Crisis management in times of uncertain supply and value chains

Supply chain managers are forced to develop crisis-induced strategies due to the complexity of crises, as opposed to the more traditional strategies that prioritize competitive priorities. The increasing frequency and severity of recent crises, such as the coronavirus outbreaks, widespread product recalls, and financial crises, highlight the need for introspective and retrospective socio-economic insights on the contexts, priorities, and themes of supply chain management in times of crisis. This article's goal is to review the literature on supply chain management during times of crisis, organizing the relevant body of scholarly work in a systematic way, outlining current research methodologies, capturing strategic priorities and themes of complexity in research studies, and highlighting opportunities for additional research. Four factors for restorative priorities are identified by the review, which is based on a systematic analysis of 250 academic publications from 1996 to 2021 and reflects operations strategy in times of crisis: Critical supplies with important services, prompt action with restoration, safety with security, and traceability with transparency are just a few examples. The analysis also reveals that network configurations and business cycle complexity, optimal choices and provisioning system complexity, complicated learning processes and demand forecast are all sources of operational complexity during crises. The build-to-cycle, organic capabilities, and operational mindfulness framings for supply chain management in emergency situations are suggested with the use of review insights. The article ends with suggestions for future research on supply chain improvements, diagnosis, solidarity, mapping, temporariness, and thresholds, as well as optimal selection issues on connecting crisis network allocations with cross-functionalities and connecting crisis systems investments with liabilities.

Epidemics, pandemics and dentistry: a commentary

There is no doubt that epidemics and pandemics have transformed dentistry beyond recognition. In this commentary we recapitulate the possible reasons for the emergence of major global epidemics and pandemics, how and why they emerge, and the successful attempts of the dental profession to mitigate infectious transmission in the clinic, which in turn has metamorphosed our profession today. We also peer into the future of dentistry through the prism of the new conceptual approach of 'one world, one health' recently declared by the Centers for Disease Control (CDC). Finally, we discuss five realms of dentistry that have been irretrievably impacted by the recent COVID-19 pandemic, viz vaccines, point of care diagnostics, teledentistry, reinforced infection control, and dental pedagogy. CPD/Clinical Relevance: Vaccines and vaccinations have become integral to societal wellbeing and the prevention of global pandemics.

Adaptive reuse of closed malls for dementia programs and services: Community focus group feedback

The double societal hit of dementia and infectious disease outbreaks like COVID-19 have raised a convergence of concerns for the future of care settings for people living with dementia. Images of institutionalized older adults who are quarantined in closed settings have led developers, government agencies, and care administrators to search for innovative options to create more autonomy and quality of life in care settings while protecting the health of residents. This chapter describes the qualitative work being conducted by a Midwestern university research team, laying the groundwork for the conceptual adaptive reuse of an 800,000 square-foot closed mall site for centralized dementia programs, services, housing, and an on-site quarantine and medical center. Focus group outcomes from architects and developers highlighted five principle themes relating to the barriers and benefits of adaptive reuse for this model which include: mixed-use precedents, linking the old with the new, economic factors, development partnerships, and sustainable building practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Trending the Variants of SARS-CoV-2 in the Veteran Population: How Things Have Changed from Before to the Interesting Present

Introduction/Objective In both the past and for the foreseeable future, SARS-CoV-2 (the coronavirus that causes COVID-19 disease) will continue to evolve. This evolution has already and will lead to new variants that will then cause surges of infection. These outbreaks in the past with the variant responsible have previously been reported individually. However, a timeline perspective on the changing SARS-CoV-2 variant landscape is sparse in the literature, particularly for testing performed at a Veteran Affairs Medical Center (VAMC). The Veteran population has increased comorbidities compared to the general population leading to susceptibility to infection including SARS-CoV-2. Hence, it is of utmost importance to explore the trending variants of SARS-CoV-2 in the veteran population as this epidemiological information may help in preventing transmission, which remains key in the management of COVID-19. Methods/Case Report Samples from selected patients from March 2021 to June 2022 who tested positive for SARS- CoV-2 by reverse transcriptase polymerase chain reaction with a cycle threshold or number <30 (required for sequencing) were sent for SARS-CoV-2 sequencing analysis. Results (if a Case Study enter NA) There were a total of 19 VAMC patients who were sequenced during the entire study period (March 2021 to June 2022). From March to May 2021, there were 8 patients, from which 6 demonstrated Pango Lineage B.1.1.7, 1 demonstrated Pango Lineage B.1.526.1, and 1 demonstrated Pango Lineage B.1. Later in 2021 (August to October 2021), there were 4 patients all of which demonstrates the Delta variant;2 of these 4 demonstrated the Delta subvariant Pango Lineage AY.25 and the other 2 demonstrated Pango Lineage AY.44. By May to June 2022, there were 7 patients, all of whom demonstrated infection by the Omicron variant. Interestingly, 6 of these 7 patients demonstrated the newly emerging subvariant BA.2.12.1 and the remaining 1 demonstrated BA.2.9. Conclusion SARS-CoV-2 has continued to evolve throughout the course of the pandemic, which has led to variants and subvariants that have predominated for a time to cause an outbreak only to be replaced later by a different strain. This timeline epidemiological perspective demonstrates that the Veteran population has also been affected by the variants that have led to outbreaks in the past within the general population.

