Search Results (8,953)

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

Background: The COVID-19 pandemic exposed major vulnerabilities in healthcare accessibility and may have influenced preventive attitudes among people living with HIV (PLWH). However, the relationship between pandemic-related healthcare experiences and vaccination uptake remains insufficiently understood. Materials: A cross-sectional survey was conducted among 203 adults living with HIV receiving follow-up care in Romania between October 2025 and March 2026. The questionnaire evaluated vaccination uptake, vaccine-related perceptions, healthcare information sources, and pandemic-related experiences. Multivariable logistic regression analysis was performed to identify factors independently associated with vaccination uptake. Results: Only 38.9% of participants reported receiving at least one vaccine within the previous three years. The main barriers to vaccination were perceived lack of necessity, lack of physician recommendation, fear of adverse effects, and lack of trust. Multivariable logistic regression identified positive vaccine-related beliefs (OR = 0.454, 95% CI: 0.235–0.876, p = 0.019) and CD4+ T-cell count above 500 cells/mm³ (OR = 0.448, 95% CI: 0.232–0.867, p = 0.017) as independently associated with lower odds of being non-vaccinated. More than half of participants (52.7%) reported at least one pandemic-related disruption or negative health impact. The pandemic-related negative impact composite was not significantly associated with vaccination status (p = 0.209), whereas confirmed COVID-19 infection was more frequent among vaccinated participants than among non-vaccinated participants (43.0% vs. 28.2%, p = 0.030). Pandemic-related negative impact was associated with a greater demand for physician-provided information (p = 0.011). Conclusions: Pandemic-related healthcare experiences were associated with greater demand for physician-provided preventive information, while confirmed COVID-19 infection was more frequent among vaccinated participants. Positive vaccine-related beliefs and higher CD4+ T-cell counts were independently associated with vaccination uptake, while lack of physician recommendation remained a major barrier to vaccination. These findings emphasize the critical role of physicians in improving vaccination coverage among people living with HIV in the post-pandemic era. Full article

Background: COVID-19 vaccination has demonstrated a favorable safety profile in children; however, factors associated with the occurrence of adverse events (AEs) following immunization remain insufficiently characterized. This study aimed to identify the demographic and clinical factors associated with AEs following COVID-19 vaccination in children aged 5–11 years. Methods: We conducted an ambispective observational cohort study in Madrid, Spain, including children aged 5–11 years vaccinated with the 10 µg formulation of BNT162b2 (Comirnaty^®, Pfizer-BioNTech). Data were obtained from vaccination registries, electronic health records, and structured telephone interviews with parents or legal guardians. Demographic characteristics, anthropometric variables, previous SARS-CoV-2 infection, medical history, and concomitant medication use were evaluated. Univariable analyses and multivariable logistic regression were performed to identify factors independently associated with the occurrence of suspected AEs. Results: A total of 2026 children were included. Suspected AEs were reported in 759 participants (37.5%). In univariable analyses, greater weight, height, pre-existing medical conditions, concomitant medication use, clinically vulnerable status, and previous SARS-CoV-2 infection were significantly associated with AEs. In the multivariable model, previous SARS-CoV-2 infection (OR 4.07, 95% CI 3.13–5.30), number of concomitant medications (OR 7.77, 95% CI 5.22–11.56), number of pre-existing medical conditions (OR 1.86, 95% CI 1.62–2.14), and height (OR 1.03, 95% CI 1.01–1.04) remained independently associated with AEs. Age, sex, body mass index, and clinically vulnerable status were not independently associated with AE occurrence. Conclusions: In this large real-world pediatric cohort, previous SARS-CoV-2 infection, comorbidity burden, and concomitant medication use were independently associated with adverse events following COVID-19 vaccination. These findings suggest that underlying clinical complexity may be a more important determinant of post-vaccination reactogenicity than demographic characteristics and support the value of individualized pre-vaccination assessment in pediatric populations. Full article

