Excess mortality in Europe coincides with peaks of COVID-19, influenza and respiratory syncytial virus (RSV), November 2023 to February 2024.

Since the end of November 2023, the European Mortality Monitoring Network (EuroMOMO) has observed excess mortality in Europe. During weeks 48 2023-6 2024, preliminary results show a substantially increased rate of 95.3 (95% CI:  91.7-98.9) excess all-cause deaths per 100,000 person-years for all ages. This excess mortality is seen in adults aged 45 years and older, and coincides with widespread presence of COVID-19, influenza and respiratory syncytial virus (RSV) observed in many European countries during the 2023/24 winter season.

Effectiveness of a fourth SARS-CoV-2 vaccine dose in previously infected individuals from Austria.

INTRODUCTION: Evidence is limited on the effectiveness of a fourth vaccine dose against coronavirus disease 2019 (COVID-19) in populations with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We estimated the risk of COVID-19 deaths and SARS-CoV-2 infections according to vaccination status in previously infected individuals in Austria. METHODS: This is a nationwide retrospective observational study. We calculated age and gender adjusted Cox proportional hazard ratios (HRs) of COVID-19 deaths (primary outcome) and SARS-CoV-2 infections (secondary outcome) from 1 November to 31 December 2022, primarily comparing individuals with four versus three vaccine doses. Relative vaccine effectiveness (rVE) was calculated as (1-HR) X 100. RESULTS: Among 3,986,312 previously infected individuals, 281,291 (7,1%) had four and 1,545,242 (38.8%) had three vaccinations at baseline. We recorded 69 COVID-19 deaths and 89,056 SARS-CoV-2 infections. rVE for four versus three vaccine doses was -24% (95% CI: -120 to 30) against COVID-19 deaths, and 17% (95% CI: 14-19) against SARS-CoV-2 infections. This latter effect rapidly diminished over time and infection risk with four vaccinations was higher compared to less vaccinated individuals during extended follow-up until June 2023. Adjusted HR (95% CI) for all-cause mortality for four versus three vaccinations was 0.79 (0.74-0.85). DISCUSSION: In previously infected individuals, a fourth vaccination was not associated with COVID-19 death risk, but with transiently reduced risk of SARS-CoV-2 infections and reversal of this effect in longer follow-up. All-cause mortality data suggest healthy vaccinee bias.

Implementation of a Surveillance System for Severe Acute Respiratory Infections at a Tertiary Care Hospital in Austria: Protocol for a Retrospective Longitudinal Feasibility Study.

BACKGROUND: The risk of a large number of severe acute respiratory infection (SARI) cases emerging is a global concern. SARI can overwhelm the health care capacity and cause several deaths. Therefore, the Austrian Agency for Health and Food Safety will explore the feasibility of implementing an automatic electronically based SARI surveillance system at a tertiary care hospital in Austria as part of the hospital network, initiated by the European Centre for Disease Prevention and Control. OBJECTIVE: We aim to investigate the availability of routinely collected health record data pertaining to respiratory infections and the optimal approach to use such available data for systematic surveillance of SARI in a real-world setting, describe the characteristics of patients with SARI before and after the beginning of the COVID-19 pandemic, and investigate the feasibility of identifying the risk factors for a severe outcome (intensive care unit admission or death) in patients with SARI. METHODS: We will test the feasibility of a surveillance system, as part of a large European network, at a tertiary care hospital in the province of Lower Austria (called Regional Hospital Wiener Neustadt). It will be a cross-sectional study for the inventory of the electronic data records and implementation of automatic data retrieval for the period of January 2019 through the end of December 2022. The analysis will include an exploration of the database structure, descriptive analysis of the general characteristics of the patients with SARI, estimation of the SARI incidence rate, and assessment of the risk factors and different levels of severity of patients with SARI using logistic regression analysis. RESULTS: This will be the first study to assess the feasibility of SARI surveillance at a large 800-bed tertiary care hospital in Austria. It will provide a general overview of the potential for establishing a hospital-based surveillance system for SARI. In addition, if successful, the electronic surveillance will be able to improve the response to early warning signs of new SARI, which will better inform policy makers in strengthening the surveillance system. CONCLUSIONS: The findings will support the expansion of the SARI hospital-based surveillance system to other hospitals in Austria. This network will be of use to Austria in preparing for future pandemics. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/47547.

