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To assess the impact of learner-participation and instructor-led simulation videos on nurses' CPR skills, focusing on iterative learning to boost proficiency in ACLS. Advanced cardiac life support (ACLS) training is crucial for nurses, especially to improve cardiopulmonary resuscitation (CPR) proficiency, for which an effective training strategy is needed. A quasi-experimental, pretest–posttest design was implemented to assess the impact of self-simulation and model simulation videos on sustaining CPR education. The research was carried out at a university hospital in Korea from August 2021 to July 2022. A total of 110 nurses were allocated into three groups based on the building of their workplace in the hospital. Each group watched training videos at 4-month intervals after the simulation training. The self-video group viewed simulations featuring their participation, while the model video group watched instructor-led simulations. A comparison group participated in the simulations without subsequent video boosting. Both the self-video and model video groups exhibited significantly superior ACLS performance compatred with the comparison group at both four months (H = 70.33, p <.001) and eight months (H = 81.52, p <.001) following the intervention, with large effect sizes (self-video vs. comparison: d = 4.73 at four months, d = 12.54 at eight months; model video vs. comparison: d = 4.53 at four months, d = 11.01 at eight months). ACLS knowledge scores also significantly increased over time in both intervention groups (self-video: χ² = 22.09, p <.001; model video: χ² = 24.13, p <.001), but not in the comparison group (χ² = 3.75, p =.153). There were no significant differences among the groups in terms of CPR self-efficacy or stress at either time point. Supplementary training using simulation videos is an effective method for maintaining and enhancing nurses' ACLS competency, offering a sustainable approach to repetitive CPR training. This study underscores the value of incorporating recorded simulation videos in clinical training, offering insights into efficient methods for continuous learning and CPR proficiency among nursing professionals. [ABSTRACT FROM AUTHOR]

"New nurses" are those with less than a year of work experience at a hospital. To address the challenges of new nurses caused by their limited experience, the Mentoring New Nurses for Transition and Empowerment Program (MNTEP) was designed based on the Stress-Appraisal-Coping Model of Lazarus and Folkman. This study aimed to explore the impact of the MNTEP, in which clinical nurse educators teach stress-coping strategies, on the clinical transition of new nurses in South Korea. This study used a mixed-methods design with a pretest-posttest non-equivalent comparison group and focus group interviews (FGIs). The research was conducted at a hospital in South Korea. The intervention and comparison groups comprised 30 and 28 new nurses, respectively. Also, 12 MNTEP participants were subjected to three separate FGIs. To comprehensively assess the program's effects, quantitative data were collected through self-report surveys, while qualitative data were obtained from March 2022 to March 2023 using semi-structured interviews that allowed for open-ended responses. There were significant differences in mean self-efficacy scores (t = 2.45, p = 0.017) and perceived social support from clinical nurse educators (F = 4.51, p = 0.038) between the intervention and comparison groups. Additionally, significant changes were observed in the field adaptation pre-test and post-test scores within the intervention group (t = −3.12, p = 0.004). However, there was no statistically significant difference between the groups in terms of active and passive coping strategies. FGIs yielded two main themes: (1) gaining positive energy through empowerment and solidarity; and (2) clinical nurse educators sharing strategies for improved role adaptation and capacity building. MNTEP led by clinical nurse educators positively influenced new nurses' self-efficacy and facilitated their transition to clinical settings. These findings underscore the importance of mentorship programs and clinical nurse educators. • The study examines transition challenges for new nurses, emphasizing effective stress management for successful adaptation. • It underscores the importance of mentorship programs, led by clinical nurse educators, in boosting new nurse confidence. • The research also shows that social support is crucial for easing new nurses into clinical environments. [ABSTRACT FROM AUTHOR]

• Three dose primary Hantavax® immunization was immunogenic. • Hantavax® vaccination showed a booster effect. • Revised 3 + 1 vaccination schedule can provide rapid protection against hantavirus infection. • Adverse events did not increase with repeated vaccinations. Hemorrhagic fever with renal syndrome is a serious health problem in Eurasian countries. This study aimed to evaluate the immunogenicity and safety of formalin-inactivated Hantaan virus vaccine (Hantavax®) with a 3 + 1 vaccination schedule. A phase III, multi-center clinical trial was conducted to evaluate the immunogenicity and safety of Hantavax® (three primary doses and a booster dose schedule at 0, 1, 2 and 13 months) among healthy adults. Immune responses were assessed using the plaque reduction neutralizing antibody test (PRNT) and immunofluorescent antibody assay (IFA). Systemic and local adverse events were assessed. A total of 320 healthy subjects aged ≥19 years were enrolled. Following three primary doses of Hantavax®, the seroconversion rate was 80.97% and 92.81% by PRNT and IFA, respectively. With booster administration, seropositive rates were 67.47% and 95.68% at one-month post-vaccination according to PRNT and IFA, respectively. Solicited local and systemic adverse events were reported in 30.50–42.81% and 16.67–33.75% during the three primary dose vaccination, while those were reported 36.57% and 21.36% after the booster doses. Both local and systemic adverse events did not increase with repeated vaccinations. Hantavax® showed a high seroconversion rate after the three-dose priming, and additional dose administration with 11-month interval induced good booster effects. (ClinicalTrials.gov Identifier: NCT02553837). [ABSTRACT FROM AUTHOR]

