{"messages":[{"status":"ok","cursor":0,"count":30,"total":31542}], "collection":[{"rel_doi":"10.64898\/2026.05.25.727697","rel_title":"Antibody Transcytosis and Neutralizing Activity in Respiratory Epithelial Cells","rel_date":"2026-05-27","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.25.727697","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by_nc","type":"new results","category":"microbiology"},{"rel_doi":"10.64898\/2026.05.23.726423","rel_title":"Low seroprevalence of neutralizing antibodies to gorilla adenovirus 32 (GRAd32) in southern African populations supports evaluation of this vector platform for HIV vaccine development","rel_date":"2026-05-26","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.23.726423","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by","type":"new results","category":"immunology"},{"rel_doi":"10.64898\/2026.05.22.727251","rel_title":"Substrate and target selectivity of 4'-fluoroadenosine against viral and host polymerases","rel_date":"2026-05-26","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.22.727251","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_no","type":"new results","category":"microbiology"},{"rel_doi":"10.64898\/2026.05.22.727291","rel_title":"Epistatic evolution drives HLA-dependent CD8+ T Cell escape risk in diverse populations","rel_date":"2026-05-26","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.22.727291","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by_nc","type":"new results","category":"genomics"},{"rel_doi":"10.64898\/2026.05.24.727525","rel_title":"Antigenic characterization of SARS-CoV-2 variants BA.3.2.1 and BA.3.2.2 in three animal models","rel_date":"2026-05-26","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.24.727525","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by","type":"new results","category":"microbiology"},{"rel_doi":"10.64898\/2026.05.22.727328","rel_title":"Rapid in vitro synthesis of DNA templates via Sidewinder for polyadenylated Hantavirus mRNA vaccine candidates","rel_date":"2026-05-25","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.22.727328","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_no","type":"new results","category":"biochemistry"},{"rel_doi":"10.64898\/2026.05.21.726678","rel_title":"Antioxidant properties of Rhodiola rosea","rel_date":"2026-05-22","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.21.726678","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_no","type":"new results","category":"biochemistry"},{"rel_doi":"10.64898\/2026.05.21.727024","rel_title":"Force-regulated catch bonds and fusion peptide exposure drive coronavirus entry","rel_date":"2026-05-22","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.21.727024","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_no","type":"new results","category":"biophysics"},{"rel_doi":"10.64898\/2026.05.21.725708","rel_title":"Mitigation of imprinted antibody responses in elderly COVID-19 highly vaccinated individuals","rel_date":"2026-05-22","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.21.725708","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by_nc_nd","type":"new results","category":"microbiology"},{"rel_doi":"10.64898\/2026.05.20.726704","rel_title":"Ribophorin-1 Governs Spike Abundance of Highly Pathogenic Coronaviruses by ER-associated degradation","rel_date":"2026-05-21","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.20.726704","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_no","type":"new results","category":"microbiology"},{"rel_doi":"10.64898\/2026.05.20.726568","rel_title":"Spike antibodies targeting GRP78 predispose to cardiovascular complications compared to Dengue","rel_date":"2026-05-21","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.20.726568","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by_nc_nd","type":"new results","category":"microbiology"},{"rel_doi":"10.64898\/2026.05.20.725438","rel_title":"Direct serological antibody discovery by integrative proteomics yields potent neutralizers overlooked by single-cell BCR sequencing","rel_date":"2026-05-20","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.20.725438","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by_nc","type":"new results","category":"immunology"},{"rel_doi":"10.64898\/2026.05.18.726016","rel_title":"Mechanochemical Decoupling of ATP Hydrolysis and RNA Translocation in SARS-CoV-2 nsp13 by the L405D Mutation","rel_date":"2026-05-20","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.18.726016","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by","type":"new results","category":"biophysics"},{"rel_doi":"10.64898\/2026.05.18.26353482","rel_title":"The Potential Clinical and Economic Impact of a Combination COVID-19 and Influenza Vaccine (mRNA-1083) in Canada","rel_date":"2026-05-20","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.18.26353482","rel_abs":"AimsCOVID-19 and influenza continue to impose a substantial burden on the Canadian healthcare system, particularly among adults aged [&ge;]65 years. This study compared the clinical and economic outcomes of a \"Stand-alone\" vaccination strategy with separate influenza and COVID-19 vaccines versus a \"Combination\" strategy incorporating mRNA-1083, an investigational vaccine targeting both infections.