[Brote de la COVID-19 en una residencia en ancianos correctamente vacunados. Influencia de la inmunidad híbrida en la carga viral, el riesgo de infección y el riesgo de progresión de la enfermedad]. / COVID-19 outbreak in a properly vaccinated nursing home. Influence of hybrid immunity on viral load, risk of infection and risk of disease progression.

OBJECTIVE: This study addressed a COVID-19 outbreak in a nursing home, where the residents were vaccinated with two doses of Comirnaty® and thirty of them had previously had the infection. Outbreaks in closed communities are opportunities to study the entire clinical spectrum of the disease and, as in this case, the effect of hybrid immunity on transmission, infection progression and viral load. METHODS: A descriptive and retrospective cohort study in the resident population was carried out. Attack rates were calculated for one of four stages of the disease: infection, symptomatic infection, hospitalization, and death. Relative risks (RR) were then estimated using simple and multivariate Poisson regression for each of these stages. RESULTS: The attack rate was 59% (56/95). The clinical spectrum was the same in both sexes. There was a notable protective effect of hybrid immunity against transmission (67%). In terms of progression, those with hybrid immunity had a lower risk of symptomatic infection. Nasopharyngeal viral load was significantly lower in individuals with hybrid immunity and asymptomatic individuals, supporting the idea of lower transmissibility in this group. Age was identified as a risk factor for disease progression. Molecular analysis identified the Delta B.1.617.2 variant in the patients and an air sample, supporting aerosol transmission in closed, poorly ventilated environments. CONCLUSIONS: This study provides a comprehensive view of an outbreak in a vaccinated nursing home, highlighting the importance of hybrid immunity. The results support the individual consideration of previous infection history when assessing the risk of COVID-19, contributing to the understanding of the evolution of the pandemic in the future.

OBJECTIVE: Este estudio abordó un brote de la COVID-19 en una residencia de ancianos, donde los residentes estaban vacunados con dos dosis de Comirnaty® y treinta de ellos habían pasado anteriormente la infección. Los brotes en colectivos cerrados son oportunidades para estudiar todo el espectro clínico de la enfermedad y, como en este caso, el efecto de la inmunidad híbrida sobre la transmisión, la progresión de la infección y la carga viral. METHODS: Se realizó un estudio descriptivo y de cohortes retrospectivo en la población de residentes. Se calcularon las tasas de ataque para uno de cuatro estadios de la enfermedad: infección, infección sintomática, hospitalización y defunción. Después se estimaron los riesgos relativos (RR) mediante regresión de Poisson simple y multivariante para cada uno de esos estadios. RESULTS: La tasa de ataque fue del 59% (56/95). El espectro clínico fue igual en ambos sexos. Hubo un notable efecto protector de la inmunidad híbrida contra la transmisión (67%). En términos de progresión, aquellos con inmunidad híbrida presentaron un riesgo menor de infección sintomática. La carga viral nasofaríngea fue significativamente menor en individuos con inmunidad híbrida y asintomáticos, respaldando la idea de una menor transmisibilidad en este grupo. La edad se identificó como un factor de riesgo para la progresión de la enfermedad. El análisis molecular identificó la variante Delta B.1.617.2 en los pacientes y una muestra de aire, lo que respaldó la transmisión por aerosol en entornos cerrados y mal ventilados. CONCLUSIONS: Este estudio proporciona una visión integral de un brote en una residencia de ancianos vacunados, destacando la importancia de la inmunidad híbrida. Los resultados respaldan la consideración individual de la historia de infección previa al evaluar el riesgo de la COVID-19, contribuyendo a la comprensión de la evolución de la pandemia en el futuro.

[Impact of the pandemic on various infectious diseases with different epidemiological patterns of seasonality, transmission and age]. / Impacto de la pandemia en varias enfermedades infecciosas con patrones epidemiológicos distintos de estacionalidad, transmisión y edad.

