Abstract Background Growth charts are essential for detecting early health conditions in children. This study aims to create up-to-date and region-specific growth charts for children and adolescents using large real-world data from primary care electronic health records (EHR) in Catalonia, Spain. Methods We used routinely collected EHR of the Institut Català de la Salut, the main primary care provider in Catalonia. We included children aged one month to 14 years with a birthweight greater than 2500 gr, and at least one anthropometric measurement registered (2013–2019). Growth references for head circumference, weight, length/height, and body mass index (BMI) were fitted using GAMLSS models. We built our charts with data recorded in 2013, validated them using data from 2014 to 2019 and compared them to WHO and Spanish growth charts. Results With a total of 876,097 records from 155,950 children, we estimated new growth charts. Our curves were higher in the highest percentile, especially for weight and BMI (starting from 4 years old), compared to the WHO standards and for extreme percentiles compared to outdated national charts but were similar to more recent national curves. Validation analyses showed similar results with differences only seen for extreme weight and BMI percentile curves, older ages and later years. Conclusions We created new growth charts using a novel approach, accurately representing local growth patterns in the population living in Catalonia. These charts offer primary care professionals a valuable tool for assessing children’s and adolescents’ growth in the region.

BACKGROUND:Herpangina and hand, foot, and mouth disease (HFMD) are common pediatric enterovirus syndromes, but long-term evidence from European primary care remains scarce. METHODS:Primary care electronic health records from the public healthcare system in Catalonia, Spain, were retrospectively analyzed for the academic years 2014-2015 to 2024-2025 using International Classification of Diseases, 10th revision codes. Incidence trends, age and sex patterns, seasonal peak timing, and peak-to-peak dependence were assessed in children younger than 5 years. RESULTS:A total of 137,460 diagnoses were identified, including 54,060 herpangina and 83,400 HFMD. Both syndromes showed recurrent bimodal seasonality aligned with school holidays. Peak magnitudes were negatively correlated at both 6-month and 1-year lags, consistent with susceptible depletion and replenishment. Before the pandemic, spring herpangina peaks shifted about 1.5 weeks later for each 1-week delay in Easter. Incidence declined sharply in 2020 and rebounded from autumn 2021, particularly for HFMD. Most diagnoses occurred in children aged 1-2 years, with a transient post-pandemic shift toward ages 3-4 years in the first post-pandemic season. Age-specific curves were highly synchronized, with no pediatric age group consistently preceding the others. CONCLUSIONS:This large primary care series, among the very few long-term European studies of herpangina and HFMD, supports structured seasonal dynamics shaped by school-calendar timing and susceptible dynamics over successive seasons. Long-term primary care surveillance may help interpret atypical transmission patterns and support pediatric preparedness when virologic surveillance is limited.

Background:Nirsevimab, a long-acting monoclonal antibody against respiratory syncytial virus (RSV), was recently introduced in Catalonia (Spain, 2023-2024 season onwards) and Italy (2024-2025 season). The United Kingdom (UK) instead introduced maternal RSV vaccination (RSVpreF) in the 2024-2025 season. Our aim was to analyse emergency department (ED) attendances and admissions to hospital following RSVpreF and nirsevimab introduction, with hospitals in Iceland and Romania, where no intervention was introduced, used as comparators. Methods:Multi-national retrospective analysis of ED attendances and admissions for all diagnoses, respiratory diagnoses excluding bronchiolitis, and bronchiolitis from all hospitals in Catalonia (Spain), four UK hospitals (Bristol, Edinburgh, Glasgow, and Leicester), and one hospital in Italy (Rome), Romania (Bucharest), and Iceland (Reykjavík) from April 2018 to March 2025. Bronchiolitis diagnoses in the 2024-2025 season were compared to previous pre-intervention seasons (2018-2023, excluding the 2020-2021 COVID-19 year) by applying a generalised linear model in Poisson regression to obtain risk ratios (RR) and 95% confidence intervals (95% CI). Findings:In the 2024-2025 season, in Catalonia, there was a reduction in the RR for bronchiolitis ED attendances and admissions in infants of age <6 months (RR 0.45; 95% CI 0.43-0.47 and RR 0.40; 95% CI 0.37-0.43, respectively). This was not seen in Rome, where the RR for ED attendances with bronchiolitis in infants of age <6 months was 1.09 (95% CI 0.92-1.30) and the RR for admissions was 1.12 (95% CI 0.83-1.52). In the UK, for infants of age <6 months with bronchiolitis, there was a significant but modest reduction in 1 out of 4 hospitals for ED attendances (Leicester; RR 0.91, 95% CI 0.85-0.97) and in 2 out of 4 hospitals for admissions (Leicester; RR 0.80, 95% CI 0.69-0.94 and Edinburgh; RR 0.85, 95% CI 0.76-0.95). Interpretation:In Catalonia, there was a sustained reduction in bronchiolitis ED attendances and admissions for infants in the 2024-2025 season. However, no substantial reduction in bronchiolitis ED attendances or admissions was observed in Rome or the UK. These differences are likely to relate to the reduced uptake of RSV prevention products in these settings compared to Catalonia. Funding:None.

