesis and spectrum of neurological symptoms in COVID‐19 and post‐COVID‐19 syndrome: a narrative review

  • Neurological symptoms are not uncommon during severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and reflect a broad spectrum of neurological disorders of which clinicians should be aware.
  • The underlying pathogenesis of neurological disease in coronavirus disease 2019 (COVID‐19) may be due to four mechanisms of nervous system dysfunction and injury: i) direct viral neurological invasion; ii) immune dysregulation; iii) endothelial dysfunction and coagulopathy; and iv) severe systemic COVID‐19 disease.
  • Neurological manifestations of acute COVID‐19 include headache, peripheral neuropathies, seizures, encephalitis, Guillain–Barré syndrome, and cerebrovascular disease.
  • Commonly reported long term neurological sequelae of COVID‐19 are cognitive dysfunction and dysautonomia, which despite being associated with severe acute disease are also seen in people with mild disease.
  • Assessment of cognitive dysfunction after COVID‐19 is confounded by a high prevalence of comorbid fatigue, anxiety, and mood disorders. However, other markers of neuroaxonal breakdown suggest no significant neuronal injury apart from during severe acute COVID‐19.
  • The long term impact of COVID‐19 on neurological diseases remains uncertain and requires ongoing vigilance.

MJA 21 August 2023

Long-term symptom severity and clinical biomarkers in post-COVID-19/chronic fatigue syndrome: results from a prospective observational cohort
These findings suggest that Post-COVID-19 syndrome (PCS) can persist beyond 20 months post-infection and encompass the full scope of post-infectious ME/CFS as defined by the Canadian Consensus Criteria (CCC). Sub-classifying patients with PCS based on the CCC can assist in the management and monitoring of patients with PCS-ME/CFS due to their persistently higher symptom severity. eClinicalMedicine 18 August 2023

Pathophysiology, diagnosis, and management of neuroinflammation in covid-19
Although neurological complications of SARS-CoV-2 infection are relatively rare, their potential long term morbidity and mortality have a significant impact, given the large numbers of infected patients. Covid-19 is now in the differential diagnosis of a number of common neurological syndromes including encephalopathy, encephalitis, acute demyelinating encephalomyelitis, stroke, and Guillain-Barré syndrome. BMJ 18 BMJ 2023

COVID-19 and hospitalizations by variant era among vaccinated solid organ transplant recipients
In this study, 19.7% of participants reported incident COVID-19, 7.5% of whom required hospitalization. Transplant recipient COVID-19 incidence followed US case count trends, with higher incidence in later Omicron waves potentially due to home test capture and/or increased susceptibility to SARS-CoV-2 variants. JAMA 18 August 2023


Updated 21 September 2023 

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

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 (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

Tecovirimat treatment for Monkeypox Virus Keratouveitis
Currently, there is no specific medication to treat human monkeypox, and antiviral agents approved to treat smallpox have been used for its management. Compassionate use of tecovirimat has been reported in this setting, with minimal adverse effects. A case of MPXV keratouveitis confirmed by PCR and treated with tecovirimat was presented. Patients should be advised not to rub the eyes, since self-inoculation of the ocular surface from contaminated hands may occur. Although possible, we do not know whether MPXV is transmissible through tears. Resources are more than needed to put in place new action plans and strategies. JAMA 22 December 2022

Audio interview: Applying new studies of Mpox and Ebola to Covid-19
In this audio interview conducted on December 9, 2022, the editors discuss new data on mpox and Ebola and how what we’ve learned can be applied to the Covid-19 pandemic. NEJM 15 December 2022

Breakthrough infections after postexposure vaccination against Mpox
During the current outbreak of monkeypox (recently renamed mpox), smallpox vaccination has been recommended to prevent mpox infection in persons who have had mpox exposure, but evidence to support this practice is limited.1,2 We conducted a study to evaluate potential breakthrough infections in participants who had received smallpox vaccine after high-risk exposure to mpox. In this study population, 4% of the participants who had received postexposure vaccination with a third-generation smallpox vaccine had a subsequent mpox infection during the first month after receipt of the first vaccination. NEJM 7 December 2022

