COVID

Isolation, quarantine, and contact tracing are some of the most critical and commonly employed non-pharmaceutical interventions used to control the spread of COVID-19. However, the effectiveness of these strategies and their implementation depends on many factors, including a country’s population, the availability of resources to diagnose and effectively isolate infected individuals, culture and societal beliefs, family dynamics, and the feasibility and acceptability of isolation and quarantine policies among the public. This narrative review aims to appraise the evidence on the implementation strategies and shortcomings of isolation and quarantine strategies adopted during the COVID-19 pandemic. Previous evidence has found that early quarantine and isolation of COVID-19 patients were more effective than late adoption (5-fold vs. 2.6-fold). Approximately 90% of outbreaks could have been managed if 80% of contacts were monitored, traced, and isolated within four days of the index case being identified. For each new case of COVID-19, around thirty-six individuals should be traced. When the percentage of asymptomatic individuals is greater than 30%, isolation and contact tracing alone cannot contain the infection. The delay between symptom onset and isolation was the most important factor in determining infection control. Symptom-based isolation strategies should not be considered the sole criterion for isolation, as many asymptomatic individuals escaped isolation and increased the risk of disease transmission. Digital contact tracing, telemedicine, and artificial intelligence (AI)-based surveillance systems are potential adjuncts to support isolation and quarantine measures. Changes in societal behaviors and cultural norms, fear of stigma, psychological issues, economic burden, poverty, poor literacy rates, lack of public trust in government, and language were identified as challenges and barriers associated with the effective implementation of isolation and quarantine measures during the COVID-19 pandemic. Full article

This paper focuses on the wellbeing of a sample of older and predominantly middle-class UK individuals drawn from the Mass Observation Project (MOP) participant panel in 2020, covering the first months of the global COVID-19 pandemic and first UK national lockdown. It finds that socio-economic circumstances to some extent cushioned individuals against negative impacts of the pandemic but given the range of experiences within the sample, individual wellbeing cannot be explained by socio-economic position alone. Wellbeing emerged through a complex interaction of attitudes, activities, resources and circumstances, highlighting the dynamic interplay of agency and social structures that helps to understand more general features of living well. The findings also highlight that self-evaluated happiness depends partly on what individuals consider happiness to mean. Full article

Long COVID, defined by the National Academies of Sciences as an infection-associated chronic condition persisting at least three months following SARS-CoV-2 infection, presents a growing public health challenge. Despite national prevalence estimates of 11 to 15 percent among U.S. adults who have had COVID-19, the general population estimates of approximately 5 to 7 percent population-level symptom burden in diverse metropolitan areas remain insufficiently characterized. A cross-sectional survey was administered to adults residing in Houston and Harris County. Participants self-reported infection history, persistent symptoms lasting at least 90 days, health status, access to care, and functional impacts. Descriptive statistics summarize infected and affected, symptom frequency, and functional limitations. Of 264 eligible respondents who tested positive for COVID and rated the worst symptoms, 92 (34.85 percent) met the operational definition of Long COVID, representing an estimated sample-based prevalence of 16.91 percent across all 544 survey respondents. Given the use of convenience sampling, this figure should be interpreted as descriptive of this sample rather than as a generalized population-level estimate. Fatigue was the most reported persistent symptom (69.32 percent), followed by brain fog (62.5 percent), shortness of breath (48.84 percent), headache or migraine (43.02 percent), and joint or muscle pain (41.38 percent). Cognitive and functional symptoms predominate over respiratory symptoms. These findings demonstrate a substantial burden of persistent, multisystem symptoms in a sample of community-dwelling urban adults, highlighting the need for longitudinal research and targeted public health strategies to address long-term consequences of SARS-CoV-2 infection in diverse metropolitan settings. Full article

