DEP - Artigos em revistas internacionais
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- Effectiveness of the autumn 2023 COVID-19 vaccine dose in hospital-based healthcare workers: results of the VEBIS healthcare worker vaccine effectiveness cohort study, seven European countries, season 2023/24Publication . Savulescu, Camelia; Prats-Uribe, Albert; Brolin, Kim; Uusküla, Anneli; Bergin, Colm; Fleming, Catherine; Murri, Rita; Zvirbulis, Viesturs; Zavadska, Dace; Gaio, Vania; Popescu, Corneliu P.; Hrisca, Raluca; Cisneros, Maria; Latorre-Millán, Miriam; Lohur, Liis; McGrath, Jonathan; Ferguson, Lauren; De Gaetano Donati, Katleen; Abolina, Ilze; Gravele, Dagne; Machado, Ausenda; Florescu, Simin-Aysel; Lazar, Mihaela; Subirats, Pilar; Clusa Cuesta, Laura; Sui, Jacklyn; Kenny, Claire; Santangelo, Rosaria; Krievins, Dainis; Barzdina, Elza Anna; Valadas Henriques, Camila; Kosa, Alma Gabriela; Pohrib, Saftica-Mariana; Muñoz-Almagro, Carmen; Milagro, Ana; Bacci, Sabrina; Nardone, Anthony; VEBIS HCW VE study group; Collaborators in VEBIS HCW study groupCOVID-19 vaccination recommendations prioritise healthcare workers (HCWs), considering their exposure to severe acute respiratory coronavirus 2 (SARS-CoV-2) and their key role in the functioning of healthcare systems. In the European Union/European Economic Area (EU/EEA), HCWs were considered a priority for COVID-19 revaccination during the autumn 2023 campaign [1], and the World Health Organization (WHO) recommended revaccination of HCWs 12 months after their last dose [2]. Because the Omicron sub-lineage XBB.1.5 predominated in spring 2023, the COVID-19 vaccines were adapted to target this emerging strain, and the first XBB.1.5 vaccine was authorised for use in the EU/EEA in August 2023. Omicron BA.2.86/JN.1 emerged in the EU/EEA at the end of 2023, according to data available on the European Respiratory Virus Surveillance Summary (ERVISS) [3]. Evidence for COVID-19 vaccine recommendation in the HCW population remains scarce. Within the Vaccine Effectiveness, Burden and Impact (VEBIS) project, we aimed to measure the COVID-19 vaccine effectiveness (CVE) in HCWs, in the winter season 2023/24.
- Hybrid, infection‑ and vaccination‑induced protection against laboratory‑ confirmed SARS‑CoV‑2 infection in a European multi‑centre prospective cohort of healthcare workers, 2021–2024Publication . Rojas‑Castro, Madelyn; Mulchandani, Ranya; Brolin, Kim; Makarić, Zvjezdan Lovrić; Uusküla, Anneli; Bergin, Colm; Fleming, Catherine; Bonfanti, Paolo; Murri, Rita; Zvirbulis, Viesturs; Zavadska, Dace; Szuldrzynski, Konstanty; Gaio, Vânia; Popescu, Corneliu Petru; Craiu, Mihai; Hrișcă, Raluca‑Maria; Cisneros, Maria; Latorre‑Millán, Miriam; Petrović, Goranka; Lohur, Liss; McGrath, Jonathan; Ferguson, Lauren; Spolti, Anna; Donati, Katleen De Gaetano; Abolina, Ilze; Gravele, Dagne; Machado, Ausenda; Florescu, Simin Aysel; Lazar, Mihaela; Subirats, Pilar; Clusa, Laura; Sarajlić, Gordan; Sui, Jacklyn; Kenny, Claire; Santangelo, Rosaria; Krievins, Dainis; Barzdina, Elsa Anna; Henriques, Camila Valadas; Kosa, Alma Gabriela; Pohrib, Săftica‑Mariana; Miron, Victor Daniel; Muñoz‑Almagro, Carmen; Milagro, Anna Maria; Bacci, Sabrina; Savulescu, Camelia; VEBIS HCW VE study groupBackground: Healthcare workers (HCWs) face high occupational exposure to SARS-CoV-2 and are a priority group for vaccination. Both natural infection and vaccination-individually or combined as hybrid immunity-confer protection against SARS-CoV-2 infection. This study aimed to evaluate the protection conferred by hybrid, infection-induced, and booster vaccine-induced immunity against laboratory-confirmed SARS-CoV-2 infections in HCWs during the circulation of three pandemic and one post-pandemic Omicron sublineages. Methods: We conducted a prospective cohort study of HCWs from 18 hospitals across nine European countries. Participants underwent RT-PCR testing at enrolment and during weekly or fortnightly follow-ups. The study period was divided based on dominant Omicron sublineage circulation: BA.1/2 (Dec 16, 2021-Jun 1, 2022), BA.4/5/BQ.1 (Jun 2-Dec 31, 2022), BA.2/XBB (Jan 1-May 2, 2023), and post-pandemic XBB.1.5/BA.2.86 (Sep 1, 2023-May 21, 2024). Participants were classified into four