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Abstract

Objectives: To assess the impact of the transition from film to digital mammography in the Australian national breast cancer screening program.

Study design: Retrospective linked population health data analysis (New South Wales Central Cancer Registry, BreastScreen NSW); interrupted time series analysis.

Setting: New South Wales, 2002–2016.

Participants: Women aged 40 years or older with breast cancer diagnosed during 2002–2017 who had been screened by BreastScreen NSW and for whom complete follow‐up information until the end of the recommended re‐screening interval was available.

Intervention: Transition from film to digital mammography; 2009 defined as transition year (digital mammography becomes dominant screening modality).

Main outcome measures: Population rates of screen‐detected cancer, interval cancer, recalls, and false positive findings.

Results: The study cohort comprised 967 573 women; of the 2 741 555 screens, 1 535 184 used film mammography (2002–2010) and 1 206 371 used digital mammography (2006–2016). The screen‐detected cancer rate was 4.86 (95% confidence interval [CI], 4.75–4.97) cases per 1000 screens with film mammography and 6.11 (95% CI, 5.97–6.24) cases per 1000 screens with digital mammography (unadjusted difference, 1.24 [95% CI, 1.06–1.41] cases per 1000 screens). The interval cancer rate was 2.56 (95% CI, 2.48–2.64) cases per 1000 screens with film mammography and 2.84 (95% CI, 2.75–2.94) cases per 1000 screens with digital mammography (unadjusted difference, 0.27 [95% CI, 0.15–0.40] cases per 1000 screens). With the transition to digital mammography, the screen‐detected cancer rate increased by 0.07 per 1000 screens, the sum of the decline in the invasive cancer rate (–0.21 cases per 1000 screens) and the rise in the ductal carcinoma in situ detection rate (0.28 cases per 1000 screens); during 2009–2015, it increased by 0.18 cases per 1000 screens per year. With the transition to digital mammography, the interval cancer rate increased by 0.75 cases per 1000 screens (invasive cancer: by 0.69 cases per 1000 screens); during 2009–2015, it declined by 0.13 cases per 1000 screens per year. The recall rate increased by 8.02 per 1000 screens and the false positive rate by 7.16 per 1000 screens following the transition; both rates subsequently declined to pre‐transition levels.

Conclusions: The increased screen‐detected cancer rate following the transition to digital mammography was not accompanied by a reduction in interval cancer detection rates.

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1 Sydney School of Public Health, the University of Sydney, Sydney, NSW
2 The Family Planning Australia Research Centre, Sydney, NSW

Correspondence: katy.bell@sydney.edu.au

Open access:

Open access publishing facilitated by The University of Sydney, as part of the Wiley ‐ The University of Sydney agreement via the Council of Australian University Librarians.

Data Sharing:

Access to the data and analysis files underlying this report is permitted only with the explicit permission of the approving human research ethics committees and the data custodians. Analysis of linked data is currently authorised at only one location.

Acknowledgements:

This study was supported by funding from the National Health and Medical Research Council (NHMRC) Centre for Research Excellence (CIA Alexandra Barratt, 1104136). Rachel Farber received funding from the NHMRC (1168688) and the National Breast Cancer Foundation (NBCF) (DS‐19‐02). Katy Bell holds an NHMRC Investigator grant (1174523). Nehmat Houssami holds an NHMRC Investigator grant (1194410) and an NBCF Chair in Breast Cancer Prevention grant (EC‐21‐001). The funders had no role in the study design, data collection, analysis or interpretation, reporting or publication.

Competing interests:

No relevant disclosures.

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Urban green space provision: the case for policy‐based solutions to support human health

Craig Williams, Christie Byrne, Shannon Evenden, Veronica Soebarto, Stefan Caddy‐Retalic, Carmel Williams, Yonatal Tefera, Xiaoqi Feng and Andrew Lowe

Med J Aust || doi: 10.5694/mja2.52569
Published online: 20 January 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Global health

As one of the world's most urbanised nations, Australia1 is particularly vulnerable to diseases causally linked with urban living.2 Further urban growth requires systemic health policy solutions. Urban green spaces (UGS) are dynamic contributors to the wellbeing of our cities, offering benefits to the health of humans, society, and natural and managed ecosystems. Here we define UGS to encompass planned and intentional green spaces such as parks, curated gardens, sports and recreation areas as well as urban forests and nature reserves, and unconventional green zones such as easements, road and infrastructure routes, streetscapes and commercial precincts.

