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A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Public Health Microbiology".

Deadline for manuscript submissions: closed (28 February 2026) | Viewed by 17351

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Prof. Dr. Eduardo Araújo Oliveira

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Guest Editor

Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130-100, MG, Brazil
Interests: COVID-19; vaccines; pediatrics, CAKUT

Prof. Dr. Ana Cristina Simões E Silva

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Guest Editor

Departamento de Pediatria, Faculdade de Medicina UFMG, Belo Horizonte, Brazil
Interests: pediatrics; kidney function; chronic kidney disease; renin angiotensin system
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Special Issue Information

Dear Colleagues,

It has been over 4 years since the coronavirus disease 2019 (COVID-19) pandemic was first declared. As of February 2024, the World Health Organization (WHO) had reported over 826 million confirmed COVID-19 cases and 7 million COVID-19-related deaths globally. Following global mass vaccination efforts, the WHO declared the end of the COVID-19 Public Health Emergency in May 2023, citing a decline in deaths and hospitalizations.

While the acute phase of the pandemic may be subsiding, its long-term impact on public health remains significant. In this post-pandemic era, understanding the transition of SARS-CoV-2 to endemicity, its continuous circulation, and its interaction with seasonal viruses is crucial in designing effective preventive and control strategies. This Special Issue will focus on this new scenario, especially regarding the long-term consequences of COVID-19, particularly in vulnerable populations. We aim to gather research that investigates the lasting effects of the virus on physical and mental health, the impact of COVID-19 on healthcare systems, and the development of effective strategies for the long-term management of post-COVID conditions.

For this Special Issue, we encourage submissions that utilize innovative methodologies, such as big data analysis, artificial intelligence, and community-based participatory research, to address these critical challenges. Research articles, review articles, and short communications dealing with various aspects of SARS-CoV-2 infection in the post-pandemic context are welcome, with possible topics including, but not limited to, long-term health consequences, viral evolution, vaccine effectiveness, vaccine safety, and the impact of COVID-19 on healthcare systems. By learning from the past and embracing innovative research approaches, we can better prepare for future public health challenges and ensure a more resilient and equitable healthcare system.

Prof. Dr. Eduardo Araújo Oliveira
Prof. Dr. Ana Cristina Simões E Silva
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Microorganisms is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

SARS-CoV-2
prevention
vaccines
artificial intelligence

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Published Papers (8 papers)

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Research

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20 pages, 1638 KB

Open AccessArticle

Temporal Dynamics of Vaccine Uptake: Perceptual and Social Drivers of Adoption Speed Across Innovation Diffusion Curve

by Rungting Tu, Cheryl Lin, G. Natasha Santoso, Wendy E. Braund, Ann M. Reed and Pikuei Tu

Microorganisms 2026, 14(5), 1049; https://doi.org/10.3390/microorganisms14051049 - 7 May 2026

Viewed by 247

Abstract

The effectiveness of infection prevention depends on not only uptake but also the timing of adoption. Vaccination studies typically treat uptake as binary, overlooking when while investigating why individuals get vaccinated. Using the novel mRNA COVID-19 vaccines as a case study, the influences of risk perceptions and social norms on vaccination timing were examined through an Innovation Diffusion framework. An online survey was conducted in November 2021 to assess vaccination behaviors, attitudes, and peer expectations of 1710 U.S. residents (51.64% females, 31.23% minorities, with a relatively balanced distribution across age and income brackets). Participants were classified by vaccination timing and intentions as early adopters, early majority, late majority, or laggards for comparative analyses. One year after vaccine rollout, 64.3% had received at least one dose; 20.1% reported no intention to vaccinate, and this resistance persisted through May 2023 when the pandemic ended. Vaccine confidence and prior behavior (e.g., influenza vaccination) demonstrated strong gradients across adoption timing. Earlier uptake was associated with higher perceived vaccine importance, infection risk, and peer uptake, whereas age and education effects diminished over time. Perceived illness severity and disease knowledge showed inconsistent influences. Later adopters anticipated higher post-vaccination infection risk and greater peer non-vaccination, reinforcing hesitancy. Social norms (but not risk perception) mediated the relationship between confidence and timing; earlier adoption further predicted booster acceptance. These findings highlight the importance of trust, correcting efficacy misperceptions, and leveraging positive peer norms to promote timely vaccination and inform strategies for other infectious diseases. Full article