\n\nMethodsThe study adopted the public healthcare payer perspective and adapted a previously published static model to predict COVID-19 and influenza infections across a one-year time horizon. Relative vaccine effectiveness (rVE) for mRNA-1083 against COVID-19 compared with the stand-alone vaccine (SPIKEVAX (R)) was based on the pivotal clinical trial of mRNA-1083s COVID-19 component (mRNA-1283). For influenza, no incremental VE was assumed versus the adjuvanted stand-alone vaccine (FLUAD(R)). Infections were modeled independently. Clinical outcomes included symptomatic infections, hospitalizations, and deaths. The economically justifiable price (EJP) was calculated at the willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life-year (QALY) gained. mRNA-1083 uptake was assumed to yield absolute increases in COVID-19 and influenza coverage by 10% and 3%, respectively.\n\nResultsCompared with the Stand-alone strategy, the Combination strategy was projected to reduce the number of COVID-19-related symptomatic infections, hospitalizations, and deaths (n=71,074; 5,008; 935, respectively), and corresponding influenza outcomes (n=3,985; 362; 69, respectively). The use of mRNA-1083 within the Combination strategy generated a cost-savings of $90,440,471 in vaccine administration fees and an EJP of $304 per dose. Results were sensitive to rVE, coverage, administration fees, mortality and incidence.\n\nLimitationsmRNA-1083s rVE is being evaluated in clinical trials and the impact of mRNA-1083 on vaccine coverage and administration fees is uncertain.\n\nConclusionsmRNA-1083 may reduce the burden of COVID-19 and influenza in adults aged [&ge;]65 years in Canada, while offering good economic value because it has the potential to increase coverage and VE while reducing administration fees.","rel_num_authors":6,"rel_authors":[{"author_name":"Kelly Fust","author_inst":"Quadrant Health Economics, Inc."},{"author_name":"Michele Kohli","author_inst":"Quadrant Health Economics, Inc."},{"author_name":"Shannon Cartier","author_inst":"Quadrant Health Economics, Inc."},{"author_name":"Nicolas Van de Velde","author_inst":"Moderna Tx, Inc."},{"author_name":"Darshan Mehta","author_inst":"Moderna Tx, Inc."},{"author_name":"Michelle Blake","author_inst":"Moderna Biopharma Corporation"}],"version":"1","license":"cc_by","type":"PUBLISHAHEADOFPRINT","category":"health economics"},{"rel_doi":"10.64898\/2026.05.18.26353402","rel_title":"Exploring the genetic architecture of multimorbidity and its impact on long COVID risk","rel_date":"2026-05-20","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.18.26353402","rel_abs":"Multimorbidity, the co-occurrence of multiple long-term conditions, represents a major challenge for ageing populations, yet its genetic architecture and relationship to long COVID remain unclear, despite shared epidemiological risk factors. We analysed multimorbidity patterns in 86,756 White British UK Biobank participants aged [&ge;]65 years, identifying six clusters spanning neurodegenerative, cardiac, gastrointestinal, musculoskeletal, vascular, and cancer & eye disease domains. Genome-wide association studies and post-GWAS analyses revealed significant loci in five clusters, including APOE, LPA, and CDKN2B-AS1, with patterns of genetic correlation consistent with known disease relationships. Notably, a shared variant within the APOE-APOC1 locus showed opposite effect directions for the musculoskeletal and vascular clusters, consistent with their negative genetic correlation. Investigating the multimorbidity-long COVID relationship via genetic correlation and Mendelian randomisation revealed no evidence of significant shared genetic architecture or causal effects. These findings indicate that multimorbidity clusters represent biologically structured, partly heritable phenotypes, whereas genetic overlap with long COVID appears limited.","rel_num_authors":8,"rel_authors":[{"author_name":"Sasha J. M. Bauer","author_inst":"King's College London"},{"author_name":"Ruth C. E. Bowyer","author_inst":"King's College London"},{"author_name":"Laura Bravo Merodio","author_inst":"University of Birmingham"},{"author_name":"Georgios Gkoutos","author_inst":"University of Birmingham"},{"author_name":"Davide Vetrano","author_inst":"Karolinska Institutet"},{"author_name":"Thomas Jackson","author_inst":"University of Birmingham"},{"author_name":"Claire J. Steves","author_inst":"King's College London"},{"author_name":"Maxim B. Freidin","author_inst":"King's College London"}],"version":"1","license":"cc_by_nc","type":"PUBLISHAHEADOFPRINT","category":"genetic and genomic medicine"},{"rel_doi":"10.64898\/2026.05.14.26353257","rel_title":"Occupational hierarchy, racialization, and COVID-19 health outcomes among meat processing plant workers in Alberta: a community-engaged mixed-methods study","rel_date":"2026-05-20","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.14.26353257","rel_abs":"BackgroundMeat processing plants in Alberta, Canada experienced among North Americas largest COVID-19 outbreaks. We examined health impacts among workers by occupational hierarchy and equity-relevant characteristics.