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Vaccination during pregnancy is increasingly adopted worldwide in order to protect the mother and her offspring. We studied the current vaccination programs specifically for pregnant women in 42 European countries. Vaccination programs for pregnant women are in place in 37 countries, as follows: influenza (36 countries), pertussis (28), hepatitis B (12), tetanus (10), pneumococcal disease (10), meningococcal disease (10), rabies (8), tick-borne encephalitis (6), hepatitis A (5), poliomyelitis (4), diphtheria (3), Haemophilus influenzae (2), and human papilloma virus (1). Recommendations for vaccination against influenza and pertussis concern almost exclusively pregnant women regardless of high-risk conditions, however differences between vaccination recommendations are noted in terms of timing. Vaccinations against hepatitis B, hepatitis A, pneumococcal disease, meningococcal disease, poliomyelitis, H. influenzae, rabies, and tick-born encephalitis mainly concern pregnant women at high-risk for exposure or serious illness and post-exposure vaccinations. Overall, five European countries have no vaccination recommendations specifically for pregnant women. In conclusion, there are significant differences in vaccination programs for pregnant women in Europe. Vaccination programs for pregnant women should expand in order to protect maternal and infant health. A consensus-based vaccination program is needed.
Helena C. Maltezou; Evgnosia Effraimidou; Dimitrios C. Cassimos; Snezana Medic; Maria Topalidou; Theocharis Konstantinidis; Maria Theodoridou; Alexandros Rodolakis. Vaccination programs for pregnant women in Europe, 2021. Vaccine 2021, 1 .
AMA StyleHelena C. Maltezou, Evgnosia Effraimidou, Dimitrios C. Cassimos, Snezana Medic, Maria Topalidou, Theocharis Konstantinidis, Maria Theodoridou, Alexandros Rodolakis. Vaccination programs for pregnant women in Europe, 2021. Vaccine. 2021; ():1.
Chicago/Turabian StyleHelena C. Maltezou; Evgnosia Effraimidou; Dimitrios C. Cassimos; Snezana Medic; Maria Topalidou; Theocharis Konstantinidis; Maria Theodoridou; Alexandros Rodolakis. 2021. "Vaccination programs for pregnant women in Europe, 2021." Vaccine , no. : 1.
Contamination of surfaces has been implicated in transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We tested by real-time PCR for SARS-CoV-2 contamination environmental samples from three hospitals during the peak of the third pandemic wave. Overall, 19 of 463 (4.1%) samples tested positive: 12 of 173 (6.9%) samples from a COVID-19 hospital, 3 of 177 (1.7%) samples from a non-COVID-19 hospital, and 4 of 113 (3.5%) samples from a pediatric hospital with dedicated COVID-19 clinics. Most positive samples originated from emergency departments (EDs) (47.3%) and the intensive care units (ICUs) (26.3%) of the COVID-19 hospital. Positive samples belonged almost exclusively (18/19) to the highly transmissible B.1.1.7 cluster, that might explain environmental contamination at this stage of the pandemic. The frequency and efficiency of disinfection in high-risk patient areas, such as EDs and ICUs, should be reinforced, especially during this period where highly transmissible variants of concern are widespread.
Helena C. Maltezou; Maria Tseroni; Charalampos Daflos; Cleo Anastassopoulou; Antonios Vasilogiannakopoulos; Olga Daligarou; Maria Panagiotou; Evanthia Botsa; Nikolaos Spanakis; Athanasia Lourida; Athanasios Tsakris. Environmental testing for SARS-CoV-2 in three tertiary-care hospitals during the peak of the third COVID-19 wave. American Journal of Infection Control 2021, 1 .
AMA StyleHelena C. Maltezou, Maria Tseroni, Charalampos Daflos, Cleo Anastassopoulou, Antonios Vasilogiannakopoulos, Olga Daligarou, Maria Panagiotou, Evanthia Botsa, Nikolaos Spanakis, Athanasia Lourida, Athanasios Tsakris. Environmental testing for SARS-CoV-2 in three tertiary-care hospitals during the peak of the third COVID-19 wave. American Journal of Infection Control. 2021; ():1.
Chicago/Turabian StyleHelena C. Maltezou; Maria Tseroni; Charalampos Daflos; Cleo Anastassopoulou; Antonios Vasilogiannakopoulos; Olga Daligarou; Maria Panagiotou; Evanthia Botsa; Nikolaos Spanakis; Athanasia Lourida; Athanasios Tsakris. 2021. "Environmental testing for SARS-CoV-2 in three tertiary-care hospitals during the peak of the third COVID-19 wave." American Journal of Infection Control , no. : 1.
The coronavirus disease 2019 (COVID-19), which is mainly transmitted through droplets without overlooking other sources of transmission, rendered attention on the air quality in indoor areas and more specifically in healthcare settings. The improvement of indoor air quality (IAQ) is ensured by frequent changes of the air that must be carried out in healthcare areas and with assistance from special devices that undertake the filtration of the air and its purification through special filters and lamps. In this research, the performance of air purifiers is assessed in terms of the limitation of PM2.5, PM10, VOCs and CO2 in a postgraduate clinic of the Dentistry School of the National and Kapodistrian University of Athens in parallel with mechanical ventilation. Our findings indicate that the use of mechanical ventilation plays a key role on the results, retaining good IAQ levels within the clinic and that air purifiers show a positive impact on IAQ by mainly reducing the levels of PM2.5 and secondly of TVOC.
Ioannis Tzoutzas; Helena C. Maltezou; Nikolaos Barmparesos; Panagiotis Tasios; Chrysanthi Efthymiou; Margarita Niki Assimakopoulos; Maria Tseroni; Rengina Vorou; Fotios Tzermpos; Maria Antoniadou; Vassilios Panis; Phoebus Madianos. Indoor Air Quality Evaluation Using Mechanical Ventilation and Portable Air Purifiers in an Academic Dentistry Clinic during the COVID-19 Pandemic in Greece. International Journal of Environmental Research and Public Health 2021, 18, 8886 .
AMA StyleIoannis Tzoutzas, Helena C. Maltezou, Nikolaos Barmparesos, Panagiotis Tasios, Chrysanthi Efthymiou, Margarita Niki Assimakopoulos, Maria Tseroni, Rengina Vorou, Fotios Tzermpos, Maria Antoniadou, Vassilios Panis, Phoebus Madianos. Indoor Air Quality Evaluation Using Mechanical Ventilation and Portable Air Purifiers in an Academic Dentistry Clinic during the COVID-19 Pandemic in Greece. International Journal of Environmental Research and Public Health. 2021; 18 (16):8886.
