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- 6th International Conference on Food Contaminants: Challenges on Emerging Contaminants and Planetary Health: Book of AbstractsPublication . Vasco, Elsa; Alvito, PaulaThe 6th International Conference on Food Contaminants (ICFC2025), focused on Challenges in Emerging Contaminants and Planetary Health, was held in person from 25–26 September 2025 at the auditorium of the Museu de Eletricidade, Casa da Luz, in Funchal, Madeira, Portugal. The conference addressed the growing challenge posed by emerging contaminants (ECs) in food and the environment, emphasising how their spread through the food chain threatens food safety and public health. Discussions explored policies to reduce exposure to food contaminants, examined the health impacts of chemical and biological contaminants—including occurrence, exposure assessment, and biomonitoring—highlighted advances in analytical methods for detecting emerging contaminants, and considered the full spectrum of their toxicity. These interconnected themes framed a comprehensive dialogue on safeguarding both human health and the wider ecosystem. This multidisciplinary meeting provided a dynamic forum for established experts and early-career researchers to exchange the latest knowledge on food contaminants and their implications for human and planetary health. The scientific programme featured one keynote lecture, five invited lectures, 14 oral presentations, 43 poster presentations, and two round-table discussions. A Best Poster Award was also presented.
- EVITA – Epidemiologia e Vigilância dos Traumatismos e Acidentes: relatório 2023Publication . Alves, Tatiana; Silva, Susana; Rodrigues, Emanuel; Braz, Paula; Aniceto, Carlos; Mexia, Ricardo; Matias Dias, CarlosRelatório EVITA – Epidemiologia e Vigilância dos Traumatismos e Acidentes relativo ao ano de 2023. O sistema EVITA é um sistema de recolha e análise de dados sobre os acidentes domésticos e de lazer que implicaram recurso às urgências das unidades do Serviço Nacional de Saúde (SNS). Em Portugal, a notificação dos acidentes domésticos e de lazer (ADL) realiza-se através do sistema de vigilância EVITA, criado em 2000 na continuidade do sistema ADELIA (Acidentes Domésticos e de Lazer – Informação Adequada), sob a coordenação do Departamento de Epidemiologia do INSA. Este sistema conta com a colaboração da entidade Serviços Partilhados do Ministério da Saúde. Os objetivos do sistema EVITA são: a) fornecer informação essencial sobre a epidemiologia dos ADL em Portugal; b) manter um sistema de vigilância que permita a caracterização dos ADL, a identificação das situações de risco, os agentes envolvidos, bem como os produtos perigosos que propiciem a ocorrência de ADL; c) manter uma base de dados disponível para a comunidade cientifica, a partir da qual seja possível realizar estudos epidemiológicos na área dos ADL, e avaliar políticas de prevenção baseadas na evidência. O presente relatório apresenta a análise descritiva dos dados recolhidos pelo sistema EVITA no decurso do ano de 2023. Evidenciam-se, dessa análise, os seguintes resultados: - Uma proporção de ADL superior no sexo feminino nos grupos etários acima dos 55 anos; - Uma frequência mais elevada de ADL ocorridos na habitação, com destaque para o sexo masculino dos 0-44 anos e para o sexo feminino a partir dos 75 anos; - A proporção de ADL ocorridos em “Escola, área institucional e recintos públicos” foi mais elevada no sexo masculino entre os 0 e os 54 anos, e a partir dos 55 anos no sexo feminino; - O “Mecanismo de lesão” mais frequente foi a “Queda”; - Cerca de 57% de todos os ADL envolveram uma “Contusão, hematoma”; - A parte do corpo lesada referida com maior frequência foram os “Membros”.