(This article belongs to the Special Issue SARS-CoV-2: Infection, Transmission, and Prevention)

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13 pages, 1086 KB

Open AccessArticle

Effectiveness of COVID-19 Vaccines Against Hospitalization and Severe Disease in Children with Diabetes Mellitus During Pandemic and Post-Pandemic Eras

by Laura G. Coelho, Lilian M. Diniz, Stella C. Galante, Cristiane S. Dias, Maria Christina L. Oliveira, Enrico A. Colosimo, Ana Cristina Simões e Silva, Fernanda N. Duelis, Maria Eduarda T. Bernardes, Daniela R. Martelli, Fabrício Emanuel S. Oliveira, Hercílio Martelli-Junior, Robert H. Mak and Eduardo A. Oliveira

Microorganisms 2026, 14(2), 501; https://doi.org/10.3390/microorganisms14020501 - 20 Feb 2026

Cited by 1 | Viewed by 759

Abstract

Pediatric patients with SARS-CoV-2 infection are at an increased risk of severe disease and adverse outcomes. Nevertheless, comprehensive data on COVID-19 vaccine effectiveness (VE) in children with diabetes during the post-pandemic period remain limited. This study assessed the VE against severe COVID-19 outcomes during both the pandemic and post-pandemic phases in children with and without diabetes mellitus (DM). A cohort study based on population data was carried out, including all patients under 18 years of age with symptomatic SARS-CoV-2 infection as registered in the Brazilian national surveillance systems from February 2020 to June 2025. The main outcomes were hospitalization due to COVID-19 and severe illness, which included admission to the intensive care unit (ICU), need for invasive ventilation, and death. Utilizing a propensity score-matched cohort, we estimated the VE and the number needed to vaccinate (NNV) for a booster dose against these outcomes by comparing vaccinated and unvaccinated individuals, employing conditional logistic regression adjusted for confounding variables. The cohort comprised 3,730,007 pediatric patients with COVID-19, of whom 7675 (0.2%) had DM. At baseline, children with DM exhibited a significantly higher prevalence of hospitalization (11.2% vs. 2.0%), severe COVID-19 (6.4% vs. 0.6%), and mortality (1.9% vs. 0.1%) than those without DM (all p < 0.001). During the pandemic period, the adjusted VE was consistently higher in children with DM. Against severe disease, the VE was 72.8% (95% CI: 12.3–93.2) in the DM cohort compared with 45.7% (28.1–59.0) in the non-DM cohort. This increased effectiveness corresponded to a more favorable NNV; the NNV to prevent one severe case was 24 (95% CI: 12–232) for children with DM versus 243 (168–440) for those without DM. In the post-pandemic period, the VE remained significantly higher in the DM cohort. Against severe disease, the VE was 76.2% (11.5–93.5) for children with DM and 52.9% (32.7–67.1) for those without. The NNV to prevent one severe case was consistently lower in the DM cohort (8 vs. 591). In conclusion, a complete vaccination regimen, including a booster dose, substantially mitigated severe COVID-19 outcomes in children with DM in the pandemic and post-pandemic periods. Full article

(This article belongs to the Special Issue SARS-CoV-2: Infection, Transmission, and Prevention)

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17 pages, 2163 KB

Open AccessArticle

Immunogenicity and Breakthrough Outcomes of mRNA Booster Strategies Among Healthcare Workers During the BA.1/BA.2 Omicron Surge

by Song Mi Moon, Jung Nam An, Jae Hyun Kwon, Sung Gyun Kim and Han Wool Kim

Microorganisms 2025, 13(10), 2362; https://doi.org/10.3390/microorganisms13102362 - 14 Oct 2025

