Influenza poses a particularly severe threat to older adults, yet vaccination coverage among this vulnerable population remains suboptimal in China. To address this public health challenge, Zhejiang Province initiated a free influenza vaccination program for older residents starting in 2020. This study evaluated the effectiveness of influenza vaccination in reducing outpatient visits among adults aged ≥60 years during three consecutive influenza seasons (2021-2024).

We employed a test-negative design (TND) among adults aged ≥60 years presenting with influenza-like illness (ILI) at sentinel surveillance hospitals in two cities in Zhejiang Province from October 2021 to April 2024. Standardized questionnaires were administered to collect demographic and clinical data. Respiratory specimens were tested for influenza virus types and subtypes using RT-PCR. Multivariable logistic regression models were employed to assess factors associated with vaccination status and influenza virus detection, with subsequent estimation of influenza vaccine effectiveness (VE).

A total of 3,796 ILI cases were enrolled, with 644 testing positive for influenza, yielding a positivity rate of 16.97%. The results of multivariable logistic regression analysis showed that age, whether vaccinated in the current year, and whether vaccinated in the previous year were the influencing factors for influenza-positive ILI cases (p < 0.05). The influenza vaccination coverage in the current season was 33.14%. The overall VE was 47.21% (95% CI: 35.38 to 56.88%). Subtype-specific VE was 55.81% (95% CI: 34.83 to 70.03%) for H1N1, 40.72% (95% CI: 23.30 to 54.18%) for H3N2, and 55.16% (95% CI: 21.77 to 74.30%) for B/Victoria. Age-stratified VE analysis showed effectiveness of 70.34% (95% CI: 41.47 to 84.98%) among those aged 60-69 years, 49.48% (95% CI: 34.41 to 61.09%) in the 70-79 age group, and 38.34% (95% CI: 10.35 to 57.60%) among individuals aged 80 years and older.

Influenza vaccination provides moderate protection for adults aged ≥60 years, with effectiveness varying by subtype, age, and season, particularly limited in the older population aged ≥80 years.

Rapid detection of infectious disease agents is crucial for timely public health responses. Wastewater and environmental surveillance (WES) offers a complementary approach by detecting pathogens shed by infected individuals, including asymptomatic cases. This scoping review provides an overview of reported public health actions in response to WES for human pathogens. It also summarizes sampling and analysis methods and offers insights for future implementation.

The protocol for this review was registered in the PROCEED open-access registry. A systematic search was conducted in MEDLINE, EMBASE, and Web of Science for peer-reviewed literature published up to 31 July 2024. Studies were included if they reported public health actions in response to WES related to infectious diseases in human populations. Two reviewers independently screened studies and extracted data on public health responses, sampling, and analytical methods.

Of the 6,630 articles screened, 49 met the inclusion criteria. Most studies (92%) were published between 2021 and 2024, with SARS-CoV-2 as the primary focus (82%), followed by poliovirus (16%). Research was largely conducted in high-income regions: North America (51%), Asia (22%), and Europe (14%). Target populations included urban residents (57%) and on-campus students (31%) and local authorities were more often involved in WES efforts than national agencies (51% vs. 33%). In 75% of studies, at least two public health actions were implemented, and 20% reported five or more. The most common actions related to reactive disease control (n = 69), including testing, isolation, and contact tracing. Proactive disease control actions (n = 33) and public health communication (n = 22) were also described. Weekly sampling (57%) and composite methods (67%) were most used. Manhole sampling, despite equal frequency with treatment plant sampling (35%), led to significantly more public health actions (61 vs. 35). Long-term surveillance was often reported but rarely sustained. Quantitative and molecular analyses dominated; sequencing was rarely used (4%).

While reporting on public health actions following WES remains limited, this review illustrates its potential to inform timely, local interventions. Future studies should broaden pathogen targets, embed public health action planning in study design, and expand WES use in low-resource settings.

