Effectiveness of azvudine in reducing mortality of COVID-19 patients: a systematic review and meta-analysis

{ 'indexed': {'date-parts': [[2024, 2, 24]], 'date-time': '2024-02-24T00:28:18Z', 'timestamp': 1708734498944}, 'reference-count': 37, 'publisher': 'Springer Science and Business Media LLC', 'issue': '1', 'license': [ { 'start': { 'date-parts': [[2024, 2, 23]], 'date-time': '2024-02-23T00:00:00Z', 'timestamp': 1708646400000}, 'content-version': 'tdm', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}, { 'start': { 'date-parts': [[2024, 2, 23]], 'date-time': '2024-02-23T00:00:00Z', 'timestamp': 1708646400000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}], 'funder': [ {'name': 'National Key Research and Development Program of China', 'award': ['2023YFC3041900']}, { 'name': 'Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences', 'award': ['2021-I2M-1-048']}], 'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False}, 'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>Azvudine has been approved for the treatment of coronavirus disease ' '2019 (COVID-19) patients in China, and this meta-analysis aims to illustrate the safety of ' 'azvudine and its effectiveness in reducing mortality.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>PubMed, Embase, Web of science, Cochrane Library and the ' 'Epistemonikos COVID-19 Living Overview of Evidence database (L.OVE) were searched to ' 'aggregate currently published studies. Cochrane risk of bias tool and ROBINS-I tool were used ' 'to assess the risk of bias of randomized controlled study and cohort study respectively. Odds ' 'radios (ORs) with 95% confidence interval (CIs) were combined for dichotomous variables. ' 'Publication bias was assessed by Egger’s test and funnel plots.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>A total of 184 articles were retrieved from the included databases ' 'and 17 studies were included into the final analysis. Pooled analysis showed that azvudine ' 'significantly reduced mortality risk in COVID-19 patients compared with controls (OR: 0.41, ' '95%CI 0.31–0.54, <jats:italic>p</jats:italic>\u2009&lt;\u20090.001). Besides, either mild to ' 'moderate or severe COVID-19 patients could benefit from azvudine administration. There was no ' 'significant difference in the incidence of ICU admission (OR: 0.90, 95%CI 0.47–1.72, ' '<jats:italic>p</jats:italic>\u2009=\u20090.74) and invasive ventilation (OR: 0.94, 95%CI ' '0.54–1.62, <jats:italic>p</jats:italic>\u2009=\u20090.82) between azvudine and control group. ' 'The incidence of adverse events was similar between azvudine and control (OR: 1.26, 95%CI ' '0.59–2.70, <jats:italic>p</jats:italic>\u2009=\u20090.56).</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusions</jats:title>\n' ' <jats:p>This meta-analysis suggests that azvudine could reduce the mortality ' 'risk of COVID-19 patients, and the safety of administration is acceptable.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Trial registration</jats:title>\n' ' <jats:p>PROSPERO; No.: CRD42023462988; URL: <jats:ext-link ' 'xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" ' 'xlink:href="https://www.crd.york.ac.uk/prospero/">https://www.crd.york.ac.uk/prospero/</jats:ext-link>.