Incubation Period and Serial Interval of Mpox in 2022 Global Outbreak Compared with Historical Estimates.

Understanding changes in the transmission dynamics of mpox requires comparing recent estimates of key epidemiologic parameters with historical data. We derived historical estimates for the incubation period and serial interval for mpox and contrasted them with pooled estimates from the 2022 outbreak. Our findings show the pooled mean infection-to-onset incubation period was 8.1 days for the 2022 outbreak and 8.2 days historically, indicating the incubation periods remained relatively consistent over time, despite a shift in the major mode of transmission. However, we estimated the onset-to-onset serial interval at 8.7 days using 2022 data, compared with 14.2 days using historical data. Although the reason for this shortening of the serial interval is unclear, it may be because of increased public health interventions or a shift in the mode of transmission. Recognizing such temporal shifts is essential for informed response strategies, and public health measures remain crucial for controlling mpox and similar future outbreaks.

Transmission potential of mpox in mainland China, June-July 2023: estimating reproduction number during the initial phase of the epidemic.

Despite reporting very few mpox cases in early 2023, mainland China observed a surge of over 500 cases during the summer. Amid ambiguous prevention strategies and stigma surrounding mpox transmission, the epidemic silently escalated. This study aims to quantify the scale of the mpox epidemic and assess the transmission dynamics of the virus by estimating the effective reproduction number (Re) during its early phase. Publicly available data were aggregated to obtain daily mpox case counts in mainland China, and the Re value was estimated using an exponential growth model. The mean Re value was found to be 1.57 (95% credible interval [1.38-1.78]), suggesting a case doubling time of approximately 2 weeks. This estimate was compared with Re values from 16 other countries' national outbreaks in 2022 that had cumulative case count exceeding 700 symptomatic cases by the end of that year. The Re estimates for these outbreaks ranged from 1.13 for Portugal to 2.31 for Colombia. The pooled mean Re was 1.49 (95% credible interval [1.32-1.67]), which aligns closely with the Re for mainland China. These findings underscore the need for immediate and effective control measures including targeted vaccination campaigns to mitigate the further spread and impact of the epidemic.

The first laboratory-confirmed neonatal Mpox infection in Sri Lanka.

In 2022-2023, a global outbreak of Mpox was reported especially in nonendemic countries. We report the first laboratory-confirmed neonatal case of Mpox infection complicated by bronchopneumonia in Sri Lanka.

Analysing features of home-based workout during COVID-19 pandemic: a systematic review.

OBJECTIVE: Since the beginning of the COVID-19 pandemic, a decrease in physical activity (PA) related to home confinement has been reported worldwide. However, some individuals were able to engage in physical activities at home. Thus, in a perspective of public health, it may be useful to analyse the available evidence regarding PA adopted during home restrictions, in order to identify possible strategies to help people stay active even during emergency situations. The aim of this review was to analyse how healthy individuals spontaneously exercised at home in the course of the pandemic, in order to detect possible factors associated with this behaviour. STUDY DESIGN: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS: The protocol was registered in PROSPERO, an international prospective register of systematic reviews, with the registration number CRD42023394673. A literature search was conducted in PubMed, Scopus, and Web of Science. Cross-sectional studies published in English from the inception of each database to February 06th 2023 and focused on healthy individuals practicing spontaneous PA/exercise at home during the pandemic were considered eligible. The quality assessment was performed using the adapted Newcastle-Ottawa Quality Assessment Scale. Bibliographic information, sample size, study paricipant/population with age, gender, ethnicity, socioeconomic status, education, smart workers or not, anthropometric parameters, characteristics of at home exercises, athletic status and sedentariness, associated health-related effects, and main findings were synthetised. RESULTS: From 504 articles, 19 were included. Notwithstanding the differences in the studies examined, the majority of them reported that previous PA level was associated with exercise in such challenging conditions. Furthermore, technologies aimed at supporting exercise were shown to be a useful resource. CONCLUSIONS: Being habitually active and using digital supports may be associated with a positive attitude towards exercise at home during isolation. This suggests that in emergency situations, exercise should be promoted, also through digital media, especially among those groups who are usually less engaged in PA. Further analyses of longitudinal studies are needed to confirm these findings.

Human Monkeypox Experience in a Tertiary Level Hospital in Milan, Italy, between May and October 2022: Epidemiological Features and Clinical Characteristics.