OBJECTIVE: The COVID-19 pandemic has had a strong impact on other infectious diseases. The aim of this paper was to analyze the epidemiological changes that occurred during the pandemic in eight infectious diseases with different epidemiological patterns: influenza, respiratory syncytial virus, rotavirus, pneumococcus, Campylobacter, non-typhoid Salmonella, gonorrhea and herpes zoster. METHODS: From the Microbiological Surveillance Network, the time series of cases was traced from January 2017 to March 2023. Three periods were distinguished: reference, pandemic and beginning of the post-pandemic. The distribution by age and sex in these periods was analyzed. Incidence rates and rate ratios (RR) were calculated. These RRs and their 95% confidence intervals were estimated overall and by year of age in children under five years of age. RESULTS: Statistically significant differences were found in the impact that the pandemic had on each of these diseases. Some, after a period of epidemic silence, have revealed an intense post-pandemic rebound. The post-pandemic global RT increased for influenza (2.4), RSV (1.9) and gonorrhea (3.1); rotavirus recovered its pre-pandemic level (1.07); and pneumococcus (0.84), Campylobacter (0.83) and Salmonella (0.60) decreased. In children under 5 years of age, the patterns were specific and heterogeneous for each disease. CONCLUSIONS: The impact of the pandemic is very different in these diseases. Pediatric and respiratory-transmitted seasonal viral infections are the ones that are most affected, but with different patterns of recovery to normality. Gastrointestinal bacterial infections suffer fewer variations, except for rotavirus. Gonorrhea do not interrupt its increasing trend seen in the pre-pandemic. Shingles show a slight post-pandemic increase. Several diseases with different epidemiological patterns have been studied for a sufficient period to observe how the acute phase of the pandemic emerges.

OBJECTIVE: La pandemia de la COVID-19 ha tenido un fuerte impacto sobre otras enfermedades infecciosas. El objetivo de este trabajo fue analizar los cambios epidemiológicos acaecidos durante la pandemia en ocho enfermedades infecciosas con patrones epidemiológicos distintos: la gripe; virus respiratorio sincitial; rotavirus; neumococo; Campylobacter; Salmonella no tifoidea; gonococia; herpes zóster. METHODS: A partir de la Red de Vigilancia Microbiológica, se trazó la serie temporal de casos desde enero de 2017 a marzo de 2023. Se distinguieron tres periodos: prepandemia (referencia), pandemia e inicio de la pospandemia. Se analizó la distribución por edad y sexo en esos periodos. Se calcularon las tasas de incidencia y las razones de tasas (RT). Se estimaron esas RT globales y sus intervalos de confianza al 95% por cada año de edad en menores de cinco años. RESULTS: Se encontraron diferencias estadísticamente significativas en el impacto que la pandemia tuvo en cada una de esas enfermedades. Algunas, tras un periodo de silencio epidémico, revelaron un repunte intenso pospandémico. Incrementaron la RT global postpandémica la gripe (2,4), VRS (1,9) y gonococia (3,1); recuperó su nivel prepandémico el rotavirus (1,07); y disminuyeron el neumococo (0,84), Campylobacter (0,83) y Salmonella (0,60). En menores de cinco años, los patrones fueron específicos y heterogéneos para cada enfermedad. CONCLUSIONS: El impacto de la pandemia es muy diferente en estas enfermedades. Las infecciones víricas estacionales pediátricas y de transmisión respiratoria son las que más se ven afectadas, pero con patrones de recuperación de la normalidad distintos. Las infecciones bacterianas gastrointestinales sufren menos variaciones, salvo el rotavirus. La gonococia no interrumpe su tendencia al aumento avistada ya en la prepandemia. El herpes zóster muestra un ligero incremento pospandémico. Se han estudiado varias enfermedades con distinto patrón epidemiológico durante un periodo suficiente para observar cómo se produce la salida de la fase aguda de la pandemia.

