Immunogenicity and safety of inactivated SARS-CoV-2 vaccine (CoronaVac) using two-dose primary protocol in children and adolescents (Immunita-002, Brazil): A phase IV six-month follow up (preprint)

Introduction: Vaccines are essential for the prevention and control of several diseases, indeed, monitoring the immune response generated by vaccines is crucial. The immune response generated by vaccination against SARS-CoV-2 in children and adolescents is not well defined regarding to the intensity and medium to long-term duration of a protective immune response, which may point out the need of booster doses and might support the decisions in public health.Objective The study aims to evaluate the immunogenicity and safety of inactivated SARS-CoV-2 vaccine (CoronaVac) in a two-dose primary protocol in children and adolescent aging from 3 to 17 years old in Brazil.Methods Participants were invited to participate in the research at two public healthcare centers located in Serrana (São Paulo) and Belo Horizonte (Minas Gerais), Brazil. Participants underwent medical interviews to gather their medical history, including COVID-19 history and medical records. Physical exams were conducted, including weight, blood pressure, temperature, and pulse rate measurements. Blood samples were obtained from the participants before vaccination, 1 month after the first dose, and 1, 3, and 6 months after the second dose and were followed by a virtual platform for monitoring post-vaccination reactions and symptoms of COVID-19. SARS-CoV-2 genome from Swab samples of COVID-19 positive individuals were sequenced by NGS. Total antibodies were measured by ELISA and neutralizing antibodies to B.1 lineage and Omicron variant (BA.1) quantified by PRNT and VNT. The cellular immune response was evaluated by flow cytometry by the quantification of systemic soluble immune mediators.Results The follow-up of 640 participants showed that the CoronaVac vaccine (Sinovac/Butantan Institute) was able to significantly induce the production of total IgG antibodies to SARS-CoV-2 and the production of neutralizing antibodies to B.1 lineage and Omicron variant. In addition, a robust cellular immune response was observed with wide release of pro-inflammatory and regulatory mediators in the early post-immunization moments. Adverse events recorded so far have been mild and transient except for seven serious adverse events reported on VigiMed.Conclusions The results indicate a robust and sustained immune response induced by the CoronaVac vaccine in children and adolescents up to six months, providing evidences to support the safety and immunogenicity of this effective immunizer.

Estimated number of lives directly saved by COVID-19 vaccination programs in the WHO European Region, December 2020 to March 2023 (preprint)

BackgroundBy March 2023, 54 countries, areas and territories (thereafter "CAT") reported over 2.2 million coronavirus disease 2019 (COVID-19) deaths to the World Health Organization (WHO) Regional Office for Europe (1). Here, we estimate how many lives were directly saved by vaccinating adults in the Region, from December 2020 through March 2023. MethodsWe estimated the number of lives directly saved by age-group, vaccine dose and circulating Variant of Concern (VOC) period, both regionally and nationally, using weekly data on COVID-19 mortality and COVID-19 vaccine uptake reported by 34 CAT, and vaccine effectiveness (VE) data from the literature. We calculated the percentage reduction in the number of expected and reported deaths. FindingsWe found that vaccines reduced deaths by 57% overall (CAT range: 15% to 75%), representing [~]1.4 million lives saved in those aged [≥]25 years (range: 0.7 million to 2.6 million): 96% of lives saved were aged [≥]60 years and 52% were aged [≥]80 years; first boosters saved 51%, and 67% were saved during the Omicron period. InterpretationOver nearly 2.5 years, most lives saved by COVID-19 vaccinationwere in older adults by first booster dose and during the Omicron period, reinforcing the importance of up-to-date vaccination among these most at-risk individuals. Further modelling work should evaluate indirect effects of vaccination and public health and social measures. FundingThis work was supported by a US Centers for Disease Control cooperative agreement (Grant number 6 NU511P000936-02-020), who had no role in data analysis or interpretation. DisclaimerThe authors affiliated with the World Health Organization (WHO) are alone responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the WHO. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSSince first identified in late 2019, COVID-19 has caused disproportionately high mortality rates in older adults. With the rapid development and licensing of novel COVID-19 vaccines, immunization campaigns across the WHO European Region started in late 2020 and early 2021, initially targeting the most vulnerable and exposed populations, including older adults, people with comorbidities and healthcare professionals. Several studies have estimated the number of lives saved by COVID-19 vaccination, both at national and multi-country level in the earlier stages of the pandemic. However, only one multi-country study has assessed the number of lives saved beyond the first year of the pandemic, particularly when the Omicron variant of concern (VOC) circulated, a period when vaccination coverage was high in many countries, areas and territories (CAT), but COVID-19 transmission was at its highest. Added value of this studyHere we quantified the impact of COVID-19 vaccination in adults by age-group, vaccine dose and period of circulation of VOC, across diverse settings, using real world data reported by 34 CAT in the WHO European Region for the period December 2020 to April 2023. We estimated that COVID-19 vaccination programs were associated with a 57% reduction (CAT range: 15% to 75%) in the number of deaths among the [≥]25 years old, representing over 1.5 million lives saved (range: 0.7 million to 2.6 million) in 34 European CAT during the first 2.5 years following vaccine introduction. The first booster savedthe most lives (721,122 / 1,408,967, (57%) of all lives saved). The [≥]60 years old age group accounted for 96% of the total lives saved (1,349,617 / 1,408,967) whereas the [≥]80 years old age group represented 52% of the total lives saved (728,858 / 1,408,967 lives saved) and 67% of all lives were saved during the Omicron period (942,571 / 1,408,967). Implications of all the available evidenceOur results reinforce the importance of up-to-date COVID-19 vaccination, particularly among older age-groups. Communication campaigns supporting COVID-19 vaccination should stress the value of COVID-19 vaccination in saving lives to ensure vulnerable groups are up-to-date with vaccination ahead of periods of potential increased transmission.

