Rebound of pediatric invasive pneumococcal disease in Portugal after the COVID-19 pandemic was not associated with significant serotype changes
The COVID-19 pandemic led to the institution of public health measures in many countries which reduced respiratory infections. We aimed to identify and characterize changes in pediatric (
Gespeichert in:
| Veröffentlicht in: | The Journal of infection 2024-10, Vol.89 (4), p.106242, Article 106242 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | 4 |
| container_start_page | 106242 |
| container_title | The Journal of infection |
| container_volume | 89 |
| creator | Silva-Costa, Catarina Gomes-Silva, Joana Pinho, Marcos Friães, Ana Subtil-Limpo, Fábio Ramirez, Mário Melo-Cristino, José |
| description | The COVID-19 pandemic led to the institution of public health measures in many countries which reduced respiratory infections. We aimed to identify and characterize changes in pediatric ( |
| doi_str_mv | 10.1016/j.jinf.2024.106242 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3090945385</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0163445324001762</els_id><sourcerecordid>3090945385</sourcerecordid><originalsourceid>FETCH-LOGICAL-c237t-75375ab7d40312f2e484aee2714eba27191bb5f273f494f864b1ed9063b63cda3</originalsourceid><addsrcrecordid>eNp9kc9uEzEQhy0EomnLC3BAPnLZ4H-7G0tcUAq0UqUiBL1aXnucOMrai-1N1afglXGU0mNPI81885NmPoTeU7KkhHafdsudD27JCBO10THBXqEFbTlrWC_Ya7SoEG-EaPkZOs95RwiRXHZv0RmXlHZSyAX6-xOGOAeLo8MTWK9L8gb7cNDZHwBPAeYxmmiM3mPrM-gMdYp_xFTmTe1pVyDhsgW8vru_uWqoxJMOFsaa8qAzDrFgnXM0NRksfvBli7PfBO-80aHgDCmWxwmw2eqwgXyJ3ji9z_DuqV6g39--_lpfN7d332_WX24bw3hfmr7lfauH3grCKXMMxEpoANZTAYOuRdJhaB3ruRNSuFUnBgpWko4PHTdW8wv08ZQ7pfhnhlzU6LOB_V4HiHNWnEgi6-dWbUXZCTUp5pzAqSn5UadHRYk6ilA7dRShjiLUSURd-vCUPw8j2OeV_5-vwOcTAPXKg4eksvEQTHWQwBRlo38p_x8Cv5tp</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3090945385</pqid></control><display><type>article</type><title>Rebound of pediatric invasive pneumococcal disease in Portugal after the COVID-19 pandemic was not associated with significant serotype changes</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Silva-Costa, Catarina ; Gomes-Silva, Joana ; Pinho, Marcos ; Friães, Ana ; Subtil-Limpo, Fábio ; Ramirez, Mário ; Melo-Cristino, José</creator><creatorcontrib>Silva-Costa, Catarina ; Gomes-Silva, Joana ; Pinho, Marcos ; Friães, Ana ; Subtil-Limpo, Fábio ; Ramirez, Mário ; Melo-Cristino, José ; on behalf of the Portuguese Group for the Study of Streptococcal Infections and the Portuguese Study Group of Invasive Pneumococcal Disease of the Pediatric Infectious Disease Society ; Portuguese Group for the Study of Streptococcal Infections and the Portuguese Study Group of Invasive Pneumococcal Disease of the Pediatric Infectious Disease Society</creatorcontrib><description>The COVID-19 pandemic led to the institution of public health measures in many countries which reduced respiratory infections. We aimed to identify and characterize changes in pediatric (<18 years) invasive pneumococcal disease (pIPD) in Portugal in 2018–2023.
pIPD cases were identified by culture and molecular methods and stratified by age and serotype. When available the susceptibility of the isolates to antimicrobials was evaluated.