SARS-CoV-2 Delta-variant breakthrough infections in nursing home residents at midterm after Comirnaty® COVID-19 vaccination.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant breakthrough infections in nursing home residents following vaccination with Comirnaty® COVID-19 vaccine were characterized. In total, 201 participants (median age, 87 years; range, 64-100; 133 female) from two nursing homes in the Valencian community (Spain) were included. SARS-CoV-2-Spike (S) antibody responses were determined by a lateral flow immunocromatography (LFIC) assay and by quantitative electrochemiluminescent assay in LFIC-negative participants. SARS-CoV-2-S-IFNγ T cells were enumerated by flow cytometry in 10 participants. Nasopharyngeal SARS-CoV-2 RNA loads were quantified by real-time polymerase chain reaction assays. Vaccine breakthrough COVID-19 due to the Delta variant occurred in 39 residents (median age, 87 years; range, 69-96; 31 female) at a median of 6.5 months after vaccination (nine requiring hospitalization). Breakthrough infections occurred at a higher rate (p < 0.0001) in residents who had not been previously infected with SARS-CoV-2 (naïve) (33/108; 18%) than in those with prior diagnosis of SARS-CoV-2 infection (experienced) (6/93; 6.4%), and were more likely (p < 0.0001) to develop in residents who tested negative by LFIC (20/49) at 3 months after vaccination as compared to their LFIC-positive counterparts (19/142). Among LFIC-negative residents, a trend towards lower plasma anti-RBD antibody levels was noticed in those developing breakthrough infection (p = 0.16). SARS-CoV-2 RNA loads in nasopharyngeal specimens were lower in SARS-CoV-2-experienced residents (p < 0.001) and in those testing positive by LFIC (p = 0.13). The frequency of SARS-CoV-2-S-reactive T cells at 3 months was similar in LFIC-negative residents with (n = 7) or without (n = 3) breakthrough infection. Prior history of SARS-CoV-2 infection and detection of S-reactive antibodies by LFIC at 3 months is associated with a lower risk of Delta-variant breakthrough infection in nursing home residents at midterm after Comirnaty® COVID-19 vaccination.

An outbreak of monophasic and biphasic Salmonella Typhimurium, and Salmonella Derby associated with the consumption of dried pork sausage in Castellon (Spain).

An outbreak of S.Typhimurium occurred in several towns and cities in the province of Castellon (Spain) between 23 February and 27 May 2011. On April 5, the microbiology laboratory of a hospital in Castellon alerted the health authorities to the increase in S.Typhimurium isolated in fecal culture of children with gastroenteritis. The serotype and phage-type of 83 positive cases of S.Typhimurium isolated in these period included 49 monophasic/biphasic S.Typhimurium phage type 138, phage type 193, S.Derby, and 34 other S.Typhimurium phage-types. The median of age of patients was 4 years with a range of 0.6-80 years, and the 18% of patients were hospitalised. Two incident matched case-control studies were carried out; the first with S.Typhimurium phage type 138, 193, and S.Derby cases and the second with the other cases. The two studies found that the consumption of brand X dried pork sausage, purchased in a supermarket chain A, was associated with the disease (matched Odds Ratio [mOR]=13.74 95% Confidence Interval [CI] 4.84-39.06 and mOR=8.20 95% CI 2.32-28.89), respectively). S.Typhimurium phage type 193 and S.Derby were isolated in the food taken from the household of two patients and from the supermarket chain's A central warehouse. The pulsed-field gel electrophoresis study confirmed the similarity of the strains from the patients and the food. On May 25 2011, a national food alert led to the withdrawal of the food from the chain A and the outbreak ended.

Outbreak of multidrug-resistant tuberculosis in two secondary schools.

