Current awareness service
Current awareness services
The current awareness service is designed to keep you up to date with the latest research and developments in specific areas.
The latest news and research is carefully curated by library staff, with article links and summaries readily available for you to access.
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What's new in the medical literature
Updated 17 January 2025
UpToDate
- Association of myocardial fibrosis with sudden cardiac death risk in children with hypertrophic cardiomyopathy
- CT-guided biopsy and cystic airspaces
- Extracorporeal life support for hypothermic cardiac arrest
- Extended versus standard lymphadenectomy for right-sided colon cancer
- Intensive blood pressure lowering in patients with type 2 diabetes mellitus
- Laparoscopic repair of intestinal malrotation without volvulus in children
- Point-of-care-ultrasound in patients with shock
- Seventh World Symposium pulmonary hypertension guidelines
- Standard versus extended lymphadenectomy for bladder cancer
- Ultrasound imaging of enthesitis
- Vitamin K2 supplementation for older adults with nocturnal muscle cramps
Cochrane Library
- Ankle‐foot orthoses for improving walking in adults with calf muscle weakness due to neuromuscular disorders
- Anti‐PD‐1 and anti‐PD‐L1 antibodies for glioma
- Gonadotropin‐releasing hormone agonist protocols for pituitary suppression in assisted reproduction
- Incentives for smoking cessation
- Interventions for quitting vaping
- Oral and intranasal aspirin desensitisation for non‐steroidal anti‐inflammatory drug (NSAID)‐exacerbated respiratory disease
- Pre‐emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients
- Preservation of the azygos vein versus ligation of the azygos vein during primary surgical repair of congenital esophageal atresia
- Tranexamic acid for preventing postpartum haemorrhage after vaginal birth
- Virtual reality for multiple sclerosis rehabilitation
MJA
- The impact of the BreastScreen NSW transition from film to digital mammography, 2002–2016: a linked population health data analysis
- Human case of diphyllobothriasis in Australia
MJA insight
- Building climate-resilient health care with the National Health and Climate Strategy
- Flipping the script on loneliness with green prescriptions
- Indigenous researcher teaches students about periods, puberty and consent in groundbreaking new project
- The entwinement of social determinants of health, the social model of disability and the Disability Royal Commission
- What to do with the mountains of plastic waste in health care?
BMJ
- Effectiveness of shared decision making strategies for stroke prevention among patients with atrial fibrillation: cluster randomized controlled trial
- Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial
- Living with the uncertainty of Parkinson’s
- Management of alcohol withdrawal syndromes in general hospital settings
- The efficacy and safety of thymosin α1 for sepsis (TESTS): multicentre, double blinded, randomised, placebo controlled, phase 3 trial
- Time to nursing home admission and death in people with dementia: systematic review and meta-analysis
NEJM
- Fracture prevention with infrequent Zoledronate in women 50 to 60 years of age
- Heart failure with Preserved Ejection Fraction
- Survival with Trastuzumab Emtansine in Residual HER2-Positive breast cancer
- Talquetamab plus Teclistamab in relapsed or refractory Multiple Myeloma
JAMA
- Cochlear Implant electrode placement and music perception
- Global prevalence of sexual violence against children: A systematic review and meta-analysis
- Noise exposure history and age-related changes to hearing
- Palliative care initiated in the emergency department: A cluster randomized clinical trial
- Smoking cessation interventions in the lung cancer screening setting: A randomized clinical trial
Other journals
- A framework for the continuous monitoring of person-centred hospital care: validation of a checklist for participatory service improvement
- CAD-Q (COPD-Asthma Differentiation Questionnaire): Performance of a new diagnostic score to differentiate between COPD and asthma in adults
- Delirium at the intensive care unit and long-term survival: a retrospective study
- Determining timeframes to death for imminently dying patients: a retrospective cohort study
- Duration of antibiotic therapy in the intensive care unit: factors influencing decision-making during multidisciplinary meetings
- How can I better recognize and manage delirium in my hospitalized patients?
- Intravenous lidocaine decreased oxygen-desaturation episodes induced by propofol-based sedation for gastrointestinal endoscopy procedures: a prospective, randomized, controlled trial
- Management of acute ischemic stroke in the emergency department: optimizing the brain
- Preterm preeclampsia screening and prevention: a comprehensive approach to implementation in a real-world setting
- Preoperative smoking cessation interventions: a systematic review and meta-analysis
- Risk prediction models for falls in hospitalized older patients: a systematic review and meta-analysis
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UpToDate
Association of myocardial fibrosis with sudden cardiac death risk in children with hypertrophic cardiomyopathy
In children with hypertrophic cardiomyopathy (HCM), growing evidence suggests that the burden of late gadolinium enhancement (LGE; a surrogate for myocardial fibrosis) on cardiac magnetic resonance (CMR) imaging provides valuable information for assessing the risk of sudden cardiac death (SCD). In a recent study of 700 patients <21 years of age with HCM, the risk of SCD events increased with increasing LGE burden, even after adjustment for multiple variables associated with SCD [29]. In patients whose risk of SCD is unclear, incorporating LGE burden into the overall risk assessment may influence the decision to place an internal cardioverter-defibrillator (ICD). (See "Hypertrophic cardiomyopathy in children: Management and prognosis", section on 'Other risk factors'.)
CT-guided biopsy and cystic airspaces
Clinicians may hesitate to biopsy cystic lung lesions due to concerns regarding safety or diagnostic yield. However, a retrospective study demonstrated a similar frequency of complications among 90 patients with cystic lung lesions and 180 patients with non-cystic lung lesions who underwent computed tomography (CT)-guided transthoracic needle biopsy (40 versus 38 percent) [25]. Both groups had similar rates of specific complications (eg, hemorrhage, pneumothorax) and similar rates of non-diagnostic biopsies (12 versus 9 percent). These data suggest that CT-guided biopsy is a reasonable option for properly selected patients with cystic lung lesions, bearing in mind that these study findings may be subject to selection bias. (See "Diagnostic evaluation of the incidental pulmonary nodule", section on 'Transthoracic needle biopsy'.)
Extracorporeal life support for hypothermic cardiac arrest
Extracorporeal life support (ECLS) may improve overall survival and neurologically intact survival in select adults with hypothermic cardiac arrest. A multicenter registry study of 127 patients in hypothermic cardiac arrest treated with ECLS reported a survival rate of 49 percent, with 89 percent of survivors having good neurologic outcomes [2]. Lower age and lower serum potassium and lactate concentrations were associated with a higher likelihood of survival. This survival rate, compared with a historical survival rate of 10 to 37 percent without ECLS, supports our recommendation for treatment with ECLS in a salvageable patient with severe hypothermia and a non-perfusing cardiac rhythm. A Hypothermia Outcome Prediction after ECLS probability ≥10 percent is one reasonable criterion to determine salvageability. (See "Accidental hypothermia in adults: Management", section on 'Benefit of extracorporeal life support'.)
Extended versus standard lymphadenectomy for right-sided colon cancer
The standard approach of colon cancer surgery is to remove the tumor-bearing segment along with the associated mesentery up to the origin of the named primary feeding vessel. A large multicenter trial (RELARC) involving 995 patients with right-sided colon cancers compared extended lymphadenectomy (removing lymph nodes beyond the primary feeding vessels) with the standard approach and found that extended lymphadenectomy did not improve three-year survival but incurred more vascular injuries [3]. We do not perform routine extended lymphadenectomy in patients with colon cancer but will perform it selectively when clinically indicated. (See "Surgical resection of primary colon cancer", section on 'Regional lymphadenectomy'.)
Intensive blood pressure lowering in patients with type 2 diabetes mellitus
We suggest intensive blood pressure (BP) lowering (eg, systolic blood pressure [SBP] <125 mmHg using standardized methods) for patients with type 2 diabetes based on goal BP trials that included diabetic patients and indirect data from the SPRINT trial, although one trial found no significant benefit to this approach. In a randomized trial in over 12,800 patients with type 2 diabetes, hypertension, and other cardiovascular risk factors, patients assigned to a target SBP of <120 mmHg had a lower incidence of a cardiovascular composite of nonfatal stroke, nonfatal myocardial infarction, heart failure, and cardiovascular death at a median of 4.2 years, compared with patients assigned to a target SBP of <140 mmHg [3]. The algorithm for follow-up and antihypertensive therapy was similar to that used in the SPRINT trial. These data, combined with previous studies, support a strong recommendation for intensive BP lowering in patients with diabetes mellitus. (See "Goal blood pressure in adults with hypertension", section on 'Patients with diabetes mellitus'.)
Laparoscopic repair of intestinal malrotation without volvulus in children
Laparoscopic repair is an option for children who have malrotation without volvulus, but, compared with laparotomy, it has been associated with a higher risk of postoperative volvulus. However, in a retrospective study of 226 such children with malrotation, laparoscopic repair and laparotomy were both associated with a low rate of postoperative volvulus (≤1 percent) [28]. These data suggest that laparoscopic repair in these patients may have fewer postoperative complications than previously believed, particularly when performed by an experienced surgeon in an older child without comorbidities. (See "Intestinal malrotation in children", section on 'Laparoscopic repair'.)
Point-of-care-ultrasound in patients with shock
Point-of-care-ultrasound (POCUS) is increasingly being used in patients with shock to assess etiology and monitor treatment response. A recent meta-analysis of 18 randomized trials in patients with shock found that POCUS-guided resuscitation reduced the duration of vasoactive medication (mean difference -0.73 days), and may reduce 28-day mortality and the need for kidney replacement therapy (relative risk 0.88 and 0.80, respectively; borderline statistical significance) [1]. The use of POCUS did not impact the administration of fluids or inotropes, length of stay, or need for mechanical ventilation. We continue to encourage the use of POCUS when managing patients with shock of unclear etiology. (See "Evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock", section on 'Point-of-care ultrasonography'.)
Seventh World Symposium pulmonary hypertension guidelines
Guidelines were issued by the Seventh World Symposium on Pulmonary Hypertension (PH) [26]. These guidelines highlight the importance of fast-track referral to PH centers. comprehensive baseline risk assessment prior to treatment, initial combination therapy (even for mild pulmonary arterial [PAH]), and the inclusion of sotatercept (a new class of medication that inhibits transforming growth factor-beta) to PAH regimens. The new guidelines also replace the term "acute responders at vasoreactivity testing" with "long-term responders to calcium channel blockers (CCB)," since some acute responders still require treatment with PAH-targeted drugs beyond CCB. We agree with these recommendations. (See "Clinical features and diagnosis of pulmonary hypertension of unclear etiology in adults", section on 'Introduction'.)