- Tracking epidemiological shifts in hepatitis A in Portugal: a comparison of seroprevalence between two nationwide surveys, 2001 to 2002 and 2015 to 2016Publication . Manageiro, Vera; Matos, Rita; Palminha, Paula; Cortes-Martins, Helena; Nunes, Baltazar; de Sousa, RitaHepatitis A incidence in Portugal declined from 20.1 to 0.4/100,000 population between 1987 and 2023, changing non-vaccinated population susceptibility. This shift has contributed to more frequent outbreaks, including in 2024-25, highlighting the need to enhance surveillance and integrate serological data. We aimed to describe the exposure profile of the Portuguese population to hepatitis A virus (HAV) over time by estimating and comparing the seroprevalence of hepatitis A in two nationwide surveys. Data from two cross-sectional seroprevalence studies performed in 2001-02 and 2015-16 in the population aged ≥ 2 years were analysed. Seroprevalence was weighted for population distribution by age, sex and region, and then analysed by birth cohort (1911 -2014) and compared using Poisson regression. Overall prevalence of anti-HAV IgG antibodies was 67.3% (95% CI: 64.2-70.3) in 2001-02 (n = 1,642) and 56.3% (95% CI: 52.4-60.2) in 2015-16 (n = 2,052), showing an 11-percentage-point decline. Birth cohort analysis revealed consistent seroprevalence within each cohort in both surveys, i.e. seroprevalence for the 1981-90 birth cohort was 16.7% and 18.7%, respectively, suggesting that higher seroprevalence is more closely associated with birth cohort (cohort effect) rather than a specific time point. Additionally, we found that individuals aged ≥ 30 years, born before the 1980s, and those with lower education had higher seroprevalence. The immunological profile of anti-HAV antibodies in the Portuguese population has shifted over the last decades. High susceptibility and shifting age distribution of Hepatitis A-seropositive individuals highlight the need to revise future vaccination strategies in Portugal.
- Prevalence and risk factors for post COVID condition 12 months after a test: evidence from a Portuguese regionPublication . Moniz, M.; Ruivinho, Carolina; Goes, Ana Rita; Soares, Patrícia; Leite, Andreia; LOCUS groupBackground/Objectives: PCC prevalence estimates vary widely. Additionally, its development is associated with multiple factors, from individual characteristics to the broader impacts of the pandemic. The aim of this study was to characterise the prevalence of symptoms 12 months after SARS-CoV-2 testing, comparing individuals with positive and negative test results, and to analyse the factors associated with the prevalence of Long COVID symptoms in individuals with a positive test in Lisbon and Tagus Valley. Methods: Cross-sectional study with individuals randomly selected from the National Epidemiological Surveillance System (SINAVE) of Portugal. We included individuals who underwent a SARS-CoV-2 test in August 2022, resided in the Lisbon and Tagus Valley region, were 18 years or older, and consented to participate. PCC was defined as the presence of #1 1 symptom 12 months after testing. Prevalence (Pr) was estimated for participants with positive and negative test results, with the respective 95% confidence interval (95%CI). To study the factors associated with Long COVID, we considered individuals with a positive test and applied a robust Poisson regression to estimate prevalence ratios (PR), with the respective 95%CI. Results: A total of 6,642 individuals were contacted, and the final sample included 699 individuals: 226 with a negative test and 473 with a positive test. PCC symptoms were slightly higher in individuals who tested positive (Pr: 41.65, 95%CI: 37.17; 46.24) than negative (Pr: 35.84, 95%CI: 29.59; 42.47), with confidence interval overlapping. Fatigue was the most prevalent symptom, particularly among positive individuals (Pr: 18.39, 95%CI: 15.00; 22.18 vs. 10.18, 95%CI: 6.56; 14.88). Factors associated with PCC symptoms were female (PR: 1.48 95%CI: 1.13; 1.96), age (PR: 1.01, 95%CI: 1.00; 1.02), number of symptoms during COVID-19 infection (PR: 1.06, 95%CI: 1.03; 1.09) and smoking (PR: 1.39, 95%CI: 1.08; 1.79). Conclusions/Recommendations: Most of the symptoms analysed did not show a higher prevalence in those who tested positive, highlighting the need to distinguish these symptoms from other postviral conditions and the broader effects of the pandemic. Factors associated with higher risk of PCC symptoms, highlight the importance of targeted follow-up and preventive strategies for these individuals. As our sample is predominantly composed of cases that did not require hospital care during the acute infection, the results also emphasise that symptoms can emerge in non-severe cases, representing a wider range of people at risk.
