Serotype 3 is a common serotype causing invasive pneumococcal disease in children less than 5 years old, as identified by real-time PCR.

Serotype 3 is one of the most often detected pneumococcal serotypes in adults and it is associated with serious disease. In contrast, the isolation of serotype 3 by bacterial culture is unusual in children with invasive pneumococcal disease (IPD). The purpose of this study was to learn the serotype distribution of IPD, including culture-negative episodes, by using molecular methods in normal sterile samples. We studied all children<5 years of age with IPD admitted to two paediatric hospitals in Catalonia, Spain, from 2007 to 2009. A sequential real-time polymerase chain reaction (PCR) approach was added to routine methods for the detection and serotyping of pneumococcal infection. Among 257 episodes (219 pneumonia, 27 meningitis, six bacteraemia and five others), 33.5% were identified by culture and the rest, 66.5%, were detected exclusively by real-time PCR. The most common serotypes detected by culture were serotypes 1 (26.7%) and 19A (25.6%), and by real-time PCR, serotypes 1 (19.8%) and 3 (18.1%). Theoretical coverage rates by the PCV7, PCV10 and PCV13 vaccines were 10.5, 52.3 and 87.2%, respectively, for those episodes identified by culture, compared to 5.3, 31.6 and 60.2% for those identified only by real-time PCR. Multiplex real-time PCR has been shown to be useful for surveillance studies of IPD. Serotype 3 is underdiagnosed by culture and is important in paediatric IPD.

Measles antibodies and response to vaccination in children aged less than 14 months: implications for age of vaccination.

Passive immunity against measles decreases during the first months of life. The objective of this study was to determine titres of measles antibodies in children aged 9-14 months and their mothers before vaccination, and the children's response to vaccination. Blood samples were collected by capillary puncture before and 28 days after vaccination. Samples were obtained between February and June 2007 during an ongoing measles outbreak. Titres of specific measles IgG antibodies were determined by enzyme-linked immunosorbent assay. Seroconversion was defined as the presence of antibodies after vaccination in subjects without antibodies before vaccination. Maternal antibodies were present in 37·7% of all 69 children included and in 45·1% of children aged 9 months. Of the 51 children in whom a second sample was obtained, 31 (60·8%) were seronegative before vaccination and 61·3% seroconverted. Interference of maternal antibodies was 30%. Advancing the first dose of measles vaccination from 15 to 12 months is a correct strategy, given the increase in the time of susceptibility of infants to measles.

Hepatitis A outbreaks: the effect of a mass vaccination programme.

A Hepatitis A vaccination programme of people belonging to risk groups begun in Catalonia in 1995 and a universal vaccination programme of pre-adolescents 12 years of age with the hepatitis A + B vaccine was added in 1998. The aim of the study was to investigate the characteristics of hepatitis A outbreaks occurring in Catalonia between 1991 and 2007 to determine the associated risk factors and optimize the use of vaccination. Incidence rates of outbreaks, cases and hospitalizations associated with outbreaks and the rate ratios (RR) of person-to-person transmission outbreaks between the periods before and after mass vaccination and their 95% confidence intervals (CI) were calculated. A rate of 2.45 outbreaks per million persons per year was found. The rate of cases affected in these outbreaks was 1.28 per 10(5) persons per year and the rate of hospitalizations was 0.45 per million persons per year. In person-to-person outbreaks, the highest incidence rate (5.26 and 6.33 per million persons per year) of outbreaks according to the age of the index case was in the 5 to 14 year age group in both periods (RR:0.83; 95% CI:0.48-1.43). A significant increase was observed in the 25 to 44 year age group (RR: 0.35; 95% CI 0.14-0.77). Hepatitis A vaccination has made an important impact on burden and characteristics of outbreaks and could provide greater benefits to the community if the vaccine was administrated to children during their first years of life.

The influence of public or private paediatric health care on vaccination coverages in children in Catalonia (Spain).

BACKGROUND: Maintaining high vaccination coverages is necessary in order to control vaccine-preventable diseases. We studied vaccination coverages in a representative sample of 630 children aged <3 years in Catalonia in order to determine the relationship between vaccination coverages and socioeconomic factors. METHODS: Sampling was carried out in a representative sample of the health regions in Catalonia stratified according to habitat. A sample of 630 parents of children aged <3 years born in October 2001 were interviewed by telephone. Information collected included sociodemographic data, type of health care provider (public or private) and information on vaccination coverage for the basic plus booster immunization series (BBI) which consisted of: four DTP, four OPV, one MMR and the doses of Hib and MenC necessary according to age of administration of the first dose. RESULTS: A total of 87.62% of the children were vaccinated with the BBI series, and no statistically significant differences in coverage between public (87.93%) and private (88.30%) paediatric providers, or between social classes (high: 87.58%, low: 88.81%) were found. Vaccination coverage was associated with attending a day-care centre (OR: 1.89; 95% CI: 1.12-3.21) and maternal university education (OR: 1.84; 95% CI: 1.01-3.33). CONCLUSION: Vaccination coverages are high and are similar between types of provider, probably due to preventive policies which have made a concerted effort to ensure universal vaccination.

