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- COVID-19 Vaccine Effectiveness among older adultsPublication . Laniece Delaunay, Charlotte; Mateo-Urdiales, Alberto; Pérez-Gimeno, Gloria; O'Reilly, Karen; Uras, Marina; Erdwiens, Annika; Mlinaric, Ivan; Túri, Gergo; Martínez-Baz, Iván; Meijer, Adam; Rodrigues, Ana Paula; Lazar, Mihaela; Latorre-Margalef, Neus; Lucaccioni, Héloïse; Verdasca, Nuno; Bella, Antonino; Rafael de la Cruz Lopez, Maria Angeles; Kelly, Eva; Enouf, Vincent; Tolksdorf, Kristin; Puzelli, Simona; Ibáñez Pérez, Ana Carmen; Fitzgerald, Margaret; Masse, Shirley; Oh, Djin-Ye; Kaczmarek, Marlena; Bacci, Sabrina; Kissling, Esther; VEBIS Primary Care Vaccine Effectiveness GroupIntroduction: From September to November 2025, many European countries launched COVID-19 vaccination campaigns, when SARS-CoV-2 incidence was decreasing after a period of high circulation.1 These campaigns targeted specific groups, including older adults (ie, individuals aged at or above a minimum threshold that varied from age 60 to 70 years across countries). We estimated the effectiveness of COVID-19 vaccines administered during these seasonal vaccination campaigns in Europe against medically attended, symptomatic SARS-CoV-2 infection among older adults, from September 29, 2025, to January 10, 2026.
- COVID-19 vaccination and antibody response in healthcare workers: a longitudinal serological study following the 2023-2024 COVID-19 vaccination campaignPublication . Almeida Santos, João; Henriques, Camila; Amaral, Palmira; Guiomar, Raquel; Machado, Ausenda; Gaio, VâniaBackground: Healthcare workers (HCWs) are essential frontline responders to public health emergencies and are one of the risk groups targeted by annual vaccination campaigns. Serological studies are valuable for high-risk groups such as HCWs, as they contribute to assess vulnerability, monitor infection control measures, and guide vaccination strategies in high-risk settings. This study aimed to assess humoral response at baseline, 3 and 6 months after the 2023–2024 COVID-19 vaccination campaign in HCWs, and to identify demographic and clinical factors associated with variations in antibody levels over time. Methods: Prospective cohort study of vaccinated HCWs at a central hospital in Portugal (September 2023–May 2024). Serial serological tests to assess anti-spike receptor-binding domain (anti-RBD/S) and anti-nucleocapsid protein (anti-N) IgG antibodies were used to monitor the immune response and SARS-CoV-2 infection history, respectively. Wilcoxon signed-rank tests were used to assess changes in antibody levels over time, and linear regression models were used to identify factors associated with variations in SARS-CoV-2 anti-RBD/S IgG concentrations, on the basis of available demographic and clinical data. Results: In a cohort of 166 HCWs who received the 2023–2024 COVID-19 booster vaccine, anti-RBD/S IgG antibody levels significantly increased at 3 months post-vaccination (16 007.4 vs. 30 572.9 AU/mL) before declining by 6 months (18 327.3 AU/mL), nearing baseline levels. Previous infection (β = 1.92, 95% CI: 1.33-2.77) and older age (β = 2.65, 95%CI: 1.64‐4.29) were associated with higher antibody concentrations at baseline, whereas smoking was linked to lower antibody levels at 6 months (β = 0.32, 95%CI: 0.11–0.88). Other factors, such as sex and chronic conditions, had no consistent significant impact over time. Conclusions: Although SARS-CoV-2 anti-RBD/S IgG antibody concentrations declined significantly six months after the 2023–2024 COVID-19 booster vaccination, they remained at relatively high concentrations over the follow-up period. This study provides new insight into these dynamics in a highly vaccinated and exposed HCWs cohort during a later post-pandemic phase, highlighting the influence of prior infection, age, and smoking on antibody persistence and reinforces the relevance of ongoing immune monitoring of this risk group to guide tailored control strategies. However, vaccine effectiveness studies in highly exposed and vaccinated populations, such as HCWs, are needed to better inform the role of antibody monitoring in this context, especially given the ongoing trend of annually updated vaccines.
