COVID-19

COVID-19 Latest from research publications
compiled by the SALHN (SA Health) library staff - updated 21 February 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 

Hospitalizations and mortality among older adults with and without restricted access to Nirmatrelvir-Ritonavir
The authors identified 1,620 884 Ontarians aged 65 to 74 years during the study period most (87.5%) received at least 2 COVID-19 vaccines. Findings indicated that a more than doubled rate of nirmatrelvir-ritonavir prescriptions was not associated with reductions in hospitalizations or mortality among highly vaccinated older adults in Ontario. JAMA 19 February 2025

The impact of COVID vaccination on incidence of long COVID and healthcare resource utilisation in a primary care cohort in England, 2021–2022
Vaccination against COVID-19 may reduce the risk of long COVID in both immunocompetent and immunocompromised patients. However, no association was found between frequency of primary care visits and vaccination among patients diagnosed in 2021. Future studies with larger sample size, higher vaccine uptake, and longer study periods during the pandemic are needed to further quantify the impact of vaccination on long COVID. BMC infectious diseases 13 February 2025

Prophylaxis for renal patients at risk of COVID-19 infection: results from the intranasal niclosamide randomised, double blinded, placebo controlled arm of the PROTECT-V platform trial
Intranasal niclosamide did not reduce risk of symptomatic COVID-19 infection in this cohort compared to placebo. BMC infectious diseases 11 February 2025

Healthcare utilization patterns before and after a long COVID diagnosis: a case-control study
Long COVID patients increased outpatient healthcare utilization following a diagnosis, switching from acute care settings. The change in service settings among this population suggests that diagnosis could lead to better patient management. Healthcare utilization among these patients is high, underscoring the need to understand the Long COVID burden on healthcare systems with population-level data. BMC public health 10 February 2025

The source of coronavirus anxiety: a longitudinal network analyses of the symptoms in the coronavirus anxiety scale (CAS) and their associations with depression, anxiety, stress and alcohol use
The Covid-19 Pandemic and subsequent actions taken by national/international organizations has generated a large amount of anxiety which may roam into the realm of pathology– COVID Anxiety. To measure this phenomenon, measures such as the CAS have been developed. The CAS being a self-report measure of anxiety-related physiologically symptoms that are aroused by information and thoughts related to COVID-19. However, as the CAS is fairly new it requires validation and examination. Current psychology 8 February 2025

Factors associated with the transmission of the delta SARS-CoV-2 variant in households: the Israeli COVID-19 Family Study (ICoFS)
Understanding how interpersonal interactions and immunological factors shape SARS-CoV-2 transmission in households is crucial for designing control measures. The auhors developed a Bayesian data augmentation transmission model to evaluate the effects of isolation, parental care, and vaccine-induced immunity on Delta variant transmission from the follow-up of 1,093 Israeli households (July–August 2021). Among the 2883 household contacts, 1096 (38%) were infected. Children were 38% (CI: 7-81) more likely to be infected than adults. Isolation measures reduced transmission by 52% (CI: 46-57). Transmission was 39% (CI: 11-76) higher between children and adult females than males. Vaccine effectiveness was 78% (CI: 54-90), 85% (CI: 70-94), and 73% (CI: 49-88) for one, two, and three doses of recent vaccination (< 90 days), respectively but dropped to 18% (CI: (-6)-36) for two doses administered more than 90 days ago. Household member interactions significantly shaped transmission, and isolation measures effectively reduced transmission. Journal of infectious disease 8 February 2025

Pediatric gastrointestinal tract outcomes during the postacute phase of COVID-19
In this cohort study, the increased risk of GI tract symptoms and disorders was associated with the documented SARS-CoV-2 infection in children or adolescents during the postacute or chronic phase. Clinicians should note that lingering GI tract symptoms may be more common in children after documented SARS-CoV-2 infection than in those without documented infection. JAMA 7 February 2025

COVID-19 Latest from research publications 

Compiled by SA Health Library Service staff.  Last updated 20 February 2025.

