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- Reasons for non-uptake of Influenza Vaccination: comparison between high-risk and non-high risk groups in the Portuguese populationPublication . Santos, Ana João; Kislaya, Irina; Machado, Ausenda; Matias, Carlos Matias; Neto, MarianaBackground & objective: In Portugal, the Influenza Vaccine (IV) coverage remains bellow the coverage goals proposed by the European Union. Understanding motives for IV non-uptake, particularly for high-risk groups is essential for intervention purposes. The Health Belief Model (HBM) has been one of the most used theoretical frameworks to understand vaccination. This study aims to describe the Portuguese non-uptake and differences between HBM dimensions (susceptibility, severity, benefits, barriers and cues for action) frequency for high-risk and non-high-risk groups. Methods: A cross-sectional study was developed using the panel of families, a probabilistic dual-sampling frame telephone household panel of Portugal. The survey was conducted between June and September 2021-2013, with data collected by questionnaire applied to one element of each household unit with 18+ years (n=1050). Content thematic analysis was conducted in one open question about the reasons for IV non-uptake and included in HBM dimensions. Statistical analysis focused on estimating non-adherence to IV and frequency of the HBM categories stratified by target group recommended for vaccination. Results were weighted by age group and region Results: The response rate was 68%. Of the total sample (n=1050), 671 individuals did not uptake the IV (69.3%, CI95%:64.8-73.5). For the population recommended for the IV, non-uptake was 49.8 (CI95%:43.6-55.9). The perception of low Susceptibility was more common in individuals who did not belong to the target group (74%, CI95%:63.4-82.3 vs. 26%, CI95%:17.7-36.6). By contrast, the Barriers dimension was more frequently mentioned by the target population (45%, CI95%:32.4-58.2 vs. 55%, CI95%:41.8-67.6), namely due to unavailability of stock. Conclusion: IV non-uptake was lower for high-risk group of the Portuguese population, compared to the general population. Differences between the reasons not to take the IV, suggest that the group to whom the IV is recommended, due to increased risk of complications, is aware of increased susceptibility. Overall, these results indicate that vaccination campaign seem to be successfully targeting high-risk group, even then efforts need to be maintained to decrease non-uptake.
- Impact of influenza vaccination strategy on medically attended influenza in Portugal in five pre-pandemic seasons (2015/16 to 2019/20)Publication . Machado, Ausenda; Kislaya, IrinaBackground: There is limited research on the impact of the yearly influenza vaccination programs in the eligible population. This study aimed to estimate the number of primary care medically attended influenza-confirmed cases (MAICC) among the population aged ≥65 years averted by influenza vaccination programme in Portugal during five seasons in the pre-COVID pandemic period (2015/16 to 2019/20). Methods: We compared the number of observed MAICC to the estimated number that would have occurred in a population without seasonal influenza vaccination (N). To estimate N, we used: i) number of MAICC estimated from national influenza surveillance systems, ii) vaccine coverage (VC) collected in a national telephone survey, iii) influenza vaccine effectiveness (IVE) estimates weighted by the proportion of virus circulation each season in Portugal. We estimated the number of MAICC averted (NAE) by the influenza vaccination programme per 100.000 inhabitants and number needed to vaccinate to prevent one MAICC. We used Monte-Carlo simulations to estimate 95% uncertainty intervals (UI). Results: Comparing with results from 2015/16 to 2017/18 (NAE ranged 24 to 44 per 100.000 inhab) the season 2018/19 showed the highest NAE (62.3 per 100.000 inhab) attributed to the influenza vaccination programme. In 2019/20 season the vaccination strategy averted approximately 11.7 per 100.000 inhab (95%UI: 6.0 to 20.9) events and it was necessary to vaccinate 549 (95%UI: 436 to 742) to prevent one MAICC in primary care. Conclusion: The influenza vaccination strategy had consistent and positive benefit, with more pronounced impact in 2018/19 season. This results were mainly due to a combination of a higher vaccination coverage assumed for 2018/19 (60.8%) and one of the highest vaccine effectiveness (34.8% vs. previous study range 8.5% to 40.6%). To maximize its impact, efforts should be conducted to increase the vaccine coverage. In addition, the surge for more effective vaccines should be maintained.
