Acute health effects after accidental exposure to styrene from drinking water in Spain.

OBJECTIVES: We studied subjective health symptoms in a population accidentally exposed to high styrene concentrations in drinking tap water. The contamination occurred during the reparation of a water tank. METHODS: Residents of 27 apartments in two buildings using the contaminated water were contacted. A questionnaire on subjective symptoms was administered to 84 out of 93 persons living in the apartments at the time of the accident. Styrene concentration was measured in samples of water collected two days after the accident. The means of exposure associated with appearance of symptoms were examined through case-control analyses. RESULTS: Styrene in water reached concentrations up to 900 microg/L. Symptoms were reported by 46 persons (attack rate 55 %). The most frequent symptoms were irritation of the throat (26%), nose (19%), eyes (18%) and the skin (14%). General gastrointestinal symptoms were observed with 11% reporting abdominal pain and 7% diarrhea. The factors most strongly associated with symptoms were drinking tap water (OR = 7.8, 95% CI 1.3-48), exposure to vapors from the basement (OR = 10.4, 2.3-47) and eating foods prepared with tap water (OR = 8.6, 1.9-40). All residents in the ground floor reported symptoms. CONCLUSIONS: This accidental contamination led to very high styrene concentrations in water and was related to a high prevalence of subjective symptoms of the eyes, respiratory tract and skin. Similar exposures have been described in workers but not in subjects exposed at their residence. Various gastrointestinal symptoms were also observed in this population probably due to a local irritative effect

The seasonality of tuberculosis, sunlight, vitamin D, and household crowding.

BACKGROUND: Unlike other respiratory infections, tuberculosis diagnoses increase in summer. We performed an ecological analysis of this paradoxical seasonality in a Peruvian shantytown over 4 years. METHODS: Tuberculosis symptom-onset and diagnosis dates were recorded for 852 patients. Their tuberculosis-exposed cohabitants were tested for tuberculosis infection with the tuberculin skin test (n = 1389) and QuantiFERON assay (n = 576) and vitamin D concentrations (n = 195) quantified from randomly selected cohabitants. Crowding was calculated for all tuberculosis-affected households and daily sunlight records obtained. RESULTS: Fifty-seven percent of vitamin D measurements revealed deficiency (<50 nmol/L). Risk of deficiency was increased 2.0-fold by female sex (P < .001) and 1.4-fold by winter (P < .05). During the weeks following peak crowding and trough sunlight, there was a midwinter peak in vitamin D deficiency (P < .02). Peak vitamin D deficiency was followed 6 weeks later by a late-winter peak in tuberculin skin test positivity and 12 weeks after that by an early-summer peak in QuantiFERON positivity (both P < .04). Twelve weeks after peak QuantiFERON positivity, there was a midsummer peak in tuberculosis symptom onset (P < .05) followed after 3 weeks by a late-summer peak in tuberculosis diagnoses (P < .001). CONCLUSIONS: The intervals from midwinter peak crowding and trough sunlight to sequential peaks in vitamin D deficiency, tuberculosis infection, symptom onset, and diagnosis may explain the enigmatic late-summer peak in tuberculosis

Atopic dermatitis incidence and risk factors in young adults in Castellon (Spain): A prospective cohort study

Introduction: There are few atopic dermatitis (AD) incidence cohort studies in young adults, the etiology of this disease remains obscure, and AD risk factors in adults are not well understood. The objective of this study was to estimate AD ten-year incidence and prevalence in a cohort of adolescent aged 14–16 at inception in Castellon province in Valencia Region, Spain and describe related risk factors. Material and methods: From 2002 to 2012, a population-based prospective cohort study was carried out. Questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC) were used with an additional questionnaire for related factors completed by participants and their parents, respectively, in 2002. In 2012 the same questionnaires were completed by the participants’ through a telephone interview, and incidence and prevalence of AD were estimated. Directed acyclic graphs, Poisson regression and inverse probability weighted regression adjustment were used. Results: The participation rate was 79.5% (1435/1805) with AD lifetime prevalence of 34.9% and AD incidence of 13.5 per 1000 person years. Females presented higher prevalence and incidence than males. After adjustment significant risk factors were being female, history of asthma or allergic rhinitis, family history of AD, history of respiratory infections, history of bronchitis, history of pneumonia, history of sinusitis, and birthplace outside Castellon province. The highest AD population attributable risks were female, 30.3%, and history of respiratory infections 15.3%. Differences with AD childhood risk factors were found. Conclusions: AD incidence in our cohort was high and several risks factors were related to AD

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Setting-specific Transmission Rates: A Systematic Review and Meta-analysis.