Standard versus extended lymphadenectomy for bladder cancer
The optimal extent of pelvic lymphadenectomy for bladder cancer is debated. In a recent randomized trial including nearly 600 patients with cT2-4a N0-2 bladder cancer, extended lymphadenectomy resulted in more lymph nodes removed, more severe complications, and more deaths within 90 days compared with standard lymphadenectomy [22]. However, rates of nodal metastasis, five-year disease-free survival, and overall survival were similar. Based on these data, we suggest standard lymphadenectomy for localized muscle-invasive bladder cancer. (See "Radical cystectomy", section on 'Lymphadenectomy'.)
Ultrasound imaging of enthesitis
Enthesitis (the inflammation of tendon or ligament attachment sites) is a hallmark of spondyloarthritis (SpA), but its identification can be challenging. In a cross-sectional study involving 413 patients with SpA, ultrasound of the entheses demonstrated no evidence of active inflammation in 68 percent of patients diagnosed clinically with enthesitis, while ultrasound identified subclinical enthesitis in 15 percent of patients [7]. Ultrasound may be useful for identifying subtle evidence of enthesitis and differentiating active enthesitis from inactive disease. (See "Diagnosis and differential diagnosis of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults", section on 'Imaging of enthesitis'.)
Vitamin K2 supplementation for older adults with nocturnal muscle cramps
Nocturnal muscle cramps are common, particularly among older patients, but the optimal treatment is unknown. A recent multicenter trial randomly assigned 199 patients aged 65 and older with nocturnal leg cramps to an eight-week course of vitamin K2 (180 micrograms/day) or placebo [24]. Compared with the placebo group, patients treated with vitamin K2 experienced a greater reduction in the mean frequency of cramps from baseline to the intervention period; the vitamin K2 group also experienced comparably greater improvements in the severity and mean duration of cramping. This study suggests that vitamin K may be a reasonable alternative to other supplements used to treat nocturnal muscle cramps, particularly in older adults. (See "Nocturnal muscle cramps", section on 'Initial drug therapies'.)
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MJA
The impact of the BreastScreen NSW transition from film to digital mammography, 2002–2016: a linked population health data analysis
The known: Breast cancer screening around the world has switched from film to digital mammography. The impacts of this change on health outcomes are unknown.
The new: In NSW, increased cancer detection with the new technology was predominantly of ductal carcinomas in situ; the detection of invasive cancer initially declined slightly. The interval cancer detection rate also increased, particularly the detection of invasive cancers. An initial increase in the rate of recalls for further assessment was largely attributable to the increased false positive result rate.
The implications: The transition from film to digital mammography may have increased the detection of indolent cancers. MJA 12 January 2025
Human case of diphyllobothriasis in Australia
Lessons from practice
- Multiple converging factors place humans at risk of infection with fish parasites. History of raw fish consumption is an important epidemiological risk when assessing patients.
- Clinician education and awareness of fish parasites are required to facilitate timely patient diagnosis and treatment, and to mitigate ecological risk.
- Diagnostic laboratories need to maintain competency in the identification of fish parasites. If required, expert consultation should be sought to ensure timely and accurate identification.
- Diagnosis using molecular methods is suggested to avoid misidentification, and to generate better epidemiological understanding to inform risks to human health and economy.
MJA 9 January 2025
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MJA insight
Building climate-resilient health care with the National Health and Climate Strategy
The National Health and Climate Strategy aims to build a sustainable, climate-resilient, high quality, net zero health system for Australia. MJA insight 13 January 2024
Flipping the script on loneliness with green prescriptions
Green prescriptions — a prescription for an individual to step outside and spend time in nature and community — are an effective, inexpensive way to ease the burden of loneliness. MJA insight 13 January 2024
Indigenous researcher teaches students about periods, puberty and consent in groundbreaking new project
An Indigenous-led, student-focused program to educate students about menstruation is attracting support in multiple states. MJA insight 13 January 2024
The entwinement of social determinants of health, the social model of disability and the Disability Royal Commission
The medical profession must understand and addresses the social influences on the lives of people with disability in order to improve the health, wellbeing and lives of people with disability. MJA insight 13 January 2024
What to do with the mountains of plastic waste in health care?
The health care sector is a substantial contributor to the plastic pollution crisis due to our reliance on single-use plastic packaging. MJA insight 13 January 2025
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BMJ
Effectiveness of shared decision making strategies for stroke prevention among patients with atrial fibrillation: cluster randomized controlled trial
Patients who received any decision aid (encounter decision aid, patient decision aid, or both) had lower decisional conflict, better shared decision making, and greater knowledge than those receiving no decision aid, except for the effect of the patient decision aid on decisional conflict, which did not reach statistical significance. The study establishes that use of either pre-visit or in-visit decision aids individually or in combination is advantageous compared with usual care. BMJ 9 January 2025
Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial
In patients with acute ischaemic stroke due to acute posterior large or proximal vessel occlusion, intra-arterial tenecteplase administered after successful recanalisation was not associated with a statistically significant reduction in combined disability and mortality at 90 days. BMJ 14 January 2025
Living with the uncertainty of Parkinson’s
What you need to know
- Be as honest, yet empathic as possible when delivering a life changing diagnosis
- Respond to questions about disease progression with as much information as you can, but explain that predictions are never certain
BMJ 8 January 2025
Management of alcohol withdrawal syndromes in general hospital settings
The prevalence of at-risk alcohol use and use disorder in the general hospital warrants routine screening and assessment. Symptom triggered alcohol withdrawal management with benzodiazepine drugs is common across general hospital settings, though this treatment approach might be inadequate for the subset of individuals at greatest risk for severe alcohol withdrawal syndromes. This group might require fixed dose benzodiazepine drug loading or escalation to phenobarbital treatment to address resistance to benzodiazepine drugs. BMJ 8 January 2025
The efficacy and safety of thymosin α1 for sepsis (TESTS): multicentre, double blinded, randomised, placebo controlled, phase 3 trial
This trial found no clear evidence to suggest that thymosin α1 decreases 28 day all cause mortality in adults with sepsis. BMJ 15 January 2025
Time to nursing home admission and death in people with dementia: systematic review and meta-analysis
The average life expectancy of people with dementia at time of diagnosis ranged from 5.7 years at age 65 to 2.2 at age 85 in men and from 8.0 to 4.5, respectively, in women. About one third of remaining life expectancy was lived in nursing homes, with more than half of people moving to a nursing home within five years after a dementia diagnosis. Prognosis after a dementia diagnosis is highly dependent on personal and clinical characteristics, offering potential for individualised prognostic information and care planning. BMJ 8 January 2025
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NEJM
Fracture prevention with infrequent Zoledronate in women 50 to 60 years of age
Ten years after trial initiation, zoledronate administered at baseline and 5 years was effective in preventing morphometric vertebral fracture in early postmenopausal women. NEJM 15 January 2025
Heart failure with Preserved Ejection Fraction
- Heart failure with preserved ejection fraction is a heterogeneous syndrome.
- The diagnosis of the condition requires ruling out potential confounders such as respiratory disease, ischemic heart disease, hypertensive or valvular heart disease, cardiomyopathies, and amyloidosis.
- Symptoms and signs of heart failure, a left ventricular ejection fraction of 50% or greater, and evidence of cardiac structural abnormalities at rest or with exercise are required for the diagnosis.
- Contemporary guidelines recommend diuretic therapy and treatment with sodium–glucose cotransporter 2 (SGLT2) inhibitors for acute heart failure to reduce congestion and the continuation of SGLT2 inhibitors to reduce the risk of hospitalization for heart failure.
- New cardiometabolic drugs such as glucagon-like peptide-1 agonists have been shown to reduce symptoms and improve quality of life and exercise tolerance in patients with both heart failure with preserved ejection fraction and obesity.
- No available medical therapy has resulted in a reduction in mortality among patients with heart failure with preserved ejection fraction. Therefore, the current aims of medical treatment are to reduce the risk of hospitalization and improve quality of life.
NEJM 8 January 2025
Identification and treatment of alcohol use disorder
Key points:
- A quantitative alcohol history should be recorded for all patients, because alcohol use contributes to many physical and mental disorders.
- A person-centered, nonjudgmental approach should be adopted.
- Brief interventions can be delivered effectively by most health care professionals.
- Pharmacologic treatment is effective and underused.
- Specialist services offer comprehensive care, including psychosocial interventions.
- Follow-up is recommended owing to the relapsing and remitting nature of alcohol use disorder.
NEJM 15 January 2025
Survival with Trastuzumab Emtansine in Residual HER2-Positive breast cancer
As compared with trastuzumab, T-DM1 improved overall survival with sustained improvement in invasive disease–free survival among patients with HER2-positive early breast cancer with residual invasive disease after neoadjuvant therapy. NEJM 15 January 2025
Talquetamab plus Teclistamab in relapsed or refractory Multiple Myeloma
The incidence of grade 3 or 4 infections with talquetamab plus teclistamab was higher than has been observed with either therapy alone. A response was observed in a high percentage of patients across all dose levels, with durable responses with the recommended phase 2 regimen. NEJM 8 January 2025
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JAMA
Cochlear Implant electrode placement and music perception
The study results suggest that image-guided cochlear implant programming can help improve music perception with cochlear implants. JAMA 9 January 2025
Global prevalence of sexual violence against children: A systematic review and meta-analysis
The findings of this systematic review and meta-analysis highlight the burden of sexual violence against children worldwide based on current available evidence. There is a pressing need to enhance data collection efforts globally, especially in underresearched regions and for boys. JAMA 13 January 2025
Palliative care initiated in the emergency department: A cluster randomized clinical trial
his multicomponent intervention to initiate palliative care in the ED did not have an effect on hospital admission, subsequent health care use, or short-term mortality in older adults with serious, life-limiting illness. JAMA 15 January 2025
Noise exposure history and age-related changes to hearing
In this cohort study, noise exposure was associated with poorer baseline hearing and higher rates of annual decline at some midfrequencies. Noise exposure can have immediate and potentially long-term negative impacts on hearing. JAMA 9 January 2025
Smoking cessation interventions in the lung cancer screening setting: A randomized clinical trial
Integrated care involving medication and intensive counseling provided the optimal smoking cessation intervention in the lung cancer screening (LCS) setting. JAMA 13 January 2025
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Other journals
A framework for the continuous monitoring of person-centred hospital care: validation of a checklist for participatory service improvement
This study validated a “core” checklist that can be routinely used to monitor the implementation of person-centred care in Italian hospitals. The tool can be applied more widely by multiple stakeholders as a measurement instrument for the participatory evaluation of person-centredness. Archives of public health 14 January 2025
CAD-Q (COPD-Asthma Differentiation Questionnaire): Performance of a new diagnostic score to differentiate between COPD and asthma in adults
The CAD-Q questionnaire effectively discriminated between COPD and asthma, outperforming previous tools. BMC pulmonary medicine 15 January 2025
Delirium at the intensive care unit and long-term survival: a retrospective study
In the study population, ICU-delirium was independently associated with a reduced long-term survival. Patients who developed ICU-delirium had a reduced survival up to four years after ICU discharge and this association was particularly evident in patients above 55 years of age. BMC neurology 15 January 2025
Determining timeframes to death for imminently dying patients: a retrospective cohort study
Results provide clinicians with validated data to guide communication when answering ‘how long’ questions at end-of-life. Knowledge of projected time to death can prompt timely conversations while the patient can understand and engage in meaningful conversations. The importance of considering covariates such as location and diagnosis in determining timeframes has been highlighted. Shared decision-making and essential person-centered end-of-life care can be planned. BMC palliative care 13 January 2025
Duration of antibiotic therapy in the intensive care unit: factors influencing decision-making during multidisciplinary meetings
This study identified numerous factors that influence decisions about the duration of antibiotic therapy during multidisciplinary meetings (MDMs) in the ICU. By describing these factors throughout the decision-making process, the authors provided valuable insights into barriers that commonly arise in specific steps, highlighting critical areas for improvement. Daily MDMs were deemed essential for informed decision-making regarding antibiotic therapy duration by the interviewees. Strategies to improve appropriate duration in the ICU should prioritise strengthening interdisciplinary communication between healthcare professionals and adding structure to these meetings. BMJ quality and safety 9 January 2025
How can I better recognize and manage delirium in my hospitalized patients?
