ABSTRACT Introduction: Influenza is a global threat, with high epidemic potential and affects between 5 and 15% of the world's population annually. In the hospital environment, vaccination is crucial to protect healthcare professionals. However, despite international recommendations, vaccination uptake is low due to safety concerns and/or distrust. Studies show that vaccinated professionals have lower rates of absenteeism, and when infected with the virus, they present milder symptoms. In this work, a retrospective cross-sectional observational study is carried out on the vaccination rate against this disease in a population of hospital-based workers, from 2019 to 2023. To understand the importance of vaccination against Influenza in these workers and which behavioral determinants may justify considering this evolution, we carried out a review of the challenges of vaccination among health professionals and identified key points to develop strategies with the aim of promoting adherence to vaccination campaigns. Methodology: For the observational study, vaccination data from hospital health professionals by the Occupational Health Service was used, recorded on a specific form at the time of administration. Professional category was the only variable considered. Data analysis was performed using Microsoft® Excel®. For the review, the databases Medline, Science Direct and Google Scholar were used, with the keywords "Influenza vaccine”, “health professional” and “behaviour”, selecting studies from 2010 to 2024. From the result of 1277 works, the exclusion criteria, which included vaccination for other diseases and target populations that did not include health professionals, 22 bibliographic sources were selected. To reflect the national reality, articles on the topic published by the Revista Portuguesa de Saúde Ocupacional Online were included, as well as complementary studies and reference documents. Results: The study of adherence to flu vaccination in this hospital peripheral to Lisbon, between 2019 and 2023, showed a variation in vaccination adherence, with an average of 30%, a value below the ones reported in other countries. The categories most hesitant about this vaccine were Nursing Staff and Technical Assistants; at the opposite extreme, there was greater adherence from Medical Personnel and Technical Assistants. During the COVID-19 Pandemic, an increasing number of professionals were vaccinated annually, with this trend reversing after the end of the global emergency of this disease. From the review of the literature on vaccine hesitancy, 8 of the 14 behavioral domains stand out that represent theories of behavioral change that constitute modifiable factors that influence behavior in relation to the vaccine. We approach each of them from this perspective, namely: knowledge, the environmental context and resources, social influence, beliefs and knowledge about consequences, beliefs about individual capacity, identity and social/professional role, reinforcement and emotion. Discussion: Flu vaccine hesitancy among healthcare professionals can be a cause of morbidity and mortality for patients. Understanding the barriers and motivation for healthcare professionals to adhere to flu vaccination campaigns is crucial. Professionals who are asymptomatic carriers become sources of transmission. Annual vaccination, although safe and effective, faces variability due to antigenic concordance. In Portugal, educational and communication strategies are vital, highlighting the role of health professionals as models of preventive behavior. Easy access to medical consultations and Occupational Health recommendations is associated with greater adherence. In times of pandemic, the propensity for vaccination has increased, and it is important to promote this change. Strategies adapted to the cultural context are essential to boost adherence to Influenza vaccination among healthcare professionals. Conclusion: The approach to combating barriers and promoting vaccination among healthcare professionals must involve multiple areas and multiple levels, with communication targeted at specific groups, to increase its effectiveness. The message must be adapted to different population groups and different levels of health literacy. Knowing these behavioral determinants can help develop vaccination promotion campaigns from new perspectives and finding strategies to increase vaccination coverage is crucial for Occupational Health Services. Due to the ethical characteristics of the professions involved in providing direct care to patients, there is a need to reinforce the idea that vaccination among healthcare professionals is not only for their benefit, but above all for the protection of their patients.

