[Impacto de la pandemia de la COVID-19 en los sistemas de vigilancia epidemiologica de la infección por vih en España.] / Impact of the COVID-19 pandemic on the epidemiological surveillance systems of hiv infection in Spain.

OBJECTIVE: The COVID-19 pandemic indirectly affected other communicable diseases, such as human immunodeficiency virus (HIV) infection. The aim of this paper was to evaluate the impact of the COVID-19 pandemic on the epidemiological surveillance of HIV through epidemiological indicators. METHODS: Data collected in the New HIV Diagnosis Information System (SINIVIH, acronym in Spanish) in the period 2013-2021 was analyzed. The epidemiological indicators analyzed were: 1) Reporting delay of new diagnoses; 2) Under diagnosis of cases, calculated per month of diagnosis and for each year of diagnosis; 3) Late diagnosis, cases diagnosed with less than 350 CD4 cell/mm3. RESULTS: Regarding the reporting delay of new diagnoses, in 2022 2,770 diagnoses were reported in 2020, 43.8% more than those reported in 2021 for that year. The cases diagnosed per month between 2016 and 2019 followed a constant trend. In 2020, a significant decrease in diagnoses was observed between March and May that was not recovered after correcting for reporting delay. When comparing the rates of cases diagnosed in 2013 with the successive years, a continuous decrease was interrupted in the last year of the study period. The percentage of cases with late diagnosis had remained stable in the study period (between 46% and 50%), and a decrease in this percentage was observed after correcting for reporting delay. CONCLUSIONS: The epidemiological surveillance of HIV suffered a significant reporting delay. A decrease in cases diagnosed is confirmed, partly due to lockdown and lack of access to the health system. Changes on late diagnosis is not observed.

OBJECTIVE: La pandemia de la COVID-19 afectó de forma indirecta a otras enfermedades transmisibles, como la infección por el virus de la inmunodeficiencia humana (VIH). El objetivo de este estudio fue evaluar el impacto de la pandemia de la COVID-19 en la vigilancia epidemiológica del VIH a través de indicadores epidemiológicos. METHODS: Se analizaron los datos recogidos en el Sistema de Información de Nuevos Diagnósticos de VIH (SINIVIH) en el periodo 2013-2021. Los indicadores epidemiológicos analizados fueron: 1) Retraso en la notificación de nuevos diagnósticos; 2) Infradiagnóstico de caso, calculado por mes y por cada año de diagnóstico; 3) Diagnóstico tardío, casos diagnosticados con menos de 350 células CD4/mm3. RESULTS: Respecto al retraso en la notificación de nuevos diagnósticos, en 2022 se notificaron 2.770 casos diagnosticados en 2020, un 43,8% más respecto a los notificados en 2021 para ese año. Los casos diagnosticados por mes entre 2016 y 2019 seguían una tendencia constante. En 2020 se observó un descenso importante de diagnósticos entre marzo y mayo que no se recuperó al corregir por retraso en la notificación. Al comparar las tasas de casos diagnosticados en 2013 con los años sucesivos, se observó un descenso continuo que se interrumpía en el último año del periodo de estudio. El porcentaje de casos con diagnóstico tardío se mantuvo estable en el periodo de estudio (entre el 46% y el 50%), observándose un descenso al corregir por retraso en la notificación. CONCLUSIONS: La vigilancia epidemiológica del VIH sufrió un importante retraso en la notificación. Se constata un descenso en los casos diagnosticados, en parte debido al confinamiento y la falta de acceso a pruebas diagnósticas. No se observan cambios en el diagnóstico tardío.

[Surveillance of influenza pandemic (H1N1)2009 in Spain]. / Vigilancia de la pandemia de gripe (H1N1) 2009 en España.