1 University of South Australia, Adelaide, SA
2 Environment Institute, University of Adelaide, Adelaide, SA
3 University of Adelaide, Adelaide, SA
4 University of Sydney, Sydney, NSW
5 South Australian Health and Medical Research Institute, Adelaide, SA
6 University of New South Wales, Sydney, NSW

Correspondence: craig.williams@unisa.edu.au

Acknowledgements:

We acknowledge the HEAL (Healthy Environments And Lives) National Research Network, which receives funding from the National Health and Medical Research Council Special Initiative in Human Health and Environmental Change (Grant No. 2008937). Support was also provided by the Environment Institute at the University of Adelaide. The funding source was not involved in the authoring of this work. The work of the Dynamic State Summit (2022) in catalysing this work is acknowledged.

Competing interests:

No relevant disclosures.

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Japanese encephalitis transmission in Australia: challenges and future perspectives

Caroline K Dowsett, Francesca Frentiu, Gregor J Devine and Wenbiao Hu

Med J Aust || doi: 10.5694/mja2.52550
Published online: 13 January 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Infectious diseases

Japanese encephalitis is caused by the Japanese encephalitis virus (JEV). JEV is the main cause of viral encephalitis in Asia,1 and is endemic in many countries on that continent and islands of the Pacific region. Although only a small percentage of cases are symptomatic, 20–30% are fatal and 30–50% develop significant neurological sequelae.2 Australia has escaped relatively unscathed, with only a few cases detected in the late 1990s, mostly from international travellers, with local transmission limited to the Torres Strait and Cape York.2,3 The last detection of JEV in Cape York was from feral pigs and an isolate of mosquitoes in 2005. Sentinel animal surveillance in Australia was phased out in 2011 due to costs and labour‐intensive maintenance, potential occupational health and safety issues, and concerns about the potential public health risk of using amplifying hosts (pigs), which may contribute to transmission when they become viremic.3 Sentinel animal use was replaced by a general mosquito trap‐based surveillance system.3 The Box provides a timeline of JEV milestones in Australia from the 1990s to 2023, with details on animal and human cases, and corresponding changes in surveillance.

1 Queensland University of Technology, Brisbane, QLD
2 Mosquito Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD

Correspondence: w2.hu@qut.edu.au

Acknowledgements:

We acknowledge the HEAL (Healthy Environments And Lives) National Research Network, which receives funding from the National Health and Medical Research Council (NHMRC) Special Initiative in Human Health and Environmental Change Initiative (Grant No. 2008937). Caroline Dowsett is funded by a Queensland University of Technology Post‐graduate Research Award (QUTPRA). We also acknowledge the National Foundation for Australia‐China Relations (Grant No. 220011), the Australian Department of Foreign Affairs and Trade.

Competing interests:

No relevant disclosures.

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Aboriginal and Torres Strait Islander infants admitted to the Hunter New England neonatal intensive care unit, 2016-2021: a retrospective medical record audit

Jessica Bennett, Michelle Kennedy, Jamie Bryant, Amanual Mersha, Larissa Korostenski, Michelle Stubbs, Justine Parsons and Luke Wakely

Med J Aust || doi: 10.5694/mja2.52533
Published online: 9 December 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Indigenous health

Pediatric medicine

Global health

In Australia, 24.4% of newborn Aboriginal or Torres Strait Islander infants were admitted to neonatal intensive care units (NICUs) or special care nurseries during 2022, compared with 16.3% of non‐Indigenous infants.1 For Aboriginal and Torres Strait Islander people, culture is a protective factor for strong health and wellbeing,2 but neonatal care can disrupt usual parent–infant care and cultural care practices. Understanding the characteristics of Aboriginal and Torres Strait Islander families receiving neonatal care is important for supporting their needs. Routinely collected national and state data do not typically provide detailed information about Aboriginal and Torres Strait Islander infants admitted to NICUs,1 leading to gaps in knowledge about how to optimise care, particularly at the local level.

