Concern over spillover events caused by high-consequence pathogens has grown in recent years due to the increased occurrence of such events, and because the COVID-19 pandemic demonstrated how severe the consequences of spillover events can be. As such, there is escalading interest in uncovering the factors that make spillover events more likely, specifically for high-consequence pathogens. An important aspect of this work involves researching how high-consequence pathogens interact with their reservoir hosts. Thus, this chapter discusses the importance of studying high-consequence pathogens in their reservoir hosts, specifically in experimental laboratory settings, with a special emphasis on Sin Nombre virus and Lassa virus, and their respective rodent reservoir hosts, Peromyscus maniculatus and Mastomys natalensis. Value gained from this research, as well as the current limitations faced when conducting this work are also discussed. Overall, this work helps to shed light on various aspects of these pathogens such as their transmission patterns, pathogenesis (and lack thereof), and mechanisms of persistence in their reservoir hosts. Limitations include a need for highly developed laboratory infrastructure, demanding funding requirements, and a lack of compatible reagents for the exotic species that are often the subject of these studies. Continued interest and research is needed to expand this work to include host reservoirs of other high consequence pathogens so that the risks of future spillover events can be mitigated as best as possible.

Zoonotic infections with emerging influenza viruses occur in the context of population-wide immunity to seasonal strains. Because of the worldwide spread of highly pathogenic clade 2.3.4.4b H5N1 influenza viruses in wild birds, there have been numerous spillover events into mammals. This includes a recent spillover into dairy cows that started an ongoing outbreak across the United States. Human infections with avian and bovine origin H5N1 influenza viruses have been documented, raising concern that these viruses may cause a pandemic. Therefore, using a ferret model, we evaluated the impact of preexisting, infection-elicited immunity on susceptibility to H5N1 infection and on severity of disease. Preexisting immunity to the 2009 pandemic H1N1 influenza virus prevented severe H5N1 disease and reduced susceptibility to infection through direct contact with an infected donor ferret. These studies demonstrate that preexisting immunity to influenza viruses, especially the 2009 pandemic H1N1 virus, is a barrier to infection and disease caused by clade 2.3.4.4b H5N1 viruses.

Trends in maternal mortality (MMR) and late maternal mortality ratios (LMMR) were estimated, in periods with and without H1N1 and COVID-19 pandemics, in Rio de Janeiro, Brazil, from 2009 to 2021.

Ecological study of temporal trends. Data was obtained from the Mortality and Live Birth Information Systems. The annual MMR and LMMR per 100,000 live births (LB) were calculated and the trends were estimated using the joinpoint regression model.

In 2009, the MMR was 103.1, reaching 152.4/100,000 LB in 2021, with an annual reduction of 3.3% (95% confidence interval - 95%CI -5.5; -1.7) until 2019 and an increase of 51.2% (95%CI 23.5; 64.5) in 2020/21. Excluding the years of the COVID-19 pandemic, it was observed that an annual decline of 3.3% and, with the concomitant exclusion of the years of the H1N1 pandemic, stability. The LMMR were 8.3 (2009) and 22.2 (2021) per 100,000 LB, with an annual growth of 28.2% (95%CI 11.8; 47.8) until 2011, remaining stationary from 2011 to 2015, followed by an increase of 11.7% until 2021; with the exclusion of the final biennium, the trend is upward (3.8%) and also with the exclusion of the initial biennium, the trend became downward (7%) until 2014 and upward (8.2%) from then on.

There was a change in trend with the separate or joint incorporation of pandemic biennia: without pandemics, maternal mortality would be stationary, despite actions to prevent maternal deaths, and late maternal mortality, would be descending until 2014 and then ascending, crediting itself in part, to improving death investigation.

Initial research suggested that intimate partner violence (IPV) increased over COVID-19 due to social restrictions. This IPV increase during COVID-19 has been termed the 'twin pandemics'. Closer inspection of the evidence, however, challenges this notion. In this study, Australian residents (N = 608) who were either exposed to strict, prolonged lockdown orders (Victorian residents) or not (non-Victorian residents) completed 10 waves of IPV perpetration assessment online over five months and baseline assessments of instigating factors (situational factors that increase IPV perpetration), impelling factors (personal characteristics that increase IPV perpetration) and inhibiting factors (personal and situational factors that diminish IPV perpetration). Latent profile analysis and conditional latent growth curve modelling revealed that lockdown alone did not predict IPV trajectories. However, individuals whose profiles evidenced higher instigating and impelling factors and lower inhibiting factors (i.e. perfect storm profile) demonstrated elevated physical and psychological IPV over time compared to those whose profiles evidenced lower instigating and impelling factors and higher inhibiting factors (i.e. low-risk profile). Those with a perfect storm profile also evidenced steeper acceleration in physical and psychological IPV over time. The findings call into question the 'twin pandemics' notion and suggest that IPV over COVID-19 is best predicted by a specific risk profile.

