Sharp increase in gonorrhoea notifications among young people, EU/EEA, July 2022 to June 2023.

Gonorrhoea cases increased steeply in women aged 20 to 24 years across 15 EU/EEA countries in July to December 2022 and January to June 2023 with, respectively, 73% and 89% more cases reported than expected, based on historical data from 2015 to 2019. Smaller increases among men due to heterosexual transmission were observed in nine EU/EEA countries. Interventions to raise awareness among young people about sexually transmitted infection risks are needed, emphasising the benefit of safe sexual practices and testing.

A standardised protocol for relative SARS-CoV-2 variant severity assessment, applied to Omicron BA.1 and Delta in six European countries, October 2021 to February 2022.

Several SARS-CoV-2 variants that evolved during the COVID-19 pandemic have appeared to differ in severity, based on analyses of single-country datasets. With decreased testing and sequencing, international collaborative studies will become increasingly important for timely assessment of the severity of new variants. Therefore, a joint WHO Regional Office for Europe and ECDC working group was formed to produce and pilot a standardised study protocol to estimate relative case-severity of SARS-CoV-2 variants during periods when two variants were co-circulating. The study protocol and its associated statistical analysis code was applied by investigators in Denmark, England, Luxembourg, Norway, Portugal and Scotland to assess the severity of cases with the Omicron BA.1 virus variant relative to Delta. After pooling estimates using meta-analysis methods (random effects estimates), the risk of hospital admission (adjusted hazard ratio (aHR) = 0.41; 95% confidence interval (CI): 0.31-0.54), admission to intensive care unit (aHR = 0.12; 95% CI: 0.05-0.27) and death (aHR = 0.31; 95% CI: 0.28-0.35) was lower for Omicron BA.1 compared with Delta cases. The aHRs varied by age group and vaccination status. In conclusion, this study demonstrates the feasibility of conducting variant severity analyses in a multinational collaborative framework and adds evidence for the reduced severity of the Omicron BA.1 variant.

Task Force for a rapid response to an outbreak of severe acute hepatitis of unknown aetiology in children in Portugal in 2022.

On 5 April 2022, the United Kingdom reported an increase of cases of severe acute hepatitis of unknown aetiology in children, several needing hospitalisation and some required liver transplant or died. Thereafter, 35 countries reported probable cases, almost half of them in Europe. Facing the alert, on 28 April, Portugal created a multidisciplinary Task Force (TF) for rapid detection of probable cases and response. The experts of the TF came from various disciplines: clinicians, laboratory experts, epidemiologists, public health experts and national and international communication. Moreover, Portugal adopted the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) case definition and recommendations. By 31 December 2022, 28 probable cases of severe acute hepatitis of unknown aetiology were reported: 16 male and 17 aged under 2 years. Of these cases, 23 were hospitalised but none required liver transplant or died. Adenovirus was detected from nine of 26 tested cases. No association was observed between adenovirus infection and hospital admission after adjusting for age, sex and region in a binomial regression model. The TF in Portugal may have contributed to increase awareness among clinicians, enabling early detection and prompt management of the outbreak.

Tracking SARS-CoV-2 lineage B.1.1.7 dissemination: insights from nationwide spike gene target failure (SGTF) and spike gene late detection (SGTL) data, Portugal, week 49 2020 to week 3 2021.

We show that the SARS-CoV-2 B.1.1.7 lineage is highly disseminated in Portugal, with the odds of B.1.1.7 proportion increasing at an estimated 89% (95% confidence interval: 83-95%) per week until week 3 2021. RT-PCR spike gene target late detection (SGTL) can constitute a useful surrogate to track B.1.1.7 spread, besides the spike gene target failure (SGTF) proxy. SGTL/SGTF samples were associated with statistically significant higher viral loads, but not with substantial shift in age distribution compared to non-SGTF/SGTL cases.

mRNA vaccine effectiveness against COVID-19-related hospitalisations and deaths in older adults: a cohort study based on data linkage of national health registries in Portugal, February to August 2021.