- Vaccine effectiveness against medically attended, laboratory-confirmed influenza in the I-MOVE primary care network in Europe, VEBIS project, 2024/25Publication . Lucaccioni, Héloïse; Pozo, Francisco; Pérez-Gimeno, Gloria; Dürrwald, Ralf; Uras, Marina; Domegan, Lisa; Oroszi, Beatrix; Meijer, Adam; Trobajo-Sanmartín, Camino; Ujvari, Dorina; Rodrigues, Ana Paula; Mlinarić, Ivan; Lazar, Mihaela; Rivas Wagner, Eva; Erdwiens, Annika; Enouf, Vincent; McKenna, Adele; Túri, Gergő; de Lange, Marit; Martínez-Baz, Iván; Latorre-Margalef, Neus; Guiomar, Raquel; Kurečić Filipovic, Sanja; Dinu, Sorin; Mokoroa, Olatz; Tolksdorf, Kristin; Masse, Shirley; Bennett, Charlene; Kristóf, Katalin; Hooiveld, Mariette; Castilla, Jesús; Santos Almeida, João; Višekruna Vučina, Vesna; Popescu, Rodica; Bacci, Sabrina; Kaczmarek, Marlena; Kissling, EstherBackground: We conducted a multicenter test-negative study to estimate vaccine effectiveness (VE) against medically attended, laboratory-confirmed influenza in primary care, Europe, 2024/25. Research design and methods: Specimens were collected from patients with acute respiratory infection. All or a random sample of viruses were sequenced. VE was (1-odds ratio) × 100, adjusted for confounders. Results: We included 7275 cases and 17,516 controls (weeks 40-2024-18-2025). The overall VE was 46% (95% CI: 40-52), lowest in adults ≥65 years at 28% (95% CI: 12-42). VE against influenza A(H1N1)pdm09 was 30% (95% CI: 19-40); ranging 16-34% by age and vaccination target group. Most (88%) circulating clades were 5a.2a, distinct from the vaccine clade. VE was 28% (95% CI: 7-45) against 5a.2a (C.1.9), and 6% (95% CI: -62-45) against the vaccine-matched clade 5a.2a.1 (D). VE against influenza A(H3N2) was 38% (95% CI: 26-49); ranging 20-66% by age and target group. Circulating viruses belonged to the vaccine clade 2a.3a.1, with 88% subclade (J.2). VE against influenza B was 76% (95% CI: 69-81); ranging 70-80% by age and target group; all viruses belonged to the vaccine clade V1A.3a.2, with diverse subclades. Conclusions: Influenza vaccination protected approximately one in two vaccinated individuals against medically attended infection in primary care in Europe, 2024/25, varying by (sub)type and age.
- When disinfection fails: Biocide tolerance as a driver of campylobacter persistence and resistancePublication . Fonseca, Inês M.; Martins, Inês; Oleastro, Mónica; Ferreira, SusanaCampylobacter spp. constitutes a significant global public health hazard as it is a leading cause of reported foodborne diseases. Human infection is predominantly acquired through the ingestion of contaminated food, unpasteurized milk and untreated water, prompting the widespread implementation of chemical disinfection across several sectors, from healthcare, domestic environments, and food-processing to animal husbandry. While these biocidal agents encompass multiples classes with different modes of action and efficacy, growing evidence suggests that their extensive and repeated use may unintentionally promote bacterial persistence, tolerance and adaptive responses. Although biocide resistance has been documented in several foodborne pathogens, data on biocide tolerance in Campylobacter spp. remain limited. Available studies report variable degrees of reduced susceptibility to commonly used biocides among isolates originating from poultry production, food-processing environments, and water systems. Importantly, while biocide-induced adaptive responses in Campylobacter spp. may potentially overlap with antimicrobial resistance mechanisms, the extent to which these agents drive co-selection, persistence, or dissemination requires further elucidation. Evidence remains limited on the effects of long-term and repeated exposure under realistic processing conditions, the interplay between stress-induced gene regulation and stable genetic changes, and the contribution of mobile genetic elements, biofilm formation, and microbial communities in shaping antimicrobial resistance evolution. In light of the global health burden imposed by campylobacteriosis and the rising challenge of antimicrobial-resistant Campylobacter, this review brings together current evidence on the role of biocides in shaping bacterial survival, adaptation, and resistance mechanisms.
