Antigenic changes in influenza A(H3N2) driven by genetic evolution: Insights from virological surveillance, EU/EEA, week 40/2023 to week 9/2024
BackgroundDuring the 2023/24 influenza season in the European Union/European Economic Area (EU/EEA), influenza viruses A(H1N1)pdm09, A(H3N2) and B/Victoria viruses were co-circulating.AimWe aimed to describe the circulating influenza viruses by (sub)type, genetic clade, antigenic group and antiviral...
Gespeichert in:
| Veröffentlicht in: | Euro surveillance : bulletin européen sur les maladies transmissibles 2024-12, Vol.29 (50), p.1 |
|---|---|
| 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 | 50 |
| container_start_page | 1 |
| container_title | Euro surveillance : bulletin européen sur les maladies transmissibles |
| container_volume | 29 |
| creator | Broberg, Eeva K Vukovikj, Maja Svartström, Olov Hasibra, Iris Riess, Maximilian Melidou, Angeliki |
| description | BackgroundDuring the 2023/24 influenza season in the European Union/European Economic Area (EU/EEA), influenza viruses A(H1N1)pdm09, A(H3N2) and B/Victoria viruses were co-circulating.AimWe aimed to describe the circulating influenza viruses by (sub)type, genetic clade, antigenic group and antiviral susceptibility in that season in the EU/EEA.MethodsWe collected surveillance data from EU/EEA countries through weekly submissions to The European Surveillance System (TESSy). Data were submitted in strain-based format for weeks 40/2023 to 9/2024.ResultsTwenty-nine EU/EEA countries reported 154,718 influenza virus detections (primary care sentinel and non-sentinel combined), of which 97% (150,692) were type A and 3% (4,026) were type B. Of the subtyped influenza A viruses, 30,463 (75%) were influenza A(H1)pdm09 and 10,174 (25%) were influenza A(H3). For 809 (20%) of the type B viruses, the lineage was determined; all were B/Victoria/2/87 lineage, and none were B/Yamagata/16/88 lineage. Genetic diversification of seasonal influenza viruses continued, and clade 5a.2a of A(H1N1)pdm09, 2a.3a.1 of A(H3N2) and V1A.3a.2 of B/Victoria-lineage viruses dominated. Of the A(H3N2) 2a.3a.1 viruses, 23% were antigenically distinct from the 2023/24 vaccine virus.ConclusionThe 2023/24 influenza season was characterised by co-circulation of different influenza (sub)types, antigenically similar to the components recommended for the 2023/24 northern hemisphere vaccine, A/Victoria/4897/2022 (egg-based) and A/Wisconsin/67/2022 (cell culture- or recombinant-based). However, genetic diversification of the viruses continued. The World Health Organization's vaccine recommendations for the northern hemisphere 2024/25 season were updated to include a new A(H3N2) component, while maintaining the current A(H1N1)pdm09 and B/Victoria components. |
| doi_str_mv | 10.2807/1560-7917.ES.2024.29.50.2400395 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11650508</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3145835227</sourcerecordid><originalsourceid>FETCH-LOGICAL-p1078-f584183ad352d261d5ad69a6155038c9c4630d485cbeb2b9e12f2e4dfb7ed1c33</originalsourceid><addsrcrecordid>eNpVUV1rFTEQDaLYWv0LEvBBhe7efG_ii1zKagtFH7Tg25LNzu5N3ZvcZj-k_gn_spHWojAwc5jDOWcYhF5TUjJNqg2VihSVoVVZfykZYaJkppR5KQjhRj5Cxw-Mx3kmTBbCqG9H6Nk0XRMiODHsKTriRildKXWMfm3D7AcI3mG3s2GACfuQqx8XCD8t3r4555_YW9wlv0LA7S3OZJgzHdY4LrOP4R2-CJMfdvOE-xT3ePUpjnHwzo54WtIKfhxtcHCK66tNXW9P8Q-A71iQTT6A4zneYfMHiufoSW_HCV7c9xN09aH-enZeXH7-eHG2vSwOlFS66KUWVHPbcck6pmgnbaeMVVRKwrUzTihOOqGla6FlrQHKegai69sKOuo4P0Hv73QPS7uHzkGYkx2bQ_J7m26baH3z_yb4XTPEtaFUSSKJzgqv7hVSvFlgmpvruKSQQzecCqlzMlZl1st_fR4M_n6A_waIoopF</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3145835227</pqid></control><display><type>article</type><title>Antigenic changes in influenza A(H3N2) driven by genetic evolution: Insights from virological surveillance, EU/EEA, week 40/2023 to week 9/2024</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><creator>Broberg, Eeva