Background:Long COVID-19 has emerged as a growing global public health challenge requiring patient-centred responses, yet its prevalence and management are often underestimated. We aimed to investigate the rehabilitation status and medical choice behaviours among patients with long COVID-19 in China during the Omicron wave. Methods:We conducted a national cross-sectional study and a discrete choice experiment (DCE) in China from 4 July to 11 August 2023. We used the modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) to assess rehabilitation status. We collected preferences for medical choice behaviours of long COVID-19, demographics, health-related factors, and COVID-19 history. We assessed preferences for medical choice behaviours among people with long COVID-19 using mixed logit models. Results:Among 2942 participants health status was significantly poorer than before COVID-19 infection. The prevalence of common symptoms assessed by C19-YRSm ranged from 21.52% to 72.67%, with fatigue (72.67%) being the most common, followed by breathlessness on walking up a flight of stairs (64.96%) and sleep problems (62.95%). Of these symptoms, the majority of participants (15.06-47.65%) reported mild problems. Of the five functional limitations, difficulty with other activities of daily living (31.03%) was the most common, followed by difficulty with communication (28.04%), while difficulty with personal care (9.65%) was the least common. The DCE results showed that the strongest attribute affecting preferences was medical distance (β = -1.135). While seeking healthcare for long COVID-19, people preferred lower out-of-pocket costs, a closer distance, a higher hospital level, nutritional supportive therapies or rehabilitation training, and medical services that integrate traditional Chinese and Western medicine. Conclusions:A substantial proportion of individuals developed long COVID-19 symptoms and functional limitations, most of which were mild. These findings highlight the importance of ongoing screening and comprehensive, tailored rehabilitation services to promote recovery and avert a public health crisis of long COVID-19.

INTRODUCTION:After the WHO prequalified the first vaccine against mpox, we aimed to identify the influence of vaccine attributes on mpox vaccination preferences among the African adults. METHODS:A discrete choice experiment was conducted among 1832 African adults across six countries. Respondents answered eight questions, each requiring them to choose between two hypothetical vaccines, with variations in distance from home to vaccination facilities, cost, effectiveness, duration of the protective effect, supply and side effects. A mixed logit model was employed to estimate vaccination preferences. Willingness to pay and changes in probability were also estimated from the regression coefficients. RESULTS:The strongest vaccine attribute was the higher effectiveness of vaccines (≥90% vs <60%: b=1.196, 95% CI 1.089 to 1.303), then followed by a longer duration of protective effect (lifetime vs <6 months: b=1.053, 95% CI 0.920 to 1.186), a low risk of side effects (<30% vs ≥30%: b=0.495, 95% CI 0.427 to 0.562) and sufficient vaccine supply (sufficient vs limited: b=0.417, 95% CI 0.360 to 0.475). Although compared with a walking distance of 60 min, a walking distance of 45 min was significant (b=0.402, 95% CI 0.296 to 0.508), there was no significant difference for walking distance at 15 and 30 min. Scenario prediction analysis showed that higher vaccine effectiveness (≥90%: 53.55%; 80%-89.99%: 51.41%; 60%-79.99%: 25.85%), a longer duration of protective effect (lifetime: 48.28%; 12-36 months: 25.51%; 6-11 months: 14.39%), lower vaccine costs (US$0: 28.10%; US$20: 25.42%; US$100: 14.34%), a risk of side effects of less than 30% (24.24%) and sufficient vaccine supply (20.57%) all increased the probability of vaccine uptake. Populations living with children preferred vaccines with sufficient supply and lower cost, compared with those living without children. INTERPRETATION:In Africa, alongside providing more reliable mpox vaccines, offering sufficient vaccine free of charge, particularly to those living with children, would encourage higher vaccine uptake.

