Epidemiological analysis of severe hospitalized 2009 pandemic influenza A (H1N1) cases in Catalonia, Spain.

From 25th April 2009 to 20th January 2010, 771 laboratory confirmed cases of 2009 pandemic influenza A (H1N1) were admitted to intensive care units (ICU) or hospitalized in medical wards with clinical criteria of severe disease (hospitalized pneumonias, multiorganic failure, septic shock or admitted to ICU or death while hospitalized). 82% of cases were hospitalized between epidemiological week 43 and 48 (25th October - 5th December 2009). Median age of patients was 40 years (range 0-89 years) and 56% were males. 38.7% cases were in the 15-44 year age-group, 29.4% in the 45-64 and 21.8% were children under 15 years of age. 36.8% were admitted to an ICU and 48 died. Underlying conditions were absent in 29% of patients (up to 38% among those under 15 years old). Differences in the prevalence of underlying conditions were found between children and adults. In children less than 15 years old, asthma (16.2%), other respiratory diseases (12.7%), cognitive disorders (10.2%), epilepsy (8.7%) and neuromuscular disorders (7.1%) were the most frequent. In adults, chronic obstructive pulmonary disease (14.8%), cardiovascular diseases (12.6%), asthma (11.5%), diabetes (11.2%) and morbid obesity (10.6%) were the most frequent. Further surveillance is needed to better characterize the epidemiology of this pandemic.

Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia.

BACKGROUND: Patients with a history of tuberculosis (TB) have a high probability of recurrence because long-term cure is not always maintained in successfully treated patients. The aim of this study was to identify the probability of TB recurrence and its predictive factors in a cohort of socially vulnerable patients who completed treatment in the TB referral center in Catalonia, which acts as the center for patients with social and health problems. METHODS: This retrospective open cohort study included all patients diagnosed with TB who were admitted and successfully treated in Serveis Clínics between 2000 and 2016 and who remained disease-free for a minimum of 1 year after treatment completion. We calculated the incidence density of TB recurrences per person-years of follow-up. We also estimated the cumulative incidence of TB recurrence at 1, 2, 5, and 10 years of follow-up. Bivariate analysis was conducted using Kaplan-Meier curves. Multivariate analysis was conducted using Cox regression. Hazard ratios (HR) were calculated with their 95% confidence intervals (95%CI). RESULTS: There were 839 patients and 24 recurrences (2.9%), representing 0.49 per 100 person-years. The probability of a recurrence was 0.63% at 1 year of follow-up, 1.35% at 2 years, and 3.69% at 5 years. The multivariate analysis showed that the predictive factors of recurrence were age older than 34 years (aHR = 3.90; CI = 1.06-14.34 at age 35-45 years and aHR = 3.88; CI = 1.02-14.80 at age >45 years) and resistance to at least one anti-TB drug (aHR = 2.91; CI = 1.11-7.65). CONCLUSIONS: Attention should be paid to socially vulnerable persons older than 34 years with a previous episode of resistant TB. Surveillance resources should be directed toward adequately treated patients who nevertheless have a high risk of recurrence.

Immigrants do not transmit tuberculosis more than indigenous patients in Catalonia (Spain).

BACKGROUND: Immigrants may not transmit tuberculosis (TB) more than indigenous patients. The objective was to study the prevalence of TB infection among contacts of immigrant and indigenous TB patients and the risk factors associated with latent TB infection. METHODS: Contacts of TB cases recorded in 2005 and 2006 were surveyed using a standardized Health Department questionnaire. Infections were diagnosed using the tuberculin skin test (TST) (cut-off ≥ 5 mm). The risk of infection was determined by multivariate logistic regression and the adjusted odds ratios (aOR) with the 95% confidence intervals (CI) were calculated. RESULTS: The study of contacts was completed in 1329 cases of TB. The prevalence of infection was 32.3% (3038/9406) in all contacts, 41.4% in contacts of immigrant cases and 29.2% in contacts of indigenous cases. In the multivariate analysis, immigrant index cases were not associated with an increased risk (aOR = 0.9; 95%CI: 0.8-1.0). The prevalence of TST conversion was 10.0% (296/2969) in all contacts, 11.2% in immigrant contacts and 9.7% in indigenous contacts (p = 0.158). CONCLUSIONS: Immigrants do not transmit TB more than indigenous TB patients. Infections which may have occurred in the countries of origin of immigrants were detected by the systematic study of contacts.

