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BackgroundAs Ireland prepared for an autumn 2023 COVID-19 vaccination booster campaign, there was concern that vaccine fatigue would affect uptake, which has been abating.AimThis study aimed to quantify the direct impact of the COVID-19 vaccination programme in Ireland on averted COVID-19-related outcomes including symptomatic presentations to primary care/community testing centres, emergency department (ED) presentations, hospitalisations, intensive care unit (ICU) admissions and deaths, in individuals aged ≥ 50 years, during Omicron dominance.MethodsWe conducted a retrospective observational COVID-19 vaccine impact study in December 2021-March 2023 in Ireland. We used national data on notified outcomes and vaccine coverage, as well as vaccine effectiveness (VE) estimates, sourced from the World Health Organization's live systematic review of VE, to estimate the count and prevented fraction of outcomes in ≥ 50-year-olds averted by the COVID-19 vaccination programme in this age group.ResultsThe COVID-19 vaccination programme averted 48,551 symptomatic COVID-19 presentations to primary care/community testing centres (36% of cases expected in the absence of vaccination), 9,517 ED presentations (53% of expected), 102,160 hospitalisations (81% of expected), 3,303 ICU admissions (89% of expected) and 15,985 deaths (87% of expected).ConclusionsWhen Omicron predominated, the COVID-19 vaccination programme averted symptomatic and severe COVID-19 cases, including deaths due to COVID-19. In line with other international vaccine impact studies, these findings emphasise the benefits of COVID-19 vaccination for population health and the healthcare system and are relevant for informing COVID-19 booster vaccination programmes, pandemic preparedness and communicating the reason for and importance of COVID-19 vaccination in Ireland and internationally.

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BACKGROUND: Healthcare workers (HCWs) are at increased risk of SARS-CoV-2 infection. This risk persists despite the implementation of mitigating factors, including vaccination. The ongoing impact of incident SARS-CoV-2 infection and symptomatic COVID-19 disease in vaccinated healthcare workers is poorly understood. AIM: We aimed to describe the epidemiology of incident SARS-CoV-2 infections, as well as investigating the serological, clinical and demographic factors associated with developing infection. DESIGN: This was a multi-centre prospective longitudinal study followed a HCW cohort over a nine-month period. METHODS: Spike and nucleocapsid SARS-CoV-2 antibodies were measured at enrolment. Vaccination status, demographics, and medical history were collated. Incident infection over the study period was recorded. Multivariable regression models investigated factors associated with nucleocapsid antibody status, incident infection, and symptomatic infection. RESULTS: 1,260 participants took part, of whom n = 1,006 were anti-nucleocapsid antibody positive. Negative anti-nucleocapsid antibody was associated with older age and having a known SARS-CoV-2 acquisition risk. There were n = 274 (22%) incident infections, with n = 225 (87%) diagnosed using antigen tests. Incident infections were associated with lower anti-nucleocapsid titres, increased time since previous SARS-CoV-2 infection, and having a known acquisition risk, but were not associated with vaccination status. CONCLUSIONS: This study demonstrates a high rate of incident SARS-CoV-2 infection amongst healthcare workers, despite broad vaccine coverage. There is a shift in diagnostics, from PCR to antigen testing. We identify at-risk groups for incident infection, and these should continue be targeted as part of risk reduction campaigns. Vaccination status and prior infection status alone are not surrogates for protection.

