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COVID-19 vaccines have been illustrated to lessen the growth of sickness caused by the virus effectively. In any case, inoculation has consistently been controversial, with differing opinions and viewpoints. This has compelled some individuals to decide against receiving the vaccine. These divergent viewpoints have had a trivial impact on the epidemic's dynamics and the disease's development. In response to vaccinated individuals still falling ill, many countries have implemented booster vaccines to protect further. In this specific investigation, a mathematical model composed of seven compartments is employed to examine the effectiveness of a booster dose in preventing and treating the transmission of COVID-19. The principles of mathematics are employed to analyse and investigate the dynamics of the disease. Using a qualitative prototype analysis, we acquired valuable insights into its effectiveness. One essential aspect is the basic reproduction number, a critical determinant of the disease's spread. This calculation is determined by studying the system's equilibrium and evaluating its stability. Furthermore, we examined the balance from a local and global viewpoint, considering the possibility of bifurcation and the model's reproductive number sensitivity index. Through numerical simulations, we have visually illustrated the analytical findings outlined in this research paper and presented a thorough examination of the efficacy of booster shots as a preventive and therapeutic measure in the spread dynamics of COVID-19., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

We provide experimental evidence that role models can galvanize prosocial actions amid global crises, exemplified by the COVID-19 pandemic. In a randomized control trial comparing role models, cash incentives, and celebrity endorsements, only role models successfully mitigated vaccine reluctance and ameliorated pandemic-induced educational setbacks. Monthly tracking of vaccination status was achieved via QR-code-verified certificates. Theory-of-mind behavioral data on the mentalizing of others shed light on the mechanism underlying the role model effect. This research, from Pakistan, suggests how role models and theory of mind have the potential to play a role in tackling global challenges., Competing Interests: Competing interests statement:The authors declare no competing interest.

We develop a game-theoretic model of strategic interdependence and tipping in public policy choices and show that the model can be estimated by probit and logit estimators. We test its validity and applicability by using daily data on state-level COVID-19 responses in the United States. Social distancing via shelter-in-place (SIP) strategies and wearing masks emerged as the most effective nonpharmaceutical ways of combatting COVID-19. In the United States, choices about these policies are made by individual states. We develop a game-theoretic model of such choices and test it econometrically, confirming strong interdependence in the implementation of these policies. If enough states engage in social distancing or mask wearing, others will be tipped to follow suit. Policy choices are influenced mainly by the choices of other states, especially those of similar political orientation and to a lesser degree by the number of new COVID-19 cases. The choice of mask-wearing policies is more sensitive to peer choices than the choice of SIP policies, and Republican states are much less likely than Democratic to introduce mask-wearing policies. The choices of policies are influenced more by political than public health considerations. These findings emphasize strategic interdependence in policy choice and offer an analytical framework for these complex dynamics., Competing Interests: Competing interests statement:The authors declare no competing interest.

This prospective observational study examined changing trends of excess self-protective behavior (EPB), and their association with perceived risk, perceived severity, and irrational beliefs about prevention during the Chinese COVID-19 epidemic. Participants were recruited for an online panel survey. There are 150 participants for the baseline and 102 for the final survey. There were 5 waves of interviews. Perceptions of risk and disease severity were measured by single items. Irrational beliefs about prevention and EPB comprised 5 common prevention misconceptions. Descriptive statistics and the CATMOD program were used for data analysis. The prevalence of participants perceiving personal risk of contracting COVID-19 and severe consequences of the disease was 18.6% and 25.5%, respectively, at baseline, and declining to 4.9% and 17.6% at final observation. The 5 selected EPB also showed a diminishing trend. Belief in COVID-19 prevention myths trended upwards. Perceived risk was positively associated with each EPB, and perceived severity with disinfection of clothes and hoarding of products. Myth adherence was positively associated with disinfection of clothes and both hand washing and sanitization. This study yields new information about EPB among the Chinese public. Policy modifications and public education interventions are essential for minimizing the adverse health effects of subscribing to irrational beliefs.

Test-negative designs (TNDs) are used to assess vaccine effectiveness (VE). Protection from infection-induced immunity may confound the association between case and vaccination status, but collecting reliable infection history can be challenging. If vaccinated individuals have less infection-induced protection than unvaccinated individuals, failure to account for infection history could underestimate VE, though the bias is not well understood. We simulated individual-level SARS-CoV-2 infection and COVID-19 vaccination histories and a TND. VE against symptomatic infection and VE against severe disease estimates unadjusted for infection history underestimated VE compared to estimates adjusted for infection history, and unadjusted estimates were more likely to be below 0%, which could lead to an incorrect interpretation that COVID-19 vaccines are harmful. TNDs assessing VE immediately following vaccine rollout introduced the largest bias and potential for negative VE against symptomatic infection. Despite the potential for bias, VE estimates from TNDs without prior infection information are useful because underestimation is rarely more than 8 percentage points., Competing Interests: Competing interests: The authors declare that they do not have any commercial or other associations that might pose a conflict of interest., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

The COVID-19-Curated and Open Analysis and Research Platform (CO-CONNECT) project worked with 22 organizations across the United Kingdom to build a federated platform, enabling researchers to instantaneously and dynamically query federated datasets to find relevant data for their study. Finding relevant data takes time and effort, reducing the efficiency of research. Although data controllers could understand the value of such a system, there were significant challenges and delays in setting up the platform in response to COVID-19. This paper aims to present the challenges and lessons learned from the CO-CONNECT project to support other similar initiatives in the future. The project encountered many challenges, including the impacts of lockdowns on collaboration, understanding the new architecture, competing demands on people's time during a pandemic, data governance approvals, different levels of technical capabilities, data transformation to a common data model, access to granular-level laboratory data, and how to engage public and patient representatives meaningfully on a highly technical project. To overcome these challenges, we developed a range of methods to support data partners such as explainer videos; regular, short, "touch base" videoconference calls; drop-in workshops; live demos; and a standardized technical onboarding documentation pack. A 4-stage data governance process emerged. The patient and public representatives were fully integrated team members. Persistence, patience, and understanding were key. We make 8 recommendations to change the landscape for future similar initiatives. The new architecture and processes developed are being built upon for non-COVID-19-related data, providing an infrastructural legacy., (©Emily Jefferson, Gordon Milligan, Jenny Johnston, Shahzad Mumtaz, Christian Cole, Joseph Best, Thomas Charles Giles, Samuel Cox, Erum Masood, Scott Horban, Esmond Urwin, Jillian Beggs, Antony Chuter, Gerry Reilly, Andrew Morris, David Seymour, Susan Hopkins, Aziz Sheikh, Philip Quinlan. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.11.2024.)

To prevent infection, the experience of the recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic has led to recognition of the importance of not only vaccines but also the strengthening of mucosal barriers by secretory immunoglobulin A (IgA). Strong mucosal barrier provided by IgA is also possible to prevent allergies and chronic inflammatory conditions in the intestinal tract, since it can protect foreign enemies or antigens at the first line of defense before their invasion. Therefore, it is important to understand the role of IgA antibodies secreted by the mucosa of the body. In this section, we discuss the role of mucosal IgA antibodies in relation to three disease states: control of intestinal microbiota, protection against infection, and allergy. In addition, we provide the evidence in which the quality as well as the quantity of IgA is critical for disease prevention. Therefore, we discuss about novel strategies to enhance mucosal barriers by induction of high-quality IgA., Competing Interests: Declarations: No competing interests to be declared., (© 2024. The Author(s).)