Chicago/Turabian StyleIoannis Tzoutzas; Helena C. Maltezou; Nikolaos Barmparesos; Panagiotis Tasios; Chrysanthi Efthymiou; Margarita Niki Assimakopoulos; Maria Tseroni; Rengina Vorou; Fotios Tzermpos; Maria Antoniadou; Vassilios Panis; Phoebus Madianos. 2021. "Indoor Air Quality Evaluation Using Mechanical Ventilation and Portable Air Purifiers in an Academic Dentistry Clinic during the COVID-19 Pandemic in Greece." International Journal of Environmental Research and Public Health 18, no. 16: 8886.
From the beginning of the coronavirus disease 2019 (COVID-19) pandemic it became evident that children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain mostly asymptomatic or mildly symptomatic. We reviewed the epidemiologic and clinical features of children with SARS-CoV-2 infection. The true prevalence of asymptomatic SARS-CoV-2 infection is most likely underestimated, as asymptomatic children are less frequently tested. Serologic surveys indicate that half of children tested positive for SARS-CoV-2 report no symptoms. Anosmia/ageusia is not frequent in children but it is the strongest predictor of a positive SARS-CoV-2 test. In general, children with COVID-19 are at lower risk of hospitalization and life-threatening complications. Nevertheless, cases of severe disease or a post-infectious multisystem hyperinflammatory syndrome named multisystem inflammatory syndrome in children (MIS-C) have been described. Rarely children with severe COVID-19 develop neurologic complications. In addition, studies indicate that school closures have a limited impact on SARS-CoV-2 transmission, much less than other social distancing measures. The past months new SARS-CoV-2 variants emerged with higher transmissibility and an increased impact on morbidity and deaths. The role of children in the transmission dynamics of these variants must be elucidated. Lastly, preliminary results from COVID-19 vaccine trials indicate very good efficacy and tolerability in children. Very recently the United States Centers for Disease Control and Prevention and other public health authorities recommend vaccination of children 12 years or older to protect them but mostly to contribute to the achievement of herd immunity.
Georgia B. Nikolopoulou; Helena C. Maltezou. COVID-19 in children: where do we stand? Archives of Medical Research 2021, 1 .
AMA StyleGeorgia B. Nikolopoulou, Helena C. Maltezou. COVID-19 in children: where do we stand? Archives of Medical Research. 2021; ():1.
Chicago/Turabian StyleGeorgia B. Nikolopoulou; Helena C. Maltezou. 2021. "COVID-19 in children: where do we stand?" Archives of Medical Research , no. : 1.
Post-COVID syndrome is increasingly recognized as a new clinical entity in the context of SARS-CoV-2 infection. Symptoms persisting for more than three weeks after the diagnosis of COVID-19 characterize the post-COVID syndrome. Its incidence ranges from 10% to 35%, however, rates as high as 85% have been reported among patients with a history of hospitalization. Currently, there is no consensus on the classification of post-COVID syndrome. We reviewed the published information on post-COVID syndrome, putting emphasis on its pathogenesis. The pathogenesis of post-COVID syndrome is multi-factorial and more than one mechanism may be implicated in several clinical manifestations. Prolonged inflammation has a key role in its pathogenesis and may account for some neurological complications, cognitive dysfunction, and several other symptoms. A multisystem inflammatory syndrome in adults (MIS-A) of all ages has been also described recently, similarly to multisystem inflammatory syndrome in children (MIS-C). The post-infectious inflammatory pathogenetic mechanism of MIS-A is supported by the fact that its diagnosis is established through serology in up to one third of cases. Other pathogenetic mechanisms that are implicated in post-COVID syndrome include immune-mediated vascular dysfunction, thromboembolism, and nervous system dysfunction. Although the current data are indicating that the overwhelming majority of patients with post-COVID syndrome have a good prognosis, registries to actively follow them are needed in order to define the full clinical spectrum and its long-term outcome. A consensus-based classification of post-COVID syndrome is essential to guide clinical, diagnostic, and therapeutic management. Further research is also imperative to elucidate the pathogenesis of post-COVID syndrome.
Helena Maltezou; Androula Pavli; Athanasios Tsakris. Post-COVID Syndrome: An Insight on Its Pathogenesis. Vaccines 2021, 9, 497 .
AMA StyleHelena Maltezou, Androula Pavli, Athanasios Tsakris. Post-COVID Syndrome: An Insight on Its Pathogenesis. Vaccines. 2021; 9 (5):497.
Chicago/Turabian StyleHelena Maltezou; Androula Pavli; Athanasios Tsakris. 2021. "Post-COVID Syndrome: An Insight on Its Pathogenesis." Vaccines 9, no. 5: 497.
Post-COVID syndrome also known as long COVID refers to symptoms persisting for more than three weeks after the diagnosis of COVID-19. We reviewed the current evidence on post-COVID syndrome, focusing on its clinical manifestations and addressing the challenges for its management in primary healthcare. The incidence of post-COVID syndrome is estimated at 10–35%, while for hospitalized patients it may reach 85%. Fatigue is the most common symptom reported in 17.5–72% of post-COVID cases, followed by residual dyspnea with an incidence ranging from 10–40%. Mental problems, chest pain, and olfactory and gustatory dysfunction may affect up to 26%, 22% and 11% of patients, respectively. More than one third of patients with post-COVID syndrome have pre-existing comorbidities, hypertension and diabetes mellitus being the most common. Beyond the prolonged duration of symptoms, the scarce published data indicate that most patients with post-COVID syndrome have a good prognosis with no further complications or fatal outcomes reported. Given the clinical spectrum of patients with post-COVID syndrome, most of them will be managed by primary healthcare professionals, in conjunction with pre-existing or new co-morbidities, which, in turn, may increase the burden of COVID-19 on primary healthcare. In conclusion approximately 10% of patients with COVID-19 may have symptoms persisting beyond three weeks, fulfilling the criteria of post-COVID syndrome. Primary healthcare professionals have a key role in the management of patients with post-COVID syndrome. Research is needed to elucidate the pathogenesis, clinical spectrum, and prognosis of post-COVID syndrome.
