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- COVID-19 vaccine effectiveness in the paediatric population aged 5-17 years: a multicentre cohort study using electronic health registries in six European countries, 2021 to 2022Publication . Soares, Patricia; Machado, Ausenda; Nicolay, Nathalie; Monge, Susana; Sacco, Chiara; Hansen, Christian Holm; Meijerink, Hinta; Martínez-Baz, Iván; Schmitz, Susanne; Humphreys, James; Fabiani, Massimo; Echeverria, Aitziber; AlKerwi, Ala'a; Nardone, Anthony; Mateo-Urdiales, Alberto; Castilla, Jesús; Kissling, Esther; Nunes, Baltazar; VEBIS-Lot 4 working groupBackground: During the first year of the COVID-19 pandemic, vaccination programmes targeted children and adolescents to prevent severe outcomes of SARS-CoV-2 infection. Aim: To estimate COVID-19 vaccine effectiveness (VE) against hospitalisation due to COVID-19 in the paediatric population, among those with and without previously documented SARS-CoV-2 infection. Methods: We established a fixed cohort followed for 12 months in Denmark, Norway, Italy, Luxembourg, Navarre (Spain) and Portugal using routine electronic health registries. The study commenced with paediatric COVID-19 vaccination campaign at each site between June 2021 and January 2022. The outcome was hospitalisation with a laboratory-confirmed SARS-CoV-2 infection or COVID-19 as the main diagnosis. Using Cox proportional hazard models, VE was estimated as 1 minus the confounder-adjusted hazard ratio of COVID-19 hospitalisation between vaccinated and unvaccinated. A random-effects meta-analysis was used to pool VE estimates. Results: We included 4,144,667 5-11-year-olds and 3,861,841 12-17-year-olds. In 12-17-year-olds without previous infection, overall VE was 69% (95% CI: 40 to 84). VE declined with time since vaccination from 77% ≤ 3 months to 48% 180-365 days after immunisation. VE was 94% (95% CI: 90 to 96), 56% (95% CI: 3 to 80) and 41% (95% CI: -14 to 69) in the Delta, Omicron BA.1/BA.2 and BA.4/BA.5 periods, respectively. In 12-17-year-olds with previous infection, one dose VE was 80% (95% CI: 18 to 95). VE estimates were similar for 5-11-year-olds but with lower precision. Conclusion: Vaccines recommended for 5-17-year-olds provided protection against COVID-19 hospitalisation, regardless of a previously documented infection of SARS-CoV-2, with high levels of protection in the first 3 months of the vaccination.
- Effectiveness of the XBB.1.5 COVID-19 Vaccines Against SARS-CoV-2 Hospitalisation Among Adults Aged ≥ 65 Years During the BA.2.86/JN.1 Predominant Period, VEBIS Hospital Study, Europe, November 2023 to May 2024Publication . Antunes, Liliana; Rojas-Castro, Madelyn; Lozano, Marcos; Martínez-Baz, Iván; Leroux-Roels, Isabel; Borg, Maria-Louise; Oroszi, Beatrix; Fitzgerald, Margaret; Dürrwald, Ralf; Jancoriene, Ligita; Machado, Ausenda; Petrović, Goranka; Lazar, Mihaela; Součková, Lenka; Bacci, Sabrina; Howard, Jennifer; Verdasca, Nuno; Basile, Luca; Castilla, Jesús; Ternest, Silke; Džiugytė, Aušra; Túri, Gergő; Duffy, Roisin; Hackmann, Carolin; Kuliese, Monika; Gomez, Verónica; Makarić, Zvjezdana Lovrić; Marin, Alexandru; Husa, Petr; Nicolay, Nathalie; Rose, Angela M.C.; VEBIS SARI VE network teamWe estimated the effectiveness of the adapted monovalent XBB.1.5 COVID-19 vaccines against PCR-confirmed SARS-CoV-2 hospitalisation during the BA.2.86/JN.1 lineage-predominant period using a multicentre test-negative case-control study in Europe. We included older adults (≥ 65 years) hospitalised with severe acute respiratory infection from November 2023 to May 2024. Vaccine effectiveness was 46% at 14-59 days and 34% at 60-119 days, with no effect thereafter. The XBB.1.5 COVID-19 vaccines conferred protection against BA.2.86 lineage hospitalisation in the first 4 months post-vaccination.
