Cessation of Face Mask Use after COVID-19 Vaccination in Patients with Diabetes: Prevalence and Determinants.

Studies on the cessation of face mask use after a COVID-19 vaccine in patients with diabetes are not available, despite their greater predisposition to complications. We estimated the prevalence of cessation of face mask use after receiving the COVID-19 vaccine in patients with diabetes and identified which factor was most strongly associated with non-use. This was a cross-sectional study in patients with diabetes 18-70 years with at least one dose of vaccine against COVID-19 (n = 288). Participants were asked to respond face-to-face to a questionnaire in a primary care center. Descriptive statistics, chi-square tests, and multivariate binary logistic regression were used for analyzing the association between vulnerability, benefits, barriers, self-efficacy, vaccine expectations (independent variables), and cessation of use (dependent variable), controlling for sociodemographic, smoking, medical, vaccine, and COVID-19 history. The prevalence of cessation of face masks was 25.3% (95% CI 20.2, 30.5). Not feeling vulnerable to hospitalization increased the odds of non-use (adjusted OR = 3.3, 95% CI 1.2, 8.6), while perceiving benefits did the opposite (adjusted OR = 0.4, 95% CI 0.2, 0.9). The prevalence was low, and only two factors were associated with the cessation of face mask use after COVID-19 vaccination in patients with type 2 diabetes.

Comparison Of The Effectiveness Of Four SARS-COV-2 Vaccines In Nuevo Leon, Mexico: A Test-Negative Control Study

Objetivo: El objetivo del presente estudio fue proporcionar estimaciones a nivel estatal de la efectividad en el mundo real para reducir las probabilidades de un resultado primario (infección sintomática por COVID-19) y dos resultados secundarios (hospitalización e infección grave por COVID-19) por cuatro vacunas BNT162b2 (Pfizer- BioNTech), ChAdOx1 (AstraZeneca), Ad5-nCoV (CanSinoBIO) y CoronaVac (Sinovac Life Sciences), utilizados en el noreste de México. Diseño: Realizamos un estudio de casos y controles y analizamos los datos de vigilancia en todo el estado desde diciembre de 2020 hasta agosto de 2021;Emplazamiento: Atención primaria y hospitalización. Participantes: Se aplicaron dos criterios de inclusión, edad ≥ 18 años y tener prueba de RT-PCR tiempo real o una prueba rápida para la detección de antígeno en muestras posnasales (N = 164.052). La vacunación se consideró completa si habían transcurrido al menos 14 días desde la aplicación de la dosis única o segunda y el inicio de la sintomatología. Intervenciones: No aplica Mediciones Principales: Se calcularon los puntos e intervalos de confianza (IC) del 95% de la efectividad de la vacuna por tipo de vacuna utilizando la fórmula 1: razón de probabilidades, ajustada por sexo y edad. Resultados: Vacunación completa que ofrece desde ninguna (CoronaVac - Sinovac) hasta 75% (95%IC 71, 77) (BNT162b2 -Pfizer) de efectividad en la reducción de la infección sintomática por COVID-19, independientemente del sexo y la edad. El esquema completo con ChAdOx1 (AstraZeneca) alcanzó la máxima efectividad en hospitalización (80%, 95% IC 69, 87) y el esquema completo con BNT162b2 (Pfizer) la máxima efectividad en gravedad (81%, 95% IC 64, 90). Conclusiones: Se necesitan más estudios para comparar los beneficios de las diferentes vacunas y guiar a los responsables en formulación de políticas a seleccionar la mejor opción para su población.

Comparison of the effectiveness of four SARS-COV-2 v accines in Nuevo Leon, Mexico: A test-negative control study.