A review of the epidemiology, diagnosis, treatment, vaccines and economic impact of human monkeypox (Mpox) outbreaks

The current monkeypox outbreak is a public health emergency of international concern and is coming in the wake of the SARS-CoV-2 pandemic. Human monkeypox is a viral zoonotic infection caused by monkeypox virus, an enveloped double-stranded DNA virus of the genus Orthopoxvirus and family Poxviridae that also contain smallpox, cowpox, Orf, and vaccinia viruses. Online databases including PubMed, Google Scholar and Web of Science were searched to obtain relevant publications on the epidemiology, treatment, vaccines and the economic impacts of the current monkeypox (Mpox) outbreak.

Unfolding Outbreak Scenarios Can Be a Bite-Size Treat and Other Lessons From New Zealand's First Online Environmental Health Conference

The New Zealand Institute of Environmental Health (NZIEH) is a nongovernmental institute for all environmental health professionals in New Zealand. In 2021, NZIEH held its annual conference as an online virtual event for the first time. One inclusion to the program was an evolving outbreak scenario delivered in installments including "injects" of information (i.e., inserts of information relevant to the scenario) that mimic the evolution of a real-life epidemiological outbreak investigation. Questions were posed to attendees related to each added information inject. The scenario also included discussion in virtual breakout rooms that allowed attendees to network and reach consensus before responding to questions;discussions were also initiated by the scenario facilitators. Details of the scenario, its aims, evaluation of success, and limitations of this approach are discussed.

Repositioning Primary Education for Sustainability in Post Covid-19 Era

The outbreak of mysterious pneumonia caused by a novel corona virus vis-à-vis Respiratory Syndrome Corona virus 2 (SARS-Cov-2) began in Wuhan China in the Month of December of the year 2019. SARS-Cov-2 exhibited person to person transmission of what became labeled as COVID-19 which quickly led to a World Wide (WW) outbreak of potentially fatal pneumonia and was declared as a pandemic in March 11, 2020 by World Health Organization (WHO). It has spread (WW) with over 174 million infected cases and more than 3.79 million deaths as at (June 11, 2021).This paper is therefore centered on the repositioning of primary education for sustainability in the post covid-19 era. The concept of primary education as perceived by various authors was brought to bear as well as the objectives of primary education as stipulated in the National Policy on Education. The paper considered the different challenges of primary education such as;covid-19 pandemic which led to lockdown and closure of schools, insecurity, food insecurity, inadequate competent and qualified teachers, poor funding among others. The repositioning of primary education was highlighted based on the identified challenges/problems. This include the following;establishment of good safety and health habits through vigorous compliance with covid-19 protocols by wearing nose masks, face mask, practicing regular hand washing and maintaining of social distance in the schools;equitable and adequate funding of primary education to check future interruption of the primary education sector etc.

Relationship between attentional Bias, anxiety, depression and post-traumatic stress disorder in primary and middle school students

