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- Rapidly adapting primary care sentinel surveillance across seven countries in Europe for COVID-19 in the first half of 2020: strengths, challenges, and lessons learnedPublication . Bagaria, Jayshree; Jansen, Tessa; Marques, Diogo F.P.; Hooiveld, Mariette; McMenamin, Jim; de Lusignan, Simon; Vilcu, Ana-Maria; Meijer, Adam; Rodrigues, Ana Paula; Brytting, Mia; Mazagatos, Clara; Cogdale, Jade; van der Werf, Sylvie; Dijkstra, Frederika; Guiomar, Raquel; Enkirch, Theresa; Valenciano, Marta; I-MOVE-COVID-19 study teamAs the COVID-19 pandemic began in early 2020, primary care influenza sentinel surveillance networks within the Influenza - Monitoring Vaccine Effectiveness in Europe (I-MOVE) consortium rapidly adapted to COVID-19 surveillance. This study maps system adaptations and lessons learned about aligning influenza and COVID-19 surveillance following ECDC / WHO/Europe recommendations and preparing for other diseases possibly emerging in the future. Using a qualitative approach, we describe the adaptations of seven sentinel sites in five European Union countries and the United Kingdom during the first pandemic phase (March–September 2020). Adaptations to sentinel systems were substantial (2/7 sites), moderate (2/7) or minor (3/7 sites). Most adaptations encompassed patient referral and sample collection pathways, laboratory testing and data collection. Strengths included established networks of primary care providers, highly qualified testing laboratories and stakeholder commitments. One challenge was the decreasing number of samples due to altered patient pathways. Lessons learned included flexibility establishing new routines and new laboratory testing. To enable simultaneous sentinel surveillance of influenza and COVID-19, experiences of the sentinel sites and testing infrastructure should be considered. The contradicting aims of rapid case finding and contact tracing, which are needed for control during a pandemic and regular surveillance, should be carefully balanced.
- Vigilância do vírus sincicial respiratório em Portugal - VigiRSVPublication . Azevedo, Inês; Rodrigues, Ana Paula; Gaio, Vânia; Melo, Aryse; Guiomar, Raquel; Equipa VigiRSVEste trabalho descreve os principais resultados da vigilância das infeções por VSR em Portugal na época 2022/23.
- Effectiveness of complete primary vaccination against COVID-19 at primary care and community level during predominant Delta circulation in Europe: multicentre analysis, I-MOVE-COVID-19 and ECDC networks, July to August 2021Publication . Kissling, Esther; Hooiveld, Mariëtte; Martínez-Baz, Iván; Mazagatos, Clara; William, Naoma; Vilcu, Ana-Maria; Kooijman, Marjolein N.; Ilić, Maja; Domegan, Lisa; Machado, Ausenda; de Lusignan, Simon; Lazar, Mihaela; Meijer, Adam; Brytting, Mia; Casado, Itziar; Larrauri, Amparo; Murray, Josephine-L.K.; Behillil, Sylvie; de Gier, Brechje; Mlinarić, Ivan; O’Donnell, Joan; Rodrigues, Ana Paula; Tsang, Ruby; Timnea, Olivia; de Lange, Marit; Riess, Maximilian; Castilla, Jesús; Pozo, Francisco; Hamilton, Mark; Falchi, Alessandra; Knol, Mirjam J.; Kurečić Filipović, Sanja; Dunford, Linda; Guiomar, Raquel; Cogdale, Jade; Cherciu, Carmen; Jansen, Tessa; Enkirch, Theresa; Basile, Luca; Connell, Jeff; Gómez, Verónica; Sandonis Martín, Virginia; Bacci, Sabrina; Rose, Angela M.C.; Pastore Celentano, Lucia; Valenciano, Marta; I-MOVE-COVID-19 and ECDC primary care study teamsIntroduction: In July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe. Aim: Using a multicentre test-negative study, we measured COVID-19 vaccine effectiveness (VE) against symptomatic infection. Methods: Individuals with COVID-19 or acute respiratory symptoms at primary care/community level in 10 European countries were tested for SARS-CoV-2. We measured complete primary course overall VE by vaccine brand and by time since vaccination. Results: Overall VE was 74% (95% CI: 69–79), 76% (95% CI: 71–80), 63% (95% CI: 48–75) and 63% (95% CI: 16–83) among those aged 30–44, 45–59, 60–74 and ≥ 75 years, respectively. VE among those aged 30–59 years was 78% (95% CI: 75–81), 66% (95% CI: 58–73), 91% (95% CI: 87–94) and 52% (95% CI: 40–61), for Comirnaty, Vaxzevria, Spikevax and COVID-19 Vaccine Janssen, respectively. VE among people 60 years and older was 67% (95% CI: 52–77), 65% (95% CI: 48–76) and 83% (95% CI: 64–92) for Comirnaty, Vaxzevria and Spikevax, respectively. Comirnaty VE among those aged 30–59 years was 87% (95% CI: 83–89) at 14–29 days and 65% (95% CI: 56–71%) at ≥ 90 days between vaccination and onset of symptoms. Conclusions: VE against symptomatic infection with the SARS-CoV-2 Delta variant varied among brands, ranging from 52% to 91%. While some waning of the vaccine effect may be present (sample size limited this analysis to only Comirnaty), protection was 65% at 90 days or more between vaccination and onset.