[Evidence of the validity of a Brazilian version of the Fear of COVID-19 Scale]. / Evidências de validade de uma versão brasileira da Fear of COVID-19 Scale.

This study sought to analyze the evidence of the validity of a Brazilian version of the Fear of COVID-19 Scale (FCV-19S), based on indicators relating to: (1) the internal structure; (2) the internal consistency; (3) the relation with external variables; and (4) the content. The instrument was culturally adapted, focusing on semantic and specifically Brazilian linguistic aspects. The Brazilian version of the FCV-19S was then applied, in a virtual environment, to 211 participants (72.98% female) with an average age of 37.07 years (SD=13.03), together with the Self-Perception Questionnaire on Mental Health in Pandemics and the Sociodemographic and Functional Questionnaire. The confirmatory factor analysis revealed one-dimensionality. The internal consistency indices obtained (Cronbach's alpha =0.921; McDonald's omega =0.926) can be considered high. The correlation between fear and obsessive thinking of the disease, generalized anxiety, generalized stress, phobic-avoidant behavior and bereavement due to the pandemic was found to be statistically significant. Evidence of the validity related to content, derived from a qualitative approach, were satisfactory. The conclusion drawn is that the Brazilian version of the FCV-19S proved to be adequate regarding the evidence of the expected validity.

O presente estudo teve como objetivo analisar evidências de validade de uma versão brasileira da Fear of COVID-19 Scale (FCV-19S), com base em indicadores concernentes: (1) à estrutura interna; (2) à consistência interna; (3) à relação com variáveis externas; e (4) ao conteúdo. Procedeu-se a adaptação cultural do instrumento, com foco em aspectos semânticos e linguísticos próprios do Brasil. A seguir, esta versão brasileira da FCV-19S foi aplicada, em um ambiente virtual, em 211 participantes (72,98% do sexo feminino), com idade média de 37,07 anos (DP=13,03), juntamente com o Questionário de Autopercepção de Saúde Mental em Pandemia e o Questionário Sociodemográfico e Funcional. A análise fatorial confirmatória atestou unidimensionalidade. Os índices de consistência interna obtidos (alfa de Cronbach =0,921; ômega de McDonald =0,926) podem ser considerados elevados. Constatou-se correlação estatisticamente significativa entre medo e pensamento obsessivo, ansiedade generalizada, estresse generalizado, comportamento fóbico-evitativo e vivência de luto pela pandemia. As evidências de validade relativas ao conteúdo, oriundas de uma abordagem qualitativa, foram satisfatórias. Conclui-se que esta versão brasileira da FCV-19S mostrou-se adequada quanto às evidências de validade contempladas.

Infectious SARS-CoV-2 Particles from Rectal Swab Samples from COVID-19 Patients in Brazil.

