The impact of COVID-19 pandemic on the incidence of acute gastroenteritis outbreaks in Catalonia (Spain).

We carried out a retrospective study of acute gastroenteritis (AGE) outbreaks reported between 1 January 2015 and 31 December 2021 in Catalonia (Spain) to compare the incidence from 2015 to 2019 with that observed from 2020 to 2021. We observed a higher incidence rate of outbreaks during the prepandemic period (16.89 outbreaks/1,000,000 person-years) than during the pandemic period (6.96 outbreaks/1,000,000 person-years) (rate ratio (RR) 0.41; 95% confidence interval (CI) 0.34 to 0.51). According to the aetiology of the outbreak, those of viral aetiology decreased from 7.82 to 3.38 outbreaks/1,000,000 person-years (RR 2.31; 95% CI 1.72 to 3.12), and those of bacterial aetiology decreased from 5.01 to 2.78 outbreaks/1,000,000 person-years (RR 1.80; 95% CI 1.29 to 2.52). There was a great reduction in AGE outbreaks in Catalonia. This reduction may have been due to the effect of the nonpharmaceutical measures applied to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the collapse of the healthcare system and epidemiological surveillance services may also have had a strong influence.

Foodborne nosocomial outbreak of SHV1 and CTX-M-15-producing Klebsiella pneumoniae: epidemiology and control.

BACKGROUND: We describe a foodborne nosocomial outbreak due to extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae. METHODS: An outbreak of ESBL K. pneumoniae was detected in March 2008. Initial control measures included contact isolation and a protocol for routine detection and reinforcement in hand hygiene practices. ESBL producers were screened for the bla(TEM), bla(SHV), and bla(CTX-M) genes. Pulsed-field gel electrophoresis analysis was performed using XbaI as a restriction endonuclease. RESULTS: One hundred fifty-six colonized and/or infected patients were identified, 35 (22.4%) of whom had infection. The outbreak affected all hospital wards. Fecal carriage was up to 38% of patients in some wards. Of note, investigation revealed a very short delay between admission and colonization. None of the health care workers or environmental surfaces in the wards was found to be colonized. This prompted an epidemiological investigation of a possible foodborne transmission. We found that up to 35% of the hospital kitchen-screened surfaces or foodstuff were colonized and that 6 (14%) of 44 food handlers were found to be fecal carriers. Phenotypic and genotypic analysis of all clinical, environmental, and fecal carrier isolates showed the dissemination of a single strain of SHV-1 and CTX-M-15-producing K. pneumoniae. At that time, structural and functional reforms in the kitchen were performed. These were followed by a progressive reduction in colonization and infection rates among inpatients until complete control was obtained in December 2008. No restrictions in the use of antibiotics were needed. CONCLUSIONS: To our knowledge, this is the first reported hospital outbreak that provides evidence that food can be a transmission vector for ESBL K. pneumoniae.

Large outbreak of measles in a community with high vaccination coverage: implications for the vaccination schedule.

BACKGROUND: Attempts to eliminate measles from a country or region may be disrupted by an imported case that affects indigenous persons. The objective of this study was to analyze epidemiological and clinical characteristics of a measles outbreak in Catalonia, Spain, in 2006. METHODS: Data on cases of measles reported to the Department of Health, Generalitat of Catalonia, during the period 28 August 2006 through 8 July 2007 were collected. Suspected cases were confirmed by determination of measles-specific immunoglobulin M antibodies and/or detection of virus genome. Incidences were calculated using the estimated population of Catalonia for 2006, and 95% confidence intervals were determined assuming a Poisson distribution. The association between proportions was determined using the chi(2) test and Fisher's exact test. The level of statistical significance was set at alpha = .05. RESULTS: A total of 381 cases were confirmed, for an incidence of 6.6 cases per 100,000 persons. A total of 89.5% of cases occurred in nonvaccinated persons, mainly those aged < or =15 months (incidence, 278.2 cases per 100,000 persons; mean age of patients, 12 months). Indigenous subjects accounted for 89.8% of cases, and laboratory confirmation of results was obtained for 87.1%. Measles genotype D4 was identified in all sequenced samples. CONCLUSIONS: The age distribution of cases of measles among children aged <15 months suggests that the first dose of vaccine should be routinely administered at the age of 12 months.

Descriptive study of severe hospitalized cases of laboratory-confirmed influenza during five epidemic seasons (2010-2015).