K ; Vukovikj, Maja ; Svartström, Olov ; Hasibra, Iris ; Riess, Maximilian ; Melidou, Angeliki</creator><creatorcontrib>Broberg, Eeva K ; Vukovikj, Maja ; Svartström, Olov ; Hasibra, Iris ; Riess, Maximilian ; Melidou, Angeliki ; Members of the ERLI-Net network</creatorcontrib><description>BackgroundDuring the 2023/24 influenza season in the European Union/European Economic Area (EU/EEA), influenza viruses A(H1N1)pdm09, A(H3N2) and B/Victoria viruses were co-circulating.AimWe aimed to describe the circulating influenza viruses by (sub)type, genetic clade, antigenic group and antiviral susceptibility in that season in the EU/EEA.MethodsWe collected surveillance data from EU/EEA countries through weekly submissions to The European Surveillance System (TESSy). Data were submitted in strain-based format for weeks 40/2023 to 9/2024.ResultsTwenty-nine EU/EEA countries reported 154,718 influenza virus detections (primary care sentinel and non-sentinel combined), of which 97% (150,692) were type A and 3% (4,026) were type B. Of the subtyped influenza A viruses, 30,463 (75%) were influenza A(H1)pdm09 and 10,174 (25%) were influenza A(H3). For 809 (20%) of the type B viruses, the lineage was determined; all were B/Victoria/2/87 lineage, and none were B/Yamagata/16/88 lineage. Genetic diversification of seasonal influenza viruses continued, and clade 5a.2a of A(H1N1)pdm09, 2a.3a.1 of A(H3N2) and V1A.3a.2 of B/Victoria-lineage viruses dominated. Of the A(H3N2) 2a.3a.1 viruses, 23% were antigenically distinct from the 2023/24 vaccine virus.ConclusionThe 2023/24 influenza season was characterised by co-circulation of different influenza (sub)types, antigenically similar to the components recommended for the 2023/24 northern hemisphere vaccine, A/Victoria/4897/2022 (egg-based) and A/Wisconsin/67/2022 (cell culture- or recombinant-based). However, genetic diversification of the viruses continued. The World Health Organization's vaccine recommendations for the northern hemisphere 2024/25 season were updated to include a new A(H3N2) component, while maintaining the current A(H1N1)pdm09 and B/Victoria components.</description><identifier>ISSN: 1025-496X</identifier><identifier>EISSN: 1560-7917</identifier><identifier>DOI: 10.2807/1560-7917.ES.2024.29.50.2400395</identifier><identifier>PMID: 39668766</identifier><language>eng</language><publisher>Sweden: Centre Europeen pour la Surveillance Epidemiologique du SIDA (European Centre for the Epidemiological Monitoring of AIDS)</publisher><subject>Antigens, Viral - genetics ; Antigens, Viral - immunology ; Antiviral Agents - therapeutic use ; Europe - epidemiology ; European Union ; Evolution, Molecular ; Humans ; Immunization ; Influenza ; Influenza A Virus, H1N1 Subtype - genetics ; Influenza A Virus, H1N1 Subtype - immunology ; Influenza A Virus, H1N1 Subtype - isolation & purification ; Influenza A Virus, H3N2 Subtype - genetics ; Influenza A Virus, H3N2 Subtype - immunology ; Influenza A Virus, H3N2 Subtype - isolation & purification ; Influenza B virus - genetics ; Influenza B virus - immunology ; Influenza B virus - isolation & purification ; Influenza, Human - epidemiology ; Influenza, Human - virology ; Phylogeny ; Population Surveillance ; Seasons ; Sentinel Surveillance ; Surveillance ; Vaccines ; Viruses</subject><ispartof>Euro surveillance : bulletin européen sur les maladies transmissibles, 2024-12, Vol.29 (50), p.1</ispartof><rights>Copyright Centre Europeen pour la Surveillance Epidemiologique du SIDA (European Centre for the Epidemiological Monitoring of AIDS) Dec 12, 2024</rights><rights>This article is copyright of the authors or their affiliated institutions, 2024. 