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Background: The emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, notably Omicron and Delta, necessitates a detailed analysis of the amino acid substitutions occurring within the spike (S) protein. The substitutions mentioned above are crucial in regulating the interactions between the virus and its host receptor angiotensin-converting enzyme 2 (ACE2), in addition to impacting the effectiveness of monoclonal antibodies (mAbs) used in therapy. Methods: In this paper, we employed computational mutational analysis using PremPS to predict the stability scores of the S protein. Our analysis highlighted several key mutations, including G181V and A222V, which exhibited significant alterations in stability, particularly within the N-terminal domain (NTD), and were notably prevalent in the Omicron variant. To further elucidate the impact of these mutations, we conducted docking simulations employing HADDOCK 2.4 to assess the binding affinity between the Omicron receptor-binding domain (RBD) and ACE2. Results: Our outcomes emerged that the Omicron RBD has a stronger attraction to ACE2, driven by mutations such as Q493R, Q498R, S477N, T478K, G496S and L452R, which significantly influenced the RBD-ACE2 complex dynamics. Additionally, we ascertained the potential for immune evasion by these mutations through docking simulations with mAbs. Our findings identified specific interactions between mutations like L452R, E484Q/A and Q493R with mAbs, suggesting their potential to evade immune recognition. Conclusions: In summary, our paper provides insight into the complex connection between the fluctuation of the SARS-CoV-2 S protein, receptor binding dynamics, and immunotherapeutic efficacy. These insights are essential for guiding the development of novel therapeutics and informing public health strategies aimed at combating the ongoing COVID-19 pandemic. Our study explores the impact of mutations in the SARS-CoV-2 spike protein, focusing on the Omicron and Delta variants, using computational mutational analysis and docking simulations. Key mutations, such as Q493R and T478K, were found to enhance ACE2 binding affinity, while others like L452R and E484Q facilitate immune evasion. These findings provide valuable insights into the virus's adaptive mechanisms, aiding in the development of effective therapeutics and immunotherapies. [ABSTRACT FROM AUTHOR]

Viral respiratory infections are a significant clinical problem among the pediatric population and are one of the leading causes of hospitalization. Most often, upper respiratory tract infections are self-limiting. Still, those that involve the lower respiratory tract are usually associated with asthma exacerbations, leading to worsening or even the initiation of the disease. A key role in regulating the immune response and inflammation during viral infections and their impact on the progression of asthma has been demonstrated for miRNA molecules (microRNA). Their interaction with mRNA (messenger RNA) regulates gene expression in innate and acquired immune responses, making them valuable biomarkers for diagnostics, monitoring, and predicting asthma exacerbations. The following paper presents changes in the expression of miRNAs during the five most common viral infections causing asthma worsening, with particular emphasis on the pediatric population. In addition, we describe the molecular mechanisms by which miRNAs influence the pathogenesis of viral infection, immune responses, and asthma exacerbations. These molecules represent promising targets for future innovative therapeutic strategies, paving the way for developing personalized medicine for patients with viral-induced asthma exacerbations. [ABSTRACT FROM AUTHOR]

Some of the millions of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have developed new sequelae after recovering from the initial disease, termed post-acute sequelae of coronavirus disease 2019 (PASC). One symptom is anxiety, which is likely due to three etiologies: brain structural changes, neuroendocrine disruption, and neurotransmitter alterations. This review provides an overview of the current literature on the pathophysiological pathways linking coronavirus disease 2019 to anxiety, as well as the possible mechanisms of action in which an increasingly scrutinized treatment method, enhanced external counter-pulsation (EECP), is able to alleviate anxiety. SARS-CoV-2 triggers increased inflammatory cytokine production, as well as oxidative stress; these processes contribute to the aforementioned three etiologies. The potential treatment approach of EECP, involving sequenced inflation and deflation of specifically-placed airbags, has become of increasing interest, as it has been found to alleviate PASC-associated anxiety by improving patient cardiovascular function. These functional improvements were achieved by EECP stimulating anti-inflammatory and pro-angiogenic processes, as well as improving endothelial cell function and coronary blood flow, partially via counteracting against the negative effects of SARS-CoV-2 infection on the renin–angiotensin–aldosterone system. Therefore, EECP could promote both psychosomatic and cardiac rehabilitation. Further research, though, is still needed to fully determine its benefits and mechanism of action. [ABSTRACT FROM AUTHOR]

OBJECTIVES: COVID-19 treatment guidelines recommend baricitinib or tocilizumab for the management of hospitalized patients with COVID-19. We compared the effectiveness of baricitinib vs. tocilizumab on mortality and clinical outcomes among hospitalized patients with COVID-19. DESIGN: Multicenter, retrospective, propensity-weighted cohort study using a target trial emulation approach. SETTING: The National COVID Cohort Collaborative (N3C), which is the largest electronic health records data on COVID-19 in the United States. The setting included 75 hospitals. PATIENTS: Adults who were hospitalized for COVID-19. INTERVENTIONS: Newly initiated on baricitinib or tocilizumab. MEASUREMENTS AND MAIN RESULTS: Our primary outcome was 28-day mortality. We used propensity scores with inverse probability of treatment weights (IPTWs) to control bias and confounding while comparing treatments. Among 10,661 individuals included in the study, 6,229 (58.4%) received baricitinib and 4,432 (41.6%) tocilizumab. Overall, the mean age of the cohort was 60.0 ± 15.1 years, 6429 (60.3%) were male, and 19.2% received invasive mechanical ventilation. After IPTW adjustment, baricitinib use was associated with lower 28-day mortality (odds ratio [OR], 0.91; 95% CI, 0.85–0.98) and hospital (OR, 0.88; 95% CI, 0.82–0.94) mortality compared with tocilizumab. Baricitinib was also associated with shorter hospital length of stay (incident rate ratio, 0.92; 95% CI, 0.90–0.94) and lower rates of hospital-acquired infections (OR, 0.86; 95% CI, 0.75–0.99), although no difference in ICU length of stay was noted between the two groups. CONCLUSIONS: In this large, diverse cohort of U.S. hospitalized adults with COVID-19, baricitinib was associated with significantly lower 28-day mortality, hospital mortality, shorter hospital length of stay, and less hospital-acquired infections compared with tocilizumab. [ABSTRACT FROM AUTHOR]

