Surveillance towards preventing paediatric incidence of respiratory syncytial virus attributable respiratory tract infection in primary and secondary/tertiary healthcare settings in Merseyside, Cheshire and Bristol, UK.

INTRODUCTION: Respiratory syncytial virus (RSV) is a common respiratory virus, particularly affecting children, and can cause respiratory infections such as croup and bronchiolitis. The latter is a leading cause of paediatric hospitalisation within the UK. Children <3 years of age and/or with underlying health conditions are more vulnerable to severe RSV infection.There are currently limited data on the incidence of laboratory-confirmed RSV, particularly within primary care settings and outside the typical 'RSV season', which in the Northern hemisphere tends to coincide with winter months. There is also a lack of data on the health economic impact of RSV infection on families and healthcare systems.This observational surveillance study aims to collect data on the incidence of laboratory-confirmed RSV-attributable respiratory tract infection (RTI) in children aged <3 years presenting to primary, secondary or tertiary care; it also aims to estimate the health economic and quality of life impact of RSV-attributable infection in this cohort. Such data will contribute to informing public health strategies to prevent RSV-associated infection, including use of preventative medications. METHODS AND ANALYSIS: Parents/carers of children <3 years of age with RTI symptoms will consent for a respiratory sample (nasal swab) to be taken. Laboratory PCR testing will assess for the presence of RSV and/or other pathogens. Data will be obtained from medical records on demographics, comorbidities, severity of infection and hospitalisation outcomes. Parents will complete questionnaires on the impact of ongoing infection symptoms at day 14 and 28 following enrolment. The primary outcome is incidence of laboratory-confirmed RSV in children <3 years presenting to primary, secondary or tertiary care with RTI symptoms leading to health-seeking behaviours. Recruitment will be carried out from December 2021 to March 2023, encompassing two UK winter seasons and intervening months. ETHICS AND DISSEMINATION: Ethical approval has been granted (21/WS/0142), and study findings will be published as per International Committee of Medical Journal Editors' guidelines.

Cell-type specific distribution and activation of type I IFN pathway molecules at the placental maternal-fetal interface in response to COVID-19 infection.

Background and objective: COVID-19 infection in pregnancy significantly increases risks of adverse pregnancy outcomes. However, little is known how the innate immunity at the placental maternal-fetal interface responds to COVID-19 infection. Type I IFN cytokines are recognized as a key component of the innate immune response against viral infection. In this study, we specifically evaluated expression of IFN antiviral signaling molecules in placentas from women infected with COVID-19 during pregnancy. Methods: Expression of IFN activation signaling pathway molecules, including cyclic GMP-AMP synthase (cGAS), stimulator of interferon genes (STING), interferon regulatory factor 3 (IRF3), Toll-like receptor 7 (TLR7), mitochondrial antiviral-signaling protein (MAVS), and IFNß were determined in formalin-fixed paraffin embedded (FFPE) placental tissue sections (villous and fetal membrane) by immunostaining. A total of 20 placentas were examined, 12 from COVID-19 patients and 8 from non-COVID-19 controls. Patient demographics, clinical data, and placental pathology report were acquired via EPIC medical record review. Results: Except BMI and placental weight, there was no statistical difference between COVID and non-COVID groups in maternal age, gestational age at delivery, gravity/parity, delivery mode, and newborn gender and weight. In COVID-exposed group, the main pathological characteristics in the placental disc are maternal and fetal vascular malperfusion and chronic inflammation. Compared to non-COVID controls, expression of IFN activation pathway molecules were all upregulated with distinct cell-type specific distribution in COVID-exposed placentas: STING in villous and decidual stromal cells; IRF3 in cytotrophoblasts (CTs) and extra-villous trophoblasts (EVTs); and TLR7 and MAVS in syncytiotrophoblasts (STs), CTs, and EVTs. Upregulation of STING, MAVS and TLR7 was also seen in fetal endothelial cells. Conclusions: STING, IRF3, TLR7, and MAVS are key viral sensing molecules that regulate type I IFN production. Type I IFNs are potent antiviral cytokines to impair and eradicate viral replication in infected cells. The finding of cell-type specific distribution and activation of these innate antiviral molecules at the placental maternal-fetal interface provide plausible evidence that type I IFN pathway molecules may play critical roles against SARS-CoV-2 infection in the placenta. Our findings also suggest that placental maternal-fetal interface has a well-defined antiviral defense system to protect the developing fetus from SARS-CoV-2 infection.

