Abstract: Infections with H5N1, a type of pathogenic avian influenza (HPAI) virus, are spreading among livestock farmers, particularly among dairy cows in the United States. Until now, HPAI/H5N1 has rarely infected humans, but transmission from H5N1-infected dairy cows to dairy workers has been reported. Additionally, cases of human-to-human transmission of H5N1 have been reported. It is thought that perhaps, during the process of repeated amplification and replication of H5N1 viral genes in the mammary tissue of dairy cows, genetic mutations occurred that make H5N1 more susceptible to human infection. As more human spillover events are identified, there is pressing need to apply a one health approach to better characterize circulating highly pathogenic avian influenza (HPAI) viruses in wild migratory birds globally. It is important to develop a comprehensive international strategy for surveillance and monitoring systems in wild birds so the epidemiology of HPAI can be compared between countries and regions. In this review, we discusse the importance of One Health in preventing the spread of highly pathogenic avian influenza/H5N1.

Abstract:

Introduction: Accurate and comprehensible health information is essential for medical decision-making, yet AI-generated health content varies in readability and quality. In adolescent idiopathic scoliosis (AIS), where treatment decisions depend on complex factors, the reliance on AI-generated materials raises concerns about accuracy and accessibility. This study evaluates the readability and quality of AI-generated scoliosis education materials to assess their effectiveness in improving health literacy. Methods: Five AI models (ChatGPT-4o, ChatGPT-o1, ChatGPT-o3 mini-high, DeepSeek-V3, DeepSeek-R1) were tested on three scoliosis-related inquiries. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL) and Reading Ease Score (FRES), while content quality was evaluated using the DISCERN score. Statistical analyses were performed in R-Studio. Results: DeepSeek-R1 achieved the lowest FKGL (6.2) and the highest FRES (64.5), indicating superior readability. In contrast, ChatGPT-o1 and ChatGPT-o3 mini-high scored above FKGL 12.0, requiring college-level reading skills. Despite readability differences, DISCERN scores remained stable across models (~50.5), suggesting comparable content quality. However, all responses lacked citations, limiting reliability. Conclusion: AI-generated scoliosis education materials vary significantly in readability, with DeepSeek-R1 being the most accessible. Future AI models should enhance readability without compromising information accuracy and integrate real-time citation mechanisms for improved trustworthiness.

Abstract:

Background: Artificial intelligence (AI) is increasingly used in healthcare for patient education, clinical decision support, and medical information dissemination. ChatGPT-4o, an advanced large language model (LLM) with web search functionality, claims to improve response accuracy and relevance. However, its reliability and ability to provide comprehensive and evidence-based medical information remain uncertain. This study evaluates the quality, readability, and accuracy of ChatGPT-4o’s responses to common patient inquiries regarding ankle stabilization surgery. Methods: On January 30, 2025, ChatGPT-4o was prompted with frequently asked questions about ankle stabilization surgery. The web search function was enabled to enhance response accuracy. Three independent reviewers assessed the AI-generated responses using the DISCERN tool for quality and the Flesch-Kincaid metrics for readability. Inter-rater reliability was calculated to determine rating consistency. Results: The readability analysis revealed that ChatGPT-4o’s responses were highly complex (Flesch-Kincaid Reading Ease Score = 23.07, Grade Level = 13.9), requiring a college-level education for comprehension. DISCERN scores ranged from 47 to 58, indicating moderate quality. The inter-rater reliability score of 0.73 demonstrated substantial agreement. Limitations included overly optimistic recovery timelines, lack of authoritative citations, and insufficient discussion of surgical risks. Conclusion: ChatGPT-4o provides structured and accessible medical information but exhibits limitations in accuracy, transparency, and risk disclosure. Future improvements should focus on enhancing source reliability, readability, and personalization to improve AI-assisted patient education.