- Mark-Release-Recapture of Aedes albopictus in Portugal: the influence of climatic factorsPublication . Soares, Patricia; Carvalho, Danilo O.; Silva, Susana Pereira; Gomez Pacheco, Maylen; Amaro, Fátima; Amaro F.; Osório, HugoAedes albopictus mosquitoes spread diseases like dengue, Zika, yellow fever, and chikungunya. The Sterile Insect Technique (SIT), which is based on production of male sterile mosquitoes through radiation and in the release in target areas, can be used as a prevention and control tool against Ae. albopictus native populations. Mark-Release-Recapture trials (MRR) estimate the number of mosquitoes to release during the SIT, but weather conditions can affect results. Thus, we aimed to understand the influence of climatic factors on mosquito collection. MRRs were conducted in October 2022 in Faro, Southern Portugal. Mosquito sterilisation, marking and transport followed protocols from the International Atomic Energy Agency. Releases occurred weekly for three consecutive weeks at two different sites, and mosquitoes were collected using Human Landing Collections (HLC) one, two, four and six days after release. Climatic data, such as temperature, humidity, wind intensity (moderate 15-35 km/h vs weak <15 km/h) and precipitation, were obtained from the Portuguese Institute of the Sea and the Atmosphere. We used generalised linear models with a negative binomial family and log function to estimate factors associated with the number of captured mosquitoes, estimated prevalence ratios (PRs), and the 95% confidence intervals (CI). We released 84 000 marked sterile male mosquitoes and recaptured 528 marked males (0.7%) by HLC. The prevalence of captured mosquitoes was 23% lower when the wind intensity was moderate compared with a weak wind intensity (PR: 0.77, 95% CI: 0.61−0.98). We did not find a statistically significant association between the number of captured mosquitoes and humidity (PR: 0.98, 95% CI: 0.96−1.00), temperature (PR: 1.03, 95% CI: 0.83−1.28) and precipitation (PR: 1.07, 95% CI: 0.60−2.03). Conclusion: It is crucial to plan MRRs carefully and consider weather conditions during their execution to avoid underestimating the population needed for the SIT and compromising the effectiveness of this control method.
- Implementation of a Nationwide Surveillance Network of Respiratory Syncytial Virus in Children < 2 years old in PortugalPublication . Melo, Aryse; Torres, Ana Rita; Lança, Miguel; Gaio, Vânia; Rodrigues, Ana Paula; Guiomar, Raquel; Bandeira, Teresa; Azevedo, Inês; VigiRSV networkHuman respiratory syncytial virus (RSV) is associated with substantial morbidity and mortality in infants, young children and elderly. Monoclonal antibodies (MAb) therapy is the available method to prevent and combat severe disease in infants, nevertheless there is a global effort in the development of vaccines and new generation of MAb. In this sense, RSV surveillance is essential to estimate the burden of RSV infection, evaluate the impact of preventive measures and to support public health decisions. Following European recommendations, a nationwide hospital-based RSV sentinel network denominated VIGIRSV was set up in Portugal. The aim of this work is to describe the implementation of VIGIRSV and report preliminary results obtained in this surveillance. VIGIRSV was implemented in 2021 with the initiative of the National Institute of Health Dr.outor Ricardo Jorge (INSA) and the Portuguese Paediatrics Society (PPS), and in 2023, 20 Hospitals collaborate in the surveillance. The surveillance is based on the recruitment of children <2 years-old hospitalized for, at least, 24 hours, that fulfill the case definition fordue to an RSVAcute Respiratory Infection (ARI). At recruitment, the paediatrician fills an epidemiological clinical questionnaire, and biological samples are collected for laboratorial diagnosis. Positive samples for RSV are forwarded to INSA for complementary virological analyses such as genetic characterization of the virus. Preliminary results from the first 2 years of surveillance are presented in table 1 and show an early RSV activity with high intensity in the 2022/23 season.. The data obtained from VIGIRSV´s results integrate the weekly published “Epidemiological surveillance bulletin of Influenza and other respiratory viruses” which can be foundavailable at https://www.insa.min-saude.pt/category/informacao-e-cultura-cientifica/publicacoes/atividade-gripal/, as well as the surveillance at European level. In addition, epidemiological and virological results are disclosed in scientific publications. The maintenance of such important surveillance is possible due to effort of distinct organizations and professionals, and has impact on the public health service.
