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We made several regionalizations of the Iberian Peninsula based on the distributions of the pteridophyte flora to see whether the regionalization depended on the type and scale of lattice or the similarity index considered. We used five types of lattice in which the scale also varied: river basins, mountains and plains, natural regions, physiographic and geological regions, and administrative provinces; and two similarity indices: those of Jaccard and of Baroni-Urbani and Buser. The regionalizations varied according to the type of lattice, the grain size, and the similarity index used. To assess the different regionalizations we used four methods: 1) the coefficient of variation of the size of sites in each lattice, 2) the bestblock method, which considers as the best lattice that which maximizes the number of matches between presences over all pairwise site comparisons, 3) the Mantel test, to assess the statistical significance of the regionalizations obtained, and 4) mapability, which considers the most contiguous regionalization to be the best. The best regionalization according to our four criteria was that based on administrative provinces and Jaccard's index. This yielded a small central region and three large regions: northern, western, and eastern. [ABSTRACT FROM AUTHOR]

Background: Seroepidemiological studies provide estimates of population-level immunity, prevalence/incidence of infections, and evaluation of vaccination programs. We assessed the seroprevalence of protective antibodies against influenza and evaluated the correlation of seroprevalence with the cumulative annual influenza incidence rate., Methods: We conducted an annual repeated cross-sectional seroepidemiological survey, during June-August, from 2014 to 2019, in Portugal. A total of 4326 sera from all age groups, sex, and regions was tested by hemagglutination inhibition assay. Seroprevalence and geometric mean titers (GMT) of protective antibodies against influenza were assessed by age group, sex, and vaccine status (65+ years old). The association between summer annual seroprevalence and the difference of influenza incidence rates between one season and the previous one was measured by Pearson correlation coefficient (r)., Results: Significant differences in seroprevalence of protective antibodies against influenza were observed in the population. Higher seroprevalence and GMT for A(H1N1)pdm09 and A(H3N2) were observed in children (5-14); influenza B seroprevalence in adults 65+ was 1.6-4.4 times than in children (0-4). Vaccinated participants (65+) showed significant higher seroprevalence/GMT for influenza. A strong negative and significant correlation was found between seroprevalence and ILI incidence rate for A(H1N1)pdm09 in children between 5 and 14 (r = -0.84; 95% CI, -0.98 to -0.07); a weak negative correlation was observed for A(H3N2) and B/Yamagata (r ≤ -0.1)., Conclusions: The study provides new insight into the anti-influenza antibodies seroprevalence measured in summer on the ILI incidence rate in the next season and the need for adjusted preventive health care measures to prevent influenza infection and transmission., (© 2024 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Background: The global scale-up of antiretroviral treatment (ART) offers significant health benefits by suppressing HIV-1 replication and increasing CD4 cell counts. However, incomplete viral suppression poses a potential threat for the emergence of drug resistance mutations (DRMs), limiting ART options, and increasing HIV transmission., Objective: We investigated the patterns of transmitted drug resistance (TDR) and acquired drug resistance (ADR) among HIV-1 patients in Portugal., Methods: Data were obtained from 1050 HIV-1 patient samples submitted for HIV drug resistance (HIVDR) testing from January 2022 to June 2023. Evaluation of DRM affecting viral susceptibility to nucleoside/tide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) was performed using an NGS technology, the Vela Diagnostics Sentosa SQ HIV-1 Genotyping Assay., Results: About 71% of patients were ART naïve and 29% were experienced. Overall, 20% presented with any DRM. The prevalence of TDR and ADR was 12.6% and 41.1%, respectively. M184V, T215S, and M41L mutations for NRTI, K103N for NNRTI, and M46I/L for PIs were frequent in naïve and treated patients. E138K and R263K mutations against INSTIs were more frequent in naïve than treated patients. TDR and ADR to INSTIs were 0.3% and 7%, respectively. Patients aged 50 or over (OR: 1.81, p = 0.015), originating from Portuguese-speaking African countries (PALOPs) (OR: 1.55, p = 0.050), HIV-1 subtype G (OR: 1.78, p = 0.010), and with CD4 < 200 cells/mm 3 (OR: 1.70, p = 0.043) were more likely to present with DRMs, while the males (OR: 0.63, p = 0.003) with a viral load between 4.1 to 5.0 Log 10 (OR: 0.55, p = 0.003) or greater than 5.0 Log 10 (OR: 0.52, p < 0.001), had lower chances of presenting with DRMs., Conclusions: We present the first evidence on TDR and ADR to INSTI regimens in followed up patients presenting for healthcare in Portugal. We observed low levels of TDR to INSTIs among ART-naïve and moderate levels in ART-exposed patients. Regimens containing PIs could be an alternative second line in patients with intermediate or high-level drug resistance, especially against second-generation INSTIs (dolutegravir, bictegravir, and cabotegravir).