Previous studies have shown that social relationships positively contribute to functional status. However, studies comparing the influence under changing social circumstances are still limited. Consequently, this study investigated how social interaction influenced long-term functional status among older Japanese adults before and during the COVID-19 pandemic.

A two-wave longitudinal cohort design was used to compare pre-pandemic (2017-2020) and post-pandemic (2020-2023) cohorts. Data were obtained from the Community Empowerment and Care study in T-Village, Aichi Prefecture, Japan. Social interaction was assessed using the Index of Social Interaction (ISI) and functional status was measured based on long-term care needs. Logistic regression analyzed predictors of functional health over 3 years, controlling for demographic and life-style covariates.

Social interaction declined during the pandemic. Higher ISI scores, particularly for social curiosity and adaptability, predicted better functional outcomes in both cohorts. Interaction with non-family members and willingness to use new technology were strong protective factors.

Promoting meaningful social engagement and behavioral adaptability may help preserve functional independence in aging populations, especially during periods of social disruption.

In the context of viral pneumonia, immunocompromised status represents a recognized risk factor for invasive pulmonary aspergillosis (IPA), its association with the timing of IPA diagnosis remains unclear.

In the present study, 261 patients hospitalized with viral pneumonia were consecutively enrolled and categorized as immunocompromised hosts (ICHs) or non-ICHs. Baseline characteristics, outcomes, and time to IPA diagnosis were compared. Cox regression was used to evaluate the association between immunocompromised status and adverse outcomes. Patients diagnosed with IPA were further stratified into early (diagnosis within 5 days of admission) and late groups. Logistic regression was employed to evaluate the association of immunocompromised status with early-onset IPA.

Among the enrolled patients, 122 (46.7%) were immunocompromised. Relative to the non-ICH group, ICH patients were older, had a lower body mass index, and contained a smaller proportion of never-smokers. They also presented with higher respiratory rates, CRP, PCT, lower PaO₂/FiO₂ ratios, and greater illness severity. Significantly higher rates of invasive mechanical ventilation (20.5% vs. 2.2%), IPA incidence (22.1% vs. 9.4%), and 30-day mortality (23.8% vs. 5.0%) were observed in the ICH group compared to the non-ICH group. Multivariable Cox regression identified immunocompromised status as an independent risk factor for IPA (adjusted HR, 2.33; 95% CI, 1.07-5.06). Strikingly, immunocompromised hosts (ICHs) accounted for 80.0% of the early-onset IPA cases, compared to only 46.2% in the late-onset group. This association was confirmed in the adjusted analysis, where immunocompromised status remained a powerful independent risk factor for early diagnosis (adjusted OR 35.7, 95% CI 3.71-763.00).

Immunocompromised status is an independent risk factor for both the development and earlier onset of IPA in patients with viral pneumonia, underscoring the need for heightened vigilance and early investigation in this high-risk population.

Skeletal muscles secrete myokines, including irisin and myostatin, which regulate inflammation and metabolism and may influence the severity of SARS-CoV-2 infection. This study investigated the associations between serum irisin and myostatin levels and COVID-19 severity.

Ninety-nine adult patients hospitalized with PCR-confirmed COVID-19 were included. Serum irisin and myostatin concentrations were measured by ELISA at admission and discharge. Disease severity was evaluated using a four-point clinical scale, the RALE score for lung involvement, oxygenation indices (PaO₂/FiO₂ and SaO₂/FiO₂), and inflammatory markers (MMP-9, ferritin, S100B, CRP, D-dimers, NLR, PLR, and SII).

Higher irisin concentrations at admission were associated with more severe clinical condition, increased systemic inflammation, impaired oxygenation, and greater lung involvement. Elevated irisin levels were linked to an increased risk of progression to critical illness, although they were not independent predictors. During hospitalization, irisin levels declined in most patients, in parallel with clinical improvement and reductions in inflammatory markers. Myostatin concentrations at admission correlated with ferritin and D-dimer levels. Higher myostatin levels were associated with severe disease and poorer oxygenation at discharge. Myostatin concentrations remained stable in most patients. Those with declining levels had higher inflammatory markers at baseline but did not differ clinically from others.