Abstract:

Obesity has emerged as a global health crisis, with its pathogenesis being closely linked to metabolic dysregulation in brown adipose tissue (BAT). However, the underlying mechanisms by which high-fat diets and environmental endocrine disruptors, such as bisphenol A (BPA), affect BAT remain largely unknown. This study was conducted to investigate how combined exposure to BPA and a high-fat diet influences BAT function and the development of obesity via the VEGF/VEGFR2/PI3K/AKT pathway.Male C57BL/6J mice were randomly assigned to four groups and received different treatments for 90 days: a normal chow diet (NCD), a normal chow diet supplemented with BPA (NCD + BPA), a high-fat diet (HFD), or a high-fat diet supplemented with BPA (HFD + BPA). Additionally, cell experiments were carried out using C3H10T1/2 cells induced to differentiate into brown adipocytes. These cells were exposed to different combinations of BPA and palmitic acid (PA).To comprehensively assess the effects on mice and cells, a variety of assays were employed, including cell viability assays, hematoxylin and eosin (H&E) staining, enzyme-linked immunosorbent assay (ELISA), immunohistochemistry, immunofluorescence, Western blotting, and mitochondrial electron microscopy.The combined treatment of BPA and HFD (PA) successfully established an animal obesity model and a cellular triglyceride (TG) accumulation model. BPA and HFD exposure affected serum lipid levels and the expression of inflammatory factors in animals. It also inhibited brown adipose tissue thermogenesis and the expression of VEGF pathway proteins, leading to a reduction in capillaries and mitochondrial damage. Similarly, the combined treatment of BPA and PA influenced the expression of inflammatory factors in mature brown adipose cells and inhibited the expression of related proteins.Overall, combined exposure to BPA and a high-fat diet impairs BAT function through multiple mechanisms, including inflammation, thermogenic dysfunction, microvascular damage, mitochondrial injury, and alteration of the VEGF/VEGFR2/PI3K/AKT pathway. These findings suggest that such combined exposure ultimately promotes the development of obesity.

Abstract:

Background: Systemic racism in Canadian healthcare is deep-rooted, generating inequities in workforce diversity and patient care. Black, racialized, and Indigenous communities encounter heightened barriers to accessing medical care and career advancement due to institutionally rooted biases

. Despite Canada’s single-payer, universally accessible care, studies have documented widespread inequities in access, care, and health outcomes. The exclusion of foreign-trained healthcare professionals who benefited from the Canadian Immigration Point-Based Comprehensive Ranking System (CRS) from the labor force further entrenches inequities, mirroring systemic biases [14]. Addressing these issues is crucial for ensuring equitable healthcare delivery. Objective: This narrative review critically assesses systemic racism in Canadian healthcare, with consideration for racial inequality in patient care, career barriers for racialized healthcare professionals, and institution policies with a discriminatory intention. It identifies the structural barriers that preserve inequity and proposes policy-guided recommendations for systemic reform. Methods: This narrative review synthesizes empirical research, government reports, and case studies to examine systemic racism in Canadian healthcare. Sources were selected based on relevance, credibility, and publication within the last 15 years. Inclusion criteria focused on studies examining racial disparities in healthcare access, professional barriers, and policy interventions. Case studies were chosen based on their legal and policy significance, particularly those highlighting systemic failures leading to patient harm. Thematic analysis was used to categorize key issues, ensuring a comprehensive policy-driven discussion. Results: The review identifies three primary systemic barriers: 1. Racial biases in patient care lead to delayed treatment, misdiagnoses, and higher mortality rates among Black and Indigenous patients. 2. Institutional racism in healthcare workforce structures restricts opportunities for racialized healthcare professionals, limiting diversity in medical leadership. 3. Credentialing barriers disproportionately affect internationally trained physicians (ITPs), preventing them from contributing to Canada’s overburdened healthcare system. Case studies highlight the severe consequences of healthcare discrimination. Brian Sinclair, an Indigenous man, died after being ignored for 34 hours in a Winnipeg ER. Joyce Echaquan, an Atikamekw woman, live-streamed racist abuse from nurses before her death. These cases underscore the urgent need for systemic policy reforms to prevent further medical neglect. Conclusion: Several evidence-based policy interventions are necessary to dismantle racism in Canadian healthcare. Some of these interventions include mandatory anti-racism and cultural competency training for Healthcare professionals, the collection of race-based health data to track disparities and inform policies, and fair credentialing processes for international medical school graduates to address workforce shortages. Independent accountability and review processes must also be established to prevent medical abuse. By taking such actions, a fairer, accessible, and effective system will ensure that racialized communities receive the care they deserve.

