Epidemiología de los brotes de gastroenteritis de etiología vírica en instituciones cerradas y semicerradas

[spa] INTRODUCCIÓN: El principal agente de gastroenteritis aguda (GEA) de etiología vírica es norovirus, aunque también son frecuentes los adenovirus, astrovirus, rotavirus y sapovirus. Las GEA de origen vírico son cuadros clínicos autolimitados de corta duración y de baja letalidad. Representan el 80% de todas las gastroenteritis agudas. La levedad de los cuadros clínicos ha hecho que su importancia haya sido infravalorada, pero las GEA víricas son la principal causa de morbilidad en niños y ancianos. Son la octava causa de muerte a nivel mundial y la segunda causa por etiología infecciosa, después de las infecciones de las vías respiratorias. Se presentan frecuentemente en instituciones cerradas y semicerradas, incluidas las residencias geriátricas, en las que la avanzada edad y la pluripatología de los residentes facilita la aparición de complicaciones, el ingreso hospitalario e incluso la muerte. HIPÓTESIS: 1) Los brotes de gastroenteritis aguda de etiología vírica son una importante causa de morbilidad en las instituciones cerradas y semicerradas. 2) Cuando se produce un brote de gastroenteritis aguda de etiología vírica en una institución cerrada o semicerrada, la transmisión de la infección no queda limitada a dicha institución, pudiéndose producir casos secundarios entre los familiares de trabajadores y usuarios. La detección de estos casos secundarios no es fácil y frecuentemente no se contabilizan como vinculados al brote, por lo que la magnitud de dichos brotes puede estar infraestimada. 3) La carga viral detectada en heces puede variar según la presencia o no de síntomas y del tipo de virus implicado, aspectos que puede influir en la extensión del brote. 4) Los brotes de gastroenteritis pueden haber disminuido durante la pandemia de COVID-19, por lo que parece razonable comparar la incidencia y características de dichos brotes durante la pandemia respecto al periodo prepandémico. OBJETIVO: El objetivo principal de trabajo es investigar los brotes de GEA de etiología vírica en instituciones cerradas y semicerradas y sus determinantes, tanto a nivel de la afectación de las personas expuestas en la institución en la que ha aparecido el brote como entre sus contactos domiciliarios. Para ello se plantean los siguientes objetivos específicos: 1 Estimar las tasas de ataque y los modos de transmisión en los brotes de gastroenteritis aguda en centros geriátricos, centros educativos y casas de colonias, así como en los trabajadores de dichas instituciones. 2. Investigar la afectación entre los trabajadores y entre los contactos domiciliarios de las personas expuestas en las instituciones en que se han producido brotes de gastroenteritis aguda. 3. Analizar la carga viral en los infectados sintomáticos y asintomáticos detectados en los brotes de gastroenteritis aguda. 4. Analizar la repercusión de la pandemia de COVID-19 en la incidencia de brotes de gastroenteritis aguda declarados a los servicios de vigilancia epidemiológica

Norovirus outbreaks in long-term care facilities in Catalonia from 2017 to 2018

Norovirus is the leading cause of outbreaks of acute viral gastroenteritis. We carried out this study to investigate outbreaks in long-term care facilities reported in 2017 and 2018 in Catalonia (Spain). The characteristics of the centers, exposed persons and the genogroups responsible were analyzed. Viral loads were estimated. The attack rate (AR) of the outbreaks studied, and the rate ratio (RR) and the odds ratio (OR) and their 95% confdence intervals as measures of association were calculated. The mean cycle thresholds were compared using the t-test for independent means. We included 30 outbreaks (4631 exposed people). The global AR was 25.93%. The RR of residents vs. staf was 2.28 (95% CI 2.0-2.6). The RR between AR in residents with total or severe dependence vs. residents with moderate, low or no-dependence was 1.23 (95% CI 1.05-1.45). The AR were higher in smaller centers than in larger ones (38.47% vs. 19.25% and RR 2; 95% CI 1.82-2.2). GII was responsible for 70% of outbreaks. No association was found between the genogroup and presenting symptoms (OR 0.96; 95% CI 0.41-2.26). Viral loads were higher in symptomatic than in asymptomatic patients (p = 0.001)

