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Maltezou HC, Kontogianni S, Michailidou E, Vergadi E, Giannouchos TV, Steletou E, Sipsas NV, Galanakis E, Syrogiannopoulos GA, Roilides E. Effectiveness of COVID-19 vaccination against school absenteeism in children and adolescents hospitalized with COVID-19. Vaccine 2024; 42:2941-2944. [PMID: 38556391 DOI: 10.1016/j.vaccine.2024.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND COVID-19 vaccination has been recommended for children to protect them and to enable in-person educational and social activities. METHODS We estimated COVID-19 vaccination effectiveness (VE) against school absenteeism in children 5-17 years old hospitalized from September 1, 2021 through May 31, 2023. Full vaccination was defined as two vaccine doses. RESULTS We studied 231 children admitted to hospital with COVID-19, including 206 (89.2 %) unvaccinated/partially vaccinated and 25 (10.8 %) fully vaccinated. Unvaccinated/partially vaccinated children were absent from school for longer periods compared to fully vaccinated children (median absence: 14 versus 10 days; p-value = 0.05). Multivariable regression showed that full COVID-19 vaccination was associated with fewer days of absence compared to no/partial vaccination on average (adjusted relative risk: 0.77; 95 % CI: 0.61 to 0.98). COVID-19 VE was 50.7 % (95 % CI: -11.3 % to 78.2 %) for school absenteeism above the median duration of absenteeism. CONCLUSIONS Full COVID-19 vaccination conferred protection against school absenteeism in hospitalized school-aged children with COVID-19.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | | | - Elisavet Michailidou
- Third Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, and Hippokration General Hospital, Thessaloniki, Greece
| | - Eleni Vergadi
- Department of Pediatrics, Medical School, University of Crete, Heraklion, Greece
| | - Theodoros V Giannouchos
- Department of Health Policy & Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Evangelia Steletou
- Department of Pediatrics, School of Medicine, University of Patras, Patras, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens Laiko General Hospital of Athens, Athens, Greece
| | - Emmanouil Galanakis
- Department of Pediatrics, Medical School, University of Crete, Heraklion, Greece
| | | | - Emmanuel Roilides
- Third Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, and Hippokration General Hospital, Thessaloniki, Greece
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Kassianos G, Cohen JM, Civljak R, Davidovitch N, Pecurariu OF, Froes F, Galev A, Ivaskeviciene I, Kõivumägi K, Kristufkova Z, Kuchar E, Kyncl J, Maltezou HC, Marković M, Nitsch-Osuch A, Ortiz de Lejarazu R, Rossi A, Schelling J, van Essen GA, Zavadska D. The influenza landscape and vaccination coverage in older adults during the SARS-Cov-2 pandemic: data from Several European Countries and Israel. Expert Rev Respir Med 2024. [PMID: 38652642 DOI: 10.1080/17476348.2024.2340470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION The Raise Awareness of Influenza Strategies in Europe (RAISE) group gathered information about the healthcare burden of influenza (hospitalizations, intensive care unit [ICU] admissions, and excess deaths), surveillance systems, and the vaccine coverage rate (VCR) in older adults in 18 European countries and Israel. AREAS COVERED Published medical literature and official medical documentation on the influenza disease burden in the participating countries were reviewed from 2010/11 until the 2022/23 influenza seasons. Information on the framework for monitoring the disease burden and the provision for ensuring older adults had access to vaccination in their respective countries was provided. Data on influenza VCR in older adults were collected for the 2019/20 to 2022/23 influenza seasons. Data are reported descriptively. EXPERT OPINION Influenza presents a significant healthcare burden in older adults. Reporting outcomes across participating countries is heterogeneous, highlighting the need for standardized approaches. Although older adults receive free influenza vaccination, vaccine uptake is highly variable among countries. Moreover, hospitalization rates remain high even in countries reporting a high VCR. Increased awareness and education on the burden of disease and the broader use of improved influenza vaccines for older adults may help reduce the disease burden on this population.
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Affiliation(s)
| | - Jean-Marie Cohen
- IEP Paris, University Paris-Descartes, France
- Journal La Recherche, University Claude Bernard Paris, France
| | - Rok Civljak
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department for Acute Respiratory Infections (Head), Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Zagreb, Croatia
| | | | - Oana Falup Pecurariu
- Transilvania University Brasov, Romania
- Children's Clinic Hospital, Brasov, Romania
| | - Filipe Froes
- Thorax Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Inga Ivaskeviciene
- Paediatirc Infectious Disease, Clinic of Children'sChildren's Diseases, Institute of Clinical Medicine, Medicine, Vilnius University, Vilnius, Lithuania
| | - Kadri Kõivumägi
- Institute of Clinical Medicine, University of Tartu, Estonia
| | - Zuzana Kristufkova
- Medical Epidemiologist and Head of Department, Department of Epidemiology, Faculty of Public Health, Slovak Medical University Bratislava, Slovakia
| | - Ernest Kuchar
- Head of Department,Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Jan Kyncl
- Medical Epidemiologist and Head of Department, Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
- Department of Epidemiology and Biostatistics, Medicine, Charles University, Prague, Czech Republic
| | - Helena C Maltezou
- Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
| | - Miloš Marković
- Immunology, Institute of Microbiology and Immunology, Medicine, University of Belgrade, Belgrade, Serbia
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Raul Ortiz de Lejarazu
- National Influenza Centre, Hospital Clínico Universitario and University of Valladolid, Valladoild, Spain
| | | | - Jörg Schelling
- Medizinische Klinik IV, Klinikum der Ludwig-Maximilians-Universität München, Deutschland, Europe
| | | | - Dace Zavadska
- Department of Paediatrics, Riga Stradins University, Latvia, Europe
- Family Vaccination Centre, Children's Clinical University Hospital, Riga, Latvia
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Pavli A, Maltezou HC. Asclepieia in ancient Greece: pilgrimage and healing destinations, the forerunner of medical tourism. Infez Med 2024; 32:113-115. [PMID: 38456023 PMCID: PMC10917557 DOI: 10.53854/liim-3201-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/13/2024] [Indexed: 03/09/2024]
Abstract
Asclepios, the first physician-demigod in Greek mythology, was born in Thessaly of the God Apollo and Coronis, a mortal mother. Asclepieia were healing sanctuaries dedicated to Asclepios. Asclepieia were located throughout the Eastern Mediterranean area, in ancient Greece and the Roman world. Travelers from all over the Mediterranean area seeking healing made pilgrimages to the Asclepieia, the early forerunner of "medical tourism".
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Affiliation(s)
- Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Helena C. Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
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Maltezou HC, Pavli A. Challenges with medical tourism. Curr Opin Crit Care 2024:00075198-990000000-00158. [PMID: 38441086 DOI: 10.1097/mcc.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW With the return of international travels to almost prepandemic levels, the number of patients who travel abroad to seek healthcare services is once again growing rapidly. Nevertheless, the expected benefits of medical tourism may be challenged by serious infectious complications. This review summarizes the evolving published evidence on infectious complications related with medical tourism of the last eighteen months. RECENT FINDINGS There has been an increase of reported infectious complications in patients who had received healthcare abroad. Such complications were frequently associated with serious and prolonged morbidity, repeated treatments and hospitalizations, high healthcare costs, and occasionally fatalities. A devastating outbreak of fungal meningitis occurred among US residents who underwent epidural anesthesia for cosmetic surgery in two clinics in Mexico. Overall, as of July 5, 2023 there were 31 cases with severe cerebrovascular complications and eight deaths. Infections caused by nontuberculum mycobacteria and Candida sp have been also reported the last years. SUMMARY Considering the expected expansion of medical tourism in the forthcoming years, public health authorities and scientific societies should raise awareness of such infections among physicians and other healthcare professionals and issue recommendations for their management. A system to report complications in patients receiving healthcare abroad is needed.
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Affiliation(s)
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
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Young S, Goldin S, Dumolard L, Shendale S, McMurren B, Maltezou HC, Desai S. National vaccination policies for health workers - A cross-sectional global overview. Vaccine 2024; 42:757-769. [PMID: 37321897 DOI: 10.1016/j.vaccine.2023.04.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Immunization is essential for safeguarding health workers from vaccine-preventable diseases (VPDs) that they may encounter at work; however, information about the prevalence and scope of national policies that protect health workers through vaccination is limited. Understanding the global landscape of health worker immunization programmes can help direct resources, assist decision-making and foster partnerships as nations consider strategies for increasing vaccination uptake among health workers. METHODS A one-time supplementary survey was distributed to World Health Organization (WHO) Member States using the WHO/United Nations Children's Fund (UNICEF) Joint Reporting Form on Immunization (JRF). Respondents described their 2020 national vaccination policies for health workers - detailing VPD policies and characterising technical and funding support, monitoring and evaluation activities and provisions for vaccinating health workers in emergencies. RESULTS A total of 53 % (103/194) Member States responded and described health worker policies: 51 had a national policy for vaccinating health workers; 10 reported plans to introduce a national policy within 5 years; 20 had subnational/institutional policies; 22 had no policy for vaccinating health workers. Most national policies were integrated with occupational health and safety policies (67 %) and included public and private providers (82 %). Hepatitis B, seasonal influenza and measles were most frequently included in policies. Countries both with and without national vaccination policies reported monitoring and reporting vaccine uptake (43 countries), promoting vaccination (53 countries) and assessing vaccine demand, uptake or reasons for undervaccination (25 countries) among health workers. Mechanisms for introducing a vaccine for health workers in an emergency existed in 62 countries. CONCLUSION National policies for vaccinating health workers were complex and context specific with regional and income-level variations. Opportunities exist for developing and strengthening national health worker immunization programmes. Existing health worker immunization programmes might provide a foothold on which broader health worker vaccination policies can be built and strengthened.
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Affiliation(s)
- Stacy Young
- Independent Consultant, Chapel Hill, NC, USA
| | | | | | | | | | - Helena C Maltezou
- Directorate for Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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Steletou E, Giannouchos T, Dimitriou G, Karatza A, Sinopidis X, Maltezou HC, Souliotis K, Gkentzi D. Parental concerns and vaccine hesitancy against COVID-19 vaccination for children in Greece: A cross-sectional survey. Vaccine 2024; 42:448-454. [PMID: 38185545 DOI: 10.1016/j.vaccine.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/13/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Parental hesitancy against children's COVID-19 vaccination remains a challenge globally. Although many studies have explored parental hesitancy, less is known about parental intentions towards COVID-19 vaccination of 6-month to 4-year-old children who were the last age group that became eligible for vaccination and for older children throughout the Omicron predominance period. METHODS We conducted a nationwide cross-sectional survey from November to December 2022 in Greece. We aimed to explore parental COVID-19 vaccination intentions for their children, reasons against vaccination, and to estimate the association between parents' intentions and child and parental characteristics and parental attitudes towards COVID-19 vaccination. RESULTS Of 431 parents, 243 (56.4 %) had not or did not intend to vaccinate their children against COVID-19. Most parents were vaccinated against COVID-19 (64.7 % no booster; 14.2 % at least one booster). Among parents with children under the age of 5, 13.0 % intended to vaccinate their children against COVID-19, while 47.3 % of parents with children 5 years of age or older reported intention or had already completed vaccination. The most common reasons against COVID-19 vaccination were fear of side effects (32.9 %), perceived short length of clinical trials (29.2 %), and the child having previously contracted COVID-19 (12.0 %). The strongest factors associated with intention or already completed vaccination were parental own vaccination against COVID-19, using a pediatrician or a healthcare professional as the main source of vaccine-related information for their children, agreeing with their pediatrician regarding COVID-19 vaccination, and trusting official healthcare guidelines. Stratified analyses by the two children's age groups (<5 and 5 to 17) yielded similar estimates. Among parents who had not or did not intend to vaccinate their children, 11.9 % would do so if recommended by a pediatrician. CONCLUSIONS Our findings highlight the need to incentivize healthcare professionals and pediatricians to inform parents about vaccines, clarify misconceptions and address concerns.