[M1]References should be numbered in order of appearance. Please rearrange all the references to appear in numerical order.

Abstract:

Background: Pediatric diaphyseal forearm fractures, often caused by sports or leisure activities, require treatment based on fracture stability. While stable fractures can be managed conservatively, unstable fractures typically require surgery, with elastic stable intramedullary (IM) nailing (ESIN) being the gold standard. Bioabsorbable IM nails (BINs) offer an alternative by eliminating the need for implant removal surgery. Methods: Between May 2023 and January 2025 we consecutively managed 161 children with poly-L-lactic-co-glycolic acid (PLGA) BINs in two healthcare centers for diaphyseal forearm fracture and evaluated every reported difficulty and complication of resorbable IM nails. Results: Seven unique peri- or postoperative events occurred during the study period . Even with high success rate, some complications occurred during the study period. The difficulties and complications are independent of the implant, but to the surgical tehnique. Iatrogenic complications such as bone cortex perforation and implant end split were evaluated, along with anatomical variations like focal and general medullary cavity stenosis narrowings that affected implant insertion. Secondary malalignment and one early (2 months) refracture and one recurrant fracture (2 years) were also noted. Conclusion: Although BINs reduce the need for a second surgery, careful planning, technique, and follow-up are crucial for optimal outcomes. Further research is needed to assess long-term results and complications.

Abstract: Background: The diagnostic approach to prostate cancer (PCa) has evolved from sys-tematic biopsies to imaging-guided strategies that improve detection of clinically sig-nificant PCa (csPCa) while reducing overdiagnosis. Multiparametric MRI (mpMRI) has emerged as the gold standard for pre-biopsy evaluation, while micro-ultrasound (Mi-croUS) offers a promising alternative with real-time imaging capabilities. Objective: This review summarizes the evidence supporting mpMRI and MicroUS for PCa diagnosis, highlighting their respective advantages, limitations, and roles in optimizing diagnostic pathways. Methods: We examined the principles, image interpretation frameworks (PI-RADS and PRI-MUS), and clinical applications of mpMRI and MicroUS, comparing their diagnostic accuracy in biopsy-naïve patients, repeat biopsy scenarios, active sur-veillance, and staging. Results: mpMRI improves csPCa detection, reduces unnecessary biopsies, and enhances risk stratification. Landmark studies such as PRECISION and PRIME confirm its superiority over systematic biopsy. However, mpMRI remains re-source-intensive, with limitations in accessibility and interpretation variability. Con-versely, MicroUS, with its high-resolution real-time imaging, shows non-inferiority to mpMRI and potential advantages in MRI-ineligible patients. It improves lesion visual-ization and biopsy targeting, with ongoing trials such as OPTIMUM evaluating its standalone efficacy. Conclusions: mpMRI and MicroUS are complementary modalities in PCa diagnosis. While mpMRI remains the preferred imaging standard, MicroUS offers an alternative, particularly in patients with MRI contraindications. Combining these tech-niques could enhance diagnostic accuracy, reduce unnecessary interventions, and refine active surveillance strategies. Future research should focus on integrating both modalities into standardized diagnostic pathways for a more individualized approach.