- Impact of a revised late HIV diagnosis definition on late HIV estimates in Europe: A multi-country pilot studyPublication . Kirwan, P.; Stengaard, A.; Brännström, J.; Van Beckhoven, D.; van Sighem, A.; Op de Coul, E.; Bartmeyer, B.; Koppe, U.; C. Martins, H.; Maly, M.; Wessman, M.; Tsiara, C.; Ferentinos, G.; Suligoi, B.; Grabar, S.; Sullivan, A.K.; Reyes, J.; Pharris, A.; Kuchukhidze, G.; Kirk, O.; Croxford, S.; Delpech, V.; Raben, D.; EuroTEST Steering CommitteePurpose: Late HIV diagnosis has been defined as a CD4 count <350 cells/mL or AIDS-defining event. With improvements in HIV tests and testing frequency, more people in Europe are diagnosed during the acute/seroconversion phase, when their CD4 count can be temporarily low. A revised consensus definition of late HIV diagnosis* enables better distinction between people diagnosed late and those diagnosed during the acute/seroconversion phase. We aimed to pilot this revised definition with European countries. Method: Pseudo-anonymised HIV diagnosis records for 2022-2023 were collected from nine countries. Records included markers of recent HIV acquisition from laboratory evidence (RITA, p24), testing history (negative HIV test within 12 months), or clinical evidence (e.g. seroconversion illness). We applied the revised definition to reclassify those with recently acquired HIV as ‘not-late’. Late diagnosis correction factors were calculated as: (number reclassified)/(number with CD4<350 or AIDS-defining event) and evaluated by demographic factor. Results: Availability of recent acquisition evidence varied by country and individual marker. Of 10,241 diagnoses with CD4 counts reported, 56% (5,696/10,241) had a CD4<350 or AIDS-defining event, i.e. were initially classified as late. Of these, 563 had evidence of recent HIV acquisition: 168 had laboratory evidence, 238 testing history evidence, and 260 clinical evidence (could have multiple). After reclassification the late diagnosis rate was reduced from 56% to 50%,with an overall correction factor of 10% (563/5,696), ranging between 3-25% across countries . The correction factor was higher for younger individuals compared to older, and for MSM compared to other transmission routes . Conclusions: Without reclassification, late HIV diagnosis rates are overestimated, by up to 25% in young MSM. This correction addresses a lack of progress in reducing the percentage of people diagnosed late. For countries to undertake this correction, improved collection of recent acquisition markers at clinic and national levels is needed.
- Late HIV diagnosis: trends, risk factors, and progress toward the 2025 target of <20% late diagnosis in 23 EU/EEA countries, 2022 to 2024Publication . Reyes-Urueña, Juliana; Stoppa, Giorgia; Pizzolato, Federica; Marrone, Gaetano; Hansson, Disa; EU/EEA HIV networkIn 2022-2024, 14,153 of 28,521 (49.6%) new HIV diagnoses in 23 European Union and Economic Area (EU/EEA) countries were late. In adjusted analyses, older age and migrant status increased late diagnosis risk. The proportion of late diagnoses was 2.6-fold higher among migrants with pre-migration HIV acquisition than post-migration. Late-diagnosed migrants with likely post-migration HIV acquisition were often women, ≥ 50-year-olds, heterosexuals, people who inject drugs, or from South and South-East Asia. The 2025 target of < 20% late diagnosis was unachieved.
- A New World disease: Dual diagnostic challenges in travelers returning from Costa RicaPublication . Brazão, Cláudia; Borges-Costa, João; Antunes-Duarte, Sofia; Mancha, Dora; Sun, Lanyu; Marques, Tiago; Gargaté, Maria João; Vilares, Anabela; Reis, Tânia; de Vasconcelos, Pedro; Soares-de-Almeida, Luís; Filipe, PauloCutaneous diseases in returning travelers encompass a wide spectrum of etiologies and often pose diagnostic challenges. We present the cases of a 50-year-old man and a 57-year-old woman who presented with a 3-month history of erythematous, ulcerated plaques with well-defined elevated borders and a necrotic center on the lower limbs that began 3 weeks after returning from vacation in Costa Rica. Cutaneous biopsy revealed epidermal ulceration and extensive caseating granulomas throughout the full thickness of the dermis. Giemsa staining revealed no amastigotes. Microbiological examinations identified Leishmania braziliensis and excluded mycobacteria and fungi. The diagnosis of cutaneous Leishmaniasis was established. Owing to clinical severity and antimonial unavailability, the man was treated with liposomal amphotericin B. The woman underwent surgical excision of the single lesion, along with oral fluconazole. Complete resolution was documented in both patients. These cases, which posed diagnostic and therapeutic challenges, highlight that cutaneous leishmaniasis, in all its versatile and often perplexing presentations, is a parasitic infection that should always be considered in dermatologic patients returning from vacation in endemic countries.
- Relatório Saúde e Ambiente 2024Publication . Observatório Português da Saúde e Ambiente; Nicola, Paulo Jorge; Campos, LuísO Observatório Português da Saúde e Ambiente foi criado pelo Conselho Português para a Saúde e Ambiente (CPSA) em 2024 e tem como objetivo avaliar e monitorizar a relação entre as alterações climáticas, a degradação ambiental e a saúde humana em Portugal. O relatório publicado, trata-se de uma publicação composta por capítulos temáticos, da autoria de equipas especializadas. Áreas em destaque: 1. Determinantes Ambientais da Saúde, nomeadamente a sobrepopulação, as alterações climáticas, a poluição e degradação dos ecossistemas, e a biodiversidade e recursos naturais; 2. Impacto na Saúde Humana, das doenças associadas a fatores ambientais, zoonoses e doenças transmitidas por vetores, poluição química e saúde mental; 3. Ações de Mitigação e Adaptação, ao nível dos compromissos e desafios, mas também das iniciativas municipais; 4. Impacto Ambiental do Setor da Saúde, a sua pegada ambiental, bem como as iniciativas e áreas negligenciadas; 5. Resiliência do Sistema de Saúde, os seus desafios estruturais e ao nível dos recursos humanos; 6. Literacia, Educação e Investigação, desde a consciencialização, à formação e à investigação; 7. Boas Práticas e Recomendações.
