Epidemiology, diagnosis, vaccines, and bibliometric analysis of the 100 top-cited studies on Hepatitis E virus

Post-operative infections after cardiothoracic surgery and vascular procedures: a bibliometric and visual analysis of the 100 most-cited articles in the past 2 decades

Aim

To recognize and analyze the 100 most-cited articles on post-operative infections following cardiothoracic surgery and vascular procedures in the past 20 years.

Methods

Articles published on post-operative infections following cardiothoracic surgery and vascular procedures from inception 1986 till 2020 were reviewed and selected by two authors, based on their number of citations using the Scopus database. Their characteristics were recorded, i.e., title, authors, publication date, total no. of citations, citations per year (CPY), country of research, institutional affiliation, journal, research subject, and article type.

Results

The top 100 most influential articles were published between 1968 and 2017, with the peak in 2002. The mean number of total citations was 236.79 (range: 108-1,157). Areas with a medical focus were predominant in the studied research articles on the researched topic. The top-most journals in which these articles were published include Annals of Thoracic Surgery (14), followed by Circulation (8), and the New England Journal of Medicine (8). The number of publications affiliated with an institution were highest in the United States, with the Cleveland Clinic Foundation (6) having the most.

Conclusion

These findings highlight that there is a great potential to conduct research and publish the prevalence, causes, risk factors, pathogenesis and molecular biology of post-cardiac and -vascular surgery infections to prevent their adverse effects. The results can be taken into consideration for policy making to improve post-cardiac-surgery outcomes.

Hepatitis E associated determinants and diagnostic biomarkers during pregnancy and its prenatal consequences in Multan, Punjab tertiary care setting (Pakistan)

OBJECTIVE

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the world. Hepatitis E infection is commonly widespread by the fecal oral routes and contaminated water. This study was designed to explore the prevalence and risk factors of hepatitis E infection in pregnant women of the Multan district, Pakistan.

METHODS

The study comprised of a total of 500 enrolled patients, among which, 105 pregnant females with hepatitis E infection fulfilled the criteria for anti-HEV antibodies. Pregnant women without significant complications and without hepatitis E infection were excluded from this study. Hepatic profile, complete blood count, coagulation markers, and standard protocol were also assessed for fetal maternal hemorrhage.

RESULTS

Our results showed that 105 patients (66.66%, CI 95%) had HEV infection with mean age 25±5 years. Serum bilirubin levels were increased in 74 patients (70.47%), aspartate transaminase was elevated > 200 IU/L in 71 patients (67.61%), alanine transaminase was above the 100 IU/L in 65 patients (245 IU/L), and low platelet counts were found in 45 patients (42.85%). Moreover, fetal distress cases were 9 (10.84%) and maternal distress cases were about 11 (13.25%). Fetal mortality cases were 39 (37.14%), and maternal mortality cases were about 22 (20.95%) due to hepatic comma, intravascular coagulation, and hepatic failure.

CONCLUSION

It was concluded that the prevalence of Hepatitis E during pregnancy is associated with high risk factors of unhygienic practices, blood transfusion, and noncompliance with universal infection control techniques. Maternal fatalities and fetal consequences were exacerbated by HEV infection.

A bibliometric analysis of the top 100 most cited papers and research trends in breast cancer related BRCA1 and BRCA2 genes

This study aimed to identify, characterize, and map the important attributes of the top 100 most cited papers on BRCA1 and BRCA2 genes. The scientific literature on BRCA1 and BRCA2 was searched in the Web of Science Core Collection database using the keywords "BRCA1" OR "BRCA2" (Title). The top 100 most cited papers were selected based on citations. The obtained data were exported into HistCiteTM, RStudio, and VOSviewer software for prerequisite analysis. The top 100 most cited papers on BRCA1 and BRCA2 were authored by 932 authors from 24 countries and published in 27 journals. These papers were cited 79,713 times, ranging from 441 to 4671 citations. The highly cited paper was cited 4671 times and published in Science (1994). The leading author, journal, publication year, institution, and country were Easton DF (n = 16), Nature Genetics (n = 11), 2002 (n = 11), University of Pennsylvania (n = 17), and the USA (n = 76), respectively. The results show that all the top 100 papers were produced in developed countries. The collaboration index among the authors was 9.49. The most frequently appeared keywords were ovarian-cancer, breast-cancer, mutations, gene, and familial breast. In recent times, the trend topics were patients, mutations, carriers, ovarian, and risk.

