Enfermedad invasora por Haemophilus Influenzae (2015-2020)

[ES] La enfermedad invasora por Haemophilus influenzae es de declaración obligatoria (EDO) en la Red Nacional de Vigilancia Epidemiológica (RENAVE) desde el año 2014. A partir de 2015, la mayoría de las comunidades y ciudades autónomas (CCAA) han ido incorporando esta enfermedad en sus circuitos de vigilancia. Este estudio muestra los resultados obtenidos durante el periodo analizado, 2015-2020. Se dispone de información de prácticamente todas CCAA, excepto de Baleares y Asturias. En general, durante el periodo 2015-2019 se observa una tendencia creciente de la incidencia en todos los grupos de edad, siendo más acusado en los grupos de edad con mayor incidencia. Durante el año pandémico, 2020, la incidencia descendió en todos los grupos de edad.[EN] The invasive disease by Haemophilus influenzae has been reported as a mandatory disease (EDO) in the National Epidemiological Surveillance Network (RENAVE) since 2014. As of 2015, most regions have incorporated this disease in their surveillance circuits. This study shows the results obtained during the period analyzed, 2015-2020. Information is available from virtually all regions, except the regions of the Balearic Islands and Asturias. In general, during the period 2015-2019 there is a growing trend in incidence in all age groups, being more pronounced in the age groups with the highest incidence. During the pandemic year, 2020, incidence declined in all age groups.N

Repercusiones de la vigilancia sobre la política de vacunación

Comunicación presentada en las II Jornada del Centro Nacional de Epidemiología - 2021.Se describe la importancia de la vigilancia de enfermedades inmunoprevenibles para la salud pública. Está vigilancia permite: 1. Detectar cualquier cambio de tendencia de la enfermedad, 2. Valorar el impacto de la vacunación, 3. Generar señales alertando de necesidad de cambios en los programas, y 4. No perder de vista lo que pasa a nuestro alrededor ya que “los microorganismos no entienden de fronteras”

Ratio of the Dead to Wounded (D/W) Indicators and Associated Factors in Major Earthquakes of America from 1960 to 2011

Corrigendum to “Ratio of the Dead to Wounded (D/W) Indicators and Associated Factors in Major Earthquakes of America from 1960 to 2011”. Journal of Earthquakes 2015; 436960, http://dx.doi.org/10.1155/2015/436960.The paper presented deals with the casualties, mortality, and morbidity occurred during the major earthquakes of America during a period of 51 years. The work provides statistical evidence that the deaths/wounded (D/W) ratio used for many agencies in the planning of the preparation and response activities to earthquakes does not fit the relation 1 : 3. In addition, a model is presented in order to evaluate the possible association between different analysis variables such as the subregion of the American continent affected, population density, HDI, and the time and magnitude of the earthquake and the effects of these on the death toll, the number of the wounded, and the D/W indexes. Although the model generated it is not robust enough for decision making, it could be useful and improvable in order to apply it in the planning and management of these kinds of natural disasters. For these reasons, we think that it would be interesting to do further progress in this line of research by making a more comprehensive study of the variables associated with mortality and morbidity, using a more representative sample of earthquakes that sure will confirm the results presented in this work.This work was funded by the Spanish Field Epidemiology Training Program and was done as part of research activities of Ana Ayuso-Alvárez, M.S., Marcello S. Rossi S., D.S., and Dante Culqui, M.S., in the Spanish Field Epidemiology Training Program.S