Androula Pavli; Maria Theodoridou; Helena C. Maltezou. Post-COVID syndrome: Incidence, clinical spectrum, and challenges for primary healthcare professionals. Archives of Medical Research 2021, 1 .
AMA StyleAndroula Pavli, Maria Theodoridou, Helena C. Maltezou. Post-COVID syndrome: Incidence, clinical spectrum, and challenges for primary healthcare professionals. Archives of Medical Research. 2021; ():1.
Chicago/Turabian StyleAndroula Pavli; Maria Theodoridou; Helena C. Maltezou. 2021. "Post-COVID syndrome: Incidence, clinical spectrum, and challenges for primary healthcare professionals." Archives of Medical Research , no. : 1.
Summary Background Healthcare personnel (HCP) are at increased risk for SARS-CoV-2 infection. Aim To estimate the costs related to COVID-19 exposure and infection among HCP in Greece. Methods Data were retrieved from the national database of SARS-CoV-2 infections and from the database of HCP exposed to COVID-19. A cost-of-illness analysis was performed to estimate total, direct and indirect, costs. Results We studied 254 HCP with COVID-19 and 3,332 HCP exposed to COVID-19 during the first epidemic wave. Of the 254 HCP with COVID-19, 49 (19.3%) were hospitalized (mean hospitalization: 11.6 days) and four were admitted to intensive care unit (mean duration: 10.8 days). Overall, 1,332 (40%) exposed HCP had a mean duration of absenteeism of 7.5 days while 252 (99.2%) HCP with COVID-19 had a mean duration of absenteeism of 25.8 days. The total costs for the management of the two groups were estimated at 1,735,830 Euros (772,890 Euros for the HCP with COVID-19 and 962,940 Euros for the exposed HCP). Absenteeism accounted for the large share of total costs (80.4% of all expenditures), followed by costs for RT-PCR and hospitalization costs (10.2% and 6.5% of all expenditures, respectively). Conclusion Our study confirms that COVID-19 is associated with increased rates and duration of absenteeism among HCP. Indirect costs and particularly absenteeism is the major driver of total costs among exposed to and infected with COVID-19 HCP. The estimated total costs are underestimated. Studies are needed to explore the impact of COVID-19 vaccination of HCP on absenteeism and COVID-19-associated costs.
Helena C. Maltezou; Theodoros V. Giannouchos; Androula Pavli; Paraskeui Tsonou; Xanthi Dedoukou; Maria Tseroni; Kalliopi Papadima; Dimitrios Hatzigeorgiou; Nikolaos V. Sipsas; Kyriakos Souliotis. Costs associated with COVID-19 in healthcare personnel in Greece: a cost-of-illness analysis. Journal of Hospital Infection 2021, 114, 126 -133.
AMA StyleHelena C. Maltezou, Theodoros V. Giannouchos, Androula Pavli, Paraskeui Tsonou, Xanthi Dedoukou, Maria Tseroni, Kalliopi Papadima, Dimitrios Hatzigeorgiou, Nikolaos V. Sipsas, Kyriakos Souliotis. Costs associated with COVID-19 in healthcare personnel in Greece: a cost-of-illness analysis. Journal of Hospital Infection. 2021; 114 ():126-133.
Chicago/Turabian StyleHelena C. Maltezou; Theodoros V. Giannouchos; Androula Pavli; Paraskeui Tsonou; Xanthi Dedoukou; Maria Tseroni; Kalliopi Papadima; Dimitrios Hatzigeorgiou; Nikolaos V. Sipsas; Kyriakos Souliotis. 2021. "Costs associated with COVID-19 in healthcare personnel in Greece: a cost-of-illness analysis." Journal of Hospital Infection 114, no. : 126-133.
Helena C. Maltezou; Kalliopi Papadima; Kassiani Gkolfinopoulou; George Ferentinos; Elisavet Mouratidou; Anastasia Andreopoulou; Androula Pavli; Ioanna Magaziotou; Theano Georgakopoulou; Kassiani Mellou; Rengina Vorou; Anastasia Antoniadou; Anastasia Stathakarou; Anastasios Chrysochoou; Charalambos Gogos; Angeliki Karaiskou; Anastasia Kotanidou; Antonia Koutsoukou; Markos Marangos; Andreas Mentis; Symeon Metallidis; Anna Papa; Angelos Pefanis; Athanasios Tsakris; Nikolaos V. Sipsas. Coronavirus disease 2019 pandemic in Greece, February 26 – May 3, 2020: The first wave. Travel Medicine and Infectious Disease 2021, 41, 102051 -102051.
AMA StyleHelena C. Maltezou, Kalliopi Papadima, Kassiani Gkolfinopoulou, George Ferentinos, Elisavet Mouratidou, Anastasia Andreopoulou, Androula Pavli, Ioanna Magaziotou, Theano Georgakopoulou, Kassiani Mellou, Rengina Vorou, Anastasia Antoniadou, Anastasia Stathakarou, Anastasios Chrysochoou, Charalambos Gogos, Angeliki Karaiskou, Anastasia Kotanidou, Antonia Koutsoukou, Markos Marangos, Andreas Mentis, Symeon Metallidis, Anna Papa, Angelos Pefanis, Athanasios Tsakris, Nikolaos V. Sipsas. Coronavirus disease 2019 pandemic in Greece, February 26 – May 3, 2020: The first wave. Travel Medicine and Infectious Disease. 2021; 41 ():102051-102051.
Chicago/Turabian StyleHelena C. Maltezou; Kalliopi Papadima; Kassiani Gkolfinopoulou; George Ferentinos; Elisavet Mouratidou; Anastasia Andreopoulou; Androula Pavli; Ioanna Magaziotou; Theano Georgakopoulou; Kassiani Mellou; Rengina Vorou; Anastasia Antoniadou; Anastasia Stathakarou; Anastasios Chrysochoou; Charalambos Gogos; Angeliki Karaiskou; Anastasia Kotanidou; Antonia Koutsoukou; Markos Marangos; Andreas Mentis; Symeon Metallidis; Anna Papa; Angelos Pefanis; Athanasios Tsakris; Nikolaos V. Sipsas. 2021. "Coronavirus disease 2019 pandemic in Greece, February 26 – May 3, 2020: The first wave." Travel Medicine and Infectious Disease 41, no. : 102051-102051.