1 The University of Newcastle, Newcastle, NSW
2 John Hunter Children's Hospital, Newcastle, NSW
3 Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW

Correspondence: jessica.bennett@newcastle.edu.au

Data Sharing:

In line with Indigenous data sovereignty and Aboriginal and Torres Strait Islander ethical research principles, data sharing is available for this study.

Acknowledgements:

This study was funded by an Ikara–Flinders Ranges Challenge Grant. We respectfully acknowledge all Aboriginal and Torres Strait Islander people whose data were included in our analysis, and the governing services (Tamworth Aboriginal Medical Service, Tamworth Aboriginal Land Council, Walgett Aboriginal Medical Service, and the Aboriginal Advisory Group) for the leadership, knowledge, and wisdom shared with the investigators.

Competing interests:

No relevant disclosures.

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3. Walter MA, Anderson, C. Indigenous statistics: a quantitative research methodology. London: Taylor & Francis, 2013.
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7. United Nations (General Assembly). Declaration on the rights of Indigenous People. 13 Sept 2007. https://www.un.org/development/desa/indigenouspeoples/wp‐content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf (viewed Apr 2024).
8. Nolan‐Isles D, Macniven R, Hunter K, et al. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. Int J Environ Res Public Health 2021; 18: 3014.

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Perspective

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Disorders of gut–brain interaction, eating disorders and gastroparesis: a call for coordinated care and guidelines on nutrition support

Trina Kellar, Chamara Basnayake, Rebecca E Burgell, Michael Kamm, Hannah W Kim, Kate Lane, Kate Murphy and Nicholas J Talley

Med J Aust || doi: 10.5694/mja2.52537
Published online: 2 December 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Digestive system diseases

Mental disorders

Untangling the complex interplay between eating disorders, gut–brain disorders and motility disorders is challenging. Nationally and internationally, there has been a concerning increase in patients receiving artificial nutrition that may be unnecessary.1 This places patients at risk of iatrogenic harm and results in considerable economic burden to health services. There is a clear need for high quality research to guide care, but in its absence, now more than ever, we require a national treatment consensus to support clinicians working in this field. This article aims to highlight the current status, knowledge, and service limitations in treating this difficult cohort of patients, and make recommendations on future strategies within Australia to move forward for better patient outcomes.

1 University of Queensland, Brisbane, QLD
2 St Vincent's Hospital Melbourne, Melbourne, VIC
3 Alfred Health, Melbourne, VIC
4 University of Melbourne, Melbourne, VIC
5 Orygen the National Centre of Excellence in Youth Mental Health, Melbourne, VIC
6 Queensland Eating Disorder Service, Brisbane, QLD
7 Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW

Correspondence: rbwh-nmc-admin@health.qld.gov.au

Competing interests:

Nicholas Talley is the Emeritus Editor‐In‐Chief of the MJA. We confirm that he was not involved in any review, decision making, or editorial processes for this manuscript.