Background: The COVID-19 pandemic disrupted primary care services worldwide, reducing quality-of-care. Understanding the impact of quality improvement strategies can guide system resilience. Aim: To assess whether information provision and financial incentives to primary care professionals supported recovery of pre-pandemic quality-of-care after pandemic-related declines. Design and Setting: Descriptive analysis at the primary care practice (PCP) and aggregated indicator levels in Catalonia, Spain. Method: Data on 37 quality-of-care indicators from 287 PCPs (5,250,531 adults) were analyzed monthly from 2019–2024. Financial incentives were suspended in 2020; 13 indicators were reintegrated into pay-for-performance schemes in 2021 (early-incentivised), while 24 remained unincentivised until 2023 (late-incentivised). Outcomes were annual changes in indicator results and variability, and time to recover pre-pandemic levels. A multivariate Cox model estimated the effect of incentives; K-means clustering identified PCP recovery profiles. Results: In 2021, 11/13 (85%) of early-incentivised indicators started recovering versus 5/24 (21%) of late-incentivised. By December 2024, recovery of pre-pandemic results occurred in 85% and 50%, respectively, despite larger pandemic drops in early-incentivised indicators. Early incentivization doubled the likelihood of recovery before 2023 (2.06 times), with effects varying by indicator type. However, many PCPs recovered late-incentivised indicators before incentives resumed, when only informed. Clustering revealed four PCP profiles; faster recoverers were smaller, rural practices with milder declines. Conclusion: Financial incentives accelerated quality-of-care recovery after a system shock, particularly when tailored to indicator types and practice contexts, and complemented by timely information provision. Policymakers can use these findings to guide recovery strategies and strengthen resilience in primary care.

OBJECTIVE:To assess trends and excess of recorded scabies diagnoses in Catalonia before and after the COVID-19 pandemic. METHOD:Population-based time-series study using primary care electronic health records of scabies diagnosis from January 2014 to December 2024. Expected monthly rates of recorded diagnoses were estimated with a time-series regression model including a linear time trend and monthly seasonal components, fitted with 2014-2018 data as the reference pre-pandemic period. Excess was calculated overall and stratified by age, sex, and socioeconomic status. RESULTS:Among 254,941 diagnoses, 83.8% occurred since 2020. Monthly rates increased from 4-16 cases per 100,000 in 2014-2017 to 117 in 2023. Annual excesses were 14.8% in 2020, 118.6% in 2021, 281.6% in 2022, and 318.9% in 2023. All socioeconomic and age groups were affected. CONCLUSIONS:Recorded scabies diagnoses rate increased markedly after the pandemic and remained above expected levels through 2024, highlighting the need for strengthened surveillance and control strategies.

