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What's new in the medical literature

Updated 24 May 2024

UpToDate

Cochrane Library

Cochrane clinical answers

MJA

BMJ

NEJM

JAMA

Other journals

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UpToDate

Limited benefit of nirmatrelvir-ritonavir in non-high-risk individuals with mild-to-moderate COVID-19
Although nirmatrelvir-ritonavir reduces COVID-19-associated hospitalization and death in patients at high risk for severe disease, the benefit in lower-risk patients is uncertain. The EPIC-SR trial evaluated nirmatrelvir-ritonavir. In the trial, nirmatrelvir-ritonavir did not reduce duration of symptoms, the risk of hospitalization from COVID-19, or all-cause mortality compared with placebo. We continue to suggest against treating patients who are not at high risk for severe disease. (See "COVID-19: Management of adults with acute illness in the outpatient setting", section on 'Efficacy and rationale'.)

New guidelines for cannabinoid hyperemesis syndrome
Cannabinoid hyperemesis syndrome (CHS) causes severe abdominal pain and vomiting that occurs in a cyclical pattern associated with prolonged, regular cannabis use. Standard antiemetics (eg, ondansetronmetoclopramide) are typically ineffective. The Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4) from the Society for Academic Emergency Medicine suggest using dopamine antagonists such as droperidol or haloperidol in addition to usual care to manage symptoms of CHS in adult patients [19]. Capsaicin cream may be used as an adjunct but is often less effective. (See "Cannabinoid hyperemesis syndrome", section on 'All patients: IV fluids, dopamine antagonists'.)

SCCM guidelines on the management of hyperglycemia in critically ill patients
The Society of Critical Care Medicine (SCCM) has issued new guidelines for the management of hyperglycemia in critically ill adults and children [56,57]. Compared with the 2012 guidelines, emphasis was placed on the use of management protocols (with decision support tools) that avoid hypoglycemia and liberalization of blood glucose targets (eg, 7.8 to 11.1 mmol/L [140 to 200 mg/dL]) with frequent monitoring (≤1 hourly). We agree with the new SCCM recommendations. While we use a lower upper limit for blood glucose (180 mg/dL [10 mmol/L]) than that recommended by the SCCM, it is unlikely to be clinically meaningful. (See "Glycemic control in critically ill adult and pediatric patients", section on 'Our approach'.)

New guidelines with revised diagnostic criteria for allergic bronchopulmonary aspergillosis
Allergic bronchopulmonary aspergillosis (ABPA), a complex hypersensitivity reaction to airway colonization with Aspergillus fumigatus, can be hard to distinguish from difficult-to-treat asthma or cystic fibrosis. The International Society for Human and Animal Mycology (ISHAM) working group for ABPA recently published revised diagnostic criteria that make some key changes to improve the sensitivity and specificity of the diagnosis [58]: Total serum immunoglobulin (Ig) E levels of ≥500 international units/mL are sufficient for the diagnosis, rather than the previously higher threshold of 1000 international units/mL. Elevated Aspergillus IgG levels by enzyme immunoassay or lateral flow assay are more sensitive for detecting sensitivity to Aspergillus antigens and should be used preferentially over Aspergillus serum precipitins. Our authors agree with the revised ISHAM diagnostic approach (table 2). (See "Clinical manifestations and diagnosis of allergic bronchopulmonary aspergillosis", section on 'Diagnostic criteria'.) 

 

Drug therapy to prevent recurrent urinary stone disease
In patients with kidney stones, drug therapy to reduce stone recurrence is indicated if the stone disease remains active or there is insufficient improvement in urine chemistries despite dietary modification; however, evidence for its effectiveness is limited. In a study of over 5600 adults with urinary stone disease and at least one urinary abnormality (hypercalciuria, hypocitraturia, or hyperuricosuria), drug therapy (thiazide diuretics, alkali therapy, or uric acid-lowering medications) was associated with a 19 percent lower risk of clinically significant recurrent stone disease over 12 to 36 months compared with no treatment. (See "Kidney stones in adults: Prevention of recurrent kidney stones", section on 'Drug therapy for specific metabolic abnormalities'.)

Pregnancy outcome among individuals with obesity and low gestational weight gain
For individuals with obesity, increasing evidence suggests that gestational weight gain (GWG) below standard recommendations (5 kg) is safe and may result in a more favorable pregnancy outcome. In an observational study including over 11,000 pregnancies with class I obesity, 3000 with class II obesity, and 900 with class III obesity, GWG below 5 kg was not associated with an increased risk of the composite adverse outcome in those with class I or II obesity and was associated with a 20 percent risk reduction in those with class III obesity [1]. These findings suggest that GWG recommendations should be revised downward for individuals with obesity, particularly those with class III obesity. We do not advise pregnant people with obesity and GWG below 5 kg to increase weight gain if the fetus is growing appropriately on ultrasound examination. (See "Gestational weight gain", section on 'Approach to weight gain below IOM recommendations'.)

