Listeriosis en España según el registro de hospitalizaciones: un problema emergente de salud pública

La listeriosis es un importante problema de salud pública en España que debe ser priorizado, especialmente debido a su creciente tendencia y a su gravedad. Se recomienda mejorar las medidas de prevención (educación sobre seguridad alimentaria y mensajes en todos los grupos en riesgo, etc.). Por último, estas mejoras tienen que ir en paralelo a mejoras (y homogeneización) regulatorias, ya que un enfoque global, integrado y multisectorial es la única forma de prevenir y controlar con éxito la listeriosis.N

Epidemiología de la malaria

A pesar de los importantes avances logrados en la lucha contra la malaria en las últimas dos décadas, el avance en el control de esta enfermedad parece haberse estancado en los últimos años. Esto se debe fundamentalmente al déficit en la financiación de los programas de control y al nuevo paradigma al que se enfrentan algunos países endémicos, especialmente aquellos que han conseguido reducir significativamente la prevalencia de esta enfermedad y que se enfrentan a nuevos retos, como la emergencia de las multirresistencias o el paso del control a la eliminación de la enfermedad. La pandemia actual por COVID representa un importante desafío adicionalen el control y la lucha frente a la malaria, y sus consecuencias son aún desconocidas, aunque se prevén importantes dado el impacto que dicha pandemia está teniendo en la prestación de servicios de salud esenciales en todo el mundo. En este capítulo revisamos la epidemiología de esta enfermedad, así como su abordaje desde un enfoque de salud pública, analizando en último lugar cual podría ser el impacto de la pandemia en el abordaje de la misma.Despite the important advances made in the fight against malaria in the last two decades, progress in controlling this disease appears to have stalled in recent years. This is fundamentally due to the deficit in financing control programs and the new paradigm faced by some endemic countries, especially those that have managed to significantly reduce the prevalence of this disease and that are facing new challenges, such as the emergence of multi-resistance or the step from control to elimination of thedisease. The current COVID pandemic represents an important additional challenge in the control and fight against malaria, and its consequences are still unknown, although they are expected to be important given the impact that this pandemic is having on the provision of essential health services throughout the world. In this chapter we review the epidemiology of this disease, as well as its approach from a public health perspective, analyzing lastly what the impact of the pandemic could be in addressing it

Estado nutricional y dieta de los niños y niñas en edad escolar de la región de Amhara (Etiopía)

Una nutrición adecuada es esencial durante la infancia para asegurar un crecimiento sano, la formación de los órganos, un sistema inmunológico fuerte y el correcto desarrollo neurológico y cognitivo del niño. El estado nutricional tiene además un impacto importante en la supervivencia de los niños, principalmente debido a las relaciones sinérgicas entre la desnutrición y las enfermedades. En África oriental y meridional, la desnutrición es una de las principales causas subyacentes de la persistencia de una elevada mortalidad infantil, contribuyendo a más de un tercio de todas las muertes entre los niños menores de 5 años [1]. La desnutrición abarca la malnutrición crónica (MC), la malnutrición aguda (MA) y los déficits de vitaminas y minerales esenciales (denominados colectivamente como micronutrientes). La MC y MA se producen a raíz de diferentes historias de carencias nutricionales para el niño. La MC se asocia frecuentemente con la exposición repetida a condiciones económicas adversas, la falta de saneamiento, los efectos interactivos de una pobre ingesta de nutrientes y la presencia de infecciones repetidas. La MA o el bajo índice de masa corporal (IMC) se relaciona por lo general con el padecimiento de una enfermedad y/o un estado de privación de alimentos reciente. A nivel mundial, en 2012, 162 y 51 millones de menores de cinco años presentaron MC y MA, respectivamente [2]. El déficit de micronutrientes (DM) constituye uno de los principales problemas nutricionales, y contribuye de manera significativa a la morbilidad y mortalidad infantil en el mundo, aunque este hecho solo ha comenzado a ser reconocido recientemente por parte la comunidad de expertos en nutrición..

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

Clinical Cysticercosis epidemiology in Spain based on the hospital discharge database: What's new?

BACKGROUND: Cysticercosis (CC) is a tissue infection caused by the larval cysts of the pork tapeworm Taenia solium. It is usually acquired by eating contaminated food or drinking water. CC Cysts can develop in the muscles, the eyes, the brain, and/or the spinal cord. T. solium is found worldwide, but its prevalence has decreased in developed countries due to stricter meat inspection and better hygiene and sanitation. Nevertheless, CC is still a leading cause of seizures and epilepsy. In Spain, The disease is not nationally reportable and data on CC infected animals are also missing, despite the European Directive 2003/99/EC. METHODOLOGY/PRINCIPAL FINDINGS: We performed a retrospective descriptive study using the Spanish Hospitalization Minimum Data Set (CMBD). Data with ICD-9 CM cysticercosis code ("123.1") placed in first or second diagnostic position from 1997 to 2014 were analyzed. Hospitalization rates were calculated and clinical characteristics were described. Spatial distribution of cases and their temporal behavior were also assessed. A total of 1,912 hospital discharges with clinical cysticercosis were identified. From 1998 to 2008, an increasing trend in the number of CC hospitalizations was observed, decreasing afterwards, in parallel with a decrease in the external migration rate. The Murcia region had the highest median hospitalization rate (13.37 hospitalizations/100,000 population), followed by Navarra and Madrid. The 16-44 age group was the most represented (63.6%). The three most frequent associated diagnoses were epilepsy and convulsions (49.5%), hydrocephalus (11.8%) and encephalitis/myelitis/meningitis (11.6%). CONCLUSIONS/SIGNIFICANCE: There is a need for a common strategy on data collection, monitoring and reporting, which would facilitate a more accurate picture on the CC epidemiological scenario. Even if most cases might be imported, improving the human and animal CC surveillance will result useful both in gaining extended disease knowledge and reducing morbidity and related-costs.The authors received no specific funding for this work.S

