Little is known about the ongoing monkeypox (mpox) outbreak, and the clinical features of mpox in patients worldwide have not been rigorously analysed. Thus, we aimed to investigate the clinical ...features associated with mpox infection and understand the pathophysiology and characteristics of the disease. For this systematic review and meta‐analysis, we searched PubMed/MEDLINE, Embase, CINAHL, Google Scholar, and the Cochrane Database of Systematic Reviews for articles published till 16 September 2022. We used a random effects model to calculate the pooled prevalence and 95% confidence interval (CI). We used the I2 statistic to assess heterogeneity, Egger's test to assess publication bias, 95% prediction interval to determine the level of uncertainty, and the Newcastle‐Ottawa Scale and Joanna Briggs Institute quality assessment tool to assess the risk of bias. Twenty‐six relevant articles from 19 countries across 5 continents were included, and data on 5472 mpox patients with 18 unique features were analysed. The pooled prevalence of clinical features of mpox were rash (85.7%, 95% CI: 68.3–94.3; k = 21), chills (77.8%, 95% CI: 70.5–83.7; k = 3), and fever (62.3%, 95% CI: 51.3–71.6; k = 25), lymphadenopathy (58.6%, 95% CI: 47.2–69.2; k = 21), lethargy or exhaustion (46.8%, 95% CI: 30.7–63.5; k = 14), pruritus (40.6%, 95% CI: 28.5–54.0; k = 5), myalgia (36.0%, 95% CI: 24.3–49.7; k = 16), headache (34.6%, 95% CI: 23.4–47.8; k = 17), skin ulcer (31.1%, 95% CI: 18.6–47.1; k = 7), abdomen symptom (24.2%, 95% CI: 17.9–31.9; k = 11), pharyngitis (23.0%, 95% CI: 12.7–37.9; k = 14), respiratory symptom (19.5%, 95% CI: 6.8–44.6; k = 6), nausea or vomiting (13.0%, 95% CI: 4.6–31.9; k = 3), scrotal or penile oedema (10.7%, 95% CI: 6.3–17.7; k = 4), conjunctivitis (7.1%, 95% CI: 2.4–18.9; k = 6), and death (0.9%, 95% CI: 0.4–2.0; k = 26). This is the first international and comprehensive study to examine all clinical presentations of human mpox infection. Our systematic review proposes a comprehensive understanding of the current mpox outbreak and may serve as key data for future studies on the pathological mechanisms and epidemiology of mpox infections.
With the ongoing COVID‐19 pandemic, several previous studies from different countries showed that physical activity (PA) decreased during the COVID‐19 outbreak. However, few studies have examined the ...recent tendency of PA in the adolescent population. Thus, we aimed to investigate the long‐term trend of PA in Korean youth and the prevalence changes between before and during the COVID‐19 pandemic. Data from Korea Youth Risk Behavior Web‐Based Survey (KYRBS) was collected for consecutive years between 2009 and 2021. The period was separated into prepandemic (2009−2019), early‐pandemic (2020), and mid‐pandemic (2021). Self‐reported amount of PA was categorized into four groups (insufficient, aerobic, muscle strengthening, and both physical activities) according to World Health Organization (WHO) PA guidelines. A total of 840 488 adolescents aged 12−18 who fully responded to the survey were selected (response rate: 95.2%). The 13‐year trends in the proportion of adolescents who reported aerobic and muscle‐strengthening activities met or exceeded 2020 WHO exercise guidelines for adolescents plateaued (11.9% from 2009 to 2011, 14.2% from 2018 to 2019, 14.4% from 2020, and 14.0% from 2021); however, the slope decreased during the pandemic (βdiff, −0.076; 95% confidence interval CI, −0.123 to −0.029). Proportion of sufficient aerobic exercise among adolescents sharply decreased midst the pandemic (28.0% from 2009 to 2011, 29.4% from 2018 to 2019, and 23.8% from 2020; βdiff, −0.266; 95% CI, −0.306 to −0.226) but increased again in 2021 (26.0% from mid‐COVID 19; 95% CI, 25.4−26.7). Similar patterns were observed in Metabolic Equivalent Task (MET) score (MET‐min/week; 804.1 from 2018 to 2019, 720.9 from 2020, and 779.6 from 2021). The mean difference in MET score between pre‐COVID and post‐COVID was −55.4 MET‐min/week (95% CI, −70.5 to −40.3). Through a nationwide representative study, there was no significant difference with regard to the number of Korean adolescents who achieved the PA guidelines (pre and postpandemic); however, the prevalence of recommended levels of PA needs to increase more based on the trend before the COVID‐19 outbreak. The findings of this study suggest reinforcement of the importance of public health policies for Korean youths to be more physically active, especially during and after the pandemic.
Owing to 2018 expanded diagnostic criteria for eosinophilic esophagitis (EoE) and thus a possible increase in diagnosis, previous studies on the global incidence and prevalence of EoE may need to be ...updated. We aimed to describe global, regional, and national trends in the incidence and prevalence of EoE from 1976 to 2022 and analyze their associations with geographic, demographic, and social factors through a systematic review.
