Pilot study to harmonize the reported influenza intensity levels within the Spanish Influenza Sentinel Surveillance System (SISSS) using the Moving Epidemic Method (MEM).

The intensity of annual Spanish influenza activity is currently estimated from historical data of the Spanish Influenza Sentinel Surveillance System (SISSS) using qualitative indicators from the European Influenza Surveillance Network. However, these indicators are subjective, based on qualitative comparison with historical data of influenza-like illness rates. This pilot study assesses the implementation of Moving Epidemic Method (MEM) intensity levels during the 2014-2015 influenza season within the 17 sentinel networks covered by SISSS, comparing them to historically reported indicators. Intensity levels reported and those obtained with MEM at the epidemic peak of the influenza wave, and at national and regional levels did not show statistical difference (P = 0·74, Wilcoxon signed-rank test), suggesting that the implementation of MEM would have limited disrupting effects on the dynamic of notification within the surveillance system. MEM allows objective influenza surveillance monitoring and standardization of criteria for comparing the intensity of influenza epidemics in regions in Spain. Following this pilot study, MEM has been adopted to harmonize the reporting of intensity levels of influenza activity in Spain, starting in the 2015-2016 season.

Estimating influenza vaccine effectiveness in Spain using sentinel surveillance data.

We aimed to estimate influenza vaccine effectiveness (VE) against laboratory-confirmed influenza during three influenza seasons (2010/11 to 2012/2013) in Spain using surveillance data and to compare the results with data obtained by the cycEVA study, the Spanish component of the Influenza Monitoring Vaccine Effectiveness (I-MOVE) network. We used the test-negative case­control design, with data from the Spanish Influenza Sentinel Surveillance System (SISS) or from the cycEVA study. Cases were laboratory-confirmed influenza patients with the predominant influenza virus of each season, and controls were those testing negative for any influenza virus. We calculated the overall and age-specific adjusted VE. Although the number of patients recorded in the SISS was three times higher than that in the cycEVA study, the quality of information for important variables, i.e. vaccination status and laboratory results, was high in both studies. Overall, the SISS and cycEVA influenza VE estimates were largely similar during the study period. For elderly patients (> 59 years), the SISS estimates were slightly lower than those of cycEVA, and estimates for children (0­14 years) were higher using SISS in two of the three seasons studied. Enhancing the SISS by collecting the date of influenza vaccination and reducing the percentage of patients with incomplete information would optimise the system to provide reliable annual influenza VE estimates to guide influenza vaccination policies.

Influenza vaccine effectiveness in Spain 2013/14: subtype-specific early estimates using the cycEVA study.

Adjusted early estimates of the 2013/14 influenza vaccine effectiveness (VE) in Spain for all age groups was 35% (95% CI: -9 to 62), 33% (95% CI: -33 to 67) and 28% (95% CI: -33 to 61) against any influenza virus type, A(H1N1)pdm09 and A(H3N2) viruses, respectively. For the population targeted for vaccination, the adjusted VE was 44% (95% CI: -11 to 72), 36% (95% CI: -64 to 75) and 42% (95% CI: -29 to 74), respectively. These preliminary results in Spain suggest a suboptimal protective effect of the vaccine against circulating influenza viruses.

Early estimates of the effectiveness of the 2011/12 influenza vaccine in the population targeted for vaccination in Spain, 25 December 2011 to 19 February 2012.

We present early estimates of influenza vaccine effectiveness (VE) in the population targeted for vaccination, during 25 December 2011 to 19 February 2012. The adjusted VE was 55% (95% CI: 3 to 79) against any type of influenza virus and 54% (95% CI: 1 to 79) against influenza A(H3N2) virus. This suggests a moderate protective effect of the vaccine in the targeted population in a late influenza epidemic with limited match between vaccine and circulating strains.

Improvement in chromatin maturity of human spermatozoa selected through density gradient centrifugation.

