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- COVID-19 vaccine effectiveness among healthcare workers: a hospital-based cohort studyPublication . Gaio, Vânia; Santos, Ana João; Amaral, Palmira; Faro Viana, João; Antunes, Isabel; Pacheco, Vânia; Paiva, Artur; Pinto Leite, Pedro; Antunes Gonçalves, Lígia; Araújo, Lucília; Silva, Adriana; Matias Dias, Carlos; Kislaya, Irina; Nunes, Baltazar; Machado, AusendaObjectives: Healthcare workers (HCWs) were the first to be prioritised for COVID-19 vaccination. This study aims to estimate the COVID-19 vaccine effectiveness (VE) against SARS-CoV-2 symptomatic infection among HCWs in Portuguese hospitals. Design: Prospective cohort study. Setting and participants: We analysed data from HCWs (all professional categories) from three central hospitals: one in the Lisbon and Tagus Valley region and two in the central region of mainland Portugal, between December 2020 and March 2022. VE against symptomatic SARS-CoV-2 infection was estimated as one minus the confounder adjusted HRs by Cox models considering age group, sex, self-reported chronic disease and occupational exposure to patients diagnosed with COVID-19 as adjustment variables. Results: During the 15 months of follow-up, the 3034 HCWs contributed a total of 3054 person-years at risk, and 581 SARS-CoV-2 events occurred. Most participants were already vaccinated with a booster dose (n=2653, 87%), some are vaccinated with only the primary scheme (n=369, 12.6%) and a few remained unvaccinated (n=12, 0.4%) at the end of the study period. VE against symptomatic infection was 63.6% (95% CI 22.6% to 82.9%) for HCWs vaccinated with two doses and 55.9% (95% CI -1.3% to 80.8%) for HCWs vaccinated with one booster dose. Point estimate VE was higher for individuals with two doses taken between 14 days and 98 days (VE=71.9%; 95% CI 32.3% to 88.3%). Conclusion: This cohort study found a high COVID-19 VE against symptomatic SARS-CoV-2 infection in Portuguese HCWs after vaccination with one booster dose, even after Omicron variant occurrence. The small sample size, the high vaccine coverage, the very low number of unvaccinated individuals and the few events observed during the study period contributed to the low precision of the estimates.
- Efetividade da vacina contra a COVID-19: implementação de estudo de coorte em profissionais de saúde dos hospitais em PortugalPublication . Gaio, Vânia; Silva, Adriana; Amaral, Palmira; Viana, João Faro; Antunes, Isabel; Gonçalves, João; Gonçalves, Lígia A.; Leite, Pedro; Machado, Ausenda; Project Research GroupNum contexto de pandemia, os profissionais de saúde dos hospitais são considerados um grupo de elevado risco para a infeção por SARS-CoV-2 sendo um grupo prioritário para a vacinação. Apesar dos bons resultados da eficácia das vacinas nos ensaios clínicos, são muitos os fatores que podem influenciar a sua eficácia no mundo real (efetividade). Com base num desenho de estudo de coorte prospetivo, desenvolveu-se um projeto cujo objetivo foi avaliar a efetividade da vacina contra a COVID-19 em profissionais de saúde no ambiente hospitalar. Foram recrutados 2367 profissionais de saúde e o seguimento do estudo ocorreu até abril de 2022. A maioria reportou ser enfermeiro (39.8%), do sexo feminino (80,7%) e do grupo etário 40-49 anos (29,5%). Verificou-se ainda que 95,3% dos participantes tinham vacinação completa. Adicionalmente, 3,1% dos profissionais reportou ter tido infeção por SARS-CoV-2 antes da vacinação e 2,8% reportou infeção após vacinação completa. Numa altura em que praticamente toda a população se encontra vacinada contra a COVID-19 é essencial a existência de estudos para o apoio à decisão política na gestão da pandemia e das medidas de saúde pública que possam ser necessárias de implementar.