The aim was to determine whether various clinical specimens obtained from COVID-19 patients contain the infectious virus. To demonstrate whether various clinical specimens contain the viable virus, we collected naso/oropharyngeal swabs and saliva, urine and stool samples from five COVID-19 patients and performed a quantitative polymerase chain reaction (qPCR) to assess viral load. Specimens positive with qPCR were subjected to virus isolation in Vero cells. We also used urine and stool samples to intranasally inoculate ferrets and evaluated the virus titres in nasal washes on 2, 4, 6 and 8 days post infection. SARS-CoV-2 RNA was detected in all naso/oropharyngeal swabs and saliva, urine and stool samples collected between days 8 and 30 of the clinical course. Notably, viral loads in urine, saliva and stool samples were almost equal to or higher than those in naso/oropharyngeal swabs (urine 1.08 ± 0.16–2.09 ± 0.85 log 10 copies/mL, saliva 1.07 ± 0.34–1.65 ± 0.46 log 10 copies/mL, stool 1.17 ± 0.32 log 10 copies/mL, naso/oropharyngeal swabs 1.18 ± 0.12–1.34 ± 0.30 log 10 copies/mL). Further, viable SARS-CoV-2 was isolated from naso/oropharyngeal swabs and saliva of COVID-19 patients, as well as nasal washes of ferrets inoculated with patient urine or stool. Viable SARS-CoV-2 was demonstrated in saliva, urine and stool samples from COVID-19 patients up to days 11–15 of the clinical course. This result suggests that viable SARS-CoV-2 can be secreted in various clinical samples and respiratory specimens. [ABSTRACT FROM AUTHOR]

• TNA films grown on Ti substrates are transferred onto FTO via a two-step anodization. • TNA films are vertically aligned in normal and reverse ways, and irradiated through FTO (SE) or solution (EE). • The front and back planes of TNA films are the same in XRD, XPS, and UV–vis transmittance. • Irradiation direction is a key factor in photocurrent generation. • In photocatalysis, the effect of alignment direction is comparable to that of irradiation direction. Although one-dimensional TiO 2 nanotube arrays (TNA) grown on Ti substrates via electrochemical anodization are extensively studied in photoelectrochemistry, the photo(electro)catalytic activity of TNA detached from the Ti substrates remains unexplored. Herein, we synthesize TNA samples with various pore sizes (40–100 nm) and tube lengths (4–15 μm) via two-step electrochemical anodization, and transfer them to transparent conducting oxide (i.e. fluorine-doped tin oxide; FTO) substrates in normal (n) alignment (front plane outward) and reverse (r) alignment (backplane outward). The front and back planes of the as-fabricated TNA film are the same based on X-ray diffraction (anatase structure), X-ray photoelectron spectroscopy (Ti and O), and UV–vis transmittance data, though the tubes are open in the front and closed in the back. Regardless of the direction of irradiation (SE : FTO → TNA vs. EE : TNA → FTO), longer tubes generate a higher photocurrent (I ph) due to the large light absorption. However, for the same alignment of TNA (either n- or r -TNA), SE irradiation leads to a very large I ph (e.g., nSE > nEE), whereas n -TNA consistently generates a larger I ph than r -TNA for a given irradiation direction (i.e., n > r). The photocatalytic decomposition of phenol follows the same tendency (n > r); however, the Faraday efficiency (based on the photocharge) is higher with EE (nEE 28%, rEE 20%) than SE (rSE 11%, nSE 7%) irradiation. These photoelectrochemical and photocatalytic behaviors are explained in terms of charge carrier generation (FTO/TNA vs. TNA/solution), dissimilar charge carrier transfer pathways (e − transfer through tube framework vs. h + transfer via radial direction), and charge injection at the tube (open vs. clogged tube mouth)/solution interface. The time-resolved photoluminescence (TRPL) emission and incident photon-to-current efficiency (IPCE) are also studied to gain insight into the charge transfer kinetics. [ABSTRACT FROM AUTHOR]

• To counteract COVID-19 pandemics, more airborne-infection isolation rooms are needed • Negative air machines can generate negative pressure in patient rooms. • Every effort should be made to equip anterooms in airborne-infection isolation rooms. • When selecting isolation rooms, oxygen and medical air supply should be checked. More airborne-infection isolation rooms are needed in centers that treat severely affected coronavirus 2019 patients. Wards and rooms must be carefully checked to ensure an ample supply of medical air and oxygen. Anterooms adjacent to airborne-infection isolation rooms are required to maintain pressure differentials and provide an area for donning/doffing or disinfecting medical equipment. [ABSTRACT FROM AUTHOR]