Objective: To investigate the relationship between negative attentional bias and post-traumatic stress disorder(PTSD) in the context of higher depression and anxiety symptoms after the outbreak of COVID-19, so as to provide scientific basis for mental health education in primary and secondary schools. Methods: From March to April 2021, a total of 708 students from primary school and junior high school (grade 6 through grade 9) in Beijing, Shanxi, Hunan, Shandong, Hebei, Hubei of China were selected. The Children's Revised Impact of Event Scale(CRIES), the Attention to Positive and Negative Information Scale (APNI)and Depression, Anxiety and Stress Scale-21(DASS-21) were used in a questionnaire survey. Results: A total of 242 students were diagnosed with PTSD, and the detection rate was 34.2%. The scores of intrusion and high arousal of boys(7.92+or-5.33, 8.60+or-5.41) were lower than those of girls(8.72+or-4.85, 9.50+or-4.76), and the difference was statistically significant (t=-2.04, -2.32, P < 0.05). There were statistically significant differences of negative attention bias, CRIES score, intrusion, debarb and high arousal among primary and middle school students of different grades (F=3.57, 5.99, 4.45, 4.60, 7.40, P < 0.05). Negative attention bias, anxiety, depression and post-traumatic stress symptoms were significantly positively correlated (r=0.27-0.84, P < 0.05). Logistic regression analysis showed that anxiety (OR=1.13, 95%CI=1.06-1.20) and negative attention bias (OR=1.10, 95%CI=1.07-1.12) were positively associated with PTSD symptoms in primary and middle school students(P < 0.01). Conclusion: Anxiety and depressive symptoms show impacts on negative attention bias and might exacerbate the symptoms of post-traumatic stress disorder. Therefore, emotional adjustments can help reduce the post-traumatic stress response in the post-epidemic period.

Zoonotic diseases in animal agriculture and beyond: a one health perspective

This publication focuses on a group of vignettes to help understand zoonotic diseases, the anthropogenic factors accelerating their emergence, and the consequences of these events. While human activities and behavior are mostly responsible for creating this new era, the world struggles to prepare, change behavior, and rethink strategies to effectively address the inevitability of more frequent occurrences and severity of disease outbreaks and pandemics. Although we know and have experienced the cost of failure, past disease outbreaks seem to be quickly lost from our collective memories and new innovative interventions have not been imagined or adopted. This publication highlights examples that challenge our traditional actions and thinking and emphasize the need to adopt new approaches to prevent or ameliorate zoonotic diseases. The consensus of the experts contributing to this publication is that One Health should be embraced to achieve these results. The growing costs and societal disruptions of outbreaks and pandemics demand that zoonoses be part of our national security planning and deserve commensurate investments in preparedness, prevention, research, and resilience. This publication also highlights the necessity to fundamentally rethink and reestablish new relationships among institutions, organizations, and countries and especially between humanity and our natural systems worldwide.

Keep Calm and Go Out: Urban Nature Exposure, Mental Health, and Perceived Value during the COVID-19 Lockdown

The COVID-19 pandemic has highlighted the importance of incorporating nature-based solutions in urban design, in order to create sustainable and resilient cities. Inspired by these events, the present study aims at exploring the mental health benefits of nature exposure during the outbreak. Secondarily, we investigate changes in use patterns towards urban green spaces (UGS) and urban blue spaces (UBS) and whether extreme conditions, such as these of a lockdown, can lead to an increase in people's appreciation of urban nature. Through an online survey, we observed that the pandemic resulted in a decrease in the frequency of visitation to UGS/UBS (p < 0.001). Significant differences were found for exercise (p < 0.001) and socialization (p < 0.05) as main drivers for visiting urban nature pre- and post-lockdown. Accordingly, visitation rates for forests (p < 0.05), playgrounds (p < 0.001), and the sea (p < 0.001) differed significantly when comparing the two periods. In people's perception, UGS/UBS are important for the urban fabric (89%). Our structural equation model indicated that nature exposure had a beneficial effect on participants' mental health (p < 0.001). Pathways that explain the relationship between nature exposure and post- lockdown value were nature relatedness, motivation, and perceived importance of UGS/UBS. No mediation could be extracted for nature exposure and mental health. Our findings show the positive association between nature exposure and mental health improvement, especially in times of crisis, as well as a shift in the "value domain” towards urban nature.