</jats:p>\n' ' </jats:sec>', 'DOI': '10.1186/s12985-024-02316-y', 'type': 'journal-article', 'created': {'date-parts': [[2024, 2, 23]], 'date-time': '2024-02-23T19:02:30Z', 'timestamp': 1708714950000}, 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Effectiveness of azvudine in reducing mortality of COVID-19 patients: a systematic review and ' 'meta-analysis', 'prefix': '10.1186', 'volume': '21', 'author': [ {'given': 'Yaqi', 'family': 'Wang', 'sequence': 'first', 'affiliation': []}, {'given': 'Huaiya', 'family': 'Xie', 'sequence': 'additional', 'affiliation': []}, {'given': 'Luo', 'family': 'Wang', 'sequence': 'additional', 'affiliation': []}, {'given': 'Junping', 'family': 'Fan', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ying', 'family': 'Zhang', 'sequence': 'additional', 'affiliation': []}, {'given': 'Siqi', 'family': 'Pan', 'sequence': 'additional', 'affiliation': []}, {'given': 'Wangji', 'family': 'Zhou', 'sequence': 'additional', 'affiliation': []}, {'given': 'Qiaoling', 'family': 'Chen', 'sequence': 'additional', 'affiliation': []}, {'given': 'Xueqi', 'family': 'Liu', 'sequence': 'additional', 'affiliation': []}, {'given': 'Aohua', 'family': 'Wu', 'sequence': 'additional', 'affiliation': []}, {'given': 'Hong', 'family': 'Zhang', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jinglan', 'family': 'Wang', 'sequence': 'additional', 'affiliation': []}, {'given': 'Xinlun', 'family': 'Tian', 'sequence': 'additional', 'affiliation': []}], 'member': '297', 'published-online': {'date-parts': [[2024, 2, 23]]}, 'reference': [ { 'key': '2316_CR1', 'unstructured': 'WHO COVID-19 Dashboard. Geneva: World Health Organization; 2020. ' 'Available online: https://covid19.who.int/'}, { 'key': '2316_CR2', 'doi-asserted-by': 'publisher', 'first-page': '216', 'DOI': '10.3389/fpubh.2020.00216', 'volume': '8', 'author': 'R Keni', 'year': '2020', 'unstructured': 'Keni R, Alexander A, Nayak PG, Mudgal J, Nandakumar K. COVID-19: ' 'emergence, spread, possible treatments, and global burden. Front Public ' 'Health. 2020;8:216.', 'journal-title': 'Front Public Health'}, { 'key': '2316_CR3', 'unstructured': 'Joint prevention and control Mechnism of The State Council for the Novel ' 'Coronavirus Pneumonia. Notice on further optimizing and implementing the ' 'prevention and control measures of the novel coronavirus. ' '[http://www.gov.cn/xinwen/2022-12/07/content_5730443.htm]'}, { 'key': '2316_CR4', 'doi-asserted-by': 'publisher', 'first-page': '2376', 'DOI': '10.1002/jmv.27643', 'volume': '94', 'author': 'D Tian', 'year': '2022', 'unstructured': 'Tian D, Sun Y, Xu H, Ye Q. The emergence and epidemic characteristics of ' 'the highly mutated SARS-CoV-2 Omicron variant. J Med Virol. ' '2022;94:2376–83.', 'journal-title': 'J Med Virol'}, { 'key': '2316_CR5', 'first-page': 'm3379', 'volume': '370', 'author': 'F Lamontagne', 'year': '2020', 'unstructured': 'Lamontagne F, Agarwal A, Rochwerg B, Siemieniuk RA, Agoritsas T, Askie ' 'L, Lytvyn L, Leo YS, Macdonald H, Zeng L, et al. A living WHO guideline ' 'on drugs for covid-19. BMJ. 2020;370:m3379.', 'journal-title': 'BMJ'}, { 'key': '2316_CR6', 'unstructured': 'General Office of the National Health Commission. Notice on including ' 'azovudine tablets into the diagnosis and treatment protocol for COVID-19 ' 'in China. ' '[https://www.gov.cn/zhengce/zhengceku/2022-08/10/content_5704788.htm]'}, { 'key': '2316_CR7', 'doi-asserted-by': 'publisher', 'first-page': '414', 'DOI': '10.1038/s41392-021-00835-6', 'volume': '6', 'author': 'JL Zhang', 'year': '2021', 'unstructured': 'Zhang JL, Li YH, Wang LL, Liu HQ, Lu SY, Liu Y, Li K, Liu B, Li SY, Shao ' 'FM, et al. Azvudine is a thymus-homing anti-SARS-CoV-2 drug effective in ' 'treating COVID-19 patients. Signal Transduct Target Ther. 2021;6:414.', 'journal-title': 'Signal Transduct Target Ther'}, { 'key': '2316_CR8', 'doi-asserted-by': 'crossref', 'unstructured': 'Yu B, Chang J. Azvudine (FNC): a promising clinical candidate for ' 'COVID-19 treatment. Signal Transduct Target Therapy. 