{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T02:10:06Z","timestamp":1742955006119,"version":"3.40.3"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001866","name":"Fonds National de la Recherche Luxembourg","doi-asserted-by":"publisher","award":["COVID-19\/15929296","COVID-19\/15929296","COVID-19\/15929296","COVID-19\/15929296","COVID-19\/15929296"],"award-info":[{"award-number":["COVID-19\/15929296","COVID-19\/15929296","COVID-19\/15929296","COVID-19\/15929296","COVID-19\/15929296"]}],"id":[{"id":"10.13039\/501100001866","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>In summer 2021, while the Delta variant was predominant in many European countries, Luxembourg experienced a large outbreak of the P.1.17.1 SARS-CoV-2 Gamma variant. This surge coincided with the introduction of digital COVID-19 certificates and eased restrictions prior to national holiday festivities. We investigated the molecular and epidemiological factors contributing to SARS-CoV-2 Gamma transmission. All laboratory SARS-CoV-2 confirmed cases were interviewed by contact tracing teams on exposures at nightlife venues, family gatherings, schools, and workplaces. Gamma sublineages were investigated through environmental wastewater surveillance, in addition to whole genome sequencing of clinical data. Infection clusters were analysed combining phylogenetic with epidemiological exposures. From June 22 to August 12, 2021, we identified 1,049 cases of the Gamma P.1.17.1 sublineage, representing 39.2% of all sequenced cases. Initially, nightlife was the most frequent source setting (49.1%) with young adults accounting for 92.3% of these cases. Later, transmission shifted towards family (30.4%) setting with a corresponding increase in the age distribution. The C26645T mutation in the M-protein was associated with attending specific nightclub venues. Notably, 96.8% of cases were in unvaccinated individuals, and while P.1.17.1 was also detected in neighboring countries, 75.6% of the sequences submitted to GISAID were from Luxembourg. The study suggests the role of nightlife and low population immunity in driving the summer surge of SARS-CoV-2 among young adults, with digital certificates showing minimal impact on transmission. Sequencing of clinical and wastewater samples in combination with contact tracing was crucial to inform the outbreak investigation.<\/jats:p>","DOI":"10.1038\/s41598-025-94323-4","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T01:51:39Z","timestamp":1742953899000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nightlife and low immunity drove transmission of SARS-CoV-2 gamma in Luxembourg, 2021"],"prefix":"10.1038","volume":"15","author":[{"given":"Yolanda Pires","family":"Afonso","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dritan","family":"Bejko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corinna","family":"Ernst","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conny","family":"Huberty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anke","family":"Wienecke-Baldacchino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sibel","family":"Berger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malte","family":"Herold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9cile","family":"Walczak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie","family":"Ogorzaly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Vergison","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00ebl","family":"Mossong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"94323_CR1","unstructured":"WHO. WHO Coronavirus (COVID-19) Dashboard. https:\/\/covid19.who.int\/"},{"key":"94323_CR2","doi-asserted-by":"crossref","unstructured":"Campbell, F. et al. Increased transmissibility and global spread of SARS-CoV-2 variants of concern as at June 2021. Eurosurveillance 26 (2021).","DOI":"10.2807\/1560-7917.ES.2021.26.24.2100509"},{"key":"94323_CR3","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1038\/s41586-021-03471-w","volume":"593","author":"S Cele","year":"2021","unstructured":"Cele, S. et al. Escape of SARS-CoV-2 501Y.V2 from neutralization by convalescent plasma. Nature 593, 142\u2013146 (2021).","journal-title":"Nature"},{"key":"94323_CR4","unstructured":"Funk, T. et al. Characteristics of SARS-CoV-2 variants of concern B.1.1.7, B.1.351 or P.1: data from seven EU\/EEA countries, weeks 38\/2020 to 10\/202. Eurosurveillance 26(16), 2100348 (2021)."