The main objective of this study was to investigate the dynamic of SARS-CoV-2 viral excretion in rectal swab (RS), saliva, and nasopharyngeal swab (NS) samples from symptomatic patients and asymptomatic contacts. In addition, in order to evaluate the replication potential of SARS-CoV-2 in the gastrointestinal (GI) tract and the excretion of infectious SARS-CoV-2 from feces, we investigated the presence of subgenomic nucleoprotein gene (N) mRNA (sgN) in RS samples and cytopathic effects in Vero cell culture. A prospective cohort study was performed to collect samples from symptomatic patients and contacts in Rio de Janeiro, Brazil, from May to October 2020. One hundred and seventy-six patients had samples collected at home visits and/or during the follow up, resulting in a total of 1633 RS, saliva, or NS samples. SARS-CoV-2 RNA was detected in 130 (73.9%) patients who had at least one sample that tested positive for SARS-CoV-2. The presence of replicating SARS-CoV-2 in RS samples, measured by the detection of sgN mRNA, was successfully achieved in 19.4% (6/31) of samples, whilst infectious SARS-CoV-2, measured by the generation of cytopathic effects in cell culture, was identified in only one RS sample. Although rare, our results demonstrated the replication capacity of SARS-CoV-2 in the GI tract, and infectious viruses in one RS sample. There is still a gap in the knowledge regarding SARS-CoV-2 fecal-oral transmission. Additional studies are warranted to investigate fecal or wastewater exposure as a risk factor for transmission in human populations.

Development of an amplicon-based sequencing approach in response to the global emergence of mpox.

The 2022 multicountry mpox outbreak concurrent with the ongoing Coronavirus Disease 2019 (COVID-19) pandemic further highlighted the need for genomic surveillance and rapid pathogen whole-genome sequencing. While metagenomic sequencing approaches have been used to sequence many of the early mpox infections, these methods are resource intensive and require samples with high viral DNA concentrations. Given the atypical clinical presentation of cases associated with the outbreak and uncertainty regarding viral load across both the course of infection and anatomical body sites, there was an urgent need for a more sensitive and broadly applicable sequencing approach. Highly multiplexed amplicon-based sequencing (PrimalSeq) was initially developed for sequencing of Zika virus, and later adapted as the main sequencing approach for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Here, we used PrimalScheme to develop a primer scheme for human monkeypox virus that can be used with many sequencing and bioinformatics pipelines implemented in public health laboratories during the COVID-19 pandemic. We sequenced clinical specimens that tested presumptively positive for human monkeypox virus with amplicon-based and metagenomic sequencing approaches. We found notably higher genome coverage across the virus genome, with minimal amplicon drop-outs, in using the amplicon-based sequencing approach, particularly in higher PCR cycle threshold (Ct) (lower DNA titer) samples. Further testing demonstrated that Ct value correlated with the number of sequencing reads and influenced the percent genome coverage. To maximize genome coverage when resources are limited, we recommend selecting samples with a PCR Ct below 31 Ct and generating 1 million sequencing reads per sample. To support national and international public health genomic surveillance efforts, we sent out primer pool aliquots to 10 laboratories across the United States, United Kingdom, Brazil, and Portugal. These public health laboratories successfully implemented the human monkeypox virus primer scheme in various amplicon sequencing workflows and with different sample types across a range of Ct values. Thus, we show that amplicon-based sequencing can provide a rapidly deployable, cost-effective, and flexible approach to pathogen whole-genome sequencing in response to newly emerging pathogens. Importantly, through the implementation of our primer scheme into existing SARS-CoV-2 workflows and across a range of sample types and sequencing platforms, we further demonstrate the potential of this approach for rapid outbreak response.

Music Listening in Times of COVID-19 Outbreak: A Brazilian Study.

The COVID-19 outbreak required diverse strategies, such as social distancing and self-isolation, to avoid a healthcare system crisis. However, these measures have been associated with the onset or increase of anxiety and depression symptoms in the population. Music listening was previously shown to regulate emotion, consequently reducing depression symptoms. Since previous studies with Brazilian samples have already shown a high prevalence of depressive symptoms during the first confinement period, the aim of this study was threefold: (i) to compare groups with severe depression symptoms and no depression in what concerns to demographic and socio-economic factors as well as symptoms of anxiety and resilience levels, (ii) to explore changes in music listening daily routine during the confinement measures by both groups (no depression and severe depression), and (iii) to investigate which were the main factors influencing both two groups to music listening during the COVID-19 pandemic. This cross-sectional study included 494 Brazilian respondents aged 18 years and above. Our online survey comprised demographics, socio-economic, and COVID-19 related questionnaires, with questions regarding music listening used during social distancing measures on which the participants rated how much each of the 41 potential reasons for listening to music changed in importance compared to the situation before the pandemic and also the evaluation of anxiety, depression, and resilience levels. The respondents with severe depression were younger and showed higher levels of anxiety symptoms and lower resilience level. Furthermore, they were increasingly likely to listen to music to feel emotionally better with the situation, to feel comfort, to forget problems, to be energetic, to decrease sad feelings, to relax, to cheer up, to forget concerns, to express feelings, to reduce anxiety, to remember better times, to relieve boredom, to mentally stimulate themselves, and to ward off stressful thoughts compared to the participants with no depression. The exploratory factor analysis (FA) identified four types of music listening functions during social distancing measures: negative mood management, cognitive functioning, positive mood management, and physical involvement, in which the participants with severe depression revealed significant differences compared to non-depressed participants for the negative mood management factor, which shows the importance of music listening to regulate their negative emotions. As a conclusion, we can argue that most of our respondents used music listening to cope with and regulate their moods during confinement, especially those who presented with severe depression symptoms.