2024 The authors or their affiliated institutions</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650508/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650508/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39668766$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Broberg, Eeva K</creatorcontrib><creatorcontrib>Vukovikj, Maja</creatorcontrib><creatorcontrib>Svartström, Olov</creatorcontrib><creatorcontrib>Hasibra, Iris</creatorcontrib><creatorcontrib>Riess, Maximilian</creatorcontrib><creatorcontrib>Melidou, Angeliki</creatorcontrib><creatorcontrib>Members of the ERLI-Net network</creatorcontrib><title>Antigenic changes in influenza A(H3N2) driven by genetic evolution: Insights from virological surveillance, EU/EEA, week 40/2023 to week 9/2024</title><title>Euro surveillance : bulletin européen sur les maladies transmissibles</title><addtitle>Euro Surveill</addtitle><description>BackgroundDuring the 2023/24 influenza season in the European Union/European Economic Area (EU/EEA), influenza viruses A(H1N1)pdm09, A(H3N2) and B/Victoria viruses were co-circulating.AimWe aimed to describe the circulating influenza viruses by (sub)type, genetic clade, antigenic group and antiviral susceptibility in that season in the EU/EEA.MethodsWe collected surveillance data from EU/EEA countries through weekly submissions to The European Surveillance System (TESSy). Data were submitted in strain-based format for weeks 40/2023 to 9/2024.ResultsTwenty-nine EU/EEA countries reported 154,718 influenza virus detections (primary care sentinel and non-sentinel combined), of which 97% (150,692) were type A and 3% (4,026) were type B. Of the subtyped influenza A viruses, 30,463 (75%) were influenza A(H1)pdm09 and 10,174 (25%) were influenza A(H3). For 809 (20%) of the type B viruses, the lineage was determined; all were B/Victoria/2/87 lineage, and none were B/Yamagata/16/88 lineage. Genetic diversification of seasonal influenza viruses continued, and clade 5a.2a of A(H1N1)pdm09, 2a.3a.1 of A(H3N2) and V1A.3a.2 of B/Victoria-lineage viruses dominated. Of the A(H3N2) 2a.3a.1 viruses, 23% were antigenically distinct from the 2023/24 vaccine virus.ConclusionThe 2023/24 influenza season was characterised by co-circulation of different influenza (sub)types, antigenically similar to the components recommended for the 2023/24 northern hemisphere vaccine, A/Victoria/4897/2022 (egg-based) and A/Wisconsin/67/2022 (cell culture- or recombinant-based). However, genetic diversification of the viruses continued. The World Health Organization's vaccine recommendations for the northern hemisphere 2024/25 season were updated to include a new A(H3N2) component, while maintaining the current A(H1N1)pdm09 and B/Victoria components.</description><subject>Antigens, Viral - genetics</subject><subject>Antigens, Viral - immunology</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Europe - epidemiology</subject><subject>European Union</subject><subject>Evolution, Molecular</subject><subject>Humans</subject><subject>Immunization</subject><subject>Influenza</subject><subject>Influenza A Virus, H1N1 Subtype - genetics</subject><subject>Influenza A Virus, H1N1 Subtype - immunology</subject><subject>Influenza A Virus, H1N1 Subtype - isolation & purification</subject><subject>Influenza A Virus, H3N2 Subtype - genetics</subject><subject>Influenza A Virus, H3N2 Subtype - immunology</subject><subject>Influenza A Virus, H3N2 Subtype - isolation & purification</subject><subject>Influenza B virus - genetics</subject><subject>Influenza B virus - immunology</subject><subject>Influenza B virus - isolation & purification</subject><subject>Influenza, Human - epidemiology</subject><subject>Influenza, Human - virology</subject><subject>Phylogeny</subject><subject>Population Surveillance</subject><subject>Seasons</subject><subject>Sentinel