[Surveillance of the pandemic influenza (H1N1) 2009 in Catalonia: results and implications]. / Vigilancia de la de gripe pandémica (H1N1) 2009 en Cataluña: Resultados e implicaciones.

BACKGROUND: Pandemics require an assessment of its severity. The objective was to determine the characteristics of pandemic influenza in Catalonia. METHODS: We conducted a surveillance study on the incidence of ILI and severe cases between June 2009 and May 2010. A network of 55 doctors reported influenza-like illness and collected nasopharyngeal swabs. The severity of the pandemic was assessed through severe cases confirmed.We calculated the lethality and incidence rates and mortality. The differences are studied with the relative risk (RR) with confidence intervals (CI) of 95%. RESULTS: The incidence of ILI was much higher in the 5 to 14 and from 0 to 4 years old (1227.8 and 1048.4, respectively, in the week of maximum incidence). Of positive samples, 52.4% (477/916) were positive for influenza virus and the majority, 456 (95.6%) were the pandemic influenza virus (H1N1) 2009.The incidence of severe cases was 10.3 per 10(5) and was higher in children (14,5) and adults under 65 years (10,2) (p < 0.0001). Overall mortality was 0.7 per 10(5) and was also higher in children and adults under 65 but the differences were not statistically significant. The fatality rate was estimated at 0.03% and was much higher in the 15 to 44 years (0,03%) (RR = 3.1, 95% CI 1.2 to 8.3), 45 to 64 years (0,11%) (RR = 11.9 95% CI 4.3 to 32.7) and over 64 years (0,73%) (RR = 79.6, 95% CI 25.3 to 250.9) compared to group 5 to 14 years (0,01%). CONCLUSIONS: The incidence of severe hospitalized cases was similar to or lower than that observed in the southern hemisphere. The lower risk of hospitalization in people over 64 years suggests the relative protection of this age group against the pandemic virus.

[Characteristics of cases hospitalized for severe pandemic (H1N1) 2009 in Catalonia]. / Características de los casos graves hospitalizados por gripe pandémica a (H1N1) 2009 en Cataluña.

BACKGROUND: Influenza pandemics may cause more severe cases. The objective was to determine the characteristics of hospitalized severe cases of pandemic influenza in Catalonia and to study risk factors for admission to intensive care unit (ICU). METHODS: A prospective epidemiologic study of new cases of pandemic influenza hospitalized by their severity between June 2009 and May 2010. Hospitals were asked to declare laboratory confirmed pandemic influenza cases that met the case specific case definition for severe case. A standardized epidemiological survey was conducted to collect information on demographics, clinical characteristics, risk factors, treatment and outcome. Differences between the cases in ICU compared to other severe cases were studied with the odds ratio (OR), which were adjusted using a logistic regression model. RESULTS: We detected total of 773 pandemic influenza (H1N1) 2009 severe cases; 465 (60.2%) of them had at least one risk factor and the most prevalent were: pregnancy 19 (13%), asthma 87 (12%), chronic obstructive pulmonary disease 87 (11.4%) and heart disease 80 (10.5%). Required admission to ICU 293 patients (37.9%). Factors associated with ICU admission were obesity BMI>40 (adjusted OR = 2.5, 95% CI 1.4-4.5) and chronic liver disease (adjusted OR = 2.3, 95% CI 1.1-4.8). CONCLUSIONS: This study confirms the high prevalence of pregnancy, chronic respiratory diseases, diabetes and obesity among pandemic influenza severe cases. Obesity acts as a risk factor for ICU admission and should therefore be considered as an indicator for influenza vaccination.

Risk Factors for AIDS Associated Kaposi's Sarcoma. An European Multicentre Case Control Study.

EURO-SHAKS, European study on HIV associated Kaposi's sarcoma, is a BIOMED 1 project financed by the European Union (DG XII). The Spanish side of the project has been financed by FISS (Fondo de Investigaciones Sanitarias). The aims of this study are to identify possible genetic, behavioural, biological and environmental risk factors for HIV associated Kaposi's sarcoma through a multicentre case-control study. An extensive personal questionnaire, a clinical data form and blood sample is required from all participants. In addition, a cutaneous biopsy is request from KS patients. The presence of several European groups in this project implies a large and diverse sample size and will allow to correlate the behaviour, clinical and biological data in different geographical areas, and therefore study the possible transmission routes as well as the natural history of the putative causal agent of KS. One of the main objectives of EURO-SHAKS is to create a European Bank of AIDS biological samples for possible future investigations.