Background: Prevalence of seropositivity following SARS-CoV-2 infection is vital in evaluating herd immunity. However, depending on illness severity, it remains unclear whether the breadth and magnitude of immune response to SARS-CoV-2 infection is for short or long term. Objective: To test the persistence of humoral antibody responses after SARS-CoV-2 exposure in patients with different illness severity and among volunteers who had been vaccinated. Methods: This study was conducted in two Saudi Arabian tertiary hospitals. Participants were categorized as critically ill COVID-19 patients, non-critically ill COVID-19 patients, or vaccinated volunteers. We collected demographic data, COVID-19 exposure history, symptoms, vaccination details, and serum samples to analyze antibody persistence. We evaluated SARS-CoV-2 antibody concentrations in COVID-19 patients with varying disease severity and age groups, as well as in BNT162b2-vaccinated individuals, focusing on IgG levels against the S.FL and S1 domains of the spike protein. Results: The study included 172 adults: 92 unvaccinated hospitalized COVID-19 patients and 80 vaccinated volunteers. All vaccinated subjects demonstrated seropositivity to the SARS-CoV-2 spike protein, with nearly 80% having a median antibody titer of 13,500 AU/mL. Notably, vaccinated subjects exhibited significantly higher IgG levels than naturally infected patients (P < 0.001), including higher S.FL and S1 titers, regardless of severity. Age, comorbidities, and previous infections influenced S-specific antibody levels. Among hospitalized patients, 58% required intensive care, with 28- and 90-day mortality rates of 23% and 43%, respectively. Conclusion: These findings shed light on the immune response dynamics following SARS-CoV-2 infection compared to vaccinated individuals, where the latter showed significantly higher level of antibodies response, providing crucial insights for evaluating short-term herd immunity and the effectiveness of natural infection-induced immunity. [ABSTRACT FROM AUTHOR]

In many COVID-19 survivors, symptoms continue for a long time. This study aims to examine the relationship between the long-term effects of COVID-19, levels of anxiety and depression, and suicidal ideation with sociodemographic factors and symptoms. A cross-sectional study was conducted on patients who came for control at least 3 months after having COVID-19 disease, in the stable period, and still have symptoms after COVID-19. Demographic characteristics, symptoms, The Beck Depression Scale (BDS), The Beck Anxiety Scale (BAS), and suicidal ideation were assessed with face-to-face questionnaires. A total of 490 patients participated in the study. Thirty percent of patients scored positive on the BDS and 46% scored high on the BAS. Female sex was found to be a risk factor. Anxiety and depression were found to be significantly associated with long COVID symptoms. Both BAS and BDS scores were significantly higher in people with suicidality compared to others, and long-term symptoms were found to be statistically associated with this situation. Depression and anxiety are common in cases of long COVID. It is important for healthcare professionals to be aware of these potential mental health consequences, especially suicidality, and to provide appropriate support and interventions for individuals with long COVID. [ABSTRACT FROM AUTHOR]

The Coronavirus Disease 2019 (COVID-19) has created serious risks to human health and public safety. Hence, there is a pressing demand for uncomplicated and precise diagnostic assays to ensure accurate identification of the infection. SARS-CoV-2, like other coronaviruses, is classified as a single-stranded, positive-sense RNA virus with four key structural proteins: the spike (S), envelope (E), membrane (M), and nucleocapsid (N) proteins. The spike protein holds significant importance in early diagnosis of SARS-COV-2 infection due to its role in viral attachment, fusion, and cellular entry. In the current study, the diagnostic performance of SARS-CoV-2 Spike Protein S1 RBD was evaluated. Clinical samples (n =75) (nasopharyngeal and blood specimens) were collected from confirmed infected patients using reverse transcription polymerase chain reaction RT-PCR. In addition, 25 healthy participants were included as controls. Routine laboratory markers were evaluated for all participants and the SARS-CoV-2 Spike Protein S1 RBD was determined using sandwich ELISA for all participants. The result showed that the spike protein level demonstrated a statistically significant difference (p < 0.0001) in COVID-19 patients compared to healthy participants. Furthermore, the variables D-Dimer and CRP demonstrated a statistically significant difference (p < 0.0001) with the existence of COVID-19. In contrast, the analysis revealed no differences regarding LDH, body mass index, or gender among the studied groups. In addition, there was a significant positive correlation between D-dimer (r = 0.57, p<0.0001) and spike antigen. Spike antigen was the most effective biomarker in distinguishing COVID from healthy participants, with an AUC of 0.99, sensitivity of 98%, and specificity of 94%. Additionally, D-dimer has a sensitivity of 93%, a specificity of 92%, and an AUC of 0.96, and CRP has a sensitivity of 87%, a specificity of 80%, AUC=0.88. And finally, ferritin has a sensitivity of 61%, a specificity of 64%, and an AUC of 0.64. SARS-COV-2. Spike antigen can be used as a suitable diagnostic test for identifying COVID-19 infection with higher sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Aim: Medical institutions restricted visitation to neonatal intensive care units (NICUs) during the coronavirus disease (COVID‐19) pandemic. Therefore, this study aimed to investigate the impact of COVID‐19 NICU visitor restrictions on parents. Methods: We conducted a questionnaire of 378 parents of infants who were hospitalised for more than 1 week at two NICUs in our area and discharged between 1 April 2020 and 31 March 2022. While the visiting rules for NICUs during this period varied depending on the phase of the COVID‐19 epidemic, generally, only parents were allowed to visit the NICUs for a few hours daily. Results: A total of 157 parents (A University Hospital (AMUH), n = 79; AK General Hospital (AKGH), n = 78) responded to the survey (41.3% response rate), with 40% stating that their emotions towards their infants were affected by restrictions due to the COVID‐19 pandemic. Parents' feelings towards their infants were influenced by mode of delivery, parity, duration of hospitalisation and opportunities to visit the NICU. More than 70% of respondents felt stressed due to COVID‐19 restrictions, and anxiety and emotional stress related to visitor restrictions were significantly affected by the number and duration of visits and allowability of family member visits. Parents felt that the restrictions had a negative impact on breastfeeding, overall infant care and infant–family bonding. Conclusion: As parents felt an impact on the bond with their infant during visitation restrictions, it is essential for facilities to implement measures to protect infant–family bonding during potential future pandemics. [ABSTRACT FROM AUTHOR]