A two-step gradient density centrifugation system has been set up to isolate two contrasting sperm populations of normozoospermic and oligoasthenoteratozoospermic (OAT) men. High- and low-density fractions were characterized by total and free thiol fluorescence as determined by monobromobimane-flow cytometry and by protamine/DNA ratios after protamine extraction and polyacrylamide acid-urea gel electrophoresis. Further chromatin characterization was performed through immunofluorescence (IF) with specific antibodies to nucleosomes, histone subtypes (H3.1/H3.2 and TH2B), histone modifications (KM-2 and H4K8ac) and precursor protamine 2. The native sperm samples from normozoospermic and OAT patients showed a biphasic distribution of total thiol levels, which changed in the sperm fractions obtained using the density isolation protocol presented here. Moreover, significant differences were detected in the protamine content in the different fractions of OAT and fertile donor samples. In addition, in the high-density fractions from OAT and normozoospermics, higher IF levels for H4K8ac and TH2B were seen. These results would be consistent with the intended beneficial effect on chromatin maturity of the density selection techniques currently being used in assisted fertilization procedures. However, most nucleosome and related proteins/modifications differ between OAT and normozoospermic men, even after gradient centrifugation, providing evidence for incomplete nuclear maturity in OAT patients.

Effectiveness of the 2010/11 seasonal trivalent influenza vaccine in Spain: preliminary results of a case-control study.

We present preliminary results of a case-control study to estimate influenza vaccine effectiveness in Spain, from week 50 of 2010 to week 6 of 2011. The adjusted effectiveness of the vaccine in preventing laboratory-confirmed influenza due to any type of influenza virus was 50% (95% CI: -6 to 77%) for the trivalent seasonal vaccine and 72% (95% CI: 7 to 92%) for both trivalent seasonal and monovalent pandemic vaccines, suggesting a protective effect of seasonal vaccination lower than that reported for the previous season.

Characterisation of swabbing for virological analysis in the Spanish Influenza Sentinel Surveillance System during four influenza seasons in the period 2002-2006.

This study sought to characterise the swabbing pattern in the Spanish Influenza Sentinel Surveillance System (SISSS) and ascertain to what extent the system meets the guidelines currently being drafted by The European Influenza Surveillance Scheme (EISS). Data on seasons 2002/2003 to 2005/2006 were drawn from SISSS. The study analysed collection and dispatch of swab specimens for virological analysis by reference to variables relating to patient sex, age group, vaccination status, specimen collection period, period of influenza activity, time of swabbing and epidemiological season. SISSS adapts to EISS recommendations with respect to the specimen collection period and period of influenza activity, but there is a tendency to collect fewer specimens than recommended as the age of patients increases, and in the case of elderly patients (65 years and older), frequency of collection is clearly insufficient. Furthermore, sentinel physicians collect a higher percentage of specimens in cases where patients have received the influenza vaccine.

Standardisation or modelling of mortality rates.

STUDY OBJECTIVE: To compare the results obtained when estimating a standardised rate using the conventional technique of stratified analysis and using Poisson regression, and to evaluate the speed of the two techniques in making the calculation. DESIGN: Cross sectional study. SETTING AND PARTICIPANTS: The trend in motor vehicle accident mortality in males from 1985 to 1992 in Spain was compared using stratified analysis and Poisson regression. In the stratified analysis the calculations were made using a specially designed spreadsheet while in the Poisson regression the statistical program used was EGRET. RESULTS: The stratified analysis took two hours and the Poisson regression 15 minutes to complete. In the stratified analysis a single estimate for each year was obtained, whereas the model of Poisson regression that best fitted the data included an interaction term between age and year. CONCLUSION: Poisson regression can be considered a serious alternative to stratified analysis when the objective is to compare mortality rates standardised by one or two variables.

Legionnaires' disease clusters associated with travel to Spain during the period January 2001 to July 2003.

Epidemiological surveillance and control of travel associated cases of legionnaires' disease are necessary tasks for public health and collaboration between countries is necessary to do this. Within the framework of the European Surveillance Scheme for Travel Associated Legionnaires' Disease (EWGLINET), European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease have been produced . This has established the reporting and response criteria when cases or clusters appear. In this paper the analysis of the information corresponding to the 46 reported clusters related to Spain is presented. Data corresponds to the period January 2001 to July 2003.

Outbreak of legionnaire s disease in two groups of tourists staying at camp sites in France.

On 11 June 1996, three suspected cases of legionnaires disease in a group of 42 Dutch tourists were reported to the local public health authority by Millau hospital in south west France. The group (group 1) had been touring with caravans and staying at d

[Socioeconomic differences in mortality in 8 Spanish provinces]. / Diferencias socioeconómicas en mortalidad en ocho provincias españolas.

