Does Influenza Vaccination Reduce the Risk of Contracting COVID-19?

The concurrent timing of the COVID-19 pandemic and the seasonal occurrence of influenza, makes it especially important to analyze the possible effect of the influenza vaccine on the risk of contracting COVID-19, or in reducing the complications caused by both diseases, especially in vulnerable populations. There is very little scientific information on the possible protective role of the influenza vaccine against the risk of contracting COVID-19, particularly in groups at high-risk of influenza complications. Reducing the risk of contracting COVID-19 in high-risk patients (those with a higher risk of infection, complications, and death) is essential to improve public well-being and to reduce hospital pressure and the collapse of primary health centers. Apart from overlapping in time, COVID-19 and flu share common aspects of transmission, so that measures to protect against flu might be effective in reducing the risk of contracting COVID-19. In this study, we conclude that the risk of contracting COVID-19 is reduced if patients are vaccinated against flu, but the reduction is small (0.22%) and therefore not clinically important. When this reduction is analysed based on the risk factor suffered by the patient, statistically significant differences have been obtained for patients with cardiovascular problems, diabetics, chronic lung and chronic kidney disease; in all four cases the reduction in the risk of contagion does not reach 1%. It is worth highlighting the behaviour that is completely different from the rest of the data for institutionalized patients. The data for these patients does not suggest a reduction in the risk of contagion for patients vaccinated against the flu, but rather the opposite, a significant increase of 6%. Socioeconomic conditions, as measured by the MEDEA deprivation index, explain increases in the risk of contracting COVID-19, and awareness campaigns should be increased to boost vaccination programs.

Impacto de la fragilidad y COVID-19 en una cohorte de gente mayor de la ciudad de Barcelona / Frailty impact on COVID-19 disease in an older cohort from the city of Barcelona

Objetivo: Describir la incidencia y mortalidad de COVID-19, durante la primera ola, en la población de personas mayores de Barcelona, según sus niveles previos de fragilidad. Diseño: Estudio de cohortes retrospectivo. Emplazamiento y participantes: Población de 65 o más años asignada a los centros de Atención Primaria de Barcelona del Institut Català de la Salut, seguidos entre marzo y junio de 2020. Mediciones principales: Fragilidad calculada al inicio a partir de la historia clínica informatizada. Resultados durante el seguimiento: diagnóstico de COVID-19, posible o confirmado con PCR y mortalidad por todas las causas. Resultados: Se analizaron 251788 mayores de 64 años. Un 61,3% tenían algún nivel de fragilidad, 27,8% moderada o grave. La incidencia de COVID-19 fue de 3,13 casos por 100 habitantes (N = 7883) y la mortalidad por COVID-19 fue del 21,5% (N =1 691). Tanto la incidencia como la mortalidad por COVID-19 fueron superiores a mayor edad, en hombres, a mayor privación y a mayor nivel de fragilidad. Los individuos con fragilidad leve, moderada y grave tuvieron un hazard ratio ajustado de enfermedad por COVID-19 de 1,47, 2,08 y 3,50 respectivamente. Entre los sujetos con COVID-19, aquéllos con fragilidad leve, moderada y grave tuvieron un hazard ratio ajustado de mortalidad por COVID-19 de 1,44, 1,69 y 2,47 respectivamente. Conclusiones: Consideramos necesario el abordaje de la fragilidad también en situación de pandemia, dado que es una condición tratable y a su vez factor de riesgo de COVID-19 más grave, donde el papel de la Atención Primaria es primordial, por su accesibilidad y longitudinalidad.(AU)

Objetive: To describe the incidence and mortality of the first wave of COVID-19 in the elderly population of Barcelona, according to their previous levels of frailty. Design: Retrospective cohort study. Setting and participants: Population aged 65 or over assigned to the Barcelona Primary Care centres of the Institut Català de la Salut, followed between March and June 2020. Main measurements: Frailty was calculated at baseline from the computerised medical records. Results during follow-up: diagnosis of COVID-19, possible or confirmed with PCR and all-cause mortality. Results: 251788 patients over 64 years of age were analysed, 61.3% had some level of frailty, 27.8% moderate or severe. The incidence of COVID-19 was 3.13 cases per 100 inhabitants (N=7883) and the mortality from COVID-19 was 21.5% (N=1691). Both the incidence and mortality from COVID-19 were higher at older age, in men, at greater deprivation and at a higher level of frailty. Individuals with mild, moderate, and severe frailty had an adjusted Hazard Ratio (HR) for COVID-19 disease of 1.47, 2.08, and 3.50, respectively. Among subjects with COVID-19, those with mild, moderate, and severe frailty had an adjusted HR for COVID-19 mortality of 1.44, 1.69, and 2.47, respectively. Conclusions: We consider it necessary to address frailty also in a pandemic situation, since it is a treatable condition and in turn a more serious risk factor for COVID-19, where the role of primary care is essential, due to its accessibility and longitudinal character.(AU)

