COVID-19 Pandemic Period Research Articles

Macrolide resistance outcomes after the Covid-19 pandemic: A one health approach investigation

During the Covid-19 pandemic period, the indiscriminate use of macrolide-class antibiotics was frequent among the Brazilian population due to the lack of knowledge and information with a scientific basis. Thus, the class of drugs that includes azithromycin, clarithromycin, and erythromycin, which alter metabolic reactions in the body and act on the immune system, was widely used without medical prescription. Samples of bacterial strains from hospital environments were obtained during the most extensive spread of Covid-19 and studied in the present article, emphasizing the investigation for macrolide resistance genes (erm and msr) and bacteria of the genus Staphylococcus isolated from urinary tract infections. In addition, the physiological, genetic, immunological, and socio-epidemiological aspects were highlighted with a focus on the One Health approach and implications on the gut-brain axis in this integrative research, revealing that the inappropriate use of antibiotics directly affects entire communities, representing a significant concern for public and environmental health.

Impact of Covid-19 pandemic on HIV testing, recent infections and annualized incidence among cisgender men who have sex with men and transgender women in Brazil

Background: The Covid-19 pandemic had great impact on HIV care and prevention worldwide, including in Brazil. We compared HIV testing, recent infection, and annualized incidence according to Covid-19 pandemic period among men who have sex with men (MSM) and transgender women (TGW). Setting: HIV/STI testing, prevention and treatment referral service in Rio de Janeiro, Brazil Methods: We used Maxim HIV-1 Limiting Antigen Avidity EIA as part of recent infection testing algorithm to identify recent HIV infections and estimate annualized HIV incidences in pre- (March/2018-February/2020) and post-Covid-19 pandemic onset period (March/2020-January 2022). Multivariable logistic regression model assessed factors associated with recent HIV infection. Results: Among 4590 MSM and TGW, 593 (12.9%) tested positive for HIV and 119 (2.6%) were identified as having recent infection. Percentage of recent HIV infection did not differ between Covid-19 periods. Overall annualized HIV incidence rates were 6.0% (95%CI:4.2-7.7) and 6.6% (95%CI:4.3-9.0) in pre- and post-Covid-19 periods, respectively. During the post-Covid-19 period, higher incidence rates were observed among TGW (8.4%[95%CI:2.9-13.9]), those aged 18-24 years (7.8%[ 95%CI:4.0-11.7]), Black race (7.9%[95%CI:3.8-12.0]), and with <12 years of schooling (7.8%[95%CI:4.8-10.8]). Incidence rates were significantly higher in the post-Covid-19 period for those aged>30 years and TGW, and lower for those with more years of schooling. Conclusion: HIV incidence estimates remain high among MSM and TGW in Brazil, especially among the most vulnerable. The consequences of the Covid-19 pandemic on the HIV epidemic will likely persist and contribute to worsening HIV outcomes.

COVID-19 in patients receiving treatment at an outpatient chemotherapy unit.

During the COVID-19 pandemic period, many patients who required outpatient chemotherapy developed COVID-19, requiring chemotherapy interruption. However, there are no clear guidelines regarding the safe timing for restarting chemotherapy. We conducted a retrospective study to assess when such patients can safely recommence chemotherapy. Of the 40 patients included in this study, 34 restarted anticancer drug therapy after COVID-19 infection. Six patients, four with multiple myeloma, and one each with follicular lymphoma and glioma, remained SARS-CoV-2 antigen positive >20days after COVID-19 onset. Multiple myeloma patients recorded significantly higher frequencies of SARS-CoV-2 antigen positivity >20days after COVID-19 onset compared with solid tumor patients, with no significant differences in the frequency of SARS-CoV-2 positivity during 5-20days from COVID-19 onset between them. According to our data, most solid tumor patients achieved SARS-CoV-2 antigen negativity after 20days from COVID-19 onset. On the other hand, multiple myeloma patients might need serial antigen tests before restarting anticancer therapy in the outpatient chemotherapy setting.

Immunity Debt Regarding the Aspect of Influenza in the Post-COVID-19 Era in Taiwan.