Fetal endoscopic tracheal occlusion for managing congenital diaphragmatic hernia
Emerging data support use of fetal endoscopic tracheal occlusion (FETO) for management of isolated, moderate-to-severe, left-sided congenital diaphragmatic hernia (CDH). In a study of such patients in the North American Fetal Therapy Network (NAFTNet) FETO Consortium, FETO was associated with higher survival at six months of age compared with expectant management (70 versus 58 percent), although the difference was not statistically significant [2]. FETO was also associated with a higher rate of preterm prelabor rupture of membranes (PPROM), earlier gestational age at delivery, and lower birth weight. Among patients with severe CDH, FETO was associated with fewer days of extracorporeal membrane oxygenation (9 versus 17 days). These data suggest that FETO may improve survival and can help decrease pediatric morbidity, despite a higher risk of PPROM. (See "Congenital diaphragmatic hernia: Prenatal issues", section on 'Outcome of FETO'.)

Reducing alcohol use during pregnancy
Clinicians caring for pregnant persons are advised to routinely educate and counsel about the harms of alcohol use during pregnancy. A meta-analysis of three trials reported more pregnant patients continuously abstained from alcohol consumption after receiving psychosocial interventions compared with usual care (69 versus 51 percent) [3]. We encourage clinicians caring for pregnant individuals to offer access to psychosocial interventions (eg, information sessions, self-help groups, cognitive behavioral therapy) in addition to routinely educating them about the dangers of alcohol use during pregnancy. (See "Alcohol intake and pregnancy", section on 'Management of screen-positive pregnant persons'.)

Updated vulvar carcinoma staging system
An updated version of the American Joint Committee on Cancer tumor, node, metastasis staging for vulvar carcinoma has been published (table 2) [33]. This version is now in alignment with the 2021 International Federation of Gynecology and Obstetrics vulvar carcinoma staging system. Both systems are used worldwide to stage patients with squamous and basal cell carcinomas, adenocarcinomas, and carcinomas arising from the Bartholin gland. (See "Squamous cell carcinoma of the vulva: Staging and surgical treatment", section on 'Staging system'.)

Machine learning model for oxygenation targets in mechanically ventilated patients
In mechanically ventilated patients, ideal oxygenation targets are unknown and vary depending on the population being treated. One recent study examined the ability of machine learning to individualize oxygen targets based upon data from previously published trials [9]. The use of an individual peripheral oxygen saturation (SpO2) target based upon that predicted by the machine learning model would have reduced the absolute overall mortality by 6.4 percent compared with the randomized SpO2 target. While these results are encouraging, a prospective trial is needed before a model such as this can be applied in routine practice. (See "Overview of initiating invasive mechanical ventilation in adults in the intensive care unit", section on 'Fraction of inspired oxygen'.)

Machine learning to narrow pleural effusion differential
Determining the etiology of a pleural effusion can be challenging. Machine learning has recently been used to help clinicians narrow the differential. One study of over 2200 patients who underwent thoracentesis found good performance when a machine learning model used 18 of 49 clinical, blood, and pleural fluid parameters to identify five common types of pleural effusion (transudative, malignant, parapneumonic, tuberculous, and other; area under the receiver operating characteristic curve 0.930 [validation set] and 0.916 [extra-validation set]) [31]. Further study in different populations and refinement are needed before a model such as this can be clinically useful. (See "Diagnostic evaluation of the hemodynamically stable adult with a pleural effusion", section on 'Making a preliminary diagnosis'.)

Risk of autoimmune inflammatory rheumatic disease following COVID-19
The risk of developing autoimmune inflammatory rheumatic diseases (AIRDs) following COVID-19 has recently been studied (eg, rheumatoid, psoriatic, and spondyloarthritides and connective tissue disorders) [36]. A Korean and Japanese cohort analysis of 22 million patients reported an increased risk of AIRDs in patients who had COVID-19 compared with uninfected patients (hazard ratio [HR], 1.25 [Korea], 1.79 [Japan]) and with patients who had influenza (HR, 1.30 [Korea], 1.14 [Japan]). The risk appeared to diminish over time and was likely reduced by vaccination. Clinicians should be aware of the risk of AIRD following COVID-19 and investigate appropriately when suspected. (See "COVID-19: Clinical presentation and diagnosis of adults with persistent symptoms following acute illness ("long COVID")", section on 'Physical symptoms'.)