An outbreak of school influenza complicated with Mycoplasma pneumoniae infection

Objective: To describe the clinical features, causal agent and transmission mode of a fever outbreak in a school in Shanghai. Methods: Field epidemiological approaches including case definition development, searching for contacts, distribution of diseases description, environmental sampling and laboratory testing. Results: A total of 16 influenza-like cases were included, all concentrated in the one class of grade two, including 15 students and 1 teacher. Among student cases, the incidence rate was 36.59%(15/41), the average age was 7.4 years, the incidence rate was 36.84%(7/19) for boys, 36.36%(8/22) for girls. The clinical course was 5-15 days, with the median of 9 days, and 18.75%(3/16) of the cases stayed studying while sick. The nasopharyngeal swab specimens in 16 cases all tested positive for influenza B, of which 11 tested positive for mycoplasma pneumoniae and 1 case also tested positive for coronavirus OC43. Body temperature, number of mononuclear cells, and treatment time of patients infected with Influenza B and mycoplasma pneumoniae were higher than those of patients infected with influenza B alone(P < 0.05). The outbreak lasted for 12 days, all sick students were treated and discharged from hospital, with no severe cases or death, and the outbreak was effectively controlled. Conclusion: This campus cluster outbreak caused by influenza B and mycoplasma pneumoniae. Patients with influenza B with mycoplasma pneumoniae have severe symptoms and a long course of illness, suggesting the importance of early management of the epidemic.

Clostridium perfringens spores in urology hospital

Background: Clostridium spp. spores are resistant to many factors, including alcohol-based disinfectants. The presence of clostridial spores in a hospital environment may lead to infection outbreaks among patients and health care workers. Background: This study is aimed to detect clostridial spores in the aurology hospital using C diff Banana BrothTM and assess the antibiotic sensitivity and toxinotypes of isolates. Methods: After diagnosing COVID-19 in medical staff and closing an 86-bed urology hospital in 2020 for H2O2 fogging, 58 swabs from the hospital environment were inoculated to C diff Banana BrothTM, incubated at 37 degrees C for 14 days, checked daily, and positive broths were sub-cultured anaerobically for 48 h at 37 degrees C. After identification, multiplex PCR (mPCR) was performed for Clostridium perfringens, C. difficile toxin genes, and minimum inhibitory concentration (MIC) determination. Results: In this study, 16 out of 58 (~ 28%) strains of Clostridium spp. were cultured: 11 - C. perfringens, 2 - C. baratii, and 1 each of C. paraputrificum, C. difficile, and C. clostridioforme. 11 C. perfringens were positive for the cpa, 7 - the cpb2, 2 - cpiA, and 1 - cpb toxin genes. All isolates were sensitive to metronidazole, vancomycin, moxifloxacin, penicillin/tazobactam, and rifampicin. Two out of the 11 C. perfringens strains were resistant to erythromycin and clindamycin. Conclusions: Regardless of the performed H2O2 fogging, antibiotic-resistant, toxigenic strains of C. perfringens (69%) obtained from the urology hospital environment were cultured using C diff Banana BrothTM, indicating the need to develop the necessary sanitary and epidemiological procedures in this hospital.

Investigation and control actions of an outbreak COVID-19 onset in a hospital at Campos Gerais, Parana

As a result of the COVID-19 pandemic, several hospitals around the world reported the transmission of the disease in inpatient units not directed to the care of patients affected by the disease. The objective was to report the epidemiological investigation of two outbreaks of COVID-19 in an onset of a university hospital in the general fields. It took place between July and October/2021, the data were analyzed with the SIR model (susceptible-infected-recovered) to obtain the transmission rate (R). In the first outbreak (July-August), 49 people were investigated, 25/49 (51.0%) cases, 10/25 (40.0%) staff, 15/25 (60.0%) patients, 8/25 (33.3%) medical clinic, 16/25 (66.7%) surgical clinic and 21/25 (84.0%) symptomatic. Among the cases in patients, 11/15 (73.3%) had onset of symptoms after 7 days of hospitalization. The 5W2H matrix was used as an action plan. After the execution of the actions, there were active cases for 7-10 days. The duration was 35 days, the most critical moment occurred 17 days after the first patient presented symptoms, there were 15 patients active at the same time and the R was 2.92. In the second outbreak (SeptemberOctober), 127 people were investigated and there were 6/127, of these 2/6 (33.3%) staff, 4/6 (66.6%) patients, 4/6 (66.6%) medical clinic, 2/6 (33.3%) surgical clinic, 4/6 (66.6%) symptomatic. After the execution of the actions, there were active cases for 7-10 days and there were no new cases. The duration was 18 days, the most critical moment occurred after 7 days of the first patient presenting symptoms, there were 6 people active at the same time and the R was 1.35. The first experience was effective, however late in controlling the cases. The second experiment, using data from the first, was timely, the investigation was more robust and contained the outbreak quickly and efficiently.

