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Objectives Little is currently known about vaccine effectiveness (VE) for either two doses of Oxford-AstraZeneca (ChAdOx1) viral vector vaccine or CoronaVac inactivated viral vaccine followed by a third dose of mRNA vaccine (Pfizer/BioNTech) among healthcare workers (HCWs). Methods We conducted a retrospective cohort study among HCWs (aged ≥18 years) working in a private healthcare system in Brazil from January to December 2021. VE was defined as 1-IRR (incidence rate ratio), with IRR determined using Poisson models with the occurrence of laboratory-confirmed COVID-19 infection as the outcome, adjusting for age, sex, and job type. We compared those receiving viral vector or inactivated viral primary series (two doses) to those who received an mRNA booster. Results A total of 11,427 HCWs met the inclusion criteria. COVID-19 was confirmed in 31.5% of HCWs receiving two doses of CoronaVac vaccine vs. 0.9% of HCWs receiving two doses of CoronaVac vaccine with mRNA booster (p < 0.001), and 9.8% of HCWs receiving two doses of ChAdOx1 vaccine vs. 1% among HCWs receiving two doses of ChAdOx1 vaccine with mRNA booster (p < 0.001). In the adjusted analyses, the estimated VE was 92.0% for two CoronaVac vaccines plus mRNA booster, and 60.2% for two ChAdOx1 vaccines plus mRNA booster, when compared to those with no mRNA booster. Of 246 samples screened for mutations, 191 (77.6%) were Delta variants. Conclusions While two doses of ChAdOx1 or CoronaVac vaccines prevent COVID-19, the addition of a Pfizer/BioNTech booster provided significantly more protection.

A few studies have performed to evaluate the temperature variation influences over on the stroke rates in Brazil. Method: 176 medical records of inpatients were analyzed after having had a stroke between 2004 and 2006 at Hospital Israelita Albert Einstein. The temperature preceding the occurrence of the symptoms was recorded, as well as the temperature 6, 12 and 24 hours before the symptoms in 6 different weather substations, closest to their houses in São Paulo. results: Strokes occurred more frequently after a variation of 3ºC between 6 and 24 hours before the symptoms. There were most hospitalizations between 23-24ºC. conclusion: Incidence of stroke on these patients was increased after a variation of 3º Celsius within 24 hours before the ictus. The temperature variations could be an important factor in the occurrence of strokes in this population. Key words: stroke, temperature, cardiovascular risk, seasonal.Variação da temperatura nas 24 horas anteriores aos sintomas iniciais do acidente vascular cerebral resuMo Poucos trabalhos têm estudado a variação sazonal e de temperatura em acidente vascular cerebral (AVC) no Brasil. Método: Foram analisados 176 registros de pacientes com AVC no Hospital Israelita Albert Einstein entre 2004 e 2006. Foram anotadas as temperaturas ambientes do início dos sintomas, bem como as temperaturas de 6, 12 e 24 horas antes dos sintomas, em 6 diferentes subestações metereológicas mais próximas da casa do paciente em São Paulo. resultados: Houve aumento da incidência do AVC com a variação de 3ºC entre 6 e 24 horas antes do início dos sintomas. Houve um pico de internação entre 23-24ºC. conclusão: A variação de temperatura de 3ºC nas 24 horas que antecederam o início dos sintomas pode ter sido um fator importante na ocorrência do AVC. Palavras-chave: acidente vascular cerebral, temperatura, risco cardiovascular, sazonal. The correlation between strokes and seasonal variations have been studied in various places [1][2][3][4][5][6][7][8] . Some studies around the world have reported an increase of incidence, mortality, and stroke hospitalization during the coldest months of winter.The authors suggest that the temperature variations may trigger responses of vasoconstriction with increase in cardiovascular events. However, the understanding of the relation between changes of weather and cardiovascular events is limited 9-13 . The variation of temperatures before the occurrence of ictus has not been frequently observed. The change in temperature before a stroke could has play a more important role than the season it self. Authors show that the incidence of hemorrhagic stroke (HS) was higher on those days during which the temperature varied significantly 12 .

