Detection of dengue in German tourists returning from Ibiza, Spain, related to an autochthonous outbreak, August to October 2022.

In February 2023, German public health authorities reported two dengue cases (one confirmed, one probable) and four possible cases who travelled to Ibiza, Spain, in late summer/autumn 2022; the infection was probably acquired through mosquito bites. Case 1 visited Ibiza over 1 week in late August with two familial companions; all three developed symptoms the day after returning home. Only Case 1 was tested; dengue virus (DENV) infection was confirmed by presence of NS1 antigen and IgM antibodies. Case 2 travelled to Ibiza with two familial companions for 1 week in early October, and stayed in the same town as Case 1. Case 2 showed symptoms on the day of return, and the familial companions 1 day before and 3 days after return; Case 2 tested positive for DENV IgM. The most probable source case had symptom onset in mid-August, and travelled to a dengue-endemic country prior to a stay in the same municipality of Ibiza for 20 days, until the end of August. Dengue diagnosis was probable based on positive DENV IgM. Aedes albopictus, a competent vector for dengue, has been present in Ibiza since 2014. This is the first report of a local dengue transmission event on Ibiza.

Assessment of tuberculosis surveillance by capture-recapture in the Balearic Islands, Spain, 2005-2007.

The tuberculosis surveillance system in the Balearic Islands was assessed from 2005 to 2007. Applying the capture-recapture method the completeness of this system was evaluated to be 58.4%. When a new electronic recorded data was included in Primary Health Care, up to 66.5% was obtained. This new source of data increased the detected cases of pulmonary tuberculosis from 572 to 681. As a result, the estimated annual incidence rate increases from 18.9 cases/10(5) to 22.6 cases/10(5) [95% CI, 20.9-24.3], similar to figures issued by WHO.

Estimated Impact of Nirsevimab on the Incidence of Respiratory Syncytial Virus Infections Requiring Hospital Admission in Children < 1 Year, Weeks 40, 2023, to 8, 2024, Spain.

BACKGROUND: Data from the sentinel surveillance system of severe acute respiratory infections in Spain were used to estimate the impact of administration of nirsevimab to children born from 1 April 2023 onwards. METHODS: Estimated RSV hospitalisations in < 1-year-olds during weeks 40, 2023, to 8, 2024, were compared to the number that would be expected after accounting for the background change in RSV circulation in the 2023/24 season, compared to 2022/23. RESULTS: We estimated 9364-9875 RSV hospitalisations less than expected, corresponding to a 74%-75% reduction.

An outbreak of cutaneous infection due to Mycobacterium abscessus associated to mesotherapy.

INTRODUCTION: In February 2009 an outbreak of subcutaneous abscesses due to Mycobacterium abscessus was detected in Spain which affected healthy women who had undergone mesotherapy procedures in an aesthetic clinic. METHODS: Epidemiological research, health inspection and microbiological studies were conducted. The patients were given antibiotic treatment (according to susceptibility testing) with clarithromycin, and in some cases, combined with amikacin. RESULTS: Seventeen out of 77 patients treated in the clinic were affected. The products used for the injections were homeopathic drugs in multi-dose vials. The environmental samples were negative. The sterile injection equipment and the clinical procedures were evaluated as correct. The storage conditions for the drugs were also correct, and all the samples tested negative for Mycobacteria. However Paenibacillus provencensis was isolated from samples of unused multi-dose vials and the withdrawal of the product from distribution was ordered. Deficiencies were detected in the sterile products process of at the homeopathic drug factory, so the production line was suspended. CONCLUSIONS: The results of environmental investigation suggest the most likely cause of the outbreak could have been the contamination of the products in the factory, although there was no laboratory confirmation. The widespread use of homeopathic products in invasive procedures requires extreme control during the manufacturing, handling and packaging process. It is important to consider mesotherapy and parenteral use of homeopathic medicines as potential sources of infection and therefore the same precautions in the procedures and quality assurance of products should be applied as with any other drug or medical activity.

[Outbreak of pandemic virus (H1N1) 2009 in a residence for mentally disabled persons in Balearic Island, Spain]. / Brote de gripe por virus pandémico (H1N1) 2009 en una residencia para personas discapacitadas psíquicas en las Islas Baleares.

BACKGROUND: The flu season 2009-2010 has been shorter and less severe than expected. Since January 2010, influenza surveillance systems indicated rates of very low incidence of influenza without detection of virus circulation. In this context, a hospital reported a suspected outbreak of severe respiratory disease, the aetiology proved influenza A(H1N1)v. We describe the outbreak and public health measures for their control. METHODS: Descriptive study of an outbreak of pandemic influenza virus in a residency home for mentally disabled. Establishment of active surveillance. The case definition of influenza was very sensitive to detect new cases early, treated early and minimize transmission. Steps were taken to contain the influenza virus infection. RESULTS: Among 38 cases detected 7 had serious complications(all of them with risk factors). There were no deaths. The overall attack rate was 35.2%. The first cases were workers. The residents were ill at the peak of the outbreak, and among workers the presentation was more dispersed. None of the workers and only three of residents had been vaccinated. CONCLUSIONS: Workers possibly have initiated and contributed to the maintenance of transmission. We emphasize the need to comply with vaccination recommendations, not just those with risk factors, but particularly for workers in contact with those.