2020;5.', 'DOI': '10.1038/s41392-020-00351-z'}, { 'key': '2316_CR9', 'doi-asserted-by': 'crossref', 'unstructured': 'Ren Z, Luo H, Yu Z, Song J, Liang L, Wang L, Wang H, Cui G, Liu Y, Wang ' 'J et al. A randomized, open-label, controlled clinical trial of azvudine ' 'tablets in the treatment of mild and common COVID-19, a pilot study. Adv ' 'Sci. 2020;7.', 'DOI': '10.1002/advs.202001435'}, { 'key': '2316_CR10', 'doi-asserted-by': 'crossref', 'unstructured': 'da Silva RM, Cabral PGA, de Souza SB, Arruda RF, Cabral SPF, de Assis ' 'ALEM, Martins YPM, Tavares CAdA, Viana Junior AB, Chang J et al. Serial ' 'viral load analysis by DDPCR to evaluate FNC efficacy and safety in the ' 'treatment of mild cases of COVID-19. Front Med. 2023;10.', 'DOI': '10.3389/fmed.2023.1143485'}, { 'key': '2316_CR11', 'doi-asserted-by': 'crossref', 'unstructured': 'Cabral P, de Souza S, Silva R, Arruda R, Cabral S, de Assis A, Júnior A, ' 'Degrave W, Moreira A, Silva C et al. Serial viral load analysis by Ddpcr ' 'to evaluate Fnc efficacy and safety in the treatment of moderate cases ' 'of Covid-19. ResearchSquare. 2022.', 'DOI': '10.21203/rs.3.rs-2273657/v1'}, { 'key': '2316_CR12', 'doi-asserted-by': 'crossref', 'unstructured': 'Zong K, Zhou H, Li W, Jiang E, Liu Y, Li S. Azvudine reduces the ' 'in-hospital mortality of COVID-19 patients: a retrospective cohort ' 'study. Acta Pharm Sinica B. 2023.', 'DOI': '10.2139/ssrn.4380058'}, { 'key': '2316_CR13', 'doi-asserted-by': 'crossref', 'unstructured': 'Shen M, Xiao C, Sun Y, Li D, Wu P, Jin L, Wu Q, Dian Y, Meng Y, Zeng F ' 'et al. Real-world effectiveness of azvudine in hospitalized patients ' 'with COVID-19: a retrospective cohort study. medRxiv. 2023.', 'DOI': '10.1101/2023.01.23.23284899'}, { 'key': '2316_CR14', 'doi-asserted-by': 'crossref', 'unstructured': 'Deng G, Li D, Sun Y, Jin L, Zhou Q, Xiao C, Wu Q, Sun H, Dian Y, Zeng F ' 'et al. Real-world effectiveness of azvudine versus ' 'nirmatrelvir-ritonavir in hospitalized patients with COVID-19: a ' 'retrospective cohort study. J Med Virol. 2023;95.', 'DOI': '10.1002/jmv.28756'}, { 'key': '2316_CR15', 'doi-asserted-by': 'crossref', 'unstructured': 'Zhao Q, Zheng B, Han B, Feng P, Xia Z, Jiang H, Ying Y, Zhu J, Fei C, ' 'Xiang J, et al. Is azvudine comparable to nirmatrelvir-ritonavir in ' 'real-world efficacy and safety for hospitalized patients with COVID-19? ' 'A retrospective cohort study. Infect Dis Ther. 2023.', 'DOI': '10.1007/s40121-023-00845-7'}, { 'key': '2316_CR16', 'doi-asserted-by': 'publisher', 'first-page': 'e20153', 'DOI': '10.1016/j.heliyon.2023.e20153', 'volume': '9', 'author': 'Z Chen', 'year': '2023', 'unstructured': 'Chen Z, Tian F. Efficacy and safety of azvudine in patients with ' 'COVID-19: a systematic review and meta-analysis. Heliyon. 