Abstract: With the successful deployment of several mRNA vaccines against SARS-CoV2, an mRNA vaccine against RSV (respiratory syncytial virus) and a large pipeline of mRNA products against other infectious diseases, cancers and rare diseases, it is important to examine the whole product lifecycle. mRNA technology enables product design, testing and manufacturing systems to be rapidly developed, but these advantages can be lost if other factors that determine public access are not closely considered. This review analyzes key aspects of the mRNA product lifecycle including candidate design, manufacturing, quality systems and product safety and storage. Regulatory thinking is well advanced in some countries but not others, but more thought on regulation of mRNA vaccines outside of a pandemic situation as well as mRNA therapeutics including individual neoantigen therapies and rare disease treatments is needed. Consumer acceptance - the “social license to operate” around mRNA products - is critical for their uptake, particularly outside of a pandemic.

Abstract: Background: The global ageing population presents significant challenges for healthcare and social systems, with the number of individuals aged 60 and above projected to exceed 2 billion by 2050. In Singapore, where seniors constitute 12% of the population, nursing homes play a critical role in providing care. However, residents often lead sedentary lifestyles, increasing their risk of physical and cognitive decline. Recreational interventions, such as game rooms, offer opportunities for social interaction, emotional well-being, and cognitive stimulation. This study explores the influence of a game room on nursing home residents’ social interactions, emotional well-being, and quality of life, addressing gaps in understanding how such spaces can enhance residents’ daily experiences. Methods: This study was undertaken via a qualitative, phenomenological approach. Data was collected through face-to-face semi structured interviews and observations with field notes. Interviews were transcribed verbatim and thematically analysed. Baseline interviews were conducted prior to the initiation of the game room. After baseline data was collected, the game room was set up and introduced to the nursing home environment. Follow-up interviews were conducted three months after the initiation of the game room. Results: Findings revealed significant improvements in residents’ social connections, emotional states, and overall satisfaction. Residents reported forming new friendships, experiencing joy and purpose, and feeling more engaged in daily life. Observations corroborated these accounts, showing increased participation, positive interactions, and enthusiasm for game room activities. Conclusion: The game room emerged as a valuable intervention, enhancing residents’ well-being and fostering a sense of community. These results highlight the importance of recreational spaces in nursing homes and their potential to improve residents’ quality of life.

Abstract: Background and Objectives: Anastomotic leakage (AL) is a major complication of colorectal surgery (CRS), increasing morbidity, mortality, and healthcare costs. While several AL risk factors have been identified, the role of aortic calcification (AC) remains unclear. As a marker of systemic atherosclerosis, AC may impair tissue perfusion and anastomotic healing. Additionally, tumor factors (TNM stage, histology, localization) and patient comorbidities (hypertension, cardiovascular disease, neoadjuvant therapy) may contribute to AL risk. This study evaluates the association between preoperative AC and AL incidence while considering additional risk factors. Materials and Methods: This retrospective cohort study included 151 patients undergoing CRS from January 2020 to October 2023. Preoperative CT scans classified AC into Stage 0 (none), Stage 1 (< 50%), and Stage 2 (>50%) of the aortic circumference. Data on demographics, tumor characteristics, neoadjuvant therapy, and comorbidities were collected. AL risk factors were analyzed using univariate and multivariate logistic regression. Results: AL occurred in 5.96% (9/151) of patients. AL incidence was significantly higher in patients with >50% AC (44.47% vs. 11.27%, p=0.012). Multivariate analysis confirmed AC as an independent AL predictor (OR = 10.38, 95% CI: 1.243–92.118, p=0.032). Rectal tumor localization (p=0.038), hypertension (p=0.027), cardiovascular disease (p=0.014), and neoadjuvant therapy (p=0.045) were also associated with increased AL risk. Conclusions: Severe AC is an independent predictor of AL in CRS. Additionally, rectal tumors, hypertension, cardiovascular disease, and neoadjuvant therapy contribute to AL risk. Preoperative vascular assessments and comprehensive risk stratification models may help identify high-risk patients and guide perioperative management strategies to reduce AL incidence.

