Dispersion of Aedes albopictus in the Spanish Mediterranean Area.

Emergence and re-emergence of arboviral disease in new areas of southern Europe is becoming a public health problem. Since Aedes albopictus was first detected in 2004 in Catalonia, it has spread along the Spanish Mediterranean coast. Results of an entomological surveillance carried out by the Spanish Ministry of Health to monitor the expansion of Ae. albopictus along the Spanish Mediterranean coast between 2009 and 2012 are presented. Besides the new locations in Valencia and Murcia regional communities, it was identified in five municipalities in the Balearic Islands in 2012. A comprehensive plan aiming the control of invasive vector-borne diseases including entomological surveillance should be considered.

[Monitoring and non pharmacologic measures during a pandemic virus (H1N1) 2009 in Spain]. / Bases epidemiológicas para la toma de decisiones sobre medidas de salud pública (no farmacológicas) durante la respuesta a la pandemia de gripe (H1N1) 2009.

Nonpharmacological public health measures are used to reduce exposure of susceptible persons to an infectious agent. Its use is recommended at the start of a pandemic, when the transmission begins, and the characteristics of the new virus are unknown. The National Plan for Preparedness and Response to Pandemic Influenza included the application of these measures, recommending the establishment of an Advisory Committee for implementation, with a multidisciplinary composition. The mandate at this Committee is to analyze the epidemiological and social context in confronting the pandemic and to propose public health measures according to their evolution. This article describes isolation, quarantine and closure of schools measures, aiming to reduce the spread of the virus in the population. It also reviews the epidemiological parameters that help to understand the impact of its implementation. The public health measures reviewed in this paper reduce transmission of the virus, and they have to be considered in response to an influenza pandemic. The impact on health will depend on how quickly they are taken and how people accept and follow them. Response plans should recommend its use, depending on the severity and characteristics of the new pandemic virus. The data analysis should be considered as part of the response, because the information collection and analysis will be key to advising health authorities on what measures should be adopted.

[Surveillance and control measures of avian influenza in birds. Implications for public health]. / Medidas de vigilancia y contención de la influenza aviar en aves. Implicaciones para la salud pública.

Avian influenza is an infectious disease that mainly affects birds, caused by influenza A type viruses, in most cases of low pathogenecity. Rapid mutations of these viruses to highly pathogenic forms represent a serious risk for animal and public health. Since 2003, an outbreak of highly pathogenic avian influenza in birds is taking place with transmission and resulting illness in humans and which is believed to be able to start a human influenza pandemic. To face these outbreaks, a joint effort between the animal and public health sector is needed to identify areas affected by animal disease and to intensify surveillance of human cases in them. Control measures in animals must be compatible with risk reduction of human exposure. The aim of this article is to review the general control measures developed against avian influenza in birds, highlighting coordination and communication aspects between Animal Health and Public Health, taking into account that legislation is constantly being updated as the dynamic of the disease changes.

[Burden of disease in Spanish population under 15 years old in 1999]. / Carga de enfermedad de la población española menor de 15 años para el año 1999.

BACKGROUND AND OBJECTIVE: Burden of disease (DALYs) can help define health priorities. Our objective was to assess DALYs of those illnesses most important in Spanish children and teenagers. MATERIAL AND METHOD: We calculated DALYs components (YLL, YLD) by age groups and sex. Sources used were Spanish mortality data and WHO DALY's estimates. RESULTS: Total DALYs was 46.57/1000 habitants and it was highest in children aged less than 1 year. The first cause was represented by non-communicable diseases and the second by communicable-perinatal diseases in less than 1 year and 1-4 years and injuries in 5-14 years. CONCLUSIONS: DALYs is a good indicator to define health's population.

[Cost-effectiveness of varicella vaccination in Spanish adolescents]. / Coste-efectividad de la vacunación contra la varicela en adolescentes en España.