[Frailty impact on COVID-19 disease in an older cohort from the city of Barcelona]. / Impacto de la fragilidad y COVID-19 en una cohorte de gente mayor de la ciudad de Barcelona.

Objetive To describe the incidence and mortality of the first wave of COVID-19 in the elderly population of Barcelona, according to their previous levels of frailty. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Population aged 65 or over assigned to the Barcelona Primary Care centres of the Institut Català de la Salut, followed between March and June 2020. MAIN MEASUREMENTS: Frailty was calculated at baseline from the computerised medical records. Results during follow-up: diagnosis of COVID-19, possible or confirmed with PCR and all-cause mortality. RESULTS: 251788 patients over 64 years of age were analysed, 61.3% had some level of frailty, 27.8% moderate or severe. The incidence of COVID-19 was 3.13 cases per 100 inhabitants (N=7883) and the mortality from COVID-19 was 21.5% (N=1691). Both the incidence and mortality from COVID-19 were higher at older age, in men, at greater deprivation and at a higher level of frailty. Individuals with mild, moderate, and severe frailty had an adjusted Hazard Ratio (HR) for COVID-19 disease of 1.47, 2.08, and 3.50, respectively. Among subjects with COVID-19, those with mild, moderate, and severe frailty had an adjusted HR for COVID-19 mortality of 1.44, 1.69, and 2.47, respectively. CONCLUSIONS: We consider it necessary to address frailty also in a pandemic situation, since it is a treatable condition and in turn a more serious risk factor for COVID-19, where the role of primary care is essential, due to its accessibility and longitudinal character.

[Characteristics and factors associated with the severity of COVID-19 in Primary Care professionals followed in a Basic Prevention Unit.] / Características y factores asociados a la gravedad de COVID-19 en profesionales de Atención Primaria seguidos en una Unidad Básica de Prevención.

OBJECTIVE: 24.1% of COVID-19 cases reported in Spain from the start of the COVID-19 alert until 29 May 2020 were in healthcare workers. The aim was to describe the demographic, clinical and epidemiological characteristics of Primary Care professionals notified for suspected or contact COVID-19 and to know the factors associated with the severity of the disease. This will allow the development of risk prevention strategies in Primary Care professionals. METHODS: We included all Primary Care professionals of the Territorial Management of Barcelona (GTBCN) notified as suspicion or contact with COVID-19 between March 15 and June 15, 2020. Demographic, clinical and epidemiological variables of the professionals and episodes reported were collected, as well as possible risk factors associated with severity. Descriptive and logistic regression analysis were performed. RESULTS: 1,511 episodes corresponding to 1,427 professionals (31.3% of the GTBCN staff) were reported. 76.4% were women, with a mean age of 45.32 years. Of the professionals reported, 28.5% presented COVID-19 in some episode, and of these 18.2% presented severe symptomatology. Risk factors associated with severity were: respiratory pathology (OR: 2.54, 95%CI: 1.16-5.56) and neoplasia (OR: 4.48, 95%CI: 1.38-14.55). CONCLUSIONS: The proportion of professionals notified due to suspicion or contact with COVID-19 is similar to that observed in other studies, being mostly concentrated in the care categories of primary care teams. The factors associated with symptom severity were previous respiratory disease and neoplasia.