Objetivos Actualizar las curvas de crecimiento de peso, talla y perímetro craneal (PC) a partir de los datos de la historia clínica electrónica de Atención Primaria (HCEAP). Material y métodos Estudio retrospectivo de una cohorte de base poblacional usando datos recogidos de forma rutinaria en la HCEAP de una comunidad autónoma. Se incluyeron todos los registros de peso, talla y PC de los años 2013 a 2019 de los niños de entre 0 y 15 años. Para la obtención de las curvas se utilizó una metodología reproducible y sistemática de 5 pasos: 1) extracción de los datos de la HCEAP; 2) limpieza de valores implausibles y errores usando los rangos definidos por la Organización Mundial de la Salud (OMS); 3) selección de las edades para ajustar a partir de la guía del programa del niño sano; 4) ajuste usando modelos GAMLSS con datos 2013; 5) validación con datos de 2014 a 2019. Se compararon las nuevas curvas con Orbegozo, OMS y Estudio español 2010 para los percentiles P3, P50 y P97. Aspectos eticolegales: estudio aprobado por el comité de ética correspondiente. Resultados Se extrajeron 18M registros de la HCEAP, de los cuales, tras los filtros de limpieza y selección, se utilizaron 5,9M (0,9M para estimar y 5M para validar) correspondientes a 546.700 niños (28% ámbito rural, 13% nivel socioeconómico muy alto, 22% nivel socioeconómico muy bajo, 93% nacionalidad española y 48% niñas). Las curvas estimadas son muy parecidas a las del estudio español de 2010. Las diferencias más destacadas se encuentran en el P97 del peso en edades mayores de 2 años, comparándolas con la OMS y Orbegozo. La validación con los datos observados muestra que el P97 de edades superiores aumenta con los años. Conclusiones Es posible obtener y actualizar curvas de crecimiento representativas de la población a partir de los datos recogidos rutinariamente en la HCEAP. CEI Protocolo 23/091-P autorizado por el CEIC IDIAP Jordi Gol.

OBJECTIVES:To evaluate the effect of the selective pressure exerted by nirsevimab on human respiratory syncytial virus (HRSV) in Catalonia (2023-2024) by analysing viral mutations, diversity, and evolutionary dynamics, based on viruses characterised from non-immunised and previously immunised patients. METHODS:Respiratory samples were collected through the SIVIC sentinel network and three hospitals in Catalonia. HRSV-positive samples underwent whole-genome sequencing (WGS), or F gene sequencing when WGS was not feasible. Viral diversity, phylogenetics, and selection pressure were assessed. RESULTS:A total of 251 WGS (HRSV-A: 165; HRSV-B: 86) and 27 F gene sequences (HRSV-A: 13; HRSV-B: 14) were obtained for the non-immunised group. For immunised cases, 79 WGS (HRSV-A: 67; HRSV-B: 12) and 12 F sequences (HRSV-A: 10; HRSV-B: 2) were analysed. Lineage distribution remained similar between groups. Nucleotide diversity was similar for HRSV-A groups, though reduced in immunised HRSV-B. Selection pressure analyses suggested a shift toward neutral evolution in immunised samples. Mutations N63S, K65R, I206T, and K209E (HRSV-A) and K68E, R209Q, and S211N (HRSV-B) were detected in nirsevimab epitope, with K209E and K68E absent in non-immunised samples. CONCLUSIONS:Nirsevimab immunisation may influence HRSV evolution, particularly in HRSV-B. Continued genomic surveillance is crucial for early mAb-resistant mutants detection.

