Effectiveness of acellular pertussis vaccination during childhood (<7 years of age) for preventing pertussis in household contacts 1-9 years old in Catalonia and Navarra (Spain).

Pertussis vaccination with 4-5 doses of acellular vaccines is recommended in Spain to all children at 2 months to 6 years of age. The effectiveness of the acellular pertussis vaccination was assessed in this study by comparing the incidence of secondary pertussis in vaccinated (4-5 doses) and unvaccinated or partially vaccinated (0-3 doses) household contacts 1-9 years old of confirmed cases of pertussis in Spain in 2012-13. Eighty-five percent of contacts had been vaccinated with 4-5 doses of acellular pertussis vaccines. During the 2-year study period, 64 cases of secondary pertussis were detected among 405 household contacts 1-9 years old: 47 among vaccinated and 17 among unvaccinated or partially vaccinated contacts. The effectiveness for preventing secondary pertussis, calculated as 1 minus the relative risk (RR) of secondary pertussis in vaccinated vs. unvaccinated/partially vaccinated contacts, was 50 % [95 % confidence interval (CI): 19-69 %, p < 0.01] when household contacts were vaccinated using DTaP, Tdap, hexavalent or heptavalent vaccines, and it was 51.3 % (95 % CI: 21-70 %, p < 0.01) when they were vaccinated using DTaP or TdaP vaccines. The effectiveness adjusted for age, sex, pertussis chemotherapy and type of household contact was 58.6 % (95 % CI: 17-79 %, p < 0.05) when contacts were vaccinated using available acellular vaccines, and it was 59.6 % (95 % CI: 18-80 %, p < 0.01) when they were vaccinated using DTaP vaccines. Acellular pertussis vaccination during childhood was effective for preventing secondary pertussis in household contacts 1-9 years old of pertussis cases in Catalonia and Navarra, Spain.

Cryptosporidium hominis genotypes involved in increased incidence and clusters of cases, Navarra, Spain, 2012.

SUMMARY Two clusters of confirmed cryptosporidiosis infections were detected in Navarra, Spain, in the summer of 2012, in the context of an increased incidence in the region. Molecular subtyping of Cryptosporidium hominis determined that one cluster, occurring in an urban area, was due to the predominant circulating subtype IbA10G2R2 and the other cluster, with cases occurring in a rural area, was due to a rare subtype IaA18R3. No single exposure was associated with infection, although exposure to certain children's pools was reported by a majority of patients interviewed in each cluster. Genotyping tools were useful in the investigation and could aid investigation of cryptosporidiosis outbreaks in Spain in the future.

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 influenza vaccine effectiveness in Navarre, Spain: 2012/13 mid-season analysis.

We present estimates of influenza vaccine effectiveness (VE) in Navarre, Spain, in the early 2012/13 season, which was dominated by influenza B. In a population-based cohort using electronic records from physicians, the adjusted VE in preventing influenzalike illness was 32% (95% confidence interval (CI): 15 to 46). In a nested test-negative case-control analysis the adjusted VE in preventing laboratory-confirmed influenza was 86% (95% CI: 45 to 96). These results suggest a high protective effect of the vaccine.

Decline in influenza vaccine effectiveness with time after vaccination, Navarre, Spain, season 2011/12.

This study evaluates the influenza vaccine effectiveness (VE) in preventing laboratory-confirmed cases in Navarre, Spain, in the 2011/12 season in which the peak was delayed until week 7 of 2012. We conducted a test-negative case­control study. Patients with influenza-like illness in hospitals and primary healthcare were swabbed for testing by reverse transcription-polymerase chain reaction. Influenza vaccination status and other covariates were obtained from healthcare databases. The vaccination status of confirmed cases and negative controls was compared after adjusting for potential confounders. VE was calculated as (1-odds ratio)x100. The 411 confirmed cases (93% influenza A(H3)) were compared with 346 controls. Most characterised viruses did not match the vaccine strains. The adjusted estimate of VE was 31% (95% confidence interval (CI): -21 to 60) for all patients, 44% (95% CI: -11 to 72) for those younger than 65 years and 19% (95% CI: -146 to 73) for those 65 or older. The VE was 61% (95% CI: 5 to 84) in the first 100 days after vaccination, 42% (95% CI: -39 to 75) between 100 and 119 days, and zero thereafter. This decline mainly affected people aged 65 or over. These results suggest a low preventive effect of the 2011/12 seasonal influenza vaccine, and a decline in VE with time since vaccination.