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Affiliation(s)
- E Steletou
- Department of Pediatrics, Patras Medical School, Greece.
| | - T Giannouchos
- Department of Health Policy & Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - G Dimitriou
- Department of Pediatrics, Patras Medical School, Greece
| | - A Karatza
- Department of Pediatrics, Patras Medical School, Greece
| | - X Sinopidis
- Department of Pediatrics, Patras Medical School, Greece
| | - H C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - K Souliotis
- Department of Social and Education Policy, University of Peloponnese, Corinth, Greece; Health Policy Institute, Athens, Greece
| | - D Gkentzi
- Department of Pediatrics, Patras Medical School, Greece
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Nikolopoulou GB, Tzoutzas I, Tsakris A, Maltezou HC. Hepatitis B in Healthcare Personnel: An Update on the Global Landscape. Viruses 2023; 15:2454. [PMID: 38140695 PMCID: PMC10748141 DOI: 10.3390/v15122454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023] Open
Abstract
Despite the outstanding progress that has been made in the prevention, detection, and management of hepatitis B during the past decades, hepatitis B remains a problem among healthcare personnel (HCP) in many countries. We reviewed studies on all aspects of hepatitis B in HCP published from 2017 through April 2023. They revealed wide variations on the prevalence of infection among HCP, ranging from 0.6% in Europe to >8.7% in Africa, almost always in association with very low vaccination rates. Many studies found a significant association between HCP's knowledge about hepatitis B and hepatitis B vaccines, their vaccination status, and practices. This research also discloses global inequities regarding vaccination policies against hepatitis B, free-of-charge vaccinations, and access to post-exposure prophylaxis (PEP). Strategies to prevent and manage accidental exposures are needed in order to reduce the burden of hepatitis B on HCP, while written policies for all aspects of infection prevention, protective equipment, and PEP should be available. Lastly, HCP should be accordingly educated. These are all imperative given the decline of routine vaccinations in the COVID-19 era, particularly in countries with fragile vaccination programs, and the disruptions of interventions for hepatitis B that are expected to provide a pool of virus transmission to future generations.
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Affiliation(s)
- Georgia B. Nikolopoulou
- Department of Hepatitis, National Public Health Organization, 3-5 Agrafon Street, 15123 Athens, Greece;
| | - Ioannis Tzoutzas
- School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Street, 11527 Athens, Greece;
| | - Athanasios Tsakris
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
| | - Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 3-5 Agrafon Street, 15123 Athens, Greece
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Ledda C, Motta G, Rapisarda V, Maltezou HC. Influenza immunization of healthcare personnel in the post-COVID-19 pandemic era: Still a lot to do! Vaccine X 2023; 15:100402. [PMID: 38058792 PMCID: PMC10696103 DOI: 10.1016/j.jvacx.2023.100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/28/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
Healthcare-associated influenza is frequently encountered in healthcare settings with significant morbidity and mortality among vulnerable patients, absenteeism among healthcare personnel (HCP), and interruption of healthcare services. Numerous investigations indicate that nosocomial outbreaks are often traced to HCP. Despite the international and national endorsements, seasonal influenza vaccine acceptance among HCP continues suboptimal worldwide. Infection control is the major objective for healthcare risk management in order to guarantee patient safety, limit the cost of hospitalization and assurance health management in controlling influenza seasons. Vigilance and anticipation are required as globally we are moving from a reactive COVID-19 pandemic response phase to one of planning for the co-circulation of viral respiratory infections. Declining to understand HCP perception of influenza risk and acceptance of vaccination might have impact patient safety as well as healthcare services.
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Affiliation(s)
- Caterina Ledda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Motta
- Occupational Medicine Unit, “Garibaldi” Hospital of Catania, Catania, Italy
| | - Venerando Rapisarda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Occupational Medicine Unit, “G. Rodolico – San Marco” University Hospital, Catania, Italy
| | - Helena C. Maltezou
- Directorate for Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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Maltezou HC, Ledda C, Sipsas NV. Absenteeism of Healthcare Personnel in the COVID-19 Era: A Systematic Review of the Literature and Implications for the Post-Pandemic Seasons. Healthcare (Basel) 2023; 11:2950. [PMID: 37998442 PMCID: PMC10671277 DOI: 10.3390/healthcare11222950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
This systematic review aimed to assess COVID-19-associated absenteeism among healthcare personnel (HCP). PubMed was searched on 4 February 2023. Inclusion criteria were the presentation of original data on COVID-19-associated absenteeism among HCP. Exclusion criteria were absenteeism associated with burnout, mental health illness, post-COVID syndrome, or child-care. Nineteen articles were identified; fifteen concerned almost exclusively the first pandemic year. Hospitals accounted for most data. There was heterogeneity across studies in terms of presentation of absenteeism data. Before COVID-19 vaccines became available, COVID-19 was a major driver of HCP absenteeism with excess costs, while the mean duration of absenteeism ranged from 5.82 to 33 days per episode of absence. Determinant factors of absenteeism rates were department of employment, high-risk exposure, age, profession, and work experience of HCP, suspected COVID-19, SARS-CoV-2 testing, SARS-CoV-2 positivity, and return-to-work strategy. Two studies demonstrated that COVID-19 vaccination significantly reduced the burden of absenteeism. Routine testing of asymptomatic HCP and use of personal protective equipment also significantly ameliorated absenteeism. In conclusion, COVID-19 has been a major driver of HCP absenteeism. Research is needed to assess how COVID-19 will impact HCP in the next years, considering the new SARS-CoV-2 variants, the co-circulation of other respiratory viruses, and the newer COVID-19 vaccines. Networks are needed to survey morbidity and absenteeism among HCP in real-time and guide vaccination policies.
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Affiliation(s)
- Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 3-5 Agrafon Street, Marousi, 15123 Athens, Greece
| | - Caterina Ledda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, 87 Santa Sofia Street, 95124 Catania, Italy;
| | - Nikolaos V. Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Goudi, 11527 Athens, Greece;
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Effraimidou E, Cassimos DC, Medic S, Topalidou M, Theodoridou M, Maltezou HC. Vaccination programs for children aged up to 18 years in Europe, 2020. J Child Health Care 2023; 27:336-350. [PMID: 34844456 DOI: 10.1177/13674935211055294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although all European countries have vaccination policies for children, there are no comprehensive studies of pediatric vaccination programs in Europe. We studied vaccination programs for children in Europe. Vaccinations against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, hepatitis B, measles, mumps, rubella, and influenza existed in 42 countries, against human papilloma virus in 41 countries, and against pneumococcus in 40 countries. In addition, the following vaccinations existed: against tuberculosis (35 countries), hepatitis A (33), meningococcus A, C, W, Y (30), rotavirus and varicella (28 countries each), meningococcus B (24), tick-born encephalitis (22), and meningococcus C (16). Mandatory vaccinations are implemented in 21 countries, mainly against diphtheria, tetanus, pertussis, poliomyelitis, H. influenzae type b, hepatitis B, measles, mumps, rubella, tuberculosis, and pneumococcus. There are significant differences among pediatric vaccination programs in Europe regarding number, schedules, indications, and regulatory frame (recommended or mandatory vaccinations). A consensus-based vaccination program for all children is needed.
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Affiliation(s)
| | | | - Snezana Medic
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Maria Topalidou
- Pediatric Clinic, Komotini General Hospital, Komotini, Greece
| | - Maria Theodoridou
- First Department of Pediatrics, University of Athens, Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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Papanikolopoulou A, Gargalianos-Kakolyris P, Stoupis A, Moussas N, Pangalis A, Theodoridou K, Chronopoulou G, Pantazis N, Kantzanou M, Maltezou HC, Tsakris A. Carbapenem-Resistant Pseudomonas aeruginosa Bacteremia, through a Six-Year Infection Control Program in a Hospital. Microorganisms 2023; 11:1315. [PMID: 37317288 DOI: 10.3390/microorganisms11051315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a life-threatening healthcare-associated infection affecting especially patients with immunosuppression and comorbidities. We investigated the association between the incidence of CRPA bacteremia, antibiotic consumption, and infection control measures in a hospital during 2013-2018. METHODS We prospectively recorded the incidence of CRPA bacteremia, antibiotic consumption, use of hand-hygiene solutions, and isolation rates of multidrug-resistant (MDR) carrier patients. FINDINGS The consumption of colistin, aminoglycosides, and third-generation cephalosporins decreased significantly in the total hospital and its divisions (p-value < 0.001 for all comparisons) while the consumption of carbapenems decreased significantly in the adults ICU (p-value = 0.025). In addition, the incidence of CRPA significantly decreased in the total hospital clinics and departments (p-values = 0.027 and 0.042, respectively) and in adults clinics and departments (p-values = 0.031 and 0.051, respectively), while in the adults ICU, the incidence remained unchanged. Increased isolation rates of MDR carrier patients, even two months before, significantly correlated with decreased incidence of CRPA bacteremia (IRR: 0.20, 95% CI: 0.05-0.73, p-value = 0.015) in the adults ICU. Interestingly, when the use of hand-hygiene solutions (alcohol and/or scrub) increased, the consumption of advanced, nonadvanced, and all antibiotics decreased significantly. CONCLUSION In our hospital, multimodal infection control interventions resulted in a significant reduction of CRPA bacteremia, mostly due to the reduction of all classes of antibiotics.
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Affiliation(s)
- Amalia Papanikolopoulou
- Clinical Pharmacology Department, Athens Medical Center, 5-7 Distomou Str., 15125 Marousi, Greece
| | | | - Athina Stoupis
- Clinical Infectious Diseases Department, Athens Medical Center, 1 Delfon Str., 15125 Marousi, Greece
| | - Nikos Moussas
- Clinical Infectious Diseases Department, Athens Medical Center, 1 Delfon Str., 15125 Marousi, Greece
| | - Anastasia Pangalis
- Biopathology Department, Athens Medical Center, 5-7 Distomou Str., 15125 Marousi, Greece
| | - Kalliopi Theodoridou
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece
- Department of Microbiology, Andreas Syggros Hospital for Skin and Venereal Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Genovefa Chronopoulou
- Biopathology Department, Athens Medical Center, 5-7 Distomou Str., 15125 Marousi, Greece
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 3-5 Agrafon Str., 15123 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece
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Maltezou HC, Papamichalopoulos N, Horefti E, Tseroni M, Karapanou A, Gamaletsou MN, Veneti L, Ioannidis A, Panagiotou M, Dimitroulia E, Vasilogiannakopoulos A, Angelakis E, Chatzipanagiotou S, Sipsas NV. Effectiveness of a Self-Decontaminating Coating Containing Usnic Acid in Reducing Environmental Microbial Load in Tertiary-Care Hospitals. Int J Environ Res Public Health 2023; 20:ijerph20085434. [PMID: 37107716 PMCID: PMC10138069 DOI: 10.3390/ijerph20085434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 05/11/2023]
Abstract
Surfaces have been implicated in the transmission of pathogens in hospitals. This study aimed to assess the effectiveness of an usnic-acid-containing self-decontaminating coating in reducing microbial surface contamination in tertiary-care hospitals. Samples were collected from surfaces 9 days before coating application, and 3, 10, and 21 days after its application (phases 1, 2, 3, and 4, respectively). Samples were tested for bacteria, fungi, and SARS-CoV2. In phase 1, 53/69 (76.8%) samples tested positive for bacteria, 9/69 (13.0%) for fungi, and 10/139 (7.2%) for SARS-CoV-2. In phase 2, 4/69 (5.8%) samples tested positive for bacteria, while 69 and 139 samples were negative for fungi and SARS-CoV-2, respectively. In phase 3, 3/69 (4.3%) samples were positive for bacteria, 1/139 (0.7%) samples tested positive for SARS-CoV-2, while 69 samples were negative for fungi. In phase 4, 1/69 (1.4%) tested positive for bacteria, while no fungus or SARS-CoV-2 were detected. After the coating was applied, the bacterial load was reduced by 87% in phase 2 (RR = 0.132; 95% CI: 0.108-0.162); 99% in phase 3 (RR = 0.006; 95% CI: 0.003-0.015); and 100% in phase 4 (RR = 0.001; 95% CI: 0.000-0.009). These data indicate that the usnic-acid-containing coating was effective in eliminating bacterial, fungal, and SARS-CoV-2 contamination on surfaces in hospitals.Our findings support the benefit ofan usnic-acid-containing coating in reducing the microbial load on healthcare surfaces.