Situación de la Varicela y del Herpes Zóster en España, 1998-2012

En España la vacuna de la varicela se introdujo en calendario de vacunación en 2005 para adolescentes susceptibles. Entre 2006 y 2008 Madrid, Navarra, Ceuta y Melilla incluyeron también la vacunación sistemática en la infancia. Además entre 2004 y 2014 la vacuna ha estado disponible en farmacias, con lo que en el resto de comunidades autónomas se ha vacunado a los niños fuera de las recomendaciones oficiales de vacunación. Para evaluar el impacto de la vacunación de varicela en la epidemiología de la varicela y del herpes zóster (HZ), se compara el periodo pre-vacunación (1998-2004) con el periodo post-vacunación (2006-2012) y, las comunidades autónomas que han introducido oficialmente la vacuna de varicela en la infancia con las que no la han introducido. Después de introducir la vacuna en calendario, la incidencia y las hospitalizaciones por varicela se han reducido, más en las comunidades que vacunan sistemáticamente en la infancia que en el resto (la incidencia se redujo un 16% y un 9% respectivamente y las hospitalizaciones un 64% y un 43% respectivamente). Las hospitalizaciones por HZ han aumentado en los mayores de 64 años, sobre todo en las regiones en las que más ha bajado la incidencia de varicela. Coberturas de vacunación entre el 20% y el 80% pueden retrasar la edad de presentación de la varicela, aumentando el riesgo de enfermedad grave y de mortalidad. Esta situación puede haberse reproducido en las comunidades autónomas en las que se ha vacunado a los niños fuera del calendario de vacunación y es previsible que, en mayor o menor medida, se incremente el porcentaje de adolescentes que cumplan los 12 años siendo susceptibles a varicela. Hay que fortalecer los programas de vacunación de varicela para asegurar que todos los adolescentes susceptibles reciban dos dosis de vacuna antes de llegar a la edad adulta. Además es preciso consolidar la vigilancia para monitorizar la evolución de la varicela y del HZ en los próximos años.N

Carga hospitalaria de enfermedad de Lyme en España (2005-2019)

[ES] La enfermedad de Lyme es una zoonosis producida por la bacteria Borrellia burdogferi y transmitida por garrapatas duras. Se considera una patología emergente en Europa y, en España, se cataloga como Enfermedad de Declaración Obligatoria (EDO) de vigilancia endémica regional según la Orden SSI/445/2015. El Centro Europeo para la Prevención y Control de Enfermedades (ECDC) incluyó la neuroborreliosis en su lista de enfermedades sujetas a vigilancia epidemiológica en 2018. Con el objetivo de aproximarnos a la situación en España se ha realizado un análisis descriptivo de los datos de pacientes hospitalizados con enfermedad de Lyme incluidos en el Registro de Atención Sanitaria Especializada (RAE-CMBD), entre 2005-2019. Durante este periodo se registraron 1.865 pacientes con esta enfermedad; desde 2005 a 2019 se produjo un incremento de hospitalizaciones del 191,80%. La tasa de hospitalizados (TH) media durante todo el periodo fue de 0,28 por 100.000 habitantes. La mayoría de los ingresos se corresponden con hombres (58,71%; TH=0,32) y, por edad, a mayores de 65 años (34,48%, TH=0,52). Las Comunidades Autónomas (CCAA) con más hospitalizados con este diagnóstico fueron Asturias (16,38%, TH=1,99), seguida de Galicia (13,46%, TH=0,66). Se observa un incremento generalizado de los ingresos en todas las CCAA, excepto en Extremadura donde disminuyeron, y una ampliación de la distribución territorial de la enfermedad. La presentación clínica más frecuente es la neurológica. [EN] Lyme disease is a zoonosis caused by Borrelia burdogferi and transmitted by hard ticks. It is considered an emerging pathology in Europe; the ECDC included neuroborreliosis in the list of diseases under surveillance in 2018. In Spain, it is classified as regional notifiable disease according to Order SSI/445/2015. In order to describe the situation in Spain, a descriptive analysis of Lyme disease discharge data registered in the MBDS (2005-2019). During that period, 1865 admissions were registered with an increase from of 191.80% 2005 to 2019. The average hospitalization rate (HT) throughout the period was 0.28 per 100,000 inhabitants. Most of the admissions were men (58.71%; TH=0.32) and the majority were over 65 years of age (34.48%, TH=0.52). Asturias had the highest rate of admission (16.38%, TH=1.99) and Galicia (13.46%, TH=0.66). A generalized increase in hospitalizations was observed in all the Autonomous Communities, except in Extremadura. In general, a wide distribution and increase in the geographical distribution of the disease was observed. The most frequent clinical presentation are the neurological symptoms