INTRODUCTION: Varicella is a highly contagious disease. In Spain, in 1996, 91% of the population aged 13 years old had been infected. The complications of varicella are more frequent in adults. Herpes zoster infection can be reactivated after the initial infection in 15%. A vaccine against varicella has recently been authorized in Spain for use in individuals aged more than 13 years old with negative serology. OBJECTIVE: To determine the cost-effectiveness of vaccination of the cohort aged 13 years old in 2001 and to perform a sensitivity analysis of the parameters that are affected. MATERIAL AND METHOD: Tree decision: Decision Analysis by Tree-Age program. Probabilities and costs were calculated using Microsoft Excel. Population size was obtained from the 2001 Census of the National Institute of Statistics to which we applied the percentage of susceptibility from the seroepidemiological study in Spain. Probabilities were calculated by the Bayes Theorem, using the incidence rates by age of a country in the northern hemisphere. Hospital-related data were obtained from the minimum data set. We used the effectiveness of the vaccine licensed in the USA, with a total effectiveness of 71% and a partial effectiveness of 24%, represented by milder varicella in vaccinated individuals (breakthrough varicella). Only direct costs were considered. Costs were obtained by direct consultation of different sources. A discount rate of 3% was used. RESULTS: Varicella vaccination could prevent 27,278 cases of the disease. Prevention of one case would cost the public health system 131 Euros. DISCUSSION: This study constitutes an approach to the cost of introducing varicella vaccination in the Spanish vaccination schedule, from the payer's perspective. However, to take a decision, some unknown factors, such as the effect of vaccination on the incidence of herpes zoster, should be assessed. With currently available data, the introduction of vaccination in adolescence would seem to be the best strategy, but further studies are needed.

[A study of whooping cough epidemic outbreak in Castellon, Spain]. / Estudio de un brote epidémico de tos ferina en Castellón.

BACKGROUND: Based on the report of several cases at one school, a study of an epidemic outbreak was started for the purpose of characterizing this outbreak from the person, place and time standpoint, calculating the effectiveness of the immunization and the concordance of the cases with the positive result of the serological study. METHODS: A "case" is defined as being that individual who has a cough fasting for two weeks. A study is made of the spread of the disease by means of the epidemic curve and the effectiveness of the pertussis vaccine. The concordance of the cases and the positive serology is evaluated by way of the Kappa index. RESULTS: From among the students at several schools and those with whom they were living at the time, a total of 130 individuals were surveyed, 94 of whom fit the "case" definition. The average age of the cases was 10.5 years of age, 42.6% being males and 84% school age children, 71.3% showing signs of recent infection (positive IgM), the average length of time since the last whooping cough immunization being 8.25 years. The effectiveness of the whooping cough booster is 66%. The concordance between the cases and the positive results of the serology reveals a Kappa = 0.45. No B. Pertussis was isolated in the 25 throat swab samples. CONCLUSIONS: Classrooms and the family environment are a factor in spreading this disease. The including of a booster at 18 months improves the effectiveness of the whooping cough immunization. The isolation of B. Pertussis is not very frequent, and the serology may be an alternative when this disease is clinically suspected.

[Possible introduction and autochthonous transmission of dengue virus in Spain]. / Posibilidad de introducción y circulación del virus del Dengue en España.

Dengue has become a major public health problem worldwide. Ae. albopictus, vector responsible for transmission, was first detected in Catalonia in 2004. Since then, it has established along Mediterranean coast. The aim of this paper is to describe the risk of importation and possible autochthonous transmission of dengue virus in Spain, qualitatively reviewing factors that could influence the emergence of dengue in our country, and the implications for public health. No autochthonous transmission has occurred in our country to date, but infected travelers coming from endemic countries are arriving to Spain constantly. The transmission of this disease could occur on the Mediterranean coast. Transmission would be more likely in the warmer months due to cultural habits and higher vector densities. While most of the population would be susceptible, given the characteristics of the disease, the impact on health's population would be low. The main public health strategy to reduce the risk of importation and possible dengue transmission should focus on primary prevention, to prevent interaction of the virus, vector and human. These three components must be addressed in a comprehensive and multisectoral plan of action, intensifying some activities in the areas of greatest risk. Coordination of public health from all sectors involved is essential for the proper functioning of this integrated response plan for vector-borne diseases.

[Review of the current situation and the risk factors of Leishmania infantum in Spain]. / Situación epidemiológica y de los factores de riesgo de transmisión de Leishmania infantum en España.