Viewed by 708

Abstract

Throughout the 2019 coronavirus disease pandemic, various vaccine regimens were implemented. Real-world data comparing their effectiveness during the BA.1/BA.2 Omicron wave remain limited. We prospectively enrolled healthcare workers who had completed two doses of mRNA or ChAdOx1 (A) vaccine and received an mRNA vaccine booster (BNT162b2 (P) or mRNA-1273 (M)). Neutralizing antibody levels were measured 6 months after the primary vaccinations and 1 month post-booster vaccination using a surrogate virus neutralization assay. Breakthrough infections were identified through institutional surveillance and the national reporting system. Among 318 participants (P-P-P: 71; A-A-P: 205; A-P-P: 19; M-M-M: 23), pre-booster neutralizing activity was lowest in the ChAdOx1-primed groups. One month post-booster vaccination, the neutralizing activity exceeded 97% across all regimens. The cumulative incidence of breakthrough infection varied significantly from 43.7% (P-P-P) to 84.2% (A-P-P). In adjusted Cox models, A-P-P showed the highest infection risk (HR 2.99, 95% CI 1.65–5.42). In summary, mRNA boosters restored neutralizing activity, but during the early BA.1/BA.2 Omicron wave they were less effective in preventing infections regardless of disease severity. Therefore, antibody titers alone are insufficient for evaluating protection, underscoring the need for continuous monitoring to support timely policy decisions during epidemic surges. Full article

(This article belongs to the Special Issue SARS-CoV-2: Infection, Transmission, and Prevention)

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14 pages, 545 KB

Open AccessArticle

Long-Term Safety of Anti-COVID-19 mRNA Vaccines in Patients with Systemic Lupus Erythematosus and Lupus-like Diseases with a Previous History of Myocarditis

by Giovanni Benanti, Marta Secci, Andrea Villatore, Sara Angiulli, Chiara Calabrese, Gabriele Domenico Gallina, Veronica Batani, Giacomo De Luca, Corrado Campochiaro, Giuseppe Pizzetti, Giovanni Peretto, Simone Sala, Enrica P. Bozzolo, Luca Moroni, Marco Matucci-Cerinic, Giuseppe A. Ramirez and Lorenzo Dagna

Microorganisms 2025, 13(10), 2266; https://doi.org/10.3390/microorganisms13102266 - 26 Sep 2025

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Abstract

Non-viral myocarditis is rare but relatively more frequent in patients with systemic autoimmune diseases (such as systemic lupus erythematosus, SLE, and allied conditions) than in the general population. In rare cases, mRNA-based vaccines can also trigger non-viral myocarditis. Limited data are available about the cardiac safety of mRNA vaccines in this subset of patients. Here, we report data from a third-level hospital on long-term safety, leveraging on a previously described cohort of 13 consecutive patients with SLE, Undifferentiated (UCTD) and Mixed Connective Tissue disease (MCTD), and a history of myocarditis, who had received anti-COVID-19 vaccination between April 2021 and January 2022. Demographics and clinical data (including validated clinometric for SLE) were collected at baseline, at the first available visit following the primary vaccination cycle, after an additional 12 months, and at the last available follow-up after at least 36 months. Twelve patients, seven females, ten with SLE, one MCTD, and one UCTD, had a median follow-up of 41 (35–45) months. One patient was lost at follow-up. No disease flare or sign of myocarditis recurrence were observed. At last visit, all patients were in a low disease activity state (LLDAS), and all but one were in remission, according to the Definition of Remission in SLE (DORIS) criteria. No significant variations in disease activity or damage accrual nor in markers of inflammation and myocardial injury were observed. Our data suggest that mRNA-based anti-COVID-19 vaccines in patients with previous autoimmune myocarditis in the context of SLE and allied conditions have a good long-term safety profile. Full article

(This article belongs to the Special Issue SARS-CoV-2: Infection, Transmission, and Prevention)

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13 pages, 518 KB

Open AccessArticle

COVID-19 Vaccination Still Makes Sense: Insights on Pneumonia Risk and Hospitalization from a Large-Scale Study at an Academic Tertiary Center in Italy

by Elena Azzolini, Brenda Lupo Pasinetti, Antonio Voza, Antonio Desai, Michele Bartoletti, Stefano Aliberti and Massimiliano Greco

Microorganisms 2025, 13(8), 1744; https://doi.org/10.3390/microorganisms13081744 - 25 Jul 2025

