Incidence, Hospitalization, Mortality and Risk Factors of COVID-19 in Long-Term Care Residential Homes for Patients with Chronic Mental Illness.

Long-term care residential homes (LTCRH) for patients with chronic mental illness have suffered the enormous impact of COVID-19. This study aimed to estimate incidence, hospitalization, mortality, and risk factors of COVID-19 to prevent future epidemics. From March 2020 to January 2021 and before vaccination anti-SARS-CoV-2 begins, cumulate incidence rate (CIR), hospitalization rate (HR), mortality rate (MR), and risk factors of COVID-19 in the 11 LTCRH of two Health Departments of Castellon (Spain) were studied by epidemiological surveillance and an ecological design. Laboratory tests confirmed COVID-19 cases, and multilevel Poisson regression models were employed. All LTCRH participated and comprised 346 residents and 482 staff. Residents had a mean age of 47 years, 40% women, and suffered 75 cases of COVID-19 (CIR = 21.7%), five hospitalizations (HR = 1.4%), and two deaths (MR = 0.6%) with 2.5% fatality-case. Staff suffered 74 cases of the disease (CIR = 15.4%), one hospitalization (HR = 0.2%), and no deaths were reported. Risk factors associated with COVID-19 incidence in residents were private ownership, severe disability, residents be younger, CIR in municipalities where LTCRH was located, CIR in staff, and older age of the facilities. Conclusion: COVID-19 incidence could be prevented by improving infection control in residents and staff and modernizing facilities with increased public ownership.

Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes.

During the period from March 2020 to January 2021, we performed an analysis of incidence, mortality, and risk factors of COVID-19 in nursing homes (NHs) in two health departments (HDs) of Castellon (Spain) 2021 through epidemiological surveillance and an ecological design. Laboratory-confirmed COVID-19 cases, cumulative incidence rate (CIR), and mortality rate (MR) of 27 NHs were collected. Information of residents, staff, and facilities was obtained by questionnaire. Multilevel Poisson regression models were applied. All NHs in the HDs participated with 2229 residents (median: 83 years old, 67.3% women) and 1666 staff. Among residents, 815 cases (CIR: 34.8 per 100) and 202 deaths (MR: 8.7 per 100, case fatality 21.0%) were reported and, among staff, 296 cases (CIR: 19.2 per 100) without deaths. Residents' CIR and MR increased with staff CIR, age of the building, residents/staff ratios, occupancy rate, and crowding index; CIR increased with private NH ownership, large NH size, large urban area, and the percentage of women residents; and MR was associated with residents' severe disabilities. In conclusion, several risk factors of COVID-19 incidence and mortality can be prevented by improving infection and quality controls, ameliorating residents/staff ratios, improving structural facilities, and increasing NH public ownership to avoid new outbreaks.

[Post-vaccination antibodies against SARS-CoV-2 in a cohort of workers of a general hospital]. / Anticuerpos postvacunales frente a SARS-CoV-2 en una cohorte de trabajadores de un hospital general.

INTRODUCTION: The aim was to estimate the evolution of the levels of anti-SARS-CoV-2 antibodies, the associated factors, and the incidence of new infections during the follow-up period.  Method: Prospective cohort study of a representative sample of workers at the General University Hospital of Castellon 8 months after receiving the second dose of Pfizer-BioNTech vaccine against SARS-CoV-2, by determining IgG-S, IgG-NP, follow-up and response to a questionnaire. The results were compared with those at the start of the cohort in February 2021. Multivariate linear regression and Poisson regression were used.  Results: A total of 253 workers participated out of the 275 in the start of the cohort. All had detectable levels of IgG-S, median 691% AU/ml, decreasing by 93.3% compared with the first study. The decline of IgG-S increased with age and obesity; and decreased with a COVID-19 previous history, regular exercise, and in smokers. IgG-NP was positively associated with a history of COVID-19, taking vitamin D, and decreased from 4.4% to 1.2%. There were 4 new cases of COVID-19 in the cohort, with and incidence rate of 1.7%. One death occurred in a participant with immunosuppressive treatment, only one case was asymptomatic and no reinfections occurred. CONCLUSIONS: A general decrease of IgG-S and IgG-NP antibodies after the second dose of Pfizer-BioNTech vaccine was observed in the cohort, as well as with new SARS-CoV-2 infections. Booster doses, maintaining protective measures and further determination of the protection threshold of vaccination are recommended.

