Near real-time surveillance of the SARS-CoV-2 epidemic with incomplete data.

When responding to infectious disease outbreaks, rapid and accurate estimation of the epidemic trajectory is critical. However, two common data collection problems affect the reliability of the epidemiological data in real time: missing information on the time of first symptoms, and retrospective revision of historical information, including right censoring. Here, we propose an approach to construct epidemic curves in near real time that addresses these two challenges by 1) imputation of dates of symptom onset for reported cases using a dynamically-estimated "backward" reporting delay conditional distribution, and 2) adjustment for right censoring using the NobBS software package to nowcast cases by date of symptom onset. This process allows us to obtain an approximation of the time-varying reproduction number (Rt) in real time. We apply this approach to characterize the early SARS-CoV-2 outbreak in two Spanish regions between March and April 2020. We evaluate how these real-time estimates compare with more complete epidemiological data that became available later. We explore the impact of the different assumptions on the estimates, and compare our estimates with those obtained from commonly used surveillance approaches. Our framework can help improve accuracy, quantify uncertainty, and evaluate frequently unstated assumptions when recovering the epidemic curves from limited data obtained from public health systems in other locations.

Absence of protective ethnic density effect on Ecuadorian migrants' mental health in a recent migration setting: a multilevel analysis.

PURPOSE: We aimed to study the association between the Ecuadorians' ethnic density (EED) of the areas of residence (AR) with the mental health of Ecuadorians in Spain. METHODS: Multilevel study of 568 Ecuadorian adults in 33 AR randomly selected from civil registries and interviewed at home. Possible psychiatric case (PPC) was measured by scoring ≥5 in General Health Questionnaire-28. Ecuadorians' ethnic density was dichotomized in high and low EED (<6 %). Multilevel logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS: Prevalence of PPC, 24 % (95 %CI 20-28 %), varied by area of residence. Ecuadorians' ethnic density varied by area of residence ranging from 0.9 to 19.5 %. PPC prevalence in High Ecuadorians' ethnic density AR was 29.5 and 20.4 % in low EED AR (p 0.013). Ecuadorians from High EED AR had higher odds of PPC than those from Low EED AR (OR 1.65 95 %CI 1.01-2.72). Adjusting for individual confounders (largely self-perceived discrimination), OR decreased to 1.48 (95 %CI 0.87-2.55). The final model, adjusted by area of residence and educational level, yielded an OR 1.37 (95 %CI 0.78-2.40). CONCLUSIONS: No protective association between the Ecuadorians' ethnic density of the Area of residence and Ecuadorian migrants' mental health was found. Mechanisms underlying beneficial ethnic density effects may be absent in recent migration settings.

COVID-19 vaccine effectiveness against hospitalization due to SARS-CoV-2: A test-negative design study based on Severe Acute Respiratory Infection (SARI) sentinel surveillance in Spain.

BACKGROUND: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for acute respiratory infection (ARI) surveillance in primary care and a network of sentinel hospitals for severe ARI (SARI) surveillance in hospitals. METHODS: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 vaccine effectiveness (VE) against hospitalization, by age group, vaccine type, time since vaccination, and SARS-CoV-2 variant. RESULTS: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. CONCLUSIONS: The SiVIRA sentinel hospital surveillance network in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations and provide estimates of COVID-19 VE in the population under surveillance. Our estimates add to evidence of high effectiveness of mRNA vaccines against severe COVID-19 and waning of protection with time since vaccination in those aged 80 or older. No substantial differences were observed between SARS-CoV-2 variants (Alpha vs. Delta).

Mental health in Ecuadorian migrants from a population-based survey: the importance of social determinants and gender roles.