},{"key":"94323_CR5","unstructured":"WHO. WHO Announces Simple, Easy-to-Say Labels for SARS-CoV-2 Variants of Interest and Concern. (2021). https:\/\/www.who.int\/news\/item\/31-05-2021-who-announces-simple-easy-to-say-labels-for-sars-cov-2-variants-of-interest-and-concern"},{"key":"94323_CR6","doi-asserted-by":"crossref","first-page":"eabg3055","DOI":"10.1126\/science.abg3055","volume":"372","author":"NG Davies","year":"2021","unstructured":"Davies, N. G. et al. Estimated transmissibility and impact of SARS-CoV-2 lineage B.1.1.7 in England. Science 372, eabg3055 (2021).","journal-title":"Science"},{"key":"94323_CR7","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1038\/s41586-021-03402-9","volume":"592","author":"H Tegally","year":"2021","unstructured":"Tegally, H. et al. Detection of a SARS-CoV-2 variant of concern in South Africa. Nature 592, 438\u2013443 (2021).","journal-title":"Nature"},{"key":"94323_CR8","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1126\/science.abh2644","volume":"372","author":"NR Faria","year":"2021","unstructured":"Faria, N. R. et al. Genomics and epidemiology of the P.1 SARS-CoV-2 lineage in Manaus, Brazil. Science 372, 815\u2013821 (2021).","journal-title":"Science"},{"key":"94323_CR9","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1038\/s41586-021-03944-y","volume":"599","author":"P Mlcochova","year":"2021","unstructured":"Mlcochova, P. et al. SARS-CoV-2 B.1.617.2 delta variant replication and immune evasion. Nature 599, 114\u2013119 (2021).","journal-title":"Nature"},{"key":"94323_CR10","first-page":"2100256","volume":"26","author":"DJ Grint","year":"2021","unstructured":"Grint, D. J. et al. Case fatality risk of the SARS-CoV-2 variant of concern B.1.1.7 in England, 16 November to 5 February. Euro. Surveill Bull. Eur. Sur Mal Transm Eur. Commun. Dis. Bull. 26, 2100256 (2021).","journal-title":"Euro. Surveill Bull. Eur. Sur Mal Transm Eur. Commun. Dis. Bull."},{"key":"94323_CR11","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1186\/s12879-022-07657-z","volume":"22","author":"M Stepanova","year":"2022","unstructured":"Stepanova, M. et al. The impact of variants and vaccination on the mortality and resource utilization of hospitalized patients with COVID-19. BMC Infect. Dis. 22, 702 (2022).","journal-title":"BMC Infect. Dis."},{"key":"94323_CR12","first-page":"2300048","volume":"28","author":"T Nyberg","year":"2023","unstructured":"Nyberg, T. et al. A standardised protocol for relative SARS-CoV-2 variant severity assessment, applied to Omicron BA.1 and delta in six European countries, October 2021 to February 2022. Euro. Surveill Bull. Eur. Sur Mal Transm Eur. Commun. Dis. Bull. 28, 2300048 (2023).","journal-title":"Euro. Surveill Bull. Eur. Sur Mal Transm Eur. Commun. Dis. Bull."},{"key":"94323_CR13","doi-asserted-by":"crossref","first-page":"eabd9338","DOI":"10.1126\/science.abd9338","volume":"371","author":"JM Brauner","year":"2021","unstructured":"Brauner, J. M. et al. Inferring the effectiveness of government interventions against COVID-19. Science 371, eabd9338 (2021).","journal-title":"Science"},{"key":"94323_CR14","doi-asserted-by":"crossref","unstructured":"Naveca, F. G. COVID-19 in Amazonas, Brazil, was driven by the persistence of endemic lineages and P.1 emergence. Nat. Med. 27, 1230\u20131238 (2021).","DOI":"10.1038\/s41591-021-01378-7"},{"key":"94323_CR15","unstructured":"WHO. Tracking SARS-CoV-2 Variants. https:\/\/www.who.int\/en\/activities\/tracking-SARS-CoV-2-variants"},{"key":"94323_CR16","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1038\/s41577-021-00556-5","volume":"21","author":"RK Gupta","year":"2021","unstructured":"Gupta, R. K. & Will SARS-CoV-2 variants of concern affect the promise of vaccines? Nat. Rev. Immunol. 