Predictors of the survival of AIDS cases in Barcelona, Spain.

Factors influencing the outcome of disease were analysed in 289 adults presenting with AIDS in Barcelona, Spain from January 1986 (31 cases) to December 1987 (258 cases). One hundred and fifty-four (53.3%) were parenteral drug addicts and 100 (34.6%) were male homosexuals. Ninety-six (33.2%) presented with tuberculosis, 148 (51.2%), with other opportunistic infections, 34 (11.7%) with Kaposi's sarcoma, and the remaining 11 with a lymphoma. By February 1988, 144 (49.8%) of the 289 had died, with an actuarial survival probability of 46.7% at 2 years (40.7%-52.7%, 95% confidence interval). The factors selected by the multivariate analysis as independently worsening the prognosis were: having been diagnosed as having AIDS before 1986, being more than 45 years old, not being a parenteral drug addict and presenting with an opportunistic infection other than a tuberculosis or with a malignancy. In conclusion, some factors influencing the prognosis for AIDS patients are very dependent upon the geographical area of the series.

Influence of treatment with zidovudine (ZDV) on the long-term survival of AIDS patients.

The influence of treatment with zidovudine (ZDV) and other factors on long-term survival of AIDS patients was analyzed in a cohort of 629 adults. A total of 434 (69%) were diagnosed before ZDV became routinely available in Spain (December 1987) or refused the drug, while the remaining 195 (31%) received ZDV (starting at a dose of 750-1,200 mg/day). A total of 412 (65.5%) were parenteral drug addicts and 217 (34.5%) male homosexuals. Two hundred thirty-two (36.9%) presented with a tuberculosis, 303 (48.2%) with other opportunistic infections, 69 (11%) with Kaposi's sarcoma, and the remaining 25 (4%) with a lymphoma. By December 1990, 251 (39.9%) of the 629 have already died with a cumulative survival probability of 50.6% after 2 years (45.3-55.9%; 95% confidence interval). When patients receiving ZDV were compared with those untreated, the estimated survival probability was significantly (p less than 0.0001) higher (89% vs. 59% after 1 year, 69% vs. 48% after 2 years, and 55% vs. 40% after 3 years). Moreover, treatment with ZDV (p less than 0.0001) together with being less than 45 years old (p less than 0.0001), being a parenteral drug addict (p = 0.016), and presenting with tuberculosis (p less than 0.0001) were the factors selected by the multivariate analysis as independently improving the prognosis. In conclusion, adult AIDS patients (homosexual or drug addicts) may benefit from treatment with ZDV, at least during 3 years.

[Lipomatous hypertrophy of the interatrial septum. Report of 2 cases diagnosed in vivo]. / Hipertrofia lipomatosa del tubérculo intervenoso. A propósito de dos casos diagnosticados en vivo.

Lipomatous hypertrophy of intervenous tubercle is a clinicopathological entity characterized by an accumulation of not capsulated fatty tissue, with its thickness exceeding 15 mm, in the atrial septum, above the fossa ovalis, at the intervenous level and protruding into the right atrium. It can be clinically associated with atrial electric abnormalities such as disorders of the atrial conduction and supraventricular arrhythmias, difficulty of the venous return and sudden death. Nowadays its diagnosis is not difficult using non invasive image techniques. We present two cases of lipomatous hypertrophy of intervenous tubercle which were suspected by echocardiography. In one of them we used transthoracic echocardiography and in the other one transesophageal echocardiography. The diagnostic was latter confirmed by magnetic nuclear resonance and axial computerized tomography.

[Isolated congenital diverticulum of the left ventricle]. / Divertículo congénito aislado del ventrículo izquierdo.

Congenital diverticulum of the left ventricle is an uncommon cardiac malformation. We present a 45 years old woman, previously asymptomatic. The symptoms and electrocardiogramas suggested ischemic heart disease. The left ventriculogram demonstrated an isolated apical diverticulum, although the coronary arteries were normal. We will consider the etiopathogeny, classification, clinical history, diagnosis and treatment of the isolated apical diverticulum.

[A community outbreak of Legionnaires' disease in Barcelona: epidemiologic and environmental study]. / Brote comunitario de enfermedad de los legionarios en Barcelona: investigación epidemiológica y medioambiental.

The investigation of the outbreak of legionellosis which developed in Barcelona in February 1988 included: 1) a case-control study, with the patients with Legionella pneumophila pneumonia (n = 56) and those with pneumonia by other organisms (n = 109) in the Hospital Clínic i Provincial (HCP); 2) a review of refrigeration towers and the water supply system; 3) a meteorological study, and 4) a survey of the construction works being carried out in the HCP area. The cases lived in the urban district 2 more often than the controls (odds ratio = 3.73, 95% confidence intervals 1.8-7.6), and were not associated with hospitals of hotels. L. pneumophila was not recovered from the environmental samples. The temperatures were unusually high, with a low air humidity. In the area near the HCP demolition materials were frequently removed. A causative focus was not detected; it cannot be ruled out, however, that the source of the outbreak was the removal of demolition materials in the affected area on the days preceding the epidemic outbreak.