\n\nMethodsThis exploratory sequential mixed-methods study was guided by community-based participatory research and the PROGRESS-Plus framework. Multilingual qualitative interviews and surveys using validated instruments were conducted among meat plant workers who experienced outbreaks. Interviews were analysed using inductive-deductive thematic analysis. Multivariable logistic regression and linear regression estimated associations between occupational group, racialization, facility, and self-reported COVID-19 diagnosis, physical and mental health, and mean Everyday Discrimination Scale score. We integrated findings using joint displays.\n\nFindingsQualitative and integrated analysis of thirty-six interviews described occupational hierarchy shaping unequal protection, limited communication, constrained agency, and psychosocial harms, amplified by income insecurity and family separation. Among 187 survey respondents, compared with general labour, skilled labour (aOR 0{middle dot}38; 95% CI 0{middle dot}15-0{middle dot}89) and management (aOR 0{middle dot}13; 95% CI 0{middle dot}01-0{middle dot}75) had lower odds of reported COVID-19 diagnosis. Compared with Black workers, other racialized workers had lower odds of reporting fair or poor mental (aOR 0{middle dot}24; 95% CI 0{middle dot}09-0{middle dot}58) and physical health (aOR 0{middle dot}20; 95% CI 0{middle dot}06-0{middle dot}54). Compared with workers from the primary facility, others reported lower mean everyday discrimination scores ({beta} = -0{middle dot}54; 95% CI -0{middle dot}96 to -0{middle dot}12).\n\nInterpretationCOVID-19 harms followed workplace social hierarchies. Pandemic preparedness should combine infection-control measures with paid sick leave and income protection, multilingual communication, enforceable anti-discrimination standards, and independent reporting mechanisms.\n\nFundingCanadian Institutes for Health Research (CIHR Application no. 469206).\n\nResearch in ContextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed\/MEDLINE, Scopus, and Web of Science from June 2020 to December 2025, using terms for COVID-19, meat processing, meatpacking, occupation, and workers including migrants, racialized workers, refugees or immigrants for empirical studies published without language restrictions. Existing studies showed that meat processing plants were sites of occupational COVID-19 outbreaks and that immigrant and racialized workers experienced disproportionate infections and adverse health outcomes. The literature described pre-existing structural vulnerabilities in these settings including crowded working conditions, inadequate occupational protections, and barriers related to language, job security, and access to health information. These inequities intensified during the pandemic, leading to disproportionate infection rates, morbidity, mortality, and psychosocial stress.\n\nAdded value of this studyThis exploratory sequential mixed-methods study used the PROGRESS-Plus framework and a community-based participatory research approach to examine COVID-19-related health impacts after large outbreaks among meat processing plant workers in Alberta, Canada. By integrating multilingual qualitative interviews with quantitative survey data, the study identified how occupational hierarchy, racialization, and processing plant shaped self-reported COVID-19 diagnosis, physical and mental health, and experiences of discrimination. The study also centres workers perspectives to show how workplace hierarchy, unequal communication, and limited agency contributed to health inequities during the pandemic.\n\nImplications of all the available evidencePrevious and current findings suggest that COVID-19 harms in meat processing plants were shaped by pre-existing structural and workplace inequities rather than by exposure alone. Working conditions in large meat processing plants were already difficult for immigrant and racialized workers, particularly those in labour-intensive roles, and the COVID-19 pandemic exacerbated existing health inequities. Preparedness and response in high-risk industrial settings should therefore combine infection-control measures with multilingual communication, stronger worker protections, explicit anti-discrimination safeguards addressing ethnicity, language, and gender, and material supports that reduce the need to work while ill.","rel_num_authors":16,"rel_authors":[{"author_name":"Mohammad Yasir Essar","author_inst":"University of Calgary"},{"author_name":"Eric Norrie","author_inst":"University of Calgary"},{"author_name":"Edna Ramirez Cerino","author_inst":"University of Calgary"},{"author_name":"Minnella Antonio","author_inst":"University of Calgary"},{"author_name":"Ammar Saad","author_inst":"University of Ottawa"},{"author_name":"Mussie Yemane","author_inst":"University of Calgary"},{"author_name":"Linda Holdbrook","author_inst":"University of Calgary"},{"author_name":"Adanech Sahilie","author_inst":"University of Calgary"},{"author_name":"Michael Youssef","author_inst":"University of Calgary"},{"author_name":"Nour Hassan","author_inst":"University of Calgary"},{"author_name":"Olivia Magwood","author_inst":"Bruyere Health Research Institute"},{"author_name":"Samuel T. Edwards","author_inst":"Oregon Health & Science University"},{"author_name":"Denise Spitzer","author_inst":"University of Alberta"},{"author_name":"Annalee Coakley","author_inst":"University of Calgary"},{"author_name":"Kevin Pottie","author_inst":"Western