The COVID-19 pandemic, caused by SARS-CoV-2, has emerged as one of most significant health emergencies in recent history. SARS-CoV-2 has been characterized by the emergence of highly mutated variants that exhibit high transmissibility, virulence, and the capability of immune escape. The constantly evolving nature of the COVID-19 pandemic has underscored the necessity for a thorough comprehension of viral transmission dynamics, the effectiveness of novel monitoring techniques, and the determinants of health inequalities. This study explored several aspects of the pandemic, specifically emphasizing the emergence and dissemination of the Delta variant in Florida, the significance of environmental surveillance, and the factors associated with COVID-19 outcomes. Phylogenetic analysis using SARS-CoV-2 genome revealed that multiple independent introductions of the Delta variant fueled its spread within Florida. Further, we hypothesized that high-touch surface monitoring can be an alternative noninvasive approach to determine infection trend and detect variants. The study found high contamination rate on high-touch surfaces and the viral gene copy was positively correlated to the clinical cases in the university. Moreover, genome sequencing of environmental surface samples detected circulating and emerging variants. Additionally, spatial autocorrelation and regression analysis was conducted to investigate the relationship between county-level demographic, socioeconomic, and health-related factors and variation in COVID-19 cases, mortality, and case fatality rates. This study identified significant variations in COVID-19 outcomes across Florida counties, with factors such as age, obesity, rurality and importantly, vaccination rates playing key roles in explaining these disparities. Overall, this study emphasizes the importance of robust genomic surveillance for monitoring the emergence and spread of viral variants, the potential of environmental surface monitoring as a complementary public health tool, and the urgent need to address the underlying drivers of health disparities. These findings contribute to a more nuanced understanding of pandemic dynamics and inform data-driven strategies to mitigate the impact of future public health emergencies.

Yes

Sammanfattning Sedan sjukdomen Covid-19s uppdykande i början av 2020 har forskning pågått för att karaktärisera sjukdomen ur alla tänkbara vinklar för att på kortast möjliga tid bereda väg för ett fungerande botemedel. Effektiva läkemedel som kan minska risken för allvarligt sjuka patienter att avlida i sjukdomen behövs; många preparat har föreslagits och testats och i Sverige har hittills två läkemedel godkänts för Covid-19. Ett av dessa är kortikosteroiden dexametason som godkänts för Covid-19-patienter i behov av syrgas eller respirator. Syftet med detta arbete var att undersöka hur effektiv kortikosteroidbehandling av svårt sjuka Covid-19-patienter var i jämförelse med standardbehandling utan kortikosteroider. En litteratursökning gjordes i PubMed och i covid-nma efter randomiserade kliniska studier av kortikosteroider jämfört med standardbehandling till patienter med Covid-19. Ur resultatet som inkluderade 7 kontrollerade studier med 7784 svårt sjuka patienter från 11 länder och fem kontinenter, gjordes en sammanvägning av den primära utfallsvariabeln mortalitet 28 dagar efter randomisering varpå relativ risk (RR) räknades ut individuellt per studie och sammanvägt för alla studier. Analysen gjordes också med den mest dominanta studien borträknad. Vidare utforskades möjliga samband mellan sjukdomsgrad och effektstorlek, dels genom ett försök till metaregression av studiemortalitet och andningshjälpsnivå mot RR som var inkonklusivt, men också genom att leta efter speciellt sjuka undergrupper i studierna. 