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.

Effectiveness of trivalent seasonal and monovalent influenza A(H1N1)2009 vaccines in population with major chronic conditions of Navarre, Spain: 2010/11 mid-season analysis.

We defined a cohort of people with major chronic conditions (152,585 subjects) in Navarre, Spain, using electronic records from physicians, to obtain 2010/11 mid-season estimates of influenza vaccine effectiveness. The adjusted estimates of the effectiveness of the 2010/11 trivalent influenza vaccine were 31% (95% confidence interval (CI): 20­40%) in preventing medically attended influenza-like illness, and 58% (95% CI: 11­80%) in preventing laboratory-confirmed influenza. Having received the monovalent influenza A(H1N1)2009 vaccine in the 2009/10 season had an independent preventive effect against medically attended influenza-like illness (17%, 95% CI: 1­30%), and having received both vaccines had 68% (95% CI: 23­87%) effectiveness in preventing laboratory-confirmed influenza.

[Influenza and cardiorespiratory events: a clinical-epidemiological review with a multidisciplinary point of view]. / Gripe y eventos cardiorrespiratorios: una revisión clínico-epidemiológica multidisciplinar.

There is accumulating evidence showing that influenza infection and cardiorespiratory diseases are closely associated. Influenza has been described as a triggering factor capable of both exacerbate underlying chronic diseases as well as inducing the appearance of new respiratory and cardiovascular events. Consequently, influenza infection and its associated comorbidity have a significant impact on the health system. In this document, we extensively reviewed the current literature to describe the most relevant data on the relationship between influenza infection and cardiorespiratory diseases. Likewise, we analyzed the possible pathophysiological mechanisms explaining the connection between influenza infection and cardiac and respiratory events. Finally, reviewed data has been put into perspective to highlight the importance of influenza vaccination as an effective measure in the prevention of cardiorespiratory diseases, especially in the population with underlying chronic diseases.

Population-based contact investigation of a cluster of tuberculosis cases in a small village.

A cluster of five cases of tuberculosis (TB) in persons aged 19-23 years who were not close contacts was detected in a small village in Spain in 2006. All culture isolates had the same chromosomal-DNA restriction pattern. Contact investigations of family members, friends, workmates and schoolmates were complemented with tuberculin screening offered to the resident population born between 1976 and 1995. Expanded contact tracing detected two new cases of TB, 27 tuberculin conversions and an excess of latent tuberculosis infections (LTI) in persons born between 1978 and 1990. The contacts of two cases had a significantly elevated prevalence of LTI. Two secondary cases of TB, 33.3% of those diagnosed with LTI and 47.8% of the converters were unaware of any contact with the TB cases, but had frequented some of the same bars. This study suggests that a considerable percentage of the episodes of TB transmission in young people may escape detection in conventional contact studies.

[Heptavalent-pneumococcal conjugate vaccine (Prevenar). Differences in effectiveness between populations]. / La vacuna neumocócica conjugada heptavalente (Prevenar). Diferencias en su efectividad en distintas poblaciones.