OBJECTIVE: The objective of the present study was to provide statewide estimates of real-world effectiveness in reducing the odds of one primary (symptomatic COVID-19 infection) and two secondary outcomes (hospitalization and severe COVID-19 infection) by four vaccines BNT162b2 (Pfizer-BioNTech), ChAdOx1 (AstraZeneca), Ad5-nCoV (CanSinoBIO), and CoronaVac (Sinovac Life Sciences), used in Northeast Mexico. DESIGN: We conducted a test-negative case-control study and analyzed statewide surveillance data from December 2020 to August 2021. SITE: Primary attention and hospitalization. PARTICIPANTS: Two inclusion criteria were applied, age≥18 years and having a real-time reverse-transcriptase-polymerase-chain-reaction assay or a rapid test for antigen detection in postnasal samples (N=164,052). The vaccination was considered complete if at least 14 days had passed since the application of the single or second dose and the beginning of symptomatology. INTERVENTIONS: Does not apply. MAIN MEASUREMENTS: Point and 95% confidence intervals (CI) of vaccine effectiveness were calculated per type of vaccine using the formula 1 - odds ratio, adjusted by sex and age. RESULTS: Complete vaccination offered from none (CoronaVac - Sinovac) to 75% (95%CI 71, 77) (BNT162b2 - Pfizer) effectiveness in reducing symptomatic COVID-19 infection, regardless of sex and age. The fully ChAdOx1 (AstraZeneca) scheme reached the maximum effectiveness in hospitalization (80%, 95%CI 69, 87) and the fully BNT162b2 (Pfizer) scheme the maximum effectiveness in severity (81%, 95%CI 64, 90). CONCLUSIONS: More studies are needed to compare benefits of different vaccines and guide policy makers select the best option for their population.

Efficacy of Bromhexine versus Standard of Care in Reducing Viral Load in Patients with Mild-to-Moderate COVID-19 Disease Attended in Primary Care: A Randomized Open-Label Trial.

A 28-day randomized open-label multicenter study was conducted to assess the efficacy of bromhexine plus standard of care (SOC) (n = 98) vs. SOC alone (n = 93) in 191 outpatients with mild-to-moderate COVID-19 in the primary health care setting. Bromhexine three daily doses of 10 mL (48 mg/day) were administered for seven days. The primary efficacy endpoint was the reduction of viral load estimated as the cycle thresholds (Ct) to detect ORF1ab, N Protein, and S Protein genes by RT-qPCR in saliva samples on day 4 as compared with baseline. Ct values of the three genes increased from baseline throughout days 4 to 14 (p < 0.001) but significant differences between the study groups were not found. Differences in the percentages of patients with low, medium, and high viral loads at 4, 7, and 14 days were not found either. In summary, treatment with bromhexine plus SCO was associated with a viral load reduction of ORF1ab, N Protein, and S Protein genes at day 4, which was not significantly different than similar viral load reductions observed with SOC alone. The present findings do not seem to favor the use of bromhexine as an antiviral in patients with COVID-19.

[Repercussions of COVID-19 in a participatory action-research process with adolescent Roma women]. / Repercusiones de la COVID-19 en un proceso de investigación-acción participativa con adolescentes gitanas.

The objective of this article is to describe the impact of the COVID-19 pandemic on the implementation of the RoMoMatter project, using a community-based participatory action research methodology, in Córdoba (Spain). Five academic researchers and 30 community members participated. Individual interviews, focus groups and field notes were used as data collection techniques. The interviews were audio-recorded with the consent of the participants and transcribed verbatim. The information collected was coded using Atlas Ti software. The efforts of adaptation to the new pandemic scenario made by the participants and the technical and emotional support role played by the adaptation team are highlighted. It is concluded that the main impact of the pandemic was evidenced in the participatory process of all the people involved, and in the format and number of activities.

[Experiences and impact on the quality of life of people with long COVID]. / Vivencias e impacto en la calidad de vida de personas con COVID persistente.