BACKGROUND: Understanding the drivers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is crucial for control policies, but evidence of transmission rates in different settings remains limited. METHODS: We conducted a systematic review to estimate secondary attack rates (SARs) and observed reproduction numbers (Robs) in different settings exploring differences by age, symptom status, and duration of exposure. To account for additional study heterogeneity, we employed a beta-binomial model to pool SARs across studies and a negative-binomial model to estimate Robs. RESULTS: Households showed the highest transmission rates, with a pooled SAR of 21.1% (95% confidence interval [CI]:17.4-24.8). SARs were significantly higher where the duration of household exposure exceeded 5 days compared with exposure of ≤5 days. SARs related to contacts at social events with family and friends were higher than those for low-risk casual contacts (5.9% vs 1.2%). Estimates of SARs and Robs for asymptomatic index cases were approximately one-seventh, and for presymptomatic two-thirds of those for symptomatic index cases. We found some evidence for reduced transmission potential both from and to individuals younger than 20 years of age in the household context, which is more limited when examining all settings. CONCLUSIONS: Our results suggest that exposure in settings with familiar contacts increases SARS-CoV-2 transmission potential. Additionally, the differences observed in transmissibility by index case symptom status and duration of exposure have important implications for control strategies, such as contact tracing, testing, and rapid isolation of cases. There were limited data to explore transmission patterns in workplaces, schools, and care homes, highlighting the need for further research in such settings

Latent tuberculosis infection, tuberculin skin test and vitamin D status in contacts of tuberculosis patients: a cross-sectional and case-control study

<p>Abstract</p> <p>Background</p> <p>Deficient serum vitamin D levels have been associated with incidence of tuberculosis (TB), and latent tuberculosis infection (LTBI). However, to our knowledge, no studies on vitamin D status and tuberculin skin test (TST) conversion have been published to date. The aim of this study was to estimate the associations of serum 25-hydroxyvitamin D₃(25[OH]D) status with LTBI prevalence and TST conversion in contacts of active TB in Castellon (Spain).</p> <p>Methods</p> <p>The study was designed in two phases: cross-sectional and case-control. From November 2009 to October 2010, contacts of 42 TB patients (36 pulmonary, and 6 extra-pulmonary) were studied in order to screen for TB. LTBI and TST conversion cases were defined following TST, clinical, analytic and radiographic examinations. Serum 25(OH)D levels were measured by electrochemiluminescence immunoassay (ECLIA) on a COBAS^®410 ROCHE^®analyzer. Logistic regression models were used in the statistical analysis.</p> <p>Results</p> <p>The study comprised 202 people with a participation rate of 60.1%. Only 20.3% of the participants had a sufficient serum 25(OH)D (≥ 30 ng/ml) level. In the cross-sectional phase, 50 participants had LTBI and no association between LTBI status and serum 25(OH)D was found. After 2 months, 11 out of 93 negative LTBI participants, without primary prophylaxis, presented TST conversion with initial serum 25(OH)D levels: a:19.4% (7/36): < 20 ng/ml, b:12.5% (4/32):20-29 ng/ml, and c:0%(0/25) ≥ 30 ng/ml. A sufficient serum 25(OH)D level was a protector against TST conversion a: Odds Ratio (OR) = 1.00; b: OR = 0.49 (95% confidence interval (CI) 0.07-2.66); and c: OR = 0.10 (95% CI 0.00-0.76), trends p = 0.019, adjusted for high exposure and sputum acid-fast bacilli positive index cases. The mean of serum level 25(OH)D in TST conversion cases was lower than controls,17.5 ± 5.6 ng/ml versus 25.9 ± 13.7 ng/ml (p = 0.041).</p> <p>Conclusions</p> <p>The results suggest that sufficient serum 25(OH)D levels protect against TST conversion.</p

Infant mortality in the European Union: A time trend analysis of the 1994---2015 period

Background: Infant mortality is an indicator of child health, and an explanatory variable to reflect the socioeconomic development of a country. We aimed to examine the changes and trends of infant mortality in the European Union (EU) and its 28 member states in the 1994-2015 period. Methods: We extracted data of deaths in children aged less than one year between 1994 and 2015 from the Eurostat database. We analysed secular variation in the EU overall, by country and by geographical region using joinpoint regression analysis. We conducted additional analyses to examine neonatal and early neonatal mortality trends. Results: Infant mortality in the EU has declined significantly from 8,3 to 3,6 per 1,000 live births (annual percent change=-3,8%; 95% confidence interval, -4,1 to -3,6). Among EU countries, we found the highest mortality rates throughout the study period in Romania and Bulgaria, and the lowest rates in Scandinavian countries (Finland, Sweden). There were significant decreasing trends in every country of the EU, which were most pronounced in former Soviet Baltic states and Eastern European countries, and least pronounced in Western European countries. Mortality rates have increased significantly in Greece in the last years, and plateaued in the United Kingdom and Ireland. Conclusions: Our findings, which are based on official data, provide consistent evidence that infant mortality has declined steadily in the EU and its member states in the past decades, most markedly in Eastern European countries and former Soviet Baltic states. However, rates have risen or levelled off in some western countries in the past few years.Introducción: La mortalidad infantil es un indicador de la salud infantil y una variable explicativa del desarrollo socioeconómico. Nuestro objetivo fue examinar los cambios y tendencias de la mortalidad infantil en la Unión Europea (UE) y sus 28 países miembros en el período 1994-2015. Métodos: Se recopilaron datos de muertes de niños menores de un año entre 1994 y 2015 de la base de datos Eurostat. Estudiamos las tendencias en la UE, por países y regiones, utilizando el análisis de regresión joinpoint. Se condujeron análisis adicionales para estudiar las tendencias de mortalidad neonatal y neonatal precoz. Resultados: La mortalidad infantil en la UE ha disminuido significativamente de 8.3 a 3.6 por 1.000 (porcentaje de cambio anual = −3.8%, intervalos de confianza del 95% −4.1; −3.6). Las tasas de mortalidad más altas se registraron en Rumanía y Bulgaria, y las tasas más bajas en países escandinavos (Finlandia, Suecia). Se encontraron tendencias descendentes significativas en los países de la UE, más pronunciadas en los países bálticos exsoviéticos y países de Europa oriental, mientras que los países de Europa occidental mostraron los descensos menos pronunciados. La mortalidad infantil ha aumentado significativamente en Grecia en los últimos años, mientras que en el Reino Unido e Irlanda las tasas se han estabilizado. Conclusiones: La mortalidad infantil ha disminuido en la UE y sus países en las últimas décadas, más pronunciadamente en los países de Europa oriental y los países bálticos exsoviéticos, mientras que en varios países de Europa occidental las tasas aumentaron o se han estabilizado en los últimos anos

Vitamin D status and latent tuberculosis infection: conversion in nursing homes, Spain

OBJECTIVE: To examine the potential association between vitamin D (VitD) deficiency and latent tuberculosis infection (LTBI) and its effect on TB infection conversion (TBIC) incidence. MATERIAL AND METHODS: We carried out a cross-sectional and prospective cohort study of nine pulmonary TB cases that occurred in 2015–2016 in five nursing homes and one mental disability institution in Castellon, Spain. QuantiFERON®-TB Gold and the tuberculin skin test were used to detect LTBI and TBIC, respectively. Serum 25-hydroxyvitamin D was measured using chemiluminescence immunoassay. Poisson regression and inverse probability weighting were used for statistical analyses. RESULTS: The study included 448 residents, 341 staff members with 48 relatives of TB cases (participation rate 82%): of these, respectively 122 (27.2%), 37 (10.9%) and 7 (14.6%) were LTBI-positive; and respectively 22 (7.7%), 10 (3.8%) and 1 (3.7%) were TBIC-positive. LTBI was not associated with VitD status. Severe VitD deficiency (SVDD; defined as VitD level < 10 ng/ml), found in 45.1% of residents, as well as VitD levels of <30 ng/ml (aRR 10.41 95% CI 1.48–73.26), were associated with increased TBIC risk (adjusted relative risk [aRR] 12.1, 95% CI 1.51–97.10), suggesting SVDD as a threshold effect. CONCLUSION: Severe VitD deficiency is a TBIC risk factor

Report 38: SARS-CoV-2 setting-specific transmission rates: a systematic review and meta-analysis

Since the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly across the world. Understanding the drivers of SARS-CoV-2 transmission is crucial for disease control policies but evidence of transmission rates in different settings remains limited. We conducted a systematic review to estimate the secondary attack rate (SAR) and observed reproduction number (Robs) in different settings and to explore differences by age, symptom status, duration of exposure and household size. A total of 97 studies were identified, 45 of which met inclusion criteria for meta-analysis. Households showed the highest transmission rates, with pooled SAR and Robs estimates of 21.1% (95% CI: 17.4%-24.8%) and 0.96 (95% CI: 0.67-1.32), respectively. Household SAR estimates were significantly higher where the duration of household exposure exceeded 5 days compared with exposure of 5 days or less. Attack rates related to familiar and prolonged close contacts, such as social events with family and friends were higher than those related to low-risk casual contacts, such as strangers (SAR of 5.9%, 95% CI: 3.8%-8.1% vs. 1.2%, 95% CI: 0.3%-2.1%). Estimates of SAR for asymptomatic index cases were approximately two thirds of those for symptomatic index (3.5% vs. 12.8%, p<0.001). We find moderate evidence for less transmission both from and to individuals under 20 years of age in the household context, but this difference is less evident when examining all settings. Prolonged contact in households and in settings with familiar close contacts increases the potential for transmission of SARS-CoV-2. Additionally, the differences observed in transmissibility by symptom status of index cases and the potential for age-dependent effects has important implications for outbreak control strategies such as contact tracing, testing and rapid isolation of cases. There was limited data to allow exploration of transmission patterns in workplaces, schools, and care-homes, highlighting the need for further research in such settings