OBJECTIVE: The Plan of Information on Acute Respiratory Infections in Catalonia (PIDIRAC) included the surveillance of severe hospitalized cases of laboratory-confirmed influenza (SHCLCI) in 2009. The objective of this study was to determine the clinical, epidemiological and virological features of SHCLCI recorded in 12 sentinel hospitals during five influenza seasons. RESULTS: From a sample of SHCLCI recorded during the 5 influenza epidemics seasons from 2010-2011 to 2014-2015, Cases were confirmed by PCR and/or viral isolation in cell cultures from respiratory samples. A total of 1400 SHCLCI were recorded, 33% required ICU admission and 12% died. The median age of cases was 61 years (range 0-101 years); 70.5% were unvaccinated; 80.4% received antiviral treatment (in 79.6 and 24% of cases within 48 h after hospital admission and the onset of symptoms, respectively); influenza virus A [37.9% A (H1N1)pdm09, 29.3% A (H3N2)] was identified in 87.7% of cases. Surveillance of SHCLCI provides an estimate of the severity of seasonal influenza epidemics and the identification and characterization of at-risk groups in order to facilitate preventive measures such as vaccination and early antiviral treatment.

[Reporting of newly diagnosed HIV infections in Catalonia, Barcelona, Spain. Implementation and results]. / Declaración de los nuevos diagnósticos de infección por el VIH en Cataluña. Implementación y resultados.

OBJECTIVES: To describe newly diagnosed HIV infections from the HIV Reporting System in Catalonia (2001-2003), and to compare the characteristics of the epidemic based on the use of the HIV Reporting System and the Catalonian AIDS Registry versus those based on the Catalonian AIDS Registry alone. METHODS: Data were collected from newly diagnosed HIV infections and AIDS cases between 2001 and 2003 in Catalonia. RESULTS: Among the newly diagnosed HIV infections (1,765) the most frequent route of HIV infection was heterosexual transmission (46.8%), followed by men who had sex with men (26.7%), and injecting drug use (19.9%). Out of the 1,210 AIDS cases, the most common route of HIV transmission was injecting drug used (42.2%), followed by (heterosexual transmission 34.5%) and MSM (18.0%). Comparison of routes of HIV transmission in the two reporting systems (HIV/AIDS versus AIDS) revealed statistically significant differences. CONCLUSIONS: The HIV/AIDS Reporting System based on reporting of newly diagnosed HIV infections is feasible, since it has been useful in achieving the objectives of epidemiological HIV infection surveillance. It also provides more accurate information than does the AIDS Registry, which can be used to describe recent patterns of HIV transmission. The completeness of the new reporting system may be enhanced by including the diagnosis of HIV infection among the diseases of mandatory notification.

Changes in the epidemiology of hepatitis A outbreaks 13 years after the introduction of a mass vaccination program.

A hepatitis A+B vaccine vaccination program of 12-year-olds was introduced in Catalonia in 1998. The aim of this study was to investigate the evolution of hepatitis A outbreaks in Catalonia and estimate the preventable fraction of cases associated with outbreaks as a measure of the impact of the vaccination program. Hepatitis A outbreaks reported to the Health Department between 1991 and 2012 were analyzed. The incidence rates of outbreaks, outbreak-associated cases and hospitalizations were calculated. The preventable fraction (PF) and 95% confidence intervals (CI) were estimated for the whole study period (pre-vaccination and post-vaccination) and the post-vaccination period.   One-hundred-eight (108) outbreaks (rate of 2.21 per 10(6) persons-year) were reported in the pre-vaccination period and 258 outbreaks (rate of 2.82 per 10(6) persons-year) in the post-vaccination period. The rate of cases associated with outbreaks was 1.52 per 10(5) persons-year in the pre-vaccination period and 1.28 per 10(5) persons-year in the post-vaccination period. Hospitalization rates were 0.08 and 0.75 per 10(6) persons-year, respectively. The number of person-to-person outbreaks whose index case was a school contact decreased in the post-vaccination period (aOR 2.72; 95%CI 1.35-5.48), but outbreaks whose index case was a man who has sex with men (MSM) or an immigrant increased. The PF of all outbreak-associated cases was 6.46% (95%CI 3.11-9.82) and the highest PF was in the 15-24 years age group (42.53%; 95%CI 29.30-55.75). In the 0-4 years age group, the PF was 18.35% (95%CI 9.59-27.11), suggesting a protective herd effect in unvaccinated subjects. Vaccination of immigrants traveling to endemic countries and MSM should be reinforced.

Epidemiology of pertussis in a country with high vaccination coverage.