OBJETIVO: El 24,1% de los casos de COVID-19 notificados en España desde el inicio de la alerta por COVID-19 hasta el 29 de mayo 2020 fue en trabajadores de la salud. El objetivo de este trabajo fue describir las características demográficas, clínicas y epidemiológicas de los profesionales de Atención Primaria notificados por sospecha o contacto COVID-19 y conocer los factores asociados a la gravedad de la enfermedad. Esto permitirá desarrollar estrategias de prevención de riesgos en los profesionales de Atención Primaria. METODOS: Se incluyeron todos los profesionales de Atención Primaria de la Gerencia Territorial de Barcelona (GTBCN) del Institut Català de la Salut notificados como sospecha o contacto con COVID-19 entre el 15 de marzo y el 15 de junio de 2020. Se recogieron variables demográficas, clínicas, epidemiológicas de los profesionales y episodios notificados, así como posibles factores de riesgo asociados a gravedad. Se realizó análisis descriptivo y de regresión logística. RESULTADOS: Se notificaron 1.511 episodios correspondientes a 1.427 profesionales (31,3% de la plantilla de la GTBCN). El 76,4% fueron mujeres, con una edad media de 45,32 años. El 28,5% de los profesionales notificados presentaron COVID-19 en algún episodio, y de estos 18,2% presentó sintomatología grave. Los factores de riesgo asociados a gravedad fueron: patología respiratoria (OR: 2,54, IC95%: 1,16-5,56) y neoplasia (OR: 4,48, IC95%: 1,38-14,55). CONCLUSIONES: El porcentaje de profesionales afectados por sintomatología compatible o contacto con COVID-19 es similar al observado en otros estudios concentrándose mayoritariamente en las categorías asistenciales de los equipos de atención primaria. Los factores asociados con la gravedad de los síntomas son enfermedad respiratoria previa y neoplasia.

Me voy al dentista: ¿antibiótico como prevención o como tratamiento? / I’m going to the dentist: Antibiotic as a prevention or as a treatment?

Las infecciones odontogénicas representan el 10% de las prescripciones antibióticas. A pesar de la reconocida frecuencia e importancia de estas llama la atención la frecuente confusión entre profilaxis y tratamiento. La cavidad bucal forma un complejo ecosistema compuesto por más de 500 especies bacterianas. Es indispensable la anamnesis y exploración de cada infección y conocer los antecedentes que modifiquen nuestra conducta terapéutica y/o profiláctica. Durante muchos años ha sido aceptado el uso de la profilaxis con antibióticos en pacientes con riesgo de endocarditis infecciosa. Actualmente sus indicaciones se están restringiendo y en muchas ocasiones los riesgos de tomar antibiótico preventivo son superiores a los beneficios. Carecemos de estudios para conocer el antibiótico y la pauta mejor indicada. Hemos de basarnos en el documento de consenso español. Tampoco sabemos cómo influye el uso de antibióticos en las resistencias, no solo de la cepa patógena sino también en la flora habitual del paciente(AU)

Odontogenic infections account for 10% of all antibiotic prescriptions in Spain. Despite the frequency and importance of these infections, there is often confusion between prophylaxis and treatment. The oral cavity is a complex ecosystem made up of over 500 bacterial species. It is essential to take the medical history, examine each infection, and know about previous illnesses that could change our therapeutic and/or prophylactic attitude. The use of prophylaxis with antibiotics in patients at risk of infective endocarditis has been accepted for many years. Nowadays this is being restricted, and in many cases the risks of taking preventive antibiotics outweigh its benefits. There are no serious studies to determine the best antibiotic and its dosage, thus the Spanish consensus guidelines have to be followed. It is not known how the misuse of antibiotics influences bacterial resistance, not only on pathogen strains, but also on the common oral flora(AU)

[I'm going to the dentist: antibiotic as a prevention or as a treatment?]. / Me voy al dentista: ¿antibiótico como prevención o como tratamiento?

Odontogenic infections account for 10% of all antibiotic prescriptions in Spain. Despite the frequency and importance of these infections, there is often confusion between prophylaxis and treatment. The oral cavity is a complex ecosystem made up of over 500 bacterial species. It is essential to take the medical history, examine each infection, and know about previous illnesses that could change our therapeutic and/or prophylactic attitude. The use of prophylaxis with antibiotics in patients at risk of infective endocarditis has been accepted for many years. Nowadays this is being restricted, and in many cases the risks of taking preventive antibiotics outweigh its benefits. There are no serious studies to determine the best antibiotic and its dosage, thus the Spanish consensus guidelines have to be followed. It is not known how the misuse of antibiotics influences bacterial resistance, not only on pathogen strains, but also on the common oral flora.