A photoelectrochemical (PEC) cell composed of a WO 3 /dye-sensitized solar cell (WO 3 /DSSC) and copper oxide (Cu x O, where x =1 and 2) wire arrays as a dual-absorber photoanode and cathode, respectively, is demonstrated as a stand-alone, durable device for CO 2 photoconversion. The Cu x O wire arrays, which have high surface-to-volume ratios, exhibit promising electrocatalytic activity for CO 2 conversion to CO at Faradaic efficiencies of ~80% and ~60% at E=−0.2 and −0.4 V vs . RHE, respectively, and H 2 production is minimized at a Faradaic efficiency <~20% in the potential range between −0.2 and −1.0 V vs . RHE. The single-absorber cell of a WO 3 photoanode and Cu x O wire array cathode couple (WO 3 -Cu x O) requires a minimum overpotential of ~0.7 V to drive CO 2 conversion. For stand-alone CO 2 conversion, a DSSC is coupled to the WO 3 -Cu x O system. In the dual-absorber cell (WO 3 /DSSC-Cu x O), the long-wave band (λ > ca . 450 nm) passed through the semitransparent WO 3 film is absorbed by the dye-sensitized TiO 2 electrode of the DSSC. The WO 3 /DSSC-Cu x O shows a potential gain of ~0.7 V and is able to successfully drive CO 2 conversion on Cu x O and simultaneously oxidize water on WO 3 without an external power supply. In this stand-alone system, the primary CO 2 conversion product is CO, with a solar-to-chemical energy efficiency of ~2.5%; H 2 and formate are obtained with energy efficiencies of 0.7% and 0.25%, respectively, in 5 h (overall efficiency ~3.45%). Neither CO 2 conversion product nor H 2 is found using the single-absorber system. [ABSTRACT FROM AUTHOR]

Our understanding of adaptive immune responses in patients with coronavirus disease 2019 (COVID-19) is rapidly evolving, but information on the innate immune responses by natural killer (NK) cells is still insufficient. We aimed to examine the phenotypic and functional status of NK cells and their changes during the course of mild and severe COVID-19. We performed RNA sequencing and flow cytometric analysis of NK cells from patients with mild and severe COVID-19 at multiple time points in the course of the disease using cryopreserved PBMCs. In RNA-sequencing analysis, the NK cells exhibited distinctive features compared with healthy donors, with significant enrichment of proinflammatory cytokine-mediated signaling pathways. Intriguingly, we found that the unconventional CD56dimCD16neg NK-cell population expanded in cryopreserved PBMCs from patients with COVID-19 regardless of disease severity, accompanied by decreased NK-cell cytotoxicity. The NK-cell population was rapidly normalized alongside the disappearance of unconventional CD56dimCD16neg NK cells and the recovery of NK-cell cytotoxicity in patients with mild COVID-19, but this occurred slowly in patients with severe COVID-19. The current longitudinal study provides a deep understanding of the NK-cell biology in COVID-19. [Display omitted] [ABSTRACT FROM AUTHOR]

Summary: Objectives: The aim of this study was to determine the risk factors for the recovery of low-level mupirocin-resistant (mupr) or -susceptible (mups) MRSA from patients in intensive care units (ICUs). Methods: A case–case–control study was conducted from November 2003 to April 2004. Two case groups consisted of patients with low-level mupr MRSA and mups MRSA. A control group was frequency matched. Results: Mupr MRSA and mups MRSA were isolated from 20 to 51 patients, respectively, during a six-month period. Risk factors identified for mupr MRSA were as follows: exposure to piperacillin–tazobactam (odds ratio [OR] 13.8; 95% confidence intervals [CI], 1.8–105.0), third-generation cephalosporins (OR, 5.0; 95% CI, 1.6–15.5) and quinolones (OR, 3.4; 95% CI, 1.1–10.7). Risk factors identified for mups MRSA were as follows: length of ICU stay (OR, 1.1; 95% CI, 1.0–1.1), surgery (OR, 3.7; 95% CI, 1.5–9.0), exposure to third-generation cephalosporins (OR, 8.4; 95% CI, 3.3–21.7) and quinolones (OR, 7.7; 95% CI, 2.8–21.3). Conclusions: Our results suggest that nosocomial isolation of low-level mupr MRSA may be affected by piperacillin–tazobactam. [Copyright &y& Elsevier]