BACKGROUND: During the summer of 2009, Spain experienced the circulation of the novel influenza (H1N1)2009 virus, beyond the usual period of influenza activity, increasingly evolving up to the presentation in the early autumn of the first wave of the pandemic virus. The objectives of this study are to describe the evolution of the pandemic wave in our country and to assess their impact on morbidity and mortality of the Spanish population. METHOD: From the information obtained from the Spanish Influenza Surveillance System and the Coordinating Centre for Health Alerts and Emergencies within Spanish Ministry of Health and Social Policy have been estimated a number of epidemiological and virological indicators that were used to assess the level of activity and intensity of the pandemic wave, as well as its severity RESULTS: The beginning of the pandemic wave in Spain started in early autumn 2009 reaching the maximum weekly incidence rate of 372.15 cases/100,000 inhabitants. The highest incidence was registered in under 15 years old. Viral detection rate registered during the pandemic period remained at the range of previously recorded (46.4%). We estimated an overall mortality rate of 0.43 deaths per 1,000 pandemic cases. The 64% of deaths from pandemic influenza occurred in young adults and the highest mortality rates were registered in the 45-64 years age group with 9.35 deaths/1,000,000 inhabitants. Mortality associated with seasonal influenza in the period 2001-2008 was highest in those over 64 years (95% of all deaths). CONCLUSIONS: The influenza (H1N1)2009 pandemic wave in Spain showed an early presentation and a medium level of influenza intensity compared to the previous thirteen seasonal influenza waves. Considering lethality or mortality rates, this first pandemic wave was also characterized by a mild severity, although a high percentage of deaths confirmed by the new virus were observed in population under 65 years.

[Premature mortality excess related to influenza in Spain during an interpandemic period]. / Exceso de mortalidad precoz relacionado con la gripe en España durante un período interpandémico.

BACKGROUND: The indicator of Potential Years of Life Lost (PYLL) has been frequently used to analysis of premature mortality and recently has been used to estimate the impact of the last influenza A(H1N1)pdm09 pandemic. The aim of this study was to estimate the excess deaths from pneumonia and influenza (P&I) in Spain and the PYLL during the period 1980-2008, measuring the mortality attributable to influenza regarding the type/subtype of influenza dominant in each season. METHODS: Monthly excess deaths were calculated with cyclical regression models. The PYLL calculation was performed as the product of the number of excess deaths and the difference between life expectancy at birth and years lived for each age group. The analysis of the variation between P&I excess deaths and PYLL, depending on the predominant influenza virus type/subtype was carried out with a Poisson regression analysis. RESULTS: In seasons dominated by influenza virus A(H3) the average P&I excess deaths was estimated at 1,348, and for PYLL in 5.297, while in seasons dominated by A(H1) or B the average P&I excess deaths was 648, and for PYLL 2.885. The adjusted rate ratios of excess (2.11, CI-95%=2.05-2.16) and PYLL (1.86, CI-95%=1.83-1.88) indicate that the relative frequencies for both indicators are significantly larger in seasons dominated by influenza virus A(H3). CONCLUSIONS: Excess deaths and PYLL doubled when comparing seasons predominantly subtype A(H3) and other influenza viruses.

[Transmissibility and severity of the pandemic influenza A (H1N1) 2009 virus in Spain]. / Transmisibilidad y gravedad de la pandemia de gripe A(H1N1)2009 en España.

OBJECTIVES: To estimate the value of the basic reproduction number for the pandemic wave of influenza A (H1N1) 2009 in Spain and to assess its impact on morbidity and mortality in the Spanish population compared with those in the previous influenza season. METHODS: Data on the incidence of influenza and viral detections were obtained from the Spanish Influenza Surveillance System. Deaths from pandemic influenza were obtained from the Coordinating Center for Health Alerts and Emergencies of the Spanish Ministry of Health and Social Policy, and deaths from seasonal influenza during the period 2003-2008 were obtained from the National Statistics Institute. The reproduction number was estimated by two methods: firstly, by using the growth rate of the cumulative incidence of influenza during the exponential growth phase of the pandemic wave, and secondly (maximum likelihood estimation), through analysis the dates of onset of symptoms observed in pairs of cases based on generation time distribution. We calculated the fatality rate and mortality from influenza by comparing potential years of life lost in the pandemic season with those in previous interpandemic seasons. RESULTS: The start of the pandemic wave occurred in Spain earlier in week 40/2009 (from 4 to 10 October), with an absolute predominance of the new strain in the pattern of circulating viruses. The value of R(0) in the growth phase of the wave was 1.29 (95% CI: 1.25-1.33), estimated with the first method, and was 1.01 (95% CI: 0.99-1.03) with the second method. During the pandemic season, there were 318 deaths from pandemic influenza, affecting younger age groups than in previous interpandemic seasons. Consequently, the number of potential years of life lost in the pandemic season (11,612) was estimated at six times the adjusted annual average of the interpandemic influenza seasons for comparison (1,802). CONCLUSIONS: The estimates of R(0) for the growth phase of the pandemic wave were in the lower range of estimates of this parameter in previous pandemics. Mortality indicators calculated in the pandemic period showed an increase in deaths compared with previous interpandemic seasons, which was most pronounced in young patients.