PURPOSE: To describe the prevalence of and the risk factors for poor mental health in female and male Ecuadorian migrants in Spain compared to Spaniards. METHOD: Population-based survey. Probabilistic sample was obtained from the council registries. Subjects were interviewed through home visits from September 2006 to January 2007. Possible psychiatric case (PPC) was measured as score of ≥5 on the General Health Questionnaire-28 and analyzed with logistic regression. RESULTS: Of 1,122 subjects (50% Ecuadorians, and 50% women), PPC prevalence was higher in Ecuadorian (34%, 95% CI 29-40%) and Spanish women (24%, 95% CI 19-29%) compared to Ecuadorian (14%, 95% CI 10-18%) and Spanish men (12%, 95% CI 8-16%). Shared risk factors for PPC between Spanish and Ecuadorian women were: having children (OR 3.1, 95% CI 1.4-6.9), work dissatisfaction (OR 4.1, 95% CI 1.6-10.5), low salaries (OR 2.5, 95% CI 1.1-5.9), no economic support (OR 1.8, 95% CI 0.9-3.4), and no friends (OR 2.2, 95% CI 1.1-4.2). There was an effect modification between the nationality and educational level, having a confidant, and atmosphere at work. Higher education was inversely associated with PPC in Spanish women, but having university studies doubled the odds of being a PPC in Ecuadorians. Shared risk factors for PPC in Ecuadorian and Spanish men were: bad atmosphere at work (OR 2.4, 95% CI 1.3-4.4), no economic support (OR 3.5, 95% CI 1.3-9.5), no friends (OR 2.5, 95% CI 0.9-6.6), and low social support (OR 1.6, 95% CI 0.9-2.9), with effect modification between nationality and partner's emotional support. CONCLUSIONS: Mental health in Spanish and Ecuadorian women living in Spain is poorer than men. Ecuadorian women are the most disadvantaged group in terms of prevalence of and risk factors for PPC.

Characterization of the first autochthonous dengue outbreak in Spain (August-September 2018).

On October 3rd 2018, dengue virus (DENV) infection was confirmed in three family members (symptoms onset between August 18th and 27th) without travel history outside of Spain. They had been together in the Autonomous Communities (AC) of Murcia and Andalusia. By the end of October, a second cluster of two dengue cases (symptoms onset on September 27th and 30th) was confirmed in the AC of Murcia. DENV type 1 sequence was identical to the first cluster, and the epidemiological link was a visit from a case of the first cluster to a fruit-farm neighboring the small village of residence of the second cluster. The entomological investigation found Aedes albopictus activity in this area although all mosquitoes were PCR-negative for DENV. This is the first autochthonous dengue outbreak identified in Spain. This outbreak highlights challenges to timely detect and respond to DENV transmission and opens questions on dengue dynamics in a non-endemic context.

[Methodology and fieldwork logistics of a multilevel research study on the influence of neigbourdhood's characteristics on natives and Ecuadorian's mental health in Spain]. / Metodología y logística de campo de un estudio multinivel sobre la influencia en España de las características medioambientales en la salud mental de población autóctona y ecuatoriana inmigrante.

The methodological design, characteristics and fieldwork stage of a multilevel research study on the impact of the environmental characteristics on mental health in an autochthonous and immigrant population are described in this paper. Individual data were obtained using a core questionnaire 40 minutes length from home interviews of Spanish and Ecuadorian adults from September 2006 to January 2007. A random sample of 1186 people aged 18-55, with equal distribution of gender and nationality was obtained from Civil Registers of 33 areas (municipalities or neighbourhoods) of Madrid, Alicante, Almeria and Murcia, chosen by ethnic density and socioeconomic criteria. Previously, a pilot study was carried out. Socioeconomic indicators of neighbourhoods and selected communities were obtained from Municipal Registers and other secondary sources. Finally, 1144 people were interviewed (96%). Each person was contacted at home at two different times. The global response rate was 61%, higher among Ecuadorians (69%), who presented more problems of localisation (34%). Analyzing methods and fieldwork process the conclusion is that sample strategies for this type of population studies should be evaluated using feasibility criteria given time and money constraints, against the need to obtain representative samples of the target populations. There were serious shortcomings in the availability of social integration indicators at the neighbourhood level.

[Effect of weather temperature on hospital emergencies in the Region of Murcia, Spain, throughout the 2000-2005 and its use in epidemiological surveillance]. / Efecto del calor sobre el número de urgencias hospitalarias en la Región de Murcia durante los veranos del período 2000-2005 y su uso en la vigilancia epidemiológica.