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MJA

Cardiovascular outcomes for people hospitalised with COVID-19 in Australia, and the effect of vaccination: an observational cohort study
Although troponin levels were elevated in a considerable proportion of people hospitalised with COVID-19, clinical cardiovascular events were infrequent, and their likelihood was not influenced by vaccination. COVID-19 vaccination, however, was associated with reduced likelihood of in-hospital death and intubation. MJA 13 May 2024

The burden of working time lost to compensable occupational injury and disease in Australia, 2012–17: a retrospective population-based study
The known: Applying population-based measures to assessing the working time lost to occupational injury and disease has not been reported in Australia.
The new: Injury and disease for which workers’ compensation was granted resulted in 41 194 working years lost (WYL) per annum in Australia during 2012–17, 40% of which was attributable to traumatic injuries and 21% to musculoskeletal disorders. The WYL was greater for male than female workers, and the individual burden increased with age.
The implications: Occupational injury and disease substantially impair labour force productivity. Measuring their impact is important for effective health surveillance, policy development, and resource allocation. MJA 19 May 2024

A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline
A total of 39 recommendations on screening, preventing, diagnosing and managing HDP, especially preeclampsia, are presented in this guideline. Recommendations are presented as either evidence-based recommendations or practice points. Evidence-based recommendations are presented with the strength of recommendation and quality of evidence. Practice points were generated where there was inadequate evidence to develop specific recommendations and are based on the expertise of the working group. MJA 19 May 2024

Which reference equation should we use for interpreting spirometry values for First Nations Australians? A cross-sectional study
The known: Spirometry, critical for diagnosing lung conditions, relies on reference equations that reflect normal values for the relevant population. No validated equations are available for First Nations Australians.
The new: Analysis of spirometry data for 1467 healthy First Nations children and adults indicated that the Global Lung Function Initiative (GLI)-2012 other/mixed and the race-neutral GLI-2022 global reference equations can be used to assess lung function in First Nations people. Mean spirometry values were poorer in rural and remote than in urban areas.
The implications: Until more data from urban areas are available, the race-neutral GLI-2022 global and GLI-2012 other/mixed reference equations are appropriate for assessing lung function in First Nations Australians. MJA 13 May 2024

Misperceptions about routine childhood vaccination among parents in Australia, before and after the COVID-19 pandemic: a cross-sectional survey study
In Australia, the proportion of 12-month-old children who were fully vaccinated declined from 94.31% in 20193 to 93.16% in 2023; among Indigenous children it declined from 92.61% to 90.39%.Practical barriers contributed to these changes, but reduced confidence in vaccines was also a factor; general public perceptions of the importance of childhood vaccination had declined in 52 of 55 countries examined by a 2023 UNICEF report. In Australia, a 2022 report found that the proportion of parents of children aged 0–5 years who strongly support childhood vaccination had declined from 72% in 2017 to 50% in 2022. MJA 12 May 2024

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BMJ

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

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

BMJ 22 May 2024

Clinical and healthcare use outcomes after cessation of long term opioid treatment due to prescriber workforce exit: quasi-experimental difference-in-differences study
The loss of a prescriber was associated with increased occurrences of discontinuation of long term opioid treatment and transient increases in adverse outcomes, such as suicide attempts, but not other outcomes, such as overdoses. Long term opioid treatment discontinuation may be associated with a temporary period of adverse health impacts after accounting for unobserved confounding. BMJ 16 May 2024

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

Long acting progestogens versus combined oral contraceptive pill for preventing recurrence of endometriosis related pain: the PRE-EMPT pragmatic, parallel group, open label, randomised controlled trial
Postoperative prescription of a long acting progestogen or the combined oral contraceptive pill results in similar levels of improvement in endometriosis related pain at three years, with both groups showing around a 40% improvement compared with preoperative levels. While women can be reassured that both options are effective, the reduced risk of repeat surgery for endometriosis and hysterectomy might make long acting reversible progestogens preferable for some. BMJ 15 May 2024

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

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

BMJ 10 May 2024

Cardiovascular toxicity of immune therapies for cancer
In addition to conventional chemoradiation and targeted cancer therapy, the use of immune based therapies, specifically immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T cell therapy (CAR-T), has increased exponentially across a wide spectrum of cancers. This has been paralleled by recognition of off-target immune related adverse events that can affect almost any organ system including the cardiovascular system. The use of ICIs has been associated with myocarditis, a less common but highly fatal adverse effect, pericarditis and pericardial effusions, vasculitis, thromboembolism, and potentially accelerated atherosclerosis. CAR-T resulting in a systemic cytokine release syndrome has been associated with myriad cardiovascular consequences including arrhythmias, myocardial infarction, and heart failure. This review summarizes the current state of knowledge regarding adverse cardiovascular effects associated with ICIs and CAR-T. BMJ 15 May 2024

A lack of quality statistics is hiding the real heatwave death toll
Heatwaves are intensifying but gaps in the data mean that the number of people who have died from rising temperatures is unclear. BMJ 14 May 2024