OBJECTIVES: To describe an outbreak of multidrug-resistant tuberculosis (MDR-TB) in two schools METHODS: This was a prospective, observational study of an outbreak of MDR-TB in 2 schools located in the towns of Onda and Nules, in the Spanish province of Castellon, from the moment of detection in November 2008 until November 2014, including patient follow-up and contact tracing. RESULTS: Five cases of MDR-TB were diagnosed. Overall attack rate was 0.9%, and among the contacts traced, 66 had latent tuberculous infection, with an infection rate of 14.4%. Molecular characterization of the 5M. tuberculosis isolates was performed by restriction fragment length polymorphism (RFLP) analysis of the IS6110 sequence. In all 5 patients, cultures were negative at 4-month follow-up, showing the efficacy of the treatment given. No recurrence has been reported to date. CONCLUSIONS: In the context of globalization and the increased prevalence of MDR-TB, outbreaks such as the one presented here are only to be expected. Contact tracing, strict follow-up of confirmed cases, the availability of fast diagnostic techniques to avoid treatment delay, and chemoprophylaxis, together with the molecular characterization of strains, are still essential.

An estimate of the incidence of influenza-like illness during the influenza pandemic of 2009.

INTRODUCTION: The influenza pandemic of 2009 had a great social impact. Many health resources were devoted to the care, prevention and surveillance of this disease. Epidemiological surveillance is based on the reporting of cases of influenza-like illness (ILI) and confirmed influenza cases. The objective was to estimate the true incidence of ILI during the influenza pandemic of 2009. METHODS: The capture-recapture method was applied during the month of highest influenza incidence in Castellón. Two notification systems were used: (i)electronic reporting of Notifiable Diseases (ND), and (ii)laboratory-based (LAB) data collection. Estimates were made by stratifying by age group and week. Independence coefficients were calculated for those strata. RESULTS: No dependence was found between stratification variables and the reporting system. A total of 7,181 ND cases and 524 LAB cases were identified, of which 211 were recorded in both systems. The estimated total of cases was 17,785 in a single month. In the study period, almost 4% of people in the area suffered flu symptoms (cumulative incidence), with 1% being affected each day (daily prevalence). The sensitivity of the ND system was 40%, i.e., the percentage of patients seeking primary care. CONCLUSIONS: To obtain an estimate of the actual incidence of influenza-like illness in the population during a pandemic period, the number of medical consultations should be multiplied by a factor of 2.5. This factor is lower than that estimated for periods without pandemic alert.

Rotavirus vaccination effectiveness: a case-case study in the EDICS project, Castellón (Spain).

In Spain, in 2006, two oral live-attenuated vaccines against rotavirus disease were licensed for infants up to 6 months. Recent data suggest that vaccine efficacy may vary by region. This makes the real-life postmarketing monitoring of rotavirus vaccination effectiveness an important aspect of rotavirus epidemiologic surveillance. We carried out a case-case study to assess the rotavirus vaccination effectiveness in children from 2 to 35 months of age during the year 2009 in Castellón. As a second- and counterfactual objective to evaluate the possible selection bias and the specificity of the association, we evaluated the "effectiveness" of pneumococcal vaccination against rotavirus diarrhea. Cases were 71 children with confirmed rotavirus gastroenteritis, and controls were 261 children with positive results to any other organism that was not rotavirus. The immunization status of each child, the number of doses and dates of vaccination were assessed by consulting the Regional Immunization Registry. The lowest proportion of vaccinated cases was observed among rotavirus diarrhea (2.8%). The proportion of vaccinated children among the control group was 21.8%. The effectiveness of vaccination with at least one dose of vaccine against rotavirus was 87.7% (45.5-99.7%). If we restrict the analysis to non-hospitalized children, this figure was slightly lower, 83.5% (25.4-96.3%). As expected, pneumococcal vaccination was not protective against rotavirus infection showing the specificity of the association found. The immunization information systems in combination with population-based studies of the incidence of infectious gastroenteritis, such as EDICS offer appropriate conditions for postmarketing monitoring of vaccine effectiveness.