We searched the PubMed/MEDLINE, Embase, CINAHL, Google Scholar, and Cochrane databases from their inception dates to December 20, 2022, for studies that reported the incidence or prevalence of EoE in the general population. We calculated the global incidence and prevalence of EoE using pooled estimates with 95% confidence intervals (CIs) and performed subgroup analysis based on age, sex, race, geographical area, World Bank income group, and diagnostic criteria of EoE.
Forty studies met the eligibility criteria, including over 288 million participants and 147,668 patients with EoE from 15 countries across the five continents. The global pooled incidence and prevalence of EoE were 5.31 cases per 100,000 inhabitant-years (95% CI, 3.98-6.63; number of studies, 27; sample population, 42,191,506) and 40.04 cases per 100,000 inhabitant-years (95% CI, 31.10-48.98; number of studies, 20; sample population, 30,467,177), respectively. The pooled incidence of EoE was higher in high-income countries (vs low- or middle-income countries), males, and North America (vs Europe and Asia). The global prevalence of EoE followed a similar pattern. The pooled prevalence of EoE gradually increased from 1976 to 2022 (1976-2001; 8.18; 95% CI, 3.67-12.69 vs 2017-2022; 74.42; 95% CI, 39.66-109.19 cases per 100,000 inhabitant-years).
The incidence and prevalence of EoE have increased substantially and vary widely across the world. Further research is needed to evaluate the incidence and prevalence of EoE in Asia, South America, and Africa.
Abstract
Benefits of breastfeeding for both the mother and the child are well established, but a comprehensive and robust study to investigate the protective effect of breastfeeding and attenuated ...time effect stratified by cause of morbidity are lacking. This study is based on the nationwide birth cohort in Korea that includes data on all infants born from 2009 to 2015. Of 1,608,540 children, the median follow-up period was 8.41 years (interquartile range, 6.76-10.06). When compared to children with fully formula feeding, the hospital admission rate was 12% lower in those with partially breastfeeding and 15% lower in those with exclusive breastfeeding. The apparent protective effect of breastfeeding was reduced with increasing age. Our study provides potential evidence of the beneficial association of breastfeeding on subsequent hospital admissions. The protective effect declined over time as the children grew older. Encouraging any breastfeeding for at least the first 6 months among infants is an important public health strategy to improve overall child health.
Lipopolysaccharide (LPS)-binding protein (LBP) is an acute-phase reactant that mediates innate immune responses triggered by LPS. Recent studies indicated a positive correlation of circulating LBP ...level with chronic low-grade inflammation, a condition present in many non-communicable diseases. We determined the association of serum LBP concentration with allergic sensitization in a general pediatric population. Serum LBP was measured in a sample of children (n = 356; mean age = 9.6 ± 0.2 years) in this population-based cross-sectional study. Skin prick tests (SPTs) were performed to assess allergic sensitization to 22 common inhalant and food allergens. One hundred and seven children (30.1%) were nonsensitized, 160 (44.9%) were monosensitized, and 89 (25.0%) were polysensitized. Children who were mono- or polysensitized had a significantly higher median serum LBP level (25.5 ng/mL, inter-quartile range IQR 20.3-30.7) than those who were nonsensitized (20.3 ng/mL, IQR = 14.81-25.8, P < 0.0001). Multivariate logistic regression analysis with adjustment for confounders indicated that serum LBP level was positively associated with allergic sensitization overall (adjusted odds ratio aOR 1.041; 95% CI 1.007-1.076, P = 0.016), with sensitization to food allergens in particular (aOR 1.080, 95% CI 1.029-1.133, P = 0.002), but not with sensitization to aeroallergens (aOR 1.010, 95% CI 0.982-1.040, P = 0.467). LBP level was not associated with allergic diseases after adjustment. We suggest the possibility of sensitization to food allergens may be related to gut-derived low-grade inflammation, and large sized longitudinal investigations are needed to elucidate the relationship.
Background Recent evidence suggests that prenatal maternal distress increases the risk of allergic diseases in offspring. However, the effect of prenatal maternal depression and anxiety on atopic ...dermatitis (AD) risk remains poorly understood. Objective We investigated whether prenatal maternal distress is associated with AD risk in offspring and whether the mechanism is mediated by reactive oxygen species. Methods Two general population-based birth cohorts formed the study. One cohort (Cohort for Childhood Origin of Asthma and Allergic Diseases COCOA) consisted of 973 mother-baby dyads, and the other (Panel Study on Korean Children PSKC) consisted of 1531 mother-baby dyads. The association between prenatal distress and AD was assessed by using Cox proportional hazards and logistic regression models. In COCOA placental 11β-hydroxysteroid dehydrogenase type 2 and glutathione levels and serum IgE levels in 1-year-old children were measured. Results In COCOA and PSKC AD occurred in 30.6% (lifetime prevalence) and 11.6% (1 year prevalence) of offspring, respectively. Prenatal maternal distress increased the risk of AD in offspring, both in COCOA (hazard ratio for depression, 1.31 95% CI, 1.02-1.69; hazard ratio for anxiety, 1.41 95% CI, 1.06-1.89) and PSKC (odds ratio for distress, 1.85 95% CI, 1.06-3.25). In COCOA both prenatal maternal depression and anxiety scores were positively related to the predicted probability of AD ( P < .001 in both). Prenatal distress decreased placental glutathione to glutathione disulfide ratios ( P = .037) and, especially in those who later had AD, decreased placental 11β-hydroxysteroid dehydrogenase type 2 levels ( P = .010) and increased IgE levels at 1 year of age ( P = .005). Conclusion Prenatal maternal depression and anxiety promote risk of AD in offspring. Maternal distress increases the predicted probability of AD. The mechanism might involve chronic stress, abnormal steroid levels, and reactive oxygen species.
