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 año

Vigilancia del Sarampión, Rubéola y Síndrome de Rubéola Congénita. España 2011

Entre 2010 y 2012 España, igual que otros países europeos, ha sufrido una onda epidémica de sarampión; se han registrado las mayores incidencias desde que se implantó el Plan Nacional de Eliminación de Sarampión: 0,66 casos/100.000 habitantes en 2010, 7,45/100.000 habitantes en 2011 y 2,54/100.00 habitantes en 2012. En 2011 se notificaron 3.518 casos confirmados de sarampión; los niños < 4 años y los adultos jóvenes (20-29 años) han sido los más afectados; la mayoría de los casos (96 %) estaban sin vacunar o mal vacunados. Grupos de niños mal vacunados y profesionales sanitarios sin inmunizar han tenido mucha importancia en la generación y difusión de los brotes. Los países de la Región Europea de la Organización Mundial de la Salud (OMS), están inmersos en la última fase del proceso con el objetivo de interrumpir la circulación del sarampión y de la rubéola endémicos en la región en 2015. El avance hacia la eliminación se conseguirá si se mantiene la calidad del sistema de vigilancia y se mantienen altas coberturas de vacunación (> 95 %) con dos dosis de vacuna triple vírica en todos los niveles geográficos y grupos de población; establecer recordatorios sistemáticos para las dosis del calendario de vacunación infantil y asegurar que los profesionales sanitarios se vacunen son intervenciones eficaces para evitar que un caso importado origine un brote cuando el sarampión y la rubéola están próximos a la eliminación

Resultados de la Vigilancia de la Parálisis Flácida Aguda y Vigilancia de Enterovirus, España año 2016

[ES] Los resultados de la vigilancia de parálisis flácida aguda (PFA) y de la vigilancia de enterovirus (EV) muestran que en España en el año 2016 no hubo casos de polio ni circulación de poliovirus. En 2016, comparando con años previos, la parálisis flácida se notificó en niños más pequeños con cuadros clínicos más graves y con más disfunción residual. Se detectaron diferentes EV-no polio asociados a cuadros respiratorios y neurológicos, fundamentalmente en la edad pediátrica. EV-D68 se asoció con infecciones respiratorias y E-30 con meningitis; durante los meses de primavera y verano se identificó en zonas del noreste, región mediterránea y centro peninsular, un agrupamiento de cuadros neurológicos graves en niños asociado a una nueva variante recombinante altamente patógena del subgenogrupo C1 de EV-A71, que previamente no había circulado en nuestro país. Hay que mantener y reforzar los sistemas de vigilancia establecidos para monitorizar la circulación de enterovirus-polio y no polio en nuestro país. Hay que evaluar los sistemas conjuntamente y adaptarlos, si fuera necesario, para poder identificar señales tempranas que alerten sobre la circulación inesperada de un poliovirus o de un EV-no polio emergente. [EN] The Acute Flaccid Paralysis (AFP) Surveillance and the Enterovirus (EV) Surveillance did not reveal polio cases no poliovirus circulation in our country, suggesting Spain was polio-free during the year 2016. In 2016, comparing to previous years, AFP cases were more frequently diagnosed in Young children presenting more serious clinical symptoms and more lasting residual paralysis. Along the year different non-polio enteroviruses were detected mainly associated with respiratory and neurological illness over all in children. EV-D68 was associated with respiratory illness while E-30 was associated with meningitis; a highly pathogenic new variant of subgenotype of EV-A71 was detected in an outbreak of severe neurological cases diagnosed in young children; the cases appeared in zones of the northeast, Mediterranean coast and central regions of Spain. The existing networks devoted to Surveillance of enteroviruses -polio and non-polio- should be maintained and enhanced. AFP, viral meningitis and enterovirus surveillance should be monitored as a comprehensive surveillance system. Collected clinical, epidemiological and virological information would be invaluable to understanding the epidemiology of enteroviruses and to prompt detection of any poliovirus or any unexpected circulation of other enteroviruses

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Mineralogy of a Mudstone at Yellowknife Bay, Gale Crater, Mars

Sedimentary rocks at Yellowknife Bay (Gale Crater) on Mars include mudstone sampled by the Curiosity rover. The samples, John Klein and Cumberland, contain detrital basaltic minerals, Ca-sulfates, Fe oxide/hydroxides, Fe-sulfides, amorphous material, and trioctahedral smectites. The John Klein smectite has basal spacing of ~10 Å indicating little interlayer hydration. The Cumberland smectite has basal spacing at ~13.2 Å as well as ~10 Å. The ~13.2 Å spacing suggests a partially chloritized interlayer or interlayer Mg or Ca facilitating H_2O retention. Basaltic minerals in the mudstone are similar to those in nearby eolian deposits. However, the mudstone has far less Fe-forsterite, possibly lost with formation of smectite plus magnetite. Late Noachian/Early Hesperian or younger age indicates that clay mineral formation on Mars extended beyond Noachian time

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Martian fluvial conglomerates at gale crater

Observations by the Mars Science Laboratory Mast Camera (Mastcam) in Gale crater reveal isolated outcrops of cemented pebbles (2 to 40 millimeters in diameter) and sand grains with textures typical of fluvial sedimentary conglomerates. Rounded pebbles in the conglomerates indicate substantial fluvial abrasion. ChemCam emission spectra at one outcrop show a predominantly feldspathic composition, consistent with minimal aqueous alteration of sediments. Sediment was mobilized in ancient water flows that likely exceeded the threshold conditions (depth 0.03 to 0,9 meter, average velocity 0.20 to 0.75 meter per second) required to transport the pebbles. Climate conditions at the time sediment was transported must have differed substantially from the cold, hyper-arid modern environment to permit aqueous flows across several kilometers

Soil Diversity and Hydration as Observed by ChemCam at Gale Crater, Mars

The ChemCam instrument, which provides insight into martian soil chemistry at the submillimeter scale, identified two principal soil types along the Curiosity rover traverse: a fine-grained mafic type and a locally derived, coarse-grained felsic type. The mafic soil component is representative of widespread martian soils and is similar in composition to the martian dust. It possesses a ubiquitous hydrogen signature in ChemCam spectra, corresponding to the hydration of the amorphous phases found in the soil by the CheMin instrument. This hydration likely accounts for an important fraction of the global hydration of the surface seen by previous orbital measurements. ChemCam analyses did not reveal any significant exchange of water vapor between the regolith and the atmosphere. These observations provide constraints on the nature of the amorphous phases and their hydration