Change in Age profile of Respiratory Syncytial Virus disease over the course of annual epidemics: a multi-national study

OBJECTIVES

We aimed to study whether the percentwise age distribution of RSV cases changes over time during annual epidemics.

METHODS

We used surveillance data (2008-2019) from the Netherlands, Lyon (France), Portugal, Singapore, Ecuador, South Africa, and New Zealand. In each country, every season was divided into "epidemic quarters", i.e. periods corresponding to each quartile of RSV cases. Multinomial logistic regression models were fitted to evaluate whether the likelihood of RSV cases being aged <1 or ≥5 years (vs. 1 to <5) changed over time within a season.

RESULTS

In all countries, RSV cases were significantly more likely to be aged <1 year in the 4th vs. 1st epidemic quarter; the relative risk ratio [RRR] ranged between 1.35 and 2.56. Likewise, RSV cases were significantly more likely to be aged ≥5 years in the 4th vs. 1st epidemic quarter (except in Singapore); the RRR ranged from 1.75 to 6.70. The results did not change when stratifying by level of care or moving the lower cut-off to 6 months.

CONCLUSIONS

The age profile of RSV cases shifts within a season, with infants and adolescents, adults, and the elderly constituting a higher proportion of cases in the later phases of annual epidemics. These findings may have implications for RSV prevention policies with newly approved vaccines.

Excess mortality in Europe coincides with peaks of COVID-19, influenza and respiratory syncytial virus (RSV), November 2023 to February 2024

Since the end of November 2023, the European Mortality Monitoring Network (EuroMOMO) has observed excess mortality in Europe. During weeks 48 2023-6 2024, preliminary results show a substantially increased rate of 95.3 (95% CI:  91.7-98.9) excess all-cause deaths per 100,000 person-years for all ages. This excess mortality is seen in adults aged 45 years and older, and coincides with widespread presence of COVID-19, influenza and respiratory syncytial virus (RSV) observed in many European countries during the 2023/24 winter season.

COVID-19 vaccine effectiveness against symptomatic infection with SARS-CoV-2 BA.1/BA.2 lineages among adults and adolescents in a multicentre primary care study, Europe, December 2021 to June 2022

BackgroundScarce European data in early 2021 suggested lower vaccine effectiveness (VE) against SARS-CoV-2 Omicron lineages than previous variants.AimWe aimed to estimate primary series (PS) and first booster VE against symptomatic BA.1/BA.2 infection and investigate potential biases.MethodsThis European test-negative multicentre study tested primary care patients with acute respiratory symptoms for SARS-CoV-2 in the BA.1/BA.2-dominant period. We estimated PS and booster VE among adults and adolescents (PS only) for all products combined and for Comirnaty alone, by time since vaccination, age and chronic condition. We investigated potential bias due to correlation between COVID-19 and influenza vaccination and explored effect modification and confounding by prior SARS-CoV-2 infection.ResultsAmong adults, PS VE was 37% (95% CI: 24-47%) overall and 60% (95% CI: 44-72%), 43% (95% CI: 26-55%) and 29% (95% CI: 13-43%) < 90, 90-179 and ≥ 180 days post vaccination, respectively. Booster VE was 42% (95% CI: 32-51%) overall and 56% (95% CI: 47-64%), 22% (95% CI: 2-38%) and 3% (95% CI: -78% to 48%), respectively. Primary series VE was similar among adolescents. Restricting analyses to Comirnaty had little impact. Vaccine effectiveness was higher among older adults. There was no signal of bias due to correlation between COVID-19 and influenza vaccination. Confounding by previous infection was low, but sample size precluded definite assessment of effect modification.ConclusionPrimary series and booster VE against symptomatic infection with BA.1/BA.2 ranged from 37% to 42%, with similar waning post vaccination. Comprehensive data on previous SARS-CoV-2 infection would help disentangle vaccine- and infection-induced immunity.

Do spirituality and emotional intelligence improve the perception of the ability to provide care at the end of life? The role of knowledge and self-efficacy

OBJECTIVES

Spirituality, emotional intelligence, and palliative care (PC) knowledge have a positive and direct influence on self-efficacy and on perception of preparation and ability to provide end-of-life (EOL) care. The aim of this work is to propose a conceptual model that relates spirituality, emotional intelligence, PC knowledge, self-efficacy, and the preparation and ability to provide EOL care by doctors and nurses.

METHODS

Quantitative, exploratory, descriptive, and inferential study applied to doctors and nurses in a hospital in the north of Portugal, between May and July 2022. The data collection instrument includes a questionnaire. The relationships between latent variables were evaluated using structural equation models by the partial least squares method using the Smart PLS 3.0 software. It was obtained the previous authorization of the ethics committee.

RESULTS

The results (n = 380) indicate that self-efficacy, spirituality, and PC knowledge have a positive influence on the ability to provide EOL care. Emotional intelligence and spirituality have a direct and positive effect on self-efficacy. There is no direct influence of emotional intelligence on the ability to provide EOL care, but emotional intelligence has an indirect effect mediated by self-efficacy.

SIGNIFICANCE OF RESULTS

Spirituality, self-efficacy, and emotional intelligence are very important for the ability of doctors and nurses to provide EOL care. The identification of predictive factors of the ability to provide EOL care and the determination of the relationship between them can improve the provision of EOL care, reduction of health costs, timely and early referral of people to PC, and increase life quality.

Interim 2023/24 influenza A vaccine effectiveness: VEBIS European primary care and hospital multicentre studies, September 2023 to January 2024

Influenza A viruses circulated in Europe from September 2023 to January 2024, with influenza A(H1N1)pdm09 predominance. We provide interim 2023/24 influenza vaccine effectiveness (IVE) estimates from two European studies, covering 10 countries across primary care (EU-PC) and hospital (EU-H) settings. Interim IVE was higher against A(H1N1)pdm09 than A(H3N2): EU-PC influenza A(H1N1)pdm09 IVE was 53% (95% CI: 41 to 63) and 30% (95% CI: -3 to 54) against influenza A(H3N2). For EU-H, these were 44% (95% CI: 30 to 55) and 14% (95% CI: -32 to 43), respectively.

Influenza vaccine effectiveness in Europe: Results from the 2022-2023 VEBIS (Vaccine Effectiveness, Burden and Impact Studies) primary care multicentre study

Background

Influenza A(H3N2) viruses dominated early in the 2022-2023 influenza season in Europe, followed by higher circulation of influenza A(H1N1)pdm09 and B viruses. The VEBIS primary care network estimated the influenza vaccine effectiveness (VE) using a multicentre test-negative study.

Materials and Methods

Primary care practitioners collected information and specimens from patients consulting with acute respiratory infection. We measured VE against any influenza, influenza (sub)type and clade, by age group, by influenza vaccine target group and by time since vaccination, using logistic regression.

Results

We included 38 058 patients, of which 3786 were influenza A(H3N2), 1548 influenza A(H1N1)pdm09 and 3275 influenza B cases. Against influenza A(H3N2), VE was 36% (95% CI: 25-45) among all ages and ranged between 30% and 52% by age group and target group. VE against influenza A(H3N2) clade 2b was 38% (95% CI: 25-49). Overall, VE against influenza A(H1N1)pdm09 was 46% (95% CI: 35-56) and ranged between 29% and 59% by age group and target group. VE against influenza A(H1N1)pdm09 clade 5a.2a was 56% (95% CI: 46-65) and 79% (95% CI: 64-88) against clade 5a.2a.1. VE against influenza B was 76% (95% CI: 70-81); overall, 84%, 72% and 71% were among 0-14-year-olds, 15-64-year-olds and those in the influenza vaccination target group, respectively. VE against influenza B with a position 197 mutation of the hemagglutinin (HA) gene was 79% (95% CI: 73-85) and 90% (95% CI: 85-94) without this mutation.

Conclusion

The 2022-2023 end-of-season results from the VEBIS network at primary care level showed high VE among children and against influenza B, with lower VE against influenza A(H1N1)pdm09 and A(H3N2).