University"},{"author_name":"Gabriel E. Fabreau","author_inst":"University of Calgary"}],"version":"1","license":"cc_by_nc","type":"PUBLISHAHEADOFPRINT","category":"public and global health"},{"rel_doi":"10.64898\/2026.05.16.725625","rel_title":"Variant emergence, not vaccine deployment, drives episodic positive selection on the SARS-CoV-2 spike at provincial scale in Canada","rel_date":"2026-05-19","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.16.725625","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by_nc_nd","type":"new results","category":"evolutionary biology"},{"rel_doi":"10.64898\/2026.05.15.26353349","rel_title":"SARS-CoV-2 Vaccination Status and MIS-C Incidence: A Systematic Review","rel_date":"2026-05-19","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.15.26353349","rel_abs":"Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition associated with pediatric SARS-CoV-2 infection. While COVID-19 vaccines prevent infection and reduce severity, less conclusive evidence exists regarding their role in preventing MIS-C during breakthrough infections. This systematic review assessed the impact of SARS-CoV-2 vaccination on MIS-C risk during breakthrough infection. Cross-sectional studies, surveillance studies, and cohort studies were included. Of the 944 studies identified, 6 were included. A significant protective effect was seen in patients who received two doses of SARS-CoV-2 vaccination after exclusion of a biased sample (d= 0.71 [95% CI 0.07 to 1.35; p=0.03]). A trend towards a protective effect was seen after one dose of vaccination, but this effect was not statistically significant. Current literature supports a protective effect of two doses of SARS-CoV-2 vaccination against development of MIS-C in breakthrough COVID-19. The evidence supports clinician advocacy for continued vaccination of children against SARS-CoV-2.\n\nArticle Summary LineThis systematic review investigates the protective effect of SARSCoV-2 vaccination against development of MIS-C in breakthrough COVID-19 infections.","rel_num_authors":5,"rel_authors":[{"author_name":"Katherine Katherine Carroll","author_inst":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell"},{"author_name":"Hanwen Yang","author_inst":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell"},{"author_name":"Ariana Mastrogiannis","author_inst":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell"},{"author_name":"Kianna Rojas","author_inst":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell"},{"author_name":"Joseph  Steven Cervia","author_inst":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell"}],"version":"1","license":"cc_by","type":"PUBLISHAHEADOFPRINT","category":"infectious diseases"},{"rel_doi":"10.64898\/2026.05.14.26353263","rel_title":"The SARS-CoV-2 Integrated Genomic Epidemiology Database (IGED): Linking viral genomes with patient-level metadata to advance statewide genomic surveillance in California","rel_date":"2026-05-19","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.14.26353263","rel_abs":"In July 2021, the California Code of Regulations Title 17 required all laboratories performing SARS-CoV-2 whole genome sequencing (WGS) to report their sequencing results to the California Department of Public Health (CDPH). These viral genomic data and patient metadata were compiled into the Integrated Genomic Epidemiology Database (IGED). Linking anonymized viral sequences with patient-level information enabled monitoring of infectiousness, pathogenicity, transmission dynamics, evolution, and vaccine evasion among emerging SARS-CoV-2 lineages. Laboratories performing SARS-CoV-2 WGS transmitted sequencing results to CDPH through Electronic Laboratory Reporting (ELR) and non-ELR pathways. CDPH applied uniform reporting requirements but allowed flexibility in specific data formats to accommodate diverse data systems. To preserve data quality and interoperability across heterogeneous sources, CDPH implemented standardization, validation, and deduplication protocols. Snowflake, a cloud-based data storage and analytics platform, and Posit Connect, a cloud deployment and automation platform, supported the management, processing, and integration of data within the IGED. The IGED established links between SARS-CoV-2 WGS data and epidemiologic metadata for 801,418 sequences, representing 81.7% of all sequences reported in California. Lineages reported to the IGED showed strong concordance with lineage proportions in GISAID. Sequences reported to the IGED had average turnaround times longer than one month, and the majority of sequencing was performed in Southern California and Los Angeles. The IGED enhanced genomic surveillance through predictive modeling and monitoring concerning evolutionary trends such as recombination and saltations in persistent infections. Development of the IGED highlighted the need for standardized data requirements, sustained funding for sequencing, incentives for data submission, and interdisciplinary collaboration to build an effective genomic surveillance system. This framework for linking genomic and epidemiologic data has not only generated critical insights for SARS-CoV-2 but also provided the foundation for CDPH and other public health organizations to develop similar IGED-like systems for other priority pathogens as genomic surveillance expands.