A case of respiratory toxigenic diphtheria: contact tracing results and considerations following a 30-year disease-free interval, Catalonia, Spain, 2015.

In May 2015, following a 30-year diphtheria-free interval in Catalonia, an unvaccinated 6-year-old child was diagnosed with diphtheria caused by toxigenic Corynebacterium diphtheriae. After a difficult search for equine-derived diphtheria antitoxin (DAT), the child received the DAT 4 days later but died at the end of June. Two hundred and seventeen contacts were identified in relation to the index case, and their vaccination statuses were analysed, updated and completed. Of these, 140 contacts underwent physical examination and throat swabs were taken from them for analysis. Results were positive for toxigenic C. diphtheriae in 10 contacts; nine were asymptomatic vaccinated children who had been in contact with the index case and one was a parent of one of the nine children. Active surveillance of the 217 contacts was initiated by healthcare workers from hospitals and primary healthcare centres, together with public health epidemiological support. Lack of availability of DAT was an issue in our case. Such lack could be circumvented by the implementation of an international fast-track procedure to obtain it in a timely manner. Maintaining primary vaccination coverage for children and increasing booster-dose immunisation against diphtheria in the adult population is of key importance.

[Evaluation of the autochthonous transmission risk of Zika virus and other emerging mosquito-borne viral diseases in Catalonia (Spain)]. / Evaluación del riesgo de transmisión autóctona del virus Zika y otras enfermedades virales emergentes transmitidas por mosquitos en Cataluña.

The recent Zika virus epidemic has highlighted the potential risk of introducing the arbovirosis to Europe, especially within the Mediterranean region where the vector, Aedes albopictus, has become established as an invasive species. In this context, a comprehensive evaluation of the risk of introducing the Zika virus and other mosquito-borne viruses of public health importance in Catalonia (Spain) was carried out. This article summarises the results of the preliminary assessment and the recommendations for the public health preparedness and response plan against the threat posed by these emerging diseases.

[Ebola alert: results and challenges in public health. A view from Catalonia (Spain)]. / Resultados y retos en salud pública ante la alerta por Ébola: una perspectiva desde Cataluña.

The Ebola outbreak in Guinea Conakry was notified to the World Health Organization (WHO) in March 2014. It is the most complex Ebola outbreak to date, affecting Guinea Conakry as well as the surrounding countries and with a risk of the disease spreading outside Africa. For this reason, the World Health Organization declared this Ebola outbreak an international public health emergency in August 2014. The Public Health Agency of Catalonia, through the Spanish Alert and Emergencies Coordination Network, initiated public health actions in March 2014, developing a single protocol of action to be applied by all the health care providers in the whole Catalan territory, advice for travellers and voluntary workers arriving from affected countries and a weekly newsletter addressed to health professionals. At the same time, the Ebola Analysis and Monitoring Committee and the Ebola Scientific and Advisory Committee were established. More than 9600 professional health workers attended training sessions and informative sessions. From August 2014, the Catalan Epidemiological Surveillance Emergency Service (SUVEC) reported 117 suspected Ebola cases, of which only 3 met the epidemiological and clinical criteria leading to the activation of the action protocol. All 3 cases proved negative for Ebola. Also, 95 voluntary workers were monitored, 52% of whom were female and 74% had returned from Sierra Leone. Dealing with the suspected Ebola cases required a detailed advance preparation and planning, with a coordinated effort between the epidemiological and health-care network, and all the agents involved, as well as precise, realistic and appropriate risk communication. The prior screening of suspected Ebola cases by the SUVEC meant the immediate protocol was activated only in the cases that met the epidemiological and clinical criteria. This is a key point to be reinforced in any future international public health alerts.