RESUMO Introdução: A Gripe é uma ameaça global, com alto potencial epidémico e afeta anualmente entre 5 a 15% da população mundial. No ambiente hospitalar, a vacinação é crucial para proteger os Profissionais de Saúde. No entanto, apesar das recomendações internacionais, a adesão é baixa devido a preocupações de segurança e/ou desconfiança. Estudos mostram que os profissionais vacinados têm menores taxas de absentismo e, perante infeção pelo vírus, apresentam sintomatologia mais ligeira. Neste trabalho é realizado um estudo observacional transversal retrospetivo da taxa de vacinação contra esta doença numa população de trabalhadores de base hospitalar, no período de 2019 a 2023. Para compreender a importância da vacinação contra a Influenza nestes trabalhadores e quais os determinantes comportamentais que podem justificar esta evolução, realizou-se uma revisão dos desafios da vacinação entre Profissionais de Saúde, para identificar pontos chave e elaborar estratégias com o objetivo de promover a adesão às campanhas de vacinação. Metodologia: Para o estudo observacional da taxa de adesão à vacinação contra a Gripe num hospital periférico foram utilizados os dados de vacinação dos Profissionais de Saúde disponibilizados nos registos do Serviço de Saúde Ocupacional. A categoria profissional foi a única variável considerada. A análise dos dados foi realizada com o Microsoft® Excel®. Para a revisão recorreu-se às bases de dados Medline, Science Direct, Google Scholar; com as palavras-chave "Influenza vaccine”; “health professional” e “behaviour" e filtraram-se estudos de 2010 a 2024. Resultaram 1277 trabalhos e, após aplicar os critérios de exclusão, que incluíam vacinação para outras doenças e populações alvo que não os Profissionais de Saúde, foram selecionadas 22 fontes bibliográficas. Para espelhar a realidade nacional foram incluídos os artigos sobre o tema publicados pela Revista Portuguesa de Saúde Ocupacional Online, assim como estudos complementares e documentos de referência. Resultados: O estudo da adesão à vacinação contra a Gripe neste hospital periférico a Lisboa, entre 2019 e 2023, mostrou uma variação na adesão à vacinação, com uma média de 30%, valor abaixo dos valores reportados noutros países. As categorias com maior hesitação a esta vacina foram o Pessoal de Enfermagem e os Assistentes Técnicos. Na situação oposta estavam o Pessoal Médico e os Assistentes Técnicos. Durante a Pandemia COVID-19 existiu um número crescente de profissionais vacinados anualmente, tendo esta tendência invertido após o fim da emergência global desta doença. Da revisão da bibliografia sobre a hesitação vacinal destaca-se 8 dos 14 domínios comportamentais que representam as teorias de mudança comportamental que constituem fatores modificáveis que influenciam a atitude em relação à vacina. Abordou-se sobre esta perspetiva cada um deles, nomeadamente, o conhecimento; o contexto ambiental e recursos; influência social; crenças e conhecimento sobre consequências; bem como sobre a capacidade individual; identidade e papel social/profissional; reforço e emoção. Discussão: A hesitação vacinal contra a Gripe entre Profissionais de Saúde pode ser uma causa de morbilidade e mortalidade para os doentes. Compreender as barreiras e motivação para a adesão dos Profissionais de Saúde às campanhas de vacinação contra a Gripe é crucial. Profissionais portadores assintomáticos, tornam-se fontes de transmissão. A vacinação anual, embora segura e eficaz, enfrenta variabilidade devido à concordância antigénica. Em Portugal, estratégias educacionais e de comunicação são vitais, destacando o papel dos Profissionais de Saúde como modelos de comportamento preventivo. O acesso fácil a consultas médicas e tal ser recomendado pela Saúde Ocupacional é associado a maior adesão. Em tempos de pandemia, a propensão à vacinação aumentou, importando promover esta mudança. Estratégias adaptadas ao contexto cultural são essenciais para impulsionar a adesão à vacinação contra a Gripe entre Profissionais de Saúde. Conclusão: A abordagem para combater as barreiras e promover a vacinação nos Profissionais de Saúde deve envolver múltiplas áreas e vários níveis, com uma comunicação dirigida a grupos específicos, para aumentar a sua eficácia. Deve adaptar-se a mensagem aos diferentes grupos populacionais e aos diferentes níveis de literacia em saúde. Conhecer estes determinantes comportamentais pode ajudar a desenvolver campanhas de promoção da vacinação a partir de novas perspetivas e encontrar estratégias para aumentar a cobertura vacinal é crucial para os Serviços de Saúde Ocupacional. Pelas características éticas das profissões envolvidas na prestação de cuidados diretos aos doentes, existe a necessidade de reforçar a ideia de que a vacinação entre Profissionais de Saúde não é apenas para seu benefício mas, acima de tudo, para proteção dos seus doentes.

Abstract The present work studies and analyzes six books of the sick and two books of the sick of the Hospital Juanino de Nuestra Señora de los Desamparados of the city of Tezcoco elaborated in the XVIII century; but it focuses its attention on three important epidemics that struck the local population in 1737 (Matlazahuatl), 1784 (Influenza) and 1813 (Typhus). These manuscripts have remained in historiographic oblivion and their analysis allows us to know the ages, origin and “sickness” that were treated in a hospital during the eighteenth century.

Resumen El presente trabajo estudia y analiza seis libros de enfermos y dos de enfermas del hospital juanino de Nuestra Señora de los Dolores, de la ciudad de Tezcoco, elaborados en el siglo XVIII. La atención estará centrada en tres importantes epidemias que azotaron a la población local en 1737 (matlazahuatl), en 1784 (influenza) y en 1813 (tifo). Dichos manuscritos han permanecido en el olvido historiográfico y su análisis permite conocer las edades, procedencia y “enfermad” que era atendida en un hospital durante el siglo XVIII.

Résumé Cet article étudie et analyse huit ouvrages rédigés au XVIIIème par des patients, dont deux par des femmes, provenant de l’Hôpital Nuestra Señora de los Dolores de la ville de Tezcoco, fondé par l’ordre des Frères de la Charité (Juaninos). Il se focalise sur trois épidémies importantes qui ont frappé la population locale en 1737 (Matlazahuatl), 1784 (grippe) et 1813 (typhus). Ces manuscrits sont restés dans l’oubli historiographique mais leur analyse nous offre des informations essentielles sur l’âge, la provenance et le type de maladie des personnes qui étaient prises en charge dans un hôpital au XVIIIème.

Abstract Objective: To evaluate if the comorbidity and coinfections presented by SARS-CoV-2 infection vs. COVID-19 impact our Mexican children. Method: Prospective and observational study that included the 2020-2021 peak influenza season. All patients with a diagnosis of infection by SARS-CoV-2 vs. COVID-19 who were admitted to the Hospital Infantil de Mexico were analyzed. Real-time RT-PCR for SARS-CoV-2 was performed in all patients, determining E, RdRp and RP genes and protein N, as well as RT-PCR for detection of respiratory viruses. Results: The inclusion criteria were met by 163 patients. The group with the highest risk of becoming ill was adolescents (40.4%), followed by schoolchildren and preschoolers (21.4% and 19.6% of the cases, respectively). There were three cases with viral coinfection: two (1.2%) with parvovirus B-19 and one (0.6%) with herpes type I; another two (1.2%) showed bacterial coinfection. The main comorbidity were obesity, acute lymphoblastic leukemia and arterial hypertension. Regarding mortality, we only had four cases (2.4%). Conclusions: Obesity, cancer, hypertension, heart disease and diabetes are comorbidity present in our patients, as referred to in literature, but not coinfections. In our study, we did not have any associated mortality related to comorbidity.