\n\nAuthor SummaryIn California, the COVID-19 pandemic generated an unprecedented volume of anonymized viral genomic data, creating a critical need to link sequencing results with patient information for genomic epidemiology. To meet this need, we developed the Integrated Genomic Epidemiology Database (IGED), a comprehensive resource that connects SARS-CoV-2 whole-genome sequencing (WGS) data with corresponding patient records. Using cloud-based computational infrastructure, we standardized and integrated submissions from numerous laboratories and jurisdictions, each with distinct technical requirements for providing data to CDPH. Of nearly one million records received, we successfully linked 801,418 WGS records to patient data. The IGED supported public reporting of circulating SARS-CoV-2 lineages, improved understanding of viral evolutionary dynamics, and served as the foundation for a genomic epidemiology tool used in outbreak investigations. By establishing a robust framework for linking WGS and patient-level data, we provide a model that can be adapted by other public health agencies for emerging pathogens of concern.","rel_num_authors":28,"rel_authors":[{"author_name":"Rahil Ryder","author_inst":"California Department of Public Health"},{"author_name":"Jesse Elder","author_inst":"California Department of Public Health"},{"author_name":"Mayuri Panditrao","author_inst":"California Department of Public Health"},{"author_name":"Kaitlin Grosgebauer","author_inst":"California Department of Public Health"},{"author_name":"Rebecca Katz","author_inst":"California Department of Public Health"},{"author_name":"Lawrence Tello","author_inst":"California Department of Public Health"},{"author_name":"Ellaison Carroll","author_inst":"California Department of Public Health"},{"author_name":"Deva Borthwick","author_inst":"California Department of Public Health"},{"author_name":"Chaman Kaur","author_inst":"California Department of Public Health"},{"author_name":"Romario Smith","author_inst":"California Department of Public Health"},{"author_name":"Victor Shiau","author_inst":"California Department of Public Health"},{"author_name":"Will Wheeler","author_inst":"California Department of Public Health"},{"author_name":"Emilia Reilly","author_inst":"California Department of Public Health"},{"author_name":"Jennifer Myers","author_inst":"California Department of Public Health"},{"author_name":"Lauren Nelson","author_inst":"California Department of Public Health"},{"author_name":"Esther Lim","author_inst":"California Department of Public Health"},{"author_name":"Phacharee Arunleung","author_inst":"California Department of Public Health"},{"author_name":"Elizabeth Baylis","author_inst":"California Department of Public Health"},{"author_name":"Sabrina Gilliam","author_inst":"California Department of Public Health"},{"author_name":"Tamara Hennesy-Burt","author_inst":"California Department of Public Health"},{"author_name":"Brooke Bregman","author_inst":"California Department of Public Health"},{"author_name":"Elana Silver","author_inst":"California Department of Public Health"},{"author_name":"Curtis Kapsak","author_inst":"Theiagen Genomics"},{"author_name":"Sage Wright","author_inst":"Theiagen Genomics"},{"author_name":"Tomas Leon","author_inst":"California Department of Public Health"},{"author_name":"John Bell","author_inst":"California Department of Public Health"},{"author_name":"Christina Morales","author_inst":"California Department of Public Health"},{"author_name":"Debra  A. Wadford","author_inst":"California Department of Public Health"}],"version":"1","license":"cc_by","type":"PUBLISHAHEADOFPRINT","category":"health informatics"},{"rel_doi":"10.64898\/2026.05.14.26353230","rel_title":"How the COVID-19 pandemic and cost-of-living crisis shaped reach and engagement in the ECAIL trial targeting socially disadvantaged families: an interdisciplinary implementation study","rel_date":"2026-05-19","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.14.26353230","rel_abs":"BackgroundThe ECAIL trial, launched in 2017, targets hard-to-reach families and evaluates a multicomponent childhood obesity prevention intervention. At a maternity hospital in Lille, France, healthcare providers screened pregnant women experiencing social vulnerability, and dietitians delivered a home-based intervention until age 2. The COVID-19 pandemic led to a six-month suspension in 2020. This study compared eligibility and participation before the pandemic and after resumption, and examined how the pandemic and subsequent cost-of-living crisis shaped implementation and reach.\n\nMethodsWe analyzed 5,744 eligibility questionnaires distributed at the maternity ward. Inclusion criteria included [&ge;]1 indicator of social vulnerability (e.g., socioeconomic disadvantage, precarious housing, or social isolation). To capture implementation experiences, a psychosocial researcher conducted a focus group with six dietitians delivering the intervention; it was recorded, transcribed, and analyzed thematically focusing on reach, acceptability, and adaptation.