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What's new in the medical literature

Updated 16 February 2024

UpToDate

Cochrane Library

Cochrane clinical answers

MJA

MJA insight

BMJ

NEJM

JAMA

Other journals

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UpToDate

Severe hypocalcemia with denosumab therapy in dialysis-treated patients
Denosumab use is not restricted in individuals with osteoporosis who have advanced kidney disease. However, concerns remain regarding the risk of severe hypocalcemia in such patients. In a cohort study of 2804 female patients (aged ≥65 years) with osteoporosis and undergoing dialysis, severe hypocalcemia (serum calcium <7.5 mg/dL [1.9 mmol/L] or hypocalcemia requiring emergency care) occurred in a higher proportion of patients who initiated denosumab compared with those who initiated an oral bisphosphonate (12-week weighted cumulative incidence 41.1 versus 2 percent, respectively) [10]. Denosumab also was associated with a higher incidence of very severe hypocalcemia (serum calcium <6.5 mg/dL [1.6 mmol/L]). A boxed warning about risk of severe hypocalcemia in individuals with advanced kidney disease, especially patients on dialysis, has been added for brand name denosumab (Prolia) [11], underscoring the need for greater caution and increased monitoring during treatment. (See "Denosumab for osteoporosis", section on 'Hypocalcemia'.)

Dupilumab for refractory eosinophilic esophagitis
Few data are available on the use of dupilumab (a monoclonal antibody) for treating refractory eosinophilic esophagitis. In a cohort study of 46 patients with refractory eosinophilic esophagitis, dupilumab therapy was associated with histologic remission (defined as <15 eosinophils/high-power field) in 37 patients (80 percent) and with symptomatic improvement in 42 patients (91 percent) after a median of six months [2]. These data support our approach of using dupilumab for patients with eosinophilic esophagitis who have not responded to other therapies (eg, topical glucocorticoids). (See "Treatment of eosinophilic esophagitis (EoE)", section on 'Dupilumab'.)

Combined use of metformin and insulin for treating diabetes in pregnancy
In patients with type 2 diabetes, insulin is the mainstay for managing hyperglycemia in pregnancy. The addition of metformin improves maternal glucose control and reduces the chances of a large for gestational age newborn, but a prior randomized trial reported an increased risk for birth of a small for gestational age (SGA) infant. A recent randomized trial comparing use of insulin alone with insulin plus metformin in nearly 800 adult pregnant patients with either preexisting type 2 diabetes or diabetes diagnosed in early pregnancy confirmed the previously reported benefits but found that both treatment groups had low and similar rates of SGA [1]. The discordancy in SGA risk needs to be explored further, as metformin cotreatment would be undesirable if this risk is real. (See "Pregestational (preexisting) diabetes mellitus: Antenatal glycemic control", section on 'Metformin'.)

Fetoplacental GDF15 linked to nausea and vomiting of pregnancy
Almost all pregnant people experience nausea with or without vomiting in early pregnancy; however, the pathogenesis of the disorder has been unclear. Previous studies have shown that GDF15 is expressed in a wide variety of cells, with the highest expression in placental trophoblast, and that its protein (GDF15) appears to regulate appetite. A recent study confirmed the fetoplacental unit as a major source of GDF15 and also found that higher GDF15 levels correlated with more severe nausea and vomiting of pregnancy [2]. In the future, drugs targeting the production or action of GDF15 are a potential novel pathway for treating nausea and vomiting of pregnancy, if safety and efficacy are established. (See "Nausea and vomiting of pregnancy: Clinical findings and evaluation", section on 'Pathogenesis'.)

Use of cerebroplacental ratio at term does not reduce perinatal mortality
Cerebral blood flow may increase in chronically hypoxemic fetuses to compensate for the decrease in available oxygen and can be assessed by the cerebroplacental ratio (CPR; middle cerebral artery pulsatility index divided by the umbilical artery pulsatility index). However, increasing evidence indicates that use of the CPR does not reduce perinatal mortality in low-risk pregnancies. In a randomized trial comparing fetal growth assessment plus revealed versus concealed CPR in over 11,000 low-risk pregnancies at term, knowledge of CPR combined with a recommendation for delivery if the CPR was <5th percentile did not reduce perinatal mortality compared with usual care (concealed group) [3]. We do not perform umbilical artery Doppler surveillance, including the CPR, in low-risk pregnancies. (See "Doppler ultrasound of the umbilical artery for fetal surveillance in singleton pregnancies", section on 'Low-risk and unselected pregnancies'.)

Intrauterine postpartum hemorrhage control devices for managing postpartum hemorrhage
Intrauterine balloon tamponade and vacuum-induced uterine compression are the most common devices used for intrauterine postpartum hemorrhage (PPH) control in patients with atony, but it is unclear which device is superior as few comparative studies have been performed. In a retrospective study including nearly 380 patients with PPH, quantitative blood loss after placement, rate of blood transfusion, and discharge hematocrit were similar for both devices [19]. Based on these and other data, in the setting of ongoing uterine bleeding, rapid use of one of these devices is likely to be more important than the choice of device when both devices are available. (See "Postpartum hemorrhage: Use of an intrauterine hemorrhage-control device", section on 'Choice of method'.)

Overall survival with adjuvant pembrolizumab in localized renal cell carcinoma
In patients with localized clear cell renal cell carcinoma (RCC) treated with nephrectomy, adjuvant immunotherapy is an established treatment option, but long-term data on overall survival (OS) were previously limited. In extended follow-up of a randomized trial in approximately 1000 patients with clear cell RCC treated with nephrectomy, one year of adjuvant pembrolizumab improved four-year OS compared with placebo (91 versus 86 percent) [18]. For patients with clear cell RCC at intermediate-high or high risk of disease recurrence following nephrectomy, we recommend adjuvant pembrolizumab. (See "Overview of the treatment of renal cell carcinoma", section on 'Approach to adjuvant therapy'.)

Management of children with mild sleep-disordered breathing
For children with mild sleep-disordered breathing (SDB) and relevant symptoms, little evidence has been available to guide a choice between adenotonsillectomy and watchful waiting. In a randomized trial in 459 children 3 to <13 years with tonsillar hypertrophy and mild SDB (defined by habitual snoring with occasional episodes of obstruction with apnea per hour of sleep), executive function and attention were similar for individuals assigned to adenotonsillectomy compared with watchful waiting at 12 months follow-up [5]. However, children treated with adenotonsillectomy had greater decrease in snoring, obstruction with apnea or hypopnea, blood pressure, and caregiver-reported symptoms (sleep symptoms, behavioral problems, sleepiness) as well as increased quality of life. These findings support our suggestion to offer adenotonsillectomy to children with mild obstructive sleep apnea and relevant symptoms although watchful waiting is a reasonable alternative. (See "Management of obstructive sleep apnea in children", section on 'Adenotonsillectomy'.)