Introducción: Estimar la evolución de los niveles de anticuerpos anti-SARS-CoV-2 y los factores asociados, así como la incidencia de nuevas infecciones. Método: Estudio de cohorte prospectivo de una muestra representativa de trabajadores del Hospital General Universitario de Castellón a los 8 meses de recibir la 2ª dosis de la vacuna Pfizer-BioNTech contra el SARS-CoV-2, mediante la determinación de anticuerpos IgG-S y IgG-NP, y la cumplimentación de un cuestionario. Se compararon los resultados con los del inicio de la cohorte en febrero de 2021. Se usó regresión lineal múltiple y regresión de Poisson.  Resultados: Participaron 253 trabajadores de los 275 reclutados al inicio de la cohorte (92%). Todos mantenían niveles detectables de IgG-S, mediana de 691,5 UA/ml, disminuyendo un 93,3% con respecto al inicio. Los descensos de IgG-S fueron mayores con la edad y la obesidad, y menores en aquellos con historia de COVID-19, IgG-S elevada inicial, practicar ejercicio habitual y ser fumador. Tener IgG-NP se asoció positivamente con historia de COVID-19, tomar vitamina D, y disminuyeron del 4,4% al 1,2%. Se produjeron 4 casos de COVID-19 en la cohorte, con una tasa de incidencia del 1,7%, con un fallecimiento en un participante con tratamiento inmunosupresor, solo un caso fue asintomático y no hubo reinfecciones.  Conclusiones: Se produce un descenso general de los anticuerpos IgG-S e IgG-NP después de la segunda dosis de vacuna Pfizer-BioNTech, así como nuevas infecciones por SARS-CoV-2. Se recomienda dosis de recuerdo, mantener medidas protectoras y determinar el umbral de anticuerpos protectores de la vacunación.

[Comparison of postvaccinal antibodies to SARS-CoV-2 in asymptomatic cases, symptomatic cases, and non-cases in a cohort of general hospital workers]. / Comparación de anticuerpos postvacunales al SARS-CoV-2 en casos asintomáticos, casos sintomáticos, y no casos de una cohorte de trabajadores de un hospital general.

Estimada Sra. Directora: Agradecemos a los doctores Rujittika Mungmunpuntipantip y Viroj Wiwanitkit su interés por nuestra publicación(1) en la carta en la que se subrayan la importancia de los casos asintomáticos de COVID-19 en la evaluación de los efectos de la vacunación anti-SARS-CoV-2(2). Compartimos con ellos que las personas asintomáticas al COVID-19 pueden presentar unos niveles de anticuerpos anti-SARS-CoV-2 IgG-S mayores que las personas sin historia previa de COVID-19, y que pueden diferir en las reacciones a la vacunación, considerando que la prevalencia de COVID-19 asintomáticos se ha descrito como elevada(3).  En nuestra cohorte de trabajadores del Hospital General Universitario de Castellón, se detectaron 5 casos de COVID-19 asintomáticos (CA), incluyendo los dos seguimientos realizados(1,4), y 20 casos presentaron síntomas de COVID-19 (CS), con un total de 25 casos con confirmación por el laboratorio, 20 % tasa de asintomáticos (5/25). En la tabla 1 se recogen las características de los CA, CS, y de los participantes que no habían sufrido la enfermedad. Los CA eran más jóvenes que los otros 2 grupos, y la proporción de varones era significativamente mayor (p=0,027). En cuanto a los anticuerpos Anti-SARS-CoV-2 IgG-S al mes de la vacunación, los niveles de los CS fueron mayores que los de CA, y de los no casos, siendo estos últimos los que tuvieron significativamente menores niveles (p<0,001). Sin embargo, a los 8 meses de la vacunación la caída de IgG-S fue general, y los niveles de IgG-S eran mayores en los CA que en los CS y en los no casos (p<0,001). Los niveles de IgG-S considerados como protectores ? 4160 UA/ml, eran mayores en los CA y CS que el de los no casos (p=0,001). Si bien, el declive era similar en los tres grupos (p=0,084). Los síntomas y los efectos secundarios de las dos dosis de vacuna Pfizer-BioNTech no presentaron diferencias significativas entre los grupos. Estos resultados son coincidentes con númerosos estudios, en los que se constata que los casos de COVID-19 presentan niveles más elevados de IgG-S que las personas que no han sufrido la enfermedad(5), y se apreció que en valores medio no se alcanzaron los niveles de IgG-S protectores. De aquí la importancia de disponer de marcadores más efectivos de la situación de protección de la personas vacunadas tanto si han sufrido la enfermedad como sino. Además de los anticuerpos neutralizantes, la determinación de la inmunidad celular podría ser muy conveniente para conocer los niveles de protección.