21, 340\u2013341 (2021).","journal-title":"Nat. Rev. Immunol."},{"key":"94323_CR17","doi-asserted-by":"crossref","first-page":"245","DOI":"10.4269\/ajtmh.21-1264","volume":"107","author":"AP Zavascki","year":"2022","unstructured":"Zavascki, A. P. et al. Evaluation of clinical course of gamma (P.1) variant of concern versus lineages in hospitalized patients with COVID-19 in a reference center in Brazil. Am. J. Trop. Med. Hyg. 107, 245\u2013251 (2022).","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"94323_CR18","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.ijid.2021.08.003","volume":"111","author":"CKV Nonaka","year":"2021","unstructured":"Nonaka, C. K. V. et al. SARS-CoV-2 variant of concern P.1 (Gamma) infection in young and middle-aged patients admitted to the intensive care units of a single hospital in Salvador, Northeast Brazil, February 2021. Int. J. Infect. Dis. 111, 47\u201354 (2021).","journal-title":"Int. J. Infect. Dis."},{"key":"94323_CR19","unstructured":"Le Gouvernement du Grand-Duch\u00e9 de Luxembourg. Version Consolid\u00e9e Applicable Au 01\/02\/2021: Loi Du 17 Juillet 2020 Portant Introduction d\u2019une S\u00e9rie de Mesures de Lutte Contre La Pand\u00e9mie Covid-19. (2021). https:\/\/legilux.public.lu\/eli\/etat\/leg\/loi\/2020\/07\/17\/a624\/consolide\/20210201"},{"key":"94323_CR20","unstructured":"Gangavarapu, K. et al. P.1.17.1 Lineage Report. https:\/\/outbreak.info\/situation-reports?xmin=2022-07-17&xmax=2023-01-17&pango=P.1.17.1"},{"key":"94323_CR21","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.3201\/eid2805.212019","volume":"28","author":"J Koopsen","year":"2022","unstructured":"Koopsen, J. et al. Epidemiologic and genomic analysis of SARS-CoV-2 delta variant Superspreading event in nightclub, the Netherlands, June 2021. Emerg. Infect. Dis. 28, 1012\u20131016 (2022).","journal-title":"Emerg. Infect. Dis."},{"key":"94323_CR22","doi-asserted-by":"crossref","first-page":"645","DOI":"10.3201\/eid2702.204443","volume":"27","author":"N Muller","year":"2020","unstructured":"Muller, N. et al. Severe acute respiratory syndrome coronavirus 2 outbreak related to a nightclub, Germany, 2020. Emerg. Infect. Dis. 27, 645\u2013648 (2020).","journal-title":"Emerg. Infect. Dis."},{"key":"94323_CR23","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.3201\/eid2610.202573","volume":"26","author":"CR Kang","year":"2020","unstructured":"Kang, C. R. et al. Coronavirus disease exposure and spread from nightclubs, South Korea. Emerg. Infect. Dis. 26, 2499\u20132501 (2020).","journal-title":"Emerg. Infect. Dis."},{"key":"94323_CR24","unstructured":"Picard, G. Investigation de cas group\u00e9s d\u2019infections \u00e0 SARS-CoV-2 dans la station baln\u00e9aire de Quiberon, Bretagne, Juillet-Ao\u00fbt 2020 \/ Investigation of cluster of SARS-CoV-2 infections in the seaside resort of quiberon, Brittany, France, July-August. (2020)."},{"key":"94323_CR25","doi-asserted-by":"crossref","unstructured":"Brandal, L. T. et al. Outbreak caused by the SARS-CoV-2 Omicron variant in Norway, November to December 2021. Eurosurveillance 26, (2021).","DOI":"10.2807\/1560-7917.ES.2021.26.50.2101147"},{"key":"94323_CR26","doi-asserted-by":"crossref","first-page":"1183877","DOI":"10.3389\/fmicb.2023.1183877","volume":"14","author":"BMJW van der Veer","year":"2023","unstructured":"van der Veer, B. M. J. W. et al. SARS-CoV-2 transmission dynamics in bars, restaurants, and nightclubs. Front. Microbiol. 14, 1183877 (2023).","journal-title":"Front. Microbiol."