Effectiveness of the adapted bivalent mRNA COVID-19 vaccines against hospitalisation in individuals aged ≥ 60 years during the Omicron XBB lineage-predominant period: VEBIS SARI VE network, Europe, February to August, 2023.

We conducted a multicentre hospital-based test-negative case-control study to measure the effectiveness of adapted bivalent COVID-19 mRNA vaccines against PCR-confirmed SARS-CoV-2 infection during the Omicron XBB lineage-predominant period in patients aged ≥ 60 years with severe acute respiratory infection from five countries in Europe. Bivalent vaccines provided short-term additional protection compared with those vaccinated > 6 months before the campaign: from 80% (95% CI: 50 to 94) for 14-89 days post-vaccination, 15% (95% CI: -12 to 35) at 90-179 days, and lower to no effect thereafter.

Interim 2023/24 influenza A vaccine effectiveness: VEBIS European primary care and hospital multicentre studies, September 2023 to January 2024.

Influenza A viruses circulated in Europe from September 2023 to January 2024, with influenza A(H1N1)pdm09 predominance. We provide interim 2023/24 influenza vaccine effectiveness (IVE) estimates from two European studies, covering 10 countries across primary care (EU-PC) and hospital (EU-H) settings. Interim IVE was higher against A(H1N1)pdm09 than A(H3N2): EU-PC influenza A(H1N1)pdm09 IVE was 53% (95% CI: 41 to 63) and 30% (95% CI: -3 to 54) against influenza A(H3N2). For EU-H, these were 44% (95% CI: 30 to 55) and 14% (95% CI: -32 to 43), respectively.

Bilateral Hyperplasia of Mandibular Coronoid Processes in a Pediatric Patient.

Langen Beck disease, a rare idiopathic disorder, causes enlarged coronoid processes of the mandible, leading to restricted oral opening and deteriorating health. This paper presents a 10-year-old boy's case with bilateral hyperplasia of the coronoid processes (HCP), diagnosed using cranial computed tomography, severely limiting oral opening to 18 mm. Treatment involved early intraoral coronoidectomy followed by physiotherapy, yielding immediate oral opening improvement without recurrence after 1 year. Surgical timing should consider age, disease severity, and progression risk. While HCP etiology lacks conclusive evidence, genetic mutations may explain cases without identifiable causes. This case underscores the significance of timely intervention for HCP to alleviate symptoms and improve long-term outcomes, emphasizing individualized treatment strategies.

[Comparison of a portable hemoglobinometer (Verio Q Red) with clinical laboratory results in routine clinical practice]. / Comparación de un hemoglobinómetro portátil (Verio Q Red) con los resultados del laboratorio clínico en la práctica clínica habitual.

OBJECTIVE: To analyze the concordance between a hemoglobinometer with capillary blood sample and the clinical laboratory with a venous blood sample. DESIGN: Cross-sectional concordance study. LOCATION: Care Centre Primary Bufalà-Canyet Primary and Care Centre Primary Dalt la Vila Primary Care Center, Badalona, Barcelona. PARTICIPANTS: Random selection of participants who attended routine blood tests. Over 18years old. No abandonment or loss was obtained. MAIN INTERVENTIONS AND MEASUREMENTS: Sex, age, and reason for the blood test were collected from the medical history. Venous blood is drawn, and simultaneously, capillary blood is collected. RESULTS: 120 individuals are included, with an average age of 58.9years. The Bland-Almant graph showed differences within the confidence intervals for hemoglobin and hematocrit. The mean differences between the values of the Verio Q Red hemoglobinometer and those of the clinical laboratory were -0.42mg/dl for hemoglobin and -1.25% for hematocrit. The intraclass correlation coefficient showed excellent correlation for hemoglobin and hematocrit between the Verio Q Red hemoglobinometer and the clinical laboratory. Pearson's correlation for hemoglobin was 0.737 and for hematocrit 0.787. CONCLUSIONS: The Verio Q hemoglobinometer is a valid tool for the early diagnosis of anemias and can be very useful in primary care consultations.

Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Alpha- and Delta-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021.

IntroductionTwo large multicentre European hospital networks have estimated vaccine effectiveness (VE) against COVID-19 since 2021.AimWe aimed to measure VE against PCR-confirmed SARS-CoV-2 in hospitalised severe acute respiratory illness (SARI) patients ≥ 20 years, combining data from these networks during Alpha (March-June)- and Delta (June-December)-dominant periods, 2021.MethodsForty-six participating hospitals across 14 countries follow a similar generic protocol using the test-negative case-control design. We defined complete primary series vaccination (PSV) as two doses of a two-dose or one of a single-dose vaccine ≥ 14 days before onset.ResultsWe included 1,087 cases (538 controls) and 1,669 cases (1,442 controls) in the Alpha- and Delta-dominant periods, respectively. During the Alpha period, VE against hospitalisation with SARS-CoV2 for complete Comirnaty PSV was 85% (95% CI: 69-92) overall and 75% (95% CI: 42-90) in those aged ≥ 80 years. During the Delta period, among SARI patients ≥ 20 years with symptom onset ≥ 150 days from last PSV dose, VE for complete Comirnaty PSV was 54% (95% CI: 18-74). Among those receiving Comirnaty PSV and mRNA booster (any product) ≥ 150 days after last PSV dose, VE was 91% (95% CI: 57-98). In time-since-vaccination analysis, complete all-product PSV VE was > 90% in those with their last dose < 90 days before onset; ≥ 70% in those 90-179 days before onset.ConclusionsOur results from this EU multi-country hospital setting showed that VE for complete PSV alone was higher in the Alpha- than the Delta-dominant period, and addition of a first booster dose during the latter period increased VE to over 90%.

Monitoring COVID-19 and Influenza: The Added Value of a Severe Acute Respiratory Infection Surveillance System in Portugal.

Background: 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.

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 2021.

IntroductionIn July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe.AimUsing a multicentre test-negative study, we measured COVID-19 vaccine effectiveness (VE) against symptomatic infection.MethodsIndividuals 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.ResultsOverall 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.ConclusionsVE 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.

Symptom attribution in patients with medically unexplained symptoms. A scale development and validation study.

INTRODUCTION: In the care of patients with medically unexplained physical symptoms (MUPS) it is important what they think about their symptoms. OBJECTIVE: To validate the psychometric properties of a symptom attribution scale in patients with MUPS and to verify its reliability. METHODS: A non-probabilistic sample of 400 male and female adult patients were interviewed in the outpatient services of a family medicine hospital, 200 with MUPS and 200 with a defined organic pathology. Each group was diagnosed with defined criteria, and a scale with content and construct validity was applied by means of principal component analysis with varimax rotation. RESULTS: The scale was made up of 12 items with two factors, one of symptom psychosocial attribution and other with organic attribution. The psychosocial-origin factor showed a variance of 49.7%. The goodness-of-fit test demonstrated that the correlation matrix was adequate, and Bartlett's sphericity test indicated statistical significance (p < 0.0001); Cronbach's alpha was 0.841. CONCLUSION: The scale showed acceptable construct validity and good reliability and stability. The implications of these results for future measurement research are discussed.

INTRODUCCIÓN: En la atención de pacientes con síntomas físicos médicamente no explicables (SFMNE) es importante lo que el paciente piensa de sus síntomas. OBJETIVO: Validar propiedades psicométricas de una escala de atribución del síntoma en pacientes con SFMNE y verificar su confiabilidad. MÉTODOS: Se entrevistó a una muestra no probabilística de 400 pacientes adultos, hombres y mujeres, en la consulta de un hospital con medicina familiar, 200 con SFMNE y 200 con patología orgánica concreta. Se diagnosticó a cada grupo con criterios definidos y se aplicó una escala con validez de contenido y de constructo por medio de análisis de componentes principales con rotación varimax. RESULTADOS: La escala quedó integrada por 12 reactivos con dos factores, uno de atribución psicosocial y otro de atribución orgánica del síntoma. El factor de origen psicosocial tuvo una varianza de 49.7 %. La prueba de bondad de ajuste mostró que la matriz de correlaciones fue adecuada y la prueba de esfericidad de Bartlett indicó significación estadística (p < 0.0001); el alfa de Cronbach fue de 0.841. CONCLUSIÓN: La escala mostró una validez de constructo aceptable y buena confiabilidad y estabilidad. Se discuten las implicaciones de estos resultados para la investigación de mediciones futuras.