Aim To investigate intention rates to get vaccinated against COVID-19 among healthcare personnel (HCP) in Greece. Methods Cross-sectional survey. Results The response rate was 14.5%. Of 1,521 HCP with a known profession, 607 (39.9%) were nursing personnel, 480 (31.6%) physicians, 171 (11.2%) paramedical personnel, 72 (4.7%) supportive personnel, and 191 (12.6%) administrative personnel. Overall, 803 of 1,571 HCP (51.1%) stated their intention to get vaccinated while 768 (48.9%) stated their intention to decline vaccination. Most HCP (71.3%) who reported intent to get vaccinated noted contributing to the control of the pandemic and protecting their families and themselves as their reasons, while the most common reason for reporting intent to decline vaccination was inadequate information about the vaccines (74.9%), followed by concerns about vaccine safety (36.2%).Logistic regression analysis revealed that the probability of intending to get vaccinated increased with male gender, being a physician, history of complete vaccination against hepatitis B, history of vaccination against pandemic A (H1N1) in 2009-2010, belief that COVID-19 vaccination should be mandatory for HCP, and increased confidence in vaccines in general during the COVID-19 pandemic. The following factors were associated with a lower intention to get vaccinated: no vaccination against influenza the past season, no intention to get vaccinated against influenza in 2020-2021, and no intention to recommend COVID-19 vaccination to high-risk patients. Conclusions There is an urgent need to built safety perception towards COVID-19 vaccines and raise vaccine uptake rates by HCP, and thus to protect the healthcare workforce and the healthcare services.
Helena C. Maltezou; Androula Pavli; Xanthi Dedoukou; Theano Georgakopoulou; Vasilios Raftopoulos; Ioannis Drositis; Emmanouil Bolikas; Caterina Ledda; Georgios Adamis; Andronikos Spyrou; Eleni Karantoni; Maria N. Gamaletsou; Dimitra Maria Koukou; Athanasia Lourida; Nikolaos Moussas; Vasilios Petrakis; Periklis Panagopoulos; Dimitrios Hatzigeorgiou; Maria Theodoridou; Marios Lazanas; Panagiotis Gargalianos; Nikolaos V. Sipsas. Determinants of intention to get vaccinated against COVID-19 among healthcare personnel in hospitals in Greece. Infection, Disease & Health 2021, 26, 189 -197.
AMA StyleHelena C. Maltezou, Androula Pavli, Xanthi Dedoukou, Theano Georgakopoulou, Vasilios Raftopoulos, Ioannis Drositis, Emmanouil Bolikas, Caterina Ledda, Georgios Adamis, Andronikos Spyrou, Eleni Karantoni, Maria N. Gamaletsou, Dimitra Maria Koukou, Athanasia Lourida, Nikolaos Moussas, Vasilios Petrakis, Periklis Panagopoulos, Dimitrios Hatzigeorgiou, Maria Theodoridou, Marios Lazanas, Panagiotis Gargalianos, Nikolaos V. Sipsas. Determinants of intention to get vaccinated against COVID-19 among healthcare personnel in hospitals in Greece. Infection, Disease & Health. 2021; 26 (3):189-197.
Chicago/Turabian StyleHelena C. Maltezou; Androula Pavli; Xanthi Dedoukou; Theano Georgakopoulou; Vasilios Raftopoulos; Ioannis Drositis; Emmanouil Bolikas; Caterina Ledda; Georgios Adamis; Andronikos Spyrou; Eleni Karantoni; Maria N. Gamaletsou; Dimitra Maria Koukou; Athanasia Lourida; Nikolaos Moussas; Vasilios Petrakis; Periklis Panagopoulos; Dimitrios Hatzigeorgiou; Maria Theodoridou; Marios Lazanas; Panagiotis Gargalianos; Nikolaos V. Sipsas. 2021. "Determinants of intention to get vaccinated against COVID-19 among healthcare personnel in hospitals in Greece." Infection, Disease & Health 26, no. 3: 189-197.
Vaccine hesitancy amongst healthcare personnel (HCP) is a critical issue. The aim was to explore the factors that determine the intention to opt for COVID-19 vaccine among HCP from two southern European countries. An anonymous online self-administered survey using Google Forms has been conducted between December 1st to December 15th, 2020 among the HCP in Greece and the Republic of Cyprus. A total of 2,238 HCPs participated in the study (1,220/54.5% from Republic of Cyprus and 1,018 from Greece). Overall 1,082 (48.3%) stressed their intention to get vaccinated (64.4% for Greece and 34.9% for Republic of Cyprus). The main reasons for those who intend to get the COVID-19 vaccine include self (94.2%), family (98.7%), and patients protection (95.2%) as well as mitigation of COVID-19 pandemic (95.4%). The multivariate logistic regression that was performed for the total sample revealed that the following variables were significantly associated with an increased probability to get vaccinated against COVID-19: being a physician, a member of the nursing personnel, paramedical staff, working in Greece, age, the belief that influenza vaccination should be mandatory for HCP, and the rating of the overall management of COVID-19 pandemic in the country and from the public hospitals. Physicians were more likely to get vaccinated against COVID-19 than other HCP. The age was a predictor of COVID-19 uptake intention in the Republic of Cyprus. The belief that there was a successful management of the COVID-19 pandemic contributed to the intention to COVID-19 vaccination uptake.
Vasilios Raftopoulos; Stelios Iordanou; Angeliki Katsapi; Xanthi Dedoukou; Helena C. Maltezou. A comparative online survey on the intention to get COVID-19 vaccine between Greek and Cypriot healthcare personnel: is the country a predictor? Human Vaccines & Immunotherapeutics 2021, 1 -8.
AMA StyleVasilios Raftopoulos, Stelios Iordanou, Angeliki Katsapi, Xanthi Dedoukou, Helena C. Maltezou. A comparative online survey on the intention to get COVID-19 vaccine between Greek and Cypriot healthcare personnel: is the country a predictor? Human Vaccines & Immunotherapeutics. 2021; ():1-8.
Chicago/Turabian StyleVasilios Raftopoulos; Stelios Iordanou; Angeliki Katsapi; Xanthi Dedoukou; Helena C. Maltezou. 2021. "A comparative online survey on the intention to get COVID-19 vaccine between Greek and Cypriot healthcare personnel: is the country a predictor?" Human Vaccines & Immunotherapeutics , no. : 1-8.