Global research trends in MERS-CoV: A comprehensive bibliometric analysis from 2012 to 2021

Background

The Middle East respiratory syndrome coronavirus (MERS-CoV) was first reported in Saudi Arabia in 2012. So far, the cases of MERS-CoV have been reported in 27 countries. The virus causes severe health complications, resulting high mortality.

Aim

The current study aimed to evaluate the global research trends and key bibliometric indices in MERS-CoV research from 2012 to 2021.

Methods

A retrospective bibliometric and visualized study was conducted. The Science Citation Index Expanded Edition of Web of Science Core Collection database was utilized to retrieve published scientific literature on MERS-CoV. The retrieved publications were assessed for a number of bibliometric attributes. The data were imported into HistCite^TM and VOSviewer software to calculate the citations count and perform the visualization mapping, respectively. In addition, countries or regions collaboration, keywords analysis, and trend topics in MERS-CoV were assessed using the Bibliometrix: An R-tool.

Results

A total of 1,587 publications, published in 499 journals, authored by 6,506 authors from 88 countries or regions were included in the final analysis. Majority of these publications were published as research article (n = 1,143). Globally, these publications received 70,143 citations. The most frequent year of publication was 2016 (n = 253), while the most cited year was 2014 (11,517 citations). The most prolific author was Memish ZA (n = 94), while the most published journal was Emerging Infectious Diseases (n = 80). The United States of America (USA) (n = 520) and Saudi Arabia (n = 432) were the most influential and largest contributors to the MERS-CoV publications. The extensively studied research area was infectious diseases. The most frequently used author keywords other than search keywords were Saudi Arabia, SARS-CoV-2, COVID-19, epidemiology, transmission, spike protein, vaccine, outbreak, camel, and pneumonia.

Conclusion

This study provides an insight into MERS-CoV-related research for scientific community (researchers, academicians) to understand and expand the basic knowledge structure, potential collaborations, and research trend topics. This study can also be useful for policy makers. After the emergence of MERS-CoV, a significant increase in scientific production was observed in the next 4 years (2013–2016). In 2021, the trend topics in MERS-CoV-related research were COVID-19, clinical characteristics, and cytokine storm. Saudi Arabia had the strongest collaboration with the USA, while the USA had the highest collaboration with China.

Mapping of global research on familial Mediterranean fever: a SCI-Expanded-based bibliometric analysis

BACKGROUND

Familial Mediterranean fever (FMF) is a disease of the innate immune system. The disease is prevalent in the Mediterranean region. A comprehensive bibliometric analysis of the published literature on FMF indexed in the SCI-Expanded is lacking.

OBJECTIVE

To review the global research trend, developments, leading authors, journals, institutions, and countries, and visualization mapping of the published scientific literature on FMF.

METHODS

The data were obtained from SCI-Expanded of the WoSCC database. The obtained data were analyzed using Bibliometrix: An R-tool and an online Bibliometric tool. P-value less than 0.05 was considered statistically significant.

RESULTS

In this study, a total of 1665 publications (research article, 92% and review, 8%) on FMF were analyzed and characterized. These publications were authored by 5630 authors, and published in 465 journals. The scientific production in FMF research has been increasing over time (p < 0.0001), with scientific annual growth of 3.96%. The most frequent year of publications was 2021 (n = 98), while the most attractive and published journal in FMF research was Rheumatology International (n = 116). The leading institution was Hacettepe University. The top ranked and most cited country in FMF research was Turkey. In total, the authors' collaboration index was 3.47.

CONCLUSION

Generally, FMF scientific research production has increased over the last two decades. The most studied research areas in FMF were rheumatology, general internal medicine and genetics heredity. The most studied recent trend topics in FMF research were validity, reliability, endothelial dysfunction, management, and recommendations. Moreover, regional collaboration between less active countries should be extended in order to expand FMF-related research and thus prevent and control the disease in the near future.