Gender and fiction: a window to history

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Impact of Plasmodium falciparum pfhrp2 and pfhrp3 gene deletions on malaria control worldwide: a systematic review and meta-analysis

Background: Deletion of pfhrp2 and/or pfhrp3 genes cause false negatives in malaria rapid diagnostic test (RDT) and threating malaria control strategies. This systematic review aims to assess the main methodological aspects in the study of pfhrp2 and pfhrp3 gene deletions and its global epidemiological status, with special focus on their distribution in Africa; and its possible impact in RDT. Methods: The systematic review was conducted by examining the principal issues of study design and methodological workflow of studies addressing pfhrp2 deletion. Meta-analysis was applied to represent reported prevalences of pfhrp2 and pfhrp3 single and double deletion in the World Health Organization (WHO) region. Pooled-prevalence of deletions was calculated using DerSimonnian-Laird random effect model. Then, in-deep analysis focused on Africa was performed to assess possible variables related with these deletions. Finally, the impact of these deletions in RDT results was analysed combining reported information about RDT sensitivity and deletion prevalences. Results: 49 articles were included for the systematic review and 37 for the meta-analysis, 13 of them placed in Africa. Study design differs significantly, especially in terms of population sample and information reported, resulting in high heterogeneity between studies that difficulties comparisons and merged conclusions. Reported prevalences vary widely in all the WHO regions, significantly higher deletion were reported in South-Central America, following by Africa and Asia. Pfhrp3 deletion is more prevalent (43% in South-Central America; 3% in Africa; and 1% in Asia) than pfhrp2 deletion (18% in South-Central America; 4% in Africa; and 3% in Asia) worldwide. In Africa, there were not found differences in deletion prevalence by geographical or population origin of samples. The prevalence of deletion among false negatives ranged from 0 to 100% in Africa, but in Asia and South-Central America was only up to 90% and 48%, respectively, showing substantial relation between deletions and false negatives. Conclusion: The concerning prevalence of pfhrp2, pfhrp3 and pfhrp2/3 gene deletions, as its possible implications in malaria control, highlights the importance of regular and systematic surveillance of these deletions. This review has also outlined that a standardized methodology could play a key role to ensure comparability between studies to get global conclusions.I.M.F. received a research fellowship from the University of Alcalá that enables her to develop this study.S

Children's dietary diversity and related factors in Rwanda and Burundi: A multilevel analysis using 2010 Demographic and Health Surveys

BACKGROUND: One of the reported causes of high malnutrition rates in Burundi and Rwanda is children's inadequate dietary habits. The diet of children may be affected by individual characteristics and by the characteristics of the households and the communities in which they live. We used the minimum dietary diversity of children (MDD-C) indicator as a proxy of diet quality aiming at: 1) assess how much of the observed variation in MDD-C was attributed to community clustering, and 2) to identify the MDD-C associated factors. METHODS: Data was obtained from the 2010 Demographic and Health Surveys of Burundi and Rwanda, from which only children 6 to 23 months from rural areas were analysed. The MDD-C was calculated according to the 2007 WHO/UNICEF guidelines. We computed the intra-class coefficient to assess the percentage of variation attributed to the clustering effect of living in the same community. And then we applied two-level logit regressions to investigate the association between MDD-C and potential risk factors following the hierarchical survey structure of DHS. RESULTS: The MDD-C was 23% in rural Rwanda and 16% in rural Burundi, and a 29% of its variation in Rwanda and 17% in Burundi was attributable to community clustering. Increasing age and living standards were associated with higher MDD-C in both countries, and only in Burundi also increasing level of education of the mother's partner. In Rwanda alone, the increasing ages of the head of the household and of the mother at first birth were also positively associated with it. Despite the identification of an important proportion of the MDD-C variation due to clustering, we couldn't identify any community variable significantly associated with it. CONCLUSIONS: We recommend further research using hierarchical models, and to integrate dietary diversity in holistic interventions which take into account both the household's and the community's characteristics the children live in.The authors received no specific funding for this work.S

Estimating human leishmaniasis burden in Spain using the capture-recapture method, 2016-2017

Leishmaniasis is endemic and a mandatory reporting disease in Spain since 1982. However, between 1996 and 2014, surveillance on public health was decentralized and only some autonomous regions monitored the disease. The aim of this study is to estimate the incidence of leishmaniasis and to evaluate the extent of underreporting in Spain. A capture-recapture (CRC) study was conducted to calculate the incidence of human leishmaniasis using reports from the National Surveillance Network (RENAVE) and the Hospital Discharge Records of the National Health System (CMBD) for 2016 and 2017. During the study period, 802 cases were reported to RENAVE and there were 1,149 incident hospitalizations related to leishmaniasis. The estimated incidence rates through the CRC study were 0.79 per 100,000 inhabitants for visceral leishmaniasis (VL), 0.88 (cutaneous leishmaniasis (CL)) and 0.12 (mucocutaneous leishmaniasis (MCL)) in 2016 and 0.86 (VL), 1.04 (CL) and 0.12 (MCL) in 2017. An underreporting of 14.7-20.2% for VL and 50.4-55.1% for CL was found. The CRC method has helped us to assess the sensitivity and representativeness of leishmaniasis surveillance in Spain, being a useful tool to assess whether the generalization of leishmaniasis surveillance throughout the Spanish territory achieves a reduction in underreporting.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