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Affiliation(s)
- Helena C. Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, 15123 Athens, Greece
- Correspondence:
| | - Nikolaos Papamichalopoulos
- Department of Medical Biopathology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 72–74 Vas. Sophias Ave, 11528 Athens, Greece
| | - Elina Horefti
- Diagnostic Department and Public Health Laboratories, Hellenic Pasteur Institute, 127 Vas. Sophias Ave, 11521 Athens, Greece
| | - Maria Tseroni
- Directorate of Epidemiological Surveillance for Infectious Diseases, National Public Health Organization, 15123 Athens, Greece
| | - Amalia Karapanou
- Infection Control Committee, Laiko General Hospital, 11527 Athens, Greece
| | - Maria N. Gamaletsou
- Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Anastasios Ioannidis
- Department of Nursing, Faculty of Health Sciences, University of Peloponnese, 22100 Tripoli, Greece
| | - Marina Panagiotou
- Infection Control Committee, Henry Dunant Hospital Center, 11526 Athens, Greece
| | | | | | - Emmanouil Angelakis
- Diagnostic Department and Public Health Laboratories, Hellenic Pasteur Institute, 127 Vas. Sophias Ave, 11521 Athens, Greece
| | - Stylianos Chatzipanagiotou
- Department of Medical Biopathology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 72–74 Vas. Sophias Ave, 11528 Athens, Greece
| | - Nikolaos V. Sipsas
- Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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13
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Ledda C, Rapisarda V, Maltezou HC. COVID-19 vaccination refusal and suspension of work among healthy healthcare personnel in Italy: A cross-sectional study of their knowledge and attitudes toward vaccinations. Vaccine X 2023; 13:100275. [PMID: 36819213 PMCID: PMC9918318 DOI: 10.1016/j.jvacx.2023.100275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 01/26/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
Despite the initial optimistic projections from various countries and the evidence that vaccination against coronavirus disease 2019 (COVID-19) reduces the associated hospitalization rates and mortality, vaccine hesitancy and refusal among healthcare personnel (HCP) became a major public health concern globally. The aim of this survey was to estimate the knowledge about the Italian Vaccination Plan for HCP and attitudes about occupational vaccinations for HCP among Italian HCP who refused COVID-19 vaccination and were suspended from work. A total of 52 HCP participated in the study. Nurses were the prevalent profession among vaccination refusers. About COVID-19, 24 (26.2%) of all responders have been involved in COVID-19 care and 21 (40.4%) had a history of COVID-19. None had received influenza and pneumococcus vaccination in the past. Knowledge of vaccinations recommended for HCP was high, ranging from 75% to 98% by vaccine. Instead, all HCP were against any mandatory vaccination policy for all HCP. Finally, most HCP questioned the expected benefits and safety of vaccines in general, raised issues of mistrust of information provided for authorities and of compliance with their HCP' vaccination recommendations. Our study indicates good knowledge of occupational vaccinations but strong anti-vaccination beliefs among Italian HCP who refused COVID-19 vaccination and were suspended from work.
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Affiliation(s)
- Caterina Ledda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Corresponding author.
| | - Venerando Rapisarda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Occupational Medicine Unit, “G. Rodolico-San Marco” University Hospital, Catania, Italy
| | - Helena C. Maltezou
- Directorate for Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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14
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Maltezou HC, Papanikolopoulou A, Vassiliu S, Theodoridou K, Nikolopoulou G, Sipsas NV. COVID-19 and Respiratory Virus Co-Infections: A Systematic Review of the Literature. Viruses 2023; 15:865. [PMID: 37112844 PMCID: PMC10142898 DOI: 10.3390/v15040865] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Τhe COVID-19 pandemic highly impacted the circulation, seasonality, and morbidity burden of several respiratory viruses. We reviewed published cases of SARS-CoV-2 and respiratory virus co-infections as of 12 April 2022. SARS-CoV-2 and influenza co-infections were reported almost exclusively during the first pandemic wave. It is possible that the overall incidence of SARS-CoV-2 co-infections is higher because of the paucity of co-testing for respiratory viruses during the first pandemic waves when mild cases might have been missed. Animal models indicate severe lung pathology and high fatality; nevertheless, the available literature is largely inconclusive regarding the clinical course and prognosis of co-infected patients. Animal models also indicate the importance of considering the sequence timing of each respiratory virus infection; however, there is no such information in reported human cases. Given the differences between 2020 and 2023 in terms of epidemiology and availability of vaccines and specific treatment against COVID-19, it is rational not to extrapolate these early findings to present times. It is expected that the characteristics of SARS-CoV-2 and respiratory virus co-infections will evolve in the upcoming seasons. Multiplex real-time PCR-based assays have been developed in the past two years and should be used to increase diagnostic and infection control capacity, and also for surveillance purposes. Given that COVID-19 and influenza share the same high-risk groups, it is essential that the latter get vaccinated against both viruses. Further studies are needed to elucidate how SARS-CoV-2 and respiratory virus co-infections will be shaped in the upcoming years, in terms of impact and prognosis.
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Affiliation(s)
- Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 15123 Athens, Greece
| | - Amalia Papanikolopoulou
- Third Department of Internal Medicine, Sotiria General Hospital for Thoracic Diseases, National and Kapodistrian University of Athens, School of Medicine, Sotiria General Hospital, 11527 Athens, Greece
| | | | - Kalliopi Theodoridou
- Department of Microbiology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Georgia Nikolopoulou
- Department of Hepatitides, National Public Health Organization, 15123 Athens, Greece
| | - Nikolaos V. Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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15
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Boufidou F, Hatziantoniou S, Theodoridou K, Maltezou HC, Vasileiou K, Anastassopoulou C, Medić S, Tsakris A. Anaphylactic Reactions to COVID-19 Vaccines: An Updated Assessment Based on Pharmacovigilance Data. Vaccines (Basel) 2023; 11:vaccines11030613. [PMID: 36992197 DOI: 10.3390/vaccines11030613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/25/2023] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
This study aimed at producing an updated assessment of the incidence of anaphylaxis associated with COVID-19 vaccines based on pharmacovigilance data. Anaphylactic reaction and anaphylactic shock data post-COVID-19-vaccination reported from week 52, 2020 to week 1 or week 2, 2023 were collected from the VAERS and EudraVigilance databases, respectively, and analyzed comparatively. Incidence rates were calculated using the corresponding administered vaccine doses as denominators for all licensed vaccines and both platform types (mRNA or vectored). The latest data from the present analysis showed lower anaphylaxis incidence associated with COVID-19 vaccination compared to previous estimates from week 52, 2020 to week 39, 2021 (anaphylactic reaction: 8.96 (95% CI 8.80-9.11)/million doses overall (EEA: 14.19 (95% CI 13.92-14.47)/million/US: 3.17 (95% CI 3.03-3.31)/million); anaphylactic shock: 1.46 (95% CI 1.39-1.52)/million doses overall (EEA: 2.47 (95% CI 2.36-2.58)/million/US: 0.33 (95% CI 0.29-0.38)/million)). Incidence rates varied by vaccine and were higher as captured in EudraVigilance compared to the VAERS and for vectored compared to mRNA vaccines. Most reported cases had a favorable outcome. The extremely rare fatalities (overall rates across continents 0.04 (95% CI 0.03-0.06)/million doses for anaphylactic reaction and 0.02 (95% CI 0.01-0.03)/million vaccine doses for anaphylactic shock) were also associated with vector-rather than mRNA-based vaccines. The diminished incidence of anaphylaxis post-vaccination with COVID-19 vaccines offers assurance about their safety, as does the continuous potential adverse events monitoring through specialized pharmacovigilance databases.
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Affiliation(s)
- Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Sophia Hatziantoniou
- Laboratory of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Kalliopi Theodoridou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Microbiology, Andreas Syggros Hospital for Skin and Venereal Diseases, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 15123 Athens, Greece
| | - Konstantinos Vasileiou
- Department of Pharmacy, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Snežana Medić
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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16
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Maltezou HC, Hatziantoniou S, Theodoridou K, Vasileiou K, Anastassopoulou C, Tsakris A. Anaphylaxis rates following mRNA COVID-19 vaccination in children and adolescents: Analysis of data reported to EudraVigilance. Vaccine 2023; 41:2382-2386. [PMID: 36872145 PMCID: PMC9968615 DOI: 10.1016/j.vaccine.2023.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/14/2023] [Accepted: 02/22/2023] [Indexed: 03/01/2023]
Abstract
AIM The present study aimed to estimate the anaphylaxis rates following mRNA COVID-19 vaccination in children and adolescents in Europe. METHODS We retrieved data on 371 anaphylaxis cases following mRNA COVID-19 vaccination in children ≤ 17 years old notified to EudraVigilance as of October 8, 2022. Overall, 27,120,512 doses of BNT162b2 vaccine and 1,400,300 doses of mRNA-1273 vaccine have been delivered to children during the study period. RESULTS The overall mean anaphylaxis rate was 12.81 [95% confidence interval (CI): 11.49-14.12] per 106 mRNA vaccine doses [12.14 (95% CI: 6.37-17.91) per 106 doses for mRNA-1273 and 12.84 (95% CI: 11.49-14.19) per 106 doses for BNT162b2]. Children 12-17 years old accounted for 317 anaphylaxis cases, followed by 48 cases in children 3-11 years old, and 6 cases in children 0-2 years old. Children 10-17 years old had a mean anaphylaxis rate of 13.52 (95% CI: 12.03-15.00) cases per 106 mRNA vaccine doses and children 5-9 years old had a mean anaphylaxis rate of 9.51 (95% CI: 6.82-12.20) cases per 106 mRNA vaccine doses. There were two fatalities, both in the 12-17 years age group. The fatal anaphylaxis rate was 0.07 cases per 106 mRNA vaccine doses. CONCLUSIONS Anaphylaxis is a rare adverse event after receiving an mRNA COVID-19 vaccine in children. Continuous surveillance of serious adverse events is needed to guide vaccination policies as we move towards SARS-CoV-2 endemicity. Larger real-world studies on COVID-19 vaccination in children, using clinical case confirmation, are imperative.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - Sophia Hatziantoniou
- Laboratory of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
| | - Kalliopi Theodoridou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Microbiology, Andreas Syggros Hospital for Skin and Venereal Diseases, National and Kapodistrian University of Athens, 161 21 Athens, Greece
| | | | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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17
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Maltezou HC, Basoulis D, Bonelis K, Gamaletsou MN, Giannouchos TV, Karantoni E, Karapanou Α, Kounouklas K, Livanou ME, Zotou M, Rapti V, Stamou P, Loulakis D, Souliotis K, Chini M, Panagopoulos P, Poulakou G, Syrigos KN, Hatzigeorgiou D, Sipsas NV. Effectiveness of full (booster) COVID-19 vaccination against severe outcomes and work absenteeism in hospitalized patients with COVID-19 during the Delta and Omicron waves in Greece. Vaccine 2023; 41:2343-2348. [PMID: 36740558 PMCID: PMC9892328 DOI: 10.1016/j.vaccine.2023.01.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
AIM We estimated vaccine effectiveness (VE) of full (booster) vaccination against severe outcomes in hospitalized COVID-19 patients during the Delta and Omicron waves. METHODS The study extended from November 15, 2021 to April 17, 2022. Full vaccination was defined as a primary vaccination plus a booster ≥ 6 months later. RESULTS We studied 1138 patients (mean age: 66.6 years), of whom 826 (72.6 %) had > 1 comorbidity. Of the 1138 patients, 75 (6.6 %) were admitted to intensive care unit (ICU), 64 (5.6 %) received mechanical ventilation, and 172 (15.1 %) died. There were 386 (33.9 %) fully vaccinated, 172 (15.1 %) partially vaccinated, and 580 (51 %) unvaccinated patients. Unvaccinated patients were absent from work for longer periods compared to partially or fully vaccinated patients (mean absence of 20.1 days versus 12.3 and 17.3 days, respectively; p-value = 0.03). Compared to unvaccinated patients, fully vaccinated patients were less likely to be admitted to ICU [adjusted relative risk (ARR: 0.49; 95 % CI: 0.29-0.84)], mechanically ventilated (ARR: 0.43; 95 % CI: 0.23-0.80), and die (ARR: 0.57; 95 % CI: 0.42-0.78), while they were hospitalized for significantly shorter periods (ARR: 0.79; 95 % CI: 0.70-0.89). The adjusted full VE was 48.8 % (95 % CI: 42.7 %-54.9 %) against ICU admission, 55.4 % (95 % CI: 52.0 %-56.2 %) against mechanical ventilation, and 22.6 % (95 % CI: 7.4 %-34.8 %) against death. For patients with ≥ 3 comorbidities, VE was 56.2 % (95 % CI: 43.9 %-67.1 %) against ICU admission, 60.2 % (95 % CI: 53.7 %-65.4 %) against mechanical ventilation, and 43.9 % (95 % CI: 19.9 %-59.7 %) against death. CONCLUSIONS Full (booster) COVID-19 vaccination conferred protection against severe outcomes, prolonged hospitalization, and prolonged work absenteeism.