[cycEVA study: case control study measuring influenza vaccine effectiveness in Spain, 2008-2013]. / Estudio cycEVA: casos y controles para la estimación de la efectividad de la vacuna antigripal en España, 2008-2013.

BACKGROUND: In Spain, influenza vaccine effectiveness (EV) is estimated since 2008-09 season through the cycEVA case-control study, the Spanish component of the European I-MOVE (Monitoring Influenza Vaccine Effectiveness in the EU/EEA) network. We aimed at describing cycEVA performance in its five consolidated editions 2008/09 -; 2012/13. METHODS: During the study period the following indicators were analysed: 1) the participation of sentinel general practitioners and pediatricians (MP), 2) the population studied and the study period, 3) the data quality and 4) the dissemination of the cycEVA results. Trend analysis of the indicators was done using the Cochran-Armitage test to compute the Annual Percentage Change (PCA). RESULTS: The number of participating MP increased from 164 in 2008-09 to 246 in the following editions. The percentage of MP recruiting at least one patient increased significantly annually (PCA = 15.33%). The percentage of recruited patients included into the analysis increased (PCA=5.91%) from 77% in 2008-09 to more than 95% in the following editions. The percentage of cycEVA patients contributing to the I-MOVE study ranged between 23% and 30% in the pilot and 2011-12 editions respectively.. Final results were disseminated in quartile 2 peer-reviewed journals and 2010-11 and 2011-12 preliminary EV estimates were published in quartile 1 journals. cycEVA publications received 97 citations. CONCLUSION: cycEVA study achieved more quality information, timely EV estimates and a higher impact of the results.

Outbreak of hepatitis A in a nursery school.

In a background of very low incidence of hepatitis A HA in the last decade (annual average of 1.8 cases per 100,000 inhabitants) we describe an outbreak of HA which evolved in Mallorca between May and August 2010, whose main focus was a nursery school where more cases were parents and other young relatives of the children of the institution. Thirty-four cases were defined as outbreak cases. Ten were children of the nursery or their siblings and 22 adults (3 staff members of the nursery and 19 relatives; median age 33 years). The first detected cases were children of the same class. There were 2 adults with haematological complications, though not severe. All children, nursery staff members, parents, and siblings of the cases of the first affected class were immediately offered HA vaccination, but only 43.3% eligible individuals accepted it. None of the cases had been vaccinated. The outbreak spread mostly from asymptomatic children to young adults, showing the changes in HA pattern. That is of great concern as the risk of severe illness rises with age. This incident shows the need to implement new HA vaccination policies in outbreak control. This was later carried out.

[Tuberculosis surveillance in the Balearic Islands and characteristics of unreported cases from 2005 to 2007]. / Vigilancia de la tuberculosis en las Islas Baleares y caracterización de los casos infradeclarados entre los años 2005 y 2007.

We performed a descriptive study of tuberculosis cases detected by the Epidemiological Surveillance System in the Balearic Islands in the triennium 2005-2007. Our goal was to characterize underreported cases in sociodemographic terms and their contact with primary care. Overall, underreporting of tuberculosis was approximately 20%. Significant factors in multivariate analysis were social marginality (consisting of alcoholism, intravenous drug use or indigence) (aOR: 2.6 [1.2 to 5.3]), contact with primary care (aOR: 3.2 [1.4 to 7.1]), and extrapulmonary tuberculosis (aOR: 5.5[3.2-9.6]). We recommend strengthening notification by hospital specialists through the use of hospital electronic records. Our findings show that the information obtained from the primary care computerized history is helpful in improving the epidemiological surveillance of tuberculosis.

Brote escolar de gastroenteritis aguda por Salmonella typhimurium / School outbreak of acute gastroenteritis caused by Salmonella typhimurium

Se produjo un brote de gastroenteritis aguda por Salmonella typhimurium asociado con el consumo de hamburguesas en una escuela de verano, con una elevada tasa de ataque y un alto porcentaje de hospitalizaciones en el grupo de menor edad. Las edades de los niños expuestos oscilaban entre los 8 y los 16 años. Se produjeron 7 casos graves que requirieron ingreso hospitalario. Se propusieron dos hipótesis, que no pudieron ser verificadas, como origen del brote: contaminación en origen o durante el proceso de elaboración, con mayor probabilidad en la trituradora. Los factores causantes del brote podrían haber sido un tiempo excesivo de descongelación, el uso inadecuado de la temperatura, un tratamiento térmico insuficiente y deficiencias en la limpieza y desinfección de la máquina picadora de carne. No se pudo descartar un portador asintomático como origen de la contaminación, ya que no se procedió a la toma de muestras de heces del personal manipulador. La investigación de este brote demuestra la importancia de la colaboración de las propias empresas de alimentación con el departamento de Salud Pública (en este caso a través de la consultoría sanitaria) para conocer el origen del brote y sus posibles factores contribuyentes. Sin embargo, la falta de rigurosidad en los registros de los procesos de autocontrol dificulta la identificación de la fuente de contaminación y las posibles deficiencias en la manipulación o conservación de los alimentos...