Vaccinated COVID-19 Index Cases Are Less Likely to Transmit SARS-CoV-2 to Their Household Contacts: A Cohort Study.

The aim of this study was to evaluate the impact of index case vaccination on SARS-CoV-2 transmission to household contacts. In our epidemiological cohort study (May 2022-November 2023), we surveyed registered index case vaccination status and test results for contacts (testing on day 0, and on day 7 for negative contacts) and calculated the secondary attack rate (SAR), i.e., newly infected contacts/susceptible included contacts. The association of the independent variable, index case COVID-19 vaccination (yes/no), with household contact infection was determined using the adjusted odds ratio (aOR) and its 95% confidence interval (CI). We recorded 181 index cases and 314 contacts, of whom 250 agreed to participate; 16 contacts were excluded upon testing positive on day 0. Of the 234 included contacts, 49.1% were women, and the mean (SD) age was 51.9 (19.8) years. The overall SAR of 37.2% (87/234) was lower in the contacts of both vaccinated index cases (34.9% vs. 63.2%; p = 0.014) and index cases with a previous SARS-CoV-2 infection history (27.0% vs. 46.3%; p = 0.002). Index case vaccination showed a protective effect against infection for their household contacts (aOR = 0.21; 95% CI: 0.07, 0.67). The household SAR was high when the Omicron variant circulated. Vaccinated index cases were less likely to transmit SARS-CoV-2 to their contacts.

Factors Associated with Non-Adherence to Tuberculosis Preventive Treatment among Adult Contacts of Pulmonary Tuberculosis Cases with Latent Tuberculosis Infection in Catalonia, Spain, in 2019-2021.

The aim of this study was to identify factors associated with non-adherence to tuberculosis (TB) preventive treatment among contacts with latent TB infection for new cases of pulmonary TB cases reported in Catalonia in 2019-2021. All contacts aged 18 years or older with a latent TB infection who received a TB preventive treatment were included in the study. The Chi square test and the odds ratios (OR) were used to assess the association between non-adherence to TB preventive treatment and the study variables; a p < 0.05 was considered statistically significant. Multiple logistic regression analysis was used to detect the independent factors associated with TB preventive treatment non-adherence; a p < 0.05 was considered statistically significant. The percentage of non-adherence to TB preventive treatment found in this study was 23.7%. A multivariable logistic regression analysis determined that the following factors were significantly associated with TB preventive treatment non-adherence among adult contacts: "exposure at school or workplace" (aOR = 3.34), "exposure to an index case without laboratory confirmation of TB" (aOR = 2.07), "immigrant contact" (aOR = 1.81), "male gender" (aOR = 1.75) and "exposure duration < 6 h per week or sporadic" (aOR = 1.60. By contrast, the factor "short-term TB preventive treatment regimen" (aOR = 0.38) was significantly associated with a lower treatment non-adherence. Adherence to TB preventive treatment should be improved among adult contacts of TB pulmonary cases with latent TB infection by recommending short-term treatment regimens and by developing health education activities, with a greater focus on contacts with factors associated with treatment non-adherence.

Effectiveness of Influenza Vaccination and Early Antiviral Treatment in Reducing Pneumonia Risk in Severe Influenza Cases.

INTRODUCTION: Influenza vaccination may be effective in preventing influenza infection and may reduce the risk of influenza-associated pneumonia. The study aim was to evaluate the effect of influenza vaccination in preventing pneumonia when it failed to prevent influenza hospitalization. METHODS: This was a case-control study comparing hospitalized cases of influenza with and without pneumonia in patients aged ≥18 years in 16 hospitals in Catalonia over 10 influenza seasons (2010-11 to 2019-20). Data on sociodemographic, virological characteristics, comorbidities, vaccination history, and antiviral treatment were collected and analysed. The crude odds ratio (OR) and adjusted OR (aOR) with the corresponding 95% confidence interval (CI) values were calculated. RESULTS: In total, 5080 patients hospitalized for severe influenza were included, 63.5% (3224/5080) of whom had pneumonia-mostly men (56.8%; 1830/3224) and mostly in the ≥75 age group (39.3%; 1267/3224)-and of whom 14.0% died (451/3224). Virus A and virus B accounted for 78.1% (2518/3224) and 21.9% (705/3224) of influenza types, respectively. Starting antiviral treatment ≤48 h after symptom onset (aOR = 0.69; 95%CI: 0.53-0.90) and a history of seasonal influenza vaccination (aOR = 0.85; 95%CI: 0.72-0.98) were protective factors in developing pneumonia. CONCLUSIONS: Adherence to seasonal influenza vaccination and starting antiviral treatment within 48 h of symptom onset can reduce pneumonia risk in severe influenza cases.