Immunity debt for various viral infections was reported globally in the post-COVID-19 era, but the data about influenza are lacking. This study collected data from Taiwan's CDC Open Data Portal. We analyzed the weekly number of influenza hospitalizations from January 2017 to May 2024. We divided the study period into four phases: the pre-COVID-19 without influenza epidemics, pre-COVID-19 with an influenza epidemic, COVID-19 pandemic lockdown control, and COVID-19 pandemic unlock periods. The Wilcoxon rank-sum test and interrupted time series analysis were used. The median case numbers of the four time periods were 174 (IQR = 98), 431 (IQR = 160), 8, and 155 (IQR = 175), respectively. Under the COVID-19 pandemic lockdown control, the weekly influenza hospitalization case number decreased by 90.2% (p < 0.001). The non-pharmaceutical intervention (NPI) policies during the COVID-19 pandemic helped Taiwan reduce influenza hospitalizations significantly. Till now, a comparison of the prevalence of influenza pre-COVID-19 and post-COVID-19 has yet to be reported. In our study, with the pandemic unlocking, it increased by 20-fold (p < 0.001), but the case number was still significantly lower than that pre-COVID-19. Amongst other factors, this may be associated with continuing self-induced NPIs in Taiwan.

The Impact of the COVID-19 Pandemic on Melanoma Diagnosis: A Single-Center Study.

(1) Background: Melanoma represents the most aggressive form of skin cancer, with an increasing incidence and numerous risk factors. The COVID-19 pandemic has led to modifications in work protocols. This study aims to elucidate potential changes in the number and characteristics of primary melanomas diagnosed in the Pathology Department of the Târgu Mureș County Clinical Hospital before, during, and after the COVID-19 pandemic. (2) Methods: This study included 140 patients grouped into six periods: two pre-COVID-19 periods, the COVID-19 pandemic period, and three post-COVID-19 periods. Epidemiological data, diagnoses, and histopathological reports were analyzed. (3) Results: The number of cases diagnosed during the COVID-19 pandemic was significantly lower than in the other analyzed periods. Regarding the monitored parameters, a statistically significant increase was observed in the first two post-COVID-19 periods, with a return to values similar to those of the first period in the last analyzed period. Additionally, a statistically significant increase in the incidence of distant metastases was identified in the post-COVID-19 periods. (4) Conclusions: The COVID-19 pandemic had a negative impact on the diagnosis of new melanoma cases, leading to an increase in the number of cases and a worsening of prognostic parameters.

Air rage from the sharp end: cabin crew perspectives on disruptive passenger behaviour in Europe and its impact on occupational safety and well-being

Disruptive passenger behaviour (DPB) incidents spiked during the COVID-19 pandemic period, compromising the safety of commercial flights on a daily basis. This qualitative semi-structured interview study examined the perceived triggering factors and motivations for DPB and the subsequent impact of DPB upon cabin crew well-being and safety. Twenty-four European cabin crew disclosed experiences, subjective observations of perpetrator traits, assessment of DPB development and information regarding their well-being and perceived safety. Thematic analysis revealed that the perceived frequency of DPB had increased, driven by an accumulation of pandemic-related factors – such as enforcing mask wearing amongst intoxicated passengers. DPB was found to decrease resilience and spur maladaptive coping strategies in crew. Suggested enhancements to current DPB mitigation consisted of stricter punishment for DPB as a deterrent, alcohol bans and higher quality training. These findings can inform decision-makers’ efforts to support cabin crew well-being and create safer cabin workplaces in the future.