"Fortune amidst misfortune”: The impact of Covid-19 city lockdowns on air quality

Air pollution is one of the major causes of health risks as it leads to widespread disease and death each year. Countries have invested heavily in fighting air pollution, arguably without convincing results. The outbreak of the highly infectious disease COVID-19 in December 2019 has been declared a pandemic and a worldwide health crisis by World Health Organization (WHO). Countries resorted to city lockdowns that sternly curtailed personal mobility and economic activities to control the spread of this deadly coronavirus disease. This paper examines the impact of Covid-19 city lockdowns on air quality. The researchers adopted a comprehensive interpretative document analysis for this study, which guided the careful but rigorous examination of air quality and coronavirus data. This method affirmed the authenticity of the information examined and interpreted in the US, Italy and China, the study areas. The study found that Covid-19 city lockdowns have contributed to a significant improvement in air quality within the first four months of the outbreak of Covid-19. National Aeronautics and Space Administration (NASA) had reported that NO2 concentrations in the study areas had reduced significantly using evidence from their Sentinel-5P instrument. Air quality in Covid-19 cities' lockdowns also improved because of the enforcement of other types of measures enacted to battle the virus. WHO still believes that the amount of NO2 concentration in the atmosphere is still high per their standards and regulations. Based on this, the researchers recommend that governments and other stakeholders put in much effort in terms of legislation to "win the war” against air pollution.

Descriptive epidemiological study of coronavirus disease distribution in specific geographic location: unique public health practice in outbreak analysis

Since the emergence of the Coronavirus disease outbreak, the world has witnessed great changes that have impacted humanity. A study of the pattern of the pandemic would be of great importance to understand the trending behavior for the spreading of the disease within any country. Visualization of the outbreak progression - through accumulated records in the datasets - using statistical tools showed that the initial fast increase rate of the affected cases in the original province in China was followed by a stability period till the end of the reporting date. Hong Kong - which was next to Hubei province in the cases - showed a different surge of slow growth curve with distinct major wave levels. The remaining territories showed a much smaller magnitude of morbidities. However, investigating the similarity levels for the daily kinetics of cases showed a clustering tendency between different political regions suggesting a significant correlation. The technique would be useful for public health authorities work.

Communities in Transitions: Reflection on the Impact of the Outbreak of COVID-19 on Urban China

"Community”, as a basic category of urban socio-space, has undergone evolution within academic, policy, and day-to-day life contexts in China. Through years of transitions, a kind of dual community emerged in Chinese cities before the epidemic. It encompassed a "conceptual community” based on the concept of (social) co-governance and an "experiential community” based on citizens' daily living. The disparity between the two had given rise to a paradoxical situation in local community governance practices. The outbreak of COVID-19 brought fundamental changes to the transition process. Through the analysis of 21 recording reports during the outbreak period, we found that to contain the pandemic, the community epidemic prevention measures necessitated both these communities to overlap within a brief time frame. This led to reinforced community boundaries, the coexistence of multiple actors, the reconstruction of a sense of security-based belongingness, and the reformulation of the governance symbolic system that temporarily resolved the paradoxical governance practices. What happened under the preface of co-governance logic during the outbreak period was the coverage and shaping of the conceptual community over the experiential community, which may continue during the post-epidemic era. This study offers a relatively new approach and valuable insights into examining the long-lasting impact of the epidemic on urban social space and sustainable development in the post-epidemic era.

The skin damage in the control of COVID-2019 infections and strategy to guide the treatment in a new stage

Since the outbreak of the novel coronavirus in 2019, with the relentless efforts of the country in the early stage to the "10 new measures" now, the prevention and control has been gradually released from strict regulations. The number of COVID-19 infections increased, and wide attention has been attracted by the primary skin diseases, deterioration of pre-existing skin diseases, and other skin damage that resulted from self-protection and treatment. Considering the series of skin problems caused by COVID-19 infection and prevention measures, we mainly summarize the common skin damage after the"10 new measures" and propose a strategy to guide the treatment in this article.

Public Attitudes to Immigration in the Aftermath of COVID-19: Little Change in Policy Preferences, Big Drops in Issue Salience: IMR

How has the COVID-19 pandemic affected public attitudes toward immigration? Long-term evidence in Europe and the United States suggests attitudes to immigration are relatively stable and, in some cases, becoming more favorable with high volatility instead of the perceived importance of the issue. However, theoretically a global pandemic could exacerbate people's fears of outsiders or that migration may contribute to the disease. By contrast, attitudes could remain stable if their distal drivers prove to be robust enough to withstand the shock of COVID-19. We draw from Eurobarometer data from 2014 to 2021 across 28 European countries, weekly national survey data during the outbreak from the United States and individual panel data from the United Kingdom and Germany to find little systematic change in immigration preferences and no country-level correlation between the observed changes and the outbreak's severity. Instead, the perceived importance of immigration has consistently and significantly decreased. These findings suggest that, if COVID-19 is to have an impact on attitudes to migration, it is likely to emerge via longer-term means, such as early-life socialization and value change, rather than reactions to the immediate pandemic shock.