Short-course antibiotic therapy in children with febrile UTI
In children with urinary tract infection (UTI) without suspected kidney involvement, there is controversy about the duration of empiric antibiotic therapy. In an unblinded trial from Italy of amoxicillin-clavulanate to treat uncomplicated febrile UTI, 142 children three months to five years of age were randomly assigned to a 10-day course (standard) or a 5-day course (short) of antibiotics [22]. Fewer children assigned to the short course had recurrent febrile UTI within 30 days of antibiotic completion, but the difference was not statistically significant (1.4 versus 5.7 percent [difference -4.33 percent, 95% CI -10.40 to 1.75]). Resistance to amoxicillin-clavulanate within 5 days following completion of antibiotics (1.4 versus 4.3 percent) and within 30 days (1.4 versus 0 percent) were similar. In children with uncomplicated febrile UTIs, we suggest a 5-day course of antibiotics. (See "Urinary tract infections in infants older than one month and children less than two years: Acute management, imaging, and prognosis", section on 'Preferred empiric oral regimens'.)

Guidelines on management of acute respiratory distress syndrome
The American Thoracic Society recently updated their guidelines on the management of patients ventilated for acute respiratory distress syndrome (ARDS) [6]. Compared with previous recommendations, emphasis was placed on the value of systemic corticosteroid administration, early use of extracorporeal membrane oxygenation, and use of neuromuscular blockade, particularly in patients with severe ARDS. Recommendations also focus on the avoidance of recruitment maneuvers, especially prolonged maneuvers. We agree with these recommendations. (See "Acute respiratory distress syndrome: Ventilator management strategies for adults", section on 'Introduction'.)

New proposed definition for acute respiratory distress syndrome
A new "global definition" of acute respiratory distress syndrome has been proposed [7]. This new definition expands upon the older Berlin definition to include ultrasound for the evaluation of pulmonary infiltrates, the additional use of peripheral oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) to assess oxygenation, and the use of separate criteria for patients on high-flow oxygen or noninvasive ventilation. Accommodations were also made for diagnostic criteria for patients in resource-limited settings. We agree with the proposed changes and their future implementation. (See "Acute respiratory distress syndrome: Clinical features, diagnosis, and complications in adults", section on 'Clinical diagnosis'.)

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MJA

The participation of Aboriginal and Torres Strait Islander parents in Australian trials of parenting programs for improving children's health: a scoping review
The specific needs and interests of Aboriginal and Torres Strait Islander families have not generally been considered in Australian trials of parenting programs that aim to improve the mental and physical health of children. Further, Indigenous people are rarely involved in the planning and implementation of the interventions, few of which are designed to be culturally appropriate for Indigenous people. If parenting research in Australia is to support Aboriginal and Torres Strait Islander families, it must include consultation with local communities, adapt interventions and research methods to the needs of the participating parents and their communities, and improve the recruitment and retention of Aboriginal and Torres Strait Islander participants. MJA 12 February 2024

Bronchiectasis among Indigenous adults in the Top End of the Northern Territory, 2011–2020: a retrospective cohort study
The known: Chronic respiratory diseases are a major cause of poor health and mortality among Aboriginal and Torres Strait Islander people. Little is known about the prevalence of bronchiectasis among adult Indigenous Australians.
The new: The prevalence of bronchiectasis among adult Indigenous Australians in the Top End of the Northern Territory and the associated all‐cause mortality are alarmingly high. The prevalence is highest among people aged 40 years or more, and is generally higher among women than men and in rural and remote areas than in urban communities.
The implications: Characterising the epidemiology of bronchiectasis in Indigenous Australia is crucial for its accurate diagnosis and effective management, as well as for designing population‐level strategies for improving health outcomes.
MJA 5 February 2024

Why clinical artificial intelligence is (almost) non‐existent in Australian hospitals and how to fix it
In‐hospital clinical artificial intelligence (AI) encompasses learning algorithms that use real‐time electronic medical record (EMR) data to support clinicians in making treatment, prognostic or diagnostic decisions. In the United States, the implementation of hospital‐based clinical AI, such as sepsis or deterioration prediction, has accelerated over the past five years,1 while in Australia, outside of digital imaging‐based AI products, nearly all hospitals remain clinical AI‐free zones. MJA 5 February 2024

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MJA insight

Vale Dr Lowitja O’Donoghue, a leading Indigenous health advocate
The Medical Journal of Australia pays its respects to Dr Lowitja O’Donoghue, a leading Indigenous health advocate. MJA insight 12 February 2024

World-first approach to eliminating rheumatic heart disease in Indigenous communities
In a world first, the National Aboriginal Community Controlled Health Organisation (NACCHO) has partnered with the Australian Government to establish a community-led initiative to combat acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Aboriginal and Torres Strait Islander communities throughout Australia. MJA insight 12 February 2024

Doctors under attack at work
With Queensland health care workers facing alarming levels of workplace violence and aggression, it is essential for health organisations to adopt a safety culture to stop this bad behaviour in its tracks. MJA insight 12 February 2024

An updated guide for managing menopause
The Practitioner’s Toolkit for Managing Menopause has now been updated and is available to everyone, not just medical practitioners. MJA insight 5 February 2024

How self-compassion can help reduce depression in women
There are several ways women can build self-compassion to adopt a kinder, less self-critical attitude to the self. MJA insight 5 February 2024

Colorectal cancer an increasing risk for younger people
More young people are being diagnosed with colorectal cancer in Australia, a disease that is frequently diagnosed in its later stages. MJA insight 5 February 2024

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BMJ

Advances in diagnosis and treatment of bladder cancer
Bladder cancer remains a leading cause of cancer death worldwide and is associated with substantial impacts on patient quality of life, morbidity, mortality, and cost to the healthcare system. Defining better selection criteria to identify the patients most likely to benefit from a specific treatment is an urgent need. BMJ 12 January 2024

Challenges in diagnosing asthma in children
What you need to know

  • Asthma in children is a clinical diagnosis based on history and examination, and in many cases a response to a trial of inhaled corticosteroid treatment
  • Asthma can be diagnosed in children under 5, but is unlikely to explain recurrent respiratory symptoms in children under 2
  • Tests can be done to help support (or exclude) a clinical diagnosis but should not be used solely to make (or exclude) a diagnosis of asthma

BMJ 13 February 2024

Atypia detected during breast screening and subsequent development of cancer: observational analysis of the Sloane atypia prospective cohort in England
Many atypia could represent risk factors rather than precursors of invasive cancer requiring surgery in the short term. Women with atypia detected more recently have lower rates of subsequent cancers detected, which might be associated with changes to mammography and biopsy techniques identifying forms of atypia that are more likely to represent overdiagnosis. Annual mammography in the short term after atypia diagnosis might not be beneficial. More evidence is needed about longer term risks. BMJ 1 February 2024

Pulmonary embolism
What you need to know

  • Diagnosis of pulmonary embolism (PE) is frequently missed. An estimated 12-36% of patients with PE are misdiagnosed during initial evaluation in emergency departments or primary care clinics
  • Delayed and missed diagnoses are more common in older adults, in patients with chronic cardiopulmonary disease, those with low pre-test risk of PE, and in patients presenting with cough or gradual onset dyspnoea. Most patients with PE have no symptoms of deep vein thrombosis, and many have no chest pain.
  • Using D-dimer thresholds adjusted for age or probability may reduce false positive results and rates of computed tomography pulmonary angiography scans.