Background: This study aims to characterise the clinical and radiological features of Posterior reversible encephalopathy syndrome (PRES) in the context of multisystem inflammatory syndrome in children (MIS-C), consolidating reported cases to aid clinicians in diagnosis, management, and future research. Methods: A systematic review was conducted, adhering to PRISMA guidelines and registered under PROSPERO (CRD420251011869). Four academic databases and grey literature sources were searched up to April 2025. Inclusion criteria were cases with confirmed MIS-C and a diagnosis of PRES supported by compatible clinical and radiological findings or reported by the original investigators when detailed imaging information was unavailable. Results: Sixteen studies encompassing sixteen pediatric cases were identified. The majority were female, with a median age of 9 years. Among patients with available data, hypertension was reported in 8 cases, seizures in 9 cases, and visual disturbances in 4 cases. MRI findings predominantly showed cortical-subcortical hyperintensities in the parieto-occipital, posterior temporal, and frontal lobes. CT was frequently normal. Radiological regression was observed in most follow-up MRIs. Reported management was heterogeneous and variably described, including treatment of hypertension and seizures when present, alongside treatment of MIS-C and other potential precipitating conditions. Favourable clinical outcomes were reported in the published cases in which outcome information was available, with a median length of hospital stay of 26 days (range: 8–45 days). PRES is a rare but clinically important neurological condition reported in children with MIS-C. MRI remains the imaging modality of choice due to its sensitivity in detecting characteristic vasogenic edema, which is often missed on CT. Conclusions: PRES has been reported in a small number of children with MIS-C, but the available evidence is heterogeneous and subject to substantial diagnostic, selection, and publication biases. The relationship between MIS-C and PRES and the prognosis of affected patients still remain to be further elucidated. Full article

The COVID-19 pandemic lockdowns heavily impacted the stress levels of families worldwide. We examined parental stress levels regarding a variety of subtopics (including finances, schooling, and seeing extended family) in North Bay, Ontario, Canada. A mixed-method survey approach was used with a volunteer sample of 101 parents from the North Bay community. Included in the survey were 25 potential parental stressors, which parents were asked to rate in terms of their stressfulness, both during the COVID-19 lockdowns and post-pandemic. To accomplish this, participants were administered only one questionnaire, after the height of the pandemic was over, and asked to reflect on both the current time and on the time during the lockdown phase of the pandemic. General stress levels were higher after the lockdowns ended compared to during the lockdowns, indicated by 20 out of the 25 surveyed parental stressors. Four themes were identified in the qualitative data obtained from open-ended questions: ability to parent; requiring additional support; mental and physical well-being; and child-rearing. Specifically, in terms of the first theme, some parents felt that parenting had become more difficult, while others did not. With respect to theme two, many parents felt a need for support in a variety of areas, which relates to theme three, as supports were often desired to improve mental or physical well-being. The fourth theme highlighted the opportunity to spend more time at home with family and raise children according to parents’ own principles. Parents were also asked about changes in their behaviours, like gambling and alcohol use; gambling, in particular, increased during and after the pandemic compared to before. However, parents reported that the difficulty associated with continuing to parent as they did before the lockdowns was minimal, and that it did not change during or after the lockdowns. Finally, parents were asked about changes to their own mental and physical health; results were mixed, but approximately half of participants perceived positive changes in their well-being. Thus, compared to existing research, the current study provides a more comprehensive overview of stressors experienced by families in the wake of COVID-19 lockdowns. It also brings to light suggestions and recommendations from survey respondents to improve parents’ quality of life in post-COVID-19 North Bay, Ontario. Full article

