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TropicalMed
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Post-Pandemic Challenges: Endemic COVID-19, Vaccine Hesitancy, and Viral Resurgence
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Post-Pandemic Challenges: Endemic COVID-19, Vaccine Hesitancy, and Viral Resurgence

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 3915

Special Issue Editors

Dr. Marcin Walkowiak

E-Mail Website
Guest Editor
Department of Preventive Medicine, Poznan University of Medical Sciences, Święcickiego Str. 6, 60-781 Poznan, Poland
Interests: vaccine hesitancy; biostatistics; environmental health; epidemiology; mortality
Dr. Constantinos Tsioutis

E-Mail Website
Guest Editor
School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
Interests: infection control; long covid; COVID-19; antimicrobial resistance; antimicrobial stewardship
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

While the pandemic has ended, the virus persists, now in a milder form that continues to circulate. This pattern is not new; it also followed the Spanish Flu, with influenza A H1N1 still taking lives every winter. The familiarity of this cycle is striking.

The aim of this Special Issue is to analyze numerous post-pandemic challenges that are the result of or have become especially glaring due to the pandemic. The first and most natural is dealing with a virus that appears to be becoming endemic. This requires a nuanced approach that neither overemphasizes a virus that is now just one of many respiratory pathogens nor underestimates its potential. If we use the analogy that was frowned upon during the pandemic—"It’s just the flu"—the situation remains concerning, as influenza takes a significant toll every year and occasionally causes spectacular, though less publicized, epidemics like those in 1957 and 1968. The ultimate trajectory of COVID-19 is a crucial question. This also allows for a retrospective analysis of the shift to endemicity, assessing the suitability of the public health measures taken and identifying lessons that could be learned regarding policy lag and the suboptimal allocation of public health efforts.

The second challenge is vaccine hesitancy—not merely in relation to vaccination against this particular virus, but as a broader consequence of the pandemic. Whether one attributes this to the spread of misinformation, public health blunders that damaged trust, or a combination of factors, the issue is acute and warrants thorough investigation.

The third challenge is the viral rebound in an increasingly interconnected world. Pandemic restrictions were effective at suppressing viruses in general, even leading to the extinction of the influenza B/Yamagata lineage. However, once restrictions were lifted, we observed a spectacular and out-of-season rebound among a population with diminished natural immunity due to prior shielding.

Dr. Marcin Walkowiak
Dr. Constantinos Tsioutis
Guest Editors

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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

  • vaccine hesitancy
  • COVID-19
  • epidemiology
  • endemic viruses
  • natural immunity

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Published Papers (5 papers)