These findings suggest that, through the release of bioactive myokines, skeletal muscles contribute to the regulation of systemic inflammation and oxygenation, thereby influencing the clinical course of SARSCoV-2 infection. Elevated irisin reflects heightened inflammation, severe hypoxemia, and extensive lung involvement, whereas increased myostatin is associated with severe inflammation and critical illness.

To evaluate the efficacy and safety of tofacitinib (TOF) plus iguratimod (IGU) in treating progressive fibrosing rheumatoid arthritis-associated interstitial lung disease (PF-RA ILD).

This historical-controlled study enrolled 28 PF-RA ILD patients (13 received TOF plus IGU; 15 received the biologic/conventional synthetic disease-modifying anti-rheumatic drugs (b/csDMARDs). Disease activity, pulmonary function (PFTs), high-resolution computed tomography (HRCT) scores, and safety were assessed longitudinally and between groups.

Baseline characteristics were comparable (P>0.05). The TOF plus IGU group showed significant improvements: C-reactive protein (CRP) decreased (30.5 ± 23.1 to 5.1 ± 3.3 mg/L, P < 0.05), erythrocyte sedimentation rate: 46.2 ± 18.8 to 20.1 ± 18.9 mm/h, P = 0.012). The disease activity score 28-joint count with CRP declined from high to low activity, and rheumatoid factor titers dropped (79.7 ± 64.2 to 23.4 ± 21.7 IU/mL at 12 months, P = 0.023). Similarly, anti-cyclic citrullinated peptide levels declined from 157 ± 57.5 RU/mL to 109.8 ± 32.6 RU/mL at 6 months (P = 0.028). Pulmonary function improved, with forced vital capacity increasing from 79.5 ± 12.9% to 85.3 ± 13.6% at 6 months (P = 0.008). HRCT fibrosis scores decreased from 9.6 ± 2.5 to 5.1 ± 1.6 (P = 0.026). Compared to controls, TOF plus IGU demonstrated superior outcomes: lower CRP (8.5 vs 20.2 mg/L, P = 0.002), higher diffusing capacity for carbon monoxide at 3 months (73.1 ± 19.6% vs 61.1 ± 14.5%, P = 0.045), and lower fibrosis scores at 12 months (5.1 vs 7.5, P = 0.004). At 12 months, imaging stability/regression occurred in 92.3% vs 60.0% (P = 0.047). All TOF plus IGU patients tapered prednisone. No thromboembolic events or severe infections occurred.

TOF plus IGU demonstrated dual efficacy in controlling synovitis and lung fibrosis, with a favorable safety profile.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive and fatal interstitial lung disease with limited therapeutic options. Recent evidence highlights dysregulated iron metabolism in macrophages as a critical yet underrecognized driver of disease progression. Excess iron accumulation functions as a signaling cue that promotes macrophage polarization toward the pro-fibrotic M2 phenotype through pathways such as HIF-1α/IL-10/STAT6, contributing to aberrant tissue repair, myofibroblast activation, and excessive extracellular matrix (ECM) deposition. This review synthesizes current findings on the mechanistic interplay between iron homeostasis and macrophage phenotypic switching in IPF and evaluates emerging therapeutic strategies that target iron availability, including iron chelators, ferroportin modulators, and targeted nanocarrier delivery systems. While these approaches show promise, challenges remain regarding specificity, off-target effects, and systemic toxicity. By integrating mechanistic insights with translational advances, this review underscores the therapeutic potential of targeting the macrophage-iron axis and outlines how precision medicine-based interventions may offer novel avenues for effective IPF treatment.

the government of Nigeria, through concerned agencies/authorities, is ensuring a large-scale and equitable distribution of COVID-19 vaccination across the country. To understand how the eligible population accesses these vaccines, we assessed the perception of availability and accessibility of the COVID-19 vaccines in Nigeria.