Association between exposure to antibiotics during pregnancy or early infancy and risk of autism spectrum disorder, intellectual disorder, language disorder, and epilepsy in children: population based cohort study
In this large cohort study, antibiotic exposure during pregnancy or early infancy was not associated with an increased risk of autism spectrum disorder, intellectual disorder, or language disorder in children. However, elevated risks were observed in several subgroups such as children using antibiotics during very early life and those with long term antibiotic use, which warrants attention and further investigation. Moreover, antibiotic use during infancy was modestly associated with epilepsy, even after control for indications and familial factors. When prescribing antibiotics to pregnant women and infants, clinicians should carefully balance the benefits of use against potential risks. BMJ 22 May 2024

Epidural analgesia during labour and severe maternal morbidity: population based study
Epidural analgesia during labour was associated with a 35% reduction in severe maternal morbidity (SMM), and showed a more pronounced effect in women with medical indications for epidural analgesia and with preterm births. Expanding access to epidural analgesia for all women during labour, and particularly for those at greatest risk, could improve maternal health. BMJ 22 May 2024

How to deliver equitable access to the best possible care
Healthcare services often fall short in their efforts to provide the best care possible to everyone they treat. Some failures in healthcare concentrate in conditions that don’t receive the attention warranted by their impact on people’s wellbeing and quality of life. For instance, infertility affects one in six people in their lifetime, yet access to assisted reproductive technology remains inequitable globally. BMJ 23 May 2024

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NEJM

Early diagnosis and treatment of COPD and Asthma — A randomized, controlled trial
In this trial in which a strategy was used to identify adults in the community with undiagnosed asthma or COPD, those who received pulmonologist-directed treatment had less subsequent health care utilization for respiratory illness than those who received usual care. NEJM 19 May 2024

Dupilumab for COPD with blood Eosinophil evidence of type 2 inflammation
In patients with COPD and type 2 inflammation as indicated by elevated blood eosinophil counts, dupilumab was associated with fewer exacerbations and better lung function than placebo. NEJM 20 May 2024

Climate change, extreme heat, and health
Climate change has led to a rise of 1.1°C in mean global temperature since the Industrial Revolution, with projected increases of 2.5 to 2.9°C by the end of the century, in the absence of drastic reductions in greenhouse gas emissions. A recent study showed that more than one third of heat-related deaths in the period from 1991 through 2018 across 43 countries, including the United States, were attributable to anthropogenic greenhouse gas emissions. NEJM 15 May 2024

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JAMA

Time- vs step-based physical activity metrics for health
Results of this study suggest that among females 62 years or older, moderate to vigorous PA (MVPA) time and step counts were qualitatively similar in their associations with all-cause mortality and CVD. Step count–based goals should be considered for future guidelines along with time-based goals, allowing for the accommodation of personal preferences. JAMA 20 May 2024

Liver resection vs nonsurgical treatments for patients with early multinodular hepatocellular carcinoma
For patients with early multinodular hepatocellular carcinoma (HCC) who are ineligible for transplant, liver resection (LR) should be prioritized as the primary therapeutic option, followed by percutaneous radiofrequency ablation (PRFA) and transarterial chemoembolization (TACE) when LR is not feasible. These findings provide valuable insights for clinical decision-making in this patient population. JAMA 15 May 2024

Breast cancer risk after bariatric surgery and influence of insulin levels: A nonrandomized controlled trial
This prospective clinical trial indicated a reduced risk of breast cancer after bariatric surgery in women with obesity. The surgical treatment benefit was predominantly seen in women with hyperinsulinemia. JAMA 15 May 2024

Hypertension and kidney function after living kidney donation
After accounting for differences in baseline risk, living donors had a similar risk of hypertension as nondonors in the 7 years following donation and no significant difference in mean blood pressure. JAMA 23 May 2024

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Other journals

Cross-sectional study of psychiatric disorders in patients with chronic musculoskeletal pain and individuals without pain
Positive correlations of mental disorders and chronic musculoskeletal pain have been documented. This suggests that psychiatric components must be taken into account in the management of chronic pain syndromes. The use of Mini Plus as a diagnostic tool for psychiatric disorders can contribute to optimizing the diagnosis and treatment of patients with chronic pain and encourage the creation of policies with strategies and criteria for quick access to Multi-professional Services. Advances in rheumatology 10 May 2024

Preoperative weight loss interventions before total hip and knee arthroplasty: a systematic review of randomized controlled trials
Weight loss intervention can achieve significant reductions in body weight and body mass index before arthroplasty, with fewer postoperative complications reported. Further studies with different populations could confirm the effect of these interventions among populations with different obesity characteristics. Arthroplasty 17 May 2024

Asking patients if they have any questions can help improve patient satisfaction with medical team communication in the emergency department
This study implements a concrete way to improve patients’ satisfaction with medical communication in the ED. BMC emergency medicine 20 May 2024

Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?
This randomised controlled trial did not show that our health mediation intervention was effective in reducing the use of emergency services by frequent users of EDs (FUED) living in precarious conditions. Some limitations are discussed: the duration of the intervention (90 days), the long-term effects (> 6 months), the involvement of the ED staff. BMC emergency medicine 15 May 2024

