Publications by authors named "Helena C Maltezou"

110 Publications

Vaccination of pregnant women against influenza: what is the optimal timing?

Hum Vaccin Immunother 2021 Feb 18:1-5. Epub 2021 Feb 18.

First Department of Obstetrics and Gynecology, University of Athens, Alexandra General Hospital , Athens, Greece.

Pregnant women and young infants are at increased risk for severe influenza and its complications. Influenza vaccination during pregnancy is increasingly implemented as a strategy aiming to protect the pregnant woman, the fetus and the young infant. In clinical practice, the achievement of satisfactory protection for the pregnant woman without compromising the protection of her infant during the first months of life remains a challenge. Determinants that are implicated in the optimal timing of influenza vaccination in pregnancy include influenza season, trimester of pregnancy, maternal host factors and infant factors. This article addresses influenza vaccination in pregnancy and presents recent published evidence on issues that affect the optimization of the timing of maternal vaccination.
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http://dx.doi.org/10.1080/21645515.2021.1889934DOI Listing
February 2021

Preparing dental schools to refunction safely during the COVID-19 pandemic: an infection prevention and control perspective.

J Infect Dev Ctries 2021 Jan 31;15(1):22-31. Epub 2021 Jan 31.

School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.

In late 2019 a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China and spread throughout the world over a short period of time causing a pandemic of a respiratory disease named coronavirus disease 2019 (COVID-19). SARS-CoV-2 is easily transmitted from person to person through respiratory droplets and direct contact. The scarce available data indicate that dental healthcare personnel are at increased risk for acquisition of infection. Following the lockdown lifting, dental schools should be prepared to refunction safely and provide essential educational and healthcare services while protecting their students, patients, and personnel. The generation of aerosols in dental practice, in association with the high-transmissibility of SARS-CoV-2 through aerosol-generation procedures, the simultaneous provision of dental services to patients in the same areas, and the fact that asymptomatic and pre-symptomatic infected persons may transmit the virus, render the implementation of specific infection prevention and control measures imperative for dental schools. Herein we review the few evidence-based data available to guide infection prevention and control measures for COVID-19 in dental schools.
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http://dx.doi.org/10.3855/jidc.14336DOI Listing
January 2021

Are Sink Drainage Systems a Reservoir for Hospital-Acquired Gammaproteobacteria Colonization and Infection? A Systematic Review.

Open Forum Infect Dis 2021 Feb 8;8(2):ofaa590. Epub 2020 Dec 8.

Sinai Health System, Toronto, Ontario, Canada.

Increasing rates of antimicrobial-resistant organisms have focused attention on sink drainage systems as reservoirs for hospital-acquired Gammaproteobacteria colonization and infection. We aimed to assess the quality of evidence for transmission from this reservoir. We searched 8 databases and identified 52 studies implicating sink drainage systems in acute care hospitals as a reservoir for Gammaproteobacterial colonization/infection. We used a causality tool to summarize the quality of evidence. Included studies provided evidence of co-occurrence of contaminated sink drainage systems and colonization/infection, temporal sequencing compatible with sink drainage reservoirs, some steps in potential causal pathways, and relatedness between bacteria from sink drainage systems and patients. Some studies provided convincing evidence of reduced risk of organism acquisition following interventions. No single study provided convincing evidence across all causality domains, and the attributable fraction of infections related to sink drainage systems remains unknown. These results may help to guide conduct and reporting in future studies.
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http://dx.doi.org/10.1093/ofid/ofaa590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856333PMC
February 2021

Association between upper respiratory tract viral load, comorbidities, disease severity and outcome of patients with SARS-CoV-2 infection.

J Infect Dis 2021 Jan 3. Epub 2021 Jan 3.

Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Background: There is limited information on the association between upper respiratory tract (URT) viral loads, host factors, and disease severity in SARS-CoV-2 infected patients.

Methods: We studied 1,122 patients (mean age: 46 years) diagnosed by PCR. URT viral load, measured by PCR cycle threshold, was categorized as high, moderate or low.

Results: There were 336 (29.9%) patients with comorbidities; 309 patients (27.5%) had high, 316 (28.2%) moderate, and 497 (44.3%) low viral load. In univariate analyses, compared to patients with moderate or low viral load, patients with high viral load were older, had more often comorbidities, developed symptomatic disease, were intubated and died; in addition, patients with high viral load had longer stay in intensive care unit and longer intubation compared to patients with low viral load (p-values <0.05 for all). Patients with chronic cardiovascular disease, hypertension, chronic pulmonary disease, immunosuppression, obesity and chronic neurological disease had more often high viral load (p-value<0.05 for all). Multivariate analysis found that a high viral load was associated with COVID-19. The level of viral load was not associated with any other outcome.

Conclusions: URT viral load could be used to identify patients at higher risk for morbidity or severe outcome.
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http://dx.doi.org/10.1093/infdis/jiaa804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7798974PMC
January 2021

Infectious complications related to medical tourism.

J Travel Med 2021 01;28(1)

Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.