Resumen Objetivo: Evaluar el impacto de la comorbilidad y de las coinfecciones presentadas por la infección por SARS-CoV-2 vs. COVID-19 en niños mexicanos. Método: Estudio prospectivo y observacional que comprendió la temporada alta de influenza 2020-2021, analizando todos los pacientes con diagnóstico de infección vs. enfermedad por SARS-CoV-2 vs. COVID-19 que ingresaron al Hospital Infantil de México. Se realizó en todos RT-PCR en tiempo real para SARS-CoV-2, determinando gen E, gen RdRp, gen RP y proteína N, y RT-PCR multiplex para detección de virus respiratorios. Resultados: Los criterios de inclusión los cumplieron 163 pacientes. El grupo con mayor riesgo de enfermar fueron los adolescentes (40.4%), seguidos de los escolares y preescolares (21.4% y 19.6% de los casos, respectivamente). Hubo tres casos con coinfección viral: dos (1.2%) con parvovirus B-19 y uno (0.6%) con herpes tipo I; hubo otros dos (1.2%) con coinfección bacteriana. La principal comorbilidad correspondió a obesidad, leucemia linfoblástica aguda e hipertensión arterial. En cuanto a mortalidad, solo hubo cuatro casos (2.4%). Conclusiones: Obesidad, cáncer, hipertensión, cardiopatías y diabetes constituyen la comorbilidad en nuestros pacientes, como se refiere en la literatura, no así las coinfecciones. En nuestro estudio no hubo casos de mortalidad relacionada con la comorbilidad.

BACKGROUND: Dentistry is regarded as a high-risk profession due to increased levels of exposure to oral secretions, aerosols and fomites that harbour infectious microorganism. Yet evidence indicates poor uptake of vaccines against HBV and, most recently, Covid-19. This study sought to investigate the predictors of Covid-19 vaccination intention among oral health professionals in South Africa. METHODOLOGY: In 2022, a representative national sample of oral health professionals was surveyed using an online questionnaire. Consenting practitioners provided demographic data, information on vaccination history and five psychological antecedents of Covid-19 vaccine. Data analysis was undertaken using SPSS ver. 29.0. RESULTS: Our findings indicate high vaccination intention rate among the OHPs (77.9%), especially those with history of influenza vaccination (OR=2.65, p=0.003). The was a positive correlation between the 5C psychological antecedents (confidence and collective benefit) and intention to vaccinate. Positive Covid-19 diagnosis did not affect vaccination intention. CONCLUSION: Most oral health professionals intended to get the Covid-19 vaccination. For those showing low willingness to vaccinate, psychological antecedent factors such as complacency and calculation should be addressed to improve vaccination intention and uptake.

RESUMEN Introducción: A nivel mundial, la cobertura de vacunación contra el COVID-19, así como contra la influenza es baja tanto en la población general como en los profesionales de la salud a pesar de que la vacuna es gratuita y obligatoria en el personal sanitario. Objetivo: Describir la cobertura de vacunación contra el COVID -19, y la influenza en personal de salud y administrativo de un hospital de referencia del Ministerio de Salud Pública y Bienestar Social en el periodo 2021-2022. Metodología: Estudio observacional descriptivo de corte trasverso. Se hizo la revisión de los registros del personal sanitario y administrativo del centro vacunatorio del Hospital Nacional de Itauguá de la campaña vacunal contra el COVID-19 y de anti-influenza en el periodo 2021- 2022. Resultados: De los 3.586 funcionarios, 999 (27,9 %) eran médicos, 1494 (41,7 %) personal de enfermería, 366 (10,2 %) otra categoría de personal sanitario, y 727 (20,3 %) personal administrativo. En forma global, el 86,5 % de los funcionarios recibió por lo menos las dos dosis que constituyen el esquema primario y el 73 % la dosis de refuerzo. El 2,1 % del personal no recibió ninguna dosis de vacuna anti covid-19, la cifra fue mayor en el personal administrativo (4,8 %). La cobertura de vacunación contra la influenza fue de 20 % en el 2021 y 25 % en el 2022. Discusión: Si bien cobertura de vacunación anti-COVID-19 fue comparable a otros países, la vacunación contra la influenza fue muy baja. Es urgente implementar estrategias dirigidas a aumentar la percepción de riesgo y aceptabilidad de las vacunas obligatorias para el personal sanitario.

ABSTRACT Introduction: Worldwide, vaccination coverage against COVID-19, as well as against influenza, is low both in the general population and in health professionals, despite the fact that the vaccine is free and mandatory for health personnel. Objective: To describe the COVID -19 and influenza vaccination coverage in health and administrative personnel of a reference hospital of the Ministry of Public Health and Social Welfare in the period 2021-2022. Methods: Cross-sectional descriptive observational study. Charts of the health and administrative personnel of the vaccination center of the Itauguá National Hospital of the COVID-19 and influenza vaccination campaign in the period 2021-2022 were reviewed. Results: Of the 3,586 personnel, 999 (27.9%) were medical personnel, 1,494 (41.7%) nursing personnel, 366 (10.2%) other category of health personnel, and 727 (20.3%) administrative personnel. Overall, 86.5% of the employees received at least the two doses that constitute the primary schedule and 73% the booster dose; 2.1% of the staff did not receive any dose of the anti COVID-19 vaccine, which was higher in the administrative staff (4.8%). Influenza vaccination coverage was 20% in 2021 and 25% in 2022. Discussion: Even though the vaccination coverage of anti-COVID-19 was comparable to other countries, vaccination anti-influenza was very low. It is urgent to implement strategies aimed at increasing the perception of risk and acceptability of mandatory vaccines for health personnel.