No effect modification of influenza virus vaccine effectiveness by age or chronic condition was observed in the 2010/11 to 2017/18 seasons.

PURPOSE: Most European influenza vaccine strategies target individuals at higher risk of complications, which include, among others, individuals aged ≥65 years and with chronic conditions. These individuals not only have a high-risk of post-infection complications but also could have lower capacity of acquiring adequate vaccine-induced protection. As such, chronic conditions and age could modify the effect of vaccines. This study aimed at assessing the potential effect modification of influenza vaccine effectiveness (IVE) by age and chronic conditions. METHODS: We used eight-season data from the Portuguese vaccine effectiveness study. Every season, physicians at primary care units recruited patients with influenza-like illness. Clinical data and swabs were collected for Reverse Transverse Polymerase Chain Reaction (RT-PCR) detection of influenza. Trivalent inactivated IVE was estimated as 1 - odds ratio (OR) of being vaccinated in cases (RT-PCR positive for influenza) versus negative controls. ORs were obtained using a multivariable conditional logistic regression model, paired by week of onset within each season. Confounders were assessed by designing a specific causal diagram. Age (< 65 or ≥65 years) and chronic conditions (diabetes, cardiovascular disease, chronic renal disease, chronic hepatic disease, obesity, chronic respiratory disease, and congenital or acquired immunodeficiency) were studied as effect modifiers by including an interaction term in the regression models. Significance was established at 5%. RESULTS: Point estimates indicate a higher IVE in the chronic condition strata compared to that in the no chronic condition strata. Regarding age, different results were obtained considering the virus type and (sub)type. When comparing the ≥65 years with the <65 years of age strata, we observed a higher IVE against A(H1N1)pdm09, an equal IVE against A(H3N2) and a lower IVE against B virus. However, all interaction terms were statistically insignificant, and this may be due to a small sample size. CONCLUSION: The potential effect modification of age or chronic condition was not observed within our study.

Pressure-Modulated Broadband Emission in 2D Layered Hybrid Perovskite-Like Bromoplumbate.

Two-dimensional (2D) layered hybrid bromoplumbate perovskites are promising candidates for solution-processed light-emitting materials. Here, we report the synthesis and characterization of two novel layered bromoplumbates: (4BrPhMA)2PbBr4 (1) and (4BrPhA)6Pb3Br12 (2), where 4BrPhMA is (4-bromophenyl)methylammonium and 4BrPhA is (4-bromophenyl) ammonium. Despite similar optical absorption, these materials show remarkably different photoluminescence properties: 1 emits a narrow exciton band at ca. 395 nm with a very small bandwidth (particularly at low temperatures of 15-50 K) and Stokes shift, while 2 exhibits a broad emission at ca. 560 nm with a large Stokes shift, both at low and ambient temperatures. However, under several kbar of hydrostatic pressure, the broad emission diminishes and a new band reversibly develops at ca. 395 nm, similar to that in 1. Our results emphasize organic layer flexibility as an important design factor for this class of perovskite-like materials featuring broadband emission.

Elemental Depth Profiling of Chlorinated Polyamide-Based Thin-Film Composite Membranes with Elastic Recoil Detection.