The following 4 steps can help clinicians to better recognize delirium: (1) familiarize yourself with the 3 phenotypes of delirium (hyperactive, hypoactive, and mixed) that describe the associated motor activity in patients with delirium; (2) take into account the patient’s baseline mental status, medical history, and timeline of symptom onset; (3) use a delirium assessment tool; and (4) consider ordering an electroencephalogram. Cleveland Clinic journal of medicine 12 January 2025
Intravenous lidocaine decreased oxygen-desaturation episodes induced by propofol-based sedation for gastrointestinal endoscopy procedures: a prospective, randomized, controlled trial
IV lidocaine adjuvant to propofol-based sedation could reduce the incidence of oxygen-desaturation episodes and involuntary body movements, with fewer adverse circulatory events. BMC anesthesiology 11 January 2025
Management of acute ischemic stroke in the emergency department: optimizing the brain
Acute ischemic stroke is a devastating condition that afflicts more than 12 million people every year. Globally, stroke is the 2nd leading cause of death and 3rd leading cause of disability worldwide. While not all patients can avail themselves of existing acute therapies, all patients can benefit from brain optimization measures. This paper details the 12 steps in the management of acute ischemic stroke in the emergency department. International journal of emergency medicine 7 January 2025
Preterm preeclampsia screening and prevention: a comprehensive approach to implementation in a real-world setting
The study confirms the feasibility of integrating comprehensive preeclampsia screening into clinical practice, notwithstanding geographic separation between laboratory and clinical settings. BMC pregnancy and childbirth 15 January 2025
Preoperative smoking cessation interventions: a systematic review and meta-analysis
This meta-analysis revealed that patients who attend preoperative smoking cessation interventions are more likely to quit smoking at the time of surgery and to maintain abstinence until the last follow-up compared with patients assigned to usual care. Perioperative medicine 10 January 2025
Risk prediction models for falls in hospitalized older patients: a systematic review and meta-analysis
In the present study, all included studies had a high risk of bias, primarily due to the lack of prospective study design, inappropriate data analysis, and the absence of robust external validation. Future studies should prioritize the use of rigorous methodologies for the external validation of fall risk prediction models in hospitalized older adults. BMC geriatrics 14 January 2025
COVID-19
COVID-19 Latest from research publications
compiled by the SALHN (SA Health) library staff - updated 22 January 2025.
For older articles please click here and you will be directed to the archival page on the SA health Library website
Key information sources - coronavirus resource pages have been created by various medical publications in order to disseminate clinical information as soon as it is available
- OzSAGE
- BMJ
- UpToDate
- Walters Kluwer (UpToDate) resources and tools
- Elsevier (Clinical Key)
- NEJM
- Lancet
- JAMA
- World Health Organization technical guidance
- Global research on coronavirus disease (COVID-19) (WHO)
- National Covid-19 Clinical taskforce
- Australian Department of Health
- SA Health
- NICE (National Institute for Health and Care Excellence)
- John Hopkins University COVID-19 Global case tracker
- COVID-19: examining the effectiveness of non-pharmaceutical interventions
Experiences of intimate-partner violence and violence from a family member during COVID-19 among LGBTQ adults in Australia
The risks of violence from an intimate partner or family member among LGBTQ individuals were high during the pandemic in Australia, regardless of lockdown measures. The findings underscore the importance of efforts to understand the systemic factors influencing IPV and violence from a family member within the LGBTQ community and address the enduring impacts of the pandemic. Journal of family violence 15 January 2025
Prevalence and correlates of severe anxiety among front-line nurses during and after the COVID-19 pandemic: a large-scale multi-center study
The study underscores the importance of understanding and addressing severe anxiety among frontline nurses during and after the COVID-19 pandemic. Future research should delve into long-term psychological effects and implement effective intervention measures to support nurses’ mental health. BMC nursing 15 January 2025
Blood absolute lymphocyte count and trajectory are important in understanding severe COVID-19
Lymphopenia was predictive of severe COVID-19 outcomes, particularly when persistent or new during hospitalization. A better understanding of the underlying risk factors for lymphopenia will help illuminate disease pathogenesis and guide management strategies. BMC infectious diseases 15 January 2025
Clinical outcomes of COVID-19 in patients with liver cirrhosis - a propensity-matched analysis from a multicentric Brazilian cohort
This study has shown that COVID-19 inpatients with cirrhosis had significantly higher incidence of severe outcomes, as well as higher frequency of institution of palliative care when compared to matched controls. These findings underscore the need for these patients to receive particular attention from healthcare teams and allocated resources. BMC infectious diseases 15 January 2025
Comparative analysis of C-Reactive protein levels among Non-comorbid, Comorbid, and Multimorbid Hospitalized COVID-19 patients
Elevated C-reactive protein (CRP) levels in COVID-19 patients with comorbidities like diabetes, hypertension, ischemic heart disease, and chronic kidney disease were strongly associated with increased disease severity, including higher ventilation requirements and mortality. BMC infectious diseases 14 January 2025
Effectiveness and user experience of nose and throat swabbing techniques for SARS-CoV-2 detection: results from the UK COVID-19 National Testing Programme
User experience analyses supported a preference for nose-only swabbing. Nose-only swabbing for lateral flow devices (LFDs) provided sufficient diagnostic accuracy, supporting its use as a viable option in the COVID-19 National Testing Programme. Less invasive swabbing approaches are important to maximize testing accessibility and alongside other behavioral interventions, increase user uptake. BMC global and public health 13 January 2025
Six-month outcomes in the long-term outcomes after the multisystem inflammatory syndrome in children study
Results of this cohort study suggest that although children and young adults with Multisystem inflammatory syndrome in children (MIS-C) can have severe disease during the acute phase, most recovered quickly and had a reassuring midterm prognosis. JAMA 13 January 2025
Safety and immunogenicity of SARS-CoV-2 spike receptor-binding domain and N-terminal domain mRNA vaccine
mRNA-1283 was well tolerated and exhibited improved immunogenicity compared to mRNA-1273. Journal of infectious diseases 10 January 2025
Effectiveness of mRNA COVID-19 vaccines and hybrid immunity in preventing SARS-CoV-2 infection and symptomatic COVID-19 among adults in the United States
Adults with both prior infection and recent vaccination had high protection against infection and symptomatic illness. Recent vaccination alone provided moderate protection. Journal of infectious diseases 8 January 2025
Role of social determinants of health in COVID-19 recovery: A qualitative study
The findings suggest that social determinants of health (SDOH) both support and hinder recovery from COVID-19 and may inform how health systems integrate social and medical care. JAMA 6 January 2025
Risk factors for bloodstream infection in COVID-19 patients in intensive care units: a systematic review and meta-analysis
The authors identified 10 risk factors for intensive care unit - bloodstream infection (ICU-BSI) in COVID-19 patients. In future studies, these factors can be combined to establish a more comprehensive and accurate prediction model for ICU-BSI in COVID-19 patients. Targeted measures can be taken earlier to control BSI. BMC infectious diseases 3 January 2025
Kidney function decline after COVID-19 infection
Findings of this study suggest an association between COVID-19 and accelerated kidney function decline, especially among people who were hospitalized; these people need closer monitoring of kidney function for early diagnosis and management of chronic kidney disease. JAMA 26 December 2024
Combination of spatial transcriptomics analysis and retrospective study reveals liver infection of SARS-COV-2 is associated with clinical outcomes of COVID-19
This study provides clinical evidence for liver infection with SARS-CoV-2, insight into the impact of SARS-CoV-2 on the liver, and a potential way to evaluate the risk of death via assessing serum ALB concentration fluctuations in patients with COVID-19. eBioMedicine 21 December 2024
Protective role of school climate for impacts of COVID-19 on depressive symptoms and psychotic experiences among adolescents: a population-based cohort study
The negative mental health effects of the pandemic were significantly mitigated among adolescents experiencing a supportive school climate. A positive school climate can protect adolescent mental health during challenging social conditions, such as pandemics. Psychological medicine 20 December 2024
Brief outpatient rehabilitation program for Post–COVID-19 condition: A randomized clinical trial
The findings of this trial suggest that brief outpatient rehabilitation based on a cognitive and behavioral approach is effective and safe for patients with Post–COVID-19 condition (PCC). JAMA 19 December 2024
2024 update of the RECOVER-adult long COVID research index
The 2024 long COVID (LC) research index for adults builds on the 2023 index with additional data and symptoms to help researchers classify symptomatic LC and its symptom subtypes. Continued future refinement of the index will be needed as the understanding of LC evolves. JAMA 18 December 2024
Prevalence of post-acute sequelae of SARS-CoV-2 infection in people living with HIV: a systematic review with meta-analysis
Current evidence indicates that the prevalence of Long COVID in adults living with HIV may be high, suggesting the need for increased awareness and education of healthcare providers and policy makers. Evidence on whether HIV positivity increases the risk of Long COVID is limited and inconclusive, highlighting a need for further research to clarify this potential association. eClinicalMedicine 17 December 2024
Decline of antibodies to major viral and bacterial respiratory pathogens during the COVID-19 pandemic
Surges in infections caused by respiratory pathogens have been documented in multiple settings after relaxation of pandemic restrictions. Antibodies to major antigens from respiratory syncytial virus and Group A Streptococcus waned significantly in a longitudinal adult cohort throughout the pandemic. This waning may have contributed to the pathogen-surges that followed. Journal of infectious diseases 14 December 2024
Mental health symptoms and burdens after a SARS-CoV-2 infection
The results suggest that mental health care should focus on individuals who suffer from a severe acute COVID-19 infection or have a history of mental illness. BMC public health 13 December 2024
Association between COVID-19 infection and new-onset dementia in older adults: a systematic review and meta-analysis
Under normal circumstances, the authors believe that COVID-19 infection is likely to be a risk factor for developing new-onset dementia (NOD) in older adults over time. While the increased NOD risk due to COVID-19 infection appears to be similar to that associated with other respiratory infections, it warrants and necessitates investigation with longer observations. BMC geriatrics 13 December 2024
Prevalence of Post–COVID-19 condition and activity-limiting Post–COVID-19 condition among adults
In this cross-sectional study, updated national prevalence estimates of post–COVID-19 condition (PCC) (ever and current) and new estimates of activity-limiting PCC are provided. JAMA 13 December 2024
BNT162b2 XBB vaccine for COVID-19 among children 5-17 years of age
These results suggest that the BNT162b2 XBB vaccine provided protection against COVID-19–associated hospitalization and ED or urgent care visits among children 5 to 17 years of age during the 2023-2024 season with estimated vaccine effectiveness point estimates ranging from 63% to 73%. JAMA 12 December 2024
Clinical phenotype of COVID-19 vaccine-associated myocarditis in Victoria, 2021–22: a cross-sectional study
The known: COVID-19 vaccines are associated with a slightly increased risk of myocarditis.