[Comparative study of human cutaneous sensitivity to 2 and 5 international units of the PPD RT 23 tuberculin with Tween 80]. / Estudio comparativo de la sensibilidad cutánea humana a 2 y 5 unidades internacionales de la tuberculina PPD RT 23 con Tween 80.

BACKGROUND: The aim of this study was to know whether the human reaction to the Mantoux test with 5 UT of PPD RT 23 is similar to that achieved with the same test but with 2 UT of the same substance. METHODS: A simultaneous double Mantoux test was used at doses of 2 UT and another of 5 UT of the same trade mark of tuberculin PPD RT 23 with Tween 80 in 2,575 individuals. The subjects were distributed into two different groups of different ages, taking into consideration the possible presence of BCG vaccination. RESULTS: The doses of 5 UT produced a greater number of tuberculin positive individuals and a greater diameter of induration of reaction than that of the doses of 2 UT in both groups and with significant statistical differences. One hundred ninety-six (7%) subjects were tuberculin positive with 5 UT and negative with 2 UT. CONCLUSIONS: The reactions produced by the Mantoux test with 5 and 5 UT PPD RT were different since the two doses are not bioequivalent.

[Congenital diverticulum of the left ventricle (author's transl)]. / Divertículo congénito de ventrículo izquierdo.

A case of congenital diverticulum of the left ventricle associated with probable mitral and tricuspid prolapses is presented. The authors comment on the absence of symptomatology in patients affected with this disease and point out the electrocardiographic, radiologic, and phonomechanocardiographic data. The importance of the left ventriculography in the diagnosis and classification of this disease stands out, as does the value of echocardiography (mode-M) in the diagnosis of mitral and tricuspid valvular prolapses which were associated in the present case. The classifications given by various authors in connection with this anomaly are reviewed and lastly the appropriate therapeutic approach is discussed. There is a surgical possibility for young asymptomatic patients, taking into account the little experience we have at present on the natural history of this disease.

[Changes in seroepidemiology of hepatitis A virus infection in Catalonia in the period 1989-1996. Implications for new vaccination strategy]. / Cambios en la seroepidemiología de la infección por el virus de la hepatitis A en Cataluña en el período 1989-1996. Implicaciones para una nueva estrategia vacunal.

BACKGROUND: The aim of this study was to investigate the prevalence of the risk factors of hepatitis A virus infection (HAV) in a representative sample of a Catalonian population obtained from 1995 to 1996 and the changes in the prevalence of this infection over the period of 1989-1996. SUBJECTS AND METHODS: The prevalence of anti-HAV was determined by an ELISA test in a randomized sample of 2,142 individuals, 884 from 6 to 14 years of age and 1,248 over the age of 15 years. The results were related to sociodemographic variables and multiple logistic regression analysis was performed to establish which variables were related to the risk of infection. RESULTS: The global prevalence of HAV infection was 67.8%. The prevalence of HAV infection increased from 3.5% in the group from 5-14 years of age to 99% in that over the age of 64 years (p < 0.001). A higher prevalence was observed in those born outside of Catalonia (odds ratio [OR] = 3.97; 95% CI, 2.4-6.4) and in those with a lower level of education (OR = 2.60; 95% CI, 1.9-3.5). In the period 1989-1996 the prevalence of the infection has decreased in the population under the age of 45, the differences being statistically significant in the age groups 10-14 (p < 0.0001) and 25-34 (p < 0.0001). CONCLUSIONS: The prevalence of HAV infection has progressively decreased in Catalonia while it proportionally increases the susceptible population under the age of 45 years. These findings may be important in the design of strategies for the prevention of HAV infection with universal vaccination programs against this disease.

[Prevention of serogroup B meningococcal disease using a four-component vaccine]. / Prevención de la enfermedad meningocócica por el serogrupo B mediante una vacuna de 4 componentes.

INTRODUCTION: Meningococcal disease is an infection caused by Neisseria meningitidis, and those of serogroup B are currently the most predominant. It has been difficult to create effective vaccines for this serogroup in order to modify or reduce its morbidity. The aim of this study was to review existing data on the new vaccine 4CMenB and its potential contribution to the prevention of this infection. METHODS: A panel of 12 experts (from Pediatrics, Public Health and Vaccinology) conducted a literature search and prioritized 74 publications. A review of the vaccine was then prepared, which was discussed in a meeting and subsequently validated by e-mail. RESULTS: 4CMenB vaccine, based on four components (NadA, fHbp, NHBA and OMVnz), was designed by reverse vaccinology. The Meningococcal Antigen Typing System (MATS) shows a potential of 70-80% coverage of the strains in Europe. Clinical trials show that the vaccine is safe and immunogenic in infants, children, adolescents, and adults, and induces an anamnestic response. The incidence of fever is similar to systemic vaccines administered alone, but higher when co-administered with them, although the fever pattern is predictable and self-limited. It is compatible with the Spanish routine vaccines, and can be administered simultaneously with the currently available hexavalent and pentavalent vaccines, as well as the pneumococcal conjugate vaccine. CONCLUSIONS: The 4CMenB vaccine is the only strategy currently available to prevent meningococcal disease caused by serogroup B.