BMJ 8 February 2024

Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial
n adults with post-covid-19 condition, an online, home based, supervised, group physical and mental health rehabilitation programme was clinically effective at improving health related quality of life at three and 12 months compared with usual care. BMJ 7 February 2024

Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study
This analysis of a large multicenter registry of in-hospital cardiac arrest quantified the time dependent probabilities of patients’ outcomes in each minute of duration of cardiopulmonary resuscitation. The findings provide resuscitation teams, patients, and their surrogates with insights into the likelihood of favorable outcomes if patients pending the first return of spontaneous circulation continue to receive further cardiopulmonary resuscitation. BMJ 7 February 2024

Thiazide diuretics
What you need to know

  • Thiazide type and thiazide-like diuretics are effective antihypertensives, and are useful for mild hypervolaemia, or for potentiating loop diuretics
  • They are first line medications for treating hypertension in many countries, but not in the UK
  • Measure serum electrolytes and creatinine one to two weeks after initiating a thiazide diuretic to assess for electrolyte disturbances, most commonly hyponatraemia

BMJ 5 February 2024

Attention deficit/hyperactivity disorder (ADHD) in children: more focus on care and support, less on diagnosis
Key messages

  • Diagnoses of attention deficit/hyperactivity disorder (ADHD) in children and adolescents have increased globally over the past 30 years
  • Diagnosing ADHD in children is assumed to result in better long term outcomes for them, but this is not well supported by evidence
  • Potential benefits of an ADHD diagnosis for access to interventions are often overemphasised in research and guideline development, whereas potential harms are generally overlooked
  • Providing symptom appropriate care and support for children with inattentive/hyperactive behaviours, regardless of diagnosis, might improve access to beneficial interventions while limiting harms from the diagnostic label
  • Robust studies on who is most likely to benefit, or be harmed, by an ADHD diagnosis are needed

BMJ 8 February 2024

Association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: nationwide population based study
Non-alcoholic fatty liver disease (NAFLD)  in patients with Type 2 diabetes mellitus (T2DM)seems to be associated with a higher risk of cardiovascular disease and all cause death, even in patients with mild NAFLD. Risk differences for cardiovascular disease and all cause death between the no NAFLD group and the grade 1 or grade 2 NAFLD groups were higher in patients with T2DM than in those without T2DM. BMJ 13 February 2024

Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials
Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. BMJ 14 February 2024

Advances in diagnosis and treatment of bladder cancer
Non-muscle-invasive bladder cancer (NMIBC)  is managed initially with  transurethral resection of a bladder tumor (TURBT), followed by a risk stratified approach to adjuvant IVe, and is associated with a 90% overall survival. By contrast, cure rates remain lower for muscle invasive bladder cancer (MIBC). Tumor heterogeneity with unique pathological and molecular characteristics is behind the observed differences of NMIBC and MIBC groupings. For NMIBC, IVe immunotherapy (primarily BCG) remains a gold standard treatment for high risk disease to reduce or prevent both recurrence and progression after initial TURBT; recently completed novel trials have incorporated immune checkpoint inhibitors, IVe gene treatment, and combination IVe chemotherapy, with promising results in reducing recurrence and progression to MIBC. BMJ 12 February 2024

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NEJM

Treatment-resistant depression in older adults

Key clinical points

  • Treatment-resistant depression is common in older adults with depression and is associated with several biologic, psychological, and social factors, as well as with adverse clinical and functional outcomes.
  • A commonly accepted definition of treatment-resistant depression is a lack of improvement despite adequate trials of two different classes of antidepressants for at least 8 weeks.
  • Assessment of treatment-resistant depression includes screening for coexisting medical and psychiatric conditions.
  • Measurement-based collaborative care with the use of validated instruments (e.g., the nine-item Patient Health Questionnaire) is recommended for the management of depression, with continuous monitoring and adjustment of treatment until remission is reached and sustained.
  • The best evidence for a pharmacologic approach to the management of treatment-resistant depression rests on augmentation strategies, such as the use of second-generation antipsychotic agents, lithium, or another antidepressant agent, or a switch to a different class of agent.
  • Referral for a psychiatric evaluation for consideration of electroconvulsive therapy or other treatment is recommended for patients with severe depression, worsening suicidal ideation, psychosis, or coexisting cognitive impairment.

NEJM 15 February 2024

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JAMA

Time to Anticoagulation reversal and outcomes after Intracerebral Hemorrhage
This study highlights the importance of rapid treatment in improving survival and discharge to hospice for patients with anticoagulation-associated intracerebral hemorrhage, underscoring the need for efficient health care delivery in emergency settings. JAMA 9 February 2024

Development and validation of a risk score predicting death without transplant in adult heart transplant candidates
In this registry-based study of US heart transplant candidates, a continuous multivariable allocation score outperformed the 6-status system in rank ordering heart transplant candidates by medical urgency and may be useful for the medical urgency component of heart allocation. JAMA 13 February 2024

Long-term brain structure and cognition following Bariatric Surgery
These findings suggest that bariatric surgery was associated with long-term health benefits, including improvements in comorbidities, inflammation, and cognition; moreover, higher cortical thickness and lower spatial coefficient of variation were found in the temporal lobe 2 years after surgery. JAMA 9 February 2024

Hyperbaric Oxygen Therapy and late local toxic effects in patients with irradiated breast cancer : A randomized clinical trial
Hyperbaric oxygen therapy (HBOT) seems effective for reducing pain and fibrosis in women with late local toxic effects after breast irradiation. JAMA 8 February 2024

Emergency department volume and delayed diagnosis of serious pediatric conditions
EDs with fewer pediatric encounters had more possible delayed diagnoses across 23 serious conditions. Tools to support timely diagnosis in low-volume EDs are needed. JAMA 12 February 2024

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Other journals

A modified frailty index predicts complication, readmission, and 30-day mortality following the revision total hip arthroplasty
Increasing modified frailty index (MFI) scores correlate with increased odds of complication and readmission in patients who have undergone revision total hip arthroplasty (THA). This MFI may be used to predict the risks after revision THA. Arthroscopy 4 February 2024

The effect of haloperidol’s perioperative application on postoperative delirium in elderly patients: a systematic review and meta-analysis
The meta-analysis revealed perioperative application of haloperidol could decrease the occurrence of postoperative delirium without obvious side effects in elderly people, and high-dose haloperidol (5 mg daily) possessed a greater positive effect. BMC Anesthesiology 3 February 2024