Norovirus outbreaks in long-term care facilities in Catalonia from 2017 to 2018

Norovirus is the leading cause of outbreaks of acute viral gastroenteritis. We carried out this study to investigate outbreaks in long-term care facilities reported in 2017 and 2018 in Catalonia (Spain). The characteristics of the centers, exposed persons and the genogroups responsible were analyzed. Viral loads were estimated. The attack rate (AR) of the outbreaks studied, and the rate ratio (RR) and the odds ratio (OR) and their 95% confidence intervals as measures of association were calculated. The mean cycle thresholds were compared using the t-test for independent means. We included 30 outbreaks (4631 exposed people). The global AR was 25.93%. The RR of residents vs. staff was 2.28 (95% CI 2.0–2.6). The RR between AR in residents with total or severe dependence vs. residents with moderate, low or no-dependence was 1.23 (95% CI 1.05–1.45). The AR were higher in smaller centers than in larger ones (38.47% vs. 19.25% and RR 2; 95% CI 1.82–2.2). GII was responsible for 70% of outbreaks. No association was found between the genogroup and presenting symptoms (OR 0.96; 95% CI 0.41–2.26). Viral loads were higher in symptomatic than in asymptomatic patients (p = 0.001).This study was funded by Instituto de Salud Carlos III through the project PI16/02005 (Co-funded by European Regional Development Fund “Investing in your future”) and the Catalan Agency for the Management of Grants for University (AGAUR Grant No. 2017/SGR 1342). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication

Involvement of workers in closed and semiclosed institutions in outbreaks of acute gastroenteritis due to norovirus

Norovirus outbreaks frequently occur in closed or semiclosed institutions. Recent studiesin Catalonia and various countries indicate that, during outbreaks in these institutions, norovirus isdetected in between 23% and 60% of workers, and the prevalence of infection in asymptomatic workersinvolved in outbreaks ranges from 17% to 40%. In this work, we carried out a prospective studyto investigate the involvement of workers in closed and semiclosed institutions during outbreaks.The attack rates (ARs) and the rate ratios (RRs) were calculated according to the type of transmissionand occupational category. The RRs and 95% confidence intervals (CIs) between workers and userswere calculated. The mean cycle of quantification (Cq) values were compared according to thegenogroup and the presence of symptoms. ARs were higher in person-to-person transmission thanin common vehicle outbreaks, and 38.8% of workers were symptomatic. The RR between workersand users was 0.46 (95% CI 0.41-0.52). The ARs in workers were high, particularly in workers withcloser contact with users. The mean Cq was lower in patients than in asymptomatic infected persons,although the difference was only significant for genogroup I (GI). The frequency of asymptomaticinfected persons suggests that personal hygiene measures should be followed by all workers in thecenters affected

A foodborne norovirus outbreak in a nursing home and spread to staff and their household contacts

On 16 March 2018, a nursing home notified a possible acute gastroenteritis outbreak that affected 11 people. Descriptive and case-control studies and analysis of clinical and environmental samples were carried out to determine the characteristics of the outbreak, its aetiology, the transmission mechanism and the causal food. The extent of the outbreak in and outside the nursing home was determined and the staff factors influencing propagation were studied by multivariate analysis. A turkey dinner on March 14 was associated with the outbreak (OR 4.22, 95% CI 1.11-16.01). Norovirus genogroups I and II were identified in stool samples. The attack rates in residents, staff and household contacts of staff were 23.49%, 46.22% and 22.87%, respectively. Care assistants and cleaning staff were the staff most frequently affected. Cohabitation with an affected care assistant was the most important factor in the occurrence of cases in the home (adjusted OR 6.37, 95% CI 1.13-36.02). Our results show that staff in close contact with residents and their household contacts had a higher risk of infection during the norovirus outbreak

Impact of the COVID-19 pandemic on contact tracing of patients with pulmonary tuberculosis

