COVID-19 vaccine effectiveness among healthcare workers: a hospital-based cohort study.

OBJECTIVES: Healthcare workers (HCWs) were the first to be prioritised for COVID-19 vaccination. This study aims to estimate the COVID-19 vaccine effectiveness (VE) against SARS-CoV-2 symptomatic infection among HCWs in Portuguese hospitals. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: We analysed data from HCWs (all professional categories) from three central hospitals: one in the Lisbon and Tagus Valley region and two in the central region of mainland Portugal, between December 2020 and March 2022. VE against symptomatic SARS-CoV-2 infection was estimated as one minus the confounder adjusted HRs by Cox models considering age group, sex, self-reported chronic disease and occupational exposure to patients diagnosed with COVID-19 as adjustment variables. RESULTS: During the 15 months of follow-up, the 3034 HCWs contributed a total of 3054 person-years at risk, and 581 SARS-CoV-2 events occurred. Most participants were already vaccinated with a booster dose (n=2653, 87%), some are vaccinated with only the primary scheme (n=369, 12.6%) and a few remained unvaccinated (n=12, 0.4%) at the end of the study period. VE against symptomatic infection was 63.6% (95% CI 22.6% to 82.9%) for HCWs vaccinated with two doses and 55.9% (95% CI -1.3% to 80.8%) for HCWs vaccinated with one booster dose. Point estimate VE was higher for individuals with two doses taken between 14 days and 98 days (VE=71.9%; 95% CI 32.3% to 88.3%). CONCLUSION: This cohort study found a high COVID-19 VE against symptomatic SARS-CoV-2 infection in Portuguese HCWs after vaccination with one booster dose, even after Omicron variant occurrence. The small sample size, the high vaccine coverage, the very low number of unvaccinated individuals and the few events observed during the study period contributed to the low precision of the estimates.

Torquetenovirus viral load is associated with anti-spike antibody response in SARS-CoV-2 mRNA BNT162b2 vaccinated kidney transplant patients.

INTRODUCTION: Kidney transplant patients (KT) are at high risk for severe COVID-19 and presented attenuated antibody responses to vaccination when compared to immunocompetent individuals. Torquetenovirus (TTV) has recently gained attention as a potential surrogate marker of the net state of immunosuppression. We evaluated the association between pre-vaccination TTV viral load and anti-spike total antibody response to SARS-CoV-2 vaccination in KT. MATERIAL AND METHODS: The 114 adult KT recipients enrolled in this prospective single-center cohort study received two doses of SARS-CoV-2 mRNA BNT162b2 vaccine. Serum samples were collected immediately before vaccination at the days when patients received both the first (T0) and the second dose (T1) and 16-45 days after the second dose (T2). Primary endpoint was the development of anti-spike total antibodies after vaccination. Demographic, clinical, and laboratorial parameters were compared between patients with and without detectable SARS-CoV-2 antibodies at T2. RESULTS: Ninety-nine patients (86.8%) were naïve for SARS-CoV-2 before vaccination. Fifty-six (56.6%) patients developed anti-spike total antibodies at T2. The use of mTOR inhibitors was associated with a favorable response (p = .005); conversely, mycophenolic acid (MPA) was associated with a negative response (p = .006). In a multivariable model, the presence of TTV at T0 ≥ 3.36 log10 cp/ml was associated with unfavorable vaccine response (OR: 5.40; 95% CI: 1.47-19.80; p = .011), after adjusting for age and eGFR at T0. CONCLUSIONS: Higher TTV viral loads before vaccination are associated with reduced anti-spike total antibody response in SARS-CoV-2 mRNA BNT162b2 vaccinated KT patients. The association between TTV viral load and vaccine response may be an added-value in the optimization of vaccination regimens in KT.