Background: Medical tourism has been increasing dramatically globally, with people travelling from developed countries to low-income or middle-income countries, often to avoid high costs or long delays associated with seeking healthcare in their countries of origin. The current review summarizes healthcare-related infections associated with medical tourism, focusing on cosmetic surgery and organ transplantation.

Methods: A systematic MEDLINE and PubMed search from January 2010 to December 2019 yielded 80 relevant articles, including 49 articles on medical tourism-related infections focusing on cosmetic surgery and organ transplantation, which were included in this reviews.

Results: The literature reveals specific types of cross-border, healthcare-related infections depending on medical intervention. Destinations include low-income countries such as countries of Asia and the Indian subcontinent, middle-income countries including Central and South America, and high-income countries such as the United States and Europe. In terms of type of infections, in 36 (68%) and 15 (28.3%) studies, wound and blood-borne infections were documented, respectively, while in 21 studies (58.3%) non-tuberculous mycobacteria were isolated, including Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium senegalense and Mycobacterium fortuitum. The choices of medical tourists could have significant consequences for them and their home countries, including infectious complications and importation of pathogens, particularly antibiotic-resistant microorganisms, with public health implications.

Conclusions: There is a need for public health strategies in order to prevent morbidity and mortality as well as future management and education of patients engaging in medical tourism.
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http://dx.doi.org/10.1093/jtm/taaa210DOI Listing
January 2021

Knowledge, attitudes and practices about vaccine-preventable diseases and vaccinations of children among pregnant women in Greece.

Vaccine 2020 11 17;38(48):7654-7658. Epub 2020 Oct 17.

First Department of Obstetrics and Gynecology, University of Athens, Alexandra General Hospital, Athens, Greece.

Vaccine hesitancy has been recognized by the World Health Organization as one of ten threats to public health globally in 2019. Pregnant women constitute an extremely important group for the study of knowledge and attitudes towards pediatric vaccinations. This is a cross-sectional survey conducted in two maternity hospitals in Athens. A standardized questionnaire was used. A total of 814 pregnant women with a mean age of 33.1 years and a mean gestational age of 24.4 weeks were studied. Overall, 717 (89%) of 804 pregnant women reported that they intend to vaccinate their baby in accordance with the National Vaccination Program, 7 (1%) that they do not, while 80 (10%) reported that they have not decided yet. The women provided a mean of 11.4 correct replies out of 14 questions about vaccine-preventable diseases and vaccines (mean knowledge score: 81.5%). A pediatrician has been recognized as the source for information about vaccines in most cases (611/809, 75.5%), while in 215 (26.6%) the internet was also used. Overall, pregnant women trusted physicians about information for vaccines ("very much trusted" in 55.9% and "quite trusted" in 40% of cases). Lastly, 642 (81%) women agreed with the statement "vaccinations should be mandatory for school entry" while 70 (9%) women agreed with the statement "parents should have the right to refuse their children vaccinations". A multivariate analysis found that a gestational age of ≤20 weeks (OR = 2.33, CIs: 1.27-4.28, p-value = 0.006), having another child (OR = 4.44, CIs: 2.30-8.58, p-value < 0.001), a history of influenza vaccination (OR = 2.54, CIs = 1.37-4.71, p-value = 0.003), and a higher knowledge score about vaccine-preventable diseases and vaccines (OR = 1.33, CIs: 1.23-1.45, p-value < 0.001) were significantly associated with an increased probability to get their child vaccinated in accordance with the National Vaccination Program.
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http://dx.doi.org/10.1016/j.vaccine.2020.10.003DOI Listing
November 2020

Influenza vaccination policies for health workers in low-income and middle-income countries: A cross-sectional survey, January-March 2020.

Vaccine 2020 11 13;38(47):7433-7439. Epub 2020 Oct 13.

Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.

Introduction: The World Health Organization (WHO) recommends vaccination of health workers against influenza, but uptake in low-resource settings remains low. To complement routine global data collection efforts we conducted a detailed survey on influenza vaccination policies for health workers in low-income and middle-income countries (LMICs) in early 2020.

Methods: Health worker vaccination policy data were collected via a web-based survey tool sent to Expanded Programme on Immunization managers or equivalent managers of all eligible countries. High-income countries and countries with active civil war were excluded from the participation. The survey was sent by email to 109 LMICs in all WHO Regions to invite participation. Data were analyzed by World Bank income category and WHO Region. Statistical methods were applied to assess mean vaccination rates across countries.

Results: Sixty-eight (62%) out of 109 invited LMICs were studied. Thirty-five (51.5%) reported to have a policy for influenza vaccination of health workers. Vaccinations were voluntary in 23 countries (66%), mandatory in 4 (11%), while in 8 countries (23%) mixed vaccination policies existed. A mechanism to estimate vaccine uptake existed in 26 countries (74%). Low-income and African Region countries were less likely to have influenza vaccination policies for health workers (p-values < 0.001 and 0.009, respectively). The most common reason for not having a vaccination policy for health workers was influenza not being a priority (48.5%).