Bicycles are key elements for local micromobility and sport activity. Several western countries have a long tradition of cycling sport activity, and they must face road safety issues.

The present study has investigated the safety of competitive road cyclists in Italy, focusing on a seven-year period, comprising the COVID-19 pandemic event.

An anonymous dataset containing 5754 injury events involving competitive athletes (Italian Cycling Federation, FCI) in the period 2017-2023 has been statistically analysed. Starting from public data (National Institute of Statistics) the mortality of FCI athletes has been compared to that of non-FCI cyclists.

In the years from 2017 to 2023 the dataset presented 36 deaths of FCI athletes (7 during races, 29 during training sessions, belonging to the categories Juniores, Under 23, Elite and Master). No deaths involved athletes under 16 years old. Young athletes were characterized by a reduced rate of injuries when compared to Elite and Master cyclists. The data described an inverse correlation between the value of inhabitants per square km and the number of normalized injuries. Mortality of FCI athletes was lower than non-FCI cyclists, especially after the COVID-19 pandemic (p> 0.01).

The presented data showed a safer condition for younger FCI athletes when compared to Elite athletes. The comparison with general population using the bicycle for personal mobility is more complex, but some interesting data show a reduced mortality rate in FCI athletes. It is possible to speculate that specific training of FCI athletes and the regular adoption of protective equipment can play a role in reducing mortality: additional studies are required to clarify this aspect.

Long Covid (LC) is a multisystem condition that can cause persistent symptoms such as breathlessness, fatigue, cognitive problems and pain, with major effects on individuals and healthcare systems. Globally, nearly 400 million people have been affected. New-onset pain is among the most commonly reported symptoms and may develop into chronic pain, contributing to reduced health-related quality of life (HRQoL) and highlighting the need for appropriate care. Given its global prevalence, exploring how people experience new-onset LC pain and how it impacts their lives can help improve pain management and support services.

A mixed-methods scoping review was conducted following the Joanna Briggs Institute (JBI) guidance and the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR). The review mapped and synthesised evidence from eligible primary research articles (quantitative, qualitative and mixed-methods) published in English between December 2019 and June 2024. Seven studies using cross-sectional, case-control and observational designs (n = 30 to 2507 participants) were included, with data collected from Europe and Asia.

While qualitative data on lived experience were limited, 69.5% of LC patients reported new-onset pain, most commonly musculoskeletal (MSK) pain (73.2%). Psychological symptoms such as post-traumatic stress disorder (PTSD) were also reported (38%). Pain medications were widely used. Findings suggest that new-onset LC pain affects physical, psychological and social well-being. No studies involving children or adolescents were identified, indicating a gap in the evidence on paediatric experiences of new-onset LC pain.

This review highlights major gaps in the literature, especially the lack of qualitative research on how people experience new-onset LC pain. Future research should explore these experiences in depth, with involvement from patients and the public, to inform the development of appropriate treatment and support strategies.

During the review process, opportunities to involve PPI were not fully explored due to limited awareness of how to support meaningful involvement in a scoping review, alongside time and resource constraints. Such involvement could have helped shape the review question, refine the search terms and interpret the findings in ways that better reflect lived experience. This is acknowledged as both a limitation and a learning point. PPI will be actively embedded in the next phases of the research.

The COVID-19 pandemic has highlighted the essential role of a strong immune system in fighting infectious diseases. Understanding the relationship between exercise, physical activity, and immune function is crucial for recognizing how lifestyle factors can improve immune resilience. This review article aims to provide a comprehensive overview of the effects of exercise on the immune system during the COVID-19 pandemic. Additionally, it presents recommendations, guidelines, and considerations for engaging in physical activity during this period. Based on the literature review, there is some controversy regarding the effects of high-intensity exercise on individuals' immune systems, whereas moderate exercise is generally beneficial in almost all cases. Also, individuals experiencing severe COVID-19 symptoms or other acute illnesses should abstain from physical activity until recovery.

Mathematical models play a crucial role in understanding the spread of infectious disease outbreaks and influencing policy decisions. These models have aided pandemic preparedness by predicting outcomes under hypothetical scenarios and identifying weaknesses in existing frameworks; however, their accuracy, utility, and comparability are being scrutinised. Agent-based models (ABMs) have emerged as a valuable tool, capturing population heterogeneity and spatial effects, particularly when assessing potential intervention strategies. Here we present EpiGeoPop, a user-friendly tool for rapidly preparing spatially accurate population configurations of entire countries. EpiGeoPop helps to address the problem of complex and time-consuming model set-up in ABMs, specifically improving the integration of real-world spatial detail. We subsequently demonstrate the importance of accurate spatial detail in ABM simulations of disease outbreaks using Epiabm, an ABM based on Imperial College London's CovidSim with improved modularity, documentation and testing. Our simulations present a number of possible applications of ABMs where including spatially accurate data is crucial, highlighting the potential impact of EpiGeoPop in facilitating this process using multiple international data sources.

