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Background: Covid-19 is still pandemic with population vaccination, including among children, remaining the mainstay for hastening the exit from the pandemic. The article provides an insight in Malta's national paediatric vaccination modus operandi, vaccination uptake, and epidemiological trends while exploring geographical social inequalities among the ≤ 15 years cohort up till end of August 2022. Methods: The Vaccination Coordination Unit in Malta's only regional hospital provided an account of the strategic roll-out along with anonymised cumulative vaccination doses by age band and district. Descriptive and multivariant logistic regression analyses were performed. Results: By mid-August 2022, 44.18% of the under 15's population had received at least 1 vaccine dose. A bi-directional relationship was observed between increased cumulative vaccination and reported Covid-19 cases until early 2022. Central vaccination hubs were set up with invitation letters and SMSs sent to parents. Children residing in the Southern Harbour district (OR: 0.42, P < 0.01) had the highest full vaccination uptake (46.66%) as opposed to the Gozo district (lowest at 27.23%; OR: 0.3, P = 0.01). Conclusion: Successful paediatric vaccination is not only dependent on easily accessible vaccination but also on vaccine effectiveness against variants, as well as population characteristics, with potential geographical social inequalities hindering uptake.
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Background Disease burden can be quantified by mortality. The European Islands of Malta experienced a seesaw of Covid-19 surges in mortality and cases across the pandemic. The study aims to assess the impact of Covid-19 mortality across the four phases dominated by different variants while considering the vaccination coverage among the Malta population. Methods Covid-19 epidemiological data was obtained up till end of February 2022 from the websites of the Malta Ministry of Health and the European Centre for Disease Prevention and Control. Data was categorised into the four periods according to reported dominant Covid-19 variant. The Years of life lost (YLL) and Case-Fatality-Ratio (CFR) for each period were estimated. Correlations were performed between mortality and vaccinated age-groups. Results The original Covid-19 period (54 weeks) had the highest YLL (6633.53), followed by the Omicron variant period (12 weeks;2,692.17). The Alpha variant period (7 weeks) had the highest CFR (1.89) followed by the Original Covid-19 (1.37). A significant negative correlation was present between two dose vaccination and the 60-69 years (p = 0.01), 70-79 years (p = <0.01), and 80+ years (p = <0.01) age groups, while a positive correlation was present between the booster dose and the 60-69 years (p = 0.01) age group. Conclusions Covid-19 variant’s infectivity, transmissibility, and the effectiveness of the vaccine against the variant play an important role in the ultimate outcome. Reducing mortality by embracing mass vaccination that targets current variants along with other non-pharmaceutical interventions remains paramount. Key messages • Mortality is an indicator for assessing the burden of an emerging variant within a population. • The effectiveness of vaccination against emerging variants plays a role in reducing mortality rates.
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INTRODUCTION Vaccine hesitancy is a chronic public health threat. This study was carried out to ascertain Maltese healthcare workers’ hesitancy to COVID-19 vaccination and correlate this with influenza vaccine uptake. METHODS A short, anonymous questionnaire was sent out to all of Malta’s government sector healthcare workers via the service’s standard email services (11-19/09/2020). A total of 9,681 questionnaires were posted electronically, with 10.4% response. RESULTS The proportion of Maltese healthcare workers who “will take” the influenza vaccine increased significantly. Doctors had the highest baseline uptake and highest likely influenza vaccine uptake next winter. The likely/undecided/unlikely to take a COVID-19 vaccine were 52/22/26% respectively. Males were likelier to take the vaccine. Doctors had the highest projected likelihood to take vaccines. Likelihood of taking COVID-19 vaccine was directly related to the likelihood of influenza vaccination. Concerns raised were related to insufficient knowledge about such a novel vaccine, especially unknown long term side effects. DISCUSSION The anticipated increased uptake of influenza vaccine is probably due to increased awareness of respiratory viral illness. Doctors may have higher vaccine uptakes due to greater awareness and knowledge of vaccine safety. The proportions of who are likely/undecided/unlikely (half, quarter, quarter respectively) to take a COVID-19 are similar to rates reported in other countries. The higher male inclination to take the vaccine may be due the innate male propensity for perceived risk taking. Shared COVID-19 with influenza vaccine hesitancy implies an innate degree of vaccine reluctance/hesitancy and not merely reluctance based on novel vaccine knowledge gap.