The chlorine resistance of nanofiltration and reverse osmosis membranes is of high importance in the water treatment industry. Elastic recoil detection (ERD) is now presented as a powerful tool to uniquely provide elemental depth profiles, including hydrogen, of NaOCl-treated polyamide-based thin-film composite (TFC) membranes. The influence of pressure, pH, and chlorine feed concentration on the volume-averaged Cl uptake, the location of chlorine throughout the membrane, and the z-gradient in the Cl/N ratio is demonstrated. The results suggest that (i) higher volume-averaged Cl uptakes are achieved at higher chlorine doses and at acidic pH; (ii) chlorination is mostly restricted to the top layer; (iii) a gradient in the Cl/N ratio exists along the membrane depth; and (iv) the shape of this gradient is influenced by the chlorination pH and the applied pressure. Conclusions on the chlorination mechanisms could also be deduced. Conversely, no conclusive relationships between H fractions and Cl uptake could be drawn, even though changes in the H content after chlorination were observed. To corroborate these results and fully exploit the potential of ERD, the exact microstructure of the (chlorinated) TFC membranes should be better understood.

Low 2018/19 vaccine effectiveness against influenza A(H3N2) among 15-64-year-olds in Europe: exploration by birth cohort.

IntroductionInfluenza A(H3N2) clades 3C.2a and 3C.3a co-circulated in Europe in 2018/19. Immunological imprinting by first childhood influenza infection may induce future birth cohort differences in vaccine effectiveness (VE).AimThe I-MOVE multicentre primary care test-negative study assessed 2018/19 influenza A(H3N2) VE by age and genetic subgroups to explore VE by birth cohort.MethodsWe measured VE against influenza A(H3N2) and (sub)clades. We stratified VE by usual age groups (0-14, 15-64, ≥ 65-years). To assess the imprint-regulated effect of vaccine (I-REV) hypothesis, we further stratified the middle-aged group, notably including 32-54-year-olds (1964-86) sharing potential childhood imprinting to serine at haemagglutinin position 159.ResultsInfluenza A(H3N2) VE among all ages was -1% (95% confidence interval (CI): -24 to 18) and 46% (95% CI: 8-68), -26% (95% CI: -66 to 4) and 20% (95% CI: -20 to 46) among 0-14, 15-64 and ≥ 65-year-olds, respectively. Among 15-64-year-olds, VE against clades 3C.2a1b and 3C.3a was 15% (95% CI: -34 to 50) and -74% (95% CI: -259 to 16), respectively. VE was -18% (95% CI: -140 to 41), -53% (95% CI: -131 to -2) and -12% (95% CI: -74 to 28) among 15-31-year-olds (1987-2003), 32-54-year-olds (1964-86) and 55-64-year-olds (1954-63), respectively.DiscussionThe lowest 2018/19 influenza A(H3N2) VE was against clade 3C.3a and among those born 1964-86, corresponding to the I-REV hypothesis. The low influenza A(H3N2) VE in 15-64-year-olds and the public health impact of the I-REV hypothesis warrant further study.

Low 2016/17 season vaccine effectiveness against hospitalised influenza A(H3N2) among elderly: awareness warranted for 2017/18 season.

In a multicentre European hospital study we measured influenza vaccine effectiveness (IVE) against A(H3N2) in 2016/17. Adjusted IVE was 17% (95% confidence interval (CI): 1 to 31) overall; 25% (95% CI: 2 to 43) among 65-79-year-olds and 13% (95% CI: -15 to 30) among those ≥ 80 years. As the A(H3N2) vaccine component has not changed for 2017/18, physicians and public health experts should be aware that IVE could be low where A(H3N2) viruses predominate.

2015/16 seasonal vaccine effectiveness against hospitalisation with influenza A(H1N1)pdm09 and B among elderly people in Europe: results from the I-MOVE+ project.