ABSTRACT Cardiovascular diseases stand as the leading cause of mortality among adults globally. For decades, comprehensive evidence has underscored the correlation between infections, particularly those involving the respiratory system, and an elevated risk of cardiovascular and cerebrovascular events, as well as all-cause mortality. The mechanisms through which infections heighten cardiovascular events are intricate, encompassing immune system activation, systemic inflammation, hypercoagulable states, sympathetic system activation, and increased myocardial oxygen demand. Respiratory infections further contribute hypoxemia to this complex interplay. These mechanisms intertwine, giving rise to endothelial dysfunction, plaque ruptures, myocardial depression, and heart failure. They can either instigate de novo cardiovascular events or exacerbate pre-existing conditions. Compelling evidence supports the safety of influenza, pneumococcal, herpes zoster, COVID-19 and respiratory syncytial virus vaccines in individuals with cardiovascular risk factors or established cardiovascular disease. Notably, the influenza vaccine has demonstrated safety even when administered during the acute phase of a myocardial infarction in individuals undergoing angioplasty. Beyond safety, these vaccinations significantly reduce the incidence of cardiovascular events in individuals with an augmented cardiovascular risk. Nevertheless, vaccination rates remain markedly suboptimal. This manuscript delves into the intricate relationship between infections and cardiovascular events. Additionally, we highlight the role of vaccinations as a tool to mitigate these occurrences and reduce residual cardiovascular risk. Finally, we emphasize the imperative need to optimize vaccination rates among individuals with heart diseases.

Abstract Investigating the interplay of factors that result in a viral zoonotic outbreak is difficult, though it is increasingly important. As anthropogenic influences shift the delicate balance of ecosystems, new zoonoses emerge in humans. Sub-Saharan Africa is a notable hotspot for zoonotic disease due to abundant competent mammalian reservoir hosts. Furthermore, poverty, corruption, and an overreliance on natural resources play considerable roles in depleting biological resources, exacerbating the population's susceptibility. Unsurprisingly, viral zoonoses have emerged in Africa, including HIV/AIDS, Ebola, Avian influenza, Lassa fever, Zika, and Monkeypox. These diseases are among the principal causes of death in endemic areas. Though typically distinct in their manifestations, viral zoonoses are connected by underlying, definitive factors. This review summarises vital findings on viral zoonoses in Africa using nine notable case studies as a benchmark for future studies. We discuss the importance of ecological recuperation and protection as a central strategy to control zoonotic diseases. Emphasis was made on moderating key drivers of zoonotic diseases to forestall future pandemics. This is in conjunction with attempts to redirect efforts from reactive to pre-emptive through a multidisciplinary “one health” approach. difficult important ecosystems humans SubSaharan Sub Saharan hosts Furthermore poverty corruption populations population s susceptibility Unsurprisingly HIVAIDS HIV AIDS HIV/AIDS Ebola influenza fever Zika Monkeypox areas manifestations underlying pandemics preemptive pre emptive one health approach

Resumo Investigar a interação de fatores que resultam em um surto zoonótico viral é difícil, embora seja cada vez mais relevante. À medida que as influências antropogênicas mudam o delicado equilíbrio dos ecossistemas, novas zoonoses surgem em humanos. A África Subsaariana é um ponto crítico notável para doenças zoonóticas devido a abundantes reservatórios mamíferos competentes. Além disso, a pobreza, a corrupção e o excesso de confiança nos recursos naturais desempenham papéis consideráveis no esgotamento dos recursos biológicos, exacerbando a suscetibilidade da população. Sem surpresa, zoonoses virais surgiram na África, incluindo HIV/AIDS, Ebola, gripe aviária, febre de lassa, zika e varíola dos macacos. Essas doenças estão entre as principais causas de morte em áreas endêmicas. Apesar de serem tipicamente distintas em suas manifestações, as zoonoses virais estão conectadas por fatores subjacentes e definitivos. Esta revisão resume descobertas vitais sobre zoonoses virais na África usando nove estudos de caso notáveis como referência para estudos futuros. Discutimos a importância da recuperação e proteção ecológica como estratégia central para o controle de doenças zoonóticas. Foi dada ênfase à moderação dos principais impulsionadores de doenças zoonóticas para prevenir futuras pandemias. Isso ocorre em conjunto com tentativas de redirecionar os esforços de reativos para preventivos por meio de uma abordagem multidisciplinar de “uma só saúde”. difícil relevante ecossistemas humanos competentes disso pobreza biológicos população surpresa HIVAIDS HIV AIDS HIV/AIDS Ebola aviária lassa macacos endêmicas manifestações definitivos futuros pandemias saúde. saúde . saúde”