End of season 2022/2023 quadrivalent influenza vaccine effectiveness in preventing influenza in primary care in Portugal

Using a test-negative case-control design, we aim to estimate influenza vaccine effectiveness (VE) against medically attended laboratory-confirmed influenza in Portugal in 2022/2023 season. Between week 41/2022 and week 14/2023, data on 592 patients with influenza-like illness aged 18 or more years old were collected by the national sentinel influenza surveillance system in primary care settings. Of those, 218 were positive for influenza and 374 were negative controls. We estimated seasonal influenza VE as (1-odds ratio)*100% of being vaccinated in laboratory-confirmed influenza cases vs. negative controls using logistic regression model adjusted for age group, sex, presence of chronic conditions, and month of symptoms onset. The seasonal VE was 59.3% (95% confidence interval (CI): 27.3 to 77.3) against any laboratory-confirmed influenza and not statistically significant 44.5% (95% CI: -5.6 to 70.8) against influenza A (H3N2). In the 2022/2023 season, characterized by early and low influenza activity and predominant A (H3N2) circulation, vaccination provided a moderate protection against medically attended laboratory-confirmed influenza in primary care.

Red sacaca essential oil-loaded nanostructured lipid carriers optimized by factorial design: cytotoxicity and cellular reactive oxygen species levels

Amazonian flora includes several species with the potential to develop pharmaceutical and biotechnological products. The essential oils from Amazonian species possess some biological properties, such as antioxidant, antibacterial, and cytotoxic activities. The essential oil of red sacaca (RSO), Croton cajucara Benth., contains metabolites characterized by antioxidant and anti-inflammatory activities. Nanostructured lipid carriers (NLC) are an advantageous alternative for the effective delivery of drugs because they can solubilize lipophilic actives and reduce their cytotoxicity. This study aimed to optimize the synthesis of RSO-loaded nanostructured lipid carriers (NLC-RSO) using a 23 factorial design and investigate their antioxidant and cytotoxic effects. The red sacaca essential oil (RSO) metabolite profile was characterized using gas chromatography coupled with a mass spectrometer (GC-MS), identifying 33 metabolites, with linalool and 7-hydroxy-calamenene as the major ones, as reported in the literature. The optimized NLC-RSO formulation had a particle size less than 100 nm and a polydispersity index lower than 0.25. After characterizing NLC-RSO using Fourier-transform infrared spectroscopy, powder X-ray diffraction, zeta potential, moisture content, and wettability, in vitro cytotoxicity were performed in A549 and BEAS-2B cell lines using the resazurin metabolism assay. The data indicated a lower IC50 for RSO than for NLC-RSOs in both cell lines. Furthermore, low cytotoxicity of blank nanoparticles (blank NP) and medium chain triglycerides-loaded nanostructured lipid carriers (NLC-MCT) towards both pulmonary cell lines was noted. At a concentration of 50-100 μg/mL, free RSO exhibited higher cytotoxicity than NLC-RSO, demonstrating the protective effect of this lipid carrier in reducing cytotoxicity during metabolite delivery. Similarly, free RSO showed higher 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging than NLC-RSO, also indicating this protective effect. The 2',7'-dichlorofluorescein diacetate (DCFH-DA) intracellular reactive oxygen species (ROS) level assay did not show differences between the treatments at higher but non-cytotoxic dosages. Taken together, our results suggest that NLC-RSOs are potential RSO delivery systems for applications related to cancer treatment.

Resurgence of Respiratory Syncytial Virus in Children: An Out-of-Season Epidemic in Portugal

INTRODUCTION

An out-of-season increase in respiratory syncytial virus (RSV) incidence was observed in Portugal from June 2021 onwards, revealing a continuing surge in cases throughout 2021/2022 autumn/winter. We aimed to describe this out-of-season epidemic and define its epidemic period, by analysing RSV incidence from week 40 of 2020 (2020-W40) to week 18 of 2022 (2022-W18).

MATERIAL AND METHODS

Surveillance data on weekly RSV laboratory confirmed cases, in Portugal, was used to monitor RSV incidence using CUSUM test methodology for count data.

RESULTS

In 2021-W23, the CUSUM score identified a significant increase in the risk of RSV. By that time, the percentage of RSV positive tests rose from 1% in 2021-W22 (3/265) to 6% in 2021-W23 (18/298). Despite a sharp decrease in RSV incidence on 2021-W33 and on 2022-W02, the CUSUM score stayed over the limit up to 2022-W07, indicating that the RSV activity remained at an epidemic level. Distinct peaks of RSV cases were observed between 2021-W30 and 2021-W32 (average of 77 RSV cases per week) and between 2021-W39 and 2021-W41 (average of 79 RSV cases per week) with positivity rates around 60%.

CONCLUSION

An out-of-season RSV epidemic was identified, with a longer epidemic period compared with previous seasons. Possible reasons include relaxation of COVID-19 physical distancing measures and a greater proportion of population susceptible to disease. As several factors may change the pattern of RSV activity, countries should implement year-round surveillance RSV surveillance systems. These findings might have an impact on public health planning regarding future RSV surges, namely, on the palivizumab prophylaxis period for high-risk infants.

New perspectives on respiratory syncytial virus surveillance at the national level: lessons from the COVID-19 pandemic

The emergence of SARS-CoV-2 and the resulting coronavirus disease 2019 (COVID-19) pandemic has led to the reconsideration of surveillance strategies for respiratory syncytial virus (RSV) and other respiratory viruses. The COVID-19 pandemic and the non-pharmaceutical interventions for COVID-19 had a substantial impact on RSV transmission in many countries, with close to no transmission detected during parts of the usual season of 2020–2021. Subsequent relaxation of social restrictions has resulted in unusual out-of-season resurgences of RSV in several countries, causing a higher healthcare burden and often a higher proportion of hospitalisations than usual among children older than 1 year in age [1]. In case of an emerging infectious disease with pandemic potential, preparedness to scale up surveillance for the emerging disease while continuing the maintenance of surveillance activities of pre-existing seasonal diseases is necessary.

Learning from the COVID-19 pandemic and considering the effects of this pandemic, we provide recommendations that can guide towards sustainable RSV surveillance with the potential to be integrated into the broader perspective of respiratory surveillance. https://bit.ly/40TsO0G

Assessment of Physicochemical Parameters in Two Winegrapes Varieties after Foliar Application of ZnSO4 and ZnO

One-third of the world's population is suffering from "hidden hunger" due to micronutrient deficiency. Zinc is acquired through diet, leading its deficiency to the development of disorders such as retarded growth, anorexia, infections, and hypogeusia. Accordingly, this study aimed to develop an agronomic workflow for Zn biofortification on two red winegrapes varieties (cv. Castelão and Syrah) and determine the physicochemical implications for winemaking. Both varieties produced in Setúbal (Portugal) were submitted to four foliar applications of ZnSO₄ or ZnO (900 and 1350 g ha^-1, respectively), during the production cycle. At harvest, Zn biofortification reached a 4.3- and 2.3-fold increase with ZnO 1350 g ha^-1 in Castelão and Syrah, respectively (although, with ZnSO₄ 1350 g ha^-1 both varieties revealed an increase in Zn concentration). On a physiological basis, lower values of NDVI were found in the biofortified grapes, although not reflected in photosynthetic parameters with cv. Syrah shows even a potential benefit with the use of Zn fertilizers. Regarding physical and chemical parameters (density, total soluble solids, dry weight, and color), relative to the control no significant changes in both varieties were observed, being suitable for winemaking. It was concluded that ZnSO₄ and ZnO foliar fertilization efficiently increased Zn concentration on both varieties without a negative impact on quality, but cv. Castelão showed a better index of Zn biofortification and pointed to a potentially higher quality for winemaking.

Seroprevalence of Specific SARS-CoV-2 Antibodies during Omicron BA.5 Wave, Portugal, April-June 2022

After the rapid spread of SARS-CoV-2 BA.5 Omicron lineage in Portugal, we developed a seroepidemiologic survey based on a sample of 3,825 residents. Results indicated that from April 27 through June 8, 2022, the estimated seroprevalence of SARS-CoV-2 nucleocapsid or spike IgG was 95.8%, which indicates a high level of protection.

SARS-CoV-2 Seroprevalence Following a Large-Scale Vaccination Campaign in Portugal: Results of the National Serological Survey, September - November 2021

INTRODUCTION

Following a COVID-19 mass vaccination campaign, it is important to evaluate the population level of SARS-CoV-2 antibodies. The aim of this study was to estimate the seroprevalence rate of SARS-CoV-2 specific antibodies acquired due to infection or vaccination in the Portuguese population.