Introduction: HIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019., Methods: We included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP)., Results: The median age was 31 years, 51% had a current income between 501-1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP., Conclusion: Our study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Abrantes, Pimentel, Miranda, Silva, Diniz, Ascenção, Piñeiro, Koch, Rodrigues, Caldas, Morais, Faria, Gomes da Silva, Teófilo, Monteiro, Roxo, Maltez, Rodrigues, Gaião, Ramos, Costa, Germano, Simões, Oliveira, Ferreira, Poças, Saraiva da Cunha, Soares, Fernandes, Mansinho, Pedro, Aleixo, Gonçalves, Manata, Mouro, Serrado, Caixeiro, Marques, Costa, Pacheco, Proença, Rodrigues, Pinho, Tavares, Correia de Abreu, Côrte-Real, Serrão, Sarmento e Castro, Nunes, Faria, Baptista, Simões, Mendão, Martins, Gomes, Pingarilho, Abecasis and the BESTHOPE Study Group.)

BackgroundWest Nile virus (WNV) is a flavivirus with an enzootic cycle between birds and mosquitoes; humans and horses are incidental dead-end hosts. In 2020, the largest outbreak of West Nile virus infection in the Iberian Peninsula occurred, with 141 clusters in horses and 77 human cases.AimWe analysed which drivers influence spillover from the cycle to humans and equines and identified areas at risk for WNV transmission.MethodsBased on data on WNV cases in horses and humans in 2020 in Portugal and Spain, we developed logistic regression models using environmental and anthropic variables to highlight risk areas. Models were adapted to a high-resolution risk map.ResultsCases of WNV in horses could be used as indicators of viral activity and thus predict cases in humans. The risk map of horses was able to define high-risk areas for previous cases in humans and equines in Portugal and Spain, as well as predict human and horse cases in the transmission seasons of 2021 and 2022. We found that the spatial patterns of the favourable areas for outbreaks correspond to the main hydrographic basins of the Iberian Peninsula, jointly affecting Portugal and Spain.ConclusionA risk map highlighting the risk areas for potential future cases could be cost-effective as a means of promoting preventive measures to decrease incidence of WNV infection in Europe, based on a One Health surveillance approach.

Background: Lymphogranuloma venereum (LGV) is a sexual transmitted infection (STI), currently endemic within the population of men who have sex with men (MSM) of Western Countries. L2B variant has been reported as the predominant strain in the current LGV epidemics, although a shift towards L2-434 has been observed in some European countries., Objectives: To evaluate and characterize the population with LGV infection diagnosed in Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal., Methods: A retrospective analysis of all LGV diagnoses between 2016 and 2019 was performed. The diagnosis was established through ompA-genotyping of samples yielding a positive result to Chlamydia trachomatis (CT). All considered samples were retrieved from the clinician activity, through swabbing and urine analysis and CT infection diagnosis was obtained using real-time PCR., Results: During the period studied 16 279 CT diagnostics tests were employed, with a striking increase from 2016 (n = 467) to 2019 (n = 9362). A total of 1602 diagnoses of CT were established, from which 168 (10.5%) corresponded to LGV, with both infections showing a rising evolution, between 2016 and 2019, of 2.9 and 2.7 times, respectively. The majority of the LGV strains were genotyped as L2/434 (67.3%; n = 113). LGV predominantly affected MSM and men who have sex with men and women (97.0%; n = 163). Anorectal infection was the most prevalent one (90.5%; n = 152), being proctitis the main clinical presentation (76.2%; n = 128). Absence of symptoms was reported in almost 15% of the cases (n = 24). The presence of concomitant infection with human immunodeficiency virus was dominant (73.2%; n = 123) and the prevalence of one or more STI co-infections was about 60.1% (n = 99)., Conclusions: An increasing evolution of CT and LGV testing and diagnosing was observable throughout the studied period. Characteristics of the population are similar with those described within LGV epidemics. In accordance with recent European studies, predominance towards L2 genotype was identified., (© 2021 European Academy of Dermatology and Venereology.)