Toll-like receptors (TLRs) play an important role in innate immunity, mediating viral recognition, antiviral responses, and cytokine production. This study evaluated TLR7 and TLR9 expression levels in COVID-19 patients and their associations with COVID-19 infection and disease severity. A total of 134 adults were included: 94 COVID-19 patients and 40 controls. RT-PCR confirmed SARS-CoV-2 infection; TLR7 and TLR9 expression levels were determined by quantitative real-time PCR. Participants’ clinical characteristics and laboratory findings were evaluated. TLR7 and TLR9 expression levels were significantly higher in COVID-19 patients than in controls (both p < 0.001). Both markers were independently associated with COVID-19 infection by multivariate analysis (OR: 6996.516, p < 0.001; OR: 7.365, p = 0.004) and showed excellent discriminatory performance by ROC analysis (AUC: 0.973 and 0.937, both p < 0.001). Among COVID-19 patients, TLR9 expression and ALT were independently associated with moderate-to-critical disease (OR: 1.448, p = 0.030; OR: 1.092, p = 0.032). TLR9 expression and ALT showed modest discriminatory performance for distinguishing moderate-to-critical COVID-19 from mild disease (AUC: 0.623, p = 0.042; AUC: 0.641, p = 0.020, respectively), while the combined model demonstrated a slight improvement (AUC: 0.659, p = 0.008). TLR7 and TLR9 may represent potential biomarkers for distinguishing COVID-19 patients from controls, and TLR9 may provide additional information on disease severity. These findings need validation in larger, multicenter studies before clinical application. Full article

Background: Transparent measurement is essential when organizational capacity is compared across public health institutions. The supplied analytic dataset did not contain repeated annual scores or indicator-level evidence for the previously proposed five-domain maturity model. We therefore conducted a reproducible cross-sectional analysis limited to the variables available in the dataset. Methods: Twenty Romanian public health directorates (PHDs)—10 in counties with a university medical center (CU) and 10 in counties without one (FU)—were compared using structural indicators, eight binary COVID-19 re-sponse measures, and a composite capacity–response index. The index was the equally weighted arithmetic mean of four sample-normalized components: employees per 100,000 inhabitants, budget per capita, previous-crisis experience, and the number of documented COVID-19 measures. Results are presented as medians and interquartile ranges. Mann–Whitney U and Fisher exact tests were used, with Holm correction within comparison families. Results: The composite index was higher in CU than FU institutions (55.0 [38.0–66.3] vs. 22.0 [19.3–31.3]; U = 93.0; p = 0.0013; Holm-adjusted p = 0.0077; rank-biserial r = 0.86). CU institutions also had larger populations, more employees, larger total budgets, higher per capita budgets, more previous-crisis experience, and more documented response measures. Employees per 100,000 inhabitants did not differ significantly. After multiplicity correction, vaccination-center involvement and communication/education were more frequently documented in the CU group. Digital platforms were recorded for only two institutions and cannot be interpreted as a digital-maturity domain. Conclusions: The available data support descriptive evidence of institutional disparities associated with the university-center context, but they do not support causal inference or validation of a maturity model. The composite index should be treated as an exploratory, sample-dependent benchmarking measure pending prospective instrument development, documented scoring rules, independent assessment, and external criterion validation. Its group difference largely reflects the four constituent components, which should remain the primary basis for interpretation. Full article

Mathematical modeling has played a crucial role in epidemiological research, its importance amplified during the COVID-19 pandemic. This comprehensive review provides a five-year analysis of mathematical models developed to understand and control COVID-19 transmission. The reviewed studies include deterministic models such as SIR and SEIR frameworks, stochastic models incorporating random effects, age-structured models accounting for demographic heterogeneity, within-host models describing viral dynamics and immune responses, and hybrid, multi-strain, agent-based, and network-based approaches. A literature search was conducted across major databases, and studies were categorized by model structure, analytical methods, and data integration strategies. The review examines the predictive capabilities of deterministic models, the role of stochasticity in capturing uncertainty, and the importance of demographic structure in explaining transmission and mortality patterns. The effectiveness of non-pharmaceutical interventions and vaccination strategies is also assessed. The integration of real-time epidemiological data into modeling efforts is discussed, highlighting insights into hospitalization demand, ICU utilization, and mortality trends across pandemic waves. By analyzing the strengths and limitations of each approach, this review aims to inform future pandemic management, concluding with emerging trends, including the integration of genomic data, and future directions for the field. Full article