AVALIAÇÃO DA EFICÁCIA DA VACINAÇÃO DE HEPATITE B EM PACIENTES COM ESQUISTOSSOMOSE MANSONI HEPATOESPLÊNICA NO HOSPITAL DAS CLÍNICAS, SÃO PAULO, BRASIL

Introdução A coinfecção, esquistossomose mansoni e vírus da hepatite B, aumenta a morbimortalidade dos portadores. No ano de 2012, desenvolveu-se um protocolo de vacinação aos pacientes da forma hepatoesplênica acompanhados no Ambulatório de Esquistossomose, em conjunto com o Centro Referência de Imunobiológicos Especiais (CRIE), Divisão de Moléstias Infecciosas e Parasitárias, do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Além da vacina de hepatite B, as vacinas antipneumocócica 23, dupla adulto, febre amarela, influenza, meningocócica C e COVID-19 foram contempladas. Objetivo O objetivo desse trabalho foi de avaliar a resposta sorológica a vacinação de hepatite B em 64 indivíduos com esquistossomose hepatoesplênica grave em seguimento no Ambulatório de Esquistossomose do HCFMUSP. Método Trata-se de um estudo descritivo, retrospectivo e de corte transversal, o qual avaliou os prontuários dos pacientes em seguimento ambulatorial, no período de 2012 a 2022, e registros de doses de vacina aplicadas nos sistemas SICRIE e SIPNI. O projeto foi aprovado pelo Comitê de Ética em Pesquisa, CAAE 42292820.6.0000.0068. Resultados Durante investigação sorológica pré-vacinal, observou-se que 17,2% (n = 11/64) dos pacientes apresentaram imunidade adquirida, devido a presença concomitante de anti-HBs e anti-HBc IgG ou total. Os demais que não tiveram contato prévio com o vírus da hepatite B, 62,7% (n = 32/51) realizam o esquema vacinal completo com três doses da vacina de hepatite B. A soroconversão, anti-HBs positivo, foi observada em 34,4% (n = 11/32) dos pacientes, 30 a 180 dias após a administração da última dose. Os negativos foram encaminhados para quarta dose da vacina de hepatite B. Conclusão O baixo percentual de pacientes com soroconversão pós-vacinal reforça achados de estudos anteriores, os quais indicam que as infecções por Schistosoma mansoni são capazes de influenciar a cinética de respostas de anticorpos induzidas por vacinas e desencadear diminuição da resposta imune contra a hepatite B, mesmo naquelas com baixa carga parasitaria. A priorização da vacina de hepatite B dos pacientes com forma grave de esquistossomose não foi suficiente para manter uma cobertura vacinal de hepatite B acima 95%. Para atingir essa meta, ações como a busca ativa e a requisição do cartão vacinal durante o seguimento serão necessárias.

Longitudinal Analysis of Antibody Responses to the mRNA BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis: A 6-Month Follow-Up.

Background: Patients on hemodialysis (HD) are at higher risk for COVID-19, overall are poor responders to vaccines, and were prioritized in the Portuguese vaccination campaign. Objective: This work aimed at evaluating in HD patients the immunogenicity of BTN162b2 after the two doses induction phase, the persistence of specific antibodies along time, and factors predicting these outcomes. Methods: We performed a prospective, 6-month long longitudinal cohort analysis of 156 HD patients scheduled to receive BTN162b2. ELISA quantified anti-spike IgG, IgM, and IgA levels in sera were collected every 3 weeks during the induction phase (t0 before vaccine; t1, d21 post first dose; and t2 d21 post second dose), and every 3-4 months during the waning phase (t3, d140, and t4, d180 post first dose). The age-matched control cohort was similarly analyzed from t0 to t2. Results: Upon exclusion of participants identified as previously exposed to SARS-CoV-2, seroconversion at t1 was lower in patients than controls (29 and 50%, respectively, p = 0.0014), while the second vaccine dose served as a boost in both cohorts (91 and 95% positivity, respectively, at t2, p = 0.2463). Lower response in patients than controls at t1 was a singularity of the participants ≤ 70 years (p = 2.01 × 10-05), associated with immunosuppressive therapies (p = 0.013), but not with lack of responsiveness to hepatitis B. Anti-spike IgG, IgM, and IgA levels decreased at t3, with IgG levels further waning at t4 and resulting in >30% seronegativity. Anti-spike IgG levels at t1 and t4 were correlated (ρ = 0.65, p < 2.2 × 10-16). Conclusions: While most HD patients seroconvert upon 2 doses of BNT162b2 vaccination, anti-spike antibodies levels wane over the following 4 months, leading to early seroreversion in a sizeable fraction of the patients. These findings warrant close monitoring of COVID-19 infection in vaccinated HD patients, and advocate for further studies following reinforced vaccination schedules.