OBJECTIVE: To explore the experiences of people with persistent COVID in the Basque Country more than a year after the start of the pandemic, in order to understand the health and social impact it has, as well as to detect possible areas for improvement in the care that these people receive in order to develop health programms to support their recovery. METHOD: Qualitative phenomenological study. In-depth interviews will be carried out as a data collection technique until saturation of the discourse. Patients of legal age who present persistent COVID symptomatology with an evolution time of more than 12 weeks were included. Contact with the patients was made through the Basque Long COVID Collective. The interviews were carried out and recorded through the ZOOM application. After the literal transcription of the interviews, the thematic analysis will be carried out, identifying the first units of meaning and assigning codes that will later be grouped into the different categories. RESULTS: 20 patients participated. A total of three main categories emerged from the analysis of the discourses: 1) affecting/impacting patients' quality of life; 2) identifying improvements in healthcare; and 3) comforting aspects. CONCLUSIONS: This study shows the significant impact on the quality of life suffered by these people. It is necessary to design health policies that favour a personalised, comprehensive and multidisciplinary approach to these patients.

Bronchiolitis before and after the SARS-CoV-2 pandemic: Twelve years of experience in a Spanish paediatric hospital.

INTRODUCTION: Acute bronchiolitis is the main cause of hospitalization in children under 2 years of age, with a regular seasonality, mostly due to the respiratory syncytial virus. OBJECTIVES: To describe the epidemiology of bronchiolitis hospitalizations in our center in the last 12 years, and analyze the changes in clinical characteristics, microbiology, and adverse outcomes during the SARS-CoV-2 pandemic. METHODS: Observational study including patients admitted for bronchiolitis between April 2010 and December 2021 in a Spanish tertiary paediatric hospital. Relevant demographic, clinical, microbiological, and adverse outcome variables were collected in an anonymized database. The pandemic period (April 2020 to December 2021) was compared to 2010-2015 seasons using appropriate statistical tests. RESULTS: There were 2138 bronchiolitis admissions, with a mean of 195.6 per year between 2010 and 2019 and a 2-4-month peak between November and March. In the expected season of 2020, there was a 94.4% reduction of bronchiolitis hospitalizations, with only 11 cases admitted in the first year of the pandemic. Bronchiolitis cases increased from the summer of 2021 during a 6-month long peak, reaching a total of 171 cases. Length of stay was significantly shorter during the pandemic, but no differences were found in clinical and microbiological characteristics or other adverse outcomes. CONCLUSIONS: The SARS-CoV-2 pandemic has modified the seasonality of bronchiolitis hospitalizations, with a dramatic decrease in cases during the expected season of 2020-2021, and an extemporaneous summer-autumn peak in 2021 with longer duration but similar patient characteristics and risk factors.

Desinformación en España un año después de la COVID-19. Análisis de las verificaciones de Newtral y Maldita

Introducción. Un año después del inicio del estado de alarma en España se ha realizado un estudio para comprobar cuál es la situación de las noticias falsas. Metodologia. Se ha realizado análisis de contenido de todas las verificaciones realizadas por las plataformas de fact checking Maldito Bulo y Newtral durante el mes del aniversario (14 de marzo a l4 de abril de 202l). En total, se han analizado 255 fact checks. Resultados. Son las noticias falsas sobre el debate político, al margen de la pandemia, las que más se están difundiendo. Los contenidos relacionados con la crisis sanitaria más difundidos son los vinculados con las vacunas y el proceso de vacunación. Casi una cuarta parte de los bulos tiene como protagonista al Gobierno de España, a gobiernos autonómicos y a otras instituciones, siendo el Ejecutivo español del que más se habla. Por el contrario, la mitad de las informaciones falsas detectadas han sido creadas por personas que no son conocidas socialmente o por personas cuya identidad se desconoce, también por los medios de comunicación y partidos de la oposición. Conclusiones y Discusión. Encontramos que las noticias falsas sobre la COVID-19 suponen un año más tarde poco más de una cuarta parte de todos los bulos existentes, lo que supone un claro descenso en comparación con los primeros meses de pandemia. Las noticias falsas continúan siendo difundidas especialmente por Twitter y WhatsApp.Alternate :Introduction. One year after the beginning of the state of alarm in Spain, a study has been carried out to check the situation of fake news. Methodology. A content analysis of all the checks made by the fact checking platforms Maldito Bulo and Newtral during the month of the anniversary (March 14 to April 14, 2021) has been carried out. In total, 255 fact checks were analyzed. Results. The fake news that are spreading the most are related to the political debate, beyond the pandemic. The most disseminated content related to the health crisis are linked to vaccines and the vaccination process. Almost a quarter of the hoaxes have the Spanish Government, regional governments and other institutions as protagonists, with the Spanish Executive being the most commented. On the other hand, half of the false information detected has been created by people who are not socially known or whose identity is unknown, as well as by the media and opposition parties. Conclusions and Discussion. We found that fake news about COVID-19 account one year later for a little more than a quarter of all existing hoaxes, which is a clear decrease compared to the first months of the pandemic. Fake news continues to be spread especially by Twitter and WhatsApp.