Objective: To evaluate the association between 9-valent human papillomavirus (HPV9) vaccination and the risk of new-onset juvenile idiopathic arthritis (JIA), with particular attention to sex-specific differences, including the relative lack of evidence in males and the potential impact of the COVID-19 pandemic. Patients and Methods: Using the TriNetX U.S. Collaborative Network (2016–2023), children aged 9–13 years who received HPV9 vaccination were compared with unvaccinated controls in prepandemic and pandemic periods. Incident JIA was assessed using matched cohort analyses and time-to-event methods. Results: Similar sex-specific patterns were observed across both periods. HPV9 vaccination was associated with a lower risk of JIA among girls (HR = 0.45 95% CI = 0.22–0.95 in prepandemic and HR = 0.36 95% CI = 0.17–0.74 during pandemic period), while no increased risk was observed among boys (HR = 1.57 95% CI = 0.67–4.05 in prepandemic and HR = 1.14 95% CI = 0.56–2.34 during pandemic period). Among unvaccinated individuals, girls consistently exhibited a higher incidence of JIA than boys. The COVID-19 pandemic did not alter these associations. Conclusions: HPV9 vaccination was not associated with an increased risk of JIA in either sex. A consistent sex-specific pattern was observed across both study periods, with a lower risk of JIA among vaccinated girls but not boys. This finding suggests a potential sex difference in the association between HPV9 vaccination and JIA and warrants further investigation. However, residual confounding, including healthy-vaccinee bias and differences in healthcare utilization, cannot be fully excluded. Full article

Background: In Gulf nations such as Saudi Arabia, where COVID-19 vaccination is optional, parental decision-making regarding vaccinating children is critical. Understanding the psychological factors that drive these decisions can shape future vaccination strategies. Methods: Between November 2021 and January 2022, a cross-sectional, web-based validated survey was conducted using chain-referral (snowball) sampling across multiple social media platforms. A total of 2176 parents residing in Saudi Arabia with children aged 5–18 years participated. The 5C psychological antecedents (confidence, complacency, constraints, calculation, and collective responsibility) were assessed. Multinomial logistic regression was employed to determine factors influencing parental decision-making across three child age groups: 5–11 years only, 12–18 years only, and both age ranges (5–18 years). Results: Overall, 77.9% of parents agreed to receive all scheduled doses of the COVID-19 vaccine themselves, while 58.6% agreed to vaccinate children aged 12 years or older, and only 41.9% agreed to vaccinate children younger than 12 years. Fathers were significantly more likely to accept vaccination [Odds ratio (OR) = 17.48, p = 0.01] compared to mothers, who showed higher reluctance (OR = 15.08, p = 0.01). Having a child aged 5–11 years increased reluctance threefold (OR = 3.16, p = 0.01). Parents who believed that returning to school was safe showed increased vaccine acceptance (OR = 4.32, p = 0.01). Confidence and collective responsibility were the strongest positive predictors of vaccine acceptance, particularly for younger children, with OR estimates of 1.23–1.53 for confidence and 1.33–2.13 for collective responsibility. Conversely, extensive information seeking (calculation) was associated with lower acceptance (OR = 0.09, p = 0.03). A history of COVID-19 hospitalization among family or friends was significantly associated with increased parental reluctance (p = 0.03). Conclusions: This study identifies key psychological and demographic factors influencing parental decisions regarding COVID-19 vaccination for children. Building parental confidence and fostering collective responsibility are essential for increasing vaccination rates, particularly among parents of younger children aged 5–11 years. Healthcare authorities should address vaccine safety concerns, provide clear and accurate information, and tailor strategies to parents who remain hesitant. 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 exacerbated longstanding social and health inequities in predominantly Black and Latino communities in North and Central Brooklyn, in the form of disproportionately high hospitalization and mortality rates. Community organizations served as critical sources of information and resources during this period. Methods: The Bureau of Brooklyn Neighborhood Health within the NYC Health Department, conducted semi-structured virtual interviews with 19 representatives from 15 organizations that had partnered with the Bureau within the past five years. Interviews were conducted between November 2021 and February 2022. Transcripts were coded and analyzed using a hybrid deductive–inductive approach incorporating constant comparative techniques. Results: Partners described worsening food insecurity, inequitable vaccine and testing access, digital divide challenges, funding instability, staffing shortages, and escalating mental health needs. Organizations pivoted from routine operations to provide emergency food distribution, virtual programming, mental health support, advocacy, and disseminating information as trusted messengers in the community. Conclusions: Findings underscore the essential role of local community organizations in crisis response and recovery. Future preparedness efforts must center community expertise, strengthen cross-sector collaboration, streamline funding processes, and investments in social and digital infrastructures to advance health equity and community resilience. Full article