INTRODUCTION: Pertussis has been a preventable disease in Catalonia since 1965, but the annual number of cases remains high. The aim of this study was to analyze the epidemiology of pertussis in Catalonia and its implications for control purposes. METHODS: An epidemiological study was carried out in Catalonia between 2004 and 2008. Pertussis cases reported to the Department of Health were collected and disease reports were filled out with the case information. Incidence rates, rate ratios (RR) and their 95% confidence intervals (CI) were calculated. RESULTS: 963 cases were reported: 555 (57.6%) were confirmed and 408 (42.4%) were suspected cases. The reported incidence rate was 2.01 × 10(-5) person years in 2004 and 4.34 in 2008. The biggest increase in cases between 2004 and 2008 was observed in the ≥35 years age group (RR: 6.98; 95%CI: 2.11-36.36). 303 (31.5%) patients were hospitalized, of whom 93.7% were aged <1 year. Clinical differences were observed in paroxysmal cough (83.8% in suspected and 76.4% in confirmed cases, p=0.005), posttussive vomiting (47.1% and 36.1%, respectively, p=0.001), apnoea (13.7% and 21.3%, respectively, p=0.003) and fever (20.1% and 12.4%, respectively, p=0.001). CONCLUSION: Pertussis incidence rates increased during the study period, with the greatest increase occurring in the ≥35 years age group. A booster dose of vaccine in young people could reduce the circulation of B. pertussis in adolescents and adults and indirectly reduce the incidence in children.

Impact of the Legionella urinary antigen test on epidemiological trends in community outbreaks of legionellosis in Catalonia, Spain, 1990-2004.

OBJECTIVES: To describe the characteristics of community outbreaks of legionellosis in Catalonia, Spain from 1990 to 2004, to compare two time periods (1990-1996 and 1997-2004), and to assess the influence of outbreak characteristics on the case fatality rate (CFR). METHODS: This is a descriptive analysis of the outbreaks detected by epidemiological surveillance units in Catalonia. Variables potentially related to the CFR were analyzed by logistic regression. RESULTS: Of the 118 outbreaks involving 690 patients (overall CFR 4.5%), the urinary antigen test (UAT) was used for first case diagnosis in 80.5%. The origin of the outbreak was identified as a cooling tower in 35.6%, as a water distribution system in a public building in 14.4%, and a water distribution system at other sites in 7.6%. Statistically significant differences were found in the CFR (12.2% vs. 3.9%; p=0.018) and detection of the first case by UAT (0.0% vs. 87.2%; p<0.001) between the two time periods investigated. Logistic regression showed an increase in the CFR according to outbreak size (adjusted odds ratio (aOR) 1.18; 95% confidence interval (CI) 1.05-1.33) that was significantly lower in the second period (aOR 0.09; 95% CI 0.04-0.20). CONCLUSIONS: Since the UAT was introduced, early diagnosis and treatment has helped to improve the outcomes and CFR of cases involved in outbreaks of legionellosis.

Mumps: a year of enhanced surveillance in Catalonia, Spain.

Mumps is a vaccine-preventable disease candidate for elimination. Positive predictive value (PPV) of clinical case definition was assessed. During 2007, 410 suspected cases were reported in Catalonia: 348 fulfilled clinical case definition and 159 were laboratory confirmed. Incidence rate was 4.8 per 100,000 for cases that fulfilled the clinical definition, and 2.2 for laboratory confirmed cases. Global PPV was 44.5%; 38.5% in <15 years and 50% in > or =15 years (p=0.04). Most laboratory confirmed cases (72.3%) received at least one MMR dose. With sustained high MMR coverage, laboratory confirmation is necessary to control the disease and assess vaccine failure.

[Multislice CT angiography in the study of aneurysm of the abdominal aorta: comparison of three different volumes of contrast agent]. / Angio-tomografía computarizada multidetector en el estudio del aneurisma de aorta abdominal. Comparación de tres volúmenes de contraste diferentes.

OBJECTIVE: To prospectively and quantitatively compare the use of different volumes of contrast in 16-slice CT angiography for the study of aneurysms of the abdominal aorta before and/or after treatment. MATERIAL AND METHODS: From November 2005 to March 2006, we included 63 consecutive patients referred for CT angiography for aneurysm of the abdominal aorta or for post-treatment follow-up. Each patient was randomly assigned to one of three groups: group A was administered 100 mL of contrast agent, group B 80 mL, and group C 60 mL. In all cases, contrast was administered with 40 mL of physiological serum at a rate of 4 ml/s. A 16-detector CT scanner was used. In the last 61 patients, attenuation was measured in different locations using circular ROIs. Hounsfield units were recorded in the first slice (initial contrast), in the last slice (final contrast), at their maximum value, and also at one-second intervals. RESULTS: No statistically significant differences in the Hounsfield units recorded in the first slice, in the last slice, or in the maximum values were found between the different groups. Mean values were above 200 in 58 of 61 patients. Weight and body mass index (BMI) were negatively correlated with aortoiliac attenuation. CONCLUSION: Using a 16-detector CT scanner enables the volume of contrast for studies of aneurysms of the abdominal aorta to be reduced considerably; however, 60 mL might not be sufficient for patients with high weight or BMI.