MATERIAL AND METHODS

The National Serological Survey (third wave - ISN3COVID-19) is a cross-sectional nationwide epidemiological study developed on a sample of 4545 Portuguese residents aged one year or older, between the 28th September 2021 and the 19th November 2021. The SARS-CoV-2 anti-nucleoprotein and anti-spike IgG antibody levels were determined in serum samples using Abbott Chemiluminescent Microparticle Immunoassays. Seroprevalence estimates were stratified by age group, sex, administrative region and self-reported chronic conditions. Medians and respective 95% confidence intervals were used to describe the distribution of SARS-CoV-2 specific antibodies in specific population subgroups.

RESULTS

The total seroprevalence rate of SARS-CoV-2 was 86.4% (95% CI: 85.2% to 87.6%). A higher seroprevalence rate was estimated for women (88.3%), 50 to 59 years-old (96.5%) and in those with two or more self-reported chronic conditions (90.8%). A higher IgG (anti-Spike) concentration was observed in individuals vaccinated with the booster dose (median = 1 2601.3 AU/mL; 95% CI: 4127.5 to 19 089.1).

CONCLUSION

There was a significant increase in SARS-CoV-2 seroprevalence following the mass vaccination campaign in Portugal. It is important to continue to monitor the distribution of specific SARS-COV-2 antibody at the population level to further inform public health policies.

Influenza vaccine effectiveness against influenza A subtypes in Europe: Results from the 2021-2022 I-MOVE primary care multicentre study

BACKGROUND

In 2021-2022, influenza A viruses dominated in Europe. The I-MOVE primary care network conducted a multicentre test-negative study to measure influenza vaccine effectiveness (VE).

METHODS

Primary care practitioners collected information on patients presenting with acute respiratory infection. Cases were influenza A(H3N2) or A(H1N1)pdm09 RT-PCR positive, and controls were influenza virus negative. We calculated VE using logistic regression, adjusting for study site, age, sex, onset date, and presence of chronic conditions.

RESULTS

Between week 40 2021 and week 20 2022, we included over 11 000 patients of whom 253 and 1595 were positive for influenza A(H1N1)pdm09 and A(H3N2), respectively. Overall VE against influenza A(H1N1)pdm09 was 75% (95% CI: 43-89) and 81% (95% CI: 45-93) among those aged 15-64 years. Overall VE against influenza A(H3N2) was 29% (95% CI: 12-42) and 25% (95% CI: -41 to 61), 33% (95% CI: 14-49), and 26% (95% CI: -22 to 55) among those aged 0-14, 15-64, and over 65 years, respectively. The A(H3N2) VE among the influenza vaccination target group was 20% (95% CI: -6 to 39). All 53 sequenced A(H1N1)pdm09 viruses belonged to clade 6B.1A.5a.1. Among 410 sequenced influenza A(H3N2) viruses, all but eight belonged to clade 3C.2a1b.2a.2.

DISCUSSION

Despite antigenic mismatch between vaccine and circulating strains for influenza A(H3N2) and A(H1N1)pdm09, 2021-2022 VE estimates against circulating influenza A(H1N1)pdm09 were the highest within the I-MOVE network since the 2009 influenza pandemic. VE against A(H3N2) was lower than A(H1N1)pdm09, but at least one in five individuals vaccinated against influenza were protected against presentation to primary care with laboratory-confirmed influenza.

Impact of booster vaccination on COVID-19 outcomes in Portuguese population aged 80 or more years old

Background

Vaccination is essential to control SARS-CoV-2 transmission and complications. The study aimed to estimate the number of SARS-CoV-2 infections, COVID-19 hospitalizations and deaths averted by booster vaccination in Portuguese population aged 80 or more years old.

Methods

We developed an ecological study for the period of the Omicron variant of concern predominance (week 2 to week 16, 2022). Data on vaccine coverage and effectiveness, and number of events of different severity reported to the national COVID-19 surveillance system were used to estimate the number of averted events, prevented fraction and number needed to vaccinate. Uncertainty intervals (UI) were obtained using Monte Carlo simulations.

Results

By week 2 2022, vaccination coverage in the target population reached 91.2%. Booster vaccine effectiveness was 4.1% (CI95%: -0.1 to 9.0), 87.5% (CI95%: 84.9 to 89.7) and 83.2 (CI95%: 80.3 to 85.7) against infection, hospitalization and death, respectively. During the study period, 70862 SARS-CoV-2 infections, 2697 COVID-19 hospitalizations and 2106 deaths were reported. Booster vaccination averted 2731 (UI95%: -298 to 5838) infections, 10629 (UI95%: 9173 to 12127) hospitalizations and 6608 (UI95%: 5725 to 7546) COVID-19 related deaths among individuals aged 80 years or more resident in Portugal. Prevented fractions were 3.7% (UI95%: 0 to 7.6%), 79.7% (UI95%: 77.3 to 81.7%) and 75.8% (UI95%: 73.2 to 78.1%), respectively. It would require to vaccinate 59 individuals (UI95%: 52 to 69) to prevent one hospitalization and 94 individuals (UI95%: 82 to 109) to prevent one death in the target population.

Conclusions

The booster vaccination strategy had considerable impact on preventing severe outcomes in the Portuguese population aged 80 and more years old.

Key messages

• High vaccine coverage combined with high vaccine effectiveness resulted in considerable reduction of severe COVID-19 outcomes.

• Information on number of outcomes of different severity levels averted by COVID-19 booster vaccination allows to strength public health communication.

Seroprevalence and SARS-CoV-2 antibodies distribution in Portugal following mass vaccination campaign

Introduction

Information on post-infection and vaccine-induced SARS-CoV-2 seroprevalence is important for public health policies. A 3rd wave of National Serological Survey (ISN3COVID-19) was conducted to measure SARS-CoV-2 seroprevalence and characterize specific antibodies distribution in Portuguese population in September - November 2021, following a mass vaccination campaign.

Methods

ISN3COVID-19 was a cross-sectional epidemiological study that collected serum samples and questionnaire data on a sample of Portuguese residents aged 1 year or older (n = 4545). SARS-CoV-2 IgG anti-nucleoprotein and anti-spike antibody levels were measured using Abbott Chemiluminescent Microparticle Immunoassays. Seroprevalence was estimated for the overall sample and stratified by age group, sex, region and self-reported chronic conditions. Medians and respective 95% confidence intervals (95%CI) were used to describe the distribution of SARS-CoV-2 antibodies in specific population subgroups.

Results

The overall seroprevalence of SARS-CoV-2 (post-infection or vaccine-induced) was 86.4% (95%CI: 85.2 to 87.6%), post-infection seroprevalence was 7.5% (95%CI: 6.6 to 8.5). Higher seroprevalence was observed among 50-59 years-old (96.5%), women (88.3%), and those with two or more self-reported chronic conditions (90.8%). Higher IgG (anti-Spike) levels were estimated for individuals vaccinated with the booster dose (median=12601.3 AU/ml; 95%CI: 4127.5 to 19089.1) and for those vaccinated with two doses of Spikevax® vaccine (median=7012.7 AU/ml, 95%CI: 5568.8 to 8456.6).

Conclusions

The SARS-CoV-2 seroprevalence was high and consistent with vaccine coverage in Portugal. Seropositivity was associated with sex, age and previous chronic conditions. The anti-SARS-CoV-2 anti-spike IgG levels varied according to vaccine brand and number of doses. These results show that monitoring seroprevalence and SARS-CoV-2 antibody distribution is of paramount importance to guide public health policies.

Key messages

• Significant increase in SARS-CoV-2 seroprevalence following the mass vaccination campaign consistent with the high vaccine coverage achieved in Portugal.

• Continuous monitoring of the population‐level IgG response after vaccination remains important to guide further public health measures.