Background:Infectious diseases remain a major source of health loss, yet long-term, cause-comparable assessments that jointly integrate incidence, disability-adjusted life-years (DALYs), age patterns, and risk attribution for China are fragmented and not comprehensively synthesized within a unified framework. We aimed to evaluate the trends in incidence and DALYs of infectious diseases in China from 2000 to 2023 to inform current priority setting by clarifying long-term trends and changes observed during the COVID-19 pandemic. Methods:Data on the number and rate of incidence and DALYs of five major infectious-disease cause groups (HIV/AIDS and sexually transmitted infections, respiratory infections and tuberculosis, enteric infections, neglected tropical diseases and malaria, and other infectious diseases) and 40 specific infectious diseases in China were obtained from the Global Burden of Disease Study (GBD) 2023. Estimated annual percentage changes (EAPCs) in age-standardized incidence rates (ASIRs) and age-standardized DALY rates (ASDRs) were calculated overall and by sex and age group to quantify temporal trends from 2000 to 2023. We conducted comparative risk assessment using population attributable fractions (PAFs) to quantify risk-attributable DALYs, and decomposition analyses to assess the contributions of population growth, population ageing and epidemiologic change to changes in incident cases, deaths, and DALYs. Sensitivity analyses were also conducted to examine the robustness of the results. Findings:From 2000 to 2023, age-standardized DALY rates declined in four of the five major infectious disease cause groups in China. The largest decrease was observed for enteric infections, with DALY rates falling from 365.4 to 43.8 per 100,000 (EAPC -11.0% [95% CI -12.2 to -9.7]). Among all groups, respiratory infections and tuberculosis had the highest DALY burden throughout the study period, while their DALY rates decreased from 2559.5 to 688.1 per 100,000 (EAPC -8.1% [-9.2 to -7.0]). It's estimated that HIV/AIDS and sexually transmitted infections were the only cause group with an increasing DALY rate, rising from 79.7 to 103.7 per 100,000 (EAPC 1.0% [0.6 to 1.4]). The increase was greatest among adults aged 20-54 years, in whom DALY rates rose from 71.1 to 152.0 per 100,000 (EAPC 3.3% [2.7 to 3.9]). Risk attribution varied by cause and age group. Unsafe sex accounted for most DALYs for sexually transmitted infections excluding HIV and more than 70% of HIV/AIDS DALYs. For lower respiratory infections, child and maternal malnutrition accounted for 42.2% of DALYs in those aged < 20 years, whereas tobacco use accounted for 38.1% in adults aged 20-54 years. Enteric infection DALYs were mainly attributable to unsafe water, sanitation, and handwashing, accounting for more than 70% across age groups. Decomposition analysis showed that epidemiologic change was the main driver of changes in infectious disease burden from 2000 to 2023. Interpretation:China's infectious disease DALY burden declined from 2000 to 2023, but progress was uneven across causes and increasingly concentrated in older adults. Persistent incidence-DALY discordance and heterogeneous age-specific risk profiles indicate that current priority setting should move beyond incidence-led targets towards reducing preventable disability and premature mortality through age- and mechanism-tailored prevention and care. Funding:Prevention and Control of Emerging and Major Infectious Diseases-National Science and Technology Major Project.

BACKGROUND:Intrahepatic cholestasis of pregnancy (ICP) is a multifactorial liver disorder associated with adverse pregnancy outcomes. Chronic hepatitis B (CHB) has been reported with increased risk of ICP, while the clinical characteristics and outcomes of isolated ICP compared with ICP involving CHB remain poorly understood. METHODS:ICP involving CHB was defined as the co-concurrence of ICP with CHB, categorized into immune-tolerant CHB (n=44), inactive CHB (n=86), immune-active CHB (n=127), and grey zone CHB (n=89). Isolated ICP (n=826) was defined as ICP without viral hepatitis, while immune-active CHB with normal elevated total bile acid (TBA) (n=87) serves as controls. RESULTS:Women with ICP involving immune-active CHB experienced the most severe biochemical abnormalities and adverse outcomes, whereas other CHB subgroups exhibited biochemical profiles and outcomes comparable to isolated ICP cases. Assisted reproductive technology (aOR, 1.24), TBA levels (40-99.9 µmol/L-aOR, 1.27, ≥100 µmol/L-aOR, 1.60), and immune-active CHB (aOR, 1.12) were associated with increased risks of composite adverse outcomes. Stratified analysis revealed that TBA ≥40 µmol/L significantly correlated with increased risks of total and iatrogenic preterm birth and neonatal intensive care unit admission (p<0.05); while TBA ≥100 µmol/L was further associated with elevated risks of meconium-stained amniotic fluid and lower Apgar scores (p<0.05). Immune-active CHB women with normal TBA demonstrated relatively higher levels of transaminase but achieved the most favorable pregnancy outcomes. CONCLUSIONS:ICP involving immune-active CHB demonstrated the most severe biochemical abnormalities and adverse pregnancy outcomes, while ICP involving other CHB immune phases showed transient mild biochemical changes and outcomes comparable to isolated ICP. The findings underscore the need to tailor diagnostic, monitoring, and management strategies based on TBA levels and the immune status of CHB.