BACKGROUND: The scarce fulfillment of the job in the Bulletin on Death (BD) has limited the study of the socioeconomic differences in mortality in Spain. Nonetheless, the authors have studied the socioeconomic differences in mortality by different causes of death, using the Spanish geographical areas in which the information regarding the occupation of the deceased persons in the BD is of good quality. METHODS: Males between 30-64 years of age who died in eight Spanish provinces from 1988-1990 were included in the study. Overall mortality was compared by the relative risk of mortality adjusted for age and by the main causes of death among the professionals and managers, manual workers and farmers. The relative risk was calculated with the use of log-lineal models (Poisson regression) taking the group of professionals and managers as the reference group. RESULTS: The global relative risk of mortality in the group of manual workers was 1.72 and was 1.56 in the farmers. The highest mortality by different causes of death was observed in the manual workers while intermediate mortality was found in the farmers. The exceptions to this general pattern were colon and rectum cancer and leukemias with a higher mortality being found in the group of professionals and managers, although the differences were not statistically significant. Cerebrovascular diseases, suicide and cancer of the nervous system showed the highest relative risk of mortality in the farmers. Both the manual workers and the farmers demonstrated the highest relative risks of mortality in the youngest age groups although this difference attenuated with age. CONCLUSIONS: Except for colon and rectal cancer and leukemias, manual workers and farmers present higher mortality than professionals and managers. Furthermore, these differences may be underestimated since only the active economic population was studied, thereby excluding the individuals pertaining to the population groups with higher mortality rates.

[Socioeconomic differences in the use and accessibility of health care services in Spain]. / Diferencias socioeconómicas en la utilización y accesibilidad de los servicios sanitarios en España.

BACKGROUND: One of the main goals of the public health care systems is to assure an equitable accessibility and utilization of health care services according to the need for care. The present study evaluates the extent to which this objective has been reached in the Spanish National Health System from the socioeconomic perspective. POBLATION AND METHOD: The 1993 National Health Survey was used. Doctor consultation, use of inpatient hospital services, dentist consultation and gynaecologist consultation were the indicators of utilization analysed. Accessibility was measured by time spent travelling to the health centre, time spent waiting at health centre and time spent waiting for an ordinary admission to hospital. Educational level was the socioeconomic variable used. RESULTS: Doctor consultation and use of inpatient hospital services were more frequent in individuals with the lowest level of education, while dentist and gynaecologist consultation were in those with the highest level. No statistically significant differences were observed in doctor consultation and use of inpatient hospital services after adjusting for age, sex, health care coverage and several need indicators by using a multiple logistic regression model. On the contrary, the odds ratios for individuals with first, second and third educational level were 1.31 (CI 95% = 1.14-1.51), 1.74 (1.49-2.03) and 2.06 (1.71-2.47) in dentist consultation and 2.01 (1.71-2.35), 2.40 (2.01-2.87) and 2.54 (2.02-3.21) in gynaecologist consultation. On the other hand, individuals with no education showed the longest average waiting times, especially for an ordinary admission to hospital, which was 83.5 days for subjects with no education and 18.8 for those with third educational level. However, the multiple linear regression analysis only found statistically significant results in time spent travelling to the health center and time spent waiting at the health center. CONCLUSIONS: Although no differences in doctor consultation and use of inpatient hospital services by socioeconomic status were found, the results obtained regarding the use of other health care services and waiting times indicate the persistence of barriers limiting the equitable access and utilization of health care services in Spain.

[Public health surveillance systems: let's not ask for the impossible]. / Sistemas de vigilancia de la salud pública: no pidamos peras al olmo.

The publication of the Decree creating the National Epidemiological Surveillance Network, 7 years ago now, invites us to reflect on public health surveillance systems in our country and to highlight those aspects that help or obstruct these systems in meeting their basic objective of providing information that can be used to facilitate disease control. Many of the events that have taken place in the health arena in recent years, labeled as health crises by the communications media, have been considered by the population as unacceptable risks that the health system should have avoided; defects in surveillance systems are one of the errors always mentioned in this respect. Some of these defects arise because of limitations of the instruments used to measure and classify health problems, but others are due to an inappropriate understanding of surveillance, which make it difficult to assess the true impact of health problems. A discussion of the two types of defects will not solve surveillance problems, but it may help many people to stop asking our surveillance systems for what they cannot offer.