Seroprevalence of SARS-CoV-2 in a Fully Operative Dentistry Academic Center in Madrid (Spain) During the De-escalation Phase of the COVID-19 Pandemic. Are Our Dentists at Greater Risk?

PURPOSE: To determine the prevalence of COVID-19 infection among dental professionals at an Academic Center in Madrid (Spain) at the beginning of the pandemic's de-escalation phase. MATERIALS AND METHODS: A cross-sectional study was designed. COVID-19 infection was determined by membrane-based immunoassay qualitative detection of IgG and IgM antibodies in human whole blood. Age, sex, race and professional qualification were recorded, as were symptoms compatible with COVID-19 infection whenever present. Data collected were analysed by means of descriptive and qualitative (X2) statistical analyses. RESULTS: A total of 195 individuals were included (40 administrative professionals and 155 dentists). Seroprevalence at the end of the de-escalation phase was 20.0% among all the participants. The highest prevalence was found among the orthodontists (34.8%), followed by the paediatric dentists (28.6%) and oral surgeons (14.7%). Most subjects were positive for IgG and negative for IgM (79.5%). CONCLUSIONS: The seroprevalence of SARS-CoV-2 among dental professionals at the end of the de-escalation phase after the first wave of the pandemic was almost double the seroprevalence of the general population. Orthodontists had the highest rates of SARS-CoV-2 infection.

Age-adjusted NT-proBNP could help in the early identification and follow-up of children at risk for severe multisystem inflammatory syndrome associated with COVID-19 (MIS-C).

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) has emerged as a new disease associated with COVID-19 that presents in acute critically ill children with acute cardiovascular dysfunction. AIM: To determine whether the age-adjusted N-terminal pro-brain natriuretic peptide (NT-proBNP) value (Z-log-NT-proBNP) is associated with severe MIS-C and myocardial dysfunction. METHODS: A retrospective study was conducted which included children with MIS-C managed at our institution between April 1, 2020, and February 28, 2022. We divided the population into groups depending on severity based on pediatric intensive care unit (PICU) admission. We compared Z-log-NT-proBNP values across these groups and analyzed Z-log-NT-proBNP dynamics during the one-month follow-up. RESULTS: We included 17 participants [median age 3 (2-9) years] and seven (41%) required PICU admission. All (100%) of these cases presented very high (Z-log > 4) levels of NT-proBNP at the time of admission compared to only 5 (50%) patients with non-severe MIS-C (P = 0.025). NT-proBNP was significantly correlated with high-sensitive Troponin I levels (P = 0.045), Ross modified score (P = 0.003) and left ventricle ejection fraction (P = 0.021). CONCLUSION: Raised NT-proBNP, specifically very high values (Z-log-NT-proBNP > 4) could help in the early identification of MIS-C patients with myocardial dysfunction requiring inotropic support and PICU admission.

SARS-CoV-2 Viremia Precedes an IL6 Response in Severe COVID-19 Patients: Results of a Longitudinal Prospective Cohort.