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In conclusion, between 2004 and 2010, stroke mortality rates decreased by 28·5% in São Paulo. A geographical pattern in stroke mortality could be observed, with considerable differences according the human development index level of the place of living.

Objectives: We aimed to investigate real-world vaccine effectiveness (VE) for Oxford-AstraZeneca (ChAdOx1) and CoronaVac against laboratory-confirmed COVID-19 infection among healthcare workers (HCWs). Methods: We conducted a retrospective cohort study among HCWs (aged ≥18 years) working in a private healthcare system in Brazil between January 1, 2021 and August 3, 2021. To assess VE, we calculated VE=1-RR (rate ratio), with RR determined by adjusting Poisson models with the occurrence of COVID-19 infection as the outcome, and the vaccination status as the main exploratory variable. We used the logarithmic link function and simple models adjusting for sex, age and job types. Results: 13,813 HCWs met the inclusion criteria for this analysis. 6,385 (46.2%) received the CoronaVacvaccine, 5,916 (42.8%) received the ChAdOx1 vaccine, and 1,512 (11.0%) were not vaccinated. Overall, COVID-19 infection cases happened in 6% of unvaccinated HCWs, 3% of HCWs receiving two doses of CoronaVacvaccine, and 0.7% of HCWs receiving two doses of ChAdOx1 vaccine (p-value< 0.001). In the adjusted analyses, the estimated VE was 51.3% for CoronaVac, and 88.1% for ChAdOx1 vaccine. Both vaccines reduced the number of hospitalizations, the length of hospital stay, and the need of mechanical ventilation. Nineteen SARSCoV-2 samples from nineteen HCWs were screened for mutations of interest. Eighteen out of nineteen of those samples were Gamma SARS-CoV-2 variant. Conclusions: While both COVID-19 vaccines (viral vector and inactivated virus) can significantly prevent COVID-19 infection among HCWs, CoronaVac was much less effective. The COVID-19 vaccines were also effective even against a dominant Gamma variant.

Georeferencing data from death certificates or other sources can be a powerful tool to uncover regional epidemiological differences between populations. Our study revealed an even distribution of sepsis all over the inhabited areas of São Paulo.

Objective: To determine risk factors for the development of long coronavirus disease 2019 (COVID-19) in healthcare personnel (HCP). Methods: We conducted a case–control study among HCP who had confirmed symptomatic COVID-19 working in a Brazilian healthcare system between March 1, 2020, and July 15, 2022. Cases were defined as those having long COVID according to the Centers for Disease Control and Prevention definition. Controls were defined as HCP who had documented COVID-19 but did not develop long COVID. Multiple logistic regression was used to assess the association between exposure variables and long COVID during 180 days of follow-up. Results: Of 7,051 HCP diagnosed with COVID-19, 1,933 (27.4%) who developed long COVID were compared to 5,118 (72.6%) who did not. The majority of those with long COVID (51.8%) had 3 or more symptoms. Factors associated with the development of long COVID were female sex (OR, 1.21; 95% CI, 1.05–1.39), age (OR, 1.01; 95% CI, 1.00–1.02), and 2 or more SARS-CoV-2 infections (OR, 1.27; 95% CI, 1.07–1.50). Those infected with the SARS-CoV-2 δ (delta) variant (OR, 0.30; 95% CI, 0.17–0.50) or the SARS-CoV-2 o (omicron) variant (OR, 0.49; 95% CI, 0.30–0.78), and those receiving 4 COVID-19 vaccine doses prior to infection (OR, 0.05; 95% CI, 0.01–0.19) were significantly less likely to develop long COVID. Conclusions: Long COVID can be prevalent among HCP. Acquiring >1 SARS-CoV-2 infection was a major risk factor for long COVID, while maintenance of immunity via vaccination was highly protective.