The new: In Victoria, COVID-19 vaccine-associated myocarditis was generally milder than for other myocarditis forms. Electrocardiographic abnormalities were more frequent in male patients and those aged 24 years or younger; cardiac MRI abnormalities were not seen in patients for whom troponin levels were increased threefold or less.
The implications: Young men are at particular risk of COVID-19 vaccine-associated myocarditis, and warrant close follow-up to determine long term outcomes. A threefold or greater increase in troponin level may be a clinically useful predictor of cardiac MRI abnormalities. MJA 10 December 2024
Knowledge about COVID-19 vaccines among Aboriginal and Torres Strait Islander people, and attitudes to and behaviours regarding COVID-19 and influenza vaccination: a survey
The known: Aboriginal and Torres Strait Islander people were among the first groups in Australia to be targeted for vaccination against coronavirus disease 2019 (COVID-19.
The new: Our survey indicated that most Aboriginal and Torres Strait Islander people believed the COVID-19 vaccines to be very or extremely trustworthy (71%) and very or extremely effective (73%), but levels varied by sex and location.
The implications: Health messages in future pandemics should be tailored to the concerns of their target audiences, particularly those of Aboriginal and Torres Strait Islander women and people living in regional and remote areas. MJA 10 December 2024
Prolonged SARS-CoV-2 shedding in a lung transplant recipient: time for flexibility in infection prevention?
Lessons from practice
- Protracted viral shedding is relatively common in immunocompromised hosts and existing de-isolation guidelines may result in impractical long periods of isolation.
- Existing coronavirus disease 2019 (COVID-19) diagnostics, including rapid antigen tests, polymerase chain reaction cycle threshold value and culturable virus, are imperfect surrogates for infectivity; however, collectively can play a role in assessing prolonged viral shedding.
- Pragmatic de-isolation strategies are required for patients with prolonged SARS-CoV-2 infections.
MJA 10 December 2024
Barriers, facilitators and next steps for sustaining and scaling virtual hospital services in Australia: a qualitative descriptive study
The known: The Australian health care system requires innovative approaches to meet the rising demand for services. Virtual hospital (VH) models of care have shown promise in improving care efficiency and experiences while maintaining patient outcomes.
The new: Barriers to and facilitators of implementing and delivering VH services and gaps in evidence and practice were identified, setting a research and practice agenda for ongoing improvement.
The implications: Successful practices can be adopted by organisations looking to implement new VH services or improve existing VH services. Future research and policy changes should address gaps in evidence and practice; this should include the evaluation of care models and technologies, and development of funding models for VH services. MJA 9 December 2024
Long COVID appears to be driven by ‘long infection’. Here’s what the science says
Around 5–10% of people with COVID infections go on to experience long COVID, with symptoms lasting three months or more. MJA insight 9 December 2024
Effectiveness of the BNT162b2 XBB.1.5-adapted vaccine against COVID-19 hospitalization related to the JN.1 variant in Europe: a test-negative case-control study using the id.DRIVE platform
BNT162b2 XBB.1.5-adapted vaccine provided protection against JN.1-related hospitalization, regardless of prior vaccination history, with no evidence of waning through five months. These data support yearly vaccination against COVID-19 to prevent severe illness during the respiratory virus season. eClinicalMedicine 7 December 2024
The relationship between predisposing risk factors and COVID-19: An observational study
The study shows that the severity of the disease increased as the number of risk factors increased. This information can help in taking early and active measures in these groups of patients with multiple comorbid illnesses. Cureus 3 December 2024
Fostamatinib for hospitalized adults with COVID-19 and hypoxemia: A randomized clinical trial
In this randomized clinical trial of adults hospitalized with COVID-19 and hypoxemia, fostamatinib did not increase the number of oxygen-free days compared with placebo. These results do not support the hypothesis that fostamatinib improves outcomes among adults hospitalized with hypoxemia during the Omicron era. JAMA 3 December 2024
Castleman disease following post-coronavirus disease 2019 multisystem inflammatory syndrome in adults
Lessons from practice
- Consider Castleman disease in patients re-presenting with similar symptoms as post-coronavirus disease 2019 multisystem inflammatory syndrome in adults.
- Non-caseating granulomas have a wide range of differentials; including infections, vasculitis, occupational diseases and haematological aetiologies.
- Excisional lymph node biopsy is the gold standard to diagnose unexplained lymphadenopathy.
- Enlargement of cherry angiomas is a sign of Castleman disease.
BMJ 1 December 2024
Bivalent Omicron BA.1 vaccine booster increases memory B cell breadth and neutralising antibodies against emerging SARS-CoV-2 variants
These results suggest that the bivalent vaccine confers an advantage against future novel variants due to increased frequency of broadly reactive RBD-specific B cells. eBioMedicine 28 November 2024
Interventions for the management of long covid (post-covid condition): living systematic review
Moderate certainty evidence suggests that cognitive behavioural therapy (CBT) and physical and mental health rehabilitation probably improve symptoms of long covid. BMJ 27 November 2024
mRNA COVID-19 vaccine safety among children and adolescents: a Canadian National Vaccine Safety Network cohort study
The findings suggest that reported health events, including myocarditis/pericarditis, vary by pediatric age group. Vaccinated adolescents reported health events more frequently following the second mRNA COVID-19 vaccine dose, while younger age groups did not report events more frequently than their unvaccinated counterparts. The Lancet regional health – Americas 27 November 2024
Experiences and perspectives of the COVID-19 pandemic and vaccinations in culturally and linguistically diverse (CALD) populations in Australia: A qualitative study
This research paper highlights the issues experienced by culturally and linguistically diverse (CALD) members during the COVID-19 pandemic and vaccination rollout. Cureus 26 November 2024
COVID-19 vaccine reactogenicity among young children
No unexpected reactions were identified. Similar to the authors study, data from clinical trials and V-safe found that irritability was the most common systemic reaction among children aged 6 months to younger than 2 years, followed by fever and fatigue or sleepiness. JAMA 25 November 2024
Towards a cure for long COVID: the strengthening case for persistently replicating SARS‐CoV‐2 as a driver of post‐acute sequelae of COVID‐19
Evidence is mounting that at least some of the potential mechanisms driving long COVID mentioned herein (immune and inflammatory dysregulation, microbiota dysbiosis, autoimmunity and endothelial dysfunction) may themselves have the common denominator of persistent SARS‐CoV‐2 infection. This has several important implications:
- Prioritise long COVID: the notion of “long infection” should help further demystify long COVID, validating individuals who live with this illness (and post‐acute infection syndromes in general) and have it move into the mainstream of surveillance and strategies for diagnosis, treatment and prevention.
- Ramp‐up existing antiviral approaches: existing approaches, including vaccines and therapies, appear to decrease the risk of long COVID and should be more actively included in trials for long COVID. This recognition and the potential cost‐effectiveness implications should prompt reassessment of eligibility requirements for access to therapies and vaccines to promote their use in younger people and to individuals even with milder forms of acute infection.
- Urgently develop new antiviral approaches and long COVID diagnostics: there is now increased impetus for the development of improved therapeutics and vaccines for SARS‐CoV‐2 in addition to definitive biological long COVID diagnostic tests to complement clinical diagnoses.
- Strengthen prevention approaches: long COVID incidence remains high, and this carries a large health, labour and economic impact. It is therefore critical that sustainable prevention strategies are strengthened, especially in higher transmission‐risk settings. Major recent advances towards safer indoor air environments offer one clear avenue to achieve this.