- Sintomas de COVID-19 durante predominância da variante Delta versus Ómicron: coorte prospetiva de profissionais de saúdePublication . Gaio, Vânia; Ramalhete, Sara; Santos, Ana João; Melo, Aryse; Guiomar, Raquel; Machado, AusendaIntrodução: A apresentação clínica da COVID-19, na maioria dos pacientes infetados, foi considerada como leve sem necessidade de hospitalização. No entanto, ao longo da pandemia, o padrão de sintomatologia variou, nomeadamente pela influência da introdução da vacina, mas também consoante a variante SARS-CoV-2 em circulação. Objetivos: Neste estudo pretende-se comparar a sintomatologia autorreportada pelos profissionais de saúde num período de predominância (>50%) da variante Delta (PVD) comparativamente a um período de predominância da Variante Ómicron (PVO). Metodologia: Foram utilizados os dados de um estudo de coorte realizado entre 1 de junho de 2021 e 26 de janeiro de 2022, no qual foram seguidos 3255 profissionais de saúde (PS) com idades compreendidas entre os 18 e os 70 anos. Foram comparados os sintomas autorreportados pelos PS que manifestaram doença sintomática (teste PCR positivo e autorreporte de sintomas) durante o período de PVD (1.6.2021 a 19.12.2021) comparativamente ao período de PVO (3.1.2022 a 26.1.2022). As diferenças entre os dois grupos foram analisadas usando o teste Qui-quadrado ou o teste exato de Fisher no caso de menos de 5 eventos. Resultados: De entre o total de 3255 PS seguidos, 84 tiveram um teste positivo com reporte de sintomatologia durante o período do estudo (43 durante o período PVD e 41 durante o período PVO). Os sintomas febre, anosmia, e ageusia foram mais reportados durante o período PVD comparativamente ao período PDO (46,2% versus 21,6%, p=0.04; 64,3% versus 11,1%, p<0.001; 56,1% versus 17,1%, p=0.001). O sintoma dor de garganta foi mais reportado durante o período PVO do que no período PVD (9,0% versus 36,7%, p=0.006). As percentagens dos casos sintomáticos que tinham a 1ª dose de reforço da vacina foram de 45,7% e 91,4% nos períodos PVD e PVO, respetivamente. Conclusões: Os resultados obtidos através deste estudo permitiram verificar que houve uma alteração nas frequências dos sintomas reportados pelos PS durante o período PVD comparativamente ao período PVO. É essencial o desenvolvimento e manutenção de estudos de seguimento que permitam monitorizar a evolução desta sintomatologia para reconhecer a apresentação clínica da doença e identificar possíveis causas virológicas e imunológicas para as alterações observadas.