- Implementation Gaps of the Portuguese Nacional Health Plan 2012 2021: Evidence Mapping AnalysisPublication . Costa, Alexandra; Costa, Luciana; Rosa, Arminda; Mexia, Ricardo; Matias-Dias, CarlosThe National Institute of Health Doutor Ricardo Jorge (INSA) is responsible for carrying out the evaluation of the Portuguese National Health Plan (PNS) 2012-2016, extended to 2020 (and later to 2021). As part of PNS evaluation, this study aims to identify gaps in the implementation of the PNS 2012-2021, and to identify the degree of alignment and coherence between the strategic axis, goals, and monitoring framework issued by the PNS at different levels of implementation (national, regional, local and municipal). Methods: A mix study, employing both qualitative and quantitative approaches was performed based upon a modified scoping review. Portuguese healthcare institutional websites and municipality websites were identified as the main data sources and secondary data were gathered. Evidence (plans, programs, or strategies) with publication date between 2015 and 2020 were included. A data collection matrix was validated by a group of experts from major stakeholders from academia and public health services. The matrix included 3 main categories following the PNS intervention logic (5 strategic axis, 4 goals and 37 monitoring indicators). Results: A total of 204 documents met the inclusion criteria. Evidence from national level (55%) and local level (35%) represented about 90% of the sample. Overall, three implementation gaps were identified: 1) absence of two Regional Health Plans (in a total of 5 mainland health regions); 2) lack of about 1/3 of the expected Local Health Plans (16 out of 53) and, 3) low transposition (or approximation) of the PNS monitoring framework into the hospital and primary care contract-programs, one of the main management tools for planning. Conclusions: The identification and analysis of implementation gaps contribute to the final evaluation of the PNS. Moreover, the results can guide the next planning cycle pointing out sensitive areas of implementation which need more attention from various stakeholders.
- An integrated solution using bench spreadsheets to monitor Quality control indicators and performance in medicine laboratoriesPublication . Miranda, Armandina; Costa, Sandra; Costa, Alcina; Alvim, Marta; Correia, Helena; Carletto, Aline; Faria, Ana PaulaLaboratory Quality Control (LQC) in medical laboratories is a tool to monitor the procedures of pre analytical, intra analytical and post analytical phases. The data statistic analyze allow the quantification of the random errors using the variation coefficients (CV%) obtained by Internal Quality Control (IQC) and the systematic errors (bias%), from the results of External Quality Control (EQC). These results are combined to calculate the Total Error (TE) and Measurement of Uncertainty (MAU), that allows the knowledge of the precision and accuracy and follow the performance of laboratory by comparison with the quality specifications. The main objective is to present a tool as a bench spreadsheet developed in National Institute of Health Doctor Ricardo Jorge (INSA), aiming to help the national and portuguese speaking countries laboratories, to calculate the main indicators of the LQC: TE, Sigma level and MU using IQC and EQC results, in a simplified way.
- Implementation of Internal Quality Control in Clinical Laboratories of Portuguese Speaking CountriesPublication . Pinto, Mariana; Viegas, Silvia; Miranda, Armandina; Vieira, Cristina; Fernandes, Lília; Constantino, José; Alvim, Marta; Leal, Silvânia; dos Santos, Menilita; Rodrigues, Nádia; da Luz, Maria; Martinello, Flávia; Pimenta, Manuela; Faria, AnaProMeQuaLab (Laboratory Quality Improvement Project for Portuguese Speaking Countries) is an ongoing project started in 2015 aiming to improve the quality of laboratory results in Portuguese Speaking countries ( It focuses on training in laboratory quality control, implementation and monitoring of quality indicators, and the organisation of a biennial congress. In 2023 within the scope of ProMeQuaLab and in collaboration with the National Health Institute Doctor Ricardo Jorge ( and the Faculty of Pharmacy of University of Lisbon, the Master's thesis "Development of tools and documentation for implementation of laboratory Quality Control in Portuguese Speaking countries" is being carried out. AIMS: Development and application tools for implementation of Internal Quality Control in the areas of Clinical Chemistry and Haematology, in PLP laboratories, from February to August 2023
- Portuguese EQA Assessment in Parasite Morphology 26 years experiencePublication . Correia, Helena; Júlio, Cláudia; Baptista-Fernandes, Teresa; Faria, Ana PaulaThe Parasite Morphology Programme was implemented in 1996 by the Portuguese External Quality Assessment Programme (PNAEQ), with a pilot round the previous year, which includes the assessment of stool and blood samples, as well as other matrices. The program is supported by a group of experts for sample selection and preparation, result analysis and training. Aim: Evaluation of the performance of participants in the parasite morphology program by optical microscopy (1996-2022).
