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Factor de impacto: 25,71 Q1 Background: The omicron (B.1.1.529) variant of SARS-CoV-2 has increased capacity to elude immunity and cause breakthrough infections. The aim of this study was to estimate the effectiveness of mRNA-based vaccine boosters (third dose) against infection with the omicron variant by age, sex, time since complete vaccination, type of primary vaccine, and type of booster. Methods: In this nationwide cohort study, we linked data from three nationwide population registries in Spain (Vaccination Registry, Laboratory Results Registry, and National Health System registry) to select community-dwelling individuals aged 40 years or older, who completed their primary vaccine schedule at least 3 months before the start of follow-up, and had not tested positive for SARS-CoV-2 since the start of the pandemic. On each day between Jan 3, and Feb 6, 2022, we matched individuals who received a booster mRNA vaccine and controls of the same sex, age group, postal code, type of vaccine, time since primary vaccination, and number of previous tests. We estimated risk of laboratory-confirmed SARS-CoV-2 infection using the Kaplan-Meier method and compared groups using risk ratios (RR) and risk differences. Vaccine effectiveness was calculated as one minus RR. Findings: Between Jan 3, and Feb 6, 2022, 3 111 159 matched pairs were included in our study. Overall, the estimated effectiveness from day 7 to 34 after a booster was 51·3% (95% CI 50·2-52·4). Estimated effectiveness was 52·5% (51·3-53·7) for an mRNA-1273 booster and 46·2% (43·5-48·7) for a BNT162b2 booster. Effectiveness was 58·6% (55·5-61·6) if primary vaccination had been with ChAdOx1 nCoV-19 (Oxford-AstraZeneca), 55·3% (52·3-58·2) with mRNA-1273 (Moderna), 49·7% (48·3-51·1) with BNT162b2 (Pfizer-BioNTech), and 48·0% (42·5-53·7) with Ad26.COV2.S (Janssen). Estimated effectiveness was 43·6% (40·0-47·1) when the booster was administered between 151 days and 180 days after complete vaccination and 52·2% (51·0-53·3) if administered more than 180 days after primary scheduled completion. Interpretation: Booster mRNA vaccine-doses were moderately effective in preventing infection with the omicron variant of SARS-CoV-2 for over a month after administration, which indicates their suitability as a strategy to limit the health effects of COVID-19 in periods of omicron variant domination. Estimated effectiveness was higher for mRNA-1273 compared with BNT162b2 and increased with time between completed primary vaccination and booster. Sí

Our goal was to analyze the results of a multicity program offering rapid HIV testing in a mobile unit in central locations. Between October 2006 and December 2007, 7138 persons were tested, providing a finger-prick blood sample and filling out a brief questionnaire while waiting for the results of the Determine((R)) test. Seventy people were classified as reactive and 3 as indeterminate. Confirmatory test results were obtained for 83.6%. Of the 56 reactive persons contacted, 2 were confirmed as negative, giving a positive predictive value of 96.6%. Those tested were primarily men (60.6%), persons with university education (47.4%), and included a large percentage of immigrants (26.2%), especially from Latin America, and 37.3% were men who have sex with men (MSM). Forty-seven percent had ever been tested for HIV. Global HIV prevalence was 0.98% (confidence interval [CI]: 0.75-1.21), 1.59%, (CI: 1.21-1.97) in men and 0.19%, (CI: 0.02-0.35) in women. In the tree analysis the high prevalence node included Latin Americans with only primary studies (study level finished at least at the age of 12). Of the 64% HIV-positive tests in 2007 with available CD4 counts, 18.75% had CD4 counts under 350. Street-based mobile units offering rapid HIV testing in selected sites, may diagnose HIV at an earlier stage of infection than clinic-based sites, and have a low rate of false-positives.