- Spatiotemporal trends in dementia hospitalisation and mortality rates between 2010-2019: the Portuguese casePublication . Moniz, M.; Alvez, Joana; Leite, AndreiaBackground/Objectives: Dementia affects over 55 million people worldwide and is a leading cause of death and disability, with cases expected to rise due to ageing. In Portugal, dementia prevalence is projected to reach 2.5% by 2040. Dementia increases hospitalisation risk, being the most common neurodegenerative disease-related hospitalisation in Portugal (43.4%). Despite previous studies, there is a lack of detailed spatial analysis on dementia trends in Portugal. Thus, we aimed to analyse spatiotemporal trends of dementia at the municipal level, focusing on hospitalisation and mortality. Methods: This ecological study analysed dementia hospitalisation and mortality rates in Portugal from 2010 to 2019 among individuals aged 55 and older. Hospitalisation data was retrieved from the Portuguese public hospitals administrative data (Base de Dados de Morbilidade Hospitalar) (2010–2018). Statistics Portugal provided mortality. Dementia cases were identified using ICD-9 and ICD-10. Crude rates were obtained using population data from Statistics Portugal, overall and stratified by region, municipality and year and then standardised by age and sex. We used a spatiotemporal clustering analysis with SaTScan to identify high-risk mortality and hospitalisation municipalities. Results: We ascertained 271,197 episodes of dementia-related hospitalisation between 2010 and 2018. The highest dementia-related hospitalisation rate per 10,000 habitants was observed in 2016 in Vila de Rei [297.48, 95% confidence interval (95%CI): 222.17;390.11]. When standardised by age and sex, Mesão Frio presented the highest rate 217.2 (95%CI: 145.9;314.2) in the same year. Four spatiotemporal clusters were found, where the number of dementia-related hospitalisations were significatively higher than expected. The clusters were mainly in the North, all between 2014 and 2016. Mortality wise, there was 52,267 dementia-related deaths between 2010 and 2019. At the municipality level, the highest mortality rate was in 2015 in Monforte, both crude [553.30 (95%CI: 429.7;701.4) per 10,000] and standardised [581.4 (95%CI: 443.2;752.3)]. We identified seven spatiotemporal clusters, mainly in the North and Azores, between 2015 and 2019. Conclusions/Recommendations: We identified geographic disparities in hospitalisation and mortality rates, with high-risk clusters found mainly in the North. The presence of multiple high-risk clusters suggests underlying local factors influencing dementia-related outcomes, emphasising the importance of resource allocation to mitigate dementia’s impact in high-risk municipalities.
- Transição geracional em Epidemiologia e Saúde Pública: Perspetiva de carreira intermédia em PortugalPublication . Leite, AndreiaA transição geracional em epidemiologia e saúde pública é essencial para a continuidade destas áreas. Em Portugal, o número de profissionais nestas áreas é limitado, particularmente no grupo de médicos de saúde pública que se encontra envelhecido. Nesta comunicação partilharei a experiência e os desafios do trabalho em epidemiologia e saúde pública na perspetiva de transição geracional em Portugal, ao longo dos últimos 10 anos, em representação da Associação Portuguesa de Epidemiologia. Desde 2013 conclui o internato médico em saúde pública, terminei o doutoramento, desempenhei funções enquanto professora auxiliar na Escola Nacional de Saúde Pública e médica de saúde pública no Instituto Nacional de Saúde Doutor Ricardo Jorge. Fui responsável por unidades curriculares na área da epidemiologia e estatística, orientei alunos de mestrado e doutoramento e estágios de investigação, e participei em mais de 10 projetos de investigação que resultaram na publicação de 39 artigos em revistas científicas. Quando ingressei no internato médico de saúde pública o ensino da epidemiologia focava-se nos desenhos de estudo clássicos em epidemiologia, com limites entre os estudos observacionais e experimentais. Ao longo deste período incorporei a perspetiva de inferência causal nas sessões de epidemiologia e ferramentas de inferência causal, tais como os grafos acíclicos dirigidos (Directed Acyclic Graphs, DAG), e desenhos de estudo quasi-experimentais. Promovi uma maior articulação entre a epidemiologia e estatística, bem como a atualização de software de acesso aberto (e.g. R). Atualmente, encontro-me a integrar ferramentas de inteligência artificial (e.g. large language models) no ensino da epidemiologia. A nível da investigação procurei promover a incorporação dos métodos e ferramentas mencionadas nos projetos em que participei. Como principais desafios identifico a resistência à mudança e incorporação de novos conceitos e ideias nas várias vertentes do trabalho realizado, a existência limitada de elementos sénior para efeitos de mentoria e a ausência de tempo para atualização de conhecimentos e práticas. Adicionalmente, será desafiante garantir a formação adequada de todos o número de novos profissionais a ingressar nesta área em Portugal, em particular no internato médico de saúde pública, atendendo à superioridade numérica em relação aos profissionais mais velhos. A formação contínua e alinhamento entre gerações será essencial de modo a conseguir garantir o sucesso e a qualidade do trabalho realizado na área.