Objectives: Advanced age is a well-established risk factor for severe coronavirus disease 2019 (COVID-19). Exacerbated inflammation affects multiple organs, among which hematopoiesis responds by increased output of various cells. We aimed to determine the association between COVID-19 progression and large immature cell (LIC) counts, changes in erythrocyte and platelet distribution widths (RDW, PDW) with reference to patients' age. Methods: A total of 755 patients with complete blood cell (CBC) analysis in the first 24 h of hospitalization were enrolled. Patients were divided into two groups: under and above 65 years of age. Results: The LIC counts were different in both groups (p < 0.003). However, only the senior patients had markedly different values of RDW and PDW (p < 0.001). The receiver operating characteristic (ROC) curve analysis provided increased LIC (AUC = 0.600), RDW (AUC = 0.609), PDW (AUC = 0.556), and platelet to LIC ratio (AUC = 0.634) as significant in discriminating outcome in the older group. Importantly, these results were not repeated in the younger patients. In the elderly, the progression was predicted with LIC cut-off at ≥ 0.305 × 109/L (OR = 3.166) and RDW over 12.15% (OR = 2.081). Discussion: Aging is characterized by a decline in immunological competence with a compromised control of inflammation leading to a proinflammatory state. This background together with the actions of pathogens may lead to emergency myelopoiesis. Conclusion: Our results point to the important differences between age groups regarding CBC-related parameters of stress hematopoiesis during severe infection. Higher LIC, RDW and PDW levels were reliable in the early identification of COVID-19 progression only in the elderly. [ABSTRACT FROM AUTHOR]

Objectives: We aim to study the relative viral load using salivary polymerase chain reaction among pregnant women treated with Paxlovid. Methods: Pregnant women with coronavirus disease 2019 were allocated to two groups: those receiving Paxlovid and those receiving no antiviral agents. We compared the nasopharyngeal and salivary relative viral loads and their changes in saliva specimens. Results: Among the thirty-seven pregnant women, seventeen received Paxlovid, and twenty received no antiviral agents. The viral cycle threshold value of saliva was significantly higher than that from nasopharynx, with a median ± interquartile range of 26.44 ± 7.68 versus 17.6 ± 9.6 in the Paxlovid group (p = 0.005). Following treatment, the median salivary viral load decreased by 13.40 cycle threshold values in the Paxlovid group (from a median of [Day 0 Ct] to [Day 4/5 Ct]), compared to a change of −1.59 cycle threshold values in the no-antiviral group (from a median of [Day 0 Ct] to [Day 4/5 Ct]) (p = 0.021). The detection rate of coronavirus disease 2019 using salivary polymerase chain reaction was 83.8% (31/37). Conclusions: This study showed that saliva is a useful diagnostic tool for coronavirus disease 2019 in pregnant women, and a significant decrease in the relative viral load of saliva was observed in those treated with Paxlovid. [ABSTRACT FROM AUTHOR]

We collected social contact data in Greece to measure contact patterns before (January 2020) and during the COVID-19 pandemic (March 2020–October 2021) and assess the effects of social distancing over time. During lockdowns, mean daily contacts decreased to 2.8–5.9 (mean prepandemic 20.4). Persons >65 years of age retained the fewest contacts during the pandemic (2.1–4.1). Compared with the first lockdown (March–April 2020), the second lockdown (November–December 2020) and third lockdown (April 2021) showed higher numbers of contacts (incidence rate ratio 1.50 [95% CI 1.27–1.76] in second lockdown and 2.19 [95% CI 1.86–2.58] in third lockdown). In 2021, an increase in contacts was apparent, which persisted during the April 2021 lockdown among persons 18–64 years of age. Our study provides evidence of the waning observance of physical distancing. Effective risk communication alongside targeted social distancing could offer alternatives to repeated lockdowns.

To support the ongoing management of viral respiratory diseases while transitioning out of the acute phase of the COVID-19 pandemic, many countries are moving toward an integrated model of surveillance for SARS-CoV-2, influenza virus, and other respiratory pathogens. Although many surveillance approaches catalyzed by the COVID-19 pandemic provide novel epidemiologic insight, continuing them as implemented during the pandemic is unlikely to be feasible for nonemergency surveillance, and many have already been scaled back. Furthermore, given anticipated cocirculation of SARS-CoV-2 and influenza virus, surveillance activities in place before the pandemic require review and adjustment to ensure their ongoing value for public health. In this report, we highlight key challenges for the development of integrated models of surveillance. We discuss the relative strengths and limitations of different surveillance practices and studies as well as their contribution to epidemiologic assessment, forecasting, and public health decision-making.

Introduction: Coronavirus Disease 2019 (COVID-19) has increased the burden of hospitalised pneumonia cases and related complications. Spontaneous Pneumothorax (PT) and Pneumomediastinum (PM) have been reported in both spontaneously breathing and ventilated patients with COVID-19 pneumonia. Aim: To determine the incidence and outcomes of spontaneous alveolar air leak events in COVID-19 pneumonia. Materials and Methods: This prospective cohort study was carried out from June 2020 to June 2021 at a tertiary care centre in Western India. All incident cases of alveolar air leaks in COVID-19 pneumonia were included. Clinical and demographic data were collected, and statistical analysis was performed. The Chi-square test or Fisher’s exact test were used to assess the differences in subgroup proportions. Results: A total of 79 patients (63 males and 16 females) experienced spontaneous alveolar air leaks in the form of PT, PM (mediastinal emphysema), or Subcutaneous Emphysema (SE), either isolated or in combination. A total of 58 patients (73.41%) had PT, while 8 patients (10.12%) had isolated PM and 2 patients (2.53%) had isolated SE. Of the total events, 35 (44.30%) occurred in spontaneously breathing patients, among them vigorous coughing was an important precipitating factor. At the time of the incident, 1.27%, 21.52%, and 77.21% of the affected cases belonged to mild, moderate, and severe COVID-19 categories, respectively. Male patients (n-63, 79.74%) in the age group of 30-60 years were predominantly affected. A total of 38 events (48.10%) occurred within two weeks (early) of symptom onset. The PaO2:FiO2 ratio at the time of the alveolar leak showed a significant association with the outcome. Patients with PT had a poorer outcome compared to those with other types of alveolar leaks (p-value

We conducted a self-controlled case series study to investigate the association between COVID-19 vaccination and facial palsy (FP) in South Korea. We used a large immunization registry linked with the national health information database. We included 44,564,345 patients >18 years of age who received >1 dose of COVID-19 vaccine (BNT162b2, mRNA-1273, ChAdOx1 nCoV-19, or Ad.26.COV2.S) and had an FP diagnosis and corticosteroid prescription within 240 days postvaccination. We compared FP incidence in a risk window (days 1–28) with a control window (the remainder of the 240-day observation period, excluding any risk windows). We found 5,211 patients experienced FP within the risk window and 10,531 experienced FP within the control window. FP risk increased within 28 days postvaccination, primarily after first and second doses and was observed for both mRNA and viral vaccines. Clinicians should carefully assess the FP risk-benefit profile associated with the COVID-19 vaccines and monitor neurologic signs after vaccination.