Effects of COVID-19 on passenger shipping activities and emissions: empirical analysis of passenger ships in Danish waters

This paper focuses on the analysis of the COVID-19 effects on passenger shipping in Danish waters as an example and aims to analyse the differences in passenger vessel activities and emissions before and after the COVID-19 outbreak. Two sets of Automatic Identification System (AIS) data for the passenger ships sailing in Danish waters associated with the whole year respectively for 2020 and 2019 are used for a comprehensive evaluation of the passenger shipping activities in the region by means of the analysis of variance and bottom-up emission models. A comparison of those results based on the two datasets shows that the COVID-19 pandemic has a major impact on cruise ships, with a significant reduction in the number of ships, average speed, and average draught. In contrast, the pandemic has a smaller impact on ferry-pax only and ferry-ro pax vessels. The effects can also be seen from the fact that, after the COVID-19 outbreak, SOx emissions from cruise ships, ferry-pax only and ferry-ro pax vessels were reduced by 50.71%, 0.51% and 0.82%, respectively. This investigation provides an important reference for policy makers in the marine environment sector.

THE CONTRIBUTION OF THE 3RD AND 4TH BOOSTER BNT162B2 MRNA VACCINES TO PREVENT SEVERE COVID-19 AMONG AUTOIMMUNE INFLAMMATORY RHEUMATOID DISEASES (AIRD) PATIENTS DURING THE OMICRON OUTBREAKS

BackgroundThe 3rd booster of mRNA vaccines against SARS COV2 was highly efficient against delta variant but data regarding the efficacy of the 3rd and 4th boosters against the omicron variants, among AIRD pts are scarce.ObjectivesWe aimed to assess the effect of the 3rd and 4th booster mRNA vaccines against SARS CoV2, in preventing severe COVID-19, in AIRD patients (pts) treated with immunomodulating drugs.Methods212 pts (mean age(SD) 57(13), disease duration 11.2(7.4), who received the 3rd booster (Pfizer) were included in the study. We performed serology tests 24 weeks after the second dose of vaccine and 4-8 weeks after the 3rd booster. IgG Antibodies (Ab) against SARS COV2 virus were detected using the SARS-Cov-2 IgG II Quant (Abbott) assay. The test was considered positive above 50 AU/ml. Data regarding COVID-19 infection during the 5th outbreak (omicron) were collected from the medical files. The length of observation period was defined as the time from the 3rd booster to the last hospital visit or COVID 19 diagnosis, whichever occurred first.ResultsThe 3rd booster administration (Pfizer) significantly augmented the humoral response (from mean(SD) 1121(4723) AU/ml to 12153(13687)). 58 patients received the 4th booster and 18 the 5th booster. COVID-19 was diagnosed in 103 pts (49%) within mean(SD) 224.8(106.5) days after the 3rd booster vaccination. 109 pts remained free of disease during mean(SD) follow-up 230.6(133.9). Following the 4th booster, 26 (45%) out of 58pts contracted COVID-19 within mean(SD) 97.6(78.7) days after the vaccination. One 70 year old patient (vaccinated 3 times) died and 2 other pts (rituximab treated) had severe COVID-19. The IgG Ab titer after the 3rd booster was lower in pts who contracted COVID 19 compared to those uninfected (mean(SD), median 8777.9(11716.4),3475 AU/ml vs 15348.1(14649.1),10801, p=0.004).There were no statistically significant differences between the pts with COVID-19 and those without, regarding age, type of disease, treatment and humoral response 24 weeks after the 2nd vaccination.ConclusionDespite an enhanced humoral response obtained after the 3rd booster, 49% of AIRD pts vaccinated with 3 doses and 45% of pts vaccinated with 4 doses had COVID-19 during the omicron outbreaks. Higher humoral response to the 3rd booster was associated with a lower rate of COVID19. The booster vaccines conferred 99% protection against severe COVID-19.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.