Determinantes espaciales de la malaria en España del siglo XVIII al XX

Nowadays paludism, also known as malaria, is not an active disease in most of high-rent countries, while the majority of newly reported cases are located in the African continent. Malaria was present in Spain until 1964, when its eradication was confirmed in our country. The aim of this study is to investigate paludism in Spain through XVIIIth, XIXth and XXth centuries, from a holistic, geographical perspective. In most of our selected time lapse, persistent endemic situations spread along the main western hydrographic basins of the Peninsula, and also affected the Mediterranean coastal provinces: such distribution was determined by several interrelating factors. However, it was human activity that utterly shaped the local configuration of paludism, creating or transforming environmental conditions related to the development of endemic or epidemic situations. Epidemic malaria was also a product of interactions taking place in a complex system, and extreme atmospheric phenomena may have played an important role in it.Actualmente, el paludismo o malaria no circula de forma activa en muchos países de renta alta, y la mayoría de los casos que se producen en el mundo se localizan en el continente africano. España fue un territorio habitual para el paludismo hasta 1964, fecha en que se confirmó su erradicación en nuestro país. El objetivo de este estudio es investigar, desde una perspectiva geográfica e integradora, el paludismo en España a lo largo de los siglos XVIII, XIX y XX. La interrelación o superposición de diversos factores resultaría determinante en la persistencia de situaciones endémicas a lo ancho de las grandes cuencas hidrográficas al oeste e interior peninsular, así como en la fachada levantina, principalmente. No obstante, sería la actividad humana la que moduló, en última instancia, fluctuaciones locales en esta distribución, creando o modificando las condiciones idóneas para la aparición del paludismo. La malaria epidémica también se caracterizaría por emerger de una interrelación de partes en un sistema complejo, y en ella destacó el papel de fenómenos atmosféricos extremos

Geographic health inequalities in Madrid city: Exploring spatial patterns of respiratory disease mortality

The unequal geographic distribution of health determinants could denote situations of environmental injustice. This work aims to identify spatial patterns of respiratory disease mortality and their association with the education level and the atmospheric pollution in Madrid. To this purpose, we applied spatial analysis through statistical techniques and Geographic Information Systems at the census tract level. The analysis showed a slight but significantly higher risk of mortality in areas with more unfavourable socioeconomic and environmental conditions. This work has the potential to inform public policy and research on links among social, environmental and health inequalities in Madrid City.Fil: Prieto Flores, María Eugenia. Universidad Nacional de La Pampa. Facultad de Ciencias Humanas. Instituto de Geografía; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Confluencia; ArgentinaFil: Gómez-Barroso, Diana. Instituto de Salud Carlos III; EspañaFil: Cañada Torrecilla, Rosa. Universidad Autónoma de Madrid; EspañaFil: Moreno Jiménez, Antonio. Universidad Autónoma de Madrid; Españ

Análisis espacial de la mortalidad por enfermedades cardiovasculares en la ciudad de Madrid, España

Fundamentos: Las enfermedades cardiovasculares son la principal causa de muerte en el mundo, aunque su distribución espacial no es homogénea. El objetivo del estudio fue analizar el patrón espacial de la mortalidad por enfermedades cardiovasculares en el área urbana poblada (AUP) del municipio de Madrid así como identificar agregaciones espaciales. Métodos: Se realizó un estudio ecológico, por sección censal, para hombres y mujeres durante 2010. Se calculó la Razón de Mortalidad Estandarizada (RME), Riesgo Relativo Suavizado (RRS) y Probabilidad Posterior (PP) de que el RRS fuera mayor que 1. Para identificar clusters espaciales se utilizó el índice de Moran (I Moran) y el Índice Local de Autocorrelación Espacial (LISA). Los resultados fueron representados cartográficamente. Resultados: En el caso de los hombres se observó una RME mayor de 1,1 especialmente en áreas centrales y en en el grupo de las mujeres ocurrió en la periferia. LA PP de que el RRS fuera mayor que 1 superó el 0,8 en el centro para los hombres y en la periferia en mujeres. El I Moran fue de 0,04 para hombres y de 0,03 para mujeres (p <0,05 en ambos casos). Conclusiones: En el patrón espacial de la mortalidad por enfermedades cardiovasculares en Madrid, se observaron diferencias por sexo. Los mapas de RME, RRS y PP mostraron un patrón más heterogéneo en los hombres mientras que en las mujeres se detectó uno más definido, con un riesgo relativamente mayor en zonas periféricas del AUP. El método LISA mostró agrupaciones espaciales similares a los patrones anteriormente observadosBackground: Cardiovascular disease is the leading cause of death worldwide, but its spatial distribution is not homogeneous. The objective of this study is to analyze the spatial pattern of mortality from these diseases for men and women, in the populated urban area (AUP) of the municipality of Madrid, and to identify spatial aggregations. Methods: An ecological study was carried out by census tract, for men and women in 2010. Standardized Mortality Ratio (SMR), Relative Risk Smoothing (RRS) and Posterior Probability (PP) were calculated to consider the spatial pattern of the disease. To identify spatial clusters the Moran index (Moran I) and the Local Index of Spatial Autocorrelation (LISA) were used. The results were mapped. Results: SMR higher than 1.1 was observed mainly in central areas among men and in peripheral areas among women. The PP that RRS was higher than 1 surpassed 0.8 in the center and in the periphery, in both men and women. Moran’s I was 0.04 for men and 0.03 for women (p <0.05 in both cases). Conclusions: Sex differences were observed in the spatial distribution of mortality cases. RME RRS and PP maps showed a heterogeneous pattern in men, whereas in women a clearer pattern was detected, with a relatively higher risk in peripheral areas of the AUP. The LISA method showed similar patterns to those previously observe