Introduction: The project 'Integrated Monitoring of Vaccines in Europe' aimed to measure seasonal influenza vaccine effectiveness against hospitalised adults, aged 65 years and over, with influenza. We describe the protocol implementation in Portugal., Material and Methods: We implemented a test-negative design, targeting community-dwelling patients aged 65 years old and over hospitalised with severe acute respiratory illness. Patients were reverse transverse-polymerase chain reaction tested for influenza. Cases were those positive for influenza while others were controls. Most variables were collected using hospital medical records. Selection bias was evaluated by comparison with the laboratory influenza test requests database according to demographic characteristics. Crude, season-adjusted influenza vaccine effectiveness was estimated as = 1 - odds ratio, and 95% confidence intervals were obtained by conditional logistical regression, matched with the disease onset month., Results: The recruitment rate was 37.8%. Most participants (n = 368) were female (55.8%) and aged 80 years old and over (55.8%). This was similar to values for potentially eligible severe acute respiratory illness patients (80 years old and over: 56.8%, female: 56.2%). The proportion of missing values was below 2.5% for 20 variables and above 5% (maximum 11.6%) for six variables. Influenza vaccine effectiveness estimates were 62.1% against AH1pdm09 (95% confidence intervals: -28.1 to 88.8), 14.9% against A(H3N2) (95% confidence intervals: -69.6 to 57.3), 43.6% against B/Yam (95% confidence intervals: -66.2 to 80.8)., Discussion: Given the non-existence of a coded admission database in either participating hospital the selection of severe acute respiratory illness due to clinical features was the feasible one. These results are only valid for the older adult population residing in the catchment area of the two participating hospitals who were admitted to a public hospital with severe influenza or SARI symptoms., Conclusion: Despite the low participation rate, we observed comparable characteristics of participants and eligible severe acute respiratory illness patients. Data quality was high, and influenza vaccine effectiveness results were in accordance with the results of meta-analyses and European season-specific estimates. The final sample size was low, which inhibited obtaining estimates with good precision.