Cited by 2 | Viewed by 1817

Abstract

COVID-19 vaccines have revolutionized prevention and clinical management by reducing disease severity and mortality. However, their long-term impact on hospitalization is unclear. This retrospective study assessed whether vaccination status, timing, and number of vaccine doses influence the risk of hospitalization and COVID-19 pneumonia in a large cohort in Italy, several years after initial vaccine rollout. From 1 October 2023, to 2 February 2024, at Humanitas Research Hospital (Milan) and two affiliates, we recorded age, sex, comorbidities, vaccination status (number of doses and time since last dose), admission type (urgent vs. elective), and pneumonia diagnosis. Baseline health was quantified by the Charlson Comorbidity Index. Among 16,034 admissions (14,874 patients), vaccination data were available for 5743 cases: 40.8% were in the emergency setting and 59.2% were elective. Patients presented with pneumonia in 6.8% of cases. Laboratory results confirmed COVID-19 pneumonia occurred in 43.7% of pneumonia cases, with a 16.9% mortality. Patients with no vaccine dose had a higher proportion of COVID-19 pneumonia, while COVID-19 pneumonia rates were lower in individuals who had received more vaccine doses. There were no significant differences in COVID-19 pneumonia risk by timing of last vaccination. Moreover, hospitalized unvaccinated patients had overall more frequent emergency admissions (57.3%), while patients with three or more doses had about a ~40% emergency admission rate. COVID-19 positivity during hospitalization was highest in unvaccinated patients (90.7%) and declined with vaccination status. Vaccinated patients, especially those with multiple doses, had significantly lower COVID-19 pneumonia rates and emergency admissions. These findings suggest a possible protective effect of vaccination in modifying the clinical presentation and severity of illness among those who are hospitalized and support continued vaccination efforts for high-risk groups to reduce severe adverse outcomes. Full article

(This article belongs to the Special Issue SARS-CoV-2: Infection, Transmission, and Prevention)

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17 pages, 1425 KB

Open AccessArticle

COVID-19 Vaccine Effectiveness and Risk Factors of Booster Failure in 480,000 Patients with Diabetes Mellitus: A Population-Based Cohort Study

by Maria Christina L. Oliveira, Daniella R. Martelli, Ana Cristina Simões e Silva, Cristiane S. Dias, Lilian M. Diniz, Enrico A. Colosimo, Clara C. Pinhati, Stella C. Galante, Fernanda N. Duelis, Laura E. Carvalho, Laura G. Coelho, Maria Eduarda T. Bernardes, Hercílio Martelli-Júnior, Fabrício Emanuel S. de Oliveira, Robert H. Mak and Eduardo A. Oliveira

Microorganisms 2025, 13(5), 979; https://doi.org/10.3390/microorganisms13050979 - 24 Apr 2025

Cited by 2 | Viewed by 2576

Abstract

To investigate the real-world effectiveness of COVID-19 vaccines in a large cohort of patients with diabetes mellitus (DM), we analyzed all >18-year-old patients with COVID-19 registered in a Brazilian nationwide surveillance database between February 2020 and February 2023. The primary outcome of interest was vaccine effectiveness against death, evaluated using multivariate logistic regression models. Among the 2,131,089 patients registered in the SIVEP-Gripe, 482,677 (22.6%) had DM. After adjusting for covariates, patients with DM had a higher risk of death than those without comorbidities (adjusted odds ratio [aOR] = 1.43, 95% CI, 1.39–1.47). For patients without comorbidities (72.7%, 95% CI, 70.5–74.7) and those with DM (73.4%, 95% CI, 68.2–76.7), vaccine effectiveness was similar after the booster dose. However, it was reduced in patients with DM associated with other comorbidities (60.5%; 95% CI, 57.5–63.2). The strongest factor associated with booster failure was the omicron variant (aOR = 27.8, 95% CI, 19.9–40.1). Our study revealed that COVID-19 vaccines provided robust protection against death in individuals with DM. However, our findings underscore the need to update vaccines and develop tailored strategies for individuals with diabetes, especially those with additional underlying conditions. Full article

(This article belongs to the Special Issue SARS-CoV-2: Infection, Transmission, and Prevention)