Global Research Mapping of Psycho-Oncology Between 1980 and 2021: A Bibliometric Analysis

Background and Aim

Psycho-oncology is a cross-disciplinary and collaborative sub-specialty of oncology that focuses on the psychological, behavioral, ethical, and social aspects of cancer in clinical settings. The aim of this bibliometric study was to analyze and characterize the research productivity and trends in psycho-oncology between 1980 and 2021.

Methodology

In May 2022, the Scopus^® database was searched for psycho-oncology-related publications using predetermined search keywords with specific restrictions. Lotka’s law was applied to check the authors’ productivity, while Bradford’s law was used to assess the core journals in this field. The data was analyzed for different bibliometric indicators in the Biblioshiny package, an RStudio tool for bibliometric analysis.

Results

The initial search resulted in a total of 2,906 publications. Of which, 1,832 publications were included in the final analysis, published between 1980 and 2021. The analyzed publications were written by 7,363 authors from 74 countries and published in 490 journals. There has been a significant increase in psycho-oncology-related publications after 2010. The most productive year was 2021 (n = 365). The annual scientific growth rate was found to be 13.9%. The most relevant leading author in terms of publications was Luigi Grassi from the University of Ferrara, Italy (n = 42). Lotka’s law found that the number of authors declined as the number of papers written increased. The core journals were Psycho-Oncology, Supportive Care in Cancer, and Journal of Psychosocial Oncology. The most frequently used author’s keywords other than searching keywords were cancer, oncology, quality of life, depression, and anxiety. Recent psycho-oncology-related topics included mental health, COVID-19 infection in humans, people, pandemic, and tumor. The University of Sydney was the top-ranked institution. The leading country in terms of publications, citations, corresponding author country, and international collaboration was the United States of America (United States). The United States had the strongest collaboration with Australia and Canada.

Conclusion

The research hotspots include mental health conditions and interventions in cancer patients. We identified international collaboration and research expenditure to be strongly associated with psycho-oncology research productivity. Researchers’ collaboration, which is visible among developed countries, should be extended to low-income countries in order to expand psycho-oncology-related research and understanding.

Knowledge Mapping of Multicriteria Decision Analysis in Healthcare: A Bibliometric Analysis

Objective

Multicriteria decision analysis (MCDA) is a useful tool in complex decision-making situations, and has been used in medical fields to evaluate treatment options and drug selection. This study aims to provide valuable insights into MCDA in healthcare through examining the research focus of existing studies, major fields, major applications, most productive authors and countries, and most common journals in the domain.

Methods

A bibliometric analysis was conducted on the publication related to MCDA in healthcare from the Web of Science Core Collection (WoSCC) database on 14 July 2021. Three bibliometric software (VOSviewer, R-bibliometrix, and CiteSpace) were used to conduct the analysis including years, countries, institutes, authors, journals, co-citation references, and keywords.

Results

A total of 410 publications were identified with an average yearly growth rate of 32% (1999–2021), from 196 academic journals with 23,637 co-citation references by 871 institutions from 70 countries/regions. The United States was the most productive country (n = 80). Universiti Pendidikan Sultan Idris (n = 16), Université de Montréal (n = 13), and Syreon Research Institute (n = 12) were the top productive institutions. A A Zaidan, Mireille Goetghebeur and Zoltan Kalo were the biggest nodes in every cluster of authors' networks. The top journals in terms of the number of articles (n = 17) and citations (n = 1,673) were Value in Health and Journal of Medical Systems, respectively. The extant literature has focused on four aspects, including the analytic hierarchy process (AHP), decision-making, health technology assessment, and healthcare waste management. COVID-19 and fuzzy TOPSIS received careful attention from MCDA applications recently. MCDA in big data, telemedicine, TOPSIS, and fuzzy AHP is well-developed and an important theme, which may be the trend in future research.

