Listeriosis in Spain based on hospitalisation records, 1997 to 2015: need for greater awareness

Introduction Listeriosis is a food-borne disease of public health importance that has recently been involved in prolonged outbreaks. Despite its relevance, listeriosis is under-reported in many European countries.AimWe aimed to describe listeriosis epidemiology in Spain from 1997-2015.MethodsWe performed a retrospective study using the Spanish hospitalisation database. We calculated the mean number of hospitalisations per year and region. Pregnancy and neonatal-related listeriosis rates were computed. Relation between death and the presence of underlying health conditions was explored.ResultsBetween 1997-2015, 5,696 listeriosis hospitalisations occurred, showing a constantly increasing trend. Higher hospitalisation rates were located in the north of the country compared to southern regions. The age group ≥ 65 years old was the most represented (50%). Pregnant women and newborns accounted for 7% and 4% of hospitalisations, respectively. An underlying immunocompromising condition was present in 56.4% of patients: cancer (22.8%), diabetes mellitus (16.6%) and chronic liver disease (13.1%). Death occurred in 17% of patients, more frequently among those ≥ 65 years old (67.5%), with sepsis (39.9%) or with meningoencephalitis (19.2%).ConclusionListeriosis is an emergent public health problem in Spain that calls for targeted action. Further prevention strategies are urgently needed, including food safety education and messaging for all at-risk groups.We would like to thank the General Sub-direction of the Institute for Health Information, Spanish Ministry of Health, Consumer Affairs and Social Welfare, for providing the information on which this study is based. The corresponding author’s affiliation centre belongs to the ISCIII-Sub. Gral. Redes- Network Biomedical Research on Tropical Diseases (RICET in Spanish) grant RD16CIII/0003/0001, RD16/0027/0020, RD16CIII/0003/0001 and the European Regional Development Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010-2017

We conducted a retrospective cohort study to assess the effect of influenza virus type and subtype on disease severity among hospitalized influenza patients in Spain. We analyzed the cases of 8,985 laboratory-confirmed case-patients hospitalized for severe influenza by using data from a national surveillance system for the period 2010-2017. Hospitalized patients with influenza A(H1N1)pdm09 virus were significantly younger, more frequently had class III obesity, and had a higher risk for pneumonia or acute respiratory distress syndrome than patients infected with influenza A(H3N2) or B (p<0.05). Hospitalized patients with influenza A(H1N1)pdm09 also had a higher risk for intensive care unit admission, death, or both than patients with influenza A(H3N2) or B, independent of other factors. Determining the patterns of influenza-associated severity and how they might differ by virus type and subtype can help guide planning and implementation of adequate control and preventive measures during influenza epidemics.S

Using hospital discharge database to characterize Chagas disease evolution in Spain: there is a need for a systematic approach towards disease detection and control

After the United States, Spain comes second in the list of countries receiving migrants from Latin America, and, therefore, it is the European country with the highest expected number of infected patients of Chagas disease. We have studied the National Health System's Hospital Discharge Records Database (CMBD) in order to describe the disease evolution from 1997 to 2011 in Spain. We performed a retrospective descriptive study using CMBD information on hospitalizations including Chagas disease. Data was divided in two periods with similar length in time: 1997-2004 and 2005-2011. Hospitalization rates were calculated and clinical characteristics were described. We used multivariable logistic regression to calculate adjusted odds-ratio (aOR) for the association between various conditions and being hospitalized with organ affectation. A total of 1729 hospitalization records were identified. Hospitalization rates for the two periods were 18 and 242.8/100000 population, respectively. The median age was 35 years (range 0-87), 74% were female and the 16-45 age-group was mostly represented (69.8%). Overall, 23.4% hospitalizations included the diagnosis of Chagas disease with organ complications. Being male [aOR: 1.3 (1.00-1.77)], aged 45 and 64 years [aOR: 2.59 (1.42-4.71)], and a median hospitalization cost above 3,065 euro [aOR: 2.03 (3.73-7.86)] were associated with hospitalizations with organ affectation. Since 2005, the number of detected infections increased in Spain. The predominant patients' profile (asymptomatic women at fertile age) and the conditions associated with organ affectation underlines the need for increased efforts towards the early detection of T cruzi.We would like to thank the General Sub-direction of the Institute for Health Information, Spanish Ministry of Health, Social Services and Equality, for providing the information on which this study is based. Corresponding author's affiliation center belongs to the Network Biomedical Research on Tropical Diseases (RICET in Spanish): RD12/0018/0001.S