Low-dose short infusion ketamine as adjunct to morphine for acute long bone fracture in the emergency department: a randomized controlled trial
Short infusion low-dose ketamine, as an adjunct to morphine, is effective in reducing pain during the initial 30 to 60 min and demonstrated comparability to intravenous morphine alone in reducing pain over the subsequent 60 min for acute long bone fractures. However, it was associated with a higher incidence of dizziness. BMC emergency medicine 9 May 2024

Combined systematic screening for malnutrition and dysphagia in hospitalized older adults: a scoping review
Most of the studies considered the prevalence and association of dysphagia and malnutrition with varying outcomes such as nutritional status, pneumonia, oral nutrition, and swallowing function. Only two studies had implemented multi-professional nutrition teams. BMC geriatrics 21 May 2024

Development and validation of the tic score for early detection of traumatic coagulopathy upon hospital admission: a cohort study
The trauma-induced coagulopathy (TIC) Score is quick and easy to calculate and can accurately identify patients with TIC upon hospital admission. Critical care 18 May 2024

Assessing the impact of early progressive mobilization on moderate-to-severe traumatic brain injury: a randomized controlled trial
The early progressive out-of-bed mobilization protocol can enhance mobility and functional outcomes and shorten ICU stay and ventilation duration of patients with moderate-to-severe Traumatic brain injury (TBI). The study’s results support further investigation of early progressive mobilization (EPM) through larger, randomized clinical trials. Critical care 22 May 2024

Targeted temperature control following traumatic brain injury: ESICM/NACCS best practice consensus recommendations
Based on a modified Delphi expert consensus process, this report aims to inform on best practices for targeted temperature control (TTC) delivery for patients following traumatic brain injury (TBI), and to highlight areas of need for further research to improve clinical guidelines in this setting. Critical care 21 May 2024

Evaluation of Apixaban standard dosing in underweight patients with non-valvular atrial fibrillation: a retrospective cohort study
This exploratory study revealed that underweight patients with non-valvular atrial fibrillation (NVAF) who received standard doses of Apixaban had fewer stroke events compared to normal-weight patients, without statistically significant differences in bleeding events. To confirm these findings, further randomized controlled trials with larger sample sizes and longer observation durations are required. Thrombosis journal 22 May 2024

Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support
Implementing Comprehensive Preoperative Assessment and Support (CPAS) significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic. World journal of surgical oncology 23 May 2024

COVID-19

COVID-19 Latest from research publications
compiled by the SALHN (SA Health) library staff - updated 29 May 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

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

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

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

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

Health policy 24 May 2024

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

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

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

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

BMJ 22 May 2024

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

BMJ 10 May 2024

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Longitudinal evaluation of SARS-CoV-2 T cell immunity over 2 years following vaccination and infection
These findings highlight the boosting effect on T cell immunity of repeated vaccine administration. The combination of multiple vaccine doses and SARS-CoV-2 infections maintains population T cell immunity although with reduced levels in the elderly. Journal of infectious diseases 30 April 2024

Association of new-onset seizures with SARS-CoV-2 vaccines
According to this systematic review and meta-analysis, there was no statistically significant difference in the risk of new-onset seizure incidence between vaccinated individuals and placebo recipients. JAMA 29 April 2024

Machine learning to understand risks for severe COVID-19 outcomes: a retrospective cohort study of immune-mediated inflammatory diseases, immunomodulatory medications, and comorbidities in a large US health-care system
These results suggest that age, chronic comorbidities, and not being fully vaccinated might be greater risk factors for severe COVID-19 outcomes in patients with immune-mediated inflammatory diseases (IMIDs) than the use of IMMs or the IMIDs themselves. Overall, there is a need to take age and comorbidities into consideration when developing COVID-19 guidelines for patients with IMIDs. Further research is needed for specific IMIDs (including IMID severity at the time of SARS-CoV-2 infection) and IMMs (considering dosage and timing before a patient's first COVID-19 infection). The Lancet – digital health 26 April 2024

Abatacept pharmacokinetics and exposure response in patients hospitalized with COVID-19: A secondary analysis of the ACTIV-1 IM randomized clinical trial
In this study, abatacept was shown to be efficacious in patients hospitalized with severe COVID-19, although some patients may require higher dosing. JAMA 25 April 2024

Characteristics of X (Formerly Twitter) community notes addressing COVID-19 vaccine misinformation
A sample of Community Notes added to posts on X containing COVID-19 vaccination misinformation primarily addressed adverse events and conspiracy theories, were accurate, cited moderate and high credibility sources, and were attached to posts viewed hundreds of millions of times. JAMA 24 April 2024