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Affiliation(s)
- Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece,Corresponding author at: at: Directorate of Research, Studies and Documentation, National Public Health Organization, 3-5 Agrafon Street, Athens 15123 Greece
| | - Dimitrios Basoulis
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Bonelis
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria N. Gamaletsou
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Greece
| | - Theodoros V. Giannouchos
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Eleni Karantoni
- Second Clinic of Internal Medicine, COVID-19 Department, 251 Hellenic Air Force General Hospital, Athens, Greece
| | - Αmalia Karapanou
- Infection Control Committee, Laiko General Hospital, Athens, Greece
| | - Konstantinos Kounouklas
- Second Clinic of Internal Medicine, COVID-19 Department, 251 Hellenic Air Force General Hospital, Athens, Greece
| | - Maria Effrosyni Livanou
- Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, Sotiria General Hospital, Athens, Greece
| | - Maria Zotou
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneio-Benakeio Red Cross Hospital, Athens, Greece
| | - Vasiliki Rapti
- Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, Sotiria General Hospital, Athens, Greece
| | - Panagiota Stamou
- Second Clinic of Internal Medicine, COVID-19 Department, 251 Hellenic Air Force General Hospital, Athens, Greece
| | - Dimitrios Loulakis
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneio-Benakeio Red Cross Hospital, Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece,Health Policy Institute, Athens, Greece
| | - Maria Chini
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneio-Benakeio Red Cross Hospital, Athens, Greece
| | - Periklis Panagopoulos
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Garyfalia Poulakou
- Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, Sotiria General Hospital, Athens, Greece
| | - Konstantinos N. Syrigos
- Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, Sotiria General Hospital, Athens, Greece
| | | | - Nikolaos V. Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Greece
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18
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Maltezou HC, Martínez-Jarreta B, Rapisarda V, Ledda C. Editorial: Occupational risks of healthcare personnel. Front Public Health 2022; 10:1022327. [PMID: 36211662 PMCID: PMC9533770 DOI: 10.3389/fpubh.2022.1022327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Helena C. Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece,*Correspondence: Helena C. Maltezou
| | - Begoña Martínez-Jarreta
- Forensic and Occupational Medicine, Department of Pathological Anatomy, Forensic and Legal Medicine and Toxicology, University of Zaragoza, Zaragoza, Spain
| | - Venerando Rapisarda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Caterina Ledda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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19
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Papanikolopoulou A, Maltezou HC, Stoupis A, Kalimeri D, Pavli A, Boufidou F, Karalexi M, Pantazis N, Pantos C, Tountas Y, Koumaki V, Kantzanou M, Tsakris A. Catheter-Associated Urinary Tract Infections, Bacteremia, and Infection Control Interventions in a Hospital: A Six-Year Time-Series Study. J Clin Med 2022; 11:jcm11185418. [PMID: 36143064 PMCID: PMC9501203 DOI: 10.3390/jcm11185418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Urine catheters are often reservoirs of multidrug-resistant (MDR) bacteria and sources of pathogens transmission to other patients. The current study was conducted to investigate the correlation between CAUTIs, MDR bacteremia, and infection control interventions, in a tertiary-care hospital in Athens, from 2013 to 2018. The following data were analyzed per month: 1. CAUTI incidence; 2. consumption of hand hygiene disinfectants; 3. incidence of isolation of MDR carrier patients, and 4.incidence of bacteremia/1000 patient-days [total resistant a.Gram-negative: carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae; b.Gram-positive: vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus]. The use of scrub disinfectant solutions was associated with decreased CAUTI rate in Total Hospital Clinics (OR: 0.97, 95% CI: 0.96−0.98, p-value: <0.001) and in Adults ICU (OR: 0.79, 95% CI: 0.65−0.96, p-value:0.018) while no correlation was found with isolation rate of MDR-carrier pathogens. Interestingly, an increase in total bacteremia (OR: 0.81, 95% CI: 0.75−0.87, p-value:<0.001) or carbapenem-resistant bacteremia correlated with decreased incidence of CAUTIs (OR: 0.96, 95% CI: 0.94−0.99, p-value: 0.008). Hand hygiene measures had a robust and constant effect on infection control, reducing the incidence of CAUTIs.
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Affiliation(s)
- Amalia Papanikolopoulou
- Clinical Pharmacology Department, Athens Medical Center, 5-7 Distomou Str., Marousi, 15125 Athens, Greece
| | - Helena C. Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, 3-5 AgrafonStr., Marousi, 15123 Athens, Greece
- Correspondence: ; Tel.: +30-210-5212175
| | - Athina Stoupis
- Clinical Infectious Diseases Department, Athens Medical Center, 58 Kifissias Avenue, Marousi, 15125 Athens, Greece
| | - Dimitra Kalimeri
- Nurse Department Athens Medical Center, 5-7 Distomou Str., Marousi, 15125 Athens, Greece
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, 3-5 Agrafon Str., Marousi, 15123 Athens, Greece
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Maria Karalexi
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Constantinos Pantos
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Yannis Tountas
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Vasiliki Koumaki
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
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20
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Souliotis K, Peppou LE, Giannouchos TV, Samara M, Sifaki-Pistolla D, Economou M, Maltezou HC. COVID-19 Vaccination and Mental Health Outcomes among Greek Adults in 2021: Preliminary Evidence. Vaccines (Basel) 2022; 10:vaccines10081371. [PMID: 36016258 PMCID: PMC9412301 DOI: 10.3390/vaccines10081371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Existing research on the association between COVID-19 vaccination and quantitatively measured mental health outcomes is scarce. We conducted a cross-sectional telephone survey on a random sample of 1039 adult Greek citizens in June 2021. Among the participants, 39.6% were vaccinated with two doses, 23.1% with one dose, 21.4% were planning to become vaccinated later, and 8.1% refused vaccination. Compared to those fully vaccinated, those against vaccination (“deniers”) and those who planned to do so later on (“not vaccinated yet”) had significantly higher scores across three stress, anxiety, and depression construct scales. Our findings suggest an association between COVID-19 vaccination status and mental health.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, 221 00 Corinth, Greece
- Health Policy Institute, 151 23 Athens, Greece
- Correspondence:
| | - Lily E. Peppou
- Unit of Social Psychiatry & Psychosocial Care, University Mental Health, Neurosciences & Precision Medicine Research Institute, “Costas Stefanis” (UMHRI), 156 01 Athens, Greece
- Prefrecture of Athens Mental Health Promotion Programme, First Department of Psychiatry, Medical School, Aiginition Hospital, National & Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Theodoros V. Giannouchos
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Myrto Samara
- Third Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | | | - Marina Economou
- Unit of Social Psychiatry & Psychosocial Care, University Mental Health, Neurosciences & Precision Medicine Research Institute, “Costas Stefanis” (UMHRI), 156 01 Athens, Greece
- Prefrecture of Athens Mental Health Promotion Programme, First Department of Psychiatry, Medical School, Aiginition Hospital, National & Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Helena C. Maltezou
- Directorate for Research, Studies and Documentation, National Public Health Organization, 151 23 Athens, Greece
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Maltezou HC, Pavli A. Pausanias, the first travel writer: a historical perspective. J Travel Med 2022; 29:taac066. [PMID: 35639762 DOI: 10.1093/jtm/taac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, 3-5 Agrafon Street, Athens 15123, Greece
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens15123, Greece
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22
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Papanikolopoulou A, Maltezou HC, Stoupis A, Pangalis A, Kouroumpetsis C, Chronopoulou G, Kalofissoudis Y, Kostares E, Boufidou F, Karalexi M, Koumaki V, Pantazis N, Tsakris A, Kantzanou M. Ventilator-Associated Pneumonia, Multidrug-Resistant Bacteremia and Infection Control Interventions in an Intensive Care Unit: Analysis of Six-Year Time-Series Data. Antibiotics (Basel) 2022; 11:antibiotics11081128. [PMID: 36009998 PMCID: PMC9405435 DOI: 10.3390/antibiotics11081128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/28/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) occurs more than 48h after mechanical ventilation and is associated with a high mortality rate. The current hospital-based study aims to investigate the association between VAP rate, incidence of bacteremia from multidrug-resistant (MDR) pathogens, and infection control interventions in a single case mix ICU from 2013 to 2018. Methods: The following monthly indices were analyzed: (1) VAP rate; (2) use of hand hygiene disinfectants; (3) isolation rate of patients with MDR bacteria; and (4) incidence of bacteremia/1000 patient-days (total cases, total carbapenem-resistant cases, and carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae cases separately). Results: Time trends of infection control interventions showed increased rates in isolation of patients with MDR pathogens (p <0.001) and consumption of hand disinfectant solutions (p =0.001). The last four years of the study an annual decrease of VAP rate by 35.12% (95% CI: −53.52 to −9.41; p =0.01) was recorded, which significantly correlated not only with reduced trauma and cardiothoracic surgery patients (IRR:2.49; 95% CI: 2.09−2.96; p <0.001), but also with increased isolation rate of patients with MDR pathogens (IRR: 0.52; 95% CI: 0.27−0.99; p = 0.048), and hand disinfectants use (IRR: 0.40; 95% CI: 0.18−0.89; p =0.024). Conclusions: Infection control interventions significantly contributed to the decrease of VAP rate. Constant infection control stewardship has a stable time-effect and guides evidence-based decisions.
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Affiliation(s)
| | - Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 15123 Athens, Greece
| | - Athina Stoupis
- Clinical Infectious Diseases Department, Athens Medical Center, 15125 Athens, Greece
| | - Anastasia Pangalis
- Biopathology Department Athens Medical Center, Marousi, 15125 Athens, Greece
| | | | | | - Yannis Kalofissoudis
- Quality Assurance Department, Athens Medical Center, Marousi, 15125 Athens, Greece
| | - Evangelos Kostares
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Maria Karalexi
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
| | - Vasiliki Koumaki
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-210-7462011
| | - Maria Kantzanou
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
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23
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Psaridi L, Maltezou HC, Simonidou S, Lialliou I, Athanasopoulou D, Haila Z, Kyrimi A, Giannopoulou I, Giannousa S, Pseimada M, Christofilea O, Dounias G, Lanitis S, Kremasmenou E. Neutralizing antibody responses in healthcare personnel after three doses of mRNA BNT162b2 vaccine and association with baseline characteristics and past SARS-CoV-2 infection. Vaccine 2022; 40:5752-5756. [PMID: 36008235 PMCID: PMC9388445 DOI: 10.1016/j.vaccine.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/12/2022] [Accepted: 08/15/2022] [Indexed: 11/24/2022]
Abstract
Aim To estimate neutralizing antibody (NAb) immunity against SARS-CoV-2 in 739 healthcare personnel (HCP) vaccinated with three doses of BNT162b2 mRNA vaccine. Methods Serum samples were collected at 3, 6, and 9 months after the second vaccine dose and at 7–55 days after the third dose. Samples were tested for NAbs against SARS-CoV-2 receptor binding domain. Results The mean inhibition rates at 3, 6, and 9 months after the second dose were 86.33%, 73.38%, and 61.18%, and increased to 95.57% after the booster dose. Younger HCP and HCP with past SARS-CoV-2 infection had higher inhibition rates while there was an inverse correlation between NAb levels and comorbidities or tobacco use (p-values < 0.001). Increased NAb titers were also noticed in women (p-value = 0.033), especially at the end of the 9-month study period. Conclusion NAb levels increased considerably after a booster mRNA vaccine dose. Host factors and past SARS-CoV-2 infection influence NAb titers.
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Affiliation(s)
- Loukia Psaridi
- Department of Immunology, Red Cross General Hospital of Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece.
| | - Sofia Simonidou
- Department of Immunology, Red Cross General Hospital of Athens, Greece
| | - Ioanna Lialliou
- Department of Immunology, Red Cross General Hospital of Athens, Greece
| | | | - Zoi Haila
- Department of Immunology, Red Cross General Hospital of Athens, Greece
| | - Areti Kyrimi
- Department of Immunology, Red Cross General Hospital of Athens, Greece
| | | | | | - Maria Pseimada
- Department of Immunology, Red Cross General Hospital of Athens, Greece
| | | | - George Dounias
- Department of Public Health Policies, School of Public Health, University of West Attica, Athens, Greece
| | - Sophocles Lanitis
- 2(nd) Surgical Department and Unit of Surgical Oncology, Red Cross General Hospital of Athens, Athens, Greece
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Maltezou HC, Poland GA, Poland CM. Immunization of healthcare personnel: A continuing issue. Vaccine X 2022; 11:100169. [PMID: 35574172 PMCID: PMC9088093 DOI: 10.1016/j.jvacx.2022.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Helena C. Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, 3-5 Agrafon Street, Athens, Greece
- Corresponding author at: Directorate of Research, Studies, and Documentation, National Public Health Organization, 3-5 Agrafon Street, Athens, Greece.
| | - Gregory A. Poland
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, 200 First Street, Rochester, MN 55905, United States
| | - Caroline M. Poland
- Poland and Associates Consulting, LLC, 10401 N Meridian St, Suite 450, Indianapolis, IN 46290, United States
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25
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Maltezou HC, Dounias G, Rapisarda V, Ledda C. Vaccination policies for healthcare personnel: Current challenges and future perspectives. Vaccine X 2022; 11:100172. [PMID: 35719325 PMCID: PMC9190304 DOI: 10.1016/j.jvacx.2022.100172] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/10/2022] [Accepted: 05/09/2022] [Indexed: 01/05/2023] Open
Abstract
Healthcare personnel (HCP) are at occupational risk for acquisition of several vaccine-preventable diseases and transmission to patients. Vaccinations of HCP are justified to confer them immunity but also to protect susceptible patients and healthcare services from outbreaks, HCP absenteeism and presenteeism. Mandatory vaccination policies for HCP are increasingly adopted and achieve high and sustainable vaccination rates in short term. In this article we review the scientific evidence for HCP vaccination. We also address issues pertaining to vaccination policies for HCP and present the challenges of implementation of mandatory versus voluntary vaccination policies. Finally, we discuss the issue of mandatory vaccination of HCP against COVID-19.