BACKGROUND: Monkeypox virus (mpxv) started to spread to Europe and North America at the beginning of the current outbreak in May 2022, and the World Health Organization (WHO) declared Human Monkeypox (mpox) as a public health emergency of international concern (PHEIC) in July 2022. The aim of this observational analysis is to describe demographical data, symptoms presentation and clinical course till outcome of individuals diagnosed with mpox, between May and October 2022, at our open-access Sexual Health Clinic in IRCCS San Raffaele Hospital in Milan, Italy. METHODS: Among people who accessed our Sexual Health Clinic, we considered, as suspected diagnosis of mpox, individuals with consistent symptoms and epidemiological criteria. Following the physical examination, oropharyngeal, anal, genital and cutaneous swabs, plus plasma, urine and seminal fluid were collected as biological materials to detect mpxv DNA. We also performed a screening for sexually transmitted infections (STIs). RESULTS: Overall, 140 individuals with mpox were included in this study. Median age was 37 (interquartile, IQR 33, 43) years old. Males were 137 (98%) and men who have sex with men (MSM) were 134 (96%). As risk factors, we detected travels abroad in 35 (25%) individuals and close contact with mpox cases in 49 (35%). There were 66 (47%) people living with HIV (PLWH). Most frequent symptoms were fever (59%), lymphadenopathy (57%), cutaneous (77%), genital (42%), anal (34%) and oral (26%) lesions, proctitis (39%), sore throat (22%) and generalized rash (5%). At mpox diagnosis, we also observed N. gonorrhoeae in 18 (13%) cases, syphilis in 14 (10%) and C. trachomatis in 12 (9%). Two (1%) people received a concomitant diagnosis of HIV infection. We attended to 21 (15%) complications, with nine (6%) cases of hospitalization including six (IQR 3,7) median hospital days. Forty-five (32%) patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs), 37 (26%) with antibiotics and eight (6%) with antiviral drugs. CONCLUSIONS: Similarly to other international cohorts, sexual transmission was most frequently present, and concomitant STIs were common. Symptoms were heterogenous, self-resolving and responsive to therapy. Hospitalization was necessary in few patients. There is uncertainty about the future development of mpox and further studies (e.g., potential disease reservoirs, other possible means of transmission, predictors of severe disease) are still needed.

Facilitating the deployment of Japanese human resources for responding global outbreaks of emerging and Re-emerging infectious diseases: A cross-sectional study.

INTRODUCTION: In response to global outbreaks of infectious diseases, the need for support from organizations such as the World Health Organization Global Outbreak Alert and Response Network (GOARN) is increasing. Identifying the obstacles and support needs for applicants could increase GOARN deployments from Japan. METHODS: This cross-sectional study involved a web-based, self-administered questionnaire survey targeting Japanese participants in the GOARN Tier 1.5 training workshop, held in Tokyo in December 2019. RESULTS: All 47 Japanese participants in the workshop responded to the survey. Most responders were male and in their 30s and 40s. Participants specialized in case management (42.6%), infection prevention and control (25.6%), epidemiology and surveillance (19.1%). Only two participants (4.6%) had experienced a GOARN deployment. Their motivations for joining the GOARN training workshop were "Desire to be part of an international emerging infectious disease response team" (44.6%), "Interest in making an international contribution" (19.1%), and "Interest in working for the Japanese government in the field of international infectious diseases" (14.9%). Obstacles to GOARN deployments were "Making time for deployments" (45.7%) and "Lack of required professional skills and knowledge" (40.4%). The support needs for GOARN deployments constituted "Periodic simulation training" (51.1%), "Financial support during deployments" (44.7%), and "Technical support for deployments" (40.4%). CONCLUSIONS: Our study revealed the obstacles and support needs of Japanese candidates for GOARN deployment. Making time and upskilling for GOARN deployment were the main obstacles. More practical training (like GOARN Tier 2.0) with other supports are needed. The national framework is desirable to realize these supports.

COVID-19: morphology and mechanism of the SARS-CoV-2, global outbreak, medication, vaccines and future of the virus.