Background: The COVID-19 pandemic could have negative effects on tuberculosis (TB) control. The objective was to assess the impact of the pandemic in contact tracing, TB and latent tuberculosis infection (LTBI) in contacts of patients with pulmonary TB in Catalonia (Spain). Methods: Contact tracing was carried out in cases of pulmonary TB detected during 14 months in the pre-pandemic period (1 January 2019 to 28 February 2020) and 14 months in the pandemic period (1 March 2020 to 30 April 2021). Contacts received the tuberculin skin test and/or interferon gamma release assay and it was determined whether they had TB or LTBI. Variables associated with TB or LTBI in contacts (study period and sociodemographic variables) were analyzed using adjusted odds ratio (aOR) and the 95% confidence intervals (95% CI). Results: The pre-pandemic and pandemic periods showed, respectively: 503 and 255 pulmonary TB reported cases (reduction of 50.7%); and 4676 and 1687 contacts studied (reduction of 36.1%). In these periods, the proportion of TB cases among the contacts was 1.9% (84/4307) and 2.2% (30/1381) (P = 0.608); and the proportion of LTBI was 25.3% (1090/4307) and 29.2% (403/1381) (P < 0.001). The pandemic period was associated to higher LTBI proportion (aOR = 1.3; 95% CI 1.1–1.5), taking into account the effect on LTBI of the other variables studied as sex, age, household contact and migrant status. Conclusions: COVID-19 is affecting TB control due to less exhaustive TB and LTBI case detection. An increase in LTBI was observed during the pandemic period. Efforts should be made to improve detection of TB and LTBI among contacts of TB cases.This study was supported by the Ministry of Science and Innovation, Institute of Health Carlos III (Project PI18/01751) and Fondo Europeo de Desarrollo Regional (FEDER-Una manera de hacer Europa)

Los alumnos de nuevo ingreso de origen asiático en la Facultad de Ciencias Políticas y Sociología. Análisis, estudio y propuestas de acción II. Hacia un protocolo de actuación

El Proyecto es la continuación del ya desarrollado en la convocatoria del curso pasado PIE 2017/222 en el que constatábamos que la Facultad de Ciencias Políticas y Sociología recibe cada curso académico un mayor número de alumnos de origen asiático que sufren fuertes dificultades en su proceso de adaptación e integración en los diferentes Grados que se imparten en dicha Facultad (Ciencias Políticas, Sociología, Gestión y Administración Pública, Antropología Social y Cultural, Relaciones Internacionales y los Dobles Grados de Derecho y Ciencias Políticas, Relaciones Internacionales y Sociología, Gestión y Administración Pública y Económicas, y Ciencias Políticas y Filosofía). El alumnado chino constituye uno de los mayores retos que tiene la Universidad Complutense en el esfuerzo por la mejora de la institución en su conjunto y el servicio que da a la sociedad en el proceso de internacionalización de la UCM

Involvement of Workers in Closed and Semiclosed Institutions in Outbreaks of Acute Gastroenteritis Due to Norovirus

Norovirus outbreaks frequently occur in closed or semiclosed institutions. Recent studies in Catalonia and various countries indicate that, during outbreaks in these institutions, norovirus is detected in between 23% and 60% of workers, and the prevalence of infection in asymptomatic workers involved in outbreaks ranges from 17% to 40%. In this work, we carried out a prospective study to investigate the involvement of workers in closed and semiclosed institutions during outbreaks. The attack rates (ARs) and the rate ratios (RRs) were calculated according to the type of transmission and occupational category. The RRs and 95% confidence intervals (CIs) between workers and users were calculated. The mean cycle of quantification (Cq) values were compared according to the genogroup and the presence of symptoms. ARs were higher in person-to-person transmission than in common vehicle outbreaks, and 38.8% of workers were symptomatic. The RR between workers and users was 0.46 (95% CI 0.41–0.52). The ARs in workers were high, particularly in workers with closer contact with users. The mean Cq was lower in patients than in asymptomatic infected persons, although the difference was only significant for genogroup I (GI). The frequency of asymptomatic infected persons suggests that personal hygiene measures should be followed by all workers in the centers affected