Conclusions: Despite policies being in place in more than half LMICs studied, gaps remain in translating vaccination policies to action, particularly in low-income and African Region countries. To optimize the operationalization of policies, further research is needed within countries, to enable evidence-based introduction decisions, categorization of health workers for vaccination, identification of factors impacting effective service delivery, strengthening monitoring and estimation of vaccination uptake rates and ensure sustainability of funding.
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http://dx.doi.org/10.1016/j.vaccine.2020.10.001DOI Listing
November 2020

Children and Adolescents With SARS-CoV-2 Infection: Epidemiology, Clinical Course and Viral Loads.

Pediatr Infect Dis J 2020 12;39(12):e388-e392

Second Department of Pediatrics, National and Kapodistrian University of Athens, Aglaia Kyriakou Children's Hospital, Athens, Greece.

Background: There is limited information on severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection in children.

Methods: We retrieved data from the national database on SARS-CoV-2 infections. We studied in-family transmission. The level of viral load was categorized as high, moderate, or low based on the cycle threshold values.

Results: We studied 203 SARS-CoV-2-infected children (median age: 11 years; range: 6 days to 18.4 years); 111 (54.7%) had an asymptomatic infection. Among the 92 children (45.3%) with coronavirus disease 2019 (COVID-19), 24 (26.1%) were hospitalized. Infants <1 year were more likely to develop COVID-19 (19.5% of all COVID-19 cases) (P-value = 0.001). There was no significant difference between viral load and age, sex, underlying condition, fever and hospitalization, as well as between type of SARS-CoV-2 infection and age, sex, underlying condition and viral load. Transmission from a household member accounted for 132 of 178 (74.2%) children for whom the source of infection was identified. An adult member with COVID-19 was the first case in 125 (66.8%) family clusters. Child-to-adult transmission was found in one occasion only.

Conclusions: SARS-CoV-2 infection is mainly asymptomatic or mild during childhood. Adults appear to play a key role in spread of the virus in families. Most children have moderate or high viral loads regardless of age, symptoms or severity of infection. Further studies are needed to elucidate the role of children in the ongoing pandemic and particularly in light of schools reopening and the need to prioritize groups for vaccination, when COVID-19 vaccines will be available.
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http://dx.doi.org/10.1097/INF.0000000000002899DOI Listing
December 2020

Coverage rates against vaccine-preventable diseases among healthcare workers in Sicily (Italy).

Eur J Public Health 2021 Feb;31(1):56

Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties, University of Palermo, Palermo, Italy.

Background: Vaccination of healthcare workers (HCWs) reduces the risk of occupational vaccine-preventable diseases (VPDs), prevents their nosocomial transmission and preserves healthcare delivery during outbreaks. Extensive implementation of vaccination programmes for HCWs allowed the elimination or control of several VPDs within healthcare facilities; despite these, the vaccine adherence rates among HCWs are persistently suboptimal.

Methods: A questionnaire was self-administered by HCWs to assess their vaccination rates against several VPDs and self-reported immunity in two university hospitals of Southern Italy (Catania and Palermo).

Results: A total of 2586 questionnaires were analysed. More than 50% of HCWs did not know their own immunization status against diphtheria, tetanus and pertussis. More than half of the HCWs interviewed at University Hospital (UH) of Catania (UHC) was immune against measles (72.1%), in contrast with data reported at the UH of Palermo (UHP) (45.9%). Immunization status against mumps (67.5% UHC vs. 40.6% UHP), rubella (69.9% UHC vs. 46.6% UHP) and varicella (70.4% UHC vs. 50.7% UHP). Overall, about 30% of HCWs did not know their own immunization status against these VPDs. Moreover, 84.2% at UHC and 66.7% at UHP stated that was previously vaccinated against hepatitis B.

Conclusion: Vaccination coverage rates reported from the HCWs against influenza during the last three seasons were considerably low. In conclusion, totally inadequate vaccination rates against several VPDs were found in two university hospitals in Sicily, in terms of preventing not only disease transmission by susceptible HCWs, but also nosocomial outbreaks, confirming data from previous national and international studies.
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http://dx.doi.org/10.1093/eurpub/ckaa179DOI Listing
February 2021

In-flight transmission of COVID-19 on flights to Greece: An epidemiological analysis.

Travel Med Infect Dis 2020 Nov - Dec;38:101882. Epub 2020 Sep 17.

Department of Research, Studies and Documentation, National Public Health Organization, 3-5 Agrafon Street, Athens, 15123, Greece. Electronic address:

Background: The emergence in China in late 2019 and subsequent progression of a pandemic of a respiratory disease named coronavirus disease 2019 (COVID-19) was highly facilitated by international travel. We present 5 cases of probable in-flight transmission in Greece.

Methods: We studied international passengers arriving to or departing from Greece from February 26 through March 9, 2020. Contact tracing extended up to 4 days before the onset of symptoms and focused on close contacts. Close contacts were defined as persons sitting within a distance of <2 m for >15 min, including passengers seated two seats around the index case and all crew members and persons who had close contact with the index case.