Characterization and Simulation of Shear-Induced Damage in Selective-Laser-Sintered Polyamide 12.

This paper presents the characterisation of selective-laser-sintered (SLS) samples of polyamide 12 (PA12) under shear loading. PA12 is a semi-crystalline thermoplastic and is used in various industries. Its behaviour under shear stress, which is particularly important for product reliability, has not yet been sufficiently investigated. This research focuses on understanding the material and damage behaviour of PA12 under shear-induced stress conditions. The study included quasi-static experiments and numerical simulations. Samples were prepared via SLS and tested according to ASTM standards. Digital image correlation (DIC) was used for precise deformation measurements. The Chaboche material model was used for the viscoplastic behaviour in the numerical simulations. Due to existing material discontinuities in the form of voids, the material model was coupled with the Gurson-Tvergaard-Needleman (GTN) damage model. A modified approach of the GTN model was used to account for low stress triaxiality under shear loading. These models were implemented in MATLAB and integrated into Abaqus via a User Material (UMAT) subroutine. The results of the experiments and simulations showed a high degree of accuracy. An important finding was the significant influence of the shear factor kw on the damage behaviour, especially during failure. This factor proved to be essential for the accurate prediction of material behaviour under shear-induced stress conditions. The integration of the modified GTN model with the Chaboche material model in UMAT enables an accurate prediction of the material and damage behaviour and thus makes an important contribution to the understanding of the mechanical material behaviour of SLS PA12 specimens.

Poverty in old age in times of COVID-19-Empirical results from Austria.

Early in the pandemic, researchers were cautioning that COVID-19 and the associated health policy countermeasures would have an increased negative impact on groups that were already vulnerable before the pandemic. One of these groups are older people affected by poverty, who according to official figures make up 13.9% of older population in Austria. Even before the pandemic, their living situation was considered precarious. Not without reason, this group has been identified as a high-risk group of the pandemic, due to their increased likelihood of severe COVID-19 related illness and their limited monetary resources and thus lower chances of coping with the pandemic. Nevertheless, research on this group has remained sparse to date. Therefore, the aim of the study is to focus on older people (60+ years) below the poverty line and to compare them with non-poor individuals. Data from the SHARE (Survey of Health Aging and Retirement in Europe) project is used, combining data from the two SHARE Corona Surveys (summer 2020 and summer 2021) and the SHARE Corona Special Austria Survey (December 2020) to gain the most complete picture of life situation during the pandemic. Results demonstrate that older people in poverty were more likely to report poor subjective health before as well as during the pandemic yet were significantly more likely to refuse vaccination against COVID-19, despite adhering to other measures against the pandemic to the same extent as non-poor people. Restrictions in the health care system affected both groups equally and no significant differences in the frequency of social contacts could be found. However, older people below the poverty line were significantly more likely to rely on social support to obtain necessities during the pandemic and were less likely to use the internet. Together, these results point out that disadvantage exist for the older poor in some but not all areas of life during the pandemic. This paper is aimed at providing first insights into the lives of poor older persons during a taxing time and may perhaps inspire more in-depth study of this particularly understudied population.

Diagnostic Study to Assess the Performance of a New Urinary Legionella Antigen Test-A National Study in Three Referral University Hospitals in Austria during 2014-2017.