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Key Words
- CI, confidence interval
- COVID-19
- COVID-19, coronavirus disease 2019
- HCP, healthcare personnel
- Healthcare personnel
- ICU, intensive care unit
- ILI, influenza-like illness
- Immunization
- MMR, measles-mumps-rubella
- Mandatory
- NICU, neonatal intensive care unit
- Occupational
- PCR, polymerase chain reaction
- Policies
- RR, relative risk
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- US, United States
- VE, vaccine effectiveness
- VPD, vaccine-preventable disease
- Vaccination
- Vaccine-preventable diseases
- WHO, World Health Organization
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens 15123, Greece
| | - George Dounias
- Department of Occupational and Environmental Health, University of West Attica, Athens, Greece
| | - Venerando Rapisarda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Caterina Ledda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Papanikolopoulou A, Maltezou HC, Kritikou H, Papadopoulos T, Kandalepas G, Pentzouris A, Kartsonakis I, Chronopoulou G, Gargalianos-Kakolyris P, Pantazis N, Tsakris A, Kantzanou M. Six-Year Time-Series Data on Multidrug-Resistant Bacteremia, Antibiotic Consumption, and Infection Control Interventions in a Hospital. Microb Drug Resist 2022; 28:806-818. [PMID: 35834622 DOI: 10.1089/mdr.2022.0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Background: Multidrug-resistant (MDR) bacteremia is a serious health care-associated infection with significant morbidity and excess hospitalization costs. Our aim is to study the association between incidences of MDR bacteremia, antibiotic consumption, and infection control measures in a hospital from 2013 to 2018. Methods: We analyzed the following indices: (1) incidence of bacteremia (carbapenem-resistant Acinetobacter baumanii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci); (2) use of antibiotics; (3) consumption of disinfectant solutions for hand hygiene; and (4) isolation rates of MDR carrier patients. Findings: The use of advanced antibiotics (p = 0.001) and carbapenems (p = 0.008) decreased significantly in all hospital departments but the incidence of total MDR bacteremia did not change significantly. Increased use of hand disinfectant solutions was statistically associated with decreased incidence of total MDR bacteremia (incidence rate ratio [IRR]: 0.94, confidence interval [95% CI]: 0.90-0.99, p: 0.020) in all hospital. Also, increased isolation rates of MDR carrier patients 2 months before correlated with decreased incidence of bacteremia due to carbapenem-resistant gram-negative pathogens (IRR: 0.35, 95% CI: 0.18-0.66, p: 0.001) in adults intensive care unit. Conclusion: In our hospital, hand hygiene and isolation of MDR carrier patients controlled MDR bacteremia.
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Affiliation(s)
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - Helen Kritikou
- Department of Pharmacy, Alexandra General Hospital, Athens, Greece
| | - Thomas Papadopoulos
- Department of Pharmacy, European Interbalkan Medical Center, Thessaloniki, Greece
| | | | | | | | | | | | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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27
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Maltezou HC, Pavli A, Tsonou P, Balaska A, Raftopoulos V, Papadima K, Andreopoulou A, Tentolouris A, Gamaletsou MN, Sipsas NV, Tentolouris N. Role of diabetes mellitus in the clinical course and outcome of SARS-CoV-2 infected patients. Hormones (Athens) 2022; 21:221-227. [PMID: 35138606 DOI: 10.1007/s42000-021-00342-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 12/07/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Our aim was to study patients with diabetes mellitus and SARS-CoV-2-infection diagnosed during the first pandemic wave in Greece. METHODS Cases were retrieved from the national database of SARS-CoV-2 infections. RESULTS We studied 2624 SARS-CoV-2 infected cases, including 157 with diabetes. Patients with diabetes more often had other comorbidities (68.8 vs. 24.1%; p-value < 0.001). Among patients with diabetes, 149 (94.9%) developed symptomatic disease (COVID-19) compared to 1817 patients (73.7%) without diabetes (p-value < 0.001). A total of 126 patients with diabetes and COVID-19 were hospitalized and 41 died (27.5% case-fatality rate compared to 7.5% among patients without diabetes; p-value < 0.001). Patients with diabetes more often were hospitalized, developed complications, were admitted to the intensive care unit (ICU), received invasive mechanical ventilation, and died compared to patients without diabetes (p-values < 0.001 to 0.002 for all comparisons). Multivariate logistic regression analyses revealed that diabetes, having other comorbidities, and older age were significantly associated with higher risk for hospitalization, ICU admission, invasive mechanical ventilation, and death, and that obesity was significantly associated with higher risk for hospitalization, ICU admission, and mechanical intubation, while female gender protected against these outcomes. CONCLUSION COVID-19 is associated with increased rates of serious morbidity and adverse outcome in patients with diabetes and represents a severe illness for them.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Paraskevi Tsonou
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Asimina Balaska
- Directorate of Non-Communicable Diseases, National Public Health Organization, Athens, Greece
| | | | - Kalliopi Papadima
- Department of Respiratory Infections, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasia Andreopoulou
- Department of Respiratory Infections, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria N Gamaletsou
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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28
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Mellou K, Gkolfinopoulou K, Andreopoulou A, Tsekou A, Papadima K, Stamoulis K, Kossyvakis A, Mentis A, Maltezou HC. A COVID-19 outbreak among migrants in a hosting facility in Greece, April 2020. J Infect Prev 2022; 23:235-238. [PMID: 36003137 PMCID: PMC9389273 DOI: 10.1177/17571774221092568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/22/2022] [Indexed: 12/04/2022] Open
Abstract
In April 2020, a coronavirus disease 2019 outbreak was identified among migrants/refugees
in Greece. Overall, 155 of 450 hosted migrants and two of 46 employees were infected
(attack rates: 34.4% and 4.3%, respectively). The mean age of infected migrants was
24.9 years (3 days-68 years). In addition, 177 community contacts were tested negative.
Cases were cohorted in separate rooms from people tested negative. Surfaces were cleaned
and disinfected daily. The implementation of measures for the containment of the outbreak
was challenging due to language barriers and lack of space for cohorting. At that time,
there was no official recommendation to the general population regarding the use of masks
or other personal protective equipment. Extensive testing of vulnerable populations and
building trust in order to report symptoms and comply with the recommendations are
essential.
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Affiliation(s)
- Kassiani Mellou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kassiani Gkolfinopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasia Andreopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Aikaterini Tsekou
- Directorate of Preparedness and Response, National Public Health Organization, Athens, Greece
| | - Kalliopi Papadima
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | | | - Athanasios Kossyvakis
- National Reference Laboratory for Influenza and Other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Andreas Mentis
- National Reference Laboratory for Influenza and Other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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29
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Hatziantoniou S, Anastassopoulou C, Lampropoulou V, Maltezou HC, Andreakos E, Poland GA, Tsakris A. Comparative assessment of allergic reactions to COVID-19 vaccines in Europe and the United States. Allergy 2022; 77:1630-1633. [PMID: 35174502 PMCID: PMC9111347 DOI: 10.1111/all.15257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/01/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sophia Hatziantoniou
- Laboratory of Pharmaceutical Technology Department of Pharmacy School of Health Sciences University of Patras Patras Greece
| | - Cleo Anastassopoulou
- Department of Microbiology Medical School National and Kapodistrian University of Athens Athens Greece
| | - Vicky Lampropoulou
- Department of Microbiology Medical School National and Kapodistrian University of Athens Athens Greece
- Laboratory of Immunobiology Center for Clinical Experimental Surgery and Translational ResearchBiomedical Research Foundation of the Academy of Athens Athens Greece
| | - Helena C. Maltezou
- Directorate of Research, Studies and Documentation National Public Health Organization Athens Greece
| | - Evangelos Andreakos
- Laboratory of Immunobiology Center for Clinical Experimental Surgery and Translational ResearchBiomedical Research Foundation of the Academy of Athens Athens Greece
| | - Gregory A. Poland
- Mayo Clinic Vaccine Research Group Mayo Clinic Rochester Minnesota USA
| | - Athanasios Tsakris
- Department of Microbiology Medical School National and Kapodistrian University of Athens Athens Greece
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30
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Maltezou HC, Medic S, Cassimos DC, Effraimidou E, Poland GA. Decreasing routine vaccination rates in children in the COVID-19 era. Vaccine 2022; 40:2525-2527. [PMID: 35341648 PMCID: PMC8938181 DOI: 10.1016/j.vaccine.2022.03.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece.
| | - Snezana Medic
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | | | - Evgnosia Effraimidou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
| | - Gregory A Poland
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, MN, United States
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31
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Maltezou HC, Tseroni M, Drositis I, Gamaletsou MN, Koukou DM, Bolikas E, Peskelidou E, Daflos C, Panagiotaki E, Ledda C, Pavli A, Moussas N, Kontogianni S, Svarna E, Ploumidis M, Spyrou A, Chini M, Adamis G, Lourida A, Hatzigeorgiou D, Gargalianos P, Syrogiannopoulos G, Sipsas NV. Vaccination coverage rates and attitudes towards mandatory vaccinations among healthcare personnel in tertiary-care hospitals in Greece. Expert Rev Vaccines 2022; 21:853-859. [PMID: 35382665 DOI: 10.1080/14760584.2022.2063118] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES : Our aim was to estimate vaccination and susceptibility rates against vaccine-preventable diseases among healthcare personnel (HCP) in eight hospitals. METHODS This study was a cross-sectional survey. RESULTS A total of 1284 HCP participated (physicians: 31.3%, nursing personnel: 36.6%, paramedical personnel: 11.1%, administrative personnel: 13.2%, supportive personnel: 7.3%). Vaccination rates were 32.9% against measles and mumps, 38.1% against rubella, 5.7% against varicella, 9.2% against hepatitis A, 65.8% against hepatitis B, 31.8% against tetanus-diphtheria, 7.1% against pertussis, 60.2% against influenza, and 80.1% against COVID-19. Susceptibility rates were: 27.8% for measles, 39.6% for mumps, 33.4% for rubella, 22.2% for varicella, 86.3% for hepatitis A, 34.2% for hepatitis B, 68.2% for tetanus-diphtheria, and 92.9% for pertussis. Older HCP had higher susceptibility rates against mumps, rubella, varicella, hepatitis A, hepatitis B, tetanus-diphtheria, and pertussis (p-values <0.001 for all). Mandatory vaccinations were supported by 81.85% of HCP. CONCLUSIONS Although most HCP supported mandatory vaccinations, significant vaccination gaps and susceptibility rates were recorded. The proportion of susceptible HCP to measles, mumps, rubella, and varicella increased the past decade, mostly because of reduction of acquired cases of natural illness. Vaccination programs for HCP should be developed. A national registry to follow HCP' vaccination rates is urgently needed.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
| | - Maria Tseroni
- Directorate of Epidemiological Surveillance of Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Ioannis Drositis
- Medical Oncology Department, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | - Maria N Gamaletsou
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
| | - Dimitra Maria Koukou
- First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Emmanouil Bolikas
- Infection Control Committee, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | - Emmanuela Peskelidou
- COVID-19 Intensive Care Unit, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
| | - Charalambos Daflos
- Infection Control Committee, Korgialeneio-Benakeio Red Cross General Hospital, Athens, Greece
| | | | - Caterina Ledda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Androula Pavli
- Department for Travel Medicine, National Public Health Organization, Athens, Greece
| | - Nikolaos Moussas
- Internal Medicine and Infectious Diseases Clinic, Iatriko Athinon General Hospital, Athens, Greece
| | | | - Eftychia Svarna
- Department of Pediatrics, University of Thessaly, Larissa, Greece
| | - Michalis Ploumidis
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - Andronikos Spyrou
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - Maria Chini
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneio-Benakeio Red Cross Hospital, Athens, Greece
| | - Georgios Adamis
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - Athanasia Lourida
- Infection Prevention and Control Committee, Aghia Sofia Children's Hospital, Athens, Greece
| | | | - Panagiotis Gargalianos
- Internal Medicine and Infectious Diseases Clinic, Iatriko Athinon General Hospital, Athens, Greece
| | | | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
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Papanikolopoulou A, Maltezou HC, Gargalianos-Kakolyris P, Pangalis A, Pantazis N, Pantos C, Tountas Y, Tsakris A, Kantzanou M. Association between consumption of antibiotics, infection control interventions and Clostridioides difficile infections: Analysis of six-year time-series data in a tertiary-care hospital in Greece. Infect Dis Health 2022; 27:119-128. [PMID: 35153189 DOI: 10.1016/j.idh.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/21/2021] [Accepted: 01/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND To investigate the association between Clostridioides difficile infection (CDI), antibiotic use, and infection control interventions, during an antibiotic stewardship program (ASP) implemented in a tertiary-care hospital in Greece from 2013 to 2018. METHODS Analysis was applied for the following monthly indices: 1. consumption of antibiotics; 2. use of hand hygiene disinfectant solutions; 3. percentage of isolations of patients either with multidrug-resistant (MDR) bacteria, or CDI, or admitted from another hospital; and 4. percentage of patients with CDI divided into two groups: community-acquired CDI (CACDI) and hospital-associated CDI (HACDI) (onset ≤72 h and >72 h after admission, respectively). RESULTS During the study, a significant reduction in CACDI rate from 0.3%/admissions [95% CI 0.1-0.6] to 0.1%/admissions [95% CI 0.0-0.3] (p-value = 0.035) was observed in adults ICU, while CDI rates were stable in the rest of the hospital. Antibiotic consumption showed a significant reduction in total hospital, from 91.7 DDDs [95% CI 89.7-93.7] to 80.1 DDDs [95% CI 79.1-81.1] (p-value<0.001), except adults ICU. Non-advanced antibiotics correlated with decreased CDI rates in Adults Clinic Departments and ICU. Isolation of patients one and two months earlier correlated with decreased CACDI rates per 20% [95% CI 0.64-1.00, p-value = 0.046] and HACDI per 23% [95% CI 0.60-1.00, p-value = 0.050] in Adults Clinic Departments. Consumption of disinfectant solutions current month correlated with decreased rate for CACDI per 33% [95% CI 0.49-0.91, p-value = 0.011] and HACDI per 38% [95% CI 0.40-0.98, p-value = 0.040] in total Hospital Clinics. CONCLUSION Rational antibiotic prescribing during ASP along with multipronged intervention strategy focusing on hand hygiene and patient isolation measures prevent and control CDI outbreaks in the hospital setting.