1. Lal S, Paine P, Tack J, et al. Avoiding the use of long‐term parenteral support in patients without intestinal failure: a position paper from the European Society of Clinical Nutrition & Metabolism, the European Society of Neurogastroenterology and Motility and the Rome Foundation for Disorders of Gut‐Brain Interaction. Neurogastroenterol Motil 2024; 36: e14853.
2. Emmanuel AV, Stern J, Treasure J, et al. Anorexia nervosa in gastrointestinal practice. Eur J Gastroenterol Hepatol 2004; 16: 1135‐1142.
3. Hollis E, Murray HB, Parkman HP. Relationships among symptoms of gastroparesis to those of avoidant/restrictive food intake disorder in patients with gastroparesis. Neurogastroenterol Motil 2024; 36: e14725.
4. Schalla MA, Stengel A. Gastrointestinal alterations in anorexia nervosa ‐ a systematic review. Eur Eat Disord Rev 2019; 27: 447‐461.
5. Murray HB, Bailey AP, Keshishian AC, et al. Prevalence and characteristics of avoidant/restrictive food intake disorder in adult neurogastroenterology patients. Clin Gastroenterol Hepatol 2020; 18: 1995‐2002.
6. Peters JE, Basnayake C, Hebbard GS, et al. Prevalence of disordered eating in adults with gastrointestinal disorders: a systematic review. Neurogastroenterol Motil 2022; 34: e14278.
7. Gallo R, Armstrong E, Griffin H, et al. Impact of enteral tube feeding for individuals with disorders of the gut brain interaction. Clin Nutr ESPEN 2023; 58: 604.
8. Martin LD, Wang X, Day C, et al. Enteral tube feeding in functional gastrointestinal disorders: a game of chance? Clin Nutr ESPEN 2023; 57: 849.
9. Gillanders L, Angstmann K, Ball P, et al. AuSPEN clinical practice guideline for home parenteral nutrition patients in Australia and New Zealand. Nutrition 2008; 24: 998‐1012.
10. Camilleri M, Kuo B, Nguyen L, et al. ACG clinical guideline: gastroparesis. Am J Gastroenterol 2022; 117: 1197‐1220.
11. Cobbaert L, Hay P, Mitchell PB, et al. Sensory processing across eating disorders: a systematic review and meta‐analysis of self‐report inventories. Int J Eat Disord 2024; 57: 1465‐1488.
12. Chiarioni G, Bassotti G, Monsignori A, et al. Anorectal dysfunction in constipated women with anorexia nervosa. Mayo Clin Proc 2000; 75: 1015‐1019.
13. Joyeux MA, Pierre A, Barrois M, et al. Stomach size in anorexia nervosa: a new challenge? Eur Eat Disord Rev 2024; 32: 784‐794.
14. West M, McMaster CM, Staudacher HM, et al. Gastrointestinal symptoms following treatment for anorexia nervosa: a systematic literature review. Int J Eat Disord 2021; 54: 936‐951.
15. Riedlinger C, Schmidt G, Weiland A, et al. Which symptoms, complaints and complications of the gastrointestinal tract occur in patients with eating disorders? A systematic review and quantitative analysis. Front Psychiatry 2020; 11: 195.
16. Andreani NA, Sharma A, Dahmen B, et al. Longitudinal analysis of the gut microbiome in adolescent patients with anorexia nervosa: microbiome‐related factors associated with clinical outcome. Gut Microbes 2024; 16: 2304158.
17. Powell N, Walker MM, Talley NJ. The mucosal immune system: master regulator of bidirectional gut‐brain communications. Nat Rev Gastroenterol Hepatol 2017; 14: 143‐159.
18. Aguilera‐Lizarraga J, Hussein H, Boeckxstaens GE. Immune activation in irritable bowel syndrome: what is the evidence? Nat Rev Immunol 2022; 22: 674‐686.
19. Simons J, Shajee U, Palsson O, et al. Disorders of gut‐brain interaction: highly prevalent and burdensome yet under‐taught within medical education. United European Gastroenterol J 2022; 10: 736‐744.
20. Denman E, Parker EK, Ashley MA, et al. Understanding training needs in eating disorders of graduating and new graduate dietitians in Australia: an online survey. J Eat Disord 2021; 9: 27.
21. Knowles SR, Apputhurai P, Palsson OS, et al. The epidemiology and psychological comorbidity of disorders of gut–brain interaction in Australia: results from the Rome Foundation Global Epidemiology Study. Neurogastroenterol Motil 2023; 35: e14594.

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Perspective

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The equitable challenges to quality use of modulators for cystic fibrosis in Australia

Laura K Fawcett, Shafagh A Waters and Adam Jaffe

Med J Aust || doi: 10.5694/mja2.52527
Published online: 2 December 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Respiratory tract diseases

Health services administration

Cystic fibrosis, an autosomal recessive disease, causes premature mortality with a current life expectancy of 56 years.1 Variations in a single gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR), an anion channel, cause this multisystemic disease.2 Bronchiectasis remains the most significant contributor to mortality, with other affected systems including the gastrointestinal, pancreatic, hepatobiliary, sweat glands and reproductive systems.3 Clinical manifestations of cystic fibrosis vary widely, leading to diverse phenotypic expressions.