Conclusion

This study uncovers a holistic picture of the performance of MCDA-related literature published in healthcare. MCDA has a broad application on different topics and would be helpful for practitioners, researchers, and decision-makers working in healthcare to advance the wheel of medical complex decision-making. It can be argued that the door is still open for improving the role of MCDA in healthcare, whether in its methodology (e.g., fuzzy TOPSIS) or application (e.g., telemedicine).

Bibliometric Analysis and Visualization Mapping of Anthrax Vaccine Publications from 1991 through 2021

Purpose: This study aims to analyze and characterize anthrax vaccine-related research, key developments, global research trends, and mapping of published scientific research articles during the last three decades (1991–2021). Methods: A bibliometric and visualized study was conducted. The Web of Science Core Collection database (WoSCC) was searched using relevant keywords (“Anthrax” OR “Anthrax bacterium” OR “Bacillus anthracis” OR “Bacteridium anthracis” OR “Bacillus cereus var. Anthracis” (Topic)) AND (“Vaccine” OR “Vaccines” OR “Immunization” OR “Immunisation” OR “Immunizations” OR “Immunisations” (Topic)) with specific restrictions. The data was analyzed and plotted by using different bibliometric software and tools (HistCiteTM software, version 12.3.17, Bibliometrix: An R-tool version 3.2.1, and VOSviewer software, version 1.6.17). Results: The initial search yielded 1750 documents. After screening the titles and abstracts of the published studies, a total of 1090 articles published from 1991 to 2021 were included in the final analysis. These articles were published in 334 journals and were authored by 4567 authors from 64 countries with a collaboration index of 4.32. The annual scientific production growth rate was found to be 9.68%. The analyzed articles were cited 31335 times. The most productive year was 2006 (n = 77, 7.06%), while the most cited year was 2007 (2561 citations). The leading authors and journals in anthrax research were Rakesh Bhatnagar from Jawaharlal Nehru University, India (n = 35, 3.21%), and Vaccine (n = 1830, 16.51%), while the most cited author and journal were Arthur M. Friedlander from the United States Department of Defense (n = 2762), and Vaccine (n = 5696), respectively. The most studied recent research trend topics were lethal, double-blind, epidemiology, B surface antigen, disease, and toxin. The United States of America (USA) was the most dominant country in terms of publications, citations, corresponding author country, and global collaboration in anthrax vaccine research. The USA had the strongest collaboration with the United Kingdom (UK), China, Canada, Germany, and France. Conclusion: This is the first bibliometric study that provides a comprehensive historical overview of scientific studies. From 2006 to 2008, more than 20% of the total articles were published; however, a decrease was observed since 2013 in anthrax vaccine research. The developed countries made significant contributions to anthrax vaccine-related research, especially the USA. Among the top 10 leading authors, six authors are from the USA. The majority of the top leading institutions are also from the USA. About 90% of the total studies were funded by the United States Department of Health and Human Services (HHS), National Institutes of Health (NIH), USA, and the National Institute of Allergy and Infectious Diseases (NIAID), USA.

Mapping of global research output in congenital cataracts from 1903 to 2021

BACKGROUND AND AIM

Globally, congenital cataract remains one of the main causes of visual loss in children. This study was designed to plot the overall research output and evaluate some key bibliometric indicators in congenital cataracts research.

METHODS

Publications on congenital cataracts were retrieved from the Web of Science Core Collection database. The published literature was searched using the keywords "congenital cataract" OR "congenital cataracts" in the title filed with document types and language restrictions. The data were exported into HistCite to analyze; publication year, top authors, countries, institutions, journals, keywords, and most cited studies. VOSviewer software was used to construct network visualization mapping.

RESULTS

A total of 1427 publications (1903-2021) published in English language were included in this study. Over the past few decades, the total number of publications in congenital cataracts was found to be increased. The most productive year was 2016 (n = 72), while the most cited year was 1941 (1268 citations). The Investigative Ophthalmology & Visual Science (Impact Factor: 4.799) was the most attractive journal with 161 publications, and the Molecular Vision (Impact Factor : 2.367) was the most cited journal with 1915 citations and 161.723 citations per year. The most productive country was the United States of America (USA) (n = 325), while the most active institute was Sun Yat-sen University, China (n = 36). The most prolific author was Yao K (n = 27). The most studied Web of Science category was ophthalmology (n = 852). The most widely used keyword was congenital (n = 1427). The most cited paper in congenital cataracts was "Congenital cataract following German measles in the mother, cited 1268 times. The USA and author keyword congenital cataract had the highest total link strength.