the study was part of a larger cross-sectional survey conducted in Nigeria between July and August 2021 to understand broader behavioral, social, and access-related drivers of COVID-19 vaccines among healthcare workers (HCW) and non-healthcare workers (NHCWs) using a data tool adapted from the World Health Organization (WHO) guidance on behavioral and social drivers of vaccination. Data was collected from 1548 respondents across 8 Nigerian states using a multistage sampling approach and analyzed descriptively and inferentially, using SPSS Version 20 to understand the perceptions of vaccine availability and accessibility.

individual perceptions on the availability of vaccines were significant across two categories (that is, for NHCWs and HCWs) across rural and urban areas (X²=14.121, p<0.001) and between NHCWs and HCWs (X²=23.508, p<0.001). Non-health care workers were significantly more likely to perceive difficulties in accessing COVID-19 vaccines compared to health care workers (X²=29.8, p<0.001), and rural residents reported more challenges than their urban counterparts (X²=23.0, p<0.001).

the study found that respondents' perceptions of vaccine availability and accessibility were mostly influenced by location and recommended more vaccination points across rural and urban communities to improve the COVID-19 vaccination experience.

This study aimed to identify distinct patterns of chronic disease resource utilization among patients with chronic obstructive pulmonary disease (COPD) and to examine their association with illness uncertainty.

A cross-sectional study.

This study enrolled COPD patients hospitalized in the Department of Respiratory Medicine at a tertiary hospital in Zhejiang Province, China, between April and December 2023. All participants completed a general information form, the Chronic Illness Resource Survey (CIRS), and the Mishel Uncertainty in Illness Scale (MUIS). Latent profile analysis (LPA) was conducted to identify subgroups of resource utilization patterns. Subsequently, hierarchical linear regression was employed to assess the associations between these patterns and illness uncertainty. Ethical approval was obtained from the Institutional Review Board of the Fourth Affiliated Hospital of Zhejiang University (Approval No. K2022057).

A total of 308 participants were included. Two latent classes of resource utilization were identified: the Suboptimal Utilization Group (n = 209) and the Effective Utilization Group (n = 99). Patients in the effective utilization group reported significantly lower levels of illness uncertainty (R² = 0.587, p < 0.001).

Distinct patterns of chronic disease resource utilization exist among COPD patients and are significantly associated with illness uncertainty. Healthcare providers should recognize these subgroups and implement targeted interventions to enhance access to disease-related support resources, thereby mitigating illness uncertainty.

Understanding COPD patients' varying patterns of resource utilization enables healthcare professionals and related industries to deliver personalized, resource-based interventions tailored to individual needs, ultimately reducing illness-related uncertainty and improving disease management outcomes.

The sense of smell, with its extensive evolutionary history, is highly prone to disorders that can have a profound impact on daily life. Anosmia affects approximately 5% of the population, with an additional 15% exhibiting reduced olfactory function. The prevalence of olfactory dysfunction (OD) varies by population and age group, and standardized testing reveals a broad range of impacts. OD includes various causes, most commonly aging, inflammation of the olfactory epithelium, upper respiratory tract infections (URTI), traumatic brain injury, and neurological conditions. The recent COVID-19 pandemic has highlighted the association between viral infections and olfactory dysfunction, with severe hyposmia/anosmia being an early marker of infection. Despite its importance, the assessment of olfactory function remains inconsistent across clinical practices. Psychophysical smell tests, while vital for diagnosis and patient management, are underutilized, especially outside of specialized centers. Standardized testing methods are crucial for objective diagnosis, but significant challenges, including test variability, lack of comparability, and healthcare reimbursement issues, persist. The European Academy of Allergy and Immunology (EAACI) advocates for improvements in the quality and standardization of chemosensory assessments. Future efforts must prioritize education, incentives for better testing, and the integration of digital tools to expand access to olfactory testing and diagnosis in remote or quarantine situations. However, office-based testing remains irreplaceable, even with advancements in telemedicine.