Zinc Biofortification in Vitis vinifera: Implications for Quality and Wine Production

Nowadays, there is a growing concern about micronutrient deficits in food products, with agronomic biofortification being considered a mitigation strategy. In this context, as Zn is essential for growth and maintenance of human health, a workflow for the biofortification of grapes from the Vitis vinifera variety Fernão Pires, which contains this nutrient, was carried out considering the soil properties of the vineyard. Additionally, Zn accumulation in the tissues of the grapes and the implications for some quality parameters and on winemaking were assessed. Vines were sprayed three times with ZnO and ZnSO₄ at concentrations of 150, 450, and 900 g ha^-1 during the production cycle. Physiological data were obtained through chlorophyll a fluorescence data, to access the potential symptoms of toxicity. At harvest, treated grapes revealed significant increases of Zn concentration relative to the control, being more pronounced for ZnO and ZnSO₄ in the skin and seeds, respectively. After winemaking, an increase was also found regarding the control (i.e., 1.59-fold with ZnSO₄-450 g ha^-1). The contents of the sugars and fatty acids, as well as the colorimetric analyses, were also assessed, but significant variations were not found among treatments. In general, Zn biofortification increased with ZnO and ZnSO₄, without significantly affecting the physicochemical characteristics of grapes.

COVID-19 mRNA vaccine effectiveness (second and first booster dose) against hospitalisation and death during Omicron BA.5 circulation: cohort study based on electronic health records, Portugal, May to July 2022

We measured vaccine effectiveness (VE) against COVID-19-related severe outcomes in elderly people in Portugal between May and July 2022. In ≥ 80 year-olds, the second booster dose VE was 81% (95% CI: 75–85) and 82% (95% CI: 77–85), respectively, against COVID-19-related hospitalisation and death. The first booster dose VE was 63% (95% CI: 55–70) in ≥ 80 year-olds and 74% (95% CI: 66–80) in 60–79 year-olds against hospitalisation, and 63% (95% CI: 57–69) and 65% (95% CI: 54–74) against death.

COVID-19 vaccine effectiveness against symptomatic SARS-CoV-2 infections, COVID-19 related hospitalizations and deaths, among individuals aged ≥65 years in Portugal: A cohort study based on data-linkage of national registries February-September 2021

Background

Using data from electronic health registries, this study intended to estimate the COVID-19 vaccine effectiveness (VE) in the population aged 65 years and more, against symptomatic infection, COVID-19-related hospitalizations, and deaths, overall and by time since complete vaccination for the period February to September 2021

Methods

We established a cohort of individuals aged 65 and more years old, resident in Portugal mainland, using the National Health Service User number to link eight electronic health registries. Outcomes included were symptomatic SARS-CoV-2 infections, COVID-19-related hospitalizations or deaths. The exposures of interest were the mRNA vaccines (Comirnaty or Spikevax) and the viral vector (Vaxzevria) vaccine. Complete schedule VE was estimated as one minus the confounder adjusted hazard ratio, for each outcome, estimated by time-dependent Cox regression with time-dependent vaccine exposure.

Results

For the cohort of individuals aged 65–79 years, complete scheme VE against symptomatic infection varied 43 (95%CI: 37–49) (Vaxzevria) and 65 (95%CI: 62–68) (mRNA vaccines). This estimate was slightly lower in the ≥80 years cohort (53, 95%CI: 45–60) for mRNA vaccines). VE against COVID-19 hospitalization varied between 89% (95%CI: 52–94) for Vaxzevria and 95% (95%CI: 93–97) for mRNA vaccines for the cohort aged 65–79 years and was 76% (95%CI: 67–83) for mRNA vaccines in the ≥80 years cohort. High VE against COVID-19-related deaths was estimated, for both vaccine types, 95% and 81 (95%CI:76–86) for the 65–79 years and the ≥80 years cohort, respectively. We observed a significant waning of VE against symptomatic infection, with VE estimates reaching approximately 34% for both vaccine types and cohorts. Significant waning was observed for the COVID-19 hospitalizations in the ≥80 years cohort (decay from 83% (95%CI:68 to 91) 14–41 days to 63% (95%CI:37 to 78) 124 days after mRNA second dose). No significant waning effect was observed for COVID-19-related deaths in the period of follow-up of either cohort.

Conclusions

In a population with a high risk of SARS-CoV-2 complications, we observed higher overall VE estimates against more severe outcomes for both age cohorts when compared to symptomatic infections. Considering the analysis of VE according to time since complete vaccination, the results showed a waning effect for both age cohorts in symptomatic infection and COVID-19 hospitalization for the 80 and more years cohort.

Local problem solving in the Portuguese health examination survey: a mixed method study

Background

Participation rates in health surveys, recognized as an important quality dimension, have been declining over the years, which may affect representativeness and confidence in results. The Portuguese national health examination survey INSEF (2015) achieved a participation rate of 43.9%, which is in line with participation rates from other similar health examination surveys. The objective of this article is to describe how local teams of survey personnel conducted the survey, describing strategies used to solve practical survey problems and to try to increase the participation rate.

Methods

After a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. Forty-one of the local staff members (survey personnel) also filled in a short questionnaire anonymously. The interviews and self-administered questionnaires were analysed using mixed methods, informed by thematic analysis.

Results

The local teams believed that the detailed manual, described as a “cookbook for making a health examination survey”, made it possible to maintain high scientific standards while allowing for improvising solutions to problems in the local context. The quality of the manual, supported by a series of training workshops with the central research and support team, gave the teams the confidence and knowledge to implement local solutions. Motivation and cohesion within the local teams were among the goals of the training process.

Local teams felt empowered by being given large responsibilities and worked hard to incite people to attend the examination through a close and persuasive approach.

Local teams praised their INSA contacts for being available for assistance throughout the survey, and said they were inspired to try harder to reach participants to please their contacts for interpersonal reasons.

Conclusions

The theory of organizational improvisation or bricolage, which means using limited resources to solve problems, was useful to discuss and understand what took place during INSEF.

A detailed manual covering standard procedures, continuous monitoring of the data collection and face-to-face workshops, including role-play, were vital to assure high scientific standards and high participation rates in this health examination survey. Close contacts between the central team and local focal points in all regions and all survey sites were key to accommodating unexpected challenges and innovative solutions.

Impact of stringent non-pharmaceutical interventions applied during the second and third COVID-19 epidemic waves in Portugal, 9 November 2020 to 10 February 2021: an ecological study

Background

Non-pharmaceutical interventions (NPIs) were implemented worldwide to control the spread of SARS-CoV-2.

Aim

To evaluate the impact of tiered NPIs and a nationwide lockdown on reduction of COVID-19 incidence during the second and third epidemic waves in Portugal.

Methods

Surveillance data on laboratory-confirmed COVID-19 cases were used to conduct an interrupted time series analysis to estimate changes in daily incidence during a second wave tiered NPI period (9 November–18 December 2020), and a third wave lockdown period without (15–21 January 2021) and with school closure (22 January–10 February 2021).

Results

Significant changes in trends were observed for the overall incidence rate; declining trends were observed for tiered NPIs (−1.9% per day; incidence rate ratio (IRR): 0.981; 95% confidence interval (CI): 0.973–0.989) and a lockdown period without (−3.4% per day; IRR: 0.966; 95% CI: 0.935–0.998) and with school closure (−10.3% per day, IRR: 0.897; 95% CI: 0.846–0.951). Absolute effects associated with tiered NPIs and a lockdown on a subsequent 14-day period yielded 137 cases and 437 cases per 100,000 population potentially averted, respectively.

Conclusion

Our results indicate that tiered NPIs implemented during the second wave caused a decline in COVID-19 incidence, although modest. Moreover, a third wave lockdown without school closure was effective in reducing COVID-19 incidence, but the addition of school closure provided the strongest effect. These findings emphasise the importance of early and assertive decision-making to control the pandemic.