Dementia and Parkinson’s disease (PD) are among the most prevalent neurological disorders globally. Most previous research has focused on these two diseases in isolation; however, their co-occurrence has rarely been examined, limiting understanding of shared mechanisms and hindering integrated prevention and resource planning. This study aimed to characterize global co-occurrence patterns of dementia and PD from a spatial perspective and to identify the corresponding risk factors underlying this co-burden. We extracted incidence rates of dementia and PD and exposure levels of 58 detailed risk factors among individuals aged ≥ 55 years from the Global Burden of Disease Study 2021 for 204 countries and territories. According to the quartiles of global incidence rates for both diseases, countries were categorized into three co-occurrence regions: consistent, dementia-dominant, and PD-dominant. Machine learning and negative binomial regression were used to screen and quantify key risk factors. A composite risk index was then constructed to assess the combined effects of these factors on global burden. Eighty-two countries were classified as consistent, 65 as dementia-dominant, and 57 as PD-dominant. The spatial distribution of these three regions overlapped substantially with exposure to health-related, dietary, and behavioral risk factors. Five risk factors were identified: high low-density lipoprotein (LDL) cholesterol, alcohol use, and smoking as common factors; kidney dysfunction specific to dementia; and diet high in sugar-sweetened beverages specific to PD. High LDL cholesterol exerted the strongest effect on both dementia (RR = 1.12, 95

Mpox, formerly known as monkeypox, has been spread to more than 100 countries until now. Vaccines are vital measures to protect against mpox infection. However, vaccine hesitancy remains a barrier to achieving widespread vaccination coverage. We aimed to investigate the prevalence of mpox vaccination hesitancy and its associated factors in China. We conducted a cross-sectional survey among 3669 participants aged 18 years and above in China from September 15 to October 9, 2024. The main outcomes measured were the hesitancy to get vaccinated against mpox for oneself and for one's children. Data were analyzed using chi-square tests and logistic regression model. The overall hesitancy rate for mpox vaccination was 28.4% for oneself and 24.5% for one's children. Higher hesitancy was observed among male individuals (30.8%), those aged >40 years (31.2%), married individuals (29.6%), and those with high mpox-related knowledge (30.9%). Multivariable logistic regression analysis showed that females had lower hesitancy (aOR = 0.84, 95% CI: 0.72-0.97), while individuals with high mpox-related knowledge had higher hesitancy (aOR = 1.23, 95% CI: 1.03-1.47). These findings provide valuable data for public health authorities to design effective strategies for mpox vaccination rollout in China.

Research assessing the dynamic landscape of infectious disease vaccine candidates has been limited. We extracted comprehensive data on vaccine candidates through the Pharmcube system as of March 21, 2025, to analyze the latest trends and disparities in the research and development (R&D) landscape for infectious disease vaccines since 2015. The global vaccine R&D landscape comprises 919 candidates. The top three diseases targeted for vaccine R&D are COVID-19 (245 candidates), influenza (118 candidates), and HIV (68 candidates). Among these, 25% (231 candidates) are nucleic acid vaccines, followed by recombinant protein vaccines (125 candidates) and viral vector vaccines (73 candidates). More than 50% of the candidates are in the pre-phase II stage, while nearly 15% are in phase II (144 candidates) or phase III (137 candidates). Of the 36 countries or territories reporting vaccine candidates, China leads with 313 candidates, followed by the USA with 276 candidates and the UK with 63 candidates. The majority of the candidates are being developed independently or collaboratively by private companies/industry in China (289 candidates), France (30 candidates), the Republic of Korea (27 candidates), Germany (26 candidates), the USA (217 candidates), and the UK (43 candidates). The USA, France, and the Republic of Korea mainly predominantly develop mRNA vaccines, while China primarily develops recombinant protein vaccines, and the UK focuses on viral vector vaccines. Strengthening interagency and international cooperation, along with implementing supportive policies, may be effective in accelerating R&D for infectious diseases in the future.