ABSTRACT Objective: To evaluate severe acute respiratory syndrome surveillance in a pediatric unit. Methods: Descriptive study of reported severe acute respiratory syndrome cases with the detection of respiratory viruses in the nasopharyngeal sample of patients hospitalized between 2013 and 2019, in a reference hospital in the Federal District, Brazil. Results: A total of 269 children had one or more viruses detected, resulting in 280 viruses, of which 152 (54%) were respiratory syncytial virus. The detection of respiratory syncytial virus was higher during the autumn-winter period. Children´s median age was 6.9 months, 156 (58%) were male, 104 (39%) had comorbidity, 197 (73%) required mechanical ventilation, 241 (90%) received antibiotics, and 146 (54%) oseltamivir. There were 19 (7%) deaths. The median time from symptom onset to sample collection was 5 days and the median time from sample collection to final results was 6 days. Conclusions: The system needs to reduce the time to deliver results so that inappropriate use of antibiotics and antivirals can be avoided. Moreover, the burden of viral pneumonia was relevant and the system must be flexible enough to include emerging viruses in order to be useful in responding to public health emergencies caused by respiratory viruses. Objective unit Methods 201 2019 District Brazil Results 26 detected 28 15 54% 54 (54% autumnwinter autumn winter period Childrens Children s 69 9 6. months 58% 58 (58% male 10 39% 39 (39% comorbidity 73% 73 (73% ventilation 24 90% 90 (90% 14 oseltamivir 1 7% 7 (7% deaths Conclusions avoided Moreover 20 2 (54 (58 3 (39 (73 (90 (7 (5 (3 (9 (

RESUMO Objetivo: Avaliar a vigilância da síndrome respiratória aguda grave em uma unidade pediátrica. Métodos: Estudo descritivo dos casos de síndrome respiratória aguda grave, notificados e com a detecção de vírus respiratório em amostra de nasofaringe de pacientes internados entre 2013 e 2019, em um hospital de referência do Distrito Federal. Resultados: Um total de 269 crianças tiveram algum vírus detectado, resultando em 280 vírus, sendo 152 (54%) vírus sincicial respiratório. A detecção do vírus sincicial respiratório foi maior durante o período de outono-inverno. A mediana da idade das crianças foi de 6,9 meses, 156 (58%) eram do sexo masculino, 104 (39%) tinham comorbidade, 197 (73%) necessitaram de ventilação mecânica, 241 (90%) receberam antibióticos e 146 (54%) oseltamivir. Ocorreram 19 (7%) óbitos. A mediana do tempo desde o início dos sintomas até a coleta da amostra foi de 5 dias, e do tempo da coleta até o resultado foi de 6 dias. Conclusões: O sistema necessita reduzir o tempo do resultado final para que seja possível evitar o uso inadequado de antibióticos e antivirais. Ademais, o impacto das pneumonias virais foi relevante e o sistema deve ser flexível suficiente para incluir vírus emergentes, para ser útil na resposta às emergências de saúde pública causada por vírus respiratórios. Objetivo pediátrica Métodos 201 2019 Federal Resultados 26 detectado 28 15 54% 54 (54% outonoinverno. outonoinverno outono inverno. inverno outono-inverno 69 9 6, meses 58% 58 (58% masculino 10 39% 39 (39% comorbidade 73% 73 (73% mecânica 24 90% 90 (90% 14 oseltamivir 1 7% 7 (7% óbitos dias Conclusões antivirais Ademais emergentes respiratórios 20 2 (54 (58 3 (39 (73 (90 (7 (5 (3 (9 (

ABSTRACT Objective To review the long-term outcomes (functional status and psychological sequelae) of survivors of critical illnesses due to epidemic viral pneumonia before the COVID-19 pandemic and to establish a benchmark for comparison of the COVID-19 long-term outcomes. Methods This systematic review of clinical studies reported the long-term outcomes in adults admitted to intensive care units who were diagnosed with viral epidemic pneumonia. An electronic search was performed using databases: MEDLINE®, Web of Science™, LILACS/IBECS, and EMBASE. Additionally, complementary searches were conducted on the reference lists of eligible studies. The quality of the studies was assessed using the Newcastle-Ottawa Scale. The results were grouped into tables and textual descriptions. Results The final analysis included 15 studies from a total of 243 studies. This review included 771 patients with Influenza A, Middle East Respiratory Syndrome, and Severe Acute Respiratory Syndrome. It analyzed the quality of life, functionality, lung function, mortality, rate of return to work, rehospitalization, and psychiatric symptoms. The follow-up periods ranged from 1 to 144 months. We found that the quality of life, functional capacity, and pulmonary function were below expected standards. Conclusion This review revealed great heterogeneity between studies attributed to different scales, follow-up time points, and methodologies. However, this systematic review identified negative long-term effects on patient outcomes. Given the possibility of future pandemics, it is essential to identify the long-term effects of viral pneumonia outbreaks. This review was not funded. Prospero database registration: (www.crd.york.ac.uk/prospero) under registration ID CRD42021190296. longterm long term sequelae COVID19 COVID 19 COVID-1 databases MEDLINE MEDLINE® Science Science™ LILACSIBECS LILACS IBECS LILACS/IBECS EMBASE Additionally NewcastleOttawa Newcastle Ottawa Scale descriptions 24 77 A Syndrome life functionality mortality work rehospitalization symptoms followup follow up 14 months capacity standards scales points methodologies However pandemics outbreaks funded www.crd.york.ac.uk/prospero wwwcrdyorkacukprospero www crd york ac uk prospero (www.crd.york.ac.uk/prospero CRD42021190296 CRD COVID1 COVID- 2 7 CRD4202119029 CRD420211902 CRD42021190 CRD4202119 CRD420211 CRD42021 CRD4202 CRD420 CRD42 CRD4