MJA 25 November 2025
Maternal COVID-19 infection and risk of respiratory distress syndrome among newborns: a systematic review and meta-analysis
Newborns born to mothers with COVID-19 have a substantially increased risk of developing respiratory distress syndrome (RDS) These findings emphasize the need for vigilant monitoring and appropriate management of pregnant women with COVID-19 to mitigate adverse neonatal outcomes. BMC infectious diseases 19 November 2024
Role of 2-Deoxy-D-Glucose in enhancing the efficacy of standard of care for moderate to severe COVID-19: A comparative analysis of clinical outcomes
2-DG demonstrates significant efficacy as an adjunct therapy for moderate to severe COVID-19, reducing both time to clinical improvement (5.2 vs. 7.5 days, p < 0.001) and hospital stay duration. Additionally, fewer adverse events were reported, and viral clearance rates were higher in the 2-DG group. These findings highlight 2-DG’s potential to improve clinical outcomes in COVID-19 care,. Cureus 19 November 2024
Cross-sectional and longitudinal genotype to phenotype surveillance of SARS-CoV-2 variants over the first four years of the COVID-19 pandemic
The emergence of many SARS-CoV-2 lineages documented at the end of 2023 was found to be initially associated with lowered neutralisation responses. This continued to be countered by the gradual maturation of cross-reactive neutralisation responses over time. The later appearance and dominance of the divergent JN.1 lineage cannot be attributed to a lack of neutralisation responses alone, and our data supports that its dominance is a culmination of both lowered neutralisation and changes in ACE2/TMPRSS2 entry preferences. eBioMedicine 15 November 2024
Postural orthostatic tachycardia syndrome after COVID-19 vaccination: A systematic review
The risk of POTS following COVID-19 vaccination is lower than that observed post-SARS-CoV-2 infection; however, existing studies are limited by small sample sizes and methodological variability. BMC cardiovascular disorders 14 November 2024
Humoral and cellular responses to a fifth bivalent SARS-CoV-2 vaccine dose in patients with immune-mediated inflammatory diseases on tumour necrosis factor inhibitors: a prospective cohort study
In patients on tumour necrosis factor inhibitors (TNFi) with hybrid immunity, there was no immunological benefit of an updated fifth SARS-CoV-2 booster dose. Stable CD8 cellular responses following four doses indicate established protective immunity. Patients whose only risk factor is TNFi may in future follow vaccine recommendations for the general population. The Lancet regional health - Europe 14 November 2024
Association of mRNA COVID-19 vaccination and reductions in Post-COVID Conditions following SARS-CoV-2 infection in a US prospective cohort of essential workers
COVID-19 vaccination protected against development of post-COVID conditions (PCC) among persons with mild infection during both Delta and Omicron variant predominance, supporting vaccination as an important tool for PCC prevention. Journal of infectious diseases 13 November 2024
Rheumatoid arthritis and COVID-19 outcomes: a systematic review and Meta-analysis
Rheumatoid arthritis patients have a significantly greater risk of COVID-19 infection, hospitalization, ICU admission, and death than individuals without rheumatoid arthritis. However, rheumatoid arthritis did not show a significant association with the risk of severe COVID-19. These findings underscore the need for tailored management strategies and vigilant monitoring of COVID-19 outcomes in rheumatoid arthritis patients. BMC rheumatology 12 November 2024
Trends in alcohol use after the COVID-19 pandemic: A national cross-sectional study
The study included 24 965 respondents from 2018, 30 829 from 2020, and 26 806 from 2022. Compared with 2018, there were absolute increases in any alcohol use in 2020 and 2022. Numerical increases in any alcohol use occurred in 2020 and 2022 versus 2018 among all subgroups. Annals of internal medicine 12 November 2024
A substitution at the cytoplasmic tail of the spike protein enhances SARS-CoV-2 infectivity and immunogenicity
This study offers mechanistic insight into the constantly increasing transmissibility of SARS-CoV-2 Omicron variants and provides a meaningful optimisation strategy for vaccine development against SARS-CoV-2. eBioMedicine 11 November 2024
The COVID-19 pandemic and patient expectations about recovery from acute respiratory failure
In this cohort study, the authors found no clinically meaningful change in expectations about recovery during the COVID-19 pandemic among survivors of non–COVID-19 acute respiratory failure (ARF); expectations were high and similar to previously described expectations in survivors of ARF. JAMA 8 November 2024
Global landscape of COVID-19 vaccination programmes for older adults: a descriptive study
Progress of COVID-19 vaccination programmes for older adults is uneven across countries, emphasising an ongoing challenge to achieve vaccine equity for this high-risk age group. Therefore, it is essential to establish robust and timely vaccination surveillance systems, especially to facilitate data-driven policies that promote COVID-19 vaccination campaigns worldwide. The Lancet – healthy longevity 7 November 2024
Impact of JN.1 booster vaccination on neutralisation of SARS-CoV-2 variants KP.3.1.1 and XEC
The XEC S protein retains the ability to efficiently engage ACE2 and drive cell entry, although entry into Calu-3 lung cells was reduced. Both KP.3.1.1pp and XECpp were generally less well neutralised compared with JN.1pp, indicating elevated immune evasion. Importantly, JN.1 booster vaccination considerably improved neutralisation of all lineages tested and therefore will likely increase protection against hospitalisation and post-COVID sequelae from infection caused by KP.3.1.1 and XEC. The Lancet infectious diseases 7 November 2024
Neurodevelopment in the first 2 years of life following prenatal exposure to maternal SARS-CoV-2 infection
In this longitudinal cohort study of multiple aspects of child neurodevelopment between ages 6 and 24 months, negligible associations between prenatal exposure to SARS-CoV-2 infection and child outcomes were observed. Follow-up research is warranted to determine whether these predominantly null effects persist into later childhood. JAMA 7 November 2024
Global landscape of COVID-19 vaccination programmes for older adults: a descriptive study
Progress of COVID-19 vaccination programmes for older adults is uneven across countries, emphasising an ongoing challenge to achieve vaccine equity for this high-risk age group. Therefore, it is essential to establish robust and timely vaccination surveillance systems, especially to facilitate data-driven policies that promote COVID-19 vaccination campaigns worldwide. The Lancet – healthy longevity 7 November 2024
Long-term risk of autoimmune and autoinflammatory connective tissue disorders following COVID-19
This retrospective cohort study with an extended follow-up period found associations between COVID-19 and the long-term risk of various autoimmune and autoinflammatory connective tissue disorders. Long-term monitoring and care of patients is crucial after COVID-19, considering demographic factors, disease severity, and vaccination status, to mitigate these risks. JAMA 6 November 2024
Safety of simultaneous vs sequential mRNA COVID-19 and inactivated influenza vaccines: A randomized clinical trial
The findings support simultaneous administration of mRNA COVID-19 and inactivated influenza vaccines as an acceptable option to achieve timely vaccination. JAMA 6 November 2024
Virological characteristics of the SARS-CoV-2 XEC variant
Altogether, here we showed that XEC exhibited higher pseudovirus infectivity and higher immune evasion than KP.3. Particularly, XEC exhibited more robust immune resistance to KP.3.3 BTI sera than KP.3.1.1. This data suggest that the higher Re of XEC than KP.3.1.1 is attributed to this property and XEC will be a predominant SARS-CoV-2 variant in the world in the near future. The Lancet infectious diseases 6 November 2024
Long COVID and recovery from Long COVID: quality of life impairments and subjective cognitive decline at a median of 2 years after initial infection
Long COVID is associated with long-term subjective cognitive decline and diminished quality of life. Clinically significant cognitive complaints, fatigue, and pain were present even in those who reported they had recovered from Long COVID. These findings have implications for the sustainability of participation in work, education, and social activities. BMC infectious diseases 5 November 2024
Hospital COVID-19 burden and adverse event rates
The results of this study suggest a need for greater resilience in hospitals to prevent declines in patient safety and effectiveness of care during increases in demand, such as from pandemics, natural disasters, or other causes. JAMA 4 November 2024
The economic burden of long COVID in Australia: more noise than signal?
The known: Robust evidence on the economic burden of long COVID in Australia is limited.
The new: Long COVID potentially peaked in late July or early August 2022, based on COVID‐19 case numbers for the period January 2021 to April 2023. The estimated cost of long COVID in 2022 was about $1.7 billion to $6.3 billion — a fraction of a percentage point of Australia's gross domestic product. Labour market analysis indicates that more working age Australians than expected may now be unable to work, potentially because of long COVID.
The implications: Long COVID likely had a small but perceptible impact on the Australian economy, which can provide insights for shaping Australia's policy response. MJA 4 November 2024
Beyond acute infection: mechanisms underlying post-acute sequelae of COVID-19 (PASC)
Summary
- Immune dysregulation is a key aspect of post-acute sequelae of coronavirus disease 2019 (PASC), also known as long COVID, with sustained activation of immune cells, T cell exhaustion, skewed B cell profiles, and disrupted immune communication thereby resulting in autoimmune-related complications.
- The gut is emerging as a critical link between microbiota, metabolism and overall dysfunction, potentially sharing similarities with other chronic fatigue conditions and PASC.
- Immunothrombosis and neurological signalling dysfunction emphasise the complex interplay between the immune system, blood clotting, and the central nervous system in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
- Clear research gaps in the design of PASC studies, especially in the context of longitudinal research, stand out as significant areas of concern.
MJA 3 November 2024
Factors associated with general practitioner-led diagnosis of long COVID: an observational study using electronic general practice data from Victoria and New South Wales, Australia
The known: Long COVID is a growing concern worldwide. Research outside Australia has identified demographic factors and pre-existing conditions as potential risk factors for long COVID.
The new: In an Australian population, patients who were female, aged 40–59 years or of high socio-economic status, and those who had a pre-existing mental health condition, respiratory condition, cancer or musculoskeletal condition, had an increased risk of general practitioner-led diagnosis of long COVID.
The implications: Identification of predisposing risk factors is essential to inform early intervention and management strategies for those at greatest risk of long COVID and to help alleviate the burden of long COVID on the health care system. MJA 3 November 2024
Hospital costs of COVID-19, post-COVID-19 condition and other viral pneumonias: a cost comparison analysis
The known: International research indicates that hospital admissions for COVID-19 are costlier than admissions for other viral pneumonias, but detailed economic analysis from the Australian context has been lacking.
The new: During the original and Delta waves of the pandemic, admissions for COVID-19 incurred 29% higher costs than those for other viral pneumonias. The costs of admissions that included intensive care were six times higher than those that were managed on general wards.
The implications: Acute COVID-19 and post-COVID-19 condition cases have had a significant financial impact on Australian hospitals. Further analysis is required to identify trends over time in the context of increased vaccination rates and subsequent variants of severe acute respiratory syndrome coronavirus 2. MJA 3 November 2024
Persistent symptoms after COVID-19: an Australian stratified random health survey on long COVID
The known: Persistent symptoms can occur following COVID-19 and may be associated with ongoing impairment.
The new: A survey of adults in Victoria, Australia, who had had a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection showed that one in seven reported persistent new symptoms and being less than 80% recovered three months after the infection (meeting the survey criteria for clinical long COVID). One in five of those with clinical long COVID reported at least moderate impairment at 12 months after the infection.
The implications: Although more recent SARS-CoV-2 variants are less virulent, infections are likely to continue to cause persistent symptoms, and a minority of those affected will experience decreased function. Improved community understanding of long COVID is required, and health systems need to develop clear pathways for treating patients, especially for those with persistent impairment. MJA 3 November 2024
Monkeypox
Updated 20 January 2025
Department of Health and Aged Care – health alert – Monkeypox (MPX) resources
- Monkeypox – Laboratory case definition
- ATAGI clinical guidance on vaccination against Monkeypox
- Monkeypox treatment guidelines
- ICEG interim guidance on Monkeypox for health workers
- CDNA Monkeypox virus infection case and contact management guidelines
SA Health – health alert – Monkeypox
UpToDate – Monkeypox if accessing outside of SA Health computer network use your library login
Monkeypox Resources for Health Professionals (Wolters Kluwer)
Monkeypox Resource Centre (JAMA)
World Health Organization Health alert
Journal articles
Mpox: What have we learned and how do we better prepare for the future?
