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Essler S, Christner N, Paulus M. Short-term and long-term effects of the COVID-19 pandemic on child psychological well-being: a four-wave longitudinal study. Eur Child Adolesc Psychiatry 2024; 33:909-922. [PMID: 37119393 PMCID: PMC10148581 DOI: 10.1007/s00787-023-02215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/15/2023] [Indexed: 05/01/2023]
Abstract
As the COVID-19 pandemic further unfolds, it becomes a key theoretical and practical question to identify trajectories of child psychological well-being and to explore risk and resilience factors for developmental adjustment. The current study addressed this research gap by means of an ecological design: A (lockdown)-B (relaxation)-B (relaxation)-A (lockdown). We collected parental reports via online questionnaires over four measurement occasions during the COVID-19 pandemic in Germany (non-probabilistic sample): from the first lockdown (T1-spring 2020, N = 1769) to the following period of relaxation (T2-summer 2020, n = 873; T3-fall 2020, n = 729) on to the second lockdown (T4-winter 2020/21, n = 748). Key measures at T1-T4 were child emotional and behavioral problems as well as hyperactivity, child emotional and family-related well-being, parental strain, and parent-child relationship quality. We found evidence for quadratic growth models. While child problem behaviors (b = 0.32, p < 0.001) and emotional well-being (b = - 0.33, p < 0.001) improved after the first lockdown during subsequent periods of relaxation before worsening again in the second lockdown, child family-related well-being steadily decreased over all four measurement points (T1-T2: p < 0.001; T2-T3: p = 0.045; T3-T4: p = 0.030). Importantly, parental stress emerged as a strong risk factor (ps < 0.11) and the parent-child relationship quality constituted a resilience factor (p = 0.049) for child psychological well-being. These findings have major implications for policies aiming to further child health during the COVID-19 pandemic.
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Affiliation(s)
- Samuel Essler
- Developmental Psychology, Ludwig-Maximilians-Universität München, Leopoldstr. 13, 80802, Munich, Germany.
- FOM University of Applied Sciences, Essen, Germany.
| | - Natalie Christner
- Developmental Psychology, Ludwig-Maximilians-Universität München, Leopoldstr. 13, 80802, Munich, Germany
| | - Markus Paulus
- Developmental Psychology, Ludwig-Maximilians-Universität München, Leopoldstr. 13, 80802, Munich, Germany
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Koehler A, Strauß B, Briken P, Fisch M, Riechardt S, Nieder TO. (De-)centralized health care delivery, surgical outcome, and psychosocial health of transgender and gender-diverse people undergoing vaginoplasty: results of a retrospective, single-center study. World J Urol 2023; 41:1775-1783. [PMID: 36961526 PMCID: PMC10352146 DOI: 10.1007/s00345-023-04348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/23/2023] [Indexed: 03/25/2023] Open
Abstract
PURPOSE Previous research on genital gender-affirming surgery lacked to build a framework that took various surrounding factors into account. E.g., transgender health care services are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different medical institutions spread over several locations). The present study investigated the effects of different structural and clinical aspects of gender-affirming genital surgery on psychosocial outcomes. METHODS We surveyed former transgender and gender-diverse people who completed a vaginoplasty between 2014 and 2018. 45 participants were included in the study. We calculated hierarchical linear regression analyses to assess the relationship between psychosocial outcome measures (gender congruence, mental health, quality of life) and different aspects of gender-affirming genital surgery (e.g., setting of service delivery). To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identify predictors that are actually related to the outcomes. RESULTS A non-responder analysis revealed no systematic bias in the recruitment procedure. Treatment satisfaction was a significant predictor for gender congruence. Moreover, we found the setting of service delivery (centralized, decentralized) to predict psychological health and the physical health dimension of quality of life. The effect sizes of our models were moderate to high, and models explained up to 26% of the total variance with a power up to 0.83. CONCLUSION The present study is an exploratory attempt into the manifold relationships between treatment-related factors (e.g., aesthetic outcome), the setting of service delivery, and their effects on gender-affirming genital surgery.
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Affiliation(s)
- Andreas Koehler
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine, Psychotherapy, and Psycho-Oncology, University Hospital Jena, Jena, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Riechardt
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Biedermann P, Klink P, Nocke MK, Papp CP, Harms D, Kebelmann M, Thürmer A, Choi M, Altmann B, Todt D, Hofmann J, Bock CT. Insertions and deletions in the hypervariable region of the hepatitis E virus genome in individuals with acute and chronic infection. Liver Int 2023; 43:794-804. [PMID: 36617681 DOI: 10.1111/liv.15517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/30/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Hepatitis E virus is a major cause of acute hepatitis worldwide and can progress to chronicity in immunocompromised individuals. Various virus-host recombination events have been reported in the hypervariable region of the hepatitis E virus genome, but the patterns of assembly and selection remain unclear. METHODS To gain further insight into viral evolution, we assessed the presence of low abundance variants in 16 samples from individuals with acute or chronic infection using a targeted next-generation sequencing approach. RESULTS In seven samples, different variants with insertions and/or deletions were identified. Among them, eight insertions originating either from human genes or from the hepatitis E virus genome. Five different deletions could be identified. The amino acid composition of sequences with insertions showed a higher frequency of lysine and a lower abundance of proline, and additionally acetylation and ubiquitination sites were more frequent than in hepatitis E virus wild-type sequences. CONCLUSIONS These findings suggest that the nucleotide composition of insertions and sites for post-translational modification may contribute to recombination events. Although the impact of low-level hepatitis E virus variants is uncertain, our results highlight the importance of a highly sensitive next-generation sequencing approach to capture the full diversity of hypervariable region.