• The long-term impact of immunogenicity induced by the primary COVID-19 vaccine series were evaluated. • Humoral and cellular immunogenicity were evaluated by anti-spike protein antibody, SARS-CoV-2–specific IGRA, and multiplex cytokine assays. • The primary vaccine series with BNT162b2 showed stronger immunogenicity than ChAdOx1 after the third booster dose and BA.1/2 breakthrough infections. • Differences in immunogenicity based on the type of primary vaccine platform persisted over time. The long-term impact of initial immunogenicity induced by different primary COVID-19 vaccine series remains unclear. A prospective cohort study was conducted at 10 tertiary hospitals in Korea from March 2021 to September 2022. Immunogenicity assessments included anti–spike protein antibody (Sab), SARS-CoV-2–specific interferon-gamma releasing assay (IGRA), and multiplex cytokine assays for spike protein–stimulated plasma. Spike proteins derived from wild-type SARS-CoV-2 and alpha variant (Spike 1) and beta and gamma variant (Spike 2) were utilized. A total of 235 healthcare workers who had received a two-dose primary vaccine series of either ChAdOx1 or BNT162b2, followed by a third booster dose of BNT162b2 (166 in the ChAdOx1/ChAdOx1/BNT162b2 (CCB) group and 69 in the BNT162b2/BNT162b2/BNT162b2 (BBB) group, based on the vaccine series) were included. Following the primary vaccine series, the BBB group exhibited significantly higher increases in Sab levels, IGRA responses, and multiple cytokines (CCL2/MCP-1, CCL3/MIP-1α, CCL4/MIP-1β, interleukin (IL)-1ra, IFN-γ, IL-2, IL-4, and IL-10) compared to the CCB group (all P < 0.05). One month after the third BNT162b2 booster, the CCB group showed Sab levels comparable to those of the BBB group, and both groups exhibited lower levels after six months without breakthrough infections (BIs). However, among those who experienced BA.1/2 BIs after the third booster, Sab levels increased significantly more in the BBB group than in the CCB group (P < 0.001). IGRA responses to both Spike 1 and Spike 2 proteins were significantly stronger in the BBB group than the CCB group after the third booster, while only the Spike 2 response were higher after BIs (P = 0.007). The BBB group exhibited stronger enhancement of T-cell cytokines (IL-2, IL-4, and IL-17A) after BIs than in the CCB group (P < 0.05). Differences in immunogenicity induced by the two primary vaccine series persisted, modulated by subsequent booster vaccinations and BIs. [ABSTRACT FROM AUTHOR]

Studying the effect of nanoscale morphology on the photoelectrochemical performance of semiconductor electrodes has been in the forefront of research for over a decade, there are still major inconsistencies and controversies in the literature. Here we aimed to resolve some of these issues, by the controlled preparation of TiO 2 photoelectrodes from nanoparticles, nanorods, and nanosheets, where the nano dimension of the 0D, 1D, and 2D structures was kept similar (about 10 nm). XRD, Raman spectroscopy, XPS and UPS were employed to confirm that the chemical nature of the nanostructures is nearly identical, they only differ in their morphology. Photoelectrodes were prepared keeping the loading amount, surface area, or the film thickness identical, to deconvolute all trivial effects, and only scrutinize the role of morphology. TiO 2 nanorod (NR) films exhibited the best photoelectrochemical performance in all comparisons, achieving ~4 mA cm−2 at 0.2 V vs. Ag/AgCl (under 100 mW cm−2, Xe-lamp illumination). In stark contrast, TiO 2 nanosheet (NS) film showed the lowest performance owing to the small amount of active sites on the basal plane of the NSs and the insufficient charge carrier transport through the film. Overall, we have demonstrated that under carefully controlled conditions, it is possible to compare the PEC behavior of TiO 2 photoelectrodes, and that the 1D nanostructures outperformed its 0D and 2D counterparts. Image, graphical abstract [ABSTRACT FROM AUTHOR]

The Streptococcus anginosus group (SAG) is a subgroup of viridans streptococci comprising three species: S. anginosus, S. constellatus, and S. intermedius. SAG usually resides in the oral cavity and colonizes the throat, and the gastrointestinal and genitourinary tracts. SAG can form abscesses in various parts of the body; however, the clinical features of SAG infection are not clear. Here, we reviewed the medical records of all SAG bacteremia patients aged over 18 years who were diagnosed between January 2010 and December 2021 at a tertiary university hospital. We then compared clinical characteristics, source of infection, need for surgical or interventional treatment, and 28-day mortality rates among each species of SAG. Differences in percentages between groups were compared using a proportion test, and differences between mean values were assessed using the Kruskal-Wallis test with post-hoc Bonferroni correction. In total, 84 cases of SAG bacteremia (40 S. anginosus cases, 31 S. constellatus cases, and 13 S. intermedius cases) were identified. The most common comorbidity was diabetes mellitus (n = 26, 31%), and the most common source was hepatobiliary infection (n = 30, 35.7%). Polymicrobial bacteremia was observed in 22.6% (19/84) of cases. Twenty-eight day mortality due to S. anginosus bacteremia was 12.5%; no deaths were reported in the S. constellatus and S. intermedius groups. However, the difference among the groups was not significant (p = 0.054). Hepatobiliary infection was the most common source of SAG bacteremia. In addition, S. anginosus bacteremia resulted in more severe disease and higher mortality rates than S. constellatus or S. intermedius bacteremia. [ABSTRACT FROM AUTHOR]