Clinical Profile and Risk Factors for Severe COVID-19 in Hospitalized Patients from Rio de Janeiro, Brazil: Comparison between the First and Second Pandemic Waves.

Since COVID-19 was declared a pandemic, Brazil has become one of the countries most affected by this disease. A year into the pandemic, a second wave of COVID-19 emerged, with a rapid spread of a new SARS-CoV-2 lineage of concern. Several vaccines have been granted emergency-use authorization, leading to a decrease in mortality and severe cases in many countries. However, the emergence of SARS-CoV-2 variants raises the alert for potential new waves of transmission and an increase in pathogenicity. We compared the demographic and clinical data of critically ill patients infected with COVID-19 hospitalized in Rio de Janeiro during the first and second waves between July 2020 and October 2021. In total, 106 participants were included in this study; among them, 88% had at least one comorbidity, and 37% developed severe disease. Disease severity was associated with older age, pre-existing neurological comorbidities, higher viral load, and dyspnea. Laboratory biomarkers related to white blood cells, coagulation, cellular injury, inflammation, renal, and liver injuries were significantly associated with severe COVID-19. During the second wave of the pandemic, the necessity of invasive respiratory support was higher, and more individuals with COVID-19 developed acute hepatitis, suggesting that the progression of the second wave resulted in an increase in severe cases. These results can contribute to understanding the behavior of the COVID-19 pandemic in Brazil and may be helpful in predicting disease severity, which is a pivotal for guiding clinical care, improving patient outcomes, and defining public policies.

Effect of a cardiac telerehabilitation program during COVID-19 associated social isolation.

This study aimed to compare the impact of a cardiac telerehabilitation (CTR) protocol aimed at patients with cardiovascular diseases (CVDs) during the period of coronavirus disease 2019 (COVID-19) associated with social isolation. This retrospective cohort study included 58 participants diagnosed with stable cardiovascular diseases (CVDs), which were divided into three groups: conventional cardiac rehabilitation (CCR) group (n â€‹= â€‹20), composed of patients undergoing conventional cardiac rehabilitation; cardiac telerehabilitation (CTR) group (n â€‹= â€‹18), composed of patients undergoing cardiac telerehabilitation and control group (n â€‹= â€‹20), composed of patients admitted for cardiac rehabilitation who had not started training programs. The results showed that body mass index was reduced (p â€‹= â€‹0.019) and quality of life was improved (e.g., limitations due to physical aspects [p â€‹= â€‹0.021), vitality [p â€‹= â€‹0.045] and limitations due to emotional aspects [p â€‹= â€‹0.024]) by CCR compared to baseline. These outcomes were not improved by CTR (p â€‹> â€‹0.05). However, this strategy prevented clinical deterioration in the investigated patients. Although CCR achieved a superior effect on clinical improvement and quality of life, CTR was relevant to stabilize the blood pressure and quality of life of patients with cardiovascular diseases during the period of COVID-19-associated social isolation.

