Search

Respiratory syncytial virus (RSV) causes most of the cases of bronchiolitis and thousands of deaths annually, particularly in infants less than 6 months old. In Catalonia (Spain), infants born between April 2023 and March 2024 aged 0–6 months during their frst RSV season have been candidates to receive nirsevimab, the novel monoclonal antibody against RSV, since October 2023. We aimed to analyse the dynamics of all-causes bronchiolitis diagnoses and RSV community infections in the current season and compare them to pre-nirsevimab epidemics. We collected epidemiological data from the Information System for Surveillance of Infections in Catalonia (SIVIC) on daily all-causes bronchiolitis clinical diagnoses and RSV-confrmed cases provided by rapid antigen tests in primary care practices. We calculated the rate ratio (RR) for the incidence of all-causes bronchiolitis for children aged 0-11 m-old with respect to 12-35 m-old between September 2014 and January 2024. We analysed the RR of the incidence of RSV-confrmed infection for 0-11 m-old and 12-35 m-old with respect to the>35 m-old, from January 2021 to January 2024. We then computed the relative diference of the RR, designated as percentage of reduction of risk, between season 2023/2024 and former epidemics. With a global coverage recorded rate for nirsevimab of 82.2% in January 2024, the age-specifc 0-11 m-old RR (95% CI) of RSV infection incidence for>35 m-old was 1.7 (1.5–2.0) in season 2023/2024. The RR (95% CI) had been 7.4 (5.6–9.9), 8.8 (6.9–11.3), and 7.1 (5.7–8.9) in 2020/2021, 2021/2022, and 2022/2023, respectively. Regarding the incidence of all-causes bronchiolitis for the 0-11 m-old group compared to the 12-35 m-old, the pre-pandemic (2014/2015–2019/2020) and 2022/2023 RR (95% CI) were 9.4 (9.2–9.6) and 6.0 (5.7–6.2), respectively, signifcantly higher than the RR of 3.6 (3.4–3.8) for the most recent season, 2023/2024. Conclusion: Concurring with the introduction of nirsevimab, the risk of RSV infection fo, Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. The author(s) declare financial sup- port was received for the research, authorship, and/or publication of this article. ASA has received honoraria for attending scientific meetings from Sanofi, MSD, and Pfizer. Funding was also received from grant number 202134–30-31, funded by “La Fundació La Marató de TV3”, and grant PDI2022-139215NB-I00 funded by MCIN/AEI/https://doi. org/10.13039/501100011033and by “ERDF A way of making Europe”., Peer Reviewed, Objectius de Desenvolupament Sostenible::3 - Salut i Benestar, Postprint (published version)

Background In Catalonia, infants under 6¿months old were eligible to receive nirsevimab, a novel monoclonal antibody against respiratory syncytial virus (RSV). We aimed to analyse nirsevimab’s effectiveness across primary and hospital care outcomes. Methods Retrospective cohort study from 1 October 2023 to 31 January 2024, including all infants born between April and September 2023. We established two cohorts based on nirsevimab administration (immunised and non-immunised). We followed individuals until the earliest moment of an outcome—RSV infection, primary care attended bronchiolitis and pneumonia, hospital emergency visits due to bronchiolitis, hospital admission or intensive care unit (ICU) admission due to RSV bronchiolitis—death or the end of the study. We used the Kaplan-Meier estimator and fitted Cox regression models using a calendar time scale to estimate HRs and their 95% CIs. Results Among 26¿525 infants, a dose of nirsevimab led to an adjusted HR for hospital admission due to RSV bronchiolitis of 0.124 (95% CI: 0.086 to 0.179) and an adjusted HR for ICU admission of 0.099 (95% CI: 0.041 to 0.237). Additionally, the adjusted HRs observed for emergency visits were 0.446 (95% CI: 0.385 to 0.516) and 0.393 (95% CI: 0.203 to 0.758) for viral pneumonia, 0.519 (95% CI: 0.467 to 0.576) for bronchiolitis attended in primary care and 0.311 (95% CI: 0.200 to 0.483) for RSV infection. Conclusion We demonstrated nirsevimab’s effectiveness with reductions of 87.6% and 90.1% in hospital and ICU admissions, respectively. These findings offer crucial guidance for public health authorities in implementing RSV immunisation campaigns., Peer Reviewed, Postprint (published version)