\n\nResultsEligibility increased from 29.7% (n=955) prepandemic to 33.6% (n=849) after resumption, while the distribution of vulnerability criteria remained similar across periods: 78.3% received social\/medical benefits; employment was not the main source of household income for 58.7%; 24.4% experienced financial hardship; 14.7% reported social isolation; 6.0% lived in precarious housing; and 19.0% had three or more vulnerabilities. Participation among eligible women remained stable (24.6%; n=443). Qualitative findings indicated dietitians satisfaction and participants enthusiasm for the resumption of home visits, particularly in addressing social isolation. After resumption, the introduction of a pre-visit COVID-19 questionnaire reduced missed appointments. Converging qualitative and quantitative findings indicated sustained, and in some cases strengthened, provider engagement despite pandemic-related strain on hospital services.\n\nConclusionsThis study shows that a complex intervention can maintain reach and acceptability through adaptive implementation under major contextual disruptions. The rapid resumption of home-based services emerged as a robust strategy for engaging and retaining socially disadvantaged families, highlighting the importance of flexible, context-sensitive approaches during social and economic crises.\n\nTrial registrationClinicaltrials.gov NCT03003117; registration date: 21\/12\/2016; https:\/\/clinicaltrials.gov\/study\/NCT03003117","rel_num_authors":17,"rel_authors":[{"author_name":"Delphine Poquet","author_inst":"INSERM"},{"author_name":"Camille Le Gal","author_inst":"INSERM"},{"author_name":"Pascale Hincker","author_inst":"CHU Lille: Centre Hospitalier Universitaire de Lille"},{"author_name":"Laurent B\u00e9ghin","author_inst":"CHU Lille: Centre Hospitalier Universitaire de Lille"},{"author_name":"Dominique Deplanque","author_inst":"CHU Lille: Centre Hospitalier Universitaire de Lille"},{"author_name":"Damien Subtil","author_inst":"CHU Lille: Centre Hospitalier Universitaire de Lille"},{"author_name":"Oriane Sion","author_inst":"Programme Malin"},{"author_name":"Benjamin Cavalli","author_inst":"Programme Malin"},{"author_name":"Lucie VANHOUTTE","author_inst":"INSERM"},{"author_name":"Victoria Jacobsen","author_inst":"INSERM"},{"author_name":"Ketevan Marr","author_inst":"INSERM"},{"author_name":"Ioannis Sakellaris","author_inst":"INSERM"},{"author_name":"Blandine de Lauzon Guillain","author_inst":"INSERM"},{"author_name":"Marie-Aline Charles","author_inst":"INSERM"},{"author_name":"Delphine Ley","author_inst":"CHU Lille: Centre Hospitalier Universitaire de Lille"},{"author_name":"Priscille Sauvegrain","author_inst":"INSERM"},{"author_name":"Sandrine Lioret","author_inst":"INSERM"}],"version":"1","license":"cc_by","type":"PUBLISHAHEADOFPRINT","category":"public and global health"},{"rel_doi":"10.64898\/2026.05.14.26353186","rel_title":"Wastewater Surveillance as an Event Detection System: Outbreak and Peak Detection of SARS-CoV-2 Across 281 U.S. Counties","rel_date":"2026-05-19","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.14.26353186","rel_abs":"Wastewater-based surveillance (WBS) is increasingly used to monitor infectious disease dynamics, yet most evaluations focus on correlation or forecasting--neither of which directly assesses whether wastewater signals can identify the epidemiological events most relevant to public health decision-making. We argue that outbreak onset and epidemic peak detection are the operationally critical use cases of WBS, requiring a fundamentally different evaluation framework. We introduce a classification-based framework that treats WBS as an event-detection problem, defining outbreaks and peaks as discrete events, establishing detection intervals to account for timing uncertainty, and incorporating censoring and data completeness criteria for valid comparisons against imperfect clinical reference outcomes. Within this framework, we apply a Bayesian exponential growth model for outbreak detection - benchmarked against a standard reproductive number (Rt)-based method - and a rule-based algorithm for peak detection, evaluating performance via sensitivity and positive predictive value (PPV). Applied to county-level SARS-CoV-2 wastewater data from 281 U.S. counties (Biobot, 2021-2024), the exponential growth approach substantially outperforms the Rt-based baseline: sensitivity 0.82 and PPV 0.64 versus sensitivity 0.58 and PPV 0.19 for the best-performing Rt variant. Peak detection achieves sensitivity 0.84 and PPV 0.70 at the county level. Both peak and outbreak detection achieve strong and consistent performance against hospitalizations and deaths at the state level. Spatial aggregation yields a statistically significant improvement in peak detection PPV against a curated reference standard (p < 0.001), while outbreak detection improvements under aggregation are directionally consistent but not statistically significant. Wastewater leads case-defined outbreaks by 4-6 days but minimally leads epidemic peaks, consistent with wastewater approximating prevalence rather than incidence. These findings demonstrate that wastewater signals can reliably detect outbreak onset and epidemic peaks across spatial scales and clinical outcomes, and that the choice of detection method matters substantially in practice. The classification framework developed here provides a reusable and principled tool for evaluating any surveillance signal as an event-detection system, with direct relevance to how WBS is actually used in public health decision-making.