Results: We investigated 18 international flights with 2224 passengers and 110 crew members. Main countries of departure included Northern Italy, Israel and the United Kingdom. In accordance with the national surveillance investigation, in these flights there were 21 index cases and 891 contact traced cases. Six index cases were symptomatic during the flight. Of the 891 contact traced cases, 4 passengers and 1 crew member developed laboratory-confirmed infection (3 with COVID-19 and 2 with asymptomatic infection); they travelled on the same flight with two COVID-19 cases.

Conclusions: Air travel has played a central role in the progression of the COVID-19 pandemic. However, there are scarce data about in-flight transmission. Our extensive investigation showed five cases of probable in-flight transmission. Efforts should be placed in order to ensure the prompt implementation of appropriate infection control measures on board.
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http://dx.doi.org/10.1016/j.tmaid.2020.101882DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494513PMC
January 2021

Influenza immunization and COVID-19.

Vaccine 2020 09 29;38(39):6078-6079. Epub 2020 Jul 29.

Mayo Vaccine Research Group, Mayo Clinic and Foundation, 200 First Street, SW Rochester, MN 55905, United States.

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http://dx.doi.org/10.1016/j.vaccine.2020.07.058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388780PMC
September 2020

Transmission dynamics of SARS-CoV-2 within families with children in Greece: A study of 23 clusters.

J Med Virol 2021 03 26;93(3):1414-1420. Epub 2020 Aug 26.

Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection clustering within families with children. We aimed to study the transmission dynamics of SARS-CoV-2 within families with children in Greece. We studied 23 family clusters of coronavirus disease 2019 (COVID-19). Infection was diagnosed by reverse-transcriptase polymerase chain reaction in respiratory specimens. The level of viral load was categorized as high, moderate, or low based on the cycle threshold values. There were 109 household members (66 adults and 43 children). The median attack rate per cluster was 60% (range: 33.4%-100%). An adult member with COVID-19 was the first case in 21 (91.3%) clusters. Transmission of infection occurred from an adult to a child in 19 clusters and/or from an adult to another adult in 12 clusters. There was no evidence of child-to-adult or child-to-child transmission. In total 68 household members (62.4%) tested positive. Children were more likely to have an asymptomatic SARS-CoV-2 infection compared to adults (40% vs 10.5%; P = .021). In contrast, adults were more likely to develop a severe clinical course compared with children (8.8% vs 0%; P = .021). In addition, infected children were significantly more likely to have a low viral load while adults were more likely to have a moderate viral load (40.7% and 18.6% vs 13.8% and 51.7%, respectively; P = .016). In conclusion, while children become infected by SARS-CoV-2, they do not appear to transmit infection to others. Furthermore, children more frequently have an asymptomatic or mild course compared to adults. Further studies are needed to elucidate the role of viral load on these findings.
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http://dx.doi.org/10.1002/jmv.26394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441283PMC
March 2021

SARS-CoV-2 Infection in Healthcare Personnel With High-risk Occupational Exposure: Evaluation of 7-Day Exclusion From Work Policy.

Clin Infect Dis 2020 12;71(12):3182-3187

Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Background: As of late February 2020, Greece has been experiencing the coronavirus disease 2019 (COVID-19) epidemic. Healthcare personnel (HCP) were disproportionately affected, accounting for ~10% of notified cases. Exclusion from work for 7 days was recommended for HCP with high-risk occupational exposure. Our aim was to evaluate the 7-day exclusion from work policy for HCP with high-risk exposure.

Methods: HCP with a history of occupational exposure to COVID-19 were notified to the Hellenic National Public Health Organization, regardless of their exposure risk category. Exposed HCP were followed for 14 days after last exposure.

Results: We prospectively studied 3398 occupationally exposed HCP; nursing personnel accounted for most exposures (n = 1705; 50.2%). Of the 3398 exposed HCP, 1599 (47.1%) were classified as low-risk, 765 (22.5%) as moderate-risk, and 1031 (30.4%) as high-risk exposures. Sixty-six (1.9%) HCP developed COVID-19 at a mean of 3.65 (range: 0-17) days postexposure. Of the 66 HCP with COVID-19, 46, 7, and 13 had a history of high-, moderate- or low-risk exposure (4.5%, 0.9%, and 0.8% of all high-, moderate-, and low-risk exposures, respectively). Hospitalization and absenteeism were more prevalent among HCP with high-risk exposure. A logistic regression analysis showed that the following variables were significantly associated with an increased risk for the onset of COVID-19: male, administrative personnel, underlying disease, and high-risk exposure.

Conclusions: HCP with high-risk occupational exposure to COVID-19 had increased probability of serious morbidity, healthcare seeking, hospitalization, and absenteeism. Our findings justify the 7-day exclusion from work policy for HCP with high-risk exposure.
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http://dx.doi.org/10.1093/cid/ciaa888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337654PMC
December 2020

A cluster of COVID-19 in pilgrims to Israel.