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Research

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18 pages, 1875 KiB  
Article
Burden in Colombia of COVID-19 in Adults and the Associated Clinical Characteristics: A Retrospective Database Analysis
by Jair Arciniegas, Juan Manuel Reyes, Jhon Bolaños-López, Julia Regazzini Spinardi, Jingyan Yang, Farzaneh Maleki, Farley Johanna Gonzalez, Carlos Jose Bello, Ana Catalina Herrera-Díaz, Omar Escobar, Andrea Rubio, Monica Garcia, Luz Eugenia Pérez Jaramillo, Jorge La Rotta, Moe H. Kyaw and Carlos Fernando Mendoza
Trop. Med. Infect. Dis. 2025, 10(6), 146; https://doi.org/10.3390/tropicalmed10060146 - 22 May 2025
Viewed by 92
Abstract
Studies on the burden of COVID-19 cases in Colombia have focused on specific populations and short timeframes. A retrospective observational study was conducted on adult patients aged 18 diagnosed with COVID-19 who received inpatient and/or outpatient medical care at a large health maintenance [...] Read more.
Studies on the burden of COVID-19 cases in Colombia have focused on specific populations and short timeframes. A retrospective observational study was conducted on adult patients aged 18 diagnosed with COVID-19 who received inpatient and/or outpatient medical care at a large health maintenance organization, to evaluate the burden of COVID-19 cases in Colombia (from March 2020 to January 2023) and associations with demographic and clinical characteristics. COVID-19 cases were identified with ICD-10 codes and confirmed by a laboratory test. The statistical analysis focused on descriptors of the frequency of events. A multivariate regression model was used to identify factors associated with severe conditions and death. Of the 953,661 cases detected, most cases (~79%) were mild or moderate (handled as outpatients). There were 20.1% (N = 191,260) severe cases and 0.9% (N = 8841) critical cases. Most COVID patients were unvaccinated (94.6%) and had, on average, one comorbidity. Hypertension (19.1%), immunocompromised condition (23.8%), mental health conditions (15%), obesity (10.8%), and cancer (11.2%) were the common prevalent comorbidities. The presence of comorbidity increased the risk of severe or critical COVID-19. COVID-19 cases were associated with the lack of vaccination and comorbidities. Effective vaccination strategies are needed to reduce the burden of COVID-19 in Colombia and, considering budgetary constraints, it is advisable to prioritize the elderly or populations with underlying conditions. Full article
(This article belongs to the Special Issue Post-Pandemic Challenges: Endemic COVID-19, Vaccine Hesitancy, and Viral Resurgence)
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16 pages, 803 KiB  
Article
Vitamin D Status and Incidence of SARS-CoV-2 Reinfections in the Borriana COVID-19 Cohort: A Population-Based Prospective Cohort Study
by Salvador Domènech-Montoliu, Laura López-Diago, Isabel Aleixandre-Gorriz, Óscar Pérez-Olaso, Diego Sala-Trull, Alba Del Rio-González, Maria Rosario Pac-Sa, Manuel Sánchez-Urbano, Paloma Satorres-Martinez, Juan Casanova-Suarez, Cristina Notari-Rodriguez, Raquel Ruiz-Puig, Gema Badenes-Marques, Laura Aparisi-Esteve, Carmen Domènech-León, Maria Angeles Romeu-Garcia and Alberto Arnedo-Pena
Trop. Med. Infect. Dis. 2025, 10(4), 98; https://doi.org/10.3390/tropicalmed10040098 - 6 Apr 2025
Viewed by 524
Abstract
A deficient vitamin D (VitD) status has been associated with SARS-CoV-2 infections, severity, and mortality. However, this status related to SARS-CoV-2 reinfections has been studied little. Our aim was to quantify the risk of reinfections considering VitD status before reinfection. Methods: We performed [...] Read more.
A deficient vitamin D (VitD) status has been associated with SARS-CoV-2 infections, severity, and mortality. However, this status related to SARS-CoV-2 reinfections has been studied little. Our aim was to quantify the risk of reinfections considering VitD status before reinfection. Methods: We performed a population-based prospective cohort study in Borriana (Valencia Community, Spain) during 2020–2023, measuring 25-hydroxyvitamin D [25(OH)D] levels by electrochemiluminescence. Cox proportional hazards models were employed. Results: Of a total of 644 SARS-CoV-2 cases with confirmed laboratory tests, 378 (58.9%) were included in our study, with an average age of 38.8 years; 241 were females (63.8%), and 127 reinfections occurred (33.6%). SARS-CoV-2 reinfection incidence rates per 1000 person-days by VitD status were 0.50 for a deficient status (<20 ng/mL), 0.50 for an insufficient status (20–29 ng/mL), and 0.37 for a sufficient status (≥30 ng/mL). Compared with a sufficient VitD status, adjusted hazard ratios were 1.79 (95% confidence interval [CI] 0.89–3.59) for a deficient status and 1.59 (95% CI 1.06–2.38) for an insufficient status with a significant inverse dose–response (p = 0.02). These results can help improve nutritional actions against SARS-CoV-2 reinfections. Conclusions: These results suggest that a VitD status lower than 30 ng/mL showed a higher risk of SARS-CoV-2 reinfection. Achieving and maintaining a sufficient VitD status is recommended to prevent reinfections. Full article
(This article belongs to the Special Issue Post-Pandemic Challenges: Endemic COVID-19, Vaccine Hesitancy, and Viral Resurgence)
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11 pages, 813 KiB  
Article
COVID-19 in Morocco: Nurses’ Knowledge of Anti-COVID-19 Vaccines and Their Involvement in Vaccine Vigilance
by Fatima Zahra Laamiri, Manar Aarrad, Abdelmounaim Manoussi, Youssef Baba Khouya, Fatine Hadrya, Mohamed Chahboune and Amina Barkat
Trop. Med. Infect. Dis. 2025, 10(4), 97; https://doi.org/10.3390/tropicalmed10040097 - 6 Apr 2025
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Abstract
The COVID-19 pandemic has highlighted the crucial role of nurses in managing health crises, particularly in implementing vaccination campaigns launched in many countries worldwide. This descriptive study assesses nurses’ knowledge of COVID-19 vaccines and their involvement in vaccine vigilance. Conducted over four months [...] Read more.
The COVID-19 pandemic has highlighted the crucial role of nurses in managing health crises, particularly in implementing vaccination campaigns launched in many countries worldwide. This descriptive study assesses nurses’ knowledge of COVID-19 vaccines and their involvement in vaccine vigilance. Conducted over four months in 2022 among 200 primary healthcare nurses in the Fès-Meknès region, the data were collected using a questionnaire developed and validated by a multidisciplinary team. The results show that 60% of participants self-reported being unaware of the nature of COVID-19 vaccines, and 49.5% did not understand the concept of vaccine pharmacovigilance. Additionally, 76.5% had not received any pharmacovigilance training in this pandemic context, 80% had never been in contact with pharmacovigilance centers, and 48.5% expressed a need for training in this field. One-third of the participants were unaware of severe adverse effects. The most frequently reported adverse effects were fever (76.5%), malaise (73%), and anxiety (63%). These results highlight the importance of strengthening continuous training and improving the coordination among various healthcare sector stakeholders to reduce vaccine hesitancy, enhance healthcare expertise, and ensure the effectiveness of vaccination campaigns during current and future pandemics. Full article
(This article belongs to the Special Issue Post-Pandemic Challenges: Endemic COVID-19, Vaccine Hesitancy, and Viral Resurgence)
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20 pages, 7746 KiB  
Article
Clinical Characteristics and Outcomes of Hospitalized COVID-19 Patients with Different Variants of SARS-CoV-2 in a Tertiary Care Hospital, Thailand
by Kitchawan Hengkrawit, Juthamas Thananon, Kritakarn Telapol and Chirawat Chiewchalermsri
Trop. Med. Infect. Dis. 2024, 9(11), 266; https://doi.org/10.3390/tropicalmed9110266 - 5 Nov 2024
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Abstract
The different strains of SARS-CoV-2 were detected and labeled in 2021. Each strain differs in both clinical symptoms and severity. Previous studies found different clinical symptoms and treatment outcomes between outbreak waves; however, data in Southeast Asia were limited. This study collected data [...] Read more.
The different strains of SARS-CoV-2 were detected and labeled in 2021. Each strain differs in both clinical symptoms and severity. Previous studies found different clinical symptoms and treatment outcomes between outbreak waves; however, data in Southeast Asia were limited. This study collected data of hospitalized COVID-19 patients from a Tertiary hospital in Thailand between January 2020 and December 2023 and analyzed patients’ data in each outbreak wave using Pearson’s chi-square. A total of 1084 inpatients were included for analysis. The median age was 64 (IQR, 0.4–100) years. The patients were hospitalized in predominantly Alpha (22.78%), Delta (21.68%), and Omicron (5.07%) periods of the virus outbreak. The largest age group was elderly (over 65 years old) in all three variant of concern (VOC) periods; 82.65% of the patients had comorbidities, including 58.5% hypertension, 46.5% dyslipidemia, and 42.0% diabetes mellitus (DM). The study found pneumonia at 67.53%, septic shock at 4.61%, acute respiratory distress syndrome (ARDS) at 2.86%, and congestive heart failure at 0.83% in all age groups with no significant difference between outbreak periods. The overall mortality rate was 16.14%. A total of 75% of deaths occurred in patients over 65 years old. The mortality rates in each VOC period were 20.0% Delta, 19.83% Alpha, and 13.23% Omicron. In the elderly group, the mortality rates were Delta 15.32%, Alpha 11.75%, and Omicron 10.88%. The Omicron VOC was less severe than other variants, particularly in the elderly (≥65 years). There were no significant differences in the younger (<65 years) age group. The elderly still had more severe symptoms and the highest mortality rates in every wave of outbreak. Full article
(This article belongs to the Special Issue Post-Pandemic Challenges: Endemic COVID-19, Vaccine Hesitancy, and Viral Resurgence)
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Review