Safety of ancestral Monovalent BNT162b2, mRNA-1273, and NVX-CoV2373 COVID-19 vaccines in US children aged 6 months to 17 Years
In this cohort study of pediatric enrollees across 3 commercial health insurance databases, statistical signals detected for myocarditis or pericarditis after BNT162b2 (ages 12-17 years) were consistent with previous reports, and seizures after BNT162b2 (ages 2-4 years) and mRNA-1273 vaccinations (ages 2-5 years) should be further investigated in a robust epidemiologic study with confounding adjustment. The US Food and Drug Administration concludes that the known and potential benefits of COVID-19 vaccination outweigh the known and potential risks of COVID-19 infection. JAMA 24 April 2024

Comparison of the analytical sensitivity of COVID-19 rapid antigen tests in Australia and Canada
Highlights

  • The performance of COVID-19 rapid antigen tests was compared in Australia and Canada.
  • The nucleocapsid protein is an easy-to-use, relevant and robust reference material.
  • NCAP-1 and NP-GFP reference materials produced highly comparable test lines.
  • Analytical sensitivity based on NP concentration is more informative than TCID50.

Talanta 23 April 2024

Can hospitalists improve COVID-19 vaccination rates?
This quality improvement project aimed to increase COVID-19 primary and booster vaccine efforts through a multi-pronged approach of increased collaboration with specialised staff and optimisation of use of our electronic health record system. BMJ open quality 23 April 2024

Long-term taste and smell outcomes after COVID-19
In this study, taste dysfunction as measured objectively was absent 1 year after exposure to COVID-19 while some smell loss remained in nearly one-third of individuals with this exposure, likely explaining taste complaints of many individuals with post–COVID-19 condition. Infection with earlier untyped and Alpha variants was associated with the greatest degree of smell loss. JAMA 23 April 2024

COVID-19 vaccination and incidence of pediatric SARS-CoV-2 infection and hospitalization
The findings of this case series analysis of 3 913 063 cases suggest reduced pediatric SARS-CoV-2 transmission following immunization. These results support the use of COVID-19 vaccines to reduce COVID-19 incidence and hospitalization in pediatric populations. JAMA 23 April 2024

Serum and salivary IgG and IgA response after COVID-19 messenger RNA vaccination
The findings of this cohort study suggest that mRNA vaccination was associated with mucosal immunity in individuals without prior SARS-CoV-2 infection, but at much lower levels than in previously infected individuals. Further studies are needed to determine the association between specific saliva IgA levels and prevention of infection or transmission. JAMA 23 April 2024

Post-COVID-19 condition: recommendations for pregnant individuals
Post-COVID-19 condition affects females more than males and can develop in about 10%–30% of people following acute infection during pregnancy. Currently, there are no guidelines for managing obstetric patients with post-COVID-19 condition. The authors propose an approach to individuals with post-COVID-19 condition who are planning to conceive or are already pregnant. The Lancet regional health – Europe 22 April 2024

The persistence of SARS-CoV-2 in tissues and its association with long COVID symptoms: a cross-sectional cohort study in China
These findings suggest that residual SARS-CoV-2 can persist in patients who have recovered from mild COVID-19 and that there is a significant association between viral persistence and long COVID symptoms. Further research is needed to verify a mechanistic link and identify potential targets to improve long COVID symptoms. The Lancet infectious diseases 22 April 2024

The role of colchicine in the management of COVID-19: a Meta-analysis
Colchicine caused a significant clinical improvement among COVID-19 patients as compared with the standard care or placebo, in terms of the need for O2, and mortality. This beneficial effect could play a role in the management of COVID-19 especially severe cases to decrease need for oxygen and to decrease mortality among these patients. BMC pulmonary medicine 20 April 2024

Maternal COVID-19 vaccination status and association with neonatal congenital anomalies
The authors add additional information regarding the safety of COVID-19 vaccination status and timing as it pertains to neonatal composite congenital anomalies, with no association demonstrated. The findings agree with prior literature that COVID-19 vaccination is not associated with adverse pregnancy outcomes or small for gestational age neonates. Further research is needed to elucidate the association between COVID-19 vaccination and eye, ear, face, neck, anomalies. Frontiers in pediatrics 19 April 2024

COVID-19 and surgery: A post-pandemic update
The Annals Consult Guys discuss the approach to a patient who requires nonemergent surgery after COVID-19 and other viral infections. They update their 2022 guidance to postpone surgery for 7 weeks after COVID diagnosis. Annals of internal medicine 16 April 2024

Changes in hospital mortality in patients with cancer during the COVID-19 pandemic (ISARIC-CCP-UK): a prospective, multicentre cohort study
People with cancer have a higher risk of mortality from COVID-19 than those without cancer. Patients younger than 50 years with cancer treatment have the highest relative risk of death. Continued action is needed to mitigate the poor outcomes in patients with cancer, such as through optimising vaccination, long-acting passive immunisation, and early access to therapeutics. These findings underscore the importance of the ISARIC-WHO pandemic preparedness initiative. The Lancet oncology 12 April 2024