We studied SARS-CoV-2 binding and neutralizing antibody titers among previously infected persons in the United States over time. We assayed SARS-CoV-2 spike protein receptor-binding domain and neutralizing antibody titers for a convenience sample of residual clinical serum specimens that had evidence of prior SARS-CoV-2 infection gathered during January 2021–February 2022. We correlated titers and examined them by age group (65 years) across 4 different SARS-CoV-2 variant epochs. Among selected specimens, 30,967 had binding antibody titers and 744 had neutralizing titers available. Titers in specimens from children and adults correlated. In addition, mean binding antibody titers increased over time for all age groups, and mean neutralization titers increased over time for persons 16–49 and >65 years of age. Incorporating binding and neutralization antibody titers into infectious disease surveillance could provide a clearer picture of overall immunity and help target vaccination campaigns.

We tested 130 rats captured in Berlin for coronaviruses. SARS-CoV-2 antibodies were detected in 1 rat, but all animals were negative by reverse transcription PCR, suggesting SARS-CoV-2 was not circulating in the rat population. However, alphacoronaviruses were found. Monitoring rodent populations helps to determine coronavirus occurrence, transmission, and zoonotic potential.

Abstract Introduction The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare systems globally. The lack of quality guidelines on the management of COVID-19 in rheumatologic disease, renal disease, hematological malignancy, and solid organ transplant recipients has resulted in a wide variation in clinical practice. Methods Using a Delphi process, a panel of 16 key opinion leaders developed clinical practice statements regarding vaccine recommendations in areas where standards are absent or limited. Agreement among practicing physicians with consensus statements was also assessed via an online physician survey. The strength of the consensus was determined by the following rating system: a strong rating was defined as all four key opinion leaders (KOLs) rating the statement ≥ 8, a moderate rating was defined as three out of four KOLs rating the statement ≥ 8, and no consensus was defined as less than three out of four KOLs provided a rating of ≤ 8. Specialists voted on agreement with each consensus statement for their disease area using the same ten-point scoring system. Results Key opinion leaders in rheumatology, nephrology, and hematology achieved consensuses for all nine statements pertaining to the primary and booster series with transplant physicians reaching consensus on eight of nine statements. Experts agreed that COVID-19 vaccines are safe, effective, and well tolerated by patients with rheumatological conditions, renal disease, hematologic malignancy, and recipients of solid organ transplants. The Delphi process yielded strong to moderate suggestions for the use of COVID-19 messenger ribonucleic acid (mRNA) vaccines and the necessity of the COVID-19 booster for the immunocompromised population. The expert panel had mixed feelings concerning the measurement of antibody titers, higher-dose mRNA vaccines, and the development of disease-specific COVID-19 guidance. Conclusions These results confirmed the necessity of COVID-19 vaccines and boosters in immunocompromised patients with rheumatologic disease, renal disease, hematological malignancy, and solid organ transplant recipients. Statements where consensus was not achieved were due to absent or limited evidence.

Abstract Introduction The United States Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control (CDC) recommend COVID-19 vaccines for all immunocompromised individuals. Certain disease groups are at increased risk of comorbidity and death for which disease-specific recommendations should be considered. The objective of the Delphi panel of experts was to summarize expert consensus on COVID-19 vaccinations for patients with rheumatologic disease, renal disease, hematologic malignancy and solid organ transplant (SOT) in the US. Methods A two-stage Delphi panel method was employed, starting with qualitative interviews with key opinion leaders (KOLs) in the four disease areas (n = 4 KOLs, n = 16 total) followed by three rounds of iterative revision of disease-specific COVID-19 vaccine recommendations. Final consensus was rated after the third round. Statements addressed primary and booster dosing (e.g., number and frequency) and other considerations such as vaccine type or heterologous messenger ribonucleic acid (mRNA) vaccination. Following the Delphi Panel, an online survey was conducted to assess physician agreement within the disease areas (n = 50 each, n = 200 total) with the consensus statements. Results Moderate to strong consensus was achieved for all primary series vaccination statements across disease groups, except one in hematology. Similarly, moderate to strong consensus was achieved for all booster series statements in all disease areas. However, statements on antibody titer measurements for re-vaccination considerations and higher dosages for immunocompromised patients did not reach agreement. Overall, approximately 62%–96% of physicians strongly agreed with the primary and booster vaccine recommendations. However, low agreement (29%–69%) was found among physicians for time interval between disease-specific treatment and vaccination, recommendations for mRNA vaccines, heterologous mRNA vaccination, antibody titer measurement and higher vaccine dosage for immunocompromised groups. Conclusion Consensus was achieved for disease-specific COVID-19 vaccine recommendations concerning primary and booster series vaccines and was generally well accepted by practicing physicians.

The Centers for Disease Control and Prevention defines SARS-CoV-2 reinfection as a positive COVID-19 test result >90 days after the collection date for the initial positive test or if sequencing confirms a different lineage is causing the reinfection. Reinfection dynamics have been examined by using PCR or antigen surveillance data. We identified patients in the US Military Health System who had >1 positive SARS-CoV-2 test during March 2020–July 2022 by using whole-genome sequencing data to identify reinfection cases, then compared those data with patient demographics, symptoms, and vaccination status. We identified 267 reinfections, of which 90% were caused by the SARS-CoV-2 Omicron variant. Reinfection symptom severity correlated with initial symptom severity and time since first infection. Furthermore, we found intrahost mutation rates varied greatly in 72 cases of continuing infections with the same variant. Continued investigations of reinfections caused by emerging SARS-CoV-2 variants of concern is needed to maintain US military readiness.