To identify the self-perceived reasons for unintentional opioid overdose of young heroin users in three Spanish cities and their agreement with objective risk factors for overdose. Computer-Assisted Personal Interviews (CAPI) were held with 991 street-recruited current heroin users aged 18-30. The general reasons for overdose and the reasons for the last overdose suffered were explored with open-ended (OEQs) and pre-coded questions (PCQs). Limited knowledge of overdose risk factors was defined as mention of fewer than two objective risk factors for unintentional overdose in the OEQ. Univariate, bivariate, and logistic regression methods were used. 77.8% (Seville), 64.9% (Madrid) and 57.2% (Barcelona) of participants have limited knowledge of overdose risk factors. Residence in Seville and not having attended courses or meetings on overdoses were significantly associated with limited knowledge, after adjusting for other factors. The most frequently identified general reasons in OEQ or PCQ were using heroin in large amounts (66.8%), together with tranquilizers (62.0%), adulterated (60.7%), or purer than usual (57.6%). Most reasons were selected more frequently in PCQ than in OEQ, especially rapid injection of the entire dose and using heroin shortly after using tranquilizers or alcohol, by injection, or after a period of abstinence. The results were similar for overdoses suffered by participants. Most young heroin users do not have sufficient knowledge of overdose risk factors, especially the use of heroin by injection, after a period of abstinence, or together with alcohol or methadone. Specific informational or educational programs adapted to the local context are critically needed. Financial Support: Recruitment of the cohort was financed by the Fundación para Investigación y la Prevención del Sida en España (FIPSE 3035/99); the field work for the section on overdose by FIS 00/1017, and the analyses by FIS-Redes de investigación cooperativa RTICS: C03-09 (RECEPS) and G03 03-005 (RTA).

Background: Opioid overdose risk reduction behaviours include some preventive behaviours to avoid overdoses (PB) and others to avoid death after overdose, such as never using heroin while alone (NUA). Few studies have examined the prevalence and predictors of these behaviours. Aim: To establish the prevalence and predictors of PBs and NUA among heroin users, both injectors and non-injectors, in three Spanish cities. Methods: 516 injecting and 475 non-injecting heroin users aged 18-30 were street-recruited in 2001-2003 and interviewed by face-to-face computer-assisted interview. PBs and NUA in the last 12 months were explored using open-ended and precoded questions, respectively. Specific predictors for three PB categories were investigated: control of route of drug administration, control of quantity or type of heroin used, and control of co-use of other drugs. Bivariate and logistic regression methods were used. Results: Overall, the most prevalent PBs were: using a stable and not excessive amount of heroin (12.7%), injecting or using the whole heroin dose slowly or dividing it into smaller doses (12.4%), reducing or stopping heroin injection (8.3%), and not mixing heroin with tranquillisers (5.1%). Most PBs were significantly more prevalent among injectors than non-injectors. No one mentioned reducing the amount of heroin after an abstinence period. Some 36.2% had NUA. In multiple regression analysis, knowledge of risk factors for opioid overdose was a predictor of specific PBs, although this was not always the case. Use of syringe exchange programmes was a predictor of PB among injectors. However, attending methadone maintenance treatment (MMT) or other drug-dependence treatment was not a predictor of any opioid overdose reduction behaviour. Only ever having witnessed or experienced an overdose predicted PB in both injectors and non-injectors. Conclusions: The proportion of heroin users with opioid overdose risk reduction behaviours is very low. Additional specific measures to prevent overdose are needed, as well as increased emphasis on reducing the risk of overdose in programmes to prevent HIV and other blood-borne infections in heroin injectors. (C) 2010 Elsevier B.V. All rights reserved.