Background: Interleukin 6 (IL6) levels and SARS-CoV-2 viremia have been correlated with COVID-19 severity. The association over time between them has not been assessed in a prospective cohort. Our aim was to evaluate the relationship between SARS-CoV-2 viremia and time evolution of IL6 levels in a COVID-19 prospective cohort. Methods: Secondary analysis from a prospective cohort including COVID-19 hospitalized patients from Hospital Universitario La Princesa between November 2020 and January 2021. Serial plasma samples were collected from admission until discharge. Viral load was quantified by Real-Time Polymerase Chain Reaction and IL6 levels with an enzyme immunoassay. To represent the evolution over time of both variables we used the graphic command twoway of Stata. Results: A total of 57 patients were recruited, with median age of 63 years (IQR [53-81]), 61.4% male and 68.4% Caucasian. The peak of viremia appeared shortly after symptom onset in patients with persistent viremia (more than 1 sample with > 1.3 log10 copies/ml) and also in those with at least one IL6 > 30 pg/ml, followed by a progressive increase in IL6 around 10 days later. Persistent viremia in the first week of hospitalization was associated with higher levels of IL6. Both IL6 and SARS-CoV-2 viral load were higher in males, with a quicker increase with age. Conclusion: In those patients with worse outcomes, an early peak of SARS-CoV-2 viral load precedes an increase in IL6 levels. Monitoring SARS-CoV-2 viral load during the first week after symptom onset may be helpful to predict disease severity in COVID-19 patients.

Repercusiones de la COVID-19 en un proceso de investigación-acción participativa con adolescentes gitanas Repercussions of COVID-19 in a participatory action-research process with adolescent Roma women

El objetivo de este artículo es describir la repercusión que ha tenido la pandemia de COVID-19 en la implementación del proyecto RoMoMatter, con una metodología de investigación-acción participativa basada en la comunidad, en Córdoba. Participaron cinco investigadoras académicas y 30 de la comunidad. Se utilizaron como técnicas de recogida de datos la entrevista individual, los grupos focales y las notas de campo. Las entrevistas fueron grabadas en audio con el consentimiento de las participantes y se transcribieron textualmente. La información recogida fue codificada mediante el software Atlas Ti. Se destacan los esfuerzos de adaptación al nuevo escenario de la pandemia realizados por las participantes y el papel de apoyo técnico y emocional que tuvo el equipo de adaptación. Se concluye que la principal repercusión de la pandemia se evidenció en el proceso participativo de todas las personas implicadas, y en el formato y el número de actividades.

Gastrointestinal and sensory manifestations, nutrition management, and energy-protein intake in hospitalized patients with COVID-19.

BACKGROUND: Gastrointestinal and sensory manifestations (GSMs) of coronavirus disease 2019 (COVID-19) may affect food intake, resulting in malnutrition and poor outcomes. We characterized the impact of GSMs and oral nutrition supplementation on energy-protein intake (EPI) and hospital discharge in adult patients with COVID-19. METHODS: Patients from two hospitals were enrolled (n = 357). We recorded the presence and type of GSM at admission, estimated energy requirements (EER) and the EPI based on regular food intake (plate diagram sheets) during hospital stays. Patients not achieving 60% of their EER from food over 2 consecutive days received oral nutrition supplementation (ONS) with a high-energy-protein oral drink. RESULTS: Most patients (63.6%) presented with GSMs at admission. Anorexia was the most common manifestation (44%). Patients with anorexia or more than one GSMs were more likely to not achieve 60% EER on the first day of follow-up and to require the ONS intervention (P ≤ 0.050). Prevalence of at least one GSM was higher in patients who did not achieve hospital discharge than in patients who achieved it (74.2% vs 54.6%, P = 0.038). The patients requiring ONS (26.9%) demonstrated good adherence to the intervention (79.3%), achieved their EER during 95.7% of the supplementation time, and presented with hospital discharge rates similar to patients not requiring ONS (92.2% vs 91.9%, respectively; P = 1.000). CONCLUSIONS: GSM were prevalent in COVID-19 and it impaired EER attendance and patient recovery. ONS was well-tolerated, aided EER attendance, and potentially facilitated hospital discharge.

Network pharmacology reveals multitarget mechanism of action of drugs to be repurposed for COVID-19.