Evaluación del riesgo de transmisión autóctona del virus Zika y otras enfermedades virales emergentes transmitidas por mosquitos en Cataluña / Evaluation of the autochthonous transmission risk of Zika virus and other emerging mosquito-borne viral diseases in Catalonia (Spain)

La reciente epidemia del virus Zika ha hecho evidente el riesgo de introducción de arbovirosis en Europa, especialmente en la región mediterránea, donde el vector Aedes albopictus se ha establecido como especie invasora. En dicho contexto, se realizó una evaluación integral del riesgo de introducción y transmisión autóctona del virus Zika y otros arbovirus de importancia para la salud pública en Cataluña. Se resumen los aspectos más importantes de dicha evaluación, así como las principales conclusiones y recomendaciones para la preparación y la respuesta en salud pública frente a la amenaza que suponen las arbovirosis emergentes (AU)

The recent Zika virus epidemic has highlighted the potential risk of introducing the arbovirosis to Europe, especially within the Mediterranean region where the vector, Aedes albopictus, has become established as an invasive species. In this context, a comprehensive evaluation of the risk of introducing the Zika virus and other mosquito-borne viruses of public health importance in Catalonia (Spain) was carried out. This article summarises the results of the preliminary assessment and the recommendations for the public health preparedness and response plan against the threat posed by these emerging diseases (AU)

Resultados y retos en salud pública ante la alerta por Ébola: una perspectiva desde Cataluña / Ebola alert: results and challenges in public health. A view from Catalonia (Spain)

El brote de enfermedad por virus Ébola iniciado en Guinea Conakry y notificado a la Organización Mundial de la Salud en marzo de 2014ha sido el mayor documentado hasta la fecha. Su extensión a países limítrofes y el riesgo de expansión fuera del continente africano hicieron que, en agosto de 2014, fuese declarado emergencia de salud pública internacional. En el marco de lo establecido por el Centro de Coordinación de Alertas y Emergencias Sanitarias, la Agencia de Salud Pública de Cataluña inició las actuaciones de salud pública en marzo de 2014 y elaboró un único protocolo para todo el territorio, consejos para viajeros y cooperantes procedentes de países afectados, y una nota informativa semanal. Asimismo, en Cataluña, se crearon el Comité de Análisis y Seguimiento de Ébola y el Comité Científico Asesor de Ébola. Se realizaron sesiones informativas y formativas a más de 9600 profesionales de la salud de diferentes ámbitos. Desde agosto de 2014, a través del Sistema de Urgencias de Vigilancia Epidemiológica de Cataluña se notificaron 117 sospechas de Ébola. En tres casos se activó el protocolo con derivación al centro hospitalario de referencia, siendo los resultados descartados microbiológicamente. Se realizó la vigilancia de 95 cooperantes, un 52% mujeres y un 74% procedentes de Sierra Leona. En la gestión de alertas fueron esenciales la preparación y la planificación previas, el trabajo sinérgico entre la red epidemiológica, la asistencial y el conjunto de agentes implicados, así como la comunicación de riesgo precisa, veraz y proporcionada. Fue clave el circuito de cribado previo establecido ante la sospecha de casos por parte de los servicios de vigilancia epidemiológica. Así, solo se activó el protocolo de inmediato en aquellos casos que cumplían estrictamente los criterios. Este es un aspecto esencial a reforzar y mantener de cara a futuras alertas de salud pública internacional (AU)

The Ebola outbreak in Guinea Conakry was notified to the World Health Organization (WHO) in March 2014. It is the most complex Ebola outbreak to date, affecting Guinea Conakry as well as the surrounding countries and with a risk of the disease spreading outside Africa. For this reason, the World Health Organization declared this Ebola outbreak an international public health emergency in August 2014. The Public Health Agency of Catalonia, through the Spanish Alert and Emergencies Coordination Network, initiated public health actions in March 2014, developing a single protocol of action to be applied by all the health care providers in the whole Catalan territory, advice for travellers and voluntary workers arriving from affected countries and a weekly newsletter addressed to health professionals. At the same time, the Ebola Analysis and Monitoring Committee and the Ebola Scientific and Advisory Committee were established. More than 9600 professional health workers attended training sessions and informative sessions. From August 2014, the Catalan Epidemiological Surveillance Emergency Service (SUVEC) reported 117 suspected Ebola cases, of which only 3 met the epidemiological and clinical criteria leading to the activation of the action protocol. All 3 cases proved negative for Ebola. Also, 95 voluntary workers were monitored, 52% of whom were female and 74% had returned from Sierra Leone. Dealing with the suspected Ebola cases required a detailed advance preparation and planning, with a coordinated effort between the epidemiological and health-care network, and all the agents involved, as well as precise, realistic and appropriate risk communication. The prior screening of suspected Ebola cases by the SUVEC meant the immediate protocol was activated only in the cases that met the epidemiological and clinical criteria. This is a key point to be reinforced in any future international public health alerts (AU)