We conducted a multicentre test-negative case-control study in 27 hospitals of 11 European countries to measure 2015/16 influenza vaccine effectiveness (IVE) against hospitalised influenza A(H1N1)pdm09 and B among people aged ≥ 65 years. Patients swabbed within 7 days after onset of symptoms compatible with severe acute respiratory infection were included. Information on demographics, vaccination and underlying conditions was collected. Using logistic regression, we measured IVE adjusted for potential confounders. We included 355 influenza A(H1N1)pdm09 cases, 110 influenza B cases, and 1,274 controls. Adjusted IVE against influenza A(H1N1)pdm09 was 42% (95% confidence interval (CI): 22 to 57). It was 59% (95% CI: 23 to 78), 48% (95% CI: 5 to 71), 43% (95% CI: 8 to 65) and 39% (95% CI: 7 to 60) in patients with diabetes mellitus, cancer, lung and heart disease, respectively. Adjusted IVE against influenza B was 52% (95% CI: 24 to 70). It was 62% (95% CI: 5 to 85), 60% (95% CI: 18 to 80) and 36% (95% CI: -23 to 67) in patients with diabetes mellitus, lung and heart disease, respectively. 2015/16 IVE estimates against hospitalised influenza in elderly people was moderate against influenza A(H1N1)pdm09 and B, including among those with diabetes mellitus, cancer, lung or heart diseases.

Easy Excited-State Trapping and Record High TTIESST in a Spin-Crossover Polyanionic Fe(II) Trimer.

Reaction of the polysulfonated triazole ligand L = 4-(1,2,4-triazol-4-yl)ethanedisulfonate) with iron(II) salts in water yields the trimeric species [Fe3(µ-L)6(H2O)6](6-). This polyanion, as the dimethylammonium salt, shows a thermally induced spin transition above room temperature for the central Fe position in the trimer with a large hysteresis cycle (>85 K) and remarkably slow dynamics. This allows easy quenching of the metastable high-spin (HS) state via gradual cooling (5 K min(-1)). Once it is trapped, the HS state remains metastable. Thermal energy is not able to promote relaxation into the low-spin ground state below 215 K, with a characteristic TTIESST = 250 K, the highest temperature ever observed for thermal trapping of an excited spin state in a switchable molecular material.

Hysteretic spin crossover above room temperature and magnetic coupling in trinuclear transition-metal complexes with anionic 1,2,4-triazole ligands.

The reaction of 4-(1,2,4-triazol-4-yl)ethanesulfonate (L) with Zn(2+), Cu(2+), Ni(2+), Co(2+), and Fe(2+) gave a series of analogous neutral trinuclear complexes with the formula [M3(µ-L)6(H2O)6] (1-5). These compounds were characterized by single-crystal X-ray diffraction, thermogravimetry, and elemental analysis. The magnetic properties of compounds 2-5 were studied. Complexes 2-4 show weak antiferromagnetic superexchange, with J values of -0.33 (2), -9.56 (3), and -4.50 cm(-1) (4) (exchange Hamiltonian H = -2 J (S1S2+S2S3)). Compound 5 shows two additional crystallographic phases (5 b and 5 c) that can be obtained by dehydration and/or thermal treatment. These three phases exhibit distinct magnetic behavior. The Fe(2+) centers in 5 are in high-spin (HS) configuration at room temperature, with the central one exhibiting a non-cooperative gradual spin transition below 250 K with T1/2 = 150 K. In 5 b, the central Fe(2+) stays in its low-spin (LS) state at room temperature, and cooperative spin transition occurs at higher temperatures and with the appearance of memory effect (T1/2↑ = 357 K and T1/2↓ = 343 K). In the case of 5 c, all iron centers remain in their HS configuration down to very low temperatures, with weak antiferromagnetic coupling (J = -1.16 cm(-1)). Compound 5 b exhibits spin transition with memory effect at the highest temperature reported, which matches the remarkable features of coordination polymers.

Cassava bagasse starch and oregano essential oil as a potential active food packaging material: A physicochemical, thermal, mechanical, antioxidant, and antimicrobial study.