SUMMARY OBJECTIVE: The aim of this study was to estimate the prevalence of influenza immunization in elderly people in Brazil in 2019. METHODS: This is a population-based cross-sectional study. The Brazilian individuals (≥60 years) who participated in the 2019 National Health Survey were included. The survey was conducted in permanent households in Brazil from August 2019 to March 2020. The prevalences of influenza vaccination and their respective confidence intervals (95%CI) were estimated according to sociodemographic characteristics and the diagnosis of chronic diseases. RESULTS: The prevalence of influenza vaccination was 72.4% (95%CI 71.5–73.2), with statistically significant differences observed between genders (p=0.001), age groups (p=0.001), and those living with a spouse/partner (p=0.002). Significant differences were found in groups with arterial hypertension (75.2%, p<0.001), diabetes (77.2%, p<0.001), and arthritis or rheumatism (75.5%, p<0.001). CONCLUSION: A global prevalence of influenza vaccination of 72.4% was estimated among elderly people in Brazil. OBJECTIVE METHODS populationbased population based crosssectional cross sectional ≥60 60 (≥6 years 201 included 2020 95%CI 95CI CI 95 diseases RESULTS 724 72 4 72.4 71.5–73.2, 715732 71.5–73.2 , 71 5 73 2 71.5–73.2) p=0.001, p0001 p p=0.001 0 001 (p=0.001) spousepartner spouse partner p=0.002. p0002 p=0.002 . 002 (p=0.002) 75.2%, 752 75 (75.2% p<0.001, p<0.001 p<0.001) 77.2%, 772 77 (77.2% 75.5%, 755 (75.5% p<0.001. CONCLUSION ≥6 6 (≥ 20 202 9 7 72. 71573 71.5–73. p000 p=0.00 00 (p=0.001 (p=0.002 75.2% (75.2 p<0.00 77.2% (77.2 75.5% (75.5 ≥ ( 7157 71.5–73 p00 p=0.0 (p=0.00 75.2 (75. p<0.0 77.2 (77. 75.5 715 71.5–7 p0 p=0. (p=0.0 75. (75 p<0. 77. (77 71.5– p=0 (p=0. (7 p<0 71.5 p= (p=0 p< 71. (p= (p

ABSTRACT Objective: To analyze the influence of individual and contextual factors of the hospital and the municipality of care on the survival of patients with Severe Acute Respiratory Syndrome due to COVID-19. Methods: Hospital cohort study with data from 159,948 adults and elderly with Severe Acute Respiratory Syndrome due to COVID-19 hospitalized from January 1 to December 31, 2022 and reported in the Influenza Epidemiological Surveillance Information System. The contextual variables were related to the structure, professionals and equipment of the hospital establishments and socioeconomic and health indicators of the municipalities. The outcome was hospital survival up to 90 days. Survival tree and Kaplan-Meier curves were used for survival analysis. Results: Hospital lethality was 30.4%. Elderly patients who underwent invasive mechanical ventilation and were hospitalized in cities with low tax collection rates had lower survival rates compared to other groups identified in the survival tree (p<0.001). Conclusion: The study indicated the interaction of contextual factors with the individual ones, and it shows that hospital and municipal characteristics increase the risk of death, highlighting the attention to the organization, operation, and performance of the hospital network. Objective COVID19. COVID19 COVID 19. 19 Methods 159948 159 948 159,94 COVID-1 31 202 System structure municipalities 9 days KaplanMeier Kaplan Meier analysis Results 304 30 4 30.4% p<0.001. p0001 p p<0.001 . 0 001 (p<0.001) Conclusion ones death organization operation network COVID1 15994 15 94 159,9 COVID- 3 20 30.4 p000 p<0.00 00 (p<0.001 1599 159, 2 30. p00 p<0.0 (p<0.00 p0 p<0. (p<0.0 p<0 (p<0. p< (p<0 (p< (p

RESUMO Objetivo: Analisar a influência dos fatores individuais e contextuais do hospital e do município de assistência sobre a sobrevida de pacientes com Síndrome Respiratória Aguda Grave por COVID-19. Métodos: Estudo de coorte hospitalar com dados de 159.948 adultos e idosos com Síndrome Respiratória Aguda Grave por COVID-19 internados de 01 de janeiro a 31 de dezembro de 2022 e notificados no Sistema de Informação de Vigilância Epidemiológica da Influenza. As variáveis contextuais foram relacionadas à estrutura, aos profissionais e equipamentos dos estabelecimentos hospitalares e indicadores socioeconômicos e de saúde dos municípios. O desfecho foi a sobrevida hospitalar em até 90 dias. Árvore de sobrevida e curvas de Kaplan-Meier foram utilizados para analisar a sobrevida. Resultados: A letalidade hospitalar foi de 30,4%. Idosos submetidos à ventilação mecânica invasiva e internados em cidades com baixo percentual de arrecadação de impostos apresentaram menor sobrevida quando comparados aos demais grupos identificados na árvore de sobrevida (p<0,001). Conclusão: O estudo indicou a interação de fatores contextuais com os individuais, e evidencia que características hospitalares e dos municípios aumentam o risco de óbito, destacando a atenção à organização, ao funcionamento e desempenho da rede hospitalar. Objetivo COVID19. COVID19 COVID 19. 19 Métodos 159948 159 948 159.94 COVID-1 0 3 202 Influenza estrutura 9 dias KaplanMeier Kaplan Meier Resultados 304 30 4 30,4% p<0,001. p0001 p p<0,001 . 001 (p<0,001) Conclusão óbito organização COVID1 1 15994 15 94 159.9 COVID- 20 30,4 p000 p<0,00 00 (p<0,001 1599 159. 2 30, p00 p<0,0 (p<0,00 p0 p<0, (p<0,0 p<0 (p<0, p< (p<0 (p< (p