Monkeypox – review article
The gradual decline in immunity to smallpox may partly explain an increase in the incidence of monkeypox in some regions where the disease is endemic. However, the current epidemic reminds us that viral emergence is a permanent phenomenon without boundaries and is often unpredictable in its nature, target, and magnitude. This outbreak illustrates how a disease affecting one region of the world can have a strong effect on areas where it is not endemic, with different target populations and new clinical presentations. NEJM 10 November 2022

Contact tracing and exposure investigation in response to the first case of Monkeypox Virus infection in the United States during the 2022 Global Monkeypox Outbreak
In a contact tracing investigation involving 166 community and health care contacts of a patient with monkeypox, no secondary cases were identified. Annals of infectious diseases 8 November 2022

Immunological signature in human cases of monkeypox infection in 2022 outbreak: an observational study
Our data showed the immunological signature of monkeypox virus infection, characterised by an early expansion of activated effector CD4+ and CD8+ T cells that persisted over time. Almost all patients, even regardless of HIV infection, developed a poxvirus-specific Th1 cell response. These results might have implications on the expected immunogenicity of monkeypox vaccination, suggesting that it might not be necessary to vaccinate people who have already been infected. The Lancet infectious diseases 7 November 2022

Monkeypox virus and ophthalmology—A primer on the 2022 Monkeypox outbreak and Monkeypox-related ophthalmic disease
The ophthalmologist may play an important role in the diagnosis and management of monkeypox. MPXROD may be associated with severe ocular and visual morbidity. As the current outbreak evolves, up-to-date guidance from public health organizations and professional societies are critical. JAMA 3 November 2022

Ocular pox lesions in a male patient with Monkeypox treated with Tecovirimat
Monkeypox can be transmitted via bodily fluids, blood, infected lesions, or respiratory droplets. The infection is usually self-limited, lasting 2 to 4 weeks. Along with cutaneous and systemic findings, ocular manifestations include conjunctivitis, eyelid edema, keratitis, corneal scarring, and conjunctival lesions. Herein, the authors describe a case of ocular pox lesions in a male individual successfully treated with tecovirimat, an expanded-access investigational therapy, and conservative ocular management. JAMA 3 November 2022

Transmission dynamics of monkeypox in the United Kingdom: contact tracing study
Analysis of the instantaneous growth rate of monkeypox incidence indicates that the epidemic peaked in the UK as of 9 July and then started to decline. Short serial intervals were more common than short incubation periods suggesting considerable pre-symptomatic transmission, which was validated through linked patient level records. For patients who could be linked through personally identifiable data, four days was the maximum time that transmission was detected before symptoms manifested. An isolation period of 16 to 23 days would be required to detect 95% of people with a potential infection. The 95th centile of the serial interval was between 23 and 41 days, suggesting long infectious periods. BMJ 2 November 2022

Monkeypox : review article
The gradual decline in immunity to smallpox may partly explain an increase in the incidence of monkeypox in some regions where the disease is endemic. However, the current epidemic reminds us that viral emergence is a permanent phenomenon without boundaries and is often unpredictable in its nature, target, and magnitude. This outbreak illustrates how a disease affecting one region of the world can have a strong effect on areas where it is not endemic, with different target populations and new clinical presentations. NEJM 26 October 2022

Monkeypox: Challenging clinical questions
This article summarizes the ACP/Annals virtual forum held on 11 October 2022. Annals of internal medicine 14 October 2022

Neonatal Monkeypox virus infection
Reports of neonatal monkeypox virus infection are rare. This was a case of neonatal monkeypox virus infection after peripartum transmission within a family cluster; transplacental transmission could not be ruled out. Because this was a single case, it is not possible to attribute the clinical illness to either pathogen (monkeypox virus or adenovirus) directly, nor is it possible to attribute the improvement in the infant’s clinical condition to the use of tecovirimat or cidofovir. Monkeypox virus infection should be considered in the differential diagnosis of a neonatal vesicular rash. NEJM 12 October 2022

Development of an accessible and scalable qPCR assay for Monkeypox virus detection
During the 2022 monkeypox (MPX) outbreak, testing has been limited and results delayed, allowing ongoing transmission. Gold-standard qPCR diagnostics are difficult to obtain. This research adapted the June 2022 CDC MPX qPCR assay for broad implementation. Validated using MPX stocks in a matrix with multiple sample types, MPX was detected with Cq values of 17.46 to 35.59 and titer equivalents 8.01 × 106 to 2.45 × 100 PFU/mL. The detection limit was 3.59 PFU/mL. Sensitivity and specificity were both 100%. This qPCR assay can be quickly and broadly implemented in research and public health labs to increase diagnostic capacity amid the growing MPX outbreak. Journal of infectious diseases 12 October 2022