Experiences of delivering and receiving mental healthcare in the acute hospital setting: a qualitative study
The assessment and treatment of people who attend ED with mental health problems needs to improve and particular attention should be given to the stressful nature of the ED environment for those who are extremely agitated or distressed. BMC health services research 12 February 2024

Early blood pressure lowering therapy is associated with good functional outcome in patients with intracerebral hemorrhage
In intracerebral hemorrhage (ICH) patients presenting within 6 h after symptom onset, early BP reduction within first 12 h is associated with good outcome and functional independence when compared to those who do not undergo such early intervention. Implementation of quality measures to ensure early BP reduction is crucial for management of ICH. BMC neurology 14 February 2024

Plant-based diets and cardiovascular risk factors: a comparison of flexitarians, vegans and omnivores in a cross-sectional study
The flexitarian diet (characterised by plant-based eating habits with occasional consumption of meat and processed meat products) appears to confer cardiovascular benefits. While vegans had the most favorable results overall, this study supports that reducing meat and processed meat products intake, as in flexitarianism, may contribute to CVD risk factor advantages. BMC nutrition 12 February 2024

“They choke to death in front of your very eyes”: nurses’ lived experiences and perspectives on end-of-life care during COVID-19
The study offers insights into the nurses’ attitudes towards death, dying, and end-of-life care. An emphasis should be placed on the key elements that emerged in this study, to assist nurses in overcoming these difficulties during and after medical crises, to enhance end-of-life care and professionalism and decrease burnout. BMC palliative care 8 February 2024

How do postnatal care guidelines in Australia compare to international standards? A scoping review and comparative analysis
Recommendations from postnatal guidelines in Australia have a high level of agreement with corresponding NICE/WHO recommendations. The few disagreements and modifications found in guideline recommendations - both across Australia’s guidelines and between Australia’s and the NICE/WHO guidelines - are worrying and warrant further examination, as they may result in different standards of care across Australia. Identified gaps in guidance should be prioritised for inclusion in new or updated guidelines where appropriate. BMC pregnancy and childbirth 9 February 2024

Thiamine administration in septic shock: a post hoc analysis of two randomized trials
In the combined analysis of two previous randomized trials, thiamine administration was associated with higher odds of being alive and renal replacement therapy (RRT)-free at hospital discharge in patients with septic shock. This signal was stronger in patients with thiamine deficiency. Critical care 6 February 2024

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COVID-19

COVID-19 Latest from research publications
compiled by the SALHN (SA Health) library staff - updated  27 February 2024

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

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

A risk profile using simple Hematologic parameters to assess benefits from Baricitinib in patients hospitalized with COVID-19: A post hoc analysis of the Adaptive COVID-19 Treatment Trial-2
The Adaptive COVID-19 Treatment Trial (ACCT) risk profile identifies a subgroup of hospitalized patients who benefit most from baricitinib treatment and captures a patient phenotype of treatment response to an immunomodulator and an antiviral. Changes in absolute lymphocyte count (ALC) and absolute neutrophil count (ANC) trajectory suggest a mechanism whereby an immunomodulator limits severe COVID-19. Annals of internal medicine 27 February 2024

Adverse events after XBB.1.5-containing COVID-19 mRNA vaccines
In a nationwide cohort of more than 1 million adults aged 65 years and older, no increased risk of 28 adverse events was observed following vaccination with a monovalent XBB.1.5-containing vaccine. JAMA 26 February 2024

COVID-19−associated acute kidney injury and longitudinal kidney outcomes
The findings of this multicenter cohort study indicate that survivors of hospitalization with COVID- acute kidney injury (AKI) experience lower rates of major adverse kidney events (MAKE), long-term kidney function decline, and mortality compared with patients with AKI associated with other illnesses. JAMA 26 February 2024

Data from four consecutive cohorts of students in Australia (2019–2022) show the impact of the COVID-19 pandemic on domestic and international university students’ mental health
The pandemic was associated with a marked increase in psychological distress in first-year university students, not all of which settled with the easing of restrictions. Post-pandemic recovery in the Australian university sector must include university-wide access to mental health information and support for incoming students. ANZ journal of psychiatry 21 February 2024

Results of the Cologne Corona Surveillance (CoCoS) project– a cross-sectional study: survey data on risk factors of SARS-CoV-2 infection, and moderate-to-severe course in primarily immunized adults
The results provide a first indication of which factors may be associated with SARS-CoV-2 breakthrough infection and moderate-to-severe course of infection despite vaccination. However, the retrospective nature of the study and risk of bias in the reporting of breakthrough infection severity limit the strength of the results. BMC public health 21 February 2024

The mediating role of coping styles in the relationship between fear of COVID-19 and mental health problems: a cross-sectional study among nurses
Fear of being infected by coronavirus disease 2019 (COVID-19) could trigger mental health problems among nurses at the frontline. BMC public health 21 February 2024

Internet use and difficulties in acquiring health resources among older adults with disabilities during the COVID-19 pandemic: a population-based cross-sectional study
Considering that older adults with disabilities experience triple the burden amid COVID-19 due to old age, disabilities, and the digital divide, policymakers, healthcare professionals, and engineers should aim to narrow the gaps between Internet users and Internet non-users among this population. Narrowing the gaps will make decreasing health gaps and increasing well-being among older adults with disabilities more attainable. BMC public health 20 February 2024

A forecasting tool for a hospital to plan inbound transfers of COVID-19 patients from other regions
Coordination between hospitals was necessary due to the high stress on the health care system. A simple planning tool can help to understand the impact of patient transfers on capacity utilization and improve the confidence of hospital leaders when making transfer decisions. The model was also helpful in investigating other operational scenarios and may be helpful when preparing for future outbreaks or public health emergencies. BMC Public health 16 February 2024

Long-term risks of respiratory diseases in patients infected with SARS-CoV-2: a longitudinal, population-based cohort study
This research suggests that patients with COVID-19 may have an increased risk of developing respiratory diseases, and the risk increases with the severity of infection and reinfection. Even during the 24-month follow-up, the risk of asthma and bronchiectasis continued to increase. Hence, implementing appropriate follow-up strategies for these individuals is crucial to monitor and manage potential long-term respiratory health issues. Additionally, the increased risk in lung cancer in the COVID-19 individuals was probably due to the diagnostic tests conducted and incidental diagnoses. eClinicalMedicine 15 February 2024

What is the specific role of schools and daycares in COVID-19 transmission? A final report from a living rapid review
Findings indicate that school settings do not substantially contribute to community incidence, hospitalisations, or mortality (low certainty). This living review provides a synthesis of global evidence for the role of schools and daycares during COVID-19, which might be helpful in future pandemics. The Lancet child and adolescent health 15 February 2024