Vaccines constitute highly effective tools for controlling and eliminating vaccine-preventable diseases (VPDs) and are assessed to avert between two to three million deaths per year globally. Healthcare personnel (HCP) constitute a priority group for several vaccinations. However, studies indicate significant rates of vaccine hesitancy among them and, therefore, of acceptance of vaccination recommendations. This cross-sectional study was conducted in a university hospital in Southern Italy to assess the knowledge and attitudes of HCP about VPDs before and during the COVID-19 pandemic, estimate their intention to get vaccinated against COVID-19, and search for determinants that may influence their choice. A self-administered questionnaire was used. HCP improved their knowledge about VPDs and were more favorable to vaccinations in September–December 2020 compared to January–December 2019. Overall, 75% of respondents would get a COVID-19 vaccine. Our findings indicate a potential role of the ongoing COVID-19 pandemic on Italian HCP’s knowledge and attitudes towards vaccines.
Caterina Ledda; Claudio Costantino; Mario Cuccia; Helena C. Maltezou; Venerando Rapisarda. Attitudes of Healthcare Personnel towards Vaccinations before and during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health 2021, 18, 2703 .
AMA StyleCaterina Ledda, Claudio Costantino, Mario Cuccia, Helena C. Maltezou, Venerando Rapisarda. Attitudes of Healthcare Personnel towards Vaccinations before and during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2021; 18 (5):2703.
Chicago/Turabian StyleCaterina Ledda; Claudio Costantino; Mario Cuccia; Helena C. Maltezou; Venerando Rapisarda. 2021. "Attitudes of Healthcare Personnel towards Vaccinations before and during the COVID-19 Pandemic." International Journal of Environmental Research and Public Health 18, no. 5: 2703.
Summary Healthcare workers (HCWs) have been recognized as a high-risk group for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This study estimated their risk of infection based on hospital characteristics. Factors significantly associated with increased risk for SARS-CoV-2 infection were: working in a non-referral hospital compared with a coronavirus disease 2019 (COVID-19) referral hospital, working in a hospital with a high number of employees, and working in a hospital with an increased number of patients with COVID-19. This study revealed gaps in infection control in the non-referral hospitals. There is an urgent need for continuous training in infection control practices. Compliance of HCWs with the use of personal protective equipment should also be addressed.
H.C. Maltezou; X. Dedoukou; P. Tsonou; M. Tseroni; V. Raftopoulos; A. Pavli; K. Papadima; A. Chrysochoou; E. Randou; G. Adamis; E. Kostis; A. Pefanis; C. Gogos; N.V. Sipsas. Hospital factors associated with SARS-CoV-2 infection among healthcare personnel in Greece. Journal of Hospital Infection 2021, 109, 40 -43.
AMA StyleH.C. Maltezou, X. Dedoukou, P. Tsonou, M. Tseroni, V. Raftopoulos, A. Pavli, K. Papadima, A. Chrysochoou, E. Randou, G. Adamis, E. Kostis, A. Pefanis, C. Gogos, N.V. Sipsas. Hospital factors associated with SARS-CoV-2 infection among healthcare personnel in Greece. Journal of Hospital Infection. 2021; 109 ():40-43.
Chicago/Turabian StyleH.C. Maltezou; X. Dedoukou; P. Tsonou; M. Tseroni; V. Raftopoulos; A. Pavli; K. Papadima; A. Chrysochoou; E. Randou; G. Adamis; E. Kostis; A. Pefanis; C. Gogos; N.V. Sipsas. 2021. "Hospital factors associated with SARS-CoV-2 infection among healthcare personnel in Greece." Journal of Hospital Infection 109, no. : 40-43.
Pregnant women and young infants are at increased risk for severe influenza and its complications. Influenza vaccination during pregnancy is increasingly implemented as a strategy aiming to protect the pregnant woman, the fetus and the young infant. In clinical practice, the achievement of satisfactory protection for the pregnant woman without compromising the protection of her infant during the first months of life remains a challenge. Determinants that are implicated in the optimal timing of influenza vaccination in pregnancy include influenza season, trimester of pregnancy, maternal host factors and infant factors. This article addresses influenza vaccination in pregnancy and presents recent published evidence on issues that affect the optimization of the timing of maternal vaccination.
Helena C. Maltezou; Alexandros Rodolakis. Vaccination of pregnant women against influenza: what is the optimal timing? Human Vaccines & Immunotherapeutics 2021, 1 -5.
AMA StyleHelena C. Maltezou, Alexandros Rodolakis. Vaccination of pregnant women against influenza: what is the optimal timing? Human Vaccines & Immunotherapeutics. 2021; ():1-5.
Chicago/Turabian StyleHelena C. Maltezou; Alexandros Rodolakis. 2021. "Vaccination of pregnant women against influenza: what is the optimal timing?" Human Vaccines & Immunotherapeutics , no. : 1-5.
In late 2019 a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China and spread throughout the world over a short period of time causing a pandemic of a respiratory disease named coronavirus disease 2019 (COVID-19). SARS-CoV-2 is easily transmitted from person to person through respiratory droplets and direct contact. The scarce available data indicate that dental healthcare personnel are at increased risk for acquisition of infection. Following the lockdown lifting, dental schools should be prepared to refunction safely and provide essential educational and healthcare services while protecting their students, patients, and personnel. The generation of aerosols in dental practice, in association with the high-transmissibility of SARS-CoV-2 through aerosol-generation procedures, the simultaneous provision of dental services to patients in the same areas, and the fact that asymptomatic and pre-symptomatic infected persons may transmit the virus, render the implementation of specific infection prevention and control measures imperative for dental schools. Herein we review the few evidence-based data available to guide infection prevention and control measures for COVID-19 in dental schools.
Helena C Maltezou; Maria Tseroni; Rengina Vorou; Anastasia Koutsolioutsou; Maria Antoniadou; Ioannis Tzoutzas; Vassilios Panis; Fotios Tzermpos; Phoebus Madianos. Preparing dental schools to refunction safely during the COVID-19 pandemic: an infection prevention and control perspective. The Journal of Infection in Developing Countries 2021, 15, 22 -31.