Population homogeneity for the antibody response to COVID-19 BNT162b2/Comirnaty vaccine is only reached after the second dose across all adult age ranges.

While mRNA vaccines are administrated worldwide in an effort to contain the COVID-19 pandemic, the heterogeneity of the humoral immune response they induce at the population scale remains unclear. Here, in a prospective, longitudinal, cohort-study, including 1245 hospital care workers and 146 nursing home residents scheduled for BNT162b2 vaccination, together covering adult ages from 19 to 99 years, we analyse seroconversion to SARS-CoV-2 spike protein and amount of spike-specific IgG, IgM and IgA before vaccination, and 3-5 weeks after each dose. We show that immunogenicity after a single vaccine dose is biased to IgG, heterogeneous and reduced with increasing age. The second vaccine dose normalizes IgG seroconversion in all age strata. These findings indicate two dose mRNA vaccines is required to reach population scale humoral immunity. The results advocate for the interval between the two doses not to be extended, and for serological monitoring of elderly and immunosuppressed vaccinees.

Controlling the pandemic during the SARS-CoV-2 vaccination rollout.

There is a consensus that mass vaccination against SARS-CoV-2 will ultimately end the COVID-19 pandemic. However, it is not clear when and which control measures can be relaxed during the rollout of vaccination programmes. We investigate relaxation scenarios using an age-structured transmission model that has been fitted to age-specific seroprevalence data, hospital admissions, and projected vaccination coverage for Portugal. Our analyses suggest that the pressing need to restart socioeconomic activities could lead to new pandemic waves, and that substantial control efforts prove necessary throughout 2021. Using knowledge on control measures introduced in 2020, we anticipate that relaxing measures completely or to the extent as in autumn 2020 could launch a wave starting in April 2021. Additional waves could be prevented altogether if measures are relaxed as in summer 2020 or in a step-wise manner throughout 2021. We discuss at which point the control of COVID-19 would be achieved for each scenario.

An Open Source GIS Application for Spatial Assessment of Health Care Quality Indicators

Prevention quality indicators (PQIs) constitute a set of measures that can be combined with hospital inpatient data to identify the quality of care for ambulatory care sensitive conditions (ACSC). Geographical information system (GIS) web mapping and applications contribute to a better representation of PQI spatial distribution. Unlike many countries in the world, in Portugal, this type of application remains underdeveloped. The main objective of this work was to facilitate the assessment of geographical patterns and trends of health data in Portugal. Therefore, two innovative open source applications were developed. Leaflet Javascript Library, PostGIS, and GeoServer were used to create a web map application prototype. Python language was used to develop the GIS application. The geospatial assessment of geographical patterns of health data in Portugal can be obtained through a GIS application and a web map application. Both tools proposed allowed for an easy and intuitive assessment of geographical patterns and time trends of PQI values in Portugal, alongside other relevant health data, i.e., the location of health care facilities, which, in turn, showed some association between the location of facilities and quality of health care. However, in the future, more research is still required to map other relevant data, for more in-depth analyses.

FEEdBACk: An ICT-Based Platform to Increase Energy Efficiency through Buildings’ Consumer Engagement

Energy efficiency in buildings can be enhanced by several actions: encouraging users to comprehend and then adopt more energy-efficient behaviors;aiding building managers in maximizing energy savings;and using automation to optimize energy consumption, generation, and storage of controllable and flexible devices without compromising comfort levels and indoor air-quality parameters. This paper proposes an integrated Information and communications technology (ICT) based platform addressing all these factors. The gamification platform is embedded in the ICT platform along with an interactive energy management system, which aids interested stakeholders in optimizing “when and at which rate” energy should be buffered and consumed, with several advantages, such as reducing peak load, maximizing local renewable energy consumption, and delivering more efficient use of the resources available in individual buildings or blocks of buildings. This system also interacts with an automation manager and a users’ behavior predictor application. The work was developed in the Horizon 2020 FEEdBACk (Fostering Energy Efficiency and BehAvioral Change through ICT) project.