Characterizing the epidemiology of circulating respiratory pathogens during the COVID-19 pandemic could clarify the burden of acute respiratory infections and monitor outbreaks of public health and military relevance. The US Department of Defense supported 2 regions for influenza-like illness and severe acute respiratory infections surveillance, one in the Middle East through US Naval Medical Research Unit EURAFCENT, and another in Latin America through US Naval Medical Research Unit SOUTH. During 2020‒2022, coinciding with the COVID-19 pandemic, we collected a total of 16,146 nasopharyngeal and oropharyngeal swab samples from sentinel sites in Jordan (n = 11,305) and Latin America (n = 4,841). Samples were tested for SARS-CoV-2, influenza, and other respiratory pathogens. SARS-CoV-2 was the most frequently detected pathogen during 2020; other respiratory pathogens had distinct temporal and frequency distributions according to geographic location. Our findings support the need for continued sentinel surveillance as a vital tool for assessing the burden of respiratory diseases globally.

Purpose To present a case of bilateral neurotrophic keratopathy (NK) following an inactivated coronavirus disease 2019 (COVID-19) vaccine administration. Methods Case report. Results A 46-year-old female patient was referred to our cornea department with unhealing corneal epithelial defects in both eyes. The patient’s complaints, including ocular redness, sensitivity to light and blurred vision, started 1 week after the second dose of CoronaVac® vaccine and continued to increase for 2 months. Ophthalmological examination revealed mild ocular redness, epithelial defects in the central cornea, and decreased corneal sensitivity in both eyes. No pathology that could cause NK was detected in the patient’s anamnesis and tests. Treatment including bandage contact lens application, autologous serum eye drops, preservative-free artificial tears, and oral doxycycline resulted in closure of the epithelial defect on the 10th day, and on the 2-month follow-up visit, it was observed that corneal sensitivity had increased. Conclusions In the presented case, it is thought that bilateral NK may be associated with the vaccine due to the chronological relationship between the vaccine administration and the lack of any other explanatory etiology. A cure was achieved in a short time with appropriate treatment, and the increase in corneal sensitivity over time indicates that the corneal neuropathy was reversible. Nowadays, with the worldwide administration of COVID-19 vaccines, ophthalmologists should keep in mind that, although rare, NK manifestation may still be encountered after vaccination.

We conducted a longitudinal cohort study of SARS-CoV-2 and influenza rates in childcare centers and schools in Wuxi, China, collecting 1,760 environmental samples and 9,214 throat swabs from 593 students (regardless of symptoms) in weekly collections during February–June 2023. We estimated a cumulative infection rate of 124.8 (74 episodes)/1,000 persons for SARS-CoV-2 and 128.2 (76 episodes)/1,000 persons for influenza. The highest SARS-CoV-2 infection rate was in persons 18 years of age, and for influenza, in children 4 years of age. The asymptomatic proportion of SARS-CoV-2 was 59.6% and 66.7% for influenza; SARS-CoV-2 symptomatic proportion was lower in 16–18-year-olds than in 4–6-year-olds. Only samples from frequently touched surface tested positive for SARS-CoV-2 (4/1,052) and influenza (1/1,052). We found asynchronous circulation patterns of SARS-CoV-2 and influenza, similar to trends in national sentinel surveillance. The results support vaccination among pediatric populations and other interventions, such as environmental disinfection in educational settings.

Using participatory, virologic, and wastewater surveillance systems, we estimated when and to what extent reported data of adult COVID-19 cases underestimated COVID-19 incidence in Germany. We also examined how case underestimation evolved over time. Our findings highlight how community-based surveillance systems can complement official notification systems for respiratory disease dynamics.

Pneumocystis jirovecii pneumonia is an opportunistic infection that affects HIV-infected and immunocompromised persons and rarely affects immunocompetent patients. However, after the advent of the COVID-19 pandemic, some COVID-19 patients without immunocompromise or HIV were infected with P. jirovecii. Clinical manifestations were atypical, easily misdiagnosed, and rapidly progressive, and the prognosis was poor.

Abstract Background Japan implemented strict border control measures and all incoming passengers were subject to entry screening with reverse transcription–polymerase chain reaction or antigen testing. From late 2020, exit screening within 72 h of departure to Japan also became mandatory. In this study, we evaluated the effectiveness of the exit screening policy in Japan by analyzing airport screening data from October 2020 to April 2022. Methods In addition to assessing entry screening data over time of passengers from the United Kingdom, we examined the prevalence of coronavirus disease 2019 (COVID-19) in the United Kingdom based on the Office of National Statistics infection survey. We constructed a statistical model that described entry screening positivity over time using Office of National Statistics prevalence data as the explanatory variable. Ideally, the time-dependent patterns of entry screening and Office of National Statistics prevalence data should resemble each other; however, we found that, sometimes, they were different and regarded the difference to statistically partly reflect the effectiveness of exit screening. Results The average proportion positive in one month before mandatory exit screening was implemented among Japanese passengers was 0.67% (95% confidence interval [CI]: 0.45, 0.98), whereas the proportion positive decreased to 0.49% (95% CI: 0.21, 1.15) in the first month of exit screening. Adjusting for time-dependent prevalence at the origin, we concluded that exit screening contributed to reducing passenger positivity by 59.3% (95% CI: 19.6, 81.3). The overall positivity values among passengers during the Delta and Omicron variant periods were 3.46 times and 1.46 times that during the pre-Delta variant period, respectively. Conclusions We used a simplistic statistical model and empirical data from passengers arriving in Japan from the United Kingdom to support that exit screening helped to reduce the proportion positive by 59%. Although the proportion positive later increased considerably and precluded preventing the introduction of imported cases, submitting a certificate for a negative test result contributed to reducing the positivity among travelers.