[Outbreaks of acute viral gastroenteritis in geriatric homes: threshold detection system for prevalence (SiDUP)]. / Brotes de gastroenteritis aguda vírica en residencias de ancianos: Sistema de detección por umbral de prevalencia (SiDUP).

We describe the interventions carried out in a local epidemiology unit related to the epidemiology of gastroenteritis due to norovirus in geriatric homes in Castellón (Spain) during several years. These range from various outbreaks in the same geriatric home to the study of sporadic cases which determine the endemic situation. This study focuses on the analysis of this endemic situation of digestive symptoms in silent epidemic periods and proposes a simple method to detect the initiation of GEA of progressive transmission (person-person) which we call System of Detection by Prevalence Threshold (SiDUP). The epidemiological spectrum of gastroenteritis due to norovirus in geriatric homes is discussed.

[Risk factors for symptoms of allergic rhinitis in adolescents in Castellón, Spain]. / Factores de riesgo de síntomas de rinitis alérgica en adolescentes de Castellón, España.

OBJECTIVE: To estimate the risk factor for symptoms of allergic rhinitis in adolescents in Castellón, Spain. METHODS: A cross-sectional population based study of Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC) conducted in 2002 among adolescents from 13-14 years of age. The ISAAC questionnaire was used to define cases of allergic rhinitis. Logistic regression models were used to estimate odds ratio (OR) and their 95% confidence intervals (95%CI). RESULTS: Participation was 66.8% (3,995 adolescents of the 5,981 total). The prevalence of rhinoconjunctivitis symptoms in the last 12 months was 16.5% and the prevalence of nasal allergy at some point was 7.4%. Logistic regression showed that rhinoconjunctivitis was associated with being female (OR = 1.63; 95%CI: 1.33-2.00); a mother who smokes in the home (OR = 1.32; 95%CI: 1.08-1.63); a history of sinusitis (OR = 2.02; 95%CI: 1.51-2.70); and living on a street with heavy truck traffic (OR = 1.58; 95%CI: 1.02-2.44). Likewise, nasal allergy was associated with a family history of allergic rhinitis (OR = 2.62; 95%CI: 1.90-3.63); a history of sinusitis (OR = 2.65; 95% CI: 1.77-3.96); a history of bronchitis (OR = 1.68; 95%CI: 1.19-2.36); and social class, with a steady decline when comparing higher classes to lower classes. CONCLUSIONS: Various environmental risk factors were associated with the symptoms of nasal allergies, which points to the importance of implementing specific preventive measures.

Factores de riesgo de síntomas de rinitis alérgica en adolescentes de Castellón, España / Risk factors for symptoms of allergic rhinitis in adolescents in Castellón, Spain

OBJETIVOS: Estimar factores de riesgo de síntomas de rinitis alérgica en adolescentes de Castellón, España. MÉTODOS: Estudio transversal de base poblacional a partir de la fase III del ISAAC (International Study of Asthma and Allergies in Childhood) llevado a cabo en 2002 entre adolescentes de 13 a 14 años. Se utilizó el cuestionario ISAAC para definir los casos de rinitis alérgica. Se estimaron razones de posibilidades (RP) y sus intervalos de confianza de 95 por ciento (IC95 por ciento) mediante modelos de regresión logística. RESULTADOS: La participación fue de 66,8 por ciento (3 995 adolescentes de un total de 5 981). La prevalencia de síntomas de rinoconjuntivitis en los últimos 12 meses fue de 16,5 por ciento, y la prevalencia de alergia nasal alguna vez, de 7,4 por ciento. Con la regresión logística, la rinoconjuntivitis se asoció a la mujer (RP=1,63; IC95 por ciento:1,33-2,00); fumar la madre en casa (RP=1,32; IC95 por ciento:1,08-1,63); historia de sinusitis (RP=2,02; IC95 por ciento:1,51-2,70), y circulación constante de camiones por la calle de residencia (RP=1,58; IC95 por ciento:1,02-2,44). De igual manera, la alergia nasal se asoció con la historia familiar de rinitis alérgica (RP=2,62; IC95 por ciento:1,90-3,63); historia de sinusitis (RP=2,65; IC95 por ciento:1,77-3,96), historia de bronquitis (RP=1,68; IC95 por ciento:1,19-2,36), y clase social, con descensos progresivos al comparar las clases superiores e inferiores. CONCLUSIONES: Diferentes factores de riesgo medioambientales se asociaron con el hecho de sufrir síntomas de alergia nasal; se sugiere la importancia de adecuar medidas preventivas específicas.