3 studier rapporterade mortalitet efter 28 dagar, 1 studie rapporterade mortalitet efter 21 dagar, 2 studier rapporterade död på sjukhus och en studie rapporterade död efter 15 dagar. Testade preparat var dexametason, hydrokortison och metylprednisolon. Av 2885 patienter som randomiserats till någon kortikosteroid, dog 739, medan det av de 4899 som randomiserats till standardbehandling dog 1347 patienter vilket gav en icke signifikant RR på 0,93 (95% CI 0,86–1,01). Vid borträkning av den största studien som bestod av relativt friskare patienter erhölls en starkare och signifikant effekt med RR 0,80 (95% CI 0,70–0,92) baserat på 257 av 781 döda i steroidgrupperna jämfört med 237av 578 döda i någon kontrollgrupp med standardbehandling. Resultatet var även i linje med analysen av olika sjuka undergrupper från största studien som visade bäst effekt hos de med invasiv mekanisk andningshjälp (absolut riskreduktion 12,1%) samt en icke signifikant försämring hos de friskaste patienterna utan syrgasbehov. Sammantaget tyder dessa resultat på att behandling av svårt sjuka Covid-19-patienter med kortikosteroider minskar mortaliteten efter 28 dagar. Dessutom ger studien en stark indikation på att bästa effekten fås om kortikosteroiderna ges till patienter där den systemiska inflammationen i lungorna nått en gasutbyteshämmande nivå / ABSTRACT Since the emergence of the new corona virus disease, Covid-19, much research effort has gone into characterising every possible angle of the disease to pave the way for a possible cure in the shortest possible time. Effective therapies are needed that will reduce the risk of dying for severely to critically ill Covid-19 patients. Many existing therapies have been suggested, tested and repurposed for the treatment of Covid-19 but so far only two drugs have been approved in Sweden for this indication, namely the antiviral drug remdesivir and the corticosteroid dexamethasone. Corticosteroids are both immunosuppressive and anti-inflammatory and when they were administered previously for severe acute respiratory syndrome (SARS), middle east respiratory syndrome (MERS) and influenza they were found to increase the time to rid the body of virus. The purpose of this study was to investigate evidence found in the research literature of how effective corticosteroids are in reducing the risk of dying as compared to standard treatment with no corticosteroids when administered to hospitalised patients with severe Covid-19. A literature search was made in the PubMed and covid-nma databases for randomized clinical studies of corticosteroids versus standard treatment to patients with Covid-19. The result included 7 studies with 7784 patients from 11 countries and 5 continents which all reported death as an outcome in groups that were receiving corticosteroids compared to groups that were receiving standard care. The studies used one of the following corticosteroids as intervention: dexamethasone, methylprednisolone and hydrocortisone in different doses. In the groups receiving standard care, 1347 patients out of 4899 died while in the corticosteroid groups 739 of 2885 patients died. When doing a statistical calculation these figures indicated that the risk of dying when getting corticosteroids was 93% of the risk when not getting corticosteroids, however the difference was not statistically significant. After omitting the largest study from the material, that contributed the absolute majority of total participants, who were deemed relatively healthy or well taken care of, the results were instead that 257 out of 781 died in the steroid groups and 237 of 578 died in the control groups. This later comparison among supposedly sicker patients, gave a statistically significant 8,1% lower absolute risk of dying in the corticosteroid groups; an effect that could also be expressed as for every 25 patients treated, 2 more lives would be saved. A further control of a more severely sick subgroup of patients from the largest study, in need of invasive mechanical ventilation, revealed an absolute reduction of the risk of dying when given corticosteroids of 12,1%. This group showed the most effectful response to the administered corticosteroids in this study which could also be expressed as 1 more life saved for every 8 patients treated. Another sub group analysis of the patients from the largest study that were not in need of any type of oxygen support, indicated on the other hand a possible harm of corticosteroids. This potentially harmful effect was however not statistically significant. In summary, the results of this study imply that administration of corticosteroids to patients with severe Covid-19 will reduce the risk of dying. The greatest effect is seen in those patients that has reached a level of illness were the gas exchange in the lungs is impaired by the inflammation. Furthermore, caution must be taken not to introduce harm by giving corticosteroids to patients with milder disease in which the immunosuppressive properties of the drug could lead to unintended worsening of the illness.