The coronavirus disease 2019 pandemic accelerated drug/vaccine development processes, integrating scientists all over the globe to create therapeutic alternatives against this virus. In this work, we have collected information regarding proteins from SARS-CoV-2 and humans and how these proteins interact. We have also collected information from public databases on protein-drug interactions. We represent this data as networks that allow us to gain insights into protein-protein interactions between both organisms. With the collected data, we have obtained statistical metrics of the networks. This data analysis has allowed us to find relevant information on which proteins and drugs are the most relevant from the network pharmacology perspective. This method not only allows us to focus on viral proteins as the main targets for COVID-19 but also reveals that some human proteins could be also important in drug repurposing campaigns. As a result of the analysis of the SARS-CoV-2-human interactome, we have identified some old drugs, such as disulfiram, auranofin, gefitinib, suloctidil, and bromhexine as potential therapies for the treatment of COVID-19 deciphering their potential complex mechanism of action.

Glycosylation of Epigallocatechin Gallate by Engineered Glycoside Hydrolases from Talaromyces amestolkiae: Potential Antiproliferative and Neuroprotective Effect of These Molecules.

Glycoside hydrolases (GHs) are enzymes that hydrolyze glycosidic bonds, but some of them can also catalyze the synthesis of glycosides by transglycosylation. However, the yields of this reaction are generally low since the glycosides formed end up being hydrolyzed by these same enzymes. For this reason, mutagenic variants with null or drastically reduced hydrolytic activity have been developed, thus enhancing their synthetic ability. Two mutagenic variants, a glycosynthase engineered from a ß-glucosidase (BGL-1-E521G) and a thioglycoligase from a ß-xylosidase (BxTW1-E495A), both from the ascomycete Talaromyces amestolkiae, were used to synthesize three novel epigallocatechin gallate (EGCG) glycosides. EGCG is a phenolic compound from green tea known for its antioxidant effects and therapeutic benefits, whose glycosylation could increase its bioavailability and improve its bioactive properties. The glycosynthase BGL-1-E521G produced a ß-glucoside and a ß-sophoroside of EGCG, while the thioglycoligase BxTW1-E495A formed the ß-xyloside of EGCG. Glycosylation occurred in the 5″ and 4″ positions of EGCG, respectively. In this work, the reaction conditions for glycosides' production were optimized, achieving around 90% conversion of EGCG with BGL-1-E521G and 60% with BxTW1-E495A. The glycosylation of EGCG caused a slight loss of its antioxidant capacity but notably increased its solubility (between 23 and 44 times) and, in the case of glucoside, also improved its thermal stability. All three glycosides showed better antiproliferative properties on breast adenocarcinoma cell line MDA-MB-231 than EGCG, and the glucosylated and sophorylated derivatives induced higher neuroprotection, increasing the viability of SH-S5Y5 neurons exposed to okadaic acid.

Surveillance of influenza B severe hospitalized cases during 10 seasons in Catalonia: Does the lineage make a difference?