1 Sydney Children's Hospital Randwick, Sydney, NSW
2 University of New South Wales, Sydney, NSW

Correspondence: laura.fawcett@health.nsw.gov.au

Acknowledgements:

LF is supported by the Rotary Club of Sydney Cove/Sydney Children's Hospital Foundation and UNSW postgraduate award scholarships. SW is supported by the UNSW Scientia program and the Australian National Health and Medical Research Council. There was no role of the funding sources in the planning, writing or publication of the work. Colman Taylor provided feedback on a draft manuscript regarding health technology assessment pathways.

Competing interests:

AJ is chair of the scientific and medical advisory committee of Rare Voices Australia and has received speaker payments from Vertex Pharmaceuticals. LF has been a sub‐investigator on Vertex clinical trials and received sponsorship of travel costs to attend educational meetings. SW has received competitive funding sponsored by Vertex Pharmaceuticals. Vertex Pharmaceuticals had no involvement in the planning, writing or publication of this article.

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4. Clinical and Functional Translation of CFTR, CFTR2 Variant List History [website]. US Cystic Fibrosis Foundation, John Hopkins University, The Hospital for Sick Children. https://cftr2.org/mutations_history (viewed Feb 2024).
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16. Sondo E, Cresta F, Pastorino C, et al. The L467F‐F508del complex allele hampers pharmacological rescue of mutant CFTR by elexacaftor/tezacaftor/ivacaftor in cystic fibrosis patients: the value of the ex vivo nasal epithelial model to address non‐responders to CFTR‐modulating drugs. Int J Mol Sci 2022; 23: 3175.
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41. Sutharsan S, McKone EF, Downey DG, et al. Efficacy and safety of elexacaftor plus tezacaftor plus ivacaftor versus tezacaftor plus ivacaftor in people with cystic fibrosis homozygous for F508del‐CFTR: a 24‐week, multicentre, randomised, double‐blind, active‐controlled, phase 3b trial. Lancet Respir Med 2022; 10: 267‐277.
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43. Mall MA, Brugha R, Gartner S, et al. Efficacy and safety of elexacaftor/tezacaftor/ivacaftor in children 6 through 11 years of age with cystic fibrosis heterozygous for F508del and a minimal function mutation A phase 3b, randomized, placebo‐controlled study. Am J Respir Crit Care Med 2022; 206: 1361‐1369.
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45. Lorentzos MS, Metz D, Moore AS, et al. Providing Australian children and adolescents with equitable access to new and emerging therapies through clinical trials: a call to action. Med J Aust 2024; 220: 121‐125. https://www.mja.com.au/journal/2024/220/3/providing‐australian‐children‐and‐adolescents‐equitable‐access‐new‐and‐emerging
46. Burgel PR, Sermet‐Gaudelus I, Durieu I, et al. The French Compassionate Program of elexacaftor‐tezacaftor‐ivacaftor in people with cystic fibrosis with advanced lung disease and no F508del CFTR variant. Eur Respir J 2023; 61: 2202437.

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Systematic review

Online first

Interventions for Aboriginal and Torres Strait Islander people with type 2 diabetes that modify its management and cardiometabolic risk factors: a systematic review

Ciying Tan, Zoe Williams, Mohammad Ashraful Islam, Ray Kelly, Tuguy Esgin and Elif I Ekinci

Med J Aust || doi: 10.5694/mja2.52508
Published online: 25 November 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Endocrine system diseases

Indigenous health

Statistics, epidemiology and research design

Abstract

Objectives: To review studies of interventions for reducing the impact of type 2 diabetes in Aboriginal and Torres Strait Islander people. The primary aim was to review and summarise the characteristics and findings of the interventions. The secondary aims were to assess their effects on diabetes and cardiometabolic risk factors, and the proportions of people with type 2 diabetes who achieved therapeutic targets with each intervention.