Cell-type specific distribution and activation of type I IFN pathway molecules at the placental maternal-fetal interface in response to COVID-19 infection

Background and objective COVID-19 infection in pregnancy significantly increases risks of adverse pregnancy outcomes. However, little is known how the innate immunity at the placental maternal-fetal interface responds to COVID-19 infection. Type I IFN cytokines are recognized as a key component of the innate immune response against viral infection. In this study, we specifically evaluated expression of IFN antiviral signaling molecules in placentas from women infected with COVID-19 during pregnancy. Methods Expression of IFN activation signaling pathway molecules, including cyclic GMP–AMP synthase (cGAS), stimulator of interferon genes (STING), interferon regulatory factor 3 (IRF3), Toll-like receptor 7 (TLR7), mitochondrial antiviral-signaling protein (MAVS), and IFNβ were determined in formalin-fixed paraffin embedded (FFPE) placental tissue sections (villous and fetal membrane) by immunostaining. A total of 20 placentas were examined, 12 from COVID-19 patients and 8 from non-COVID-19 controls. Patient demographics, clinical data, and placental pathology report were acquired via EPIC medical record review. Results Except BMI and placental weight, there was no statistical difference between COVID and non-COVID groups in maternal age, gestational age at delivery, gravity/parity, delivery mode, and newborn gender and weight. In COVID-exposed group, the main pathological characteristics in the placental disc are maternal and fetal vascular malperfusion and chronic inflammation. Compared to non-COVID controls, expression of IFN activation pathway molecules were all upregulated with distinct cell-type specific distribution in COVID-exposed placentas: STING in villous and decidual stromal cells;IRF3 in cytotrophoblasts (CTs) and extra-villous trophoblasts (EVTs);and TLR7 and MAVS in syncytiotrophoblasts (STs), CTs, and EVTs. Upregulation of STING, MAVS and TLR7 was also seen in fetal endothelial cells. Conclusions STING, IRF3, TLR7, and MAVS are key viral sensing molecules that regulate type I IFN production. Type I IFNs are potent antiviral cytokines to impair and eradicate viral replication in infected cells. The finding of cell-type specific distribution and activation of these innate antiviral molecules at the placental maternal-fetal interface provide plausible evidence that type I IFN pathway molecules may play critical roles against SARS-CoV-2 infection in the placenta. Our findings also suggest that placental maternal-fetal interface has a well-defined antiviral defense system to protect the developing fetus from SARS-CoV-2 infection.

Peritoneal dialysis-associated peritonitis presenting with Ralstonia pickettii infection: A novel series of three cases during the COVID-19 pandemic.

Peritoneal dialysis (PD)-associated peritonitis secondary to Ralstonia infection is very rare. Ralstonia pickettii is an organism that can grow in contaminated saline, water, chlorhexidine, and other medical products used in laboratories and the clinical setting. Infective endocarditis, prosthetic joint, and severe chest infections are previously reported with R. pickettii infection. We report a novel series of three cases diagnosed with PD-associated peritonitis caused by R. pickettii, where the cases appeared consecutively to our unit during a span of 4 weeks. During the COVID-19 pandemic, there were increased uses of non-sterile gloves by clinical staff as a form of personal protective equipment throughout patient interaction and PD exchange, as recommended by local hospital policy for all staff attending to patient care. A multidisciplinary team root cause analysis of our cases suggested non-sterile gloves being the likely source of environmental contamination, leading to PD-associated peritonitis caused by R. pickettii in this scenario.

Investigating Longer Term Antibody Response Following Covid-19 Vaccination in Patients Receiving Peritoneal Dialysis—a Single-Center Observational Study