In Spain, leishmaniasis is an endemic zoonosis present in most of the Iberian Peninsula and the Balearic Islands. The parasite detected is Leishmania infantum and the main reservoir is the dog. Competent vectors to transmit the parasite are sandflies, of which there are two species distributed throughout the Iberian Peninsula and the Balearic Islands. This article reviews the current situation and the behaviour of leishmaniasis in Spain. It analyzes and compares information about the disease from hospital discharges and from the National Epidemiological Surveillance Network. It also analyses the risk factors that facilitate transmission identified in previous studies. Since 2009 an outbreak is occurring in the southwest part of the Community of Madrid, with a significant number of cases, about 400 and the detection of a new reservoir, the hare. The conditions that can increase the incidence of leishmaniasis are linked to the increase number of infected vectors, increase sandfly density, increase hosts or the appearance of new reservoirs in a geographic area. This infection has got a complex transmission dynamic. To timely respond to outbreaks a comprehensive and multisectoral action plan should be developed joined by all the institutions involved in the preparation and response. Before an outbreak occurs, it is important to study all the factors affecting the transmission in that place and to adapt the action plan to the specific characteristics.

Enfermedades transmitidas por vectores. Un nuevo reto para los sistemas de vigilancia y la salud pública / Vector-transmitted diseases. A new challenge for public health surveillance systems

No disponible

Posibilidad de introducción y circulación del virus del Dengue en España / Possible introduction and autochthonous transmission of Dengue virus in Spain

El dengue se ha convertido en un importante problema de salud pública mundial. Ae. albopictus, vector competente para su transmisión, se detectó por primera vez en Cataluña en 2004. Desde entonces se ha establecido por la costa Mediterránea. El objetivo del artículo es describir el riesgo de importación y posible transmisión del dengue en España, revisando cualitativamente los factores que podrían influir en su emergencia en nuestro país, así como las implicaciones que tendría a nivel de salud pública. Aunque el virus no circula actualmente en España, constantemente llegan personas infectadas procedentes de países endémicos. La transmisión de esta enfermedad podría ocurrir en la costa mediterránea. Sería más probable en los meses más cálidos por los hábitos socioculturales y las mayor presencia del vector.Aunque la mayoría de la población es susceptible, el impacto en la salud de la población sería bajo dadas las características de la enfermedad. La estrategia fundamental de salud pública para reducir el riesgo de importación y posible transmisión del dengue debe enfocarse a la prevención primaria para evitar la interacción del virus, el vector y los seres humanos. Estos tres componentes deben abordarse dentro de un plan de acción integral y multisectorial, intensificando algunas actividades en las zonas de mayor riesgo. La coordinación desde salud pública de todos los sectores implicados es imprescindible para el correcto funcionamiento de este plan integral de respuesta ante enfermedades transmitidas por vectores (AU)

Dengue has become a major public health problem worldwide. Ae. albopictus, vector responsible for transmission, was first detected in Catalonia in 2004. Since then, it has established along Mediterranean coast. The aim of this paper is to describe the risk of importation and possible autochthonous transmission of dengue virus in Spain, qualitatively reviewing factors that could influence the emergence of dengue in our country, and the implications for public health. No autochthonous transmission has occurred in our country to date, but infected travelers coming from endemic countries are arriving to Spain constantly. The transmission of this disease could occur on the Mediterranean coast. Transmission would be more likely in the warmer months due to cultural habits and higher vector densities. While most of the population would be susceptible, given the characteristics of the disease, the impact on health’s population would be low. The main public health strategy to reduce the risk of importation and possible dengue transmission should focus on primary prevention, to prevent interaction of the virus, vector and human. These three components must be addressed in a comprehensive and multisectoral plan of action, intensifying some activities in the areas of greatest risk. Coordination of public health from all sectors involved is essential for the proper functioning of this integrated response plan for vector-borne diseases (AU)

Situación epidemiológica y de los factores de riesgo de transmisión de Leishmania Infantum en España / Review of the current situation and the risk factors of Leishmania Infantum in Spain