groups: hybrid (prior infection and recent booster vaccination 7-179 days), infection-induced (prior infection, no recent vaccination), vaccine-induced immunity (recent booster vaccination, no prior infection), and a reference group (no prior infection, no recent booster vaccination). Adjusted hazard ratios (aHRs) for infection were estimated using Cox regression, adjusting for hospital, age, sex, chronic condition, and patient-facing role. Results: A total of 3 133 HCWs were included: 2572 (82%) female, 1734 (55%) aged 40-59, and 563 (29%) with ≥ 1 chronic condition. Hybrid immunity showed significant protection during BA.1/2 (aHR = 0.37, 95%CI 0.21-0.63), BA.4/5/BQ.1 (aHR = 0.36, 95%CI 0.22-0.58), and XBB.1.5/BA.2.86 (aHR = 0.53, 95%CI 0.37-0.74) periods. Infection-induced immunity was protective across all periods, most during BA.1/2 (aHR = 0.26, 95%CI 0.12-0.53), and least during BA.2/XBB (aHR = 0.66, 95%CI 0.36-1.22). Vaccine-induced immunity alone offered limited protection during BA.1/2 (aHR = 0.72, 95%CI 0.49-1.06) and BA.4/5/BQ.1 (aHR = 0.77, 95%CI 0.50-1.19), with wide confidence intervals suggesting low statistical significance. Conclusions: Hybrid and infection-induced immunity groups were more protected against infection caused by earlier Omicron sub-lineages and more protected than vaccination alone, which had no significant protective effect. These findings highlight the need for adaptive public health strategies, including timely vaccine updates and understanding of prior SARS-CoV-2 infection to inform COVID-19 vaccination policies for HCWs in the post-pandemic era.
- Relative effectiveness of the second booster COVID-19 vaccines against laboratory confirmed SARS-CoV-2 infection in healthcare workers: VEBIS HCW VE cohort study (1 October 2022-2 May 2023)Publication . Savulescu, Camelia; Prats-Uribe, Albert; Brolin, Kim; Uusküla, Anneli; Bergin, Colm; Fleming, Catherine; Zvirbulis, Viesturs; Zavadska, Dace; Szułdrzyński, Konstanty; Gaio, Vânia; Popescu, Corneliu Petru; Craiu, Mihai; Cisneros, Maria; Latorre-Millán, Miriam; Lohur, Liis; McGrath, Jonathan; Ferguson, Lauren; Abolina, Ilze; Gravele, Dagne; Machado, Ausenda; Florescu, Simin Aysel; Lazar, Mihaela; Subirats, Pilar; Clusa Cuesta, Laura; Sui, Jacklyn; Kenny, Claire; Krievins, Dainis; Barzdina, Elza Anna; Melo, Aryse; Kosa, Alma Gabriela; Miron, Victor Daniel; Muñoz-Almagro, Carmen; Milagro, Ana María; Bacci, Sabrina; Kramarz, Piotr; Nardone, Anthony; VEBIS HCW Study GroupIntroduction: Repeated COVID-19 booster vaccination was recommended in healthcare workers (HCWs) to maintain protection. We measured the relative vaccine effectiveness (rVE) of the second booster dose of COVID-19 vaccine compared to the first booster, against laboratory-confirmed SARS-CoV-2 infection in HCWs. Methods: In a prospective cohort study among HCWs from 12 European hospitals, we collected nasopharyngeal or saliva samples at enrolment and during weekly/fortnightly follow-up between October 2022 and May 2023. We estimated rVE of the second versus first COVID-19 vaccine booster dose against SARS-CoV-2 infection, overall, by time since second booster and restricted to the bivalent vaccines only. Using Cox regression, we calculated the rVE as (1-hazard ratio)*100, adjusting for hospital, age, sex, prior SARS-CoV-2 infection and at least one underlying condition. Results: Among the 979 included HCWs eligible for a second booster vaccination, 392 (40 %) received it and 192 (20 %) presented an infection during the study period. The rVE of the second versus first booster dose was -5 % (95 %CI: -46; 25) overall, 3 % (-46; 36) in the 7-89 days after receiving the second booster dose. The rVE was 11 % (-43; 45) when restricted to the use of bivalent vaccines only. Conclusion: The bivalent COVID-19 could have reduced the risk of SARS-CoV-2 infection among HCWs by 11 %. However, we note the limitation of imprecise rVE estimates due to the proportion of monovalent vaccine used in the study, the small sample size and the study being conducted during the predominant circulation of XBB.1.5 sub-lineage. COVID-19 vaccine effectiveness studies in HCWs can provide important evidence to inform the optimal timing and the use of updated COVID-19 vaccines.