• With increasing pneumococcal vaccine uptake, epidemiology of community-acquired pneumonia may change. • Indirect effect from pediatric PCV13 immunization might be insufficient. • PPSV23 might reduce the severity of pneumococcal pneumonia in the elderly. • Serotypes 3 and 19A were still the major serotypes of pneumococcal pneumonia in adults. South Korea has been providing 10-valent pneumococcal conjugate vaccine/(PCV10)/13-valent pneumococcal conjugate vaccine (PCV13) to children and 23-valent pneumococcal polysaccharide vaccine (PPSV23) to older adults as part of a national immunization program. From September 2015 to August 2017, a prospective cohort study was conducted for adults aged ≥19 years with community-acquired pneumonia (CAP) at four university hospitals. All-cause and pneumococcal CAP incidence and mortality rates were evaluated on the basis of hospital catchment population. Serotype distribution of pneumococcal CAP was also evaluated. Among 2669 patients with CAP, 252 cases (9.4%) were pneumococcal CAP cases. The annual incidences of all-cause and pneumococcal CAP were 194.3 cases and 18.3 cases respectively, per 100,000 persons. Serotyped Streptococcus pneumoniae was identified in 107 cases (42.5%) through culture or a serotype-specific urinary antigen detection assay. Pneumococcal CAP caused by the PCV13 and PPSV23 serotypes were 50 cases (46.7% of serotyped pneumococcal CAP and 19.8% of pneumococcal CAP), and 83 cases (77.6% of serotyped pneumococcal CAP and 32.9% of pneumococcal CAP), respectively. The most prevalent serotype was 3 (n = 21, 19.6% of serotyped pneumococcal CAP), followed by 19A (n = 10, 9.3% of serotyped pneumococcal CAP) and 11A (n = 10, 9.3% of serotyped pneumococcal CAP). Compared with non-pneumococcal CAP patients, pneumococcal CAP patients were more likely to have a higher CURB-65 scores (P = 0.002). The overall 30-day mortality rate of pneumococcal CAP was higher than that of non-pneumococcal CAP (6.3% versus 5.6%; odds ratio [OR], 1.15; 95% confidence interval [CI], 0.67–1.96), but this trend was reversed in patients aged 65–74 years (4.2% versus 8.6%; OR, 0.47; 95% CI, 0.14–1.54). The disease burden of PCV13-serotype pneumococcal CAP remains significantly high in Korean adults, particularly among elderly people, even after a high uptake of pediatric PCVs. [ABSTRACT FROM AUTHOR]

Comparative analyses of SARS-CoV-2-specific immune responses elicited by diverse prime-boost regimens are required to establish efficient regimens for the control of COVID-19. In this prospective observational cohort study, spike-specific immunoglobulin G (IgG) and neutralizing antibodies (nAbs) alongside spike-specific T -cell responses in age-matched groups of homologous BNT162b2/BNT162b2 or AZD1222/AZD1222 vaccination, heterologous AZD1222/BNT162b2 vaccination, and prior wild-type SARS-CoV-2 infection/vaccination were evaluated. Peak immune responses were achieved after the second vaccine dose in the naïve vaccinated groups and after the first dose in the prior infection/vaccination group. Peak titers of anti-spike IgG and nAb were significantly higher in the AZD1222/BNT162b2 vaccination and prior infection/vaccination groups than in the BNT162b2/BNT162b2 or AZD1222/AZD1222 groups. However, the frequency of interferon-γ-producing CD4+ T cells was highest in the BNT162b2/BNT162b2 vaccination group. Similar results were observed in the analysis of polyfunctional T cells. When nAb and CD4+ T -cell responses against the Delta variant were analyzed, the prior infection/vaccination group exhibited higher responses than the groups of other homologous or heterologous vaccination regimens. nAbs are efficiently elicited by heterologous AZD1222/BNT162b2 vaccination, as well as prior infection/vaccination, whereas spike-specific CD4+ T -cell responses are efficiently elicited by homologous BNT162b2 vaccination. Variant-recognizing immunity is more efficiently generated by prior infection/vaccination than the other homologous or heterologous vaccination regimens. [ABSTRACT FROM AUTHOR]