Background: The COVID-19 pandemic has seriously affected older adults' social lives, physical activity, and cognitive functions. Additionally, the lockdowns have disrupted regular healthcare for patients with chronic illnesses or needing acute care. Furthermore, the pandemic has negatively affected different psychosocial influences in each country due to the various cultural characteristics, technology, health system, and financial opportunities. This study aimed to investigate the effects of COVID-19 on mood, social participation, and healthcare use in older adults living in Turkey., Methods: A cross-sectional study was conducted during the third wave of the COVID-19 pandemic (March-December 2021) in three medical centers in Turkey. Patients aged 60 + years without significant cognitive impairment were recruited by mail or at hospital admissions. Information on demographics, pandemic-related distancing measures, healthcare use, lifestyle, symptoms of anxiety, depression, and social participation were assessed., Results: A total of 343 participants were included in the study. Women had a higher rate of hypertension, symptoms of anxiety, depression, and fatigue compared to men (p < 0.05). Since the start of the pandemic, only 22.4% of non-acute healthcare appointments were conducted face-to-face. Time spent with family and friends, hope for the future, and physical activity decreased. At the same time, the experience of loneliness, the number of meals and unhealthy snacks, and the use of digital services increased. Women were also more concerned about getting coronavirus infection, transmitting the virus to others, and being discriminated against because of the infection (p < 0.05)., Conclusions: These pandemic days have had a significant psychosocial impact on Turkish older adults, especially women. As a strategy of the health care policy, easy access and follow-up to the health system should be provided, and the necessary support should be procured to minimize the detrimental effects of the pandemic on older people., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Dokuz Eylul University of Non-Interventional Clinical Researches Ethics Board as a multicenter study and conformed to the Declaration of Helsinki. Permission was also obtained from the Turkish Ministry of Health for research on COVID-19. All participants provided written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Full coverage of childhood vaccines is a persistent challenge in low- and middle-income countries, suggesting the presence of specific contextual barriers. The emergence of the COVID-19 pandemic further worsened the situation. The complementary use of community-based participatory research (CBPR) and human-centered design (HCD) approaches has the potential to effectively create tailored interventions for improving public health outcomes. This protocol provides examples of methods to evaluate the use of these novel approaches in low- and middle-income countries. The 'Let's talk about vaccines' project is a multisite community-based participatory project by VillageReach that uses the CBPR and HCD approaches to identify the barriers and co-create interventions/solutions to address under two routine immunization access and uptake in Malawi and Mozambique., Methods: Guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework, this evaluation prospectively evaluates the effectiveness (on under-two immunization coverage and related outcomes) of VillageReach's co-created interventions and processes of implementation (reach, adoption, implementation and maintenance) in two districts in Mozambique and two in Malawi. This paper will also describe the theory of change for VillageReach's project. Thematic analysis will be used to analyze the qualitative data, and interrupted time series analysis used to analyze the co-created interventions' effectiveness on specific under two immunization outcomes. The analysis will integrate complex systems thinking and constructs inherent in health systems strengthening., Discussion: This evaluation is an opportunity to share the use of novel and best practices, opportunities and challenges for improved community-responsive programming in routine immunization. It will be fundamental in providing evidence on the impact of interventions, evidence on mechanisms behind improvements in under- two immunization outcomes due to codesigned community-driven solutions and informing their scalability in similar contexts. Findings will inform the development of a comprehensive framework to guide the scalability of community-based approaches on childhood immunization uptake and access into similar contexts., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Shuro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The mucosal immune response plays a crucial role in the prevention of respiratory viruses. Given the risk of recurrent SARS-CoV-2 infections in the population, the rapid development of next-generation intranasal COVID-19 vaccines with high safety and efficacy is paramount. In the current study, we developed a protein-based intranasal vaccine comprising the XBB.1.5 receptor binding domain (RBD)-derived trimeric recombinant protein (RBD XBB.1.5 -HR) and an MF59-like oil-in-water adjuvant. Intranasal administration of RBD XBB.1.5 -HR vaccine elicited robust and sustained humoral immune responses in mice and rats, resulting in high levels of neutralizing antibodies against XBB-lineage subvariants, with protection lasting for at least six months. The intranasal RBD XBB.1.5 -HR vaccine generated potent mucosal immune responses, characterized by the inductions of tissue-resident T (T RM ) cells, local cellular immunity, germinal center, and memory B cell responses in the respiratory tract. The combination of intramuscular and intranasal delivery of the RBD XBB.1.5 -HR vaccine demonstrated exceptional systemic and mucosal protective immunity. Furthermore, intranasal delivery of RBD XBB.1.5 -HR vaccine as a heterologous booster shot showed more effective boosting effects after mRNA administration compared to homologous vaccination, as evidenced by the induction of superior systemic and extra mucosal immune response. Importantly, the intranasal RBD XBB.1.5 -HR vaccine conferred efficient protection against the challenge with authentic EG.5.1 viruses in vivo. These findings identify the intranasal RBD XBB.1.5 -HR vaccine as a potential mucosal vaccine candidate for the prevention of SARS-CoV-2 infection., Competing Interests: Competing interests This work was supported by the WestVac Biopharma Co. Ltd. Jingyun Yang, Jiong Li, L.Y., Z.W., W.W., G.S., Jinliang Yang, Z.Z., G.L., and X.W. are also working at the WestVac Biopharma Co. Ltd. The remaining authors declare no competing interests., (© 2024. The Author(s).)

Nitrate (NO 3 - ) is an important contributor to PM 2.5 which can adversely affect the environment and human health. A noticeable decrease in NO x concentrations has been reported due to the lockdown measures implemented to curb the spread of Corona Virus Disease 2019 (COVID-19). However, questions remain, regarding the nonlinear relationship between NO x and NO 3 - . Here, we collected PM 2.5 samples in two periods, before and during the lockdown of COVID-19 in Shanghai. Dual isotopes (δ 18 O-NO 3 - and δ 15 N-NO 3 - ) of NO 3 - were measured to investigate the formation pathways and potential sources of NO 3 - . The results showed that the concentration of NO 3 - decreased significantly during the lockdown period compared to the period before the lockdown. Additionally, the hydroxyl pathway was the dominant contributor to NO 3 - production during the lockdown period, while N 2 O 5 hydrolyses dominated the formation of NO 3 - before the lockdown. This change is largely attributable to alterations in the oxidative potential of the environment. In comparison to the period preceding the lockdown, the relative contributions of each NO x source remained largely unchanged throughout the lockdown periods. Nevertheless, the concentration of NO 3 - contributed by each NO x source exhibited a notable decline, particularly the mobile sources and coal combustion. Furthermore, the reduction extent of NO 3 - due to the lockdown period was also greater than the reduction during the Clean Air Actions (2013-2017). Our findings provide evidence that the COVID-19 lockdown led to a decrease in NO 3 - concentration due to changes in the formation pathway and reductions in NO x emissions from various sources., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: The objective is to externally validate and assess the opportunity to update the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among consecutive non-palliative COVID-19 patients infected with Omicron subvariants at a time when vaccinations were widespread., Design: This observational study validated the CCMS in an external cohort at a time when Omicron variants were dominant. We assessed the potential to update the rule and improve its performance by recalibrating and adding vaccination status in a subset of patients from provinces with access to vaccination data and created the adjusted CCMS (CCMS adj ). We followed discharged patients for 30 days after their index emergency department visit or for their entire hospital stay if admitted., Setting: External validation cohort for CCMS: 36 hospitals participating in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). Update cohort for CCMS adj : 14 hospitals in CCEDRRN in provinces with vaccination data., Participants: Consecutive non-palliative COVID-19 patients presenting to emergency departments., Main Outcome Measures: In-hospital mortality., Results: Of 39 682 eligible patients, 1654 (4.2%) patients died. The CCMS included age, sex, residence type, arrival mode, chest pain, severe liver disease, respiratory rate and level of respiratory support and predicted in-hospital mortality with an area under the curve (AUC) of 0.88 (95% CI 0.87 to 0.88) in external validation. Updating the rule by recalibrating and adding vaccination status to create the CCMS adj changed the weights for age, respiratory status and homelessness, but only marginally improved its performance, while vaccination status did not. The CCMS adj had an AUC of 0.91 (95% CI 0.89 to 0.92) in validation. CCMS adj scores of <10 categorised patients as low risk with an in-hospital mortality of <1.6%. A score>15 had observed mortality of >56.8%., Conclusions: The CCMS remained highly accurate in predicting mortality from Omicron and improved marginally through recalibration. Adding vaccination status did not improve the performance. The CCMS can be used to inform patient prognosis, goals of care conversations and guide clinical decision-making for emergency department patients with COVID-19., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: COVID-19 vaccination rates remain low for children aged 11 and below, and understanding the extent to which parental decisions impact their children's vaccination status remains a challenge. This study aimed to explore the concordance and motivations for vaccination among parent-child dyads and determine the associated factors influencing their children's vaccination status., Design: A cross-sectional study was conducted from 1 March 2023 to 30 March 2023, recruiting parents from six representative primary schools across Butuan City, the Philippines. Pilot-tested, self-administered questionnaires were used during the face-to-face surveys with parent participants. To determine the associated factors of parental decisions to vaccinate their children, mixed-effects logistic regression was used, with school districts as a random effect., Participants: A total of 593 participating parents were included in the study, with the majority being females (n=484, 81.6%) and underserved, characterised by lacking a college degree (n=305, 51.4%) and having low to no income (n=511, 86.1%)., Results: While 80.6% (n=478) of parents reported being vaccinated against COVID-19, only 36.2% (n=215) of them chose to vaccinate their children. A significant number of parents (n=285, 48.1%) reported psychological distress, with higher levels of distress prevalent among those who are indigenous, reside in rural areas and have lower income levels. Parental education and vaccination status emerged as influential factors. Specifically, parents with advanced degrees were 48% less likely to have unvaccinated children (adj OR (AOR)=0.52; 95% CI 0.30, 0.87), while unvaccinated parents had a sixfold increase in the likelihood of having unvaccinated children (AOR 6.1; 95% CI 3.14, 12.02) compared with their counterparts., Conclusions: Efforts to increase paediatric vaccination rates should focus more on actively engaging parents, educating them about the vaccine's benefits and necessity, rather than solely relying on mandates to improve paediatric vaccination rates. Further research is needed to understand the reluctance of unvaccinated parents to vaccinate themselves and their children against COVID-19, identifying specific facilitators and barriers to develop more effective communication strategies and bolster vaccine acceptance., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In the context of advancing medical procedures, postoperative infections in cancer patients, particularly those involving multidrug-resistant organisms, have become a significant clinical concern. This study aims to comprehensively and systematically evaluate the effectiveness of infection prevention and control for multidrug-resistant organisms (MDROs) in postoperative cancer patients using Failure Mode and Effects Analysis (FMEA). This study was conducted in a tertiary A-level cancer specialty hospital in China, employing Failure Mode and Effects Analysis (FMEA) to assess the risks of hospital infections. Intervention measures were implemented for high-risk and medium-high-risk factors. Through the hospital's infection information system, data on patients who underwent surgical treatment from 2017 to 2022 were extracted. Data from 2017 to 2019 served as the control group, and data from 2020 to 2022 as the intervention group, to compare the changes in hospital infection incidence and MDRO infection incidence before and after the intervention. Categorical data were described in terms of frequency and percentage. The chi-square test was utilized for statistical inference to assess the differences in infection rates before and after the intervention. Prior to the intervention (2017-2019), the incidence rate of hospital infections was 1.66%, which decreased to 1.22% after the intervention (2020-2022), showing a statistically significant difference (χ 2  = 48.83, P < 0.001). The incidence rate of MDRO infections also decreased from 1.808‰ before the intervention to 1.136‰ after the intervention, with a statistically significant difference (χ 2  = 11.417, P = 0.001). This study confirms the effectiveness of the FMEA method in preventing and controlling MDRO infections in postoperative cancer patients. It highlights the practicality and value of widespread adoption of this method, particularly in the context of the COVID-19 pandemic., Competing Interests: Declarations Competing interests The authors declare no competing interests. Consent to participate declaration For this study, all data were sourced from the hospital information system and anonymized to ensure patient confidentiality and privacy. Patients were informed at the time of admission that their medical records might be used for research purposes with ensured privacy, thus negating the need for separate consent for this study. This article does not contain any studies with animals conducted by any of the authors., (© 2024. The Author(s).)