Effectiveness of complete primary vaccination against COVID-19 at primary care and community level during predominant Delta circulation in Europe: multicentre analysis, I-MOVE-COVID-19 and ECDC networks, July to August 2021

IntroductionIn July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe.AimUsing a multicentre test-negative study, we measured COVID-19 vaccine effectiveness (VE) against symptomatic infection.MethodsIndividuals with COVID-19 or acute respiratory symptoms at primary care/community level in 10 European countries were tested for SARS-CoV-2. We measured complete primary course overall VE by vaccine brand and by time since vaccination.ResultsOverall VE was 74% (95% CI: 69-79), 76% (95% CI: 71-80), 63% (95% CI: 48-75) and 63% (95% CI: 16-83) among those aged 30-44, 45-59, 60-74 and ≥ 75 years, respectively. VE among those aged 30-59 years was 78% (95% CI: 75-81), 66% (95% CI: 58-73), 91% (95% CI: 87-94) and 52% (95% CI: 40-61), for Comirnaty, Vaxzevria, Spikevax and COVID-19 Vaccine Janssen, respectively. VE among people 60 years and older was 67% (95% CI: 52-77), 65% (95% CI: 48-76) and 83% (95% CI: 64-92) for Comirnaty, Vaxzevria and Spikevax, respectively. Comirnaty VE among those aged 30-59 years was 87% (95% CI: 83-89) at 14-29 days and 65% (95% CI: 56-71%) at ≥ 90 days between vaccination and onset of symptoms.ConclusionsVE against symptomatic infection with the SARS-CoV-2 Delta variant varied among brands, ranging from 52% to 91%. While some waning of the vaccine effect may be present (sample size limited this analysis to only Comirnaty), protection was 65% at 90 days or more between vaccination and onset.

The modifying role of major cardiovascular risk factors in the association between retirement and cardiovascular disease: Results from SHARE Portugal

BACKGROUND

Despite the actual demographic trends and the global burden of cardiovascular diseases, there is little knowledge concerning the effects of retirement on this health outcome.

OBJECTIVE

We aimed to quantify the associations between retirement, and retirement age, with cardiovascular disease (heart disease and stroke) in the Portuguese population.

METHODS

We used data from the first Portuguese wave of the Survey of Health Ageing and Retirement in Europe. Logistic regression was applied to quantify the associations. The major risk factors for cardiovascular diseases and several features of retirement were considered as possible confounders or effect modifiers. Analysis was restricted to retirees in retirement process (retired for 5 years or less) and not retired because of illness.

RESULTS

An opposite direction of the association between retirement and heart disease was observed according to hypertension status, although not significant. Early retirement increased the odds of having a stroke, merely in individuals without heart disease (OR = 8.87; 95% CI 1.63-48.26). On the contrary, in individuals with heart disease, decreased the odds of having a stroke in (OR = 0.08; 95% CI 0.01-0.68).

CONCLUSIONS

Our findings suggest that retirement and retirement age may be beneficial or harmful, respectively, in the presence or absence of major risk factors for heart disease and stroke. We suggest that work-related stress affecting differently workers with and without these risk factors may eventually explain these findings.

Challenges for maintaining surgical care practices in the COVID-19 pandemic: an integrative review

OBJECTIVES

To present the knowledge produced on challenges of health services for maintaining surgical care practices in times of the COVID-19 pandemic.

METHODS

This is an integrative literature review, performed with descriptors 'Operating rooms' and 'Coronavirus Infections' in the MEDLINE/PubMed Central, IBECS, LILACS, BDENF, Coleta SUS, BIGG, BINACIS, SciELO, PubMed, Science Direct, and Cochrane Library databases.

RESULTS

Of the 405 studies analyzed, 27 met the inclusion criteria. The main challenges for surgical services during the pandemic were: (i) rearrangement of general practice in surgical units; (ii) administration and management of resources and elective surgeries; (iii) follow-up and control of preoperative patients to medium term; (iv) maintenance of patients' and health professionals' autonomy and mental health in this context; and (v) teaching health residents in the operating room.

CONCLUSIONS

For surgical care services, the challenges caused by managing the high demand of patients in need of care resulted in the transfer of own resources to other units and the consequent hiring of professionals to meet the demand for these services due to the damming of postponed elective surgeries. This knowledge will allow us to propose strategies in decision making in this scenario, considering the new waves that may arise from this disease.

Encapsulation of safflower oil in nanostructured lipid carriers for food application

Safflower oil (SO) is mainly rich in linoleic acid (ω-6), oleic acid (ω-9), and other bioactives with potential antioxidant, antidiabetic, thermogenic, anti-inflammatory, cardioprotective and anticancer activities. The reduced aqueous solubility and high susceptibility to oxidative degradation are undesirable for food applications and can be overcome by incorporation in lipid nanoparticles. Thus, the main goal was to develop and characterize SO-loaded nanostructured lipid carriers (NLC-SO) and to evaluate their potential for protection of the antioxidant activity of the bioactive. NLC-SO showed average size of 222 ± 2.0 nm, zeta potential of  43 ± 3.5 mV and the encapsulation efficiency was 49.0 ± 2.8%, combined with high thermal compatibility (up to 228 °C) and physical stability for up to 60 days in aqueous dispersion. Besides, the NLC-SO showed threefold reduction in the DPPH radical scavenge activity after encapsulation, indicating protection of the antioxidant components of the SO and preservation of the bioactives.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13197-021-05078-5.

SARS-CoV-2 seroprevalence in Portugal following the third epidemic wave: results of the second National Serological Survey (ISN2COVID-19)

BACKGROUND

Integrated approaches to surveillance of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection are important for public health actions. The 2nd National Serological Survey (ISN2COVID-19) aimed to characterize the extent of SARS-CoV-2 infection and vaccine-induced response in the Portuguese population following the third epidemic wave and the launch of the vaccination campaign.

METHODS

A cross-sectional study was performed using data on 8463 Portuguese 1-79 years of age, collected in February and March, 2021. SARS-CoV-2 IgM and IgG (anti-nucleoprotein and anti-spike) antibodies were determined in serum samples using Abbott Architect chemiluminescent microparticle assays. Post-infection and vaccine-induced seroprevalence with 95% confidence intervals (95%CI) were estimated in the overall sample and stratified by population characteristics.

RESULTS

The estimated seroprevalence was 15.5% (95%CI:14.6-16.5%), of which 13.5% (95%CI: 12.6-14.4%) was attributable to natural infection and 2.0% (95%CI:1.7-2.4%) to vaccination. The lowest seroprevelence was observed in persons aged 70-79 years (8.9% 95%CI:6.8-11.6), while seroprevalence in children (14.3%; 95%CI:11.5-17.6%) and adolescents (12.9%; 95%CI:10.5-15.7%) was similar to that of persons aged between 20 and 69 years. Of seropositive individuals, 22.6% (95%CI:19.7-25.9%) did not report any symptoms in 6 months prior to interview. Of persons with completed vaccination (2-doses), 98.6% (95%CI: 93.0-99.7%) had specific IgG (anti-S) antibodies.

CONCLUSIONS

After the third epidemic wave, the post-infection SARS-CoV-2 seroprevalence was 1.7 times higher than the cumulative incidence based on PCR-testing, but was higher (2.7 times) in children may be due to the high proportion of asymptomatic and mild infections.

Evaluation of hydrogen peroxide efficacy against AZD1222 chimpanzee adenovirus strain in the recombinant COVID-19 vaccine for application in cleaning validation in a pharmaceutical manufacturing industry

This study aimed to evaluate the performance of hydrogen peroxide vapour (HPV) to inactivate the chimpanzee adenovirus AZD1222 vaccine strain used in the production of recombinant COVID-19 vaccine for application in cleaning validation in pharmaceutical industries production areas. Two matrixes were tested: formulated recombinant COVID-19 vaccine (FCV) and active pharmaceutical ingredient (API). The samples were dried on stainless steel and exposed to HPV in an isolator. One biological indicator with population >10⁶ Geobacillus stearothermophilus spores was used to validate the HPV decontamination cycle as standard. HPV exposure resulted in complete virus inactivation in FVC (≥5·03 log₁₀ ) and API (≥6·40 log₁₀ ), showing HPV efficacy for reducing chimpanzee adenovirus AZD1222 vaccine strain. However, the optimum concentration and contact time will vary depending on the type of application. Future decontamination studies scaling up the process to the recombinant COVID-19 vaccine manufacturing areas are necessary to evaluate if the HPV will have the same or better virucidal effectivity in each specific production area. In conclusion, HPV showed efficacy for reducing AZD1222 chimpanzee adenovirus strain and can be a good choice for pharmaceutical industries facilities disinfection during recombinant COVID-19 vaccine production.

mRNA vaccine effectiveness against COVID-19-related hospitalisations and deaths in older adults: a cohort study based on data linkage of national health registries in Portugal, February to August 2021

Through deterministic data linkage of health registries, mRNA vaccine effectiveness (VE) against COVID-19-related hospitalisations and deaths was measured in 1,880,351 older adults. VE against hospitalisations was 94% (95% confidence interval (CI): 88–97) and 82% (95% CI: 72–89) for those 65–79 and ≥ 80 years old, with no evidence of waning 98 days after dose two. VE against mortality was 96% (95% CI: 92–98) and 81% (95% CI: 74–87) in these two age groups.