2023;9:e20153.', 'journal-title': 'Heliyon'}, { 'key': '2316_CR17', 'doi-asserted-by': 'publisher', 'first-page': 'b2700', 'DOI': '10.1136/bmj.b2700', 'volume': '339', 'author': 'A Liberati', 'year': '2009', 'unstructured': 'Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, ' 'Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for ' 'reporting systematic reviews and meta-analyses of studies that evaluate ' 'healthcare interventions: explanation and elaboration. BMJ. ' '2009;339:b2700.', 'journal-title': 'BMJ'}, { 'key': '2316_CR18', 'doi-asserted-by': 'publisher', 'first-page': 'd5928', 'DOI': '10.1136/bmj.d5928', 'volume': '343', 'author': 'JP Higgins', 'year': '2011', 'unstructured': 'Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic ' 'J, Schulz KF, Weeks L, Sterne JA. The Cochrane collaboration’s tool for ' 'assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.', 'journal-title': 'BMJ'}, { 'key': '2316_CR19', 'doi-asserted-by': 'publisher', 'first-page': 'i4919', 'DOI': '10.1136/bmj.i4919', 'volume': '355', 'author': 'JA Sterne', 'year': '2016', 'unstructured': 'Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, ' 'Henry D, Altman DG, Ansari MT, Boutron I, et al. ROBINS-I: a tool for ' 'assessing risk of bias in non-randomised studies of interventions. BMJ. ' '2016;355:i4919.', 'journal-title': 'BMJ'}, { 'key': '2316_CR20', 'doi-asserted-by': 'publisher', 'first-page': 'e28947', 'DOI': '10.1002/jmv.28947', 'volume': '95', 'author': 'H Yang', 'year': '2023', 'unstructured': 'Yang H, Wang Z, Jiang C, Zhang Y, Zhang Y, Xu M, Zhang Y, Wang Y, Liu X, ' 'An Z, et al. Oral azvudine for mild-to-moderate COVID-19 in high risk, ' 'nonhospitalized adults: results of a real-world study. J Med Virol. ' '2023;95:e28947.', 'journal-title': 'J Med Virol'}, { 'key': '2316_CR21', 'doi-asserted-by': 'crossref', 'unstructured': 'Shao J, Fan R, Guo C, Huang X, Guo R, Zhang F, Hu J, Huang G, Cao L. ' 'Composite interventions on outcomes of severely and critically ill ' 'patients with COVID-19 in Shanghai, China. Microorganisms. 2023;11.', 'DOI': '10.1101/2023.05.10.23289325'}, { 'key': '2316_CR22', 'doi-asserted-by': 'publisher', 'first-page': '103', 'DOI': '10.1097/CP9.0000000000000049', 'volume': '8', 'author': 'R Chen', 'year': '2023', 'unstructured': 'Chen R, Guo Y, Deng S, Wang J, Gao M, Han H, Wang L, Jiang H, Huang K. ' 'All-cause mortality in moderate and severe COVID-19 patients with ' 'myocardial injury receiving versus not receiving azvudine: a propensity ' 'score-matched analysis. Cardiol Plus. 2023;8:103–10.', 'journal-title': 'Cardiol Plus'}, { 'key': '2316_CR23', 'doi-asserted-by': 'publisher', 'first-page': 'e29007', 'DOI': '10.1002/jmv.29007', 'volume': '95', 'author': 'S Shang', 'year': '2023', 'unstructured': 'Shang S, Fu B, Geng Y, Zhang J, Zhang D, Xiao F, Sheng Z, Zhai J, Li W, ' 'Chen X, et al. Azvudine therapy of common COVID-19 in hemodialysis ' 'patients. J Med Virol. 2023;95:e29007.', 'journal-title': 'J Med Virol'}, { 'key': '2316_CR24', 'doi-asserted-by': 'crossref', 'unstructured': 'Chen W, Xu H, Hong L, Yang R, Peng C, Wang G, Li W. Oral azvudine (FNC) ' 'tablets in patients infected with SARS-CoV-2 Omicron variant. A ' 'retrospective cohort study. 2023.', 'DOI': '10.1101/2023.01.05.23284180'}, { 'key': '2316_CR25', 'doi-asserted-by': 'crossref', 'unstructured': 'Han X, Han X, Wang Y, Wang Z, Cui J, Zhao W, Mo G, Liu Y, Zheng M, Xie F ' 'et al. Effectiveness and optimal timing of azvudine in COVID-19 ' 'patients: a multi-center retrospective study in Beijing, China. ' 'ResearchSquare. 