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Affiliation(s)
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, 15123 Greece.
| | | | - Anastasia Pangalis
- Biopathology Department, Athens Medical Center, Marousi, Athens, 15125 Greece
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, 15772 Greece
| | - Constantinos Pantos
- Department of Pharmacology, School of Medicine, National and Kapodistrian University of Athens, Athens, 15772 Greece
| | - Yannis Tountas
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, 15772 Greece
| | - Athanasios Tsakris
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, Athens, 15772 Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, 15772 Greece
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Ledda C, Costantino C, Motta G, Cunsolo R, Stracquadanio P, Liberti G, Maltezou HC, Rapisarda V. SARS-CoV-2 mRNA Vaccine Breakthrough Infections in Fully Vaccinated Healthcare Personnel: A Systematic Review. Trop Med Infect Dis 2022; 7:9. [PMID: 35051125 PMCID: PMC8781002 DOI: 10.3390/tropicalmed7010009] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 12/20/2022] Open
Abstract
The number of people vaccinated against COVID-19 increases worldwide every day; however, it is important to study the risk of breakthrough infections in vaccinated individuals at high risk of exposure such as healthcare personnel (HCP). A systematic literature review (SLR) applying the PRISMA declaration and the PECOS format using the following entry terms was used: "Health Personnel OR Healthcare Worker OR Healthcare Provider OR Healthcare Personnel AND breakthrough OR infection after vaccine*". The research was carried out utilizing the following databases: SCOPUS, PubMed, Embase, and Web of Sciences. An overall very low incidence of post-vaccination breakthrough infections was found, ranging from 0.011 to 0.001 (per 100 individuals at risk). Our findings further support the published high effectiveness rates of mRNA vaccines in preventing SARS-CoV-2 infections among fully vaccinated HCP. Additional studies are needed to define the duration of the vaccine-induced protection among HCP.
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Affiliation(s)
- Caterina Ledda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy;
| | - Claudio Costantino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy;
| | - Giuseppe Motta
- Occupational Medicine Unit, “Garibaldi” Hospital of Catania, 95123 Catania, Italy;
| | - Rosario Cunsolo
- Hospital Health Management, “G. Rodolico-San Marco” Polyclinic University Hospital, 95123 Catania, Italy;
| | - Patrizia Stracquadanio
- Occupational Medicine Unit, “G. Rodolico-San Marco” University Hospital, 95123 Catania, Italy;
| | - Giuseppe Liberti
- Commissioner Office in Acta for the COVID-19 Emergency, Provincial Health Authority of Catania, 95123 Catania, Italy;
| | - Helena C. Maltezou
- Directorate for Research, Studies and Documentation, National Public Health Organization, 15123 Athens, Greece;
| | - Venerando Rapisarda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy;
- Occupational Medicine Unit, “G. Rodolico-San Marco” University Hospital, 95123 Catania, Italy;
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Abstract
From the beginning of the coronavirus disease 2019 (COVID-19) pandemic it became evident that children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain mostly asymptomatic or mildly symptomatic. We reviewed the epidemiologic and clinical features of children with SARS-CoV-2 infection. The true prevalence of asymptomatic SARS-CoV-2 infection is most likely underestimated, as asymptomatic children are less frequently tested. Serologic surveys indicate that half of children tested positive for SARS-CoV-2 report no symptoms. Anosmia/ageusia is not frequent in children but it is the strongest predictor of a positive SARS-CoV-2 test. In general, children with COVID-19 are at lower risk of hospitalization and life-threatening complications. Nevertheless, cases of severe disease or a post-infectious multisystem hyperinflammatory syndrome named multisystem inflammatory syndrome in children (MIS-C) have been described. Rarely children with severe COVID-19 develop neurologic complications. In addition, studies indicate that school closures have a limited impact on SARS-CoV-2 transmission, much less than other social distancing measures. The past months new SARS-CoV-2 variants emerged with higher transmissibility and an increased impact on morbidity and deaths. The role of children in the transmission dynamics of these variants must be elucidated. Lastly, preliminary results from COVID-19 vaccine trials indicate very good efficacy and tolerability in children. Very recently the United States Centers for Disease Control and Prevention and other public health authorities recommend vaccination of children 12 years or older to protect them but mostly to contribute to the achievement of herd immunity.
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Affiliation(s)
| | - Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece,Address reprint requests to: Helena C. Maltezou, Dr. Directorate of Research, Studies and Documentation, National Public Health Organization, 3-5 Agrafon Street, Marousi, 15123 Athens, Greece; Phone: 0030-210-5212175
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Abstract
Vaccinations are an important component of travel medicine. Beyond protection of travelers, vaccines are administered to prevent the importation of vaccine-preventable diseases at home and at destination. Proof of immunization to travel dates back to the first smallpox vaccine, developed by Edward Jenner in 1796. However, it took one century to generate the next vaccines against cholera, rabies, and typhoid fever. During the 20th century the armamentarium of vaccines used in travelers largely expanded with yellow fever, poliomyelitis, tetravalent meningococcal, and hepatitis A vaccines. The International Certificate of Inoculation and Vaccination was implemented in 1933. Currently there are vaccines administered to travelers following risk assessment, but also vaccines required according to the 2005 International Health Regulations and vaccines required at certain countries. Finally, within less than one year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic, the first COVID-19 vaccines were launched and approved for emergency use to control the pandemic. Despite practical and ethical challenges, COVID-19 vaccine verifications have been widely used since spring 2021 in many activities, including international travel. In this article, we review the course of development of travel vaccines focusing on those for which a proof of vaccination has been or is required.
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Affiliation(s)
- Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Helena C. Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece,Corresponding author. Directorate for Research, Studies, and Documentation, National Public Health Organization, 3-5 Agrafon Street, Athens, 15123, Greece
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Maltezou HC, Stavros S, Asimakopoulos G, Pergialiotis V, Raftopoulos V, Talias MA, Pavli A, Daskalakis G, Sindos M, Koutroumanis P, Theodora M, Antsaklis P, Kostis E, Stratiki E, Kossyvakis A, Theodoridou M, Mentis A, Drakakis P, Loutradis D, Rodolakis A. Effectiveness of maternal vaccination with quadrivalent inactivated influenza vaccine in pregnant women and their infants in 2019-2020. Expert Rev Vaccines 2021; 21:983-992. [PMID: 34878959 DOI: 10.1080/14760584.2022.2013820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Influenza is associated with an increased risk for serious illness, hospitalization and death in pregnant women and young infants. Our aim was to estimate the effectiveness of a quadrivalent inactivated influenza vaccine (QIV) in pregnant women and their infants during 2019-2020 influenza season. METHODS A QIV vaccine was offered to pregnant women followed in a maternity hospital. Women were contacted weekly during the influenza season and asked about symptoms. Polymerase chain reaction testing in pharyngeal samples was offered to pregnant women and infants with influenza-like illness. A Bayesian beta-binomial model was used. RESULTS We studied 636 pregnant women (406 vaccinated and 230 unvaccinated) and 474 infants (281 of mothers vaccinated in pregnancy and 193 of unvaccinated mothers). Using a Bayesian beta-binomial model, it was estimated that influenza vaccination of pregnant women reduced their logit to develop laboratory-confirmed influenza by -4.2 (95% CI -3,7 -4,7) and the logit of their infants to develop laboratory-confirmed influenza by -4.2 (95% CI -3.6, -4.9). The QIV effectiveness against laboratory-confirmed influenza was 43.5% in pregnant women and 31.4% in infants. CONCLUSION Maternal influenza vaccination with QIV in pregnancy reduced the odds of pregnant women and their infants to develop influenza. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov identifier is NCT04723771.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - Sofoklis Stavros
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - George Asimakopoulos
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Michael A Talias
- Healthcare Management Postgraduate Program, Open University of Cyprus, Nicosia, Cyprus
| | | | - George Daskalakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Michael Sindos
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Pelopidas Koutroumanis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Marianna Theodora
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Panagiotis Antsaklis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Evangelia Stratiki
- Neonatal Intensive Care Unit, Alexandra General Hospital, Athens, Greece
| | - Athanasios Kossyvakis
- National Influenza Reference Laboratory of Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Maria Theodoridou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Mentis
- National Influenza Reference Laboratory of Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Petros Drakakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
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Maltezou HC, Anastassopoulou C, Hatziantoniou S, Poland GA, Tsakris A. Anaphylaxis rates associated with COVID-19 vaccines are comparable to those of other vaccines. Vaccine 2021; 40:183-186. [PMID: 34863620 PMCID: PMC8626274 DOI: 10.1016/j.vaccine.2021.11.066] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
We retrieved data on 8940 anaphylaxis cases post-COVID-19 vaccination from the US Vaccine Adverse Event Reporting System and the European EudraVigilance from week 52/2020 through week 31/2021 and compared them with those of other vaccines. Overall, 837,830,000 COVID-19 vaccine doses were delivered in the US and Europe during the study period, for which the vaccine name was known. The mean anaphylaxis rate was estimated at 10.67 cases per 106 doses of COVID-19 vaccines (range: 7.99-19.39 cases per 106 doses depending on the vaccine). COVID-19 vaccines ranked fifth in reported anaphylaxis rates, behind rabies, tick-borne encephalitis, measles-mumps-rubella-varicella, and human papillomavirus vaccines (70.77, 20, 19.8, and 13.65 cases per 106 vaccine doses, respectively). COVID-19 vaccines are within the range of anaphylaxis rates reported across several common vaccines in these two passive reporting systems. These data should be communicated to reassure the general population about the safety profile of COVID-19 vaccines.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Hatziantoniou
- Laboratory of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, United States
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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38
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Maltezou HC, Krumbholz B, Mavrouli M, Tseroni M, Gamaletsou MN, Botsa E, Anastassopoulou C, Gikas A, Fournarakou E, Kavieri M, Koureli A, Mandilara D, Marinopoulou A, Theodorikakou A, Tsiahris P, Zarzali A, Pournaras S, Lourida A, Elefsiniotis I, Vrioni G, Sipsas NV, Tsakris A. A study of the evolution of the third COVID-19 pandemic wave in the Athens metropolitan area, Greece, through two cross-sectional seroepidemiological surveys: March, June 2021. J Med Virol 2021; 94:1465-1472. [PMID: 34812522 PMCID: PMC9011894 DOI: 10.1002/jmv.27465] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 12/22/2022]
Abstract
We studied the third coronavirus disease 2019 (COVID‐19) pandemic wave in Athens metropolitan area (3 738 901 inhabitants) through two seroepidemiological surveys. Persons presenting in 12 healthcare facilities across Athens in March and June 2021 were studied (764 and 901, respectively). Immunoglobulin G antibodies against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) spike protein were measured by a chemiluminescent microparticle immunoassay. In March the seroprevalence rate was 11.6%, meaning that 435 208 residents of Athens had evidence of immunity. The respective values in June were 55.7% and 2 082 568 residents. The highest seroprevalence rates attributed to SARS‐CoV‐2 infection were recorded in persons <18 years (16.3% in March and 31.6% in June), while immunity was mainly vaccine‐induced in persons 18–64 years and >65 years. Infection‐attributed immunity also increased in older‐age groups. Wide ranges in seroprevalence rates were noted across areas in March and June. The highest seroprevalence rates were recorded in Piraeus (47.2%) and West Attica (37.5%). However, the highest increase (>5 times) occurred in Piraeus and the South Section of Athens, which are among the most densely populated areas in Athens. In both study periods, history of COVID‐19 or febrile episode, and having a cohabitant with COVID‐19 were associated with increased risk for seropositivity among unvaccinated persons (p values <0.001 for all). Residing in Piraeus, the South Section or West Attica was associated with increased risk for seropositivity in June (p values <0.001). Wide heterogeneity in seroprevalence rates was found across areas in Athens, which is mainly attributed to population density. The impact of population mobility and socioeconomic status should be explored.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
| | | | - Maria Mavrouli
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Tseroni
- Directorate of Epidemiological Surveillance of Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Maria N Gamaletsou
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
| | - Evanthia Botsa
- First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | - Dionysia Mandilara
- Academic Department of Internal Medicine, General Oncology Hospital of Kifisia "Agioi Anargyroi", National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | - Spyridon Pournaras
- Laboratory of Clinical Microbiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasia Lourida
- Infection Control Committee, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ioannis Elefsiniotis
- Academic Department of Internal Medicine, General Oncology Hospital of Kifisia "Agioi Anargyroi", National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Maltezou HC. Vaccination of healthcare personnel in the COVID-19 era: A call for actions. Vaccine 2021; 39:7363-7365. [PMID: 34772543 PMCID: PMC8560546 DOI: 10.1016/j.vaccine.2021.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece.