},{"key":"94323_CR27","doi-asserted-by":"crossref","unstructured":"Brown, C. M. et al. July. Outbreak of SARS-CoV-2 Infections, including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings \u2014 Barnstable County, Massachusetts, 70, (2021). (2021).","DOI":"10.15585\/mmwr.mm7031e2"},{"key":"94323_CR28","doi-asserted-by":"crossref","first-page":"310","DOI":"10.3201\/eid2701.203480","volume":"27","author":"NVV Chau","year":"2021","unstructured":"Chau, N. V. V. et al. Superspreading event of SARS-CoV-2 infection at a bar, Ho Chi Minh City, Vietnam. Emerg. Infect. Dis. 27, 310\u2013314 (2021).","journal-title":"Emerg. Infect. Dis."},{"key":"94323_CR29","doi-asserted-by":"crossref","first-page":"e230589","DOI":"10.1001\/jamanetworkopen.2023.0589","volume":"6","author":"T Imamura","year":"2023","unstructured":"Imamura, T. et al. Transmission of COVID-19 in nightlife, household, and health care settings in Tokyo, Japan, in 2020. JAMA Netw. Open. 6, e230589 (2023).","journal-title":"JAMA Netw. Open."},{"key":"94323_CR30","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1093\/tbm\/ibab059","volume":"11","author":"HK Allen","year":"2021","unstructured":"Allen, H. K., Cohen-Winans, S., Armstrong, K., Clark, N. C. & Ford, M. A. COVID-19 exposure and diagnosis among college student drinkers: links to alcohol use behavior, motives, and context. Transl Behav. Med. 11, 1348\u20131353 (2021).","journal-title":"Transl Behav. Med."},{"key":"94323_CR31","doi-asserted-by":"crossref","unstructured":"Gurrieri, L., Fairbairn, C. E., Sayette, M. A. & Bosch, N. Alcohol narrows physical distance between strangers. Proc. Natl. Acad. Sci. 118, e2101937118 (2021).","DOI":"10.1073\/pnas.2101937118"},{"key":"94323_CR32","doi-asserted-by":"crossref","first-page":"42","DOI":"10.15288\/jsad.2021.82.42","volume":"82","author":"N Fitzgerald","year":"2021","unstructured":"Fitzgerald, N. et al. Managing COVID-19 transmission risks in bars: an interview and observation study. J. Stud. Alcohol Drugs. 82, 42\u201354 (2021).","journal-title":"J. Stud. Alcohol Drugs"},{"key":"94323_CR33","doi-asserted-by":"crossref","first-page":"e211085","DOI":"10.1001\/jamanetworkopen.2021.1085","volume":"4","author":"P Poletti","year":"2021","unstructured":"Poletti, P. et al. Association of age with likelihood of developing symptoms and critical disease among close contacts exposed to patients with confirmed SARS-CoV-2 infection in Italy. JAMA Netw. Open. 4, e211085 (2021).","journal-title":"JAMA Netw. Open."},{"key":"94323_CR34","doi-asserted-by":"crossref","first-page":"3942","DOI":"10.1038\/s41467-022-31394-1","volume":"13","author":"M Oliu-Barton","year":"2022","unstructured":"Oliu-Barton, M. et al. The effect of COVID certificates on vaccine uptake, health outcomes, and the economy. Nat. Commun. 13, 3942 (2022).","journal-title":"Nat. Commun."},{"key":"94323_CR35","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1016\/S2468-2667(21)00273-5","volume":"7","author":"MC Mills","year":"2022","unstructured":"Mills, M. C. & R\u00fcttenauer, T. The effect of mandatory COVID-19 certificates on vaccine uptake: synthetic-control modelling of six countries. Lancet Public. Health. 7, e15\u2013e22 (2022).","journal-title":"Lancet Public. Health"},{"key":"94323_CR36","doi-asserted-by":"crossref","unstructured":"Dinnes, J. et al. Rapid, point-of-care antigen tests for diagnosis of SARS-CoV-2 infection. Cochrane Database Syst. Rev. (2022). (2022).","DOI":"10.1002\/14651858.CD013705.pub3"},{"key":"94323_CR37","doi-asserted-by":"crossref","first-page":"2734","DOI":"10.3390\/v14122734","volume":"14","author":"LV Moen","year":"2022","unstructured":"Moen, L. V., Vollan, H. S., Br\u00e5te, J., Hungnes, O. & Bragstad, K. Molecular epidemiology of the Norwegian SARS-CoV-2 delta lineage AY.63. Viruses 14, 2734 (2022).","journal-title":"Viruses"},{"key":"94323_CR38","doi-asserted-by":"crossref","unstructured":"Alizon, S. et al. Rapid spread of the SARS-CoV-2 Delta variant in some French regions, June 2021. Eurosurveillance 26, (2021).","DOI":"10.2807\/1560-7917.ES.2021.26.28.2100573"},{"key":"94323_CR39","doi-asserted-by":"crossref","first-page":"107970","DOI":"10.1016\/j.jmgm.2021.107970","volume":"107","author":"M Bello","year":"2021","unstructured":"Bello, M., Hasan, M. K. & Hussain, N. Energetic and structural basis for the differences in infectivity between the wild-type and mutant Spike proteins of SARS-CoV-2 in the Mexican population. J. Mol. Graph Model. 