- Interim 2019/20 influenza vaccine effectiveness: six European studies, September 2019 to January 2020Publication . Rose, Angela; Kissling, Esther; Emborg, Hanne-Dorthe; Larrauri, Amparo; McMenamin, Jim; Pozo, Francisco; Trebbien, Ramona; Mazagatos, Clara; Whitaker, Heather; Machado, Ausenda; Gómez, Verónica; Nunes, Baltazar; Kislaya, Irina; Pechirra, Pedro; Conde, Patrícia; Rodrigues, Ana Paula; Cristóvão, Paula; Costa, Inês; Guiomar, Raquel; European IVE GroupBackground: Influenza A(H1N1)pdm09, A(H3N2) and B viruses were co-circulating in Europe between September 2019 and January 2020. Aim: To provide interim 2019/20 influenza vaccine effectiveness (VE) estimates from six European studies, covering 10 countries and both primary care and hospital settings. Methods: All studies used the test-negative design, although there were some differences in other study characteristics, e.g. patient selection, data sources, case definitions and included age groups. Overall and influenza (sub)type-specific VE was estimated for each study using logistic regression adjusted for potential confounders. Results: There were 31,537 patients recruited across the six studies, of which 5,300 (17%) were cases with 5,310 infections. Most of these (4,466; 84%) were influenza A. The VE point estimates for all ages were 29% to 61% against any influenza in the primary care setting and 35% to 60% in hospitalised older adults (aged 65 years and over). The VE point estimates against A(H1N1)pdm09 (all ages, both settings) was 48% to 75%, and against A(H3N2) ranged from −58% to 57% (primary care) and −16% to 60% (hospital). Against influenza B, VE for all ages was 62% to 83% (primary care only). Conclusions: Influenza vaccination is of continued benefit during the ongoing 2019/20 influenza season. Robust end-of-season VE estimates and genetic virus characterisation results may help understand the variability in influenza (sub) type-specific results across studies.
- Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Omicron-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021 to 2022Publication . Rose, Angela M.C.; Nicolay, Nathalie; Sandonis Martín, Virginia; Mazagatos, Clara; Petrović, Goranka; Baruch, Joaquin; Denayer, Sarah; Seyler, Lucie; Domegan, Lisa; Launay, Odile; Machado, Ausenda; Burgui, Cristina; Vaikutyte, Roberta; Niessen, F Annabel; Loghin, Isabela I.; Husa, Petr; Aouali, Nassera; Panagiotakopoulos, George; Tolksdorf, Kristin; Horváth, Judit Krisztina; Howard, Jennifer; Pozo, Francisco; Gallardo, Virtudes; Nonković, Diana; Džiugytė, Aušra; Bossuyt, Nathalie; Demuyser, Thomas; Duffy, Róisín; Luong Nguyen, Liem binh; Kislaya, Irina; Martínez-Baz, Iván; Gefenaite, Giedre; Knol, Mirjam J.; Popescu, Corneliu; Součková, Lenka; Simon, Marc; Michelaki, Stella; Reiche, Janine; Ferenczi, Annamária; Delgado-Sanz, Concepción; Lovrić Makarić, Zvjezdana; Cauchi, John Paul; Barbezange, Cyril; Van Nedervelde, Els; O’Donnell, Joan; Durier, Christine; Guiomar, Raquel; Castilla, Jesús; Jonikaite, Indrė; Bruijning-Verhagen, Patricia C.J.L.; Lazar, Mihaela; Demlová, Regina; Wirtz, Gil; Amerali, Marina; Dürrwald, Ralf; Kunstár, Mihály Pál; Kissling, Esther; Bacci, Sabrina; Valenciano, Marta; I-MOVE-COVID-19 hospital study team; VEBIS hospital study team; Members of the I-MOVE-COVID-19 and VEBIS hospital study teams (in addition to authors above)Introduction: The I-MOVE-COVID-19 and VEBIS hospital networks have been measuring COVID-19 vaccine effectiveness (VE) in participating European countries since early 2021. Aim: We aimed to measure VE against PCR-confirmed SARS-CoV-2 in patients ≥ 20 years hospitalised with severe acute respiratory infection (SARI) from December 2021 to July 2022 (Omicron-dominant period). Methods: In both networks, 46 hospitals (13 countries) follow a similar test-negative case-control protocol. We defined complete primary series vaccination (PSV) and first booster dose vaccination as last dose of either vaccine received ≥ 14 days before symptom onset (stratifying first booster into received < 150 and ≥ 150 days after last PSV dose). We measured VE overall, by vaccine category/product, age group and time since first mRNA booster dose, adjusting by site as a fixed effect, and by swab date, age, sex, and presence/absence of at least one commonly collected chronic condition. Results: We included 2,779 cases and 2,362 controls. The VE of all vaccine products combined against hospitalisation for laboratory-confirmed SARS-CoV-2 was 43% (95% CI: 29-54) for complete PSV (with last dose received ≥ 150 days before onset), while it was 59% (95% CI: 51-66) after addition of one booster dose. The VE was 85% (95% CI: 78-89), 70% (95% CI: 61-77) and 36% (95% CI: 17-51) for those with onset 14-59 days, 60-119 days and 120-179 days after booster vaccination, respectively. Conclusions: Our results suggest that, during the Omicron period, observed VE against SARI hospitalisation improved with first mRNA booster dose, particularly for those having symptom onset < 120 days after first booster dose.