Objetivo Conocer el grado de atracción hacia Medicina Familiar y Comunitaria (MFyC) entre los candidatos y candidatas MIR mediante el cálculo del Índice de preferencia competitiva (IPC) en las convocatorias 2020 a 2024. Diseño Estudio observacional de análisis de fuentes secundarias basadas en la información de la página web del Ministerio de Sanidad. Sitio y participantes Se escogieron las plazas de los candidatos y candidatas MIR de las 5 ciudades españolas más pobladas. Intervenciones y mediciones principales La construcción del IPC parte de la comparación de MFyC con cada especialidad, teniendo en cuenta la igualdad de oportunidad de elegir MFyC u otra especialidad, y se tiene en cuenta el porcentaje de elección de MFyC en el momento en el que se ha finalizado la elección de esa otra especialidad. Resultados En relación con las especialidades de laboratorios y servicios centrales, el IPC medio de MFyC ha sido positivo respecto a todas las especialidades, en todas las ciudades analizadas, a excepción de radiodiagnóstico.En relación con las especialidades médicas, el IPC es positivo en todas las ciudades analizadas respecto a 8 especialidades (Alergología, Geriatría, Medicina del Trabajo, Medicina Física y Rehabilitación, Medicina Preventiva, Nefrología, Oncología Radioterápica y Reumatología).En relación con las especialidades quirúrgicas, es positivo en todas las ciudades analizadas respecto a 3 especialidades (Cirugía Vascular, Cirugía Cardiovascular y Cirugía Torácica). Conclusiones La especialidad de MFyC presenta un notable atractivo entre los candidatos y candidatas MIR, ya que se obtienen resultados positivos en la comparativa con la mayoría de especialidades, y en la mayoría de las ciudades analizadas.

To analyse the effect of nirsevimab immunoprophylaxis on RSV-associated outcomes after two consecutive epidemic seasons in infants born and Living in Catalonia, Spain. We conducted a population-based retrospective cohort study including all infants born in Catalonia between April 2023 and March 2024. We established two cohorts (immunised with nirsevimab and non-immunised). We estimated adjusted cumulative incidences (CInc) curves for RSV-associated hospital admissions, paediatric intensive care unit (PICU) admissions, emergency department (ED) visits for bronchiolitis, and RSV infections and bronchiolitis registered in primary care from October 2023 to mid-February 2025 using inverse probability-weighted Kaplan–Meier methods. Marginal risk differences and risk ratios (RR) with 95

AIM:To assess the impact of an electronic scheduling tool (Planificat) on the management of type 2 diabetes mellitus (T2DM) in primary care settings. METHODS:This paired cohort study used data from the Catalan primary care electronic health records. The intervention cohort, using Planificat, included all patients aged 15 years or older with T2DM and was matched 1:1 with a control cohort. The study period lasted one year. Mixed general linear models estimated Odds Ratios (OR) and 95 % confidence intervals (95 %CI) for primary outcomes, including T2DM clinical tests (LDL cholesterol, HbA1c), visit frequency, and non-attendance rates. RESULTS:A total of 51,619 patients (mean age 68.3 years, 42.1 % of female sex) and their paired controls were included. In the primary analysis, significant increases were observed in the Planificat group (N = 18,542) regarding several measures: cholesterol tests performed (83.5 % vs. 75.4 %; OR: 1.65 [95 %CI: 1.57-1.74]), HbA1c tests performed (83.7 % vs. 75.4 %; OR: 1.7 [95 %CI: 1.61-1.79]), and electrocardiograms (65 % vs. 52 %; OR: 1.72 [95 %CI: 1.65-1.8]). Additionally, there was a 36 % increase in patients achieving HbA1c levels < 8 % (OR: 1.36 [95 %CI: 1.3-1.42]). Statistically significant improvements of 30 % and 40 % were also observed in foot and retinopathy screenings, respectively. Face-to-face visits with general practitioners and non-attendance rates remained comparable between cohorts, while face-to-face nurse visits increased by 7 %. CONCLUSIONS:Planificat significantly improved T2DM management indicators, promoting proactive scheduling and enhancing follow-up in primary care without impacting face-to-face visits. These findings support its integration as a complementary strategy for optimizing chronic disease management.