Abstract:

Interpersonal violence involves intentional physical harm with psychological effects, influenced by interper-sonal and societal factors. Health systems play a vital role in detecting and addressing such violence, requir-ing improved training and surveillance. Our hospital established a registry for suspected violence cases re-ported by healthcare professionals to enhance understanding, prevention strategies, and recognition of vio-lence types and risk factors. Since 2009, all admitted patients suspected of experiencing violence were in-cluded, regardless of age or gender. Data from 2009 to 2022 covered demographics, violence details, medical interventions, and legal actions. Among 1,284 patients, 83.4% were seen in the emergency department, with women comprising 80.8% and a mean age of 33.19 years. Reports of violence rose from 1.9% in 2009 to 16.9% in 2022. Risk factors included pregnancy [5.6%], age below 18 or over 80 [18.9%], disability [10.2%], and psy-chiatric conditions [11.3%]. Perpetrators were known in 56.8% of cases, mainly intimate partners [25.2%], with 29.4% of victims living with the aggressor. Doctors were primary reporters, and injury reports were is-sued in 65.5% of cases. Violence types included physical [44.5%], sexual [22.4%], psychological [13.3%], and economic [12.5%], with 36.3% involving multiple types. Routine hospital screening and trained staff can im-prove victim support and enable injury prevention programs.

Abstract:

Objectives: To investigate a non-linear relationship between serum vitamin D level and uric acid concentration and to evaluate the potential of vitamin D as a biomarker for inflammatory diseases such as hyperuricemia. Methods: Using data from the Korea National Health and Nutrition Examination Survey (KNHANES), an analysis was conducted on 10,864 adults aged 19 years or more. Serum vitamin D levels were categorized into quartiles (Q1–Q4) for analysis. Their linear and non-linear relationships with uric acid concentrations were assessed using Pearson correlation analysis, analysis of variance (ANOVA), and restricted cubic spline regression. Confounding variables including age, sex, BMI, kidney function, chronic diseases, and macronutrient intake were adjusted for in the analysis. Results: In univariate analysis, a statistically significant but weak negative correlation was observed between serum vitamin D and uric acid levels (Pearson’s correlation coefficient: -0.089, < 0.001). However, after adjusting for confounders, multivariate regression revealed a weak positive association. Restricted cubic spline regression identified significant positive associations in lower quartiles (Q1–Q3), with the strongest effect observed in Q3 (beta-coefficient: 0.643, 95% CI: 0.09–1.20, p = 0.023). No significant association was found in the highest quartile (Q4). Conclusions: Vitamin D and uric acid metabolism have a non-linear relationship, particularly showing a positive association in vitamin D insufficiency (< 30 ng/mL). These findings support the potential of vitamin D as a biomarker for hyperuricemia and related inflammatory-metabolic diseases.

Abstract: Background/Objectives: Although burnout among physicians is a serious and growing problem in healthcare, research on this issue in Ecuador is scarce and suffers from methodological limita-tions. This study examined the prevalence of burnout among Ecuadorian medical professionals at the national level, as well as its correlates and consequences on their mental health. Methods: A cross-sectional study was conducted with a sample of 1,976 physicians (51.8% women, mean age 37.1 years) from all provincial capitals of Ecuador. The presence of burnout was assessed, as well as sociodemographic, organizational, and psychological variables (including psychological in-flexibility, perceived loneliness, and symptoms of depression, anxiety, and stress). Results: Notably, 9.0% of physicians exhibited burnout syndrome. Working in shifts for more than eight hours a day, having work-family conflict, psychological inflexibility, and perceived loneliness were associated with an increased risk of suffering burnout. Meanwhile, being a woman was associated with a decrease in risk. The presence of burnout significantly increased the risk of experiencing depressive and stress symptoms. Conclusions: Clearly, a significant number of medical professionals suffer from burnout. As such, stakeholders should promote the develop-ment of prevention programs that incorporate the insights from this and other studies to design effective psychological interventions for burnout adapted to the specific needs of this population.