Introduction: Respiratory syncytial virus (RSV) is associated with substantial morbidity and mortality since it is a predominant viral agent causing respiratory tract infections in infants, young children and the elderly. Considering the availability of the RSV vaccines in the coming years, molecular understanding in RSV is necessary., Objective: The objective of the present study was to describe RSV epidemiology and genotype variability in Portugal during the 2014/15-2017/18 period., Material and Methods: Epidemiological data and RSV-positive samples from patients with a respiratory infection were collected through the non-sentinel and sentinel influenza surveillance system (ISS). RSV detection, subtyping in A and B, and sequencing of the second hypervariable region (HVR2) of G gene were performed by molecular methods. Phylogenetic trees were generated using the Neighbor-Joining method and p-distance model on MEGA 7.0., Results: RSV prevalence varied between the sentinel (2.5%, 97/3891) and the non-sentinel ISS (20.7%, 3138/16779), being higher (P < 0.0001) among children aged <5 years. Bronchiolitis (62.9%, 183/291) and influenza-like illness (24.6%, 14/57) were associated (P < 0.0001) with RSV laboratory confirmation among children aged <6 months and adults ≥65 years, respectively. The HVR2 was sequenced for 562 samples. RSV-A (46.4%, 261/562) and RSV-B (53.6%, 301/562) strains clustered mainly to ON1 (89.2%, 233/261) and BA9 (92%, 277/301) genotypes, respectively, although NA1 and BA10 were also present until 2015/2016., Conclusion: The sequence and phylogenetic analysis reflected the relatively high diversity of Portuguese RSV strains. BA9 and ON1 genotypes, which have been circulating in Portugal since 2010/2011 and 2011/2012 respectively, predominated during the whole study period., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Chlamydia trachomatis is the most prevalent sexually transmitted bacterium worldwide and the causative agent of trachoma. Its strains are classified according to their ompA genotypes, which are strongly linked to differential tissue tropism and disease outcomes [ocular disease, urogenital disease and lymphogranuloma venereum (LGV)]. While the genome-based species phylogenetic tree presents four main clades correlating with tropism/prevalence, namely ocular, LGV, urogenital T1 (more prevalent genotypes) and urogenital T2 (less prevalent genotypes), inter-clade exchange of ompA is considered a rare phenomenon probably mediating marked tropism alterations. An LGV epidemic, associated with the clonal expansion of the L2b genotype, has emerged in the last few decades, raising concerns particularly due to its atypical clinical presentation (ulcerative proctitis) and circulation among men who have sex with men (MSM). Here, we report an LGV outbreak, mostly affecting human immunodeficiency virus-positive MSM engaging in high-risk sexual practices, caused by an L2b strain with a rather unique non-LGV ompA signature that precluded the laboratory notification of this outbreak as LGV. C. trachomatis whole-genome capture and sequencing directly from clinical samples was applied to deeply characterize the genomic backbone of this novel LGV outbreak-causing clone. It revealed a chimeric genome structure due to the genetic transfer of ompA and four neighbouring genes from a serovar D/Da strain, likely possessing the genomic backbone associated with the more prevalent urogenital genotypes (T1 clade), to an LGV (L2b) strain. The hybrid L2b/D-Da strain presents the adhesin and immunodominant antigen MOMP (major outer membrane protein) (encoded by ompA ) with an epitope repertoire typical of non-invasive genital strains, while keeping the genome-dispersed virulence fingerprint of a classical LGV strain. As previously reported for inter-clade ompA exchange among non-LGV clades, this novel C. trachomatis genomic mosaic involving a contemporary epidemiologically and clinically relevant LGV strain may have implications on its transmission, tissue tropism and pathogenic capabilities. The emergence of variants with epidemic and pathogenic potential highlights the need for more focused surveillance strategies to capture C. trachomatis evolution in action.

We modelled the distributions of two toads (Bufo bufo and Epidalea calamita) in the Iberian Peninsula using the favourability function, which makes predictions directly comparable for different species and allows fuzzy logic operations to relate different models. The fuzzy intersection between individual models, representing favourability for the presence of both species simultaneously, was compared with another favourability model built on the presences shared by both species. The fuzzy union between individual models, representing favourability for the presence of any of the two species, was compared with another favourability model based on the presences of either or both of them. The fuzzy intersections between favourability for each species and the complementary of favourability for the other (corresponding to the logical operation "A and not B") were compared with models of exclusive presence of one species versus the exclusive presence of the other. The results of modelling combined species data were highly similar to those of fuzzy logic operations between individual models, proving fuzzy logic and the favourability function valuable for comparative distribution modelling. We highlight several advantages of fuzzy logic over other forms of combining distribution models, including the possibility to combine multiple species models for management and conservation planning.

Chorotypes--statistically significant groups of coincident distribution areas--constitute biogeographic units that are fuzzy by nature. This quality has been referred to in the literature but has not been analyzed in depth or methodologically developed. The present work redefines chorotypes as fuzzy sets from a pragmatic perspective and basically focuses on the methodological and interpretative implications of this approach. The amphibian fauna in the Iberian Peninsula was used as an example to explore the fuzzy nature of chorotypes. The method on which this article is based is a widely used technique to define chorotypes. This method involves the fuzziness that is inherent to the identification between degree of similarity and degree of membership and includes a probabilistic analysis of the classification for the objective delimitation of chorotypes. The main innovation of this paper is a procedure to analyze chorotypes as fuzzy biogeographic units. A set of fuzzy parameters to deal with the biogeographic interpretation of fuzzy chorotypes is also described. A computer program has been developed and is freely available. History may be related to the degree of fuzziness of chorotypes. In our example, with amphibian distributions in Iberia, less fuzzy chorotypes could have a historical explanation, and the internal fuzziness of chorotypes increases with their distance to hypothetical Pleistocene refugia.