China implemented strict prevention and control measures during the COVID-19 pandemic, leading to prolonged home confinement of children and significantly reduced exposure to respiratory pathogens. The ability of children under these conditions to resist respiratory pathogens post-lifting of containment measures remained unknown. The children's ability to face respiratory pathogens post-isolation was assessed through collecting respiratory pathogens detection data, statistical analysis and comparing with pre-epidemic data. In this way, we addressed data gaps in related fields and provided empirical support for research and public health sectors.

The pathogen detection method was real-time polymerase chain reaction (PCR). Data analysis software: SPSS Statistics 23.

Four environmental factors-temperature, humidity, wind speed and sunshine time-exerted interactive effects ton respiratory pathogens prevalence. Influenza A and B viruses, Mycoplasma pneumoniae and adenovirus exhibited seasonally prevalent patterns in winter, while respiratory syncytial virus showed lower prevalence in summer, and rhinovirus had no significant seasonal variation. The infection rate of respiratory syncytial virus and the number of expected infections decreased with the increase of age, whereas adenovirus, influenza virus, Mycoplasma pneumoniae and bacterial pathogens showed age-related increases in both metrics. Gender-related differences were observed in higher infection rates of Klebsiella pneumoniae, Haemophilus influenzae and Pseudomonas aeruginosa in men compared to women. Co-infection analysis revealed that respiratory syncytial virus exhibited the highest co-infection diversity, followed by influenza B virus, Mycoplasma pneumoniae, and Staphylococcus aureus. Pseudomonas aeruginosa showed inhibition of co-infection with Klebsiella pneumoniae. Streptococcus pneumoniae had been shown to inhibit co-infection with Haemophilus influenzae, Staphylococcus aureus, and Klebsiella pneumoniae. The lower respiratory tract infection rate of Mycoplasma pneumoniae and bacterial pathogens exceeded the overall infection rate. Infection rates of influenza B virus and adenovirus were lower than the overall rate, while those of influenza A and rhinovirus paralleled the overall rate. Analysis of statistical data from China and Gansu Provincial Centers for Disease Control and Prevention revealed that most respiratory pathogens showed an increase in the infection rates post-COVID-19, particularly respiratory syncytial virus, indicating altered prevalence patterns in children due to prolonged exposure to isolated pathogens.

We evaluated the effects of environmental factors on the occurrence and regression of coronary artery lesions (CAL) in patients with Kawasaki disease (KD), intending to provide a scientific basis for the prevention, treatment, and long-term management of KD.

We enrolled pediatric patients with KD hospitalized in the Pediatric Cardiovascular Department of a tertiary comprehensive hospital between June 2015 and December 2020 as research subjects. The medical record information of the children during hospitalization and follow-up was obtained by reviewing the hospital's electronic medical record system. The air pollutants including CO, NO₂, PM₁₀, PM_2.5, SO₂ and O₃ were collected from the National Urban Air Quality Real-time Release Platform of the China National Environmental Monitoring Centre. The meteorological data were sourced from the China Meteorological Data Network, including the daily average temperature and the daily average relative humidity. We assessed the individual and combined effects of air pollutants and meteorological factors on CAL by Unconditional logistic regression and Bayesian kernel regression, respectively, and to explore their dose-response relationships. We estimated the overall time to regression of CAL by Kaplan-Meier, assessed the effects of air pollutants and meteorological factors on the regression of CAL by Cox proportional risk regression model, and evaluated the dose-response relationship by restricted cubic spline.

The OR for CAL formation in children with KD was 1.267 (95% CI: 1.060-1.514) for every 10 µg/m³ increase in SO₂ concentration, and the risk of CAL formation gradually increased with increasing SO₂ concentration (P_overall=0.027, P_nonlinear=0.329). The HR for regression of CAL in KD children was 0.387 (95% CI: 0.174-0.861) for each 1mg/m³ increase in CO concentration, and the likelihood of CAL regression gradually decreased with increasing air CO concentration (P_overall=0.030, P_nonlinear=0.182).

Atmospheric SO₂ exposure was significantly associated with CAL occurrence in children with KD in this study, and there is a dose-response relationship. Atmospheric CO exposure was an independent risk factor preventing CAL regression in children with KD, and there was a dose-response relationship between atmospheric CO concentration and CAL regression. These findings indicate that relevant departments should take measures to strengthen the monitoring and control of environmental factors.