Assessment of risk for sudden cardiac death among adolescents and young adults after receipt of COVID-19 vaccine — Oregon, June 2021–December 2022
The data do not support an association of COVID-19 vaccination with sudden cardiac death among previously healthy young persons. COVID-19 vaccination is recommended for all persons aged ≥6 months to prevent COVID-19 and complications, including death. Morbidity and Mortality Weekly Report (MMWR) 11 April 2024

Lung outcomes and related risk factors in patients after SARS-CoV-2 infection: a hospitalised single-centre cohort from Johannesburg, South Africa
This study demonstrates substantial lung and functional morbidity within the first weeks post-COVID-19, particularly in individuals with pre-existing comorbidities including TB, HIV, and low or high BMI. Chest-CT and diffusing capacity for the lung for carbon monoxide (DLCO) show best early potential at reflecting COVID-19-related pathologies. eClinicalMedicine 11 April 2024

Efficacy and safety of GST-HG171 in adult patients with mild to moderate COVID-19: a randomised, double-blind, placebo-controlled phase 2/3 trial
Treatment with GST-HG171 plus Ritonavir has demonstrated benefits in symptom recovery and viral clearance among low-risk vaccinated adult patients with COVID-19, without apparent safety concerns. As most patients were treated within 2 days after symptom onset in our study, confirming the potential benefits of symptom recovery for patients with a longer duration between symptom onset and treatment initiation will require real-world studies. eClinicalMedicine 10 April 2024

Effectiveness of COVID-19 vaccines to prevent long COVID: data from Norway
This study using data from more than 20 million participants has shown that COVID-19 vaccines consistently prevent long COVID symptoms in adults, with meta-analytic calibrated subdistribution hazard ratio. In addition, when considering post-COVID thromboembolic and cardiovascular complications as outcomes of interest, recently published data have shown that vaccination with any COVID-19 first vaccine dose (ChAdOx1, BNT162b2, and mRNA-1273) is associated with reduced risk of post-acute heart failure 0–30 days after SARS-CoV-2 infection; 91–180 days after SARS-CoV-2 infection), venous thromboembolism 0–30 days after SARS-CoV-2 infection; 91–180 days after SARS-CoV-2 infection), and arterial thrombosis 0–30 days after SARS-CoV-2 infection; 180 days after SARS-CoV-2 infection). The Lancet respiratory medicine 10 April 2024

Long-term symptoms associated with SARS-CoV-2 infection among blood donors
This study’s findings suggest that long-term symptoms lasting more than 4 weeks are common in the adult population, but there is a significantly higher prevalence among those with SARS-CoV-2 infection. Continued efforts to define and track long-term sequelae of SARS-CoV-2 using a control group without infection and serologic information to include those who had asymptomatic or unidentified infections are needed. JAMA 8 April 2024

Attitudes toward COVID-19 vaccines among pregnant and recently pregnant individuals
Decreasing confidence in COVID-19 vaccine safety in a large, diverse pregnant and recently pregnant insured population is a public health concern. JAMA 8 April 2024

Plasma-based antigen persistence in the post-acute phase of COVID-19
Although not without limitations this study’s data provides strong evidence that SARS-CoV-2, in some form or location, persists for up to 14 months following acute SARS-CoV-2 infection. This persistence is influenced by the events of acute infection. These findings motivate an urgent research agenda regarding the clinical manifestations of SARS-CoV-2 persistence, specifically whether it is causally related to either post-acute chronic symptoms (eg, fatigue, pain, and cognitive difficulty) or discrete incident complications (eg, cardiovascular events). The Lancet infectious diseases 8 April 2024

Why we must keep using the term 'long COVID'
Our understanding of long COVID is still evolving and incomplete, but the future looks brighter as we move beyond “what is it?” to “what can we do about it?” MJA insight 8 April 2024

What is the economic benefit of annual COVID-19 vaccination from the adult individual perspective?
There is both clinical and economic incentive for the individual to continue to get vaccinated against COVID-19 each year. JAMA 6 April 2024

Cough symptoms in children following COVID-19: a single-center retrospective study
Allergic disease contributes to the prolonged duration and severity of coughing in children with mild COVID-19 Frontiers in pediatrics 5 April 2024

Potential strategies for supporting mental health and mitigating the risk of burnout among healthcare professionals: insights from the COVID-19 pandemic
Healthcare professionals (HCPs) experienced prolonged stressful conditions during the coronavirus disease 2019 pandemic, and the global situation (particularly in the United Kingdom) meant that they continue to sustain mental stress related to the subsequent cost-of-living and healthcare budgeting crises. The psychological toll on HCPs may lead to increased staff attrition, adversely impacting the quality of patient care and work security. To help mitigate this psychological impact, the current evidence is strongly supportive of healthcare providers consistently adopting programmes fostering improvement in coping and resilience, facilitating healthy lifestyle, and allocating some resources for therapeutic strategies (e.g. cognitive behavioural therapy-based strategies and other strategies specified to trauma-related issues) which can be delivered by trained professionals. We stress that some approaches are not a one-size-fits-all strategy, and we also highlight the need to encourage treatment-seeking among those who need it. These strategies are highly relevant to healthcare employers and policymakers to support all HCPs in settings marked by prolonged periods of stress. The investment in these strategies are expected not only to reduce staff attrition in the long-term, but are likely to add to the cost-effectiveness of overall healthcare budgetary allocation. eClinicalMedicine 5 April 2024