BACKGROUND AND AIMS Individuals with end-stage kidney disease (ESKD) have a greater susceptibility towards coronavirus disease 2019 (COVID-19) infection compared to those without chronic kidney disease or ESKD, and these patients are more vulnerable to poor clinical outcomes. The introduction of COVID-19 vaccination programs displayed efficacy to improving clinical outcomes. A study based in the UK reported excellent humoral responses to the Pfizer BNT162b2 vaccine, but suboptimal responses to the Oxford AstraZeneca ChAdOx1-nCoV-19(AZD1222) vaccine amongst hemodialysis patients. High rate of humoral responses to two doses of the COVID-19 vaccination has been reported within small cohorts of peritoneal dialysis (PD) patients 3 to 8 weeks post vaccination, whilst one study confirmed maintenance of significant humoral responses 6 months post vaccination with the Pfizer BNT162b2 vaccine. Our study aimed at evaluating longer-term antibody responses—6 months after a two-dose regimen of the Pfizer BNT162b2 and Oxford AstraZeneca ChAdOx1-nCoV-19 (AZD1222) vaccines in patients receiving PD. METHOD This is a single-center observational study conducted for PD patients who were offered both doses of the COVID-19 vaccine [either Pfizer BNT162b2 or Oxford AstraZeneca ChAdOx1-nCoV-19(AZD1222)] since universal introduction of the vaccination program in our local area in December 2020. COVID-19 antibody testing was performed using the Siemens’ immunoassay targeting the spike protein S1 RBD (an index ≥ 1.0 was deemed as a positive result) between October and November 2021. Demographic and baseline clinical data were collected for each patient, and analysis focused on comparing the characteristics between PD patients with positive and negative COVID-19 antibody statuses. Statistical analysis was performed using SPSS version 24. RESULTS Eighty-six patients were included in this study. The median age was 62 years (47–71) with a predominance of males (61.6%) and Caucasian ethnicity (75.6%). The majority of patients have hypertension (84.8%) with 38% having a history of cardiovascular disease and 34% being diabetic. Ten patients (11.6%) previously received a kidney transplant with 7 patients (8.2%) currently on immunosuppressive treatment, and 15 patients (17.4%) previously receiving such treatments. A total of 81 patients received both doses of the COVID-19 vaccine, of which 57 (70.4%) received Pfizer BNT162b2, 16 (19.7%) received Oxford AstraZeneca ChAdOx1-nCoV-19 (AZD1222) and the type of vaccine was unknown in 8 patients (9.9%). A total of 72 patients were COVID-19 antibody tested between October and November 2021 in which 68 (94.4%) had a positive antibody and 4 (5.6%) had a negative antibody test. The median time between first dose of the COVID-19 vaccination and antibody testing was 9 (8.6–9.5) months and the median time between second dose of the COVID-19 vaccination and antibody testing was 6.3 (5.8–6.7) months. Comparing the demographic and clinical characteristics between patients with positive and negative antibodies, a higher proportion of patients with history of receiving immunosuppression (currently or previously;P = 0.004) had a negative antibody status despite receiving two doses of COVID-19 vaccination. There were no further significant differences observed. Full study results are presented in Tables 1 and 2. CONCLUSION In our cohort of PD patients, detectable humoral response to COVID-19 vaccination was sustained 6 months following vaccination irrespective of the type of vaccination received. A higher proportion of patients with a history of receiving immunosuppression (current or past) had a poor antibody response following COVID-19 vaccinations, highlighting the importance of considering focused COVID-19 vaccination strategies in the context of immunosuppression.

Ibrutinib plus Bendamustine and Rituximab in Untreated Mantle-Cell Lymphoma.

BACKGROUND: Ibrutinib, a Bruton's tyrosine kinase inhibitor, may have clinical benefit when administered in combination with bendamustine and rituximab and followed by rituximab maintenance therapy in older patients with untreated mantle-cell lymphoma. METHODS: We randomly assigned patients 65 years of age or older to receive ibrutinib (560 mg, administered orally once daily until disease progression or unacceptable toxic effects) or placebo, plus six cycles of bendamustine (90 mg per square meter of body-surface area) and rituximab (375 mg per square meter). Patients with an objective response (complete or partial response) received rituximab maintenance therapy, administered every 8 weeks for up to 12 additional doses. The primary end point was progression-free survival as assessed by the investigators. Overall survival and safety were also assessed. RESULTS: Among 523 patients, 261 were randomly assigned to receive ibrutinib and 262 to receive placebo. At a median follow-up of 84.7 months, the median progression-free survival was 80.6 months in the ibrutinib group and 52.9 months in the placebo group (hazard ratio for disease progression or death, 0.75; 95% confidence interval, 0.59 to 0.96; P = 0.01). The percentage of patients with a complete response was 65.5% in the ibrutinib group and 57.6% in the placebo group (P = 0.06). Overall survival was similar in the two groups. The incidence of grade 3 or 4 adverse events during treatment was 81.5% in the ibrutinib group and 77.3% in the placebo group. CONCLUSIONS: Ibrutinib treatment in combination with standard chemoimmunotherapy significantly prolonged progression-free survival. The safety profile of the combined therapy was consistent with the known profiles of the individual drugs. (Funded by Janssen Research and Development and Pharmacyclics; SHINE ClinicalTrials.gov number, NCT01776840.).