Introduktion: Sjukvårdspersonal runt om i världen har stått på frontlinjen i stressiga arbetsmiljöer och tagit hand om COVID-19-patienter sedan SARS-CoV-2 förklarades som en global pandemi. Under pandemiska förhållanden står sjukvårdspersonal inför specifika utmaningar, där vissa leder till symptom på psykisk ohälsa. Statliga resurser till sjukvårdspersonal har ofta avsatts för kortsiktiga insatser. Långsiktiga investeringar med fokus på främjande av sjukvårdpersonalens psykiska hälsa behövs för att förhindra förvärrade folkhälsoproblem på grund av SARS-CoV-2. Syfte: Studiens syfte var att belysa hur sjukvårdspersonal rapporterar att deras psykiska hälsa påverkats av SARS-CoV-2-pandemin och vilka erfarenheter från tidigare interventioner för psykisk hälsa som skulle kunna vara användbara för att förbättra sjukvårdspersonals psykiska hälsa genom att belysa några exempel. Metod: En systematisk litteraturöversikt genomfördes, där 20 vetenskapliga artiklar inkluderades och analyserades med tematisk analys. Resultat: Totalt nio teman identifierades: psykisk ohälsa hos sjukvårdspersonal, SARS-CoV-2-pandemin, interventioner för psykisk hälsa, vårdkvalitet, säkerhetskultur, arbetsplatsbaserade tillvägagångssätt, mindfulness och konstaktivitetsmetoder, biomarkörbaserade tillvägagångssätt samt tekniska tillvägagångssätt. Viktiga fynd i denna litteraturöversikt är att teman säkerhetskultur och vårdkvalitet är associerade med de andra teman. Slutsats: När tillvägagångssätt implementeras i insatser för sjukvårdspersonals psykiska hälsa som främjar säkerhetskultur och vårdkvalitet främjar det också, enligt resultaten i denna översikt, långsiktiga effekter på individuell psykisk hälsa hos sjukvårdspersonal. Detta bör omedelbart beaktas av dem som utvecklar nya program för att främja psykisk hälsa för att stödja sjukvårdspersonal i effekterna av pandemin. / Introduction: Healthcare workers around the world have stood on the front lines in stressful work-environments, caring for COVID-19 patients since SARS-CoV-2 was declared a global pandemic. Under pandemic conditions healthcare workers face specific challenges, where some lead to symptoms of mental illness. Governmental resources to the healthcare workforce have often been allocated to short-term efforts. Long-term investments focusing on mental health promotion for HCW are needed to prevent worsening public health issues due to SARS-CoV-2. Aim: The aim of the study was to illuminate how HCW report that their mental health has been affected by the SARS-CoV-2 pandemic and what experiences from previous mental health interventions that may be useful in promoting HCW mental health by highlighting some examples. Methods: A systematic literature review was conducted, including 20 scientific articles analyzed with thematic analysis. Results: A total of nine themes were identified: mental distress in HCW, SARS-CoV-2 pandemic, mental health interventions, quality of care, safety culture, workplace-based approaches, mindfulness and art activity approaches, biomarker-based approaches as well as technology approaches. Important findings in this literature review are the themes safety culture and quality of care being associated with the other themes. Conclusion: When implementing approaches in mental health interventions for HCW that promote safety culture and quality of care, it also promotes, according to the findings in this review, long-term effects in individual mental health in HCW. This should be urgently taken into consideration by those developing new mental health promotion programs to support HCW in the effects of the pandemic.