Comparative complete scheme and booster effectiveness of COVID‐19 vaccines in preventing SARS‐CoV‐2 infections with SARS‐CoV‐2 Omicron (BA.1) and Delta (B.1.617.2) variants: A case–case study based on electronic health records

Background Information on vaccine effectiveness in a context of novel variants of concern (VOC) emergence is of key importance to inform public health policies. This study aimed to estimate a measure of comparative vaccine effectiveness between Omicron (BA.1) and Delta (B.1.617.2 and sub‐lineages) VOC according to vaccination exposure (primary or booster). Methods We developed a case–case study using data on RT‐PCR SARS‐CoV‐2‐positive cases notified in Portugal during Weeks 49–51, 2021. To obtain measure of comparative vaccine effectiveness, we compared the odds of vaccination in Omicron cases versus Delta using logistic regression adjusted for age group, sex, region, week of diagnosis, and laboratory of origin. Results Higher odds of vaccination were observed in cases infected by Omicron VOC compared with Delta VOC cases for both complete primary vaccination (odds ratio [OR] = 2.1;95% confidence interval [CI]: 1.8 to 2.4) and booster dose (OR = 5.2;95% CI: 3.1 to 8.8), equivalent to reduction of vaccine effectiveness from 44.7% and 92.8%, observed against infection with Delta, to −6.0% (95% CI: 29.2% to 12.7%) and 62.7% (95% CI: 35.7% to 77.9%), observed against infection with Omicron, for complete primary vaccination and booster dose, respectively. Conclusion Consistent reduction in vaccine‐induced protection against infection with Omicron was observed. Complete primary vaccination may not be protective against SARS‐CoV‐2 infection in regions where Omicron variant is dominant.

Factors associated with molecular diagnosis for COVID-19: a cross-sectional study, Espírito Santo/Brazil

Introdução: o Brasil demorou a implementar uma política de testagem ampliada para COVID-19 no qual pode ter afetado o acesso da população mais vulnerável aos serviços de testagem. Objetivo: analisar os fatores associados à realização de testes moleculares para o diagnóstico da COVID-19. Método: estudo transversal de dados secundários do painel COVID-19 do estado do Espírito Santo. Foram incluídas fichas de notificação de suspeita de COVID-19 entre 11 de setembro de 2020 a 02 de março de 2021. Empregou-se regressão logística hierárquica para estimativa de razão de chances (odds ratio, OR) com intervalo de confiança de 95% (IC95%). Resultados: Foram incluídos no estudo 419.771 fichas de notificação. A prevalência da realização do teste molecular para COVID-19 foi 81,1 % (IC95% 81,0%;81,2%). Idosos (OR= 2,70 – IC95% 2,56-2,85), profissional da saúde (OR=1,43 – IC95% 1,36-1,50), doença cardiovascular crônica (OR=1,13 – IC95% 1,09-1,17), diabetes mellitus (OR=1,07 – IC95% 1,01-1,14) e hospitalização (OR=5,95 – IC95% 4,53;7,82) apresentaram maior chance de ter realizado o teste molecular. Sexo masculino (OR=0,96 – IC95% 0,94-0,98), cor da pele preta (OR= 0,75 – IC95% 0,73-0,78), cor da pele amarela (OR=0,74 – IC95% 0,71-0,77), residir na região norte de saúde (OR=0,37 – IC95% 0,36-0,39) e a população em situação de rua (OR=0,76 – IC95% 0,67-0,85) apresentaram a menor chance de ter realizado o teste molecular. Conclusão: Fatores sociais, econômicos e o risco de agravamento da doença foram associados a realização do teste molecular para COVID-19 no estado do Espírito Santo. É necessário ações que garantam o acesso da população mais vulnerável ao teste molecular.Alternate : Backgroung: Brazil was slow to implement an expanded testing policy for COVID-19, which may have affected the most vulnerable population's access to testing services. Objective: to evaluate the factors associated with performing the molecular test for COVID-19. Methods: cross-sectional study of secondary data from the COVID-19 panel in the state of Espírito Santo. COVID-19 suspicion notification forms were included between September 11, 2020 and March 2, 2021. Hierarchical logistic regression was used to estimate the odds ratio (OR) with 95% confidence interval (CI95%). Results: 419,771 notification forms were analyzed. The prevalence of performing the molecular teste for COVID-19 was 81.1% (CI95% 81.0-81.2). Elderly (OR= 2.70 – CI95% 2.56-2.85), health professional (OR=1 .43 – CI95% 1.36-1.50), chronic cardiovascular disease (OR=1.13 – CI95% 1.09-1.17), diabetes mellitus (OR=1.07 – CI95% 1.01- 1.14) and hospitalization (OR=5.95 – CI95% 4.53;7.82) were more likely to have undergone the molecular test. Male sex (OR=0.96 – CI95% 0.94-0.98), black skin color (OR=0.75 – CI95% 0.73-0.78), yellow skin color (OR=0.74 – CI95% 0.71-0.77), residing in the northern health region (OR=0.37 – CI95% 0.36-0.39) and the homeless population (OR=0.76 – CI95% 0.67-0.85) had the lowest chance of having undergone the molecular test. Conclusion: Social, economic, contextual factors and the risk of aggravation of the disease were associated with carrying out the molecular test for COVID-19 in the state of Espírito Santo. Actions are needed to guarantee the access of the most vulnerable population to molecular testing.