OBJECTIVES: To estimate the risk factor for symptoms of allergic rhinitis in adolescents in Castellón, Spain. METHODS: A cross-sectional population based study of Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC) conducted in 2002 among adolescents from 13-14 years of age. The ISAAC questionnaire was used to define cases of allergic rhinitis. Logistic regression models were used to estimate odds ratio (OR) and their 95 percent confidence intervals (95 percentCI). RESULTS: Participation was 66.8 percent (3 995 adolescents of the 5 981 total). The prevalence of rhinoconjunctivitis symptoms in the last 12 months was 16.5 percent and the prevalence of nasal allergy at some point was 7.4 percent. Logistic regression showed that rhinoconjunctivitis was associated with being female (OR = 1.63; 95 percentCI: 1.33-2.00); a mother who smokes in the home (OR = 1.32; 95 percentCI: 1.08-1.63); a history of sinusitis (OR = 2.02; 95 percentCI: 1.51-2.70); and living on a street with heavy truck traffic (OR = 1.58; 95 percentCI: 1.02-2.44). Likewise, nasal allergy was associated with a family history of allergic rhinitis (OR = 2.62; 95 percentCI: 1.90-3.63); a history of sinusitis (OR = 2.65; 95 percent CI: 1.77-3.96); a history of bronchitis (OR = 1.68; 95 percentCI: 1.19-2.36); and social class, with a steady decline when comparing higher classes to lower classes. CONCLUSIONS: Various environmental risk factors were associated with the symptoms of nasal allergies, which points to the importance of implementing specific preventive measures.

[Aggregation of cases of legionella pneumonia in workers related to the ceramic industry in Castellon, Spain, 2006]. / Agregación de casos de neumonía por Legionella en trabajadores relacionados con la industria de la cerámica en Castellón en 2006.

BACKGROUND: Cases of legionellosis sometimes arise in the form of aggregations which are difficult to interpret. This study provides an analysis of these groupings having arisen one summer in Castellon. METHODS: Microbiological, clinical and epidemiological field methods were employed. RESULTS: Within a few days, there were five (5) cases of legionella pneumonia in workers related to various ceramic industries within an area where a large number of these plants are located. Two constituted a minor outbreak. By means of molecular biology techniques performed on the strains, the common origins of three of the cases were ruled out. CONCLUSIONS: It is debated whether this episode of an outbreak having arisen within the context of a broader-ranging cluster of cases of a multi-focal origin was a chance event or whether it was the manifestation of a risk related to this industrial activity which might repeat itself.

[Infectious diarrhea study in Castellón, Spain (EDICS): population incidence of sporadic cases in 2004 and comparison with the year 2000]. / Estudio de la diarrea infecciosa en Castellón (EDICS): incidencia poblacional de casos esporádicos en 2004 y comparación con el año 2000.