Through deterministic data linkage of health registries, mRNA vaccine effectiveness (VE) against COVID-19-related hospitalisations and deaths was measured in 1,880,351 older adults. VE against hospitalisations was 94% (95% confidence interval (CI): 88-97) and 82% (95% CI: 72-89) for those 65-79 and ≥ 80 years old, with no evidence of waning 98 days after dose two. VE against mortality was 96% (95% CI: 92-98) and 81% (95% CI: 74-87) in these two age groups.

Understanding spatiotemporal patterns of COVID-19 incidence in Portugal: A functional data analysis from August 2020 to March 2022.

During the SARS-CoV-2 pandemic, governments and public health authorities collected massive amounts of data on daily confirmed positive cases and incidence rates. These data sets provide relevant information to develop a scientific understanding of the pandemic's spatiotemporal dynamics. At the same time, there is a lack of comprehensive approaches to describe and classify patterns underlying the dynamics of COVID-19 incidence across regions over time. This seriously constrains the potential benefits for public health authorities to understand spatiotemporal patterns of disease incidence that would allow for better risk communication strategies and improved assessment of mitigation policies efficacy. Within this context, we propose an exploratory statistical tool that combines functional data analysis with unsupervised learning algorithms to extract meaningful information about the main spatiotemporal patterns underlying COVID-19 incidence on mainland Portugal. We focus on the timeframe spanning from August 2020 to March 2022, considering data at the municipality level. First, we describe the temporal evolution of confirmed daily COVID-19 cases by municipality as a function of time, and outline the main temporal patterns of variability using a functional principal component analysis. Then, municipalities are classified according to their spatiotemporal similarities through hierarchical clustering adapted to spatially correlated functional data. Our findings reveal disparities in disease dynamics between northern and coastal municipalities versus those in the southern and hinterland. We also distinguish effects occurring during the 2020-2021 period from those in the 2021-2022 autumn-winter seasons. The results provide proof-of-concept that the proposed approach can be used to detect the main spatiotemporal patterns of disease incidence. The novel approach expands and enhances existing exploratory tools for spatiotemporal analysis of public health data.

Spatial Analysis of Determinants of COVID-19 Vaccine Hesitancy in Portugal.

Vaccine hesitancy tends to exhibit geographical patterns and is often associated with social deprivation and migrant status. We aimed to estimate COVID-19 vaccination hesitancy in a high-vaccination-acceptance country, Portugal, and determine its association with sociodemographic risk factors. We used the Registry of National Health System Users to determine the eligible population and the Vaccination Registry to determine individuals without COVID-19 vaccine doses. Individuals older than five with no COVID-19 vaccine dose administered by 31 March 2022 were considered hesitant. We calculated hesitancy rates by municipality, gender, and age group for all municipalities in mainland Portugal. We used the spatial statistical scan method to identify spatial clusters and the Besag, Yorke, and Mollié (BYM) model to estimate the effect of age, gender, social deprivation, and migrant proportion across all mainland municipalities. The eligible population was 9,852,283, with 1,212,565 (12%) COVID-19 vaccine-hesitant individuals. We found high-hesitancy spatial clusters in the Lisbon metropolitan area and the country's southwest. Our model showed that municipalities with higher proportions of migrants are associated with an increased relative risk (RR) of vaccine hesitancy (RR = 8.0; CI 95% 4.6; 14.0). Social deprivation and gender were not associated with vaccine hesitancy rates. We found COVID-19 vaccine hesitancy has a heterogeneous distribution across Portugal and has a strong association with the proportion of migrants per municipality.

Real-Time Classification of Causes of Death Using AI: Sensitivity Analysis.

