COVID-19 vaccine effectiveness against symptomatic disease and severe outcomes, 2021-2022: a test-negative case-control study

Objectives This study evaluated the effectiveness of COVID-19 vaccines in preventing symptomatic and severe disease. Study design This was an observational test-negative case-control study. Methods Study participants were adults with at least one symptom included in the World Health Organization COVID-19 definition who sought healthcare in a public emergency department between 1 November 2021 and 2 March 2022 (corresponding with the fifth pandemic wave in Portugal dominated by the Omicron variant). This study used multivariable logistic regression models to estimate and compare the odds ratio of vaccination between test-positive cases and test-negative controls to calculate the absolute and relative vaccine effectiveness. Results The study included 1059 individuals (522 cases and 537 controls) with a median age of 56 years and 58% were women. Compared with the relative effectiveness of the primary vaccination scheme that had been completed ≥180 days earlier, the effectiveness against symptomatic infection of a booster administered between 14 and 132 days earlier was 71% (95% confidence interval [CI]: 57%, 81%;p < 0.001). The effectiveness of the primary series against symptomatic infection peaked at 85% (95% CI: 56%, 95%) between 14 and 90 days after the last inoculation and decreased to 34% (95% CI: −42.6%, 49.5%) after ≥180 days. Conclusions Despite the known immunological evasion characteristics of the Omicron variant, results from this study show that vaccine effectiveness increases after booster administration. COVID-19 vaccine effectiveness decreases to less than 50% between 3 and 6 months after completion of the primary cycle;therefore, this would be an appropriate time to administer a booster to restore immunity.

COVID-19 collaborative screening: An action-research project for large scale contact tracing in Northern Portugal.

In late November 2020, when Europe reached the highest 14-day incidence of COVID-19 cases, the resource-intensive and time-consuming traditional contact tracing performed by Public Health was challenged. In this context, innovative approaches were necessary to guarantee a timely interruption of disease transmission. "COVID-19 Collaborative Screening" Project was developed as a faster solution, not only because the contact tracing process is simpler for the operator, but mainly because it is possible to quickly scale up the number of operators involved. It was designed to interrupt family and social transmission chains, in a partnership with the Local Public Health Services - allowing these services to dedicate to scenarios of more complex risk assessment, using the traditional contact tracing. To perform contact tracing, this method involves Public Servants, Armed Forces and Medical Dentists. The Project also promotes participatory citizenship, by delegating to the citizen the responsibility of registering his/hers contacts with high-risk exposure in an online form, in contrast to the traditional contact tracing method which is more health professional-dependent. Until the end of January 2021, the Project has trained eight teams, enrolling a total of 213 professionals, and was implemented in eight Health Regions (with an estimated population of 1,346,150 inhabitants). The Project was successful at facing the delays in case interview and contact tracing. The strategy implemented by ColabCOVID is assembled as a sustainable, reproducible and scalable platform and is ready to be re-implemented to face the emergence of more contagious variants, as well as an eventual forthcoming health threat.

Evaluation of the Real-World Effectiveness of Vaccines against COVID-19 at a Local Level: Protocol for a Test-Negative Case-Control Study.

Vaccines against COVID-19 approved for use in the EU/EEA have been shown to be highly effective against wild-type SARS-CoV-2. However, their effectiveness against new variants may be reduced. This study aims to evaluate the effectiveness of vaccines against COVID-19 in the prevention of symptomatic and severe disease, during pre- and post-omicron phases. Individuals who sought treatment at the emergency department of a Portuguese hospital with COVID-19-like disease and were tested for SARS-CoV-2 are the subjects of the study. Patients who received a positive result are considered cases, while those with negative results are the controls. The test-negative case-control method is one of the study designs recommended by WHO to estimate the effectiveness of vaccines against COVID-19. The main advantage of this design is that it controls for the healthcare seeking bias, commonly present in traditional cohort and case-control designs. This study may have broad implications for understanding the real-world performance of the COVID-19 vaccines at the local level, which may play a key role in promoting adherence to vaccination. Moreover, this study may contribute to inform decisions regarding booster doses and variant-specific vaccine formulations leading to the control of this and future pandemics.

A qualitative study on the impact of death during COVID-19: Thoughts and feelings of Portuguese bereaved adults.

As a global threat, the COVID-19 pandemic has been an important factor in increasing death rate worldwide. As the virus spreads across international borders, it causes severe illness, death, and disruptions in our daily lives. Death and dying rituals and customs aid bereaved people in overcoming their grief. In this sense, the purpose of this study was to access thoughts and feelings of Portuguese adults and the impact of the loss in daily life during COVID-19. A structured online questionnaire was applied (snowball sampling) and qualitative data on death and mourning namely the impact of the loss in daily life, was collected. One hundred and sixty-six individuals have lost someone since the beginning of the pandemic and were included. Analysis was inspired by Braun and Clark's content analysis. Most participants were female (66.9%), the median age was of 37.3 years, and 70.5% had a high education degree. Moreover, 30.7% of the participants present anxiety symptoms and 10.2% depression symptoms. The answers of studied participants gave insights on the extent of the loss in day-to-day life and four thematic themes were found: (1) The perceived inadequacy of the funeral rituality, (2) Sadness, fear and loneliness, (3) Changes in sleeping and concentration and increased levels of anxiety and (4) Concerns regarding the pandemic situation. We found a high prevalence of anxiety and depression symptoms in the study sample. Also, the changes in post mortem procedures, have shown to be of great importance in the mourning procedure of the participants.