Comparative complete scheme and booster effectiveness of COVID-19 vaccines in preventing SARS-CoV-2 infections with SARS-CoV-2 Omicron (BA.1) and Delta (B.1.617.2) variants: A case-case study based on electronic health records.

Background: Information on vaccine effectiveness in a context of novel variants of concern (VOC) emergence is of key importance to inform public health policies. This study aimed to estimate a measure of comparative vaccine effectiveness between Omicron (BA.1) and Delta (B.1.617.2 and sub-lineages) VOC according to vaccination exposure (primary or booster). Methods: We developed a case-case study using data on RT-PCR SARS-CoV-2-positive cases notified in Portugal during Weeks 49-51, 2021. To obtain measure of comparative vaccine effectiveness, we compared the odds of vaccination in Omicron cases versus Delta using logistic regression adjusted for age group, sex, region, week of diagnosis, and laboratory of origin. Results: Higher odds of vaccination were observed in cases infected by Omicron VOC compared with Delta VOC cases for both complete primary vaccination (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 1.8 to 2.4) and booster dose (OR = 5.2; 95% CI: 3.1 to 8.8), equivalent to reduction of vaccine effectiveness from 44.7% and 92.8%, observed against infection with Delta, to -6.0% (95% CI: 29.2% to 12.7%) and 62.7% (95% CI: 35.7% to 77.9%), observed against infection with Omicron, for complete primary vaccination and booster dose, respectively. Conclusion: Consistent reduction in vaccine-induced protection against infection with Omicron was observed. Complete primary vaccination may not be protective against SARS-CoV-2 infection in regions where Omicron variant is dominant.

A Novel Host of an Emerging Disease: SARS-CoV-2 Infection in a Giant Anteater (Myrmecophaga tridactyla) Kept Under Clinical Care in Brazil.

A young male free-ranging giant anteater (Myrmecophaga tridactyla) was found with paralysis of pelvic limbs on a highway and kept under human care. Radiographs confirmed multiple incomplete fractures in the thoracolumbar vertebrae. Due to the poor prognosis, euthanasia was chosen. The infection was established by viral SARS-CoV-2 RNA detection in the rectal swab, spleen and kidney samples. Immunohistochemistry detected the viral nucleocapsid protein in sections of the lungs, liver, spleen, lymph nodes, and large intestine sections, and spike protein antigen in the lung tissue. Pilosa order species should be included as potential hosts of natural infection of SARS-CoV-2.

Nucleotides Entrapped in Liposome Nanovesicles as Tools for Therapeutic and Diagnostic Use in Biomedical Applications.

The use of nucleotides for biomedical applications is an old desire in the scientific community. As we will present here, there are references published over the past 40 years with this intended use. The main problem is that, as unstable molecules, nucleotides require some additional protection to extend their shelf life in the biological environment. Among the different nucleotide carriers, the nano-sized liposomes proved to be an effective strategic tool to overcome all these drawbacks related to the nucleotide high instability. Moreover, due to their low immunogenicity and easy preparation, the liposomes were selected as the main strategy for delivery of the mRNA developed for COVID-19 immunization. For sure this is the most important and relevant example of nucleotide application for human biomedical conditions. In addition, the use of mRNA vaccines for COVID-19 has increased interest in the application of this type of technology to other health conditions. For this review article, we will present some of these examples, especially focused on the use of liposomes to protect and deliver nucleotides for cancer therapy, immunostimulatory activities, enzymatic diagnostic applications, some examples for veterinarian use, and the treatment of neglected tropical disease.

Comparative Effectiveness of COVID-19 Vaccines in Preventing Infections and Disease Progression from SARS-CoV-2 Omicron BA.5 and BA.2, Portugal.