Influenza B viruses circulate in two lineages (B/Victoria and B/Yamagata). Although classically affecting children, recently it has shown a high rate of infection and increased hospitalization in the elderly. To describe and analyze the clinical and epidemiological characteristics of severe hospitalized laboratory-confirmed influenza B virus (SHLCI-B) cases in Catalonia associated with mismatch from Influenza B virus strain included in the trivalent influenza vaccine (TIV). SHLCI-B was registered by the influenza sentinel surveillance system of Catalonia (PIDIRAC) during ten surveillance seasons from 2010 to 2020. Variables age, comorbidities, and vaccination status were recorded. Vaccine effectiveness was estimated as (1-OR) for intensive care unit (ICU) admission. Statistical significance was established at p < 0.05. A total of 1159 SHLCI-B were registered, of these 68.2% (791) corresponded to the 2017-2018 season; 21.8% (253) were admitted to ICU and 13.8% (160) were exitus; 62.5% (725) cases occurred in those aged >64 years; most frequent risk factor was cardiovascular disease (35.1%, 407) followed by chronic pulmonary obstructive disease-COPD (24.6%, 285) and diabetes (24.1%, 279). In four seasons, the predominant circulating lineage was B/Victoria, in two seasons the B/Yamagata lineage and four seasons had no IBV activity. Four seasons presented discordance with the strain included within the TIV. Vaccine effectiveness (VE) to prevent ICU admission was 31% (95% confidence interval [CI]: 4%-51%; p = 0.03); being 29% (95% CI: -3% to 51%) in discordant and 43% (95% CI:-43% to 77%) in concordant seasons. Significant differences were observed in the number of affected aged > 64 years (odds ratio [OR] = 2.5; 95% CI: 1.9-3.4; p < 0.001) and in patients with heart disease (OR = 2.40 95% CI: 1.7-3.4; p < 0.001), COPD (OR = 1.6 95% CI: 1.1-2.3; p = 0.01), and diabetes (OR = 1.5 95% CI: 1.1-2.1; p = 0.04) between discordant and concordant seasons. The increase in hospitalization rate in people> 64 years of age and those presenting comorbidities in seasons with circulating influenza B virus belonging to a lineage discordant with the strain included in the TIV and the decrease of VE to prevent ICU admissions evidence the vital need to administer the quadrivalent influenza vaccine regardless of the findings of predominant circulation in the previous season.

COVID-19 vaccine effectiveness against hospitalization due to SARS-CoV-2: A test-negative design study based on Severe Acute Respiratory Infection (SARI) sentinel surveillance in Spain.

BACKGROUND: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for acute respiratory infection (ARI) surveillance in primary care and a network of sentinel hospitals for severe ARI (SARI) surveillance in hospitals. METHODS: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 vaccine effectiveness (VE) against hospitalization, by age group, vaccine type, time since vaccination, and SARS-CoV-2 variant. RESULTS: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. CONCLUSIONS: The SiVIRA sentinel hospital surveillance network in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations and provide estimates of COVID-19 VE in the population under surveillance. Our estimates add to evidence of high effectiveness of mRNA vaccines against severe COVID-19 and waning of protection with time since vaccination in those aged 80 or older. No substantial differences were observed between SARS-CoV-2 variants (Alpha vs. Delta).

Relevant SARS-CoV-2 viremia is associated with COVID-19 severity: Prospective cohort study and validation cohort.

Early kinetics of SARS-CoV-2 viral load (VL) in plasma determined by quantitative reverse-transcription polymerase chain reaction (RT-PCR) was evaluated as a predictor of poor clinical outcome in a prospective study and assessed in a retrospective validation cohort. Prospective observational single-center study including consecutive adult patients hospitalized with COVID-19 between November 2020 and January 2021. Serial plasma samples were obtained until discharge. Quantitative RT-PCR was performed to assess SARS-CoV-2 VL. The main outcomes were in-hospital mortality, admission to the Intensive Care Unit (ICU), and their combination (Poor Outcome). Relevant viremia (RV), established in the prospective study, was assessed in a retrospective cohort including hospitalized COVID-19 patients from April 2021 to May 2022, in which plasma samples were collected according to clinical criteria. Prospective cohort: 57 patients were included. RV was defined as at least a twofold increase in VL within ≤2 days or a VL > 300 copies/ml, in the first week. Patients with RV (N = 14; 24.6%) were more likely to die than those without RV (35.7% vs. 0%), needed ICU admission (57% vs. 0%) or had Poor Outcome (71.4% vs. 0%), (p < 0.001 for the three variables). Retrospective cohort: 326 patients were included, 18.7% presented RV. Patients with RV compared with patients without RV had higher rates of ICU-admission (odds ratio [OR]: 5.6 [95% confidence interval [CI]: 2.1-15.1); p = 0.001), mortality (OR: 13.5 [95% CI: 6.3-28.7]; p < 0.0001) and Poor Outcome (OR: 11.2 [95% CI: 5.8-22]; p < 0.0001). Relevant SARS-CoV-2 viremia in the first week of hospitalization was associated with higher in-hospital mortality, ICU admission, and Poor Outcome. Findings observed in the prospective cohort were confirmed in a larger validation cohort.