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40
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Maltezou HC, Tseroni M, Daflos C, Anastassopoulou C, Vasilogiannakopoulos A, Daligarou O, Panagiotou M, Botsa E, Spanakis N, Lourida A, Tsakris A. Environmental testing for SARS-CoV-2 in three tertiary-care hospitals during the peak of the third COVID-19 wave. Am J Infect Control 2021; 49:1435-1437. [PMID: 34455029 PMCID: PMC8388137 DOI: 10.1016/j.ajic.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/21/2022]
Abstract
Contamination of surfaces has been implicated in transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We tested by real-time PCR for SARS-CoV-2 contamination environmental samples from three hospitals during the peak of the third pandemic wave. Overall, 19 of 463 (4.1%) samples tested positive: 12 of 173 (6.9%) samples from a COVID-19 hospital, 3 of 177 (1.7%) samples from a non-COVID-19 hospital, and 4 of 113 (3.5%) samples from a pediatric hospital with dedicated COVID-19 clinics. Most positive samples originated from emergency departments (EDs) (47.3%) and the intensive care units (ICUs) (26.3%) of the COVID-19 hospital. Positive samples belonged almost exclusively (18/19) to the highly transmissible B.1.1.7 cluster, that might explain environmental contamination at this stage of the pandemic. The frequency and efficiency of disinfection in high-risk patient areas, such as EDs and ICUs, should be reinforced, especially during this period where highly transmissible variants of concern are widespread.
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Maltezou HC, Effraimidou E, Cassimos DC, Medic S, Topalidou M, Konstantinidis T, Theodoridou M, Rodolakis A. Vaccination programs for pregnant women in Europe, 2021. Vaccine 2021; 39:6137-6143. [PMID: 34462162 DOI: 10.1016/j.vaccine.2021.08.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/14/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
Vaccination during pregnancy is increasingly adopted worldwide in order to protect the mother and her offspring. We studied the current vaccination programs specifically for pregnant women in 42 European countries. Vaccination programs for pregnant women are in place in 37 countries, as follows: influenza (36 countries), pertussis (28), hepatitis B (12), tetanus (10), pneumococcal disease (10), meningococcal disease (10), rabies (8), tick-borne encephalitis (6), hepatitis A (5), poliomyelitis (4), diphtheria (3), Haemophilus influenzae (2), and human papilloma virus (1). Recommendations for vaccination against influenza and pertussis concern almost exclusively pregnant women regardless of high-risk conditions, however differences between vaccination recommendations are noted in terms of timing. Vaccinations against hepatitis B, hepatitis A, pneumococcal disease, meningococcal disease, poliomyelitis, H. influenzae, rabies, and tick-born encephalitis mainly concern pregnant women at high-risk for exposure or serious illness and post-exposure vaccinations. Overall, five European countries have no vaccination recommendations specifically for pregnant women. In conclusion, there are significant differences in vaccination programs for pregnant women in Europe. Vaccination programs for pregnant women should expand in order to protect maternal and infant health. A consensus-based vaccination program is needed.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | | | | | - Snezana Medic
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Maria Topalidou
- Pediatric Clinic, Komotini General Hospital, Komotini, Greece
| | | | - Maria Theodoridou
- First Department of Pediatrics, University of Athens, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, University of Athens, Alexandra General Hospital, Athens, Greece
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Raftopoulos V, Iordanou S, Katsapi A, Dedoukou X, Maltezou HC. A comparative online survey on the intention to get COVID-19 vaccine between Greek and Cypriot healthcare personnel: is the country a predictor? Hum Vaccin Immunother 2021; 17:2397-2404. [PMID: 33754953 PMCID: PMC8475582 DOI: 10.1080/21645515.2021.1896907] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022] Open
Abstract
Vaccine hesitancy amongst healthcare personnel (HCP) is a critical issue. The aim was to explore the factors that determine the intention to opt for COVID-19 vaccine among HCP from two southern European countries. An anonymous online self-administered survey using Google Forms has been conducted between December 1st to December 15th, 2020 among the HCP in Greece and the Republic of Cyprus. A total of 2,238 HCPs participated in the study (1,220/54.5% from Republic of Cyprus and 1,018 from Greece). Overall 1,082 (48.3%) stressed their intention to get vaccinated (64.4% for Greece and 34.9% for Republic of Cyprus). The main reasons for those who intend to get the COVID-19 vaccine include self (94.2%), family (98.7%), and patients protection (95.2%) as well as mitigation of COVID-19 pandemic (95.4%). The multivariate logistic regression that was performed for the total sample revealed that the following variables were significantly associated with an increased probability to get vaccinated against COVID-19: being a physician, a member of the nursing personnel, paramedical staff, working in Greece, age, the belief that influenza vaccination should be mandatory for HCP, and the rating of the overall management of COVID-19 pandemic in the country and from the public hospitals. Physicians were more likely to get vaccinated against COVID-19 than other HCP. The age was a predictor of COVID-19 uptake intention in the Republic of Cyprus. The belief that there was a successful management of the COVID-19 pandemic contributed to the intention to COVID-19 vaccination uptake.
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Affiliation(s)
- Vasilios Raftopoulos
- Epidemiological Surveillance of HIV/AIDS Division, National Public Health Organization, Athens, Greece
| | - Stelios Iordanou
- Intensive Care Unit, Limassol General Hospital, Limassol, Cyprus
| | - Angeliki Katsapi
- Euro-Mediterranean Institute for Quality and Safety in Health Services Avedis Donabedian, Athens, Greece
| | | | - Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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Maltezou HC, Giannouchos TV, Pavli A, Tsonou P, Dedoukou X, Tseroni M, Papadima K, Hatzigeorgiou D, Sipsas NV, Souliotis K. Costs associated with COVID-19 in healthcare personnel in Greece: a cost-of-illness analysis. J Hosp Infect 2021; 114:126-133. [PMID: 33894306 PMCID: PMC8061082 DOI: 10.1016/j.jhin.2021.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/17/2021] [Accepted: 04/17/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Healthcare personnel (HCP) are at increased risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the aetiological agent of coronavirus disease 2019 (COVID-19). AIM To estimate the costs related to SARS-CoV-2 exposure and infection among HCP in Greece. METHODS Data were retrieved from the national database of SARS-CoV-2 infections and from the database of HCP exposed to patients with COVID-19. A cost-of-illness analysis was performed to estimate total, direct and indirect costs. RESULTS In total, 254 HCP with COVID-19 and 3332 HCP exposed to patients with COVID-19 during the first epidemic wave were studied. Of the 254 HCP with COVID-19, 49 (19.3%) were hospitalized (mean length of hospitalization 11.6 days) and four were admitted to intensive care units (mean duration 10.8 days). Overall, 1332 (40%) exposed HCP had a mean duration of absenteeism of 7.5 days, and 252 (99.2%) HCP with COVID-19 had a mean duration of absenteeism of 25.8 days. The total costs for the management of the two groups were estimated at €1,735,830 (€772,890 Euros for HCP with COVID-19 and €962,940 for exposed HCP). Absenteeism accounted for a large proportion of the total costs (80.4% of all expenditures), followed by costs for reverse transcriptase polymerase chain reaction and hospitalization (10.2% and 6.5% of all expenditures, respectively). CONCLUSION COVID-19 is associated with increased rates and duration of absenteeism among HCP. Indirect costs, particularly absenteeism, are the major driver of total costs among exposed HCP and HCP with COVID-19. The estimated total costs are conservative. Studies are needed to explore the impact of COVID-19 vaccination of HCP on absenteeism and COVID-19-associated costs.
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Affiliation(s)
- H C Maltezou
- Directorate for Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - T V Giannouchos
- Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - A Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - P Tsonou
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - X Dedoukou
- National Public Health Organization, Athens, Greece
| | - M Tseroni
- Directorate for Epidemiologic Surveillance of Infectious Diseases, National Public Health Organization, Athens, Greece
| | - K Papadima
- Directorate for Epidemiologic Surveillance of Infectious Diseases, National Public Health Organization, Athens, Greece
| | - D Hatzigeorgiou
- Medical Directorate, Hellenic Air Force General Staff, Athens, Greece
| | - N V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - K Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece; Health Policy Institute, Athens, Greece
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Maltezou HC, Pavli A, Dedoukou X, Georgakopoulou T, Raftopoulos V, Drositis I, Bolikas E, Ledda C, Adamis G, Spyrou A, Karantoni E, Gamaletsou MN, Koukou DM, Lourida A, Moussas N, Petrakis V, Panagopoulos P, Hatzigeorgiou D, Theodoridou M, Lazanas M, Gargalianos P, Sipsas NV. Determinants of intention to get vaccinated against COVID-19 among healthcare personnel in hospitals in Greece. Infect Dis Health 2021; 26:189-197. [PMID: 33906828 PMCID: PMC8011642 DOI: 10.1016/j.idh.2021.03.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND To investigate intention rates to get vaccinated against COVID-19 among healthcare personnel (HCP) in Greece. METHODS Cross-sectional survey. RESULTS The response rate was 14.5%. Of 1521 HCP with a known profession, 607 (39.9%) were nursing personnel, 480 (31.6%) physicians, 171 (11.2%) paramedical personnel, 72 (4.7%) supportive personnel, and 191 (12.6%) administrative personnel. Overall, 803 of 1571 HCP (51.1%) stated their intention to get vaccinated while 768 (48.9%) stated their intention to decline vaccination. Most HCP (71.3%) who reported intent to get vaccinated noted contributing to the control of the pandemic and protecting their families and themselves as their reasons, while the most common reason for reporting intent to decline vaccination was inadequate information about the vaccines (74.9%), followed by concerns about vaccine safety (36.2%). Logistic regression analysis revealed that the probability of intending to get vaccinated increased with male gender, being a physician, history of complete vaccination against hepatitis B, history of vaccination against pandemic A (H1N1) in 2009-2010, belief that COVID-19 vaccination should be mandatory for HCP, and increased confidence in vaccines in general during the COVID-19 pandemic. The following factors were associated with a lower intention to get vaccinated: no vaccination against influenza the past season, no intention to get vaccinated against influenza in 2020-2021, and no intention to recommend COVID-19 vaccination to high-risk patients. CONCLUSION There is an urgent need to built safety perception towards COVID-19 vaccines and raise vaccine uptake rates by HCP, and thus to protect the healthcare workforce and the healthcare services.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, 11523, Greece.
