Unlinked anonymous testing to estimate HIV prevalence among pregnant women in Catalonia, Spain, 1994 to 2009.

This paper estimates the prevalence of human immunodeficiency virus (HIV) infections in women giving birth and women voluntarily terminating pregnancy over a period of sixteen years in Catalonia. Samples for HIV antibody detection were collected from the Neonatal Early Detection Programme for congenital metabolic diseases that covers 99% of infants born in Catalonia. The sampling method collected information of 50% of births every year and of all women attending three clinics for voluntary interruption of pregnancy. Using two sequential immunoassays we analysed unlinked anonymous blood spot samples from 549,689 newborns between 1994 and 2009 and from 31,904 women who voluntarily interrupted pregnancy between 1999 and 2006. HIV prevalence among women giving birth decreased from 3.2 per 1,000 in 1994 to 1.7 per 1,000 in 2009 (p<0.01) and the mean age of infected mothers increased from 26 years in 1994 to 32 years in 2009 (p=0.001). A decrease in HIV prevalence was also observed in women voluntarily terminating pregnancy, from 2.3 per 1,000 in 1999 to 1.0 per 1,000 in 2006 (p<0.01). In contrast, estimated HIV prevalence in mothers born outside Spain increased from 2.2 per 1,000 in 2002 to 3 per 1,000 in 2009 (p<0.01) and their average age increased from 27 years in 2003 to 31 years in 2009 (p<0.01).

A Cryptosporidium hominis outbreak in north-west Wales associated with low oocyst counts in treated drinking water.

An outbreak in the autumn of 2005 resulted in 218 confirmed cases of Cryptosporidium hominis. The attack rate (relative risk 4.1, 95%CI 2.8-9.1) was significantly higher in the population supplied by Cwellyn Water Treatment Works (WTW). A case-control study demonstrated a statistically significant association (odds ratio 6.1, 95% CI 1.8-23.8) between drinking unboiled tap water and C. hominis infection. The association remained significant in a logistic regression analysis, with an adjusted odds ratio of 1.30 (95 CI 1.05-1.61) per glass of unboiled tap water consumed per day. This evidence together with environmental and associated microbiological investigations, and the absence of effective treatment to remove Cryptosporidium oocysts at the WTW, led to the conclusion that the outbreak was waterborne. Oocyst counts in final treated water at the WTW and at different points in the distribution system were consistently very low, maximum count in continuous monitoring 0.08 oocysts per 10 litres. Data from continuous monitoring and the epidemic curve is consistent with the hypothesis that low numbers of oocysts of C hominis were present in treated water continuously during the outbreak and these were of sufficient infectivity to cause illness. All surface water derived water supplies present a potential risk to human health and appropriate control measures should be in place to minimise these risks.

Eliminating congenital rubella syndrome in Spain: does massive immigration have any influence?

In this short report we highlight the importance of implementing good immunization programs adapted to the epidemiological situation of rubella and congenital rubella syndrome (CRS), discuss the influence of massive immigration and stress the need to improve surveillance and control by implementing comprehensive national surveillance and promoting awareness among primary healthcare workers and midwives to find out any signs and symptoms compatible with rubella in pregnant women who have recently arrived from countries with high susceptibility to rubella infection.

Factors associated with late presentation of HIV infection in Catalonia, Spain.

We sought to describe the prevalence, trends and factors associated with late diagnosis of HIV infection between 2001 and 2008 in Catalonia, Spain. Adults over 13 years of age with available CD4 cell counts, who were notified to the Catalonia Voluntary HIV Surveillance System between January 2001 and December 2008, were included in the study. Late presentation for HIV infection was defined as a CD4 cell count <350 cells/µL or with an AIDS-defining condition at presentation. Multivariable logistic regression was used to identify factors independently associated with late diagnosis of HIV. Of the 4651 newly diagnosed HIV-infected individuals with available CD4 counts, 2598 (55.9%) were diagnosed late. The proportion of people with a late diagnosis decreased from 60.4% in 2001 to 50% in 2008, a significant trend (P < 0.001). Older age, male gender, foreign birth, heterosexuality and injecting drug use were independent risk factors for late diagnosis. Strategies to actively promote HIV testing to populations at risk of late diagnosis of HIV or those never attending health systems should be implemented.

Risk factors for hospital-acquired methicillin-resistant Staphylococcus aureus bacteraemia: a case-control study.

A case-control study was undertaken in an acute district general hospital to identify risk factors for hospital-acquired bacteraemia caused by methicillin-resistant Staphylococcus aureus (MRSA). Cases of hospital-acquired MRSA bacteraemia were defined as consecutive patients from whom MRSA was isolated from a blood sample taken on the third or subsequent day after admission. Controls were randomly selected from patients admitted to the hospital over the same time period with a length of stay of more than 2 days who did not have bacteraemia. Data on 42 of the 46 cases of hospital-acquired bacteraemia and 90 of the 92 controls were available for analysis. There were no significant differences in the age or sex of cases and controls. After adjusting for confounding factors, insertion of a central line [adjusted odds ratio (aOR) 35.3, 95% confidence interval (CI) 3.8-325.5] or urinary catheter (aOR 37.1, 95% CI 7.1-193.2) during the admission, and surgical site infection (aOR 4.3, 95% CI 1.2-14.6) all remained independent risk factors for MRSA bacteraemia. The adjusted population attributable fraction, showed that 51% of hospital-acquired MRSA bacteraemia cases were attributable to a urinary catheter, 39% to a central line, and 16% to a surgical site infection. In the United Kingdom, measures to reduce the incidence of hospital-acquired MRSA bacteraemia in acute general hospitals should focus on improving infection control procedures for the insertion and, most importantly, care of central lines and urinary catheters.