“The magic triangle between bed, office, couch”: a qualitative exploration of job demands, resources, coping, and the role of leadership in remote work during the COVID-19 pandemic
The results expand the knowledge about healthy remote work by adding specific demands, resources, and coping strategies employees and managers experienced during the extreme situation of the COVID-19 pandemic to the picture as well as specifying the role of leadership. Moreover, the findings provide a foundation for guidelines for healthy remote work design and collaboration in times of abrupt change and crises. BMC public health 15 February 2024

Reverse shock index multiplied by simplified motor score as a predictor of clinical outcomes for patients with COVID-19
Compared with the shock index (SI), modified SI (mSI), and reverse shock index (rSI) combined with the Glasgow Coma Scale (rSI-GCS), the rSI-sMS has a higher predictive accuracy for general ward admission, ICU admission, and mortality among patients with COVID-19. BMC Emergency medicine 14 February 2024

Posttraumatic growth of medical staff during COVID-19 pandemic: A scoping review
This review discovered moderate posttraumatic growth (PTG) levels among medical staff during the COVID-19 pandemic, with critical areas in interpersonal relationships, life philosophy, and personal competence. The identified influencing factors can inform future research and interventions to enhance healthcare workers’ psychological resilience and well-being. BMC public health 14 February 2024

Association between social support and the severity of positive symptoms in rural community-dwelling patients with schizophrenia during the COVID-19 pandemic
The study confirmed the importance of social support, especially subjective support, provided to rural community-dwelling schizophrenia patients during the COVID-19 pandemic. This support should be addressed and strengthened for such patients in emergent events. BMC psychiatry 14 February 2024

The role of vaccine status homophily in the COVID-19 pandemic: a cross-sectional survey with modelling
The uneven uptake of COVID-19 vaccines and the nature of the contact network in the population play important roles in shaping COVID-19 transmission dynamics. BMC public health 14 February 2024

Cognitive symptoms of Post–COVID-19 condition and daily functioning
The findings of this study suggest that self-reported cognitive symptoms are prevalent in post–COVID-19 condition, often co-occur with depressive symptoms, and are associated with functional impairment. JAMA 14 February 2024

Cognitive, psychological, and physiological effects of a web-based mindfulness intervention in older adults during the COVID-19 pandemic: an open study
The results of this study show that a web-based mindfulness-based intervention (MBI) in older adults leads to improvements in cognitive and psychological measures, with associated modulations in specific brain rhythms. While these findings are promising, further controlled studies are required to validate these preliminary results. BMC geriatrics 14 February 2024

Trajectories of mental health outcomes following COVID-19 infection: a prospective longitudinal study
The findings of this study suggest that mental health outcomes following COVID-19 infection exhibit a dynamic pattern over time. The study provides valuable insights into the mental health trajectory following COVID-19 infection, emphasizing the need for ongoing assessment, support, and interventions tailored to the evolving mental health needs of this population. BMC public health 13 February 2024

Pre-pandemic physical activity and risk of COVID-19 diagnosis and hospitalization in older adults
In this cohort study of adults aged 45 years or older, those who adhered to physical activity (PA) guidelines before the pandemic had lower odds of developing or being hospitalized for COVID-19. Thus, higher prepandemic PA levels may be associated with reduced odds of SARS-CoV-2 infection and hospitalization for COVID-19. JAMA 13 February 2024

COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals
This multi-country analysis confirmed pre-established safety signals for myocarditis, pericarditis, Guillain-Barre syndrome, and cerebral venous sinus thrombosis. Other potential safety signals that require further investigation were identified. Vaccine 12 February 2024

Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial
In adults with post-covid-19 condition, an online, home based, supervised, group physical and mental health rehabilitation programme was clinically effective at improving health related quality of life at three and 12 months compared with usual care. BMJ 9 February 2024

Efficacy and safety of 5-day oral Ensitrelvir for patients with mild to moderate COVID-19: The SCORPIO-SR randomized clinical trial
In this randomized clinical trial, 125-mg ensitrelvir treatment reduced the time to resolution of the 5 typical COVID-19 symptoms compared with placebo in patients treated in less than 72 hours of disease onset; the absolute difference in median time to resolution was approximately 1 day. Ensitrelvir demonstrated clinical and antiviral efficacy without new safety concerns. Generalizability to populations outside Asia should be confirmed. JAMA 9 February 2024

Real-world use of nirmatrelvir-ritonavir in COVID-19 outpatients during BQ.1, BQ.1.1., and XBB.1.5 predominant omicron variants in three U.S. health systems: a retrospective cohort study
Real-world evidence from major US healthcare systems suggests ongoing NMV-r effectiveness in preventing hospitalisation during a BQ.1/BQ.1.1/XBB.1.5-predominant phase in the U.S, supporting its continued use in similar patient populations. The Lancet regional health -Americas 9 February 2024

Immunomodulators for immunocompromised patients hospitalized for COVID-19: a meta-analysis of randomized controlled trials
Immunomodulators, compared to control, were not associated with harmful or beneficial outcomes, including mortality, secondary infections, and change in ordinal scale, when administered to immunocompromised patients hospitalized for COVID-19. eClinicalMedicine 8 February 2024

The global prevalence of depression, anxiety, and sleep disorder among patients coping with Post COVID-19 syndrome (long COVID): a systematic review and meta-analysis
This systematic review and meta-analysis demonstrate a considerable burden of mental health issues, including depression, anxiety, and sleep disorders, among individuals recovering from COVID-19. The findings emphasize the need for comprehensive mental health support and tailored interventions for patients experiencing persistent symptoms after COVID-19 recovery. BMC psychiatry 6 February 2024

Changes in mental health services in response to the COVID-19 pandemic in high-income countries: a rapid review
A shift to telecommunication technologies had a significant impact on patients and care providers’ experiences of mental health care. Improvements to care access, flexibility, remote forms of care delivery and lengths of operating service hours emerged as crucial changes, which supported accessibility to mental health services, increased attendance and reduced dropouts from care. The relationships between patients and care providers were influenced by service changes and were vastly depending on technological literacy and context of patients and availability and care access ranging from regular contact to a loss of in-person contact. The review also identified an increase in care inequality and a feeling of being disconnected among marginalised groups including homeless people, veterans and ethic minority groups. Telehealth in mental care could be a viable alternative to face-to-face service delivery with effective treatment outcomes. Further research is needed to better understand the impact of the changes identified particularly on underserved populations. BMC psychiatry 6 February 2024

Effectiveness of Bivalent mRNA COVID-19 vaccines in preventing SARS-CoV-2 infection in children and adolescents aged 5 to 17 years
The bivalent COVID-19 vaccines protected children and adolescents against SARS-CoV-2 infection and symptomatic COVID-19. These data demonstrate the benefit of COVID-19 vaccine in children and adolescents. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations. JAMA 6 February 2024

Neonatal outcomes after COVID-19 vaccination in pregnancy
In this large population-based study, vaccination of pregnant individuals with mRNA COVID-19 vaccines was not associated with increased risks of neonatal adverse events in their infants. JAMA 6 February 2024