- Results of the Portuguese EQA program for molecular detection of SARS-CoV-2, 2020-2022Publication . Correia, Helena; Silva, Susana; Ventura, Catarina; Melo, Aryse; Guiomar, Raquel; Faria, Ana PaulaThe initial strategy for containing the spread of SARS CoV 2 was the prompt identification of COVID 19 cases. National Reference laboratory implemented the biomolecular assays to detect SARS-CoV-2. In June 2020 the Portuguese National External Quality Assessment Program (PNAEQ) in collaboration with National Reference Laboratory for Influenza and Other Respiratory Viruses (NRL) organized the first National External Quality Assessment Program (EQA) for detection of SARS CoV 2 virus by molecular methods. The majority of the rounds included extra analytical questions The aim of EQA programs is to evaluate the participant’s performance and also estimate the overall detection rate of multiple national laboratories. We aimed to evaluate the results of implementation of a national external quality assessment program for the molecular detection of SARS-CoV-2 virus during 2020-2022.
- Vigilância do vírus sincicial respiratório em crianças menores de 2 anos em Portugal, 2022/23Publication . Guiomar, Raquel; Verdasca, Nuno; Melo, Aryse; Gomes, Licínia; Henriques, Camila; Dias, Daniela; Lança, Miguel; Torres, Ana Rita; Pernadas, Bernardo; Gaio, Vânia; Rodrigues, Ana PaulaO vírus sincicial respiratório (Respiratory Syncytial Virus - RSV) é um dos principais agentes etiológicos de infeções respiratórias do trato respiratório inferior, com elevado impacto na morbilidade e mortalidade em crianças menores de 5 anos. É por isso considerado um problema de saúde pública pela Organização Mundial de Saúde, com prioridade na vigilância e prevenção. Este trabalho pretende descrever e caraterizar os casos de infeção por RSV identificados no sistema de vigilância VigiRSV durante a época 2022/23.
- Monitoring COVID-19 and Influenza: The Added Value of a Severe Acute Respiratory Infection Surveillance System in PortugalPublication . Torres, Ana Rita; Gómez, Verónica; Kislaya, Irina; Rodrigues, Ana Paula; Tavares, Margarida Fernandes; Pereira, Ana Catarina; Pereira, Débora; Côrte-Real, Rita; Flores, Carlos Humberto; Verdasca, Nuno; Guiomar, Raquel; Machado, AusendaBackground: Severe acute respiratory infections (SARI) surveillance is recommended to assess the severity of respiratory infections disease. In 2021, the National Institute of Health Doutor Ricardo Jorge, in collaboration with two general hospitals, implemented a SARI sentinel surveillance system based on electronic health registries. We describe its application in the 2021/2022 season and compare the evolution of SARI cases with the COVID-19 and influenza activity in two regions of Portugal. Methods: The main outcome of interest was the weekly incidence of patients hospitalized due to SARI, reported within the surveillance system. SARI cases were defined as patients containing ICD-10 codes for influenza-like illness, cardiovascular diagnosis, respiratory diagnosis, and respiratory infection in their primary admission diagnosis. Independent variables included weekly COVID-19 and influenza incidence in the North and Lisbon and Tagus Valley regions. Pearson and cross-correlations between SARI cases, COVID-19 incidence and influenza incidence were estimated. Results: A high correlation between SARI cases or hospitalizations due to respiratory infection and COVID-19 incidence was obtained (ρ = 0.78 and ρ = 0.82, respectively). SARI cases detected the COVID-19 epidemic peak a week earlier. A weak correlation was observed between SARI and influenza cases (ρ = -0.20). However, if restricted to hospitalizations due to cardiovascular diagnosis, a moderate correlation was observed (ρ = 0.37). Moreover, hospitalizations due to cardiovascular diagnosis detected the increase of influenza epidemic activity a week earlier. Conclusion: In the 2021/2022 season, the Portuguese SARI sentinel surveillance system pilot was able to early detect the COVID-19 epidemic peak and the increase of influenza activity. Although cardiovascular manifestations associated with influenza infection are known, more seasons of surveillance are needed, to confirm the potential use of cardiovascular hospitalizations as an indicator of influenza activity.
- 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.