The global outbreak of clade IIb mpox in 2022-2023 changed our understanding of the epidemiology and prevention of mpox, simultaneously highlighting inequities in access to vaccines, diagnostics, and therapeutics. With the recent multinational spread of clade Ib mpox, it is important to revisit these lessons to improve future response. In September 2024, an international mpox symposium was held at Johns Hopkins University to discuss what we have learned and how to better prepare for the future. Here the authors highlight perspectives from that meeting and priorities for future mpox research. Journal of infectious diseases 17 January 2024
Efficacy of laundry practices in eliminating monkeypox virus (MPXV) from fabrics
Given the expected concentrations of MPXV on fabrics, the low transfer rate of viruses from porous surfaces to skin, the effective inactivation of laundry processes, and the expected doses required for infection, we expect the risk of transmission after laundering contaminated fabrics to be low. This study provides evidence to support WHO guidance for MPXV inactivation, reducing the viral load on fabrics to prevent the spread of mpox in both healthcare and household settings. Journal of infectious diseases 7 December 2024
What every intensivist needs to know about mpox
As the mpox outbreak intensifies, by August 31, 2024, a total of 106,310 confirmed cases have been reported across 123 countries worldwide, resulting in 234 laboratory-confirmed deaths. Intensivists who are caring for mpox patients should consider receiving the modified vaccinia Ankara (MVA) vaccine (JYNNEOS, Bavarian Nordic) to reduce the risk of infection. For individuals with compromised immune systems, including those with HIV, primary immunodeficiencies, or those undergoing immunosuppressive therapy, the MVA vaccine is considered safe. Critical care 4 November 2024
Mpox clinical presentation, diagnostic approaches, and treatment strategies: A review
Mpox is a viral infection transmitted primarily through close skin to skin contact that typically causes a self-resolving illness but can result in severe illness and death in immunocompromised individuals. First-line therapy is supportive care, although patients with severe mpox infection may be treated with advanced therapeutics. Mpox vaccination is effective and, if available, should be offered to individuals at risk of exposure to mpox. JAMA 14 October 2024
Mpox needs a locally tailored global response
Mpox has spread rapidly across continents, igniting fear and uncertainty. Since 2022, 52 329 cases have been recorded (of which 9335 are confirmed), and 1798 deaths. The disease has shown potential for sexual transmission, particularly among men who have sex with men, but more recently has spread in other populations, including in children. BMJ 27 September 2024
Vaccination to prevent mpox
Understanding the effectiveness of vaccination to prevent mpox will determine how the vaccine can be used, along with other control measures, to limit spread. BMJ 23 September 2024
Mpox on the rise
Doctors are being urged to be on the lookout for mpox symptoms with a recent increase of cases in Australia. According to the National Notifiable Disease Surveillance System, as of 10 September 2024, there had been 480 notifications of mpox (formerly monkeypox) in 2024, with most of these in NSW (237 cases). MJA Insight 23 September 2024
Effectiveness of modified vaccinia Ankara-Bavarian Nordic vaccine against mpox infection: emulation of a target trial
The findings of this study, conducted in the context of a targeted vaccination programme and evolving outbreak of mpox, suggest that one dose of MVA-BN is moderately effective in preventing mpox infection. BMJ 11 September 2024
Mpox in pregnancy — Risks, vertical transmission, prevention, and treatment
The alarming surge in human-to-human transmission of monkeypox virus (MPXV) infections, particularly in high-risk, sexually active, and reproductive-age populations, along with the known association between MPXV infection and adverse obstetrical outcomes, highlights the urgent need for data to enhance our understanding and mitigate the risks of MPXV infection during pregnancy. NEJM 28 August 2024
The Mpox global health emergency — A time for solidarity and equity
This mpox Public Health Emergency of International Concern (PHEIC) declaration is the third in 5 years — a clear acknowledgment of ongoing threats to health security. Each declared emergency spurs international action, which then wanes without bringing endemic disease to an end. Bringing sustained attention and investment to the Democratic Republic of Congo (DRC) and its neighbors is good for the region and good for the world. NEJM 28 August 2024
Dynamic landscape of mpox importation risks driven by heavy-tailed sexual contact networks among men who have sex with men in 2022
The accumulation of immunity among high-risk individuals over highly heterogeneous sexual networks may have contributed to the slowdown in the rate of mpox importations. Nevertheless, the existence of countries with the potential to contribute to the global spread of mpox highlights the importance of equitable resource access to prevent the global resurgence of mpox. Journal of infectious diseases 28 August 2024
The resurgence of Mpox in Africa
The current epidemiological characteristics in the Democratic Republic of the Congo (DRC) differ greatly from those of the 2022 clade II global epidemic, which is still ongoing but at a much-reduced level. The 2022 mpox epidemic (clade II) has been primarily spread through sexual contact among men who have sex with men. As such, adult men are almost exclusively affected. The clade II global epidemic has had a relatively low case fatality risk of less than 1% overall. In contrast, the DRC is seeing a sizable burden of cases in children attributed to clade I. More than 50% of reported cases, and a majority of deaths, are in children younger than 5 years. Although confirmatory testing is uncommon, these infections are presumed to be clade Ia, which is endemic in the region. JAMA 20 August 2024
Mpox outbreaks in Africa—we must avert another failure of global solidarity
On 13 August 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared the ongoing mpox outbreak a public health emergency of continental security. This outbreak is driven by the emergence of a new clade 1b variant that is better adapted to human-to-human transmission. On 14 August, the World Health Organization (WHO) declared the current outbreak a public health emergency of international concern (PHEIC) under the International Health Regulations (2005). Amid another widespread epidemic is another unfolding story of vaccine inequity, and yet another looming failure of global solidarity. We have seen this before, and it does not end well for anyone. BMJ 15 August 2024
Mpox: two years on
Two years on from the global “monkeypox” epidemic, the disease now called mpox remains dangerous. BMJ 30 July 2024
Intriguing insight into unanswered questions about Mpox: exploring health policy implications and considerations
The 2022 multi-country Monkeypox (Mpox) outbreak has added concerns to scientific research. However, unanswered questions about the disease remain. These unanswered questions lie in different aspects, such as transmission, the affected community, clinical presentations, infection and prevention control and treatment and vaccination. It is imperative to address these issues to stop the spread and transmission of disease. We documented unanswered questions with Mpox and offered suggestions that could help put health policy into practice. One of those questions is why gay, bisexual or other men who have sex with men (gbMSM) are the most affected community, underscoring the importance of prioritizing this community regarding treatment, vaccination and post-exposure prophylaxis. In addition, destigmatizing gbMSM and implementing community-based gbMSM consultation and action alongside ethical surveillance can facilitate other preventive measures such as ring vaccination to curb disease transmission and track vaccine efficacy. Relevant to that, vaccine and drug side effects have implied the questionability of their use and stimulated the importance of health policy development regarding expanded access and off-label use, expressing the need for safe drug and vaccine development manufacturing. The possibility of reverse zoonotic has also been raised, thus indicating the requirement to screen not only humans, but also their related animals to understand the real magnitude of reverse zoonosis and its potential risks. Implementing infection prevention and control measures to stop the virus circulation at the human–animal interface that includes One Health approach is essential. Health research policy and systems 22 March 2024
Sources of information on monkeypox virus infection. A systematic review with meta-analysis
The study suggests that people access a variety of information sources to gain knowledge about Mpox virus infection, with a strong emphasis on online sources such as social networks and the Internet. However, it is important to note that the quality and accuracy of information available from these sources can vary, underscoring the need to promote access to reliable and up-to-date information about this disease to ensure public health. BMC public health 24 January 2024
Pathology and monkeypox virus localization in tissues from immunocompromised patients with severe or fatal mpox
Severe mpox in immunocompromised patients is characterized by extensive viral infection of tissues and viremic dissemination that can progress despite available therapeutics. Digestive tract and lung involvement are common and associated with prominent histopathological and clinical manifestations. Coinfections may complicate mpox diagnosis and treatment. Significant viral DNA (likely correlating to infectious virus) in tissues necessitates enhanced biosafety measures in healthcare and autopsy settings. Journal of infectious diseases 18 January 2024
Early Tecovirimat treatment for Mpox Disease among people with HIV
Results of this cohort study support starting tecovirimat in all people with HIV (PWH) as soon as an mpox diagnosis is suspected. Additional research is warranted to confirm these findings. JAMA 8 January 2024
Lessons from the Mpox response
The last few years have been remarkable in how infectious diseases have taken a toll. The lesson from the mpox response is clear: community engagement and flexibility of response are necessary as well as the existing public health infrastructure that can be deployed to manage outbreaks. Medical countermeasures are key, but so are community partnerships, flexibility, and persistence. That is how infectious disease outbreaks should be managed now and in the future. JAMA 8 January 2024
Prevalence of intentions to receive monkeypox vaccine. A systematic review and meta-analysis
The study highlights the importance of recognizing regional and subgroup disparities in Mpox vaccine willingness and refusal. It emphasizes the importance of employing strategies to achieve widespread vaccination coverage and safeguard public health worldwide. BMC public health 2 January 2024
Time series analysis and short-term forecasting of monkeypox outbreak trends in the 10 major affected countries
This research provides profile of ten most severely hit countries by monkeypox transmission around the world and thus assists in epidemiological management. The prediction trends indicate that the confirmed cases in the USA may exceed than other contemporaries. Based on the findings of this study, it remains plausible to recommend that more robust health surveillance strategy is required to control the transmission flow of the virus especially in USA. BMC infectious diseases 2 January 2024
Antibody Titers against Mpox Virus after vaccination
These findings provide data for policymakers in case of mpox resurgence and the need for reinvigorated education and vaccination campaigns. The authors observed similar MPXV immunogenicity regardless of the vaccination route or HIV status. The IgG data through 3 months suggest a need for studies to determine whether booster vaccination may be needed for longer-term immunity and the correlation of the antibody titer with vaccine protection. NEJM 14 December 2023