JLSC Board Editorial 2021

It hardly needs to be said that 2020 was a difficult year for the world. COVID-19 has infected over 120 million people and killed over 2 million as of March 2021 (Johns Hopkins). At the same time, police violence against people of color continues, even as communities engage in long-overdue reckoning initiatives. Across the globe, researchers, governments, and communities needed quick, open, up-to-date information on testing for, treating, and preventing COVID-19. Our increased dependence on technology during lockdowns provided some with safety and continuity, while others experienced the widening of the digital divide. There is no greater urgency than the work of identifying and addressing issues of inequality and lack of equity and inclusivity. Although the results remain to be seen, the field of scholarly communications experienced disruption in 2020. The editorials below discuss these recent changes and imagine what could come out of the pandemic. We hope that these reflections invite conversation and action.

Broad-spectrum CRISPR-mediated inhibition of SARS-CoV-2 variants and endemic coronaviruses in vitro.

A major challenge in coronavirus vaccination and treatment is to counteract rapid viral evolution and mutations. Here we demonstrate that CRISPR-Cas13d offers a broad-spectrum antiviral (BSA) to inhibit many SARS-CoV-2 variants and diverse human coronavirus strains with >99% reduction of the viral titer. We show that Cas13d-mediated coronavirus inhibition is dependent on the crRNA cellular spatial colocalization with Cas13d and target viral RNA. Cas13d can significantly enhance the therapeutic effects of diverse small molecule drugs against coronaviruses for prophylaxis or treatment purposes, and the best combination reduced viral titer by over four orders of magnitude. Using lipid nanoparticle-mediated RNA delivery, we demonstrate that the Cas13d system can effectively treat infection from multiple variants of coronavirus, including Omicron SARS-CoV-2, in human primary airway epithelium air-liquid interface (ALI) cultures. Our study establishes CRISPR-Cas13 as a BSA which is highly complementary to existing vaccination and antiviral treatment strategies.

Increasing Uptake of COVID-19 Vaccination and Reducing Health Inequalities in Patients on Renal Replacement Therapy-Experience from a Single Tertiary Centre.

BACKGROUND: COVID-19 vaccination has changed the landscape of the COVID-19 pandemic; however, decreased uptake due to vaccine hesitancy has been observed, particularly in patients from minority ethnic backgrounds and socially deprived areas. These patient characteristics are common in patients on Renal Replacement Therapy (RRT), a population at extremely high risk of developing serious illness from COVID-19 and who would thus benefit the most from the vaccination programme. We designed a bespoke COVID-19 vaccination programme for our RRT population with the aim of decreasing health inequalities and increasing vaccination uptake. METHODS: Key interventions included addressing vaccine hesitancy by deploying the respective clinical teams as trusted messengers, prompt eligible patient identification and notification, the deployment of resources to optimise vaccine administration in a manner convenient to patients, and the timely collection and analysis of local safety and efficacy data. First, COVID-19 vaccination data in relation to ethnicity and social deprivation in our RRT population, measured by the multiple deprivation index, were analysed and compared to uptake data in the total regional adult clinically extremely vulnerable (CEV) population in Greater Manchester (GM). Univariate logistic regression analysis was used to explore the factors associated with not receiving a vaccine. RESULTS: Out of 1156 RRT patients included in this analysis, 96.7% received the first dose of the vaccination compared to 93% in the cohort of CEV patients in the GM. Age, gender, ethnicity, and a lower index of multiple deprivation were not identified as significant risk factors for poor first dose vaccine uptake in our cohort. Vaccine uptake in Asian and Black RRT patients was 94.9% and 92.3%, respectively, compared to 93% and 76.2% for the same ethnic groups in the reference CEV GM. Vaccine uptake was 96.1% for RRT patients in the lowest quartile of the multiple deprivation index, compared to 90.5% in the GM reference population. CONCLUSION: Bespoke COVID-19 vaccination programmes based on local clinical teams as trusted messengers can improve negative attitudes towards vaccination and reduce health inequalities.

Why Do People (Not) Engage in Social Distancing? Proximate and Ultimate Analyses of Norm-Following During the COVID-19 Pandemic.