AMA StyleHelena C Maltezou, Maria Tseroni, Rengina Vorou, Anastasia Koutsolioutsou, Maria Antoniadou, Ioannis Tzoutzas, Vassilios Panis, Fotios Tzermpos, Phoebus Madianos. Preparing dental schools to refunction safely during the COVID-19 pandemic: an infection prevention and control perspective. The Journal of Infection in Developing Countries. 2021; 15 (1):22-31.
Chicago/Turabian StyleHelena C Maltezou; Maria Tseroni; Rengina Vorou; Anastasia Koutsolioutsou; Maria Antoniadou; Ioannis Tzoutzas; Vassilios Panis; Fotios Tzermpos; Phoebus Madianos. 2021. "Preparing dental schools to refunction safely during the COVID-19 pandemic: an infection prevention and control perspective." The Journal of Infection in Developing Countries 15, no. 1: 22-31.
Background There is limited information on the association between upper respiratory tract (URT) viral loads, host factors, and disease severity in SARS-CoV-2–infected patients. Methods We studied 1122 patients (mean age, 46 years) diagnosed by polymerase chain reaction (PCR). URT viral load, measured by PCR cycle threshold, was categorized as high, moderate, or low. Results There were 336 (29.9%) patients with comorbidities; 309 patients (27.5%) had high, 316 (28.2%) moderate, and 497 (44.3%) low viral load. In univariate analyses, compared to patients with moderate or low viral load, patients with high viral load were older, more often had comorbidities, developed Symptomatic disease (COVID-19), were intubated, and died. Patients with high viral load had longer stay in intensive care unit and longer intubation compared to patients with low viral load (P values < .05 for all comparisons). Patients with chronic cardiovascular disease, hypertension, chronic pulmonary disease, immunosuppression, obesity, and chronic neurological disease more often had high viral load (P value < .05 for all comparisons). In multivariate analysis high viral load was associated with COVID-19. Level of viral load was not associated with any other outcome. Conclusions URT viral load could be used to identify patients at higher risk for morbidity or severe outcome.
Helena C Maltezou; Vasilios Raftopoulos; Rengina Vorou; Kalliopi Papadima; Kassiani Mellou; Nikolaos Spanakis; Athanasios Kossyvakis; Georgia Gioula; Maria Exindari; Elisavet Froukala; Beatriz Martinez-Gonzalez; Georgios Panayiotakopoulos; Anna Papa; Andreas Mentis; Athanasios Tsakris. Association Between Upper Respiratory Tract Viral Load, Comorbidities, Disease Severity, and Outcome of Patients With SARS-CoV-2 Infection. The Journal of Infectious Diseases 2021, 223, 1132 -1138.
AMA StyleHelena C Maltezou, Vasilios Raftopoulos, Rengina Vorou, Kalliopi Papadima, Kassiani Mellou, Nikolaos Spanakis, Athanasios Kossyvakis, Georgia Gioula, Maria Exindari, Elisavet Froukala, Beatriz Martinez-Gonzalez, Georgios Panayiotakopoulos, Anna Papa, Andreas Mentis, Athanasios Tsakris. Association Between Upper Respiratory Tract Viral Load, Comorbidities, Disease Severity, and Outcome of Patients With SARS-CoV-2 Infection. The Journal of Infectious Diseases. 2021; 223 (7):1132-1138.
Chicago/Turabian StyleHelena C Maltezou; Vasilios Raftopoulos; Rengina Vorou; Kalliopi Papadima; Kassiani Mellou; Nikolaos Spanakis; Athanasios Kossyvakis; Georgia Gioula; Maria Exindari; Elisavet Froukala; Beatriz Martinez-Gonzalez; Georgios Panayiotakopoulos; Anna Papa; Andreas Mentis; Athanasios Tsakris. 2021. "Association Between Upper Respiratory Tract Viral Load, Comorbidities, Disease Severity, and Outcome of Patients With SARS-CoV-2 Infection." The Journal of Infectious Diseases 223, no. 7: 1132-1138.
Vaccine hesitancy has been recognized by the World Health Organization as one of ten threats to public health globally in 2019. Pregnant women constitute an extremely important group for the study of knowledge and attitudes towards pediatric vaccinations. This is a cross-sectional survey conducted in two maternity hospitals in Athens. A standardized questionnaire was used. A total of 814 pregnant women with a mean age of 33.1 years and a mean gestational age of 24.4 weeks were studied. Overall, 717 (89%) of 804 pregnant women reported that they intend to vaccinate their baby in accordance with the National Vaccination Program, 7 (1%) that they do not, while 80 (10%) reported that they have not decided yet. The women provided a mean of 11.4 correct replies out of 14 questions about vaccine-preventable diseases and vaccines (mean knowledge score: 81.5%). A pediatrician has been recognized as the source for information about vaccines in most cases (611/809, 75.5%), while in 215 (26.6%) the internet was also used. Overall, pregnant women trusted physicians about information for vaccines (“very much trusted” in 55.9% and “quite trusted” in 40% of cases). Lastly, 642 (81%) women agreed with the statement “vaccinations should be mandatory for school entry” while 70 (9%) women agreed with the statement “parents should have the right to refuse their children vaccinations”. A multivariate analysis found that a gestational age of ≤20 weeks (OR = 2.33, CIs: 1.27–4.28, p-value = 0.006), having another child (OR = 4.44, CIs: 2.30–8.58, p-value < 0.001), a history of influenza vaccination (OR = 2.54, CIs = 1.37–4.71, p-value = 0.003), and a higher knowledge score about vaccine-preventable diseases and vaccines (OR = 1.33, CIs: 1.23–1.45, p-value < 0.001) were significantly associated with an increased probability to get their child vaccinated in accordance with the National Vaccination Program.
Helena C. Maltezou; Marianna Theodora; Theodore Lytras; Aikaterini Fotiou; Emily Nino; Maria Theodoridou; Alexandros Rodolakis. Knowledge, attitudes and practices about vaccine-preventable diseases and vaccinations of children among pregnant women in Greece. Vaccine 2020, 38, 7654 -7658.
AMA StyleHelena C. Maltezou, Marianna Theodora, Theodore Lytras, Aikaterini Fotiou, Emily Nino, Maria Theodoridou, Alexandros Rodolakis. Knowledge, attitudes and practices about vaccine-preventable diseases and vaccinations of children among pregnant women in Greece. Vaccine. 2020; 38 (48):7654-7658.