pIPD cases were markedly reduced in the last trimester of 2019–2020 and the entire 2020–2021 season. While 2021–2022 was in line with pre-pandemic seasons, in 2022–2023, the number of pIPD cases exceeded those found pre-pandemic. Molecular tests were responsible for identifying and serotyping 30% of cases, highlighting their importance in evaluating pIPD. Among the 316 pIPD cases, 37 different serotypes were detected, of which serotypes 3 (n = 85, 26.9%), 8 (n = 25, 7.9%), 10A (n = 21, 6.6%) and 24F (n = 20, 6.3%) were the most frequent. The post-pandemic serotype distribution reflected mostly pre-pandemic trends and the rebound was not driven by particular serotypes. We identified many vaccine failures, most (n = 37) representing serotype 3 infections. Penicillin non-susceptibility increased from 14% pre-pandemic to 29%, with serotype 24F becoming particularly significant.
The higher number of cases of pIPD post-COVID-19 in Portugal raises the possibility of a higher burden of pneumococcal disease in Europe post-pandemic. The relatively stable serotype distribution and the current availability of the higher valency conjugate vaccines PCV15 and PCV20, potentially preventing a large proportion of pIPD (43% and 67%, respectively), offer an opportunity to control this increase.
•Pediatric pneumococcal invasive disease decreased during the COVID-19 pandemic.•Rebound exceeded pre-pandemic levels with serotypes reflecting pre-pandemic trends.•Molecular methods are essential to detect an important fraction of invasive disease.•Vaccine failures or breakthrough cases occurred mostly with serotype 3.•Non-vaccine types are important contributors to antimicrobial resistance.</description><identifier>ISSN: 0163-4453</identifier><identifier>ISSN: 1532-2742</identifier><identifier>EISSN: 1532-2742</identifier><identifier>DOI: 10.1016/j.jinf.2024.106242</identifier><identifier>PMID: 39116949</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adolescent ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Child ; Child, Preschool ; COVID-19 - epidemiology ; Epidemiology ; Female ; Humans ; Infant ; Infant, Newborn ; Invasive disease ; Male ; Molecular diagnostics ; Pandemics ; Pediatric infectious disease ; Pneumococcal Infections - epidemiology ; Pneumococcal Infections - microbiology ; Pneumococcal Vaccines - administration & dosage ; Portugal - epidemiology ; SARS-CoV-2 ; Serogroup ; Serotypes ; Serotyping ; Streptococcus pneumoniae ; Streptococcus pneumoniae - classification ; Streptococcus pneumoniae - drug effects ; Streptococcus pneumoniae - isolation & purification ; Vaccines</subject><ispartof>The Journal of infection, 2024-10, Vol.89 (4), p.106242, Article 106242</ispartof><rights>2024 The Author(s)</rights><rights>Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c237t-75375ab7d40312f2e484aee2714eba27191bb5f273f494f864b1ed9063b63cda3</cites><orcidid>0000-0002-4298-0014 ; 0000-0003-3658-1102 ; 0000-0001-9681-0574 ; 0000-0002-7567-2405</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jinf.2024.106242$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39116949$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Silva-Costa, Catarina</creatorcontrib><creatorcontrib>Gomes-Silva, Joana</creatorcontrib><creatorcontrib>Pinho, Marcos</creatorcontrib><creatorcontrib>Friães, Ana</creatorcontrib><creatorcontrib>Subtil-Limpo, Fábio</creatorcontrib><creatorcontrib>Ramirez, Mário</creatorcontrib><creatorcontrib>Melo-Cristino, José</creatorcontrib><creatorcontrib>on behalf of the Portuguese Group for the Study of Streptococcal Infections and the Portuguese Study Group of Invasive Pneumococcal Disease of the Pediatric Infectious Disease Society</creatorcontrib><creatorcontrib>Portuguese Group for the Study of Streptococcal Infections and the Portuguese Study Group of Invasive Pneumococcal Disease of the Pediatric Infectious Disease Society</creatorcontrib><title>Rebound of pediatric invasive pneumococcal disease in Portugal after the COVID-19 pandemic was not associated with significant serotype changes</title><title>The Journal of infection</title><addtitle>J Infect</addtitle><description>The COVID-19 pandemic led to the institution of public health measures in many countries which reduced respiratory infections. We aimed to identify and characterize changes in pediatric (<18 years) invasive pneumococcal disease (pIPD) in Portugal in 2018–2023.