Coronavirus disease 2019 (covid-19) är en smittsam infektionssjukdom som orsakas av viruset severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sedan sjukdomens utbrott i december 2019 har viruset spridits globalt och infekterat fler än 270 miljoner människor världen över. Majoriteten av de som insjuknar i covid-19 får lindriga till måttliga besvär, men en liten del blir allvarligt sjuka och behöver sjukhusvård. Bland de patienter som blir allvarligt sjuka i covid-19 diagnostiseras en betydande del i det akuta skedet med sväljsvårigheter, eller dysfagi. Föreliggande studie bestod i en retrospektiv journalgranskning, som en del av ett kvalitetssäkringsarbete inom Region Gävleborg. Syftet med studien var att undersöka hur sväljsvårigheter kan manifesteras hos personer som vårdas på sjukhus till följd av covid-19 och som remitterats till logoped för bedömning och åtgärder. 60 deltagare inkluderades i studien, varav 17 var kvinnor och 43 var män. Resultaten visar att förekomsten av dysfagi var hög i det akuta skedet, där 42 deltagare (70 %) bedömdes ha dysfagi vid första logopedbedömning. Många deltagare återhämtade sig från sin dysfagi under vårdtiden, men 12 deltagare (20 %) hade kvarstående dysfagi vid utskrivning. Behovet av nutritionsstöd och andningsstöd under vårdtiden var stort. Vanliga fynd under de kliniska sväljbedömningarna var hosta, trögutlöst sväljning och nedsatt oral bearbetning. Deltagarna erhöll logopediska rekommendationer främst gällande anpassad kost, sittställning och munvård. Deltagarnas sväljförmåga skattades med Functional Oral Intake Scale (FOIS) vid första logopedbedömning och vid utskrivning. Vid första bedömning rekommenderades en majoritet av deltagarna anpassad kost (FOIS 1–6) och medelvärdet för FOIS var 3,5 ± 2,1. Vid utskrivning hade de flesta återgått till normalkost (FOIS 7) och medelvärdet för FOIS var 6,0 ± 1,8 (p < 0,001). Denna studie visar att en majoritet av de som vårdats på sjukhus till följd av covid-19 i Region Gävleborg och som remitterats till logoped, uppvisade dysfagi i det akuta skedet men kunde vid utskrivning äta normalkost. Behovet av mer forskning och vidare analyser av hur sväljsvårigheter manifesteras och upplevs hos patientgruppen är fortsatt stort. / Coronavirus disease 2019 (COVID-19) is a contagious infectious disease caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the outbreak in December of 2019, the virus has spread globally and infected more than 270 million people worldwide. The majority of people infected with COVID-19 will have mild to moderate symptoms, but some will suffer from severe illness which requires hospital care. Many of those who experience severe illness from COVID-19 are diagnosed with swallowing difficulties, or dysphagia, in the acute stage. This study consisted of a retrospective medical chart review and is part of a review of quality control in Region Gävleborg. The aim of the study was to investigate how swallowing difficulties manifest in people who require hospital care due to COVID-19 and who have been referred to the Speech and Language Therapy department. 60 participants were included in the study, of whom 17 were women and 43 were men. The results show that the prevalence of dysphagia was high in the acute stage, where 42 participants (70%) were diagnosed with dysphagia during the first SLT assessment. Many participants recovered from their dysphagia during their hospital stay, but 12 participants (20%) had persistent dysphagia at discharge. The need for nutritional and respiratory support was high. Common findings from the clinical swallowing assessments were coughing, difficulty initiating swallowing as well as affected oral processing. Common SLT recommendations included modified consistencies, posture and oral care. Swallowing ability was graded with the Functional Oral Intake Scale (FOIS) at first SLT assessment and at discharge. At first SLT assessment a majority of the participants were recommended a modified diet (FOIS 1-6) and the average FOIS was 3.5 ± 2.1. At discharge most participants had returned to a normal diet (FOIS 7) and the average FOIS was 6.0 ± 1.8 (p < 0,001). This study shows that a majority of the people who were hospitalized due to COVID-19 in Region Gävleborg and who were referred for an SLT evaluation, had dysphagia in the acute stage and recovered from their swallowing difficulties before discharge. More research and further analyses of how swallowing difficulties manifest in patients hospitalized due to COVID-19 is still needed.