BACKGROUND: The effect of the weather temperature on mortality has been studied more in depth than its effect on morbidity. In Murcia, the number of daily emergencies and the cases of heat stroke for which care is provided at the hospitals in this Region have been studied. OBJECTIVE: to evaluate the effect that the weather temperature has on the number of hospital emergencies and the use of these indicators for the surveillance of hot weather-related morbidity. METHODS: The effect of the weather temperature on the number of summertime emergencies (2000-2005) has been studied by estimating the percentage increase in emergencies when the weather temperature thresholds established by the Ministry of Health and Consumer Affairs (Max. 38 degrees C and Min. 22.4 degrees C) are exceeded, and by each degree of temperature rise. Results have been stated as Relative Risk (RR) with a 95% CI. A comparison has been drawn between the heat strokes notified and the hospital admissions recorded in the Minimum Basic Data Set at Hospital Discharge (MBDS). RESULTS: Within the 2000-2005 period, the number of emergencies rose by 1.6% on those days when the minimum temperature for the day was above 22.4 degrees C (RR: 1.016; 95% CI 1.0076-1.0244) and by 0.21% for each degree of rise in the minimum temperature for the day (RR: 1.0021, 95% CI 1.0000-1.0044). A total of 38% of the heat strokes admitted to hospital were not reported, of which 40% had occupational exposure. CONCLUSIONS: The minimum temperature for the day could have a greater effect in Murcia than the maximum for the day. Based on the current thresholds, the number of emergencies/day does not seem to be a suitable indicator for monitoring the effect of the weather temperature, information on the diagnosis and the age being needed. Heat strokes provide partial information on the impact, but highlight less-considered population groups at risk.

Violence in adulthood and mental health: gender and immigrant status.

The aim of this study was to describe perceived abuse in adult Spanish and Ecuadorian women and men and to assess its association with mental health. A population-based survey was conducted in Spain in 2006. Data were taken from a probabilistic sample allowing for an equal number of men and women, Spaniards and Ecuadorians. Mental disorder was measured with the General Health Questionnaire-28. The nine questions on exposure to physical, sexual, and psychological abuse during the previous year were self-administered. Multivariate logistic regression was used to assess the association between exposure to abuse and poor mental health, adjusting for potential confounders. The sample was composed of 1,059 individuals aged 18 to 54, 104 of whom reported physical, psychological, or sexual abuse. Some 6% refused to answer the questions on abuse. Overall, reported abuse ranged from 13% in Ecuadorian women to 5% in Spanish men. Psychological abuse was the most frequent. Half the abused women, both Spanish and Ecuadorian, reported intimate partner violence (IPV), as did 22% of abused men. Poor mental health was found in 61% of abused Spanish women (adjusted Odds Ratio [ORa] = 5.1; 95% CI: 1.8-14.4), and 62% abused Ecuadorian women (ORa = 4; 95% CI: 2-7.9), in 36% of abused Spanish men (ORa = 3; 95% CI: 0.9-10.7) and in 30% abused Ecuadorian men (ORa = 2.8; 95% CI: 1-7.7). Interpersonal violence is frequent in relations with the partner, the family, and outside the family, and it seriously affects the mental health. Ecuadorian women stand out as the most vulnerable group.

Hepatitis C and hepatitis B-related mortality in Spain.

BACKGROUND: Although hepatitis C and hepatitis B virus (HCV/HBV) infections are an important health problem worldwide, their burden of disease (BoD) taking into account their chronic consequences, cirrhosis, and hepatocellular carcinoma (HCC), is still unknown. Our aim was to assess the total number of deaths attributable to these viruses in Spain and the years of life lost, first component of the disability adjusted life years, a comparative index of BoD. METHODS: We selected the International Classification of Diseases-Tenth Revision specific codes related to HCV/HBV. For unspecified cirrhosis and HCC, the attributable fraction of mortality was assessed in two steps: literature review and expert panel. Deaths in Spain in 2000 were obtained from the National Statistics Institute. Years of life lost were calculated using the estimated mortality and life expectancies (Princeton Model Life Table). RESULTS: HCV could have caused around 70% of HCC deaths and 50% of cirrhosis mortality in Spain in 2000 (60% HCC, 40% cirrhosis with HCV lower estimate). For HBV these proportions are 10 and 13%, respectively. We estimated 4342 HCV-related deaths and 877 HBV-related deaths in Spain in 2000, globally 1.5% of total deaths in Spain that year. Mortality by cirrhosis and HCC represented most of these viral-related deaths. Attributable mortality in AIDS patients was also estimated. CONCLUSION: HCV leads the list of infectious disease-related mortality in Spain in 2000, doubling the AIDS mortality even if lower HCV attributable fractions are considered. Exclusion of cirrhosis and HCC-related mortality severely underestimates the BoD attributable to HCV/HBV. Improving early diagnosis and access to treatment could have an important impact on mortality because of hepatitis virus in the next decades.