Background: Studies predating widespread COVID-19 vaccination identified patients with congenital heart disease (CHD) as a group at increased risk of severe outcomes from COVID-19. Here we evaluate the impact of vaccination on COVID-19 outcomes among patients with CHD., Methods: We conducted a case-control study using linked English electronic health records (n=3 18 135). Patients with CHD were matched with controls by age, sex, ethnicity and GP practice. The 'prevaccination' cohort comprised unvaccinated patients with CHD and matched controls with first-recorded SARS-CoV-2 infection between 1 March and 8 December 2020 (7805 cases, 27 620 controls). The 'post-vaccination' cohort comprised vaccinated patients with CHD and matched controls with first-recorded SARS-CoV-2 infection between 1 March 2021 and 1 April 2022, at least 14 days after vaccination (57 550 cases, 225 160 controls). Odds of severe COVID-19 outcomes were compared using conditional logistic regression. We also compared the rate at which vaccine efficacy diminished, and the incidence of vaccine-associated complications., Results: Compared with the prevaccination cohort, postvaccination patients with CHD exhibited markedly reduced rates of COVID-19-related hospitalisation (0.5% vs 15.8%) and mortality rates (0.5% vs 4.6%). Compared with vaccinated controls, vaccinated patients with CHD remained at increased risk of hospitalisation (0.5% vs 0.2%, adjusted OR 2.24 (1.88-2.65); p<0.001) and death (0.5% vs 0.3%, adjusted OR 1.81 (1.54-2.13); p<0.001). There was no evidence that vaccine efficacy declined faster in patients with CHD, or that patients with CHD experienced a larger increase in incidence of myocarditis, pericarditis or thrombotic events., Conclusion: We observed a lower absolute risk of hospitalisation and death from COVID-19 in CHD patients after vaccination. However, in vaccinated CHD patients, an elevated risk of severe outcomes persists compared with vaccinated people without CHD. These results emphasise the importance of vaccination in the CHD population, and of vigilance among care providers dealing with COVID-19 infection in CHD patients, even if fully vaccinated., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Administration of coronavirus disease-2019 (COVID-19) vaccines with appropriate booster doses through painful injections under clinical supervision was challenging during the recent COVID-19 pandemic. As an alternative solution, we designed a safer, edible probiotic yogurt vaccine prototype (YoVac) that can be orally consumed by circumventing painful injections and clinical supervision. We hypothesized that YoVac prepared using Lactobacillus carrying an antigen coding gene (donor) can transfer the same to other bacteria (recipients) in the human gut microbiome (hgMb) through lateral gene transfer (LGT) for boosted antigen levels potentially triggering a robust immune response. In this study we confirmed the in vitro LGT efficiency of a plasmid (pRBD-Amp r ) containing severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) spike protein-receptor binding domain (RBD) coding gene along with an ampicillin-resistance gene (selection marker) from the probiotic Lactobacillus (donor) cultured from homemade yogurt to E. coli and Helicobacter pylori (recipients). Both the donor and recipient bacteria not only exhibited ampicillin-resistance from pRBD-Amp r but also expressed RBD protein. Furthermore, Lactobacillus isolated from YoVac consistently showed the expression of RBD protein over a period of one month confirming the shelf life of our prototype stored at 4 °C. Taken together, our in vitro results provide a preliminary basis for the potential in vivo transfer of RBD coding gene from YoVac to other bacterial species in the hgMb through LGT and may potentially boost the vaccine dosage by delegating them., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The global pandemic caused by the SARS-CoV-2 virus led to a statewide lockdown in Illinois starting in March 2020. To ensure students' and employees' safety for school reopening, protective measures, such as a statewide mask mandate and weekly testing, were in place in Illinois from Spring 2021 to Spring 2022. The study objective is to 1) estimate the in-school and external transmission of SARS-CoV-2 in elementary and middle schools under mask mandate and weekly surveillance and 2) estimate the impacts of protective measures such as testing and mask proportion and testing frequency on SARS-CoV-2 transmission., Methods: A stochastic compartmental model was built to simulate the SARS-CoV-2 transmission within and between the student and employee groups in primary and middle schools participating in the weekly testing program and to evaluate the effectiveness of these protective measures. This stochastic model was modified from a susceptible-infected-recovered framework and calibrated to SARS-CoV-2 surveillance data in 116 primary and middle school districts from Spring 2021 to March 2022. This model calibration was assessed using the surveillance data from the rest of the spring semester in 2022., Results: Overall, the external transmission rates in students and employees were significantly greater than those within schools, and the external transmission rates in middle school students and school employees were greater than those in primary school students. Our sensitivity analysis showed that transmission rates within student groups could significantly influence overall infection rates in vaccinated and unvaccinated students in large school districts. Under the protective measures implemented in the studied period in Illinois, an increased proportion of students and employees participating in the weekly testing can decrease infections. However, community-level measures of self-reported mask adherence among adults were not significantly associated with the infections during the study period, when a universal mask policy was in place for the state., Conclusions: Although increased testing proportion and/or frequency can reduce the SARS-CoV-2 infections, the costs of testing can increase with the testing volume. Further studies on the cost-effectiveness between the testing volume and cases reduction or learning disturbance can aid in policy development to reduce transmission effectively., Competing Interests: Declarations Ethics approval and consent to participate All analyses were declared to be exempt by University of Illinois Institutional Review Boards (protocol #22843). The requirement for ethical approval and informed consent was waived by the University of Illinois Institutional Review Boards (protocol #22843) because of the retrospective nature of the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Based on the Health Belief Model (HBM), this study examined what messages about COVID-19 were presented on the World Health Organization (WHO)'s Facebook posts, and evaluated WHO's health promotion strategies by examining the public engagement and sentiment stimulated by different health promotion constructs. One issue with previous studies on HBM and social networking sites is that many researchers considered positive "online engagements" as evidence of "effective health promotion". However, online engagement measures such as shares and comments cannot reflect the sentiment's valence. Another limitation in previous studies is that they often failed to differentiate between sentiments towards health measures and sentiments towards the disease. We utilized Facebook's emojis to explore the public's distinct sentiments towards the WHO's COVID-19-related health measures and sentiments towards COVID-19. We used content analysis to examine the all the COVID-19-related Facebook posts published by the WHO in 2020, the first year of the pandemic when the COVID-19 vaccines were not generally available to the public. In general, the use of HBM constructs was successful in capturing users' attention and generating engagement. However, regarding the effect of the use of HBM constructs on the beliefs in COVID-19-related health measures, the results were complex. The mentioning of the beliefs about a disease (perceived susceptibility and severity) tend to induce people's negative sentiments. The mentioning of ways to increase self-efficacy and cues to actions significantly reduced people's online engagements and sentiment (either positive or negative). Benefits only stimulated users' negative reactions while barriers could not stimulate any reactions. Video and text posts generally attracted more Facebook engagement than image and text posts, while text-only posts generally received the least Facebook engagement. We demonstrated that certain health promotion strategies can backfire and even induce negative reactions. Policymakers should be alert to this phenomenon when mentioning certain constructs during health promotions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Supplier concentration (SUC) has disadvantage of vulnerability along with cost savings and efficiency. While current scholarship focus on the vulnerability of firms with centralized suppliers during the COVID-19 epidemic, there is no empirical study that explores the impact of post-disaster SUC on firm value as countries removing regional isolation policy. I focus on the impact of COVID-19 reopening policy on investor attitudes towards SUC after the resolution of a supply chain disruption crisis. I try to examine whether investors still perceive SUC as a risk signal or as a positive signal for rapid recovery. Using the event shock of China's reopening announcement and data on A-share listed companies, I find that SUC has a positive impact on cumulative abnormal returns at reopening. I also find that positive effect of SUC is more prominent for firms that benefit from a larger reduction in transaction costs due to the reopening policy. I also analyze the moderating effect and find that information intermediaries such as analysts and media attention amplify the positive effects of SUC. My research provides new perspective on achieving post-disaster value enhancement through SUC., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jie Su. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This paper draws on a series of transdisciplinary research projects examining the role of the built environment in supporting quality of life in long-term residential care settings (LTRC) in Ireland. Acknowledging the impact of COVID-19, these projects include airborne infection control as a key theme. Moreover, considering the wide spectrum of needs, impairment, and health conditions experienced by people living in these settings, along with the diversity of residents, staff, and visitors who occupy LTRC buildings, the research is underpinned by a Universal Design (UD) approach. Finally, climate change is examined as emerging challenge, particularly for older people living in LTRC. Starting with these major concerns, this exploratory paper examines how UD can act as a bridging concept to bring together inclusion, quality of life, health and wellbeing, and climate resilience in the context of long-term residential care in Ireland and beyond.