BACKGROUND: In 2021, the European Union reported >270,000 excess deaths, including >16,000 in Portugal. The Portuguese Directorate-General of Health developed a deep neural network, AUTOCOD, which determines the primary causes of death by analyzing the free text of physicians' death certificates (DCs). Although AUTOCOD's performance has been established, it remains unclear whether its performance remains consistent over time, particularly during periods of excess mortality. OBJECTIVE: This study aims to assess the sensitivity and other performance metrics of AUTOCOD in classifying underlying causes of death compared with manual coding to identify specific causes of death during periods of excess mortality. METHODS: We included all DCs between 2016 and 2019. AUTOCOD's performance was evaluated by calculating various performance metrics, such as sensitivity, specificity, positive predictive value (PPV), and F1-score, using a confusion matrix. This compared International Statistical Classification of Diseases and Health-Related Problems, 10th Revision (ICD-10), classifications of DCs by AUTOCOD with those by human coders at the Directorate-General of Health (gold standard). Subsequently, we compared periods without excess mortality with periods of excess, severe, and extreme excess mortality. We defined excess mortality as 2 consecutive days with a Z score above the 95% baseline limit, severe excess mortality as 2 consecutive days with a Z score >4 SDs, and extreme excess mortality as 2 consecutive days with a Z score >6 SDs. Finally, we repeated the analyses for the 3 most common ICD-10 chapters focusing on block-level classification. RESULTS: We analyzed a large data set comprising 330,098 DCs classified by both human coders and AUTOCOD. AUTOCOD demonstrated high sensitivity (≥0.75) for 10 ICD-10 chapters examined, with values surpassing 0.90 for the more prevalent chapters (chapter II-"Neoplasms," chapter IX-"Diseases of the circulatory system," and chapter X-"Diseases of the respiratory system"), accounting for 67.69% (223,459/330,098) of all human-coded causes of death. No substantial differences were observed in these high-sensitivity values when comparing periods without excess mortality with periods of excess, severe, and extreme excess mortality. The same holds for specificity, which exceeded 0.96 for all chapters examined, and for PPV, which surpassed 0.75 in 9 chapters, including the more prevalent ones. When considering block classification within the 3 most common ICD-10 chapters, AUTOCOD maintained a high performance, demonstrating high sensitivity (≥0.75) for 13 ICD-10 blocks, high PPV for 9 blocks, and specificity of >0.98 in all blocks, with no significant differences between periods without excess mortality and those with excess mortality. CONCLUSIONS: Our findings indicate that, during periods of excess and extreme excess mortality, AUTOCOD's performance remains unaffected by potential text quality degradation because of pressure on health services. Consequently, AUTOCOD can be dependably used for real-time cause-specific mortality surveillance even in extreme excess mortality situations.

COVID-19 vaccine effectiveness among healthcare workers: a hospital-based cohort study.

OBJECTIVES: Healthcare workers (HCWs) were the first to be prioritised for COVID-19 vaccination. This study aims to estimate the COVID-19 vaccine effectiveness (VE) against SARS-CoV-2 symptomatic infection among HCWs in Portuguese hospitals. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: We analysed data from HCWs (all professional categories) from three central hospitals: one in the Lisbon and Tagus Valley region and two in the central region of mainland Portugal, between December 2020 and March 2022. VE against symptomatic SARS-CoV-2 infection was estimated as one minus the confounder adjusted HRs by Cox models considering age group, sex, self-reported chronic disease and occupational exposure to patients diagnosed with COVID-19 as adjustment variables. RESULTS: During the 15 months of follow-up, the 3034 HCWs contributed a total of 3054 person-years at risk, and 581 SARS-CoV-2 events occurred. Most participants were already vaccinated with a booster dose (n=2653, 87%), some are vaccinated with only the primary scheme (n=369, 12.6%) and a few remained unvaccinated (n=12, 0.4%) at the end of the study period. VE against symptomatic infection was 63.6% (95% CI 22.6% to 82.9%) for HCWs vaccinated with two doses and 55.9% (95% CI -1.3% to 80.8%) for HCWs vaccinated with one booster dose. Point estimate VE was higher for individuals with two doses taken between 14 days and 98 days (VE=71.9%; 95% CI 32.3% to 88.3%). CONCLUSION: This cohort study found a high COVID-19 VE against symptomatic SARS-CoV-2 infection in Portuguese HCWs after vaccination with one booster dose, even after Omicron variant occurrence. The small sample size, the high vaccine coverage, the very low number of unvaccinated individuals and the few events observed during the study period contributed to the low precision of the estimates.