WP4.1 - Costs of acute appendicitis in COVID-19 pandemic period: a cohort study

Abstract Aims During COVID 19 pandemic, aerosol generating procedures were deemed high risk for patients &amp; staff. NHS England set guidelines on appendicitis management, thus acute appendictomy rates were reduced. Aim of study is to assess cost implications of appendicitis management at a single centre. Methods Cohort study carried out from Mar'2020 to Jan'2024. Descriptive demography &amp; post-operative outcomes were evaluated in appendicitis in COVID19, post-COVID19 appendicitis were controls. Costing calculated using the standardised NHS cost ledger for resources, procurement and services Results COVID (n = 306) Post COVID (n = 446) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 35.2 38.0 47.9 &amp;lt; 0.0005 Sex(M : F) 155 : 151 216 : 230 19 : 26 NS BMI(kg/m2) 25.4 25.8 26.5 NS GP 49 162 A &amp; E 257 284 WCC(x109/L) 12.5 13.1 6.5 &amp;lt; 0.0001 CRP(mg/L) 67.2 70.9 3.4 &amp;lt; 0.0001 Conservative(n) 148 87 0 &amp;lt; 0.0001 Surgery(n) 158 359 45 &amp;lt; 0.0001 Open(n) 6 2 0 NS Lap(n) 300 444 45 &amp;lt; 0.0001 ASA(median) 2 1 2 NS Uncomplicated 178 170 42 &amp;lt; 0.0001 Complicated 128 276 3 &amp;lt; 0.0001 Clinical 0 21 USS scan 89 113 CT scan 334 312 Op time(mins) 72.8 75.9 74.4 NS LOS(days)(med) 2 2 0 &amp;lt; 0.0001 IP AB(days) 2 2 0 &amp;lt; 0.0001 Post-op AB(days) 5 3 0 &amp;lt; 0.0001 Appendix HPA(mm) Length 66.8 66.5 55.7 &amp;lt; 0.005 Diameter 11.5 11.1 9.9 NS Cost(£) 2160 4422 1046 &amp;lt; 0.0001 Conclusion Clinically &amp; radiologically grading of appendicitis (uncomplicated or complicated) has allowed safe conservative management (antibiotic therapy). Non surgical management is cheaper for index admission, but there are additional costs &amp; workload.

Racial Disinformation, Populism and Associated Stereotypes across Three European Countries during the COVID-19 Pandemic

Within the realm of disinformation, across all media platforms, a crucial subject of interest seems to be immigration, which produces the so-called ‘racial hoaxes’. Racial hoaxes are closely linked to the spread of populist ideologies and ethnic stereotypes, both of which are psychosocial processes that, during health crises, could acquire particular features based on cultural differences. This study analysed the main contents of 239 racial hoaxes in relation to three main features: the country of origin (i.e., France, Italy and Spain), the stereotypical contents, and the COVID-19 pandemic period. The results highlight some similarities across these three countries but also peculiarities in terms of topics and stereotypical contents that were magnified during the pandemic period. The peculiarities of emerging racial hoaxes are discussed in relation to the stereotype content model and the literature on populist discourses, providing valuable information for use in psycho-educational intervention, policymaking and social integration efforts.

Wavelet Based Semblance Analysis of Anthropogenic Aerosol Control on Air Quality During the COVID-19 Pandemic Period

Wavelet Based Semblance Analysis of Anthropogenic Aerosol Control on Air Quality During the COVID-19 Pandemic Period

Specific persistent symptoms of COVID-19 and associations with reinfection: a community-based survey study in southern China.

Surveillance remains fundamental to understanding the changes in epidemiological patterns regarding post-COVID conditions and reinfections. Persistent symptoms and reinfection in previously infected individuals are increasing being reported in many countries, but their associations among general populations were seldomly reported. Understanding the association with persistent symptoms of COVID-19 reinfection is essential to develop strategies to mitigate the long-term health and socio-economic impacts of the post-COVID conditions. This study aimed to investigate the incidence of COVID-19 persistent symptoms among previously infected Chinese community residents and explore associations of specific COVID-19 persistent symptoms with reinfection and other factors. A community-based survey was conducted in a southern city of China with about 20 million residents from August 3 to 24, 2023. Face-to-face questionnaires were distributed to a total of 1,485 residents to collect their information about COVID-19 infection, reinfection, specific ongoing persistent symptoms, and other COVID-19 related information. Multivariable logistic regression analysis was used to examine the association between specific persistent symptoms and reinfection of COVID-19, along with age, gender, and educational level. Of the 1,485 participants, 1,089 (73.3%) reported they had been infected with COVID-19. Among them, 89.1% reported having ongoing persistent symptoms and 14.2% reported had two or more times of infection. About 20% participants were infected 1 year or more since their initial infection. Fatigue, cough, and headaches were the top 3 symptoms being reported. Participants with reinfection were associated with a higher probability of reporting headaches (OR: 1.54, 95% CI: 1.06-2.25), loss of or change in smell and/or taste (OR: 1.90, 95% CI: 1.27-2.83), impaired sleep (OR: 1.55, 95% CI: 1.02-2.35), and brain fog (OR: 1.76, 95% CI: 1.12-2.76). Participants aged 45 and above and who had a bachelor's or higher degree were more likely to report chest tightness or shortness of breath, impaired sleep, and brain fog. During the post-emergency period of COVID-19 pandemic, the incidence of ongoing persistent symptoms among Chinese residents remains high. Individuals whose initial infection was longer than 1 year have the highest probability of reporting having multiple symptoms. Reinfection may increase the risk of reporting headaches, loss of or change in smell and/or taste, impaired sleep, and brain fog. It is important to maintain routine syndromic surveillance among previously infected people and provide recommendations for clinical management of individuals with multiple ongoing symptoms.