• Serotype 3 and 19A were still most prevalent in adults in the era vaccines. • Ceftriaxone non-susceptible rate was high (32.5%) in invasive pneumococci. • Serotypes 11A/E and 19A pneumococci showed low ceftriaxone susceptibility. • Ceftriaxone non-susceptibility was related to sequence type 166 and 320. Invasive pneumococcal disease (IPD) is associated with substantial morbidity and mortality in children and elderly populations. Serotype distribution and antibiotic susceptibility of IPD isolates are changing with the implementation of pneumococcal vaccination and increasing antibiotic use worldwide. We aimed to determine serotype distribution, antibiogram, and molecular epidemiology of pneumococci in the late stage of PCV13 era. Prospective multicenter IPD surveillance study was conducted for adults aged ≥ 19 years from July 2019 to June 2021. Clinical and epidemiologic data were collected. In addition, antibiotic susceptibility test, serotype identification and multi-locus sequence typing (MLST) was taken for pneumococcal isolates. A total of 160 IPD cases were collected with mean age of 65.1 years (male, 72.5%). Serotyping was taken for 116 available pneumococcal isolates. PCV13 and PPSV23 serotypes were 32.8% (n = 38) and 56.0% (n = 65), respectively. Serotype 3 (13.8%) and 19A (9.5%) were the most common causative agents of IPD, followed by serogroup 11 (6.9%), 23A (6.9%), 10A (4.3%), and 15B (4.3%). Notably, 32.5% of invasive pneumococcal isolates were non-susceptible to ceftriaxone. Serotypes 11A, 11E and 19A pneumococci showed high ceftriaxone non-susceptible rate (80%, 100% and 81.8% respectively), and they were related to sequence type (ST) 166 and ST320. In comparison, most serotype 3 isolates were ceftriaxone susceptible and related to ST180. PCV serotypes, especially 3 and 19A, are still prevalent in adult IPDs, suggesting that individual PCV13 immunization would be necessary for the elderly people and chronically ill patients. Ceftriaxone non-susceptible rate was remarkably high in invasive pneumococcal isolates. [ABSTRACT FROM AUTHOR]

• The effectiveness of repeated influenza vaccination was investigated. • Repeated vaccination was not effective during consecutive flu A/H3N2 epidemics. • About 80% of Korean elderly people receive influenza vaccination annually. • Poor influenza vaccine effectiveness was pronounced among the elderly population. Annually, about 80% of the Korean elderly aged ≥65 years receive influenza vaccination. Repeated annual vaccination has been suggested as an important factor of poor influenza vaccine effectiveness (VE), though reported conflicting results. During the consecutive A/H3N2-dominant influenza seasons between 2012 and 2015, we comparatively evaluated the VE (repeated vs. current season only) against laboratory-confirmed influenza, pneumonia and hospitalization in the elderly aged ≥65 years with influenza-like illness (ILI). Clinical and demographic data were collected prospectively, and vaccination status of prior and current seasons was verified using the immunization registry data of Korean Centers for Disease Control and Prevention. During the first A/H3N2-dominant season in 2012–2013, influenza vaccine showed statistically significant effectiveness against influenza A infection only and when vaccinated in the current season only (VE 53%, 95% CI 15–77). In the latter two seasons (2013–2015 years), the adjusted VE for influenza A was indistinguishable between repeated vaccination and vaccination in the current season only. During consecutive influenza A/H3N2 epidemics, poor influenza vaccine effectiveness may be more pronounced among the elderly population with a high annual vaccine uptake rate. [ABSTRACT FROM AUTHOR]

• National immunization program for PPV23 for the elderly was implemented in Korea. • PPV23 was effective against IPD and NBPP for young elderly patients aged 65–74. • Effectiveness of PPV23 against IPD was higher for PPV23 unique serotypes. • PPV23 was non-protective against IPD caused by PCV13 serotypes. While herd effects and serotype replacement by childhood pneumococcal protein conjugated vaccines (PCVs) continues to accumulate worldwide, direct effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPV23) against pneumococcal diseases in the elderly has been challenged. We estimated the direct effectiveness of PPV23 in the elderly population. For a hospital-based case-control study, cases of invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) (adults ≥ 65 years) were identified in 14 hospitals participated in the pneumococcal surveillance program from March 2013 to October 2015, following implementation of PPV23 national immunization program (NIP) for the elderly in the Republic of Korea. Controls matched by age, sex, and hospital were selected at ratios of 1:2 (IPD) or 1:1 (NBPP). Clinical data and vaccination records were collected. Vaccine effectiveness was calculated as (1-adjusted odds ratio) × 100. We enrolled 148 IPD and 557 NBPP cases, and 295 IPD and 557 NBPP controls for analyses. Overall effectiveness of PPV23 against IPD was 28.5% [95% confidence interval (CI) −5.8%–51.6%] and against NBPP was 10.2% (-15.1-30.6) in all patients ≥ 65 years. However, in subgroup analysis of patients aged 65–74 years, PPV23 was protective against IPD [effectiveness 57.4% (19.4–77.5)] and against NBPP [effectiveness 35.0% (2.3–56.7)]. Furthermore, serotype-specific effectiveness of PPV23 against IPD was 90.6% (27.6–98.8) for PPV23-unique serotypes and 81.3% (38.6–94.3) for PPV23 serotypes excluding serotype 3. This study indicates that PPV23 with broad serotype coverage might be beneficial in preventing IPD and NBPP due to non-PCV13 serotypes in the young-elderly, with potentially increasing effectiveness in the setting of childhood PCV NIP. [ABSTRACT FROM AUTHOR]