Distribution models are used increasingly for species conservation assessments over extensive areas, but the spatial resolution of the modeled data and, consequently, of the predictions generated directly from these models are usually too coarse for local conservation applications. Comprehensive distribution data at finer spatial resolution, however, require a level of sampling that is impractical for most species and regions. Models can be downscaled to predict distribution at finer resolutions, but this increases uncertainty because the predictive ability of models is not necessarily consistent beyond their original scale. We analyzed the performance of downscaled, previously published models of environmental favorability (a generalized linear modeling technique) for a restricted endemic insectivore, the Iberian desman (Galemys pyrenaicus), and a more widespread carnivore, the Eurasian otter (Lutra lutra), in the Iberian Peninsula. The models, built from presence-absence data at 10 × 10 km resolution, were extrapolated to a resolution 100 times finer (1 × 1 km). We compared downscaled predictions of environmental quality for the two species with published data on local observations and on important conservation sites proposed by experts. Predictions were significantly related to observed presence or absence of species and to expert selection of sampling sites and important conservation sites. Our results suggest the potential usefulness of downscaled projections of environmental quality as a proxy for expensive and time-consuming field studies when the field studies are not feasible. This method may be valid for other similar species if coarse-resolution distribution data are available to define high-quality areas at a scale that is practical for the application of concrete conservation measures., (© 2010 Society for Conservation Biology.)

After a brief introduction about rickettsioses, we analyse Mediterranean Spotted Fever (MSF) in Portugal, and review Portuguese medical literature. We focussed on the seasonal summer pattern of the disease. MSF is very frequent in Portugal, nearly 1,000 cases are reported every year and young age groups are the most afflicted. Although usually regarded as a benign condition, MSF has emerged as a potentially lethal disease in recent years. The clinical presentation is protean, but usually suggestive enough to allow a clinical diagnosis. The complications are well documented, elderly and people with chronic debilitating diseases being the most affected. Q fever is also endemic in Portugal, although with more modest numbers (about 50 cases a year). Serological studies, however, suggest a higher incidence, probably because the disease is unfamiliar to many clinicians and, as such, it is difficult to diagnose and, consequently, then an important number of subclinical or self-limited cases. In Portugal, fever with hepatic involvement is the most common clinical presentation. Other less frequent clinical forms are atypical pneumonia and CNS involvement. Chronic Q fever is a rare condition.

We present an epidemiological and serological study in 286 health care students. We found susceptibility for measles in 11.7% individuals (95% confidence interval (95% CI): 8.0-15%), for rubella: 6.7% (95% CI: 3.8-9.6%) for mumps: 12.7% (95% CI: 8.0-16.6%) and for varicella 8.5% (95% CI: 5.3-11.7%). Compared to a similar study, performed in 1992 in a population of health care workers, we found an increasing susceptibility to these diseases except for mumps, that had decreased. Among those who received one dose of measles vaccine we found 12.1% non immune. We found an high level of immunity (97.1%) for those who received rubella vaccination. We could not draw any conclusions for mumps because only seven had been vaccinated.

We present an epidemiological and serological study in 409 health care workers randomly selected from the 4,103 workers of the University Hospital of Coimbra. A low level of susceptibility for measles (1.2%; 95% confidence interval (95% CI): 0.15-2.23%), rubella (2.4%; 95% CI: 0.9-3.9) and varicella (3.2%; 95% CI: 1.5-4.7%) and a very high one for mumps (17.3%; 95% CI: 13.7-21.1%), were found. Ineffectiveness of historical information in predicting immune status to all of these diseases was found. An economic analysis of preventive measures was done. A mumps vaccination policy for health care workers is recommended and the opportunity of measles and rubella vaccination is discussed, facing the results of this study. Continuous monitoring of these diseases is needed anticipating the changes in epidemiology that are expected to occur with childhood vaccination.