2023.', 'DOI': '10.21203/rs.3.rs-3145554/v1'}, { 'key': '2316_CR26', 'doi-asserted-by': 'publisher', 'first-page': 'E24', 'DOI': '10.1016/j.jinf.2023.05.012', 'volume': '87', 'author': 'Y Dian', 'year': '2023', 'unstructured': 'Dian Y, Meng Y, Sun Y, Deng G, Zeng F. Azvudine versus paxlovid for oral ' 'treatment of COVID-19 in Chinese patients with pre-existing ' 'comorbidities. J Infect. 2023;87:E24–7.', 'journal-title': 'J Infect'}, { 'key': '2316_CR27', 'doi-asserted-by': 'publisher', 'first-page': 'E158', 'DOI': '10.1016/j.jinf.2023.03.023', 'volume': '86', 'author': 'Y Gao', 'year': '2023', 'unstructured': 'Gao Y, Luo Z, Ren S, Duan Z, Han Y, Liu H, Gao Z, Zhang X, Hu Z, Ma Y. ' 'Antiviral effect of azvudine and nirmatrelvir-ritonavir among ' 'hospitalized patients with COVID-19. J Infect. 2023;86:E158–60.', 'journal-title': 'J Infect'}, { 'key': '2316_CR28', 'doi-asserted-by': 'crossref', 'unstructured': 'Zhou Y, Liu Y, Jiang L, Zhang R, Zhang H, Shi Q, Yang Z, Mao Y, Liu S, ' 'Yang Z, et al. Azvudine and nirmatrelvir–ritonavir in hospitalised ' 'patients with moderate–to–severe covid–19: emulation of a randomised ' 'target trial. SSRN; 2023.', 'DOI': '10.2139/ssrn.4478199'}, { 'key': '2316_CR29', 'doi-asserted-by': 'crossref', 'unstructured': 'Sun Y, Jin L, Dian Y, Shen M, Zeng F, Chen X, Deng G. Oral azvudine for ' 'hospitalised patients with COVID-19 and pre-existing conditions: a ' 'retrospective cohort study. Eclinicalmedicine. 2023;59.', 'DOI': '10.1016/j.eclinm.2023.101981'}, { 'key': '2316_CR30', 'doi-asserted-by': 'publisher', 'first-page': '1213', 'DOI': '10.1016/S0140-6736(22)01586-0', 'volume': '400', 'author': 'CKH Wong', 'year': '2022', 'unstructured': 'Wong CKH, Au ICH, Lau KTK, Lau EHY, Cowling BJ, Leung GM. Real-world ' 'effectiveness of molnupiravir and nirmatrelvir plus ritonavir against ' 'mortality, hospitalisation, and in-hospital outcomes among ' 'community-dwelling, ambulatory patients with confirmed SARS-CoV-2 ' 'infection during the omicron wave in Hong Kong: an observational study. ' 'Lancet. 2022;400:1213–22.', 'journal-title': 'Lancet'}, { 'key': '2316_CR31', 'doi-asserted-by': 'publisher', 'first-page': '1681', 'DOI': '10.1016/S1473-3099(22)00507-2', 'volume': '22', 'author': 'CKH Wong', 'year': '2022', 'unstructured': 'Wong CKH, Au ICH, Lau KTK, Lau EHY, Cowling BJ, Leung GM. Real-world ' 'effectiveness of early molnupiravir or nirmatrelvir-ritonavir in ' 'hospitalised patients with COVID-19 without supplemental oxygen ' 'requirement on admission during Hong Kong’s omicron BA.2 wave: a ' 'retrospective cohort study. Lancet Infect Dis. 2022;22:1681–93.', 'journal-title': 'Lancet Infect Dis'}, { 'key': '2316_CR32', 'doi-asserted-by': 'publisher', 'first-page': 'e28441', 'DOI': '10.1002/jmv.28441', 'volume': '95', 'author': 'B Amani', 'year': '2023', 'unstructured': 'Amani B, Amani B. Efficacy and safety of nirmatrelvir/ritonavir ' '(paxlovid) for COVID-19: a rapid review and meta-analysis. J Med Virol. ' '2023;95:e28441.', 'journal-title': 'J Med Virol'}, { 'key': '2316_CR33', 'doi-asserted-by': 'publisher', 'first-page': 'e28471', 'DOI': '10.1002/jmv.28471', 'volume': '95', 'author': 'HA Cheema', 'year': '2023', 'unstructured': 'Cheema HA, Jafar U, Sohail A, Shahid A, Sahra S, Ehsan M, Athar F, Shah ' 'J, Sah R. Nirmatrelvir-Ritonavir for the treatment of COVID-19 patients: ' 'a systematic review and meta-analysis. J Med Virol. 