BACKGROUND: We evaluated the performance of a rapid diagnostic antigen test (Coris) as an index test versus the urinary Antigen ELISA (Bartels) as the reference test. METHODS: Prospective diagnostic accuracy study (2014-2017) at three university hospitals in Austria. RESULTS: A total of 996 patients were included in the study. Legionellosis was diagnosed in 49/996 (4.9%) using the reference test. The sensitivity and specificity of the Coris test were 75.5% (95% CI 61.1-86.7%) and 100% (95%CI 99.6-100%), respectively. The PPV was 100% and when using the lower 95% CI limit of the estimate for sensitivity, the resulting PPV was 61.1%. The NPV was 98.7% and the accuracy was 98.8%. The index test showed a PPV > 97% during the period of summer and autumn (May through November) and ≥88% during winter (December through February). The NPV was >97% during all of the periods. The median of the monthly incidence in the general population was 0.1 per 100,000 (IQR 0.1; 0.3). CONCLUSION: The new rapid test gave a high level of diagnostic accuracy in a rapid fashion. The test can be applied at the bedside by non-laboratory staff.

Ultra-rapid rollout vaccination with BNT162b2 to reduce SARS-CoV-2 infections in the general population.

This study aimed to determine the impact of ultra-rapid rollout vaccination on incidence of SARS-CoV-2 infection. Vaccination with BNT162b2 was provided to 66.9% of eligible residents of the Schwaz district in Tyrol, Austria, within six days per dose (first dose: 11-16 March 2021, second dose: 8-13 April 2021). Of 11,955 individuals enrolled at nine vaccination centers (median age 44.6 years; 51.3% female), 71 had incident SARS-CoV-2 over a six-month follow-up. Incidence rates per 100,000 person-weeks were 92.3 (95% confidence interval [CI]: 70.8-120.2) at weeks 1-5 and 6.4 (3.9-10.4) at ≥6 weeks after dose 1. In these two periods, effectiveness of the vaccination campaign to reduce incident SARS-CoV-2 was 58.6% (50.8%-65.2%) and 91.1% (89.6%-92.3%) in study participants and 28.3% (23.1%-33.0%) and 64.0% (61.7%-66.1%) in the Schwaz district, compared with districts with slower vaccination rollout. Therefore, the vaccination campaign in the Schwaz district illustrates the impact of accelerated vaccination rollout in controlling the pandemic.

Viral variant-resolved wastewater surveillance of SARS-CoV-2 at national scale.

SARS-CoV-2 surveillance by wastewater-based epidemiology is poised to provide a complementary approach to sequencing individual cases. However, robust quantification of variants and de novo detection of emerging variants remains challenging for existing strategies. We deep sequenced 3,413 wastewater samples representing 94 municipal catchments, covering >59% of the population of Austria, from December 2020 to February 2022. Our system of variant quantification in sewage pipeline designed for robustness (termed VaQuERo) enabled us to deduce the spatiotemporal abundance of predefined variants from complex wastewater samples. These results were validated against epidemiological records of >311,000 individual cases. Furthermore, we describe elevated viral genetic diversity during the Delta variant period, provide a framework to predict emerging variants and measure the reproductive advantage of variants of concern by calculating variant-specific reproduction numbers from wastewater. Together, this study demonstrates the power of national-scale WBE to support public health and promises particular value for countries without extensive individual monitoring.

Examining the Impact of COVID-19 Experiences on Reported Psychological Burden Increase in Older Persons: The Effects of Illness Severity and Social Proximity.

Previous findings have provided indications that experience of COVID-19 illness of self and other affect mental health unfavorably. However, prior studies do not satisfactorily differentiate according to severity of COVID-19 illness or social proximity, which are both hypothesized to be relevant factors for increased psychological burden. This study provides an in-depth examination of the impact of Covid-19 experience of self and other on mental health, considering illness severity as well as proximity to the infected person (self, close and distant network). It used data on an older population (50+ years) from 28 European countries (n > 40 000 persons) surveyed in summer of 2021 using the Survey of Health and Retirement in Europe (SHARE). Aside from bivariate analyses, a logistic regression model was computed to test the effects of illness severity by personal proximity over and above other stressors of life in the pandemic. Severity of illness was shown to be a contributor to psychological burden increase with the strongest effects among persons who reported own illness experiences or experiences in the close network. Regression analysis confirmed the impact of severe Covid-19 experience in self, close and distant relations. Moreover, even a less severe course impacted burden unfavorably when experienced in the own person and more distant relations. These results prove troubling. Psychological burden is impacted by infection, with experiences in self or close persons being strongest, while even 'lighter' experiences in the distant network also have an unfavorable effect, emphasizing the need to gain control of the present pandemic.

