Brote de parotiditis vírica en un colegio de Bizkaia en 2006

Fundamento: Recientemente se han registrado brotes de parotiditis en España y en otros países desarrollados. Los motivos barajados son la baja cobertura vacunal de las poblaciones afectadas y/o la baja efectividad de las cepas vacunales empleadas. Este trabajo describe un brote de parotiditis ocurrido en Bizkaia y valora la efectividad de las cepas vacunales y la utilidad de las pruebas diagnósticas actualmente empleadas. Métodos: Se etiquetaron como casos aquéllos con clínica compatible y vínculo epidemiológico en el periodo de estudio (febrero-mayo-2006). Se recogieron muestras de sangre para estudio de IgM e IgG y de saliva para detección de RNA y genotipo. Se averiguó el estado vacunal y la cepa empleada mediante los registros del reparto vacunal. Se realizó un análisis univariante de los datos y se obtuvieron riesgos relativos según las cepas vacunales empleadas. Resultados: Se detectaron 63 casos; 52 eran alumnos del mismo colegio. El 50% tenía entre 9 y 13 años. El 88,5% de los casos del colegio estaba correctamente vacunado. La sensibilidad de la IgM fue del 9% y la de la PCR del 37%. El riesgo relativo de los alumnos vacunados con una primera dosis de cepa Rubini frente a los vacunados con cepa Jeryl-Lynn fue de 3,8 (IC95% 2,27-6,49). Conclusiones: La elevada cobertura vacunal no impide el desarrollo de brotes en lugares con un alto grado de exposición. La IgM se muestra poco sensible para el diagnóstico de parotiditis. Parece necesario replantearse las estrategias vacunales y los métodos diagnósticos actuales

Brote de parotiditis vírica en un colegio de Bizkaia en 2006

Fundamento: Recientemente se han registrado brotes de parotiditis en España y en otros países desarrollados. Los motivos barajados son la baja cobertura vacunal de las poblaciones afectadas y/o la baja efectividad de las cepas vacunales empleadas. Este trabajo describe un brote de parotiditis ocurrido en Bizkaia y valora la efectividad de las cepas vacunales y la utilidad de las pruebas diagnósticas actualmente empleadas. Métodos: Se etiquetaron como casos aquéllos con clínica compatible y vínculo epidemiológico en el periodo de estudio (febrero-mayo-2006). Se recogieron muestras de sangre para estudio de IgM e IgG y de saliva para detección de RNA y genotipo. Se averiguó el estado vacunal y la cepa empleada mediante los registros del reparto vacunal. Se realizó un análisis univariante de los datos y se obtuvieron riesgos relativos según las cepas vacunales empleadas. Resultados: Se detectaron 63 casos; 52 eran alumnos del mismo colegio. El 50% tenía entre 9 y 13 años. El 88,5% de los casos del colegio estaba correctamente vacunado. La sensibilidad de la IgM fue del 9% y la de la PCR del 37%. El riesgo relativo de los alumnos vacunados con una primera dosis de cepa Rubini frente a los vacunados con cepa Jeryl-Lynn fue de 3,8 (IC95% 2,27-6,49). Conclusiones: La elevada cobertura vacunal no impide el desarrollo de brotes en lugares con un alto grado de exposición. La IgM se muestra poco sensible para el diagnóstico de parotiditis. Parece necesario replantearse las estrategias vacunales y los métodos diagnósticos actuales

Serum levels of Clara cell secretory protein, asthma, and lung function in the adult general population.

Clara cell secretory protein (CC-16) has anti-inflammatory properties and protective effects from oxidative stress on the respiratory tract and has been proposed as a biological marker of lung epithelial injury and pulmonary permeability. In this study, we evaluated serum CC-16 level as a biomarker relevant in the study of asthma and lung function phenotypes in adults from the Spanish branch of the population-based multicenter European Community Respiratory Health Survey.We measured CC-16 in serum samples of 859 participants (mean age 41 yrs; 51% women) of 3 Spanish ECRHS centers using an immunoassay. Current asthma, airflow limitation (AL) and lung function parameters (FEV1% and FVC% predicted and FEV1/FVC ratio) were considered. All estimates were adjusted for centre, type of sample, sex, age, smoking, pack-years, body mass index (BMI), and height. Mean serum CC-16 levels were 5.8 \ub1 2.9 \u3bcg/L, ranging from 0.37 to 19.7 \u3bcg/L. Serum CC-16 levels did not vary with current asthma in the total population. However, lower serum CC-16 levels were associated with current asthma among never smokers. Reduced CC-16 levels were associated with AL (OR=0.71, P=0.03) and with moderate severe COPD stages (RRR=0.52, P=0.01 vs no AL). CC-16 level increased with FEV1% predicted (beta=1.92, p<0.001) and FEV1/FVC (beta=0.84, p<0.001) and was borderline significant for FVC% predicted (beta=0.84, P=0.06).In summary, we found reduced serum CC-16 levels to be associated with airflow limitation and lower lung function in the general population after adjusting for the effects of cigarette smoking and other covariates. These data warrant evaluation of serum CC-16 level as a potential biomarker of lung function deficits and obstructive lung disease in the longitudinal setting