[pt] A pandemia do COVID-19 teve impactos sem precedentes em indivíduos e comunidades em todo o mundo. Uma questão de grande preocupação é o impacto da pandemia na saúde mental. O isolamento, o medo e a incerteza causados pelo vírus levaram ao aumento das taxas de ansiedade, depressão e outros problemas de saúde mental. As preocupações com o aumento da prevalência de distúrbios psicológicos já estão levando os países a incluir a saúde mental e o apoio psicossocial em seus planos de resposta à COVID-19, mas, apesar disso, permanecem grandes lacunas e preocupações. Os múltiplos estressores desencadeados pelo vírus, somados às graves interrupções nos serviços públicos, deixaram sérias lacunas no atendimento de quem mais precisa. Além do agravamento e generalização de condições de saúde mental pré-existentes, agora também há a necessidade de acomodar questões recém-desenvolvidas. Nosso objetivo é, portanto, investigar os principais motivos que levaram os pacientes do Serviço de Psicologia Aplicada da PUC-Rio a buscar tratamento psicológico antes (2019) e durante a pandemia (2020 e 2021). Através de uma análise lexical dos formulários de demanda psicológica, pretendemos rastrear as possíveis transições e agravos entre demandas psicológicas de adultos (artigo 1) e famílias (artigo 2) utilizando o software IRaMuTeQ e o método Reinert, que analisa qualitativa e quantitativamente as transcrições relatórios. Por meio desse recurso de análise, é possível começar a mapear e investigar as queixas subjetivas desses pacientes, sua evolução e suas correlações. / [en] The COVID-19 pandemic has had unprecedented impacts on individuals and communities around the world. A matter of great concern is the impact of the pandemic on mental health. The isolation, fear and uncertainty caused by the virus has led to increased rates of anxiety, depression and other mental health issues. Concerns about the increasing prevalence of psychological disorders are already leading countries to include mental health and psychosocial support in their COVID-19 response plans, but despite this, major gaps and concerns remain. The multiple stressors triggered by the virus, in addition to the severe interruptions in public services, have left serious gaps in the care of those who need it most. In addition to the worsening and generalization of pre-existing mental health conditions, there is now also a need to accommodate newly developed issues. Our objective is therefore to investigate the main reasons that led patients from the Service of Applied Psychology at PUC-Rio to seek psychological treatment before (2019) and during the pandemic (2020 and 2021). Through a lexical analysis of the psychological demand forms, we intend to trace the possible transitions and aggravations between psychological demands of adults (article 1) and families (article 2) using the IRaMuTeQ software and the Reinert method, which qualitatively and quantitatively analyzes the transcribed reports. Through this analysis resource, it is possible to start mapping and investigating the subjective complaints of these patients, their development and their correlations.

Dependent on the excretion pattern, wastewater monitoring of viruses can be a valuable approach to characterizing their circulation in the human population. Using polyethylene glycol precipitation and reverse transcription-quantitative PCR, the occurrence of RNA of SARS-CoV-2 and influenza viruses A/B in the raw wastewater of two treatment plants in Germany between January and May 2022 was investigated. Due to the relatively high incidence in both exposal areas (plant 1 and plant 2), SARS-CoV-2-specific RNA was determined in all 273 composite samples analyzed (concentration of E gene: 1.3 × 10⁴ to 3.2 × 10⁶ gc/L). Despite a nation-wide low number of confirmed infections, influenza virus A was demonstrated in 5.2% (concentration: 9.8 × 10² to 8.4 × 10⁴ gc/L; plant 1) and in 41.6% (3.6 × 10³ to 3.0 × 10⁵ gc/L; plant 2) of samples. Influenza virus B was detected in 36.0% (7.2 × 10² to 8.5 × 10⁶ gc/L; plant 1) and 57.7% (9.6 × 10³ to 2.1 × 10⁷ gc/L; plant 2) of wastewater samples. The results of the study demonstrate the frequent detection of two primary respiratory viruses in wastewater and offer the possibility to track the epidemiology of influenza by wastewater-based monitoring.