Human mpox (formerly known as monkeypox) historically received little attention until its emergence beyond African countries in 2022. As of September 30, 2024, a total of 109,699 laboratory-confirmed mpox cases have been reported to the World Health Organization (WHO).[1] It has been more than one year since the WHO announced on May 11, 2023, that the mpox epidemic did not constitute a public health emergency of international concern (PHEIC). However, on August 14, 2024, the WHO declared that the upsurge of mpox in the Democratic Republic of the Congo (DRC) and an increasing number of countries in Africa constituted a PHEIC once again. Although the WHO has proposed the "Strategic Framework for Enhancing Prevention and Control of Mpox 2024–2027", controlling and eliminating the mpox from 2024 to 2025, as planned, appears to be a significant challenge.[2] Additionally, various vulnerable populations (such as children, pregnant women, and immunosuppressed individuals), adverse outcomes (such as myocarditis), and hospital management strategies for mpox complicate prevention and control efforts.[3–5] To effectively prevent and control mpox in the public, it is critical to understand the epidemic trends, the threat posed by Clade Ib, and the necessary control measures. Mpox epidemic trends: Over the past two years, the peak of the mpox epidemic has fluctuated across various regions. Since the first mpox case was reported in the UK on May 7, 2022, the epidemic has spread to other continents beyond Africa, including the American region, the Western Pacific region, and the Eastern Mediterranean region.[6] The United States was the first country in the Americas to report an adult male case on May 18, 2022. Two days later, Australia became the first country in the Western Pacific region to report two cases. Subsequently, Morocco reported one case on June 2, 2022, becoming the first country in the Eastern Mediterranean region to do so. At this point, mpox cases have been reported in nearly all five WHO regions.[6] As of September 30, 2024, of the total reported cases, the America region reported the highest total number of cases (65,877), following by European region (28,176), African region (9425), Western Pacific region (4379), South-East Asia region (971), and Eastern Mediterranean region (871).[1] However, it is important not to focus solely on the total number of cases, changes in epidemic trends reflect the current focus and direction of control measures. According to the WHO report, peak time in the European and the Americas regions was July and August in 2022, respectively. Subsequently, the number of cases peaked in Southeast Asia and the Eastern Mediterranean in August 2023, and in the Western Pacific in September 2023. While it appears that the mpox epidemic is no longer as severe, the African region has reported a significant increase in cases during the first half of 2024.[1] As of October 13, 2024, the African region has reported a total of 10,944 laboratory-confirmed cases, with 78.06% of these cases occurring in 2024 across 15 countries.[1] In the first half of 2024 (February 1, 2024 to July 31, 2024), the African region was the most affected, recording 3061 cases and 23 deaths. This was followed by the American region (2236 cases, 0 deaths) and the European Region (837 cases, 2 deaths).[1] The rapidly escalating epidemic in the African region is one of the factors contributing to the renewed declaration of a PHEIC. The population is generally susceptible to mpox. Individuals who have been vaccinated against smallpox may have approximately 85% effectiveness in preventing mpox virus (MPXV) infection.[7] However, during this multi-country mpox outbreak, men who have sex with men (MSM) represent a high-risk population. The MPXV is divided into two distinct clades: Clade I (formerly known as the Congo Basin or Central African clade) and Clade II (formerly known as the West African clade). Furthermore, Clade II is subdivided into two subclades, IIa and IIb. Clade IIb is responsible for the ongoing multicountry outbreak from 2022 to 2024.[8] As of now, Clade IIb remains the predominant epidemic clade affecting MSM through human-to-human sexual contact in countries outside the African continent.[8,9] However, during the years 2022–2023, the initial declaration of a PHEIC was not taken seriously enough, as most MPXV infections were self-limited and characterized by low-level transmission. The rapidly increasing infections in the African region in 2024 suggest that the global transmission dynamics of MPXV are beginning to change. First, the emergence of a new offshoot of Clade I, known as Clade Ib, has complicated the global response to the outbreak. The current outbreak in the DRC is attributed to Clade Ib, which is associated with more severe disease than Clade II.[10] The rapid spread of the Clade Ib, particularly in eastern DRC and neighboring countries, along with its recent detection in Sweden and Thailand, underscores the growing threat of potential international transmission.[8] Up to now, there has been limited research reported on the epidemic characteristics of Clade Ib. The Lancet published an article stating corresponding epidemiological data in the African region is vital for formulating effective mpox prevention plans and policies.[11] According to report from WHO, as of October 13, 2024, the DRC has reported a total of 8207 cases (27 deaths), of which, 6962 cases and 25 deaths occurred in 2024. As of October 13, 2024, 18 countries have reported 8540 confirmed cases and 33 deaths. These data may suggest that Clade Ib had a higher case fatality rate (CFR) and greater transmissibility. However, further research is needed to compare the epidemic characteristics of different clades.[1] Meanwhile, the presence of other spreading clades, including Clade Ia and Clade II in various African countries, indicates that the detection techniques and prognosis assessment need to be more precise.[8] Importantly, the latest study reported that due to the significant mutational potential of MPXV in the future, its spread could be more extensive, potentially affecting demographics beyond the currently impacted.[12] Existing strains and the evolutionary dynamics of MPXV underscore the importance of ongoing surveillance and its implication for public health policy.[12] Additionally, the WHO indicated in 2022 that mpox can be transmitted through respiratory droplets during prolonged face-to-face contact.[13] However, few cases of droplet exposure have been specifically documented, as these are included in the broader category of person-to-person transmission. Some studies have detected the virus in saliva, but the viral load is significantly lower than that found in feces, anal swabs, and crusts, making droplet transmission generally considered less likely.[14,15] Notably, Thailand, as the first Asian country, reported cases of Clade Ib infection through droplet transmission on August 22, 2024. Although more evidence is needed to determine the extent of droplet transmission, the emergence of this case presents a greater challenge to mpox control among the general population. Finally, it is crucial to pay attention to the CFR, particularly among children aged 15 years and younger. During the 2022–2023 period, Laurenson-Schafer et al[16] reported that, compared to the population aged 15–44 years, the risk of hospitalization among children aged 0–4 years increased by 112%. However, this increase was not significant among those aged 5–14 years (adjusted odds ratio [aOR] = 0.81, 95% confidence interval [CI]: 0.44, 1.51).