Background:Nirsevimab, a novel monoclonal antibody with a long half-life, has received European Union approval to prevent lower respiratory tract infections (LRTIs) caused by respiratory syncytial virus (RSV) during the first season of exposure. It was implemented in Catalonia (Spain) in the 2023-2024 season. Our main objective was to analyse the impact of the nirsevimab on LRTIs presenting to the Emergency Department (ED) in Catalonia (Spain) by comparing presentations to those at five sites in the United Kingdom (UK) and Rome (Italy). Methods:In this multi-national retrospective analysis of emergency department attendances and admissions, we retrospectively collected information for all diagnoses, respiratory diagnoses excluding bronchiolitis, and bronchiolitis, for different age groups from 68 hospitals in Catalonia (Spain), one hospital in Rome (Italy), and four hospitals in the UK (Bristol, Leicester, Glasgow, and Edinburgh), from May 1st, 2018, to April 30th 2024. Applying a generalised linear model (GLM) in Poisson regression, we obtained the risk ratio (RR) and 95% confidence intervals (CI) of bronchiolitis in 2023-2024 season compared to the mean of all previous seasons. We analysed data in annual bins, from May 1st to April 30th, excluding 2020-21 as a COVID year, for a total of 5 years of data. Findings:Data was available for 1,574,392 ED attendances (96,028 for bronchiolitis) and 255,689 hospital admissions (27,691 for bronchiolitis). In the 2023-2024 season, in Catalonia there was a reduction in the RR for bronchiolitis hospital admissions in the youngest infants aged <6 months (0.52, 95% CI: 0.48-0.55). There was also a reduction in Catalonia in the RR for hospital attendances for bronchiolitis in nirsevimab eligible age groups (0-11 months), with a RR of 0.56 (95% CI: 0.54-0.58) for infants <6 m and 0.93 (95% CI: 0.89-0.97) for infants 6-11 m. None of the other sites or age groups showed a significant reduction in the RR for attendances or admissions for the 2023-2024 season compared to previous years. Interpretation:Nirsevimab had a clear impact in reducing attendances and admissions for infants with bronchiolitis aged <6 months in Catalonia. However, the impact on older infants was less clear. Funding:None.

Influenza is a respiratory disease that causes annual epidemics during cold seasons. These epidemics increase pressure on healthcare systems, sometimes provoking their collapse. For this reason, a tool is needed to predict when an influenza epidemic will occur so that the healthcare system has time to prepare for it. This study therefore aims to develop a statistical model capable of predicting the onset of influenza epidemics in Catalonia, Spain. Influenza seasons from 2011 to 2017 were used for model training, and those from 2017 to 2018 were used for validation. Logistic regression, Support Vector Machine, and Random Forest models were used to predict the onset of the influenza epidemic. The logistic regression model was able to predict the start of influenza epidemics at least one week in advance, based on clinical diagnosis rates of various respiratory diseases and meteorological variables. This model achieved the best punctual estimates for two of three performance metrics. The most important variables in the model were the principal components of bronchiolitis rates and mean temperature. The onset of influenza epidemics can be predicted from clinical diagnosis rates of various respiratory diseases and meteorological variables. Future research should determine whether predictive models play a key role in preventing influenza.

Background The aim of our study is to analyse the trends in the diagnosis of sexually transmitted infections (STIs) during the COVID-19 pandemic.Methods We conducted an observational retrospective population-based study using data from primary care electronic health records spanning from January 2016 to December 2022 (involving 5.1 million people older than 14 years). We described the daily number of new STI diagnoses from 2016 to 2022; as well as the monthly accumulation of new STI diagnoses for each year. We compared the monthly averages of new diagnoses in 2019, 2020, 2021 and 2022 using the T-test. Finally, we performed a segmented regression analysis of the daily number of STI diagnoses.Results We analysed 200,676 new STI diagnoses. The number of diagnoses abruptly decreased coinciding with the lockdown. Overall in 2020, we observed a reduction of 15%, with higher reductions for specific STIs such as gonorrhoea (-21%), chlamydia (-24%), and HIV (-31%) compared to 2019. Following this drastic drop, which was temporarily associated with the lockdown, we observed a rapid rebound. In 2021, the number of STI diagnoses was similar to that of 2019. Notably, we found a considerable increase in 2022, particularly for non-specific STI, which lack laboratory confirmation (67% increase). HIV was the only STI with a reduction of up to -38% in diagnoses at the end of 2022 compared to 2019.Conclusions After a significant reduction in 2020, the number of STIs recorded in primary care rapidly rebounded, and the current trend is similar to that of 2019, except for HIV. These findings underscore the dynamic impact of the COVID-19 pandemic on STI diagnoses and highlight the importance of ongoing monitoring and public health interventions in the post-pandemic period.