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11 pages, 523 KB

Open AccessArticle

Risk Factors for Flares and New Lesions of Hidradenitis Suppurativa Following COVID-19 Disease: A Retrospective Cohort Study of 310 Patients in Greece

by Aikaterini I. Liakou, Andreas G. Tsantes, Evangelia-Konstantina Bompou, Magdalini Kalamata, Efthymia Agiasofitou, Soultana Vladeni, Angeliki Dragoutsou, Konstantina A. Tsante, Petros Ioannou, Eleni Chatzidimitriou, Ourania Kotsafti, George Samonis, Georgia Vrioni, Stefanos Bonovas and Alexander I. Stratigos

Microorganisms 2025, 13(3), 542; https://doi.org/10.3390/microorganisms13030542 - 27 Feb 2025

Cited by 2 | Viewed by 1828

Abstract

Background: COVID-19 disease has been associated with flares or new onsets of various autoinflammatory diseases such as psoriasis and atopic dermatitis. Our aim is to investigate the occurrence and risk factors of flares or new onsets of Hidradenitis Suppurativa (HS) following COVID-19 disease. Methods: A retrospective cohort study was performed including 310 patients with HS following COVID-19 disease. Data on the rate of HS flares, new lesions, time of flare onset, and flare duration were recorded. Demographics, clinical characteristics, and treatment parameters were compared between patients with and without HS flares. Results: HS flares developed in 69 (22.2%) patients, with 14 experiencing their first episode. The median period between COVID-19 and flare onset was 17 days, with a median flare duration of 14 days. For new HS onset, the median period was 9.5 days, and the median duration was 13 days. Biologic treatment was less common in patients with flares (7.2% vs. 23.2%, p = 0.003), and fewer patients with flares were vaccinated (81.1% vs. 99.1%, p < 0.001). Multivariable analysis showed lower risk for flares in those receiving biologics (aOR = 0.14, p = 0.002) and those who were vaccinated (aOR = 0.02, p < 0.001). Conclusions: COVID-19 may trigger HS flares and new onset, with biologic treatment and vaccination offering protection. Full article

(This article belongs to the Special Issue SARS-CoV-2: Infection, Transmission, and Prevention)

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Review

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16 pages, 698 KB

Open AccessReview

Autoimmune Skin Diseases in the Era of COVID-19: Pathophysiological Insights and Clinical Implications

by Aikaterini I. Liakou, Eleni Routsi, Kalliopi Plisioti, Eleni Tziona, Dimitra Koumaki, Magdalini Kalamata, Evangelia-Konstantina Bompou, Rozeta Sokou, Petros Ioannou, Stefanos Bonovas, George Samonis, Andreas G. Tsantes and Alexander Stratigos

Microorganisms 2025, 13(9), 2129; https://doi.org/10.3390/microorganisms13092129 - 11 Sep 2025

Cited by 3 | Viewed by 3110

Abstract

The COVID-19 pandemic has highlighted intricate associations between SARS-CoV-2 infection and autoimmune skin diseases (ASDs). This review examines the bidirectional relationship between COVID-19 and ASDs including hidradenitis suppurativa, psoriasis, atopic dermatitis, alopecia areata, autoimmune bullous diseases, cutaneous and systemic lupus erythematosus, systemic sclerosis, dermatomyositis, and lichen planus. Current evidence indicates that SARS-CoV-2 may precipitate or worsen ASDs via mechanisms such as molecular mimicry, dysregulated cytokine signaling, and enhanced Th1/Th17 immune responses, leading to loss of self-tolerance and autoantibody production. Epidemiological studies have identified increased incidence and flares of psoriasis, hidradenitis suppurativa, and other ASDs following both COVID-19 infection and vaccination, with mRNA vaccines associated with a higher risk of flare in hidradenitis suppurativa compared with non-mRNA vaccines. Notably, severe COVID-19 is associated with a greater risk of new-onset autoimmune disease, and patients with pre-existing inflammatory skin conditions may have increased susceptibility to SARS-CoV-2 infection but experience less severe COVID-19 courses. These findings underscore the need for ongoing surveillance and mechanistic studies to clarify the immunopathogenic links between SARS-CoV-2 and ASDs and inform management strategies for affected patients in the context of both infection and vaccination. Full article

(This article belongs to the Special Issue SARS-CoV-2: Infection, Transmission, and Prevention)

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