We estimated comparative primary and booster vaccine effectiveness (VE) of SARS-CoV-2 Omicron BA.5 and BA.2 lineages against infection and disease progression. During April-June 2022, we implemented a case-case and cohort study and classified lineages using whole-genome sequencing or spike gene target failure. For the case-case study, we estimated the adjusted odds ratios (aORs) of vaccination using a logistic regression. For the cohort study, we estimated VE against disease progression using a penalized logistic regression. We observed no reduced VE for primary (aOR 1.07 [95% CI 0.93-1.23]) or booster (aOR 0.96 [95% CI 0.84-1.09]) vaccination against BA.5 infection. Among BA.5 case-patients, booster VE against progression to hospitalization was lower than that among BA.2 case-patients (VE 77% [95% CI 49%-90%] vs. VE 93% [95% CI 86%-97%]). Although booster vaccination is less effective against BA.5 than against BA.2, it offers substantial protection against progression from BA.5 infection to severe disease.

Mortality and Associated Factors in Patients with COVID-19: Cross-Sectional Study.

The novel virus severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is highly virulent and causes coronavirus disease 2019 (COVID-19), resulting in high morbidity and mortality mainly associated with pulmonary complications. Because this virus is highly transmissible, it was quickly spread globally, resulting in COVID-19 being declared as a pandemic. This study aimed to analyze the prevalence of mortality and the factors related to mortality due to COVID-19 in patients with severe acute respiratory syndrome (SARS) at a university hospital in the Central­West region of Brazil. This retrospective cross-sectional study was based on an analysis of the medical records of patients with SARS aged >18 years and admitted to an intensive care unit due to COVID-19 with the requirement of invasive mechanical ventilation. Hospital death was considered as an outcome variable in this study. Moreover, demographic and lifestyle-related variables as well as the therapeutic measures used during the hospital stay were recorded and correlated with the death outcome. After excluding 188 medical records, 397 were analyzed. Most of the participants were men (59.7%), and the mortality rate in patients with SARS due to COVID-19 was 46.1%. Multiple regression analysis indicated that the independent factors associated with mortality in patients with SARS due to COVID-19 were the age of >60 years (p < 0.001) and the use of azithromycin (p = 0.012). Protective factors for mortality were considered as not having the following diseases: hyperthyroidism, asthma, hepatic inheritance, and not being a smoker. The mortality rate in patients with SARS due to COVID-19 was associated with older age and the use of azithromycin.

Acute corneal allograft rejection following SARS-CoV-2 vaccination-A systematic review.

All documented cases of acute corneal allograft rejection following SARS-CoV-2 vaccination were examined, to characterize possible risk factors and graft outcomes. Comprehensive search (4 electronic databases: PubMed, CENTRAL, ClinicalTrials.gov, Google Scholar, plus manual search in articles' reference lists) until March 1st 2022 to identify studies reporting acute corneal allograft rejection following SARS-CoV-2 vaccination; study protocol was developed in line with PRISMA statement. We analysed demographics, allograft type, rejection prophylaxis regime at the time of vaccination, transplantation-to-vaccination time (G-Vt), vaccination-to-immune reaction onset time (V-Rt), management, best-corrected visual acuity before and after rejection, and graft survival. Of 169 titles/abstracts screened, 16 studies (n  = 36 eyes) met the inclusion criteria. Fourteen eyes (38.9%) had received >1 graft, and 11.1% of cases had history of immune reactions; 52.9% of cases occurred after the first dose. Median (P25-P75) G-Vt was 48 (10-78) months; median V-Rt was 9 (7-14) days. In eyes with resolved rejection, median time-to-resolution was 3 (1-4) weeks. Four eyes (11.1%) had partial resolution of corneal decompensation, and 5 grafts (13.9%) failed. Acute corneal allograft rejection after SARS-CoV-2 vaccination is a rare event, but may occur any time post-keratoplasty. Early recognition and prompt, aggressive treatment is warranted to optimize vision and graft survival. Well-known risk factors for rejection may be confounding factors, including the high proportion of cases with a history of previous grafts and the rejection prophylaxis regimes at the time of vaccination. Increasing immunosuppressants in the peri-vaccination period may decrease the risk of immune reactions, especially in high-risk cases.