- Psychosocial factors of vaccine confidence: an exploratory study among Portuguese healthcare workersPublication . Gaio, Vânia; Saraiva, Ana Leonor; Santos, Ana João; Amaral, Palmira; Machado, AusendaBackground: Healthcare workers (HCWs) play a critical role in vaccination uptake, both through personal adherence and by promoting immunisation among patients. Low vaccine confidence among HCWs can undermine public health efforts by reducing personal vaccination rates, but also impacting vaccine recommendations. This study aimed to assess psychosocial determinants influencing vaccine confidence among HCWs in Portugal. Methods: A cross-sectional study was conducted between October and November 2024 among doctors and nurses from a Portuguese healthcare unit. An online questionnaire incorporating an adapted short version of the Professionals Vaccine Confidence and Behaviors (Pro-VC-Be) scale was applied. Exploratory factor analysis (EFA) was conducted to assess the scale’s unidimensionality. Descriptive statistics, bivariate analyses (vaccinated vs. non-vaccinated) using Fisher’s exact and Pearson’s Chi-squared tests were performed to identify key psychosocial dimensions of vaccine confidence. Results: Among 112 HCWs (82% female; 71% nurses), 67% were vaccinated against COVID-19 in the 2024/25 season. EFA suggested an unidimensional structure, with one dominant factor (eigenvalue=1.90) explaining 56% of the variance. Vaccinated HCWs showed significantly higher confidence scores (mean=42.9 vs. 40.8; p=0.003). Trust in vaccine safety (p=0.027), belief in vaccine benefits (p=0.011), and complacency (p=0.048) were positively associated with COVID-19 vaccination status. Conclusions: This exploratory study highlights key psychosocial determinants of vaccine confidence among Portuguese HCWs, notably perceived safety and effectiveness. Given the small sample size, results should be interpreted with caution. Applying the scale to a larger and more diverse population of HCWs is essential to validate these findings and support the development of targeted strategies focusing on building trust and combating misinformation to enhance vaccine uptake.
- SARS-CoV-2 serological 6-months follow-up study of a hospital-based cohort of healthcare workers following 2023 COVID-19 vaccination programPublication . Santos, João Almeida; Gaio, Vânia; Amaral, Palmira; Henriques, Camila; Guiomar, Raquel; Machado, AusendaObjective: Healthcare workers (HCWs) have a higher risk of SARS-CoV-2 infection due to their direct contact with patients. On the other hand, they can also act as a source of in-hospital transmission. We assessed SARS-CoV-2 serological status of HCWs at a Portuguese central hospital before vaccination, three and six months after the 2023 COVID-19 booster vaccination program. Methods: We conducted a serological follow-up study among a cohort of HCWs from a Portuguese central hospital, with three rounds of testing: pre-COVID-19 vaccination (September/October 2023), three months (January/February 2024), and six months (April/May 2024) post-vaccination. During follow-up, only participants who underwent pre-vaccination serology and were vaccinated were included. SARS-CoV-2 spike receptor-binding domain (anti-RBD/S) protein-specific IgG antibodies were measured (upper limit of detection 40000 AU/mL). Descriptive statistics and Pearson Chi-Square test analysis were performed. Results: All participants (n=177, median age: 47 years, 77,4% females) had the complete primary COVID-19 vaccination with 78,0% having received 2 additional booster doses prior to 2023 vaccination program. At pre-vaccination, all HCWs had anti-RBD/S IgG antibodies with 11,9% (n=21) presenting a concentration >40000 AU/mL. Three months later, 35,0% HCWs (n=62) underwent retesting, with 40,3% presenting anti-RBD/S IgG antibody concentrations >40000 AU/mL. After six months, 26,6% HCWs (n=47) repeated testing, with 21,3% (n=10) having antibody concentrations >40000 AU/mL. The differences in anti-RBD/S IgG antibody concentrations between the three rounds of testing were significant. Conclusions: Three months post-COVID-19 2023 autumn vaccination, an increase in the concentration of anti-RBD/S antibodies was identified among HCW, but after six months this concentration decreased. These results are in line with the expected decay of antibodies over time after 3 months of vaccination and reinforce the importance of revaccination in HCWs.