[16] Cases and deaths among adults over 40 years remain infrequent, likely due to residual immunity from the smallpox vaccination campaigns conducted in the 1960s and 1970s.[17] The primary affected population consists of MSM, who exhibit a low CFR; consequently, the CFR among children during the 2022–2023 multicountry outbreak has not received adequate attention. One meta-analysis indicated that, among children under 10 years old, the CFR was nearly 100% from 1970 to 1990.[18] Across all countries, the calculated pooled estimate of the CFR was 8.7% prior to 2022.[18] However, a surge in cases caused by Clade Ib has been associated with a higher CFR (reported to be as high as 10%) compared to the Clade II, which was responsible for the 2022–2023 global outbreak.[17] The deaths are concentrated in children aged 15 years and younger (nearly 78%), and even stillbirths in 2024.[19,20] In contrast, there was 37.5% (6/16) of deaths occurred in children under 10 years old from 2000 to 2019.[18] The higher CFR and the surge in child deaths during the first half of the year are raise concerning. Our focus should not only be on the rapid spread of Clade Ib among adults through close physical contact but also on the shifting affected groups, particularly children, through households transmission.[8] The threat posed by Clade Ib underscores the need for further research on epidemic characteristics (i.e., transmission parameters, risk factors, transmission risks from various types of contact, and severity risk factors), detection methods, and vaccine effectiveness. Prevention and control measures: Important actions must be taken to address this challenge [Supplementary Figure 1, https://links.lww.com/CM9/C292]. First, it is essential to strengthen surveillance, case management, and public health education. The Centers for Disease Control and Prevention (CDC) should enhance the timeliness and accuracy of disease surveillance capacity. In epidemic areas, there is an urgent need for improved surveillance to monitor the growth of mpox epidemics and the transmission dynamics of new virus strains, which is critical for advanced planning and resource allocation, including medical care and vaccination. New surveillance tools, such as environmental monitoring through wastewater analysis, should be consistently developed. Wastewater samples have been utilized to track the presence of the MPXV, drawing on the experience of wastewater monitoring during the coronavirus disease 2019 (COVID-19) pandemic in USA, as proposed by the CDC.[21] Additionally, in non-epidemic countries, customs checkpoints should strictly prevent the importation of the virus and enhance monitoring of individuals traveling from high-risk countries to mitigate the risk of local outbreaks. In line with the previous epidemic trends, it is crucial to emphasize dynamic and timely assessments for evaluating imported risk. Factors such as the volume of exchanges, their nature (travel, work, study, etc.), and the epidemic severity of the area of stay should be considered in the import risk assessment. Given that Cade Ib may have a higher likelihood of droplet transmission and a greater CFR, the case management should be adjusted promptly. Furthermore, hospital-based disease surveillance and case management should be adopted, as they paly critical roles in clinical diagnosis and treatment.[4] Enhancing the capacity for human resource management, healthcare professional education, and facilities and resource management is essential to counteract the upsurge of cases in epidemic area.[4] Additionally, precise clinical diagnosis and laboratory testing, appropriate operational medical equipment, and effective case classification management should be integral components of hospital-based disease surveillance and case management. The WHO has issued guidance on clinical management and infection prevention and control for mpox in 2022.[22] The WHO has also listed the first mpox in vitro diagnostic under its Emergency Use Listing procedure, marking a significant step toward improving global access to mpox testing.[23] Precise clinical assessment tools, such as visual assessment for lesions and robust biological indicators to diagnose Clade I and predict severe outcomes in the early stages, may prove to be more effective than limited point-of-care tests.[24] The most important aspect of public health education is to maintain measures such as reducing travel to affected countries and unsafe sex. Considering the high CFR and the potential for household transmission among children, it is essential to disinfect clothing, supplies, and any potentially contaminated environments before returning home. This practice will help prevent indirect contact with children through contaminated materials and reduce the risk of household transmission. Family members are advised to seek medical care immediately and avoid contact with children if they have been in the DRC or its neighboring countries in the last 21 days and develop suspected symptoms.[25] Secondly, in addition to avoiding close contact with suspected cases, vaccination against mpox remains the most effective strategy for individuals, particularly given the high CFR in children.[26] Several potential vaccine candidates are under consideration, including modified vaccinia Ankara-Bavarian Nordic (MVA-BN), LC16m8, ACAM2000, BNT166a, and BNT166c.[8] On September 13, 2024, the WHO approved an application for emergency authorization for the use of MVA-BN. While MVA-BN is currently not licensed for individuals under 18 years of age, this vaccine may be used in children in outbreak settings where the benefits of vaccination outweigh the potential risks.[27] Meanwhile, the effectiveness and safety of these vaccines, along with their delivery, production scalability, and equitable access, still need to be addressed in the current outbreak.[2,8] More long-term studies are being conducted to monitor the durability of immune responses and to determine the need for booster doses, which will be critical in shaping future vaccination strategies and policies.[8] However, an immediate plan is urgently needed for the development and deployment of a vaccination strategy that prioritizes sex workers and other vulnerable populations at risk.[26] It should be emphasized that there is insufficient evidence to confirm the safety and effectiveness of vaccinations in children. In response to the current outbreak, international cooperation is of utmost importance. Information sharing regarding vaccine development, clinical evaluation, and surveillance methods for Clade Ib, is interconnected. The allocation of medical resources including human resources, pharmaceuticals, and vaccines, through international collaboration among public and private entities is essential to prevent epidemics in low-income countries and to curb the spread to other nations. Urgent action is required to prevent the broader geographic dissemination of Clade Ib, with particular emphasis on addressing the needs of vulnerable populations, especially children. Funding This study was supported by a grant from the National Natural Science Foundation of China (No. 72122001). Conflicts of interest None.