Resumo Surtos frequentes do vírus da gripe aviária H9N2 no Paquistão revelaram que esse subtipo se tornou endêmico na avicultura e, além das perdas econômicas, representa uma ameaça à saúde pública. O presente estudo descreve a caracterização molecular e as alterações patológicas em frangos de corte naturalmente infectados com a atual cepa H9N2 e sua dinâmica filogenômica. Neste estudo, amostras de tecidos (traqueia, pulmões, rim e intestino) de 100 lotes comerciais de frangos foram coletadas de julho de 2018 a agosto de 2019. As amostras foram submetidas à detecção molecular, filogenia e posterior exame patológico. O comprimento completo do gene HA foi amplificado com sucesso em cinco amostras. O sequenciamento de nucleotídeos revelou amostras positivas colocadas em um clado pertencente à sublinhagem B2 do genótipo G1 e categorizado como LPAIV com base na sequência de aminoácidos do gene da hemaglutinina (HA) no local de clivagem (PAKSSR/G). A análise genética do gene da HA revelou: nt = 80,5%-99,5%; aa = 83,8%-98,9% de homologia com cepas de H9N2 relatadas anteriormente no Paquistão e em países vizinhos (A/Quail/Hong Kong/G1/97). As lesões macroscópicas incluíram aerossaculite leve, hemorragias leves, congestão difusa e exsudato purulento na mucosa traqueal, cilindro fibrinonecrótico no lúmen da traqueia e congestão pulmonar leve. As alterações histopatológicas incluíram descamação de células epiteliais, infiltração de células inflamatórias na traqueia, infiltração de células mononucleares (MNCs), congestão pulmonar e exsudato no lúmen dos parabrônquios, congestão peritubular nos rins com degeneração das células epiteliais tubulares, alterações degenerativas nas células epiteliais das vilosidades intestinais e hiperplasia de células caliciformes. A análise imunoistoquímica confirmou a presença do antígeno AIVH9N2 na traqueia, nos pulmões, no rim e no intestino. A microscopia eletrônica revelou alterações ultraestruturais na traqueia, incluindo cílios degenerados, inchaço mitocondrial e retículo endoplasmático aumentado. Com base em todas as análises, o presente estudo revelou a distribuição do vírus H9N2 do genótipo G1 em Punjab, Paquistão, com patogenicidade de leve a moderada.

Abstract Frequent outbreaks of avian influenza H9N2 virus in Pakistan revealed that this subtype has become endemic in the poultry industry and, besides economic losses, poses a threat to public health. The present study describes the molecular characterization and pathological alterations in naturally infected broiler chickens with the current H9N2 field strain and their phylogenomic dynamics. In this study, tissue samples (trachea, lung, kidney and intestine) from 100 commercial chicken flocks were collected from July 2018 to August 2019. Samples were subjected to molecular detection, phylogeny and subsequent pathological examination. The complete length of the HA gene was successfully amplified in five samples. Nucleotide sequencing revealed positive samples placed in a clade belonging to the B2 sub-lineage of the G1 genotype and categorized as LPAIV based on the amino acid sequence of the HA gene at the cleavage site (PAKSSR/G). Genetic analysis of the haemagglutinin (HA) gene revealed nt: 80.5%-99.5%; aa: 83.8%-98.9% homology to H9N2 strains reported previously from Pakistan, neighbouring countries, and (A/Quail/Hong Kong/G1/97). Gross lesions include a slight airsacculitis, mild hemorrhages, diffuse congestion and purulent exudate in tracheal mucosa, fibrinonecrotic cast in the trachea lumen and mild pulmonary congestion. Histopathological alterations include sloughing of epithelial cells and infiltration of inflammatory cells in the trachea, mononuclear cells (MNCs) infiltration, pulmonary congestion and exudate in the lumen of parabronchi, peritubular congestion in the kidneys with degeneration of tubular epithelial cells and degenerative changes in the intestinal villi epithelial cells and goblet cell hyperplasia. Immunohistochemistry analysis confirmed the presence of AIVH9N2 antigen in the trachea, lungs, kidney and intestine. Electron microscopy revealed ultrastructural changes in the trachea, including degenerated cilia, mitochondrial swelling and enlarged endoplasmic reticulum. Based on all essential analysis, the present study revealed the distribution of the H9N2 virus of G1 genotype in Punjab, Pakistan, with mild to moderate pathogenicity.