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Affiliation(s)
- Paula Biedermann
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
- German Centre for Infection Research, Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Patrycja Klink
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Maximilian K Nocke
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Christian-Patrick Papp
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
- German Centre for Infection Research, Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Dominik Harms
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Marianne Kebelmann
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Andrea Thürmer
- Genome Sequencing, Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Mira Choi
- Department of Nephrology and Intensive Medical Care, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Britta Altmann
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Daniel Todt
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
- European Virus Bioinformatics Center (EVBC), Jena, Germany
| | - Jörg Hofmann
- German Centre for Infection Research, Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Labor Berlin, Charité-Vivantes GmbH, Berlin, Germany
| | - Claus-Thomas Bock
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
- Institute of Tropical Medicine, University of Tuebingen, Tuebingen, Germany
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Plank IS, Hindi Attar C, Kunas SL, Dziobek I, Bermpohl F. Motherhood and theory of mind: increased activation in the posterior cingulate cortex and insulae. Soc Cogn Affect Neurosci 2022; 17:470-481. [PMID: 34592763 PMCID: PMC9071419 DOI: 10.1093/scan/nsab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/24/2021] [Accepted: 09/30/2021] [Indexed: 01/27/2023] Open
Abstract
Despite growing evidence on effects of parenthood on social understanding, little is known about the influence of parenthood on theory of mind (ToM), the capacity to infer mental and affective states of others. It is also unclear whether any possible effects of parenthood on ToM would generalise to inferring states of adults or are specific to children. We investigated neural activation in mothers and women without children while they predicted action intentions from child and adult faces. Region-of-interest analyses showed stronger activation in mothers in the bilateral posterior cingulate cortex, precuneus (ToM-related areas) and insulae (emotion-related areas). Whole-brain analyses revealed that mothers compared to non-mothers more strongly activated areas including the left angular gyrus and the ventral prefrontal cortex but less strongly activated the right supramarginal gyrus and the dorsal prefrontal cortex. These differences were not specific to child stimuli but occurred in response to both adult and child stimuli and might indicate that mothers and non-mothers employ different strategies to infer action intentions from affective faces. Whether these general differences in affective ToM between mothers and non-mothers are due to biological or experience-related changes should be subject of further investigation.
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Affiliation(s)
- Irene Sophia Plank
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10099, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin 10099, Germany
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Stefanie Lydia Kunas
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Isabel Dziobek
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10099, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin 10099, Germany
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Felix Bermpohl
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin 10099, Germany
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
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Plank IS, Hindi Attar C, Kunas SL, Dziobek I, Bermpohl F. Increased activation in the bilateral anterior insulae in response to others in pain in mothers compared to non-mothers. Sci Rep 2021; 11:22757. [PMID: 34815443 PMCID: PMC8610985 DOI: 10.1038/s41598-021-02162-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/10/2021] [Indexed: 12/21/2022] Open
Abstract
Empathy allows us to share emotions and encourages us to help others. It is especially important in the context of parenting where children's wellbeing is dependent on their parents' understanding and fulfilment of their needs. To date, little is known about differences in empathy responses of parents and non-parents. Using stimuli depicting adults and children in pain, this study focuses on the interaction of motherhood and neural responses in areas associated with empathy. Mothers showed higher activation to both adults and children in pain in the bilateral anterior insulae, key regions of empathy for pain. Additionally, mothers more strongly activated the inferior frontal, superior temporal and the medial superior frontal gyrus. Differences between adult and child stimuli were only found in occipital areas in both mothers and non-mothers. Our results suggest a stronger neural response to others in pain in mothers than non-mothers regardless of whether the person is a child or an adult. This could indicate a possible influence of motherhood on overall neural responses to others in pain rather than motherhood specifically shaping child-related responses. Alternatively, stronger responses to others in pain could increase the likelihood for women to be in a relationship and subsequently to have a child.
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Affiliation(s)
- Irene Sophia Plank
- Department of Psychology, Institute of Life Sciences, Humboldt-Universität Zu Berlin, Berlin, Germany.
- Berlin School of Mind and Brain, Humboldt-Universität Zu Berlin, Berlin, Germany.