This meta-analysis aimed to quantify the latest cardiovascular disease (CVD) incidence rate and assess the impact of risk factors among people living with HIV (PLWH). We searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Library for studies published up to September 14, 2023. To evaluate effect sizes, we employed multilevel (three-level) random-effects meta-analyses. The pooled incidence rate of CVD was 6.31 per 1,000 person-years. Among the 14 risk factors analyzed, the most prevalent was a history of CVD (odds ratio [OR]=3.47), followed by age (per 10-year increase) (OR=1.79), current smoking (OR=1.76), hypertension (OR=1.57), smoking (OR=1.53), diabetes (OR=1.50), previous smoking (OR=1.30), and hepatitis C virus (HCV) infection (OR=1.18). However, there was no statistical significance associated with HIV-specific factors (abacavir use, efavirenz use, and CD4 nadir, etc.). The CVD incidence rate was high among PLWH, with risk factors including both conventional CVD risk factors and HCV infection. There is an urgent need for more high-quality research to better understand the effects of HIV progression and drug use.

BACKGROUND:Hand hygiene (HH) is crucial for preventing healthcare-associated infections (HAIs), with compliance notably increasing during the COVID-19 pandemic. Whether this adherence can be sustained remains uncertain. We sought to assess changes in HH compliance following the pandemic and explore its correlation with HAIs. METHODS:A longitudinal study was launched to assess HH compliance and HAIs across two phases. Phase 1 spanned from October 2021 to January 2023, a period of normalized prevention and control of COVID-19, while phase 2 extended from February 2023 to July 2024, following the downgrade in the management of COVID-19. Observers recorded HH practices. HAIs were identified through using semi-automated, continuous surveillance software. Pearson correlation coefficient (rs) was used to evaluate the relationship between HAIs and HH. RESULTS:A total of 2,233 HH opportunities were observed with 966 during Phase 1 and 1,267 in Phase 2. Compliance with HH significantly declined from 90.27% (95% CI: 85.34% to 95.4%) in Phase 1 to 82.56% (95% CI: 80.35% to 84.61%) in Phase 2 (P < 0.001). Concurrently, the incidence of HAI rose notably from 16.79‰ (95% CI: 16.20‰ to 17.39‰) to 18.71‰ (95% CI: 18.20‰ to 19.24‰) (P < 0.001). However, despite these concurrent trends, monthly analysis found no statistically significant correlation between HH compliance and HAI incidence (rs = -0.296; P = 0.0897). CONCLUSIONS:As the pandemic threat waned, maintaining high HH compliance became challenging, indicating it's time to implement additional strategies. Moreover, the correlation between HH and HAI requires further study to uncover.

