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- COVID-19 Vaccine Effectiveness Against Hospitalization in Older Adults, VEBIS Hospital Network, Europe, September 2024-May 2025Publication . Rojas-Castro, Madelyn; Verdasca, Nuno; Monge, Susana; De Mot, Laurane; Trobajo-Sanmartín, Camino; Duffy, Róisín; Túri, Gergő; Kuliese, Monika; Duerrwald, Ralf; Borg, Maria-Louise; Popovici, Odette; Gomez, Verónica; Makarić, Zvjezdana Lovrić; Launay, Odile; Marques, Diogo F.P.; Pozo, Francisco; Witdouck, Arne; Martínez-Baz, Iván; Fitzgerald, Margaret; Oroszi, Beatrix; Jančorienė, Ligita; Buda, Silke; Dziugyte, Ausra; Lazăr, Mihaela; Machado, Ausenda; Tabain, Irena; Nguyen, Liem Binh Luong; Wagner, Eva Rivas; Dufrasne, François; Castilla, Jesús; Domegan, Lisa; Velkey, Viktória; Majauskaite, Fausta; Hackmann, Carolin; Nicolay, Nathalie; Bacci, Sabrina; Rose, Angela M.C.; European Hospital Vaccine Effectiveness GroupWe estimated COVID-19 vaccine effectiveness (VE) against PCR-confirmed SARS-CoV-2 hospitalization in patients ≥ 60 years with severe acute respiratory infection, using a multicenter, test-negative, case-control study across seven sites in six European countries between September 2024 and May 2025. We included 352 cases (115 vaccinated; 33%) and 9980 controls (5024 vaccinated; 50%). VE was 42% (95% CI: 15; 61) 14-59 days post-vaccination, 32% (95% CI: -1; 54) at 60-119 days, and 36% (95% CI: 2; 60) at 120-179 days, and no effect thereafter. Among adults aged 60-79 and ≥ 80 years, we observed moderate VE against COVID-19 hospitalization for up to 2 and 4 months, respectively.
- 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.
- Do COVID-19 and Influenza vaccines influence susceptibility to other respiratory viruses? A population based studyPublication . Almeida Santos, João; Gomez, Verónica; Guiomar, Raquel; Verdasca, Nuno; Gomes, Licínia; Machado, Ausenda; Rodrigues, Ana PaulaIntroduction: Studies have raised concerns that Influenza and COVID-19 vaccination may influence susceptibility to other respiratory viruses (ORV), potentially increasing the risk of non-target infections. This challenges a key assumption of test-negative design studies—that vaccines do not affect the risk of other infections within the same clinical syndrome. Nevertheless, current evidence remains inconclusive. This study aimed to evaluate the association between COVID-19 and influenza vaccination and the risk of non-influenza/COVID-19 respiratory virus infections. Methods: Test-negative design (TND) study using Portuguese data from a primary care vaccine effectiveness study (VEBIS Primary Care study) between October/2022-April/2025. Data on influenza/COVID-19 vaccination status, age, sex and chronic conditions were collected. Samples were tested by RT-PCR for influenza, SARS-CoV-2 and ORV. Patients with laboratory-confirmed influenza/COVID-19 infection were excluded. Logistic regression estimated adjusted odds ratios (aOR) of being vaccinated among cases (ORV positive) and controls (pan-negative). Results: Of the 1096 patients included, 4.5% received the COVID-19 vaccine, 5.9% the influenza vaccine, 13.3% both, and 76.3% neither. Human Rhinovirus (44.2%), human Coronavirus (14.6%) and Respiratory Syncytial Virus (14.1%) were the viruses more frequently identified. Individuals 65+ exhibited significant lower odds of infection with ORV (OR=0.45, 95%CI:0.25-0.81) compared to younger age group (<18yo). Vaccination status, including influenza only (aOR=1.01, 95%CI:0.59‐1.72), COVID only (aOR=0.88, 95%CI:0.48‐1.59), and both vaccines (aOR=1.38, 95%CI:0.92‐2.06), were not associated to ORV infection risk. Conclusions: Our results suggest that vaccination status—whether for influenza, COVID-19, or both—was not significantly associated with the risk of ORV infections. This supports the use of test-negative controls for influenza/COVID-19 within the same clinical syndrome, as it upholds a key TND assumption of no association between vaccination and risk of non-target infections. While mechanisms such as reduced cross-protection from natural infection or potential vaccine-induced cross-immunity have been proposed, our findings reinforce the validity of the primary methodological assumption rather than suggesting evidence for these alternative effects.
- 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.