Abstract:

Background/Objectives: Males exhibit higher health-related risk behaviours compared to females. This study aimed to determine the anthropometric status of adult males and associations of the anthropometric indicators with demographic and socioeconomic factors, with the goal of guiding healthy anthropometric status and nutrition interventions. Methods: A cross-sectional study was conducted on 453 Vietnamese males aged ≥18 years. Weight, height and waist circumference measurements were collected and BMI, A Body Shape Index (ABSI), Body Roundness Index (BRI) and Waist to Height Ratio (WtHR) were calculated. Demographic and socioeconomic data included age, ethnicity, marital status, education level, employment status, monthly household income, monthly personal income, monthly household food expenditure, and the total number of household possessions. Results: Education level showed a significant association with BMI (negative association), while age (positive association) and monthly household income (negative association) were significantly associated with WtHR. Employment was significantly associated with ABSI. Education level was significantly associated with BRI. Conclusions: The findings highlight the complex relationship between anthropometric measurements reflecting nutritional status and demographic and socioeconomic factors, underscoring the importance of considering these variables in public health strategies aimed at reducing poor health and improving nutritional status in males in Vietnam.

Abstract: Objective euDKA is a fatal complication of diabetes, but its symptoms overlap with common symptoms after cardiac surgery and are not easily detected. euDKA associated with SGLT2i was reported, highlighting the importance of recognizing novel hypoglycemic agents for this condition in different populations. Methods We describe the management of a 58-year-old diabetic man who developed severe nonhyperglycemic ketoacidosis after cardiac surgery. A detailed clinical care assessment and management was performed, including dietary history, physical examination, laboratory evaluation of blood ketone bodies, and results of blood gas analysis for metabolic analysis. Results The results showed that the blood ketone body was elevated, accompanied by severe metabolic acidosis and clinical symptoms of polydipsia, polyphagia and polyuria. After massive fluid replacement, small dose insulin treatment, and adjustment of diet structure, the patient's clinical symptoms disappeared, and the blood ketone body laboratory results returned to normal. Conclusions This case highlights the association between non-hyperglycemic diabetic ketoacidosis and sodium-glucose cotransporter 2 inhibitors, and emphasizes the importance of thorough medication history and blood test results for accurate diagnosis. As de novo diabetes agents become more popular worldwide, increased awareness of nonhyperglycemic diabetic ketoacidosis is critical to ensure prompt diagnosis and effective management.

Abstract: Peripherally inserted central catheters (PICCs) play a crucial role in providing long-term intravenous therapy for patients requiring extended vascular access. With multiple PICC types available, understanding their cost-effectiveness is essential for healthcare decisions that balance clinical benefits with economic considerations. This study assesses the economic and clinical outcomes of chlorhexidine-coated PICCs (Type A) versus standard PICCs (Type B), aiming to guide best practices in vascular access by addressing the gap in comprehensive cost-effectiveness comparisons. Using a decision-analytic model, costs and quality-adjusted life years (QALYs) between the two types were compared. Primary data from five Chinese university-affiliated medical centers were gathered from 2020 to 2023, with a Delphi panel validating the model inputs. The analysis revealed that while Type A PICCs offer lower initial placement costs, they incur higher complication rates compared to Type B PICCs, which influences long-term cost-effectiveness. After adjusting for complication rates and QALYs, Type B PICCs emerged as more cost-effective over a one-year period, with an incremental cost-effectiveness ratio (ICER) of ¥-40,043.78 ($5,905.90, average exchange rate ¥678.03=$100) per QALY gained. Although Type B PICCs have higher initial costs, their lower complication rates make them a more valuable option for long-term vascular access, offering better overall cost-efficiency.