Air and surface sampling for monkeypox virus in a UK hospital: an observational study
These data show contamination in isolation facilities and potential for suspension of monkeypox virus into the air during specific activities. PPE contamination was observed after clinical contact and changing of bedding. Contamination of hard surfaces in doffing areas supports the importance of cleaning protocols, PPE use, and doffing procedures. The Lancet microbe 7 October 2022

Epidemiological and clinical characteristics of patients with monkeypox in the GeoSentinel Network: a cross-sectional study
Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact. The Lancet infectious diseases 7 October 2022

Asymptomatic monkeypox infection: a call for greater control of infection and transmission
National surveillance programmes should be conducted, particularly among populations at high risk of infection, to detect asymptomatic cases. Such surveillance will require rapid diagnostic or home-based tests that could identify undiagnosed infections. Surveillance at a country's entry points (eg, airports) might be effective, particularly in non-endemic countries with little evidence of local transmission, similar to approaches previously suggested for asymptomatic COVID-19 transmission.9,  10 Health-care providers should also establish a proper differential diagnosis before excluding monkeypox, especially considering the increasing non-specific presentations of the disease. Finally, cases could be decreased and the processes of case identification and contact tracing could be facilitated by individuals limiting their numbers of sexual partners and by limitations on areas and gatherings where people commonly engage in anonymous sexual activities. The Lancet microbe 6 October 2022

Recognizing minimal cutaneous involvement or systemic symptoms in Monkeypox
In patients with umbilicated or ulcerated lesions, particularly localized to the anogenital region, clinicians should perform a thorough social history and maintain a high index of suspicion for monkeypox, even in those with mild constitutional symptoms, who report a new sexual partner in the preceding 2 weeks. Increased public awareness of risk factors, the ability to recognize subtle skin findings, as well the increased availability/dissemination of vaccines will be important in containing and preventing further outbreaks. JAMA 6 October 2022

Human Monkeypox virus infection in the immediate period after receiving modified Vaccinia Ankara vaccine
In this small study, the majority of postvaccination monkeypox infections occurred within 2 weeks of receiving the first dose of MVA-BN, before full effectiveness was likely to have been achieved, in line with published immunogenicity data. Because the incubation period for monkeypox is 3 to 17 days, some of the cases occurring between 1 and 14 days after vaccination may not represent true vaccine failure because patients may have sought vaccination after realizing they were exposed. Of concern is that at least 2 breakthrough infections were observed in individuals at least 3 weeks after a second dose. JAMA 30 September 2022

Intradermal vaccination for Monkeypox — Benefits for individual and public health
Despite limited clinical evidence, all available data suggest that intradermal administration of JYNNEOS will be as immunogenic as subcutaneous dosing for preventing monkeypox infection and illness, which leads the authors to favor intradermal use from both the individual and public health perspectives. The Centers for Disease Control and Prevention and the FDA are committed to performing the studies needed to assure that these expectations are borne out. In the meantime, they urge people who are at the highest risk for infection to receive both doses of the two-dose vaccine, and we encourage manufacturers to consider routinely testing intradermal dose administration in future clinical vaccine trials, in order to expand our understanding of this operationally attractive option. The currently available evidence suggests that shifting to intradermal dosing that requires less vaccine is not a lesser option. Rather, it is a rational, evidence-informed means of advancing access, equity, and our chances of controlling the monkeypox outbreak. NEJM 29 September 2022

Neurologic complications of Smallpox and Monkeypox: A review
Monkeypox should be considered in high-risk populations who present with neurologic syndromes. Diagnosis may require serology and polymerase chain reaction testing of blood and spinal fluid. Antiviral therapy should be initiated early in the course of the illness. JAMA 20 September 2022

Monkeypox prevention and treatment while nursing
Although no specific guidelines have appeared for monkeypox, individuals with smallpox are recommended not to breastfeed their infant because of the risk of passing variola virus to the infant through direct contact. Presumably, the same precautions apply with monkeypox. Providing pumped milk to the infant may be possible if no lesions are near the breast and adequate precautions are taken with respect to cleaning hands, breasts, breast pumps, and any other apparatuses used to provide milk to the infant. As the current monkeypox situation evolves, recommendations may change, so refer to the CDC website for the most up-to-date information Breastfeeding medicine 15 September 2022