J Travel Med 2020 Aug;27(5)

Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece.

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http://dx.doi.org/10.1093/jtm/taaa102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337872PMC
August 2020

Effectiveness of quadrivalent influenza vaccine in pregnant women and infants, 2018-2019.

Vaccine 2020 06 8;38(29):4625-4631. Epub 2020 May 8.

First Department of Gynecology and Obstetrics, National Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.

Influenza is associated with an increased risk for serious illness, hospitalization and/or death in pregnant women and young infants. We prospectively studied the effectiveness of a quadrivalent inactivated influenza vaccine (QIV) in pregnant women and their infants during the 2018-2019 influenza season. A QIV was offered to pregnant women cared in a maternity hospital in Athens. Women were contacted weekly by telephone during the influenza season and PCR test was offered to women or infants who developed influenza-like illness (ILI). We studied 423 pregnant women and 446 infants. Unvaccinated pregnant women had a 7.5% probability to develop laboratory-confirmed influenza compared to 2.1% among vaccinated women (Odds ratio: 3.6; confidence intervals: 1.14-11.34, p-value = 0.029). Infants whose mothers were not vaccinated had a 7.9% probability to develop laboratory-confirmed influenza compared to 2.8% among infants of vaccinated mothers (Odds ratio = 2.849, confidence intervals: 0.892-9.102, p-value = 0.053). Cox regression analyses showed that QIV vaccination was significantly associated with a decreased probability for laboratory-confirmed influenza, ILI, healthcare seeking and hospitalization among pregnant women and a decreased probability for laboratory-confirmed influenza, healthcare seeking and prescription of antibiotics among infants. The effectiveness of QIV against laboratory-confirmed influenza was 72% among pregnant women and 64.5% among infants during the 2018-2019 influenza season. Vaccination of pregnant women with the QIV was associated with a lower risk for laboratory-confirmed influenza for them and their infants during the influenza season. Our findings strongly support the World Health Organization recommendations for vaccinating pregnant women against influenza.
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http://dx.doi.org/10.1016/j.vaccine.2020.04.060DOI Listing
June 2020

Immunization of healthcare personnel in Europe: Time to move forward with a common program.

Vaccine 2020 04 12;38(16):3187-3190. Epub 2020 Mar 12.

Mayo Vaccine Research Group, Mayo Clinic and Foundation, 200 First Street, Rochester, MN 55905, United States.

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http://dx.doi.org/10.1016/j.vaccine.2020.02.090DOI Listing
April 2020

Vaccination Programs for Adults in Europe, 2019.

Vaccines (Basel) 2020 Jan 20;8(1). Epub 2020 Jan 20.

Department for Interventions in Health Care Facilities, National Organization of Public Health, 15123 Athens, Greece.

Background: While all European countries implement vaccination programs for children, there are gaps in terms of vaccination programs for adults.

Methods: We studied the 2019 vaccination policies for adults in 42 European countries.

Results: Vaccination programs for adults were in place in all countries. However, there were considerable differences between countries in terms of number of vaccinations, target populations and frame of implementation (recommended or mandatory vaccinations). In particular the following vaccination policies were in place: influenza (42 countries), tetanus (31), diphtheria (30), pneumococcus (29), hepatitis B (20), pertussis (18), measles (14), human papilloma virus (14), meningococcus tetravalent A,C,W,Y (14), rubella (13), hepatitis A (11), mumps (11), poliomyelitis (10), herpes zoster (9), varicella (8), tick-born encephalitis (8), meningococcus B (6), rabies (6), type b (5), tuberculosis (3), typhoid fever (3), meningococcus C (2), and yellow fever (1). Seventeen countries implement mandatory vaccinations, mainly against diphtheria, tetanus and hepatitis B.

Conclusions: There are significant differences in vaccination programs for adults in Europe. Routine vaccination programs for adults need to be strengthened. A consensus-based vaccination program is needed.
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http://dx.doi.org/10.3390/vaccines8010034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7157239PMC
January 2020

Circulation of Influenza Type B Lineages in Greece During 2005-2015 and Estimation of Their Impact.

Viral Immunol 2020 03 6;33(2):94-98. Epub 2020 Jan 6.

National Influenza Reference Laboratory for Northern Greece, Microbiology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