[Neurosurgical Residency in Portugal: What is the National Panorama?] / O Internato de Formação Especializada em Neurocirurgia: Qual o Atual Panorama Nacional?

INTRODUCTION: In Portugal, the number of neurosurgery residents has been rising steadily. However, there are no robust studies assessing the level of satisfaction and quality of the current training programs. The aim of this study was to describe and quantify the level of satisfaction about Neurosurgery residency in 2019, in Portugal. MATERIAL AND METHODS: Quantitative observational cross-sectional study based on an original questionnaire about the level of satisfaction of neurosurgical training in Portugal in 2019, sent electronically to residents and young consultants between October and December 2019. RESULTS: A total of 37 responses were obtained from physicians aged around 29.0 (± 4.0) years old, of which 78.4% were men and 54.1% from centers in the center/south of the country/islands. Overall, 51.4% of the answers came from first three years' residents. As for the theoretical training, there was dissatisfaction with the morbidity and mortality meetings (59.5%), existence of sessions/anatomical lab (89.2%), participation in medical education (64.9%) and in research (64.9%). As for practical training, there was dissatisfaction only towards outpatient clinics (56.8%). There is a tendency for the first surgery to occur in the first month of residency and, in ascending order, firstly a cranial trauma surgery (5.09 ± 4.59 months), then for cerebrospinal fluid diseases (5.95 ± 4.3 months), peripheral nerves (6.0 ± 7.0 months), craniotomy (6.59 ± 3.88 months) and lumbar spine diseases (11.41 ± 1.5 months). Pediatric surgery was the last type of surgery to begin (19.36 ± 20.0 months). There seems to be a generalized satisfaction with the annual (59.5%) but not with the final examination (37.8%). CONCLUSION: This study has succeed at being a better description of the Portuguese neurosurgical centers and of the level of satisfaction about neurosurgical training in Portugal.

Introdução: Em Portugal, o número de médicos internos em Neurocirurgia tem vindo a aumentar progressivamente ao longo dos anos, contudo esta evolução não tem sido acompanhada de estudos que permitam compreender o estado atual da formação. Foi objetivo deste estudo caracterizar e quantificar a satisfação na formação especializada em Neurocirurgia, em Portugal, no ano de 2019.Material e Métodos: Estudo quantitativo, observacional e transversal baseado num questionário original enviado eletronicamente aos internos e recém-especialistas de Neurocirurgia entre outubro e dezembro de 2019. Incluiu-se perguntas sobre características e satisfação em termos de formação teórica, prática, entre outras.Resultados: Obtiveram-se 37 respostas em médicos com cerca de 29,0 (± 4,0) anos, 78,4% homens e 54,1% provenientes de centros do Centro/Sul/Ilhas. Do total de respostas obtidas, 51,4% vieram de internos dos três primeiros anos. Quanto à formação teórica, evidenciou-se insatisfação em relação às reuniões de morbimortalidade (59,5%), existência de sessões/laboratório anatómico (89,2%), participação no ensino graduado (64,9%) e em investigação (64,9%). Quanto à formação prática, a insatisfação evidencia-se apenas em relação à consulta externa (56,8%). A primeira intervenção cirúrgica tende a ser realizada no primeiro mês de internato, no primeiro ano. Por ordem crescente, a primeira cirurgia é de trauma craniano (5,09 ± 4,59 meses), patologia de liquor (5,95 ± 4,3 meses), nervos periféricos (6,0 ± 7,0 meses), craniotomia (6,59 ± 3,88 meses) e patologia lombar (11,41 ± 1,5 meses). A cirurgia pediátrica é a última a ser iniciada (19,36 ± 20,0 meses). Parece existir satisfação geral com a avaliação anual (59,5%) mas não com a final (37,8%).Conclusão: Este estudo cumpriu o objetivo principal de ser um ponto de partida na caracterização dos centros neurocirúrgicos portugueses e da satisfação no internato de formação especializada em Neurocirurgia.