Using surveillance data to estimate pandemic vaccine effectiveness against laboratory confirmed influenza A(H1N1)2009 infection: two case-control studies, Spain, season 2009-2010.

BACKGROUND: Physicians of the Spanish Influenza Sentinel Surveillance System report and systematically swab patients attended to their practices for influenza-like illness (ILI). Within the surveillance system, some Spanish regions also participated in an observational study aiming at estimating influenza vaccine effectiveness (cycEVA study). During the season 2009-2010, we estimated pandemic influenza vaccine effectiveness using both the influenza surveillance data and the cycEVA study. METHODS: We conducted two case-control studies using the test-negative design, between weeks 48/2009 and 8/2010 of the pandemic season. The surveillance-based study included all swabbed patients in the sentinel surveillance system. The cycEVA study included swabbed patients from seven Spanish regions. Cases were laboratory-confirmed pandemic influenza A(H1N1)2009. Controls were ILI patients testing negative for any type of influenza. Variables collected in both studies included demographic data, vaccination status, laboratory results, chronic conditions, and pregnancy. Additionally, cycEVA questionnaire collected data on previous influenza vaccination, smoking, functional status, hospitalisations, visits to the general practitioners, and obesity. We used logistic regression to calculate adjusted odds ratios (OR), computing pandemic influenza vaccine effectiveness as (1-OR)*100. RESULTS: We included 331 cases and 995 controls in the surveillance-based study and 85 cases and 351 controls in the cycEVA study. We detected nine (2.7%) and two (2.4%) vaccine failures in the surveillance-based and cycEVA studies, respectively. Adjusting for variables collected in surveillance database and swabbing month, pandemic influenza vaccine effectiveness was 62% (95% confidence interval (CI): -5; 87). The cycEVA vaccine effectiveness was 64% (95%CI: -225; 96) when adjusting for common variables with the surveillance system and 75% (95%CI: -293; 98) adjusting for all variables collected. CONCLUSION: Point estimates of the pandemic influenza vaccine effectiveness suggested a protective effect of the pandemic vaccine against laboratory-confirmed influenza A(H1N1)2009 in the season 2009-2010. Both studies were limited by the low vaccine coverage and the late start of the vaccination campaign. Routine influenza surveillance provides reliable estimates and could be used for influenza vaccine effectiveness studies in future seasons taken into account the surveillance system limitations.

Characteristics and trends of newly diagnosed HIV-infections, 2000-2004.

OBJECTIVE: To describe the characteristics and trends of newly diagnosed HIV-infections. METHODS: We analysed all newly diagnosed HIV-infections among residents of the Canary Islands, Ceuta, La Rioja, Navarre and the Basque Country (Spain) between 2000 and 2004. RESULTS: In total, 1,807 HIV-infections -74.4 per million inhabitants, per year- were diagnosed. The heterosexual transmission category was the most frequent (48.6%), followed by that of homo/bisexual men (23.0%) and injecting drug users (IDU) (22.5%). From 2000 to 2004, the rate of new diagnoses of HIV infection decreased by 29.8% (p < 0.0001). The rate of diagnoses of infections acquired by IDU diminished by 58.5% (p < 0.0001), and the rate of infections associated with homo/bisexual practices in men descended by 33.9% (p = 0.0318). Nevertheless, the rate of diagnoses of infections by heterosexual transmission has not undergone significant changes. In the period 2002-2004, 28.7% of cases were diagnosed in foreigners, but the rate of diagnoses in the population of non-Spanish origin diminished by 24% (p = 0.0534). 39.7% of HIV diagnoses were delayed (with CD4 < 200 cells/microlitre or coinciding with the diagnosis of AIDS). This situation was less frequent in women (odds ratio = 0.5; p < 0.001) and increased with age amongst people over 30. The proportion of delayed diagnoses reached a maximum in 2001 (47.5%) and then declined until 2004 (38.6%; p = 0.022). CONCLUSIONS: Although none of the analysed indicators evolved unfavourably, it is important to insist on the prevention of sexual transmission, the early diagnosis of HIV infection, and the need to adapt preventive activities and focus them on people from other countries.

[Palliative and support care at home in primary care]. / Atención sanitaria paliativa y de soporte de los equipos de atención primaria en el domicilio.

OBJECTIVES: To estimate the proportion of people requiring palliative and support care at home in primary care and to describe their characteristics. METHODS: A descriptive study was carried out by five Spanish sentinel networks between October 2007 and March 2008 in 282,216 people attended by 218 general practitioners and nurses. Patients receiving comprehensive, active and continued care at home were included if the aim was not to prolong life but to achieve the best quality of life for the patient, the family and the carers. A standard form was used to collect data on age, sex, type of patient, underlying diseases and other variables related to the process. Crude and age-adjusted rates were estimated. RESULTS: Of the 400 men and 792 women registered, 12% were strictly terminal. The mean age was 82.4 years and was higher in patients with functional disability (82.9 years) than in terminally-ill patients (78.9 years) (p<0.01). The estimated prevalence was 422.3 per 100,000 inhabitants aged 14 years or more (95% CI: 398.7-447.0) and was much higher in women than in men (553.9 versus 287.3, p<0.01). The estimate for the entire Spanish population was 309.0 per 100,000 inhabitants (95% CI: 286.0-332.0). CONCLUSIONS: The prevalence of palliative and support care in Spain is around three cases per 1,000 inhabitants and is higher in elderly populations. More than 85% of patients needing palliative or support care have a life expectancy of over 6 months and thus represent the majority of persons using this type of medical and social support. The most susceptible groups are women and the oldest-old.

Cystic fibrosis mortality trends in Spain among infants and young children: 1981-2004.

UNLABELLED: This paper sought to analyse mortality trends among infants and young children who died with a diagnosis of cystic fibrosis (CF) in Spain, during the period 1981-2004. STUDY DESIGN: Descriptive observational study, using joinpoint regression models. PARTICIPANTS: Data on cystic fibrosis deaths were drawn from the National Statistics Institute (Instituto Nacional de Estadística), which collects data from all death certificates in Spain. During the period 1981-2004, overall CF mortality in Spain decreased by an annual average of 4% in both sexes. A breakdown by age showed that patients under 15 years registered a declining and those over 15 years a rising mortality rate over the study period. Mean and median age at death from CF increased with time, from a median of 4.4 years (males) and 3.8 years (females) in 1981 to 20.1 years (males) and 17.7 years (females) in 2004. The results of this study show that, as in other Western countries, CF is no longer a major cause of death in childhood, and that the challenge now lies in caring for adults who suffer from this disease. The fact that our study was descriptive meant that the reasons for the decrease in CF mortality in Spain could not be identified. Other authors have shown that this decrease is associated with improved treatment for pulmonary complications, better nutritional control and lung transplants.