The past decades influenza B lineages Victoria and Yamagata cocirculated. Our aim was to estimate the distribution of the two lineages circulating in Greece and any possible mismatching with vaccine influenza B strains. We studied 490 laboratory-confirmed influenza B nonsevere acute respiratory infection (non-SARI) cases diagnosed in the two National Influenza Reference Laboratories by reverse transcriptase polymerase chain reaction from July 1, 2005 to June 30, 2015 and 100 influenza B SARI cases diagnosed from July 1, 2011 to June 30, 2015. Median matching between the circulating influenza B lineages and the vaccine influenza B strains was 19.2% (range: 0-100%) for non-SARI cases during 2005-2015 and 67.6% (range: 41.2-94.1%) for SARI cases during 2011-2015. In two influenza seasons (2005-2006 and 2006-2007), complete lineage mismatch between influenza B non-SARI cases and influenza B vaccine strains was found. We estimated that 5, 12, or 16 laboratory-confirmed SARI cases could have been prevented by quadrivalent influenza inactivated vaccine (QIV) during the 2011-2012 season and 1, 2, or 3 SARI cases during the 2014-2015 season, with a vaccination coverage rate of 70% and a vaccine effectiveness of 20%, 50%, or 70%, respectively. Significant cocirculation of Victoria and Yamagata B strains and mismatching with vaccine influenza B strains were found during 2005-2015 in Greece. The wide use of a QIV instead of a TIV will confer additional immunity and therefore protection against influenza B, and it is expected to prevent several SARI cases annually. Our findings strongly support the recommendations for using QIV.
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http://dx.doi.org/10.1089/vim.2019.0110DOI Listing
March 2020

Herpes zoster after vaccination with one dose varicella vaccine to a 4-year-old child.

Infez Med 2019 12;27(4):449-451

Department for Interventions in Healthcare Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.

Clinical observations from the international literature report that herpes zoster occurs after varicella vaccination in immunocompetent children. We present the case of a four-year-old immunocompetent girl who developed herpes zoster after she had received one dose of varicella-zoster virus live attenuated vaccine at the age of 15 months. Continued surveillance for herpes zoster among vaccinated persons is important to evaluate the varicella vaccination program and to detect any changes in the epidemiology of herpes zoster. Vaccinated children appear to have a lower risk of herpes zoster than people who were infected naturally with varicella zoster virus (chickenpox).
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December 2019

Vaccination coverage and immunity levels against vaccine-preventable diseases in male Air Force recruits in Greece.

Vaccine 2020 01 21;38(5):1181-1185. Epub 2019 Nov 21.

Medical Directorate, Hellenic Air Force General Staff, Athens, Greece.

Aim: Data about susceptibility rates in young adults are scarce. We estimated the complete vaccination rates, timeliness of vaccinations and susceptibility rates among male military recruits in Greece.

Methods: A standardized form was used to collect data. Immunity against measles, rubella, varicella, hepatitis A and hepatitis B was serologically estimated.

Results: We studied 385 recruits with a mean age of 23.5 years (range: 18.3-29.9 years). Complete vaccination rates were 94.3% for measles, 100% for rubella, 15% for varicella, 73.9% for hepatitis A and 96.5% for hepatitis B. Only 10.8% of participants were fully vaccinated against all five diseases. Timely vaccination was 47.2% for measles, 89.3% for rubella and 48.1% for hepatitis B. Recruits >23 years had a 1.5-fold increased probability for incomplete vaccinations compared to younger recruits. Laboratory-confirmed immunity rates were 80% against measles, 85.7% against rubella, 85.2% against varicella, 69.4% against hepatitis A and 77.1% against hepatitis B. It is estimated that approximately 388,696 persons aged 18-30 years are susceptible to measles, 277,640 persons to rubella, 287,736 persons to varicella, 595,664 persons to hepatitis A and 444,224 persons to hepatitis B in Greece.

Conclusion: Our study showed that young adults have significant immunity gaps against measles, rubella, varicella, hepatitis A and hepatitis B. Complete vaccination rates were suboptimal against hepatitis A and varicella. Strategies to access young adults and increase immunity rates through catch-up vaccination services should be investigated. A third dose of MMR vaccine should be considered for young adolescents in Greece.
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http://dx.doi.org/10.1016/j.vaccine.2019.11.021DOI Listing
January 2020

Vaccination of healthcare personnel in Europe: Update to current policies.

Vaccine 2019 12 14;37(52):7576-7584. Epub 2019 Oct 14.

Director, Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN, United States.

We investigated and compared current national vaccination policies for health-care personnel (HCP) in Europe with results from our previous survey. Data from 36 European countries were collected using the same methodology as in 2011. National policies for HCP immunization were in place in all countries. There were significant differences in terms of number of vaccinations, target HCP and healthcare settings, and implementation regulations (recommended or mandatory vaccinations). Vaccination policies against hepatitis B and seasonal influenza were present in 35 countries each. Policies for vaccination of HCP against measles, mumps, rubella and varicella existed in 28, 24, 25 and 19 countries, respectively; and against tetanus, diphtheria, pertussis and poliomyelitis in 21, 20, 19, and 18 countries, respectively. Recommendations for hepatitis A immunization existed in 17 countries, and against meningococcus B, meningococcus C, meningococcus A, C, W, Y, and tuberculosis in 10, 8, 17, and 7 countries, respectively. Mandatory vaccination policies were found in 13 countries and were a pre-requisite for employment in ten. Comparing the vaccination programs of the 30 European countries that participated in the 2011 survey, we found that more countries had national vaccination policies against measles, mumps, rubella, hepatitis A, diphtheria, tetanus, poliomyelitis, pertussis, meningococcus C and/or meningococcus A, C, W, Y; and more of these implemented mandatory vaccination policies for HCP. In conclusion, European countries now have more comprehensive national vaccination programs for HCP, however there are still gaps. Given the recent large outbreaks of vaccine-preventable diseases in Europe and the occupational risk for HCP, vaccination policies need to be expanded and strengthened in several European countries. Overall, vaccination policies for HCP in Europe should be periodically re-evaluated in order to provide optimal protection against vaccine-preventable diseases and infection control within healthcare facilities for HCP and patients.
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http://dx.doi.org/10.1016/j.vaccine.2019.09.061DOI Listing
December 2019

The role of healthcare providers in HPV vaccination programs - A meeting report.