In der vorliegenden Arbeit wurden modernste Multiplexing-Ansätze der quantitativen Proteomanalyse angewandt, um das neuartige Virus SARS-CoV-2 zu untersuchen, den Erreger der globalen COVID-19 Pandemie, die Ende 2019 begann. Trotz enormer internationaler Anstrengungen zur Erforschung dieser Krankheit sind viele Aspekte der grundlegenden Virusbiologie, Virus-Wirt-Interaktionen und der COVID-19-Pathophysiologie noch immer unbekannt. Dies verhindert die Entwicklung gezielter Behandlungen, insbesondere für COVID-19-Patienten mit schwerem Verlauf. Im ersten Teil dieser Arbeit wurde die Infektionsdynamik in lungenähnlichen Zelllinien untersucht. Der Vergleich von SARS-CoV mit SARS-CoV-2-Infektion in Zellen mit niedriger ACE2 Expression ermöglichte es, die Rolle anderer Membranproteine ​​als Virus Eintrittsfaktoren neu zu bewerten. In SARS-CoV-2 infizierten Calu-3-Zellen konnten Reaktionen der Wirtszellen beobachtet werden, die die Interaktion zwischen viralen Proteinen und Proteikinasen der Wirtszelle vermitteln. Im nächsten Teil wurde die angeborene Immunantwort des Wirts auf das Virus untersucht. Primäre, aus Blut isolierte Monozyten, die mit SARS-CoV-2 behandelt wurden, wiesen eine spezifische Protein-Signatur auf, die auf eine Polarisierung der Zellen zu einem profibrischen Makrophagen-Phänotyp hindeutet. Weitere Analysen zeigten, dass dieser Prozess weitgehend unabhängig von bekannten antiviralen Reaktionen und viraler RNA-Sensoren in Monozyten abläuft. Die durch das Virus hervorgerufene Phosphoproteom-Signatur deutet an, dass die profibrotische Polarisierung durch die kombinierte Wechselwirkung von viralen Proteinen und Infektionsnebenprodukten mit Wirtsrezeptoren induziert wurde. Zusammenfassend liefert diese Arbeit einen wertvollen Beitrag zur Aufklärung von Mechanismen, die zu einem schweren COVID-19 Verlauf führen können und hebt dabei die Bedeutung von Proteomanalysen in der Erforschung viraler Erkrankungen hervor. / In this thesis, we used cutting-edge multiplexed quantitative proteomics and phosphoproteomics approaches to study the virus SARS-CoV-2. The newly emerged betacoronavirus is the causative agent of the global pandemic of COVID-19 that began in late 2019. Despite the tremendous research effort in studying this disease, many aspects of the basic viral biology, virus-host interactions and COVID-19 pathophysiology still remain obscure. This prevents the development of targeted treatments, especially for severe COVID-19 patients. In the first part of this thesis, we studied infection dynamics in lung-like cell lines. Comparison between SARS-CoV and SARS-CoV-2 infections in low-ACE2-expressing cells allowed us to re-evaluate the role of other membrane proteins as entry factors. In Calu-3 cells, we could observe host responses mediating the interactions between viral proteins and host kinases. Next, we focused on the innate immune response of the host to the virus. Ex vivo monocytes treated with SARS-CoV-2 exhibited a specific proteomic signature indicating a polarization toward a profibric macrophage phenotype. Further dissection of this response revealed it to be largely independent from the viral RNA sensing and antiviral response cellular mechanisms. Furthermore, the specific phosphoproteomics signature induced by the virus indicated that the profibrotic polarization was induced by the combined interaction between viral proteins and infection byproducts with host receptors. In summary, this thesis shows the power of mass spectrometry based proteomics to study the complex dynamics between viruses and host cells. Furthermore, we uncovered a potential mechanism contributing to the development of severe COVID-19.

Introduktion: SARS-CoV-2-pandemin resulterar i katastrofala både direkta och indirekta konsekvenser, speciellt i utvecklingsländer. Hälso- och sjukvårdspersonal påverkar samhällets åsikter, acceptans och beslutsfattande gällande vaccinering vilket gör att det är viktigt att förstå SARS-CoV-2-vaccintäckning, samt kunskap och attityd gentemot SARS-CoV-2-vaccin i denna målgrupp. Syfte: Att bestämma vilka variabler som är associerade med SARS-CoV-2-vaccination, samt kunskap och attityd gentemot det samma, hos hälso- och sjukvårdspersonal inom nivå 2- och 3-verksamheter i Nairobi. Metod: Ett kvantitativt frågeformulär delades ut till hälso- och sjukvårdspersonal som arbetar inom nivå 2- och 3-verksamheter i Nairobi. Data analyserades med hjälp av IBM SPSS Statistics 28. Chi-square test, Fisher’s exact test, t-test och envägs-ANOVA användes för att bestämma signifikant associerade variabler med SARSCoV-2 vaccinering, samt kunskap och attityd gentemot det samma. Resultat: Studien fann signifikanta samband mellan vaccinationsstatus och kunskapsindex (p=0,04). Gruppen sjuksköterskor, undersköterskor och läkare hade större sannolikhet att vara vaccinerade än andra yrkesgrupper (p=0,027). Positiva signifikanta samband