Vaccine effectiveness against symptomatic SARS-CoV-2 infection in adults aged 65 years and older in primary care: I-MOVE-COVID-19 project, Europe, December 2020 to May 2021

We measured COVID-19 vaccine effectiveness (VE) against symptomatic SARS-CoV-2 infection at primary care/outpatient level among adults ≥ 65 years old using a multicentre test-negative design in eight European countries. We included 592 SARS-CoV-2 cases and 4,372 test-negative controls in the main analysis. The VE was 62% (95% CI: 45–74) for one dose only and 89% (95% CI: 79–94) for complete vaccination. COVID-19 vaccines provide good protection against COVID-19 presentation at primary care/outpatient level, particularly among fully vaccinated individuals.

Defining the seasonality of respiratory syncytial virus around the world: National and subnational surveillance data from 12 countries

Background

Respiratory syncytial virus (RSV) infections are one of the leading causes of lower respiratory tract infections and have a major burden on society. For prevention and control to be deployed effectively, an improved understanding of the seasonality of RSV is necessary.

Objectives

The main objective of this study was to contribute to a better understanding of RSV seasonality by examining the GERi multi‐country surveillance dataset.

Methods

RSV seasons were included in the analysis if they contained ≥100 cases. Seasonality was determined using the “average annual percentage” method. Analyses were performed at a subnational level for the United States and Brazil.

Results

We included 601 425 RSV cases from 12 countries. Most temperate countries experienced RSV epidemics in the winter, with a median duration of 10–21 weeks. Not all epidemics fit this pattern in a consistent manner, with some occurring later or in an irregular manner. More variation in timing was observed in (sub)tropical countries, and we found substantial differences in seasonality at a subnational level. No association was found between the timing of the epidemic and the dominant RSV subtype.

Conclusions

Our findings suggest that geographical location or climatic characteristics cannot be used as a definitive predictor for the timing of RSV epidemics and highlight the need for (sub)national data collection and analysis.

Temporal Variations in Respiratory Syncytial Virus Epidemics, by Virus Subtype, 4 Countries

Temporal variation of respiratory syncytial virus (RSV) epidemics was recently reported to be determined by the dominant RSV subtype. However, when we repeated the analysis for 4 countries in the Northern and Southern Hemispheres, the dominant subtype did not seem to affect temporal variation of RSV epidemics.

No effect modification of influenza virus vaccine effectiveness by age or chronic condition was observed in the 2010/11 to 2017/18 seasons

PURPOSE

Most European influenza vaccine strategies target individuals at higher risk of complications, which include, among others, individuals aged ≥65 years and with chronic conditions. These individuals not only have a high-risk of post-infection complications but also could have lower capacity of acquiring adequate vaccine-induced protection. As such, chronic conditions and age could modify the effect of vaccines. This study aimed at assessing the potential effect modification of influenza vaccine effectiveness (IVE) by age and chronic conditions.

METHODS

We used eight-season data from the Portuguese vaccine effectiveness study. Every season, physicians at primary care units recruited patients with influenza-like illness. Clinical data and swabs were collected for Reverse Transverse Polymerase Chain Reaction (RT-PCR) detection of influenza. Trivalent inactivated IVE was estimated as 1 - odds ratio (OR) of being vaccinated in cases (RT-PCR positive for influenza) versus negative controls. ORs were obtained using a multivariable conditional logistic regression model, paired by week of onset within each season. Confounders were assessed by designing a specific causal diagram. Age (< 65 or ≥65 years) and chronic conditions (diabetes, cardiovascular disease, chronic renal disease, chronic hepatic disease, obesity, chronic respiratory disease, and congenital or acquired immunodeficiency) were studied as effect modifiers by including an interaction term in the regression models. Significance was established at 5%.

RESULTS

Point estimates indicate a higher IVE in the chronic condition strata compared to that in the no chronic condition strata. Regarding age, different results were obtained considering the virus type and (sub)type. When comparing the ≥65 years with the <65 years of age strata, we observed a higher IVE against A(H1N1)pdm09, an equal IVE against A(H3N2) and a lower IVE against B virus. However, all interaction terms were statistically insignificant, and this may be due to a small sample size.

CONCLUSION

The potential effect modification of age or chronic condition was not observed within our study.

The Global Epidemiology of RSV in Community and Hospitalized Care: Findings From 15 Countries

Background

Respiratory syncytial virus (RSV) is one of the leading causes of acute respiratory tract infections. To optimize control strategies, a better understanding of the global epidemiology of RSV is critical. To this end, we initiated the Global Epidemiology of RSV in Hospitalized and Community care study (GERi).

Methods

Focal points from 44 countries were approached to join GERi and share detailed RSV surveillance data. Countries completed a questionnaire on the characteristics of their surveillance system.

Results

Fifteen countries provided granular surveillance data and information on their surveillance system. A median (interquartile range) of 1641 (552–2415) RSV cases per season were reported from 2000 and 2020. The majority (55%) of RSV cases occurred in the <1-year-olds, with 8% of cases reported in those aged ≥65 years. Hospitalized cases were younger than those in community care. We found no age difference between RSV subtypes and no clear pattern of dominant subtypes.

Conclusions

The high number of cases in the <1-year-olds indicates a need to focus prevention efforts in this group. The minimal differences between RSV subtypes and their co-circulation implies that prevention needs to target both subtypes. Importantly, there appears to be a lack of RSV surveillance data in the elderly.

[Early Detection of COVID-19 in Portugal: Use of Clinical Records]

INTRODUCTION

Syndromic surveillance allows early detection of changes in the population's morbidity pattern. The aim of this study is to evaluate the usefulness of indicators related to access to healthcare services, in COVID-19 surveillance.

MATERIAL AND METHODS

A time series analysis was performed using the weekly incidence rate of COVID-19 in Mainland Portugal, between weeks 14/2020 (March 30 to April 5) and 25/2020 (June 15 to 21), and six indicators: 1) COVID-19 consultations in primary healthcare; 2) number of COVID-19 emergency department visits; 3) number of emergency department visits due to viral pneumonia; 4) number of hospitalizations due to viral pneumonia; 5) proportion of emergency department visits due to viral pneumonia; and 6) proportion of hospitalizations for viral pneumonia. Pearson correlation and cross-correlations were computed.

RESULTS

A strong correlation was found between the weekly incidence rate of COVID-19 and all indicators. [(1) 0.76; (2) 0.82; (3) 0.77; (4) 0.84; (5) 0.86; e (6) 0.90]. Emergency department visits and hospitalizations for viral pneumonia detect variations in the frequency of the disease with a one week lag compared to the incidence rate of COVID-19, in one week. COVID-19 consultations in primary healthcare and emergency department visits trail behind the incidence rate of COVID-19, in one week. The proportion of viral pneumonias in emergency department visits, or hospitalizations, is temporally aligned with the weekly incidence rate of COVID-19.

DISCUSSION

The delay found in the COVID-19 primary healthcare consultations and emergency department visits, may be related to changes in access to healthcare services and clinical coding. Emergency department visits and hospitalizations for viral pneumonia may be useful in the early detection of COVID-19. Viral pneumonia may have been coded as being of unknown origin. Future monitoring of these indicators is necessary to ascertain whether the incidence of COVID-19 is significantly influenced by changes in testing strategies. The indicators described in this study will be an asset for the optimization of testing strategies, allocation of healthcare resources to the communities that are most vulnerable to severe morbidity and assessing vaccination impact. As such, surveillance systems based on clinical data will be a valuable complementary tool to SINAVE.

CONCLUSION

The indicators under analysis could be used regularly, with special attention to viral pneumonias, to detect outbreaks of COVID-19. Information on pneumonia of unknown etiology may be considered in the surveillance of COVID-19.

Seroprevalence of SARS-CoV-2 Infection in Portugal in May-July 2020: Results of the First National Serological Survey (ISNCOVID-19)

INTRODUCTION

The aim of this study was to estimate and describe the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specific antibodies (immunoglobulin M and/or immunoglobulin G) in Portugal in May-July 2020.