- SARS-CoV-2 Seroprevalence among healthcare workers compared to the general population, 2021-22Publication . Gaio, Vânia; Amaral, Palmira; Santos, Ana João; Henriques, Camila; Guiomar, Raquel; Rodrigues, Ana Paula; Machado, Ausenda; Guiomar, RaquelHealthcare workers (HCWs) are essential as frontline responders during infectious disease health emergencies. Protecting them is crucial to ensure their health, maintain continuous patient care, and prevent transmission to patients. This study aimed to estimate the SARS-CoV-2 seroprevalence trend among HCWs from a Portuguese hospital cohort between May 2021 and June 2022. It also aimed to compare it with the seroprevalence trend in the general population aged 40-49. Additionally, the characterization of HCWs with seroconversion was performed based on their positivity for anti-nucleocapsid (Anti-N) IgG antibodies. As part of a vaccine effectiveness study, HCWs were screened for anti-RBD/Spike IgG antibodies against SARS-CoV-2 in three time points: May–July 2021, September–November 2021, and May–June 2022. At the last moment, Anti-N IgG antibodies were also assessed. To compare with data on the general population, we used results from three National Serological Surveys (NSS) phases (February–March 2021, September–November 2021, and April–June 2022) focusing on the 40–49 age group, the most representative among HCW. HCW characteristics were compared according to anti-N IgG seropositivity using the Chi-square and Mann-Whitney tests, assuming a significance level of 0.05. HCWs screening at the 3 moments included 909, 474, and 67 individuals respectively with SARS-CoV-2 seroprevalence was 86%, 90%, and 100%, respectively. These seroprevalences were similar to those found in the Portuguese general population, except for the first period (86% versus 18.8% in the general population, age group 40-49 years). At the last moment, the post-infection seroprevalence (anti-N IgG antibodies) was higher among HCWs than in the general population (41% versus 27%). A lower age and direct contact with COVID-19 patients were associated with anti-N IgG antibody positivity. The increasing trend of seroprevalence among HCWs follows the same trend in the general population. Although the time points differ, in the first moment, higher SARS-CoV-2 seroprevalence was probably linked to priority vaccine uptake. In the third moment, the higher post-infection seroprevalence among HCWs suggests a raised exposure and infection incidence in HCWs following the Omicron wave. Given the decline in COVID-19 vaccination coverage among HCWs in the post-pandemic period, ongoing monitoring of seroprevalence and COVID-19 infection rates in this group remains crucial.
- SARS-CoV-2 Seroprevalence among hospital healthcare workers in comparison with the general population, 2021-2022Publication . Gaio, Vânia; Amaral, Palmira; Santos, Ana João; Henriques, Camila; Valadas Henriques, Camila; Guiomar, Raquel; Rodrigues, Ana Paula; Machado, AusendaBackground/Objectives: Healthcare workers (HCWs) are essential as frontline responders during infectious disease health emergencies. Protecting them is crucial to ensure their health, maintain continuous patient care, and prevent transmission to patients. This study aimed to estimate the SARS-CoV-2 seroprevalence trend among HCWs from a Portuguese hospital cohort between May 2021 and June 2022. It also aimed to compare it with the seroprevalence trend in the general population aged 40-49. Additionally, the characterization of HCWs with seroconversion was performed based on their positivity for anti-nucleocapsid (Anti-N) IgG antibodies. Methods: As part of a vaccine effectiveness study, HCWs were screened for anti-RBD/Spike IgG antibodies against SARS-CoV-2 in three time points: May–July 2021, September-November 2021, and May–June 2022. At the last moment, Anti-N IgG antibodies were also assessed. To compare with data on the general population, we used results from three National Serological Surveys (NSS) phases (February–March 2021, September–November 2021, and April–June 2022) focusing on the 40–49 age group, the most representative among HCW. HCW characteristics were compared according to anti-N IgG seropositivity using the Chi-square and Mann-Whitney tests, assuming a significance level of 0.05. Results: HCWs screening at the 3 moments included 909, 474, and 67 individuals respectively with SARS-CoV-2 seroprevalence was 86%, 90%, and 100%, respectively. These seroprevalences were similar to those found in the Portuguese general population, except for the first period (86% versus 18.8% in the general population, age group 40-49 years). At the last moment, the post-infection seroprevalence (anti-N IgG antibodies) was higher among HCWs than in the general population (41% versus 27%). A lower age and direct contact with COVID-19 patients were associated with anti-N IgG antibody positivity. Conclusions/Recommendations: The increasing trend of seroprevalence among HCWs follows the same trend in the general population. Although the time points differ, in the first moment, higher SARS-CoV-2 seroprevalence was probably linked to priority vaccine uptake. In the third moment, the higher post-infection seroprevalence among HCWs suggests a raised exposure and infection incidence in HCWs following the Omicron wave. Given the decline in COVID-19 vaccination coverage among HCWs in the post-pandemic period, ongoing monitoring of seroprevalence and COVID-19 infection rates in this group remains crucial.