COVID-19 has had a profound negative effect on many aspects of human life. While pharmacological solutions are being developed and implemented, the onus of mitigating the impact of the virus falls, in part, on individual citizens and their adherence to public health guidelines. However, promoting adherence to these guidelines has proven challenging. There is a pressing need to understand the factors that influence people's adherence to these guidelines in order to improve public compliance. To this end, the current study investigated whether people's perceptions of others' adherence predict their own adherence. We also investigated whether any influence of perceived social norms was mediated by perceptions of the moral wrongness of non-adherence, anticipated shame for non-adherence, or perceptions of disease severity. One hundred fifty-two Australians participated in our study between June 6, 2020 and August 21, 2020. Findings from this preliminary investigation suggest that (1) people match their behavior to perceived social norms, and (2) this is driven, at least in part, by people using others' behavior as a cue to the severity of disease threat. Such findings provide insight into the proximate and ultimate bases of norm-following behavior, and shed preliminary light on public health-related behavior in the context of a pandemic. Although further research is needed, the results of this study-which suggest that people use others' behavior as a cue to how serious the pandemic is and as a guide for their own behavior-could have important implications for public health organizations, social movements, and political leaders and the role they play in the fight against epidemics and pandemics.

Supporting Students and Faculty In The Implementation Of Capstone Projects Into Programmes In a Pandemic Education Environment

The current Covid environment, with no or limited access to research facilities, has made it impossible for undergraduate students to undertake laboratory-based final year research projects. Lewis (2020) currently offers his students a sector-leading portfolio of 15 different traditional research and capstone project opportunities to choose from. Our aim was therefore to share our knowledge and expertise of research and capstone project opportunities which can be undertaken remotely, and supporting resources, with colleagues globally to enable them to provide meaningful and educationally robust projects for their students. In March-August 2020, online interactive workshops were provided for colleagues. To provide scaffolding and support, Choosing Your Capstone and How to do it guides were created for students and Faculty respectively, and shared globally. Collections of simulations and large publically available datasets were also shared. Follow-up surveys of workshop participants were undertaken in December 2020. This research was approved by the University of Leeds Faculty of Biological Sciences Research Ethics Committee. The workshops attracted over 500 participants. The support resources have been viewed 11,000 times from over 50 Countries. All survey participants, representing 53 Universities within the UK and overseas, found the workshops extremely informative and inspirational. All are implementing multiple formats of non-traditional capstones as alternatives to laboratory-based research projects into their programmes in 2020-21. Eighty-six percent wish to be involved with this initiative going forward. This programme of work has shown the need for alternatives to laboratory-based research projects for students in the Biosciences, not only during the current pandemic, but going forward. By offering a portfolio of both traditional research and non-traditional capstone projects, students can select the project that best provides the experience and develops the skills required for their particular career intentions. We have also developed a global community of practice to take this initiative forward. Lewis DI (2020). Final year undergraduate research project or a ?Capstone Experience?? Time for a re-think. Brit J. Clin. Pharmacol. 86 (6): 1227-1228

CO-aVoID: coronavirus outbreak affecting variability of presentations to a local emergency department.

BACKGROUND: The impact of the COVID-19 pandemic on public health, specifically on patients presenting to the emergency department (ED) with non-COVID-related diseases, remains largely undocumented. OBJECTIVE: This study explored how overall rates of presentations to the emergency department were impacted immediately after the declaration of the COVID-19 pandemic, and specifically how key presenting symptoms representing emergency, standard and low-acuity conditions were impacted. METHODS: A sequential modified Delphi survey and cross-sectional analysis of administrative census data from a tertiary care center in New Brunswick, Canada, were performed. Details of ED presentations for emergency, standard and low-acuity conditions from February 1 to April 30, 2020, were compared to data from previous years. RESULTS: There was a significant decrease in the number of patients visiting the ED with emergency, standard and low-acuity complaints immediately after March 13, 2020, compared to 2019. The proportion of females and males remained similar, with a median age of 48 years in 2020 and 44 years in 2019. Total presentation patterns to the ED (registrations, admissions to hospital and left without being seen numbers) decreased, compared to previous years. CONCLUSIONS: We report a predictable decrease in patient visits to the ED with minor, non-life-threatening conditions during a pandemic. However, we also report a decrease in presentations for emergency and standard conditions. Improved messaging highlighting the need to seek help for "true" emergencies, while providing non-ED options for minor, non-life-threatening conditions, may be helpful under normal circumstances and during future pandemics.