This study examines trends in measles burden and measles-containing vaccine (MCV) coverage among children under five years old, with a focus on the impact of the COVID-19 pandemic. We analyzed measles incidence, mortality, and DALYs in children under five years old using GBD 2021 data and MCV coverage in 204 countries from the Global Health Data Exchange (GHDx). Trends from 1990 to 2021 were assessed through estimated annual percentage change (EAPC) at global, regional, and national levels. In 2021, measles caused 4.1 million cases, 48.1 thousand deaths, and 4.2 million disability-adjusted life years (DALYs) among children under five years old globally. From 1990 to 2021, incidence, mortality, and DALYs declined by over 90%, but low Socio-demographic Index (SDI) regions continued to bear the highest burden. During the COVID-19 pandemic (2019-2021), the global measles burden declined overall, but mortality (estimated annual percentage change, EAPC = 155.55, 95% CI: 53.89 to 324.38) and DALY rates (EAPC = 146.94, 95% CI: 46.25 to 316.94) in East Asia increased. The pandemic also disrupted vaccination, with MCV1 coverage declining (EAPC = -2.08, 95% CI: -3.30 to -0.85), reversing previous trends in 68 countries (33.33%) for MCV1 and 50 countries (24.51%) for MCV2. Global measles incidence has declined over the past 30 years, but regional disparities persist. The COVID-19 pandemic disrupted vaccination efforts, raising the risk of outbreaks among children. Enhanced efforts are critical to achieving measles elimination.

Objectives: This study examines trends in measles burden and measles-containing vaccine (MCV) coverage among children under 5 years old, with a focus on the impact of the COVID-19 pandemic. Methods: We analyzed measles incidence, mortality, and disability-adjusted life years (DALYs) in children under 5 years old using Global Burden of Disease 2021 data and MCV coverage in 204 countries from the Global Health Data Exchange. Trends from 1990 to 2021 were assessed through estimated annual percentage change (EAPC) at global, regional, and national levels. Results: In 2021, measles caused 4.1 million cases, 48.1 thousand deaths, and 4.2 million DALYs among children under 5 years old globally. From 1990 to 2021, incidence, mortality, and DALYs declined by over 90%, but low socio-demographic index regions continued to bear the highest burden. During the COVID-19 pandemic (2019-2021), the global measles burden declined overall, but mortality (EAPC = 155.55, 95% confidence interval [CI]: 53.89-324.38) and DALY rates (EAPC = 146.94, 95% CI: 46.25-316.94) in East Asia increased. The pandemic also disrupted vaccination, with MCV1 coverage declining (EAPC = −2.08, 95% CI: −3.30 to −0.85), reversing previous trends in 68 countries (33.33%) for MCV1 and 50 countries (24.51%) for MCV2. Conclusion: Global measles incidence has declined over the past 30 years, but regional disparities persist. The COVID-19 pandemic disrupted vaccination efforts, raising the risk of outbreaks among children. Enhanced efforts are critical to achieving measles elimination.

Background:Mpox is a zoonotic infectious disease caused by the mpox virus. It was first reported in humans in the Democratic Republic of the Congo in 1970. Since then, it has mainly been prevalent in Central and West Africa. Starting from 2022, the mpox epidemic has spread globally. The objective of this study was to obtain key transmission parameters of the mpox virus, providing evidence-based support for scientific prevention and control of the epidemic worldwide. Methods:We used "mpox" and "monkeypox" as the keywords to retrieve studies from PubMed, Web of Science, and Scopus databases up to February 2025. Four key transmission parameters-basic reproduction number (R0), effective reproduction number (Rt), incubation period, and serial interval were extracted. Fixed-effect or random-effect models were used to estimate the pooled parameters. Hartung-Knapp (HKSJ) confidence intervals was reported to reflect uncertainty under high heterogeneity. The protocol of this study has been registered in the PROSPERO database (CRD42022339404). Findings:The study screened 2910 articles and included 47 articles (covering 43,387 mpox patients) based on inclusion and exclusion criteria. The R0 of mpox was 2.13 (95% CI [HKSJ]: 1.63, 2.62), the Rt of mpox was 2.51 (95% CI [HKSJ]: 2.05, 2.97), the incubation period of mpox was 9.21 (95% CI [HKSJ]: 8.03, 10.39) days, and the serial interval of mpox was 12.00 (95% CI [HKSJ]: 8.01, 15.99) days. Subgroup analysis found no significant differences in incubation period, and serial interval between men who have sex with men (MSM) and the general population. However, the Rt in the general population (2.20, 95% CI [HKSJ]: 1.71, 2.70) was smaller than the Rt in the MSM (3.08, 95% CI [HKSJ]: 2.41, 3.76). Interpretation:Mpox is a threat to global public health that cannot be ignored. This study found that each person infected with the mpox virus transmitted it to two others, and the epidemic has continued to spread. Both the incubation period and the serial interval exceeded one week, which is relatively long and has increased the difficulty of prevention and control. It is recommended that in the future, early monitoring and early warning be strengthened for high-risk populations to prevent the risk of mpox transmission. Funding:This study was funded by the Youth Beijing Scholars Program (087), National Natural Science Foundation of China (72474005, 72122001), and China Primary Health Care Foundation (20250307). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the paper. No payment was received by any of the co-authors for the preparation of this article.