CONCLUSION

These findings provide useful insights, current status, and trends in clinical research in congenital cataracts. This study can be used to identify future research areas and standard bibliography references for better diagnosis and disease control.

Development of a competitive ELISA for detecting antibodies against genotype 1 hepatitis E virus

Hepatitis E, a significant global public health issue in China, is caused by sporadic infections with regional hepatitis E virus (HEV) genotypes 1, 3, and 4. To date, most immunoassays currently used to test human sera for the presence of anti-HEV antibodies cannot identify HEV at the genotype level. However, such information would be useful for identifying the source of infecting virus. Therefore, here we describe the development of a competitive enzyme-linked immunosorbent assay (ELISA) for detecting anti-genotype 1 HEV antibodies in human sera. Using recombinant genotype 1 HEV ORF3 protein as immunogen, traditional hybridoma technology was employed to generate seven monoclonal antibodies (mAbs), of which two mAbs specifically reacted with the immunogen. One of these two mAbs, 1D2, was labeled with horseradish peroxidase (HRP) for use in competitive ELISA (cELISA). After cELISA optimization using a checkerboard assay design, the amount of ORF3^SAR-55 as coating antigen (100 ng/well), HRP-1D2 mAb concentration (1 μg/mL), and test serum dilution (1:10) were selected and a result ≥ 19.5 was used as the cutoff for a positive result. Importantly, cross-genotype cELISA results indicated that the cELISA could not detect anti-genotype 3 rabbit and 4 swine HEV antibodies. Moreover, human sera confirmed as negative for anti-HEV antibodies using the commercial ELISA kit were all negative via cELISA. However, because the commercial ELISA kit detects anti-all genotypes HEV antibodies and the cELISA only detects anti-genotype 1 HEV antibodies, the consistence rate of two assays detecting positive sera is low. In summary, here a cELISA for detecting anti-genotype 1 HEV antibodies was developed for use in epidemiological investigations of genotype 1 HEV infections in humans. KEY POINTS: • Seven mAbs were produced using genotype 1 HEV ORF3 protein as immunogen. • One mAb that specifically bound to genotype 1 HEV ORF3 protein was selected and labeled for use in a cELISA to detect anti-genotype 1 HEV antibodies. • The competitive ELISA developed here will aid clinical diagnosis of HEV infections and will be useful for large-scale serological testing of genotype 1 HEV infections in humans.

A Bibliometric Analysis of 14,822 Researches on Myocardial Reperfusion Injury by Machine Learning

Myocardial ischemia is the major cause of death worldwide, and reperfusion is the standard intervention for myocardial ischemia. However, reperfusion may cause additional damage, known as myocardial reperfusion injury, for which there is still no effective therapy. This study aims to analyze the landscape of researches concerning myocardial reperfusion injury over the past three decades by machine learning. PubMed was searched for publications from 1990 to 2020 indexed under the Medical Subject Headings (MeSH) term “myocardial reperfusion injury” on 13 April 2021. MeSH analysis and Latent Dirichlet allocation (LDA) analyses were applied to reveal research hotspots. In total, 14,822 publications were collected and analyzed in this study. MeSH analyses revealed that time factors and apoptosis were the leading terms of the pathogenesis and treatment of myocardial reperfusion injury, respectively. In LDA analyses, research topics were classified into three clusters. Complex correlations were observed between topics of different clusters, and the prognosis is the most concerned field of the researchers. In conclusion, the number of publications on myocardial reperfusion injury increases during the past three decades, which mainly focused on prognosis, mechanism, and treatment. Prognosis is the most concerned field, whereas studies on mechanism and treatment are relatively lacking.