Analysis of Hospital Care Registers due to Silicosis in Spain, 1997-2020

Ministerio de Sanidad (contrato para la elaboración de un informe sobre la emergencia de la silicosis en España, 2021-2022)Fundamentos: La remergencia de la silicosis en España desde 2007 ha sido objetivada por el incremento de partes de enfermedad profesional. El objetivo de nuestro estudio es analizar los procesos asistenciales por silicosis atendidos por el Sistema Nacional de Salud entre 1997 y 2020 para una mejor comprensión de la dimensión epidemiológica del problema. Métodos: Se empleó el RAE-CMBD, aplicando los códigos CIE-9-CM 500 y 502 (1997-2016) y CIE-10-CM J60, J62.0 y J62.8 (2017-2020). Se aplicaron métodos de estadística descriptiva y modelización por regresiones logísticas y metodología de regresión Joinpoint. Resultados: Se obtuvieron 111.325 registros (20-100 años), el 4,3% por silicosis como diagnóstico principal (DP) y el 95,7% como diagnóstico secundario (DS). El 98,0% hombres y el 2,0% mujeres. La edad media de los procesos por DS fue de 75,1, y 68,7 para los procesos por DP. La mediana de edad aumentó 8 años para los DS y disminuyó 3 para los DP. Aunque la carga asistencial global disminuyó, los procesos en menores de 50 años por DP entre 2006 y 2009 registraron una tendencia ascendente (APC=27,01%). Los procesos por DS mostraron una tendencia ascendente no significativa (APC=1,92%) entre 2005 y 2020. Conclusiones: La tendencia al crecimiento de los procesos asistenciales por silicosis en menores de 50 años desde 2005 confirma el impacto asistencial de la remergencia de la silicosis en España. La carga asistencial asociada constituye un problema de salud pública presente y futuro dada la reducción de edad de los afectados.Background: The re-emergence of silicosis in Spain since 2007 has been identified by the increase in the number of occupational disease reports. The aim of our study is to analyse the silicosis care processes attended by the National Health System between 1997 and 2020 to better understand the epidemiological dimension of the problem. Methods: Processes were obtained from the Registro de Actividad Sanitaria Especializada (RAE-CMBD), with ICD-9-CM codes 500 and 502 (1997-2016) and ICD-10-CM J60, J62.0 and J62.8 (2017-2020). Descriptive statistical methods and modelling by logistic regression and Joinpoint regression methodology were applied. Results: A total of 111,325 records were obtained (ages 20-100 years), 4.3% for silicosis as the main diagnosis (PD) and 95.7% as a secondary diagnosis (SD). Men accounted for 98.0% and women for 2.0%. The mean age for SD processes was 75.1, and 68.7 for PD processes. The median age increased by 8 years for SD and decreased by 3 years for PD. Although the overall burden of care decreased, under-50 PD procedures between 2006 and 2009 showed an upward trend (APC=27.01%). SD processes showed a non-significant upward trend (APC=1.92%) between 2005 and 2020. Conclusions: The upward trend in silicosis care processes in people under 50 years of age since 2005 confirms the healthcare impact of the re-emergence of silicosis in Spain. The associated burden of care constitutes a present and future public health problem given the decreasing age of those affected.Ministerio de Sanida

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

Epidemiological Changes in Leishmaniasis in Spain According to Hospitalization-Based Records, 1997-2011: Raising Awareness towards Leishmaniasis in Non-HIV Patients