2023;95:e28471.', 'journal-title': 'J Med Virol'}, { 'key': '2316_CR34', 'doi-asserted-by': 'crossref', 'unstructured': 'Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, ' 'Holden KA, Read JM, Dondelinger F, Carson G et al. Features of 20 133 UK ' 'patients in hospital with covid-19 using the ISARIC WHO clinical ' 'characterisation protocol: prospective observational cohort study. BMJ. ' '2020;369m1985.', 'DOI': '10.1136/bmj.m1985'}, { 'key': '2316_CR35', 'doi-asserted-by': 'publisher', 'first-page': '701', 'DOI': '10.1001/jamainternmed.2022.1827', 'volume': '182', 'author': 'VT Chu', 'year': '2022', 'unstructured': 'Chu VT, Schwartz NG, Donnelly MAP, Chuey MR, Soto R, Yousaf AR, ' 'Schmitt-Matzen EN, Sleweon S, Ruffin J, Thornburg N, et al. Comparison ' 'of home antigen testing with RT-PCR and viral culture during the course ' 'of SARS-CoV-2 infection. JAMA Intern Med. 2022;182:701–9.', 'journal-title': 'JAMA Intern Med'}, { 'key': '2316_CR36', 'doi-asserted-by': 'publisher', 'first-page': '509', 'DOI': '10.1016/j.therap.2022.03.005', 'volume': '77', 'author': 'F Lemaitre', 'year': '2022', 'unstructured': 'Lemaitre F, Grégoire M, Monchaud C, Bouchet S, Saint-Salvi B, Polard E. ' 'Management of drug-drug interactions with nirmatrelvir/ritonavir in ' 'patients treated for Covid-19: guidelines from the French society of ' 'pharmacology and therapeutics (SFPT). Therapie. 2022;77:509–21.', 'journal-title': 'Therapie'}, { 'key': '2316_CR37', 'doi-asserted-by': 'publisher', 'first-page': '8554', 'DOI': '10.1021/acs.jmedchem.0c00940', 'volume': '63', 'author': 'L Sun', 'year': '2020', 'unstructured': 'Sun L, Peng Y, Yu W, Zhang Y, Liang L, Song C, Hou J, Qiao Y, Wang Q, ' 'Chen J, et al. Mechanistic insight into antiretroviral potency of ' '2’-Deoxy-2’-β-fluoro-4’-azidocytidine (FNC) with a long-lasting effect ' 'on HIV-1 prevention. J Med Chem. 2020;63:8554–66.', 'journal-title': 'J Med Chem'}], 'container-title': 'Virology Journal', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1186/s12985-024-02316-y.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1186/s12985-024-02316-y/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1186/s12985-024-02316-y.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2024, 2, 23]], 'date-time': '2024-02-23T19:03:00Z', 'timestamp': 1708714980000}, 'score': 1, 'resource': {'primary': {'URL': 'https://virologyj.biomedcentral.com/articles/10.1186/s12985-024-02316-y'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2024, 2, 23]]}, 'references-count': 37, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2024, 12]]}}, 'alternative-id': ['2316'], 'URL': 'http://dx.doi.org/10.1186/s12985-024-02316-y', 'relation': {}, 'ISSN': ['1743-422X'], 'subject': ['Infectious Diseases', 'Virology'], 'container-title-short': 'Virol J', 'published': {'date-parts': [[2024, 2, 23]]}, 'assertion': [ { 'value': '27 November 2023', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '12 February 2024', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '23 February 2024', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, {'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Declarations'}}, { 'value': 'Not applicable.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'Not applicable.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent for publication'}}, { 'value': 'The authors declare no competing interests.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '46'}