COVID-19 vaccination roll-out and uptake among refugees and migrants in Greece: a retrospective analysis of national vaccination routine data.

OBJECTIVES: Refugees and migrants (R&Ms) exhibited higher risk of COVID-19 infection, and higher mortality rates during the pandemic. Acknowledging these risks, R&Ms early in the pandemic were identified by WHO as a priority vaccination group in need of protection. The aim of this study was to assess the vaccination roll-out and uptake among R&Ms residing in Reception Identification Centers (RICs) and Reception Sites (RSs) in Greece, relative to the general population. STUDY DESIGN: Nationwide observational study. METHODS: Retrospective analysis of national vaccination routine data and population census data, collected and triangulated from multiple official/governmental sources. Weekly vaccine roll-out and uptake were calculated for the general Greek population and the R&M population, through the first year of the vaccination programme in Greece (December 2020-December 2021). RESULTS: Vaccine roll-out among migrants in RICs/RSs started with a 22-week delay, compared to the general population. By the end of the first year of the vaccination programme in Greece in December 2021, the national vaccination uptake among registered R&Ms residing in official reception facilities was 27.3 % for 1st dose and 4.7 % for booster dose; considerably lower compared to the general population (69.5 % uptake for 1st dose, 64.7 % for 2nd dose, and 32.0 % for 3rd dose). CONCLUSION: Delayed vaccine roll-out and low vaccine uptake among R&Ms in Greece are signs of low prioritisation and implementation failures in the R&M vaccination strategy. In face of future public health threats, lessons should be learned, and vaccine equity should be insured for all socially vulnerable and high-risk population groups.

Intrauterine growth restriction, brain-sparing effect, and neurotrophins.

Intrauterine growth restriction (IUGR) is failure of the fetus to achieve his or her intrinsic growth potential, due to anatomical/functional diseases or disorders in the feto-placental-maternal unit. Growth restriction successfully balances reduced oxygen delivery and consumption; however, chronic hypoxia is responsible for fetal blood flow redistribution to cardinal organs (brain, myocardium, and adrenal glands), the so-called brain-sparing effect. The neurotrophin family comprises four structurally related molecules: the nerve growth factor (NGF), the brain-derived neurotrophic factor (BDNF), the neurotrophin-3 (NT-3), and the neurotrophin-4 (NT-4). By exerting neuroprotection, neurotrophins are critical for pre- and postnatal brain development. Based on the assumption that the brain-sparing effect might be activated in full-term IUGR infants, we hypothesized that circulating neurotrophin levels should not differ between IUGR and appropriate for gestational age (AGA) infants. Indeed, we found that in both groups, circulating NT-3, NT-4, and BDNF levels do not differ, and this finding could possibly be attributed to the activation of the brain-sparing effect. In contrast, NGF levels were higher in the AGA compared to the IUGR group. However, only NGF levels positively correlated with the customized centile and the birth weight of the infants, and both of them were lower in the IUGR group.

The varying patterns of neurotrophin changes in the perinatal period.

Neurotrophins (NTs), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), NT-3, and NT-4 are of major importance in prenatal and postnatal brain development, due to their neuroprotective action. Developmental changes alter the neuronal responsiveness to certain NTs, which subsequently are variously expressed, to properly balance their action. The following study aimed at examining the pattern of perinatal changes of the four NTs--NGF, BDNF, NT-3, and NT-4 in 30 appropriate for gestational age (AGA) full-term fetuses and neonates by determining their circulating levels at characteristic time points. This study show a gradual decrease of circulating levels of the NTs, NT-3 and NT-4 from umbilical cord (UC) to neonates day 4 (N4), while circulating levels of NGF and BDNF present the opposite pattern: an increase from UC to N4. These patterns of perinatal changes differ according to their impact on the process of neuronal development and their reaction to perinatal stress. NT3 and NT4 have been documented to act at early stages of neuronal development and to decrease after hypoxia-ischemia, while NGF and BDNF to increase. Further studies should investigate these patterns in premature or full-term infants, presenting various pathological conditions in the perinatal period.

[Extrahepatic manifestations of chronic hepatitis C virus infection]. / Extrahepatische Manifestationen der chronischen Hepatitis-C-Virus-Infektion.

Current data suggest that HCV infection should be regarded as a systemic infectious disease with multiorgan involvement. More than 50 % of HCV-positive patients develop during the course of the disease at least one extrahepatic manifestation (EHM). The EHMs are often the first and only clinical signs of a chronic hepatitis C. Evidence of HCV infection should always be sought out in cases of unspecific chronic fatigue and/or rheumatic, haematological, endocrine or dermatological disorders. Key pathogenetic factors for the development of EHM are undisputably the HCV lymphotropism and cryoglobulinaemia. Nevertheless, the exact pathogenesis of many EHM still remains unclear. The therapeutic approach to EHM should concentrate on the eradication of HCV. Antiviral therapy in the form of peg-interferon and ribavirin should be regarded as the first-line therapy. Viral response leads mostly to a consecutive clinical response. However, in the case of HCV-related cytopaenias or neuropathies, antiviral therapy may trigger an aggravation of these conditions. Thus, organ-involvement, severity and course of the EHM should be always taken into account when choosing the appropriate therapeutic strategy. Immunosuppressive drugs, plasmapheresis and lately rituximab are counted among therapies that can be applied complementarly or alternatively to the antiviral therapy.