Highlights • National immunization of the elderly with the 23-valent polysaccharide vaccine (PPSV23) was implemented in Korea in 2013. • Overall in-hospital mortality was 34.2% for adult invasive pneumococcal disease (IPD) and 51.0% for patients ≥75 years of age. • Mortality risks were older age, higher bacteremia score, and immunocompromised status. • An effective vaccination strategy for those at higher risk of IPD is needed. Abstract Objectives This study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK). Methods Clinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015. Results A total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18–49 years, 23.7% in those aged 50–64 years, 33.0% in those aged 65–74 years, and 51.0% in those aged ≥75 years (p < 0.001). In particular, early death within 7 days of hospitalization accounted for 60.6% (66/109). While old age (≥65 years), higher Pitt bacteremia score (≥4), and bacteremic pneumonia were independently associated with IPD mortality in all age groups, an additional mortality risk factor of immunocompromised status was identified for patients aged 50–64 years. PPSV23 serotypes accounted for 64.4% (122/189) of the pneumococcal isolates serotyped. Conclusions This study suggests that vaccine-type IPD continues to place a substantial burden on older adults in the ROK, necessitating an effective vaccination strategy for those at higher risk. [ABSTRACT FROM AUTHOR]

We aimed to characterize the lineages of influenza B viruses obtained from clinical specimens during the 2007–2014 seasons in South Korea. RT-PCR for the partial hemagglutinin gene of influenza B virus was performed on laboratory-confirmed influenza B samples from the 2007–2008 season to 2013–2014 season. A phylogenetic tree was generated, and current influenza vaccine strains for the Northern Hemisphere were used as representative strains of Victoria and Yamagata lineages. A total of 571 influenza B virus sequences were analyzed. During the 2009–2010 season, most of the circulating influenza B viruses matched the vaccine strain; 91.0% (91/100) of viruses belonged to the Victoria lineage. In the 2007–2008, 2011–2012, and 2013–2014 seasons, co-circulation of each influenza B lineage was found with a match ratio to the vaccine strain of 53.2% (42/79), 40.9% (63/154), and 58.3% (134/230), respectively. Overall, 41.7% (238/571) of the circulating influenza B viruses belonged to the lineage mismatching the vaccine strain. During the seven influenza seasons, influenza B epidemics were substantial in four seasons in South Korea. Significant mismatches of the vaccine and lineage of the circulating influenza B viruses were found. The current trivalent influenza vaccine may not be fully suitable for effective protection against influenza B. [ABSTRACT FROM AUTHOR]

We assessed humoral responses and reactogenicity following the heterologous vaccination compared to the homologous vaccination groups. We enrolled healthcare workers (HCWs) who were either vaccinated with ChAdOx1 followed by BNT162b2 (heterologous group) or 2 doses of ChAdOx1 (ChAdOx1 group) or BNT162b2 (BNT162b2 group). Immunogenicity was assessed by measuring antibody titers against receptor-binding domain (RBD) of SARS-CoV-2 spike protein in all participants and neutralizing antibody titer in 100 participants per group. Reactogenicity was evaluated by a questionnaire-based survey. We enrolled 499 HCWs (ChAdOx1, n = 199; BNT162b2, n = 200; heterologous ChAdOx1/BNT162b2, n = 100). The geometric mean titer of anti–receptor-binding domain antibody at 14 days after the booster dose was significantly higher in the heterologous group (11 780.55 binding antibody unit (BAU)/mL [95% CI, 10 891.52–12 742.14]) than in the ChAdOx1 (1561.51 [95% CI, 1415.03–1723.15]) or BNT162b2 (2895.90 [95% CI, 2664.01–3147.98]) groups (both p < 0.001). The neutralizing antibody titer of the heterologous group (geometric mean ND 50 , 2367.74 [95% CI, 1970.03–2845.74]) was comparable to that of the BNT162b2 group (2118.63 [95% CI, 1755.88–2556.32]; p > 0.05) but higher than that of the ChAdOx1 group (391.77 [95% CI, 326.16–470.59]; p < 0.001). Compared with those against wild-type SARS-CoV-2, the geometric mean neutralizing antibody titers against the Delta variant at 14 days after the boosting were reduced by 3.0-fold in the heterologous group (geometric mean ND 50 , 872.01 [95% CI, 685.33–1109.54]), 4.0-fold in the BNT162b2 group (337.93 [95% CI, 262.78–434.57]), and 3.2-fold in the ChAdOx1 group (206.61 [95% CI, 144.05–296.34]). The local or systemic reactogenicity after the booster dose in the heterologous group was higher than that of the ChAdOx1 group but comparable to that of the BNT162b2 group. Heterologous ChAdOx1 followed by BNT162b2 vaccination with a 12-week interval induced a robust humoral immune response against SARS-CoV-2, including the Delta variant, that was comparable to the homologous BNT162b2 vaccination and stronger than the homologous ChAdOx1 vaccination, with a tolerable reactogenicity profile. [ABSTRACT FROM AUTHOR]