Annals on call - Diagnosis and treatment of Monkeypox Proctitis
In this episode of Annals On Call, Dr. Centor discusses the diagnosis and treatment of monkeypox proctitis with Drs. Jose Lucar and Tara Palmore. Annals of internal medicine 13 September 2022

Vaccinia-virus-based vaccines are expected to elicit highly cross-reactive immunity to the 2022 Monkeypox Virus
Beginning in May 2022, a novel cluster of monkeypox virus infections was detected in humans. This virus has spread rapidly to non-endemic countries, sparking global concern. Specific vaccines based on the vaccinia virus (VACV) have demonstrated high efficacy against monkeypox viruses in the past and are considered an important outbreak control measure. Viruses observed in the current outbreak carry distinct genetic variations that have the potential to affect vaccine-induced immune recognition. Here, by investigating genetic variation with respect to orthologous immunogenic vaccinia-virus proteins, we report data that anticipates immune responses induced by VACV-based vaccines, including the currently available MVA-BN and ACAM2000 vaccines, to remain highly cross-reactive against the newly observed monkeypox viruses. Viruses 3 September 2022

Reports of asymptomatic Monkeypox suggest that, at the very least, some infections go unnoticed
Two recent case reports from Europe have raised the possibility that some monkeypox virus infections may be asymptomatic. Whether or not these infections were truly symptom free, the studies suggest that clinicians and individuals at high risk should be aware that monkeypox can go unnoticed—possibly even when it’s transmissible. JAMA 31 August 2022

Monkeypox Virus infection in humans across 16 Countries — April–June 2022
In this case series, monkeypox manifested with a variety of dermatologic and systemic clinical findings. The simultaneous identification of cases outside areas where monkeypox has traditionally been endemic highlights the need for rapid identification and diagnosis of cases to contain further community spread. NEJM 25 August 2022

Compassionate use of Tecovirimat for the treatment of Monkeypox infection
The authors assessed adverse events and clinical resolution of systemic symptoms and lesions in an uncontrolled cohort study of patients with monkeypox who were treated with tecovirimat on a compassionate use basis. In this preliminary study, oral tecovirimat was well tolerated by all patients with monkeypox infection, with minimal adverse effects. However, adverse effects could not always be differentiated from symptoms related to the infection. No control group was included, limiting conclusions of antiviral efficacy pertaining to duration of symptoms or severity. Time from symptom onset to presentation was variable among patients, and conclusions related to antiviral use vs natural evolution of disease should be made with caution. Limited clinical data exist on the use of tecovirimat for monkeypox infection. In one case report, no new lesions followed 24 hours of therapy and no adverse effects occurred by treatment completion at 14 days. JAMA 22 August 2022

How does monkeypox spread? An epidemiologist explains why it isn’t an STI and what counts as close contact
The monkeypox virus typically spreads through direct contact with respiratory secretions, such as mucus or saliva, or skin lesions. Skin lesions traditionally appear soon after infection as a rash – small pimples or round papules on the face, hands or genitalia. These lesions may also appear inside the mouth, eyes and other parts of the body that produce mucus. They can last for several weeks and be a source of virus before they are fully healed. Other symptoms usually include fever, swollen lymph nodes, fatigue and headache. MJA Insight 22 August 2022

Audio interview: Responding to Monkeypox
In this audio interview conducted on August 16, 2022, the editors are joined by White House National Monkeypox Response Deputy Coordinator Demetre Daskalakis to discuss the new public health emergency and what HIV and Covid-19 have taught us. NEJM 18 August 2022

Update on the Monkeypox Outbreak
The current monkeypox outbreak illustrates why global health cannot be ignored. Despite monkeypox being endemic in Africa for decades, clinical trials on treatments and vaccines were not done. Now more than 3 months into the global monkeypox outbreak, there is much to learn. While test capacity has been increased, more is needed. Contact tracing is not happening, and data systems are not informing the response in rapid fashion. Many individuals at risk for monkeypox may not be engaged with the health care system, making diagnosis, containment, and prevention challenging. The demand for vaccines far exceeds availability. Although the supply of tecovirimat has increased, this drug must still be used under an IND protocol, which limits access. In addition, a decentralized and wholly underresourced public health infrastructure is even more strained as officials must now respond to both COVID-19 and monkeypox. JAMA 11 August 2022