This article reviews the publications on the effectiveness of heptavalent-pneumococcal conjugate vaccine (PCV7) in the prevention of invasive pneumococcal disease (IPD) in children under five years of age. It also analyses the characteristics of the vaccine and its impact on the epidemiology of IPD in different places. Before the introduction of PCV7, the percentage of cases of IPD due to vaccine serogroups oscillated between 89% in the United States and 43% in Asia. In Spain it was 68%. Active laboratory-based surveillance shows that the introduction of PCV7 has had a highly variable impact on the incidence of IPD, with falls oscillating between 91% in the United States and 12% in Navarre, Spain. The global effectiveness of VNC7v in published studies varies between 31% and 89%, chiefly depending on the patterns of pneumococcal serotypes in each place. Numerous studies show a variable replacement capacity of the pneumococci, which means the effect of the vaccine can be reduced, as non-vaccine serotypes occupy the space left by the vaccine ones. A study in Navarre has found a risk of IPD due to non-vaccine serotypes that is 6 times higher in vaccinated children than in unvaccinated ones. In places where less than 70% of the serotypes that cause IPD are represented in the VNC7v, the effectiveness of its introduction in the vaccination will probably be slight and the routine vaccination schedule serotypes fast. In these cases, VNC7v could be reserved for children with IPD risk factors.

[Varicella and herpes zoster incidence prior to the introduction of systematic child vaccination in Navarre, 2005-2006]. / Incidencia de la varicela y el herpes zóster antes de la introducción de la vacunación sistemática infantil en Navarra, 2005-2006.

Varicella is an acute and highly contagious disease produced by the varicella-zoster virus, which leaves lasting immunity. Herpes zoster is produced by reactivation of a latent infection of the same virus. The introduction of systematic and free vaccination against varicella in children of 15 months in Navarre from 2007 onwards can be expected to produce important epidemiological changes. For this reason we describe the previous epidemiological situation in the period from 2005 to 2006. We analysed all cases of varicella and herpes zoster registered in the electronic clinical files of primary care, in the database of hospital discharges and in the mortality register. Between 2005 and 2006, 9,908 cases of varicella were diagnosed (8.29 annually per 1,000 inhabitants), with 90% in children under 15 years old. There were 80 hospital admissions (8 for every 1,000 cases), complications in 2.5 out of every 1,000 cases, and there was one death due to this cause (0.1 per 1,000 cases). In the same period, 4,959 cases of herpes zoster were diagnosed (4.15 cases per 1,000 inhabitants), half in people over 55 years old. There were 179 hospital admissions (36 per 1,000 cases), whose average age was 77, and 83 presented complications (16.7 per 1,000 cases). This epidemiological pattern is similar to that found in other places before the introduction of the vaccine.

[Prevalence of nosocomial infection in Navarre. Aggregated data of the EPINE study for 2005]. / Prevalencia de la infección nosocomial en Navarra. Resultados agregados del estudio EPINE 2005.

Nosocomial infection is a serious problem of morbidity and mortality that, according to the 2003 national prevalence data affected 6,5-7% of all the patients admitted in Spanish hospitals. Our aim is to assess the prevalence of nosocomial infection in Navarre, from the aggregated data of each participant in the EPINE (Study of Prevalence of Nosocomial Infection in Spain) in 2005, and to analyse different features of the nosocomial infections to compare them with the global data for Spain. The prevalence of patients with nosocomial infection was 5,6% and the prevalence of patients with community infection was 13,2%. The prevalence of nosocomial infection, excluding those that acquired the nosocomial infection in a previous admission to the hospital, was 6,2%. The prevalence of community infection was 14,2%.

[Epidemiology of notifiable diseases in Navarre, 2006]. / Vigilancia epidemiológica de las enfermedades transmisibles en Navarra, 2006.