[Vaccine response to SARS-CoV-2 in hospital workers]. / Respuesta vacunal frente a SARS-CoV-2 en trabajadores de un hospital.

INTRODUCTION: The aim of this study was to measure anti-SARS-CoV-2 immunity of hospital workers after a completed 2-dose Pfizer-BionTech vaccination, and to examine factors potentially associated with immunity status. Side effects of the vaccine were also studied. METHOD: This was a cross-sectional study of a representative sample of General University Hospital of Castellon workers, vaccinated with two doses in January and February 2021. We measured IgG antibodies against protein N (IgG-NP), IgM against protein S (IgM-S), and quantitative levles of IgG against protein S (IgG-Quant) one month after the last dose. We obtained information on demographic, risk factors, and vaccine side effects via a self-completed questionnaire. For the statistical analysis we used multiple regression models. RESULTS: Two hundred seventy-five workers participated (96.8%, 275/284). Positive IgG-Quant, IgM-S, and IgG-NP were 99.6%, 14.9% and 4.4%, respectively. Adjusted IgG-Quant levels increased significantly with obesity, nonsmoking status, positive IgM-S, and/or IgG-NP. The prevalence of IgM-S was higher in males, and associated with the same factors as those for IgG-Quant. Among those with a history of COVD-19 infection, 42.9% did not have IgG-NP. Overall 86.5% of participants had side effects, which were associated with positive IgG-NP, high IgG-Quant levels, younger age, and being female. CONCLUSIONS: All but one participant developed immunity. Those who had suffered from COVID-19 infection had higher antibody levels. A high proportion of participants had mild secondary effects, especially those with previous COVID-19 infection.

Introducción: Evaluar la inmunidad de los trabajadores de un hospital tras haber completado la vacunación Pfizer-BionTech, y su relación con factores individuales. También describir los efectos adversos de la vacuna. Método: Estudio transversal de una muestra de los trabajadores del Hospital General Universitario de Castellón vacunados con dos dosis en enero y febrero de 2021. Un mes después se detectaron: anticuerpos IgG frente a la proteína N (IgG-NP), de IgM frente a la proteína S (IgM-S) y detección cuantitativa de IgG frente a la proteína S (IgG-Quant). Se utilizó un cuestionario para recoger datos demográficos, factores de riesgo y efectos secundarios. En el análisis estadístico se utilizaron modelos de regresión múltiple. Resultados: La participación fue del 96,8% (275/284). Presentaron IgG-Quant el 99,6%, 14,9% IgM-S, y 4,4% IgG-NP. El nivel ajustado de IgG-Quant aumentó significativamente con la obesidad, en no fumadores y con positividad IgM-S y/o IgG-NP. La prevalencia de IgM-S era mayor en varones, y se asociaba con los mismos factores que la IgG-Quant. De los infectados por COVID-19, el 42,9% no presentaron IgG-NP. Un 86,5% sufrió algún efecto secundario que se asoció a tener IgG-NP, mayores niveles de IgG-Quant, y fue más frecuente en jóvenes y mujeres. Conclusiones: Todos los participantes desarrollaron inmunidad humoral excepto uno. Tuvieron mayores niveles de anticuerpos los que habían padecido la COVID-19. Un porcentaje alto desarrolló efectos secundarios leves, más frecuentes en los que habían padecido la enfermedad.

Impact in children under the age of one of Tdap vaccination programme on pregnant women in Castelló. / Impacto en niños menores de un año del programa de vacunación con dTpa en embarazadas en Castelló.