Background/Objectives: Severe acute respiratory syndrome (SARS) remains an important cause of hospitalization and mortality, particularly among vulnerable populations. Understanding the factors associated with previous hospitalization may support more effective prevention and vaccination strategies. This study aimed to analyze the epidemiological profile of previous hospitalization among patients with SARS in the state of Pernambuco, Brazil. Methods: A quantitative, retrospective, cross-sectional study was conducted using data from the Influenza Epidemiological Surveillance System (SIVEP-Gripe), including 79,852 adult patients (≥18 years) notified with SARS in Pernambuco between 2021 and 2024. Sociodemographic, clinical, and vaccination-related variables were analyzed to identify factors associated with previous hospitalization. Results: The prevalence of previous hospital admission (readmission history) was 6.6%. Patients with previous hospitalization had a significantly higher median age compared to those without previous hospitalization (66 vs. 63 years; p < 0.001). The prevalence of previous hospitalization was higher among individuals with chronic comorbidities, particularly hematologic diseases (prevalence ratio [PR] = 1.95; 95% confidence interval [CI]: 1.51–2.51; p < 0.001) and asthma (PR = 1.67; 95% CI: 1.42–1.96; p < 0.001). Influenza vaccination was associated with a lower prevalence of previous SARS hospitalization (PR = 1.29; 95% CI: 1.03–1.61; p = 0.023). In contrast, COVID-19 vaccination status showed no significant association with previous hospitalization. A history of previous SARS hospitalization was associated with a higher prevalence of death in subsequent hospitalizations (PR = 1.09; 95% CI: 1.01–1.18; p = 0.022). Conclusions: Older adults and individuals with chronic comorbidities showed a higher prevalence of previous SARS hospitalization in Pernambuco. The findings show an association between influenza vaccination and a lower prevalence of previous SARS hospitalization and highlight the importance of post-discharge follow-up and epidemiological surveillance. Full article

Background/Objectives: Concern that COVID-19 vaccination causes pulmonary nodules persists because vaccination coincided with expanded computed tomography (CT), low-dose CT (LDCT) screening, post-COVID imaging and artificial intelligence (AI)-assisted detection. This review asks whether the current literature supports causality and how vaccination history should inform thoracic imaging. Methods: A focused search of PubMed, PubMed Central and the Cochrane Library was performed through 15 July 2026. Evidence was classified as direct or contextual; no PRISMA screening, risk-of-bias scoring or quantitative synthesis was performed. Results: Direct evidence remains sparse. One case report was too confounded for inference. A two-sample Mendelian randomization study found no broad lung disease risk signal, but nodules were not modeled and the heterogeneous endpoints were exploratory. An ecological study of 1,616,750 samples linked rising detection to SARS-CoV-2 infection waves and AI-assisted reading; lacking individual vaccination data, it cannot establish whether vaccination affected detection. Screening interruption produced the opposite pattern: Lung-RADS 4 nodules rose from 8% to 29%. The most reproducible post-vaccination thoracic finding is regional lymph-node activation on [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT), an expected immune response rather than a parenchymal nodule. Conclusions: Current evidence is insufficient to establish vaccination as an independent, population-level cause of pulmonary nodules. Vaccination history should guide [18F]FDG-PET/CT interpretation; CT-detected parenchymal nodules warrant standard risk stratification. 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

Population immune pressure from vaccination and prior infection continues to drive the evolution of SARS-CoV-2. Systematic characterization of RBD mutations under complex immune backgrounds is essential for understanding viral adaptation and evolutionary trajectories. Here, we applied a deep mutational scanning (DMS) to comprehensively map the neutralization escape landscape of the Omicron variant JN.1 and its descendant lineage XEC, under immune pressure from individuals who experienced Omicron breakthrough infections following three doses of inactivated vaccines. A neutralization escape map for the single amino acid substitutions in the RBD of JN.1 or XEC was generated, and the escape efficiency of each mutation was determined. The results show that RBD escape mutations are hierarchically organized: low-intensity signals are widespread, whereas high-intensity escape is confined to a few key sites. These escape mutations are not confined solely to the receptor-binding motif (RBM) but are broadly distributed across the entire RBD. Many escape sites could accommodate multiple amino acid substitutions. Integration of DMS data with genomic surveillance of circulating variants from 2024 to 2025 revealed significant overlap between experimentally identified escape sites and mutations observed in natural isolates. This overlap increased substantially in 2025, with site concordance rising from 27.17% and 26.81% to 45.09% and 47.10% for JN.1 and XEC, respectively. The natural prevalence of these escape mutations is further shaped by factors such as receptor-binding affinity, protein stability, and epistatic interactions. Overall, our findings suggest that SARS-CoV-2 antigenic evolution follows the pattern of multiple pathways within a constrained space, providing new insights into the adaptive mechanisms of Omicron-derived variants under hybrid immune pressure. Full article