Background
Vaccine‐associated anaphylaxis is a rare but life‐threatening reaction that occurs within minutes to hours of exposure to allergens. As studies utilizing large‐scale data to investigate ...this topic are limited, further research is needed to assess its burden, long‐term trends, and associated risk factors so as to gain a comprehensive understanding of vaccine‐associated anaphylaxis globally. Therefore, this study aimed to investigate the global burden of vaccine‐associated anaphylaxis and related vaccines.
Method
This study utilized the World Health Organization International Pharmacovigilance Database, in which reports of vaccine‐associated anaphylaxis between 1967 and 2023 were obtained (total reports = 131,255,418). We estimated the global reporting counts, reported odds ratio (ROR), and information component (IC) to identify the relationship between 19 vaccines and associated anaphylaxis in 156 countries and territories.
Results
We identified 31,676 reports of vaccine‐associated anaphylaxis among 363,290 reports of all‐cause anaphylaxis. The cumulative number of reports on vaccine‐associated anaphylaxis has gradually increased over time, with a dramatic increase after 2020, owing to reports of COVID‐19 mRNA vaccine‐associated anaphylaxis. The typhoid vaccines were associated with the most anaphylactic reports (ROR: 4.35; IC0.25: 1.86), followed by encephalitis (3.27; 1.45), hepatitis B (2.69; 1.30), cholera (2.65; 0.54), hepatitis A (2.44; 1.12), influenza (2.36; 1.16), inactivated whole‐virus COVID‐19 (2.21; 1.02), and COVID‐19 mRNA vaccines (1.89; 0.79). In terms of age‐ and sex‐specific risks, vaccine‐associated anaphylaxis reports develop more frequently in females and at young ages. The Ad5‐vectored COVID‐19 vaccine anaphylaxis reports were associated with the highest fatality rate (15.0%).
Conclusions
Although multiple vaccines are associated with various spectra and risks of anaphylaxis, clinicians should recognize the possibility of anaphylaxis occurring with all vaccines, particularly the COVID‐19 mRNA and inactivated whole‐virus COVID‐19 vaccines, and consider the risk factors associated with vaccine anaphylaxis reports. Further studies are warranted to identify better ways of preventing vaccine‐associated anaphylaxis.
We identified 31,676 reports of vaccine‐associated anaphylaxis among 363,290 reports of all‐cause anaphylaxis from the World Health Organization International Pharmacovigilance Database. The cumulative number of reports on vaccine‐associated anaphylaxis has gradually increased over time, with a dramatic increase after 2020, owing to COVID‐19 mRNA vaccine‐associated anaphylaxis. The typhoid vaccines caused the most anaphylactic reports, followed by encephalitis, hepatitis B, cholera, hepatitis A, influenza, inactivated whole‐virus COVID‐19, and COVID‐19 mRNA vaccines. COVID‐19, coronavirus disease 2019; MMR, measles, mumps, and rubella; WHO, World Health OrganizationAbbreviations: COVID‐19, coronavirus disease 2019; MMR, measles, mumps, and rubella; WHO, World Health Organization.
Air pollution may influence prenatal maternal stress, but research evidence is scarce. Using data from a prospective cohort study conducted on pregnant women (n = 2153), we explored the association ...between air pollution and perceived stress, which was assessed using the 14-item Perceived Stress Scale (PSS), among pregnant women. Average exposures to particulate matter with an aerodynamic diameter of < 2.5 µm (PM
) or < 10 µm (PM
), nitrogen dioxide (NO
), and ozone (O
) for each trimester and the entire pregnancy were estimated at maternal residential addresses using land-use regression models. Linear regression models were applied to estimate associations between PSS scores and exposures to each air pollutant. After adjustment for potential confounders, interquartile-range (IQR) increases in whole pregnancy exposures to PM
, PM
, and O
in the third trimester were associated with 0.37 (95% confidence interval CI 0.01, 0.74), 0.54 (95% CI 0.11, 0.97), and 0.30 (95% CI 0.07, 0.54) point increases in prenatal PSS scores, respectively. Furthermore, these associations were more evident in women with child-bearing age and a lower level of education. Also, the association between PSS scores and PM
was stronger in the spring. Our findings support the relationship between air pollution and prenatal maternal stress.
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