Trends in hepatitis A research indexed in the Web of Science: a bibliometric analysis over the period from 1985 to 2019

OBJECTIVE

A bibliometric analysis was conducted to build an all-inclusive view of the status of research on hepatitis A virus (HAV) for facilitating researchers, health professionals, and policymakers to understand the characteristics of research output in this particular domain.

METHODS

A comprehensive search was conducted in the Web of Science database. The obtained data were exported into Microsoft Excel 2019, OriginPro 2018 and VOSviewer software for windows.

RESULTS

From 1985 to 2019, a total of 5,950 studies on HAV were published, with an overall h-index of 105, and 90,350 total citations. The most cited article on HAV was "Classification of chronic viral hepatitis: a need for reassessment" authored by Scheuer in the Journal of Hepatology with a total of 1,121 citations. The most cited article on HAV vaccine was "A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children" by Werzberger et al. in the New England Journal of Medicine with 401 citations. The most frequent year of publication was 2019 (n = 250). The largest number of studies were funded by the United States Department of Health Human Services (n = 199). The organization with the highest number of publications was the United States Centers for Disease Control and Prevention (n = 228). The United State of America (n = 1,500) was the country with the most publications. 'Vaccine' was the leading journal with 299 publications.

CONCLUSIONS

The highest numbers of studies were published in developed countries. There is a clear need for interdisciplinary research approaches to evaluate and intervene in HAV endemic areas.

Research trends in rabies vaccine in the last three decades: a bibliometric analysis of global perspective

INTRODUCTION

Rabies is an infectious zoonotic viral disease which mainly occurs in Africa and Asia. Dogs are predominantly responsible for rabies transmission contributing up to 99% of all human rabies cases. Rabies is a vaccine preventable disease in both animals and humans.

OBJECTIVE

This study aimed to quantify and characterize the scientific literature and identify the top most cited studies in rabies vaccine research (RVR) from 1991 to 2020.

METHODS

The data used in this study were downloaded from Web of Science Core Collection (WoSCC), Science Citation Index-Expanded (SCI-E) database. Network visualization analysis was performed using VOSviewer software.

RESULTS

A total of 1,042 papers (article: n = 986, 94.6%, review: n = 56, 5.4%) were included in this study. These have been cited 17,390 times with an average citation per paper was 16.69 times. The most frequent publication year was 2019 (n = 75, 7.2%). More than 55% studies were published from the United State of America (USA) (n = 380, 36.5%), France (n = 128, 12.3%), and China (n = 97, 9.3%). The most studied Web of Science (WoS) category was immunology (n = 344, 33%). The most prolific author in RVR was Rupprecht CE (n = 55, 5.3%). 'Vaccine' was the leading journal (n = 218, 20.9%). Rabies was the most widely used keyword.

CONCLUSION

Abundant literature has been published on RVR in developed countries. This study might provide a reference to understand the current and future research trends in RVR. In developing countries research collaboration and co-operation among institutes and researchers needs to be strengthened with developed countries.

Bibliometric analysis of the top 100 most cited studies in apolipoprotein E (ApoE) research

The apolipoprotein E (ApoE) is a glycoprotein which plays a vital role in different inflammatory conditions and in the catabolism of lipids and triglycerides. The aim of this study was to identify and evaluate the top 100 most cited studies on ApoE research. A bibliometric study was conducted. On January 18, 2021, studies published on ApoE were searched in the Web of Science Core Collection database without any limitations. The obtained data were analyzed for a number of attributes using HistCiteTM and VOSviewer software. The search yielded a total of 16,242 results. Of the total retrieved results, the top 100 most cited studies were selected. The top 100 most cited studies on ApoE were published from 1977 to 2017 and were cited 86,181 times. Single study citations ranged from 426 to 6,327. The studies were published in 41 journals authored by 589 authors. The study "Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families" was cited 6,327 times. Mahley RW, Roses AD, and Saunders AM were the most prolific authors who published ten studies each. Most of the studies were published in Proceedings of the National Academy of Sciences of the United States of America. A total of 151 institutions were involved, and the USA was the most productive country. Our finding provides valuable insight on ApoE research which may be useful for researchers, academia, and funding agencies to identify new future research domains.