[An evaluation of the statistical significance and calculation of the confidence interval for the standardized mortality ratio]. / Evaluación de la significación estadística y cálculo del intervalo de confianza de la razón de mortalidad estandarizada.

The standardized mortality ratio (SMR) is the ratio of the number of deaths observed (D) to the number expected (E), on the basis of the mortality rates of some reference population. Several procedures have been proposed in order to test its significance and to estimate its confidence intervals. In this study, the SMR of two causes of death in 27 health areas of Castilla-La Mancha have been calculated. The significance has been evaluated by exact Poisson test and by four methods approximating the Poisson distribution by the normal: 1) a Z statistic based on the assumption that a Poisson variate with expectation E has a standard deviation equal to square root of E; 2) the Z statistic with a continuity correction; 3) a Z statistic based on the square root transformation of a Poisson variable and 4) an approximation of the exact test by Byar. Also, the confidence intervals have been estimated by exact method and by three approximate procedures: 1) by Byar; 2) by Z statistic uncorrected and 3) by the square root transformation of the Poisson distribution. With the exact methods and Byar procedure the results were very similar; therefore, using the last to testing significance and estimate the confidence intervals of SMR, is suggested.

Effectiveness of the 2010-11 seasonal trivalent influenza vaccine in Spain: cycEVA study.

BACKGROUND: In Spain, the influenza vaccine effectiveness (VE) was estimated in the last three seasons using an observational study (cycEVA) conducted in the frame of the Spanish Influenza Sentinel Surveillance System. We aimed to measure the effectiveness of the seasonal trivalent vaccine in preventing influenza like illness (ILI) laboratory-confirmed influenza infection at the end of the season 2010-11. METHODS: We conducted a test-negative case-control study between weeks 50/2010 and 12/2011. Cases were ILI laboratory-confirmed influenza infection and controls were those testing negative. Sentinel physicians collected data on demographic and clinical characteristics, vaccination status, and on covariates related to confounding factors associating with influenza VE. We calculated adjusted odds ratios (OR), using logistic regression and computed influenza VE as (1-OR) × 100. RESULTS: The adjusted influenza VE against A(H1N1)pdm09 infection was 46% (95% confidence interval (95%CI): 0; 72). In A(H1N1)pdm09 infected patients who had received both 2010-11 trivalent influenza seasonal and 2009 monovalent pandemic vaccines, influenza VE was 74% (95%CI: 13; 93). The adjusted influenza VE against B infection was 23% (95%CI: -180; 79). CONCLUSION: The trivalent influenza vaccine 2010-11 showed a moderate VE for preventing ILI laboratory confirmed influenza infections. Influenza VE estimates were higher in patients who had received both 2010-11 seasonal trivalent and 2009 monovalent pandemic vaccines.

Heterogeneous trend in smoking prevalence by sex and age group following the implementation of a national smoke-free law.

OBJECTIVE: Given the limited evidence available about the effects of clean indoor air laws on smoking behaviour in the general population, the impact of national smoke-free workplace, bar and restaurant legislation, implemented on 1 January 2006, on smoking prevalence in Spain was assessed in this study. METHODS: Population-based trend analysis using estimates for 27 periods from the beginning of 2000 to the end of 2008-three periods per year. To calculate the period per cent change in smoking prevalence, the permutation test for joinpoint regression to detect significant changes was used. RESULTS: In men and women aged 15-24 years, the prevalence of smoking declined between the first period in 2000 and the third period in 2008, whereas in women aged 45-64 years, it increased by 1.7% per period. A declining trend was detected up to the first period in 2006 in men and women aged 25-44 years and in men aged 45-64 years, but between the beginning of 2006 and the end of 2008 the prevalence of smoking increased by 1.2%, 0.7% and 2.0% per period in men aged 25-44 years, in women aged 25-44 years and in men aged 45-64 years, respectively. CONCLUSIONS: 3 years after a national smoke-free law was implemented, the trend in smoking prevalence in some population groups was unchanged; however, in others, the declining trend of previous years was reversed. The similarity of these findings to those observed in other countries suggests that clean indoor air laws, although effective in reducing exposure to second-hand smoke, may not achieve the secondary objective of reducing the prevalence of smoking in the population.