- Genomic Analysis of Antibiotic Resistance and Virulence Profiles in Escherichia coli Linked to Sternal Bursitis in Chickens: A One Health PerspectivePublication . Ribeiro, Jessica; Silva, Vanessa; Freitas, Catarina; Pinto, Pedro; Vieira-Pinto, Madalena; Batista, Rita; Nunes, Alexandra; Gomes, João Paulo; Pereira, José Eduardo; Igrejas, Gilberto; Barros, Lillian; Heleno, Sandrina A.; Reis, Filipa S.; Poeta, PatríciaAbstract: Sternal bursitis is an underexplored lesion in poultry, often overlooked in microbiological diagnostics. In this study, we characterized 36 Escherichia coli isolates recovered from sternal bursitis in broiler chickens, combining phenotypic antimicrobial susceptibility testing, PCRbased screening, and whole genome sequencing (WGS). The genetic analysis revealed a diverse population spanning 15 sequence types, including ST155, ST201, and ST58. Resistance to tetracycline and ciprofloxacin was common, and several isolates carried genes encoding β-lactamases, including blaTEM-1B. Chromosomal mutations associated with quinolone and fosfomycin resistance (e.g., gyrA p.S83L, glpT_E448K) were also identified. WGS revealed a high number of virulence-associated genes per isolate (58–96), notably those linked to adhesion (fim, ecp clusters), secretion systems (T6SS), and iron acquisition (ent, fep, fes), suggesting strong pathogenic potential. Many isolates harbored virulence markers typical of ExPEC/APEC, such as iss, ompT, and traT, even in the absence of multidrug resistance. Our findings suggest that E. coli from sternal bursitis may act as reservoirs of resistance and virulence traits relevant to animal and public health. This highlights the need for including such lesions in genomic surveillance programs and reinforces the importance of integrated One Health approaches.
- Genomic diversity of Enterobacteriaceae on food-processing surfaces: an overlooked non-clinical setting with public health implicationsPublication . Peixoto, Andreia; Nova, Lúcia; Mourão, Joana; Matos, Cátia; Santos, Susana; Rodrigues, João; Saraiva, Margarida; Correia, Cristina Belo; Batista, Rita; Peixe, Luísa; Novais, Carla; Antunes, PatríciaBacterial hazards on contaminated surfaces in food-processing environments pose significant food safety risks. Hygiene monitoring of surfaces in direct or indirect contact with food typically relies on a limited set of bacterial indicators, such as Enterobacteriaceae counts. However, their genomic diversity remains poorly characterised. The aim of this study was to provide a comprehensive genomic characterisation of Enterobacteriaceae recovered from food-contact surfaces after cleaning and disinfection with biocides in foodservice units. Diverse strains were identified, with some STs shared across samples and/or foodservices. - A diverse Enterobacteriaceae population persists on food-contact surfaces even after cleaning and disinfection with biocides, with evidence of cross-contamination. - These surfaces represent critical points of contact for strains that are genetically similar to those circulating in food, environment, and human clinical sources, including strains carrying clinically relevant AMR genes. - Further research is needed to understand the factors driving their persistence and dissemination in foodservice environments, aiming to enhance food safety risk management protocols and protect public health.
- 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.
- The impact of orthopoxvirus vaccination and Mpox infection on cross-protective immunity: a multicohort observational studyPublication . Crandell, Jameson; Pischel, Lauren; Fang, Zhenhao; Conde, Luciana; Zhong, Yi; Lawres, Lauren; Meira de Asis, Gustavo; Maciel, Gabriela; Zaleski, Agnieszka; Lira, Guilherme S.; Higa, Luiza M.; Breban, Mallery I.; Vogels, Chantal B.F.; Caria, João; Pinto, Ana Raquel; Almeida, Vasco; Maltez, Fernando; Cordeiro, Rita; Póvoas, Diana; Grubaugh, Nathan D.; Aoun-Barakat, Lydia; Grifoni, Alba; Sette, Alessandro; Castineiras, Terezinha M.; Chen, Sidi; Yildirim, Inci; Vale, Andre M.; Omer, Saad B.Background: Cross-reactive immune memory responses to orthopoxviruses in humans remain poorly characterised despite their relevance for vaccine design and outbreak control. We aimed to assess the magnitude, specificity, and durability of cross-reactive immune responses elicited by smallpox vaccines and mpox virus infection. Methods: We did a multicohort observational study involving participants from the USA, Brazil, and Portugal across four groups: Dryvax (first-generation smallpox vaccine) recipients vaccinated 40-80 years ago, JYNNEOS (third-generation smallpox vaccine) recipients vaccinated within the past year, a cohort receiving both vaccines, and patients infected with clade IIb mpox. Samples were analysed for systemic and mucosal humoral responses, neutralising antibody titres, viral antigen structural analysis, and T-cell cross-reactivity to vaccina virus, cowpox virus, and mpox virus. Statistical analyses included correlation assessments and comparisons across cohorts to determine the magnitude, longevity, and breadth of immune responses. Findings: Between July 7, 2022, and Aug 3, 2023, 262 participants were recruited, resulting in analysis of 378 samples. Both first-generation and third-generation smallpox vaccines elicited vaccinia virus-reactive and mpox virus-reactive antibodies, with the strongest responses targeting the less conserved extracellular virion antigens B5 and A33. Despite high concentrations of anti-mpox virus antibodies in the plasma, cross-neutralisation activity correlated with viral antigenic distance. Higher neutralisation was observed for cowpox virus than for mpox virus, which has lower antigenic conservation with vaccina virus. Complement-mediated neutralisation enhanced mpox virus neutralisation, overcoming the limitations of antigenic distance. Dryvax recipients sustained vaccina virus neutralisation titres for over 80 years, whereas cross-reactive responses did not show this durability. JYNNEOS-induced responses waned within a year. T-cell cross-reactivity was long-lasting, detected up to 70 years after vaccination. Booster vaccinations augmented the magnitude, breadth, and longevity of cross-neutralising responses. Interpretation: Our findings highlight the potential combined role of antibody effector functions and T-cell memory in cross-protection against orthopoxviruses. Complement-mediated neutralisation enhances cross-protection, overcoming antigenic distance. These Fc-mediated functions, along with T-cell responses, contribute to effective and long-lasting immunity conferred by smallpox vaccines against other orthopoxviruses.