Trends in psychological distress and outpatient mental health care of adults during the COVID-19 era 
These trends and patterns underscore the persistent challenges of connecting older adults, unemployed persons, and seriously distressed adults to outpatient mental health care and the difficulties faced by older, less educated, lower-income, unemployed, and rural patients in accessing outpatient mental health care via video. Annals of internal medicine 6 February 2024

The Alfred Health post‐COVID‐19 service, Melbourne, 2020–2022: an observational cohort study
The known: Some people report persistent symptoms after acute COVID‐19, including dyspnoea, fatigue, and cognitive changes.
The new: Our Post‐COVID service invited people admitted to Alfred Health with COVID‐19 or referred by their general practitioners for follow‐up eight weeks after the onset of acute COVID‐19. A questionnaire‐based symptom assessment is followed by multidisciplinary management and referral to other medical and non‐medical services as needed. About 11% of eligible people used the service during 2020–2022, of whom 60% (5.7% of those invited) reported persistent symptoms.
The implications: A small proportion of people have persistent symptoms after COVID‐19 that require specialist assessment and management. Our outpatient triage model can efficiently facilitate appropriate care for this group. MJA 5 February 2024

The impact of changes in opioid dependency treatment upon COVID-19 transmission in Sydney, Australia: a retrospective longitudinal observational study
Clients attending South Eastern Sydney Local Health District (SESLHD) ODT services are significantly more likely to acquire COVID-19 than the NSW population at large. Promoting vaccination uptake, transferring clients to pharmacy, and reducing the frequency of dosing (by use of takeaway doses or long-acting depot buprenorphine) are all potential methods to reduce this risk. BMC Public health 2 February 2023

Predictors of non-recovery from fatigue and cognitive deficits after COVID-19: a prospective, longitudinal, population-based study
Fatigue and cognitive deficits are common sequelae after SARS-CoV-2 infection. These syndromes improved over time and about half of the patients recovered within two years. The identified risk factors for non-recovery from fatigue and cognitive deficits could play an important role in shaping targeted strategies for treatment and prevention. eClinicalMedicine 2 February 2024

Deadly places: The role of geography in Aboriginal and Torres Strait Islander COVID-19 vaccination
Findings underscore the extent to which area-level demographic influence the COVID-19 vaccination for Aboriginal and Torres Strait Islander Australians. ANZ journal of public health 1 February 2024

In-hospital mortality during the wild-type, alpha, delta, and omicron SARS-CoV-2 waves: a multinational cohort study in the EuCARE project
The herein observed decrease in in-hospital mortality seems to reflect a combined effect of immunity from vaccinations and previous infections, although differences in virulence between SARS-CoV-2 variants may also have contributed. The Lancet regional health -Europe 1 February 2024

Behavioural activation to mitigate the psychological impacts of COVID-19 restrictions on older people in England and Wales (BASIL+): a pragmatic randomised controlled trial
Behavioural activation is an effective and potentially scalable intervention that can reduce symptoms of depression and emotional loneliness in at-risk groups in the short term. The findings of this trial add to the range of strategies to improve the mental health of older adults with multiple long-term conditions. These results can be helpful to policy makers beyond the pandemic in reducing the global burden of depression and addressing the health impacts of loneliness, particularly in at-risk groups. The Lancet healthy longevity 1 February 2024

Cognitive dysfunction after covid-19
What you need to know

  • Cognitive problems are common after acute SARS-CoV-2 infection and can be disabling and frightening
  • Symptoms tend to improve, but this may take up to a year. Those with chronically persistent symptoms lasting more than 12 months have a lower chance of improving
  • Symptoms usually fluctuate
  • Assessment should be directed to documenting the nature and trajectory of the impairment and excluding alternative diagnoses
  • Self-management techniques may help patients manage their condition

BMJ 1 February 2024

Source of SARS-CoV-2 infection: results from a series of 584,846 cases in France from October 2020 to August 2022
Two-thirds of infections were attributed to interactions with close relatives, friends, or work colleagues. Extra-household indoor encounters without masks were commonly reported and represented avoidable circumstances of infection. BMC public health 30 January 2024

Intimate partner violence during COVID-19: systematic review and meta-analysis according to methodological choices
During the pandemic, IPV prevalence studies showed great methodological variation. Most studies were conducted online, reflecting adaptation to pandemic measures implemented worldwide. Prevalence estimates were higher in face-to-face studies and in studies using a standardized tool. However, estimates of the different forms of IPV during the pandemic do not suggest a marked change in prevalence compared to pre-pandemic global prevalence estimates, suggesting that one in five women experienced IPV during this period. BMC public health 29 January 2024

COVID-19 information seeking and individuals’ protective behaviors: examining the role of information sources and information content
These findings demonstrated that individuals seek various COVID-19 information from multiple sources. The direct and degree of association of information sources and content with individuals’ preventive behaviors vary from source to source and from content to content. Information sources and content could combinatorially promote individuals to adopt preventive behaviors through several configurations. BMC public health 29 January 2024

SARS-CoV-2 shedding and evolution in patients who were immunocompromised during the omicron period: a multicentre, prospective analysis
In this cohort, prolonged replication-competent omicron SARS-CoV-2 infections were uncommon. Within-host evolutionary rates were similar across patients, but individuals with infections lasting longer than 56 days accumulated spike mutations, which were distinct from those seen globally. Populations at high risk should be targeted for repeated testing and treatment and monitored for the emergence of antiviral resistance. The Lancet microbe 26 January 2024

Incidence of fit test failure during N95 respirator reuse and extended use
The findings suggest substantial rates of fit failure among health care workers (HCWs) practicing N95 reuse, which could inform policies related to N95 selection and reuse practices. JAMA 26 January 2024

Lung function trajectories in mild COVID-19 with two-year follow-up
The study’s results indicate that mild COVID-19 infection affects lung function at time of infection with limited recovery two years after infection. Journal of infectious diseases 25 January 2024

Efficacy of Tixagevimab-Cilgavimab as Immunoprophylaxis in patients with Hematologic Cancer
These findings suggest that prophylactic tixagevimab-cilgavimab may reduce the incidence and severity of COVID-19 and may be a complementary tool to vaccination boosters in patients with HMTs. JAMA 25 January 2024

Social determinants of health during and after coronavirus: a qualitative study
According to the present study, a grand plan to cover all positive and negative social effects of COVID-19 should have at least seven different dimensions. However, the present models of effective social determinants in health do not have such comprehensiveness. Future studies may provide a proper model to be used in clinical and research fields. BMC public health 24 January 2024

Immunomodulatory therapy in children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS, MIS-C; RECOVERY): a randomised, controlled, open-label, platform trial
Moderate evidence suggests that, compared with usual care, first-line intravenous methylprednisolone reduces duration of hospital stay for children with PIMS-TS. Good evidence suggests that second-line tocilizumab reduces duration of hospital stay for children with inflammation refractory to initial treatment. Neither intravenous immunoglobulin nor anakinra had any effect on duration of hospital stay compared with usual care. The Lancet child and adolescent health 22 January 2024