Enhancing Emergency Department Management: A Data-Driven Approach to Detect and Predict Surge Persistence.

The prediction of patient attendance in emergency departments (ED) is crucial for effective healthcare planning and resource allocation. This paper proposes an early warning system that can detect emerging trends in ED attendance, offering timely alerts for proactive operational planning. Over 13 years of historical ED attendance data (from January 2010 till December 2022) with 1,700,887 data points were used to develop and validate: (1) a Seasonal Autoregressive Integrated Moving Average with eXogenous factors (SARIMAX) forecasting model; (2) an Exponentially Weighted Moving Average (EWMA) surge prediction model, and (3) a trend persistence prediction model. Drift detection was achieved with the EWMA control chart, and the slopes of a kernel-regressed ED attendance curve were used to train various machine learning (ML) models to predict trend persistence. The EWMA control chart effectively detected significant COVID-19 events in Singapore. The surge prediction model generated preemptive signals on changes in the trends of ED attendance over the COVID-19 pandemic period from January 2020 until December 2022. The persistence of novel trends was further estimated using the trend persistence model, with a mean absolute error of 7.54 (95% CI: 6.77-8.79) days. This study advanced emergency healthcare management by introducing a proactive surge detection framework, which is vital for bolstering the preparedness and agility of emergency departments amid unforeseen health crises.

Personal Competence or Environmental Characteristics? Factors Influencing Happiness among Ageing Adults in Hong Kong Around the Period of COVID-19 Pandemic.

Drawing upon person-environment fit perspective, this study examines the joint and interactive influences of personal competence and environmental characteristics on the happiness of ageing adults around the period of COVID-19 pandemic. Data was collected in two rounds, before and during the pandemic, with 2,028 participants aged 55 years and older in Hong Kong. Personal competence encompassed financial status, physical health, and mental capital, while environmental characteristics included experiences of ageism, perceived social conditions, and age-friendly policies. Ordinary least squares regression was used to examine personal and environmental influences on happiness. Results indicated a significant decline in happiness following the onset of COVID-19 pandemic. Mental capital was found to have the strongest positive influence on happiness, followed by physical health, financial status, and social conditions. Mental capital mitigated the negative relationship between experiences of ageism and happiness. Practical interventions are informed to improve the well-being of ageing adults during pandemic.

The impact of the COVID-19 Pandemic on hypertension phenotypes (ESH ABPM COVID-19 study)

ObjectiveThe COVID-19 pandemic had a major impact on medical care. This study evaluated the influence of the pandemic on blood pressure (BP) control and hypertension phenotypes as assessed by office and 24-hour ambulatory BP monitoring (ABPM). Design and MethodsData were collected from 33 centers including Excellence Centers of the European Society of Hypertension. Two groups of patients with treated hypertension were compared. Pandemic group: including participants who had ABPM twice - at visit 2 during the COVID-19 pandemic and visit 1 performed 9–15 months prior to visit 2. Pre-pandemic group: had ABPM at two visits, performed before the pandemic within 9–15 months interval. We determined the following hypertension phenotypes: masked hypertension, white coat hypertension, sustained controlled hypertension (SCH) and sustained uncontrolled hypertension (SUCH). We analyzed the prevalence of phenotypes and their changes between visits. ResultsData of 1419 patients, 616 (43 %) in the pandemic group and 803 (57 %) in the pre-pandemic group, were analyzed. At baseline (visit 1), the prevalence of hypertension phenotypes did not differ between groups. In the pandemic group, the change in hypertension phenotypes between two visits was not significant (p = 0.08). In contrast, in the pre-pandemic group, the prevalence of SCH increased during follow-up (28.8 % vs 38.4 %, p < 0.01) while the prevalence of SUCH decreased (34.2 % vs 27.8 %, p < 0.01). In multivariable adjusted analysis, the only factor influencing negative changes of hypertension phenotypes was the COVID-19 pandemic period. ConclusionThese results indicate a negative impact of the COVID-19 pandemic on BP control assessed by hypertension phenotypes.