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Introduction: COVID-19 spread globally, including across the Balkans, resulting in different morbidity and mortality outcomes in different countries. The aim of this study was to review the impact of COVID-19 over 17 months with regards to pandemic progression, implemented mitigation strategies, and COVID-19 vaccination programs across the Balkan countries, while identifying any valuable pieces of information acquired serendipitously throughout the pandemic that can be implemented in future action plans. Methods: A longitudinal ecological study was conducted across the Balkan countries from the onset of COVID-19 in these countries up until 1st August 2021. Epidemiological data was obtained from Our World in Data databases, while Ministry of Health websites for each respective country as well as local newspapers were utilized to review COVID-19-related mitigation and vaccination strategies. Comparisons of vaccination coverage, incident cases and mortality were made across neighboring countries, by converting the respective data to rates per 100,000 population for each country using Microsoft® Excel for mac (Version 16.59). Results: More than 10 million positive COVID-19 cases and 164,470 deaths were observed across the Balkan countries up until 1st August 2021. Trends in COVID morbidity and mortality outcomes were evident across neighbouring countries. A staggered vaccination rollout was observed, with various rollout speeds, although gradual decline in both morbidity and mortality occurred. Conclusion: Results obtained from this study strongly indicate that COVID-19 outcome for a particular country is not only dependent on the country’s own level of viral transmission, mitigations, and vaccination rates but also on neighbouring countries’ COVID-19 situation. Hence, cross-border governance action and recovery plans are recommended along with targeting vaccination hesitance. © 2021 Tehran University of Medical Sciences.
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BACKGROUND COVID-19 was a global shock, causing challenges to many countries’ healthcare services. This paper provides a summary of Malta’s healthcare system journey during the COVID-19 pandemic with its initial preparedness for COVID-19 pandemic and the impact of COVID-19 on the service during the first 12 months of the pandemic. METHODS A literature search was conducted using Google and reviewing Maltese online newspapers. A comprehensive summary of internal operations conducted at Mater Dei Hospital, the country’s only acute general hospital, was provided by the Chief Operating Officer. RESULTS Several infrastructural changes including the increase in bed capacity and ITU areas were instituted in preparation for the pandemic. The health system showed resilience during the first wave. However, the situation was more precarious during the second wave. The end of December 2020 saw the start of the Covid-19 vaccination rollout, with over 30 health system hubs offering this service across the islands. Simultaneously health professional’s burnout is on the rise as resources and workforce are overstretched. CONCLUSION The collaborative effort between the guidance provided by the Public Health Authorities and the hospital’s multi-disciplinary team have been pinnacle during the pandemic. However, the future of the healthcare system is heavily dependent on the population’s behaviour, timely measures, the vaccination rollout and the type of immunity acquired through vaccination or infection.
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Introduction: Non-communicable diseases (NCDs) have been a global epidemic long before the advent of COVID-19. Understandably, with the onset of COVID-19, health priorities shifted. The aim of this study was to explore the impact of COVID-19 through attitudes and experiences on the health and well-being of the Malta adult population suffering from NCDs, a year into COVID-19. Methods: An anonymous survey was distributed online between February 1 and 26, 2021 using Google Forms(R). This assessed the impact of COVID-19 on medical care, intention to take a COVID-19 vaccine, and whether COVID-19 was acquired. Quantitative and qualitative analyses were performed. Results: Out of the 1,034 participants, 34.82% (95% CI, 31.97-37.77;n = 360) reported to suffer from NCDs (single NCD, n = 276;2 NCDs, n = 56;3 NCDs, n = 28) with 6.94% (95% CI, 4.71-10.09) of these reported acquiring COVID-19. Since COVID-19, the NCD population visited the general practitioners less (47%) than those without NCDs (32%) (p <= 0.001). With a consensus of concern and fear, "I rather skip check-ups than risk getting COVID-19 in waiting room or clinic." Postponement and cancellations of medical appointments were reported: "had to do blood tests privately as health centre was not doing them" and "delayed treatment and still awaiting further appointments that were postponed more than once." The majority intended to take COVID-19 vaccine. Conclusions: It is clear that individuals with NCDs have experienced a general negative effect on their medical care. It's recommended that a dual action strategy is embraced to ensure that both NCDs and COVID-19 are treated simultaneously, leaving no one behind.