Successful treatment of recalcitrant Mpox lesions with Intralesional Cidofovir in a patient with HIV/AIDS
Increased efficacy with intralesional treatment may stem from higher concentrations of cidofovir in affected skin vs that achieved with systemic agents, particularly in this patient reliant on direct medication effects with minimal immune assistance. The authors hope this strategy will be useful to others as they approach similarly recalcitrant lesions or patients with risk of toxic effects from systemic cidofovir. JAMA 6 December 2023
The diagnostic dilemma for atypical presentation of progressive human Mpox
Suspicion for human mpox should be high in young men who have sex with men (MSM) and persons living with HIV (PLHIV) who present with rash and mpox should be ruled out earlier. BMC infectious diseases 5 December 2023
Preparing for mpox resurgence: Surveillance lessons from outbreaks in Toronto, Canada
This investigation demonstrates the importance of ongoing surveillance and preparedness for mpox outbreaks. Undetected local transmission was not a likely source of the 2022-2023 resurgence. Ongoing pre-exposure vaccine promotion remains important to mitigate disease burden. Journal of infectious diseases 30 November 2023
Prolonged mpox disease in people with advanced HIV: characterization of mpox skin lesions
The authorsreport three complicated and prolonged cases of mpox in people with advanced HIV not on antiretroviral therapy (ART) at mpox diagnosis. Multiple medical countermeasures were used, including prolonged tecovirimat treatment and immune optimization with ART initiation. Immunofluorescence of skin biopsies demonstrated a dense immune infiltrate of predominantly myeloid and CD8+ T-cells, with a strong type-I interferon local response. RNAscope detected abundant replication of monkeypox virus (MPXV) in epithelial cells and dendritic cells. These data suggest that prolonged mpox in people with advanced HIV may be due to ongoing MPXV replication, warranting aggressive medical countermeasures and immune optimization. Journal of infectious diseases 29 November 2023
Healthcare personnel exposure risk assessment and management during a Mpox outbreak in Chicago, Illinois, May 17-July 8, 2022
This report summarizes risk assessment interviews and follow up with healthcare personnel (HCP) after exposure to patients with mpox disease during May 17-July 8, 2022. HCP-case interactions were assessed using a standard questionnaire to categorize the risk associated with patient encounters. We assessed 150 interactions among 142 HCP and 30 cases. Four(2.7%) interactions were defined as high risk, 5(3.3%) intermediate, 107(71.3%) low, and 31(20.7%) no risk. High and intermediate exposures were offered post-exposure prophylaxis; four accepted. No documented mpox transmission after exposure was identified. These findings suggest transmission risk in healthcare settings during routine patient care is low. Journal of infectious diseases 29 November 2023
Associations between HIV and Severe Mpox in an Atlanta Cohort
People with HIV (PWH) with non-suppressed HIV viral loads had more mpox complications, hospitalizations, and protracted disease courses than people without HIV or PWH with suppressed viral loads. PWH with non-suppressed HIV viral loads who are diagnosed with mpox warrant particularly aggressive monitoring and treatment. Journal of infectious diseases 24 November 2023
Mpox knowledge, behaviours and barriers to public health measures among gay, bisexual and other men who have sex with men in the UK: a qualitative study to inform public health guidance and messaging
There are differential needs, preferences, and experiences of gay, bisexual, or other men who have sex with men (GBMSM) that limit the acceptability of some mitigation and prevention measures. Future public health interventions and campaigns should be co-designed in consultation with key groups and communities to ensure greater acceptability and credibility in different contexts and communities. BMC public health 17 November 2023
Mpox viral lineage analysis and technique development using next generation sequencing approach
The authors developed next generation sequencing (NGS) workflows to precisely detect and analyze Mpox viral clade and lineages and aid in genomic surveillance. Journal of infectious diseases 16 November 2023
Development and pilot of an Mpox severity scoring system (MPOX-SSS)
Clinical severity scores facilitate comparisons to understand risk factors for severe illness. For the 2022 multinational monkeypox Clade IIb virus outbreak, we developed a 7-item mpox severity scoring system (MPOX-SSS) with initial variables refined based on data availability and parameter correlation. Application of MPOX-SSS to the first 200 patients diagnosed with mpox revealed higher scores in those treated with tecovirimat, presenting >3 days after symptom onset and with CD4 counts <200 cells/mm3 . For individuals evaluated repeatedly, serial scores were concordant with clinical observations. The pilot MPOX-SSS demonstrated good discrimination, distinguished change over time, and identified higher scores in expected groups. Journal of infectious diseases 13 November 2023
Prior sexually transmitted infections and HIV in mpox patients, Chicago, Illinois—(June 2022–March 2023
HIV is associated with severe mpox. Sexually transmitted infections (STIs) could facilitate mpox transmission. The authors estimated HIV and STI frequency among patients with mpox, and compared characteristics associated with mpox severity. Mpox cases during June 1, 2022–March 31, 2023, were matched to Illinois HIV/AIDS surveillance data. Among 1,124 mpox patients, 489 (44%) had HIV and 786 (70%) had prior or concurrent STI; 307 (39%) had ≥3 STI episodes. More mpox patients living with HIV were hospitalized than without HIV (10.3% vs 4.1%, P <0.001). STI screening visits are opportunities to vaccinate against mpox and provide HIV prophylaxis or treatment. Journal of infectious diseases 8 November 2023
APOBEC3 deaminase editing in mpox virus as evidence for sustained human transmission since at least 2016
In March 2022, an international epidemic of human Mpox was detected, showing that it was not solely a zoonotic infection. A hallmark of the approximately 88,000 cases that have been reported were TC>TT and GA>AA mutations in Mpox viruses, which were acquired at a surprisingly high evolutionary rate for a pox virus. Knowing that these types of mutation are a sign of activity by a host antiviral enzyme called APOBEC3, O’Toole et al. investigated whether the mutations reflected human-to-human transmission rather than repeated zoonotic spillover. Bayesian evolutionary analysis showed that Mpox virus recently diversified into several lineages in humans that display elevated numbers of mutations, signaling APOBEC exposure and sustained human-to-human transmission rather than zoonosis as the source of new cases. Science 2 November 2023
Tzanck smear of Ulcerated Plaques
Tzanck smear is a useful technique that can be used to differentiate mpox from other infections at the bedside or in remote settings where PCR or additional culture techniques are not easily accessible. Infection prevention and control precautions are important to help prevent additional spread of this virus with sharp injuries, and caution with unroofing of the lesions is critical to avoid additional spread.7 Knowledge of the cytologic differences of mpox compared with other viral infections is important in the early recognition, diagnosis, and treatment of these patients. JAMA 25 October 2023
Detection of Mpox Virus using Microbial Cell-free DNA: the potential of Pathogen-Agnostic Sequencing for rapid identification of emerging pathogens
The authors demonstrate the potential of plasma mcfDNA sequencing to detect, quantify, and, for acute infections with high sequencing coverage, subtype MPXV using a single non-invasive test. Sequencing plasma mcfDNA may augment existing mpox testing in vulnerable patient populations or in patients with atypical symptoms or unrecognized mpox. Strain type information may supplement disease surveillance and facilitate tracking emerging pathogens. Journal of infectious diseases 12 October 2023
Effectiveness of Smallpox vaccination to prevent Mpox in military personnel
The authors conducted a retrospective, test-negative case–control study among current and former U.S. military personnel to determine the effectiveness of smallpox vaccines against mpox. Previous vaccination at a median of 13 years earlier with either a first- or second-generation smallpox vaccine reduced the likelihood of testing positive for orthopoxvirus among current or former military personnel for whom vaccination data were available. NEJM 21 September 2023
Mpox: Keep it on the differential
Key points:
- In its worldwide outbreak in 2022, mpox was remarkably different from its historic profile, a viral zoonotic disease that inefficiently spread from person to person.
- Mpox is currently primarily affecting men who have sex with men and is mainly transmitted through direct contact with an infectious lesion.
- Clinicians should keep mpox in the differential diagnosis for single, multiple, or diffuse genital, anal, or skin lesions, as well as pharyngitis and proctitis.
- Patients with suspected mpox should also be tested for sexually transmitted infections including human immunodeficiency virus (HIV), and should be offered HIV postexposure or preexposure prophylaxis and mpox vaccine if appropriate.
Cleveland journal of medicine 13 September 2023
Mpox
Mpox (formerly monkeypox) emerged as a global pandemic in 2022 with more than 80,000 cases diagnosed to date worldwide. This Interactive Perspective is designed to aid clinicians in understanding the disease transmission, recognizing clinical signs, and treating mpox effectively. NEJM 7 September 2023
Breakthrough mpox despite two‐dose vaccination
Lessons from practice
- Since May 2022, there has been a global outbreak of mpox, predominantly in gay, bisexual and other men who have sex with men.
- Limited data exist for clinical vaccine effectiveness, but it has been estimated at about 85% after a full vaccination course.
- Clinicians should be aware of the possibility of breakthrough infection, possibly of less severity and without typical constitutional symptoms, in patients with epidemiological risk factors and a characteristic vesiculopustular rash, irrespective of a history of previous vaccination.
- Individuals at high risk should be offered vaccination, if not yet already received. These groups include gay, bisexual and other men who have sex with men; sex workers; and sexual partners of these groups.
MJA 4 September 2023
Sexual health doctors urge vigilance on mpox
Sexual health clinicians are urging GPs to keep an eye out for breakthrough mpox infection, even in vaccinated patients. MJA insight 4 September 2023
Mpox: China’s health authorities fight surge in cases of unknown origin
Chinese health authorities are facing an escalating outbreak of mpox where most cases are of unknown origin. A World Health Organization mpox situation report published on 14 August singled out “sustained community transmission in China” as driving the rise in cases in the region, which has bucked a broad global decline. BMJ 22 August 2023
Mpox and primary syphilis co‐infection in a newly arrived traveller from South America
Lessons from practice
- Mpox, syphilis and genital herpes should be considered in at‐risk patients presenting with genital ulcers, as co‐infection may be present.
- A detailed sexual and travel history is important to narrow down the differential diagnosis.
- Careful examination and appropriate sampling for testing and consideration of presumptive treatment for syphilis and herpes simplex virus are crucial before isolation of the patient if mpox is suspected.
- Information provision in the patients’ language and liaison with the public health unit is essential in contact tracing and provision of patient‐centred care for mpox.