pIPD cases were identified by culture and molecular methods and stratified by age and serotype. When available the susceptibility of the isolates to antimicrobials was evaluated.
pIPD cases were markedly reduced in the last trimester of 2019–2020 and the entire 2020–2021 season. While 2021–2022 was in line with pre-pandemic seasons, in 2022–2023, the number of pIPD cases exceeded those found pre-pandemic. Molecular tests were responsible for identifying and serotyping 30% of cases, highlighting their importance in evaluating pIPD. Among the 316 pIPD cases, 37 different serotypes were detected, of which serotypes 3 (n = 85, 26.9%), 8 (n = 25, 7.9%), 10A (n = 21, 6.6%) and 24F (n = 20, 6.3%) were the most frequent. The post-pandemic serotype distribution reflected mostly pre-pandemic trends and the rebound was not driven by particular serotypes. We identified many vaccine failures, most (n = 37) representing serotype 3 infections. Penicillin non-susceptibility increased from 14% pre-pandemic to 29%, with serotype 24F becoming particularly significant.
The higher number of cases of pIPD post-COVID-19 in Portugal raises the possibility of a higher burden of pneumococcal disease in Europe post-pandemic. The relatively stable serotype distribution and the current availability of the higher valency conjugate vaccines PCV15 and PCV20, potentially preventing a large proportion of pIPD (43% and 67%, respectively), offer an opportunity to control this increase.
•Pediatric pneumococcal invasive disease decreased during the COVID-19 pandemic.•Rebound exceeded pre-pandemic levels with serotypes reflecting pre-pandemic trends.•Molecular methods are essential to detect an important fraction of invasive disease.•Vaccine failures or breakthrough cases occurred mostly with serotype 3.•Non-vaccine types are important contributors to antimicrobial resistance.</description><subject>Adolescent</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>COVID-19 - epidemiology</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Invasive disease</subject><subject>Male</subject><subject>Molecular diagnostics</subject><subject>Pandemics</subject><subject>Pediatric infectious disease</subject><subject>Pneumococcal Infections - epidemiology</subject><subject>Pneumococcal Infections - microbiology</subject><subject>Pneumococcal Vaccines - administration & dosage</subject><subject>Portugal - epidemiology</subject><subject>SARS-CoV-2</subject><subject>Serogroup</subject><subject>Serotypes</subject><subject>Serotyping</subject><subject>Streptococcus pneumoniae</subject><subject>Streptococcus pneumoniae - classification</subject><subject>Streptococcus pneumoniae - drug effects</subject><subject>Streptococcus pneumoniae - isolation & purification</subject><subject>Vaccines</subject><issn>0163-4453</issn><issn>1532-2742</issn><issn>1532-2742</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9uEzEQhy0EomnLC3BAPnLZ4H-7G0tcUAq0UqUiBL1aXnucOMrai-1N1afglXGU0mNPI81885NmPoTeU7KkhHafdsudD27JCBO10THBXqEFbTlrWC_Ya7SoEG-EaPkZOs95RwiRXHZv0RmXlHZSyAX6-xOGOAeLo8MTWK9L8gb7cNDZHwBPAeYxmmiM3mPrM-gMdYp_xFTmTe1pVyDhsgW8vru_uWqoxJMOFsaa8qAzDrFgnXM0NRksfvBli7PfBO-80aHgDCmWxwmw2eqwgXyJ3ji9z_DuqV6g39--_lpfN7d332_WX24bw3hfmr7lfauH3grCKXMMxEpoANZTAYOuRdJhaB3ruRNSuFUnBgpWko4PHTdW8wv08ZQ7pfhnhlzU6LOB_V4HiHNWnEgi6-dWbUXZCTUp5pzAqSn5UadHRYk6ilA7dRShjiLUSURd-vCUPw8j2OeV_5-vwOcTAPXKg4eksvEQTHWQwBRlo38p_x8Cv5tp</recordid><startdate>202410</startdate><enddate>202410</enddate><creator>Silva-Costa, Catarina</creator><creator>Gomes-Silva, Joana</creator><creator>Pinho, Marcos</creator><creator>Friães, Ana</creator><creator>Subtil-Limpo, Fábio</creator><creator>Ramirez, Mário</creator><creator>Melo-Cristino, José</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4298-0014</orcidid><orcidid>https://orcid.org/0000-0003-3658-1102</orcidid><orcidid>https://orcid.org/0000-0001-9681-0574</orcidid><orcidid>https://orcid.org/0000-0002-7567-2405</orcidid></search><sort><creationdate>202410</creationdate><title>Rebound