- 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.
- Efetividade da vacina contra a COVID-19 na população pediátrica em PortugalPublication . Machado, Ausenda; Soares, PatriciaAntecedentes/Objetivos: A vacinação é uma das principais intervenções em saúde pública, responsável pela redução da incidência de diversas doenças e da morbi-mortalidade associadas. Perante a pandemia por COVID-19, esta foi uma das estratégias implementadas na população pediátrica com idade entre 5 e 17 anos, potenciando o efeito direto da vacinação (reduzir doença) e permitir o normal desenrolar das atividades escolares, sociais e outras. Medir o efeito direto da vacina, através do cálculo da efetividade da vacina (EV), é fundamental na avaliação da estratégia em saúde pública. Este estudo pretende estimar a EV contra o internamento devido à COVID-19 na população pediátrica dos 5 aos 11 anos e dos 12 aos 17 anos com e sem infeção prévia por SARS-CoV-2 em Portugal. Métodos: Utilizamos uma abordagem de coorte fixa, sendo que a constituição e seguimento de coorte foi realizado através da ligação direta de dados de registos de saúde eletrónicos constantes em 6 sistemas de informação. O estudo começou no início da campanha de vacinação para cada coorte (5-11 anos e 12-17 anos), sendo o tempo de seguimento de 12 meses. O outcome de interesse foi hospitalização codificada como COVID-19 como diagnóstico principal. As estimativas da EV foram obtidas utilizando o modelo de regressão de Cox. A EV foi estimada como 1- a razão de risco ajustada para confundimento (aHR) do internamento por COVID-19 entre vacinados e não vacinados. Resultados: Na coorte dos 12 aos 17 anos, sem infeção prévia, a EV geral foi de 68% (IC 95%: 31% a 75%). Observámos que a EV diminuiu com o tempo desde a vacinação, tendo sido obtidas estimativas mais elevadas nos primeiros três meses após a imunização (EV=84%). Na coorte dos 12 aos 17 anos com infeção prévia, a EV de uma dose foi de 93% (IC 95%: 54% a 99%). As estimativas de EV foram semelhantes para a coorte dos 5 aos 11 anos, mas com menor precisão. Conclusões/Recomendações: Os resultados do estudo, indicam uma elevada EV na redução de doença grave na população pediátrica alvo da estratégia de vacinação. A opção de administrar apenas uma dose em indivíduos com uma dose, foi bem sucedida, atingindo-se elevada proteção com gestão na utilização das doses existentes. Embora o SARS-CoV-2 tenha sido descrito como estando associado a uma doença ligeira em crianças e, portanto, potencialmente associado a menor benefícios direto para a saúde decorrentes da vacinação, outros efeitos indiretos e o contexto epidemiológico dos países necessitam ser considerados na decisão de implementar programas de vacinação na população pediátrica. Estes resultados poderão também ser utilizados no desenho de estratégias de vacinação.