- Influenza vaccine effectiveness in Europe and the birth cohort effect against influenza A(H1N1)pdm09: VEBIS primary care multicentre study, 2023/24Publication . Kissling, Esther; Maurel, Marine; Pozo, Francisco; Pérez-Gimeno, Gloria; Buda, Silke; Sève, Noémie; Domegan, Lisa; Hooiveld, Mariëtte; Oroszi, Beatrix; Martínez-Baz, Iván; Guiomar, Raquel; Latorre-Margalef, Neus; Mlinarić, Ivan; Lazar, Mihaela; Giménez Duran, Jaume; Dürrwald, Ralf; Enouf, Vincent; McKenna, Adele; de Lange, Marit; Túri, Gergő; Trobajo-Sanmartín, Camino; GOMEZ TEIXEIRA PINTO, VERÓNICA DEL PILAR; Samuelsson Hagey, Tove; Višekruna Vučina, Vesna; Cherciu, Maria Carmen; García Vazquez, Miriam; Erdwiens, Annika; Masse, Shirley; Bennett, Charlene; Meijer, Adam; Kristóf, Katalin; Castilla, Jesús; Rodrigues, Ana Paula; Kurečić Filipović, Sanja; Ivanciuc, Alina Elena; Bacci, Sabrina; Kaczmarek, MarlenaIntroduction: Influenza A(H1N1)pdm09, A(H3N2) and B/Victoria viruses circulated in Europe in 2023/24, with A(H1N1)pdm09 dominance. First influenza infections in childhood may lead to different vaccine effectiveness (VE) in subsequent years. Aim: The VEBIS primary care network estimated influenza VE in Europe using a multicentre test-negative study. Methods: Primary care practitioners collected information and specimens from patients consulting with acute respiratory infection. We estimated VE against influenza (sub)type and clade, by age group and by year of age for A(H1N1)pdm09, using logistic regression. Results: We included 29,958 patients, with 3,054, 1,053 and 311 influenza A(H1N1)pdm09, A(H3N2) and B cases, respectively. All-age VE against influenza A(H1N1)pdm09 was 52% (95% CI: 44-59). By year of age, VE was 27% (95% CI: -2 to 47) at 44 years with peaks at 72% (95% CI: 52-84) and 54% (95% CI: 41-64) among children and those 65 years and older, respectively. All-age A(H1N1)pdm09 VE against clade 5a.2a was 41% (95% CI: 24-54) and -11% (95% CI: -69 to 26) against clade 5a.2a.1. The A(H3N2) VE was 35% (95% CI: 20-48) among all ages and ranged between 34% and 40% by age group. All-age VE against clade 2a.3a.1 was 38% (95% CI: 1-62). All-age VE against B/Victoria was 83% (95% CI: 65-94), ranging between 70 and 92% by age group. Discussion: The 2023/24 VEBIS primary care VE against medically attended symptomatic influenza infection was high against influenza B/Victoria, but lower against influenza A(H1N1)pdm09 and A(H3N2). Clade- and age-specific effects may have played a role in the lower A(H1N1)pdm09 VE.
- Interim 2024/25 influenza vaccine effectiveness: eight European studies, September 2024 to January 2025Publication . Rose, Angela; Lucaccioni, Héloïse; Marsh, Kimberly; Kirsebom, Freja; Whitaker, Heather; Emborg, Hanne-Dorthe; Botnen, Amanda Bolt; O’Doherty, Mark G.; Pozo, Francisco; Shahul Hameed, Safraj; Andrews, Nick; Hamilton, Mark; Lauenborg Møller, Karina; Trebbien, Ramona; Marques, Diogo F.P.; European IVE groupThe 2024/25 influenza season in Europe is currently characterised by the co-circulation of influenza A(H1N1)pdm09, A(H3N2) and B/Victoria viruses, with influenza A(H1N1)pdm09 predominating. Interim vaccine effectiveness estimates from eight European studies conducted in 17 countries indicate an overall influenza A vaccine effectiveness of 32–53% in primary care settings and 33–56% in hospital settings, with some indications of lower effectiveness by subtype and higher effectiveness against influenza B (≥58% across settings). Where feasible, influenza vaccination should be encouraged and other preventive measures strengthened.