Methodological approaches to the study of cancer risk in the vicinity of pollution sources: the experience of a population-based case–control study of childhood cancer

Background: Environmental exposures are related to the risk of some types of cancer, and children are the most vulnerable group of people. This study seeks to present the methodological approaches used in the papers of our group about risk of childhood cancers in the vicinity of pollution sources (industrial and urban sites). A populationbased case–control study of incident childhood cancers in Spain and their relationship with residential proximity to industrial and urban areas was designed. Two methodological approaches using mixed multiple unconditional logistic regression models to estimate odds ratios (ORs) and 95% confdence intervals (95% CIs) were developed: (a) “near vs. far” analysis, where possible excess risks of cancers in children living near (“near”) versus those living far (“far”) from industrial and urban areas were assessed; and (b) “risk gradient” analysis, where the risk gradient in the vicinity of industries was assessed. For each one of the two approaches, three strategies of analysis were implemented: “joint”, “stratifed”, and “individualized” analysis. Incident cases were obtained from the Spanish Registry of Childhood Cancer (between 1996 and 2011). Results: Applying this methodology, associations between proximity (≤2 km) to specifc industrial and urban zones and risk (OR; 95% CI) of leukemias (1.31; 1.04–1.65 for industrial areas, and 1.28; 1.00–1.53 for urban areas), neuroblastoma (2.12; 1.18–3.83 for both industrial and urban areas), and renal (2.02; 1.16–3.52 for industrial areas) and bone (4.02; 1.73–9.34 for urban areas) tumors have been suggested. Conclusions: The two methodological approaches were used as a very useful and fexible tool to analyze the excess risk of childhood cancers in the vicinity of industrial and urban areas, which can be extrapolated and generalized to other cancers and chronic diseases, and adapted to other types of pollution sources

Patrón espacial de la legionelosis en España, 2003-2007

ResumenObjetivosAnalizar el patrón espacial de la legionelosis en España para hombres y mujeres durante el periodo 2003-2007, e identificar agrupamientos espaciales del riesgo.MétodosSe identificó el patrón espacial de la distribución de las tasas de legionelosis a partir del cálculo de las tasas por municipio por el método directo. Se realizó el suavizado de estas tasas por el método Empirical Bayes para estudiar el patrón espacial de la enfermedad, para ambos sexos. Se utilizó el índice de correlación espacial de Moran para analizar la autocorrelación global de las tasas. Localmente se utilizó el índice local de Moran (LISA) para analizar los agrupamientos (clusters) de municipios con mayor riesgo.ResultadosUna vez suavizado el riesgo, las mayores tasas (más de 50 por 100.000 habitantes) se agrupan en las zonas costeras del Mediterráneo oriental y en el norte de la Península, así como en los territorios insulares del Mediterráneo. El índice de Moran de las tasas suavizadas es 0,15 para los hombres y 0,23 para las mujeres. Las agrupaciones espaciales de las tasas más altas estadísticamente significativas calculadas mediante el LISA se distribuyen en el eje norte-levante para ambos sexos.ConclusionesEstos métodos de análisis espacial permiten identificar los patrones de distribución de la enfermedad. Los métodos empleados presentan resultados similares. Estas técnicas son una herramienta complementaria para la vigilancia epidemiológica de las enfermedades infecciosas.AbstractObjectivesTo analyze the spatial pattern of legionellosis in Spain for men and women during the period 2003-2007 and to identify spatial clustering of risk.MethodsWe identified the spatial pattern of the distribution of legionellosis rates based on calculation of rates by municipality through the direct method. Smoothing of these rates was performed by the Empirical Bayes method for studying the spatial pattern of disease for both sexes. We used Morańs index to analyze spatial autocorrelation rates globally. To calculate local rates, the Local Moran's Index [known as local indicators of spatial association (LISA)], was used to analyze the clusters of municipalities with the highest risk.ResultsAfter smoothing the risk, the highest rates (over 50 per 100,000 inhabitants) were grouped in the eastern Mediterranean coastal areas and the north of the mainland, as well as in the Mediterranean islands. Moran's index smoothed rates were 0.15 for men and 0.23 for women. The spatial clusters of statistically significant higher rates calculated by the LISA index were distributed in the north and east for both sexes.ConclusionsThese methods of spatial analysis allow patterns of disease distribution to be identified. All the methods used yielded similar results. These techniques are a complementary tool for epidemiological surveillance of infectious diseases

