Characteristics of COVID-19 cases with breakthrough infection in the governorate of Sousse, Tunisia

Abstract Introduction In early 2021, Tunisia implemented a national COVID-19 strategy of vaccination aimed at disease elimination. In this study, we aimed to investigate the characteristics of the breakthrough COVID-19 infection in the governorate of Sousse, Tunisia. Methodology We conducted a cross-sectional study including all post-vaccination COVID-19 cases from March 2021 to August 2021. We collected data via 15-minute telephonic call interviews. We estimated the specific incidence rates (SIR) of confirmed cases by vaccine type and expressed them as cases per 100 000 inhabitants. Statistical analyzes were carried out using anonymous and codified Excel tables and SPSS 20. Results Overall, we included 618 cases of breakthrough COVID-19 infection. The majority were female (sex-ratio=0.8), and the average age of the overall cases was 55.7±14.5 years (range:19-91). Nearly half (49%) of participants had comorbidities, 19.6% were healthcare workers, and 17.9% were smokers. The majority of cases (70%) received at least one dose of Pfizer vaccine followed by CORONAVAC (15.6%; n = 96). Nevertheless, we found a higher incidence rate of COVID-19 among those vaccinated with SPUTNIK V (SIR=1551.2) followed by SINOPHARM (SIR=823.7). Fifty-eight percent of patients reported a poor adhesion to preventive measures, whereas 38.6% reported high respect for the preventive measures. COVID-19 infection led to hospitalization in 8.1% of cases, hospitalization in intensive care units in 2.1% of cases, and death in 1.8% of cases. Conclusions The findings of our study highlight the low rate of severe cases of COVID-19 among the vaccinated population. Furthermore, we found a discrepancy in the effectiveness of vaccines in the prevention of transmission potential. Yet, many factors could influence the transmission and the severity of COVID-19 breakthrough infection from one region to another. Key messages • low rate of severe cases of COVID-19 among the vaccinated population. • discrepancy in the effectiveness of vaccines in the prevention of transmission potential.


Background:
Local contact tracing teams needed to be reinforced in preparation for a peak in Covid-19 cases. The Portuguese Armed Forces showed availability and their members initiated a formal training facilitated by the Public Health Unit (PHU) of Amadora. Health systems must be prepared to respond to all threats, as the COVID-19 pandemic showed us the need for quick task shifting and the training of non-experts' workers.

Objectives:
The aim of the project was to develop contact tracing skills by non-health professionals, in the context of the COVID-19 pandemic. The training program was held online, with a total duration of 48 hours, distributed by the topics described: introduction to health and epidemiology concepts, the national guidelines, and the information systems (13h). We privileged demonstrative and participatory training methods, followed by continuous supervision of each contact tracing survey and constant feedback (35h). Learning support materials were sent out to assist the trainees, including written and video support.

Results:
More than 200 personnel -sailors, soldiers and airmen -were trained. Each Lisbon and Tagus Valley area PHU was reinforced with a team of military professionals in order to support the contact tracing process, with an increase in the number of surveys completed. We highlight as positive aspects: increased number of contact tracing surveys carried out; growth of inter-institutional partnerships; freeing up of specialized PHU resources to other important tasks. As for negative aspects we focus on the complexity in health communication, the limited time for training, and the lack of specific health knowledge of the trainees.

Conclusions:
This pandemic revealed the Portuguese need for a transdisciplinary approach in the provision of care, specially at a Public Health level. Training programs like these highlight the vital role of reshaping and reorganizing the healthcare workforce answering Public Health necessities. Key messages: Training programs for non-health workers must be prepared to reinforce health systems when necessary. The reinforcement of contact tracing teams by the Portuguese Armed Forces was a great example. A transdisciplinary approach in the provision of care was essential during the COVID-19 pandemic. Specific training of non-health workers can be planned in time to respond to health threats. Italy was the first European country to be hit hard by the pandemic and in the context of the Covid-19 pandemic, there were several closures of education and care facilities. The first closure of education facilities lasted continuously from March to September 2020, followed by numerous shorter closures. However, if working parents continue to (have to) work, the question arises who will look after the children during this time when facilities close. To answer this question a quantitative survey of working parents during a 'hard closure' week in February/March 2021 was conducted in the province of Bolzano (Northern Italy). 3725 adults as parents of a total of 7,372 children from different households responded. Although not officially allowed, 53.4% of all participants sought help from people outside the nuclear family to bridge the situation, mostly from grandparents (79%; n = 1855). The situation that grandparents represented the main risk group at the time and could not yet have sufficient vaccination protection appears particularly worrying here. Other parents' coping strategies included working early in the morning or at night (23 %; n = 850), or leaving children unsupervised (25 %, n = 929).

Conclusions:
School closures shift families to new strategies, including unhealthy models of alternating work/childcare, 'illegal' involvement of third parties outside the nuclear family, and neglect of age-appropriate childcare. Our findings highlight that when childcare facilities are repeatedly closed, working families need additional support strategies to reduce contact and minimize secondary harms. Key messages: When schools close, parents have to find new strategies for where to take their children, many have contacts outside the home. Grandparents (also as a risk group) play a major role in childcare even during a lockdown.

Introduction:
In early 2021, Tunisia implemented a national COVID-19 strategy of vaccination aimed at disease elimination. In this study, we aimed to investigate the characteristics of the

Conclusions:
The findings of our study highlight the low rate of severe cases of COVID-19 among the vaccinated population. Furthermore, we found a discrepancy in the effectiveness of vaccines in the prevention of transmission potential. Yet, many factors could influence the transmission and the severity of COVID-19 breakthrough infection from one region to another. Key messages: low rate of severe cases of COVID-19 among the vaccinated population. discrepancy in the effectiveness of vaccines in the prevention of transmission potential.

Introduction:
The use of Vape has increased during the pandemic due to the changes generated by it. Currently we have finished the conditions of confinement, so it is important to identify Objective: To determine the factors associated with post-COVID-19 confinement vape consumption in young adults Methods: A cross-sectional, prospective study was carried out between January and April 2022, including men and women residents of Veracruz aged between 18 and 35 years, excluding participants with addiction treatment or with a diagnosis of a lung disease. A survey was applied through Google Forms to identify the factors associated with Vape consumption after confinement by COVID-19, including depression, anxiety and stress evaluated with the DASS-21 instrument (Cronbach's alpha between 0.79 and 0.87). For data analysis, SPSS v22 software was used, X2 test with Odds Ratio (OR) and 95% confidence interval (CI95%) and MannWhitney U test, assigning statistical significance with p < 0.05.