BACKGROUND:In Catalonia, infants <6 months old were eligible to receive nirsevimab, a novel monoclonal antibody against respiratory syncytial virus (RSV). We aimed to analyze nirsevimab's effectiveness in hospital-related outcomes of the seasonal cohort (born during the RSV epidemic from October to January 2024) and compared them with the catch-up cohort (born from April to September 2023). METHODS:Retrospective cohort study of all infants born between October 1, 2023, and January 21, 2024, according to their immunization with nirsevimab (immunized and nonimmunized). We followed individuals until the earliest of an outcome-hospital emergency visits, hospital admission or pediatric intensive care unit (PICU) admission due to RSV-associated or all-causes 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 hazard ratios (HRs) and their 95% confidence interval (CI). Sensitivity analysis was performed through matching. RESULTS:Among 15,341 infants, a dose of nirsevimab led to an adjusted HR for hospital admission, PICU admission and emergency visits due to RSV bronchiolitis of 0.26 (95% CI: 0.17-0.39), 0.15 (95% CI: 0.07-0.28) and 0.46 (95% CI: 0.23-0.90), respectively. For all-causes bronchiolitis, the former adjusted HRs were 0.45 (95% CI: 0.31-0.63), 0.23 (95% CI: 0.13-0.41) and 0.49 (95% CI: 0.35-0.68), respectively. CONCLUSIONS:Nirsevimab was associated with reductions of 74% and 85% hospitalizations and PICU admissions regarding RSV-associated bronchiolitis, respectively. These percentages are slightly lower than those for the catch-up cohort. This information may help the implementation of RSV-immunization campaigns by public health authorities.

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 first 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-confirmed 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-confirmed 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 difference 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

Background The relative efficacy of information provision versus financial incentives in improving primary care quality remains a critical, unresolved question. We investigated these two strategies in Catalonia's public primary care system from 2010 to 2019: an innovative online platform providing real-time quality indicator information and targeted economic incentives for achieving indicator goals. Methods We conducted a comprehensive interrupted time series regression analysis on data from 272 primary care practices (5,628,080 patients). This analysis used linear regression models with Newey-West standard errors, and a sensitivity analysis including logit transformations to address ceiling effects. We evaluated 1) immediate post-intervention changes (step changes) in indicator results and inter-practice variability (coefficient of variation, CV), and 2) shifts in pre-intervention trends (slopes). We scrutinized 39 indicators after rigorous quality control: 23 novel (12 informed, 11 incentivized) and 16 derived from existing incentivized indicators. Robustness checks included 14 consistently incentivized and 10 non-intervened indicators. Overall, we assessed 63 indicators: 18 control, 13 follow-up, 9 quaternary prevention, 7 treatment, 7 diagnosis, 6 screening and 3 vaccination indicators. Findings Informed indicators showed positive impacts in 75% (9/12) of cases, and incentivized indicators in 64% (7/11) of cases. Incentivized indicators displayed improvements in annual trends ranging from 6.66 to 1.25 percentage points, with step changes up to 8.87 percentage points. Information led to step changes ranging from 19.67 to 1.07 percentage points, along with trend improvements between 1.09 and 0.34 percentage points annually. Both interventions were associated with step reductions in variability (up to -0.18 CV reduction) and significant trend improvements. Derived indicators showed limited improvements in results or variability (31%, 5/16), with minor step increases up to 2.22 percentage points. Interpretation Our findings reveal that information provision alone can match or even surpass the impact of financial incentives in improving care quality and reducing practice variability. This challenges conventional wisdom and offers a cost-effective, scalable approach to primary care quality enhancement, with far-reaching implications for global health policy. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