Scabies in Spain? A comprehensive epidemiological picture

Introduction: Scabies is a neglected disease stablished worldwide with a fairy well determined incidence. In high-income countries, it often causes outbreaks affecting the residents and staff of institutions and long-term facilities, usually hard to detect and control due to the difficult diagnosis and notification delay. This study aim at characterizing the affected population, geographical distribution, and evolution of scabies in Spain from 1997-2019 as well as to describe the main environments of transmission using different data sources. Methods: We carried out a nationwide retrospective study using four databases, which record data from different perspectives: hospital admissions, patients attended at primary healthcare services, outbreaks, and occupational diseases. We described the main characteristics from each database and calculated annual incidences in order to evaluate temporal and geographical patterns. We also analyzed outbreaks and occupational settings to characterize the main transmission foci and applied Joinpoint regression models to detect trend changes. Results: The elderly was the most frequent collective among the hospital admitted patients and notified cases in outbreaks, while children and young adults were the most affected according to primary care databases. The majority of the outbreaks occurred in homes and nursing homes; however, the facilities with more cases per outbreak were military barracks, healthcare settings and nursing homes. Most occupational cases occurred also in healthcare and social services settings, being healthcare workers the most common affected professional group. We detected a decreasing trend in scabies admissions from 1997 to 2014 (annual percentage change -APC- = -11.2%) and an increasing trend from 2014 to 2017 (APC = 23.6%). Wide geographical differences were observed depending on the database explored. Discussion: An increasing trend in scabies admissions was observed in Spain since 2014, probably due to cutbacks in social services and healthcare in addition to worsen of living conditions as a result of the 2008 economic crisis, among other reasons. The main transmission foci were healthcare and social settings. Measures including enhancing epidemic studies and national registries, reinforcing clinical diagnosis and early detection of cases, hygiene improvements and training of the staff and wide implementation of scabies treatment (considering mass drug administration in institutions outbreaks) should be considered to reduce the impact of scabies among most vulnerable groups in Spain.S

Enfermedades transmitidas por mosquito AEDES SPP. En España: resultados de la vigilancia de Dengue, enfermedad por virus CHikungunya y Zika según los casos notificados a la Red Nacional de Vigilancia Epidemiológica de 2014 a 2018 .

[ES] Las enfermedades causadas por virus chikungunya (VCHIK), dengue (VDEN) y Zika (VZK) son principalmente importadas en España. Son de declaración obligatoria desde 2015 (VCHIK y VDEN) y 2016 (VZK). Este informe consta de tres partes, en las que se describen los resultados de la vigilancia y la calidad de los datos. Se incluyeron los casos del 01/01/2014 al 31/12/2018. Hubo 691 notificaciones de VCHIK, 838 de VDEN, 541 de VZK y 5 casos congénitos. La mayoría fueron de Madrid y Cataluña y más frecuente entre 25-44 años. Un 15% precisaron hospitalización, no se notificaron defunciones y hubo variables con porcentaje elevado de datos faltantes. Un porcentaje elevado de casos se notificó en verano, en periodo de actividad de A. albopictus y fueron importados de regiones endémicas, sobre todo por visitas familiares o turismo. Se identifican perfiles de viajero. La vigilancia junto a otras medidas son útiles para prevenir la aparición de casos endémicos. [EN] Most of the chikungunya (VCHIK), dengue (VDEN) and Zika virus (VZK) disease cases are imported in Spain. They are notifiable since 2015 (VCHIK y VDEN) and 2016 (VZK) through the national surveillance network. This report consists of three parts, where the main surveillance results and data quality are described. Cases from 01/01/2014 to 31/12/2018 were included. There were 691 cases of VCHIK, 838 of VDEN, 541 of VZK and 5 congenital cases. The majority were from Madrid or Catalonia and were more frequent between ages 25-44 years. Hospitalization was required for 15%, no deaths were reported and several variables had high proportions of missing data. A high percentage of cases were reported in summer, during A. albopictus season and were imported from endemic regions, especially after visiting friends/relatives or tourism. Traveler patterns were identified. Surveillance activities together with additional measures are considered to be useful to prevent autochthonous cases