The long-term sequelae of coronavirus disease 2019 (COVID-19) and its recovery have becoming significant public health concerns. Therefore, this study aimed to enhance the limited evidence regarding the relationship between sleep quality on long COVID among the older population aged 60 years or old. Our study included 4,781 COVID-19 patients enrolled from April to May 2023, based on the Peking University Health Cohort. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale. Long COVID was evaluated by well-trained health professionals through patients’ self-reported symptoms. Binary logistic regression models were employed to calculate odds ratios (OR) and 95

Given the increasing aging global population and advancements in dementia action plans, the latest disparities in the dementia burden may evolve. This study aimed to analyze and compare temporal trends at regional, national, and sociodemographic levels to provide evidence for public health planning and resource prioritization. The age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate (ASDR) were derived from the Global Burden of Disease 2021 study. Estimated annual percentage changes (EAPCs) were calculated to quantify their temporal trends. Correlations between EAPC and the human resources for health (HRH) were assessed using Pearson correlation analysis. Although the ASPR and ASIR remained stable or decreased globally, they both greatly increased in East Asia (ASPR: EAPC = 0.43; 95

Background: The potential mutual effect of physical and psychological disorders on cognitive function is critical for preventing cognitive impairment among older adults. We aimed to investigate the mediating role of physical and psychological disorders in their associations with cognitive function. Methods: We conducted a prospective cohort study using the Health and Retirement Study, involving 5308 adults aged 60 years or older. Physical disorders included seven self-reported physician-diagnosed conditions. Psychological disorder and cognitive function were ascertained using the 8-item Centers for Epidemiologic Research Depression scale and the 27-point HRS cognitive scale, respectively. Multivariable linear regression models were used to assess the association of the baseline scores of physical and psychological disorders with subsequent cognitive scores. Second-order cross-lagged panel models (CLPM) were used to assess the longitudinal mediating roles, respectively. Results: The higher psychological disorder scores (beta = -0.15; P < 0.0001) and physical disorders scores (beta = -0.18; P < 0.0001) were, the worse the cognitive function was. CLPM revealed a significant longitudinal mediating effect of baseline physical disorders through changes in psychological disorder from 2002 to 2010 on the cognitive scores changes from 2002 to 2010 (beta = -0.02; P < 0.0001). Meanwhile, the longitudinal mediating effect of baseline psychological disorder scores through physical disorders changes from 2002 to 2010 on the cognitive scores changes from 2002 to 2010 was significant (beta = -0.004; P = 0.005). Conclusions: The mutual longitudinal mediating effects of psychological disorder and physical disorder indicate that among older adults, physical and psychological disorders accelerate cognitive impairment as a whole and mutually reinforcing process.

Background The associations between trajectories of different health conditions and cognitive impairment among older adults were unknown. Our cohort study aimed to investigate the impact of various trajectories, including sleep disturbances, depressive symptoms, functional limitations, and multimorbidity, on the subsequent risk of cognitive impairment. Methods We conducted a prospective cohort study by using eight waves of national data from the Health and Retirement Study (HRS 2002–2018), involving 4319 adults aged 60 years or older in the USA. Sleep disturbances and depressive symptoms were measured using the Jenkins Sleep Scale and the Centers for Epidemiologic Research Depression (CES-D) scale, respectively. Functional limitations were assessed using activities of daily living (ADLs) and instrumental activities of daily living (IADLs), respectively. Multimorbidity status was assessed by self-reporting physician-diagnosed diseases. We identified 8-year trajectories at four examinations from 2002 to 2010 using latent class trajectory modeling. We screened participants for cognitive impairment using the 27-point HRS cognitive scale from 2010 to 2018 across four subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models. Results During 25,914 person-years, 1230 participants developed cognitive impairment. In the fully adjusted model 3, the trajectories of sleep disturbances and ADLs limitations were not associated with the risk of cognitive impairment. Compared to the low trajectory, we found that the increasing trajectory of depressive symptoms (HR = 1.39; 95% CI = 1.17–1.65), the increasing trajectory of IADLs limitations (HR = 1.88; 95% CI = 1.43–2.46), and the high trajectory of multimorbidity status (HR = 1.48; 95% CI = 1.16–1.88) all posed an elevated risk of cognitive impairment. The increasing trajectory of IADLs limitations was associated with a higher risk of cognitive impairment among older adults living in urban areas (HR = 2.30; 95% CI = 1.65–3.21) and those who smoked (HR = 2.77; 95% CI = 1.91–4.02) (all P for interaction < 0.05). Conclusions The results suggest that tracking trajectories of depressive symptoms, instrumental functioning limitations, and multimorbidity status may be a potential and feasible screening method for identifying older adults at risk of cognitive impairment.