Surveillance</subject><subject>Surveillance</subject><subject>Vaccines</subject><subject>Viruses</subject><issn>1025-496X</issn><issn>1560-7917</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUV1rFTEQDaLYWv0LEvBBhe7efG_ii1zKagtFH7Tg25LNzu5N3ZvcZj-k_gn_spHWojAwc5jDOWcYhF5TUjJNqg2VihSVoVVZfykZYaJkppR5KQjhRj5Cxw-Mx3kmTBbCqG9H6Nk0XRMiODHsKTriRildKXWMfm3D7AcI3mG3s2GACfuQqx8XCD8t3r4555_YW9wlv0LA7S3OZJgzHdY4LrOP4R2-CJMfdvOE-xT3ePUpjnHwzo54WtIKfhxtcHCK66tNXW9P8Q-A71iQTT6A4zneYfMHiufoSW_HCV7c9xN09aH-enZeXH7-eHG2vSwOlFS66KUWVHPbcck6pmgnbaeMVVRKwrUzTihOOqGla6FlrQHKegai69sKOuo4P0Hv73QPS7uHzkGYkx2bQ_J7m26baH3z_yb4XTPEtaFUSSKJzgqv7hVSvFlgmpvruKSQQzecCqlzMlZl1st_fR4M_n6A_waIoopF</recordid><startdate>20241212</startdate><enddate>20241212</enddate><creator>Broberg, Eeva K</creator><creator>Vukovikj, Maja</creator><creator>Svartström, Olov</creator><creator>Hasibra, Iris</creator><creator>Riess, Maximilian</creator><creator>Melidou, Angeliki</creator><general>Centre Europeen pour la Surveillance Epidemiologique du SIDA (European Centre for the Epidemiological Monitoring of AIDS)</general><general>European Centre for Disease Prevention and Control (ECDC)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>5PM</scope></search><sort><creationdate>20241212</creationdate><title>Antigenic changes in influenza A(H3N2) driven by genetic evolution: Insights from virological surveillance, EU/EEA, week 40/2023 to week 9/2024</title><author>Broberg, Eeva K ; Vukovikj, Maja ; Svartström, Olov ; Hasibra, Iris ; Riess, Maximilian ; Melidou, Angeliki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p1078-f584183ad352d261d5ad69a6155038c9c4630d485cbeb2b9e12f2e4dfb7ed1c33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Antigens, Viral - genetics</topic><topic>Antigens, Viral - immunology</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Europe - epidemiology</topic><topic>European Union</topic><topic>Evolution, Molecular</topic><topic>Humans</topic><topic>Immunization</topic><topic>Influenza</topic><topic>Influenza A Virus, H1N1 Subtype - genetics</topic><topic>Influenza A Virus, H1N1 Subtype - immunology</topic><topic>Influenza A Virus, H1N1 Subtype - isolation & purification</topic><topic>Influenza A Virus, H3N2 Subtype - genetics</topic><topic>Influenza A Virus, H3N2 Subtype - immunology</topic><topic>Influenza A Virus, H3N2 Subtype - isolation & purification</topic><topic>Influenza B virus - genetics</topic><topic>Influenza B virus - immunology</topic><topic>Influenza B virus - isolation & purification</topic><topic>Influenza, Human - epidemiology</topic><topic>Influenza, Human - virology</topic><topic>Phylogeny</topic><topic>Population Surveillance</topic><topic>Seasons</topic><topic>Sentinel Surveillance</topic><topic>Surveillance</topic><topic>Vaccines</topic><topic>Viruses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Broberg, Eeva K</creatorcontrib><creatorcontrib>Vukovikj, Maja</creatorcontrib><creatorcontrib>Svartström, Olov</creatorcontrib><creatorcontrib>Hasibra, Iris</creatorcontrib><creatorcontrib>Riess, Maximilian</creatorcontrib><creatorcontrib>Melidou, Angeliki</creatorcontrib><creatorcontrib>Members of the ERLI-Net network</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Euro surveillance : bulletin européen sur les maladies transmissibles</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Broberg, Eeva K</au><au>Vukovikj, Maja</au><au>Svartström, Olov</au><au>Hasibra, Iris</au><au>Riess, Maximilian</au><au>Melidou, Angeliki</au><aucorp>Members of the ERLI-Net network</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antigenic changes in influenza A(H3N2) driven by genetic evolution: Insights from virological surveillance, EU/EEA, week 40/2023 to week 9/2024</atitle><jtitle>Euro surveillance : bulletin européen sur les maladies transmissibles</jtitle><addtitle>Euro Surveill</addtitle><date>2024-12-12</date><risdate>2024</risdate><volume>29</volume><issue>50</issue><spage>1</spage><pages>1-</pages><issn>1025-496X</issn><eissn>1560-7917</eissn><abstract>BackgroundDuring the 2023/24 influenza season in the European Union/European Economic Area (EU/EEA), influenza viruses A(H1N1)pdm09, A(H3N2) and B/Victoria