En España la leishmaniasis es una zoonosis endémica presente en la mayor parte del territorio peninsular e Islas Baleares. El parásito que se detecta es la Leishmania infantum y el principal reservorio es el perro. Los vectores competentes para transmitir el parásito son los flebotomos, de los que existen dos especies distribuidas por todo el territorio peninsular e Islas Baleares. En este artículo se revisa la situación actual y el comportamiento de la leishmaniasis en España. Se analiza y compara la información sobre la enfermedad procedente de las altas hospitalarias y de la Red Nacional de Vigilancia Epidemiológica así como los factores de riesgo identificados en estudios anteriores que facilitan la transmisión. Desde 2009 está teniendo lugar un brote en el suroeste de la Comunidad de Madrid, destacando el elevado número de casos, cerca de 400 y la detección de un nuevo reservorio, la liebre. Las condiciones que pueden incrementar la incidencia de la leishmaniasis están asociadas al aumento del número de vectores infectados, al de la densidad del flebotomo, al de hospedadores o la aparición de nuevos reservorios en un área geográfica. Esta infección tiene una dinámica de transmisión compleja y para responder oportunamente a los brotes debe estar previamente desarrollado un plan de acción integral y multisectorial en el que participen todas las instituciones involucradas. Ante un brote, es importante estudiar los factores que condicionan la transmisión del lugar y adaptar el plan de acción a sus características específicas(AU)

In Spain, leishmaniasis is an endemic zoonosis present in most of the Iberian Peninsula and the Balearic Islands. The parasite detected is Leishmania infantum and the main reservoir is the dog. Competent vectors to transmit the parasite are sandflies, of which there are two species distributed throughout the Iberian Peninsula and the Balearic Islands. This article reviews the current situation and the behaviour of leishmaniasis in Spain. It analyzes and compares information about the disease from hospital discharges and from the National Epidemiological Surveillance Network. It also analyses the risk factors that facilitate transmission identified in previous studies. Since 2009 an outbreak is occurring in the southwest part of the Community of Madrid, with a significant number of cases, about 400 and the detection of a new reservoir, the hare. The conditions that can increase the incidence of leishmaniasis are linked to the increase number of infected vectors, increase sandfly density, increase hosts or the appearance of new reservoirs in a geographic area. This infection has got a complex transmission dynamic. To timely respond to outbreaks a comprehensive and multisectoral action plan should be developed joined by all the institutions involved in the preparation and response. Before an outbreak occurs, it is important to study all the factors affecting the transmission in that place and to adapt the action plan to the specific characteristics(AU)

Bases epidemiológicas para la toma de decisiones sobre medidas de salud pública (no farmacológicas) durante la respuesta a la pandemia de gripe (H1N1) 2009 / Monitoring and non pharmacologic measures during a pandemic virus (H1N1) 2009 in Spain

Las medidas de salud pública no farmacológicas se utilizan para reducir la exposición de las personas susceptibles a un agente infec-cioso. Se recomiendan al comienzo de una pandemia cuando la transmisión comienza y no se conocen las características del nuevo virus. El Plan Nacional de Preparación y Respuesta ante una Pande-mia de Gripe desarrolla la aplicación de estas medidas, recomendan-do la constitución de un Comité Asesor para su aplicación, multidis-ciplinar en su composición, con el fin de analizar el contexto epide-miológico y social en el que se desarrolla la pandemia y proponer medidas de salud pública según su evolución. En este artículo se describen las medidas de aislamiento, cuaren-tena y cierre de escuelas, que tienen el objetivo de reducir la difusión del virus en la población, y se revisan las bases teóricas que ayudan comprender el impacto de su aplicación. Las medidas de salud pública revisadas en este artículo reducen la transmisión del virus por lo que tienen que ser consideradas en la respuesta a una pandemia de gripe. El impacto sobre la salud depen-derá de la rapidez con que se tomen y del grado de aceptación y seguimiento que consigan. Los planes de respuesta deberán reco-mendar su uso en función de la gravedad ylas características del nue-vo virus pandémico. El análisis de los datos debería ser considerado como parte de la respuesta, ya que la información recogida y su análisis será la clave para asesorar a las autoridades sanitarias sobre las medidas que debe-rían adoptar(AU)