Functional limitations and exercise intolerance in patients with Post-COVID condition: A randomized crossover clinical trial
In this study, nonhospitalized patients with post-COVID condition (PCC)  generally tolerated exercise with preserved cardiovascular function but showed lower aerobic capacity and less muscle strength than the control group. They also showed signs of postural orthostatic tachycardia and myopathy. The findings suggest cautious exercise adoption could be recommended to prevent further skeletal muscle deconditioning and health impairment in patients with PCC. JAMA 4 April 2024

Severity of Respiratory Syncytial Virus vs COVID-19 and Influenza among hospitalized US adults
Among adults hospitalized in this US cohort during the 16 months before the first RSV vaccine recommendations, RSV disease was less common but similar in severity compared with COVID-19 or influenza disease among unvaccinated patients and more severe than COVID-19 or influenza disease among vaccinated patients for the most serious outcomes of invasive mechanical ventilation (IMV) or death. JAMA 4 April 2024

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Lancet 3 April 2024

Viral clearance as a surrogate of clinical efficacy for COVID-19 therapies in outpatients: a systematic review and meta-analysis
Despite the aggregation of studies with differing designs, and evidence of risk of bias in some virological outcomes, this review provides evidence that treatment-induced acceleration of viral clearance within the first 5 days after treatment is a potential surrogate of clinical efficacy to prevent hospitalisation with COVID-19. This work supports the use of viral clearance as an early phase clinical trial endpoint of therapeutic efficacy. The Lancet microbe 3 April 2024

Nirmatrelvir for vaccinated or unvaccinated adult outpatients with Covid-19
The time to sustained alleviation of all signs and symptoms of Covid-19 did not differ significantly between participants who received nirmatrelvir–ritonavir and those who received placebo. NEJM 3 April 2024 

Ipsilateral and contralateral coadministration of influenza and COVID-19 vaccines produce similar antibody responses
Coadministration of influenza and bivalent COVID-19 vaccines in the same arm or different arms did not strongly influence the antibody response to either vaccine. eBioMedicine 3 April 2024

High frequency of prior SARS-CoV-2 infection by sensitive Nucleocapsid Assays
Prior infection with SARS-CoV-2 is typically measured by nucleocapsid serology assays. In this study, the authors show that the Simoa serology assays and T cell intracellular cytokine staining assays are more sensitive than the clinical Elecsys assay for detection of nucleocapsid-specific immune responses. These data suggest that the prevalence of prior SARS-CoV-2 infection in the population may be higher than currently appreciated. Journal of infectious diseases 3 April 2024

Long COVID in a highly vaccinated but largely unexposed Australian population following the 2022 SARS‐CoV‐2 Omicron wave: a cross‐sectional survey
The known: The estimated prevalence of long COVID varies widely between studies (range, 9–81% of people with SARS‐CoV‐2 infections).
The new: In a highly vaccinated population not broadly exposed to earlier SARS‐CoV‐2 variants, 18% of people infected with the Omicron variant reported symptoms consistent with long COVID 90 days after infection; 18% of these people had not fully resumed previous work or study by three months, and 38% required care from general practitioners for their symptoms two to three months after infection.
The implications: Long COVID affects a considerable number of people in Australia, and general practices play a major role in managing its burden. MJA 1 April 2024

Post‐COVID‐19 condition symptoms 12 and 24 months after COVID‐19 during the first month of the pandemic in Melbourne: a cohort study
In this article, the authors report the 12‐ and 24‐month follow‐up of a cohort of people infected with SARS‐CoV‐2 during a five‐week period in 2020. MJA 1 April 2024

Monkeypox

Updated 27 March  2024

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

SA Health – health alert – Monkeypox

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

Monkeypox Resources for Health Professionals (Wolters Kluwer)

Monkeypox Resource Centre (JAMA)

World Health Organization Health alert

Journal articles

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mpox: Keep it on the differential
Key points:

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

Cleveland journal of medicine 13 September 2023

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

Breakthrough mpox despite two‐dose vaccination
Lessons from practice

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

MJA 4 September 2023

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

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

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

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

MJA 7 August 2023

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Human monkeypox: diagnosis and management
What you need to know

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

BMJ 6 February 2023

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

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

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

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

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SA Health Library Service 12/8/2022