Evaluation of psychological distress, burnout and structural empowerment status of healthcare workers during the outbreak of coronavirus disease (COVID-19): a cross-sectional questionnaire-based study
Health professionals had high levels of burnout and psychological symptoms during the COVID-19 emergency. Monitoring and timely treatment of these conditions is needed. BMC psychiatry 22 January 2024

In utero exposure to maternal COVID-19 vaccination and offspring neurodevelopment at 12 and 18 months
Results of this cohort study suggest that COVID-19 vaccination was safe during pregnancy from the perspective of infant neurodevelopment to 18 months of age. Additional longer-term research should be conducted to corroborate these findings and buttress clinical guidance with a strong evidence base. JAMA 22 January 2024

Timing of maternal COVID-19 vaccine and antibody concentrations in infants born preterm
In this prospective cohort study of pregnant individuals with preterm and full-term deliveries, receipt of 3 or more compared with 2 doses of COVID-19 vaccine before delivery resulted in 10-fold higher cord anti-S antibody levels. Maternal antibody concentration appeared more important than delivery gestational age in determining cord anti-S antibody levels. The number of doses and timing considerations for COVID-19 vaccine in pregnancy should include individuals at risk for preterm delivery. JAMA 19 January 2024

Association between vaccination rates and COVID-19 health outcomes in the United States: a population-level statistical analysis
This study concludes that despite the emergence of new variants, vaccines remain highly correlated with reduced COVID-19 harm. Therefore, given the ongoing threat posed by COVID-19, vaccines remain a critical line of defense for protecting the public and reducing the burden on healthcare systems. BMC public health 18 September 2024

Oral Simnotrelvir for adult patients with mild-to-moderate Covid-19
Early administration of simnotrelvir plus ritonavir shortened the time to the resolution of symptoms among adult patients with Covid-19, without evident safety concerns. NEJM 18 January 2024

The impact of the COVID-19 pandemic on mental health and quality of life in people living with and beyond breast, prostate and colorectal cancer – a qualitative study
People living with and beyond cancer have past and ongoing experiences that make them vulnerable to adverse psychosocial reactions and outcomes. Support for this population needs to provide greater clarity of risk, clearer guidelines specific to their personal circumstances, and regular updates on scheduling of important follow up care and monitoring. BMC psychology 16 January 2023

Clinical characteristics and outcomes among critically ill patients with cancer and COVID-19-related acute respiratory failure
Critically ill patients with cancer experiencing COVID-19-related acute respiratory failure present unique clinical features and worse clinical outcomes compared with those without cancer. Smoking, elevated lactate dehydrogenase (LDH), vasopressor use, and new renal replacement therapy were risk factors for in-hospital mortality in these patients. BMC pulmonary medicine 16 January 2023

SARS-CoV-2 vaccination and Neuroimmunological Disease: A review
The associated risk between SARS-CoV-2 vaccination and Guillain-Barré syndrome (GBS), and possibly Bell palsy, is slight, and this should not change the recommendation for individuals to be vaccinated. The same advice should be given to those with preexisting neurological autoimmune disease. JAMA 16 January 2024

Long-term microvascular changes in multisystem inflammatory syndrome in children
This study found significant, persistent microvascular damage with redistribution of the vessel architecture (ie, loss of capillaries with relative increase in larger vessels) in patients with MIS-C and suggests a long-term association with arterial stiffness. Our findings suggest that MIS-C’s pathogenesis may go beyond the acute hyperinflammatory reaction, possibly involving independent effects of SARS-CoV-2 on the endothelium and vascular system. JAMA 16 January 2024

Deciphering factors linked with reduced SARS-CoV-2 susceptibility in the Swiss HIV Cohort Study
The findings of two independent protective factors, smoking and HCoV antibodies, both affecting the respiratory environment, underscore the importance of the local immune milieu in regulating susceptibility to SARS-CoV-2. Journal of infectious diseases 16 January 2024

Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales
Rates of undervaccination against COVID-19 ranged from 32·8% to 49·8% across the four UK nations in summer, 2022. Undervaccination was associated with an elevated risk of severe COVID-19 outcomes. The Lancet 15 January 2024

What set some young adults apart during the COVID-19 pandemic? Mental health trajectories, risk and protective factors in an Australian longitudinal study
Most young adults demonstrated stable trajectories of low or high symptoms during the pandemic, with smaller groups showing initially severe or reactive symptoms followed by marked improvements over time. Vulnerable subgroups (gender- or sexuality-diverse, those with prior adversity or pre-existing mental ill-health) may face ongoing impacts and require targeted psychosocial supports to assist their mental health recovery post-COVID-19 and in the event of future crises. Australian and New Zealand Journal of psychiatry 11 January 2024

Pandemic fatigue and depressive symptoms among college students in the COVID-19 context: indirect effects through sense of control and intolerance of uncertainty
The findings expand the application of the stress process model to the context of COVID-19 and deepen the understanding of pandemic fatigue—depressive symptoms link with considering the indirect roles of sense of control and intolerance of uncertainty. Psychological distress in the context of COVID-19 could be alleviated by the interventions on strengthening sense of control and tolerance of uncertainty and lessening the adverse effects of pandemic fatigue. BMC psychology 11 January 2024

Mental health self-care during the COVID-19 pandemic: a prospective cohort study in Australia
Actions to manage mental health concerns during the pandemic were common, as were conversations with friends or family members. During economic crises, support and services should focus on reducing barriers to formal mental health care, particularly for people who less commonly seek help, and those experiencing moderate to high levels of psychological distress. BMC public health 10 January 2024

Risks of digestive diseases in long COVID: evidence from a population-based cohort study
This study provides insights into the association between COVID-19 and the long-term risk of digestive system disorders. COVID-19 patients are at a higher risk of developing digestive diseases. The risks exhibited a stepwise escalation with the severity of COVID-19, were noted in cases of reinfection, and persisted even after 1-year follow-up. This highlights the need to understand the varying risks of digestive outcomes in COVID-19 patients over time, particularly those who experienced reinfection, and develop appropriate follow-up strategies. BMC medicine 10 January 2024

Update to living systematic review on SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission
The latest version of this living systematic review (update 1) includes 643 studies of which 343 are cohort studies and 300 case series and case reports. 2.7% of the babies born to mothers with SARS-CoV-2 infection tested positive with RT-PCR. Positivity rates varied between regions, being the highest in studies from Latin America and the Caribbean (8.5%). Severe maternal covid-19, maternal death, maternal postnatal infection, caesarean section, and preterm delivery are associated with SARS-CoV-2 positivity in offspring. Of the positive babies with data for the timing of exposure and type and timing of tests, 32 had confirmed mother-to-child transmission. The results confirm vertical transmission of SARS-CoV-2, although this is rare. BMJ 10 January 2024