Abstract: Background: Pediatric olecranon fractures, which involve a break in the bony prominence of the elbow, are relatively rare but can be serious. Treatment options typically depend on the type and severity of the fracture. Displaced, intraarticular fractures require surgical intervention, where resorbable implants are becoming a promising alternative to traditional metal hardware. Methods: Our prospective, single-center, single-arm case series evaluates three pediatric olecranon fracture patients treated by resorbable poly-L-lactic-co-glycolic acid (PLGA) pins and polydioxanone (PDS) loops between Jan 2022 and January 2023 at the Department of Pediatrics, University of Pécs, Clinical Complex. Results: All patients achieved complete radiological healing with excellent functional recovery and no implant-related complications at one-year follow-up. Conclusion: Resorbable PLGA pins and PDS loops provide a promising alternative to conventional metallic fixation in pediatric olecranon fractures, abolishing the need for a second implant removal surgery while maintaining stability and biocompatibility. Our findings support the child-friendly nature and growing role of biodegradable materials in pediatric fracture management.

Abstract: Dietary habits significantly influence students' health status, with overweight and obesity posing serious global challenges linked to chronic diseases like type 2 diabetes and cardiovascular conditions. Our cross-sectional study assessed overweight and obesity prevalence among students in Guarda, Portugal, analysing the nutritional and lifestyle habits of 2,083 students aged 6 to 58 years. The sample included 1,762 school children and 321 higher education adults, grouped into age intervals: 6–12, 12–19, 20–39, and 40–58 years. BMI analysis revealed obesity rates of 9.1% in children and 9.7% in adults, with younger children, particularly males, showing higher rates compared to older children. Increased physical activity and reduced sedentary time were correlated with a lower BMI. These findings underscore the critical need for public health interventions in schools to promote healthy diets and active lifestyles, aiming to reduce obesity rates and associated health risks.

Abstract: This study presents the development of a fine-grained COVID-19 agent-based model (Agent-based Model (ABM)) specifically designed for Malta, leveraging a synthetic population that captures the country’s demographic and tourism characteristics. The research is structured into three phases. In Phase 1, the SynthPops framework is extended to generate a statistically accurate synthetic population, enriched with additional attributes such as employment, education, BMI, and long-term illnesses. A detailed tourism model is also integrated to reflect Malta’s unique visitor dynamics. Phase 2 focuses on implementing the Agent-based Model (ABM), which incorporates detailed daily itineraries, a contact network, and virus transmission dynamics. Transmission is influenced by factors such as individual sociability, contact duration, and public health interventions. The model is used to simulate multiple intervention scenarios, producing epidemiological outcomes that align closely with the input parameters and provide actionable insights. In Phase 3, the study evaluates four computational strategies to optimise execution time and scalability: single-node multiprocessing and three distributed approaches using Dask Distributed. Among these, the actor-based strategy demonstrates the best performance, achieving up to a 13-fold speed-up in specific tasks and scaling effectively with population size. Testing on a high-performance machine reveals that the model performs well for Malta’s population size, with distributed setups showing potential for larger populations. This research provides a robust and scalable framework for simulating COVID- 19 dynamics in islands such as Malta, offering valuable insights for public health decision-making and highlighting computational strategies for efficient large-scale simulations.

Abstract: In December 2021, an outbreak of the SARS-CoV-2 B.1.640.2 variant, potentially originating from Cameroon, was investigated among schoolchildren in Germany. The index case, an adult who had recently returned from a three-week stay in the Republic of Congo, introduced the variant into a school setting via their children, resulting in subsequent transmission within the school and ultimately to a hospital ward. Whole-genome sequencing of viral samples identified both B.1.640.1 and B.1.640.2 lineages. This outbreak highlights the unpredictable nature of emerging SARS-CoV-2 variants and emphasizes the importance of early detection and containment to mitigate transmission to high-risk populations. Notably, wastewater surveillance detected the variant during the study peri-od, reinforcing the utility of wastewater-based epidemiology as a complementary tool for early warning and containment of novel variants. These findings underline the critical need for timely research and adherence to quarantine measures to enhance outbreak control efforts.