Background: The COVID-19 pandemic simultaneously affected vascular risk and healthcare utilization. We evaluated whether monthly trajectories of Brazilian Unified Health System (Sistema Único de Saúde; SUS)-financed hospitalizations for different cerebrovascular categories changed differently during the pandemic in the municipality of São Paulo. Methods: We conducted an ecological time-series study using monthly Hospital Information System of the Brazilian Unified Health System (SIH-SUS), Department of Informatics of the Unified Health System (DATASUS) data from January 2017 through December 2021. Nontraumatic intracranial hemorrhage (I60–I62), cerebral infarction (I63), unspecified stroke (I64), and other cerebrovascular diseases (I65–I69) were included. The analytical dataset comprised 240 monthly observations. Annual IBGE population estimates were used as denominators. The primary analysis used segmented negative-binomial regression with log(population) offset, temporal trend, an immediate level change from March 2020, post-intervention slope change, and annual harmonic terms for seasonality. Poisson and negative-binomial models were compared using overdispersion diagnostics and Akaike information criterion (AIC). Residual autocorrelation, category-by-intervention interactions, alternative intervention dates, and leave-one-month-out influence were assessed. Results: A total of 60,756 hospitalizations were identified. Descriptive differences in mean annual counts between the pre-pandemic and pandemic periods were +3.7% for intracranial hemorrhage, +15.2% for cerebral infarction, −16.2% for unspecified stroke, and −27.2% for other cerebrovascular diseases. All categories were overdispersed (Pearson ratios 2.16–5.05), and AIC was consistently lower for negative-binomial models. In the primary segmented model, March 2020 was associated with an immediate 39.3% decrease in other cerebrovascular diseases (incidence rate ratio [IRR] 0.607; 95% confidence interval [CI] 0.512–0.720; p < 0.001) and a 10.0% decrease in unspecified stroke (IRR 0.900; 95% CI 0.817–0.991; p = 0.032). No statistically significant immediate level change was found for intracranial hemorrhage (IRR 1.018; p = 0.760) or cerebral infarction (IRR 0.868; p = 0.086). No category showed a significant post-intervention slope change. The formal category-by-level-change interaction was significant (Wald p = 0.004), indicating heterogeneity among categories. LjungBox tests at 12 lags showed no significant residual autocorrelation. Conclusions: SUS-financed cerebrovascular hospitalizations showed heterogeneous temporal changes during the pandemic, particularly immediate decreases in I64 and I65–I69. The findings support differences in trajectories across diagnostic categories but do not demonstrate diagnostic migration, individual biological mechanisms, or causality. Changes in care-seeking, referral, coding, diagnostic availability, and healthcare organization remain plausible but untested explanations. Full article

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in substantial global morbidity and mortality since its emergence in late 2019. This retrospective study aims to determine the comorbidity patterns, co-occurrence networks, and associated demographic factors among 244 deceased COVID-19 cases in Grenada between 2021 and 2022. The prevalence of comorbid conditions varied considerably across diseases. Hypertension was the most frequently observed condition (41%) followed by diabetes (34.8%), and ARDS (27%). Our co-occurrence analysis revealed a densely interconnected core of cardiometabolic and respiratory conditions, particularly involving hypertension, diabetes, and ARDS. Stratified clustering analyses demonstrated that multimorbidity patterns were broadly consistent across gender but differed by age group and vaccination status, with older individuals showing more pronounced clustering of cardiometabolic conditions. Logistic regression analysis further identified age and gender as significant factors associated with the distribution of specific comorbidities, including higher odds of hypertension among older individuals. This study highlights the central role of cardiometabolic diseases and older age in COVID-19 mortality in Grenada in 2021–2022 and underscores the importance of multimorbidity structures rather than isolated conditions. We suggest early identification of high-risk multimorbidity profiles, particularly among older adults, to improve clinical management and preventive strategies during future infectious disease outbreaks. Full article