Strategies to Mitigate the Pandemic Aftermath on Perioperative Professionalism

This retrospective comparative cohort study aimed to evaluate the effects of COVID-19 on professionalism within the perioperative environment of a tertiary cancer center across three periods: pre-pandemic, pandemic, and an interventional endemic phase. A retrospective observational review of a prospectively maintained safety event report (SER) database at MD Anderson Cancer Center, with an intervention during the COVID-19 endemic phase, was conducted. This was performed to compare the incidence of professionalism-related events (PRE), which are included in the SER database, during the COVID-19 pandemic period (March 2020 to May 2022), with a pre-pandemic period (September 2011 to February 2020) and a postintervention endemic phase (June 2022 to March 2023). Study interventions included the application of the Vanderbilt Professionalism Escalation Model with broad staff and surgical team education. During the study period, 17,425 SERs were reviewed. Of these, 11,731 (mean 115.0 SERs/month) were reported in the pre-pandemic period, 4,004 SERs (mean 148.3 SERs/month) in the pandemic period, and 1,690 SERs (mean 169.0 SERs/month) in the endemic phase (p = 0.001). There was a statistically significant increase in the incidence of PRE during the pandemic compared to the pre-pandemic and endemic periods. Specifically, 264 PRE (1.5%) were identified during the study period: 114 PRE (mean 1.1 PRE/month) in the pre-pandemic period, 121 PRE (mean 4.5 PRE/month) in the pandemic period, and 29 PRE (mean 2.9 PRE/month) in the endemic phase (p = 0.001). The increase in PRE during the pandemic period corresponded to a concomitant increase in staff turnover rates (15.5%) compared to the pre-pandemic period (8.3%). However, a time shift of four months into the postintervention endemic phase demonstrated a successful reduction to less than pre-pandemic levels of staff turnover (6.7%, p = 0.001). The COVID-19 pandemic was associated with a significant increase in SERs describing professionalism lapses among health care providers in the perioperative environment. Hospital organizations must recognize the impact of professionalism on morale and turnover and seek to mitigate its effects. Education, promoting individual accountability, confidential reporting, addressing wellness concerns, and providing modes of resilience can enhance workplace culture and potentially cultivate better employee retention rates.

Candidaemia and Central Line-Associated Candidaemia in a Network of Indian ICUs: Impact of COVID-19 Pandemic.

Candidaemia is a potentially life-threatening emergency in the intensive care units (ICUs). Surveillance using common protocols in a large network of hospitals would give meaningful estimates of the burden of candidaemia and central line associated candidaemia in low resource settings. We undertook this study to understand the burden and epidemiology of candidaemia in multiple ICUs of India, leveraging the previously established healthcare-associated infections (HAI) surveillance network. Our aim was also to assess the impact that the pandemic of COVID-19 had on the rates and associated mortality of candidaemia. This study included adult patients from 67 Indian ICUs in the AIIMS-HAI surveillance network that conducted BSI surveillance in COVID-19 and non-COVID-19 ICUs during and before the COVID-19 pandemic periods. Hospitals identified healthcare-associated candidaemia and central line associated candidaemia and reported clinical and microbiological data to the network as per established and previously published protocols. A total of 401,601 patient days and 126,051 central line days were reported during the study period. A total of 377 events of candidaemia were recorded. The overall rate of candidaemia in our network was 0.93/1000 patient days. The rate of candidaemia in COVID-19 ICUs (2.52/1000 patient days) was significantly higher than in non-COVID-19 ICUs (1.05/patient days) during the pandemic period. The rate of central line associated candidaemia in COVID-19 ICUs (4.53/1000 central line days) was also significantly higher than in non-COVID-19 ICUs (1.73/1000 central line days) during the pandemic period. Mortality in COVID-19 ICUs associated with candidaemia (61%) was higher than that in non-COVID-19 ICUs (41%). A total of 435 Candida spp. were isolated. C. tropicalis (26.7%) was the most common species. C. auris accounted for 17.5% of all isolates and had a high mortality. Patients in ICUs with COVID-19 infections have a much higher risk of candidaemia, CLAC and its associated mortality. Network level data helps in understanding the true burden of candidaemia and will help in framing infection control policies for the country.