Chicago/Turabian StyleHelena C. Maltezou; Marianna Theodora; Theodore Lytras; Aikaterini Fotiou; Emily Nino; Maria Theodoridou; Alexandros Rodolakis. 2020. "Knowledge, attitudes and practices about vaccine-preventable diseases and vaccinations of children among pregnant women in Greece." Vaccine 38, no. 48: 7654-7658.
The World Health Organization (WHO) recommends vaccination of health workers against influenza, but uptake in low-resource settings remains low. To complement routine global data collection efforts we conducted a detailed survey on influenza vaccination policies for health workers in low-income and middle-income countries (LMICs) in early 2020. Health worker vaccination policy data were collected via a web-based survey tool sent to Expanded Programme on Immunization managers or equivalent managers of all eligible countries. High-income countries and countries with active civil war were excluded from the participation. The survey was sent by email to 109 LMICs in all WHO Regions to invite participation. Data were analyzed by World Bank income category and WHO Region. Statistical methods were applied to assess mean vaccination rates across countries. Sixty-eight (62%) out of 109 invited LMICs were studied. Thirty-five (51.5%) reported to have a policy for influenza vaccination of health workers. Vaccinations were voluntary in 23 countries (66%), mandatory in 4 (11%), while in 8 countries (23%) mixed vaccination policies existed. A mechanism to estimate vaccine uptake existed in 26 countries (74%). Low-income and African Region countries were less likely to have influenza vaccination policies for health workers (p-values < 0.001 and 0.009, respectively). The most common reason for not having a vaccination policy for health workers was influenza not being a priority (48.5%). Despite policies being in place in more than half LMICs studied, gaps remain in translating vaccination policies to action, particularly in low-income and African Region countries. To optimize the operationalization of policies, further research is needed within countries, to enable evidence-based introduction decisions, categorization of health workers for vaccination, identification of factors impacting effective service delivery, strengthening monitoring and estimation of vaccination uptake rates and ensure sustainability of funding.
Helena C. Maltezou; Kalliopi Theodoridou; Maria Tseroni; Vasilios Raftopoulos; Amanda Bolster; Alison Kraigsley; Joseph Bresee; Philipp Lambach. Influenza vaccination policies for health workers in low-income and middle-income countries: A cross-sectional survey, January-March 2020. Vaccine 2020, 38, 7433 -7439.
AMA StyleHelena C. Maltezou, Kalliopi Theodoridou, Maria Tseroni, Vasilios Raftopoulos, Amanda Bolster, Alison Kraigsley, Joseph Bresee, Philipp Lambach. Influenza vaccination policies for health workers in low-income and middle-income countries: A cross-sectional survey, January-March 2020. Vaccine. 2020; 38 (47):7433-7439.
Chicago/Turabian StyleHelena C. Maltezou; Kalliopi Theodoridou; Maria Tseroni; Vasilios Raftopoulos; Amanda Bolster; Alison Kraigsley; Joseph Bresee; Philipp Lambach. 2020. "Influenza vaccination policies for health workers in low-income and middle-income countries: A cross-sectional survey, January-March 2020." Vaccine 38, no. 47: 7433-7439.
Background: There is limited information on severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection in children. Methods: We retrieved data from the national database on SARS-CoV-2 infections. We studied in-family transmission. The level of viral load was categorized as high, moderate, or low based on the cycle threshold values. Results: We studied 203 SARS-CoV-2-infected children (median age: 11 years; range: 6 days to 18.4 years); 111 (54.7%) had an asymptomatic infection. Among the 92 children (45.3%) with coronavirus disease 2019 (COVID-19), 24 (26.1%) were hospitalized. Infants <1 year were more likely to develop COVID-19 (19.5% of all COVID-19 cases) (P-value = 0.001). There was no significant difference between viral load and age, sex, underlying condition, fever and hospitalization, as well as between type of SARS-CoV-2 infection and age, sex, underlying condition and viral load. Transmission from a household member accounted for 132 of 178 (74.2%) children for whom the source of infection was identified. An adult member with COVID-19 was the first case in 125 (66.8%) family clusters. Child-to-adult transmission was found in one occasion only. Conclusions: SARS-CoV-2 infection is mainly asymptomatic or mild during childhood. Adults appear to play a key role in spread of the virus in families. Most children have moderate or high viral loads regardless of age, symptoms or severity of infection. Further studies are needed to elucidate the role of children in the ongoing pandemic and particularly in light of schools reopening and the need to prioritize groups for vaccination, when COVID-19 vaccines will be available.
Helena C. Maltezou; Ioanna Magaziotou; Xanthi Dedoukou; Eirini Eleftheriou; Vasilios Raftopoulos; Athanasios Michos; Athanasia Lourida; Maria Panopoulou; Konstantinos Stamoulis; Vasiliki Papaevangelou; Efthimia Petinaki; Andreas Mentis; Anna Papa; Athanasios Tsakris; Emmanuel Roilides; George A. Syrogiannopoulos; Maria Tsolia; for Greek Study Group on SARS-CoV-2 Infections in Children. Children and Adolescents With SARS-CoV-2 Infection. Pediatric Infectious Disease Journal 2020, 39, e388 -e392.
AMA StyleHelena C. Maltezou, Ioanna Magaziotou, Xanthi Dedoukou, Eirini Eleftheriou, Vasilios Raftopoulos, Athanasios Michos, Athanasia Lourida, Maria Panopoulou, Konstantinos Stamoulis, Vasiliki Papaevangelou, Efthimia Petinaki, Andreas Mentis, Anna Papa, Athanasios Tsakris, Emmanuel Roilides, George A. Syrogiannopoulos, Maria Tsolia, for Greek Study Group on SARS-CoV-2 Infections in Children. Children and Adolescents With SARS-CoV-2 Infection. Pediatric Infectious Disease Journal. 2020; 39 (12):e388-e392.
Chicago/Turabian StyleHelena C. Maltezou; Ioanna Magaziotou; Xanthi Dedoukou; Eirini Eleftheriou; Vasilios Raftopoulos; Athanasios Michos; Athanasia Lourida; Maria Panopoulou; Konstantinos Stamoulis; Vasiliki Papaevangelou; Efthimia Petinaki; Andreas Mentis; Anna Papa; Athanasios Tsakris; Emmanuel Roilides; George A. Syrogiannopoulos; Maria Tsolia; for Greek Study Group on SARS-CoV-2 Infections in Children. 2020. "Children and Adolescents With SARS-CoV-2 Infection." Pediatric Infectious Disease Journal 39, no. 12: e388-e392.