Food Insecurity in Portugal during the COVID-19 Pandemic: Prevalence and Associated Sociodemographic Characteristics Insegurança alimentar em Portugal durante a pandemia de COVID-19: prevalência e características sociodemográficas associadas

Introduction The current worldwide COVID-19 pandemic has been having a considerable impact not only on health but also on the economy of societies, emphasizing food insecurity as a significant public health concern. Aim The objective of this study was to characterize the scenario of food insecurity in Portugal during the COVID-19 pandemic and explore its related sociodemographic characteristics. Methodology This is a cross-sectional study, using data from an online survey, performed from November 2020 until February 2021, including 882 residents aged 18 years or older in Portugal. Data on sociodemographics and food security status were collected, the latter was evaluated using the United States Household Food Security Survey Module: Six-Item Short Form. Crude and adjusted logistic regression models were performed (covariates: education, household income perception, and the working status during the COVID-19 pandemic). The odds ratio (OR) and respective 95% confidence intervals (CI) were estimated. Results Most participants were women (71.3%), with a mean age of 36.8 years (SD 11.0). Food insecurity prevalence was 6.8%. Less-educated individuals (≤12 years of schooling;OR 2.966;95% CI 1.250–7.042), and those who were and remained unemployed since the beginning of the pandemic (OR 2.602;95% CI 1.004–6.742) had higher odds of belonging to a food-insecure household, regardless of education, working status during the COVID-19 pandemic, and household income perception. Moreover, lower odds of belonging to a food-insecure household were observed among those reporting a comfortable household income (OR 0.007;95% CI 0.001–0.062) than those who perceived their household income as insufficient, independently of education and the working status during the COVID-19 pandemic. Conclusions These findings highlight the population groups that are at a greater risk of food insecurity during the current COVID-19 pandemic. Effective public health strategies should be developed aiming to address food insecurity during this crisis, especially among the higher risk groups.

The bad, the ugly and the monster behind the mirror - Food insecurity, mental health and socio-economic determinants.

INTRODUCTION: Food insecurity is associated with poor mental health outcomes, including depression and anxiety and COVID-19 could increase these relations. In this sense, we aimed to explore the relationship between food insecurity and mental health features and behaviors in adults from Portugal. METHODOLOGY: We conducted a cross-sectional online snowball study from November 2020 until February 2021. A total of 882 Portuguese residents 18 years of age or older with food security data were included. Data on socio-demographics, food security status, and anxiety and depression symptoms were collected. Crude and adjusted logistic regression models were performed. Odds ratio (OR) and respective 95% confidence intervals (CI) were estimated. RESULTS: Most participants were women (71.3%), with a mean (SD) age of 36.8 (10.9) years, three-thirds had a university degree (76.7%), and 65.3% lived in the country's northern region. Regarding the characteristics associated with food insecurity, we observed that less-educated participants (OR = 7.84; 95% CI: 3.67-16.73), with depression symptoms (OR = 5.91; 95% CI: 3.12-11.19) and with anxiety symptoms (OR = 6.41; 95% CI: 3.02-13.59), had a higher odds of belonging to a food-insecure household. After adjustments less educated individuals (OR = 8.37; 95% CI: 3.81-18.35), those who faced a reduction in income (OR = 0.27; 95% CI: 0.13-0.53) and, presenting anxiety symptoms (OR = 7.32; 95% CI: 3.53-15.17) had a higher odds of belonging to a food-insecure household. CONCLUSIONS: Approaching food insecurity without addressing mental health, and the opposite is making partial and reductive interventions. It is important to have an integrative approach.

Food insecurity and mental health features and behaviours in adults from Portugal

Background COVID-19 pandemic has been affecting population's health and economies, in which food insecurity appears as important concern, particularly considering its associations with mental health and adverse behaviours. This study explored the relationship between food insecurity and mental health features and behaviours in adults from Portugal. Methods A cross-sectional study using data from an online survey was performed, including Portugal's residents aged ≥18 years. Data on sociodemographics, behaviours, mental health features and food security status were collected. Food security status was evaluated with the United States Household Food Security Survey Module: Six-item Short Form. Chi-square test or Fisher's exact test, as appropriate, were used to explore the relationship between food security status and categorical variables. Results Food insecurity prevalence was 6.8%;showed to be significantly higher among less educated individuals (≤12 years of schooling) (p <0.001), those who were employed and remained since the beginning of the pandemic (p <0.001) and among those reporting need to be careful about expenses (p <0.001). Comparing to individuals who were food secure, food insecure participants were more likely to smoke (p =0.009), to report depressive symptoms (p <0.001) and anxiety (p <0.001), measured by the Hospital Anxiety and Depression Scale. Conclusions From the present study, it can be concluded that the COVID-19 pandemic can affect food security in different subpopulations. Key messages The findings of this study have several implications for health policy and reinforce the need for investment in contexts of populations vulnerable to food insecurity [ABSTRACT FROM AUTHOR] Copyright of International Journal of Epidemiology is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)