- Acidentes Domésticos e de Lazer com bicicleta em crianças, durante a pandemia COVID-19, em PortugalPublication . Alves, Tatiana; Silva, Susana; Braz, Paula; Rodrigues, Emanuel; Neto, Mariana; Mexia, Ricardo; Matias Dias, CarlosOs acidentes e lesões não intencionais têm representado a maior causa de internamento hospitalar e morte para as crianças no mundo, sendo uma prioridade de intervenção na área pediátrica. Atendendo às alterações no quotidiano e nas rotinas das crianças, decorrentes das medidas impostas face o contexto pandémico da Covid-19, que limitaram a sua participação em atividades de grupo, sociais e desportivas, o uso de bicicleta e outros equipamentos com rodas (trotinete, patins, skate) tem vindo a aumentar. Considerando ainda o estadio de desenvolvimento deste grupo etário, o presente estudo assume particular relevo no entendimento desta problemática de saúde pública. Este estudo tem como objetivo descrever a evolução da frequência dos episódios de ADL com bicicleta e outros equipamentos com rodas, nas crianças e jovens dos 5 aos 14 anos, que recorreram ao SU por esse motivo, em 2019 e 2020. Através de uma análise secundária dos dados recolhidos pelo sistema EVITA, respeitantes a crianças e jovens dos 5 aos 14 anos, entre 2019 e 2020, procedeu-se à análise descritiva dos dados, com o apuramento das frequências absolutas e relativas (percentagens). Comparações entre proporções foram realizadas através do teste do Qui-quadrado de Pearson com um nível de significância de 5%. Nesta análise foi utilizado o programa estatístico SPSS V.24. Nos dois anos foram registados 1322 episódios de ADL (607 em 2019 e 715 em 2020), com envolvimento de bicicleta e outros equipamentos com rodas, nas crianças e jovens dos 5 aos 14 anos. A distribuição dos episódios de admissão ao SU devidos a ADL por grupo etário revelou que 31% ocorreram nas crianças dos 5 aos 9 anos e 69% no grupo dos 10 aos 14 anos, numa maior proporção no sexo masculino (58,8%; 75,2%, respetivamente). As quedas constituíram o principal mecanismo de lesão em 2019 e em 2020, nas crianças dos 5 aos 9 anos (91,7%) e dos 10 aos 14 anos (96,5%), destacando-se o “Ar livre” (38,1%; 42,4%) e as “Áreas de transporte” (18,8%; 18,9%) como os locais onde ocorreram em maior frequência em ambos os grupos etários, respetivamente. Em 2020, entre os meses de maio e novembro, com exceção do mês de julho, o número mensal de episódios de ADL com recurso ao SU com envolvimento de bicicleta e outros equipamentos com rodas manteve-se acima dos valores do período homólogo, em 2019 (p<0,01). No geral, destaca-se o aumento percentual de episódios de ADL com bicicleta e outros equipamentos com rodas ocorridos ao “Ar livre” (26%), em “Áreas de transporte” (13%), em “Casa” (43%) e uma diminuição percentual em “Área desportiva” (-52%) e “Área diversão”(-15%) em 2020, face a 2019. Dado o aumento do número de episódios de ADL com bicicleta em 2020 considera-se útil uma análise mais detalhada que permita conhecer a distribuição destas frequências por tipologia de lesão, parte do corpo lesada, bem como, a continuidade do estudo, aumentando o período de observação.
- External Quality Assessment in Laboratory Safety Area (PNAEQ-1S Segurança Laboratorial)Publication . Ventura, Catarina; Cardoso, Ana; Pires, Ana; Faria, Ana PaulaIntroduction: The National External Quality Assessment Program (PNAEQ) provides tools for carrying out external quality assessment in Laboratory Safety area, since 2010. These tools have changed over the years, but all of them allow the identification of occurrences and/or critical points in the operation, installations or equipment, that could have impact on the safety of patients and workers, beyond prioritize the necessary improvement actions. Aims: Presentation of data and methodology implemented in PNAEQ since 2010, for the External Quality Assessment (EQA) in Laboratory Safety area.