Ready for Vaccination? COVID-19 Vaccination Willingness of Older People in Austria.

In spite of findings highlighting higher health risk from infection compared to younger people, a certain percentage of older people in Austria still lack a valid vaccination certificate. The current gaps in vaccination coverage in countries such as Austria are likely to be in large part due to vaccination refusal and pose or will pose problems for the health system and consequently for all of society should the initial findings on Omicron coronavirus infectivity prove true. Surprisingly, only a few studies around the globe explicitly address older people's COVID-19 vaccination willingness. The present work therefore intends to contribute to this field by identifying factors associated with the decision for or against a vaccination among the older population in Austria. Data collected between late 2020 and early 2021 via the cross-national panel study Survey of Health, Aging and Retirement in Europe (SHARE) are used to perform multinomial logistic regression to analyse differences between COVID-19 vaccination supporters, undecided persons and rejectors. The results show that persons exhibiting a low risk assessment toward COVID-19, less health protection behaviors, lower education and belonging to households with financial burdens are significantly more likely to refuse vaccination or be ambivalent. Although multimorbidity reduces risk of vaccination refusal, poor subjective health was significantly related to a higher risk of refusing vaccination. The results point to the importance of addressing the factors related to refusal. Only by understanding these factors will it be possible to increase vaccination rates and thus minimize other restrictive measures.

Freeform shaping of fused silica substrates via viscous deformation induced by a laser patterned, stressed film.

Freeform optics enable improved optical solutions but their fabrication usually requires complicated precision machining processes. We report on an approach for freeform shaping of optical surfaces via a stress-induced viscous deformation of glass plates. We studied the deformation of fused silica substrates covered by specifically laser patterned films of substoichiometric silicon oxide during annealing at about 1100 °C in an oxidizing ambient. The obtained large deformation of the substrates can be understood by a mostly viscous deformation but can be described in analogy to a purely elastic deformation. Our results demonstrate the feasibility of a method for freeform shaping of individual optical substrates that only requires the preparation of a flat surface.

Assessing the impact of SARS-CoV-2 prevention measures in Austrian schools using agent-based simulations and cluster tracing data.

We aim to identify those measures that effectively control the spread of SARS-CoV-2 in Austrian schools. Using cluster tracing data we calibrate an agent-based epidemiological model and consider situations where the B1.617.2 (delta) virus strain is dominant and parts of the population are vaccinated to quantify the impact of non-pharmaceutical interventions (NPIs) such as room ventilation, reduction of class size, wearing of masks during lessons, vaccinations, and school entry testing by SARS-CoV2-antigen tests. In the data we find that 40% of all clusters involved no more than two cases, and 3% of the clusters only had more than 20 cases. The model shows that combinations of NPIs together with vaccinations are necessary to allow for a controlled opening of schools under sustained community transmission of the SARS-CoV-2 delta variant. For plausible vaccination rates, primary (secondary) schools require a combination of at least two (three) of the above NPIs.

[Development of loneliness in old age in times of COVID-19]. / Entwicklung des Einsamkeitsempfindens im Alter in Zeiten von COVID-19: Gruppenvergleiche älterer Menschen vor und in der ersten Welle der Pandemie.

The article investigates the development of loneliness before and in the first months of the Covid-19 pandemic against the background of the socio-economic situation of older people. For this purpose, variance analyses are carried out with data from Lower Austria utilizing two surveys (pre-pandemic, peri-pandemic). The analyses show that older people are not a homogeneous group, i.e. the level of loneliness was already divergent before the pandemic and these existing differences were largely maintained at a somewhat higher level during the pandemic with little variation.