Papillomavirus Res 2019 12 30;8:100183. Epub 2019 Aug 30.

Centre for the Evaluation of Vaccination, University of Antwerp, Belgium.

The Human Papillomavirus (HPV) Prevention and Control Board convened a meeting in Bucharest, Romania (May 2018), to discuss the role of healthcare providers (HCPs) in prevention programs, with a focus on HPV vaccination and cervical cancer screening. International and local experts discussed the role that HCPs can play to increase the uptake of HPV vaccine and screening. Experts recommended: 1) increasing HCP norms of getting vaccinated; 2) training providers to make effective recommendations; 3) making culturally appropriate materials available, in local languages; and 4) centralizing and coordinating education and information material, to direct both HCPs and the general public to the best material available.
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http://dx.doi.org/10.1016/j.pvr.2019.100183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268105PMC
December 2019

A case of Crimean-Congo haemorrhagic fever imported in Greece: Contact tracing and management of exposed healthcare workers.

J Infect Prev 2019 Jul 6;20(4):171-178. Epub 2019 Jun 6.

Department of Infection Control, University Hospital of Alexandroupolis, Alexandroupolis, Greece.

Background: Nosocomial transmission is a major mode of infection of Crimean-Congo haemorrhagic fever (CCHF). In May 2018, a patient with CCHF was hospitalised in Greece.

Objective: Our aim was to present the management of healthcare workers (HCWs) to the CCHF case.

Methods: Contact tracing, risk assessment and follow-up of exposed HCWs were performed. Testing (RT-PCR and/or serology) was offered to contacts. Post-exposure prophylaxis (PEP) with ribavirin was considered for high-risk exposures.

Results: Ninety-one HCWs were exposed to the case. Sixty-six HCWs were grouped as high-risk exposures. Ribavirin PEP was offered to 29 HCWs; seven agreed to receive prophylaxis. Forty-one HCWs were tested for CCHF infection; none was found positive. Gaps in infection control occurred.

Discussion: CCHF should be considered in patients with compatible travel history and clinical and laboratory findings. Early clinical suspicion and laboratory confirmation are imperative for the implementation of appropriate infection control measures. Ribavirin should be considered for high-risk exposures. Infection control capacity for highly pathogenic agents should increase.
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http://dx.doi.org/10.1177/1757177419852666DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683607PMC
July 2019

Mandatory vaccinations for children in Italy: The need for a stable frame.

Vaccine 2019 07 4;37(32):4419-4420. Epub 2019 Jul 4.

Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Italy.

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http://dx.doi.org/10.1016/j.vaccine.2019.05.095DOI Listing
July 2019

Seasonal influenza vaccination in healthcare personnel in Greece: 3-year report.

Future Microbiol 2019 Jun 27;14:55-58. Epub 2019 Jun 27.

Department of Occupational & Industrial Hygiene, National School of Public Health, Attica, Greece.

Influenza vaccination rates of healthcare personnel (HCP) have been largely unsatisfactory in Greece. In September 2016, the Ministry of Health established a Steering Committee in order to raise influenza vaccine uptake by HCP. Hereby, we present the results of the actions undertaken by the Steering Committee during the first 2 years of operation. From the 2015-2016 through the 2017-2018 influenza season, influenza vaccination rates among HCP rose from 10.9 to 24.9% in hospitals, and from 24.3 to 40.2% in primary healthcare centers (increases of 128 and 65%, respectively). Rewards were consistently associated with higher vaccine uptake rates among HCP. The following strategies were also significantly associated with increased vaccination rates: vaccination on-site, vaccination of the heads of the departments and promotion of a culture of safety and ethical duty in the workplace.
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http://dx.doi.org/10.2217/fmb-2018-0266DOI Listing
June 2019

Vaccination of healthcare personnel: time to rethink the current situation in Europe.

Future Microbiol 2019 06 12;14:5-8. Epub 2019 Jun 12.

Occupational Medicine, Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy.