The phenomenon of illicit drug use in Spain during the last thirty years has been marked by the extremely serious consequences of heroin use (mainly injecting). More than 300,000 persons were treated for heroin dependence, 20,000-25,000 died from overdose, 100,000 became infected with HIV through drug injection and quite more with hepatitis virus. Some of these consequences can be attributed to the delay in the implementation of effective interventions, such as methadone maintenance treatment (MMT). Currently, the decreasing number of injectors and the positive effects of interventions, mainly MMT, have led to an important decline of the mentioned health problems. However, overdose mortality remains very high (more than 700 deceased per year), prevalence of both HIV and HCV are still high among injectors, and consequences of chronic liver diseases are emerging. In the last years the use of cocaine and associated problems have increased a lot. Nowadays there are more than 100,000 weekly cocaine users, 25.000 persons are annually treated from cocaine abuse or dependence, and cocaine has an important impact on medical emergency services, while its impact on mortality is unknown. Both cannabis use and related problems are increasing too (there are half a million of daily users). We propose to maintain and to strengthen harm reduction programs (MMT, syringe exchange, save-use and injection rooms, hepatitis A and B vaccination, etc.), to urgently develop specific strategies targeted to reduce overdose mortality and cocaine related problems, and to re-evaluate the effectiveness of preventive and supply control strategies.

The phenomenon of illicit drug use in Spain during the last thirty years has been marked by the extremely serious consequences of heroin use (mainly injecting). More than 300,000 persons were treated for heroin dependence, 20,000-25,000 died from overdose, 100,000 became infected with HIV through drug injection and quite more with hepatitis virus. Some of these consequences can be attributed to the delay in the implementation of effective interventions, such as methadone maintenance treatment (MMT). Currently, the decreasing number of injectors and the positive effects of interventions, mainly MMT, have led to an important decline of the mentioned health problems. However, overdose mortality remains very high (more than 700 deceased per year), prevalence of both HIV and HCV are still high among injectors, and consequences of chronic liver diseases are emerging. In the last years the use of cocaine and associated problems have increased a lot. Nowadays there are more than 100,000 weekly cocaine users, 25.000 persons are annually treated from cocaine abuse or dependence, and cocaine has an important impact on medical emergency services, while its impact on mortality is unknown. Both cannabis use and related problems are increasing too (there are half a million of daily users). We propose to maintain and to strengthen harm reduction programs (MMT, syringe exchange, save-use and injection rooms, hepatitis A and B vaccination, etc.), to urgently develop specific strategies targeted to reduce overdose mortality and cocaine related problems, and to re-evaluate the effectiveness of preventive and supply control strategies. Las dramáticas consecuencias del consumo de heroína (principalmente inyectada) han marcado el fenómeno de las drogas ilegales en España en los últimos treinta años. Más de 300.000 personas han sido tratadas por dependencia de heroína, 20.000-25.000 han muerto por «sobredosis», 100.000 han adquirido el VIH mediante inyección de drogas y bastantes más se han infectado con los virus de la hepatitis. Algunas de estas consecuencias pueden atribuirse al retraso en la puesta en marcha de intervenciones efectivas, como los tratamientos de mantenimiento con metadona (TMM). Actualmente han descendido mucho estos problemas por el descenso del número de personas que se inyectan y el efecto de las intervenciones, principalmente los TMM. Sin embargo, la mortalidad por sobredosis sigue siendo muy alta (más de 700 muertes anuales), y entre los consumidores por vía intravenosa persiste una elevada prevalencia de VIH y hepatitis C, y están emergiendo las consecuencias de las hepatopatías crónicas. Paralelamente, ha aumentado espectacularmente el uso de la cocaína y con él los problemas que causa: hay más de 100.000 consumidores semanales, 25.000 personas tratadas anualmente por abuso o dependencia, y un impacto importante sobre los servicios médicos de urgencia. Su efecto sobre la mortalidad es desconocido. Están aumentando también el consumo y los problemas por cannabis (existe medio millón de consumidores diarios). Se propone mantener y reforzar los programas de reducción del daño (TMM, intercambio de jeringas, salas de consumo, vacunación de hepatitis A y B, etc.), desarrollar con urgencia estrategias específicas para reducir las muertes por sobredosis y los problemas por cocaína, y reevaluar la efectividad de las estrategias preventivas y de control de la oferta.