- Systematic review and modelling of seroprevalence in humans, Europe, 2000 to 2021Publication . Friesema, Ingrid Hm; Waap, Helga; Swart, Arno; Györke, Adriana; Le Roux, Delphine; Evangelista, Francisco Md; Spano, Furio; Schares, Gereon; Deksne, Gunita; Gargaté, Maria João; Calero-Bernal, Rafael; Jokelainen, Pikka; Seeber, Frank; Sroka, Jacek; Lundén, Anna; van den Berg, Oda; Jore, Solveig; Wisselink, Henk J.; Dámek, Filip; Vestergaard, Lasse S.; Opsteegh, Marieke; APAGARBackground: Toxoplasma gondii is a zoonotic protozoan capable of infecting warm-blooded animal species and humans. Although toxoplasmosis presents mostly as mild or asymptomatic infection in immunocompetent individuals, in unborn children and people with weakened immune systems, the disease can be severe with ocular, neurological or multi-systemic manifestations and even death. Aim: We aimed to collate and analyse data on T. gondii seroprevalence in humans to model and compare age-dependent prevalence in geographic regions in Europe. Methods: A systematic review identified 1,822 scientific publications, from which seroprevalence data were extracted from 69 studies. Data were analysed using a Bayesian hierarchical model. Results: The modelling of the seroprevalence indicated the highest incidence rates in eastern (50%) and western (48%) Europe, with the lowest estimates in northern Europe (18%) and the United Kingdom (UK) (18%). Eastern and western Europe were regions where T. gondii infections occurred earliest in life, with half of the population expected to be seropositive by the age of 44 and 47 years, respectively. In contrast, in northern Europe and the UK the modelled median time to infection exceeded 170 years. Conclusions: Results of the study provide a robust baseline for future epidemiological research on human T. gondii infections in Europe and may be useful to validate subsequent research, such as risk assessment studies.
- Umrah- and travel-associated meningococcal disease due to multiple serogroup W ST-11 sub-strains pre-Hajj 2024Publication . Lucidarme, Jay; Deghmane, Ala-Eddine; Sharma, Shalabh; Meilleur, Courtney; Eriksson, Lorraine; Mölling, Paula; Claus, Heike; van Sorge, Nina; Bettencourt, Célia; Bajanca-Lavado, Paula; Tsang, Raymond S.W.; Caugant, Dominique A.; Stefanelli, Paola; Neri, Arianna; Tzanakaki, Georgina; Lekshmi, Aiswarya; Campbell, Helen; Clark, Stephen A.; Heymer, Emma J.; Ribeiro, Sonia; Willerton, Laura; Walsh, Lloyd; Bai, Xilian; Lâm, Thiên-Trí; Wagle, Basanta R.; Walia, Vishakh; Howie, Rebecca L.; Neatherlin, John; Rubis, Amy; Vachon, Madhura; McNamara, Lucy A.; Ladhani, Shamez N.; Taha, Muhamed-Kheir; Borrow, RayObjectives: Collectively, the Hajj and Umrah pilgrimages draw > 30 million pilgrims to the Kingdom of Saudi Arabia (KSA) each year. Before Hajj 2024 (14 to 19 June), the meningococcal serogroup W ST-11 complex (W:cc11) Hajj-strain sublineage caused multiple international cases of invasive meningococcal disease (IMD) associated with travel to the Middle East and Asia. Here we identify and characterise the strains responsible. Methods: All Hajj strain sublineage genomes on PubMLST.org underwent core genome MLST comparisons (PubMLST.org). Results: Isolates from 30 cases, across seven countries, formed five phylogenetic clusters within two distinct strains. Travel histories included KSA, other Middle Eastern countries, India, Mauritius, Kenya via Turkey, and no known associated travel. The prevalent strain, representing four clusters, had no African, and limited Middle Eastern, representation. The geo-temporal distribution of available genomes indicated Eastern Europe as a possible source. Conclusions: The rapid expansion of Umrah/travel-related W:cc11 IMD cases in early 2024 was due to multiple strains/sublineages. Despite the involvement of non-KSA travel-destinations, the coincidence of cases with the busy month of Ramadan, and the abrupt cessation during Hajj (when vaccine compliance is maximal), suggest that Umrah was a key driver and highlight the need to reinforce mandatory vaccination whilst maintaining global vigilance.