The changing face of monkeypox
What should patients and clinicians look out for? BMJ 10 August 2022

Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study
In this cohort, monkeypox caused genital, perianal, and oral lesions and complications including proctitis and tonsillitis. Because of the variability of presentations, clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed the highest viral loads, which, combined with the history of sexual exposure and the distribution of lesions, suggests close contact is probably the dominant transmission route in the current outbreak. The Lancet 8 August 2022

Ophthalmic manifestation of monkeypox infection
Despite mucosal localisation of vesicles being not uncommon in monkeypox, the diagnosis might be overlooked. During the ongoing monkeypox outbreak, monkeypox should be included in the differential diagnosis of patients with vesicular and pustular eye lesions, especially in the presence of epidemiological links or risk factors. The Lancet infectious diseases 29 July 2022

Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series
These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission. BMJ 28 July 2022

Monkeypox virus infection in humans across 16 countries — April–June 2022
In this case series, monkeypox manifested with a variety of dermatologic and systemic clinical findings. The simultaneous identification of cases outside areas where monkeypox has traditionally been endemic highlights the need for rapid identification and diagnosis of cases to contain further community spread. NEJM 21 July 2022

Is Australia ready for monkeypox?
Disease control efforts can draw on lessons from the past and prevent the epidemic from becoming established in Australia MJA 18 July 2022

Monkeypox emerges on a global scale: a historical review and dermatological primer
The current monkeypox outbreak reawakens the concern that poxviridae have high potential of zoonotic spillover and for causing pandemic.1 Much fieldwork and research has been done by healthcare and public health workers in Africa during previous human outbreaks, and their knowledge should inform our global response to the current outbreak. However, unusual clinical presentations now have potential implications in recognizing disease. Infections from poxviridae such as monkeypox have common cutaneous signs that occur early, may be related to periods of transmissibility, and can leave scarring. Therefore, dermatologists will play a key role in recognizing and diagnosing infections, and in educating and preparing front-line healthcare workers for early detection of new cases and clusters of monkeypox. Journal of the American Academy of Dermatology 8 July 2022

Efficacy of biocidal agents and disinfectants against the monkeypox virus and other orthopoxviruses
As orthopoxviruses may stay infectious on inanimate surfaces under laboratory conditions for up to 42 days, disinfection may be relevant in the surroundings of confirmed cases. The aim of this review was to evaluate published data on the antiviral efficacy of biocidal agents and disinfectants against the monkeypox virus and other orthopoxviruses. Journal of hospital infection 28 June 2022

The outbreak of monkeypox 2022: An overview
On May 6, 2022 an outbreak of monkeypox (MPX) was confirmed in the United Kingdom, originating from a British resident who had travelled to Nigeria. As of May 21, 2022, 92 cases have been confirmed worldwide, from 13 countries where monkeypox virus (MPXV) is not endemic. Reported cases thus far have mainly but not exclusively been identified among gay and bisexual men aged 20–50. MPXV is a viral zoonosis transmitted to humans via contacting or eating an infected animal, and direct connect with natural host’s blood and body fluids. In addition to contacting with a patient’s respiratory droplets, lesions, body fluids and polluted personal objects. Symptoms including shivers, headaches, fainting, backaches, and myodynia do not have any specific characteristics making it difficult to establish a proper diagnosis. Nevertheless, lymphatic hyperplasia, one of the most common symptoms of monkeypox, can be useful for diagnosing the disease. Clinical symptoms help establish the suspicion of monkeypox. However, in the absence of confirmed diagnostic tests it is very difficult to verify the disease and determine its cause based on clinical symptoms alone. There are numerous methods for detecting MPX, involving genetic, phenotypic, immunological methods, and electron microscopy. These tests require modern equipment and expert hands, which may not be available in developing countries where this disease is prevalent. Currently, there is no definite treatment for MPX. CDC recommends administering the smallpox vaccine within 4 days of exposure which may prevent the disease from happening, and within 2 weeks to reduce symptoms severity. To promptly identify patients and prevent further spreading, physicians should be aware of the travel or contact history of the patient with compatible symptoms. Annals of medicine and surgery 24 June 2022

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