Changes in the epidemiology of hepatitis A: Clinical and preventive implications. / Cambios en la epidemiología de la hepatitis A: repercusiones clínicas y preventivas.

INTRODUCTION AND OBJECTIVES: Hepatitis A Virus Infection (HAI) has been related to the hygienic-sanitary situation of an area, the changes in the epidemiology of HAI in the province of Guadalajara between 1991 and 2017 are analyzed. MATERIALS AND METHODS: Cases of HAI declared between 1991 and 2017 in Guadalajara were included. The variables analyzed were age, sex, environment, risk factors for HAI and need for hospitalization. The incidence was compared in three periods: 1991-1999, 2000-2008 and 2009-2017. RESULTS: Two hundred and thirty-three cases of HAI were declared, the average incidence rate was 4.27 cases/100,000 inhabitants, highest between 1991 and 1999 (6.93) and lowest between 2009 and 2017 (1.92), with an increment in 2017 (5.5). The median age was 16 years (IR: 8.5-28.5 years), 58.4% were male, and the highest incidence occurred between 5 and 14 years in both sexes. The most frequent risk factors were family and non-family contact and trips to endemic areas (18.6%, 17.3% and 18.2%, respectively). The last risk factor increased after 2000 (P=.001), as did the incidence in urban areas. The MSM group showed an increase in the last period (P<.001). Hospital admissions increased progressively from the first to the third period studied (P=.001). CONCLUSIONS: HAI has a low incidence in our area. More cases related to travel or sexual practices are observed. This should be considered when establishing prevention policies, including vaccination of the most exposed people.

Measles outbreak in the sanitary area of Guadalajara (Spain): difficulty in microbiological diagnosis in the era of its elimination.

INTRODUCTION: In Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tolos for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain). METHODS: Serological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system. RESULTS: A total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in two that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or two vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis. CONCLUSIONS: The combination of molecular tests and the presence of specific IgM is necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.

Measles outbreak in the sanitary area of Guadalajara (Spain): Difficulty in microbiological diagnosis in the era of its elimination. / Brote de sarampión en el área sanitaria de Guadalajara (España): dificultad en el diagnóstico microbiológico en la era de su eliminación.

INTRODUCTION: In Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tools for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain). METHODS: Serological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system. RESULTS: A total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in 2 that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or 2 vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis. CONCLUSIONS: The combination of molecular tests and the presence of specific IgG and IgM are necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.