Study design: We searched eight electronic databases for publications of studies including Aboriginal or Torres Strait Islander people aged 15 years or older with diagnoses of type 2 diabetes, describing one or more diabetes interventions, and published in English during 1 January 2000 – 31 December 2020. Reference lists in the assessed articles were checked for further relevant publications.

Data sources: MEDLINE (Ovid), Web of Science (Clarivate), the Cochrane Library, Global Health (EBSCO), Indigenous Collection and Indigenous Australia (Informit), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the World Health Organization International Clinical Trials Registry Platform (WHO‐ICTRP).

Results: The database searches yielded 1424 unique records; after screening by title and abstract, the full text of 55 potentially relevant articles were screened, of which seventeen met our eligibility criteria: eleven cohort studies (seven retrospective audits and four prospective studies), three randomised controlled trials, and three observational, non‐randomised follow‐up studies. Twelve publications reported site‐based (Aboriginal or Torres Strait Islander health service or diabetes clinic) rather than individual‐based diabetes interventions. Interventions with statistically significant effects on mean glycated haemoglobin (HbA_1c) levels were laparoscopic adjustable gastric banding, a 5‐day diabetes self‐management camp, treatment of Strongyloides stercoralis infections, community‐based health worker‐led management, point‐of‐care testing, and self‐management approaches.

Conclusions: Few interventions for Aboriginal and Torres Strait Islander people with type 2 diabetes have been reported in peer‐reviewed publications. Improving diabetes care services resulted in larger proportions of people achieving therapeutic HbA_1c targets. Outcomes were better when Aboriginal and Torres Strait Islander communities were involved at all levels of an intervention. High quality studies of holistic, culturally safe and accessible interventions should be the focus of research.

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1 The Australian Centre for Accelerating Diabetes Innovations, Melbourne Medical School, the University of Melbourne, Melbourne, VIC
2 Austin Health, Melbourne, VIC
3 The University of Sydney, Sydney, NSW
4 Edith Cowan University, Perth, WA

Correspondence: elif.ekinci@unimelb.edu.au

Acknowledgements:

We thank Anita Horvath (Medical Education, University of Melbourne) for her support and advice in the standard structure and format of the review.

Competing interests:

Elif I Ekinci has received payment for sitting on an advisory panel for Eli Lilly Australia; and donated the money to her institution for diabetes research. She has received research support from Eli Lilly Australia, Novo Nordisk, Boehringer Ingelheim, the Eli Lilly Alliance, Versanis, Endogenex Insulet Corporation, and Medtronic.

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Towards a cure for long COVID: the strengthening case for persistently replicating SARS‐CoV‐2 as a driver of post‐acute sequelae of COVID‐19

Michelle JL Scoullar, Gabriela Khoury, Suman S Majumdar, Emma Tippett and Brendan S Crabb

Med J Aust || doi: 10.5694/mja2.52517
Published online: 25 November 2024

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Infectious diseases

New insights into post‐acute sequelae of coronavirus disease 2019 (PASC) or long COVID are emerging at great speed. Proposed mechanisms driving long COVID include the overlapping pathologies of immune and inflammatory dysregulation, microbiota dysbiosis, autoimmunity, endothelial dysfunction, abnormal neurological signalling, reactivation of endogenous herpesviruses, and persistence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).1,2 In this commentary, we describe some of these advances that indicate that long COVID may be driven by “long infection” and that persistent replicating SARS‐CoV‐2 may be the potentially mechanistically unifying driver for long COVID.

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1 Burnet Institute, Melbourne, VIC
2 Clinic Nineteen, Melbourne, VIC
3 Monash University, Melbourne, VIC
4 University of Melbourne, Melbourne, VIC

Correspondence: michelle.scoullar@burnet.edu.au

Acknowledgements:

The Burnet Institute is supported by an Operational Infrastructure Grant from the State Government of Victoria, Australia, and the Independent Research Institutes Infrastructure Support Scheme of the NHMRC of Australia.

Competing interests:

No relevant disclosures.

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