Hitting Close to Home: The Effect of COVID-19 Illness in the Social Environment on Psychological Burden in Older Adults.

This study examines the impact of COVID-19 experience of infection in the individual's social environment on psychological burden controlling for a broad range of factors using data on an older population (50+ years). Based on the empirical evidence of preexisting studies, it is hypothesized that psychological burden will increase concurrent to the severity of COVID-19 experience (tested positive, hospitalized, and death) independent of the other stressors resulting from the pandemic, such as a subjective sense of uncertainty or financial burden. Data of the Survey of Health, Aging and Retirement in EUROPE, and a European cross-national panel study were used to examine this hypothesis. Besides Chi2 test and Spearman's rho, a logistic regression model was constructed to test the hypothesized model. The study confirms that there is significantly higher risk for psychological burden by heightened COVID-19 severity in the social environment independent of multiple also significantly influential variables depicting stressors to everyday life of older people during the pandemic. The results point to the importance of multiple factors (social, financial, health, and sociodemographic) which have significantly affected the psychological condition of the individual during the past year. Conclusively, the results illustrate the dilemma that infection and illness in the social circle, as well as countermeasures (social distancing), have negative consequences for our mental health.

Optical Investigation of Individual Red Blood Cells for Determining Cell Count and Cellular Hemoglobin Concentration in a Microfluidic Channel.

We demonstrate a blood analysis routine by observing red blood cells through light and digital holographic microscopy in a microfluidic channel. With this setup a determination of red blood cell (RBC) concentration, the mean corpuscular volume (MCV), and corpuscular hemoglobin concentration mean (CHCM) is feasible. Cell count variations in between measurements differed by 2.47% with a deviation of -0.26×106 µL to the reference value obtained from the Siemens ADVIA 2120i. Measured MCV values varied by 2.25% and CHCM values by 3.78% compared to the reference ADVIA measurement. Our results suggest that the combination of optical analysis with microfluidics handling provides a promising new approach to red blood cell counts.

Performance of Four IgM Antibody Assays in the Diagnosis of Measles Virus Primary Infection and Cases with a Serological Profile Indicating Reinfection.

The object of this study was to determine the diagnostic performance of four commercially available IgM tests in the diagnosis of measles virus (MeV) primary infection and cases with a serological profile indicating reinfection. Sera from 187 patients with MeV primary infection, 30 patients with suspected reinfection (after vaccine failure), and 153 patients with rash-like symptoms after exclusion of MeV infection were retested with four IgM tests. MeV infection was verified by reverse transcriptase PCR (RT-PCR), and primary and suspected reinfections were differentiated by IgG avidity and neutralization assays. All IgM assays displayed significant agreement (Cohen's κ, ≥0.604; all P < 0.001) and a higher diagnostic accuracy in primary infection than in suspected reinfection (indicated by high IgG avidity and significantly higher anti-MeV-IgG and neutralizing titers). In the overall cohort, the areas under the curve (AUC) were comparable among all tests, ranging from 0.875 to 0.931, with ranges increasing to 0.911 to 0.930 in the primary infection and decreasing to 0.765 to 0.940 in the setting of high anti-MeV-IgG avidity, and all tests displayed high specificity (81.1 to 92.2%). Of note, IgM tests with the highest diagnostic accuracy had discriminatory abilities not significantly different than PCR from serum. Although reinfections pose a challenge for IgM testing, IgM assays remain a cornerstone in the diagnosis of MeV infections. Especially in samples with a serological profile indicating reinfections, IgM tests displayed an equal or even superior diagnostic ability compared to PCR from serum.

SARS-CoV-2 re-infection risk in Austria.