\n\nHighlightsO_LIWe evaluate wastewater surveillance as an event-detection system for outbreak onset and epidemic peak timing.\nC_LIO_LIWe introduce a classification-based framework that accounts for timing uncertainty, censoring, and data completeness.\nC_LIO_LIWastewater signals detect case-defined outbreaks and peaks with strong sensitivity and positive predictive value across spatial scales.\nC_LIO_LIPeak and outbreak detection show modest gains under aggregation, particularly for noisier outcomes such as deaths.\nC_LIO_LIThe proposed framework provides a reusable approach for evaluating surveillance signals against epidemiologically meaningful events.\nC_LI","rel_num_authors":4,"rel_authors":[{"author_name":"Nicholas B Link","author_inst":"Network Science Institute, Northeastern University"},{"author_name":"Raul Garrido","author_inst":"Network Science Institute, Northeastern University; Physics Department, Northeastern University"},{"author_name":"Anjalika Nande","author_inst":"Nuffield Department of Primary Care Health Sciences, University of Oxford; Institute for Computational Medicine, Johns Hopkins University"},{"author_name":"Mauricio Santillana","author_inst":"Network Science Institute, Northeastern University"}],"version":"1","license":"cc_by","type":"PUBLISHAHEADOFPRINT","category":"infectious diseases"},{"rel_doi":"10.64898\/2026.05.15.725410","rel_title":"Environmental stochasticity can account for patterns of within-host respiratory virus evolution","rel_date":"2026-05-18","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.15.725410","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by","type":"new results","category":"evolutionary biology"},{"rel_doi":"10.64898\/2026.05.15.725542","rel_title":"Orally Bioavailable SARS-CoV-2 Protease Inhibitors Bearing a Hydroxymethyl Ketone Warhead","rel_date":"2026-05-18","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.15.725542","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by_nc_nd","type":"new results","category":"pharmacology and toxicology"},{"rel_doi":"10.64898\/2026.05.15.26347859","rel_title":"Who infected the reported cases? Evidence from 678,482 COVID-19 cases with identified infector collected in routine surveillance in the Netherlands, 2020-2022.","rel_date":"2026-05-17","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.15.26347859","rel_abs":"BackgroundDuring infectious disease outbreaks, characteristics of reported cases are routinely collected. These give information on becoming infected but not on infecting others. We assess whether linking infectees to infectors, together with their characteristics, can help understand transmission.\n\nMethodsFrom the start of the COVID-19 pandemic in the Netherlands, reported cases were asked to identify their most probable infector in routine surveillance, enabling the linking of cases. We assess for the period 27 February 2020 - 11 April 2022 whether the infectees of these transmission pairs are representative of all reported cases, whether the transmission pairs yield verifiable estimates of epidemiological characteristics (here the serial interval), and whether they provide information on transmission that cannot be obtained otherwise.\n\nResultsOf 8,003,008 reported cases, 678,482 (8.5%) could be linked to their most probable infector. These infectees were largely representative of the reported cases regarding age group, sex, and geographical location. The mean serial interval of 3.6 days (sd 3.4 days) from transmission pairs aligns with literature. Transmissions between age groups largely follow known contact patterns. Most transmissions in September 2021 occurred between persons who were not (fully) vaccinated, indicating the effectiveness of the vaccine, and relatively few between persons with different vaccination status, indicating assortative mixing in vaccination status.\n\nConclusionTransmission pairs can be efficiently collected in routine surveillance, providing insight into disease transmission. The current post-pandemic period provides an excellent opportunity to adjust reporting systems for linking infectees to their most probable infector as preparation for future outbreaks.","rel_num_authors":7,"rel_authors":[{"author_name":"Jantien A. Backer","author_inst":"National Institute for Public Health and the Environment (RIVM)"},{"author_name":"Ka Yin Leung","author_inst":"National Institute for Public Health and the Environment (RIVM)"},{"author_name":"Stijn P. Andeweg","author_inst":"National Institute for Public Health and the Environment (RIVM)"},{"author_name":"Jan Van de Kassteele","author_inst":"National Institute for Public Health and the Environment (RIVM)"},{"author_name":"Irene Veldhuijzen","author_inst":"National Institute for Public Health and the Environment (RIVM)"},{"author_name":"Susan Hahne","author_inst":"National Institute for Public Health and the Environment (RIVM)"},{"author_name":"Jacco Wallinga","author_inst":"National Institute for Public Health and the Environment (RIVM)"}],"version":"1","license":"cc_by_nc_nd","type":"PUBLISHAHEADOFPRINT","category":"epidemiology"},{"rel_doi":"10.64898\/2026.05.13.725047","rel_title":"Immunological imprinting shapes the cross-reactive antibody responses to the KP.2 and LP.8.1 vaccine