Epidemiology of varicella in spain pre-and post-vaccination periods

BACKGROUND: Varicella virus can cause two different diseases: chickenpox and herpes zoster. In 2005 varicella vaccine has been introduced in the Spanish national vaccination schedule for 10-14 years old non-immune people, in order to reduce the severity of the disease. In 2007 a new surveillance protocol with aggregate data for chickenpox and herpes zoster was approved in order to detect any change in age distribution, severity and complications of the chickenpox and herpes zoster cases. The aim of this study is to know the burden of diseases (in the last ten years). METHODS: Number of cases, hospitalization and incidence for chickenpox and herpes zoster were study for two periods 1997-2003 and 2005-2007. Analysis for 1996-2007 fatal cases was done too. We decided to remove year 2004 because the extremely high chickenpox incidence registered. SOURCES OF DATA: RENAVE (Spanish Surveillance Network), Spanish hospital surveillance system (CMBD), and mortality registries. RESULTS: Chickenpox incidence decreased since 2005, but an increasing trend was detected in hospitalisation with an average of 1,311 hospitalizations every year. For the 32%-36% of hospitalized cases, the main diagnosis was not chickenpox. 4-14 deaths per year have been detected; 80% of them were older than 14 years. Annual rate of herpes zoster hospitalization was 2.5 per 100,000 inhabitants, similar in both sexes. Case fatality rate per year was 0.31 per million inhabitants. No significant changes were detected in age and sex in complicated cases between the two periods. 88% of chickenpox cases were younger than 15 years old and 64% of herpes zoster older than 50 years in 2007. CONCLUSIONS: Chickenpox has been decreasing during 2005-2007 in Spain. The impact of vaccination is difficult to asses, because of a peak registered in 2004 but also because the lack of vaccination coverage information for this period and the case-data information is available only for the last year. Fundamento: El virus varicela zoster puede causar dos enfermedades, la varicela y el herpes zóster. La vacuna frente a la varicela se incorporó en España en 2005 para personas susceptibles de entre 10 y 14 años. En 2007 se aprobó una propuesta de vigilancia de la varicela y herpes zóster que permitiera detectar posibles cambios en los patrones de distribución por edad, en la gravedad y complicaciones. El objetivo de este trabajo es conocer la carga de enfermedad por varicela antes y después de la vacunación. Método: Se analizan los datos agregados (casos e incidencia) de varicela y herpes zóster en España en el sistema CMBD para 1997-2003 y 2005-2007, así como la mortalidad por esta enfermedad a nivel nacional para e período 1999-2006. Resultados: El 88,1% de los casos de varicela se da en personas menores de 15 años. En el CMBD se registró un promedio anual de 1.311 ingresos. No se observaron cambios significativos en la distribución por edad, sexo ni complicaciones durante los ingresos en ninguno de los períodos estudiados. El 32-36% anual ingresó por un motivo diferente a varicela. La mortalidad osciló entre 4 y 14 individuos/año, el 80% mayores de 14 años. El 64% de los casos notificados de herpes zóster fueron mayores de 50 años. La tasa media anual de ingresos por fue de 2,5 por 100.000 habitantes sin diferencias por sexo. La tasa media anual de defunciones fue 0,31 por millón de habitantes. Conclusiones: En España la varicela tuvo una disminución generalizada durante 2005-2007, pero es difícil valorar el impacto de la vacunación por la falta de cifras de cobertura vacunal y porque este período coincide con el inmediato a la última onda epidémica, cuyo máximo se registró en 2004

Incidence and risk factors for acute gastroenteritis among pilgrims following the French way to Santiago de Compostela (Spain) in summer 2008.