Vaccination of healthcare personnel (HCP) is a key measure for their protection but mainly for the protection of the susceptible patients from healthcare-associated transmission of vaccine-preventable diseases. Studies indicate that there are significant immunity gaps as well as suboptimal vaccination uptake rates among HCP across Europe. Despite the fact that all European countries have vaccination policies for HCP, there are significant variations among them in terms of recommended vaccines and implementation frameworks (recommended or mandatory). In an environment of increasing vaccine hesitancy, Italy has one of the highest rates of skepticism related to safety and effectiveness of vaccines. It is also one of the first European countries to address this issue in a comprehensive way, implementing mandatory vaccination policies for several vaccinations included in the routine vaccination program, but also for HCPs as a requirement for employment.
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http://dx.doi.org/10.2217/fmb-2018-0262DOI Listing
June 2019

Vaccination in healthcare workers: risk assessment, planning, strategy of intervention and legal implications.

Future Microbiol 2019 06 11;14:1-3. Epub 2019 Jun 11.

Department for Interventions in Healthcare Facilities, Hellenic Centre for Disease Control & Prevention, Athens, Greece.

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http://dx.doi.org/10.2217/fmb-2018-0235DOI Listing
June 2019

Partnering for enhanced digital surveillance of influenza-like disease and the effect of antivirals and vaccines (PEDSIDEA).

Influenza Other Respir Viruses 2019 07 6;13(4):309-318. Epub 2019 Jun 6.

National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany.

Background: Standardised clinical outcome measures are urgently needed for the surveillance of influenza and influenza-like illness (ILI) based on individual patient data (IPD).

Objectives: We report a multicentre prospective cohort using a predefined disease severity score in routine care.

Patients/methods: The Vienna Vaccine Safety initiative (ViVI) Disease Severity Score ("ViVI Score") was made available as an android-based mobile application to three paediatric hospitals in Berlin and Athens between 2013 and 2016. Healthcare professionals assessed ILI patients at the point of care including severity, risk factors and use of antibiotics/antivirals/vaccines. RT-PCR for influenza A/B viruses was performed at the Hellenic Pasteur Institute and the Robert Koch Institute. PCR testing was blinded to severity scoring and vice versa.

Results: A total of 1615 children aged 0-5 years (54.4% males) were assessed at the three sites. The mean age was 1.7 years (SD 1.5; range 0-5.9). The success rate (completion of the scoring without disruption to the ER workflow) was 100%. ViVI Disease Severity Scores ranged from 0 to 35 (mean 13.72). Disease severity in the Berlin Cohort was slightly higher (mean 15.26) compared to the Athens Cohorts (mean 10.86 and 11.13). The administration of antibiotics was most prevalent in the Berlin Cohort, with 41.2% on antibiotics (predominantly cefuroxime) as opposed to only 0.5% on neuraminidase inhibitors. Overall, Risk-adjusted ViVI Scores were significantly linked to the prescription of both, antibiotics and antivirals.

Conclusions: The Risk-adjusted ViVI Score enables a precision medicine approach to managing ILI in multicentre settings. Using mobile applications, severity data will be obtained in real time with important implications for the evaluation of antiviral/vaccine use.
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http://dx.doi.org/10.1111/irv.12645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586183PMC
July 2019

Knowledge about influenza and adherence to the recommendations for influenza vaccination of pregnant women after an educational intervention in Greece.

Hum Vaccin Immunother 2019 20;15(5):1070-1074. Epub 2019 Feb 20.

b First Department of Gynecology and Obstetrics, National and Kapodistrian University of Athens , Alexandra General Hospital , Athens , Greece.

Pregnant women and young infants are at increased risk for influenza-associated severe disease, complications and hospitalizations. In Greece influenza vaccination during pregnancy remains extremely low. We studied the knowledge about influenza and the adherence to the recommendations for influenza vaccination of pregnant women following an educational intervention in a large maternity hospital. A standardized questionnaire was used. A knowledge score was calculated for each woman. A total of 304 pregnant women were studied [mean age: 31.5 years (standard deviation (SD): 5.4 years), mean gestational age: 27.8 weeks (SD: 9.6 weeks)]. Their mean knowledge score was 87%. Sixty pregnant women (19.5%) were vaccinated against influenza at a mean gestational age of 24.6 weeks (SD: 7.5 weeks). Multiple regression analysis revealed that previous influenza vaccination and information about the need to get vaccinated were the only significant factors associated with an increased probability for influenza vaccination during pregnancy (47% versus 17% in women with and without a history of influenza vaccination in the past, respectively; odds ratio = 3.6; p-value = 0.016, and 32% versus 4% in women informed compared to those uninformed about the need for vaccination during pregnancy, respectively; odds ratio = 17.8; p-value<0.001). Seventy women provided a reason for refusing influenza vaccination. "Fear of adverse events" (for them or the fetus) was the prevalent reason for refusing influenza vaccination (19 women; 27%), followed by the statements "influenza vaccination is not necessary" (13; 18.5%) and "not at risk to get influenza" (9; 13%). In conclusion, an educational intervention was associated with an influenza vaccination rate of 19.5% among pregnant women compared to <2% the past years. In order to improve vaccine uptake by pregnant women and protect them and their babies, more intensified interventions should be explored.
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http://dx.doi.org/10.1080/21645515.2019.1568158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605856PMC
February 2020