Asociación entre el cociente FEF 25-75% / FVC y la hiperreactividad bronquial

Objetivo: La desproporción entre el calibre de la vía aérea y el parénquima pulmonar tiene una relación negativa con la presencia de hiperreactividad bronquial (HRB). El objetivo del presente estudio es medir la asociación entre el calibre de la vía aérea relativa a la talla pulmonar, expresado por el cociente entre el flujo mesoespiratorio entre el 25 y el 75% de la capacidad vital forzada dividido por la capacidad vital forzada (FEF25-75%/FVC), con la HRB medida por el test de metacolina, ajustando por edad, altura, sexo, consumo de tabaco, área geográfica, síntomas respiratorios y volumen espiratorio forzado en el primer segundo previo. Material y métodos: Estudio multicéntrico transversal sobre población general española (2.647 sujetos) del Estudio de Salud Respiratoria de la Comunidad Europea (ECRHS-I). Se aplicó un cuestionario llamado ECRHS, se determinó la inmunoglobulina E total y específica, y se realizaron pruebas cutáneas, espirometría y test de metacolina. Resultados: Se presenta la relación entre las diferentes variables sociodemográficas y clínicas con los 2 parámetros de positividad del test de metacolina. Hay aumento del riesgo de HRB a menor cociente FEF25-75%/FVC ajustado por diferentes variables (odds ratio = 0,09; intervalo de confianza del 95%, 0,04-0,18, para PC20, y odds ratio = 0,06; intervalo de confianza del 95%, 0,03-0,12 para PD20). Conclusiones: El cociente FEF25-75%/FVC está asociado significativamente a la HRB, independientemente de la edad, la existencia de atopia, el consumo de tabaco, el área geográfica, los síntomas respiratorios y el volumen espiratorio forzado en el primer segundo

Menopause is associated with accelerated lung function decline

RATIONALE: Menopause is associated with changes in sex hormones, which affect immunity, inflammation, and osteoporosis and may impair lung function. Lung function decline has not previously been investigated in relation to menopause. OBJECTIVES: To study whether lung function decline, assessed by forced vital capacity and forced expiratory volume in one second, is accelerated in women who undergo menopause. METHODS: The population-based longitudinal European Community Respiratory Health Survey provided serum samples, spirometry and questionnaire data about respiratory and reproductive health from three study waves (N=1438). We measured follicle stimulating hormone and luteinizing hormone and added information on menstrual patterns, to determine menopausal status using latent class analysis. Associations with lung function decline were investigated using linear mixed effects models, adjusting for age, height, weight, packyears, current smoking, age at completed full-time education, spirometer and including study center as random effect. MEASUREMENTS AND MAIN RESULTS: Menopausal status was associated with accelerated lung function decline. The adjusted mean forced vital capacity decline was increased by -10.2 ml/yr (95% Confidence interval -13.1 to -7.2) in transitional women and -12.5 ml/yr (-16.2 to -8.9) in postmenopausal women, compared to women menstruating regularly. The adjusted mean forced expiratory volume in one second decline increased by -3.8 ml/yr (-6.3 to -2.9) in transitional women and -5.2 ml/yr (-8.3 to -2.0) in postmenopausal women. CONCLUSIONS: Lung function declined more rapidly among transitional and postmenopausal women, in particular for forced vital capacity, beyond the expected age change. Clinicians should be aware that respiratory health often deteriorates during reproductive aging

Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II).

Summary Background The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. Methods We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990\u201395) and did not report respiratory symptoms or a history of asthma at the time of the fi rst study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defi ned by high-risk occupations, an asthma-specifi c job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. Findings A signifi cant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1\ub76, 95% CI 1\ub71\u20132\ub73, p=0\ub7017). Risks were highest for asthma defi ned by bronchial hyper-reactivity in addition to symptoms (2\ub74, 1\ub73\u20134\ub76, p=0\ub7008). Of common occupations, a signifi cant excess risk of asthma was seen for nursing (2\ub72, 1\ub73\u20134\ub70, p=0\ub7007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fi re, mixing cleaning products, or chemical spills (RR=3\ub73, 95% CI 1\ub70\u201311\ub71, p=0\ub7051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250\u2013300 cases per million people per year. Interpretation Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely

Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II)

BACKGROUND: The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. METHODS: We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. FINDINGS: A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4, 1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2, 1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year. INTERPRETATION: Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely