La importància del gènere en la prevenció i l’atenció de les ITS/VIH en l’Atenció Primària

Género; Prevención; VIH; Atención primariaGènere; Prevenció; VIH; Atenció primàriaGender; Prevention; HIV; Primary careEn aquest article, es fa una introducció a la complexitat que hi ha al darrera del terme sexualitat i també es fa una sèrie de reflexions sobre com cal enfocar la relació entre els professionals de la salut i els pacients tenint en compte la diversitat sexual de les persones usuàries dels serveis sanitaris

Pneumònia bacteriana adquirida a la comunitat per Legionel·la al Vallès (2010-2017)

Pneumònia adquirida a la comunitat; Legionel·la; Epidemiologia; Incidència; MortalitatNeumonía adquirida en la comunidad; Legionela; Epidemiología; incidencia; MortalidadCommunity-acquired pneumonia; Legionella; Epidemiology; Incidence; MortalityIntroducció. S’analitza l’epidemiologia de la pneumònia adquirida a la comunitat per Legionel·la (PAC-L) a les comarques del Vallès durant el període 2010-2017. Mètodes i resultats. Durant el període 2010-2017 es va analitzar la incidència i la mortalitat de PAC-L al Vallès i a Catalunya. Al Vallès se’n van notificar 569 casos, dels quals el 83,3% eren persones de ≥ 50 anys i el 72,9% eren homes. La taxa d’incidència (TI) al Vallès (TI 5,47/100.000 habitants; IC 95% 5,02-5,92), i sobretot al Vallès Oriental (TI 7,94/100.000 habitants, IC 95% 6,97-8,92) supera la de la resta de Catalunya (TI 3,03/100.000 habitants; IC 95% 2,88-3,18). El risc relatiu (RR) d’incidència de PAC-L al Vallès respecte a la resta de Catalunya va ser de l’1,80 (IC 95% 1,64-1,99). La taxa de mortalitat (TM) al Vallès (TM 0,36/100.000 habitants; IC 95% 0,24-0,47) supera la de la resta de Catalunya (TM 0,16/100.000 habitants; IC 95% 0,13-0,19), amb un RR de 3,08 (IC 95% 2,03-4,66). La mortalitat augmenta amb l’edat i el càncer. Conclusions. La incidència i la mortalitat de PAC-L al Vallès són superiors a les de la resta de Catalunya. El mètode epidemiològic utilitzat és apropiat per analitzar l’epidemiologia de la PAC-L i l’eficàcia de les mesures de prevenció i control.N. Introducción. Se analiza la epidemiología de la neumonía adquirida en la comunidad por Legionella (NAC-L) en las comarcas del Vallès durante el período 2010-2017. Métodos y resultados. Durante el periodo 2010-2017 se analizaron la incidencia y la mortalidad de NAC-L en el Vallès y en Cataluña. En el Vallès se notificaron 569 casos, de los cuales el 83,3% eran personas de ≥ 50 años y el 72,9% eran hombres. La tasa de incidencia (TI) en el Vallès (TI 5,47/100.000 habitantes; IC 95% 5,02-5,92), y sobre todo en el Vallès Oriental (TI 7,94/100.000 habitantes, IC 95% 6,97- 8,92), supera la del resto de Cataluña (TI 3,03/100.000 habitantes; IC 95% 2,88-3,18). El riesgo relativo (RR) de incidencia de NAC-L en el Vallès respecto al resto de Cataluña fue del 1,80 (IC 95% 1,64-1,99). La tasa de mortalidad (TM) en el Vallès (TM 0,36/100.000 habitantes; IC 95% 0,24-0,47) supera la del resto de Cataluña (TM 0,16/100.000 habitantes; IC 95% 0,13-0,19) con un RR de 3,08 (IC 95% 2,03-4,66). La mortalidad aumenta con la edad y el cáncer. Conclusiones. La incidencia y la mortalidad de NAC-L en el Vallès son superiores a las del resto de Cataluña. El método epidemiológico utilizado es apropiado para analizar la epidemiología de la NAC-L y la eficacia de las medidas de prevención y controlIntroduction: The epidemiology of Legionella Community-Acquired Pneumonia (L-CAP) in Vallès County during the period 2010-2017 is analysed. Methods and results. The incidence and mortality of L-CAP in Vallès County and in Catalonia during the period 2010-2017 is analysed. In Vallès 569 cases were reported, of which 83.3% ≥ 50 years, and 72.9% in men. The incidence rate (IR) in Vallès (IT 5.47/100 000 inhabitants; 95% CI 5.02-5.92), and especially in Vallès Oriental (IR 7.94/100.000 inhabitants, 95% CI 6.97-8.92) exceeds the rest of Catalonia (IR 3.03/100 000 inhabitants; 95% CI 2.88-3.18). The relative risk (RR) of incidence of L-CAP in Vallès in relation to the rest of Catalonia was 1.80 (95% CI 1.60-1.99). The mortality rate (MR) in Vallès (TM 0.38/100 000 inhabitants; 95% CI 0.24-0.47) exceeds the rest of Catalonia (MR 0.16/100 000 inhabitants; 95%CI 0.13-0.19) with a RR of 3.08 (95% CI 2.03-4.66). Mortality increases with age and cancer. Conclusions. The incidence and mortality of L-CAP in Vallès are higher than the rest of Catalonia. The epidemiological method used is appropriate for analysing the epidemiology of L-CAP and the effectiveness of preventive and control measure

Mycobacterium tuberculosis acquires limited genetic diversity in prolonged infections, reactivations and transmissions involving multiple hosts

Publisher Copyright: © 2018 Herranz, Pole, Ozere, Chiner-Oms, Martínez-Lirola, Pérez-García, Gijón, Serrano, Romero, Cuevas, Comas, Bouza, Pérez-Lago and García-de-Viedma.Background: Mycobacterium tuberculosis (MTB) has limited ability to acquire variability. Analysis of its microevolution might help us to evaluate the pathways followed to acquire greater infective success. Whole-genome sequencing (WGS) in the analysis of the transmission of MTB has elucidated the magnitude of variability in MTB. Analysis of transmission currently depends on the identification of clusters, according to the threshold of variability (<5 SNPs) between isolates. Objective: We evaluated whether the acquisition of variability in MTB, was more frequent in situations which could favor it, namely intrapatient, prolonged infections or reactivations and interpatient transmissions involving multiple sequential hosts. Methods: We used WGS to analyze the accumulation of variability in sequential isolates from prolonged infections or translations from latency to reactivation. We then measured microevolution in transmission clusters with prolonged transmission time, high number of involved cases, simultaneous involvement of latency and active transmission. Results: Intrapatient and interpatient acquisition of variability was limited, within the ranges expected according to the thresholds of variability proposed, even though bursts of variability were observed. Conclusions: The thresholds of variability proposed for MTB seem to be valid in most circumstances, including those theoretically favoring acquisition of variability. Our data point to multifactorial modulation of microevolution, although further studies are necessary to elucidate the factors underlying this modulation.publishersversionPeer reviewe

Recomanacions per a la realització d’estudis de contactes de malalts amb tuberculosi a Catalunya

Tuberculosi; Estudis de contactes; EpidemiologiaTuberculosis; Estudios de contactos; EpidemiologíaTuberculosis; Contact studies; EpidemiologyL’objectiu d’aquest document és desenvolupar un protocol eficient d’actuació en la investigació dels contactes dels malalts amb TB que sigui comú a tot el territori. El document s’adreça a tots aquells professionals sanitaris que treballen en la prevenció i el control de la TB des dels diferents nivells assistencials, els serveis de salut pública i les institucions penitenciàries. En primer lloc s’aborda el marc d’actuació dels estudis de contactes davant la situació epidemiològica actual de la TB a Catalunya. Posteriorment, es tracten aspectes metodològics i la política d’actuació en la realització d’aquests estudis i, posteriorment, es revisa l’ús i la interpretació de les proves diagnòstiques per avaluar els contactes, i el tractament de la infecció tuberculosa latent. Finalment, es dedica un capítol a aspectes organitzatius en la realització d’aquests estudis, amb l’objectiu de millorar la coordinació entre els diferents agents implicats.El objetivo de este documento es desarrollar un protocolo eficiente de actuación en la investigación de los contactos de los enfermos con TB que sea común a todo el territorio. El documento se dirige a todos aquellos profesionales sanitarios que trabajan en la prevención y el control de la TB desde los diferentes niveles asistenciales, los servicios de salud pública y las instituciones penitenciarias. En primer lugar se aborda el marco de actuación de los estudios de contactos ante la situación epidemiológica actual de la TB en Cataluña. Posteriormente, se tratan aspectos metodológicos y la política de actuación en la realización de estos estudios y, posteriormente, se revisa el uso y la interpretación de las pruebas diagnósticas para evaluar los contactos, y el tratamiento de la infección tuberculosa latente. Finalmente, se dedica un capítulo a aspectos organizativos en la realización de estos estudios, con el objetivo de mejorar la coordinación entre los diferentes agentes implicados.The objective of this document is to develop an efficient protocol for the investigation of the contacts of the patients with TB that is common throughout the territory. The document is aimed at all those health professionals who work on the prevention and control of TB from different levels of care, public health services and penitentiary institutions. In the first place, the framework for action of contact studies is addressed with the current epidemiological situation of TB in Catalonia. Later, they deal with methodological aspects and the policy of action in the realization of these studies and, later, the use and the interpretation of the diagnostic tests to evaluate the contacts, and the treatment of the latent tuberculous infection are reviewed. Finally, a chapter is devoted to organizational aspects in the conduct of these studies, with the aim of improving the coordination between the different agents involved

Epidemiologia recent dels nous diagnòstic de VIH a Catalunya, 2017

Epidemiologia; VIH; CatalunyaEpidemiología; VIH, CataluñaEpidemiology; HIV; CataloniaL’objectiu d’aquest article és descriure els casos de VIH i sida notificats durant l’any 2017, així com les tendències dels darrers deu 10 anys (2008‐2017)

Q-SAPS?: què saben sobre salut pública a l’atenció primària?

Malalties; Declaració obligatòria; Brots epidèmicsEnfermedades; Declaración obligatoria; Brotes epidémicosDiseases; Mandatory declaration; Epidemic outbreaksEl treball d’aquesta comunitat de pràctica (CoP) pretén ajudar a detectar mancances de coneixement sobre la salut pública entre els professionals de l’atenció primària i elaborar un document de propostes per millorar el coneixement referit en aquest àmbit. Amb les següents propostes de valor: 1-Conèixer les funcions de cada actor en les malalties de declaració obligatòria (MDO), emergents i brots epidèmics. 2-Detectar mancances de coneixement i dificultats per a declarar. 3-Saber la utilitat de declarar MDO i brots epidèmics, ja que no és només un simple registre sinó que hi ha una actuació al darrere. 4-Conèixer les actuacions comunitàries que cal fer en cada malaltia per controlar-la, i brots epidèmics.El trabajo de esta comunidad de práctica (CoP) pretende ayudar a detectar carencias de conocimiento sobre la salud pública entre los profesionales de la atención primaria y elaborar un documento de propuestas para mejorar el conocimiento referido en este ámbito. Con las siguientes propuestas de valor: 1-Conocer las funciones de cada actor en las enfermedades de declaración obligatoria (MDO), emergentes y brotes epidémicos. 2-Detectar carencias de conocimiento y dificultades para declarar. 3-Saber la utilidad de declarar EDO y brotes epidémicos, ya que no es sólo un simple registro sino que hay una actuación detrás. 4-Conocer las actuaciones comunitarias a realizar en cada enfermedad para controlarla, y brotes epidémicos.The work of this community of practice (CoP) aims to help detect gaps in knowledge about public health among primary care professionals and prepare a document of proposals to improve the knowledge referred to in this area. With the following value propositions: 1-Know the functions of each actor in notifiable diseases, emerging diseases and epidemic outbreaks. 2-Detect knowledge gaps and difficulties in declaring. 3-Know the usefulness of declaring notifiable diseases and epidemic outbreaks, since it is not just a simple record but there is an action behind it. 4-Know the community actions to be carried out in each disease to control it, and epidemic outbreaks

Safety and immunogenicity of the protein-based PHH-1V compared to BNT162b2 as a heterologous SARS-CoV-2 booster vaccine in adults vaccinated against COVID-19 : a multicentre, randomised, double-blind, non-inferiority phase IIb trial

A SARS-CoV-2 protein-based heterodimer vaccine, PHH-1V, has been shown to be safe and well-tolerated in healthy young adults in a first-in-human, Phase I/IIa study dose-escalation trial. Here, we report the interim results of the Phase IIb HH-2, where the immunogenicity and safety of a heterologous booster with PHH-1V is assessed versus a homologous booster with BNT162b2 at 14, 28 and 98 days after vaccine administration. The HH-2 study is an ongoing multicentre, randomised, active-controlled, double-blind, non-inferiority Phase IIb trial, where participants 18 years or older who had received two doses of BNT162b2 were randomly assigned in a 2:1 ratio to receive a booster dose of vaccine-either heterologous (PHH-1V group) or homologous (BNT162b2 group)-in 10 centres in Spain. Eligible subjects were allocated to treatment stratified by age group (18-64 versus ≥65 years) with approximately 10% of the sample enrolled in the older age group. The primary endpoints were humoral immunogenicity measured by changes in levels of neutralizing antibodies (PBNA) against the ancestral Wuhan-Hu-1 strain after the PHH-1V or the BNT162b2 boost, and the safety and tolerability of PHH-1V as a boost. The secondary endpoints were to compare changes in levels of neutralizing antibodies against different variants of SARS-CoV-2 and the T-cell responses towards the SARS-CoV-2 spike glycoprotein peptides. The exploratory endpoint was to assess the number of subjects with SARS-CoV-2 infections ≥14 days after PHH-1V booster. This study is ongoing and is registered with , . From 15 November 2021, 782 adults were randomly assigned to PHH-1V (n = 522) or BNT162b2 (n = 260) boost vaccine groups. The geometric mean titre (GMT) ratio of neutralizing antibodies on days 14, 28 and 98, shown as BNT162b2 active control versus PHH-1V, was, respectively, 1.68 (p < 0.0001), 1.31 (p = 0.0007) and 0.86 (p = 0.40) for the ancestral Wuhan-Hu-1 strain; 0.62 (p < 0.0001), 0.65 (p < 0.0001) and 0.56 (p = 0.003) for the Beta variant; 1.01 (p = 0.92), 0.88 (p = 0.11) and 0.52 (p = 0.0003) for the Delta variant; and 0.59 (p ≤ 0.0001), 0.66 (p < 0.0001) and 0.57 (p = 0.0028) for the Omicron BA.1 variant. Additionally, PHH-1V as a booster dose induced a significant increase of CD4 + and CD8 + T-cells expressing IFN-γ on day 14. There were 458 participants who experienced at least one adverse event (89.3%) in the PHH-1V and 238 (94.4%) in the BNT162b2 group. The most frequent adverse events were injection site pain (79.7% and 89.3%), fatigue (27.5% and 42.1%) and headache (31.2 and 40.1%) for the PHH-1V and the BNT162b2 groups, respectively. A total of 52 COVID-19 cases occurred from day 14 post-vaccination (10.14%) for the PHH-1V group and 30 (11.90%) for the BNT162b2 group (p = 0.45), and none of the subjects developed severe COVID-19. Our interim results from the Phase IIb HH-2 trial show that PHH-1V as a heterologous booster vaccine, when compared to BNT162b2, although it does not reach a non-inferior neutralizing antibody response against the Wuhan-Hu-1 strain at days 14 and 28 after vaccination, it does so at day 98. PHH-1V as a heterologous booster elicits a superior neutralizing antibody response against the previous circulating Beta and the currently circulating Omicron BA.1 SARS-CoV-2 variants in all time points assessed, and for the Delta variant on day 98 as well. Moreover, the PHH-1V boost also induces a strong and balanced T-cell response. Concerning the safety profile, subjects in the PHH-1V group report significantly fewer adverse events than those in the BNT162b2 group, most of mild intensity, and both vaccine groups present comparable COVID-19 breakthrough cases, none of them severe. HIPRA SCIENTIFIC, S.L.U

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease : A Multicentre Study of Geteccu

Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC. Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered "exposed". The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis. Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2-2.0), urgent surgery (OR: 1.6; 95% CI: 1.2-2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1-1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3-2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97-1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03-2.27). Conclusions: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC. Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered “exposed”. The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis. Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2–2.0), urgent surgery (OR: 1.6; 95% CI: 1.2–2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1–1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3–2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97–1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03–2.27). Conclusions: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections

La importància del gènere en la prevenció i l’atenció de les ITS/VIH en l’Atenció Primària

Género; Prevención; VIH; Atención primariaGènere; Prevenció; VIH; Atenció primàriaGender; Prevention; HIV; Primary careEn aquest article, es fa una introducció a la complexitat que hi ha al darrera del terme sexualitat i també es fa una sèrie de reflexions sobre com cal enfocar la relació entre els professionals de la salut i els pacients tenint en compte la diversitat sexual de les persones usuàries dels serveis sanitaris