MJA 7 August 2023
Tecovirimat resistance in an immunocompromised patient with Mpox and prolonged viral shedding
The objective of this paper is to describe the rapid selection of a tecovirimat-resistant MPXV variant during treatment of a severely immunocompromised patient with prolonged MPXV infection. Annals of internal medicine 25 July 2023
Vaccine effectiveness of JYNNEOS against Mpox disease in the United States
In this study using nationwide EHR data, patients with mpox were less likely to have received one or two doses of JYNNEOS vaccine than control patients. The findings suggest that JYNNEOS vaccine was effective in preventing mpox disease, and a two-dose series appeared to provide better protection. NEJM 29 June 2023
Monkeypox detection using deep neural networks
The DenseNet201 model outperforms the other models in terms of the confusion metrics, regardless of the scenario. One significant accomplishment of this study is the utilization of LIME and Grad-Cam to identify the affected areas and assess their significance in diagnosing diseases based on skin images. By incorporating these techniques, we enhance our understanding of the infected regions and their relevance in distinguishing Monkeypox from other similar diseases. Our proposed model can serve as a valuable auxiliary tool for diagnosing Monkeypox and distinguishing it from other related conditions. BMC infectious diseases 27 June 2023
WHO ends public health emergency designation for mpox
On 11 May 2023 the World Health Organization declared that the 2022-23 mpox epidemic was no longer a public health emergency of international concern (PHEIC). The decision, which followed the same announcement for covid-19 by only six days, is perhaps unsurprising; in most places new cases have tapered off, thanks to rapid vaccination and information campaigns. BMJ 5 June 2023
APOBEC3F is a mutational driver of the human Monkeypox virus identified in the 2022 outbreak
Stochastic or transient overexpression of APOBEC3F gene exposes the MPXV genome to a broad spectrum of mutations that may be modeling the mutational landscape after multiple cycles of viral replication. Journal of infectious diseases 24 May 2023
Vaccine effectiveness of JYNNEOS against Mpox disease in the United States
In this study using nationwide Epic electronic health record (EHR) data, patients with mpox were less likely to have received one or two doses of JYNNEOS vaccine than control patients. The findings suggest that JYNNEOS vaccine was effective in preventing mpox disease, and a two-dose series appeared to provide better protection. NEJM 18 May 2023
Short-term adverse events following immunization with modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine for Mpox
This post marketing study of adverse events following MVA-BN vaccination found that local adverse event rates were highest following intradermal administration. However, absolute event rates were lower than in previous studies, which reported more than 30% systemic adverse events following both routes and local adverse event rates of more than 50% following subcutaneous administration and nearly 100% following intradermal vaccination. This study also found a low percentage of people reporting medical review or missing daily activities, suggesting that the vaccine is generally well-tolerated. JAMA 5 May 2023
Stability and inactivation of monkeypox virus on inanimate surfaces
The spread of non-zoonotic monkeypox virus (MPXV) infections necessitates the re-evaluation of hygiene measures. To date, only limited data is available on MPXV surface stability. Here, the authors evaluate the stability of infectious MPXV on stainless steel stored at different temperatures, while using different interfering substances to mimic environmental contamination. MPXV persistence increased with decreasing temperature. Additionally, they were able to show that MPXV could efficiently be inactivated by alcohol- and aldehyde-based surface disinfectants. These findings underline the stability of MPXV on inanimate surfaces and supports the recommendations to use alcohol-based disinfectants as prevention measure or in outbreak situations. Journal of infectious diseases 2 May 2023
Tecovirimat treatment of people with HIV during the 2022 Mpox outbreak
In this cohort of patients treated with tecovirimat for severe mpox, HIV status did not seem to affect treatment outcomes. Annuals of internal medicine 2 May 2023
Severe mpox in persons with advanced HIV (UptoDate)
In patients with mpox, severe disease can occur in the context of advanced HIV infection. In a multisite study that included 382 patients with HIV and a CD4 count <350 cells/microL, 107 (28 percent) were hospitalized [16]. All 27 deaths occurred in people with CD4 counts of <200 cells/microL. Some developed widespread, large, necrotizing skin lesions and unusual nodular lung lesions. One-quarter of the 85 people who started or restarted antiretroviral therapy (ART) had suspected immune reconstitution inflammatory syndrome (IRIS). Clinicians should be aware of these clinical features so that appropriate treatment can be initiated. We do not delay ART, despite the potential for IRIS, given the importance of immune recovery. (See "Epidemiology, clinical manifestations, and diagnosis of mpox (monkeypox)", section on 'Complications in people with advanced HIV'.)
Impact of mpox virus infection on immune parameters of a female person with HIV receiving clinically effective antiretroviral therapy
The authors describe the immunologic and virologic impact of mpox infection in a female person with HIV whose plasma viremia was suppressed by clinically effective antiretroviral therapy. Extensive phenotypic analyses of B and T cells in peripheral blood and biomarkers in plasma showed significant immunologic perturbations despite the presence of mild mpox disease. Dramatic shifts were noted in the frequencies of total B cells, plasmablasts (PB), and PB immunoglobulin isotypes. Flow cytometric analyses showed a dramatic increase in the frequency of CD38+HLA-DR+ CD8+ cells following mpox. This data offer guidance for future studies involving mpox infection in affected populations. Journal of infectious diseases 6 April 2023
Time scales of human mpox transmission in the Netherlands
Mpox has spread rapidly to many countries in non-endemic regions. After reviewing detailed exposure histories of 109 pairs of mpox cases in the Netherlands, the authors identified 34 pairs where transmission was likely and the infectee reported a single potential infector with a mean serial interval of 10.1 days (95% CI: 6.6–14.7 days). Further investigation into pairs from one regional public health service revealed that pre-symptomatic transmission may have occurred in five out of eighteen pairs. These findings emphasize that precaution remains key, regardless of the presence of recognizable symptoms of mpox. Journal of infectious diseases 4 April 2023
Erythema and Induration after Mpox (JYNNEOS) vaccination revisited
In a trial of Mpox vaccine, intradermal administration led to more erythema and induration than the subcutaneous route but resulted in a similar level of immune response with 20 % of the dose NEJM 22 March 2023
Monkeypox epidemiology, clinical presentation, and transmission: a systematic review
Monkeypox human-to-human and human-to-animal transmission are rising. Thus, it is essential to do research on the prevention, clinicodemographic trends, and treatment of monkeypox. Understanding this will enable us to treat monkeypox patients with a targeted and focused approach International journal of emergency medicine 17 March 2023
Monkeypox (Mpox) and occupational exposure
The highest work-related risk for mpox transmission has been noted among healthcare professionals, people working with animals, and sex workers. There is general agreement that a paramount issue to avoid transmission of infection in occupational settings is an appropriate decontamination of often-touched surfaces and usage of appropriate personal protective equipment by the workers at high risk of infection. The group that should especially protect themselves and be educated in the field of early symptoms of the disease and prevention are dentists, who are often the first to detect the symptoms of the disease on the oral mucosa. International journal of environmental research and public health 14 March 2023
Therapeutics for treating mpox in humans
This review found no evidence from randomized trials from which to draw certain conclusions concerning the efficacy of therapeutics in humans with mpox. Cochrane Database of Systematic Reviews – Intervention 14 March 2023
Potential anti-mpox virus activity of atovaquone, mefloquine, and molnupiravir, and their potential use as treatments
These data suggest that atovaquone would be potential candidates for treating mpox. Journal of infectious diseases 9 March 2023
Severe corneal involvement associated with Mpox infection
Mpox keratitis is rare but potentially severe. Infection of the eyelids should be monitored because it can spread to the cornea afterwards. Corneal infection is very painful and evolves from the limbus centripetally with a pathognomonic arcuate serpiginous epithelial pattern. The role of antivirals remains to be determined. JAMA 9 March 2023
An Mpox-related death in the United States
In hospitalized patients with severe mpox, it is important to consider treatment with intravenous tecovirimat. Second-line therapies including cidofovir, brincidofovir, and vaccinia immune globulin may also be considered. If progressive or persistent lesions are present after 14 days of treatment with tecovirimat, pharmacokinetic testing of tecovirimat and testing of lesion specimens for antiviral resistance are warranted. Patients with low CD4+ T-cell counts who become infected with MPXV should be monitored closely, given the potential risk of more severe illness. NEJM 8 March 2023
Brief report: Monkeypox virus cross-neutralizing antibodies in clinical trial subjects vaccinated with Modified Vaccinia Virus Ankara Encoding MERS-Coronavirus Spike Protein
Modified vaccinia virus Ankara (MVA) is used as a vaccine against monkeypox virus (MPXV) and as a viral vaccine vector. MVA-MERS-S is a vaccine candidate against Middle East respiratory syndrome- associated coronavirus (MERS-CoV). Here, we report that cross-reactive MPXV nAbs were detectable in only a single subject after the first dose, 3 out of 10 after the 2nd dose, and in 10 out of 10 after the 3rd dose of MVA-MERS-S vaccine. Journal of infectious diseases 1 March 2023
Possibility of mpox viral transmission and control from high-risk to the general population: a modeling study
Mpox has high transmissibility in men who have sex with men (MSM), which required minimize the risk of infection and exposure to high-risk populations. Community prevention and control is the top priority of interventions to contain the spread of mpox. BMC infectious diseases 24 February 2023
Mpox in people with advanced HIV infection: a global case series
A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death. The Lancet 21 February 2023
Mpox—A rapidly evolving disease
This Special Communication provides an overview of the evolution of mpox skin findings from its initial description in humans in 1970 to the present-day multinational outbreak. JAMA 9 February 2023
Human monkeypox: diagnosis and management
What you need to know
- Consider coinfections with monkeypox and other sexually transmitted infections among patients presenting with an acute rash or skin lesions and systemic symptoms
- While it is safe to manage monkeypox patients virtually, they may need advice to maintain infection control measures and interventions to manage complications
- A specialist infectious disease unit with access to novel antivirals such as tecovirimat and cidofovir should manage high risk patients
- Healthcare workers should be aware of the stigma surrounding monkeypox, which may result in reduced health-seeking behaviours; healthcare staff should screen patients sensitively, using inclusive language to avoid alienating patients
BMJ 6 February 2023
Mpox vaccination encouraged ahead of World Pride
With upcoming World Pride events in Sydney, now is the perfect time to raise awareness and encourage vaccination against mpox. MJA InSight 30 January 2023
Use of wastewater for Mpox outbreak surveillance in California
Real-time results informed the state and local public health response, allowing for escalation of the state response level when detection in multiple watersheds suggested that MPXV was widespread or unexpected, alerting clinicians, and guiding the allocation of resources (e.g., testing, vaccines, and therapeutics) and personnel in affected areas. This experience in adapting routine wastewater-surveillance infrastructure to monitor for a nonenteric, nonrespiratory virus such as MPXV shows promise for the future use of this method as an adjunct public health tool. NEJM 18 January 2023
Real-time forecasting the trajectory of monkeypox outbreaks at the national and global levels, July–October 2022
The top-ranked model consistently predicted a decreasing trend in monkeypox cases on the global and country-specific scale during the last ten sequential forecasting periods. The findings reflect the potential impact of increased immunity, and behavioral modification among high-risk populations. BMC medicine 16 January 2023
MPXV transmission at a tattoo parlor
The authors describe cases of MPXV transmission that were likely to have occurred by means of direct inoculation from piercing and tattooing; such transmission has been observed with other poxviruses, such as Molluscum contagiosum. To date, sexual transmission of MPXV has been the most common mode of transmission, with men who have sex with men being disproportionately affected. In contrast, the cases in this report mostly involved female patients. MPXV may develop new networks of transmission, with epidemiologic changes of the disease. NEJM 5 January 2022
SA Health Library Service 12/8/2022