Since COVID-19, reliance on digital technology has surged, and digital literacy has gained attention as a key factor in explaining changes in how people use the Internet. However, most existing studies have focused on the general public, and there has been insufficient research on how digital literacy relates to changes in Internet usage among people with disabilities. This study examined the effect of digital literacy among people with physical disabilities on changes in Internet use on personal computers (PC) and smart devices during the COVID-19 pandemic using data extracted from the 2020 Digital Divide Survey conducted by the National Information Society Agency. The survey was conducted between September and December 2020. A total of 75,000 individuals participated, of which 2200 were disabled. Data was extracted from participants who used the Internet, and the final analysis data included the response results of 1239 individuals. The findings suggest competence is unrelated to changes in Internet use in PCs and smart environments during COVID-19. For example, use/behavior, search, email, content, life services, and economic activities are related to Internet use changes on PCs and remain static with smart devices. Social media services (SNS), networking, and social participation are negatively related to changes in Internet use on PCs and smart devices. This study extends the discourse on the role of digital literacy among people with disabilities by empirically elucidating the relationship between digital literacy and changes in Internet use among people with physical disabilities during the pandemic, drawing on a nationally representative sample. The results of this study suggest that a digital literacy education program must be developed for people with physical disabilities to lead the necessary digital life in crises such as COVID-19. Full article

Severe coronavirus disease 2019 (COVID-19) is characterized by acute immune dysregulation, with monocytes playing a central role in driving inflammation and disease severity. However, the transcriptional and post-transcriptional regulatory mechanisms underlying monocyte dysfunction in severe COVID-19 remain unexplored. In the study, an integrative analysis of paired bulk RNA-seq and miRNA-seq datasets was performed together with independent single-cell RNA-seq (scRNA-seq) data from convalescent individuals with a history of ICU or non-ICU COVID-19. Pooled cell proportions descriptively indicated a higher proportion of classical monocytes and lower proportions of non-classical monocytes, B cells and dendritic cells in individuals with a history of ICU disease; however, none of these differences was statistically significant in patient-level analyses after multiple-testing correction. Using the miRSCAPE framework, miRNA expression was inferred at single-cell resolution and identified distinct cluster-specific inferred miRNA expression patterns. Differential expression analysis of classical monocyte populations identified 284 nominally significant differentially expressed genes between convalescent ICU and non-ICU samples. Integration of miRNA-mRNA correlation analysis with experimentally validated interactions and independent assessment highlighted a focused regulatory network centered on ZMAT3, RHOB and HLA-DQA1. Host–pathogen interaction analysis identified database-supported SARS-CoV-2-host interactions involving ORF3a-RHOB and nucleoprotein-RHPN2, with additional host–host interactions connecting RHPN2, HLA-C and HLA-DQA1. Collectively, these findings provide a computational framework for investigating inferred miRNA associations of monocyte inflammatory pathways associated with prior COVID-19 severity and highlight regulatory interactions that warrant further experimental validation. Full article

Background/Objectives: Post-COVID syndrome (PCS) remains a clinically heterogeneous condition. In patients with chronic diseases, real-world evidence is needed to describe its frequency and to identify clinical factors associated with its current presence. This study assessed the prevalence of PCS and factors associated with current PCS status among patients with chronic diseases. Methods: This observational cross-sectional study included a consecutively enrolled source clinical sample of 850 adults receiving inpatient or outpatient care in Almaty and the Almaty Region between June and December 2025. The primary analytic cohort comprised participants with documented prior COVID-19 (n = 250). PCS was assessed at study enrollment according to the national clinical protocol as current symptoms persisting for more than 12 weeks and not explained by an alternative diagnosis. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). COVID-19 vaccination was excluded from the primary model and evaluated only in a sensitivity analysis because vaccination timing relative to infection was unavailable. The exploratory association-based probability model was evaluated using the AUC with 95% CI, Brier score, calibration assessment, bootstrap internal validation with 1000 resamples, assessment of age nonlinearity, and decision curve analysis. Results: PCS was identified in 147 of 250 participants with prior COVID-19 (58.8%). In the revised primary multivariable model, age (OR = 1.24 per 10-year increase; 95% CI: 1.01–1.54; p = 0.040) and endocrine diseases (OR = 3.36; 95% CI: 1.69–6.98; p < 0.001) remained associated with current PCS status. The association with endocrine diseases persisted after adjustment for body mass index. The apparent AUC was 0.687 (95% CI: 0.620–0.753), and the Brier score was 0.218. Bootstrap internal validation yielded an optimism-corrected AUC of 0.655, a calibration intercept of 0.061, and a calibration slope of 0.816. Conclusions: PCS was frequent among patients with chronic diseases who had prior COVID-19. Older age and endocrine pathology were the most consistent factors associated with current PCS status. All model-performance estimates were obtained within the development sample; the model should not be used for individual prediction or follow-up planning without prospective external validation. Full article