doses","rel_date":"2026-05-15","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.13.725047","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_no","type":"new results","category":"immunology"},{"rel_doi":"10.64898\/2026.05.15.725307","rel_title":"A Structural Domain in the genomic RNA of SARS-CoV-2 Folds into a Compact Granular Structure without the N protein: A Single-Molecule Fluorescence Spectroscopic Investigation","rel_date":"2026-05-15","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.15.725307","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by_nc_nd","type":"new results","category":"biophysics"},{"rel_doi":"10.64898\/2026.05.14.725177","rel_title":"Expansion Revealing of Pathology Resolves Nanostructures Associated with Inflammatory Phenotypes in COVID-19 Decedent Human Brain Tissue","rel_date":"2026-05-15","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.14.725177","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by","type":"new results","category":"neuroscience"},{"rel_doi":"10.64898\/2026.05.12.724509","rel_title":"Pathogen-specific host responses define distinct pneumonia endotypes in the human lung","rel_date":"2026-05-14","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.12.724509","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by_nc_nd","type":"new results","category":"immunology"},{"rel_doi":"10.64898\/2026.05.11.26352906","rel_title":"Transcranial direct current stimulation-augmented cognitive training for post-COVID-19 cognition: A phase IIb randomized controlled trial","rel_date":"2026-05-14","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.11.26352906","rel_abs":"BackgroundCognitive dysfunction is a prevalent and debilitating symptom of post-COVID-19 condition with limited evidence-based interventions. Here, we assessed the efficacy of cognitive training (CT) alone and combined with transcranial direct current stimulation (tDCS) for cognitive enhancement in post-COVID-19 patients.\n\nMethodsNeuromod-COV was a phase IIb, prospective, randomized, open-label, blinded-endpoint trial conducted at University Medicine Greifswald, Germany. The tDCS intervention was evaluated through a double-blind, sham-controlled design. Adults aged 18-60 with confirmed SARS-CoV-2 infection [&ge;] 6 weeks prior and post-infection cognitive complaints were eligible. Participants were randomly assigned (1:1:1) to CT with active tDCS (CT+AtDCS), CT with sham tDCS (CT+StDCS), or progressive muscle relaxation (PMR, non-cognitive control intervention) with sham tDCS. Intervention consisted of nine 20-minute sessions over three weeks of CT (letter updating task) or PMR with 2 mA tDCS (active\/sham) applied over the left dorsolateral prefrontal cortex. The primary outcome was untrained working memory (WM; measured by N-back task accuracy) comparing CT with PMR at post-intervention. Secondary outcomes included trained and untrained WM, visuospatial memory, and self-report measures at post-intervention and 1-month follow-up comparing CT vs. PMR and CT+AtDCS vs. CT+StDCS. The trial was registered at ClinicalTrials.gov (NCT04944147).\n\nResultsBetween October 1, 2021, and August 7, 2024, 60 participants were randomized (76.7% female) to CT+AtDCS (n = 20), CT+StDCS (n = 20), or PMR (n = 20). CT did not improve untrained WM at post-intervention compared with PMR (primary outcome: {beta} = 1.59, 95% CI - 1.30 to 4.48, p = 0.278; 1-back: {beta} = 2.52, 95% CI -1.27 to 6.31, p = 0.191; 2-back: {beta} = 0.66, 95% CI -3.12 to 4.44, p = 0.732). However, CT+AtDCS enhanced untrained WM at post-intervention and follow-up, and visuospatial memory at post-intervention compared with CT+StDCS (secondary outcomes). No intervention improved self-report outcomes. No serious adverse events occurred and incidence rate ratios were similar between groups.\n\nConclusionCT alone did not improve untrained WM performance. However, CT with tDCS enhanced untrained WM and visuospatial memory, suggesting potential benefits of combined neuromodulation approaches for cognitive enhancement in post-COVID-19 patients.","rel_num_authors":9,"rel_authors":[{"author_name":"Catalina Trujillo Llano","author_inst":"University Medicine Greifswald"},{"author_name":"Anna Elisabeth Fromm","author_inst":"University Medicine Greifswald"},{"author_name":"Lydia Lingemann","author_inst":"University Medicine Greifswald"},{"author_name":"Ulrike Grittner","author_inst":"Charite University Medicine"},{"author_name":"Marcus F Meinzer","author_inst":"University Medicine Greifswald"},{"author_name":"Robert Fleischmann","author_inst":"University Medicine Greifswald"},{"author_name":"Eva-Lotta Brakemeier","author_inst":"University of Greifswald"},{"author_name":"Daria F Antonenko","author_inst":"University Medicine Greifswald"},{"author_name":"Agnes Floeel","author_inst":"University Medicine Greifswald"}],"version":"1","license":"cc_no","type":"PUBLISHAHEADOFPRINT","category":"neurology"},{"rel_doi":"10.64898\/2026.05.07.723210","rel_title":"Temperature-Dependent Replication and Sensitivity to Innate Immunity of Human Coronavirus HKU1","rel_date":"2026-05-12","rel_site":"medRxiv","rel_link":"https:\/\/medrxiv.org\/cgi\/content\/short\/10.64898\/2026.05.07.723210","rel_num_authors":0,"rel_authors":null,"version":"1","license":"cc_by_nc_nd","type":"new results","category":"microbiology"}]}