RéSUMé: CONTEXTE: L'impact de la pandémie COVID-19 sur la santé publique, en particulier sur les patients se présentant aux services d'urgence (SU) avec des maladies non liées à la COVID, demeure en grande partie non documenté. OBJECTIF: Cette étude a exploré la façon dont les taux globaux de présentations au service des urgences ont été touchés immédiatement après la déclaration de la pandémie de COVID-19, et plus particulièrement la façon dont les principaux symptômes représentant des conditions d'urgence, standard et de faible acuité ont été touchés. MéTHODES: Une enquête Delphi séquentielle modifiée et une analyse transversale des données du recensement administratif provenant d'un centre de soins tertiaires du Nouveau-Brunswick, au Canada, ont été réalisées. Les détails des présentations du SU pour les conditions d'urgence, standard et de faible acuité du 1er février au 30 avril 2020 ont été comparés aux données des années précédentes. RéSULTATS: Il y a eu une diminution significative du nombre de patients se rendant au service d'urgence avec des plaintes d'urgence, standard et de faible gravité immédiatement après le 13 mars 2020, par rapport à 2019. La proportion de femmes et d'hommes est demeurée semblable, avec un âge médian de 48 ans en 2020 et de 44 ans en 2019. Le nombre total de modèles de présentation à l'urgence (inscriptions, admissions à l'hôpital et nombre laissé sans être vu) a diminué par rapport aux années précédentes. CONCLUSIONS: Nous faisons état d'une diminution prévisible des visites de patients aux urgences pour des affections mineures qui ne mettent pas leur vie en danger pendant une pandémie. Toutefois, nous signalons également une diminution des présentations pour les situations d'urgence et les conditions normales. Des messages améliorés soulignant la nécessité de demander de l'aide pour les urgences « réelles ¼, tout en offrant des options non urgentes pour des conditions mineures et qui ne mettent pas la vie en danger peuvent être utiles dans des circonstances normales et lors de futures pandémies.

Potential and demonstrated impacts of the COVID-19 pandemic on sexually transmissible infections: Republication.

PURPOSE OF REVIEW: This review considers the potential and demonstrated impacts of SARS-CoV-2 on the sexually transmissible infection (STI)/HIV transmission. RECENT FINDINGS: COVID-19 increases the vulnerability of those at highest risk of acquiring STI/HIV. Altered health-seeking behaviour, reductions in STI/HIV clinic capacity, service disruptions and redeployment of human resources to assist COVID-19 control efforts have impacted on STI/HIV control programmes. Reports of reduced STI incidence are emerging, but it is hard to determine whether this is real or due to decreased testing during COVID-19 lockdown periods. Fear of COVID-19 and implemented control measures have altered STI/HIV transmission dynamics. Sexual health services adapted to the pandemic by reducing face-to-face patient encounters in favour of telehealth and mail-based initiatives as well as more stringent triage practice. Many sexual health and HIV treatment services now operate at reduced capacity and experience ongoing service disruptions, which necessarily translates into poorer outcomes for patients and their communities. SUMMARY: In the short-term, COVID-19 related sexual behaviour change is driving STI/HIV transmission downwards. However, the impacts of the global COVID-19 response on sexual health-seeking behaviour and STI/HIV services threaten to drive STI/HIV transmission upwards. Ultimately, the expected rebound in STI/HIV incidence will require an appropriate and timely public health response. VIDEO ABSTRACT: http://links.lww.com/COID/A31.

Potential and demonstrated impacts of the COVID-19 pandemic on sexually transmissible infections.

PURPOSE OF REVIEW: This review considers the potential and demonstrated impacts of SARS-CoV-2 on the sexually transmissible infection (STI)/HIV transmission. RECENT FINDINGS: COVID-19 increases the vulnerability of those at highest risk of acquiring STI/HIV. Altered health-seeking behaviour, reductions in STI/HIV clinic capacity, service disruptions and redeployment of human resources to assist COVID-19 control efforts have impacted on STI/HIV control programmes. Reports of reduced STI incidence are emerging, but it is hard to determine whether this is real or due to decreased testing during COVID-19 lockdown periods. Fear of COVID-19 and implemented control measures have altered STI/HIV transmission dynamics. Sexual health services adapted to the pandemic by reducing face-to-face patient encounters in favour of telehealth and mail-based initiatives as well as more stringent triage practice. Many sexual health and HIV treatment services now operate at reduced capacity and experience ongoing service disruptions, which necessarily translates into poorer outcomes for patients and their communities. SUMMARY: In the short-term, COVID-19 related sexual behaviour change is driving STI/HIV transmission downwards. However, the impacts of the global COVID-19 response on sexual health-seeking behaviour and STI/HIV services threaten to drive STI/HIV transmission upwards. Ultimately, the expected rebound in STI/HIV incidence will require an appropriate and timely public health response. VIDEO ABSTRACT: http://links.lww.com/COID/A31.