The COVID-19 pandemic caused major disruptions to agricultural value chains in the Global South, revealing vulnerabilities in food production, processing and distribution. Global estimates reveal that the COVID-19 pandemic did, in fact, worsen food insecurity in the Global South. This paper, through a systematic literature review, clarifies the relationship between agricultural value chains and the four dimensions of food security and proposes policy paths to enhance the resilience of agricultural value chains in the Global South. The literature reveals that resilience of agricultural value chains is not an intrinsic trait, but a dynamic result of ecosystem governance. It is essential, therefore, that policy interventions move beyond simple input subsidies and toward the integration of digital financial tools and formalized relational governance to link farmers to formal markets. Full article

Working during an outbreak poses additional challenges for staff working in long-term care facilities (LTCFs). The existing literature explores the experiences of LTCF staff during the COVID-19 pandemic, but there is a paucity of research focusing on the specific challenges of working during COVID-19 outbreaks in rural and northern communities. Secondary analysis was conducted on interview transcripts from sixteen participants with experience working during COVID-19 outbreaks in northern LTCFs. Participants engaged in in-depth semi-structured interviews and shared their experiences working during COVID-19 outbreaks in the COVID-19 pandemic. Seven themes emerged through thematic analysis, including: (1) personal fear and moral distress, (2) coping with resident death due to COVID-19, (3) relationship dynamics, (4) changing workload expectations during staffing shortages, (5) resource constraints and organizational support gaps, (6) resources and support, and (7) impact of vaccinations. Findings emphasize the increased complexity of working during a COVID-19 outbreak in rural and northern communities and describe factors that shaped both the positives and negatives of the experience for staff. These findings show that rural and northern LTCFs faced additional challenges during COVID-19 outbreaks due to pre-existing resource and staffing shortages. However, we also highlight the unique strength of these communities in how they coped and supported each other through COVID-19 outbreaks. This study provides practical insights to inform improved outbreak management, including the need for region-specific guidance and support, clear communication from management, reliable access to personal protective equipment, consistent staffing, and support for grief and burnout, all while highlighting the voices of those who worked through these outbreaks. Full article

Background: Local vaccine manufacturing is being pursued across Africa to improve pandemic preparedness and reduce reliance on imports. In Nigeria, where COVID-19 vaccines were largely imported, willingness to accept locally produced vaccines is important for sustainable domestic production. The objective of this study was to estimate willingness to accept a locally manufactured COVID-19 vaccine among adults in Lagos, Nigeria, and to identify demographic predictors. Methods: We conducted a cross-sectional survey of adults in Lagos State from 7 September to 16 September 2024, using a questionnaire administered in four open-air markets. The primary outcome was willingness to accept a COVID-19 vaccine manufactured in Nigeria (yes/no). We summarized respondent characteristics, tested bivariate associations using chi-square tests, and estimated adjusted odds ratios (AORs) using multivariable logistic regression. Model calibration and discrimination were assessed using Hosmer–Lemeshow testing and the area under the ROC curve (AUC). Results: Of 388 consenting respondents, 335 provided complete data (86.3%). Respondents were predominantly female (60.6%); the largest age groups were 25–34 (30.2%) and 35–44 (28.4%) years. Overall, 75.8% reported willingness to accept a Nigerian-made COVID-19 vaccine. Willingness differed by age group (p = 0.0028; trend p = 0.0002) and religion (p = 0.0403). In adjusted models, respondents aged 45–54 years (aOR 6.54; 95% CI: 1.73–24.79) and 55–64 years (aOR 4.97; 95% CI: 1.05–23.55) had higher odds of acceptance than those aged 18–24 years. Christian affiliation was associated with lower odds than Muslim affiliation (aOR 0.41; 95% CI: 0.20–0.83). Discrimination was acceptable (AUC 0.75; 95% CI: 0.69–0.80). Conclusions: Most respondents were willing to accept a Nigerian-made COVID-19 vaccine, suggesting demand-side readiness. Confidence-building strategies tailored to younger adults and implemented with faith-based and community institutions may support uptake of locally produced vaccines. Full article