Epidemiological vigilance in Navarre (601,874 inhabitants) in 2006 included 34 diseases whose notification is compulsory and epidemic outbreaks. Notification is carried out on a weekly basis by the doctors from paediatrics, primary care and specialised care facing any suspicion of these processes, and is completed with microbiological diagnoses. In 2006 the incidence of influenza reached 16.8 cases per 1,000 inhabitants (Epidemic Index, EI: 0.46), showing a late seasonal peak (March) of low dimensions. The incidence of respiratory tuberculosis was 11.3 cases per 100,000 inhabitants, and that of non-respiratory tuberculosis was 2.3; both at similar levels to recent years. Seven cases of tuberculosis occurred in three aggregates amongst cohabitants, and another 7 in non-cohabiting persons resident in the same municipality. Six percent of the cases were coinfected with HIV, and 37% occurred in immigrants. The incidence of meningococcal disease rose to 19 cases (3.2 cases per 100,000 inhabitants; EI 1.46), all of them sporadic. Neisseria meningitidis serogroup B was isolated in 16 cases. There was one case of serogroup C, in a child who had received 3 doses of combined vaccine. In two cases (11%) death occurred. The incidence of legionnaire's disease rose to 28 cases per 100,000 inhabitants (EI:4.88), due to a community outbreak that affected 146 people. Excluding this outbreak, incidence was similar to previous years (3.3 per 100,000 inhabitants). In August an outbreak of parotitis began, and 911 cases had been counted until the end of 2006; and it has continued during 2007. Eleven cases of malaria were registered, all imported. Notifications of toxic food infections has continued to fall (IE:0.48).

[Epidemiology of tuberculosis in Navarre]. / Situación epidemiológica de la tuberculosis en Navarra, 2006.

BACKGROUND: To describe the tendency and epidemiological characteristics of tuberculosis and estimate the prevalence of tuberculosis infection in Navarre. Methods. An analysis was made of the cases of tuberculosis reported in the 1993-2006 period, completed with microbiological information and data from other registries. RESULTS: The incidence of tuberculosis in Navarre declined from 24.0 cases per 100,000 inhabitants in 1993 to 13.7 per 100,000 in 2006. Between 2000 and 2006 the incidence of tuberculosis fell by an annual 6.5% in those born in Spain and by an annual 9.3% in those born in other countries. In the 2004-2006 period, the diagnoses of tuberculosis were more frequent in males (60%), between the ages of 25 and 34 years (26.1%), and over 65 years of age (24.1%), and in persons born in Spain (69.0%). Four point three percent of the cases were coinfected with HIV. Six point six percent had had prior antituberculosis treatment, 5.4% showed resistance to some antituberculosis drug, and 2.3% resistance to more than one. There was a predominance of pulmonary forms (68.9%) and 37% of the total had positive sputum bacilloscopy. Death occurred in 6.2% of the cases before treatment was finalised. Between 2004 and 2006 15 clusters of cases were detected, 11 amongst cohabitants. Ninety-three percent of the secondary cases occurred from index cases born in Spain. CONCLUSION: There has been a notable advance in the control of tuberculosis, both in the native population and in that from other countries, although there is still room for improvement.

[The ASA index as an indicator of nosocomial infection risk in non-surgical patients]. / El índice ASA como indicador de riesgo de infección nosocomial en pacientes no quirúrgicos.

OBJECTIVE: To determine the relation between health status of patients from a non-surgical unit, measured with the ASA score, and the presence on nosocomial infection (NI). MATERIAL AND METHOD: Our ability to measure the health status with the ASA score was done with a sample of 150 surgical patients, using the Kappa test for interobserver agreement. We assigned the ASA score both cases (patients with NI) and controls to evaluate health status ad admission in the Internal Medicine Unit of our hospital. Statistical analysis was performed with the Mantel-Haenszel chi-square test, odds ratio (OR) and its 95% confidence interval (95%OR(CI)), and the chi-square test for linear association. RESULTS: We observed a global kappa value of 0.81 (p < 0.1), that meant high agreement in ASA score assignation, and statistical association between health status and the presence of NI (Weighted MH(OR) = 4.88; 95%OR(CI): 2.34-10.19). CONCLUSION: Health status, measured with the ASA score is statistically related with the presence of NI in non-surgical patients and could be useful as a comparison indicator of different levels of NI.