Background: The COVID-19 pandemic has underscored the need for increased vaccine availability and uptake, with vaccine hesitancy posing a significant barrier, particularly among young adults. Evidence from various countries highlight high levels of hesitancy among young people, necessitating targeted interventions. Engaging young adults as key stakeholders in shaping public health strategies is crucial, as their perspectives can enhance vaccine acceptance. This study aimed to assess the overall acceptability of the COVID-19 vaccine among young people and to explore the factors influencing their willingness or reluctance to be vaccinated now and in the future., Methods: This study used qualitative data from 165 young adults in Nigeria, South Africa, and Zambia, to explore their suggestions for policies and strategies aimed at enhancing the acceptance of the Covid-19 vaccination among their age group. Data collection involved focus groups and interviews that explored participants' perceptions and recommendations regarding COVID-19 vaccination acceptability. Thematic analysis was used to analyse the data., Results: Thematic analysis identified several factors influencing vaccine acceptability among young people and suggested recommendations to improve it. The themes included developing targeted communication strategies for accurate vaccine information, offering alternative vaccination methods, promoting vaccine education in schools, and using trusted public figures to share accurate information., Conclusions: Persistent dissatisfaction with vaccine information dissemination underscores the need for more targeted communication strategies among young adults. Recommendations include developing non-injection vaccine options, incorporating vaccine education into school curricula and community programs, and leveraging influential public figures to build credibility. These insights are valuable for designing future programs to enhance vaccine acceptance among adolescents., Competing Interests: Declarations Ethics approval and consent to participate Ethical approval for this study was obtained from the Biomedical Research Ethics Committee of the University of the Western Cape (BM21/10/39). The research was conducted in accordance with the Declaration of Helsinki. We obtained written consent from all participants, with additional consent obtained from parents or guardians for participants under 18 years of age. Consent forms were translated into the relevant local languages and explained verbally to participants. As a token of appreciation for their involvement in the research, IDI participants received airtime compensation, while the FGD participants were provided with snacks and a hot meal and reimbursed for their transport expenses. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Long COVID, a highly heterogeneous syndrome affecting millions of people worldwide, is emerging as an urgent public health threat, but data on the predictors of specific clinical manifestations over long follow-up periods are limited. The aim of this study is to investigate the role of viral variants and other predictors in long COVID incidence and clinical manifestations., Methods: All COVID-19 patients aged > 18 years and hospitalized from March 1 2020 to April 2022 in two Italian University Hospitals were enrolled. Incidence and clinical presentation of long COVID were assessed through structured questionnaires delivered by phone calls. The association between possible risk factors collected during hospitalization and long COVID was reported using an adjusted logistic regression and reported as odds ratios (ORs) with their 95% confidence intervals (CIs)., Results: Among 1,012 recruited patients, over a median follow-up of 19 months (IQR: 15-24 months), the cumulative incidence of long COVID was 91.7%, with the most common clinical manifestations involving the respiratory system (80.5%) and the neurological system (77.3%). Among 1,012 recruited patients, over a median follow-up of 19 months (IQR: 15-24 months), the cumulative incidence of long COVID was 91.7%, with the most common clinical manifestations involving the respiratory system (80.5%) and the neurological system (77.3%). Overall, 54% reported long COVID symptomatology between 18 and 24 months. Multivariate analysis suggested that being vaccinated against SARS-CoV-2 was associated with reduced odds of reporting any long COVID symptomatology (OR: 0.34; 95% CI: 0.21-0.58), while infection with the Delta variant was a strong predictor (OR: 9.61, p < 0.0001) for the development of post-COVID conditions characterized by neuropsychiatric symptoms., Conclusions: In this study long COVID symptoms were still highly prevalent after 18-24 months of follow-up and, when compared to wild-type virus, infection with the Delta variant was associated with a higher risk of developing a neurological post-COVID condition., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Ethical Committee of the University of Palermo during the session of the 28th of April 2021 (number 04/2021). The study is in accordance with the declaration of Helsinki relevant institutional guidelines. Informed consent was obtained from each participant and/or their legal guardian(s) who received information verbally and read the information letter. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: Italy often experiences major events, such as earthquakes, floods, and migrant shipwrecks. Current and future global challenges for health workers are made up by climate change, pandemics, and wars. In this work, we will assess the state-of-art of training and interest towards these challenges among Italian post-degree public health schools., Methods: A cross-sectional survey was conducted in Italy in June 2023 among Italian public health residents. The study investigated training levels and updates regarding emergencies in Italian residencies. It also analyzed interest and importance of topic, impact of the COVID-19 pandemic, and sources of information., Results: Of 289 respondents, 86.2% deemed the topic important and 74.4% expressed interest. 90.1% pointed out the lack of dedicated courses and 93.1% of specialized master's programs. Perceived importance in the topic was associated with the desire to attend dedicated conferences. As for COVID-19, 24.6% recognized the importance of this topic pre-pandemic, while 50.9% raised awareness during the pandemic., Conclusions: This survey shows the need for the offer of emergency training programs in Italian public health schools. Professionals in public health can make a great contribution to emergencies, not only in preparedness, but also in response and recovery phases.

Since the beginning of mass vaccination campaign for COVID-19 in Italy (December 2020) and following the rapidly increasing vaccine administration, sex differences have been emphasized. Nevertheless, incomplete and frequently incoherent sex-disaggregated data for COVID-19 vaccinations are currently available, and vaccines clinical studies generally do not include sex-specific analyses for safety and efficacy. We looked at sex variations in the COVID-19 vaccine's effectiveness against infection and severe disease outcomes. We conducted a nationwide retrospective cohort study on Italian population, linking information on COVID-19 vaccine administrations obtained through the Italian National Vaccination Registry, with the COVID-19 integrated surveillance system, held by the Istituto Superiore di Sanità. The results showed that, in all age groups, vaccine effectiveness (VE) was higher in the time-interval ≤120 days post-vaccination. In terms of the sex difference in vaccination effectiveness, men and women were protected against serious illness by vaccination in a comparable way, while men were protected against infection to a somewhat greater extent than women. To fully understand the mechanisms underlying the sex difference in vaccine response and its consequences for vaccine effectiveness and development, further research is required. The sex-related analysis of vaccine response may contribute to adjust vaccination strategies, improving overall public health programmes.

Background: While the COVID-19 pandemic disrupted HIV preventative services in sub-Saharan Africa, little is known about the specific impacts the pandemic has had on men who have sex with men (MSM) in Kenya., Methods: Data were from an HIV self-testing intervention implemented in Kisumu, Mombasa and Kiambu counties in Kenya. Baseline data collection took place from May to July 2019, and endline in August-October 2020, coinciding with the lifting of some COVID-19 mitigation measures. Using endline data, this study characterised the impact the pandemic had on participants' risk behaviours, experience of violence and behaviours related to HIV. Logistic regression was used to understand factors related to changes in risk behaviours and experiences of violence; adjusted AORs (AORs) and 95% CIs are reported., Results: Median age was 24 years (IQR: 21-27). Most respondents (93.9%) reported no change or a decrease in the number of sexual partners (median number of male sexual partners: 2, IQR: 2-4). Some participants reported an increase in alcohol (10%) and drug (16%) consumption, while 40% and 28% reported decreases in alcohol and drug consumption, respectively. Approximately 3% and 10% reported an increase in violence from intimate partners and police/authorities, respectively. Compared with those with primary education, those with post-secondary education were 60% less likely to report an increase in the number of male sexual partners per week (AOR: 0.4, 95% CI: 0.2 to 0.9), while those who were HIV positive were at twofold the odds of reporting an increase or sustained levels of violence from intimate partners (AOR: 2.0, 95% CI: 1.1 to 4.0)., Conclusion: The results of this study demonstrate heterogeneity in participants' access to preventative HIV and clinical care services in Kenya after the onset of the COVID-19 epidemic. These results indicate the importance of responding to specific needs of MSM and adapting programmes during times of crisis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Purpose: The COVID-19 pandemic has affected lives and dental treatment. Aerosols and droplets generated during dental treatment present a risk of infection for dental care workers. However, detailed elucidation of the conditions under which those are generated has yet to be presented, and no clear countermeasures for protection have been established. The present study aimed to clarify the process of generation of aerosol and droplets in dental treatment, as well as their dynamics for establishment of effective countermeasures and protection strategies., Methods: Images were obtained using a high-speed camera of aerosol and droplets generated during dental treatments performed on a mannequin. The effects of intraoral vacuum and extraoral vacuum to reduce those, as well as splash range with different body position were examined. Quantitative evaluations of aerosol and droplets were also performed using water-sensitive paper., Results: Aerosol and droplets quantities were significantly reduced by use of both intraoral and extraoral vacuums as compared to no vacuum in both image analysis and findings obtained with water-sensitive paper (p < 0.05). Additionally, the intensity of aerosol and droplets when using the intraoral and extraoral vacuum devices with a body position of 45 degrees was a significantly less as compared to the other settings (p < 0.001)., Conclusions: The present study demonstrated the effectiveness of visualization of the aerosol and droplets generated by dental tools using a high-speed camera. Use of an extraoral vacuum resulted in a reduction of those generated during simulated dental treatment, and also contributed to diffusion prevention to protect the operator and assistant. Nevertheless, it is necessary to be careful because the use of extraoral vacuums may reverse the spread of aerosol and droplets depending on the position of patient., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Messenger RNA (mRNA) vaccines are a key technology in combating existing and emerging infectious diseases. However, improving the immunogenicity and durability of mRNA vaccines remains a challenge. To elicit optimal immune responses, integrating antigen-encoded mRNA and immunostimulatory adjuvants into a single formulation is a promising approach to enhancing the efficacy of mRNA vaccines. Here, we report an adjuvant strategy to enhance the efficacy of mRNA vaccines by co-loading mRNA encoding the antigen (rabies virus glycoprotein, RABV-G) and mRNA encoding IL-7 into lipid nanoparticles, achieving co-delivery to the same antigen-presenting cells. A single immunization with G&IL-7 mRNA vaccine elicited robust humoral immune responses in mice and conferred complete protection against RABV challenge. Notably, the high levels of neutralizing antibody induced by the G&IL-7 mRNA vaccine were maintained for at least 6 months, providing mice with long-term significant and complete protection against RABV. Additionally, IL-7 also enhanced antibody responses against the SARS-CoV-2. These data demonstrate that IL-7 is a potent mRNA vaccine adjuvant that can provide the required immune stimulation in various mRNA vaccine formulations., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Maintaining a healthy weight postintentional weight loss is crucial for preventing chronic health conditions, yet many regain weight postintervention. Electronic health record (EHR) portals offer a promising avenue for weight management interventions, leveraging patient-primary care relationships. Our previous research demonstrated that coaching alongside self-monitoring improves weight maintenance compared to monitoring alone. Integrating weight management into routine clinical practice by training existing staff could enhance scalability and sustainability. However, challenges such as inconsistent staff qualifications and high coach turnover rates could affect intervention effectiveness. Standardizing services, training, and coaching continuity seem crucial for success. To report on developing, testing, and evaluating an EHR-based coaching training program for clinical staff, guided by an implementation tool for the MAINTAIN PRIME study. Conducted across 14 University of Utah primary care sites, we developed, tested, and evaluated a coaching training for clinical staff. Guided by a planning model and the Predisposing, Enabling, and Reinforcing (PER) tool, stakeholders actively participated in planning, ensuring alignment with clinic priorities. All clinical staff were invited to participate voluntarily. Evaluation measures included staff interest, training effectiveness, confidence, and readiness. Data collection utilized REDCap, with survey results analyzed using descriptive statistics. Despite increased clinical workload and reassignments posed by coronavirus disease 2019, we were able to train 39 clinical staff, with 34 successfully coaching patients. Feedback indicated high readiness and positive perceptions of coaching feasibility. Coaches reported satisfaction with training, support, and enjoyed establishing connections with patients. The PER strategies allowed us to implement a well-received training program found effective by primary care coaches., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