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The COVID-19 pandemic highlighted the importance of strengthening health protection worldwide. To address this as a public health priority in Ireland, between December 2021 and October 2022 the first national Health Protection Strategy (2022-2027) for the Irish Health Service Executive (HSE) was developed. We describe the approach taken to develop a first national health protection strategy for Ireland, and highlight the key lessons learned. Key steps in strategy formation included detailed stakeholder analysis, exploration of the context for the strategy and development of a comprehensive consultation plan. Two stakeholder consultation workshops were held. The first focused on defining strategic vision, aim and objectives, the second verified objectives and identified enablers. A subsequent e-consultation invited feedback from wider stakeholders. The published strategy outlines 10 strategic objectives and 11 enablers. Key lessons identified from the strategy development process include the importance of clear leadership and oversight, the value of identifying the context for change, ensuring adequate consultation planning, taking a multidisciplinary approach with strong stakeholder engagement and the need to maintain a strategic perspective. Lessons from our experience can support colleagues internationally to strategically set out their priorities for health protection beyond COVID-19.

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INTRODUCTION: Vaccine hesitancy is complex and multifactorial and a threat to global health. Uptake of some recommended childhood immunisations in Ireland remains below World Health Organisation targets. The aim of this study was to determine factors associated with vaccine uptake in Ireland. METHODS: A cross-sectional, national survey of parental attitudes towards childhood vaccination for children aged 0 to 48 months was conducted between June and August 2021 (N = 855). A descriptive analysis of questionnaire responses was conducted. Univariate and multivariable logistic regression models were constructed to identify the association of demographic parental characteristics and parental vaccine attitude scores with a delay in or lack of parental vaccine acceptance. RESULTS: There was a strongly positive sentiment towards childhood vaccinations. Self-reported uptake of recommended vaccines was 96.1 % with a strong belief in the importance (94.4 %) and safety (89.2 %) of vaccines. Trust in official vaccine information sources was high; 91.5 % and 89.2 % reported trust in the vaccine information provided by healthcare professionals and the Health Service Executive (HSE) respectively. The most commonly identified reasons for missed vaccines were concerns about safety and vaccine side effects. In multivariable regression analysis, parental trust in official vaccine information sources was a significant predictor of vaccine acceptance. For every one unit increase in the median parental trust in official vaccine information score, the odds of a parent having reduced vaccine acceptance decreased significantly (aOR 0.27 95 % CI 0.16, 0.46, p < 0.001). CONCLUSION: Understanding parental attitudes towards vaccination will inform the development of evidence-informed, targeted interventions to increase childhood immunisation uptake. Vaccine information for parents should focus on vaccine safety and public health action should be taken to build trust and engage communities in order to increase and sustain the uptake of childhood vaccines delivered as part of the national childhood primary immunisation programme in Ireland.

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As the COVID-19 pandemic progressed, so too did the proportion of cases admitted to critical care in Ireland who were fully vaccinated. Reporting of this observation has public health implications as incorrect interpretation may affect public confidence in COVID-19 vaccines. A potential explanation is the reduced ability of those who are immunocompromised to produce an adequate, sustained immune response to vaccination. We conducted an analysis of the association between COVID-19 vaccination status and underlying degree of immunocompromise among a cohort of critical care patients all with a confirmed diagnosis of COVID-19 admitted to critical care between July and October 2021. Multinomial logistic regression was used to estimate an odds ratio of immunocompromise among vaccinated COVID-19 cases in critical care compared to unvaccinated cases. In this study, we found a statistically significant association between the vaccination status of severe COVID-19 cases requiring critical care admission and underlying immunocompromise. Fully vaccinated patients were significantly more likely to be highly (OR = 19.3, 95 % CI 7.7-48.1) or moderately immunocompromised (OR = 9.6, 95 % CI 5.0-18.1) compared to unvaccinated patients with COVID-19. These findings support our hypothesis, that highly immunocompromised patients are less likely to produce an adequate and sustained immune response to COVID-19 vaccination, and are therefore more likely to require critical care admission for COVID-19 infection.