Risk of Alopecia Areata after COVID-19
COVID-19 is associated with exacerbation or triggering of various autoimmune diseases, such as systemic lupus erythematosus, inflammatory bowel disease, and rheumatoid arthritis. Alopecia areata (AA) is autoimmune hair loss that occurs in susceptible individuals by environmental triggers, such as viruses, vaccinations, and psychological stress. There is a growing number of reports on new onset, exacerbation, and recurrence of AA after COVID-19. However, evidence supporting an association between COVID-19 and AA is limited. JAMA 10 January 2024

Vegetarian and plant-based diets associated with lower incidence of COVID-19
Plant-based and mainly vegetarian diets were associated with a lower incidence of COVID-19 infection. These dietary patterns may be considered protective against COVID-19 infection. BMJ nutrition, prevention and health 9 January 2024

Habitual salt preference worsens blood pressure in hospitalized hypertensive patients with omicron infection under epidemic-related stress
Habitual salt preference (SP) and psychosocial stress were associated with higher blood pressure (BP) in Omicron-infected patients both with and without hypertension. Nonpharmaceutical intervention including dietary guidance and psychiatric therapy are crucial for BP control during the long COVID-19 period. BMC public health 9 January 2024

Real-world effectiveness of BNT162b2 against infection and severe diseases in children and adolescents
This study suggests that BNT162b2 was effective for various COVID-19–related outcomes in children and adolescents during the Delta and Omicron periods, and there is some evidence of waning effectiveness over time. Annals of internal medicine 9 January 2024

COVID-19 immunization coverage among people with sickle cell disease
In this population-level study, COVID-19 immunization completion was nearly 2 times lower for people with vs without sickle cell disease (SCD). This discrepancy was particularly large among adults aged 18 to 64 years. These results are consistent with findings from health system–based studies in which fewer than half of patients with SCD completed the vaccination series. JAMA 8 January 2024

Severe COVID anxiety among adults in the United Kingdom: cohort study and nested feasibility trial
While the mental health of people with severe COVID anxiety appears to improve over time, many continue to experience high levels of anxiety and poor social functioning. Health anxiety is highly prevalent among people with severe COVID anxiety and may provide a target for psychological treatment. BMC psychiatry 6 January 2024

Public health impact of Paxlovid as treatment for COVID-19, United States
fast-acting antiviral drugs like Paxlovid can serve as invaluable tools to mitigate COVID-19 epidemics. By increasing supplies and improving infrastructure to enable rapid and equitable distribution, such drugs could substantially mitigate the health and societal burdens of COVID-19. Emerging infectious diseases 5 January 2024

The mental health of Australians bereaved during the first two years of the COVID-19 pandemic: a latent class analysis
COVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society into the foreseeable future. These lessons learned must inform policymakers and healthcare professionals to improve bereavement care and ensure preparedness during and following future predicted pandemics to prevent negative impacts. Psychological medicine 5 January 2024

Occurrences of post-traumatic stress disorder, anxiety, depression, and burnout syndrome in ICU staff workers after two-year of the COVID-19 pandemic: the international PSY-CO in ICU study
The present study confirmed that ICU staff workers, whether they treated COVID-19 patients or not, have a substantial prevalence of psychological disorders. Annals of general psychiatry 3 January 2024

Effectiveness and safety of awake prone positioning in COVID-19-related acute hypoxaemic respiratory failure: an overview of systematic reviews
The available Systematic reviews (SRs) suggest that awake prone positioning (APP) has benefits in terms of reducing intubation rates and improving oxygenation for COVID-19-related acute hypoxemic respiratory failure, without an increased risk of adverse events. The conclusion should be treated with caution because of the generally low quality of methodology and evidence. BMC pulmonary medicine 2 January 2024

Persistent intracranial hyper-inflammation in ruptured cerebral aneurysm after COVID-19: case report and review of the literature
Subarachnoid hemorrhage (SAH) is a severe complication of COVID-19 in children and adults who have asymptomatic cerebrovascular aneurysms. The markedly high levels of cytokines detected in the cerebrospinal fluid suggested that intracranial hyperinflammatory condition might be one of the possible mechanisms involved in the rupture of a preexisting cerebrovascular aneurysms. BMC neurology 2 January 2024

Perceived risk of infection, ethical challenges and motivational factors among frontline nurses in Covid-19 pandemic: prerequisites and lessons for future pandemic
During the pandemic, nurses were afraid to work and faced personal and family risks of contracting the virus. Despite these challenges, they still feel a strong sense of commitment and dedication to providing the best possible care. Nurse administrators need to create a supportive environment that follows ethical principles and meets the needs of nurses to boost their motivation and encourage them to continue working for longer periods. BMC nursing 2 January 2024

Collateral effects of COVID-19 stay-at-home orders on violence against women in the United States, January 2019 to December 2020
The benefits of risk-mitigation strategies to reduce the health impacts directly associated with a pandemic should be weighed against their costs with respect to women’s heightened exposure to certain forms of violence and the potentially cascading impacts of such exposure on health. The effects of COVID-19 non-pharmaceutical risk-mitigation (NPRM) strategies on intimate partner violence (IPV) risk nationally and its immediate and long-term health sequelae should be studied, with stressors like ongoing pandemic-related economic hardship and substance misuse still unfolding. Findings should inform the development of social policies to mitigate the collateral impacts of crisis-response efforts on the risk of VAW and its cascading sequelae. BMC public health 2 January 2024

Global COVID-19 vaccine acceptance level and its determinants: an umbrella review
The pooled level of COVID-19 vaccine acceptance highly varied and found to be unacceptably low particularly in low-income countries. Higher level of education, good level of knowledge, favourable attitude, previous history of COVID-19, male sex, and chronic disease were factors of COVID-19 vaccine acceptance rate. A collaborative effort of stakeholders such as policymakers, and vaccine campaign program planners is needed to improve the acceptance rate of COVID-19 vaccine. BMC public health 2 January 2024

Positive and negative aspects of the COVID-19 pandemic among a diverse sample of US adults: an exploratory mixed-methods analysis of online survey data
Positive and negative experiences during the COVID-19 pandemic varied widely and differed across race-ethnicity, gender, and age. Future public health interventions should work to mitigate negative social and economic impacts and facilitate posttraumatic growth associated with pandemics. BMC public health 2 January 2024

Monkeypox

Updated 25 January 2024

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

SA Health – health alert – Monkeypox

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

Monkeypox Resources for Health Professionals (Wolters Kluwer)

Monkeypox Resource Centre (JAMA)

World Health Organization Health alert

Journal articles

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mpox: Keep it on the differential
Key points:

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

Cleveland journal of medicine 13 September 2023

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

Breakthrough mpox despite two‐dose vaccination
Lessons from practice

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

MJA 4 September 2023

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

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

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

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

MJA 7 August 2023

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Human monkeypox: diagnosis and management
What you need to know

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

BMJ 6 February 2023

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

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

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

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

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SA Health Library Service 12/8/2022