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

The Library service also offers a range of current awareness topics, to view and subscribe please click here 

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

• 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)
• COVID-19: examining the effectiveness of non-pharmaceutical interventions 

The impact of COVID vaccination on incidence of long COVID and healthcare resource utilisation in a primary care cohort in England, 2021–2022
Vaccination against COVID-19 may reduce the risk of long COVID in both immunocompetent and immunocompromised patients. However, no association was found between frequency of primary care visits and vaccination among patients diagnosed in 2021. Future studies with larger sample size, higher vaccine uptake, and longer study periods during the pandemic are needed to further quantify the impact of vaccination on long COVID. BMC infectious diseases 13 February 2025

Assessment of psychosocial aspects in adults in post-COVID-19 condition: the EURONET-SOMA recommendations on core outcome domains for clinical and research use
The recommended core domains help to increase consistency in a biopsychosocial approach to post-COVID-19 condition across investigations, improve synergies, and facilitate decision-making when comparing different interventional approaches. It allows to better identify relevant subgroups in heterogeneous post-COVID-19 condition populations offering practical tools for routine clinical practice through the clinical core set. BMC Medicine 11 February 2025

Prophylaxis for renal patients at risk of COVID-19 infection: results from the intranasal niclosamide randomised, double blinded, placebo controlled arm of the PROTECT-V platform trial
Intranasal niclosamide did not reduce risk of symptomatic COVID-19 infection in this cohort compared to placebo. BMC infectious diseases 11 February 2025

Prophylaxis for renal patients at risk of COVID-19 infection: results from the intranasal niclosamide randomised, double blinded, placebo controlled arm of the PROTECT-V platform trial
Intranasal niclosamide did not reduce risk of symptomatic COVID-19 infection in this cohort compared to placebo. BMC infectious diseases 11 February 2025

Healthcare utilization patterns before and after a long COVID diagnosis: a case-control study
Long COVID patients increased outpatient healthcare utilization following a diagnosis, switching from acute care settings. The change in service settings among this population suggests that diagnosis could lead to better patient management. Healthcare utilization among these patients is high, underscoring the need to understand the Long COVID burden on healthcare systems with population-level data. BMC public health 10 February 2025

Factors associated with the transmission of the delta SARS-CoV-2 variant in households: the Israeli COVID-19 Family Study (ICoFS)
Understanding how interpersonal interactions and immunological factors shape SARS-CoV-2 transmission in households is crucial for designing control measures. The auhors developed a Bayesian data augmentation transmission model to evaluate the effects of isolation, parental care, and vaccine-induced immunity on Delta variant transmission from the follow-up of 1,093 Israeli households (July–August 2021). Among the 2883 household contacts, 1096 (38%) were infected. Children were 38% (CI: 7-81) more likely to be infected than adults. Isolation measures reduced transmission by 52% (CI: 46-57). Transmission was 39% (CI: 11-76) higher between children and adult females than males. Vaccine effectiveness was 78% (CI: 54-90), 85% (CI: 70-94), and 73% (CI: 49-88) for one, two, and three doses of recent vaccination (< 90 days), respectively but dropped to 18% (CI: (-6)-36) for two doses administered more than 90 days ago. Household member interactions significantly shaped transmission, and isolation measures effectively reduced transmission. Journal of infectious disease 8 February 2025

Pediatric gastrointestinal tract outcomes during the postacute phase of COVID-19
In this cohort study, the increased risk of GI tract symptoms and disorders was associated with the documented SARS-CoV-2 infection in children or adolescents during the postacute or chronic phase. Clinicians should note that lingering GI tract symptoms may be more common in children after documented SARS-CoV-2 infection than in those without documented infection. JAMA 7 February 2025

Prevalence of cardiovascular symptoms in post-acute COVID-19 syndrome: a meta-analysis
These findings indicate that 15% of COVID-19 patients experience cardiovascular sequelae. Furthermore, COVID-19 infection significantly increases the likelihood of developing these sequelae compared to uninfected individuals. Future research should prioritize investigating the underlying pathological mechanisms and developing targeted preventive and management strategies. BMC medicine 6 February 2025

Two-year trajectory of functional recovery and quality of life in post-intensive care syndrome: a multicenter prospective observational study on mechanically ventilated patients with coronavirus disease-19
Critically ill patients had Post-intensive care syndrome (PICS) for a long period and followed different trajectories for each impairment component. Based on trajectories, known PICS risk factors such as prolonged ventilation and delirium were associated with impaired recovery, while extracorporeal membrane oxygenation (ECMO) and the presence of family were associated with recovery from PICS. In critically ill COVID-19 patients, delirium management and family interventions may play an important role in promoting recovery from PICS. Journal of intensive care 6 February 2025

Evaluation of a pragmatic approach to predicting COVID-19-positive hospital bed occupancy
The model produced useful predictions of COVID-19-positive bed occupancy prior to the emergence of the Omicron variant, but accuracy deteriorated after this. In practice, the model offers a pragmatic approach to predicting bed occupancy within a pandemic wave. However, this approach requires continual monitoring of errors to ensure that the periods of poor performance are identified quickly. BMJ Health care informatics 5 February 2025