- A single amino acid substitution in CspA increases germination sensitivity and broadens bile salt germinant specificity in clostridioides difficile sporesPublication . Roseiro, Isabel; Nunes, Alexandra; Martins, Diogo; Alves, Frederico; Persson, Søren; Henriques, Adriano O.; Oleastro, Mónica; Serrano, MónicaOnce regarded primarily as a healthcare-associated pathogen, Clostridioides difficile has increasingly been reported as a cause of community-acquired infection, raising questions about the contribution of animal and environmental reservoirs to persistence and transmission. Ribotype 033 (RT033) is predominantly associated with animal and environmental reservoirs, yet key traits underlying its ecology are poorly defined. Here we show that RT033 strains produce spores with enhanced germination sensitivity and expanded germinant specificity, enabling germination at low concentrations of bile-salts and in response to bile-salts that are typically inhibitory, including those more typical of animal hosts. Genetic analysis identified a single amino acid substitution (R1036I) in CspA, a component of the CspBAC germination apparatus, as the determinant of this phenotype. Expression of the RT033 cspBAC operon in a laboratory strain was sufficient to confer increased sensitivity and expanded bile-salt responsiveness. The R1036I substitution disrupts a conserved salt bridge at the CspA:CspC interface while not causing major destabilisation of the complex in the absence or presence of germinants and co-germinants. Together, our findings reveal a naturally occurring rewiring of bile-salt sensing in spores of RT033 strains that likely reflects adaptation to animal-associated bile-acid environments and may influence persistence, transmission, and zoonotic potential of this lineage.
- Genomic evolution and re-emergence of a multidrug-resistant Clostridioides difficile RT027 clone with reduced vancomycin susceptibility driving a prolonged hospital outbreakPublication . Isidro, Joana; Dionísio, Filipa; Alves, Frederico; Almeida, Soraia; Santos, Cláudia; Santos, Manuel Mota; Reis, Ernestina; Oliveira, Júlio R.; Gomes, João Paulo; Oleastro, MónicaFollowing an extended period of declining prevalence of the epidemic Clostridioides difficile ribotype 027 (RT027) in Portugal, a genetically distinct, multidrug-resistant (MDR) RT027 strain with reduced susceptibility to vancomycin has emerged, causing a 15-month outbreak. This investigation provides epidemiological and genomic evidence for renewed circulation and evolutionary adaptation of this high-risk lineage. A comprehensive outbreak investigation was conducted in a tertiary-care hospital in northern Portugal between 2023 and 2025. Epidemiological and clinical data, antimicrobial exposures, and infection-control measures were analysed. Whole-genome sequencing (WGS) was performed to characterize the outbreak clone. Sixty-six RT027 C. difficile infection (CDI) cases were confirmed, with incidence peaking at 5.46 cases per 10,000 patient-bed days in April 2024. WGS revealed an unusual accumulation of AMR determinants conferring a broad MDR phenotype. Notably, all isolates harboured the VanR T115A substitution, a rare mutation previously linked to reduced vancomycin susceptibility, raising concerns regarding evolving antimicrobial tolerance within RT027. The close relatedness to 2016-2018 USA isolates suggests a recent emergence of this clone. Transmission was facilitated by structural constraints, limited isolation capacity and shared sanitary facilities. This prolonged outbreak documents the re-emergence and genomic evolution of a hypervirulent RT027 lineage, characterized by a concerning expansion of antimicrobial resistance and decreased vancomycin susceptibility and a high recurrence rate (25%). These findings highlight the ongoing adaptive potential of C. difficile under antimicrobial pressure and underscore the need for strengthened surveillance, genomic monitoring, and infection-prevention strategies to mitigate re-establishment of epidemic RT027 strains in Europe and beyond.