MATERIAL AND METHODS

A cross-sectional seroepidemiological survey was developed after the peak of the first epidemic wave on a sample of 2301 Portuguese residents, aged 1 year or older. Survey sample was selected using a two-stage stratified non-probability sampling design (quota sampling). SARS-CoV-2 immunoglobulin M and immunoglobulin G antibodies were measured in serum samples by enzyme-linked immunosorbent assay. Seroprevalence estimates of immunoglobulin M and/or immunoglobulin G and 95% confidence intervals were stratified by sex, age group, health region and education.

RESULTS

Overall, seroprevalence was 2.9% (95% confidence interval: 2.0% - 4.2%). Higher prevalence rates were observed in male (4.1%, 95% confidence interval: 2.6% - 6.6%) and those with secondary education (6.4%, 95% confidence interval: 3.2% - 12.5%). Differences in seroprevalence by age group and region were not statistically significant.

DISCUSSION

The estimated seroprevalence of SARS-CoV-2 was higher than the cumulative incidence reported by the National Surveillance System but far from necessary to reach herd immunity.

CONCLUSION

Our results support limited extent of infection by SARS-CoV-2 in the study population possibly due to early lockdown measures implemented in Portugal and support the need to continue monitoring of SARS-CoV-2 seroprevalence in order to increase our knowledge about the evolution of the epidemic and to estimate the proportion of the susceptible population over time.

Novel ultraviolet absorbers derived from cashew nut shell liquid: spectrophotometric, in silico and in vitro assays

The cashew nut shell liquid (CNSL) constituents were isolated by our group leading to four mixtures and seventeen pure compounds, which had chromophoric groups similar to organic ultraviolet (UV) absorbers. In addition, C15 and C8 CNSL-derivatives molecules were rationally planned as UV absorbers. Mixtures and isolated CNSL compounds were demonstrated to be non-phototoxic when evaluated in a phototoxicity assay using the yeast Saccharomyces cerevisiae. Considering the absorption values on the UV range, 6 compounds showed appropriate SPF values regarding the spectrophotometric test. Additionally, in silico and in vitro evaluations were performed, showing non-oral bioavailability, as well as non-mutagenic, non-genotoxic and non-phototoxic properties for the tested compounds. These results contribute favorably to the aimed use of the compounds under analysis as novel organic UV absorbers that have as precursor the phenolic lipid component of CNSL, a waste product obtained as the by-product of cashew nut food processing.

Quantification and Tissue Localization of Selenium in Rice (Oryza sativa L., Poaceae) Grains: A Perspective of Agronomic Biofortification

In worldwide production, rice is the second-most-grown crop. It is considered a staple food for many populations and, if naturally enriched in Se, has a huge potential to reduce nutrient deficiencies in foodstuff for human consumption. This study aimed to develop an agronomic itinerary for Se biofortification of Oryza sativa L. (Poaceae) and assess potential physicochemical deviations. Trials were implemented in rice paddy field with known soil and water characteristics and two genotypes resulting from genetic breeding (OP1505 and OP1509) were selected for evaluation. Plants were sprayed at booting, anthesis and milky grain phases with two different foliar fertilizers (sodium selenate and sodium selenite) at different concentrations (25, 50, 75 and 100 g Se·ha⁻¹). After grain harvesting, the application of selenate showed 4.9–7.1 fold increases, whereas selenite increased 5.9–8.4-fold in OP1509 and OP1505, respectively. In brown grain, it was found that in the highest treatment selenate or selenite triggered much higher Se accumulation in OP1505 relatively to OP1509, and that no relevant variation was found with selenate or selenite spraying in each genotype. Total protein increased exponentially in OP1505 genotype when selenite was applied, and higher dosage of Se also increased grain weight and total protein content. It was concluded that, through agronomic biofortification, rice grain can be enriched with Se without impairing its quality, thus highlighting its value in general for the industry and consumers with special needs.

Estimation of the 10-Year Risk of Fatal Cardiovascular Disease in the Portuguese Population: Results from the First Portuguese Health Examination Survey (INSEF 2015)

INTRODUCTION

Cardiovascular disease is the leading cause of morbidity and mortality in Portugal and globally. Cardiovascular risk algorithms, namely the SCORE (Systematic Coronary Risk Evaluation), are recommended in the context of cardiovascular disease prevention. Our aim is to estimate and characterize the cardiovascular risk of the Portuguese population aged between 40 and 65 years old, in 2015, using the SCORE algorithm.

MATERIAL AND METHODS

This study was performed on a subsample of the first Portuguese National Health Examination Survey - INSEF, including all participants between 40 and 65 years old with available data on sex, age, smoking status, total cholesterol and systolic blood pressure (n = 2945). The prevalence of the cardiovascular risk categories were stratified by sex, age group, marital status, educational level, occupational activity, urbanization of living area, region and income.

RESULTS

In 2015, about 5.1% and 11.9% of the Portuguese resident population aged between 40 and 65 years old were, respectively, at high and very high risk of having a fatal CV event in the following 10 years. The highest prevalence of very high cardiovascular risk was found in males, individuals aged 60-65 years old, married or living with someone, without any formal education or just with the 1st cycle of basic education and belonging to the less skilled category of the occupational activity (C category) in comparison with the othercorresponding groups.

DISCUSSION

A previous national study found a similar proportion of the population at high/very high cardiovascular risk (19.5% versus 17.1%). Our study is representative of the adult Portuguese population and adopted the European Health Examination Survey procedures, which are essential for future comparisons with other European countries. Some of the limitations of this study include the possible participation bias and the non-calibration of the SCORE algorithm for the Portuguese population.

CONCLUSION

In 2015, a considerable proportion of the Portuguese population aged between 40 and 65 years old had a high or very high risk of developing a fatal cardiovascular event in the next 10 years. Due to the possible overestimation of the cardiovascular risk already reported in other European countries, it will be important to carry out a follow-up study to validate the adequacy of using the SCORE algorithm in the Portuguese population.

[Economic Crisis in Portugal: Trajectory of the Incidence of Depression and Correlation With Unemployment]

INTRODUCTION

Previous studies have found an increase in the incidence rate of depression between 2007 - 2013 in Portugal, with a positive correlation with the unemployment rate, namely, in men. So, it was hypothesized that this increase is related with the situation of economic crisis. This study aimed to investigate if the correlation between unemployment rates and the incidence of depression is maintained in the post-crisis period of economic recovery in Portugal (2016 - 2018).

MATERIAL AND METHODS

An ecological study was carried out, using data from the General Practitioners Sentinel Network concerning depression incidence (first episodes and relapses) and data from the National Statistics Institute on unemployment rates in the Portuguese population. The correlation coefficient was estimated using linear regression and the results were disaggregated by sex.

RESULTS

Between 2016 and 2018, there was a consistent decrease in the incidence of depression in both sexes. During the 1995 - 2018 period, a positive correlation was observed between unemployment and depression, with a coefficient of 0.833 (p = 0.005) in males and of 0.742 (p = 0.022) in females.

DISCUSSION

The reduction in the incidence of depression in both sexes observed between 2016 - 2018 corroborates a positive correlation between unemployment and depression in the Portuguese population, previously observed between 2007 - 2013.

CONCLUSION

This study highlights the need to monitor the occurrence of mental illness in the Portuguese population, especially in moments of greatest social vulnerability in order to establish preventive measures, as a way to mitigate the impact of future economic crises.

Influenza burden estimates in Portugal: seasons 2013/14 to 2018/19

Background

Reliable influenza burden estimates are essential for a true understanding of the influenza epidemics' impact; informed decision-making and effective risk communication. This study aimed to estimate the influenza burden in Portugal in 2013/14 - 2018/19 seasons.

Methods

We estimated seasonal influenza burden, ranging from medically attended influenza cases in primary care to influenza-attributable deaths, using surveillance data. Data were collected for influenza like illness (ILI) epidemic periods, determined by the Moving Epidemic Method. Medically attended influenza cases were estimated by multiplying the number of ILI cases in primary care by the percentage of influenza-positive samples. Hospitalized severe acute respiratory infections (SARI) positive for influenza estimates were computed, multiplying the number of SARI by the percentage of influenza-positive samples. To determine influenza-attributable deaths, a Poisson regression model was used.