The COVID-19 epidemic not only impacted China's economy but also induced periodic anxiety among employees, especially during its peak. Even as governmental controls relaxed, enterprises seemed unaffected externally. However, beneath the surface, the lingering effects on employee mental health persisted. Many faced dual stressors concerning their job and personal well-being due to the epidemic, heightening work-related anxieties. This research, a year after China resumed work, delves into the psychological stress influencing this sustained anxiety. A survey of 516 employees helped test the hypothesis using a multiple regression model. Findings indicated heightened continuous work anxiety due to the epidemic, particularly in hard-hit areas. However, individual resilience, organizational, and social support were found to mitigate these effects. The study underscores the sustained psychological aftermath of the epidemic on employees, urging health authorities to address it.

Background: Although several training courses for Health Care Workers (HCWs) on COVID-19 were conducted in Yemen, no evaluation has been done to assess the effectiveness of such training on the Knowledge, Attitude and Practice (KAP) of HCWs. Therefore, this study aimed to assess the effectiveness of training on the KAP of HCWs toward infection prevention and control (IPC) for COVID-19, determine the relationship between the change in the KAP of HCWs, and identify the associated factors with the change in KAP., Methodology: A cross-sectional study was conducted from April to December 2021. It was conducted among 186 HCWs working at COVID-19 isolation centers and caring for COVID-19 patients, in all Yemen's governorates. The data were collected one week before and immediately after the training session. SPSS version 26 was used for data entry and analysis. The median, interquartile range (IQR) and median difference were calculated. The Wilcoxon Signed Ranks Test was used to estimate the significant difference between KAP pre- and post-training scores. Kurskal-Wallis and Mann-Whitney U tests were used to assess the associated factors. Spearman's correlation coefficient test was used to assess the statistical relationship between the change in KAP. A P value < 0.05 was considered statistically significant., Results: Out of 186 HCWs, 181 HCWs filled the pre- and post-assessment, with a response rate of 97.3%. The median difference (IQR) in the KAP scores were 3.0 (1.0 and 6.0), 1.0 (-1.0 and 4.0) and 2.0 (-1.0 and 5.0), respectively. However, there are statistical difference in the KAP scores between the pre- and post-training (p value = 0.000, 0.004 and 0.000, respectively). There are significant positive correlations between the change in knowledge, attitude and practice (all p values < 0.01). A significantly change in knowledge was found among those working in epidemiological surveillance (p value = 0.031)., Conclusions: This evaluation concludes that the training program is effective in improving the KAP of HCWs toward IPC for COVID-19. It provides scientific evidence about the importance of training courses for HCWs during the COVID-19 pandemic. Further study is recommended to evaluate the retention of the KAP after a period of training., Competing Interests: Declarations Ethics approval and consent to participate This study was approved by the Research and Ethics Committee at MoPHP in the Republic of Yemen (Registration number: 2656- 15/03/2021). Methods were performed in accordance with the Declaration of Helsinki. The aim of the study was explained to all study participants. Informed consent was obtained from all participants. Their participation was entirely voluntary through answering question consent before starting the questionnaire. The collected information remained anonymous. Confidentiality of data was assured and ensured. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

This review examines key events, challenges, and responses to the mpox public health emergency following the Africa CDC's declaration of a Public Health Emergency of Continental Concern on August 13, 2024. In response to the crisis, over 3.6 million vaccine doses and more than $150 million in funding have been mobilized globally, with contributions from the United States, European Union, and Japan. However, challenges persist, particularly in the Democratic Republic of Congo, where a humanitarian crisis in Kinshasa has complicated mpox diagnostics and treatment. In response, the Africa CDC has deployed its One Continental Incident Management Support team, with a focus on decentralizing diagnostics and enhancing sample movement through additional PCR equipment, funded by the Pandemic Fund and USAID. To reinforce laboratory diagnostics, surveillance, and case management, the Africa CDC has adopted a comprehensive "One Team, One Plan, One Budget, One M&E" approach and has deployed 72 epidemiologists to improve data integration. Collaborative efforts with WHO, GAVI, and UNICEF aim to expedite vaccine distribution, with a target of 10 million doses by 2025, alongside enhanced vaccine safety monitoring., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: We are now in the fifth year of an ongoing pandemic, and Canada continues to experience significant surges of COVID-19 infections. In addition to the acute impacts of deaths and hospitalizations, there is growing awareness of an accumulation of organ damage and disability which is building a "health debt" that will affect Canadians for decades to come. Calls in 2023 for an inquiry into the handling of the COVID-19 pandemic went unheeded, despite relevant precedent. Canada urgently needs a comprehensive review of its successes and failures to chart a better response in the near- and long-term., Main Body: While Canada fared better than many comparators in the early years of the COVID-19 pandemic, it is clearly still in a public health crisis. Infections are not only affecting Canadians' daily lives but also eroding healthcare capacity. Post-COVID condition is having accumulating and profound individual, social, and economic consequences. An inquiry is needed to understand the current evidence underlying policy choices, identify a better course of action on various fronts, and build resilience. More must be done to reduce transmission, including a serious public education campaign to better inform Canadians about COVID and effective mitigations, especially the benefits of respirator masks. We need a national standard for indoor air quality to make indoor public spaces safer, particularly schools. Data collection must be more robust, especially to understand and mitigate the disproportionate impacts on under-served communities and high-risk populations. General confidence in public health must be rebuilt, with a focus on communication and transparency. In particular, the wide variation in provincial policies has sown mistrust: evidence-based policy should be consistent. Finally, Canada's early success in vaccination has collapsed, and this development needs a careful post-mortem., Conclusions: A complete investigation of Canada's response to the pandemic is not yet possible because that response is still ongoing and, while we have learned much, there remain areas of dispute and uncertainty. However, an inquiry is needed to conduct a rapid assessment of the current evidence and policies and provide recommendations on how to improve in 2025 and beyond as well as guidance for future pandemics., Competing Interests: Declarations Ethics approval and consent to participate N/A. Consent for publication N/A. Competing interests Dr. David Fisman has served on advisory boards related to influenza and SARS-CoV-2 vaccines for Seqirus, Pfizer, Astrazeneca and Sanofi-Pasteur Vaccines, and has served as a legal expert on issues related to COVID-19 epidemiology for the Elementary Teachers Federation of Ontario and the Registered Nurses Association of Ontario. He is a member of the Canadian COVID Society. Dr. Jillian Horton has received speaking fees from AstraZeneca for delivering talks related to healthcare worker burnout. Dr. Mark Ungrin is the co-chair of the Legal Committee of the non-profit Canadian Covid Society. He receives no remuneration for this work. Dr. Joe Vipond is the co-chair of the non-profit Canadian Covid Society. He receives no remuneration for this work. Dr. Julia M. Wright served on the Royal Society of Canada’s Task Force on COVID-19 and now serves on the Board for the Canadian Lung Association. She receives no remuneration for this work. Dr. Dick Zoutman has served as an expert in legal proceedings and class actions concerning COVID-19. He is also a board member of the Canadian Covid Society for which he receives no renumeration. No other author has competing interestss COI to declare., (© 2024. The Author(s).)