- Serological evidence of SARS-CoV-2 infection in a hospital based cohort study of healthcare workers following the 2023 COVID-19 vaccination programPublication . Almeida Santos, João; Gaio, Vânia; Amaral, Palmira; Henriques, Camila; Guiomar, Raquel; Machado, AusendaObjective: Healthcare workers (HCWs) are a high-risk population to acquire SARS-CoV-2 infection and becoming a focus of transmission. It is therefore important to monitor these professionals, especially due to asymptomatic infections. The objective the study was to assess SARS-CoV-2 infection rates in healthcare professionals at a central Portuguese hospital using serological tests, three and six months after the 2023 COVID-19 booster vaccination program. Methods: A prospective cohort study was established through serological follow-up in a cohort of healthcare professionals from a central Portuguese hospital, with three rounds of tests: pre-COVID-19 vaccination (September/October 2023), 3 months (January/February 2024) and 6 months (April/May 2024) post-vaccination. IgG antibodies specific to the SARS-CoV-2 nucleocapsid protein (anti-N) were measured. Data was analyzed trough descriptive statistics (frequency, mean, percentages) and infection rates at each testing moment (0, 3 and 6 months). Results: At baseline, all participants (n=177, median age: 47years, 77,4% females) had the complete primary COVID-19 vaccination, with 78% having received 2 additional booster doses prior to 2023 vaccination program. Pre vaccination, 48,6% (86/177) of HCWs had detectable anti-N IgG antibodies, of which 24,4% (21/86) self-reported having had a SARS-Cov-2 infection in 2022/2023. After 3 months, 17,7% (n=11/62) had detectable anti-N IgG antibodies although being negative in the pre-vaccination testing. After 6 months, 4,3% (n=2/47) had detectable anti-N IgG antibodies but were negative in the previous two rounds. Conclusions: During the study period, several cases of SAR-CoV-2 infection (n=13) were identified serologically among the HCW monitored, without concomitant signs and symptoms that would allow the identification of a potential infection. These results support that monitoring the infection among HCW (regardless of history of symptoms) can provide valuable information for assessing the level of exposure among hospital personnel and identifying high-risk departments. This information could allow early intervention by, for example, reminding and reinforcing the importance of personal protection standards for HCWs.
- Seroprevalência de SARS-CoV-2 em profissionais de saúde de hospitais em comparação com a população geral, 2021-2022Publication . Gaio, Vânia; Amaral, Palmira; Santos, Ana João; Henriques, Camila; Guiomar, Raquel; Rodrigues, Ana Paula; Machado, AusendaOs profissionais de saúde (PS) desempenham um papel essencial na linha de frente durante emergências de saúde causadas por doenças infeciosas. Protegê-los é crucial para garantir a sua saúde, manter a continuidade do atendimento aos pacientes e prevenir a transmissão durante a prestação de cuidados. Este estudo teve como objetivo estimar a tendência da seroprevalência de SARS-CoV-2 entre PS de uma coorte hospitalar entre maio de 2021 e junho de 2022 e compará-la com a tendência de seroprevalência na população geral com 40-49 anos. Adicionalmente, foi feita a caracterização dos PS de acordo com o seu estado de seropositividade relativa aos anticorpos IgG anti-nucleocapside (IgG Anti-N). No âmbito de um estudo da efetividade das vacinas, os PS foram testados para deteção de anticorpos IgG anti-RBD/Spike contra o SARS-CoV-2 em três períodos: maio-junho de 2021, setembro-novembro de 2021 e maio-junho de 2022. No terceiro momento, também foram avaliados anticorpos IgG Anti-N. Para comparação com a população geral, foram usados os resultados de três fases do Inquérito Serológico Nacional à COVID-19 (ISN COVID-19): fevereiro-março de 2021, setembro-novembro de 2021 e abril-junho de 2022. Um total de 977, 509 e 67 PS foram testados nos três momentos, com uma seroprevalência de 85%, 89% e 100%, respetivamente. Essas taxas foram semelhantes às encontradas na população geral portuguesa, exceto no primeiro período (85% versus 19% na população geral, grupo etário 40-49 anos). No terceiro momento, a seroprevalência pós-infeção (anticorpos IgG anti-nucleocápside) foi maior entre os PS do que na população geral (41% versus 27%). A idade menor e o contacto direto com pacientes com COVID-19 estavam associados à positividade para os anticorpos IgG anti-N. A tendência crescente da seroprevalência nos PS segue a mesma tendência observada na população geral. Embora os períodos não coincidam exatamente, no 1º momento, a seroprevalência para SARS-CoV-2 mais elevada entre os PS esteve provavelmente associada à vacinação prioritária desse grupo. No 3º momento, a maior seroprevalência pós-infeção entre os PS indica um aumento na exposição e incidência de infeção nesse grupo após a onda da variante Ômicron. Considerando a diminuição da cobertura vacinal contra a COVID-19 entre os PS, é essencial continuar a monitorização da seroprevalência e a incidência de infeção por COVID-19 neste grupo.