Nonpharmacological public health measures are used to reduce exposure of susceptible persons to an infectious agent. Its use is recommended at the start of a pandemic, when the transmission begins, and the characteristics of the new virus are unknown. The National Plan for Preparedness and Response to Pandemic Influenza included the application of these measures, recommending the esta-blishment of an Advisory Committee for implementation, with a multidisciplinary composition. The mandate at this Committee is to analyze the epidemiological and social context in confronting the pandemic and to propose public health measures according to their evolution. This article describes isolation, quarantine and closure of schools measures, aiming to reduce the spread of the virus in the population. It also reviews the epidemiological parameters that help to unders-tand the impact of its implementation. The public health measures reviewed in this paper reduce trans-mission of the virus, and they have to be considered in response to an influenza pandemic. The impact on health will depend on how quickly they are taken and how people accept and follow them. Res-ponse plans should recommend its use, depending on the severity and characteristics of the new pandemic virus. The data analysis should be considered as part of the response, because the information collection and analysis will be key to advi-sing health authorities on what measures should be adopted(AU)

Medidas de vigilancia y contención de la influenza aviar en aves. Implicaciones para la salud pública / Surveillance and control measures of avian influenza in birds. Implications for public health

La Influenza Aviar es una enfermedad infecciosa que afecta principalmentea las aves, producida por virus de la gripe A, en la mayoríade los casos de baja patogenicidad. Debido a la rápida mutaciónde estos virus a formas altamente patógenas, el nivel de riesgo parala sanidad animal y la salud pública puede ser alto. Desde el año2003, está teniendo lugar un brote de Influenza Aviar en aves producidopor el subtipo H5N1 de alta patogenicidad, con transmisión yafectación humana y que presenta un riesgo potencial de produciruna nueva pandemia de gripe. Ante estos brotes, es fundamental lacolaboración entre los sectores implicados de la Sanidad Animal ySalud Pública que permita localizar con precisión las zonas de actividadde la enfermedad en los animales e intensificar en ellas la vigilanciade los casos en humanos. Las medidas de control de la enfermedaden animales deben ser compatibles con la reducción del riesgode exposición humana.El objetivo de este artículo es hacer una revisión de las medidasgenerales desarrolladas contra la Influenza Aviar en aves, destacandolos aspectos de coordinación y comunicación entre las autoridadesde Sanidad Animal y Salud Pública, teniendo en cuenta que lalegislación está sujeta a una renovación rápida y constante en consonanciacon la dinámica de esta enfermedad(AU)

Avian influenza is an infectious disease that mainly affectsbirds, caused by influenza A type viruses, in most cases of lowpathogenecity. Rapid mutations of these viruses to highly pathogenicforms represent a serious risk for animal and public health. Since2003, an outbreak of highly pathogenic avian influenza in birdsis taking place with transmission and resulting illness in humansand which is believed to be able to start a human influenza pandemic.To face these outbreaks, a joint effort between the animal andpublic health sector is needed to identify areas affected by animaldisease and to intensify surveillance of human cases in them. Controlmeasures in animals must be compatible with risk reduction ofhuman exposure.The aim of this article is to review the general control measuresdeveloped against avian influenza in birds, highlighting coordinationand communication aspects between Animal Health and PublicHealth, taking into account that legislation is constantly being updatedas the dynamic of the disease changes(AU)

Coste-efectividad de la vacunación contra la varicela en adolescentes en España / Cost-effectiveness of varicella vaccination in Spanish adolescents