of pediatric invasive pneumococcal disease in Portugal after the COVID-19 pandemic was not associated with significant serotype changes</title><author>Silva-Costa, Catarina ; Gomes-Silva, Joana ; Pinho, Marcos ; Friães, Ana ; Subtil-Limpo, Fábio ; Ramirez, Mário ; Melo-Cristino, José</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c237t-75375ab7d40312f2e484aee2714eba27191bb5f273f494f864b1ed9063b63cda3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adolescent</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>COVID-19 - epidemiology</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Invasive disease</topic><topic>Male</topic><topic>Molecular diagnostics</topic><topic>Pandemics</topic><topic>Pediatric infectious disease</topic><topic>Pneumococcal Infections - epidemiology</topic><topic>Pneumococcal Infections - microbiology</topic><topic>Pneumococcal Vaccines - administration & dosage</topic><topic>Portugal - epidemiology</topic><topic>SARS-CoV-2</topic><topic>Serogroup</topic><topic>Serotypes</topic><topic>Serotyping</topic><topic>Streptococcus pneumoniae</topic><topic>Streptococcus pneumoniae - classification</topic><topic>Streptococcus pneumoniae - drug effects</topic><topic>Streptococcus pneumoniae - isolation & purification</topic><topic>Vaccines</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Silva-Costa, Catarina</creatorcontrib><creatorcontrib>Gomes-Silva, Joana</creatorcontrib><creatorcontrib>Pinho, Marcos</creatorcontrib><creatorcontrib>Friães, Ana</creatorcontrib><creatorcontrib>Subtil-Limpo, Fábio</creatorcontrib><creatorcontrib>Ramirez, Mário</creatorcontrib><creatorcontrib>Melo-Cristino, José</creatorcontrib><creatorcontrib>on behalf of the Portuguese Group for the Study of Streptococcal Infections and the Portuguese Study Group of Invasive Pneumococcal Disease of the Pediatric Infectious Disease Society</creatorcontrib><creatorcontrib>Portuguese Group for the Study of Streptococcal Infections and the Portuguese Study Group of Invasive Pneumococcal Disease of the Pediatric Infectious Disease Society</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Silva-Costa, Catarina</au><au>Gomes-Silva, Joana</au><au>Pinho, Marcos</au><au>Friães, Ana</au><au>Subtil-Limpo, Fábio</au><au>Ramirez, Mário</au><au>Melo-Cristino, José</au><aucorp>on behalf of the Portuguese Group for the Study of Streptococcal Infections and the Portuguese Study Group of Invasive Pneumococcal Disease of the Pediatric Infectious Disease Society</aucorp><aucorp>Portuguese Group for the Study of Streptococcal Infections and the Portuguese Study Group of Invasive Pneumococcal Disease of the Pediatric Infectious Disease Society</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rebound of pediatric invasive pneumococcal disease in Portugal after the COVID-19 pandemic was not associated with significant serotype changes</atitle><jtitle>The Journal of infection</jtitle><addtitle>J Infect</addtitle><date>2024-10</date><risdate>2024</risdate><volume>89</volume><issue>4</issue><spage>106242</spage><pages>106242-</pages><artnum>106242</artnum><issn>0163-4453</issn><issn>1532-2742</issn><eissn>1532-2742</eissn><abstract>The COVID-19 pandemic led to the institution of public health measures in many countries which reduced respiratory infections. We aimed to identify and characterize changes in pediatric (<18 years) invasive pneumococcal disease (pIPD) in Portugal in 2018–2023.
pIPD cases were identified by culture and molecular methods and stratified by age and serotype. When available the susceptibility of the isolates to antimicrobials was evaluated.
