[Epidemic outbreak of tularemia in Palencia]. / Brote epidémico de tularemia en Palencia.

BACKGROUND: Tularemia can become a health problem after its recent emergence in Spain. OBJECTIVE: To describe the clinico-epidemiologic characteristics of a tularemia outbreak occurred in Palencia (October 1997 to March 1998). DESIGN: Case-control study. MATERIAL AND METHODS: A clinico-epidemiologic survey was conducted. The Chi square test and the Student "t" test were used and a logistic regression analysis was made. The diagnosis was made by serology (microagglutination or macroagglutination) or culture. RESULTS: There were 151 cases; 74.5% of cases were confirmed or likely. The ulceroglandular was the most common clinical form of the disease (49%) and 23.2% of patients required hospital admission; 93.4% of patients had exposure to hares, and 86.7% of them handled them. Higher risk practices included skinning (adjusted OR: 3.9; 95% CI [1.03-14.7]; p = 0.04) and cutting/cooking (adjusted OR: 2.7; 95% CI [1.01-6.7]; p = 0.03). Streptomycin therapy was used for 51.6% of cases. CONCLUSIONS: The clinico-epidemiologic surveillance of this disease in Spain is necessary.

[The incidence and distribution of accidents with biological fluids among health personnel and the general population]. / Incidencia y distribución de accidentes con fluidos biológicos en personal sanitario y población general.

OBJECTIVES: To assess the informative usefulness of the Registry, to calculate the incidence rates of accident with biological fluids among health care workers and in the community, to know about the postaccident rate of seroconversion to HIV and to identify risk groups. METHODS: A descriptive study of the HIV records file of the Registry of Accidental Contacts to Biological Fluids in the Clinic Hospital of Zaragoza was conducted, between January 1987 and September 1993. The registry includes the reports of health care workers and the general population of Health Area III in Aragón (Spain), except for the Calatayud's Hospital. Incidence rates, rate ratios and their 95% confidence intervals were calculated. RESULTS: A total number of 595 accidents were reported, in none of them and HIV infection occurred subsequently. The incidence rate in health care workers was of 1.7 reports per 100 workers per year, while in the community it was of 8.1 per 100,000 people. The housekeeping staff was the group with a higher incidence (rate = 6.7; 95% IC: 3-14.8) and the type of accident more frequently described was needlestick injury. CONCLUSIONS: The incidence of reported accidents has increased in the community and in health care workers, which may be due to the increase in the reporting. In health care workers, the incidence in 1993 was within the range reported from other countries. The perception of risk is universal after accidents with unknown biological fluids. The correct disposal of material with biological contamination should be the more important preventive action.