| | - Androula Pavli
- Department for Travel Medicine, National Public Health Organization, Athens, 11523, Greece
| | | | - Theano Georgakopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, 11523, Greece
| | - Vasilios Raftopoulos
- HIV Surveillance Department, National Public Health Organization, Athens, 11523, Greece
| | - Ioannis Drositis
- Medical Oncology Department, Venizeleio-Pananeio General Hospital, Heraklion, 71409, Greece
| | - Emmanouil Bolikas
- Infection Control Committee, Venizeleio-Pananeio General Hospital, Heraklion, 71409, Greece
| | - Caterina Ledda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, 95124, Italy
| | - Georgios Adamis
- First Department of Internal Medicine, Infectious Diseases Unit, Gennimatas General Hospital, Athens, 11527, Greece
| | - Andronikos Spyrou
- First Department of Internal Medicine, Infectious Diseases Unit, Gennimatas General Hospital, Athens, 11527, Greece
| | - Eleni Karantoni
- Medical Directorate, Hellenic Air Force General Staff, Athens, 11525, Greece
| | - Maria N Gamaletsou
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, 11527, Greece
| | - Dimitra Maria Koukou
- First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, 11527, Greece
| | - Athanasia Lourida
- Infection Prevention and Control Committee, Aghia Sofia Children's Hospital, Athens, 11527, Greece
| | - Nikolaos Moussas
- Internal Medicine and Infectious Diseases Clinic, Iatriko Athinon General Hospital, Athens, 11523, Greece
| | - Vasilios Petrakis
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece
| | - Periklis Panagopoulos
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece
| | | | - Maria Theodoridou
- First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, 11527, Greece
| | - Marios Lazanas
- Internal Medicine and Infectious Diseases Department, Iaso Maternity Hospital, Athens, 11523, Greece
| | - Panagiotis Gargalianos
- Internal Medicine and Infectious Diseases Clinic, Iatriko Athinon General Hospital, Athens, 11523, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, 11527, Greece
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Mellou K, Sideroglou T, Kefaloudi C, Tryfinopoulou K, Chrysostomou A, Mandilara G, Pavlaki M, Maltezou HC. Waterborne outbreak in a rural area in Greece during the COVID-19 pandemic: contribution of community pharmacies. Rural Remote Health 2021; 21:6630. [PMID: 34320325 DOI: 10.22605/rrh6630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION On 15 June 2020, the National Public Health Organization was informed about the identification of two cases of Escherichia coli Ο157 infection in a small town in the Peloponnese Region in Greece and we suspected an outbreak. METHODS We asked the local pharmacist to assist us to verify the outbreak by providing the daily number of over-the-counter anti-diarrheal drugs sold from 20 May 2020 onwards. The pharmacist asked customers with gastroenteritis to submit stool samples at the local hospital. Samples were tested for 22 pathogens. We conducted a 1 : 1 case-control study. Cases and controls were retrieved from the pharmacy client list. Chlorination records of the water supply system were retrieved, and water samples were tested for microbiological indicators and viruses. RESULTS The increased number of sales of anti-diarrheal drugs verified the outbreak. Overall, 58 cases and 57 controls were recruited for the study. Tap water consumption (odds ratio (OR)=10.9, 95% confidence interval (CI)=3.1-38.0, p<0.001) and consumption of ice cubes made from tap water (OR=39.3, 95%CI=10.3-150.9, p<0.001) were independently associated with gastroenteritis occurrence. Eleven stool samples were tested; one was positive for shigatoxin-producing E. coli, one for enteropathogenic E. coli, four for E. coli Ο157 and one for Salmonella spp. Four samples tested negative. Five water samples collected on 18 June tested negative. The residual chlorine on 5 and 14 June ranged from 0.12 mg/L to 0.14 mg/L. CONCLUSION This was the first investigation of a waterborne outbreak in Greece performed with the collaboration of a local pharmacy. The COVID-19 pandemic favored the use of alternative resources and channels of communication with the local population, which can also be used in the future, especially in remote areas of the country.
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Affiliation(s)
- Kassiani Mellou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, 3-5 Agrafon Street, Athens 15123, Greece
| | - Theologia Sideroglou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, 3-5 Agrafon Street, Athens 15123, Greece
| | - Chrysovalanti Kefaloudi
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, 3-5 Agrafon Street, Athens 15123, Greece; and European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Gustav III Boulevard 40, Solna 16973, Stockholm, Sweden
| | | | - Anthi Chrysostomou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, 3-5 Agrafon Street, Athens 15123, Greece
| | - Georgia Mandilara
- National Reference Laboratory for Salmonella-Shigella, Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Ave, Athens 111521, Greece
| | - Maria Pavlaki
- Infectious Diseases Unit, Health Care Unit of Argos, General Hospital of Argolida, 191 Korinthou Ave, 21200 Argos, Argolida, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 3-5 Agrafon St, Athens 15123, Greece
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Ledda C, Rapisarda V, Maltezou HC, Contrino E, Conforto A, Maida CM, Tramuto F, Vitale F, Costantino C. Coverage rates against vaccine-preventable diseases among healthcare workers in Sicily (Italy). Eur J Public Health 2021; 31:56. [PMID: 33001212 DOI: 10.1093/eurpub/ckaa179] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Vaccination of healthcare workers (HCWs) reduces the risk of occupational vaccine-preventable diseases (VPDs), prevents their nosocomial transmission and preserves healthcare delivery during outbreaks. Extensive implementation of vaccination programmes for HCWs allowed the elimination or control of several VPDs within healthcare facilities; despite these, the vaccine adherence rates among HCWs are persistently suboptimal. METHODS A questionnaire was self-administered by HCWs to assess their vaccination rates against several VPDs and self-reported immunity in two university hospitals of Southern Italy (Catania and Palermo). RESULTS A total of 2586 questionnaires were analysed. More than 50% of HCWs did not know their own immunization status against diphtheria, tetanus and pertussis. More than half of the HCWs interviewed at University Hospital (UH) of Catania (UHC) was immune against measles (72.1%), in contrast with data reported at the UH of Palermo (UHP) (45.9%). Immunization status against mumps (67.5% UHC vs. 40.6% UHP), rubella (69.9% UHC vs. 46.6% UHP) and varicella (70.4% UHC vs. 50.7% UHP). Overall, about 30% of HCWs did not know their own immunization status against these VPDs. Moreover, 84.2% at UHC and 66.7% at UHP stated that was previously vaccinated against hepatitis B. CONCLUSION Vaccination coverage rates reported from the HCWs against influenza during the last three seasons were considerably low. In conclusion, totally inadequate vaccination rates against several VPDs were found in two university hospitals in Sicily, in terms of preventing not only disease transmission by susceptible HCWs, but also nosocomial outbreaks, confirming data from previous national and international studies.
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Affiliation(s)
- Caterina Ledda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Venerando Rapisarda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Helena C Maltezou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Eleonora Contrino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties, University of Palermo, Palermo, Italy
| | - Arianna Conforto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties, University of Palermo, Palermo, Italy
| | - Carmelo Massimo Maida
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties, University of Palermo, Palermo, Italy
| | - Fabio Tramuto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties, University of Palermo, Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties, University of Palermo, Palermo, Italy
| | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties, University of Palermo, Palermo, Italy
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Abstract
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues despite the implementation of effective restrictive public health measures, including strict travel restrictions. In light of safe and effective vaccines against COVID-19, ‘vaccine passports’, as a temporary recommendation will facilitate resumption of travel.
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Affiliation(s)
- Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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Kraigsley AM, Moore KA, Bolster A, Peters M, Richardson D, Arpey M, Sonnenberger M, McCarron M, Lambach P, Maltezou HC, Bresee JS. Barriers and activities to implementing or expanding influenza vaccination programs in low- and middle-income countries: A global survey. Vaccine 2021; 39:3419-3427. [PMID: 33992439 DOI: 10.1016/j.vaccine.2021.04.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/02/2021] [Accepted: 04/21/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Despite considerable global burden of influenza, few low- and middle-income countries (LMICs) have national influenza vaccination programs. This report provides a systematic assessment of barriers to and activities that support initiating or expanding influenza vaccination programs from the perspective of in-country public health officials. METHODS Public health officials in LMICs were sent a web-based survey to provide information on barriers and activities to initiating, expanding, or maintaining national influenza vaccination programs. The survey primarily included Likert-scale questions asking respondents to rank barriers and activities in five categories. RESULTS Of 109 eligible countries, 62% participated. Barriers to influenza vaccination programs included lack of data on cost-effectiveness of influenza vaccination programs (87%) and on influenza disease burden (84%), competing health priorities (80%), lack of public perceived risk from influenza (79%), need for better risk communication tools (77%), lack of financial support for influenza vaccine programs (75%), a requirement to use only WHO-prequalified vaccines (62%), and young children require two vaccine doses (60%). Activities for advancing influenza vaccination programs included educating healthcare workers (97%) and decision-makers (91%) on the benefits of influenza vaccination, better estimates of influenza disease burden (91%) and cost of influenza vaccination programs (89%), simplifying vaccine introduction by focusing on selected high-risk groups (82%), developing tools to prioritize target populations (80%), improving availability of influenza diagnostic testing (79%), and developing collaborations with neighboring countries for vaccine procurement (74%) and regulatory approval (73%). Responses varied by country region and income status. CONCLUSIONS Local governments and key international stakeholders can use the results of this survey to improve influenza vaccination programs in LMICs, which is a critical component of global pandemic preparedness for influenza and other pathogens such as coronaviruses. Additionally, strategies to improve global influenza vaccination coverage should be tailored to country income level and geographic location.
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Affiliation(s)
- Alison M Kraigsley
- Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, Minneapolis, MN, USA.
| | - Kristine A Moore
- Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, Minneapolis, MN, USA
| | | | - Maya Peters
- Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, Minneapolis, MN, USA
| | | | - Meredith Arpey
- Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, Minneapolis, MN, USA
| | - Michelle Sonnenberger
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - Joseph S Bresee
- The Task Force for Global Health, Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA
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Maltezou HC, Pavli A, Tsakris A. Post-COVID Syndrome: An Insight on Its Pathogenesis. Vaccines (Basel) 2021; 9:497. [PMID: 34066007 PMCID: PMC8151752 DOI: 10.3390/vaccines9050497] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/22/2022] Open
Abstract
Post-COVID syndrome is increasingly recognized as a new clinical entity in the context of SARS-CoV-2 infection. Symptoms persisting for more than three weeks after the diagnosis of COVID-19 characterize the post-COVID syndrome. Its incidence ranges from 10% to 35%, however, rates as high as 85% have been reported among patients with a history of hospitalization. Currently, there is no consensus on the classification of post-COVID syndrome. We reviewed the published information on post-COVID syndrome, putting emphasis on its pathogenesis. The pathogenesis of post-COVID syndrome is multi-factorial and more than one mechanism may be implicated in several clinical manifestations. Prolonged inflammation has a key role in its pathogenesis and may account for some neurological complications, cognitive dysfunction, and several other symptoms. A multisystem inflammatory syndrome in adults (MIS-A) of all ages has been also described recently, similarly to multisystem inflammatory syndrome in children (MIS-C). The post-infectious inflammatory pathogenetic mechanism of MIS-A is supported by the fact that its diagnosis is established through serology in up to one third of cases. Other pathogenetic mechanisms that are implicated in post-COVID syndrome include immune-mediated vascular dysfunction, thromboembolism, and nervous system dysfunction. Although the current data are indicating that the overwhelming majority of patients with post-COVID syndrome have a good prognosis, registries to actively follow them are needed in order to define the full clinical spectrum and its long-term outcome. A consensus-based classification of post-COVID syndrome is essential to guide clinical, diagnostic, and therapeutic management. Further research is also imperative to elucidate the pathogenesis of post-COVID syndrome.
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Affiliation(s)
- Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 11523 Athens, Greece
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, 11523 Athens, Greece;
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
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Pavli A, Theodoridou M, Maltezou HC. Post-COVID Syndrome: Incidence, Clinical Spectrum, and Challenges for Primary Healthcare Professionals. Arch Med Res 2021; 52:575-581. [PMID: 33962805 PMCID: PMC8093949 DOI: 10.1016/j.arcmed.2021.03.010] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 12/16/2022]
Abstract
Post-COVID syndrome also known as long COVID refers to symptoms persisting for more than three weeks after the diagnosis of COVID-19. We reviewed the current evidence on post-COVID syndrome, focusing on its clinical manifestations and addressing the challenges for its management in primary healthcare. The incidence of post-COVID syndrome is estimated at 10–35%, while for hospitalized patients it may reach 85%. Fatigue is the most common symptom reported in 17.5–72% of post-COVID cases, followed by residual dyspnea with an incidence ranging from 10–40%. Mental problems, chest pain, and olfactory and gustatory dysfunction may affect up to 26, 22 and 11% of patients, respectively. More than one third of patients with post-COVID syndrome have pre-existing comorbidities, hypertension and diabetes mellitus being the most common. Beyond the prolonged duration of symptoms, the scarce published data indicate that most patients with post-COVID syndrome have a good prognosis with no further complications or fatal outcomes reported. Given the clinical spectrum of patients with post-COVID syndrome, most of them will be managed by primary healthcare professionals, in conjunction with pre-existing or new co-morbidities, which, in turn, may increase the burden of COVID-19 on primary healthcare. In conclusion approximately 10% of patients with COVID-19 may have symptoms persisting beyond three weeks, fulfilling the criteria of post-COVID syndrome. Primary healthcare professionals have a key role in the management of patients with post-COVID syndrome. Research is needed to elucidate the pathogenesis, clinical spectrum, and prognosis of post-COVID syndrome.
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Affiliation(s)
- Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Maria Theodoridou
- First Department of Pediatrics, University of Athens, Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
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