Abstract Background With the release of the coronavirus disease 2019 (COVID-19) pandemic in late 2022 in China, the number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) roared, including neonatal cases. However, there were few studies on neonatal COVID-19, especially multi-center case reports. This study aimed to explore clinical characteristics and short-term outcomes of neonatal COVID-19 in China. Methods We reviewed 187 cases of neonatal COVID-19 between December 11, 2022, and January 12, 2023. The diagnosis was assessed by symptoms, laboratory tests, X-ray manifestations, and diagnosis code. Clinical characteristics and outcomes were evaluated. Results In 187 neonatal cases with COVID-19, 84 (44.9%) had severe SARS-CoV-2 infection. Most patients had confirmed exposure to SARS-CoV-2. Fever and respiratory symptoms were common (75.4% and 71.7%, respectively). Severe patients were more likely to have high alanine transaminase (ALT) (> 40U/L) (11.9% vs. 3.9%) and high N-terminal pro-brain natriuretic peptide (NT-proBNP) (> 2000pg/mL) (38.0% vs. 19.6%), compared with nonsevere ones (P

Background and Aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 1 million people and caused more than 100,000 deaths in Indonesia. This condition was augmented by a less advanced health system, especially in providing diagnostic facilities for the novel coronavirus, and the high mutation rate of the novel coronavirus, which may promote the generation of specific strains in Indonesia. This study aimed to propose a specific primer (in-house primer) toward open reading frame 1a/b (ORF1ab) and the spike protein gene of SARS-CoV-2 to detect SARS-CoV-2 and to analyze the presence of mutations. Materials and Methods: One hundred and nine samples were collected from patients in Malang, East Java, Indonesia. The samples were extracted using QIAamp viral RNA kits. The in-house primer was designed using Clone Manager 9.0 and amplified using nested polymerase chain reaction (PCR). Then, the amplicon was analyzed through sequencing. The detection results were compared with those obtained using the quantitative PCR (qPCR). Results: Nested PCR was 74.3% positive, whereas qPCR was 45.9% positive. Furthermore, sequencing analysis of the amplicon revealed the mutation at locations T3187C, T2889C/T, G3189T (spike), and C364T (ORF1ab). The sensitivity and specificity of nested PCR were 92.6% and 43.6%, respectively. This result indicated that the in-house primer performed well at screening. Conclusion: In-house primers could detect SARS-CoV-2 and mutations in samples from Malang, East Java, Indonesia. In the future, this method could be recommended as a screening tool for monitoring SARS-CoV-2 infection.

Background: Coronavirus disease 2019 (COVID-19) vaccination has been shown to elicit both humoral (antibody) and cell-mediated (T-cell) immune responses. This study aimed to characterize and compare the QuantiFERON severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and anti-SARS-CoV-2 antibody responses in vaccinated and unvaccinated COVID-19 patients, as well as vaccinated healthy controls (HCs). Methods: A total of 96 COVID-19 patients (68 vaccinated with Sinopharm and 15 with AstraZeneca), 13 unvaccinated COVID-19 patients, and 16 vaccinated HCs (8 Sinopharm and 8 AstraZeneca) were included. Serum antibodies against the SARS-CoV-2 spike (S1) protein and nucleocapsid (N) protein were measured by enzyme-linked immunosorbent assay. T-cell responses were evaluated using the QuantiFERON assay against three SARS-CoV-2 viral antigens (Ag1, Ag2, and Ag3). Results: There were no significant differences in S1 antibody levels between COVID-19 patients (vaccinated or unvaccinated) and HCs. However, 100% of unvaccinated COVID-19 patients had anti-N antibodies, which was significantly higher than the AstraZeneca-vaccinated group. T-cell responses did not differ significantly between vaccinated and unvaccinated patients or between vaccinated patients and HCs. Vaccination with Sinopharm induced higher levels of total N antibodies and greater interferon-gamma release against the viral antigens compared to the other groups. Conclusions: Vaccination, especially with Sinopharm, induced robust humoral (N antibodies) and cellular (T-cell) immune responses in COVID-19 patients. The findings highlight the importance of vaccination in eliciting a comprehensive immune response against SARS-CoV-2, even in the context of prior infection.

OBJECTIVE: To investigate BK pathway dysregulation among and between COVID-19 survivors and the deceased. METHODOLOGY: This case-control study was performed between 2020 and 2022 in Imam Hasan Hospital, Bojnurd, Iran. SARS-CoV-2 infected patients, comprising 40 deceased and 15 surviving patients, were recruited according to specific inclusion and exclusion criteria. A blood sample was taken from subjects during the disease. Blood BK levels in subjects (the groups of patients (55) and control (15)) were measured by the ELISA technique. All patients were selected from individuals over 18 years old with real-time PCR-proven SARS-CoV-2 infection. Also, the studied patients did not have metabolic syndrome (blood pressure, abdominal obesity, diabetes, cardiovascular disease). SPSS version 26 was used to compare the means. RESULTS: The blood serum BK level was significantly related to the outcome of COVID-19 disease (P=0.006) using a multiple logistic regression test. A week before death, a significant increase in the blood BK levels among deceased patients compared to survivors was seen (p=0.0001). The probability of death in patients with SARS-CoV-2 infection linearly increased by 4% (OR = 1.04) for each pg/ml increase in the BK level. CONCLUSION: There is a close relationship between the rise in BK concentration during a COVID-19 infection and the disease outcome.