Risk of tuberculosis among pulmonary tuberculosis contacts: the importance of time of exposure to index cases.

INTRODUCTION: The intensity of exposure to index cases of tuberculosis [TB] may increase the risk of TB in their contacts. The aim was to determine TB risk factors among contacts of TB index cases. METHODS: A cohort study was carried out in the contacts of pulmonary TB cases registered by the epidemiological surveillance network from 01/01/2019 to 06/30/2021. The factors associated with the risk of TB in contacts were determined using the adjusted odds ratio [aOR] and its 95% confidence interval [CI]. RESULTS: From 847 TB cases, 7087 contacts were identified. The prevalence of TB was 2.0% [145/7087] and was higher in < 5 years compared to those ≥ 65 years [4.4% versus 1.2%; p < 0.001], in those exposed ≥ 6 h daily [4%], and < 6 h daily [1.6%] with respect to weekly exposure of < 6 h [0.7%; p < 0.001]. Those contacts exposed ≥ 6 h daily [aOR= 6.9; 95%CI:2.1-22.1], < 5 years [aOR= 8.3; 95%CI:1.8-37.8] and immigrants [aOR= 1.7; 95%CI:1.1-2.7] had a higher risk of TB. CONCLUSIONS: The risk of TB increases with the time of exposure to the index case and this risk is also higher in < 5 years and immigrants. Contact tracing has a high yield for detecting new cases of TB.

[Towards COVID-19 control through vaccination: obstacles, challenges and opportunities. SESPAS Report 2022]. / Hacia el control de la COVID-19 a través de la vacunación: obstáculos, desafíos y oportunidades. Informe SESPAS 2022.

In Spain, the vaccination program began in a context of high transmission and low availability of vaccines. The objective of this article is to review the vaccination program against COVID-19 in Europe (3/03/2022) and assess the obstacles, challenges and opportunities posed by the control of this disease. Five vaccines are currently available in Europe: two based on mRNA technology (Comirnaty® and Spikevax®); two based on a non-replicative vector (Vaxzevria® and Janssen); and another based on subunit S (Novavax®). Health authorities have developed comprehensive vaccination strategies prioritizing the prevention of hospitalizations and deaths. In January 2022, 90% of the population was exceeded with full vaccination and 95% coverage in people over 50 years of age. The new challenge is to achieve similar coverage in the rest of the age groups. Vaccination in children and adolescents has become a priority due to the educational and social implications derived from COVID-19 in this population. Communication strategies must be renewed and access barriers eliminated to achieve good coverage. In Spain, studies have been published that find a high effectiveness of vaccination. The main strategy for controlling the pandemic and recovering social activity is the vaccination, but everything indicates that very high levels of vaccination coverage will be necessary and to follow with the non-pharmaceutical measures. In a globalized world, COVID-19 control will only be achieved with a coordinated global strategy and technical and economic support for the vaccination strategy in resource-poor countries.

A comparison of emotional wellbeing and burnout of primary care professionals in 2014 and 2021.

Background: Due to the pandemic that started in February-March 2020 and after many years of economic restrictions suffered by our health system, the levels of stress, exhaustion and suffering among health workers has increased. Objective: Our study aims to perform a comparative analysis of the degree of burnout and emotional wellbeing among health professionals between 2014 and 2021. Methods: This is a comparative descriptive study of two cohorts of primary care professionals of the Lleida health region (SPAIN). We have one cohort from 2014 and another from 2021 with the same selection criteria. Burnout was assessed using the Maslach Burnout Inventory (MBI-HSS) test. Gender, age, professional category and work environment were also evaluated. Results: We obtained a response rate in 2014 of 52.7% (n = 267) and of 41.4% (n = 217) in 2021 with similar sociodemographic characteristics. There are significant differences (p < 0.001) in the three categories of burnout. The high scores for emotional exhaustion and depersonalization have increased, rising between 2014 and 2021 from 23.2 to 60.8% and from 12.4 to 42.4%, respectively. However, there is also a significant increase in high personal accomplishment, rising from 9.0% in 2014 to 26.7%. We have also detected differences depending on age and professional role. Conclusion: This study shows worsening burnout levels of primary care professionals in our region, specifically emotional exhaustion and depersonalization. However, it also shows that during the pandemic, personal accomplishment was reinforced.