BACKGROUND AND OBJECTIVE: Infectious intestinal diseases are highly prevalent, and among them sporadic cases are the most common processes. The aim of this study was to estimate the incidence of sporadic cases diagnosed in a healthcare district of Castellón (Spain) in the year 2004, and to compare them with those of the year 2000. MATERIAL AND METHOD: Based on routine coprocultures and individual demographic data of each patient, we calculated the population rates by age for the more frequent microorganisms, especially detailed for children up to 5 years of age. We report the results of the year 2004, and compare these with the previous study of the year 2000. RESULTS: Campylobacter showed the highest rate (1.01 x 103), followed by Salmonella (0.75), each without significant differences regarding the year 2000. The rate of rotavirus cases (0.65) was smaller than in 2000; and for adenovirus 2004 was an atypical seasonal year. In children younger than 3 years, rates were 26.54; 10.23 and 11.75. As in the previous study, the age-distribution in children < 5 years was very particular. An U inverted shape was seen for Campylobacer, and the rates for rotavirus decreased after the peak observed in the youngest group (< 6 months). Among hospitalized patients rotavirus was the most common and Campylobacter the less common. CONCLUSIONS: The epidemiological traits of the rates by age until the age of five are characteristic for each microorganism, as are the proportions of hospitalization. Rates of Campylobacter and Salmonella in the year 2004 were similar to the year 2000, but a decrease in the rotavirus rates was observed.

[Incidence of reactive arthritis and other musculoskeletal sequelae following a foodborne outbreak of Salmonella enteritidis phago type 14 b infection]. / Incidencia de artritis reactiva y síntomas osteoarticulares después de un brote de Salmonella enteritidis fagotipo 14 b.

BACKGROUND AND OBJECTIVE: We intended to estimate the prevalence of reactive arthritis (ReA) and other musculoskeletal sequelae after a foodborne outbreak of Salmonella enteritidis phago type 14 b in a banquet in Castellón in June 5th, 2004. PATIENTS AND METHOD: A prospective cohort study was carried out with 125 subjects (90.6%) out of the banquet participants. Sixty-two symptomatic infected cases occurred, 33 with positive cultures of S. enteritidis phago type 14 b, and 54 non-infected subjects. After 4 months of the outbreak, all 125 subjects were studied by means of a symptoms questionnaire of ReA based on Buxton et al, administered by telephone. Medical examination of subjects with musculoskeletal symptoms, 29 of 30, was done by a rheumatologist. Relative risk (RR) with 95% confidence interval (CI) was estimated by Poisson regression models. RESULTS: Any symptoms were reported by 32 (52%) of infected cases versus 13 (24%) of non-infected (RR adjusted = 2.49; 95% CI, 1.26-4.95); 20 (32%) infected cases reported muskuloskeletal symptoms compared to 4 (7%) non-infected (RR adjusted = 4.96; 95% CI, 1.64-15.04). The medical examination of the subjects with musculoskeletal symptoms revealed 3 infected cases with ReA (4.8%; 3/62). In addition, several reactive musculoskeletal sequelae associated with salmonellosis infection were found in 4 subjects (1 neck pain, 1 polyarthralgias, and 2 enthesopathy). CONCLUSIONS: The occurrence of ReA was lower than other studies but the incidence of musculoskeletal symptoms was increased. The infection by Salmonella supposes a risk for joint symptoms that could be important taking into account the high incidence of salmonellosis.

The protective effect of alcoholic beverages on the occurrence of a Salmonella food-borne outbreak.

BACKGROUND: There are few studies about the effect of alcoholic beverages in food-borne disease outbreaks. METHODS: We studied this effect during an outbreak of Salmonella ohio infection that occurred in Castellón (Spain) in May 2000. S. ohio was isolated in stools of patients and also in implicated foods. RESULTS: Analysis was restricted to the group that was exposed to contaminated food (51 persons). We compared attack rates by level of alcohol intake (none, 1-40 gm, and >40 gm). The adjusted relative risks in the two alcohol categories were 0.73 [95% confidence interval (CI) = 0.46-1.15] and 0.54 (95% CI = 0.31-0.96), respectively. CONCLUSIONS: We discuss the possible protective effect of alcoholic beverages in some food-borne infectious outbreaks.