Rare Recombinant GI.5[P4] Norovirus That Caused a Large Foodborne Outbreak of Gastroenteritis in a Hotel in Spain in 2021

Noroviruses are among the most important causes of acute gastroenteritis (AGE). In summer 2021, a large outbreak of norovirus infections affecting 163 patients, including 15 norovirus-confirmed food handlers, occurred in a hotel in Murcia in southeast Spain. A rare GI.5[P4] norovirus strain was identified as the cause of the outbreak. The epidemiological investigation determined that norovirus transmission might have been initiated through an infected food handler. The food safety inspection found that some symptomatic food handlers continued working during illness. Molecular investigation with whole-genome and ORF1 sequencing provided enhanced genetic discrimination over ORF2 sequencing alone and enabled differentiation of the GI.5[P4] strains into separate subclusters, suggesting different chains of transmission. These recombinant viruses have been identified circulating globally over the last 5 years, warranting further global surveillance. IMPORTANCE Due to the large genetic diversity of noroviruses, it is important to enhance the discriminatory power of typing techniques to differentiate strains when investigating outbreaks and elucidating transmission chains. This study highlights the importance of (i) using whole-genome sequencing to ensure genetic differentiation of GI noroviruses to track chains of transmission during outbreak investigations and (ii) the adherence of symptomatic food handlers to work exclusion rules and strict hand hygiene practices. To our knowledge, this study provides the first full-length genome sequences of GI.5[P4] strains apart from the prototype strain.We thank the Genomics and Bioinformatic Departments at the ISCIII for technical assistance. This study was partially funded through project PI20CIII/00005.S

An imported case of vaccine-derived poliovirus type 2, Spain in the context of the ongoing polio Public Health Emergency of International Concern, September 2021

The monthly retrospective search for unreported acute flaccid paralysis (AFP) cases conducted as a complementary component of the Spanish AFP surveillance system identified a case of AFP in a child admitted in Spain from Senegal during August 2021. Vaccine-derived poliovirus 2 was identified in the stool in September 2021. We present public health implications and response undertaken within the framework of the National Action Plan for Polio Eradication and the Public Health Emergency of International Concern.S

Review of hepatitis C screening programs for immigrants in Spain from endemic countries.

hepatitis C virus (HCV) screening strategies in European countries do not usually include the migrant population from endemic countries as a target group for screening. The aim of this study is to describe and to evaluate HCV screening strategies for the migrant population residing in Spain and to compare the differences at a regional level. on-line research on every Health Public Department's website of each autonomous community was carried out during 2017 and 2019. Aragon, Cantabria, Catalunya, Canary Islands and Madrid have HCV screening programmes and include migrants from high-endemic countries as a high-risk group that should be targeted in the screening programme. The Valencian Community and the Basque Country have an HCV programme although migrants for high endemic countries are not included as a high-risk group. Finally, the other autonomic communities have no specific programme for HCV in place. Few of them have a screening control system and/or evaluation. there is heterogeneity on the different HCV autonomic programs concerning the risk groups that should be targeted. A homogenization of such criteria would be recommended. HCV screening in migrant populations from endemic countries should be extended to the rest of autonomic communities. More measures for control and evaluation should be implemented in autonomic strategies with specific indicators for migrant populations.S

Plan Nacional de Eliminación del Sarampión y Rubeola en España. Informe anual 2020