[ES] Conocer la incidencia de gastroenteritis aguda en los peregrinos del Camino de Santiago, los factores de riesgo asociados y su caracterización microbiológica. Se diseñaron dos estudios simultáneos, uno transversal mediante encuestas autocumplimentadas de peregrinos llegados a Santiago y otro de casos y controles a los peregrinos en el camino. Se hizo un análisis multivariado mediante regresión logística. En el estudio transversal la densidad de incidencia fue de 23,5 episodios de gastroenteritis aguda por 1.000 peregrinos-día (intervalo de confianza del 95% [IC95%]: 18,9–29,4/103). En el estudio de casos y controles los factores de mayor riesgo fueron la edad <20 años (odds ratio [OR]=4,72; IC95%: 2,16–10,28), viajar en grupo (tres personas o más) (OR=1,49; IC95%: 0,98–2,28) y consumir agua no embotellada (OR=2,09; IC95%: 0,91–4,82). Norovirus fue el microorganismo aislado con más frecuencia (56%). Ser peregrino menor de 20 años, realizar el camino en grupo y consumir agua no embotellada se asocian con un mayor riesgo de presentar gastroenteritis aguda. [EN] To determine the incidence of acute gastroenteritis in pilgrims on St. James' Way, as well as associated risk factors and microbiological characteristics. Two studies were designed simultaneously: a cross-sectional study through self-completed questionnaires among pilgrims reaching Santiago, and a case-control study of pilgrims traveling along the Way. Multivariate analysis was performed using logistic regression. In the cross-sectional study, the incidence rate was 23.5 episodes of acute gastroenteritis/10³ pilgrims-day (95% CI: 18.9-2.4/10³. In the case-control study, the major risk factors were age <20 years (OR=4.72; 95% CI: 2.16-10.28), traveling in groups (three or more) (OR=1.49; 95% CI: 0.98-2.28), and drinking unbottled water (OR=2.09; 95% CI: 0.91-4.82). The most frequent etiologic agent was norovirus (56%). Age less than 20 years, traveling in groups and drinking unbottled water were important risk factors for acute gastroenteritis.Para desarrollar el trabajo de campo, el Centro Nacional de Epidemiología (Instituto de Salud Carlos III) financió el desplazamiento y las dietas de los miembros del PEAC, la Consellería de Sanidade de Galicia aportó el material técnico necesario y cedió un vehículo para los desplazamientos a lo largo del Camino, y S.A. de Xestion do Xacobeo facilitó el alojamiento de los investigadores de campo.S

Increase of pertussis incidence in 2010 to 2012 after 12 years of low circulation in Spain

In Spain, whole cell pertussis vaccination started in 1975, with three doses before the age of 6-7 months. Doses at 15-18 months and 4-6 years were introduced in 1996 and 2001, respectively. Spain switched to an acellular vaccine in 2005. From 1998 to 2009, pertussis incidence rates remained ≤1.5 cases/100,000 inhabitants but increased from 2010 to 7.5 cases/100,000 in 2012. Data from 1998 to 2012 were analysed to assess disease trends and susceptible populations. We defined four epidemic periods: 1998-2001 (reference), 2002-05, 2006-09 and 2010-12. In 2002-05, the incidence rate increased in individuals aged 15-49 years (IRR: 1.41 (95% CI: 1.11-1.78)) and ≥50 years (IRR: 2.78 (95% CI: 1.78-4.33)) and in 2006-09 increased also in infants aged <3 months (IRR: 1.83 (95% CI: 1.60-2.09)). In 2010-12, the incidence rate increased notably in all age groups, with IRRs ranging between 2.5 (95% CI: 2.3-2.8) in 5-9 year-olds and 36.0 (95% CI: 19.4-66.8) in 20-29 year-olds. These results, consistent with the country's vaccination history, suggest a progressive accumulation of susceptible individuals due to waning immunity after years of low incidence. Further vaccination strategies should be assessed and implemented to prevent pertussis in pre-vaccinated infants, in whom the disease is more severe.S