hittades även mellan kunskapsindex och: ålder (p=0,031), att vara kvinna (p=0,029), erfarenhet (p=0,019), att vara vaccinerad (p=0,007), och attitydindex (p= <0,001). Studien fann även ett signifikant samband mellan kunskapsindex och subcounty (p=0,032). Dagoretti South, Embakasi East och Westlands hade de lägsta kunskapsindexen bland de subcounties som deltog i studien. Studien fann även positiva signifikanta samband mellan attitydindex och följande variabler: erfarenhet (p=0,022), att vara vaccinerad (p=<0,001) och kunskapsindex (p=<0,001). Resultaten visar även ett signifikant samband mellan attitydindex och yrke (p=0,025). Slutsats: Resultaten visar på hög vaccinationstäckning och en generellt positiv attityd. Dock belyser studien viktiga kunskapsluckor om COVID-19-vaccin hos deltagarna som bör adresseras i syfte att förbättrabåde kunskapsläget och vaccinationstäckningen i populationen. / Introduction: The pandemic caused by SARS-CoV-2 is having, and will have devastating indirect consequences, affecting developing countries in particular. The SARS-CoV-2 vaccine acceptance, knowledge and attitude among healthcare workers are important to understand since they influence public opinion, community vaccine acceptance, and decision-making regarding vaccination. Aim: To determine the associated variables with SARS-CoV-2 vaccine uptake, knowledge, and attitude among health workers in level 2 and 3 facilities in Nairobi.  Methods: A quantitative questionnaire was distributed to healthcare workers in level 2 and 3 health facilities in Nairobi. Data was analysed using IBM SPSS Statistics 28. Chi-square tests, Fisher’s exact tests, t-tests and one-way ANOVA tests were conducted to determine the associated variables with SARS-CoV-2 vaccine uptake, knowledge, and attitude. Results: A positively significant association was found between vaccine uptake and knowledge index (p=0,04). The group nurses, assistant nurses and physicians were more likely to be vaccinated than other health professions (p=0,027). A positively significant association was found between knowledge index and: age (p=0,031), being female (p=0,029), years of experience (p=0,019), being vaccinated (p=0,007), and attitude index (p=<0,001). A significant association was found between knowledge index and subcounty (p=0,032). Dagoretti South, Embakasi East and Westlands had the lowest knowledge indexes among the subcounties. A positively significant association was determined between attitude index and: years of experience (p=0,022), being vaccinated (p=<0,001), and knowledge index (p=<0,001). Health profession was also found to be significantly associated with attitude index (p=0,025). Conclusion: The results reflect a high vaccination uptake and a general positive attitude. However, the findings identified essential knowledge gaps regarding COVID-19 vaccines among the participants that should be addressed.

Purpose To investigate the relationship between the risk of pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in children and the predominance of different SARS-CoV-2 variants of concern (VOC) over time. Methods In relation to the Alpha, Delta, and Omicron VOC phases of the pandemic, the risk of developing PIMS-TS was calculated by analyzing data for rtPCR-confirmed SARS-CoV-2 infections reported to the German statutory notification system, along with data captured by a separate, national PIMS-TS registry. Both overall infection rates and age group-specific ratios of PIMS-TS during the different pandemic phases were calculated using the Alpha period as the baseline. Results The PIMS-TS rate changed significantly over time. When the Alpha VOC was dominant [calendar week (CW) 11 in March–CW 31 in August 2021], the PIMS-TS rate was 6.19 [95% confidence intervals (95% CI) 5.17, 7.20]. When Delta prevailed (CW 32 in August 2021–CW 4 in January 2022), the rate decreased to 1.68 (95% CI 1.49, 1.87). During the Omicron phase (CW 5 in January–CW 16 in April 2022), the rate fell further to 0.89 (95% CI 0.79, 1.00). These changes correspond to a decreased PIMS-TS rate of 73% (rate ratio 0.271, 95% CI 0.222; 0.332) and 86% (rate ratio 0.048, 95% CI 0.037; 0.062), respectively, in comparison to the Alpha period. Rate ratios were nearly identical for all age groups. Conclusion The data strongly suggest an association between the risk for PIMS-TS and the prevailing VOC, with highest risk related to Alpha and the lowest to Omicron. Given the uniformity of the decreased risk across age groups, vaccination against SARS-CoV-2 does not appear to have a significant impact on the risk of children developing PIMS-TS.