Background Genetic vulnerability to mental disorders has been associated with coronavirus disease-19 (COVID-19) outcomes. We explored whether polygenic risk scores (PRSs) for several mental disorders predicted poorer clinical and psychological COVID-19 outcomes in people with pre-existing depression. Methods Data from three assessments of the Australian Genetics of Depression Study (N = 4405; 52.2 years ± 14.9; 76.2% females) were analyzed. Outcomes included COVID-19 clinical outcomes (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection and long COVID, noting the low incidence of COVID-19 cases in Australia at that time) and COVID-19 psychological outcomes (COVID-related stress and COVID-19 burnout). Predictors included PRS for depression, bipolar disorder, schizophrenia, and anxiety. The associations between these PRSs and the outcomes were assessed with adjusted linear/logistic/multinomial regressions. Mediation (N = 4338) and moderation (N = 3326) analyses were performed to explore the potential influence of anxiety symptoms and resilience on the identified associations between the PRSs and COVID-19 psychological outcomes. Results None of the selected PRS predicted SARS-CoV-2 infection or long COVID. In contrast, the depression PRS predicted higher levels of COVID-19 burnout. Anxiety symptoms fully mediated the association between the depression PRS and COVID-19 burnout. Resilience did not moderate this association. Conclusions A higher genetic risk for depression predicted higher COVID-19 burnout and this association was fully mediated by anxiety symptoms. Interventions targeting anxiety symptoms may be effective in mitigating the psychological effects of a pandemic among people with depression. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza, and respiratory syncytial virus (RSV) are significant global health threats. The need for low-cost, easily synthesized oral drugs for rapid deployment during outbreaks is crucial. Broad-spectrum therapeutics, or pan-antivirals, are designed to target multiple viral pathogens simultaneously by focusing on shared molecular features, such as common metal cofactors or conserved residues in viral catalytic domains. This study introduces a new generation of potent sartans, known as bisartans, engineered in our laboratories with negative charges from carboxylate or tetrazolate groups. These anionic tetrazoles interact strongly with cationic arginine residues or metal cations (e.g., Zn2+) within viral and host target sites, including the SARS-CoV-2 ACE2 receptor, influenza H1N1 neuraminidases, and the RSV fusion protein. Using virtual ligand docking and molecular dynamics, we investigated how bisartans and their analogs bind to these viral receptors, potentially blocking infection through a pan-antiviral mechanism. Bisartan, ACC519TT, demonstrated stable and high-affinity docking to key catalytic domains of the SARS-CoV-2 NSP3, H1N1 neuraminidase, and RSV fusion protein, outperforming FDA-approved drugs like Paxlovid and oseltamivir. It also showed strong binding to the arginine-rich furin cleavage sites S1/S2 and S2′, suggesting interference with SARS-CoV-2's spike protein cleavage. The results highlight the potential of tetrazole-based bisartans as promising candidates for developing broad-spectrum antiviral therapies. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus Disease 2019 (COVID-19) has increased the burden of hospitalised pneumonia cases and related complications. Spontaneous Pneumothorax (PT) and Pneumomediastinum (PM) have been reported in both spontaneously breathing and ventilated patients with COVID-19 pneumonia. Aim: To determine the incidence and outcomes of spontaneous alveolar air leak events in COVID-19 pneumonia. Materials and Methods: This prospective cohort study was carried out from June 2020 to June 2021 at a tertiary care centre in Western India. All incident cases of alveolar air leaks in COVID-19 pneumonia were included. Clinical and demographic data were collected, and statistical analysis was performed. The Chi-square test or Fisher's exact test were used to assess the differences in subgroup proportions. Results: A total of 79 patients (63 males and 16 females) experienced spontaneous alveolar air leaks in the form of PT, PM (mediastinal emphysema), or Subcutaneous Emphysema (SE), either isolated or in combination. A total of 58 patients (73.41%) had PT, while 8 patients (10.12%) had isolated PM and 2 patients (2.53%) had isolated SE. Of the total events, 35 (44.30%) occurred in spontaneously breathing patients, among them vigorous coughing was an important precipitating factor. At the time of the incident, 1.27%, 21.52%, and 77.21 % of the affected cases belonged to mild, moderate, and severe COVID- 19 categories, respectively. Male patients (n-63, 79.74%) in the age group of 30-60 years were predominantly affected. A total of 38 events (48.10%) occurred within two weeks (early) of symptom onset. The PaO2:FiO2 ratio at the time of the alveolar leak showed a significant association with the outcome. Patients with PT had a poorer outcome compared to those with other types of alveolar leaks (p-value<0.005). Major bleeding occurred in 2 (3.33%) of the total 60 Intercostal Drainage (ICD) procedures. Prolonged alveolo-pleural fistula healed spontaneously in four out of five cases. The cumulative incidence for air leak events was 1.55%, and for barotrauma, it was 6.47%. The overall mortality in this cohort was 74.68% (n=59), while it was 29.41% (5 out of 17) in the moderate severity group. Patients with late- onset events had a better outcome (p-value<0.005). Conclusion: In this cohort of COVID-19 pneumonia from Western India, the cumulative incidence of spontaneous alveolar air leaks was 1.55%, predominantly affecting males. The early occurrence of PT in severely hypoxic patients on mechanical ventilator was associated with higher mortality. [ABSTRACT FROM AUTHOR]

Introduction: The United States Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control (CDC) recommend COVID-19 vaccines for all immunocompromised individuals. Certain disease groups are at increased risk of comorbidity and death for which disease-specific recommendations should be considered. The objective of the Delphi panel of experts was to summarize expert consensus on COVID-19 vaccinations for patients with rheumatologic disease, renal disease, hematologic malignancy and solid organ transplant (SOT) in the US. Methods: A two-stage Delphi panel method was employed, starting with qualitative interviews with key opinion leaders (KOLs) in the four disease areas (n = 4 KOLs, n = 16 total) followed by three rounds of iterative revision of disease-specific COVID-19 vaccine recommendations. Final consensus was rated after the third round. Statements addressed primary and booster dosing (e.g., number and frequency) and other considerations such as vaccine type or heterologous messenger ribonucleic acid (mRNA) vaccination. Following the Delphi Panel, an online survey was conducted to assess physician agreement within the disease areas (n = 50 each, n = 200 total) with the consensus statements. Results: Moderate to strong consensus was achieved for all primary series vaccination statements across disease groups, except one in hematology. Similarly, moderate to strong consensus was achieved for all booster series statements in all disease areas. However, statements on antibody titer measurements for re-vaccination considerations and higher dosages for immunocompromised patients did not reach agreement. Overall, approximately 62%–96% of physicians strongly agreed with the primary and booster vaccine recommendations. However, low agreement (29%–69%) was found among physicians for time interval between disease-specific treatment and vaccination, recommendations for mRNA vaccines, heterologous mRNA vaccination, antibody titer measurement and higher vaccine dosage for immunocompromised groups. Conclusion: Consensus was achieved for disease-specific COVID-19 vaccine recommendations concerning primary and booster series vaccines and was generally well accepted by practicing physicians. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare systems globally. The lack of quality guidelines on the management of COVID-19 in rheumatologic disease, renal disease, hematological malignancy, and solid organ transplant recipients has resulted in a wide variation in clinical practice. Methods: Using a Delphi process, a panel of 16 key opinion leaders developed clinical practice statements regarding vaccine recommendations in areas where standards are absent or limited. Agreement among practicing physicians with consensus statements was also assessed via an online physician survey. The strength of the consensus was determined by the following rating system: a strong rating was defined as all four key opinion leaders (KOLs) rating the statement ≥ 8, a moderate rating was defined as three out of four KOLs rating the statement ≥ 8, and no consensus was defined as less than three out of four KOLs provided a rating of ≤ 8. Specialists voted on agreement with each consensus statement for their disease area using the same ten-point scoring system. Results: Key opinion leaders in rheumatology, nephrology, and hematology achieved consensuses for all nine statements pertaining to the primary and booster series with transplant physicians reaching consensus on eight of nine statements. Experts agreed that COVID-19 vaccines are safe, effective, and well tolerated by patients with rheumatological conditions, renal disease, hematologic malignancy, and recipients of solid organ transplants. The Delphi process yielded strong to moderate suggestions for the use of COVID-19 messenger ribonucleic acid (mRNA) vaccines and the necessity of the COVID-19 booster for the immunocompromised population. The expert panel had mixed feelings concerning the measurement of antibody titers, higher-dose mRNA vaccines, and the development of disease-specific COVID-19 guidance. Conclusions: These results confirmed the necessity of COVID-19 vaccines and boosters in immunocompromised patients with rheumatologic disease, renal disease, hematological malignancy, and solid organ transplant recipients. Statements where consensus was not achieved were due to absent or limited evidence. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed the effectiveness of the oral antiviral agents nirmatrelvir – ritonavir (NMV-r) and molnupiravir (MOV) for treating mild-to-moderate coronavirus disease 2019 (COVID-19) in patients with COPD. Methods: This retrospective cohort study extracted data from the TriNetX platform and examined 94,984 COVID-19 patients with preexisting COPD from 1 January 2022, to 1 October 2023. Patients receiving NMV-r or MOV (study group) were compared with those not receiving oral antiviral agents (control group) after propensity score matching (PSM). Results: After PSM, 7,944 patients were classified into the study and control groups. The primary composite outcome of all-cause hospitalization, or death in 30 days was reported in 458 (5.7%) patients in the study group and 566 (7.1%) patients in the control cohort, yielding a hazard ratio [HR] of 0.79 (95% confidence interval [CI]: 0.70–0.89; Table 2). Compared with the control group, the study group had a significantly lower risk of all-cause hospitalization (HR, 0.87; 95% CI: 0.76–0.99) and death (HR: 0.21, 95% CI: 0.13–0.35). Conclusions: This study revealed that oral antivirals – NMV-r or MOV might improve clinical outcomes in patients with preexisting COPD and COVID-19. However, only a small proportion of preexisting COPD patients with COVID-19 received oral antiviral treatment. [ABSTRACT FROM AUTHOR]