In Spain, Leishmania infantum is endemic, human visceral and cutaneous leishmaniasis cases occurring both in the Peninsula, as well as in the Balearic Islands. We aimed to describe the clinical characteristics of leishmaniasis patients and the changes in the disease evolution after the introduction of antiretroviral therapy in 1997. In this descriptive study, we used Spanish Centralized Hospital Discharge Database for the hospitalized leishmaniasis cases between 1997 and 2011. We included in the analysis only the records having leishmaniasis as the first registered diagnosis and calculated the hospitalization rates. Disease trend was described taking into account the HIV status. Adjusted odds-ratio was used to estimate the association between clinical and socio-demographic factors and HIV co-infection. Of the total 8010 Leishmaniasis hospitalizations records, 3442 had leishmaniasis as first diagnosis; 2545/3442 (75.6%) were males and 2240/3442 (65.1%) aged between 14-65 years. Regarding disease forms, 2844/3442 (82.6%) of hospitalizations were due to visceral leishmaniasis (VL), while 118/3442 (3.4%) hospitalizations were cutaneous leishmaniasis (CL). Overall, 1737/2844 of VL (61.1%) were HIV negatives. An overall increasing trend was observed for the records with leishmaniasis as first diagnosis (p=0.113). Non-HIV leishmaniasis increased during this time period (p=0.021) while leishmaniasis-HIV co-infection hospitalization revealed a slight descending trend (p=0.717). Leishmaniasis-HIV co-infection was significantly associated with male sex (aOR=1.6; 95% CI: 1.25-2.04), 16-64 years age group (aOR=17.4; 95%CI: 2.1-143.3), visceral leishmaniasis aOR=6.1 (95%CI: 3.27-11.28) and solid neoplasms 4.5 (95% CI: 1.65-12.04). The absence of HIV co-infection was associated with lymph/hematopoietic neoplasms (aOR=0.3; 95%CI:0.14-0.57), other immunodeficiency (aOR=0.04; 95% CI:0.01-0.32) and transplant (aOR=0.01; 95%CI:0.00-0.07). Our findings suggest a significant increase of hospitalization in the absence of HIV co-infection, with a predomination of VL. We consider that clinicians in Spain should be aware of leishmaniasis not only in the HIV population but also in non HIV patients, especially for those having immunosuppression as an associate condition

¿Sarna en España? Desentrañando el contexto epidemiológico actual

Este trabajo estudia la sarna en España y su contexto epimiológico. El objetivo del estudio es caracterizar la población afectada, la distribución geográfica y la evolución temporal de la escabiosis en España desde 1997 hasta 2019 así como describir los principales entornos de contagio, consultando cuatro fuentes de datos. Su finalidad es conocer el contexto epidemiológico en España así como otros países de renta alta similares en términos de demografía, sistema sanitario y servicios sociales, para distribuir oportunamente los recursos y dirigir las estrategias de salud pública disminuyendo la incidencia e impacto de la escabiosis.N

Informe de situación: Actividad gripal en la temporada 2018-19 Evaluación de riesgo hasta semana 03/2019

[ES] La epidemia gripal 2018-19 se ha iniciado en España en la semana 01/2019, tres semanas más tarde que en las dos temporadas previas, pero en el rango de las temporadas post-pandémicas previas. La incidencia de gripe se asocia de forma casi exclusiva a la circulación de virus de la gripe tipo A. Aunque la proporción entre subtipos A(H1N1)pdm09 y A(H3N2) es similar, la tendencia de las últimas semanas indica un aumento en la proporción del primero. Los datos de vigilancia en hospitales señalan una distribución similar por tipo/subtipo de virus. Si bien el grupo de mayores de 65 años es el mayoritario (53%), este porcentaje es inferior al que se puede observar en aquellas temporadas en las que predomina A(H3N2) y se parece más a aquellas temporadas en las que predominó A(H1N1)pdm09. Hasta el momento, la epidemia gripal 2018-19 presenta un nivel bajo de transmisibilidad en todos los grupos de edad. El impacto ocasionado en la población española se estima medio, en términos de tasa de hospitalización y bajo en términos de excesos de mortalidad por todas las causas. Ambos indicadores, así como la gravedad clínica de la enfermedad, se seguirán evaluando en las semanas próximas de la epidemia gripal. Las estimaciones preliminares de EV antigripal de esta temporada en Canadá señalan un valor de EV frente a A(H1N1)pdm09 por encima del 70%, en consonancia con datos preliminares de la red Europea I-MOVE. La EV antigripal frente a A(H3N2) es subóptima hasta el momento. Sin embargo, se han estimado valores moderados de EV antigripal frente a todos los virus A en grupos recomendados de vacunación, lo que refuerza la recomendación oficial de vacunación antigripal en estos grupos de riesgo de complicaciones por gripe. En definitiva, las características de la epidemia 2018-19 hasta el momento se mueven en un patrón intermedio entre las temporadas de A(H1N1)pdm09 y las de A(H3N2), de forma que según derive la circulación mayoritaria de uno u otro virus, cabe esperar que predominen unas u otras características. [EN] Influenza activity in Spain started this 2018-19 season in week 01/2019, three weeks later than in the previous two seasons, but in the range of the previous post-pandemic seasons. So far, the influenza season 2018-19 is characterized by the predominant circulation of type A. Although both A(H1N1) pdm09 and A(H3N2) subtypes are co-circulating in similar proportions, the trend of the last weeks indicates an increase in the proportion of the first. Surveillance data in hospitals indicate a similar distribution by type/subtype. Although 53% were adults 65 years of age and older, this percentage is lower than that observed in seasons associated with A(H3N2) predominance, and more similar to those seasons in which A(H1N1)pdm09 predominated. So far, the influenza season 2018-19 has a low level of transmissibility in all age groups. The impact caused in the Spanish population is estimated as “medium”, in terms of hospitalization rates, and “low” in terms of all causes excess mortality. Both indicators, as well as the clinical severity of the disease, will continue to be evaluated in the next few weeks of the flu epidemic. Preliminary estimates of the effectiveness of influenza vaccine this season in Canada indicate good vaccine effectiveness (VE) (above 70%), in line with preliminary data from the European I-MOVE network. The VE against influenza A(H3N2) viruses is suboptimal so far. However, moderate values of VE have been estimated against all A viruses in recommended groups of vaccination, which reinforces the official recommendation of influenza vaccination in these risk groups of complications due to influenza. In short, the characteristics of the influenza season 2018-19 so far move in an intermediate pattern between the A(H1N1)pdm09 seasons and those with A(H3N2) predominance. It is expected that some or other characteristics will prevail depending on the predominance of the circulation of one or the other virus