Towards the Improved Accuracy of Hepatitis E Diagnosis in Vulnerable and Target Groups: A Global Perspective on the Current State of Knowledge and the Implications for Practice

The hepatitis E virus (HEV) is a positive single-stranded, icosahedral, quasi-enveloped RNA virus in the genus Orthohepevirus of the family Hepeviridae. Orthohepevirus A is the most numerous species of the genus Orthohepevirus and consists of eight different HEV genotypes that can cause infection in humans. HEV is a pathogen transmitted via the fecal-oral route, most commonly by consuming fecally contaminated water. A particular danger is the HEV-1 genotype, which poses a very high risk of vertical transmission from the mother to the fetus. Several outbreaks caused by this genotype have been reported, resulting in many premature births, abortions, and also neonatal and maternal deaths. Genotype 3 is more prevalent in Europe; however, due to the openness of the market, i.e., trade-in animals which represent a natural reservoir of HEV (such as pigs), there is a possibility of spreading HEV infections outside endemic areas. This problem is indeed global and requires increased hygiene measures in endemic areas, which entails special care for pregnant women in both endemic and non-endemic regions. As already highlighted, pregnant women could have significant health consequences due to the untimely diagnosis of HEV infection; hence, this is a population that should be targeted with a specific combination of testing approaches to ensure optimal specificity and sensitivity. Until we advance from predominantly supportive treatment in pregnancy and appraise the safety and efficacy of a HEV vaccine in this population, such screening approaches represent the mainstay of our public health endeavors.

"Does Pakistan still have polio cases?": Exploring discussions on polio and polio vaccine in online news comments in Pakistan

INTRODUCTION

Polio, which is caused by poliovirus, is a contagious, potentially crippling, and deadly disease. Pakistan is one of the countries in which polio is still endemic in the 21st century. In 2019, 146 polio cases were reported across the country with some resulting in deaths. Following the spread of rumors insinuating that children were falling sick after receiving an anti-polio vaccine, a mob attacked and set fire to a small hospital in the Peshawar district in April 2019. The present study investigates readers' discussions that emerged from Dawn's online readers' comments on polio-related news stories in Pakistan.

METHODS

Using thematic analysis, we analyzed (N = 2216) comments made by readers in the polio-related news stories published on Dawn.com from January 1, 2012, to March 1, 2020.

RESULTS

Seven major themes emerged from the analysis of the comments: 1) reasons for and challenges resulting in the failure to eradicate polio; 2) proposed solutions and policy changes to eradicate polio; 3) misinformation; 4) criticism, frustration, and shame; 5) comparison of Pakistan to other countries; 6) the internet as a public sphere; 7) suffering, empathy, and appreciation. Overall, our findings suggested that commenters are knowledgeable about polio vaccines and consider polio a serious threat to public health in Pakistan.

CONCLUSION

Our study not only validated previous study findings such as reasons, challenges, and issues related to polio vaccination, but also found new challenges in online news sites concerning misinformation on polio and polio vaccination in Pakistan.

Sociocultural, behavioural and political factors shaping the COVID-19 pandemic: the need for a biocultural approach to understanding pandemics and (re)emerging pathogens

Although there has been increasing focus in recent years on interdisciplinary approaches to health and disease, and in particular the dimension of social inequalities in epidemics, infectious diseases have been much less focused on. This is especially true in the area of cultural dynamics and their effects on pathogen behaviours, although there is evidence to suggest that this relationship is central to shaping our interactions with infectious disease agents on a variety of levels. This paper makes a case for a biocultural approach to pandemics such as COVID-19. It then uses this biocultural framework to examine the anthropogenic dynamics that influenced and continue to shape the COVID-19 pandemic, both during its initial phase and during critical intersections of the pandemic. Through this understanding of biocultural interactions between people, animals and pathogens, a broader societal and political dimension is drawn as a function of population level and international cultures, to reflect on the culturally mediated differential burden of the pandemic. Ultimately, it is argued that a biocultural perspective on infectious disease pandemics will allow for critical reflection on how culture shapes our behaviours at all levels, and how the effects of these behaviours are ultimately foundational to pathogen ecology and evolution.