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
| | - Catherine Hindi Attar
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Stefanie L Kunas
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Isabel Dziobek
- Department of Psychology, Institute of Life Sciences, Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität Zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Berlin School of Mind and Brain, Humboldt-Universität Zu Berlin, Berlin, Germany
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
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Christner N, Essler S, Hazzam A, Paulus M. Children's psychological well-being and problem behavior during the COVID-19 pandemic: An online study during the lockdown period in Germany. PLoS One 2021; 16:e0253473. [PMID: 34161376 PMCID: PMC8221463 DOI: 10.1371/journal.pone.0253473] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/06/2021] [Indexed: 12/11/2022] Open
Abstract
As COVID-19 dramatically changes human social life, restrictive lockdown periods to slow the spread of the virus have been suggested to particularly affect the psychological well-being of children and their families. To capture lockdown-related effects on a large scale, the present study used an online questionnaire completed by parents of 3-10-year-olds during the most restrictive lockdown period in Germany thus far (N = 2,672). Parents reported their stress level, their child’s well-being, and their child’s problem behaviors among others. Results showed that most parents and children experienced lockdown-related stress. Concerning children, not being able to meet with friends and family members outside the household emerged as the primary challenge. Older children (7–10 years) evidenced more emotional symptoms as well as less conduct problems and hyperactivity than younger children (3–6 years). Children’s own and their parents’ stress level, the degree to which children missed other children, and children’s age all showed to be negatively related to children’s general life satisfaction. Single parenthood and being an only child were associated with higher levels of child problems. Taken together, these findings shed light on the psychological well-being of children and their families during governmental lockdown measures, as well as on relations between children’s coping and demographic background. They have implications for possible avenues for interventions, inter alia by encouraging policies that facilitate the maintenance of social relationships and focus particularly on children from single parent families, on only children as well as on families in challenging housing situations.
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Affiliation(s)
- Natalie Christner
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
- * E-mail:
| | - Samuel Essler
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Astrid Hazzam
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Markus Paulus
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
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Wang B, Akanbi OA, Harms D, Adesina O, Osundare FA, Naidoo D, Deveaux I, Ogundiran O, Ugochukwu U, Mba N, Ihekweazu C, Bock CT. A new hepatitis E virus genotype 2 strain identified from an outbreak in Nigeria, 2017. Virol J 2018; 15:163. [PMID: 30352598 PMCID: PMC6199738 DOI: 10.1186/s12985-018-1082-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/16/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In 2017 the Nigerian Ministry of Health notified the World Health Organization (WHO) of an outbreak of hepatitis E located in the north-east region of the country with 146 cases with 2 deaths. The analysis of the hepatitis E virus (HEV) genotypes responsible for the outbreak revealed the predominance of HEV genotypes 1 (HEV-1) and 2 (HEV-2). Molecular data of HEV-2 genomes are limited; therefore we characterized a HEV-2 strain of the outbreak in more detail. FINDING The full-length genome sequence of an HEV-2 strain (NG/17-0500) from the outbreak was amplified using newly designed consensus primers. Comparison with other HEV complete genome sequences, including the only HEV-2 strain (Mex-14) with available complete genome sequences and the availability of data of partial HEV-2 sequences from Sub-Saharan Africa, suggests that NG/17-0500 belongs to HEV subtype 2b (HEV-2b). CONCLUSIONS We identified a novel HEV-2b strain from Sub-Saharan Africa, which is the second complete HEV-2 sequence to date, whose natural history and epidemiology merit further investigation.
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Affiliation(s)
- Bo Wang
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
| | - Olusola Anuoluwapo Akanbi
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
| | - Dominik Harms
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
| | - Olufisayo Adesina
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
| | - Folakemi Abiodun Osundare
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
- Ladoke Akintola University of Technology, Ogbomoso, Oyo State P.M.B 4000 Nigeria
| | - Dhamari Naidoo
- Infectious Hazard Management Department, World Health Organization, Geneva, Switzerland
| | - Isabel Deveaux
- Nigeria Centre for Disease Control, Plot 801, Ebitu Ukiwe Street, Jabi, Abuja, Nigeria
| | - Opeayo Ogundiran
- Nigeria Centre for Disease Control, Plot 801, Ebitu Ukiwe Street, Jabi, Abuja, Nigeria
| | - Uzoma Ugochukwu
- Nigeria Centre for Disease Control, Plot 801, Ebitu Ukiwe Street, Jabi, Abuja, Nigeria
| | - Nwando Mba
- Nigeria Centre for Disease Control, Plot 801, Ebitu Ukiwe Street, Jabi, Abuja, Nigeria
| | - Chikwe Ihekweazu
- Nigeria Centre for Disease Control, Plot 801, Ebitu Ukiwe Street, Jabi, Abuja, Nigeria
| | - C.-Thomas Bock
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
- Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany
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