viruses were co-circulating.AimWe aimed to describe the circulating influenza viruses by (sub)type, genetic clade, antigenic group and antiviral susceptibility in that season in the EU/EEA.MethodsWe collected surveillance data from EU/EEA countries through weekly submissions to The European Surveillance System (TESSy). Data were submitted in strain-based format for weeks 40/2023 to 9/2024.ResultsTwenty-nine EU/EEA countries reported 154,718 influenza virus detections (primary care sentinel and non-sentinel combined), of which 97% (150,692) were type A and 3% (4,026) were type B. Of the subtyped influenza A viruses, 30,463 (75%) were influenza A(H1)pdm09 and 10,174 (25%) were influenza A(H3). For 809 (20%) of the type B viruses, the lineage was determined; all were B/Victoria/2/87 lineage, and none were B/Yamagata/16/88 lineage. Genetic diversification of seasonal influenza viruses continued, and clade 5a.2a of A(H1N1)pdm09, 2a.3a.1 of A(H3N2) and V1A.3a.2 of B/Victoria-lineage viruses dominated. Of the A(H3N2) 2a.3a.1 viruses, 23% were antigenically distinct from the 2023/24 vaccine virus.ConclusionThe 2023/24 influenza season was characterised by co-circulation of different influenza (sub)types, antigenically similar to the components recommended for the 2023/24 northern hemisphere vaccine, A/Victoria/4897/2022 (egg-based) and A/Wisconsin/67/2022 (cell culture- or recombinant-based). However, genetic diversification of the viruses continued. The World Health Organization's vaccine recommendations for the northern hemisphere 2024/25 season were updated to include a new A(H3N2) component, while maintaining the current A(H1N1)pdm09 and B/Victoria components.</abstract><cop>Sweden</cop><pub>Centre Europeen pour la Surveillance Epidemiologique du SIDA (European Centre for the Epidemiological Monitoring of AIDS)</pub><pmid>39668766</pmid><doi>10.2807/1560-7917.ES.2024.29.50.2400395</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1025-496X |
| ispartof | Euro surveillance : bulletin européen sur les maladies transmissibles, 2024-12, Vol.29 (50), p.1 |
| issn | 1025-496X 1560-7917 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11650508 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Antigens, Viral - genetics Antigens, Viral - immunology Antiviral Agents - therapeutic use Europe - epidemiology European Union Evolution, Molecular Humans Immunization Influenza Influenza A Virus, H1N1 Subtype - genetics Influenza A Virus, H1N1 Subtype - immunology Influenza A Virus, H1N1 Subtype - isolation & purification Influenza A Virus, H3N2 Subtype - genetics Influenza A Virus, H3N2 Subtype - immunology Influenza A Virus, H3N2 Subtype - isolation & purification Influenza B virus - genetics Influenza B virus - immunology Influenza B virus - isolation & purification Influenza, Human - epidemiology Influenza, Human - virology Phylogeny Population Surveillance Seasons Sentinel Surveillance Surveillance Vaccines Viruses |
| title | Antigenic changes in influenza A(H3N2) driven by genetic evolution: Insights from virological surveillance, EU/EEA, week 40/2023 to week 9/2024 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-21T06%3A10%3A45IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Antigenic%20changes%20in%20influenza%20A(H3N2)%20driven%20by%20genetic%20evolution:%20Insights%20from%20virological%20surveillance,%20EU/EEA,%20week%2040/2023%20to%20week%209/2024&rft.jtitle=Euro%20surveillance%20:%20bulletin%20europ%C3%A9en%20sur%20les%20maladies%20transmissibles&rft.au=Broberg,%20Eeva%20K&rft.aucorp=Members%20of%20the%20ERLI-Net%20network&rft.date=2024-12-12&rft.volume=29&rft.issue=50&rft.spage=1&rft.pages=1-&rft.issn=1025-496X&rft.eissn=1560-7917&rft_id=info:doi/10.2807/1560-7917.ES.2024.29.50.2400395&rft_dat=%3Cproquest_pubme%3E3145835227%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3145835227&rft_id=info:pmid/39668766&rfr_iscdi=true |