BACKGROUND // The aim of this paper was to estimate the SARS-CoV-2 infection incidence regarding the occupation in Catalonia, globally and in the different waves of the pandemic. METHODS // We performed a retrospective cohort study. We included all people between 16 and 65 years old with an occupation identified from the sick leave recorded in the primary care electronic health records of the Institut Català de la Salut (ICS) (total n=2,199,745 people). The study period was from March 1st, 2020 to September 16th, 2021. RESULTS // Healthcare workers had the highest incidence, with an age and sex adjusted cumulative rate of 27.7% [95% CI: 27.3%- 28.1%]: 29.4% in nursing assistants, 27.3% in medical professions and 26.3% in nursing professionals; followed by the elementary occupations group with an adjusted incidence of 16.9% [95% CI: 16.7%-17%], such as the agricultural laborers (23% [95% CI: 21%-25.1%]) and rural occupations (19.1% [95% CI: 18.3%-19.8%) —especially during the 2020 summer period—, the domestic employees (20.5% [95% CI: 18.9%-22.2%]) and cleaning professionals (17.5% [95% CI: 17.2%-17.9%]). CONCLUSIONS // Healthcare workers are the hardest hit during the pandemic. On the other hand, the less qualified professions have high incidences, highlighting the different inequities in access to telework, working conditions and other social determinants of health., FUNDAMENTOS // El objetivo de este estudio fue estimar la incidencia de la infección por SARS-CoV-2 según la ocupación en Cataluña, tanto de forma global como en distintos periodos de la pandemia de COVID-19. MÉTODOS // Se realizó un estudio retrospectivo de una cohorte. Se incluyeron todas las personas entre 16 y 65 años con una ocupación identificada a partir de las bajas laborales registradas en la historia clínica informatizada de Atención Primaria del Institut Català de la Salut (ICS) (N total=2.199.745 personas). El periodo de estudio fue del 1 de marzo de 2020 al 16 de septiembre de 2021. RESULTADOS // Las ocupaciones sanitarias fueron las que más incidencia tuvieron, con una tasa acumulada ajustada por edad y sexo del 27,7% [IC 95%: 27,3%-28,1%]: un 29,4% en auxiliares de enfermería, un 27,3% en profesionales de medicina y un 26,3% en profesionales de enfermería. Éstas fueron seguidas por el grupo de ocupaciones elementales con una incidencia ajustada de un 16,9% [IC 95%: 16,7 -17%], destacando en este grupo los peones agropecuarios (23% [IC 95%: 21%-25,1%]) y agrícolas (19,1% [IC 95%: 18,3%-19,8%]) —especialmente en el periodo del verano de 2020—, los empleados domésticos (20,5% [IC 95%: 18,9%-22,2%) y los profesionales de limpieza (17,5% [IC 95%: 17,2%-17,9%]). CONCLUSIONES // Las ocupaciones sanitarias son las más afectadas durante la pandemia. Por otro lado, las ocupaciones menos cualificadas presentan también incidencias elevadas, poniendo de manifiesto las distintas inequidades en el acceso al teletrabajo, en las condiciones laborales y en otros determinantes sociales de la salud.

Monitoring transmission is a prerequisite for containing COVID-19. We report on effective potential growth (EPG) as a novel measure for the early identification of local outbreaks based on primary care electronic medical records (EMR) and PCR-confirmed cases. Secondly, we studied whether increasing EPG precedes local hospital and intensive care (ICU) admissions and mortality. Population-based cohort including all Catalan citizens’ PCR tests, hospitalization, intensive care (ICU) and mortality between 1/07/2020 and 13/09/2020; linked EMR covering 88.6% of the Catalan population was obtained. Nursing home residents were excluded. COVID-19 counts were ascertained based on EMR and PCRs separately. Weekly empirical propagation (¿7) and 14-day cumulative incidence (A14) and 95% confidence intervals were estimated at care management area (CMA) level, and combined as EPG = ¿7 × A14. Overall, 7,607,201 and 6,798,994 people in 43 CMAs were included for PCR and EMR measures, respectively. A14, ¿7, and EPG increased in numerous CMAs during summer 2020. EMR identified 2.70-fold more cases than PCRs, with similar trends, a median (interquartile range) 2 (1) days earlier, and better precision. Upticks in EPG preceded increases in local hospital admissions, ICU occupancy, and mortality. Increasing EPG identified localized outbreaks in Catalonia, and preceded local hospital and ICU admissions and subsequent mortality. EMRs provided similar estimates to PCR, but some days earlier and with better precision. EPG is a useful tool for the monitoring of community transmission and for the early identification of COVID-19 local outbreaks., Peer Reviewed, Objectius de Desenvolupament Sostenible::3 - Salut i Benestar, Objectius de Desenvolupament Sostenible::3 - Salut i Benestar::3.3 - Per a 2030, posar fi a les epidèmies de la sida, tuberculosi, malària i les malalties tropicals desateses, i com­batre l’hepatitis, les malalties transmeses per l’aigua i altres malalties transmissibles, Postprint (published version)