Abstract: Introduction: the vaccination program is a public health intervention aimed at controlling or eliminating vaccine-preventable diseases. The objective of the study was to estimate the evolution of the vaccine budget between 2007 and 2022 and the impact of potential improvements in Paraguay’s vaccination schedule. Method: the evolution of the vaccine budget was estimated considering the changes introduced between 2007 and 2022 and the impact of alternative schedules versus the current one. These alternatives include the addition of the quadrivalent influenza vaccine, the hexavalent vaccine for infants, the inclusion of the HPV vaccine for boys, and the ACYW meningococcal ACYW vaccine for adolescents. The analysis was conducted from the perspective of the Ministry of Health, with a time horizon of one year. The results of the alternatives are expressed as budget impact compared to the year 2022. Results: between 2007 and 2022, the number of biological products in the EPI increased from 11 to 18, and additional indications for some vaccines were incorporated. The budget is estimated to have increased from 3.8 to 29.9 million USD over the series. The alternatives would result in individual increases of 13%, 35%, 5%, and 10%. The combined increase reaches 62%. Conclusions: the increase in vaccine expenditure was eightfold between 2007 and 2022. The budget impact was estimated in different scenarios, interpreted as improvements compared to the current 2022 scenario, with the most demanding increase being 35%. The generated evidence can assist in the decision-making process regarding this public policy in Paraguay.

Resumo: Introdução: o programa de vacinação é uma intervenção de saúde pública cuja finalidade é controlar ou eliminar doenças imunopreveníveis. O objetivo deste estudo foi estimar a evolução do orçamento de vacinas entre 2007 e 2022 e o impacto de possíveis melhorias no cronograma de vacinação do Paraguai. Métodos: estimamos a evolução do orçamento de vacinas de acordo com as mudanças ocorridas entre 2007 e 2022 e o impacto de esquemas alternativos em relação ao atual, que incluem a vacina quádrupla contra a gripe, a sextupla em bebês, a adição da vacina contra o papilomavírus em homens e a vacina meningocócica ACYW em adolescentes. A perspectiva da análise foi a do Ministerio de Salud e o intervalo de tempo foi de um ano. Os resultados das alternativas são expressos como impacto orçamentário em relação a 2022. Resultados: Entre 2007 e 2022, o número de produtos biológicos do PAI aumentou de 11 para 18 e incorporou indicações para algumas vacinas. Estima-se que o orçamento tenha aumentado de US$ 3,8 milhões para US$ 29,9 milhões entre os extremos da série. As alternativas implicariam em um aumento de 13%, 35%, 5% e 10% individualmente. O aumento geral chega a 62%. Conclusões: o aumento nos gastos com vacinas foi de oito vezes entre 2007-2022. O impacto orçamentário é estimado em diferentes cenários que são interpretados como melhorias em comparação com o cenário de 2022, sendo que o aumento mais exigente é de 35%. As evidências geradas podem contribuir para o processo de tomada de decisão relacionado a essa política pública no Paraguai.

Resumen: Introducción: el programa de vacunación es una intervención de salud pública cuyo propósito es controlar o eliminar enfermedades inmunoprevenibles. El objetivo de este trabajo fue estimar la evolución del presupuesto en vacunas entre 2007 y 2022, y el impacto de potenciales mejoras en el calendario de vacunaciones de Paraguay. Método: se estimó la evolución del presupuesto en vacunas según los cambios entre 2007 y 2022, y el impacto de esquemas alternativos versus el actual, que incluyen la vacuna contra la influenza cuádruple, séxtuple en lactantes, el agregado de la vacuna contra papiloma en varones y meningococo ACYW en adolescentes. La perspectiva del análisis fue la del Ministerio de Salud Pública y el horizonte temporal de un año. Los resultados de las alternativas se expresan como impacto presupuestal versus el año 2022. Resultados: entre 2007 y 2022 la cantidad de biológicos del Programa Ampliado de Inmunizaciones pasó de 11 a 18 e incorporó indicaciones de algunas vacunas. Se estima que el presupuesto se incrementó de 3,8 a 29,9 millones de dólares entre los extremos de la serie. Las alternativas implicarían un incremento de 13%, 35%, 5% y 10%, individualmente. El incremento en conjunto alcanza el 62%. Conclusiones: el aumento del gasto en vacunas fue de ocho veces entre 2007 y 2022. Se estima el impacto presupuestal en diferentes escenarios que se interpretan como mejoras comparadas con el actual de 2022, siendo el incremento más exigente de un 35%. La evidencia generada puede colaborar en el proceso de toma de decisiones acerca de esta política pública en Paraguay.

Abstract During the COVID-19 pandemic, H1N1 seasonality disappeared worldwide. In Brazil, information on how coronavirus impacted this seasonality is scarce. In this study, we aimed to verify whether COVID-19 pandemic was associated with changes in the seasonality of H1N1, modeling the time series of H1N1 between pre-pandemic (2018 and 2019), pandemic (2020 and 2021) and post-pandemic (2022 and 2023) periods. For this purpose, we superimposed on this time series cases of COVID-19 from 2020 to 2023. Our findings highlighted that H1N1 exhibited a consistent seasonal pattern in the pre-pandemic period, with peaks mainly in months with the highest rainfall. However, this seasonality disappeared during the pandemic, with a significant decrease in the number of cases, in contrast with the predicted seasonality of H1N1 for the same period. In addition, the seasonal pattern of H1N1 in the post-pandemic showed a return to that observed in the pre-pandemic period, especially in 2023. We observed that the COVID-19 pandemic was consistently associated with changes in H1N1 seasonality in Brazil, underscoring the relative importance of monitoring patterns of respiratory syndromes to enhance our understanding of how coronavirus is associated with changes in seasonal diseases. COVID19 COVID 19 COVID-1 HN H N H1N worldwide Brazil scarce study prepandemic pre 2018 (201 2019, 2019 , 2019) (202 2021 postpandemic post 2022 2023 periods purpose 202 period rainfall However addition diseases COVID1 1 COVID- 201 (20 20 (2 2 (