Situación del paludismo en España. Evolución del tipo de notificación a la Red Nacional de Vigilancia Epidemiológica y resumen de los resultados de la vigilancia de 2014 a 2017

[ES]El paludismo en España es una enfermedad importada desde su eliminación en 1964. Es de declaración obligatoria a través de la Red Nacional de Vigilancia Epidemiológica (RENAVE). El protocolo se actualizó en 2013. Los objetivos del informe son conocer la evolución del número de casos notificados y describir su epidemiología. Se analizó el número de casos por año (notificación agregada e individualizada) de 1980 a 2017. Se realizó estudio descriptivo de los casos de 2014-2017, a partir de la información individualizada. Desde 1980 la tendencia de casos notificados ha sido ascendente. Desde 2014 todas las Comunidades Autónomas (CCAA) realizan notificación individualizada. Entre 2014-2017 hubo 3005 casos, 5 de ellos no importados. 2310 casos (76,9%) correspondieron a Cataluña, Madrid, Andalucía, Comunidad Valenciana y País Vasco. 2045 (68,1%) eran hombres, y la edad mediana 36 años (RI: 27-44). El 95,4% de los casos importados se contagiaron en África, el 57,4% viajaron por visitas familiares y en el 90,2% el agente fue P. falciparum. El 75,3% hospitalizaron y fallecieron 15 (0,5%). Sólo el 19,0% inició alguna quimioprofilaxis. La tendencia ascendente se puede deber a la mejora en la notificación junto a factores relacionados con los flujos migratorios y de viajeros. La mayoría de los casos importados se contagiaron en África por P. falciparum durante visitas familiares y la proporción de viajeros que tomaron quimioprofilaxis fue muy baja. Las estrategias deben dirigirse hacia estos grupos, a la mejora de la adherencia a quimioprofilaxis y la atención a los inmigrantes. [EN] Malaria is an imported disease in Spain since it was eradicated in 1964. Reporting is compulsory through the National Surveillance Network (RENAVE). The protocol was updated in 2013. The aims of the report are to know the evolution on the number of reported cases and to describe its epidemiology. The number of cases per year (both aggregated and individualized cases) from 1980 to 2017 were analysed. A descriptive study on individualized cases from 2014-2017 was also performed. The trend of reported cases since 1980 on has been upward. Since 2014, all the Autonomous Regions made case-based notification. Between 2014-2017 there were 3005 cases, 5 of whom were not imported. 2310 cases (76.9%) corresponded to Catalonia, Madrid Region, Andalusia, the Valencian Region and the Basque Country. 2045 (68.1%) were men, and the median age was 36 years (IR: 27-44). 95.4% of the imported cases were infected in Africa, 57.4% travelled for family visits and for 90.2% the agent was P. falciparum. 75.3% required hospitalization and 15 died (0.5%). Only 19.0% started chemoprophylaxis. The upward trend may be due to the improvement on reporting together with factors related to migratory and travellers flow. The majority of imported cases were infected in Africa by P. falciparum during family visits. The proportion of travellers who took chemoprophylaxis was very low. Strategies should focus on these groups, on the improvement of adherence to chemoprophylaxis and on the attention to immigrants

Data management in epiGraph COVID-19 epidemic simulator

The transmission of COVID-19 through a population depends on many factors which model, incorporate, and integrate a large number of heterogeneous data sources. The work we describe in this paper focuses on the data management aspect of EpiGraph, a scalable agent-based virus-propagation simulator. We describe the data acquisition and pre-processing tasks that are necessary to map the data to the different models implemented in EpiGraph in a way that is efficient and comprehensible. We also report on post-processing, analysis, and visualization of the outputs, tasks that are fundamental to make the simulation results useful for the final users. Our simulator captures complex interactions between social processes, virus characteristics, travel patterns, climate, vaccination, and non-pharmaceutical interventions. We end by demonstrating the entire pipeline with one evaluation for Spain for the third COVID wave starting on December 27th of 2020.This work has been supported by the Spanish Instituto de Salud Carlos III under the project grant 2020/00183/001, the project grant BCV-2021-1-0011, of the Spanish Supercomputing Network (RES) and the European Union's Horizon 2020 JTI-EuroHPC research and innovation program under grant agreement No 956748