pIPD cases were markedly reduced in the last trimester of 2019–2020 and the entire 2020–2021 season. While 2021–2022 was in line with pre-pandemic seasons, in 2022–2023, the number of pIPD cases exceeded those found pre-pandemic. Molecular tests were responsible for identifying and serotyping 30% of cases, highlighting their importance in evaluating pIPD. Among the 316 pIPD cases, 37 different serotypes were detected, of which serotypes 3 (n = 85, 26.9%), 8 (n = 25, 7.9%), 10A (n = 21, 6.6%) and 24F (n = 20, 6.3%) were the most frequent. The post-pandemic serotype distribution reflected mostly pre-pandemic trends and the rebound was not driven by particular serotypes. We identified many vaccine failures, most (n = 37) representing serotype 3 infections. Penicillin non-susceptibility increased from 14% pre-pandemic to 29%, with serotype 24F becoming particularly significant.
The higher number of cases of pIPD post-COVID-19 in Portugal raises the possibility of a higher burden of pneumococcal disease in Europe post-pandemic. The relatively stable serotype distribution and the current availability of the higher valency conjugate vaccines PCV15 and PCV20, potentially preventing a large proportion of pIPD (43% and 67%, respectively), offer an opportunity to control this increase.
•Pediatric pneumococcal invasive disease decreased during the COVID-19 pandemic.•Rebound exceeded pre-pandemic levels with serotypes reflecting pre-pandemic trends.•Molecular methods are essential to detect an important fraction of invasive disease.•Vaccine failures or breakthrough cases occurred mostly with serotype 3.•Non-vaccine types are important contributors to antimicrobial resistance.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>39116949</pmid><doi>10.1016/j.jinf.2024.106242</doi><orcidid>https://orcid.org/0000-0002-4298-0014</orcidid><orcidid>https://orcid.org/0000-0003-3658-1102</orcidid><orcidid>https://orcid.org/0000-0001-9681-0574</orcidid><orcidid>https://orcid.org/0000-0002-7567-2405</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0163-4453 |
| ispartof | The Journal of infection, 2024-10, Vol.89 (4), p.106242, Article 106242 |
| issn | 0163-4453 1532-2742 1532-2742 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3090945385 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adolescent Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Child Child, Preschool COVID-19 - epidemiology Epidemiology Female Humans Infant Infant, Newborn Invasive disease Male Molecular diagnostics Pandemics Pediatric infectious disease Pneumococcal Infections - epidemiology Pneumococcal Infections - microbiology Pneumococcal Vaccines - administration & dosage Portugal - epidemiology SARS-CoV-2 Serogroup Serotypes Serotyping Streptococcus pneumoniae Streptococcus pneumoniae - classification Streptococcus pneumoniae - drug effects Streptococcus pneumoniae - isolation & purification Vaccines |
| title | Rebound of pediatric invasive pneumococcal disease in Portugal after the COVID-19 pandemic was not associated with significant serotype changes |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-07T15%3A40%3A05IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Rebound%20of%20pediatric%20invasive%20pneumococcal%20disease%20in%20Portugal%20after%20the%20COVID-19%20pandemic%20was%20not%20associated%20with%20significant%20serotype%20changes&rft.jtitle=The%20Journal%20of%20infection&rft.au=Silva-Costa,%20Catarina&rft.aucorp=on%20behalf%20of%20the%20Portuguese%20Group%20for%20the%20Study%20of%20Streptococcal%20Infections%20and%20the%20Portuguese%20Study%20Group%20of%20Invasive%20Pneumococcal%20Disease%20of%20the%20Pediatric%20Infectious%20Disease%20Society&rft.date=2024-10&rft.volume=89&rft.issue=4&rft.spage=106242&rft.pages=106242-&rft.artnum=106242&rft.issn=0163-4453&rft.eissn=1532-2742&rft_id=info:doi/10.1016/j.jinf.2024.106242&rft_dat=%3Cproquest_cross%3E3090945385%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3090945385&rft_id=info:pmid/39116949&rft_els_id=S0163445324001762&rfr_iscdi=true |