In the current COVID-19 landscape dominated by Omicron subvariants, understanding the timing and efficacy of vaccination against emergent lineages is crucial for planning future vaccination campaigns, yet detailed studies stratified by subvariant, vaccination timing, and age groups are scarce. This retrospective study analyzed COVID-19 cases from December 2021 to January 2023 in Catalonia, Spain, focusing on vulnerable populations affected by variants BA.1, BA.2, BA.5, and BQ.1 and including two national booster campaigns. Our database includes detailed information such as dates of diagnosis, hospitalization and death, last vaccination, and cause of death, among others. We evaluated the impact of vaccination on disease severity by age, variant, and vaccination status, finding that recent vaccination significantly mitigated severity across all Omicron subvariants, although efficacy waned six months post-vaccination, except for BQ.1, which showed more stable levels. Unvaccinated individuals had higher hospitalization and mortality rates. Our results highlight the importance of periodic vaccination to reduce severe outcomes, which are influenced by variant and vaccination timing. Although the seasonality of COVID-19 is uncertain, our analysis suggests the potential benefit of annual vaccination in populations >60 years old, probably in early fall, if COVID-19 eventually exhibits a major peak similar to other respiratory viruses.

IntroductionISMiHealth is a clinical decision support system, integrated as a software tool in the electronic health record system of primary care, that aims to improve the screening performance on infectious diseases and female genital mutilation (FGM) in migrants. The aim of this study is to assess the health impact of the tool and to perform a process evaluation of its feasibility and acceptability when implemented in primary care in Catalonia (Spain).Methods and analysisThis study is a cluster randomised control trial where 35 primary care centres in Catalonia, Spain will be allocated into one of the two groups: intervention and control. The health professionals in the intervention centres will receive prompts, through the ISMiHealth software, with screening recommendations for infectious diseases and FGM targeting the migrant population based on an individualised risk assessment. Health professionals of the control centres will follow the current routine practice.A difference in differences analysis of the diagnostic rates for all aggregated infections and each individual condition between the intervention and control centres will be performed. Mixed-effects logistic regression models will be carried out to identify associations between the screening coverage and predictor factors. In addition, a process evaluation will be carried out using mixed methodology.Ethics and disseminationThe study protocol has been approved by the institutional review boards at Hospital Clínic (16 June 2022, HCB/2022/0363), Clinical Research Ethics Committee of the Primary Care Research Institute IDIAPJGol (22 June 2022, 22/113-P) and the Almería Research Ethics Committee (27 July 2022, EMC/apg). The study will follow the tenets of the Declaration of Helsinki and Good Clinical Practice. All researchers and associates signed a collaboration agreement in which they undertake to abide by good clinical practice standards.Findings will be disseminated in peer-reviewed journals and communications to congresses.Trial registration numberNCT05868005.

Abstract Background With more than 7500 cases reported since April 2022, Spain has experienced the highest incidence of mpox in Europe. From 12 July onward, the modified vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for those receiving pre-exposure prophylaxis for human immunodeficiency virus (HIV-PrEP). Our aim was to assess the effectiveness of 1 dose of MVA-BN vaccine as pre-exposure prophylaxis against mpox virus (MPXV) infection in persons on HIV-PrEP. Methods National retrospective cohort study between 12 July and 12 December 2022. Individuals aged ≥18 years receiving HIV-PrEP as of 12 July with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of vaccine and unvaccinated controls of the same age and region. We used a Kaplan–Meier estimator, calculated risk ratios (RR) and vaccine effectiveness (VE = [1 − RR]x100). Results We included 5660 matched pairs, with a median follow-up of 62 days (interquartile range, 24–97). Mpox cumulative incidence was 5.6 per 1000 (25 cases) in unvaccinated and 3.5 per 1000 (18 cases) in vaccinated. No effect was found during days 0–6 post-vaccination (VE, −38.3; 95% confidence interval [CI], −332.7 to 46.4), but VE was 65% at ≥7 days (95% CI, 22.9 to 88.0) and 79% at ≥14 days (95% CI, 33.3 to 100.0) post-vaccination. Conclusions One dose of MVA-BN vaccine offered protection against mpox in most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.