A Viral Infection Risk Indoor Simulator (VIRIS) has been developed to quickly assess and compare mitigations for airborne disease spread. This agent-based simulator combines people movement in an indoor space, viral transmission modelling and detailed architectural design, and it is powered by topologicpy, an open-source Python library. VIRIS generates very fast predictions of the viral concentration and the spatiotemporal infection risk for individuals as they move through a given space. The simulator is validated with data from a courtroom superspreader event. A sensitivity study for unknown parameter values is also performed. We compare several non-pharmaceutical interventions (NPIs) issued in UK government guidance, for two indoor settings: a care home and a supermarket. Additionally, we have developed the user-friendly VIRIS web app that allows quick exploration of diverse scenarios of interest and visualisation, allowing policymakers, architects and space managers to easily design or assess infection risk in an indoor space., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

In this prospective longitudinal study, we evaluated the durability of humoral responses to SARS-CoV-2 mRNA booster vaccination in 93 people with HIV, exploring the possible role of T-cell dysfunction and inflammaging biomarkers in predicting antibody waning. We found that, despite a negligible influence of the inflammaging milieu, low CD4/CD8 ratio and CD4+CD127+ percentage as well as high CD8+CD38+CD45RO+ percentage are associated with faster antibody waning, in turn contributing to our understanding of the determinants of COVID-19 vaccine-elicited immune response in this population., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Respiratory infectious diseases have long been a serious public health problem. This study explores the significance of respiratory infectious disease prevention and control systems worldwide, particularly during and after the COVID-19 pandemic. The epidemiology of many respiratory diseases such as influenza changed over the past two years, and the incidence of pathogens such as Mycoplasma pneumoniae and Bordetella pertussis has also increased. Based on influenza surveillance data in China, the influenza season in 2023 was notably delayed and extended, with A(H1N1) pdm09 being the predominant strain. This editorial also reviewed the gradual establishment of China's infectious disease prevention and control system following the 2003 SARS outbreak, highlighting the role of medical facilities in managing public health emergencies, conducting infectious disease pre-screening, and reporting cases to networks in real time. In the future, China will further develop an intelligent, multi-trigger infectious disease surveillance and early warning system to increase the early detection of unknown infectious diseases and optimize the allocation of medical resources. A robust infectious disease control system is crucial to addressing future pandemic threats.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic disrupted respiratory syncytial virus (RSV) seasonality. To optimize the use and evaluation of RSV infant immunization strategies, monitoring changes in RSV epidemiology is essential., Methods: Hospitalizations for acute respiratory infections (ARIs) and RSV-coded ARI in children <2 years were extracted in 4 European hospitals, according to predefined case definitions (International Classification of Diseases, Tenth Revision codes). Prepandemic RSV seasons (2017-2018 to 2019-2020) were compared to 2021-2022 and 2022-2023., Results: In 2021-2022 and 2022-2023, the peak number of RSV hospitalizations was higher than prepandemic peaks after short periods of RSV circulation, and lower than prepandemic peaks after long periods of RSV circulation. A greater proportion of RSV hospitalizations occurred in children 1 to <2 years in 2021-2022 in the Netherlands (18% vs 9%, P = .04). No increase in age was observed elsewhere. High-risk children represented a greater proportion of RSV hospitalizations during the pandemic. The proportion of pediatric intensive care unit admissions did not increase., Conclusions: A decrease in population immunity has been linked to older age at RSV hospitalization. We did not observe an increase in age in 3 of the 4 participating countries. Broad age categories may have prevented detecting an age shift. Monitoring RSV epidemiology is essential as Europe implements RSV immunization., Competing Interests: Potential conflicts of interest. J. G. W. has been an investigator for clinical trials sponsored by pharmaceutical companies, including AstraZeneca, Merck, Pfizer, Sanofi, and Janssen, and participated in the advisory boards of Janssen and Sanofi and was a speaker at a Sanofi sponsored symposium (all fees/honoraria were paid to UMCU). T. H. has received honoraria for lectures or participation in advisory boards or data monitoring committees from Janssen, Sanofi, Enanta, MSD, Pfizer, Moderna, and Shionogi. A. D.-U. participated in clinical trials for vaccines, monoclonals, and antivirals for RSV as a subinvestigator. All honoraria were paid to the institution. F. M.-T. reports honoraria from GSK, Pfizer, Sanofi Pasteur, MSD, Seqirus, Biofabri, and Janssen for taking part in advisory boards and expert meetings and for acting as a speaker in congresses, outside the submitted work; and principal investigator role in randomized controlled trials for GSK, Pfizer, Sanofi Pasteur, MSD, Seqirus, Biofabri, Janssen, Ablynx, Gilead, Regeneron, Roche, Abbott, Novavax, and MedImmune, with honoraria paid to his institution. S. C. has provided consultancy or investigator roles in relation to product development for Ablynx, Janssen, MedImmune, AstraZeneca, Pfizer, GSK, Vertex, AbbVie, and Boehringer Ingelheim, with fees paid to the University of Edinburgh. L. J. B. has regular interaction with pharmaceutical and other industrial partners. He has not received personal fees or other personal benefits. UMCU has received major funding (>€100 000 per industrial partner) for investigator-initiated studies from AbbVie, MedImmune, AstraZeneca, Sanofi, Janssen, Pfizer, MSD, and MeMed Diagnostics. UMCU has received major funding for the RSV GOLD study from the Bill & Melinda Gates Foundation. UMCU has received major funding as part of the public-private partnership IMI-funded RESCEU and PROMISE projects with partners GSK, Novavax, Janssen, AstraZeneca, Pfizer, and Sanofi. UMCU has received major funding by Julius Clinical for participating in clinical studies sponsored by MedImmune and Pfizer. UMCU received minor funding (€1000–€25 000 per industrial partner) for consultation and invited lectures by AbbVie, MedImmune, Ablynx, Bavaria Nordic, MabXience, GSK, Novavax, Pfizer, Moderna, AstraZeneca, MSD, Sanofi, Janssen. L. B. is the founding chairman of the ReSViNET Foundation. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Therapeutic monoclonal antibodies (mAbs) have been studied in humans, but the impact on immune memory of mAb treatment during an ongoing infection remains unclear. We evaluated the effect of infusion of the anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike receptor-binding domain (RBD) mAb bamlanivimab on memory B cells (MBCs) in SARS-CoV-2-infected individuals. Bamlanivimab treatment skewed the repertoire of MBCs targeting spike toward non-RBD epitopes. Furthermore, the relative affinity of RBD MBCs was weaker in mAb-treated individuals compared to placebo-treated individuals over time. Subsequently, after mRNA coronavirus disease 2019 vaccination, MBC differences persisted and mapped to a specific reduction in recognition of the class II RBD site, the same RBD epitope recognized by bamlanivimab. These findings indicate a substantial role of antibody feedback in regulating MBC responses to infection, and single mAb administration can continue to impact MBC responses to additional antigen exposures months later., Competing Interests: Potential conflicts of interest. S. C. has consulted for GSK, JP Morgan, Citi, Morgan Stanley, Avalia NZ, Nutcracker Therapeutics, University of California, California State Universities, United Airlines, Adagio, Sanofi, and Roche. J. S. C. has consulted for Merck and Company. P. K. is an employee and shareholder of Eli Lilly and Company. K. W. C. has consulted for Pardes Biosciences. D. M. S. has consulted for and has equity stake in Linear Therapies, Model Medicines, and Vx Biosciences and has consulted for Bayer, Kiadis, Signant Health, and Brio Clinical. All other authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Little is known about rates of COVID-19 vaccine uptake among youth with bipolar spectrum disorders (BSD). As such, the aim of this study is to assess rates and predictors of COVID-19 vaccine uptake among youth with BSD and their caregivers in the United States., Methods: Youth and their main caregiver were recruited from a large pragmatic study cohort. Youth who were aged 8-22 at the time of this data collection, had a bipolar-spectrum disorder diagnosis, had overweight or obesity, and were treated with a second-generation antipsychotic were invited to participate in an online survey and interview assessing the impact of the COVID-19 pandemic., Results: A total of 453 surveys and 341 interviews were completed 07/2021-05/2022 by youth and their caregivers. Sixty-seven percent of caregivers and 63 % of youth reported receiving the COVID-19 vaccine. Vaccine uptake rates among youth and caregivers were highly correlated. Predictors of vaccine uptake among youth were older age and living in the Northeast Region of the United States. Predictors of caregiver vaccine uptake were male sex, higher annual household income and not having to quarantine due to COVID-19., Limitations: The sample was small and not a full representation of a population with bipolar-spectrum disorders therefore, the results may not be generalizable. The study design and statistical method do not allow for causal inferences to be made., Conclusions: These findings may aid in targeting interventions to maximize COVID-19 and other vaccine uptake in youth with bipolar disorders and their families., Competing Interests: Declaration of competing interest Author Disclosures: Dr. DelBello has received research support from Allergan, Alkermes, Janssen, Johnson and Johnson, Lundbeck, Myriad, NIMH, Otsuka, PCORI, Pfizer, Shire, and Sunovion. She has received consulting/advisory/board/honoraria support from Alkermes, CMEology, Johnson and Johnson, Medscape, Myriad, and Sage. Dr. Correll has been a consultant and/or advisor to or has received honoraria from: AbbVie, Acadia, Adock Ingram, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Bristol-Meyers Squibb, Car dio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Delpor, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Tabuk, Takeda, Teva, Tolmar, Vertex, and Viatris. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Compass Pathways, Denovo, Lundbeck, Relmada, Reviva, Rovi, Supernus, and Teva. He has received grant support from Janssen,Takeda and PCORI. He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Kuleon Biosciences, LB Pharma, Mindpax, and Quantic. Dr. Patino has received research support from NIMH, PCORI, Acadia, Alkermes, Allergan, Janssen, Johnson and Johnson, Lundbeck, Myriad, Otsuka, Pfizer, Sunovion, and Shire. Drs. Klein, Welge, Fornari, and Higdon and Mr. Blom received salary support from PCORI. Ms. Keller and Ms. Wingler declare they have no financial interests. This study was funded by: PCORI Award Number: PCS-1406-19276., (Published by Elsevier B.V.)