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a lethal virus that was detected back on 31st December 2019 in Wuhan, Hubei province in China, and since then this virus has been spreading across the globe causing a global outbreak and has left the world fighting against the virus. The disease caused by the SARS-CoV-2 was named COVID-19 and this was declared a pandemic disease by the World Health Organization on 11th March 2020. Several nations are trying to develop a vaccine that can save millions of lives. This review outlines the morphological features of the virus describing the outer and inner structures of the virus along with the entry mechanism of the virus into the host body and the infection process. Detailed reports of global outbreak along with preventive measures have also been included, with special emphasis on China, the United States of America, India, Italy, and South Korea. Broad-spectrum antiviral drugs being used at various health care centres around the world, namely Remdesivir, Camostat & Nafamostat, Famotidine, Chloroquine & Hydroxychloroquine, Lopinavir/ritonavir, Ivermectin, and Tocilizumab & Sarilumab have also been included. World Health Organization guidelines on preventive measures and use of soaps, alcohol-based hand-rubs and wearing face masks have also been described. The vaccines that are in one of the phases of human trials, namely Oxford University's vaccine, the United States-based Moderna's vaccine, India's Covaxin and the Russian vaccine, have also been incorporated in the review article.

Global Pandemicity of COVID-19: Situation Report as of June 9, 2020.

A novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, China in December 2019. This cluster quickly spread across the globe and led the World Health Organization (WHO) to declare severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic on March 11, 2020. It's sudden emergence, ceaseless human-to-human transmission, and rapid spread has led to continuous pandemicity. As of June 9, 2020, there were 7 039 918 confirmed cases and 404 396 deaths globally. The rate of spread of COVID-19 is affected through respiratory droplets, most commonly when infected individuals cough or talk. The virus is released through respiratory secretions that infect individuals once contact with mucous membranes is made directly or indirectly. Our research was conducted via an electronic literature review on PubMed, Google Scholar, and MedLine Plus. Data were then collected from peer-reviewed articles that included applicable keywords and published between January 1, 2020, and June 9, 2020. This article highlights the rapid spread of SARS-CoV-2 worldwide and indicates a higher number of mortalities in the elderly and those with comorbidities. As the number of cases increases, an immediate need to "flatten the curve" is essential to avoid catastrophic overwhelming of hospital systems across the affected countries. To do so, there is an emphasis on detection, testing, isolating the infected, and organizing the healthcare response to the virus. The rapid spread of infection has impacted over 200 countries and territories to date. This report takes a closer look at the cases, fatalities, and recoveries in different regions of the world with details regarding the geographic scale of SARS-CoV-2 spread, risks, and the subsequent impact on the countries affected. Also, this report discusses some effective measures that were carried out by some countries that helped them to mitigate the pandemic and flatten the curve of COVID-19 spread as early as possible.

Recent Advancements on COVID-19: A Comprehensive Review.

Over the last few decades, there have been several global outbreaks of severe respiratory infections. The causes of these outbreaks were coronaviruses that had infected birds, mammals and humans. The outbreaks predominantly caused respiratory tract and gastrointestinal tract symptoms and other mild to very severe clinical signs. The current coronavirus disease-2019 (COVID-19) outbreak, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a rapidly spreading illness affecting millions of people worldwide. Among the countries most affected by the disease are the United States of America (USA), India, Brazil, and Russia, with France recording the highest infection, morbidity, and mortality rates. Since early January 2021, thousands of articles have been published on COVID-19. Most of these articles were consistent with the reports on the mode of transmission, spread, duration, and severity of the sickness. Thus, this review comprehensively discusses the most critical aspects of COVID-19, including etiology, epidemiology, pathogenesis, clinical signs, transmission, pathological changes, diagnosis, treatment, prevention and control, and vaccination.

Epigallocatechin gallate and theaflavin gallate interaction in SARS-CoV-2 spike-protein central channel with reference to the hydroxychloroquine interaction: Bioinformatics and molecular docking study.

SARS-CoV-2 or COVID-19 pandemic global outbreak created the most unstable situation of human health-economy. In the past two decades different parts of the word experienced smaller or bigger outbreak related to human coronaviruses. The spike glycoproteins of the COVID-19 (similar to SARS-CoV) attach to the angiotensin-converting enzyme (ACE2) and transit over a stabilized open state for the viral internalization to the host cells and propagate with great efficacy. Higher rate of mutability makes this virus unpredictable/less sensitive to the protein/nucleic acid based drugs. In this emergent situation, drug-induced destabilization of spike binding to RBD could be a good strategy. In the current study we demonstrated by bioinformatics (CASTp: computed atlas of surface topography of protein, PyMol: molecular visualization) and molecular docking (PatchDock and Autodock) experiments that tea flavonoids catechin products mainly epigallocatechin gallate or other like theaflavin gallate demonstrated higher atomic contact energy (ACE) value, binding energy, Ki value, ligand efficiency, surface area and more amino acid interactions than hydroxychloroquine (HCQ) during binding in the central channel of the spike protein. Moreover, out of three distinct binding sites (I, II and III) of spike core when HCQ binds only with site III (farthest from the nCoV-RBD of ACE2 contact), epigallocatechin gallate and theaflavin gallate bind all three sites. As sites I and II are in closer contact with open state location and viral-host contact area, these drugs might have significant effects. Taking into account the toxicity/side effects by chloroquine/HCQ, present drugs may be important. Our laboratory is working on tea flavonoids and other phytochemicals in the protection from toxicity, DNA/mitochondrial damage, inflammation and so on. The present data might be helpful for further analysis of flavonoids in this emergent pandemic situation.