Students’ eating styles and palatable eating motives during the COVID-19 pandemic

This study aimed to describe students’ driving factors of eating behavior, namely eating-styles and palatable-eating-motives, and to determine clusters based on both. Conducted during the COVID-19 pandemic, this cross-sectional study was carried out in response to the intervention program, the nusantara movement to reduce obesity rate (gerakan nusantara tekan angka obesitas (GENTAS)), launched by the Indonesian government to reduce obesity rate. Involving general population, 135 undergraduate students at a university in Bandung, Indonesia (the average age was 20.5 years, 71.9% of them were female) were selected using multi-stage-cluster-sampling. Data was collected through online questionnaires and was analyzed using SPSS 22.00 for Mac. Results indicated that participants’ eating behavior was generally more characterized by uncontrolled-eating-style, and participants’ eating palatable foods was more driven by the motive of reward-enhancement. This study obtained three clusters, including the cluster composed of emotional-eating-style and coping-motives, the cluster involving cognitive-restraint-eating-styles, and the cluster composed of uncontrolled-eating-style and all palatable-eating-motives. Findings about the clusters brought possibilities to develop new approach in eating behavior intervention for GENTAS’ implementation among students, focusing on tailored intervention based on the cluster of the individual participant, and utilizing the available channels at the institution. An online or hybrid intervention was an introduced choice that was relevant during COVID-19 pandemic and non-COVID period.

Disaster Risk Management and Resilience Assessment of Small Communities in Iran

One of the main challenges facing rural areas in Iran is a lack of disaster risk management. This calls for a comprehensive framework for assessing resilience in small communities. This study seeks to establish such a framework based on the general principles of the Sendai Framework. So, an attempt is made to use a combination of quantitative and qualitative methods to operationalize and score indicators and risk management components, and then choose one of the rural areas in northern Iran as a sample for the framework’s implementation. The results show that a resilience assessment on small communities should do two things: outline the resilience situation and create a platform for dialogue and mutual thinking. Residents should be able to talk about risk reduction continuously and purposefully and take small, purposeful steps in this direction. It seems that Iran’s centralized planning system is more flexible in entrusting affairs to small communities and is more likely to form active cooperative cores. For this reason, it can be seen that voluntary activities have played an essential role in providing social services during the COVID-19 pandemic and quarantine period, and the volunteers themselves have also benefited from voluntary activities. As a result, volunteer groups have gained opportunities to promote local development and foster ownership and responsibility. However, there are concerns about the sustainability of these activities, which are related to the two issues of ensuring financial stability and providing volunteers in the long term.

The Profile of Bacterial Infections in a Burn Unit during and after the COVID-19 Pandemic Period.

Infections represent a major complication for burn-injured patients. The aim of this study was to highlight the changes in the incidence and antimicrobial resistance of bacterial strains isolated from burn patients, at the end of the COVID-19 pandemic, in relation to the antibiotics used during the pandemic. A comparative analysis of the demographic data and the microorganisms identified in the clinical samples of two groups of burn patients admitted to a university hospital in Romania was carried out. The first group consisted of 48 patients and the second of 69 patients, hospitalized in January-August 2020 and 2023, respectively. The bacterial species with the highest incidence were S. aureus, A. baumannii, Pseudomonas spp. The significant changes between 2023 and 2020 are reflected in the increase in the frequency of non-fermentative Gram-negative bacteria, especially S. maltophilia, and the increase in antimicrobial resistance of Pseudomonas and Klebsiella spp. Klebsiella spp. did not change in frequency (7%), but there was a significant increase in the incidence of K. pneumoniae strains with pan-drug resistant behaviour to antibiotics (40%), including colistin. The phenomenon can be explained by the selection of specimens carrying multiple resistance genes, as a result of antibiotic treatment during the COVID-19 period. The post-pandemic antimicrobial resistance detected in burn patients indicates the need for permanent surveillance of the resistance trends, primarily due to the limited therapeutic options available for these patients.