Background: Pneumococcal carriage is associated with increased acquisition and duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among adults. While pneumococcal conjugate vaccines (PCVs) prevent carriage of vaccine-serotype pneumococci, their potential impact on coronavirus disease 2019 (COVID-19)-related outcomes remains poorly understood in populations with prevalent immunity against SARS-CoV-2., Methods: We undertook a retrospective cohort study of adults aged ≥65 years in the Kaiser Permanente Southern California healthcare system who had received ≥2 COVID-19 vaccine doses, comparing risk of SARS-CoV-2 infection between 1 January 2021 and 31 December 2022 among recipients and nonrecipients of 13-valent PCV (PCV13) employing multiple strategies to mitigate bias from differential test-seeking behavior., Results: The ajusted hazard ratio of confirmed SARS-CoV-2 infection comparing PCV13 recipients to nonrecipients was 0.92 (95% confidence interval [CI], .90-.95), corresponding to prevention of 3.9 (95% CI, 2.6-5.3) infections per 100 person-years. Following receipt of 2, 3, and ≥4 COVID-19 vaccine doses, aHRs (95% CI) were 0.85 (.81-.89), 0.94 (.90-.97), and 0.99 (.93-1.04), respectively. The aHR (95% CI) for persons who had not received COVID-19 vaccination in the preceding 6 months was 0.90 (.86-.93), versus 0.94 (.91-.98) within 6 months after COVID-19 vaccination. Similarly, aHRs (95% CI) were 0.92 (.89-.94) for persons without history of documented SARS-CoV-2 infection, versus 1.00 (.90-1.12) for persons with documented prior infection., Conclusions: Among older adults who had received ≥2 COVID-19 vaccine doses, PCV13 was associated with modest protection against SARS-CoV-2 infection. Protective effects of PCV13 were greater among individuals expected to have weaker immune protection against SARS-CoV-2 infection., Competing Interests: Potential conflicts of interest. J. A. L. discloses receipt of research grants and consulting honoraria from Pfizer and Merck, Sharp & Dohme and consulting honoraria from Seqirus and VaxCyte, all unrelated to this research. S. Y. T. reports receipt of research grants related and unrelated to this research from Pfizer. L. R. G., A. A., A. C., L. J., and B. D. G. are employees of Pfizer and may hold stocks or stock options. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: During the COVID-19 pandemic, hospitals implemented visitor restrictions to curtail the spread of the virus. The study aims to understand the perspectives of hospitalized patients and their family visitors on visitation restrictions and the factors influencing their willingness to adhere to these restrictions., Methods: This cross-sectional survey invited 1,200 participants, with 1,032 valid responses received, including 460 hospitalized patients and 572 family visitors., Results: The survey indicated that 88.91% of hospitalized patients and 93.00% of family visitors complied and adhered to the visitor restrictions. The predominant mode of communication was via phone (77.62%), with emotional support (56.40%) recognized as the primary purpose of visitation. Visitor restrictions significantly affected hospitalized patients, with 51.65% reporting feelings of loneliness and 42.44% reporting anxiety. After adjusting for age, gender, and other factors, hospitalized patients' willingness to follow visitation restrictions was linked to their awareness of the restrictions (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.09-0.44) and their desire to protect (OR = 0.32, 95% CI: 0.14-0.76). Family members' willingness to follow the restrictions was related to their awareness of them (OR = 0.34, 95% CI: 0.12-0.95) and how well they communicated (OR = 0.23, 95% CI: 0.09-0.58)., Conclusions: Participants generally followed visitation restrictions, but these measures negatively impacted the psychological and social well-being of patients and their families, leading to increased feelings of loneliness and anxiety. Healthcare providers, hospital administrators, and policymakers should acknowledge the complex effects of these restrictions and focus on improving patient experiences in the future., Competing Interests: Declarations Ethical approval and consent to participate The Ningbo Medical Center LiHuili Hospital approved the study protocols for collecting and analyzing the survey data (No: KY2022SL246). Written informed consent was obtained from all participants. All procedures were performed following the relevant guidelines and regulations. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: A promising strategy to increase population physical activity is through promotion of dog walking. Informed by multi-process action control and nascent dog-walking theory, we examined the effectiveness of a 3-month technology-based (dog tracker) 2-arm randomised controlled dog-walking intervention to increase dog-owner daily physical activity in the general community in Sydney, Australia., Results: 37 participants were allocated to the intervention group (mean age = 43.2 [SD 11.9]) and 40 to the control group (mean age = 42.3 [SD 11.9]). Both groups averaged more than 10,500 steps/day at baseline. There was no evidence of within- or between-group physical activity differences across timepoints. The results remained consistent after exclusion of participants who had data collected during COVID-19 lockdowns. Compared with baseline, both groups had significant increases in sedentary time during the post-intervention, and 6 month follow-up. The absence of significant differences between-group physical activity differences may be attributable to the ceiling effect of both groups already being sufficiently active. These results provide useful guidance to future studies intended to assess the efficacy of technology-based dog-walking interventions. Future dog-walking interventions should specifically target physically inactive dog owners., Trial Registration: ACTRN12619001391167 (10/10/2019); Retrospectively registered., Competing Interests: Declarations Ethics approval and consent to participate Ethical approval was obtained from the University of Sydney Human Research Ethics Committee (2016/921) and the Animal Ethics Committee (2017/1134). The study was registered with the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/). All participants provided informed written consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Pregnant and parenting youth in Canada face multiple challenges in fulfilling their parenting responsibilities while meeting their own unique needs. The COVID-19 pandemic and its associated public health restrictions exacerbated their challenges by reducing access to support networks, limiting opportunities to promote growth and well-being, and destabilizing their financial and economic standing. The impacts of the pandemic on the mental, physical, and emotional health of individuals are well-documented in the literature. However, there is limited research on how the pandemic influenced the lives, health, and well-being of pregnant and parenting youth and their children in Canada. Therefore, we aimed to examine the wider impacts (social and structural determinants that directly or indirectly impact health and well-being) of the pandemic and its implications for this population., Methods: We used a constructivist grounded theory approach to explore the experiences of pregnant and parenting youth during the pandemic and how certain social determinants of health intersected to shape health outcomes and influence their ability to access services. We conducted qualitative interviews using a semi-structured interview guide over Zoom. Using grounded theory principles, we inductively analyzed the data and categorized our findings into themes., Results: We recruited a total of 50 participants from different regions in Canada. The findings from the interviews were categorized into the following themes: (1) "They bear the burden alone": Struggles of pregnant and parenting youth, (2) "How will I live the next day?": Concerns and consequences arising from the pandemic, and (3) "Try to keep your mask on": Navigating healthcare services while maintaining public health guidelines. Our findings highlight the various challenges encountered by the youth during the pandemic, particularly those associated with financial and economic constraints, lack of accessible health and social services, and increased stress from parenting responsibilities., Conclusion: Pregnant and parenting youth in Canada encountered various barriers while accessing health and social services, maintaining their well-being, and connecting with reliable sources of support during the pandemic. Our study findings emphasize the urgent need for adaptable and comprehensive support systems explicitly catering to the needs of pregnant and parenting youth during crises, such as the pandemic., Competing Interests: Declarations Ethics approval and consent to participate Ethics approval was obtained from the University of Alberta Health Research Ethics Board (Pro00118543). Informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: During the COVID-19 pandemic, an increased need for novel solutions such as digital contact tracing apps to mitigate virus spread became apparent. These apps have the potential to enhance public health initiatives through timely contact tracing and infection rate reduction. However, public and academic scrutiny has emerged around the adoption and use of these apps due to privacy concerns., Objective: This study aims to investigate public attitudes and preferences for contact tracing apps, specifically in Japan, using conjoint analysis to examine what specifications the public values most in such apps. By offering a nuanced understanding of the values that citizens prioritize, this study can help balance public health benefits and data privacy standards when designing contact tracing apps and serve as reference data for discussions on legal development and social consensus formation in the future., Methods: A cross-sectional, web-based questionnaire survey was conducted to determine how various factors related to the development and integration of infectious disease apps affect the public's intention to use such apps. Individuals were recruited anonymously by a survey company. All respondents were asked to indicate their preferences for a combination of basic attributes and infectious disease app features for conjoint analysis. The respondents were randomly divided into 2 groups: one responded to a scenario where the government was assumed to be the entity dealing with infectious disease apps (ie, the government cluster), and the other responded to a scenario where a commercial company was assumed to be this entity (ie, the business cluster). Samples of 500 respondents from each randomly selected group were used as target data., Results: For the government cluster, the most important attribute in scenario A was distributor rights (42.557), followed by public benefits (29.458), personal health benefits (22.725), and profit sharing (5.260). For the business cluster, the most important attribute was distributor rights (45.870), followed by public benefits (32.896), personal health benefits (13.994), and profit sharing (7.240). Hence, personal health benefits tend to be more important in encouraging active app use than personal financial benefits. However, the factor that increased motivation for app use the most was the public health benefits of cutting infections by half. Further, concern about the use of personal data collected by the app for any secondary purpose was a negative incentive, which was more significant toward app use compared to the other 3 factors., Conclusions: The findings suggest that potential app users are positively motivated not only by personal health benefits but also by contributing to public health. Thus, a combined approach can be taken to increase app use., (©Seiji Bito, Yachie Hayashi, Takanori Fujita, Ikuo Takahashi, Hiromi Arai, Shigeto Yonemura. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 14.11.2024.)