Coronavirus Disease - 2019-nCoV (COVID-19).

According to the World Health Organization (WHO) (2020b), coronaviruses refer to a large family of viruses known to be zoonotic (transmitted from animals to humans) and cause a variety of illnesses from the common cold to more concerning diseases such as severe lower respiratory tract infections (LRTIs). These viruses are called coronaviruses because their surfaces have crown-like spikes and "corona" is the Latin word for crown (WHO, 2020b). The potential community health risk caused by the current coronavirus (2019-nCoV) is high for young children, older adults, persons with comorbid cardiac or respiratory diseases, and immunocompromised individuals because their immune systems may be weak, making them more susceptible to contracting the coronavirus. Other members of the community that are at risk include healthcare and essential community workers at the forefront of this global epidemic, anyone with close person to person contact, and recent travelers to Wuhan and its surrounding provinces in China (Chinazzi et al., 2020). Healthcare and other frontline workers must be knowledgeable and prepared for the global outbreak of the coronavirus.

Energetics and IC50 based epitope screening in SARS CoV-2 (COVID 19) spike protein by immunoinformatic analysis implicating for a suitable vaccine development.

BACKGROUND: The recent outbreak by SARS-CoV-2 has generated a chaos in global health and economy and claimed/infected a large number of lives. Closely resembling with SARS CoV, the present strain has manifested exceptionally higher degree of spreadability, virulence and stability possibly due to some unidentified mutations. The viral spike glycoprotein is very likely to interact with host Angiotensin-Converting Enzyme 2 (ACE2) and transmits its genetic materials and hijacks host machinery with extreme fidelity for self propagation. Few attempts have been made to develop a suitable vaccine or ACE2 blocker or virus-receptor inhibitor within this short period of time. METHODS: Here, attempt was taken to develop some therapeutic and vaccination strategies with a comparison of spike glycoproteins among SARS-CoV, MERS-CoV and the SARS-CoV-2. We verified their structure quality (SWISS-MODEL, Phyre2, and Pymol) topology (ProFunc), motifs (MEME Suite, GLAM2Scan), gene ontology based conserved domain (InterPro database) and screened several epitopes (SVMTrip) of SARS CoV-2 based on their energetics, IC50 and antigenicity with regard to their possible glycosylation and MHC/paratope binding (Vaxigen v2.0, HawkDock, ZDOCK Server) effects. RESULTS: We screened here few pairs of spike protein epitopic regions and selected their energetic, Inhibitory Concentration50 (IC50), MHC II reactivity and found some of those to be very good target for vaccination. A possible role of glycosylation on epitopic region showed profound effects on epitopic recognition. CONCLUSION: The present work might be helpful for the urgent development of a suitable vaccination regimen against SARS CoV-2.

Travel-Associated Zika Cases and Threat of Local Transmission during Global Outbreak, California, USA.

Zika and associated microcephaly among newborns were reported in Brazil during 2015. Zika has since spread across the Americas, and travel-associated cases were reported throughout the United States. We reviewed travel-associated Zika cases in California to assess the potential threat of local Zika virus transmission, given the regional spread of Aedes aegypti and Ae. albopictus mosquitoes. During November 2015-September 2017, a total of 588 travel-associated Zika cases were reported in California, including 139 infections in pregnant women, 10 congenital infections, and 8 sexually transmitted infections. Most case-patients reported travel to Mexico and Central America, and many returned during a period when they could have been viremic. By September 2017, Ae. aegypti mosquitoes had spread to 124 locations in California, and Ae. albopictus mosquitoes had spread to 53 locations. Continued human and mosquito surveillance and public health education are valuable tools in preventing and detecting Zika virus infections and local transmission in California.