Inclusión sociolaboral tras la pandemia: un nuevo reto global para la educación social

RESUMEN: Se aborda en este artículo la posición de la Educación Social frente a la incidencia a nivel mundial del COVID-19 en el ámbito de la inclusión sociolaboral, que ha supuesto y supone un nuevo reto global para sus profesionales. El aumento de la pobreza, el desempleo, las desigualdades y la calidad de la educación son elementos clave frente a los que actuar;como lo son también ese nuevo mundo de seres solitarios y distantes que se ha incrementado y que persiste, como nueva invisibilidad, luchando por la supervivencia, los ingresos y el trabajo, en busca de un sentido a su humanidad. Una situación de crisis planetaria frente a la que diferentes profesionales de la acción socioeducativa han reaccionado con responsabilidad y efectividad, a pesar de las dificultades, la impotencia y la incertidumbre iniciales, junto a una significativa falta de recursos. La Educación Social ha de multiplicar sus efectos, desde la coproducción de significados y de realidades, en los espacios de participación que le son habituales y con los Objetivos de Desarrollo Sostenible (ODS) como objetivos compartidos. Frente a unas perspectivas de recuperación mundial poco alentadoras y al pronóstico a medio y largo plazo de un importanteAlternate :This article addresses the position of Social Education in relation to the global impact of COVlD-19 in the field of socio-professional inclusion, which meant and still means a new global challenge for its professionals. The increase in poverty, unemployment, inequalities, and the quality of education are key elements to be tackled;as well as the new world of solitary and distant beings that has increased and persists, like a new invisibility, struggling for survival, income and work, in search of a meaning for their humanity. A situation of planetary crisis to which socio-educational professionals reacted responsibly and effectively, despite the initial difficulties, impotence and uncertainty, together with a significant lack of resources. Social Education must multiply the effects of its intervention, based on the co-production of meanings and realities, in the spaces and contexts of participation, with the Sustainable Development Goals (SDG) as shared objectives. Faced with a gloomy perspective of global recovery and the medium and long-term prognosis of a significant generational educational gap, which will directly affect the possibilities of social and labour inclusion of the young population, there is a need to promote a close education, which promotes the well-being and autonomy, active citizenship but also critical, transformative and committed to sustainable, fair and solidary societies.Alternate :RESUMO: Este artigo aborda a posiçao da Educaçao Social em relaçao ao impacto global da COVID-19 no domínio da inclusao socioprofissional, o que significou e ainda significa um novo desafio global para os seus profissionais. O aumento da pobreza, do desemprego, das desigualdades e da qualidade da educaçao sao elementos-chave a combater;assim como o novo mundo de seres solitários e distantes que aumentou e que persiste, como uma nova invisibilidade, lutando pela sobrevivencia, rendimento e trabalho, em busca de um significado para a sua humanidade. Uma situaçao de crise planetaria a qual os profissionais da açao sócio-educativa reagiram de forma responsável e eficaz, apesar das dificuldades, impotencia e incerteza iniciais, a par de uma significativa falta de recursos. A Educaçao Social deve multiplicar os efeitos da sua intervençao, a partir da co-produçao de significados e realidades, nos espaços de participaçao que lhe sao comuns e com os Objectivos do Desenvolvimento Sustentável (ODS) como objectivos partilhados. Face a uma perspectiva sombria de recuperaçao global e ao prognóstico a médio e longo prazo de um significativo fosso educativo geracional, que afectará directamente as possibilidades de inclusao social e laboral da populaçao jovem, há necessidade de promover uma educaçao presencial, próxima, que promova o bem-estar e a auton mia, a cidadania activa e que seja, como está sendo, crítica, transformadora e empenhada em sociedades sustentáveis, justas e solidárias.

Comparison of the healthcare system of Chile and Brazil: strengths, inefficiencies, and expenditures.

BACKGROUND: Governments in Latin America are constantly facing the problem of managing scarce resources to satisfy alternative needs, such as housing, education, food, and healthcare security. Those needs, combined with increasing crime levels, require financial resources to be solved. OBJECTIVE: The objective of this review was to characterizar the health system and health expenditure of a large country (Brazil) and a small country (Chile) and identify some of the challenges these two countries face in improving the health services of their population. METHODS: A literature review was conducted by searching journals, databases, and other electronic resources to identify articles and research publications describing health systems in Brazil and Chile. RESULTS: The review showed that the economic restriction and the economic cycle have an impact on the funding of the public health system. This result was true for the Brazilian health system after 2016, despite the change to a unique health system one decade earlier. In the case of Chile, there are different positions about which one is the best health system: a dual public and private or just public one. As a result, a referendum on September 4, 2022, of a new constitution, which incorporated a unique health system, was rejected. At the same time, the Government ended the copayment in the public health system in September 2022, excluding illnesses referred to the private sector. Another issue detected was the fragility of the public and private sector coverage due to the lack of funding. CONCLUSIONS: The health care system in Chile and Brazil has improved in the last decades. However, the public healthcare systems still need additional funding and efficiency improvement to respond to the growing health requirements needed from the population.