INTRODUCTION: The objective was to compare incidence rates of pertussis in children under the age of one in Castelló, before and after the introduction of vaccination of pregnant women in January 2015. METHODS: The incidence of the post-vaccine period (2015-2018) was compared with the pre-vaccine period (2011-2014) in all ages, in children from 3 to 11 months and under 3 months. The relative risks and their 95% confidence intervals (95% CI) were calculated. RESULTS: The overall rate of pertussis in all ages was higher in the post-vaccine period than in the pre-vaccine period (0.23 vs. 0.15 per 1.000 person-years), but decreased in those under 3 months. The relative risks were: 1.56 (95% CI 1.34-1.82) in all ages; 1.73 (95% CI 0.87-3.57) for children aged 3 to 11 months, and 0.35 (95% CI 0.16-0.69) for children under 3 months. A similar pattern was observed for hospitalised children. CONCLUSIONS: The incidence rate in children under 3 months was reduced by 65% in the period after the intervention, and the hospitalisation risk rate by 71%, suggesting that the measure has been effective and specific for this age group.

Comparison of sporadic cases of Salmonella Typhimurium with other Salmonella serotypes in Castellon (Spain): case-case study.

INTRODUCTION: Salmonella infections (SI) are common in Spain. The aim of this study was to appraise risk factors and the clinical characteristics of sporadic Salmonella Typhimurium infections compared with other sporadic salmonella serotype infections (OSI). METHODS: From September 2014 to August 2015, a case-case study was carried out by the Epidemiology Division of the Public Health Centre of Castellon. Case 1 consisted of patients with sporadic S. Typhimurium infections, while case 2 comprised OSI patients, assessed according to the stool cultures analyzed by the Microbiology Laboratories of Hospital General de Castellon and Hospital de La Plana in Vila-real. Patients from detected outbreaks were not included. The salmonella serotype was identified by the National Centre of Microbiology (Madrid). RESULTS: The total number of SI patients reported was 327, 242 of whom were studied (74.0%). 148 patients had sporadic S. Typhimurium infection and 64 had OSI, with median ages of 4 and 8.5 years, respectively. Sporadic S. Typhimurium infection patients presented more blood in feces and diarrhea episodes. Consumption of pork meat (OR=2.22; 95% CI 1.12-4.43), cold pork meats (OR=2.49; 95% CI 1.32-4.68) and playing in the dirt (OR=3.02; 95% CI 1.55-5.88), were associated with sporadic S. Typhimurium infection. In the 0-4 year-old group, the associated factors were consumption of cold pork meats, omelets and female gender. In the 5-year-old and over group, only playing in soil was associated with sporadic S. Typhimurium infection. CONCLUSIONS: The consumption of pork and omelets, as well as playing in the dirt, were the main factors associated with infection. Children were most affected by sporadic S. Typhimurium infection.

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.

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.

[Trichosporon asahii fatal infection in a preterm newborn]. / Infección fatal por Trichosporon asahii en una recién nacida de pretérmino.

We present a case of Trichosporon asahii fatal infection recognized post mortem in a premature newborn baby of 685 g. Trichosporon asahii isolated from endovascular catheters and endotraqueal tube, is an opportunistic yeast described like an emergent pathogen in serious systemic infections and nosocomial infections in the neonatal intensive care units. The colonization and disease by this uncommon microorganism, usually is unspecific and has similar clinical presentation to other fungal infections with a bad prognosis.

Infección fatal por Trichosporon asahii en una recién nacida de pretérmino / Trichosporon asahii fatal infection in a preterm newborn

Se presenta un caso fatal de infección por Trichos-poron asahii diagnosticado post mortem en una neonato de pretérmino que pesó 685 grs al nacer. De los cultivos de catéteres y del tubo endotraqueal se aisló T. asahii, levadura oportunista descrita como un patógeno emergente en infecciones sistémicas graves e infecciones nosocomiales en las unidades de cuidados intensivos neonatales. La colonización y enfermedad por este microorganismo poco común suele ser inespecífica y con mal pronóstico, de presentación clínica similar a otras infecciones fúngicas.

We present a case of Trichosporon asahii fatal infection recognized post mortem in a premature newborn baby of 685 g. Trichosporon asahii isolated from endovascular catheters and endotraqueal tube, is an opportunistic yeast described like an emergent pathogen in serious systemic infections and nosocomial infections in the neonatal intensive care units. The colonization and disease by this uncommon microorganism, usually is unspecific and has similar clinical presentation to other fungal infections with a bad prognosis.