Background Previous reports mostly from Europe suggested an association between an occurrence of narcolepsy and an influenza A(H1N1)pdm09 vaccine adjuvanted with AS03 (Pandemrix ® ). During the 2009 H1N1 pandemic vaccination campaign, the Korean military performed a vaccination campaign with one type of influenza vaccine containing MF59-adjuvants. This study was conducted to investigate the background incidence rate of narcolepsy in South Korean soldiers and the association of the MF59-adjuvanted vaccine with the occurrence of narcolepsy in a young adult group. Methods To assess the incidence of narcolepsy, we retrospectively reviewed medical records of suspicious cases of narcolepsy in 2007–2013 in the whole 20 military hospitals of the Korean military. The screened cases were classified according to the Brighton Collaboration case definition of narcolepsy. After obtaining the number of confirmed cases of narcolepsy per 3 months in 2007–2013, we compared the crude incidence rate of narcolepsy before and after the vaccination campaign. Results We included 218 narcolepsy suspicious cases in the initial review, which were screened by the diagnostic code on the computerized disease registry in 2007–2013. Forty-one cases were finally diagnosed with narcolepsy in 2007–2013 (male sex, 95%; median age, 21 years). The average background incidence rate of narcolepsy in Korean soldiers was 0.91 cases per 100,000 persons per year. During the 9 months before vaccination implementation (April to December 2009), 6 narcolepsy cases occurred, whereas during the next 9 months (January to September 2010) including the 3-month vaccination campaign, 5 cases occurred. Conclusions The incidence of narcolepsy in South Korean soldiers was not increased after the pandemic vaccination campaign using the MF59-adjuvanted vaccine. Our results suggest that the MF59-adjuvanted H1N1 vaccine did not contribute to the occurrence of narcolepsy in this young adult group. [ABSTRACT FROM AUTHOR]

Abstract: The 2009 influenza pandemic was caused by a novel triple-reassortant influenza A/H1N1 virus that was further recombined with a Eurasian pig flu virus. Vaccination is a key countermeasure for disease; however, little data assessing vaccine effectiveness (VE) against the pandemic H1N1 virus are available. We conducted a matched case–control study to assess effectiveness of the 2009 influenza A/H1N1 monovalent vaccine against laboratory-confirmed, medically attended influenza patients. Subjects included in the study were ≥10 years of age and were treated at five university hospitals in the Republic of Korea (ROK) from December 2009 through March 2010. For subjects visiting outpatient clinics with influenza-like illness (ILI), real time reverse transcription polymerase chain reaction (rRT-PCR) was used to diagnose 2009 H1N1 influenza virus infection. Subjects with positive rRT-PCR were classified as cases, while those testing negative were controls. A valid vaccination corresponded to ≥14 days between receiving a dose of vaccine and symptom onset. Overall, 416 ILI subjects were analyzed, and 60 (14.4%) were vaccinated with the 2009 influenza A/H1N1 monovalent vaccine. The overall VE against pandemic 2009 A/H1N1 virus illness after adjustment for age group and presence of chronic medical conditions was 73.4% (95% confidence interval [CI]=49.1–86.1%). Both vaccine formulations (unadjuvanted and MF-59 adjuvanted) showed a statistically significant VE. In conclusion, the 2009 influenza A/H1N1 monovalent vaccine was substantially protective against pandemic influenza in the ROK during the 2009–2010 season. [Copyright &y& Elsevier]

Metal oxide anode electrocatalysts are important for an effective removal of contaminants and the enhancement of electrode durability in the electrochemical oxidation process. Herein, we report the enhanced lifetime of RuO x −TiO 2 composite anodes that was achieved by optimizing the fabrication conditions (e.g., the Ru mole fraction, total metal content, and calcination time). The electrode durability was assessed through accelerated service lifetime tests conducted under harsh environmental conditions, by using 3.4% NaCl and 1.0 A/cm2. The electrochemical characteristics of the anodes prepared with metal oxides having different compositions were evaluated using cyclic voltammetry, electrochemical impedance spectroscopy, and X-ray analyses. We noticed that, the larger the Ru mole fraction, the more durable were the electrodes. The RuO x −TiO 2 electrodes were found to be highly stable when the Ru mole fraction was >0.7. The 0.8RuO x −0.2TiO 2 electrode was selected as the one with the most appropriate composition, considering both its stability and contaminant treatability. The electrodes that underwent a 7-h calcination (between 1 and 10 h) showed the longest lifetime under the tested conditions, because of the formation of a stable Ru oxide structure (i.e., RuO 3) and a lower resistance to charge transfer. The electrode deactivation mechanism that occurred due to the dissolution of active catalysts over time was evidenced by an impedance analysis of the electrode itself and surface elemental mapping. Image 1 • Optimization studies obtained highly durable RuO x –TiO 2 composite anodes. • Electrodes with Ru mole fractions >0.7 exhibited substantive stability. • The effects of Ir doping on the electrodes' lifetimes were insignificant. • The 7-h calcined electrode was the most durable owing to its RuO 3 structures. • Ru dissolution deactivated the electrode, increasing electrical resistances. [ABSTRACT FROM AUTHOR]