Nationwide upsurge in invasive disease in the context of longitudinal surveillance of carriage and invasive Streptococcus pyogenes 2009-2023, the Netherlands: a molecular epidemiological study.

Since 2022, many countries have reported an upsurge in invasive group A streptococcal (iGAS) infections. We explored whether changes in Streptococcus pyogenes carriage rates or emergence of strains with potentially altered virulence, such as emm1 variants M1UK and M1DK, contributed to the 2022/2023 surge in the Netherlands. We determined emm (sub)type distribution for 2,698 invasive and 351 S. pyogenes carriage isolates collected between January 2009 and March 2023. Genetic evolution of emm1 was analyzed by whole-genome sequencing of 497 emm1 isolates. The nationwide iGAS upsurge coincided with a sharp increase of emm1.0 from 18% (18/100) of invasive isolates in Q1 2022 to 58% (388/670) in Q1 2023 (Fisher's exact test, P < 0.0001). M1UK became dominant among invasive emm1 isolates in 2016 and further expanded from 72% in Q1 2022 to 96% in Q1 2023. Phylogenetic comparison revealed evolution and clonal expansion of four new M1UK clades in 2022/2023. DNase Spd1 and superantigen SpeC were acquired in 9% (46/497) of emm1 isolates. S. pyogenes carriage rates and emm1 proportions in carriage isolates remained stable during this surge, and the expansion of M1UK in iGAS was not reflected in carriage isolates. During the 2022/2023 iGAS surge in the Netherlands, expansion of four new M1UK clades was observed among invasive isolates, but not carriage isolates, suggesting increased virulence and fitness of M1UK compared to contemporary M1 strains. The emergence of more virulent clades has important implications for public health strategies such as antibiotic prophylaxis for close contacts of iGAS patients.IMPORTANCEThis study describes the molecular epidemiology of invasive group A streptococcal (iGAS) infections in the Netherlands based on >3,000 Streptococcus pyogenes isolates from both asymptomatic carriers and iGAS patients collected before, during, and after the COVID-19 pandemic period (2009-2023) and is the first to assess whether changes in carriage rates or carried emm types contributed to the alarming post-COVID-19 upsurge in iGAS infections. We show that the 2022/2023 iGAS surge coincided with a sharp increase of emm1, particularly the toxicogenic M1UK variant, in invasive isolates, but not in carriage isolates. These findings suggest that increased virulence and fitness of M1UK likely contributes to an increased dissemination between hosts. The emergence of a more virulent and fit lineage has important implications for iGAS control interventions such as antibiotic prophylaxis for close contacts of iGAS patients and calls for a reappraisal of iGAS control interventions and guidelines.

Analysis of Sexually Transmitted Infections during the COVID-19 pandemic in Brazil

Objective: To analyze the trend and impact that COVID-19 had on the notifications of STIs (HIV/AIDS, Syphilis, HBV, and HCV) in Brazil. Methods: This is an ecological study, analyzing the temporal trend of STIs notifications based on the detection rate of infections across the five geographical regions of Brazil from 2015 to 2021. The trend analysis from 2015 to 2021 was conducted using a linear regression model for historical series. To assess the impact of the pandemic, the expected cases were compared with the observed cases for the years 2015 to 2021. A significance level of 5% was established, with trend analyses conducted using the Joinpoint Regression Program, and the expected values were estimated using the R software. Results: The results demonstrate that there was a sharp decrease in the detection rates of mandatory notifiable STIs in Brazil during the COVID-19 pandemic period, and this trend was reflected across all regions of the country. Conclusion: During the COVID-19 pandemic, there was a reduction in STIs notifications. These results support the establishment of surveillance and health care strategies to minimize the impact of delays in the diagnosis and treatment of these infections.