Vaccine hesitancy (VH) is an issue for healthcare students, influenced by safety concerns and misinformation. The need for better communication training and understanding sociocultural factors in VH was highlighted in a European University Alliance seminar. Practical exercises like simulation role-playing, interprofessional collaboration, and digital literacy may improve vaccine education., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Measles vaccination effectively prevents measles, a highly contagious disease that can cause severe complications and death and requires high population immunity to interrupt transmission. This report describes measles elimination progress during 2000-2023. During 2000-2023, an estimated 60.3 million measles deaths were averted by vaccination. However, despite commitment from all six World Health Organization regions to eliminate measles, no region has successfully achieved and maintained measles elimination as of the end of 2023. During the COVID-19 pandemic, estimated global coverage with the first dose of measles-containing vaccine (MCV1) declined to 81%, the lowest level since 2008. MCV1 coverage improved to 83% in 2022 but was unchanged in 2023. From 2022 to 2023, estimated measles cases increased 20% worldwide, from 8,645,000 to 10,341,000; the number of countries experiencing large or disruptive outbreaks increased from 36 to 57. Estimated measles deaths decreased 8%, from 116,800 in 2022 to 107,500 in 2023, primarily because an increased number of cases occurred in countries with lower risk for death. The stagnation in MCV1 coverage means millions of children remain unprotected, leading to increases in cases and outbreaks. Coverage with measles-containing vaccine (MCV) is lower, and measles incidence is higher, in low-income countries and countries experiencing fragile, conflict-affected, and vulnerable settings, which exacerbate inequities. Urgent and targeted efforts are needed to ensure that all children receive 2 MCV doses and that surveillance is strengthened to hasten progress toward measles elimination., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Matt Ferrari reports institutional support from the World Health Organization, Gavi, the Vaccine Alliance, and the Bill and Melinda Gates Foundation; grants or contracts from Gavi, the Vaccine Alliance, the Bill and Melinda Gates Foundation, and the National Science Foundation; and travel support from the World Health Organization, the Bill and Melinda Gates Foundation, and Imperial College. No other potential conflicts of interest were disclosed.

Background: In response to the challenge of maintaining COVID-19 vaccination coverage amidst the pandemic, VillageReach, in collaboration with the Ministry of Public Health Prevention and Hygiene in Kinshasa, DRC, integrated COVID-19 vaccination with routine immunization services at two primary healthcare facilities. This initiative, launched in July 2022, represented the first of its kind in the DRC, aiming to assess the effectiveness and scalability of a multimodal vaccination approach., Methods: Through a rapid appraisal involving key informant interviews and analysis of pre- and post-integration service delivery data, this case study explores the operational dynamics and outcomes of integrating COVID-19 and routine immunizations., Results: Results demonstrated that the integrated approach not only maintained COVID-19 vaccine coverage but also significantly enhanced routine immunization uptake, particularly among under-immunized and zero-dose children. Overall, the vaccination sites, outreach, and integrated health facilities administered 229,983 (33 %) of COVID-19 vaccines in Kinshasa, of which 53 % were referred by community health workers. Additionally, 998 under-immunized children received routine immunizations, of whom 126 were zero-dose children. Key success factors included sustained community health worker engagement, neighborhood-specific strategies, accessible vaccination points, and robust data management. The findings suggest that such integrative strategies can effectively bolster immunization coverage in urban poor communities, offering valuable insights for similar initiatives in the DRC and beyond., Conclusion: This study advocates for sustained investment in innovative immunization models to strengthen primary healthcare systems post-pandemic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The SARS-COV2 pandemic caused significant disruptions in immunization delivery. Baseline deficit gaps in immunization completion exacerbated ongoing disparities in immunization coverage in low- and middle-income. Emerging reports focused on global strategies for return to routine immunization schedules. Currently, there are no studies that examined the dual challenge of returning to normal immunization in a conflict-recovery setting, such as the ISIS (Islamic State of Iraq and Syria) occupation of Iraq post-COVID-19 pandemic. The objective of this study was to estimate the number of children in Hadeetha, Iraq from 12 to 24 months of age who continued to be lost to the routine immunization schedule due to the COVID-19 pandemic shutdowns. Random sampling occurred from a compiled district health facility registrar of all children in the target birth cohort who had a 12-month immunization scheduled during the 2020 lockdown and were lost to the immunization schedule. A total of 171 households from the sampling frame were included in the final sample. In this cross-sectional study, survey data was collected on the head of the household, the caregiver and the child. Additional questions assessed vaccine hesitancy, vaccine information trusted sources and COVID-19 impact on healthcare access. A risk factor analysis was applied to assess using Chi-square (Χ 2 ) for predictors of lack of DTP3 (Diphtheria, Tetanus and Polio) third dose completion. Of children in the study, 67.3 % did not complete the 6-antigen series at 12-months of age and 46.2 % were missing DTP3 for vaccines to be completed during the pandemic shutdown. Specific risk factors for lack of immunization for the DTP3 vaccine included area of residence, age and caregiver knowledge of vaccines. Respondents indicated a dependence on mass vaccination campaigns but also indicated a willingness to receive phone reminders and television campaigns about vaccination schedules., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sara Al-Dahir reports a relationship with Pfizer Inc. that includes: funding grants. Sara Al-Dahir reports a relationship with Genentech Inc. that includes: funding grants. Kawsar Talaat reports a relationship with Pfizer that includes: funding grants. Kawsar Talaat reports a relationship with AstraZeneca Pharmaceuticals LP that includes: funding grants. Kawsar Talaat reports a relationship with Moderna Inc. that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: BBV152 (Covaxin™) is a whole-virion inactivated SARS-CoV-2 vaccine mixed with an immune adjuvant. We aimed to compare immune responses after booster vaccination with heterologous BBV152 versus homologous mRNA vaccine., Methods: We conducted a randomized, participant-blinded, controlled trial. Fifty mRNA-vaccinated participants were enrolled and randomized to receive an mRNA booster (n = 26) or BBV152 (n = 24). Blood samples were collected pre-vaccination, and at Day 7, 28, 180 and 360 post-booster for analysis of humoral and cellular immune responses. Primary end point was the SARS-CoV-2 anti-spike antibody titer at day 28., Results: Recruitment began in January 2022 and was terminated early due to the BBV152 group meeting pre-specified criteria for futility. At Day 28 post-boost, mean SARS-CoV-2 spike antibody titers were lower with BBV152 (2004 IU/mL; 95 % confidence interval [CI], 1132-3548) vs mRNA (26,669 IU/mL; 95 % CI, 21,330-33,266; p < 0.0001), but comparable levels of spike-specific CD4 and cytotoxic T-cells were observed. Anti-spike antibody titers remained significantly different at Day 180: BBV152 4467 IU/mL (95 % CI, 1959-10,186) vs mRNA 20,749 IU/mL (95 % CI, 12,303-35,075; p = 0.0017). Levels of surrogate virus neutralizing antibodies against ancestral and Omicron subvariants BA.1 and BA.2 were significantly higher among mRNA recipients at Day 180, including after adjusting for intercurrent infection. By Day 360, anti-spike antibody titers and neutralizing antibody levels against Omicron subvariants became similar between vaccine groups. By the end of the study, 16 in each arm (mRNA 64 % and BBV152 69.6 %) had breakthrough infections and time to COVID-19 infection between vaccine groups were similar (p = 0.63)., Conclusions: Wild-type SARS-CoV-2 anti-spike antibody titer and surrogate virus neutralizing test levels against wild-type SARS-CoV-2 and Omicron subvariants BA.1/BA.2/BA.5 were significantly higher at Day 28 and 180 in individuals who received booster vaccination with an mRNA vaccine compared with BBV152., Clinical Trial Registration Number: NCT05142319., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Anti-SARS-CoV-2 vaccination has saved millions of lives in the past few years. To maintain a high level of protection, particularly in at-risk populations, booster doses are recommended to counter the waning of circulating antibody levels over time and the continuous emergence of immune escape variants of concern (VOCs). As anti-spike serology is now widely available, it may be considered a useful tool to identify individuals needing an additional vaccine dose, i.e., to screen certain populations to identify those whose plasma antibody levels are too low to provide protection. However, no recommendations are currently available on this topic. We reviewed the relevant supporting and opposing arguments, including areas of uncertainty, and concluded that in most populations, spike serology should not be used to decide about the administration of a booster dose. The main counterarguments are as follows: correlates of protection are imperfectly characterised, essentially owing to the emergence of VOCs; spike serology has an intrinsic inability to comprehensively reflect the whole immune memory; and booster vaccines are now VOC-adapted, while the commonly available commercial serological assays explore antibodies against the original virus., Competing Interests: Declaration of competing interest Anna L. Goodman reports grants from Novavax to run vaccine trials and non-commercial funding from the INSIGHT network (NIH-TICO trial) to her institution outside of the submitted work; moreover, ALG is named on a patent AstraZeneca vaccine issued to the University of Oxford and has received personal financial contributions for this. Manuel Krone received honoraria from Abbott, GSK and Pfizer outside this work. All other authors have not conflict of interest to declare., (Copyright © 2024. Published by Elsevier Ltd.)