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Background COVID-19 vaccination is critical to protect healthcare workers (HCWs) from serious infection. The first vaccine approved for emergency use was the Pfizer-BioNtech vaccine. European countries received their first supplies at the end of December 2020. The European country of Malta started its vaccination roll-out immediately targeting HCWs. The aim of this study was to evaluate side effects. Methods An anonymous online Google Forms survey was disseminated to all HCWs via work e-mail addresses (29th March to 9th April 2021). This gathered demographic data and side-effects regarding pain, redness, and swelling at the injection site, fever, chills, fatigue, muscle/joint pains, headache, vomiting, and diarrhea severity following each dose (Likert scale). Descriptive, comparative, and multiple binary regression analyses were performed. Results There were 1480 responses (response rate 30.30%). The commonest side-effect (SE) was pain at the injection site (88.92% CI95%:87.21-90.42), with the majority reporting it as mild (51%) and moderate (43%). Fatigue reported by 72.97% (CI95%:70.65-75.17), with 42% reporting it as mild and 41% as moderate. Headaches reported by 44.28% (CI95%:41.74-46.80), with 51% claiming to be mild and 34% as moderate. Females had significantly (p = <0.01 respectively) more pain (OR:1.90), redness (OR:2.49), swelling at the injection site (OR:1.33), fever (OR:1.74), chills (OR:2.32), fatigue (OR:2.43), muscle (OR:1.54) and joint pains (OR:2.01), headache (OR:2.07) and vomiting (OR:3.43) when adjusted for age and HCW role. Younger individuals (18-34 years) reported higher SE rates than older adults. Localised SE was reported following both vaccine doses, unlike systemic SE that was mostly reported following second doses. Conclusions Females and young adults appeared to be more susceptible to SE among this study's cohort, however the nature of these SE was mostly mild or moderate. This is encouraging and should allay vaccine apprehension/hesitancy. Key messages Vaccination benefits outweigh the minor side effects experienced. Caring physicians should be notified of the female higher susceptibility to side effects. Vaccination should be encouraged among all eligible population.
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OBJECTIVES: The COVID-19 pandemic has spread throughout the world, including Cyprus, Iceland and Malta. Considering the small population sizes of these three island countries, it was anticipated that COVID-19 would be adequately contained and mortality would be low. This study aims to compare and contrast COVID-19 mortality with mortality from all causes and common non-communicable diseases (NCDs) over 8 months between these three islands. METHODS: Data were obtained from the Ministry of Health websites and COVID dashboards from Cyprus, Iceland and Malta. The case-to-fatality ratio (CFR) and years of life lost (YLLs) were calculated. Comparisons were made between the reported cases, deaths, CFR, YLLs, swabbing rates, restrictions and mitigation measures. RESULTS: Low COVID-19 case numbers and mortality rates were observed during the first wave and transition period in Cyprus, Iceland and Malta. The second wave saw a drastic increase in the number of confirmed cases and mortality rates, especially for Malta, with high CFR and YLLs. Similar restrictions and measures were evident across the three island countries. Results show that COVID-19 mortality was generally lower than mortality from NCDs. CONCLUSIONS: The study highlights that small geographical and population size, along with similar restrictive measures, did not appear to have an advantage against the spread and mortality rate of COVID-19, especially during the second wave. Population density, an ageing population and social behaviours may play a role in the burden of COVID-19. It is recommended that a country-specific syndemic approach is used to deal with the local COVID-19 spread based on the population's characteristics, behaviours and the presence of other pre-existing epidemics.
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COVID-19 , Noncommunicable Diseases , Cyprus , Humans , Iceland , Malta , Pandemics , SARS-CoV-2ABSTRACT
OBJECTIVES: Multimorbidity, defined as the co-occurrence of at least two chronic diseases, is a common occurrence with ageing and a recognised public health concern, especially during the COVID-19 pandemic. The multimorbidity population is more susceptible to the virus, its complications, and death. The study aimed to explore the multimorbidity characteristics and their associations at a population level for the first time in Malta. Such data enables adequate priority and policy planning due to COVID-19's predilection for this population. STUDY AND METHODS: Baseline data was collected from 3,947 adults recruited between 2014-2016 through a cross-sectional study. A single-stage sampling strategy was implemented and stratified by age (18 -70 years), sex and locality. Participants were invited to attend a health examination survey consisting of a questionnaire, anthropometric and biological measurements. Descriptive (chi-square) and analytic (regression modelling) statistics were used to determine the characteristics and associations of the multimorbidity population. The chronic diseases considered for multimorbidity were type 2 diabetes, obesity, hypertension, myocardial infraction, coronary heart disease and dyslipidaemia. RESULTS: Multimorbidity was present in 33% (95% confidence interval 31.54-34.47) of the study population, with a male predominance. Hypertension and myocardial infarction were the commonest multimorbidity combination from a young age group (20-30 years). Low socio-economic status and residing on the island of Gozo were positively associated with multimorbidity. CONCLUSION: Multimorbidity in Malta was evident from a young age, with the highest occurrence among the low socio-economic status and residents of Gozo, bringing forward the need for preventive action. An adaptive healthcare system and policies are recommended to prevent, support, and manage multimorbidity non-communicable diseases while bracing for the current COVID-19 pandemic.