BACKGROUND: A key question concerning coronavirus disease 2019 (COVID-19) is how effective and long lasting immunity against this disease is in individuals who were previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to evaluate the risk of SARS-CoV-2 re-infections in the general population in Austria. METHODS: This is a retrospective observational study using national SARS-CoV-2 infection data from the Austrian epidemiological reporting system. As the primary outcome, we aim to compare the odds of SARS-CoV-2 re-infections of COVID-19 survivors of the first wave (February to April 30, 2020) versus the odds of first infections in the remainder general population by tracking polymerase chain reaction (PCR)-confirmed infections of both groups during the second wave from September 1 to November 30, 2020. Re-infection counts are tentative, since it cannot be excluded that the positive PCR in the first and/or second wave might have been a false positive. RESULTS: We recorded 40 tentative re-infections in 14 840 COVID-19 survivors of the first wave (0.27%) and 253 581 infections in 8 885 640 individuals of the remaining general population (2.85%) translating into an odds ratio (95% confidence interval) of 0.09 (0.07 to 0.13). CONCLUSIONS: We observed a relatively low re-infection rate of SARS-CoV-2 in Austria. Protection against SARS-CoV-2 after natural infection is comparable with the highest available estimates on vaccine efficacies. Further well-designed research on this issue is urgently needed for improving evidence-based decisions on public health measures and vaccination strategies.

Real-time monitoring shows substantial excess all-cause mortality during second wave of COVID-19 in Europe, October to December 2020.

The European monitoring of excess mortality for public health action (EuroMOMO) network monitors weekly excess all-cause mortality in 27 European countries or subnational areas. During the first wave of the coronavirus disease (COVID-19) pandemic in Europe in spring 2020, several countries experienced extraordinarily high levels of excess mortality. Europe is currently seeing another upsurge in COVID-19 cases, and EuroMOMO is again witnessing a substantial excess all-cause mortality attributable to COVID-19.

The Effect of COVID-19 on Loneliness in the Elderly. An Empirical Comparison of Pre-and Peri-Pandemic Loneliness in Community-Dwelling Elderly.

Old-age loneliness is a global problem with many members of the scientific community suspecting increased loneliness in the elderly population during COVID-19 and the associated safety measures. Although hypothesized, a direct comparison of loneliness before and during the pandemic is hard to achieve without a survey of loneliness prior to the pandemic. This study provides a direct comparison of reported loneliness before and during the pandemic using 1:1 propensity score matching (PSM) on a pre- and a peri-pandemic sample of elderly (60+ years) individuals from Lower Austria, a county of Austria (Europe). Differences on a loneliness index computed from the short De Jong Gierveld scale were found to be significant, evidencing that loneliness in the elderly population had in fact risen slightly during the COVID-19 pandemic and its associated safety measures. Although the reported loneliness remained rather low, this result illustrated the effect of the "new normal" under COVID-19. As loneliness is a risk factor for physical and mental illness, this result is important in planning the future handling of the pandemic, as safety measures seem to have a negative impact on loneliness. This work confirms the anticipated increase in loneliness in the elderly population during COVID-19.

Fabrication of Periodic Nanostructures on Silicon Suboxide Films with Plasmonic Near-Field Ablation Induced by Low-Fluence Femtosecond Laser Pulses.

Silicon suboxide (SiOx, x ≈ 1) is a substoichiometric silicon oxide with a large refractive index and optical absorption coefficient that oxidizes to silica (SiO2) by annealing in air at ~1000 °C. We demonstrate that nanostructures with a groove period of 200-330 nm can be formed in air on a silicon suboxide film with 800 nm, 100 fs, and 10 Hz laser pulses at a fluence an order of magnitude lower than that needed for glass materials such as fused silica and borosilicate glass. Experimental results show that high-density electrons can be produced with low-fluence femtosecond laser pulses, and plasmonic near-fields are subsequently excited to create nanostructures on the surface because silicon suboxide has a larger optical absorption coefficient than glass. Calculations using a model target reproduce the observed groove periods well and explain the mechanism of the nanostructure formation.