The global outbreak alert and response network.

The Global Outbreak Alert and Response Network (GOARN) was established in 2000 as a network of technical institutions, research institutes, universities, international health organisations and technical networks willing to contribute and participate in internationally coordinated responses to infectious disease outbreaks. It reflected a recognition of the need to strengthen and coordinate rapid mobilisation of experts in responding to international outbreaks and to overcome the sometimes chaotic and fragmented operations characterising previous responses. The network partners agreed that the World Health Organization would coordinate the network and provide a secretariat, which would also function as the operational support team. The network has evolved to comprise 153 institutions/technical partners and 37 additional networks, the latter encompassing a further 355 members and has been directly involved in 137 missions to 79 countries, territories or areas. Future challenges will include supporting countries to achieve the capacity to detect and respond to outbreaks of international concern, as required by the International Health Regulations (2005). GOARN's increasing regional focus and expanding geographic composition will be central to meeting these challenges. The paper summarises some of network's achievements over the past 13 years and presents some of the future challenges.

Lessons learned from international responses to severe acute respiratory syndrome (SARS).

In early February 2003, a previously unknown disease causing severe pneumonia was recognised. This disease which is now known as severe acute respiratory syndrome (SARS) is believed to have had its origins in the Guangdong Province of China, and was the cause of a multi-country epidemic resulting in significant morbidity and mortality. The World Health Organization (WHO) has been coordinating the international response to provide the epidemiological, laboratory, clinical and logistic requirements needed to contain this disease.A rapid spread of SARS around the world occurred at its onset, facilitated greatly by air travel. Between November 2002 and July 2003, a total of 8,094 cases and 774 cases were reported from 26 countries worldwide.WHO responded quickly to this multi-country outbreak and on 12 March released a "global alert" about SARS. This was followed by the first WHO travel advisory on 15 March. The Global Outbreak Alert and Response Network was activated, and international experts were brought together to implement enhanced global surveillance systems for SARS.The international community has learned a lot of lessons from the SARS outbreak. Particularly, rapid and transparent information sharing between countries is critical to prevent international spread of the disease. However, information exchange was less than optimal in the early phase of the outbreak.

Lessons learned from international responses to severe acute respiratory syndrome (SARS)

In early February 2003, a previously unknown disease causing severe pneumonia was recognised. This disease which is now known as severe acute respiratory syndrome (SARS) is believed to have had its origins in the Guangdong Province of China, and was the cause of a multi-country epidemic resulting in significant morbidity and mortality. The World Health Organization (WHO) has been coordinating the international response to provide the epidemiological, laboratory, clinical and logistic requirements needed to contain this disease.A rapid spread of SARS around the world occurred at its onset, facilitated greatly by air travel. Between November 2002 and July 2003, a total of 8,094 cases and 774 cases were reported from 26 countries worldwide.WHO responded quickly to this multi-country outbreak and on 12 March released a "global alert" about SARS. This was followed by the first WHO travel advisory on 15 March. The Global Outbreak Alert and Response Network was activated, and international experts were brought together to implement enhanced global surveillance systems for SARS.The international community has learned a lot of lessons from the SARS outbreak. Particularly, rapid and transparent information sharing between countries is critical to prevent international spread of the disease. However, information exchange was less than optimal in the early phase of the outbreak.

Lessons Learned from International Responses to Severe Acute Respiratory Syndrome (SARS)

In early February 2003, a previously unknown disease causing severe pneumonia was recognised. This disease which is now known as severe acute respiratory syndrome (SARS) is believed to have had its origins in the Guangdong Province of China, and was the cause of a multi-country epidemic resulting in significant morbidity and mortality. The World Health Organization (WHO) has been coordinating the international response to provide the epidemiological, laboratory, clinical and logistic requirements needed to contain this disease. A rapid spread of SARS around the world occurred at its onset, facilitated greatly by air travel. Between November 2002 and July 2003, a total of 8,094 cases and 774 cases were reported from 26 countries worldwide. WHO responded quickly to this multi-country outbreak and on 12 March released a “global alert” about SARS. This was followed by the first WHO travel advisory on 15 March. The Global Outbreak Alert and Response Network was activated, and international experts were brought together to implement enhanced global surveillance systems for SARS. The international community has learned a lot of lessons from the SARS outbreak. Particularly, rapid and transparent information sharing between countries is critical to prevent international spread of the disease. However, information exchange was less than optimal in the early phase of the outbreak.