The COVID-19 pandemic resulted in historically high levels of psychological distress. Significant age differences in distress were consistently observed, and they present an opportunity to identify the mechanisms driving the prosocial decision-making underlying pandemic mitigation behaviors. As predicted by the cascade model of individual and age differences in prosocial motivation, re-analyses of the data from two previous surveys revealed the positive role of prosocial motivation in pandemic decisions as well as the negative roles played by neuroticism, anxiety, and depression. Social distancing was altruistically motivated, as evidenced by its positive associations with both altruism and sympathy measures. Moreover, the increases in distancing with age and concern for close others suggests that distancing was not primarily driven by concerns regarding the personal consequences of infection. Multiple age-related positivity effects were observed in which concerns and risk assessments decreased with age. Concern for others decreased with age less than concerns for oneself, suggesting a possible basis for age-related increases in altruism. Taken together, these findings suggest theoretical linkages between the cascade model and socioemotional selectivity theory, linkages that may have implications for prosocial public health messaging. Full article

Introduction: Community engagement offers an approach to improve our understanding of vaccine hesitancy, yet some worry that public engagement centered around controversial and politicized topics such as COVID-19 vaccines carries a risk of increasing concerns. Methods: Respondents who reported hesitance to vaccinate against COVID-19 in a December 2020 national panel survey were recruited to participate in three interactive and respectful virtual community engagement meetings. A second survey in September 2021 resampled respondents to ascertain changes over time. Of the 291 respondents to both survey waves who had been willing to participate in community meetings, 94 (32%) participated. Multivariate linear and logistic regressions were used to assess the potential impact of meeting participation on outcomes of interest. Results: At follow-up, participants had nearly double the odds of vaccinating against COVID-19 (adjusted Odds Ratio: 1.88; 95% Confidence Interval: 1.06–3.34), about one-third the odds of contracting COVID-19 disease (aOR: 0.37; 95% CI: 0.14–0.96), and increased trust in the Centers for Disease Control and Prevention (CDC) (adjusted Regression Coefficient: 4.16; 95% CI: 0.37–7.94), compared to non-participants. Most participants found the meetings unbiased (89%) and trustworthy (90%). Conclusions: The design of our community meetings to focus on learning from and supporting the decision-maker (versus only promoting “shots in arms”) improved health outcomes and increased trust. Similar meetings could improve how public health engages communities. Full article

Cancer survivors face an elevated risk of severe COVID-19 outcomes and were prioritized for vaccination, yet reported rates of vaccination refusal in this population vary widely. The objective of this scoping review was to map the available evidence on COVID-19 vaccination refusal among adult cancer survivors in the United States, to characterize the reported barriers and enablers, and to examine how differences in measurement account for variation in the reported estimates. PubMed, EBSCOhost, CINAHL, medRxiv, and Google Scholar were searched for studies published between 1 December 2020 and 30 April 2026 reporting primary data on COVID-19 vaccination refusal among U.S. adults with a current or previous cancer diagnosis. Findings were charted and summarized descriptively. Six sources comprising 3344 participants met the eligibility criteria. Reported refusal ranged from 7.3% to 39.0%, a more than fivefold difference, with a median of 14.7%. This variation corresponded closely to what each source measured: declination of an offered vaccine, likelihood of acceptance on a Likert scale, hesitancy assessed before vaccines were widely available, or observed non-receipt of any dose. Barriers included concerns about vaccine safety, efficacy, and interaction with cancer treatment, mistrust of science and government, and low perceived need; clinician recommendation was the most consistent enabler. Estimates of vaccination refusal in this population are not directly comparable and should be interpreted alongside the construct measured. Full article