Situación de la actividad gripal en España en el pico de la epidemia 2017-18

[ES] La onda epidémica gripal de la temporada 2017-18 se inició en España en la semana 50/2017,con mayor anticipación, junto con la temporada 2016-17, que todas las epidemias gripales desde la pandemia de 20091. La máxima tasa de incidencia gripal se ha alcanzado en la semana 03/2018, con un nivel medio de actividad gripal2, calificado de alto en el grupo de mayores de 64 años. La actividad se ha asociado a la circulación predominante de virus de la gripe B (68%), cuya contribución ha ido disminuyendo conforme avanzaba el mes de enero a favor de los dos subtipo de virus A circulantes [A(H3N2) y A(H1N1)pdm09]. El 86% de los virus B caracterizados hasta el momento pertenecen al linaje B/Yamagata y el 14% al linaje Victoria, incluido en la vacuna de esta temporada; entre los virus B/Victoria el 70% pertenecen a un nuevo subgrupo representado por B/Norway/2409/2017, caracterizado por presentar una deleción en los aminoácidos 162 y 163 de la hemaglutinina. Los estudios antigénicos deben confirmar las diferencias antigénicas de los virus circulantes con respecto a los virus incluidos en la vacuna estacional de la presente temporada. En términos de hospitalizaciones graves de gripe, se han notificado hasta el momento al sistema de vigilancia de casos graves hospitalizados confirmados de gripe (CGHCG) las mayores tasas de hospitalización globales y en mayores de 64 años desde la temporada 2013-14. Sin embargo, la tasa de letalidad y admisión en UCI entre los CGHCG están en el rango, o incluso son inferiores, que las de temporadas previas. Se ha identificado un exceso de mortalidad que se concentra como es habitual en las personas mayores de 64 años, concomitante en el tiempo tanto con el pico de actividad gripal como con una ola de frío en España, pudiendo ambos ser factores contribuyentes. Las estimaciones preliminares de efectividad de la vacuna antigripal en la temporada 2017-18 muestran valores moderados de protección frente casos de gripe B, el virus que ha circulado mayoritariamente hasta ahora en España. Además se ha observado un efecto protector de la vacuna de esta temporada en la admisión en UCI y evolución fatal entre los casos graves hospitalizados confirmados de gripe que se notifican a nuestro sistema de vigilancia. [EN] Influenza activity in Spain started early this 2017-18 season (week 50/2017), which is, along with the 2016-17 season, the earliest week of all seasons since the 2009 pandemic. The peak of influenza incidence rate has been reached in the week 03/2018, with a medium level of influenza activity (high in people older than 64 years). So far, the influenza season 2017-18 is characterized by the predominant circulation of type B virus (68%), decreasing its contribution in favor of type A [A(H3N2) and A(H1N1)pdm09] as the month of January progressed. Eighty-six percent of the B viruses characterized so far belong to the B/Yamagata-lineage and 14% to the B/Victoria-lineage, included in the vaccine this season; among B / Victoria viruses, 70% belong to a new subgroup represented by B/Norway/2409/2017, which carries the HA1 double amino acid deletion, Δ162-163. Antigenic studies should confirm the antigenic differences of circulating viruses with respect to vaccine virus component of the current season. This season shows the highest rates of hospitalization (global and over 64 years of age group) since the 2013-14 season. However, the case-fatality rate and ICU admissions among severe hospitalized confirmed influenza cases (SHCIC) are in the range, or even lower, than in previous seasons. An excess of all-cause mortality was identified, coinciding with both the rise of the epidemic wave, as with extremely cold weather in the beginning of the year, which probably contributed to the excess mortality. This excess of all-cause mortality was concentrated as usual in people over 64 years. Preliminary estimates of the effectiveness of influenza vaccine in the 2017-18 season show moderate protection against cases of influenza B, the virus that has circulated so far in Spain. In addition, a protective effect of this season’s vaccine on ICU admissions has been observed, as well as case-fatality rate among SHCIC reported to our surveillance system