Instituto de Salud Carlos III (ISCIII), CIBERESP y Ministerio de Sanidad. Plan de Eliminación del Sarampión y la Rubeola en España. Informe anual 2020. Madrid, 4 de marzo de 2022.[ES] OMS ha declarado la eliminación del sarampión y de la rubeola en España reconociendo que desde el año 2014 está interrumpida la transmisión endémica de los virus en el territorio. En España el sarampión y la rubeola son enfermedades importadas. Tras una importación se suelen producir brotes limitados, con afectación fundamentalmente de adultos no vacunados o que presentan evanescencia de la protección conferida por las vacunas que recibieron en su infancia. La transmisión del sarampión se concentra en los sitios de alta exposición, como son los centros de atención sanitaria. En los primeros años de la fase de post-eliminación (2014-2016) se registró una incidencia anual muy baja (2014-2016) se registró una incidencia anual muy baja (<0,1 casos por millón); entre 2017 y 2019 ocurrió un repunte del sarampión en España (6 casos por millón/año) coincidiendo con el resurgimiento de la enfermedad en Europa y en otras zonas del mundo; desde el primer trimestre del año 2020, coincidiendo con el establecimiento de las restricciones al movimiento de personas por la pandemia de Covid-19, la circulación de virus del sarampión se ha reducido drásticamente en todo el mundo. En España, la incidencia de sarampión en el año 2020 fue de 1,9 casos por millón de habitantes. Se notificó transmisión del sarampión en dos brotes activos durante el primer trimestre del año 2020 (último caso en estos brotes con fecha de exantema el 26 marzo 2020). Desde entonces y hasta febrero 2022 no se ha notificado transmisión del sarampión en España. En 2020, de los 159 casos sospechosos notificados, 88 se confirmaron y 71 se descartaron. Se identificó un caso importado, 84 casos secundarios a importación y tres casos para los que no se pudo determinar el origen; 86 casos ocurrieron asociados a brotes y dos fueron casos esporádicos. Se notificaron tres brotes de sarampión, dos de ellos iniciados a finales de 2019 y que se pudieron caracterizar molecularmente. En uno de ellos se identificó el caso índice procedente de Rumanía. El 71,6% de los casos de sarampión eran adultos de 20 o más años y el 12,5% niños menores de un año. La mayoría de los casos -61,4%- no estaban vacunados, el 9,1% había recibido una dosis de vacuna triple vírica y el 15,9% había recibido dos dosis. En el 13,6% de los casos se desconocía el estado de vacunación. En 2020, se notificaron tres sospechas de rubéola: una se confirmó por laboratorio y dos se descartaron. La rubeola confirmada fue importada y se diagnosticó en un adulto no vacunado que no había nacido en España. En 2020 no se notificó ningún caso de SRC. En cuanto a los indicadores de calidad de la vigilancia, la tasa de investigación de laboratorio, la proporción de casos con el origen de infección identificado y la puntualidad de la investigación fueron superiores al 80%. La tasa de casos descartados para sarampión fue de 0,20 por cada 100.000 habitantes, lejos del objetivo marcado por OMS de detectar, investigar y descartar al menos 2 casos de sarampión por cada 100.000 habitantes y año. El bajo número de sospechas de rubéola notificadas durante 2020 no permite obtener conclusiones sobre la calidad de la vigilancia para este año. En el estudio molecular de las cepas se encontraron los genotipos B3 y D8 del virus del sarampión. En el brote de Cataluña se identificó el haplotipo MVs/Barcelona.ESP/52.19/[B3], que tras el análisis filogenético se concluyó que formaba parte del clado filogenético de la variante MVi/Harare.ZWE/38.09/[B3] (B3-Harare). En el brote de Galicia importado de Rumania se identificó la variante MVs/Gir Somnath.IND/42.16/ [D8] ampliamente distribuida en Europa. En el caso importado de Mozambique, el análisis molecular confirmó este origen puesto que se identificó el haplotipo Mvs/Gaziantep.TUR/13.17/[D8] que estaba circulando en ese país. El patrón de genotipos y variantes no muestra circulación continua de ninguno de ellos y no hay detección de genotipos endémicos. En 2020 no hay resultados del estudio molecular del único caso confirmado de rubeola por falta de muestras disponibles. En el año 2020 la cobertura nacional de la vacuna triple vírica fue del 96,3% con la primera dosis y del 93,9% con la segunda. [EN] The WHO has declared the elimination of measles and rubella in Spain, recognizing that since 2014 the endemic transmission of the viruses has been interrupted in the territory. Measles and rubella are imported diseases in Spain. Following importation, there are usually limited outbreaks, mainly affecting unvaccinated adults or adults who have lost the protection conferred by the vaccines they received as children. Measles transmission is concentrated in high-exposure sites, such as health care settings. In the first years of the post-elimination phase (2014-2016), a very low annual incidence (<0.1 cases per millón) was recorded; between 2017 and 2019 there was an upsurge of measles in Spain (6cases per million/year) coinciding wirth the resurgence of the disease in Europe and other áreas of the world; since the first quarter of 2020, coinciding with the establishment of restrictions on the movement of people due to the Covid-19 pandemic, measles virus circulation has been drastically reduced worldwide. In Spain, measles incidence in 2020 was 1.9 cases per million population. Measles transmission was reported in two active outbreaks during the first quarter of 2020 (last case in these outbreaks with an exanthema date of March 26th 2020). Since then and until February 2022, no measles transmission has been reported in Spain. In 2020, of the 159 suspected cases reported, 88 were confirmed and 71 were ruled out. Only one imported case was identified, 84 cases secondary to importation and three other cases for which the origin could not be determined; 86 cases occurred in association with outbreaks and two were sporadic cases. Three measles outbreaks were reported, two of which started in late 2019 and could be molecularly characterized. In one of them, the index case from Romania was identified. Of the measles cases, 71.6% were adults aged 20 years or older and 12.5% were children under one year of age. The majority of cases - 61.4% - were unvaccinated, 9.1% had received one dose of MMR vaccine and 15.9% had received two doses. Vaccination status was unknown in 13.6% of cases. In 2020, three suspected rubella cases were reported: one was laboratory confirmed and two were ruled out. The confirmed rubella was imported and diagnosed in an unvaccinated adult who was not born in Spain. No CRS cases were reported in 2020. In terms of surveillance quality indicators, the laboratory investigation rate, the proportion of cases with identified source of infection and the timeliness of investigation were above 80%. The rate of discarded cases for measles was 0.20 per 100,000 population, far from the WHO target of detecting, investigating and discarding at least 2 measles cases per 100,000 population per year. The low number of suspected cases of rubella reported during 2020 does not allow conclusions to be drawn on the quality of surveillance for this year. Measles virus genotypes B3 and D8 were found in the molecular study of the strains. In the outbreak in Catalonia, the haplotype MVs/Barcelona.ESP/52.19/[B3] was identified, which after phylogenetic analysis was concluded to be part of the phylogenetic clade of the variant MVi/Harare.ZWE/38.09/[B3] (B3-Harare). In the Galicia outbreak, imported from Romania, the MVs/Gir Somnath.IND/42.16/ [D8] variant widely distributed in Europe was identified. In the case imported from Mozambique, molecular analysis confirmed this origin as the haplotype Mvs/Gaziantep.TUR/13.17/[D8] was identified as circulating in that country. The pattern of genotypes and variants does not show continuous circulation of any of them without detection of endemic genotypes of measles virus. In 2020 there are no results of the molecular study of the only confirmed rubella case due to lack of available samples. In 2020, vaccination coverage of MMR vaccine was 96,3% for the first dose and 93,9% for the second dose.N