Introduction: In Brazil, few studies were performed regarding the co-detection of respiratory viruses in hospitalized patients. In this way, the study aimed to describe the epidemiological profile of hospitalized patients due to influenza virus infection that presented co-detection with another respiratory virus. Methods: The epidemiological analysis was made by collecting data from Open-Data-SUS. The study comprised patients infected by the influenza A or B virus with positive co-detection of another respiratory virus, such as adenovirus, bocavirus, metapneumovirus, parainfluenza virus (types 1, 2, 3, and 4), rhinovirus, and respiratory syncytial virus (RSV). The markers [gender, age, clinical signs and symptoms, comorbidities, need for intensive care unit (ICU) treatment, and need for ventilatory support] were associated with the chance of death. The data was collected during the first three years of the coronavirus disease (COVID)-19 pandemic--from December 19, 2019, to April 06, 2023. Results: A total of 477 patients were included, among them, the influenza A virus was detected in 400 (83.9%) cases. The co-detection occurred, respectively, for RSV (53.0%), rhinovirus (14.0%), adenovirus (13.4%), parainfluenza virus type 1 (10.7%), parainfluenza virus type 3 (5.2%), metapneumovirus (3.8%), parainfluenza virus type 2 (3.6%), bocavirus (3.4%), and parainfluenza virus type 4 (1.5%). The co-detection rate was higher in the male sex (50.7%), age between 0-12 years of age (65.8%), and white individuals (61.8%). The most common clinical symptoms were cough (90.6%), dyspnea (78.8%), and fever (78.6%). A total of 167 (35.0%) people had at least one comorbidity, mainly cardiopathy (14.3%), asthma (8.4%), and diabetes mellitus (7.3%). The need for ICU treatment occurred in 147 (30.8%) cases, with most of them needing ventilatory support (66.8%), mainly non-invasive ones (57.2%). A total of 33 (6.9%) patients died and the main predictors of death were bocavirus infection (OR = 14.78 [95%CI = 2.84-76.98]), metapneumovirus infection (OR = 8.50 [95%CI = 1.86-38.78]), race (other races vs. white people) (OR = 3.67 [95%CI = 1.39-9.74]), cardiopathy (OR = 3.48 [95%CI = 1.13-10.71]), and need for ICU treatment (OR = 7.64 [95%CI = 2.44-23.92]). Conclusion: Co-detection between the influenza virus and other respiratory viruses occurred, mainly with RSV, rhinovirus, and adenovirus being more common in men, white people, and in the juvenile phase. Co-detection of influenza virus with bocavirus and metapneumovirus was associated with an increased chance of death. Other factors such as race, cardiopathy, and the need for an ICU were also associated with a higher chance of death. [ABSTRACT FROM AUTHOR]

Background: Respiratory viruses are known to represent a high burden in winter, yet the seasonality of many viruses remains poorly understood. Better knowledge of co‐circulation and interaction between viruses is critical to prevention and management. We use > 10‐year active surveillance in the Valencia Region to assess seasonality and co‐circulation. Methods: Over 2010–2021, samples from patients hospitalised for acute respiratory illness were analysed using multiplex real‐time PCR to test for 9 viruses: influenza, respiratory syncytial virus (RSV), parainfluenza virus (PIV), rhino/enteroviruses (HRV/ENV), metapneumovirus (MPV), bocavirus, adenovirus, SARS‐CoV‐2 and non‐SARS coronaviruses (HCoV). Winter seasonal patterns of incidence were examined. Instances of co‐detection of multiple viruses in a sample were analysed and compared with expected values under a crude model of independent circulation. Results: Most viruses exhibited consistent patterns between years. Specifically, RSV and influenza seasons were clearly defined, peaking in December–February, as did HCoV and SARS‐CoV‐2. MPV, PIV and HRV/ENV showed less clear seasonality, with circulation outside the observed period. All viruses circulated in January, suggesting any pair had opportunity for co‐infection. Multiple viruses were found in 4% of patients, with more common co‐detection in children under 5 (9%) than older ages. Influenza co‐detection was generally observed infrequently relative to expectation, while RSV co‐detections were more common, particularly among young children. Conclusions: We identify characteristic patterns of viruses associated with acute respiratory hospitalisation during winter. Simultaneous circulation permits extensive co‐detection of viruses, particularly in young children. However, virus combinations appear to differ in their rates of co‐detection, meriting further study. [ABSTRACT FROM AUTHOR]