Informe de situación: Actividad gripal en la temporada 2018-19 Evaluación de riesgo hasta semana 03/2019

[ES] La epidemia gripal 2018-19 se ha iniciado en España en la semana 01/2019, tres semanas más tarde que en las dos temporadas previas, pero en el rango de las temporadas post-pandémicas previas. La incidencia de gripe se asocia de forma casi exclusiva a la circulación de virus de la gripe tipo A. Aunque la proporción entre subtipos A(H1N1)pdm09 y A(H3N2) es similar, la tendencia de las últimas semanas indica un aumento en la proporción del primero. Los datos de vigilancia en hospitales señalan una distribución similar por tipo/subtipo de virus. Si bien el grupo de mayores de 65 años es el mayoritario (53%), este porcentaje es inferior al que se puede observar en aquellas temporadas en las que predomina A(H3N2) y se parece más a aquellas temporadas en las que predominó A(H1N1)pdm09. Hasta el momento, la epidemia gripal 2018-19 presenta un nivel bajo de transmisibilidad en todos los grupos de edad. El impacto ocasionado en la población española se estima medio, en términos de tasa de hospitalización y bajo en términos de excesos de mortalidad por todas las causas. Ambos indicadores, así como la gravedad clínica de la enfermedad, se seguirán evaluando en las semanas próximas de la epidemia gripal. Las estimaciones preliminares de EV antigripal de esta temporada en Canadá señalan un valor de EV frente a A(H1N1)pdm09 por encima del 70%, en consonancia con datos preliminares de la red Europea I-MOVE. La EV antigripal frente a A(H3N2) es subóptima hasta el momento. Sin embargo, se han estimado valores moderados de EV antigripal frente a todos los virus A en grupos recomendados de vacunación, lo que refuerza la recomendación oficial de vacunación antigripal en estos grupos de riesgo de complicaciones por gripe. En definitiva, las características de la epidemia 2018-19 hasta el momento se mueven en un patrón intermedio entre las temporadas de A(H1N1)pdm09 y las de A(H3N2), de forma que según derive la circulación mayoritaria de uno u otro virus, cabe esperar que predominen unas u otras características. [EN] Influenza activity in Spain started this 2018-19 season in week 01/2019, three weeks later than in the previous two seasons, but in the range of the previous post-pandemic seasons. So far, the influenza season 2018-19 is characterized by the predominant circulation of type A. Although both A(H1N1) pdm09 and A(H3N2) subtypes are co-circulating in similar proportions, the trend of the last weeks indicates an increase in the proportion of the first. Surveillance data in hospitals indicate a similar distribution by type/subtype. Although 53% were adults 65 years of age and older, this percentage is lower than that observed in seasons associated with A(H3N2) predominance, and more similar to those seasons in which A(H1N1)pdm09 predominated. So far, the influenza season 2018-19 has a low level of transmissibility in all age groups. The impact caused in the Spanish population is estimated as “medium”, in terms of hospitalization rates, and “low” in terms of all causes excess mortality. Both indicators, as well as the clinical severity of the disease, will continue to be evaluated in the next few weeks of the flu epidemic. Preliminary estimates of the effectiveness of influenza vaccine this season in Canada indicate good vaccine effectiveness (VE) (above 70%), in line with preliminary data from the European I-MOVE network. The VE against influenza A(H3N2) viruses is suboptimal so far. However, moderate values of VE have been estimated against all A viruses in recommended groups of vaccination, which reinforces the official recommendation of influenza vaccination in these risk groups of complications due to influenza. In short, the characteristics of the influenza season 2018-19 so far move in an intermediate pattern between the A(H1N1)pdm09 seasons and those with A(H3N2) predominance. It is expected that some or other characteristics will prevail depending on the predominance of the circulation of one or the other virus.N