Long COVID prevalence and associated activity limitation in US children
In 2023, post–COVID condition (PCC) continued to affect US children at similar levels as 2022 and to have similar sociodemographic patterns. The large proportion of children experiencing PCC with any activity limitation highlights the need to examine the severity of activity limitation, functional outcomes, and days lost from school. JAMA 3 February 2025

Effectiveness of a personalised self-management intervention for people living with long covid (Listen trial): pragmatic, multicentre, parallel group, randomised controlled trial
The personalised self-management support intervention of the Listen trial resulted in non-significant short term improvements in routine activities when compared with usual care. Improvements in emotional wellbeing, fatigue, quality of life, and self-efficacy for people living with long covid were also reported. Physical health and social engagement were not affected by the trial intervention. The limited understanding of how much change is clinically meaningful in this population along with the unblinded design, the use of self-referral as a recruitment method and variable usual care may have introduced unintended bias and thus limits robust conclusions about this intervention. Further research is required to fully establish the impact of the intervention. BMJ medicine 31 January 2025

Measures to prevent and control COVID-19 in skilled nursing facilities: A scoping review
These findings indicate that many preventive measures were implemented in skilled nursing facilities, but few had clear evidence of effectiveness; future implementation should be commensurate with demonstrated effectiveness. JAMA 31 January 2025

Putting international practice into action: the first case of lung transplantation for COVID-19 in Victoria, Australia
Lessons from practice

• Lung transplantation is a potential curative therapy for coronavirus disease 2019 (COVID-19)-related lung injury that does not improve with optimal medical therapy and mechanical ventilation.
• Short term survival and functional outcomes are similar between COVID-19 and non-COVID-19 lung transplantation.
• Red blood cell and platelet transfusions should be minimised if transplantation is to be considered to minimise human leukocyte antigen sensitisation.
• Awake extracorporeal membrane oxygenation allows patients to be involved in decision-making discussions and engage in physiotherapy.

MJA 30 January 2025

Decentralised COVID-19 molecular point-of-care testing: lessons from implementing a primary care-based network in remote Australian communities
To inform future infectious disease pandemic preparedness and responses, the authors used an adapted POC testing framework, based on the World Health Organization health system building blocks to systematically review program documents, including standard operating procedures, internal team communications, and formal program updates to partners. The review process identified, collated and documented key recommendations. The updated framework, which now includes workforce and training, results support, and reflects an enhanced focus on the community as central to program effectiveness. MJA 29 January 2025

Severity and long-term mortality of COVID-19, Influenza, and Respiratory Syncytial Virus
This cohort study showed that, during the 2022 to 2023 season, infection with SARS-CoV-2 was associated with more severe disease outcomes than influenza or RSV, whereas differences were less pronounced during the 2023 to 2024 season. During both seasons, RSV remained a milder illness, whereas COVID-19 was associated with higher long-term mortality. Vaccination attenuated differences in disease severity and long-term mortality. JAMA 27 January 2025

COVID-19 on patients with immune-mediated rheumatic disease: a comparative study of disease activity, fatigue, and psychological distress over six months
Post-COVID-19  immune-mediated rheumatic disease (IMRD) patients exhibited significant fatigue, depression, anxiety, and stress, which can be mistaken for disease activity, despite having similar disease activity scores. The variability in reports on IMRD flares and the potential triggering of SARS-CoV-2 for autoimmune manifestations underscore the need for detailed clinical assessment and a comprehensive approach to managing them. Advances in rheumatology 22 January 2025

Sex differences in Long COVID
In this prospective cohort study of the NIH RECOVER-Adult cohort, female sex was associated with an increased risk of long COVID compared with male sex, and this association was age, pregnancy, and menopausal status dependent. These findings highlight the need to identify biological mechanisms contributing to sex specificity to facilitate risk stratification, targeted drug development, and improved management of long COVID. JAMA 22 January 2025

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

Monkeypox

Updated 14 February 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

Neuroinflammatory disorders of the central nervous system associated with monkeypox virus: a systematic review and call to action
Monkeypox virus (MPXV)-associated neuroinflammatory disorders of the central nervous system (CNS) are rare but cause significant complications. The findings underscore the need for clinical vigilance, advanced diagnostic approaches, and targeted therapeutic strategies. Further research is essential to elucidate mechanisms underlying MPXV neurovirulence and develop effective treatments for these life-threatening conditions. BMC medicine 12 February 2025

Evolving epidemiology of Mpox in Africa in 2024
The high mpox disease burden in Africa, especially in the DRC — with a rising number of cases, high case fatality rate, and high degree of spread to other previously mpox-free African countries — is cause for increased international concern. Case detection, contact tracing, public health measures, and affordable vaccines are needed to implement interventions in the DRC to reduce the risk of global spread of the virus. NEJM 29 January 2025

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

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