Waterborne outbreak among Spanish tourists in a holiday resort in the Dominican Republic, August 2002

On 3 September 2002, the Spanish national centre of epidemiology (Centro Nacional de Epidemiologia--CNE) was alerted to a high number of gastroenteritis cases in Spanish tourists who had travelled to a hotel in Punta Cana on different days during august 2002. Entamoeba hystolitica cysts have been visualised by microscopy in the stools of several patients that sought medical attention in the Dominican Republic. The CNE informed the health authorities in the Dominican Republic and conducted in conjunction an epidemiological investigation. A descriptive study of the 76 initial cases estimated a mean illness duration of 5.1+2.9 days and a exposure period of 3.6+2.2 days. Following a retrospective cohort study, the attack rate was found to be 32.4%. Consequently, 216 (95% CI=114.75-317.25) spanish tourists had probably developed the illness. Stool samples were collected in Spain from untreated patients who still felt unwell. None of the samples were positive for E.hystolitica. On 10 September, a hygiene inspection was undertaken at the hotel. Samples of the ice and meals served at the buffet that day, yielded coliform bacteria. Consumption of water from the resort water system was the only risk factor associated with the symptoms (RR= 3.55; 95% CI =1.13-10.99). To avoid similar outbreaks occurring again at the hotel, it is essential to regularly monitor the water quality and to improve food handling hygiene standards. Basic food hygiene training for food handlers should be mandatory. An international guideline for the management foodborne and waterborne outbreaks among tourists in holiday resorts should be drawn up, involving all competent authorities of both destination and tourist origin countries.The collaboration of the regional epidemiology services has been crucial to the success of the investigation, since they were in charge of interviewing all cases. We especially recognize the quality of the work and appreciate the interest of: Natalia Méndez Menéndez (Asturias), María Teresa León Espinosa de los Monteros (Andalucia), Cristina Ruiz Sopeña (Madrid), Ana Martínez (Cataluña) and Rocio Maldonado (Barcelona), Isidro de la Cruz de Julián (Castilla La Mancha), Miguel Ángel García Calabuig (País Vasco). Isabel Fuentes Corripio from the National Centre of Microbiology coordinated the analysis of the stool specimens

Shift within age-groups of mumps incidence, hospitalizations and severe complications in a highly vaccinated population. Spain, 1998-2014

The mumps vaccine (Jeryl-Lynn-strain) was introduced in Spain in 1981, and a vaccination policy which included a second dose was added in 1995. From 1992-1999, a Rubini-strain based vaccine was administered in many regions but later withdrawn due to lack of effectiveness. Despite high levels of vaccination coverage, epidemics have continued to appear. We characterized the three epidemic waves of mumps between 1998 and 2014, identifying major changes in susceptible populations using Poisson regression. For the period 1998-2003 (P1), the most affected group was from 1 to 4years old (y) [Incidence Rate (IR)=71.7 cases/100,000 population]; in the periods 2004-2009 (P2) and 2010-2014 (P3) IR ratio (IRR) increased among 15-24y (P2=1.46; P3=2.68) and 25-34y (P2=2.17; P3=4.05). Hospitalization rate (HR), complication rate (CR) and neurological complication rate (NR) among hospitalized subjects decreased across the epidemics, except for 25-34y which increased: HR ratio (HRR) (P2=2.18; P3=2.16), CRR (P3=2.48), NRR (P3=2.41). In Spain mumps incidence increased, while an overall decrease of hospitalizations and severe complications occurred across the epidemics. Cohorts born during periods of low vaccination coverage and those vaccinated with Rubini-strain were the most affected populations, leading to a shift in mumps cases from children to adolescents and young adults; this also reveals the waning immunity provided by the mumps vaccine. Despite not preventing all mumps cases, the vaccine appears to prevent serious forms of the disease.This study was funded in part by Fondo de Investigación Sanitaria, Instituto de Salud Carlos III (PI12/02006) and by Acción Estratégica de Salud, Instituto de Salud Carlos III (PI15CIII/00023)