This research evaluates the use of cassava bagasse starch and oregano essential oil (OEO) in an active film. For comparison, films of cassava starch (CS) and cassava bagasse starch (BS) were prepared with OEO at 1, 2, and 3 %. Physical, thermal, mechanical, antioxidant, and antimicrobial properties were determined. BS films presented higher thickness, WVP, ΔE, modulus of elasticity, and maximum stress, but lower strain at break compared to CS films. Adding OEO into the films increased their thickness, moisture, solubility, WVP and strain at break. However, maximum stress, modulus of elasticity, and T dmax decreased. The CS films added with 3 % of OEO showed higher WVP (6.32 × 10-14 kg m/m2.s.Pa), intermediate solubility of 39 % and low maximum stress (0.19 MPa) while the BS film with 3 % of OEO presented 5.73 × 10-14 kg m/m2.s.Pa, 30 % and 0.39 MPa, respectively. The increase from 1 % to 3 % of OEO increased the total phenolic compound content and antioxidant activity of the films by 1.3-fold and 3.7-fold, respectively. The incorporation of 3 % OEO in the films inhibited the growth of S. aureus and E. coli. Therefore, BS and OEO films offer a promising solution as biodegradable active food packaging, providing a more sustainable alternative to traditional non-biodegradable plastic packaging.

New Evidence for the Bronze Age Zooarchaeology in the Inland Area of the Iberian Peninsula through the Analysis of Pista de Motos (Villaverde Bajo, Madrid).

The Bronze Age zooarchaeological research for the interior and other regions of the Iberian Peninsula is currently limited. Despite several sites with known zooarchaeological profiles from the period, the main issue is that most of these derive from fragmentary and unrepresentative faunal records or are biased profiles from old excavations. New work has yielded novel zooarchaeological results in recent years that could help fill the existing zooarchaeological information gap in the Iberian inland, particularly in the Middle Tagus Valley. However, these projects are in the initial research stages and have not published much of their results. This paper presents the zooarchaeological profile of the Pista de Motos Bronze Age site to help fill this information gap. It analyses the taxonomic representation, skeletal profiles, and human activity patterns associated with faunal use. These observations suggest that animal exploitation at the site followed two primary purposes. One was linked to economic activities, mainly to obtain meat, milk, wool, or animal labour. The other was probably associated with symbolic-ritual practices suggested by the complete animal burials in some excavated units. We contextualise these interpretations with evidence from other Bronze Age sites in the Middle Tagus Valley. Finally, the paper assesses to what extent Pista de Motos is a relevant site for the zooarchaeology of the Bronze Age in the Iberian inland.

Exploring the effect of clinical case definitions on influenza vaccine effectiveness estimation at primary care level: Results from the end-of-season 2022-23 VEBIS multicentre study in Europe.

BACKGROUND: Within influenza vaccine effectiveness (VE) studies at primary care level with a laboratory-confirmed outcome, clinical case definitions for recruitment of patients can vary. We used the 2022-23 VEBIS primary care European multicentre study end-of-season data to evaluate whether the clinical case definition affected IVE estimates. METHODS: We estimated VE using a multicentre test-negative case-control design. We measured VE against any influenza and influenza (sub)types, by age group (0-14, 15-64, ≥65 years) and by influenza vaccine target group, using logistic regression. We estimated IVE among patients meeting the European Union (EU) acute respiratory infection (ARI) case definition and among those meeting the EU influenza-like illness (ILI) case definition, including only sites providing information on specific symptoms and recruiting patients using an ARI case definition (as the EU ILI case definition is a subset of the EU ARI one). RESULTS: We included 24 319 patients meeting the EU ARI case definition, of whom 21 804 patients (90 %) meet the EU ILI case definition, for the overall pooled VE analysis against any influenza. The overall and influenza (sub)type-specific VE varied by ≤2 % between EU ILI and EU ARI populations. DISCUSSION: Among all analyses, we found similar VE estimates between the EU ILI and EU ARI populations, with few (10%) additional non-ILI ARI patients recruited. These results indicate that VE in the 2022-23 influenza season was not affected by use of a different clinical case definition for recruitment, although we recommend investigating whether this holds true for next seasons.