Introducción: La varicela es una enfermedad muy contagiosa. En España, en 1996, el 91 por ciento de la población de 13 años la había padecido. Las complicaciones son más frecuentes en adultos. El herpes zoster puede reactivarse tras la primoinfección en un 15 por ciento de los casos. Se ha autorizado en España una vacuna en mayores de 13 años con serología negativa. Objetivo: Conocer la relación coste-efectividad de vacunar a los individuos susceptibles de la cohorte de 13 años en el año 2001 y realizar una análisis de la sensibilidad de parámetros que lo condicionan. Material y método: Árbol de decisión: programa Decission Analysis by Tree-Age. Las probabilidades y costes se calcularon con Microsof Excel. Para determinar la población se aplicó el porcentaje de susceptibilidad del estudio seroepidemiológico en España al Censo del Instituto Nacional de Estadística de 2001. Las probabilidades se calcularon con el teorema de Bayes aplicando la tasa de incidencia por edad de un país del hemisferio norte. Los datos hospitalarios se obtuvieron del conjunto mínimo de datos básicos (CMBD). Se ha utilizado la efectividad de la vacuna de Estados Unidos, con una efectividad total del 71 por ciento y parcial del 24 por ciento, representada por una varicela más leve en individuos vacunados (breakthrough). Para determinar los costes, se ha efectuado una consulta directa con diferentes fuentes. Sólo se tiene en cuenta los costes directos. Se les aplica un factor de descuento del 3 por ciento. Resultados: La vacunación contra la varicela podría evitar 27.278 casos, y evitar un caso costaría 131 euros al Sistema Nacional de Salud (SNS).Discusión: Ésta es una aproximación del coste de introducir la vacuna de la varicela en el calendario español, desde la perspectiva del pagador; sin embargo, para tomar la decisión se debería tener en cuenta factores hasta el momento desconocidos, como el efecto de la vacuna en la incidencia del herpes zoster. Con los datos disponibles hasta el momento actual, la introducción de la vacuna en la adolescencia parece la estrategia más adecuada, pero se necesita de más estudios sobre el tema (AU)

Sobre el estudio del impacto de introducir una vacuna en el calendario de vacunación / Impact of a new vaccination in the vaccination agenda

No disponible

Estudio de un brote epidémico de tos ferina en Castellón / A study of a whooping cough epidemic outbreak in Castellon, Spain

Fundamento: A partir de la declaración de varios casos en un centro escolar se inicia el estudio de brote con el objetivo de caracterizar éste desde el punto de vista de persona, lugar y tiempo; se calcula la efectividad de la vacuna, y se estudia la concordancia entre los casos y el resultado positivo del estudio serológico. Métodos: Se define caso a la persona que presenta tos persistente de dos semanas de duración. Se realiza estudio de la difusión de la enfermedad a través de la curva epidémica, y de la efectividad de la dosis de refuerzo de la vacuna antipertussis. La concordancia entre los casos y la serología positiva se evalúa por el índice Kappa. Resultados: Entre los alumnos de varios centros escolares y sus convivientes se encuesta a 130 personas, de los que 94 entran en la definición de caso. La media de edad de los casos es 10,5 años, un 42,6 per cent son varones, el 84 per cent escolares, el 71,3 per cent muestra signos de infección reciente (IgM positiva), y el tiempo medio desde la última dosis de vacuna antipertussis es de 8,25 años. La efectividad de la dosis de refuerzo de la vacuna es del 66 per cent. La concordancia entre los casos y el resultado positivo de la serología muestra un Kappa igual a 0,45. No se aisló B. Pertussis en las 25 muestras de frotis faríngeo. Conclusiones: Las aulas y el medio familiar son un factor de difusión de la enfermedad. La inclusión de una dosis de refuerzo a los 18 meses mejora la efectividad de la vacuna antipertussis. El aislamiento de la B. Pertussis es poco frecuente, y la serología, puede ser una alternativa ante la sospecha clínica de la enfermedad (AU)

Carga de enfermedad de la población española menor de 15 años para el año 1999 / Burden of disease in Spanish population under 15 years old in 1999

FUNDAMENTO Y OBJETIVO: La carga de enfermedad (determinada mediante los años de vida ajustados por discapacidad, AVAD) podría definir prioridades sanitarias. El objetivo de este estudio fue determinar las enfermedades que causan mayor carga de enfermedad en la población infantojuvenil española. MATERIAL Y MÉTODO: Cálculo de los componentes de AVAD (años de vida perdidos + años vividos con discapacidad) por grupos de edad y sexo. Se emplearon como fuentes el registro de mortalidad nacional y las estimaciones de AVAD de la Organización Mundial de la Salud. RESULTADOS: La tasa total de AVAD fue de 46,57/1.000 habitantes, con una mayor proporción en los menores de 1 año de edad. La primera causa de AVAD son las enfermedades no transmisibles, seguidas de las transmisibles y perinatales, aunque en el segmento de edad entre 5 y 14 años la segunda causa la constituyen los accidentes y lesiones, con una mayor proporción de varones en estos pacientes. CONCLUSIONES: La carga de enfermedad determinada mediante AVAD es un buen indicador para definir la salud de la población (AU)