Results

The median number of medically attended influenza cases in primary care was 33,668 (325.8 cases per 10,000 population), ranging between 21,393 in 2017/18, [Influenza B and A(H1) co-dominance] and 61,768 in 2014/15 [Influenza B and A(H3) co-dominance]. The median number of SARI positive for influenza was 8,724 (84.4 cases per 10,000 population), ranging between 7,099 in 2013/14 [A(H1) and A(H3) co-dominance], and 9,125 in 2014/15. The median number of influenza-attributable deaths was 3,311 (32.0 cases per 10,000 population), ranging between 96 in 2015/16 [A(H1) dominance], and 5,224 in 2014/15.

Conclusions

Higher mortality, and higher rate of medically attended influenza cases, were found in seasons with A(H3) circulation. Little variability was observed in the number of influenza-positive SARI. The relationship between the number of SARI and the number of deaths requires further investigation. This work highlights the need of health surveillance systems for a better understanding of the influenza impact.

Key messages

Lower burden of influenza is found in seasons with A(H1) co-dominance. Higher burden of influenza is found in seasons with A(H3) circulation. Health surveillance systems are essential to provide data for a better understanding of the epidemiology and extent of seasonal influenza.

Performance of surveillance case definitions for respiratory syncytial virus infections through the sentinel influenza surveillance system, Portugal, 2010 to 2018

BackgroundWell-established influenza surveillance systems (ISS) can be used for respiratory syncytial virus (RSV) surveillance. In Portugal, RSV cases are detected through the ISS using the European Union (EU) influenza-like illness (ILI) case definition.AimTo investigate clinical predictors for RSV infection and how three case definitions (EU ILI, a modified EU acute respiratory infection, and one respiratory symptom) performed in detecting RSV infections in Portugal.MethodsThis observational retrospective study used epidemiological and laboratory surveillance data (October 2010-May 2018). Associations between clinical characteristics and RSV detection were analysed using logistic regression. Accuracy of case definitions was assessed through sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). A 0.05 significance level was accepted.ResultsThe study involved 6,523 persons, including 190 (2.9%) RSV cases. Among 183 cases with age information, RSV infection was significantly more frequent among individuals < 5 years (n = 23; 12.6%) and ≥ 65 years (n = 45; 24.6%) compared with other age groups (p < 0.0001). Cough (odds ratio (OR): 2.4; 95% confidence interval (CI): 1.2-6.5) was the best RSV-infection predictor considering all age groups, while shortness of breath was particularly associated with RSV-positivity among ≤ 14 year olds (OR: 6.7; 95% CI: 2.6-17.4 for 0-4 year olds and OR: 6.7; 95% CI: 1.5-28.8 for 5-14 year olds). Systemic symptoms were significantly associated with RSV-negative and influenza-positive cases. None of the case definitions were suitable to detect RSV infections (AUC = 0.51).ConclusionTo avoid underestimating the RSV disease burden, RSV surveillance within the Portuguese sentinel ISS would require a more sensitive case definition than ILI and, even a different case definition according to age.

Assessing the use and understanding of the Portuguese heat-health warning system (ÍCARO)

BACKGROUND

Heatwaves can lead to increased mortality. In the Portuguese heat-health warning system (HHWS), ÍCARO, a daily report with heat-related mortality prediction is sent to heat-health action plan (HHAP) practitioners. HHAP practitioners assess risk and implement measures to prevent heatwave-related impact, but ÍCARO's use and understanding are unknown. We assessed ÍCARO's use and understanding by key HHAP practitioners.

METHODS

We conducted semi-structured interviews with national/regional HHAP practitioners. Interviews were recorded, transcribed and analysed using thematic content analysis. To maximize credibility a validation process was implemented through researcher triangulation; a sample of 30 segments was recorded by independent researchers.

RESULTS

We conducted six interviews with nine professionals (mean time 52 min) from five regions. We identified four categories: report's content and presentation, report's reception and communication, ÍCARO and risk assessment and other issues. Practitioners use ÍCARO and perceived it as relevant; they raised issues on its interpretation and felt these were not fully addressed, given researchers' use of statistical/epidemiological terms. We identified the need for improved communication and report's clarity.

CONCLUSIONS

Our study stresses the need for collaboration between experts within HHWS/HHAP. Despite ÍCARO's understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ÍCARO's interpretation. Practitioners' needs should be considered when developing/revising tools.

Risk Factors Associated with Cardiac Autonomic Modulation in Obese Individuals

Obesity leads to an imbalance in the autonomic nervous system, especially in increased sympathetic modulation and decreased vagal tone, and some anthropometric, metabolic, and lifestyle variables may increase the risk of developing cardiovascular disease. Objective. To analyze the association between cardiovascular autonomic modulation and biochemical and anthropometric markers, food intake, and physical activity level in severely obese individuals. Methodology. The present study is a cutout of a randomized clinical trial "Effect of nutritional intervention and olive oil in severe obesity" (DieTBra Trial), where the baseline data were analyzed. Anthropometric data, biochemical exams, heart rate variability (HRV), accelerometry, and 24 h recall (R24H) of obese patients (body mass index BMI ≥35 kg/m2) were collected. Results. 64 obese patients were analyzed, with a mean age of 39.10 ± 7.74 years (27 to 58 years). By HRV analysis, in the frequency domain, the obese had a higher predominance of sympathetic autonomic modulation (low frequency (LF) 56.44 ± 20.31 nu) and lower parasympathetic modulation (high frequency (HF) 42.52 ± 19.18 nu). A negative association was observed between the variables Homeostasis Evaluation Model (HOMA-IR) and HF (p = 0.049). In the physical activity analysis, there was a negative association between moderate to vigorous physical activity and the sympathetic component (p = 0.043), and for sedentary time (ST), there was a negative association with HF (p = 0.049) and LF/HF (p = 0.036) and a positive association with LF (p = 0.014). For multiple linear regression, waist circumference (WC) and HOMA-IR values were negatively associated with HF (β = -0.685, p = 0.010; β = -14.989, p = 0.010; respectively). HOMA-IR (β = 0.141, p = 0.003) and the percentage of lipids ingested (β = -0.030, p = 0.043) were negatively associated with LF/HF. Conclusion. Among the cardiovascular risk variables studied, insulin resistance and central adiposity showed the greatest influence on cardiac autonomic modulation of obese, increasing the risk for cardiovascular disease.

Eosinophilic dermatosis of hematologic malignancy: a case report

Eosinophilic dermatosis of hematologic malignancy (EDHM) is a dermatosis characterized by tissue eosinophilia that has been previously reported as insect bite-like reaction. It is a rare condition with a wide variety of clinical presentations ranging from papules, nodules, or blisters that simulate arthropod bites, to the formation of plaques of differing sizes. We report a case of eosinophilic dermatosis of hematologic malignancy in a patient with a hematoproliferative disorder.

Effect of lifestyle on blood pressure in patients under antihypertensive medication: An analysis from the Portuguese Health Examination Survey

INTRODUCTION AND OBJECTIVES

Hypertension is one of the main risk factors for disability and death from cardiovascular disease. Current guidelines include initiatives to control blood pressure in hypertensive patients that focus on lifestyle changes. The main objective of this study was to analyze the association between lifestyle and blood pressure in patients under antihypertensive medication.

METHODS

Data collected in the Portuguese National Health Examination Survey (INSEF) were analyzed. Individuals who met INSEF inclusion criteria and reported being under antihypertensive medication in the two weeks prior to the questionnaire were studied. Lifestyle variables (alcohol consumption, smoking, added salt intake, fruit and vegetable consumption, and physical activity) were assessed by questionnaire, and systolic and diastolic blood pressure were measured by physical examination. Associations between lifestyle factors and blood pressure, stratified by gender and adjusted for sociodemographic variables and obesity, were estimated through a multiple linear regression model.

RESULTS

Alcohol consumption (beta=6.31, p=0.007) and smoking (beta=4.72, p=0.018) were positively associated with systolic blood pressure in men. Added salt intake, fruit and vegetable consumption, and physical activity were not associated with blood pressure in men. In women, no association was observed for any behavioral variable.

CONCLUSIONS

These conclusions highlight the need in the population under antihypertensive medication, particularly in men, to focus on the fight against high systolic blood pressure in the two modifiable and preventable behaviors of smoking and alcohol consumption.