- The rise and fall of SARS-CoV-2 rapid antigen self-tests at primary care level: a Portuguese case-studyPublication . Santos, João Almeida; Gomez, Verónica; Rodrigues, Ana PaulaBackground/Aim: SARS-CoV-2 rapid antigen self-tests are available, allowing individuals to diagnose a SARS-CoV-2 infection prior to a consultation with a healthcare professional. Self-testing may affect the general practitioner (GP) consultation behaviour and represent a selection bias in primary care vaccine effectiveness (VE) studies. The aim of this study was to describe self-testing patterns and differences between self-testers and non-self-testers in primary care in Portugal in the 2022-23, 2023-24 and 2024-25 seasons. Methods: Data (September 2022-March 2025) from a primary care VE study (VEBIS Primary Care study) was used, and were included patients aged 60+ with Acute Respiratory Infection (ARI) consulting a GP. Data on demographics, vaccination, self-test use, laboratory results (RT-PCR positive for SARS-CoV-2 - Cases; Negative - Controls) and clinical status was collected. Results: Of the 382 patients included (47 cases, 335 controls), 67 (40%), 53 (43%) and 10 (11%) performed a self-test in the 2022-23, 2023-24 and 2024-25 seasons, respectively. Patients that self-tested were more likely to be female (72%, 57%, and 90%) and aged 60–79yo (94%, 62%, 70%) across all seasons. Self-tests positivity increased across the seasons (6%, 25%, 80%). Those who self-tested had a lower SARS-CoV-2 positivity rate in 2022-23 (10% vs. 14%) but higher in 2023-24 (23% vs. 14%) and 2024-25 (10% vs. 4%) season than those that not self-tested. Similarly, a lower prevalence of chronic conditions (64% vs. 79%) was observed in 2022-23 but higher in 2023-24 (85% vs. 84%) and 2024-25 (100% vs. 82%) seasons. Seasonal COVID-19 vaccination rate was lower in 2022-23 (39% vs. 53%) and 2023-24 (30% vs. 33%) but higher in 2024-25 (30% vs. 26%) season for those who self-tested. In the 2022-23 and 2023-24 seasons, the increase and decrease of self-testing overlapped with the months with the highest prevalence of ARI cases. In the 2024-25 season, self-testing was lower and did not overlap with trends of ARI cases. Conclusions: Results suggest that the potential negative association between vaccination and self-testing (unvaccinated patients were more likely to self-test) practically disappeared in the following seasons. In the present season, the use of self-tests decreased and their use does not reflect the notification of ARI cases, that is, in periods with a greater number of cases there is no increase in self-testing. However, the small sample size limited further analysis, highlighting the need for larger studies with vaccine effectiveness estimates stratified by self-testing.
- Review of adherence to the acute respiratory infection (ARI) case definition in a primary care vaccine effectiveness study in PortugalPublication . Santos, João Almeida; Kissling, Esther; Rodrigues, Ana PaulaBackground/Aim: To expand surveillance to include respiratory viruses other than influenza, many European countries adapted their approach after the COVID-19 pandemic by transitioning from solely using the influenza-like illness (ILI) case definition to incorporating both ILI and acute respiratory infection (ARI) definitions, or ARI case definition alone. The aim of this study was to assess adherence to the application of the ARI case definition by sentinel general practitioners (GPs) in Portugal integrated in a primary care vaccine effectiveness (VE) study - VEBIS. Methods: An anonymous online questionnaire was sent to 119 Portuguese sentinel GPs for influenza surveillance between April 16th-May 9th, 2024. Invitation to the questionnaire was sent four times during this period, by email. A descriptive analysis of the responses was performed. Results: The participation rate was 46% (55/119). The majority of GPs indicated ARI case definition identifies influenza (85%) and COVID-19 patients (73%) well. There was no clear pattern in GPs agreeing that the ARI case definition was appropriate for selecting young children, with 36% agreeing and 31% disagreeing. Conversely, 56% agreed that the ARI case definition works for the selection of older patients. 27% percent indicated immunocompromised, patients with COPD and cardiac diseases, children and elderly were not well captured by the ARI case definition. Although the majority (85%) indicated that no change is needed in the surveillance questionnaire, some GPs (11%) indicated that diarrhea, vomiting, fever, wheezing, and fever duration were variables that should be considered including in case definitions. 45% of GPs agreed that they select patients they highly suspect of having influenza/COVID-19, even if they do not meet the case definition. Regarding clinical presentation, 71% of GPs agreed being more likely to select patients with a more severe clinical presentation. The majority (75%) reported not using any additional criterion for patient selection during weeks of high workload. However, 22% reported that older and more symptomatic patients were chosen preferentially during these periods. Conclusions: The results indicate Portuguese sentinel GPs consider the proposed case definition identifies patients with influenza and COVID-19, consequently, the majority do not suggest changes to the ARI case definition. However, 27% reported the case definition does not adequately capture children, elderly and patients with chronic conditions, and some GPs indicated the inclusion of other signs and symptoms.