The emergence in China in late 2019 and subsequent progression of a pandemic of a respiratory disease named coronavirus disease 2019 (COVID-19) was highly facilitated by international travel. We present 5 cases of probable in-flight transmission in Greece. We studied international passengers arriving to or departing from Greece from February 26 through March 9, 2020. Contact tracing extended up to 4 days before the onset of symptoms and focused on close contacts. Close contacts were defined as persons sitting within a distance of 15 min, including passengers seated two seats around the index case and all crew members and persons who had close contact with the index case. We investigated 18 international flights with 2224 passengers and 110 crew members. Main countries of departure included Northern Italy, Israel and the United Kingdom. In accordance with the national surveillance investigation, in these flights there were 21 index cases and 891 contact traced cases. Six index cases were symptomatic during the flight. Of the 891 contact traced cases, 4 passengers and 1 crew member developed laboratory-confirmed infection (3 with COVID-19 and 2 with asymptomatic infection); they travelled on the same flight with two COVID-19 cases. Air travel has played a central role in the progression of the COVID-19 pandemic. However, there are scarce data about in-flight transmission. Our extensive investigation showed five cases of probable in-flight transmission. Efforts should be placed in order to ensure the prompt implementation of appropriate infection control measures on board.
Androula Pavli; Paraskevi Smeti; Sophia Hadjianastasiou; Kalliopi Theodoridou; Athina Spilioti; Kalliopi Papadima; Anastasia Andreopoulou; Kassiani Gkolfinopoulou; Spyros Sapounas; Nikolaos Spanakis; Athanasios Tsakris; Helena C. Maltezou. In-flight transmission of COVID-19 on flights to Greece: An epidemiological analysis. Travel Medicine and Infectious Disease 2020, 38, 101882 -101882.
AMA StyleAndroula Pavli, Paraskevi Smeti, Sophia Hadjianastasiou, Kalliopi Theodoridou, Athina Spilioti, Kalliopi Papadima, Anastasia Andreopoulou, Kassiani Gkolfinopoulou, Spyros Sapounas, Nikolaos Spanakis, Athanasios Tsakris, Helena C. Maltezou. In-flight transmission of COVID-19 on flights to Greece: An epidemiological analysis. Travel Medicine and Infectious Disease. 2020; 38 ():101882-101882.
Chicago/Turabian StyleAndroula Pavli; Paraskevi Smeti; Sophia Hadjianastasiou; Kalliopi Theodoridou; Athina Spilioti; Kalliopi Papadima; Anastasia Andreopoulou; Kassiani Gkolfinopoulou; Spyros Sapounas; Nikolaos Spanakis; Athanasios Tsakris; Helena C. Maltezou. 2020. "In-flight transmission of COVID-19 on flights to Greece: An epidemiological analysis." Travel Medicine and Infectious Disease 38, no. : 101882-101882.
Background There is limited information on SARS‐CoV‐2 infection clustering within families with children. We aimed to study the transmission dynamics of SARS‐CoV‐2 within families with children in Greece. Methods We studied 23 family clusters of COVID‐19. Infection was diagnosed by RT‐PCR in respiratory specimens. The level of viral load was categorized as high, moderate, or low based on the cycle threshold values. Results There were 109 household members (66 adults and 43 children). The median attack rate per cluster was 60% (range: 33.4%‐100%). An adult member with COVID‐19 was the first case in 21 (91.3%) clusters. Transmission of infection occurred from an adult to a child in 19 clusters and/or from an adult to another adult in 12 clusters. There was no evidence of child‐to‐adult or child‐to‐child transmission. In total 68 household members (62.4%) tested positive. Children were more likely to have an asymptomatic SARS‐CoV‐2 infection compared to adults (40% versus 10.5%, p‐value=0.021). In contrast, adults were more likely to develop a severe clinical course compared to children (8.8% versus 0%, p‐value=0.021). In addition, infected children were significantly more likely to have a low viral load while adults were more likely to have a moderate viral load (40.7% and 18.5% versus 13.8% and 51.7%, respectively; p‐value=0.016). Conclusions While children become infected by SARS‐CoV‐2, they do not appear to transmit infection to others. Furthermore, children more frequently have an asymptomatic or mild course compared to adults. Further studies are needed to elucidate the role of viral load on these findings. This article is protected by copyright. All rights reserved.
Helena C. Maltezou; Rengina Vorou; Kalliopi Papadima; Athanasios Kossyvakis; Nikolaos Spanakis; Georgia Gioula; Maria Exindari; Symeon Metallidis; Athanasia N. Lourida; Vasilios Raftopoulos; Elisavet Froukala; Beatriz Martinez‐Gonzalez; Athanasios Mitsianis; Emmanuel Roilides; Andreas Mentis; Athanasios Tsakris; Anna Papa. Transmission dynamics of SARS‐CoV‐2 within families with children in Greece: A study of 23 clusters. Journal of Medical Virology 2020, 93, 1414 -1420.
AMA StyleHelena C. Maltezou, Rengina Vorou, Kalliopi Papadima, Athanasios Kossyvakis, Nikolaos Spanakis, Georgia Gioula, Maria Exindari, Symeon Metallidis, Athanasia N. Lourida, Vasilios Raftopoulos, Elisavet Froukala, Beatriz Martinez‐Gonzalez, Athanasios Mitsianis, Emmanuel Roilides, Andreas Mentis, Athanasios Tsakris, Anna Papa. Transmission dynamics of SARS‐CoV‐2 within families with children in Greece: A study of 23 clusters. Journal of Medical Virology. 2020; 93 (3):1414-1420.
Chicago/Turabian StyleHelena C. Maltezou; Rengina Vorou; Kalliopi Papadima; Athanasios Kossyvakis; Nikolaos Spanakis; Georgia Gioula; Maria Exindari; Symeon Metallidis; Athanasia N. Lourida; Vasilios Raftopoulos; Elisavet Froukala; Beatriz Martinez‐Gonzalez; Athanasios Mitsianis; Emmanuel Roilides; Andreas Mentis; Athanasios Tsakris; Anna Papa. 2020. "Transmission dynamics of SARS‐CoV‐2 within families with children in Greece: A study of 23 clusters." Journal of Medical Virology 93, no. 3: 1414-1420.