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21 pages, 541 KiB  
Review
Alterations and Dynamics of Major Meningitis Etiological Agents During and Post-COVID-19 Pandemic: A Systematic Review
by Luís Arthur Brasil Gadelha Farias, Larissa Santos Weyne, Lenifer Siqueira Landim, Pablo Eliack Linhares de Holanda, Aliniana da Silva Santos, Luciano Pamplona de Góes Cavalcanti, Lourrany Borges Costa, Antonio Gutierry Neves Dantas de Melo, Melissa Soares Medeiros, Evelyne Santana Girão, Tânia Mara Silva Coelho and Lauro Vieira Perdigão Neto
Trop. Med. Infect. Dis. 2025, 10(3), 81; https://doi.org/10.3390/tropicalmed10030081 - 18 Mar 2025
Viewed by 795
Abstract
The transmission dynamics of many pathogens were altered during the coronavirus disease 2019 (COVID-19) pandemic. Several factors, including control measures and social distancing, have influenced the circulation and epidemiology of major etiological agents of meningitis during this period. This review examined trends in [...] Read more.
The transmission dynamics of many pathogens were altered during the coronavirus disease 2019 (COVID-19) pandemic. Several factors, including control measures and social distancing, have influenced the circulation and epidemiology of major etiological agents of meningitis during this period. This review examined trends in the primary etiologic agents of meningitis during and after the COVID-19 pandemic. A comprehensive literature search was conducted using the MEDLINE, Embase, LILACS, and SciELO databases for studies published between 2020 and 2024. The data were summarized descriptively and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-eight studies are included in this review. Bacterial and viral meningitis pathogens exhibited significant epidemiological shifts during the pandemic. A marked decline in infections caused by the enteroviruses, Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae was observed from 2020 to 2021 in the northern and southern hemispheres during the pandemic. Post-pandemic, meningitis cases increased, with a resurgence in various countries. Despite the heterogeneity of the studies, the evidence indicates that the COVID-19 pandemic significantly affected the epidemiology of meningitis-causing microorganisms during and after the pandemic. Understanding these epidemiological shifts and dynamics is crucial for defining the control measures, vaccination strategies, and public health policies in the post-COVID-19 era. Full article
(This article belongs to the Special Issue Post-Pandemic Challenges: Endemic COVID-19, Vaccine Hesitancy, and Viral Resurgence)
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