- A multinational genomic framework for predicting β-lactam resistance in Haemophilus influenzaePublication . Deghmane, A.E.; Asmi, M.; Abel, S.; Bajanca-Lavado, P.; Claus, H.; D'Aeth, J.; Garcia, I.; Kiedrowska, M.; Lam, T.T.; Litt, D.; Martiny, D.; Meilleur, C.; Skoczyńska, A; Tzanakaki, G.; Xirogianni, A.; Taha, M. K.Background: Haemophilus influenzae resistance to β-lactams is mediated by β-lactamase and amino acid alterations in penicillin-binding protein 3 encoded by ftsI gene, which shows incomplete phenotype-genotype concordance. Objectives: To develop and evaluate a genomic classification framework to predict clinically relevant β-lactam resistance categories. Methods: We analysed 5288 H. influenzae isolates collected in eight European countries and Canada. Among these, 4833 isolates had phenotypic β-lactam susceptibility that were classified into three categories: susceptible to amoxicillin (AMX), resistant to AMX but susceptible to cefotaxime and resistant to both. A 621 bp DNA fragments of the whole ftsI gene (between codons 326 and 532) were analysed to construct category-specific k-mer vocabulary and an allele classifier using Python scripts. Performance was assessed using independent allele validation and agreement with phenotypic classification was evaluated using Cohen's κ coefficient. An additional 455 isolates lacked phenotypic data and were used for external genomic application. Results: Forty-seven frequent ftsI alleles and 34 additional alleles were used for the implementation and the refinement of the vocabulary. Subsequently, 23 other alleles were used for independent allele validation and resulted in correctly predicted resistance categories for 21 alleles (accuracy 91.3%). Agreement with phenotypic classification was high (Cohen's κ 0.853; weighted κ 0.880). Application of the classifier to 455 UK isolates predicted resistance distributions consistent with those observed in phenotypically characterized datasets. Conclusions: A recurrence-filtered k-mer-based vocabulary provides a promising standardized genomic framework that complements phenotypic AST, particularly when phenotypic testing is unavailable, incomplete or heterogeneous.
- First identification and molecular characterization of CTX-M-15 extended-spectrum β-lactamase and OXA-9 β-lactamase in Haemophilus influenzae in the Iberian PeninsulaPublication . González-Díaz, A.; Pinto, M.; Cadenas-Jiménez, I.; Duarte, S.; Ardanuy, C.; Ribeiro, M.M.; Martí, S.; Bajanca-Lavado, P.We describe, for the first time, the presence and characterization of CTX-M-15 and OXA-9 in two Haemophilus influenzae strains: PTHi-14525 (CTX-M-15) from Portugal and HUB-HI042681 (OXA-9) from Spain. Multidrug-resistant PTHi-14525 carried blaCTX-M-15 (two copies) and blaTEM-1 in an ICEHpaHUB5-like element. HUB-HI042681, resistant to β-lactams and aminoglycosides, carried a novel ICEHinHUB1. These findings highlight the genomic plasticity and expanded resistome of H. influenzae, raising concerns about treatment and emphasizing the need for continuous genomic surveillance.
- Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018Publication . Camarinha, Catarina de Paraíso; Oliveira, Maria Miguel Gomes; Elias, Cecília; Nobre, Miguel de Araújo; Nicolau, Leonor Bacelar Costa; Furtado, Cristina; Costa, Andreia Silva da; Nogueira, Paulo Jorge da SilvaBackground: Hospital discharge data are essential for maternal health surveillance, clinical research, and healthcare resource allocation. In 2017, Portuguese hospitals transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th edition, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS), impacting the recording of delivery hospitalizations. This study examines trends in delivery hospitalizations from 2010 to 2018 and assesses the impact of the ICD-10-CM/PCS transition. Methods: We conducted a register-based observational cross-sectional analysis using data from the National Hospital Discharge Database, covering delivery hospitalizations in public hospitals from January 1, 2010, to December 31, 2018. Delivery episodes were identified using diagnosis codes, normal delivery codes, diagnosis-related group (DRG) codes, and procedure codes. Statistical analyses included descriptive statistics, interrupted time series with segmented regression, and Prophet forecasting models to evaluate trends and the impact of the coding transition. Results: A total of 673,978 delivery hospitalizations were recorded. The transition from ICD-9-CM to ICD-10-CM/PCS in 2017 had minimal overall impact on delivery trends. DRG codes consistently identified the majority of delivery episodes, with outcome of delivery codes and selected procedure codes showing varying trends. An increase in episodes identified by normal delivery codes and a significant decrease in episodes identified by procedure codes was observed immediately after the ICD-10 transition (p < 0.001). The Prophet model indicated improved forecast accuracy for procedure codes when including the ICD-10 transition variable. Conclusion: The transition to ICD-10-CM/PCS had a limited impact on overall delivery hospitalization trends but significantly affected procedure coding. These findings underscore the importance of considering coding system changes in healthcare data analyses. Further research should incorporate private hospital data and continuously monitor coding practices to ensure reliable health data for research and policy-making.
- 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.