107, 107970 (2021).","journal-title":"J. Mol. Graph Model."},{"key":"94323_CR40","doi-asserted-by":"crossref","first-page":"4659","DOI":"10.1038\/s41598-021-84053-8","volume":"11","author":"Y Sixto-L\u00f3pez","year":"2021","unstructured":"Sixto-L\u00f3pez, Y. et al. Structural insights into SARS-CoV-2 Spike protein and its natural mutants found in Mexican population. Sci. Rep. 11, 4659 (2021).","journal-title":"Sci. Rep."},{"key":"94323_CR41","unstructured":"Le Gouvernement du Grand-Duch\u00e9 de Luxembourg. Version Consolid\u00e9e Applicable Au 13\/06\/2021: Loi Du 17 Juillet 2020 Portant Introduction d\u2019une S\u00e9rie de Mesures de Lutte Contre La Pand\u00e9mie Covid-19. (2021). https:\/\/legilux.public.lu\/eli\/etat\/leg\/loi\/2020\/07\/17\/a624\/consolide\/20210613"},{"key":"94323_CR42","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3390\/geriatrics8010019","volume":"8","author":"C Ernst","year":"2023","unstructured":"Ernst, C. et al. A molecular and epidemiological investigation of a large SARS-CoV-2 outbreak in a Long-Term care facility in Luxembourg, 2021. Geriatr. Basel Switz. 8, 19 (2023).","journal-title":"Geriatr. Basel Switz."},{"key":"94323_CR43","doi-asserted-by":"crossref","first-page":"3018","DOI":"10.3390\/w13213018","volume":"13","author":"M Herold","year":"2021","unstructured":"Herold, M. et al. Genome sequencing of SARS-CoV-2 allows monitoring of variants of concern through wastewater. Water 13, 3018 (2021).","journal-title":"Water"},{"key":"94323_CR44","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1186\/s13059-022-02805-9","volume":"23","author":"JA Baaijens","year":"2022","unstructured":"Baaijens, J. A. et al. Lineage abundance Estimation for SARS-CoV-2 in wastewater using transcriptome quantification techniques. Genome Biol. 23, 236 (2022).","journal-title":"Genome Biol."},{"key":"94323_CR45","doi-asserted-by":"crossref","first-page":"3094","DOI":"10.1093\/bioinformatics\/bty191","volume":"34","author":"H Li","year":"2018","unstructured":"Li, H. Minimap2: pairwise alignment for nucleotide sequences. Bioinformatics 34, 3094\u20133100 (2018).","journal-title":"Bioinformatics"},{"key":"94323_CR46","unstructured":"Pathogenwatch A Global Platform for Genomic Surveillance. https:\/\/pathogen.watch\/."},{"key":"94323_CR47","doi-asserted-by":"crossref","first-page":"W293","DOI":"10.1093\/nar\/gkab301","volume":"49","author":"I Letunic","year":"2021","unstructured":"Letunic, I. & Bork, P. Interactive tree of life (iTOL) v5: an online tool for phylogenetic tree display and annotation. Nucleic Acids Res. 49, W293\u2013W296 (2021).","journal-title":"Nucleic Acids Res."},{"key":"94323_CR48","doi-asserted-by":"crossref","first-page":"4121","DOI":"10.1093\/bioinformatics\/bty407","volume":"34","author":"J Hadfield","year":"2018","unstructured":"Hadfield, J. et al. Nextstrain: real-time tracking of pathogen evolution. Bioinforma Oxf. Engl. 34, 4121\u20134123 (2018).","journal-title":"Bioinforma Oxf. Engl."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94323-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94323-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94323-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T01:53:09Z","timestamp":1742953989000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94323-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["94323"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-94323-4","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,25]]},"assertion":[{"value":"21 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Ethical approval was not obtained for this study as it was based on the analysis of routinely collected anonymised surveillance data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical statement"}}],"article-number":"10293"}}