Background/Objectives: Neurocognitive disorders represent a growing burden among older adults. Although respiratory vaccines have demonstrated efficacy and safety in preventing acute respiratory events, their potential impact on the development of chronic neurocognitive disorders, such as cognitive impairment, dementia, and Alzheimer’s disease (AD), has not been extensively explored. The objective of this scoping review was to synthesize and analyze the available evidence on the association between respiratory vaccination and the risk of developing cognitive impairment, dementia, and Alzheimer’s disease. Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. A literature search was performed in the PubMed, Scopus, and Web of Science databases through 15 June 2026. Studies involving older adults (≥60 years), irrespective of their baseline neurocognitive status, were included. Observational studies (cohort and case–control studies) were considered. Editorials, narrative reviews, and other non-original articles were excluded. Results: Eighteen studies were included, with cohort studies being the predominant design. Four main categories of respiratory vaccines were evaluated: influenza, COVID-19, respiratory syncytial virus (RSV), and pneumococcal vaccines, in relation to the risk of cognitive impairment, dementia, and AD. Influenza vaccination was associated with a lower risk of dementia and AD, with a potential dose–response relationship observed, whereby a greater number of vaccinations was associated with a greater reduction in risk. Pneumococcal vaccination was also associated with a lower risk of dementia and AD, particularly among individuals who received a greater number of vaccine doses. In contrast, the evidence regarding COVID-19 and RSV vaccines was limited and yielded heterogeneous findings. Conclusions: Influenza and pneumococcal vaccination maybe associated with a lower risk of Alzheimer’s disease and dementia. However, the evidence regarding COVID-19 and RSV vaccines remains limited, and additional studies are needed to clarify their impact on the risk of developing neurocognitive disorders. Full article

Coronaviruses are responsible for numerous diseases causing substantial morbidity and mortality to both humans and animals. In particular, they have caused three significant outbreaks in humans including severe acute respiratory syndrome 1 (SARS-CoV-1), Middle East respiratory syndrome (MERS-CoV), and, most recently, the severe acute respiratory syndrome 2 (SARS-CoV-2) pandemic. Two relevant veterinary diseases are porcine transmissible gastroenteritis virus (TGEV) and porcine epidemic diarrhea virus (PEDV), which cause severe losses in the pork industry. While efficacious vaccines were developed in an unprecedented timeframe for COVID-19, vaccines have not been commercialized for other human coronaviruses and vaccines against animal coronaviruses have limited efficacy and logistical challenges in administration. There is a clear need for more efficacious vaccines with simpler methods of delivery and administration for both human and veterinary use. The production of subunit vaccines in plant systems holds great promise in addressing the current challenges and facilitate the preparation for future potential outbreaks and new viruses. This review will summarize the state of development of vaccines in plant systems including tobacco, rice, maize, and others. Full article

Background/Objectives: Autoimmune and immune-mediated adverse events coded in reports listing COVID-19 vaccines as suspect products are rare, heterogeneous, and difficult to evaluate in spontaneous reporting systems. We characterized autoimmune reporting signals using strict case definitions and an active-comparator disproportionality design. Methods: FAERS reports from 2021Q1 to 2023Q4 were deduplicated and harmonized by vaccine product, platform, sex, age group, and MedDRA Preferred Term (PT). COVID-19 vaccine reports recorded as primary or secondary suspect products were compared with traditional non-COVID vaccine reports. Strict autoimmune events were grouped into neurological, endocrine, rheumatological, hematological, dermatological, and cardiac categories. Reporting odds ratios (RORs), proportional reporting ratios (PRRs), PT-level rankings, masking audits, and sensitivity analyses were evaluated. Results: The primary analysis included 4191 COVID-19 vaccine reports, 2817 comparator reports, and 311 strict-autoimmune reports contributing 316 report-category observations. Positive category-level signals were identified for dermatological (ROR 10.49; 95% CI: 2.51–43.86), endocrine (ROR 5.39; 95% CI: 1.24–23.48), hematological (ROR 4.68; 95% CI: 2.32–9.44), and neurological events (ROR 1.63; 95% CI: 1.16–2.29). Rheumatological reporting was lower, strict cardiac events were absent, and hematological signals were most consistent across sensitivity analyses. Among five adjusted-positive finite PT signals, immune thrombocytopenia was more stable, multiple sclerosis intermediate, and acquired hemophilia, myasthenia gravis, and optic neuritis sparse/imprecise. A post hoc audit identified four potential clusters among 20 acquired-hemophilia reports; cluster collapse reduced the ROR to 2.70 (95% CI 0.30–24.18; p = 0.654). Conclusions: These findings are hypothesis-generating and do not establish incidence, absolute risk, or causality. Full article