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Vaccination of children aged 5 years and older is recommended as part of a multifaceted strategy to protect children against SARS CoV-2 infection and serious disease, and to control the spread of infection. COVID-19 vaccine trials in children aged less than5 years are underway, however, parental acceptance of vaccines for this age group is unknown. Between June and August 2021, a cross-sectional national survey of parental attitudes towards childhood vaccination in Ireland was conducted. Parents of children aged 0-48 months were surveyed to determine their attitudes towards COVID-19 vaccines for their children. A total of 855 parents were surveyed. Overall, 50.6 % reported that they intend to vaccinate their child, 28.7 % reported that they did not intend to vaccinate and 20.2 % were unsure. Among those who stated that they did not intend to vaccinate their child, concern about risks and side effects of vaccination was the primary reason reported (45.6 %). The most frequently reported information needs related to side effects of the vaccine (64.7 %) and vaccine safety (60.3 %). Results of the multivariable analysis showed that believing COVID-19 can be a serious illness in children was a strong predictor of parental intention to vaccinate (aOR 4.88, 95 % CI 2.68, 8.91, p-value < 0.001). In comparison with Irish-born parents, parents born in a Central and Eastern European country were less likely to report intention to vaccinate (aOR 0.21, 95 % CI 0.09, 0.47, p-value, <0.001). Parental belief in vaccine importance and safety and parental trust in official vaccine information sources were associated with increased parental intention to vaccinate. Understanding parental attitudes to vaccination of young children against COVID-19 is important to tailor the provision of information to parents' needs, and to inform the development of vaccination information and communication campaigns for current and future COVID-19 immunisations programmes for children.

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The disproportionately high prevalence of tobacco use among prisoners remains an important public health issue. While Ireland has well-established legislative bans on smoking in public places, these do not apply in prisons. This study evaluates a multi-component tobacco control intervention in a medium security prison for adult males in Ireland. A stop-smoking intervention, targeting staff and prisoners, was designed, implemented, and evaluated with a before-and-after study. Analysis was conducted using McNemar's test for paired binary data, Wilcoxon signed rank test for ordinal data, and paired T-tests for continuous normal data. Pre-intervention, 44.3% (n = 58) of the study population were current smokers, consisting of 60.7% of prisoners (n = 51) and 15.9% of staff (n = 7). Post-intervention, 45.1% of prisoners (n = 23/51) and 100% of staff (n = 7/7) who identified as current smokers pre-intervention reported abstinence from smoking. Among non-smokers, the proportion reporting being exposed to someone else's cigarette smoke while being a resident or working in the unit decreased from 69.4% (n = 50/72) pre-intervention to 27.8% (n = 20/72) post-intervention (p < 0.001). This multicomponent intervention resulted in high abstinence rates, had high acceptability among both staff and prisoners, and was associated with wider health benefits across the prison setting.

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BACKGROUND: Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. METHODS: A retrospective, population-based, observational study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. RESULTS: Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). DISCUSSION: While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.

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INTRODUCTION: The purpose of this study was to compare root and root canal width measurements between digital intraoral radiography (IOR) and micro-computed tomography (µCT). The accuracy of IOR measurements of canine mandibular molars was scrutinized to assess feasibility of developing a model to estimate animal age based on dentinal thickness. MATERIALS AND METHODS: Thirty-nine canine mandibular first molars were imaged using µCT and IOR. For each tooth, the root and root canal width of the mesial and distal roots were measured by a single observer at 3 marked sites on µCT and IOR. Two different software programs were used to measure the radiographs. The radiograph measurements were compared to each other and to the µCT measurements. The µCT images were considered the anatomic reference standard for structural representation. RESULTS: The data collected demonstrated IOR bias and variability throughout all measurement sites, with some sites being more affected than others. Neither IOR system produced unbiased measurements that closely reflected the µCT measurements consistently. The overall lack of agreement between measurements demonstrated the difficulties in developing a standardized protocol for measuring root and root canal width for the first molar teeth in dogs. CONCLUSION: Developing a protocol to accurately measure and compare µCT and IOR measurements is challenging. Designing a measurement system that would allow for universal application to age dogs would require continued research utilizing a standardized approach to overcome the limitations identified in this article.

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